Procedure,Code Type,Code,NDC,Procedure Description,IP/OP,Charge,Cash Discount (74%), Payor Rate Min,Payor Rate Max ,Aetna/Coventry Exp Reimbursement,Ambetter  Exp Reimbursement ,Amerigroup Exp Reimbursement ,Anthem BCBS HMO/POS Exp Reimbursement,BCBS PPO Exp Reimbursement,Caresource Exp Reimbursement,Cigna Exp Reimbursement,Eon Health Exp Reimbursement,Humana Exp Reimbursement,Kaiser Exp Reimbursement,Multiplan Exp Reimbursement,NaphCare/USP Exp Reimbursement,Peachstate Exp Reimbursement,Tricare/Veteran's Choice Exp Reimbursement,Wellcare Medicaid Exp Reimbursement,Wellcare Medicare Exp Reimbusrement 
"MS003","DRG","MS003","","ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES","INPATIENT ONLY","$846,619.47 ","$626,498.41 ","$0.00 ","$573,019.79 ","$545,963.96 ","$226,063.68 ","$0.00 ","$450,985.30 ","$450,985.30 ","$194,687.78 ","$382,149.53 ","$136,503.65 ","$413,995.33 ","$504,437.36 ","$573,019.79 ","$182,532.67 ","$185,417.02 ","$167,931.68 ","$136,503.65 ","$194,687.78 "
"MS004","DRG","MS004","","TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES","INPATIENT ONLY","$560,790.65 ","$414,985.08 ","$0.00 ","$500,611.30 ","$303,701.56 ","$117,598.72 ","$139,546.44 ","$0.00 ","$0.00 ","$36,289.36 ","$379,251.00 ","$112,641.38 ","$410,855.25 ","$500,611.30 ","$0.00 ","$134,386.24 ","$32,473.86 ","$147,233.83 ","$107,277.50 ","$34,561.30 "
"MS011","DRG","MS011","","TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC","INPATIENT ONLY","$341,624.34 ","$252,802.01 ","$0.00 ","$53,518.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47,587.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53,518.70 ","$45,321.23 ","$0.00 "
"MS012","DRG","MS012","","TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC","INPATIENT ONLY","$435,854.28 ","$322,532.17 ","$0.00 ","$131,299.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131,299.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112,717.74 ","$124,172.81 ","$0.00 ","$40,861.37 "
"MS013","DRG","MS013","","TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC","INPATIENT ONLY","$427,041.11 ","$316,010.42 ","$0.00 ","$28,929.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,929.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,929.99 ","$0.00 "
"MS020","DRG","MS020","","INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC","INPATIENT ONLY","$640,592.00 ","$474,038.08 ","$0.00 ","$461,392.05 ","$0.00 ","$130,119.32 ","$0.00 ","$395,862.19 ","$395,862.19 ","$0.00 ","$349,539.44 ","$87,750.60 ","$378,667.73 ","$461,392.05 ","$0.00 ","$121,357.54 ","$0.00 ","$101,514.63 ","$83,572.00 ","$0.00 "
"MS021","DRG","MS021","","INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC","INPATIENT ONLY","$829,388.27 ","$613,747.32 ","$0.00 ","$583,001.67 ","$432,052.38 ","$185,501.54 ","$0.00 ","$208,069.92 ","$208,069.92 ","$0.00 ","$441,667.93 ","$0.00 ","$478,473.59 ","$583,001.67 ","$0.00 ","$152,156.12 ","$0.00 ","$91,625.03 ","$0.00 ","$0.00 "
"MS022","DRG","MS022","","INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC","INPATIENT ONLY","$262,016.11 ","$193,891.92 ","$0.00 ","$95,010.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40,476.72 ","$0.00 ","$95,010.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38,549.28 ","$0.00 ","$90,486.22 ","$40,476.72 "
"MS023","DRG","MS023","","CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR","INPATIENT ONLY","$218,569.58 ","$161,741.49 ","$0.00 ","$139,066.20 ","$122,687.67 ","$63,817.39 ","$0.00 ","$139,066.20 ","$139,066.20 ","$55,770.42 ","$97,291.30 ","$52,188.44 ","$105,398.91 ","$128,424.52 ","$123,922.26 ","$56,307.53 ","$53,114.71 ","$59,017.16 ","$49,703.28 ","$55,770.42 "
"MS024","DRG","MS024","","CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC","INPATIENT ONLY","$157,585.04 ","$116,612.93 ","$0.00 ","$101,279.86 ","$101,279.86 ","$0.00 ","$0.00 ","$12,087.95 ","$12,278.79 ","$0.00 ","$60,566.78 ","$41,250.33 ","$33,522.62 ","$79,948.14 ","$86,190.36 ","$40,262.62 ","$0.00 ","$45,945.91 ","$39,286.03 ","$0.00 "
"MS025","DRG","MS025","","CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC","INPATIENT ONLY","$478,309.25 ","$353,948.85 ","$0.00 ","$226,592.28 ","$226,592.28 ","$0.00 ","$111,176.48 ","$202,785.63 ","$202,785.63 ","$0.00 ","$141,483.39 ","$43,833.50 ","$153,273.67 ","$186,758.08 ","$99,788.97 ","$44,051.81 ","$0.00 ","$49,032.85 ","$41,746.19 ","$0.00 "
"MS026","DRG","MS026","","CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC","INPATIENT ONLY","$270,390.78 ","$200,089.18 ","$0.00 ","$363,866.18 ","$363,866.18 ","$115,593.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38,018.73 ","$0.00 ","$0.00 "
"MS027","DRG","MS027","","CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$150,043.04 ","$111,031.85 ","$0.00 ","$232,805.15 ","$0.00 ","$0.00 ","$54,890.22 ","$6,278.59 ","$6,691.99 ","$0.00 ","$176,367.53 ","$30,181.04 ","$191,064.82 ","$232,805.15 ","$82,819.30 ","$36,977.13 ","$0.00 ","$32,717.89 ","$28,743.85 ","$0.00 "
"MS028","DRG","MS028","","SPINAL PROCEDURES WITH MCC","INPATIENT ONLY","$378,830.18 ","$280,334.33 ","$0.00 ","$171,853.56 ","$0.00 ","$77,466.83 ","$0.00 ","$118,180.23 ","$118,180.23 ","$0.00 ","$130,192.10 ","$52,005.99 ","$141,041.44 ","$171,853.56 ","$0.00 ","$56,039.87 ","$0.00 ","$58,799.12 ","$49,529.51 ","$0.00 "
"MS029","DRG","MS029","","SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS","INPATIENT ONLY","$255,521.10 ","$189,085.61 ","$0.00 ","$229,583.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,718.41 ","$0.00 ","$0.00 ","$229,583.19 ","$0.00 ","$0.00 ","$39,335.16 ","$34,017.53 ","$0.00 "
"MS030","DRG","MS030","","SPINAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$247,560.24 ","$183,194.58 ","$0.00 ","$29,329.56 ","$0.00 ","$0.00 ","$19,797.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,329.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,932.91 ","$0.00 "
"MS031","DRG","MS031","","VENTRICULAR SHUNT PROCEDURES WITH MCC","INPATIENT ONLY","$411,152.28 ","$304,252.69 ","$0.00 ","$59,024.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,366.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,834.72 ","$59,024.65 ","$0.00 ","$23,976.45 "
"MS032","DRG","MS032","","VENTRICULAR SHUNT PROCEDURES WITH CC","INPATIENT ONLY","$213,869.28 ","$158,263.27 ","$0.00 ","$14,380.55 ","$14,380.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS033","DRG","MS033","","VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$184,494.76 ","$136,526.12 ","$0.00 ","$12,635.25 ","$9,990.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,635.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,033.57 ","$0.00 ","$0.00 ","$12,635.25 "
"MS034","DRG","MS034","","CAROTID ARTERY STENT PROCEDURES WITH MCC","INPATIENT ONLY","$284,867.36 ","$210,801.85 ","$0.00 ","$160,900.01 ","$160,900.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43,799.77 ","$0.00 ","$0.00 "
"MS035","DRG","MS035","","CAROTID ARTERY STENT PROCEDURES WITH CC","INPATIENT ONLY","$129,223.20 ","$95,625.17 ","$0.00 ","$58,140.79 ","$0.00 ","$0.00 ","$0.00 ","$58,140.79 ","$58,140.79 ","$0.00 ","$0.00 ","$29,535.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,946.16 ","$28,128.81 ","$0.00 "
"MS036","DRG","MS036","","CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$63,272.72 ","$46,821.81 ","$0.00 ","$11,686.15 ","$9,048.30 ","$0.00 ","$0.00 ","$11,686.15 ","$11,686.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS037","DRG","MS037","","EXTRACRANIAL PROCEDURES WITH MCC","INPATIENT ONLY","$179,064.31 ","$132,507.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS038","DRG","MS038","","EXTRACRANIAL PROCEDURES WITH CC","INPATIENT ONLY","$162,863.49 ","$120,518.98 ","$0.00 ","$26,825.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,825.78 ","$0.00 ","$0.00 "
"MS039","DRG","MS039","","EXTRACRANIAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$99,295.23 ","$73,478.47 ","$0.00 ","$53,458.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,555.38 ","$0.00 ","$43,873.91 ","$53,458.66 ","$0.00 ","$11,340.50 ","$0.00 ","$22,384.03 ","$0.00 ","$0.00 "
"MS040","DRG","MS040","","PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC","INPATIENT ONLY","$181,156.10 ","$134,055.51 ","$0.00 ","$120,959.00 ","$114,037.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,186.61 ","$91,635.60 ","$40,730.30 ","$99,271.90 ","$120,959.00 ","$0.00 ","$39,499.78 ","$26,844.41 ","$45,324.46 ","$38,790.76 ","$28,186.61 "
"MS041","DRG","MS041","","PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR","INPATIENT ONLY","$127,537.44 ","$94,377.71 ","$0.00 ","$72,242.00 ","$37,578.12 ","$0.00 ","$27,327.64 ","$0.00 ","$0.00 ","$27,464.00 ","$32,608.13 ","$30,008.81 ","$6,724.57 ","$72,242.00 ","$0.00 ","$23,772.63 ","$26,156.21 ","$32,512.09 ","$28,579.82 ","$27,464.00 "
"MS042","DRG","MS042","","PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$105,060.67 ","$77,744.90 ","$0.00 ","$125,934.52 ","$18,514.80 ","$16,589.36 ","$107,683.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125,934.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS052","DRG","MS052","","SPINAL DISORDERS AND INJURIES WITH CC/MCC","INPATIENT ONLY","$156,658.67 ","$115,927.42 ","$0.00 ","$167,513.45 ","$0.00 ","$0.00 ","$0.00 ","$167,513.45 ","$167,513.45 ","$0.00 ","$63,079.81 ","$24,934.09 ","$68,336.46 ","$83,265.35 ","$0.00 ","$16,328.58 ","$0.00 ","$26,447.68 ","$23,746.75 ","$0.00 "
"MS053","DRG","MS053","","SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC","INPATIENT ONLY","$178,803.45 ","$132,314.55 ","$0.00 ","$12,615.31 ","$0.00 ","$0.00 ","$0.00 ","$12,615.31 ","$12,615.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS054","DRG","MS054","","NERVOUS SYSTEM NEOPLASMS WITH MCC","INPATIENT ONLY","$57,218.00 ","$42,341.32 ","$0.00 ","$32,180.45 ","$28,652.18 ","$11,646.29 ","$0.00 ","$2,686.98 ","$3,100.38 ","$16,209.33 ","$18,426.38 ","$22,960.49 ","$15,497.86 ","$32,180.45 ","$0.00 ","$13,433.57 ","$16,209.33 ","$24,089.19 ","$21,867.13 ","$16,209.33 "
"MS055","DRG","MS055","","NERVOUS SYSTEM NEOPLASMS WITHOUT MCC","INPATIENT ONLY","$29,991.33 ","$22,193.58 ","$0.00 ","$20,540.66 ","$12,259.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,918.59 ","$0.00 ","$20,540.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,303.42 ","$0.00 ","$19,562.53 ","$12,918.59 "
"MS056","DRG","MS056","","DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC","INPATIENT ONLY","$74,193.16 ","$54,902.94 ","$0.00 ","$51,366.19 ","$12,532.35 ","$15,722.67 ","$27,637.01 ","$50,952.79 ","$51,366.19 ","$4,348.77 ","$0.00 ","$28,784.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,891.53 ","$31,049.49 ","$27,414.20 ","$4,141.69 "
"MS057","DRG","MS057","","DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC","INPATIENT ONLY","$48,700.14 ","$36,038.10 ","$0.00 ","$24,142.42 ","$24,142.42 ","$9,014.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,648.50 ","$20,335.16 ","$9,564.24 ","$17,411.42 ","$0.00 ","$12,137.42 ","$0.00 ","$18,349.35 ","$19,366.82 ","$0.00 "
"MS058","DRG","MS058","","MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC","INPATIENT ONLY","$57,255.06 ","$42,368.74 ","$0.00 ","$35,850.39 ","$0.00 ","$0.00 ","$0.00 ","$8,998.30 ","$9,189.14 ","$0.00 ","$30,877.13 ","$0.00 ","$8,006.13 ","$27,593.07 ","$0.00 ","$19,594.52 ","$0.00 ","$35,850.39 ","$0.00 ","$0.00 "
"MS059","DRG","MS059","","MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC","INPATIENT ONLY","$42,378.53 ","$31,360.11 ","$0.00 ","$63,687.23 ","$63,687.23 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$0.00 ","$18,994.38 ","$21,254.77 ","$16,079.42 ","$33,948.36 ","$0.00 ","$10,931.50 ","$0.00 ","$22,050.83 ","$20,242.64 ","$0.00 "
"MS060","DRG","MS060","","MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC","INPATIENT ONLY","$17,859.37 ","$13,215.93 ","$0.00 ","$10,125.78 ","$0.00 ","$0.00 ","$0.00 ","$10,125.78 ","$10,125.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS061","DRG","MS061","","ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC","INPATIENT ONLY","$95,693.84 ","$70,813.44 ","$0.00 ","$215,011.32 ","$92,084.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162,887.36 ","$32,892.67 ","$176,461.31 ","$215,011.32 ","$0.00 ","$32,518.99 ","$0.00 ","$35,958.33 ","$31,326.35 ","$0.00 "
"MS062","DRG","MS062","","ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC","INPATIENT ONLY","$103,906.20 ","$76,890.59 ","$0.00 ","$73,869.50 ","$19,584.47 ","$16,561.69 ","$0.00 ","$15,389.95 ","$15,580.79 ","$0.00 ","$27,654.00 ","$27,546.62 ","$15,607.97 ","$73,869.50 ","$0.00 ","$20,160.87 ","$0.00 ","$29,569.72 ","$26,234.88 ","$0.00 "
"MS063","DRG","MS063","","ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC","INPATIENT ONLY","$95,685.66 ","$70,807.39 ","$0.00 ","$50,374.27 ","$8,398.95 ","$13,476.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,111.00 ","$0.00 ","$18,358.07 ","$50,374.27 ","$0.00 ","$16,848.86 ","$0.00 ","$26,871.51 ","$0.00 ","$0.00 "
"MS064","DRG","MS064","","INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC","INPATIENT ONLY","$123,857.52 ","$91,654.56 ","$0.00 ","$110,327.78 ","$110,327.78 ","$15,513.81 ","$25,409.92 ","$29,622.92 ","$32,103.32 ","$55,740.19 ","$25,778.50 ","$26,614.49 ","$27,643.93 ","$64,405.47 ","$0.00 ","$18,793.56 ","$44,500.15 ","$28,455.79 ","$25,347.13 ","$25,793.36 "
"MS065","DRG","MS065","","INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS","INPATIENT ONLY","$79,103.20 ","$58,536.37 ","$0.00 ","$60,123.35 ","$27,569.45 ","$9,499.65 ","$13,734.30 ","$8,998.30 ","$9,189.14 ","$0.00 ","$14,130.88 ","$20,825.64 ","$15,153.44 ","$60,123.35 ","$54,112.55 ","$10,301.98 ","$0.00 ","$21,537.99 ","$19,833.94 ","$0.00 "
"MS066","DRG","MS066","","INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC","INPATIENT ONLY","$41,730.17 ","$30,880.33 ","$0.00 ","$30,837.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,858.75 ","$18,702.38 ","$8,810.14 ","$30,837.84 ","$0.00 ","$7,187.44 ","$0.00 ","$19,000.67 ","$17,811.79 ","$0.00 "
"MS067","DRG","MS067","","NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC","INPATIENT ONLY","$113,443.89 ","$83,948.48 ","$0.00 ","$25,105.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,105.11 ","$0.00 ","$0.00 "
"MS068","DRG","MS068","","NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC","INPATIENT ONLY","$68,653.56 ","$50,803.63 ","$0.00 ","$20,522.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,976.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,522.91 ","$19,024.95 ","$0.00 "
"MS069","DRG","MS069","","TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC","INPATIENT ONLY","$52,701.73 ","$38,999.28 ","$0.00 ","$19,517.62 ","$4,165.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,134.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,517.62 ","$18,223.78 ","$0.00 "
"MS070","DRG","MS070","","NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC","INPATIENT ONLY","$118,539.35 ","$87,719.12 ","$0.00 ","$32,577.11 ","$16,579.68 ","$14,672.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,234.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,577.11 ","$28,582.72 ","$0.00 "
"MS071","DRG","MS071","","NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC","INPATIENT ONLY","$54,131.74 ","$40,057.49 ","$0.00 ","$35,678.57 ","$4,086.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,600.14 ","$0.00 ","$0.00 ","$35,678.57 ","$0.00 ","$0.00 ","$21,268.52 ","$19,619.18 ","$0.00 "
"MS072","DRG","MS072","","NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$61,347.12 ","$45,396.87 ","$0.00 ","$18,849.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,849.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,951.72 ","$0.00 "
"MS073","DRG","MS073","","CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC","INPATIENT ONLY","$41,000.17 ","$30,340.13 ","$0.00 ","$24,705.77 ","$0.00 ","$0.00 ","$14,136.39 ","$18,808.86 ","$21,702.66 ","$0.00 ","$0.00 ","$23,476.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,705.77 ","$22,358.52 ","$0.00 "
"MS074","DRG","MS074","","CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC","INPATIENT ONLY","$33,436.38 ","$24,742.92 ","$0.00 ","$36,882.23 ","$25,719.00 ","$0.00 ","$8,974.55 ","$5,373.96 ","$6,200.76 ","$9,019.34 ","$13,586.38 ","$20,555.00 ","$14,569.53 ","$36,882.23 ","$0.00 ","$9,905.01 ","$8,589.85 ","$21,214.59 ","$19,576.19 ","$9,019.34 "
"MS075","DRG","MS075","","VIRAL MENINGITIS WITH CC/MCC","INPATIENT ONLY","$63,854.38 ","$47,252.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS077","DRG","MS077","","HYPERTENSIVE ENCEPHALOPATHY WITH MCC","INPATIENT ONLY","$29,147.98 ","$21,569.51 ","$0.00 ","$25,742.09 ","$13,255.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,343.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,742.09 ","$23,184.42 ","$0.00 "
"MS078","DRG","MS078","","HYPERTENSIVE ENCEPHALOPATHY WITH CC","INPATIENT ONLY","$59,520.47 ","$44,045.15 ","$0.00 ","$20,376.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,376.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,406.35 ","$0.00 "
"MS080","DRG","MS080","","NONTRAUMATIC STUPOR AND COMA WITH MCC","INPATIENT ONLY","$109,992.22 ","$81,394.24 ","$0.00 ","$29,003.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,003.98 ","$0.00 ","$0.00 "
"MS081","DRG","MS081","","NONTRAUMATIC STUPOR AND COMA WITHOUT MCC","INPATIENT ONLY","$65,998.93 ","$48,839.21 ","$0.00 ","$20,324.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,324.45 ","$0.00 ","$0.00 "
"MS082","DRG","MS082","","TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC","INPATIENT ONLY","$109,243.85 ","$80,840.45 ","$0.00 ","$73,345.89 ","$12,231.51 ","$17,085.63 ","$0.00 ","$32,838.37 ","$32,838.37 ","$0.00 ","$30,962.25 ","$29,190.82 ","$60,195.49 ","$73,345.89 ","$0.00 ","$22,572.74 ","$0.00 ","$31,534.56 ","$27,800.78 ","$0.00 "
"MS083","DRG","MS083","","TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC","INPATIENT ONLY","$91,871.44 ","$67,984.87 ","$0.00 ","$83,592.12 ","$19,781.66 ","$11,068.80 ","$0.00 ","$23,591.33 ","$23,591.33 ","$0.00 ","$63,327.35 ","$22,759.59 ","$68,604.63 ","$83,592.12 ","$0.00 ","$13,138.85 ","$0.00 ","$23,849.11 ","$21,675.80 ","$0.00 "
"MS084","DRG","MS084","","TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC","INPATIENT ONLY","$60,065.16 ","$44,448.22 ","$0.00 ","$105,860.74 ","$105,860.74 ","$0.00 ","$0.00 ","$18,103.32 ","$18,103.32 ","$0.00 ","$68,328.43 ","$18,985.24 ","$74,022.47 ","$90,193.56 ","$0.00 ","$8,994.81 ","$0.00 ","$20,473.08 ","$18,985.24 ","$0.00 "
"MS085","DRG","MS085","","TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC","INPATIENT ONLY","$133,066.60 ","$98,469.28 ","$0.00 ","$189,335.99 ","$129,464.98 ","$0.00 ","$0.00 ","$102,971.71 ","$102,971.71 ","$7,054.97 ","$143,436.35 ","$29,149.82 ","$155,389.38 ","$189,335.99 ","$0.00 ","$23,840.21 ","$6,719.03 ","$39,231.69 ","$27,761.73 ","$7,054.97 "
"MS086","DRG","MS086","","TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC","INPATIENT ONLY","$91,005.46 ","$67,344.04 ","$0.00 ","$156,793.36 ","$16,054.95 ","$9,979.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,531.72 ","$22,261.41 ","$21,878.17 ","$26,657.70 ","$156,793.36 ","$12,408.08 ","$0.00 ","$23,253.77 ","$21,201.34 ","$0.00 "
"MS087","DRG","MS087","","TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC","INPATIENT ONLY","$54,038.57 ","$39,988.54 ","$0.00 ","$54,184.31 ","$10,442.68 ","$6,658.59 ","$6,337.82 ","$0.00 ","$0.00 ","$6,369.44 ","$11,539.00 ","$19,537.48 ","$44,469.44 ","$54,184.31 ","$0.00 ","$8,412.39 ","$6,066.14 ","$19,998.62 ","$18,607.12 ","$6,369.44 "
"MS088","DRG","MS088","","CONCUSSION WITH MCC","INPATIENT ONLY","$61,942.49 ","$45,837.44 ","$0.00 ","$12,687.93 ","$0.00 ","$0.00 ","$12,687.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS089","DRG","MS089","","CONCUSSION WITH CC","INPATIENT ONLY","$82,992.64 ","$61,414.55 ","$0.00 ","$74,998.20 ","$74,998.20 ","$0.00 ","$0.00 ","$12,615.31 ","$12,615.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS090","DRG","MS090","","CONCUSSION WITHOUT CC/MCC","INPATIENT ONLY","$63,676.92 ","$47,120.92 ","$0.00 ","$19,599.65 ","$0.00 ","$6,563.09 ","$0.00 ","$12,615.31 ","$12,615.31 ","$0.00 ","$0.00 ","$19,599.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,666.33 ","$0.00 "
"MS091","DRG","MS091","","OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC","INPATIENT ONLY","$52,693.58 ","$38,993.25 ","$0.00 ","$25,926.64 ","$0.00 ","$0.00 ","$0.00 ","$6,750.52 ","$6,750.52 ","$0.00 ","$0.00 ","$24,498.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,926.64 ","$23,331.51 ","$0.00 "
"MS092","DRG","MS092","","OTHER DISORDERS OF NERVOUS SYSTEM WITH CC","INPATIENT ONLY","$112,379.69 ","$83,160.97 ","$0.00 ","$60,857.94 ","$4,119.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,283.88 ","$20,404.67 ","$3,652.60 ","$60,857.94 ","$0.00 ","$9,684.47 ","$0.00 ","$21,034.94 ","$19,433.02 ","$0.00 "
"MS093","DRG","MS093","","OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC","INPATIENT ONLY","$23,227.89 ","$17,188.64 ","$0.00 ","$21,343.61 ","$5,791.65 ","$0.00 ","$7,940.48 ","$17,402.15 ","$17,402.15 ","$0.00 ","$10,466.50 ","$19,004.44 ","$4,008.53 ","$21,343.61 ","$0.00 ","$7,630.49 ","$0.00 ","$19,361.64 ","$18,099.47 ","$0.00 "
"MS094","DRG","MS094","","BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC","INPATIENT ONLY","$208,527.33 ","$154,310.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS095","DRG","MS095","","BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC","INPATIENT ONLY","$128,295.60 ","$94,938.74 ","$0.00 ","$2,114.21 ","$0.00 ","$0.00 ","$0.00 ","$2,114.21 ","$2,114.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS097","DRG","MS097","","NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC","INPATIENT ONLY","$40,298.97 ","$29,821.24 ","$0.00 ","$46,143.44 ","$13,337.55 ","$0.00 ","$0.00 ","$19,067.63 ","$20,403.25 ","$0.00 ","$0.00 ","$38,239.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,143.44 ","$0.00 "
"MS098","DRG","MS098","","NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC","INPATIENT ONLY","$81,880.42 ","$60,591.51 ","$0.00 ","$27,162.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,162.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,869.11 ","$0.00 "
"MS099","DRG","MS099","","NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC","INPATIENT ONLY","$174,672.76 ","$129,257.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS100","DRG","MS100","","SEIZURES WITH MCC","INPATIENT ONLY","$113,408.24 ","$83,922.10 ","$0.00 ","$127,077.03 ","$41,317.50 ","$13,659.94 ","$16,066.40 ","$98,169.13 ","$98,264.55 ","$0.00 ","$96,270.47 ","$26,241.38 ","$104,293.01 ","$127,077.03 ","$0.00 ","$18,246.24 ","$0.00 ","$28,009.92 ","$24,991.79 ","$0.00 "
"MS101","DRG","MS101","","SEIZURES WITHOUT MCC","INPATIENT ONLY","$40,436.43 ","$29,922.96 ","$0.00 ","$30,456.31 ","$20,980.25 ","$0.00 ","$7,244.17 ","$10,125.78 ","$10,125.78 ","$7,280.31 ","$12,139.88 ","$19,836.12 ","$3,828.93 ","$30,456.31 ","$28,419.72 ","$8,850.46 ","$6,933.64 ","$20,355.50 ","$18,891.54 ","$7,280.31 "
"MS102","DRG","MS102","","HEADACHES WITH MCC","INPATIENT ONLY","$29,362.26 ","$21,728.07 ","$0.00 ","$8,589.34 ","$8,589.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS103","DRG","MS103","","HEADACHES WITHOUT MCC","INPATIENT ONLY","$49,370.41 ","$36,534.10 ","$0.00 ","$19,674.42 ","$15,663.02 ","$6,172.14 ","$0.00 ","$0.00 ","$0.00 ","$6,704.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,384.88 ","$19,674.42 ","$0.00 ","$6,704.13 "
"MS113","DRG","MS113","","ORBITAL PROCEDURES WITH CC/MCC","INPATIENT ONLY","$138,306.42 ","$102,346.75 ","$0.00 ","$276,386.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176,625.91 ","$28,372.83 ","$191,344.73 ","$233,146.18 ","$276,386.52 ","$36,547.34 ","$0.00 ","$30,557.04 ","$27,021.74 ","$0.00 "
"MS114","DRG","MS114","","ORBITAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$87,408.31 ","$64,682.15 ","$0.00 ","$22,869.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,940.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,869.95 ","$20,895.44 ","$0.00 "
"MS115","DRG","MS115","","EXTRAOCULAR PROCEDURES EXCEPT ORBIT","INPATIENT ONLY","$67,898.23 ","$50,244.69 ","$0.00 ","$105,509.24 ","$105,509.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS116","DRG","MS116","","INTRAOCULAR PROCEDURES WITH CC/MCC","INPATIENT ONLY","$82,320.88 ","$60,917.45 ","$0.00 ","$30,595.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,725.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,595.31 ","$0.00 "
"MS117","DRG","MS117","","INTRAOCULAR PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$367,970.92 ","$272,298.48 ","$0.00 ","$61,633.31 ","$0.00 ","$61,633.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS121","DRG","MS121","","ACUTE MAJOR EYE INFECTIONS WITH CC/MCC","INPATIENT ONLY","$15,973.21 ","$11,820.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS123","DRG","MS123","","NEUROLOGICAL EYE DISORDERS","INPATIENT ONLY","$44,663.68 ","$33,051.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS124","DRG","MS124","","OTHER DISORDERS OF THE EYE WITH MCC","INPATIENT ONLY","$29,314.17 ","$21,692.49 ","$0.00 ","$26,180.77 ","$26,180.77 ","$10,203.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,104.25 ","$0.00 ","$3,939.75 ","$21,706.29 ","$0.00 ","$13,927.76 ","$0.00 ","$24,491.81 ","$0.00 ","$0.00 "
"MS125","DRG","MS125","","OTHER DISORDERS OF THE EYE WITHOUT MCC","INPATIENT ONLY","$41,942.08 ","$31,037.14 ","$0.00 ","$19,591.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,197.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,591.92 ","$18,282.99 ","$0.00 "
"MS137","DRG","MS137","","MOUTH PROCEDURES WITH CC/MCC","INPATIENT ONLY","$21,396.53 ","$15,833.43 ","$0.00 ","$22,914.03 ","$13,358.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,799.70 ","$0.00 ","$22,914.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,380.67 ","$0.00 ","$21,822.89 ","$8,799.70 "
"MS138","DRG","MS138","","MOUTH PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$106,064.54 ","$78,487.76 ","$0.00 ","$8,601.10 ","$8,601.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS139","DRG","MS139","","SALIVARY GLAND PROCEDURES","INPATIENT ONLY","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS140","DRG","MS140","","MAJOR HEAD AND NECK PROCEDURES WITH MCC","INPATIENT ONLY","$309,670.31 ","$229,156.03 ","$0.00 ","$194,628.71 ","$194,628.71 ","$194,363.69 ","$0.00 ","","","","","","","","","","","","",""
"MS141","DRG","MS141","","MAJOR HEAD AND NECK PROCEDURES WITH CC","INPATIENT ONLY","$205,684.54 ","$152,206.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS142","DRG","MS142","","MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$165,428.82 ","$122,417.33 ","$0.00 ","$91,709.28 ","$91,709.28 ","$24,814.35 ","$0.00 ","","","","","","","","","","","","",""
"MS143","DRG","MS143","","OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$304,173.95 ","$225,088.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS144","DRG","MS144","","OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC","INPATIENT ONLY","$18,109.68 ","$13,401.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS145","DRG","MS145","","OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$93,894.95 ","$69,482.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS146","DRG","MS146","","EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC","INPATIENT ONLY","$179,849.11 ","$133,088.34 ","$0.00 ","$28,926.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,982.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,926.04 ","$25,697.29 ","$0.00 "
"MS147","DRG","MS147","","EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC","INPATIENT ONLY","$66,379.23 ","$49,120.63 ","$0.00 ","$97,982.21 ","$97,982.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS149","DRG","MS149","","DYSEQUILIBRIUM","INPATIENT ONLY","$20,824.61 ","$15,410.21 ","$0.00 ","$19,110.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,794.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,110.92 ","$17,899.66 ","$0.00 "
"MS150","DRG","MS150","","EPISTAXIS WITH MCC","INPATIENT ONLY","$39,367.10 ","$29,131.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS152","DRG","MS152","","OTITIS MEDIA AND URI WITH MCC","INPATIENT ONLY","$24,484.17 ","$18,118.29 ","$0.00 ","$20,902.85 ","$0.00 ","$0.00 ","$0.00 ","$12,373.56 ","$12,564.40 ","$0.00 ","$0.00 ","$20,902.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,907.48 ","$0.00 "
"MS153","DRG","MS153","","OTITIS MEDIA AND URI WITHOUT MCC","INPATIENT ONLY","$23,118.21 ","$17,107.48 ","$0.00 ","$18,914.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,713.00 ","$0.00 ","$10,415.87 ","$16,796.75 ","$0.00 ","$7,081.17 ","$0.00 ","$18,914.10 ","$0.00 ","$0.00 "
"MS154","DRG","MS154","","OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC","INPATIENT ONLY","$93,847.35 ","$69,447.04 ","$0.00 ","$13,877.82 ","$0.00 ","$0.00 ","$0.00 ","$13,877.82 ","$13,877.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS155","DRG","MS155","","OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC","INPATIENT ONLY","$43,876.11 ","$32,468.32 ","$0.00 ","$20,504.12 ","$0.00 ","$0.00 ","$0.00 ","$9,814.28 ","$10,227.68 ","$6,474.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,166.65 ","$20,504.12 ","$0.00 ","$6,474.98 "
"MS156","DRG","MS156","","OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$23,686.23 ","$17,527.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS157","DRG","MS157","","DENTAL AND ORAL DISEASES WITH MCC","INPATIENT ONLY","$74,941.49 ","$55,456.70 ","$0.00 ","$92,183.95 ","$0.00 ","$0.00 ","$0.00 ","$90,943.75 ","$92,183.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,908.70 ","$0.00 ","$0.00 "
"MS158","DRG","MS158","","DENTAL AND ORAL DISEASES WITH CC","INPATIENT ONLY","$78,110.53 ","$57,801.79 ","$0.00 ","$20,222.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,794.95 ","$0.00 ","$19,724.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,376.14 ","$20,222.38 ","$18,785.45 ","$8,794.95 "
"MS159","DRG","MS159","","DENTAL AND ORAL DISEASES WITHOUT CC/MCC","INPATIENT ONLY","$77,636.24 ","$57,450.82 ","$0.00 ","$49,192.35 ","$17,283.48 ","$0.00 ","$0.00 ","$9,814.28 ","$10,227.68 ","$0.00 ","$9,252.38 ","$18,401.02 ","$7,632.24 ","$49,192.35 ","$0.00 ","$6,745.36 ","$0.00 ","$18,640.54 ","$17,524.78 ","$0.00 "
"MS163","DRG","MS163","","MAJOR CHEST PROCEDURES WITH MCC","INPATIENT ONLY","$279,043.80 ","$206,492.41 ","$0.00 ","$296,439.13 ","$137,000.36 ","$0.00 ","$51,285.84 ","$0.00 ","$0.00 ","$0.00 ","$224,575.09 ","$0.00 ","$243,289.68 ","$296,439.13 ","$0.00 ","$60,731.26 ","$0.00 ","$52,946.21 ","$0.00 ","$0.00 "
"MS164","DRG","MS164","","MAJOR CHEST PROCEDURES WITH CC","INPATIENT ONLY","$282,327.09 ","$208,922.05 ","$0.00 ","$222,897.67 ","$220,306.22 ","$62,096.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168,861.87 ","$31,102.90 ","$182,933.69 ","$222,897.67 ","$0.00 ","$34,322.38 ","$0.00 ","$33,819.53 ","$29,621.81 ","$0.00 "
"MS165","DRG","MS165","","MAJOR CHEST PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$65,007.56 ","$48,105.59 ","$0.00 ","$28,246.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,439.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,246.73 ","$25,180.51 ","$0.00 "
"MS166","DRG","MS166","","OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$178,026.71 ","$131,739.77 ","$0.00 ","$55,255.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51,297.13 ","$39,297.27 ","$16,179.17 ","$55,255.73 ","$0.00 ","$37,397.68 ","$0.00 ","$43,611.96 ","$47,571.93 ","$0.00 "
"MS167","DRG","MS167","","OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC","INPATIENT ONLY","$133,062.87 ","$98,466.52 ","$0.00 ","$70,722.18 ","$0.00 ","$0.00 ","$0.00 ","$69,481.98 ","$70,722.18 ","$18,341.98 ","$26,323.00 ","$26,885.12 ","$16,604.60 ","$32,510.42 ","$0.00 ","$19,190.53 ","$17,468.56 ","$28,779.21 ","$25,604.88 ","$18,341.98 "
"MS168","DRG","MS168","","OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$296,531.05 ","$219,432.98 ","$0.00 ","$22,868.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,868.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,779.93 ","$0.00 "
"MS175","DRG","MS175","","PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE","INPATIENT ONLY","$46,945.21 ","$34,739.46 ","$0.00 ","$101,945.47 ","$26,408.34 ","$0.00 ","$0.00 ","$101,023.25 ","$101,945.47 ","$0.00 ","$19,860.50 ","$23,432.41 ","$16,704.06 ","$38,070.00 ","$0.00 ","$14,479.10 ","$0.00 ","$24,940.97 ","$22,316.58 ","$0.00 "
"MS176","DRG","MS176","","PULMONARY EMBOLISM WITHOUT MCC","INPATIENT ONLY","$35,673.42 ","$26,398.33 ","$0.00 ","$18,666.99 ","$0.00 ","$0.00 ","$0.00 ","$2,811.52 ","$2,906.94 ","$8,645.42 ","$0.00 ","$18,666.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,736.43 ","$18,474.68 ","$18,666.99 ","$8,233.74 "
"MS177","DRG","MS177","","RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC","INPATIENT ONLY","$54,920.67 ","$40,641.30 ","$2,527.77 ","$35,112.81 ","$24,674.54 ","$17,398.03 ","$18,110.89 ","$10,747.92 ","$12,401.52 ","$2,824.77 ","$26,004.00 ","$26,726.58 ","$8,082.82 ","$21,757.37 ","$11,693.56 ","$18,957.97 ","$2,527.77 ","$35,112.81 ","$30,597.17 ","$2,690.25 "
"MS178","DRG","MS178","","RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC","INPATIENT ONLY","$41,304.99 ","$30,565.69 ","$0.00 ","$31,014.33 ","$4,086.60 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$3,998.66 ","$17,095.38 ","$22,298.99 ","$10,783.80 ","$31,014.33 ","$27,319.11 ","$12,463.21 ","$3,578.23 ","$27,587.02 ","$24,618.39 ","$3,808.24 "
"MS179","DRG","MS179","","RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC","INPATIENT ONLY","$14,995.29 ","$11,096.51 ","$0.00 ","$27,548.37 ","$0.00 ","$0.00 ","$6,204.24 ","$0.00 ","$0.00 ","$0.00 ","$11,908.88 ","$19,721.29 ","$12,770.64 ","$27,548.37 ","$11,997.43 ","$8,682.05 ","$0.00 ","$23,205.61 ","$21,137.62 ","$0.00 "
"MS180","DRG","MS180","","RESPIRATORY NEOPLASMS WITH MCC","INPATIENT ONLY","$96,534.84 ","$71,435.78 ","$0.00 ","$27,231.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,590.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,231.65 ","$24,371.54 ","$0.00 "
"MS181","DRG","MS181","","RESPIRATORY NEOPLASMS WITH CC","INPATIENT ONLY","$48,052.18 ","$35,558.61 ","$0.00 ","$22,553.09 ","$4,515.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,675.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,553.09 ","$20,642.93 ","$0.00 "
"MS182","DRG","MS182","","RESPIRATORY NEOPLASMS WITHOUT CC/MCC","INPATIENT ONLY","$48,193.46 ","$35,663.16 ","$0.00 ","$19,562.08 ","$16,511.68 ","$7,219.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,562.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,630.55 ","$0.00 "
"MS183","DRG","MS183","","MAJOR CHEST TRAUMA WITH MCC","INPATIENT ONLY","$71,723.96 ","$53,075.73 ","$0.00 ","$24,116.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,116.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,967.71 ","$0.00 "
"MS184","DRG","MS184","","MAJOR CHEST TRAUMA WITH CC","INPATIENT ONLY","$80,313.41 ","$59,431.92 ","$0.00 ","$64,519.81 ","$22,437.76 ","$0.00 ","$0.00 ","$18,103.32 ","$18,103.32 ","$0.00 ","$14,000.25 ","$20,760.71 ","$52,951.87 ","$64,519.81 ","$0.00 ","$10,206.75 ","$0.00 ","$21,460.41 ","$19,772.10 ","$0.00 "
"MS185","DRG","MS185","","MAJOR CHEST TRAUMA WITHOUT CC/MCC","INPATIENT ONLY","$50,595.65 ","$37,440.78 ","$0.00 ","$19,139.50 ","$12,596.89 ","$5,915.97 ","$0.00 ","$18,103.32 ","$18,103.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,139.50 ","$0.00 ","$0.00 "
"MS186","DRG","MS186","","PLEURAL EFFUSION WITH MCC","INPATIENT ONLY","$30,155.37 ","$22,314.97 ","$0.00 ","$31,067.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,067.06 ","$0.00 ","$0.00 "
"MS187","DRG","MS187","","PLEURAL EFFUSION WITH CC","INPATIENT ONLY","$66,163.36 ","$48,960.89 ","$0.00 ","$20,826.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,826.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,835.22 ","$0.00 "
"MS188","DRG","MS188","","PLEURAL EFFUSION WITHOUT CC/MCC","INPATIENT ONLY","$23,754.99 ","$17,578.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS189","DRG","MS189","","PULMONARY EDEMA AND RESPIRATORY FAILURE","INPATIENT ONLY","$40,618.71 ","$30,057.85 ","$0.00 ","$36,477.30 ","$25,196.85 ","$9,782.23 ","$12,640.58 ","$2,811.52 ","$2,906.94 ","$0.00 ","$16,715.88 ","$22,110.38 ","$15,587.39 ","$36,477.30 ","$26,164.57 ","$12,186.54 ","$0.00 ","$23,073.29 ","$21,057.50 ","$0.00 "
"MS190","DRG","MS190","","CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC","INPATIENT ONLY","$22,075.42 ","$16,335.81 ","$0.00 ","$22,487.76 ","$8,385.55 ","$0.00 ","$10,092.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,620.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,487.76 ","$20,590.86 ","$0.00 "
"MS191","DRG","MS191","","CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC","INPATIENT ONLY","$27,212.46 ","$20,137.22 ","$0.00 ","$20,436.33 ","$0.00 ","$0.00 ","$14,254.34 ","$2,686.98 ","$3,100.38 ","$0.00 ","$0.00 ","$19,903.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,436.33 ","$18,955.96 ","$0.00 "
"MS192","DRG","MS192","","CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC","INPATIENT ONLY","$39,809.35 ","$29,458.92 ","$0.00 ","$18,936.98 ","$8,173.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,649.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,936.98 ","$17,761.04 ","$0.00 "
"MS193","DRG","MS193","","SIMPLE PNEUMONIA AND PLEURISY WITH MCC","INPATIENT ONLY","$53,920.15 ","$39,900.91 ","$0.00 ","$43,491.25 ","$24,519.60 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$12,776.92 ","$18,335.63 ","$22,915.39 ","$3,781.24 ","$33,085.28 ","$43,491.25 ","$13,367.42 ","$12,168.50 ","$24,035.30 ","$21,824.18 ","$12,776.92 "
"MS194","DRG","MS194","","SIMPLE PNEUMONIA AND PLEURISY WITH CC","INPATIENT ONLY","$23,780.48 ","$17,597.56 ","$0.00 ","$20,557.21 ","$0.00 ","$0.00 ","$0.00 ","$13,434.90 ","$15,501.90 ","$3,239.94 ","$12,218.25 ","$19,875.06 ","$6,896.00 ","$20,557.21 ","$0.00 ","$8,907.60 ","$2,899.29 ","$20,402.05 ","$18,928.63 ","$3,085.65 "
"MS195","DRG","MS195","","SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC","INPATIENT ONLY","$27,752.98 ","$20,537.21 ","$0.00 ","$18,715.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,270.32 ","$0.00 ","$18,463.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,926.47 ","$18,715.67 ","$17,584.66 ","$3,114.59 "
"MS196","DRG","MS196","","INTERSTITIAL LUNG DISEASE WITH MCC","INPATIENT ONLY","$62,019.94 ","$45,894.76 ","$0.00 ","$50,112.69 ","$4,298.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,036.75 ","$25,251.85 ","$24,703.77 ","$50,112.69 ","$0.00 ","$16,794.73 ","$0.00 ","$26,827.41 ","$24,049.38 ","$0.00 "
"MS197","DRG","MS197","","INTERSTITIAL LUNG DISEASE WITH CC","INPATIENT ONLY","$33,882.40 ","$25,072.98 ","$0.00 ","$21,487.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,487.37 ","$0.00 ","$0.00 "
"MS198","DRG","MS198","","INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC","INPATIENT ONLY","$58,135.75 ","$43,020.46 ","$0.00 ","$6,111.70 ","$0.00 ","$0.00 ","$6,111.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS199","DRG","MS199","","PNEUMOTHORAX WITH MCC","INPATIENT ONLY","$87,933.44 ","$65,070.75 ","$0.00 ","$71,834.87 ","$22,271.35 ","$16,374.25 ","$20,990.30 ","$15,188.24 ","$16,428.44 ","$14,397.09 ","$24,668.88 ","$0.00 ","$19,741.79 ","$71,834.87 ","$0.00 ","$17,984.61 ","$13,711.52 ","$27,796.78 ","$0.00 ","$14,397.09 "
"MS200","DRG","MS200","","PNEUMOTHORAX WITH CC","INPATIENT ONLY","$88,938.55 ","$65,814.53 ","$6,062.24 ","$41,863.22 ","$26,577.44 ","$9,000.71 ","$7,212.00 ","$6,062.24 ","$6,475.64 ","$7,589.69 ","$14,878.88 ","$21,197.39 ","$7,597.89 ","$33,230.54 ","$41,863.22 ","$10,847.31 ","$6,902.85 ","$21,982.26 ","$20,187.99 ","$7,247.99 "
"MS201","DRG","MS201","","PNEUMOTHORAX WITHOUT CC/MCC","INPATIENT ONLY","$18,226.67 ","$13,487.74 ","$0.00 ","$28,659.30 ","$28,659.30 ","$0.00 ","$5,832.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,709.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,818.31 ","$0.00 "
"MS202","DRG","MS202","","BRONCHITIS AND ASTHMA WITH CC/MCC","INPATIENT ONLY","$27,125.85 ","$20,073.13 ","$0.00 ","$20,887.13 ","$8,642.61 ","$0.00 ","$7,793.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,280.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,887.13 ","$19,315.22 ","$0.00 "
"MS203","DRG","MS203","","BRONCHITIS AND ASTHMA WITHOUT CC/MCC","INPATIENT ONLY","$17,147.67 ","$12,689.28 ","$0.00 ","$18,811.21 ","$0.00 ","$0.00 ","$3,735.21 ","$13,808.52 ","$14,921.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,811.21 ","$0.00 ","$0.00 "
"MS204","DRG","MS204","","RESPIRATORY SIGNS AND SYMPTOMS","INPATIENT ONLY","$12,787.21 ","$9,462.54 ","$0.00 ","$114,402.61 ","$114,402.61 ","$19,192.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,354.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,780.56 ","$18,433.32 ","$0.00 "
"MS205","DRG","MS205","","OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC","INPATIENT ONLY","$71,391.42 ","$52,829.65 ","$0.00 ","$46,642.66 ","$16,664.62 ","$12,495.13 ","$0.00 ","$8,060.94 ","$9,301.14 ","$0.00 ","$22,470.25 ","$24,970.31 ","$12,908.72 ","$46,642.66 ","$0.00 ","$16,381.71 ","$0.00 ","$26,490.96 ","$23,781.25 ","$0.00 "
"MS206","DRG","MS206","","OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC","INPATIENT ONLY","$30,695.99 ","$22,715.03 ","$0.00 ","$34,911.74 ","$0.00 ","$0.00 ","$6,502.44 ","$0.00 ","$0.00 ","$0.00 ","$11,996.88 ","$19,765.04 ","$4,150.00 ","$34,911.74 ","$0.00 ","$8,746.21 ","$0.00 ","$20,270.57 ","$18,823.85 ","$0.00 "
"MS207","DRG","MS207","","RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS","INPATIENT ONLY","$381,382.83 ","$282,223.29 ","$0.00 ","$391,535.95 ","$136,076.60 ","$0.00 ","$62,949.70 ","$391,440.53 ","$391,535.95 ","$0.00 ","$265,173.58 ","$50,474.52 ","$287,271.37 ","$350,029.12 ","$0.00 ","$78,281.84 ","$0.00 ","$59,984.89 ","$50,474.52 ","$0.00 "
"MS208","DRG","MS208","","RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS","INPATIENT ONLY","$129,996.22 ","$96,197.20 ","$0.00 ","$33,431.63 ","$26,856.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,140.35 ","$30,778.29 ","$5,386.48 ","$22,287.15 ","$0.00 ","$24,901.37 ","$0.00 ","$33,431.63 ","$29,312.66 ","$0.00 "
"MS215","DRG","MS215","","OTHER HEART ASSIST SYSTEM IMPLANT","INPATIENT ONLY","$302,673.62 ","$223,978.48 ","$0.00 ","$426,802.21 ","$177,689.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323,335.01 ","$101,862.99 ","$350,279.60 ","$426,802.21 ","$0.00 ","$129,174.20 ","$0.00 ","$118,379.20 ","$97,012.37 ","$0.00 "
"MS216","DRG","MS216","","CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC","INPATIENT ONLY","$844,071.58 ","$624,612.97 ","$0.00 ","$363,816.68 ","$363,816.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95,156.23 ","$0.00 ","$0.00 "
"MS219","DRG","MS219","","CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC","INPATIENT ONLY","$652,285.78 ","$482,691.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS220","DRG","MS220","","CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC","INPATIENT ONLY","$834,118.48 ","$617,247.68 ","$0.00 ","$314,960.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238,606.64 ","$0.00 ","$258,490.53 ","$314,960.76 ","$0.00 ","$67,066.33 ","$0.00 ","$56,475.77 ","$0.00 ","$0.00 "
"MS222","DRG","MS222","","CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC","INPATIENT ONLY","$557,934.66 ","$412,871.65 ","$0.00 ","$652,154.79 ","$652,154.79 ","$0.00 ","$0.00 ","$168,085.11 ","$168,498.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81,291.22 ","$0.00 ","$0.00 "
"MS224","DRG","MS224","","CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC","INPATIENT ONLY","$224,109.48 ","$165,841.02 ","$0.00 ","$66,349.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66,349.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63,190.05 ","$0.00 "
"MS225","DRG","MS225","","CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC","INPATIENT ONLY","$304,647.12 ","$225,438.87 ","$0.00 ","$59,276.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49,909.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59,276.04 ","$49,909.59 ","$0.00 "
"MS226","DRG","MS226","","CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC","INPATIENT ONLY","$262,894.89 ","$194,542.22 ","$0.00 ","$59,504.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59,504.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56,671.10 ","$0.00 "
"MS227","DRG","MS227","","CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC","INPATIENT ONLY","$237,743.92 ","$175,930.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS228","DRG","MS228","","OTHER CARDIOTHORACIC PROCEDURES WITH MCC","INPATIENT ONLY","$357,913.50 ","$264,855.99 ","$0.00 ","$66,076.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66,076.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64,482.16 ","$66,076.66 ","$0.00 "
"MS233","DRG","MS233","","CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC","INPATIENT ONLY","$709,784.74 ","$525,240.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS234","DRG","MS234","","CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC","INPATIENT ONLY","$480,271.74 ","$355,401.09 ","$0.00 ","$55,662.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55,662.39 ","$0.00 ","$0.00 "
"MS235","DRG","MS235","","CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC","INPATIENT ONLY","$433,659.48 ","$320,908.02 ","$0.00 ","$82,191.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,536.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82,191.24 ","$44,320.66 ","$0.00 "
"MS236","DRG","MS236","","CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC","INPATIENT ONLY","$407,163.36 ","$301,300.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS239","DRG","MS239","","AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC","INPATIENT ONLY","$309,142.02 ","$228,765.09 ","$0.00 ","$520,828.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$394,567.12 ","$45,984.42 ","$427,447.72 ","$520,828.58 ","$0.00 ","$126,573.84 ","$0.00 ","$51,280.25 ","$43,794.69 ","$0.00 "
"MS240","DRG","MS240","","AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC","INPATIENT ONLY","$156,536.31 ","$115,836.87 ","$0.00 ","$35,684.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,140.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,684.78 ","$32,140.33 ","$0.00 "
"MS241","DRG","MS241","","AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC","INPATIENT ONLY","$120,662.24 ","$89,290.06 ","$0.00 ","$25,528.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,528.14 ","$0.00 ","$0.00 "
"MS242","DRG","MS242","","PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC","INPATIENT ONLY","$265,067.17 ","$196,149.71 ","$0.00 ","$43,451.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43,451.88 ","$0.00 ","$0.00 "
"MS243","DRG","MS243","","PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC","INPATIENT ONLY","$158,068.54 ","$116,970.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS244","DRG","MS244","","PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC","INPATIENT ONLY","$95,847.00 ","$70,926.78 ","$0.00 ","$30,094.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,985.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,094.00 ","$26,652.72 ","$0.00 "
"MS245","DRG","MS245","","AICD GENERATOR PROCEDURES","INPATIENT ONLY","$152,256.14 ","$112,669.54 ","$0.00 ","$49,391.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49,391.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47,039.42 ","$0.00 "
"MS246","DRG","MS246","","PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS","INPATIENT ONLY","$209,787.55 ","$155,242.79 ","$0.00 ","$81,055.22 ","$24,732.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61,405.47 ","$35,484.73 ","$17,653.94 ","$81,055.22 ","$0.00 ","$31,805.11 ","$0.00 ","$39,055.90 ","$33,794.98 ","$0.00 "
"MS247","DRG","MS247","","PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC","INPATIENT ONLY","$113,312.93 ","$83,851.57 ","$0.00 ","$74,539.79 ","$15,580.11 ","$0.00 ","$0.00 ","$5,277.93 ","$5,277.93 ","$0.00 ","$27,977.13 ","$27,707.22 ","$30,001.65 ","$74,539.79 ","$58,858.96 ","$20,396.45 ","$0.00 ","$29,761.63 ","$26,387.83 ","$0.00 "
"MS248","DRG","MS248","","PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS","INPATIENT ONLY","$176,079.18 ","$130,298.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS249","DRG","MS249","","PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC","INPATIENT ONLY","$68,186.12 ","$50,457.73 ","$0.00 ","$26,900.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,900.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,619.19 ","$0.00 "
"MS250","DRG","MS250","","PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC","INPATIENT ONLY","$159,798.37 ","$118,250.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS251","DRG","MS251","","PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC","INPATIENT ONLY","$72,880.41 ","$53,931.50 ","$0.00 ","$14,894.34 ","$0.00 ","$0.00 ","$14,894.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS252","DRG","MS252","","OTHER VASCULAR PROCEDURES WITH MCC","INPATIENT ONLY","$145,151.23 ","$107,411.91 ","$0.00 ","$100,414.90 ","$12,259.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,220.00 ","$0.00 ","$0.00 ","$100,414.90 ","$0.00 ","$0.00 ","$39,934.57 ","$34,495.24 ","$0.00 "
"MS253","DRG","MS253","","OTHER VASCULAR PROCEDURES WITH CC","INPATIENT ONLY","$129,099.23 ","$95,533.43 ","$0.00 ","$34,432.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,615.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34,432.01 ","$30,109.93 ","$0.00 "
"MS254","DRG","MS254","","OTHER VASCULAR PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$209,675.21 ","$155,159.66 ","$0.00 ","$26,240.69 ","$7,561.44 ","$15,445.08 ","$0.00 ","$0.00 ","$0.00 ","$17,984.48 ","$0.00 ","$26,240.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,128.08 ","$0.00 ","$24,991.13 ","$17,984.48 "
"MS255","DRG","MS255","","UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC","INPATIENT ONLY","$101,664.29 ","$75,231.57 ","$0.00 ","$85,925.68 ","$85,925.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,909.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,389.81 ","$0.00 "
"MS256","DRG","MS256","","UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC","INPATIENT ONLY","$55,860.77 ","$41,336.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS258","DRG","MS258","","CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC","INPATIENT ONLY","$237,539.00 ","$175,778.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS259","DRG","MS259","","CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC","INPATIENT ONLY","$113,151.42 ","$83,732.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS260","DRG","MS260","","CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC","INPATIENT ONLY","$163,381.24 ","$120,902.12 ","$0.00 ","$43,357.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43,357.97 ","$0.00 ","$0.00 "
"MS261","DRG","MS261","","CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC","INPATIENT ONLY","$51,477.15 ","$38,093.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS262","DRG","MS262","","CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC","INPATIENT ONLY","$57,243.02 ","$42,359.83 ","$0.00 ","$10,687.26 ","$0.00 ","$0.00 ","$0.00 ","$10,273.86 ","$10,687.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS264","DRG","MS264","","OTHER CIRCULATORY SYSTEM O.R. PROCEDURES","INPATIENT ONLY","$0.00 ","$0.00 ","$0.00 ","$39,670.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,999.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,670.80 ","$34,285.03 ","$0.00 "
"MS265","DRG","MS265","","AICD LEAD PROCEDURES","INPATIENT ONLY","$281,375.98 ","$208,218.23 ","$0.00 ","$35,132.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,132.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33,459.78 ","$0.00 "
"MS269","DRG","MS269","","AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC","INPATIENT ONLY","$295,971.85 ","$219,019.17 ","$0.00 ","$42,958.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42,958.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40,912.47 ","$0.00 "
"MS270","DRG","MS270","","OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC","INPATIENT ONLY","$509,550.86 ","$377,067.64 ","$0.00 ","$340,524.80 ","$340,524.80 ","$0.00 ","$0.00 ","$117,429.85 ","$118,256.65 ","$0.00 ","$148,491.41 ","$48,724.42 ","$160,865.70 ","$196,008.66 ","$0.00 ","$51,226.20 ","$0.00 ","$54,877.59 ","$46,404.21 ","$0.00 "
"MS271","DRG","MS271","","OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC","INPATIENT ONLY","$275,679.20 ","$204,002.61 ","$0.00 ","$185,320.36 ","$185,320.36 ","$185,320.36 ","$5,081.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38,048.73 ","$0.00 ","$0.00 ","$161,466.25 ","$0.00 ","$0.00 ","$42,119.94 ","$36,236.89 ","$0.00 "
"MS272","DRG","MS272","","OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$163,285.34 ","$120,831.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS273","DRG","MS273","","PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC","INPATIENT ONLY","$346,813.41 ","$256,641.92 ","$0.00 ","$91,804.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69,549.02 ","$39,157.85 ","$44,119.66 ","$91,804.70 ","$0.00 ","$37,193.18 ","$0.00 ","$43,445.35 ","$37,293.19 ","$0.00 "
"MS274","DRG","MS274","","PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC","INPATIENT ONLY","$132,117.47 ","$97,766.93 ","$0.00 ","$35,395.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,395.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33,710.36 ","$0.00 "
"MS280","DRG","MS280","","ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC","INPATIENT ONLY","$61,063.46 ","$45,186.96 ","$0.00 ","$306,336.59 ","$306,336.59 ","$0.00 ","$0.00 ","$16,869.12 ","$17,441.64 ","$0.00 ","$22,424.88 ","$24,947.74 ","$17,813.05 ","$20,968.38 ","$0.00 ","$16,348.64 ","$0.00 ","$32,089.26 ","$23,759.75 ","$0.00 "
"MS281","DRG","MS281","","ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC","INPATIENT ONLY","$26,455.86 ","$19,577.34 ","$0.00 ","$42,566.21 ","$12,468.89 ","$9,146.20 ","$0.00 ","$19,680.64 ","$20,348.58 ","$0.00 ","$13,319.63 ","$20,422.44 ","$13,390.76 ","$42,566.21 ","$0.00 ","$9,710.54 ","$0.00 ","$21,056.17 ","$19,449.94 ","$0.00 "
"MS282","DRG","MS282","","ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC","INPATIENT ONLY","$93,190.71 ","$68,961.13 ","$0.00 ","$19,171.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,845.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,171.35 ","$17,947.82 ","$0.00 "
"MS283","DRG","MS283","","ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC","INPATIENT ONLY","$189,098.49 ","$139,932.88 ","$0.00 ","$96,797.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73,331.75 ","$28,357.09 ","$11,537.64 ","$96,797.90 ","$0.00 ","$18,040.74 ","$0.00 ","$27,842.50 ","$27,006.75 ","$0.00 "
"MS286","DRG","MS286","","CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC","INPATIENT ONLY","$170,797.89 ","$126,390.44 ","$0.00 ","$145,102.74 ","$145,102.74 ","$34,337.57 ","$0.00 ","$16,121.88 ","$18,602.28 ","$0.00 ","$0.00 ","$28,819.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,090.31 ","$27,446.73 ","$0.00 "
"MS287","DRG","MS287","","CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC","INPATIENT ONLY","$67,028.40 ","$49,601.02 ","$0.00 ","$29,646.46 ","$0.00 ","$0.00 ","$0.00 ","$11,246.08 ","$11,627.76 ","$0.00 ","$15,842.75 ","$21,676.42 ","$5,663.06 ","$29,646.46 ","$0.00 ","$11,550.01 ","$0.00 ","$22,554.71 ","$20,644.21 ","$0.00 "
"MS288","DRG","MS288","","ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC","INPATIENT ONLY","$106,406.72 ","$78,740.97 ","$0.00 ","$34,846.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34,846.87 ","$0.00 ","$0.00 "
"MS291","DRG","MS291","","HEART FAILURE AND SHOCK WITH MCC","INPATIENT ONLY","$40,413.15 ","$29,905.73 ","$0.00 ","$59,590.83 ","$19,939.50 ","$13,475.17 ","$13,083.40 ","$10,976.02 ","$10,976.02 ","$13,148.68 ","$18,504.75 ","$21,904.23 ","$19,843.82 ","$59,590.83 ","$0.00 ","$13,490.72 ","$12,522.56 ","$24,135.73 ","$21,904.23 ","$13,148.68 "
"MS292","DRG","MS292","","HEART FAILURE AND SHOCK WITH CC","INPATIENT ONLY","$31,089.32 ","$23,006.10 ","$0.00 ","$25,542.17 ","$16,088.88 ","$8,768.64 ","$0.00 ","$15,816.70 ","$15,816.70 ","$0.00 ","$12,450.63 ","$19,990.54 ","$3,423.49 ","$22,244.34 ","$25,542.17 ","$9,077.01 ","$0.00 ","$20,540.04 ","$19,038.61 ","$0.00 "
"MS293","DRG","MS293","","HEART FAILURE AND SHOCK WITHOUT CC/MCC","INPATIENT ONLY","$25,091.99 ","$18,568.07 ","$0.00 ","$19,670.90 ","$15,852.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,280.74 ","$0.00 ","$0.00 ","$19,670.90 ","$0.00 ","$0.00 ","$18,496.80 ","$17,410.23 ","$0.00 "
"MS294","DRG","MS294","","DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC","INPATIENT ONLY","$51,250.50 ","$37,925.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS296","DRG","MS296","","CARDIAC ARREST, UNEXPLAINED WITH MCC","INPATIENT ONLY","$60,132.19 ","$44,497.82 ","$0.00 ","$55,644.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,534.30 ","$0.00 ","$0.00 ","$55,644.87 ","$0.00 ","$0.00 ","$0.00 ","$23,366.00 ","$0.00 "
"MS299","DRG","MS299","","PERIPHERAL VASCULAR DISORDERS WITH MCC","INPATIENT ONLY","$61,640.61 ","$45,614.05 ","$0.00 ","$24,984.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,709.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,984.23 ","$22,580.44 ","$0.00 "
"MS300","DRG","MS300","","PERIPHERAL VASCULAR DISORDERS WITH CC","INPATIENT ONLY","$33,127.53 ","$24,514.37 ","$0.00 ","$48,648.19 ","$48,648.19 ","$8,720.44 ","$0.00 ","$2,686.98 ","$3,100.38 ","$9,821.82 ","$0.00 ","$20,824.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,354.11 ","$21,537.17 ","$19,833.27 ","$9,821.82 "
"MS301","DRG","MS301","","PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$26,808.70 ","$19,838.44 ","$0.00 ","$18,762.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,762.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,869.07 ","$0.00 "
"MS302","DRG","MS302","","ATHEROSCLEROSIS WITH MCC","INPATIENT ONLY","$27,989.74 ","$20,712.41 ","$0.00 ","$22,147.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,147.21 ","$0.00 ","$0.00 "
"MS303","DRG","MS303","","ATHEROSCLEROSIS WITHOUT MCC","INPATIENT ONLY","$9,872.00 ","$7,305.28 ","$0.00 ","$18,663.40 ","$8,245.79 ","$5,445.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,420.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,663.40 ","$17,543.00 ","$0.00 "
"MS304","DRG","MS304","","HYPERTENSION WITH MCC","INPATIENT ONLY","$53,951.20 ","$39,923.89 ","$0.00 ","$22,059.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,261.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,059.01 ","$20,249.16 ","$0.00 "
"MS305","DRG","MS305","","HYPERTENSION WITHOUT MCC","INPATIENT ONLY","$25,501.90 ","$18,871.41 ","$0.00 ","$19,723.81 ","$16,899.41 ","$5,598.22 ","$0.00 ","$8,060.94 ","$9,301.14 ","$0.00 ","$10,058.13 ","$12,322.90 ","$3,994.80 ","$19,723.81 ","$0.00 ","$7,332.77 ","$0.00 ","$19,119.10 ","$12,322.90 ","$0.00 "
"MS306","DRG","MS306","","CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC","INPATIENT ONLY","$21,558.58 ","$15,953.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS307","DRG","MS307","","CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC","INPATIENT ONLY","$33,309.85 ","$24,649.29 ","$0.00 ","$20,349.78 ","$4,312.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,349.78 ","$0.00 ","$0.00 "
"MS308","DRG","MS308","","CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC","INPATIENT ONLY","$49,289.07 ","$36,473.91 ","$0.00 ","$22,844.63 ","$4,086.60 ","$0.00 ","$0.00 ","$5,623.04 ","$5,813.88 ","$0.00 ","$20,330.88 ","$21,919.03 ","$3,891.70 ","$14,418.05 ","$0.00 ","$11,905.86 ","$0.00 ","$22,844.63 ","$20,875.27 ","$0.00 "
"MS309","DRG","MS309","","CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC","INPATIENT ONLY","$32,971.70 ","$24,399.06 ","$0.00 ","$19,321.62 ","$0.00 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$0.00 ","$0.00 ","$18,970.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,321.62 ","$18,067.58 ","$0.00 "
"MS310","DRG","MS310","","CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$26,112.51 ","$19,323.26 ","$0.00 ","$22,828.20 ","$4,086.60 ","$4,902.90 ","$5,253.92 ","$0.00 ","$0.00 ","$3,409.57 ","$7,690.38 ","$17,624.69 ","$3,748.58 ","$22,828.20 ","$0.00 ","$5,606.59 ","$3,051.09 ","$17,712.81 ","$16,785.42 ","$3,247.21 "
"MS311","DRG","MS311","","ANGINA PECTORIS","INPATIENT ONLY","$52,330.57 ","$38,724.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS312","DRG","MS312","","SYNCOPE AND COLLAPSE","INPATIENT ONLY","$61,214.52 ","$45,298.74 ","$0.00 ","$21,765.49 ","$8,863.70 ","$0.00 ","$0.00 ","$6,787.90 ","$6,787.90 ","$7,256.54 ","$0.00 ","$19,383.03 ","$0.00 ","$0.00 ","$21,765.49 ","$0.00 ","$6,911.00 ","$19,814.06 ","$18,460.03 ","$7,256.54 "
"MS313","DRG","MS313","","CHEST PAIN","INPATIENT ONLY","$33,212.42 ","$24,577.19 ","$0.00 ","$18,986.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,707.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,986.78 ","$17,816.56 ","$0.00 "
"MS314","DRG","MS314","","OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC","INPATIENT ONLY","$76,851.46 ","$56,870.08 ","$0.00 ","$90,518.61 ","$0.00 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$68,574.70 ","$27,671.68 ","$27,623.06 ","$90,518.61 ","$0.00 ","$20,344.32 ","$0.00 ","$29,719.16 ","$26,353.98 ","$0.00 "
"MS315","DRG","MS315","","OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC","INPATIENT ONLY","$25,527.92 ","$18,890.66 ","$0.00 ","$54,485.36 ","$54,485.36 ","$8,580.30 ","$0.00 ","$0.00 ","$0.00 ","$10,816.43 ","$0.00 ","$20,434.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,679.17 ","$21,070.06 ","$19,461.01 ","$10,301.36 "
"MS316","DRG","MS316","","OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$10,452.75 ","$7,735.04 ","$0.00 ","$56,774.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,205.25 ","$0.00 ","$10,943.74 ","$56,774.44 ","$0.00 ","$7,440.03 ","$0.00 ","$19,206.47 ","$0.00 ","$0.00 "
"MS326","DRG","MS326","","STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC","INPATIENT ONLY","$251,818.24 ","$186,345.50 ","$0.00 ","$291,990.40 ","$291,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115,554.98 ","$49,819.86 ","$125,184.57 ","$152,532.58 ","$0.00 ","$52,833.10 ","$0.00 ","$74,365.49 ","$47,447.49 ","$0.00 "
"MS327","DRG","MS327","","STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC","INPATIENT ONLY","$345,047.66 ","$255,335.27 ","$0.00 ","$181,704.09 ","$181,704.09 ","$0.00 ","$0.00 ","$2,811.52 ","$2,906.94 ","$0.00 ","$0.00 ","$31,385.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34,156.81 ","$29,890.60 ","$0.00 "
"MS328","DRG","MS328","","STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$223,193.30 ","$165,163.04 ","$0.00 ","$94,605.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94,605.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS329","DRG","MS329","","MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC","INPATIENT ONLY","$274,008.89 ","$202,766.58 ","$0.00 ","$145,226.91 ","$136,237.60 ","$114,248.26 ","$46,129.16 ","$18,747.83 ","$19,988.03 ","$46,359.35 ","$110,020.39 ","$47,337.16 ","$119,188.76 ","$145,226.91 ","$0.00 ","$49,191.26 ","$44,151.78 ","$53,219.79 ","$45,083.01 ","$46,359.35 "
"MS330","DRG","MS330","","MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC","INPATIENT ONLY","$213,414.08 ","$157,926.42 ","$0.00 ","$229,756.74 ","$229,756.74 ","$0.00 ","$0.00 ","$107,244.69 ","$107,244.69 ","$0.00 ","$100,401.45 ","$31,070.11 ","$108,768.24 ","$132,529.93 ","$0.00 ","$25,329.40 ","$0.00 ","$33,780.33 ","$29,590.58 ","$0.00 "
"MS331","DRG","MS331","","MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$192,463.33 ","$142,422.86 ","$0.00 ","$148,688.87 ","$107,640.79 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$16,029.62 ","$112,643.08 ","$25,346.16 ","$122,030.00 ","$148,688.87 ","$0.00 ","$16,933.05 ","$15,266.31 ","$26,940.12 ","$24,139.20 ","$16,029.62 "
"MS332","DRG","MS332","","RECTAL RESECTION WITH MCC","INPATIENT ONLY","$887,584.06 ","$656,812.20 ","$0.00 ","$90,845.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90,845.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86,519.75 ","$0.00 "
"MS333","DRG","MS333","","RECTAL RESECTION WITH CC","INPATIENT ONLY","$620,492.87 ","$459,164.72 ","$0.00 ","$56,104.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56,104.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53,432.55 ","$0.00 "
"MS335","DRG","MS335","","PERITONEAL ADHESIOLYSIS WITH MCC","INPATIENT ONLY","$532,766.31 ","$394,247.07 ","$0.00 ","$110,895.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84,011.79 ","$0.00 ","$91,012.77 ","$110,895.56 ","$0.00 ","$40,549.32 ","$0.00 ","$46,179.48 ","$0.00 ","$0.00 "
"MS336","DRG","MS336","","PERITONEAL ADHESIOLYSIS WITH CC","INPATIENT ONLY","$219,777.95 ","$162,635.68 ","$0.00 ","$72,874.87 ","$0.00 ","$0.00 ","$0.00 ","$71,221.27 ","$72,874.87 ","$0.00 ","$0.00 ","$29,289.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,652.16 ","$27,894.51 ","$0.00 "
"MS337","DRG","MS337","","PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC","INPATIENT ONLY","$186,895.48 ","$138,302.66 ","$0.00 ","$43,588.46 ","$0.00 ","$0.00 ","$0.00 ","$41,934.86 ","$43,588.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS338","DRG","MS338","","APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC","INPATIENT ONLY","$181,523.85 ","$134,327.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS339","DRG","MS339","","APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC","INPATIENT ONLY","$125,577.54 ","$92,927.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS340","DRG","MS340","","APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","INPATIENT ONLY","$100,873.09 ","$74,646.09 ","$0.00 ","$86,067.33 ","$86,067.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS341","DRG","MS341","","APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC","INPATIENT ONLY","$126,465.33 ","$93,584.34 ","$0.00 ","$36,751.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,751.27 ","$0.00 "
"MS342","DRG","MS342","","APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC","INPATIENT ONLY","$99,896.38 ","$73,923.32 ","$0.00 ","$60,127.78 ","$4,542.21 ","$11,703.42 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$22,141.63 ","$0.00 ","$5,521.83 ","$60,127.78 ","$0.00 ","$16,142.14 ","$0.00 ","$26,295.79 ","$0.00 ","$0.00 "
"MS343","DRG","MS343","","APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","INPATIENT ONLY","$99,694.46 ","$73,773.90 ","$0.00 ","$70,753.35 ","$0.00 ","$0.00 ","$0.00 ","$9,441.14 ","$10,267.94 ","$0.00 ","$15,834.50 ","$0.00 ","$7,075.14 ","$70,753.35 ","$58,511.81 ","$11,543.98 ","$0.00 ","$22,549.80 ","$0.00 ","$0.00 "
"MS344","DRG","MS344","","MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC","INPATIENT ONLY","$63,631.33 ","$47,087.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS345","DRG","MS345","","MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC","INPATIENT ONLY","$164,994.22 ","$122,095.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS346","DRG","MS346","","MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$74,406.10 ","$55,060.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS347","DRG","MS347","","ANAL AND STOMAL PROCEDURES WITH MCC","INPATIENT ONLY","$26,552.02 ","$19,648.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS348","DRG","MS348","","ANAL AND STOMAL PROCEDURES WITH CC","INPATIENT ONLY","$83,349.83 ","$61,678.87 ","$0.00 ","$24,654.33 ","$0.00 ","$0.00 ","$16,830.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,433.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,654.33 ","$22,317.52 ","$0.00 "
"MS349","DRG","MS349","","ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$65,922.10 ","$48,782.35 ","$0.00 ","$40,375.68 ","$0.00 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$0.00 ","$13,487.38 ","$0.00 ","$6,026.40 ","$40,375.68 ","$0.00 ","$9,832.84 ","$0.00 ","$21,155.80 ","$0.00 ","$0.00 "
"MS350","DRG","MS350","","INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC","INPATIENT ONLY","$281,616.81 ","$208,396.44 ","$0.00 ","$30,472.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,472.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,021.10 ","$0.00 "
"MS351","DRG","MS351","","INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC","INPATIENT ONLY","$141,041.73 ","$104,370.88 ","$0.00 ","$114,048.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86,400.20 ","$0.00 ","$93,600.21 ","$114,048.28 ","$0.00 ","$14,618.44 ","$0.00 ","$25,054.47 ","$0.00 ","$0.00 "
"MS352","DRG","MS352","","INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$80,949.32 ","$59,902.50 ","$0.00 ","$120,426.90 ","$120,426.90 ","$0.00 ","$0.00 ","$4,400.68 ","$4,814.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,938.97 ","$0.00 ","$0.00 "
"MS353","DRG","MS353","","HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC","INPATIENT ONLY","$250,528.06 ","$185,390.76 ","$0.00 ","$77,604.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40,794.88 ","$34,077.63 ","$5,681.42 ","$77,604.07 ","$0.00 ","$29,741.12 ","$0.00 ","$37,374.40 ","$32,454.89 ","$0.00 "
"MS354","DRG","MS354","","HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC","INPATIENT ONLY","$283,035.02 ","$209,445.91 ","$0.00 ","$101,424.28 ","$101,424.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,208.78 ","$0.00 ","$0.00 "
"MS355","DRG","MS355","","HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC","INPATIENT ONLY","$131,335.21 ","$97,188.06 ","$0.00 ","$40,274.04 ","$0.00 ","$0.00 ","$0.00 ","$39,447.24 ","$40,274.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS356","DRG","MS356","","OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$231,882.30 ","$171,592.90 ","$0.00 ","$68,067.76 ","$0.00 ","$0.00 ","$0.00 ","$65,587.36 ","$68,067.76 ","$0.00 ","$0.00 ","$39,681.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,441.63 ","$39,681.10 ","$0.00 "
"MS357","DRG","MS357","","OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC","INPATIENT ONLY","$246,036.70 ","$182,067.16 ","$0.00 ","$27,791.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,791.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,791.66 ","$0.00 "
"MS358","DRG","MS358","","OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$305,696.80 ","$226,215.63 ","$0.00 ","$66,333.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,859.50 ","$0.00 ","$5,778.35 ","$66,333.91 ","$0.00 ","$13,749.33 ","$0.00 ","$24,346.43 ","$0.00 ","$0.00 "
"MS368","DRG","MS368","","MAJOR ESOPHAGEAL DISORDERS WITH MCC","INPATIENT ONLY","$44,626.39 ","$33,023.53 ","$0.00 ","$28,691.00 ","$17,417.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,174.50 ","$0.00 ","$4,678.10 ","$21,077.61 ","$0.00 ","$19,082.27 ","$0.00 ","$28,691.00 ","$0.00 ","$0.00 "
"MS369","DRG","MS369","","MAJOR ESOPHAGEAL DISORDERS WITH CC","INPATIENT ONLY","$33,210.98 ","$24,576.13 ","$0.00 ","$21,827.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,617.63 ","$0.00 ","$8,473.19 ","$17,181.21 ","$0.00 ","$10,656.83 ","$0.00 ","$21,827.08 ","$0.00 ","$0.00 "
"MS370","DRG","MS370","","MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$70,028.29 ","$51,820.93 ","$0.00 ","$9,760.80 ","$9,760.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS371","DRG","MS371","","MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC","INPATIENT ONLY","$90,719.83 ","$67,132.67 ","$0.00 ","$27,236.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,594.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,236.55 ","$24,375.45 ","$0.00 "
"MS372","DRG","MS372","","MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC","INPATIENT ONLY","$41,041.65 ","$30,370.82 ","$0.00 ","$21,495.52 ","$0.00 ","$0.00 ","$3,697.23 ","$16,122.38 ","$18,602.78 ","$0.00 ","$0.00 ","$20,790.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,495.52 ","$19,800.09 ","$0.00 "
"MS373","DRG","MS373","","MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC","INPATIENT ONLY","$25,826.81 ","$19,111.84 ","$0.00 ","$18,871.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,871.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,973.20 ","$0.00 "
"MS374","DRG","MS374","","DIGESTIVE MALIGNANCY WITH MCC","INPATIENT ONLY","$130,953.52 ","$96,905.60 ","$0.00 ","$103,204.32 ","$8,173.20 ","$0.00 ","$0.00 ","$10,502.56 ","$10,502.56 ","$0.00 ","$0.00 ","$27,453.01 ","$0.00 ","$0.00 ","$103,204.32 ","$0.00 ","$0.00 ","$25,228.00 ","$26,145.72 ","$0.00 "
"MS375","DRG","MS375","","DIGESTIVE MALIGNANCY WITH CC","INPATIENT ONLY","$43,263.16 ","$32,014.74 ","$0.00 ","$23,004.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,052.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,004.69 ","$21,002.83 ","$0.00 "
"MS376","DRG","MS376","","DIGESTIVE MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$50,921.70 ","$37,682.06 ","$0.00 ","$20,645.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,645.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,662.12 ","$0.00 "
"MS377","DRG","MS377","","GASTROINTESTINAL HEMORRHAGE WITH MCC","INPATIENT ONLY","$78,283.67 ","$57,929.92 ","$0.00 ","$56,749.25 ","$20,646.76 ","$0.00 ","$15,384.27 ","$9,562.04 ","$9,657.46 ","$0.00 ","$0.00 ","$25,897.63 ","$0.00 ","$0.00 ","$56,749.25 ","$0.00 ","$0.00 ","$27,599.14 ","$24,664.41 ","$0.00 "
"MS378","DRG","MS378","","GASTROINTESTINAL HEMORRHAGE WITH CC","INPATIENT ONLY","$34,470.23 ","$25,507.97 ","$0.00 ","$34,384.78 ","$17,023.65 ","$0.00 ","$0.00 ","$11,560.74 ","$12,482.96 ","$9,378.74 ","$13,586.38 ","$19,576.19 ","$14,569.53 ","$34,384.78 ","$0.00 ","$9,905.01 ","$8,932.14 ","$21,214.59 ","$19,576.19 ","$9,378.74 "
"MS379","DRG","MS379","","GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC","INPATIENT ONLY","$37,486.96 ","$27,740.35 ","$0.00 ","$18,418.41 ","$8,963.57 ","$6,048.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,215.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,418.41 ","$17,347.75 ","$0.00 "
"MS380","DRG","MS380","","COMPLICATED PEPTIC ULCER WITH MCC","INPATIENT ONLY","$26,794.24 ","$19,827.74 ","$0.00 ","$194,237.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147,149.99 ","$0.00 ","$159,412.49 ","$194,237.98 ","$0.00 ","$24,569.41 ","$0.00 ","$28,560.33 ","$0.00 ","$0.00 "
"MS381","DRG","MS381","","COMPLICATED PEPTIC ULCER WITH CC","INPATIENT ONLY","$46,100.59 ","$34,114.44 ","$0.00 ","$21,938.15 ","$8,173.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,160.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,938.15 ","$20,152.85 ","$0.00 "
"MS382","DRG","MS382","","COMPLICATED PEPTIC ULCER WITHOUT CC/MCC","INPATIENT ONLY","$31,452.30 ","$23,274.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS383","DRG","MS383","","UNCOMPLICATED PEPTIC ULCER WITH MCC","INPATIENT ONLY","$24,431.24 ","$18,079.12 ","$0.00 ","$23,976.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,976.51 ","$0.00 ","$0.00 "
"MS384","DRG","MS384","","UNCOMPLICATED PEPTIC ULCER WITHOUT MCC","INPATIENT ONLY","$33,274.53 ","$24,623.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS385","DRG","MS385","","INFLAMMATORY BOWEL DISEASE WITH MCC","INPATIENT ONLY","$67,760.04 ","$50,142.43 ","$0.00 ","$24,806.99 ","$0.00 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$0.00 ","$0.00 ","$24,806.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,625.70 ","$0.00 "
"MS386","DRG","MS386","","INFLAMMATORY BOWEL DISEASE WITH CC","INPATIENT ONLY","$56,023.07 ","$41,457.07 ","$0.00 ","$21,190.92 ","$20,433.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,535.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,190.92 ","$19,557.33 ","$0.00 "
"MS387","DRG","MS387","","INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC","INPATIENT ONLY","$23,208.03 ","$17,173.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS388","DRG","MS388","","GASTROINTESTINAL OBSTRUCTION WITH MCC","INPATIENT ONLY","$77,758.35 ","$57,541.18 ","$0.00 ","$25,918.43 ","$25,918.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,224.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,599.99 ","$23,071.18 ","$0.00 "
"MS389","DRG","MS389","","GASTROINTESTINAL OBSTRUCTION WITH CC","INPATIENT ONLY","$39,413.46 ","$29,165.96 ","$0.00 ","$31,553.56 ","$0.00 ","$0.00 ","$0.00 ","$28,246.36 ","$31,553.56 ","$0.00 ","$0.00 ","$19,540.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,002.70 ","$18,610.37 ","$0.00 "
"MS390","DRG","MS390","","GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC","INPATIENT ONLY","$29,912.81 ","$22,135.48 ","$0.00 ","$95,740.02 ","$95,740.02 ","$0.00 ","$5,565.81 ","$0.00 ","$0.00 ","$5,593.59 ","$0.00 ","$17,763.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,327.23 ","$0.00 ","$16,917.55 ","$5,593.59 "
"MS391","DRG","MS391","","ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC","INPATIENT ONLY","$41,863.55 ","$30,979.03 ","$0.00 ","$23,230.90 ","$0.00 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$16,981.25 ","$22,242.27 ","$7,432.68 ","$17,525.21 ","$0.00 ","$12,380.02 ","$0.00 ","$23,230.90 ","$21,183.11 ","$0.00 "
"MS392","DRG","MS392","","ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC","INPATIENT ONLY","$33,170.14 ","$24,545.90 ","$0.00 ","$41,242.74 ","$12,630.39 ","$0.00 ","$2,286.70 ","$2,686.98 ","$3,100.38 ","$4,472.47 ","$10,470.63 ","$19,006.49 ","$11,228.32 ","$41,242.74 ","$23,420.75 ","$7,633.51 ","$4,002.23 ","$19,364.08 ","$18,101.42 ","$4,259.49 "
"MS393","DRG","MS393","","OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC","INPATIENT ONLY","$50,282.24 ","$37,208.86 ","$0.00 ","$26,411.73 ","$16,829.88 ","$15,078.24 ","$0.00 ","$18,875.00 ","$19,701.80 ","$0.00 ","$0.00 ","$24,904.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,411.73 ","$23,718.10 ","$0.00 "
"MS394","DRG","MS394","","OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC","INPATIENT ONLY","$43,731.97 ","$32,361.66 ","$0.00 ","$21,956.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,859.66 ","$12,898.88 ","$20,213.34 ","$7,280.15 ","$21,956.06 ","$0.00 ","$9,403.81 ","$5,243.56 ","$20,806.29 ","$19,250.80 ","$5,580.62 "
"MS395","DRG","MS395","","OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$22,243.70 ","$16,460.34 ","$0.00 ","$24,982.77 ","$24,982.77 ","$5,867.77 ","$0.00 ","$2,686.98 ","$3,100.38 ","$4,987.03 ","$8,998.00 ","$0.00 ","$7,147.50 ","$12,116.27 ","$0.00 ","$6,559.90 ","$4,462.69 ","$18,489.46 ","$0.00 ","$4,749.55 "
"MS405","DRG","MS405","","PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC","INPATIENT ONLY","$200,263.23 ","$148,194.79 ","$0.00 ","$50,890.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50,890.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48,467.35 ","$0.00 "
"MS406","DRG","MS406","","PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC","INPATIENT ONLY","$83,962.91 ","$62,132.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS407","DRG","MS407","","PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$379,474.22 ","$280,810.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS408","DRG","MS408","","BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC","INPATIENT ONLY","$436,154.41 ","$322,754.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS410","DRG","MS410","","BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC","INPATIENT ONLY","$300,972.34 ","$222,719.53 ","$0.00 ","$201,119.77 ","$193,135.50 ","$49,341.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$152,363.46 ","$0.00 ","$165,060.42 ","$201,119.77 ","$0.00 ","$26,144.96 ","$0.00 ","$26,701.64 ","$0.00 ","$0.00 "
"MS414","DRG","MS414","","CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC","INPATIENT ONLY","$156,040.59 ","$115,470.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS415","DRG","MS415","","CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC","INPATIENT ONLY","$136,109.70 ","$100,721.18 ","$0.00 ","$120,290.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91,128.81 ","$0.00 ","$98,722.88 ","$120,290.03 ","$0.00 ","$20,566.86 ","$0.00 ","$29,900.46 ","$0.00 ","$0.00 "
"MS416","DRG","MS416","","CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC","INPATIENT ONLY","$292,085.37 ","$216,143.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS417","DRG","MS417","","LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC","INPATIENT ONLY","$137,676.65 ","$101,880.72 ","$0.00 ","$146,623.60 ","$0.00 ","$0.00 ","$21,096.73 ","$0.00 ","$0.00 ","$0.00 ","$111,078.49 ","$30,276.71 ","$120,335.03 ","$146,623.60 ","$0.00 ","$24,165.59 ","$0.00 ","$32,832.21 ","$28,834.96 ","$0.00 "
"MS418","DRG","MS418","","LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC","INPATIENT ONLY","$146,973.04 ","$108,760.05 ","$0.00 ","$84,039.69 ","$84,039.69 ","$0.00 ","$28,650.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,207.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,007.06 ","$0.00 "
"MS419","DRG","MS419","","LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC","INPATIENT ONLY","$132,793.00 ","$98,266.82 ","$0.00 ","$104,723.37 ","$91,322.65 ","$12,698.94 ","$10,708.77 ","$0.00 ","$0.00 ","$11,300.32 ","$79,335.88 ","$22,732.94 ","$85,947.21 ","$104,723.37 ","$67,774.35 ","$13,099.76 ","$10,762.21 ","$23,817.26 ","$21,650.42 ","$11,300.32 "
"MS420","DRG","MS420","","HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC","INPATIENT ONLY","$138,545.38 ","$102,523.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS423","DRG","MS423","","OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$287,776.74 ","$212,954.79 ","$0.00 ","$381,197.38 ","$0.00 ","$0.00 ","$0.00 ","$379,130.38 ","$381,197.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS432","DRG","MS432","","CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC","INPATIENT ONLY","$71,759.88 ","$53,102.31 ","$0.00 ","$28,036.05 ","$8,624.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,071.75 ","$26,263.25 ","$17,070.50 ","$27,475.36 ","$0.00 ","$18,278.31 ","$0.00 ","$28,036.05 ","$25,012.62 ","$0.00 "
"MS433","DRG","MS433","","CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC","INPATIENT ONLY","$45,714.27 ","$33,828.56 ","$0.00 ","$29,212.66 ","$4,086.60 ","$8,187.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,190.00 ","$20,855.02 ","$14,492.23 ","$29,212.66 ","$0.00 ","$10,345.09 ","$0.00 ","$21,573.12 ","$19,861.92 ","$0.00 "
"MS434","DRG","MS434","","CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC","INPATIENT ONLY","$20,195.51 ","$14,944.68 ","$0.00 ","$18,175.50 ","$4,086.60 ","$0.00 ","$6,206.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,175.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,310.00 ","$0.00 "
"MS435","DRG","MS435","","MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC","INPATIENT ONLY","$95,710.06 ","$70,825.44 ","$0.00 ","$27,004.64 ","$13,847.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,400.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,004.64 ","$24,190.62 ","$0.00 "
"MS436","DRG","MS436","","MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC","INPATIENT ONLY","$52,499.34 ","$38,849.51 ","$0.00 ","$21,514.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,514.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,489.83 ","$0.00 "
"MS437","DRG","MS437","","MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC","INPATIENT ONLY","$67,843.68 ","$50,204.32 ","$0.00 ","$19,475.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,475.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,475.99 ","$0.00 "
"MS438","DRG","MS438","","DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC","INPATIENT ONLY","$45,592.09 ","$33,738.15 ","$0.00 ","$26,524.44 ","$0.00 ","$0.00 ","$0.00 ","$10,747.92 ","$12,401.52 ","$0.00 ","$0.00 ","$24,998.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,524.44 ","$23,807.93 ","$0.00 "
"MS439","DRG","MS439","","DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC","INPATIENT ONLY","$35,242.46 ","$26,079.42 ","$0.00 ","$27,105.60 ","$27,105.60 ","$0.00 ","$8,501.51 ","$0.00 ","$0.00 ","$8,543.93 ","$11,649.00 ","$19,592.13 ","$3,287.36 ","$18,691.33 ","$0.00 ","$8,492.59 ","$8,137.08 ","$20,063.94 ","$18,659.17 ","$8,543.93 "
"MS440","DRG","MS440","","DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$36,890.80 ","$27,299.19 ","$0.00 ","$8,173.20 ","$8,173.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS441","DRG","MS441","","DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC","INPATIENT ONLY","$49,349.00 ","$36,518.26 ","$0.00 ","$26,532.44 ","$0.00 ","$0.00 ","$0.00 ","$10,747.92 ","$12,401.52 ","$0.00 ","$0.00 ","$26,532.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,575.49 ","$26,532.44 ","$0.00 "
"MS442","DRG","MS442","","DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC","INPATIENT ONLY","$39,164.06 ","$28,981.40 ","$0.00 ","$35,767.17 ","$16,346.40 ","$0.00 ","$0.00 ","$35,767.17 ","$35,767.17 ","$0.00 ","$0.00 ","$20,181.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,767.89 ","$19,220.20 ","$0.00 "
"MS443","DRG","MS443","","DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC","INPATIENT ONLY","$37,763.49 ","$27,944.98 ","$0.00 ","$38,930.80 ","$12,711.30 ","$5,812.44 ","$0.00 ","$0.00 ","$0.00 ","$6,477.83 ","$9,354.13 ","$0.00 ","$10,031.02 ","$38,930.80 ","$0.00 ","$6,819.53 ","$6,169.37 ","$18,700.96 ","$0.00 ","$6,477.83 "
"MS444","DRG","MS444","","DISORDERS OF THE BILIARY TRACT WITH MCC","INPATIENT ONLY","$40,567.37 ","$30,019.85 ","$0.00 ","$24,914.95 ","$16,346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,914.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,728.52 ","$0.00 "
"MS445","DRG","MS445","","DISORDERS OF THE BILIARY TRACT WITH CC","INPATIENT ONLY","$39,233.35 ","$29,032.68 ","$0.00 ","$21,920.18 ","$0.00 ","$0.00 ","$10,502.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,145.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,920.18 ","$20,138.52 ","$0.00 "
"MS446","DRG","MS446","","DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC","INPATIENT ONLY","$46,325.27 ","$34,280.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS453","DRG","MS453","","COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC","INPATIENT ONLY","$438,917.25 ","$324,798.77 ","$0.00 ","$215,352.80 ","$0.00 ","$0.00 ","$0.00 ","$215,352.80 ","$215,352.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS454","DRG","MS454","","COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC","INPATIENT ONLY","$407,718.97 ","$301,712.04 ","$0.00 ","$104,673.75 ","$0.00 ","$0.00 ","$104,673.75 ","$0.00 ","$0.00 ","$77,117.24 ","$0.00 ","$55,659.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63,264.79 ","$63,164.90 ","$53,008.86 ","$50,919.68 "
"MS455","DRG","MS455","","COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC","INPATIENT ONLY","$334,789.12 ","$247,743.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS456","DRG","MS456","","SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC","INPATIENT ONLY","$340,429.20 ","$251,917.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS457","DRG","MS457","","SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC","INPATIENT ONLY","$334,299.43 ","$247,381.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS459","DRG","MS459","","SPINAL FUSION EXCEPT CERVICAL WITH MCC","INPATIENT ONLY","$590,788.39 ","$437,183.41 ","$0.00 ","$294,344.86 ","$294,344.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160,054.37 ","$60,627.44 ","$173,392.23 ","$211,271.76 ","$0.00 ","$68,686.54 ","$0.00 ","$69,101.93 ","$57,740.42 ","$0.00 "
"MS460","DRG","MS460","","SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC","INPATIENT ONLY","$243,368.62 ","$180,092.78 ","$0.00 ","$169,581.78 ","$0.00 ","$0.00 ","$49,968.85 ","$169,581.78 ","$169,581.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS463","DRG","MS463","","WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC","INPATIENT ONLY","$340,239.14 ","$251,776.96 ","$0.00 ","$407,660.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308,834.05 ","$55,832.33 ","$334,570.22 ","$407,660.93 ","$0.00 ","$94,279.70 ","$0.00 ","$55,837.96 ","$53,173.65 ","$0.00 "
"MS464","DRG","MS464","","WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC","INPATIENT ONLY","$323,690.26 ","$239,530.79 ","$0.00 ","$146,335.63 ","$115,976.76 ","$0.00 ","$88,498.29 ","$0.00 ","$0.00 ","$28,628.74 ","$110,860.33 ","$0.00 ","$120,098.69 ","$146,335.63 ","$0.00 ","$29,598.76 ","$27,265.48 ","$37,258.44 ","$0.00 ","$28,628.74 "
"MS465","DRG","MS465","","WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$180,920.22 ","$133,880.96 ","$0.00 ","$101,350.92 ","$101,350.92 ","$23,618.90 ","$0.00 ","$0.00 ","$0.00 ","$13,952.11 ","$26,334.00 ","$0.00 ","$28,239.62 ","$77,963.23 ","$0.00 ","$19,198.54 ","$13,287.73 ","$28,785.73 ","$0.00 ","$13,952.11 "
"MS466","DRG","MS466","","REVISION OF HIP OR KNEE REPLACEMENT WITH MCC","INPATIENT ONLY","$222,148.64 ","$164,389.99 ","$0.00 ","$54,786.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54,786.94 ","$0.00 ","$0.00 "
"MS467","DRG","MS467","","REVISION OF HIP OR KNEE REPLACEMENT WITH CC","INPATIENT ONLY","$270,187.14 ","$199,938.48 ","$0.00 ","$41,826.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37,803.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41,826.76 ","$36,003.24 ","$0.00 "
"MS468","DRG","MS468","","REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC","INPATIENT ONLY","$240,260.62 ","$177,792.86 ","$0.00 ","$36,110.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,110.24 ","$0.00 ","$0.00 "
"MS469","DRG","MS469","","MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT","INPATIENT ONLY","$181,244.35 ","$134,120.82 ","$0.00 ","$165,554.86 ","$0.00 ","$0.00 ","$0.00 ","$163,074.46 ","$165,554.86 ","$0.00 ","$0.00 ","$35,259.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38,787.20 ","$33,580.84 ","$0.00 "
"MS470","DRG","MS470","","MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC","INPATIENT ONLY","$140,929.21 ","$104,287.62 ","$0.00 ","$90,107.90 ","$90,107.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,254.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,220.19 ","$25,956.32 ","$0.00 "
"MS471","DRG","MS471","","CERVICAL SPINAL FUSION WITH MCC","INPATIENT ONLY","$357,681.21 ","$264,684.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS472","DRG","MS472","","CERVICAL SPINAL FUSION WITH CC","INPATIENT ONLY","$261,184.95 ","$193,276.86 ","$0.00 ","$160,311.29 ","$0.00 ","$0.00 ","$97,395.39 ","$90,267.65 ","$90,267.65 ","$0.00 ","$121,447.94 ","$34,587.43 ","$131,568.61 ","$160,311.29 ","$0.00 ","$30,488.93 ","$0.00 ","$37,983.62 ","$32,940.41 ","$0.00 "
"MS473","DRG","MS473","","CERVICAL SPINAL FUSION WITHOUT CC/MCC","INPATIENT ONLY","$239,665.96 ","$177,352.81 ","$0.00 ","$99,766.44 ","$99,766.44 ","$0.00 ","$40,046.68 ","$73,815.33 ","$73,815.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS474","DRG","MS474","","AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC","INPATIENT ONLY","$201,974.02 ","$149,460.77 ","$0.00 ","$86,905.25 ","$0.00 ","$0.00 ","$0.00 ","$86,905.25 ","$86,905.25 ","$0.00 ","$0.00 ","$40,282.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38,364.46 ","$0.00 "
"MS475","DRG","MS475","","AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC","INPATIENT ONLY","$105,803.89 ","$78,294.88 ","$0.00 ","$326,501.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247,349.82 ","$28,160.30 ","$267,962.31 ","$326,501.77 ","$0.00 ","$64,048.46 ","$0.00 ","$30,303.06 ","$26,819.33 ","$0.00 "
"MS476","DRG","MS476","","AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$108,051.26 ","$79,957.93 ","$0.00 ","$9,120.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,120.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,685.83 ","$0.00 ","$0.00 ","$9,120.12 "
"MS477","DRG","MS477","","BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","INPATIENT ONLY","$61,538.76 ","$45,538.68 ","$0.00 ","$39,729.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,729.61 ","$0.00 ","$0.00 "
"MS478","DRG","MS478","","BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","INPATIENT ONLY","$39,367.17 ","$29,131.71 ","$0.00 ","$217,556.76 ","$217,556.76 ","$61,408.69 ","$0.00 ","$120,451.69 ","$121,691.89 ","$21,403.57 ","$0.00 ","$29,637.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,384.36 ","$32,067.82 ","$28,225.77 ","$21,403.57 "
"MS479","DRG","MS479","","BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","INPATIENT ONLY","$106,309.92 ","$78,669.34 ","$0.00 ","$71,699.35 ","$0.00 ","$15,452.22 ","$15,243.66 ","$0.00 ","$0.00 ","$0.00 ","$24,503.88 ","$0.00 ","$18,769.33 ","$71,699.35 ","$0.00 ","$17,864.32 ","$0.00 ","$27,698.78 ","$0.00 ","$0.00 "
"MS480","DRG","MS480","","HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC","INPATIENT ONLY","$243,911.55 ","$180,494.55 ","$0.00 ","$155,993.30 ","$155,993.30 ","$0.00 ","$68,695.36 ","$78,713.33 ","$79,540.13 ","$0.00 ","$108,852.10 ","$34,430.27 ","$117,923.11 ","$143,684.76 ","$0.00 ","$30,258.36 ","$0.00 ","$37,795.79 ","$32,790.73 ","$0.00 "
"MS481","DRG","MS481","","HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC","INPATIENT ONLY","$187,285.44 ","$138,591.23 ","$0.00 ","$103,487.69 ","$103,487.69 ","$0.00 ","$34,406.15 ","$50,746.67 ","$51,986.87 ","$20,409.50 ","$28,707.25 ","$28,070.09 ","$19,240.38 ","$68,283.40 ","$91,568.13 ","$20,928.74 ","$16,097.59 ","$30,195.26 ","$26,733.42 ","$16,920.75 "
"MS482","DRG","MS482","","HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC","INPATIENT ONLY","$152,211.21 ","$112,636.30 ","$0.00 ","$106,385.28 ","$106,385.28 ","$94,795.46 ","$28,317.96 ","$0.00 ","$0.00 ","$15,767.20 ","$62,356.82 ","$25,046.15 ","$20,216.62 ","$82,311.01 ","$82,947.32 ","$16,492.99 ","$15,016.39 ","$26,581.60 ","$23,853.48 ","$15,767.20 "
"MS483","DRG","MS483","","MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES","INPATIENT ONLY","$217,236.63 ","$160,755.11 ","$0.00 ","$32,680.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,149.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,680.33 ","$28,713.91 ","$0.00 "
"MS485","DRG","MS485","","KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC","INPATIENT ONLY","$181,169.09 ","$134,065.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS486","DRG","MS486","","KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC","INPATIENT ONLY","$132,640.30 ","$98,153.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS487","DRG","MS487","","KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC","INPATIENT ONLY","$66,172.30 ","$48,967.50 ","$0.00 ","$24,785.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,785.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,605.52 ","$0.00 "
"MS488","DRG","MS488","","KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC","INPATIENT ONLY","$194,584.23 ","$143,992.33 ","$0.00 ","$263,384.75 ","$137,696.34 ","$0.00 ","$31,065.50 ","$11,740.43 ","$12,567.23 ","$14,369.52 ","$125,430.67 ","$27,259.61 ","$135,883.23 ","$165,568.51 ","$263,384.75 ","$19,739.85 ","$13,685.26 ","$29,226.72 ","$25,961.53 ","$14,369.52 "
"MS489","DRG","MS489","","KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC","INPATIENT ONLY","$85,707.36 ","$63,423.45 ","$0.00 ","$242,647.77 ","$199,162.73 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$93,585.19 ","$22,406.27 ","$101,383.95 ","$123,532.45 ","$242,647.77 ","$12,620.61 ","$0.00 ","$23,426.88 ","$21,339.30 ","$0.00 "
"MS492","DRG","MS492","","LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC","INPATIENT ONLY","$180,446.20 ","$133,530.19 ","$0.00 ","$167,518.79 ","$137,567.97 ","$0.00 ","$28,627.59 ","$75,969.03 ","$76,795.83 ","$0.00 ","$126,908.17 ","$37,346.90 ","$137,483.85 ","$167,518.79 ","$97,394.98 ","$42,010.85 ","$0.00 ","$41,281.24 ","$35,568.48 ","$0.00 "
"MS493","DRG","MS493","","LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC","INPATIENT ONLY","$173,538.94 ","$128,418.82 ","$4,787.73 ","$118,634.14 ","$118,634.14 ","$30,494.41 ","$20,250.93 ","$4,787.73 ","$5,201.13 ","$13,089.73 ","$82,516.28 ","$28,127.50 ","$89,392.64 ","$108,921.50 ","$67,758.80 ","$23,075.96 ","$12,466.42 ","$31,944.52 ","$28,127.50 ","$13,089.73 "
"MS494","DRG","MS494","","LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC","INPATIENT ONLY","$138,260.52 ","$102,312.78 ","$8,346.59 ","$95,441.38 ","$26,344.79 ","$13,742.95 ","$16,007.13 ","$37,586.24 ","$39,653.24 ","$13,089.73 ","$24,906.75 ","$26,181.24 ","$8,346.59 ","$77,751.89 ","$95,441.38 ","$18,158.03 ","$12,466.42 ","$27,938.05 ","$24,934.51 ","$13,089.73 "
"MS495","DRG","MS495","","LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC","INPATIENT ONLY","$91,782.64 ","$67,919.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS496","DRG","MS496","","LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC","INPATIENT ONLY","$169,241.03 ","$125,238.36 ","$0.00 ","$29,808.99 ","$19,806.91 ","$0.00 ","$0.00 ","$21,164.34 ","$23,644.74 ","$13,676.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,025.13 ","$29,808.99 ","$0.00 ","$13,676.38 "
"MS497","DRG","MS497","","LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC","INPATIENT ONLY","$75,872.17 ","$56,145.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS498","DRG","MS498","","LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC","INPATIENT ONLY","$117,318.76 ","$86,815.88 ","$0.00 ","$146,260.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110,803.75 ","$30,532.28 ","$120,037.39 ","$146,260.94 ","$0.00 ","$24,540.49 ","$0.00 ","$33,137.63 ","$29,078.36 ","$0.00 "
"MS499","DRG","MS499","","LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC","INPATIENT ONLY","$81,325.84 ","$60,181.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS500","DRG","MS500","","SOFT TISSUE PROCEDURES WITH MCC","INPATIENT ONLY","$578,168.03 ","$427,844.34 ","$0.00 ","$102,731.36 ","$102,731.36 ","$0.00 ","$0.00 ","$49,944.68 ","$50,771.48 ","$0.00 ","$80,884.60 ","$0.00 ","$80,884.60 ","$80,884.60 ","$0.00 ","$80,884.60 ","$0.00 ","$37,768.84 ","$0.00 ","$0.00 "
"MS501","DRG","MS501","","SOFT TISSUE PROCEDURES WITH CC","INPATIENT ONLY","$72,783.50 ","$53,859.79 ","$0.00 ","$116,069.81 ","$4,437.05 ","$0.00 ","$0.00 ","$20,127.55 ","$21,463.17 ","$0.00 ","$87,931.67 ","$25,269.62 ","$95,259.31 ","$116,069.81 ","$62,879.13 ","$16,820.79 ","$0.00 ","$26,848.64 ","$24,066.30 ","$0.00 "
"MS502","DRG","MS502","","SOFT TISSUE PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$101,560.84 ","$75,155.02 ","$0.00 ","$164,767.02 ","$98,313.18 ","$0.00 ","$0.00 ","$10,747.92 ","$12,401.52 ","$0.00 ","$124,823.50 ","$22,827.91 ","$135,225.45 ","$164,767.02 ","$0.00 ","$14,731.48 ","$0.00 ","$23,930.76 ","$21,740.87 ","$0.00 "
"MS503","DRG","MS503","","FOOT PROCEDURES WITH MCC","INPATIENT ONLY","$73,724.81 ","$54,556.36 ","$0.00 ","$187,255.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187,255.41 ","$32,367.16 ","$187,255.41 ","$148,306.29 ","$0.00 ","$187,255.41 ","$0.00 ","$35,330.35 ","$30,825.87 ","$0.00 "
"MS504","DRG","MS504","","FOOT PROCEDURES WITH CC","INPATIENT ONLY","$113,617.68 ","$84,077.08 ","$0.00 ","$142,601.36 ","$142,601.36 ","$33,045.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87,686.05 ","$0.00 ","$94,993.22 ","$115,745.60 ","$0.00 ","$17,407.21 ","$0.00 ","$27,326.39 ","$0.00 ","$0.00 "
"MS505","DRG","MS505","","FOOT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$141,271.98 ","$104,541.27 ","$0.00 ","$133,223.81 ","$14,075.15 ","$0.00 ","$0.00 ","$954.94 ","$954.94 ","$0.00 ","$100,927.12 ","$0.00 ","$109,337.71 ","$133,223.81 ","$0.00 ","$16,855.87 ","$0.00 ","$26,878.91 ","$0.00 ","$0.00 "
"MS506","DRG","MS506","","MAJOR THUMB OR JOINT PROCEDURES","INPATIENT ONLY","$77,651.23 ","$57,461.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS507","DRG","MS507","","MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC","INPATIENT ONLY","$147,482.67 ","$109,137.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS508","DRG","MS508","","MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$152,347.28 ","$112,736.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS510","DRG","MS510","","SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC","INPATIENT ONLY","$272,856.35 ","$201,913.70 ","$0.00 ","$179,649.18 ","$0.00 ","$0.00 ","$0.00 ","$70,509.31 ","$71,336.11 ","$0.00 ","$136,097.86 ","$0.00 ","$147,439.34 ","$179,649.18 ","$0.00 ","$27,947.77 ","$0.00 ","$35,913.41 ","$0.00 ","$0.00 "
"MS511","DRG","MS511","","SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC","INPATIENT ONLY","$155,199.53 ","$114,847.65 ","$0.00 ","$119,097.38 ","$119,097.38 ","$0.00 ","$0.00 ","$25,351.72 ","$26,178.52 ","$14,912.43 ","$76,929.96 ","$26,678.75 ","$83,340.79 ","$101,547.55 ","$0.00 ","$18,887.80 ","$14,202.32 ","$28,532.58 ","$25,408.33 ","$14,912.43 "
"MS512","DRG","MS512","","SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$130,533.10 ","$96,594.49 ","$0.00 ","$69,039.85 ","$4,526.08 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$9,824.67 ","$20,814.75 ","$0.00 ","$8,928.39 ","$69,039.85 ","$47,895.51 ","$15,174.79 ","$9,356.83 ","$25,507.72 ","$0.00 ","$9,824.67 "
"MS513","DRG","MS513","","HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC","INPATIENT ONLY","$82,233.47 ","$60,852.77 ","$0.00 ","$95,133.80 ","$0.00 ","$0.00 ","$0.00 ","$39,948.95 ","$41,602.55 ","$0.00 ","$21,685.13 ","$0.00 ","$8,775.22 ","$34,223.36 ","$95,133.80 ","$15,809.32 ","$0.00 ","$26,024.64 ","$0.00 ","$0.00 "
"MS514","DRG","MS514","","HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$65,501.95 ","$48,471.44 ","$0.00 ","$38,957.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,668.50 ","$21,109.64 ","$5,825.91 ","$38,957.44 ","$0.00 ","$10,693.93 ","$0.00 ","$21,857.31 ","$20,104.47 ","$0.00 "
"MS515","DRG","MS515","","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$247,874.96 ","$183,427.47 ","$0.00 ","$265,646.77 ","$265,646.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158,611.27 ","$35,356.23 ","$171,828.87 ","$209,366.89 ","$0.00 ","$31,616.65 ","$0.00 ","$38,902.35 ","$33,672.60 ","$0.00 "
"MS516","DRG","MS516","","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC","INPATIENT ONLY","$202,001.98 ","$149,481.47 ","$0.00 ","$192,718.78 ","$6,477.57 ","$18,238.84 ","$59,746.59 ","$0.00 ","$0.00 ","$0.00 ","$26,662.63 ","$27,053.91 ","$6,215.66 ","$41,578.09 ","$192,718.78 ","$19,438.14 ","$0.00 ","$28,980.91 ","$25,765.63 ","$0.00 "
"MS517","DRG","MS517","","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$105,666.11 ","$78,192.92 ","$0.00 ","$260,109.45 ","$260,109.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93,200.66 ","$0.00 ","$100,967.39 ","$123,024.86 ","$194,960.94 ","$14,187.39 ","$0.00 ","$24,703.31 ","$0.00 ","$0.00 "
"MS518","DRG","MS518","","BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR","INPATIENT ONLY","$305,899.54 ","$226,365.66 ","$0.00 ","$35,329.63 ","$0.00 ","$0.00 ","$34,583.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,329.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,329.63 ","$0.00 "
"MS519","DRG","MS519","","BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC","INPATIENT ONLY","$247,143.59 ","$182,886.26 ","$0.00 ","$259,633.24 ","$259,633.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111,039.92 ","$0.00 ","$120,293.25 ","$146,572.73 ","$101,333.30 ","$19,133.38 ","$0.00 ","$28,732.65 ","$0.00 ","$0.00 "
"MS520","DRG","MS520","","BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC","INPATIENT ONLY","$263,064.66 ","$194,667.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS522","DRG","MS522","","HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC","INPATIENT ONLY","$164,480.28 ","$121,715.41 ","$0.00 ","$110,446.07 ","$110,446.07 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS533","DRG","MS533","","FRACTURES OF FEMUR WITH MCC","INPATIENT ONLY","$19,588.32 ","$14,495.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS534","DRG","MS534","","FRACTURES OF FEMUR WITHOUT MCC","INPATIENT ONLY","$31,460.66 ","$23,280.89 ","$0.00 ","$19,117.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,117.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,207.50 ","$0.00 "
"MS535","DRG","MS535","","FRACTURES OF HIP AND PELVIS WITH MCC","INPATIENT ONLY","$54,105.68 ","$40,038.20 ","$0.00 ","$55,410.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,872.63 ","$22,188.27 ","$45,475.45 ","$55,410.08 ","$0.00 ","$12,300.82 ","$0.00 ","$23,166.38 ","$21,131.69 ","$0.00 "
"MS536","DRG","MS536","","FRACTURES OF HIP AND PELVIS WITHOUT MCC","INPATIENT ONLY","$55,004.91 ","$40,703.63 ","$0.00 ","$51,105.97 ","$10,159.55 ","$0.00 ","$0.00 ","$18,103.32 ","$18,103.32 ","$0.00 ","$10,429.38 ","$18,985.98 ","$41,943.03 ","$51,105.97 ","$0.00 ","$7,603.43 ","$0.00 ","$19,339.59 ","$18,081.89 ","$0.00 "
"MS539","DRG","MS539","","OSTEOMYELITIS WITH MCC","INPATIENT ONLY","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS540","DRG","MS540","","OSTEOMYELITIS WITH CC","INPATIENT ONLY","$56,790.13 ","$42,024.70 ","$0.00 ","$23,761.72 ","$0.00 ","$0.00 ","$12,280.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,686.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,761.72 ","$21,606.16 ","$0.00 "
"MS541","DRG","MS541","","OSTEOMYELITIS WITHOUT CC/MCC","INPATIENT ONLY","$16,708.96 ","$12,364.63 ","$0.00 ","$20,549.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,467.13 ","$0.00 ","$6,521.61 ","$13,050.54 ","$0.00 ","$9,089.03 ","$0.00 ","$20,549.86 ","$0.00 ","$0.00 "
"MS542","DRG","MS542","","PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC","INPATIENT ONLY","$48,347.24 ","$35,776.96 ","$0.00 ","$28,047.49 ","$20,433.00 ","$17,380.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,047.49 ","$0.00 ","$0.00 "
"MS543","DRG","MS543","","PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC","INPATIENT ONLY","$138,113.94 ","$102,204.32 ","$0.00 ","$57,212.40 ","$57,212.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,021.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,020.07 ","$0.00 "
"MS544","DRG","MS544","","PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$34,792.01 ","$25,746.09 ","$0.00 ","$20,893.70 ","$20,893.70 ","$7,083.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,338.77 ","$0.00 ","$0.00 "
"MS545","DRG","MS545","","CONNECTIVE TISSUE DISORDERS WITH MCC","INPATIENT ONLY","$64,829.08 ","$47,973.52 ","$0.00 ","$41,824.02 ","$26,284.20 ","$22,618.69 ","$41,824.02 ","$0.00 ","$0.00 ","$21,592.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,564.56 ","$33,790.14 ","$0.00 ","$21,592.78 "
"MS546","DRG","MS546","","CONNECTIVE TISSUE DISORDERS WITH CC","INPATIENT ONLY","$55,499.36 ","$41,069.53 ","$0.00 ","$39,074.00 ","$20,716.21 ","$0.00 ","$11,246.10 ","$0.00 ","$0.00 ","$11,302.22 ","$16,546.75 ","$0.00 ","$17,744.13 ","$39,074.00 ","$23,690.09 ","$12,063.24 ","$10,764.02 ","$22,972.84 ","$0.00 ","$11,302.22 "
"MS547","DRG","MS547","","CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$25,917.84 ","$19,179.20 ","$0.00 ","$21,983.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,138.88 ","$19,338.61 ","$3,981.64 ","$21,983.21 ","$0.00 ","$8,120.69 ","$0.00 ","$19,760.97 ","$18,417.72 ","$0.00 "
"MS548","DRG","MS548","","SEPTIC ARTHRITIS WITH MCC","INPATIENT ONLY","$413,977.48 ","$306,343.34 ","$0.00 ","$33,605.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33,605.39 ","$0.00 ","$0.00 "
"MS549","DRG","MS549","","SEPTIC ARTHRITIS WITH CC","INPATIENT ONLY","$59,228.85 ","$43,829.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS550","DRG","MS550","","SEPTIC ARTHRITIS WITHOUT CC/MCC","INPATIENT ONLY","$68,433.98 ","$50,641.15 ","$0.00 ","$20,201.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,880.00 ","$0.00 ","$3,746.96 ","$9,998.30 ","$0.00 ","$8,661.00 ","$0.00 ","$20,201.14 ","$0.00 ","$0.00 "
"MS551","DRG","MS551","","MEDICAL BACK PROBLEMS WITH MCC","INPATIENT ONLY","$114,513.50 ","$84,739.99 ","$0.00 ","$26,358.23 ","$26,358.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,545.38 ","$0.00 ","$24,664.14 ","$0.00 ","$0.00 ","$25,317.60 ","$0.00 ","$10,043.22 ","$26,125.09 ","$23,489.66 ","$10,545.38 "
"MS552","DRG","MS552","","MEDICAL BACK PROBLEMS WITHOUT MCC","INPATIENT ONLY","$72,301.05 ","$53,502.78 ","$3,841.70 ","$46,583.09 ","$42,175.25 ","$7,763.60 ","$8,531.79 ","$15,188.24 ","$16,428.44 ","$8,574.36 ","$12,538.63 ","$20,034.27 ","$3,841.70 ","$46,583.09 ","$46,274.32 ","$9,141.16 ","$8,166.06 ","$41,185.53 ","$19,080.26 ","$8,574.36 "
"MS553","DRG","MS553","","BONE DISEASES AND ARTHROPATHIES WITH MCC","INPATIENT ONLY","$51,045.58 ","$37,773.73 ","$0.00 ","$28,077.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,587.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,077.22 ","$21,511.79 ","$0.00 "
"MS554","DRG","MS554","","BONE DISEASES AND ARTHROPATHIES WITHOUT MCC","INPATIENT ONLY","$34,943.63 ","$25,858.29 ","$0.00 ","$19,573.95 ","$8,173.20 ","$6,492.58 ","$0.00 ","$0.00 ","$0.00 ","$7,576.01 ","$0.00 ","$19,182.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,215.26 ","$19,573.95 ","$18,268.68 ","$7,576.01 "
"MS555","DRG","MS555","","SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","INPATIENT ONLY","$55,014.70 ","$40,710.88 ","$0.00 ","$25,282.80 ","$0.00 ","$0.00 ","$10,813.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,791.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,282.80 ","$0.00 "
"MS556","DRG","MS556","","SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC","INPATIENT ONLY","$15,857.45 ","$11,734.51 ","$0.00 ","$19,611.52 ","$0.00 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,611.52 ","$0.00 ","$0.00 "
"MS557","DRG","MS557","","TENDONITIS, MYOSITIS AND BURSITIS WITH MCC","INPATIENT ONLY","$24,976.66 ","$18,482.73 ","$0.00 ","$25,053.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,431.03 ","$20,050.25 ","$0.00 ","$7,288.53 ","$23,483.23 ","$0.00 ","$14,617.44 ","$8,981.94 ","$25,053.66 ","$0.00 ","$9,431.03 "
"MS558","DRG","MS558","","TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC","INPATIENT ONLY","$29,084.09 ","$21,522.23 ","$0.00 ","$20,179.91 ","$0.00 ","$0.00 ","$7,373.78 ","$0.00 ","$0.00 ","$7,410.57 ","$11,844.25 ","$19,689.18 ","$6,684.92 ","$14,709.82 ","$0.00 ","$8,634.93 ","$7,057.69 ","$20,179.91 ","$18,751.60 ","$7,410.57 "
"MS559","DRG","MS559","","AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","INPATIENT ONLY","$71,553.76 ","$52,949.78 ","$0.00 ","$26,115.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,115.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,872.05 ","$0.00 "
"MS560","DRG","MS560","","AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","INPATIENT ONLY","$37,994.06 ","$28,115.60 ","$0.00 ","$9,664.00 ","$0.00 ","$0.00 ","$4,841.55 ","$9,250.60 ","$9,664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS561","DRG","MS561","","AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","INPATIENT ONLY","$13,202.24 ","$9,769.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS562","DRG","MS562","","FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC","INPATIENT ONLY","$19,338.11 ","$14,310.20 ","$0.00 ","$29,572.12 ","$21,147.88 ","$0.00 ","$0.00 ","$9,814.28 ","$10,227.68 ","$0.00 ","$18,522.63 ","$23,008.32 ","$24,270.04 ","$29,572.12 ","$0.00 ","$13,503.74 ","$0.00 ","$24,146.36 ","$21,912.69 ","$0.00 "
"MS563","DRG","MS563","","FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC","INPATIENT ONLY","$45,179.03 ","$33,432.48 ","$2,686.98 ","$30,007.85 ","$8,550.54 ","$6,922.80 ","$10,446.77 ","$2,686.98 ","$3,100.38 ","$8,143.64 ","$11,742.50 ","$19,638.62 ","$24,627.66 ","$30,007.85 ","$29,566.02 ","$8,560.76 ","$7,755.86 ","$20,119.49 ","$18,703.45 ","$8,143.64 "
"MS564","DRG","MS564","","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC","INPATIENT ONLY","$28,508.20 ","$21,096.07 ","$0.00 ","$25,493.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,783.08 ","$0.00 ","$24,135.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,269.60 ","$25,493.02 ","$22,985.93 ","$10,783.08 "
"MS565","DRG","MS565","","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC","INPATIENT ONLY","$58,776.46 ","$43,494.58 ","$0.00 ","$58,773.78 ","$0.00 ","$0.00 ","$0.00 ","$22,118.54 ","$23,835.84 ","$10,783.08 ","$13,481.88 ","$0.00 ","$42,888.55 ","$52,258.04 ","$58,773.78 ","$9,828.83 ","$10,269.60 ","$21,152.55 ","$0.00 ","$10,783.08 "
"MS566","DRG","MS566","","OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$52,050.86 ","$38,517.64 ","$0.00 ","$19,333.07 ","$14,242.21 ","$0.00 ","$0.00 ","$12,501.26 ","$13,328.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,333.07 ","$0.00 ","$0.00 "
"MS570","DRG","MS570","","SKIN DEBRIDEMENT WITH MCC","INPATIENT ONLY","$176,422.47 ","$130,552.63 ","$0.00 ","$37,352.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,679.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37,352.79 ","$29,679.42 ","$0.00 "
"MS571","DRG","MS571","","SKIN DEBRIDEMENT WITH CC","INPATIENT ONLY","$85,212.35 ","$63,057.14 ","$0.00 ","$92,480.47 ","$0.00 ","$0.00 ","$14,515.09 ","$80,227.85 ","$82,294.85 ","$0.00 ","$70,060.96 ","$25,230.67 ","$7,827.96 ","$92,480.47 ","$0.00 ","$16,763.65 ","$0.00 ","$26,802.10 ","$24,029.21 ","$0.00 "
"MS572","DRG","MS572","","SKIN DEBRIDEMENT WITHOUT CC/MCC","INPATIENT ONLY","$94,703.95 ","$70,080.92 ","$0.00 ","$187,600.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187,600.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS574","DRG","MS574","","SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC","INPATIENT ONLY","$148,433.14 ","$109,840.52 ","$0.00 ","$94,618.60 ","$94,618.60 ","$23,472.88 ","$0.00 ","","","","","","","","","","","","",""
"MS575","DRG","MS575","","SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC","INPATIENT ONLY","$159,802.59 ","$118,253.92 ","$0.00 ","$106,610.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106,610.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS576","DRG","MS576","","SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC","INPATIENT ONLY","$201,124.76 ","$148,832.32 ","$0.00 ","$52,745.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52,745.32 ","$0.00 ","$0.00 "
"MS577","DRG","MS577","","SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC","INPATIENT ONLY","$326,238.97 ","$241,416.84 ","$0.00 ","$210,439.66 ","$0.00 ","$0.00 ","$21,509.22 ","$0.00 ","$0.00 ","$21,616.55 ","$159,423.97 ","$30,310.19 ","$172,709.30 ","$210,439.66 ","$0.00 ","$30,411.56 ","$20,587.20 ","$32,872.23 ","$28,866.85 ","$21,616.55 "
"MS578","DRG","MS578","","SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC","INPATIENT ONLY","$195,675.49 ","$144,799.86 ","$0.00 ","$89,151.39 ","$0.00 ","$0.00 ","$15,734.20 ","$41,042.07 ","$41,042.07 ","$0.00 ","$67,538.93 ","$0.00 ","$6,314.74 ","$89,151.39 ","$0.00 ","$16,313.56 ","$0.00 ","$26,435.44 ","$0.00 ","$0.00 "
"MS579","DRG","MS579","","OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC","INPATIENT ONLY","$204,580.32 ","$151,389.44 ","$0.00 ","$37,531.20 ","$0.00 ","$0.00 ","$0.00 ","$13,787.57 ","$15,441.17 ","$0.00 ","$0.00 ","$34,208.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37,531.20 ","$32,579.85 ","$0.00 "
"MS580","DRG","MS580","","OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC","INPATIENT ONLY","$135,202.42 ","$100,049.79 ","$0.00 ","$103,996.14 ","$103,996.14 ","$0.00 ","$17,934.78 ","$65,020.71 ","$65,020.71 ","$17,313.20 ","$73,225.58 ","$24,796.03 ","$13,426.57 ","$96,657.78 ","$0.00 ","$16,126.10 ","$13,096.07 ","$26,282.71 ","$23,615.27 ","$13,137.34 "
"MS581","DRG","MS581","","OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$103,131.58 ","$76,317.37 ","$0.00 ","$289,721.02 ","$98,764.64 ","$0.00 ","$34,620.26 ","$0.00 ","$0.00 ","$9,351.17 ","$219,485.64 ","$22,377.58 ","$237,776.11 ","$289,721.02 ","$0.00 ","$51,492.35 ","$8,905.88 ","$23,392.60 ","$21,311.98 ","$9,351.17 "
"MS582","DRG","MS582","","MASTECTOMY FOR MALIGNANCY WITH CC/MCC","INPATIENT ONLY","$129,566.31 ","$95,879.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS583","DRG","MS583","","MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$162,444.59 ","$120,209.00 ","$0.00 ","$22,037.12 ","$0.00 ","$0.00 ","$22,037.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS584","DRG","MS584","","BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC","INPATIENT ONLY","$94,531.64 ","$69,953.41 ","$0.00 ","$474,664.05 ","$474,664.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,271.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,496.32 ","$0.00 ","$0.00 ","$16,271.13 "
"MS585","DRG","MS585","","BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$165,756.69 ","$122,659.95 ","$0.00 ","$77,375.13 ","$0.00 ","$0.00 ","$32,770.74 ","$0.00 ","$0.00 ","$77,375.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66,928.30 ","$0.00 ","$0.00 ","$15,175.67 "
"MS592","DRG","MS592","","SKIN ULCERS WITH MCC","INPATIENT ONLY","$22,209.32 ","$16,434.90 ","$0.00 ","$21,094.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,094.03 ","$0.00 ","$0.00 "
"MS593","DRG","MS593","","SKIN ULCERS WITH CC","INPATIENT ONLY","$15,697.87 ","$11,616.42 ","$0.00 ","$22,518.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,646.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,518.78 ","$20,615.57 ","$0.00 "
"MS594","DRG","MS594","","SKIN ULCERS WITHOUT CC/MCC","INPATIENT ONLY","$24,390.66 ","$18,049.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS595","DRG","MS595","","MAJOR SKIN DISORDERS WITH MCC","INPATIENT ONLY","$29,157.59 ","$21,576.62 ","$0.00 ","$525,887.27 ","$525,887.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS596","DRG","MS596","","MAJOR SKIN DISORDERS WITHOUT MCC","INPATIENT ONLY","$18,558.10 ","$13,732.99 ","$0.00 ","$123,653.36 ","$0.00 ","$0.00 ","$0.00 ","$123,653.36 ","$123,653.36 ","$0.00 ","$0.00 ","$20,459.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.29 ","$19,485.10 ","$0.00 "
"MS597","DRG","MS597","","MALIGNANT BREAST DISORDERS WITH MCC","INPATIENT ONLY","$151,439.02 ","$112,064.87 ","$0.00 ","$26,970.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,679.69 ","$0.00 ","$25,371.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,123.52 ","$26,970.32 ","$24,163.28 ","$11,679.69 "
"MS598","DRG","MS598","","MALIGNANT BREAST DISORDERS WITH CC","INPATIENT ONLY","$10,043.51 ","$7,432.20 ","$0.00 ","$35,696.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,968.25 ","$21,241.80 ","$10,944.14 ","$35,696.67 ","$0.00 ","$10,912.47 ","$0.00 ","$22,035.33 ","$20,230.29 ","$0.00 "
"MS600","DRG","MS600","","NON-MALIGNANT BREAST DISORDERS WITH CC/MCC","INPATIENT ONLY","$24,329.27 ","$18,003.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS601","DRG","MS601","","NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$11,235.84 ","$8,314.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS602","DRG","MS602","","CELLULITIS WITH MCC","INPATIENT ONLY","$39,242.55 ","$29,039.49 ","$0.00 ","$24,821.74 ","$4,323.53 ","$12,993.19 ","$0.00 ","$5,623.04 ","$5,813.88 ","$0.00 ","$0.00 ","$23,573.49 ","$0.00 ","$0.00 ","$18,754.05 ","$0.00 ","$0.00 ","$24,821.74 ","$22,450.94 ","$0.00 "
"MS603","DRG","MS603","","CELLULITIS WITHOUT MCC","INPATIENT ONLY","$33,623.54 ","$24,881.42 ","$0.00 ","$20,033.73 ","$16,457.97 ","$7,539.56 ","$0.00 ","$8,060.94 ","$9,301.14 ","$8,400.36 ","$11,598.13 ","$19,566.86 ","$6,546.00 ","$17,835.13 ","$0.00 ","$8,455.50 ","$8,000.35 ","$20,033.73 ","$18,635.10 ","$8,400.36 "
"MS604","DRG","MS604","","TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC","INPATIENT ONLY","$58,470.55 ","$43,268.21 ","$0.00 ","$101,032.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76,539.94 ","$23,810.62 ","$82,918.27 ","$101,032.73 ","$0.00 ","$14,680.60 ","$0.00 ","$25,105.11 ","$22,676.78 ","$0.00 "
"MS605","DRG","MS605","","TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC","INPATIENT ONLY","$44,177.90 ","$32,691.65 ","$0.00 ","$33,846.48 ","$11,723.60 ","$0.00 ","$6,598.94 ","$12,615.31 ","$12,615.31 ","$6,631.86 ","$12,040.88 ","$19,786.89 ","$27,778.04 ","$33,846.48 ","$0.00 ","$8,778.29 ","$6,316.06 ","$20,354.44 ","$18,844.66 ","$6,631.86 "
"MS606","DRG","MS606","","MINOR SKIN DISORDERS WITH MCC","INPATIENT ONLY","$38,821.50 ","$28,727.91 ","$0.00 ","$25,358.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,358.28 ","$0.00 ","$0.00 "
"MS607","DRG","MS607","","MINOR SKIN DISORDERS WITHOUT MCC","INPATIENT ONLY","$24,146.53 ","$17,868.43 ","$0.00 ","$19,891.64 ","$4,312.35 ","$0.00 ","$6,557.31 ","$0.00 ","$0.00 ","$0.00 ","$11,358.88 ","$19,447.95 ","$6,767.14 ","$9,573.60 ","$0.00 ","$8,281.08 ","$0.00 ","$19,891.64 ","$18,521.86 ","$0.00 "
"MS614","DRG","MS614","","ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC","INPATIENT ONLY","$332,589.59 ","$246,116.30 ","$0.00 ","$167,928.51 ","$0.00 ","$0.00 ","$39,122.95 ","$0.00 ","$0.00 ","$0.00 ","$127,218.57 ","$30,431.14 ","$137,820.12 ","$167,928.51 ","$0.00 ","$24,392.14 ","$0.00 ","$33,016.77 ","$28,982.04 ","$0.00 "
"MS615","DRG","MS615","","ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$152,983.56 ","$113,207.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS616","DRG","MS616","","AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","INPATIENT ONLY","$192,155.28 ","$142,194.91 ","$0.00 ","$45,817.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41,143.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45,817.70 ","$39,183.85 ","$0.00 "
"MS617","DRG","MS617","","AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC","INPATIENT ONLY","$70,219.82 ","$51,962.67 ","$0.00 ","$78,850.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,205.38 ","$27,820.65 ","$30,246.42 ","$78,850.16 ","$0.00 ","$20,562.86 ","$0.00 ","$29,897.18 ","$26,495.86 ","$0.00 "
"MS622","DRG","MS622","","SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","INPATIENT ONLY","$231,450.41 ","$171,273.30 ","$0.00 ","$41,216.66 ","$0.00 ","$41,216.66 ","$0.00 ","","","","","","","","","","","","",""
"MS623","DRG","MS623","","SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC","INPATIENT ONLY","$112,314.61 ","$83,112.81 ","$0.00 ","$37,368.58 ","$0.00 ","$0.00 ","$0.00 ","$32,821.18 ","$37,368.58 ","$0.00 ","$0.00 ","$25,933.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,698.30 ","$0.00 "
"MS626","DRG","MS626","","THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC","INPATIENT ONLY","$190,024.42 ","$140,618.07 ","$0.00 ","$6,200.76 ","$0.00 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS627","DRG","MS627","","THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$133,664.81 ","$98,911.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS628","DRG","MS628","","OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$110,871.85 ","$82,045.17 ","$0.00 ","$39,014.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,014.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37,156.53 ","$0.00 "
"MS629","DRG","MS629","","OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC","INPATIENT ONLY","$112,509.13 ","$83,256.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS630","DRG","MS630","","OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$158,798.79 ","$117,511.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS637","DRG","MS637","","DIABETES WITH MCC","INPATIENT ONLY","$36,108.73 ","$26,720.46 ","$0.00 ","$40,133.70 ","$16,572.15 ","$12,446.04 ","$23,792.53 ","$12,812.76 ","$13,226.16 ","$12,842.52 ","$19,053.38 ","$23,272.11 ","$20,432.15 ","$40,133.70 ","$0.00 ","$13,890.67 ","$12,230.98 ","$24,461.58 ","$22,163.91 ","$12,842.52 "
"MS638","DRG","MS638","","DIABETES WITH CC","INPATIENT ONLY","$34,793.06 ","$25,746.86 ","$0.00 ","$22,063.63 ","$12,998.32 ","$0.00 ","$7,457.98 ","$10,747.92 ","$12,401.52 ","$3,201.70 ","$12,156.38 ","$19,844.30 ","$3,621.13 ","$22,063.63 ","$0.00 ","$8,862.48 ","$2,865.07 ","$20,365.28 ","$18,899.33 ","$3,049.24 "
"MS639","DRG","MS639","","DIABETES WITHOUT CC/MCC","INPATIENT ONLY","$23,626.99 ","$17,483.97 ","$0.00 ","$31,516.95 ","$0.00 ","$0.00 ","$4,826.72 ","$8,310.02 ","$8,914.26 ","$5,219.92 ","$8,431.50 ","$17,993.04 ","$7,233.31 ","$31,516.95 ","$0.00 ","$6,146.90 ","$4,971.35 ","$18,153.00 ","$17,136.23 ","$5,219.92 "
"MS640","DRG","MS640","","MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC","INPATIENT ONLY","$49,024.53 ","$36,278.15 ","$0.00 ","$79,244.98 ","$8,356.69 ","$0.00 ","$9,176.07 ","$0.00 ","$0.00 ","$9,221.86 ","$60,034.09 ","$22,100.13 ","$17,903.38 ","$79,244.98 ","$0.00 ","$12,171.50 ","$8,782.73 ","$23,061.04 ","$21,047.74 ","$9,221.86 "
"MS641","DRG","MS641","","MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC","INPATIENT ONLY","$51,782.41 ","$38,318.98 ","$0.00 ","$120,359.68 ","$12,711.30 ","$6,293.53 ","$0.00 ","$8,424.16 ","$8,424.16 ","$7,062.58 ","$91,181.59 ","$17,809.69 ","$98,780.05 ","$120,359.68 ","$0.00 ","$7,584.39 ","$6,726.27 ","$19,324.07 ","$16,961.90 ","$7,062.58 "
"MS642","DRG","MS642","","INBORN AND OTHER DISORDERS OF METABOLISM","INPATIENT ONLY","$38,588.82 ","$28,555.73 ","$0.00 ","$6,200.76 ","$0.00 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS643","DRG","MS643","","ENDOCRINE DISORDERS WITH MCC","INPATIENT ONLY","$53,294.85 ","$39,438.19 ","$0.00 ","$82,100.01 ","$0.00 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$62,196.98 ","$24,910.85 ","$22,826.66 ","$82,100.01 ","$0.00 ","$16,294.50 ","$0.00 ","$26,419.91 ","$23,724.62 ","$0.00 "
"MS644","DRG","MS644","","ENDOCRINE DISORDERS WITH CC","INPATIENT ONLY","$30,234.31 ","$22,373.39 ","$0.00 ","$21,541.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,828.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,541.26 ","$19,836.54 ","$0.00 "
"MS645","DRG","MS645","","ENDOCRINE DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$20,021.98 ","$14,816.27 ","$0.00 ","$19,394.31 ","$0.00 ","$0.00 ","$4,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,031.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,394.31 ","$18,125.50 ","$0.00 "
"MS653","DRG","MS653","","MAJOR BLADDER PROCEDURES WITH MCC","INPATIENT ONLY","$422,791.72 ","$312,865.87 ","$0.00 ","$120,632.51 ","$120,632.51 ","$0.00 ","$45,216.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58,358.97 ","$0.00 ","$0.00 "
"MS654","DRG","MS654","","MAJOR BLADDER PROCEDURES WITH CC","INPATIENT ONLY","$254,371.61 ","$188,234.99 ","$0.00 ","$398,005.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398,005.53 ","$0.00 ","$33,020.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398,005.53 ","$38,871.58 ","$31,448.06 ","$398,005.53 "
"MS655","DRG","MS655","","MAJOR BLADDER PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$248,905.14 ","$184,189.80 ","$0.00 ","$75,740.26 ","$0.00 ","$0.00 ","$0.00 ","$74,500.06 ","$75,740.26 ","$0.00 ","$0.00 ","$27,896.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,568.11 ","$0.00 "
"MS656","DRG","MS656","","KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC","INPATIENT ONLY","$508,652.91 ","$376,403.15 ","$0.00 ","$253,891.46 ","$0.00 ","$0.00 ","$0.00 ","$252,651.26 ","$253,891.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS657","DRG","MS657","","KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC","INPATIENT ONLY","$225,332.95 ","$166,746.38 ","$0.00 ","$173,329.09 ","$0.00 ","$0.00 ","$0.00 ","$172,088.89 ","$173,329.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS658","DRG","MS658","","KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC","INPATIENT ONLY","$296,090.66 ","$219,107.09 ","$0.00 ","$58,312.85 ","$0.00 ","$0.00 ","$0.00 ","$58,312.85 ","$58,312.85 ","$0.00 ","$0.00 ","$24,530.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,362.74 ","$0.00 "
"MS659","DRG","MS659","","KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC","INPATIENT ONLY","$74,221.21 ","$54,923.70 ","$0.00 ","$35,029.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,090.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,657.76 ","$35,029.80 ","$0.00 ","$9,090.65 "
"MS660","DRG","MS660","","KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC","INPATIENT ONLY","$15,538.14 ","$11,498.22 ","$0.00 ","$175,248.02 ","$175,248.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,511.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75,856.50 ","$22,391.71 ","$0.00 "
"MS661","DRG","MS661","","KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC","INPATIENT ONLY","$84,694.84 ","$62,674.18 ","$0.00 ","$160,446.31 ","$115,839.73 ","$21,549.38 ","$40,633.76 ","$8,060.94 ","$9,301.14 ","$0.00 ","$121,550.23 ","$0.00 ","$131,679.42 ","$160,446.31 ","$0.00 ","$12,993.46 ","$0.00 ","$44,096.27 ","$0.00 ","$0.00 "
"MS663","DRG","MS663","","MINOR BLADDER PROCEDURES WITH CC","INPATIENT ONLY","$199,962.84 ","$147,972.50 ","$0.00 ","$132,197.62 ","$0.00 ","$26,512.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100,149.71 ","$0.00 ","$108,495.52 ","$132,197.62 ","$0.00 ","$15,271.03 ","$0.00 ","$25,586.10 ","$0.00 ","$0.00 "
"MS664","DRG","MS664","","MINOR BLADDER PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$0.00 ","$0.00 ","$0.00 ","$12,130.79 ","$0.00 ","$0.00 ","$0.00 ","$11,717.39 ","$12,130.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS667","DRG","MS667","","PROSTATECTOMY WITHOUT CC/MCC","INPATIENT ONLY","$77,902.65 ","$57,647.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS668","DRG","MS668","","TRANSURETHRAL PROCEDURES WITH MCC","INPATIENT ONLY","$158,833.08 ","$117,536.48 ","$0.00 ","$35,915.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,915.88 ","$0.00 ","$0.00 "
"MS669","DRG","MS669","","TRANSURETHRAL PROCEDURES WITH CC","INPATIENT ONLY","$91,302.59 ","$67,563.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS670","DRG","MS670","","TRANSURETHRAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$139,074.86 ","$102,915.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS671","DRG","MS671","","URETHRAL PROCEDURES WITH CC/MCC","INPATIENT ONLY","$232,859.23 ","$172,315.83 ","$0.00 ","$156,574.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118,616.94 ","$26,291.95 ","$128,501.69 ","$156,574.35 ","$0.00 ","$18,320.42 ","$0.00 ","$28,070.35 ","$25,039.95 ","$0.00 "
"MS672","DRG","MS672","","URETHRAL PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$137,707.44 ","$101,903.51 ","$0.00 ","$177,791.94 ","$177,791.94 ","$36,697.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103,447.01 ","$0.00 ","$112,067.60 ","$136,550.05 ","$0.00 ","$10,357.11 ","$0.00 ","$21,582.93 ","$0.00 ","$0.00 "
"MS673","DRG","MS673","","OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC","INPATIENT ONLY","$110,049.20 ","$81,436.41 ","$0.00 ","$42,337.17 ","$34,498.80 ","$31,260.58 ","$25,130.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,410.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42,337.17 ","$36,410.02 ","$0.00 "
"MS674","DRG","MS674","","OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC","INPATIENT ONLY","$131,367.95 ","$97,212.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS675","DRG","MS675","","OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$139,199.75 ","$103,007.82 ","$0.00 ","$26,473.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,473.00 ","$0.00 ","$0.00 "
"MS682","DRG","MS682","","RENAL FAILURE WITH MCC","INPATIENT ONLY","$43,843.12 ","$32,443.91 ","$0.00 ","$45,225.20 ","$45,225.20 ","$13,561.75 ","$0.00 ","$12,937.30 ","$13,032.72 ","$15,998.23 ","$20,322.50 ","$23,902.86 ","$21,793.11 ","$26,628.42 ","$0.00 ","$14,815.93 ","$11,998.26 ","$25,215.35 ","$22,764.63 ","$12,616.02 "
"MS683","DRG","MS683","","RENAL FAILURE WITH CC","INPATIENT ONLY","$43,023.52 ","$31,837.40 ","$0.00 ","$31,160.10 ","$16,589.21 ","$0.00 ","$0.00 ","$3,375.26 ","$3,375.26 ","$0.00 ","$12,337.88 ","$19,934.50 ","$10,177.45 ","$31,160.10 ","$0.00 ","$8,994.81 ","$0.00 ","$20,236.40 ","$18,985.24 ","$0.00 "
"MS684","DRG","MS684","","RENAL FAILURE WITHOUT CC/MCC","INPATIENT ONLY","$10,087.95 ","$7,465.08 ","$0.00 ","$18,170.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,460.38 ","$0.00 ","$3,360.22 ","$8,379.35 ","$0.00 ","$6,167.96 ","$0.00 ","$18,170.14 ","$0.00 ","$0.00 "
"MS686","DRG","MS686","","KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC","INPATIENT ONLY","$27,117.25 ","$20,066.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS687","DRG","MS687","","KIDNEY AND URINARY TRACT NEOPLASMS WITH CC","INPATIENT ONLY","$34,699.96 ","$25,677.97 ","$0.00 ","$21,741.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,741.34 ","$0.00 ","$0.00 "
"MS689","DRG","MS689","","KIDNEY AND URINARY TRACT INFECTIONS WITH MCC","INPATIENT ONLY","$52,264.96 ","$38,676.07 ","$0.00 ","$22,280.33 ","$12,330.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,446.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,280.33 ","$20,425.54 ","$0.00 "
"MS690","DRG","MS690","","KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC","INPATIENT ONLY","$34,630.42 ","$25,626.51 ","$0.00 ","$38,475.04 ","$4,086.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,873.50 ","$19,206.72 ","$6,663.05 ","$38,475.04 ","$0.00 ","$7,927.21 ","$0.00 ","$17,599.41 ","$18,292.11 ","$0.00 "
"MS693","DRG","MS693","","URINARY STONES WITH MCC","INPATIENT ONLY","$37,763.02 ","$27,944.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS694","DRG","MS694","","URINARY STONES WITHOUT MCC","INPATIENT ONLY","$27,812.82 ","$20,581.49 ","$0.00 ","$22,027.43 ","$4,116.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,180.50 ","$18,862.29 ","$8,086.81 ","$22,027.43 ","$0.00 ","$7,422.00 ","$0.00 ","$19,191.77 ","$17,964.09 ","$0.00 "
"MS695","DRG","MS695","","KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC","INPATIENT ONLY","$30,389.68 ","$22,488.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS696","DRG","MS696","","KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC","INPATIENT ONLY","$8,697.46 ","$6,436.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS698","DRG","MS698","","OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC","INPATIENT ONLY","$62,273.78 ","$46,082.60 ","$0.00 ","$26,363.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,863.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,363.55 ","$23,679.70 ","$0.00 "
"MS699","DRG","MS699","","OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC","INPATIENT ONLY","$34,407.79 ","$25,461.76 ","$0.00 ","$21,922.34 ","$8,173.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,436.27 ","$14,199.63 ","$20,859.81 ","$10,876.54 ","$19,704.17 ","$0.00 ","$10,352.10 ","$3,969.84 ","$21,922.34 ","$19,866.49 ","$4,225.02 "
"MS700","DRG","MS700","","OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$33,843.09 ","$25,043.89 ","$0.00 ","$35,130.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,198.38 ","$18,871.19 ","$7,542.32 ","$35,130.91 ","$0.00 ","$7,435.02 ","$0.00 ","$19,202.40 ","$17,972.56 ","$0.00 "
"MS707","DRG","MS707","","MAJOR MALE PELVIC PROCEDURES WITH CC/MCC","INPATIENT ONLY","$245,462.36 ","$181,642.15 ","$0.00 ","$26,581.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,581.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,315.26 ","$0.00 "
"MS708","DRG","MS708","","MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$191,309.76 ","$141,569.22 ","$0.00 ","$25,003.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,725.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,003.02 ","$22,595.42 ","$0.00 "
"MS709","DRG","MS709","","PENIS PROCEDURES WITH CC/MCC","INPATIENT ONLY","$184,084.60 ","$136,222.60 ","$0.00 ","$43,219.19 ","$0.00 ","$0.00 ","$0.00 ","$41,565.59 ","$43,219.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,790.56 ","$0.00 ","$0.00 "
"MS710","DRG","MS710","","PENIS PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$64,254.48 ","$47,548.32 ","$0.00 ","$120,205.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120,205.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS711","DRG","MS711","","TESTES PROCEDURES WITH CC/MCC","INPATIENT ONLY","$99,610.22 ","$73,711.56 ","$0.00 ","$85,899.31 ","$0.00 ","$0.00 ","$17,621.76 ","$0.00 ","$0.00 ","$0.00 ","$65,075.23 ","$0.00 ","$4,158.09 ","$85,899.31 ","$0.00 ","$21,484.09 ","$0.00 ","$30,647.69 ","$0.00 ","$0.00 "
"MS713","DRG","MS713","","TRANSURETHRAL PROSTATECTOMY WITH CC/MCC","INPATIENT ONLY","$82,750.61 ","$61,235.45 ","$0.00 ","$25,084.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,822.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,211.96 ","$25,084.68 ","$0.00 ","$12,822.56 "
"MS714","DRG","MS714","","TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC","INPATIENT ONLY","$112,034.77 ","$82,905.73 ","$0.00 ","$20,620.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,620.89 ","$0.00 ","$0.00 "
"MS715","DRG","MS715","","OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC","INPATIENT ONLY","$40,796.73 ","$30,189.58 ","$0.00 ","$148,588.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112,566.97 ","$0.00 ","$121,947.55 ","$148,588.40 ","$0.00 ","$21,416.93 ","$0.00 ","$30,592.97 ","$0.00 ","$0.00 "
"MS717","DRG","MS717","","OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC","INPATIENT ONLY","$2,327,046.38 ","$1,722,014.32 ","$0.00 ","$326,740.55 ","$178,318.50 ","$0.00 ","$0.00 ","$24,896.03 ","$26,963.03 ","$0.00 ","$0.00 ","$23,674.83 ","$0.00 ","$0.00 ","$326,740.55 ","$0.00 ","$0.00 ","$0.00 ","$23,674.83 ","$0.00 "
"MS718","DRG","MS718","","OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$158,309.83 ","$117,149.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS722","DRG","MS722","","MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC","INPATIENT ONLY","$13,710.93 ","$10,146.09 ","$0.00 ","$26,136.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,136.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,892.20 ","$0.00 "
"MS723","DRG","MS723","","MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC","INPATIENT ONLY","$21,568.66 ","$15,960.81 ","$0.00 ","$22,188.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,370.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,188.86 ","$20,352.65 ","$0.00 "
"MS725","DRG","MS725","","BENIGN PROSTATIC HYPERTROPHY WITH MCC","INPATIENT ONLY","$120,705.19 ","$89,321.84 ","$0.00 ","$23,861.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,381.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,861.50 ","$21,315.89 ","$0.00 "
"MS727","DRG","MS727","","INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC","INPATIENT ONLY","$19,627.88 ","$14,524.63 ","$0.00 ","$23,556.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,556.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,434.67 ","$0.00 "
"MS728","DRG","MS728","","INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC","INPATIENT ONLY","$17,324.91 ","$12,820.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS729","DRG","MS729","","OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC","INPATIENT ONLY","$53,996.15 ","$39,957.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS730","DRG","MS730","","OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$55,239.20 ","$40,877.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS736","DRG","MS736","","UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC","INPATIENT ONLY","$342,516.71 ","$253,462.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS737","DRG","MS737","","UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC","INPATIENT ONLY","$149,825.85 ","$110,871.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS738","DRG","MS738","","UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$190,239.02 ","$140,776.87 ","$0.00 ","$23,225.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,225.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,119.65 ","$0.00 "
"MS739","DRG","MS739","","UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC","INPATIENT ONLY","$345,645.71 ","$255,777.83 ","$0.00 ","$76,002.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,391.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76,002.23 ","$37,515.77 ","$0.00 "
"MS740","DRG","MS740","","UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC","INPATIENT ONLY","$289,589.03 ","$214,295.88 ","$0.00 ","$27,721.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,721.64 ","$0.00 ","$0.00 "
"MS741","DRG","MS741","","UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$220,233.64 ","$162,972.89 ","$0.00 ","$156,113.16 ","$141,373.62 ","$29,872.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118,267.54 ","$0.00 ","$128,123.16 ","$156,113.16 ","$0.00 ","$13,327.31 ","$0.00 ","$24,002.64 ","$0.00 ","$0.00 "
"MS742","DRG","MS742","","UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC","INPATIENT ONLY","$178,499.01 ","$132,089.27 ","$0.00 ","$144,571.35 ","$4,086.60 ","$0.00 ","$14,751.72 ","$99,078.57 ","$100,318.77 ","$0.00 ","$109,523.76 ","$25,364.14 ","$118,650.74 ","$144,571.35 ","$135,777.03 ","$16,936.07 ","$0.00 ","$26,942.56 ","$24,156.36 ","$0.00 "
"MS743","DRG","MS743","","UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC","INPATIENT ONLY","$215,798.10 ","$159,690.59 ","$0.00 ","$113,095.63 ","$113,095.63 ","$0.00 ","$22,501.93 ","$38,115.55 ","$38,942.35 ","$9,034.34 ","$71,594.65 ","$0.00 ","$16,934.63 ","$94,504.91 ","$0.00 ","$11,512.92 ","$8,031.14 ","$22,524.51 ","$0.00 ","$8,432.69 "
"MS744","DRG","MS744","","D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC","INPATIENT ONLY","$235,639.36 ","$174,373.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS745","DRG","MS745","","D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC","INPATIENT ONLY","$91,531.43 ","$67,733.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS746","DRG","MS746","","VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC","INPATIENT ONLY","$0.00 ","$0.00 ","$0.00 ","$75,281.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,948.45 ","$0.00 ","$0.00 ","$75,281.45 ","$0.00 ","$0.00 ","$0.00 ","$23,760.43 ","$0.00 "
"MS748","DRG","MS748","","FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","INPATIENT ONLY","$154,956.04 ","$114,667.47 ","$0.00 ","$101,307.70 ","$0.00 ","$14,571.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76,748.26 ","$0.00 ","$83,143.95 ","$101,307.70 ","$0.00 ","$13,249.13 ","$0.00 ","$23,938.94 ","$0.00 ","$0.00 "
"MS749","DRG","MS749","","OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC","INPATIENT ONLY","$113,765.76 ","$84,186.66 ","$0.00 ","$104,733.83 ","$104,733.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,516.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,015.58 ","$0.00 "
"MS754","DRG","MS754","","MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC","INPATIENT ONLY","$172,896.37 ","$127,943.31 ","$0.00 ","$27,533.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,213.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,631.52 ","$27,533.80 ","$0.00 ","$12,213.09 "
"MS755","DRG","MS755","","MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC","INPATIENT ONLY","$31,589.96 ","$23,376.57 ","$0.00 ","$20,798.98 ","$0.00 ","$0.00 ","$6,164.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,798.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,808.55 ","$0.00 "
"MS756","DRG","MS756","","MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","INPATIENT ONLY","$13,121.56 ","$9,709.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS757","DRG","MS757","","INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC","INPATIENT ONLY","$32,053.15 ","$23,719.33 ","$0.00 ","$29,643.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,508.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,643.01 ","$22,389.11 ","$0.00 "
"MS758","DRG","MS758","","INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC","INPATIENT ONLY","$32,039.33 ","$23,709.10 ","$0.00 ","$20,399.89 ","$12,259.80 ","$9,388.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,399.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,428.47 ","$0.00 "
"MS759","DRG","MS759","","INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","INPATIENT ONLY","$31,529.67 ","$23,331.96 ","$0.00 ","$5,834.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,834.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,556.33 ","$0.00 ","$0.00 ","$5,834.14 "
"MS760","DRG","MS760","","MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC","INPATIENT ONLY","$22,036.45 ","$16,306.97 ","$0.00 ","$12,958.36 ","$12,958.36 ","$0.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS761","DRG","MS761","","MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$26,444.46 ","$19,568.90 ","$0.00 ","$12,489.77 ","$12,489.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS768","DRG","MS768","","VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C","INPATIENT ONLY","$40,711.25 ","$30,126.33 ","$0.00 ","$21,373.04 ","$19,822.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,092.76 ","$13,853.13 ","$0.00 ","$14,855.59 ","$20,902.18 ","$0.00 ","$10,099.48 ","$5,802.63 ","$21,373.04 ","$0.00 ","$6,092.76 "
"MS769","DRG","MS769","","POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES","INPATIENT ONLY","$269,978.86 ","$199,784.36 ","$0.00 ","$172,148.03 ","$172,148.03 ","$43,372.20 ","$12,300.04 ","$10,125.78 ","$10,125.78 ","$12,361.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,772.78 ","$0.00 ","$0.00 ","$12,361.42 "
"MS770","DRG","MS770","","ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY","INPATIENT ONLY","$31,584.85 ","$23,372.79 ","$0.00 ","$6,160.27 ","$0.00 ","$0.00 ","$6,129.68 ","$0.00 ","$0.00 ","$6,160.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,866.92 ","$0.00 ","$0.00 ","$6,160.27 "
"MS776","DRG","MS776","","POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES","INPATIENT ONLY","$15,568.58 ","$11,520.75 ","$0.00 ","$18,942.70 ","$8,173.20 ","$0.00 ","$2,725.88 ","$5,373.96 ","$6,200.76 ","$6,166.92 ","$3,843.48 ","$0.00 ","$3,376.61 ","$3,044.04 ","$13,481.20 ","$3,843.48 ","$5,873.26 ","$18,942.70 ","$0.00 ","$6,166.92 "
"MS779","DRG","MS779","","ABORTION WITHOUT D&C","INPATIENT ONLY","$16,003.04 ","$11,842.25 ","$0.00 ","$23,300.47 ","$4,106.40 ","$0.00 ","$5,080.47 ","$4,686.44 ","$4,686.44 ","$1,598.25 ","$15,699.75 ","$0.00 ","$16,835.84 ","$23,300.47 ","$0.00 ","$11,445.75 ","$1,430.21 ","$22,469.79 ","$0.00 ","$1,522.14 "
"MS783","DRG","MS783","","CESAREAN SECTION WITH STERILIZATION WITH MCC","INPATIENT ONLY","$71,796.43 ","$53,129.36 ","$0.00 ","$13,830.75 ","$13,830.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,542.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,087.89 ","$0.00 ","$0.00 ","$9,542.28 "
"MS784","DRG","MS784","","CESAREAN SECTION WITH STERILIZATION WITH CC","INPATIENT ONLY","$69,676.31 ","$51,560.47 ","$0.00 ","$37,137.03 ","$0.00 ","$0.00 ","$0.00 ","$6,748.70 ","$6,748.70 ","$9,542.28 ","$14,371.50 ","$0.00 ","$7,705.74 ","$37,137.03 ","$12,460.97 ","$10,477.40 ","$9,087.89 ","$21,680.91 ","$0.00 ","$9,542.28 "
"MS785","DRG","MS785","","CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC","INPATIENT ONLY","$66,138.83 ","$48,942.73 ","$0.00 ","$52,378.97 ","$14,254.51 ","$52,378.97 ","$0.00 ","$6,748.70 ","$6,748.70 ","$9,542.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,087.89 ","$0.00 ","$0.00 ","$9,542.28 "
"MS786","DRG","MS786","","CESAREAN SECTION WITHOUT STERILIZATION WITH MCC","INPATIENT ONLY","$64,226.23 ","$47,527.41 ","$0.00 ","$51,796.52 ","$13,929.31 ","$7,050.47 ","$0.00 ","$6,748.70 ","$6,748.70 ","$9,542.28 ","$23,574.38 ","$0.00 ","$24,076.48 ","$51,796.52 ","$27,565.16 ","$17,186.67 ","$9,087.89 ","$27,146.72 ","$0.00 ","$9,542.28 "
"MS787","DRG","MS787","","CESAREAN SECTION WITHOUT STERILIZATION WITH CC","INPATIENT ONLY","$60,021.02 ","$44,415.55 ","$0.00 ","$38,858.99 ","$13,908.48 ","$9,500.59 ","$0.00 ","$8,614.80 ","$8,614.80 ","$9,542.28 ","$14,375.63 ","$20,947.28 ","$7,707.95 ","$38,858.99 ","$0.00 ","$10,480.42 ","$9,087.89 ","$21,683.37 ","$19,949.79 ","$9,542.28 "
"MS788","DRG","MS788","","CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC","INPATIENT ONLY","$53,940.94 ","$39,916.30 ","$0.00 ","$37,750.88 ","$13,582.80 ","$7,920.73 ","$0.00 ","$0.00 ","$0.00 ","$7,775.68 ","$12,460.25 ","$0.00 ","$13,361.92 ","$37,750.88 ","$0.00 ","$9,084.02 ","$7,405.42 ","$20,545.77 ","$0.00 ","$7,775.68 "
"MS789","DRG","MS789","","NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY","INPATIENT ONLY","$12,236.12 ","$9,054.73 ","$0.00 ","$23,015.92 ","$4,334.40 ","$0.00 ","$18,997.58 ","$3,375.26 ","$3,375.26 ","$23,015.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,596.05 ","$0.00 ","$0.00 ","$219.20 "
"MS790","DRG","MS790","","EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE","INPATIENT ONLY","$47,484.99 ","$35,138.89 ","$0.00 ","$345,528.12 ","$227,852.34 ","$0.00 ","$6,824.32 ","$64,129.94 ","$64,129.94 ","$25,214.25 ","$261,763.73 ","$0.00 ","$283,577.38 ","$345,528.12 ","$0.00 ","$76,626.93 ","$24,017.10 ","$58,657.03 ","$0.00 ","$25,214.25 "
"MS791","DRG","MS791","","PREMATURITY WITH MAJOR PROBLEMS","INPATIENT ONLY","$106,775.51 ","$79,013.88 ","$0.00 ","$131,833.16 ","$86,741.10 ","$0.00 ","$3,625.61 ","$0.00 ","$0.00 ","$22,302.88 ","$19,759.75 ","$0.00 ","$16,878.92 ","$15,649.71 ","$131,833.16 ","$19,759.75 ","$21,244.37 ","$44,228.51 ","$0.00 ","$22,302.88 "
"MS792","DRG","MS792","","PREMATURITY WITHOUT MAJOR PROBLEMS","INPATIENT ONLY","$9,474.02 ","$7,010.77 ","$0.00 ","$31,899.59 ","$5,534.55 ","$0.00 ","$2,752.37 ","$1,783.96 ","$1,783.96 ","$3,643.33 ","$5,340.18 ","$0.00 ","$5,340.18 ","$4,229.42 ","$0.00 ","$5,340.18 ","$3,473.37 ","$31,899.59 ","$0.00 ","$3,643.33 "
"MS793","DRG","MS793","","FULL TERM NEONATE WITH MAJOR PROBLEMS","INPATIENT ONLY","$31,960.27 ","$23,650.60 ","$0.00 ","$45,073.74 ","$32,199.00 ","$16,677.00 ","$0.00 ","$1,873.16 ","$1,873.16 ","$22,302.88 ","$4,386.25 ","$0.00 ","$4,386.25 ","$3,473.91 ","$19,810.22 ","$4,386.25 ","$21,244.37 ","$45,073.74 ","$0.00 ","$22,302.88 "
"MS794","DRG","MS794","","NEONATE WITH OTHER SIGNIFICANT PROBLEMS","INPATIENT ONLY","$6,506.03 ","$4,814.46 ","$0.00 ","$24,446.07 ","$3,699.60 ","$4,761.00 ","$0.00 ","$1,873.16 ","$1,873.16 ","$2,765.74 ","$5,394.25 ","$0.00 ","$5,394.25 ","$4,272.25 ","$0.00 ","$5,394.25 ","$2,637.56 ","$24,446.07 ","$0.00 ","$2,765.74 "
"MS795","DRG","MS795","","NORMAL NEWBORN","INPATIENT ONLY","$4,674.03 ","$3,458.78 ","$0.00 ","$14,674.90 ","$3,689.70 ","$1,012.00 ","$1,296.58 ","$2,809.74 ","$2,809.74 ","$2,149.62 ","$2,575.38 ","$0.00 ","$1,781.77 ","$3,743.93 ","$2,259.28 ","$1,877.55 ","$2,050.78 ","$14,674.90 ","$0.00 ","$2,149.62 "
"MS796","DRG","MS796","","VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC","INPATIENT ONLY","$54,907.25 ","$40,631.37 ","$0.00 ","$8,366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,967.75 ","$0.00 ","$0.00 ","$8,366.13 "
"MS797","DRG","MS797","","VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC","INPATIENT ONLY","$45,318.16 ","$33,535.44 ","$0.00 ","$8,366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,967.75 ","$0.00 ","$0.00 ","$8,366.13 "
"MS798","DRG","MS798","","VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC","INPATIENT ONLY","$52,110.07 ","$38,561.45 ","$0.00 ","$8,366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,967.75 ","$0.00 ","$0.00 ","$8,366.13 "
"MS799","DRG","MS799","","SPLENECTOMY WITH MCC","INPATIENT ONLY","$327,183.49 ","$242,115.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS801","DRG","MS801","","SPLENECTOMY WITHOUT CC/MCC","INPATIENT ONLY","$172,895.48 ","$127,942.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS802","DRG","MS802","","OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC","INPATIENT ONLY","$596,528.35 ","$441,430.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS803","DRG","MS803","","OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC","INPATIENT ONLY","$251,863.58 ","$186,379.05 ","$0.00 ","$27,694.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,694.69 ","$0.00 ","$0.00 "
"MS805","DRG","MS805","","VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC","INPATIENT ONLY","$30,983.57 ","$22,927.84 ","$0.00 ","$29,462.16 ","$11,805.47 ","$29,462.16 ","$0.00 ","$8,418.64 ","$8,418.64 ","$6,961.79 ","$14,309.63 ","$0.00 ","$7,672.56 ","$14,281.34 ","$0.00 ","$10,432.30 ","$6,630.28 ","$25,233.70 ","$0.00 ","$6,961.79 "
"MS806","DRG","MS806","","VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC","INPATIENT ONLY","$25,294.22 ","$18,717.72 ","$0.00 ","$21,350.23 ","$8,052.96 ","$6,550.61 ","$0.00 ","$4,686.44 ","$4,686.44 ","$6,092.76 ","$9,751.50 ","$18,649.09 ","$7,746.04 ","$13,604.81 ","$21,350.23 ","$7,109.24 ","$5,802.63 ","$18,936.98 ","$17,761.04 ","$6,092.76 "
"MS807","DRG","MS807","","VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC","INPATIENT ONLY","$22,303.67 ","$16,504.72 ","$0.00 ","$18,264.05 ","$8,254.49 ","$5,733.00 ","$0.00 ","$4,686.44 ","$4,686.44 ","$6,092.76 ","$8,618.50 ","$0.00 ","$8,401.97 ","$11,615.99 ","$17,521.13 ","$6,283.23 ","$5,802.63 ","$18,264.05 ","$0.00 ","$6,092.76 "
"MS808","DRG","MS808","","MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC","INPATIENT ONLY","$34,593.18 ","$25,598.95 ","$0.00 ","$30,536.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,536.62 ","$0.00 ","$0.00 "
"MS809","DRG","MS809","","MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC","INPATIENT ONLY","$75,870.07 ","$56,143.85 ","$0.00 ","$22,111.75 ","$0.00 ","$0.00 ","$12,843.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,111.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,058.81 ","$0.00 "
"MS810","DRG","MS810","","MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$26,038.35 ","$19,268.38 ","$0.00 ","$20,194.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,194.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,233.22 ","$0.00 "
"MS811","DRG","MS811","","RED BLOOD CELL DISORDERS WITH MCC","INPATIENT ONLY","$37,057.02 ","$27,422.19 ","$0.00 ","$78,735.41 ","$23,615.76 ","$11,450.82 ","$3,403.76 ","$13,434.90 ","$15,501.90 ","$30,963.95 ","$18,429.13 ","$22,961.85 ","$19,762.72 ","$78,735.41 ","$0.00 ","$13,435.57 ","$30,963.95 ","$24,090.82 ","$21,868.43 ","$30,963.95 "
"MS812","DRG","MS812","","RED BLOOD CELL DISORDERS WITHOUT MCC","INPATIENT ONLY","$30,116.25 ","$22,286.03 ","$0.00 ","$24,519.60 ","$24,519.60 ","$7,285.18 ","$8,031.31 ","$2,686.98 ","$2,686.98 ","$8,071.38 ","$11,972.13 ","$19,752.74 ","$3,776.02 ","$13,151.79 ","$0.00 ","$8,728.17 ","$7,687.04 ","$20,255.87 ","$18,812.13 ","$8,071.38 "
"MS813","DRG","MS813","","COAGULATION DISORDERS","INPATIENT ONLY","$130,887.07 ","$96,856.43 ","$0.00 ","$87,448.69 ","$0.00 ","$0.00 ","$11,549.79 ","$0.00 ","$0.00 ","$0.00 ","$66,249.02 ","$0.00 ","$23,373.77 ","$87,448.69 ","$0.00 ","$15,890.52 ","$0.00 ","$52,183.21 ","$0.00 ","$0.00 "
"MS814","DRG","MS814","","RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC","INPATIENT ONLY","$30,605.13 ","$22,647.80 ","$0.00 ","$27,429.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,755.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,429.29 ","$24,529.05 ","$0.00 "
"MS815","DRG","MS815","","RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC","INPATIENT ONLY","$62,708.27 ","$46,404.12 ","$0.00 ","$21,416.31 ","$0.00 ","$0.00 ","$11,825.34 ","$16,564.80 ","$16,978.20 ","$0.00 ","$0.00 ","$20,723.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,416.31 ","$19,736.96 ","$0.00 "
"MS816","DRG","MS816","","RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC","INPATIENT ONLY","$36,966.21 ","$27,355.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS817","DRG","MS817","","OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$331,165.41 ","$245,062.40 ","$0.00 ","$196,880.15 ","$12,259.80 ","$196,880.15 ","$0.00 ","$0.00 ","$0.00 ","$15,615.48 ","$34,597.75 ","$0.00 ","$32,736.50 ","$78,339.09 ","$0.00 ","$25,223.16 ","$11,253.79 ","$33,693.78 ","$0.00 ","$7,558.26 "
"MS818","DRG","MS818","","OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC","INPATIENT ONLY","$97,432.35 ","$72,099.94 ","$0.00 ","$86,024.42 ","$0.00 ","$86,024.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS819","DRG","MS819","","OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$70,909.67 ","$52,473.16 ","$0.00 ","$7,495.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,495.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,138.29 ","$0.00 ","$0.00 ","$7,495.20 "
"MS821","DRG","MS821","","LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC","INPATIENT ONLY","$162,576.13 ","$120,306.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS823","DRG","MS823","","LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC","INPATIENT ONLY","$630,888.82 ","$466,857.73 ","$0.00 ","$65,586.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65,586.69 ","$0.00 ","$0.00 "
"MS824","DRG","MS824","","LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC","INPATIENT ONLY","$51,601.70 ","$38,185.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS826","DRG","MS826","","MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$379,947.04 ","$281,160.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS827","DRG","MS827","","MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC","INPATIENT ONLY","$423,291.52 ","$313,235.72 ","$0.00 ","$32,906.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,906.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,906.05 ","$0.00 "
"MS828","DRG","MS828","","MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$247,026.79 ","$182,799.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","","","","","","","","","","","","",""
"MS829","DRG","MS829","","MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC","INPATIENT ONLY","$279,328.65 ","$206,703.20 ","$0.00 ","$38,787.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38,787.20 ","$0.00 ","$0.00 "
"MS830","DRG","MS830","","MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$211,300.46 ","$156,362.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS831","DRG","MS831","","OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$29,160.39 ","$21,578.69 ","$0.00 ","$21,952.85 ","$20,552.75 ","$10,012.94 ","$0.00 ","$0.00 ","$0.00 ","$7,495.20 ","$14,829.38 ","$0.00 ","$9,939.05 ","$19,151.15 ","$0.00 ","$10,811.22 ","$7,138.29 ","$21,952.85 ","$0.00 ","$7,495.20 "
"MS832","DRG","MS832","","OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC","INPATIENT ONLY","$20,347.40 ","$15,057.08 ","$0.00 ","$18,988.42 ","$12,259.80 ","$0.00 ","$0.00 ","$5,373.96 ","$6,200.76 ","$7,495.20 ","$13,838.13 ","$18,692.12 ","$2,930.57 ","$10,159.89 ","$0.00 ","$7,172.39 ","$7,138.29 ","$18,988.42 ","$17,802.02 ","$7,495.20 "
"MS833","DRG","MS833","","OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$14,743.82 ","$10,910.43 ","$0.00 ","$8,272.70 ","$8,272.70 ","$2,152.00 ","$0.00 ","$2,686.98 ","$3,100.38 ","$6,092.76 ","$7,048.80 ","$0.00 ","$7,048.80 ","$7,048.80 ","$6,068.80 ","$7,048.80 ","$5,802.63 ","$7,048.80 ","$0.00 ","$6,092.76 "
"MS834","DRG","MS834","","ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$507,748.30 ","$375,733.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS835","DRG","MS835","","ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC","INPATIENT ONLY","$40,262.10 ","$29,793.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS836","DRG","MS836","","ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$18,640.57 ","$13,794.02 ","$0.00 ","$23,905.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,905.45 ","$0.00 ","$0.00 "
"MS837","DRG","MS837","","CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC","INPATIENT ONLY","$51,339.82 ","$37,991.47 ","$0.00 ","$62,068.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62,068.97 ","$0.00 ","$0.00 "
"MS838","DRG","MS838","","CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT","INPATIENT ONLY","$48,284.50 ","$35,730.53 ","$0.00 ","$31,012.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,012.72 ","$0.00 ","$0.00 "
"MS839","DRG","MS839","","CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC","INPATIENT ONLY","$46,940.94 ","$34,736.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS840","DRG","MS840","","LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC","INPATIENT ONLY","$189,074.54 ","$139,915.16 ","$0.00 ","$34,299.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34,299.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,807.13 ","$34,299.15 ","$0.00 "
"MS841","DRG","MS841","","LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC","INPATIENT ONLY","$15,184.92 ","$11,236.84 ","$0.00 ","$19,565.68 ","$0.00 ","$0.00 ","$13,446.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,565.68 ","$0.00 ","$0.00 "
"MS842","DRG","MS842","","LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC","INPATIENT ONLY","$38,523.96 ","$28,507.73 ","$0.00 ","$21,645.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,645.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,614.66 ","$0.00 "
"MS843","DRG","MS843","","OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC","INPATIENT ONLY","$90,251.16 ","$66,785.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS844","DRG","MS844","","OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC","INPATIENT ONLY","$25,954.84 ","$19,206.58 ","$0.00 ","$22,057.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,057.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,007.37 ","$0.00 "
"MS846","DRG","MS846","","CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC","INPATIENT ONLY","$30,411.91 ","$22,504.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS847","DRG","MS847","","CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC","INPATIENT ONLY","$31,407.44 ","$23,241.51 ","$0.00 ","$45,264.16 ","$8,173.20 ","$5,107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,093.63 ","$0.00 ","$19,402.95 ","$45,264.16 ","$34,827.46 ","$13,190.98 ","$0.00 ","$23,891.56 ","$0.00 ","$0.00 "
"MS848","DRG","MS848","","CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC","INPATIENT ONLY","$30,134.29 ","$22,299.37 ","$0.00 ","$22,966.96 ","$12,259.80 ","$7,545.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,494.25 ","$0.00 ","$12,768.30 ","$22,966.96 ","$0.00 ","$9,837.86 ","$0.00 ","$21,159.88 ","$0.00 ","$0.00 "
"MS853","DRG","MS853","","INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$349,119.20 ","$258,348.21 ","$0.00 ","$890,931.60 ","$17,269.35 ","$0.00 ","$50,464.10 ","$890,931.60 ","$890,931.60 ","$0.00 ","$428,083.19 ","$48,645.14 ","$463,756.79 ","$565,069.81 ","$228,902.42 ","$140,496.05 ","$0.00 ","$54,782.85 ","$46,328.70 ","$0.00 "
"MS854","DRG","MS854","","INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC","INPATIENT ONLY","$172,549.34 ","$127,686.51 ","$0.00 ","$28,571.70 ","$0.00 ","$0.00 ","$0.00 ","$766.50 ","$766.50 ","$0.00 ","$0.00 ","$28,571.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,211.14 ","$0.00 "
"MS856","DRG","MS856","","POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$469,903.79 ","$347,728.80 ","$0.00 ","$49,287.63 ","$21,079.29 ","$0.00 ","$37,955.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49,287.63 ","$0.00 ","$0.00 "
"MS857","DRG","MS857","","POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC","INPATIENT ONLY","$110,455.26 ","$81,736.89 ","$0.00 ","$409,840.86 ","$90,864.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310,485.49 ","$27,697.65 ","$336,359.28 ","$409,840.86 ","$0.00 ","$88,518.80 ","$0.00 ","$53,140.71 ","$26,378.71 ","$0.00 "
"MS858","DRG","MS858","","POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC","INPATIENT ONLY","$300,169.86 ","$222,125.70 ","$0.00 ","$206,438.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206,438.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS862","DRG","MS862","","POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC","INPATIENT ONLY","$41,178.47 ","$30,472.07 ","$0.00 ","$28,258.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,258.17 ","$0.00 ","$0.00 "
"MS863","DRG","MS863","","POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC","INPATIENT ONLY","$26,750.77 ","$19,795.57 ","$0.00 ","$20,554.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,554.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,575.56 ","$0.00 "
"MS864","DRG","MS864","","FEVER AND INFLAMMATORY CONDITIONS","INPATIENT ONLY","$19,333.68 ","$14,306.92 ","$0.00 ","$47,628.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47,628.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,690.76 ","$0.00 "
"MS865","DRG","MS865","","VIRAL ILLNESS WITH MCC","INPATIENT ONLY","$14,496.05 ","$10,727.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS866","DRG","MS866","","VIRAL ILLNESS WITHOUT MCC","INPATIENT ONLY","$34,717.88 ","$25,691.23 ","$0.00 ","$26,124.06 ","$0.00 ","$0.00 ","$6,802.34 ","$0.00 ","$0.00 ","$0.00 ","$11,257.13 ","$0.00 ","$10,651.53 ","$26,124.06 ","$0.00 ","$8,206.90 ","$0.00 ","$19,831.20 ","$0.00 ","$0.00 "
"MS867","DRG","MS867","","OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC","INPATIENT ONLY","$63,136.42 ","$46,720.95 ","$0.00 ","$112,359.77 ","$112,359.77 ","$0.00 ","$16,751.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS868","DRG","MS868","","OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC","INPATIENT ONLY","$30,779.69 ","$22,776.97 ","$0.00 ","$69,508.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,083.75 ","$0.00 ","$16,175.27 ","$69,508.29 ","$0.00 ","$10,996.66 ","$0.00 ","$22,103.93 ","$0.00 ","$0.00 "
"MS869","DRG","MS869","","OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC","INPATIENT ONLY","$15,619.28 ","$11,558.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS870","DRG","MS870","","SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS","INPATIENT ONLY","$342,603.24 ","$253,526.40 ","$0.00 ","$437,462.32 ","$222,926.65 ","$0.00 ","$53,865.50 ","$329,494.18 ","$329,589.60 ","$0.00 ","$331,410.85 ","$57,021.26 ","$359,028.42 ","$437,462.32 ","$0.00 ","$105,276.97 ","$0.00 ","$64,792.48 ","$71,505.46 ","$0.00 "
"MS871","DRG","MS871","","SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC","INPATIENT ONLY","$99,302.62 ","$73,483.94 ","$7,088.64 ","$69,468.99 ","$49,039.20 ","$16,130.58 ","$17,521.48 ","$7,088.64 ","$7,088.64 ","$17,608.91 ","$25,661.63 ","$26,556.42 ","$27,518.59 ","$69,468.99 ","$47,721.33 ","$18,708.37 ","$16,770.40 ","$28,386.40 ","$30,367.39 ","$17,608.91 "
"MS872","DRG","MS872","","SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC","INPATIENT ONLY","$39,146.17 ","$28,968.17 ","$0.00 ","$25,653.18 ","$12,923.98 ","$9,397.01 ","$9,417.32 ","$0.00 ","$0.00 ","$7,781.16 ","$14,290.38 ","$20,904.90 ","$7,127.66 ","$25,653.18 ","$0.00 ","$10,418.26 ","$6,963.04 ","$21,632.73 ","$19,909.43 ","$7,410.63 "
"MS876","DRG","MS876","","O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS","INPATIENT ONLY","$147,401.50 ","$109,077.11 ","$0.00 ","$46,127.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,127.21 ","$0.00 ","$0.00 "
"MS880","DRG","MS880","","ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION","INPATIENT ONLY","$37,752.98 ","$27,937.21 ","$0.00 ","$50,316.83 ","$4,100.18 ","$0.00 ","$5,575.59 ","$6,750.52 ","$6,750.52 ","$5,883.58 ","$11,782.38 ","$50,316.83 ","$7,019.44 ","$50,065.60 ","$33,004.93 ","$8,589.83 ","$5,603.41 ","$20,143.15 ","$49,378.27 ","$5,883.58 "
"MS881","DRG","MS881","","DEPRESSIVE NEUROSES","INPATIENT ONLY","$19,663.24 ","$14,550.80 ","$0.00 ","$19,401.50 ","$12,913.95 ","$5,769.59 ","$0.00 ","$0.00 ","$0.00 ","$5,075.40 ","$0.00 ","$19,401.50 ","$0.00 ","$0.00 ","$5,860.95 ","$0.00 ","$4,833.71 ","$0.00 ","$18,477.62 ","$5,075.40 "
"MS882","DRG","MS882","","NEUROSES EXCEPT DEPRESSIVE","INPATIENT ONLY","$20,130.12 ","$14,896.29 ","$0.00 ","$12,620.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,620.55 ","$0.00 ","$0.00 "
"MS883","DRG","MS883","","DISORDERS OF PERSONALITY AND IMPULSE CONTROL","INPATIENT ONLY","$21,248.40 ","$15,723.82 ","$0.00 ","$22,936.59 ","$16,782.35 ","$0.00 ","$0.00 ","$5,619.48 ","$5,619.48 ","$7,497.10 ","$0.00 ","$22,936.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,140.10 ","$7,183.84 ","$21,844.37 ","$7,497.10 "
"MS884","DRG","MS884","","ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY","INPATIENT ONLY","$38,142.56 ","$28,225.49 ","$0.00 ","$69,644.94 ","$69,644.94 ","$9,624.61 ","$10,098.77 ","$2,686.98 ","$3,100.38 ","$0.00 ","$0.00 ","$23,629.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,888.70 ","$22,504.30 ","$0.00 "
"MS885","DRG","MS885","","PSYCHOSES","INPATIENT ONLY","$27,249.99 ","$20,164.99 ","$4,682.90 ","$16,711.75 ","$5,534.55 ","$9,119.42 ","$6,833.56 ","$4,682.90 ","$4,682.90 ","$6,867.66 ","$16,711.75 ","$9,222.35 ","$12,800.77 ","$14,261.38 ","$11,383.39 ","$9,000.00 ","$6,540.64 ","$4,851.36 ","$8,783.19 ","$6,867.66 "
"MS886","DRG","MS886","","BEHAVIORAL AND DEVELOPMENTAL DISORDERS","INPATIENT ONLY","$18,427.83 ","$13,636.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS887","DRG","MS887","","OTHER MENTAL DISORDER DIAGNOSES","INPATIENT ONLY","$41,241.49 ","$30,518.70 ","$0.00 ","$57,514.90 ","$0.00 ","$8,326.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,961.38 ","$0.00 ","$16,044.03 ","$57,514.90 ","$0.00 ","$10,907.45 ","$0.00 ","$22,031.26 ","$0.00 ","$0.00 "
"MS894","DRG","MS894","","ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA","INPATIENT ONLY","$21,543.05 ","$15,941.86 ","$0.00 ","$17,768.90 ","$4,086.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,291.30 ","$0.00 ","$17,768.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,658.39 ","$0.00 ","$16,922.76 ","$13,291.30 "
"MS896","DRG","MS896","","ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC","INPATIENT ONLY","$49,326.69 ","$36,501.75 ","$0.00 ","$40,932.53 ","$4,136.10 ","$13,606.38 ","$0.00 ","$3,375.26 ","$3,375.26 ","$0.00 ","$23,645.88 ","$25,554.59 ","$15,138.49 ","$40,932.53 ","$0.00 ","$17,238.80 ","$0.00 ","$27,189.19 ","$24,337.70 ","$0.00 "
"MS897","DRG","MS897","","ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC","INPATIENT ONLY","$30,584.36 ","$22,632.43 ","$0.00 ","$41,618.80 ","$12,711.30 ","$6,163.22 ","$0.00 ","$5,623.04 ","$5,813.88 ","$6,821.08 ","$41,618.80 ","$19,418.55 ","$41,618.80 ","$32,962.09 ","$14,261.88 ","$41,618.80 ","$6,496.27 ","$4,824.19 ","$18,493.86 ","$6,821.08 "
"MS901","DRG","MS901","","WOUND DEBRIDEMENTS FOR INJURIES WITH MCC","INPATIENT ONLY","$368,092.68 ","$272,388.58 ","$0.00 ","$137,327.80 ","$0.00 ","$0.00 ","$0.00 ","$137,327.80 ","$137,327.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS902","DRG","MS902","","WOUND DEBRIDEMENTS FOR INJURIES WITH CC","INPATIENT ONLY","$122,560.83 ","$90,695.01 ","$0.00 ","$29,207.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,243.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,207.95 ","$25,946.57 ","$0.00 "
"MS903","DRG","MS903","","WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC","INPATIENT ONLY","$69,084.55 ","$51,122.57 ","$0.00 ","$342,304.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259,321.57 ","$0.00 ","$280,931.70 ","$342,304.46 ","$0.00 ","$66,795.60 ","$0.00 ","$40,627.42 ","$0.00 ","$0.00 "
"MS904","DRG","MS904","","SKIN GRAFTS FOR INJURIES WITH CC/MCC","INPATIENT ONLY","$587,248.63 ","$434,563.99 ","$0.00 ","$136,934.37 ","$0.00 ","$0.00 ","$0.00 ","$132,961.05 ","$132,961.05 ","$25,040.40 ","$103,738.17 ","$0.00 ","$112,383.02 ","$136,934.37 ","$0.00 ","$35,459.97 ","$23,848.01 ","$42,033.36 ","$0.00 ","$25,040.40 "
"MS905","DRG","MS905","","SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC","INPATIENT ONLY","$130,398.68 ","$96,495.02 ","$0.00 ","$57,852.44 ","$0.00 ","$0.00 ","$0.00 ","$57,852.44 ","$57,852.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS906","DRG","MS906","","HAND PROCEDURES FOR INJURIES","INPATIENT ONLY","$173,990.59 ","$128,753.04 ","$0.00 ","$184,096.43 ","$184,096.43 ","$49,807.27 ","$0.00 ","$102,200.59 ","$102,200.59 ","$0.00 ","$118,233.52 ","$0.00 ","$128,086.32 ","$156,068.25 ","$0.00 ","$17,451.31 ","$0.00 ","$27,362.32 ","$0.00 ","$0.00 "
"MS907","DRG","MS907","","OTHER O.R. PROCEDURES FOR INJURIES WITH MCC","INPATIENT ONLY","$314,976.43 ","$233,082.56 ","$0.00 ","$388,246.60 ","$217,751.34 ","$0.00 ","$30,419.81 ","$71,015.93 ","$71,015.93 ","$41,365.72 ","$189,941.91 ","$0.00 ","$205,770.40 ","$250,723.31 ","$0.00 ","$45,461.07 ","$39,395.94 ","$388,246.60 ","$0.00 ","$41,365.72 "
"MS908","DRG","MS908","","OTHER O.R. PROCEDURES FOR INJURIES WITH CC","INPATIENT ONLY","$152,656.61 ","$112,965.89 ","$0.00 ","$182,669.21 ","$0.00 ","$0.00 ","$34,521.96 ","$0.00 ","$0.00 ","$16,654.30 ","$89,996.30 ","$27,901.30 ","$97,496.00 ","$118,795.12 ","$182,669.21 ","$20,681.15 ","$15,861.25 ","$29,993.55 ","$26,572.67 ","$16,654.30 "
"MS909","DRG","MS909","","OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC","INPATIENT ONLY","$15,837.75 ","$11,719.94 ","$0.00 ","$58,188.52 ","$0.00 ","$0.00 ","$11,600.88 ","$0.00 ","$0.00 ","$16,654.30 ","$18,132.13 ","$22,814.25 ","$47,755.73 ","$58,188.52 ","$0.00 ","$13,219.05 ","$15,861.25 ","$23,914.43 ","$21,727.86 ","$16,654.30 "
"MS913","DRG","MS913","","TRAUMATIC INJURY WITH MCC","INPATIENT ONLY","$58,527.66 ","$43,310.47 ","$0.00 ","$25,201.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,201.47 ","$0.00 ","$0.00 "
"MS914","DRG","MS914","","TRAUMATIC INJURY WITHOUT MCC","INPATIENT ONLY","$50,070.45 ","$37,052.13 ","$0.00 ","$42,063.45 ","$19,477.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,848.38 ","$0.00 ","$34,521.77 ","$42,063.45 ","$0.00 ","$8,637.95 ","$0.00 ","$20,182.36 ","$0.00 ","$0.00 "
"MS915","DRG","MS915","","ALLERGIC REACTIONS WITH MCC","INPATIENT ONLY","$13,523.90 ","$10,007.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS916","DRG","MS916","","ALLERGIC REACTIONS WITHOUT MCC","INPATIENT ONLY","$18,896.57 ","$13,983.46 ","$0.00 ","$18,988.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,129.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,316.33 ","$18,988.45 ","$0.00 "
"MS917","DRG","MS917","","POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC","INPATIENT ONLY","$41,023.80 ","$30,357.61 ","$0.00 ","$51,372.18 ","$17,715.70 ","$12,541.54 ","$6,253.67 ","$9,562.04 ","$9,657.46 ","$11,999.16 ","$20,119.00 ","$23,801.74 ","$17,979.07 ","$51,372.18 ","$0.00 ","$14,667.56 ","$11,427.78 ","$25,094.49 ","$22,668.32 ","$11,999.16 "
"MS918","DRG","MS918","","POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC","INPATIENT ONLY","$26,175.61 ","$19,369.95 ","$2,488.34 ","$19,547.84 ","$4,453.30 ","$2,488.34 ","$6,225.23 ","$5,623.04 ","$5,813.88 ","$6,256.30 ","$10,780.00 ","$19,160.25 ","$3,729.06 ","$12,112.06 ","$13,648.19 ","$6,834.23 ","$5,958.38 ","$19,547.84 ","$18,247.86 ","$6,256.30 "
"MS919","DRG","MS919","","COMPLICATIONS OF TREATMENT WITH MCC","INPATIENT ONLY","$64,348.49 ","$47,617.88 ","$0.00 ","$69,950.28 ","$5,749.93 ","$0.00 ","$11,257.45 ","$0.00 ","$0.00 ","$0.00 ","$25,097.88 ","$26,276.23 ","$26,914.05 ","$69,950.28 ","$0.00 ","$18,297.37 ","$0.00 ","$28,051.57 ","$25,024.98 ","$0.00 "
"MS920","DRG","MS920","","COMPLICATIONS OF TREATMENT WITH CC","INPATIENT ONLY","$24,394.92 ","$18,052.24 ","$0.00 ","$28,277.30 ","$0.00 ","$0.00 ","$0.00 ","$6,750.52 ","$6,750.52 ","$0.00 ","$13,853.13 ","$20,687.60 ","$14,855.59 ","$28,277.30 ","$0.00 ","$10,099.48 ","$0.00 ","$21,373.04 ","$19,702.48 ","$0.00 "
"MS921","DRG","MS921","","COMPLICATIONS OF TREATMENT WITHOUT CC/MCC","INPATIENT ONLY","$34,245.21 ","$25,341.46 ","$0.00 ","$18,521.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,521.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,639.98 ","$0.00 "
"MS922","DRG","MS922","","OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC","INPATIENT ONLY","$72,838.99 ","$53,900.85 ","$0.00 ","$61,719.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,492.22 ","$22,049.50 ","$0.00 ","$3,753.19 ","$61,719.57 ","$0.00 ","$16,074.98 ","$1,335.32 ","$26,241.08 ","$0.00 ","$1,421.16 "
"MS923","DRG","MS923","","OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC","INPATIENT ONLY","$20,532.46 ","$15,194.02 ","$0.00 ","$2,906.94 ","$0.00 ","$0.00 ","$0.00 ","$2,811.52 ","$2,906.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS927","DRG","MS927","","EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT","INPATIENT ONLY","$756,935.58 ","$560,132.33 ","$0.00 ","$636,813.54 ","$636,813.54 ","$0.00 ","$122,178.14 ","$0.00 ","$0.00 ","$128,927.26 ","$277,762.11 ","$0.00 ","$300,908.95 ","$366,645.98 ","$0.00 ","$199,919.71 ","$122,787.92 ","$176,013.20 ","$0.00 ","$128,927.26 "
"MS928","DRG","MS928","","FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC","INPATIENT ONLY","$201,318.93 ","$148,976.01 ","$0.00 ","$242,850.15 ","$242,850.15 ","$48,038.28 ","$21,161.06 ","$98,182.96 ","$98,182.96 ","$21,266.66 ","$95,851.28 ","$56,136.99 ","$103,838.89 ","$126,523.70 ","$0.00 ","$62,099.56 ","$20,253.97 ","$63,735.75 ","$53,463.80 ","$21,266.66 "
"MS929","DRG","MS929","","FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC","INPATIENT ONLY","$110,995.12 ","$82,136.39 ","$9,637.44 ","$80,164.64 ","$67,878.36 ","$20,836.22 ","$9,637.44 ","$80,164.64 ","$80,164.64 ","$10,169.81 ","$48,185.37 ","$33,904.08 ","$52,200.82 ","$63,604.70 ","$60,897.37 ","$62,099.56 ","$9,685.54 ","$63,735.75 ","$32,289.60 ","$10,169.81 "
"MS933","DRG","MS933","","EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT","INPATIENT ONLY","$239,425.50 ","$177,174.87 ","$0.00 ","$35,261.93 ","$0.00 ","$0.00 ","$34,672.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,261.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33,582.79 ","$0.00 "
"MS934","DRG","MS934","","FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY","INPATIENT ONLY","$21,519.08 ","$15,924.12 ","$0.00 ","$32,060.98 ","$32,060.98 ","$0.00 ","$9,096.60 ","$5,099.09 ","$5,099.09 ","$2,480.91 ","$12,524.62 ","$26,170.31 ","$4,043.26 ","$16,532.51 ","$0.00 ","$18,141.99 ","$2,220.06 ","$27,924.99 ","$24,924.10 ","$2,362.77 "
"MS935","DRG","MS935","","NON-EXTENSIVE BURNS","INPATIENT ONLY","$41,960.79 ","$31,050.98 ","$0.00 ","$28,925.37 ","$15,650.93 ","$0.00 ","$8,178.90 ","$8,993.40 ","$8,993.40 ","$2,693.89 ","$23,337.97 ","$27,007.44 ","$15,169.68 ","$18,483.67 ","$7,817.30 ","$19,369.96 ","$2,410.65 ","$28,925.37 ","$25,721.37 ","$2,565.61 "
"MS940","DRG","MS940","","O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC","INPATIENT ONLY","$94,350.10 ","$69,819.07 ","$0.00 ","$27,930.95 ","$20,433.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,930.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,930.95 ","$0.00 "
"MS941","DRG","MS941","","O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC","INPATIENT ONLY","$142,894.44 ","$105,741.89 ","$0.00 ","$26,996.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,996.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,710.97 ","$0.00 "
"MS947","DRG","MS947","","SIGNS AND SYMPTOMS WITH MCC","INPATIENT ONLY","$47,907.15 ","$35,451.29 ","$0.00 ","$22,923.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,525.45 ","$0.00 ","$21,984.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,833.77 ","$22,923.01 ","$20,937.74 ","$14,525.45 "
"MS948","DRG","MS948","","SIGNS AND SYMPTOMS WITHOUT MCC","INPATIENT ONLY","$17,563.09 ","$12,996.69 ","$0.00 ","$31,248.40 ","$20,433.00 ","$0.00 ","$7,783.43 ","$2,686.98 ","$3,100.38 ","$0.00 ","$10,719.50 ","$19,130.18 ","$3,483.39 ","$31,248.40 ","$17,149.01 ","$6,011.26 ","$0.00 ","$19,511.90 ","$18,219.22 ","$0.00 "
"MS950","DRG","MS950","","AFTERCARE WITHOUT CC/MCC","INPATIENT ONLY","$41,083.74 ","$30,401.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS951","DRG","MS951","","OTHER FACTORS INFLUENCING HEALTH STATUS","INPATIENT ONLY","$55,607.65 ","$41,149.66 ","$0.00 ","$20,033.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,033.73 ","$0.00 ","$0.00 "
"MS955","DRG","MS955","","CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","INPATIENT ONLY","$622,062.28 ","$460,326.09 ","$0.00 ","$646,654.77 ","$646,654.77 ","$0.00 ","$0.00 ","$155,516.11 ","$155,516.11 ","$56,532.01 ","$333,518.09 ","$74,415.79 ","$361,311.27 ","$440,243.88 ","$303,884.19 ","$105,609.45 ","$53,840.04 ","$62,801.51 ","$70,872.18 ","$56,532.01 "
"MS956","DRG","MS956","","LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","INPATIENT ONLY","$228,564.82 ","$169,137.97 ","$0.00 ","$278,577.75 ","$147,277.43 ","$0.00 ","$117,843.05 ","$57,043.76 ","$57,043.76 ","$103,932.75 ","$161,097.81 ","$40,613.44 ","$174,522.63 ","$212,649.13 ","$278,577.75 ","$39,328.35 ","$84,114.71 ","$45,184.81 ","$38,679.47 ","$53,545.64 "
"MS957","DRG","MS957","","OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC","INPATIENT ONLY","$302,297.61 ","$223,700.23 ","$62,177.15 ","$661,644.95 ","$303,164.25 ","$144,907.91 ","$80,138.05 ","$190,235.48 ","$190,235.48 ","$80,537.94 ","$256,957.20 ","$65,286.01 ","$278,370.30 ","$339,183.51 ","$661,644.95 ","$78,684.59 ","$76,702.83 ","$74,669.01 ","$62,177.15 ","$80,537.94 "
"MS958","DRG","MS958","","OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC","INPATIENT ONLY","$285,394.08 ","$211,191.62 ","$0.00 ","$243,925.14 ","$243,925.14 ","$0.00 ","$33,019.28 ","$132,225.45 ","$132,225.45 ","$33,184.05 ","$120,574.69 ","$42,442.17 ","$130,622.58 ","$159,158.58 ","$179,708.38 ","$42,010.85 ","$31,603.87 ","$47,370.16 ","$40,421.11 ","$33,184.05 "
"MS959","DRG","MS959","","OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC","INPATIENT ONLY","$198,587.32 ","$146,954.62 ","$0.00 ","$121,673.30 ","$117,245.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,439.46 ","$92,176.73 ","$0.00 ","$99,858.13 ","$121,673.30 ","$0.00 ","$28,073.07 ","$19,466.16 ","$36,015.52 ","$0.00 ","$20,439.46 "
"MS963","DRG","MS963","","OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC","INPATIENT ONLY","$102,608.59 ","$75,930.36 ","$0.00 ","$113,231.89 ","$29,282.40 ","$24,162.84 ","$0.00 ","$69,300.83 ","$69,300.83 ","$30,904.01 ","$37,470.13 ","$32,425.24 ","$64,598.93 ","$78,711.32 ","$113,231.89 ","$27,317.23 ","$29,432.41 ","$35,399.75 ","$30,881.18 ","$30,904.01 "
"MS964","DRG","MS964","","OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC","INPATIENT ONLY","$102,198.77 ","$75,627.09 ","$0.00 ","$62,293.64 ","$19,477.40 ","$13,182.41 ","$17,222.51 ","$36,292.83 ","$36,292.83 ","$4,534.88 ","$20,535.63 ","$0.00 ","$51,124.83 ","$62,293.64 ","$33,880.61 ","$14,971.29 ","$4,058.08 ","$25,341.92 ","$0.00 ","$4,318.93 "
"MS965","DRG","MS965","","OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC","INPATIENT ONLY","$110,685.47 ","$81,907.25 ","$0.00 ","$46,222.92 ","$15,656.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,595.28 ","$12,610.13 ","$0.00 ","$37,935.50 ","$46,222.92 ","$0.00 ","$9,193.30 ","$8,185.98 ","$20,634.78 ","$0.00 ","$8,595.28 "
"MS969","DRG","MS969","","HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC","INPATIENT ONLY","$353,828.86 ","$261,833.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS970","DRG","MS970","","HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC","INPATIENT ONLY","$159,032.74 ","$117,684.23 ","$0.00 ","$36,966.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,966.90 ","$0.00 ","$0.00 "
"MS974","DRG","MS974","","HIV WITH MAJOR RELATED CONDITION WITH MCC","INPATIENT ONLY","$73,178.08 ","$54,151.78 ","$0.00 ","$64,425.98 ","$35,613.99 ","$0.00 ","$0.00 ","$58,478.37 ","$59,718.57 ","$0.00 ","$36,766.13 ","$27,554.25 ","$13,595.40 ","$64,425.98 ","$0.00 ","$26,803.98 ","$0.00 ","$44,204.35 ","$27,554.25 ","$0.00 "
"MS975","DRG","MS975","","HIV WITH MAJOR RELATED CONDITION WITH CC","INPATIENT ONLY","$51,952.99 ","$38,445.21 ","$0.00 ","$25,529.20 ","$16,572.15 ","$0.00 ","$11,270.70 ","$21,105.77 ","$21,105.77 ","$0.00 ","$0.00 ","$22,973.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,104.72 ","$25,529.20 ","$0.00 "
"MS976","DRG","MS976","","HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC","INPATIENT ONLY","$22,299.59 ","$16,501.70 ","$0.00 ","$36,779.40 ","$36,779.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,764.33 ","$0.00 ","$0.00 "
"MS977","DRG","MS977","","HIV WITH OR WITHOUT OTHER RELATED CONDITION","INPATIENT ONLY","$39,015.42 ","$28,871.41 ","$0.00 ","$23,765.79 ","$8,399.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,765.79 ","$0.00 ","$0.00 "
"MS981","DRG","MS981","","EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC","INPATIENT ONLY","$206,905.41 ","$153,110.00 ","$0.00 ","$389,857.92 ","$389,857.92 ","$0.00 ","$47,997.68 ","$6,750.52 ","$6,750.52 ","$0.00 ","$0.00 ","$44,568.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47,748.94 ","$42,445.83 ","$0.00 "
"MS982","DRG","MS982","","EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC","INPATIENT ONLY","$141,904.77 ","$105,009.53 ","$0.00 ","$33,055.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,856.15 ","$0.00 ","$30,463.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,815.40 ","$33,055.16 ","$29,012.63 ","$21,856.15 "
"MS983","DRG","MS983","","EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","INPATIENT ONLY","$191,096.52 ","$141,411.42 ","$0.00 ","$84,648.54 ","$0.00 ","$0.00 ","$0.00 ","$39,894.90 ","$40,721.70 ","$0.00 ","$64,127.69 ","$0.00 ","$7,786.79 ","$84,648.54 ","$0.00 ","$16,410.80 ","$0.00 ","$26,514.63 ","$0.00 ","$0.00 "
"MS987","DRG","MS987","","NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC","INPATIENT ONLY","$116,755.62 ","$86,399.16 ","$0.00 ","$129,871.79 ","$111,671.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62,005.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$129,871.79 ","$59,052.55 ","$0.00 "
"MS988","DRG","MS988","","NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC","INPATIENT ONLY","$301,856.57 ","$223,373.86 ","$0.00 ","$101,160.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76,636.84 ","$24,328.59 ","$83,023.25 ","$101,160.63 ","$0.00 ","$17,224.76 ","$0.00 ","$27,177.75 ","$24,328.59 ","$0.00 "
"MS989","DRG","MS989","","NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","INPATIENT ONLY","$35,912.44 ","$26,575.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS998","DRG","MS998","","PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS","INPATIENT ONLY","$72,064.04 ","$53,327.39 ","$0.00 ","$6,092.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,092.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,802.63 ","$0.00 ","$0.00 ","$6,092.76 "
"MS999","DRG","MS999","","UNGROUPABLE","INPATIENT ONLY","$30,544.21 ","$22,602.72 ","$0.00 ","$62,801.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62,801.51 ","$0.00 ","$0.00 "
"812","EAP","CPT� 00812","","ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$446.06 ","$446.06 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$0.00 ","$0.00 "
"813","EAP","CPT� 00813","","ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$446.06 ","$446.06 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$0.00 ","$0.00 "
"11200","EAP","CPT�11200","","PR DEBRIDEMENT OF NAILS, 6 OR MORE","BOTH IP/OP","$255.00 ","$188.70 ","$53.15 ","$255.00 ","255","175.86","53.15","","","","","","","","","","","","",""
"11976","EAP","CPT�11976","","CHEM CAUTERY GRANULATN TISSUE","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$408.00 ","$408.00 ","$0.00 ","$0.00 ","$0.00 ","$53.40 ","$305.00 ","$175.24 ","$305.00 ","$241.56 ","$244.00 ","$243.48 ","$37.05 ","$38.57 ","$48.56 ","$166.90 "
"11981","EAP","CPT�11981","","PR REMOVAL OF BREAST LESION","BOTH IP/OP","$286.00 ","$211.64 ","$59.61 ","$286.00 ","286","110.43","59.61","","","","","","","","","","","","",""
"11983","EAP","CPT�11983","","INJECT CARPAL TUNNEL","BOTH IP/OP","$402.00 ","$297.48 ","$0.00 ","$402.00 ","$402.00 ","$265.79 ","$83.79 ","$0.00 ","$0.00 ","$49.73 ","$284.00 ","$262.54 ","$284.00 ","$224.93 ","$227.20 ","$284.00 ","$44.45 ","$59.49 ","$45.21 ","$250.04 "
"17250","EAP","CPT� 17250","","INJECT TENDON ORIGIN/INSERT","BOTH IP/OP","$256.00 ","$189.44 ","$0.00 ","$262.54 ","$256.00 ","$175.86 ","$53.36 ","$0.00 ","$0.00 ","$35.37 ","$202.00 ","$262.54 ","$202.00 ","$159.98 ","$161.60 ","$202.00 ","$0.00 ","$41.47 ","$32.16 ","$250.04 "
"20526","EAP","CPT� 20526","","INJECT TRIGGER POINTS, > 3","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$262.54 ","$232.00 ","$232.00 ","$48.35 ","$0.00 ","$0.00 ","$40.27 ","$230.00 ","$262.54 ","$230.00 ","$182.16 ","$184.00 ","$230.00 ","$66.56 ","$45.07 ","$36.62 ","$250.04 "
"20550","EAP","CPT� 20550","","ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US","BOTH IP/OP","$162.00 ","$119.88 ","$28.97 ","$262.54 ","$162.00 ","$162.00 ","$33.76 ","$182.00 ","$182.00 ","$31.87 ","$182.00 ","$262.54 ","$182.00 ","$144.14 ","$145.60 ","$182.00 ","$54.79 ","$37.50 ","$28.97 ","$250.04 "
"20551","EAP","CPT� 20551","","ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.98 ","$274.00 ","$262.54 ","$274.00 ","$217.01 ","$219.20 ","$274.00 ","$69.40 ","$47.60 ","$43.62 ","$250.04 "
"20552","EAP","CPT� 20552","","ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$626.89 ","$0.00 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$53.05 ","$303.00 ","$626.89 ","$303.00 ","$239.98 ","$242.40 ","$303.00 ","$76.82 ","$54.81 ","$48.24 ","$597.04 "
"20553","EAP","CPT� 20553","","PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"20600","EAP","CPT� 20600","","ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","BOTH IP/OP","$150.00 ","$111.00 ","$31.26 ","$262.54 ","$150.00 ","$150.00 ","$31.26 ","$223.00 ","$223.00 ","$39.05 ","$223.00 ","$262.54 ","$223.00 ","$176.62 ","$178.40 ","$223.00 ","$70.76 ","$47.59 ","$35.50 ","$250.04 "
"20604","EAP","CPT� 20604","","ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.18 ","$338.00 ","$262.54 ","$338.00 ","$267.70 ","$270.40 ","$338.00 ","$88.61 ","$62.38 ","$53.81 ","$250.04 "
"20606","EAP","CPT� 20606","","CLOSED RX METATARSAL FX","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$790.00 ","$252.00 ","$252.00 ","$52.52 ","$0.00 ","$0.00 ","$138.32 ","$790.00 ","$216.27 ","$790.00 ","$625.68 ","$632.00 ","$300.48 ","$214.80 ","$210.83 ","$125.77 ","$205.98 "
"20610","EAP","CPT�20610","","CLOSED RX TOE FX","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$346.90 ","$183.00 ","$183.00 ","$38.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$346.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20610","EAP","CPT� 20610","","PR SHOULDER SCOPE BONE SHAVING","BOTH IP/OP","$183.00 ","$135.42 ","$38.14 ","$183.00 ","183","183","38.14","","","","","","","","","","","","",""
"20611","EAP","CPT� 20611","","PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG","BOTH IP/OP","$281.00 ","$207.94 ","$58.57 ","$281.00 ","281","255.86","58.57","","","","","","","","","","","","",""
"20612","EAP","CPT�20612","","PR CATHETER ASPIRATN,NASOTRACH","BOTH IP/OP","$181.00 ","$133.94 ","$0.00 ","$181.00 ","181","181","0","","","","","","","","","","","","",""
"25600","EAP","CPT�25600","","PHLEB, VENIPUNCTURE","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$3.00 ","$3.00 ","$1.93 ","$11.00 ","$3.15 ","$5.50 ","$8.71 ","$8.80 ","$4.35 ","$1.72 ","$3.00 ","$1.75 ","$3.00 "
"28470","EAP","CPT� 28470","","PR INSERT NON-TUNNEL CV CATH","BOTH IP/OP","$620.00 ","$458.80 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"28490","EAP","CPT�28490","","REMOVE TONSILS/ADENOIDS,<12 Y/O","BOTH IP/OP","$401.00 ","$296.74 ","$0.00 ","$401.00 ","401","201.85","0","","","","","","","","","","","","",""
"28510","EAP","CPT� 28510","","PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"36415","EAP","CPT� 36415","","PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD","BOTH IP/OP","$11.00 ","$8.14 ","$1.35 ","$5.97 ","5.97","1.5","1.35","","","","","","","","","","","","",""
"43235","EAP","CPT�43235","","COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE","BOTH IP/OP","$867.00 ","$641.58 ","$0.00 ","$1,530.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$267.89 ","$1,530.00 ","$1,007.17 ","$1,530.00 ","$1,211.76 ","$1,224.00 ","$1,399.33 ","$353.17 ","$208.77 ","$243.58 ","$959.21 "
"43239","EAP","CPT�43239","","PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","BOTH IP/OP","$1,110.00 ","$821.40 ","$0.00 ","$1,110.00 ","1110","792.43","0","","","","","","","","","","","","",""
"43239","EAP","CPT� 43239","","COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ","BOTH IP/OP","$1,110.00 ","$821.40 ","$0.00 ","$1,598.00 ","$1,110.00 ","$792.43 ","$0.00 ","$1,482.64 ","$1,482.64 ","$279.80 ","$1,598.00 ","$1,007.17 ","$1,598.00 ","$1,265.62 ","$1,278.40 ","$1,399.33 ","$450.95 ","$265.02 ","$254.40 ","$959.21 "
"43246","EAP","CPT�43246","","PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX","BOTH IP/OP","$557.00 ","$412.18 ","$0.00 ","$557.00 ","557","557","0","","","","","","","","","","","","",""
"45330","EAP","CPT� 45330","","PR LAP,CHOLECYSTECTOMY","BOTH IP/OP","$542.00 ","$401.08 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"45331","EAP","CPT�45331","","PR REPAIR ING HERNIA,5+Y/O,REDUCIBL","BOTH IP/OP","$844.00 ","$624.56 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"45335","EAP","CPT�45335","","PR BIOPSY OF PROSTATE,NEEDLE/PUNCH","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"45378","EAP","CPT�45378","","PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL ROBOTIC","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","984","777.17","0","","","","","","","","","","","","",""
"45378","EAP","CPT� 45378","","BIOPSY VULVA/PERINEUM,ONE LESN","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$984.00 ","$777.17 ","$0.00 ","$328.00 ","$328.00 ","$57.43 ","$328.00 ","$640.34 ","$328.00 ","$259.78 ","$262.40 ","$328.00 ","$84.36 ","$63.10 ","$52.22 ","$609.84 "
"45380","EAP","CPT�45380","","COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG","BOTH IP/OP","$1,268.00 ","$938.32 ","$0.00 ","$1,268.00 ","$1,268.00 ","$1,015.53 ","$0.00 ","$594.00 ","$594.00 ","$104.00 ","$594.00 ","$271.52 ","$594.00 ","$470.45 ","$475.20 ","$377.23 ","$99.94 ","$140.25 ","$94.56 ","$258.59 "
"45380","EAP","CPT� 45380","","COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX","BOTH IP/OP","$1,268.00 ","$938.32 ","$0.00 ","$1,268.00 ","$1,268.00 ","$1,015.53 ","$0.00 ","$560.00 ","$560.00 ","$98.05 ","$560.00 ","$271.52 ","$560.00 ","$443.52 ","$448.00 ","$377.23 ","$145.54 ","$115.02 ","$89.15 ","$258.59 "
"45381","EAP","CPT�45381","","COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG","BOTH IP/OP","$1,294.00 ","$957.56 ","$0.00 ","$1,294.00 ","$1,294.00 ","$1,015.53 ","$0.00 ","$526.00 ","$526.00 ","$92.10 ","$526.00 ","$271.52 ","$526.00 ","$416.59 ","$420.80 ","$377.23 ","$137.69 ","$106.36 ","$83.74 ","$258.59 "
"45385","EAP","CPT�45385","","BIOPSY/EXCIS CERVICAL LESN","BOTH IP/OP","$1,318.00 ","$975.32 ","$0.00 ","$1,318.00 ","$1,318.00 ","$1,015.53 ","$0.00 ","$518.00 ","$518.00 ","$90.70 ","$518.00 ","$640.34 ","$518.00 ","$410.26 ","$414.40 ","$518.00 ","$71.26 ","$78.23 ","$82.47 ","$609.84 "
"45385","EAP","CPT� 45385","","BIOPSY OF UTERUS LINING","BOTH IP/OP","$1,318.00 ","$975.32 ","$0.00 ","$1,318.00 ","$1,318.00 ","$1,015.53 ","$0.00 ","$353.00 ","$353.00 ","$61.81 ","$353.00 ","$166.54 ","$353.00 ","$279.58 ","$282.40 ","$231.38 ","$59.72 ","$67.07 ","$56.20 ","$158.61 "
"56605","EAP","CPT� 56605","","PR OBSTETRICAL CARE,VAG DELIV ONLY","BOTH IP/OP","$276.00 ","$204.24 ","$57.53 ","$276.00 ","276","276","57.53","","","","","","","","","","","","",""
"57454","EAP","CPT� 57454","","PR FULL ROUT OBSTE CARE,CESAREAN DELIV","BOTH IP/OP","$482.00 ","$356.68 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"57455","EAP","CPT� 57455","","PR ROUT OB CARE,VAG DELIV,PREV C-SEC","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"57456","EAP","CPT� 57456","","PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN","BOTH IP/OP","$432.00 ","$319.68 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"57500","EAP","CPT� 57500","","PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","BOTH IP/OP","$448.00 ","$331.52 ","$93.37 ","$448.00 ","448","448","93.37","","","","","","","","","","","","",""
"57505","EAP","CPT�57505","","INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH","BOTH IP/OP","$449.00 ","$332.26 ","$0.00 ","$626.89 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$275.00 ","$48.15 ","$275.00 ","$626.89 ","$275.00 ","$217.80 ","$220.00 ","$275.00 ","$85.27 ","$44.35 ","$43.78 ","$597.04 "
"58100","EAP","CPT� 58100","","PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL","BOTH IP/OP","$292.00 ","$216.08 ","$60.86 ","$292.00 ","292","166.84","60.86","","","","","","","","","","","","",""
"58110","EAP","CPT� 58110","","PR DISCISSION,2ND CATARACT,LASER","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"58300","EAP","CPT� 58300","","PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP","BOTH IP/OP","$265.00 ","$196.10 ","$51.66 ","$265.00 ","265","51.66","55.23","","","","","","","","","","","","",""
"58301","EAP","CPT� 58301","","PR INJECT INTRAVITREAL PHARMCOLOGIC","BOTH IP/OP","$316.00 ","$233.84 ","$65.86 ","$316.00 ","316","276.2","65.86","","","","","","","","","","","","",""
"64450","EAP","CPT� 64450","","PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS","BOTH IP/OP","$216.00 ","$159.84 ","$45.02 ","$216.00 ","216","216","45.02","","","","","","","","","","","","",""
"69210","EAP","CPT� 69210","","CHG RADIOLOGIC EXAM CHEST 2 VIEWS","BOTH IP/OP","$134.00 ","$99.16 ","$27.93 ","$134.00 ","134","54.51","27.93","","","","","","","","","","","","",""
"70360","EAP","CPT� 70360","","X-RAY RIBS, CHEST 4+ VW","BOTH IP/OP","$90.00 ","$66.60 ","$18.76 ","$124.00 ","$63.70 ","$79.21 ","$18.76 ","$85.48 ","$85.48 ","$21.71 ","$124.00 ","$112.41 ","$29.76 ","$98.21 ","$99.20 ","$124.00 ","$50.44 ","$35.30 ","$19.74 ","$107.06 "
"70450","EAP","CPT�70450","","PR CT SCAN,THORAX,W/O CONTRAST","BOTH IP/OP","$313.00 ","$231.62 ","$65.24 ","$313.00 ","313","106.62","65.24","","","","","","","","","","","","",""
"70450","EAP","CPT� 70450","","CT SCAN,THORAX,W/O CONTRAST","BOTH IP/OP","$313.00 ","$231.62 ","$55.40 ","$354.00 ","$313.00 ","$106.62 ","$65.24 ","$354.00 ","$354.00 ","$61.98 ","$354.00 ","$112.41 ","$84.96 ","$280.37 ","$283.20 ","$156.18 ","$55.40 ","$101.21 ","$56.36 ","$107.06 "
"70487","EAP","CPT�70487","","CAT SCAN OF CHEST CONTRAST","BOTH IP/OP","$451.00 ","$333.74 ","$74.02 ","$473.00 ","$451.00 ","$174.93 ","$94.00 ","$473.00 ","$473.00 ","$82.82 ","$473.00 ","$202.33 ","$113.52 ","$374.62 ","$378.40 ","$281.11 ","$74.02 ","$135.06 ","$75.30 ","$192.70 "
"70491","EAP","CPT�70491","","PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC","BOTH IP/OP","$550.00 ","$407.00 ","$114.63 ","$550.00 ","550","174.93","114.63","","","","","","","","","","","","",""
"70492","EAP","CPT� 70492","","CT ANGIO, CHEST, COMBO, INCL IMAGE PROC","BOTH IP/OP","$661.00 ","$489.14 ","$0.00 ","$637.00 ","$0.00 ","$0.00 ","$0.00 ","$637.00 ","$637.00 ","$111.53 ","$637.00 ","$202.33 ","$152.88 ","$504.50 ","$509.60 ","$281.11 ","$99.69 ","$214.30 ","$101.41 ","$192.70 "
"71045","EAP","CPT�71045","","CHG X-RAY THORACIC SPINE 2 VW","BOTH IP/OP","$74.00 ","$54.76 ","$15.42 ","$74.00 ","45.3","74","15.42","","","","","","","","","","","","",""
"71046","EAP","CPT�71046","","X-RAY THORACIC SPINE 2 VW","BOTH IP/OP","$96.00 ","$71.04 ","$12.10 ","$112.41 ","$69.46 ","$79.21 ","$20.01 ","$53.49 ","$53.49 ","$13.31 ","$76.00 ","$112.41 ","$18.24 ","$60.19 ","$60.80 ","$76.00 ","$35.88 ","$21.61 ","$12.10 ","$107.06 "
"71046","EAP","CPT� 71046","","X-RAY THOR-LUMB SP 2 VW","BOTH IP/OP","$96.00 ","$71.04 ","$13.05 ","$82.00 ","$69.46 ","$79.21 ","$20.01 ","$56.99 ","$56.99 ","$14.36 ","$82.00 ","$80.04 ","$19.68 ","$64.94 ","$65.60 ","$82.00 ","$36.61 ","$23.41 ","$13.05 ","$76.23 "
"71110","EAP","CPT�71110","","CHG X-RAY LUMBAR SPINE 2/3 VW","BOTH IP/OP","$126.00 ","$93.24 ","$26.26 ","$106.62 ","85.46","106.62","26.26","","","","","","","","","","","","",""
"71111","EAP","CPT� 71111","","X-RAY LUMBAR SPINE 2/3 VW","BOTH IP/OP","$150.00 ","$111.00 ","$15.12 ","$112.41 ","$109.64 ","$106.62 ","$31.26 ","$64.85 ","$64.85 ","$16.63 ","$95.00 ","$112.41 ","$22.80 ","$75.24 ","$76.00 ","$95.00 ","$36.61 ","$27.01 ","$15.12 ","$107.06 "
"71250","EAP","CPT�71250","","CHG X-RAY LUMBAR SPINE 4 VW","BOTH IP/OP","$393.00 ","$290.82 ","$81.91 ","$393.00 ","393","106.62","81.91","","","","","","","","","","","","",""
"71250","EAP","CPT� 71250","","X-RAY LUMBAR SPINE 4 VW","BOTH IP/OP","$393.00 ","$290.82 ","$19.90 ","$393.00 ","$393.00 ","$106.62 ","$81.91 ","$90.72 ","$90.72 ","$21.89 ","$125.00 ","$112.41 ","$30.00 ","$99.00 ","$100.00 ","$125.00 ","$50.44 ","$35.66 ","$19.90 ","$107.06 "
"71260","EAP","CPT�71260","","PR CT SCAN,CERVICAL SPINE,W/O CONTRAST","BOTH IP/OP","$494.00 ","$365.56 ","$102.96 ","$494.00 ","494","174.93","102.96","","","","","","","","","","","","",""
"71260","EAP","CPT� 71260","","CT SCAN,LUMBAR SPINE,W/O CONTRAST","BOTH IP/OP","$494.00 ","$365.56 ","$58.06 ","$494.00 ","$494.00 ","$174.93 ","$102.96 ","$371.00 ","$371.00 ","$64.96 ","$371.00 ","$112.41 ","$371.00 ","$293.83 ","$296.80 ","$156.18 ","$58.06 ","$105.89 ","$59.06 ","$107.06 "
"71275","EAP","CPT�71275","","PR MRI, CERV SPINE","BOTH IP/OP","$763.00 ","$564.62 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"71275","EAP","CPT� 71275","","PR MRI, LUMBAR SPINE","BOTH IP/OP","$763.00 ","$564.62 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"72040","EAP","CPT�72040","","CHG X-RAY PELVIS 1/2 VW","BOTH IP/OP","$113.00 ","$83.62 ","$23.55 ","$79.21 ","74.98","79.21","23.55","","","","","","","","","","","","",""
"72040","EAP","CPT� 72040","","CHG X-RAY PELVIS 3+ VW","BOTH IP/OP","$113.00 ","$83.62 ","$23.55 ","$79.21 ","74.98","79.21","23.55","","","","","","","","","","","","",""
"72050","EAP","CPT� 72050","","PR CT SCAN OF PELVIS CONTRAST","BOTH IP/OP","$152.00 ","$112.48 ","$31.68 ","$106.62 ","103.2","106.62","31.68","","","","","","","","","","","","",""
"72052","EAP","CPT� 72052","","X-RAY SACRUM/COCCYX 2+ VW","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$80.04 ","$0.00 ","$0.00 ","$36.89 ","$49.14 ","$49.14 ","$13.83 ","$79.00 ","$80.04 ","$18.96 ","$62.57 ","$63.20 ","$79.00 ","$30.55 ","$22.69 ","$12.58 ","$76.23 "
"72070","EAP","CPT�72070","","X-RAY CLAVICLE","BOTH IP/OP","$94.00 ","$69.56 ","$12.90 ","$94.00 ","$77.40 ","$94.00 ","$19.59 ","$45.08 ","$45.08 ","$14.18 ","$81.00 ","$80.04 ","$19.44 ","$64.15 ","$64.80 ","$81.00 ","$27.72 ","$23.05 ","$12.90 ","$76.23 "
"72070","EAP","CPT� 72070","","CHG X-RAY SHOULDER 2+ VW","BOTH IP/OP","$94.00 ","$69.56 ","$19.59 ","$94.00 ","77.4","94","19.59","","","","","","","","","","","","",""
"72080","EAP","CPT� 72080","","X-RAY SHOULDER 2+ VW","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$48.26 ","$48.26 ","$14.53 ","$83.00 ","$80.04 ","$19.92 ","$65.74 ","$66.40 ","$83.00 ","$30.90 ","$23.77 ","$13.21 ","$76.23 "
"72100","EAP","CPT�72100","","CHG X-RAY HUMERUS","BOTH IP/OP","$114.00 ","$84.36 ","$23.76 ","$106.62 ","79.81","106.62","23.76","","","","","","","","","","","","",""
"72100","EAP","CPT� 72100","","X-RAY HUMERUS","BOTH IP/OP","$114.00 ","$84.36 ","$12.90 ","$106.62 ","$79.81 ","$106.62 ","$23.76 ","$48.26 ","$48.26 ","$14.18 ","$81.00 ","$80.04 ","$19.44 ","$64.15 ","$64.80 ","$81.00 ","$30.55 ","$23.05 ","$12.90 ","$76.23 "
"72110","EAP","CPT�72110","","CHG X-RAY ELBOW 2 VW","BOTH IP/OP","$147.00 ","$108.78 ","$0.00 ","$111.25 ","111.25","106.62","0","","","","","","","","","","","","",""
"72110","EAP","CPT� 72110","","X-RAY ELBOW 2 VW","BOTH IP/OP","$147.00 ","$108.78 ","$0.00 ","$111.25 ","$111.25 ","$106.62 ","$0.00 ","$45.08 ","$45.08 ","$12.43 ","$71.00 ","$80.04 ","$17.04 ","$56.23 ","$56.80 ","$71.00 ","$27.38 ","$20.17 ","$11.30 ","$76.23 "
"72114","EAP","CPT�72114","","X-RAY ELBOW 3+ VW","BOTH IP/OP","$177.00 ","$130.98 ","$12.42 ","$141.08 ","$141.08 ","$106.62 ","$36.89 ","$60.47 ","$60.47 ","$13.66 ","$78.00 ","$80.04 ","$18.72 ","$61.78 ","$62.40 ","$78.00 ","$30.55 ","$22.33 ","$12.42 ","$76.23 "
"72125","EAP","CPT�72125","","CHG X-RAY FOREARM 2 VW","BOTH IP/OP","$385.00 ","$284.90 ","$80.24 ","$385.00 ","385","106.62","80.24","","","","","","","","","","","","",""
"72131","EAP","CPT� 72131","","X-RAY FOREARM 2 VW","BOTH IP/OP","$383.00 ","$283.42 ","$0.00 ","$80.04 ","$0.00 ","$0.00 ","$0.00 ","$45.08 ","$45.08 ","$12.61 ","$72.00 ","$80.04 ","$17.28 ","$57.02 ","$57.60 ","$72.00 ","$27.72 ","$20.53 ","$11.46 ","$76.23 "
"72170","EAP","CPT�72170","","X-RAY WRIST 3+ VW","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$106.00 ","$72.57 ","$80.00 ","$0.00 ","$59.03 ","$59.03 ","$18.56 ","$106.00 ","$80.04 ","$25.44 ","$83.95 ","$84.80 ","$106.00 ","$28.79 ","$30.25 ","$16.88 ","$76.23 "
"72190","EAP","CPT�72190","","X-RAY HAND 2 VW","BOTH IP/OP","$121.00 ","$89.54 ","$12.26 ","$112.41 ","$86.28 ","$106.62 ","$25.22 ","$44.19 ","$44.19 ","$13.48 ","$77.00 ","$112.41 ","$18.48 ","$60.98 ","$61.60 ","$77.00 ","$27.37 ","$21.97 ","$12.26 ","$107.06 "
"72220","EAP","CPT� 72220","","X-RAY HAND 3+ VW","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$92.00 ","$63.70 ","$79.21 ","$0.00 ","$52.06 ","$52.06 ","$16.11 ","$92.00 ","$80.04 ","$22.08 ","$72.86 ","$73.60 ","$92.00 ","$28.79 ","$26.29 ","$14.65 ","$76.23 "
"73000","EAP","CPT� 73000","","CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW","BOTH IP/OP","$92.00 ","$68.08 ","$19.18 ","$79.21 ","62.88","79.21","19.18","","","","","","","","","","","","",""
"73030","EAP","CPT�73030","","CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS","BOTH IP/OP","$99.00 ","$73.26 ","$20.63 ","$79.21 ","66.11","79.21","20.63","","","","","","","","","","","","",""
"73030","EAP","CPT� 73030","","RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS","BOTH IP/OP","$99.00 ","$73.26 ","$19.10 ","$120.00 ","$66.11 ","$79.21 ","$20.63 ","$72.12 ","$72.12 ","$21.01 ","$120.00 ","$80.04 ","$28.80 ","$95.04 ","$96.00 ","$111.21 ","$39.45 ","$34.22 ","$19.10 ","$76.23 "
"73060","EAP","CPT�73060","","RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS","BOTH IP/OP","$91.00 ","$67.34 ","$16.08 ","$112.41 ","$66.11 ","$79.21 ","$18.97 ","$67.83 ","$67.83 ","$17.68 ","$101.00 ","$112.41 ","$24.24 ","$79.99 ","$80.80 ","$101.00 ","$37.75 ","$28.81 ","$16.08 ","$107.06 "
"73060","EAP","CPT� 73060","","RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS","BOTH IP/OP","$91.00 ","$67.34 ","$18.97 ","$131.00 ","$66.11 ","$79.21 ","$18.97 ","$80.69 ","$80.69 ","$22.94 ","$131.00 ","$112.41 ","$31.44 ","$103.75 ","$104.80 ","$131.00 ","$46.58 ","$37.46 ","$20.86 ","$107.06 "
"73070","EAP","CPT�73070","","CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS","BOTH IP/OP","$83.00 ","$61.42 ","$17.30 ","$79.21 ","62.09","79.21","17.3","","","","","","","","","","","","",""
"73070","EAP","CPT� 73070","","RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS","BOTH IP/OP","$83.00 ","$61.42 ","$14.17 ","$89.00 ","$62.09 ","$79.21 ","$17.30 ","$54.94 ","$54.94 ","$15.58 ","$89.00 ","$80.04 ","$21.36 ","$70.49 ","$71.20 ","$89.00 ","$30.93 ","$25.57 ","$14.17 ","$76.23 "
"73080","EAP","CPT� 73080","","CHG X-RAY KNEE 1 OR 2 VIEW","BOTH IP/OP","$93.00 ","$68.82 ","$19.38 ","$79.21 ","70.96","79.21","19.38","","","","","","","","","","","","",""
"73090","EAP","CPT�73090","","X-RAY KNEE 1 OR 2 VIEW","BOTH IP/OP","$83.00 ","$61.42 ","$17.30 ","$132.00 ","$58.87 ","$79.21 ","$17.30 ","$45.95 ","$45.95 ","$23.11 ","$132.00 ","$80.04 ","$31.68 ","$69.70 ","$105.60 ","$111.21 ","$28.43 ","$25.21 ","$21.01 ","$76.23 "
"73090","EAP","CPT� 73090","","X-RAY KNEE 3 VIEW","BOTH IP/OP","$83.00 ","$61.42 ","$16.72 ","$105.00 ","$58.87 ","$79.21 ","$17.30 ","$57.87 ","$57.87 ","$18.38 ","$105.00 ","$80.04 ","$25.20 ","$83.16 ","$84.00 ","$105.00 ","$31.26 ","$29.89 ","$16.72 ","$76.23 "
"73100","EAP","CPT� 73100","","X-RAY KNEE 4+ VIEW","BOTH IP/OP","$97.00 ","$71.78 ","$18.31 ","$115.00 ","$66.11 ","$79.21 ","$20.22 ","$66.59 ","$66.59 ","$20.14 ","$115.00 ","$112.41 ","$27.60 ","$91.08 ","$92.00 ","$115.00 ","$34.81 ","$32.78 ","$18.31 ","$107.06 "
"73110","EAP","CPT�73110","","CHG X-RAY TIB + FIB, 2VW","BOTH IP/OP","$117.00 ","$86.58 ","$24.39 ","$80.63 ","80.63","79.21","24.39","","","","","","","","","","","","",""
"73110","EAP","CPT� 73110","","X-RAY TIB + FIB, 2VW","BOTH IP/OP","$117.00 ","$86.58 ","$12.58 ","$80.63 ","$80.63 ","$79.21 ","$24.39 ","$43.33 ","$43.33 ","$13.83 ","$79.00 ","$80.04 ","$18.96 ","$62.57 ","$63.20 ","$79.00 ","$28.43 ","$22.69 ","$12.58 ","$76.23 "
"73120","EAP","CPT� 73120","","CHG X-RAY ANKLE 2 VW","BOTH IP/OP","$89.00 ","$65.86 ","$18.55 ","$89.00 ","59.66","89","18.55","","","","","","","","","","","","",""
"73130","EAP","CPT�73130","","X-RAY ANKLE 2 VW","BOTH IP/OP","$105.00 ","$77.70 ","$13.05 ","$82.00 ","$70.14 ","$79.21 ","$21.88 ","$44.19 ","$44.19 ","$14.36 ","$82.00 ","$80.04 ","$19.68 ","$64.94 ","$65.60 ","$82.00 ","$27.37 ","$23.41 ","$13.05 ","$76.23 "
"73130","EAP","CPT� 73130","","CHG X-RAY ANKLE 3+ VW","BOTH IP/OP","$105.00 ","$77.70 ","$21.88 ","$79.21 ","70.14","79.21","21.88","","","","","","","","","","","","",""
"73140","EAP","CPT�73140","","X-RAY ANKLE 3+ VW","BOTH IP/OP","$107.00 ","$79.18 ","$14.65 ","$92.00 ","$71.76 ","$79.21 ","$22.30 ","$52.06 ","$52.06 ","$16.11 ","$92.00 ","$80.04 ","$22.08 ","$72.86 ","$73.60 ","$92.00 ","$28.79 ","$26.29 ","$14.65 ","$76.23 "
"73200","EAP","CPT�73200","","CHG X-RAY FOOT 2 VW","BOTH IP/OP","$451.00 ","$333.74 ","$0.00 ","$451.00 ","451","106.62","0","","","","","","","","","","","","",""
"73501","EAP","CPT�73501","","X-RAY FOOT 2 VW","BOTH IP/OP","$93.00 ","$68.82 ","$11.30 ","$80.04 ","$67.72 ","$79.21 ","$19.38 ","$42.45 ","$42.45 ","$12.43 ","$71.00 ","$80.04 ","$17.04 ","$56.23 ","$56.80 ","$71.00 ","$27.37 ","$20.17 ","$11.30 ","$76.23 "
"73502","EAP","CPT�73502","","CHG X-RAY FOOT 3+ VW","BOTH IP/OP","$134.00 ","$99.16 ","$27.93 ","$94.33 ","94.33","79.21","27.93","","","","","","","","","","","","",""
"73502","EAP","CPT� 73502","","X-RAY FOOT 3+ VW","BOTH IP/OP","$134.00 ","$99.16 ","$13.69 ","$94.33 ","$94.33 ","$79.21 ","$27.93 ","$51.19 ","$51.19 ","$15.06 ","$86.00 ","$80.04 ","$20.64 ","$68.11 ","$68.80 ","$86.00 ","$28.79 ","$24.49 ","$13.69 ","$76.23 "
"73521","EAP","CPT� 73521","","X-RAY TOE(S)","BOTH IP/OP","$118.00 ","$87.32 ","$12.10 ","$106.62 ","$90.29 ","$106.62 ","$24.59 ","$48.57 ","$48.57 ","$13.31 ","$76.00 ","$80.04 ","$18.24 ","$60.19 ","$60.80 ","$76.00 ","$23.09 ","$21.61 ","$12.10 ","$76.23 "
"73522","EAP","CPT� 73522","","CT SCAN,LOWER EXTREMITY,W/O CONTRAST","BOTH IP/OP","$153.00 ","$113.22 ","$31.89 ","$371.00 ","$111.25 ","$106.62 ","$31.89 ","$371.00 ","$371.00 ","$64.96 ","$371.00 ","$112.41 ","$371.00 ","$293.83 ","$296.80 ","$156.18 ","$58.06 ","$105.89 ","$59.06 ","$107.06 "
"73552","EAP","CPT�73552","","PR MRI LOWER EXTREM JT, W/O CONTRAST","BOTH IP/OP","$101.00 ","$74.74 ","$21.05 ","$79.21 ","74.18","79.21","21.05","","","","","","","","","","","","",""
"73552","EAP","CPT� 73552","","CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW","BOTH IP/OP","$101.00 ","$74.74 ","$21.05 ","$79.21 ","74.18","79.21","21.05","","","","","","","","","","","","",""
"73560","EAP","CPT�73560","","CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES","BOTH IP/OP","$98.00 ","$72.52 ","$20.43 ","$79.21 ","70.14","79.21","20.43","","","","","","","","","","","","",""
"73560","EAP","CPT� 73560","","RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$115.00 ","$70.14 ","$79.21 ","$20.43 ","$76.04 ","$76.04 ","$20.14 ","$115.00 ","$112.41 ","$27.60 ","$91.08 ","$92.00 ","$115.00 ","$44.36 ","$32.78 ","$0.00 ","$107.06 "
"73562","EAP","CPT� 73562","","CT SCAN,ABDOMEN,W/O CONTRAST","BOTH IP/OP","$117.00 ","$86.58 ","$24.39 ","$316.00 ","$81.42 ","$79.21 ","$24.39 ","$316.00 ","$316.00 ","$55.33 ","$316.00 ","$112.41 ","$316.00 ","$250.27 ","$252.80 ","$156.18 ","$49.45 ","$90.40 ","$50.31 ","$107.06 "
"73564","EAP","CPT� 73564","","CT SCAN OF ABDOMEN CONTRAST","BOTH IP/OP","$132.00 ","$97.68 ","$27.51 ","$637.00 ","$90.29 ","$106.62 ","$27.51 ","$637.00 ","$637.00 ","$111.53 ","$637.00 ","$202.33 ","$637.00 ","$504.50 ","$509.60 ","$281.11 ","$99.69 ","$185.49 ","$101.41 ","$192.70 "
"73590","EAP","CPT�73590","","CT SCAN OF ABDOMEN COMBO","BOTH IP/OP","$90.00 ","$66.60 ","$18.76 ","$637.00 ","$65.31 ","$79.21 ","$18.76 ","$637.00 ","$637.00 ","$111.53 ","$637.00 ","$202.33 ","$637.00 ","$504.50 ","$509.60 ","$281.11 ","$99.69 ","$211.06 ","$101.41 ","$192.70 "
"73590","EAP","CPT� 73590","","PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES","BOTH IP/OP","$90.00 ","$66.60 ","$18.76 ","$79.21 ","65.31","79.21","18.76","","","","","","","","","","","","",""
"73600","EAP","CPT�73600","","CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES","BOTH IP/OP","$92.00 ","$68.08 ","$19.18 ","$1,046.00 ","$67.72 ","$79.21 ","$19.18 ","$755.50 ","$755.50 ","$183.15 ","$1,046.00 ","$387.01 ","$251.04 ","$828.43 ","$836.80 ","$537.70 ","$163.70 ","$298.94 ","$166.52 ","$368.58 "
"73600","EAP","CPT� 73600","","CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST","BOTH IP/OP","$92.00 ","$68.08 ","$19.18 ","$79.21 ","67.72","79.21","19.18","","","","","","","","","","","","",""
"73610","EAP","CPT�73610","","CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$398.00 ","$71.76 ","$79.21 ","$21.88 ","$0.00 ","$0.00 ","$0.00 ","$398.00 ","$0.00 ","$95.52 ","$315.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73610","EAP","CPT� 73610","","CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","BOTH IP/OP","$105.00 ","$77.70 ","$21.88 ","$79.21 ","71.76","79.21","21.88","","","","","","","","","","","","",""
"73620","EAP","CPT�73620","","CT SCAN,ABDOMENT AND PELVIS,W CONTRAST","BOTH IP/OP","$81.00 ","$59.94 ","$0.00 ","$835.00 ","$58.87 ","$79.21 ","$16.88 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$200.40 ","$661.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73620","EAP","CPT� 73620","","PR MRI, ABDOMEN, COMBO","BOTH IP/OP","$81.00 ","$59.94 ","$16.88 ","$79.21 ","58.87","79.21","16.88","","","","","","","","","","","","",""
"73630","EAP","CPT�73630","","US, HEAD/NECK TISSUES,REAL TIME","BOTH IP/OP","$99.00 ","$73.26 ","$20.63 ","$79.21 ","66.11","79.21","20.63","","","","","","","","","","","","",""
"73630","EAP","CPT� 73630","","US,HEAD/NECK TISSUES,B-SCAN/REAL TIME","BOTH IP/OP","$99.00 ","$73.26 ","$20.63 ","$311.00 ","$66.11 ","$79.21 ","$20.63 ","$196.88 ","$196.88 ","$54.45 ","$311.00 ","$112.41 ","$74.64 ","$246.31 ","$248.80 ","$156.18 ","$82.37 ","$88.96 ","$49.51 ","$107.06 "
"73660","EAP","CPT� 73660","","CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"73700","EAP","CPT� 73700","","PR US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","BOTH IP/OP","$383.00 ","$283.42 ","$79.83 ","$383.00 ","383","106.62","79.83","","","","","","","","","","","","",""
"74018","EAP","CPT�74018","","PR US, ABDOMEN LIMITED","BOTH IP/OP","$86.00 ","$63.64 ","$17.92 ","$79.21 ","62.2","79.21","17.92","","","","","","","","","","","","",""
"74022","EAP","CPT�74022","","SONO ABDOMEN LIMITED","BOTH IP/OP","$143.00 ","$105.82 ","$29.80 ","$219.00 ","$101.59 ","$106.62 ","$29.80 ","$175.05 ","$175.05 ","$38.35 ","$219.00 ","$112.41 ","$52.56 ","$173.45 ","$175.20 ","$156.18 ","$83.78 ","$62.67 ","$34.86 ","$107.06 "
"74022","EAP","CPT� 74022","","US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","BOTH IP/OP","$143.00 ","$105.82 ","$29.80 ","$306.00 ","$101.59 ","$106.62 ","$29.80 ","$160.30 ","$160.30 ","$53.58 ","$306.00 ","$112.41 ","$73.44 ","$242.35 ","$244.80 ","$156.18 ","$90.50 ","$87.52 ","$48.72 ","$107.06 "
"74150","EAP","CPT� 74150","","PR US,RETROPERIT,REAL TIME,COMPLETE","BOTH IP/OP","$406.00 ","$300.44 ","$84.62 ","$406.00 ","406","106.62","84.62","","","","","","","","","","","","",""
"74160","EAP","CPT� 74160","","US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE","BOTH IP/OP","$691.00 ","$511.34 ","$0.00 ","$691.00 ","$691.00 ","$174.93 ","$0.00 ","$222.59 ","$222.59 ","$47.45 ","$271.00 ","$112.41 ","$65.04 ","$214.63 ","$216.80 ","$156.18 ","$112.23 ","$77.44 ","$43.14 ","$107.06 "
"74170","EAP","CPT� 74170","","SONO ABD RETROPERITNL LTD","BOTH IP/OP","$708.00 ","$523.92 ","$0.00 ","$194.25 ","$0.00 ","$0.00 ","$0.00 ","$194.25 ","$194.25 ","$18.56 ","$106.00 ","$112.41 ","$25.44 ","$83.95 ","$84.80 ","$106.00 ","$83.43 ","$30.25 ","$16.88 ","$107.06 "
"74174","EAP","CPT�74174","","CHG US, OB >/= 14 WKS, SNGL FETUS","BOTH IP/OP","$1,140.00 ","$843.60 ","$237.60 ","$1,140.00 ","1140","360.63","237.6","","","","","","","","","","","","",""
"74174","EAP","CPT� 74174","","CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES","BOTH IP/OP","$1,140.00 ","$843.60 ","$237.60 ","$1,140.00 ","1140","360.63","237.6","","","","","","","","","","","","",""
"74176","EAP","CPT�74176","","CHG US,PREGNANT UTERUS,F/U,TRANSABD APP","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$242.00 ","242","0","0","","","","","","","","","","","","",""
"74176","EAP","CPT� 74176","","CHG US,PREGNANT UTERUS,TRANSVAGINAL","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$242.00 ","242","0","0","","","","","","","","","","","","",""
"74177","EAP","CPT�74177","","CHG FETAL BIOPHYS PROF,W/O NST","BOTH IP/OP","$920.00 ","$680.80 ","$0.00 ","$920.00 ","920","0","0","","","","","","","","","","","","",""
"74177","EAP","CPT� 74177","","CHG DOPPLER FETAL UMBILICAL ARTERY","BOTH IP/OP","$920.00 ","$680.80 ","$0.00 ","$920.00 ","920","0","0","","","","","","","","","","","","",""
"74178","EAP","CPT�74178","","CHG ECHOGRAPHY,TRANSVAGINAL","BOTH IP/OP","$1,030.00 ","$762.20 ","$0.00 ","$1,030.00 ","1030","0","0","","","","","","","","","","","","",""
"76536","EAP","CPT�76536","","PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE","BOTH IP/OP","$322.00 ","$238.28 ","$67.11 ","$266.85 ","266.85","106.62","67.11","","","","","","","","","","","","",""
"76536","EAP","CPT� 76536","","ECHO,PELVIC (NONOBSTETRIC)","BOTH IP/OP","$322.00 ","$238.28 ","$42.51 ","$267.00 ","$266.85 ","$106.62 ","$67.11 ","$204.41 ","$204.41 ","$46.75 ","$267.00 ","$112.41 ","$64.08 ","$211.46 ","$213.60 ","$156.18 ","$92.96 ","$76.36 ","$42.51 ","$107.06 "
"76700","EAP","CPT�76700","","US,EXTREMITY,NONVASCULAR,REAL-TIME IMAGE,LIMITED","BOTH IP/OP","$338.00 ","$250.12 ","$0.00 ","$280.53 ","$280.53 ","$106.62 ","$70.45 ","$0.00 ","$0.00 ","$0.00 ","$116.00 ","$0.00 ","$27.84 ","$91.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76700","EAP","CPT� 76700","","CHG US GUIDE, VASCULAR ACCESS","BOTH IP/OP","$338.00 ","$250.12 ","$70.45 ","$280.53 ","280.53","106.62","70.45","","","","","","","","","","","","",""
"76705","EAP","CPT�76705","","SONO GUIDE NEEDLE BIOPSY","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$360.62 ","$209.59 ","$106.62 ","$52.52 ","$360.62 ","$360.62 ","$15.93 ","$91.00 ","$0.00 ","$21.84 ","$72.07 ","$72.80 ","$0.00 ","$92.25 ","$25.93 ","$14.49 ","$0.00 "
"76705","EAP","CPT� 76705","","SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","BOTH IP/OP","$252.00 ","$186.48 ","$14.01 ","$209.59 ","$209.59 ","$106.62 ","$52.52 ","$61.68 ","$61.68 ","$15.41 ","$88.00 ","$26.75 ","$21.12 ","$69.70 ","$70.40 ","$25.21 ","$53.24 ","$25.21 ","$14.01 ","$25.21 "
"76706","EAP","CPT� 76706","","CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","BOTH IP/OP","$307.00 ","$227.18 ","$63.99 ","$214.45 ","214.45","106.62","63.99","","","","","","","","","","","","",""
"76770","EAP","CPT�76770","","CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","BOTH IP/OP","$313.00 ","$231.62 ","$65.24 ","$259.59 ","259.59","106.62","65.24","","","","","","","","","","","","",""
"76770","EAP","CPT� 76770","","CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","BOTH IP/OP","$313.00 ","$231.62 ","$65.24 ","$259.59 ","259.59","106.62","65.24","","","","","","","","","","","","",""
"76775","EAP","CPT� 76775","","CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","BOTH IP/OP","$165.00 ","$122.10 ","$34.39 ","$133.82 ","133.82","106.62","34.39","","","","","","","","","","","","",""
"76830","EAP","CPT�76830","","CHG DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL","BOTH IP/OP","$345.00 ","$255.30 ","$71.91 ","$280.55 ","280.55","106.62","71.91","","","","","","","","","","","","",""
"76830","EAP","CPT� 76830","","ASSAY OF PHENYTOIN TOTAL","BOTH IP/OP","$345.00 ","$255.30 ","$71.91 ","$280.55 ","280.55","106.62","71.91","","","","","","","","","","","","",""
"76856","EAP","CPT�76856","","ASSAY OF VANCOMYCIN","BOTH IP/OP","$305.00 ","$225.70 ","$63.57 ","$253.12 ","253.12","106.62","63.57","","","","","","","","","","","","",""
"76856","EAP","CPT� 76856","","URINALYSIS NONAUTO W/ SCOPE","BOTH IP/OP","$305.00 ","$225.70 ","$63.57 ","$253.12 ","253.12","106.62","63.57","","","","","","","","","","","","",""
"76857","EAP","CPT�76857","","URINALYSIS WITH MICROSCOPY","BOTH IP/OP","$136.00 ","$100.64 ","$3.17 ","$110.46 ","$110.46 ","$106.62 ","$28.35 ","$4.63 ","$4.63 ","$4.68 ","$11.00 ","$3.33 ","$8.86 ","$8.71 ","$8.80 ","$4.60 ","$4.99 ","$3.17 ","$3.49 ","$3.17 "
"76870","EAP","CPT� 76870","","CHG URINALYSIS NONAUTO W/O SCOPE","BOTH IP/OP","$291.00 ","$215.34 ","$60.65 ","$156.39 ","156.39","106.62","60.65","","","","","","","","","","","","",""
"76882","EAP","CPT� 76882","","URINALYSIS","BOTH IP/OP","$160.00 ","$118.40 ","$2.25 ","$106.62 ","$82.24 ","$106.62 ","$10.15 ","$3.28 ","$3.28 ","$3.33 ","$8.00 ","$2.36 ","$6.28 ","$6.34 ","$6.40 ","$3.26 ","$3.55 ","$2.25 ","$2.48 ","$2.25 "
"76942","EAP","CPT� 76942","","URINE PREGNANCY TEST","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$137.83 ","137.83","0","34.39","","","","","","","","","","","","",""
"77063","EAP","CPT� 77063","","PREGNANCY TEST-URINE","BOTH IP/OP","$149.00 ","$110.26 ","$6.98 ","$126.56 ","$126.56 ","$46.99 ","$31.06 ","$9.24 ","$9.24 ","$9.36 ","$30.00 ","$9.04 ","$17.68 ","$23.76 ","$24.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"77063","EAP","CPT�77063","","URINALYSIS VOLUME MEASURE","BOTH IP/OP","$149.00 ","$110.26 ","$31.06 ","$126.56 ","126.56","46.99","31.06","","","","","","","","","","","","",""
"77067","EAP","CPT�77067","","INSERT,IMPLANT CONTRACEPTIVE","BOTH IP/OP","$366.00 ","$270.84 ","$76.28 ","$310.36 ","310.36","113.86","76.28","","","","","","","","","","","","",""
"77067","EAP","CPT� 77067","","REMOVE WITH REINSERTION OF DRUG IMPLANT","BOTH IP/OP","$366.00 ","$270.84 ","$76.28 ","$310.36 ","310.36","113.86","76.28","","","","","","","","","","","","",""
"77080","EAP","CPT� 77080","","ASPIRATION/INJ.,GANGION CYST","BOTH IP/OP","$105.00 ","$77.70 ","$21.88 ","$105.00 ","93.51","105","21.88","","","","","","","","","","","","",""
"77081","EAP","CPT� 77081","","TREAT FRACTURE RADIUS/ULNA","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$79.21 ","63.7","79.21","0","","","","","","","","","","","","",""
"80048","EAP","CPT�80048","","G-TUBE INSERTION","BOTH IP/OP","$26.00 ","$19.24 ","$4.23 ","$17.45 ","17.45","4.23","4.23","","","","","","","","","","","","",""
"80053","EAP","CPT�80053","","#N/A","BOTH IP/OP","$32.00 ","$23.68 ","$5.28 ","$21.81 ","21.81","5.28","5.28","","","","","","","","","","","","",""
"80061","EAP","CPT�80061","","SIGMOIDOSCOPY W/SUBMUC INJ","BOTH IP/OP","$41.00 ","$30.34 ","$6.70 ","$27.64 ","27.64","6.7","6.7","","","","","","","","","","","","",""
"80069","EAP","CPT�80069","","#N/A","BOTH IP/OP","$27.00 ","$19.98 ","$4.34 ","$17.93 ","17.93","4.34","4.34","","","","","","","","","","","","",""
"80076","EAP","CPT�80076","","ECC CERVICAL SCRAPE","BOTH IP/OP","$25.00 ","$18.50 ","$4.09 ","$16.87 ","16.87","4.09","4.09","","","","","","","","","","","","",""
"81001","EAP","CPT� 81001","","FINGER  3 VIEWS","BOTH IP/OP","$10.00 ","$7.40 ","$1.58 ","$6.55 ","6.55","1.59","1.58","","","","","","","","","","","","",""
"81003","EAP","CPT� 81003","","CT, ABD AND PELVIS W&W/O CONTRAST","BOTH IP/OP","$7.00 ","$5.18 ","$1.12 ","$4.65 ","4.65","1.13","1.12","","","","","","","","","","","","",""
"81003","EAP","CPT�81003","","US PELVIS LTD/FU NON-OB","BOTH IP/OP","$7.00 ","$5.18 ","$1.12 ","$4.65 ","4.65","1.13","1.12","","","","","","","","","","","","",""
"81025","EAP","CPT�81025","","BASIC METABOLIC PANEL","BOTH IP/OP","$26.00 ","$19.24 ","$3.87 ","$13.04 ","13.04","4.31","3.87","","","","","","","","","","","","",""
"81025","EAP","CPT� 81025","","RENAL FUNCTION PANEL, EVD","BOTH IP/OP","$26.00 ","$19.24 ","$3.87 ","$13.04 ","13.04","4.31","3.87","","","","","","","","","","","","",""
"82150","EAP","CPT�82150","","RETICULOCYTES, AUTOMATED","BOTH IP/OP","$20.00 ","$14.80 ","$3.24 ","$13.38 ","13.38","3.24","3.24","","","","","","","","","","","","",""
"82274","EAP","CPT� 82274","","VFC FLU. VAC. 3-21 YRS","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"82565","EAP","CPT�82565","","NICU/PED/DEVELOP.TESTING,LIMI","BOTH IP/OP","$16.00 ","$11.84 ","$2.56 ","$10.59 ","10.59","2.56","2.56","","","","","","","","","","","","",""
"82947","EAP","CPT�82947","","BLOOD,OCCULT,FECAL HGB,FECES,1-3 SIMULT","BOTH IP/OP","$12.00 ","$8.88 ","$0.00 ","$56.00 ","$8.10 ","$1.97 ","$0.00 ","$23.22 ","$23.22 ","$25.48 ","$56.00 ","$16.72 ","$44.44 ","$44.35 ","$44.80 ","$23.08 ","$27.15 ","$15.92 ","$19.01 ","$15.92 "
"82977","EAP","CPT�82977","","ASSAY OF IONIZED CALCIUM","BOTH IP/OP","$22.00 ","$16.28 ","$3.60 ","$14.86 ","14.86","3.6","3.6","","","","","","","","","","","","",""
"83036","EAP","CPT� 83036","","TOTAL CORTISOL","BOTH IP/OP","$30.00 ","$22.20 ","$4.86 ","$20.04 ","20.04","4.86","4.86","","","","","","","","","","","","",""
"83036","EAP","CPT�83036","","ASSAY OF CK (CPK)","BOTH IP/OP","$30.00 ","$22.20 ","$4.86 ","$20.04 ","20.04","4.86","4.86","","","","","","","","","","","","",""
"83540","EAP","CPT�83540","","CREATINE MB FRACTION","BOTH IP/OP","$20.00 ","$14.80 ","$3.24 ","$13.36 ","13.36","3.24","3.24","","","","","","","","","","","","",""
"83615","EAP","CPT�83615","","ASSAY OF URINE CREATININE","BOTH IP/OP","$19.00 ","$14.06 ","$3.02 ","$12.46 ","12.46","3.02","3.02","","","","","","","","","","","","",""
"83690","EAP","CPT�83690","","ASSAY OF FERRITIN","BOTH IP/OP","$21.00 ","$15.54 ","$3.44 ","$14.23 ","14.23","3.45","3.44","","","","","","","","","","","","",""
"83721","EAP","CPT�83721","","ASSAY OF FOLIC ACID SERUM","BOTH IP/OP","$32.00 ","$23.68 ","$4.77 ","$19.69 ","19.69","5.25","4.77","","","","","","","","","","","","",""
"83735","EAP","CPT�83735","","BLOOD PH","BOTH IP/OP","$21.00 ","$15.54 ","$3.35 ","$13.83 ","13.83","3.35","3.35","","","","","","","","","","","","",""
"84100","EAP","CPT�84100","","ASSAY OF HAPTOGLOBIN QUANT","BOTH IP/OP","$15.00 ","$11.10 ","$2.37 ","$9.79 ","9.79","2.37","2.37","","","","","","","","","","","","",""
"84132","EAP","CPT�84132","","HEMOGLOBIN ELECTROPHORESIS","BOTH IP/OP","$15.00 ","$11.10 ","$2.30 ","$9.50 ","9.5","2.38","2.3","","","","","","","","","","","","",""
"84155","EAP","CPT�84155","","LACTATE (LD) (LDH) ENZYME","BOTH IP/OP","$12.00 ","$8.88 ","$0.00 ","$7.58 ","7.58","1.84","0","","","","","","","","","","","","",""
"84550","EAP","CPT�84550","","ASSAY OF SERUM POTASSIUM","BOTH IP/OP","$14.00 ","$10.36 ","$2.26 ","$9.32 ","9.32","2.26","2.26","","","","","","","","","","","","",""
"85018","EAP","CPT� 85018","","ASSAY OF PSA TOTAL","BOTH IP/OP","$8.00 ","$5.92 ","$1.18 ","$4.88 ","4.88","1.19","1.18","","","","","","","","","","","","",""
"85018","EAP","CPT�85018","","PROTEIN ELECTROPHORESIS SERUM","BOTH IP/OP","$8.00 ","$5.92 ","$1.18 ","$4.88 ","4.88","1.19","1.18","","","","","","","","","","","","",""
"85025","EAP","CPT� 85025","","ASSAY OF SERUM SODIUM","BOTH IP/OP","$24.00 ","$17.76 ","$3.88 ","$16.05 ","16.05","3.89","3.88","","","","","","","","","","","","",""
"85025","EAP","CPT�85025","","ASSAY OF URINE SODIUM","BOTH IP/OP","$24.00 ","$17.76 ","$3.88 ","$16.05 ","16.05","3.89","3.88","","","","","","","","","","","","",""
"85027","EAP","CPT� 85027","","ASSAY OF TOTAL TESTOSTERONE","BOTH IP/OP","$20.00 ","$14.80 ","$3.23 ","$13.36 ","13.36","3.24","3.23","","","","","","","","","","","","",""
"85027","EAP","CPT�85027","","ASSAY OF FREE THYROXINE","BOTH IP/OP","$20.00 ","$14.80 ","$3.23 ","$13.36 ","13.36","3.24","3.23","","","","","","","","","","","","",""
"85046","EAP","CPT�85046","","ASSAY THYROID STIM HORMONE","BOTH IP/OP","$17.00 ","$12.58 ","$2.79 ","$11.48 ","11.48","2.79","2.79","","","","","","","","","","","","",""
"85610","EAP","CPT� 85610","","ASSAY OF URINE/UREA-N","BOTH IP/OP","$13.00 ","$9.62 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"85610","EAP","CPT�85610","","ASSAY OF BLOOD/URIC ACID","BOTH IP/OP","$13.00 ","$9.62 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"87070","EAP","CPT� 87070","","THROMBOPLASTIN TIME PARTIAL","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"87210","EAP","CPT�87210","","VIRUS ANTIBODY NOS","BOTH IP/OP","$18.00 ","$13.32 ","$2.62 ","$8.82 ","8.82","2.91","2.62","","","","","","","","","","","","",""
"87210","EAP","CPT� 87210","","SPECIMEN INFECT AGENT CONCNTJ","BOTH IP/OP","$18.00 ","$13.32 ","$2.62 ","$8.82 ","8.82","2.91","2.62","","","","","","","","","","","","",""
"87430","EAP","CPT� 87430","","Culture Other Specimen Aerobic","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$12.57 ","$12.57 ","$12.73 ","$30.00 ","$9.05 ","$24.06 ","$23.76 ","$24.00 ","$12.50 ","$13.56 ","$8.62 ","$0.00 ","$0.00 "
"90460","EAP","CPT� 90460","","TISSUE HOMOGENIZATION CULTURE","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$17.04 ","0","17.04","0","","","","","","","","","","","","",""
"90461","EAP","CPT� 90461","","MICROBE SUSCEPTIBLE MIC","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$12.86 ","0","12.86","0","","","","","","","","","","","","",""
"90471","EAP","CPT�90471","","SMEAR GRAM STAIN","BOTH IP/OP","$47.00 ","$34.78 ","$9.80 ","$39.19 ","25.52","39.19","9.8","","","","","","","","","","","","",""
"90471","EAP","CPT� 90471","","SMEAR FLOURESCENT/ACID STAIN","BOTH IP/OP","$47.00 ","$34.78 ","$9.80 ","$39.19 ","25.52","39.19","9.8","","","","","","","","","","","","",""
"90472","EAP","CPT�90472","","SMEAR WET MOUNT SALINE/INK","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$19.55 ","19.55","0","7.5","","","","","","","","","","","","",""
"90472","EAP","CPT� 90472","","O & P DIRECT, SMEAR","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$20.00 ","$19.55 ","$0.00 ","$7.50 ","$6.23 ","$6.23 ","$6.30 ","$20.00 ","$6.11 ","$11.92 ","$15.84 ","$16.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"90620","EAP","CPT� 90620","","CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE","BOTH IP/OP","$30.00 ","$22.20 ","$6.25 ","$171.96 ","13.5","171.96","6.25","","","","","","","","","","","","",""
"90621","EAP","CPT� 90621","","IAAD IA STREPTOCOCCUS GROUP A","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$17.71 ","$59.00 ","$17.65 ","$33.52 ","$46.73 ","$47.20 ","$24.37 ","$18.87 ","$16.81 ","$13.21 ","$16.81 "
"90632","EAP","CPT� 90632","","CHG CYTOPATH FLUIDS,SMEAR,INTERP","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$56.67 ","13.5","0","56.67","","","","","","","","","","","","",""
"90633","EAP","CPT� 90633","","CHG CYTOPATH, CELL ENHANCE TECH","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$13.50 ","13.5","0","9.4","","","","","","","","","","","","",""
"90636","EAP","CPT� 90636","","CYTOPATH C/V THIN LAYER","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"90647","EAP","CPT� 90647","","CYTOPATH FNA MISC","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$13.50 ","13.5","0","0","","","","","","","","","","","","",""
"90648","EAP","CPT� 90648","","BODY FLUID CELL COUNT","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$13.50 ","13.5","0","6.25","","","","","","","","","","","","",""
"90651","EAP","CPT� 90651","","IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$229.60 ","$13.50 ","$229.60 ","$6.25 ","$15.65 ","$15.65 ","$3.84 ","$21.93 ","$21.90 ","$10.97 ","$17.37 ","$17.54 ","$14.42 ","$7.83 ","$14.42 ","$0.00 ","$14.42 "
"90658","EAP","CPT�90658","","IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$21.93 ","$13.50 ","$15.36 ","$0.00 ","$15.65 ","$15.65 ","$3.84 ","$21.93 ","$13.61 ","$10.97 ","$17.37 ","$17.54 ","$12.98 ","$0.00 ","$12.98 ","$0.00 ","$12.98 "
"90670","EAP","CPT� 90670","","PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID","BOTH IP/OP","$30.00 ","$22.20 ","$6.25 ","$230.14 ","13.5","230.14","6.25","","","","","","","","","","","","",""
"90674","EAP","CPT� 90674","","IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID","BOTH IP/OP","$30.00 ","$22.20 ","$6.25 ","$50.00 ","$13.50 ","$29.23 ","$6.25 ","$35.69 ","$35.69 ","$8.75 ","$50.00 ","$38.22 ","$25.00 ","$39.60 ","$40.00 ","$50.00 ","$7.83 ","$14.42 ","$7.96 ","$36.40 "
"90680","EAP","CPT� 90680","","PR IMMUNIZ,ADMIN,EACH ADDL","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$13.50 ","13.5","0","6.25","","","","","","","","","","","","",""
"90681","EAP","CPT� 90681","","IMMUNIZ,ADMIN,EACH ADDL","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$119.46 ","$13.50 ","$119.46 ","$6.25 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$12.98 ","$7.16 ","$0.00 "
"90685","EAP","CPT� 90685","","MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$200.63 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$200.63 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$200.63 ","$0.00 ","$191.04 ","$0.00 "
"90686","EAP","CPT� 90686","","MENB RECOMBINANT LIPOPROTEIN VACCINE IM","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$163.94 ","$11.25 ","$19.58 ","$5.21 ","$21.41 ","$21.41 ","$163.94 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$163.94 ","$0.00 ","$156.09 ","$0.00 "
"90696","EAP","CPT� 90696","","HEPA VACCINE ADULT IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$70.39 ","$13.50 ","$0.00 ","$6.25 ","$21.41 ","$21.41 ","$70.39 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$70.39 ","$0.00 ","$67.03 ","$0.00 "
"90698","EAP","CPT� 90698","","HEPA VACCINE PED/ADOL-2 DOSE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90700","EAP","CPT� 90700","","HEPA/HEPB VACCINE ADULT IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$122.20 ","$13.50 ","$0.00 ","$6.25 ","$21.41 ","$21.41 ","$122.20 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$122.20 ","$0.00 ","$116.36 ","$0.00 "
"90707","EAP","CPT� 90707","","HIB VACCINE, PRP-OMP, IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$13.50 ","$0.00 ","$11.75 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90710","EAP","CPT� 90710","","HIB VACCINE, PRP-T, IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$13.50 ","$0.00 ","$6.25 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90713","EAP","CPT� 90713","","HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$267.82 ","$13.50 ","$0.00 ","$9.40 ","$21.41 ","$21.41 ","$267.82 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$267.82 ","$0.00 ","$255.01 ","$0.00 "
"90715","EAP","CPT� 90715","","PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$252.18 ","$13.50 ","$0.00 ","$6.25 ","$21.41 ","$21.41 ","$252.18 ","$30.00 ","$4.38 ","$15.00 ","$23.76 ","$24.00 ","$4.38 ","$252.18 ","$7.80 ","$240.12 ","$7.80 "
"90716","EAP","CPT� 90716","","CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE","BOTH IP/OP","$30.00 ","$22.20 ","$4.38 ","$136.66 ","$13.50 ","$136.66 ","$9.40 ","$21.41 ","$21.41 ","$33.05 ","$30.00 ","$4.38 ","$15.00 ","$23.76 ","$24.00 ","$4.38 ","$33.05 ","$7.80 ","$31.47 ","$7.80 "
"90723","EAP","CPT� 90723","","ROTOVIRUS VACCINE, ORAL","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$79.00 ","$13.50 ","$79.00 ","$6.25 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90732","EAP","CPT� 90732","","ROTOVIRUS VACCINE, HUMAN ATTENUATED, 2 DOSE, ORAL","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$119.92 ","$13.50 ","$119.92 ","$9.40 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90734","EAP","CPT� 90734","","IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$129.14 ","$13.50 ","$129.14 ","$9.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.76 ","$0.00 ","$0.00 ","$4.70 ","$0.00 ","$0.00 ","$0.00 "
"90744","EAP","CPT� 90744","","IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$28.21 ","$13.50 ","$28.21 ","$0.00 ","$17.84 ","$17.84 ","$22.36 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$22.36 ","$6.50 ","$21.29 ","$6.50 "
"90746","EAP","CPT� 90746","","DTAP-IPV, IM, AGE 4-6 YEAR","BOTH IP/OP","$227.00 ","$167.98 ","$0.00 ","$102.15 ","$102.15 ","$69.65 ","$70.16 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90791","EAP","CPT� 90791","","DTAP-HIB-IP VACCINE, IM","BOTH IP/OP","$494.00 ","$365.56 ","$0.00 ","$268.24 ","$268.24 ","$131.03 ","$102.96 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90792","EAP","CPT�90792","","DTAP IMMUNIZATION, IM","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$300.28 ","$300.28 ","$131.03 ","$115.26 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90832","EAP","CPT�90832","","MMR VIRUS IMMUNIZATION, SUBCUT","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$131.03 ","$116.75 ","$131.03 ","$44.81 ","$21.41 ","$21.41 ","$92.45 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$92.45 ","$0.00 ","$88.03 ","$0.00 "
"90832","EAP","CPT� 90832","","COMBINED VACCINE,MMR+VARICELLA,SQ","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$131.03 ","$116.75 ","$131.03 ","$44.81 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"90834","EAP","CPT�90834","","POLIOMYELITIS IMMUNIZATN,INACTV,SQ","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$154.21 ","$154.21 ","$131.03 ","$59.19 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90837","EAP","CPT�90837","","TDAP VACCINE >7 IM","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$226.43 ","$226.43 ","$131.03 ","$86.91 ","$21.41 ","$21.41 ","$39.53 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$39.53 ","$0.00 ","$37.64 ","$0.00 "
"90837","EAP","CPT� 90837","","CHICKEN POX VACCINE,LIVE,SUBCUT","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$226.43 ","$226.43 ","$131.03 ","$86.91 ","$21.41 ","$21.41 ","$159.48 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$159.48 ","$0.00 ","$151.85 ","$0.00 "
"91111","EAP","CPT� 91111","","HEP B VACCINE,PED/ADOL,IM","BOTH IP/OP","$2,479.00 ","$1,834.46 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$4.70 ","$7.80 ","$0.00 ","$7.80 "
"92250","EAP","CPT�92250","","PR PSYCHOTHERAPY W/PATIENT 45 MINUTES","BOTH IP/OP","$105.00 ","$77.70 ","$21.88 ","$105.00 ","57.02","105","21.88","","","","","","","","","","","","",""
"92250","EAP","CPT� 92250","","PR PSYCHOTHERAPY W/PATIENT 60 MINUTES","BOTH IP/OP","$105.00 ","$77.70 ","$21.88 ","$105.00 ","57.02","105","21.88","","","","","","","","","","","","",""
"92551","EAP","CPT� 92551","","PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS","BOTH IP/OP","$40.00 ","$29.60 ","$8.34 ","$21.72 ","21.72","11.81","8.34","","","","","","","","","","","","",""
"92552","EAP","CPT� 92552","","PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"93000","EAP","CPT� 93000","","PR EYE EXAM, EST PATIENT,COMPREHESV","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$37.57 ","37.57","14.92","0","","","","","","","","","","","","",""
"93015","EAP","CPT� 93015","","PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$169.04 ","169.04","71.62","0","","","","","","","","","","","","",""
"93225","EAP","CPT�93225","","PR FUNDAL PHOTOGRAPHY","BOTH IP/OP","$59.00 ","$43.66 ","$12.30 ","$59.00 ","58.71","59","12.3","","","","","","","","","","","","",""
"93227","EAP","CPT�93227","","FUNDAL PHOTOGRAPHY","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$160.00 ","$56.00 ","$18.80 ","$0.00 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$109.35 ","$80.00 ","$126.72 ","$128.00 ","$151.93 ","$59.03 ","$23.77 ","$25.47 ","$104.14 "
"93242","EAP","CPT�93242","","PR SPEECH/HEARING THERAPY","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"93244","EAP","CPT�93244","","PURE TONE HEARING TEST, AIR","BOTH IP/OP","$73.00 ","$54.02 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$7.70 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$26.40 ","$9.01 ","$0.00 ","$7.00 ","$0.00 "
"93246","EAP","CPT�93246","","PURE TONE AUDIOMETRY, AIR","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$79.93 ","$79.93 ","$19.61 ","$112.00 ","$109.35 ","$56.00 ","$88.70 ","$89.60 ","$112.00 ","$17.48 ","$32.05 ","$17.83 ","$104.14 "
"93248","EAP","CPT�93248","","PR TYMPANOMETRY","BOTH IP/OP","$81.00 ","$59.94 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"93306","EAP","CPT�93306","","PR AUDITORY EVOKED POTENTIAL, LIMITED","BOTH IP/OP","$566.00 ","$418.84 ","$117.97 ","$504.77 ","504.77","473.2","117.97","","","","","","","","","","","","",""
"93306","EAP","CPT� 93306","","PR EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION","BOTH IP/OP","$566.00 ","$418.84 ","$117.97 ","$504.77 ","504.77","473.2","117.97","","","","","","","","","","","","",""
"93880","EAP","CPT� 93880","","CV STRS TST XERS&/OR RX CONT ECG W/SI&R","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$252.00 ","$116.00 ","$116.00 ","$24.18 ","$179.85 ","$179.85 ","$44.12 ","$252.00 ","$76.29 ","$126.00 ","$199.58 ","$201.60 ","$72.09 ","$110.83 ","$72.09 ","$0.00 ","$72.09 "
"93926","EAP","CPT� 93926","","PR CARDIAC STRESS TST,TRACING ONLY","BOTH IP/OP","$381.00 ","$281.94 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"93970","EAP","CPT�93970","","PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER","BOTH IP/OP","$102.00 ","$75.48 ","$21.26 ","$102.00 ","102","102","21.26","","","","","","","","","","","","",""
"93970","EAP","CPT� 93970","","ECHO HEART XTHORACIC,COMPLETE W DOPPLER","BOTH IP/OP","$102.00 ","$75.48 ","$21.26 ","$739.00 ","$102.00 ","$102.00 ","$21.26 ","$527.42 ","$527.42 ","$129.39 ","$739.00 ","$483.00 ","$369.50 ","$585.29 ","$591.20 ","$671.06 ","$254.50 ","$136.14 ","$117.65 ","$460.00 "
"93971","EAP","CPT�93971","","PR ECHO HEART XTHORACIC,LIMITED","BOTH IP/OP","$343.00 ","$253.82 ","$71.49 ","$266.11 ","266.11","106.62","71.49","","","","","","","","","","","","",""
"93971","EAP","CPT� 93971","","PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I","BOTH IP/OP","$343.00 ","$253.82 ","$71.49 ","$266.11 ","266.11","106.62","71.49","","","","","","","","","","","","",""
"94640","EAP","CPT� 94640","","DUPLEX LO EXTREM ART UNILAT/LTD","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$479.00 ","$0.00 ","$0.00 ","$0.00 ","$424.07 ","$424.07 ","$83.87 ","$479.00 ","$112.41 ","$239.50 ","$379.37 ","$383.20 ","$156.18 ","$120.13 ","$127.86 ","$76.26 ","$107.06 "
"94664","EAP","CPT�94664","","DUPLEX EXTREM VENOUS,BILAT","BOTH IP/OP","$48.00 ","$35.52 ","$10.00 ","$695.00 ","$26.06 ","$48.00 ","$10.00 ","$523.58 ","$523.58 ","$121.69 ","$695.00 ","$233.72 ","$347.50 ","$550.44 ","$556.00 ","$324.73 ","$199.35 ","$163.16 ","$110.64 ","$222.60 "
"96110","EAP","CPT�96110","","PR POS AIRWAY PRESSURE, CPAP","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$10.07 ","0","10.07","0","","","","","","","","","","","","",""
"96127","EAP","CPT�96127","","PR EXHALED AIR ANALYSIS: O2, CO2","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","0","14","0","","","","","","","","","","","","",""
"96161","EAP","CPT� 96161","","PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","BOTH IP/OP","$8.00 ","$5.92 ","$0.00 ","$8.00 ","0","8","0","","","","","","","","","","","","",""
"96361","EAP","CPT� 96361","","PR DIFFUSING CAPACITY","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$7.71 ","0","0","7.71","","","","","","","","","","","","",""
"96372","EAP","CPT� 96372","","PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","BOTH IP/OP","$41.00 ","$30.34 ","$8.55 ","$41.00 ","22.26","41","8.55","","","","","","","","","","","","",""
"97802","EAP","CPT� 97802","","PR DEBRIDEMENT OPEN WOUND 20 SQ CM<","BOTH IP/OP","$104.00 ","$76.96 ","$21.68 ","$56.47 ","56.47","33.05","21.68","","","","","","","","","","","","",""
"97803","EAP","CPT� 97803","","PR ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","BOTH IP/OP","$90.00 ","$66.60 ","$18.76 ","$48.87 ","48.87","28.17","18.76","","","","","","","","","","","","",""
"98966","EAP","CPT� 98966","","PR ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"98967","EAP","CPT� 98967","","MED NUTR THER, 1ST, INDIV, EA 15 MIN","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$134.00 ","$0.00 ","$0.00 ","$0.00 ","$95.64 ","$95.64 ","$23.46 ","$134.00 ","$29.55 ","$67.00 ","$106.13 ","$107.20 ","$34.61 ","$20.97 ","$34.61 ","$21.33 ","$34.61 "
"98968","EAP","CPT� 98968","","MED NUTR THER, SUBSQ, INDIV, EA 15 MIN","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$82.79 ","$82.79 ","$20.31 ","$116.00 ","$25.06 ","$58.00 ","$91.87 ","$92.80 ","$29.21 ","$18.15 ","$29.21 ","$18.47 ","$29.21 "
"99024","EAP","CPT� 99024","","NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99173","EAP","CPT� 99173","","NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$266.00 ","$0.00 ","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$159.60 ","$41.63 ","$0.00 ","$0.00 ","$0.00 "
"99202","EAP","CPT�99202","","POST-OP FOLLOW-UP VISIT","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$67.13 ","$0.00 ","$49.57 ","$67.13 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99202","EAP","CPT� 99202","","VISUAL SCREENING TEST, BILAT","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$67.13 ","$0.00 ","$49.57 ","$67.13 ","$7.85 ","$7.85 ","$1.93 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$6.60 ","$1.72 ","$0.00 ","$0.00 ","$0.00 "
"99203","EAP","CPT�99203","","OFFICE OUTPATIENT NEW 10 MINUTES","BOTH IP/OP","$314.00 ","$232.36 ","$0.00 ","$329.00 ","$0.00 ","$83.89 ","$67.13 ","$299.34 ","$299.34 ","$57.61 ","$329.00 ","$28.83 ","$164.50 ","$260.57 ","$263.20 ","$27.04 ","$108.52 ","$27.04 ","$99.16 ","$27.04 "
"99203","EAP","CPT� 99203","","PR OFFICE OUTPATIENT NEW 20 MINUTES","BOTH IP/OP","$314.00 ","$232.36 ","$0.00 ","$83.89 ","0","83.89","67.13","","","","","","","","","","","","",""
"99204","EAP","CPT�99204","","OFFICE OUTPATIENT NEW 20 MINUTES","BOTH IP/OP","$467.00 ","$345.58 ","$0.00 ","$378.00 ","$0.00 ","$136.63 ","$67.13 ","$299.34 ","$299.34 ","$66.18 ","$378.00 ","$54.20 ","$189.00 ","$299.38 ","$302.40 ","$51.57 ","$108.52 ","$51.57 ","$99.16 ","$51.57 "
"99204","EAP","CPT� 99204","","PR OFFICE OUTPATIENT NEW 30 MINUTES","BOTH IP/OP","$467.00 ","$345.58 ","$0.00 ","$136.63 ","0","136.63","67.13","","","","","","","","","","","","",""
"99205","EAP","CPT�99205","","OFFICE OUTPATIENT NEW 30 MINUTES","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$442.00 ","$0.00 ","$185.53 ","$67.13 ","$299.34 ","$299.34 ","$77.39 ","$442.00 ","$82.35 ","$221.00 ","$350.06 ","$353.60 ","$77.17 ","$108.52 ","$77.17 ","$99.16 ","$77.17 "
"99205","EAP","CPT� 99205","","PR OFFICE OUTPATIENT NEW 45 MINUTES","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$185.53 ","0","185.53","67.13","","","","","","","","","","","","",""
"99211","EAP","CPT�99211","","OFFICE OUTPATIENT NEW 45 MINUTES","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$569.00 ","$0.00 ","$9.03 ","$67.13 ","$299.34 ","$299.34 ","$99.63 ","$569.00 ","$138.78 ","$284.50 ","$450.65 ","$455.20 ","$131.98 ","$108.52 ","$131.98 ","$99.16 ","$131.98 "
"99211","EAP","CPT� 99211","","PR OFFICE OUTPATIENT NEW 60 MINUTES","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$67.13 ","0","9.03","67.13","","","","","","","","","","","","",""
"99212","EAP","CPT�99212","","OFFICE OUTPATIENT NEW 60 MINUTES","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$686.00 ","$0.00 ","$36.10 ","$67.13 ","$299.34 ","$299.34 ","$120.11 ","$686.00 ","$181.26 ","$343.00 ","$543.31 ","$548.80 ","$172.37 ","$108.52 ","$172.37 ","$99.16 ","$172.37 "
"99212","EAP","CPT� 99212","","PR OFFICE OUTPATIENT VISIT 5 MINUTES","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$67.13 ","0","36.1","67.13","","","","","","","","","","","","",""
"99213","EAP","CPT�99213","","OFFICE OUTPATIENT VISIT 5 MINUTES","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$299.34 ","$0.00 ","$67.67 ","$67.13 ","$299.34 ","$299.34 ","$50.78 ","$290.00 ","$9.84 ","$145.00 ","$229.68 ","$232.00 ","$9.38 ","$108.52 ","$9.38 ","$99.16 ","$9.38 "
"99213","EAP","CPT� 99213","","PR OFFICE OUTPATIENT VISIT 10 MINUTES","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$67.67 ","0","67.67","67.13","","","","","","","","","","","","",""
"99214","EAP","CPT�99214","","OFFICE OUTPATIENT VISIT 10 MINUTES","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$313.00 ","$0.00 ","$99.97 ","$67.13 ","$299.34 ","$299.34 ","$54.80 ","$313.00 ","$27.29 ","$156.50 ","$247.90 ","$250.40 ","$26.32 ","$108.52 ","$26.32 ","$99.16 ","$26.32 "
"99214","EAP","CPT� 99214","","PR OFFICE OUTPATIENT VISIT 15 MINUTES","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$99.97 ","0","99.97","67.13","","","","","","","","","","","","",""
"99215","EAP","CPT�99215","","OFFICE OUTPATIENT VISIT 15 MINUTES","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$399.00 ","$0.00 ","$147.16 ","$67.13 ","$299.34 ","$299.34 ","$69.86 ","$399.00 ","$54.93 ","$199.50 ","$316.01 ","$319.20 ","$52.29 ","$108.52 ","$52.29 ","$99.16 ","$52.29 "
"99215","EAP","CPT� 99215","","PR OFFICE OUTPATIENT VISIT 25 MINUTES","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$147.16 ","0","147.16","67.13","","","","","","","","","","","","",""
"99242","EAP","CPT�99242","","OFFICE OUTPATIENT VISIT 25 MINUTES","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$491.00 ","$0.00 ","$67.99 ","$0.00 ","$299.34 ","$299.34 ","$85.97 ","$491.00 ","$84.06 ","$245.50 ","$388.87 ","$392.80 ","$80.42 ","$108.52 ","$80.42 ","$99.16 ","$80.42 "
"99243","EAP","CPT�99243","","PR OFFICE OUTPATIENT VISIT 40 MINUTES","BOTH IP/OP","$436.00 ","$322.64 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"99243","EAP","CPT� 99243","","OFFICE OUTPATIENT VISIT 40 MINUTES","BOTH IP/OP","$436.00 ","$322.64 ","$0.00 ","$541.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$94.72 ","$541.00 ","$118.93 ","$270.50 ","$428.47 ","$432.80 ","$113.60 ","$108.52 ","$113.60 ","$99.16 ","$113.60 "
"99244","EAP","CPT�99244","","PR OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$152.96 ","0","152.96","0","","","","","","","","","","","","",""
"99244","EAP","CPT� 99244","","OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$436.00 ","$0.00 ","$152.96 ","$0.00 ","$299.34 ","$299.34 ","$76.34 ","$436.00 ","$0.00 ","$218.00 ","$345.31 ","$348.80 ","$261.60 ","$112.44 ","$0.00 ","$0.00 ","$0.00 "
"99381","EAP","CPT� 99381","","PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$76.64 ","0","76.64","0","","","","","","","","","","","","",""
"99382","EAP","CPT� 99382","","OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$652.00 ","$0.00 ","$81.52 ","$0.00 ","$299.34 ","$299.34 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$391.20 ","$155.65 ","$0.00 ","$0.00 ","$0.00 "
"99383","EAP","CPT� 99383","","PREVENTIVE VISIT,NEW,INFANT < 1 YR","BOTH IP/OP","$429.00 ","$317.46 ","$0.00 ","$395.00 ","$0.00 ","$86.72 ","$0.00 ","$299.34 ","$299.34 ","$69.16 ","$395.00 ","$0.00 ","$197.50 ","$312.84 ","$316.00 ","$237.00 ","$61.82 ","$0.00 ","$0.00 ","$0.00 "
"99384","EAP","CPT� 99384","","PREVENTIVE VISIT,NEW,AGE 1-4","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$413.00 ","$0.00 ","$101.65 ","$0.00 ","$299.34 ","$299.34 ","$72.31 ","$413.00 ","$0.00 ","$206.50 ","$327.10 ","$330.40 ","$247.80 ","$64.63 ","$0.00 ","$0.00 ","$0.00 "
"99385","EAP","CPT�99385","","PREVENTIVE VISIT,NEW,AGE5-11","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$429.00 ","$0.00 ","$97.50 ","$0.00 ","$299.34 ","$299.34 ","$75.11 ","$429.00 ","$0.00 ","$214.50 ","$339.77 ","$343.20 ","$257.40 ","$67.14 ","$0.00 ","$0.00 ","$0.00 "
"99385","EAP","CPT� 99385","","PREVENTIVE VISIT,NEW,12-17","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$485.00 ","$0.00 ","$97.50 ","$0.00 ","$299.34 ","$299.34 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$291.00 ","$75.90 ","$0.00 ","$0.00 ","$0.00 "
"99386","EAP","CPT�99386","","PR PREVENTIVE VISIT,NEW,18-39","BOTH IP/OP","$545.00 ","$403.30 ","$0.00 ","$118.64 ","0","118.64","0","","","","","","","","","","","","",""
"99386","EAP","CPT� 99386","","PREVENTIVE VISIT,NEW,18-39","BOTH IP/OP","$545.00 ","$403.30 ","$0.00 ","$469.00 ","$0.00 ","$118.64 ","$0.00 ","$299.34 ","$299.34 ","$82.12 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$281.40 ","$84.34 ","$0.00 ","$0.00 ","$0.00 "
"99387","EAP","CPT� 99387","","PR PREVENTIVE VISIT,NEW,40-64","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$0.00 ","0","0","0","","","","","","","","","","","","",""
"99391","EAP","CPT� 99391","","PREVENTIVE VISIT,NEW,40-64","BOTH IP/OP","$354.00 ","$261.96 ","$0.00 ","$545.00 ","$0.00 ","$69.73 ","$0.00 ","$299.34 ","$299.34 ","$95.43 ","$545.00 ","$0.00 ","$272.50 ","$431.64 ","$436.00 ","$327.00 ","$84.34 ","$0.00 ","$0.00 ","$0.00 "
"99392","EAP","CPT� 99392","","PREVENTIVE VISIT,NEW,65 & OVER","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$591.00 ","$0.00 ","$76.64 ","$0.00 ","$299.34 ","$299.34 ","$0.00 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99393","EAP","CPT� 99393","","PREVENTIVE VISIT,EST, INFANT < 1 YR","BOTH IP/OP","$377.00 ","$278.98 ","$0.00 ","$354.00 ","$0.00 ","$76.64 ","$0.00 ","$299.34 ","$299.34 ","$61.98 ","$354.00 ","$0.00 ","$177.00 ","$280.37 ","$283.20 ","$212.40 ","$55.40 ","$0.00 ","$0.00 ","$0.00 "
"99394","EAP","CPT� 99394","","PREVENTIVE VISIT,EST,AGE 1-4","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$378.00 ","$0.00 ","$86.72 ","$0.00 ","$299.34 ","$299.34 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$226.80 ","$59.16 ","$0.00 ","$0.00 ","$0.00 "
"99395","EAP","CPT� 99395","","PREVENTIVE VISIT,EST,AGE5-11","BOTH IP/OP","$423.00 ","$313.02 ","$0.00 ","$377.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$66.01 ","$377.00 ","$0.00 ","$188.50 ","$298.58 ","$301.60 ","$226.20 ","$59.00 ","$0.00 ","$0.00 ","$0.00 "
"99396","EAP","CPT� 99396","","PREVENTIVE VISIT,EST,12-17","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$414.00 ","$0.00 ","$96.80 ","$0.00 ","$299.34 ","$299.34 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$248.40 ","$64.79 ","$0.00 ","$0.00 ","$0.00 "
"99397","EAP","CPT�99397","","PREVENTIVE VISIT,EST,18-39","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$423.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$74.06 ","$423.00 ","$0.00 ","$211.50 ","$335.02 ","$338.40 ","$253.80 ","$84.34 ","$0.00 ","$0.00 ","$0.00 "
"99406","EAP","CPT� 99406","","PREVENTIVE VISIT,EST,40-64","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$270.00 ","$84.34 ","$0.00 ","$0.00 ","$0.00 "
"99441","EAP","CPT� 99441","","TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$299.34 ","$0.00 ","$36.10 ","$0.00 ","$299.34 ","$299.34 ","$9.45 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99442","EAP","CPT� 99442","","PHYS/QHP TELEPHONE EVALUATION 5-10 MIN","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$161.00 ","$0.00 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$96.60 ","$25.20 ","$0.00 ","$0.00 ","$0.00 "
"99443","EAP","CPT� 99443","","PHYS/QHP TELEPHONE EVALUATION 11-20 MIN","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$266.00 ","$0.00 ","$100.28 ","$0.00 ","$0.00 ","$0.00 ","$46.57 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$159.60 ","$41.63 ","$0.00 ","$0.00 ","$0.00 "
"99495","EAP","CPT� 99495","","PHYS/QHP TELEPHONE EVALUATION 21-30 MIN","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$386.00 ","$0.00 ","$116.36 ","$67.13 ","$0.00 ","$0.00 ","$67.59 ","$386.00 ","$0.00 ","$193.00 ","$305.71 ","$308.80 ","$231.60 ","$60.41 ","$0.00 ","$0.00 ","$0.00 "
"99496","EAP","CPT� 99496","","TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE","BOTH IP/OP","$777.00 ","$574.98 ","$0.00 ","$656.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$114.86 ","$656.00 ","$116.27 ","$328.00 ","$519.55 ","$524.80 ","$161.54 ","$102.66 ","$125.50 ","$104.44 ","$110.73 "
"99497","EAP","CPT�99497","","TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE","BOTH IP/OP","$236.00 ","$174.64 ","$0.00 ","$867.00 ","$0.00 ","$73.28 ","$67.13 ","$299.34 ","$299.34 ","$151.80 ","$867.00 ","$116.27 ","$433.50 ","$686.66 ","$693.60 ","$161.54 ","$135.69 ","$165.53 ","$0.00 ","$0.00 "
"10932085","EAP","HCPCS C1729","","Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$18.73 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$16.75 ","$0.00 ","$17.03 ","$0.00 "
"10933190","EAP","HCPCS C1729","","Catheter Urethral 18fr Foley 2 Way Medium Olive Coude Tip 1","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$4.55 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$4.07 ","$0.00 ","$4.14 ","$0.00 "
"10945160","EAP","HCPCS C1751","","Catheter Umb 3.5fr 15in .15ml Clr Strl Lf Arg 1 Lum Ll Hub","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"10945178","EAP","HCPCS C1751","","Cap Tube 13mm Blu Eztpr Dbl Flng Sl Thb Tab Pe","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"10945194","EAP","HCPCS C1729","","System Drn 35cm 700ml Blu Strl Lf Be2 Mntr Trndcr Atch Vntrc","BOTH IP/OP","$742.00 ","$549.08 ","$0.00 ","$1,307.00 ","$402.91 ","$0.00 ","$154.65 ","$932.81 ","$932.81 ","$228.85 ","$1,307.00 ","$0.00 ","$653.50 ","$1,035.14 ","$1,045.60 ","$0.00 ","$204.55 ","$0.00 ","$208.07 ","$0.00 "
"10961170","EAP","HCPCS C1751","","Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$57.00 ","$20.63 ","$0.00 ","$7.92 ","$40.68 ","$40.68 ","$9.98 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$8.92 ","$0.00 ","$9.07 ","$0.00 "
"11100001","EAP","Custom 11100001","","HB MED-SUR-GY/PVT","BOTH IP/OP","$3,058.00 ","$2,262.92 ","$0.00 ","$2,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,696.00 ","$0.00 ","$0.00 ","$2,135.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100003","EAP","Custom 11100003","","Tele Private Med Surg","BOTH IP/OP","$3,378.00 ","$2,499.72 ","$0.00 ","$2,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,978.00 ","$0.00 ","$0.00 ","$2,358.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100021","EAP","Custom 11100021","","HB  PVT GYN","BOTH IP/OP","$3,058.00 ","$2,262.92 ","$0.00 ","$2,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,696.00 ","$0.00 ","$0.00 ","$2,135.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100023","EAP","Custom 11100023","","Tele Private  Gyn","BOTH IP/OP","$3,378.00 ","$2,499.72 ","$0.00 ","$2,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,978.00 ","$0.00 ","$0.00 ","$2,358.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100501","EAP","Custom 11100501","","Trauma Private Med Surg","BOTH IP/OP","$3,398.00 ","$2,514.52 ","$0.00 ","$2,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,996.00 ","$0.00 ","$0.00 ","$2,372.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100503","EAP","Custom 11100503","","Trauma Tele Private Med Surg","BOTH IP/OP","$3,718.00 ","$2,751.32 ","$0.00 ","$3,278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,278.00 ","$0.00 ","$0.00 ","$2,596.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100521","EAP","Custom 11100521","","Trauma Private  Gyn","BOTH IP/OP","$3,398.00 ","$2,514.52 ","$0.00 ","$2,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,996.00 ","$0.00 ","$0.00 ","$2,372.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11100523","EAP","Custom 11100523","","Trauma Tele Private  Gyn","BOTH IP/OP","$3,718.00 ","$2,751.32 ","$0.00 ","$3,278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,278.00 ","$0.00 ","$0.00 ","$2,596.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11200001","EAP","Custom 11200001","","Private Ob","BOTH IP/OP","$3,218.00 ","$2,381.32 ","$0.00 ","$2,838.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,838.00 ","$0.00 ","$0.00 ","$2,247.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11200002","EAP","Custom 11200002","","Tele Private Ob","BOTH IP/OP","$3,533.00 ","$2,614.42 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$2,467.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11200501","EAP","Custom 11200501","","Trauma Private Ob","BOTH IP/OP","$3,559.00 ","$2,633.66 ","$0.00 ","$3,138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,138.00 ","$0.00 ","$0.00 ","$2,485.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11200502","EAP","Custom 11200502","","Trauma Tele Private Ob","BOTH IP/OP","$3,873.00 ","$2,866.02 ","$0.00 ","$3,415.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,415.00 ","$0.00 ","$0.00 ","$2,704.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11400002","EAP","Custom 11400002","","Private Psy","BOTH IP/OP","$2,837.00 ","$2,099.38 ","$0.00 ","$2,501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,501.00 ","$0.00 ","$0.00 ","$1,980.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11400502","EAP","Custom 11400502","","Trauma Private Psy","BOTH IP/OP","$3,177.00 ","$2,350.98 ","$0.00 ","$2,801.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,801.00 ","$0.00 ","$0.00 ","$2,218.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11500001","EAP","Custom 11500001","","Inpatient Hospice","BOTH IP/OP","$3,065.00 ","$2,268.10 ","$0.00 ","$2,702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,702.00 ","$0.00 ","$0.00 ","$2,139.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11500501","EAP","Custom 11500501","","TRAUMA INPATIENT HOSPICE","BOTH IP/OP","$3,176.00 ","$2,350.24 ","$0.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,800.00 ","$0.00 ","$0.00 ","$2,217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100001","EAP","Custom 12100001","","Semiprivate Medsurg","BOTH IP/OP","$2,166.00 ","$1,602.84 ","$0.00 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,910.00 ","$0.00 ","$0.00 ","$1,512.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100003","EAP","Custom 12100003","","Tele Semiprivate","BOTH IP/OP","$2,550.00 ","$1,887.00 ","$0.00 ","$2,248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,248.00 ","$0.00 ","$0.00 ","$1,780.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100021","EAP","Custom 12100021","","Semiprivate Gyn","BOTH IP/OP","$2,166.00 ","$1,602.84 ","$0.00 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,910.00 ","$0.00 ","$0.00 ","$1,512.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100023","EAP","Custom 12100023","","Tele Semiprivate Gyn","BOTH IP/OP","$2,550.00 ","$1,887.00 ","$0.00 ","$2,248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,248.00 ","$0.00 ","$0.00 ","$1,780.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100501","EAP","Custom 12100501","","Trauma Semiprivate Medsurg","BOTH IP/OP","$2,507.00 ","$1,855.18 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$1,750.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100503","EAP","Custom 12100503","","Trauma Tele Semiprivate","BOTH IP/OP","$2,890.00 ","$2,138.60 ","$0.00 ","$2,548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,548.00 ","$0.00 ","$0.00 ","$2,018.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100521","EAP","Custom 12100521","","Trauma Semiprivate Gyn","BOTH IP/OP","$2,507.00 ","$1,855.18 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$1,750.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12100523","EAP","Custom 12100523","","Trauma Tele Semiprivate Gyn","BOTH IP/OP","$2,890.00 ","$2,138.60 ","$0.00 ","$2,548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,548.00 ","$0.00 ","$0.00 ","$2,018.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12200001","EAP","Custom 12200001","","Semiprivate Ob","BOTH IP/OP","$2,359.00 ","$1,745.66 ","$0.00 ","$2,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,080.00 ","$0.00 ","$0.00 ","$1,647.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12200002","EAP","Custom 12200002","","Tele Semiprivate Ob","BOTH IP/OP","$2,391.00 ","$1,769.34 ","$0.00 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,108.00 ","$0.00 ","$0.00 ","$1,669.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12200501","EAP","Custom 12200501","","Trauma Semiprivate Ob","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,380.00 ","$0.00 ","$0.00 ","$1,884.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12200502","EAP","Custom 12200502","","Trauma Tele Semiprivate Ob","BOTH IP/OP","$2,732.00 ","$2,021.68 ","$0.00 ","$2,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,408.00 ","$0.00 ","$0.00 ","$1,907.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12400002","EAP","Custom 12400002","","Semiprivate Psych","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$1,833.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12400502","EAP","Custom 12400502","","Trauma Semiprivate Psych","BOTH IP/OP","$2,966.00 ","$2,194.84 ","$0.00 ","$2,615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,615.00 ","$0.00 ","$0.00 ","$2,071.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400001","EAP","Custom 16400001","","Tele.isolation","BOTH IP/OP","$3,488.00 ","$2,581.12 ","$0.00 ","$3,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,075.00 ","$0.00 ","$0.00 ","$2,435.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400002","EAP","Custom 16400002","","Isolation Med Surg","BOTH IP/OP","$3,362.00 ","$2,487.88 ","$0.00 ","$2,964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,964.00 ","$0.00 ","$0.00 ","$2,347.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400004","EAP","Custom 16400004","","Isolation Med Surg","BOTH IP/OP","$3,362.00 ","$2,487.88 ","$0.00 ","$2,964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,964.00 ","$0.00 ","$0.00 ","$2,347.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400005","EAP","Custom 16400005","","Isolation Ob","BOTH IP/OP","$3,563.00 ","$2,636.62 ","$0.00 ","$3,142.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,142.00 ","$0.00 ","$0.00 ","$2,488.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400006","EAP","Custom 16400006","","Tele.isolation Ob","BOTH IP/OP","$3,581.00 ","$2,649.94 ","$0.00 ","$3,157.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.00 ","$0.00 ","$0.00 ","$2,500.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400007","EAP","Custom 16400007","","Isolation High-risk Scu","BOTH IP/OP","$3,953.00 ","$2,925.22 ","$0.00 ","$3,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,485.00 ","$0.00 ","$0.00 ","$2,760.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400022","EAP","Custom 16400022","","Isolation  Gyn","BOTH IP/OP","$3,362.00 ","$2,487.88 ","$0.00 ","$2,964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,964.00 ","$0.00 ","$0.00 ","$2,347.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400501","EAP","Custom 16400501","","Trauma Tele.isolation","BOTH IP/OP","$3,828.00 ","$2,832.72 ","$0.00 ","$3,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,375.00 ","$0.00 ","$0.00 ","$2,673.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400502","EAP","Custom 16400502","","Trauma Isolation Med Surg","BOTH IP/OP","$3,702.00 ","$2,739.48 ","$0.00 ","$3,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,264.00 ","$0.00 ","$0.00 ","$2,585.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400504","EAP","Custom 16400504","","Trauma Isolation Med Surg","BOTH IP/OP","$3,702.00 ","$2,739.48 ","$0.00 ","$3,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,264.00 ","$0.00 ","$0.00 ","$2,585.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400505","EAP","Custom 16400505","","Trauma Isolation Ob","BOTH IP/OP","$3,904.00 ","$2,888.96 ","$0.00 ","$3,442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,442.00 ","$0.00 ","$0.00 ","$2,726.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400506","EAP","","","Trauma Tele.isolation Ob","BOTH IP/OP","$3,457.00 ","$2,558.18 ","$0.00 ","$3,457.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,457.00 ","$0.00 ","$0.00 ","$2,737.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400507","EAP","Custom 16400507","","Trauma Isolation High-risk Scu","BOTH IP/OP","$4,293.00 ","$3,176.82 ","$0.00 ","$3,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,785.00 ","$0.00 ","$0.00 ","$2,997.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16400522","EAP","Custom 16400522","","Trauma Isolation  Gyn","BOTH IP/OP","$3,702.00 ","$2,739.48 ","$0.00 ","$3,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,264.00 ","$0.00 ","$0.00 ","$2,585.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17000001","EAP","Custom 17000001","","General Nursery","BOTH IP/OP","$849.00 ","$628.26 ","$0.00 ","$748.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$748.00 ","$0.00 ","$0.00 ","$592.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17100001","EAP","Custom 17100001","","NURSERY/LEVEL I","BOTH IP/OP","$1,331.00 ","$984.94 ","$0.00 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,026.00 ","$0.00 ","$0.00 ","$812.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17100002","EAP","Custom 17100002","","Nursery Level I","BOTH IP/OP","$1,331.00 ","$984.94 ","$0.00 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,026.00 ","$0.00 ","$0.00 ","$812.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200002","EAP","Custom 17200002","","Nursery Level Ii","BOTH IP/OP","$3,458.00 ","$2,558.92 ","$0.00 ","$3,049.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,049.00 ","$0.00 ","$0.00 ","$2,414.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17300001","EAP","Custom 17300001","","Nursery Level Iii","BOTH IP/OP","$5,760.00 ","$4,262.40 ","$0.00 ","$5,078.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,078.00 ","$0.00 ","$0.00 ","$4,021.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17400001","EAP","Custom 17400001","","Nursery/level Iv","BOTH IP/OP","$6,717.00 ","$4,970.58 ","$0.00 ","$5,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,922.00 ","$0.00 ","$0.00 ","$4,690.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18000010","EAP","Custom 18000010","","Leave Of Absence","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19818887","EAP","HCPCS A6197","","Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19979858","EAP","HCPCS C1729","","Kit Pressure Monitr Transducer Tipped Catheter Drill Bit","BOTH IP/OP","$2,403.00 ","$1,778.22 ","$0.00 ","$2,403.00 ","$0.00 ","$0.00 ","$0.00 ","$1,715.02 ","$1,715.02 ","$420.75 ","$2,403.00 ","$0.00 ","$1,201.50 ","$1,903.18 ","$1,922.40 ","$0.00 ","$376.07 ","$0.00 ","$382.56 ","$0.00 "
"19988898","EAP","Custom 19988898","","Catheter Pressure 3.5mm 5mm 82cm 2cm Sensor Tip External","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$41.39 ","$41.39 ","$0.00 ","$58.00 ","$0.00 ","$29.00 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19993849","EAP","HCPCS C1751","","Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$29.00 ","$15.75 ","$0.00 ","$6.04 ","$20.70 ","$20.70 ","$5.08 ","$29.00 ","$0.00 ","$14.50 ","$22.97 ","$23.20 ","$0.00 ","$4.54 ","$0.00 ","$4.62 ","$0.00 "
"19993898","EAP","HCPCS C1729","","Tray Catheterization 16fr Foley Antireflux Evident Seal","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$14.12 ","$0.00 ","$5.42 ","$18.56 ","$18.56 ","$4.55 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$4.07 ","$0.00 ","$4.14 ","$0.00 "
"19994800","EAP","Custom 19994800","","Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp","BOTH IP/OP","$701.00 ","$518.74 ","$0.00 ","$2,065.00 ","$0.00 ","$0.00 ","$0.00 ","$1,473.79 ","$1,473.79 ","$0.00 ","$2,065.00 ","$0.00 ","$1,032.50 ","$1,635.48 ","$1,652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20000001","EAP","Custom 20000001","","Intensive Care Icu Ob","BOTH IP/OP","$6,502.00 ","$4,811.48 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$4,539.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20000501","EAP","Custom 20000501","","Trauma Intensive Care Icu Ob","BOTH IP/OP","$6,842.00 ","$5,063.08 ","$0.00 ","$6,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,032.00 ","$0.00 ","$0.00 ","$4,777.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20100001","EAP","Custom 20100001","","Intensive Care Icu Surgical","BOTH IP/OP","$6,502.00 ","$4,811.48 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$4,539.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20100501","EAP","Custom 20100501","","Trauma Intensive Care Icu Surgical","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,032.00 ","$0.00 ","$0.00 ","$4,777.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20200001","EAP","Custom 20200001","","Intensive Care Icu Medical","BOTH IP/OP","$6,502.00 ","$4,811.48 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$4,539.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20200501","EAP","Custom 20200501","","Trauma Intensive Care Icu Medical","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,032.00 ","$0.00 ","$0.00 ","$4,777.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20600001","EAP","Custom 20600001","","Intermediate Care","BOTH IP/OP","$4,007.00 ","$2,965.18 ","$0.00 ","$3,513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,513.00 ","$0.00 ","$0.00 ","$2,782.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20600002","EAP","Custom 20600002","","Intermediate Care Burn","BOTH IP/OP","$9,266.00 ","$6,856.84 ","$0.00 ","$8,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,145.00 ","$0.00 ","$0.00 ","$6,450.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20600005","EAP","Custom 20600005","","Intermediate Care","BOTH IP/OP","$4,007.00 ","$2,965.18 ","$0.00 ","$3,513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,513.00 ","$0.00 ","$0.00 ","$2,782.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20600501","EAP","Custom 20600501","","Trauma Intermediate Care","BOTH IP/OP","$4,708.00 ","$3,483.92 ","$0.00 ","$3,813.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,813.00 ","$0.00 ","$0.00 ","$3,019.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20600502","EAP","Custom 20600502","","Trauma Intermediate Care Burn","BOTH IP/OP","$9,580.00 ","$7,089.20 ","$0.00 ","$8,445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,445.00 ","$0.00 ","$0.00 ","$6,688.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20700001","EAP","Custom 20700001","","Intensive Care Icu Burn","BOTH IP/OP","$10,118.00 ","$7,487.32 ","$0.00 ","$8,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,884.00 ","$0.00 ","$0.00 ","$7,036.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20700501","EAP","Custom 20700501","","Trauma Intensive Care Icu Burn","BOTH IP/OP","$10,421.00 ","$7,711.54 ","$0.00 ","$9,184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,184.00 ","$0.00 ","$0.00 ","$7,273.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21000001","EAP","Custom 21000001","","Intensive Care Icu Medical","BOTH IP/OP","$6,502.00 ","$4,811.48 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,732.00 ","$0.00 ","$0.00 ","$4,539.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21400005","EAP","","","Intermediate Coronary Care Unit","BOTH IP/OP","$4,793.00 ","$3,546.82 ","$0.00 ","$4,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.00 ","$0.00 ","$0.00 ","$3,318.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21400505","EAP","Custom 21400505","","Trauma Intermediate Coronary Care Unit","BOTH IP/OP","$5,219.00 ","$3,862.06 ","$0.00 ","$4,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,490.00 ","$0.00 ","$0.00 ","$3,556.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21900001","EAP","Custom 21900001","","Intermediate Care","BOTH IP/OP","$3,741.00 ","$2,768.34 ","$0.00 ","$3,513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,513.00 ","$0.00 ","$0.00 ","$2,782.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000134","EAP","Custom 25000134","","Rocephin 250mg","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000141","EAP","Custom 25000141","","Toradol 30 Mg","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000153","EAP","Custom 25000153","","Rocephin 250mg, Im","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000157","EAP","Custom 25000157","","Depoprovera 150mg","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$128.47 ","$128.47 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000169","EAP","Custom 25000169","","Vit B 12 100mcg","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$32.83 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000182","EAP","Custom 25000182","","Rocephin Injection","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000187","EAP","Custom 25000187","","Rocephin 250mg","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000189","EAP","Custom 25000189","","Bicillin Injection","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000224","EAP","Custom 25000224","","Rocephin 250mg (cef","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000226","EAP","Custom 25000226","","Depo Provera Inject","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$122.04 ","$122.04 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000227","EAP","Custom 25000227","","Oral Contraceptives","BOTH IP/OP","$13.00 ","$9.62 ","$0.00 ","$13.00 ","$0.00 ","$0.00 ","$0.00 ","$9.28 ","$9.28 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000229","EAP","Custom 25000229","","Plan B","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000230","EAP","Custom 25000230","","Evra Transdermal Pa","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000327","EAP","Custom 25000327","","Oral Contraceptives","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$7.85 ","$7.85 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000908","EAP","Custom 25000908","","Evra Trandermal Pat","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000960","EAP","Custom 25000960","","Hetastarch (hespan)","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$0.00 ","$0.00 ","$0.00 ","$310.46 ","$310.46 ","$0.00 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000961","EAP","Custom 25000961","","Hetastarch","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$0.00 ","$0.00 ","$0.00 ","$310.46 ","$310.46 ","$0.00 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000966","EAP","Custom 25000966","","Rocephin 250mg, 1gm","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25000990","EAP","Custom 25000990","","Nitric Oxide (per Hr)","BOTH IP/OP","$789.00 ","$583.86 ","$0.00 ","$789.00 ","$0.00 ","$0.00 ","$0.00 ","$563.11 ","$563.11 ","$0.00 ","$789.00 ","$0.00 ","$394.50 ","$624.89 ","$631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25002130","EAP","Custom 25002130","","Zithromax","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$17.13 ","$17.13 ","$0.00 ","$24.00 ","$0.00 ","$12.00 ","$19.01 ","$19.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25500016","EAP","HCPCS Q9965","","Locm 150-199mg/ml I","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25500039","EAP","HCPCS Q9965","","Locm 150-199mg/ml I","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800010","EAP","Custom 25800010","","Solutions Sodium Ch","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800013","EAP","Custom 25800013","","Solution Iv D 5% In","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800016","EAP","Custom 25800016","","Solution Iv Lactate","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800017","EAP","Custom 25800017","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800018","EAP","Custom 25800018","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800019","EAP","Custom 25800019","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800020","EAP","Custom 25800020","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800031","EAP","Custom 25800031","","Solution Iv D 5% In","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800033","EAP","Custom 25800033","","Solution Iv Lactate","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800034","EAP","Custom 25800034","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800037","EAP","Custom 25800037","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800038","EAP","Custom 25800038","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800039","EAP","Custom 25800039","","Solution Iv Nacl 0.","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800060","EAP","Custom 25800060","","Iv Fluids","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800061","EAP","Custom 25800061","","Iv Fluids","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800062","EAP","Custom 25800062","","I.v. Fluids 500ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800063","EAP","Custom 25800063","","I.v. Fluid 100ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800080","EAP","Custom 25800080","","Iv Fluids 1000ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800095","EAP","Custom 25800095","","Solution Iv Water For Irr","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800260","EAP","Custom 25800260","","Iv Fluid 500ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800262","EAP","Custom 25800262","","Solutions  Advantage Glou","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800263","EAP","Custom 25800263","","Solution Irrigation Water 150","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800264","EAP","Custom 25800264","","Solutions Iv Water For Inject","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800265","EAP","Custom 25800265","","Solutions Sodium Chloride","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800267","EAP","Custom 25800267","","Iv Fluids, 100cc","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800268","EAP","Custom 25800268","","Iv Fluids, 500cc","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800269","EAP","Custom 25800269","","Iv Fluids, 1000cc","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800274","EAP","Custom 25800274","","Solution Iv Nacl 0.9% Gla","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800277","EAP","Custom 25800277","","Solution Iv Nacl 0.9% 50m","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800278","EAP","Custom 25800278","","Iv Fluids, 50cc","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800401","EAP","Custom 25800401","","I.v. Fluids","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800402","EAP","Custom 25800402","","I.v. Fluids 1000cc","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800403","EAP","Custom 25800403","","I.v. Fluids 500ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800404","EAP","Custom 25800404","","Iv Fluid 1000cc","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800405","EAP","Custom 25800405","","Iv Fluid, # Bags","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800406","EAP","Custom 25800406","","Iv Fluid, #bags","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800407","EAP","Custom 25800407","","Iv Fluids 1000ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800408","EAP","Custom 25800408","","Iv Fluids 500cc","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800409","EAP","Custom 25800409","","Iv Fluids 50cc","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800410","EAP","Custom 25800410","","Iv Fluids-500ml","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800411","EAP","Custom 25800411","","Solution Intravenous Viaflex Latex Free Plasma-lyte A","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$29.00 ","$0.00 ","$0.00 ","$0.00 ","$20.70 ","$20.70 ","$0.00 ","$29.00 ","$0.00 ","$14.50 ","$22.97 ","$23.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25800412","EAP","Custom 25800412","","Solution Irr 0.9% Na Chlor Urmtc 3l Strl Lf","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$19.27 ","$19.27 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25900227","EAP","Custom 25900227","","Oral Contraceptives","BOTH IP/OP","$12.00 ","$8.88 ","$0.00 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$8.56 ","$8.56 ","$0.00 ","$12.00 ","$0.00 ","$6.00 ","$9.50 ","$9.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25900255","EAP","Custom 25900255","","Insulin 5 Units","BOTH IP/OP","$4.00 ","$2.96 ","$0.00 ","$4.00 ","$0.00 ","$0.00 ","$0.00 ","$2.85 ","$2.85 ","$0.00 ","$4.00 ","$0.00 ","$2.00 ","$3.17 ","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26000001","EAP","CPT� 96360","","Iv Hydra Initial (31 Min To 1 Hr)","BOTH IP/OP","$1,030.00 ","$762.20 ","$34.59 ","$881.00 ","$559.29 ","$200.34 ","$214.68 ","$628.77 ","$628.77 ","$154.26 ","$881.00 ","$184.28 ","$440.50 ","$697.75 ","$704.80 ","$256.03 ","$53.93 ","$34.59 ","$140.26 ","$175.50 "
"26000003","EAP","CPT� 96361","","Iv Hydra Add'l (31 Min To 1 Hr)","BOTH IP/OP","$347.00 ","$256.78 ","$13.69 ","$296.00 ","$188.42 ","$39.19 ","$72.32 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$38.22 ","$148.00 ","$234.43 ","$236.80 ","$53.10 ","$15.67 ","$13.69 ","$47.12 ","$36.40 "
"26000005","EAP","CPT� 96365","","Iv Infus Ther,prophylax,dx Initial (16 Min To 1 Hr)","BOTH IP/OP","$1,796.00 ","$1,329.04 ","$65.68 ","$1,538.00 ","$975.23 ","$200.34 ","$374.33 ","$1,097.67 ","$1,097.67 ","$269.29 ","$1,538.00 ","$184.28 ","$769.00 ","$1,218.10 ","$1,230.40 ","$256.03 ","$65.68 ","$72.05 ","$244.85 ","$175.50 "
"26000006","EAP","CPT� 96366","","Iv Infus Ther,prophylax,dx Add'l (31 Min To 1 Hr)","BOTH IP/OP","$347.00 ","$256.78 ","$20.85 ","$296.00 ","$188.42 ","$39.19 ","$72.32 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$38.22 ","$148.00 ","$234.43 ","$236.80 ","$53.10 ","$20.85 ","$21.98 ","$47.12 ","$36.40 "
"26000007","EAP","CPT� 96367","","Iv Infus Ther,prophylax,dx Add'l New Med (31 Min To 1 Hr)","BOTH IP/OP","$523.00 ","$387.02 ","$31.35 ","$447.00 ","$283.99 ","$60.72 ","$109.01 ","$319.02 ","$319.02 ","$78.27 ","$447.00 ","$60.65 ","$223.50 ","$354.02 ","$357.60 ","$84.26 ","$32.97 ","$31.35 ","$71.16 ","$57.76 "
"26000008","EAP","CPT� 96368","","Iv Infus Ther,prophylax,dx Add'l Concur (31 Min To 1 Hr)","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$490.00 ","$342.09 ","$0.00 ","$131.31 ","$349.71 ","$349.71 ","$85.80 ","$490.00 ","$0.00 ","$245.00 ","$388.08 ","$392.00 ","$0.00 ","$19.47 ","$21.26 ","$78.01 ","$0.00 "
"26000111","EAP","CPT� 96374","","Iv Push - Ther,prophylax,dx 1st Med","BOTH IP/OP","$630.00 ","$466.20 ","$39.99 ","$490.00 ","$342.09 ","$200.34 ","$131.31 ","$349.71 ","$349.71 ","$85.80 ","$490.00 ","$184.28 ","$245.00 ","$388.08 ","$392.00 ","$256.03 ","$52.02 ","$39.99 ","$78.01 ","$175.50 "
"26000112","EAP","CPT� 96375","","Iv Push - Ther,prophylax,dx Add'l Med","BOTH IP/OP","$523.00 ","$387.02 ","$16.57 ","$447.00 ","$283.99 ","$39.19 ","$109.01 ","$319.02 ","$319.02 ","$78.27 ","$447.00 ","$38.22 ","$223.50 ","$354.02 ","$357.60 ","$53.10 ","$22.60 ","$16.57 ","$71.16 ","$36.40 "
"26000113","EAP","CPT� 96376","","Iv Push - Ther,prophylax,dx Ea Push Same Med","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$298.00 ","$189.51 ","$0.00 ","$72.74 ","$212.68 ","$212.68 ","$52.18 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$0.00 ","$46.64 ","$0.00 ","$47.44 ","$0.00 "
"26000114","EAP","CPT� 96523","","Picc/portacath Line Flush","BOTH IP/OP","$282.00 ","$208.68 ","$27.46 ","$241.00 ","$73.05 ","$54.51 ","$58.78 ","$172.00 ","$172.00 ","$42.20 ","$241.00 ","$55.17 ","$120.50 ","$190.87 ","$192.80 ","$76.65 ","$27.46 ","$28.10 ","$38.37 ","$52.54 "
"27000010","EAP","Custom 27000010","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000011","EAP","Custom 27000011","","Tube Salem Silicone Size","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000012","EAP","Custom 27000012","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000015","EAP","Custom 27000015","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000016","EAP","Custom 27000016","","Scaple Surg W/handle Atta","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000019","EAP","Custom 27000019","","Kit L.f. Trach Care","BOTH IP/OP","$511.00 ","$378.14 ","$0.00 ","$511.00 ","$0.00 ","$0.00 ","$0.00 ","$364.70 ","$364.70 ","$0.00 ","$511.00 ","$0.00 ","$255.50 ","$404.71 ","$408.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000024","EAP","Custom 27000024","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000026","EAP","Custom 27000026","","Kit Triple Lumen Catheter","BOTH IP/OP","$587.00 ","$434.38 ","$0.00 ","$587.00 ","$0.00 ","$0.00 ","$0.00 ","$418.94 ","$418.94 ","$0.00 ","$587.00 ","$0.00 ","$293.50 ","$464.90 ","$469.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000027","EAP","Custom 27000027","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000029","EAP","Custom 27000029","","Set T-port Small Bore Ext","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000031","EAP","Custom 27000031","","Tray Douch Disposable","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000033","EAP","Custom 27000033","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000034","EAP","Custom 27000034","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000035","EAP","Custom 27000035","","Tray Thoracentesis Dispos","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000036","EAP","Custom 27000036","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000045","EAP","Custom 27000045","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000046","EAP","Custom 27000046","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000047","EAP","Custom 27000047","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000048","EAP","Custom 27000048","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$663.00 ","$490.62 ","$0.00 ","$663.00 ","$0.00 ","$0.00 ","$0.00 ","$473.18 ","$473.18 ","$0.00 ","$663.00 ","$0.00 ","$331.50 ","$525.10 ","$530.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000066","EAP","Custom 27000066","","Tray,instrumen 13-1/2x9/34x5/8","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$391.00 ","$0.00 ","$0.00 ","$0.00 ","$279.06 ","$279.06 ","$0.00 ","$391.00 ","$0.00 ","$195.50 ","$309.67 ","$312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000076","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$23.89 ","$0.00 ","$9.17 ","$31.40 ","$31.40 ","$7.70 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$6.89 ","$0.00 ","$7.00 ","$0.00 "
"27000078","EAP","Custom 27000078","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000079","EAP","Custom 27000079","","Kit Tracheotomy Care Ster","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000081","EAP","Custom 27000081","","Scapel Surg W/ Handle Attached","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$94.21 ","$94.21 ","$0.00 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000087","EAP","Custom 27000087","","Kit Thoracotomy","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$0.00 ","$0.00 ","$0.00 ","$144.88 ","$144.88 ","$0.00 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000093","EAP","Custom 27000093","","Bag 1000ml Pump Set","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000094","EAP","Custom 27000094","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000097","EAP","Custom 27000097","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000098","EAP","Custom 27000098","","Vest Econo Cotton Small","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000101","EAP","Custom 27000101","","Vest Econo Cotton X-large","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000103","EAP","Custom 27000103","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000107","EAP","Custom 27000107","","Tray Foley Perconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000109","EAP","Custom 27000109","","Tray Thoracentesis Dispos","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000119","EAP","Custom 27000119","","3ml Posiflush Saline Syringe","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000125","EAP","Custom 27000125","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000127","EAP","Custom 27000127","","Tray,catheter Instrument Dulmn","BOTH IP/OP","$718.00 ","$531.32 ","$0.00 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$512.44 ","$512.44 ","$0.00 ","$718.00 ","$0.00 ","$359.00 ","$568.66 ","$574.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000150","EAP","Custom 27000150","","Catheter Urethral Two-eye","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000151","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27000152","EAP","HCPCS C1729","","Catheter Coude 30cc 24fr","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$47.24 ","$0.00 ","$18.13 ","$62.09 ","$62.09 ","$15.23 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$13.62 ","$0.00 ","$13.85 ","$0.00 "
"27000153","EAP","Custom 27000153","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000154","EAP","Custom 27000154","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000155","EAP","Custom 27000155","","Kit Tracheotomy Care Ster","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000168","EAP","Custom 27000168","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000169","EAP","Custom 27000169","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000173","EAP","Custom 27000173","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000174","EAP","Custom 27000174","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000179","EAP","Custom 27000179","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000181","EAP","Custom 27000181","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000182","EAP","Custom 27000182","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000184","EAP","Custom 27000184","","Tray Thoracentesis Dispos","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000191","EAP","Custom 27000191","","Suture,silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000197","EAP","Custom 27000197","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000198","EAP","Custom 27000198","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000199","EAP","Custom 27000199","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000200","EAP","Custom 27000200","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$663.00 ","$490.62 ","$0.00 ","$663.00 ","$0.00 ","$0.00 ","$0.00 ","$473.18 ","$473.18 ","$0.00 ","$663.00 ","$0.00 ","$331.50 ","$525.10 ","$530.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000222","EAP","Custom 27000222","","Catheter Urethral 14fr","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000223","EAP","Custom 27000223","","Catheter Urethral Two-eye","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000224","EAP","Custom 27000224","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000225","EAP","Custom 27000225","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000226","EAP","Custom 27000226","","Kit Tracheotomy Care Ster","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000228","EAP","Custom 27000228","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000232","EAP","Custom 27000232","","Cream Baza 5oz","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000240","EAP","Custom 27000240","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000241","EAP","Custom 27000241","","Needle Port-cath 20ga X 1","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000242","EAP","Custom 27000242","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000245","EAP","Custom 27000245","","Kit Triple Lumen Catheter","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$299.75 ","$299.75 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000250","EAP","Custom 27000250","","Tray Foley Preconnected W","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000251","EAP","Custom 27000251","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000252","EAP","Custom 27000252","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000253","EAP","Custom 27000253","","Tray Thoracentesis/parace","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$0.00 ","$0.00 ","$0.00 ","$47.82 ","$47.82 ","$0.00 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000254","EAP","Custom 27000254","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000259","EAP","Custom 27000259","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000265","EAP","Custom 27000265","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000266","EAP","Custom 27000266","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000267","EAP","Custom 27000267","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000268","EAP","Custom 27000268","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000293","EAP","Custom 27000293","","Catheter Urethral Two-eye","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000294","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27000295","EAP","HCPCS C1729","","Catheter Coude 30cc 24fr","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$47.24 ","$0.00 ","$18.13 ","$62.09 ","$62.09 ","$15.23 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$13.62 ","$0.00 ","$13.85 ","$0.00 "
"27000296","EAP","Custom 27000296","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000297","EAP","Custom 27000297","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000298","EAP","Custom 27000298","","Kit Tracheotomy Care Ster","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000300","EAP","Custom 27000300","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000314","EAP","Custom 27000314","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000315","EAP","Custom 27000315","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000318","EAP","Custom 27000318","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000319","EAP","Custom 27000319","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000323","EAP","Custom 27000323","","Vest Econo Cotton X-large","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000324","EAP","Custom 27000324","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000326","EAP","Custom 27000326","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000327","EAP","Custom 27000327","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000330","EAP","Custom 27000330","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000335","EAP","Custom 27000335","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000341","EAP","Custom 27000341","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000342","EAP","Custom 27000342","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000343","EAP","Custom 27000343","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000344","EAP","Custom 27000344","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000345","EAP","Custom 27000345","","Tubes Extension Plain Pla","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000358","EAP","Custom 27000358","","Catheter  Thoracic 16f","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000359","EAP","Custom 27000359","","Catheter  Thoracic 20fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000360","EAP","Custom 27000360","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000361","EAP","Custom 27000361","","Catheter Ventricular 20cm","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$524.57 ","$524.57 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000362","EAP","Custom 27000362","","Catheter Edm 11 Becker","BOTH IP/OP","$1,339.00 ","$990.86 ","$0.00 ","$1,339.00 ","$0.00 ","$0.00 ","$0.00 ","$955.64 ","$955.64 ","$0.00 ","$1,339.00 ","$0.00 ","$669.50 ","$1,060.49 ","$1,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000363","EAP","Custom 27000363","","Tube Feeding Plastic 8fr","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000364","EAP","Custom 27000364","","Artery Arterial Catheriza","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000365","EAP","Custom 27000365","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000366","EAP","Custom 27000366","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000367","EAP","Custom 27000367","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000368","EAP","Custom 27000368","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000369","EAP","Custom 27000369","","Kit Tracheotomy Care Ster","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000371","EAP","Custom 27000371","","Bag Drainage Becker","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$140.60 ","$140.60 ","$0.00 ","$197.00 ","$0.00 ","$98.50 ","$156.02 ","$157.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000372","EAP","Custom 27000372","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$377.00 ","$278.98 ","$0.00 ","$377.00 ","$0.00 ","$0.00 ","$0.00 ","$269.06 ","$269.06 ","$0.00 ","$377.00 ","$0.00 ","$188.50 ","$298.58 ","$301.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000373","EAP","Custom 27000373","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000374","EAP","Custom 27000374","","Scaple Surg W/handle Atta","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000376","EAP","Custom 27000376","","Set Blood Administration","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000378","EAP","Custom 27000378","","Cream Baza 5oz","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000386","EAP","Custom 27000386","","Pouch Fecal Incontinence","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000387","EAP","Custom 27000387","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000388","EAP","Custom 27000388","","Transducer  Disp For Icp","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000389","EAP","Custom 27000389","","Bridge Kit Bifurated Resp","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000390","EAP","Custom 27000390","","Kit Transducer Monitoring","BOTH IP/OP","$339.00 ","$250.86 ","$0.00 ","$339.00 ","$0.00 ","$0.00 ","$0.00 ","$241.94 ","$241.94 ","$0.00 ","$339.00 ","$0.00 ","$169.50 ","$268.49 ","$271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000392","EAP","Custom 27000392","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000394","EAP","Custom 27000394","","Bag 1000ml Pump Set","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000395","EAP","Custom 27000395","","Kit Pecutaneous Introduce","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000396","EAP","Custom 27000396","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000403","EAP","Custom 27000403","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000404","EAP","Custom 27000404","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000405","EAP","Custom 27000405","","Catheter Swan Ganz","BOTH IP/OP","$674.00 ","$498.76 ","$0.00 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$481.03 ","$481.03 ","$0.00 ","$674.00 ","$0.00 ","$337.00 ","$533.81 ","$539.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000406","EAP","Custom 27000406","","Delivery System Closed In","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000407","EAP","Custom 27000407","","Probe V-pacing","BOTH IP/OP","$1,403.00 ","$1,038.22 ","$0.00 ","$1,403.00 ","$0.00 ","$0.00 ","$0.00 ","$1,001.32 ","$1,001.32 ","$0.00 ","$1,403.00 ","$0.00 ","$701.50 ","$1,111.18 ","$1,122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000410","EAP","Custom 27000410","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000412","EAP","Custom 27000412","","Kit Ventriculostomy","BOTH IP/OP","$1,652.00 ","$1,222.48 ","$0.00 ","$1,652.00 ","$0.00 ","$0.00 ","$0.00 ","$1,179.03 ","$1,179.03 ","$0.00 ","$1,652.00 ","$0.00 ","$826.00 ","$1,308.38 ","$1,321.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000414","EAP","Custom 27000414","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000454","EAP","Custom 27000454","","Catheter  Thoracic 28fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000455","EAP","Custom 27000455","","Catheter Thoracic 32fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000456","EAP","Custom 27000456","","Catheter Thoracic 36fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000457","EAP","Custom 27000457","","Catheter Urethral 14fr","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000458","EAP","Custom 27000458","","Catheter Urethral Two-eye","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000459","EAP","Custom 27000459","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000460","EAP","Custom 27000460","","Tube Salem Silicone Size","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000461","EAP","Custom 27000461","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000462","EAP","Custom 27000462","","Kit Tracheotomy Care Ster","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000464","EAP","Custom 27000464","","Scaple Surg W/handle Atta","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000474","EAP","Custom 27000474","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000475","EAP","Custom 27000475","","Needle Port-cath 20ga X 1","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000476","EAP","Custom 27000476","","Chest Unit Drainage Pleur","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$0.00 ","$0.00 ","$0.00 ","$139.17 ","$139.17 ","$0.00 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000481","EAP","Custom 27000481","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000482","EAP","Custom 27000482","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000483","EAP","Custom 27000483","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000484","EAP","Custom 27000484","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000487","EAP","Custom 27000487","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000488","EAP","Custom 27000488","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000489","EAP","Custom 27000489","","Tray Thoracentesis Dispos","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000491","EAP","Custom 27000491","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000495","EAP","Custom 27000495","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000501","EAP","Custom 27000501","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000502","EAP","Custom 27000502","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000503","EAP","Custom 27000503","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000504","EAP","Custom 27000504","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$616.00 ","$0.00 ","$0.00 ","$0.00 ","$439.64 ","$439.64 ","$0.00 ","$616.00 ","$0.00 ","$308.00 ","$487.87 ","$492.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000530","EAP","Custom 27000530","","Catheter  Thoracic 28fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000531","EAP","Custom 27000531","","Catheter Thoracic 32fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000532","EAP","Custom 27000532","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000533","EAP","Custom 27000533","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000534","EAP","Custom 27000534","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000535","EAP","Custom 27000535","","Kit Tracheotomy Care Ster","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000538","EAP","Custom 27000538","","Scapel Surg W/ Handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000543","EAP","Custom 27000543","","Kit Thoracotomy","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000549","EAP","Custom 27000549","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000551","EAP","Custom 27000551","","Chest Unit Drainage Pleur","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000556","EAP","Custom 27000556","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000557","EAP","Custom 27000557","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000558","EAP","Custom 27000558","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000559","EAP","Custom 27000559","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000560","EAP","Custom 27000560","","Tray Douch Disposable","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000562","EAP","Custom 27000562","","Tray Foley Preconnected 1","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000563","EAP","Custom 27000563","","Tray Foley Perconnected 1","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000564","EAP","Custom 27000564","","Tray Thoracentesis Dispos","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$0.00 ","$0.00 ","$0.00 ","$186.28 ","$186.28 ","$0.00 ","$261.00 ","$0.00 ","$130.50 ","$206.71 ","$208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000570","EAP","Custom 27000570","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000577","EAP","Custom 27000577","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000578","EAP","Custom 27000578","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000579","EAP","Custom 27000579","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000580","EAP","Custom 27000580","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$616.00 ","$0.00 ","$0.00 ","$0.00 ","$439.64 ","$439.64 ","$0.00 ","$616.00 ","$0.00 ","$308.00 ","$487.87 ","$492.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000604","EAP","Custom 27000604","","Catheter  Thoracic 28fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000605","EAP","Custom 27000605","","Catheter Thoracic 32fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000606","EAP","Custom 27000606","","Catheter Thoracic 36fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000607","EAP","Custom 27000607","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000608","EAP","Custom 27000608","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000612","EAP","Custom 27000612","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000613","EAP","Custom 27000613","","Scaple Surg W/handle Atta","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000618","EAP","Custom 27000618","","Kit Thoracotomy","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$66.37 ","$66.37 ","$0.00 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000624","EAP","Custom 27000624","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000625","EAP","Custom 27000625","","Chest Unit Drainage Pleur","BOTH IP/OP","$332.00 ","$245.68 ","$0.00 ","$332.00 ","$0.00 ","$0.00 ","$0.00 ","$236.95 ","$236.95 ","$0.00 ","$332.00 ","$0.00 ","$166.00 ","$262.94 ","$265.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000630","EAP","Custom 27000630","","Dressing X-large","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000632","EAP","Custom 27000632","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000633","EAP","Custom 27000633","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000637","EAP","Custom 27000637","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000638","EAP","Custom 27000638","","Tray Douch Disposable","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000640","EAP","Custom 27000640","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000641","EAP","Custom 27000641","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000642","EAP","Custom 27000642","","Tray Thoracentesis Dispos","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000648","EAP","Custom 27000648","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000653","EAP","Custom 27000653","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000654","EAP","Custom 27000654","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000655","EAP","Custom 27000655","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000656","EAP","Custom 27000656","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$663.00 ","$490.62 ","$0.00 ","$663.00 ","$0.00 ","$0.00 ","$0.00 ","$473.18 ","$473.18 ","$0.00 ","$663.00 ","$0.00 ","$331.50 ","$525.10 ","$530.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000666","EAP","Custom 27000666","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000667","EAP","Custom 27000667","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000679","EAP","Custom 27000679","","Kit Triple Lumen Catheter","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$461.05 ","$461.05 ","$0.00 ","$646.00 ","$0.00 ","$323.00 ","$511.63 ","$516.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000680","EAP","Custom 27000680","","Filter Set 0.22 Micron","BOTH IP/OP","$7.00 ","$5.18 ","$0.00 ","$7.00 ","$0.00 ","$0.00 ","$0.00 ","$5.00 ","$5.00 ","$0.00 ","$7.00 ","$0.00 ","$3.50 ","$5.54 ","$5.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000683","EAP","Custom 27000683","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000686","EAP","Custom 27000686","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000687","EAP","Custom 27000687","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000689","EAP","Custom 27000689","","Tray Thoracentesis Dispos","BOTH IP/OP","$216.00 ","$159.84 ","$0.00 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$154.16 ","$154.16 ","$0.00 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000691","EAP","Custom 27000691","","Bag Drainage Ureteral","BOTH IP/OP","$92.00 ","$68.08 ","$0.00 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$65.66 ","$0.00 ","$92.00 ","$0.00 ","$46.00 ","$72.86 ","$73.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000696","EAP","Custom 27000696","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000697","EAP","Custom 27000697","","10ml Posiflush Saline Syringe","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000701","EAP","Custom 27000701","","Sleeve Knee Regular Dvt","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$269.78 ","$269.78 ","$0.00 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000702","EAP","Custom 27000702","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000703","EAP","Custom 27000703","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000704","EAP","Custom 27000704","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000705","EAP","Custom 27000705","","Sucrose Analgesia","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000709","EAP","Custom 27000709","","Tray Circumcision","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000710","EAP","Custom 27000710","","Needle Spinal 22g 25/bx","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000712","EAP","Custom 27000712","","Tubes Capillary Hepariniz","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000714","EAP","Custom 27000714","","Tube Feeding Plastic 8fr","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000715","EAP","Custom 27000715","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000721","EAP","Custom 27000721","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000723","EAP","Custom 27000723","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000724","EAP","Custom 27000724","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000725","EAP","HCPCS C1751","","Catheter  Iv 26g 120/cs","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$4.38 ","$0.00 ","$4.46 ","$0.00 "
"27000726","EAP","Custom 27000726","","Sleeve Knee Regular Dvt","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$118.47 ","$118.47 ","$0.00 ","$166.00 ","$0.00 ","$83.00 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000727","EAP","Custom 27000727","","Sleeve Knee X-large Dvt","BOTH IP/OP","$201.00 ","$148.74 ","$0.00 ","$201.00 ","$0.00 ","$0.00 ","$0.00 ","$143.45 ","$143.45 ","$0.00 ","$201.00 ","$0.00 ","$100.50 ","$159.19 ","$160.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000728","EAP","Custom 27000728","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000741","EAP","Custom 27000741","","Catheter  Thoracic 28fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000742","EAP","Custom 27000742","","Catheter Thoracic 32fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000743","EAP","Custom 27000743","","Catheter Thoracic 36fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000744","EAP","Custom 27000744","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000745","EAP","Custom 27000745","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000748","EAP","Custom 27000748","","Scapel Surg W/handle Att","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000760","EAP","Custom 27000760","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000762","EAP","Custom 27000762","","Chest Unit Drainage Pleur","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$299.75 ","$299.75 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000765","EAP","Custom 27000765","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000766","EAP","Custom 27000766","","Kit Triple Lumen Catheter","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000770","EAP","Custom 27000770","","Filter Set 0.22 Micron","BOTH IP/OP","$7.00 ","$5.18 ","$0.00 ","$7.00 ","$0.00 ","$0.00 ","$0.00 ","$5.00 ","$5.00 ","$0.00 ","$7.00 ","$0.00 ","$3.50 ","$5.54 ","$5.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000771","EAP","Custom 27000771","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000772","EAP","Custom 27000772","","Tray Douch Disposable","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000773","EAP","Custom 27000773","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000774","EAP","Custom 27000774","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000775","EAP","Custom 27000775","","Tray Thoracentesis Dispos","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000776","EAP","Custom 27000776","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000781","EAP","Custom 27000781","","Suture, Silk, 0","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000784","EAP","Custom 27000784","","3ml Posiflush Saline Syringe","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000787","EAP","Custom 27000787","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000788","EAP","Custom 27000788","","Sleeve Knee X-ray Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000789","EAP","Custom 27000789","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000790","EAP","Custom 27000790","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000791","EAP","Custom 27000791","","First Step Select Overlay","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000792","EAP","Custom 27000792","","Telemetry Med Supplies","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000793","EAP","Custom 27000793","","Med/surg Isolation Supplies","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$0.00 ","$0.00 ","$0.00 ","$200.55 ","$200.55 ","$0.00 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000803","EAP","Custom 27000803","","Dialysis Filter","BOTH IP/OP","$699.00 ","$517.26 ","$0.00 ","$699.00 ","$0.00 ","$0.00 ","$0.00 ","$498.88 ","$498.88 ","$0.00 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000810","EAP","Custom 27000810","","Needle Spinal 18ga","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000811","EAP","Custom 27000811","","Needle Spinal Sterile 20g","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000815","EAP","Custom 27000815","","Catheter  Thoracic 28fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000816","EAP","Custom 27000816","","Catheter Thoracic 32fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000817","EAP","Custom 27000817","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000818","EAP","HCPCS C1729","","Catheter Foley 30cc 28fr","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$21.18 ","$0.00 ","$8.13 ","$27.83 ","$27.83 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"27000819","EAP","Custom 27000819","","Artery Arterial Catheriza","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000820","EAP","Custom 27000820","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000821","EAP","Custom 27000821","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000822","EAP","Custom 27000822","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000826","EAP","Custom 27000826","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$434.00 ","$321.16 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000828","EAP","Custom 27000828","","Catheter Peritoneal Adult","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$149.88 ","$149.88 ","$0.00 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000829","EAP","Custom 27000829","","Triconnector With Valve","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000830","EAP","Custom 27000830","","Set Blood Administration","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000834","EAP","Custom 27000834","","Kit L.f. Trach Care","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$0.00 ","$169.15 ","$169.15 ","$0.00 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000836","EAP","Custom 27000836","","Kit Thoracotomy","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$0.00 ","$0.00 ","$0.00 ","$154.87 ","$154.87 ","$0.00 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000841","EAP","Custom 27000841","","Pouch Fecal Incontinence","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000842","EAP","Custom 27000842","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000843","EAP","Custom 27000843","","Kit Transducer Monitoring","BOTH IP/OP","$339.00 ","$250.86 ","$0.00 ","$339.00 ","$0.00 ","$0.00 ","$0.00 ","$241.94 ","$241.94 ","$0.00 ","$339.00 ","$0.00 ","$169.50 ","$268.49 ","$271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000844","EAP","Custom 27000844","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000846","EAP","Custom 27000846","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000847","EAP","Custom 27000847","","Kit Pecutaneous Introduce","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$212.68 ","$212.68 ","$0.00 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000848","EAP","Custom 27000848","","Chest Unit Drainage Pleur","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$299.75 ","$299.75 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000849","EAP","Custom 27000849","","Chest Unit Dry Suction Sy","BOTH IP/OP","$316.00 ","$233.84 ","$0.00 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$225.53 ","$225.53 ","$0.00 ","$316.00 ","$0.00 ","$158.00 ","$250.27 ","$252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000854","EAP","Custom 27000854","","Trac Dressing Xl","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$49.96 ","$49.96 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000857","EAP","Custom 27000857","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000858","EAP","Custom 27000858","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000859","EAP","Custom 27000859","","Catheter Swan Ganz","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$726.00 ","$0.00 ","$0.00 ","$0.00 ","$518.15 ","$518.15 ","$0.00 ","$726.00 ","$0.00 ","$363.00 ","$574.99 ","$580.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000860","EAP","Custom 27000860","","Delivery System Closed In","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000866","EAP","Custom 27000866","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000868","EAP","Custom 27000868","","Tray Urine Meter 18fr","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000869","EAP","Custom 27000869","","Kit Ventriculostomy","BOTH IP/OP","$763.00 ","$564.62 ","$0.00 ","$763.00 ","$0.00 ","$0.00 ","$0.00 ","$544.55 ","$544.55 ","$0.00 ","$763.00 ","$0.00 ","$381.50 ","$604.30 ","$610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000870","EAP","Custom 27000870","","Tray Thoracentesis Dispos","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000872","EAP","Custom 27000872","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000880","EAP","Custom 27000880","","Femoral Arterial Line Kit","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$127.04 ","$127.04 ","$0.00 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000881","EAP","Custom 27000881","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000882","EAP","Custom 27000882","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000883","EAP","Custom 27000883","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000884","EAP","Custom 27000884","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000886","EAP","Custom 27000886","","Med/surg Isolation Supplies","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$0.00 ","$0.00 ","$0.00 ","$200.55 ","$200.55 ","$0.00 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000887","EAP","Custom 27000887","","Med/pri Supplies","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000888","EAP","Custom 27000888","","Med/surg Semi-supplies","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000902","EAP","Custom 27000902","","Catheter  Thoracic 28fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000903","EAP","Custom 27000903","","Catheter Thoracic 32fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000904","EAP","Custom 27000904","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000905","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27000906","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27000907","EAP","HCPCS C1729","","Catheter Coude Size 16fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27000908","EAP","Custom 27000908","","Artery Arterial Catheriza","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000909","EAP","Custom 27000909","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000910","EAP","Custom 27000910","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000911","EAP","Custom 27000911","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000912","EAP","Custom 27000912","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000915","EAP","Custom 27000915","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$937.00 ","$693.38 ","$0.00 ","$937.00 ","$0.00 ","$0.00 ","$0.00 ","$668.74 ","$668.74 ","$0.00 ","$937.00 ","$0.00 ","$468.50 ","$742.10 ","$749.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000916","EAP","Custom 27000916","","Scaple Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000918","EAP","Custom 27000918","","Triconnector With Valve","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000922","EAP","Custom 27000922","","Pouch Active Life Squib Drain","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000926","EAP","Custom 27000926","","Kit Thoracotomy","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$149.88 ","$149.88 ","$0.00 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000931","EAP","Custom 27000931","","Pouch Fecal Incontinence","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000932","EAP","Custom 27000932","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000933","EAP","Custom 27000933","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000934","EAP","Custom 27000934","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000935","EAP","Custom 27000935","","Needle Port-cath 20ga X 1","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000936","EAP","Custom 27000936","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000941","EAP","Custom 27000941","","Dressing X-large","BOTH IP/OP","$321.00 ","$237.54 ","$0.00 ","$321.00 ","$0.00 ","$0.00 ","$0.00 ","$229.10 ","$229.10 ","$0.00 ","$321.00 ","$0.00 ","$160.50 ","$254.23 ","$256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000942","EAP","Custom 27000942","","Trac Dressing Xl","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000945","EAP","Custom 27000945","","Tube Feeding Ng 8fr 36in Entri","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000946","EAP","Custom 27000946","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000949","EAP","Custom 27000949","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000951","EAP","Custom 27000951","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000952","EAP","Custom 27000952","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000953","EAP","Custom 27000953","","Tray Thoracentesis Dispos","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000955","EAP","Custom 27000955","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000962","EAP","Custom 27000962","","Sleeve Knee Regular Dvt","BOTH IP/OP","$370.00 ","$273.80 ","$0.00 ","$370.00 ","$0.00 ","$0.00 ","$0.00 ","$264.07 ","$264.07 ","$0.00 ","$370.00 ","$0.00 ","$185.00 ","$293.04 ","$296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000963","EAP","Custom 27000963","","Sleeve Knee X-large Dvt","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$321.17 ","$321.17 ","$0.00 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000964","EAP","Custom 27000964","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$529.00 ","$391.46 ","$0.00 ","$529.00 ","$0.00 ","$0.00 ","$0.00 ","$377.55 ","$377.55 ","$0.00 ","$529.00 ","$0.00 ","$264.50 ","$418.97 ","$423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000965","EAP","Custom 27000965","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$348.29 ","$348.29 ","$0.00 ","$488.00 ","$0.00 ","$244.00 ","$386.50 ","$390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000968","EAP","Custom 27000968","","Dialysis Fluid Bag","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$118.47 ","$118.47 ","$0.00 ","$166.00 ","$0.00 ","$83.00 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000969","EAP","Custom 27000969","","Dialysis Filter","BOTH IP/OP","$699.00 ","$517.26 ","$0.00 ","$699.00 ","$0.00 ","$0.00 ","$0.00 ","$498.88 ","$498.88 ","$0.00 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000975","EAP","Custom 27000975","","Ioban 2 Drape Incise Smal","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000977","EAP","Custom 27000977","","Ioban 2 Drape Incise Larg","BOTH IP/OP","$462.00 ","$341.88 ","$0.00 ","$462.00 ","$0.00 ","$0.00 ","$0.00 ","$329.73 ","$329.73 ","$0.00 ","$462.00 ","$0.00 ","$231.00 ","$365.90 ","$369.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000978","EAP","Custom 27000978","","Needle Spinal 18ga","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000982","EAP","Custom 27000982","","Catheter Thoracic 32fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000983","EAP","Custom 27000983","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000984","EAP","Custom 27000984","","Catheter Urethral Two-eye","BOTH IP/OP","$7.00 ","$5.18 ","$0.00 ","$7.00 ","$0.00 ","$0.00 ","$0.00 ","$5.00 ","$5.00 ","$0.00 ","$7.00 ","$0.00 ","$3.50 ","$5.54 ","$5.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000985","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27000986","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27000987","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27000988","EAP","HCPCS C1729","","Catheter Foley 3-way 30cc","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$20.09 ","$0.00 ","$7.71 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"27000989","EAP","Custom 27000989","","Catheter Ventricular 20cm","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000990","EAP","Custom 27000990","","Catheter Edm Ii Becker","BOTH IP/OP","$617.00 ","$456.58 ","$0.00 ","$617.00 ","$0.00 ","$0.00 ","$0.00 ","$440.35 ","$440.35 ","$0.00 ","$617.00 ","$0.00 ","$308.50 ","$488.66 ","$493.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000991","EAP","Custom 27000991","","Artery Arterial Catheriza","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000992","EAP","Custom 27000992","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000993","EAP","Custom 27000993","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000994","EAP","Custom 27000994","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000995","EAP","Custom 27000995","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000996","EAP","Custom 27000996","","Kit Percuatane Trache 7fr","BOTH IP/OP","$1,219.00 ","$902.06 ","$0.00 ","$1,219.00 ","$0.00 ","$0.00 ","$0.00 ","$870.00 ","$870.00 ","$0.00 ","$1,219.00 ","$0.00 ","$609.50 ","$965.45 ","$975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000997","EAP","Custom 27000997","","Kit Percuatane Trache 8fr","BOTH IP/OP","$1,424.00 ","$1,053.76 ","$0.00 ","$1,424.00 ","$0.00 ","$0.00 ","$0.00 ","$1,016.31 ","$1,016.31 ","$0.00 ","$1,424.00 ","$0.00 ","$712.00 ","$1,127.81 ","$1,139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27000998","EAP","Custom 27000998","","Kit Tracheotomy Care Ster","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001001","EAP","Custom 27001001","","Bag Drainage Becker","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$0.00 ","$0.00 ","$0.00 ","$152.02 ","$152.02 ","$0.00 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001002","EAP","Custom 27001002","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$937.00 ","$693.38 ","$0.00 ","$937.00 ","$0.00 ","$0.00 ","$0.00 ","$668.74 ","$668.74 ","$0.00 ","$937.00 ","$0.00 ","$468.50 ","$742.10 ","$749.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001006","EAP","Custom 27001006","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001007","EAP","Custom 27001007","","Scaple Surg W/handle Atta","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001009","EAP","Custom 27001009","","Triconnector With Valve","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001012","EAP","Custom 27001012","","Cream Baza 5oz","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001016","EAP","Custom 27001016","","Valve Anti-reflux Salem S","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001017","EAP","Custom 27001017","","Kit L.f. Trach Care","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$0.00 ","$169.15 ","$169.15 ","$0.00 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001019","EAP","Custom 27001019","","Kit Thoracotomy","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$0.00 ","$0.00 ","$0.00 ","$154.87 ","$154.87 ","$0.00 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001025","EAP","Custom 27001025","","Pouch Fecal Incontinence","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001026","EAP","Custom 27001026","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001027","EAP","Custom 27001027","","Transducer  Disp For Icp","BOTH IP/OP","$79.00 ","$58.46 ","$0.00 ","$79.00 ","$0.00 ","$0.00 ","$0.00 ","$56.38 ","$56.38 ","$0.00 ","$79.00 ","$0.00 ","$39.50 ","$62.57 ","$63.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001028","EAP","Custom 27001028","","Kit Transducer Monitoring","BOTH IP/OP","$339.00 ","$250.86 ","$0.00 ","$339.00 ","$0.00 ","$0.00 ","$0.00 ","$241.94 ","$241.94 ","$0.00 ","$339.00 ","$0.00 ","$169.50 ","$268.49 ","$271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001029","EAP","Custom 27001029","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001031","EAP","Custom 27001031","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001032","EAP","Custom 27001032","","Kit Pecutaneous Introduce","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$212.68 ","$212.68 ","$0.00 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001033","EAP","Custom 27001033","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001034","EAP","Custom 27001034","","Chest Unit Dry Suction Sy","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$237.66 ","$237.66 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001035","EAP","Custom 27001035","","Bag  Auto-transfusion Ple","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$174.86 ","$174.86 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001040","EAP","Custom 27001040","","Dressing X-large","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001041","EAP","Custom 27001041","","Trac Dressing Xl","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$121.33 ","$121.33 ","$0.00 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001044","EAP","Custom 27001044","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001045","EAP","Custom 27001045","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001046","EAP","Custom 27001046","","Wire Guide Dual Purpose","BOTH IP/OP","$362.00 ","$267.88 ","$0.00 ","$362.00 ","$0.00 ","$0.00 ","$0.00 ","$258.36 ","$258.36 ","$0.00 ","$362.00 ","$0.00 ","$181.00 ","$286.70 ","$289.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001047","EAP","Custom 27001047","","Kit Monitoring Intracrani","BOTH IP/OP","$426.00 ","$315.24 ","$0.00 ","$426.00 ","$0.00 ","$0.00 ","$0.00 ","$304.04 ","$304.04 ","$0.00 ","$426.00 ","$0.00 ","$213.00 ","$337.39 ","$340.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001048","EAP","Custom 27001048","","Cath  Trauma Ventricular","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$0.00 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001049","EAP","Custom 27001049","","Catheter Swan Ganz","BOTH IP/OP","$309.00 ","$228.66 ","$0.00 ","$309.00 ","$0.00 ","$0.00 ","$0.00 ","$220.53 ","$220.53 ","$0.00 ","$309.00 ","$0.00 ","$154.50 ","$244.73 ","$247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001050","EAP","Custom 27001050","","Delivery System Closed In","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001051","EAP","Custom 27001051","","Probe V-pacing","BOTH IP/OP","$1,277.00 ","$944.98 ","$0.00 ","$1,277.00 ","$0.00 ","$0.00 ","$0.00 ","$911.39 ","$911.39 ","$0.00 ","$1,277.00 ","$0.00 ","$638.50 ","$1,011.38 ","$1,021.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001055","EAP","Custom 27001055","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001057","EAP","Custom 27001057","","Tray Foley Preconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001058","EAP","Custom 27001058","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001060","EAP","Custom 27001060","","Tray Urine Meter 18fr","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001061","EAP","Custom 27001061","","Kit Ventriculostomy","BOTH IP/OP","$1,782.00 ","$1,318.68 ","$0.00 ","$1,782.00 ","$0.00 ","$0.00 ","$0.00 ","$1,271.81 ","$1,271.81 ","$0.00 ","$1,782.00 ","$0.00 ","$891.00 ","$1,411.34 ","$1,425.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001062","EAP","Custom 27001062","","Tray Thoracentesis Dispos","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001063","EAP","Custom 27001063","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001064","EAP","Custom 27001064","","Bag Drainage Ureteral","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001078","EAP","Custom 27001078","","Femoral Arterial Line Kit","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001079","EAP","Custom 27001079","","Kit Percutane Trache 9fr","BOTH IP/OP","$3,007.00 ","$2,225.18 ","$0.00 ","$3,007.00 ","$0.00 ","$0.00 ","$0.00 ","$2,146.10 ","$2,146.10 ","$0.00 ","$3,007.00 ","$0.00 ","$1,503.50 ","$2,381.54 ","$2,405.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001081","EAP","Custom 27001081","","Cath Cco Swan Ganz 8fr","BOTH IP/OP","$2,182.00 ","$1,614.68 ","$0.00 ","$2,182.00 ","$0.00 ","$0.00 ","$0.00 ","$1,557.29 ","$1,557.29 ","$0.00 ","$2,182.00 ","$0.00 ","$1,091.00 ","$1,728.14 ","$1,745.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001082","EAP","Custom 27001082","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001083","EAP","Custom 27001083","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001084","EAP","Custom 27001084","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001085","EAP","Custom 27001085","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001086","EAP","Custom 27001086","","First Step Select Overlay","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001096","EAP","Custom 27001096","","Dialysis Filter","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001101","EAP","Custom 27001101","","Needle Spinal 22ga X 3-1/","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001106","EAP","Custom 27001106","","Catheter  Thoracic 28fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001107","EAP","Custom 27001107","","Catheter Thoracic 32fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001108","EAP","Custom 27001108","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001109","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27001110","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27001111","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27001112","EAP","HCPCS C1729","","Catheter Foley 30cc 28fr","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$21.18 ","$0.00 ","$8.13 ","$27.83 ","$27.83 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"27001113","EAP","Custom 27001113","","Catheter Ventricular 20cm","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$524.57 ","$524.57 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001114","EAP","Custom 27001114","","Catheter Edm Ii Becker","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$1,027.73 ","$1,027.73 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001115","EAP","Custom 27001115","","Tube  Feeding Ng  8fr 43in En","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001116","EAP","Custom 27001116","","Artery Arterial Catheriza","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001117","EAP","Custom 27001117","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001118","EAP","Custom 27001118","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001119","EAP","Custom 27001119","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001120","EAP","Custom 27001120","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001124","EAP","Custom 27001124","","Bag Drainage Becker","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$0.00 ","$0.00 ","$0.00 ","$152.02 ","$152.02 ","$0.00 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001125","EAP","Custom 27001125","","Blades Surgical #10 W/o H","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001126","EAP","Custom 27001126","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001127","EAP","Custom 27001127","","Triconnector With Valve","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001129","EAP","Custom 27001129","","Set Blood Administration","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001135","EAP","Custom 27001135","","Valve Anti-reflux Salem S","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001137","EAP","Custom 27001137","","Kit Thoracotomy","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$0.00 ","$0.00 ","$0.00 ","$154.87 ","$154.87 ","$0.00 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001142","EAP","Custom 27001142","","Pouch Fecal Incontinence","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001143","EAP","Custom 27001143","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001144","EAP","Custom 27001144","","Transducer  Disp For Icp","BOTH IP/OP","$79.00 ","$58.46 ","$0.00 ","$79.00 ","$0.00 ","$0.00 ","$0.00 ","$56.38 ","$56.38 ","$0.00 ","$79.00 ","$0.00 ","$39.50 ","$62.57 ","$63.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001145","EAP","Custom 27001145","","Bridge Kit Bifurated Resp","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$85.64 ","$85.64 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001146","EAP","Custom 27001146","","Kit Transducer Monitoring","BOTH IP/OP","$339.00 ","$250.86 ","$0.00 ","$339.00 ","$0.00 ","$0.00 ","$0.00 ","$241.94 ","$241.94 ","$0.00 ","$339.00 ","$0.00 ","$169.50 ","$268.49 ","$271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001147","EAP","Custom 27001147","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001149","EAP","Custom 27001149","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001150","EAP","Custom 27001150","","Kit Pecutaneous Introduce","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001151","EAP","Custom 27001151","","Chest Unit Drainage Pleur","BOTH IP/OP","$401.00 ","$296.74 ","$0.00 ","$401.00 ","$0.00 ","$0.00 ","$0.00 ","$286.19 ","$286.19 ","$0.00 ","$401.00 ","$0.00 ","$200.50 ","$317.59 ","$320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001152","EAP","Custom 27001152","","Chest Unit Dry Suction Sy","BOTH IP/OP","$316.00 ","$233.84 ","$0.00 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$225.53 ","$225.53 ","$0.00 ","$316.00 ","$0.00 ","$158.00 ","$250.27 ","$252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001157","EAP","Custom 27001157","","Dressing X-large","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001158","EAP","Custom 27001158","","Trac Dressing Xl","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001161","EAP","Custom 27001161","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001162","EAP","Custom 27001162","","Kit Triple Lumen Catheter","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$245.51 ","$245.51 ","$0.00 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001163","EAP","Custom 27001163","","Wire Guide Dual Purpose","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$0.00 ","$0.00 ","$0.00 ","$279.77 ","$279.77 ","$0.00 ","$392.00 ","$0.00 ","$196.00 ","$310.46 ","$313.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001164","EAP","Custom 27001164","","Kit Monitoring Intracrani","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$328.30 ","$328.30 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001165","EAP","Custom 27001165","","Cath  Trauma Ventricular","BOTH IP/OP","$1,014.00 ","$750.36 ","$0.00 ","$1,014.00 ","$0.00 ","$0.00 ","$0.00 ","$723.69 ","$723.69 ","$0.00 ","$1,014.00 ","$0.00 ","$507.00 ","$803.09 ","$811.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001166","EAP","Custom 27001166","","Catheter Swan Ganz","BOTH IP/OP","$309.00 ","$228.66 ","$0.00 ","$309.00 ","$0.00 ","$0.00 ","$0.00 ","$220.53 ","$220.53 ","$0.00 ","$309.00 ","$0.00 ","$154.50 ","$244.73 ","$247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001167","EAP","Custom 27001167","","Delivery System Closed In","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001173","EAP","Custom 27001173","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001174","EAP","Custom 27001174","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001176","EAP","Custom 27001176","","Kit Ventriculostomy","BOTH IP/OP","$1,782.00 ","$1,318.68 ","$0.00 ","$1,782.00 ","$0.00 ","$0.00 ","$0.00 ","$1,271.81 ","$1,271.81 ","$0.00 ","$1,782.00 ","$0.00 ","$891.00 ","$1,411.34 ","$1,425.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001178","EAP","Custom 27001178","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001179","EAP","Custom 27001179","","Kit Lumbar Drainage Edm","BOTH IP/OP","$788.00 ","$583.12 ","$0.00 ","$788.00 ","$0.00 ","$0.00 ","$0.00 ","$562.40 ","$562.40 ","$0.00 ","$788.00 ","$0.00 ","$394.00 ","$624.10 ","$630.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001190","EAP","Custom 27001190","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001191","EAP","Custom 27001191","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001192","EAP","Custom 27001192","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001193","EAP","Custom 27001193","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$663.00 ","$490.62 ","$0.00 ","$663.00 ","$0.00 ","$0.00 ","$0.00 ","$473.18 ","$473.18 ","$0.00 ","$663.00 ","$0.00 ","$331.50 ","$525.10 ","$530.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001194","EAP","Custom 27001194","","First Step Select Overlay","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001205","EAP","Custom 27001205","","Dialysis Filter","BOTH IP/OP","$651.00 ","$481.74 ","$0.00 ","$651.00 ","$0.00 ","$0.00 ","$0.00 ","$464.62 ","$464.62 ","$0.00 ","$651.00 ","$0.00 ","$325.50 ","$515.59 ","$520.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001206","EAP","Custom 27001206","","Tubes Extension Plain Pla","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001218","EAP","Custom 27001218","","Catheter Thoracic 16f","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001219","EAP","Custom 27001219","","Catheter Thoracic 20fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001220","EAP","Custom 27001220","","Catheter Thoracic 24fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001221","EAP","Custom 27001221","","Catheter Thoracic 28fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001222","EAP","Custom 27001222","","Catheter Thoracic 32fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001223","EAP","Custom 27001223","","Catheter Urethral 8fr","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001224","EAP","Custom 27001224","","Entriflex","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001225","EAP","Custom 27001225","","Tube  Feeding Nasogastric","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001226","EAP","Custom 27001226","","Artery Arterial Catheriza","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001227","EAP","Custom 27001227","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001228","EAP","Custom 27001228","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001229","EAP","Custom 27001229","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001231","EAP","Custom 27001231","","Set Urinary Drain W/conta","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001232","EAP","Custom 27001232","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$434.00 ","$321.16 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001234","EAP","Custom 27001234","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001235","EAP","Custom 27001235","","Stapler Skin Disposable 3","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001236","EAP","Custom 27001236","","Triconnector With Valve","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001240","EAP","Custom 27001240","","Aquacel Ag 4x4","BOTH IP/OP","$92.00 ","$68.08 ","$0.00 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$65.66 ","$0.00 ","$92.00 ","$0.00 ","$46.00 ","$72.86 ","$73.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001243","EAP","Custom 27001243","","Electrodes Operative","BOTH IP/OP","$289.00 ","$213.86 ","$0.00 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$206.26 ","$206.26 ","$0.00 ","$289.00 ","$0.00 ","$144.50 ","$228.89 ","$231.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001249","EAP","Custom 27001249","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001250","EAP","Custom 27001250","","Kit Transducer Monitoring","BOTH IP/OP","$339.00 ","$250.86 ","$0.00 ","$339.00 ","$0.00 ","$0.00 ","$0.00 ","$241.94 ","$241.94 ","$0.00 ","$339.00 ","$0.00 ","$169.50 ","$268.49 ","$271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001252","EAP","Custom 27001252","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001254","EAP","Custom 27001254","","Bag 1000ml Pump Set","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001255","EAP","Custom 27001255","","Kit Pecutaneous Introduce","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001256","EAP","Custom 27001256","","Chest Unit Drainage Pleur","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$0.00 ","$0.00 ","$0.00 ","$139.17 ","$139.17 ","$0.00 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001257","EAP","Custom 27001257","","Bag Pressure  500cc","BOTH IP/OP","$82.00 ","$60.68 ","$0.00 ","$82.00 ","$0.00 ","$0.00 ","$0.00 ","$58.52 ","$58.52 ","$0.00 ","$82.00 ","$0.00 ","$41.00 ","$64.94 ","$65.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001258","EAP","Custom 27001258","","Bag Pressure 1000cc","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001260","EAP","Custom 27001260","","Tube Feeding Ng 8fr 36in Entri","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001261","EAP","Custom 27001261","","Multi Lumen Cvc W/o Silver Su","BOTH IP/OP","$751.00 ","$555.74 ","$0.00 ","$751.00 ","$0.00 ","$0.00 ","$0.00 ","$535.99 ","$535.99 ","$0.00 ","$751.00 ","$0.00 ","$375.50 ","$594.79 ","$600.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001262","EAP","Custom 27001262","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001263","EAP","Custom 27001263","","Catheter Swan Ganz","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$726.00 ","$0.00 ","$0.00 ","$0.00 ","$518.15 ","$518.15 ","$0.00 ","$726.00 ","$0.00 ","$363.00 ","$574.99 ","$580.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001264","EAP","Custom 27001264","","Delivery System Closed In","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$0.00 ","$0.00 ","$0.00 ","$100.63 ","$100.63 ","$0.00 ","$141.00 ","$0.00 ","$70.50 ","$111.67 ","$112.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001265","EAP","Custom 27001265","","Set T-port Small Bore Ext","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001268","EAP","Custom 27001268","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001270","EAP","Custom 27001270","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001271","EAP","Custom 27001271","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001272","EAP","Custom 27001272","","Tray Thoracentesis Dispos","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$147.74 ","$147.74 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001273","EAP","Custom 27001273","","Sponges Laparotomy 6522","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$0.00 ","$0.00 ","$0.00 ","$84.93 ","$84.93 ","$0.00 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001274","EAP","Custom 27001274","","Bovie Pencil Valleylab","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001283","EAP","Custom 27001283","","Dressing Acticoat 16x16","BOTH IP/OP","$678.00 ","$501.72 ","$0.00 ","$678.00 ","$0.00 ","$0.00 ","$0.00 ","$483.89 ","$483.89 ","$0.00 ","$678.00 ","$0.00 ","$339.00 ","$536.98 ","$542.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001284","EAP","Custom 27001284","","Kit Vascular Conform","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$77.08 ","$77.08 ","$0.00 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001285","EAP","Custom 27001285","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001286","EAP","Custom 27001286","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001287","EAP","Custom 27001287","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001288","EAP","Custom 27001288","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001289","EAP","Custom 27001289","","1st First Select Overlay","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001298","EAP","Custom 27001298","","Therapy For Cvvh/cvvhd 4","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$118.47 ","$118.47 ","$0.00 ","$166.00 ","$0.00 ","$83.00 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001299","EAP","Custom 27001299","","Dialysis Filter","BOTH IP/OP","$699.00 ","$517.26 ","$0.00 ","$699.00 ","$0.00 ","$0.00 ","$0.00 ","$498.88 ","$498.88 ","$0.00 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001312","EAP","Custom 27001312","","Catheter  Thoracic 20fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001313","EAP","Custom 27001313","","Catheter Thoracic 32fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001314","EAP","Custom 27001314","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001315","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27001316","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27001317","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27001318","EAP","Custom 27001318","","Catheter Ventricular 20cm","BOTH IP/OP","$683.00 ","$505.42 ","$0.00 ","$683.00 ","$0.00 ","$0.00 ","$0.00 ","$487.46 ","$487.46 ","$0.00 ","$683.00 ","$0.00 ","$341.50 ","$540.94 ","$546.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001319","EAP","Custom 27001319","","Catheter Edm Ii Becker","BOTH IP/OP","$1,339.00 ","$990.86 ","$0.00 ","$1,339.00 ","$0.00 ","$0.00 ","$0.00 ","$955.64 ","$955.64 ","$0.00 ","$1,339.00 ","$0.00 ","$669.50 ","$1,060.49 ","$1,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001320","EAP","Custom 27001320","","Artery Arterial Catheriza","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001321","EAP","Custom 27001321","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001322","EAP","Custom 27001322","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001323","EAP","Custom 27001323","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001324","EAP","Custom 27001324","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001328","EAP","Custom 27001328","","Bag Drainage Becker","BOTH IP/OP","$202.00 ","$149.48 ","$0.00 ","$202.00 ","$0.00 ","$0.00 ","$0.00 ","$144.17 ","$144.17 ","$0.00 ","$202.00 ","$0.00 ","$101.00 ","$159.98 ","$161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001329","EAP","Custom 27001329","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$937.00 ","$693.38 ","$0.00 ","$937.00 ","$0.00 ","$0.00 ","$0.00 ","$668.74 ","$668.74 ","$0.00 ","$937.00 ","$0.00 ","$468.50 ","$742.10 ","$749.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001330","EAP","Custom 27001330","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001331","EAP","Custom 27001331","","Triconnector With Valve","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001337","EAP","Custom 27001337","","Cable Patient 12 Pin #r53","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001341","EAP","Custom 27001341","","Kit Thoracotomy","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$0.00 ","$0.00 ","$0.00 ","$154.87 ","$154.87 ","$0.00 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001347","EAP","Custom 27001347","","Pouch Fecal Incontinence","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001348","EAP","Custom 27001348","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001349","EAP","Custom 27001349","","Transducer  Disp For Icp","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001350","EAP","Custom 27001350","","Bridge Kit Bifurated Resp","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$85.64 ","$85.64 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001351","EAP","Custom 27001351","","Kit Transducer Monitoring","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001352","EAP","Custom 27001352","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001354","EAP","Custom 27001354","","Bag Feeding Gavage 500ml","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001355","EAP","Custom 27001355","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001356","EAP","Custom 27001356","","Kit Pecutaneous Introduce","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$92.07 ","$92.07 ","$0.00 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001357","EAP","Custom 27001357","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001358","EAP","Custom 27001358","","Chest Imot Dry Suction Sy","BOTH IP/OP","$316.00 ","$233.84 ","$0.00 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$225.53 ","$225.53 ","$0.00 ","$316.00 ","$0.00 ","$158.00 ","$250.27 ","$252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001363","EAP","Custom 27001363","","Trac Dressing Xl","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001366","EAP","Custom 27001366","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001367","EAP","Custom 27001367","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001369","EAP","Custom 27001369","","Kit Monitoring Intracrani","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$328.30 ","$328.30 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001370","EAP","Custom 27001370","","Catheter Swan Ganz","BOTH IP/OP","$674.00 ","$498.76 ","$0.00 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$481.03 ","$481.03 ","$0.00 ","$674.00 ","$0.00 ","$337.00 ","$533.81 ","$539.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001371","EAP","Custom 27001371","","Delivery System Closed In","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001372","EAP","Custom 27001372","","Probe V-pacing","BOTH IP/OP","$1,403.00 ","$1,038.22 ","$0.00 ","$1,403.00 ","$0.00 ","$0.00 ","$0.00 ","$1,001.32 ","$1,001.32 ","$0.00 ","$1,403.00 ","$0.00 ","$701.50 ","$1,111.18 ","$1,122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001374","EAP","Custom 27001374","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001376","EAP","Custom 27001376","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001377","EAP","Custom 27001377","","Kit Ventriculostomy","BOTH IP/OP","$1,782.00 ","$1,318.68 ","$0.00 ","$1,782.00 ","$0.00 ","$0.00 ","$0.00 ","$1,271.81 ","$1,271.81 ","$0.00 ","$1,782.00 ","$0.00 ","$891.00 ","$1,411.34 ","$1,425.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001379","EAP","Custom 27001379","","Tray Pericardiocentesis","BOTH IP/OP","$1,235.00 ","$913.90 ","$0.00 ","$1,235.00 ","$0.00 ","$0.00 ","$0.00 ","$881.42 ","$881.42 ","$0.00 ","$1,235.00 ","$0.00 ","$617.50 ","$978.12 ","$988.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001380","EAP","Custom 27001380","","Central Line Dressing Tray With Biopatch","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001391","EAP","Custom 27001391","",".014 Nitrex Guidewire","BOTH IP/OP","$2,554.00 ","$1,889.96 ","$0.00 ","$2,554.00 ","$0.00 ","$0.00 ","$0.00 ","$1,822.79 ","$1,822.79 ","$0.00 ","$2,554.00 ","$0.00 ","$1,277.00 ","$2,022.77 ","$2,043.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001392","EAP","Custom 27001392","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001393","EAP","Custom 27001393","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001394","EAP","Custom 27001394","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$394.68 ","$394.68 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001395","EAP","Custom 27001395","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$616.00 ","$0.00 ","$0.00 ","$0.00 ","$439.64 ","$439.64 ","$0.00 ","$616.00 ","$0.00 ","$308.00 ","$487.87 ","$492.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001399","EAP","Custom 27001399","","Tray Circumcision","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001400","EAP","Custom 27001400","","Needle Neo-natal Lumbar P","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001401","EAP","Custom 27001401","","Tubes Capillary Hepariniz","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001403","EAP","Custom 27001403","","Tube Feeding Plastic 8fr","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001408","EAP","Custom 27001408","","Bag Feeding Gavage 500ml","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001409","EAP","Custom 27001409","","Set Breast Pump Complete","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$0.00 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001410","EAP","Custom 27001410","","Cassettes Imed #9260 20/c","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001411","EAP","Custom 27001411","","Catheter Quick Iv 22ga","BOTH IP/OP","$7.00 ","$5.18 ","$0.00 ","$7.00 ","$0.00 ","$0.00 ","$0.00 ","$5.00 ","$5.00 ","$0.00 ","$7.00 ","$0.00 ","$3.50 ","$5.54 ","$5.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001412","EAP","Custom 27001412","","Filter Set 0.22 Micron","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001413","EAP","Custom 27001413","","Set T-port Small Bore Ext","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001415","EAP","Custom 27001415","","Tube Sump Gastric 50/cs","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001418","EAP","Custom 27001418","","Precision Introd.26g(1.9f)","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$0.00 ","$0.00 ","$0.00 ","$106.34 ","$106.34 ","$0.00 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001419","EAP","Custom 27001419","","26g Catheter(1.9f 1st Picc Bd)","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$185.56 ","$185.56 ","$0.00 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001420","EAP","Custom 27001420","","Picc Tray (bd Procedure Tray)","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$0.00 ","$0.00 ","$0.00 ","$156.30 ","$156.30 ","$0.00 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001421","EAP","Custom 27001421","","Precision Introducer 22g(2.8f)","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$183.00 ","$0.00 ","$0.00 ","$0.00 ","$130.61 ","$130.61 ","$0.00 ","$183.00 ","$0.00 ","$91.50 ","$144.94 ","$146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001422","EAP","Custom 27001422","","22g Catheter(2.8f 1st Picc Bd)","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$343.00 ","$0.00 ","$0.00 ","$0.00 ","$244.80 ","$244.80 ","$0.00 ","$343.00 ","$0.00 ","$171.50 ","$271.66 ","$274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001423","EAP","Custom 27001423","","Argyle Picc 1.9frx39cm Dual Lu","BOTH IP/OP","$423.00 ","$313.02 ","$0.00 ","$423.00 ","$0.00 ","$0.00 ","$0.00 ","$301.90 ","$301.90 ","$0.00 ","$423.00 ","$0.00 ","$211.50 ","$335.02 ","$338.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001424","EAP","Custom 27001424","","20g(3fr)bdl Cath Picc Dual Lum","BOTH IP/OP","$154.00 ","$113.96 ","$0.00 ","$154.00 ","$0.00 ","$0.00 ","$0.00 ","$109.91 ","$109.91 ","$0.00 ","$154.00 ","$0.00 ","$77.00 ","$121.97 ","$123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001428","EAP","Custom 27001428","","Tray Circumcision","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001429","EAP","Custom 27001429","","Needle Neo-natal Lumbar P","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001430","EAP","Custom 27001430","","Needle Spinal 22g 25/bx","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001431","EAP","Custom 27001431","","Tubes Capillary Hepariniz","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001432","EAP","Custom 27001432","","Tube Nasogastric Feeding","BOTH IP/OP","$91.00 ","$67.34 ","$0.00 ","$91.00 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$64.95 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001435","EAP","Custom 27001435","","Catheter Urethral 8fr","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001436","EAP","Custom 27001436","","Catheter Umbilical 15 3-","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001437","EAP","Custom 27001437","","Catheter Umbilical 15 5f","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001438","EAP","Custom 27001438","","Tube Feeding Plastic 8fr","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001441","EAP","Custom 27001441","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001443","EAP","Custom 27001443","","Pouch Little Ones  Cut To","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001446","EAP","Custom 27001446","","Transducer With Interg 43","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001447","EAP","Custom 27001447","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001448","EAP","Custom 27001448","","Catheter  Thoracic Trocar","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$134.00 ","$0.00 ","$0.00 ","$0.00 ","$95.64 ","$95.64 ","$0.00 ","$134.00 ","$0.00 ","$67.00 ","$106.13 ","$107.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001449","EAP","Custom 27001449","","Catheter Thoracic Trocar 10 F","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001450","EAP","Custom 27001450","","Chest Unit  Drainage Pleur","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001451","EAP","Custom 27001451","","Cassettes Imed #9260 20/c","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001452","EAP","Custom 27001452","","Catheter Quick Iv 22gax1-","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001453","EAP","Custom 27001453","","Catheter Introducer Steri","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001454","EAP","Custom 27001454","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001455","EAP","Custom 27001455","","Set T-port Small Bore Ext","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001456","EAP","Custom 27001456","","Tray Transfusion Sterile","BOTH IP/OP","$597.00 ","$441.78 ","$0.00 ","$597.00 ","$0.00 ","$0.00 ","$0.00 ","$426.08 ","$426.08 ","$0.00 ","$597.00 ","$0.00 ","$298.50 ","$472.82 ","$477.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001458","EAP","Custom 27001458","","Tube Sump Gastric 50/cs","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001459","EAP","HCPCS C1751","","Catheter  Iv 26g 120/cs","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$4.38 ","$0.00 ","$4.46 ","$0.00 "
"27001466","EAP","Custom 27001466","","Catheter Suction 5fr Ster","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001468","EAP","Custom 27001468","","Catheter  Suction Plastic 14","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001469","EAP","Custom 27001469","","Catheter Urethral Two-eye","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001471","EAP","Custom 27001471","","Set Urinary Drain W/conta","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001473","EAP","Custom 27001473","","Scaple Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001475","EAP","Custom 27001475","","Stapler Skin Disposable 3","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$62.09 ","$62.09 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001486","EAP","Custom 27001486","","Speculum Pediatric","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001487","EAP","Custom 27001487","","Bag Hyperinflation","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$60.66 ","$60.66 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001490","EAP","Custom 27001490","","Tray Catheter Urethral 14","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001492","EAP","Custom 27001492","","Tray Foley Preconnected 1","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001494","EAP","Custom 27001494","","Sponges Laparotomy 6522","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001501","EAP","Custom 27001501","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001502","EAP","Custom 27001502","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001503","EAP","Custom 27001503","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001618","EAP","Custom 27001618","","Triadyne Ii (bed)","BOTH IP/OP","$737.00 ","$545.38 ","$0.00 ","$737.00 ","$0.00 ","$0.00 ","$0.00 ","$526.00 ","$526.00 ","$0.00 ","$737.00 ","$0.00 ","$368.50 ","$583.70 ","$589.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001620","EAP","Custom 27001620","","Fluidair Elite (bed)","BOTH IP/OP","$772.00 ","$571.28 ","$0.00 ","$772.00 ","$0.00 ","$0.00 ","$0.00 ","$550.98 ","$550.98 ","$0.00 ","$772.00 ","$0.00 ","$386.00 ","$611.42 ","$617.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001635","EAP","Custom 27001635","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001636","EAP","Custom 27001636","","Set Urinary Drain W/conta","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001641","EAP","Custom 27001641","","Tray Douch Disposable","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001644","EAP","Custom 27001644","","Tray Foley Preconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001645","EAP","Custom 27001645","","Tray Foley Perconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001647","EAP","Custom 27001647","","Arrow Super/extreme Cath Kit","BOTH IP/OP","$802.00 ","$593.48 ","$0.00 ","$802.00 ","$0.00 ","$0.00 ","$0.00 ","$572.39 ","$572.39 ","$0.00 ","$802.00 ","$0.00 ","$401.00 ","$635.18 ","$641.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001649","EAP","Custom 27001649","","Central Line Dressing Tray","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001650","EAP","Custom 27001650","","Continuous Cardiac O/put Swans","BOTH IP/OP","$604.00 ","$446.96 ","$0.00 ","$604.00 ","$0.00 ","$0.00 ","$0.00 ","$431.07 ","$431.07 ","$0.00 ","$604.00 ","$0.00 ","$302.00 ","$478.37 ","$483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001652","EAP","Custom 27001652","","Pressure Transclucer Kits","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001653","EAP","Custom 27001653","","Percutaneous Introducer Kits","BOTH IP/OP","$2,364.00 ","$1,749.36 ","$0.00 ","$2,364.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.19 ","$1,687.19 ","$0.00 ","$2,364.00 ","$0.00 ","$1,182.00 ","$1,872.29 ","$1,891.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001655","EAP","Custom 27001655","","Sutures","BOTH IP/OP","$211.00 ","$156.14 ","$0.00 ","$211.00 ","$0.00 ","$0.00 ","$0.00 ","$150.59 ","$150.59 ","$0.00 ","$211.00 ","$0.00 ","$105.50 ","$167.11 ","$168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001657","EAP","Custom 27001657","","Swan Ganz Catheters","BOTH IP/OP","$604.00 ","$446.96 ","$0.00 ","$604.00 ","$0.00 ","$0.00 ","$0.00 ","$431.07 ","$431.07 ","$0.00 ","$604.00 ","$0.00 ","$302.00 ","$478.37 ","$483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001658","EAP","Custom 27001658","","Guidewire .35x.68cm","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001660","EAP","Custom 27001660","","Huber Needle","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001665","EAP","Custom 27001665","","14fx15cm Schon Xl Dbl Lmn Vasc","BOTH IP/OP","$6,497.00 ","$4,807.78 ","$0.00 ","$6,497.00 ","$0.00 ","$0.00 ","$0.00 ","$4,636.91 ","$4,636.91 ","$0.00 ","$6,497.00 ","$0.00 ","$3,248.50 ","$5,145.62 ","$5,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001666","EAP","Custom 27001666","","14fx24cm Schon Xl Dbl Lmn Vasc","BOTH IP/OP","$6,497.00 ","$4,807.78 ","$0.00 ","$6,497.00 ","$0.00 ","$0.00 ","$0.00 ","$4,636.91 ","$4,636.91 ","$0.00 ","$6,497.00 ","$0.00 ","$3,248.50 ","$5,145.62 ","$5,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001667","EAP","Custom 27001667","","14fx20cm Schon Xl Dbl Lmn Vasc","BOTH IP/OP","$6,497.00 ","$4,807.78 ","$0.00 ","$6,497.00 ","$0.00 ","$0.00 ","$0.00 ","$4,636.91 ","$4,636.91 ","$0.00 ","$6,497.00 ","$0.00 ","$3,248.50 ","$5,145.62 ","$5,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001670","EAP","Custom 27001670","","Twist Lock Cath Gard Catheter","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$57.10 ","$57.10 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001671","EAP","Custom 27001671","","Needles 18 Ga/7cm (cook)","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001672","EAP","Custom 27001672","","Cook Tlc Tray","BOTH IP/OP","$457.00 ","$338.18 ","$0.00 ","$457.00 ","$0.00 ","$0.00 ","$0.00 ","$326.16 ","$326.16 ","$0.00 ","$457.00 ","$0.00 ","$228.50 ","$361.94 ","$365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001675","EAP","Custom 27001675","","Tubes Extension Plain Pla","BOTH IP/OP","$5.00 ","$3.70 ","$0.00 ","$5.00 ","$0.00 ","$0.00 ","$0.00 ","$3.57 ","$3.57 ","$0.00 ","$5.00 ","$0.00 ","$2.50 ","$3.96 ","$4.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001679","EAP","Custom 27001679","","Meter Astech Peak Flow","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001692","EAP","Custom 27001692","","Catheter  Thoracic 28fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001693","EAP","Custom 27001693","","Catheter Thoracic 32fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001694","EAP","Custom 27001694","","Catheter Thoracic 36fr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001695","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27001696","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27001697","EAP","HCPCS C1729","","Catheter Coude Size 16fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27001698","EAP","Custom 27001698","","Artery Arterial Catheriza","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001699","EAP","Custom 27001699","","Artery Radial Catherizati","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001700","EAP","Custom 27001700","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001701","EAP","Custom 27001701","","Tube Salem Silicone Size","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001702","EAP","Custom 27001702","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001703","EAP","Custom 27001703","","Kit Tracheotomy Care Ster","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001706","EAP","Custom 27001706","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$1,009.00 ","$746.66 ","$0.00 ","$1,009.00 ","$0.00 ","$0.00 ","$0.00 ","$720.12 ","$720.12 ","$0.00 ","$1,009.00 ","$0.00 ","$504.50 ","$799.13 ","$807.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001707","EAP","Custom 27001707","","Scapel Surg W/handle Attached","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001709","EAP","Custom 27001709","","Triconnector With Valve","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001713","EAP","Custom 27001713","","Pouch Active Life Squib Drain","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001715","EAP","Custom 27001715","","Cable Patient 12 Pin #r53","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001716","EAP","Custom 27001716","","Electrodes Operative","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$122.00 ","$0.00 ","$0.00 ","$0.00 ","$87.07 ","$87.07 ","$0.00 ","$122.00 ","$0.00 ","$61.00 ","$96.62 ","$97.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001721","EAP","Custom 27001721","","Pouch Fecal Incontinence","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001722","EAP","Custom 27001722","","Kit Pressure Monitoring T","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$126.32 ","$126.32 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001723","EAP","Custom 27001723","","Kit  Pressure Monitoring","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001725","EAP","Custom 27001725","","Bag 1000ml Pump Set","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001726","EAP","Custom 27001726","","Needle Port-cath 20ga X 1","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001727","EAP","Custom 27001727","","Chest Unit Drainage Pleur","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001732","EAP","Custom 27001732","","Dressing X-large","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001733","EAP","Custom 27001733","","Trac Dressing Xl","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001735","EAP","Custom 27001735","","Tube Feeding Ng 8fr 36in Entri","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001736","EAP","Custom 27001736","","Kit Triple Lumen Catheter","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$697.00 ","$0.00 ","$0.00 ","$0.00 ","$497.45 ","$497.45 ","$0.00 ","$697.00 ","$0.00 ","$348.50 ","$552.02 ","$557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001740","EAP","Custom 27001740","","Tube Trach #8 Dct","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$239.09 ","$239.09 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001741","EAP","Custom 27001741","","Tube Trach #6 Dct","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$239.09 ","$239.09 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001742","EAP","Custom 27001742","","Tube Trach #10 Dct","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$239.09 ","$239.09 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001743","EAP","Custom 27001743","","Tube Tracheostomy 4-dcfs","BOTH IP/OP","$326.00 ","$241.24 ","$0.00 ","$326.00 ","$0.00 ","$0.00 ","$0.00 ","$232.67 ","$232.67 ","$0.00 ","$326.00 ","$0.00 ","$163.00 ","$258.19 ","$260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001744","EAP","Custom 27001744","","Filter Set 0.22 Micron","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001746","EAP","Custom 27001746","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001747","EAP","Custom 27001747","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001748","EAP","Custom 27001748","","Tray Thoracentesis Dispos","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001763","EAP","Custom 27001763","","Sleeve Knee Regular Dvt","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001764","EAP","Custom 27001764","","Sleeve Knee X-large Dvt","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001765","EAP","Custom 27001765","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001766","EAP","Custom 27001766","","Sleeve Thigh X-large Dvt","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$0.00 ","$284.00 ","$0.00 ","$142.00 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001768","EAP","HCPCS A4300","","Temporary Ven Cath Removal","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$0.00 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001769","EAP","Custom 27001769","","Tray Catheter Insrtn Dulm","BOTH IP/OP","$1,048.00 ","$775.52 ","$0.00 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$747.96 ","$747.96 ","$0.00 ","$1,048.00 ","$0.00 ","$524.00 ","$830.02 ","$838.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001770","EAP","Custom 27001770","","Central Line Dressing Tray","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001771","EAP","Custom 27001771","","Catheter Repair Kit","BOTH IP/OP","$803.00 ","$594.22 ","$0.00 ","$803.00 ","$0.00 ","$0.00 ","$0.00 ","$573.10 ","$573.10 ","$0.00 ","$803.00 ","$0.00 ","$401.50 ","$635.98 ","$642.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001773","EAP","Custom 27001773","","Occult Blood Supply","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001778","EAP","Custom 27001778","","Needle Port-cath 20ga X 1","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001779","EAP","Custom 27001779","","Tray Catheter Urethral 14","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001781","EAP","Custom 27001781","","Ace Wrap","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001782","EAP","Custom 27001782","","Splint","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001783","EAP","Custom 27001783","","Splint - Supply","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001785","EAP","Custom 27001785","","Ace Wrap","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001786","EAP","Custom 27001786","","Ace Wrap Supply","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001788","EAP","Custom 27001788","","Wrist Brace","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27001789","EAP","Custom 27001789","","Sling/fig. 8","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$59.24 ","$59.24 ","$0.00 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002257","EAP","Custom 27002257","","Cast Application Supply","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$0.00 ","$0.00 ","$0.00 ","$404.67 ","$404.67 ","$0.00 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002259","EAP","Custom 27002259","","Sling","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$77.08 ","$77.08 ","$0.00 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002260","EAP","Custom 27002260","","Ace Bandage","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002261","EAP","Custom 27002261","","Urinary Drainage Bag","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002263","EAP","Custom 27002263","","Gastric Lavage Kit","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$234.00 ","$0.00 ","$0.00 ","$0.00 ","$167.01 ","$167.01 ","$0.00 ","$234.00 ","$0.00 ","$117.00 ","$185.33 ","$187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002265","EAP","Custom 27002265","","Pelvic Tray","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002266","EAP","Custom 27002266","","Peak Flow Meter","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$343.00 ","$0.00 ","$0.00 ","$0.00 ","$244.80 ","$244.80 ","$0.00 ","$343.00 ","$0.00 ","$171.50 ","$271.66 ","$274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002267","EAP","Custom 27002267","","Ortho Traction Pins","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$0.00 ","$0.00 ","$0.00 ","$291.19 ","$291.19 ","$0.00 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002268","EAP","Custom 27002268","","Ace Bandage","BOTH IP/OP","$147.00 ","$108.78 ","$0.00 ","$147.00 ","$0.00 ","$0.00 ","$0.00 ","$104.91 ","$104.91 ","$0.00 ","$147.00 ","$0.00 ","$73.50 ","$116.42 ","$117.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002473","EAP","Custom 27002473","","Angiocath Iv Bb 18gx1.25in Nw","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002510","EAP","Custom 27002510","","Nuva Ring","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002515","EAP","Custom 27002515","","Clavical Straps","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002516","EAP","Custom 27002516","","Fiberglass Casting","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$92.07 ","$92.07 ","$0.00 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002517","EAP","Custom 27002517","","Ankle Stirrup","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$0.00 ","$0.00 ","$0.00 ","$106.34 ","$106.34 ","$0.00 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002518","EAP","Custom 27002518","","Knee Immobilizer","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002519","EAP","Custom 27002519","","Philadephia Collar","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$193.00 ","$0.00 ","$0.00 ","$0.00 ","$137.74 ","$137.74 ","$0.00 ","$193.00 ","$0.00 ","$96.50 ","$152.86 ","$154.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002520","EAP","Custom 27002520","","Cervical Collar","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002521","EAP","Custom 27002521","","Pavlik Harness","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$127.04 ","$127.04 ","$0.00 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002522","EAP","Custom 27002522","","Cast Shoe","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002523","EAP","Custom 27002523","","Shoulder Immobilizer","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002524","EAP","Custom 27002524","","Post Op Shoe","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002525","EAP","Custom 27002525","","Hinged Knee Brace","BOTH IP/OP","$705.00 ","$521.70 ","$0.00 ","$705.00 ","$0.00 ","$0.00 ","$0.00 ","$503.16 ","$503.16 ","$0.00 ","$705.00 ","$0.00 ","$352.50 ","$558.36 ","$564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002526","EAP","Custom 27002526","","Sling/fig. 8","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002527","EAP","Custom 27002527","","Hinged Knee Sleeve","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$92.07 ","$92.07 ","$0.00 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002528","EAP","Custom 27002528","","Universal Knee Brace","BOTH IP/OP","$728.00 ","$538.72 ","$0.00 ","$728.00 ","$0.00 ","$0.00 ","$0.00 ","$519.57 ","$519.57 ","$0.00 ","$728.00 ","$0.00 ","$364.00 ","$576.58 ","$582.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002529","EAP","Custom 27002529","","Universal Knee Brace","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$0.00 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002530","EAP","Custom 27002530","","3d Walking Boot","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$140.60 ","$140.60 ","$0.00 ","$197.00 ","$0.00 ","$98.50 ","$156.02 ","$157.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002531","EAP","Custom 27002531","","Knee Immobilizer","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002532","EAP","Custom 27002532","","Shoulder Immobilizer","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002533","EAP","Custom 27002533","","Philadelphia Collar","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$147.74 ","$147.74 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002534","EAP","Custom 27002534","","Soft Collar","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$92.78 ","$92.78 ","$0.00 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002535","EAP","Custom 27002535","","Arm Sling","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002536","EAP","Custom 27002536","","Active Ankle Brace","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$0.00 ","$0.00 ","$0.00 ","$297.61 ","$297.61 ","$0.00 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002537","EAP","Custom 27002537","","Buck's Traction Splint","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002538","EAP","Custom 27002538","","Knee Brace","BOTH IP/OP","$762.00 ","$563.88 ","$0.00 ","$762.00 ","$0.00 ","$0.00 ","$0.00 ","$543.84 ","$543.84 ","$0.00 ","$762.00 ","$0.00 ","$381.00 ","$603.50 ","$609.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002539","EAP","Custom 27002539","","Jacksonville Sling","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002541","EAP","Custom 27002541","","Cast Over Wrap","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002542","EAP","Custom 27002542","","Cast Over Wrap-fiberglass","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$0.00 ","$0.00 ","$0.00 ","$83.50 ","$83.50 ","$0.00 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002543","EAP","Custom 27002543","","Sandbag","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002544","EAP","Custom 27002544","","Aspen Collar","BOTH IP/OP","$154.00 ","$113.96 ","$0.00 ","$154.00 ","$0.00 ","$0.00 ","$0.00 ","$109.91 ","$109.91 ","$0.00 ","$154.00 ","$0.00 ","$77.00 ","$121.97 ","$123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002545","EAP","Custom 27002545","","Miami J. Collar","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$0.00 ","$0.00 ","$0.00 ","$139.17 ","$139.17 ","$0.00 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002546","EAP","Custom 27002546","","Atlas Collar","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002547","EAP","Custom 27002547","","Pediatric Pmt Collar","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002548","EAP","Custom 27002548","","Abduction Pillow","BOTH IP/OP","$96.00 ","$71.04 ","$0.00 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$68.52 ","$68.52 ","$0.00 ","$96.00 ","$0.00 ","$48.00 ","$76.03 ","$76.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002549","EAP","Custom 27002549","","Neoprene Knee Sleeve","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$48.53 ","$48.53 ","$0.00 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002550","EAP","Custom 27002550","","Cuff And Collar","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002551","EAP","Custom 27002551","","Post Op Shoe","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002552","EAP","Custom 27002552","","Tlso Pre Fab","BOTH IP/OP","$2,419.00 ","$1,790.06 ","$0.00 ","$2,419.00 ","$0.00 ","$0.00 ","$0.00 ","$1,726.44 ","$1,726.44 ","$0.00 ","$2,419.00 ","$0.00 ","$1,209.50 ","$1,915.85 ","$1,935.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002564","EAP","CPT� C1751","","Cvp Kit, Double Lumen","BOTH IP/OP","$569.00 ","$421.06 ","$0.00 ","$569.00 ","$308.97 ","$0.00 ","$118.59 ","$406.10 ","$406.10 ","$99.63 ","$569.00 ","$0.00 ","$284.50 ","$450.65 ","$455.20 ","$0.00 ","$89.05 ","$0.00 ","$90.58 ","$0.00 "
"27002565","EAP","Custom 27002565","","Ett, Double-lumen","BOTH IP/OP","$837.00 ","$619.38 ","$0.00 ","$837.00 ","$0.00 ","$0.00 ","$0.00 ","$597.37 ","$597.37 ","$0.00 ","$837.00 ","$0.00 ","$418.50 ","$662.90 ","$669.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002572","EAP","Custom 27002572","","Introducer Kit","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$0.00 ","$0.00 ","$0.00 ","$186.28 ","$186.28 ","$0.00 ","$261.00 ","$0.00 ","$130.50 ","$206.71 ","$208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002573","EAP","Custom 27002573","","Radial Artery Set (arrow)","BOTH IP/OP","$92.00 ","$68.08 ","$0.00 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$65.66 ","$0.00 ","$92.00 ","$0.00 ","$46.00 ","$72.86 ","$73.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002576","EAP","Custom 27002576","","Epidural Tray","BOTH IP/OP","$316.00 ","$233.84 ","$0.00 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$225.53 ","$225.53 ","$0.00 ","$316.00 ","$0.00 ","$158.00 ","$250.27 ","$252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002579","EAP","Custom 27002579","","Level One Inserts","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002587","EAP","HCPCS C1751","","Kit Quad Lumen Cather","BOTH IP/OP","$148.00 ","$109.52 ","$0.00 ","$148.00 ","$80.36 ","$0.00 ","$30.85 ","$105.63 ","$105.63 ","$25.91 ","$148.00 ","$0.00 ","$74.00 ","$117.22 ","$118.40 ","$0.00 ","$23.16 ","$0.00 ","$23.56 ","$0.00 "
"27002589","EAP","Custom 27002589","","Aintree Intubation Changer","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$59.24 ","$59.24 ","$0.00 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002590","EAP","Custom 27002590","","Kit Triple Lumen Catheter","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$461.05 ","$461.05 ","$0.00 ","$646.00 ","$0.00 ","$323.00 ","$511.63 ","$516.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002593","EAP","Custom 27002593","","Cvp Kit, Double Lumen","BOTH IP/OP","$307.00 ","$227.18 ","$0.00 ","$307.00 ","$0.00 ","$0.00 ","$0.00 ","$219.11 ","$219.11 ","$0.00 ","$307.00 ","$0.00 ","$153.50 ","$243.14 ","$245.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002594","EAP","Custom 27002594","","Transducer And Tubing, Disp","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002595","EAP","Custom 27002595","","Fiberoptic Intubation Scope","BOTH IP/OP","$321.00 ","$237.54 ","$0.00 ","$321.00 ","$0.00 ","$0.00 ","$0.00 ","$229.10 ","$229.10 ","$0.00 ","$321.00 ","$0.00 ","$160.50 ","$254.23 ","$256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002598","EAP","Custom 27002598","","Air Embolism Detector","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002599","EAP","Custom 27002599","","Introducer Kit","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002600","EAP","Custom 27002600","","Radial Artery Set (arrow)","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002602","EAP","Custom 27002602","","Disp. Sao2 Probe","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002604","EAP","Custom 27002604","","Epidural Tray","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$94.21 ","$94.21 ","$0.00 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002605","EAP","Custom 27002605","","Spinal Tray","BOTH IP/OP","$190.00 ","$140.60 ","$0.00 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$135.60 ","$135.60 ","$0.00 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002609","EAP","Custom 27002609","","Thoracotomy Tray","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$94.21 ","$94.21 ","$0.00 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002610","EAP","Custom 27002610","","Tracheotomy Tray","BOTH IP/OP","$394.00 ","$291.56 ","$0.00 ","$394.00 ","$0.00 ","$0.00 ","$0.00 ","$281.20 ","$281.20 ","$0.00 ","$394.00 ","$0.00 ","$197.00 ","$312.05 ","$315.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002618","EAP","Custom 27002618","","Ioban 2 Drape Incise Smal","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002620","EAP","Custom 27002620","","Ioban 2 Drape Incise Larg","BOTH IP/OP","$434.00 ","$321.16 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002621","EAP","Custom 27002621","","Needle Spinal 18ga","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002624","EAP","Custom 27002624","","Catheter Texas Large","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002625","EAP","Custom 27002625","","Catheter Thoracic 32fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002626","EAP","Custom 27002626","","Catheter Thoracic 36fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002627","EAP","Custom 27002627","","Catheter Urethral Two-eye","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002628","EAP","Custom 27002628","","Artery Arterial Catheriza","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002629","EAP","Custom 27002629","","Artery Radial Catherizati","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002630","EAP","Custom 27002630","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002631","EAP","Custom 27002631","","Tube Salem Silicone Size","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002632","EAP","Custom 27002632","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002636","EAP","Custom 27002636","","Bag Drainage Becker","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$140.60 ","$140.60 ","$0.00 ","$197.00 ","$0.00 ","$98.50 ","$156.02 ","$157.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002637","EAP","Custom 27002637","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002640","EAP","Custom 27002640","","Set Blood Administration","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002643","EAP","Custom 27002643","","Cream Baza 5oz","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002646","EAP","Custom 27002646","","Electrodes Operative","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002647","EAP","Custom 27002647","","Valve Anti-reflux Salem S","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$32.83 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002649","EAP","Custom 27002649","","Kit Thoracotomy","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$0.00 ","$0.00 ","$0.00 ","$144.88 ","$144.88 ","$0.00 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002653","EAP","Custom 27002653","","Set Pediatric Measured Fi","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002656","EAP","Custom 27002656","","Pouch Fecal Incontinence","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$35.69 ","$35.69 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002657","EAP","Custom 27002657","","Kit Pressure Monitoring T","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002658","EAP","Custom 27002658","","Transducer Disp For Icp","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$49.96 ","$49.96 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002659","EAP","Custom 27002659","","Kit Transducer Monitoring","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002660","EAP","Custom 27002660","","Kit Pressure Monitoring","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$234.00 ","$0.00 ","$0.00 ","$0.00 ","$167.01 ","$167.01 ","$0.00 ","$234.00 ","$0.00 ","$117.00 ","$185.33 ","$187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002662","EAP","Custom 27002662","","Bag 1000ml Pump Set","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002663","EAP","Custom 27002663","","Kit Pecutaneous Introduce","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002664","EAP","Custom 27002664","","Chest Unit Drainage Pleur","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$299.75 ","$299.75 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002665","EAP","Custom 27002665","","Chest Unit Dry Suction Sy","BOTH IP/OP","$309.00 ","$228.66 ","$0.00 ","$309.00 ","$0.00 ","$0.00 ","$0.00 ","$220.53 ","$220.53 ","$0.00 ","$309.00 ","$0.00 ","$154.50 ","$244.73 ","$247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002666","EAP","Custom 27002666","","Bag Auto-transfusion Ple","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$174.86 ","$174.86 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002670","EAP","Custom 27002670","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002671","EAP","Custom 27002671","","Kit Triple Lumen Catheter","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$461.05 ","$461.05 ","$0.00 ","$646.00 ","$0.00 ","$323.00 ","$511.63 ","$516.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002672","EAP","Custom 27002672","","Catheter Swan Ganz","BOTH IP/OP","$674.00 ","$498.76 ","$0.00 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$481.03 ","$481.03 ","$0.00 ","$674.00 ","$0.00 ","$337.00 ","$533.81 ","$539.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002673","EAP","Custom 27002673","","Delivery System Closed In","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$0.00 ","$0.00 ","$0.00 ","$100.63 ","$100.63 ","$0.00 ","$141.00 ","$0.00 ","$70.50 ","$111.67 ","$112.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002676","EAP","Custom 27002676","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002677","EAP","Custom 27002677","","Tray Catheter Urethral 14","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002678","EAP","Custom 27002678","","Tray Foley Preconnected W","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002679","EAP","Custom 27002679","","Tray Foley Perconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002681","EAP","Custom 27002681","","Tray Urine Meter 18fr","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$60.66 ","$60.66 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002682","EAP","Custom 27002682","","Tray Thoracentesis Dispos","BOTH IP/OP","$216.00 ","$159.84 ","$0.00 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$154.16 ","$154.16 ","$0.00 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002684","EAP","Custom 27002684","","Bag Drainage Ureteral","BOTH IP/OP","$92.00 ","$68.08 ","$0.00 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$65.66 ","$0.00 ","$92.00 ","$0.00 ","$46.00 ","$72.86 ","$73.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002687","EAP","Custom 27002687","","Sleeve Knee Regular Dvt","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002688","EAP","Custom 27002688","","Sleeve Knee X-large Dvt","BOTH IP/OP","$439.00 ","$324.86 ","$0.00 ","$439.00 ","$0.00 ","$0.00 ","$0.00 ","$313.31 ","$313.31 ","$0.00 ","$439.00 ","$0.00 ","$219.50 ","$347.69 ","$351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002689","EAP","Custom 27002689","","Sleeve Thigh Regular Dvt","BOTH IP/OP","$512.00 ","$378.88 ","$0.00 ","$512.00 ","$0.00 ","$0.00 ","$0.00 ","$365.41 ","$365.41 ","$0.00 ","$512.00 ","$0.00 ","$256.00 ","$405.50 ","$409.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002697","EAP","Custom 27002697","","Catheter  Suction Plastic 14","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002701","EAP","Custom 27002701","","Set Pediatric Micro Drip","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002702","EAP","Custom 27002702","","Set Pediatric Measured Fi","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002703","EAP","Custom 27002703","","Stockings Antiembolism Thigh","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002704","EAP","Custom 27002704","","Stockings Antiembolism Thigh","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002705","EAP","Custom 27002705","","Stockings Antiembolism Thigh","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$35.69 ","$35.69 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002706","EAP","Custom 27002706","","Stockings Antiembolish Ex","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002707","EAP","Custom 27002707","","Needle Port-cath 20ga X 1","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002708","EAP","Custom 27002708","","Tray Catheter Urethral 14","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002709","EAP","Custom 27002709","","Tray Foley Preconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002710","EAP","Custom 27002710","","Bag Urine Leg","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002884","EAP","Custom 27002884","","Et/co2 Sensors","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002885","EAP","Custom 27002885","","Cpap Circuit","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$961.35 ","$961.35 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002886","EAP","Custom 27002886","","Flutter Valve","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$0.00 ","$0.00 ","$0.00 ","$119.19 ","$119.19 ","$0.00 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002892","EAP","Custom 27002892","","Fecal Occult Blood Supply","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002893","EAP","Custom 27002893","","Tubes Extension Plain Pla","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002908","EAP","Custom 27002908","","Kit Iv Start Custom","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002938","EAP","Custom 27002938","","Inflation Device","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002939","EAP","Custom 27002939","","Catheter, Thrombectomy","BOTH IP/OP","$1,076.00 ","$796.24 ","$0.00 ","$1,076.00 ","$0.00 ","$0.00 ","$0.00 ","$767.94 ","$767.94 ","$0.00 ","$1,076.00 ","$0.00 ","$538.00 ","$852.19 ","$860.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002940","EAP","HCPCS C1751","","Catheter Iv 180ga X 1x1/4","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$8.69 ","$0.00 ","$3.33 ","$11.42 ","$11.42 ","$2.80 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$2.50 ","$0.00 ","$2.55 ","$0.00 "
"27002941","EAP","HCPCS C1751","","Catheter Iv 20ga X 1","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$2.80 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$2.50 ","$0.00 ","$2.55 ","$0.00 "
"27002942","EAP","HCPCS C1751","","Catheter Iv 22ga X 1","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$8.69 ","$0.00 ","$3.33 ","$11.42 ","$11.42 ","$2.80 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$2.50 ","$0.00 ","$2.55 ","$0.00 "
"27002943","EAP","Custom 27002943","","Ioban 2 Drape Incise Medi","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002944","EAP","Custom 27002944","","Needle Spinal 18ga","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002945","EAP","Custom 27002945","","Lancet  Grady Orange","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002946","EAP","HCPCS C1751","","Catheter Iv Cut-down 14g","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$23.89 ","$0.00 ","$9.17 ","$31.40 ","$31.40 ","$7.70 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$6.89 ","$0.00 ","$7.00 ","$0.00 "
"27002947","EAP","HCPCS C1751","","Catheter Iv Cut-down 8 1","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$23.89 ","$0.00 ","$9.17 ","$31.40 ","$31.40 ","$7.70 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$6.89 ","$0.00 ","$7.00 ","$0.00 "
"27002951","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27002952","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27002953","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27002954","EAP","Custom 27002954","","Tube Salem Silicone Size","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002955","EAP","Custom 27002955","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002957","EAP","Custom 27002957","","Scaple Surg W/handle Atta","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$108.48 ","$108.48 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002958","EAP","Custom 27002958","","Scaple Surg W/handle Attached","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002959","EAP","Custom 27002959","","Bore Y Extension Small","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002961","EAP","Custom 27002961","","Pad Defi","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$35.69 ","$35.69 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002962","EAP","Custom 27002962","","Valve Reflux","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002963","EAP","Custom 27002963","","Filter,micron .22 Fluid A","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002964","EAP","Custom 27002964","","Set Scalp  Vein Infusion 21 G","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002965","EAP","Custom 27002965","","Mask Sub-micron Small","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002966","EAP","Custom 27002966","","Kit Triple Lumen Catheter","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$461.05 ","$461.05 ","$0.00 ","$646.00 ","$0.00 ","$323.00 ","$511.63 ","$516.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002967","EAP","Custom 27002967","","Catheter Swan Ganz","BOTH IP/OP","$674.00 ","$498.76 ","$0.00 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$481.03 ","$481.03 ","$0.00 ","$674.00 ","$0.00 ","$337.00 ","$533.81 ","$539.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002968","EAP","Custom 27002968","","Probe V-pacing","BOTH IP/OP","$1,403.00 ","$1,038.22 ","$0.00 ","$1,403.00 ","$0.00 ","$0.00 ","$0.00 ","$1,001.32 ","$1,001.32 ","$0.00 ","$1,403.00 ","$0.00 ","$701.50 ","$1,111.18 ","$1,122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002969","EAP","Custom 27002969","","Filter Set 0.22 Micron","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002970","EAP","Custom 27002970","","Tray Foley Preconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002971","EAP","Custom 27002971","","Tray Foley Perconnected 1","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002972","EAP","Custom 27002972","","Bag Urine Leg","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002973","EAP","Custom 27002973","","Pounches Sterilization 12","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002974","EAP","Custom 27002974","","Bag Drainage Ureteral","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$73.51 ","$73.51 ","$0.00 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002975","EAP","Custom 27002975","","Needle Hypodermic Sterile","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002976","EAP","Custom 27002976","","Drape Half","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002978","EAP","Custom 27002978","","Jcd 5.0-38-20","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002979","EAP","Custom 27002979","","Jcd 7.0-38-20","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002980","EAP","Custom 27002980","","Jcd 8.0-38-20","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002982","EAP","Custom 27002982","","Avantiplus Introducer 6fr 23cm","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$57.10 ","$57.10 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002984","EAP","Custom 27002984","","Nail Cleaner Plastic Non-steri","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002985","EAP","Custom 27002985","","Super Arrow Flex Introducer-c","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002986","EAP","Custom 27002986","","6fr-24cm Flexsheath Introducer","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$0.00 ","$0.00 ","$0.00 ","$132.03 ","$132.03 ","$0.00 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002987","EAP","Custom 27002987","","8fr-35cm Flexsheath Introducer","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$0.00 ","$0.00 ","$0.00 ","$132.03 ","$132.03 ","$0.00 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002990","EAP","Custom 27002990","","Adapter Morse - Y","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$57.10 ","$57.10 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002991","EAP","Custom 27002991","","Drape C-arm 42 X 64","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002993","EAP","Custom 27002993","","Kit Catheter Suction 14fr","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$0.00 ","$0.00 ","$0.00 ","$578.10 ","$578.10 ","$0.00 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002994","EAP","Custom 27002994","","Kit Percutaneous Introducer","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$0.00 ","$0.00 ","$0.00 ","$578.10 ","$578.10 ","$0.00 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27002995","EAP","Custom 27002995","","Kanguru Web","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003005","EAP","Custom 27003005","","Filter Set 0.22 Micron","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003006","EAP","Custom 27003006","","Tray Foley Preconnected 1","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003007","EAP","Custom 27003007","","Tray Foley Perconnected 1","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003008","EAP","Custom 27003008","","Central Line Dressing Tray","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003028","EAP","Custom 27003028","","Lumbo-sacral Support","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003040","EAP","Custom 27003040","","Walker, For Platform Only","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$0.00 ","$0.00 ","$0.00 ","$173.43 ","$173.43 ","$0.00 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003045","EAP","Custom 27003045","","Foot Plate-prefb","BOTH IP/OP","$577.00 ","$426.98 ","$0.00 ","$577.00 ","$0.00 ","$0.00 ","$0.00 ","$411.80 ","$411.80 ","$0.00 ","$577.00 ","$0.00 ","$288.50 ","$456.98 ","$461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003049","EAP","Custom 27003049","","Dressing Stick","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003050","EAP","Custom 27003050","","Leg Lifter","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003051","EAP","Custom 27003051","","Reacher","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$0.00 ","$0.00 ","$0.00 ","$83.50 ","$83.50 ","$0.00 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003053","EAP","Custom 27003053","","Abduction Pillow","BOTH IP/OP","$404.00 ","$298.96 ","$0.00 ","$404.00 ","$0.00 ","$0.00 ","$0.00 ","$288.33 ","$288.33 ","$0.00 ","$404.00 ","$0.00 ","$202.00 ","$319.97 ","$323.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003054","EAP","Custom 27003054","","Compression Glove","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003055","EAP","Custom 27003055","","Dowel","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003063","EAP","Custom 27003063","","Simple Hand-based Splint","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003065","EAP","Custom 27003065","","Custom Finger Splint","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003069","EAP","Custom 27003069","","Compression Glove","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003070","EAP","Custom 27003070","","Dowel","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$32.83 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003073","EAP","Custom 27003073","","Foot Drop Splint","BOTH IP/OP","$233.00 ","$172.42 ","$0.00 ","$233.00 ","$0.00 ","$0.00 ","$0.00 ","$166.29 ","$166.29 ","$0.00 ","$233.00 ","$0.00 ","$116.50 ","$184.54 ","$186.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003080","EAP","Custom 27003080","","Custom Finger Splint","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003081","EAP","Custom 27003081","","Safe Position Splint","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003084","EAP","Custom 27003084","","Compression Glove","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003085","EAP","Custom 27003085","","Dowel","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003087","EAP","Custom 27003087","","Tubigrip, Per Piece","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003089","EAP","Custom 27003089","","Helsper Button","BOTH IP/OP","$710.00 ","$525.40 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$506.73 ","$506.73 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003090","EAP","Custom 27003090","","Laryngectomy Tube","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$0.00 ","$0.00 ","$0.00 ","$476.04 ","$476.04 ","$0.00 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003091","EAP","Custom 27003091","","Inhealth Advan.indwelling Pros","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$0.00 ","$0.00 ","$0.00 ","$613.07 ","$613.07 ","$0.00 ","$859.00 ","$0.00 ","$429.50 ","$680.33 ","$687.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003092","EAP","Custom 27003092","","Inhealth Indwelling Prosthesis","BOTH IP/OP","$878.00 ","$649.72 ","$0.00 ","$878.00 ","$0.00 ","$0.00 ","$0.00 ","$626.63 ","$626.63 ","$0.00 ","$878.00 ","$0.00 ","$439.00 ","$695.38 ","$702.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003093","EAP","Custom 27003093","","Inhealth Low Pressure Prosthesis","BOTH IP/OP","$491.00 ","$363.34 ","$0.00 ","$491.00 ","$0.00 ","$0.00 ","$0.00 ","$350.43 ","$350.43 ","$0.00 ","$491.00 ","$0.00 ","$245.50 ","$388.87 ","$392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003094","EAP","Custom 27003094","","Duckbill Prosthesis","BOTH IP/OP","$309.00 ","$228.66 ","$0.00 ","$309.00 ","$0.00 ","$0.00 ","$0.00 ","$220.53 ","$220.53 ","$0.00 ","$309.00 ","$0.00 ","$154.50 ","$244.73 ","$247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003095","EAP","Custom 27003095","","Provox/atox Prosthesis","BOTH IP/OP","$893.00 ","$660.82 ","$0.00 ","$893.00 ","$0.00 ","$0.00 ","$0.00 ","$637.33 ","$637.33 ","$0.00 ","$893.00 ","$0.00 ","$446.50 ","$707.26 ","$714.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003096","EAP","Custom 27003096","","Insufflation Test Kit","BOTH IP/OP","$863.00 ","$638.62 ","$0.00 ","$863.00 ","$0.00 ","$0.00 ","$0.00 ","$615.92 ","$615.92 ","$0.00 ","$863.00 ","$0.00 ","$431.50 ","$683.50 ","$690.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003097","EAP","Custom 27003097","","Plug Insert","BOTH IP/OP","$339.00 ","$250.86 ","$0.00 ","$339.00 ","$0.00 ","$0.00 ","$0.00 ","$241.94 ","$241.94 ","$0.00 ","$339.00 ","$0.00 ","$169.50 ","$268.49 ","$271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003098","EAP","Custom 27003098","","Catheters","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003100","EAP","Custom 27003100","","Barton-mayo Button","BOTH IP/OP","$849.00 ","$628.26 ","$0.00 ","$849.00 ","$0.00 ","$0.00 ","$0.00 ","$605.93 ","$605.93 ","$0.00 ","$849.00 ","$0.00 ","$424.50 ","$672.41 ","$679.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003101","EAP","Custom 27003101","","Oral Tubing","BOTH IP/OP","$5.00 ","$3.70 ","$0.00 ","$5.00 ","$0.00 ","$0.00 ","$0.00 ","$3.57 ","$3.57 ","$0.00 ","$5.00 ","$0.00 ","$2.50 ","$3.96 ","$4.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003103","EAP","Custom 27003103","","Occult Blood Supply","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003104","EAP","Custom 27003104","","Interceed Sup/admin","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$302.61 ","$302.61 ","$0.00 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003105","EAP","Custom 27003105","","Pudendal Kit","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003108","EAP","Custom 27003108","","Dressing Hemostasis","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$0.00 ","$0.00 ","$0.00 ","$314.74 ","$314.74 ","$0.00 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003113","EAP","Custom 27003113","","Tegaderm Dressing","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003114","EAP","Custom 27003114","","Tegaderm Dressing","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003115","EAP","Custom 27003115","","Wound Gel, Carrington","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$73.51 ","$73.51 ","$0.00 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003116","EAP","Custom 27003116","","Kara Klenz, Wound Cleanser","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003117","EAP","Custom 27003117","","Little Ones, White Collar 4x4","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003118","EAP","Custom 27003118","","Pouch, Cut To Fit, Little Ones","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003119","EAP","Custom 27003119","","Pouch, Active Life","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003120","EAP","Custom 27003120","","Flange, Sur-fit","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003121","EAP","Custom 27003121","","Pouch Drainable Opaque","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003124","EAP","Custom 27003124","","Barrier With Convexity","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003127","EAP","Custom 27003127","","High Flow Continuous","BOTH IP/OP","$406.00 ","$300.44 ","$0.00 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$289.76 ","$289.76 ","$0.00 ","$406.00 ","$0.00 ","$203.00 ","$321.55 ","$324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003128","EAP","Custom 27003128","","Low Flow Continous","BOTH IP/OP","$406.00 ","$300.44 ","$0.00 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$289.76 ","$289.76 ","$0.00 ","$406.00 ","$0.00 ","$203.00 ","$321.55 ","$324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003130","EAP","Custom 27003130","","Mdi Spacer Supply","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$0.00 ","$0.00 ","$0.00 ","$139.17 ","$139.17 ","$0.00 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003131","EAP","Custom 27003131","","Occult Blood Supply","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003132","EAP","Custom 27003132","","Wrist Brace","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003134","EAP","HCPCS J2798","","Mirena (iud) Kit","BOTH IP/OP","$994.00 ","$735.56 ","$0.00 ","$994.00 ","$0.00 ","$0.00 ","$207.17 ","$709.42 ","$709.42 ","$0.00 ","$994.00 ","$0.00 ","$497.00 ","$787.25 ","$795.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27003153","EAP","Custom 27003153","","Nuva Ring Fp","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27004266","EAP","Custom 27004266","","13.5mm/3.2mm Wire Guide","BOTH IP/OP","$1,747.00 ","$1,292.78 ","$0.00 ","$1,747.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.83 ","$1,246.83 ","$0.00 ","$1,747.00 ","$0.00 ","$873.50 ","$1,383.62 ","$1,397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27004311","EAP","Custom 27004311","","Long Forceps 230mm","BOTH IP/OP","$2,779.00 ","$2,056.46 ","$0.00 ","$2,779.00 ","$0.00 ","$0.00 ","$0.00 ","$1,983.37 ","$1,983.37 ","$0.00 ","$2,779.00 ","$0.00 ","$1,389.50 ","$2,200.97 ","$2,223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27004327","EAP","Custom 27004327","","Medium Wire Cutter 160mm","BOTH IP/OP","$4,148.00 ","$3,069.52 ","$0.00 ","$4,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,960.43 ","$2,960.43 ","$0.00 ","$4,148.00 ","$0.00 ","$2,074.00 ","$3,285.22 ","$3,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27004640","EAP","Custom 27004640","","Large Anchoring Hook 30mm","BOTH IP/OP","$509.00 ","$376.66 ","$0.00 ","$509.00 ","$0.00 ","$0.00 ","$0.00 ","$363.27 ","$363.27 ","$0.00 ","$509.00 ","$0.00 ","$254.50 ","$403.13 ","$407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007212","EAP","Custom 27007212","","10.0mm Circular Saw 28mm","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007213","EAP","Custom 27007213","","12.0mm Circular Saw 28mm","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007214","EAP","Custom 27007214","","15.0mm Circular Saw 28mm","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007219","EAP","Custom 27007219","","Tibial Nail Driving Adaptor","BOTH IP/OP","$4,208.00 ","$3,113.92 ","$0.00 ","$4,208.00 ","$0.00 ","$0.00 ","$0.00 ","$3,003.25 ","$3,003.25 ","$0.00 ","$4,208.00 ","$0.00 ","$2,104.00 ","$3,332.74 ","$3,366.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007220","EAP","Custom 27007220","","Saw Blade 27mm Width 50mm/0.6m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007221","EAP","Custom 27007221","","Saw Blade 10mm Width 25mm/0.6m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007222","EAP","Custom 27007222","","Saw Blade 10mm Width 50mm/0.6m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007223","EAP","Custom 27007223","","Saw Blade 20mm Width 50mm/0.6m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007224","EAP","Custom 27007224","","Saw Blade 19mm Width 70mm/1.0m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007225","EAP","Custom 27007225","","Saw Blade 19mm Width 95mm/0.9m","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007226","EAP","Custom 27007226","","Saw Blade 25mm Width 95mm/0.9","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007227","EAP","Custom 27007227","","Saw Blade 25mm Width 60mm/0.9","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007228","EAP","Custom 27007228","","Saw Blade 18mm Width 70mm/1.2","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007229","EAP","Custom 27007229","","Saw Blade 19mm Width 95mm/1.25","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007230","EAP","Custom 27007230","","Saw Blade 25mm Width 95mm/1.25","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007231","EAP","Custom 27007231","","Saw Blade 19mm Width 95mm/1.4","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007232","EAP","Custom 27007232","","Saw Blade 25mm Width 95mm/1.4","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007233","EAP","Custom 27007233","","Saw Blade 12.5mm Wdth 90mm/0.9","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007234","EAP","Custom 27007234","","Saw Blade 14mm Width 50mm/0.6","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007235","EAP","Custom 27007235","","Saw Blade 27mm Width 70mm/0.8","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007236","EAP","Custom 27007236","","Saw Blade 50mm Width 70mm/0.8","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007237","EAP","Custom 27007237","","Saw Blade 27mm Width 70mm/1.0","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007238","EAP","Custom 27007238","","Saw Blade 27mm Width 70mm/1.2","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007239","EAP","Custom 27007239","","Saw Blade 6mm Width 25mm/0.6m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007240","EAP","Custom 27007240","","Saw Blade 14mm Width 25mm/0.6m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007241","EAP","Custom 27007241","","Saw Blade 6mm Width 10mm/0.4mm","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007242","EAP","Custom 27007242","","Saw Blade 6mm Width 10mm/0.4mm","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007243","EAP","Custom 27007243","","Saw Blade 10mm Width 10mm/0.4m","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007244","EAP","Custom 27007244","","Saw Blade 10mm Width 10mm/0.4m","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007245","EAP","Custom 27007245","","Saw Blade 16mm Width 10mm/0.4m","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007246","EAP","Custom 27007246","","Saw Blade 16mm Width 10mm/0.4m","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007247","EAP","Custom 27007247","","Saw Blade 4mm Width 15mm/0.4mm","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007248","EAP","Custom 27007248","","Saw Blade 4mm Width 15mm/0.4m","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007249","EAP","Custom 27007249","","Saw Blade 8mm Width 20mm/0.4mm","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007250","EAP","Custom 27007250","","Saw Blade 8mm Width 20mm/0.4","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007251","EAP","Custom 27007251","","Saw Blade 12mm Width 20mm/0.4","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007252","EAP","Custom 27007252","","Saw Blade 12mm Width 20mm/0.4","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007253","EAP","Custom 27007253","","Saw Blade 6mm Width 30mm/0.4","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007254","EAP","Custom 27007254","","Saw Blade 6mm Width 30mm/0.4","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007255","EAP","Custom 27007255","","Saw Blade 10mm Width 30mm/0.4","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007256","EAP","Custom 27007256","","Saw Blade 10mm Width 30mm/0.4","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007257","EAP","Custom 27007257","","Saw Blade 6mm Width 25mm/0.6","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007258","EAP","Custom 27007258","","Saw Blade 6mm Width 25mm/0.6","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007259","EAP","Custom 27007259","","Saw Blade 10mm Width 25mm/0.6","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007260","EAP","Custom 27007260","","Saw Blade 10mm Width 25mm/0.6","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007261","EAP","Custom 27007261","","Saw Blade 14mm Width 25mm/0.6","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007262","EAP","Custom 27007262","","Saw Blade 14mm Width 25mm/0.6","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007263","EAP","Custom 27007263","","Saw Blade 10mm Width 50mm/0.6","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007264","EAP","Custom 27007264","","Saw Bld 10 Wdth 50/0.6cut Thk","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007265","EAP","Custom 27007265","","Saw Bld 14 Wdth 50/0.6cut Thk","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007266","EAP","Custom 27007266","","Saw Bld 14 Wdth 50/0.6 Cut Thk","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007267","EAP","Custom 27007267","","Saw Bld 20 Wdth 50/0.6 Cut Thk","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007268","EAP","Custom 27007268","","Saw Bld 20 Wdth 50/0.6 Cut Thk","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007269","EAP","Custom 27007269","","Saw Bld 27 Wdth 50/0.6 Cut Thk","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007270","EAP","Custom 27007270","","Saw Bld 27 Wdth 50/0.6 Cut Thk","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007451","EAP","Custom 27007451","","Peg Fully Thread 2.5mm, 24mm","BOTH IP/OP","$398.00 ","$294.52 ","$0.00 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$284.05 ","$284.05 ","$0.00 ","$398.00 ","$0.00 ","$199.00 ","$315.22 ","$318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007489","EAP","Custom 27007489","","Mini-clip Str 3mm","BOTH IP/OP","$1,693.00 ","$1,252.82 ","$0.00 ","$1,693.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.29 ","$1,208.29 ","$0.00 ","$1,693.00 ","$0.00 ","$846.50 ","$1,340.86 ","$1,354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007557","EAP","Custom 27007557","","Screwdriver Blade","BOTH IP/OP","$1,268.00 ","$938.32 ","$0.00 ","$1,268.00 ","$0.00 ","$0.00 ","$0.00 ","$904.97 ","$904.97 ","$0.00 ","$1,268.00 ","$0.00 ","$634.00 ","$1,004.26 ","$1,014.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007632","EAP","Custom 27007632","","Rotary Mixer","BOTH IP/OP","$8,539.00 ","$6,318.86 ","$0.00 ","$8,539.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,539.00 ","$0.00 ","$4,269.50 ","$6,762.89 ","$6,831.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007633","EAP","Custom 27007633","","Srs? Fast Set Putty 3cc Steril","BOTH IP/OP","$3,760.00 ","$2,782.40 ","$0.00 ","$3,760.00 ","$0.00 ","$0.00 ","$0.00 ","$2,683.51 ","$2,683.51 ","$0.00 ","$3,760.00 ","$0.00 ","$1,880.00 ","$2,977.92 ","$3,008.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007634","EAP","Custom 27007634","","Nor? Srs? Bne Void Fill Ro 3cc","BOTH IP/OP","$3,852.00 ","$2,850.48 ","$0.00 ","$3,852.00 ","$0.00 ","$0.00 ","$0.00 ","$2,749.17 ","$2,749.17 ","$0.00 ","$3,852.00 ","$0.00 ","$1,926.00 ","$3,050.78 ","$3,081.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007635","EAP","Custom 27007635","","Srs? Fast Set Putty 5cc Steril","BOTH IP/OP","$6,218.00 ","$4,601.32 ","$0.00 ","$6,218.00 ","$0.00 ","$0.00 ","$0.00 ","$4,437.79 ","$4,437.79 ","$0.00 ","$6,218.00 ","$0.00 ","$3,109.00 ","$4,924.66 ","$4,974.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007636","EAP","Custom 27007636","","Nor? Srs? Bne Void Fill Ro 5cc","BOTH IP/OP","$6,310.00 ","$4,669.40 ","$0.00 ","$6,310.00 ","$0.00 ","$0.00 ","$0.00 ","$4,503.45 ","$4,503.45 ","$0.00 ","$6,310.00 ","$0.00 ","$3,155.00 ","$4,997.52 ","$5,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007637","EAP","Custom 27007637","","Srs? Fast Set Putty 10cc Steri","BOTH IP/OP","$12,321.00 ","$9,117.54 ","$0.00 ","$12,321.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,321.00 ","$0.00 ","$6,160.50 ","$9,758.23 ","$9,856.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007638","EAP","Custom 27007638","","Nor? Srs? Bne Vd Fill Ro Mx 10","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007639","EAP","Custom 27007639","","Srs? Fast Set Putty 15cc Ster","BOTH IP/OP","$18,167.00 ","$13,443.58 ","$0.00 ","$18,167.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,167.00 ","$0.00 ","$9,083.50 ","$14,388.26 ","$14,533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007640","EAP","Custom 27007640","","Pressure Measurement","BOTH IP/OP","$904.00 ","$668.96 ","$0.00 ","$904.00 ","$0.00 ","$0.00 ","$0.00 ","$645.18 ","$645.18 ","$0.00 ","$904.00 ","$0.00 ","$452.00 ","$715.97 ","$723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007719","EAP","Custom 27007719","","Univ Lock Troch Stab Pl 131mm","BOTH IP/OP","$2,620.00 ","$1,938.80 ","$0.00 ","$2,620.00 ","$0.00 ","$0.00 ","$0.00 ","$1,869.89 ","$1,869.89 ","$0.00 ","$2,620.00 ","$0.00 ","$1,310.00 ","$2,075.04 ","$2,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007749","EAP","Custom 27007749","","T15/2.5m Hex Cerclage But- Ste","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007795","EAP","Custom 27007795","","Swans Bur S?2.0m Hd Lgh 6.3mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007796","EAP","Custom 27007796","","Swans Bur M?2.0m Hd Lgh 6.3mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007797","EAP","Custom 27007797","","Swans Bur L?2.0m Hd Lgh 6.3mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007798","EAP","Custom 27007798","","Swans Bur S?3.0m Hd Lgh 9.7mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007799","EAP","Custom 27007799","","Swans Bur M?3.0m Hd Lgh 9.7mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007800","EAP","Custom 27007800","","Swans Bur L?3.0m Hd Lgh 9.7mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007801","EAP","Custom 27007801","","Swans Bur S?4.0m Hd Lgh 12.7mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007802","EAP","Custom 27007802","","Swans Bur M?4.0m Hd Lgh 12.7mm","BOTH IP/OP","$148.00 ","$109.52 ","$0.00 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$105.63 ","$105.63 ","$0.00 ","$148.00 ","$0.00 ","$74.00 ","$117.22 ","$118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007803","EAP","Custom 27007803","","Swans Bur L?4.0m Hd Lgh 12.7mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007810","EAP","Custom 27007810","","Swans Bur S?5.0m Hd Lgh 15.8mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007811","EAP","Custom 27007811","","Swans Bur M?5.0m Hd Lgh 15.8mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007812","EAP","Custom 27007812","","Swans Bur L?5.0m Hd Lgh 15.8mm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007840","EAP","Custom 27007840","","Lindeman Rmer Lgh 45m ?2.3m","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007853","EAP","Custom 27007853","","Saw Blade  F/sagittal Saw","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007854","EAP","Custom 27007854","","Saw Blde Cresc F/oscillat Saw","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$261.21 ","$261.21 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007864","EAP","Custom 27007864","","Tibial Nail-ex Insertion Handl","BOTH IP/OP","$5,201.00 ","$3,848.74 ","$0.00 ","$5,201.00 ","$0.00 ","$0.00 ","$0.00 ","$3,711.95 ","$3,711.95 ","$0.00 ","$5,201.00 ","$0.00 ","$2,600.50 ","$4,119.19 ","$4,160.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007865","EAP","Custom 27007865","","Rad Ruler Ti Cannul Fem Nails","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007866","EAP","Custom 27007866","","Rad Ruler Ti Cannul Tib Nails","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007867","EAP","Custom 27007867","","Rad Ruler Ti Cannul Hum Nails","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007868","EAP","Custom 27007868","","Rad Canal Wdth Estimat Im Nail","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007869","EAP","Custom 27007869","","Hold Devic Gde Wire & Ream Rod","BOTH IP/OP","$3,375.00 ","$2,497.50 ","$0.00 ","$3,375.00 ","$0.00 ","$0.00 ","$0.00 ","$2,408.74 ","$2,408.74 ","$0.00 ","$3,375.00 ","$0.00 ","$1,687.50 ","$2,673.00 ","$2,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007871","EAP","Custom 27007871","","15.0 Cannul Drl Bit Lg Qc/280m","BOTH IP/OP","$1,969.00 ","$1,457.06 ","$0.00 ","$1,969.00 ","$0.00 ","$0.00 ","$0.00 ","$1,405.28 ","$1,405.28 ","$0.00 ","$1,969.00 ","$0.00 ","$984.50 ","$1,559.45 ","$1,575.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007872","EAP","Custom 27007872","","17.0m Cannul Drl Bit Lg Qc/280","BOTH IP/OP","$2,461.00 ","$1,821.14 ","$0.00 ","$2,461.00 ","$0.00 ","$0.00 ","$0.00 ","$1,756.42 ","$1,756.42 ","$0.00 ","$2,461.00 ","$0.00 ","$1,230.50 ","$1,949.11 ","$1,968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007873","EAP","Custom 27007873","","13.0mm Protection Sleeve","BOTH IP/OP","$1,490.00 ","$1,102.60 ","$0.00 ","$1,490.00 ","$0.00 ","$0.00 ","$0.00 ","$1,063.41 ","$1,063.41 ","$0.00 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007874","EAP","Custom 27007874","","13.0/3.2 Wire Gude W/ Troc Tip","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$0.00 ","$0.00 ","$0.00 ","$421.80 ","$421.80 ","$0.00 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007875","EAP","Custom 27007875","","13 Flex Can Drl Bit Lg Qc/465","BOTH IP/OP","$2,762.00 ","$2,043.88 ","$0.00 ","$2,762.00 ","$0.00 ","$0.00 ","$0.00 ","$1,971.24 ","$1,971.24 ","$0.00 ","$2,762.00 ","$0.00 ","$1,381.00 ","$2,187.50 ","$2,209.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007876","EAP","Custom 27007876","","13 Flex Can Drl Bit Lg Qc/465","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$0.00 ","$0.00 ","$0.00 ","$2,063.31 ","$2,063.31 ","$0.00 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007877","EAP","Custom 27007877","","12.0mm Protection Sleeve","BOTH IP/OP","$1,490.00 ","$1,102.60 ","$0.00 ","$1,490.00 ","$0.00 ","$0.00 ","$0.00 ","$1,063.41 ","$1,063.41 ","$0.00 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007878","EAP","Custom 27007878","","12.0 Cannul Drl Bit Lg Qc/190","BOTH IP/OP","$2,211.00 ","$1,636.14 ","$0.00 ","$2,211.00 ","$0.00 ","$0.00 ","$0.00 ","$1,577.99 ","$1,577.99 ","$0.00 ","$2,211.00 ","$0.00 ","$1,105.50 ","$1,751.11 ","$1,768.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007879","EAP","Custom 27007879","","10.0mm Protection Sleeve","BOTH IP/OP","$1,490.00 ","$1,102.60 ","$0.00 ","$1,490.00 ","$0.00 ","$0.00 ","$0.00 ","$1,063.41 ","$1,063.41 ","$0.00 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007880","EAP","Custom 27007880","","10.0mm Cannulated Awl","BOTH IP/OP","$1,747.00 ","$1,292.78 ","$0.00 ","$1,747.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.83 ","$1,246.83 ","$0.00 ","$1,747.00 ","$0.00 ","$873.50 ","$1,383.62 ","$1,397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007881","EAP","Custom 27007881","","12.0mm Cannulated Awl","BOTH IP/OP","$1,778.00 ","$1,315.72 ","$0.00 ","$1,778.00 ","$0.00 ","$0.00 ","$0.00 ","$1,268.96 ","$1,268.96 ","$0.00 ","$1,778.00 ","$0.00 ","$889.00 ","$1,408.18 ","$1,422.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007882","EAP","Custom 27007882","","14.0mm Cannulated Awl","BOTH IP/OP","$1,855.00 ","$1,372.70 ","$0.00 ","$1,855.00 ","$0.00 ","$0.00 ","$0.00 ","$1,323.91 ","$1,323.91 ","$0.00 ","$1,855.00 ","$0.00 ","$927.50 ","$1,469.16 ","$1,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007884","EAP","Custom 27007884","","Standard Insertion Handle","BOTH IP/OP","$5,201.00 ","$3,848.74 ","$0.00 ","$5,201.00 ","$0.00 ","$0.00 ","$0.00 ","$3,711.95 ","$3,711.95 ","$0.00 ","$5,201.00 ","$0.00 ","$2,600.50 ","$4,119.19 ","$4,160.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007885","EAP","Custom 27007885","","Percutaneous Insertion Handle","BOTH IP/OP","$5,201.00 ","$3,848.74 ","$0.00 ","$5,201.00 ","$0.00 ","$0.00 ","$0.00 ","$3,711.95 ","$3,711.95 ","$0.00 ","$5,201.00 ","$0.00 ","$2,600.50 ","$4,119.19 ","$4,160.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007887","EAP","Custom 27007887","","Rec Loc Aim Arm Lat Ent Fem Nl","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.47 ","$2,905.47 ","$0.00 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007893","EAP","Custom 27007893","","Insert Hdle Ti Cann Hum Nls-ex","BOTH IP/OP","$4,522.00 ","$3,346.28 ","$0.00 ","$4,522.00 ","$0.00 ","$0.00 ","$0.00 ","$3,227.35 ","$3,227.35 ","$0.00 ","$4,522.00 ","$0.00 ","$2,261.00 ","$3,581.42 ","$3,617.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007894","EAP","Custom 27007894","","Sprl Blde Aim Arm Ti Can Hum N","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.47 ","$2,905.47 ","$0.00 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007900","EAP","Custom 27007900","","12.0mm/8.0mm Protectn Slve 188","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$662.31 ","$662.31 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007904","EAP","Custom 27007904","","11.5/8.5 Protectn Slve Rec Lck","BOTH IP/OP","$635.00 ","$469.90 ","$0.00 ","$635.00 ","$0.00 ","$0.00 ","$0.00 ","$453.20 ","$453.20 ","$0.00 ","$635.00 ","$0.00 ","$317.50 ","$502.92 ","$508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007909","EAP","Custom 27007909","","Tap For 6.5mm Recon Screws","BOTH IP/OP","$1,997.00 ","$1,477.78 ","$0.00 ","$1,997.00 ","$0.00 ","$0.00 ","$0.00 ","$1,425.26 ","$1,425.26 ","$0.00 ","$1,997.00 ","$0.00 ","$998.50 ","$1,581.62 ","$1,597.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007910","EAP","Custom 27007910","","15.0/13.0 Pro Slve F/spir Bld","BOTH IP/OP","$1,616.00 ","$1,195.84 ","$0.00 ","$1,616.00 ","$0.00 ","$0.00 ","$0.00 ","$1,153.34 ","$1,153.34 ","$0.00 ","$1,616.00 ","$0.00 ","$808.00 ","$1,279.87 ","$1,292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007911","EAP","Custom 27007911","","13.0/3.2 Wre Gde Spir Blde Aim","BOTH IP/OP","$1,222.00 ","$904.28 ","$0.00 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$872.14 ","$872.14 ","$0.00 ","$1,222.00 ","$0.00 ","$611.00 ","$967.82 ","$977.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007912","EAP","Custom 27007912","","Spir Blde Insert Retrgrde Fem","BOTH IP/OP","$3,061.00 ","$2,265.14 ","$0.00 ","$3,061.00 ","$0.00 ","$0.00 ","$0.00 ","$2,184.64 ","$2,184.64 ","$0.00 ","$3,061.00 ","$0.00 ","$1,530.50 ","$2,424.31 ","$2,448.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007913","EAP","Custom 27007913","","Speclty Lck Meas Dev Ti Fem Nl","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$616.00 ","$0.00 ","$0.00 ","$0.00 ","$439.64 ","$439.64 ","$0.00 ","$616.00 ","$0.00 ","$308.00 ","$487.87 ","$492.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007914","EAP","Custom 27007914","","14.0mm/8.0mm Drill Sleeve 130m","BOTH IP/OP","$679.00 ","$502.46 ","$0.00 ","$679.00 ","$0.00 ","$0.00 ","$0.00 ","$484.60 ","$484.60 ","$0.00 ","$679.00 ","$0.00 ","$339.50 ","$537.77 ","$543.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007919","EAP","Custom 27007919","","Spir Bld Mea Dev Ti Can Hum Nl","BOTH IP/OP","$2,296.00 ","$1,699.04 ","$0.00 ","$2,296.00 ","$0.00 ","$0.00 ","$0.00 ","$1,638.66 ","$1,638.66 ","$0.00 ","$2,296.00 ","$0.00 ","$1,148.00 ","$1,818.43 ","$1,836.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007920","EAP","Custom 27007920","","Stan Aim Arm Ti Can Hum Nls-ex","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.47 ","$2,905.47 ","$0.00 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007921","EAP","Custom 27007921","","Ream Rod Push Rod Wth Ball Hdl","BOTH IP/OP","$1,484.00 ","$1,098.16 ","$0.00 ","$1,484.00 ","$0.00 ","$0.00 ","$0.00 ","$1,059.13 ","$1,059.13 ","$0.00 ","$1,484.00 ","$0.00 ","$742.00 ","$1,175.33 ","$1,187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007932","EAP","Custom 27007932","","Hold Slve W/ Lcking Device","BOTH IP/OP","$3,354.00 ","$2,481.96 ","$0.00 ","$3,354.00 ","$0.00 ","$0.00 ","$0.00 ","$2,393.75 ","$2,393.75 ","$0.00 ","$3,354.00 ","$0.00 ","$1,677.00 ","$2,656.37 ","$2,683.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007935","EAP","Custom 27007935","","Lrg Hexa Scwdrvr 3.5 Wdth Acrs","BOTH IP/OP","$1,199.00 ","$887.26 ","$0.00 ","$1,199.00 ","$0.00 ","$0.00 ","$0.00 ","$855.73 ","$855.73 ","$0.00 ","$1,199.00 ","$0.00 ","$599.50 ","$949.61 ","$959.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007937","EAP","Custom 27007937","","Shrt Compres Dev Ti Can Tib Nl","BOTH IP/OP","$1,799.00 ","$1,331.26 ","$0.00 ","$1,799.00 ","$0.00 ","$0.00 ","$0.00 ","$1,283.95 ","$1,283.95 ","$0.00 ","$1,799.00 ","$0.00 ","$899.50 ","$1,424.81 ","$1,439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007938","EAP","Custom 27007938","","Lng Compres Dev Ti Can Tib Nl","BOTH IP/OP","$1,799.00 ","$1,331.26 ","$0.00 ","$1,799.00 ","$0.00 ","$0.00 ","$0.00 ","$1,283.95 ","$1,283.95 ","$0.00 ","$1,799.00 ","$0.00 ","$899.50 ","$1,424.81 ","$1,439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007941","EAP","Custom 27007941","","15.0can Flex Dl Bit Lrg Qc/310","BOTH IP/OP","$2,711.00 ","$2,006.14 ","$0.00 ","$2,711.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.84 ","$1,934.84 ","$0.00 ","$2,711.00 ","$0.00 ","$1,355.50 ","$2,147.11 ","$2,168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007942","EAP","Custom 27007942","","17 Can Flex Drl Bit Lrg Qc/310","BOTH IP/OP","$2,711.00 ","$2,006.14 ","$0.00 ","$2,711.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.84 ","$1,934.84 ","$0.00 ","$2,711.00 ","$0.00 ","$1,355.50 ","$2,147.11 ","$2,168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007943","EAP","Custom 27007943","","11/8 Pro Slve 188mm For Asls","BOTH IP/OP","$889.00 ","$657.86 ","$0.00 ","$889.00 ","$0.00 ","$0.00 ","$0.00 ","$634.48 ","$634.48 ","$0.00 ","$889.00 ","$0.00 ","$444.50 ","$704.09 ","$711.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007945","EAP","Custom 27007945","","Insert Hndl F/4.5 Lcp Prox Tib","BOTH IP/OP","$5,623.00 ","$4,161.02 ","$0.00 ","$5,623.00 ","$0.00 ","$0.00 ","$0.00 ","$4,013.14 ","$4,013.14 ","$0.00 ","$5,623.00 ","$0.00 ","$2,811.50 ","$4,453.42 ","$4,498.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007947","EAP","Custom 27007947","","Strt Ball Spike Low Pro Pelvic","BOTH IP/OP","$1,511.00 ","$1,118.14 ","$0.00 ","$1,511.00 ","$0.00 ","$0.00 ","$0.00 ","$1,078.40 ","$1,078.40 ","$0.00 ","$1,511.00 ","$0.00 ","$755.50 ","$1,196.71 ","$1,208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007948","EAP","Custom 27007948","","Strt Ball Spike Low Pro Pelvic","BOTH IP/OP","$1,608.00 ","$1,189.92 ","$0.00 ","$1,608.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.63 ","$1,147.63 ","$0.00 ","$1,608.00 ","$0.00 ","$804.00 ","$1,273.54 ","$1,286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007949","EAP","Custom 27007949","","Strt Reduc Forceps Low Pro Pel","BOTH IP/OP","$6,337.00 ","$4,689.38 ","$0.00 ","$6,337.00 ","$0.00 ","$0.00 ","$0.00 ","$4,522.72 ","$4,522.72 ","$0.00 ","$6,337.00 ","$0.00 ","$3,168.50 ","$5,018.90 ","$5,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007952","EAP","Custom 27007952","","Reduct Forceps For Low Pro Pel","BOTH IP/OP","$8,489.00 ","$6,281.86 ","$0.00 ","$8,489.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,489.00 ","$0.00 ","$4,244.50 ","$6,723.29 ","$6,791.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007954","EAP","Custom 27007954","","Lo Pro Pel Sys Rd Frcp 3.5 Scw","BOTH IP/OP","$7,620.00 ","$5,638.80 ","$0.00 ","$7,620.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,620.00 ","$0.00 ","$3,810.00 ","$6,035.04 ","$6,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007955","EAP","Custom 27007955","","Round Disk","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007956","EAP","Custom 27007956","","Rectangular Disk","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007966","EAP","Custom 27007966","","Instn Hndl F/4.5 Lcp Prox Tib","BOTH IP/OP","$5,623.00 ","$4,161.02 ","$0.00 ","$5,623.00 ","$0.00 ","$0.00 ","$0.00 ","$4,013.14 ","$4,013.14 ","$0.00 ","$5,623.00 ","$0.00 ","$2,811.50 ","$4,453.42 ","$4,498.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007967","EAP","Custom 27007967","","Solid 4.0 Hex Scwdrvr Shft 200","BOTH IP/OP","$1,131.00 ","$836.94 ","$0.00 ","$1,131.00 ","$0.00 ","$0.00 ","$0.00 ","$807.19 ","$807.19 ","$0.00 ","$1,131.00 ","$0.00 ","$565.50 ","$895.75 ","$904.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007969","EAP","Custom 27007969","","Spiked Round Disk","BOTH IP/OP","$1,247.00 ","$922.78 ","$0.00 ","$1,247.00 ","$0.00 ","$0.00 ","$0.00 ","$889.98 ","$889.98 ","$0.00 ","$1,247.00 ","$0.00 ","$623.50 ","$987.62 ","$997.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007970","EAP","Custom 27007970","","Spiked Rectangular Disk","BOTH IP/OP","$1,247.00 ","$922.78 ","$0.00 ","$1,247.00 ","$0.00 ","$0.00 ","$0.00 ","$889.98 ","$889.98 ","$0.00 ","$1,247.00 ","$0.00 ","$623.50 ","$987.62 ","$997.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007974","EAP","Custom 27007974","","Ped Lcp Hip Pl Gdng Blk 3.5scw","BOTH IP/OP","$1,986.00 ","$1,469.64 ","$0.00 ","$1,986.00 ","$0.00 ","$0.00 ","$0.00 ","$1,417.41 ","$1,417.41 ","$0.00 ","$1,986.00 ","$0.00 ","$993.00 ","$1,572.91 ","$1,588.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007975","EAP","Custom 27007975","","Ped Lcp Hip Pl Gdng Blck 5scw","BOTH IP/OP","$1,986.00 ","$1,469.64 ","$0.00 ","$1,986.00 ","$0.00 ","$0.00 ","$0.00 ","$1,417.41 ","$1,417.41 ","$0.00 ","$1,986.00 ","$0.00 ","$993.00 ","$1,572.91 ","$1,588.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007977","EAP","Custom 27007977","","Reduction Sleeve 4.3mm/2.8mm","BOTH IP/OP","$647.00 ","$478.78 ","$0.00 ","$647.00 ","$0.00 ","$0.00 ","$0.00 ","$461.76 ","$461.76 ","$0.00 ","$647.00 ","$0.00 ","$323.50 ","$512.42 ","$517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007979","EAP","Custom 27007979","","Positioning Device Gdng Blck","BOTH IP/OP","$1,727.00 ","$1,277.98 ","$0.00 ","$1,727.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.56 ","$1,232.56 ","$0.00 ","$1,727.00 ","$0.00 ","$863.50 ","$1,367.78 ","$1,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007980","EAP","Custom 27007980","","Medialization Gde 3.5&5.0 Lcp","BOTH IP/OP","$1,727.00 ","$1,277.98 ","$0.00 ","$1,727.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.56 ","$1,232.56 ","$0.00 ","$1,727.00 ","$0.00 ","$863.50 ","$1,367.78 ","$1,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007981","EAP","Custom 27007981","","Osteotomy Measuring Device","BOTH IP/OP","$1,061.00 ","$785.14 ","$0.00 ","$1,061.00 ","$0.00 ","$0.00 ","$0.00 ","$757.24 ","$757.24 ","$0.00 ","$1,061.00 ","$0.00 ","$530.50 ","$840.31 ","$848.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007984","EAP","Custom 27007984","","Meas Dev 3.0 Hdles Compres Scw","BOTH IP/OP","$722.00 ","$534.28 ","$0.00 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$515.29 ","$515.29 ","$0.00 ","$722.00 ","$0.00 ","$361.00 ","$571.82 ","$577.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007990","EAP","Custom 27007990","","Meas Dev F/drl Gde W/stp 3.0m","BOTH IP/OP","$642.00 ","$475.08 ","$0.00 ","$642.00 ","$0.00 ","$0.00 ","$0.00 ","$458.20 ","$458.20 ","$0.00 ","$642.00 ","$0.00 ","$321.00 ","$508.46 ","$513.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007991","EAP","Custom 27007991","","Medium Open Compressor","BOTH IP/OP","$4,431.00 ","$3,278.94 ","$0.00 ","$4,431.00 ","$0.00 ","$0.00 ","$0.00 ","$3,162.40 ","$3,162.40 ","$0.00 ","$4,431.00 ","$0.00 ","$2,215.50 ","$3,509.35 ","$3,544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007992","EAP","Custom 27007992","","Lo-pro Wrst Fxtr/schan Scr/200","BOTH IP/OP","$4,535.00 ","$3,355.90 ","$0.00 ","$4,535.00 ","$0.00 ","$0.00 ","$0.00 ","$3,236.63 ","$3,236.63 ","$0.00 ","$4,535.00 ","$0.00 ","$2,267.50 ","$3,591.72 ","$3,628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007993","EAP","Custom 27007993","","Lo-pro Wrst Fxtr/schan Scr/220","BOTH IP/OP","$4,535.00 ","$3,355.90 ","$0.00 ","$4,535.00 ","$0.00 ","$0.00 ","$0.00 ","$3,236.63 ","$3,236.63 ","$0.00 ","$4,535.00 ","$0.00 ","$2,267.50 ","$3,591.72 ","$3,628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007994","EAP","Custom 27007994","","Low-pro Wrst Fxtr/slf-drlg/200","BOTH IP/OP","$5,757.00 ","$4,260.18 ","$0.00 ","$5,757.00 ","$0.00 ","$0.00 ","$0.00 ","$4,108.77 ","$4,108.77 ","$0.00 ","$5,757.00 ","$0.00 ","$2,878.50 ","$4,559.54 ","$4,605.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007995","EAP","Custom 27007995","","Low-pro Wrst Fxtr/slf-drlg/220","BOTH IP/OP","$5,757.00 ","$4,260.18 ","$0.00 ","$5,757.00 ","$0.00 ","$0.00 ","$0.00 ","$4,108.77 ","$4,108.77 ","$0.00 ","$5,757.00 ","$0.00 ","$2,878.50 ","$4,559.54 ","$4,605.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007996","EAP","Custom 27007996","","Tensioner","BOTH IP/OP","$16,191.00 ","$11,981.34 ","$0.00 ","$16,191.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$16,191.00 ","$0.00 ","$8,095.50 ","$12,823.27 ","$12,952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007997","EAP","Custom 27007997","","Slotted Socket Wrench 11mm","BOTH IP/OP","$2,314.00 ","$1,712.36 ","$0.00 ","$2,314.00 ","$0.00 ","$0.00 ","$0.00 ","$1,651.50 ","$1,651.50 ","$0.00 ","$2,314.00 ","$0.00 ","$1,157.00 ","$1,832.69 ","$1,851.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007998","EAP","Custom 27007998","","Patient Wrench 8mm/11mm","BOTH IP/OP","$604.00 ","$446.96 ","$0.00 ","$604.00 ","$0.00 ","$0.00 ","$0.00 ","$431.07 ","$431.07 ","$0.00 ","$604.00 ","$0.00 ","$302.00 ","$478.37 ","$483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27007999","EAP","Custom 27007999","","Ratchet Wrench 11mm","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$0.00 ","$0.00 ","$0.00 ","$2,063.31 ","$2,063.31 ","$0.00 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008000","EAP","Custom 27008000","","Split Tissue Protect Slve 2.5m","BOTH IP/OP","$2,314.00 ","$1,712.36 ","$0.00 ","$2,314.00 ","$0.00 ","$0.00 ","$0.00 ","$1,651.50 ","$1,651.50 ","$0.00 ","$2,314.00 ","$0.00 ","$1,157.00 ","$1,832.69 ","$1,851.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008001","EAP","Custom 27008001","","Split Tissue Protect Slve 5mm","BOTH IP/OP","$2,314.00 ","$1,712.36 ","$0.00 ","$2,314.00 ","$0.00 ","$0.00 ","$0.00 ","$1,651.50 ","$1,651.50 ","$0.00 ","$2,314.00 ","$0.00 ","$1,157.00 ","$1,832.69 ","$1,851.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008004","EAP","Custom 27008004","","Schanz Screw Bolt Mr Safe","BOTH IP/OP","$906.00 ","$670.44 ","$0.00 ","$906.00 ","$0.00 ","$0.00 ","$0.00 ","$646.61 ","$646.61 ","$0.00 ","$906.00 ","$0.00 ","$453.00 ","$717.55 ","$724.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008005","EAP","Custom 27008005","","Pivot Schanz Screw Clamp Mr Sa","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$0.00 ","$0.00 ","$0.00 ","$1,306.07 ","$1,306.07 ","$0.00 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008006","EAP","Custom 27008006","","Locking Hinge Mr Safe","BOTH IP/OP","$906.00 ","$670.44 ","$0.00 ","$906.00 ","$0.00 ","$0.00 ","$0.00 ","$646.61 ","$646.61 ","$0.00 ","$906.00 ","$0.00 ","$453.00 ","$717.55 ","$724.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008007","EAP","Custom 27008007","","Schanz Screw Bolt Post Mount M","BOTH IP/OP","$1,045.00 ","$773.30 ","$0.00 ","$1,045.00 ","$0.00 ","$0.00 ","$0.00 ","$745.82 ","$745.82 ","$0.00 ","$1,045.00 ","$0.00 ","$522.50 ","$827.64 ","$836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008008","EAP","Custom 27008008","","Smth Wire/1.5mm Diameter 400m","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$219.82 ","$219.82 ","$0.00 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008009","EAP","Custom 27008009","","Smth Wire/1.8mm Diameter 400m","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$219.82 ","$219.82 ","$0.00 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008010","EAP","Custom 27008010","","Smth Wire/2.0mm Diameter 400m","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$219.82 ","$219.82 ","$0.00 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008011","EAP","Custom 27008011","","Smth Wire 1.5m Dia Hlf Pnt Tip","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$219.82 ","$219.82 ","$0.00 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008012","EAP","Custom 27008012","","Smth Wire 1.8m Dia Hlf Pnt Tip","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$219.82 ","$219.82 ","$0.00 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008013","EAP","Custom 27008013","","Smth Wire 2.0m Dia Hlf Pnt Tip","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$219.82 ","$219.82 ","$0.00 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008014","EAP","Custom 27008014","","Reductn Wre/1.5mm Diam 400m","BOTH IP/OP","$962.00 ","$711.88 ","$0.00 ","$962.00 ","$0.00 ","$0.00 ","$0.00 ","$686.58 ","$686.58 ","$0.00 ","$962.00 ","$0.00 ","$481.00 ","$761.90 ","$769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008015","EAP","Custom 27008015","","Reductn Wre/1.8mm Diam 400m","BOTH IP/OP","$962.00 ","$711.88 ","$0.00 ","$962.00 ","$0.00 ","$0.00 ","$0.00 ","$686.58 ","$686.58 ","$0.00 ","$962.00 ","$0.00 ","$481.00 ","$761.90 ","$769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008016","EAP","Custom 27008016","","Reductn Wire/2.0mm Diam 400m","BOTH IP/OP","$962.00 ","$711.88 ","$0.00 ","$962.00 ","$0.00 ","$0.00 ","$0.00 ","$686.58 ","$686.58 ","$0.00 ","$962.00 ","$0.00 ","$481.00 ","$761.90 ","$769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008017","EAP","Custom 27008017","","Reductn Wre 1.5mm Dia Half Pnt","BOTH IP/OP","$962.00 ","$711.88 ","$0.00 ","$962.00 ","$0.00 ","$0.00 ","$0.00 ","$686.58 ","$686.58 ","$0.00 ","$962.00 ","$0.00 ","$481.00 ","$761.90 ","$769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008018","EAP","Custom 27008018","","Reductn Wre 1.8mm Dia Hlf Pnt","BOTH IP/OP","$962.00 ","$711.88 ","$0.00 ","$962.00 ","$0.00 ","$0.00 ","$0.00 ","$686.58 ","$686.58 ","$0.00 ","$962.00 ","$0.00 ","$481.00 ","$761.90 ","$769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008019","EAP","Custom 27008019","","Reductn Wre 2.0mm Dia Half Pnt","BOTH IP/OP","$962.00 ","$711.88 ","$0.00 ","$962.00 ","$0.00 ","$0.00 ","$0.00 ","$686.58 ","$686.58 ","$0.00 ","$962.00 ","$0.00 ","$481.00 ","$761.90 ","$769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008020","EAP","Custom 27008020","","Wire Bolt/slotted Mr Safe","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$140.60 ","$140.60 ","$0.00 ","$197.00 ","$0.00 ","$98.50 ","$156.02 ","$157.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008021","EAP","Custom 27008021","","Wire Bolt/offset Mr Safe","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$183.00 ","$0.00 ","$0.00 ","$0.00 ","$130.61 ","$130.61 ","$0.00 ","$183.00 ","$0.00 ","$91.50 ","$144.94 ","$146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008024","EAP","Custom 27008024","","Schanz Scrw Bolt Can Rng Mnt","BOTH IP/OP","$906.00 ","$670.44 ","$0.00 ","$906.00 ","$0.00 ","$0.00 ","$0.00 ","$646.61 ","$646.61 ","$0.00 ","$906.00 ","$0.00 ","$453.00 ","$717.55 ","$724.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008025","EAP","Custom 27008025","","Schanz Scrw Bolt Can Post Mnt","BOTH IP/OP","$1,045.00 ","$773.30 ","$0.00 ","$1,045.00 ","$0.00 ","$0.00 ","$0.00 ","$745.82 ","$745.82 ","$0.00 ","$1,045.00 ","$0.00 ","$522.50 ","$827.64 ","$836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008026","EAP","Custom 27008026","","Square Nut Mr Safe","BOTH IP/OP","$337.00 ","$249.38 ","$0.00 ","$337.00 ","$0.00 ","$0.00 ","$0.00 ","$240.52 ","$240.52 ","$0.00 ","$337.00 ","$0.00 ","$168.50 ","$266.90 ","$269.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008027","EAP","Custom 27008027","","Nut Mr Safe","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008028","EAP","Custom 27008028","","Nut 10 Pack Mr Safe","BOTH IP/OP","$154.00 ","$113.96 ","$0.00 ","$154.00 ","$0.00 ","$0.00 ","$0.00 ","$109.91 ","$109.91 ","$0.00 ","$154.00 ","$0.00 ","$77.00 ","$121.97 ","$123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008029","EAP","Custom 27008029","","Speed Nut Mr Safe","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008030","EAP","Custom 27008030","","Wire Post-short Mr Safe","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008031","EAP","Custom 27008031","","Wire Post-tall Mr Safe","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$662.31 ","$662.31 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008032","EAP","Custom 27008032","","Spacing Washer 1mm Mr Safe","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008033","EAP","Custom 27008033","","Spacing Washer 2mm Mr Safe","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008034","EAP","Custom 27008034","","Spacing Washer 4mm Mr Safe","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008035","EAP","Custom 27008035","","Spherical Washer Couple Mr Saf","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008036","EAP","Custom 27008036","","Oblique Support Mr Safe","BOTH IP/OP","$2,314.00 ","$1,712.36 ","$0.00 ","$2,314.00 ","$0.00 ","$0.00 ","$0.00 ","$1,651.50 ","$1,651.50 ","$0.00 ","$2,314.00 ","$0.00 ","$1,157.00 ","$1,832.69 ","$1,851.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008038","EAP","Custom 27008038","","Thread Rod 80 Lng/slot Mr Safe","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$199.84 ","$199.84 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008039","EAP","Custom 27008039","","Thread Rod 100 Lng/slot Mr Sfe","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$199.84 ","$199.84 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008040","EAP","Custom 27008040","","Threaded Rod 120mm Lng Mr Safe","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$199.84 ","$199.84 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008041","EAP","Custom 27008041","","Threaded Rod 150mm Lng Mr Safe","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$199.84 ","$199.84 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008042","EAP","Custom 27008042","","Threaded Rod 200mm Lng Mr Safe","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$301.00 ","$0.00 ","$0.00 ","$0.00 ","$214.82 ","$214.82 ","$0.00 ","$301.00 ","$0.00 ","$150.50 ","$238.39 ","$240.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008043","EAP","Custom 27008043","","Threaded Rod 250mm Lng Mr Safe","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$301.00 ","$0.00 ","$0.00 ","$0.00 ","$214.82 ","$214.82 ","$0.00 ","$301.00 ","$0.00 ","$150.50 ","$238.39 ","$240.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008044","EAP","Custom 27008044","","Threaded Rod 300mm Lng Mr Safe","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$347.00 ","$0.00 ","$0.00 ","$0.00 ","$247.65 ","$247.65 ","$0.00 ","$347.00 ","$0.00 ","$173.50 ","$274.82 ","$277.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008045","EAP","Custom 27008045","","Threaded Rod 350mm Lng Mr Safe","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$347.00 ","$0.00 ","$0.00 ","$0.00 ","$247.65 ","$247.65 ","$0.00 ","$347.00 ","$0.00 ","$173.50 ","$274.82 ","$277.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008046","EAP","Custom 27008046","","Threaded Rod 400mm Lng Mr Safe","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$0.00 ","$0.00 ","$0.00 ","$314.74 ","$314.74 ","$0.00 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008051","EAP","Custom 27008051","","Standoff 20mm Long Mr Safe","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$0.00 ","$0.00 ","$0.00 ","$132.03 ","$132.03 ","$0.00 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008052","EAP","Custom 27008052","","Standoff 30mm Long Mr Safe","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$148.45 ","$148.45 ","$0.00 ","$208.00 ","$0.00 ","$104.00 ","$164.74 ","$166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008053","EAP","Custom 27008053","","Standoff 40mm Long Mr Safe","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$234.00 ","$0.00 ","$0.00 ","$0.00 ","$167.01 ","$167.01 ","$0.00 ","$234.00 ","$0.00 ","$117.00 ","$185.33 ","$187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008054","EAP","Custom 27008054","","Standoff 50mm Long Mr Safe","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$301.00 ","$0.00 ","$0.00 ","$0.00 ","$214.82 ","$214.82 ","$0.00 ","$301.00 ","$0.00 ","$150.50 ","$238.39 ","$240.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008055","EAP","Custom 27008055","","Ti Half Ring/80m Diam Mr Safe","BOTH IP/OP","$1,505.00 ","$1,113.70 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$1,074.12 ","$1,074.12 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008056","EAP","Custom 27008056","","Ti Half Ring/100m Diam Mr Safe","BOTH IP/OP","$1,624.00 ","$1,201.76 ","$0.00 ","$1,624.00 ","$0.00 ","$0.00 ","$0.00 ","$1,159.05 ","$1,159.05 ","$0.00 ","$1,624.00 ","$0.00 ","$812.00 ","$1,286.21 ","$1,299.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008057","EAP","Custom 27008057","","Ti Half Ring/110m Diam Mr Safe","BOTH IP/OP","$1,667.00 ","$1,233.58 ","$0.00 ","$1,667.00 ","$0.00 ","$0.00 ","$0.00 ","$1,189.74 ","$1,189.74 ","$0.00 ","$1,667.00 ","$0.00 ","$833.50 ","$1,320.26 ","$1,333.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008058","EAP","Custom 27008058","","Ti Half Ring/120m Diam Mr Safe","BOTH IP/OP","$1,735.00 ","$1,283.90 ","$0.00 ","$1,735.00 ","$0.00 ","$0.00 ","$0.00 ","$1,238.27 ","$1,238.27 ","$0.00 ","$1,735.00 ","$0.00 ","$867.50 ","$1,374.12 ","$1,388.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008059","EAP","Custom 27008059","","Ti Half Ring/130m Diam Mr Safe","BOTH IP/OP","$1,783.00 ","$1,319.42 ","$0.00 ","$1,783.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.53 ","$1,272.53 ","$0.00 ","$1,783.00 ","$0.00 ","$891.50 ","$1,412.14 ","$1,426.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008060","EAP","Custom 27008060","","Ti Half Ring/140m Diam Mr Safe","BOTH IP/OP","$1,850.00 ","$1,369.00 ","$0.00 ","$1,850.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.35 ","$1,320.35 ","$0.00 ","$1,850.00 ","$0.00 ","$925.00 ","$1,465.20 ","$1,480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008061","EAP","Custom 27008061","","Ti Half Ring/150m Diam Mr Safe","BOTH IP/OP","$1,969.00 ","$1,457.06 ","$0.00 ","$1,969.00 ","$0.00 ","$0.00 ","$0.00 ","$1,405.28 ","$1,405.28 ","$0.00 ","$1,969.00 ","$0.00 ","$984.50 ","$1,559.45 ","$1,575.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008062","EAP","Custom 27008062","","Ti Half Ring/160m Diam Mr Safe","BOTH IP/OP","$2,153.00 ","$1,593.22 ","$0.00 ","$2,153.00 ","$0.00 ","$0.00 ","$0.00 ","$1,536.60 ","$1,536.60 ","$0.00 ","$2,153.00 ","$0.00 ","$1,076.50 ","$1,705.18 ","$1,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008063","EAP","Custom 27008063","","Ti Half Ring/180m Diam Mr Safe","BOTH IP/OP","$2,314.00 ","$1,712.36 ","$0.00 ","$2,314.00 ","$0.00 ","$0.00 ","$0.00 ","$1,651.50 ","$1,651.50 ","$0.00 ","$2,314.00 ","$0.00 ","$1,157.00 ","$1,832.69 ","$1,851.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008064","EAP","Custom 27008064","","Ti Half Ring/200m Diam Mr Safe","BOTH IP/OP","$2,498.00 ","$1,848.52 ","$0.00 ","$2,498.00 ","$0.00 ","$0.00 ","$0.00 ","$1,782.82 ","$1,782.82 ","$0.00 ","$2,498.00 ","$0.00 ","$1,249.00 ","$1,978.42 ","$1,998.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008065","EAP","Custom 27008065","","Ti Half Ring/220m Diam Mr Safe","BOTH IP/OP","$2,663.00 ","$1,970.62 ","$0.00 ","$2,663.00 ","$0.00 ","$0.00 ","$0.00 ","$1,900.58 ","$1,900.58 ","$0.00 ","$2,663.00 ","$0.00 ","$1,331.50 ","$2,109.10 ","$2,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008066","EAP","Custom 27008066","","Ti Half Ring/240m Diam Mr Safe","BOTH IP/OP","$2,779.00 ","$2,056.46 ","$0.00 ","$2,779.00 ","$0.00 ","$0.00 ","$0.00 ","$1,983.37 ","$1,983.37 ","$0.00 ","$2,779.00 ","$0.00 ","$1,389.50 ","$2,200.97 ","$2,223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008067","EAP","Custom 27008067","","Ti Full Ring/140m Diam Mr Safe","BOTH IP/OP","$3,704.00 ","$2,740.96 ","$0.00 ","$3,704.00 ","$0.00 ","$0.00 ","$0.00 ","$2,643.54 ","$2,643.54 ","$0.00 ","$3,704.00 ","$0.00 ","$1,852.00 ","$2,933.57 ","$2,963.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008068","EAP","Custom 27008068","","Ti Full Ring/160m Diam Mr Safe","BOTH IP/OP","$4,303.00 ","$3,184.22 ","$0.00 ","$4,303.00 ","$0.00 ","$0.00 ","$0.00 ","$3,071.05 ","$3,071.05 ","$0.00 ","$4,303.00 ","$0.00 ","$2,151.50 ","$3,407.98 ","$3,442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008069","EAP","Custom 27008069","","Ti Full Ring/180m Diam Mr Safe","BOTH IP/OP","$4,627.00 ","$3,423.98 ","$0.00 ","$4,627.00 ","$0.00 ","$0.00 ","$0.00 ","$3,302.29 ","$3,302.29 ","$0.00 ","$4,627.00 ","$0.00 ","$2,313.50 ","$3,664.58 ","$3,701.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008070","EAP","Custom 27008070","","Ti Full Ring/200m Diam Mr Safe","BOTH IP/OP","$5,022.00 ","$3,716.28 ","$0.00 ","$5,022.00 ","$0.00 ","$0.00 ","$0.00 ","$3,584.20 ","$3,584.20 ","$0.00 ","$5,022.00 ","$0.00 ","$2,511.00 ","$3,977.42 ","$4,017.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008071","EAP","Custom 27008071","","Ti 5/8 Ring/130m Diam Mr Safe","BOTH IP/OP","$2,430.00 ","$1,798.20 ","$0.00 ","$2,430.00 ","$0.00 ","$0.00 ","$0.00 ","$1,734.29 ","$1,734.29 ","$0.00 ","$2,430.00 ","$0.00 ","$1,215.00 ","$1,924.56 ","$1,944.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008072","EAP","Custom 27008072","","Ti 5/8 Ring/150mm Diam Mr Safe","BOTH IP/OP","$2,663.00 ","$1,970.62 ","$0.00 ","$2,663.00 ","$0.00 ","$0.00 ","$0.00 ","$1,900.58 ","$1,900.58 ","$0.00 ","$2,663.00 ","$0.00 ","$1,331.50 ","$2,109.10 ","$2,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008073","EAP","Custom 27008073","","Ti 5/8 Ring/160mm Diam Mr Safe","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$0.00 ","$0.00 ","$0.00 ","$2,063.31 ","$2,063.31 ","$0.00 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008074","EAP","Custom 27008074","","Ti 5/8 Ring/180mm Diam Mr Safe","BOTH IP/OP","$3,358.00 ","$2,484.92 ","$0.00 ","$3,358.00 ","$0.00 ","$0.00 ","$0.00 ","$2,396.60 ","$2,396.60 ","$0.00 ","$3,358.00 ","$0.00 ","$1,679.00 ","$2,659.54 ","$2,686.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008075","EAP","Custom 27008075","","Ti 5/8 Ring/200mm Diam Mr Safe","BOTH IP/OP","$3,470.00 ","$2,567.80 ","$0.00 ","$3,470.00 ","$0.00 ","$0.00 ","$0.00 ","$2,476.54 ","$2,476.54 ","$0.00 ","$3,470.00 ","$0.00 ","$1,735.00 ","$2,748.24 ","$2,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008076","EAP","Custom 27008076","","Ti Fem Arch Pl 180 Dia/90 Degr","BOTH IP/OP","$4,165.00 ","$3,082.10 ","$0.00 ","$4,165.00 ","$0.00 ","$0.00 ","$0.00 ","$2,972.56 ","$2,972.56 ","$0.00 ","$4,165.00 ","$0.00 ","$2,082.50 ","$3,298.68 ","$3,332.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008077","EAP","Custom 27008077","","Ti Fem Arch Pl 180 Dia/120 Deg","BOTH IP/OP","$4,281.00 ","$3,167.94 ","$0.00 ","$4,281.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.35 ","$3,055.35 ","$0.00 ","$4,281.00 ","$0.00 ","$2,140.50 ","$3,390.55 ","$3,424.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008078","EAP","Custom 27008078","","Ti Fem Arch Pl 240 Dia/90 Degr","BOTH IP/OP","$4,515.00 ","$3,341.10 ","$0.00 ","$4,515.00 ","$0.00 ","$0.00 ","$0.00 ","$3,222.36 ","$3,222.36 ","$0.00 ","$4,515.00 ","$0.00 ","$2,257.50 ","$3,575.88 ","$3,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008079","EAP","Custom 27008079","","Ti Fem Arch Pl 240 Dia/120 Deg","BOTH IP/OP","$4,627.00 ","$3,423.98 ","$0.00 ","$4,627.00 ","$0.00 ","$0.00 ","$0.00 ","$3,302.29 ","$3,302.29 ","$0.00 ","$4,627.00 ","$0.00 ","$2,313.50 ","$3,664.58 ","$3,701.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008080","EAP","Custom 27008080","","Linear Distrac 60 Lng 25mm Tr","BOTH IP/OP","$2,663.00 ","$1,970.62 ","$0.00 ","$2,663.00 ","$0.00 ","$0.00 ","$0.00 ","$1,900.58 ","$1,900.58 ","$0.00 ","$2,663.00 ","$0.00 ","$1,331.50 ","$2,109.10 ","$2,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008081","EAP","Custom 27008081","","Linear Distrac 120lng 85mm Tra","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$0.00 ","$0.00 ","$0.00 ","$2,063.31 ","$2,063.31 ","$0.00 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008082","EAP","Custom 27008082","","Linear Distrac 180 Lng 145 Tra","BOTH IP/OP","$3,241.00 ","$2,398.34 ","$0.00 ","$3,241.00 ","$0.00 ","$0.00 ","$0.00 ","$2,313.10 ","$2,313.10 ","$0.00 ","$3,241.00 ","$0.00 ","$1,620.50 ","$2,566.87 ","$2,592.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008083","EAP","Custom 27008083","","Linear Distrac 250 Lng 215 Tra","BOTH IP/OP","$3,934.00 ","$2,911.16 ","$0.00 ","$3,934.00 ","$0.00 ","$0.00 ","$0.00 ","$2,807.70 ","$2,807.70 ","$0.00 ","$3,934.00 ","$0.00 ","$1,967.00 ","$3,115.73 ","$3,147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008118","EAP","Custom 27008118","","Sft Tissue Sprder Trocar 35mm","BOTH IP/OP","$1,247.00 ","$922.78 ","$0.00 ","$1,247.00 ","$0.00 ","$0.00 ","$0.00 ","$889.98 ","$889.98 ","$0.00 ","$1,247.00 ","$0.00 ","$623.50 ","$987.62 ","$997.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008119","EAP","Custom 27008119","","Sft Tissue Sprder Trocar 75","BOTH IP/OP","$1,247.00 ","$922.78 ","$0.00 ","$1,247.00 ","$0.00 ","$0.00 ","$0.00 ","$889.98 ","$889.98 ","$0.00 ","$1,247.00 ","$0.00 ","$623.50 ","$987.62 ","$997.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008122","EAP","Custom 27008122","","Straight Sharp Hook","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$428.22 ","$428.22 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008124","EAP","Custom 27008124","","Small Screw Removal Forceps","BOTH IP/OP","$1,770.00 ","$1,309.80 ","$0.00 ","$1,770.00 ","$0.00 ","$0.00 ","$0.00 ","$1,263.25 ","$1,263.25 ","$0.00 ","$1,770.00 ","$0.00 ","$885.00 ","$1,401.84 ","$1,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008125","EAP","Custom 27008125","","Large Screw Removal Forceps","BOTH IP/OP","$2,123.00 ","$1,571.02 ","$0.00 ","$2,123.00 ","$0.00 ","$0.00 ","$0.00 ","$1,515.19 ","$1,515.19 ","$0.00 ","$2,123.00 ","$0.00 ","$1,061.50 ","$1,681.42 ","$1,698.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008126","EAP","Custom 27008126","","Ti End Cap T25 Strdr 0mext Hu","BOTH IP/OP","$631.00 ","$466.94 ","$0.00 ","$631.00 ","$0.00 ","$0.00 ","$0.00 ","$450.34 ","$450.34 ","$0.00 ","$631.00 ","$0.00 ","$315.50 ","$499.75 ","$504.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008127","EAP","Custom 27008127","","Ti End Cap T25 Strdrv 0mm Ext","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$541.70 ","$541.70 ","$0.00 ","$759.00 ","$0.00 ","$379.50 ","$601.13 ","$607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008128","EAP","Custom 27008128","","Ti End Cap T25 Strdrv 5mm Ext","BOTH IP/OP","$631.00 ","$466.94 ","$0.00 ","$631.00 ","$0.00 ","$0.00 ","$0.00 ","$450.34 ","$450.34 ","$0.00 ","$631.00 ","$0.00 ","$315.50 ","$499.75 ","$504.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008129","EAP","Custom 27008129","","Ti End Cap T25 Strdrv 5mm Ext","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$541.70 ","$541.70 ","$0.00 ","$759.00 ","$0.00 ","$379.50 ","$601.13 ","$607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008130","EAP","Custom 27008130","","Ti End Cap T25 Strdrv 10mm Ex","BOTH IP/OP","$631.00 ","$466.94 ","$0.00 ","$631.00 ","$0.00 ","$0.00 ","$0.00 ","$450.34 ","$450.34 ","$0.00 ","$631.00 ","$0.00 ","$315.50 ","$499.75 ","$504.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008131","EAP","Custom 27008131","","Ti End Cap T25 Strdrv 10mm Ex","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$541.70 ","$541.70 ","$0.00 ","$759.00 ","$0.00 ","$379.50 ","$601.13 ","$607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008132","EAP","Custom 27008132","","Ti End Cap T25 Strdrv 15mm Ext","BOTH IP/OP","$631.00 ","$466.94 ","$0.00 ","$631.00 ","$0.00 ","$0.00 ","$0.00 ","$450.34 ","$450.34 ","$0.00 ","$631.00 ","$0.00 ","$315.50 ","$499.75 ","$504.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008133","EAP","Custom 27008133","","Ti End Cap T25 Strdrv 15mm Ex","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$541.70 ","$541.70 ","$0.00 ","$759.00 ","$0.00 ","$379.50 ","$601.13 ","$607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008138","EAP","Custom 27008138","","11m Ti Can Prox Hum Nl-ex/150m","BOTH IP/OP","$7,722.00 ","$5,714.28 ","$0.00 ","$7,722.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,722.00 ","$0.00 ","$3,861.00 ","$6,115.82 ","$6,177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008139","EAP","Custom 27008139","","11m Ti Can Hum Nail-ex/190-320","BOTH IP/OP","$7,722.00 ","$5,714.28 ","$0.00 ","$7,722.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,722.00 ","$0.00 ","$3,861.00 ","$6,115.82 ","$6,177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008140","EAP","Custom 27008140","","Ti End Cap T40 Sdrv 0mext Fem","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008141","EAP","Custom 27008141","","Ti End Cap T40 Sdrv 0mext Ste","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008142","EAP","Custom 27008142","","12 Ti End Cap T40 Sdrv 5m Ext","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008143","EAP","Custom 27008143","","12 Ti End Cap T40 Sdrv 5m Ext","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008144","EAP","Custom 27008144","","12 Ti End Cap T40 Sdrv 10mm Ex","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008145","EAP","Custom 27008145","","12 Ti End Cap T40 Sdrv 10mm Ex","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008146","EAP","Custom 27008146","","12 Ti End Cap T40 Sdrv 15mm Ex","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008147","EAP","Custom 27008147","","12 Ti End Cap T40 Sdrv 15mm Ex","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008148","EAP","Custom 27008148","","12 Ti End Cap T40 Sdrv 20mm Ex","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008149","EAP","Custom 27008149","","12 Ti End Cap T40 Sdrv 20mm Ex","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008150","EAP","Custom 27008150","","16 Ti End Cap T40 Sdrv 5m Ext","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008151","EAP","Custom 27008151","","16m Ti End Cap T40 Sdrv 5m Ext","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008152","EAP","Custom 27008152","","16m Ti End Cap T40 Sdrv 10mm","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008153","EAP","Custom 27008153","","16m Ti End Cap T40 Sdrv 10mm","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008154","EAP","Custom 27008154","","16m Ti End Cap T40 Sdrv 15mm","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008155","EAP","Custom 27008155","","16m Ti End Cap T40 Sdrv 15mm","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008156","EAP","Custom 27008156","","16 Ti End Cap T40 Sdrv 20mm Ex","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008157","EAP","Custom 27008157","","16 Ti End Cap T40 Sdrv 20mm Ex","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008185","EAP","Custom 27008185","","10ti Lat En Fem Nl-ex/300m-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008186","EAP","Custom 27008186","","11ti Lat En Fem Nl-ex/300m-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008187","EAP","Custom 27008187","","11ti Lat En Fem Nl-ex/300m-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008188","EAP","Custom 27008188","","12 Ti Lat En Fem Nl-ex/300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008189","EAP","Custom 27008189","","12 Ti Lat En Fem Nl-ex/300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008190","EAP","Custom 27008190","","13ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008191","EAP","Custom 27008191","","13ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008192","EAP","Custom 27008192","","14ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008193","EAP","Custom 27008193","","14ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008194","EAP","Custom 27008194","","15ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008195","EAP","Custom 27008195","","15ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008196","EAP","Custom 27008196","","16ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008197","EAP","Custom 27008197","","16ti Lat Ent Fem Nl-ex/300m480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008198","EAP","Custom 27008198","","Ti En Cp W/t40 Sdr 0m Ext F/t","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008199","EAP","Custom 27008199","","Ti En Cap W/t40 Sdr 0m Ext F/t","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008200","EAP","Custom 27008200","","Ti En Cap W/t40 Sdr 5m Ext F/t","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$0.00 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008201","EAP","Custom 27008201","","Ti En Cap W/t40 Sdr 5m Ext-ste","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$720.84 ","$720.84 ","$0.00 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008202","EAP","Custom 27008202","","Ti En Cap W/ T40 Sdr Ext F/ti","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$0.00 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008203","EAP","Custom 27008203","","Ti En Cap W/t40 Sdr 10m Ext-st","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$720.84 ","$720.84 ","$0.00 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008204","EAP","Custom 27008204","","Ti En Cap W/t40 Sdr 15m Ext","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$0.00 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008205","EAP","Custom 27008205","","Ti En Cap W/t40 Sdr 15m Ext-st","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$720.84 ","$720.84 ","$0.00 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008206","EAP","Custom 27008206","","Ti En Cap Tib Nl-ex T40 Sdr 0m","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008207","EAP","Custom 27008207","","Ti En Cap Tib Nl-ex T40 Sdr 0","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$579.52 ","$579.52 ","$0.00 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008208","EAP","Custom 27008208","","Ti En Cap Tib Nl-ex T40 Sdr 5m","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$0.00 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008209","EAP","Custom 27008209","","Ti En Cap Tib Nl-ex T40 Sdr 5m","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$720.84 ","$720.84 ","$0.00 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008210","EAP","Custom 27008210","","Ti En Cap Tib Nl-ex T40 Sdr 10","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$0.00 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008211","EAP","Custom 27008211","","Ti En Cap Tib Nl-ex T40 Sdr 10","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$720.84 ","$720.84 ","$0.00 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008212","EAP","Custom 27008212","","Ti En Cap Tib Nl-ex T40 Sdr 15","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$0.00 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008213","EAP","Custom 27008213","","Ti En Cap Tib Nl-ex T40 Sdr 15","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$720.84 ","$720.84 ","$0.00 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008216","EAP","Custom 27008216","","10m Ti Can Tib Nl-ex/255-435mm","BOTH IP/OP","$6,110.00 ","$4,521.40 ","$0.00 ","$6,110.00 ","$0.00 ","$0.00 ","$0.00 ","$4,360.71 ","$4,360.71 ","$0.00 ","$6,110.00 ","$0.00 ","$3,055.00 ","$4,839.12 ","$4,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008217","EAP","Custom 27008217","","12m Ti Can Tib Nl-ex/255-435mm","BOTH IP/OP","$6,110.00 ","$4,521.40 ","$0.00 ","$6,110.00 ","$0.00 ","$0.00 ","$0.00 ","$4,360.71 ","$4,360.71 ","$0.00 ","$6,110.00 ","$0.00 ","$3,055.00 ","$4,839.12 ","$4,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008219","EAP","Custom 27008219","","Ti En Cap T25 Sdr Hndft Art Nl","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$508.15 ","$508.15 ","$0.00 ","$712.00 ","$0.00 ","$356.00 ","$563.90 ","$569.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008220","EAP","Custom 27008220","","Ti En Cap T25 Sdr Hndft Art Nl","BOTH IP/OP","$842.00 ","$623.08 ","$0.00 ","$842.00 ","$0.00 ","$0.00 ","$0.00 ","$600.94 ","$600.94 ","$0.00 ","$842.00 ","$0.00 ","$421.00 ","$666.86 ","$673.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008221","EAP","Custom 27008221","","Ti En Cap T25 Sdr Hndft Art Nl","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$508.15 ","$508.15 ","$0.00 ","$712.00 ","$0.00 ","$356.00 ","$563.90 ","$569.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008222","EAP","Custom 27008222","","Ti En Cap T25 Sdr Hndft Art Nl","BOTH IP/OP","$842.00 ","$623.08 ","$0.00 ","$842.00 ","$0.00 ","$0.00 ","$0.00 ","$600.94 ","$600.94 ","$0.00 ","$842.00 ","$0.00 ","$421.00 ","$666.86 ","$673.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008223","EAP","Custom 27008223","","10ti Hft Art Can Nl-ex150-240m","BOTH IP/OP","$6,453.00 ","$4,775.22 ","$0.00 ","$6,453.00 ","$0.00 ","$0.00 ","$0.00 ","$4,605.51 ","$4,605.51 ","$0.00 ","$6,453.00 ","$0.00 ","$3,226.50 ","$5,110.78 ","$5,162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008224","EAP","Custom 27008224","","Ti En Cap T40 Sdr 0m Ext Retr","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$486.74 ","$486.74 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008225","EAP","Custom 27008225","","Ti Spir Bld 45m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008226","EAP","Custom 27008226","","Ti Spir Bld 50m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008227","EAP","Custom 27008227","","Ti Spir Bld 50m-ster F/ti Retr","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008228","EAP","Custom 27008228","","Ti Spir Bld 55m Ti Retr Fem","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008229","EAP","Custom 27008229","","Ti Spir Bld 55m-ster F/ti Retr","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008230","EAP","Custom 27008230","","Ti Spir Bld 65m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008231","EAP","Custom 27008231","","Ti Spir Bld 65f/ti Ret Fem Nls","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008232","EAP","Custom 27008232","","Ti Spir Bld 70m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008233","EAP","Custom 27008233","","Ti Spir Bld 70m F/ti Retr Fem","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008234","EAP","Custom 27008234","","Ti Spir Bld 75m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008235","EAP","Custom 27008235","","Ti Spir Bld 75 F/ti Ret Fem Nl","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008236","EAP","Custom 27008236","","Ti Spir Bld 80m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008237","EAP","Custom 27008237","","Ti Spir Bld 80 F/ti Ret Fem Nl","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008238","EAP","Custom 27008238","","Ti Spir Bld 85 Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008239","EAP","Custom 27008239","","Ti Spir Bld 85m F/ti Retr Fem","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008240","EAP","Custom 27008240","","Ti Spir Bld 90m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008241","EAP","Custom 27008241","","Ti Spir Bld 90m F/ti Retr Fem","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008242","EAP","Custom 27008242","","Ti Spir Bld 95m Ti Retr Fem Nl","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008243","EAP","Custom 27008243","","Ti Spir Bld 100m Ti Retr Fem","BOTH IP/OP","$2,318.00 ","$1,715.32 ","$0.00 ","$2,318.00 ","$0.00 ","$0.00 ","$0.00 ","$1,654.36 ","$1,654.36 ","$0.00 ","$2,318.00 ","$0.00 ","$1,159.00 ","$1,835.86 ","$1,854.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008244","EAP","Custom 27008244","","Ti Spir Bld 100m-st F/ti Ret","BOTH IP/OP","$2,447.00 ","$1,810.78 ","$0.00 ","$2,447.00 ","$0.00 ","$0.00 ","$0.00 ","$1,746.42 ","$1,746.42 ","$0.00 ","$2,447.00 ","$0.00 ","$1,223.50 ","$1,938.02 ","$1,957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008247","EAP","Custom 27008247","","10ti Can Ret Fem Nl-ex/160-280","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008248","EAP","Custom 27008248","","10ti Can Ret/ant Fem Nl300-480","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008249","EAP","Custom 27008249","","11ti Can Ret Fem Nl-ex/160-280","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008250","EAP","Custom 27008250","","12mmti Can Retr Fem Nl 160-280","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008251","EAP","Custom 27008251","","13ti Can Retr Fem Nl-ex160-280","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008252","EAP","Custom 27008252","","13ti Can Ret/ant Fem Nl300-480","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008253","EAP","Custom 27008253","","14ti Can Retr Fem Nl-ex160-280","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008254","EAP","Custom 27008254","","14ti Can Ret/ant Fem Nl300-480","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008255","EAP","Custom 27008255","","15ti Can Retr Fem Nl-160-280mm","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008256","EAP","Custom 27008256","","15ti Can Ret/ant Fem Nl300-480","BOTH IP/OP","$6,897.00 ","$5,103.78 ","$0.00 ","$6,897.00 ","$0.00 ","$0.00 ","$0.00 ","$4,922.39 ","$4,922.39 ","$0.00 ","$6,897.00 ","$0.00 ","$3,448.50 ","$5,462.42 ","$5,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008258","EAP","Custom 27008258","","10ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008259","EAP","Custom 27008259","","10ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008260","EAP","Custom 27008260","","11ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008261","EAP","Custom 27008261","","12ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008262","EAP","Custom 27008262","","12ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008263","EAP","Custom 27008263","","13ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008264","EAP","Custom 27008264","","13ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008265","EAP","Custom 27008265","","14ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008266","EAP","Custom 27008266","","14ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008267","EAP","Custom 27008267","","15ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008268","EAP","Custom 27008268","","15ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008269","EAP","Custom 27008269","","16ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008270","EAP","Custom 27008270","","16ti Can Lat Ent Fem Nl300-480","BOTH IP/OP","$6,829.00 ","$5,053.46 ","$0.00 ","$6,829.00 ","$0.00 ","$0.00 ","$0.00 ","$4,873.86 ","$4,873.86 ","$0.00 ","$6,829.00 ","$0.00 ","$3,414.50 ","$5,408.57 ","$5,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008275","EAP","Custom 27008275","","T15/2.5m Hex Ti Cerclage Buttn","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008276","EAP","Custom 27008276","","T25/3.5m Hex Ti Cerclage Buttn","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008281","EAP","Custom 27008281","","Saw Bld 95x19 0.89m Cut Thknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008282","EAP","Custom 27008282","","Saw Bld 95x19 1.19m Cut Thknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008283","EAP","Custom 27008283","","Saw Bld 95x19 1.27m Cut Thknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008284","EAP","Custom 27008284","","Saw Bld 95x19 1.37m Cut Thknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008285","EAP","Custom 27008285","","Saw Bld 95x 19 1.47 Cut Thknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008286","EAP","Custom 27008286","","Saw Bld 80x19 0.89 Cut Thkness","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008287","EAP","Custom 27008287","","Saw Bld 95x19 1.00 Cut Thkness","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008288","EAP","Custom 27008288","","Saw Bld 95 X 19 1.07cut Thknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008289","EAP","Custom 27008289","","Saw Bld 95x25 0.89 Cut Thkness","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008290","EAP","Custom 27008290","","Saw Bld 95x25 1.19 Cut Thcknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008291","EAP","Custom 27008291","","Saw Bld 95x25 1.27 Cut Thcknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008292","EAP","Custom 27008292","","Saw Bld 95x25 1.37 Cut Thcknes","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008293","EAP","Custom 27008293","","Saw Bld 95x25 1.47cut Thckness","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008294","EAP","Custom 27008294","","Saw Blade 95mm X 25mm 1.00mm","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008295","EAP","Custom 27008295","","Saw Blade 95mm X 25mm 1.07mm","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008296","EAP","Custom 27008296","","Saw Blade 90mm X 12.5mm 0.89m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008297","EAP","Custom 27008297","","Saw Blade 90mm X 12.5mm 1.19m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008298","EAP","Custom 27008298","","Saw Blade 90mm X 12.5mm 1.27m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008299","EAP","Custom 27008299","","Saw Blade 90mm X 12.5mm 1.37m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008300","EAP","Custom 27008300","","Saw Blade 90mm X 12.5mm 1.47m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008301","EAP","Custom 27008301","","Saw Blade 90m X 19-12.5m 0.89m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008302","EAP","Custom 27008302","","Saw Blade 90m X19-12.5mm 1.19m","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$328.00 ","$0.00 ","$0.00 ","$0.00 ","$234.09 ","$234.09 ","$0.00 ","$328.00 ","$0.00 ","$164.00 ","$259.78 ","$262.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008303","EAP","Custom 27008303","","Saw Blade 90mx19-12.5mm 1.27m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008304","EAP","Custom 27008304","","Saw Blade 90m X19-12.5m 1.37m","BOTH IP/OP","$310.00 ","$229.40 ","$0.00 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$221.25 ","$221.25 ","$0.00 ","$310.00 ","$0.00 ","$155.00 ","$245.52 ","$248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008305","EAP","Custom 27008305","","Saw Blade 90mx19-12.5mm 1.47m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008306","EAP","Custom 27008306","","Saw Blade 90mx19-12.5mm 1.00m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008307","EAP","Custom 27008307","","Saw Blade 90mm X 12.5mm 1.00m","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008308","EAP","Custom 27008308","","Saw Blade 60mm X 25mm 0.89mm","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008309","EAP","Custom 27008309","","Plan&reduct Tech In Fx Surgery","BOTH IP/OP","$781.00 ","$577.94 ","$0.00 ","$781.00 ","$0.00 ","$0.00 ","$0.00 ","$557.40 ","$557.40 ","$0.00 ","$781.00 ","$0.00 ","$390.50 ","$618.55 ","$624.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008312","EAP","Custom 27008312","","The Rational Operative Fx Care","BOTH IP/OP","$781.00 ","$577.94 ","$0.00 ","$781.00 ","$0.00 ","$0.00 ","$0.00 ","$557.40 ","$557.40 ","$0.00 ","$781.00 ","$0.00 ","$390.50 ","$618.55 ","$624.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008316","EAP","Custom 27008316","","Minimax Fracture Fixation","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$0.00 ","$0.00 ","$0.00 ","$449.63 ","$449.63 ","$0.00 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008318","EAP","Custom 27008318","","Intern Fixatn Osteoporotic Bne","BOTH IP/OP","$538.00 ","$398.12 ","$0.00 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$383.97 ","$383.97 ","$0.00 ","$538.00 ","$0.00 ","$269.00 ","$426.10 ","$430.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008321","EAP","Custom 27008321","","Oper Approach Orth Surg&trauma","BOTH IP/OP","$635.00 ","$469.90 ","$0.00 ","$635.00 ","$0.00 ","$0.00 ","$0.00 ","$453.20 ","$453.20 ","$0.00 ","$635.00 ","$0.00 ","$317.50 ","$502.92 ","$508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008324","EAP","Custom 27008324","","1.5mm Cortex Scw 6-20mm","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$59.24 ","$59.24 ","$0.00 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008325","EAP","Custom 27008325","","1.0cor Scw Self-tapg 6-14mm","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$242.66 ","$242.66 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008326","EAP","Custom 27008326","","1.3mm Cort Scw Slf-tapg 6-18","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008327","EAP","Custom 27008327","","1.5mm Cort Scw Slf-tapg 6-24","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$0.00 ","$69.23 ","$69.23 ","$0.00 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008335","EAP","Custom 27008335","","1.8mm Buttress Pin/12-30mm","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$121.33 ","$121.33 ","$0.00 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008367","EAP","Custom 27008367","","Schuhli Assembly - 4.5 Cor Scw","BOTH IP/OP","$1,039.00 ","$768.86 ","$0.00 ","$1,039.00 ","$0.00 ","$0.00 ","$0.00 ","$741.53 ","$741.53 ","$0.00 ","$1,039.00 ","$0.00 ","$519.50 ","$822.89 ","$831.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008368","EAP","Custom 27008368","","Schuhli Assembly- 3.5 Cor Scw","BOTH IP/OP","$1,039.00 ","$768.86 ","$0.00 ","$1,039.00 ","$0.00 ","$0.00 ","$0.00 ","$741.53 ","$741.53 ","$0.00 ","$1,039.00 ","$0.00 ","$519.50 ","$822.89 ","$831.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008369","EAP","Custom 27008369","","Thrded Wash 3.0 Cannul Scw","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$399.67 ","$399.67 ","$0.00 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008370","EAP","Custom 27008370","","Spiked Washer 8.0mm/3.2mm","BOTH IP/OP","$497.00 ","$367.78 ","$0.00 ","$497.00 ","$0.00 ","$0.00 ","$0.00 ","$354.71 ","$354.71 ","$0.00 ","$497.00 ","$0.00 ","$248.50 ","$393.62 ","$397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008371","EAP","Custom 27008371","","Spiked Washer 13.5mm/4.0mm","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$357.56 ","$357.56 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008372","EAP","Custom 27008372","","Spiked Washer 13.5mm/5.5mm","BOTH IP/OP","$492.00 ","$364.08 ","$0.00 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$351.14 ","$351.14 ","$0.00 ","$492.00 ","$0.00 ","$246.00 ","$389.66 ","$393.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008373","EAP","Custom 27008373","","Spher Wash/sm Oval 6.5/ 0.3mm","BOTH IP/OP","$608.00 ","$449.92 ","$0.00 ","$608.00 ","$0.00 ","$0.00 ","$0.00 ","$433.93 ","$433.93 ","$0.00 ","$608.00 ","$0.00 ","$304.00 ","$481.54 ","$486.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008374","EAP","Custom 27008374","","Spher Washer/lrg Rnd 6.5/7.3","BOTH IP/OP","$608.00 ","$449.92 ","$0.00 ","$608.00 ","$0.00 ","$0.00 ","$0.00 ","$433.93 ","$433.93 ","$0.00 ","$608.00 ","$0.00 ","$304.00 ","$481.54 ","$486.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008375","EAP","Custom 27008375","","Nut For 4.5mm Cortex Screws","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$85.64 ","$85.64 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008376","EAP","Custom 27008376","","Washer 6.5mm","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$0.00 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008377","EAP","Custom 27008377","","1.3mm Straight Plate 6 Holes","BOTH IP/OP","$789.00 ","$583.86 ","$0.00 ","$789.00 ","$0.00 ","$0.00 ","$0.00 ","$563.11 ","$563.11 ","$0.00 ","$789.00 ","$0.00 ","$394.50 ","$624.89 ","$631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008378","EAP","Custom 27008378","","1.3mm Straight Plate 12 Holes","BOTH IP/OP","$996.00 ","$737.04 ","$0.00 ","$996.00 ","$0.00 ","$0.00 ","$0.00 ","$710.85 ","$710.85 ","$0.00 ","$996.00 ","$0.00 ","$498.00 ","$788.83 ","$796.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008379","EAP","Custom 27008379","","1.3mm Extended H-plate/right","BOTH IP/OP","$954.00 ","$705.96 ","$0.00 ","$954.00 ","$0.00 ","$0.00 ","$0.00 ","$680.87 ","$680.87 ","$0.00 ","$954.00 ","$0.00 ","$477.00 ","$755.57 ","$763.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008380","EAP","Custom 27008380","","1.3mm Extended H-plate/left","BOTH IP/OP","$954.00 ","$705.96 ","$0.00 ","$954.00 ","$0.00 ","$0.00 ","$0.00 ","$680.87 ","$680.87 ","$0.00 ","$954.00 ","$0.00 ","$477.00 ","$755.57 ","$763.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008381","EAP","Custom 27008381","","1.3mm T-plte 3 Hles Hd/ 8hles","BOTH IP/OP","$913.00 ","$675.62 ","$0.00 ","$913.00 ","$0.00 ","$0.00 ","$0.00 ","$651.61 ","$651.61 ","$0.00 ","$913.00 ","$0.00 ","$456.50 ","$723.10 ","$730.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008382","EAP","Custom 27008382","","1.3mm T-plte 4hles Head/8hles","BOTH IP/OP","$954.00 ","$705.96 ","$0.00 ","$954.00 ","$0.00 ","$0.00 ","$0.00 ","$680.87 ","$680.87 ","$0.00 ","$954.00 ","$0.00 ","$477.00 ","$755.57 ","$763.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008383","EAP","Custom 27008383","","1.3mm Y-plte 3 Hles Head/8hle","BOTH IP/OP","$913.00 ","$675.62 ","$0.00 ","$913.00 ","$0.00 ","$0.00 ","$0.00 ","$651.61 ","$651.61 ","$0.00 ","$913.00 ","$0.00 ","$456.50 ","$723.10 ","$730.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008384","EAP","Custom 27008384","","Semi-tubul Plate 2 Holes 39m","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008385","EAP","Custom 27008385","","Semi-tubul Plate 3 Holes 55m","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$167.72 ","$167.72 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008386","EAP","Custom 27008386","","Semi-tubul Plate 4 Holes 71m","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$181.99 ","$181.99 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008387","EAP","Custom 27008387","","Semi-tubul Plate 5 Holes 87m","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008388","EAP","Custom 27008388","","Semi-tubulplate 6 Holes 103m","BOTH IP/OP","$283.00 ","$209.42 ","$0.00 ","$283.00 ","$0.00 ","$0.00 ","$0.00 ","$201.98 ","$201.98 ","$0.00 ","$283.00 ","$0.00 ","$141.50 ","$224.14 ","$226.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008389","EAP","Custom 27008389","","Semi-tubul Plate 7 Holes 119m","BOTH IP/OP","$307.00 ","$227.18 ","$0.00 ","$307.00 ","$0.00 ","$0.00 ","$0.00 ","$219.11 ","$219.11 ","$0.00 ","$307.00 ","$0.00 ","$153.50 ","$243.14 ","$245.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008390","EAP","Custom 27008390","","Semi-tubul Plate 8 Holes 135m","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008391","EAP","Custom 27008391","","Semi-tubul Plate 9 Holes 151m","BOTH IP/OP","$337.00 ","$249.38 ","$0.00 ","$337.00 ","$0.00 ","$0.00 ","$0.00 ","$240.52 ","$240.52 ","$0.00 ","$337.00 ","$0.00 ","$168.50 ","$266.90 ","$269.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008392","EAP","Custom 27008392","","Semi-tubul Plate 10 Holes 167m","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$0.00 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008393","EAP","Custom 27008393","","Semi-tubul Plate 11 Holes/183m","BOTH IP/OP","$356.00 ","$263.44 ","$0.00 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$254.08 ","$254.08 ","$0.00 ","$356.00 ","$0.00 ","$178.00 ","$281.95 ","$284.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008394","EAP","Custom 27008394","","Semi-tubular Plate 12 Hles/199","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$267.64 ","$267.64 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008662","EAP","Custom 27008662","","100deg Adoles Osteo Plt 50/10","BOTH IP/OP","$2,088.00 ","$1,545.12 ","$0.00 ","$2,088.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.21 ","$1,490.21 ","$0.00 ","$2,088.00 ","$0.00 ","$1,044.00 ","$1,653.70 ","$1,670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008663","EAP","Custom 27008663","","100deg Adoles Osteo Plt 50/10","BOTH IP/OP","$2,219.00 ","$1,642.06 ","$0.00 ","$2,219.00 ","$0.00 ","$0.00 ","$0.00 ","$1,583.70 ","$1,583.70 ","$0.00 ","$2,219.00 ","$0.00 ","$1,109.50 ","$1,757.45 ","$1,775.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008666","EAP","Custom 27008666","","100deg Adoles Osteo Plt 40/10","BOTH IP/OP","$2,088.00 ","$1,545.12 ","$0.00 ","$2,088.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.21 ","$1,490.21 ","$0.00 ","$2,088.00 ","$0.00 ","$1,044.00 ","$1,653.70 ","$1,670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008667","EAP","Custom 27008667","","100deg Adoles Osteo Plt 40/10","BOTH IP/OP","$2,219.00 ","$1,642.06 ","$0.00 ","$2,219.00 ","$0.00 ","$0.00 ","$0.00 ","$1,583.70 ","$1,583.70 ","$0.00 ","$2,219.00 ","$0.00 ","$1,109.50 ","$1,757.45 ","$1,775.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008670","EAP","Custom 27008670","","100deg Adoles Osteo Plt 50/15","BOTH IP/OP","$2,088.00 ","$1,545.12 ","$0.00 ","$2,088.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.21 ","$1,490.21 ","$0.00 ","$2,088.00 ","$0.00 ","$1,044.00 ","$1,653.70 ","$1,670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008671","EAP","Custom 27008671","","100deg Adoles Osteo Plt 50/15","BOTH IP/OP","$2,219.00 ","$1,642.06 ","$0.00 ","$2,219.00 ","$0.00 ","$0.00 ","$0.00 ","$1,583.70 ","$1,583.70 ","$0.00 ","$2,219.00 ","$0.00 ","$1,109.50 ","$1,757.45 ","$1,775.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008674","EAP","Custom 27008674","","100deg Adoles Osteo Plt 60/15","BOTH IP/OP","$2,088.00 ","$1,545.12 ","$0.00 ","$2,088.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.21 ","$1,490.21 ","$0.00 ","$2,088.00 ","$0.00 ","$1,044.00 ","$1,653.70 ","$1,670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008675","EAP","Custom 27008675","","100deg Adoles Osteo Plt 60/15","BOTH IP/OP","$2,219.00 ","$1,642.06 ","$0.00 ","$2,219.00 ","$0.00 ","$0.00 ","$0.00 ","$1,583.70 ","$1,583.70 ","$0.00 ","$2,219.00 ","$0.00 ","$1,109.50 ","$1,757.45 ","$1,775.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008678","EAP","Custom 27008678","","100deg Adoles Osteo Plt 40/15","BOTH IP/OP","$2,088.00 ","$1,545.12 ","$0.00 ","$2,088.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.21 ","$1,490.21 ","$0.00 ","$2,088.00 ","$0.00 ","$1,044.00 ","$1,653.70 ","$1,670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008679","EAP","Custom 27008679","","100deg Adoles Osteo Plt 40/15","BOTH IP/OP","$2,219.00 ","$1,642.06 ","$0.00 ","$2,219.00 ","$0.00 ","$0.00 ","$0.00 ","$1,583.70 ","$1,583.70 ","$0.00 ","$2,219.00 ","$0.00 ","$1,109.50 ","$1,757.45 ","$1,775.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008680","EAP","Custom 27008680","","115 Deg Bifurcatd Plte 30/5","BOTH IP/OP","$1,187.00 ","$878.38 ","$0.00 ","$1,187.00 ","$0.00 ","$0.00 ","$0.00 ","$847.16 ","$847.16 ","$0.00 ","$1,187.00 ","$0.00 ","$593.50 ","$940.10 ","$949.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008681","EAP","Custom 27008681","","115 Deg Bifurcatd Plte 30/5","BOTH IP/OP","$1,318.00 ","$975.32 ","$0.00 ","$1,318.00 ","$0.00 ","$0.00 ","$0.00 ","$940.66 ","$940.66 ","$0.00 ","$1,318.00 ","$0.00 ","$659.00 ","$1,043.86 ","$1,054.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008682","EAP","Custom 27008682","","115 Deg Bifurcatd Plte 35/5","BOTH IP/OP","$1,187.00 ","$878.38 ","$0.00 ","$1,187.00 ","$0.00 ","$0.00 ","$0.00 ","$847.16 ","$847.16 ","$0.00 ","$1,187.00 ","$0.00 ","$593.50 ","$940.10 ","$949.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27008683","EAP","Custom 27008683","","115 Deg Bifurcatd Plte 35/5","BOTH IP/OP","$1,318.00 ","$975.32 ","$0.00 ","$1,318.00 ","$0.00 ","$0.00 ","$0.00 ","$940.66 ","$940.66 ","$0.00 ","$1,318.00 ","$0.00 ","$659.00 ","$1,043.86 ","$1,054.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010225","EAP","Custom 27010225","","0.8mm Guide Wire 100mm","BOTH IP/OP","$611.00 ","$452.14 ","$0.00 ","$611.00 ","$0.00 ","$0.00 ","$0.00 ","$436.07 ","$436.07 ","$0.00 ","$611.00 ","$0.00 ","$305.50 ","$483.91 ","$488.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010807","EAP","Custom 27010807","","Bipolar Cord,disposable","BOTH IP/OP","$683.00 ","$505.42 ","$0.00 ","$683.00 ","$0.00 ","$0.00 ","$0.00 ","$487.46 ","$487.46 ","$0.00 ","$683.00 ","$0.00 ","$341.50 ","$540.94 ","$546.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010828","EAP","Custom 27010828","","Cast App'l-spica Adult","BOTH IP/OP","$749.00 ","$554.26 ","$0.00 ","$749.00 ","$0.00 ","$0.00 ","$0.00 ","$534.56 ","$534.56 ","$0.00 ","$749.00 ","$0.00 ","$374.50 ","$593.21 ","$599.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010880","EAP","Custom 27010880","","Colostomy Bag & Supplies","BOTH IP/OP","$509.00 ","$376.66 ","$0.00 ","$509.00 ","$0.00 ","$0.00 ","$0.00 ","$363.27 ","$363.27 ","$0.00 ","$509.00 ","$0.00 ","$254.50 ","$403.13 ","$407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010881","EAP","Custom 27010881","","Gen-supp-guide Wire","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010943","EAP","Custom 27010943","","Endo Stitch* Polysorb* 3/0 7 V","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$141.31 ","$141.31 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010987","EAP","Custom 27010987","","3.2mm Guide Wire 290mm","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$357.56 ","$357.56 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010993","EAP","Custom 27010993","","Humeral Fracture Brace","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010994","EAP","Custom 27010994","","Wound Care Shoe","BOTH IP/OP","$309.00 ","$228.66 ","$0.00 ","$309.00 ","$0.00 ","$0.00 ","$0.00 ","$220.53 ","$220.53 ","$0.00 ","$309.00 ","$0.00 ","$154.50 ","$244.73 ","$247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010997","EAP","Custom 27010997","","3mmx20cm Tunneler","BOTH IP/OP","$656.00 ","$485.44 ","$0.00 ","$656.00 ","$0.00 ","$0.00 ","$0.00 ","$468.19 ","$468.19 ","$0.00 ","$656.00 ","$0.00 ","$328.00 ","$519.55 ","$524.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011002","EAP","Custom 27011002","","4fr Catheter Cobra 2","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$118.47 ","$118.47 ","$0.00 ","$166.00 ","$0.00 ","$83.00 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011008","EAP","Custom 27011008","","5fr-100cm Sim 1 Cath","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011009","EAP","Custom 27011009","","5mmx19cmx90cm Monorail Bilary","BOTH IP/OP","$4,654.00 ","$3,443.96 ","$0.00 ","$4,654.00 ","$0.00 ","$0.00 ","$0.00 ","$3,321.56 ","$3,321.56 ","$0.00 ","$4,654.00 ","$0.00 ","$2,327.00 ","$3,685.97 ","$3,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011010","EAP","Custom 27011010","","5x135x40cm Unifuse Kit","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$392.54 ","$392.54 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011011","EAP","Custom 27011011","","5x135x50cm Unifuse Kit","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$392.54 ","$392.54 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011013","EAP","Custom 27011013","","6fr Al1 Catheter","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011015","EAP","Custom 27011015","","6fr Ar1 Catheter","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011028","EAP","Custom 27011028","","7.1 Fr 100cm Pigtail Cath","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011029","EAP","Custom 27011029","","8fr X 40cm Skater Biliary Drai","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$181.28 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011032","EAP","Custom 27011032","","Air Guard Valved Introducer","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$239.09 ","$239.09 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011033","EAP","Custom 27011033","","Bag Drainage Ureteral","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$73.51 ","$73.51 ","$0.00 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011037","EAP","Custom 27011037","","Balloon Dial Cath Xxl 12mmx4cm","BOTH IP/OP","$856.00 ","$633.44 ","$0.00 ","$856.00 ","$0.00 ","$0.00 ","$0.00 ","$610.93 ","$610.93 ","$0.00 ","$856.00 ","$0.00 ","$428.00 ","$677.95 ","$684.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011039","EAP","Custom 27011039","","Balloon Polar Cath 4x60x120","BOTH IP/OP","$2,002.00 ","$1,481.48 ","$0.00 ","$2,002.00 ","$0.00 ","$0.00 ","$0.00 ","$1,428.83 ","$1,428.83 ","$0.00 ","$2,002.00 ","$0.00 ","$1,001.00 ","$1,585.58 ","$1,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011040","EAP","Custom 27011040","","Balloon Polar Cath 5x40x120","BOTH IP/OP","$2,002.00 ","$1,481.48 ","$0.00 ","$2,002.00 ","$0.00 ","$0.00 ","$0.00 ","$1,428.83 ","$1,428.83 ","$0.00 ","$2,002.00 ","$0.00 ","$1,001.00 ","$1,585.58 ","$1,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011041","EAP","Custom 27011041","","Balloon Polar Cath 5x60x120","BOTH IP/OP","$2,002.00 ","$1,481.48 ","$0.00 ","$2,002.00 ","$0.00 ","$0.00 ","$0.00 ","$1,428.83 ","$1,428.83 ","$0.00 ","$2,002.00 ","$0.00 ","$1,001.00 ","$1,585.58 ","$1,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011051","EAP","Custom 27011051","","Basket Stone Removal 8-wire","BOTH IP/OP","$963.00 ","$712.62 ","$0.00 ","$963.00 ","$0.00 ","$0.00 ","$0.00 ","$687.29 ","$687.29 ","$0.00 ","$963.00 ","$0.00 ","$481.50 ","$762.70 ","$770.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011052","EAP","Custom 27011052","","Bead Block 100-300","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$0.00 ","$0.00 ","$0.00 ","$476.04 ","$476.04 ","$0.00 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011053","EAP","Custom 27011053","","Bead Block 300-500","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$0.00 ","$0.00 ","$0.00 ","$476.04 ","$476.04 ","$0.00 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011054","EAP","Custom 27011054","","Bead Block 500-700","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$0.00 ","$0.00 ","$0.00 ","$476.04 ","$476.04 ","$0.00 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011055","EAP","Custom 27011055","","Bead Block 700-900","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$0.00 ","$0.00 ","$0.00 ","$476.04 ","$476.04 ","$0.00 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011056","EAP","Custom 27011056","","Bead Block 900-1200","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$0.00 ","$0.00 ","$0.00 ","$476.04 ","$476.04 ","$0.00 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011058","EAP","Custom 27011058","","Cath 20fr 24cm Tenacath Hsg","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011061","EAP","Custom 27011061","","Cath 5fr 100cm Berenstein","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011062","EAP","Custom 27011062","","Cath 5fr 100cm Sim2","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011063","EAP","Custom 27011063","","Cath 5fr 100cm Sim3","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011065","EAP","Custom 27011065","","Cath 5fr 40cm Berenstein","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011067","EAP","Custom 27011067","","Cath 5fr 65cm Berenstein","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011068","EAP","Custom 27011068","","Cath 5fr 65cm Cobra1","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011069","EAP","Custom 27011069","","Cath 5fr 65cm Cobra2","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011070","EAP","Custom 27011070","","Cath 5fr 65cm Ns Straight","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011071","EAP","Custom 27011071","","Cath 5fr 65cm Pig","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011073","EAP","Custom 27011073","","Cath 5fr 80 Cm Mikalesson","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011074","EAP","Custom 27011074","","Cath 5fr 80cm Sos1","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$118.47 ","$118.47 ","$0.00 ","$166.00 ","$0.00 ","$83.00 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011075","EAP","Custom 27011075","","Cath 5fr 80cm Sos2","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011077","EAP","Custom 27011077","","Cath Polar Dilator Bal4x80x120","BOTH IP/OP","$2,335.00 ","$1,727.90 ","$0.00 ","$2,335.00 ","$0.00 ","$0.00 ","$0.00 ","$1,666.49 ","$1,666.49 ","$0.00 ","$2,335.00 ","$0.00 ","$1,167.50 ","$1,849.32 ","$1,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011078","EAP","Custom 27011078","","Cath Polar Dilator Bal5x80x120","BOTH IP/OP","$2,002.00 ","$1,481.48 ","$0.00 ","$2,002.00 ","$0.00 ","$0.00 ","$0.00 ","$1,428.83 ","$1,428.83 ","$0.00 ","$2,002.00 ","$0.00 ","$1,001.00 ","$1,585.58 ","$1,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011083","EAP","Custom 27011083","","Cath Triple Lumen 11fr","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$413.00 ","$0.00 ","$0.00 ","$0.00 ","$294.76 ","$294.76 ","$0.00 ","$413.00 ","$0.00 ","$206.50 ","$327.10 ","$330.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011084","EAP","Custom 27011084","","Catheter Repair Kit","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$349.00 ","$0.00 ","$0.00 ","$0.00 ","$249.08 ","$249.08 ","$0.00 ","$349.00 ","$0.00 ","$174.50 ","$276.41 ","$279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011086","EAP","Custom 27011086","","Chest Unit Drainage Pleur","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$469.00 ","$0.00 ","$0.00 ","$0.00 ","$334.73 ","$334.73 ","$0.00 ","$469.00 ","$0.00 ","$234.50 ","$371.45 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011088","EAP","Custom 27011088","","Coil 15-250 Micron (2vl/bx)","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$477.00 ","$0.00 ","$0.00 ","$0.00 ","$340.43 ","$340.43 ","$0.00 ","$477.00 ","$0.00 ","$238.50 ","$377.78 ","$381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011089","EAP","Custom 27011089","","Coil 250-355 Micron (5vl/bx)","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$0.00 ","$0.00 ","$0.00 ","$330.44 ","$330.44 ","$0.00 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011090","EAP","Custom 27011090","","Coil 355-500 Micron (5vl/bx)","BOTH IP/OP","$384.00 ","$284.16 ","$0.00 ","$384.00 ","$0.00 ","$0.00 ","$0.00 ","$274.06 ","$274.06 ","$0.00 ","$384.00 ","$0.00 ","$192.00 ","$304.13 ","$307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011091","EAP","Custom 27011091","","Coil 500-710 Micron (2vl/bx)","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$477.00 ","$0.00 ","$0.00 ","$0.00 ","$340.43 ","$340.43 ","$0.00 ","$477.00 ","$0.00 ","$238.50 ","$377.78 ","$381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011092","EAP","Custom 27011092","","Coil 710-1000 Micron (2vl/bx)","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$477.00 ","$0.00 ","$0.00 ","$0.00 ","$340.43 ","$340.43 ","$0.00 ","$477.00 ","$0.00 ","$238.50 ","$377.78 ","$381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011093","EAP","Custom 27011093","","Coil Pusher 16","BOTH IP/OP","$544.00 ","$402.56 ","$0.00 ","$544.00 ","$0.00 ","$0.00 ","$0.00 ","$388.25 ","$388.25 ","$0.00 ","$544.00 ","$0.00 ","$272.00 ","$430.85 ","$435.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011094","EAP","Custom 27011094","","Coil Pusher Trupush","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,228.00 ","$0.00 ","$0.00 ","$0.00 ","$876.42 ","$876.42 ","$0.00 ","$1,228.00 ","$0.00 ","$614.00 ","$972.58 ","$982.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011095","EAP","Custom 27011095","","Connector Ureteral Catheter","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011096","EAP","Custom 27011096","","Connectory Tuohy","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011097","EAP","Custom 27011097","","Contra 2","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011098","EAP","Custom 27011098","","Contra Flush Catheter","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$142.03 ","$142.03 ","$0.00 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011099","EAP","Custom 27011099","","Cope Suture Anchor Set","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$142.03 ","$142.03 ","$0.00 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011105","EAP","Custom 27011105","","Embolization 38-4-3","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011106","EAP","Custom 27011106","","Embolization 38-8-15","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011107","EAP","Custom 27011107","","Embolization Coil 38-5-5","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011108","EAP","Custom 27011108","","Embolization Coils 38-2-3","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011109","EAP","Custom 27011109","","Embolization Coils 38-4-2","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011110","EAP","Custom 27011110","","Embolization Coils 38-5-10","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011111","EAP","Custom 27011111","","Face Shields","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011112","EAP","Custom 27011112","","Filling Station Plus (neuro)","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011113","EAP","Custom 27011113","","Filter Jugular G-2","BOTH IP/OP","$4,337.00 ","$3,209.38 ","$0.00 ","$4,337.00 ","$0.00 ","$0.00 ","$0.00 ","$3,095.32 ","$3,095.32 ","$0.00 ","$4,337.00 ","$0.00 ","$2,168.50 ","$3,434.90 ","$3,469.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011114","EAP","Custom 27011114","","Flo-switch Hp","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$271.21 ","$271.21 ","$0.00 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011120","EAP","Custom 27011120","","Forearm Based Outrigger","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011121","EAP","Custom 27011121","","Gtgw.180cm-45deg Angle","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$357.56 ","$357.56 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011122","EAP","Custom 27011122","","Hemostasis V-pad","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011124","EAP","Custom 27011124","","Igtcfs-65-fem Celect Perm Cook","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$0.00 ","$0.00 ","$0.00 ","$2,858.37 ","$2,858.37 ","$0.00 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011125","EAP","HCPCS C1880","","Igtcfs-65-jugcelet Perm Cook","BOTH IP/OP","$4,536.00 ","$3,356.64 ","$0.00 ","$4,536.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.34 ","$3,237.34 ","$794.22 ","$4,536.00 ","$0.00 ","$2,268.00 ","$3,592.51 ","$3,628.80 ","$0.00 ","$709.88 ","$0.00 ","$722.13 ","$0.00 "
"27011126","EAP","Custom 27011126","","Inflation Device Monarch-25","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$131.32 ","$131.32 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011127","EAP","Custom 27011127","","Introducer Mpis-401","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011128","EAP","Custom 27011128","","Introducer Pinnacle 5fr 10cm","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$0.00 ","$0.00 ","$0.00 ","$47.82 ","$47.82 ","$0.00 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011129","EAP","Custom 27011129","","Jcd 10.0-38-20","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011130","EAP","Custom 27011130","","Jcd 12.0-38-20","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011131","EAP","Custom 27011131","","Jcd 14.0-38-20","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011132","EAP","Custom 27011132","","Jcd 16.0-38-20","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011133","EAP","Custom 27011133","","Jcd 4.0-25-20","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011134","EAP","Custom 27011134","","Jcd 5.0-38-20","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011135","EAP","Custom 27011135","","Jcd 6.0-38-20","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011136","EAP","Custom 27011136","","Jcd 7.0-38-20","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011137","EAP","Custom 27011137","","Jcd 8.0-38-20","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011138","EAP","Custom 27011138","","Jcd 9.0-38-20","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011139","EAP","Custom 27011139","","Jcd-20.0-38-20 Dilator","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011140","EAP","Custom 27011140","","Jcd-22.0-38-20 Dilator","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011141","EAP","Custom 27011141","","Jcd-24.0-38-20 Dilator","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011142","EAP","Custom 27011142","","Jcd-d18.0-38-20 Dilator","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011143","EAP","Custom 27011143","","Kinair Iii W/o Scale","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$137.03 ","$137.03 ","$0.00 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011148","EAP","Custom 27011148","","Kit Angio Saftey With J Wire","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$127.04 ","$127.04 ","$0.00 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011149","EAP","Custom 27011149","","Kit Fallopian Tube","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$349.00 ","$0.00 ","$0.00 ","$0.00 ","$249.08 ","$249.08 ","$0.00 ","$349.00 ","$0.00 ","$174.50 ","$276.41 ","$279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011150","EAP","Custom 27011150","","Kit Gastrostomy 18fr","BOTH IP/OP","$541.00 ","$400.34 ","$0.00 ","$541.00 ","$0.00 ","$0.00 ","$0.00 ","$386.11 ","$386.11 ","$0.00 ","$541.00 ","$0.00 ","$270.50 ","$428.47 ","$432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011151","EAP","Custom 27011151","","Kit Mahurkar 12f Triple Lumen","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011152","EAP","Custom 27011152","","Kit Pressure Monitoring T","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$0.00 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011153","EAP","Custom 27011153","","Kit Pressure Monitoring T","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011154","EAP","Custom 27011154","","Kit Triple Lumen Catheter","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$726.00 ","$0.00 ","$0.00 ","$0.00 ","$518.15 ","$518.15 ","$0.00 ","$726.00 ","$0.00 ","$363.00 ","$574.99 ","$580.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011156","EAP","Custom 27011156","","Lancet  Grady Orange","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011157","EAP","Custom 27011157","","Line Connecting 36 Hp","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011158","EAP","Custom 27011158","","Line Connecting 48 Hp","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011160","EAP","Custom 27011160","","Mask Sub-micron Small","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011161","EAP","Custom 27011161","","Med/surg Semi Supplies","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011162","EAP","Custom 27011162","","Microsphere Embogold 500-700","BOTH IP/OP","$734.00 ","$543.16 ","$0.00 ","$734.00 ","$0.00 ","$0.00 ","$0.00 ","$523.86 ","$523.86 ","$0.00 ","$734.00 ","$0.00 ","$367.00 ","$581.33 ","$587.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011163","EAP","Custom 27011163","","Microsphere Embogold 700-900","BOTH IP/OP","$734.00 ","$543.16 ","$0.00 ","$734.00 ","$0.00 ","$0.00 ","$0.00 ","$523.86 ","$523.86 ","$0.00 ","$734.00 ","$0.00 ","$367.00 ","$581.33 ","$587.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011164","EAP","Custom 27011164","","Microsphere Embogold 900-1200","BOTH IP/OP","$3,669.00 ","$2,715.06 ","$0.00 ","$3,669.00 ","$0.00 ","$0.00 ","$0.00 ","$2,618.57 ","$2,618.57 ","$0.00 ","$3,669.00 ","$0.00 ","$1,834.50 ","$2,905.85 ","$2,935.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011165","EAP","Custom 27011165","","Needle Chiba 22ga X 15cm","BOTH IP/OP","$82.00 ","$60.68 ","$0.00 ","$82.00 ","$0.00 ","$0.00 ","$0.00 ","$58.52 ","$58.52 ","$0.00 ","$82.00 ","$0.00 ","$41.00 ","$64.94 ","$65.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011166","EAP","Custom 27011166","","Needle Hypodermic Sterile","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011167","EAP","Custom 27011167","","Needle Hypodermic Sterile","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011168","EAP","Custom 27011168","","Needle Port-cath 20ga X 1","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011169","EAP","Custom 27011169","","Needle Port-cath 20ga X 1","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011172","EAP","Custom 27011172","","Olcott Torque Device","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011176","EAP","Custom 27011176","","Perc Gastrostomy Set","BOTH IP/OP","$1,079.00 ","$798.46 ","$0.00 ","$1,079.00 ","$0.00 ","$0.00 ","$0.00 ","$770.08 ","$770.08 ","$0.00 ","$1,079.00 ","$0.00 ","$539.50 ","$854.57 ","$863.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011177","EAP","Custom 27011177","","Polar Cath Inflation Unit","BOTH IP/OP","$7,912.00 ","$5,854.88 ","$0.00 ","$7,912.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,912.00 ","$0.00 ","$3,956.00 ","$6,266.30 ","$6,329.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011178","EAP","Custom 27011178","","Port Peritoneal/drain/ascites","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,070.00 ","$0.00 ","$0.00 ","$0.00 ","$763.66 ","$763.66 ","$0.00 ","$1,070.00 ","$0.00 ","$535.00 ","$847.44 ","$856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011179","EAP","Custom 27011179","","Pressure Tubing","BOTH IP/OP","$555.00 ","$410.70 ","$0.00 ","$555.00 ","$0.00 ","$0.00 ","$0.00 ","$396.10 ","$396.10 ","$0.00 ","$555.00 ","$0.00 ","$277.50 ","$439.56 ","$444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011181","EAP","Custom 27011181","","Rapad Shield","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011182","EAP","Custom 27011182","","Recovery Cone Removal System","BOTH IP/OP","$1,985.00 ","$1,468.90 ","$0.00 ","$1,985.00 ","$0.00 ","$0.00 ","$0.00 ","$1,416.69 ","$1,416.69 ","$0.00 ","$1,985.00 ","$0.00 ","$992.50 ","$1,572.12 ","$1,588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011183","EAP","Custom 27011183","","Retention Device 10fr","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011184","EAP","Custom 27011184","","Retention Device 12fr","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011185","EAP","Custom 27011185","","Retention Device 8fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011190","EAP","Custom 27011190","","Ring Transjugular Set","BOTH IP/OP","$1,404.00 ","$1,038.96 ","$0.00 ","$1,404.00 ","$0.00 ","$0.00 ","$0.00 ","$1,002.03 ","$1,002.03 ","$0.00 ","$1,404.00 ","$0.00 ","$702.00 ","$1,111.97 ","$1,123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011194","EAP","Custom 27011194","","Safety Angio Kit","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$0.00 ","$0.00 ","$0.00 ","$90.64 ","$90.64 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011195","EAP","Custom 27011195","","Safety Peg Kit Moni Bolster","BOTH IP/OP","$1,497.00 ","$1,107.78 ","$0.00 ","$1,497.00 ","$0.00 ","$0.00 ","$0.00 ","$1,068.41 ","$1,068.41 ","$0.00 ","$1,497.00 ","$0.00 ","$748.50 ","$1,185.62 ","$1,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011196","EAP","Custom 27011196","","Scaple Surg W/handle Attached","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011197","EAP","Custom 27011197","","Set Blood Administration","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011198","EAP","Custom 27011198","","Set Blood Adminstration","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011199","EAP","Custom 27011199","","Set Blood Adminstration","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011200","EAP","Custom 27011200","","Set Liver Biopsy Labs-100","BOTH IP/OP","$1,409.00 ","$1,042.66 ","$0.00 ","$1,409.00 ","$0.00 ","$0.00 ","$0.00 ","$1,005.60 ","$1,005.60 ","$0.00 ","$1,409.00 ","$0.00 ","$704.50 ","$1,115.93 ","$1,127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011201","EAP","Custom 27011201","","Set Mediport Infusion W/i","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011202","EAP","Custom 27011202","","Set Neff Perc Access","BOTH IP/OP","$244.00 ","$180.56 ","$0.00 ","$244.00 ","$0.00 ","$0.00 ","$0.00 ","$174.14 ","$174.14 ","$0.00 ","$244.00 ","$0.00 ","$122.00 ","$193.25 ","$195.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011203","EAP","Custom 27011203","","Set Pca Mini-bore W/int A","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011204","EAP","Custom 27011204","","Set Scalp  Vein Infusion 21 G","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011207","EAP","Custom 27011207","","Set Scalp Vein Infusion 2","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011208","EAP","Custom 27011208","","Set Secondary Piggy Back","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011209","EAP","Custom 27011209","","Set Urinary Drain W/conta","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011212","EAP","Custom 27011212","","Simon-nitinol Vena Cava Filte","BOTH IP/OP","$3,605.00 ","$2,667.70 ","$0.00 ","$3,605.00 ","$0.00 ","$0.00 ","$0.00 ","$2,572.89 ","$2,572.89 ","$0.00 ","$3,605.00 ","$0.00 ","$1,802.50 ","$2,855.16 ","$2,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011213","EAP","Custom 27011213","","Simon-nitinol Vena Filter An","BOTH IP/OP","$3,085.00 ","$2,282.90 ","$0.00 ","$3,085.00 ","$0.00 ","$0.00 ","$0.00 ","$2,201.76 ","$2,201.76 ","$0.00 ","$3,085.00 ","$0.00 ","$1,542.50 ","$2,443.32 ","$2,468.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011214","EAP","Custom 27011214","","Skater Introducer System","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$181.28 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011215","EAP","HCPCS C1729","","Skater Nephro Cath 8fr X 35cm","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$156.38 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27011216","EAP","Custom 27011216","","Snare Amplatz 10mm","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$653.75 ","$653.75 ","$0.00 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011217","EAP","Custom 27011217","","Snare Amplatz 5mm","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$653.75 ","$653.75 ","$0.00 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011226","EAP","Custom 27011226","","Sponge Gelfoam Gelatin","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$60.66 ","$60.66 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011227","EAP","HCPCS C1876","","Stent Vascular Covera Covered 10mm X 60mm 80cm Delivery","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"27011228","EAP","Custom 27011228","","Stent Luminex 12x60","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011229","EAP","Custom 27011229","","Stent Luminexx 7x30","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011230","EAP","Custom 27011230","","Stent Luminexx 7x40","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011231","EAP","Custom 27011231","","Stent Luminexx 8x40","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011232","EAP","Custom 27011232","","Stent Luminexx Stent 8x30","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011233","EAP","Custom 27011233","","Stiff Micropunture 5fr","BOTH IP/OP","$153.00 ","$113.22 ","$0.00 ","$153.00 ","$0.00 ","$0.00 ","$0.00 ","$109.20 ","$109.20 ","$0.00 ","$153.00 ","$0.00 ","$76.50 ","$121.18 ","$122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011234","EAP","Custom 27011234","","Stopcock 1-way Hp","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011236","EAP","Custom 27011236","","Stopcock 3-way Hp","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011237","EAP","Custom 27011237","","Supplies, Non-sterile Penumbra","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$47.10 ","$47.10 ","$0.00 ","$66.00 ","$0.00 ","$33.00 ","$52.27 ","$52.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011241","EAP","Custom 27011241","","Threapulse Ii","BOTH IP/OP","$581.00 ","$429.94 ","$0.00 ","$581.00 ","$0.00 ","$0.00 ","$0.00 ","$414.66 ","$414.66 ","$0.00 ","$581.00 ","$0.00 ","$290.50 ","$460.15 ","$464.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011242","EAP","Custom 27011242","","Tray Catheter Urethral 14","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011243","EAP","Custom 27011243","","Tray Foley Perconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011244","EAP","Custom 27011244","","Tray Foley Perconnected 1","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011245","EAP","Custom 27011245","","Tray Foley Preconnected 1","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011246","EAP","Custom 27011246","","Tray Foley Preconnected 1","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011252","EAP","Custom 27011252","","Triple Lumen Catheter Size 24","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011253","EAP","Custom 27011253","","Tube  Feeding Ng  8fr 43in En","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$48.53 ","$48.53 ","$0.00 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011254","EAP","Custom 27011254","","Tube Feeding Ng 8fr 36in Entr","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011255","EAP","Custom 27011255","","Tube Gastrostomy 18fr","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$57.10 ","$57.10 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011256","EAP","Custom 27011256","","Tube Gastrostomy 22fr","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$54.24 ","$54.24 ","$0.00 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011257","EAP","Custom 27011257","","Tube Jejunal Feeding 18 Fr O.d","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011258","EAP","Custom 27011258","","Tube Jejunostomy Feed 14 Fr","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$357.56 ","$357.56 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011259","EAP","Custom 27011259","","Tube Salem Silicone Size","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011260","EAP","Custom 27011260","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011261","EAP","Custom 27011261","","Tube Tj Feeding 18 Fr 45cm End","BOTH IP/OP","$651.00 ","$481.74 ","$0.00 ","$651.00 ","$0.00 ","$0.00 ","$0.00 ","$464.62 ","$464.62 ","$0.00 ","$651.00 ","$0.00 ","$325.50 ","$515.59 ","$520.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011262","EAP","Custom 27011262","","Tube Tj Feeding 22 Fr 45cm End","BOTH IP/OP","$651.00 ","$481.74 ","$0.00 ","$651.00 ","$0.00 ","$0.00 ","$0.00 ","$464.62 ","$464.62 ","$0.00 ","$651.00 ","$0.00 ","$325.50 ","$515.59 ","$520.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011263","EAP","Custom 27011263","","Tubes Extension Plain Pla","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011265","EAP","Custom 27011265","","Tubes Extension Plain Pla","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011266","EAP","Custom 27011266","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011267","EAP","Custom 27011267","","Ultrasound Probe Covers","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$32.83 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011268","EAP","Custom 27011268","","Valve Reflux","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011269","EAP","Custom 27011269","","Valve Reflux","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011270","EAP","Custom 27011270","",".014 Nitrex Guidewire","BOTH IP/OP","$1,219.00 ","$902.06 ","$0.00 ","$1,219.00 ","$0.00 ","$0.00 ","$0.00 ","$870.00 ","$870.00 ","$0.00 ","$1,219.00 ","$0.00 ","$609.50 ","$965.45 ","$975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011301","EAP","Custom 27011301","","Drsg Anti Sft Sil 8x20 20x50cm","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$0.00 ","$0.00 ","$0.00 ","$177.00 ","$177.00 ","$0.00 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011302","EAP","Custom 27011302","","Drsg Anti Sft Sil 8x20 20x50cm","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$0.00 ","$0.00 ","$0.00 ","$177.00 ","$177.00 ","$0.00 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011304","EAP","Custom 27011304","","Blood Administration Set","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$79.22 ","$79.22 ","$0.00 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011305","EAP","Custom 27011305","","Drsng Anti Sft Sil 6x6 15x15cm","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011306","EAP","Custom 27011306","","Drsng Anti Sft Sil 6x6 15x15cm","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011308","EAP","Custom 27011308","","Drsng Anti Sft Sil 4x4 10x10cm","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011309","EAP","Custom 27011309","","Drsng Anti Sft Sil 4x4 10x10cm","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$0.00 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011310","EAP","HCPCS C1769","","Volcano Combowire","BOTH IP/OP","$3,669.00 ","$2,715.06 ","$0.00 ","$3,669.00 ","$1,992.27 ","$0.00 ","$764.71 ","$2,618.57 ","$2,618.57 ","$642.41 ","$3,669.00 ","$0.00 ","$1,834.50 ","$2,905.85 ","$2,935.20 ","$0.00 ","$574.20 ","$0.00 ","$584.10 ","$0.00 "
"27011320","EAP","Custom 27011320","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011323","EAP","Custom 27011323","","Jcd 9.0-38-20","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011324","EAP","Custom 27011324","","Jcd 6.0-38-20","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$0.00 ","$0.00 ","$0.00 ","$119.19 ","$119.19 ","$0.00 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011325","EAP","Custom 27011325","","Tube Salem Sump 48 Lengt","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011326","EAP","Custom 27011326","","Tubes Salem Sump 48 Leng","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011327","EAP","Custom 27011327","","Jcd 9.0-38-20","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011328","EAP","Custom 27011328","","Jcd 6.0-38-20","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011401","EAP","Custom 27011401","","Super Arrow Flex Introducer -","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$251.00 ","$0.00 ","$0.00 ","$0.00 ","$179.14 ","$179.14 ","$0.00 ","$251.00 ","$0.00 ","$125.50 ","$198.79 ","$200.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011410","EAP","Custom 27011410","","Tube Trach #8 Dct","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011411","EAP","Custom 27011411","","Tube Trache 8-dcfs","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$89.93 ","$89.93 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011413","EAP","Custom 27011413","","Bag Resusitator Adult","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011421","EAP","Custom 27011421","","Blade On Titanium Lopro S3","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$67.80 ","$67.80 ","$0.00 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011422","EAP","Custom 27011422","","Blade On Titanium Lopro S4","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$67.80 ","$67.80 ","$0.00 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011423","EAP","Custom 27011423","","Kit 135cm 2.7fr 20mm Img 1 Syr Rapex Tip Radiopq","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$0.00 ","$0.00 ","$0.00 ","$1,338.19 ","$1,338.19 ","$0.00 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011425","EAP","Custom 27011425","","Mic Transgastric Jejunal Feeding Kit 18f 45cm","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$356.85 ","$356.85 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011426","EAP","HCPCS C1729","","Catheter Urethral 16fr Foley 2","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$159.87 ","$159.87 ","$39.22 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$35.06 ","$0.00 ","$35.66 ","$0.00 "
"27011427","EAP","HCPCS A4649","","Medihoney Dressing 1.5oz Tube","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$4.38 ","$0.00 ","$4.46 ","$0.00 "
"27011428","EAP","","","Tube Gstrm 12fr 10cm 5-7ml Entuit Bln Rtnt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011429","EAP","","","Tube Fd Std 14fr 10cm 5ml Entuit Thrive Bln Rtnt Sm Gstrm","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011430","EAP","","","Tube Fd Std 16fr 10cm 5ml Entuit Thrive Bln Rtnt Med Gstrm","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011431","EAP","","","Tube Gstrm Std 18fr 10cm 5ml 60ml Entuit Thrive Bln Rtnt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011432","EAP","","","Tube Fd Std 20fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011433","EAP","","","Tube Fd Std 22fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011434","EAP","","","Tube Fd Std 24fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011435","EAP","","","Kit Tracheostomy 12.3mm 9mm Complete Set Inner Cannu","BOTH IP/OP","$1,255.00 ","$928.70 ","$0.00 ","$1,255.00 ","$0.00 ","$0.00 ","$0.00 ","$895.69 ","$895.69 ","$0.00 ","$1,255.00 ","$0.00 ","$627.50 ","$993.96 ","$1,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011436","EAP","","","Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp","BOTH IP/OP","$701.00 ","$518.74 ","$0.00 ","$701.00 ","$0.00 ","$0.00 ","$0.00 ","$500.30 ","$500.30 ","$0.00 ","$701.00 ","$0.00 ","$350.50 ","$555.19 ","$560.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27011437","EAP","Custom 27011437","","Blanket Wrm 84x36in Clr Strl Lf 24x48in 3m Br Hgr Full Acc","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27100021","EAP","Custom 27100021","","Pad Gel Hypo-hyperthermia Large","BOTH IP/OP","$2,481.00 ","$1,835.94 ","$0.00 ","$2,481.00 ","$0.00 ","$0.00 ","$0.00 ","$1,770.69 ","$1,770.69 ","$0.00 ","$2,481.00 ","$0.00 ","$1,240.50 ","$1,964.95 ","$1,984.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27100022","EAP","HCPCS A4467","","POSTERIOR ELBOW SPLINT","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$112.00 ","$60.82 ","$0.00 ","$0.00 ","$79.93 ","$79.93 ","$0.00 ","$112.00 ","$0.00 ","$56.00 ","$88.70 ","$89.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27100023","EAP","Custom 27100023","","M�lnlycke Z-flo Fluidized Positioner Pad","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$122.00 ","$0.00 ","$0.00 ","$0.00 ","$87.07 ","$87.07 ","$0.00 ","$122.00 ","$0.00 ","$61.00 ","$96.62 ","$97.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27100031","EAP","Custom 27100031","","Resuscitator Manual Medium 10f","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$19.27 ","$19.27 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27100040","EAP","","","Sup Ortho Universal Abd Binder Velcro Closure","BOTH IP/OP","$538.00 ","$398.12 ","$0.00 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$383.97 ","$383.97 ","$0.00 ","$538.00 ","$0.00 ","$269.00 ","$426.10 ","$430.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200003","EAP","Custom 27200003","","Chest Unit Drainage Pleur","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$54.24 ","$54.24 ","$0.00 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200008","EAP","HCPCS C1769","",".014 Nitrex Guidewire","BOTH IP/OP","$1,295.00 ","$958.30 ","$0.00 ","$1,295.00 ","$703.19 ","$0.00 ","$269.91 ","$924.24 ","$924.24 ","$226.74 ","$1,295.00 ","$0.00 ","$647.50 ","$1,025.64 ","$1,036.00 ","$0.00 ","$202.67 ","$0.00 ","$206.16 ","$0.00 "
"27200011","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27200019","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$3.26 ","$0.00 ","$1.25 ","$4.28 ","$4.28 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"27200021","EAP","HCPCS C1729","","Catheter Foley 30cc 28fr","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$19.55 ","$0.00 ","$7.50 ","$25.69 ","$25.69 ","$6.30 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$5.63 ","$0.00 ","$5.73 ","$0.00 "
"27200024","EAP","HCPCS C1729","","Catheter Foley 3cc 10 Fr","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$18.46 ","$0.00 ","$7.09 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"27200025","EAP","HCPCS C1729","","Catheter Foley 5cc 12fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27200026","EAP","Custom 27200026","","Dress Sofsorb Absorb Buttoc Sm","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200027","EAP","Custom 27200027","","Dress Sofsorb Absorb Butto Lg","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$0.00 ","$69.23 ","$69.23 ","$0.00 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200028","EAP","Custom 27200028","","Dress Sofsorb Absorb Chest Ssm","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$0.00 ","$0.00 ","$0.00 ","$29.26 ","$29.26 ","$0.00 ","$41.00 ","$0.00 ","$20.50 ","$32.47 ","$32.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200029","EAP","Custom 27200029","","Dress Sofsorb Absors Chest Ilg","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$0.00 ","$0.00 ","$0.00 ","$29.26 ","$29.26 ","$0.00 ","$41.00 ","$0.00 ","$20.50 ","$32.47 ","$32.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200030","EAP","Custom 27200030","","Dress Sofsorb Absorb Xl Chest","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200031","EAP","Custom 27200031","","Dressing Leg/hip Adult","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$62.09 ","$62.09 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200032","EAP","Custom 27200032","","Dressing Burn Gauze 17 Ply 36'","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200033","EAP","HCPCS C1751","","Kit Cath Triple Lumen 5.5 Pedi","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$159.00 ","$86.34 ","$0.00 ","$33.14 ","$113.48 ","$113.48 ","$27.84 ","$159.00 ","$0.00 ","$79.50 ","$125.93 ","$127.20 ","$0.00 ","$24.88 ","$0.00 ","$25.31 ","$0.00 "
"27200035","EAP","HCPCS C1751","","Femoral Arterial Line Cath Kit","BOTH IP/OP","$873.00 ","$646.02 ","$0.00 ","$873.00 ","$474.04 ","$0.00 ","$181.96 ","$623.06 ","$623.06 ","$152.86 ","$873.00 ","$0.00 ","$436.50 ","$691.42 ","$698.40 ","$0.00 ","$136.62 ","$0.00 ","$138.98 ","$0.00 "
"27200040","EAP","Custom 27200040","","Kit Transducer Monitoring","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200041","EAP","Custom 27200041","","Kit  Pressure Monitoring","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$77.08 ","$77.08 ","$0.00 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200043","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$3.26 ","$0.00 ","$1.25 ","$4.28 ","$4.28 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"27200045","EAP","Custom 27200045","","Paracentesis Tray","BOTH IP/OP","$214.00 ","$158.36 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$152.73 ","$152.73 ","$0.00 ","$214.00 ","$0.00 ","$107.00 ","$169.49 ","$171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200047","EAP","Custom 27200047","","Biliary Plastic Stents","BOTH IP/OP","$1,091.00 ","$807.34 ","$0.00 ","$1,091.00 ","$0.00 ","$0.00 ","$0.00 ","$778.65 ","$778.65 ","$0.00 ","$1,091.00 ","$0.00 ","$545.50 ","$864.07 ","$872.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200048","EAP","HCPCS C1769","","Hydratomes Rx Cannulating Sphi","BOTH IP/OP","$3,556.00 ","$2,631.44 ","$0.00 ","$3,556.00 ","$1,930.91 ","$0.00 ","$741.16 ","$2,537.92 ","$2,537.92 ","$622.63 ","$3,556.00 ","$0.00 ","$1,778.00 ","$2,816.35 ","$2,844.80 ","$0.00 ","$556.51 ","$0.00 ","$566.12 ","$0.00 "
"27200049","EAP","HCPCS C1769","","Jagtomes Rx Cannulating Sphinc","BOTH IP/OP","$1,255.00 ","$928.70 ","$0.00 ","$1,255.00 ","$681.47 ","$0.00 ","$261.57 ","$895.69 ","$895.69 ","$219.74 ","$1,255.00 ","$0.00 ","$627.50 ","$993.96 ","$1,004.00 ","$0.00 ","$196.41 ","$0.00 ","$199.80 ","$0.00 "
"27200050","EAP","Custom 27200050","","Extractor Balloon","BOTH IP/OP","$1,388.00 ","$1,027.12 ","$0.00 ","$1,388.00 ","$0.00 ","$0.00 ","$0.00 ","$990.62 ","$990.62 ","$0.00 ","$1,388.00 ","$0.00 ","$694.00 ","$1,099.30 ","$1,110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200051","EAP","Custom 27200051","","Trapezoid Retrieval Baskets","BOTH IP/OP","$2,263.00 ","$1,674.62 ","$0.00 ","$2,263.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.10 ","$1,615.10 ","$0.00 ","$2,263.00 ","$0.00 ","$1,131.50 ","$1,792.30 ","$1,810.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200052","EAP","Custom 27200052","","Endoprosthesis Metal Stent","BOTH IP/OP","$9,693.00 ","$7,172.82 ","$0.00 ","$9,693.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,693.00 ","$0.00 ","$4,846.50 ","$7,676.86 ","$7,754.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200053","EAP","Custom 27200053","","Esophageal Stent","BOTH IP/OP","$11,672.00 ","$8,637.28 ","$0.00 ","$11,672.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,672.00 ","$0.00 ","$5,836.00 ","$9,244.22 ","$9,337.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200054","EAP","Custom 27200054","","Colonic And Duodenal Stent","BOTH IP/OP","$16,179.00 ","$11,972.46 ","$0.00 ","$16,179.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$16,179.00 ","$0.00 ","$8,089.50 ","$12,813.77 ","$12,943.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200055","EAP","HCPCS C1726","","Cre Balloons","BOTH IP/OP","$1,523.00 ","$1,127.02 ","$0.00 ","$1,523.00 ","$826.99 ","$0.00 ","$317.43 ","$1,086.97 ","$1,086.97 ","$266.67 ","$1,523.00 ","$0.00 ","$761.50 ","$1,206.22 ","$1,218.40 ","$0.00 ","$238.35 ","$0.00 ","$242.46 ","$0.00 "
"27200056","EAP","Custom 27200056","","Esophageal/pyloric Balloon Dil","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$1,248.98 ","$1,248.98 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200057","EAP","Custom 27200057","","Esophageal/pyloric/colonic  Ba","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$1,248.98 ","$1,248.98 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200058","EAP","Custom 27200058","","O2 Supply-each","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200060","EAP","Custom 27200060","","Venous Port - Maintenance","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$131.32 ","$131.32 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200061","EAP","Custom 27200061","","Dressing","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200062","EAP","Custom 27200062","","Dressing, Burn Supplies","BOTH IP/OP","$206.00 ","$152.44 ","$0.00 ","$206.00 ","$0.00 ","$0.00 ","$0.00 ","$147.02 ","$147.02 ","$0.00 ","$206.00 ","$0.00 ","$103.00 ","$163.15 ","$164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200063","EAP","Custom 27200063","","Iv Start Supply","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200064","EAP","Custom 27200064","","Dressing, Burn Supplies","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$193.00 ","$0.00 ","$0.00 ","$0.00 ","$137.74 ","$137.74 ","$0.00 ","$193.00 ","$0.00 ","$96.50 ","$152.86 ","$154.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200065","EAP","Custom 27200065","","Splint Supply","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200066","EAP","Custom 27200066","","Nephrostomy Bag","BOTH IP/OP","$299.00 ","$221.26 ","$0.00 ","$299.00 ","$0.00 ","$0.00 ","$0.00 ","$213.40 ","$213.40 ","$0.00 ","$299.00 ","$0.00 ","$149.50 ","$236.81 ","$239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200067","EAP","Custom 27200067","","Dressing Change","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200068","EAP","HCPCS C1729","","Catheter Foley","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$18.46 ","$0.00 ","$7.09 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"27200069","EAP","Custom 27200069","","Leg Bag","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200070","EAP","Custom 27200070","","Urinary Drainage Bag","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200074","EAP","Custom 27200074","","Acticoat Dressing","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$224.82 ","$224.82 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200075","EAP","Custom 27200075","","Feeding/ng Tube","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200076","EAP","Custom 27200076","","Triple Lumen Cath","BOTH IP/OP","$222.00 ","$164.28 ","$0.00 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$158.44 ","$158.44 ","$0.00 ","$222.00 ","$0.00 ","$111.00 ","$175.82 ","$177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200077","EAP","Custom 27200077","","Transvenous Pacing Electrode","BOTH IP/OP","$389.00 ","$287.86 ","$0.00 ","$389.00 ","$0.00 ","$0.00 ","$0.00 ","$277.63 ","$277.63 ","$0.00 ","$389.00 ","$0.00 ","$194.50 ","$308.09 ","$311.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200080","EAP","Custom 27200080","","Injection, Iv, Antibiotic","BOTH IP/OP","$214.00 ","$158.36 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$152.73 ","$152.73 ","$0.00 ","$214.00 ","$0.00 ","$107.00 ","$169.49 ","$171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200081","EAP","Custom 27200081","","Steroid Injection, Iv Supply","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$137.03 ","$137.03 ","$0.00 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200082","EAP","Custom 27200082","","Iv Start, Supply","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200084","EAP","Custom 27200084","","Emerg Infus Catheter","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200085","EAP","Custom 27200085","","Ett, Laser","BOTH IP/OP","$897.00 ","$663.78 ","$0.00 ","$897.00 ","$0.00 ","$0.00 ","$0.00 ","$640.19 ","$640.19 ","$0.00 ","$897.00 ","$0.00 ","$448.50 ","$710.42 ","$717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200086","EAP","Custom 27200086","","Ett, Rae","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$84.22 ","$84.22 ","$0.00 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200087","EAP","Custom 27200087","","Ett, Wire Reinf","BOTH IP/OP","$362.00 ","$267.88 ","$0.00 ","$362.00 ","$0.00 ","$0.00 ","$0.00 ","$258.36 ","$258.36 ","$0.00 ","$362.00 ","$0.00 ","$181.00 ","$286.70 ","$289.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200088","EAP","Custom 27200088","","Ett, Endotrol/mlt","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200090","EAP","Custom 27200090","","Cvp Kit, Single Lumen","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200091","EAP","HCPCS C1756","","Swan Paceport Cath","BOTH IP/OP","$666.00 ","$492.84 ","$0.00 ","$666.00 ","$0.00 ","$0.00 ","$0.00 ","$475.32 ","$475.32 ","$0.00 ","$666.00 ","$0.00 ","$333.00 ","$527.47 ","$532.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200092","EAP","HCPCS C1751","","Cvp Kit Triple Lumen","BOTH IP/OP","$569.00 ","$421.06 ","$0.00 ","$569.00 ","$308.97 ","$0.00 ","$118.59 ","$406.10 ","$406.10 ","$99.63 ","$569.00 ","$0.00 ","$284.50 ","$450.65 ","$455.20 ","$0.00 ","$89.05 ","$0.00 ","$90.58 ","$0.00 "
"27200093","EAP","HCPCS C1756","","Swan Ganz Cath-bipolar Pacing","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$874.28 ","$874.28 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200094","EAP","HCPCS C1756","","Swan Pacing Td","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$1,719.30 ","$1,719.30 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200096","EAP","Custom 27200096","","Adult Iv Set-up","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200097","EAP","Custom 27200097","","Ett, Endotrol/mlt","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200098","EAP","Custom 27200098","","Cvp Kit, Single Lumen","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200099","EAP","HCPCS C1756","","Swan Paceport Cath","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$634.00 ","$0.00 ","$0.00 ","$0.00 ","$452.49 ","$452.49 ","$0.00 ","$634.00 ","$0.00 ","$317.00 ","$502.13 ","$507.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200100","EAP","Custom 27200100","","Cvp Kit Triple Lumen","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$0.00 ","$0.00 ","$0.00 ","$100.63 ","$100.63 ","$0.00 ","$141.00 ","$0.00 ","$70.50 ","$111.67 ","$112.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200101","EAP","HCPCS C1756","","Swan Bipolar","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$874.28 ","$874.28 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200102","EAP","HCPCS C1756","","Swan Pacing Td","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$1,719.30 ","$1,719.30 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200104","EAP","HCPCS C1729","","Catheter Foley 30cc 28fr","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$20.09 ","$0.00 ","$7.71 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"27200107","EAP","HCPCS L8680","","Implt Neurostim Elctr Each","BOTH IP/OP","$1,605.00 ","$1,187.70 ","$0.00 ","$1,605.00 ","$0.00 ","$0.00 ","$0.00 ","$1,145.49 ","$1,145.49 ","$0.00 ","$1,605.00 ","$0.00 ","$802.50 ","$1,271.16 ","$1,284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200108","EAP","Custom 27200108","","Regional Nerve Block Tray","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200109","EAP","Custom 27200109","","Epidural Tray","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200110","EAP","Custom 27200110","","Insulated Block Needle","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$32.83 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200111","EAP","Custom 27200111","","O2 Therapy-ea 8 Hrs","BOTH IP/OP","$296.00 ","$219.04 ","$0.00 ","$296.00 ","$0.00 ","$0.00 ","$0.00 ","$211.26 ","$211.26 ","$0.00 ","$296.00 ","$0.00 ","$148.00 ","$234.43 ","$236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200113","EAP","Custom 27200113","","Peak Flow Meter","BOTH IP/OP","$487.00 ","$360.38 ","$0.00 ","$487.00 ","$0.00 ","$0.00 ","$0.00 ","$347.57 ","$347.57 ","$0.00 ","$487.00 ","$0.00 ","$243.50 ","$385.70 ","$389.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200114","EAP","Custom 27200114","","Heart Nebulizer","BOTH IP/OP","$440.00 ","$325.60 ","$0.00 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$314.03 ","$314.03 ","$0.00 ","$440.00 ","$0.00 ","$220.00 ","$348.48 ","$352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200115","EAP","Custom 27200115","","Mini Heart","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$302.61 ","$302.61 ","$0.00 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200116","EAP","Custom 27200116","","Mdi Spacer","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$137.03 ","$137.03 ","$0.00 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200117","EAP","Custom 27200117","","Inc Spir-disposable","BOTH IP/OP","$319.00 ","$236.06 ","$0.00 ","$319.00 ","$0.00 ","$0.00 ","$0.00 ","$227.67 ","$227.67 ","$0.00 ","$319.00 ","$0.00 ","$159.50 ","$252.65 ","$255.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200118","EAP","Custom 27200118","","Inner Cannula","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$134.00 ","$0.00 ","$0.00 ","$0.00 ","$95.64 ","$95.64 ","$0.00 ","$134.00 ","$0.00 ","$67.00 ","$106.13 ","$107.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200119","EAP","Custom 27200119","","Nasal Prongs","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200120","EAP","Custom 27200120","","Vent Kit Only","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$356.85 ","$356.85 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200124","EAP","Custom 27200124","","Meter Astech Peak Flow","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200125","EAP","Custom 27200125","","Sleep Apnea Supply Kit","BOTH IP/OP","$1,443.00 ","$1,067.82 ","$0.00 ","$1,443.00 ","$0.00 ","$0.00 ","$0.00 ","$1,029.87 ","$1,029.87 ","$0.00 ","$1,443.00 ","$0.00 ","$721.50 ","$1,142.86 ","$1,154.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200126","EAP","Custom 27200126","","Tracheostomy-pipe Cleaner","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$59.95 ","$59.95 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200128","EAP","Custom 27200128","","Tube Trach #8 Dct","BOTH IP/OP","$377.00 ","$278.98 ","$0.00 ","$377.00 ","$0.00 ","$0.00 ","$0.00 ","$269.06 ","$269.06 ","$0.00 ","$377.00 ","$0.00 ","$188.50 ","$298.58 ","$301.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200129","EAP","Custom 27200129","","Tube Trach #6 Dct","BOTH IP/OP","$377.00 ","$278.98 ","$0.00 ","$377.00 ","$0.00 ","$0.00 ","$0.00 ","$269.06 ","$269.06 ","$0.00 ","$377.00 ","$0.00 ","$188.50 ","$298.58 ","$301.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200130","EAP","Custom 27200130","","Tube Trach #10 Dct","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$239.09 ","$239.09 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200131","EAP","Custom 27200131","","Tube Tracheostomy 4-dcfs","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$244.09 ","$244.09 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200132","EAP","Custom 27200132","","Tube Tracheostomy 8-dcfs","BOTH IP/OP","$326.00 ","$241.24 ","$0.00 ","$326.00 ","$0.00 ","$0.00 ","$0.00 ","$232.67 ","$232.67 ","$0.00 ","$326.00 ","$0.00 ","$163.00 ","$258.19 ","$260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200133","EAP","Custom 27200133","","Mini Bal-broncho-alveolar Lava","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200134","EAP","Custom 27200134","","Cont Oxy Hood-pediatrics","BOTH IP/OP","$866.00 ","$640.84 ","$0.00 ","$866.00 ","$0.00 ","$0.00 ","$0.00 ","$618.06 ","$618.06 ","$0.00 ","$866.00 ","$0.00 ","$433.00 ","$685.87 ","$692.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200135","EAP","Custom 27200135","","He-ox Rx Airway Obs + Supply","BOTH IP/OP","$947.00 ","$700.78 ","$0.00 ","$947.00 ","$0.00 ","$0.00 ","$0.00 ","$675.87 ","$675.87 ","$0.00 ","$947.00 ","$0.00 ","$473.50 ","$750.02 ","$757.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200136","EAP","Custom 27200136","","Trach Tube/passy Muir","BOTH IP/OP","$554.00 ","$409.96 ","$0.00 ","$554.00 ","$0.00 ","$0.00 ","$0.00 ","$395.39 ","$395.39 ","$0.00 ","$554.00 ","$0.00 ","$277.00 ","$438.77 ","$443.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200137","EAP","Custom 27200137","","Intubation Specialty Tube","BOTH IP/OP","$1,545.00 ","$1,143.30 ","$0.00 ","$1,545.00 ","$0.00 ","$0.00 ","$0.00 ","$1,102.67 ","$1,102.67 ","$0.00 ","$1,545.00 ","$0.00 ","$772.50 ","$1,223.64 ","$1,236.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200138","EAP","Custom 27200138","","Pulse Oximetry Sensor","BOTH IP/OP","$292.00 ","$216.08 ","$0.00 ","$292.00 ","$0.00 ","$0.00 ","$0.00 ","$208.40 ","$208.40 ","$0.00 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200139","EAP","Custom 27200139","","Vent Circuit Kit","BOTH IP/OP","$423.00 ","$313.02 ","$0.00 ","$423.00 ","$0.00 ","$0.00 ","$0.00 ","$301.90 ","$301.90 ","$0.00 ","$423.00 ","$0.00 ","$211.50 ","$335.02 ","$338.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200140","EAP","Custom 27200140","","Specialty Vent Circuit Kit","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$706.56 ","$706.56 ","$0.00 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200143","EAP","Custom 27200143","","Blood Gas Kit","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$79.93 ","$79.93 ","$0.00 ","$112.00 ","$0.00 ","$56.00 ","$88.70 ","$89.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200144","EAP","HCPCS C1729","","Red Rubber Catheter","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$29.32 ","$0.00 ","$11.25 ","$38.54 ","$38.54 ","$9.45 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$8.45 ","$0.00 ","$8.60 ","$0.00 "
"27200145","EAP","Custom 27200145","","Air Vest-disposable","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$481.75 ","$481.75 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200148","EAP","Custom 27200148","","Iv Start, Supply","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200149","EAP","HCPCS C1769","","Guidewire:pressurewire:radi","BOTH IP/OP","$2,511.00 ","$1,858.14 ","$0.00 ","$2,511.00 ","$1,363.47 ","$0.00 ","$523.36 ","$1,792.10 ","$1,792.10 ","$439.66 ","$2,511.00 ","$0.00 ","$1,255.50 ","$1,988.71 ","$2,008.80 ","$0.00 ","$392.97 ","$0.00 ","$399.75 ","$0.00 "
"27200150","EAP","Custom 27200150","","Pericardiocentesis Kit","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$0.00 ","$0.00 ","$0.00 ","$421.80 ","$421.80 ","$0.00 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200151","EAP","HCPCS C1769","","Choice Pt X-support Guidewire","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$328.52 ","$0.00 ","$126.10 ","$431.79 ","$431.79 ","$105.93 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$94.68 ","$0.00 ","$96.32 ","$0.00 "
"27200152","EAP","HCPCS C1769","","Choice Pt Guidewire","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$328.52 ","$0.00 ","$126.10 ","$431.79 ","$431.79 ","$105.93 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$94.68 ","$0.00 ","$96.32 ","$0.00 "
"27200153","EAP","HCPCS C1769","","Glidewire .035 150cm  Angled","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"27200154","EAP","HCPCS C1892","","Custom Left Heart Kit W/transd","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"27200155","EAP","HCPCS C1892","","Custom Right Heart Kit W/trans","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$25.52 ","$0.00 ","$9.80 ","$33.54 ","$33.54 ","$8.23 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$7.36 ","$0.00 ","$7.48 ","$0.00 "
"27200156","EAP","HCPCS C2629","","Micropuncture Set","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"27200157","EAP","HCPCS C1769","",".025 X 260CM 7CM EMERALD GUIDEWIRE","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$11.40 ","$0.00 ","$4.38 ","$14.99 ","$14.99 ","$3.68 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$3.29 ","$0.00 ","$3.34 ","$0.00 "
"27200158","EAP","HCPCS C1887","","6fr Al 1 St Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200159","EAP","HCPCS C1887","","6fr Ar 2 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200160","EAP","HCPCS C1894","","6fr - 10cm  Avanti + Sheath In","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$18.46 ","$0.00 ","$7.09 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"27200161","EAP","HCPCS C1887","","6fr Jl4 St Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200162","EAP","HCPCS C1887","","6fr Mpa-1 Guiding Cath","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$102.63 ","$0.00 ","$39.39 ","$134.89 ","$134.89 ","$33.09 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$29.58 ","$0.00 ","$30.09 ","$0.00 "
"27200163","EAP","HCPCS C1887","","6ft Jr 4 St Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200164","EAP","HCPCS C1887","","7fr Ar 1 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200165","EAP","HCPCS C1887","","7fr Jr 3.5 Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200166","EAP","HCPCS C1887","","7fr H-stick Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200167","EAP","HCPCS C1887","","7fr Jl5 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200168","EAP","HCPCS C1887","","7fr Jr 4 St Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200169","EAP","HCPCS C1887","","7fr Jr 5 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200170","EAP","HCPCS C1887","","7fr Mpa-1 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200171","EAP","HCPCS C1887","","7fr Xb 3.5 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200172","EAP","HCPCS C1887","","7fr Xb 3.0 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200173","EAP","HCPCS C1887","","7fr Al 1 St Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200174","EAP","HCPCS C1887","","7fr Al 2 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200175","EAP","HCPCS C1887","","7fr Jr 4 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200176","EAP","HCPCS C1887","","7fr Im Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200177","EAP","HCPCS C1887","","6fr Ar 1 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200178","EAP","HCPCS C1887","","6fr Jl4 Sh Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200179","EAP","HCPCS C1887","","6fr Jr 4 Sh Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200180","EAP","HCPCS C1769","",".035 X 260CM 3CM  EMERALD GUIDEWIRE","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$11.95 ","$0.00 ","$4.59 ","$15.70 ","$15.70 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"27200181","EAP","HCPCS C1887","","6fr Xb 3 Sh Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200182","EAP","HCPCS C1887","","7fr Xb 3.5 Sh Guilding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200183","EAP","HCPCS C1887","","6fr Xb 3.5 Sh Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200184","EAP","HCPCS C1769","",".035 X 150CM 3CM EMERALD GUIDEWIRE","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$11.95 ","$0.00 ","$4.59 ","$15.70 ","$15.70 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"27200185","EAP","HCPCS C1887","","7fr Jl4 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200186","EAP","HCPCS C1887","","7fr Jl4 Sh Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200187","EAP","HCPCS C1887","","7fr Xb 4.0 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200188","EAP","HCPCS C1887","","7fr Jr 4 Sh Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200189","EAP","HCPCS C1887","","7fr Ar 1 Sh Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200190","EAP","HCPCS C1887","","6fr Al 1 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200191","EAP","HCPCS C1887","","6fr Xb 4.0 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200192","EAP","HCPCS C1887","","7fr Al 1 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200193","EAP","HCPCS C1887","","6fr Jl4 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200194","EAP","HCPCS C1887","","6fr Jr 4 Guiding Cath","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$102.63 ","$0.00 ","$39.39 ","$134.89 ","$134.89 ","$33.09 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$29.58 ","$0.00 ","$30.09 ","$0.00 "
"27200195","EAP","HCPCS C1887","","6fr Xb 3 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200196","EAP","HCPCS C1887","","6fr Xb 3.5 Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200197","EAP","HCPCS C1887","","6fr H-stick Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200198","EAP","HCPCS C1887","","6fr Jl3.5 Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200199","EAP","HCPCS C1887","","6fr Jr 3.5 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200200","EAP","HCPCS C1887","","6fr Al .75 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200201","EAP","HCPCS C1887","","7fr Al .75 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200202","EAP","HCPCS C1894","","7fr - 10cm Avanti + Sheath Int","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$18.46 ","$0.00 ","$7.09 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"27200203","EAP","HCPCS C1894","","8fr - 10cm Avanti + Sheath Int","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$18.46 ","$0.00 ","$7.09 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"27200204","EAP","HCPCS C1769","",".025 X 150cm Emerald Guidewire","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$11.40 ","$0.00 ","$4.38 ","$14.99 ","$14.99 ","$3.68 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$3.29 ","$0.00 ","$3.34 ","$0.00 "
"27200205","EAP","HCPCS C1769","","300cm Balanced Middleweight (b","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$156.38 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27200206","EAP","HCPCS C1769","","Amplatz Guidewire Super Stiff","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$47.24 ","$0.00 ","$18.13 ","$62.09 ","$62.09 ","$15.23 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$13.62 ","$0.00 ","$13.85 ","$0.00 "
"27200207","EAP","HCPCS C1751","","7fr-100cm Swan-ganz Td Cathete","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$102.63 ","$0.00 ","$39.39 ","$134.89 ","$134.89 ","$33.09 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$29.58 ","$0.00 ","$30.09 ","$0.00 "
"27200208","EAP","HCPCS C1894","","5fr - 10cm Avanti+sheath Intro","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$18.46 ","$0.00 ","$7.09 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$5.32 ","$0.00 ","$5.41 ","$0.00 "
"27200209","EAP","HCPCS C1887","","7fr Jl4 St Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200214","EAP","HCPCS C1884","","Filter Wire Ex-300cm","BOTH IP/OP","$5,361.00 ","$3,967.14 ","$0.00 ","$5,361.00 ","$2,911.02 ","$0.00 ","$1,117.37 ","$3,826.15 ","$3,826.15 ","$938.67 ","$5,361.00 ","$0.00 ","$2,680.50 ","$4,245.91 ","$4,288.80 ","$0.00 ","$839.00 ","$0.00 ","$853.47 ","$0.00 "
"27200215","EAP","HCPCS C1727","","2.50 X 15mm Cutting Balloon","BOTH IP/OP","$2,869.00 ","$2,123.06 ","$0.00 ","$2,869.00 ","$0.00 ","$0.00 ","$0.00 ","$2,047.61 ","$2,047.61 ","$0.00 ","$2,869.00 ","$0.00 ","$1,434.50 ","$2,272.25 ","$2,295.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200216","EAP","HCPCS C1727","","2.50 X 10cm Cutting Balloon","BOTH IP/OP","$2,869.00 ","$2,123.06 ","$0.00 ","$2,869.00 ","$0.00 ","$0.00 ","$0.00 ","$2,047.61 ","$2,047.61 ","$0.00 ","$2,869.00 ","$0.00 ","$1,434.50 ","$2,272.25 ","$2,295.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200218","EAP","HCPCS C1757","",".014-145cm Export Catheter","BOTH IP/OP","$1,865.00 ","$1,380.10 ","$0.00 ","$1,865.00 ","$1,012.70 ","$0.00 ","$388.71 ","$1,331.05 ","$1,331.05 ","$0.00 ","$1,865.00 ","$0.00 ","$932.50 ","$1,477.08 ","$1,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200219","EAP","HCPCS C1756","","Temporary Pace Eletrode Cathet","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$0.00 ","$0.00 ","$0.00 ","$421.80 ","$421.80 ","$0.00 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200220","EAP","HCPCS C1727","","Balloon Cutting Ultra Tube, 2.","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$1,837.06 ","$1,837.06 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200226","EAP","HCPCS C1725","","4.00 X 15mm Voyager Rx Balloon","BOTH IP/OP","$699.00 ","$517.26 ","$0.00 ","$699.00 ","$379.56 ","$0.00 ","$145.69 ","$498.88 ","$498.88 ","$122.39 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$109.39 ","$0.00 ","$111.28 ","$0.00 "
"27200227","EAP","HCPCS C1769","","190cm All-star Guidewire","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$156.38 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27200228","EAP","HCPCS C1769","","Choice X-support Guidewire","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$328.52 ","$0.00 ","$126.10 ","$431.79 ","$431.79 ","$105.93 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$94.68 ","$0.00 ","$96.32 ","$0.00 "
"27200229","EAP","HCPCS C1769","","Choice Standard Guidewire","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$328.52 ","$0.00 ","$126.10 ","$431.79 ","$431.79 ","$105.93 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$94.68 ","$0.00 ","$96.32 ","$0.00 "
"27200230","EAP","HCPCS C1887","","7fr Xb 3.0 Sh Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200231","EAP","HCPCS C1887","","6fr Al 2 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200238","EAP","HCPCS C1887","","7fr Ar 2 Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200239","EAP","HCPCS C1887","","7fr Jl3.5 Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200247","EAP","HCPCS C1887","","7fr Lcb Guiding Cath","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$108.06 ","$0.00 ","$41.48 ","$142.03 ","$142.03 ","$34.84 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$31.14 ","$0.00 ","$31.68 ","$0.00 "
"27200248","EAP","HCPCS C1887","","7fr Jr 4 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200249","EAP","HCPCS C1887","","7fr Ar 1 Guiding Cath","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200250","EAP","HCPCS C1769","","Glide Wire,.035 Straight","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$112.00 ","$60.82 ","$0.00 ","$23.34 ","$79.93 ","$79.93 ","$19.61 ","$112.00 ","$0.00 ","$56.00 ","$88.70 ","$89.60 ","$0.00 ","$17.53 ","$0.00 ","$17.83 ","$0.00 "
"27200251","EAP","HCPCS C1887","","6fr Mpa- 1 Guiding Cath","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200252","EAP","HCPCS C1769","","190cm J Tip Bmw Guidewire","BOTH IP/OP","$348.00 ","$257.52 ","$0.00 ","$348.00 ","$188.96 ","$0.00 ","$72.53 ","$248.37 ","$248.37 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$54.46 ","$0.00 ","$55.40 ","$0.00 "
"27200253","EAP","HCPCS C1726","","12frx28mmx70cm Inoue Balloon","BOTH IP/OP","$19,725.00 ","$14,596.50 ","$0.00 ","$19,725.00 ","$10,710.68 ","$0.00 ","$4,111.18 ","$5,158.80 ","$5,158.80 ","$3,453.69 ","$19,725.00 ","$0.00 ","$9,862.50 ","$15,622.20 ","$15,780.00 ","$0.00 ","$3,086.96 ","$0.00 ","$3,140.22 ","$0.00 "
"27200254","EAP","HCPCS C1887","","6fr H Stick Sh Guiding Cathete","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200255","EAP","HCPCS C1887","","6fr Al 1 Sh Guiding Catheter","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200256","EAP","HCPCS C1887","","6fr Al 2 Sh Guiding Catheter","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200257","EAP","HCPCS C1725","","2.0 X 9mm Maverick Monorail","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$497.39 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27200258","EAP","HCPCS C1725","","2.5 X 9mm Maverick Monorail","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$497.39 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27200259","EAP","HCPCS C1725","","3.0 X 9mm Maverick Monorail","BOTH IP/OP","$872.00 ","$645.28 ","$0.00 ","$872.00 ","$473.50 ","$0.00 ","$181.75 ","$622.35 ","$622.35 ","$152.68 ","$872.00 ","$0.00 ","$436.00 ","$690.62 ","$697.60 ","$0.00 ","$136.47 ","$0.00 ","$138.82 ","$0.00 "
"27200283","EAP","HCPCS C1769","","Hi-torque Pilot 50 Guide Wire","BOTH IP/OP","$302.00 ","$223.48 ","$0.00 ","$302.00 ","$163.99 ","$0.00 ","$62.94 ","$215.54 ","$215.54 ","$52.88 ","$302.00 ","$0.00 ","$151.00 ","$239.18 ","$241.60 ","$0.00 ","$47.26 ","$0.00 ","$48.08 ","$0.00 "
"27200285","EAP","HCPCS C1769","","Doc Guide Wire Extension","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$175.93 ","$0.00 ","$67.53 ","$231.24 ","$231.24 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"27200292","EAP","HCPCS C1725","","1.5 X 6 Sprinter Balloon","BOTH IP/OP","$853.00 ","$631.22 ","$0.00 ","$853.00 ","$463.18 ","$0.00 ","$177.79 ","$608.79 ","$608.79 ","$149.35 ","$853.00 ","$0.00 ","$426.50 ","$675.58 ","$682.40 ","$0.00 ","$133.49 ","$0.00 ","$135.80 ","$0.00 "
"27200294","EAP","HCPCS C1751","","7fr Wedge Pressure Cath","BOTH IP/OP","$153.00 ","$113.22 ","$0.00 ","$153.00 ","$83.08 ","$0.00 ","$31.89 ","$109.20 ","$109.20 ","$26.79 ","$153.00 ","$0.00 ","$76.50 ","$121.18 ","$122.40 ","$0.00 ","$23.94 ","$0.00 ","$24.36 ","$0.00 "
"27200295","EAP","Custom 27200295","","Cardiac Cath Pack","BOTH IP/OP","$190.00 ","$140.60 ","$0.00 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$135.60 ","$135.60 ","$0.00 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200296","EAP","Custom 27200296","","Contrast Inject Line-low Press","BOTH IP/OP","$7.00 ","$5.18 ","$0.00 ","$7.00 ","$0.00 ","$0.00 ","$0.00 ","$5.00 ","$5.00 ","$0.00 ","$7.00 ","$0.00 ","$3.50 ","$5.54 ","$5.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200297","EAP","Custom 27200297","","Implant Tray","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$212.00 ","$0.00 ","$0.00 ","$0.00 ","$151.30 ","$151.30 ","$0.00 ","$212.00 ","$0.00 ","$106.00 ","$167.90 ","$169.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200298","EAP","HCPCS C1893","","5fr - 10cm Pinnacle Introducer","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$20.63 ","$0.00 ","$7.92 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"27200299","EAP","HCPCS C1893","","6fr - 10cm Pinnacle Introducer","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$21.72 ","$0.00 ","$8.34 ","$28.55 ","$28.55 ","$7.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$6.26 ","$0.00 ","$6.37 ","$0.00 "
"27200300","EAP","HCPCS C1893","","7fr - 10cm Pinnacle Introducer","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$20.63 ","$0.00 ","$7.92 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"27200301","EAP","HCPCS C1893","","8fr - 10cm Pinnacle Introducer","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$20.63 ","$0.00 ","$7.92 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"27200302","EAP","HCPCS C1893","","6fr - 25cm Pinnacle Introducer","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"27200303","EAP","HCPCS C1893","","7fr - 25cm Pinnacle Introducer","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"27200304","EAP","HCPCS C1893","","8fr - 25cm Pinnacle Introducer","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"27200305","EAP","HCPCS C1887","","6fr Ebu 3.0 Guiding Catheter","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$102.63 ","$0.00 ","$39.39 ","$134.89 ","$134.89 ","$33.09 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$29.58 ","$0.00 ","$30.09 ","$0.00 "
"27200306","EAP","HCPCS C1887","","6fr Ebu 3.5 Guiding Catheter","BOTH IP/OP","$169.00 ","$125.06 ","$0.00 ","$169.00 ","$91.77 ","$0.00 ","$35.22 ","$120.62 ","$120.62 ","$29.59 ","$169.00 ","$0.00 ","$84.50 ","$133.85 ","$135.20 ","$0.00 ","$26.45 ","$0.00 ","$26.90 ","$0.00 "
"27200307","EAP","HCPCS C1887","","6fr Ebu 4.0 Guiding Catheter","BOTH IP/OP","$169.00 ","$125.06 ","$0.00 ","$169.00 ","$91.77 ","$0.00 ","$35.22 ","$120.62 ","$120.62 ","$29.59 ","$169.00 ","$0.00 ","$84.50 ","$133.85 ","$135.20 ","$0.00 ","$26.45 ","$0.00 ","$26.90 ","$0.00 "
"27200308","EAP","HCPCS C1887","","7fr Ebu 3.0 Guiding Catheter","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200309","EAP","HCPCS C1887","","7fr Ebu 3.5 Guiding Catheter","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200310","EAP","HCPCS C1887","","7fr Ebu 4.0 Guiding Catheter","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27200311","EAP","HCPCS C1887","","8fr Ebu 3.5 Guiding Catheter","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200312","EAP","HCPCS C1887","","8fr Ebu 4.0 Guiding Catheter","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$128.47 ","$128.47 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"27200313","EAP","HCPCS C1727","","3.0 X 10cm Cutting Balloon Otw","BOTH IP/OP","$986.00 ","$729.64 ","$0.00 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$703.71 ","$703.71 ","$0.00 ","$986.00 ","$0.00 ","$493.00 ","$780.91 ","$788.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200314","EAP","HCPCS C1757","","7fr Export Xt Catheter","BOTH IP/OP","$2,850.00 ","$2,109.00 ","$0.00 ","$2,850.00 ","$1,547.55 ","$0.00 ","$594.01 ","$2,034.05 ","$2,034.05 ","$0.00 ","$2,850.00 ","$0.00 ","$1,425.00 ","$2,257.20 ","$2,280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200315","EAP","HCPCS C1769","",".014 - 300cm Asahi Miraclebros","BOTH IP/OP","$691.00 ","$511.34 ","$0.00 ","$691.00 ","$375.21 ","$0.00 ","$144.02 ","$493.17 ","$493.17 ","$120.99 ","$691.00 ","$0.00 ","$345.50 ","$547.27 ","$552.80 ","$0.00 ","$108.14 ","$0.00 ","$110.01 ","$0.00 "
"27200316","EAP","HCPCS C1769","",".014 - 300cm Asahi Soft Wire","BOTH IP/OP","$268.00 ","$198.32 ","$0.00 ","$268.00 ","$145.52 ","$0.00 ","$55.86 ","$191.27 ","$191.27 ","$46.92 ","$268.00 ","$0.00 ","$134.00 ","$212.26 ","$214.40 ","$0.00 ","$41.94 ","$0.00 ","$42.67 ","$0.00 "
"27200317","EAP","HCPCS C1769","",".014 - 300cm Whisper Ms","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$331.00 ","$179.73 ","$0.00 ","$68.99 ","$236.23 ","$236.23 ","$57.96 ","$331.00 ","$0.00 ","$165.50 ","$262.15 ","$264.80 ","$0.00 ","$51.80 ","$0.00 ","$52.70 ","$0.00 "
"27200318","EAP","HCPCS C1769","",".014 - 300cm All-star Wire","BOTH IP/OP","$307.00 ","$227.18 ","$0.00 ","$307.00 ","$166.70 ","$0.00 ","$63.99 ","$219.11 ","$219.11 ","$53.75 ","$307.00 ","$0.00 ","$153.50 ","$243.14 ","$245.60 ","$0.00 ","$48.05 ","$0.00 ","$48.87 ","$0.00 "
"27200319","EAP","HCPCS C1753","","Eagle Eye Coronary Imaging Cat","BOTH IP/OP","$2,449.00 ","$1,812.26 ","$0.00 ","$2,449.00 ","$1,329.81 ","$0.00 ","$510.43 ","$1,747.85 ","$1,747.85 ","$428.80 ","$2,449.00 ","$0.00 ","$1,224.50 ","$1,939.61 ","$1,959.20 ","$0.00 ","$383.27 ","$0.00 ","$389.88 ","$0.00 "
"27200320","EAP","Custom 27200320","","Primewire","BOTH IP/OP","$2,332.00 ","$1,725.68 ","$0.00 ","$2,332.00 ","$0.00 ","$0.00 ","$0.00 ","$1,664.35 ","$1,664.35 ","$0.00 ","$2,332.00 ","$0.00 ","$1,166.00 ","$1,846.94 ","$1,865.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200321","EAP","HCPCS C1893","","8fr-35cm Super Arrow Flex Intr","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$135.21 ","$0.00 ","$51.90 ","$177.71 ","$177.71 ","$43.60 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$38.97 ","$0.00 ","$39.64 ","$0.00 "
"27200322","EAP","Custom 27200322","","Platinum Plus St .018 Guidewir","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$0.00 ","$0.00 ","$0.00 ","$205.55 ","$205.55 ","$0.00 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200323","EAP","Custom 27200323","","Platinum Plus St .014 Guidewir","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$0.00 ","$0.00 ","$0.00 ","$205.55 ","$205.55 ","$0.00 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200324","EAP","Custom 27200324","","V-18 Control Wire","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$242.66 ","$242.66 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200325","EAP","Custom 27200325","","Steel Core 18 Guidewire","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200329","EAP","Custom 27200329","","14fr Sheath Introducer","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$62.09 ","$62.09 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200338","EAP","HCPCS C1725","","Voyager Nc 2.5 X 15mm Balloon","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$634.00 ","$344.26 ","$0.00 ","$132.14 ","$452.49 ","$452.49 ","$111.01 ","$634.00 ","$0.00 ","$317.00 ","$502.13 ","$507.20 ","$0.00 ","$99.22 ","$0.00 ","$100.93 ","$0.00 "
"27200373","EAP","HCPCS C1726","","Catheter Baldilat 12 Atm 1.5mm 142cm 12mm Rapex","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$413.00 ","$224.26 ","$0.00 ","$86.08 ","$294.76 ","$294.76 ","$72.31 ","$413.00 ","$0.00 ","$206.50 ","$327.10 ","$330.40 ","$0.00 ","$64.63 ","$0.00 ","$65.75 ","$0.00 "
"27200376","EAP","HCPCS C1726","","Catheter Blndil 21cm .022in 2mm 142cm Lf 12mm Spntr Lgnd","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$413.00 ","$224.26 ","$0.00 ","$86.08 ","$294.76 ","$294.76 ","$72.31 ","$413.00 ","$0.00 ","$206.50 ","$327.10 ","$330.40 ","$0.00 ","$64.63 ","$0.00 ","$65.75 ","$0.00 "
"27200382","EAP","HCPCS C1726","","Sprinter Legend Balloon Rx 3.0","BOTH IP/OP","$569.00 ","$421.06 ","$0.00 ","$569.00 ","$308.97 ","$0.00 ","$118.59 ","$406.10 ","$406.10 ","$99.63 ","$569.00 ","$0.00 ","$284.50 ","$450.65 ","$455.20 ","$0.00 ","$89.05 ","$0.00 ","$90.58 ","$0.00 "
"27200406","EAP","HCPCS C1726","","Sprinter Nc Balloon Rx 3.50x06","BOTH IP/OP","$627.00 ","$463.98 ","$0.00 ","$627.00 ","$340.46 ","$0.00 ","$130.68 ","$447.49 ","$447.49 ","$109.78 ","$627.00 ","$0.00 ","$313.50 ","$496.58 ","$501.60 ","$0.00 ","$98.13 ","$0.00 ","$99.82 ","$0.00 "
"27200408","EAP","HCPCS C1726","","Sprinter Nc Balloon Rx 3.50x12","BOTH IP/OP","$627.00 ","$463.98 ","$0.00 ","$627.00 ","$340.46 ","$0.00 ","$130.68 ","$447.49 ","$447.49 ","$109.78 ","$627.00 ","$0.00 ","$313.50 ","$496.58 ","$501.60 ","$0.00 ","$98.13 ","$0.00 ","$99.82 ","$0.00 "
"27200417","EAP","HCPCS C1726","","Sprinter Nc Balloon Rx 4.00x15","BOTH IP/OP","$627.00 ","$463.98 ","$0.00 ","$627.00 ","$340.46 ","$0.00 ","$130.68 ","$447.49 ","$447.49 ","$109.78 ","$627.00 ","$0.00 ","$313.50 ","$496.58 ","$501.60 ","$0.00 ","$98.13 ","$0.00 ","$99.82 ","$0.00 "
"27200422","EAP","Custom 27200422","","Spacer (mdi)","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$215.00 ","$0.00 ","$0.00 ","$0.00 ","$153.45 ","$153.45 ","$0.00 ","$215.00 ","$0.00 ","$107.50 ","$170.28 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200423","EAP","Custom 27200423","","FOOT DROP SPLINT-CUSTOM","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$0.00 ","$0.00 ","$0.00 ","$173.43 ","$173.43 ","$0.00 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200425","EAP","Custom 27200425","","Catheterization Kit, Straight","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200426","EAP","Custom 27200426","","Blood Administration Set Up","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$2.14 ","$2.14 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200427","EAP","Custom 27200427","","Intra-uterine Press Cath","BOTH IP/OP","$92.00 ","$68.08 ","$0.00 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$65.66 ","$0.00 ","$92.00 ","$0.00 ","$46.00 ","$72.86 ","$73.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200428","EAP","Custom 27200428","","Pack, C-section","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200430","EAP","Custom 27200430","","Catheterization Kit, Foley","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200431","EAP","Custom 27200431","","Catheterization Kit, Straight","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$128.47 ","$128.47 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200432","EAP","Custom 27200432","","Blood Administration Set Up","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200433","EAP","Custom 27200433","","Karmen Cannula","BOTH IP/OP","$1,131.00 ","$836.94 ","$0.00 ","$1,131.00 ","$0.00 ","$0.00 ","$0.00 ","$807.19 ","$807.19 ","$0.00 ","$1,131.00 ","$0.00 ","$565.50 ","$895.75 ","$904.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200434","EAP","HCPCS A4405","","Stomahesive Paste 2 Oz Tube","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$77.08 ","$77.08 ","$0.00 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200435","EAP","Custom 27200435","","Little Ones, Pouch Flange","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200436","EAP","Custom 27200436","","Pouch, Urostomy Opaque","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200437","EAP","Custom 27200437","","Flexible Flange","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200438","EAP","Custom 27200438","","Irrigator, Visiflow W/cone","BOTH IP/OP","$201.00 ","$148.74 ","$0.00 ","$201.00 ","$0.00 ","$0.00 ","$0.00 ","$143.45 ","$143.45 ","$0.00 ","$201.00 ","$0.00 ","$100.50 ","$159.19 ","$160.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200439","EAP","Custom 27200439","","Irrigation Sleeve","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$147.74 ","$147.74 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200440","EAP","HCPCS A4371","","Stomahesive Powder","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27200441","EAP","Custom 27200441","","Mini Pouch","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200442","EAP","Custom 27200442","","Wound Pouch Med.","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$48.53 ","$48.53 ","$0.00 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200443","EAP","HCPCS A4364","","Medical Adhesive","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$36.92 ","$0.00 ","$14.17 ","$48.53 ","$48.53 ","$11.91 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$10.64 ","$0.00 ","$10.83 ","$0.00 "
"27200444","EAP","Custom 27200444","","Drain Tube Attachment","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200446","EAP","HCPCS A4364","","Skin Bond Cement, 4oz","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$41.27 ","$0.00 ","$15.84 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"27200447","EAP","HCPCS A4455","","Uni-solve Wipes,adhes. Remover","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$16.12 ","$0.00 ","$16.40 ","$0.00 "
"27200448","EAP","HCPCS A6197","","Alginate Dressing>16<= 48 Sq In","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200449","EAP","Custom 27200449","","Ace Wrap Supply","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200450","EAP","HCPCS C1728","","Catheter,brachytherapy Seed Ad","BOTH IP/OP","$10,554.00 ","$7,809.96 ","$0.00 ","$10,554.00 ","$5,730.82 ","$0.00 ","$2,199.72 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,554.00 ","$0.00 ","$5,277.00 ","$8,358.77 ","$8,443.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200452","EAP","HCPCS C1757","","Catheter 6fr X 65 Cm 9mm Cleaner Sterile","BOTH IP/OP","$1,756.00 ","$1,299.44 ","$0.00 ","$1,756.00 ","$0.00 ","$0.00 ","$0.00 ","$1,253.26 ","$1,253.26 ","$0.00 ","$1,756.00 ","$0.00 ","$878.00 ","$1,390.75 ","$1,404.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200453","EAP","HCPCS C1757","","Catheter 6fr X 135 Cm 9mm Cleaner Sterile","BOTH IP/OP","$2,351.00 ","$1,739.74 ","$0.00 ","$2,351.00 ","$0.00 ","$0.00 ","$0.00 ","$1,677.91 ","$1,677.91 ","$0.00 ","$2,351.00 ","$0.00 ","$1,175.50 ","$1,861.99 ","$1,880.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200454","EAP","HCPCS C1757","","Catheter 7 Fr X 65 Cm 9mm Cleaner Sterile","BOTH IP/OP","$2,143.00 ","$1,585.82 ","$0.00 ","$2,143.00 ","$0.00 ","$0.00 ","$0.00 ","$1,529.46 ","$1,529.46 ","$0.00 ","$2,143.00 ","$0.00 ","$1,071.50 ","$1,697.26 ","$1,714.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200455","EAP","HCPCS C1757","","Catheter 7fr X 135 Cm 9mm Cleaner Sterile","BOTH IP/OP","$2,660.00 ","$1,968.40 ","$0.00 ","$2,660.00 ","$0.00 ","$0.00 ","$0.00 ","$1,898.44 ","$1,898.44 ","$0.00 ","$2,660.00 ","$0.00 ","$1,330.00 ","$2,106.72 ","$2,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200456","EAP","HCPCS C2629","","Mic G-18 Introducer Kit","BOTH IP/OP","$585.00 ","$432.90 ","$0.00 ","$585.00 ","$0.00 ","$0.00 ","$121.93 ","$417.51 ","$417.51 ","$102.43 ","$585.00 ","$0.00 ","$292.50 ","$463.32 ","$468.00 ","$0.00 ","$91.55 ","$0.00 ","$93.13 ","$0.00 "
"27200457","EAP","HCPCS C1751","","Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pic","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$135.21 ","$0.00 ","$51.90 ","$177.71 ","$177.71 ","$43.60 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$38.97 ","$0.00 ","$39.64 ","$0.00 "
"27200458","EAP","HCPCS C1751","","Cath 5fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$141.18 ","$0.00 ","$54.19 ","$185.56 ","$185.56 ","$45.52 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$40.69 ","$0.00 ","$41.39 ","$0.00 "
"27200459","EAP","HCPCS C1751","","Cath 6fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$185.56 ","$185.56 ","$45.52 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$40.69 ","$0.00 ","$41.39 ","$0.00 "
"27200460","EAP","HCPCS C1894","","Micro Microintruducer 7cm 5.0fr Flecura Guidewire","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$21.18 ","$0.00 ","$8.13 ","$27.83 ","$27.83 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"27200461","EAP","HCPCS C1751","","Tray Cath 5fr 12cm Cen Ven Spctrm 3 Lum Pu .025in Disp D","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$320.00 ","$173.76 ","$0.00 ","$66.70 ","$228.38 ","$228.38 ","$56.03 ","$320.00 ","$0.00 ","$160.00 ","$253.44 ","$256.00 ","$0.00 ","$50.08 ","$0.00 ","$50.94 ","$0.00 "
"27200462","EAP","HCPCS C1887","","Sheath Guid 65cm 6fr Pn Dstn .038in Str Hydphi","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$121.63 ","$0.00 ","$46.69 ","$159.87 ","$159.87 ","$39.22 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$35.06 ","$0.00 ","$35.66 ","$0.00 "
"27200467","EAP","HCPCS C1769","","Guidewire Vascular Angle Standard .035in 180cm 3cm","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$21.47 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$16.12 ","$0.00 ","$16.40 ","$0.00 "
"27200470","EAP","HCPCS C1884","","Embosphere Pre-filled Syringe 300-500 Microns/2ml","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$130.27 ","$446.06 ","$446.06 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"27200471","EAP","HCPCS C1894","","Introducer Sheath 7fr .1in 80cm Tuohy Borst Sidearm Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27200472","EAP","HCPCS C1769","","Guidewire Vascular 45d .016in 180cm 2mm Angled Flexible Tip","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$725.00 ","$393.68 ","$0.00 ","$151.11 ","$517.43 ","$517.43 ","$126.94 ","$725.00 ","$0.00 ","$362.50 ","$574.20 ","$580.00 ","$0.00 ","$113.46 ","$0.00 ","$115.42 ","$0.00 "
"27200473","EAP","HCPCS C1887","","Catheter Guid Mpc Curve 5fr .056in 90cm Braid Radiopq Soft","BOTH IP/OP","$893.00 ","$660.82 ","$0.00 ","$893.00 ","$484.90 ","$0.00 ","$186.12 ","$637.33 ","$637.33 ","$156.36 ","$893.00 ","$0.00 ","$446.50 ","$707.26 ","$714.40 ","$0.00 ","$139.75 ","$0.00 ","$142.17 ","$0.00 "
"27200474","EAP","HCPCS C1725","","Catheter Angiographic Motarjeme Curve 5fr .046in 100cm Braid","BOTH IP/OP","$310.00 ","$229.40 ","$0.00 ","$168.33 ","$168.33 ","$0.00 ","$64.61 ","$22.12 ","$22.12 ","$5.43 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$4.85 ","$0.00 ","$4.94 ","$0.00 "
"27200475","EAP","HCPCS C1725","","Catheter Angiographic .035in Pigtail 5fr .052in 90cm Ultra","BOTH IP/OP","$305.00 ","$225.70 ","$0.00 ","$305.00 ","$165.62 ","$0.00 ","$63.57 ","$217.68 ","$217.68 ","$53.40 ","$305.00 ","$0.00 ","$152.50 ","$241.56 ","$244.00 ","$0.00 ","$47.73 ","$0.00 ","$48.56 ","$0.00 "
"27200476","EAP","HCPCS C1769","","Guidewire Vascular Str .018in 180cm 25cm Shapeable Shaft","BOTH IP/OP","$398.00 ","$294.52 ","$0.00 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$284.05 ","$284.05 ","$69.69 ","$398.00 ","$0.00 ","$199.00 ","$315.22 ","$318.40 ","$0.00 ","$62.29 ","$0.00 ","$63.36 ","$0.00 "
"27200477","EAP","HCPCS C1769","","Guidewire Vascular .014in 300cm 20cm Exchange Radiopq Distal","BOTH IP/OP","$896.00 ","$663.04 ","$0.00 ","$896.00 ","$486.53 ","$0.00 ","$186.75 ","$639.48 ","$639.48 ","$156.88 ","$896.00 ","$0.00 ","$448.00 ","$709.63 ","$716.80 ","$0.00 ","$140.22 ","$0.00 ","$142.64 ","$0.00 "
"27200478","EAP","HCPCS C1887","","Catheter Infus 45d .014in Micro Str 1.9-2.4fr .017in 155cm","BOTH IP/OP","$1,773.00 ","$1,312.02 ","$0.00 ","$1,773.00 ","$962.74 ","$0.00 ","$369.54 ","$1,265.39 ","$1,265.39 ","$310.44 ","$1,773.00 ","$0.00 ","$886.50 ","$1,404.22 ","$1,418.40 ","$0.00 ","$277.47 ","$0.00 ","$282.26 ","$0.00 "
"27200479","EAP","HCPCS C1887","","Catheter Infus 90d .014in Micro Str 1.9-2.4fr .017in 155cm","BOTH IP/OP","$1,688.00 ","$1,249.12 ","$0.00 ","$1,688.00 ","$916.58 ","$0.00 ","$351.82 ","$1,204.73 ","$1,204.73 ","$295.56 ","$1,688.00 ","$0.00 ","$844.00 ","$1,336.90 ","$1,350.40 ","$0.00 ","$264.17 ","$0.00 ","$268.73 ","$0.00 "
"27200481","EAP","Custom 27200481","","Catheter Vascular Occlusion 1028 Flocontrol Tn","BOTH IP/OP","$6,988.00 ","$5,171.12 ","$0.00 ","$6,988.00 ","$0.00 ","$0.00 ","$0.00 ","$4,987.34 ","$4,987.34 ","$0.00 ","$6,988.00 ","$0.00 ","$3,494.00 ","$5,534.50 ","$5,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200482","EAP","HCPCS C1757","","Catheter Reperfusion 4max","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$1,751.18 ","$0.00 ","$672.17 ","$2,301.68 ","$2,301.68 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200484","EAP","Custom 27200484","","Adhesive Ostomy Med Remain Flexible Silicone","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200485","EAP","HCPCS C1887","","Catheter Guid 9fr Balloon Cello","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27200496","EAP","HCPCS C1894","","Introducer Sheath .035in 7fr .1in 70cm Anl1 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27200714","EAP","Custom 27200714","","Compression Hose Lg/xlg Knee","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200751","EAP","Custom 27200751","","Grasping Forceps, 10mm X 120cm","BOTH IP/OP","$744.00 ","$550.56 ","$0.00 ","$744.00 ","$0.00 ","$0.00 ","$0.00 ","$530.99 ","$530.99 ","$0.00 ","$744.00 ","$0.00 ","$372.00 ","$589.25 ","$595.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200753","EAP","Custom 27200753","","Grasping Forceps, 8mm X 120cm","BOTH IP/OP","$708.00 ","$523.92 ","$0.00 ","$708.00 ","$0.00 ","$0.00 ","$0.00 ","$505.30 ","$505.30 ","$0.00 ","$708.00 ","$0.00 ","$354.00 ","$560.74 ","$566.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200755","EAP","Custom 27200755","","Grasp Forceps, Stone Retrieval","BOTH IP/OP","$705.00 ","$521.70 ","$0.00 ","$705.00 ","$0.00 ","$0.00 ","$0.00 ","$503.16 ","$503.16 ","$0.00 ","$705.00 ","$0.00 ","$352.50 ","$558.36 ","$564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200766","EAP","Custom 27200766","","Probe, Electrohydraulic Lithot","BOTH IP/OP","$428.00 ","$316.72 ","$0.00 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$305.46 ","$305.46 ","$0.00 ","$428.00 ","$0.00 ","$214.00 ","$338.98 ","$342.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200769","EAP","Custom 27200769","","Bipolar Forceps","BOTH IP/OP","$573.00 ","$424.02 ","$0.00 ","$573.00 ","$0.00 ","$0.00 ","$0.00 ","$408.95 ","$408.95 ","$0.00 ","$573.00 ","$0.00 ","$286.50 ","$453.82 ","$458.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27200834","EAP","Custom 27200834","","Wet Field Cautery","BOTH IP/OP","$136.00 ","$100.64 ","$0.00 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$97.06 ","$97.06 ","$0.00 ","$136.00 ","$0.00 ","$68.00 ","$107.71 ","$108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201077","EAP","HCPCS C1769","","Guide Wire, 292.653","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$183.00 ","$99.37 ","$0.00 ","$38.14 ","$130.61 ","$130.61 ","$32.04 ","$183.00 ","$0.00 ","$91.50 ","$144.94 ","$146.40 ","$0.00 ","$28.64 ","$0.00 ","$29.13 ","$0.00 "
"27201301","EAP","Custom 27201301","","Drill Bit, 357.047","BOTH IP/OP","$1,952.00 ","$1,444.48 ","$0.00 ","$1,952.00 ","$0.00 ","$0.00 ","$0.00 ","$1,393.14 ","$1,393.14 ","$0.00 ","$1,952.00 ","$0.00 ","$976.00 ","$1,545.98 ","$1,561.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201369","EAP","Custom 27201369","","Endo Disposable Lap. Instr.","BOTH IP/OP","$977.00 ","$722.98 ","$0.00 ","$977.00 ","$0.00 ","$0.00 ","$0.00 ","$697.28 ","$697.28 ","$0.00 ","$977.00 ","$0.00 ","$488.50 ","$773.78 ","$781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201377","EAP","Custom 27201377","","Ta Premium Dlu Staples","BOTH IP/OP","$1,093.00 ","$808.82 ","$0.00 ","$1,093.00 ","$0.00 ","$0.00 ","$0.00 ","$780.07 ","$780.07 ","$0.00 ","$1,093.00 ","$0.00 ","$546.50 ","$865.66 ","$874.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201399","EAP","Custom 27201399","","Bipolar Bovie","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$0.00 ","$9.99 ","$9.99 ","$0.00 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201400","EAP","Custom 27201400","","Micro Clips","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201403","EAP","Custom 27201403","","Abd Binder","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201407","EAP","Custom 27201407","","Dermabond","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$62.09 ","$62.09 ","$0.00 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201456","EAP","Custom 27201456","","Grasping Forceps, 10mm X 120cm","BOTH IP/OP","$744.00 ","$550.56 ","$0.00 ","$744.00 ","$0.00 ","$0.00 ","$0.00 ","$530.99 ","$530.99 ","$0.00 ","$744.00 ","$0.00 ","$372.00 ","$589.25 ","$595.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201458","EAP","Custom 27201458","","Grasping Forceps, Stone Retrie","BOTH IP/OP","$705.00 ","$521.70 ","$0.00 ","$705.00 ","$0.00 ","$0.00 ","$0.00 ","$503.16 ","$503.16 ","$0.00 ","$705.00 ","$0.00 ","$352.50 ","$558.36 ","$564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201474","EAP","Custom 27201474","","Grasping Forceps, 8mm X 120cm","BOTH IP/OP","$707.00 ","$523.18 ","$0.00 ","$707.00 ","$0.00 ","$0.00 ","$0.00 ","$504.59 ","$504.59 ","$0.00 ","$707.00 ","$0.00 ","$353.50 ","$559.94 ","$565.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201489","EAP","Custom 27201489","","Irrigation Clip","BOTH IP/OP","$214.00 ","$158.36 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$152.73 ","$152.73 ","$0.00 ","$214.00 ","$0.00 ","$107.00 ","$169.49 ","$171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201492","EAP","Custom 27201492","","Jp Drain (hemaduct)","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201536","EAP","Custom 27201536","","Compression Hose Reg. Knee","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201626","EAP","Custom 27201626","","Cath,intra-aortic Balloon","BOTH IP/OP","$4,716.00 ","$3,489.84 ","$0.00 ","$4,716.00 ","$0.00 ","$0.00 ","$0.00 ","$3,365.81 ","$3,365.81 ","$0.00 ","$4,716.00 ","$0.00 ","$2,358.00 ","$3,735.07 ","$3,772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201630","EAP","Custom 27201630","","Cath,chest Tube Rt. Angled","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$96.35 ","$96.35 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201680","EAP","Custom 27201680","","Catheter Angio .038in Ka2 Crv 5fr .046in 40cm Impr","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$117.76 ","$117.76 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201681","EAP","Custom 27201681","","Catheter Angio .038in Ka2 Crv 5fr .046in 65cm Prfm","BOTH IP/OP","$153.00 ","$113.22 ","$0.00 ","$153.00 ","$0.00 ","$0.00 ","$0.00 ","$109.20 ","$109.20 ","$0.00 ","$153.00 ","$0.00 ","$76.50 ","$121.18 ","$122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201700","EAP","Custom 27201700","","Rbc Filter Unit","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$59.24 ","$59.24 ","$0.00 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201701","EAP","Custom 27201701","","Plat Filter Unit","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$215.00 ","$0.00 ","$0.00 ","$0.00 ","$153.45 ","$153.45 ","$0.00 ","$215.00 ","$0.00 ","$107.50 ","$170.28 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201702","EAP","Custom 27201702","","Plf1 Filter Unit","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$27.83 ","$27.83 ","$0.00 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201800","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$3.26 ","$0.00 ","$1.25 ","$4.28 ","$4.28 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"27201801","EAP","HCPCS C1769","","Guidewire .35x150cm Bentson","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$41.27 ","$0.00 ","$15.84 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"27201802","EAP","HCPCS C1750","","24cm Duraflow Catheter","BOTH IP/OP","$2,096.00 ","$1,551.04 ","$0.00 ","$2,096.00 ","$1,138.13 ","$0.00 ","$436.86 ","$1,495.92 ","$1,495.92 ","$366.99 ","$2,096.00 ","$0.00 ","$1,048.00 ","$1,660.03 ","$1,676.80 ","$0.00 ","$328.02 ","$0.00 ","$333.68 ","$0.00 "
"27201803","EAP","HCPCS C1750","","28cm Duraflow Catheter","BOTH IP/OP","$1,720.00 ","$1,272.80 ","$0.00 ","$1,720.00 ","$933.96 ","$0.00 ","$358.49 ","$1,227.56 ","$1,227.56 ","$301.16 ","$1,720.00 ","$0.00 ","$860.00 ","$1,362.24 ","$1,376.00 ","$0.00 ","$269.18 ","$0.00 ","$273.82 ","$0.00 "
"27201804","EAP","HCPCS C1752","","24cm Schon Xl Temp Cath","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$224.82 ","$224.82 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201805","EAP","HCPCS C1751","","5x1235x20cm Unifuse Kit","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$298.65 ","$0.00 ","$114.63 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27201806","EAP","HCPCS C1751","","5x135x10cm Unifuse Kit","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$298.65 ","$0.00 ","$114.63 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27201807","EAP","HCPCS C1725","","8-4/5/75 Workhorse Pta","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201808","EAP","HCPCS C1752","","Temporary Dialysis Cath","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$224.82 ","$224.82 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201809","EAP","HCPCS C1752","","Temporay Dialysis Cath","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$528.14 ","$528.14 ","$0.00 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201810","EAP","HCPCS C1725","","Workhorse Pta Balloon","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201811","EAP","HCPCS C1725","","Workhorse Pta Balloon","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201812","EAP","HCPCS C1725","","Wrkhorse Balloon 5-2/5/75","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201813","EAP","HCPCS C1725","","Wrkhrse Balloon 10-4/5/75","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201814","EAP","HCPCS C1725","","Wrkhrse Balloon 5-2/5/100","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201815","EAP","HCPCS C1725","","Wrkhrse Balloon 6-2/5/75","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201816","EAP","HCPCS C1751","","5fr Dual Lumen Picc Line","BOTH IP/OP","$533.00 ","$394.42 ","$0.00 ","$533.00 ","$289.42 ","$0.00 ","$111.09 ","$380.40 ","$380.40 ","$93.32 ","$533.00 ","$0.00 ","$266.50 ","$422.14 ","$426.40 ","$0.00 ","$83.41 ","$0.00 ","$84.85 ","$0.00 "
"27201817","EAP","HCPCS C1751","","5fr Sgle Lumen Pic Line","BOTH IP/OP","$419.00 ","$310.06 ","$0.00 ","$419.00 ","$227.52 ","$0.00 ","$87.33 ","$299.04 ","$299.04 ","$73.36 ","$419.00 ","$0.00 ","$209.50 ","$331.85 ","$335.20 ","$0.00 ","$65.57 ","$0.00 ","$66.70 ","$0.00 "
"27201818","EAP","HCPCS C1757","","Thrombex Device","BOTH IP/OP","$5,955.00 ","$4,406.70 ","$0.00 ","$5,955.00 ","$3,233.57 ","$0.00 ","$1,241.17 ","$4,250.08 ","$4,250.08 ","$0.00 ","$5,955.00 ","$0.00 ","$2,977.50 ","$4,716.36 ","$4,764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201819","EAP","HCPCS C1769","","Guidewire .035/260m Exchange","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$80.91 ","$0.00 ","$31.06 ","$106.34 ","$106.34 ","$26.09 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$23.32 ","$0.00 ","$23.72 ","$0.00 "
"27201820","EAP","HCPCS C1769","","Guidewire .035-150cm Angled Stiff","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$90.68 ","$0.00 ","$34.81 ","$119.19 ","$119.19 ","$29.24 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$26.14 ","$0.00 ","$26.59 ","$0.00 "
"27201821","EAP","HCPCS C1751","","12cm Katzen Infusion Cath","BOTH IP/OP","$1,506.00 ","$1,114.44 ","$0.00 ","$1,506.00 ","$817.76 ","$0.00 ","$313.89 ","$1,074.83 ","$1,074.83 ","$263.69 ","$1,506.00 ","$0.00 ","$753.00 ","$1,192.75 ","$1,204.80 ","$0.00 ","$235.69 ","$0.00 ","$239.76 ","$0.00 "
"27201822","EAP","HCPCS C1751","","150/20 Tracker-18 Infusio","BOTH IP/OP","$3,033.00 ","$2,244.42 ","$0.00 ","$3,033.00 ","$1,646.92 ","$0.00 ","$632.15 ","$2,164.65 ","$2,164.65 ","$531.05 ","$3,033.00 ","$0.00 ","$1,516.50 ","$2,402.14 ","$2,426.40 ","$0.00 ","$474.66 ","$0.00 ","$482.85 ","$0.00 "
"27201823","EAP","HCPCS C1769","","32-150 Angled Guidewire","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$155.84 ","$0.00 ","$59.82 ","$204.83 ","$204.83 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"27201824","EAP","HCPCS C1894","","5fr Pinnacle Introducer","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$36.38 ","$0.00 ","$13.96 ","$47.82 ","$47.82 ","$11.73 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$10.49 ","$0.00 ","$10.67 ","$0.00 "
"27201825","EAP","HCPCS C1887","","5fr-100cm At Catheter","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$20.09 ","$0.00 ","$7.71 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"27201826","EAP","HCPCS C1751","","A50/20 Fastracker-18 Infu","BOTH IP/OP","$1,590.00 ","$1,176.60 ","$0.00 ","$1,590.00 ","$863.37 ","$0.00 ","$331.40 ","$1,134.78 ","$1,134.78 ","$278.40 ","$1,590.00 ","$0.00 ","$795.00 ","$1,259.28 ","$1,272.00 ","$0.00 ","$248.84 ","$0.00 ","$253.13 ","$0.00 "
"27201827","EAP","HCPCS C1769","","Amplatz Guidewire 260cm","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$70.05 ","$0.00 ","$26.89 ","$92.07 ","$92.07 ","$22.59 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$20.19 ","$0.00 ","$20.54 ","$0.00 "
"27201828","EAP","HCPCS C1725","","Catheter  Balloon 6-10/5","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$486.03 ","$486.03 ","$119.24 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$106.58 ","$0.00 ","$108.42 ","$0.00 "
"27201829","EAP","HCPCS C1887","","Glidecath C2 Hydeophilic","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$95.03 ","$0.00 ","$36.47 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"27201830","EAP","HCPCS C1769","","Glidewire .035 150cm  Angled","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$54.84 ","$0.00 ","$21.05 ","$72.08 ","$72.08 ","$17.68 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$15.81 ","$0.00 ","$16.08 ","$0.00 "
"27201831","EAP","HCPCS C1769","","Guidewire  Amplatz Super","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"27201832","EAP","HCPCS C1769","","Guidewire-long Taper","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$169.96 ","$0.00 ","$65.24 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"27201833","EAP","HCPCS C1769","","Transcend Steerable","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$667.00 ","$296.48 ","$0.00 ","$113.80 ","$476.04 ","$476.04 ","$116.79 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$104.39 ","$0.00 ","$106.19 ","$0.00 "
"27201834","EAP","HCPCS C1725","","Xxl 14-4/5.8/120","BOTH IP/OP","$856.00 ","$633.44 ","$0.00 ","$856.00 ","$464.81 ","$0.00 ","$178.41 ","$610.93 ","$610.93 ","$149.88 ","$856.00 ","$0.00 ","$428.00 ","$677.95 ","$684.80 ","$0.00 ","$133.96 ","$0.00 ","$136.28 ","$0.00 "
"27201835","EAP","HCPCS C1725","","Xxl/12-5/5.8/120 Balloon","BOTH IP/OP","$856.00 ","$633.44 ","$0.00 ","$856.00 ","$464.81 ","$0.00 ","$178.41 ","$610.93 ","$610.93 ","$149.88 ","$856.00 ","$0.00 ","$428.00 ","$677.95 ","$684.80 ","$0.00 ","$133.96 ","$0.00 ","$136.28 ","$0.00 "
"27201836","EAP","HCPCS C1769","","Guidewire .035-260cm Bentson E","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"27201837","EAP","HCPCS C1729","","10.2fr Mp Drain Catheter","BOTH IP/OP","$296.00 ","$219.04 ","$0.00 ","$296.00 ","$160.73 ","$0.00 ","$61.69 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$0.00 ","$148.00 ","$234.43 ","$236.80 ","$0.00 ","$46.32 ","$0.00 ","$47.12 ","$0.00 "
"27201838","EAP","HCPCS C1894","","11fr-70cm Introducer Set","BOTH IP/OP","$233.00 ","$172.42 ","$0.00 ","$233.00 ","$126.52 ","$0.00 ","$48.56 ","$166.29 ","$166.29 ","$40.80 ","$233.00 ","$0.00 ","$116.50 ","$184.54 ","$186.40 ","$0.00 ","$36.46 ","$0.00 ","$37.09 ","$0.00 "
"27201839","EAP","HCPCS C1729","","14.0fr Mp Drain Catheter","BOTH IP/OP","$289.00 ","$213.86 ","$0.00 ","$289.00 ","$156.93 ","$0.00 ","$60.23 ","$206.26 ","$206.26 ","$50.60 ","$289.00 ","$0.00 ","$144.50 ","$228.89 ","$231.20 ","$0.00 ","$45.23 ","$0.00 ","$46.01 ","$0.00 "
"27201840","EAP","Custom 27201840","","35-3-5 Embolization Coil","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201841","EAP","Custom 27201841","","35-5-10 Embolization Coil","BOTH IP/OP","$279.00 ","$206.46 ","$0.00 ","$279.00 ","$0.00 ","$0.00 ","$0.00 ","$199.12 ","$199.12 ","$0.00 ","$279.00 ","$0.00 ","$139.50 ","$220.97 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201842","EAP","Custom 27201842","","35-5-3 Embolization Coil","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201843","EAP","Custom 27201843","","35-5-8 Embolization Coil","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$0.00 ","$0.00 ","$0.00 ","$119.19 ","$119.19 ","$0.00 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201844","EAP","HCPCS C1893","","5fr80cm Neff Catheter","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$85.64 ","$85.64 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"27201845","EAP","HCPCS C1894","","6fr Balkan Introducer Set","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$32.58 ","$0.00 ","$12.51 ","$42.82 ","$42.82 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"27201846","EAP","HCPCS C1894","","7fr Balkan Introducer Set","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$92.31 ","$0.00 ","$35.43 ","$121.33 ","$121.33 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"27201847","EAP","HCPCS C1729","","8.5fr Mp Drain Catheter","BOTH IP/OP","$311.00 ","$230.14 ","$0.00 ","$311.00 ","$168.87 ","$0.00 ","$64.82 ","$221.96 ","$221.96 ","$54.45 ","$311.00 ","$0.00 ","$155.50 ","$246.31 ","$248.80 ","$0.00 ","$48.67 ","$0.00 ","$49.51 ","$0.00 "
"27201848","EAP","HCPCS C1729","","9.5fr Biliary Drain Cath.","BOTH IP/OP","$296.00 ","$219.04 ","$0.00 ","$296.00 ","$160.73 ","$0.00 ","$61.69 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$0.00 ","$148.00 ","$234.43 ","$236.80 ","$0.00 ","$46.32 ","$0.00 ","$47.12 ","$0.00 "
"27201849","EAP","HCPCS C1757","","Coil  Embolization 35-4-3","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$93.40 ","$0.00 ","$35.85 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201850","EAP","HCPCS C1769","","Dtdw35-80-10 Deflecting","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$520.00 ","$282.36 ","$0.00 ","$108.38 ","$371.12 ","$371.12 ","$91.05 ","$520.00 ","$0.00 ","$260.00 ","$411.84 ","$416.00 ","$0.00 ","$81.38 ","$0.00 ","$82.78 ","$0.00 "
"27201851","EAP","HCPCS C1773","","Filter Retrieval Set","BOTH IP/OP","$886.00 ","$655.64 ","$0.00 ","$886.00 ","$481.10 ","$0.00 ","$184.66 ","$632.34 ","$632.34 ","$155.13 ","$886.00 ","$0.00 ","$443.00 ","$701.71 ","$708.80 ","$0.00 ","$138.66 ","$0.00 ","$141.05 ","$0.00 "
"27201852","EAP","HCPCS C1769","","Guidewire  Cope Mandril","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$116.00 ","$62.99 ","$0.00 ","$24.18 ","$82.79 ","$82.79 ","$20.31 ","$116.00 ","$0.00 ","$58.00 ","$91.87 ","$92.80 ","$0.00 ","$18.15 ","$0.00 ","$18.47 ","$0.00 "
"27201853","EAP","HCPCS C1769","","Lewis Micropunture Set","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$70.59 ","$0.00 ","$27.10 ","$92.78 ","$92.78 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"27201854","EAP","HCPCS C2629","","Micropuncture Set","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"27201855","EAP","HCPCS C1894","","8fr-23cmavanti-introducer","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$5.43 ","$0.00 ","$2.08 ","$7.14 ","$7.14 ","$1.75 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$1.57 ","$0.00 ","$1.59 ","$0.00 "
"27201856","EAP","HCPCS C1894","","9fr-23cm Avanti Introduce","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$5.43 ","$0.00 ","$2.08 ","$7.14 ","$7.14 ","$1.75 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$1.57 ","$0.00 ","$1.59 ","$0.00 "
"27201857","EAP","HCPCS C1773","","12-20mmx120cm Std Snare","BOTH IP/OP","$1,119.00 ","$828.06 ","$0.00 ","$1,119.00 ","$607.62 ","$0.00 ","$233.23 ","$798.63 ","$798.63 ","$195.93 ","$1,119.00 ","$0.00 ","$559.50 ","$886.25 ","$895.20 ","$0.00 ","$175.12 ","$0.00 ","$178.14 ","$0.00 "
"27201858","EAP","HCPCS C1773","","9-15mmx120cm Std Snare","BOTH IP/OP","$1,119.00 ","$828.06 ","$0.00 ","$1,119.00 ","$607.62 ","$0.00 ","$233.23 ","$798.63 ","$798.63 ","$195.93 ","$1,119.00 ","$0.00 ","$559.50 ","$886.25 ","$895.20 ","$0.00 ","$175.12 ","$0.00 ","$178.14 ","$0.00 "
"27201859","EAP","HCPCS C1725","","Wrkhorse Balloon 10-4/5/100","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201860","EAP","HCPCS C1894","","Pinnacle Introducer 5fr 10cm","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$43.44 ","$0.00 ","$16.67 ","$57.10 ","$57.10 ","$14.01 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$12.52 ","$0.00 ","$12.74 ","$0.00 "
"27201861","EAP","HCPCS C1725","","Conquest Pta Balloon Dilatatio","BOTH IP/OP","$753.00 ","$557.22 ","$0.00 ","$753.00 ","$408.88 ","$0.00 ","$156.94 ","$537.42 ","$537.42 ","$131.84 ","$753.00 ","$0.00 ","$376.50 ","$596.38 ","$602.40 ","$0.00 ","$117.84 ","$0.00 ","$119.88 ","$0.00 "
"27201862","EAP","HCPCS C1725","","Opti-plast  Balloon Dilatation","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$272.04 ","$0.00 ","$104.42 ","$357.56 ","$357.56 ","$87.72 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$78.41 ","$0.00 ","$79.76 ","$0.00 "
"27201863","EAP","HCPCS C1725","","Workhorse Pta Workhorse Balloo","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27201864","EAP","HCPCS C1769","","Guidewire Straight Fixed Core","BOTH IP/OP","$86.00 ","$63.64 ","$0.00 ","$86.00 ","$46.70 ","$0.00 ","$17.92 ","$61.38 ","$61.38 ","$15.06 ","$86.00 ","$0.00 ","$43.00 ","$68.11 ","$68.80 ","$0.00 ","$13.46 ","$0.00 ","$13.69 ","$0.00 "
"27201865","EAP","HCPCS C1769","","Guidewire 3mm J Fixed Core .03","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$24.98 ","$0.00 ","$9.59 ","$32.83 ","$32.83 ","$8.05 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$7.20 ","$0.00 ","$7.32 ","$0.00 "
"27201866","EAP","HCPCS C1894","","Pinnacle Introducer 6fr 10cm","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$41.27 ","$0.00 ","$15.84 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"27201867","EAP","HCPCS C1894","","8fr 10cm Pinnacle Introducer","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$39.10 ","$0.00 ","$15.01 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$0.00 ","$11.27 ","$0.00 ","$11.46 ","$0.00 "
"27201868","EAP","HCPCS C1894","","Pinnacle Introducer 8fr 10cm","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$36.38 ","$0.00 ","$13.96 ","$47.82 ","$47.82 ","$11.73 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$10.49 ","$0.00 ","$10.67 ","$0.00 "
"27201869","EAP","HCPCS C1894","","Pinnacle Introducer 9fr 10cm","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$57.10 ","$57.10 ","$14.01 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$12.52 ","$0.00 ","$12.74 ","$0.00 "
"27201870","EAP","HCPCS C1757","","Fogarty 5.5-40cm","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$191.14 ","$0.00 ","$73.37 ","$251.22 ","$251.22 ","$0.00 ","$352.00 ","$0.00 ","$176.00 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201871","EAP","HCPCS C1757","","Fogarty 5.5 80cm","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$0.00 ","$0.00 ","$0.00 ","$251.22 ","$251.22 ","$0.00 ","$352.00 ","$0.00 ","$176.00 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201872","EAP","HCPCS C1757","","Arrow Trerotola Thromolytic De","BOTH IP/OP","$1,805.00 ","$1,335.70 ","$0.00 ","$1,805.00 ","$980.12 ","$0.00 ","$376.21 ","$1,288.23 ","$1,288.23 ","$0.00 ","$1,805.00 ","$0.00 ","$902.50 ","$1,429.56 ","$1,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201873","EAP","HCPCS C1757","","Complex Fiber Coil 18 X 3mm X","BOTH IP/OP","$1,212.00 ","$896.88 ","$0.00 ","$1,212.00 ","$658.12 ","$0.00 ","$252.61 ","$865.00 ","$865.00 ","$0.00 ","$1,212.00 ","$0.00 ","$606.00 ","$959.90 ","$969.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201874","EAP","HCPCS C1729","","Skater 10fr","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$328.52 ","$0.00 ","$126.10 ","$431.79 ","$431.79 ","$105.93 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$94.68 ","$0.00 ","$96.32 ","$0.00 "
"27201875","EAP","HCPCS C1887","","Lima Guiding Catheter 7fr-55cm","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$226.43 ","$0.00 ","$86.91 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27201876","EAP","HCPCS C1892","","Meditech Accustick Ii Introduc","BOTH IP/OP","$209.00 ","$154.66 ","$0.00 ","$209.00 ","$113.49 ","$0.00 ","$43.56 ","$149.16 ","$149.16 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"27201877","EAP","HCPCS C1769","","22g X 10cm Chiba Needle","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$70.00 ","$14.66 ","$0.00 ","$5.63 ","$49.96 ","$49.96 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"27201878","EAP","HCPCS C1769","",".038-145 Amplatz Extra Stiff","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$41.27 ","$0.00 ","$15.84 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"27201879","EAP","HCPCS C1751","","9fr Single Lumen Hickman","BOTH IP/OP","$241.00 ","$178.34 ","$0.00 ","$241.00 ","$130.86 ","$0.00 ","$50.23 ","$172.00 ","$172.00 ","$42.20 ","$241.00 ","$0.00 ","$120.50 ","$190.87 ","$192.80 ","$0.00 ","$37.72 ","$0.00 ","$38.37 ","$0.00 "
"27201880","EAP","HCPCS C1751","","9fr Dual Lumen Hickman","BOTH IP/OP","$528.00 ","$390.72 ","$0.00 ","$528.00 ","$286.70 ","$0.00 ","$110.05 ","$376.83 ","$376.83 ","$92.45 ","$528.00 ","$0.00 ","$264.00 ","$418.18 ","$422.40 ","$0.00 ","$82.63 ","$0.00 ","$84.06 ","$0.00 "
"27201881","EAP","HCPCS C1769","",".035-150cm 3mm J Guidewire","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$36.92 ","$0.00 ","$14.17 ","$48.53 ","$48.53 ","$11.91 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$10.64 ","$0.00 ","$10.83 ","$0.00 "
"27201882","EAP","HCPCS C1769","",".035-150cm Rosen Guidewire","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"27201883","EAP","HCPCS C1752","","12cm Niagra, Temp Dialysis Cat","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201884","EAP","HCPCS C1752","","15cm Niagra, Temp Dialysis Cat","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$45.68 ","$45.68 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201885","EAP","HCPCS C1725","","8-2/5/100 Workhorse Balloon","BOTH IP/OP","$427.00 ","$315.98 ","$0.00 ","$427.00 ","$231.86 ","$0.00 ","$89.00 ","$304.75 ","$304.75 ","$74.76 ","$427.00 ","$0.00 ","$213.50 ","$338.18 ","$341.60 ","$0.00 ","$66.83 ","$0.00 ","$67.98 ","$0.00 "
"27201886","EAP","HCPCS C1725","","4-2/5/75 Opti-plast Balloon","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$272.04 ","$0.00 ","$104.42 ","$357.56 ","$357.56 ","$87.72 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$78.41 ","$0.00 ","$79.76 ","$0.00 "
"27201887","EAP","HCPCS C1725","","3-way Hp Stopcock","BOTH IP/OP","$934.00 ","$691.16 ","$0.00 ","$934.00 ","$507.16 ","$0.00 ","$194.67 ","$666.60 ","$666.60 ","$163.54 ","$934.00 ","$0.00 ","$467.00 ","$739.73 ","$747.20 ","$0.00 ","$146.17 ","$0.00 ","$148.69 ","$0.00 "
"27201888","EAP","HCPCS C1894","","7fr 10cm Pinnacle Introducer","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$38.55 ","$0.00 ","$14.80 ","$50.67 ","$50.67 ","$12.43 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$11.11 ","$0.00 ","$11.30 ","$0.00 "
"27201889","EAP","HCPCS C1894","","7fr 10cm Pinnacle Introducer","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$73.31 ","$0.00 ","$28.14 ","$96.35 ","$96.35 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"27201890","EAP","HCPCS C1725","","12-2/5.8/75 Udt Dilatation Bal","BOTH IP/OP","$889.00 ","$657.86 ","$0.00 ","$889.00 ","$482.73 ","$0.00 ","$185.29 ","$634.48 ","$634.48 ","$155.66 ","$889.00 ","$0.00 ","$444.50 ","$704.09 ","$711.20 ","$0.00 ","$139.13 ","$0.00 ","$141.53 ","$0.00 "
"27201891","EAP","HCPCS C1729","","8fr Flexima Biliary Catheter","BOTH IP/OP","$271.00 ","$200.54 ","$0.00 ","$271.00 ","$147.15 ","$0.00 ","$56.48 ","$193.41 ","$193.41 ","$47.45 ","$271.00 ","$0.00 ","$135.50 ","$214.63 ","$216.80 ","$0.00 ","$42.41 ","$0.00 ","$43.14 ","$0.00 "
"27201892","EAP","HCPCS C1729","","Cx 18.0-38-40-p-32s-bcl","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27201893","EAP","Custom 27201893","","Tibia Fracture Brace","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$0.00 ","$0.00 ","$0.00 ","$346.14 ","$346.14 ","$0.00 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201905","EAP","Custom 27201905","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201906","EAP","HCPCS A6250","","Wound Paste","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"27201914","EAP","Custom 27201914","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27201930","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27201931","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27201932","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27202362","EAP","Custom 27202362","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202368","EAP","Custom 27202368","","Scapel Surg W/handle Att","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202375","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202376","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202377","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202384","EAP","HCPCS C1729","","Catheter Foley 30cc 28fr","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$21.18 ","$0.00 ","$8.13 ","$27.83 ","$27.83 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"27202388","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202389","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27202390","EAP","HCPCS C1729","","Catheter Coude Size 16fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27202395","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27202396","EAP","HCPCS C1729","","Catheter Coude 30cc 24fr","BOTH IP/OP","$82.00 ","$60.68 ","$0.00 ","$82.00 ","$44.53 ","$0.00 ","$17.09 ","$58.52 ","$58.52 ","$14.36 ","$82.00 ","$0.00 ","$41.00 ","$64.94 ","$65.60 ","$0.00 ","$12.83 ","$0.00 ","$13.05 ","$0.00 "
"27202397","EAP","Custom 27202397","","Scapel Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202403","EAP","Custom 27202403","","Scaple Surg W/handle Atta","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202406","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$25.52 ","$0.00 ","$9.80 ","$33.54 ","$33.54 ","$8.23 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$7.36 ","$0.00 ","$7.48 ","$0.00 "
"27202407","EAP","HCPCS C1729","","Catheter Coude 30cc 24fr","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$47.24 ","$0.00 ","$18.13 ","$62.09 ","$62.09 ","$15.23 ","$87.00 ","$0.00 ","$43.50 ","$68.90 ","$69.60 ","$0.00 ","$13.62 ","$0.00 ","$13.85 ","$0.00 "
"27202418","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27202419","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27202420","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27202421","EAP","HCPCS C1729","","Catheter Foley 3-way 30cc","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$20.09 ","$0.00 ","$7.71 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"27202432","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27202433","EAP","HCPCS C1729","","Catheter Coude Size 14fr","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$59.19 ","$0.00 ","$22.72 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"27202434","EAP","HCPCS C1729","","Catheter Coude Size 16fr","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$55.39 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"27202435","EAP","Custom 27202435","","Scapel Surg W/handle Attached","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202446","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202447","EAP","HCPCS C1729","","Catheter Foley 16fr","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$9.77 ","$0.00 ","$3.75 ","$12.85 ","$12.85 ","$3.15 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$2.82 ","$0.00 ","$2.87 ","$0.00 "
"27202448","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202449","EAP","HCPCS C1729","","Catheter Foley 30cc 28fr","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$21.18 ","$0.00 ","$8.13 ","$27.83 ","$27.83 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"27202462","EAP","HCPCS C1729","","Catheter Foley 5cc 14fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202463","EAP","HCPCS C1729","","Catheter Foley 5cc 18fr","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$10.32 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"27202470","EAP","HCPCS C1751","","Cragg-mcnamara 5-65-5 Infusion","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$401.82 ","$0.00 ","$154.23 ","$528.14 ","$528.14 ","$129.57 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$115.81 ","$0.00 ","$117.81 ","$0.00 "
"27202471","EAP","HCPCS C1751","","Cragg-mcnamara 5-40-20 Infusio","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$171.05 ","$0.00 ","$65.65 ","$224.82 ","$224.82 ","$55.15 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$49.30 ","$0.00 ","$50.15 ","$0.00 "
"27202472","EAP","HCPCS C1751","","Cragg-mcnamara 5-100-10 Infusi","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$171.05 ","$0.00 ","$65.65 ","$224.82 ","$224.82 ","$55.15 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$49.30 ","$0.00 ","$50.15 ","$0.00 "
"27202473","EAP","HCPCS C1773","","15mm Amplatz Snare","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$497.39 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27202474","EAP","HCPCS C1773","","25mm Amplatz Snare","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$497.39 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27202475","EAP","HCPCS C1729","","10fr X 35cm Skater Nephrostomy","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$137.92 ","$0.00 ","$52.94 ","$181.28 ","$181.28 ","$44.47 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$39.75 ","$0.00 ","$40.44 ","$0.00 "
"27202476","EAP","HCPCS C1750","","Chron Carbothane Cath 14.5f X 19cm","BOTH IP/OP","$1,054.00 ","$779.96 ","$0.00 ","$1,054.00 ","$572.32 ","$0.00 ","$219.68 ","$752.24 ","$752.24 ","$184.55 ","$1,054.00 ","$0.00 ","$527.00 ","$834.77 ","$843.20 ","$0.00 ","$164.95 ","$0.00 ","$167.80 ","$0.00 "
"27202477","EAP","HCPCS C1750","","23cm Sport Pack Perm Dialysis","BOTH IP/OP","$921.00 ","$681.54 ","$0.00 ","$921.00 ","$500.10 ","$0.00 ","$191.96 ","$657.32 ","$657.32 ","$161.26 ","$921.00 ","$0.00 ","$460.50 ","$729.43 ","$736.80 ","$0.00 ","$144.14 ","$0.00 ","$146.62 ","$0.00 "
"27202478","EAP","HCPCS C1750","","28cm Sport Pack Perm Dialysis","BOTH IP/OP","$2,263.00 ","$1,674.62 ","$0.00 ","$2,263.00 ","$1,228.81 ","$0.00 ","$471.67 ","$1,615.10 ","$1,615.10 ","$396.23 ","$2,263.00 ","$0.00 ","$1,131.50 ","$1,792.30 ","$1,810.40 ","$0.00 ","$354.16 ","$0.00 ","$360.27 ","$0.00 "
"27202479","EAP","HCPCS C1752","","19cm Q-plus Temp Dialysis Kit","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$181.28 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202480","EAP","HCPCS C1894","","Sheath Flex 6fr 11cm","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$74.93 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"27202481","EAP","HCPCS C1751","","Hickman 10.0 French Triple Lum","BOTH IP/OP","$1,357.00 ","$1,004.18 ","$0.00 ","$1,357.00 ","$736.85 ","$0.00 ","$282.83 ","$968.49 ","$968.49 ","$237.60 ","$1,357.00 ","$0.00 ","$678.50 ","$1,074.74 ","$1,085.60 ","$0.00 ","$212.37 ","$0.00 ","$216.03 ","$0.00 "
"27202482","EAP","HCPCS C1725","","Balloon Udt 4-2/5/120","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202483","EAP","HCPCS C1725","","Conquest Dialation Balloon 5mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$0.00 ","$0.00 ","$0.00 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202484","EAP","HCPCS C1725","","Conquest Dialation Balloon 5mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202485","EAP","HCPCS C1725","","Conquest Dialation Balloon 6mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202486","EAP","HCPCS C1725","","Conquest Dialation Balloon 6mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$0.00 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202487","EAP","HCPCS C1725","","Conquest Dialation Balloon 7mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$0.00 ","$0.00 ","$0.00 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202488","EAP","HCPCS C1725","","Conquest Dialation Balloon 7mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202489","EAP","HCPCS C1725","","Conquest Dialation Balloon 8mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202490","EAP","HCPCS C1725","","Conquest Dialation Balloon 8mm","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202491","EAP","HCPCS C1725","","Conquest Dialation Balloon 10m","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202492","EAP","HCPCS C1725","","Conquest Dialation Balloon 10m","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202493","EAP","HCPCS C1725","","Conquest Dialation Balloon 12m","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202494","EAP","HCPCS C1725","","Balloon Dial Cath 4mmx10cmx120","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202495","EAP","HCPCS C1751","","Vaxcel Central Venous Cath","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$3.26 ","$0.00 ","$1.25 ","$4.28 ","$4.28 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"27202496","EAP","HCPCS C1725","","4mmx2cmx90xm Monorail Balloon","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$764.00 ","$0.00 ","$293.25 ","$1,004.18 ","$1,004.18 ","$246.35 ","$1,407.00 ","$0.00 ","$703.50 ","$1,114.34 ","$1,125.60 ","$0.00 ","$220.20 ","$0.00 ","$223.99 ","$0.00 "
"27202497","EAP","HCPCS C1725","","5mmx2cmx90cm Monorail Balloon","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$764.00 ","$0.00 ","$293.25 ","$1,004.18 ","$1,004.18 ","$246.35 ","$1,407.00 ","$0.00 ","$703.50 ","$1,114.34 ","$1,125.60 ","$0.00 ","$220.20 ","$0.00 ","$223.99 ","$0.00 "
"27202498","EAP","HCPCS C1725","","5mmx15cmx90xcm Monorail Biliar","BOTH IP/OP","$4,654.00 ","$3,443.96 ","$0.00 ","$4,654.00 ","$2,527.12 ","$0.00 ","$970.01 ","$3,321.56 ","$3,321.56 ","$814.88 ","$4,654.00 ","$0.00 ","$2,327.00 ","$3,685.97 ","$3,723.20 ","$0.00 ","$728.35 ","$0.00 ","$740.92 ","$0.00 "
"27202499","EAP","HCPCS C1725","","6mmx14cmx90cm Monorail Biliary","BOTH IP/OP","$4,654.00 ","$3,443.96 ","$0.00 ","$4,654.00 ","$2,527.12 ","$0.00 ","$970.01 ","$3,321.56 ","$3,321.56 ","$814.88 ","$4,654.00 ","$0.00 ","$2,327.00 ","$3,685.97 ","$3,723.20 ","$0.00 ","$728.35 ","$0.00 ","$740.92 ","$0.00 "
"27202500","EAP","HCPCS C1725","","6mmx18cmx90cm Monorail Bilary","BOTH IP/OP","$4,654.00 ","$3,443.96 ","$0.00 ","$4,654.00 ","$2,527.12 ","$0.00 ","$970.01 ","$3,321.56 ","$3,321.56 ","$814.88 ","$4,654.00 ","$0.00 ","$2,327.00 ","$3,685.97 ","$3,723.20 ","$0.00 ","$728.35 ","$0.00 ","$740.92 ","$0.00 "
"27202501","EAP","HCPCS C1769","",".018x190cm Thruway Guidewire","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$291.00 ","$158.01 ","$0.00 ","$60.65 ","$207.69 ","$207.69 ","$50.95 ","$291.00 ","$0.00 ","$145.50 ","$230.47 ","$232.80 ","$0.00 ","$45.54 ","$0.00 ","$46.33 ","$0.00 "
"27202502","EAP","HCPCS C1893","","6frx45cm Renal Guiding Sheath","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$141.18 ","$0.00 ","$54.19 ","$185.56 ","$185.56 ","$45.52 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$40.69 ","$0.00 ","$41.39 ","$0.00 "
"27202503","EAP","HCPCS C1725","","6x40x80 Polar Cath Balloon","BOTH IP/OP","$4,496.00 ","$3,327.04 ","$0.00 ","$4,496.00 ","$2,441.33 ","$0.00 ","$937.08 ","$3,208.80 ","$3,208.80 ","$787.21 ","$4,496.00 ","$0.00 ","$2,248.00 ","$3,560.83 ","$3,596.80 ","$0.00 ","$703.62 ","$0.00 ","$715.76 ","$0.00 "
"27202504","EAP","HCPCS C1725","","7x60x80 Polar Cath Balloon","BOTH IP/OP","$4,496.00 ","$3,327.04 ","$0.00 ","$4,496.00 ","$2,441.33 ","$0.00 ","$937.08 ","$3,208.80 ","$3,208.80 ","$787.21 ","$4,496.00 ","$0.00 ","$2,248.00 ","$3,560.83 ","$3,596.80 ","$0.00 ","$703.62 ","$0.00 ","$715.76 ","$0.00 "
"27202505","EAP","HCPCS C2629","","Banana Peel Sheath","BOTH IP/OP","$151.00 ","$111.74 ","$0.00 ","$151.00 ","$0.00 ","$0.00 ","$31.47 ","$107.77 ","$107.77 ","$26.44 ","$151.00 ","$0.00 ","$75.50 ","$119.59 ","$120.80 ","$0.00 ","$23.63 ","$0.00 ","$24.04 ","$0.00 "
"27202506","EAP","HCPCS C1769","","Guidewite .014x180 Segway Gt","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$226.43 ","$0.00 ","$86.91 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27202507","EAP","HCPCS C1769","","Guidewire .018x180cm Segway Gt","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$226.43 ","$0.00 ","$86.91 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27202508","EAP","HCPCS C1769","","Str Guidewire .014x180 Segway","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$226.43 ","$0.00 ","$86.91 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27202509","EAP","HCPCS C1751","","Infusion Embo Cath Segway","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$453.41 ","$0.00 ","$174.03 ","$595.94 ","$595.94 ","$146.20 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$130.68 ","$0.00 ","$132.93 ","$0.00 "
"27202510","EAP","HCPCS C1757","","Complex Helical Coil","BOTH IP/OP","$239.00 ","$176.86 ","$0.00 ","$239.00 ","$129.78 ","$0.00 ","$49.81 ","$170.57 ","$170.57 ","$0.00 ","$239.00 ","$0.00 ","$119.50 ","$189.29 ","$191.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202511","EAP","HCPCS C1894","","6fr Dial Ease Introducer Sheat","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$23.35 ","$0.00 ","$8.96 ","$30.69 ","$30.69 ","$7.53 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$6.73 ","$0.00 ","$6.85 ","$0.00 "
"27202512","EAP","HCPCS C1725","","7-2/7/75 Workhorse Balloon","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27202513","EAP","HCPCS C1725","","7-4/5/75 Workhorse Balloon","BOTH IP/OP","$427.00 ","$315.98 ","$0.00 ","$427.00 ","$231.86 ","$0.00 ","$89.00 ","$304.75 ","$304.75 ","$74.76 ","$427.00 ","$0.00 ","$213.50 ","$338.18 ","$341.60 ","$0.00 ","$66.83 ","$0.00 ","$67.98 ","$0.00 "
"27202514","EAP","HCPCS C1894","","10fr 25cm Pinnacle Sheath Intr","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$36.38 ","$0.00 ","$13.96 ","$47.82 ","$47.82 ","$11.73 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$10.49 ","$0.00 ","$10.67 ","$0.00 "
"27202515","EAP","HCPCS C1894","","5fr 25cm Pinnacle Introducer S","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$32.04 ","$0.00 ","$12.30 ","$42.11 ","$42.11 ","$10.33 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$9.23 ","$0.00 ","$9.39 ","$0.00 "
"27202516","EAP","HCPCS C1894","","9fr 25cm Pinnacle Introducer S","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$36.38 ","$0.00 ","$13.96 ","$47.82 ","$47.82 ","$11.73 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$10.49 ","$0.00 ","$10.67 ","$0.00 "
"27202517","EAP","HCPCS C1894","","6fr 25cm Pinnacle Introducer S","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$36.38 ","$0.00 ","$13.96 ","$47.82 ","$47.82 ","$11.73 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$10.49 ","$0.00 ","$10.67 ","$0.00 "
"27202518","EAP","HCPCS C1894","","7fr 25cm Pinnacle Introducer S","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$32.04 ","$0.00 ","$12.30 ","$42.11 ","$42.11 ","$10.33 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$9.23 ","$0.00 ","$9.39 ","$0.00 "
"27202519","EAP","HCPCS C1750","","23cm Hemoglide Perm Cath","BOTH IP/OP","$2,140.00 ","$1,583.60 ","$0.00 ","$2,140.00 ","$1,162.02 ","$0.00 ","$446.03 ","$1,527.32 ","$1,527.32 ","$374.70 ","$2,140.00 ","$0.00 ","$1,070.00 ","$1,694.88 ","$1,712.00 ","$0.00 ","$334.91 ","$0.00 ","$340.69 ","$0.00 "
"27202520","EAP","HCPCS C1750","","19cm Hemoglide Perm Cath","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$497.39 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27202521","EAP","HCPCS C1769","","Nitrex Guidewire","BOTH IP/OP","$728.00 ","$538.72 ","$0.00 ","$728.00 ","$395.30 ","$0.00 ","$151.73 ","$519.57 ","$519.57 ","$127.47 ","$728.00 ","$0.00 ","$364.00 ","$576.58 ","$582.40 ","$0.00 ","$113.93 ","$0.00 ","$115.90 ","$0.00 "
"27202522","EAP","HCPCS C1769","","Disposable Tip Deflecting Wire","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$307.88 ","$0.00 ","$118.18 ","$404.67 ","$404.67 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"27202523","EAP","HCPCS C1894","","10fr Pinnacle Introducer","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$41.27 ","$0.00 ","$15.84 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"27202524","EAP","HCPCS C1752","","Niagra Dialysis Catheter","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$0.00 ","$0.00 ","$0.00 ","$144.88 ","$144.88 ","$0.00 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202525","EAP","HCPCS C2629","","5fr Tear-away Introducer","BOTH IP/OP","$81.00 ","$59.94 ","$0.00 ","$81.00 ","$0.00 ","$0.00 ","$16.88 ","$57.81 ","$57.81 ","$14.18 ","$81.00 ","$0.00 ","$40.50 ","$64.15 ","$64.80 ","$0.00 ","$12.68 ","$0.00 ","$12.90 ","$0.00 "
"27202526","EAP","HCPCS C2629","","6fr Tear-away Introducer","BOTH IP/OP","$856.00 ","$633.44 ","$0.00 ","$856.00 ","$0.00 ","$0.00 ","$178.41 ","$610.93 ","$610.93 ","$149.88 ","$856.00 ","$0.00 ","$428.00 ","$677.95 ","$684.80 ","$0.00 ","$133.96 ","$0.00 ","$136.28 ","$0.00 "
"27202527","EAP","HCPCS C2629","","8 Fr Tear Away Introducer","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$0.00 ","$0.00 ","$82.74 ","$283.34 ","$283.34 ","$69.51 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$62.13 ","$0.00 ","$63.20 ","$0.00 "
"27202528","EAP","HCPCS C2629","","9fr Tear-away Introducer","BOTH IP/OP","$81.00 ","$59.94 ","$0.00 ","$81.00 ","$0.00 ","$0.00 ","$16.88 ","$57.81 ","$57.81 ","$14.18 ","$81.00 ","$0.00 ","$40.50 ","$64.15 ","$64.80 ","$0.00 ","$12.68 ","$0.00 ","$12.90 ","$0.00 "
"27202529","EAP","HCPCS C2629","","10fr-16cm Introducer","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$17.72 ","$60.66 ","$60.66 ","$14.88 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$13.30 ","$0.00 ","$13.53 ","$0.00 "
"27202530","EAP","Custom 27202530","","18 Ga Needle  Sterile  Guide","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202531","EAP","HCPCS C1729","","12fr Flexima Biliary Cath","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$291.00 ","$158.01 ","$0.00 ","$60.65 ","$207.69 ","$207.69 ","$50.95 ","$291.00 ","$0.00 ","$145.50 ","$230.47 ","$232.80 ","$0.00 ","$45.54 ","$0.00 ","$46.33 ","$0.00 "
"27202532","EAP","HCPCS C1757","","2mmx20mm Complex Helical","BOTH IP/OP","$257.00 ","$190.18 ","$0.00 ","$257.00 ","$139.55 ","$0.00 ","$53.57 ","$183.42 ","$183.42 ","$0.00 ","$257.00 ","$0.00 ","$128.50 ","$203.54 ","$205.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202533","EAP","HCPCS C1725","","4-4/5/75 Balloon Catheter","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$369.78 ","$0.00 ","$141.94 ","$486.03 ","$486.03 ","$119.24 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$106.58 ","$0.00 ","$108.42 ","$0.00 "
"27202534","EAP","HCPCS C1769","","46fr-65cm C2 Glidecath","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$90.68 ","$0.00 ","$34.81 ","$119.19 ","$119.19 ","$29.24 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$26.14 ","$0.00 ","$26.59 ","$0.00 "
"27202535","EAP","HCPCS C1757","","4mmx30mm Complex Helical","BOTH IP/OP","$265.00 ","$196.10 ","$0.00 ","$265.00 ","$143.90 ","$0.00 ","$55.23 ","$189.13 ","$189.13 ","$0.00 ","$265.00 ","$0.00 ","$132.50 ","$209.88 ","$212.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202536","EAP","HCPCS C1725","","Bmx 8-3/5.8/75 Balloon Ca","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$497.39 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27202537","EAP","HCPCS C1725","","Bmx14-4/7/100 Ballon Gath","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$210.09 ","$719.41 ","$719.41 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"27202538","EAP","HCPCS C1729","","Catheter  10fr Flexima","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$291.00 ","$158.01 ","$0.00 ","$60.65 ","$207.69 ","$207.69 ","$50.95 ","$291.00 ","$0.00 ","$145.50 ","$230.47 ","$232.80 ","$0.00 ","$45.54 ","$0.00 ","$46.33 ","$0.00 "
"27202539","EAP","HCPCS C1729","","Catheter  14fr Flexima","BOTH IP/OP","$282.00 ","$208.68 ","$0.00 ","$282.00 ","$0.00 ","$0.00 ","$0.00 ","$201.26 ","$201.26 ","$49.38 ","$282.00 ","$0.00 ","$141.00 ","$223.34 ","$225.60 ","$0.00 ","$44.13 ","$0.00 ","$44.89 ","$0.00 "
"27202540","EAP","HCPCS C1751","","Catheter  9cm Katzen","BOTH IP/OP","$1,506.00 ","$1,114.44 ","$0.00 ","$1,506.00 ","$0.00 ","$0.00 ","$0.00 ","$1,074.83 ","$1,074.83 ","$263.69 ","$1,506.00 ","$0.00 ","$753.00 ","$1,192.75 ","$1,204.80 ","$0.00 ","$235.69 ","$0.00 ","$239.76 ","$0.00 "
"27202541","EAP","HCPCS C1725","","Catheter  Balloon  Dc/20","BOTH IP/OP","$2,062.00 ","$1,525.88 ","$0.00 ","$2,062.00 ","$0.00 ","$0.00 ","$0.00 ","$1,471.65 ","$1,471.65 ","$361.04 ","$2,062.00 ","$0.00 ","$1,031.00 ","$1,633.10 ","$1,649.60 ","$0.00 ","$322.70 ","$0.00 ","$328.27 ","$0.00 "
"27202542","EAP","HCPCS C1725","","Catheter  Balloon Ultra-","BOTH IP/OP","$718.00 ","$531.32 ","$0.00 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$512.44 ","$512.44 ","$125.72 ","$718.00 ","$0.00 ","$359.00 ","$568.66 ","$574.40 ","$0.00 ","$112.37 ","$0.00 ","$114.31 ","$0.00 "
"27202543","EAP","HCPCS C1887","","Glidecath: 100cm Straight","BOTH IP/OP","$838.00 ","$620.12 ","$0.00 ","$838.00 ","$455.03 ","$0.00 ","$174.66 ","$598.08 ","$598.08 ","$146.73 ","$838.00 ","$0.00 ","$419.00 ","$663.70 ","$670.40 ","$0.00 ","$131.15 ","$0.00 ","$133.41 ","$0.00 "
"27202544","EAP","HCPCS C1887","","Guidecath  5fr-100cm","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$95.03 ","$0.00 ","$36.47 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"27202545","EAP","HCPCS C1769","","Guidewire .035/150cm","BOTH IP/OP","$1,424.00 ","$1,053.76 ","$0.00 ","$1,424.00 ","$773.23 ","$0.00 ","$296.80 ","$1,016.31 ","$1,016.31 ","$249.33 ","$1,424.00 ","$0.00 ","$712.00 ","$1,127.81 ","$1,139.20 ","$0.00 ","$222.86 ","$0.00 ","$226.70 ","$0.00 "
"27202546","EAP","HCPCS C1769","","Transcend -ex Guidewire","BOTH IP/OP","$1,759.00 ","$1,301.66 ","$0.00 ","$1,759.00 ","$955.14 ","$0.00 ","$366.62 ","$1,255.40 ","$1,255.40 ","$307.99 ","$1,759.00 ","$0.00 ","$879.50 ","$1,393.13 ","$1,407.20 ","$0.00 ","$275.28 ","$0.00 ","$280.03 ","$0.00 "
"27202547","EAP","HCPCS C1725","","Udt6-10/5/120 Ballon Cath","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202548","EAP","HCPCS C1769","","V-18 Control Guidewires","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$169.96 ","$0.00 ","$65.24 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"27202549","EAP","HCPCS C1725","","Xxl 18-4/5.8/120e Ball Ga","BOTH IP/OP","$934.00 ","$691.16 ","$0.00 ","$934.00 ","$507.16 ","$0.00 ","$194.67 ","$666.60 ","$666.60 ","$163.54 ","$934.00 ","$0.00 ","$467.00 ","$739.73 ","$747.20 ","$0.00 ","$146.17 ","$0.00 ","$148.69 ","$0.00 "
"27202550","EAP","HCPCS C1769","","Guidewire .035-260cm Rosen","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$36.92 ","$0.00 ","$14.17 ","$48.53 ","$48.53 ","$11.91 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$10.64 ","$0.00 ","$10.83 ","$0.00 "
"27202551","EAP","HCPCS C1729","","10.2fr Biliary Drain Cath","BOTH IP/OP","$289.00 ","$213.86 ","$0.00 ","$289.00 ","$156.93 ","$0.00 ","$60.23 ","$206.26 ","$206.26 ","$50.60 ","$289.00 ","$0.00 ","$144.50 ","$228.89 ","$231.20 ","$0.00 ","$45.23 ","$0.00 ","$46.01 ","$0.00 "
"27202552","EAP","HCPCS C1729","","12.0fr Biliary Drain Cath","BOTH IP/OP","$296.00 ","$219.04 ","$0.00 ","$296.00 ","$160.73 ","$0.00 ","$61.69 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$0.00 ","$148.00 ","$234.43 ","$236.80 ","$0.00 ","$46.32 ","$0.00 ","$47.12 ","$0.00 "
"27202553","EAP","HCPCS C1729","","12.0fr Mp Drain Catheter","BOTH IP/OP","$296.00 ","$219.04 ","$0.00 ","$296.00 ","$160.73 ","$0.00 ","$61.69 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$0.00 ","$148.00 ","$234.43 ","$236.80 ","$0.00 ","$46.32 ","$0.00 ","$47.12 ","$0.00 "
"27202554","EAP","HCPCS C1729","","14.0fr Biliary Drain","BOTH IP/OP","$296.00 ","$219.04 ","$0.00 ","$296.00 ","$160.73 ","$0.00 ","$61.69 ","$211.26 ","$211.26 ","$51.83 ","$296.00 ","$0.00 ","$148.00 ","$234.43 ","$236.80 ","$0.00 ","$46.32 ","$0.00 ","$47.12 ","$0.00 "
"27202555","EAP","HCPCS C1769","","35-180 Coons Wire","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$104.26 ","$0.00 ","$40.02 ","$137.03 ","$137.03 ","$33.62 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$30.05 ","$0.00 ","$30.57 ","$0.00 "
"27202556","EAP","HCPCS C1757","","35-2-3 Embolization Coil","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$93.40 ","$0.00 ","$35.85 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202557","EAP","HCPCS C1725","","7fr-100cm Montef 10re Cat","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$29.32 ","$0.00 ","$11.25 ","$38.54 ","$38.54 ","$9.45 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$8.45 ","$0.00 ","$8.60 ","$0.00 "
"27202558","EAP","HCPCS C1894","","8fr Balkanintroducer","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$92.31 ","$0.00 ","$35.43 ","$121.33 ","$121.33 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"27202559","EAP","HCPCS C1894","","9fr Flexor Introducer","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$159.00 ","$86.34 ","$0.00 ","$33.14 ","$113.48 ","$113.48 ","$27.84 ","$159.00 ","$0.00 ","$79.50 ","$125.93 ","$127.20 ","$0.00 ","$24.88 ","$0.00 ","$25.31 ","$0.00 "
"27202560","EAP","HCPCS C1757","","Coil  Embolization 35-5-5","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$172.00 ","$93.40 ","$0.00 ","$35.85 ","$122.76 ","$122.76 ","$0.00 ","$172.00 ","$0.00 ","$86.00 ","$136.22 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202561","EAP","HCPCS C1751","","135 Cm Mass Transit Max","BOTH IP/OP","$2,960.00 ","$2,190.40 ","$0.00 ","$2,960.00 ","$1,607.28 ","$0.00 ","$616.94 ","$2,112.55 ","$2,112.55 ","$518.27 ","$2,960.00 ","$0.00 ","$1,480.00 ","$2,344.32 ","$2,368.00 ","$0.00 ","$463.24 ","$0.00 ","$471.23 ","$0.00 "
"27202562","EAP","HCPCS C1894","","Introducer Pinnacle 7fr 10cm","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$36.38 ","$0.00 ","$13.96 ","$47.82 ","$47.82 ","$11.73 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$10.49 ","$0.00 ","$10.67 ","$0.00 "
"27202563","EAP","HCPCS C1725","","Balloon Udt 4-4/5/120","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$389.33 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27202564","EAP","HCPCS C1887","","5fr.100cmhinck Headhunter","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$90.68 ","$0.00 ","$34.81 ","$119.19 ","$119.19 ","$29.24 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$26.14 ","$0.00 ","$26.59 ","$0.00 "
"27202565","EAP","HCPCS C1894","","8fr 25cm Pinnacle Introducer S","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$32.04 ","$0.00 ","$12.30 ","$42.11 ","$42.11 ","$10.33 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$9.23 ","$0.00 ","$9.39 ","$0.00 "
"27202566","EAP","HCPCS C1887","","5f-90cm Ruc Catheter","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$70.05 ","$0.00 ","$26.89 ","$92.07 ","$92.07 ","$22.59 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$20.19 ","$0.00 ","$20.54 ","$0.00 "
"27202567","EAP","HCPCS C2629","","Introducer Tear Away 120fx30cm","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$29.60 ","$101.35 ","$101.35 ","$24.86 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$22.22 ","$0.00 ","$22.61 ","$0.00 "
"27202568","EAP","HCPCS C2629","","Introducer Tear Away 16f X15cm","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$14.17 ","$48.53 ","$48.53 ","$11.91 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$10.64 ","$0.00 ","$10.83 ","$0.00 "
"27202569","EAP","HCPCS C2629","","Introducer Tear Away 14f X15cm","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$14.17 ","$48.53 ","$48.53 ","$11.91 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$10.64 ","$0.00 ","$10.83 ","$0.00 "
"27202570","EAP","HCPCS C2629","","Introducer Tear Away12.5fx15cm","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$21.47 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$16.12 ","$0.00 ","$16.40 ","$0.00 "
"27202571","EAP","HCPCS C2629","","Introducer Tear Away 6f X 10cm","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$159.00 ","$0.00 ","$0.00 ","$33.14 ","$113.48 ","$113.48 ","$27.84 ","$159.00 ","$0.00 ","$79.50 ","$125.93 ","$127.20 ","$0.00 ","$24.88 ","$0.00 ","$25.31 ","$0.00 "
"27202572","EAP","HCPCS C1769","","Amplatz Sup Guidewire,035/75gw","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$179.73 ","$179.73 ","$0.00 ","$68.99 ","$47.10 ","$47.10 ","$11.56 ","$66.00 ","$0.00 ","$33.00 ","$52.27 ","$52.80 ","$0.00 ","$10.33 ","$0.00 ","$10.51 ","$0.00 "
"27202573","EAP","HCPCS C1726","","Merci Balloon Guide Catheter","BOTH IP/OP","$2,251.00 ","$1,665.74 ","$0.00 ","$2,251.00 ","$1,222.29 ","$0.00 ","$469.16 ","$1,606.54 ","$1,606.54 ","$394.13 ","$2,251.00 ","$0.00 ","$1,125.50 ","$1,782.79 ","$1,800.80 ","$0.00 ","$352.28 ","$0.00 ","$358.36 ","$0.00 "
"27202574","EAP","HCPCS C1751","","Merci Microcatheter","BOTH IP/OP","$1,641.00 ","$1,214.34 ","$0.00 ","$1,641.00 ","$891.06 ","$0.00 ","$342.03 ","$1,171.18 ","$1,171.18 ","$287.33 ","$1,641.00 ","$0.00 ","$820.50 ","$1,299.67 ","$1,312.80 ","$0.00 ","$256.82 ","$0.00 ","$261.25 ","$0.00 "
"27202575","EAP","HCPCS C1757","","Meri V-series Retrieval V2.0","BOTH IP/OP","$10,341.00 ","$7,652.34 ","$0.00 ","$10,341.00 ","$5,615.16 ","$0.00 ","$2,155.32 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,341.00 ","$0.00 ","$5,170.50 ","$8,190.07 ","$8,272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202576","EAP","HCPCS C1757","","Meri V-series Retrieval V2.5","BOTH IP/OP","$10,708.00 ","$7,923.92 ","$0.00 ","$10,708.00 ","$5,814.44 ","$0.00 ","$2,231.81 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,708.00 ","$0.00 ","$5,354.00 ","$8,480.74 ","$8,566.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202577","EAP","HCPCS C1757","","Meri V-series Retrieval V3.0","BOTH IP/OP","$10,708.00 ","$7,923.92 ","$0.00 ","$10,708.00 ","$5,814.44 ","$0.00 ","$2,231.81 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,708.00 ","$0.00 ","$5,354.00 ","$8,480.74 ","$8,566.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202578","EAP","HCPCS C1757","","Meri V-series Retrieval V2.5","BOTH IP/OP","$10,341.00 ","$7,652.34 ","$0.00 ","$10,341.00 ","$5,615.16 ","$0.00 ","$2,155.32 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,341.00 ","$0.00 ","$5,170.50 ","$8,190.07 ","$8,272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202579","EAP","HCPCS C1751","","Catheter Reperfusion 026","BOTH IP/OP","$3,767.00 ","$2,787.58 ","$0.00 ","$3,767.00 ","$2,045.48 ","$0.00 ","$785.14 ","$2,688.51 ","$2,688.51 ","$659.57 ","$3,767.00 ","$0.00 ","$1,883.50 ","$2,983.46 ","$3,013.60 ","$0.00 ","$589.54 ","$0.00 ","$599.71 ","$0.00 "
"27202580","EAP","HCPCS C1751","","Catheter Reperfusion 032","BOTH IP/OP","$3,635.00 ","$2,689.90 ","$0.00 ","$3,635.00 ","$1,973.81 ","$0.00 ","$757.62 ","$2,594.30 ","$2,594.30 ","$636.46 ","$3,635.00 ","$0.00 ","$1,817.50 ","$2,878.92 ","$2,908.00 ","$0.00 ","$568.88 ","$0.00 ","$578.69 ","$0.00 "
"27202581","EAP","HCPCS C1751","","Catheter Reperfusion 041","BOTH IP/OP","$3,635.00 ","$2,689.90 ","$0.00 ","$3,635.00 ","$1,973.81 ","$0.00 ","$757.62 ","$2,594.30 ","$2,594.30 ","$636.46 ","$3,635.00 ","$0.00 ","$1,817.50 ","$2,878.92 ","$2,908.00 ","$0.00 ","$568.88 ","$0.00 ","$578.69 ","$0.00 "
"27202582","EAP","Custom 27202582","","Separator 026","BOTH IP/OP","$7,910.00 ","$5,853.40 ","$0.00 ","$7,910.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,910.00 ","$0.00 ","$3,955.00 ","$6,264.72 ","$6,328.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202583","EAP","Custom 27202583","","Separator 032","BOTH IP/OP","$7,639.00 ","$5,652.86 ","$0.00 ","$7,639.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,639.00 ","$0.00 ","$3,819.50 ","$6,050.09 ","$6,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202584","EAP","Custom 27202584","","Separator 041","BOTH IP/OP","$7,639.00 ","$5,652.86 ","$0.00 ","$7,639.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,639.00 ","$0.00 ","$3,819.50 ","$6,050.09 ","$6,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202585","EAP","Custom 27202585","","Tubing, Aspiration","BOTH IP/OP","$1,279.00 ","$946.46 ","$0.00 ","$1,279.00 ","$0.00 ","$0.00 ","$0.00 ","$912.82 ","$912.82 ","$0.00 ","$1,279.00 ","$0.00 ","$639.50 ","$1,012.97 ","$1,023.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202586","EAP","Custom 27202586","","Pump, Penumbra Aspiration","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202587","EAP","HCPCS C1751","","Microcatheter, Microvention","BOTH IP/OP","$2,353.00 ","$1,741.22 ","$0.00 ","$2,353.00 ","$1,277.68 ","$0.00 ","$490.42 ","$1,679.34 ","$1,679.34 ","$411.99 ","$2,353.00 ","$0.00 ","$1,176.50 ","$1,863.58 ","$1,882.40 ","$0.00 ","$368.24 ","$0.00 ","$374.60 ","$0.00 "
"27202588","EAP","Custom 27202588","","Controller, V-grip Detachment","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$399.67 ","$399.67 ","$0.00 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202589","EAP","HCPCS C1751","","Catheter, Echelon Micro","BOTH IP/OP","$2,072.00 ","$1,533.28 ","$0.00 ","$2,072.00 ","$1,125.10 ","$0.00 ","$431.86 ","$1,478.79 ","$1,478.79 ","$362.79 ","$2,072.00 ","$0.00 ","$1,036.00 ","$1,641.02 ","$1,657.60 ","$0.00 ","$324.27 ","$0.00 ","$329.86 ","$0.00 "
"27202590","EAP","HCPCS C1726","","Balloon, Hyperform 4mm X 7mm","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$2,174.72 ","$0.00 ","$834.74 ","$2,858.37 ","$2,858.37 ","$701.24 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$626.78 ","$0.00 ","$637.60 ","$0.00 "
"27202591","EAP","HCPCS C1726","","Balloon, Hyperform 7mm X 7mm","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$2,174.72 ","$0.00 ","$834.74 ","$2,858.37 ","$2,858.37 ","$701.24 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$626.78 ","$0.00 ","$637.60 ","$0.00 "
"27202592","EAP","HCPCS C1726","","Balloon, Hyperglide 4mm X 15mm","BOTH IP/OP","$3,336.00 ","$2,468.64 ","$0.00 ","$3,336.00 ","$1,811.45 ","$0.00 ","$695.31 ","$2,380.90 ","$2,380.90 ","$584.11 ","$3,336.00 ","$0.00 ","$1,668.00 ","$2,642.11 ","$2,668.80 ","$0.00 ","$522.08 ","$0.00 ","$531.09 ","$0.00 "
"27202593","EAP","HCPCS C1887","","Catheter, Envoy 6f Guiding","BOTH IP/OP","$884.00 ","$654.16 ","$0.00 ","$884.00 ","$480.01 ","$0.00 ","$184.25 ","$630.91 ","$630.91 ","$154.78 ","$884.00 ","$0.00 ","$442.00 ","$700.13 ","$707.20 ","$0.00 ","$138.35 ","$0.00 ","$140.73 ","$0.00 "
"27202594","EAP","HCPCS C1751","","Microcatheter, Rapidtransit","BOTH IP/OP","$2,002.00 ","$1,481.48 ","$0.00 ","$2,002.00 ","$1,087.09 ","$0.00 ","$417.27 ","$1,428.83 ","$1,428.83 ","$350.53 ","$2,002.00 ","$0.00 ","$1,001.00 ","$1,585.58 ","$1,601.60 ","$0.00 ","$313.31 ","$0.00 ","$318.72 ","$0.00 "
"27202595","EAP","Custom 27202595","","System,trufill N-bca Liquid Em","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$0.00 ","$0.00 ","$0.00 ","$200.55 ","$200.55 ","$0.00 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202596","EAP","HCPCS C1887","","Catheter, Envoy Xb Guiding","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$988.00 ","$536.48 ","$0.00 ","$205.92 ","$705.14 ","$705.14 ","$172.99 ","$988.00 ","$0.00 ","$494.00 ","$782.50 ","$790.40 ","$0.00 ","$154.62 ","$0.00 ","$157.29 ","$0.00 "
"27202597","EAP","HCPCS C1751","","Microcatheter, Prowler","BOTH IP/OP","$2,169.00 ","$1,605.06 ","$0.00 ","$2,169.00 ","$1,177.77 ","$0.00 ","$452.07 ","$1,548.02 ","$1,548.02 ","$379.77 ","$2,169.00 ","$0.00 ","$1,084.50 ","$1,717.85 ","$1,735.20 ","$0.00 ","$339.45 ","$0.00 ","$345.30 ","$0.00 "
"27202598","EAP","HCPCS C1751","","Microcatheter, Prowler","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,236.41 ","$0.00 ","$474.58 ","$1,625.09 ","$1,625.09 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"27202599","EAP","HCPCS C1769","","Guidewire Bentson .038 260 Exc","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"27202600","EAP","HCPCS C1769","","Guidwire Glide .038 150 Angle","BOTH IP/OP","$154.00 ","$113.96 ","$0.00 ","$154.00 ","$83.62 ","$0.00 ","$32.10 ","$109.91 ","$109.91 ","$26.96 ","$154.00 ","$0.00 ","$77.00 ","$121.97 ","$123.20 ","$0.00 ","$24.10 ","$0.00 ","$24.52 ","$0.00 "
"27202601","EAP","HCPCS C1769","","Guidwire Glide .038 180 Angle","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$20.09 ","$0.00 ","$7.71 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"27202602","EAP","HCPCS C1769","","Guidewire Transend Ex .014","BOTH IP/OP","$1,036.00 ","$766.64 ","$0.00 ","$1,036.00 ","$562.55 ","$0.00 ","$215.93 ","$739.39 ","$739.39 ","$181.40 ","$1,036.00 ","$0.00 ","$518.00 ","$820.51 ","$828.80 ","$0.00 ","$162.13 ","$0.00 ","$164.93 ","$0.00 "
"27202603","EAP","HCPCS C1769","","Guidewire Transend Ex .014st","BOTH IP/OP","$1,036.00 ","$766.64 ","$0.00 ","$1,036.00 ","$562.55 ","$0.00 ","$215.93 ","$739.39 ","$739.39 ","$181.40 ","$1,036.00 ","$0.00 ","$518.00 ","$820.51 ","$828.80 ","$0.00 ","$162.13 ","$0.00 ","$164.93 ","$0.00 "
"27202604","EAP","HCPCS C1769","","Guidewire Transend Es 300cm","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$716.76 ","$0.00 ","$275.12 ","$942.08 ","$942.08 ","$231.12 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$206.58 ","$0.00 ","$210.14 ","$0.00 "
"27202605","EAP","HCPCS C1887","","Catheter, 7fr Guider Softip","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$362.18 ","$0.00 ","$139.02 ","$476.04 ","$476.04 ","$116.79 ","$667.00 ","$0.00 ","$333.50 ","$528.26 ","$533.60 ","$0.00 ","$104.39 ","$0.00 ","$106.19 ","$0.00 "
"27202606","EAP","HCPCS C1751","","Catheter, Renegade Micro","BOTH IP/OP","$1,202.00 ","$889.48 ","$0.00 ","$1,202.00 ","$652.69 ","$0.00 ","$250.53 ","$857.87 ","$857.87 ","$210.46 ","$1,202.00 ","$0.00 ","$601.00 ","$951.98 ","$961.60 ","$0.00 ","$188.11 ","$0.00 ","$191.36 ","$0.00 "
"27202607","EAP","HCPCS C1751","","Microcatheter, Excelsior 1018","BOTH IP/OP","$2,169.00 ","$1,605.06 ","$0.00 ","$2,169.00 ","$1,177.77 ","$0.00 ","$452.07 ","$1,548.02 ","$1,548.02 ","$379.77 ","$2,169.00 ","$0.00 ","$1,084.50 ","$1,717.85 ","$1,735.20 ","$0.00 ","$339.45 ","$0.00 ","$345.30 ","$0.00 "
"27202608","EAP","HCPCS C1769","","Guidewire, Synchro2","BOTH IP/OP","$1,251.00 ","$925.74 ","$0.00 ","$1,251.00 ","$679.29 ","$0.00 ","$260.74 ","$892.84 ","$892.84 ","$219.04 ","$1,251.00 ","$0.00 ","$625.50 ","$990.79 ","$1,000.80 ","$0.00 ","$195.78 ","$0.00 ","$199.16 ","$0.00 "
"27202609","EAP","Custom 27202609","","26x12x12cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202610","EAP","Custom 27202610","","26x12x14cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202611","EAP","Custom 27202611","","12x12x13.5cm Lliac Limb Aaa St","BOTH IP/OP","$21,112.00 ","$15,622.88 ","$0.00 ","$21,112.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,112.00 ","$0.00 ","$10,556.00 ","$16,720.70 ","$16,889.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202612","EAP","Custom 27202612","","18x24x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$24,857.00 ","$18,394.18 ","$0.00 ","$24,857.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$24,857.00 ","$0.00 ","$12,428.50 ","$19,686.74 ","$19,885.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202613","EAP","HCPCS C1751","","Cath 6fr 1lum Try 3cg Shrlk Maximal Brr Picc P","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$548.43 ","$0.00 ","$210.51 ","$720.84 ","$720.84 ","$176.84 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$158.07 ","$0.00 ","$160.79 ","$0.00 "
"27202614","EAP","Custom 27202614","","Cather, Balloon, Ultra-thin Di","BOTH IP/OP","$1,580.00 ","$1,169.20 ","$0.00 ","$1,580.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.65 ","$1,127.65 ","$0.00 ","$1,580.00 ","$0.00 ","$790.00 ","$1,251.36 ","$1,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202615","EAP","Custom 27202615","","23x12x12cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202616","EAP","Custom 27202616","","23x12x14cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202617","EAP","Custom 27202617","","23x12x16cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202618","EAP","Custom 27202618","","23x12x18cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202619","EAP","Custom 27202619","","23x14.5x12cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202620","EAP","Custom 27202620","","23x14.5x14cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202621","EAP","Custom 27202621","","23x14.5x16cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202622","EAP","Custom 27202622","","23x14.5x18cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202623","EAP","Custom 27202623","","26x12x12cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202624","EAP","Custom 27202624","","26x12x14cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202625","EAP","Custom 27202625","","26x12x16cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202626","EAP","Custom 27202626","","26x12x18cm Aaa Endoprosthesis","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202627","EAP","Custom 27202627","","26x14.5x12cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202628","EAP","Custom 27202628","","26x14.5x14cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202629","EAP","Custom 27202629","","26x14.5x16cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202630","EAP","Custom 27202630","","26x14.4x18cm Aaa Endoprosthesi","BOTH IP/OP","$25,581.00 ","$18,929.94 ","$0.00 ","$25,581.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$25,581.00 ","$0.00 ","$12,790.50 ","$20,260.15 ","$20,464.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202631","EAP","Custom 27202631","","28.5x12x12cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202632","EAP","Custom 27202632","","28.5x12x14cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202633","EAP","Custom 27202633","","28.5x12x16cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202634","EAP","Custom 27202634","","28.5x12x18cm Aaa Endoprosthesi","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202635","EAP","Custom 27202635","","28.5x14.5x12cm Aaa Endoprosthe","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202636","EAP","Custom 27202636","","28.5x14.5x14cm Aaa Endoprosthe","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202637","EAP","Custom 27202637","","28.5x14.5x16cm Aaa Endoprosthe","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202638","EAP","Custom 27202638","","28.5x14.4x18cm Aaa Endoprosthe","BOTH IP/OP","$23,752.00 ","$17,576.48 ","$0.00 ","$23,752.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,752.00 ","$0.00 ","$11,876.00 ","$18,811.58 ","$19,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202639","EAP","Custom 27202639","","12x10cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202640","EAP","Custom 27202640","","12x12cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202641","EAP","Custom 27202641","","12x14cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202642","EAP","Custom 27202642","","14.5x10cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202643","EAP","Custom 27202643","","14.4x12 Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202644","EAP","Custom 27202644","","14.5x14 Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202645","EAP","Custom 27202645","","16x9.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202646","EAP","Custom 27202646","","16x11.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202647","EAP","Custom 27202647","","16x13.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202648","EAP","Custom 27202648","","18x9.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202649","EAP","Custom 27202649","","18x11.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202650","EAP","Custom 27202650","","18x13.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202651","EAP","Custom 27202651","","20x9.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202652","EAP","Custom 27202652","","20x11.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202653","EAP","Custom 27202653","","20x13.5cm Aaa Endoprosthesis","BOTH IP/OP","$22,940.00 ","$16,975.60 ","$0.00 ","$22,940.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,940.00 ","$0.00 ","$11,470.00 ","$18,168.48 ","$18,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202654","EAP","Custom 27202654","","12x12x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,214.00 ","$13,478.36 ","$0.00 ","$18,214.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,214.00 ","$0.00 ","$9,107.00 ","$14,425.49 ","$14,571.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202655","EAP","Custom 27202655","","13x13x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,214.00 ","$13,478.36 ","$0.00 ","$18,214.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,214.00 ","$0.00 ","$9,107.00 ","$14,425.49 ","$14,571.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202656","EAP","Custom 27202656","","14x14x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,214.00 ","$13,478.36 ","$0.00 ","$18,214.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,214.00 ","$0.00 ","$9,107.00 ","$14,425.49 ","$14,571.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202657","EAP","Custom 27202657","","15x15x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,214.00 ","$13,478.36 ","$0.00 ","$18,214.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,214.00 ","$0.00 ","$9,107.00 ","$14,425.49 ","$14,571.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202658","EAP","Custom 27202658","","16x16x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,214.00 ","$13,478.36 ","$0.00 ","$18,214.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,214.00 ","$0.00 ","$9,107.00 ","$14,425.49 ","$14,571.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202659","EAP","Custom 27202659","","18x18x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,898.00 ","$13,984.52 ","$0.00 ","$18,898.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,898.00 ","$0.00 ","$9,449.00 ","$14,967.22 ","$15,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202660","EAP","Custom 27202660","","20x20x8.5cm Iliac Limb Aaa Ste","BOTH IP/OP","$18,898.00 ","$13,984.52 ","$0.00 ","$18,898.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,898.00 ","$0.00 ","$9,449.00 ","$14,967.22 ","$15,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202661","EAP","Custom 27202661","","12x12x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$19,236.00 ","$14,234.64 ","$0.00 ","$19,236.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,236.00 ","$0.00 ","$9,618.00 ","$15,234.91 ","$15,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202662","EAP","Custom 27202662","","13x13x11.5cmm Iliac Limb Aaa S","BOTH IP/OP","$19,236.00 ","$14,234.64 ","$0.00 ","$19,236.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,236.00 ","$0.00 ","$9,618.00 ","$15,234.91 ","$15,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202663","EAP","Custom 27202663","","14x14x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$19,236.00 ","$14,234.64 ","$0.00 ","$19,236.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,236.00 ","$0.00 ","$9,618.00 ","$15,234.91 ","$15,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202664","EAP","Custom 27202664","","15x15x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$19,236.00 ","$14,234.64 ","$0.00 ","$19,236.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,236.00 ","$0.00 ","$9,618.00 ","$15,234.91 ","$15,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202665","EAP","Custom 27202665","","16x16x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$19,236.00 ","$14,234.64 ","$0.00 ","$19,236.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,236.00 ","$0.00 ","$9,618.00 ","$15,234.91 ","$15,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202666","EAP","Custom 27202666","","18x18x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$19,916.00 ","$14,737.84 ","$0.00 ","$19,916.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,916.00 ","$0.00 ","$9,958.00 ","$15,773.47 ","$15,932.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202667","EAP","Custom 27202667","","20x20x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$19,916.00 ","$14,737.84 ","$0.00 ","$19,916.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,916.00 ","$0.00 ","$9,958.00 ","$15,773.47 ","$15,932.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202668","EAP","Custom 27202668","","13x13x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$21,112.00 ","$15,622.88 ","$0.00 ","$21,112.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,112.00 ","$0.00 ","$10,556.00 ","$16,720.70 ","$16,889.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202669","EAP","Custom 27202669","","14x14x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$21,112.00 ","$15,622.88 ","$0.00 ","$21,112.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,112.00 ","$0.00 ","$10,556.00 ","$16,720.70 ","$16,889.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202670","EAP","Custom 27202670","","15x15x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$21,112.00 ","$15,622.88 ","$0.00 ","$21,112.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,112.00 ","$0.00 ","$10,556.00 ","$16,720.70 ","$16,889.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202671","EAP","Custom 27202671","","16x16x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$21,112.00 ","$15,622.88 ","$0.00 ","$21,112.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,112.00 ","$0.00 ","$10,556.00 ","$16,720.70 ","$16,889.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202672","EAP","Custom 27202672","","18x18x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$21,790.00 ","$16,124.60 ","$0.00 ","$21,790.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,790.00 ","$0.00 ","$10,895.00 ","$17,257.68 ","$17,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202673","EAP","Custom 27202673","","20x20x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$21,790.00 ","$16,124.60 ","$0.00 ","$21,790.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,790.00 ","$0.00 ","$10,895.00 ","$17,257.68 ","$17,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202674","EAP","Custom 27202674","","16x20x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$23,492.00 ","$17,384.08 ","$0.00 ","$23,492.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,492.00 ","$0.00 ","$11,746.00 ","$18,605.66 ","$18,793.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202675","EAP","Custom 27202675","","18x22x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$23,492.00 ","$17,384.08 ","$0.00 ","$23,492.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,492.00 ","$0.00 ","$11,746.00 ","$18,605.66 ","$18,793.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202676","EAP","Custom 27202676","","18x24x11.5cm Iliac Limb Aaa St","BOTH IP/OP","$23,492.00 ","$17,384.08 ","$0.00 ","$23,492.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,492.00 ","$0.00 ","$11,746.00 ","$18,605.66 ","$18,793.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202677","EAP","Custom 27202677","","16x20x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$24,857.00 ","$18,394.18 ","$0.00 ","$24,857.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$24,857.00 ","$0.00 ","$12,428.50 ","$19,686.74 ","$19,885.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202678","EAP","Custom 27202678","","18x22x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$24,857.00 ","$18,394.18 ","$0.00 ","$24,857.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$24,857.00 ","$0.00 ","$12,428.50 ","$19,686.74 ","$19,885.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202679","EAP","Custom 27202679","","18x24x13.5cm Iliac Limb Aaa St","BOTH IP/OP","$24,857.00 ","$18,394.18 ","$0.00 ","$24,857.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$24,857.00 ","$0.00 ","$12,428.50 ","$19,686.74 ","$19,885.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202680","EAP","Custom 27202680","","12x12x5.5cm Iliac Cuff Aaa Ste","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202681","EAP","Custom 27202681","","13x13x5.5cm Ilaic Cuff Aaa Ste","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202682","EAP","Custom 27202682","","14x14x5.5cm Iliac Cuff Aaa Ste","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202683","EAP","Custom 27202683","","15x15x5.5cm Iliac Cuff Aaa Ste","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202684","EAP","Custom 27202684","","16x15x5.5cm Iliac Cuff Aaa Ste","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202685","EAP","Custom 27202685","","18x18x5.5cm Iliac Cuff Aaa Ste","BOTH IP/OP","$15,832.00 ","$11,715.68 ","$0.00 ","$15,832.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,832.00 ","$0.00 ","$7,916.00 ","$12,538.94 ","$12,665.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202686","EAP","Custom 27202686","","20x20x5.5cm Iliac Cuff Aaa Ste","BOTH IP/OP","$15,832.00 ","$11,715.68 ","$0.00 ","$15,832.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,832.00 ","$0.00 ","$7,916.00 ","$12,538.94 ","$12,665.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202687","EAP","HCPCS C1769","","6mmx5cmx110cm 0.035 Guidewire","BOTH IP/OP","$15,219.00 ","$11,262.06 ","$0.00 ","$15,219.00 ","$8,263.92 ","$0.00 ","$3,172.02 ","$5,158.80 ","$5,158.80 ","$2,664.73 ","$15,219.00 ","$0.00 ","$7,609.50 ","$12,053.45 ","$12,175.20 ","$0.00 ","$2,381.77 ","$0.00 ","$2,422.86 ","$0.00 "
"27202688","EAP","HCPCS C1769","","6mmx10cmx110cm 0.035 Guidewire","BOTH IP/OP","$18,251.00 ","$13,505.74 ","$0.00 ","$18,251.00 ","$9,910.29 ","$0.00 ","$3,803.96 ","$5,158.80 ","$5,158.80 ","$3,195.60 ","$18,251.00 ","$0.00 ","$9,125.50 ","$14,454.79 ","$14,600.80 ","$0.00 ","$2,856.28 ","$0.00 ","$2,905.56 ","$0.00 "
"27202689","EAP","HCPCS C1769","","6mmx15cmx110cm 0.035 Guidewire","BOTH IP/OP","$21,246.00 ","$15,722.04 ","$0.00 ","$21,246.00 ","$11,536.58 ","$0.00 ","$4,428.20 ","$5,158.80 ","$5,158.80 ","$3,720.00 ","$21,246.00 ","$0.00 ","$10,623.00 ","$16,826.83 ","$16,996.80 ","$0.00 ","$3,325.00 ","$0.00 ","$3,382.36 ","$0.00 "
"27202690","EAP","HCPCS C1769","","7mmx5cmx110cm 0.035 Guidewire","BOTH IP/OP","$15,219.00 ","$11,262.06 ","$0.00 ","$15,219.00 ","$8,263.92 ","$0.00 ","$3,172.02 ","$5,158.80 ","$5,158.80 ","$2,664.73 ","$15,219.00 ","$0.00 ","$7,609.50 ","$12,053.45 ","$12,175.20 ","$0.00 ","$2,381.77 ","$0.00 ","$2,422.86 ","$0.00 "
"27202691","EAP","HCPCS C1769","","7mmx10cmx110cm 0.035 Guidewire","BOTH IP/OP","$18,251.00 ","$13,505.74 ","$0.00 ","$18,251.00 ","$9,910.29 ","$0.00 ","$3,803.96 ","$5,158.80 ","$5,158.80 ","$3,195.60 ","$18,251.00 ","$0.00 ","$9,125.50 ","$14,454.79 ","$14,600.80 ","$0.00 ","$2,856.28 ","$0.00 ","$2,905.56 ","$0.00 "
"27202692","EAP","HCPCS C1769","","7mmx15cmx110cm 0.035 Guidewire","BOTH IP/OP","$21,246.00 ","$15,722.04 ","$0.00 ","$21,246.00 ","$11,536.58 ","$0.00 ","$4,428.20 ","$5,158.80 ","$5,158.80 ","$3,720.00 ","$21,246.00 ","$0.00 ","$10,623.00 ","$16,826.83 ","$16,996.80 ","$0.00 ","$3,325.00 ","$0.00 ","$3,382.36 ","$0.00 "
"27202693","EAP","HCPCS C1769","","8mmx5cmx110cm 0.035 Guidewire","BOTH IP/OP","$15,219.00 ","$11,262.06 ","$0.00 ","$15,219.00 ","$8,263.92 ","$0.00 ","$3,172.02 ","$5,158.80 ","$5,158.80 ","$2,664.73 ","$15,219.00 ","$0.00 ","$7,609.50 ","$12,053.45 ","$12,175.20 ","$0.00 ","$2,381.77 ","$0.00 ","$2,422.86 ","$0.00 "
"27202694","EAP","HCPCS C1769","","8mmx10cmx110cm 0.035 Guidewire","BOTH IP/OP","$18,251.00 ","$13,505.74 ","$0.00 ","$18,251.00 ","$9,910.29 ","$0.00 ","$3,803.96 ","$5,158.80 ","$5,158.80 ","$3,195.60 ","$18,251.00 ","$0.00 ","$9,125.50 ","$14,454.79 ","$14,600.80 ","$0.00 ","$2,856.28 ","$0.00 ","$2,905.56 ","$0.00 "
"27202695","EAP","HCPCS C1769","","8mmx15cmx110cm 0.035 Guidewire","BOTH IP/OP","$21,246.00 ","$15,722.04 ","$0.00 ","$21,246.00 ","$11,536.58 ","$0.00 ","$4,428.20 ","$5,158.80 ","$5,158.80 ","$3,720.00 ","$21,246.00 ","$0.00 ","$10,623.00 ","$16,826.83 ","$16,996.80 ","$0.00 ","$3,325.00 ","$0.00 ","$3,382.36 ","$0.00 "
"27202696","EAP","HCPCS C1769","","10mmx5cmx110cm 0.025 Guidewire","BOTH IP/OP","$15,219.00 ","$11,262.06 ","$0.00 ","$15,219.00 ","$8,263.92 ","$0.00 ","$3,172.02 ","$5,158.80 ","$5,158.80 ","$2,664.73 ","$15,219.00 ","$0.00 ","$7,609.50 ","$12,053.45 ","$12,175.20 ","$0.00 ","$2,381.77 ","$0.00 ","$2,422.86 ","$0.00 "
"27202697","EAP","HCPCS C1769","","10mmx10cmx110cm 0.025 Guidewir","BOTH IP/OP","$18,251.00 ","$13,505.74 ","$0.00 ","$18,251.00 ","$9,910.29 ","$0.00 ","$3,803.96 ","$5,158.80 ","$5,158.80 ","$3,195.60 ","$18,251.00 ","$0.00 ","$9,125.50 ","$14,454.79 ","$14,600.80 ","$0.00 ","$2,856.28 ","$0.00 ","$2,905.56 ","$0.00 "
"27202698","EAP","HCPCS C1769","","13mmx5cmx110cm 0.025 Guidewire","BOTH IP/OP","$15,219.00 ","$11,262.06 ","$0.00 ","$15,219.00 ","$8,263.92 ","$0.00 ","$3,172.02 ","$5,158.80 ","$5,158.80 ","$2,664.73 ","$15,219.00 ","$0.00 ","$7,609.50 ","$12,053.45 ","$12,175.20 ","$0.00 ","$2,381.77 ","$0.00 ","$2,422.86 ","$0.00 "
"27202699","EAP","HCPCS C1769","","13mmx2.5cmx110cm 0.025 Guidewi","BOTH IP/OP","$15,219.00 ","$11,262.06 ","$0.00 ","$15,219.00 ","$8,263.92 ","$0.00 ","$3,172.02 ","$5,158.80 ","$5,158.80 ","$2,664.73 ","$15,219.00 ","$0.00 ","$7,609.50 ","$12,053.45 ","$12,175.20 ","$0.00 ","$2,381.77 ","$0.00 ","$2,422.86 ","$0.00 "
"27202700","EAP","Custom 27202700","","16mmx20mmx8.5cm Aaa Stent Graf","BOTH IP/OP","$22,131.00 ","$16,376.94 ","$0.00 ","$22,131.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,131.00 ","$0.00 ","$11,065.50 ","$17,527.75 ","$17,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202701","EAP","Custom 27202701","","18mmx22mmx8.5cm Aaa Stent Graf","BOTH IP/OP","$22,131.00 ","$16,376.94 ","$0.00 ","$22,131.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,131.00 ","$0.00 ","$11,065.50 ","$17,527.75 ","$17,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202702","EAP","Custom 27202702","","18mmx24mmx8.5cm Aaa Stent Graf","BOTH IP/OP","$22,131.00 ","$16,376.94 ","$0.00 ","$22,131.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,131.00 ","$0.00 ","$11,065.50 ","$17,527.75 ","$17,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202703","EAP","Custom 27202703","","20mmx4.0cm Aaa Stent Graft","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202704","EAP","Custom 27202704","","22mmx4.0cm Aaa Stent Graft","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202705","EAP","Custom 27202705","","24mmx4.0cm Aaa Stent Graft","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202706","EAP","Custom 27202706","","26mmx4.0cm Aaa Stent Graft","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202707","EAP","Custom 27202707","","28mmx4.0cm Aaa Stent Graft","BOTH IP/OP","$15,151.00 ","$11,211.74 ","$0.00 ","$15,151.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,151.00 ","$0.00 ","$7,575.50 ","$11,999.59 ","$12,120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202708","EAP","Custom 27202708","","23x3.3cm Aaa Endoprosthesis","BOTH IP/OP","$17,322.00 ","$12,818.28 ","$0.00 ","$17,322.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$17,322.00 ","$0.00 ","$8,661.00 ","$13,719.02 ","$13,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202709","EAP","Custom 27202709","","26x3.3cm Aaa Endprosthesis","BOTH IP/OP","$17,322.00 ","$12,818.28 ","$0.00 ","$17,322.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$17,322.00 ","$0.00 ","$8,661.00 ","$13,719.02 ","$13,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202710","EAP","Custom 27202710","","28.5x3.3cm Aaa Endoprosthesis","BOTH IP/OP","$16,083.00 ","$11,901.42 ","$0.00 ","$16,083.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$16,083.00 ","$0.00 ","$8,041.50 ","$12,737.74 ","$12,866.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202711","EAP","Custom 27202711","","10x7cm Aaa Endoprosthesis","BOTH IP/OP","$16,083.00 ","$11,901.42 ","$0.00 ","$16,083.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$16,083.00 ","$0.00 ","$8,041.50 ","$12,737.74 ","$12,866.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202712","EAP","Custom 27202712","","12x7cm Aaa Endoprosthesis","BOTH IP/OP","$16,083.00 ","$11,901.42 ","$0.00 ","$16,083.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$16,083.00 ","$0.00 ","$8,041.50 ","$12,737.74 ","$12,866.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202713","EAP","Custom 27202713","","14.5x7cm Aaa Endoprosthesis","BOTH IP/OP","$16,083.00 ","$11,901.42 ","$0.00 ","$16,083.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$16,083.00 ","$0.00 ","$8,041.50 ","$12,737.74 ","$12,866.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202714","EAP","Custom 27202714","","12frx30cm Introducer Sheath","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$374.69 ","$374.69 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202715","EAP","Custom 27202715","","18frx30cm Intruder Sheath","BOTH IP/OP","$902.00 ","$667.48 ","$0.00 ","$902.00 ","$0.00 ","$0.00 ","$0.00 ","$643.76 ","$643.76 ","$0.00 ","$902.00 ","$0.00 ","$451.00 ","$714.38 ","$721.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202716","EAP","Custom 27202716","","26x10cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202717","EAP","Custom 27202717","","28x10cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202718","EAP","Custom 27202718","","28x15cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202719","EAP","Custom 27202719","","31x10cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202720","EAP","Custom 27202720","","31x15cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202721","EAP","Custom 27202721","","34x10cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202722","EAP","Custom 27202722","","34x15cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202723","EAP","Custom 27202723","","34x20cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202724","EAP","Custom 27202724","","37x10cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202725","EAP","Custom 27202725","","37x15cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202726","EAP","Custom 27202726","","37x20cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202727","EAP","Custom 27202727","","40x10cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202728","EAP","Custom 27202728","","40x15cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202729","EAP","Custom 27202729","","40x20cm Thoracic Endoprosthesi","BOTH IP/OP","$23,023.00 ","$17,037.02 ","$0.00 ","$23,023.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$23,023.00 ","$0.00 ","$11,511.50 ","$18,234.22 ","$18,418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202730","EAP","Custom 27202730","","20frx30cm Introducer Sheath","BOTH IP/OP","$2,043.00 ","$1,511.82 ","$0.00 ","$2,043.00 ","$0.00 ","$0.00 ","$0.00 ","$1,458.09 ","$1,458.09 ","$0.00 ","$2,043.00 ","$0.00 ","$1,021.50 ","$1,618.06 ","$1,634.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202731","EAP","Custom 27202731","","22frx30cm Introducer Sheath","BOTH IP/OP","$2,043.00 ","$1,511.82 ","$0.00 ","$2,043.00 ","$0.00 ","$0.00 ","$0.00 ","$1,458.09 ","$1,458.09 ","$0.00 ","$2,043.00 ","$0.00 ","$1,021.50 ","$1,618.06 ","$1,634.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202732","EAP","Custom 27202732","","24frx30cm Introducer Sheath","BOTH IP/OP","$2,043.00 ","$1,511.82 ","$0.00 ","$2,043.00 ","$0.00 ","$0.00 ","$0.00 ","$1,458.09 ","$1,458.09 ","$0.00 ","$2,043.00 ","$0.00 ","$1,021.50 ","$1,618.06 ","$1,634.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202733","EAP","Custom 27202733","","Gore Tri-lobe Ballon Catheter","BOTH IP/OP","$3,391.00 ","$2,509.34 ","$0.00 ","$3,391.00 ","$0.00 ","$0.00 ","$0.00 ","$2,420.16 ","$2,420.16 ","$0.00 ","$3,391.00 ","$0.00 ","$1,695.50 ","$2,685.67 ","$2,712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202734","EAP","Custom 27202734","","20x12x135mm Aaa Stent Graft","BOTH IP/OP","$25,471.00 ","$18,848.54 ","$0.00 ","$25,471.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$25,471.00 ","$0.00 ","$12,735.50 ","$20,173.03 ","$20,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202735","EAP","Custom 27202735","","22x13x135mm Aaa Stent Graft","BOTH IP/OP","$25,471.00 ","$18,848.54 ","$0.00 ","$25,471.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$25,471.00 ","$0.00 ","$12,735.50 ","$20,173.03 ","$20,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202736","EAP","Custom 27202736","","24x14x135mm Aaa Stent Graft","BOTH IP/OP","$25,471.00 ","$18,848.54 ","$0.00 ","$25,471.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$25,471.00 ","$0.00 ","$12,735.50 ","$20,173.03 ","$20,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202737","EAP","Custom 27202737","","26x15x135mm Aaa Stent Graft","BOTH IP/OP","$25,471.00 ","$18,848.54 ","$0.00 ","$25,471.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$25,471.00 ","$0.00 ","$12,735.50 ","$20,173.03 ","$20,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202738","EAP","Custom 27202738","","28x16x135mm Aaa Stent Graft","BOTH IP/OP","$25,471.00 ","$18,848.54 ","$0.00 ","$25,471.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$25,471.00 ","$0.00 ","$12,735.50 ","$20,173.03 ","$20,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202739","EAP","Custom 27202739","","20x12x165mm Aaa Stent Graft","BOTH IP/OP","$1,232.00 ","$911.68 ","$0.00 ","$1,232.00 ","$0.00 ","$0.00 ","$0.00 ","$879.28 ","$879.28 ","$0.00 ","$1,232.00 ","$0.00 ","$616.00 ","$975.74 ","$985.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202740","EAP","Custom 27202740","","22x13x165mm Aaa Stent Graft","BOTH IP/OP","$1,232.00 ","$911.68 ","$0.00 ","$1,232.00 ","$0.00 ","$0.00 ","$0.00 ","$879.28 ","$879.28 ","$0.00 ","$1,232.00 ","$0.00 ","$616.00 ","$975.74 ","$985.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202741","EAP","Custom 27202741","","24x14x165mm Aaa Stent Graft","BOTH IP/OP","$1,232.00 ","$911.68 ","$0.00 ","$1,232.00 ","$0.00 ","$0.00 ","$0.00 ","$879.28 ","$879.28 ","$0.00 ","$1,232.00 ","$0.00 ","$616.00 ","$975.74 ","$985.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202742","EAP","Custom 27202742","","26x15x165mm Aaa Stent Graft","BOTH IP/OP","$1,232.00 ","$911.68 ","$0.00 ","$1,232.00 ","$0.00 ","$0.00 ","$0.00 ","$879.28 ","$879.28 ","$0.00 ","$1,232.00 ","$0.00 ","$616.00 ","$975.74 ","$985.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202743","EAP","Custom 27202743","","28x16x165mm Aaa Stent Graft","BOTH IP/OP","$1,232.00 ","$911.68 ","$0.00 ","$1,232.00 ","$0.00 ","$0.00 ","$0.00 ","$879.28 ","$879.28 ","$0.00 ","$1,232.00 ","$0.00 ","$616.00 ","$975.74 ","$985.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202744","EAP","Custom 27202744","","Cath, Angioplasty Spv","BOTH IP/OP","$1,074.00 ","$794.76 ","$0.00 ","$1,074.00 ","$0.00 ","$0.00 ","$0.00 ","$766.51 ","$766.51 ","$0.00 ","$1,074.00 ","$0.00 ","$537.00 ","$850.61 ","$859.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202745","EAP","HCPCS C1729","","Catheter Drainage Spv","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"27202746","EAP","Custom 27202746","","Cath, Hemodial, Long-term Spv","BOTH IP/OP","$1,131.00 ","$836.94 ","$0.00 ","$1,131.00 ","$0.00 ","$0.00 ","$0.00 ","$807.19 ","$807.19 ","$0.00 ","$1,131.00 ","$0.00 ","$565.50 ","$895.75 ","$904.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202747","EAP","Custom 27202747","","Cath, Infusion Non-hemo Spv","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$0.00 ","$0.00 ","$0.00 ","$307.60 ","$307.60 ","$0.00 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202748","EAP","Custom 27202748","","Cath, Hemodial, Short-term Spv","BOTH IP/OP","$587.00 ","$434.38 ","$0.00 ","$587.00 ","$0.00 ","$0.00 ","$0.00 ","$418.94 ","$418.94 ","$0.00 ","$587.00 ","$0.00 ","$293.50 ","$464.90 ","$469.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202749","EAP","Custom 27202749","","Cath,thrombect/embolect Spv","BOTH IP/OP","$2,336.00 ","$1,728.64 ","$0.00 ","$2,336.00 ","$0.00 ","$0.00 ","$0.00 ","$1,667.20 ","$1,667.20 ","$0.00 ","$2,336.00 ","$0.00 ","$1,168.00 ","$1,850.11 ","$1,868.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202750","EAP","Custom 27202750","","Retrieval Device Spv","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$391.00 ","$0.00 ","$0.00 ","$0.00 ","$279.06 ","$279.06 ","$0.00 ","$391.00 ","$0.00 ","$195.50 ","$309.67 ","$312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202751","EAP","Custom 27202751","","Port, Implantable Spv","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$1,377.44 ","$1,377.44 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202752","EAP","Custom 27202752","","Stent, Covrd, W/delv Spv","BOTH IP/OP","$7,595.00 ","$5,620.30 ","$0.00 ","$7,595.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,595.00 ","$0.00 ","$3,797.50 ","$6,015.24 ","$6,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202753","EAP","Custom 27202753","","Stent, Non-covrd W/delv Spv","BOTH IP/OP","$5,824.00 ","$4,309.76 ","$0.00 ","$5,824.00 ","$0.00 ","$0.00 ","$0.00 ","$4,156.59 ","$4,156.59 ","$0.00 ","$5,824.00 ","$0.00 ","$2,912.00 ","$4,612.61 ","$4,659.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202754","EAP","Custom 27202754","","Stent, Non-covrd W/o Delv Spv","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$0.00 ","$0.00 ","$0.00 ","$2,435.14 ","$2,435.14 ","$0.00 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202755","EAP","HCPCS C1887","","Catheter, Guiding Spv","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$234.03 ","$0.00 ","$89.83 ","$307.60 ","$307.60 ","$75.46 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$0.00 ","$67.45 ","$0.00 ","$68.62 ","$0.00 "
"27202756","EAP","Custom 27202756","","Workhorse Balloon Catheter","BOTH IP/OP","$1,462.00 ","$1,081.88 ","$0.00 ","$1,462.00 ","$0.00 ","$0.00 ","$0.00 ","$1,043.43 ","$1,043.43 ","$0.00 ","$1,462.00 ","$0.00 ","$731.00 ","$1,157.90 ","$1,169.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202757","EAP","Custom 27202757","","Opta 5 Balloon Catheter","BOTH IP/OP","$1,462.00 ","$1,081.88 ","$0.00 ","$1,462.00 ","$0.00 ","$0.00 ","$0.00 ","$1,043.43 ","$1,043.43 ","$0.00 ","$1,462.00 ","$0.00 ","$731.00 ","$1,157.90 ","$1,169.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202758","EAP","Custom 27202758","","Arrow-trerotola Device","BOTH IP/OP","$3,506.00 ","$2,594.44 ","$0.00 ","$3,506.00 ","$0.00 ","$0.00 ","$0.00 ","$2,502.23 ","$2,502.23 ","$0.00 ","$3,506.00 ","$0.00 ","$1,753.00 ","$2,776.75 ","$2,804.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202759","EAP","Custom 27202759","","Flexima Biliary Drain Cath W/l","BOTH IP/OP","$439.00 ","$324.86 ","$0.00 ","$439.00 ","$0.00 ","$0.00 ","$0.00 ","$313.31 ","$313.31 ","$0.00 ","$439.00 ","$0.00 ","$219.50 ","$347.69 ","$351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202760","EAP","Custom 27202760","","Catheter, Occlusion Spv","BOTH IP/OP","$2,336.00 ","$1,728.64 ","$0.00 ","$2,336.00 ","$0.00 ","$0.00 ","$0.00 ","$1,667.20 ","$1,667.20 ","$0.00 ","$2,336.00 ","$0.00 ","$1,168.00 ","$1,850.11 ","$1,868.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202761","EAP","Custom 27202761","","G - Feeding Kit, 18fr, 2.5l","BOTH IP/OP","$1,090.00 ","$806.60 ","$0.00 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$777.93 ","$777.93 ","$0.00 ","$1,090.00 ","$0.00 ","$545.00 ","$863.28 ","$872.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202786","EAP","HCPCS C1892","","8fr-14cm Peel Away Sheath","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$54.84 ","$0.00 ","$21.05 ","$72.08 ","$72.08 ","$17.68 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$15.81 ","$0.00 ","$16.08 ","$0.00 "
"27202790","EAP","Custom 27202790","","Alligator Retrieval","BOTH IP/OP","$8,967.00 ","$6,635.58 ","$0.00 ","$8,967.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,967.00 ","$0.00 ","$4,483.50 ","$7,101.86 ","$7,173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202791","EAP","HCPCS C1769","","Cadence Precision","BOTH IP/OP","$1,703.00 ","$1,260.22 ","$0.00 ","$1,703.00 ","$924.73 ","$0.00 ","$354.95 ","$1,215.43 ","$1,215.43 ","$298.18 ","$1,703.00 ","$0.00 ","$851.50 ","$1,348.78 ","$1,362.40 ","$0.00 ","$266.52 ","$0.00 ","$271.12 ","$0.00 "
"27202792","EAP","HCPCS C1751","","Catheter Echelon 10 Micro","BOTH IP/OP","$2,423.00 ","$1,793.02 ","$0.00 ","$2,423.00 ","$1,315.69 ","$0.00 ","$505.01 ","$1,729.30 ","$1,729.30 ","$424.25 ","$2,423.00 ","$0.00 ","$1,211.50 ","$1,919.02 ","$1,938.40 ","$0.00 ","$379.20 ","$0.00 ","$385.74 ","$0.00 "
"27202794","EAP","Custom 27202794","","Catheter Marathon","BOTH IP/OP","$2,152.00 ","$1,592.48 ","$0.00 ","$2,152.00 ","$0.00 ","$0.00 ","$0.00 ","$1,535.88 ","$1,535.88 ","$0.00 ","$2,152.00 ","$0.00 ","$1,076.00 ","$1,704.38 ","$1,721.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202795","EAP","HCPCS C2628","","Catheter Marksman 105cm","BOTH IP/OP","$3,587.00 ","$2,654.38 ","$0.00 ","$3,587.00 ","$1,947.74 ","$0.00 ","$747.62 ","$2,560.04 ","$2,560.04 ","$0.00 ","$3,587.00 ","$0.00 ","$1,793.50 ","$2,840.90 ","$2,869.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202796","EAP","HCPCS C2628","","Catheter Marksman 135cm","BOTH IP/OP","$3,587.00 ","$2,654.38 ","$0.00 ","$3,587.00 ","$1,947.74 ","$0.00 ","$747.62 ","$2,560.04 ","$2,560.04 ","$0.00 ","$3,587.00 ","$0.00 ","$1,793.50 ","$2,840.90 ","$2,869.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202797","EAP","Custom 27202797","","Catheter Marksman 150cm","BOTH IP/OP","$3,587.00 ","$2,654.38 ","$0.00 ","$3,587.00 ","$0.00 ","$0.00 ","$0.00 ","$2,560.04 ","$2,560.04 ","$0.00 ","$3,587.00 ","$0.00 ","$1,793.50 ","$2,840.90 ","$2,869.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202798","EAP","HCPCS C1751","","Catheter Rebar-027 130cm Micro","BOTH IP/OP","$989.00 ","$731.86 ","$0.00 ","$989.00 ","$537.03 ","$0.00 ","$206.13 ","$705.85 ","$705.85 ","$173.17 ","$989.00 ","$0.00 ","$494.50 ","$783.29 ","$791.20 ","$0.00 ","$154.78 ","$0.00 ","$157.45 ","$0.00 "
"27202799","EAP","HCPCS C1751","","Catheter Rebar-027 145cm Micro","BOTH IP/OP","$989.00 ","$731.86 ","$0.00 ","$989.00 ","$537.03 ","$0.00 ","$206.13 ","$705.85 ","$705.85 ","$173.17 ","$989.00 ","$0.00 ","$494.50 ","$783.29 ","$791.20 ","$0.00 ","$154.78 ","$0.00 ","$157.45 ","$0.00 "
"27202800","EAP","HCPCS C1751","","Catheter Rebar-10 153cm Micro","BOTH IP/OP","$1,777.00 ","$1,314.98 ","$0.00 ","$1,777.00 ","$964.91 ","$0.00 ","$370.37 ","$1,268.24 ","$1,268.24 ","$311.14 ","$1,777.00 ","$0.00 ","$888.50 ","$1,407.38 ","$1,421.60 ","$0.00 ","$278.10 ","$0.00 ","$282.90 ","$0.00 "
"27202801","EAP","HCPCS C1751","","Catheter Rebar-14 153cm Micro","BOTH IP/OP","$1,777.00 ","$1,314.98 ","$0.00 ","$1,777.00 ","$964.91 ","$0.00 ","$370.37 ","$1,268.24 ","$1,268.24 ","$311.14 ","$1,777.00 ","$0.00 ","$888.50 ","$1,407.38 ","$1,421.60 ","$0.00 ","$278.10 ","$0.00 ","$282.90 ","$0.00 "
"27202802","EAP","HCPCS C1751","","Catheter Rebar-18 130cm Micro","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"27202803","EAP","HCPCS C1751","","Catheter Rebar-18 153 Micro","BOTH IP/OP","$1,292.00 ","$956.08 ","$0.00 ","$1,292.00 ","$701.56 ","$0.00 ","$269.29 ","$922.10 ","$922.10 ","$226.22 ","$1,292.00 ","$0.00 ","$646.00 ","$1,023.26 ","$1,033.60 ","$0.00 ","$202.20 ","$0.00 ","$205.69 ","$0.00 "
"27202804","EAP","HCPCS C1751","","Catheter Rebar-18 153cm Micro","BOTH IP/OP","$1,435.00 ","$1,061.90 ","$0.00 ","$1,435.00 ","$779.21 ","$0.00 ","$299.09 ","$1,024.16 ","$1,024.16 ","$251.26 ","$1,435.00 ","$0.00 ","$717.50 ","$1,136.52 ","$1,148.00 ","$0.00 ","$224.58 ","$0.00 ","$228.45 ","$0.00 "
"27202806","EAP","Custom 27202806","","Dribath Onyx Heater Us","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$0.00 ","$0.00 ","$0.00 ","$1,279.66 ","$1,279.66 ","$0.00 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202808","EAP","HCPCS C1751","","Extended Ultraflow","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$973.60 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27202809","EAP","HCPCS C1769","","Guidewire Silverspeed .010","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$588.80 ","$588.80 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"27202810","EAP","HCPCS C1769","","Guidewire Silverspeed .014","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$588.80 ","$588.80 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"27202811","EAP","HCPCS C1769","","Guidewire Silverspeed .016","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$399.11 ","$0.00 ","$153.19 ","$524.57 ","$524.57 ","$128.69 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$115.03 ","$0.00 ","$117.01 ","$0.00 "
"27202812","EAP","HCPCS C1769","","Guidewire X-celerator .010r","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$643.46 ","$0.00 ","$246.98 ","$845.73 ","$845.73 ","$207.48 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$185.45 ","$0.00 ","$188.65 ","$0.00 "
"27202813","EAP","HCPCS C1769","","Guidewire X-celerator-14 Re","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$643.46 ","$0.00 ","$246.98 ","$845.73 ","$845.73 ","$207.48 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$185.45 ","$0.00 ","$188.65 ","$0.00 "
"27202814","EAP","HCPCS C1769","","Guidewire X-pedion 14 2","BOTH IP/OP","$897.00 ","$663.78 ","$0.00 ","$897.00 ","$487.07 ","$0.00 ","$186.96 ","$640.19 ","$640.19 ","$157.06 ","$897.00 ","$0.00 ","$448.50 ","$710.42 ","$717.60 ","$0.00 ","$140.38 ","$0.00 ","$142.80 ","$0.00 "
"27202815","EAP","HCPCS C1769","","Guidewire X-pedion-10 Re 2","BOTH IP/OP","$897.00 ","$663.78 ","$0.00 ","$897.00 ","$487.07 ","$0.00 ","$186.96 ","$640.19 ","$640.19 ","$157.06 ","$897.00 ","$0.00 ","$448.50 ","$710.42 ","$717.60 ","$0.00 ","$140.38 ","$0.00 ","$142.80 ","$0.00 "
"27202816","EAP","HCPCS C1726","","Hyperglide 3.0 X 10mm","BOTH IP/OP","$3,837.00 ","$2,839.38 ","$0.00 ","$3,837.00 ","$2,083.49 ","$0.00 ","$799.73 ","$2,738.47 ","$2,738.47 ","$671.83 ","$3,837.00 ","$0.00 ","$1,918.50 ","$3,038.90 ","$3,069.60 ","$0.00 ","$600.49 ","$0.00 ","$610.85 ","$0.00 "
"27202817","EAP","HCPCS C1726","","Hyperglide 3.0 X 15mm","BOTH IP/OP","$3,837.00 ","$2,839.38 ","$0.00 ","$3,837.00 ","$2,083.49 ","$0.00 ","$799.73 ","$2,738.47 ","$2,738.47 ","$671.83 ","$3,837.00 ","$0.00 ","$1,918.50 ","$3,038.90 ","$3,069.60 ","$0.00 ","$600.49 ","$0.00 ","$610.85 ","$0.00 "
"27202818","EAP","HCPCS C1726","","Hyperglide 4.0 X 10mm","BOTH IP/OP","$3,837.00 ","$2,839.38 ","$0.00 ","$3,837.00 ","$2,083.49 ","$0.00 ","$799.73 ","$2,738.47 ","$2,738.47 ","$671.83 ","$3,837.00 ","$0.00 ","$1,918.50 ","$3,038.90 ","$3,069.60 ","$0.00 ","$600.49 ","$0.00 ","$610.85 ","$0.00 "
"27202819","EAP","HCPCS C1726","","Hyperglide 4.0 X 20mm","BOTH IP/OP","$3,676.00 ","$2,720.24 ","$0.00 ","$3,676.00 ","$1,996.07 ","$0.00 ","$766.17 ","$2,623.56 ","$2,623.56 ","$643.64 ","$3,676.00 ","$0.00 ","$1,838.00 ","$2,911.39 ","$2,940.80 ","$0.00 ","$575.29 ","$0.00 ","$585.22 ","$0.00 "
"27202820","EAP","HCPCS C1726","","Hyperglide 5.0 X 15mm","BOTH IP/OP","$3,837.00 ","$2,839.38 ","$0.00 ","$3,837.00 ","$2,083.49 ","$0.00 ","$799.73 ","$2,738.47 ","$2,738.47 ","$671.83 ","$3,837.00 ","$0.00 ","$1,918.50 ","$3,038.90 ","$3,069.60 ","$0.00 ","$600.49 ","$0.00 ","$610.85 ","$0.00 "
"27202821","EAP","HCPCS C1726","","Hyperglide 5.0 X 20mm","BOTH IP/OP","$1,472.00 ","$1,089.28 ","$0.00 ","$1,472.00 ","$799.30 ","$0.00 ","$306.80 ","$1,050.57 ","$1,050.57 ","$257.74 ","$1,472.00 ","$0.00 ","$736.00 ","$1,165.82 ","$1,177.60 ","$0.00 ","$230.37 ","$0.00 ","$234.34 ","$0.00 "
"27202822","EAP","HCPCS C1751","","Hyperglide 5.0 X 30","BOTH IP/OP","$4,627.00 ","$3,423.98 ","$0.00 ","$4,627.00 ","$2,512.46 ","$0.00 ","$964.38 ","$3,302.29 ","$3,302.29 ","$810.15 ","$4,627.00 ","$0.00 ","$2,313.50 ","$3,664.58 ","$3,701.60 ","$0.00 ","$724.13 ","$0.00 ","$736.62 ","$0.00 "
"27202823","EAP","HCPCS C1726","","Hyperglide System - 30mm","BOTH IP/OP","$3,676.00 ","$2,720.24 ","$0.00 ","$3,676.00 ","$1,996.07 ","$0.00 ","$766.17 ","$2,623.56 ","$2,623.56 ","$643.64 ","$3,676.00 ","$0.00 ","$1,838.00 ","$2,911.39 ","$2,940.80 ","$0.00 ","$575.29 ","$0.00 ","$585.22 ","$0.00 "
"27202825","EAP","HCPCS C1769","","Meridian .014 Re","BOTH IP/OP","$1,777.00 ","$1,314.98 ","$0.00 ","$1,777.00 ","$964.91 ","$0.00 ","$370.37 ","$1,268.24 ","$1,268.24 ","$311.14 ","$1,777.00 ","$0.00 ","$888.50 ","$1,407.38 ","$1,421.60 ","$0.00 ","$278.10 ","$0.00 ","$282.90 ","$0.00 "
"27202826","EAP","HCPCS C1884","","Microcatheter Nautica","BOTH IP/OP","$1,882.00 ","$1,392.68 ","$0.00 ","$1,882.00 ","$1,021.93 ","$0.00 ","$392.26 ","$1,343.18 ","$1,343.18 ","$329.52 ","$1,882.00 ","$0.00 ","$941.00 ","$1,490.54 ","$1,505.60 ","$0.00 ","$294.53 ","$0.00 ","$299.61 ","$0.00 "
"27202827","EAP","HCPCS C1769","","Mirage Re .008","BOTH IP/OP","$1,490.00 ","$1,102.60 ","$0.00 ","$1,490.00 ","$809.07 ","$0.00 ","$310.55 ","$1,063.41 ","$1,063.41 ","$260.89 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$233.19 ","$0.00 ","$237.21 ","$0.00 "
"27202828","EAP","Custom 27202828","","Mixer Us 15-17 Mm Vial","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$0.00 ","$0.00 ","$0.00 ","$1,279.66 ","$1,279.66 ","$0.00 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202829","EAP","HCPCS C1884","","Onyx 18 Kit Avm Us","BOTH IP/OP","$8,071.00 ","$5,972.54 ","$0.00 ","$8,071.00 ","$4,382.55 ","$0.00 ","$1,682.20 ","$5,158.80 ","$5,158.80 ","$1,413.17 ","$8,071.00 ","$0.00 ","$4,035.50 ","$6,392.23 ","$6,456.80 ","$0.00 ","$1,263.11 ","$0.00 ","$1,284.90 ","$0.00 "
"27202830","EAP","HCPCS C1884","","Onyx 34 Kit Avm Us","BOTH IP/OP","$3,227.00 ","$2,387.98 ","$0.00 ","$3,227.00 ","$1,752.26 ","$0.00 ","$672.59 ","$2,303.11 ","$2,303.11 ","$565.02 ","$3,227.00 ","$0.00 ","$1,613.50 ","$2,555.78 ","$2,581.60 ","$0.00 ","$505.03 ","$0.00 ","$513.74 ","$0.00 "
"27202831","EAP","HCPCS C1751","","Onyx Hd500 Kit Aneurys","BOTH IP/OP","$9,325.00 ","$6,900.50 ","$0.00 ","$9,325.00 ","$5,063.48 ","$0.00 ","$1,943.56 ","$5,158.80 ","$5,158.80 ","$1,632.73 ","$9,325.00 ","$0.00 ","$4,662.50 ","$7,385.40 ","$7,460.00 ","$0.00 ","$1,459.36 ","$0.00 ","$1,484.54 ","$0.00 "
"27202833","EAP","Custom 27202833","","Syringe 1ml Single Pa","BOTH IP/OP","$268.00 ","$198.32 ","$0.00 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$191.27 ","$191.27 ","$0.00 ","$268.00 ","$0.00 ","$134.00 ","$212.26 ","$214.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202834","EAP","HCPCS C1726","","Syringe Adapter-carton","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$973.60 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27202835","EAP","Custom 27202835","","Ultraflow Hpc 1.5f Flow","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$0.00 ","$0.00 ","$0.00 ","$1,279.66 ","$1,279.66 ","$0.00 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202850","EAP","Custom 27202850","","Adjustable Outrigger(flex/ext)","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$0.00 ","$0.00 ","$0.00 ","$260.50 ","$260.50 ","$0.00 ","$365.00 ","$0.00 ","$182.50 ","$289.08 ","$292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202852","EAP","Custom 27202852","","Adjustable Wrist Hinge","BOTH IP/OP","$412.00 ","$304.88 ","$0.00 ","$412.00 ","$0.00 ","$0.00 ","$0.00 ","$294.04 ","$294.04 ","$0.00 ","$412.00 ","$0.00 ","$206.00 ","$326.30 ","$329.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202853","EAP","Custom 27202853","","Alumafoam Splint","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202854","EAP","Custom 27202854","","Aquacel Silver 4x4","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202855","EAP","Custom 27202855","","Aquacel Silver 6x6","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$0.00 ","$0.00 ","$0.00 ","$83.50 ","$83.50 ","$0.00 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202856","EAP","Custom 27202856","","Aquacel Silver 8x12","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202857","EAP","Custom 27202857","","Aquacel Silver Rope","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202858","EAP","Custom 27202858","","Bioconcept Brief","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202859","EAP","Custom 27202859","","Bioconcept Sleeved Vest","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202860","EAP","Custom 27202860","","Bioconcepts Brief","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202861","EAP","Custom 27202861","","Bioconcepts Digi - Sleeve","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202862","EAP","Custom 27202862","","Bioconcepts Digi Sleeves 3""","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202863","EAP","Custom 27202863","","Bioconcepts Forearm Sleeve","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202865","EAP","Custom 27202865","","Bioconcepts Gloves","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202867","EAP","Custom 27202867","","Bioconcepts Sleeved Vest","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202868","EAP","Custom 27202868","","Bioconcepts Ue Sleeve","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202869","EAP","Custom 27202869","","Chin Strap","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$0.00 ","$0.00 ","$0.00 ","$38.54 ","$38.54 ","$0.00 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202870","EAP","Custom 27202870","","Clear Acrylic Cone","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$0.00 ","$0.00 ","$0.00 ","$47.82 ","$47.82 ","$0.00 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202871","EAP","Custom 27202871","","Desensitization Kits","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202872","EAP","Custom 27202872","","Digi Sleeve","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202874","EAP","Custom 27202874","","Double Finger Stall","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202875","EAP","Custom 27202875","","Dynamic Finger Flexion Strap","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202876","EAP","Custom 27202876","","Dynamic Mp Flexion Spring","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$92.78 ","$92.78 ","$0.00 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202877","EAP","Custom 27202877","","Elbow Pad","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202878","EAP","Custom 27202878","","External Fixator Splint","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$0.00 ","$0.00 ","$0.00 ","$204.83 ","$204.83 ","$0.00 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202879","EAP","Custom 27202879","","Ezy Wrap Tigger Splint","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202881","EAP","Custom 27202881","","Finger Cylinder Cast","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202882","EAP","Custom 27202882","","Finger Knuckle Bender Splint","BOTH IP/OP","$104.00 ","$76.96 ","$0.00 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$74.22 ","$74.22 ","$0.00 ","$104.00 ","$0.00 ","$52.00 ","$82.37 ","$83.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202883","EAP","Custom 27202883","","Green Stick Splint","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202884","EAP","Custom 27202884","","Individual Outigger-each Digit","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$0.00 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202885","EAP","Custom 27202885","","Indivisual Outrigger","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$0.00 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202886","EAP","Custom 27202886","","Joint Jack","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$125.61 ","$125.61 ","$0.00 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202887","EAP","Custom 27202887","","Knee Hypercontrol Brace","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$0.00 ","$0.00 ","$0.00 ","$154.87 ","$154.87 ","$0.00 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202888","EAP","Custom 27202888","","Lmb Ulnar Deviation Splint","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$125.61 ","$125.61 ","$0.00 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202889","EAP","Custom 27202889","","Merit Static Pro Component","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$0.00 ","$0.00 ","$0.00 ","$106.34 ","$106.34 ","$0.00 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202890","EAP","Custom 27202890","","Merit Static Progressive Comp","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$0.00 ","$0.00 ","$0.00 ","$106.34 ","$106.34 ","$0.00 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202891","EAP","Custom 27202891","","Neoprene Tennis Elbow Strap","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$54.00 ","$0.00 ","$0.00 ","$0.00 ","$38.54 ","$38.54 ","$0.00 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202892","EAP","Custom 27202892","","Preformed Elbow Hinge Splint","BOTH IP/OP","$515.00 ","$381.10 ","$0.00 ","$515.00 ","$0.00 ","$0.00 ","$0.00 ","$367.56 ","$367.56 ","$0.00 ","$515.00 ","$0.00 ","$257.50 ","$407.88 ","$412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202893","EAP","Custom 27202893","","Profore","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202894","EAP","Custom 27202894","","Redi-fit Breifs","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202897","EAP","Custom 27202897","","Redi-fit Forearm Sleeves","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202898","EAP","Custom 27202898","","Redi-fit Sleeved Vest","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202899","EAP","Custom 27202899","","Redi-fit Ue Sleeves","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202900","EAP","Custom 27202900","","Reverse Knuckle Bender Splint","BOTH IP/OP","$104.00 ","$76.96 ","$0.00 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$74.22 ","$74.22 ","$0.00 ","$104.00 ","$0.00 ","$52.00 ","$82.37 ","$83.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202901","EAP","Custom 27202901","","Ring Splint","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$112.05 ","$112.05 ","$0.00 ","$157.00 ","$0.00 ","$78.50 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202902","EAP","Custom 27202902","","Soft Ulnar Deviation Support","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$49.25 ","$49.25 ","$0.00 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202903","EAP","Custom 27202903","","Supination / Pronation Kit","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202905","EAP","Custom 27202905","","Tap Splint","BOTH IP/OP","$211.00 ","$156.14 ","$0.00 ","$211.00 ","$0.00 ","$0.00 ","$0.00 ","$150.59 ","$150.59 ","$0.00 ","$211.00 ","$0.00 ","$105.50 ","$167.11 ","$168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202906","EAP","Custom 27202906","","Ulnar Deviation Slint","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$131.32 ","$131.32 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202908","EAP","Custom 27202908","","Wrap Finger Hooks","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202909","EAP","Custom 27202909","","Wrap On Finger Hooks(each)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202910","EAP","Custom 27202910","","Wrist Hinge W/ Dynamic Springs","BOTH IP/OP","$480.00 ","$355.20 ","$0.00 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$342.58 ","$342.58 ","$0.00 ","$480.00 ","$0.00 ","$240.00 ","$380.16 ","$384.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202911","EAP","HCPCS C1769","","Gwire Vasc 185cm .014in Prss Clip Conctr Radiopq Tip Trq Dev","BOTH IP/OP","$1,772.00 ","$1,311.28 ","$0.00 ","$1,772.00 ","$962.20 ","$0.00 ","$369.33 ","$1,264.68 ","$1,264.68 ","$310.26 ","$1,772.00 ","$0.00 ","$886.00 ","$1,403.42 ","$1,417.60 ","$0.00 ","$277.32 ","$0.00 ","$282.10 ","$0.00 "
"27202912","EAP","HCPCS C1769","","Abbott Vascular","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27202913","EAP","HCPCS C1725","","Cath Baldilat .035in 5fr 9mm 75cm 40mm Pta Lp Nc Mustang","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$285.08 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27202914","EAP","HCPCS C1725","","Cath Baldilat .035in 5fr 8mm 75cm 40mm Pta Lp Nc Mustang","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$285.08 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27202915","EAP","HCPCS C1726","","Catheter Baldilat Lp 5.3fr 4mm 75cm 40mm High Pressure","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$285.08 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27202916","EAP","HCPCS C1725","","Cath Baldilat 2.5mm 150cm 80mm Otw Cyte","BOTH IP/OP","$720.00 ","$532.80 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$513.86 ","$513.86 ","$126.07 ","$720.00 ","$0.00 ","$360.00 ","$570.24 ","$576.00 ","$0.00 ","$112.68 ","$0.00 ","$114.62 ","$0.00 "
"27202917","EAP","HCPCS C1725","","Catheter Balloon Dilit Coyote 2 X 220 150cm Otw","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$488.70 ","$0.00 ","$187.58 ","$642.33 ","$642.33 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"27202918","EAP","HCPCS C1725","","Balloon Coyote 2.5 X 220, 150cm, Otw","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$488.70 ","$0.00 ","$187.58 ","$642.33 ","$642.33 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"27202919","EAP","HCPCS C1725","","Catheter Balloon Dilit Coyote 3 X 100 150cm Otw","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$488.70 ","$0.00 ","$187.58 ","$642.33 ","$642.33 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"27202920","EAP","HCPCS C1725","","Cath Baldilat .035in 5fr 5mm 135cm 200mm Pta Lp Nc Mustang","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$285.08 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27202921","EAP","HCPCS C1725","","Cath Baldilat .035in 5fr 6mm 135cm 100mm Pta Lp Nc Mustang","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$0.00 ","$0.00 ","$0.00 ","$346.86 ","$346.86 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"27202922","EAP","HCPCS C1768","","Set Introd 40cm 4fr Mpnch Psh+ .018in Ntnl Trnstls Stf Cannu","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$57.02 ","$0.00 ","$21.88 ","$74.94 ","$74.94 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"27202923","EAP","HCPCS C1769","","Gwire Vasc 1.5mm Rsn Curve .035in 180cm 1.5mm Cvd Cath Exch","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"27202924","EAP","Custom 27202924","","Cath Angio .035in Vcf Curve 5fr 65cm 8 Spiraled Sdprt Hflo","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$122.04 ","$122.04 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202925","EAP","Custom 27202925","","Cath Angio .038in Kmp Curve 5fr 65cm Ang Multpur Nyl Ss Trnb","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$122.04 ","$122.04 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202926","EAP","HCPCS C1894","","Sheath Guid 45cm 6fr .087in Chk-flo Flxr .018/.038in Anl0","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$26.05 ","$89.21 ","$89.21 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"27202927","EAP","HCPCS C1894","","Sheath Guid 45cm 5fr .074in Chk-flo Flxr .018/.038in Anl0","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$64.62 ","$0.00 ","$24.80 ","$84.93 ","$84.93 ","$20.84 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$18.62 ","$0.00 ","$18.94 ","$0.00 "
"27202928","EAP","HCPCS C1769","","Gwire Vasc .035in 145cm 20cm Str Flexibile Tip Flpy Bntsn Lg","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27202929","EAP","HCPCS C1894","","Introd Shth 5fr .074in 70cm Anl1 Curve Multpur Tip Ansel","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$92.31 ","$0.00 ","$35.43 ","$121.33 ","$121.33 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"27202930","EAP","HCPCS C1887","","Cath Guid .035in 5mm Spc 3.1fr 150cm Lp Tpr Tip Sprt Radiopq","BOTH IP/OP","$2,257.00 ","$1,670.18 ","$0.00 ","$2,257.00 ","$1,225.55 ","$0.00 ","$470.42 ","$1,610.82 ","$1,610.82 ","$395.18 ","$2,257.00 ","$0.00 ","$1,128.50 ","$1,787.54 ","$1,805.60 ","$0.00 ","$353.22 ","$0.00 ","$359.31 ","$0.00 "
"27202931","EAP","HCPCS C1887","","Cath Guid .014in 3-1.9fr 150cm 3 Radiopq Mrkr Low Cx Prfl","BOTH IP/OP","$2,257.00 ","$1,670.18 ","$0.00 ","$2,257.00 ","$1,225.55 ","$0.00 ","$470.42 ","$1,610.82 ","$1,610.82 ","$395.18 ","$2,257.00 ","$0.00 ","$1,128.50 ","$1,787.54 ","$1,805.60 ","$0.00 ","$353.22 ","$0.00 ","$359.31 ","$0.00 "
"27202932","EAP","HCPCS C1769","","Gwire Vasc Std .035in 150cm 3cm Ang Tip Kink Rst Gldwr","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$226.97 ","$0.00 ","$87.12 ","$298.33 ","$298.33 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"27202933","EAP","HCPCS C1769","","Gwire Vasc Std .035in 260cm 3cm Ang Tip Stf Shft Gldwr","BOTH IP/OP","$699.00 ","$517.26 ","$0.00 ","$699.00 ","$379.56 ","$0.00 ","$145.69 ","$498.88 ","$498.88 ","$122.39 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$109.39 ","$0.00 ","$111.28 ","$0.00 "
"27202934","EAP","HCPCS C1887","","Cath Angio .038in 5fr 100cm 40cm Tpr Ang Tip Gwire Hydphi","BOTH IP/OP","$644.00 ","$476.56 ","$0.00 ","$644.00 ","$0.00 ","$0.00 ","$0.00 ","$459.62 ","$459.62 ","$112.76 ","$644.00 ","$0.00 ","$322.00 ","$510.05 ","$515.20 ","$0.00 ","$100.79 ","$0.00 ","$102.52 ","$0.00 "
"27202935","EAP","HCPCS C1769","","Gwire Vasc Endoscopic Terumo L260 Cm Od.035 In Straight","BOTH IP/OP","$623.00 ","$461.02 ","$0.00 ","$623.00 ","$338.29 ","$0.00 ","$129.85 ","$444.64 ","$444.64 ","$109.08 ","$623.00 ","$0.00 ","$311.50 ","$493.42 ","$498.40 ","$0.00 ","$97.50 ","$0.00 ","$99.18 ","$0.00 "
"27202936","EAP","Custom 27202936","","Burn Pad 36x24in Abs Drsg Slvr Strl","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$221.00 ","$0.00 ","$0.00 ","$0.00 ","$157.73 ","$157.73 ","$0.00 ","$221.00 ","$0.00 ","$110.50 ","$175.03 ","$176.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202940","EAP","Custom 27202940","","Bioconcepts Digi-sleeve (per Digit - 3"").","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$0.00 ","$0.00 ","$12.13 ","$12.13 ","$0.00 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202941","EAP","HCPCS C1769","","Stdj-185-4076","BOTH IP/OP","$223.00 ","$165.02 ","$0.00 ","$223.00 ","$121.09 ","$0.00 ","$46.48 ","$159.16 ","$159.16 ","$39.05 ","$223.00 ","$0.00 ","$111.50 ","$176.62 ","$178.40 ","$0.00 ","$34.90 ","$0.00 ","$35.50 ","$0.00 "
"27202942","EAP","HCPCS C1769","","Stdj-300-4076","BOTH IP/OP","$223.00 ","$165.02 ","$0.00 ","$223.00 ","$121.09 ","$0.00 ","$46.48 ","$159.16 ","$159.16 ","$39.05 ","$223.00 ","$0.00 ","$111.50 ","$176.62 ","$178.40 ","$0.00 ","$34.90 ","$0.00 ","$35.50 ","$0.00 "
"27202943","EAP","HCPCS C1769","","Stdj-86-15 40785","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$152.58 ","$0.00 ","$58.57 ","$200.55 ","$200.55 ","$49.20 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$43.98 ","$0.00 ","$44.74 ","$0.00 "
"27202944","EAP","HCPCS C1769","","Sdj-86-5 40785","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$152.58 ","$0.00 ","$58.57 ","$200.55 ","$200.55 ","$49.20 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$43.98 ","$0.00 ","$44.74 ","$0.00 "
"27202945","EAP","HCPCS C1725","","Coronary Sinus Balloon Venography Catheter","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$231.95 ","$231.95 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"27202950","EAP","Custom 27202950","","C-36-152 Coil Interlock Detach","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202951","EAP","Custom 27202951","","C-36-154 Coil Interlock Detach","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202952","EAP","Custom 27202952","","C-36-156 Coil Interlock Detach","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202953","EAP","Custom 27202953","","C-36-157 Coil Interlock Detach","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202954","EAP","HCPCS C1887","","Cg510 Glide Catheter Simmon1","BOTH IP/OP","$1,253.00 ","$927.22 ","$0.00 ","$1,253.00 ","$680.38 ","$0.00 ","$261.16 ","$894.27 ","$894.27 ","$219.39 ","$1,253.00 ","$0.00 ","$626.50 ","$992.38 ","$1,002.40 ","$0.00 ","$196.09 ","$0.00 ","$199.48 ","$0.00 "
"27202955","EAP","HCPCS C1725","","Cg514 Benson-hanafee 1","BOTH IP/OP","$1,193.00 ","$882.82 ","$0.00 ","$1,193.00 ","$536.85 ","$0.00 ","$248.65 ","$851.44 ","$851.44 ","$208.88 ","$1,193.00 ","$0.00 ","$596.50 ","$944.86 ","$954.40 ","$0.00 ","$186.70 ","$0.00 ","$189.93 ","$0.00 "
"27202956","EAP","HCPCS C1880","","Option Ivc Filter","BOTH IP/OP","$1,429.00 ","$1,057.46 ","$0.00 ","$1,429.00 ","$643.05 ","$0.00 ","$297.84 ","$1,019.88 ","$1,019.88 ","$250.21 ","$1,429.00 ","$0.00 ","$714.50 ","$1,131.77 ","$1,143.20 ","$0.00 ","$223.64 ","$0.00 ","$227.50 ","$0.00 "
"27202957","EAP","HCPCS C1894","","Introducer Sheath 5fr","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$6.30 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$5.63 ","$0.00 ","$5.73 ","$0.00 "
"27202958","EAP","HCPCS C1894","","Introducer Sheath 6fr","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$6.30 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$5.63 ","$0.00 ","$5.73 ","$0.00 "
"27202959","EAP","HCPCS C1725","","Catheter Glide Simmons 2","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$122.04 ","$122.04 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"27202960","EAP","HCPCS C1725","","Catheter Vertebral 5fr","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$18.00 ","$0.00 ","$8.34 ","$28.55 ","$28.55 ","$7.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$6.26 ","$0.00 ","$6.37 ","$0.00 "
"27202961","EAP","HCPCS C1751","","Microcatheter Stc","BOTH IP/OP","$1,264.00 ","$935.36 ","$0.00 ","$1,264.00 ","$686.35 ","$0.00 ","$263.45 ","$902.12 ","$902.12 ","$221.32 ","$1,264.00 ","$0.00 ","$632.00 ","$1,001.09 ","$1,011.20 ","$0.00 ","$197.82 ","$0.00 ","$201.23 ","$0.00 "
"27202962","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 30cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202963","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 40cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$3,658.73 ","$0.00 ","$1,404.37 ","$4,808.91 ","$4,808.91 ","$1,179.77 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$1,054.50 ","$0.00 ","$1,072.69 ","$0.00 "
"27202964","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 50cm Ekosonic Mach 4 Intlgnt Cath","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$3,658.73 ","$0.00 ","$1,404.37 ","$4,808.91 ","$4,808.91 ","$1,179.77 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$1,054.50 ","$0.00 ","$1,072.69 ","$0.00 "
"27202965","EAP","HCPCS C1751","","System Drg Dlv L135 Cm 12cm Ekosonic Mach 4 Intlgnt Cath","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$3,658.73 ","$0.00 ","$1,404.37 ","$4,808.91 ","$4,808.91 ","$1,179.77 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$1,054.50 ","$0.00 ","$1,072.69 ","$0.00 "
"27202966","EAP","HCPCS C1751","","System Drg Dlv L135 Cm 30cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202967","EAP","HCPCS C1751","","System Drg Dlv L135 Cm 40cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202968","EAP","HCPCS C1751","","SYSTEM DRG DLV L135 CM 50CM EKOSONIC TX ZN EVAS DEV CATH GWI","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202969","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 6cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202970","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 12cm Ekosonic Cath Us Thrmbs 106cm 12","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202971","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 18cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202972","EAP","HCPCS C1751","","System Drg Dlv L106 Cm 24cm Ekosonic Intlgnt Cath Microsonic","BOTH IP/OP","$7,074.00 ","$5,234.76 ","$0.00 ","$7,074.00 ","$3,841.18 ","$0.00 ","$1,474.40 ","$5,048.71 ","$5,048.71 ","$1,238.60 ","$7,074.00 ","$0.00 ","$3,537.00 ","$5,602.61 ","$5,659.20 ","$0.00 ","$1,107.08 ","$0.00 ","$1,126.18 ","$0.00 "
"27202973","EAP","HCPCS C1729","","Kit Cath Peritoneum Strt Pleurx 1000ml","BOTH IP/OP","$2,226.00 ","$1,647.24 ","$0.00 ","$2,226.00 ","$1,208.72 ","$0.00 ","$463.95 ","$1,588.70 ","$1,588.70 ","$389.75 ","$2,226.00 ","$0.00 ","$1,113.00 ","$1,762.99 ","$1,780.80 ","$0.00 ","$348.37 ","$0.00 ","$354.38 ","$0.00 "
"27202974","EAP","Custom 27202974","","Cable Pcng 6ft Pc Lc Trnvns Sf Dev Temp Conctr Clip Adpr","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202976","EAP","Custom 27202976","","Shld Rad16x16in Drp Armr Rdbrrier L Pstn Prtc Strl","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$51.39 ","$51.39 ","$0.00 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202977","EAP","Custom 27202977","","Trvo Prvue 4x20mm Rtrvr Kit & Trvo Pro 18 Mc","BOTH IP/OP","$13,399.00 ","$9,915.26 ","$0.00 ","$13,399.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,399.00 ","$0.00 ","$6,699.50 ","$10,612.01 ","$10,719.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202978","EAP","Custom 27202978","","Trvo Xp Prvue 4x20mm Rtrvr Kit & Trvo Pro 18 Mc","BOTH IP/OP","$13,399.00 ","$9,915.26 ","$0.00 ","$13,399.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,399.00 ","$0.00 ","$6,699.50 ","$10,612.01 ","$10,719.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202979","EAP","Custom 27202979","","Trvo Xp Prvue 3x20mm Rtrvr Kit & Trvo Pro 14 Mc","BOTH IP/OP","$13,399.00 ","$9,915.26 ","$0.00 ","$13,399.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,399.00 ","$0.00 ","$6,699.50 ","$10,612.01 ","$10,719.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202980","EAP","HCPCS C1769","","Guidewire Vasc 190cm .035in Strbl Str Htrq Scr","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$197.00 ","$106.97 ","$0.00 ","$41.06 ","$140.60 ","$140.60 ","$34.49 ","$197.00 ","$0.00 ","$98.50 ","$156.02 ","$157.60 ","$0.00 ","$30.83 ","$0.00 ","$31.36 ","$0.00 "
"27202981","EAP","HCPCS C1887","","Turnpike Catheter, Smooth Shaft, 135cm","BOTH IP/OP","$1,377.00 ","$1,018.98 ","$0.00 ","$1,377.00 ","$747.71 ","$0.00 ","$287.00 ","$982.76 ","$982.76 ","$241.10 ","$1,377.00 ","$0.00 ","$688.50 ","$1,090.58 ","$1,101.60 ","$0.00 ","$215.50 ","$0.00 ","$219.22 ","$0.00 "
"27202982","EAP","HCPCS C1887","","Turnpike Catheter, Smooth Shaft, 155cm","BOTH IP/OP","$1,561.00 ","$1,155.14 ","$0.00 ","$1,561.00 ","$847.62 ","$0.00 ","$325.35 ","$1,114.09 ","$1,114.09 ","$273.32 ","$1,561.00 ","$0.00 ","$780.50 ","$1,236.31 ","$1,248.80 ","$0.00 ","$244.30 ","$0.00 ","$248.51 ","$0.00 "
"27202983","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Hbrd Radiopq Str Tip","BOTH IP/OP","$394.00 ","$291.56 ","$0.00 ","$394.00 ","$213.94 ","$0.00 ","$82.12 ","$281.20 ","$281.20 ","$68.99 ","$394.00 ","$0.00 ","$197.00 ","$312.05 ","$315.20 ","$0.00 ","$61.66 ","$0.00 ","$62.72 ","$0.00 "
"27202984","EAP","","","Gdwire Vasc Strght; Sprg L200cm L9 Cm Od.008 In","BOTH IP/OP","$1,238.00 ","$916.12 ","$0.00 ","$1,238.00 ","$0.00 ","$0.00 ","$0.00 ","$883.56 ","$883.56 ","$0.00 ","$1,238.00 ","$0.00 ","$619.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202985","EAP","HCPCS C1769","","Gdwire Vasc 25d L150 Cm Rnd Curve L200 Cm L170","BOTH IP/OP","$1,337.00 ","$989.38 ","$0.00 ","$1,337.00 ","$725.99 ","$0.00 ","$278.66 ","$954.22 ","$954.22 ","$234.10 ","$1,337.00 ","$0.00 ","$668.50 ","$1,058.90 ","$1,069.60 ","$0.00 ","$209.24 ","$0.00 ","$212.85 ","$0.00 "
"27202986","EAP","HCPCS C1769","","Gdwire Vasc Slip Coat Stnlss Stl Polymer 25 D, L","BOTH IP/OP","$1,337.00 ","$989.38 ","$0.00 ","$1,337.00 ","$725.99 ","$0.00 ","$278.66 ","$954.22 ","$954.22 ","$234.10 ","$1,337.00 ","$0.00 ","$668.50 ","$1,058.90 ","$1,069.60 ","$0.00 ","$209.24 ","$0.00 ","$212.85 ","$0.00 "
"27202987","EAP","HCPCS C1769","","Gdwire Vasc Slip-coat; Stnlss Stl; Polymer 25 D;","BOTH IP/OP","$919.00 ","$680.06 ","$0.00 ","$919.00 ","$499.02 ","$0.00 ","$191.54 ","$655.89 ","$655.89 ","$160.91 ","$919.00 ","$0.00 ","$459.50 ","$727.85 ","$735.20 ","$0.00 ","$143.82 ","$0.00 ","$146.30 ","$0.00 "
"27202988","EAP","HCPCS C1887","","Arc Catheter","BOTH IP/OP","$4,712.00 ","$3,486.88 ","$0.00 ","$4,712.00 ","$2,558.62 ","$0.00 ","$982.10 ","$3,362.95 ","$3,362.95 ","$825.03 ","$4,712.00 ","$0.00 ","$2,356.00 ","$3,731.90 ","$3,769.60 ","$0.00 ","$737.43 ","$0.00 ","$750.15 ","$0.00 "
"27202989","EAP","HCPCS C1887","","Arc Mini Catheter","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,968.38 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27202990","EAP","HCPCS C1887","","Marksman Catheter","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"27202991","EAP","HCPCS C1769","","Guidewire Vasc 200cm .014in Str 3cm Traxcess Ntnl","BOTH IP/OP","$844.00 ","$624.56 ","$0.00 ","$844.00 ","$458.29 ","$0.00 ","$175.91 ","$602.36 ","$602.36 ","$147.78 ","$844.00 ","$0.00 ","$422.00 ","$668.45 ","$675.20 ","$0.00 ","$132.09 ","$0.00 ","$134.36 ","$0.00 "
"27202992","EAP","HCPCS C1769","","Guidewire Vasc Traxcess 3x200 Ex","BOTH IP/OP","$878.00 ","$649.72 ","$0.00 ","$878.00 ","$476.75 ","$0.00 ","$183.00 ","$626.63 ","$626.63 ","$153.73 ","$878.00 ","$0.00 ","$439.00 ","$695.38 ","$702.40 ","$0.00 ","$137.41 ","$0.00 ","$139.78 ","$0.00 "
"27202993","EAP","HCPCS C1769","","Guidewire Vasc Dck Traxcess","BOTH IP/OP","$338.00 ","$250.12 ","$0.00 ","$338.00 ","$183.53 ","$0.00 ","$70.45 ","$241.23 ","$241.23 ","$59.18 ","$338.00 ","$0.00 ","$169.00 ","$267.70 ","$270.40 ","$0.00 ","$52.90 ","$0.00 ","$53.81 ","$0.00 "
"27202994","EAP","HCPCS C1725","","Catheter 3.4fr 2.4fr 135cm Crossboss Intvn Rnd","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$0.00 ","$0.00 ","$0.00 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27202995","EAP","HCPCS C1725","","Catheter Baldilat 3.7fr 2.9fr 135cm Coron Sdprt","BOTH IP/OP","$4,738.00 ","$3,506.12 ","$0.00 ","$4,738.00 ","$2,572.73 ","$0.00 ","$987.52 ","$3,381.51 ","$3,381.51 ","$829.59 ","$4,738.00 ","$0.00 ","$2,369.00 ","$3,752.50 ","$3,790.40 ","$0.00 ","$741.50 ","$0.00 ","$754.29 ","$0.00 "
"27202996","EAP","HCPCS C1769","","Guidewire Vasc 185cm .014in True Lum Slf Ornt","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$550.06 ","$0.00 ","$211.13 ","$722.98 ","$722.98 ","$177.37 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$158.53 ","$0.00 ","$161.27 ","$0.00 "
"27202997","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in True Lum Slf Ornt","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$550.06 ","$0.00 ","$211.13 ","$722.98 ","$722.98 ","$177.37 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$158.53 ","$0.00 ","$161.27 ","$0.00 "
"27202998","EAP","HCPCS C1769","","Guidewire Vasc 20cm .014in Extn 28d Stingray","BOTH IP/OP","$305.00 ","$225.70 ","$0.00 ","$305.00 ","$0.00 ","$0.00 ","$0.00 ","$217.68 ","$217.68 ","$53.40 ","$305.00 ","$0.00 ","$152.50 ","$241.56 ","$244.00 ","$0.00 ","$47.73 ","$0.00 ","$48.56 ","$0.00 "
"27202999","EAP","HCPCS C1769","","Coronary Intervention Wire.","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203000","EAP","HCPCS C1887","","Cath Angiogrphc .038in Pigtail 145d Cv 6fr 110cm 2","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27203001","EAP","Custom 27203001","","Unit Therapeutic Incision Mngmnt Sys Peel Plc Kt","BOTH IP/OP","$1,238.00 ","$916.12 ","$0.00 ","$1,238.00 ","$0.00 ","$0.00 ","$0.00 ","$883.56 ","$883.56 ","$0.00 ","$1,238.00 ","$0.00 ","$619.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203002","EAP","HCPCS C1725","","Catheter Baldilat Lp 5.3fr 3mm 75cm 60mm High Pressure","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203003","EAP","HCPCS C1725","","Catheter Baldilat .035in 5mm 75cm 40mm High Pressure Lp","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203004","EAP","HCPCS C1725","","Catheter Baldilat .035in 6mm 75cm 20mm High Pressure Lp","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203005","EAP","HCPCS C1725","","Catheter Baldilat Lp 5.3fr 6mm 135cm 40mm High Pressure","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203006","EAP","HCPCS C1725","","Catheter Baldilat Lp 5.3fr 8mm 75cm 20mm High Pressure","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203050","EAP","Custom 27203050","","Chiba Needle 22g X 10cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203051","EAP","Custom 27203051","","Chiba Needle 18g X 10cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203052","EAP","Custom 27203052","","Chiba Needle 18g X 15cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203053","EAP","Custom 27203053","","Chiba Needle 18g X 20cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203054","EAP","Custom 27203054","","Chiba Needle 20g X 10cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203055","EAP","Custom 27203055","","Chiba Needle 20g X 15cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203056","EAP","Custom 27203056","","Chiba Needle 20g X 20cm","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203057","EAP","Custom 27203057","","6f Dilator","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203058","EAP","Custom 27203058","","7f Dilator","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203059","EAP","Custom 27203059","","8f Dilator","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$12.85 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203060","EAP","Custom 27203060","","10f Dilator","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$15.70 ","$15.70 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203061","EAP","Custom 27203061","","12f Dilator","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203062","EAP","Custom 27203062","","14f Dilator","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203063","EAP","Custom 27203063","","Introducer Needle 17g X 10cm","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$71.37 ","$71.37 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203064","EAP","Custom 27203064","","Introducer Needle 17g X 15cm","BOTH IP/OP","$115.00 ","$85.10 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$82.08 ","$82.08 ","$0.00 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203065","EAP","Custom 27203065","","Introducer Needle 19g X 6cm","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$85.64 ","$85.64 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203066","EAP","Custom 27203066","","Introducer Needle 19g X 10cm","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$92.78 ","$92.78 ","$0.00 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203067","EAP","Custom 27203067","","Introducer Needle 19g X 15cm","BOTH IP/OP","$136.00 ","$100.64 ","$0.00 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$97.06 ","$97.06 ","$0.00 ","$136.00 ","$0.00 ","$68.00 ","$107.71 ","$108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203068","EAP","Custom 27203068","","Coaxial Sets 19x10x20x15","BOTH IP/OP","$79.00 ","$58.46 ","$0.00 ","$79.00 ","$0.00 ","$0.00 ","$0.00 ","$56.38 ","$56.38 ","$0.00 ","$79.00 ","$0.00 ","$39.50 ","$62.57 ","$63.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203069","EAP","Custom 27203069","","Coaxial Sets 19x15x20x20","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$0.00 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203070","EAP","Custom 27203070","","Achieve Gun 18g X 9cm","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$96.35 ","$96.35 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203071","EAP","Custom 27203071","","Achieve Gun 18g X 11cm","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203072","EAP","Custom 27203072","","Achieve Gun 18g X 15cm","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203073","EAP","Custom 27203073","","Achieve Gun 18g X 20cm","BOTH IP/OP","$214.00 ","$158.36 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$152.73 ","$152.73 ","$0.00 ","$214.00 ","$0.00 ","$107.00 ","$169.49 ","$171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203074","EAP","Custom 27203074","","Achieve Gun 20g X 11cm","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$164.15 ","$164.15 ","$0.00 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203075","EAP","Custom 27203075","","Achieve Gun 20g X 15cm","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$0.00 ","$169.15 ","$169.15 ","$0.00 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203076","EAP","Custom 27203076","","Achieve Gun 20g X 20cm","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$174.86 ","$174.86 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203077","EAP","Custom 27203077","","Franseen Lung Bx Needle","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$122.00 ","$0.00 ","$0.00 ","$0.00 ","$87.07 ","$87.07 ","$0.00 ","$122.00 ","$0.00 ","$61.00 ","$96.62 ","$97.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203078","EAP","Custom 27203078","","Vansonnenberg Needle Set","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$104.20 ","$104.20 ","$0.00 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203079","EAP","Custom 27203079","","Bonopty Bx Set","BOTH IP/OP","$1,154.00 ","$853.96 ","$0.00 ","$1,154.00 ","$0.00 ","$0.00 ","$0.00 ","$823.61 ","$823.61 ","$0.00 ","$1,154.00 ","$0.00 ","$577.00 ","$913.97 ","$923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203080","EAP","Custom 27203080","","Bonopty Bx Penetration Set","BOTH IP/OP","$1,505.00 ","$1,113.70 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$1,074.12 ","$1,074.12 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203081","EAP","Custom 27203081","","Soft Tissue Bx Tray","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203082","EAP","Custom 27203082","","Lumbar Puncture Tray","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203083","EAP","Custom 27203083","","Para/thoracentesis Tray","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203084","EAP","Custom 27203084","","Uresil Drainage Bag","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$79.22 ","$79.22 ","$0.00 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203085","EAP","Custom 27203085","","Gelfoam Sponge","BOTH IP/OP","$464.00 ","$343.36 ","$0.00 ","$464.00 ","$0.00 ","$0.00 ","$0.00 ","$331.16 ","$331.16 ","$0.00 ","$464.00 ","$0.00 ","$232.00 ","$367.49 ","$371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203086","EAP","Custom 27203086","","Suture Silk 2-0 30in Black","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203087","EAP","Custom 27203087","","Steri-drape","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203088","EAP","Custom 27203088","","Drainge Catheters","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203090","EAP","Custom 27203090","","Cre Wg 6-8mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203091","EAP","Custom 27203091","","Cre Wg 8-10 Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203092","EAP","Custom 27203092","","Cre Wg 10-12 Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203093","EAP","Custom 27203093","","Cre 12-15mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203094","EAP","Custom 27203094","","Cre 15-18 Mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203095","EAP","Custom 27203095","","Cre 18-20 Mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$231.24 ","$231.24 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203096","EAP","Custom 27203096","","Alliance Inflation Syringe","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$37.11 ","$37.11 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203097","EAP","Custom 27203097","","2.3mm Interject Inj Needle23g","BOTH IP/OP","$732.00 ","$541.68 ","$0.00 ","$732.00 ","$0.00 ","$0.00 ","$0.00 ","$522.43 ","$522.43 ","$0.00 ","$732.00 ","$0.00 ","$366.00 ","$579.74 ","$585.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203098","EAP","Custom 27203098","","Dreamwire .035 260str Stnd","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$0.00 ","$0.00 ","$0.00 ","$200.55 ","$200.55 ","$0.00 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203099","EAP","Custom 27203099","","Extractor Rx 9-12 Mm","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$171.29 ","$171.29 ","$0.00 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203100","EAP","Custom 27203100","","Extractor Rx 12-15 Mm","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203101","EAP","Custom 27203101","","Extractor Rx 15-18 Mm","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203102","EAP","Custom 27203102","","22g Blue Sheath (stiffer)","BOTH IP/OP","$386.00 ","$285.64 ","$0.00 ","$386.00 ","$0.00 ","$0.00 ","$0.00 ","$275.49 ","$275.49 ","$0.00 ","$386.00 ","$0.00 ","$193.00 ","$305.71 ","$308.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203103","EAP","Custom 27203103","","22g Green Spring Coil Sheath","BOTH IP/OP","$386.00 ","$285.64 ","$0.00 ","$386.00 ","$0.00 ","$0.00 ","$0.00 ","$275.49 ","$275.49 ","$0.00 ","$386.00 ","$0.00 ","$193.00 ","$305.71 ","$308.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203104","EAP","Custom 27203104","","Celiac Plexus Neurolysis Needl","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$0.00 ","$0.00 ","$0.00 ","$279.77 ","$279.77 ","$0.00 ","$392.00 ","$0.00 ","$196.00 ","$310.46 ","$313.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203105","EAP","Custom 27203105","","19g Bx Needle","BOTH IP/OP","$515.00 ","$381.10 ","$0.00 ","$515.00 ","$0.00 ","$0.00 ","$0.00 ","$367.56 ","$367.56 ","$0.00 ","$515.00 ","$0.00 ","$257.50 ","$407.88 ","$412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203106","EAP","Custom 27203106","","Cytology Brush Echo -19","BOTH IP/OP","$244.00 ","$180.56 ","$0.00 ","$244.00 ","$0.00 ","$0.00 ","$0.00 ","$174.14 ","$174.14 ","$0.00 ","$244.00 ","$0.00 ","$122.00 ","$193.25 ","$195.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203108","EAP","Custom 27203108","","Olympus Endo Jaw(cold Forceps)","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$10.71 ","$10.71 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203109","EAP","Custom 27203109","","Roth Net","BOTH IP/OP","$1,278.00 ","$945.72 ","$0.00 ","$1,278.00 ","$0.00 ","$0.00 ","$0.00 ","$912.11 ","$912.11 ","$0.00 ","$1,278.00 ","$0.00 ","$639.00 ","$1,012.18 ","$1,022.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203110","EAP","Custom 27203110","","Erbe Probe","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$0.00 ","$0.00 ","$0.00 ","$205.55 ","$205.55 ","$0.00 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203111","EAP","Custom 27203111","","Ercp Forcep","BOTH IP/OP","$691.00 ","$511.34 ","$0.00 ","$691.00 ","$0.00 ","$0.00 ","$0.00 ","$493.17 ","$493.17 ","$0.00 ","$691.00 ","$0.00 ","$345.50 ","$547.27 ","$552.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203112","EAP","Custom 27203112","","Rx Dilatation Balloon 4-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$0.00 ","$0.00 ","$0.00 ","$295.47 ","$295.47 ","$0.00 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203113","EAP","Custom 27203113","","Rx Dilatation Balloon 6-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$0.00 ","$0.00 ","$0.00 ","$295.47 ","$295.47 ","$0.00 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203114","EAP","Custom 27203114","","Rx Dilatation Balloon 8-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$0.00 ","$0.00 ","$0.00 ","$295.47 ","$295.47 ","$0.00 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203115","EAP","Custom 27203115","","Rx Dilatation Balloon 10-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$0.00 ","$0.00 ","$0.00 ","$295.47 ","$295.47 ","$0.00 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203116","EAP","Custom 27203116","","Encore 26 Single","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203117","EAP","Custom 27203117","","Injection Probe 10fr","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$0.00 ","$0.00 ","$0.00 ","$307.60 ","$307.60 ","$0.00 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203118","EAP","Custom 27203118","","Injection Probe 7fr","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$0.00 ","$0.00 ","$0.00 ","$307.60 ","$307.60 ","$0.00 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203120","EAP","HCPCS C1769","",".014 Nitrex Guidewire","BOTH IP/OP","$1,295.00 ","$958.30 ","$0.00 ","$1,295.00 ","$703.19 ","$0.00 ","$269.91 ","$924.24 ","$924.24 ","$226.74 ","$1,295.00 ","$0.00 ","$647.50 ","$1,025.64 ","$1,036.00 ","$0.00 ","$202.67 ","$0.00 ","$206.16 ","$0.00 "
"27203121","EAP","Custom 27203121","","Coil Axium Helical  Qc-1.5-2-helix","BOTH IP/OP","$3,686.00 ","$2,727.64 ","$0.00 ","$3,686.00 ","$0.00 ","$0.00 ","$0.00 ","$2,630.70 ","$2,630.70 ","$0.00 ","$3,686.00 ","$0.00 ","$1,843.00 ","$2,919.31 ","$2,948.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203122","EAP","Custom 27203122","","Coil Axium Helical  Qc-2-1-helix","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$0.00 ","$0.00 ","$0.00 ","$2,655.68 ","$2,655.68 ","$0.00 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203123","EAP","Custom 27203123","","Coil Axium Helical  Qc-2-2-helix","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$0.00 ","$0.00 ","$0.00 ","$2,772.72 ","$2,772.72 ","$0.00 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203124","EAP","Custom 27203124","","Coil Axium Helical  Qc-2-3-helix","BOTH IP/OP","$3,770.00 ","$2,789.80 ","$0.00 ","$3,770.00 ","$0.00 ","$0.00 ","$0.00 ","$2,690.65 ","$2,690.65 ","$0.00 ","$3,770.00 ","$0.00 ","$1,885.00 ","$2,985.84 ","$3,016.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203125","EAP","Custom 27203125","","Coil Axium Helical  Qc-2-4-helix","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$0.00 ","$0.00 ","$0.00 ","$2,772.72 ","$2,772.72 ","$0.00 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203126","EAP","Custom 27203126","","Coil Axium Helical  Qc-2-6-helix","BOTH IP/OP","$3,819.00 ","$2,826.06 ","$0.00 ","$3,819.00 ","$0.00 ","$0.00 ","$0.00 ","$2,725.62 ","$2,725.62 ","$0.00 ","$3,819.00 ","$0.00 ","$1,909.50 ","$3,024.65 ","$3,055.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203127","EAP","Custom 27203127","","Coil Axium Helical  Qc-2-8-helix","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203128","EAP","Custom 27203128","","Coil Axium Helical  Qc-3-4-helix","BOTH IP/OP","$3,854.00 ","$2,851.96 ","$0.00 ","$3,854.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.60 ","$2,750.60 ","$0.00 ","$3,854.00 ","$0.00 ","$1,927.00 ","$3,052.37 ","$3,083.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203129","EAP","Custom 27203129","","Coil Axium Helical  Qc-3-6-helix","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$0.00 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203130","EAP","Custom 27203130","","Coil Axium Helical  Qc-3-8-helix","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$0.00 ","$0.00 ","$0.00 ","$2,772.72 ","$2,772.72 ","$0.00 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203131","EAP","Custom 27203131","","Coil Axium Helical  Qc-4-8-helix","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.47 ","$2,905.47 ","$0.00 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203132","EAP","Custom 27203132","","Coil Axium Helical  Qc-4-10-helix","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$0.00 ","$0.00 ","$0.00 ","$2,772.72 ","$2,772.72 ","$0.00 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203133","EAP","Custom 27203133","","Coil Axium Helical  Qc-4-12-helix","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$0.00 ","$2,797.70 ","$2,797.70 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203134","EAP","Custom 27203134","","Coil Axium Helical  Qc-5-15-helix","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$0.00 ","$2,797.70 ","$2,797.70 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203135","EAP","Custom 27203135","","Coil Axium Helical  Qc-5-20-helix","BOTH IP/OP","$3,955.00 ","$2,926.70 ","$0.00 ","$3,955.00 ","$0.00 ","$0.00 ","$0.00 ","$2,822.68 ","$2,822.68 ","$0.00 ","$3,955.00 ","$0.00 ","$1,977.50 ","$3,132.36 ","$3,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203136","EAP","Custom 27203136","","Coil Axium Helical  Qc-6-20-helix","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$0.00 ","$0.00 ","$0.00 ","$2,858.37 ","$2,858.37 ","$0.00 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203137","EAP","Custom 27203137","","Coil Axium Helical  Qc-7 -30-helix","BOTH IP/OP","$4,020.00 ","$2,974.80 ","$0.00 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$2,869.07 ","$2,869.07 ","$0.00 ","$4,020.00 ","$0.00 ","$2,010.00 ","$3,183.84 ","$3,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203138","EAP","Custom 27203138","","Coil Axium Helical  Qc-8-30-helix","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.47 ","$2,905.47 ","$0.00 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203139","EAP","Custom 27203139","","Coil Axium Helical  Qc-9-30-helix","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.47 ","$2,905.47 ","$0.00 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203140","EAP","Custom 27203140","","Coil Axium Helical  Qc-10-30-helix","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$0.00 ","$0.00 ","$0.00 ","$2,772.72 ","$2,772.72 ","$0.00 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203141","EAP","Custom 27203141","","Coil Axium Helical  Qc-12-30-helix","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$0.00 ","$0.00 ","$0.00 ","$2,772.72 ","$2,772.72 ","$0.00 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203142","EAP","Custom 27203142","","Coil Axium Helical  Qc-14-30-helix","BOTH IP/OP","$3,903.00 ","$2,888.22 ","$0.00 ","$3,903.00 ","$0.00 ","$0.00 ","$0.00 ","$2,785.57 ","$2,785.57 ","$0.00 ","$3,903.00 ","$0.00 ","$1,951.50 ","$3,091.18 ","$3,122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203143","EAP","Custom 27203143","","Coil Axium Helical  Qc-16-30-helix","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$0.00 ","$2,797.70 ","$2,797.70 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203144","EAP","Custom 27203144","","Coil Axium Helical  Qc-16-40-helix","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$0.00 ","$2,797.70 ","$2,797.70 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203145","EAP","Custom 27203145","","Coil Axium Helical  Qc-18-40-helix","BOTH IP/OP","$3,955.00 ","$2,926.70 ","$0.00 ","$3,955.00 ","$0.00 ","$0.00 ","$0.00 ","$2,822.68 ","$2,822.68 ","$0.00 ","$3,955.00 ","$0.00 ","$1,977.50 ","$3,132.36 ","$3,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203146","EAP","Custom 27203146","","Coil Axium Helical  Qc-20-40-helix","BOTH IP/OP","$3,936.00 ","$2,912.64 ","$0.00 ","$3,936.00 ","$0.00 ","$0.00 ","$0.00 ","$2,809.12 ","$2,809.12 ","$0.00 ","$3,936.00 ","$0.00 ","$1,968.00 ","$3,117.31 ","$3,148.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203147","EAP","Custom 27203147","","Coil Axium Helical  Qc-20-50-helix","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$0.00 ","$0.00 ","$0.00 ","$2,858.37 ","$2,858.37 ","$0.00 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203148","EAP","Custom 27203148","","Coil Axium 3d  Qc-2-2-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203149","EAP","Custom 27203149","","Coil Axium 3d  Qc-2-4-3d","BOTH IP/OP","$4,105.00 ","$3,037.70 ","$0.00 ","$4,105.00 ","$0.00 ","$0.00 ","$0.00 ","$2,929.74 ","$2,929.74 ","$0.00 ","$4,105.00 ","$0.00 ","$2,052.50 ","$3,251.16 ","$3,284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203150","EAP","Custom 27203150","","Coil Axium 3d  Qc-2-6-3d","BOTH IP/OP","$4,020.00 ","$2,974.80 ","$0.00 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$2,869.07 ","$2,869.07 ","$0.00 ","$4,020.00 ","$0.00 ","$2,010.00 ","$3,183.84 ","$3,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203151","EAP","Custom 27203151","","Coil Axium 3d  Qc-3-4-3d","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$0.00 ","$0.00 ","$0.00 ","$2,976.13 ","$2,976.13 ","$0.00 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203152","EAP","Custom 27203152","","Coil Axium 3d  Qc-3-6-3d","BOTH IP/OP","$3,245.00 ","$2,401.30 ","$0.00 ","$3,245.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.96 ","$2,315.96 ","$0.00 ","$3,245.00 ","$0.00 ","$1,622.50 ","$2,570.04 ","$2,596.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203153","EAP","Custom 27203153","","Coil Axium 3d  Qc-3-8-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203154","EAP","Custom 27203154","","Coil Axium 3d  Qc-4-8-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203155","EAP","Custom 27203155","","Coil Axium 3d  Qc-4-12-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203156","EAP","Custom 27203156","","Coil Axium 3d  Qc-5-10-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203157","EAP","Custom 27203157","","Coil Axium 3d  Qc-5-15-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203158","EAP","Custom 27203158","","Coil Axium 3d  Qc-6-15-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203159","EAP","Custom 27203159","","Coil Axium 3d  Qc-6-20-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203160","EAP","Custom 27203160","","Coil Axium 3d  Qc-7-20-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203161","EAP","Custom 27203161","","Coil Axium 3d  Qc-7-30-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203162","EAP","Custom 27203162","","Coil Axium 3d  Qc-8-20-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203163","EAP","Custom 27203163","","Coil Axium 3d  Qc-8-30-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203164","EAP","Custom 27203164","","Coil Axium 3d  Qc-9-20-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203165","EAP","Custom 27203165","","Coil Axium 3d  Qc-9-30-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203166","EAP","Custom 27203166","","Coil Axium 3d  Qc-10-20-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203167","EAP","Custom 27203167","","Coil Axium 3d  Qc-10-30-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203168","EAP","Custom 27203168","","Coil Axium 3d  Qc-12-40-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203169","EAP","Custom 27203169","","Coil Axium 3d  Qc-14-40-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203170","EAP","Custom 27203170","","Coil Axium 3d  Qc-16-40-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203171","EAP","Custom 27203171","","Coil Axium 3d  Qc-18-40-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203172","EAP","Custom 27203172","","Coil Axium 3d  Qc-20-50-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203173","EAP","Custom 27203173","","Coil Axium 3d  Qc-22-50-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203174","EAP","Custom 27203174","","Coil Axium 3d  Qc-25-50-3d","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$0.00 ","$0.00 ","$0.00 ","$995.61 ","$995.61 ","$0.00 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203180","EAP","HCPCS C1726","","Roth Net","BOTH IP/OP","$1,278.00 ","$945.72 ","$0.00 ","$1,278.00 ","$693.95 ","$0.00 ","$266.37 ","$912.11 ","$912.11 ","$223.77 ","$1,278.00 ","$0.00 ","$639.00 ","$1,012.18 ","$1,022.40 ","$0.00 ","$200.01 ","$0.00 ","$203.46 ","$0.00 "
"27203181","EAP","HCPCS C1726","","2.3mm Interject Inj Needle23g","BOTH IP/OP","$732.00 ","$541.68 ","$0.00 ","$732.00 ","$397.48 ","$0.00 ","$152.57 ","$522.43 ","$522.43 ","$128.17 ","$732.00 ","$0.00 ","$366.00 ","$579.74 ","$585.60 ","$0.00 ","$114.56 ","$0.00 ","$116.53 ","$0.00 "
"27203182","EAP","HCPCS C1726","","Ercp Forcep","BOTH IP/OP","$691.00 ","$511.34 ","$0.00 ","$691.00 ","$375.21 ","$0.00 ","$144.02 ","$493.17 ","$493.17 ","$120.99 ","$691.00 ","$0.00 ","$345.50 ","$547.27 ","$552.80 ","$0.00 ","$108.14 ","$0.00 ","$110.01 ","$0.00 "
"27203183","EAP","HCPCS C1726","","19g Bx Needle","BOTH IP/OP","$515.00 ","$381.10 ","$0.00 ","$515.00 ","$279.65 ","$0.00 ","$107.34 ","$367.56 ","$367.56 ","$90.17 ","$515.00 ","$0.00 ","$257.50 ","$407.88 ","$412.00 ","$0.00 ","$80.60 ","$0.00 ","$81.99 ","$0.00 "
"27203184","EAP","HCPCS C1751","","Cather Cco Swan-ganz Sv02 W/o","BOTH IP/OP","$479.00 ","$354.46 ","$0.00 ","$479.00 ","$0.00 ","$0.00 ","$0.00 ","$341.86 ","$341.86 ","$83.87 ","$479.00 ","$0.00 ","$239.50 ","$379.37 ","$383.20 ","$0.00 ","$74.96 ","$0.00 ","$76.26 ","$0.00 "
"27203185","EAP","HCPCS C1751","","Injection Probe 10fr","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$234.03 ","$0.00 ","$89.83 ","$307.60 ","$307.60 ","$75.46 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$0.00 ","$67.45 ","$0.00 ","$68.62 ","$0.00 "
"27203186","EAP","HCPCS C1751","","Injection Probe 7fr","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$234.03 ","$0.00 ","$89.83 ","$307.60 ","$307.60 ","$75.46 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$0.00 ","$67.45 ","$0.00 ","$68.62 ","$0.00 "
"27203187","EAP","HCPCS C1726","","Rx Dilatation Balloon 4-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"27203188","EAP","HCPCS C1726","","Rx Dilatation Balloon 6-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"27203189","EAP","HCPCS C1726","","Rx Dilatation Balloon 8-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"27203190","EAP","HCPCS C1726","","Rx Dilatation Balloon 10-4/5.8","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"27203191","EAP","HCPCS C1726","","Celiac Plexus Neurolysis Needl","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$212.86 ","$0.00 ","$81.70 ","$279.77 ","$279.77 ","$68.64 ","$392.00 ","$0.00 ","$196.00 ","$310.46 ","$313.60 ","$0.00 ","$61.35 ","$0.00 ","$62.41 ","$0.00 "
"27203192","EAP","HCPCS C1726","","22g Blue Sheath (stiffer)","BOTH IP/OP","$386.00 ","$285.64 ","$0.00 ","$386.00 ","$209.60 ","$0.00 ","$80.45 ","$275.49 ","$275.49 ","$67.59 ","$386.00 ","$0.00 ","$193.00 ","$305.71 ","$308.80 ","$0.00 ","$60.41 ","$0.00 ","$61.45 ","$0.00 "
"27203193","EAP","HCPCS C1726","","22g Green Spring Coil Sheath","BOTH IP/OP","$386.00 ","$285.64 ","$0.00 ","$386.00 ","$209.60 ","$0.00 ","$80.45 ","$275.49 ","$275.49 ","$67.59 ","$386.00 ","$0.00 ","$193.00 ","$305.71 ","$308.80 ","$0.00 ","$60.41 ","$0.00 ","$61.45 ","$0.00 "
"27203194","EAP","HCPCS C1726","","Cre Wg 8-10 Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$175.93 ","$0.00 ","$67.53 ","$231.24 ","$231.24 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"27203195","EAP","HCPCS C1726","","Cre Wg 10-12 Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$175.93 ","$0.00 ","$67.53 ","$231.24 ","$231.24 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"27203196","EAP","HCPCS C1726","","Cre 12-15mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$175.93 ","$0.00 ","$67.53 ","$231.24 ","$231.24 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"27203197","EAP","HCPCS C1726","","Cre 15-18 Mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$175.93 ","$0.00 ","$67.53 ","$231.24 ","$231.24 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"27203198","EAP","HCPCS C1726","","Cre 18-20 Mm Dilation Balloon","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$175.93 ","$0.00 ","$67.53 ","$231.24 ","$231.24 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"27203199","EAP","HCPCS C1726","","Erbe Probe","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$156.38 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27203200","EAP","HCPCS C1769","","Dreamwire .035 260str Stnd","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$152.58 ","$0.00 ","$58.57 ","$200.55 ","$200.55 ","$49.20 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$43.98 ","$0.00 ","$44.74 ","$0.00 "
"27203201","EAP","HCPCS C1726","","Cytology Brush Echo -19","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$125.98 ","$0.00 ","$48.35 ","$165.58 ","$165.58 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$36.31 ","$0.00 ","$36.93 ","$0.00 "
"27203202","EAP","HCPCS C1726","","Extractor Rx 9-12 Mm","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$124.35 ","$0.00 ","$47.73 ","$163.44 ","$163.44 ","$40.10 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$35.84 ","$0.00 ","$36.46 ","$0.00 "
"27203203","EAP","HCPCS C1726","","Extractor Rx 12-15 Mm","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$124.35 ","$0.00 ","$47.73 ","$163.44 ","$163.44 ","$40.10 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$35.84 ","$0.00 ","$36.46 ","$0.00 "
"27203204","EAP","HCPCS C1726","","Extractor Rx 15-18 Mm","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$124.35 ","$0.00 ","$47.73 ","$163.44 ","$163.44 ","$40.10 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$35.84 ","$0.00 ","$36.46 ","$0.00 "
"27203205","EAP","HCPCS C1726","","Alliance Inflation Syringe","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$28.24 ","$0.00 ","$10.84 ","$37.11 ","$37.11 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"27203206","EAP","HCPCS C1726","","Encore 26 Single","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$19.01 ","$0.00 ","$7.29 ","$24.98 ","$24.98 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"27203207","EAP","HCPCS C1726","","Rx Lckng Dvce &bx Cap/olympus","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$8.69 ","$0.00 ","$3.33 ","$11.42 ","$11.42 ","$2.80 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$2.50 ","$0.00 ","$2.55 ","$0.00 "
"27203208","EAP","HCPCS C1726","","Olympus Endo Jaw(cold Forceps)","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$14.00 ","$7.60 ","$0.00 ","$2.92 ","$9.99 ","$9.99 ","$2.45 ","$14.00 ","$0.00 ","$7.00 ","$11.09 ","$11.20 ","$0.00 ","$2.19 ","$0.00 ","$2.23 ","$0.00 "
"27203210","EAP","HCPCS C1773","","Kit Snr Agn 90d Mic 200cm 2.3-3fr 2mm Cath Loop","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27203211","EAP","HCPCS C1729","","Cath Drain Edm (ventricular) L 26cm","BOTH IP/OP","$480.00 ","$355.20 ","$0.00 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$342.58 ","$342.58 ","$84.04 ","$480.00 ","$0.00 ","$240.00 ","$380.16 ","$384.00 ","$0.00 ","$75.12 ","$0.00 ","$76.42 ","$0.00 "
"27203212","EAP","HCPCS C1729","","Catheter, Evd Bactiseal 82-1750","BOTH IP/OP","$1,924.00 ","$1,423.76 ","$0.00 ","$1,924.00 ","$1,044.73 ","$0.00 ","$401.01 ","$1,373.16 ","$1,373.16 ","$336.88 ","$1,924.00 ","$0.00 ","$962.00 ","$1,523.81 ","$1,539.20 ","$0.00 ","$301.11 ","$0.00 ","$306.30 ","$0.00 "
"27203213","EAP","HCPCS C1773","","Kit Snr Agn 90d 200cm 2.3-3fr 4mm Mcth Loop Coil","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27203214","EAP","HCPCS C1773","","Kit Snr Agn 90d 200cm 2.3-3fr 7mm Mcth Loop Coil","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27203215","EAP","HCPCS C1887","","Catheter Guid Sim2 Curve 6fr 90cm Env","BOTH IP/OP","$901.00 ","$666.74 ","$0.00 ","$901.00 ","$489.24 ","$0.00 ","$187.79 ","$643.04 ","$643.04 ","$157.76 ","$901.00 ","$0.00 ","$450.50 ","$713.59 ","$720.80 ","$0.00 ","$141.01 ","$0.00 ","$143.44 ","$0.00 "
"27203216","EAP","HCPCS C1887","","Catheter Guid Sim2 Curve 6fr 100cm Env","BOTH IP/OP","$901.00 ","$666.74 ","$0.00 ","$901.00 ","$489.24 ","$0.00 ","$187.79 ","$643.04 ","$643.04 ","$157.76 ","$901.00 ","$0.00 ","$450.50 ","$713.59 ","$720.80 ","$0.00 ","$141.01 ","$0.00 ","$143.44 ","$0.00 "
"27203217","EAP","HCPCS C1769","","Guidewire Vasc 175cm Rnd Prfl Agile Tip Smtr Rot","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$855.23 ","$0.00 ","$328.27 ","$1,124.08 ","$1,124.08 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"27203220","EAP","HCPCS C1894","","Introducer Shth Lng 5fr 30cm Gry Lf Traw Hi Kink Rst Ulsmth","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$55.39 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"27203221","EAP","HCPCS C1894","","Introducer Shth Lng 6fr 30cm Lf Traw Unq Lck Hi Kink Rst","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$55.39 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"27203222","EAP","HCPCS C1894","","Sheath Intro Lng 7fr 30cm Traw Fnl Ulsmth Dil Tpr Ptfe","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$55.39 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"27203251","EAP","Custom 27203251","","Coil Axium Helical  Qc-1.5-2-helix","BOTH IP/OP","$1,034.00 ","$765.16 ","$0.00 ","$1,034.00 ","$0.00 ","$0.00 ","$0.00 ","$737.97 ","$737.97 ","$0.00 ","$1,034.00 ","$0.00 ","$517.00 ","$818.93 ","$827.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203270","EAP","Custom 27203270","","Mpc Envoy Guiding Cath","BOTH IP/OP","$303.00 ","$224.22 ","$0.00 ","$303.00 ","$0.00 ","$0.00 ","$0.00 ","$216.25 ","$216.25 ","$0.00 ","$303.00 ","$0.00 ","$151.50 ","$239.98 ","$242.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203271","EAP","Custom 27203271","","Control Wire .018 V-18","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$0.00 ","$0.00 ","$0.00 ","$558.83 ","$558.83 ","$0.00 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203290","EAP","Custom 27203290","","Foot Drop Splint-prefab","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203400","EAP","Custom 27203400","","Interlock Detach 36-156 Coil","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203401","EAP","Custom 27203401","","Dfs100406-20 Micrus Microcoil","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$0.00 ","$0.00 ","$0.00 ","$344.72 ","$344.72 ","$0.00 ","$483.00 ","$0.00 ","$241.50 ","$382.54 ","$386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203402","EAP","Custom 27203402","","Dfs100310-20 Micrus Microcoil","BOTH IP/OP","$1,429.00 ","$1,057.46 ","$0.00 ","$1,429.00 ","$0.00 ","$0.00 ","$0.00 ","$1,019.88 ","$1,019.88 ","$0.00 ","$1,429.00 ","$0.00 ","$714.50 ","$1,131.77 ","$1,143.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203403","EAP","Custom 27203403","","Dpl100151-20 Micrus Microcoil","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$0.00 ","$1,571.00 ","$0.00 ","$0.00 ","$0.00 ","$1,121.22 ","$1,121.22 ","$0.00 ","$1,571.00 ","$0.00 ","$785.50 ","$1,244.23 ","$1,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203404","EAP","Custom 27203404","","Hel180620-2o Micrus Microcoil","BOTH IP/OP","$834.00 ","$617.16 ","$0.00 ","$834.00 ","$0.00 ","$0.00 ","$0.00 ","$595.23 ","$595.23 ","$0.00 ","$834.00 ","$0.00 ","$417.00 ","$660.53 ","$667.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203405","EAP","Custom 27203405","","Brs000609-00 Balloon Ascnt","BOTH IP/OP","$1,900.00 ","$1,406.00 ","$0.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$1,356.03 ","$1,356.03 ","$0.00 ","$1,900.00 ","$0.00 ","$950.00 ","$1,504.80 ","$1,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203406","EAP","Custom 27203406","","4.5x20 4.5x20 Viatrac Balloon","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203407","EAP","Custom 27203407","","5x20 Viatrac Balloon","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203408","EAP","Custom 27203408","","6x20 Viatrac Balloon","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203409","EAP","Custom 27203409","",".038 150cm Stiff Angled Glide","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203410","EAP","Custom 27203410","",".038 150cm Guidewire Bntsn","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203411","EAP","Custom 27203411","","9fr-30 Tear-away Introducer","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$0.00 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203412","EAP","Custom 27203412","","10fr-30cm Tear-away Introducer","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203413","EAP","Custom 27203413","","16fr-30cm Tear-away Introducer","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203414","EAP","Custom 27203414","","2.0 Mm X9 Maverick Balloon Catheter","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$653.75 ","$653.75 ","$0.00 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203415","EAP","Custom 27203415","","2.5 Mm X9 Maverick Balloon Catheter","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$653.75 ","$653.75 ","$0.00 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203416","EAP","Custom 27203416","","Stent Microdelivery System Neurform2 System 3.5 X 30mm","BOTH IP/OP","$8,535.00 ","$6,315.90 ","$0.00 ","$8,535.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,535.00 ","$0.00 ","$4,267.50 ","$6,759.72 ","$6,828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203417","EAP","Custom 27203417","","3.0 Mm X9 Maverick Balloon Catheter","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$653.75 ","$653.75 ","$0.00 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203418","EAP","Custom 27203418","","Stent Stabilizer Catheter Neurform","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.75 ","$2,737.75 ","$0.00 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203419","EAP","Custom 27203419","","Mpc Envoy Guiding Cath","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$321.17 ","$321.17 ","$0.00 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203420","EAP","Custom 27203420","","5.5 Accunet Distal Protection Device","BOTH IP/OP","$5,171.00 ","$3,826.54 ","$0.00 ","$5,171.00 ","$0.00 ","$0.00 ","$0.00 ","$3,690.54 ","$3,690.54 ","$0.00 ","$5,171.00 ","$0.00 ","$2,585.50 ","$4,095.43 ","$4,136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203421","EAP","Custom 27203421","","2.25 Minivision Stent","BOTH IP/OP","$1,256.00 ","$929.44 ","$0.00 ","$1,256.00 ","$0.00 ","$0.00 ","$0.00 ","$896.41 ","$896.41 ","$0.00 ","$1,256.00 ","$0.00 ","$628.00 ","$994.75 ","$1,004.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203422","EAP","Custom 27203422","","4.0x20mm Viatrac Balloon","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203423","EAP","Custom 27203423","","125cm Vetebral Catheter","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203425","EAP","HCPCS C1887","","Catheter Intvn 5fr .056in .046in 150cm 25cm Rapex","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"27203426","EAP","HCPCS C1887","","Catheter Intvn 7fr .078in .062in 150cm 25cm Rapex","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"27203427","EAP","HCPCS C1887","","Catheter Intvn 8fr .088in .071in 150cm 25cm Rapex","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"27203428","EAP","HCPCS C1887","","Sheath Guid 90cm 3 Radiopq Xcut Vlv Pn Dstn 8fr","BOTH IP/OP","$239.00 ","$176.86 ","$0.00 ","$239.00 ","$129.78 ","$0.00 ","$49.81 ","$170.57 ","$170.57 ","$41.85 ","$239.00 ","$0.00 ","$119.50 ","$189.29 ","$191.20 ","$0.00 ","$37.40 ","$0.00 ","$38.05 ","$0.00 "
"27203429","EAP","HCPCS C1887","","Sheath Guid 65cm 8fr Pn Dstn .038in Str Hydphi","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$121.63 ","$0.00 ","$46.69 ","$159.87 ","$159.87 ","$39.22 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$35.06 ","$0.00 ","$35.66 ","$0.00 "
"27203434","EAP","HCPCS C1769","","Moo326420 Guidewire Standard P","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$705.36 ","$0.00 ","$270.74 ","$927.10 ","$927.10 ","$227.44 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$203.29 ","$0.00 ","$206.80 ","$0.00 "
"27203450","EAP","HCPCS C1751","","105-5092-150 Echelon 14 Micro","BOTH IP/OP","$1,751.00 ","$1,295.74 ","$0.00 ","$1,751.00 ","$950.79 ","$0.00 ","$364.95 ","$1,249.69 ","$1,249.69 ","$306.59 ","$1,751.00 ","$0.00 ","$875.50 ","$1,386.79 ","$1,400.80 ","$0.00 ","$274.03 ","$0.00 ","$278.76 ","$0.00 "
"27203467","EAP","HCPCS C1884","","Spd2-us-050-320 Device Protect","BOTH IP/OP","$1,411.00 ","$1,044.14 ","$0.00 ","$1,411.00 ","$766.17 ","$0.00 ","$294.09 ","$1,007.03 ","$1,007.03 ","$247.05 ","$1,411.00 ","$0.00 ","$705.50 ","$1,117.51 ","$1,128.80 ","$0.00 ","$220.82 ","$0.00 ","$224.63 ","$0.00 "
"27203477","EAP","Custom 27203477","","36-152 Coil Detachable Interlo","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$897.12 ","$897.12 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203478","EAP","Custom 27203478","","36-154 Coil Detachable Interlo","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$942.08 ","$942.08 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203479","EAP","Custom 27203479","","36-156 Coil Detachable Interlo","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$897.12 ","$897.12 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203480","EAP","Custom 27203480","","36-157 Coil Detachable Interlo","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$897.12 ","$897.12 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203481","EAP","Custom 27203481","","Marker Straight 2-tip 150cm/6c","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$0.00 ","$0.00 ","$0.00 ","$811.48 ","$811.48 ","$0.00 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203483","EAP","HCPCS C1887","","Mpc Envoy Guiding Wire","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$321.17 ","$321.17 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"27203484","EAP","Custom 27203484","","Starclose Se","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$499.59 ","$499.59 ","$0.00 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203485","EAP","Custom 27203485","","Lc Bead 300-500","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$0.00 ","$0.00 ","$0.00 ","$952.79 ","$952.79 ","$0.00 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203487","EAP","HCPCS C1769","","Guidewire Silverspeed .014","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$588.80 ","$588.80 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"27203488","EAP","HCPCS C1769","","Guidewire Silverspeed .014","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$588.80 ","$588.80 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"27203489","EAP","HCPCS C1751","","Catheter Echelon 10 Micro","BOTH IP/OP","$2,423.00 ","$1,793.02 ","$0.00 ","$2,423.00 ","$1,315.69 ","$0.00 ","$505.01 ","$1,729.30 ","$1,729.30 ","$424.25 ","$2,423.00 ","$0.00 ","$1,211.50 ","$1,919.02 ","$1,938.40 ","$0.00 ","$379.20 ","$0.00 ","$385.74 ","$0.00 "
"27203490","EAP","HCPCS C1751","","Catheter Echelon 10 Micro","BOTH IP/OP","$2,423.00 ","$1,793.02 ","$0.00 ","$2,423.00 ","$1,315.69 ","$0.00 ","$505.01 ","$1,729.30 ","$1,729.30 ","$424.25 ","$2,423.00 ","$0.00 ","$1,211.50 ","$1,919.02 ","$1,938.40 ","$0.00 ","$379.20 ","$0.00 ","$385.74 ","$0.00 "
"27203491","EAP","HCPCS C1751","","Catheter Echelon 14 Micro","BOTH IP/OP","$2,423.00 ","$1,793.02 ","$0.00 ","$2,423.00 ","$1,315.69 ","$0.00 ","$505.01 ","$1,729.30 ","$1,729.30 ","$424.25 ","$2,423.00 ","$0.00 ","$1,211.50 ","$1,919.02 ","$1,938.40 ","$0.00 ","$379.20 ","$0.00 ","$385.74 ","$0.00 "
"27203492","EAP","HCPCS C1751","","Catheter Echelon 10micro","BOTH IP/OP","$2,423.00 ","$1,793.02 ","$0.00 ","$2,423.00 ","$1,315.69 ","$0.00 ","$505.01 ","$1,729.30 ","$1,729.30 ","$424.25 ","$2,423.00 ","$0.00 ","$1,211.50 ","$1,919.02 ","$1,938.40 ","$0.00 ","$379.20 ","$0.00 ","$385.74 ","$0.00 "
"27203493","EAP","HCPCS C1751","","Catheter Echelon 14 Micro","BOTH IP/OP","$2,423.00 ","$1,793.02 ","$0.00 ","$2,423.00 ","$1,315.69 ","$0.00 ","$505.01 ","$1,729.30 ","$1,729.30 ","$424.25 ","$2,423.00 ","$0.00 ","$1,211.50 ","$1,919.02 ","$1,938.40 ","$0.00 ","$379.20 ","$0.00 ","$385.74 ","$0.00 "
"27203494","EAP","Custom 27203494","","Alligator Retrieval","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203495","EAP","Custom 27203495","","Alligator Retrieval","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203496","EAP","Custom 27203496","","Alligator Retrieval","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203497","EAP","Custom 27203497","","Alligator Retrieval","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203498","EAP","HCPCS C1725","","Catheter Balloon Pta 3.50 X 15","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203499","EAP","HCPCS C1725","","Catheter Balloon Pta 3.00 X 15","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203500","EAP","HCPCS C1725","","Catheter Balloon Pta 2.50 X 15","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203501","EAP","HCPCS C1725","","Catheter Balloon Pta 3.50 X 9.","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203502","EAP","HCPCS C1725","","Catheter Balloon Pta 3.00 X 9.","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203503","EAP","HCPCS C1725","","Catheter Balloon 2.50 X 9.0mm","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203504","EAP","HCPCS C1725","","Catheter Balloon 2.00 X 9.0mm","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203505","EAP","HCPCS C1725","","Catheter Balloon Pta 1.50 X 9.","BOTH IP/OP","$3,387.00 ","$2,506.38 ","$0.00 ","$3,387.00 ","$1,839.14 ","$0.00 ","$705.94 ","$2,417.30 ","$2,417.30 ","$593.04 ","$3,387.00 ","$0.00 ","$1,693.50 ","$2,682.50 ","$2,709.60 ","$0.00 ","$530.07 ","$0.00 ","$539.21 ","$0.00 "
"27203506","EAP","HCPCS C1751","","Microcatheter Hi-flo Distal Fl","BOTH IP/OP","$2,270.00 ","$1,679.80 ","$0.00 ","$2,270.00 ","$1,232.61 ","$0.00 ","$473.12 ","$1,620.10 ","$1,620.10 ","$397.46 ","$2,270.00 ","$0.00 ","$1,135.00 ","$1,797.84 ","$1,816.00 ","$0.00 ","$355.26 ","$0.00 ","$361.38 ","$0.00 "
"27203507","EAP","HCPCS C1751","","Microcathter Hi-pro Distal Fl","BOTH IP/OP","$2,270.00 ","$1,679.80 ","$0.00 ","$2,270.00 ","$1,232.61 ","$0.00 ","$473.12 ","$1,620.10 ","$1,620.10 ","$397.46 ","$2,270.00 ","$0.00 ","$1,135.00 ","$1,797.84 ","$1,816.00 ","$0.00 ","$355.26 ","$0.00 ","$361.38 ","$0.00 "
"27203508","EAP","HCPCS C1751","","Microcatheter Pre-shaped 45 2-","BOTH IP/OP","$2,837.00 ","$2,099.38 ","$0.00 ","$2,837.00 ","$1,540.49 ","$0.00 ","$591.30 ","$2,024.77 ","$2,024.77 ","$496.74 ","$2,837.00 ","$0.00 ","$1,418.50 ","$2,246.90 ","$2,269.60 ","$0.00 ","$443.99 ","$0.00 ","$451.65 ","$0.00 "
"27203509","EAP","HCPCS C1769","","Guidewire Standard Pre-shap 1","BOTH IP/OP","$2,151.00 ","$1,591.74 ","$0.00 ","$2,151.00 ","$1,167.99 ","$0.00 ","$448.32 ","$1,535.17 ","$1,535.17 ","$376.62 ","$2,151.00 ","$0.00 ","$1,075.50 ","$1,703.59 ","$1,720.80 ","$0.00 ","$336.63 ","$0.00 ","$342.44 ","$0.00 "
"27203510","EAP","HCPCS C1769","","Guidewire Standard Pre-shap 2","BOTH IP/OP","$1,838.00 ","$1,360.12 ","$0.00 ","$1,838.00 ","$0.00 ","$0.00 ","$0.00 ","$1,311.78 ","$1,311.78 ","$321.82 ","$1,838.00 ","$0.00 ","$919.00 ","$1,455.70 ","$1,470.40 ","$0.00 ","$287.65 ","$0.00 ","$292.61 ","$0.00 "
"27203511","EAP","HCPCS C1769","","Guidewire Soft Pre-shaped 200c","BOTH IP/OP","$1,838.00 ","$1,360.12 ","$0.00 ","$1,838.00 ","$998.03 ","$0.00 ","$383.09 ","$1,311.78 ","$1,311.78 ","$321.82 ","$1,838.00 ","$0.00 ","$919.00 ","$1,455.70 ","$1,470.40 ","$0.00 ","$287.65 ","$0.00 ","$292.61 ","$0.00 "
"27203512","EAP","HCPCS C1887","","Catheter Utk Slip 5f 125cm","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$401.82 ","$0.00 ","$154.23 ","$528.14 ","$528.14 ","$129.57 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$115.81 ","$0.00 ","$117.81 ","$0.00 "
"27203513","EAP","HCPCS C1887","","Catheter Davis 5f .038 100cm","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$328.00 ","$178.10 ","$0.00 ","$68.36 ","$234.09 ","$234.09 ","$57.43 ","$328.00 ","$0.00 ","$164.00 ","$259.78 ","$262.40 ","$0.00 ","$51.33 ","$0.00 ","$52.22 ","$0.00 "
"27203514","EAP","HCPCS C1894","","Sheath Shuttle 7f 90cm","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$413.00 ","$224.26 ","$0.00 ","$86.08 ","$294.76 ","$294.76 ","$72.31 ","$413.00 ","$0.00 ","$206.50 ","$327.10 ","$330.40 ","$0.00 ","$64.63 ","$0.00 ","$65.75 ","$0.00 "
"27203515","EAP","HCPCS C1894","","Sheath Shuttle 6f 90cm","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$262.27 ","$0.00 ","$100.67 ","$344.72 ","$344.72 ","$84.57 ","$483.00 ","$0.00 ","$241.50 ","$382.54 ","$386.40 ","$0.00 ","$75.59 ","$0.00 ","$76.89 ","$0.00 "
"27203516","EAP","HCPCS C1894","","Sheath Shuttle 6fr 80cm.","BOTH IP/OP","$595.00 ","$440.30 ","$0.00 ","$595.00 ","$323.09 ","$0.00 ","$124.01 ","$424.65 ","$424.65 ","$104.18 ","$595.00 ","$0.00 ","$297.50 ","$471.24 ","$476.00 ","$0.00 ","$93.12 ","$0.00 ","$94.72 ","$0.00 "
"27203517","EAP","HCPCS C1884","","Roadrunners Conners.035x260cm","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$86.88 ","$0.00 ","$33.35 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$25.04 ","$0.00 ","$25.47 ","$0.00 "
"27203518","EAP","HCPCS C1887","","Catheter Envoy 6fr X13-mp","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$321.17 ","$321.17 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"27203519","EAP","HCPCS C1887","","Catheter Envoy 5fr Mipd 9","BOTH IP/OP","$1,048.00 ","$775.52 ","$0.00 ","$1,048.00 ","$569.06 ","$0.00 ","$218.43 ","$747.96 ","$747.96 ","$183.50 ","$1,048.00 ","$0.00 ","$524.00 ","$830.02 ","$838.40 ","$0.00 ","$164.01 ","$0.00 ","$166.84 ","$0.00 "
"27203520","EAP","HCPCS C1887","","Catheter Envoy Straight 9","BOTH IP/OP","$1,048.00 ","$775.52 ","$0.00 ","$1,048.00 ","$569.06 ","$0.00 ","$218.43 ","$747.96 ","$747.96 ","$183.50 ","$1,048.00 ","$0.00 ","$524.00 ","$830.02 ","$838.40 ","$0.00 ","$164.01 ","$0.00 ","$166.84 ","$0.00 "
"27203521","EAP","HCPCS C1751","","Microcathter Prowler Select L","BOTH IP/OP","$2,578.00 ","$1,907.72 ","$0.00 ","$2,578.00 ","$1,399.85 ","$0.00 ","$537.32 ","$1,839.92 ","$1,839.92 ","$451.39 ","$2,578.00 ","$0.00 ","$1,289.00 ","$2,041.78 ","$2,062.40 ","$0.00 ","$403.46 ","$0.00 ","$410.42 ","$0.00 "
"27203522","EAP","HCPCS C1751","","Microcatht.prowler Select L 2","BOTH IP/OP","$2,578.00 ","$1,907.72 ","$0.00 ","$2,578.00 ","$1,399.85 ","$0.00 ","$537.32 ","$1,839.92 ","$1,839.92 ","$451.39 ","$2,578.00 ","$0.00 ","$1,289.00 ","$2,041.78 ","$2,062.40 ","$0.00 ","$403.46 ","$0.00 ","$410.42 ","$0.00 "
"27203523","EAP","HCPCS C1751","","Microcatht.prowler Select L 3","BOTH IP/OP","$2,578.00 ","$1,907.72 ","$0.00 ","$2,578.00 ","$1,399.85 ","$0.00 ","$537.32 ","$1,839.92 ","$1,839.92 ","$451.39 ","$2,578.00 ","$0.00 ","$1,289.00 ","$2,041.78 ","$2,062.40 ","$0.00 ","$403.46 ","$0.00 ","$410.42 ","$0.00 "
"27203524","EAP","HCPCS C1751","","Microcatht.prowler Select L 4","BOTH IP/OP","$2,526.00 ","$1,869.24 ","$0.00 ","$2,526.00 ","$1,371.62 ","$0.00 ","$526.48 ","$1,802.81 ","$1,802.81 ","$442.28 ","$2,526.00 ","$0.00 ","$1,263.00 ","$2,000.59 ","$2,020.80 ","$0.00 ","$395.32 ","$0.00 ","$402.14 ","$0.00 "
"27203525","EAP","HCPCS C1751","","Microcathet.prowler Select P 1","BOTH IP/OP","$2,454.00 ","$1,815.96 ","$0.00 ","$2,454.00 ","$1,332.52 ","$0.00 ","$511.47 ","$1,751.42 ","$1,751.42 ","$429.68 ","$2,454.00 ","$0.00 ","$1,227.00 ","$1,943.57 ","$1,963.20 ","$0.00 ","$384.05 ","$0.00 ","$390.68 ","$0.00 "
"27203526","EAP","HCPCS C1751","","Microcath.prowler Select P 2","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$572.87 ","$0.00 ","$219.89 ","$752.95 ","$752.95 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"27203527","EAP","HCPCS C1751","","Catheter Echelon 14 Micro","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$1,151.16 ","$0.00 ","$441.86 ","$1,513.04 ","$1,513.04 ","$371.20 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$331.78 ","$0.00 ","$337.50 ","$0.00 "
"27203528","EAP","HCPCS C1751","","Microcath.prowler Select P 3","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$572.87 ","$0.00 ","$219.89 ","$752.95 ","$752.95 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"27203529","EAP","HCPCS C1751","","Micrcathters Rapidtransit 17","BOTH IP/OP","$2,235.00 ","$1,653.90 ","$0.00 ","$2,235.00 ","$1,213.61 ","$0.00 ","$465.83 ","$1,595.12 ","$1,595.12 ","$391.33 ","$2,235.00 ","$0.00 ","$1,117.50 ","$1,770.12 ","$1,788.00 ","$0.00 ","$349.78 ","$0.00 ","$355.81 ","$0.00 "
"27203530","EAP","HCPCS C1751","","Micrcatheter Rapidtransit 150","BOTH IP/OP","$2,235.00 ","$1,653.90 ","$0.00 ","$2,235.00 ","$1,213.61 ","$0.00 ","$465.83 ","$1,595.12 ","$1,595.12 ","$391.33 ","$2,235.00 ","$0.00 ","$1,117.50 ","$1,770.12 ","$1,788.00 ","$0.00 ","$349.78 ","$0.00 ","$355.81 ","$0.00 "
"27203531","EAP","HCPCS C1769","","Guidewire Hydrophilic Coat S 1","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"27203532","EAP","HCPCS C1769","","Guidewire Hydrophilic Coat S 2","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$21.18 ","$0.00 ","$8.13 ","$27.83 ","$27.83 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"27203533","EAP","HCPCS C1769","","Guidewire Hydrophilic Coated T","BOTH IP/OP","$585.00 ","$432.90 ","$0.00 ","$585.00 ","$317.66 ","$0.00 ","$121.93 ","$417.51 ","$417.51 ","$102.43 ","$585.00 ","$0.00 ","$292.50 ","$463.32 ","$468.00 ","$0.00 ","$91.55 ","$0.00 ","$93.13 ","$0.00 "
"27203534","EAP","HCPCS C1769","","Guidewire Hydrophilic Coat 0 1","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$23.55 ","$23.55 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"27203535","EAP","HCPCS C1769","","Guidewire Hydrophilic Coat 0 2","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$0.00 ","$0.00 ","$0.00 ","$106.34 ","$106.34 ","$26.09 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$23.32 ","$0.00 ","$23.72 ","$0.00 "
"27203536","EAP","HCPCS C1769","","Guidewire Hydrophilic Coat 3","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$29.00 ","$15.75 ","$0.00 ","$6.04 ","$20.70 ","$20.70 ","$5.08 ","$29.00 ","$0.00 ","$14.50 ","$22.97 ","$23.20 ","$0.00 ","$4.54 ","$0.00 ","$4.62 ","$0.00 "
"27203537","EAP","Custom 27203537","","Catheter Separator 054","BOTH IP/OP","$8,337.00 ","$6,169.38 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,337.00 ","$0.00 ","$4,168.50 ","$6,602.90 ","$6,669.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203538","EAP","HCPCS C1757","","Catheter Reperfilision 054","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$2,264.31 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$0.00 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203539","EAP","HCPCS C1887","","Cath.lumen Delivery Neuron 1","BOTH IP/OP","$1,719.00 ","$1,272.06 ","$0.00 ","$1,719.00 ","$933.42 ","$0.00 ","$358.28 ","$1,226.85 ","$1,226.85 ","$300.98 ","$1,719.00 ","$0.00 ","$859.50 ","$1,361.45 ","$1,375.20 ","$0.00 ","$269.02 ","$0.00 ","$273.66 ","$0.00 "
"27203540","EAP","HCPCS C1887","","Catheter Delivery Neuron 6f St","BOTH IP/OP","$3,436.00 ","$2,542.64 ","$0.00 ","$3,436.00 ","$1,865.75 ","$0.00 ","$716.15 ","$2,452.27 ","$2,452.27 ","$601.62 ","$3,436.00 ","$0.00 ","$1,718.00 ","$2,721.31 ","$2,748.80 ","$0.00 ","$537.73 ","$0.00 ","$547.01 ","$0.00 "
"27203541","EAP","HCPCS C1887","","Cath.select Neuron 5f 120 1","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$0.00 ","$0.00 ","$0.00 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27203542","EAP","HCPCS C1887","","Cath.select Neuron 5f 120 2","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$0.00 ","$0.00 ","$0.00 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27203543","EAP","HCPCS C1887","","Cath.lumen Delivery Neuron 2","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27203544","EAP","HCPCS C1887","","Cath.lumen Delivery Neuron 3","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27203545","EAP","HCPCS C1884","","Device Protection Spider Fx 5.","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$2,264.31 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27203546","EAP","HCPCS C1884","","Device Distal Protection Spide","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$2,264.31 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27203547","EAP","HCPCS C2628","","Cath.balloon Guide Concent 1","BOTH IP/OP","$2,364.00 ","$1,749.36 ","$0.00 ","$2,364.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.19 ","$1,687.19 ","$0.00 ","$2,364.00 ","$0.00 ","$1,182.00 ","$1,872.29 ","$1,891.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203548","EAP","HCPCS C2628","","Catheter Balloon Guide 9f 80cm","BOTH IP/OP","$2,364.00 ","$1,749.36 ","$0.00 ","$2,364.00 ","$1,283.65 ","$0.00 ","$492.72 ","$1,687.19 ","$1,687.19 ","$0.00 ","$2,364.00 ","$0.00 ","$1,182.00 ","$1,872.29 ","$1,891.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203549","EAP","HCPCS C2628","","Cath.balloon Guide Concent 2","BOTH IP/OP","$2,251.00 ","$1,665.74 ","$0.00 ","$2,251.00 ","$0.00 ","$0.00 ","$0.00 ","$1,606.54 ","$1,606.54 ","$0.00 ","$2,251.00 ","$0.00 ","$1,125.50 ","$1,782.79 ","$1,800.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203550","EAP","HCPCS C2628","","Cath.balloon Guide Concent 3","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$0.00 ","$0.00 ","$0.00 ","$2,084.00 ","$2,084.00 ","$0.00 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203551","EAP","HCPCS C1751","","Cath.distal Access Dac 057 1","BOTH IP/OP","$3,321.00 ","$2,457.54 ","$0.00 ","$3,321.00 ","$0.00 ","$0.00 ","$0.00 ","$2,370.20 ","$2,370.20 ","$581.48 ","$3,321.00 ","$0.00 ","$1,660.50 ","$2,630.23 ","$2,656.80 ","$0.00 ","$519.74 ","$0.00 ","$528.70 ","$0.00 "
"27203552","EAP","HCPCS C1751","","Cath.distal Access Dac 057 2","BOTH IP/OP","$3,321.00 ","$2,457.54 ","$0.00 ","$3,321.00 ","$0.00 ","$0.00 ","$0.00 ","$2,370.20 ","$2,370.20 ","$581.48 ","$3,321.00 ","$0.00 ","$1,660.50 ","$2,630.23 ","$2,656.80 ","$0.00 ","$519.74 ","$0.00 ","$528.70 ","$0.00 "
"27203553","EAP","HCPCS C1751","","Catheter Dac 044 - 130cm","BOTH IP/OP","$1,429.00 ","$1,057.46 ","$0.00 ","$1,429.00 ","$775.95 ","$0.00 ","$297.84 ","$1,019.88 ","$1,019.88 ","$250.21 ","$1,429.00 ","$0.00 ","$714.50 ","$1,131.77 ","$1,143.20 ","$0.00 ","$223.64 ","$0.00 ","$227.50 ","$0.00 "
"27203554","EAP","HCPCS C1751","","Catheter Dac 038 - 136cm","BOTH IP/OP","$3,321.00 ","$2,457.54 ","$0.00 ","$3,321.00 ","$1,803.30 ","$0.00 ","$692.18 ","$2,370.20 ","$2,370.20 ","$581.48 ","$3,321.00 ","$0.00 ","$1,660.50 ","$2,630.23 ","$2,656.80 ","$0.00 ","$519.74 ","$0.00 ","$528.70 ","$0.00 "
"27203555","EAP","HCPCS C1884","","Sph100200-20 Microcoil Platino","BOTH IP/OP","$3,586.00 ","$2,653.64 ","$0.00 ","$3,586.00 ","$1,947.20 ","$0.00 ","$747.41 ","$2,559.33 ","$2,559.33 ","$627.88 ","$3,586.00 ","$0.00 ","$1,793.00 ","$2,840.11 ","$2,868.80 ","$0.00 ","$561.21 ","$0.00 ","$570.89 ","$0.00 "
"27203556","EAP","Custom 27203556","","Marker Strght 2-tip 150cm/6cm","BOTH IP/OP","$2,518.00 ","$1,863.32 ","$0.00 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$1,797.10 ","$1,797.10 ","$0.00 ","$2,518.00 ","$0.00 ","$1,259.00 ","$1,994.26 ","$2,014.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203557","EAP","Custom 27203557","","Axium Coil Detacher","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$118.47 ","$118.47 ","$0.00 ","$166.00 ","$0.00 ","$83.00 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203558","EAP","HCPCS C1887","","Mpc Envoy Guiding Wire","BOTH IP/OP","$1,048.00 ","$775.52 ","$0.00 ","$1,048.00 ","$569.06 ","$0.00 ","$218.43 ","$747.96 ","$747.96 ","$183.50 ","$1,048.00 ","$0.00 ","$524.00 ","$830.02 ","$838.40 ","$0.00 ","$164.01 ","$0.00 ","$166.84 ","$0.00 "
"27203559","EAP","Custom 27203559","","Starclose Se","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203560","EAP","Custom 27203560","","Wrap On Finger Hooks(each)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$14.99 ","$14.99 ","$0.00 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203561","EAP","HCPCS C1729","","Shunt Prtnvn Dnvr Asct 25-40ml/min Ample Flowrate","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$3,054.38 ","$0.00 ","$1,172.39 ","$4,014.56 ","$4,014.56 ","$984.89 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$880.31 ","$0.00 ","$895.50 ","$0.00 "
"27203562","EAP","HCPCS C1729","","Cath, Drainage","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$4.55 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$4.07 ","$0.00 ","$4.14 ","$0.00 "
"27203563","EAP","HCPCS C1769","","Tray Tracheostomy 24-26-28fr 2 Cannu Tube Shiley C","BOTH IP/OP","$1,219.00 ","$902.06 ","$0.00 ","$1,219.00 ","$661.92 ","$0.00 ","$254.07 ","$870.00 ","$870.00 ","$213.44 ","$1,219.00 ","$0.00 ","$609.50 ","$965.45 ","$975.20 ","$0.00 ","$190.77 ","$0.00 ","$194.06 ","$0.00 "
"27203564","EAP","Custom 27203564","","Cannula Prfsn 22fr Vns 20d Dilat Crct Bbl Trp Fnl","BOTH IP/OP","$32,500.00 ","$24,050.00 ","$0.00 ","$32,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$32,500.00 ","$0.00 ","$16,250.00 ","$25,740.00 ","$26,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203565","EAP","HCPCS C1725","","Catheter Angio Vtk Curve 5fr 125cm Cerebrum Trnb","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$17.92 ","$0.00 ","$6.88 ","$23.55 ","$23.55 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"27203580","EAP","Custom 27203580","","Safeguard 24cm Pressure Devce","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$47.10 ","$47.10 ","$0.00 ","$66.00 ","$0.00 ","$33.00 ","$52.27 ","$52.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203590","EAP","Custom 27203590","","Needle 25g","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$0.00 ","$0.00 ","$0.00 ","$84.93 ","$84.93 ","$0.00 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203591","EAP","Custom 27203591","","Resolution235cm","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$162.72 ","$162.72 ","$0.00 ","$228.00 ","$0.00 ","$114.00 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203592","EAP","Custom 27203592","","Rx Lithotripter Basket3","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$379.00 ","$0.00 ","$0.00 ","$0.00 ","$270.49 ","$270.49 ","$0.00 ","$379.00 ","$0.00 ","$189.50 ","$300.17 ","$303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203593","EAP","Custom 27203593","","Rx Lithotripter Basket4","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$379.00 ","$0.00 ","$0.00 ","$0.00 ","$270.49 ","$270.49 ","$0.00 ","$379.00 ","$0.00 ","$189.50 ","$300.17 ","$303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203594","EAP","Custom 27203594","","Rx Lithotripter Basket5","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$379.00 ","$0.00 ","$0.00 ","$0.00 ","$270.49 ","$270.49 ","$0.00 ","$379.00 ","$0.00 ","$189.50 ","$300.17 ","$303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203595","EAP","Custom 27203595","","Rx Lithotripter Basket6","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$379.00 ","$0.00 ","$0.00 ","$0.00 ","$270.49 ","$270.49 ","$0.00 ","$379.00 ","$0.00 ","$189.50 ","$300.17 ","$303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203596","EAP","Custom 27203596","","Autotome Rx 44-20mm","BOTH IP/OP","$622.00 ","$460.28 ","$0.00 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$443.92 ","$443.92 ","$0.00 ","$622.00 ","$0.00 ","$311.00 ","$492.62 ","$497.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203597","EAP","Custom 27203597","","Autotome Rx 44-20mm","BOTH IP/OP","$592.00 ","$438.08 ","$0.00 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$422.51 ","$422.51 ","$0.00 ","$592.00 ","$0.00 ","$296.00 ","$468.86 ","$473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203598","EAP","Custom 27203598","","Hydro Tome Rx 450cm","BOTH IP/OP","$592.00 ","$438.08 ","$0.00 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$422.51 ","$422.51 ","$0.00 ","$592.00 ","$0.00 ","$296.00 ","$468.86 ","$473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203599","EAP","Custom 27203599","","Needleknife Rx","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$185.56 ","$185.56 ","$0.00 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203621","EAP","Custom 27203621","","Laceration Tray","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203624","EAP","Custom 27203624","","Standard Peg Kit 20","BOTH IP/OP","$517.00 ","$382.58 ","$0.00 ","$517.00 ","$0.00 ","$0.00 ","$0.00 ","$368.98 ","$368.98 ","$0.00 ","$517.00 ","$0.00 ","$258.50 ","$409.46 ","$413.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203680","EAP","HCPCS C1769","","Hydra-jag/.035/260cm/str","BOTH IP/OP","$647.00 ","$478.78 ","$0.00 ","$647.00 ","$351.32 ","$0.00 ","$134.85 ","$461.76 ","$461.76 ","$113.28 ","$647.00 ","$0.00 ","$323.50 ","$512.42 ","$517.60 ","$0.00 ","$101.26 ","$0.00 ","$103.00 ","$0.00 "
"27203681","EAP","HCPCS C1769","","Hydra-jag/.035/450cm/str","BOTH IP/OP","$749.00 ","$554.26 ","$0.00 ","$749.00 ","$406.71 ","$0.00 ","$156.11 ","$534.56 ","$534.56 ","$131.14 ","$749.00 ","$0.00 ","$374.50 ","$593.21 ","$599.20 ","$0.00 ","$117.22 ","$0.00 ","$119.24 ","$0.00 "
"27203682","EAP","HCPCS C1769","","Jag Hini 025/260 St Bx2","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$191.14 ","$0.00 ","$73.37 ","$251.22 ","$251.22 ","$61.63 ","$352.00 ","$0.00 ","$176.00 ","$278.78 ","$281.60 ","$0.00 ","$55.09 ","$0.00 ","$56.04 ","$0.00 "
"27203683","EAP","HCPCS C1769","","Jagwire/025/straight  450cm","BOTH IP/OP","$533.00 ","$394.42 ","$0.00 ","$533.00 ","$289.42 ","$0.00 ","$111.09 ","$380.40 ","$380.40 ","$93.32 ","$533.00 ","$0.00 ","$266.50 ","$422.14 ","$426.40 ","$0.00 ","$83.41 ","$0.00 ","$84.85 ","$0.00 "
"27203684","EAP","HCPCS C1769","","Pathfinder 018/450","BOTH IP/OP","$544.00 ","$402.56 ","$0.00 ","$544.00 ","$295.39 ","$0.00 ","$113.38 ","$388.25 ","$388.25 ","$95.25 ","$544.00 ","$0.00 ","$272.00 ","$430.85 ","$435.20 ","$0.00 ","$85.14 ","$0.00 ","$86.60 ","$0.00 "
"27203701","EAP","Custom 27203701","","Barrier Adh Abs Plvs Intcd 4x3","BOTH IP/OP","$745.00 ","$551.30 ","$0.00 ","$745.00 ","$0.00 ","$0.00 ","$0.00 ","$531.71 ","$531.71 ","$0.00 ","$745.00 ","$0.00 ","$372.50 ","$590.04 ","$596.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203702","EAP","HCPCS C1877","","Catheter Tr Renegade Hi Flo 13","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$682.55 ","$0.00 ","$261.99 ","$897.12 ","$897.12 ","$220.09 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$196.72 ","$0.00 ","$200.11 ","$0.00 "
"27203703","EAP","Custom 27203703","","Catheter Embolic F-idc 2d 3mm","BOTH IP/OP","$1,321.00 ","$977.54 ","$0.00 ","$1,321.00 ","$0.00 ","$0.00 ","$0.00 ","$942.80 ","$942.80 ","$0.00 ","$1,321.00 ","$0.00 ","$660.50 ","$1,046.23 ","$1,056.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203704","EAP","Custom 27203704","","Catheter Embolic 2/5mm X 5.8cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203705","EAP","Custom 27203705","","Cm Catheter Embolic 2/5mm X 5.8","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203706","EAP","Custom 27203706","","Coil Axium Helical Detachable  Qc-3-8-helix","BOTH IP/OP","$2,404.00 ","$1,778.96 ","$0.00 ","$2,404.00 ","$0.00 ","$0.00 ","$0.00 ","$1,715.73 ","$1,715.73 ","$0.00 ","$2,404.00 ","$0.00 ","$1,202.00 ","$1,903.97 ","$1,923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203707","EAP","Custom 27203707","","Microcoil Platinum Deltaplush 2mmx4cm","BOTH IP/OP","$3,217.00 ","$2,380.58 ","$0.00 ","$3,217.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.97 ","$2,295.97 ","$0.00 ","$3,217.00 ","$0.00 ","$1,608.50 ","$2,547.86 ","$2,573.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203708","EAP","Custom 27203708","","Microcoil Platinum Deltaplush 2mmx6cm","BOTH IP/OP","$3,217.00 ","$2,380.58 ","$0.00 ","$3,217.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.97 ","$2,295.97 ","$0.00 ","$3,217.00 ","$0.00 ","$1,608.50 ","$2,547.86 ","$2,573.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203740","EAP","HCPCS C1887","","Catheter Renegade Stc-18 130/2","BOTH IP/OP","$1,664.00 ","$1,231.36 ","$0.00 ","$1,664.00 ","$903.55 ","$0.00 ","$346.82 ","$1,187.60 ","$1,187.60 ","$291.35 ","$1,664.00 ","$0.00 ","$832.00 ","$1,317.89 ","$1,331.20 ","$0.00 ","$260.42 ","$0.00 ","$264.91 ","$0.00 "
"27203741","EAP","Custom 27203741","","Catheter Embolic F-3mm X 12cm","BOTH IP/OP","$1,321.00 ","$977.54 ","$0.00 ","$1,321.00 ","$0.00 ","$0.00 ","$0.00 ","$942.80 ","$942.80 ","$0.00 ","$1,321.00 ","$0.00 ","$660.50 ","$1,046.23 ","$1,056.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203742","EAP","Custom 27203742","","Catheter Embolic F-4mm X 8cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203743","EAP","Custom 27203743","","4mm X 15cm Catheter Embolic F-","BOTH IP/OP","$1,321.00 ","$977.54 ","$0.00 ","$1,321.00 ","$0.00 ","$0.00 ","$0.00 ","$942.80 ","$942.80 ","$0.00 ","$1,321.00 ","$0.00 ","$660.50 ","$1,046.23 ","$1,056.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203744","EAP","Custom 27203744","","Catheter Embolic F-5mm X 8cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203745","EAP","Custom 27203745","","Coil Embolization 2d Helix 5mm 15cm 8 Coil Occlusion System","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203746","EAP","Custom 27203746","","Coil Embolization 2d Helix 6mm 10cm 18 Coil Occlusion System","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203747","EAP","Custom 27203747","","Coil Embolization 2d Helix 6mm 20cm 18 Coil Occlusion System","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203748","EAP","Custom 27203748","","8MM X 20CM CATHETER EMBOLIC F-","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203749","EAP","Custom 27203749","","10MM X 20CM CATHETER EMBOLIC F","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203750","EAP","Custom 27203750","","10MM X 30CM CATHETER EMBOLIC F","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203751","EAP","Custom 27203751","","CATHETER EMBOLIC F12M X 20CM","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203752","EAP","Custom 27203752","","Catheter Embolic F 12m X 30cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203753","EAP","Custom 27203753","","Catheter Embolic F 14mm X 20cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203754","EAP","Custom 27203754","","Catheter Embolic F 14mm X 30cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203755","EAP","Custom 27203755","","CATHETER EMBOLIC F-IDC VORTX DCM","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203756","EAP","Custom 27203756","","Catheter Embolic F-2/4mm X 4.1cm","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$897.83 ","$897.83 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203766","EAP","Custom 27203766","","Catheter Swan Ganz","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$147.74 ","$147.74 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203769","EAP","Custom 27203769","","Tray Thoracentesis/parace","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$71.37 ","$71.37 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203770","EAP","HCPCS C1769","","Miraclebros Guiding Wire 14937-01","BOTH IP/OP","$2,251.00 ","$1,665.74 ","$0.00 ","$2,251.00 ","$1,222.29 ","$0.00 ","$469.16 ","$1,606.54 ","$1,606.54 ","$394.13 ","$2,251.00 ","$0.00 ","$1,125.50 ","$1,782.79 ","$1,800.80 ","$0.00 ","$352.28 ","$0.00 ","$358.36 ","$0.00 "
"27203773","EAP","Custom 27203773","","Catheter Guid 14fr Acty Pro 130d Cs-ic Curve Inr","BOTH IP/OP","$613.00 ","$453.62 ","$0.00 ","$613.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$437.50 ","$0.00 ","$613.00 ","$0.00 ","$306.50 ","$485.50 ","$490.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203774","EAP","Custom 27203774","","Catheter Gd 16fr 1.5cm Bln Loprfl","BOTH IP/OP","$1,238.00 ","$916.12 ","$0.00 ","$1,238.00 ","$0.00 ","$0.00 ","$0.00 ","$883.56 ","$883.56 ","$0.00 ","$1,238.00 ","$0.00 ","$619.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203775","EAP","Custom 27203775","","Catheter Gd 16fr 3.5cm Bln Loprfl","BOTH IP/OP","$1,238.00 ","$916.12 ","$0.00 ","$1,238.00 ","$0.00 ","$0.00 ","$0.00 ","$883.56 ","$883.56 ","$0.00 ","$1,238.00 ","$0.00 ","$619.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203776","EAP","HCPCS C1724","","Catheter Athrcm 145cm Stlth 360 1.25mm Orbtl Cls","BOTH IP/OP","$9,488.00 ","$7,021.12 ","$0.00 ","$9,488.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,488.00 ","$0.00 ","$4,744.00 ","$7,514.50 ","$7,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203777","EAP","HCPCS C1769","","Guidewire Vasc 360 Orbtl","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$488.00 ","$264.98 ","$0.00 ","$101.71 ","$348.29 ","$348.29 ","$85.44 ","$488.00 ","$0.00 ","$244.00 ","$386.50 ","$390.40 ","$0.00 ","$76.37 ","$0.00 ","$77.69 ","$0.00 "
"27203780","EAP","HCPCS C1766","","Sheath Flex 7fr 10cm","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$380.10 ","$0.00 ","$145.90 ","$499.59 ","$499.59 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"27203790","EAP","HCPCS C1751","","Microcatheter Microvention","BOTH IP/OP","$2,390.00 ","$1,768.60 ","$0.00 ","$2,390.00 ","$1,297.77 ","$0.00 ","$498.14 ","$1,705.74 ","$1,705.74 ","$418.47 ","$2,390.00 ","$0.00 ","$1,195.00 ","$1,892.88 ","$1,912.00 ","$0.00 ","$374.04 ","$0.00 ","$380.49 ","$0.00 "
"27203795","EAP","HCPCS C1751","","Microcatheter Merci","BOTH IP/OP","$1,585.00 ","$1,172.90 ","$0.00 ","$1,585.00 ","$860.66 ","$0.00 ","$330.35 ","$1,131.21 ","$1,131.21 ","$277.52 ","$1,585.00 ","$0.00 ","$792.50 ","$1,255.32 ","$1,268.00 ","$0.00 ","$248.05 ","$0.00 ","$252.33 ","$0.00 "
"27203796","EAP","HCPCS C1757","","2.5 Meri V-series Retrieval Sy","BOTH IP/OP","$10,341.00 ","$7,652.34 ","$0.00 ","$10,341.00 ","$5,615.16 ","$0.00 ","$2,155.32 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,341.00 ","$0.00 ","$5,170.50 ","$8,190.07 ","$8,272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203797","EAP","HCPCS C1757","","3.0 Meri V-series Retrieval Sy","BOTH IP/OP","$10,341.00 ","$7,652.34 ","$0.00 ","$10,341.00 ","$5,615.16 ","$0.00 ","$2,155.32 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,341.00 ","$0.00 ","$5,170.50 ","$8,190.07 ","$8,272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203798","EAP","HCPCS C1757","","Meri V-series Retrieval System","BOTH IP/OP","$10,341.00 ","$7,652.34 ","$0.00 ","$10,341.00 ","$5,615.16 ","$0.00 ","$2,155.32 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,341.00 ","$0.00 ","$5,170.50 ","$8,190.07 ","$8,272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203799","EAP","HCPCS C1751","","026 Catheter Reperfusion","BOTH IP/OP","$3,635.00 ","$2,689.90 ","$0.00 ","$3,635.00 ","$1,973.81 ","$0.00 ","$757.62 ","$2,594.30 ","$2,594.30 ","$636.46 ","$3,635.00 ","$0.00 ","$1,817.50 ","$2,878.92 ","$2,908.00 ","$0.00 ","$568.88 ","$0.00 ","$578.69 ","$0.00 "
"27203800","EAP","HCPCS C1751","","032 Catheter Reperfusion","BOTH IP/OP","$3,817.00 ","$2,824.58 ","$0.00 ","$3,817.00 ","$2,072.63 ","$0.00 ","$795.56 ","$2,724.19 ","$2,724.19 ","$668.33 ","$3,817.00 ","$0.00 ","$1,908.50 ","$3,023.06 ","$3,053.60 ","$0.00 ","$597.36 ","$0.00 ","$607.67 ","$0.00 "
"27203801","EAP","HCPCS C1751","","041 Catheter Reperfusion","BOTH IP/OP","$3,635.00 ","$2,689.90 ","$0.00 ","$3,635.00 ","$1,973.81 ","$0.00 ","$757.62 ","$2,594.30 ","$2,594.30 ","$636.46 ","$3,635.00 ","$0.00 ","$1,817.50 ","$2,878.92 ","$2,908.00 ","$0.00 ","$568.88 ","$0.00 ","$578.69 ","$0.00 "
"27203802","EAP","Custom 27203802","","026 Separator","BOTH IP/OP","$7,639.00 ","$5,652.86 ","$0.00 ","$7,639.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,639.00 ","$0.00 ","$3,819.50 ","$6,050.09 ","$6,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203803","EAP","Custom 27203803","","032 Separator","BOTH IP/OP","$7,639.00 ","$5,652.86 ","$0.00 ","$7,639.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,639.00 ","$0.00 ","$3,819.50 ","$6,050.09 ","$6,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203804","EAP","Custom 27203804","","Tubing, Aspiration","BOTH IP/OP","$1,297.00 ","$959.78 ","$0.00 ","$1,297.00 ","$0.00 ","$0.00 ","$0.00 ","$925.67 ","$925.67 ","$0.00 ","$1,297.00 ","$0.00 ","$648.50 ","$1,027.22 ","$1,037.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203805","EAP","Custom 27203805","","Supplies, Non-sterile Penumbra","BOTH IP/OP","$913.00 ","$675.62 ","$0.00 ","$913.00 ","$0.00 ","$0.00 ","$0.00 ","$651.61 ","$651.61 ","$0.00 ","$913.00 ","$0.00 ","$456.50 ","$723.10 ","$730.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203806","EAP","Custom 27203806","","Pump, Penumbra Aspiration","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203807","EAP","Custom 27203807","","Device Accunet Distal Protecti","BOTH IP/OP","$7,006.00 ","$5,184.44 ","$0.00 ","$7,006.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.18 ","$5,000.18 ","$0.00 ","$7,006.00 ","$0.00 ","$3,503.00 ","$5,548.75 ","$5,604.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203808","EAP","Custom 27203808","","1008195-20 Balloon Viatrac","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203809","EAP","Custom 27203809","","Qc-2-1 Helix Coil Axium Helica","BOTH IP/OP","$2,404.00 ","$1,778.96 ","$0.00 ","$2,404.00 ","$0.00 ","$0.00 ","$0.00 ","$1,715.73 ","$1,715.73 ","$0.00 ","$2,404.00 ","$0.00 ","$1,202.00 ","$1,903.97 ","$1,923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203810","EAP","Custom 27203810","","Qc-3-4-helix Coil Axium Helica","BOTH IP/OP","$2,404.00 ","$1,778.96 ","$0.00 ","$2,404.00 ","$0.00 ","$0.00 ","$0.00 ","$1,715.73 ","$1,715.73 ","$0.00 ","$2,404.00 ","$0.00 ","$1,202.00 ","$1,903.97 ","$1,923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203815","EAP","Custom 27203815","","Ballon-trek Mini Rx 2.0mm X 12mm","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$0.00 ","$0.00 ","$0.00 ","$488.88 ","$488.88 ","$0.00 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203816","EAP","Custom 27203816","","Ballon-TREK MINI RX 2.0MM X 15MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203817","EAP","Custom 27203817","","Ballon-TREK RX 2.50MM X 12MM","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$0.00 ","$0.00 ","$0.00 ","$488.88 ","$488.88 ","$0.00 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203818","EAP","Custom 27203818","","Ballon-TREK RX 2.50MM X 15MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203819","EAP","Custom 27203819","","Ballon-TREK RX 3.0MM X 12MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203820","EAP","HCPCS C1757","","Set Thrombectomy Dvx","BOTH IP/OP","$5,308.00 ","$3,927.92 ","$0.00 ","$5,308.00 ","$2,882.24 ","$0.00 ","$1,106.32 ","$3,788.32 ","$3,788.32 ","$0.00 ","$5,308.00 ","$0.00 ","$2,654.00 ","$4,203.94 ","$4,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203821","EAP","HCPCS C1757","","Set Thrombectomy Avx","BOTH IP/OP","$2,452.00 ","$1,814.48 ","$0.00 ","$2,452.00 ","$1,331.44 ","$0.00 ","$511.06 ","$1,749.99 ","$1,749.99 ","$0.00 ","$2,452.00 ","$0.00 ","$1,226.00 ","$1,941.98 ","$1,961.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203822","EAP","HCPCS C1757","","Set Thrombectomy Spiroflex","BOTH IP/OP","$6,464.00 ","$4,783.36 ","$0.00 ","$6,464.00 ","$3,509.95 ","$0.00 ","$1,347.26 ","$4,613.36 ","$4,613.36 ","$0.00 ","$6,464.00 ","$0.00 ","$3,232.00 ","$5,119.49 ","$5,171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203823","EAP","HCPCS C1757","","Set Thrombectomy Spiroflex Vg","BOTH IP/OP","$6,156.00 ","$4,555.44 ","$0.00 ","$6,156.00 ","$3,342.71 ","$0.00 ","$1,283.06 ","$4,393.54 ","$4,393.54 ","$0.00 ","$6,156.00 ","$0.00 ","$3,078.00 ","$4,875.55 ","$4,924.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203824","EAP","Custom 27203824","","Ballon-TREK RX 3.0MM X 15MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203825","EAP","HCPCS C1725","","Balloon Nc Trek 2.0 X 6mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203826","EAP","HCPCS C1725","","Balloon Nc Trek 2.5 X 6mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203827","EAP","HCPCS C1725","","Balloon Nc Trek 2.5 X 8mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203828","EAP","HCPCS C1725","","Balloon Nc Trek 2.5 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203829","EAP","HCPCS C1725","","Balloon Nc Trek 2.5 X 20mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203830","EAP","HCPCS C1725","","Balloon Nc Trek 2.5 X 25mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203831","EAP","HCPCS C1725","","Balloon Nc Trek 2.75 X 6mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203832","EAP","HCPCS C1725","","Balloon Nc Trek 2.75 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203833","EAP","HCPCS C1725","","Balloon, Mini Trek Otw 1.50 X","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203834","EAP","HCPCS C1725","","Balloon, Mini Trek Otw 1.50 X","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203835","EAP","HCPCS C1725","","Balloon, Mini Trek Otw 2.00 X","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$371.96 ","$0.00 ","$142.77 ","$488.88 ","$488.88 ","$119.94 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$107.20 ","$0.00 ","$109.05 ","$0.00 "
"27203836","EAP","HCPCS C1725","","Balloon, Mini Trek Otw 2.00 X","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203837","EAP","HCPCS C1725","","Balloon, Mini Trek Otw 2.00 X","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203838","EAP","HCPCS C1725","","Balloon Nc Trek 2.75 X 15mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203839","EAP","HCPCS C1725","","Balloon Nc Trek 2.75 X 20mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203840","EAP","HCPCS C1725","","Balloon Nc Trek 3.0 X 6mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203841","EAP","HCPCS C1725","","Balloon Nc Trek 3.0 X 8mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203842","EAP","HCPCS C1725","","Balloon Nc Trek 3.0 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203843","EAP","HCPCS C1725","","Balloon Nc Trek 3.0 X 15mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203844","EAP","HCPCS C1725","","Balloon Nc Trek 3.0 X 20mm","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$371.96 ","$0.00 ","$142.77 ","$488.88 ","$488.88 ","$119.94 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$107.20 ","$0.00 ","$109.05 ","$0.00 "
"27203845","EAP","HCPCS C1725","","Balloon Nc Trek 3.0 X 25mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203846","EAP","HCPCS C1725","","Balloon Nc Trek 3.25 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203847","EAP","HCPCS C1725","","Balloon Nc Trek 3.25 X 15mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203848","EAP","HCPCS C1725","","Balloon Nc Trek 3.5 X 6mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203849","EAP","HCPCS C1725","","Balloon Nc Trek 3.5 X 8mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203850","EAP","HCPCS C1725","","Balloon Nc Trek 3.5 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203851","EAP","HCPCS C1725","","Balloon Nc Trek 3.5 X 15mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203852","EAP","HCPCS C1725","","Balloon Nc Trek 3.5 X 20mm","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$371.96 ","$0.00 ","$142.77 ","$488.88 ","$488.88 ","$119.94 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$107.20 ","$0.00 ","$109.05 ","$0.00 "
"27203853","EAP","HCPCS C1725","","Balloon Nc Trek 3.5 X 25mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203854","EAP","HCPCS C1725","","Balloon Nc Trek 3.75 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203855","EAP","HCPCS C1725","","Balloon Nc Trek 3.75 X 15mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203856","EAP","HCPCS C1725","","Balloon Nc Trek 3.75 X 20mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203857","EAP","HCPCS C1725","","Balloon Nc Trek 4.0 X 8mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203858","EAP","HCPCS C1725","","Balloon Nc Trek 4.0 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203859","EAP","HCPCS C1725","","Balloon Nc Trek 4.0 X 15mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203860","EAP","HCPCS C1725","","Balloon Nc Trek 4.0 X 20mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203861","EAP","HCPCS C1725","","Balloon Nc Trek 5.0 X 8mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203862","EAP","HCPCS C1725","","Balloon Nc Trek 5.0 X 12mm","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$354.04 ","$0.00 ","$135.89 ","$465.33 ","$465.33 ","$114.16 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$102.04 ","$0.00 ","$103.80 ","$0.00 "
"27203863","EAP","HCPCS C1725","","Stent Xcience 2.25 X 8mm","BOTH IP/OP","$6,940.00 ","$5,135.60 ","$0.00 ","$6,940.00 ","$3,768.42 ","$0.00 ","$1,446.47 ","$4,953.08 ","$4,953.08 ","$1,215.14 ","$6,940.00 ","$0.00 ","$3,470.00 ","$5,496.48 ","$5,552.00 ","$0.00 ","$1,086.11 ","$0.00 ","$1,104.85 ","$0.00 "
"27203864","EAP","HCPCS C1887","","Catheter Guid Ebu3.75 Curve 8fr .09in 90cm Left","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27203865","EAP","HCPCS C1887","","Atheter Guid Xb3.5 Curve 8fr 90cm Coron Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27203867","EAP","HCPCS C1887","","Catheter Guid Jl4 Curve 8fr 90cm Coron Shr Nx Bal","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27203868","EAP","HCPCS C1887","","Catheter Guid Mb1 Curve 8fr .088in 90cm Coron Shr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27203869","EAP","HCPCS C1887","","Catheter Angio Jacky Radl 3.5 Curve 5fr 110cm","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"27203870","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 2.0x10 Mm 5f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203871","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 2.0x15 Mm 5f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203872","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 2.0x20 Mm 5f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203873","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 2.5x10 Mm 5f","BOTH IP/OP","$788.00 ","$583.12 ","$0.00 ","$788.00 ","$427.88 ","$0.00 ","$164.24 ","$562.40 ","$562.40 ","$137.97 ","$788.00 ","$0.00 ","$394.00 ","$624.10 ","$630.40 ","$0.00 ","$123.32 ","$0.00 ","$125.45 ","$0.00 "
"27203874","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 2.5x15 Mm 5f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203875","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 2.5x20 Mm 5f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203876","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 3.0x10 Mm 6f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203878","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 3.0x20 Mm 6f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203879","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 3.5x10 Mm 6f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203880","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 3.5x15 Mm 6f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203881","EAP","HCPCS C1725","","Chocolate Ptca Balloon Catheter 3.5x20 Mm 6f","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$407.25 ","$0.00 ","$156.32 ","$535.28 ","$535.28 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"27203882","EAP","HCPCS C1887","","Catheter Dlv Sys .062in 5max Max Trk Tch 125cm 129","BOTH IP/OP","$4,175.00 ","$3,089.50 ","$0.00 ","$4,175.00 ","$2,267.03 ","$0.00 ","$870.17 ","$2,979.70 ","$2,979.70 ","$731.01 ","$4,175.00 ","$0.00 ","$2,087.50 ","$3,306.60 ","$3,340.00 ","$0.00 ","$653.39 ","$0.00 ","$664.66 ","$0.00 "
"27203890","EAP","Custom 27203890","","Kit Gel Pad Medium Arctic Sun","BOTH IP/OP","$6,305.00 ","$4,665.70 ","$0.00 ","$6,305.00 ","$0.00 ","$0.00 ","$0.00 ","$4,499.88 ","$4,499.88 ","$0.00 ","$6,305.00 ","$0.00 ","$3,152.50 ","$4,993.56 ","$5,044.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203891","EAP","Custom 27203891","","Kit Gel Pad Large Arctic Sun","BOTH IP/OP","$6,305.00 ","$4,665.70 ","$0.00 ","$6,305.00 ","$0.00 ","$0.00 ","$0.00 ","$4,499.88 ","$4,499.88 ","$0.00 ","$6,305.00 ","$0.00 ","$3,152.50 ","$4,993.56 ","$5,044.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203892","EAP","Custom 27203892","","Pad Gel Universal","BOTH IP/OP","$6,005.00 ","$4,443.70 ","$0.00 ","$6,005.00 ","$0.00 ","$0.00 ","$0.00 ","$4,285.77 ","$4,285.77 ","$0.00 ","$6,005.00 ","$0.00 ","$3,002.50 ","$4,755.96 ","$4,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203895","EAP","Custom 27203895","","Ballon-TREK RX 3.50MM X 12MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203896","EAP","Custom 27203896","","Ballon-TREK RX 3.50MM X 15MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203897","EAP","Custom 27203897","","Ballon-TREK RX 4.0MM X 15MM","BOTH IP/OP","$652.00 ","$482.48 ","$0.00 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$465.33 ","$465.33 ","$0.00 ","$652.00 ","$0.00 ","$326.00 ","$516.38 ","$521.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203899","EAP","Custom 27203899","","Catheter, Tiger 4.5 Radial Access","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203900","EAP","Custom 27203900","","Device Spec Rtrvl Xtrt Pro Xl 7-6fr 12-15mm 200cm","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,784.25 ","$1,784.25 ","$0.00 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203901","EAP","Custom 27203901","","Tray Foley 16fr With Unrinemeter","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203902","EAP","HCPCS C1751","","Fa-55150-1030 Catheter Marksman","BOTH IP/OP","$3,104.00 ","$2,296.96 ","$0.00 ","$3,104.00 ","$1,685.47 ","$0.00 ","$646.95 ","$2,215.32 ","$2,215.32 ","$543.49 ","$3,104.00 ","$0.00 ","$1,552.00 ","$2,458.37 ","$2,483.20 ","$0.00 ","$485.78 ","$0.00 ","$494.16 ","$0.00 "
"27203903","EAP","HCPCS C1725","","Catheter Balloon Udt 16-449 5-10/5/75","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$634.00 ","$344.26 ","$0.00 ","$132.14 ","$452.49 ","$452.49 ","$111.01 ","$634.00 ","$0.00 ","$317.00 ","$502.13 ","$507.20 ","$0.00 ","$99.22 ","$0.00 ","$100.93 ","$0.00 "
"27203904","EAP","HCPCS C1894","","Cl-07690 Sheath Set Super Arrow Flex 90cm","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$347.00 ","$188.42 ","$0.00 ","$72.32 ","$247.65 ","$247.65 ","$60.76 ","$347.00 ","$0.00 ","$173.50 ","$274.82 ","$277.60 ","$0.00 ","$54.31 ","$0.00 ","$55.24 ","$0.00 "
"27203905","EAP","HCPCS C1894","","Cl - 07665 Sheath Set Super Arrow Flex 65cm","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$157.47 ","$0.00 ","$60.44 ","$206.97 ","$206.97 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"27203906","EAP","Custom 27203906","","Catheter Tiger Radial Access 5fr 100cm 4.0 40-5011","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$23.55 ","$23.55 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203907","EAP","Custom 27203907","","Catheter Siteseer Al 1 5 Fr 5a0018","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203908","EAP","HCPCS C1769","","Guidewire Asahi Grand Slam .014x300cm 14940","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$234.00 ","$127.06 ","$0.00 ","$48.77 ","$167.01 ","$167.01 ","$40.97 ","$234.00 ","$0.00 ","$117.00 ","$185.33 ","$187.20 ","$0.00 ","$36.62 ","$0.00 ","$37.25 ","$0.00 "
"27203909","EAP","HCPCS C1887","","La6ebu375 Catheter Guidingebu 3.75","BOTH IP/OP","$464.00 ","$343.36 ","$0.00 ","$464.00 ","$251.95 ","$0.00 ","$96.71 ","$331.16 ","$331.16 ","$81.24 ","$464.00 ","$0.00 ","$232.00 ","$367.49 ","$371.20 ","$0.00 ","$72.62 ","$0.00 ","$73.87 ","$0.00 "
"27203912","EAP","HCPCS C1887","","Catheter Guideliner 5571","BOTH IP/OP","$1,227.00 ","$907.98 ","$0.00 ","$1,227.00 ","$666.26 ","$0.00 ","$255.74 ","$875.71 ","$875.71 ","$214.84 ","$1,227.00 ","$0.00 ","$613.50 ","$971.78 ","$981.60 ","$0.00 ","$192.03 ","$0.00 ","$195.34 ","$0.00 "
"27203913","EAP","HCPCS C1887","","La7ebu375 Catheter Guiding Ebu 3.75","BOTH IP/OP","$464.00 ","$343.36 ","$0.00 ","$464.00 ","$251.95 ","$0.00 ","$96.71 ","$331.16 ","$331.16 ","$81.24 ","$464.00 ","$0.00 ","$232.00 ","$367.49 ","$371.20 ","$0.00 ","$72.62 ","$0.00 ","$73.87 ","$0.00 "
"27203914","EAP","Custom 27203914","","Catheter Siteseer Angled Pigtailed 5fr 5a0070","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203916","EAP","HCPCS C1892","","French Large Peel Away Introducer 20","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27203917","EAP","HCPCS C1892","","French Large Peel Away Introducer 22","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27203918","EAP","HCPCS C1892","","French Large Peel Away Introducer 24","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27203919","EAP","HCPCS C1892","","French Large Peel Away Introducer 26","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27203920","EAP","HCPCS C1894","","Flexor Ceckflo Introducer","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$41.27 ","$0.00 ","$15.84 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"27203921","EAP","HCPCS C1750","","French X 36 Cm Titan Hemodialysis Catheter","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$128.69 ","$0.00 ","$49.40 ","$169.15 ","$169.15 ","$41.50 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$37.09 ","$0.00 ","$37.73 ","$0.00 "
"27203922","EAP","HCPCS C1750","","French X 40 Cm Titan Hemodialysis Catheter","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$128.69 ","$0.00 ","$49.40 ","$169.15 ","$169.15 ","$41.50 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$37.09 ","$0.00 ","$37.73 ","$0.00 "
"27203923","EAP","HCPCS C1750","","Set Catheter 15.5fr 55cm 2 Lumen Titan Hd Long Term","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$339.01 ","$339.01 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"27203925","EAP","HCPCS C1752","","French X 32 Cm Titan Hemodialysis Catheter T- 3 Triple 5","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$0.00 ","$169.15 ","$169.15 ","$0.00 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203926","EAP","HCPCS C1752","","Titan Hemodialysis Catheter 14f X 30 Cm","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$0.00 ","$169.15 ","$169.15 ","$0.00 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203927","EAP","HCPCS C1892","","Tear Away Sheath Introducer","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$95.03 ","$0.00 ","$36.47 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"27203928","EAP","Custom 27203928","","Dressing Adherent Mepilex Border 9.2 X 9.2 282400","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203929","EAP","HCPCS C1892","","Large Peel Away Introducer","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27203930","EAP","HCPCS C1769","","G131660  Introducer Tracheostomy Percutaneous Ciaglia Bm","BOTH IP/OP","$1,124.00 ","$831.76 ","$0.00 ","$1,124.00 ","$610.33 ","$0.00 ","$234.27 ","$802.20 ","$802.20 ","$196.80 ","$1,124.00 ","$0.00 ","$562.00 ","$890.21 ","$899.20 ","$0.00 ","$175.91 ","$0.00 ","$178.94 ","$0.00 "
"27203931","EAP","HCPCS C1769","","G12565  Introducer Tracheostomy Percutaneous Ciaglia Blm","BOTH IP/OP","$1,124.00 ","$831.76 ","$0.00 ","$1,124.00 ","$610.33 ","$0.00 ","$234.27 ","$802.20 ","$802.20 ","$196.80 ","$1,124.00 ","$0.00 ","$562.00 ","$890.21 ","$899.20 ","$0.00 ","$175.91 ","$0.00 ","$178.94 ","$0.00 "
"27203933","EAP","HCPCS C1769","","Um-04018  Femoral Arterial Line Kit","BOTH IP/OP","$91.00 ","$67.34 ","$0.00 ","$91.00 ","$49.41 ","$0.00 ","$18.97 ","$64.95 ","$64.95 ","$15.93 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$14.24 ","$0.00 ","$14.49 ","$0.00 "
"27203937","EAP","Custom 27203937","","M827057/10.s  T.r.a.c. Pad","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$40.68 ","$40.68 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203938","EAP","HCPCS C1887","","Fa-55150-1030 Catheter Marksman","BOTH IP/OP","$3,259.00 ","$2,411.66 ","$0.00 ","$3,259.00 ","$1,769.64 ","$0.00 ","$679.26 ","$2,325.95 ","$2,325.95 ","$570.62 ","$3,259.00 ","$0.00 ","$1,629.50 ","$2,581.13 ","$2,607.20 ","$0.00 ","$510.03 ","$0.00 ","$518.83 ","$0.00 "
"27203939","EAP","HCPCS C1725","","Baloon 2.5 X 15mm Raptor 573-125","BOTH IP/OP","$743.00 ","$549.82 ","$0.00 ","$743.00 ","$403.45 ","$0.00 ","$154.86 ","$530.28 ","$530.28 ","$130.09 ","$743.00 ","$0.00 ","$371.50 ","$588.46 ","$594.40 ","$0.00 ","$116.28 ","$0.00 ","$118.29 ","$0.00 "
"27203940","EAP","Custom 27203940","","Catheter Siteseer Al1 5fr 5a0018","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203941","EAP","Custom 27203941","","Cl-07665 Sheath Set Super Arrow Flex 65cm","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203942","EAP","Custom 27203942","","Needle Guide Sterile 9001c0212","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$34.26 ","$34.26 ","$0.00 ","$48.00 ","$0.00 ","$24.00 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27203943","EAP","HCPCS C1895","","Reliance Lead,aicd, Endo Dual Coil","BOTH IP/OP","$11,794.00 ","$8,727.56 ","$0.00 ","$11,794.00 ","$6,404.14 ","$0.00 ","$2,458.16 ","$5,158.80 ","$5,158.80 ","$2,065.04 ","$11,794.00 ","$0.00 ","$5,897.00 ","$9,340.85 ","$9,435.20 ","$0.00 ","$1,845.76 ","$0.00 ","$1,877.60 ","$0.00 "
"27203945","EAP","HCPCS C1887","","6fr Acuity Cath, Guiding W Del Sys","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$263.36 ","$0.00 ","$101.09 ","$346.14 ","$346.14 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"27203946","EAP","HCPCS C1887","","8fr Acuity Cath, Guiding W Del Sys","BOTH IP/OP","$1,104.00 ","$816.96 ","$0.00 ","$1,104.00 ","$599.47 ","$0.00 ","$230.10 ","$787.92 ","$787.92 ","$193.30 ","$1,104.00 ","$0.00 ","$552.00 ","$874.37 ","$883.20 ","$0.00 ","$172.78 ","$0.00 ","$175.76 ","$0.00 "
"27203947","EAP","HCPCS C1887","","Ep Ds2c002 Slit/outer Cath, Guiding","BOTH IP/OP","$1,551.00 ","$1,147.74 ","$0.00 ","$1,551.00 ","$842.19 ","$0.00 ","$323.27 ","$1,106.95 ","$1,106.95 ","$271.57 ","$1,551.00 ","$0.00 ","$775.50 ","$1,228.39 ","$1,240.80 ","$0.00 ","$242.73 ","$0.00 ","$246.92 ","$0.00 "
"27203950","EAP","HCPCS C1769","","Neuroscout 14 Standard 601314","BOTH IP/OP","$1,111.00 ","$822.14 ","$0.00 ","$1,111.00 ","$603.27 ","$0.00 ","$231.56 ","$792.92 ","$792.92 ","$194.53 ","$1,111.00 ","$0.00 ","$555.50 ","$879.91 ","$888.80 ","$0.00 ","$173.87 ","$0.00 ","$176.87 ","$0.00 "
"27203951","EAP","HCPCS C1769","","Neuroscout 14 Soft Xl 601414","BOTH IP/OP","$1,111.00 ","$822.14 ","$0.00 ","$1,111.00 ","$499.95 ","$0.00 ","$231.56 ","$792.92 ","$792.92 ","$194.53 ","$1,111.00 ","$0.00 ","$555.50 ","$879.91 ","$888.80 ","$0.00 ","$173.87 ","$0.00 ","$176.87 ","$0.00 "
"27203952","EAP","HCPCS C1887","","Prowler 27 Microcatheter","BOTH IP/OP","$2,468.00 ","$1,826.32 ","$0.00 ","$2,468.00 ","$1,340.12 ","$0.00 ","$514.39 ","$1,761.41 ","$1,761.41 ","$432.13 ","$2,468.00 ","$0.00 ","$1,234.00 ","$1,954.66 ","$1,974.40 ","$0.00 ","$386.24 ","$0.00 ","$392.91 ","$0.00 "
"27203953","EAP","HCPCS C1887","","Catheter Delivery System Px Slim 130 D 0-.02 In Micro Lm","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$1,492.71 ","$0.00 ","$572.96 ","$1,961.96 ","$1,961.96 ","$481.33 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$430.22 ","$0.00 ","$437.64 ","$0.00 "
"27203954","EAP","HCPCS C1887","","Catheter Delivery Sys Px Slim 45 D 0-.02 In Micro L150 M","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$1,492.71 ","$0.00 ","$572.96 ","$1,961.96 ","$1,961.96 ","$481.33 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$430.22 ","$0.00 ","$437.64 ","$0.00 "
"27203955","EAP","HCPCS C1887","","Catheter Delivery Syspx Slim 90 D 0-.02 In Micro L150 Cm","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$1,492.71 ","$0.00 ","$572.96 ","$1,961.96 ","$1,961.96 ","$481.33 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$430.22 ","$0.00 ","$437.64 ","$0.00 "
"27203956","EAP","HCPCS C1887","","Catheter Delivery Sys Px Slim 130 D 0-.02 In Micro L150m","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$1,492.71 ","$0.00 ","$572.96 ","$1,961.96 ","$1,961.96 ","$481.33 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$430.22 ","$0.00 ","$437.64 ","$0.00 "
"27203957","EAP","HCPCS C1887","","Coil Detachment Handle","BOTH IP/OP","$739.00 ","$546.86 ","$0.00 ","$739.00 ","$401.28 ","$0.00 ","$154.03 ","$527.42 ","$527.42 ","$129.39 ","$739.00 ","$0.00 ","$369.50 ","$585.29 ","$591.20 ","$0.00 ","$115.65 ","$0.00 ","$117.65 ","$0.00 "
"27203958","EAP","HCPCS C1725","","Catheter Delivery System .038in Sims Curve 5fr .04","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$178.65 ","$0.00 ","$68.57 ","$234.81 ","$234.81 ","$57.61 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$51.49 ","$0.00 ","$52.38 ","$0.00 "
"27203979","EAP","HCPCS C1725","","Catheter Baldilat 12mm 75cm 40mm High Pressure Lp","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203980","EAP","HCPCS C1725","","Catheter Baldilat 10mm 75cm 40mm High Pressure Lp","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27203999","EAP","Custom 27203999","","Turnpike Catheter Lp 150cm","BOTH IP/OP","$1,488.00 ","$1,101.12 ","$0.00 ","$1,488.00 ","$0.00 ","$0.00 ","$0.00 ","$1,061.99 ","$1,061.99 ","$0.00 ","$1,488.00 ","$0.00 ","$744.00 ","$1,178.50 ","$1,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204010","EAP","Custom 27204010","","Camino Icp Catheter With Licox Bolt Fitting","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$0.00 ","$0.00 ","$0.00 ","$1,678.62 ","$1,678.62 ","$0.00 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204011","EAP","Custom 27204011","","Brain Tissue Monitoring Kit","BOTH IP/OP","$3,646.00 ","$2,698.04 ","$0.00 ","$3,646.00 ","$0.00 ","$0.00 ","$0.00 ","$2,602.15 ","$2,602.15 ","$0.00 ","$3,646.00 ","$0.00 ","$1,823.00 ","$2,887.63 ","$2,916.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204012","EAP","Custom 27204012","","Tube Blakemore Adult 20 Fr","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$695.86 ","$695.86 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204013","EAP","Custom 27204013","","Retriever, Clot,trevo Pro 4 Kit, W Guidewire Tip","BOTH IP/OP","$15,192.00 ","$11,242.08 ","$0.00 ","$15,192.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,192.00 ","$0.00 ","$7,596.00 ","$12,032.06 ","$12,153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204014","EAP","HCPCS C1886","","S-1304-cps-7-25-ls-bd Safire Blu","BOTH IP/OP","$4,717.00 ","$3,490.58 ","$0.00 ","$4,717.00 ","$2,561.33 ","$0.00 ","$983.14 ","$3,366.52 ","$3,366.52 ","$825.91 ","$4,717.00 ","$0.00 ","$2,358.50 ","$3,735.86 ","$3,773.60 ","$0.00 ","$738.21 ","$0.00 ","$750.95 ","$0.00 "
"27204015","EAP","HCPCS C1886","","S-1304-cps-7-25-ms-bd Safire Blu","BOTH IP/OP","$4,717.00 ","$3,490.58 ","$0.00 ","$4,717.00 ","$2,561.33 ","$0.00 ","$983.14 ","$3,366.52 ","$3,366.52 ","$825.91 ","$4,717.00 ","$0.00 ","$2,358.50 ","$3,735.86 ","$3,773.60 ","$0.00 ","$738.21 ","$0.00 ","$750.95 ","$0.00 "
"27204016","EAP","HCPCS C1886","","Medium Sweep Therapy Cool Path Bi-directional","BOTH IP/OP","$4,717.00 ","$3,490.58 ","$0.00 ","$4,717.00 ","$2,561.33 ","$0.00 ","$983.14 ","$3,366.52 ","$3,366.52 ","$825.91 ","$4,717.00 ","$0.00 ","$2,358.50 ","$3,735.86 ","$3,773.60 ","$0.00 ","$738.21 ","$0.00 ","$750.95 ","$0.00 "
"27204017","EAP","HCPCS C1886","","Large Sweep ��� Therapy Cool Path Bi-directional","BOTH IP/OP","$4,717.00 ","$3,490.58 ","$0.00 ","$4,717.00 ","$2,561.33 ","$0.00 ","$983.14 ","$3,366.52 ","$3,366.52 ","$825.91 ","$4,717.00 ","$0.00 ","$2,358.50 ","$3,735.86 ","$3,773.60 ","$0.00 ","$738.21 ","$0.00 ","$750.95 ","$0.00 "
"27204020","EAP","HCPCS C1733","","Safire Tx Catheter 8mm Large Curl","BOTH IP/OP","$3,388.00 ","$2,507.12 ","$0.00 ","$3,388.00 ","$1,839.68 ","$0.00 ","$706.14 ","$2,418.02 ","$2,418.02 ","$593.21 ","$3,388.00 ","$0.00 ","$1,694.00 ","$2,683.30 ","$2,710.40 ","$0.00 ","$530.22 ","$0.00 ","$539.37 ","$0.00 "
"27204021","EAP","HCPCS C1733","","Safire Cath 7f 4mm Lgcrl (us)","BOTH IP/OP","$2,138.00 ","$1,582.12 ","$0.00 ","$2,138.00 ","$1,160.93 ","$0.00 ","$445.61 ","$1,525.89 ","$1,525.89 ","$374.35 ","$2,138.00 ","$0.00 ","$1,069.00 ","$1,693.30 ","$1,710.40 ","$0.00 ","$334.60 ","$0.00 ","$340.37 ","$0.00 "
"27204022","EAP","HCPCS C1733","","Safire Tx Catheter 8mm Xlarge Curl","BOTH IP/OP","$3,227.00 ","$2,387.98 ","$0.00 ","$3,227.00 ","$1,752.26 ","$0.00 ","$672.59 ","$2,303.11 ","$2,303.11 ","$565.02 ","$3,227.00 ","$0.00 ","$1,613.50 ","$2,555.78 ","$2,581.60 ","$0.00 ","$505.03 ","$0.00 ","$513.74 ","$0.00 "
"27204023","EAP","HCPCS C1733","","Safire Cath 7f 5mm Lg Swp (us)","BOTH IP/OP","$2,062.00 ","$1,525.88 ","$0.00 ","$2,062.00 ","$1,119.67 ","$0.00 ","$429.77 ","$1,471.65 ","$1,471.65 ","$361.04 ","$2,062.00 ","$0.00 ","$1,031.00 ","$1,633.10 ","$1,649.60 ","$0.00 ","$322.70 ","$0.00 ","$328.27 ","$0.00 "
"27204024","EAP","HCPCS C1733","","Safire Cath 7f 5mm Lg Crl (us)","BOTH IP/OP","$2,165.00 ","$1,602.10 ","$0.00 ","$2,165.00 ","$1,175.60 ","$0.00 ","$451.24 ","$1,545.16 ","$1,545.16 ","$379.07 ","$2,165.00 ","$0.00 ","$1,082.50 ","$1,714.68 ","$1,732.00 ","$0.00 ","$338.82 ","$0.00 ","$344.67 ","$0.00 "
"27204025","EAP","HCPCS C1733","","Safire Cath 7f 4mm Mdcrl (us)","BOTH IP/OP","$2,036.00 ","$1,506.64 ","$0.00 ","$2,036.00 ","$1,105.55 ","$0.00 ","$424.35 ","$1,453.09 ","$1,453.09 ","$356.49 ","$2,036.00 ","$0.00 ","$1,018.00 ","$1,612.51 ","$1,628.80 ","$0.00 ","$318.63 ","$0.00 ","$324.13 ","$0.00 "
"27204026","EAP","HCPCS C1733","","Safire Cath 7f 4mm Sm Crl (us)","BOTH IP/OP","$2,036.00 ","$1,506.64 ","$0.00 ","$2,036.00 ","$1,105.55 ","$0.00 ","$424.35 ","$1,453.09 ","$1,453.09 ","$356.49 ","$2,036.00 ","$0.00 ","$1,018.00 ","$1,612.51 ","$1,628.80 ","$0.00 ","$318.63 ","$0.00 ","$324.13 ","$0.00 "
"27204041","EAP","HCPCS C1893","","Agilis Nxt 8.5f Steer Sm Crl,g2","BOTH IP/OP","$2,914.00 ","$2,156.36 ","$0.00 ","$2,914.00 ","$1,582.30 ","$0.00 ","$607.35 ","$2,079.72 ","$2,079.72 ","$510.22 ","$2,914.00 ","$0.00 ","$1,457.00 ","$2,307.89 ","$2,331.20 ","$0.00 ","$456.04 ","$0.00 ","$463.91 ","$0.00 "
"27204042","EAP","HCPCS C1893","","Trns Intro 8.5f 63cm Sl1 032gw,g2","BOTH IP/OP","$497.00 ","$367.78 ","$0.00 ","$497.00 ","$269.87 ","$0.00 ","$103.59 ","$354.71 ","$354.71 ","$87.02 ","$497.00 ","$0.00 ","$248.50 ","$393.62 ","$397.60 ","$0.00 ","$77.78 ","$0.00 ","$79.12 ","$0.00 "
"27204043","EAP","HCPCS C1893","","Trns Intro 8f 62 Cm Sl1 Tm,g2","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$215.57 ","$0.00 ","$82.74 ","$283.34 ","$283.34 ","$69.51 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$62.13 ","$0.00 ","$63.20 ","$0.00 "
"27204044","EAP","HCPCS C1893","","Trns Intro 8f 62cm Sl2 Tm,g2","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$215.57 ","$0.00 ","$82.74 ","$283.34 ","$283.34 ","$69.51 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$62.13 ","$0.00 ","$63.20 ","$0.00 "
"27204045","EAP","HCPCS C1766","","Trns Intro 8f 63cm Sl1 032gw,g2","BOTH IP/OP","$497.00 ","$367.78 ","$0.00 ","$497.00 ","$269.87 ","$0.00 ","$103.59 ","$354.71 ","$354.71 ","$87.02 ","$497.00 ","$0.00 ","$248.50 ","$393.62 ","$397.60 ","$0.00 ","$77.78 ","$0.00 ","$79.12 ","$0.00 "
"27204046","EAP","HCPCS C1894","","C-lock Hemo 8f 12cm 038gw-g2","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$32.04 ","$0.00 ","$12.30 ","$42.11 ","$42.11 ","$10.33 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$9.23 ","$0.00 ","$9.39 ","$0.00 "
"27204047","EAP","HCPCS C1894","","C-lock Hemo 7f 12cm 038gw-g2","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$30.41 ","$0.00 ","$11.67 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27204048","EAP","HCPCS C1894","","C-lock Hemo 6f 12cm 038gw-g2","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$30.41 ","$0.00 ","$11.67 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27204049","EAP","HCPCS C1894","","Duo Hemo 8f 12cm 038gw,g2","BOTH IP/OP","$91.00 ","$67.34 ","$0.00 ","$91.00 ","$49.41 ","$0.00 ","$18.97 ","$64.95 ","$64.95 ","$15.93 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$14.24 ","$0.00 ","$14.49 ","$0.00 "
"27204050","EAP","HCPCS C1893","","Hemo Intro 8f 60cm Sept Gw,g2","BOTH IP/OP","$482.00 ","$356.68 ","$0.00 ","$482.00 ","$261.73 ","$0.00 ","$100.46 ","$344.00 ","$344.00 ","$84.39 ","$482.00 ","$0.00 ","$241.00 ","$381.74 ","$385.60 ","$0.00 ","$75.43 ","$0.00 ","$76.73 ","$0.00 "
"27204051","EAP","HCPCS C1893","","Hemo Intro 8f 60cm Sr0 Tm,g2","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$215.57 ","$0.00 ","$82.74 ","$283.34 ","$283.34 ","$69.51 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$62.13 ","$0.00 ","$63.20 ","$0.00 "
"27204052","EAP","HCPCS C1893","","Hemo Intro 8f 60cm Ramp 038gw,g2","BOTH IP/OP","$497.00 ","$367.78 ","$0.00 ","$497.00 ","$269.87 ","$0.00 ","$103.59 ","$354.71 ","$354.71 ","$87.02 ","$497.00 ","$0.00 ","$248.50 ","$393.62 ","$397.60 ","$0.00 ","$77.78 ","$0.00 ","$79.12 ","$0.00 "
"27204053","EAP","HCPCS C1893","","Hemo Intro 8.5f 60cm Sept Gw,g2","BOTH IP/OP","$482.00 ","$356.68 ","$0.00 ","$482.00 ","$261.73 ","$0.00 ","$100.46 ","$344.00 ","$344.00 ","$84.39 ","$482.00 ","$0.00 ","$241.00 ","$381.74 ","$385.60 ","$0.00 ","$75.43 ","$0.00 ","$76.73 ","$0.00 "
"27204054","EAP","HCPCS C1893","","Hemo Intro 8f 60cm Sr4 Tm,g2","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$215.57 ","$0.00 ","$82.74 ","$283.34 ","$283.34 ","$69.51 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$62.13 ","$0.00 ","$63.20 ","$0.00 "
"27204055","EAP","HCPCS C1893","","Hemo Intro 8.5f 63cm Sr0 038gw,g2","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$275.84 ","$0.00 ","$105.88 ","$362.56 ","$362.56 ","$88.95 ","$508.00 ","$0.00 ","$254.00 ","$402.34 ","$406.40 ","$0.00 ","$79.50 ","$0.00 ","$80.87 ","$0.00 "
"27204056","EAP","HCPCS C1893","","Hemo Intro 8f 60cm Safl 038gw,g2","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$275.84 ","$0.00 ","$105.88 ","$362.56 ","$362.56 ","$88.95 ","$508.00 ","$0.00 ","$254.00 ","$402.34 ","$406.40 ","$0.00 ","$79.50 ","$0.00 ","$80.87 ","$0.00 "
"27204057","EAP","HCPCS C1893","","Hemo Intro 8.5f 63cm Sr2 038gw,g2","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$275.84 ","$0.00 ","$105.88 ","$362.56 ","$362.56 ","$88.95 ","$508.00 ","$0.00 ","$254.00 ","$402.34 ","$406.40 ","$0.00 ","$79.50 ","$0.00 ","$80.87 ","$0.00 "
"27204058","EAP","HCPCS C1893","","Hemo Intro 8.5f 60cm Csta Gw,g2","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$275.84 ","$0.00 ","$105.88 ","$362.56 ","$362.56 ","$88.95 ","$508.00 ","$0.00 ","$254.00 ","$402.34 ","$406.40 ","$0.00 ","$79.50 ","$0.00 ","$80.87 ","$0.00 "
"27204059","EAP","HCPCS C1893","","Hemo Intro 8f 60cm Sr2 Tm,g2","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$215.57 ","$0.00 ","$82.74 ","$283.34 ","$283.34 ","$69.51 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$62.13 ","$0.00 ","$63.20 ","$0.00 "
"27204060","EAP","HCPCS C1766","","Epicardial Catheter System","BOTH IP/OP","$3,278.00 ","$2,425.72 ","$0.00 ","$3,278.00 ","$1,779.95 ","$0.00 ","$683.22 ","$2,339.51 ","$2,339.51 ","$573.95 ","$3,278.00 ","$0.00 ","$1,639.00 ","$2,596.18 ","$2,622.40 ","$0.00 ","$513.01 ","$0.00 ","$521.86 ","$0.00 "
"27204061","EAP","HCPCS C1730","","Ep 5f Quad 5mm 120cm Crd,g2","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$431.69 ","$0.00 ","$165.70 ","$567.39 ","$567.39 ","$139.20 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$124.42 ","$0.00 ","$126.56 ","$0.00 "
"27204062","EAP","HCPCS C1730","","Ep 6f Dec 2/8mm 65cm Csl,g2","BOTH IP/OP","$1,087.00 ","$804.38 ","$0.00 ","$1,087.00 ","$590.24 ","$0.00 ","$226.56 ","$775.79 ","$775.79 ","$190.33 ","$1,087.00 ","$0.00 ","$543.50 ","$860.90 ","$869.60 ","$0.00 ","$170.12 ","$0.00 ","$173.05 ","$0.00 "
"27204063","EAP","HCPCS C1730","","Ep 5f Quad 5mm 120cm Jsn,g2","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$453.41 ","$0.00 ","$174.03 ","$595.94 ","$595.94 ","$146.20 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$130.68 ","$0.00 ","$132.93 ","$0.00 "
"27204064","EAP","HCPCS C1730","","Eps 4f Quad 5mm Crd,g2","BOTH IP/OP","$1,031.00 ","$762.94 ","$0.00 ","$1,031.00 ","$559.83 ","$0.00 ","$214.89 ","$735.82 ","$735.82 ","$180.52 ","$1,031.00 ","$0.00 ","$515.50 ","$816.55 ","$824.80 ","$0.00 ","$161.35 ","$0.00 ","$164.14 ","$0.00 "
"27204065","EAP","HCPCS C1730","","Eps 4f Hex 5mm Crd-2,g2","BOTH IP/OP","$1,093.00 ","$808.82 ","$0.00 ","$1,093.00 ","$593.50 ","$0.00 ","$227.81 ","$780.07 ","$780.07 ","$191.38 ","$1,093.00 ","$0.00 ","$546.50 ","$865.66 ","$874.40 ","$0.00 ","$171.05 ","$0.00 ","$174.01 ","$0.00 "
"27204066","EAP","HCPCS C1730","","Eps 5f Hex Uni 120cm Jsn X,g2","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$505.53 ","$0.00 ","$194.04 ","$664.45 ","$664.45 ","$163.01 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$145.70 ","$0.00 ","$148.22 ","$0.00 "
"27204067","EAP","HCPCS C1730","","Eps 4f Quad 5mm Jsn,g2","BOTH IP/OP","$1,031.00 ","$762.94 ","$0.00 ","$1,031.00 ","$559.83 ","$0.00 ","$214.89 ","$735.82 ","$735.82 ","$180.52 ","$1,031.00 ","$0.00 ","$515.50 ","$816.55 ","$824.80 ","$0.00 ","$161.35 ","$0.00 ","$164.14 ","$0.00 "
"27204068","EAP","HCPCS C1730","","Eps 4f Quad 2mm Jsn,g2","BOTH IP/OP","$1,031.00 ","$762.94 ","$0.00 ","$1,031.00 ","$559.83 ","$0.00 ","$214.89 ","$735.82 ","$735.82 ","$180.52 ","$1,031.00 ","$0.00 ","$515.50 ","$816.55 ","$824.80 ","$0.00 ","$161.35 ","$0.00 ","$164.14 ","$0.00 "
"27204069","EAP","HCPCS C1730","","Ep 6f Dec 5/5mm 120cm Csl,g2","BOTH IP/OP","$1,087.00 ","$804.38 ","$0.00 ","$1,087.00 ","$590.24 ","$0.00 ","$226.56 ","$775.79 ","$775.79 ","$190.33 ","$1,087.00 ","$0.00 ","$543.50 ","$860.90 ","$869.60 ","$0.00 ","$170.12 ","$0.00 ","$173.05 ","$0.00 "
"27204070","EAP","HCPCS C1730","","Eps 5f Quad 5mm Crd Superior,g2","BOTH IP/OP","$844.00 ","$624.56 ","$0.00 ","$844.00 ","$458.29 ","$0.00 ","$175.91 ","$602.36 ","$602.36 ","$147.78 ","$844.00 ","$0.00 ","$422.00 ","$668.45 ","$675.20 ","$0.00 ","$132.09 ","$0.00 ","$134.36 ","$0.00 "
"27204071","EAP","HCPCS C1730","","Eps 6f Hex Uni 120cm Jsn X,g2","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$505.53 ","$0.00 ","$194.04 ","$664.45 ","$664.45 ","$163.01 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$145.70 ","$0.00 ","$148.22 ","$0.00 "
"27204072","EAP","HCPCS C1730","","Eps 5f Dec 2/8mm 120cm Csl X,g2","BOTH IP/OP","$1,119.00 ","$828.06 ","$0.00 ","$1,119.00 ","$607.62 ","$0.00 ","$233.23 ","$798.63 ","$798.63 ","$195.93 ","$1,119.00 ","$0.00 ","$559.50 ","$886.25 ","$895.20 ","$0.00 ","$175.12 ","$0.00 ","$178.14 ","$0.00 "
"27204080","EAP","HCPCS C1731","","Epl 7f Duo 2/10 2m 95 S-lgcrl,g2","BOTH IP/OP","$2,932.00 ","$2,169.68 ","$0.00 ","$2,932.00 ","$1,592.08 ","$0.00 ","$611.10 ","$2,092.57 ","$2,092.57 ","$513.37 ","$2,932.00 ","$0.00 ","$1,466.00 ","$2,322.14 ","$2,345.60 ","$0.00 ","$458.86 ","$0.00 ","$466.77 ","$0.00 "
"27204081","EAP","Custom 27204081","","Eps Ext Cable B/t/q Blu 150 Us,g2 Supreme Quad Cable","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$160.58 ","$160.58 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204082","EAP","HCPCS C1731","","Epl 7f Duo Dec 2/2 115cm Med,g2 ""caterpillar""","BOTH IP/OP","$2,792.00 ","$2,066.08 ","$0.00 ","$2,792.00 ","$1,516.06 ","$0.00 ","$581.92 ","$1,992.65 ","$1,992.65 ","$488.86 ","$2,792.00 ","$0.00 ","$1,396.00 ","$2,211.26 ","$2,233.60 ","$0.00 ","$436.95 ","$0.00 ","$444.49 ","$0.00 "
"27204083","EAP","HCPCS C1731","","Inquiry Afocusil Diagnostic Catheter 20 Pole With Double Loop","BOTH IP/OP","$4,717.00 ","$3,490.58 ","$0.00 ","$4,717.00 ","$2,561.33 ","$0.00 ","$983.14 ","$3,366.52 ","$3,366.52 ","$825.91 ","$4,717.00 ","$0.00 ","$2,358.50 ","$3,735.86 ","$3,773.60 ","$0.00 ","$738.21 ","$0.00 ","$750.95 ","$0.00 "
"27204084","EAP","HCPCS C1731","","Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 20 POLE 20MM DIAMETER","BOTH IP/OP","$2,979.00 ","$2,204.46 ","$0.00 ","$2,979.00 ","$1,617.60 ","$0.00 ","$620.90 ","$2,126.11 ","$2,126.11 ","$521.60 ","$2,979.00 ","$0.00 ","$1,489.50 ","$2,359.37 ","$2,383.20 ","$0.00 ","$466.21 ","$0.00 ","$474.26 ","$0.00 "
"27204085","EAP","HCPCS C1730","","Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 10 POLE 20MM DIAMETER","BOTH IP/OP","$2,979.00 ","$2,204.46 ","$0.00 ","$2,979.00 ","$1,617.60 ","$0.00 ","$620.90 ","$2,126.11 ","$2,126.11 ","$521.60 ","$2,979.00 ","$0.00 ","$1,489.50 ","$2,359.37 ","$2,383.20 ","$0.00 ","$466.21 ","$0.00 ","$474.26 ","$0.00 "
"27204086","EAP","HCPCS C1730","","Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 10 POLE 15MM DIAMETER","BOTH IP/OP","$2,979.00 ","$2,204.46 ","$0.00 ","$2,979.00 ","$1,617.60 ","$0.00 ","$620.90 ","$2,126.11 ","$2,126.11 ","$521.60 ","$2,979.00 ","$0.00 ","$1,489.50 ","$2,359.37 ","$2,383.20 ","$0.00 ","$466.21 ","$0.00 ","$474.26 ","$0.00 "
"27204087","EAP","Custom 27204087","","Ensite Navx Surface Electrode Kit","BOTH IP/OP","$2,948.00 ","$2,181.52 ","$0.00 ","$2,948.00 ","$0.00 ","$0.00 ","$0.00 ","$2,103.99 ","$2,103.99 ","$0.00 ","$2,948.00 ","$0.00 ","$1,474.00 ","$2,334.82 ","$2,358.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204088","EAP","Custom 27204088","","Velocity, Assembly, Navx Patch, Ensite","BOTH IP/OP","$2,948.00 ","$2,181.52 ","$0.00 ","$2,948.00 ","$0.00 ","$0.00 ","$0.00 ","$2,103.99 ","$2,103.99 ","$0.00 ","$2,948.00 ","$0.00 ","$1,474.00 ","$2,334.82 ","$2,358.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204089","EAP","Custom 27204089","","EnSite Array Catheter - Domestic","BOTH IP/OP","$10,553.00 ","$7,809.22 ","$0.00 ","$10,553.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,553.00 ","$0.00 ","$5,276.50 ","$8,357.98 ","$8,442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204090","EAP","HCPCS C1888","","11403001 - KIT PROCEDURE NEVERTOUCLVET L45 CM","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$0.00 ","$0.00 ","$0.00 ","$854.30 ","$854.30 ","$0.00 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204091","EAP","HCPCS C1888","","11403002 - KIT PROCEDURE NEVERTOUC","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$0.00 ","$0.00 ","$0.00 ","$854.30 ","$854.30 ","$0.00 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204092","EAP","Custom 27204092","","Coil Detachment Handle","BOTH IP/OP","$739.00 ","$546.86 ","$0.00 ","$739.00 ","$0.00 ","$0.00 ","$0.00 ","$527.42 ","$527.42 ","$0.00 ","$739.00 ","$0.00 ","$369.50 ","$585.29 ","$591.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204093","EAP","Custom 27204093","","Quatro Cath Kit","BOTH IP/OP","$2,341.00 ","$1,732.34 ","$0.00 ","$2,341.00 ","$0.00 ","$0.00 ","$0.00 ","$1,670.77 ","$1,670.77 ","$0.00 ","$2,341.00 ","$0.00 ","$1,170.50 ","$1,854.07 ","$1,872.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204095","EAP","HCPCS C1887","","Orion 21 Microcatheter","BOTH IP/OP","$2,172.00 ","$1,607.28 ","$0.00 ","$2,172.00 ","$1,179.40 ","$0.00 ","$452.70 ","$1,550.16 ","$1,550.16 ","$380.30 ","$2,172.00 ","$0.00 ","$1,086.00 ","$1,720.22 ","$1,737.60 ","$0.00 ","$339.92 ","$0.00 ","$345.78 ","$0.00 "
"27204096","EAP","Custom 27204096","","Mini Attachable Catheter 5f","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$0.00 ","$0.00 ","$0.00 ","$421.80 ","$421.80 ","$0.00 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204097","EAP","Custom 27204097","","Captivator Snare Large Oval Stiff","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$11.42 ","$11.42 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204098","EAP","HCPCS C1726","","Cre Wg 8-10mm","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$144.44 ","$0.00 ","$55.44 ","$189.84 ","$189.84 ","$46.57 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$41.63 ","$0.00 ","$42.35 ","$0.00 "
"27204099","EAP","HCPCS C1726","","Cre Wg 10-12mm","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$144.44 ","$0.00 ","$55.44 ","$189.84 ","$189.84 ","$46.57 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$41.63 ","$0.00 ","$42.35 ","$0.00 "
"27204100","EAP","HCPCS C1726","","Cre Wg 12-15mm","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$144.44 ","$0.00 ","$55.44 ","$189.84 ","$189.84 ","$46.57 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$41.63 ","$0.00 ","$42.35 ","$0.00 "
"27204101","EAP","HCPCS C1726","","Cre Wf 15-18mm","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$144.44 ","$0.00 ","$55.44 ","$189.84 ","$189.84 ","$46.57 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$41.63 ","$0.00 ","$42.35 ","$0.00 "
"27204102","EAP","HCPCS C1769","","Dreamwire .035 260 Str Stnd","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27204103","EAP","HCPCS C1769","","Glidewire .035 260 Str","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27204105","EAP","Custom 27404105","","Extractor Rx 9-12 Mm","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$134.89 ","$134.89 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204106","EAP","Custom 27204106","","Extractor Rx 12-15 Mm","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$134.89 ","$134.89 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204107","EAP","Custom 272040107","","Cytology Brush","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$134.00 ","$0.00 ","$0.00 ","$0.00 ","$95.64 ","$95.64 ","$0.00 ","$134.00 ","$0.00 ","$67.00 ","$106.13 ","$107.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204108","EAP","Custom 27204108","","Roth Net","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204109","EAP","Custom 27204109","","Fiapc Probe","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$174.86 ","$174.86 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204110","EAP","HCPCS C1757","","Solitaire Fr 4x15","BOTH IP/OP","$11,643.00 ","$8,615.82 ","$0.00 ","$11,643.00 ","$6,322.15 ","$0.00 ","$2,426.69 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,643.00 ","$0.00 ","$5,821.50 ","$9,221.26 ","$9,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204111","EAP","HCPCS C1757","","Solitaire Fr 4x20","BOTH IP/OP","$12,225.00 ","$9,046.50 ","$0.00 ","$12,225.00 ","$6,638.18 ","$0.00 ","$2,548.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,225.00 ","$0.00 ","$6,112.50 ","$9,682.20 ","$9,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204112","EAP","HCPCS C1757","","Solitaire Fr 6x20","BOTH IP/OP","$11,643.00 ","$8,615.82 ","$0.00 ","$11,643.00 ","$6,322.15 ","$0.00 ","$2,426.69 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,643.00 ","$0.00 ","$5,821.50 ","$9,221.26 ","$9,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204113","EAP","HCPCS C1757","","Solitaire Fr 6x30","BOTH IP/OP","$12,225.00 ","$9,046.50 ","$0.00 ","$12,225.00 ","$6,638.18 ","$0.00 ","$2,548.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,225.00 ","$0.00 ","$6,112.50 ","$9,682.20 ","$9,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204114","EAP","HCPCS C1887","","NAVIEN INTRACRANIAL CATHETER 6FX 1","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$369.24 ","$0.00 ","$141.73 ","$485.32 ","$485.32 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"27204115","EAP","HCPCS C1887","","Navien Intracranial Catheter 6fx 115cm","BOTH IP/OP","$714.00 ","$528.36 ","$0.00 ","$714.00 ","$387.70 ","$0.00 ","$148.82 ","$509.58 ","$509.58 ","$125.02 ","$714.00 ","$0.00 ","$357.00 ","$565.49 ","$571.20 ","$0.00 ","$111.74 ","$0.00 ","$113.67 ","$0.00 "
"27204116","EAP","HCPCS C1887","","Navien Intracranial Catheter 5fx 115cm","BOTH IP/OP","$1,176.00 ","$870.24 ","$0.00 ","$1,176.00 ","$638.57 ","$0.00 ","$245.11 ","$839.31 ","$839.31 ","$205.91 ","$1,176.00 ","$0.00 ","$588.00 ","$931.39 ","$940.80 ","$0.00 ","$184.04 ","$0.00 ","$187.22 ","$0.00 "
"27204117","EAP","HCPCS C1887","","Navien Intracranial Catheter 5fx 125cm","BOTH IP/OP","$1,235.00 ","$913.90 ","$0.00 ","$1,235.00 ","$670.61 ","$0.00 ","$257.40 ","$881.42 ","$881.42 ","$216.24 ","$1,235.00 ","$0.00 ","$617.50 ","$978.12 ","$988.00 ","$0.00 ","$193.28 ","$0.00 ","$196.61 ","$0.00 "
"27204118","EAP","HCPCS C1887","","Navien Intracranial Catheter 5fx 130cm","BOTH IP/OP","$1,176.00 ","$870.24 ","$0.00 ","$1,176.00 ","$638.57 ","$0.00 ","$245.11 ","$839.31 ","$839.31 ","$205.91 ","$1,176.00 ","$0.00 ","$588.00 ","$931.39 ","$940.80 ","$0.00 ","$184.04 ","$0.00 ","$187.22 ","$0.00 "
"27204119","EAP","HCPCS C2629","","Pinnacle Rdc Sheath 6fr","BOTH IP/OP","$2,374.00 ","$1,756.76 ","$0.00 ","$2,374.00 ","$0.00 ","$0.00 ","$494.80 ","$1,694.32 ","$1,694.32 ","$415.67 ","$2,374.00 ","$0.00 ","$1,187.00 ","$1,880.21 ","$1,899.20 ","$0.00 ","$371.53 ","$0.00 ","$377.94 ","$0.00 "
"27204120","EAP","Custom 27204120","","Tc Catheter","BOTH IP/OP","$151.00 ","$111.74 ","$0.00 ","$151.00 ","$0.00 ","$0.00 ","$0.00 ","$107.77 ","$107.77 ","$0.00 ","$151.00 ","$0.00 ","$75.50 ","$119.59 ","$120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204121","EAP","HCPCS C1887","","Van Aman Cathter","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$30.41 ","$0.00 ","$11.67 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27204122","EAP","HCPCS C1894","","Neuron Max 088 6f Sheath","BOTH IP/OP","$1,226.00 ","$907.24 ","$0.00 ","$1,226.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$875.00 ","$214.66 ","$1,226.00 ","$0.00 ","$613.00 ","$970.99 ","$980.80 ","$0.00 ","$191.87 ","$0.00 ","$195.18 ","$0.00 "
"27204124","EAP","HCPCS C1788","","Dignity Port 6.6f","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27204125","EAP","Custom 27204125","","Long Rodch Left Gastric Catheter 5fr 65cm","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204126","EAP","Custom 27204126","","Long Rodch Left Gastric Catheter 5fr 80cm","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204127","EAP","HCPCS C1769","","Avigo Guidewire","BOTH IP/OP","$1,168.00 ","$864.32 ","$0.00 ","$1,168.00 ","$634.22 ","$0.00 ","$243.44 ","$833.60 ","$833.60 ","$204.51 ","$1,168.00 ","$0.00 ","$584.00 ","$925.06 ","$934.40 ","$0.00 ","$182.79 ","$0.00 ","$185.95 ","$0.00 "
"27204128","EAP","HCPCS C1887","","Exceisior Xt-27 Microcatheter 135cm/6cm Straight","BOTH IP/OP","$2,807.00 ","$2,077.18 ","$0.00 ","$2,807.00 ","$1,524.20 ","$0.00 ","$585.05 ","$2,003.36 ","$2,003.36 ","$491.48 ","$2,807.00 ","$0.00 ","$1,403.50 ","$2,223.14 ","$2,245.60 ","$0.00 ","$439.30 ","$0.00 ","$446.87 ","$0.00 "
"27204129","EAP","HCPCS C1887","","Exceisior Xt-27 Microcatheter 135cm/6cm Pre-shaped","BOTH IP/OP","$2,807.00 ","$2,077.18 ","$0.00 ","$2,807.00 ","$1,524.20 ","$0.00 ","$585.05 ","$2,003.36 ","$2,003.36 ","$491.48 ","$2,807.00 ","$0.00 ","$1,403.50 ","$2,223.14 ","$2,245.60 ","$0.00 ","$439.30 ","$0.00 ","$446.87 ","$0.00 "
"27204130","EAP","HCPCS C1887","","Exceisior Xt-27 Microcatheter 150 Cm/80cm Straight","BOTH IP/OP","$2,807.00 ","$2,077.18 ","$0.00 ","$2,807.00 ","$1,524.20 ","$0.00 ","$585.05 ","$2,003.36 ","$2,003.36 ","$491.48 ","$2,807.00 ","$0.00 ","$1,403.50 ","$2,223.14 ","$2,245.60 ","$0.00 ","$439.30 ","$0.00 ","$446.87 ","$0.00 "
"27204131","EAP","HCPCS C1887","","Exceisior Xt-27 Microcatheter 150cm/18cm Straight","BOTH IP/OP","$2,807.00 ","$2,077.18 ","$0.00 ","$2,807.00 ","$1,524.20 ","$0.00 ","$585.05 ","$2,003.36 ","$2,003.36 ","$491.48 ","$2,807.00 ","$0.00 ","$1,403.50 ","$2,223.14 ","$2,245.60 ","$0.00 ","$439.30 ","$0.00 ","$446.87 ","$0.00 "
"27204132","EAP","HCPCS C1887","","Exceisior Xt-27 Microcatheter 135cm/6cm Pre-shaped","BOTH IP/OP","$2,807.00 ","$2,077.18 ","$0.00 ","$2,807.00 ","$1,524.20 ","$0.00 ","$585.05 ","$2,003.36 ","$2,003.36 ","$491.48 ","$2,807.00 ","$0.00 ","$1,403.50 ","$2,223.14 ","$2,245.60 ","$0.00 ","$439.30 ","$0.00 ","$446.87 ","$0.00 "
"27204140","EAP","Custom 27204140","","Kit Catheter Presep Oligon Heparin L16 Cm Od8.5 Fr Centl","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204141","EAP","Custom 27204141","","Kit Catheter Presep Oligon L20 Cm Od8.5 Fr Arterial 3 Ln","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204142","EAP","HCPCS C1894","","Introd Shth 8fr 150cm 12cm 2 Distal Gwire Hmst Vlv Sdprt","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$30.41 ","$0.00 ","$11.67 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27204143","EAP","HCPCS C1894","","Introd Shth 9fr 150cm 12cm 2 Distal Gwire Hmst Vlv Sdprt","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$34.21 ","$0.00 ","$13.13 ","$44.96 ","$44.96 ","$11.03 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$9.86 ","$0.00 ","$10.03 ","$0.00 "
"27204144","EAP","HCPCS C1894","","Introd Cath 12cm 10fr .038in Trnspt Fstcth Hmsts","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$38.01 ","$0.00 ","$14.59 ","$49.96 ","$49.96 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"27204145","EAP","HCPCS C1893","","Introd Shth 8.5fr 180cm 63cm Superstiff Guiewire Guid Braid","BOTH IP/OP","$532.00 ","$393.68 ","$0.00 ","$532.00 ","$288.88 ","$0.00 ","$110.88 ","$379.69 ","$379.69 ","$93.15 ","$532.00 ","$0.00 ","$266.00 ","$421.34 ","$425.60 ","$0.00 ","$83.26 ","$0.00 ","$84.69 ","$0.00 "
"27204146","EAP","Custom 27204146","","Needle 71cm 18ga Curve Prc Trnspt Brk-1 Adlt","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$411.09 ","$411.09 ","$0.00 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204147","EAP","HCPCS C1766","","Introd Shth 8.5fr 91cm 71cm Dual Reach Bidir Erg Hndl Atrm","BOTH IP/OP","$2,642.00 ","$1,955.08 ","$0.00 ","$2,642.00 ","$1,434.61 ","$0.00 ","$550.66 ","$1,885.60 ","$1,885.60 ","$462.59 ","$2,642.00 ","$0.00 ","$1,321.00 ","$2,092.46 ","$2,113.60 ","$0.00 ","$413.47 ","$0.00 ","$420.61 ","$0.00 "
"27204148","EAP","HCPCS C1766","","Introd Shth 8.5fr 71cm 50mm Strbl Erg Hndl Atrm Tip Intgr","BOTH IP/OP","$2,642.00 ","$1,955.08 ","$0.00 ","$2,642.00 ","$1,434.61 ","$0.00 ","$550.66 ","$1,885.60 ","$1,885.60 ","$462.59 ","$2,642.00 ","$0.00 ","$1,321.00 ","$2,092.46 ","$2,113.60 ","$0.00 ","$413.47 ","$0.00 ","$420.61 ","$0.00 "
"27204149","EAP","HCPCS C1730","","Cable Cath Blue 150cm Rspn Ep Bipol Trplr Qdpl","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"27204150","EAP","Custom 27204150","","Cable Cath Blk 150cm Rspn Ep Hexpl","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$160.58 ","$160.58 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204151","EAP","Custom 27204151","","Cable Cath Blk 150cm Rspn Ep Hexpl Octpl Dcapl","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204152","EAP","Custom 27204152","","Cable Cath Red 150cm Rspn Ep Hexpl Octpl Dcapl Extn","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204153","EAP","HCPCS C1730","","Cath Ep 2-5-2mm Spc 1mm 6fr 115cm 4mm Qdpl Med Swp Strbl","BOTH IP/OP","$1,490.00 ","$1,102.60 ","$0.00 ","$1,490.00 ","$809.07 ","$0.00 ","$310.55 ","$1,063.41 ","$1,063.41 ","$260.89 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$233.19 ","$0.00 ","$237.21 ","$0.00 "
"27204154","EAP","HCPCS C1730","","Cath Ep 5mm Spc 1mm 5fr 115cm 2mm Hexpl Med Swp Strbl Lvwr","BOTH IP/OP","$1,608.00 ","$1,189.92 ","$0.00 ","$1,608.00 ","$873.14 ","$0.00 ","$335.15 ","$1,147.63 ","$1,147.63 ","$281.55 ","$1,608.00 ","$0.00 ","$804.00 ","$1,273.54 ","$1,286.40 ","$0.00 ","$251.65 ","$0.00 ","$255.99 ","$0.00 "
"27204155","EAP","HCPCS C1730","","Cath Ep 4mm Spc 7fr 20mm 110cm 20 Eltrd Mp Inq Afocus 2","BOTH IP/OP","$4,493.00 ","$3,324.82 ","$0.00 ","$4,493.00 ","$0.00 ","$0.00 ","$0.00 ","$3,206.65 ","$3,206.65 ","$786.69 ","$4,493.00 ","$0.00 ","$2,246.50 ","$3,558.46 ","$3,594.40 ","$0.00 ","$703.15 ","$0.00 ","$715.29 ","$0.00 "
"27204156","EAP","HCPCS C1731","","Cath Ep 99cm 7fr 15-25mm Reflexion Sprl 1-4-1mm Spc 1mm Smtr","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$0.00 ","$0.00 ","$0.00 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27204157","EAP","Custom 27204157","","Cable Cath Safire Ep Gntr Intfc","BOTH IP/OP","$449.00 ","$332.26 ","$0.00 ","$449.00 ","$0.00 ","$0.00 ","$0.00 ","$320.45 ","$320.45 ","$0.00 ","$449.00 ","$0.00 ","$224.50 ","$355.61 ","$359.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204158","EAP","Custom 27204158","","Cable Cath Safire Ep Extn","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$461.00 ","$0.00 ","$0.00 ","$0.00 ","$329.02 ","$329.02 ","$0.00 ","$461.00 ","$0.00 ","$230.50 ","$365.11 ","$368.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204159","EAP","HCPCS C2630","","Cath Ablt 110cm 7fr 4mm 2-5-2mm Spc 2mm Med Curl Thrp Cl Pth","BOTH IP/OP","$4,493.00 ","$3,324.82 ","$0.00 ","$4,493.00 ","$0.00 ","$0.00 ","$0.00 ","$3,206.65 ","$3,206.65 ","$0.00 ","$4,493.00 ","$0.00 ","$2,246.50 ","$3,558.46 ","$3,594.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204160","EAP","HCPCS C2630","","Cath Ablt 110cm 7fr 4mm 2-5-2mm Spc 2mm Lg Curl Thrp Cl Pth","BOTH IP/OP","$4,493.00 ","$3,324.82 ","$0.00 ","$4,493.00 ","$0.00 ","$0.00 ","$0.00 ","$3,206.65 ","$3,206.65 ","$0.00 ","$4,493.00 ","$0.00 ","$2,246.50 ","$3,558.46 ","$3,594.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204161","EAP","HCPCS C1759","","Cath Us 120d Intrcrd Stab 1 Hnd Cntrl M Mode Pls Wv Dplr Ice","BOTH IP/OP","$6,242.00 ","$4,619.08 ","$0.00 ","$6,242.00 ","$0.00 ","$0.00 ","$0.00 ","$4,454.92 ","$4,454.92 ","$0.00 ","$6,242.00 ","$0.00 ","$3,121.00 ","$4,943.66 ","$4,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204162","EAP","HCPCS C1730","","Cath Ep 2-5-2mm Spc Csl Curve 5fr 65cm Mp Dcapl Fix Curve","BOTH IP/OP","$1,183.00 ","$875.42 ","$0.00 ","$1,183.00 ","$0.00 ","$0.00 ","$0.00 ","$844.31 ","$844.31 ","$207.13 ","$1,183.00 ","$0.00 ","$591.50 ","$936.94 ","$946.40 ","$0.00 ","$185.14 ","$0.00 ","$188.33 ","$0.00 "
"27204164","EAP","HCPCS C1887","","Catheter Reperfusion","BOTH IP/OP","$6,176.00 ","$4,570.24 ","$0.00 ","$6,176.00 ","$3,353.57 ","$0.00 ","$1,287.23 ","$4,407.81 ","$4,407.81 ","$1,081.37 ","$6,176.00 ","$0.00 ","$3,088.00 ","$4,891.39 ","$4,940.80 ","$0.00 ","$966.54 ","$0.00 ","$983.22 ","$0.00 "
"27204168","EAP","HCPCS C1894","","Flexor Ansel Guiding Sheath/ Str","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27204169","EAP","HCPCS C1894","","Flexor Ansel Guiding Sheath/ Mp","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27204170","EAP","HCPCS C1894","","Introducer Shth 10 Fr/ 40cm","BOTH IP/OP","$216.00 ","$159.84 ","$0.00 ","$216.00 ","$117.29 ","$0.00 ","$45.02 ","$154.16 ","$154.16 ","$37.82 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$33.80 ","$0.00 ","$34.39 ","$0.00 "
"27204171","EAP","HCPCS C1887","","Catheter Angio Sim 3 Crv 5fr","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$66.79 ","$0.00 ","$25.64 ","$87.79 ","$87.79 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"27204210","EAP","HCPCS C1769","","Guidewire Vascular X-celer Hydro L300 Cm L10 Cm Od.01","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$529.43 ","$0.00 ","$203.21 ","$695.86 ","$695.86 ","$170.71 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$152.59 ","$0.00 ","$155.22 ","$0.00 "
"27204211","EAP","HCPCS C2629","","Set Introducer Aprima Hydrophilic L15 Cm Od6 Fr Odsec22a","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$212.00 ","$0.00 ","$0.00 ","$44.19 ","$151.30 ","$151.30 ","$37.12 ","$212.00 ","$0.00 ","$106.00 ","$167.90 ","$169.60 ","$0.00 ","$33.18 ","$0.00 ","$33.75 ","$0.00 "
"27204212","EAP","Custom 27204212","","Biotronik Lead Delivery System","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$0.00 ","$0.00 ","$0.00 ","$1,054.85 ","$1,054.85 ","$0.00 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204213","EAP","HCPCS C1751","","Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pip","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.71 ","$0.71 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"27204214","EAP","HCPCS C1769","","Gwire Vasc .035in 15mm 260cm 4cm 2 Cvd Exch Xstif Lndrqs Ss","BOTH IP/OP","$620.00 ","$458.80 ","$0.00 ","$620.00 ","$336.66 ","$0.00 ","$129.22 ","$442.49 ","$442.49 ","$108.56 ","$620.00 ","$0.00 ","$310.00 ","$491.04 ","$496.00 ","$0.00 ","$97.03 ","$0.00 ","$98.70 ","$0.00 "
"27204216","EAP","Custom 27204216","","Site-rite 6 Ultrasound System 21 Ga Needle Guide Kit","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204217","EAP","HCPCS C1894","","Micro Microintruducer 7cm 5.0fr Flecura Guidewire","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$98.00 ","$53.21 ","$0.00 ","$20.43 ","$69.94 ","$69.94 ","$17.16 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$0.00 ","$15.34 ","$0.00 ","$15.60 ","$0.00 "
"27204218","EAP","HCPCS C1726","","Balloon Dilatation Catheter  6mmx40mmx135cm","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$298.65 ","$0.00 ","$114.63 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27204220","EAP","HCPCS C1769","","Sphntm 30mm 5mm 3.9fr Atme Bil Pncr Gwire Cann Chnl C Md","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$2,407.12 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27204221","EAP","HCPCS C1887","","CATH GUID CS-A6 CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204222","EAP","HCPCS C1887","","CATH GUID CS-A6 CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204223","EAP","HCPCS C1887","","CATH GUID CS-EH CURVE 8FR 49CM OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204224","EAP","HCPCS C1887","","CATH GUID OUTR ACTY BRKWY CS-EH 61CM 8FR","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204225","EAP","HCPCS C1887","","CATH GUID CS-H CURVE 8FR 6.78FR 55CM 49CM IS-1 AND LV-1 LEAD","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204226","EAP","HCPCS C1887","","CATH GUID CS-H CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204227","EAP","HCPCS C1887","","CATH GUID 130D CS-IC CURVE 6FR 63CM INR ACTY BRKWY","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$461.00 ","$0.00 ","$0.00 ","$0.00 ","$329.02 ","$329.02 ","$80.72 ","$461.00 ","$0.00 ","$230.50 ","$365.11 ","$368.80 ","$0.00 ","$72.15 ","$0.00 ","$73.39 ","$0.00 "
"27204228","EAP","HCPCS C1894","","INTROD LEAD BL CODE 9.7% HE 21% OZ 27% CO 42.35% N2","BOTH IP/OP","$2,660.00 ","$1,968.40 ","$0.00 ","$2,660.00 ","$1,444.38 ","$0.00 ","$554.41 ","$1,898.44 ","$1,898.44 ","$465.74 ","$2,660.00 ","$0.00 ","$1,330.00 ","$2,106.72 ","$2,128.00 ","$0.00 ","$416.29 ","$0.00 ","$423.47 ","$0.00 "
"27204229","EAP","HCPCS C1769","","CATH ENDSCP 8.5FR NSL BIL GWIRE STRL","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$0.00 ","$0.00 ","$0.00 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"27204230","EAP","HCPCS C1769","","CATH ENDSCP 7.5FR NSL BIL GWIRE STRL","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$0.00 ","$0.00 ","$0.00 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"27204231","EAP","HCPCS C1887","","CATH GUID CS-MP CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204232","EAP","HCPCS C1887","","CATH GUID CS-MP 8FR 54CM 61CM OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204233","EAP","HCPCS C1887","","CATH GUID STR 8FR 49CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204234","EAP","HCPCS C1887","","CATH GUID CS-ST CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204235","EAP","HCPCS C1887","","CATH GUID CS-EH ST R CURVE 8FR 49CM CORON SIN OUTR ACTY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204236","EAP","HCPCS C1887","","CATH GUID CS-EH ST R CURVE 8FR 54CM OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204237","EAP","HCPCS C1887","","CATH GUID CS-W CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$184.37 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$164.79 ","$0.00 ","$167.64 ","$0.00 "
"27204238","EAP","HCPCS C1769","","CATH ENDSCP 6FR NSL BIL GWIRE STRL","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$0.00 ","$0.00 ","$0.00 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"27204239","EAP","HCPCS C1887","","ACUITY CUTAWAY LEAD DELIVERY SYSTEM - PERCUTANEOUS CATHETERS","BOTH IP/OP","$5,010.00 ","$3,707.40 ","$0.00 ","$5,010.00 ","$2,720.43 ","$0.00 ","$1,044.21 ","$3,575.64 ","$3,575.64 ","$877.21 ","$5,010.00 ","$0.00 ","$2,505.00 ","$3,967.92 ","$4,008.00 ","$0.00 ","$784.07 ","$0.00 ","$797.59 ","$0.00 "
"27204240","EAP","HCPCS C1769","","SPHNTM 20MM 7-5FR BIL PNCR GWIRE 3 LUM SHRT NOSE CANN RAPEX","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$2,407.12 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27204241","EAP","Custom 27204241","","DEVICE LCK BIOP CAP RAPEX RX BL BIL PNTX ESCP","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$0.00 ","$0.00 ","$0.00 ","$3,163.83 ","$3,163.83 ","$0.00 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204242","EAP","HCPCS C1725","","CATH BIL 12 ATM 5.8FR 8MM 180CM 2CM RAPEX NVSC BALDILAT HRCN","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$0.00 ","$0.00 ","$0.00 ","$4,218.68 ","$4,218.68 ","$1,034.97 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$941.03 ","$0.00 "
"27204243","EAP","HCPCS C1769","","Sphntm 30mm 5mm 4.4fr Atme Rx","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$2,407.12 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27204245","EAP","HCPCS C1725","","Mustang Balloon Catheter 3.0mm X 20mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204246","EAP","HCPCS C1725","","Mustang Balloon Catheter 3.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204247","EAP","HCPCS C1725","","Mustang Balloon Catheter 4.0mm X 20mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204248","EAP","HCPCS C1725","","Mustang Balloon Catheter 4.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204249","EAP","HCPCS C1725","","Mustang Balloon Catheter 4.0mm X 80mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204250","EAP","HCPCS C1887","","Cxi Support Catheter Str / 2.6fr-.018-150cm","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$272.04 ","$0.00 ","$104.42 ","$357.56 ","$357.56 ","$87.72 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$78.41 ","$0.00 ","$79.76 ","$0.00 "
"27204251","EAP","HCPCS C1725","","Cxi Support Catheter  Ang/ 2.6fr-.018-150cm","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$272.04 ","$0.00 ","$104.42 ","$357.56 ","$357.56 ","$87.72 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$78.41 ","$0.00 ","$79.76 ","$0.00 "
"27204252","EAP","HCPCS C1887","","Cxi Support Catheter  Str/ 4.0fr-.035-135cm","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$357.56 ","$357.56 ","$87.72 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$78.41 ","$0.00 ","$79.76 ","$0.00 "
"27204253","EAP","HCPCS C1725","","Mustang Balloon Catheter 6.0mm X 80mm X 135cm","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$272.04 ","$0.00 ","$104.42 ","$357.56 ","$357.56 ","$87.72 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$78.41 ","$0.00 ","$79.76 ","$0.00 "
"27204254","EAP","HCPCS C1725","","Mustang Balloon Catheter 6.0mm X 100mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204255","EAP","HCPCS C1725","","Mustang Balloon Catheter 6.0mm X 120mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204256","EAP","HCPCS C1725","","Mustang Balloon Catheter 6.0mm X 150mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204257","EAP","HCPCS C1725","","Mustang Balloon Catheter 6.0mm X 220mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204258","EAP","HCPCS C1725","","Mustang Balloon Catheter 7.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204259","EAP","HCPCS C1725","","Mustang Balloon Catheter 8.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204260","EAP","HCPCS C1725","","Mustang Balloon Catheter 9.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204261","EAP","HCPCS C1725","","Mustang Balloon Catheter 5.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204262","EAP","HCPCS C1725","","Mustang Balloon Catheter 5.0mm X 100mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204263","EAP","HCPCS C1725","","Mustang Balloon Catheter 6.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204270","EAP","HCPCS C1725","","Mustang Balloon Catheter 10.0mm X 40mm X 135cm","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$297.56 ","$0.00 ","$114.22 ","$391.11 ","$391.11 ","$95.95 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$85.76 ","$0.00 ","$87.24 ","$0.00 "
"27204280","EAP","HCPCS C1755","","Kyphopast First Fracture Kit-kpe1003","BOTH IP/OP","$10,626.00 ","$7,863.24 ","$0.00 ","$10,626.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,626.00 ","$0.00 ","$5,313.00 ","$8,415.79 ","$8,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204281","EAP","HCPCS C1755","","Kyphopasty Additonal Fracture Kit-kpe1003","BOTH IP/OP","$7,079.00 ","$5,238.46 ","$0.00 ","$7,079.00 ","$0.00 ","$0.00 ","$0.00 ","$5,052.28 ","$5,052.28 ","$0.00 ","$7,079.00 ","$0.00 ","$3,539.50 ","$5,606.57 ","$5,663.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204282","EAP","HCPCS C1713","","Kyphoplasty Cememnt Mixer-a07a","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$128.69 ","$0.00 ","$49.40 ","$169.15 ","$169.15 ","$41.50 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$37.09 ","$0.00 ","$37.73 ","$0.00 "
"27204283","EAP","HCPCS C1713","","Kyphoasty Activos Cement-c10a","BOTH IP/OP","$901.00 ","$666.74 ","$0.00 ","$901.00 ","$489.24 ","$0.00 ","$187.79 ","$643.04 ","$643.04 ","$157.76 ","$901.00 ","$0.00 ","$450.50 ","$713.59 ","$720.80 ","$0.00 ","$141.01 ","$0.00 ","$143.44 ","$0.00 "
"27204284","EAP","HCPCS C1884","","Rx Emosheild Nav6 5.0 Mm","BOTH IP/OP","$4,581.00 ","$3,389.94 ","$0.00 ","$4,581.00 ","$2,487.48 ","$0.00 ","$954.79 ","$3,269.46 ","$3,269.46 ","$802.10 ","$4,581.00 ","$0.00 ","$2,290.50 ","$3,628.15 ","$3,664.80 ","$0.00 ","$716.93 ","$0.00 ","$729.30 ","$0.00 "
"27204286","EAP","HCPCS C1884","","Rx Embosheild Nav6 7.2 Mm","BOTH IP/OP","$4,581.00 ","$3,389.94 ","$0.00 ","$4,581.00 ","$2,487.48 ","$0.00 ","$954.79 ","$3,269.46 ","$3,269.46 ","$802.10 ","$4,581.00 ","$0.00 ","$2,290.50 ","$3,628.15 ","$3,664.80 ","$0.00 ","$716.93 ","$0.00 ","$729.30 ","$0.00 "
"27204292","EAP","HCPCS C1769","","Guidewire X-pedion-10 Re 2","BOTH IP/OP","$778.00 ","$575.72 ","$0.00 ","$778.00 ","$422.45 ","$0.00 ","$162.15 ","$555.26 ","$555.26 ","$136.22 ","$778.00 ","$0.00 ","$389.00 ","$616.18 ","$622.40 ","$0.00 ","$121.76 ","$0.00 ","$123.86 ","$0.00 "
"27204293","EAP","HCPCS C1769","","Mirage Re .008","BOTH IP/OP","$1,288.00 ","$953.12 ","$0.00 ","$1,288.00 ","$699.38 ","$0.00 ","$268.45 ","$919.25 ","$919.25 ","$225.52 ","$1,288.00 ","$0.00 ","$644.00 ","$1,020.10 ","$1,030.40 ","$0.00 ","$201.57 ","$0.00 ","$205.05 ","$0.00 "
"27204294","EAP","HCPCS C1887","","Catheter Marathon","BOTH IP/OP","$1,861.00 ","$1,377.14 ","$0.00 ","$1,861.00 ","$1,010.52 ","$0.00 ","$387.88 ","$1,328.20 ","$1,328.20 ","$325.85 ","$1,861.00 ","$0.00 ","$930.50 ","$1,473.91 ","$1,488.80 ","$0.00 ","$291.25 ","$0.00 ","$296.27 ","$0.00 "
"27204295","EAP","HCPCS C1757","","Cath Thrmb 130cm 4.3fr .044in Dac Multitransition Radio Pq","BOTH IP/OP","$2,941.00 ","$2,176.34 ","$0.00 ","$2,941.00 ","$0.00 ","$0.00 ","$0.00 ","$2,098.99 ","$2,098.99 ","$0.00 ","$2,941.00 ","$0.00 ","$1,470.50 ","$2,329.27 ","$2,352.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204298","EAP","HCPCS C1894","","Sheath Long Neuronmax 90/4 Mp 6f 088","BOTH IP/OP","$1,109.00 ","$820.66 ","$0.00 ","$1,109.00 ","$0.00 ","$0.00 ","$0.00 ","$791.49 ","$791.49 ","$194.18 ","$1,109.00 ","$0.00 ","$554.50 ","$878.33 ","$887.20 ","$0.00 ","$173.56 ","$0.00 ","$176.55 ","$0.00 "
"27204299","EAP","Custom 27204299","","Turnpike Catheter Lp 135cm","BOTH IP/OP","$1,313.00 ","$971.62 ","$0.00 ","$1,313.00 ","$0.00 ","$0.00 ","$0.00 ","$937.09 ","$937.09 ","$0.00 ","$1,313.00 ","$0.00 ","$656.50 ","$1,039.90 ","$1,050.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204300","EAP","Custom 27204300","","Torque Delivery System 10 Fr","BOTH IP/OP","$1,797.00 ","$1,329.78 ","$0.00 ","$1,797.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.52 ","$1,282.52 ","$0.00 ","$1,797.00 ","$0.00 ","$898.50 ","$1,423.22 ","$1,437.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204301","EAP","Custom 27204301","","Spider Standard Surgical Platform","BOTH IP/OP","$1,034.00 ","$765.16 ","$0.00 ","$1,034.00 ","$0.00 ","$0.00 ","$0.00 ","$737.97 ","$737.97 ","$0.00 ","$1,034.00 ","$0.00 ","$517.00 ","$818.93 ","$827.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204302","EAP","HCPCS C1884","","System Embolic Spiderfx.014 In L320 Cm","BOTH IP/OP","$4,124.00 ","$3,051.76 ","$0.00 ","$4,124.00 ","$2,239.33 ","$0.00 ","$859.54 ","$2,943.30 ","$2,943.30 ","$722.08 ","$4,124.00 ","$0.00 ","$2,062.00 ","$3,266.21 ","$3,299.20 ","$0.00 ","$645.41 ","$0.00 ","$656.54 ","$0.00 "
"27204303","EAP","HCPCS C1725","","Cath Ball Dilatation Viatrac 14 Plus Xcelon .014 In L","BOTH IP/OP","$739.00 ","$546.86 ","$0.00 ","$739.00 ","$401.28 ","$0.00 ","$154.03 ","$527.42 ","$527.42 ","$129.39 ","$739.00 ","$0.00 ","$369.50 ","$585.29 ","$591.20 ","$0.00 ","$115.65 ","$0.00 ","$117.65 ","$0.00 "
"27204304","EAP","HCPCS C1894","","Sheath Check-flo Flexor .035 In L55 Cm Od6 Fr  Multi","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$36.92 ","$0.00 ","$14.17 ","$48.53 ","$48.53 ","$11.91 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$10.64 ","$0.00 ","$10.83 ","$0.00 "
"27204305","EAP","HCPCS C1894","","Sheath Check-flo Flexor .035 In L55 Cm Od6 Fr Curv Strat","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204306","EAP","HCPCS C1887","","Cath Cxi Stainless Steel Polymer L135 Cm Od4 Fr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204307","EAP","HCPCS C1769","","Guidewire Vas Pt Graph Hydro Poly Straight","BOTH IP/OP","$2,572.00 ","$1,903.28 ","$0.00 ","$2,572.00 ","$1,396.60 ","$0.00 ","$536.07 ","$1,835.64 ","$1,835.64 ","$450.34 ","$2,572.00 ","$0.00 ","$1,286.00 ","$2,037.02 ","$2,057.60 ","$0.00 ","$402.52 ","$0.00 ","$409.46 ","$0.00 "
"27204308","EAP","HCPCS C1769","","Guidewire Vascular Pt Graphix Hydro Polymer J L300 Cm","BOTH IP/OP","$2,572.00 ","$1,903.28 ","$0.00 ","$2,572.00 ","$1,396.60 ","$0.00 ","$536.07 ","$1,835.64 ","$1,835.64 ","$450.34 ","$2,572.00 ","$0.00 ","$1,286.00 ","$2,037.02 ","$2,057.60 ","$0.00 ","$402.52 ","$0.00 ","$409.46 ","$0.00 "
"27204309","EAP","HCPCS C2628","","Transform Compliant 3mm X 10mm","BOTH IP/OP","$4,222.00 ","$3,124.28 ","$0.00 ","$4,222.00 ","$2,292.55 ","$0.00 ","$879.97 ","$3,013.24 ","$3,013.24 ","$0.00 ","$4,222.00 ","$0.00 ","$2,111.00 ","$3,343.82 ","$3,377.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204310","EAP","HCPCS C2628","","Transform Compliant 3mm X 15mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204311","EAP","HCPCS C2628","","Transform Compliant 4mm X 10mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204312","EAP","HCPCS C2628","","Transform Compliant 4mm X 15mm","BOTH IP/OP","$4,222.00 ","$3,124.28 ","$0.00 ","$4,222.00 ","$2,292.55 ","$0.00 ","$879.97 ","$3,013.24 ","$3,013.24 ","$0.00 ","$4,222.00 ","$0.00 ","$2,111.00 ","$3,343.82 ","$3,377.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204313","EAP","HCPCS C2628","","Transform Compliant 4mm X 20mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204314","EAP","HCPCS C2628","","Transform Compliant 4mm X 30mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204315","EAP","HCPCS C2628","","Transform Compliant 5mm X 10mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204316","EAP","HCPCS C2628","","TransForm Compliant 5mm x 10mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204317","EAP","HCPCS C2628","","Transform Compliant 5mm X 20mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204318","EAP","HCPCS C2628","","Transform Compliant 5mm X 30mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204319","EAP","HCPCS C2628","","Transform Super Compliant 3mm X 5mm","BOTH IP/OP","$4,222.00 ","$3,124.28 ","$0.00 ","$4,222.00 ","$2,292.55 ","$0.00 ","$879.97 ","$3,013.24 ","$3,013.24 ","$0.00 ","$4,222.00 ","$0.00 ","$2,111.00 ","$3,343.82 ","$3,377.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204320","EAP","HCPCS C2628","","Transform Super Compliant 4mm X 10mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204321","EAP","HCPCS C2628","","Transform Super Compliant 4mm X 7mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204322","EAP","HCPCS C2628","","Transform Super Compliant 7mm X 10mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204323","EAP","HCPCS C2628","","Transform Super Compliant 7mm X 15mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204324","EAP","HCPCS C2628","","Transform Super Compliant 7mm X 7mm","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,183.40 ","$0.00 ","$838.08 ","$2,869.79 ","$2,869.79 ","$0.00 ","$4,021.00 ","$0.00 ","$2,010.50 ","$3,184.63 ","$3,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204330","EAP","Custom 27204330","","Probe Stereo Mammo Revolve L9 Cm Od8 Ga","BOTH IP/OP","$1,378.00 ","$1,019.72 ","$0.00 ","$1,378.00 ","$0.00 ","$0.00 ","$0.00 ","$983.48 ","$983.48 ","$0.00 ","$1,378.00 ","$0.00 ","$689.00 ","$1,091.38 ","$1,102.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204332","EAP","HCPCS C1887","","Cath Cantata 2.5f Superselective Micro 135 Cm","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$0.00 ","$0.00 ","$0.00 ","$629.48 ","$629.48 ","$154.43 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$138.03 ","$0.00 ","$140.41 ","$0.00 "
"27204333","EAP","Custom 27204333","","Cath Cantata 2.8f Superselective Micro 135 Cm","BOTH IP/OP","$897.00 ","$663.78 ","$0.00 ","$897.00 ","$0.00 ","$0.00 ","$0.00 ","$640.19 ","$640.19 ","$0.00 ","$897.00 ","$0.00 ","$448.50 ","$710.42 ","$717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204334","EAP","Custom 27204334","","Glidesheath Slender 6f","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204335","EAP","Custom 27204335","","Torque Delivery System 12 Fr","BOTH IP/OP","$1,797.00 ","$1,329.78 ","$0.00 ","$1,797.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.52 ","$1,282.52 ","$0.00 ","$1,797.00 ","$0.00 ","$898.50 ","$1,423.22 ","$1,437.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204336","EAP","Custom 27204336","","Amplatzer Sizing Balloons 34 Mm","BOTH IP/OP","$821.00 ","$607.54 ","$0.00 ","$821.00 ","$0.00 ","$0.00 ","$0.00 ","$585.95 ","$585.95 ","$0.00 ","$821.00 ","$0.00 ","$410.50 ","$650.23 ","$656.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204337","EAP","HCPCS C1759","","Viewflex Ice Plus Catheter","BOTH IP/OP","$8,102.00 ","$5,995.48 ","$0.00 ","$8,102.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,102.00 ","$0.00 ","$4,051.00 ","$6,416.78 ","$6,481.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204338","EAP","Custom 27204338","","System Fec Mgmt 60cc Ns Lf Dignishield Cath Syr Cl","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$212.68 ","$212.68 ","$0.00 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204351","EAP","HCPCS C1725","","Cath Baldilat .014in 5fr 2mm 8mm Coron Rapex Ult Lp Guid","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$278.34 ","$278.34 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"27204352","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 2mm 20mm Coron Rapex Flxb Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204354","EAP","HCPCS C1725","","Cath Baldilat .014in 5fr 2.5mm 20mm Coron Rapex Ult Lp Guid","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$211.77 ","$0.00 ","$81.29 ","$278.34 ","$278.34 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"27204356","EAP","HCPCS C1725","","Cath Baldilat .014in 5fr 3mm 8mm Coron Rapex Ult Lp Guid","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204358","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 3mm 25mm Coron Rapex Lp Flxb Tung","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$61.81 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$55.24 ","$0.00 ","$56.20 ","$0.00 "
"27204359","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 3.5mm 8mm Coron Rapex Lp Flxb Tung","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$61.81 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$55.24 ","$0.00 ","$56.20 ","$0.00 "
"27204360","EAP","HCPCS C1725","","Cath Baldilat .014in 5fr 3.5mm 20mm Coron Rapex Ult Lp Guid","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$182.45 ","$0.00 ","$70.03 ","$239.80 ","$239.80 ","$58.83 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$52.58 ","$0.00 ","$53.49 ","$0.00 "
"27204361","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 3.5mm 25mm Coron Rapex Lp Flxb Tung","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$61.81 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$55.24 ","$0.00 ","$56.20 ","$0.00 "
"27204362","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 4mm 8mm Coron Rapex Hypotube Slim","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$201.45 ","$0.00 ","$77.33 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204363","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 4mm 12mm Coron Rapex Lp Flxb Tung","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$191.68 ","$0.00 ","$73.57 ","$251.94 ","$251.94 ","$61.81 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$55.24 ","$0.00 ","$56.20 ","$0.00 "
"27204364","EAP","HCPCS C1725","","Cath Baldilat .021in 5fr 1.5mm 8mm Coron Otw Flxb Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204365","EAP","HCPCS C1725","","Cath Baldilat 2mm 8mm Coron Rapex Dual Tung Mrkr Flxb Smth","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204366","EAP","HCPCS C1725","","Cath Baldilat 2.25mm 8mm Coron Rapex Flxb Dual Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204367","EAP","HCPCS C1725","","Cath Baldilat 2.25mm 12mm Coron Rapex Flxb Dual Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204368","EAP","HCPCS C1725","","Cath Baldilat 2.25mm 15mm Coron Rapex Flxb Dual Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$201.45 ","$0.00 ","$77.33 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204369","EAP","HCPCS C1725","","Cath Baldilat 2.25mm 20mm Coron Rapex Flxb Dual Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204370","EAP","HCPCS C1725","","Cath Baldilat 2.75mm 8mm Coron Rapex Flxb Dual Tung Mrkr","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204371","EAP","HCPCS C1725","","Cath Baldilat 3.25mm 8mm Coron Rapex Dual Tung Mrkr Flxb","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$182.45 ","$0.00 ","$70.03 ","$239.80 ","$239.80 ","$58.83 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$52.58 ","$0.00 ","$53.49 ","$0.00 "
"27204372","EAP","HCPCS C1725","","Cath Baldilat 3.25mm 20mm Coron Rapex Dual Tung Mrkr Flxb","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$201.45 ","$0.00 ","$77.33 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204374","EAP","HCPCS C1725","","Cath Baldilat 4.5mm 8mm Coron Rapex Flxb Dual Tung Mrkr Smth","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$191.68 ","$0.00 ","$73.57 ","$251.94 ","$251.94 ","$61.81 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$55.24 ","$0.00 ","$56.20 ","$0.00 "
"27204375","EAP","HCPCS C1725","","Cath Baldilat 4.5mm 15mm Coron Rapex Dual Tung Mrkr Flxb","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$182.45 ","$0.00 ","$70.03 ","$239.80 ","$239.80 ","$58.83 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$52.58 ","$0.00 ","$53.49 ","$0.00 "
"27204376","EAP","HCPCS C1725","","Cath Baldilat 5mm 15mm Coron Rapex Flxb Dual Tung Mrkr Smth","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$201.45 ","$0.00 ","$77.33 ","$264.78 ","$264.78 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"27204390","EAP","Custom 27204390","","Cath Cantata Double Markers 2.5 Fr X 100 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204391","EAP","Custom 27204391","","Cath Cantata Double Markers  2.5 Fr  X 110 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204392","EAP","Custom 27204392","","Cath Cantata Double Markers  2.5 X 135 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204393","EAP","Custom 27204393","","Cath Cantata Double Markers 2.5 X 150 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204394","EAP","Custom 27204394","","Cath Cantata Double Markers 2.8 Fr X 108 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204395","EAP","Custom 27204395","","Cath Cantata Double Markers  2.8 X 110 Cm","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204396","EAP","Custom 27204396","","Cath Cantata Double Markers 2.8 X 135 Cm","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204397","EAP","Custom 27204397","","Cath Cantata Double Markers 2.8 X 150 Cm","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204398","EAP","Custom 27204398","","Cath Cantata  Markers. 2.5 X 100 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204399","EAP","Custom 27204399","","Cath Cantata  Markers. 2.5 X 110 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204400","EAP","Custom 27204400","","Cath Cantata  Markers.  2.5 X 150 Cm","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$251.94 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204401","EAP","Custom 27204401","","Cath Cantata  Markers. 2.8 X100 Cm","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204402","EAP","Custom 27204402","","Cath Cantata  Markers.  2.8 X 110  Cm","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204403","EAP","Custom 27204403","","Cath Cantata  Markers.  2.8 X 150 Cm","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$255.50 ","$255.50 ","$0.00 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204404","EAP","HCPCS C1892","","Sheath Long Neuronmax 90/4 Straight 6f 088","BOTH IP/OP","$1,086.00 ","$803.64 ","$0.00 ","$1,086.00 ","$589.70 ","$0.00 ","$226.35 ","$775.08 ","$775.08 ","$190.15 ","$1,086.00 ","$0.00 ","$543.00 ","$860.11 ","$868.80 ","$0.00 ","$169.96 ","$0.00 ","$172.89 ","$0.00 "
"27204405","EAP","HCPCS C1753","","Catheter Ultrasound Eagle Eye Gold Od5 Fr Short Tip","BOTH IP/OP","$1,999.00 ","$1,479.26 ","$0.00 ","$1,999.00 ","$1,085.46 ","$0.00 ","$416.64 ","$1,426.69 ","$1,426.69 ","$350.01 ","$1,999.00 ","$0.00 ","$999.50 ","$1,583.21 ","$1,599.20 ","$0.00 ","$312.84 ","$0.00 ","$318.24 ","$0.00 "
"27204406","EAP","Custom 27204406","","Catheter Steerable 3.2 Outer Diam 2mm Working Channel","BOTH IP/OP","$1,653.00 ","$1,223.22 ","$0.00 ","$1,653.00 ","$0.00 ","$0.00 ","$0.00 ","$1,179.75 ","$1,179.75 ","$0.00 ","$1,653.00 ","$0.00 ","$826.50 ","$1,309.18 ","$1,322.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204407","EAP","HCPCS C1887","","Trevo Microcatheter","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$622.82 ","$0.00 ","$239.06 ","$818.61 ","$818.61 ","$200.83 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$179.51 ","$0.00 ","$182.60 ","$0.00 "
"27204408","EAP","HCPCS C1757","","Retriever Stent Trevo Xp 4 X 20","BOTH IP/OP","$12,766.00 ","$9,446.84 ","$0.00 ","$12,766.00 ","$6,931.94 ","$0.00 ","$2,660.75 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,766.00 ","$0.00 ","$6,383.00 ","$10,110.67 ","$10,212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204409","EAP","HCPCS C1757","","Retriever Stent Trevo Xp 3 X 20","BOTH IP/OP","$14,776.00 ","$10,934.24 ","$0.00 ","$14,776.00 ","$8,023.37 ","$0.00 ","$3,079.69 ","$5,158.80 ","$5,158.80 ","$0.00 ","$14,776.00 ","$0.00 ","$7,388.00 ","$11,702.59 ","$11,820.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204416","EAP","HCPCS C1757","","Set Cath 135cm 5fr 3mm Spiroflex Vg Angjt .014in Thrmb Gwire","BOTH IP/OP","$5,925.00 ","$4,384.50 ","$0.00 ","$5,925.00 ","$3,217.28 ","$0.00 ","$1,234.92 ","$4,228.67 ","$4,228.67 ","$0.00 ","$5,925.00 ","$0.00 ","$2,962.50 ","$4,692.60 ","$4,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204417","EAP","HCPCS C1714","","CATHETER TURBOHAWK  High Efficiency Cutter- Large Vessel Standard Calcium","BOTH IP/OP","$9,081.00 ","$6,719.94 ","$0.00 ","$9,081.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,590.01 ","$9,081.00 ","$0.00 ","$4,540.50 ","$7,192.15 ","$7,264.80 ","$0.00 ","$1,421.18 ","$0.00 ","$1,445.70 ","$0.00 "
"27204418","EAP","HCPCS C1714","","Catheter Turbohawk �high Efficiency Cutter- Large Vessel Xtended Calcium Tip Lx-c","BOTH IP/OP","$9,081.00 ","$6,719.94 ","$0.00 ","$9,081.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,590.01 ","$9,081.00 ","$0.00 ","$4,540.50 ","$7,192.15 ","$7,264.80 ","$0.00 ","$1,421.18 ","$0.00 ","$1,445.70 ","$0.00 "
"27204419","EAP","HCPCS C1714","","Catheter Turbohawk  Smooth Cutter- Large Vessel Xtended Tip �lx-m","BOTH IP/OP","$9,081.00 ","$6,719.94 ","$0.00 ","$9,081.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,590.01 ","$9,081.00 ","$0.00 ","$4,540.50 ","$7,192.15 ","$7,264.80 ","$0.00 ","$1,421.18 ","$0.00 ","$1,445.70 ","$0.00 "
"27204420","EAP","HCPCS C1714","","Catheter Turbohawk � High Efficiency Cutter- Small Vessel Xtended Calcium Tip Sx-c","BOTH IP/OP","$9,081.00 ","$6,719.94 ","$0.00 ","$9,081.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,590.01 ","$9,081.00 ","$0.00 ","$4,540.50 ","$7,192.15 ","$7,264.80 ","$0.00 ","$1,421.18 ","$0.00 ","$1,445.70 ","$0.00 "
"27204421","EAP","HCPCS C1714","","Catheter Turbohawk� High Efficiency Cutter Small Vessel Standard Calcium Tip Long Catheter� Ss-cl","BOTH IP/OP","$9,081.00 ","$6,719.94 ","$0.00 ","$9,081.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,590.01 ","$9,081.00 ","$0.00 ","$4,540.50 ","$7,192.15 ","$7,264.80 ","$0.00 ","$1,421.18 ","$0.00 ","$1,445.70 ","$0.00 "
"27204422","EAP","HCPCS C1714","","Catheter Turbohawk  Smooth Cutter- Large Vessel Standard Tip� �ls-m","BOTH IP/OP","$9,081.00 ","$6,719.94 ","$0.00 ","$9,081.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,590.01 ","$9,081.00 ","$0.00 ","$4,540.50 ","$7,192.15 ","$7,264.80 ","$0.00 ","$1,421.18 ","$0.00 ","$1,445.70 ","$0.00 "
"27204423","EAP","HCPCS C1769","","Gwire Vasc 190cm .014in Core To Tip Str 16cm A Fldr Xt","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"27204424","EAP","HCPCS C1769","","Gwire Vasc 300cm .014in Core To Tip Str 16cm A Fldr Xt","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"27204426","EAP","Custom 27204426","","Certus Lk Ablation 15cm-17 Gauge","BOTH IP/OP","$6,063.00 ","$4,486.62 ","$0.00 ","$6,063.00 ","$0.00 ","$0.00 ","$0.00 ","$4,327.16 ","$4,327.16 ","$0.00 ","$6,063.00 ","$0.00 ","$3,031.50 ","$4,801.90 ","$4,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204427","EAP","Custom 27204427","","Certus Lk Ablation 20cm-17 Gauge","BOTH IP/OP","$6,063.00 ","$4,486.62 ","$0.00 ","$6,063.00 ","$0.00 ","$0.00 ","$0.00 ","$4,327.16 ","$4,327.16 ","$0.00 ","$6,063.00 ","$0.00 ","$3,031.50 ","$4,801.90 ","$4,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204428","EAP","Custom 27204428","","Certus Ln  Ablation 15cm-17 Gauge","BOTH IP/OP","$6,063.00 ","$4,486.62 ","$0.00 ","$6,063.00 ","$0.00 ","$0.00 ","$0.00 ","$4,327.16 ","$4,327.16 ","$0.00 ","$6,063.00 ","$0.00 ","$3,031.50 ","$4,801.90 ","$4,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204429","EAP","Custom 27204429","","Certus Ln Ablation 20cm-17 Gauge","BOTH IP/OP","$6,063.00 ","$4,486.62 ","$0.00 ","$6,063.00 ","$0.00 ","$0.00 ","$0.00 ","$4,327.16 ","$4,327.16 ","$0.00 ","$6,063.00 ","$0.00 ","$3,031.50 ","$4,801.90 ","$4,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204430","EAP","HCPCS C1769","","Gwire Vasc .035in 150cm 1.5mm Rsn Curve Jtp Fix Core Ptfe","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"27204431","EAP","HCPCS C1769","","Gwire Vasc Rsn Curve J Curve Lng .035in 260cm 1.5mm Exch","BOTH IP/OP","$82.00 ","$60.68 ","$0.00 ","$82.00 ","$44.53 ","$0.00 ","$17.09 ","$58.52 ","$58.52 ","$14.36 ","$82.00 ","$0.00 ","$41.00 ","$64.94 ","$65.60 ","$0.00 ","$12.83 ","$0.00 ","$13.05 ","$0.00 "
"27204432","EAP","HCPCS C1773","","Kit Vasc 120cm 15mm 6fr Agn Ntnl Gold Tung Loop Cath Ntnl","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$478.93 ","$0.00 ","$183.83 ","$629.48 ","$629.48 ","$154.43 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$138.03 ","$0.00 ","$140.41 ","$0.00 "
"27204433","EAP","HCPCS C1773","","Kit Vasc 120cm 25mm 6fr Agn Ntnl Gold Tung Loop Cath Ntnl","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$478.93 ","$0.00 ","$183.83 ","$629.48 ","$629.48 ","$154.43 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$138.03 ","$0.00 ","$140.41 ","$0.00 "
"27204434","EAP","HCPCS C1773","","Kit Vasc 120cm 10mm 4fr Agn Ntnl Gold Tung Loop Cath Ntnl","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$882.00 ","$478.93 ","$0.00 ","$183.83 ","$629.48 ","$629.48 ","$154.43 ","$882.00 ","$0.00 ","$441.00 ","$698.54 ","$705.60 ","$0.00 ","$138.03 ","$0.00 ","$140.41 ","$0.00 "
"27204436","EAP","HCPCS C1757","","Trevo Xp - 4mm X 20mm","BOTH IP/OP","$14,072.00 ","$10,413.28 ","$0.00 ","$14,072.00 ","$7,641.10 ","$0.00 ","$2,932.96 ","$5,158.80 ","$5,158.80 ","$0.00 ","$14,072.00 ","$0.00 ","$7,036.00 ","$11,145.02 ","$11,257.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204437","EAP","HCPCS C1887","","Flowgate Balloon Guide Catheter 8f X 95cm","BOTH IP/OP","$2,746.00 ","$2,032.04 ","$0.00 ","$2,746.00 ","$1,491.08 ","$0.00 ","$572.34 ","$1,959.82 ","$1,959.82 ","$480.80 ","$2,746.00 ","$0.00 ","$1,373.00 ","$2,174.83 ","$2,196.80 ","$0.00 ","$429.75 ","$0.00 ","$437.16 ","$0.00 "
"27204438","EAP","CPT� C1725","","Bln Splxxx Sprinter Legend Xxxxxx","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$456.00 ","$247.61 ","$0.00 ","$95.04 ","$325.45 ","$325.45 ","$79.84 ","$456.00 ","$0.00 ","$228.00 ","$361.15 ","$364.80 ","$0.00 ","$71.36 ","$0.00 ","$72.60 ","$0.00 "
"27204439","EAP","HCPCS C1887","","Flowgate Balloon Guide Catheter 8f X 85cm","BOTH IP/OP","$2,746.00 ","$2,032.04 ","$0.00 ","$2,746.00 ","$1,491.08 ","$0.00 ","$572.34 ","$1,959.82 ","$1,959.82 ","$480.80 ","$2,746.00 ","$0.00 ","$1,373.00 ","$2,174.83 ","$2,196.80 ","$0.00 ","$429.75 ","$0.00 ","$437.16 ","$0.00 "
"27204440","EAP","Custom 27204440","","Certus Pr Ablation 15cm-17 Gauge","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$3,925.35 ","$3,925.35 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204441","EAP","Custom 27204441","","Certus Pr Ablation 20cm-17 Gauge","BOTH IP/OP","$6,063.00 ","$4,486.62 ","$0.00 ","$6,063.00 ","$0.00 ","$0.00 ","$0.00 ","$4,327.16 ","$4,327.16 ","$0.00 ","$6,063.00 ","$0.00 ","$3,031.50 ","$4,801.90 ","$4,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204442","EAP","HCPCS C1724","","Cath Athrcm 135cm .58in Rtbl Rtl 1.25mm Ptfe Shth Precnct","BOTH IP/OP","$1,364.00 ","$1,009.36 ","$0.00 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$973.49 ","$973.49 ","$0.00 ","$1,364.00 ","$0.00 ","$682.00 ","$1,080.29 ","$1,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204443","EAP","HCPCS C1724","","Cath Athrcm 135cm .58in Rtbl Rtl 1.5mm Ptfe Shth Precnct","BOTH IP/OP","$1,364.00 ","$1,009.36 ","$0.00 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$973.49 ","$973.49 ","$0.00 ","$1,364.00 ","$0.00 ","$682.00 ","$1,080.29 ","$1,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204444","EAP","HCPCS C1724","","Cath Athrcm 135cm .58in Rtbl Rtl 1.75mm Precnct Exchgl Rot","BOTH IP/OP","$1,364.00 ","$1,009.36 ","$0.00 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$973.49 ","$973.49 ","$0.00 ","$1,364.00 ","$0.00 ","$682.00 ","$1,080.29 ","$1,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204445","EAP","Custom 27204445","","Pcmkr Crd Thk6mm Sm 50x46mm Endurity 2 Chmbr Is-1 Conctr W Adapter","BOTH IP/OP","$6,669.00 ","$4,935.06 ","$0.00 ","$6,669.00 ","$0.00 ","$0.00 ","$0.00 ","$4,759.67 ","$4,759.67 ","$0.00 ","$6,669.00 ","$0.00 ","$3,334.50 ","$5,281.85 ","$5,335.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204446","EAP","HCPCS C1887","","Catheter Guid .035in 4.8-3.7fr 90cm Low Crossing P","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$226.97 ","$0.00 ","$87.12 ","$298.33 ","$298.33 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"27204447","EAP","HCPCS C1887","","Catheter Gd .035in Mpb 9fr 7.2fr 45cm Atn Cmnd Sur","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$319.28 ","$0.00 ","$122.55 ","$419.66 ","$419.66 ","$102.95 ","$588.00 ","$0.00 ","$294.00 ","$465.70 ","$470.40 ","$0.00 ","$92.02 ","$0.00 ","$93.61 ","$0.00 "
"27204448","EAP","HCPCS C1887","","Catheter Gd 90d 2.4mm 1.9mm 65cm Strl Atn Slct Ii","BOTH IP/OP","$540.00 ","$399.60 ","$0.00 ","$540.00 ","$293.22 ","$0.00 ","$112.55 ","$385.40 ","$385.40 ","$94.55 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$84.51 ","$0.00 ","$85.97 ","$0.00 "
"27204449","EAP","Custom 27204449","","Catheter Gd 3drc Crv 6fr .070in 100cm Blu Ylw Strl","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$85.64 ","$85.64 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204450","EAP","HCPCS C1750","","Pack Cath 28/45cm 14.5fr Carbothane Mh Mxd 2 Lum Sh Hmdial","BOTH IP/OP","$921.00 ","$681.54 ","$0.00 ","$921.00 ","$500.10 ","$0.00 ","$191.96 ","$657.32 ","$657.32 ","$161.26 ","$921.00 ","$0.00 ","$460.50 ","$729.43 ","$736.80 ","$0.00 ","$144.14 ","$0.00 ","$146.62 ","$0.00 "
"27204451","EAP","HCPCS C1750","","Pack Cath 33/50cm 14.5fr Carbothane Mh Mxd 2 Lum Sh Hmdial","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27204452","EAP","Custom 27204452","","Obt Shth 10cm 5fr Flxb 5mm","BOTH IP/OP","$4,675.00 ","$3,459.50 ","$0.00 ","$4,675.00 ","$0.00 ","$0.00 ","$0.00 ","$3,336.55 ","$3,336.55 ","$0.00 ","$4,675.00 ","$0.00 ","$2,337.50 ","$3,702.60 ","$3,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204453","EAP","Custom 27204453","","Obt Shth 10cm 6fr Flxb 5mm","BOTH IP/OP","$4,908.00 ","$3,631.92 ","$0.00 ","$4,908.00 ","$0.00 ","$0.00 ","$0.00 ","$3,502.84 ","$3,502.84 ","$0.00 ","$4,908.00 ","$0.00 ","$2,454.00 ","$3,887.14 ","$3,926.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204454","EAP","HCPCS C1769","","Gwire Vasc 300cm .014in Shp Tip Str 3cm Runthrough Ns Ptfe","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$127.61 ","$0.00 ","$48.98 ","$167.72 ","$167.72 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"27204455","EAP","HCPCS C1887","","Cath Ep .014in 2.6-1.8fr .021-.018in 130cm 90cm Coron Mic","BOTH IP/OP","$1,621.00 ","$1,199.54 ","$0.00 ","$1,621.00 ","$0.00 ","$0.00 ","$0.00 ","$1,156.91 ","$1,156.91 ","$283.82 ","$1,621.00 ","$0.00 ","$810.50 ","$1,283.83 ","$1,296.80 ","$0.00 ","$253.69 ","$0.00 ","$258.06 ","$0.00 "
"27204456","EAP","HCPCS C1887","","Cath Ep .014in 2.6-1.8fr .021-.018in 150cm 70cm Coron Mic","BOTH IP/OP","$1,621.00 ","$1,199.54 ","$0.00 ","$1,621.00 ","$880.20 ","$0.00 ","$337.86 ","$1,156.91 ","$1,156.91 ","$283.82 ","$1,621.00 ","$0.00 ","$810.50 ","$1,283.83 ","$1,296.80 ","$0.00 ","$253.69 ","$0.00 ","$258.06 ","$0.00 "
"27204457","EAP","HCPCS C1769","","Gwire Vasc .014in 180cm 3cm Str Shp Tip Runthrough Ns Coron","BOTH IP/OP","$247.00 ","$182.78 ","$0.00 ","$247.00 ","$134.12 ","$0.00 ","$51.48 ","$176.28 ","$176.28 ","$43.25 ","$247.00 ","$0.00 ","$123.50 ","$195.62 ","$197.60 ","$0.00 ","$38.66 ","$0.00 ","$39.32 ","$0.00 "
"27204458","EAP","HCPCS C1733","","Arctic Front Advance Cryoablation Catheter 23mm","BOTH IP/OP","$12,401.00 ","$9,176.74 ","$0.00 ","$12,401.00 ","$6,733.74 ","$0.00 ","$2,584.68 ","$5,158.80 ","$5,158.80 ","$2,171.32 ","$12,401.00 ","$0.00 ","$6,200.50 ","$9,821.59 ","$9,920.80 ","$0.00 ","$1,940.76 ","$0.00 ","$1,974.24 ","$0.00 "
"27204459","EAP","HCPCS C1733","","Arctic Front Advance Cryoablation Catheter 28mm","BOTH IP/OP","$12,401.00 ","$9,176.74 ","$0.00 ","$12,401.00 ","$6,733.74 ","$0.00 ","$2,584.68 ","$5,158.80 ","$5,158.80 ","$2,171.32 ","$12,401.00 ","$0.00 ","$6,200.50 ","$9,821.59 ","$9,920.80 ","$0.00 ","$1,940.76 ","$0.00 ","$1,974.24 ","$0.00 "
"27204460","EAP","HCPCS C1733","","Freezor Max Cardiac Cryoablation Catheter Med","BOTH IP/OP","$5,236.00 ","$3,874.64 ","$0.00 ","$5,236.00 ","$0.00 ","$0.00 ","$0.00 ","$3,736.93 ","$3,736.93 ","$916.78 ","$5,236.00 ","$0.00 ","$2,618.00 ","$4,146.91 ","$4,188.80 ","$0.00 ","$819.43 ","$0.00 ","$833.57 ","$0.00 "
"27204461","EAP","HCPCS C1733","","Freezor Max Cardiac Cryoablation Catheter Lrg","BOTH IP/OP","$5,236.00 ","$3,874.64 ","$0.00 ","$5,236.00 ","$2,843.15 ","$0.00 ","$1,091.31 ","$3,736.93 ","$3,736.93 ","$916.78 ","$5,236.00 ","$0.00 ","$2,618.00 ","$4,146.91 ","$4,188.80 ","$0.00 ","$819.43 ","$0.00 ","$833.57 ","$0.00 "
"27204462","EAP","HCPCS C1733","","Freezor Cardiac Cryoablation Catheter Sm","BOTH IP/OP","$3,444.00 ","$2,548.56 ","$0.00 ","$3,444.00 ","$1,870.09 ","$0.00 ","$717.82 ","$2,457.98 ","$2,457.98 ","$603.02 ","$3,444.00 ","$0.00 ","$1,722.00 ","$2,727.65 ","$2,755.20 ","$0.00 ","$538.99 ","$0.00 ","$548.28 ","$0.00 "
"27204463","EAP","HCPCS C1733","","Freezor Cardiac Cryoablation Catheter Med","BOTH IP/OP","$3,444.00 ","$2,548.56 ","$0.00 ","$3,444.00 ","$1,870.09 ","$0.00 ","$717.82 ","$2,457.98 ","$2,457.98 ","$603.02 ","$3,444.00 ","$0.00 ","$1,722.00 ","$2,727.65 ","$2,755.20 ","$0.00 ","$538.99 ","$0.00 ","$548.28 ","$0.00 "
"27204464","EAP","HCPCS C1733","","Freezor Cardiac Cryoablation Catheter Lrg","BOTH IP/OP","$3,444.00 ","$2,548.56 ","$0.00 ","$3,444.00 ","$1,870.09 ","$0.00 ","$717.82 ","$2,457.98 ","$2,457.98 ","$603.02 ","$3,444.00 ","$0.00 ","$1,722.00 ","$2,727.65 ","$2,755.20 ","$0.00 ","$538.99 ","$0.00 ","$548.28 ","$0.00 "
"27204472","EAP","HCPCS C1766","","Flexcath Advance 12 Steerable Sheath - 12 Fr","BOTH IP/OP","$3,307.00 ","$2,447.18 ","$0.00 ","$3,307.00 ","$1,795.70 ","$0.00 ","$689.26 ","$2,360.21 ","$2,360.21 ","$579.03 ","$3,307.00 ","$0.00 ","$1,653.50 ","$2,619.14 ","$2,645.60 ","$0.00 ","$517.55 ","$0.00 ","$526.47 ","$0.00 "
"27204473","EAP","HCPCS C1766","","Flexcath 10 Steerable Sheath - 10 Fr","BOTH IP/OP","$2,067.00 ","$1,529.58 ","$0.00 ","$2,067.00 ","$1,122.38 ","$0.00 ","$430.81 ","$1,475.22 ","$1,475.22 ","$361.92 ","$2,067.00 ","$0.00 ","$1,033.50 ","$1,637.06 ","$1,653.60 ","$0.00 ","$323.49 ","$0.00 ","$329.07 ","$0.00 "
"27204474","EAP","HCPCS C1730","","Achieve Mapping Catheter Sm","BOTH IP/OP","$2,618.00 ","$1,937.32 ","$0.00 ","$2,618.00 ","$1,421.57 ","$0.00 ","$545.66 ","$1,868.47 ","$1,868.47 ","$458.39 ","$2,618.00 ","$0.00 ","$1,309.00 ","$2,073.46 ","$2,094.40 ","$0.00 ","$409.72 ","$0.00 ","$416.79 ","$0.00 "
"27204475","EAP","HCPCS C1730","","Achieve Mapping Catheter Lrg","BOTH IP/OP","$2,618.00 ","$1,937.32 ","$0.00 ","$2,618.00 ","$1,421.57 ","$0.00 ","$545.66 ","$1,868.47 ","$1,868.47 ","$458.39 ","$2,618.00 ","$0.00 ","$1,309.00 ","$2,073.46 ","$2,094.40 ","$0.00 ","$409.72 ","$0.00 ","$416.79 ","$0.00 "
"27204478","EAP","HCPCS C1730","","Cath Ep 5-5-5mm Spc Csl Curve 6fr 65cm Mp Dcapl Fix Curve","BOTH IP/OP","$965.00 ","$714.10 ","$0.00 ","$965.00 ","$524.00 ","$0.00 ","$201.13 ","$688.72 ","$688.72 ","$168.96 ","$965.00 ","$0.00 ","$482.50 ","$764.28 ","$772.00 ","$0.00 ","$151.02 ","$0.00 ","$153.63 ","$0.00 "
"27204479","EAP","HCPCS C1769","","Gwire Vasc 325cm .009in Flpy Wrclp Trq Flxb Lng Tpr 2.8cm","BOTH IP/OP","$457.00 ","$338.18 ","$0.00 ","$457.00 ","$248.15 ","$0.00 ","$95.25 ","$326.16 ","$326.16 ","$80.02 ","$457.00 ","$0.00 ","$228.50 ","$361.94 ","$365.60 ","$0.00 ","$71.52 ","$0.00 ","$72.75 ","$0.00 "
"27204480","EAP","HCPCS C1769","","Gwire Vasc 325cm .009in Flpy Wrclp Trq Flxb Lng Tpr 2.2cm","BOTH IP/OP","$457.00 ","$338.18 ","$0.00 ","$457.00 ","$248.15 ","$0.00 ","$95.25 ","$326.16 ","$326.16 ","$80.02 ","$457.00 ","$0.00 ","$228.50 ","$361.94 ","$365.60 ","$0.00 ","$71.52 ","$0.00 ","$72.75 ","$0.00 "
"27204481","EAP","Custom 27204481","","Lubricant Rotaglide","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$301.00 ","$0.00 ","$0.00 ","$0.00 ","$214.82 ","$214.82 ","$0.00 ","$301.00 ","$0.00 ","$150.50 ","$238.39 ","$240.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204482","EAP","HCPCS C1887","","Cath Infus Mic 1.9fr 1.25mm .5mm 1.5cm Dlv Drblty Dtch Tip","BOTH IP/OP","$5,498.00 ","$4,068.52 ","$0.00 ","$5,498.00 ","$2,985.41 ","$0.00 ","$1,145.92 ","$3,923.92 ","$3,923.92 ","$962.66 ","$5,498.00 ","$0.00 ","$2,749.00 ","$4,354.42 ","$4,398.40 ","$0.00 ","$860.44 ","$0.00 ","$875.28 ","$0.00 "
"27204483","EAP","HCPCS C1887","","Cath Infus Mic 1.9fr 1.25mm .5mm 3cm Dlv Drblty Dtch Tip","BOTH IP/OP","$5,498.00 ","$4,068.52 ","$0.00 ","$5,498.00 ","$0.00 ","$0.00 ","$0.00 ","$3,923.92 ","$3,923.92 ","$962.66 ","$5,498.00 ","$0.00 ","$2,749.00 ","$4,354.42 ","$4,398.40 ","$0.00 ","$860.44 ","$0.00 ","$875.28 ","$0.00 "
"27204484","EAP","HCPCS C1769","","Gwire Vasc 190cm .014in Radiopq Mrkr Core To Tip Str 3cm","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204485","EAP","HCPCS C1769","","Gwire Vasc 300cm .014in Radiopq Mrkr Core To Tip Str 3cm","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204486","EAP","HCPCS C1769","","Gwire Vasc 300cm .014in Strbl Core To Tip Radiopq Str 3cm","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204487","EAP","HCPCS C1769","","Gwire Vasc 180cm .014in Radiopq Mrkr Str 3cm A Fldr Fc","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204488","EAP","HCPCS C1769","","Gwire Vasc 300cm .014in Radiopq Mrkr Str 3cm A Fldr Fc","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204489","EAP","HCPCS C1769","","Gwire Vasc 190cm .014in Str 3cm Htorq Whspr Ms Ss Hydphi","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$117.83 ","$0.00 ","$45.23 ","$154.87 ","$154.87 ","$37.99 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$33.96 ","$0.00 ","$34.55 ","$0.00 "
"27204490","EAP","HCPCS C1757","","Cath Guid .014in Rnd 6fr .07+ In 140cm 6mm S Tp Aspirat Cmpt","BOTH IP/OP","$1,513.00 ","$1,119.62 ","$0.00 ","$1,513.00 ","$0.00 ","$0.00 ","$0.00 ","$1,079.83 ","$1,079.83 ","$0.00 ","$1,513.00 ","$0.00 ","$756.50 ","$1,198.30 ","$1,210.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204491","EAP","HCPCS C1757","","Cath Guid .014in 1mm 7fr 140cm 6mm Lg Xtrt Lum Rnd S Tp Shrt","BOTH IP/OP","$1,441.00 ","$1,066.34 ","$0.00 ","$1,441.00 ","$0.00 ","$0.00 ","$0.00 ","$1,028.44 ","$1,028.44 ","$0.00 ","$1,441.00 ","$0.00 ","$720.50 ","$1,141.27 ","$1,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204492","EAP","HCPCS C1769","","Gwire Vasc 180cm .035in Jkt Core To Tip Atrm 1.5mm Rad Std J","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$63.53 ","$0.00 ","$24.39 ","$83.50 ","$83.50 ","$20.49 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$18.31 ","$0.00 ","$18.63 ","$0.00 "
"27204493","EAP","HCPCS C1769","","Gwire Vasc 260cm .035in Jkt Core To Tip Atrm 1.5mm Rad Std J","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$71.13 ","$0.00 ","$27.30 ","$93.49 ","$93.49 ","$22.94 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$20.50 ","$0.00 ","$20.86 ","$0.00 "
"27204494","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm 3cm Strg Med Sprt Htorq Whspr Ms","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204495","EAP","HCPCS C1887","","Microcatheter Headway 21","BOTH IP/OP","$2,288.00 ","$1,693.12 ","$0.00 ","$2,288.00 ","$1,242.38 ","$0.00 ","$476.88 ","$1,632.95 ","$1,632.95 ","$400.61 ","$2,288.00 ","$0.00 ","$1,144.00 ","$1,812.10 ","$1,830.40 ","$0.00 ","$358.07 ","$0.00 ","$364.25 ","$0.00 "
"27204496","EAP","HCPCS C1887","","Microcatheter Headway Duo 17","BOTH IP/OP","$2,563.00 ","$1,896.62 ","$0.00 ","$2,563.00 ","$1,391.71 ","$0.00 ","$534.19 ","$1,829.21 ","$1,829.21 ","$448.76 ","$2,563.00 ","$0.00 ","$1,281.50 ","$2,029.90 ","$2,050.40 ","$0.00 ","$401.11 ","$0.00 ","$408.03 ","$0.00 "
"27204497","EAP","HCPCS C1887","","6fr Jr 5 Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204498","EAP","HCPCS C1887","","6fr Lcb Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204499","EAP","HCPCS C1887","","7fr Al2 Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204500","EAP","HCPCS C1887","","7fr Al 1.5 Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204501","EAP","HCPCS C1887","","7fr Al 1.0 Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204502","EAP","HCPCS C1887","","6fr Mradial Guide Catheter","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$70.59 ","$0.00 ","$27.10 ","$92.78 ","$92.78 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"27204503","EAP","HCPCS C1887","","6fr Lara Curve Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204504","EAP","HCPCS C1887","","6fr Mac3030 Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204505","EAP","HCPCS C1887","","6fr Ima Guide Catheter","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$67.33 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"27204506","EAP","HCPCS C1887","","5fr Jr4 Diagnostic Catheter 125cm","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$193.00 ","$104.80 ","$0.00 ","$40.23 ","$137.74 ","$137.74 ","$33.79 ","$193.00 ","$0.00 ","$96.50 ","$152.86 ","$154.40 ","$0.00 ","$30.20 ","$0.00 ","$30.73 ","$0.00 "
"27204507","EAP","HCPCS C1887","","5fr Jl4 Diagnostic Catheter 125cm","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$193.00 ","$104.80 ","$0.00 ","$40.23 ","$137.74 ","$137.74 ","$33.79 ","$193.00 ","$0.00 ","$96.50 ","$152.86 ","$154.40 ","$0.00 ","$30.20 ","$0.00 ","$30.73 ","$0.00 "
"27204508","EAP","HCPCS C1724","","Cath Athrcm 135cm .58in Rtbl Rtl+ 2mm Precnct Exchgl Rot","BOTH IP/OP","$3,409.00 ","$2,522.66 ","$0.00 ","$3,409.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.00 ","$2,433.00 ","$0.00 ","$3,409.00 ","$0.00 ","$1,704.50 ","$2,699.93 ","$2,727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204509","EAP","HCPCS C1724","","Cath Athrcm 135cm Rtbl Rtl+ 2.15mm Bur Precnct Exchgl Rot","BOTH IP/OP","$3,409.00 ","$2,522.66 ","$0.00 ","$3,409.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.00 ","$2,433.00 ","$0.00 ","$3,409.00 ","$0.00 ","$1,704.50 ","$2,699.93 ","$2,727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204510","EAP","HCPCS C1724","","Cath Athrcm 135cm Rtbl Rtl+ 2.25mm Bur Precnct Exchgl Rot","BOTH IP/OP","$3,409.00 ","$2,522.66 ","$0.00 ","$3,409.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.00 ","$2,433.00 ","$0.00 ","$3,409.00 ","$0.00 ","$1,704.50 ","$2,699.93 ","$2,727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204511","EAP","HCPCS C1724","","Cath Athrcm 135cm Rtbl Rtl+ 2.38mm Bur Precnct Exchgl Rot","BOTH IP/OP","$3,409.00 ","$2,522.66 ","$0.00 ","$3,409.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.00 ","$2,433.00 ","$0.00 ","$3,409.00 ","$0.00 ","$1,704.50 ","$2,699.93 ","$2,727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204512","EAP","HCPCS C1724","","Cath Athrcm 135cm Rtbl Rtl+ 2.5mm Bur Precnct Exchgl Rot Adv","BOTH IP/OP","$3,409.00 ","$2,522.66 ","$0.00 ","$3,409.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.00 ","$2,433.00 ","$0.00 ","$3,409.00 ","$0.00 ","$1,704.50 ","$2,699.93 ","$2,727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204513","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.20 X 6mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204514","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.20 X 8mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204515","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.20 X 12mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$0.00 ","$0.00 ","$0.00 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204516","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.20 X 15mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204517","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.20 X 20mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204518","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.50 X 6mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204519","EAP","HCPCS C1725","","Otw Mini Trek Ii 1.50 X 20mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204520","EAP","HCPCS C1725","","Otw Mini Trek Ii 2.00 X 6mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204521","EAP","HCPCS C1725","","Otw Mini Trek Ii 2.00 X 20mm Bdc","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204522","EAP","HCPCS C1725","","Mini Trek Rx 1.20 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204523","EAP","HCPCS C1725","","Mini Trek Rx 1.20 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204524","EAP","HCPCS C1725","","Mini Trek Rx 1.20 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204525","EAP","HCPCS C1725","","Mini Trek Rx 1.20 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204526","EAP","HCPCS C1725","","Mini Trek Rx 1.20 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204527","EAP","HCPCS C1725","","Mini Trek Rx 1.50 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204528","EAP","HCPCS C1725","","Mini Trek Rx 1.50 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204529","EAP","HCPCS C1725","","Mini Trek Rx 1.50 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204530","EAP","HCPCS C1725","","Mini Trek Rx 1.50 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204531","EAP","HCPCS C1725","","Mini Trek Rx 2.00 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204532","EAP","HCPCS C1725","","Mini Trek Rx 2.00 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204533","EAP","HCPCS C1725","","Mini Trek Rx 2.00 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204534","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204535","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204536","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204537","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204538","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204539","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204540","EAP","HCPCS C1725","","Mini Trek Rx 2.25 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204541","EAP","HCPCS C1725","","Trek Rx 2.50 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204542","EAP","HCPCS C1725","","Trek Rx 2.50 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204543","EAP","HCPCS C1725","","Trek Rx 2.75 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204544","EAP","HCPCS C1725","","Trek Rx 2.75 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204545","EAP","HCPCS C1725","","Trek Rx 2.75 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204546","EAP","HCPCS C1725","","Trek Rx 2.75 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204547","EAP","HCPCS C1725","","Trek Rx 2.75 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204548","EAP","HCPCS C1725","","Trek Rx 2.75 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204549","EAP","HCPCS C1725","","Trek Rx 2.75 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204550","EAP","HCPCS C1725","","Trek Rx 3.00 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204551","EAP","HCPCS C1725","","Trek Rx 3.00 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204552","EAP","HCPCS C1725","","Trek Rx 3.25 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204553","EAP","HCPCS C1725","","Trek Rx 3.25 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204554","EAP","HCPCS C1725","","Trek Rx 3.25 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204555","EAP","HCPCS C1725","","Trek Rx 3.25 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204556","EAP","HCPCS C1725","","Trek Rx 3.25 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204557","EAP","HCPCS C1725","","Trek Rx 3.25 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204558","EAP","HCPCS C1725","","Trek Rx 3.25 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204559","EAP","HCPCS C1725","","Trek Rx 3.50 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204560","EAP","HCPCS C1725","","Trek Rx 3.50 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204561","EAP","HCPCS C1725","","Trek Rx 3.75 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204562","EAP","HCPCS C1725","","Trek Rx 3.75 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204563","EAP","HCPCS C1725","","Trek Rx 3.75 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204564","EAP","HCPCS C1725","","Trek Rx 3.75 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204565","EAP","HCPCS C1725","","Trek Rx 3.75 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204566","EAP","HCPCS C1725","","Trek Rx 3.75 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204567","EAP","HCPCS C1725","","Trek Rx 3.75 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204568","EAP","HCPCS C1725","","Trek Rx 4.00 X 06mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204569","EAP","HCPCS C1725","","Trek Rx 4.00 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204570","EAP","HCPCS C1725","","Trek Rx 4.00 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204571","EAP","HCPCS C1725","","Trek Rx 4.00 X 30mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204572","EAP","HCPCS C1725","","Nc Trek Rx 1.50 X 06mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204573","EAP","HCPCS C1725","","Nc Trek Rx 1.50 X 08mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204574","EAP","HCPCS C1725","","Nc Trek Rx 1.50 X 12mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204575","EAP","HCPCS C1725","","Nc Trek Rx 1.50 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204576","EAP","HCPCS C1725","","Nc Trek Rx 1.50 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204577","EAP","HCPCS C1725","","Nc Trek Rx 2.00 X 15mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204578","EAP","HCPCS C1725","","Nc Trek Rx 2.00 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204579","EAP","HCPCS C1725","","Nc Trek Rx 2.25 X 06mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204580","EAP","HCPCS C1725","","Nc Trek Rx 3.00 X 8mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204581","EAP","HCPCS C1725","","Nc Trek Rx 3.25 X 06mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204582","EAP","HCPCS C1725","","Nc Trek Rx 4.50 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204583","EAP","HCPCS C1725","","Nc Trek Rx 5.00 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204584","EAP","HCPCS C1769","","Asahi Prowater Ptca Guide Wire 180cm","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204585","EAP","HCPCS C1769","","Hi-torque Iron Man Guide Wire","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$217.00 ","$117.83 ","$0.00 ","$45.23 ","$154.87 ","$154.87 ","$37.99 ","$217.00 ","$0.00 ","$108.50 ","$171.86 ","$173.60 ","$0.00 ","$33.96 ","$0.00 ","$34.55 ","$0.00 "
"27204586","EAP","HCPCS C1769","","Asahi Prowater Ptca Guide Wire 300cm","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204587","EAP","Custom 27204587","","Temporary Pacing Catheter 5fr","BOTH IP/OP","$509.00 ","$376.66 ","$0.00 ","$509.00 ","$0.00 ","$0.00 ","$0.00 ","$363.27 ","$363.27 ","$0.00 ","$509.00 ","$0.00 ","$254.50 ","$403.13 ","$407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204588","EAP","HCPCS C1757","","Cath Dx 135cm 4.2fr Fetch 2 .014in Hydphi Rapex Aspirat","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$34.21 ","$0.00 ","$13.13 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204589","EAP","HCPCS C1769","","Hi Torque 150 Gide Wire 0.014 Straight Tip 3.0 X 190cm","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204590","EAP","HCPCS C1725","","Nc Trek Rx 2.00 X 06mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204591","EAP","HCPCS C1725","","Nc Trek Rx 2.50 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204592","EAP","HCPCS C1725","","Nc Trek Rx 2.75 X 06mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204593","EAP","HCPCS C1725","","Nc Trek Rx 3.00 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204594","EAP","HCPCS C1725","","Nc Trek Rx 3.50 X 6mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204595","EAP","HCPCS C1725","","Nc Trek Rx 3.50 X 25mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204596","EAP","HCPCS C1725","","Nc Trek Rx 3.75 X 20mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204597","EAP","HCPCS C1725","","Nc Trek Rx 5.00 X 08mm Bdc","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204598","EAP","HCPCS C1769","","Extn Gwire Vasc Asa","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204599","EAP","HCPCS C1877","","Headway Duo Microtheter","BOTH IP/OP","$2,307.00 ","$1,707.18 ","$0.00 ","$2,307.00 ","$1,252.70 ","$0.00 ","$480.84 ","$1,646.51 ","$1,646.51 ","$403.94 ","$2,307.00 ","$0.00 ","$1,153.50 ","$1,827.14 ","$1,845.60 ","$0.00 ","$361.05 ","$0.00 ","$367.27 ","$0.00 "
"27204600","EAP","HCPCS C2628","","Compliant Occlusion Balloon 4.0mm X 10mm","BOTH IP/OP","$3,473.00 ","$2,570.02 ","$0.00 ","$3,473.00 ","$1,885.84 ","$0.00 ","$723.86 ","$2,478.68 ","$2,478.68 ","$0.00 ","$3,473.00 ","$0.00 ","$1,736.50 ","$2,750.62 ","$2,778.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204601","EAP","HCPCS C2628","","Compliant Occlusion Balloon 4.0mm X 15mm","BOTH IP/OP","$3,473.00 ","$2,570.02 ","$0.00 ","$3,473.00 ","$1,885.84 ","$0.00 ","$723.86 ","$2,478.68 ","$2,478.68 ","$0.00 ","$3,473.00 ","$0.00 ","$1,736.50 ","$2,750.62 ","$2,778.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204602","EAP","HCPCS C2628","","Compliant Occlusion Balloon 4.0mm X 20mm","BOTH IP/OP","$3,473.00 ","$2,570.02 ","$0.00 ","$3,473.00 ","$1,885.84 ","$0.00 ","$723.86 ","$2,478.68 ","$2,478.68 ","$0.00 ","$3,473.00 ","$0.00 ","$1,736.50 ","$2,750.62 ","$2,778.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204603","EAP","HCPCS C2628","","Occlusion Balloon Xc Catheter 4mm X 11mm","BOTH IP/OP","$3,647.00 ","$2,698.78 ","$0.00 ","$3,647.00 ","$1,980.32 ","$0.00 ","$760.13 ","$2,602.86 ","$2,602.86 ","$0.00 ","$3,647.00 ","$0.00 ","$1,823.50 ","$2,888.42 ","$2,917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204604","EAP","HCPCS C1725","","Cath Baldilat 5fr 2mm 25mm Otw Flxb Tung Mrkr Trnstls Tip","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$0.00 ","$0.00 ","$0.00 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204605","EAP","HCPCS C1725","","Cath Baldilat 5fr 2mm 30mm Otw Flxb Tung Mrkr Trnstls Tip","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$0.00 ","$0.00 ","$0.00 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27204606","EAP","HCPCS C1725","","Cath Baldilat Ult Lp 5fr 4.5mm 12mm Coron 2 Lum Rapex Flxb","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204607","EAP","HCPCS C1725","","Cath Baldilat Ult Lp 5fr 4.5mm 15mm Coron 2 Lum Rapex Flxb","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204608","EAP","HCPCS C1725","","Cath Baldilat Ult Lp 5fr 5mm 12mm Coron 2 Lum Rapex Flxb","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204609","EAP","HCPCS C1725","","Cath Baldilat Ult Lp 5fr 5mm 15mm Coron 2 Lum Rapex Flxb","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204610","EAP","HCPCS C1725","","Cath Baldilat Rnd 4.5mm 12mm 2 Mrkr Rapex Ml Lr Smth Flxb","BOTH IP/OP","$362.00 ","$267.88 ","$0.00 ","$362.00 ","$196.57 ","$0.00 ","$75.45 ","$258.36 ","$258.36 ","$63.38 ","$362.00 ","$0.00 ","$181.00 ","$286.70 ","$289.60 ","$0.00 ","$56.65 ","$0.00 ","$57.63 ","$0.00 "
"27204611","EAP","HCPCS C1769","","Cath Baldilat Rnd 2mm 12mm 2 Mrkr Rapex Ml Lr Smth Flxb","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"27204612","EAP","Custom 27204612","","Valve Hmsts Coplt 1 Un Bldbck Cntrl Vlv","BOTH IP/OP","$137.00 ","$101.38 ","$0.00 ","$137.00 ","$0.00 ","$0.00 ","$0.00 ","$97.78 ","$97.78 ","$0.00 ","$137.00 ","$0.00 ","$68.50 ","$108.50 ","$109.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204613","EAP","HCPCS C1757","","Solitaire Fr 4x40","BOTH IP/OP","$11,643.00 ","$8,615.82 ","$0.00 ","$11,643.00 ","$6,322.15 ","$0.00 ","$2,426.69 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,643.00 ","$0.00 ","$5,821.50 ","$9,221.26 ","$9,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204614","EAP","Custom 27204614","","Needle Biop 17ga 13.8cm Trgd Coax Disp Mnpty Mxcor","BOTH IP/OP","$153.00 ","$113.22 ","$0.00 ","$153.00 ","$0.00 ","$0.00 ","$0.00 ","$109.20 ","$109.20 ","$0.00 ","$153.00 ","$0.00 ","$76.50 ","$121.18 ","$122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204615","EAP","Custom 27204615","","Needle Biop 18ga 16cm 22mm Mxcor Automate Strl Disp","BOTH IP/OP","$412.00 ","$304.88 ","$0.00 ","$412.00 ","$0.00 ","$0.00 ","$0.00 ","$294.04 ","$294.04 ","$0.00 ","$412.00 ","$0.00 ","$206.00 ","$326.30 ","$329.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204616","EAP","HCPCS C1769","","Gwire Vasc .012in 200cm 55cm Sft Pshp Acces Lgth Synchro2","BOTH IP/OP","$1,283.00 ","$949.42 ","$0.00 ","$1,283.00 ","$696.67 ","$0.00 ","$267.41 ","$915.68 ","$915.68 ","$224.64 ","$1,283.00 ","$0.00 ","$641.50 ","$1,016.14 ","$1,026.40 ","$0.00 ","$200.79 ","$0.00 ","$204.25 ","$0.00 "
"27204617","EAP","HCPCS C1769","","Gwire Vasc .012in 300cm 55cm Sft Pshp Acces Lgth Synchro2","BOTH IP/OP","$1,593.00 ","$1,178.82 ","$0.00 ","$1,593.00 ","$865.00 ","$0.00 ","$332.02 ","$1,136.92 ","$1,136.92 ","$278.92 ","$1,593.00 ","$0.00 ","$796.50 ","$1,261.66 ","$1,274.40 ","$0.00 ","$249.30 ","$0.00 ","$253.61 ","$0.00 "
"27204618","EAP","Custom 27204618","","Drsg 6x3.5in Gntl Ps Strp Anmc Flxb Brthbl Ionic Slvr Sil","BOTH IP/OP","$53.00 ","$39.22 ","$0.00 ","$53.00 ","$0.00 ","$0.00 ","$0.00 ","$37.83 ","$37.83 ","$0.00 ","$53.00 ","$0.00 ","$26.50 ","$41.98 ","$42.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204619","EAP","Custom 27204619","","Drsg 10x3.5in Gntl Ps Strp Anmc Flxb Brthbl Ionic Slvr Sil","BOTH IP/OP","$62.00 ","$45.88 ","$0.00 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$44.25 ","$44.25 ","$0.00 ","$62.00 ","$0.00 ","$31.00 ","$49.10 ","$49.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204620","EAP","Custom 27204620","","Drsg 14x3.5in Gntl Ps Nstn Adh Hi Abs Sil Latex Optfm Ag","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$51.39 ","$51.39 ","$0.00 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204621","EAP","Custom 27204621","","Sensor Flw Microflow Bynt Hndl Flxb Neck 1.5mm Disp","BOTH IP/OP","$2,612.00 ","$1,932.88 ","$0.00 ","$2,612.00 ","$0.00 ","$0.00 ","$0.00 ","$1,864.18 ","$1,864.18 ","$0.00 ","$2,612.00 ","$0.00 ","$1,306.00 ","$2,068.70 ","$2,089.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204622","EAP","Custom 27204622","","Probe Surg Microflow Bynt Hndl Flxb Neck Disp 2mm","BOTH IP/OP","$2,612.00 ","$1,932.88 ","$0.00 ","$2,612.00 ","$0.00 ","$0.00 ","$0.00 ","$1,864.18 ","$1,864.18 ","$0.00 ","$2,612.00 ","$0.00 ","$1,306.00 ","$2,068.70 ","$2,089.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204623","EAP","Custom 27204623","","Probe Surg Microflow Bynt Hndl Flxb Neck Disp 3mm","BOTH IP/OP","$2,612.00 ","$1,932.88 ","$0.00 ","$2,612.00 ","$0.00 ","$0.00 ","$0.00 ","$1,864.18 ","$1,864.18 ","$0.00 ","$2,612.00 ","$0.00 ","$1,306.00 ","$2,068.70 ","$2,089.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204624","EAP","HCPCS C1769","","Gwire Vsc 190cm .014"" Mkr Tp Str 3cm Htrq Bl Mwt U","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27204625","EAP","HCPCS C1788","","Tray Infus Port Std 1 Lum Plflw Cath Introd Ndl","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27204626","EAP","HCPCS C1788","","Tray Infus Port Lp 1 Lum Introd Ndl Tnl Tl Cath 6","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27204627","EAP","HCPCS C1788","","Tray Infus Port J Lp 1 Lum Cath Introd Ndl Gwire","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$285.08 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27204628","EAP","HCPCS C1757","","Flow Restoration Catheter (6-10mm) X 155cm","BOTH IP/OP","$11,238.00 ","$8,316.12 ","$0.00 ","$11,238.00 ","$6,102.23 ","$0.00 ","$2,342.28 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,238.00 ","$0.00 ","$5,619.00 ","$8,900.50 ","$8,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204629","EAP","HCPCS C1757","","Flow Restoration Catheter (11-14mm) X 155cm","BOTH IP/OP","$11,238.00 ","$8,316.12 ","$0.00 ","$11,238.00 ","$6,102.23 ","$0.00 ","$2,342.28 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,238.00 ","$0.00 ","$5,619.00 ","$8,900.50 ","$8,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204630","EAP","HCPCS C1757","","Flow Restoration Catheter (15-18mm) X 155cm","BOTH IP/OP","$11,238.00 ","$8,316.12 ","$0.00 ","$11,238.00 ","$6,102.23 ","$0.00 ","$2,342.28 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,238.00 ","$0.00 ","$5,619.00 ","$8,900.50 ","$8,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204631","EAP","HCPCS C1757","","Aspiration Guide Catheter 20f X 95cm","BOTH IP/OP","$5,738.00 ","$4,246.12 ","$0.00 ","$5,738.00 ","$3,115.73 ","$0.00 ","$1,195.94 ","$4,095.21 ","$4,095.21 ","$0.00 ","$5,738.00 ","$0.00 ","$2,869.00 ","$4,544.50 ","$4,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204632","EAP","HCPCS C1773","","Retraction Aspirator Device","BOTH IP/OP","$787.00 ","$582.38 ","$0.00 ","$787.00 ","$427.34 ","$0.00 ","$164.03 ","$561.68 ","$561.68 ","$137.80 ","$787.00 ","$0.00 ","$393.50 ","$623.30 ","$629.60 ","$0.00 ","$123.17 ","$0.00 ","$125.29 ","$0.00 "
"27204633","EAP","HCPCS C1757","","Trevo Xp 6mm X 25mm","BOTH IP/OP","$13,402.00 ","$9,917.48 ","$0.00 ","$13,402.00 ","$7,277.29 ","$0.00 ","$2,793.31 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,402.00 ","$0.00 ","$6,701.00 ","$10,614.38 ","$10,721.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204634","EAP","HCPCS C1757","","Trevo Xp Provue Retriever 4.0 X 30mm","BOTH IP/OP","$14,072.00 ","$10,413.28 ","$0.00 ","$14,072.00 ","$7,641.10 ","$0.00 ","$2,932.96 ","$5,158.80 ","$5,158.80 ","$0.00 ","$14,072.00 ","$0.00 ","$7,036.00 ","$11,145.02 ","$11,257.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204635","EAP","HCPCS C1887","","Micrcatheter Std Straight, 2 Tip-marker, 150cm-15cm","BOTH IP/OP","$2,324.00 ","$1,719.76 ","$0.00 ","$2,324.00 ","$1,261.93 ","$0.00 ","$484.38 ","$1,658.64 ","$1,658.64 ","$406.91 ","$2,324.00 ","$0.00 ","$1,162.00 ","$1,840.61 ","$1,859.20 ","$0.00 ","$363.71 ","$0.00 ","$369.98 ","$0.00 "
"27204636","EAP","HCPCS C1887","","Microcatheter Standard Pre-shaped 45, 2-tip Mkr, 150cm/7.5cm","BOTH IP/OP","$2,381.00 ","$1,761.94 ","$0.00 ","$2,381.00 ","$1,292.88 ","$0.00 ","$496.26 ","$1,699.32 ","$1,699.32 ","$416.89 ","$2,381.00 ","$0.00 ","$1,190.50 ","$1,885.75 ","$1,904.80 ","$0.00 ","$372.63 ","$0.00 ","$379.06 ","$0.00 "
"27204637","EAP","HCPCS C1887","","Micrcatheter Std Pre-shp 90, 2-tip Mkr, 150cm/7.5cm","BOTH IP/OP","$2,381.00 ","$1,761.94 ","$0.00 ","$2,381.00 ","$1,292.88 ","$0.00 ","$496.26 ","$1,699.32 ","$1,699.32 ","$416.89 ","$2,381.00 ","$0.00 ","$1,190.50 ","$1,885.75 ","$1,904.80 ","$0.00 ","$372.63 ","$0.00 ","$379.06 ","$0.00 "
"27204639","EAP","HCPCS C1769","","Guidewire Vascular Str .035in 150cm Bentson Smooth","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$17.92 ","$0.00 ","$6.88 ","$23.55 ","$23.55 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"27204640","EAP","HCPCS C1725","","Catheter Baldilat .035in 8fr 18mm 80cm 4cm Gold","BOTH IP/OP","$722.00 ","$534.28 ","$0.00 ","$722.00 ","$392.05 ","$0.00 ","$150.48 ","$515.29 ","$515.29 ","$126.42 ","$722.00 ","$0.00 ","$361.00 ","$571.82 ","$577.60 ","$0.00 ","$112.99 ","$0.00 ","$114.94 ","$0.00 "
"27204641","EAP","HCPCS C1725","","Catheter Baldilat .035in 8fr 16mm 80cm 4cm Gold","BOTH IP/OP","$722.00 ","$534.28 ","$0.00 ","$722.00 ","$392.05 ","$0.00 ","$150.48 ","$515.29 ","$515.29 ","$126.42 ","$722.00 ","$0.00 ","$361.00 ","$571.82 ","$577.60 ","$0.00 ","$112.99 ","$0.00 ","$114.94 ","$0.00 "
"27204642","EAP","HCPCS C1725","","Catheter Baldilat .035in 7fr 14mm 80cm 4cm Gold","BOTH IP/OP","$688.00 ","$509.12 ","$0.00 ","$688.00 ","$373.58 ","$0.00 ","$143.40 ","$491.03 ","$491.03 ","$120.46 ","$688.00 ","$0.00 ","$344.00 ","$544.90 ","$550.40 ","$0.00 ","$107.67 ","$0.00 ","$109.53 ","$0.00 "
"27204643","EAP","HCPCS C1725","","Catheter Xtrt 120cm 14fr Xl .035in Str Tip Gwire","BOTH IP/OP","$1,956.00 ","$1,447.44 ","$0.00 ","$1,956.00 ","$1,062.11 ","$0.00 ","$407.68 ","$1,396.00 ","$1,396.00 ","$342.48 ","$1,956.00 ","$0.00 ","$978.00 ","$1,549.15 ","$1,564.80 ","$0.00 ","$306.11 ","$0.00 ","$311.40 ","$0.00 "
"27204644","EAP","HCPCS C1757","","Set Introd 70cm 14fr 15mm Ck-z Trchbr Gnt Rsch","BOTH IP/OP","$749.00 ","$554.26 ","$0.00 ","$749.00 ","$406.71 ","$0.00 ","$156.11 ","$534.56 ","$534.56 ","$0.00 ","$749.00 ","$0.00 ","$374.50 ","$593.21 ","$599.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204645","EAP","HCPCS C1757","","Coil Embl 132cm .064mm Penumbra Ruby Ace 5max","BOTH IP/OP","$5,484.00 ","$4,058.16 ","$0.00 ","$5,484.00 ","$2,977.81 ","$0.00 ","$1,143.00 ","$3,913.93 ","$3,913.93 ","$0.00 ","$5,484.00 ","$0.00 ","$2,742.00 ","$4,343.33 ","$4,387.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204647","EAP","HCPCS C1894","","Introducer Shth Ped 5fr 21ga 40cm 7cm Gry Hub","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$55.93 ","$0.00 ","$21.47 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$16.12 ","$0.00 ","$16.40 ","$0.00 "
"27204648","EAP","HCPCS C1894","","Introducer Shth Ped 6fr 21ga 40cm 7cm Grn Hub","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$58.64 ","$0.00 ","$22.51 ","$77.08 ","$77.08 ","$18.91 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$16.90 ","$0.00 ","$17.19 ","$0.00 "
"27204649","EAP","HCPCS C1884","","System Embl Prtc 190cm .014in 110um Crtd Gwire","BOTH IP/OP","$4,397.00 ","$3,253.78 ","$0.00 ","$4,397.00 ","$2,387.57 ","$0.00 ","$916.44 ","$3,138.14 ","$3,138.14 ","$769.88 ","$4,397.00 ","$0.00 ","$2,198.50 ","$3,482.42 ","$3,517.60 ","$0.00 ","$688.13 ","$0.00 ","$700.00 ","$0.00 "
"27204650","EAP","HCPCS C1884","","System Embl Prtc 190cm .014in 110um Sprg Crtd","BOTH IP/OP","$4,397.00 ","$3,253.78 ","$0.00 ","$4,397.00 ","$2,387.57 ","$0.00 ","$916.44 ","$3,138.14 ","$3,138.14 ","$769.88 ","$4,397.00 ","$0.00 ","$2,198.50 ","$3,482.42 ","$3,517.60 ","$0.00 ","$688.13 ","$0.00 ","$700.00 ","$0.00 "
"27204651","EAP","HCPCS C2630","","Catheter Ablt 115cm 7fr 3.5mm 75mm Curve 2-5-2mm","BOTH IP/OP","$6,561.00 ","$4,855.14 ","$0.00 ","$6,561.00 ","$0.00 ","$0.00 ","$0.00 ","$4,682.59 ","$4,682.59 ","$0.00 ","$6,561.00 ","$0.00 ","$3,280.50 ","$5,196.31 ","$5,248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204652","EAP","HCPCS C2630","","Catheter Ablt 115cm 7fr 3.5mm 65mm Curve 2-5-2mm","BOTH IP/OP","$6,561.00 ","$4,855.14 ","$0.00 ","$6,561.00 ","$0.00 ","$0.00 ","$0.00 ","$4,682.59 ","$4,682.59 ","$0.00 ","$6,561.00 ","$0.00 ","$3,280.50 ","$5,196.31 ","$5,248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204653","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc D-d Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204654","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc D-f Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204655","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-f Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204656","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-j Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204657","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc J-j Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204658","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm D Curve Flexability 4","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204659","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204660","EAP","HCPCS C2630","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc J Curve","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.21 ","$3,746.21 ","$0.00 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204661","EAP","HCPCS C1885","","Catheter Angio Jacky Radl Curve 5fr 3.5mm 100cm 2","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$0.00 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204662","EAP","HCPCS C1725","","Coronary Balloon","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204663","EAP","CPT� C1769","","Guidewire Vasc 80cm .035in Jkt Core To Tip Atrm","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$43.44 ","$0.00 ","$16.67 ","$57.10 ","$57.10 ","$14.01 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$12.52 ","$0.00 ","$12.74 ","$0.00 "
"27204664","EAP","HCPCS C1769","","035IN 150CM 7CM STANDARD TIP FIX","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$10.86 ","$0.00 ","$4.17 ","$14.27 ","$14.27 ","$3.50 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$3.13 ","$0.00 ","$3.18 ","$0.00 "
"27204665","EAP","HCPCS C1887","","Cath Angio Jr3.5 Curve 6fr 100cm Stsr","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"27204666","EAP","HCPCS C1887","","Catheter Angiographic Jl3.5 Curve 6fr 100cm Siteseer","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$92.07 ","$92.07 ","$22.59 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$20.19 ","$0.00 ","$20.54 ","$0.00 "
"27204667","EAP","HCPCS C1887","","Catheter Angiographic Jl4 Curve 6fr 100cm Siteseer","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$174.86 ","$174.86 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"27204668","EAP","HCPCS C1887","","Catheter Angiographic Jr5 Curve 5fr 100cm Siteseer","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"27204669","EAP","Custom 27204669","","Kit Pricrdcts 8.3fr Perivc Flxm Pgtl Curve 3w","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$267.64 ","$267.64 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204670","EAP","HCPCS C1887","","Catheter 6a0083 Ss 6f Jl 5.0 100cm","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$49.96 ","$49.96 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"27204671","EAP","HCPCS C1887","","Catheter Angiographic Mpa1 Curve 5fr 100cm Siteseer","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$193.00 ","$0.00 ","$0.00 ","$0.00 ","$137.74 ","$137.74 ","$33.79 ","$193.00 ","$0.00 ","$96.50 ","$152.86 ","$154.40 ","$0.00 ","$30.20 ","$0.00 ","$30.73 ","$0.00 "
"27204673","EAP","HCPCS C1887","","Catheter Guid Jr4 Curve 6fr 100cm Siteseer Stainless Steel","BOTH IP/OP","$294.00 ","$217.56 ","$0.00 ","$294.00 ","$159.64 ","$0.00 ","$61.28 ","$209.83 ","$209.83 ","$51.48 ","$294.00 ","$0.00 ","$147.00 ","$232.85 ","$235.20 ","$0.00 ","$46.01 ","$0.00 ","$46.80 ","$0.00 "
"27204674","EAP","HCPCS C1887","","Catheter,6fr Al2 Siteseer","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$85.79 ","$0.00 ","$32.93 ","$112.76 ","$112.76 ","$27.66 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$24.73 ","$0.00 ","$25.15 ","$0.00 "
"27204675","EAP","HCPCS C1894","","Set Introd .018in 4fr 10cm 40c","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$66.79 ","$0.00 ","$25.64 ","$87.79 ","$87.79 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"27204676","EAP","HCPCS C1769","","Set Introd 24-26-28fr Cgl Brhn","BOTH IP/OP","$905.00 ","$669.70 ","$0.00 ","$905.00 ","$491.42 ","$0.00 ","$188.62 ","$645.90 ","$645.90 ","$158.46 ","$905.00 ","$0.00 ","$452.50 ","$716.76 ","$724.00 ","$0.00 ","$141.63 ","$0.00 ","$144.08 ","$0.00 "
"27204677","EAP","HCPCS C1894","","Set Introd .018in 4fr 21ga 40c","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$45.07 ","$0.00 ","$17.30 ","$59.24 ","$59.24 ","$14.53 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$12.99 ","$0.00 ","$13.21 ","$0.00 "
"27204678","EAP","Custom 27204678","","Set Introd .018in Long 5fr 21g","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$67.80 ","$67.80 ","$0.00 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204679","EAP","Custom 27204679","","Set Introd .018in Long 5fr 70c","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$67.80 ","$67.80 ","$0.00 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204680","EAP","HCPCS C1894","","Set Introd 6fr 13cm 20cm Sidea","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$21.72 ","$0.00 ","$8.34 ","$28.55 ","$28.55 ","$7.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$6.26 ","$0.00 ","$6.37 ","$0.00 "
"27204681","EAP","HCPCS C1894","","Set Introd .038in 11fr 15.5cm","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$57.56 ","$0.00 ","$22.09 ","$75.65 ","$75.65 ","$18.56 ","$106.00 ","$0.00 ","$53.00 ","$83.95 ","$84.80 ","$0.00 ","$16.59 ","$0.00 ","$16.88 ","$0.00 "
"27204682","EAP","HCPCS C1894","","Set Introd .038in 12fr 15.5cm","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$57.56 ","$0.00 ","$22.09 ","$75.65 ","$75.65 ","$18.56 ","$106.00 ","$0.00 ","$53.00 ","$83.95 ","$84.80 ","$0.00 ","$16.59 ","$0.00 ","$16.88 ","$0.00 "
"27204683","EAP","HCPCS C1894","","Set Introd .038in 14fr 15.5cm","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$57.56 ","$0.00 ","$22.09 ","$75.65 ","$75.65 ","$18.56 ","$106.00 ","$0.00 ","$53.00 ","$83.95 ","$84.80 ","$0.00 ","$16.59 ","$0.00 ","$16.88 ","$0.00 "
"27204684","EAP","HCPCS C1894","","Set Introd 18fr 15.5cm Peel-aw","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$57.56 ","$0.00 ","$22.09 ","$75.65 ","$75.65 ","$18.56 ","$106.00 ","$0.00 ","$53.00 ","$83.95 ","$84.80 ","$0.00 ","$16.59 ","$0.00 ","$16.88 ","$0.00 "
"27204685","EAP","HCPCS C1769","","Set Introd 8fr J Tip Needle Gu","BOTH IP/OP","$1,198.00 ","$886.52 ","$0.00 ","$1,198.00 ","$0.00 ","$0.00 ","$0.00 ","$855.01 ","$855.01 ","$209.76 ","$1,198.00 ","$0.00 ","$599.00 ","$948.82 ","$958.40 ","$0.00 ","$187.49 ","$0.00 ","$190.72 ","$0.00 "
"27204686","EAP","Custom 27204686","","Set Introd .018in Micro Str 7f","BOTH IP/OP","$153.00 ","$113.22 ","$0.00 ","$153.00 ","$0.00 ","$0.00 ","$0.00 ","$109.20 ","$109.20 ","$0.00 ","$153.00 ","$0.00 ","$76.50 ","$121.18 ","$122.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204687","EAP","HCPCS C1894","","Set Introd 16fr 20-35mm 70cm G","BOTH IP/OP","$713.00 ","$527.62 ","$0.00 ","$713.00 ","$387.16 ","$0.00 ","$148.61 ","$508.87 ","$508.87 ","$124.84 ","$713.00 ","$0.00 ","$356.50 ","$564.70 ","$570.40 ","$0.00 ","$111.58 ","$0.00 ","$113.51 ","$0.00 "
"27204688","EAP","HCPCS C1894","","Set Introd 6fr 8fr 13.75in 3 W","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$135.21 ","$0.00 ","$51.90 ","$177.71 ","$177.71 ","$43.60 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$38.97 ","$0.00 ","$39.64 ","$0.00 "
"27204689","EAP","HCPCS C1894","","Set Introd 6fr 8fr 17.75in 3 W","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$135.21 ","$0.00 ","$51.90 ","$177.71 ","$177.71 ","$43.60 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$38.97 ","$0.00 ","$39.64 ","$0.00 "
"27204690","EAP","HCPCS C1887","","Catherer, Guiding","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204691","EAP","HCPCS C1887","","Catheter Angiographic Cobra 2 Curve 4fr .041in 65c","BOTH IP/OP","$613.00 ","$453.62 ","$0.00 ","$613.00 ","$332.86 ","$0.00 ","$127.76 ","$437.50 ","$437.50 ","$107.33 ","$613.00 ","$0.00 ","$306.50 ","$485.50 ","$490.40 ","$0.00 ","$95.93 ","$0.00 ","$97.59 ","$0.00 "
"27204694","EAP","HCPCS C1769","","Guidewire Vasc 300cm Rnd Prfl Agile Tip Smtr Rot","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"27204695","EAP","HCPCS C1757","","Indigo Catheter 8, Xtorq Tip 115cm","BOTH IP/OP","$7,255.00 ","$5,368.70 ","$0.00 ","$7,255.00 ","$3,939.47 ","$0.00 ","$1,512.12 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,255.00 ","$0.00 ","$3,627.50 ","$5,745.96 ","$5,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204696","EAP","Custom 27204696","","Indigo Separator 8","BOTH IP/OP","$4,700.00 ","$3,478.00 ","$0.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$3,354.39 ","$3,354.39 ","$0.00 ","$4,700.00 ","$0.00 ","$2,350.00 ","$3,722.40 ","$3,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204697","EAP","Custom 27204697","","Max Aspiration Tubing 3","BOTH IP/OP","$1,095.00 ","$810.30 ","$0.00 ","$1,095.00 ","$0.00 ","$0.00 ","$0.00 ","$781.50 ","$781.50 ","$0.00 ","$1,095.00 ","$0.00 ","$547.50 ","$867.24 ","$876.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204698","EAP","Custom 27204698","","Sealant Hemostatic Needle Free Adapter Floseal Matrix 10ml","BOTH IP/OP","$913.00 ","$675.62 ","$0.00 ","$913.00 ","$0.00 ","$0.00 ","$0.00 ","$651.61 ","$651.61 ","$0.00 ","$913.00 ","$0.00 ","$456.50 ","$723.10 ","$730.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204699","EAP","Custom 27204699","","Sealant Hemostatic Needle Free Adapter Floseal Matrix 5ml","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$499.00 ","$0.00 ","$0.00 ","$0.00 ","$356.14 ","$356.14 ","$0.00 ","$499.00 ","$0.00 ","$249.50 ","$395.21 ","$399.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204700","EAP","HCPCS C1887","","Catheter Interventional 6fr .07in .056in 145cm 20c","BOTH IP/OP","$1,183.00 ","$875.42 ","$0.00 ","$1,183.00 ","$642.37 ","$0.00 ","$246.57 ","$844.31 ","$844.31 ","$207.13 ","$1,183.00 ","$0.00 ","$591.50 ","$936.94 ","$946.40 ","$0.00 ","$185.14 ","$0.00 ","$188.33 ","$0.00 "
"27204702","EAP","HCPCS C1766","","Introducer Shth 8.8fr 7fr 55cm Hi Flx Dilat","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$74.93 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"27204705","EAP","","","Catheter Echelon 10 Micro","BOTH IP/OP","$1,687.00 ","$1,248.38 ","$0.00 ","$1,687.00 ","$0.00 ","$0.00 ","$0.00 ","$1,204.01 ","$1,204.01 ","$0.00 ","$1,687.00 ","$0.00 ","$843.50 ","$1,336.10 ","$1,349.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204707","EAP","","","Amplatz Super Stiff Exchange Guidewire .038x260","BOTH IP/OP","$96.00 ","$71.04 ","$0.00 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$68.52 ","$68.52 ","$0.00 ","$96.00 ","$0.00 ","$48.00 ","$76.03 ","$76.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204708","EAP","HCPCS C1769","","Guidewire .016 Fathom","BOTH IP/OP","$893.00 ","$660.82 ","$0.00 ","$893.00 ","$484.90 ","$0.00 ","$186.12 ","$637.33 ","$637.33 ","$156.36 ","$893.00 ","$0.00 ","$446.50 ","$707.26 ","$714.40 ","$0.00 ","$139.75 ","$0.00 ","$142.17 ","$0.00 "
"27204709","EAP","Custom 27204709","","Valve Rotating Hemostatic","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204710","EAP","Custom 27204710","","Manifold Kit","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$0.00 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204711","EAP","HCPCS C1887","","Axs Catalyst 5 Distal Access Catheter 0.058in X 11","BOTH IP/OP","$3,878.00 ","$2,869.72 ","$0.00 ","$3,878.00 ","$2,105.75 ","$0.00 ","$808.27 ","$2,767.73 ","$2,767.73 ","$679.01 ","$3,878.00 ","$0.00 ","$1,939.00 ","$3,071.38 ","$3,102.40 ","$0.00 ","$606.91 ","$0.00 ","$617.38 ","$0.00 "
"27204712","EAP","HCPCS C1769","","Contol Wire 200cm .018 V-18","BOTH IP/OP","$227.00 ","$167.98 ","$0.00 ","$227.00 ","$0.00 ","$0.00 ","$0.00 ","$162.01 ","$162.01 ","$39.75 ","$227.00 ","$0.00 ","$113.50 ","$179.78 ","$181.60 ","$0.00 ","$35.53 ","$0.00 ","$36.14 ","$0.00 "
"27204714","EAP","HCPCS C1894","","Introducer Shth 8fr 2.9mm 80cm Flxr Strl Acpt .038","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$26.05 ","$89.21 ","$89.21 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"27204715","EAP","HCPCS C1894","","Introducer Shth 8fr 90cm Sm Vlv Asmbly Radiopq","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$78.74 ","$0.00 ","$30.22 ","$103.49 ","$103.49 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"27204716","EAP","Custom 27204716","","Kit Pricrdcts 40cm 8fr Pgtl Curve Cath","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204717","EAP","Custom 27204717","","Catheter Angiographic Cobra 2 Curve 5fr 80cm Torcon Nb","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$46.39 ","$46.39 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204718","EAP","HCPCS C1887","","Catheter Angiographic .046in Uac Curve 5fr .046in 90cm","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$81.45 ","$81.45 ","$0.00 ","$31.26 ","$24.98 ","$24.98 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"27204719","EAP","HCPCS C1725","","Cath Baldilat 4mm 8mm Coron Rapex Nc Trek Angiopls","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27204720","EAP","HCPCS C1725","","Cath Baldilat 4mm 15mm Coron Rapex Nc Trek Angiopl","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27204721","EAP","HCPCS C1725","","Cath Baldilat 4mm 20mm Coron Rapex Nc Trek Angiopl","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27204722","EAP","HCPCS C1894","","Introducer Sheath .035in 10fr .134in 45cm Anl0 Curve Str Tip","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"27204723","EAP","HCPCS C1894","","Introducer Sheath .035in 12fr .162in 45cm Anl0 Curve Str Tip","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$74.93 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"27204724","EAP","Custom 27204724","","Set Ndl 45mm 15ga Ezio Ss 1 Port Shrp Block Drsg","BOTH IP/OP","$1,663.00 ","$1,230.62 ","$0.00 ","$1,663.00 ","$0.00 ","$0.00 ","$0.00 ","$1,186.88 ","$1,186.88 ","$0.00 ","$1,663.00 ","$0.00 ","$831.50 ","$1,317.10 ","$1,330.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204725","EAP","HCPCS C1773","","Snare Endscp .98in 47in 1 Loop Gold Plated Tungsten","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$488.70 ","$0.00 ","$187.58 ","$642.33 ","$642.33 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"27204726","EAP","HCPCS C1773","","Separator Thrmb Indg 6 Latex Free","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$1,466.10 ","$0.00 ","$562.75 ","$1,926.99 ","$1,926.99 ","$472.75 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$422.55 ","$0.00 ","$429.84 ","$0.00 "
"27204729","EAP","HCPCS C1757","","Catheter Thrmb 6fr Indg Aspirat Latex Free","BOTH IP/OP","$4,725.00 ","$3,496.50 ","$0.00 ","$4,725.00 ","$2,565.68 ","$0.00 ","$984.81 ","$3,372.23 ","$3,372.23 ","$0.00 ","$4,725.00 ","$0.00 ","$2,362.50 ","$3,742.20 ","$3,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204730","EAP","HCPCS C1757","","Catheter Thrmb 132cm 5-6fr .064in .054in Peri Unq","BOTH IP/OP","$2,908.00 ","$2,151.92 ","$0.00 ","$2,908.00 ","$1,579.04 ","$0.00 ","$606.10 ","$2,075.44 ","$2,075.44 ","$0.00 ","$2,908.00 ","$0.00 ","$1,454.00 ","$2,303.14 ","$2,326.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204731","EAP","HCPCS C1757","","Catheter Thrmb 150cm 3.4-4.1fr .041in .032in Peri","BOTH IP/OP","$2,908.00 ","$2,151.92 ","$0.00 ","$2,908.00 ","$1,579.04 ","$0.00 ","$606.10 ","$2,075.44 ","$2,075.44 ","$0.00 ","$2,908.00 ","$0.00 ","$1,454.00 ","$2,303.14 ","$2,326.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204733","EAP","HCPCS C1757","","Catheter Thrmb 85cm 8fr Indg Aspirat Trq Tip Latex","BOTH IP/OP","$7,225.00 ","$5,346.50 ","$0.00 ","$7,225.00 ","$3,923.18 ","$0.00 ","$1,505.87 ","$5,156.48 ","$5,156.48 ","$0.00 ","$7,225.00 ","$0.00 ","$3,612.50 ","$5,722.20 ","$5,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204736","EAP","HCPCS C1887","","Six Fr Asahi Fubuki Guide Catheter Dilator Kit/90cm/straight�","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27204737","EAP","HCPCS C1887","","Six Fr Asahi Fubuki Guide Catheter Dilator Kit 80cm/straight","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27204738","EAP","HCPCS C1894","","Introducer Shth 7fr 2.5cm 10cm Dilat Radiopq Mrkr","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$30.41 ","$0.00 ","$11.67 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27204739","EAP","HCPCS C1894","","Introducer Shth 8fr 2.5cm 10cm Gwire Dilat Radiopq","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$30.41 ","$0.00 ","$11.67 ","$39.97 ","$39.97 ","$9.81 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$8.76 ","$0.00 ","$8.92 ","$0.00 "
"27204740","EAP","HCPCS C1894","","Introducer Shth 7fr 2.5cm 25cm Dilat Radiopq Mrkr","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$12.43 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$11.11 ","$0.00 ","$11.30 ","$0.00 "
"27204741","EAP","HCPCS C1894","","Introducer Shth 8fr 2.5cm 25cm Dilat Radiopq Mrkr","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$38.55 ","$0.00 ","$14.80 ","$50.67 ","$50.67 ","$12.43 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$11.11 ","$0.00 ","$11.30 ","$0.00 "
"27204742","EAP","HCPCS C1887","","Catheter Angiographic Judkins Right 4 Curve 5fr 10","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$23.14 ","$79.22 ","$79.22 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"27204747","EAP","Custom 27204747","","Kit Pressure Monitr 14ga Basic Transducer Tuohy Needle","BOTH IP/OP","$1,883.00 ","$1,393.42 ","$0.00 ","$1,883.00 ","$0.00 ","$0.00 ","$0.00 ","$1,343.90 ","$1,343.90 ","$0.00 ","$1,883.00 ","$0.00 ","$941.50 ","$1,491.34 ","$1,506.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204748","EAP","Custom 27204748","","Kit Craniotomy Cranial Acces Codman","BOTH IP/OP","$635.00 ","$469.90 ","$0.00 ","$635.00 ","$0.00 ","$0.00 ","$0.00 ","$453.20 ","$453.20 ","$0.00 ","$635.00 ","$0.00 ","$317.50 ","$502.92 ","$508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204749","EAP","Custom 27204749","","System Drain Complete Nonvented Catheter Latex Free Eds Iii","BOTH IP/OP","$373.00 ","$276.02 ","$0.00 ","$373.00 ","$0.00 ","$0.00 ","$0.00 ","$266.21 ","$266.21 ","$0.00 ","$373.00 ","$0.00 ","$186.50 ","$295.42 ","$298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204750","EAP","HCPCS C1751","","Catheter Cen Ven .032in 9.3fr 38cm 75cm 3 Infus Lumen Extn","BOTH IP/OP","$1,995.00 ","$1,476.30 ","$0.00 ","$1,995.00 ","$1,083.29 ","$0.00 ","$415.81 ","$1,423.83 ","$1,423.83 ","$349.31 ","$1,995.00 ","$0.00 ","$997.50 ","$1,580.04 ","$1,596.00 ","$0.00 ","$312.22 ","$0.00 ","$317.60 ","$0.00 "
"27204751","EAP","HCPCS C1751","","Catheter Cen Ven 9.3fr 22cm 58mm Ods","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,228.00 ","$666.80 ","$0.00 ","$255.95 ","$876.42 ","$876.42 ","$215.01 ","$1,228.00 ","$0.00 ","$614.00 ","$972.58 ","$982.40 ","$0.00 ","$192.18 ","$0.00 ","$195.50 ","$0.00 "
"27204752","EAP","HCPCS C1757","","Dawn Ide, Trevo Xp 6x25 Kit","BOTH IP/OP","$12,766.00 ","$9,446.84 ","$0.00 ","$12,766.00 ","$6,931.94 ","$0.00 ","$2,660.75 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,766.00 ","$0.00 ","$6,383.00 ","$10,110.67 ","$10,212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204753","EAP","HCPCS C1757","","Dawn Ide, Trevo Xp 4x30 Kit","BOTH IP/OP","$12,766.00 ","$9,446.84 ","$0.00 ","$12,766.00 ","$6,931.94 ","$0.00 ","$2,660.75 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,766.00 ","$0.00 ","$6,383.00 ","$10,110.67 ","$10,212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204754","EAP","HCPCS C1769","","Guidewire Vascular .014in 300cm 11cm Radiopq Str T","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$321.17 ","$321.17 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"27204755","EAP","HCPCS C1769","","Guidewire Vasc 180cm Asahi Ptca Sion Blue","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27204756","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Str 3cm Sion Asahi Ss","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27204757","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in 3 Radiopq Seg Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27204758","EAP","HCPCS C1769","","Guidewire Vasc Rg3","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$312.23 ","$0.00 ","$119.84 ","$410.38 ","$410.38 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"27204759","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$321.17 ","$321.17 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"27204760","EAP","HCPCS C1769","","Catheter Guid Extra Backup 4.5 Left Curve 6fr .071","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204761","EAP","HCPCS C1769","","Catheter Guid Xb 5 Left Curve 6fr .071in 100cm","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204762","EAP","HCPCS C1769","","Catheter Atherectomy .017in .018in 165cm Shapable","BOTH IP/OP","$4,800.00 ","$3,552.00 ","$0.00 ","$4,800.00 ","$2,606.40 ","$0.00 ","$1,000.44 ","$3,425.76 ","$3,425.76 ","$840.44 ","$4,800.00 ","$0.00 ","$2,400.00 ","$3,801.60 ","$3,840.00 ","$0.00 ","$751.20 ","$0.00 ","$764.16 ","$0.00 "
"27204763","EAP","HCPCS C1882","","Catheter Angio .035in Vert Curve 5fr .046in 125cm","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$19.01 ","$0.00 ","$7.29 ","$24.98 ","$24.98 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"27204764","EAP","HCPCS C1887","","Catheter Guid Jr4 Curve 8fr 90cm Coron Sh Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204765","EAP","HCPCS C1887","","Catheter Guid Al1 Curve 8fr 90cm Coron Sh Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204766","EAP","HCPCS C1887","","Catheter Guid 3drc Curve 8fr 90cm Coron Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204767","EAP","HCPCS C1887","","Catheter Guid 3 Dmn Right Curve 8fr .09in 90cm","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204768","EAP","HCPCS C1887","","Catheter Guid Al1.5 Curve 8fr .09in 90cm Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204769","EAP","HCPCS C1887","","Catheter Guid Al1.5 Curve 8fr 90cm Coron Sh Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204770","EAP","HCPCS C1887","","Catheter Guid Al2 Curve 8fr 90cm Coron Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204771","EAP","HCPCS C1887","","Catheter Guid Al2 Curve 8fr .09in 90cm Coron Sh","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204772","EAP","HCPCS C1887","","Catheter Guid Xb4 Curve 8fr 90cm Coron Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204773","EAP","HCPCS C1887","","Catheter Guid Xb3.5 Curve 8fr 90cm Coron Sh Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204774","EAP","HCPCS C1887","","Catheter Guid Ebu3.75 Curve 8fr .09in 90cm Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204775","EAP","HCPCS C1887","","Catheter Guid Xb4 Curve 8fr 90cm Coron Sh Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204776","EAP","HCPCS C1887","","Catheter Guid Al1 Curve 8fr 90cm Coron Lnchr","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204777","EAP","HCPCS C1725","","Catheter Baldilat Lp Taper 4.8fr 6mm 135cm 80mm Ot","BOTH IP/OP","$686.00 ","$507.64 ","$0.00 ","$686.00 ","$372.50 ","$0.00 ","$142.98 ","$489.60 ","$489.60 ","$120.11 ","$686.00 ","$0.00 ","$343.00 ","$543.31 ","$548.80 ","$0.00 ","$107.36 ","$0.00 ","$109.21 ","$0.00 "
"27204778","EAP","Custom 27204778","","Catheter Angio Bcn Sim2 Curve 5fr 125cm Ss Nyl","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$23.55 ","$23.55 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204779","EAP","HCPCS C1887","","Catheter Thrmb 125cm 6fr Neuron Sim Curve Slct","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$169.96 ","$0.00 ","$65.24 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"27204782","EAP","HCPCS C1725","","Catheter Baldilat Lp Taper 3.8fr 4mm 135cm 80mm Otw Inflat","BOTH IP/OP","$686.00 ","$507.64 ","$0.00 ","$686.00 ","$372.50 ","$0.00 ","$142.98 ","$489.60 ","$489.60 ","$120.11 ","$686.00 ","$0.00 ","$343.00 ","$543.31 ","$548.80 ","$0.00 ","$107.36 ","$0.00 ","$109.21 ","$0.00 "
"27204783","EAP","HCPCS C1753","","Catheter Ultrasound .035in 8.5fr 90cm 100cm Otw Radiopq","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,357.50 ","$0.00 ","$521.06 ","$1,784.25 ","$1,784.25 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"27204785","EAP","HCPCS C1725","","Catheter Baldilat Ultra Lp Taper 6fr 4mm 150cm 220mm Coyote","BOTH IP/OP","$857.00 ","$634.18 ","$0.00 ","$857.00 ","$465.35 ","$0.00 ","$178.62 ","$611.64 ","$611.64 ","$150.05 ","$857.00 ","$0.00 ","$428.50 ","$678.74 ","$685.60 ","$0.00 ","$134.12 ","$0.00 ","$136.43 ","$0.00 "
"27204786","EAP","HCPCS C1769","","Guidewire Vascular Str Short Taper .014in 300cm 8cm Robust","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$343.00 ","$186.25 ","$0.00 ","$71.49 ","$244.80 ","$244.80 ","$60.06 ","$343.00 ","$0.00 ","$171.50 ","$271.66 ","$274.40 ","$0.00 ","$53.68 ","$0.00 ","$54.61 ","$0.00 "
"27204787","EAP","Custom 27204787","","Omni Flush (vcf) 5fr 100cm","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204790","EAP","HCPCS C1884","","System Embl Prtc 104.5cm .035in Prox Crbrl Cath","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$2,172.00 ","$0.00 ","$833.70 ","$2,854.80 ","$2,854.80 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"27204791","EAP","CPT� C1894","","Set Introd .018in 5fr 21ga 40c","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"27204792","EAP","Custom 27204792","","Band Compression Regular 24cm 2 Balloon Air Injec Port","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$53.53 ","$53.53 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204793","EAP","Custom 27204793","","Catheter Angiographic .038in 21ml/sec Radial Tiger Curve Str","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204795","EAP","HCPCS C1894","","Introducer Sheath .021in Str Thin Wall 6fr 20ga 10cm 45cm","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$74.93 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"27204796","EAP","Custom 27204796","","Tray Amniocentesis 20ga 3.5in","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$22.84 ","$22.84 ","$0.00 ","$32.00 ","$0.00 ","$16.00 ","$25.34 ","$25.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204797","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Strbl Radiopq Kink Rst","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$20.63 ","$0.00 ","$7.92 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"27204798","EAP","Custom 27204798","","Tube Gastrostomy 20fr 14.25x11.25x9in Handrail Chr","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204799","EAP","Custom 27204799","","Needle Intraosseous 15ga 25mm Ez Connect Wrist Ban","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$981.34 ","$981.34 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204802","EAP","HCPCS C1725","","Catheter Baldilat 5fr 4mm 130cm 80mm Pcltxl","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204806","EAP","HCPCS C1725","","Catheter Baldilat 5fr 5mm 130cm 40mm Pcltxl","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204807","EAP","HCPCS C1725","","Catheter Baldilat 5fr 5mm 130cm 60mm Pcltxl","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204810","EAP","HCPCS C1757","","Solitaire Revascularization Device 4-20-10","BOTH IP/OP","$10,563.00 ","$7,816.62 ","$0.00 ","$10,563.00 ","$5,735.71 ","$0.00 ","$2,201.59 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,563.00 ","$0.00 ","$5,281.50 ","$8,365.90 ","$8,450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204811","EAP","HCPCS C1757","","SOLITAIRE PLATINUM 6X20","BOTH IP/OP","$10,563.00 ","$7,816.62 ","$0.00 ","$10,563.00 ","$5,735.71 ","$0.00 ","$2,201.59 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,563.00 ","$0.00 ","$5,281.50 ","$8,365.90 ","$8,450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204812","EAP","HCPCS C1757","","Solitaire Platinum Revascularization Device 4-40","BOTH IP/OP","$10,563.00 ","$7,816.62 ","$0.00 ","$10,563.00 ","$4,753.35 ","$0.00 ","$2,201.59 ","$5,158.80 ","$7,538.81 ","$0.00 ","$10,563.00 ","$0.00 ","$5,281.50 ","$8,365.90 ","$8,450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204813","EAP","HCPCS C1758","","Catheter Urethral 16fr Foley 2 Way Medium Olive Coude Tip 1","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$14.12 ","$0.00 ","$5.42 ","$18.56 ","$18.56 ","$4.55 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$4.07 ","$0.00 ","$4.14 ","$0.00 "
"27204814","EAP","HCPCS C1887","","Catheter Angiographic Cobra 2 Curve 4fr .041in 65cm 2 Braid","BOTH IP/OP","$613.00 ","$453.62 ","$0.00 ","$613.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$437.50 ","$107.33 ","$613.00 ","$0.00 ","$306.50 ","$485.50 ","$490.40 ","$0.00 ","$95.93 ","$0.00 ","$97.59 ","$0.00 "
"27204817","EAP","HCPCS C1725","","Catheter Baldilat 6mm 130cm 40mm Lutonix Acpt 6fr","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204818","EAP","HCPCS C1725","","Catheter Baldilat 6fr 6mm 130cm 60mm Pcltxl","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204819","EAP","HCPCS C1725","","Catheter Baldilat 6fr 6mm 130cm 80mm Pcltxl","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204822","EAP","HCPCS C1725","","Catheter Baldilat 6fr 6mm 130cm 150mm Pcltxl","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,900.50 ","$0.00 ","$729.49 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27204823","EAP","HCPCS C1894","","Introducer Sheath .038in Stand","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"27204824","EAP","Custom 27204824","","Set Tubing 2.6mr 2 Way Communication Irrigation Pump","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$142.74 ","$142.74 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204825","EAP","HCPCS C1751","","Axs Catalyst 6 Distal Access Catheter","BOTH IP/OP","$4,875.00 ","$3,607.50 ","$0.00 ","$4,875.00 ","$0.00 ","$0.00 ","$0.00 ","$3,479.29 ","$3,479.29 ","$853.57 ","$4,875.00 ","$0.00 ","$2,437.50 ","$3,861.00 ","$3,900.00 ","$0.00 ","$762.94 ","$0.00 ","$776.10 ","$0.00 "
"27204826","EAP","HCPCS C1751","","Axs Catalyst 5 Distal Access Catheter","BOTH IP/OP","$4,875.00 ","$3,607.50 ","$0.00 ","$4,875.00 ","$2,647.13 ","$0.00 ","$1,016.07 ","$3,479.29 ","$3,479.29 ","$853.57 ","$4,875.00 ","$0.00 ","$2,437.50 ","$3,861.00 ","$3,900.00 ","$0.00 ","$762.94 ","$0.00 ","$776.10 ","$0.00 "
"27204827","EAP","HCPCS C1885","","Catheter Angio Kmp Curve Ang 4fr 65cm Radiopq","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$49.96 ","$49.96 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204828","EAP","Custom 27204828","","Bit Drill 25mm 4mm Strl","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$102.06 ","$102.06 ","$0.00 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204830","EAP","Custom 27204830","","Impella Rp Us Hde Pump Set","BOTH IP/OP","$62,500.00 ","$46,250.00 ","$0.00 ","$62,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$62,500.00 ","$0.00 ","$31,250.00 ","$49,500.00 ","$50,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204832","EAP","HCPCS C1894","","Sheath Introd 16fr 6.2mm 5.3mm 28cm Dryseal Dilat","BOTH IP/OP","$668.00 ","$494.32 ","$0.00 ","$668.00 ","$362.72 ","$0.00 ","$139.23 ","$476.75 ","$476.75 ","$116.96 ","$668.00 ","$0.00 ","$334.00 ","$529.06 ","$534.40 ","$0.00 ","$104.54 ","$0.00 ","$106.35 ","$0.00 "
"27204833","EAP","Custom 27204833","","Catheter Baldilat Tpr 10-50mm 65cm Stent Gft Flx","BOTH IP/OP","$1,213.00 ","$897.62 ","$0.00 ","$1,213.00 ","$0.00 ","$0.00 ","$0.00 ","$865.72 ","$865.72 ","$0.00 ","$1,213.00 ","$0.00 ","$606.50 ","$960.70 ","$970.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204835","EAP","HCPCS C1757","","System Thrmb Zelantedvt","BOTH IP/OP","$7,313.00 ","$5,411.62 ","$0.00 ","$7,313.00 ","$3,970.96 ","$0.00 ","$1,524.21 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,313.00 ","$0.00 ","$3,656.50 ","$5,791.90 ","$5,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204840","EAP","HCPCS C1884","","Axs Infinity Ls .088 Long Guide Sheath 90cm","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$794.41 ","$0.00 ","$304.93 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"27204841","EAP","HCPCS C1894","","Axs Infinity Ls .088 Long Guide Sheath 80cm","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$794.41 ","$0.00 ","$304.93 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"27204842","EAP","HCPCS C1773","","Snare Vasc 175cm .16-.32in 3.2fr Ensnr Mini Ntnl 3","BOTH IP/OP","$1,638.00 ","$1,212.12 ","$0.00 ","$1,638.00 ","$889.43 ","$0.00 ","$341.40 ","$1,169.04 ","$1,169.04 ","$286.80 ","$1,638.00 ","$0.00 ","$819.00 ","$1,297.30 ","$1,310.40 ","$0.00 ","$256.35 ","$0.00 ","$260.77 ","$0.00 "
"27204843","EAP","HCPCS C2628","","Er-reboa Catheter","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,708.48 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$0.00 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204844","EAP","HCPCS C1773","","Snare Vasc 47in .71-1.18in .055in .074in Ensnr","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$482.18 ","$0.00 ","$185.08 ","$633.77 ","$633.77 ","$155.48 ","$888.00 ","$0.00 ","$444.00 ","$703.30 ","$710.40 ","$0.00 ","$138.97 ","$0.00 ","$141.37 ","$0.00 "
"27204845","EAP","HCPCS C1894","","Percutaneous Sheath Intro Kit 6f .035in X 10cm","BOTH IP/OP","$788.00 ","$583.12 ","$0.00 ","$788.00 ","$427.88 ","$0.00 ","$164.24 ","$562.40 ","$562.40 ","$137.97 ","$788.00 ","$0.00 ","$394.00 ","$624.10 ","$630.40 ","$0.00 ","$123.32 ","$0.00 ","$125.45 ","$0.00 "
"27204846","EAP","HCPCS C1769","","Pericardio Set And Tray","BOTH IP/OP","$474.00 ","$350.76 ","$0.00 ","$474.00 ","$257.38 ","$0.00 ","$98.79 ","$338.29 ","$338.29 ","$82.99 ","$474.00 ","$0.00 ","$237.00 ","$375.41 ","$379.20 ","$0.00 ","$74.18 ","$0.00 ","$75.46 ","$0.00 "
"27204847","EAP","HCPCS C1894","","Set Catheter .035in 15cm 70cm Sidehole Removable Stylet Tip","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$0.00 ","$0.00 ","$0.00 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27204848","EAP","","","Flexor Ansel Guiding Sheath W/hfd, Check-flo 8f 2.9mm X 70cm Mp","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204849","EAP","HCPCS C1894","","Flexor Ansel Guiding Sheath W/check-flo 7f 2.5mm X 45cm Str","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"27204850","EAP","HCPCS C1725","","Viatrac 14 Plus Rx 5mm X 30mm X 135cm","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$130.27 ","$446.06 ","$446.06 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"27204851","EAP","HCPCS C1769","","X-celerator .010 10cm X 300cm","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$588.80 ","$588.80 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"27204852","EAP","HCPCS C1725","","Mustang 7fr 12.0mm X 60mm, 135cm","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27204853","EAP","Custom 27204853","","Sterling Otw 4mm X 60mm X 135cm","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$0.00 ","$0.00 ","$0.00 ","$488.88 ","$488.88 ","$0.00 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204854","EAP","HCPCS C1725","","Sterling Otw 5mm X 100mm X 135cm","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$371.96 ","$0.00 ","$142.77 ","$488.88 ","$488.88 ","$119.94 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$107.20 ","$0.00 ","$109.05 ","$0.00 "
"27204855","EAP","HCPCS C1725","","Sterling Otw 6mm X 100mm X 135cm","BOTH IP/OP","$685.00 ","$506.90 ","$0.00 ","$685.00 ","$371.96 ","$0.00 ","$142.77 ","$488.88 ","$488.88 ","$119.94 ","$685.00 ","$0.00 ","$342.50 ","$542.52 ","$548.00 ","$0.00 ","$107.20 ","$0.00 ","$109.05 ","$0.00 "
"27204856","EAP","HCPCS C1725","","Coyote 3.5mm X 220mm X 150cm","BOTH IP/OP","$856.00 ","$633.44 ","$0.00 ","$856.00 ","$464.81 ","$0.00 ","$178.41 ","$610.93 ","$610.93 ","$149.88 ","$856.00 ","$0.00 ","$428.00 ","$677.95 ","$684.80 ","$0.00 ","$133.96 ","$0.00 ","$136.28 ","$0.00 "
"27204857","EAP","HCPCS C1894","","Tear-away Intro Sheath 8f 30cm","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$477.00 ","$259.01 ","$0.00 ","$99.42 ","$340.43 ","$340.43 ","$83.52 ","$477.00 ","$0.00 ","$238.50 ","$377.78 ","$381.60 ","$0.00 ","$74.65 ","$0.00 ","$75.94 ","$0.00 "
"27204858","EAP","","","Sterling Otw 4mm X 220mm X 135cm","BOTH IP/OP","$830.00 ","$614.20 ","$0.00 ","$830.00 ","$0.00 ","$0.00 ","$0.00 ","$592.37 ","$592.37 ","$0.00 ","$830.00 ","$0.00 ","$415.00 ","$657.36 ","$664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204860","EAP","HCPCS C1887","","Catheter Guid 47cm Cps Dir 115d Upsize Latex Free","BOTH IP/OP","$1,721.00 ","$1,273.54 ","$0.00 ","$1,721.00 ","$934.50 ","$0.00 ","$358.70 ","$1,228.28 ","$1,228.28 ","$301.33 ","$1,721.00 ","$0.00 ","$860.50 ","$1,363.03 ","$1,376.80 ","$0.00 ","$269.34 ","$0.00 ","$273.98 ","$0.00 "
"27204863","EAP","Custom 27204863","","Needle Port 1in 20ga 5ml/sec Grpr Plus Deltec Pcth","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$0.00 ","$0.00 ","$0.00 ","$144.88 ","$144.88 ","$0.00 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204864","EAP","Custom 27204864","","Needle Port 1.25in 20ga 5ml/sec Grpr Plus Deltec","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$0.00 ","$0.00 ","$0.00 ","$144.88 ","$144.88 ","$0.00 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204865","EAP","Custom 27204865","","Introd Shth 9fr 14cm Hmsts Gwire Plwy .038in Trnsp","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$53.53 ","$53.53 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204870","EAP","HCPCS C1887","","Catheter Delivery System 0-.02in Micro Str 2.6-2.95fr .025in","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$0.00 ","$2,325.00 ","$1,262.48 ","$0.00 ","$484.59 ","$1,659.35 ","$1,659.35 ","$407.09 ","$2,325.00 ","$0.00 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$0.00 ","$363.86 ","$0.00 ","$370.14 ","$0.00 "
"27204871","EAP","Custom 27204871","","Axs Catalyst 5 Distal Access Catheter 0.058in X 115cm","BOTH IP/OP","$3,878.00 ","$2,869.72 ","$0.00 ","$3,878.00 ","$0.00 ","$0.00 ","$0.00 ","$2,767.73 ","$2,767.73 ","$0.00 ","$3,878.00 ","$0.00 ","$1,939.00 ","$3,071.38 ","$3,102.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204873","EAP","HCPCS C1887","","Terumo Medical Corp- Div Terumo Group","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27204874","EAP","HCPCS C1887","","Catheter Angio Radl Tiger 4.5 Curve 5fr 110cm","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27204875","EAP","HCPCS C1887","","Catheter Angio Sarah Radl 4 Curve 5fr 110cm Coron","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27204876","EAP","HCPCS C1887","","Catheter Angio Radialtiger Curve 6fr 4mm 110cm","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27204879","EAP","HCPCS C1887","","Catheter Angio Sarah Radl Curve 6fr 4mm 110cm","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27204880","EAP","HCPCS C1769","","Gui Vas St Str .035in 260cm Flexible Tip","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$20.84 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"27204881","EAP","HCPCS C1725","","Cat Baldi Lp 5.3fr 8mm 75cm 100mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$0.00 ","$0.00 ","$0.00 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204883","EAP","HCPCS C1894","","Int Sheath .035in 7fr .1in 70cm Anl0 Curve Str Tip","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204884","EAP","HCPCS C1725","","Cat Bald .018in 6fr 5mm 135mm 60mm Otw Lp Infl","BOTH IP/OP","$713.00 ","$527.62 ","$0.00 ","$713.00 ","$0.00 ","$0.00 ","$0.00 ","$508.87 ","$508.87 ","$124.84 ","$713.00 ","$0.00 ","$356.50 ","$564.70 ","$570.40 ","$0.00 ","$111.58 ","$0.00 ","$113.51 ","$0.00 "
"27204885","EAP","HCPCS C1725","","Cat Bald 6mm 75cm 40mm High Pres Lp Infla Pt","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204886","EAP","HCPCS C1887","","Cat Guid Micro Str 3-2.4fr .021in 130cm 30cm Rad","BOTH IP/OP","$806.00 ","$596.44 ","$0.00 ","$806.00 ","$0.00 ","$0.00 ","$0.00 ","$575.24 ","$575.24 ","$141.12 ","$806.00 ","$0.00 ","$403.00 ","$638.35 ","$644.80 ","$0.00 ","$126.14 ","$0.00 ","$128.32 ","$0.00 "
"27204887","EAP","HCPCS C1725","","Cat Bald 5fr 9mm 75cm 60mm High Pres Lp Infl","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204888","EAP","HCPCS C1725","","Cat Bald Lp 5.8fr 12mm 75cm 60mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204889","EAP","HCPCS C1894","","Sth Gui .018-.038in Anl2 Crve 6fr .087in 90cm Radi","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27204890","EAP","HCPCS C1725","","Cat Bald Ult Lp Tap 6fr 2.5mm 150cm 100mm Otw","BOTH IP/OP","$686.00 ","$507.64 ","$0.00 ","$686.00 ","$372.50 ","$0.00 ","$142.98 ","$489.60 ","$489.60 ","$120.11 ","$686.00 ","$0.00 ","$343.00 ","$543.31 ","$548.80 ","$0.00 ","$107.36 ","$0.00 ","$109.21 ","$0.00 "
"27204891","EAP","HCPCS C1725","","Cat Bald Lp 5.3fr 7mm 135cm 150mm High Pres","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27204892","EAP","HCPCS C1725","","Cat Bald Lp 5.3fr 5mm 75cm 20mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204893","EAP","HCPCS C1725","","Cat Bald Lp 5.3fr 9mm 75cm 20mm High Pres","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"27204894","EAP","HCPCS C1725","","Cat Bald 5.8fr 10mm 75cm 60mm High Pres Lp","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$0.00 ","$0.00 ","$0.00 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204896","EAP","HCPCS C1725","","Cat Bald Lp 5.3fr 7mm 135cm 100mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204898","EAP","HCPCS C1725","","Cat Bald 14 Atm Ult Lp 6fr 2.5mm 143cm 20mm","BOTH IP/OP","$713.00 ","$527.62 ","$0.00 ","$713.00 ","$0.00 ","$0.00 ","$0.00 ","$508.87 ","$508.87 ","$124.84 ","$713.00 ","$0.00 ","$356.50 ","$564.70 ","$570.40 ","$0.00 ","$111.58 ","$0.00 ","$113.51 ","$0.00 "
"27204899","EAP","HCPCS C1725","","Cat Bald Lp 5.3fr 6mm 135cm 60mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204900","EAP","HCPCS C1892","","Introd Shth 7fr .092in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$14.09 ","$0.00 ","$14.33 ","$0.00 "
"27204901","EAP","HCPCS C1892","","Introd Shth 7fr .092in 25cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$57.02 ","$0.00 ","$21.88 ","$74.94 ","$74.94 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"27204902","EAP","Custom 27204902","","Starclose Se","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204903","EAP","Custom 27204903","","System Embolization Nonadhesive Delivery Syringe L","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$4,014.56 ","$4,014.56 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204910","EAP","HCPCS C1894","","Shth Gu .018/.038in Anl1 Cve 6fr .087in 45cm Rad","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"27204911","EAP","HCPCS C1725","","Cat Bald Ula Lp Tper 6fr 2mm 150cm 100mm","BOTH IP/OP","$686.00 ","$507.64 ","$0.00 ","$686.00 ","$0.00 ","$0.00 ","$0.00 ","$489.60 ","$489.60 ","$120.11 ","$686.00 ","$0.00 ","$343.00 ","$543.31 ","$548.80 ","$0.00 ","$107.36 ","$0.00 ","$109.21 ","$0.00 "
"27204912","EAP","HCPCS C1725","","Catr Bald 14 Atm Lp Taer 7fr 5mm 150cm 150mm","BOTH IP/OP","$754.00 ","$557.96 ","$0.00 ","$754.00 ","$409.42 ","$0.00 ","$157.15 ","$538.13 ","$538.13 ","$132.02 ","$754.00 ","$0.00 ","$377.00 ","$597.17 ","$603.20 ","$0.00 ","$118.00 ","$0.00 ","$120.04 ","$0.00 "
"27204913","EAP","HCPCS C1725","","Catbald Lp 5.3fr 7mm 135cm 60mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204914","EAP","HCPCS C1725","","Cat Bald .035in 7mm 75cm 60mm High Pres Lp","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204916","EAP","HCPCS C1725","","Cat Bald .035in 8mm 75cm 60mm High Pre Lp","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204917","EAP","HCPCS C1725","","Cat Bald Lp 5.8fr 9mm 135cm 60mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204918","EAP","HCPCS C1725","","Cat Guid Ebu3.75 Curve 7fr .081in 100cm Luch","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27204919","EAP","HCPCS C1725","","Cat Bald .035in 6mm 75cm 60mm High Pres Lp","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27204920","EAP","HCPCS C1830","","Biopsy System Comprehensive Tray 102mm","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$249.80 ","$249.80 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204921","EAP","HCPCS C1830","","Biopsy System Comprehensive Tray 152mm","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$249.80 ","$249.80 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204923","EAP","HCPCS C1830","","Oncontrol Biopsy System Tray 152mm","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$231.95 ","$231.95 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204924","EAP","Custom 27204924","","Oncontrol Coaxial Tray 6cm 11/13 Gauge","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$0.00 ","$0.00 ","$0.00 ","$669.45 ","$669.45 ","$0.00 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204925","EAP","Custom 27204925","","Oncontrol Coaxial Tray 10cm 11/13 Gauge","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$0.00 ","$0.00 ","$0.00 ","$669.45 ","$669.45 ","$0.00 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204926","EAP","Custom 27204926","","Oncontrol Coaxial Tray 15cm 11/13 Gauge","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$0.00 ","$0.00 ","$0.00 ","$669.45 ","$669.45 ","$0.00 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204927","EAP","HCPCS C1769","","Guidewire Vasc 185cm Strl Lf Verrata + Prss Disp","BOTH IP/OP","$1,688.00 ","$1,249.12 ","$0.00 ","$1,688.00 ","$916.58 ","$0.00 ","$351.82 ","$1,204.73 ","$1,204.73 ","$295.56 ","$1,688.00 ","$0.00 ","$844.00 ","$1,336.90 ","$1,350.40 ","$0.00 ","$264.17 ","$0.00 ","$268.73 ","$0.00 "
"27204928","EAP","HCPCS C2628","","Catheter Baldilat 9fr 32mm 120cm 2 Lum Radiopq","BOTH IP/OP","$1,430.00 ","$1,058.20 ","$0.00 ","$1,430.00 ","$776.49 ","$0.00 ","$298.05 ","$1,020.59 ","$1,020.59 ","$0.00 ","$1,430.00 ","$0.00 ","$715.00 ","$1,132.56 ","$1,144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204930","EAP","HCPCS C1769","","Gwire Vasc .038in 180cm Strl 3cm Merit Laurea","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$43.44 ","$0.00 ","$16.67 ","$57.10 ","$57.10 ","$14.01 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$12.52 ","$0.00 ","$12.74 ","$0.00 "
"27204932","EAP","HCPCS C1769","","Gdwre Vasc Tper .038in 145cm 6cm Str Tip Am","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$43.54 ","$43.54 ","$10.68 ","$61.00 ","$0.00 ","$30.50 ","$48.31 ","$48.80 ","$0.00 ","$9.55 ","$0.00 ","$9.71 ","$0.00 "
"27204933","EAP","HCPCS C1769","","Set Cat 15.5fr 24cm 3 Lumen Bas Gwire Dil Scal","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$150.95 ","$0.00 ","$57.94 ","$198.41 ","$198.41 ","$48.68 ","$278.00 ","$0.00 ","$139.00 ","$220.18 ","$222.40 ","$0.00 ","$43.51 ","$0.00 ","$44.26 ","$0.00 "
"27204941","EAP","HCPCS C1769","","Set Cath 20cm 15.5fr 3 Lum Basic Gwire Dilat Scpl","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$0.00 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27204942","EAP","HCPCS C1753","","Catheter Us Kodama","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"27204943","EAP","Custom 27204943","","Glove Compression Large Open Finger Seamless Latex Free Pr","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204944","EAP","Custom 27204944","","Glove Cmpr Xs 5-6in Lf Istnr F F Thrp Mach Wshbl 80% Nyl 20% Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204945","EAP","Custom 27204945","","Glove Cmpr Med Lf Istnr Anemb F F L/r Hnd Edema Cntrl Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204946","EAP","Custom 27204946","","Glove Cmpr Sm 23-32 Mmhg 6-7in Lf Istnr F F Thrp Nyl Spndx Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204947","EAP","Custom 27204947","","Glove Cmpr Lg 23-32 Mmhg 8-9in Lf Istnr F F Thrp Nyl Spndx Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204948","EAP","Custom 27204948","","Glove Cmpr Xs 5-6in Lf Istnr Opn Fngr Ltwt Blnd Smls Sprt Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204949","EAP","Custom 27204949","","Glove Cmpr Sm Lf Istnr Opn Fngr Smls 80% Nyl 20% Spndx 23-32 Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204950","EAP","Custom 27204950","","Glove Cmpr Md Lf Istnr Opn Fngr Smls 80% Nyl 20% Spndx 23-32 Pr","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204951","EAP","Custom 27204951","","Sphere Embl Ylw Embsph 100-300um Mcsph Ns Prefl","BOTH IP/OP","$608.00 ","$449.92 ","$0.00 ","$608.00 ","$0.00 ","$0.00 ","$0.00 ","$433.93 ","$433.93 ","$0.00 ","$608.00 ","$0.00 ","$304.00 ","$481.54 ","$486.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204952","EAP","Custom 27204952","","Sphere Embl Blue Embsph 300-500um Mcsph Ns Prefl","BOTH IP/OP","$608.00 ","$449.92 ","$0.00 ","$608.00 ","$0.00 ","$0.00 ","$0.00 ","$433.93 ","$433.93 ","$0.00 ","$608.00 ","$0.00 ","$304.00 ","$481.54 ","$486.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204953","EAP","CPT� C1894","","Set Intro 5fr Mcstk Ntnl Wre Radopq Tip Coax Stf","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"27204954","EAP","CPT� C1894","","Set Intro 5fr Mcstk Radopq Coax Stf Wre Ntnl","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$8.34 ","$28.55 ","$28.55 ","$7.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$6.26 ","$0.00 ","$6.37 ","$0.00 "
"27205000","EAP","HCPCS C1769","","Guidewire Vasc 175cm .014in Radiopq Tip Snsr Elmt","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27205001","EAP","Custom 27205001","","Introd Shth 11fr .144in 25cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205003","EAP","Custom 27205003","","Introd Shth 10fr .131in 25cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205004","EAP","Custom 27205004","","Introd Shth 10.5fr .138in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205005","EAP","Custom 27205005","","Introd Shth 10fr .131in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205006","EAP","Custom 27205006","","Introd Shth 11fr .144in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205007","EAP","Custom 27205007","","Introd Shth 12.5fr .164in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205008","EAP","Custom 27205008","","Introd Shth 12fr .158in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205009","EAP","Custom 27205009","","Introd Shth 6fr .083in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205010","EAP","Custom 27205010","","Introd Shth 8.5fr .112in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205011","EAP","Custom 27205011","","Introd Shth 8fr .105in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205012","EAP","Custom 27205012","","Introd Shth 9.5fr .125in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205013","EAP","Custom 27205013","","Introd Shth 9fr .118in 13cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$191.00 ","$141.34 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205014","EAP","Custom 27205014","","Introd Shth 6fr .083in 25cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205015","EAP","Custom 27205015","","Introd Shth 9fr .118in 25cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205016","EAP","Custom 27205016","","Introd Shth 8fr .083in 25cm Rbst Vlv Splt Sdprt","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205017","EAP","HCPCS C1894","","Introd Shth 7fr 13cm 19.5cm 3w Stpck Traw Hmst Vlv","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$79.28 ","$0.00 ","$30.43 ","$104.20 ","$104.20 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.85 ","$0.00 ","$23.24 ","$0.00 "
"27205018","EAP","HCPCS C1894","","Introd Shth 9fr 13cm 19.5cm 3w Stpck Traw Hmst Vlv","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$79.28 ","$0.00 ","$30.43 ","$104.20 ","$104.20 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.85 ","$0.00 ","$23.24 ","$0.00 "
"27205019","EAP","HCPCS C1894","","Introd Lead 23cm 7fr Sfshth Ult Hmst Vlv Lp Traw","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$79.28 ","$0.00 ","$30.43 ","$104.20 ","$104.20 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.85 ","$0.00 ","$23.24 ","$0.00 "
"27205021","EAP","HCPCS C1887","","Catheter Infus Mic .027in Phenom","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"27205022","EAP","HCPCS C1887","","Catheter Infus 30cm .040in .036in .027in Phenom","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"27205023","EAP","HCPCS C1887","","Catheter Infs Mic .17in Phenom","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"27205024","EAP","HCPCS C1887","","Catheter Infus 105cm .061in .055in .044in Phenom","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"27205025","EAP","HCPCS C1887","","Catheter Infs Mic .45in Phenom","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"27205026","EAP","HCPCS C1769","","Kit Cath 13.5fr 16cm Strl Mh Q+ Strg Xtn Pu Hmdial","BOTH IP/OP","$115.00 ","$85.10 ","$0.00 ","$115.00 ","$62.45 ","$0.00 ","$23.97 ","$82.08 ","$82.08 ","$20.14 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$18.00 ","$0.00 ","$18.31 ","$0.00 "
"27205027","EAP","HCPCS C1769","","Kit Cath 19.5cm 13.5fr Pu Mh Q+ Str Extn Hmdial","BOTH IP/OP","$115.00 ","$85.10 ","$0.00 ","$115.00 ","$62.45 ","$0.00 ","$23.97 ","$82.08 ","$82.08 ","$20.14 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$18.00 ","$0.00 ","$18.31 ","$0.00 "
"27205028","EAP","HCPCS C1769","","Kit Cath Strg 13.5fr 24cm 7cm Mh Q+ 2 Lum Xtn Pu Hmdial","BOTH IP/OP","$115.00 ","$85.10 ","$0.00 ","$115.00 ","$62.45 ","$0.00 ","$23.97 ","$82.08 ","$82.08 ","$20.14 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$18.00 ","$0.00 ","$18.31 ","$0.00 "
"27205029","EAP","HCPCS C1769","","Guidewire Vascular 15d .018in 180cm 5cm Intermedia","BOTH IP/OP","$216.00 ","$159.84 ","$0.00 ","$216.00 ","$117.29 ","$0.00 ","$45.02 ","$154.16 ","$154.16 ","$37.82 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$33.80 ","$0.00 ","$34.39 ","$0.00 "
"27205032","EAP","Custom 27205032","","Kit Biopsy Tlab Metal Straight Curve L60 Cm L65 Cm","BOTH IP/OP","$1,350.00 ","$999.00 ","$0.00 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$963.50 ","$963.50 ","$0.00 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205033","EAP","HCPCS C1884","","System Embolic Protection 3.2-4.2fr 6mm 320cm 190c","BOTH IP/OP","$3,488.00 ","$2,581.12 ","$0.00 ","$3,488.00 ","$1,893.98 ","$0.00 ","$726.99 ","$2,489.39 ","$2,489.39 ","$610.72 ","$3,488.00 ","$0.00 ","$1,744.00 ","$2,762.50 ","$2,790.40 ","$0.00 ","$545.87 ","$0.00 ","$555.29 ","$0.00 "
"27205035","EAP","Custom 27205035","","Catheter Intvn 180- D 2.4-2.9fr .021in 125cm Swift","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205036","EAP","HCPCS C1725","","Catheter Baldilat Ultra Lp 5fr 1.5mm 12mm 2 Lumen","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27205037","EAP","HCPCS C1725","","Catheter Baldilat Ultra Lp 5fr 1.5mm 15mm 2 Lumen","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27205038","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 10mm Rapex Legend Semicom","BOTH IP/OP","$1,033.00 ","$764.42 ","$0.00 ","$1,033.00 ","$560.92 ","$0.00 ","$215.30 ","$737.25 ","$737.25 ","$180.87 ","$1,033.00 ","$0.00 ","$516.50 ","$818.14 ","$826.40 ","$0.00 ","$161.66 ","$0.00 ","$164.45 ","$0.00 "
"27205039","EAP","HCPCS C1725","","Catheter Baldilat Lp 5.3fr 4mm 75cm 20mm High Pres","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27205040","EAP","HCPCS C1725","","Catheter Baldilat Ultra Lp 5fr 1.5mm 20mm 2 Lumen","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27205041","EAP","HCPCS C1725","","Catheter Baldilat Ultra Lp 5fr 1.5mm 6mm 2 Lumen R","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27205042","EAP","HCPCS C1725","","Catheter Baldilat Ultra Lp 5fr 1.5mm 8mm 2 Lumen R","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27205051","EAP","HCPCS C1769","","Catheter Gd Strg 6fr 115cm Strl Lf Sofia Disp Strk","BOTH IP/OP","$4,990.00 ","$3,692.60 ","$0.00 ","$4,990.00 ","$2,709.57 ","$0.00 ","$1,040.04 ","$3,561.36 ","$3,561.36 ","$873.71 ","$4,990.00 ","$0.00 ","$2,495.00 ","$3,952.08 ","$3,992.00 ","$0.00 ","$780.94 ","$0.00 ","$794.41 ","$0.00 "
"27205052","EAP","HCPCS C1887","","Catheter Angio Sim 1 Crv 5fr .043in 100cm Gldcath Xp Gld Tch","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$122.00 ","$0.00 ","$0.00 ","$0.00 ","$87.07 ","$87.07 ","$21.36 ","$122.00 ","$0.00 ","$61.00 ","$96.62 ","$97.60 ","$0.00 ","$19.09 ","$0.00 ","$19.42 ","$0.00 "
"27205054","EAP","HCPCS C1887","","Catheter Angio Ang 5fr .043in 100cm Gldcath Xp Gld Tch 1 Brd","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$122.00 ","$0.00 ","$0.00 ","$0.00 ","$87.07 ","$87.07 ","$21.36 ","$122.00 ","$0.00 ","$61.00 ","$96.62 ","$97.60 ","$0.00 ","$19.09 ","$0.00 ","$19.42 ","$0.00 "
"27205055","EAP","HCPCS C1769","","Guidewire Vasc 90d .018in 180cm 25cm Gldwr Gt Hdrph","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$306.89 ","$306.89 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"27205056","EAP","Custom 27205056","","Catheter Balloon� 6x100mm 135c","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$203.40 ","$203.40 ","$0.00 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205057","EAP","HCPCS C1887","","Catheter Angio .035in 135cm Navicross Strg Tip","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205058","EAP","HCPCS C1887","","Catheter Angio .035in 65cm Navicross Strg Tip","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205059","EAP","HCPCS C1887","","Catheter Angio .038in 1 Crv 5fr 100cm 15cm Gldcath Xp 2","BOTH IP/OP","$121.88 ","$90.19 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$0.00 ","$86.99 ","$86.99 ","$21.34 ","$121.88 ","$0.00 ","$60.94 ","$96.53 ","$97.50 ","$0.00 ","$19.07 ","$0.00 ","$19.40 ","$0.00 "
"27205060","EAP","HCPCS C1887","","Catheter Angio .038in 5fr 100cm 15cm Gldcath Xp 2 Braid Pu","BOTH IP/OP","$121.88 ","$90.19 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$0.00 ","$86.99 ","$86.99 ","$21.34 ","$121.88 ","$0.00 ","$60.94 ","$96.53 ","$97.50 ","$0.00 ","$19.07 ","$0.00 ","$19.40 ","$0.00 "
"27205061","EAP","HCPCS C1887","","Catheter Angio .038in 5fr 65cm 15cm Gldcath Xp 2 Braid Pu","BOTH IP/OP","$121.88 ","$90.19 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$0.00 ","$86.99 ","$86.99 ","$21.34 ","$121.88 ","$0.00 ","$60.94 ","$96.53 ","$97.50 ","$0.00 ","$19.07 ","$0.00 ","$19.40 ","$0.00 "
"27205062","EAP","HCPCS C1887","","Catheter Angio .038in 5fr 70cm Gldcath Yashiro Tip","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$99.92 ","$99.92 ","$24.51 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$21.91 ","$0.00 ","$22.29 ","$0.00 "
"27205063","EAP","HCPCS C1887","","Catheter Angio .038in J Crv 4fr 65cm 15cm Gldcath Gw Hdrph","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205064","EAP","HCPCS C1887","","Catheter Angio .038in J Crv 5fr 65cm 25cm Gldcath Gw Hdrph","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205065","EAP","HCPCS C1887","","Catheter Angio .038in Jb2 Crv 4fr 100cm 15cm Gldcath Gw","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205066","EAP","HCPCS C1887","","Catheter Angio .038in Jb2 Crv 5fr 100cm 40cm Gldcath Tpr Gw","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205067","EAP","HCPCS C1887","","Catheter Angio .038in Mani Crv 4fr 100cm 15cm Gldcath Gw","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205068","EAP","HCPCS C1887","","Catheter Angio .038in Mani Crv 5fr 100cm 40cm Gldcath Gw","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205069","EAP","HCPCS C1887","","Catheter Angio .038in Sim1 Crv 4fr 100cm 15cm Gldcath Gw","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205070","EAP","HCPCS C1887","","Catheter Angio .038in Sim2 Crv 5fr 65cm Gldcath 1 Braid","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205071","EAP","HCPCS C1887","","Catheter Angio .038in Sim3 Crv 4fr 100cm 15cm Gldcath Gw","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205072","EAP","HCPCS C1887","","Catheter Angio 150cm Navicross Radopq Strg Tip Ss Hdrph","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205073","EAP","HCPCS C1887","","Catheter Angio 30d 12mm 135cm Navicross 3 Radopq Sprt Ss","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205074","EAP","HCPCS C1887","","Catheter Angio 30d 12mm 65cm Navicross 3 Radopq Sprt Ss","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205075","EAP","HCPCS C1887","","Catheter Angio 30d 150cm Navicross Sprt Radopq Ang Tip Hdrph","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205076","EAP","HCPCS C1887","","Catheter Angio 4fr","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$99.92 ","$99.92 ","$24.51 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$21.91 ","$0.00 ","$22.29 ","$0.00 "
"27205077","EAP","HCPCS C1887","","Catheter Angio 4fr .041in 150cm Gldcath Gld Tch Ang Tip 2","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205078","EAP","HCPCS C1887","","Catheter Angio Ang 4fr .041in 120cm Gldcath Gld Tch 2 Brd Ss","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205080","EAP","HCPCS C1887","","Catheter Angio Cbr 1 Crv 4fr .041in 65cm Gldcath Gld Tch 2","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205081","EAP","HCPCS C1887","","Catheter Angio Cbr 1 Crv 5fr .047in 65cm Gldcath Gld Tch 1","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205082","EAP","HCPCS C1887","","Catheter Angio Cbr 2 Crv 4fr .041in 100cm Gldcath Gld Tch 2","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205083","EAP","HCPCS C1887","","Catheter Angio Cbr 2 Crv 5fr .047in 100cm Gldcath Gld Tch 1","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205084","EAP","HCPCS C1887","","Catheter Angio Cbr 2 Crv 5fr 65cm 15cm Gldcath Xp 2 Brd Jkt","BOTH IP/OP","$121.88 ","$90.19 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$0.00 ","$86.99 ","$86.99 ","$21.34 ","$121.88 ","$0.00 ","$60.94 ","$96.53 ","$97.50 ","$0.00 ","$19.07 ","$0.00 ","$19.40 ","$0.00 "
"27205085","EAP","HCPCS C1887","","Catheter Angio Hdhntr 1 Crv 4fr .041in 100cm Gldcath Gld Tch","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205086","EAP","HCPCS C1887","","Catheter Angio Mp Crv 4fr .041in 100cm Gldcath Gld Tch 2 Brd","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205088","EAP","HCPCS C1887","","Catheter Angio Pv Mc 4fr 150cm Gldcath 2 Braid Hdrph Ss","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205089","EAP","","","Catheter Angio Rbt Crv 5fr 90cm Trnb Ad Acpt .035in Gw","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$23.20 ","$23.20 ","$0.00 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205090","EAP","HCPCS C1887","","Catheter Angio Sim2 Crv 4fr 100cm 15cm Gldcath 2 Ss Braid Pu","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205091","EAP","HCPCS C1887","","Catheter Angio Strg 4fr 150cm Gldcath 2 Braid Hdrph Ss","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205092","EAP","HCPCS C1887","","Catheter Angio Strg 5fr 150cm Gldcath Xp 2 Braid Hdrph Ss","BOTH IP/OP","$121.88 ","$90.19 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$0.00 ","$86.99 ","$86.99 ","$21.34 ","$121.88 ","$0.00 ","$60.94 ","$96.53 ","$97.50 ","$0.00 ","$19.07 ","$0.00 ","$19.40 ","$0.00 "
"27205093","EAP","HCPCS C1887","","Catheter Angio Strg Crv 4fr .041in 100cm Gldcath Gld Tch 2","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205094","EAP","HCPCS C1887","","Catheter Angio Strg Crv 4fr .041in 120cm Gldcath Gld Tch 2","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205095","EAP","HCPCS C1887","","Catheter Angio Strg Crv 4fr .041in 65cm Gldcath Gld Tch 2","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205096","EAP","HCPCS C1887","","Catheter Angio Strg Crv 5fr .043in 65cm Gldcath Xp Gld Tch 1","BOTH IP/OP","$121.88 ","$90.19 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$0.00 ","$86.99 ","$86.99 ","$21.34 ","$121.88 ","$0.00 ","$60.94 ","$96.53 ","$97.50 ","$0.00 ","$19.07 ","$0.00 ","$19.40 ","$0.00 "
"27205097","EAP","HCPCS C1887","","Catheter Angio Strg Crv 5fr .047in 65cm Gldcath Gld Tch 1","BOTH IP/OP","$121.38 ","$89.82 ","$0.00 ","$121.38 ","$0.00 ","$0.00 ","$0.00 ","$86.63 ","$86.63 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"27205098","EAP","HCPCS C1725","","Catheter Blndil .035in 6fr 3mm 90cm 120mm Metacross Rx Peri","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205099","EAP","HCPCS C1725","","Catheter Blndil 2.5mm 150cm 200mm Crosperio Otw Pta","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205100","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 150cm 20mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205101","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 150cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205102","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 150cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205103","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 90cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205104","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 90cm 20mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205105","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 90cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205106","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 1.5mm 90cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205107","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 150cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205108","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 150cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205109","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 150cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205110","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 150cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205111","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 90cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205112","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 90cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205113","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 90cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205114","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 90cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205115","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2.5mm 90cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205116","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 150cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205117","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 150cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205118","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 150cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205119","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 90cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205120","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 90cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205121","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 90cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205122","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 90cm 40mm Crosperio Rx Tpr Cor Wre","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205123","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 2mm 90cm 80mm Crosperio Rx Tpr Cor Wre","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205124","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 150cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205125","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 150cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205126","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 90cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205127","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 90cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205128","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 90cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205129","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 90cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205130","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3.5mm 90cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205131","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 150cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205132","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 150cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205133","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 150cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205134","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 90cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205135","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 90cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205136","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 90cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205138","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 3mm 90cm 80mm Crosperio Rx Tpr Cor Wre","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205139","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 4mm 150cm 40mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205140","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 4mm 150cm 80mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205141","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 4mm 90cm 120mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205142","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 4mm 90cm 150mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205143","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 4mm 90cm 40mm Crosperio Rx Tpr Cor Wre","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205144","EAP","HCPCS C1725","","Catheter Blndil 3.5fr 4mm 90cm 80mm Crosperio Rx Tpr Cor Wre","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205145","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 150cm 120mm Crosperio Otw Tpr","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205146","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 150cm 20mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205147","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 150cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205148","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 150cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205149","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 65cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205150","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 65cm 20mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205151","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 65cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205152","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 65cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205153","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 90cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205154","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 90cm 20mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205155","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 90cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205156","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 1.5mm 90cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205157","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 150cm 120mm Crosperio Otw Tpr","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205158","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 150cm 150mm Crosperio Otw Tpr","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205159","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 150cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205161","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 65cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205162","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 65cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205163","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 65cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205164","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 65cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205165","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 65cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205166","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 90cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205167","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 90cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205168","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 90cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205169","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 90cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205170","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2.5mm 90cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205171","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 150cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205172","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 150cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205173","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 150cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205174","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 150cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205175","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 150cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205176","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 65cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205177","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 65cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205178","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 65cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205179","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 65cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205180","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 65cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205181","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 90cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205182","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 90cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205183","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 90cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205184","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 90cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205185","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 2mm 90cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205186","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 150cm 120mm Crosperio Otw Tpr","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205187","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 150cm 150mm Crosperio Otw Tpr","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205188","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 150cm 200mm Crosperio Otw Tpr","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205189","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 150cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205190","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 150cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205191","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 65cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205192","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 65cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205193","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 65cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205194","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 65cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205195","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 65cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205196","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 90cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205197","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 90cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205198","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 90cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205199","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 90cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205200","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3.5mm 90cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205201","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 150cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205202","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 150cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205203","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 150cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205204","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 150cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205205","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 65cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205206","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 65cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205207","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 65cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205208","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 65cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205209","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 65cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205210","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 90cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205211","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 90cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205212","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 90cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205213","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 3mm 90cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205214","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 150cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205215","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 150cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205216","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 150cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205217","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 150cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205218","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 65cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205219","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 65cm 150mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205220","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 65cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205221","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 65cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205222","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 65cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205223","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 90cm 120mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205224","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 90cm 200mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205225","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 90cm 40mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205226","EAP","HCPCS C1725","","Catheter Blndil 3.8fr 4mm 90cm 80mm Crosperio Otw Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205227","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 100mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205228","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 120mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205229","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 150mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205230","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 200mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205231","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 20mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205232","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 40mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205233","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 60mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205234","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 150cm 80mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205235","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 100mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205236","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 120mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205237","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 150mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205238","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 200mm Crosstella Otw Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205239","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205240","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205241","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205242","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2.5mm 90cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205243","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205244","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205245","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205246","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205247","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205248","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205249","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205250","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 150cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205251","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205252","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205253","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205254","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205255","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205256","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205257","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205258","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 2mm 90cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205259","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205260","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205261","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205262","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205263","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205264","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205265","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205266","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 150cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205267","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205268","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205269","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205270","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205271","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205272","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205273","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205274","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 3mm 90cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205275","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205276","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205277","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205278","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205279","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205280","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205281","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205282","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 150cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205283","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205284","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205285","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205286","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205287","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205288","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205289","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205290","EAP","HCPCS C1725","","Catheter Blndil 3.9fr 4mm 90cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205291","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205292","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205293","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205294","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205295","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205296","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205297","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205298","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205299","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205300","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 150cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205301","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205302","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205303","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205304","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205305","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205306","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205307","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 40mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205308","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205309","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 5mm 90cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205310","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 150cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205311","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 150cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205312","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 150cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205313","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 150cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205314","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 150cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205315","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 150cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205316","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 100mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205317","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 120mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205318","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 150mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205319","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 200mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205320","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 20mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205321","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 60mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205322","EAP","HCPCS C1725","","Catheter Blndil 4.3fr 6mm 90cm 80mm Crosstella Otw Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205323","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205324","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205325","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205326","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 200mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205327","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 20mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205328","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 40mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205329","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 60mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205330","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 150cm 80mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205331","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205332","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205333","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205334","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 200mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205335","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 20mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205336","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 40mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205337","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 60mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205338","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2.5mm 90cm 80mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205339","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205340","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205341","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205342","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205343","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 200mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205344","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205345","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205346","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205347","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 150cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205348","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 100mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205349","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 120mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205350","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 150mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205351","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 200mm Crosperio Rx Tpr Cor","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205352","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 200mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205353","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205354","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205355","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205356","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 2mm 90cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205357","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205358","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205359","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205360","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 200mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205361","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205362","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205363","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205364","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 150cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205365","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 100mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205366","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 120mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205367","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 150mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205368","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 200mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205369","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205370","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205371","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205372","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 3mm 90cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205373","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205374","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205375","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205376","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 200mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205377","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205378","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205379","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205380","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 150cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205381","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 100mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205382","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 120mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205383","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 150mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205384","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 200mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205385","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205386","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205387","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205388","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 4mm 90cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205389","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 150cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205390","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 150cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205391","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 150cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205392","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 150cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205393","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 150cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205394","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 90cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205395","EAP","HCPCS C1725","","Catheter Blndil 4-3.4fr 5mm 90cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205396","EAP","HCPCS C1725","","Catheter Blndil 4-3.9fr 6mm 150cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205397","EAP","HCPCS C1725","","Catheter Blndil 4-3.9fr 6mm 150cm 40mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205398","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 150cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205399","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 150cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205401","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 90cm 100mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205402","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 90cm 120mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205403","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 90cm 150mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205404","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 90cm 200mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205405","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 90cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205406","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 5mm 90cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205407","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 150cm 100mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205408","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 150cm 120mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205409","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 150cm 150mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205410","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 150cm 200mm Crosstella Rx Tpr","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205411","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 150cm 60mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205412","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 150cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205413","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 90cm 100mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205414","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 90cm 120mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205415","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 90cm 150mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205416","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 90cm 200mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205417","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 90cm 20mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205419","EAP","HCPCS C1725","","Catheter Blndil 4-4.1fr 6mm 90cm 80mm Crosstella Rx Tpr Cor","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205420","EAP","HCPCS C1725","","Catheter Blndil 4fr 1.5mm 150cm 120mm Crosperio Rx Acpt .014","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205421","EAP","HCPCS C1725","","Catheter Blndil 4fr 2.5mm 150cm 150mm Crosperio Rx Acpt .014","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205422","EAP","HCPCS C1725","","Catheter Blndil 4fr 2mm 150cm 120mm Crosperio Rx Acpt .014in","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205423","EAP","HCPCS C1725","","Catheter Blndil 4fr 2mm 150cm 200mm Crosperio Rx Acpt .014in","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205424","EAP","HCPCS C1725","","Catheter Blndil 4fr 3.5mm 150cm 120mm Crosperio Rx Acpt .014","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205425","EAP","HCPCS C1725","","Catheter Blndil 4fr 3.5mm 150cm 150mm Crosperio Rx Acpt .014","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205427","EAP","HCPCS C1725","","Catheter Blndil 4fr 3mm 150cm 120mm Crosperio Rx Acpt .014in","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205428","EAP","HCPCS C1725","","Catheter Blndil 4fr 3mm 150cm 200mm Crosperio Rx Acpt .014in","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205429","EAP","HCPCS C1725","","Catheter Blndil 4fr 3mm 150cm 200mm Crosperio Rx Otw Acpt","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205430","EAP","HCPCS C1725","","Catheter Blndil 4fr 3mm 90cm 200mm Crosperio Rx Otw Acpt","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205431","EAP","HCPCS C1725","","Catheter Blndil 4fr 4mm 150cm 120mm Crosperio Rx Acpt .014in","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205432","EAP","HCPCS C1725","","Catheter Blndil 4fr 4mm 150cm 150mm Crosperio Rx Acpt .014in","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205433","EAP","HCPCS C1725","","Catheter Blndil 4fr 4mm 150cm 200mm Crosperio Rx Otw Acpt","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205434","EAP","HCPCS C1725","","Catheter Blndil 4mm 90cm 150mm Crosperio Otw Pta","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$383.61 ","$383.61 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"27205435","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 100mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205436","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 120mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205437","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 150mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205438","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 200mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205439","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205440","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205441","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205442","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205443","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205444","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205445","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205446","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205447","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205448","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205449","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205450","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205451","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205452","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205453","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205454","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205455","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205456","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205457","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205458","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 3mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205459","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 100mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205460","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 150mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205461","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 200mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205462","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205463","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205464","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205465","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205466","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205467","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205468","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 150mm Metacross Otw Tpr Cor","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205469","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205470","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205471","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205472","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205473","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205474","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205475","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205476","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205477","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205478","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205479","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205480","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205481","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 4mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205482","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 135cm 100mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205483","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 135cm 120mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205484","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 135cm 150mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205485","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205486","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205487","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205488","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205489","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205490","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205491","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205492","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205493","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205494","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205495","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205496","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205497","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205498","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205499","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205500","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205501","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205502","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205503","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 5mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205504","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 100mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205505","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 120mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205506","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 150mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205507","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205508","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205509","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205510","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205511","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205512","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 65cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205513","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 65cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205514","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205515","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205516","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 90cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205518","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205519","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205520","EAP","HCPCS C1725","","Catheter Blndil 5.4fr 6mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205521","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.6-9fr 9mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205522","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205523","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205524","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205526","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205527","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205528","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205529","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 10mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205530","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 12mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205531","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 12mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205532","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 12mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205534","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205535","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205536","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205537","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205538","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205539","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205540","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205542","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 90cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205543","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 90cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205544","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205545","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205546","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 3mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205547","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205548","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205549","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205550","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205551","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205552","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205553","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205554","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205555","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205556","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205557","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205559","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205560","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205561","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205562","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205563","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 4mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205564","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205565","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205567","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205568","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205569","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205570","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205571","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205572","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205573","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205575","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205576","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205577","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205578","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205579","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 5mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205580","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 135cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205581","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 135cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205583","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205584","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205585","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205586","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205587","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205588","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205589","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205590","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205591","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205592","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205593","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 6mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205594","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205595","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205596","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205597","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205598","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205599","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205600","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205601","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205602","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 100mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205603","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 120mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205604","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 150mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205605","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 200mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205606","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205607","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205608","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205609","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 7mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205610","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205611","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205612","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205613","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205614","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205615","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205616","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 90cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205617","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 8mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205618","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 135cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205619","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 135cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205620","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 135cm 60mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205621","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 135cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205622","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 90cm 20mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205623","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 90cm 40mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205624","EAP","HCPCS C1725","","Catheter Blndil 5.7-3.9fr 9mm 90cm 80mm Metacross Rx Gw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205625","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 135cm 20mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205626","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 135cm 40mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205627","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 135cm 60mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205628","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 135cm 80mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205629","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205630","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205631","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205633","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205634","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205635","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205636","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 10mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205637","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 12mm 135cm 20mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205638","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 12mm 135cm 40mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205639","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 12mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205641","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 12mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205642","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 12mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205643","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 135cm 200mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205644","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 65cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205645","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 65cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205646","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205647","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 90cm 100mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205648","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 90cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205649","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 6mm 90cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205650","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 100mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205651","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 120mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205652","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 150mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205653","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 200mm Metacross 2 Lum Otw","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205654","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205655","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205656","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205658","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205659","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205660","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205661","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205662","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205663","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205664","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205666","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 90cm 120mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205667","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 90cm 150mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205668","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 90cm 200mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205669","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205670","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205671","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 7mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205672","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 135cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205673","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205674","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205675","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205676","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205677","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205678","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205679","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205680","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205682","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205683","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 8mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205684","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 135cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205685","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 135cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205686","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 135cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205687","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 135cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205688","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 65cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205689","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 65cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205690","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 65cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205691","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 65cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205692","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 90cm 20mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205693","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 90cm 40mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205694","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 90cm 60mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205695","EAP","HCPCS C1725","","Catheter Blndil 5.7fr 9mm 90cm 80mm Metacross 2 Lum Otw Tpr","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205696","EAP","HCPCS C1725","","Catheter Blndil 5fr 4mm 135cm 120mm Metacross Otw 2 Lum Shft","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205697","EAP","HCPCS C1725","","Catheter Blndil 5fr 5mm 135cm 200mm Metacross Otw 2 Lum Shft","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205698","EAP","HCPCS C1725","","Catheter Blndil 5fr 5mm 135cm 20mm Metacross Otw 2 Lum Shft","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205700","EAP","HCPCS C1725","","Catheter Blndil 5fr 6mm 90cm 40mm Crosstella Rx Tpr Cor Wre","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$330.09 ","$330.09 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"27205701","EAP","HCPCS C1725","","Catheter Blndil 5fr 6mm 90cm 40mm Metacross Otw 2 Lum Shft","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205702","EAP","HCPCS C1725","","Catheter Blndil 6fr 4mm 135cm 60mm Metacross Rx Loow Prfl","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205703","EAP","HCPCS C1725","","Catheter Blndil 6mm 135cm 40mm Metacross Rx Sm Prfl Acpt","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$154.76 ","$0.00 ","$59.40 ","$203.40 ","$203.40 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"27205704","EAP","HCPCS C1887","","Catheter Intvn .021in 2.8fr 150cm 160cm Progreat Gldwr","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$705.90 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27205705","EAP","HCPCS C1887","","Catheter Intvn .021in 750 Psi 2.4fr 150cm 90cm Progreat Mcth","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$420.83 ","$0.00 ","$161.53 ","$553.12 ","$553.12 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"27205706","EAP","HCPCS C1887","","Catheter Intvn .021in Mic 2.4-2.9fr .022in 130cm Progreat","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$420.83 ","$0.00 ","$161.53 ","$553.12 ","$553.12 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"27205708","EAP","HCPCS C1887","","Catheter Intvn 2.7-2.9fr .021in 130cm Progreat Mcth Coax","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$705.90 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27205709","EAP","HCPCS C1887","","Catheter Intvn 2.7-2.9fr .025in 110cm Progreat Mcth Coax","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$705.90 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27205710","EAP","HCPCS C1887","","Catheter Intvn 2.7fr .021in 110cm 50cm Progreat Mcth Shp Tip","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$420.83 ","$0.00 ","$161.53 ","$553.12 ","$553.12 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"27205711","EAP","HCPCS C1887","","Catheter Intvn Mic 2.4-2.9fr .022in 110cm Progreat Coax","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$420.83 ","$0.00 ","$161.53 ","$553.12 ","$553.12 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"27205712","EAP","HCPCS C1887","","Catheter Intvn Mic 2.8-3fr .027in 110cm 50cm Progreat Coax","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$705.90 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27205713","EAP","HCPCS C1887","","Catheter Intvn Mic 2.8-3fr .027in 130cm 17cm Progreat Mrkr","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$420.83 ","$0.00 ","$161.53 ","$553.12 ","$553.12 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"27205714","EAP","HCPCS C1887","","Catheter Intvn Mic 2.8fr .027in 150cm 90cm Progreat Hmst Vlv","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$0.00 ","$0.00 ","$0.00 ","$553.12 ","$553.12 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"27205715","EAP","HCPCS C1887","","Catheter Sprt 30d 12mm 90cm Strl Lf 40cm Navicross Radopq","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$232.13 ","$0.00 ","$89.10 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205716","EAP","Custom 27205716","","Device Infl 25cc Strl Solopath Stpck","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$78.51 ","$78.51 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205717","EAP","Custom 27205717","","Device Infl 30 Atm 25ml Strl Solopath Excel Stpck","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$78.51 ","$78.51 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205718","EAP","HCPCS C1769","","Form Submission .018 Ang 300cm Gw Cert","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27205719","EAP","HCPCS C1769","","Guidewire Srg 45d .018in 180cm 3cm Gldwr Gl Ang Flx Tp Hdrph","BOTH IP/OP","$301.25 ","$222.93 ","$0.00 ","$301.25 ","$0.00 ","$0.00 ","$0.00 ","$215.00 ","$215.00 ","$52.75 ","$301.25 ","$0.00 ","$150.63 ","$238.59 ","$241.00 ","$0.00 ","$47.15 ","$0.00 ","$47.96 ","$0.00 "
"27205720","EAP","HCPCS C1769","","Guidewire Srg 45d .018in 180cm 5cm Gldwr Hdrph","BOTH IP/OP","$301.25 ","$222.93 ","$0.00 ","$301.25 ","$163.58 ","$0.00 ","$62.79 ","$215.00 ","$215.00 ","$52.75 ","$301.25 ","$0.00 ","$150.63 ","$238.59 ","$241.00 ","$0.00 ","$47.15 ","$0.00 ","$47.96 ","$0.00 "
"27205721","EAP","HCPCS C1769","","Guidewire Srg 70d .018in 180cm 3cm Gldwr Au Tip Ang Hdrph","BOTH IP/OP","$301.25 ","$222.93 ","$0.00 ","$301.25 ","$163.58 ","$0.00 ","$62.79 ","$215.00 ","$215.00 ","$52.75 ","$301.25 ","$0.00 ","$150.63 ","$238.59 ","$241.00 ","$0.00 ","$47.15 ","$0.00 ","$47.96 ","$0.00 "
"27205722","EAP","HCPCS C1769","","Guidewire Srg Ang .018in 180cm 5cm Gldwr Hdrph","BOTH IP/OP","$301.25 ","$222.93 ","$0.00 ","$301.25 ","$163.58 ","$0.00 ","$62.79 ","$215.00 ","$215.00 ","$52.75 ","$301.25 ","$0.00 ","$150.63 ","$238.59 ","$241.00 ","$0.00 ","$47.15 ","$0.00 ","$47.96 ","$0.00 "
"27205723","EAP","HCPCS C1769","","Guidewire Vasc 3mm Std .035in 150cm 3cm Gldwr Jtp Ntnl Hdrph","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205724","EAP","HCPCS C1769","","Guidewire Vasc 3mm Std .038in 150cm 3cm Gldwr Jtp Ntnl Hdrph","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205725","EAP","HCPCS C1769","","Guidewire Vasc 45d .018in 300cm 3cm Gldwr Hdrph","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$232.13 ","$0.00 ","$89.10 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205726","EAP","HCPCS C1769","","Guidewire Vasc 45d .018in 300cm 5cm Gldwr Hdrph","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$232.13 ","$0.00 ","$89.10 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205727","EAP","HCPCS C1769","","Guidewire Vasc 45d Std .018in 180cm 25cm Grind Flxb","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$264.71 ","$0.00 ","$101.61 ","$347.93 ","$347.93 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"27205728","EAP","HCPCS C1769","","Guidewire Vasc 70d .018in 300cm 3cm Gldwr Hdrph","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$232.13 ","$0.00 ","$89.10 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205729","EAP","HCPCS C1769","","Guidewire Vasc 70d .018in 300cm 5cm Gldwr Hdrph","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$232.13 ","$0.00 ","$89.10 ","$305.11 ","$305.11 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"27205730","EAP","HCPCS C1769","","Guidewire Vasc Ang .014in 180cm","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27205731","EAP","HCPCS C1769","","Guidewire Vasc Ang .014in 300cm","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$305.44 ","$0.00 ","$117.24 ","$401.46 ","$401.46 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"27205732","EAP","HCPCS C1769","","Guidewire Vasc Ang .018in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205733","EAP","HCPCS C1769","","Guidewire Vasc Ang .018in 80cm 3cm Gldwr Hdrph","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205734","EAP","HCPCS C1769","","Guidewire Vasc Ang .025in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$101.13 ","$74.84 ","$0.00 ","$101.13 ","$54.91 ","$0.00 ","$21.08 ","$72.18 ","$72.18 ","$17.71 ","$101.13 ","$0.00 ","$50.57 ","$80.09 ","$80.90 ","$0.00 ","$15.83 ","$0.00 ","$16.10 ","$0.00 "
"27205735","EAP","HCPCS C1769","","Guidewire Vasc Ang .025in 180cm 3cm Gldwr Hdrph","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205736","EAP","HCPCS C1769","","Guidewire Vasc Ang .025in 260cm 3cm Gldwr Hdrph","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$78.19 ","$0.00 ","$30.01 ","$102.77 ","$102.77 ","$25.21 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$22.54 ","$0.00 ","$22.92 ","$0.00 "
"27205737","EAP","HCPCS C1769","","Guidewire Vasc Ang .035in 80cm 3cm Gldwr Stf Shft Hdrph","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205738","EAP","HCPCS C1769","","Guidewire Vasc Ang .038in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205739","EAP","HCPCS C1769","","Guidewire Vasc Ang .038in 80cm 3cm Gldwr Hdrph","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205740","EAP","HCPCS C1769","","Guidewire Vasc Ang .038in 80cm 3cm Gldwr Stf Shft Hdrph","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205741","EAP","HCPCS C1769","","Guidewire Vasc Ang Lng Tpr .035in 150cm 5cm Gldwr Stf Shft","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205742","EAP","HCPCS C1769","","Guidewire Vasc Ang Lng Tpr .035in 260cm 5cm Gldwr Stf Shft","BOTH IP/OP","$124.63 ","$92.23 ","$0.00 ","$124.63 ","$67.67 ","$0.00 ","$25.98 ","$88.95 ","$88.95 ","$21.82 ","$124.63 ","$0.00 ","$62.32 ","$98.71 ","$99.70 ","$0.00 ","$19.50 ","$0.00 ","$19.84 ","$0.00 "
"27205743","EAP","HCPCS C1769","","Guidewire Vasc Ang Lng Tpr .038in 150cm 5cm Gldwr Stf Shft","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205744","EAP","HCPCS C1769","","Guidewire Vasc Ang Std .035in 120cm 3cm Gldwr Jkt Cor To Tip","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205745","EAP","HCPCS C1769","","Guidewire Vasc Ang Std .035in 150cm 1cm Gldwr Jkt Cor To Tip","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205746","EAP","HCPCS C1769","","Guidewire Vasc Ang Std .035in 180cm 1cm Gldwr Jkt Cor To Tip","BOTH IP/OP","$99.25 ","$73.45 ","$0.00 ","$99.25 ","$53.89 ","$0.00 ","$20.69 ","$70.83 ","$70.83 ","$17.38 ","$99.25 ","$0.00 ","$49.63 ","$78.61 ","$79.40 ","$0.00 ","$15.53 ","$0.00 ","$15.80 ","$0.00 "
"27205747","EAP","HCPCS C1769","","Guidewire Vasc Ang Std .035in 260cm 1cm Gldwr Jkt Cor To Tip","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$23.14 ","$79.22 ","$79.22 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"27205748","EAP","HCPCS C1769","","Guidewire Vasc Ang Tpr .035in 150cm 1cm Gldwr Hdrph","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205749","EAP","HCPCS C1769","","Guidewire Vasc Bolia Crv Std .035in 180cm 5cm Gldwr Jkt Cor","BOTH IP/OP","$101.13 ","$74.84 ","$0.00 ","$101.13 ","$54.91 ","$0.00 ","$21.08 ","$72.18 ","$72.18 ","$17.71 ","$101.13 ","$0.00 ","$50.57 ","$80.09 ","$80.90 ","$0.00 ","$15.83 ","$0.00 ","$16.10 ","$0.00 "
"27205750","EAP","HCPCS C1769","","Guidewire Vasc Bolia Crv Std .035in 180cm 8cm Gldwr Jkt Cor","BOTH IP/OP","$101.13 ","$74.84 ","$0.00 ","$101.13 ","$54.91 ","$0.00 ","$21.08 ","$72.18 ","$72.18 ","$17.71 ","$101.13 ","$0.00 ","$50.57 ","$80.09 ","$80.90 ","$0.00 ","$15.83 ","$0.00 ","$16.10 ","$0.00 "
"27205751","EAP","HCPCS C1769","","Guidewire Vasc Std Ang .018in 180cm 3cm Gldwr Trmo Gld Tch","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205752","EAP","HCPCS C1769","","Guidewire Vasc Std Strg .035in 150cm 1cm Gldwr Jkt Cor To","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205753","EAP","HCPCS C1769","","Guidewire Vasc Std Strg .035in 180cm 1cm Gldwr Jkt Cor To","BOTH IP/OP","$99.25 ","$73.45 ","$0.00 ","$99.25 ","$53.89 ","$0.00 ","$20.69 ","$70.83 ","$70.83 ","$17.38 ","$99.25 ","$0.00 ","$49.63 ","$78.61 ","$79.40 ","$0.00 ","$15.53 ","$0.00 ","$15.80 ","$0.00 "
"27205754","EAP","HCPCS C1769","","Guidewire Vasc Std Strg .035in 260cm 1cm Gldwr Jkt Cor To","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$23.14 ","$79.22 ","$79.22 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"27205755","EAP","HCPCS C1769","","Guidewire Vasc Strg .018in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205756","EAP","HCPCS C1769","","Guidewire Vasc Strg .018in 150cm 3cm Gldwr Shp Tip Hdrph","BOTH IP/OP","$137.38 ","$101.66 ","$0.00 ","$137.38 ","$74.60 ","$0.00 ","$28.63 ","$98.05 ","$98.05 ","$24.05 ","$137.38 ","$0.00 ","$68.69 ","$108.80 ","$109.90 ","$0.00 ","$21.50 ","$0.00 ","$21.87 ","$0.00 "
"27205757","EAP","HCPCS C1769","","Guidewire Vasc Strg .018in 180cm 3cm Gldwr Hdrph","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205758","EAP","HCPCS C1769","","Guidewire Vasc Strg .018in 260cm 3cm Gldwr Hdrph","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$100.46 ","$0.00 ","$38.56 ","$132.03 ","$132.03 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$28.95 ","$0.00 ","$29.45 ","$0.00 "
"27205759","EAP","HCPCS C1769","","Guidewire Vasc Strg .025in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$101.13 ","$74.84 ","$0.00 ","$101.13 ","$54.91 ","$0.00 ","$21.08 ","$72.18 ","$72.18 ","$17.71 ","$101.13 ","$0.00 ","$50.57 ","$80.09 ","$80.90 ","$0.00 ","$15.83 ","$0.00 ","$16.10 ","$0.00 "
"27205760","EAP","HCPCS C1769","","Guidewire Vasc Strg .025in 180cm 3cm Gldwr Hdrph","BOTH IP/OP","$134.38 ","$99.44 ","$0.00 ","$134.38 ","$72.97 ","$0.00 ","$28.01 ","$95.91 ","$95.91 ","$23.53 ","$134.38 ","$0.00 ","$67.19 ","$106.43 ","$107.50 ","$0.00 ","$21.03 ","$0.00 ","$21.39 ","$0.00 "
"27205761","EAP","HCPCS C1769","","Guidewire Vasc Strg .025in 260cm 3cm Gldwr Hdrph","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$78.19 ","$0.00 ","$30.01 ","$102.77 ","$102.77 ","$25.21 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$22.54 ","$0.00 ","$22.92 ","$0.00 "
"27205762","EAP","HCPCS C1769","","Guidewire Vasc Strg .032in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$74.00 ","$54.76 ","$0.00 ","$74.00 ","$40.18 ","$0.00 ","$15.42 ","$52.81 ","$52.81 ","$12.96 ","$74.00 ","$0.00 ","$37.00 ","$58.61 ","$59.20 ","$0.00 ","$11.58 ","$0.00 ","$11.78 ","$0.00 "
"27205763","EAP","HCPCS C1769","","Guidewire Vasc Strg .035in 150cm 3cm Gldwr Shp Tip Hdrph","BOTH IP/OP","$79.75 ","$59.02 ","$0.00 ","$79.75 ","$43.30 ","$0.00 ","$16.62 ","$56.92 ","$56.92 ","$13.96 ","$79.75 ","$0.00 ","$39.88 ","$63.16 ","$63.80 ","$0.00 ","$12.48 ","$0.00 ","$12.70 ","$0.00 "
"27205764","EAP","HCPCS C1769","","Guidewire Vasc Strg .035in 180cm 3cm Gldwr Shp Tip Hdrph","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$58.10 ","$0.00 ","$22.30 ","$76.37 ","$76.37 ","$18.73 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$16.75 ","$0.00 ","$17.03 ","$0.00 "
"27205765","EAP","HCPCS C1769","","Guidewire Vasc Strg .038in 150cm 3cm Gldwr Hdrph","BOTH IP/OP","$72.50 ","$53.65 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$15.11 ","$51.74 ","$51.74 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"27205766","EAP","HCPCS C1769","","Guidewire Vasc Strg .038in 150cm 3cm Gldwr Shp Tip Hdrph","BOTH IP/OP","$79.75 ","$59.02 ","$0.00 ","$79.75 ","$43.30 ","$0.00 ","$16.62 ","$56.92 ","$56.92 ","$13.96 ","$79.75 ","$0.00 ","$39.88 ","$63.16 ","$63.80 ","$0.00 ","$12.48 ","$0.00 ","$12.70 ","$0.00 "
"27205767","EAP","HCPCS C1769","","Guidewire Vasc Strg .038in 150cm 3cm Gldwr Stf Shft Hdrph","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205768","EAP","HCPCS C1769","","Guidewire Vasc Strg .038in 180cm 3cm Gldwr Hdrph","BOTH IP/OP","$99.25 ","$73.45 ","$0.00 ","$99.25 ","$53.89 ","$0.00 ","$20.69 ","$70.83 ","$70.83 ","$17.38 ","$99.25 ","$0.00 ","$49.63 ","$78.61 ","$79.40 ","$0.00 ","$15.53 ","$0.00 ","$15.80 ","$0.00 "
"27205769","EAP","HCPCS C1769","","Guidewire Vasc Strg .038in 180cm 3cm Gldwr Stf Shft Hdrph","BOTH IP/OP","$116.75 ","$86.40 ","$0.00 ","$116.75 ","$63.40 ","$0.00 ","$24.33 ","$83.32 ","$83.32 ","$20.44 ","$116.75 ","$0.00 ","$58.38 ","$92.47 ","$93.40 ","$0.00 ","$18.27 ","$0.00 ","$18.59 ","$0.00 "
"27205770","EAP","HCPCS C1769","","Guidewire Vasc Strg .038in 260cm 3cm Gldwr Hdrph","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$23.14 ","$79.22 ","$79.22 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"27205771","EAP","HCPCS C1769","","Guidewire Vasc Strg Lng Tpr .035in 150cm 5cm Gldwr Stf Shft","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205772","EAP","HCPCS C1769","","Guidewire Vasc Strg Lng Tpr .035in 150cm 8cm Gldwr Jkt Cor","BOTH IP/OP","$81.75 ","$60.50 ","$0.00 ","$81.75 ","$44.39 ","$0.00 ","$17.04 ","$58.34 ","$58.34 ","$14.31 ","$81.75 ","$0.00 ","$40.88 ","$64.75 ","$65.40 ","$0.00 ","$12.79 ","$0.00 ","$13.01 ","$0.00 "
"27205773","EAP","HCPCS C1769","","Guidewire Vasc Strg Lng Tpr .038in 150cm 5cm Gldwr Stf Shft","BOTH IP/OP","$112.88 ","$83.53 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$23.53 ","$80.56 ","$80.56 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.67 ","$0.00 ","$17.97 ","$0.00 "
"27205774","EAP","HCPCS C1769","","Guidewire Vasc Strg Tpr .038in 150cm 8cm Gldwr Hdrph","BOTH IP/OP","$81.75 ","$60.50 ","$0.00 ","$81.75 ","$44.39 ","$0.00 ","$17.04 ","$58.34 ","$58.34 ","$14.31 ","$81.75 ","$0.00 ","$40.88 ","$64.75 ","$65.40 ","$0.00 ","$12.79 ","$0.00 ","$13.01 ","$0.00 "
"27205775","EAP","HCPCS C1894","","Introducer Cath 17fr 5.3fr 14fr 25cm Solopath Bln Expandable","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205776","EAP","HCPCS C1894","","Introducer Cath 21fr 13fr 18fr 25cm Strl 20cm Solopath","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205777","EAP","HCPCS C1894","","Introducer Cath 21fr 5.3fr 18fr 35cm Strl 30cm Solopath Bln","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205778","EAP","HCPCS C1894","","Introducer Cath 22fr 14fr 19fr 35cm Strl 30cm Solopath","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205779","EAP","HCPCS C1894","","Introducer Cath 22fr 5.3fr 19fr 25cm 20cm Solopath Bln","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205780","EAP","HCPCS C1894","","Introducer Cath 23fr 5.3fr 20fr 35cm Strl 25cm Solopath Bln","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205781","EAP","HCPCS C1894","","Introducer Cath 24fr 14fr 21fr 35cm Strl 30cm Solopath","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205782","EAP","HCPCS C1894","","Introducer Cath 24fr 5.3fr 21fr 25cm 20cm Solopath Bln","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205783","EAP","HCPCS C1894","","Introducer Cath Loprfl 11.5-17fr 5.3fr 14fr 35cm 30cm","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205784","EAP","HCPCS C1894","","Introducer Cath Loprfl 15-19fr 5.3fr 16fr 25cm 20cm Solopath","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205785","EAP","HCPCS C1894","","Introducer Cath Loprfl 15-19fr 5.3fr 16fr 35cm 30cm Solopath","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205786","EAP","HCPCS C1894","","Introducer Cath Loprfl 15-23fr 5.3fr 20fr 25cm 20cm Solopath","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$719.48 ","$0.00 ","$276.16 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"27205787","EAP","HCPCS C1894","","Introducer Shth .035in 4fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$31.22 ","$0.00 ","$11.98 ","$41.04 ","$41.04 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"27205788","EAP","HCPCS C1894","","Introducer Shth .035in 4fr 6cm 2.5cm Pncl R/o Ii Gw Dil","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$37.47 ","$37.47 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"27205789","EAP","HCPCS C1894","","Introducer Shth .035in Shrt 7fr 4cm 40cm Pncl R/o Ii Hiflo","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$32.58 ","$0.00 ","$12.51 ","$42.82 ","$42.82 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"27205790","EAP","HCPCS C1894","","Introducer Shth .035in Shrt 8fr 4cm 2.5cm Pncl R/o Ii Hiflo","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$32.58 ","$0.00 ","$12.51 ","$42.82 ","$42.82 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"27205791","EAP","HCPCS C1894","","Introducer Shth .038in 5fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$31.22 ","$0.00 ","$11.98 ","$41.04 ","$41.04 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"27205792","EAP","HCPCS C1894","","Introducer Shth .038in 5fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$37.47 ","$37.47 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"27205793","EAP","HCPCS C1894","","Introducer Shth .038in 6fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$31.22 ","$0.00 ","$11.98 ","$41.04 ","$41.04 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"27205794","EAP","HCPCS C1894","","Introducer Shth .038in 6fr 4cm Pncl R/o Ii Hiflo Dil Radopq","BOTH IP/OP","$58.13 ","$43.02 ","$0.00 ","$58.13 ","$31.56 ","$0.00 ","$12.12 ","$41.49 ","$41.49 ","$10.18 ","$58.13 ","$0.00 ","$29.07 ","$46.04 ","$46.50 ","$0.00 ","$9.10 ","$0.00 ","$9.25 ","$0.00 "
"27205795","EAP","HCPCS C1894","","Introducer Shth .038in 6fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$37.47 ","$37.47 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"27205796","EAP","HCPCS C1894","","Introducer Shth .038in 7fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$31.22 ","$0.00 ","$11.98 ","$41.04 ","$41.04 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"27205797","EAP","HCPCS C1894","","Introducer Shth .038in 7fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$37.47 ","$37.47 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"27205798","EAP","HCPCS C1894","","Introducer Shth .038in 8fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$31.22 ","$0.00 ","$11.98 ","$41.04 ","$41.04 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"27205799","EAP","HCPCS C1894","","Introducer Shth .038in 8fr 6cm 2.5cm Pncl R/o Ii Gw Dil","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$37.47 ","$37.47 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"27205800","EAP","HCPCS C1894","","Introducer Shth .038in 9fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$31.22 ","$0.00 ","$11.98 ","$41.04 ","$41.04 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"27205801","EAP","HCPCS C1894","","Introducer Shth .038in 9fr 6cm 2.5cm Pncl R/o Ii Gw Dil","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$37.47 ","$37.47 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"27205802","EAP","HCPCS C1894","","Introducer Shth 11fr 25cm 2.5cm Pncl Dil Kink Rst Hdrph Ptfe","BOTH IP/OP","$49.88 ","$36.91 ","$0.00 ","$49.88 ","$27.08 ","$0.00 ","$10.40 ","$35.60 ","$35.60 ","$8.73 ","$49.88 ","$0.00 ","$24.94 ","$39.50 ","$39.90 ","$0.00 ","$7.81 ","$0.00 ","$7.94 ","$0.00 "
"27205803","EAP","HCPCS C1894","","Introducer Shth 4fr 10cm 2.5cm Pncl R/o Ii Dil Radopq","BOTH IP/OP","$53.50 ","$39.59 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$11.15 ","$38.18 ","$38.18 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"27205804","EAP","HCPCS C1894","","Introducer Shth 4fr 25cm 2.5cm Pncl R/o Ii Dil Radopq","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$13.55 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"27205805","EAP","HCPCS C1894","","Introducer Shth 4fr 6cm 2.5cm Pncl R/o Ii Dil Radopq","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.46 ","$0.00 ","$9.77 ","$33.46 ","$33.46 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"27205806","EAP","HCPCS C1894","","Introducer Shth 5fr 10cm 2.5cm Pncl Radopq Dil No Mn Gw","BOTH IP/OP","$53.50 ","$39.59 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$11.15 ","$38.18 ","$38.18 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"27205807","EAP","HCPCS C1894","","Introducer Shth 5fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$13.55 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"27205808","EAP","HCPCS C1894","","Introducer Shth 5fr 6cm 2.5cm Pncl Radopq Dil No Mn Gw","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.46 ","$0.00 ","$9.77 ","$33.46 ","$33.46 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"27205809","EAP","HCPCS C1894","","Introducer Shth 6fr 10cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$53.50 ","$39.59 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$11.15 ","$38.18 ","$38.18 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"27205810","EAP","HCPCS C1894","","Introducer Shth 6fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$13.55 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"27205811","EAP","HCPCS C1894","","Introducer Shth 6fr 45cm Destination Gd Hdrph Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205812","EAP","HCPCS C1894","","Introducer Shth 6fr 45cm Pn Dstn Gd Hdrph Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205813","EAP","HCPCS C1894","","Introducer Shth 6fr 45cm Pn Dstn Gd Lima Crv Xcut Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205814","EAP","HCPCS C1894","","Introducer Shth 6fr 45cm Pn Dstn Gd Mp Crv T-b Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205815","EAP","HCPCS C1894","","Introducer Shth 6fr 45cm Pn Dstn Gd Rdc Crv T-b Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205816","EAP","HCPCS C1894","","Introducer Shth 6fr 45cm Pn Dstn Hdrph Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205817","EAP","HCPCS C1894","","Introducer Shth 6fr 4cm 40cm Pncl Radopq Dil Gw","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$32.58 ","$0.00 ","$12.51 ","$42.82 ","$42.82 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"27205818","EAP","HCPCS C1894","","Introducer Shth 6fr 65cm Pn Dstn Gd Strg T-b Vlv Hdrph Ptfe","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"27205819","EAP","HCPCS C1894","","Introducer Shth 6fr 6cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.46 ","$0.00 ","$9.77 ","$33.46 ","$33.46 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"27205820","EAP","HCPCS C1894","","Introducer Shth 7fr 45cm Pn Dstn Gd Hs Crv T-b Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205821","EAP","HCPCS C1894","","Introducer Shth 7fr 45cm Pn Dstn Gd Lima Crv T-b Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205822","EAP","HCPCS C1894","","Introducer Shth 7fr 45cm Pn Dstn Gd Mp Crv T-b Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205823","EAP","HCPCS C1894","","Introducer Shth 7fr 45cm Pn Dstn Gd Rdc Crv T-b Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205824","EAP","HCPCS C1894","","Introducer Shth 7fr 45cm Pn Dstn Gd Strg T-b Vlv Hdrph Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205825","EAP","HCPCS C1894","","Introducer Shth 7fr 4cm Pncl R/o Ii Hiflo Dil Radopq","BOTH IP/OP","$58.13 ","$43.02 ","$0.00 ","$58.13 ","$31.56 ","$0.00 ","$12.12 ","$41.49 ","$41.49 ","$10.18 ","$58.13 ","$0.00 ","$29.07 ","$46.04 ","$46.50 ","$0.00 ","$9.10 ","$0.00 ","$9.25 ","$0.00 "
"27205826","EAP","HCPCS C1894","","Introducer Shth 7fr 65cm Pn Dstn Gd Hdrph Ptfe","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"27205827","EAP","HCPCS C1894","","Introducer Shth 7fr 6cm 2.5cm Pncl Radopq Dil No Mn Gw","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.46 ","$0.00 ","$9.77 ","$33.46 ","$33.46 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"27205828","EAP","HCPCS C1894","","Introducer Shth 8fr 4cm 2.5cm Pncl R/o Ii Hiflo Dil Radopq","BOTH IP/OP","$58.13 ","$43.02 ","$0.00 ","$58.13 ","$31.56 ","$0.00 ","$12.12 ","$41.49 ","$41.49 ","$10.18 ","$58.13 ","$0.00 ","$29.07 ","$46.04 ","$46.50 ","$0.00 ","$9.10 ","$0.00 ","$9.25 ","$0.00 "
"27205829","EAP","HCPCS C1894","","Introducer Shth 8fr 6cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.46 ","$0.00 ","$9.77 ","$33.46 ","$33.46 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"27205830","EAP","HCPCS C1894","","Introducer Shth 9fr 10cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$53.50 ","$39.59 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$11.15 ","$38.18 ","$38.18 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"27205831","EAP","HCPCS C1894","","Introducer Shth 9fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$13.55 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"27205832","EAP","HCPCS C1894","","Introducer Shth 9fr 6cm 2.5cm Pncl R/o Ii Dil Radopq","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.46 ","$0.00 ","$9.77 ","$33.46 ","$33.46 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"27205833","EAP","HCPCS C1894","","Sheath Escp 7fr 45cm Pn Dstn Gd Destination Hdrph Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205834","EAP","HCPCS C1887","","Sheath Gd .038in 6fr 45cm 2cm Pn Dstn T-b Vlv Strg Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205835","EAP","HCPCS C1887","","Sheath Gd .038in 7fr 45cm 2cm Pn Dstn T-b Vlv Strg Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205836","EAP","HCPCS C1894","","Sheath Gd .038in Hs Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv Hdrph","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205837","EAP","HCPCS C1894","","Sheath Gd .038in Lima Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205838","EAP","HCPCS C1894","","Sheath Gd .038in Mp Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv Kink","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205839","EAP","HCPCS C1894","","Sheath Gd .038in Mp Crv 6fr 90cm 5cm Pn Dstn T-b Vlv Hdrph","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205840","EAP","HCPCS C1894","","Sheath Gd .038in Mp Crv 7fr 90cm 5cm Pn Dstn T-b Vlv Hdrph","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205841","EAP","HCPCS C1894","","Sheath Gd .038in Mp Crv 7fr 90cm 5cm Pn Dstn Xcut Vlv Hdrph","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205842","EAP","HCPCS C1894","","Sheath Gd 22fr X 35cm Solopath","BOTH IP/OP","$1,525.00 ","$1,128.50 ","$0.00 ","$1,525.00 ","$828.08 ","$0.00 ","$317.85 ","$1,088.39 ","$1,088.39 ","$267.02 ","$1,525.00 ","$0.00 ","$762.50 ","$1,207.80 ","$1,220.00 ","$0.00 ","$238.66 ","$0.00 ","$242.78 ","$0.00 "
"27205843","EAP","HCPCS C1894","","Sheath Gd 23fr 13.5fr 19fr 25cm 20cm Solopath Expandable","BOTH IP/OP","$1,525.00 ","$1,128.50 ","$0.00 ","$1,525.00 ","$828.08 ","$0.00 ","$317.85 ","$1,088.39 ","$1,088.39 ","$267.02 ","$1,525.00 ","$0.00 ","$762.50 ","$1,207.80 ","$1,220.00 ","$0.00 ","$238.66 ","$0.00 ","$242.78 ","$0.00 "
"27205844","EAP","HCPCS C1894","","Sheath Gd 23fr 13.5fr 19fr 35cm 30cm Solopath Expandable","BOTH IP/OP","$1,525.00 ","$1,128.50 ","$0.00 ","$1,525.00 ","$828.08 ","$0.00 ","$317.85 ","$1,088.39 ","$1,088.39 ","$267.02 ","$1,525.00 ","$0.00 ","$762.50 ","$1,207.80 ","$1,220.00 ","$0.00 ","$238.66 ","$0.00 ","$242.78 ","$0.00 "
"27205845","EAP","HCPCS C1894","","Sheath Gd 24fr X 35cm Solopath","BOTH IP/OP","$1,525.00 ","$1,128.50 ","$0.00 ","$1,525.00 ","$828.08 ","$0.00 ","$317.85 ","$1,088.39 ","$1,088.39 ","$267.02 ","$1,525.00 ","$0.00 ","$762.50 ","$1,207.80 ","$1,220.00 ","$0.00 ","$238.66 ","$0.00 ","$242.78 ","$0.00 "
"27205846","EAP","HCPCS C1894","","Sheath Gd 26fr 15fr 22fr 35cm 30cm Solopath Expandable","BOTH IP/OP","$1,525.00 ","$1,128.50 ","$0.00 ","$1,525.00 ","$828.08 ","$0.00 ","$317.85 ","$1,088.39 ","$1,088.39 ","$267.02 ","$1,525.00 ","$0.00 ","$762.50 ","$1,207.80 ","$1,220.00 ","$0.00 ","$238.66 ","$0.00 ","$242.78 ","$0.00 "
"27205847","EAP","HCPCS C1894","","Sheath Gd 28.5fr 15fr 24fr 25cm 20cm Solopath Expandable","BOTH IP/OP","$1,525.00 ","$1,128.50 ","$0.00 ","$1,525.00 ","$828.08 ","$0.00 ","$317.85 ","$1,088.39 ","$1,088.39 ","$267.02 ","$1,525.00 ","$0.00 ","$762.50 ","$1,207.80 ","$1,220.00 ","$0.00 ","$238.66 ","$0.00 ","$242.78 ","$0.00 "
"27205848","EAP","HCPCS C1894","","Sheath Gd 4fr Strl Pncl Prcs Acc Sys Tl Intgr Fit Echgn Tpr","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$44.12 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205849","EAP","HCPCS C1894","","Sheath Gd Hs Crv 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205850","EAP","HCPCS C1894","","Sheath Gd Mp Crv 6fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205851","EAP","HCPCS C1894","","Sheath Gd Mp Crv 6fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205852","EAP","HCPCS C1894","","Sheath Gd Mp Crv 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205853","EAP","HCPCS C1894","","Sheath Gd Rnl 2 Crv 5fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205854","EAP","HCPCS C1894","","Sheath Gd Strg 5fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205855","EAP","HCPCS C1894","","Sheath Gd Strg 6fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205856","EAP","HCPCS C1894","","Sheath Gd Strg 6fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205857","EAP","HCPCS C1894","","Sheath Gd Strg 6fr 90cm 15cm Pn Dstn T-b Radopq Vlv Ss Ptfe","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205858","EAP","HCPCS C1894","","Sheath Gd Strg 7fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205859","EAP","HCPCS C1894","","Sheath Gd Strg 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205860","EAP","HCPCS C1894","","Sheath Gd Strg 7fr 65cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"27205861","EAP","HCPCS C1894","","Sheath Gd Strg 7fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss Ptfe","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205862","EAP","HCPCS C1894","","Sheath Gd Strg 7fr 90cm 15cm Pn Dstn T-b Radopq Vlv Ss Ptfe","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205863","EAP","HCPCS C1894","","Sheath Gd Strg 8fr 45cm 35cm Pn Dstn T-b Radopq Vlv Ss Ptfe","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27205864","EAP","HCPCS C1894","","Sheath Gd Strg 8fr 65cm 35cm Pn Dstn T-b Radopq Vlv Ss Ptfe","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"27205865","EAP","HCPCS C1894","","Sheath Gd Strg 8fr 90cm 60cm Pn Dstn T-b Radopq Vlv Ss Ptfe","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$164.15 ","$164.15 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"27205866","EAP","HCPCS C1894","","System Intro .018in 4fr 21ga 40cm Glideaccess Echgn Ndl Gw","BOTH IP/OP","$66.25 ","$49.03 ","$0.00 ","$66.25 ","$35.97 ","$0.00 ","$13.81 ","$47.28 ","$47.28 ","$11.60 ","$66.25 ","$0.00 ","$33.13 ","$52.47 ","$53.00 ","$0.00 ","$10.37 ","$0.00 ","$10.55 ","$0.00 "
"27205867","EAP","HCPCS C1894","","System Intro .018in 4fr 21ga 40cm Glideaccess Non Echgn Ndl","BOTH IP/OP","$76.88 ","$56.89 ","$0.00 ","$76.88 ","$41.75 ","$0.00 ","$16.02 ","$54.87 ","$54.87 ","$13.46 ","$76.88 ","$0.00 ","$38.44 ","$60.89 ","$61.50 ","$0.00 ","$12.03 ","$0.00 ","$12.24 ","$0.00 "
"27205868","EAP","HCPCS C1894","","System Intro .018in 4fr 40cm Glideaccess Coax Gw Echgn Ndl","BOTH IP/OP","$79.38 ","$58.74 ","$0.00 ","$79.38 ","$43.10 ","$0.00 ","$16.54 ","$56.65 ","$56.65 ","$13.90 ","$79.38 ","$0.00 ","$39.69 ","$62.87 ","$63.50 ","$0.00 ","$12.42 ","$0.00 ","$12.64 ","$0.00 "
"27205869","EAP","HCPCS C1894","","System Intro .018in 5fr 21ga 40cm Glideaccess Echgn Ndl Gw","BOTH IP/OP","$66.25 ","$49.03 ","$0.00 ","$66.25 ","$35.97 ","$0.00 ","$13.81 ","$47.28 ","$47.28 ","$11.60 ","$66.25 ","$0.00 ","$33.13 ","$52.47 ","$53.00 ","$0.00 ","$10.37 ","$0.00 ","$10.55 ","$0.00 "
"27205870","EAP","HCPCS C1894","","System Intro .018in 5fr 21ga 40cm Glideaccess Non Echgn Ndl","BOTH IP/OP","$76.88 ","$56.89 ","$0.00 ","$76.88 ","$41.75 ","$0.00 ","$16.02 ","$54.87 ","$54.87 ","$13.46 ","$76.88 ","$0.00 ","$38.44 ","$60.89 ","$61.50 ","$0.00 ","$12.03 ","$0.00 ","$12.24 ","$0.00 "
"27205871","EAP","HCPCS C1894","","System Intro .018in 5fr 40cm Glideaccess Coax Gw Echgn Ndl","BOTH IP/OP","$79.38 ","$58.74 ","$0.00 ","$79.38 ","$43.10 ","$0.00 ","$16.54 ","$56.65 ","$56.65 ","$13.90 ","$79.38 ","$0.00 ","$39.69 ","$62.87 ","$63.50 ","$0.00 ","$12.42 ","$0.00 ","$12.64 ","$0.00 "
"27205872","EAP","HCPCS C1894","","System Intro 5fr 21-19ga 45cm 10cm Pncl Prcs Acc Sys Stf","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$44.12 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205873","EAP","HCPCS C1894","","System Intro Reg 4fr Echgn Ndl Fxcr Gw Ninitol","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$44.12 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205874","EAP","HCPCS C1894","","System Intro Reg 4fr Echgn Ndl Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205875","EAP","HCPCS C1894","","System Intro Reg 5fr Echgn Ndl Fxcr Gw Ninitol","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$44.12 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205876","EAP","HCPCS C1894","","System Intro Reg 5fr Echgn Ndl Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205877","EAP","HCPCS C1894","","System Intro Reg 6fr Echgn Ndl Fxcr Gw Ninitol","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$44.12 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205878","EAP","HCPCS C1894","","System Intro Reg 6fr Echgn Ndl Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205879","EAP","HCPCS C1894","","System Intro Reg 7fr Echgn Ndl Fxcr Gw Ninitol","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$44.12 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205880","EAP","HCPCS C1894","","System Intro Reg 7fr Echgn Ndl Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205881","EAP","HCPCS C1894","","System Intro Reg 8fr Echgn Ndl Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205882","EAP","HCPCS C1894","","System Intro Strg 4fr Echgn Ndl Fxcr Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205883","EAP","HCPCS C1894","","System Intro Strg 5fr Echgn Ndl Fxcr Gw Ss","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205884","EAP","HCPCS C1894","","System Intro Tpr 8fr 19-21ga 45cm 10cm Prcs Acc Sys Pncl","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$36.56 ","$0.00 ","$16.93 ","$57.99 ","$57.99 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"27205908","EAP","","","Stabilit Full Fracture Kit - 2 Level Kit","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$3,211.65 ","$3,211.65 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205910","EAP","Custom 27205910","","Set Ndl 15ga 15mm Strl Lf Arw","BOTH IP/OP","$1,563.00 ","$1,156.62 ","$0.00 ","$1,563.00 ","$0.00 ","$0.00 ","$0.00 ","$1,115.51 ","$1,115.51 ","$0.00 ","$1,563.00 ","$0.00 ","$781.50 ","$1,237.90 ","$1,250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205911","EAP","Custom 27205911","","Kit Peritoneal Lavage .035in 8","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$60.66 ","$60.66 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205912","EAP","Custom 27205912","","Lens Irrigation Therapeutic Tu","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$556.69 ","$556.69 ","$0.00 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205913","EAP","Custom 27205913","","Dressing Nasal Standard 8cm Co","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$306.89 ","$306.89 ","$0.00 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205914","EAP","HCPCS C1769","","Tray Surg 14fr 18ga 29cm 5cm 1","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$417.00 ","$226.43 ","$0.00 ","$86.91 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"27205915","EAP","Custom 27205915","","Kit Incision And Drainage Ecc","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$285.48 ","$285.48 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205916","EAP","HCPCS C1727","","Balloon Catheter Introducer Ki","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$267.64 ","$267.64 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205917","EAP","Custom 27205917","","Kit Introd .035in 9fr 18ga 10c","BOTH IP/OP","$309.00 ","$228.66 ","$0.00 ","$309.00 ","$0.00 ","$0.00 ","$0.00 ","$220.53 ","$220.53 ","$0.00 ","$309.00 ","$0.00 ","$154.50 ","$244.73 ","$247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205918","EAP","Custom 27205918","","Kit Prss Monitr 1 Ln Trndcr 1","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$0.00 ","$0.00 ","$0.00 ","$186.28 ","$186.28 ","$0.00 ","$261.00 ","$0.00 ","$130.50 ","$206.71 ","$208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205920","EAP","HCPCS C1769","","Guidewire Vasc .038in 180cm Strl 3cm Merit Laureat","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$43.44 ","$0.00 ","$16.67 ","$57.10 ","$57.10 ","$14.01 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$12.52 ","$0.00 ","$12.74 ","$0.00 "
"27205921","EAP","HCPCS C1769","","Guidewire Vasc Ang .035in 150cm 3cm Laureate Fxcr","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27205922","EAP","HCPCS C1751","","Catheter Cen Ven 9fr 3mm 1.3mm .7mm 90cm 2 Lumen T","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$192.77 ","$0.00 ","$73.99 ","$253.36 ","$253.36 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"27205923","EAP","HCPCS C1769","","Guidewire Vascular Taper .038in 145cm 6cm Str Tip","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$42.82 ","$42.82 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"27205930","EAP","HCPCS C1729","","Catheter Urethral Standard 24f","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$140.64 ","$0.00 ","$53.98 ","$184.85 ","$184.85 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"27205931","EAP","Custom 27205931","","Needle Biop 13 1/16in 15ga 15/","BOTH IP/OP","$214.00 ","$158.36 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$152.73 ","$152.73 ","$0.00 ","$214.00 ","$0.00 ","$107.00 ","$169.49 ","$171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205932","EAP","Custom 27205932","","Speculum Vag Med Grn Ns Lf Er-","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$119.90 ","$119.90 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205933","EAP","Custom 27205933","","Needle Spinal Long Bevel Quinc","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205934","EAP","HCPCS C1729","","Tray Catheterization 16fr 2 Co","BOTH IP/OP","$73.00 ","$54.02 ","$0.00 ","$73.00 ","$39.64 ","$0.00 ","$15.22 ","$52.10 ","$52.10 ","$12.78 ","$73.00 ","$0.00 ","$36.50 ","$57.82 ","$58.40 ","$0.00 ","$11.42 ","$0.00 ","$11.62 ","$0.00 "
"27205938","EAP","Custom 27205938","","Sensor Oximeter 18in Adhesive","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205939","EAP","Custom 27205939","","Kit Laceration","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205940","EAP","HCPCS C1729","","Catheter Urethral 12fr 2 Way 1","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$4.55 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$4.07 ","$0.00 ","$4.14 ","$0.00 "
"27205941","EAP","HCPCS C1729","","Catheter Urethral 14fr Foley 2","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$14.12 ","$0.00 ","$5.42 ","$18.56 ","$18.56 ","$4.55 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$4.07 ","$0.00 ","$4.14 ","$0.00 "
"27205942","EAP","Custom 27205942","","Kit Arterial Line .018in 20ga","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$17.84 ","$17.84 ","$0.00 ","$25.00 ","$0.00 ","$12.50 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205943","EAP","","","Envelope Defibrillator 3.35x3in Resorb Aigisrx Mino","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$0.00 ","$0.00 ","$0.00 ","$1,775.69 ","$1,775.69 ","$0.00 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205944","EAP","HCPCS c1769","","Guidewire Vasc 190cm Mic J Asahi Gaia 1st Coron","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205945","EAP","HCPCS c1769","","Guidewire Vasc 300cm Jtp Mic Asahi Gaia 1st Coron","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27205946","EAP","HCPCS C1769","","Guidewire Vasc 190cm Gaia 2 Mctip J Asahi","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27205947","EAP","HCPCS C1769","","Guidewire Vasc 300cm Jtp Mic Asahi Gaia Sec Coron","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27205948","EAP","HCPCS C1769","","Guidewire Vasc 190cm Gaia 3 Mctip J Asahi","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27205949","EAP","HCPCS C1769","","Guidewire Vasc 300cm 3rd Mic J Asahi Gaia Coron","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27205950","EAP","","","Catheter Angio Brnstn 1 Crv 5fr .046in 125cm Prfm Wng Hub","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27206307","EAP","Custom 27206307","","Sheath Guid Str 8fr 45cm 35cm 3 Radiopq Cross Cut","BOTH IP/OP","$1,550.00 ","$1,147.00 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$1,106.24 ","$1,106.24 ","$0.00 ","$1,550.00 ","$0.00 ","$775.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27206308","EAP","HCPCS C1894","","Introducer Shth 23fr 55.7cm 69.9cm Micra Stpck Radopq Dil","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"27206309","EAP","HCPCS C1769","","Guidewire Hi-torque Comm Es .014"" 300cm","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$988.00 ","$536.48 ","$0.00 ","$205.92 ","$705.14 ","$705.14 ","$172.99 ","$988.00 ","$0.00 ","$494.00 ","$782.50 ","$790.40 ","$0.00 ","$154.62 ","$0.00 ","$157.29 ","$0.00 "
"27219613","EAP","HCPCS C1751","","Tray Catheterization 16fr Urine Meter Foley Statlo","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$21.72 ","$0.00 ","$8.34 ","$28.55 ","$28.55 ","$7.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$6.26 ","$0.00 ","$6.37 ","$0.00 "
"27219614","EAP","Custom 27219614","","5fr Micro Stick","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$35.69 ","$35.69 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219615","EAP","","","Tube Gstrm 18fr 10cm 5-10ml Entuit Enfit Bln Rtnt Fd","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219616","EAP","","","Tube Fd 20fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219617","EAP","","","Tube Fd 22fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219618","EAP","HCPCS C1769","","Set Gstrm Lg 20-24fr 22-26fr Strl Entuit Srt Coons Dil Plwy","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"27219620","EAP","","","Inst Ablat Spinestar 5-10 Gen2","BOTH IP/OP","$7,250.00 ","$5,365.00 ","$0.00 ","$7,250.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,250.00 ","$0.00 ","$3,625.00 ","$5,742.00 ","$5,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219621","EAP","","","Kit Angio 65in Acist Cvi Angiotouch 3w Hi-prs Stpck Prm","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219622","EAP","HCPCS C2623","","Catheter Blndil 5mm 40cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219623","EAP","HCPCS C2623","","Catheter Blndil 5mm 40cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219624","EAP","HCPCS C2623","","Catheter Blndil 5mm 40cm 80mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219625","EAP","HCPCS C2623","","Catheter Blndil 5mm 40cm 100mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219626","EAP","HCPCS C2623","","Catheter Blndil 6mm 40cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219627","EAP","HCPCS C2623","","Catheter Blndil 6mm 40cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219628","EAP","HCPCS C2623","","Catheter Blndil 6mm 40cm 80mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219629","EAP","HCPCS C2623","","Catheter Blndil 6mm 40cm 100mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219630","EAP","HCPCS C2623","","Catheter Blndil 7mm 40cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219631","EAP","HCPCS C2623","","Catheter Blndil 7mm 40cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219632","EAP","HCPCS C2623","","Catheter Blndil 8mm 40cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219633","EAP","HCPCS C2623","","Catheter Blndil 7fr 8mm 40cm 60mm Lutonix Drg Coat Acpt .035","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219634","EAP","HCPCS C2623","","Catheter Blndil 4mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219635","EAP","HCPCS C2623","","Catheter Blndil 4mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219636","EAP","HCPCS C2623","","Catheter Blndil 4mm 75cm 80mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219637","EAP","HCPCS C2623","","Catheter Blndil 4mm 75cm 100mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219638","EAP","HCPCS C2623","","Catheter Blndil 5mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219639","EAP","HCPCS C2623","","Catheter Blndil 5mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219640","EAP","HCPCS C2623","","Catheter Blndil 5mm 75cm 80mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219641","EAP","HCPCS C2623","","Catheter Blndil 5mm 75cm 100mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219642","EAP","HCPCS C2623","","Catheter Blndil 6mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219643","EAP","HCPCS C2623","","Catheter Blndil 6mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219644","EAP","HCPCS C2623","","Catheter Blndil 6mm 75cm 80mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219645","EAP","HCPCS C2623","","Catheter Blndil 6mm 75cm 100mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219646","EAP","HCPCS C2623","","Catheter Blndil 7mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219647","EAP","HCPCS C2623","","Catheter Blndil 7mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219648","EAP","HCPCS C2623","","Catheter Blndil 8mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219649","EAP","HCPCS C2623","","Catheter Blndil 8mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219650","EAP","HCPCS C2623","","Catheter Blndil 9mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219651","EAP","HCPCS C2623","","Catheter Blndil 9mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219652","EAP","HCPCS C2623","","Catheter Blndil 10mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219653","EAP","HCPCS C2623","","Catheter Blndil 10mm 75cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219654","EAP","HCPCS C2623","","Catheter Blndil 12mm 75cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219655","EAP","HCPCS C2623","","Catheter Blndil 8mm 100cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219656","EAP","HCPCS C2623","","Catheter Blndil 8mm 100cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219657","EAP","HCPCS C2623","","Catheter Blndil 9mm 100cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219658","EAP","HCPCS C2623","","Catheter Blndil 9mm 100cm 60mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219659","EAP","HCPCS C2623","","Catheter Blndil 10mm 100cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219660","EAP","HCPCS C2623","","Catheter Blndil 8fr 10mm 100cm 60mm Lutonix Drg Coat Acpt","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219661","EAP","HCPCS C2623","","Catheter Blndil 12mm 100cm 40mm Lutonix Drg Coat Acpt .035in","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"27219662","EAP","","","Tube Fd 24fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219663","EAP","","","Catheter Infs 2 2/3fr 45cm Clarivein","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219664","EAP","","","Catheter Infs 4 4/3fr 65cm Clarivein","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219665","EAP","HCPCS C1729","","Stent Intracranial Pulserider T L10 Mm Od4 Mm","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$16,968.75 ","$0.00 ","$6,513.28 ","$5,158.80 ","$5,158.80 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27219667","EAP","HCPCS C1769","","Guidewire Vasc Strg .035in 260cm 6cm Hiwire Bntsn Atrm X","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$30.95 ","$0.00 ","$11.88 ","$40.68 ","$40.68 ","$9.98 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$8.92 ","$0.00 ","$9.07 ","$0.00 "
"27219668","EAP","HCPCS C1887","","Catheter Gd 10d 2.1-3.5fr 135cm 7mm Twnps 2 Lum Otw Trq Brd","BOTH IP/OP","$1,123.00 ","$831.02 ","$0.00 ","$1,123.00 ","$609.79 ","$0.00 ","$234.06 ","$801.49 ","$801.49 ","$196.63 ","$1,123.00 ","$0.00 ","$561.50 ","$889.42 ","$898.40 ","$0.00 ","$175.75 ","$0.00 ","$178.78 ","$0.00 "
"27219669","EAP","","","Drill Srg Vertecor Bn","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$392.54 ","$392.54 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219670","EAP","","","Catheter Chlgm Spyscope Ds Acc Dlv Disp","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$4,906.69 ","$4,906.69 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219671","EAP","HCPCS C1887","","Catheter Intvn 5.1fr 150cm 13cm Trapliner Rx Gd Xtn Radopq","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27219672","EAP","HCPCS C1887","","Catheter Intvn 5.7fr 150cm 13cm Trapliner Rx Gd Xtn Radopq","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27219673","EAP","HCPCS C1887","","Catheter Intvn 6.5fr 150cm 13cm Trapliner Rx Gd Xtn Radopq","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27219674","EAP","HCPCS C1750","","Catheter Hmdial 14.5fr 19cm Mh Mxd Sportpack 2 Lum Kink Rst","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"27219675","EAP","HCPCS C1894","","Sheath Gd 8fr 2.9mm 40cm Strl Flxr Chfl Blkn Disp Acpt .038","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219676","EAP","HCPCS C1887","","Microcatheter Crbrvasc Thnwl 2fr .019in 130cm 70cm Progreat","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27219677","EAP","HCPCS C1887","","Microcatheter Crbrvasc Thnwl 2fr .019in 150cm 90cm Progreat","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"27219678","EAP","HCPCS C1769","","Embrotrap Ii Revascularization Device (5x21)","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,500.00 ","$5,158.50 ","$0.00 ","$1,980.04 ","$5,158.80 ","$5,158.80 ","$1,663.37 ","$9,500.00 ","$0.00 ","$4,750.00 ","$7,524.00 ","$7,600.00 ","$0.00 ","$1,486.75 ","$0.00 ","$1,512.40 ","$0.00 "
"27219679","EAP","HCPCS C1769","","Embrotrap Ii Revascularization Device (5x33)","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,500.00 ","$5,158.50 ","$0.00 ","$1,980.04 ","$5,158.80 ","$5,158.80 ","$1,663.37 ","$9,500.00 ","$0.00 ","$4,750.00 ","$7,524.00 ","$7,600.00 ","$0.00 ","$1,486.75 ","$0.00 ","$1,512.40 ","$0.00 "
"27219680","EAP","","","Catheter Angio.038in Chgb Crv 5fr","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219681","EAP","","","Catheter Angio Rosch Infr Mes Crv Tpr 5fr 65cm Strl 41","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219682","EAP","HCPCS C1725","","Catheter Angiographic Angle 4fr.041in 65cm 15cm 2 Braid","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$66.79 ","$0.00 ","$25.64 ","$87.79 ","$87.79 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"27219690","EAP","Custom 27219690","","Device Indfltr Plus 30 10ml Inflat 30 Atm Disp","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219691","EAP","Custom 27219691","","Kit Inflat Indfltr Plus 30 .096in Coron Rot Hmst","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219692","EAP","Custom 27219692","","Device Indfltr Plus 30 10ml Rot Hmst Vlv Gwire","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219693","EAP","Custom 27219693","","Kit Inflat Indfltr .096in Rot Hmst Vlv Gwire","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219694","EAP","Custom 27219694","","Device 20/30 Indfltr 20ml Rot Hmst Vlv Gwire","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219695","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Str Rbn 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219696","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq J Rbn 4.5cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219697","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Str Rbn 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219698","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jtp Shaping Rbn","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219699","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Strbl Core To Tip","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219700","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jtp Core To Tip","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219701","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Core To Tip Radiopq J","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219702","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Kink Rst J 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219703","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Kink Rst Str 3","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219704","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219705","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Jtp Shaping Rbn","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219706","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Kink Rst Str 3","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219707","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jtp Shaping Rbn","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219708","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jtp Shaping Rbn","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219709","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in .01in Radiopq Coil Str","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219710","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in .01in Radiopq Coil J","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219711","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in .01in Radiopq Coil Str","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219712","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jtp Core To Tip","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219713","EAP","Custom 27219713","","Valve Hmsts .096- In Coplt 20 Atm Inflat Trq Dev","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$119.90 ","$119.90 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219714","EAP","Custom 27219714","","Valve Hmsts .096- In Coplt Kit Bldbck Cntrl Vlv","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219715","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 3cm Htorq Whspr Ls","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219716","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htorq Whspr Ls","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219717","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htorq Whspr Ls","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219718","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htorq Whspr Ms","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219719","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in J 3cm Htorq Whspr Ms","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219720","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt U","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219721","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219722","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in W/o Mrkr Shaping Rbn","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219723","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt U","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219724","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt U","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219725","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Cover Str Rbn","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219726","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Bl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219727","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Str 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219728","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219729","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Mrkr Tip Str 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219730","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt U Ii","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219731","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt U","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219732","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt U Ii","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219733","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Core To","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219734","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Core To","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219735","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Jtp Core To Tip","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219736","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219737","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Core To","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219738","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Core To","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219739","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Core To","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219740","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Core To","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219741","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219742","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr J 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219743","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219744","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr J 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219745","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219746","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219747","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219748","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219749","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Str Tpr 3","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219750","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Str Tpr 3","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219751","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Str Tpr 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219752","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Str Tpr 3","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219753","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219754","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"27219755","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Mrkr Str 3cm Htrq Bl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219756","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Bl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219757","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Str 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219758","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219759","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in W/o Mrkr Str 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219760","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt Elt","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219761","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219762","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt Elt","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219763","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htorq Bal","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219764","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htorq Bal","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219765","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htorq Bal","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219766","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htorq Bal","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219767","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 3cm Htorq Bal","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219768","EAP","HCPCS C1769","","Guidewire Vasc 175cm .014in Str 3cm Htorq Bal","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219769","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq Str 3cm Htorq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219770","EAP","Custom 27219770","","Valve Hmsts .115in Duostat Rot","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$41.39 ","$41.39 ","$0.00 ","$58.00 ","$0.00 ","$29.00 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219771","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 30cm Htrq Wg Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219772","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in J Tpr 3cm Htrq Trns Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219773","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str Tpr 3cm Htrq Trns","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219774","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str Tip Tpr 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219775","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jtp Lght Sprt Shaping","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219776","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 2cm Htrq Wg Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219777","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in X Sprt Str 2cm Htrq Fl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219778","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str Tip Lght Sprt","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219779","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str Sprg Tpr 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219780","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str Sprg Tpr 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219781","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Jtp Lght Sprt Shaping","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219782","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Lght Sprt Str 30cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219783","EAP","HCPCS C1769","","Guidewire Vasc 190cm .018in Lght Sprt Str 2cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219784","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str Tip Str 2cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219785","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 2cm Htrq Fl2 Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219786","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 2cm Htorq Std Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219787","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 2cm Htorq Std Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219788","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 2cm Htorq Std Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219789","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Inm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219790","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 3cm Htrq Inm Mcgld","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219791","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htrq Inm Hdrct","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219792","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htrq Inm Hdrct","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219793","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 3cm Htrq Inm Hdrct","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219794","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str Rbn 30cm Htrq Wg","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219795","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str Shaping Rbn 2cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219796","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Lght Sprt Str 30cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219797","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Lght Sprt Str Tip 2cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219798","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 2cm Htrq Fl2 Ss","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219799","EAP","Custom 27219799","","Kit Gwire .009-.018in .115in Introd Trq Dev Rot","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219800","EAP","Custom 27219800","","Kit Gwire .01-.018in","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219801","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in X Sprt J 3cm Htorq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219802","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str Tip Core To Tip","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219803","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in X Sprt J 3cm Htrq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219804","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str Tip Str 3cm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219805","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 143cm 6mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219806","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 143cm 8mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219807","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 143cm 12mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219808","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 143cm 15mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219809","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219810","EAP","HCPCS C1725","","Catheter Baldilat 2mm 143cm 6mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219811","EAP","HCPCS C1725","","Catheter Baldilat 2mm 143cm 12mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219812","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 143cm 6mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219813","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219814","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 143cm 15mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219815","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219816","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 143cm 25mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219817","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 143cm 6mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219818","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 143cm 8mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219819","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 143cm 12mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219820","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219821","EAP","HCPCS C1725","","Catheter Baldilat 3mm 143cm 6mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219822","EAP","HCPCS C1725","","Catheter Baldilat 3mm 143cm 12mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219823","EAP","HCPCS C1725","","Catheter Baldilat 3mm 143cm 15mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219824","EAP","HCPCS C1725","","Catheter Baldilat 3mm 143cm 20mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219825","EAP","HCPCS C1725","","Catheter Baldilat 3mm 143cm 25mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219826","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 143cm 8mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219827","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 143cm 12mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219828","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 143cm 15mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219829","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219830","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 143cm 6mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219831","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 143cm 12mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219832","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 143cm 15mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219833","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219834","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 143cm 25mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219835","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 143cm 12mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219836","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 143cm 15mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219837","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219838","EAP","HCPCS C1725","","Catheter Baldilat 4mm 143cm 8mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219839","EAP","HCPCS C1725","","Catheter Baldilat 4mm 143cm 12mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219840","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 143cm 8mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219841","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 143cm 12mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219842","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 143cm 15mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219843","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 143cm 20mm Otw Smth Rnd","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219844","EAP","HCPCS C1725","","Catheter Baldilat 5mm 143cm 8mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219845","EAP","HCPCS C1725","","Catheter Baldilat 5mm 143cm 20mm Otw Smth Rnd Tip","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"27219846","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 3cm Htorq Adv Lt","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219847","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Str 3cm Htorq Adv","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219848","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in J 3cm Htorq Adv","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219849","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Str 3cm Htorq Adv","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219850","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in J 3cm Htorq Adv","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"27219851","EAP","HCPCS C1769","","Guidewire Vasc 300cm Ptca Asahi Ultimatebros 3","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219852","EAP","HCPCS C1769","","Guidewire Vasc 180cm Ptca Asahi Ultimatebros 3","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219853","EAP","HCPCS C1769","","Guidewire Vasc 300cm 3cm Str Asahi Suoh Ptca","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219854","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Sion Asahi Ptca Blue","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219855","EAP","HCPCS C1769","","Guidewire Vasc 300cm Wire J Asahi Ptca Sion Blue","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219856","EAP","HCPCS C1769","","Guidewire Vasc 190cm Str 3cm Asahi Suoh Ptca","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219857","EAP","HCPCS C1769","","Guidewire Vasc 190cm Pshp Mini 3cm Asahi Suoh Ptca","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219858","EAP","HCPCS C1769","","Guidewire Vasc 180cm Wire J Asahi Ptca Sion Blue","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219859","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip J 3cm A","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219860","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Jtp 3cm A Fldr Fc Plmr","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219861","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219862","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Core To Tip Str 11cm A","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219863","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Hbrd Radiopq Str Tip","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219864","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip J 3cm A","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219865","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Core To Tip J 3cm A","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219866","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip Str 3cm A","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219867","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Core To Tip Str 3cm A","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219868","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip J 3cm","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219869","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Core To Tip J 3cm","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219870","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Hbrd Radiopq Str Tip 3","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219871","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Hbrd Radiopq Str Tip 3","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219872","EAP","HCPCS C1769","","Guidewire Vasc 300cm Ptca A Cfnz Pro","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219873","EAP","HCPCS C1769","","Guidewire Vasc 180cm .009in Radiopq Str Tip 20cm A","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219874","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Core To Tip J","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219875","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219876","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219877","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219878","EAP","HCPCS C1769","","Guidewire Vasc 180cm J Asahi Sft Ptca","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219879","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Core To Tip","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219880","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Core To Tip J","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219881","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219882","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Core To Tip","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219883","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in .009in Radiopq Str Tip","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219884","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219885","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip J","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219886","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219887","EAP","HCPCS C1769","","Guidewire Vasc 300cm J Asahi Sft Ptca","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219888","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip J","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219889","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219890","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219891","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Str Tpr Tip 3","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"27219892","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Radiopq Core To Tip","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$509.33 ","$0.00 ","$195.50 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$0.00 ","$146.80 ","$0.00 ","$149.33 ","$0.00 "
"27219893","EAP","HCPCS C1769","","Introd Gwire .009-.018in Coron","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$15.63 ","$53.53 ","$53.53 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"27219894","EAP","Custom 27219894","","Device Trq Gwire Acpt .009-.018 In Gwire","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$89.21 ","$89.21 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219896","EAP","HCPCS C1887","","Catheter Infs Mic 2.1-1.7fr 5fr .017in 155cm .34ml 150cm","BOTH IP/OP","$1,588.00 ","$1,175.12 ","$0.00 ","$1,588.00 ","$862.28 ","$0.00 ","$330.98 ","$1,133.36 ","$1,133.36 ","$278.05 ","$1,588.00 ","$0.00 ","$794.00 ","$1,257.70 ","$1,270.40 ","$0.00 ","$248.52 ","$0.00 ","$252.81 ","$0.00 "
"27219897","EAP","HCPCS C1757","","Retriever Escp Trevo Xp Provue","BOTH IP/OP","$13,641.00 ","$10,094.34 ","$0.00 ","$13,641.00 ","$7,407.06 ","$0.00 ","$2,843.13 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,641.00 ","$0.00 ","$6,820.50 ","$10,803.67 ","$10,912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219898","EAP","HCPCS C1725","","Catheter Baldilat Lp 5.3fr 4mm 75cm 60mm High Pressure","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27219899","EAP","HCPCS C1894","","Introducer Sheath .035in Anl1 Curve 11.4fr 10fr 45cm High","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"27219900","EAP","HCPCS C1751","","Catheter Cv 9.3fr 22cm Strl Lf Cl Ln Heat Exch Kt","BOTH IP/OP","$1,288.00 ","$953.12 ","$0.00 ","$1,288.00 ","$699.38 ","$0.00 ","$268.45 ","$919.25 ","$919.25 ","$225.52 ","$1,288.00 ","$0.00 ","$644.00 ","$1,020.10 ","$1,030.40 ","$0.00 ","$201.57 ","$0.00 ","$205.05 ","$0.00 "
"27219901","EAP","HCPCS C1751","","Kit Cath 9.3fr 38cm Icy Cv","BOTH IP/OP","$2,053.00 ","$1,519.22 ","$0.00 ","$2,053.00 ","$1,114.78 ","$0.00 ","$427.90 ","$1,465.23 ","$1,465.23 ","$359.46 ","$2,053.00 ","$0.00 ","$1,026.50 ","$1,625.98 ","$1,642.40 ","$0.00 ","$321.29 ","$0.00 ","$326.84 ","$0.00 "
"27219902","EAP","HCPCS C1887","","Kit Cath 9.3fr 45cm Quattro Heat Exch 3 Lum Ll Applause Hep","BOTH IP/OP","$2,299.00 ","$1,701.26 ","$0.00 ","$2,299.00 ","$1,248.36 ","$0.00 ","$479.17 ","$1,640.80 ","$1,640.80 ","$402.54 ","$2,299.00 ","$0.00 ","$1,149.50 ","$1,820.81 ","$1,839.20 ","$0.00 ","$359.79 ","$0.00 ","$366.00 ","$0.00 "
"27219903","EAP","","","Kit Iv Clgrd 3k Srt","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$0.00 ","$324.73 ","$324.73 ","$0.00 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219904","EAP","","","Tubing Xtn 9ft","BOTH IP/OP","$511.00 ","$378.14 ","$0.00 ","$511.00 ","$0.00 ","$0.00 ","$0.00 ","$364.70 ","$364.70 ","$0.00 ","$511.00 ","$0.00 ","$255.50 ","$404.71 ","$408.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219905","EAP","","","Pack Srg 6ft Ivtm Cool Line Srt Up Disp","BOTH IP/OP","$6,725.00 ","$4,976.50 ","$0.00 ","$6,725.00 ","$0.00 ","$0.00 ","$0.00 ","$4,799.63 ","$4,799.63 ","$0.00 ","$6,725.00 ","$0.00 ","$3,362.50 ","$5,326.20 ","$5,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219906","EAP","","","Pack Srg 6ft Ivtm Icy Srt Up Disp","BOTH IP/OP","$9,640.00 ","$7,133.60 ","$0.00 ","$9,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,640.00 ","$0.00 ","$4,820.00 ","$7,634.88 ","$7,712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219907","EAP","","","Pack Srg 6ft Ivtm Quattro Srt Up Disp","BOTH IP/OP","$10,579.00 ","$7,828.46 ","$0.00 ","$10,579.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,579.00 ","$0.00 ","$5,289.50 ","$8,378.57 ","$8,463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219908","EAP","HCPCS C1887","","Catheter Advanced Support Guidewire Center Cross Ultra","BOTH IP/OP","$498.00 ","$368.52 ","$0.00 ","$498.00 ","$0.00 ","$0.00 ","$0.00 ","$355.42 ","$355.42 ","$87.20 ","$498.00 ","$0.00 ","$249.00 ","$394.42 ","$398.40 ","$0.00 ","$77.94 ","$0.00 ","$79.28 ","$0.00 "
"27219909","EAP","HCPCS C1887","","Catheter Angioplasty Microcross 0.014 In","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$988.00 ","$0.00 ","$0.00 ","$0.00 ","$705.14 ","$705.14 ","$172.99 ","$988.00 ","$0.00 ","$494.00 ","$782.50 ","$790.40 ","$0.00 ","$154.62 ","$0.00 ","$157.29 ","$0.00 "
"27219910","EAP","HCPCS C1887","","Catheter Angioplasty Microcross 0.018 In","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$988.00 ","$0.00 ","$0.00 ","$0.00 ","$705.14 ","$705.14 ","$172.99 ","$988.00 ","$0.00 ","$494.00 ","$782.50 ","$790.40 ","$0.00 ","$154.62 ","$0.00 ","$157.29 ","$0.00 "
"27219911","EAP","","","Drain Incs Strl Lf Oas Bld Rcvr Dry Sct Ats Cmpt 1 Pt Tube","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$66.37 ","$66.37 ","$0.00 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219912","EAP","","","Separator Thrmb Strl Lf Indg Sys 4 Disp","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$1,570.14 ","$1,570.14 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219913","EAP","","","Catheter Sct 16mm 105cm Strl Lf Clottriever Disp","BOTH IP/OP","$11,988.00 ","$8,871.12 ","$0.00 ","$11,988.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,988.00 ","$0.00 ","$5,994.00 ","$9,494.50 ","$9,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219914","EAP","","","Catheter Sct 4.6mm 15cm Strl Lf Clottriever Shth Disp","BOTH IP/OP","$3,238.00 ","$2,396.12 ","$0.00 ","$3,238.00 ","$0.00 ","$0.00 ","$0.00 ","$2,310.96 ","$2,310.96 ","$0.00 ","$3,238.00 ","$0.00 ","$1,619.00 ","$2,564.50 ","$2,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219915","EAP","HCPCS C1757","","Set Thrombectomy 6fr 3mm 120cm 15mm Otw Contrast Injec Port","BOTH IP/OP","$5,013.00 ","$3,709.62 ","$0.00 ","$5,013.00 ","$2,722.06 ","$0.00 ","$1,044.83 ","$3,577.78 ","$3,577.78 ","$0.00 ","$5,013.00 ","$0.00 ","$2,506.50 ","$3,970.30 ","$4,010.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219916","EAP","HCPCS C1769","","Guidewire Vasc Ang .035in 150cm Hiwire Radopq Flx Tp Stf","BOTH IP/OP","$423.00 ","$313.02 ","$0.00 ","$423.00 ","$229.69 ","$0.00 ","$88.16 ","$301.90 ","$301.90 ","$74.06 ","$423.00 ","$0.00 ","$211.50 ","$335.02 ","$338.40 ","$0.00 ","$66.20 ","$0.00 ","$67.34 ","$0.00 "
"27219917","EAP","","","Catheter Angiographic Kmp Curve 5fr 40cm Torcon Nb Advantage","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$138.46 ","$138.46 ","$0.00 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219918","EAP","HCPCS C1769","","Guidewire Vasc 3cm Strg .014in 190cm 25cm Spectre 2 Cor Kink","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$25.52 ","$0.00 ","$9.80 ","$33.54 ","$33.54 ","$8.23 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$7.36 ","$0.00 ","$7.48 ","$0.00 "
"27219919","EAP","HCPCS C1769","","Guidewire Vasc 3cm Strg .014in 300cm 25cm Spectre 2 Cor Kink","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$26.06 ","$0.00 ","$10.00 ","$34.26 ","$34.26 ","$8.40 ","$48.00 ","$0.00 ","$24.00 ","$38.02 ","$38.40 ","$0.00 ","$7.51 ","$0.00 ","$7.64 ","$0.00 "
"27219920","EAP","HCPCS C1753","","Catheter Ultrasound 20mhz 3.4fr 135cm Scanner Transducer","BOTH IP/OP","$1,688.00 ","$1,249.12 ","$0.00 ","$1,688.00 ","$916.58 ","$0.00 ","$351.82 ","$1,204.73 ","$1,204.73 ","$295.56 ","$1,688.00 ","$0.00 ","$844.00 ","$1,336.90 ","$1,350.40 ","$0.00 ","$264.17 ","$0.00 ","$268.73 ","$0.00 "
"27219921","EAP","HCPCS C1887","","Catheter Gd Mpc Crv 6fr 100cm Env Lg Inr Lum Radopq Brd Sft","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$503.90 ","$0.00 ","$193.42 ","$662.31 ","$662.31 ","$162.49 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$145.23 ","$0.00 ","$147.74 ","$0.00 "
"27219922","EAP","HCPCS C1725","","Catheter Blndil 8mm 90cm 20mm Pr Ctbln Otw Tpr Tip Infl Port","BOTH IP/OP","$1,759.00 ","$1,301.66 ","$0.00 ","$1,759.00 ","$955.14 ","$0.00 ","$366.62 ","$1,255.40 ","$1,255.40 ","$307.99 ","$1,759.00 ","$0.00 ","$879.50 ","$1,393.13 ","$1,407.20 ","$0.00 ","$275.28 ","$0.00 ","$280.03 ","$0.00 "
"27219923","EAP","","","Pad Thrp Unv Sm Ns Lf Arcticgel Inlt/otlt Cnct Ddrgl Disp","BOTH IP/OP","$218.00 ","$161.32 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$155.59 ","$155.59 ","$0.00 ","$218.00 ","$0.00 ","$109.00 ","$172.66 ","$174.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219924","EAP","HCPCS C1769","","Guidewire Vasc .014in 180cm Strl Lf Cnfnz Pro 12 Disp","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"27219925","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm Strl Lf Fielder Fc Disp","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"27219926","EAP","HCPCS C1769","","Guidewire Vasc .014in 180cm Strl Lf Fielder Fc Disp","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"27219927","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm Strl Lf Grand Slam Disp","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$156.38 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27219928","EAP","HCPCS C1769","","Guidewire Vasc .014in 180cm Strl Lf Mrclbrs 6 Disp","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"27219929","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm Strl Lf Mrclbrs 6 Disp","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"27219930","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm Strl Lf Mrclbrs 3 Disp","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"27219931","EAP","HCPCS C1769","","Guidewire Vasc .014in 180cm Strl Lf P-h2o Disp","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"27219932","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm Strl Lf P-h2o Disp","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"27219933","EAP","HCPCS C1769","","Guidewire Vasc .014in 300cm 45cm Snchr14","BOTH IP/OP","$1,798.00 ","$1,330.52 ","$0.00 ","$1,798.00 ","$976.31 ","$0.00 ","$374.75 ","$1,283.23 ","$1,283.23 ","$314.82 ","$1,798.00 ","$0.00 ","$899.00 ","$1,424.02 ","$1,438.40 ","$0.00 ","$281.39 ","$0.00 ","$286.24 ","$0.00 "
"27219934","EAP","","","Medtronic Aortic And Peripheral Vascular - Div Med","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$3,390.08 ","$3,390.08 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219935","EAP","HCPCS C1894","","Introducer Gw Grdn Ii Nc Hmsts Vlv","BOTH IP/OP","$1,688.00 ","$1,249.12 ","$0.00 ","$1,688.00 ","$916.58 ","$0.00 ","$351.82 ","$1,204.73 ","$1,204.73 ","$295.56 ","$1,688.00 ","$0.00 ","$844.00 ","$1,336.90 ","$1,350.40 ","$0.00 ","$264.17 ","$0.00 ","$268.73 ","$0.00 "
"27219936","EAP","","","Bronchoscope Flxb 600mm 3.8mm 1.2mm Slim Ambu","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$463.91 ","$463.91 ","$0.00 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219937","EAP","","","Bronchoscope Flxb 600mm 5mm 2.2mm Ambu Ascope 3","BOTH IP/OP","$985.00 ","$728.90 ","$0.00 ","$985.00 ","$0.00 ","$0.00 ","$0.00 ","$702.99 ","$702.99 ","$0.00 ","$985.00 ","$0.00 ","$492.50 ","$780.12 ","$788.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219938","EAP","","","Blade Lrnscp Mac S3 Spctrm Ti Disp Glidescope","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$71.37 ","$71.37 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219939","EAP","","","Blade Lrnscp Mac S4 Spctrm Ti Disp Glidescope","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$71.37 ","$71.37 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219940","EAP","","","Introducer Tube 15fr 70cm Strl Lf Clbrt Cde Boug Ldpe Adlt","BOTH IP/OP","$322.00 ","$238.28 ","$0.00 ","$322.00 ","$0.00 ","$0.00 ","$0.00 ","$229.81 ","$229.81 ","$0.00 ","$322.00 ","$0.00 ","$161.00 ","$255.02 ","$257.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219941","EAP","","","Catheter Primafit Sage","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$19.27 ","$19.27 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219942","EAP","HCPCS C1729","","Drain Incision Small Stature 1 Chamber Suction Control","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"27219943","EAP","HCPCS C1729","","Catheter External Drain Large 1.9mm Latex Free Bactiseal Evd","BOTH IP/OP","$1,229.00 ","$909.46 ","$0.00 ","$1,229.00 ","$667.35 ","$0.00 ","$256.15 ","$877.14 ","$877.14 ","$215.19 ","$1,229.00 ","$0.00 ","$614.50 ","$973.37 ","$983.20 ","$0.00 ","$192.34 ","$0.00 ","$195.66 ","$0.00 "
"27219945","EAP","Custom 27219945","","Tracheostomy Tray","BOTH IP/OP","$279.00 ","$206.46 ","$0.00 ","$279.00 ","$0.00 ","$0.00 ","$0.00 ","$199.12 ","$199.12 ","$0.00 ","$279.00 ","$0.00 ","$139.50 ","$220.97 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219946","EAP","Custom 27219946","","Canister Wound Drain C500ml Gel Tube Clmp Conctr Charcoal","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$59.95 ","$59.95 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219947","EAP","Custom 27219947","","Pad Wound Drain Tube Clmp Conctr Sensatrac Vac Sterile","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219948","EAP","Custom 27219948","","Airway Esophageal 3 Standard Str Mask Latex Free Auraonce","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219949","EAP","HCPCS C1769","","Guidewire Vascular .035in 26 13/16in 1 End Mark Spring Str","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$23.89 ","$0.00 ","$9.17 ","$31.40 ","$31.40 ","$7.70 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$6.89 ","$0.00 ","$7.00 ","$0.00 "
"27219950","EAP","Custom 27219950","","Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$29.00 ","$0.00 ","$0.00 ","$0.00 ","$20.70 ","$20.70 ","$0.00 ","$29.00 ","$0.00 ","$14.50 ","$22.97 ","$23.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219953","EAP","Custom 27219953","","Solution Dialysate 2 Compartment Bag Peel Seam Pureflow","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$89.21 ","$89.21 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219954","EAP","Custom 27219954","","Device Securing 6fr Kit Blue Retrival Probe White Catheter","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219955","EAP","Custom 27219955","","Device Securing Standard 8fr Kit Retrieval Probe Catheter","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219956","EAP","Custom 27219956","","Device Securing Standard 10fr Kit Retrieval Probe Catheter","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219957","EAP","Custom 27219957","","Device Scr Std 14fr Ylw Ns Lf Amt Bridle Preattach Clip Sty","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$165.58 ","$165.58 ","$0.00 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219959","EAP","Custom 27219959","","Kit Cath .032in 8.5fr 18ga 16cm Lf 2.5in Blu Flxtp Arwg+ard","BOTH IP/OP","$327.00 ","$241.98 ","$0.00 ","$327.00 ","$0.00 ","$0.00 ","$0.00 ","$233.38 ","$233.38 ","$0.00 ","$327.00 ","$0.00 ","$163.50 ","$258.98 ","$261.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219960","EAP","Custom 27219960","","Kit Urostomy Cut To Fit 2.25- In 2.75in 9in 2 Piece Belt Tab","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219961","EAP","Custom 27219961","","Suture Absorbable 3-0 Sh-1 27in Braid Coated Vicryl Undyed","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$0.00 ","$0.00 ","$0.00 ","$132.03 ","$132.03 ","$0.00 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219962","EAP","Custom 27219962","","Kit Repr 21-18ga Pilt Tube Syr Reinflate Cuf 10ml","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$19.27 ","$19.27 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219963","EAP","Custom 27219963","","Dressing Abthera Snsa Trc Foam Opn Abd Neg Prss","BOTH IP/OP","$920.00 ","$680.80 ","$0.00 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$656.60 ","$656.60 ","$0.00 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219964","EAP","Custom 27219964","","Dressing Hdrcld 8x8in Cmfl Plus Abs Wtprf Top Flm","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$40.68 ","$40.68 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219967","EAP","Custom 27219967","","Device Securing 12fr Kit Dk Blue","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$160.58 ","$160.58 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219968","EAP","Custom 27219968","","Device Securing 18fr Kit Lt Blue","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$160.58 ","$160.58 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219969","EAP","HCPCS C1752","","Kit Cath Strg 13fr 30cm Strl Pwr-trialysis 3 Lum Kink Rst","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$563.00 ","$0.00 ","$0.00 ","$0.00 ","$401.81 ","$401.81 ","$0.00 ","$563.00 ","$0.00 ","$281.50 ","$445.90 ","$450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219970","EAP","HCPCS C1752","","Kit Cath 13fr 20cm Strl Pwr-trialysis 3 Lum Shrt Term Dlys","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$563.00 ","$0.00 ","$0.00 ","$0.00 ","$401.81 ","$401.81 ","$0.00 ","$563.00 ","$0.00 ","$281.50 ","$445.90 ","$450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219971","EAP","HCPCS C1752","","Catheter Hmdial 15cm Schn Xl Kink Rst Tip Clip Sh Rem Sty","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$0.00 ","$0.00 ","$0.00 ","$84.93 ","$84.93 ","$0.00 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219972","EAP","HCPCS C1752","","Set Cath 24cm Schn Xl Bsc Sil Acute Hmdial","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219974","EAP","HCPCS C1755","","Kit Epidural Catheterization","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$104.20 ","$104.20 ","$0.00 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219975","EAP","Custom 27219975","","Kit Dressing Midline Custom Change Tray","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$34.26 ","$34.26 ","$0.00 ","$48.00 ","$0.00 ","$24.00 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219976","EAP","HCPCS C1725","","Catheter Blndil 2.25mm 142cm 35mm Mozec Rx Nyl Ptca","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27219977","EAP","HCPCS C1725","","Catheter Blndil 2.5mm 142cm 35mm Mozec Rx Nyl Ptca","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27219978","EAP","HCPCS C1725","","Catheter Blndil 2.75mm 142cm 35mm Mozec Rx Nyl Ptca","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27219979","EAP","HCPCS C1725","","Catheter Blndil 3mm Lf Crds Mozec Rx Ptca","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27219980","EAP","HCPCS C1725","","Catheter Blndil 3.5mm 142cm 35mm Mozec Rx Nyl Ptca","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27219981","EAP","HCPCS C1725","","Catheter Blndil 4mm 142cm 35mm Mozec Rx Nyl Ptca","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$134.66 ","$0.00 ","$51.69 ","$177.00 ","$177.00 ","$43.42 ","$248.00 ","$0.00 ","$124.00 ","$196.42 ","$198.40 ","$0.00 ","$38.81 ","$0.00 ","$39.48 ","$0.00 "
"27219982","EAP","HCPCS C1894","","Set Intro 8fr 80cm Lf S Arwflx 3w Stpck Shth Radopq Intgr","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$331.00 ","$179.73 ","$0.00 ","$68.99 ","$236.23 ","$236.23 ","$57.96 ","$331.00 ","$0.00 ","$165.50 ","$262.15 ","$264.80 ","$0.00 ","$51.80 ","$0.00 ","$52.70 ","$0.00 "
"27219983","EAP","Custom 27219983","","Cath Umb 3.5f Pu 15in","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219984","EAP","Custom 27219984","","Cath Umb 5f Pu 15in","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219985","EAP","Custom 27219985","","Catheter, 8f Thoracic","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219986","EAP","Custom 27219986","","Cath Trocar Fnl 10f 9in","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219987","EAP","Custom 27219987","","Cath Trocar 12fr","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219988","EAP","Custom 27219988","","Kit, Chest Tube","BOTH IP/OP","$74.00 ","$54.76 ","$0.00 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$52.81 ","$52.81 ","$0.00 ","$74.00 ","$0.00 ","$37.00 ","$58.61 ","$59.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219989","EAP","Custom 27219989","","Umbilical Vessel Catheter Tray 88-160408","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$0.00 ","$0.00 ","$0.00 ","$90.64 ","$90.64 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219990","EAP","HCPCS C1887","","Catheter Gd Strg 5fr .068in .055in 115cm 17cm Sofia Dist Acc","BOTH IP/OP","$3,040.00 ","$2,249.60 ","$0.00 ","$3,040.00 ","$1,650.72 ","$0.00 ","$633.61 ","$2,169.65 ","$2,169.65 ","$532.28 ","$3,040.00 ","$0.00 ","$1,520.00 ","$2,407.68 ","$2,432.00 ","$0.00 ","$475.76 ","$0.00 ","$483.97 ","$0.00 "
"27219991","EAP","HCPCS C1887","","Catheter Gd Strg 5fr .068in .055in 125cm 17cm Sofia Dist Acc","BOTH IP/OP","$3,230.00 ","$2,390.20 ","$0.00 ","$3,230.00 ","$1,753.89 ","$0.00 ","$673.21 ","$2,305.25 ","$2,305.25 ","$565.55 ","$3,230.00 ","$0.00 ","$1,615.00 ","$2,558.16 ","$2,584.00 ","$0.00 ","$505.50 ","$0.00 ","$514.22 ","$0.00 "
"27219992","EAP","HCPCS C1725","","Catheter Blndil 1mm 5mm Strl Lf Sphr Ii Pro Perc Ptca","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$563.00 ","$305.71 ","$0.00 ","$117.34 ","$401.81 ","$401.81 ","$98.58 ","$563.00 ","$0.00 ","$281.50 ","$445.90 ","$450.40 ","$0.00 ","$88.11 ","$0.00 ","$89.63 ","$0.00 "
"27219993","EAP","HCPCS C1725","","Catheter Blndil 1mm 8mm Strl Lf Sphr Ii Pro Perc Ptca","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$563.00 ","$305.71 ","$0.00 ","$117.34 ","$401.81 ","$401.81 ","$98.58 ","$563.00 ","$0.00 ","$281.50 ","$445.90 ","$450.40 ","$0.00 ","$88.11 ","$0.00 ","$89.63 ","$0.00 "
"27219994","EAP","HCPCS C1725","","Catheter Blndil 1mm 10mm Strl Lf Sphr Ii Pro Perc Ptca","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$563.00 ","$305.71 ","$0.00 ","$117.34 ","$401.81 ","$401.81 ","$98.58 ","$563.00 ","$0.00 ","$281.50 ","$445.90 ","$450.40 ","$0.00 ","$88.11 ","$0.00 ","$89.63 ","$0.00 "
"27219995","EAP","HCPCS C1725","","Catheter Blndil 1mm 15mm Strl Lf Sphr Ii Pro Perc Ptca","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$563.00 ","$305.71 ","$0.00 ","$117.34 ","$401.81 ","$401.81 ","$98.58 ","$563.00 ","$0.00 ","$281.50 ","$445.90 ","$450.40 ","$0.00 ","$88.11 ","$0.00 ","$89.63 ","$0.00 "
"27219996","EAP","HCPCS C1725","","Catheter Blndil 1.25mm 5mm Sphr Ii Pro Cor","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27219997","EAP","HCPCS C1725","","Catheter Blndil 1.25mm 8mm Sphr Ii Pro Cor","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27219998","EAP","HCPCS C1725","","Catheter Blndil 1.25mm 10mm Sphr Ii Pro Cor","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27219999","EAP","HCPCS C1725","","Catheter Blndil 1.25mm 15mm Sphr Ii Pro Cor","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220000","EAP","HCPCS C1725","","Catheter Blndil 1.5mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220001","EAP","HCPCS C1725","","Catheter Blndil 1.5mm Strl Lf 12mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220002","EAP","HCPCS C1725","","Catheter Blndil 1.5mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220003","EAP","HCPCS C1725","","Catheter Blndil 1.5mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220004","EAP","HCPCS C1725","","Catheter Blndil 1.75mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220005","EAP","HCPCS C1725","","Catheter Blndil 1.75mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220006","EAP","HCPCS C1725","","Catheter Blndil 1.75mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220007","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220008","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 12mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220009","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220010","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220011","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220012","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220013","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220014","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220015","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 12mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220016","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220017","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220018","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 30mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220019","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220020","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220021","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220022","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220023","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 12mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220024","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220025","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220026","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 30mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220027","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220028","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220029","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220030","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220031","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220032","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220033","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 30mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220034","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 10mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220035","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 15mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220036","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 20mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220037","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220038","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220039","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220040","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220041","EAP","HCPCS C1725","","Catheter Blndil 2mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220042","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220043","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220044","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220045","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220046","EAP","HCPCS C1725","","Catheter Blndil 2.25mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220047","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220048","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220049","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220050","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 16mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220051","EAP","HCPCS C1725","","Catheter Blndil 2.5mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220052","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220053","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220054","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220055","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220056","EAP","HCPCS C1725","","Catheter Blndil 2.75mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220057","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220058","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220059","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220060","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220061","EAP","HCPCS C1725","","Catheter Blndil 3mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220062","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220063","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220064","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 12mm Sphr Ii Pro Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220065","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220066","EAP","HCPCS C1725","","Catheter Blndil 3.25mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220067","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220068","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220069","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220070","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220071","EAP","HCPCS C1725","","Catheter Blndil 3.5mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220072","EAP","HCPCS C1725","","Catheter Blndil 3.75mm Ns Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220073","EAP","HCPCS C1725","","Catheter Blndil 3.75mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220074","EAP","HCPCS C1725","","Catheter Blndil 3.75mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220075","EAP","HCPCS C1725","","Catheter Blndil 3.75mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220076","EAP","HCPCS C1725","","Catheter Blndil 3.75mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220077","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 8mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220078","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 10mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220079","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 12mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220080","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 15mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220081","EAP","HCPCS C1725","","Catheter Blndil 4mm Strl Lf 18mm Sphr Nc + Ptca","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"27220082","EAP","HCPCS C1757","","Catheter Asp .082-.085in .071in 115cm Axs Vecta 71 Scout","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$4,014.56 ","$4,014.56 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220083","EAP","HCPCS C1757","","Catheter Asp .082-.085in .071in 125cm Axs Vecta 71 Scout","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,665.25 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220084","EAP","HCPCS C1757","","Cath Thromb Axs Vecta 71 2-4 Mm L132 Cm L150 Cm Od.082-.085","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,665.25 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220085","EAP","HCPCS C1730","","Cath, Ep, 5-5-5mm Spc Cs Lt Crv 6fr 65cm Rspn Mp Dcapl Fx","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$92.78 ","$92.78 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"27220086","EAP","HCPCS C1730","","Cath, Ep, 5-5-5-5-5mm Spc Crnnd 2 Crv 5fr 115cm Strbl 8","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$0.00 ","$0.00 ","$0.00 ","$260.50 ","$260.50 ","$63.91 ","$365.00 ","$0.00 ","$182.50 ","$289.08 ","$292.00 ","$0.00 ","$57.12 ","$0.00 ","$58.11 ","$0.00 "
"27220087","EAP","HCPCS C1730","","Cath, Ep, 2-10-2mm Spc Sup Lg Curl Crv 7fr 95cm 2mm Lvwr","BOTH IP/OP","$804.00 ","$594.96 ","$0.00 ","$804.00 ","$0.00 ","$0.00 ","$0.00 ","$573.81 ","$573.81 ","$140.77 ","$804.00 ","$0.00 ","$402.00 ","$636.77 ","$643.20 ","$0.00 ","$125.83 ","$0.00 ","$128.00 ","$0.00 "
"27220088","EAP","HCPCS C1730","","Catheter Ep 5mm Spc Crnnd Crv 5fr 120cm Rspn Qdpl","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$69.94 ","$69.94 ","$17.16 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$0.00 ","$15.34 ","$0.00 ","$15.60 ","$0.00 "
"27220089","EAP","HCPCS C1730","","Cath, Ep, 5mm Spacing Jsn Curve 5fr 120cm","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$69.94 ","$69.94 ","$17.16 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$0.00 ","$15.34 ","$0.00 ","$15.60 ","$0.00 "
"27220090","EAP","","","Cable Cath 150cm Blk Rspn Hexpl Octpl Dcapl Ep Repro","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$70.66 ","$70.66 ","$0.00 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220091","EAP","","","Catheter Ep 150cm Rspn Lvwr Hexpl Octpl Dcapl","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$70.66 ","$70.66 ","$0.00 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220092","EAP","","","Cable Cath Xtn Sjm Gntr","BOTH IP/OP","$222.00 ","$164.28 ","$0.00 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$158.44 ","$158.44 ","$0.00 ","$222.00 ","$0.00 ","$111.00 ","$175.82 ","$177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220093","EAP","HCPCS C1894","","Introducer Sheath .038in Large 18fr 30cm 42cm Radiopq Band","BOTH IP/OP","$318.00 ","$235.32 ","$0.00 ","$318.00 ","$172.67 ","$0.00 ","$66.28 ","$226.96 ","$226.96 ","$55.68 ","$318.00 ","$0.00 ","$159.00 ","$251.86 ","$254.40 ","$0.00 ","$49.77 ","$0.00 ","$50.63 ","$0.00 "
"27220094","EAP","","","Catheter Angio Chuang 2.5 Crv 5fr 80cm Trnb Ad Bcntp Mp Ss","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220095","EAP","","","Ft Retraction Aspirator Device Se","BOTH IP/OP","$3,238.00 ","$2,396.12 ","$0.00 ","$3,238.00 ","$0.00 ","$0.00 ","$0.00 ","$2,310.96 ","$2,310.96 ","$0.00 ","$3,238.00 ","$0.00 ","$1,619.00 ","$2,564.50 ","$2,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220096","EAP","","","Flowtriever Bundle","BOTH IP/OP","$22,500.00 ","$16,650.00 ","$0.00 ","$22,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$22,500.00 ","$0.00 ","$11,250.00 ","$17,820.00 ","$18,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220097","EAP","","","Tube Nasogastric 10fr 1.22mr 24 Port Vented Vinyl Pediatric","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220098","EAP","","","Tube Ng 8fr 36in Lf Entflx Fd Sty Y St","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$19.27 ","$19.27 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220099","EAP","","","Cuff Blood Pressure Clearsight Small Finger","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$446.06 ","$446.06 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220100","EAP","","","Cuff Blood Pressure Clearsight Medium Finger","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$446.06 ","$446.06 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220101","EAP","","","Cuff Blood Pressure Clearsight Large Finger","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$446.06 ","$446.06 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220102","EAP","","","Powermidline Catheter Max Barrier Tray 4f Sl","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$237.66 ","$237.66 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220103","EAP","","","Central Line 10cm 18g Basic","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220104","EAP","","","Central Line 10cm 18g Full","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220105","EAP","","","Central Line 8cm 18g Basic","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220106","EAP","","","Central Line 8cm 18g Full","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$169.86 ","$169.86 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220107","EAP","","","Soehendra Biliary Dilation Catheter","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$141.31 ","$141.31 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220108","EAP","","","Spybite Biopsy Forceps","BOTH IP/OP","$1,338.00 ","$990.12 ","$0.00 ","$1,338.00 ","$0.00 ","$0.00 ","$0.00 ","$954.93 ","$954.93 ","$0.00 ","$1,338.00 ","$0.00 ","$669.00 ","$1,059.70 ","$1,070.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220109","EAP","","","Pancreatic Stent 5fr","BOTH IP/OP","$115.00 ","$85.10 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$82.08 ","$82.08 ","$0.00 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220110","EAP","","","Ligating Device","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$157.01 ","$157.01 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220111","EAP","","","Echotip Procore Biopsy Needle","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$0.00 ","$0.00 ","$0.00 ","$722.98 ","$722.98 ","$0.00 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220112","EAP","","","Misc Central Line Supply","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$157.01 ","$157.01 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220113","EAP","HCPCS C1726","","Catheter Blndil 5mm 135cm 20mm Pr Ctbln Otw Tpr Tip Infl","BOTH IP/OP","$1,759.00 ","$1,301.66 ","$0.00 ","$1,759.00 ","$955.14 ","$0.00 ","$366.62 ","$1,255.40 ","$1,255.40 ","$307.99 ","$1,759.00 ","$0.00 ","$879.50 ","$1,393.13 ","$1,407.20 ","$0.00 ","$275.28 ","$0.00 ","$280.03 ","$0.00 "
"27220114","EAP","HCPCS C1753","","Catheter Baldilat Lp 5.3fr 4mm 135cm 60mm High Pressure","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$251.41 ","$0.00 ","$96.50 ","$330.44 ","$330.44 ","$81.07 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"27220117","EAP","HCPCS C1887","","Catheter Axs Catalyst 7 .068 Id X132cm","BOTH IP/OP","$5,288.00 ","$3,913.12 ","$0.00 ","$5,288.00 ","$2,871.38 ","$0.00 ","$1,102.15 ","$3,774.05 ","$3,774.05 ","$925.89 ","$5,288.00 ","$0.00 ","$2,644.00 ","$4,188.10 ","$4,230.40 ","$0.00 ","$827.57 ","$0.00 ","$841.85 ","$0.00 "
"27220118","EAP","HCPCS C1887","","Catheter Axs Catalyst 7 .068 Id X125cm","BOTH IP/OP","$5,288.00 ","$3,913.12 ","$0.00 ","$5,288.00 ","$0.00 ","$0.00 ","$0.00 ","$3,774.05 ","$3,774.05 ","$925.89 ","$5,288.00 ","$0.00 ","$2,644.00 ","$4,188.10 ","$4,230.40 ","$0.00 ","$827.57 ","$0.00 ","$841.85 ","$0.00 "
"27220119","EAP","HCPCS C1887","","Catheter Axs Catalyst 7 .068 Id X115cm","BOTH IP/OP","$5,288.00 ","$3,913.12 ","$0.00 ","$5,288.00 ","$0.00 ","$0.00 ","$0.00 ","$3,774.05 ","$3,774.05 ","$925.89 ","$5,288.00 ","$0.00 ","$2,644.00 ","$4,188.10 ","$4,230.40 ","$0.00 ","$827.57 ","$0.00 ","$841.85 ","$0.00 "
"27220120","EAP","HCPCS C1751","","Kit Triple Lumen Cvc, 7fr 20 Cm","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$195.48 ","$0.00 ","$75.03 ","$256.93 ","$256.93 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"27220121","EAP","HCPCS C1751","","Misc Swan Ganz Catheter","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$380.10 ","$0.00 ","$145.90 ","$499.59 ","$499.59 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"27220122","EAP","Custom 27220122","","Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$0.00 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220123","EAP","Custom 27220123","","Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft","BOTH IP/OP","$56.00 ","$41.44 ","$0.00 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$39.97 ","$0.00 ","$56.00 ","$0.00 ","$28.00 ","$44.35 ","$44.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220124","EAP","Custom 27220124","","Tray Spnl 20ga 3.5in Strl Lf 3 Spng Stk Prp Well Bndg Adlt","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220125","EAP","Custom 27220125","","Tray Spnl 22ga 1.5in 10ml Strl Spec Vl Prenumber Cap Pt Id","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$31.40 ","$31.40 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220126","EAP","Custom 27220126","","Dressing Burn 36x36in 17 Ply Gauze","BOTH IP/OP","$824.00 ","$609.76 ","$0.00 ","$41.00 ","$0.00 ","$0.00 ","$0.00 ","$29.26 ","$29.26 ","$0.00 ","$41.00 ","$0.00 ","$20.50 ","$32.47 ","$32.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220127","EAP","Custom 27220127","","Bandage Compression 10ydx4in 5ydx4in 1 Self Adherent Elast","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$18.56 ","$0.00 ","$26.00 ","$0.00 ","$13.00 ","$20.59 ","$20.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220129","EAP","Custom 27220129","","Valve Drn Sm 30ml Pnmst Grad Grmnt Atch Mlt Chst Tube Cnct","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$49.96 ","$49.96 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220130","EAP","Custom 27220130","","Dressing Prfy H2o Calcium Alg Na Cmc Gntl Dbrd","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$0.00 ","$22.12 ","$22.12 ","$0.00 ","$31.00 ","$0.00 ","$15.50 ","$24.55 ","$24.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220131","EAP","Custom 27220131","","Dressing Biatain Ag 4x4in 1 Pc Rem Abs Wnd Alg","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$19.27 ","$19.27 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220132","EAP","Custom 27220132","","Dressing Brn 48x4in Strl Lf Actct Flx 3 Anmc Brr 1 Lyr Knit","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$142.74 ","$142.74 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220133","EAP","Custom 27220133","","Dressing Wnd 8x8in Medihoney Abs Lght Ddrgl Clld Sht","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$0.00 ","$0.00 ","$0.00 ","$47.82 ","$47.82 ","$0.00 ","$67.00 ","$0.00 ","$33.50 ","$53.06 ","$53.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220134","EAP","Custom 27220134","","Gel Drsg Lf Medihoney Tub 400gm","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$134.18 ","$134.18 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220135","EAP","Custom 27220135","","Tray Dressing Cardinal Central Line  Grady Custom","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$30.69 ","$30.69 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220136","EAP","","","Pack Srg Crd Cath Haz","BOTH IP/OP","$173.00 ","$128.02 ","$0.00 ","$173.00 ","$0.00 ","$0.00 ","$0.00 ","$123.47 ","$123.47 ","$0.00 ","$173.00 ","$0.00 ","$86.50 ","$137.02 ","$138.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220137","EAP","","","Device Inflat 12fr 3in Pressure Gauge Latex Free Encore 26","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220138","EAP","","","Device Cmpr Lg 29cm Tr Band 2 Bln Trns Adj Strap Air Trtn","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$59.24 ","$59.24 ","$0.00 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220139","EAP","","","Umbilical Catheter 3.5","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$60.66 ","$60.66 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220140","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 25mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220141","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 30mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220142","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 38mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220143","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 9mm Rapex Elongate Tip","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220144","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220145","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220146","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220147","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 30mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220148","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 9mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220149","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220150","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220151","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220152","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220153","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220154","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220155","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220156","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220157","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220158","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220159","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 6mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220160","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220161","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220162","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220163","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220164","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220165","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220166","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220167","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220168","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 10mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220169","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220170","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220171","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220172","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220173","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220174","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220175","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220176","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220177","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 12mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220178","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220179","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220180","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220181","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220182","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220183","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220184","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220185","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220186","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 15mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220187","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220188","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220189","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220190","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220191","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220192","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220193","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220194","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220195","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 20mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220196","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 25mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220197","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 25mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220198","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 25mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220199","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 25mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220200","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 25mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220201","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 30mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220202","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 30mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220203","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 30mm Rapex Post Dil","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220204","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 139cm 6mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220205","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 6mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220206","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 6mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220207","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 6mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220208","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220209","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220210","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220211","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220212","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220213","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220214","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220215","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 10mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220216","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220217","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220218","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220219","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220220","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220221","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220222","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220223","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 12mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220224","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220225","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220226","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220227","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220228","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220229","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220230","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220231","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220232","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220233","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 15mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220234","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220235","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220236","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220237","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220238","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220239","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220240","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220241","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220242","EAP","HCPCS C1725","","Catheter Baldilat 4mm 139cm 20mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220243","EAP","HCPCS C1725","","Catheter Baldilat 2mm 139cm 30mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220244","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 139cm 30mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220245","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 139cm 30mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220246","EAP","HCPCS C1725","","Catheter Baldilat 3mm 139cm 30mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220247","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 139cm 30mm Rapex","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"27220248","EAP","HCPCS C1725","","Catheter Baldilat 2mm 8mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220249","EAP","HCPCS C1725","","Catheter Baldilat 2mm 10mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220250","EAP","HCPCS C1725","","Catheter Baldilat 2mm 142cm 13mm Rapex Radiopq Nc","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220251","EAP","HCPCS C1725","","Catheter Baldilat 2mm 15mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220252","EAP","HCPCS C1725","","Catheter Baldilat 2mm 18mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220253","EAP","HCPCS C1725","","Catheter Baldilat 2mm 23mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220254","EAP","HCPCS C1725","","Catheter Baldilat 2mm 28mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220255","EAP","HCPCS C1725","","Catheter Baldilat 2mm 35mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220256","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 8mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220257","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 10mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220258","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 13mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220259","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 15mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220260","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 18mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220261","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 23mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220262","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm Rapex Latex Free Crds","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220263","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm Rapex Latex Free Crds","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220264","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 10mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220265","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 13mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220266","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 15mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220267","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 18mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220268","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 23mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220269","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 28mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220270","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 8mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220271","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 10mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220272","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 13mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220273","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 15mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220274","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 18mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220275","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 23mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220276","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 28mm Rapex Nyl","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220277","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 8mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220278","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 10mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220279","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 13mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220280","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 15mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220281","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 18mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220282","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 23mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220283","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 28mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220284","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 8mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220285","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 10mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220286","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 13mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220287","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 15mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220288","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 18mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220289","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 23mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220290","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 28mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220291","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 8mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220292","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 10mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220293","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 13mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220294","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 15mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220295","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 18mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220296","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 23mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220297","EAP","HCPCS C1725","","Catheter Baldilat 4mm 142cm 28mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220298","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 8mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220299","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 10mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220300","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 13mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220301","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 15mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220302","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 18mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220303","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 23mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220304","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 28mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220305","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 142cm 35mm Rapex Nyl Mozec","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220306","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 142cm 9mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220307","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 142cm 12mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220308","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 142cm 15mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220309","EAP","HCPCS C1725","","Catheter Baldilat 2mm 142cm 9mm Rapex Elongate Tip","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220310","EAP","HCPCS C1725","","Catheter Baldilat 2mm 142cm 12mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220311","EAP","HCPCS C1725","","Catheter Baldilat 2mm 142cm 15mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220312","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 9mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220313","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220314","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220315","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220316","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 9mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220317","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220318","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220319","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220320","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 25mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220321","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 30mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220322","EAP","HCPCS C1725","","Catheter Baldilat 2.2mm 38mm Mozec Ptca","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220323","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 142cm 41mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220324","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 9mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220325","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220326","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220327","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220328","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 9mm Rapex Elongate Tip","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220329","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220330","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220331","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220332","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 25mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220333","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 30mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220334","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 38mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220335","EAP","HCPCS C1725","","Catheter Baldilat 3mm 142cm 41mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220336","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 9mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220337","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 14mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220338","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 17mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220339","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 142cm 20mm Rapex Elongate","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"27220340","EAP","HCPCS C1725","","Catheter Angiographic Angle 5fr .047in 65cm 25cm 1 Braid","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$66.79 ","$0.00 ","$25.64 ","$87.79 ","$87.79 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"27220341","EAP","HCPCS C1887","","Catheter Intvn 900- Psi 2.2-2.9fr 6- Mm .02in 110","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$1,350.98 ","$0.00 ","$518.56 ","$1,775.69 ","$1,775.69 ","$435.63 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$389.37 ","$0.00 ","$396.09 ","$0.00 "
"27220342","EAP","HCPCS C1887","","Catheter Blnocc 900- Psi 2.2-2.9fr 6- Mm .02in 130","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$1,350.98 ","$0.00 ","$518.56 ","$1,775.69 ","$1,775.69 ","$435.63 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$389.37 ","$0.00 ","$396.09 ","$0.00 "
"27220343","EAP","HCPCS C1887","","Catheter Blnocc 900- Psi 2.2-2.9fr 6- Mm .02in 150","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$1,350.98 ","$0.00 ","$518.56 ","$1,775.69 ","$1,775.69 ","$435.63 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$389.37 ","$0.00 ","$396.09 ","$0.00 "
"27220344","EAP","HCPCS C1887","","Catheter Infus 110cm 2 Lum Ang Tip Radiopq Gwire","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$1,350.98 ","$0.00 ","$518.56 ","$1,775.69 ","$1,775.69 ","$435.63 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$389.37 ","$0.00 ","$396.09 ","$0.00 "
"27220345","EAP","HCPCS C1887","","Catheter Infus 130cm 2 Lum Ang Tip Radiopq Gwire","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$1,350.98 ","$0.00 ","$518.56 ","$1,775.69 ","$1,775.69 ","$435.63 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$389.37 ","$0.00 ","$396.09 ","$0.00 "
"27220346","EAP","HCPCS C1887","","Catheter Infus 150cm 2 Lum Ang Tip Radiopq Gwire","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,488.00 ","$1,350.98 ","$0.00 ","$518.56 ","$1,775.69 ","$1,775.69 ","$435.63 ","$2,488.00 ","$0.00 ","$1,244.00 ","$1,970.50 ","$1,990.40 ","$0.00 ","$389.37 ","$0.00 ","$396.09 ","$0.00 "
"27220347","EAP","HCPCS C1887","","Catheter Angio Jl 4 Crv 5fr .047in 100cm Infnt Thrlmn Radopq","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$52.67 ","$0.00 ","$20.22 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$15.18 ","$0.00 ","$15.44 ","$0.00 "
"27220348","EAP","HCPCS C1887","","Catheter Angio Al 1 Crv 6fr 100cm Infnt Lt Cor","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$52.67 ","$0.00 ","$20.22 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$15.18 ","$0.00 ","$15.44 ","$0.00 "
"27220349","EAP","","","Kit Picc Dressing Change Tray 215","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$42.11 ","$42.11 ","$0.00 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27220352","EAP","HCPCS C1769","","Guidewire Vasc 90d 60d 2cm .018in 180cm 25cm Gldwr Gt Tip","BOTH IP/OP","$393.00 ","$290.82 ","$0.00 ","$393.00 ","$213.40 ","$0.00 ","$81.91 ","$280.48 ","$280.48 ","$68.81 ","$393.00 ","$0.00 ","$196.50 ","$311.26 ","$314.40 ","$0.00 ","$61.50 ","$0.00 ","$62.57 ","$0.00 "
"27220353","EAP","","","Device Inflat 12fr Pressure Gauge Encore 26 20ml","BOTH IP/OP","$367.00 ","$271.58 ","$0.00 ","$367.00 ","$0.00 ","$0.00 ","$0.00 ","$261.93 ","$261.93 ","$0.00 ","$367.00 ","$0.00 ","$183.50 ","$290.66 ","$293.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27300022","EAP","","","Stocking Compression 20-30 Mmhg Large Bk Od15.5-18","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27300023","EAP","","","Stocking Compression 20-30 Mmhg X-large Bk Od17.5-20","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400001","EAP","HCPCS A5121","","Skin Barrier, Solid 6X6 or Equival","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400002","EAP","HCPCS A5122","","Skin Barrier, Solid 8x8 Or Equivalent","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$96.35 ","$96.35 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400003","EAP","HCPCS L0170","","Neck Ext. Splint","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$556.60 ","$42.30 ","$530.92 ","$556.60 ","$67.09 ","$67.09 ","$16.46 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$56.40 ","$529.98 ","$0.00 ","$540.87 ","$0.00 "
"27400004","EAP","HCPCS L0150","","Cervical Collar","BOTH IP/OP","$202.00 ","$149.48 ","$0.00 ","$202.00 ","$0.00 ","$0.00 ","$0.00 ","$144.17 ","$144.17 ","$35.37 ","$202.00 ","$0.00 ","$101.00 ","$159.98 ","$161.60 ","$121.20 ","$0.00 ","$0.00 ","$89.77 ","$0.00 "
"27400005","EAP","HCPCS L0172","","Aspen Collar","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$524.00 ","$235.80 ","$0.00 ","$112.86 ","$373.98 ","$373.98 ","$91.75 ","$524.00 ","$0.00 ","$262.00 ","$415.01 ","$419.20 ","$314.40 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27400006","EAP","HCPCS L0174","","Miami Collar","BOTH IP/OP","$938.00 ","$694.12 ","$0.00 ","$938.00 ","$0.00 ","$0.00 ","$202.73 ","$669.45 ","$669.45 ","$164.24 ","$938.00 ","$0.00 ","$469.00 ","$742.90 ","$750.40 ","$562.80 ","$193.04 ","$0.00 ","$197.01 ","$0.00 "
"27400007","EAP","HCPCS L0190","","Somi Brace","BOTH IP/OP","$1,827.00 ","$1,351.98 ","$0.00 ","$1,827.00 ","$0.00 ","$0.00 ","$0.00 ","$1,303.93 ","$1,303.93 ","$0.00 ","$1,827.00 ","$0.00 ","$913.50 ","$1,446.98 ","$1,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400008","EAP","HCPCS L0200","","Cervical Thoracic Orthosis(cto","BOTH IP/OP","$1,679.00 ","$1,242.46 ","$0.00 ","$1,679.00 ","$755.55 ","$363.53 ","$381.11 ","$1,198.30 ","$1,198.30 ","$293.98 ","$1,679.00 ","$0.00 ","$839.50 ","$1,329.77 ","$1,343.20 ","$1,007.40 ","$0.00 ","$0.00 ","$370.34 ","$0.00 "
"27400009","EAP","HCPCS L0450","","Tlso Brace","BOTH IP/OP","$929.00 ","$687.46 ","$0.00 ","$929.00 ","$418.05 ","$122.60 ","$149.21 ","$663.03 ","$663.03 ","$0.00 ","$929.00 ","$0.00 ","$464.50 ","$735.77 ","$743.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400010","EAP","HCPCS L0472","","Jewett Brace","BOTH IP/OP","$1,496.00 ","$1,107.04 ","$0.00 ","$1,496.00 ","$0.00 ","$0.00 ","$0.00 ","$1,067.70 ","$1,067.70 ","$0.00 ","$1,496.00 ","$0.00 ","$748.00 ","$1,184.83 ","$1,196.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400011","EAP","HCPCS L0486","","Custom To Fit Tlso","BOTH IP/OP","$6,431.00 ","$4,758.94 ","$0.00 ","$6,431.00 ","$2,893.95 ","$1,327.28 ","$0.00 ","$4,589.80 ","$4,589.80 ","$1,126.02 ","$6,431.00 ","$0.00 ","$3,215.50 ","$5,093.35 ","$5,144.80 ","$3,858.60 ","$1,324.93 ","$0.00 ","$1,352.17 ","$0.00 "
"27400012","EAP","HCPCS L0637","","Lso Cybertech","BOTH IP/OP","$4,041.00 ","$2,990.34 ","$0.00 ","$4,041.00 ","$0.00 ","$0.00 ","$0.00 ","$2,884.06 ","$2,884.06 ","$0.00 ","$4,041.00 ","$0.00 ","$2,020.50 ","$3,200.47 ","$3,232.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400013","EAP","HCPCS L0638","","Lso Brace","BOTH IP/OP","$3,917.00 ","$2,898.58 ","$0.00 ","$3,917.00 ","$0.00 ","$0.00 ","$0.00 ","$2,795.56 ","$2,795.56 ","$685.84 ","$3,917.00 ","$0.00 ","$1,958.50 ","$3,102.26 ","$3,133.60 ","$0.00 ","$996.58 ","$0.00 ","$0.00 ","$0.00 "
"27400014","EAP","HCPCS L0700","","Ctlso Brace","BOTH IP/OP","$6,393.00 ","$4,730.82 ","$0.00 ","$6,393.00 ","$0.00 ","$0.00 ","$0.00 ","$4,562.68 ","$4,562.68 ","$0.00 ","$6,393.00 ","$0.00 ","$3,196.50 ","$5,063.26 ","$5,114.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400015","EAP","HCPCS L1686","","Hip Abduction Brace","BOTH IP/OP","$4,383.00 ","$3,243.42 ","$0.00 ","$4,383.00 ","$0.00 ","$0.00 ","$0.00 ","$3,128.15 ","$3,128.15 ","$0.00 ","$4,383.00 ","$0.00 ","$2,191.50 ","$3,471.34 ","$3,506.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400017","EAP","HCPCS L1830","","Knee Immobilizer","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$0.00 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400019","EAP","HCPCS L1940","","Ankle Foot Orthosis","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$394.54 ","$0.00 ","$0.00 ","$394.54 ","$246.23 ","$246.23 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$207.00 ","$375.67 ","$0.00 ","$383.39 ","$0.00 "
"27400020","EAP","HCPCS L1834","","Knee Ext. Splint","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$0.00 ","$0.00 ","$0.00 ","$173.43 ","$173.43 ","$0.00 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400021","EAP","HCPCS L3650","","Shoulder Immobilizer","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$264.78 ","$264.78 ","$0.00 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400022","EAP","HCPCS L3670","","Shoulder Abduction","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$103.47 ","$276.92 ","$276.92 ","$0.00 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400024","EAP","HCPCS L3702","","Custom Elbow","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$208.54 ","$43.65 ","$198.92 ","$208.54 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$58.20 ","$198.56 ","$0.00 ","$202.65 ","$0.00 "
"27400025","EAP","HCPCS L3967","","Airplane Splint","BOTH IP/OP","$406.00 ","$300.44 ","$0.00 ","$1,392.15 ","$0.00 ","$0.00 ","$0.00 ","$289.76 ","$289.76 ","$71.09 ","$406.00 ","$0.00 ","$203.00 ","$321.55 ","$324.80 ","$243.60 ","$0.00 ","$0.00 ","$1,392.15 ","$0.00 "
"27400026","EAP","HCPCS L3905","","Dynamic Wrist Splint","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$681.95 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$18.73 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$681.95 ","$0.00 ","$0.00 ","$0.00 "
"27400027","EAP","HCPCS L3935","","Any Finger Splint","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$152.21 ","$159.57 ","$141.31 ","$141.31 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$118.80 ","$151.93 ","$0.00 ","$155.06 ","$0.00 "
"27400028","EAP","HCPCS L3808","","Ulnar/radial Gutter","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$247.75 ","$31.05 ","$230.09 ","$247.75 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$41.40 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400029","EAP","HCPCS L3906","","Wrist Cockup Splint","BOTH IP/OP","$202.00 ","$149.48 ","$0.00 ","$304.68 ","$90.90 ","$290.61 ","$304.68 ","$144.17 ","$144.17 ","$35.37 ","$202.00 ","$0.00 ","$101.00 ","$159.98 ","$161.60 ","$121.20 ","$290.10 ","$0.00 ","$296.07 ","$0.00 "
"27400030","EAP","HCPCS L3925","","SPRING WIRE ASSIST SPLINT PREFAB","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$36.39 ","$39.19 ","$139.17 ","$139.17 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$117.00 ","$37.31 ","$0.00 ","$38.08 ","$0.00 "
"27400033","EAP","HCPCS L3671","","Custom Humerus","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$299.75 ","$299.75 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400034","EAP","HCPCS L3982","","RESTING HAND SPLINT-CUSTOM","BOTH IP/OP","$214.00 ","$158.36 ","$0.00 ","$275.84 ","$0.00 ","$263.10 ","$275.84 ","$152.73 ","$152.73 ","$0.00 ","$214.00 ","$0.00 ","$107.00 ","$169.49 ","$171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400038","EAP","HCPCS L3334","","Heel Lift","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$57.15 ","$28.88 ","$30.28 ","$90.64 ","$90.64 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400039","EAP","HCPCS L3710","","Hinged Elbow Brace","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$431.00 ","$0.00 ","$0.00 ","$0.00 ","$307.60 ","$307.60 ","$75.46 ","$431.00 ","$0.00 ","$215.50 ","$341.35 ","$344.80 ","$258.60 ","$99.70 ","$0.00 ","$101.75 ","$0.00 "
"27400040","EAP","HCPCS L3806","","Dorsal Block Splint W/kleine","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400050","EAP","HCPCS L3913","","Simple Hand Based Spl","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$195.60 ","$24.75 ","$186.59 ","$195.60 ","$39.25 ","$39.25 ","$9.63 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$33.00 ","$186.25 ","$0.00 ","$190.08 ","$0.00 "
"27400051","EAP","HCPCS L3808","","Dorsal Block Splint","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$247.75 ","$15.30 ","$230.09 ","$247.75 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$20.40 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400052","EAP","HCPCS L3931","","Whfo Finger Exten W/wrist Supp","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$89.93 ","$89.93 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400053","EAP","HCPCS L3807","","Ball Splint/finger Abd Splint","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$180.59 ","$0.00 ","$0.00 ","$180.59 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$96.60 ","$171.95 ","$0.00 ","$175.48 ","$0.00 "
"27400054","EAP","HCPCS L3908","","Canv/leath/ezy-on Wrist Splint","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$44.55 ","$41.27 ","$43.26 ","$70.66 ","$70.66 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$59.40 ","$41.19 ","$0.00 ","$42.04 ","$0.00 "
"27400055","EAP","HCPCS L3808","","Gauntlet With Thumb Spica","BOTH IP/OP","$91.00 ","$67.34 ","$0.00 ","$247.75 ","$40.95 ","$230.09 ","$247.75 ","$64.95 ","$64.95 ","$15.93 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$54.60 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400056","EAP","HCPCS L3807","","Prefab Burn Splint","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$349.00 ","$0.00 ","$0.00 ","$180.59 ","$249.08 ","$249.08 ","$61.11 ","$349.00 ","$0.00 ","$174.50 ","$276.41 ","$279.20 ","$209.40 ","$171.95 ","$0.00 ","$175.48 ","$0.00 "
"27400057","EAP","HCPCS L3807","","Spasticity Splint","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$175.48 ","$73.80 ","$59.92 ","$0.00 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$0.00 ","$82.00 ","$129.89 ","$131.20 ","$98.40 ","$171.95 ","$0.00 ","$175.48 ","$0.00 "
"27400058","EAP","HCPCS L3763","","Forearm Sarmiento","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$926.06 ","$0.00 ","$0.00 ","$926.06 ","$139.17 ","$139.17 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$117.00 ","$881.77 ","$0.00 ","$899.90 ","$0.00 "
"27400059","EAP","HCPCS L3931","","Whfo - Palmer","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$312.00 ","$0.00 ","$0.00 ","$0.00 ","$222.67 ","$222.67 ","$0.00 ","$312.00 ","$0.00 ","$156.00 ","$247.10 ","$249.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400060","EAP","HCPCS L3808","","Thumb Spica","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$247.75 ","$32.40 ","$230.09 ","$247.75 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$43.20 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400061","EAP","HCPCS L3808","","Whfo Wr Gaunlet/thumb Spica","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$247.75 ","$83.25 ","$230.09 ","$247.75 ","$132.03 ","$132.03 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$111.00 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400062","EAP","HCPCS L3808","","Whfo,long Opponens No Attachme","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$247.75 ","$29.25 ","$230.09 ","$247.75 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$39.00 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400066","EAP","HCPCS L3808","","Safe Position Splint","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$247.75 ","$48.15 ","$230.09 ","$247.75 ","$76.37 ","$76.37 ","$18.73 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$64.20 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400067","EAP","HCPCS L4398","","Foam Foot Drop Stop-prefab","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$33.54 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400070","EAP","HCPCS L3808","","Canv/leath/ezy-on Wrist Splint","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$247.75 ","$8.55 ","$230.09 ","$247.75 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$11.40 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400071","EAP","HCPCS L3905","","Forearm Based Outrigger","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$681.95 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$681.95 ","$0.00 ","$0.00 ","$0.00 "
"27400078","EAP","HCPCS L1834","","Knee Extension Splint(s/p Bka)","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$215.00 ","$0.00 ","$0.00 ","$0.00 ","$153.45 ","$153.45 ","$0.00 ","$215.00 ","$0.00 ","$107.50 ","$170.28 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400080","EAP","HCPCS L3807","","Resting Hand Splint-prefab","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$328.00 ","$0.00 ","$0.00 ","$180.59 ","$234.09 ","$234.09 ","$57.43 ","$328.00 ","$0.00 ","$164.00 ","$259.78 ","$262.40 ","$196.80 ","$171.95 ","$0.00 ","$175.48 ","$0.00 "
"27400085","EAP","HCPCS L3921","","Hand Based Outrigger","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$231.97 ","$53.10 ","$221.26 ","$231.97 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$70.80 ","$220.87 ","$0.00 ","$225.41 ","$0.00 "
"27400086","EAP","HCPCS A4467","","Posterior Elbow Splint-prefab","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$47.25 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400087","EAP","HCPCS L4396","","Foot Drop Splint Prefab","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$198.41 ","$198.41 ","$48.68 ","$278.00 ","$0.00 ","$139.00 ","$220.18 ","$222.40 ","$166.80 ","$126.82 ","$0.00 ","$129.42 ","$0.00 "
"27400090","EAP","HCPCS L1960","","Foot Drop Splint-custom","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$389.51 ","$0.00 ","$0.00 ","$0.00 ","$169.15 ","$169.15 ","$41.50 ","$237.00 ","$0.00 ","$118.50 ","$187.70 ","$189.60 ","$0.00 ","$389.51 ","$0.00 ","$0.00 ","$0.00 "
"27400091","EAP","HCPCS L3808","","Resting Hand/volar Wrist Custom","BOTH IP/OP","$209.00 ","$154.66 ","$0.00 ","$247.75 ","$94.05 ","$230.09 ","$247.75 ","$149.16 ","$149.16 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$125.40 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400097","EAP","HCPCS L3931","","Resting Hand Prefab Hand Rehab","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$142.03 ","$142.03 ","$0.00 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400098","EAP","HCPCS L3808","","CUSTOM RESTING HAND","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$247.75 ","$89.10 ","$230.09 ","$247.75 ","$141.31 ","$141.31 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$118.80 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400099","EAP","HCPCS L0810","","Halo And Vest","BOTH IP/OP","$7,045.00 ","$5,213.30 ","$0.00 ","$7,045.00 ","$0.00 ","$0.00 ","$0.00 ","$5,028.02 ","$5,028.02 ","$0.00 ","$7,045.00 ","$0.00 ","$3,522.50 ","$5,579.64 ","$5,636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400105","EAP","HCPCS L3808","","Extensor Tendon Splint","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$247.75 ","$59.40 ","$230.09 ","$247.75 ","$94.21 ","$94.21 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$79.20 ","$235.90 ","$0.00 ","$240.75 ","$0.00 "
"27400108","EAP","HCPCS L3980","","Humeral Fx Brace","BOTH IP/OP","$179.00 ","$132.46 ","$0.00 ","$216.95 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$127.75 ","$31.34 ","$179.00 ","$0.00 ","$89.50 ","$141.77 ","$143.20 ","$107.40 ","$212.58 ","$0.00 ","$216.95 ","$0.00 "
"27400109","EAP","HCPCS L3760","","Hinged Elbow Brace","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$0.00 ","$0.00 ","$0.00 ","$917.10 ","$917.10 ","$0.00 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400113","EAP","HCPCS A4467","","Posterior Elbow Splint-prefab","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$47.25 ","$0.00 ","$0.00 ","$74.94 ","$74.94 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400114","EAP","","","Splint Orthopedic 5ydx6in Fast","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$32.83 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400115","EAP","HCPCS L1830","","Immobilizer Orthopedic Univers","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400116","EAP","HCPCS L0150","","Collar Cerv 2-5yr Short 35-45in Chin Dot Tracheostomy Open","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$77.08 ","$77.08 ","$18.91 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$64.80 ","$0.00 ","$0.00 ","$89.77 ","$0.00 "
"27400117","EAP","HCPCS L0150","","Collar Cerv 3-6yr Regular 37-48in Chin Dot Tracheostomy Open","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$77.79 ","$77.79 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$65.40 ","$0.00 ","$0.00 ","$89.77 ","$0.00 "
"27400118","EAP","HCPCS L0172","","Collar Cerv Short Latex Free Adult","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$112.86 ","$46.35 ","$0.00 ","$112.86 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$61.80 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27400119","EAP","HCPCS L0172","","Collar Cerv Regular Chin Rest Tracheostomy Opening","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$112.86 ","$45.00 ","$0.00 ","$112.86 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$60.00 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27400120","EAP","HCPCS L0172","","Collar Cerv Tall Chin Rest Tracheostomy Opening Adjustable","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$112.86 ","$43.65 ","$0.00 ","$112.86 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$58.20 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27400121","EAP","HCPCS L0113","","Collar Cerv 1-3yr Tot 33-40in Chin Dot Tracheostomy Open","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$0.00 ","$0.00 ","$0.00 ","$72.08 ","$72.08 ","$0.00 ","$101.00 ","$0.00 ","$50.50 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27400122","EAP","HCPCS L0172","","Collar Cerv Short Chin Rest Tracheostomy Opening Adjustable","BOTH IP/OP","$115.00 ","$85.10 ","$0.00 ","$115.00 ","$51.75 ","$0.00 ","$112.86 ","$82.08 ","$82.08 ","$20.14 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$69.00 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27400123","EAP","HCPCS L0172","","Collar Cerv 9-24 Month Regular 29-37in Chin Dot Tracheostomy","BOTH IP/OP","$114.00 ","$84.36 ","$0.00 ","$114.00 ","$51.30 ","$0.00 ","$112.86 ","$81.36 ","$81.36 ","$19.96 ","$114.00 ","$0.00 ","$57.00 ","$90.29 ","$91.20 ","$68.40 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27400124","EAP","HCPCS L0172","","Collar Crv Unv Occian Bck Intuitech","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$84.60 ","$0.00 ","$112.86 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$112.80 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"27500001","EAP","HCPCS C1721","","2207-36 Current Dr Icd","BOTH IP/OP","$52,001.00 ","$38,480.74 ","$0.00 ","$52,001.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,113.11 ","$8,138.89 ","$52,001.00 ","$0.00 ","$26,000.50 ","$41,184.79 ","$41,600.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500003","EAP","HCPCS C1722","","1207-36 Current Vr Icd","BOTH IP/OP","$43,036.00 ","$31,846.64 ","$0.00 ","$43,036.00 ","$19,366.20 ","$0.00 ","$8,969.78 ","$5,158.80 ","$30,714.79 ","$7,535.26 ","$43,036.00 ","$0.00 ","$21,518.00 ","$34,084.51 ","$34,428.80 ","$0.00 ","$6,735.13 ","$0.00 ","$6,851.33 ","$0.00 "
"27500004","EAP","HCPCS C1722","","Aicd, Single Chamber","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500006","EAP","HCPCS C1779","","Capsurenovusfix Lead","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,952.26 ","$0.00 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500007","EAP","HCPCS C1785","","Philos Dr Pacemaker","BOTH IP/OP","$10,400.00 ","$7,696.00 ","$0.00 ","$10,400.00 ","$4,680.00 ","$0.00 ","$2,167.62 ","$5,158.80 ","$7,422.48 ","$1,820.96 ","$10,400.00 ","$0.00 ","$5,200.00 ","$8,236.80 ","$8,320.00 ","$0.00 ","$1,627.60 ","$0.00 ","$1,655.68 ","$0.00 "
"27500008","EAP","HCPCS C1785","","Rhaspsody Dr 2530 Pacemaker","BOTH IP/OP","$14,582.00 ","$10,790.68 ","$0.00 ","$14,582.00 ","$6,561.90 ","$0.00 ","$3,039.25 ","$5,158.80 ","$10,407.17 ","$2,553.19 ","$14,582.00 ","$0.00 ","$7,291.00 ","$11,548.94 ","$11,665.60 ","$0.00 ","$2,282.08 ","$0.00 ","$2,321.45 ","$0.00 "
"27500009","EAP","HCPCS C1785","","5386 Identity Adx Xlr Pcmkr","BOTH IP/OP","$12,195.00 ","$9,024.30 ","$0.00 ","$12,195.00 ","$5,487.75 ","$0.00 ","$2,541.74 ","$5,158.80 ","$8,703.57 ","$2,135.25 ","$12,195.00 ","$0.00 ","$6,097.50 ","$9,658.44 ","$9,756.00 ","$0.00 ","$1,908.52 ","$0.00 ","$1,941.44 ","$0.00 "
"27500010","EAP","HCPCS C1785","","Philos Ii Dr System","BOTH IP/OP","$14,735.00 ","$10,903.90 ","$0.00 ","$14,735.00 ","$6,630.75 ","$0.00 ","$3,071.14 ","$5,158.80 ","$10,516.37 ","$2,579.98 ","$14,735.00 ","$0.00 ","$7,367.50 ","$11,670.12 ","$11,788.00 ","$0.00 ","$2,306.03 ","$0.00 ","$2,345.81 ","$0.00 "
"27500011","EAP","HCPCS C1785","","Sensia Dr Pacemaker","BOTH IP/OP","$12,195.00 ","$9,024.30 ","$0.00 ","$12,195.00 ","$5,487.75 ","$0.00 ","$2,541.74 ","$5,158.80 ","$8,703.57 ","$2,135.25 ","$12,195.00 ","$0.00 ","$6,097.50 ","$9,658.44 ","$9,756.00 ","$0.00 ","$1,908.52 ","$0.00 ","$1,941.44 ","$0.00 "
"27500012","EAP","HCPCS C1785","","Symphony Dr 2550 Pacemaker","BOTH IP/OP","$15,349.00 ","$11,358.26 ","$0.00 ","$15,349.00 ","$6,907.05 ","$0.00 ","$3,199.12 ","$5,158.80 ","$10,954.58 ","$2,687.49 ","$15,349.00 ","$0.00 ","$7,674.50 ","$12,156.41 ","$12,279.20 ","$0.00 ","$2,402.12 ","$0.00 ","$2,443.56 ","$0.00 "
"27500013","EAP","HCPCS C1785","","Repy Dr Pacemaker","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27500014","EAP","HCPCS C1785","","Cylos Dr/cls Pacemaker","BOTH IP/OP","$12,195.00 ","$9,024.30 ","$0.00 ","$12,195.00 ","$5,487.75 ","$0.00 ","$2,541.74 ","$5,158.80 ","$8,703.57 ","$2,135.25 ","$12,195.00 ","$0.00 ","$6,097.50 ","$9,658.44 ","$9,756.00 ","$0.00 ","$1,908.52 ","$0.00 ","$1,941.44 ","$0.00 "
"27500015","EAP","HCPCS C1785","","Adapta Dr Pacemaker","BOTH IP/OP","$16,139.00 ","$11,942.86 ","$0.00 ","$16,139.00 ","$7,262.55 ","$0.00 ","$3,363.77 ","$5,158.80 ","$11,518.40 ","$2,825.81 ","$16,139.00 ","$0.00 ","$8,069.50 ","$12,782.09 ","$12,911.20 ","$0.00 ","$2,525.75 ","$0.00 ","$2,569.33 ","$0.00 "
"27500016","EAP","HCPCS C1785","","Philos Dr System","BOTH IP/OP","$12,195.00 ","$9,024.30 ","$0.00 ","$12,195.00 ","$5,487.75 ","$0.00 ","$2,541.74 ","$5,158.80 ","$8,703.57 ","$2,135.25 ","$12,195.00 ","$0.00 ","$6,097.50 ","$9,658.44 ","$9,756.00 ","$0.00 ","$1,908.52 ","$0.00 ","$1,941.44 ","$0.00 "
"27500017","EAP","HCPCS C1785","","Rhaspsody Dr 2530 System","BOTH IP/OP","$16,497.00 ","$12,207.78 ","$0.00 ","$16,497.00 ","$7,423.65 ","$0.00 ","$3,438.39 ","$5,158.80 ","$11,773.91 ","$2,888.49 ","$16,497.00 ","$0.00 ","$8,248.50 ","$13,065.62 ","$13,197.60 ","$0.00 ","$2,581.78 ","$0.00 ","$2,626.32 ","$0.00 "
"27500018","EAP","HCPCS C1785","","Symphony Dr 2550 System","BOTH IP/OP","$18,420.00 ","$13,630.80 ","$0.00 ","$18,420.00 ","$8,289.00 ","$0.00 ","$3,839.19 ","$5,158.80 ","$13,146.35 ","$3,225.19 ","$18,420.00 ","$0.00 ","$9,210.00 ","$14,588.64 ","$14,736.00 ","$0.00 ","$2,882.73 ","$0.00 ","$2,932.46 ","$0.00 "
"27500019","EAP","HCPCS C1785","","Reply Dr System","BOTH IP/OP","$17,932.00 ","$13,269.68 ","$0.00 ","$17,932.00 ","$8,069.40 ","$0.00 ","$3,737.48 ","$5,158.80 ","$12,798.07 ","$3,139.75 ","$17,932.00 ","$0.00 ","$8,966.00 ","$14,202.14 ","$14,345.60 ","$0.00 ","$2,806.36 ","$0.00 ","$2,854.77 ","$0.00 "
"27500020","EAP","HCPCS C1785","","Cylos Dr/cls System","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27500021","EAP","HCPCS C1785","","S403 Altrua Pacemaker","BOTH IP/OP","$22,045.00 ","$16,313.30 ","$0.00 ","$22,045.00 ","$9,920.25 ","$0.00 ","$4,594.73 ","$5,158.80 ","$15,733.52 ","$3,859.90 ","$22,045.00 ","$0.00 ","$11,022.50 ","$17,459.64 ","$17,636.00 ","$0.00 ","$3,450.04 ","$0.00 ","$3,509.56 ","$0.00 "
"27500024","EAP","HCPCS C1786","","Sensia Sr Pacemaker","BOTH IP/OP","$11,110.00 ","$8,221.40 ","$0.00 ","$11,110.00 ","$4,999.50 ","$0.00 ","$2,315.60 ","$5,158.80 ","$7,929.21 ","$0.00 ","$11,110.00 ","$0.00 ","$5,555.00 ","$8,799.12 ","$8,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500025","EAP","HCPCS C1786","","Rhapsody Sr 2210 Pacemaker","BOTH IP/OP","$11,130.00 ","$8,236.20 ","$0.00 ","$11,130.00 ","$5,008.50 ","$0.00 ","$2,319.77 ","$5,158.80 ","$7,943.48 ","$0.00 ","$11,130.00 ","$0.00 ","$5,565.00 ","$8,814.96 ","$8,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500026","EAP","HCPCS C1786","","Philos Sr Pacemaker","BOTH IP/OP","$11,130.00 ","$8,236.20 ","$0.00 ","$11,130.00 ","$5,008.50 ","$0.00 ","$2,319.77 ","$5,158.80 ","$7,943.48 ","$0.00 ","$11,130.00 ","$0.00 ","$5,565.00 ","$8,814.96 ","$8,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500027","EAP","HCPCS C1786","","Rhapsody Sr 2210 System","BOTH IP/OP","$11,835.00 ","$8,757.90 ","$0.00 ","$11,835.00 ","$5,325.75 ","$0.00 ","$2,466.71 ","$5,158.80 ","$8,446.64 ","$0.00 ","$11,835.00 ","$0.00 ","$5,917.50 ","$9,373.32 ","$9,468.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500028","EAP","HCPCS C1786","","Philos Sr System","BOTH IP/OP","$12,664.00 ","$9,371.36 ","$0.00 ","$12,664.00 ","$5,698.80 ","$0.00 ","$2,639.49 ","$5,158.80 ","$9,038.30 ","$0.00 ","$12,664.00 ","$0.00 ","$6,332.00 ","$10,029.89 ","$10,131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500029","EAP","HCPCS C1786","","Philos Ii Sr Pacemaker","BOTH IP/OP","$12,854.00 ","$9,511.96 ","$0.00 ","$12,854.00 ","$5,784.30 ","$0.00 ","$2,679.09 ","$5,158.80 ","$9,173.90 ","$0.00 ","$12,854.00 ","$0.00 ","$6,427.00 ","$10,180.37 ","$10,283.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500030","EAP","HCPCS C1786","","Sympnony Sr 2550 Pacemaker","BOTH IP/OP","$13,047.00 ","$9,654.78 ","$0.00 ","$13,047.00 ","$5,871.15 ","$0.00 ","$2,719.32 ","$5,158.80 ","$9,311.64 ","$0.00 ","$13,047.00 ","$0.00 ","$6,523.50 ","$10,333.22 ","$10,437.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500031","EAP","HCPCS C1786","","Phillos Ii Sr Pcmkr Syst","BOTH IP/OP","$13,813.00 ","$10,221.62 ","$0.00 ","$13,813.00 ","$6,215.85 ","$0.00 ","$2,878.97 ","$5,158.80 ","$9,858.34 ","$0.00 ","$13,813.00 ","$0.00 ","$6,906.50 ","$10,939.90 ","$11,050.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500032","EAP","HCPCS C1786","","Symphony Sr 2550 System","BOTH IP/OP","$13,628.00 ","$10,084.72 ","$0.00 ","$13,628.00 ","$6,132.60 ","$0.00 ","$2,840.42 ","$5,158.80 ","$9,726.30 ","$0.00 ","$13,628.00 ","$0.00 ","$6,814.00 ","$10,793.38 ","$10,902.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500033","EAP","HCPCS C1786","","Cylos Vr/cls Pacemaker","BOTH IP/OP","$12,195.00 ","$9,024.30 ","$0.00 ","$12,195.00 ","$5,487.75 ","$0.00 ","$2,541.74 ","$5,158.80 ","$8,703.57 ","$0.00 ","$12,195.00 ","$0.00 ","$6,097.50 ","$9,658.44 ","$9,756.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500034","EAP","HCPCS C1786","","Reply Sr System","BOTH IP/OP","$16,497.00 ","$12,207.78 ","$0.00 ","$16,497.00 ","$7,423.65 ","$0.00 ","$3,438.39 ","$5,158.80 ","$11,773.91 ","$0.00 ","$16,497.00 ","$0.00 ","$8,248.50 ","$13,065.62 ","$13,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500035","EAP","HCPCS C1786","","Cylos Vr/cls System","BOTH IP/OP","$13,628.00 ","$10,084.72 ","$0.00 ","$13,628.00 ","$6,132.60 ","$0.00 ","$2,840.42 ","$5,158.80 ","$9,726.30 ","$0.00 ","$13,628.00 ","$0.00 ","$6,814.00 ","$10,793.38 ","$10,902.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500036","EAP","HCPCS C1786","","Reply Sr System","BOTH IP/OP","$16,497.00 ","$12,207.78 ","$0.00 ","$16,497.00 ","$7,423.65 ","$0.00 ","$3,438.39 ","$5,158.80 ","$11,773.91 ","$0.00 ","$16,497.00 ","$0.00 ","$8,248.50 ","$13,065.62 ","$13,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500039","EAP","HCPCS C1898","","1688tc Pacemaker Lead","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$806.85 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27500040","EAP","HCPCS C1898","","Tendril St Pkg Lead","BOTH IP/OP","$1,920.00 ","$1,420.80 ","$0.00 ","$1,920.00 ","$864.00 ","$0.00 ","$400.18 ","$1,370.30 ","$1,370.30 ","$336.18 ","$1,920.00 ","$0.00 ","$960.00 ","$1,520.64 ","$1,536.00 ","$0.00 ","$300.48 ","$0.00 ","$305.66 ","$0.00 "
"27500041","EAP","HCPCS C1898","","Tendril 1688 Lead","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$806.85 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27500042","EAP","HCPCS C1898","","Tendril Sdx Lead","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$806.85 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27500043","EAP","HCPCS C1898","","Tendril St 1700 Lead","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$806.85 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27500044","EAP","HCPCS C1900","","Coronary Sinus Lead System","BOTH IP/OP","$1,920.00 ","$1,420.80 ","$0.00 ","$1,920.00 ","$864.00 ","$0.00 ","$400.18 ","$1,370.30 ","$1,370.30 ","$0.00 ","$1,920.00 ","$0.00 ","$960.00 ","$1,520.64 ","$1,536.00 ","$0.00 ","$300.48 ","$0.00 ","$0.00 ","$0.00 "
"27500045","EAP","HCPCS C1900","","Scout Pro Lead System","BOTH IP/OP","$1,920.00 ","$1,420.80 ","$0.00 ","$1,920.00 ","$864.00 ","$0.00 ","$400.18 ","$1,370.30 ","$1,370.30 ","$0.00 ","$1,920.00 ","$0.00 ","$960.00 ","$1,520.64 ","$1,536.00 ","$0.00 ","$300.48 ","$0.00 ","$0.00 ","$0.00 "
"27500046","EAP","HCPCS C1900","","Corox Bipolar Lead","BOTH IP/OP","$5,739.00 ","$4,246.86 ","$0.00 ","$5,739.00 ","$2,582.55 ","$0.00 ","$1,196.15 ","$4,095.92 ","$4,095.92 ","$0.00 ","$5,739.00 ","$0.00 ","$2,869.50 ","$4,545.29 ","$4,591.20 ","$0.00 ","$898.15 ","$0.00 ","$0.00 ","$0.00 "
"27500047","EAP","HCPCS C1900","","Corox Unipolar Lead","BOTH IP/OP","$5,739.00 ","$4,246.86 ","$0.00 ","$5,739.00 ","$2,582.55 ","$0.00 ","$1,196.15 ","$4,095.92 ","$4,095.92 ","$0.00 ","$5,739.00 ","$0.00 ","$2,869.50 ","$4,545.29 ","$4,591.20 ","$0.00 ","$898.15 ","$0.00 ","$0.00 ","$0.00 "
"27500055","EAP","HCPCS C1882","","Crt-d Dtba1qq Viva Quad Xt Us Is4 Df4 Crt","BOTH IP/OP","$50,260.00 ","$37,192.40 ","$0.00 ","$50,260.00 ","$22,617.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,870.56 ","$8,138.89 ","$50,260.00 ","$0.00 ","$25,130.00 ","$39,805.92 ","$40,208.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,001.39 ","$0.00 "
"27500056","EAP","HCPCS C1882","","Dfbr Crd Viva Qd Xt Crt-d Icd Df-1 Biphasic Wvfrm 35ml 80gm","BOTH IP/OP","$50,228.00 ","$37,168.72 ","$0.00 ","$50,228.00 ","$22,602.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,847.72 ","$8,138.89 ","$50,228.00 ","$0.00 ","$25,114.00 ","$39,780.58 ","$40,182.40 ","$0.00 ","$7,751.33 ","$0.00 ","$7,996.30 ","$0.00 "
"27500057","EAP","HCPCS C1882","","Dfbr Crd Viva Crt D Qd S Is-4 Df1 Us","BOTH IP/OP","$47,766.00 ","$35,346.84 ","$0.00 ","$47,766.00 ","$21,494.70 ","$0.00 ","$9,417.94 ","$5,158.80 ","$34,090.59 ","$8,138.89 ","$47,766.00 ","$0.00 ","$23,883.00 ","$37,830.67 ","$38,212.80 ","$0.00 ","$7,475.38 ","$0.00 ","$7,604.35 ","$0.00 "
"27500058","EAP","HCPCS C1882","","Dfbr Crd Viva Crt D Qd S Is-4 Df4 Us","BOTH IP/OP","$47,766.00 ","$35,346.84 ","$0.00 ","$47,766.00 ","$21,494.70 ","$0.00 ","$9,417.94 ","$5,158.80 ","$34,090.59 ","$8,138.89 ","$47,766.00 ","$0.00 ","$23,883.00 ","$37,830.67 ","$38,212.80 ","$0.00 ","$7,475.38 ","$0.00 ","$7,604.35 ","$0.00 "
"27500059","EAP","HCPCS C1900","","Lead Attain Performa Usa Crt","BOTH IP/OP","$5,840.00 ","$4,321.60 ","$0.00 ","$5,840.00 ","$2,628.00 ","$0.00 ","$1,217.20 ","$4,168.01 ","$4,168.01 ","$0.00 ","$5,840.00 ","$0.00 ","$2,920.00 ","$4,625.28 ","$4,672.00 ","$0.00 ","$913.96 ","$0.00 ","$0.00 ","$0.00 "
"27500060","EAP","HCPCS C1900","","Attain Bipoldr Lead","BOTH IP/OP","$6,276.00 ","$4,644.24 ","$0.00 ","$6,276.00 ","$2,824.20 ","$0.00 ","$1,308.08 ","$4,479.18 ","$4,479.18 ","$0.00 ","$6,276.00 ","$0.00 ","$3,138.00 ","$4,970.59 ","$5,020.80 ","$0.00 ","$982.19 ","$0.00 ","$0.00 ","$0.00 "
"27500062","EAP","HCPCS C1900","","Lv Quickflex Lead","BOTH IP/OP","$5,739.00 ","$4,246.86 ","$0.00 ","$5,739.00 ","$2,582.55 ","$0.00 ","$1,196.15 ","$4,095.92 ","$4,095.92 ","$0.00 ","$5,739.00 ","$0.00 ","$2,869.50 ","$4,545.29 ","$4,591.20 ","$0.00 ","$898.15 ","$0.00 ","$0.00 ","$0.00 "
"27500063","EAP","HCPCS C1900","","Lv Quicksite Leads","BOTH IP/OP","$5,739.00 ","$4,246.86 ","$0.00 ","$5,739.00 ","$2,582.55 ","$0.00 ","$1,196.15 ","$4,095.92 ","$4,095.92 ","$0.00 ","$5,739.00 ","$0.00 ","$2,869.50 ","$4,545.29 ","$4,591.20 ","$0.00 ","$898.15 ","$0.00 ","$0.00 ","$0.00 "
"27500070","EAP","HCPCS C1786","","Zepher Dr Pacemaker","BOTH IP/OP","$14,346.00 ","$10,616.04 ","$0.00 ","$14,346.00 ","$6,455.70 ","$0.00 ","$2,990.07 ","$5,158.80 ","$10,238.74 ","$0.00 ","$14,346.00 ","$0.00 ","$7,173.00 ","$11,362.03 ","$11,476.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500078","EAP","HCPCS C1721","","Teligen Rf He Dr Dual Icd","BOTH IP/OP","$50,042.00 ","$37,031.08 ","$0.00 ","$50,042.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,714.98 ","$8,138.89 ","$50,042.00 ","$0.00 ","$25,021.00 ","$39,633.26 ","$40,033.60 ","$0.00 ","$7,751.33 ","$0.00 ","$7,966.69 ","$0.00 "
"27500079","EAP","HCPCS C1721","","Confient Rf He Dual Icd","BOTH IP/OP","$41,702.00 ","$30,859.48 ","$0.00 ","$41,702.00 ","$0.00 ","$0.00 ","$8,691.74 ","$5,158.80 ","$29,762.72 ","$7,301.69 ","$41,702.00 ","$0.00 ","$20,851.00 ","$33,027.98 ","$33,361.60 ","$0.00 ","$6,526.36 ","$0.00 ","$6,638.96 ","$0.00 "
"27500080","EAP","HCPCS C1722","","Teligen Rf He Vr Icd","BOTH IP/OP","$41,702.00 ","$30,859.48 ","$0.00 ","$41,702.00 ","$18,765.90 ","$0.00 ","$8,691.74 ","$5,158.80 ","$29,762.72 ","$7,301.69 ","$41,702.00 ","$0.00 ","$20,851.00 ","$33,027.98 ","$33,361.60 ","$0.00 ","$6,526.36 ","$0.00 ","$6,638.96 ","$0.00 "
"27500081","EAP","HCPCS C1722","","Vitality 2 El Vr Icd","BOTH IP/OP","$38,365.00 ","$28,390.10 ","$0.00 ","$38,365.00 ","$17,264.25 ","$0.00 ","$7,996.23 ","$5,158.80 ","$27,381.10 ","$6,717.40 ","$38,365.00 ","$0.00 ","$19,182.50 ","$30,385.08 ","$30,692.00 ","$0.00 ","$6,004.12 ","$0.00 ","$6,107.71 ","$0.00 "
"27500082","EAP","HCPCS C1786","","Altrua 40 Sr Pacemaker","BOTH IP/OP","$11,343.00 ","$8,393.82 ","$0.00 ","$11,343.00 ","$5,104.35 ","$0.00 ","$2,364.16 ","$5,158.80 ","$8,095.50 ","$0.00 ","$11,343.00 ","$0.00 ","$5,671.50 ","$8,983.66 ","$9,074.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500083","EAP","HCPCS C1785","","Altrua 40 Dr El Dual Pacemaker","BOTH IP/OP","$6,340.00 ","$4,691.60 ","$0.00 ","$6,340.00 ","$2,853.00 ","$0.00 ","$1,321.41 ","$4,524.86 ","$4,524.86 ","$1,110.08 ","$6,340.00 ","$0.00 ","$3,170.00 ","$5,021.28 ","$5,072.00 ","$0.00 ","$992.21 ","$0.00 ","$1,009.33 ","$0.00 "
"27500084","EAP","HCPCS C1785","","Altrua 40 Dr Dual Pacemaker","BOTH IP/OP","$6,340.00 ","$4,691.60 ","$0.00 ","$6,340.00 ","$2,853.00 ","$0.00 ","$1,321.41 ","$4,524.86 ","$4,524.86 ","$1,110.08 ","$6,340.00 ","$0.00 ","$3,170.00 ","$5,021.28 ","$5,072.00 ","$0.00 ","$992.21 ","$0.00 ","$1,009.33 ","$0.00 "
"27500085","EAP","HCPCS C1882","","Cognis Rf He Crt-d","BOTH IP/OP","$73,393.00 ","$54,310.82 ","$0.00 ","$73,393.00 ","$33,026.85 ","$0.00 ","$9,417.94 ","$5,158.80 ","$52,380.58 ","$8,138.89 ","$73,393.00 ","$0.00 ","$36,696.50 ","$58,127.26 ","$58,714.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500086","EAP","HCPCS C1882","","Livian Rf He Crt-d","BOTH IP/OP","$56,714.00 ","$41,968.36 ","$0.00 ","$56,714.00 ","$25,521.30 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,476.78 ","$8,138.89 ","$56,714.00 ","$0.00 ","$28,357.00 ","$44,917.49 ","$45,371.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500087","EAP","HCPCS C1882","","Livian Rf Crt-d","BOTH IP/OP","$56,714.00 ","$41,968.36 ","$0.00 ","$56,714.00 ","$25,521.30 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,476.78 ","$8,138.89 ","$56,714.00 ","$0.00 ","$28,357.00 ","$44,917.49 ","$45,371.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500088","EAP","HCPCS C1882","","Contak Renewal Tr Crt-p","BOTH IP/OP","$21,350.00 ","$15,799.00 ","$0.00 ","$21,350.00 ","$9,607.50 ","$0.00 ","$4,449.87 ","$5,158.80 ","$15,237.50 ","$3,738.21 ","$21,350.00 ","$0.00 ","$10,675.00 ","$16,909.20 ","$17,080.00 ","$0.00 ","$3,341.28 ","$0.00 ","$3,398.92 ","$0.00 "
"27500089","EAP","HCPCS C1895","","Reliance G Af Lead","BOTH IP/OP","$15,012.00 ","$11,108.88 ","$0.00 ","$15,012.00 ","$6,755.40 ","$0.00 ","$3,128.88 ","$5,158.80 ","$10,714.06 ","$2,628.48 ","$15,012.00 ","$0.00 ","$7,506.00 ","$11,889.50 ","$12,009.60 ","$0.00 ","$2,349.38 ","$0.00 ","$2,389.91 ","$0.00 "
"27500090","EAP","HCPCS C1895","","Reliance G Pf Lead","BOTH IP/OP","$15,012.00 ","$11,108.88 ","$0.00 ","$15,012.00 ","$6,755.40 ","$0.00 ","$3,128.88 ","$5,158.80 ","$10,714.06 ","$2,628.48 ","$15,012.00 ","$0.00 ","$7,506.00 ","$11,889.50 ","$12,009.60 ","$0.00 ","$2,349.38 ","$0.00 ","$2,389.91 ","$0.00 "
"27500091","EAP","HCPCS C1895","","Relaince Af Lead","BOTH IP/OP","$12,676.00 ","$9,380.24 ","$0.00 ","$12,676.00 ","$5,704.20 ","$0.00 ","$2,642.00 ","$5,158.80 ","$9,046.86 ","$2,219.47 ","$12,676.00 ","$0.00 ","$6,338.00 ","$10,039.39 ","$10,140.80 ","$0.00 ","$1,983.79 ","$0.00 ","$2,018.02 ","$0.00 "
"27500092","EAP","HCPCS C1895","","Relaince Pf Lead","BOTH IP/OP","$12,676.00 ","$9,380.24 ","$0.00 ","$12,676.00 ","$5,704.20 ","$0.00 ","$2,642.00 ","$5,158.80 ","$9,046.86 ","$2,219.47 ","$12,676.00 ","$0.00 ","$6,338.00 ","$10,039.39 ","$10,140.80 ","$0.00 ","$1,983.79 ","$0.00 ","$2,018.02 ","$0.00 "
"27500093","EAP","HCPCS C1898","","Myocardial Lead,pmkr,other Than Trans","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27500094","EAP","HCPCS C1898","","Flexion - Oscor Lead","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27500095","EAP","HCPCS C1898","","Fineline Ii Sterox Lead,pmkr,other Than Trans","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27500096","EAP","HCPCS C1898","","Fineline Ii Sterox  Ez Lead,pmkr,other Than Trans","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27500097","EAP","HCPCS C1898","","Flextend Lead,pmkr,other Than Trans","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27500098","EAP","HCPCS C1898","","Dextrus Lead,pmkr,other Than Trans","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.61 ","$1,177.61 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"27500099","EAP","HCPCS C1900","","Acuity Steerable/spiral Lead","BOTH IP/OP","$6,672.00 ","$4,937.28 ","$0.00 ","$6,672.00 ","$3,002.40 ","$0.00 ","$1,390.61 ","$4,761.81 ","$4,761.81 ","$0.00 ","$6,672.00 ","$0.00 ","$3,336.00 ","$5,284.22 ","$5,337.60 ","$0.00 ","$1,044.17 ","$0.00 ","$0.00 ","$0.00 "
"27500100","EAP","HCPCS C1900","","Easytrack 3","BOTH IP/OP","$5,004.00 ","$3,702.96 ","$0.00 ","$5,004.00 ","$2,251.80 ","$0.00 ","$1,042.96 ","$3,571.35 ","$3,571.35 ","$0.00 ","$5,004.00 ","$0.00 ","$2,502.00 ","$3,963.17 ","$4,003.20 ","$0.00 ","$783.13 ","$0.00 ","$0.00 ","$0.00 "
"27500101","EAP","HCPCS C1900","","Easytrack 2","BOTH IP/OP","$5,004.00 ","$3,702.96 ","$0.00 ","$5,004.00 ","$2,251.80 ","$0.00 ","$1,042.96 ","$3,571.35 ","$3,571.35 ","$0.00 ","$5,004.00 ","$0.00 ","$2,502.00 ","$3,963.17 ","$4,003.20 ","$0.00 ","$783.13 ","$0.00 ","$0.00 ","$0.00 "
"27500102","EAP","HCPCS C1721","","Evera Mri Xt Dr Device- Single Chamber","BOTH IP/OP","$41,500.00 ","$30,710.00 ","$0.00 ","$41,500.00 ","$0.00 ","$0.00 ","$8,649.64 ","$5,158.80 ","$29,618.55 ","$7,266.32 ","$41,500.00 ","$0.00 ","$20,750.00 ","$32,868.00 ","$33,200.00 ","$0.00 ","$6,494.75 ","$0.00 ","$6,606.80 ","$0.00 "
"27500103","EAP","HCPCS C1722","","Evera Mri Xt Vr Device - Dual Chamber","BOTH IP/OP","$36,500.00 ","$27,010.00 ","$0.00 ","$36,500.00 ","$19,819.50 ","$0.00 ","$7,607.51 ","$5,158.80 ","$5,158.80 ","$6,390.86 ","$36,500.00 ","$0.00 ","$18,250.00 ","$28,908.00 ","$29,200.00 ","$0.00 ","$5,712.25 ","$0.00 ","$5,810.80 ","$0.00 "
"27500105","EAP","HCPCS C1721","","Fortify Assura Dr 40 Df4 Con Icd/defib/resync","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500106","EAP","HCPCS C1722","","Drbr Crd Visia Af Mri Df4 Vr","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500150","EAP","HCPCS C1785","","Pacemaker, Dual Accent Dr","BOTH IP/OP","$19,351.00 ","$14,319.74 ","$0.00 ","$19,351.00 ","$8,707.95 ","$0.00 ","$4,033.23 ","$5,158.80 ","$13,810.81 ","$3,388.21 ","$19,351.00 ","$0.00 ","$9,675.50 ","$15,325.99 ","$15,480.80 ","$0.00 ","$3,028.43 ","$0.00 ","$3,080.68 ","$0.00 "
"27500151","EAP","HCPCS C1786","","Pacemaker, Single Accent Sr","BOTH IP/OP","$17,681.00 ","$13,083.94 ","$0.00 ","$17,681.00 ","$7,956.45 ","$0.00 ","$3,685.16 ","$5,158.80 ","$12,618.93 ","$0.00 ","$17,681.00 ","$0.00 ","$8,840.50 ","$14,003.35 ","$14,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500152","EAP","HCPCS C2621","","Pacemaker, Bi-v Anthem Crt-p","BOTH IP/OP","$11,209.00 ","$8,294.66 ","$0.00 ","$11,209.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$7,999.86 ","$0.00 ","$11,209.00 ","$0.00 ","$5,604.50 ","$8,877.53 ","$8,967.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500153","EAP","HCPCS C1898","","Lead Pcng 45cm Bipol Act Fix Solia S Strd Elut","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27500154","EAP","HCPCS C1898","","Lead Pcng 53cm Solia S Ecrdl Strd Elute Bipol Act","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27500155","EAP","HCPCS C1898","","Lead Pcng 60cm Promri Solia S Strd Elut","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27500160","EAP","HCPCS C1898","","Myopore Epicardial Lead 35 Cm","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500162","EAP","HCPCS C1882","","Pacemaker Crd Viva Crt-p","BOTH IP/OP","$28,585.00 ","$21,152.90 ","$0.00 ","$28,585.00 ","$12,863.25 ","$0.00 ","$5,957.83 ","$5,158.80 ","$20,401.11 ","$5,005.00 ","$28,585.00 ","$0.00 ","$14,292.50 ","$22,639.32 ","$22,868.00 ","$0.00 ","$4,473.55 ","$0.00 ","$4,550.73 ","$0.00 "
"27500163","EAP","HCPCS C1786","","Pacemaker Crd Advisa Sr Mr Surescan 1 Chmbr Unplr","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,000.00 ","$4,950.00 ","$0.00 ","$2,292.68 ","$5,158.80 ","$7,850.70 ","$0.00 ","$11,000.00 ","$0.00 ","$5,500.00 ","$8,712.00 ","$8,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500200","EAP","HCPCS C1786","","Reply Sr System","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500201","EAP","HCPCS C1786","","Reply Sr","BOTH IP/OP","$10,344.00 ","$7,654.56 ","$0.00 ","$10,344.00 ","$4,654.80 ","$0.00 ","$2,155.95 ","$5,158.80 ","$7,382.51 ","$0.00 ","$10,344.00 ","$0.00 ","$5,172.00 ","$8,192.45 ","$8,275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500202","EAP","HCPCS C1722","","Paradym Rf Crt 9750 System","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500203","EAP","HCPCS C1722","","Paradym Rf Crt 9750","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500204","EAP","HCPCS C1722","","Paradym 9250 Rf Vr","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500205","EAP","HCPCS C1900","","Quickflex+++pmm#:89271","BOTH IP/OP","$4,729.00 ","$3,499.46 ","$0.00 ","$4,729.00 ","$2,128.05 ","$0.00 ","$985.64 ","$3,375.09 ","$3,375.09 ","$0.00 ","$4,729.00 ","$0.00 ","$2,364.50 ","$3,745.37 ","$3,783.20 ","$0.00 ","$740.09 ","$0.00 ","$0.00 ","$0.00 "
"27500206","EAP","HCPCS C1900","","Quickflex+++pmm#:89272","BOTH IP/OP","$4,729.00 ","$3,499.46 ","$0.00 ","$4,729.00 ","$2,128.05 ","$0.00 ","$985.64 ","$3,375.09 ","$3,375.09 ","$0.00 ","$4,729.00 ","$0.00 ","$2,364.50 ","$3,745.37 ","$3,783.20 ","$0.00 ","$740.09 ","$0.00 ","$0.00 ","$0.00 "
"27500207","EAP","HCPCS C1900","","Quickflex+++pmm#:89273","BOTH IP/OP","$4,729.00 ","$3,499.46 ","$0.00 ","$4,729.00 ","$2,128.05 ","$0.00 ","$985.64 ","$3,375.09 ","$3,375.09 ","$0.00 ","$4,729.00 ","$0.00 ","$2,364.50 ","$3,745.37 ","$3,783.20 ","$0.00 ","$740.09 ","$0.00 ","$0.00 ","$0.00 "
"27500208","EAP","HCPCS C1900","","Quickflex Micro","BOTH IP/OP","$5,202.00 ","$3,849.48 ","$0.00 ","$5,202.00 ","$2,340.90 ","$0.00 ","$1,084.23 ","$3,712.67 ","$3,712.67 ","$0.00 ","$5,202.00 ","$0.00 ","$2,601.00 ","$4,119.98 ","$4,161.60 ","$0.00 ","$814.11 ","$0.00 ","$0.00 ","$0.00 "
"27500209","EAP","HCPCS C1900","","Quickflex Micro","BOTH IP/OP","$5,202.00 ","$3,849.48 ","$0.00 ","$5,202.00 ","$2,340.90 ","$0.00 ","$1,084.23 ","$3,712.67 ","$3,712.67 ","$0.00 ","$5,202.00 ","$0.00 ","$2,601.00 ","$4,119.98 ","$4,161.60 ","$0.00 ","$814.11 ","$0.00 ","$0.00 ","$0.00 "
"27500210","EAP","HCPCS C1898","","Optisense","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500211","EAP","HCPCS C1898","","Optisense","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500212","EAP","HCPCS C1898","","Optisense+++pmm#:89078","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500213","EAP","HCPCS C1898","","Optisense","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500214","EAP","HCPCS C1898","","Optisense","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500215","EAP","HCPCS C1898","","Tendril St Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500216","EAP","HCPCS C1898","","Tendril St Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500217","EAP","HCPCS C1898","","Tendril St Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500218","EAP","HCPCS C1898","","Isoflex Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500219","EAP","HCPCS C1898","","Isoflex Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500220","EAP","HCPCS C1898","","Isoflex Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500221","EAP","HCPCS C1898","","Isoflex Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500222","EAP","HCPCS C1898","","Isoflex Optim","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500223","EAP","HCPCS C1786","","5157m/s","BOTH IP/OP","$10,344.00 ","$7,654.56 ","$0.00 ","$10,344.00 ","$4,654.80 ","$0.00 ","$2,155.95 ","$5,158.80 ","$7,382.51 ","$0.00 ","$10,344.00 ","$0.00 ","$5,172.00 ","$8,192.45 ","$8,275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500224","EAP","HCPCS C1785","","5357m/s","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500225","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500226","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500227","EAP","HCPCS C1895","","Durata+++pmm#:87533","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$5,585.85 ","$0.00 ","$2,587.18 ","$5,158.80 ","$8,859.16 ","$2,173.42 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$1,942.63 ","$0.00 ","$1,976.15 ","$0.00 "
"27500228","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500229","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500230","EAP","HCPCS C1895","","Durata Df4 - Active Tbp Single Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500231","EAP","HCPCS C1895","","Durata Df4 - Active Tbp Single Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500232","EAP","HCPCS C1895","","Durata Df4 - Active Tbp Single Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500233","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500234","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500235","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500236","EAP","HCPCS C1895","","Durata+++pmm#:96295","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$5,585.85 ","$0.00 ","$2,587.18 ","$5,158.80 ","$8,859.16 ","$2,173.42 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$1,942.63 ","$0.00 ","$1,976.15 ","$0.00 "
"27500237","EAP","HCPCS C1895","","Durata+++pmm#:96296","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$5,585.85 ","$0.00 ","$2,587.18 ","$5,158.80 ","$8,859.16 ","$2,173.42 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$1,942.63 ","$0.00 ","$1,976.15 ","$0.00 "
"27500238","EAP","HCPCS C1895","","Durata","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500239","EAP","HCPCS C1895","","Durata Sj4 - Passive","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$5,585.85 ","$0.00 ","$2,587.18 ","$5,158.80 ","$8,859.16 ","$2,173.42 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$1,942.63 ","$0.00 ","$1,976.15 ","$0.00 "
"27500240","EAP","HCPCS C1895","","Durata Df4 - Passive Tbp Dual Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500241","EAP","HCPCS C1895","","Durata Df4 - Passive Tbp Dual Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500242","EAP","HCPCS C1895","","Durata Sj4 - Passive","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$5,585.85 ","$0.00 ","$2,587.18 ","$5,158.80 ","$8,859.16 ","$2,173.42 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$1,942.63 ","$0.00 ","$1,976.15 ","$0.00 "
"27500243","EAP","HCPCS C1895","","Durata Df4 - Passive Tbp Dual Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500244","EAP","HCPCS C1895","","Durata Df4 - Passive Tbp Dual Shock","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500245","EAP","HCPCS C1893","","Cps Direct? Sl Ii Straight 47cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500246","EAP","HCPCS C1893","","Cps Direct? Sl Ii 135 Degrees 47cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500247","EAP","HCPCS C1893","","Cps Direct? Sl Ii Wide 47cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500248","EAP","HCPCS C1893","","Cps Direct? Sl Ii X-wide 47cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500249","EAP","HCPCS C1893","","Cps Direct? Sl Ii Right Side 47cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500250","EAP","HCPCS C1893","","Cps Direct? Sl Ii Straight 54cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500251","EAP","HCPCS C1893","","Cps Direct? Sl Ii 115 Degrees 54cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500252","EAP","HCPCS C1893","","Cps Direct? Sl Ii 135 Degrees 54cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500253","EAP","HCPCS C1893","","Cps Direct? Sl Ii Wide 54cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500254","EAP","HCPCS C1893","","Cps Direct? Sl Ii X-wide 54cm","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500255","EAP","HCPCS C1893","","Cps Aim S","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500256","EAP","HCPCS C1893","","Cps Aim Sl","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500257","EAP","HCPCS C1893","","Cps Aim S","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500258","EAP","HCPCS C1893","","Cps Aim Sl","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500259","EAP","HCPCS C1893","","Cps Aim Sl","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500260","EAP","HCPCS C1893","","Cps Aim Sl","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500261","EAP","HCPCS C1893","","Cps Aim Sl","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27500262","EAP","HCPCS C1786","","Pacemakers Single Accent Sr Rf","BOTH IP/OP","$15,665.00 ","$11,592.10 ","$0.00 ","$15,665.00 ","$7,049.25 ","$0.00 ","$3,264.98 ","$5,158.80 ","$11,180.11 ","$0.00 ","$15,665.00 ","$0.00 ","$7,832.50 ","$12,406.68 ","$12,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500263","EAP","HCPCS C1722","","Atlas Plus C Header","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500264","EAP","HCPCS C1898","","Myopore Epicardial Lead 54 Cm","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27500265","EAP","HCPCS C1898","","Passive Fixation Pacing Lead  J-shape  Silicone Insulation","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500266","EAP","HCPCS C1898","","Passive Fixation Pacing Lead  J-shape  Silicone Insulation","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500267","EAP","HCPCS C1898","","Passive Fixation Pacing Lead  Straight  Silicone Insulation","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500268","EAP","HCPCS C1898","","Passive Fixation Pacing Lead  Straight  Silicone Insulation","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500269","EAP","HCPCS C1898","","Active Fixation Pacing Lead  Electrically Active Helix  Sili","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500270","EAP","HCPCS C1898","","Active Fixation Pacing Lead  Electrically Active Helix  Sili","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500271","EAP","HCPCS C1898","","Active Fixation Pacing Lead  Electrically Active Helix  Sili","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500272","EAP","HCPCS C1898","","Active Fixation  Single Coil  Silicone Insulation  65 Cm","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500273","EAP","HCPCS C1898","","Passive Fixation  Dual Coil  Silicone Insulation  65 Cm  18","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500274","EAP","HCPCS C1898","","Active Fixation  Dual Coil  Silicone Insulation  60 Cm  16 C","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500275","EAP","HCPCS C1898","","Active Fixation  Dual Coil  Silicone Insulation  65 Cm  18 C","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500276","EAP","HCPCS C1900","","Left Ventricular Lead With 3d Pre-shaped Helix At Distal End","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27500277","EAP","HCPCS C1900","","Left Ventricular Lead With Pre-shaped Bend And Thread Fixati","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27500278","EAP","HCPCS C1900","","Left Ventricular Lead With 2d Pre-shaped Bend At Distal End","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27500279","EAP","HCPCS C1895","","Is-1  Silicone  35cm  V Placement","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500280","EAP","HCPCS C1895","","Is-1  Silicone  54cm  V Placement","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500281","EAP","HCPCS C1892","","Is-1  Polyurethane  44cm  7f Introducer  11mm Electrode Spac","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500282","EAP","HCPCS C1892","","Is-1  Polyurethane  52cm  7f Introducer  11mm Electrode Spac","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500283","EAP","HCPCS C1892","","Is-1  Polyurethane  58cm  7f Introducer  11mm Electrode Spac","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500284","EAP","HCPCS C1892","","Is-1  Polyurethane  7f  11mm Electrode Spacing  48cm  Prefor","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500285","EAP","HCPCS C1892","","Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Prefor","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500286","EAP","HCPCS C1892","","Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Straig","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500287","EAP","HCPCS C1892","","Is-1  Polyurethane  7f  11mm Electrode Spacing  58cm  Straig","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500288","EAP","HCPCS C1892","","Is-1  Polyurethane  7f  11mm Electrode Spacing  44cm  Prefor","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500289","EAP","HCPCS C1892","","Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Prefor","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27500290","EAP","HCPCS C1785","","Reply Dr V2","BOTH IP/OP","$12,413.00 ","$9,185.62 ","$0.00 ","$12,413.00 ","$5,585.85 ","$0.00 ","$2,587.18 ","$5,158.80 ","$8,859.16 ","$2,173.42 ","$12,413.00 ","$0.00 ","$6,206.50 ","$9,831.10 ","$9,930.40 ","$0.00 ","$1,942.63 ","$0.00 ","$1,976.15 ","$0.00 "
"27500291","EAP","HCPCS C1785","","Reply Dr V2  System","BOTH IP/OP","$14,777.00 ","$10,934.98 ","$0.00 ","$14,777.00 ","$6,649.65 ","$0.00 ","$3,079.90 ","$5,158.80 ","$10,546.34 ","$2,587.33 ","$14,777.00 ","$0.00 ","$7,388.50 ","$11,703.38 ","$11,821.60 ","$0.00 ","$2,312.60 ","$0.00 ","$2,352.50 ","$0.00 "
"27500292","EAP","HCPCS C1785","","Esprit Dr","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500293","EAP","HCPCS C1785","","Esprit Dr System","BOTH IP/OP","$14,777.00 ","$10,934.98 ","$0.00 ","$14,777.00 ","$6,649.65 ","$0.00 ","$3,079.90 ","$5,158.80 ","$10,546.34 ","$2,587.33 ","$14,777.00 ","$0.00 ","$7,388.50 ","$11,703.38 ","$11,821.60 ","$0.00 ","$2,312.60 ","$0.00 ","$2,352.50 ","$0.00 "
"27500294","EAP","HCPCS C1786","","Reply Sr V2","BOTH IP/OP","$9,753.00 ","$7,217.22 ","$0.00 ","$9,753.00 ","$4,388.85 ","$0.00 ","$2,032.77 ","$5,158.80 ","$6,960.72 ","$0.00 ","$9,753.00 ","$0.00 ","$4,876.50 ","$7,724.38 ","$7,802.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500295","EAP","HCPCS C1786","","Reply Sr V2 System","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$0.00 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500296","EAP","HCPCS C1786","","Esprit Sr","BOTH IP/OP","$10,344.00 ","$7,654.56 ","$0.00 ","$10,344.00 ","$4,654.80 ","$0.00 ","$2,155.95 ","$5,158.80 ","$7,382.51 ","$0.00 ","$10,344.00 ","$0.00 ","$5,172.00 ","$8,192.45 ","$8,275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500297","EAP","HCPCS C1786","","Esprit Sr System","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500298","EAP","HCPCS C1882","","Paradym Crt-d 8750","BOTH IP/OP","$55,268.00 ","$40,898.32 ","$0.00 ","$55,268.00 ","$24,870.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$39,444.77 ","$8,138.89 ","$55,268.00 ","$0.00 ","$27,634.00 ","$43,772.26 ","$44,214.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500299","EAP","HCPCS C1882","","Paradym Crt-d 8750 System","BOTH IP/OP","$65,318.00 ","$48,335.32 ","$0.00 ","$65,318.00 ","$29,393.10 ","$0.00 ","$9,417.94 ","$5,158.80 ","$46,617.46 ","$8,138.89 ","$65,318.00 ","$0.00 ","$32,659.00 ","$51,731.86 ","$52,254.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500300","EAP","HCPCS C1882","","Paradym 8250 Vr","BOTH IP/OP","$41,378.00 ","$30,619.72 ","$0.00 ","$41,378.00 ","$18,620.10 ","$0.00 ","$8,624.21 ","$5,158.80 ","$29,531.48 ","$7,244.96 ","$41,378.00 ","$0.00 ","$20,689.00 ","$32,771.38 ","$33,102.40 ","$0.00 ","$6,475.66 ","$0.00 ","$6,587.38 ","$0.00 "
"27500301","EAP","HCPCS C1882","","Paradym 8550 Dr","BOTH IP/OP","$48,767.00 ","$36,087.58 ","$0.00 ","$48,767.00 ","$21,945.15 ","$0.00 ","$9,417.94 ","$5,158.80 ","$34,805.01 ","$8,138.89 ","$48,767.00 ","$0.00 ","$24,383.50 ","$38,623.46 ","$39,013.60 ","$0.00 ","$7,632.04 ","$0.00 ","$7,763.71 ","$0.00 "
"27500302","EAP","HCPCS C1785","","Reply Dr","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27500303","EAP","HCPCS C1785","","Reply Dr System","BOTH IP/OP","$14,777.00 ","$10,934.98 ","$0.00 ","$14,777.00 ","$6,649.65 ","$0.00 ","$3,079.90 ","$5,158.80 ","$10,546.34 ","$2,587.33 ","$14,777.00 ","$0.00 ","$7,388.50 ","$11,703.38 ","$11,821.60 ","$0.00 ","$2,312.60 ","$0.00 ","$2,352.50 ","$0.00 "
"27500304","EAP","HCPCS C1883","","Is-1/df-1  Silicone 58cm Integrated Bipolar  Active Fixation","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500305","EAP","HCPCS C1722","","Paradym 9550 Rf Dr","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$20,614.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500310","EAP","HCPCS C1722","","Defib Cardiac Protecta Vr Implantable Cardioverter","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500311","EAP","HCPCS C1882","","Defibrillator Cardiac Consulta D.59 In W2.01 In X H2.72d","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$20,614.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500312","EAP","HCPCS C1786","","Dfbr Crd Inventra 7 Vr-t Dx Impltable Home Monitr","BOTH IP/OP","$49,688.00 ","$36,769.12 ","$0.00 ","$49,688.00 ","$22,359.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,462.33 ","$0.00 ","$49,688.00 ","$0.00 ","$24,844.00 ","$39,352.90 ","$39,750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500350","EAP","HCPCS C1721","","Evera Xt Dr System - Mmem","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500351","EAP","HCPCS C1721","","Evera Xt Dr System - Mmee","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500352","EAP","HCPCS C1721","","Evera S Dr System - Mmem","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500353","EAP","HCPCS C1721","","Evera S Dr System - Mmee","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500354","EAP","HCPCS C1721","","Protecta Xt Dr System - Mmem","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500355","EAP","HCPCS C1721","","Protecta Xt Dr System - Mmee","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500356","EAP","HCPCS C1722","","Evera Xt Vr System - Mmem","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500357","EAP","HCPCS C1722","","Evera Xt Vr System - Mmee","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500358","EAP","HCPCS C1722","","Evera S Vr System - Mmem","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500359","EAP","HCPCS C1722","","Evera S Vr System - Mmee","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500360","EAP","HCPCS C1722","","Protecta Xt Vr System - Emem","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500361","EAP","HCPCS C1722","","Protecta Xt Vr System - Emee","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500362","EAP","HCPCS C1721","","Icd-dr Ddbb1d1 Evera Xt Us Is1/df1","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500363","EAP","HCPCS C1721","","Icd-dr Ddbb1d4 Evera Xt Us Is1/df4","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500364","EAP","HCPCS C1721","","Icd-dr Ddbc3d1 Evera S Is1/df1 Glob","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500365","EAP","HCPCS C1721","","Icd-dr Ddbc3d4 Evera S Is1/df4 Glob","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500366","EAP","HCPCS C1721","","Icd D314drg Protecta Xt Dr Is-1/df-1 Us","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500367","EAP","HCPCS C1721","","Icd D314drm Protecta Xt Dr Us Mr Df4","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27500368","EAP","HCPCS C1722","","Icd-vr Dvbb1d1 Evera Xt Is1/df1 Us","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500369","EAP","HCPCS C1722","","Icd-vr Dvbb1d4 Evera Xt Us Is1/df4","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500370","EAP","HCPCS C1722","","Icd-vr Dvbc3d1 Evera S Is1/df1 Glob","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500371","EAP","HCPCS C1722","","Icd-vr Dvbc3d4 Evera S Df4 Glob","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500372","EAP","HCPCS C1722","","Icd D314vrg Protecta Xt Vr Us Mr Bcp","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500373","EAP","HCPCS C1722","","Icd D314vrm Protecta Xt Vr Us Mr Df4 Bcp","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27500374","EAP","HCPCS C1882","","Crt D314trg Protecta Xt Crt-d Us Mr","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500375","EAP","HCPCS C1882","","Crt D314trm Protecta Xt Crt-d Us Mr Df4","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500376","EAP","HCPCS C1882","","Protecta Xt Crtd Sys - Mmmm","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500377","EAP","HCPCS C1882","","Protecta Xt Crtd Sys - Mmme","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500378","EAP","HCPCS C1882","","Protecta Xt Crtd Sys - Mmpm","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500379","EAP","HCPCS C1882","","Protecta Xt Crtd Sys - Mmpe","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500380","EAP","HCPCS C1882","","Protecta Xt Crtd Sys - Mmam","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500381","EAP","HCPCS C1882","","Protecta Xt Crtd Sys - Mmae","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500382","EAP","HCPCS C1779","","Lead 5038s-58 Capsure Vdd Quad Av 11.5cm","BOTH IP/OP","$2,069.00 ","$1,531.06 ","$0.00 ","$2,069.00 ","$0.00 ","$0.00 ","$0.00 ","$1,476.65 ","$1,476.65 ","$0.00 ","$2,069.00 ","$0.00 ","$1,034.50 ","$1,638.65 ","$1,655.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500383","EAP","HCPCS C1779","","Lead 5038-58  Lead-quad Sngl-p A/v 58cm","BOTH IP/OP","$2,069.00 ","$1,531.06 ","$0.00 ","$2,069.00 ","$0.00 ","$0.00 ","$0.00 ","$1,476.65 ","$1,476.65 ","$0.00 ","$2,069.00 ","$0.00 ","$1,034.50 ","$1,638.65 ","$1,655.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500384","EAP","HCPCS C1779","","Lead 5038l-65  Capsure Vdd Lead 65cm","BOTH IP/OP","$2,069.00 ","$1,531.06 ","$0.00 ","$2,069.00 ","$0.00 ","$0.00 ","$0.00 ","$1,476.65 ","$1,476.65 ","$0.00 ","$2,069.00 ","$0.00 ","$1,034.50 ","$1,638.65 ","$1,655.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500385","EAP","HCPCS C1785","","Ipg A2dr01 Advisa Mri Dr.","BOTH IP/OP","$15,073.00 ","$11,154.02 ","$0.00 ","$15,073.00 ","$6,782.85 ","$0.00 ","$3,141.59 ","$5,158.80 ","$10,757.60 ","$2,639.16 ","$15,073.00 ","$0.00 ","$7,536.50 ","$11,937.82 ","$12,058.40 ","$0.00 ","$2,358.92 ","$0.00 ","$2,399.62 ","$0.00 "
"27500386","EAP","HCPCS C1785","","Ipg Rvdr01 Revo Mri 1.5t","BOTH IP/OP","$14,187.00 ","$10,498.38 ","$0.00 ","$14,187.00 ","$6,384.15 ","$0.00 ","$2,956.93 ","$5,158.80 ","$10,125.26 ","$2,484.03 ","$14,187.00 ","$0.00 ","$7,093.50 ","$11,236.10 ","$11,349.60 ","$0.00 ","$2,220.27 ","$0.00 ","$2,258.57 ","$0.00 "
"27500387","EAP","HCPCS C1785","","Advisa Mri System - Peem","BOTH IP/OP","$18,029.00 ","$13,341.46 ","$0.00 ","$18,029.00 ","$8,113.05 ","$0.00 ","$3,757.69 ","$5,158.80 ","$12,867.30 ","$3,156.73 ","$18,029.00 ","$0.00 ","$9,014.50 ","$14,278.97 ","$14,423.20 ","$0.00 ","$2,821.54 ","$0.00 ","$2,870.22 ","$0.00 "
"27500388","EAP","HCPCS C1785","","Revo Mri System - Peem","BOTH IP/OP","$17,142.00 ","$12,685.08 ","$0.00 ","$17,142.00 ","$7,713.90 ","$0.00 ","$3,572.82 ","$5,158.80 ","$12,234.25 ","$3,001.43 ","$17,142.00 ","$0.00 ","$8,571.00 ","$13,576.46 ","$13,713.60 ","$0.00 ","$2,682.72 ","$0.00 ","$2,729.01 ","$0.00 "
"27500389","EAP","HCPCS C1882","","Crt-d Dtbb1d1 Viva Sis1/df1 Us","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500390","EAP","HCPCS C1882","","Crt-d Dtbb1d4 Viva Sis1/df4 Us","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500391","EAP","HCPCS C1882","","Viva S Crtd System - Mmmm","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500392","EAP","HCPCS C1882","","Viva S Crtd System - Mmpm","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500393","EAP","HCPCS C1882","","Viva S Crtd System - Mmam","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27500394","EAP","HCPCS C1786","","Pcmkr Crd Thk6mm Sm 50x41mm Endurity 1 Chmbr Is-1 Conctr","BOTH IP/OP","$11,942.00 ","$8,837.08 ","$0.00 ","$11,942.00 ","$5,373.90 ","$0.00 ","$2,489.01 ","$5,158.80 ","$8,523.01 ","$0.00 ","$11,942.00 ","$0.00 ","$5,971.00 ","$9,458.06 ","$9,553.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500395","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity Dr 2 Chmbr Is-1 Conctr","BOTH IP/OP","$18,765.00 ","$13,886.10 ","$0.00 ","$18,765.00 ","$8,444.25 ","$0.00 ","$3,911.10 ","$5,158.80 ","$13,392.58 ","$3,285.60 ","$18,765.00 ","$0.00 ","$9,382.50 ","$14,861.88 ","$15,012.00 ","$0.00 ","$2,936.72 ","$0.00 ","$2,987.39 ","$0.00 "
"27500396","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 46x50x6 Endurity Dr 2 Chmbr Is-1 Conctr","BOTH IP/OP","$16,141.00 ","$11,944.34 ","$0.00 ","$16,141.00 ","$7,263.45 ","$0.00 ","$3,364.19 ","$5,158.80 ","$11,519.83 ","$2,826.16 ","$16,141.00 ","$0.00 ","$8,070.50 ","$12,783.67 ","$12,912.80 ","$0.00 ","$2,526.07 ","$0.00 ","$2,569.65 ","$0.00 "
"27500397","EAP","HCPCS C1786","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity Sr 1 Chmbr Is-1 Conctr","BOTH IP/OP","$14,960.00 ","$11,070.40 ","$0.00 ","$14,960.00 ","$6,732.00 ","$0.00 ","$3,118.04 ","$5,158.80 ","$10,676.95 ","$0.00 ","$14,960.00 ","$0.00 ","$7,480.00 ","$11,848.32 ","$11,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500398","EAP","HCPCS C1786","","Pcmkr Crd Thk6mm Sm 41x50 X6 Endurity Sr 1 Chmbr Is-1 Conctr","BOTH IP/OP","$12,335.00 ","$9,127.90 ","$0.00 ","$12,335.00 ","$5,550.75 ","$0.00 ","$2,570.92 ","$5,158.80 ","$8,803.49 ","$0.00 ","$12,335.00 ","$0.00 ","$6,167.50 ","$9,769.32 ","$9,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500399","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity Dr Rf Chmbr Is-1 Conctr","BOTH IP/OP","$19,946.00 ","$14,760.04 ","$0.00 ","$19,946.00 ","$8,975.70 ","$0.00 ","$4,157.25 ","$5,158.80 ","$14,235.46 ","$3,492.39 ","$19,946.00 ","$0.00 ","$9,973.00 ","$15,797.23 ","$15,956.80 ","$0.00 ","$3,121.55 ","$0.00 ","$3,175.40 ","$0.00 "
"27500400","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm Endurity Dr Rf Chmbr Is-1 Conctr Atcpt","BOTH IP/OP","$17,322.00 ","$12,818.28 ","$0.00 ","$17,322.00 ","$7,794.90 ","$0.00 ","$3,610.34 ","$5,158.80 ","$12,362.71 ","$3,032.94 ","$17,322.00 ","$0.00 ","$8,661.00 ","$13,719.02 ","$13,857.60 ","$0.00 ","$2,710.89 ","$0.00 ","$2,757.66 ","$0.00 "
"27500401","EAP","HCPCS C1786","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity 1 Chmbr Is-1 Conctr","BOTH IP/OP","$16,141.00 ","$11,944.34 ","$0.00 ","$16,141.00 ","$7,263.45 ","$0.00 ","$3,364.19 ","$5,158.80 ","$11,519.83 ","$0.00 ","$16,141.00 ","$0.00 ","$8,070.50 ","$12,783.67 ","$12,912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500402","EAP","HCPCS C1786","","Pcmkr Crd Thk6mm Sm 50x47mm Endurity 1 Chmbr Is-1 Conctr","BOTH IP/OP","$13,516.00 ","$10,001.84 ","$0.00 ","$13,516.00 ","$6,082.20 ","$0.00 ","$2,817.07 ","$5,158.80 ","$9,646.37 ","$0.00 ","$13,516.00 ","$0.00 ","$6,758.00 ","$10,704.67 ","$10,812.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500403","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x56mm Alr Qd Rf Is4-llll Conctr Is-1","BOTH IP/OP","$18,372.00 ","$13,595.28 ","$0.00 ","$18,372.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,112.10 ","$0.00 ","$18,372.00 ","$0.00 ","$9,186.00 ","$14,550.62 ","$14,697.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500404","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x55mm Alr Rf Is-1 Conctr Corvue Thor","BOTH IP/OP","$15,747.00 ","$11,652.78 ","$0.00 ","$15,747.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,238.63 ","$0.00 ","$15,747.00 ","$0.00 ","$7,873.50 ","$12,471.62 ","$12,597.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500405","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x56mm Alr Qd Pkg Is4-llll Conctr Is-1","BOTH IP/OP","$19,553.00 ","$14,469.22 ","$0.00 ","$19,553.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,954.98 ","$0.00 ","$19,553.00 ","$0.00 ","$9,776.50 ","$15,485.98 ","$15,642.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500406","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x55mm Alr Pkg Is-1 Conctr Corvue Thor","BOTH IP/OP","$16,928.00 ","$12,526.72 ","$0.00 ","$16,928.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,081.51 ","$0.00 ","$16,928.00 ","$0.00 ","$8,464.00 ","$13,406.98 ","$13,542.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500407","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x56mm Alr Qd Rf Sys Is4-llll Conctr Is-1","BOTH IP/OP","$29,001.00 ","$21,460.74 ","$0.00 ","$29,001.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,698.01 ","$0.00 ","$29,001.00 ","$0.00 ","$14,500.50 ","$22,968.79 ","$23,200.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500408","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x55mm Alr Rf Sys Is-1 Conctr Corvue Thor","BOTH IP/OP","$26,377.00 ","$19,518.98 ","$0.00 ","$26,377.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$18,825.26 ","$0.00 ","$26,377.00 ","$0.00 ","$13,188.50 ","$20,890.58 ","$21,101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500409","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x56mm Alr Crt-p Sys Is4-llll Conctr Is-1","BOTH IP/OP","$30,182.00 ","$22,334.68 ","$0.00 ","$30,182.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$21,540.89 ","$0.00 ","$30,182.00 ","$0.00 ","$15,091.00 ","$23,904.14 ","$24,145.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500410","EAP","HCPCS C2621","","Pcmkr Crd Thk6mm 59x55mm Alr Crt-p Sys Is-1 Con Corvue Thor","BOTH IP/OP","$27,558.00 ","$20,392.92 ","$0.00 ","$27,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$19,668.14 ","$0.00 ","$27,558.00 ","$0.00 ","$13,779.00 ","$21,825.94 ","$22,046.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500411","EAP","HCPCS C1785","","Pcmkr Cd 7.5mm Md Ellipse 44.5x47mm Ing Rythmiq","BOTH IP/OP","$10,498.00 ","$7,768.52 ","$0.00 ","$10,498.00 ","$4,724.10 ","$0.00 ","$2,188.05 ","$5,158.80 ","$7,492.42 ","$1,838.12 ","$10,498.00 ","$0.00 ","$5,249.00 ","$8,314.42 ","$8,398.40 ","$0.00 ","$1,642.94 ","$0.00 ","$1,671.28 ","$0.00 "
"27500412","EAP","HCPCS C1786","","Pcmkr Cd 7.5mm Md Ellipse 44.5x45.7mm Ing Rythmiq","BOTH IP/OP","$9,186.00 ","$6,797.64 ","$0.00 ","$9,186.00 ","$4,133.70 ","$0.00 ","$1,914.59 ","$5,158.80 ","$6,556.05 ","$0.00 ","$9,186.00 ","$0.00 ","$4,593.00 ","$7,275.31 ","$7,348.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500413","EAP","HCPCS C1896","","Dual Chamber Adaptive Rate Ingenior Dr System 8n22","BOTH IP/OP","$13,123.00 ","$9,711.02 ","$0.00 ","$13,123.00 ","$0.00 ","$0.00 ","$2,735.16 ","$5,158.80 ","$9,365.89 ","$0.00 ","$13,123.00 ","$0.00 ","$6,561.50 ","$10,393.42 ","$10,498.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500414","EAP","HCPCS C1896","","Single Chmbr Adptiv Rt Ingenio Sr System 8n32","BOTH IP/OP","$10,236.00 ","$7,574.64 ","$0.00 ","$10,236.00 ","$0.00 ","$0.00 ","$2,133.44 ","$5,158.80 ","$7,305.43 ","$0.00 ","$10,236.00 ","$0.00 ","$5,118.00 ","$8,106.91 ","$8,188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500415","EAP","HCPCS C1722","","Itrevia Vr-t Df-1 Hgh Eng W/ti W/hm Monitoring","BOTH IP/OP","$34,906.00 ","$25,830.44 ","$0.00 ","$34,906.00 ","$15,707.70 ","$0.00 ","$7,275.28 ","$5,158.80 ","$24,912.41 ","$6,111.76 ","$34,906.00 ","$0.00 ","$17,453.00 ","$27,645.55 ","$27,924.80 ","$0.00 ","$5,462.79 ","$0.00 ","$5,557.04 ","$0.00 "
"27500416","EAP","HCPCS C1721","","Dfbr Crd Evera Mri Surescan Df-1 Pin Plg Xt Dr","BOTH IP/OP","$41,500.00 ","$30,710.00 ","$0.00 ","$41,500.00 ","$0.00 ","$0.00 ","$8,649.64 ","$5,158.80 ","$29,618.55 ","$7,266.32 ","$41,500.00 ","$0.00 ","$20,750.00 ","$32,868.00 ","$33,200.00 ","$0.00 ","$6,494.75 ","$0.00 ","$6,606.80 ","$0.00 "
"27500417","EAP","HCPCS C1721","","Evera Mri Xt Dr Icd (dual Chamber Icd) Df4 Header","BOTH IP/OP","$41,500.00 ","$30,710.00 ","$0.00 ","$41,500.00 ","$0.00 ","$0.00 ","$8,649.64 ","$5,158.80 ","$29,618.55 ","$7,266.32 ","$41,500.00 ","$0.00 ","$20,750.00 ","$32,868.00 ","$33,200.00 ","$0.00 ","$6,494.75 ","$0.00 ","$6,606.80 ","$0.00 "
"27500418","EAP","HCPCS C1722","","Dfbr Crd Visia Af Mri Df4 Vr","BOTH IP/OP","$36,500.00 ","$27,010.00 ","$0.00 ","$36,500.00 ","$16,425.00 ","$0.00 ","$7,607.51 ","$5,158.80 ","$26,050.05 ","$6,390.86 ","$36,500.00 ","$0.00 ","$18,250.00 ","$28,908.00 ","$29,200.00 ","$0.00 ","$5,712.25 ","$0.00 ","$5,810.80 ","$0.00 "
"27500419","EAP","HCPCS C1722","","Visia Vr Icd (single Chamber Icd)  Df 1 Header","BOTH IP/OP","$36,500.00 ","$27,010.00 ","$0.00 ","$36,500.00 ","$16,425.00 ","$0.00 ","$7,607.51 ","$5,158.80 ","$26,050.05 ","$6,390.86 ","$36,500.00 ","$0.00 ","$18,250.00 ","$28,908.00 ","$29,200.00 ","$0.00 ","$5,712.25 ","$0.00 ","$5,810.80 ","$0.00 "
"27500420","EAP","HCPCS C1786","","Pacemaker Cardiac .75cm 4.45x4.81cm 1 Chamber Is1 Conctr","BOTH IP/OP","$8,600.00 ","$6,364.00 ","$0.00 ","$8,600.00 ","$3,870.00 ","$0.00 ","$1,792.46 ","$5,158.80 ","$6,137.82 ","$0.00 ","$8,600.00 ","$0.00 ","$4,300.00 ","$6,811.20 ","$6,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500421","EAP","HCPCS C1722","","Defibrillator Cardiac .99cm 5.37x7.79cm 1 Chamber Is-1 Df-4","BOTH IP/OP","$33,750.00 ","$24,975.00 ","$0.00 ","$33,750.00 ","$15,187.50 ","$0.00 ","$7,034.34 ","$5,158.80 ","$24,087.38 ","$5,909.36 ","$33,750.00 ","$0.00 ","$16,875.00 ","$26,730.00 ","$27,000.00 ","$0.00 ","$5,281.88 ","$0.00 ","$5,373.00 ","$0.00 "
"27500422","EAP","HCPCS C1721","","Defibrillator Cardiac .99cm 5.37x7.68cm 2 Chamber Extend","BOTH IP/OP","$37,500.00 ","$27,750.00 ","$0.00 ","$37,500.00 ","$0.00 ","$0.00 ","$7,815.94 ","$5,158.80 ","$26,763.75 ","$6,565.95 ","$37,500.00 ","$0.00 ","$18,750.00 ","$29,700.00 ","$30,000.00 ","$0.00 ","$5,868.75 ","$0.00 ","$5,970.00 ","$0.00 "
"27500423","EAP","HCPCS C1721","","Defibrillator Cardiac .99cm 5.37x7.79cm 2 Chamber Extend","BOTH IP/OP","$37,500.00 ","$27,750.00 ","$0.00 ","$37,500.00 ","$0.00 ","$0.00 ","$7,815.94 ","$5,158.80 ","$26,763.75 ","$6,565.95 ","$37,500.00 ","$0.00 ","$18,750.00 ","$29,700.00 ","$30,000.00 ","$0.00 ","$5,868.75 ","$0.00 ","$5,970.00 ","$0.00 "
"27500424","EAP","HCPCS C1882","","Defibrillator Cardiac .99cm 5.37x8.08cm Is-1 Df-1 Lv-1","BOTH IP/OP","$44,750.00 ","$33,115.00 ","$0.00 ","$44,750.00 ","$20,137.50 ","$0.00 ","$9,327.02 ","$5,158.80 ","$31,938.08 ","$7,835.37 ","$44,750.00 ","$0.00 ","$22,375.00 ","$35,442.00 ","$35,800.00 ","$0.00 ","$7,003.38 ","$0.00 ","$7,124.20 ","$0.00 "
"27500425","EAP","HCPCS C1893","","Acuity Pro Implant Tools/lead Delivery System","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$6,862.50 ","$0.00 ","$3,178.48 ","$5,158.80 ","$10,883.93 ","$2,670.15 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$2,386.63 ","$0.00 ","$2,427.80 ","$0.00 "
"27500426","EAP","HCPCS C2621","","Pacemaker Cardiac 3d .75cm 16.2cu Cm Spiral 2.6fr 4.45x6.13","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$10,883.93 ","$0.00 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500427","EAP","HCPCS C1882","","Defibrillator Cardiac .99in Mini 5.37x8.18cm Is-1 Df-4 Is-4","BOTH IP/OP","$44,750.00 ","$33,115.00 ","$0.00 ","$44,750.00 ","$20,137.50 ","$0.00 ","$9,327.02 ","$5,158.80 ","$31,938.08 ","$7,835.37 ","$44,750.00 ","$0.00 ","$22,375.00 ","$35,442.00 ","$35,800.00 ","$0.00 ","$7,003.38 ","$0.00 ","$7,124.20 ","$0.00 "
"27500428","EAP","HCPCS C1882","","Defibrillator Cardiac .99in Mini 5.37x8.08cm Is-1 Df-1 Is-4","BOTH IP/OP","$44,750.00 ","$33,115.00 ","$0.00 ","$44,750.00 ","$20,137.50 ","$0.00 ","$9,327.02 ","$5,158.80 ","$31,938.08 ","$7,835.37 ","$44,750.00 ","$0.00 ","$22,375.00 ","$35,442.00 ","$35,800.00 ","$0.00 ","$7,003.38 ","$0.00 ","$7,124.20 ","$0.00 "
"27500429","EAP","HCPCS C1900","","Lead Pacing X4 95 Cmconctr Acuity Left Ventricle Spiral L","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$0.00 ","$0.00 "
"27500430","EAP","HCPCS C1900","","Lead Pacing X4 86cm Conctr Acuity Left Ventricle Spiral L","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$0.00 ","$0.00 "
"27500431","EAP","HCPCS C1900","","Lead Pacing X4 95cm Conctr Acuity Left Ventricle Straight","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$0.00 ","$0.00 "
"27500432","EAP","HCPCS C1900","","Lead Pacing X4 86 Cm Conctr Acuity Left Ventricle Spiral S","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$0.00 ","$0.00 "
"27500433","EAP","HCPCS C1900","","Lead Pacing X4 95 Cm Conctr Acuity Left Ventricle Spiral S","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$0.00 ","$0.00 "
"27500434","EAP","HCPCS C1900","","Lead Pacing X4 86 Cm Conctr Acuity Left Ventricle Straight","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$0.00 ","$0.00 "
"27500435","EAP","HCPCS C1882","","Inventra 7 Vr-t Dx","BOTH IP/OP","$49,688.00 ","$36,769.12 ","$0.00 ","$49,688.00 ","$22,359.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,462.33 ","$8,138.89 ","$49,688.00 ","$0.00 ","$24,844.00 ","$39,352.90 ","$39,750.40 ","$0.00 ","$7,751.33 ","$0.00 ","$7,910.33 ","$0.00 "
"27500440","EAP","HCPCS C1785","","Pacemaker Crd Promri 2 Chmbr Eluna Dr-t","BOTH IP/OP","$14,000.00 ","$10,360.00 ","$0.00 ","$14,000.00 ","$6,300.00 ","$0.00 ","$2,917.95 ","$5,158.80 ","$9,991.80 ","$2,451.29 ","$14,000.00 ","$0.00 ","$7,000.00 ","$11,088.00 ","$11,200.00 ","$0.00 ","$2,191.00 ","$0.00 ","$2,228.80 ","$0.00 "
"27500441","EAP","HCPCS C1785","","Pacemaker Crd Promri Eluna Dr-t Lead Cllr Home","BOTH IP/OP","$16,500.00 ","$12,210.00 ","$0.00 ","$16,500.00 ","$7,425.00 ","$0.00 ","$3,439.01 ","$5,158.80 ","$11,776.05 ","$2,889.02 ","$16,500.00 ","$0.00 ","$8,250.00 ","$13,068.00 ","$13,200.00 ","$0.00 ","$2,582.25 ","$0.00 ","$2,626.80 ","$0.00 "
"27500442","EAP","HCPCS C1786","","Pacemaker Crd Eluna Sr-t Promri","BOTH IP/OP","$12,125.00 ","$8,972.50 ","$0.00 ","$12,125.00 ","$5,456.25 ","$0.00 ","$2,527.15 ","$5,158.80 ","$8,653.61 ","$0.00 ","$12,125.00 ","$0.00 ","$6,062.50 ","$9,603.00 ","$9,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27500443","EAP","HCPCS C1786","","Pacemaker Crd Promri Eluna Sr-t Lead Cllr Home","BOTH IP/OP","$13,250.00 ","$9,805.00 ","$0.00 ","$13,250.00 ","$5,962.50 ","$0.00 ","$2,761.63 ","$5,158.80 ","$9,456.53 ","$0.00 ","$13,250.00 ","$0.00 ","$6,625.00 ","$10,494.00 ","$10,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503012","EAP","HCPCS C1785","","Altrua 60 Pmkr, Dual, Rate-resp","BOTH IP/OP","$12,375.00 ","$9,157.50 ","$0.00 ","$12,375.00 ","$5,568.75 ","$0.00 ","$2,579.26 ","$5,158.80 ","$8,832.04 ","$2,166.76 ","$12,375.00 ","$0.00 ","$6,187.50 ","$9,801.00 ","$9,900.00 ","$0.00 ","$1,936.69 ","$0.00 ","$1,970.10 ","$0.00 "
"27503013","EAP","HCPCS C1786","","Altrua Pmkr, Single, Rate-resp","BOTH IP/OP","$10,553.00 ","$7,809.22 ","$0.00 ","$10,553.00 ","$4,748.85 ","$0.00 ","$2,199.51 ","$5,158.80 ","$7,531.68 ","$0.00 ","$10,553.00 ","$0.00 ","$5,276.50 ","$8,357.98 ","$8,442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503014","EAP","HCPCS C1721","","Energen Dr Aicd Dual Chamber","BOTH IP/OP","$46,552.00 ","$34,448.48 ","$0.00 ","$46,552.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$33,224.16 ","$8,138.89 ","$46,552.00 ","$0.00 ","$23,276.00 ","$36,869.18 ","$37,241.60 ","$0.00 ","$7,285.39 ","$0.00 ","$7,411.08 ","$0.00 "
"27503015","EAP","HCPCS C1722","","Energen Vr Aicd Single Chamber","BOTH IP/OP","$38,792.00 ","$28,706.08 ","$0.00 ","$38,792.00 ","$17,456.40 ","$0.00 ","$8,085.22 ","$5,158.80 ","$27,685.85 ","$6,792.17 ","$38,792.00 ","$0.00 ","$19,396.00 ","$30,723.26 ","$31,033.60 ","$0.00 ","$6,070.95 ","$0.00 ","$6,175.69 ","$0.00 "
"27503016","EAP","HCPCS C1895","","Reliance Gore Lead,aicd, Endo Dual Coil","BOTH IP/OP","$13,964.00 ","$10,333.36 ","$0.00 ","$13,964.00 ","$6,283.80 ","$0.00 ","$2,910.45 ","$5,158.80 ","$9,966.11 ","$2,444.98 ","$13,964.00 ","$0.00 ","$6,982.00 ","$11,059.49 ","$11,171.20 ","$0.00 ","$2,185.37 ","$0.00 ","$2,223.07 ","$0.00 "
"27503017","EAP","HCPCS C2621","","Contak Renewal Tr Crt-p","BOTH IP/OP","$19,861.00 ","$14,697.14 ","$0.00 ","$19,861.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$14,174.80 ","$0.00 ","$19,861.00 ","$0.00 ","$9,930.50 ","$15,729.91 ","$15,888.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503018","EAP","HCPCS C1900","","Acuity Steerable Lead, Coronary Venous","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$0.00 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$0.00 ","$0.00 "
"27503019","EAP","HCPCS C1900","","Acuity Spiral Lead,coronary Venous","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$0.00 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$0.00 ","$0.00 "
"27503020","EAP","HCPCS C1900","","Easytrak 2 Lead,coronary Venous","BOTH IP/OP","$4,656.00 ","$3,445.44 ","$0.00 ","$4,656.00 ","$2,095.20 ","$0.00 ","$970.43 ","$3,322.99 ","$3,322.99 ","$0.00 ","$4,656.00 ","$0.00 ","$2,328.00 ","$3,687.55 ","$3,724.80 ","$0.00 ","$728.66 ","$0.00 ","$0.00 ","$0.00 "
"27503021","EAP","HCPCS C1900","","Easytrak 3 Lead,coronary Venous","BOTH IP/OP","$4,656.00 ","$3,445.44 ","$0.00 ","$4,656.00 ","$2,095.20 ","$0.00 ","$970.43 ","$3,322.99 ","$3,322.99 ","$0.00 ","$4,656.00 ","$0.00 ","$2,328.00 ","$3,687.55 ","$3,724.80 ","$0.00 ","$728.66 ","$0.00 ","$0.00 ","$0.00 "
"27503022","EAP","HCPCS C1721","","Fortify Dr Aicd Dual Chamber","BOTH IP/OP","$64,394.00 ","$47,651.56 ","$0.00 ","$64,394.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$45,958.00 ","$8,138.89 ","$64,394.00 ","$0.00 ","$32,197.00 ","$51,000.05 ","$51,515.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503023","EAP","HCPCS C1785","","Accent Dr","BOTH IP/OP","$17,142.00 ","$12,685.08 ","$0.00 ","$17,142.00 ","$7,713.90 ","$0.00 ","$3,572.82 ","$5,158.80 ","$12,234.25 ","$3,001.43 ","$17,142.00 ","$0.00 ","$8,571.00 ","$13,576.46 ","$13,713.60 ","$0.00 ","$2,682.72 ","$0.00 ","$2,729.01 ","$0.00 "
"27503024","EAP","HCPCS C1786","","Accent Sr","BOTH IP/OP","$1,566.00 ","$1,158.84 ","$0.00 ","$1,566.00 ","$704.70 ","$0.00 ","$326.39 ","$1,117.65 ","$1,117.65 ","$0.00 ","$1,566.00 ","$0.00 ","$783.00 ","$1,240.27 ","$1,252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503025","EAP","HCPCS C1898","","Tendril Sts 2088tc/46","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503028","EAP","HCPCS C1721","","Fortify Assura Dr 40","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503029","EAP","HCPCS C1721","","Fortify Assura Dr 40 Df4 Connector","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503030","EAP","HCPCS C1721","","Ellipse Dr 36","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503031","EAP","HCPCS C1722","","Ellipse Dr 36 Df4 Connector","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$27,597.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503032","EAP","HCPCS C1722","","Fortify Assura Vr 40","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503033","EAP","HCPCS C1722","","Fortify Assura Vr 40 Df4 Connector","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503034","EAP","HCPCS C1722","","Ellipse Vr 36","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503035","EAP","HCPCS C1722","","Ellipse Vr 36 Df4 Connector","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503036","EAP","HCPCS C1882","","Quadra Assura Crt-d 40","BOTH IP/OP","$8,512.00 ","$6,298.88 ","$0.00 ","$8,512.00 ","$3,830.40 ","$0.00 ","$1,774.11 ","$5,158.80 ","$6,075.01 ","$1,490.38 ","$8,512.00 ","$0.00 ","$4,256.00 ","$6,741.50 ","$6,809.60 ","$0.00 ","$1,332.13 ","$0.00 ","$1,355.11 ","$0.00 "
"27503037","EAP","HCPCS C1882","","Quadra Assura Crt-d 40 Df4 Connector","BOTH IP/OP","$85,120.00 ","$62,988.80 ","$0.00 ","$85,120.00 ","$38,304.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$60,750.14 ","$8,138.89 ","$85,120.00 ","$0.00 ","$42,560.00 ","$67,415.04 ","$68,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503038","EAP","HCPCS C1882","","Unify Assura Crt-d 40","BOTH IP/OP","$85,120.00 ","$62,988.80 ","$0.00 ","$85,120.00 ","$38,304.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$60,750.14 ","$8,138.89 ","$85,120.00 ","$0.00 ","$42,560.00 ","$67,415.04 ","$68,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503039","EAP","HCPCS C1882","","Unify Assura Crt-d 40 Df4 Connector","BOTH IP/OP","$85,120.00 ","$62,988.80 ","$0.00 ","$85,120.00 ","$38,304.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$60,750.14 ","$8,138.89 ","$85,120.00 ","$0.00 ","$42,560.00 ","$67,415.04 ","$68,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503040","EAP","HCPCS C1898","","Tendril Sts 2088tc/65","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503041","EAP","HCPCS C1898","","Tendril Sts 2088tc/100","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503042","EAP","HCPCS C1785","","Adapta Vdd, Is-i","BOTH IP/OP","$4,729.00 ","$3,499.46 ","$0.00 ","$4,729.00 ","$2,128.05 ","$0.00 ","$985.64 ","$3,375.09 ","$3,375.09 ","$828.01 ","$4,729.00 ","$0.00 ","$2,364.50 ","$3,745.37 ","$3,783.20 ","$0.00 ","$740.09 ","$0.00 ","$752.86 ","$0.00 "
"27503043","EAP","HCPCS C1898","","Capsure Vdd2 Lead 5038s-52","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$590.94 ","$590.94 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"27503044","EAP","HCPCS C1898","","Capsure Vdd2 Lead 5032s-58","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$590.94 ","$590.94 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"27503045","EAP","HCPCS C1898","","Capsure Vdd2 Lead 50038-58","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$590.94 ","$590.94 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"27503046","EAP","HCPCS C1898","","Capsure Vdd2 Lead 5038-65","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$590.94 ","$590.94 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"27503050","EAP","HCPCS C1785","","Accent Dr  Pacemaker Generator","BOTH IP/OP","$17,142.00 ","$12,685.08 ","$0.00 ","$17,142.00 ","$7,713.90 ","$0.00 ","$3,572.82 ","$5,158.80 ","$12,234.25 ","$3,001.43 ","$17,142.00 ","$0.00 ","$8,571.00 ","$13,576.46 ","$13,713.60 ","$0.00 ","$2,682.72 ","$0.00 ","$2,729.01 ","$0.00 "
"27503051","EAP","HCPCS C1786","","Accent Sr Pacemaker Generator","BOTH IP/OP","$15,665.00 ","$11,592.10 ","$0.00 ","$15,665.00 ","$7,049.25 ","$0.00 ","$3,264.98 ","$5,158.80 ","$11,180.11 ","$0.00 ","$15,665.00 ","$0.00 ","$7,832.50 ","$12,406.68 ","$12,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503052","EAP","HCPCS C1898","","Tendril Sts 2088tc/46 Lead/electrode/access","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503053","EAP","HCPCS C1898","","Tendril Sts 2088tc/52 Lead/electrode/access","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503055","EAP","HCPCS C1721","","Fortify Assura Dr 40 Df4 Connector Icd/defib/resync","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503056","EAP","HCPCS C1721","","Fortify Assura Dr 40 Df4 Connector Icd/defib/resync","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503057","EAP","HCPCS C1721","","Ellipse Dr 36 Df4 Connector Icd/defib/resync","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503058","EAP","HCPCS C1721","","Ellipse Dr 36 Df4 Connector Icd/defib/resync","BOTH IP/OP","$61,328.00 ","$45,382.72 ","$0.00 ","$61,328.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,769.79 ","$8,138.89 ","$61,328.00 ","$0.00 ","$30,664.00 ","$48,571.78 ","$49,062.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503059","EAP","HCPCS C1722","","Fortify Assura Vr 40 Df4 Connector Icd/defib/resync","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503060","EAP","HCPCS C1722","","Fortify Assura Vr 40 Df4 Connector Icd/defib/resync","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503061","EAP","HCPCS C1722","","Ellipse Vr 36 Df4 Connector Icd/defib/resync","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503062","EAP","HCPCS C1722","","Ellipse Vr 36 Df4 Connector Icd/defib/resync","BOTH IP/OP","$53,200.00 ","$39,368.00 ","$0.00 ","$53,200.00 ","$23,940.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,968.84 ","$8,138.89 ","$53,200.00 ","$0.00 ","$26,600.00 ","$42,134.40 ","$42,560.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503063","EAP","HCPCS C1882","","Quadra Assura Crt-d 40 Df4 Connector Icd/defib/resync","BOTH IP/OP","$8,512.00 ","$6,298.88 ","$0.00 ","$8,512.00 ","$3,830.40 ","$0.00 ","$1,774.11 ","$5,158.80 ","$6,075.01 ","$1,490.38 ","$8,512.00 ","$0.00 ","$4,256.00 ","$6,741.50 ","$6,809.60 ","$0.00 ","$1,332.13 ","$0.00 ","$1,355.11 ","$0.00 "
"27503064","EAP","HCPCS C1882","","Quadra Assura Crt-d 40 Df4 Connector Icd/defib/resync","BOTH IP/OP","$85,120.00 ","$62,988.80 ","$0.00 ","$85,120.00 ","$38,304.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$60,750.14 ","$8,138.89 ","$85,120.00 ","$0.00 ","$42,560.00 ","$67,415.04 ","$68,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503065","EAP","HCPCS C1882","","Unify Assura Crt-d 40 Df4 Connector    Icd/defib/resync","BOTH IP/OP","$85,120.00 ","$62,988.80 ","$0.00 ","$85,120.00 ","$38,304.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$60,750.14 ","$8,138.89 ","$85,120.00 ","$0.00 ","$42,560.00 ","$67,415.04 ","$68,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503066","EAP","HCPCS C1882","","Unify Assura Crt-d 40 Df4 Connector    Icd/defib/resync","BOTH IP/OP","$85,120.00 ","$62,988.80 ","$0.00 ","$85,120.00 ","$38,304.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$60,750.14 ","$8,138.89 ","$85,120.00 ","$0.00 ","$42,560.00 ","$67,415.04 ","$68,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503067","EAP","HCPCS C1898","","Tendril Sts 2088tc/100  Lead/electrode/access","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503068","EAP","HCPCS C1898","","Tendril Sts 2088tc/65    Lead/electrode/access","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503070","EAP","HCPCS C1898","","Lead 4076110  Pkg Assy Lead 4076 Mdt Us","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503071","EAP","HCPCS C1898","","Lead 407625  Pkg Assy Lead 4076 Mdt Us M","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503072","EAP","HCPCS C1898","","Lead 407635 Capsurefix Novus","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503073","EAP","HCPCS C1898","","Lead 407645  Pkg Assy Lead 4076 Mdt Us M","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503074","EAP","HCPCS C1898","","Lead 407652  Pkg Assy Lead 4076 Mdt Us M","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503075","EAP","HCPCS C1898","","Lead 407658  Pkg Assy Lead 4076 Mdt Us M","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503076","EAP","HCPCS C1898","","Lead 407665 Capsurefix Novus","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503077","EAP","HCPCS C1898","","Lead 407685 Capsurefix Novus","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503081","EAP","HCPCS C1898","","Lead 5076-35  Lead-bipolar Sil Screw-in","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503082","EAP","HCPCS C1898","","Lead 5076-65  Lead-bipolar Sil Screw-in","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503083","EAP","HCPCS C1898","","Lead 5076-85  Lead-bipolar Sil Screw-in","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503084","EAP","HCPCS C1898","","Lead 5076110 Capsurefix Novus Pacing","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27503085","EAP","HCPCS C1895","","Lead 6947100  Lead-quadripolar Rv/svc 10","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503086","EAP","HCPCS C1895","","Lead 694758  Lead-quadripolar Rv/svc 58c","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503087","EAP","HCPCS C1895","","Lead 694765  Sprint Quad Can Rv/svc","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503088","EAP","HCPCS C1895","","Lead 694775  Lead-quadripolar Rv/svc 75c","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503089","EAP","HCPCS C1895","","Lead 6947m55 Df4 Active Dc Sprint 55 Cm","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503090","EAP","HCPCS C1895","","Lead 6947m62 Df4 Active Dc Sprint 62 Cm","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503091","EAP","HCPCS C1895","","Lead 6947m72 Df4 Active Dc Sprint 72 Cm","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503092","EAP","HCPCS C1895","","Lead 6947m97 Df4 Active Dc Sprint 97 Cm","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27503093","EAP","HCPCS C1786","","Pacemaker Single Chamber Adapta Sr","BOTH IP/OP","$10,344.00 ","$7,654.56 ","$0.00 ","$10,344.00 ","$4,654.80 ","$0.00 ","$2,155.95 ","$5,158.80 ","$7,382.51 ","$0.00 ","$10,344.00 ","$0.00 ","$5,172.00 ","$8,192.45 ","$8,275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503094","EAP","HCPCS C1882","","Generator Crt-d Maximo Ii","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503095","EAP","HCPCS C1721","","Icd Dual Chamber Maximo Ii Dr","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503096","EAP","HCPCS C1721","","Dfbr Crd Mxmo 2 Vr Impltable Cardvrt Sys","BOTH IP/OP","$38,422.00 ","$28,432.28 ","$0.00 ","$38,422.00 ","$0.00 ","$0.00 ","$8,008.11 ","$5,158.80 ","$27,421.78 ","$6,727.38 ","$38,422.00 ","$0.00 ","$19,211.00 ","$30,430.22 ","$30,737.60 ","$0.00 ","$6,013.04 ","$0.00 ","$6,116.78 ","$0.00 "
"27503097","EAP","HCPCS C1900","","Philos Dr","BOTH IP/OP","$8,572.00 ","$6,343.28 ","$0.00 ","$8,572.00 ","$3,857.40 ","$0.00 ","$1,786.62 ","$5,158.80 ","$6,117.84 ","$0.00 ","$8,572.00 ","$0.00 ","$4,286.00 ","$6,789.02 ","$6,857.60 ","$0.00 ","$1,341.52 ","$0.00 ","$0.00 ","$0.00 "
"27503098","EAP","HCPCS C1900","","Philos Sr","BOTH IP/OP","$8,276.00 ","$6,124.24 ","$0.00 ","$8,276.00 ","$3,724.20 ","$0.00 ","$1,724.93 ","$5,158.80 ","$5,906.58 ","$0.00 ","$8,276.00 ","$0.00 ","$4,138.00 ","$6,554.59 ","$6,620.80 ","$0.00 ","$1,295.19 ","$0.00 ","$0.00 ","$0.00 "
"27503099","EAP","HCPCS C1900","","Philos Dr System","BOTH IP/OP","$10,049.00 ","$7,436.26 ","$0.00 ","$10,049.00 ","$4,522.05 ","$0.00 ","$2,094.46 ","$5,158.80 ","$7,171.97 ","$0.00 ","$10,049.00 ","$0.00 ","$5,024.50 ","$7,958.81 ","$8,039.20 ","$0.00 ","$1,572.67 ","$0.00 ","$0.00 ","$0.00 "
"27503100","EAP","HCPCS C1900","","Philos Sr System","BOTH IP/OP","$9,458.00 ","$6,998.92 ","$0.00 ","$9,458.00 ","$4,256.10 ","$0.00 ","$1,971.28 ","$5,158.80 ","$6,750.17 ","$0.00 ","$9,458.00 ","$0.00 ","$4,729.00 ","$7,490.74 ","$7,566.40 ","$0.00 ","$1,480.18 ","$0.00 ","$0.00 ","$0.00 "
"27503101","EAP","HCPCS C1900","","Arox 60 Bp Lead","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$0.00 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$0.00 ","$0.00 "
"27503102","EAP","HCPCS C1900","","Arox 53 Bp Lead","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$0.00 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$0.00 ","$0.00 "
"27503103","EAP","HCPCS C1898","","Selox St 53 Lead","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503104","EAP","HCPCS C1898","","Selox St 60 Lead","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503105","EAP","HCPCS C1898","","Selox Jt 53 Lead","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503106","EAP","HCPCS C1898","","Selox Jt 45 Lead","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503107","EAP","HCPCS C1900","","Philos Ii Dr System","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$0.00 ","$0.00 "
"27503108","EAP","HCPCS C1900","","Cylos Dr With Cls Autonomic Response","BOTH IP/OP","$10,049.00 ","$7,436.26 ","$0.00 ","$10,049.00 ","$4,522.05 ","$0.00 ","$2,094.46 ","$5,158.80 ","$7,171.97 ","$0.00 ","$10,049.00 ","$0.00 ","$5,024.50 ","$7,958.81 ","$8,039.20 ","$0.00 ","$1,572.67 ","$0.00 ","$0.00 ","$0.00 "
"27503109","EAP","HCPCS C1900","","Cylos Vr With Cls Autonomic Response","BOTH IP/OP","$10,049.00 ","$7,436.26 ","$0.00 ","$10,049.00 ","$4,522.05 ","$0.00 ","$2,094.46 ","$5,158.80 ","$7,171.97 ","$0.00 ","$10,049.00 ","$0.00 ","$5,024.50 ","$7,958.81 ","$8,039.20 ","$0.00 ","$1,572.67 ","$0.00 ","$0.00 ","$0.00 "
"27503110","EAP","HCPCS C1895","","Linox Sd Steroid 65/16","BOTH IP/OP","$8,867.00 ","$6,561.58 ","$0.00 ","$8,867.00 ","$3,990.15 ","$0.00 ","$1,848.10 ","$5,158.80 ","$6,328.38 ","$1,552.54 ","$8,867.00 ","$0.00 ","$4,433.50 ","$7,022.66 ","$7,093.60 ","$0.00 ","$1,387.69 ","$0.00 ","$1,411.63 ","$0.00 "
"27503111","EAP","HCPCS C1895","","Linox Sd Steroid 75/18","BOTH IP/OP","$8,867.00 ","$6,561.58 ","$0.00 ","$8,867.00 ","$3,990.15 ","$0.00 ","$1,848.10 ","$5,158.80 ","$6,328.38 ","$1,552.54 ","$8,867.00 ","$0.00 ","$4,433.50 ","$7,022.66 ","$7,093.60 ","$0.00 ","$1,387.69 ","$0.00 ","$1,411.63 ","$0.00 "
"27503112","EAP","HCPCS C1898","","Setrox S 53 Lead","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503113","EAP","HCPCS C1898","","Setrox S 60 Lead","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503114","EAP","HCPCS C1777","","Linox S 65 Steroid","BOTH IP/OP","$8,867.00 ","$6,561.58 ","$0.00 ","$8,867.00 ","$3,990.15 ","$0.00 ","$1,848.10 ","$5,158.80 ","$6,328.38 ","$1,552.54 ","$8,867.00 ","$0.00 ","$4,433.50 ","$7,022.66 ","$7,093.60 ","$0.00 ","$1,387.69 ","$0.00 ","$1,411.63 ","$0.00 "
"27503115","EAP","HCPCS C1777","","Linox S 75 Steroid","BOTH IP/OP","$8,867.00 ","$6,561.58 ","$0.00 ","$8,867.00 ","$3,990.15 ","$0.00 ","$1,848.10 ","$5,158.80 ","$6,328.38 ","$1,552.54 ","$8,867.00 ","$0.00 ","$4,433.50 ","$7,022.66 ","$7,093.60 ","$0.00 ","$1,387.69 ","$0.00 ","$1,411.63 ","$0.00 "
"27503116","EAP","HCPCS C1895","","Linox Td Steroid 65/16 Cm","BOTH IP/OP","$8,867.00 ","$6,561.58 ","$0.00 ","$8,867.00 ","$3,990.15 ","$0.00 ","$1,848.10 ","$5,158.80 ","$6,328.38 ","$1,552.54 ","$8,867.00 ","$0.00 ","$4,433.50 ","$7,022.66 ","$7,093.60 ","$0.00 ","$1,387.69 ","$0.00 ","$1,411.63 ","$0.00 "
"27503117","EAP","HCPCS C1777","","Linox T 65 Steroid","BOTH IP/OP","$8,867.00 ","$6,561.58 ","$0.00 ","$8,867.00 ","$3,990.15 ","$0.00 ","$1,848.10 ","$5,158.80 ","$6,328.38 ","$1,552.54 ","$8,867.00 ","$0.00 ","$4,433.50 ","$7,022.66 ","$7,093.60 ","$0.00 ","$1,387.69 ","$0.00 ","$1,411.63 ","$0.00 "
"27503118","EAP","HCPCS C1900","","Corox Otw 75 Bp Lead","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27503119","EAP","HCPCS C1900","","Corox Otw 85 Bp Lead","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27503120","EAP","HCPCS C1900","","Corox Otw 75 Bp-s Lead","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27503121","EAP","HCPCS C1900","","Corox Otw 85 Bp-s Lead","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27503122","EAP","HCPCS C1882","","Lumax 340 Hf-t High Energy With Hm Landline","BOTH IP/OP","$52,461.00 ","$38,821.14 ","$0.00 ","$52,461.00 ","$23,607.45 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,441.42 ","$8,138.89 ","$52,461.00 ","$0.00 ","$26,230.50 ","$41,549.11 ","$41,968.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503123","EAP","HCPCS C1900","","Cylos Vr System With Cls Autonomic Response","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$0.00 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$0.00 ","$0.00 "
"27503124","EAP","HCPCS C1721","","Lumax 340 Dr-t High Energy With Hm Mobile Gsm","BOTH IP/OP","$42,855.00 ","$31,712.70 ","$0.00 ","$42,855.00 ","$0.00 ","$0.00 ","$8,932.05 ","$5,158.80 ","$30,585.61 ","$7,503.57 ","$42,855.00 ","$0.00 ","$21,427.50 ","$33,941.16 ","$34,284.00 ","$0.00 ","$6,706.81 ","$0.00 ","$6,822.52 ","$0.00 "
"27503125","EAP","HCPCS C1721","","Lumax 340 Dr-t High Energy System With Hm Mobile Gsm","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503126","EAP","HCPCS C1721","","Lumax 340 Dr-t High Energy System With Hm Landline","BOTH IP/OP","$48,767.00 ","$36,087.58 ","$0.00 ","$48,767.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$34,805.01 ","$8,138.89 ","$48,767.00 ","$0.00 ","$24,383.50 ","$38,623.46 ","$39,013.60 ","$0.00 ","$7,632.04 ","$0.00 ","$7,763.71 ","$0.00 "
"27503127","EAP","HCPCS C1882","","Lumax 340 Hf-t High Energy With Hm Mobile Gsm","BOTH IP/OP","$56,895.00 ","$42,102.30 ","$0.00 ","$56,895.00 ","$25,602.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,605.96 ","$8,138.89 ","$56,895.00 ","$0.00 ","$28,447.50 ","$45,060.84 ","$45,516.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503128","EAP","HCPCS C1882","","Lumax 340 Hf-t High Energy System With Hm Mobile Gsm","BOTH IP/OP","$74,628.00 ","$55,224.72 ","$0.00 ","$74,628.00 ","$33,582.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$53,262.00 ","$8,138.89 ","$74,628.00 ","$0.00 ","$37,314.00 ","$59,105.38 ","$59,702.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503130","EAP","HCPCS C1882","","Lumax 340 Hf-t High Energy System With Hm Landline","BOTH IP/OP","$68,716.00 ","$50,849.84 ","$0.00 ","$68,716.00 ","$30,922.20 ","$0.00 ","$9,417.94 ","$5,158.80 ","$49,042.61 ","$8,138.89 ","$68,716.00 ","$0.00 ","$34,358.00 ","$54,423.07 ","$54,972.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503131","EAP","HCPCS C1722","","Lumax 340 Vr-t High Energy With Hm Mobile Gsm","BOTH IP/OP","$35,467.00 ","$26,245.58 ","$0.00 ","$35,467.00 ","$15,960.15 ","$0.00 ","$7,392.21 ","$5,158.80 ","$25,312.80 ","$6,209.99 ","$35,467.00 ","$0.00 ","$17,733.50 ","$28,089.86 ","$28,373.60 ","$0.00 ","$5,550.59 ","$0.00 ","$5,646.35 ","$0.00 "
"27503132","EAP","HCPCS C1772","","Lumax 340 Vr-t High Energy System With Hm Mobile Gsm","BOTH IP/OP","$44,334.00 ","$32,807.16 ","$0.00 ","$44,334.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$31,641.18 ","$0.00 ","$44,334.00 ","$0.00 ","$22,167.00 ","$35,112.53 ","$35,467.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503133","EAP","HCPCS C1900","","Arox 45 Jbp Lead","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$0.00 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$0.00 ","$0.00 "
"27503135","EAP","HCPCS C1882","","DEFIBRILLATOR CARDIAC 2.43X3.13IN COGNIS THK.39IN VENTRICULA","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503136","EAP","HCPCS C1722","","DFBR CRD THK1.1CM 6.3X7.1CM VTL 2VR HE 1 CHMBR IMPLTABLE 35","BOTH IP/OP","$33,989.00 ","$25,151.86 ","$0.00 ","$33,989.00 ","$15,295.05 ","$0.00 ","$7,084.16 ","$5,158.80 ","$24,257.95 ","$5,951.20 ","$33,989.00 ","$0.00 ","$16,994.50 ","$26,919.29 ","$27,191.20 ","$0.00 ","$5,319.28 ","$0.00 ","$5,411.05 ","$0.00 "
"27503137","EAP","HCPCS C1722","","DFBR CRD .99CM 6.17X7.45CM TELIGEN VR DF-1 IS-1 BIPHASIC","BOTH IP/OP","$36,945.00 ","$27,339.30 ","$0.00 ","$36,945.00 ","$16,625.25 ","$0.00 ","$7,700.26 ","$5,158.80 ","$26,367.65 ","$6,468.77 ","$36,945.00 ","$0.00 ","$18,472.50 ","$29,260.44 ","$29,556.00 ","$0.00 ","$5,781.89 ","$0.00 ","$5,881.64 ","$0.00 "
"27503138","EAP","HCPCS C1721","","DFBR CRD TELIGEN DR HE DF-1 CONCTR NONPROGRAMMBALE CARDVRT","BOTH IP/OP","$44,334.00 ","$32,807.16 ","$0.00 ","$44,334.00 ","$0.00 ","$0.00 ","$9,240.31 ","$5,158.80 ","$31,641.18 ","$7,762.53 ","$44,334.00 ","$0.00 ","$22,167.00 ","$35,112.53 ","$35,467.20 ","$0.00 ","$6,938.27 ","$0.00 ","$7,057.97 ","$0.00 "
"27503139","EAP","HCPCS C1722","","DFBR CRD PUNCTUA VR ICD 1 CHMBR IMPLTABLE CARDVRT","BOTH IP/OP","$33,989.00 ","$25,151.86 ","$0.00 ","$33,989.00 ","$15,295.05 ","$0.00 ","$7,084.16 ","$5,158.80 ","$24,257.95 ","$5,951.20 ","$33,989.00 ","$0.00 ","$16,994.50 ","$26,919.29 ","$27,191.20 ","$0.00 ","$5,319.28 ","$0.00 ","$5,411.05 ","$0.00 "
"27503140","EAP","HCPCS C1772","","DFBR CRD THK9.9MM 61.7MMX32.5MM PUNCTUA AV IMPLTABLE 2CH","BOTH IP/OP","$36,945.00 ","$27,339.30 ","$0.00 ","$36,945.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,367.65 ","$0.00 ","$36,945.00 ","$0.00 ","$18,472.50 ","$29,260.44 ","$29,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503141","EAP","HCPCS C1882","","DFBR CRD PUNCTUA CRT-D RSYN THRP HI ENRG IMPLTABLE CARDVRT","BOTH IP/OP","$50,244.00 ","$37,180.56 ","$0.00 ","$50,244.00 ","$22,609.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,859.14 ","$8,138.89 ","$50,244.00 ","$0.00 ","$25,122.00 ","$39,793.25 ","$40,195.20 ","$0.00 ","$7,751.33 ","$0.00 ","$7,998.84 ","$0.00 "
"27503142","EAP","HCPCS C1882","","DFBR CRD INCEPTA CRT-D IMPLTABLE CARDVRT HI ENRG DF1 IS1 PLS","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503143","EAP","HCPCS C1722","","DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IS-1 DF-1 IMPLTABLE","BOTH IP/OP","$50,244.00 ","$37,180.56 ","$0.00 ","$50,244.00 ","$22,609.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,859.14 ","$8,138.89 ","$50,244.00 ","$0.00 ","$25,122.00 ","$39,793.25 ","$40,195.20 ","$0.00 ","$7,751.33 ","$0.00 ","$7,998.84 ","$0.00 "
"27503144","EAP","HCPCS C1722","","DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IMPLTABLE CRD RSYN","BOTH IP/OP","$50,244.00 ","$37,180.56 ","$0.00 ","$50,244.00 ","$22,609.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,859.14 ","$8,138.89 ","$50,244.00 ","$0.00 ","$25,122.00 ","$39,793.25 ","$40,195.20 ","$0.00 ","$7,751.33 ","$0.00 ","$7,998.84 ","$0.00 "
"27503145","EAP","HCPCS C1722","","DFBR CRD THK14.5MM 67X82.5MM LIVIAN RF HE IMPLTABLE RSYN","BOTH IP/OP","$50,244.00 ","$37,180.56 ","$0.00 ","$50,244.00 ","$22,609.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,859.14 ","$8,138.89 ","$50,244.00 ","$0.00 ","$25,122.00 ","$39,793.25 ","$40,195.20 ","$0.00 ","$7,751.33 ","$0.00 ","$7,998.84 ","$0.00 "
"27503146","EAP","HCPCS C1722","","Dfbr Crd Livian Rf He Cardvrt","BOTH IP/OP","$50,244.00 ","$37,180.56 ","$0.00 ","$50,244.00 ","$22,609.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,859.14 ","$8,138.89 ","$50,244.00 ","$0.00 ","$25,122.00 ","$39,793.25 ","$40,195.20 ","$0.00 ","$7,751.33 ","$0.00 ","$7,998.84 ","$0.00 "
"27503147","EAP","HCPCS C2621","","INVIVE / EASYTRAK or ACUITY: CARDIAC RESYNCHRONIZATION THERA","BOTH IP/OP","$26,452.00 ","$19,574.48 ","$0.00 ","$26,452.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$18,878.79 ","$0.00 ","$26,452.00 ","$0.00 ","$13,226.00 ","$20,949.98 ","$21,161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503148","EAP","HCPCS C1785","","PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE","BOTH IP/OP","$18,324.00 ","$13,559.76 ","$0.00 ","$18,324.00 ","$8,245.80 ","$0.00 ","$3,819.18 ","$5,158.80 ","$13,077.84 ","$3,208.39 ","$18,324.00 ","$0.00 ","$9,162.00 ","$14,512.61 ","$14,659.20 ","$0.00 ","$2,867.71 ","$0.00 ","$2,917.18 ","$0.00 "
"27503149","EAP","HCPCS C1785","","PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE","BOTH IP/OP","$18,324.00 ","$13,559.76 ","$0.00 ","$18,324.00 ","$8,245.80 ","$0.00 ","$3,819.18 ","$5,158.80 ","$13,077.84 ","$3,208.39 ","$18,324.00 ","$0.00 ","$9,162.00 ","$14,512.61 ","$14,659.20 ","$0.00 ","$2,867.71 ","$0.00 ","$2,917.18 ","$0.00 "
"27503150","EAP","HCPCS C1722","","DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503151","EAP","HCPCS C1721","","DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503152","EAP","HCPCS C1722","","DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR IMPLTABLE","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27503153","EAP","HCPCS C1722","","DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR DF-4","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27503154","EAP","HCPCS C1721","","DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503155","EAP","HCPCS C1882","","DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503156","EAP","HCPCS C1882","","INCEPTA LV-1 / EASYTRAK or ACUITY / ENDOTAK: CARDIAC RESYNCH","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503157","EAP","HCPCS C1721","","DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503158","EAP","HCPCS C1721","","DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503159","EAP","HCPCS C1721","","DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503160","EAP","HCPCS C1779","","PCMKR CRD 7.5IN MOD ELIP 44.5X47IN ADVANTIO 2CH IS-1 CONCTR","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503161","EAP","HCPCS C2619","","ADVANTIO DR IMPLANTABLE PACEMAKER SYSTEM (INCLUDES 2 LEADS)","BOTH IP/OP","$14,777.00 ","$10,934.98 ","$0.00 ","$14,777.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$10,546.34 ","$0.00 ","$14,777.00 ","$0.00 ","$7,388.50 ","$11,703.38 ","$11,821.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503162","EAP","HCPCS C1785","","PCMKR CRD THK7.5MM 44.5X45.7MM ADVANTIO RIGHTRATE ATR VNTRC","BOTH IP/OP","$10,344.00 ","$7,654.56 ","$0.00 ","$10,344.00 ","$4,654.80 ","$0.00 ","$2,155.95 ","$5,158.80 ","$7,382.51 ","$1,811.15 ","$10,344.00 ","$0.00 ","$5,172.00 ","$8,192.45 ","$8,275.20 ","$0.00 ","$1,618.84 ","$0.00 ","$1,646.76 ","$0.00 "
"27503163","EAP","HCPCS C1785","","ADVANTIO SR IMPLANTABLE PACEMAKER  SYSTEM (INCLUDES 1 LEAD)","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$2,018.29 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$1,803.98 ","$0.00 ","$1,835.10 ","$0.00 "
"27503164","EAP","HCPCS C1721","","DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503165","EAP","HCPCS C1721","","DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503166","EAP","HCPCS C1721","","DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503167","EAP","HCPCS C1722","","DFBR CRD THK9.9MM 61.7MM X 79.5MM ENERGEN VR VNTRC IMPLTABLE","BOTH IP/OP","$36,945.00 ","$27,339.30 ","$0.00 ","$36,945.00 ","$16,625.25 ","$0.00 ","$7,700.26 ","$5,158.80 ","$26,367.65 ","$6,468.77 ","$36,945.00 ","$0.00 ","$18,472.50 ","$29,260.44 ","$29,556.00 ","$0.00 ","$5,781.89 ","$0.00 ","$5,881.64 ","$0.00 "
"27503168","EAP","HCPCS C1722","","ENERGEN VR DF4 ICD SYSTEMS (1 RELIANCE NON-GORE LEAD)","BOTH IP/OP","$49,062.00 ","$36,305.88 ","$0.00 ","$49,062.00 ","$22,077.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,015.55 ","$8,138.89 ","$49,062.00 ","$0.00 ","$24,531.00 ","$38,857.10 ","$39,249.60 ","$0.00 ","$7,678.20 ","$0.00 ","$7,810.67 ","$0.00 "
"27503169","EAP","HCPCS C1785","","PCMKR CRD 2.8V 8MM MOD ELIP 43X49MM ALTRUA 60DR ATR VNTRC","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$2,018.29 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$1,803.98 ","$0.00 ","$1,835.10 ","$0.00 "
"27503170","EAP","HCPCS C1785","","PCMKR CRD ALTRUA 60 DDDR 2 CHMBR IS-1 MV BLND SNSR STOR EGMS","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$2,018.29 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$1,803.98 ","$0.00 ","$1,835.10 ","$0.00 "
"27503171","EAP","HCPCS C1785","","PCMKR CRD 8MM MOD ELLIPSE 43X49MM ALTRUA 60 ATR VNTRC 2","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$2,018.29 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$1,803.98 ","$0.00 ","$1,835.10 ","$0.00 "
"27503172","EAP","HCPCS C1785","","PCMKR CRD THK8MM 49X43MM ALTRUA 60DR ATR VNTRC IMPLTABLE 2","BOTH IP/OP","$14,482.00 ","$10,716.68 ","$0.00 ","$14,482.00 ","$6,516.90 ","$0.00 ","$3,018.41 ","$5,158.80 ","$10,335.80 ","$2,535.68 ","$14,482.00 ","$0.00 ","$7,241.00 ","$11,469.74 ","$11,585.60 ","$0.00 ","$2,266.43 ","$0.00 ","$2,305.53 ","$0.00 "
"27503173","EAP","HCPCS C1900","","PCMKR CRD THK8MM 42X42MM ALTRUA 60SR ATR VNTRC IMPLTABLE 1","BOTH IP/OP","$10,049.00 ","$7,436.26 ","$0.00 ","$10,049.00 ","$4,522.05 ","$0.00 ","$2,094.46 ","$5,158.80 ","$7,171.97 ","$0.00 ","$10,049.00 ","$0.00 ","$5,024.50 ","$7,958.81 ","$8,039.20 ","$0.00 ","$1,572.67 ","$0.00 ","$0.00 ","$0.00 "
"27503174","EAP","HCPCS C1785","","PCMKR CRD THK3MM 42MMX42MM ALTRUA 60SR IMPLTABLE 1 CHMBR RR","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27503175","EAP","HCPCS C1722","","DFBR CRD .99CM THK.39IN SM 2.43X3.13IN COGNIS ATR VNTRC IS-1","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503176","EAP","HCPCS C1772","","DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR","BOTH IP/OP","$49,062.00 ","$36,305.88 ","$0.00 ","$49,062.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$35,015.55 ","$0.00 ","$49,062.00 ","$0.00 ","$24,531.00 ","$38,857.10 ","$39,249.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503177","EAP","HCPCS C1882","","DFBR CRD COGNIS CNTK RNWL 3 RF HI ENRG","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503178","EAP","HCPCS C1882","","DFBR CRD 1.45CM 6.7X8.25CM CONFIENT RF HE ATR VNTRC 2CH","BOTH IP/OP","$36,945.00 ","$27,339.30 ","$0.00 ","$36,945.00 ","$16,625.25 ","$0.00 ","$7,700.26 ","$5,158.80 ","$26,367.65 ","$6,468.77 ","$36,945.00 ","$0.00 ","$18,472.50 ","$29,260.44 ","$29,556.00 ","$0.00 ","$5,781.89 ","$0.00 ","$5,881.64 ","$0.00 "
"27503179","EAP","HCPCS C2621","","PCMKR CRD CNTK RNWL TR ATR VNTRC 2 WRNCH IS-1 IMPLTABLE","BOTH IP/OP","$18,916.00 ","$13,997.84 ","$0.00 ","$18,916.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,500.35 ","$0.00 ","$18,916.00 ","$0.00 ","$9,458.00 ","$14,981.47 ","$15,132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503180","EAP","HCPCS C2621","","PCMKR CRD CNTK RNWL TR LV-1 IMPLTABLE","BOTH IP/OP","$18,916.00 ","$13,997.84 ","$0.00 ","$18,916.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,500.35 ","$0.00 ","$18,916.00 ","$0.00 ","$9,458.00 ","$14,981.47 ","$15,132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503181","EAP","HCPCS C1722","","DFBR CRD THK.39IN 2.43X2.69-2.89IN ENERGEN VR VNTRC 1 CHMBR","BOTH IP/OP","$36,945.00 ","$27,339.30 ","$0.00 ","$36,945.00 ","$16,625.25 ","$0.00 ","$7,700.26 ","$5,158.80 ","$26,367.65 ","$6,468.77 ","$36,945.00 ","$0.00 ","$18,472.50 ","$29,260.44 ","$29,556.00 ","$0.00 ","$5,781.89 ","$0.00 ","$5,881.64 ","$0.00 "
"27503182","EAP","HCPCS C1898","","LEAD PCNG 53CM 6.7FR 10MM SPC RIGHT AV BIPOL XTD-RETRAC HLX","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27503183","EAP","HCPCS C1722","","ENERGEN VR ICD SYSTEM (1 RELIANCE NON-GORE LEAD)","BOTH IP/OP","$49,062.00 ","$36,305.88 ","$0.00 ","$49,062.00 ","$22,077.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,015.55 ","$8,138.89 ","$49,062.00 ","$0.00 ","$24,531.00 ","$38,857.10 ","$39,249.60 ","$0.00 ","$7,678.20 ","$0.00 ","$7,810.67 ","$0.00 "
"27503184","EAP","HCPCS C1722","","DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG","BOTH IP/OP","$49,062.00 ","$36,305.88 ","$0.00 ","$49,062.00 ","$22,077.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,015.55 ","$8,138.89 ","$49,062.00 ","$0.00 ","$24,531.00 ","$38,857.10 ","$39,249.60 ","$0.00 ","$7,678.20 ","$0.00 ","$7,810.67 ","$0.00 "
"27503185","EAP","HCPCS C1721","","DFBR CRD THK9.9MM 61.7X74.5MM ENERGEN DR ATR ENTRICULAR","BOTH IP/OP","$44,334.00 ","$32,807.16 ","$0.00 ","$44,334.00 ","$0.00 ","$0.00 ","$9,240.31 ","$5,158.80 ","$31,641.18 ","$7,762.53 ","$44,334.00 ","$0.00 ","$22,167.00 ","$35,112.53 ","$35,467.20 ","$0.00 ","$6,938.27 ","$0.00 ","$7,057.97 ","$0.00 "
"27503186","EAP","HCPCS C1721","","ENERGEN DR DF4 ICD SYSTEMS (2 RELIANCE NON-GORE LEADS)","BOTH IP/OP","$57,781.00 ","$42,757.94 ","$0.00 ","$57,781.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,238.30 ","$8,138.89 ","$57,781.00 ","$0.00 ","$28,890.50 ","$45,762.55 ","$46,224.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503187","EAP","HCPCS C1721","","DFBR CRD ENERGEN DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR","BOTH IP/OP","$57,781.00 ","$42,757.94 ","$0.00 ","$57,781.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,238.30 ","$8,138.89 ","$57,781.00 ","$0.00 ","$28,890.50 ","$45,762.55 ","$46,224.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503188","EAP","HCPCS C1721","","DFBR CRD SM ENERGEN DR DF-4 2CH IMPLTABLE CARDVRT BTR-PWR","BOTH IP/OP","$44,334.00 ","$32,807.16 ","$0.00 ","$44,334.00 ","$0.00 ","$0.00 ","$9,240.31 ","$5,158.80 ","$31,641.18 ","$7,762.53 ","$44,334.00 ","$0.00 ","$22,167.00 ","$35,112.53 ","$35,467.20 ","$0.00 ","$6,938.27 ","$0.00 ","$7,057.97 ","$0.00 "
"27503189","EAP","HCPCS C1721","","ENERGEN DR ICD SYSTEM (2 RELIANCE NON-GORE LEADS)","BOTH IP/OP","$57,781.00 ","$42,757.94 ","$0.00 ","$57,781.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,238.30 ","$8,138.89 ","$57,781.00 ","$0.00 ","$28,890.50 ","$45,762.55 ","$46,224.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503190","EAP","HCPCS C1722","","DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG","BOTH IP/OP","$57,781.00 ","$42,757.94 ","$0.00 ","$57,781.00 ","$26,001.45 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,238.30 ","$8,138.89 ","$57,781.00 ","$0.00 ","$28,890.50 ","$45,762.55 ","$46,224.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503191","EAP","HCPCS C1882","","ENERGEN RF HE DF4 (with brady lead)","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503192","EAP","HCPCS C1882","","ENERGEN RF HE DF4 (without brady lead)","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503193","EAP","HCPCS C1721","","DFBR CRD THK9.9MM 79.5MMX61.7MM ENERGEN CRT-D VNTRC","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503194","EAP","HCPCS C1721","","DFBR CRD ENERGEN CRT-D IMPLTABLE CARDVRT","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503195","EAP","HCPCS C1882","","ENERGEN RF HE  (with brady lead)","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503211","EAP","HCPCS C1721","","Fortify Assura Next Nene Dr 40","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503212","EAP","HCPCS C1721","","Fortify Assura Next Gene Dr 40 Df4 Conn","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503213","EAP","HCPCS C1722","","Ellipse Next Gene Dr 36","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$20,614.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503214","EAP","HCPCS C1722","","Ellipse Next Gene Dr 36 Df4 Conn","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$20,614.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27503215","EAP","HCPCS C1722","","Fortify Assura Next Gene Vr 40","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27503216","EAP","HCPCS C1722","","Fortify Assura Next Gene Vr 40 Df4 Conn","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27503217","EAP","HCPCS C1722","","Ellipse Next Gene Vr 36","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27503218","EAP","HCPCS C1722","","Ellipse Next Gene Vr 36 Df4 Conn","BOTH IP/OP","$39,900.00 ","$29,526.00 ","$0.00 ","$39,900.00 ","$17,955.00 ","$0.00 ","$8,316.16 ","$5,158.80 ","$28,476.63 ","$6,986.17 ","$39,900.00 ","$0.00 ","$19,950.00 ","$31,600.80 ","$31,920.00 ","$0.00 ","$6,244.35 ","$0.00 ","$6,352.08 ","$0.00 "
"27503219","EAP","HCPCS C1721","","Fortify Assura Next Gene Dr 40 System","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503220","EAP","HCPCS C1721","","Fortify Assura Next Gene Dr 40 Df4 Conn System","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503221","EAP","HCPCS C1722","","Ellipse Next Gene Dr 36 System","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$26,500.05 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503222","EAP","HCPCS C1722","","Ellipse Next Gene Dr 36 Df4 Conn System","BOTH IP/OP","$58,889.00 ","$43,577.86 ","$0.00 ","$58,889.00 ","$26,500.05 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,029.08 ","$8,138.89 ","$58,889.00 ","$0.00 ","$29,444.50 ","$46,640.09 ","$47,111.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503223","EAP","HCPCS C1722","","Fortify Assura Next Gene Vr 40 System","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503224","EAP","HCPCS C1722","","Fortify Assura Next Gene Vr 40 Df4 Conn System","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503225","EAP","HCPCS C1722","","Ellipse Next Gene Vr 36 System","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503226","EAP","HCPCS C1722","","Ellipse Next Gene Vr 36 36 Df4 Conn System","BOTH IP/OP","$51,722.00 ","$38,274.28 ","$0.00 ","$51,722.00 ","$23,274.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,913.99 ","$8,138.89 ","$51,722.00 ","$0.00 ","$25,861.00 ","$40,963.82 ","$41,377.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503227","EAP","HCPCS C1882","","Quadra Assura Next Gene Crt-d 40","BOTH IP/OP","$59,111.00 ","$43,742.14 ","$0.00 ","$59,111.00 ","$26,599.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,187.52 ","$8,138.89 ","$59,111.00 ","$0.00 ","$29,555.50 ","$46,815.91 ","$47,288.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503228","EAP","HCPCS C1882","","Quadra Assura Next Gene Crt-d 40 Df4 Cc","BOTH IP/OP","$59,111.00 ","$43,742.14 ","$0.00 ","$59,111.00 ","$26,599.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,187.52 ","$8,138.89 ","$59,111.00 ","$0.00 ","$29,555.50 ","$46,815.91 ","$47,288.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503229","EAP","HCPCS C1882","","Unify Assura Next Gene Crt-d 40","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503230","EAP","HCPCS C1882","","Unify Assura Next Gene Crt-d 40 Df4 Conn","BOTH IP/OP","$53,791.00 ","$39,805.34 ","$0.00 ","$53,791.00 ","$24,205.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,390.64 ","$8,138.89 ","$53,791.00 ","$0.00 ","$26,895.50 ","$42,602.47 ","$43,032.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503231","EAP","HCPCS C1882","","Quadra Assura Next Gene Crt-d 40 System","BOTH IP/OP","$78,677.00 ","$58,220.98 ","$0.00 ","$78,677.00 ","$35,404.65 ","$0.00 ","$9,417.94 ","$5,158.80 ","$56,151.77 ","$8,138.89 ","$78,677.00 ","$0.00 ","$39,338.50 ","$62,312.18 ","$62,941.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503232","EAP","HCPCS C1882","","Quadra Assura Next Gene Crt-d Df4 Conn System","BOTH IP/OP","$78,677.00 ","$58,220.98 ","$0.00 ","$78,677.00 ","$35,404.65 ","$0.00 ","$9,417.94 ","$5,158.80 ","$56,151.77 ","$8,138.89 ","$78,677.00 ","$0.00 ","$39,338.50 ","$62,312.18 ","$62,941.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503233","EAP","HCPCS C1882","","Unify Assura Next Gene Crt-d 40 System","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503234","EAP","HCPCS C1882","","Unify Assura Next Gene Crt-d 40 Df4 Conn System","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503235","EAP","HCPCS C1722","","Generator Pulse Sq-rx And Q-trak Electrode","BOTH IP/OP","$71,926.00 ","$53,225.24 ","$0.00 ","$71,926.00 ","$32,366.70 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,333.59 ","$8,138.89 ","$71,926.00 ","$0.00 ","$35,963.00 ","$56,965.39 ","$57,540.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503236","EAP","CPT� C1722","","Generator Pulse Sq-rx","BOTH IP/OP","$59,249.00 ","$43,844.26 ","$0.00 ","$59,249.00 ","$26,662.05 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,286.01 ","$8,138.89 ","$59,249.00 ","$0.00 ","$29,624.50 ","$46,925.21 ","$47,399.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27503237","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity 2 Chmbr Is-1 Conctr","BOTH IP/OP","$19,566.00 ","$14,478.84 ","$0.00 ","$19,566.00 ","$8,804.70 ","$0.00 ","$4,078.04 ","$5,158.80 ","$13,964.25 ","$3,425.85 ","$19,566.00 ","$0.00 ","$9,783.00 ","$15,496.27 ","$15,652.80 ","$0.00 ","$3,062.08 ","$0.00 ","$3,114.91 ","$0.00 "
"27503238","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 50x46mm Endurity 2 Chmbr Is-1 Conctr","BOTH IP/OP","$15,432.00 ","$11,419.68 ","$0.00 ","$15,432.00 ","$6,944.40 ","$0.00 ","$3,216.41 ","$5,158.80 ","$11,013.82 ","$2,702.02 ","$15,432.00 ","$0.00 ","$7,716.00 ","$12,222.14 ","$12,345.60 ","$0.00 ","$2,415.11 ","$0.00 ","$2,456.77 ","$0.00 "
"27503239","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity Chmbr Is-1 Conctr Atcpt","BOTH IP/OP","$20,669.00 ","$15,295.06 ","$0.00 ","$20,669.00 ","$9,301.05 ","$0.00 ","$4,307.94 ","$5,158.80 ","$14,751.47 ","$3,618.98 ","$20,669.00 ","$0.00 ","$10,334.50 ","$16,369.85 ","$16,535.20 ","$0.00 ","$3,234.70 ","$0.00 ","$3,290.50 ","$0.00 "
"27503240","EAP","HCPCS C1785","","Pcmkr Crd Thk6mm Sm 50x47mm Assurity 1 Chmbr Is-1 Conctr","BOTH IP/OP","$17,774.00 ","$13,152.76 ","$0.00 ","$17,774.00 ","$7,998.30 ","$0.00 ","$3,704.55 ","$5,158.80 ","$12,685.30 ","$3,112.09 ","$17,774.00 ","$0.00 ","$8,887.00 ","$14,077.01 ","$14,219.20 ","$0.00 ","$2,781.63 ","$0.00 ","$2,829.62 ","$0.00 "
"27503241","EAP","HCPCS C1785","","Entovis Dr-t Promri With Landline Hm(r) Bradycardia","BOTH IP/OP","$19,759.00 ","$14,621.66 ","$0.00 ","$19,759.00 ","$8,891.55 ","$0.00 ","$4,118.27 ","$5,158.80 ","$14,102.00 ","$3,459.64 ","$19,759.00 ","$0.00 ","$9,879.50 ","$15,649.13 ","$15,807.20 ","$0.00 ","$3,092.28 ","$0.00 ","$3,145.63 ","$0.00 "
"27503242","EAP","HCPCS C1785","","Entovis Dr-t Promri System With Landline Hm(r) Bradycardia","BOTH IP/OP","$22,460.00 ","$16,620.40 ","$0.00 ","$22,460.00 ","$10,107.00 ","$0.00 ","$4,681.23 ","$5,158.80 ","$16,029.70 ","$3,932.57 ","$22,460.00 ","$0.00 ","$11,230.00 ","$17,788.32 ","$17,968.00 ","$0.00 ","$3,514.99 ","$0.00 ","$3,575.63 ","$0.00 "
"27503243","EAP","HCPCS C1785","","Entovis Dr-t Promri System With Cellular Hm(r) Bradycardia","BOTH IP/OP","$22,460.00 ","$16,620.40 ","$0.00 ","$22,460.00 ","$10,107.00 ","$0.00 ","$4,681.23 ","$5,158.80 ","$16,029.70 ","$3,932.57 ","$22,460.00 ","$0.00 ","$11,230.00 ","$17,788.32 ","$17,968.00 ","$0.00 ","$3,514.99 ","$0.00 ","$3,575.63 ","$0.00 "
"27503244","EAP","HCPCS C1786","","Entovis Sr-t Promri With Landline Hm(r) Bradycardia","BOTH IP/OP","$18,408.00 ","$13,621.92 ","$0.00 ","$18,408.00 ","$8,283.60 ","$0.00 ","$3,836.69 ","$5,158.80 ","$13,137.79 ","$0.00 ","$18,408.00 ","$0.00 ","$9,204.00 ","$14,579.14 ","$14,726.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503245","EAP","HCPCS C1786","","Entovis Sr-t Promri With Cellular Hm(r) Bradycardia","BOTH IP/OP","$18,408.00 ","$13,621.92 ","$0.00 ","$18,408.00 ","$8,283.60 ","$0.00 ","$3,836.69 ","$5,158.80 ","$13,137.79 ","$0.00 ","$18,408.00 ","$0.00 ","$9,204.00 ","$14,579.14 ","$14,726.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503246","EAP","HCPCS C1786","","Entovis Sr-t Promri System With Landline Hm(r) Bradycardia","BOTH IP/OP","$19,759.00 ","$14,621.66 ","$0.00 ","$19,759.00 ","$8,891.55 ","$0.00 ","$4,118.27 ","$5,158.80 ","$14,102.00 ","$0.00 ","$19,759.00 ","$0.00 ","$9,879.50 ","$15,649.13 ","$15,807.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503247","EAP","HCPCS C1786","","Entovis Sr-t Promri System With Cellular Hm(r) Bradycardia","BOTH IP/OP","$19,759.00 ","$14,621.66 ","$0.00 ","$19,759.00 ","$8,891.55 ","$0.00 ","$4,118.27 ","$5,158.80 ","$14,102.00 ","$0.00 ","$19,759.00 ","$0.00 ","$9,879.50 ","$15,649.13 ","$15,807.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503248","EAP","HCPCS C1785","","Evia Dr-t With Cls With Landline Hmbradycardiadual Chamber","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27503249","EAP","HCPCS C1785","","Evia Dr-t With Cls With Cellular Gsm Hmbradycardiadual Chamber","BOTH IP/OP","$17,003.00 ","$12,582.22 ","$0.00 ","$17,003.00 ","$7,651.35 ","$0.00 ","$3,543.85 ","$5,158.80 ","$12,135.04 ","$2,977.09 ","$17,003.00 ","$0.00 ","$8,501.50 ","$13,466.38 ","$13,602.40 ","$0.00 ","$2,660.97 ","$0.00 ","$2,706.88 ","$0.00 "
"27503250","EAP","HCPCS C1785","","Evia Dr-t System With Cls  With Landline Hmbradycardiadual Chamber Sys","BOTH IP/OP","$13,779.00 ","$10,196.46 ","$0.00 ","$13,779.00 ","$6,200.55 ","$0.00 ","$2,871.89 ","$5,158.80 ","$9,834.07 ","$2,412.59 ","$13,779.00 ","$0.00 ","$6,889.50 ","$10,912.97 ","$11,023.20 ","$0.00 ","$2,156.41 ","$0.00 ","$2,193.62 ","$0.00 "
"27503251","EAP","HCPCS C1785","","Evia Dr-t System With Cls A With Cellular Gsm Hmbradycardiadual Cham","BOTH IP/OP","$19,704.00 ","$14,580.96 ","$0.00 ","$19,704.00 ","$8,866.80 ","$0.00 ","$4,106.81 ","$5,158.80 ","$14,062.74 ","$3,450.01 ","$19,704.00 ","$0.00 ","$9,852.00 ","$15,605.57 ","$15,763.20 ","$0.00 ","$3,083.68 ","$0.00 ","$3,136.88 ","$0.00 "
"27503252","EAP","HCPCS C1786","","Evia Sr-t With Cls With Landline Hmbradycardiasingle Chamber","BOTH IP/OP","$9,646.00 ","$7,138.04 ","$0.00 ","$9,646.00 ","$4,340.70 ","$0.00 ","$2,010.47 ","$5,158.80 ","$6,884.35 ","$0.00 ","$9,646.00 ","$0.00 ","$4,823.00 ","$7,639.63 ","$7,716.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503253","EAP","HCPCS C1786","","Evia Sr-t With Cls With Cellular Gsm Hmbradycardiasingle Chamber","BOTH IP/OP","$15,653.00 ","$11,583.22 ","$0.00 ","$15,653.00 ","$7,043.85 ","$0.00 ","$3,262.48 ","$5,158.80 ","$11,171.55 ","$0.00 ","$15,653.00 ","$0.00 ","$7,826.50 ","$12,397.18 ","$12,522.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503254","EAP","HCPCS C1786","","Evia Sr-t System With Cls  With Landline Hmbradycardiasingle Chamber S","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$0.00 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503255","EAP","HCPCS C1786","","Evia Sr-t System With Cls With Cellular Gsm Hmbradycardiasingle Chamb","BOTH IP/OP","$17,003.00 ","$12,582.22 ","$0.00 ","$17,003.00 ","$7,651.35 ","$0.00 ","$3,543.85 ","$5,158.80 ","$12,135.04 ","$0.00 ","$17,003.00 ","$0.00 ","$8,501.50 ","$13,466.38 ","$13,602.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503256","EAP","HCPCS C2621","","Evia Hf-t With Landline Hmcrtdevice","BOTH IP/OP","$21,771.00 ","$16,110.54 ","$0.00 ","$21,771.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$15,537.96 ","$0.00 ","$21,771.00 ","$0.00 ","$10,885.50 ","$17,242.63 ","$17,416.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503257","EAP","HCPCS C2621","","Evia Hf-t With Cellular Gsm Hmcrtdevice","BOTH IP/OP","$22,597.00 ","$16,721.78 ","$0.00 ","$22,597.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$16,127.48 ","$0.00 ","$22,597.00 ","$0.00 ","$11,298.50 ","$17,896.82 ","$18,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503258","EAP","HCPCS C2621","","Evia Hf-t System With Landline Hmcrtsystem","BOTH IP/OP","$31,141.00 ","$23,044.34 ","$0.00 ","$31,141.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$22,225.33 ","$0.00 ","$31,141.00 ","$0.00 ","$15,570.50 ","$24,663.67 ","$24,912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503259","EAP","HCPCS C2621","","Evia Hf-t System With Cellular Gsm Hmcrtsystem","BOTH IP/OP","$31,692.00 ","$23,452.08 ","$0.00 ","$31,692.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$22,618.58 ","$0.00 ","$31,692.00 ","$0.00 ","$15,846.00 ","$25,100.06 ","$25,353.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503260","EAP","HCPCS C1900","","Corox Otw-l 75-bp Leadcrtlead","BOTH IP/OP","$5,512.00 ","$4,078.88 ","$0.00 ","$5,512.00 ","$2,480.40 ","$0.00 ","$1,148.84 ","$3,933.91 ","$3,933.91 ","$0.00 ","$5,512.00 ","$0.00 ","$2,756.00 ","$4,365.50 ","$4,409.60 ","$0.00 ","$862.63 ","$0.00 ","$0.00 ","$0.00 "
"27503261","EAP","HCPCS C1900","","Corox Otw-l 85-bp Leadcrtlead","BOTH IP/OP","$5,512.00 ","$4,078.88 ","$0.00 ","$5,512.00 ","$2,480.40 ","$0.00 ","$1,148.84 ","$3,933.91 ","$3,933.91 ","$0.00 ","$5,512.00 ","$0.00 ","$2,756.00 ","$4,365.50 ","$4,409.60 ","$0.00 ","$862.63 ","$0.00 ","$0.00 ","$0.00 "
"27503262","EAP","HCPCS C1898","","Lead Pcng 45cm Ecrdl Bipol Act Fix Is 1 Conctr Ring Eltrd","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$247.95 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"27503263","EAP","HCPCS C1785","","Gntr Pcmkr Entovis Dr-t Promri Crd","BOTH IP/OP","$19,759.00 ","$14,621.66 ","$0.00 ","$19,759.00 ","$8,891.55 ","$0.00 ","$4,118.27 ","$5,158.80 ","$14,102.00 ","$3,459.64 ","$19,759.00 ","$0.00 ","$9,879.50 ","$15,649.13 ","$15,807.20 ","$0.00 ","$3,092.28 ","$0.00 ","$3,145.63 ","$0.00 "
"27503265","EAP","HCPCS C1882","","Dfbr Crd .99cm Thn 5.37x8.08cm Inogen Easyview Right Atr Rv","BOTH IP/OP","$38,056.00 ","$28,161.44 ","$0.00 ","$38,056.00 ","$17,125.20 ","$0.00 ","$7,931.82 ","$5,158.80 ","$27,160.57 ","$6,663.30 ","$38,056.00 ","$0.00 ","$19,028.00 ","$30,140.35 ","$30,444.80 ","$0.00 ","$5,955.76 ","$0.00 ","$6,058.52 ","$0.00 "
"27503266","EAP","HCPCS C1785","","Pacemaker Crd .75cm 4.45x5.02cm Acld; Ltd Nxt;","BOTH IP/OP","$10,213.00 ","$7,557.62 ","$0.00 ","$10,213.00 ","$4,595.85 ","$0.00 ","$2,128.64 ","$5,158.80 ","$7,289.02 ","$1,788.21 ","$10,213.00 ","$0.00 ","$5,106.50 ","$8,088.70 ","$8,170.40 ","$0.00 ","$1,598.33 ","$0.00 ","$1,625.91 ","$0.00 "
"27503267","EAP","HCPCS C1721","","Pacemaker Crd 7.5mm 42.9x43.3mm Adapta Sr Atr","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$1,823.72 ","$5,158.80 ","$6,244.88 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"27503268","EAP","Custom 27503268","","Envelope Defibrillator Medium 2.5x2.75in Pacemaker","BOTH IP/OP","$1,738.00 ","$1,286.12 ","$0.00 ","$1,738.00 ","$0.00 ","$0.00 ","$0.00 ","$1,240.41 ","$1,240.41 ","$0.00 ","$1,738.00 ","$0.00 ","$869.00 ","$1,376.50 ","$1,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503269","EAP","Custom 27503269","","Catheter Balloon Occlusion .01in 2mm 2.5-2.8fr 4mm","BOTH IP/OP","$3,312.00 ","$2,450.88 ","$0.00 ","$3,312.00 ","$0.00 ","$0.00 ","$0.00 ","$2,363.77 ","$2,363.77 ","$0.00 ","$3,312.00 ","$0.00 ","$1,656.00 ","$2,623.10 ","$2,649.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503270","EAP","HCPCS C2621","","Quadra Allure Mp Rf Crt-p","BOTH IP/OP","$16,625.00 ","$12,302.50 ","$0.00 ","$16,625.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,865.26 ","$0.00 ","$16,625.00 ","$0.00 ","$8,312.50 ","$13,167.00 ","$13,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503271","EAP","HCPCS C2621","","Quadra Allure Mp Rf Crt-p, Merlinpkg","BOTH IP/OP","$17,625.00 ","$13,042.50 ","$0.00 ","$17,625.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,578.96 ","$0.00 ","$17,625.00 ","$0.00 ","$8,812.50 ","$13,959.00 ","$14,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503272","EAP","HCPCS C2621","","Quadra Allure Mp Rf Crt-p System","BOTH IP/OP","$23,875.00 ","$17,667.50 ","$0.00 ","$23,875.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$17,039.59 ","$0.00 ","$23,875.00 ","$0.00 ","$11,937.50 ","$18,909.00 ","$19,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503273","EAP","HCPCS C2621","","Quadra Allure Mp Crt-p System, Merlinpkg","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$17,842.50 ","$0.00 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503274","EAP","HCPCS C1898","","Lead Pcng 45cm Solia S Bp Actfx Strd Elut","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27503275","EAP","HCPCS C1898","","Lead Pcng 53cm Solia S Strd Elute Bp Actfx Ecrdl","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27503300","EAP","HCPCS C1785","","Pacemaker Crd 2 Chmbr Dr-t Etrinsa","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,500.00 ","$4,275.00 ","$0.00 ","$1,980.04 ","$5,158.80 ","$6,780.15 ","$1,663.37 ","$9,500.00 ","$0.00 ","$4,750.00 ","$7,524.00 ","$7,600.00 ","$0.00 ","$1,486.75 ","$0.00 ","$1,512.40 ","$0.00 "
"27503301","EAP","HCPCS C1785","","Etrinsa Dr-t System With Cls  With Home Monitoring","BOTH IP/OP","$12,000.00 ","$8,880.00 ","$0.00 ","$12,000.00 ","$5,400.00 ","$0.00 ","$2,501.10 ","$5,158.80 ","$8,564.40 ","$2,101.10 ","$12,000.00 ","$0.00 ","$6,000.00 ","$9,504.00 ","$9,600.00 ","$0.00 ","$1,878.00 ","$0.00 ","$1,910.40 ","$0.00 "
"27503302","EAP","HCPCS C1786","","Pacemaker Crd 1 Chmbr Etrinsa Sr-t","BOTH IP/OP","$8,375.00 ","$6,197.50 ","$0.00 ","$8,375.00 ","$3,768.75 ","$0.00 ","$1,745.56 ","$5,158.80 ","$5,977.24 ","$0.00 ","$8,375.00 ","$0.00 ","$4,187.50 ","$6,633.00 ","$6,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503303","EAP","HCPCS C1786","","Etrinsa Sr-t System With Cls  With Home Monitoring","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,500.00 ","$4,275.00 ","$0.00 ","$1,980.04 ","$5,158.80 ","$6,780.15 ","$0.00 ","$9,500.00 ","$0.00 ","$4,750.00 ","$7,524.00 ","$7,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503305","EAP","HCPCS C2621","","Percepta Bipolar Crtp","BOTH IP/OP","$29,835.00 ","$22,077.90 ","$0.00 ","$29,835.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$21,293.24 ","$0.00 ","$29,835.00 ","$0.00 ","$14,917.50 ","$23,629.32 ","$23,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503320","EAP","CPT� C1898","","Lead Pcng Strg 52cm Ingevity Mri Psv Fx Rv","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27503321","EAP","CPT� C1898","","Lead Pcng J Crv 45cm Ingevity Mri Psv Fx Prefrm Atr","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27503322","EAP","CPT� C1898","","Lead Pcng J Crv 52cm Ingevity Mri Psv Fx Prefrm Atr","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27503323","EAP","","","Lead Pcng Strg 45cm Ingevity Mri Act Bp Flx Tp Sty Av","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$802.91 ","$802.91 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503324","EAP","CPT� C1898","","Lead Pcng Strg 52cm Ingevity Mri Act Bp Flx Tp Sty Av","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"27503326","EAP","HCPCS C1785","","Pacemaker Crd Azure Wirelessly","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$5,158.80 ","$9,813.38 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"27503327","EAP","HCPCS c1786","","Pacemaker Crd Azure","BOTH IP/OP","$12,000.00 ","$8,880.00 ","$0.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,564.40 ","$0.00 ","$12,000.00 ","$0.00 ","$6,000.00 ","$9,504.00 ","$9,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503329","EAP","HCPCS C1898","","Lead Pcng 10mm Spc Sm Strg 6.2fr 2mm 45cm Strl Cp Nv Bp Scr","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$892.13 ","$892.13 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"27503330","EAP","HCPCS C1786","","Edora Promri Sr-t-sing Chmbr Pacemaker-rate-ad","BOTH IP/OP","$13,375.00 ","$9,897.50 ","$0.00 ","$13,375.00 ","$6,018.75 ","$0.00 ","$2,787.68 ","$5,158.80 ","$9,545.74 ","$0.00 ","$13,375.00 ","$0.00 ","$6,687.50 ","$10,593.00 ","$10,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27503331","EAP","HCPCS C1785","","Pm Cardiac Acld Lat Nxt Dr-el 4.45 X 5.88 X 0.75","BOTH IP/OP","$7,625.00 ","$5,642.50 ","$0.00 ","$7,625.00 ","$3,431.25 ","$0.00 ","$1,589.24 ","$5,158.80 ","$5,441.96 ","$1,335.08 ","$7,625.00 ","$0.00 ","$3,812.50 ","$6,039.00 ","$6,100.00 ","$0.00 ","$1,193.31 ","$0.00 ","$1,213.90 ","$0.00 "
"27503332","EAP","HCPCS C1722","","Dfbr Crd .99cm 5.37x7.36cm Resonate Heartlogic","BOTH IP/OP","$23,893.00 ","$17,680.82 ","$0.00 ","$23,893.00 ","$10,751.85 ","$0.00 ","$4,979.90 ","$5,158.80 ","$17,052.43 ","$4,183.47 ","$23,893.00 ","$0.00 ","$11,946.50 ","$18,923.26 ","$19,114.40 ","$0.00 ","$3,739.25 ","$0.00 ","$3,803.77 ","$0.00 "
"27800001","EAP","HCPCS V2790","","Prokera","BOTH IP/OP","$2,140.00 ","$1,583.60 ","$0.00 ","$2,140.00 ","$963.00 ","$0.00 ","$446.03 ","$1,527.32 ","$1,527.32 ","$374.70 ","$2,140.00 ","$0.00 ","$1,070.00 ","$1,694.88 ","$1,712.00 ","$0.00 ","$334.91 ","$0.00 ","$340.69 ","$0.00 "
"27800002","EAP","Custom 27800002","","Coil Embl 20mm .014in 3mm Trfl Psh Cmplx Pltn Nyl","BOTH IP/OP","$406.00 ","$300.44 ","$0.00 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$289.76 ","$289.76 ","$0.00 ","$406.00 ","$0.00 ","$203.00 ","$321.55 ","$324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800003","EAP","Custom 27800003","","Coil Embl 30mm .014in 4mm Trfl Psh Cmplx Pltn Nyl","BOTH IP/OP","$406.00 ","$300.44 ","$0.00 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$289.76 ","$289.76 ","$0.00 ","$406.00 ","$0.00 ","$203.00 ","$321.55 ","$324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800004","EAP","Custom 27800004","","Pusher Surg 195cm Trupush Embl Coil .016in","BOTH IP/OP","$1,244.00 ","$920.56 ","$0.00 ","$1,244.00 ","$0.00 ","$0.00 ","$0.00 ","$887.84 ","$887.84 ","$0.00 ","$1,244.00 ","$0.00 ","$622.00 ","$985.25 ","$995.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800005","EAP","Custom 27800005","","Coil Embl 30cm 20mm .038in Azur Frme Elc Dtch Loop","BOTH IP/OP","$3,188.00 ","$2,359.12 ","$0.00 ","$3,188.00 ","$0.00 ","$0.00 ","$0.00 ","$2,275.28 ","$2,275.28 ","$0.00 ","$3,188.00 ","$0.00 ","$1,594.00 ","$2,524.90 ","$2,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800006","EAP","Custom 27800006","","Coil Embl 30cm 20mm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$2,141.10 ","$2,141.10 ","$0.00 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800007","EAP","Custom 27800007","","Coil Embl 30cm 15mm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$2,141.10 ","$2,141.10 ","$0.00 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800008","EAP","Custom 27800008","","Azur Cx 35 Detachable 20mm/39cm","BOTH IP/OP","$2,800.00 ","$2,072.00 ","$0.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$1,998.36 ","$1,998.36 ","$0.00 ","$2,800.00 ","$0.00 ","$1,400.00 ","$2,217.60 ","$2,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800010","EAP","HCPCS C1882","","Defibrillator Cardiac Icd Df-1 Biphasic Waveform V","BOTH IP/OP","$47,875.00 ","$35,427.50 ","$0.00 ","$47,875.00 ","$21,543.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$34,168.39 ","$8,138.89 ","$47,875.00 ","$0.00 ","$23,937.50 ","$37,917.00 ","$38,300.00 ","$0.00 ","$7,492.44 ","$0.00 ","$7,621.70 ","$0.00 "
"27800011","EAP","HCPCS C1876","","Stent Vasc 8mm 40mm 75cm Slf Xpd Ilc Art Ep Ntnl Acpt 6fr","BOTH IP/OP","$2,887.00 ","$2,136.38 ","$0.00 ","$2,887.00 ","$1,299.15 ","$0.00 ","$601.72 ","$2,060.45 ","$2,060.45 ","$505.49 ","$2,887.00 ","$0.00 ","$1,443.50 ","$2,286.50 ","$2,309.60 ","$0.00 ","$451.82 ","$0.00 ","$459.61 ","$0.00 "
"27800012","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 37mm 75cm Bln Expandable Prmnt Xpr Ld Mtl","BOTH IP/OP","$2,955.00 ","$2,186.70 ","$0.00 ","$2,955.00 ","$1,329.75 ","$0.00 ","$615.90 ","$2,108.98 ","$2,108.98 ","$517.40 ","$2,955.00 ","$0.00 ","$1,477.50 ","$2,340.36 ","$2,364.00 ","$0.00 ","$462.46 ","$0.00 ","$470.44 ","$0.00 "
"27800013","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 27mm 75cm Bln Expandable Prmnt Xpr Ld Mtl","BOTH IP/OP","$2,955.00 ","$2,186.70 ","$0.00 ","$2,955.00 ","$1,329.75 ","$0.00 ","$615.90 ","$2,108.98 ","$2,108.98 ","$517.40 ","$2,955.00 ","$0.00 ","$1,477.50 ","$2,340.36 ","$2,364.00 ","$0.00 ","$462.46 ","$0.00 ","$470.44 ","$0.00 "
"27800014","EAP","Custom 27800014","","Dvc Embl 25mm 4.5mm Ppln Flx 55d 75% Cocr 25% Pltn","BOTH IP/OP","$37,389.00 ","$27,667.86 ","$0.00 ","$37,389.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,684.53 ","$0.00 ","$37,389.00 ","$0.00 ","$18,694.50 ","$29,612.09 ","$29,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800015","EAP","HCPCS C1874","","Stent Tracheobronchial 16mm Cover Icast 6mm 6fr","BOTH IP/OP","$6,009.00 ","$4,446.66 ","$0.00 ","$6,009.00 ","$2,704.05 ","$0.00 ","$1,252.43 ","$4,288.62 ","$4,288.62 ","$1,052.13 ","$6,009.00 ","$0.00 ","$3,004.50 ","$4,759.13 ","$4,807.20 ","$0.00 ","$940.41 ","$0.00 ","$956.63 ","$0.00 "
"27800016","EAP","Custom 27800016","","Dvc Embl 20mm 4.75mm Ppln Flx 55d 75% Ccr 25% Pltn","BOTH IP/OP","$34,230.00 ","$25,330.20 ","$0.00 ","$34,230.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,429.95 ","$0.00 ","$34,230.00 ","$0.00 ","$17,115.00 ","$27,110.16 ","$27,384.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800017","EAP","HCPCS C1752","","Mahurkar Elite Se Catheter Only 16cm","BOTH IP/OP","$121.00 ","$89.54 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$0.00 ","$86.36 ","$86.36 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800018","EAP","HCPCS C1752","","Mahurkar Elite Se Catheter Only 20cm","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$0.00 ","$0.00 ","$0.00 ","$90.64 ","$90.64 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800019","EAP","HCPCS C1752","","Mahurkar Elite Se Catheter Only 24cm","BOTH IP/OP","$121.00 ","$89.54 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$0.00 ","$86.36 ","$86.36 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800020","EAP","HCPCS C1874","","Stent Tracheobronchial 16mm Cvr Icast 120cm 7mm 7f","BOTH IP/OP","$6,009.00 ","$4,446.66 ","$0.00 ","$6,009.00 ","$2,704.05 ","$0.00 ","$1,252.43 ","$4,288.62 ","$4,288.62 ","$1,052.13 ","$6,009.00 ","$0.00 ","$3,004.50 ","$4,759.13 ","$4,807.20 ","$0.00 ","$940.41 ","$0.00 ","$956.63 ","$0.00 "
"27800021","EAP","HCPCS C2616","","Yttrium-90,per Source","BOTH IP/OP","$60,196.00 ","$44,545.04 ","$0.00 ","$60,196.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$42,961.89 ","$0.00 ","$60,196.00 ","$0.00 ","$30,098.00 ","$47,675.23 ","$48,156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800022","EAP","HCPCS C1874","","Stent Endoprsth 5cm 5mm Hep Ntnl Eptfe Vbhn 120cm","BOTH IP/OP","$8,123.00 ","$6,011.02 ","$0.00 ","$8,123.00 ","$3,655.35 ","$0.00 ","$1,693.04 ","$5,158.80 ","$5,797.39 ","$1,422.27 ","$8,123.00 ","$0.00 ","$4,061.50 ","$6,433.42 ","$6,498.40 ","$0.00 ","$1,271.25 ","$0.00 ","$1,293.18 ","$0.00 "
"27800023","EAP","HCPCS C1874","","Stent Endoprsth 10cm 5mm Hep Ntnl Eptfe Vbhn 120cm","BOTH IP/OP","$8,123.00 ","$6,011.02 ","$0.00 ","$8,123.00 ","$3,655.35 ","$0.00 ","$1,693.04 ","$5,158.80 ","$5,797.39 ","$1,422.27 ","$8,123.00 ","$0.00 ","$4,061.50 ","$6,433.42 ","$6,498.40 ","$0.00 ","$1,271.25 ","$0.00 ","$1,293.18 ","$0.00 "
"27800024","EAP","HCPCS C1874","","Stent Endoprsth 5cm 7mm Hep Ntnl Eptfe Vbhn 120cm","BOTH IP/OP","$8,123.00 ","$6,011.02 ","$0.00 ","$8,123.00 ","$3,655.35 ","$0.00 ","$1,693.04 ","$5,158.80 ","$5,797.39 ","$1,422.27 ","$8,123.00 ","$0.00 ","$4,061.50 ","$6,433.42 ","$6,498.40 ","$0.00 ","$1,271.25 ","$0.00 ","$1,293.18 ","$0.00 "
"27800025","EAP","HCPCS C1874","","Stent Endoprsth 10cm 7mm Hep Ntnl Eptfe Vbhn 120cm","BOTH IP/OP","$8,123.00 ","$6,011.02 ","$0.00 ","$8,123.00 ","$3,655.35 ","$0.00 ","$1,693.04 ","$5,158.80 ","$5,797.39 ","$1,422.27 ","$8,123.00 ","$0.00 ","$4,061.50 ","$6,433.42 ","$6,498.40 ","$0.00 ","$1,271.25 ","$0.00 ","$1,293.18 ","$0.00 "
"27800026","EAP","HCPCS C1757","","Mindframe Capture Lp 3x2 Revascularization Device","BOTH IP/OP","$11,643.00 ","$8,615.82 ","$0.00 ","$11,643.00 ","$5,239.35 ","$0.00 ","$2,426.69 ","$5,158.80 ","$8,309.61 ","$0.00 ","$11,643.00 ","$0.00 ","$5,821.50 ","$9,221.26 ","$9,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800029","EAP","HCPCS C1876","","Stent Vasc 13mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr","BOTH IP/OP","$17,219.00 ","$12,742.06 ","$0.00 ","$17,219.00 ","$7,748.55 ","$0.00 ","$3,588.87 ","$5,158.80 ","$12,289.20 ","$3,014.91 ","$17,219.00 ","$0.00 ","$8,609.50 ","$13,637.45 ","$13,775.20 ","$0.00 ","$2,694.77 ","$0.00 ","$2,741.26 ","$0.00 "
"27800030","EAP","HCPCS C1876","","Stent Vasc 17mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr","BOTH IP/OP","$17,219.00 ","$12,742.06 ","$0.00 ","$17,219.00 ","$7,748.55 ","$0.00 ","$3,588.87 ","$5,158.80 ","$12,289.20 ","$3,014.91 ","$17,219.00 ","$0.00 ","$8,609.50 ","$13,637.45 ","$13,775.20 ","$0.00 ","$2,694.77 ","$0.00 ","$2,741.26 ","$0.00 "
"27800031","EAP","HCPCS C1876","","Stent Vasc 23mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr","BOTH IP/OP","$17,219.00 ","$12,742.06 ","$0.00 ","$17,219.00 ","$7,748.55 ","$0.00 ","$3,588.87 ","$5,158.80 ","$12,289.20 ","$3,014.91 ","$17,219.00 ","$0.00 ","$8,609.50 ","$13,637.45 ","$13,775.20 ","$0.00 ","$2,694.77 ","$0.00 ","$2,741.26 ","$0.00 "
"27800032","EAP","HCPCS C1876","","Stent Vasc 34mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr","BOTH IP/OP","$17,219.00 ","$12,742.06 ","$0.00 ","$17,219.00 ","$7,748.55 ","$0.00 ","$3,588.87 ","$5,158.80 ","$12,289.20 ","$3,014.91 ","$17,219.00 ","$0.00 ","$8,609.50 ","$13,637.45 ","$13,775.20 ","$0.00 ","$2,694.77 ","$0.00 ","$2,741.26 ","$0.00 "
"27800033","EAP","HCPCS C1764","","System Crd Monitr Rvl Impltable Ins Loop","BOTH IP/OP","$13,900.00 ","$10,286.00 ","$0.00 ","$13,900.00 ","$6,255.00 ","$0.00 ","$2,897.11 ","$5,158.80 ","$9,920.43 ","$2,433.78 ","$13,900.00 ","$0.00 ","$6,950.00 ","$11,008.80 ","$11,120.00 ","$0.00 ","$2,175.35 ","$0.00 ","$2,212.88 ","$0.00 "
"27800035","EAP","HCPCS C1778","","Lead Nrstm 50cm Prcs .014in Trl Lnr Str Tip Preld","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$892.13 ","$892.13 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800039","EAP","HCPCS C1876","","Stent Endo 100cm 12mm 8fr 60mm 75cm Flexible Deliv","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$1,873.46 ","$1,873.46 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"27800040","EAP","HCPCS C1876","","Stent Endo 100cm 14mm 40mm 75cm Unconstrain Flex","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$1,873.46 ","$1,873.46 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"27800041","EAP","HCPCS C1876","","Stent Endo 100cm 14mm 9fr 60mm 75cm Cath","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$1,873.46 ","$1,873.46 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"27800042","EAP","HCPCS C1874","","Stent Endoprsth 8mm 7fr 5cm 120cm Delivery System","BOTH IP/OP","$7,738.00 ","$5,726.12 ","$0.00 ","$7,738.00 ","$3,482.10 ","$0.00 ","$1,612.79 ","$5,158.80 ","$5,522.61 ","$1,354.86 ","$7,738.00 ","$0.00 ","$3,869.00 ","$6,128.50 ","$6,190.40 ","$0.00 ","$1,211.00 ","$0.00 ","$1,231.89 ","$0.00 "
"27800043","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 100mm 120cm Otw Slf","BOTH IP/OP","$1,988.00 ","$1,471.12 ","$0.00 ","$1,988.00 ","$894.60 ","$0.00 ","$414.35 ","$1,418.84 ","$1,418.84 ","$348.08 ","$1,988.00 ","$0.00 ","$994.00 ","$1,574.50 ","$1,590.40 ","$0.00 ","$311.12 ","$0.00 ","$316.49 ","$0.00 "
"27800044","EAP","HCPCS C1874","","Graft Evas 32mm 8.1mm 20fr 124mm Znth 2 Intnl Stnt","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27800045","EAP","HCPCS C1874","","Graft Evas 2 Brch 12mm 8.1mm 20fr 91mm 62mm Znth I","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27800046","EAP","","","Space Oar Hydrogel","BOTH IP/OP","$7,125.00 ","$5,272.50 ","$0.00 ","$7,125.00 ","$0.00 ","$0.00 ","$0.00 ","$5,085.11 ","$5,085.11 ","$0.00 ","$7,125.00 ","$0.00 ","$3,562.50 ","$5,643.00 ","$5,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800053","EAP","HCPCS C1757","","Ace68 Reperfusion Catheter Kit","BOTH IP/OP","$6,988.00 ","$5,171.12 ","$0.00 ","$6,988.00 ","$3,144.60 ","$0.00 ","$1,456.47 ","$4,987.34 ","$4,987.34 ","$0.00 ","$6,988.00 ","$0.00 ","$3,494.00 ","$5,534.50 ","$5,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800055","EAP","HCPCS C1880","","Option Elite Vena Cava Filter System","BOTH IP/OP","$2,941.00 ","$2,176.34 ","$0.00 ","$2,941.00 ","$1,323.45 ","$0.00 ","$612.98 ","$2,098.99 ","$2,098.99 ","$514.95 ","$2,941.00 ","$0.00 ","$1,470.50 ","$2,329.27 ","$2,352.80 ","$0.00 ","$460.27 ","$0.00 ","$468.21 ","$0.00 "
"27800056","EAP","Custom 27800056","","Coil Embl 3cm 2mm Nst 4.8 Loop Sft Enh Radopc Mciol .01n","BOTH IP/OP","$279.00 ","$206.46 ","$0.00 ","$279.00 ","$0.00 ","$0.00 ","$0.00 ","$199.12 ","$199.12 ","$0.00 ","$279.00 ","$0.00 ","$139.50 ","$220.97 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800057","EAP","Custom 27800057","","Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc Mciol .01n","BOTH IP/OP","$279.00 ","$206.46 ","$0.00 ","$279.00 ","$0.00 ","$0.00 ","$0.00 ","$199.12 ","$199.12 ","$0.00 ","$279.00 ","$0.00 ","$139.50 ","$220.97 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800058","EAP","Custom 27800058","","Coil Embl 5cm 3mm Nst 5.3 Loop Sft Enh Radopc Mciol .01n","BOTH IP/OP","$271.00 ","$200.54 ","$0.00 ","$271.00 ","$0.00 ","$0.00 ","$0.00 ","$193.41 ","$193.41 ","$0.00 ","$271.00 ","$0.00 ","$135.50 ","$214.63 ","$216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800059","EAP","Custom 27800059","","Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc .035in Pln","BOTH IP/OP","$294.00 ","$217.56 ","$0.00 ","$294.00 ","$0.00 ","$0.00 ","$0.00 ","$209.83 ","$209.83 ","$0.00 ","$294.00 ","$0.00 ","$147.00 ","$232.85 ","$235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800060","EAP","Custom 27800060","","Coil Embl 7cm 8mm Nst 2.8 Loop Sft Enh Radopc .035in Pln","BOTH IP/OP","$294.00 ","$217.56 ","$0.00 ","$294.00 ","$0.00 ","$0.00 ","$0.00 ","$209.83 ","$209.83 ","$0.00 ","$294.00 ","$0.00 ","$147.00 ","$232.85 ","$235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800061","EAP","Custom 27800061","","Coil Embl 14cm 16mm Nst 2.8 Loop Sft Enh Radopc .035in N","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$228.38 ","$228.38 ","$0.00 ","$320.00 ","$0.00 ","$160.00 ","$253.44 ","$256.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800062","EAP","HCPCS C1874","","Drug Eluting Stent","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800063","EAP","HCPCS C1876","","Bare Metal Stent","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800064","EAP","HCPCS C1894","","Glidesheath Slender Ss (.021) 5fr 10cm","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$62.10 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"27800065","EAP","HCPCS C1894","","Glidesheath Slender Ss (.021) 7fr 10cm","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$62.10 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"27800066","EAP","HCPCS A4648","","Visicoil Lung Gold Seeds 0.50mm X 0.50cm Length","BOTH IP/OP","$338.00 ","$250.12 ","$0.00 ","$338.00 ","$152.10 ","$0.00 ","$70.45 ","$241.23 ","$241.23 ","$59.18 ","$338.00 ","$0.00 ","$169.00 ","$267.70 ","$270.40 ","$0.00 ","$52.90 ","$0.00 ","$53.81 ","$0.00 "
"27800100","EAP","","","Catheter Dlv Sys 130cm 5fr .04in Neuron .035in","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800101","EAP","HCPCS C1817","","Occluder Cardio 15mm Spt Sft Wire Frm Flrscp Img","BOTH IP/OP","$17,493.00 ","$12,944.82 ","$0.00 ","$17,493.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,484.75 ","$0.00 ","$17,493.00 ","$0.00 ","$8,746.50 ","$13,854.46 ","$13,994.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800102","EAP","HCPCS C1817","","Occluder Cardio 20mm Spt Sft Wire Frm Flrscp Img","BOTH IP/OP","$17,493.00 ","$12,944.82 ","$0.00 ","$17,493.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,484.75 ","$0.00 ","$17,493.00 ","$0.00 ","$8,746.50 ","$13,854.46 ","$13,994.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800103","EAP","HCPCS C1817","","Occluder Cardio 25mm Spt Sft Wire Frm Flrscp Img","BOTH IP/OP","$17,493.00 ","$12,944.82 ","$0.00 ","$17,493.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,484.75 ","$0.00 ","$17,493.00 ","$0.00 ","$8,746.50 ","$13,854.46 ","$13,994.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800104","EAP","HCPCS C1817","","Occluder Cardio 30mm Spt Sft Wire Frm Flrscp Img","BOTH IP/OP","$17,493.00 ","$12,944.82 ","$0.00 ","$17,493.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,484.75 ","$0.00 ","$17,493.00 ","$0.00 ","$8,746.50 ","$13,854.46 ","$13,994.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27800105","EAP","CPT� C1887","","Catheter Angiography Guiding Upsized Cps Direct 13","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$521.00 ","$521.00 ","$127.82 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$114.25 ","$0.00 ","$116.22 ","$0.00 "
"27801001","EAP","HCPCS C1721","","Livian Dual Crt-d Device","BOTH IP/OP","$102,209.00 ","$75,634.66 ","$0.00 ","$102,209.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$72,946.56 ","$8,138.89 ","$102,209.00 ","$0.00 ","$51,104.50 ","$80,949.53 ","$81,767.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801002","EAP","HCPCS C1721","","Entrust At Dual Icd","BOTH IP/OP","$63,028.00 ","$46,640.72 ","$0.00 ","$63,028.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$44,983.08 ","$8,138.89 ","$63,028.00 ","$0.00 ","$31,514.00 ","$49,918.18 ","$50,422.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801003","EAP","HCPCS C1721","","Maximo Dr Dual Icd","BOTH IP/OP","$48,414.00 ","$35,826.36 ","$0.00 ","$48,414.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$34,553.07 ","$8,138.89 ","$48,414.00 ","$0.00 ","$24,207.00 ","$38,343.89 ","$38,731.20 ","$0.00 ","$7,576.79 ","$0.00 ","$7,707.51 ","$0.00 "
"27801004","EAP","HCPCS C1722","","Entrust Vr Single Icd","BOTH IP/OP","$51,104.00 ","$37,816.96 ","$0.00 ","$51,104.00 ","$22,996.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$36,472.92 ","$8,138.89 ","$51,104.00 ","$0.00 ","$25,552.00 ","$40,474.37 ","$40,883.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,135.76 ","$0.00 "
"27801005","EAP","HCPCS C1722","","Maximo Vr Sindle Icd","BOTH IP/OP","$39,450.00 ","$29,193.00 ","$0.00 ","$39,450.00 ","$17,752.50 ","$0.00 ","$8,222.37 ","$5,158.80 ","$28,155.47 ","$6,907.38 ","$39,450.00 ","$0.00 ","$19,725.00 ","$31,244.40 ","$31,560.00 ","$0.00 ","$6,173.93 ","$0.00 ","$6,280.44 ","$0.00 "
"27801006","EAP","HCPCS C1722","","Virtuoso Single Icd","BOTH IP/OP","$51,104.00 ","$37,816.96 ","$0.00 ","$51,104.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$36,472.92 ","$8,138.89 ","$51,104.00 ","$0.00 ","$25,552.00 ","$40,474.37 ","$40,883.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,135.76 ","$0.00 "
"27801007","EAP","HCPCS C1721","","Ventak Prizm Dr Icd","BOTH IP/OP","$53,793.00 ","$39,806.82 ","$0.00 ","$53,793.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,392.06 ","$8,138.89 ","$53,793.00 ","$0.00 ","$26,896.50 ","$42,604.06 ","$43,034.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801008","EAP","HCPCS C1895","","Sprint 6947 Rv Lead","BOTH IP/OP","$16,139.00 ","$11,942.86 ","$0.00 ","$16,139.00 ","$7,262.55 ","$0.00 ","$3,363.77 ","$5,158.80 ","$11,518.40 ","$2,825.81 ","$16,139.00 ","$0.00 ","$8,069.50 ","$12,782.09 ","$12,911.20 ","$0.00 ","$2,525.75 ","$0.00 ","$2,569.33 ","$0.00 "
"27801009","EAP","HCPCS C1895","","Linox Sd Lead","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27801010","EAP","HCPCS C1895","","Isoline Passive Fix Lead","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27801011","EAP","HCPCS C1895","","Tachycardia Lead","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27801012","EAP","HCPCS C1895","","7120 Durata Pkg Lead","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27801013","EAP","HCPCS C1721","","Atlas Plus Dr Dual Icd","BOTH IP/OP","$50,207.00 ","$37,153.18 ","$0.00 ","$50,207.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,832.74 ","$8,138.89 ","$50,207.00 ","$0.00 ","$25,103.50 ","$39,763.94 ","$40,165.60 ","$0.00 ","$7,751.33 ","$0.00 ","$7,992.95 ","$0.00 "
"27801014","EAP","HCPCS C1722","","Atlas Plus Vr Sngl Icd","BOTH IP/OP","$39,450.00 ","$29,193.00 ","$0.00 ","$39,450.00 ","$17,752.50 ","$0.00 ","$8,222.37 ","$5,158.80 ","$28,155.47 ","$6,907.38 ","$39,450.00 ","$0.00 ","$19,725.00 ","$31,244.40 ","$31,560.00 ","$0.00 ","$6,173.93 ","$0.00 ","$6,280.44 ","$0.00 "
"27801015","EAP","HCPCS C1722","","Atlas Plus C Header Icd","BOTH IP/OP","$39,450.00 ","$29,193.00 ","$0.00 ","$39,450.00 ","$17,752.50 ","$0.00 ","$8,222.37 ","$5,158.80 ","$28,155.47 ","$6,907.38 ","$39,450.00 ","$0.00 ","$19,725.00 ","$31,244.40 ","$31,560.00 ","$0.00 ","$6,173.93 ","$0.00 ","$6,280.44 ","$0.00 "
"27801016","EAP","HCPCS C1722","","Atlas Ii Vr Sngl Icd","BOTH IP/OP","$39,450.00 ","$29,193.00 ","$0.00 ","$39,450.00 ","$17,752.50 ","$0.00 ","$8,222.37 ","$5,158.80 ","$28,155.47 ","$6,907.38 ","$39,450.00 ","$0.00 ","$19,725.00 ","$31,244.40 ","$31,560.00 ","$0.00 ","$6,173.93 ","$0.00 ","$6,280.44 ","$0.00 "
"27801017","EAP","HCPCS C1722","","Lumax 340 Vr-t Single Icd","BOTH IP/OP","$39,450.00 ","$29,193.00 ","$0.00 ","$39,450.00 ","$17,752.50 ","$0.00 ","$8,222.37 ","$5,158.80 ","$28,155.47 ","$6,907.38 ","$39,450.00 ","$0.00 ","$19,725.00 ","$31,244.40 ","$31,560.00 ","$0.00 ","$6,173.93 ","$0.00 ","$6,280.44 ","$0.00 "
"27801018","EAP","HCPCS C1721","","Lumax 340 Dr-t Dual Icd","BOTH IP/OP","$46,622.00 ","$34,500.28 ","$0.00 ","$46,622.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$33,274.12 ","$8,138.89 ","$46,622.00 ","$0.00 ","$23,311.00 ","$36,924.62 ","$37,297.60 ","$0.00 ","$7,296.34 ","$0.00 ","$7,422.22 ","$0.00 "
"27801019","EAP","HCPCS C1721","","Atlas Ii+ Dr Dual Icd","BOTH IP/OP","$66,346.00 ","$49,096.04 ","$0.00 ","$66,346.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$47,351.14 ","$8,138.89 ","$66,346.00 ","$0.00 ","$33,173.00 ","$52,546.03 ","$53,076.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801020","EAP","HCPCS C1898","","Bradycardia Lead","BOTH IP/OP","$1,920.00 ","$1,420.80 ","$0.00 ","$1,920.00 ","$864.00 ","$0.00 ","$400.18 ","$1,370.30 ","$1,370.30 ","$336.18 ","$1,920.00 ","$0.00 ","$960.00 ","$1,520.64 ","$1,536.00 ","$0.00 ","$300.48 ","$0.00 ","$305.66 ","$0.00 "
"27801021","EAP","HCPCS C1721","","Ovatio Oh60u Dr 6550 Icd","BOTH IP/OP","$53,793.00 ","$39,806.82 ","$0.00 ","$53,793.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,392.06 ","$8,138.89 ","$53,793.00 ","$0.00 ","$26,896.50 ","$42,604.06 ","$43,034.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801022","EAP","HCPCS C1722","","Ovatio Oh61u Vr Icd","BOTH IP/OP","$43,036.00 ","$31,846.64 ","$0.00 ","$43,036.00 ","$19,366.20 ","$0.00 ","$8,969.78 ","$5,158.80 ","$30,714.79 ","$7,535.26 ","$43,036.00 ","$0.00 ","$21,518.00 ","$34,084.51 ","$34,428.80 ","$0.00 ","$6,735.13 ","$0.00 ","$6,851.33 ","$0.00 "
"27801023","EAP","HCPCS C1882","","Ovatio Crt 6750 Icd","BOTH IP/OP","$69,035.00 ","$51,085.90 ","$0.00 ","$69,035.00 ","$31,065.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$49,270.28 ","$8,138.89 ","$69,035.00 ","$0.00 ","$34,517.50 ","$54,675.72 ","$55,228.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801024","EAP","HCPCS C1882","","Lumax 340 Hf-t Crt","BOTH IP/OP","$63,656.00 ","$47,105.44 ","$0.00 ","$63,656.00 ","$28,645.20 ","$0.00 ","$9,417.94 ","$5,158.80 ","$45,431.29 ","$8,138.89 ","$63,656.00 ","$0.00 ","$31,828.00 ","$50,415.55 ","$50,924.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801025","EAP","HCPCS C1882","","Concerto Bi-v Icd","BOTH IP/OP","$81,588.00 ","$60,375.12 ","$0.00 ","$81,588.00 ","$36,714.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$58,229.36 ","$8,138.89 ","$81,588.00 ","$0.00 ","$40,794.00 ","$64,617.70 ","$65,270.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801026","EAP","HCPCS C1895","","Linox S 65","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27801027","EAP","HCPCS C1895","","Kainox S 60","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27801028","EAP","HCPCS C1882","","Promote Bi-v","BOTH IP/OP","$73,870.00 ","$54,663.80 ","$0.00 ","$73,870.00 ","$33,241.50 ","$0.00 ","$9,417.94 ","$5,158.80 ","$52,721.02 ","$8,138.89 ","$73,870.00 ","$0.00 ","$36,935.00 ","$58,505.04 ","$59,096.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801029","EAP","HCPCS C1882","","Maximo Ii Crt-d","BOTH IP/OP","$77,107.00 ","$57,059.18 ","$0.00 ","$77,107.00 ","$34,698.15 ","$0.00 ","$9,417.94 ","$5,158.80 ","$55,031.27 ","$8,138.89 ","$77,107.00 ","$0.00 ","$38,553.50 ","$61,068.74 ","$61,685.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801030","EAP","HCPCS C1895","","Setrox S 45 Lead","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$806.85 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27801031","EAP","HCPCS C1895","","Setrox S 53 Lead","BOTH IP/OP","$1,793.00 ","$1,326.82 ","$0.00 ","$1,793.00 ","$806.85 ","$0.00 ","$373.71 ","$1,279.66 ","$1,279.66 ","$313.94 ","$1,793.00 ","$0.00 ","$896.50 ","$1,420.06 ","$1,434.40 ","$0.00 ","$280.60 ","$0.00 ","$285.45 ","$0.00 "
"27801032","EAP","HCPCS C1882","","Paradym Crt-d 8750","BOTH IP/OP","$82,842.00 ","$61,303.08 ","$0.00 ","$82,842.00 ","$37,278.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$59,124.34 ","$8,138.89 ","$82,842.00 ","$0.00 ","$41,421.00 ","$65,610.86 ","$66,273.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801033","EAP","HCPCS C1721","","Maximo Ii Dr Dual Icd","BOTH IP/OP","$55,588.00 ","$41,135.12 ","$0.00 ","$55,588.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$39,673.16 ","$8,138.89 ","$55,588.00 ","$0.00 ","$27,794.00 ","$44,025.70 ","$44,470.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801034","EAP","HCPCS C1722","","Maximo Ii Vr Single Icd","BOTH IP/OP","$46,622.00 ","$34,500.28 ","$0.00 ","$46,622.00 ","$20,979.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$33,274.12 ","$8,138.89 ","$46,622.00 ","$0.00 ","$23,311.00 ","$36,924.62 ","$37,297.60 ","$0.00 ","$7,296.34 ","$0.00 ","$7,422.22 ","$0.00 "
"27801035","EAP","HCPCS C1722","","1211-36 Current Vr Icd","BOTH IP/OP","$59,175.00 ","$43,789.50 ","$0.00 ","$59,175.00 ","$26,628.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,233.20 ","$8,138.89 ","$59,175.00 ","$0.00 ","$29,587.50 ","$46,866.60 ","$47,340.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801040","EAP","HCPCS C1880","","Vena Tech Lp Filter","BOTH IP/OP","$3,618.00 ","$2,677.32 ","$0.00 ","$3,618.00 ","$1,628.10 ","$0.00 ","$754.08 ","$2,582.17 ","$2,582.17 ","$633.48 ","$3,618.00 ","$0.00 ","$1,809.00 ","$2,865.46 ","$2,894.40 ","$0.00 ","$566.22 ","$0.00 ","$575.99 ","$0.00 "
"27801041","EAP","HCPCS C1876","","6fr-75cm 10x49 Wall","BOTH IP/OP","$3,307.00 ","$2,447.18 ","$0.00 ","$3,307.00 ","$1,488.15 ","$0.00 ","$689.26 ","$2,360.21 ","$2,360.21 ","$579.03 ","$3,307.00 ","$0.00 ","$1,653.50 ","$2,619.14 ","$2,645.60 ","$0.00 ","$517.55 ","$0.00 ","$526.47 ","$0.00 "
"27801042","EAP","HCPCS C1876","","6fr-8x80-75cmwallst","BOTH IP/OP","$3,307.00 ","$2,447.18 ","$0.00 ","$3,307.00 ","$1,488.15 ","$0.00 ","$689.26 ","$2,360.21 ","$2,360.21 ","$579.03 ","$3,307.00 ","$0.00 ","$1,653.50 ","$2,619.14 ","$2,645.60 ","$0.00 ","$517.55 ","$0.00 ","$526.47 ","$0.00 "
"27801043","EAP","HCPCS C1876","","7fr-75cm 10x94 Wall","BOTH IP/OP","$5,303.00 ","$3,924.22 ","$0.00 ","$5,303.00 ","$2,386.35 ","$0.00 ","$1,105.28 ","$3,784.75 ","$3,784.75 ","$928.51 ","$5,303.00 ","$0.00 ","$2,651.50 ","$4,199.98 ","$4,242.40 ","$0.00 ","$829.92 ","$0.00 ","$844.24 ","$0.00 "
"27801044","EAP","HCPCS C2625","","8fr-26cm Ureteral S","BOTH IP/OP","$404.00 ","$298.96 ","$0.00 ","$404.00 ","$181.80 ","$0.00 ","$84.20 ","$288.33 ","$288.33 ","$70.74 ","$404.00 ","$0.00 ","$202.00 ","$319.97 ","$323.20 ","$0.00 ","$63.23 ","$0.00 ","$64.32 ","$0.00 "
"27801045","EAP","HCPCS C1876","","8mmx40mm Wallstent","BOTH IP/OP","$5,303.00 ","$3,924.22 ","$0.00 ","$5,303.00 ","$2,386.35 ","$0.00 ","$1,105.28 ","$3,784.75 ","$3,784.75 ","$928.51 ","$5,303.00 ","$0.00 ","$2,651.50 ","$4,199.98 ","$4,242.40 ","$0.00 ","$829.92 ","$0.00 ","$844.24 ","$0.00 "
"27801046","EAP","HCPCS C1874","","9frx16x90-75cm Wall","BOTH IP/OP","$5,303.00 ","$3,924.22 ","$0.00 ","$5,303.00 ","$2,386.35 ","$0.00 ","$1,105.28 ","$3,784.75 ","$3,784.75 ","$928.51 ","$5,303.00 ","$0.00 ","$2,651.50 ","$4,199.98 ","$4,242.40 ","$0.00 ","$829.92 ","$0.00 ","$844.24 ","$0.00 "
"27801047","EAP","HCPCS C1874","","Wall Graft  7mm X 3","BOTH IP/OP","$6,506.00 ","$4,814.44 ","$0.00 ","$6,506.00 ","$2,927.70 ","$0.00 ","$1,356.01 ","$4,643.33 ","$4,643.33 ","$1,139.15 ","$6,506.00 ","$0.00 ","$3,253.00 ","$5,152.75 ","$5,204.80 ","$0.00 ","$1,018.19 ","$0.00 ","$1,035.76 ","$0.00 "
"27801048","EAP","HCPCS C1874","","Wallgraft  10 X 50m","BOTH IP/OP","$6,506.00 ","$4,814.44 ","$0.00 ","$6,506.00 ","$2,927.70 ","$0.00 ","$1,356.01 ","$4,643.33 ","$4,643.33 ","$1,139.15 ","$6,506.00 ","$0.00 ","$3,253.00 ","$5,152.75 ","$5,204.80 ","$0.00 ","$1,018.19 ","$0.00 ","$1,035.76 ","$0.00 "
"27801049","EAP","HCPCS C1874","","Wallgraft  12 X 70m","BOTH IP/OP","$7,505.00 ","$5,553.70 ","$0.00 ","$7,505.00 ","$3,377.25 ","$0.00 ","$1,564.23 ","$5,158.80 ","$5,356.32 ","$1,314.07 ","$7,505.00 ","$0.00 ","$3,752.50 ","$5,943.96 ","$6,004.00 ","$0.00 ","$1,174.53 ","$0.00 ","$1,194.80 ","$0.00 "
"27801050","EAP","HCPCS C1876","","21v7-7-80-8.0-30 St","BOTH IP/OP","$5,245.00 ","$3,881.30 ","$0.00 ","$5,245.00 ","$2,360.25 ","$0.00 ","$1,093.19 ","$3,743.36 ","$3,743.36 ","$918.36 ","$5,245.00 ","$0.00 ","$2,622.50 ","$4,154.04 ","$4,196.00 ","$0.00 ","$820.84 ","$0.00 ","$835.00 ","$0.00 "
"27801051","EAP","HCPCS C2625","","8.5fr-22cm Nephrour","BOTH IP/OP","$361.00 ","$267.14 ","$0.00 ","$361.00 ","$162.45 ","$0.00 ","$75.24 ","$257.65 ","$257.65 ","$63.21 ","$361.00 ","$0.00 ","$180.50 ","$285.91 ","$288.80 ","$0.00 ","$56.50 ","$0.00 ","$57.47 ","$0.00 "
"27801052","EAP","HCPCS C2625","","8.5fr-24cm Nephrour","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$249.80 ","$249.80 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"27801053","EAP","HCPCS C2625","","8.5fr-28cm Nephrour","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$249.80 ","$249.80 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"27801054","EAP","HCPCS C1876","","Ziv7-80-8.0-60 Sten","BOTH IP/OP","$5,245.00 ","$3,881.30 ","$0.00 ","$5,245.00 ","$2,360.25 ","$0.00 ","$1,093.19 ","$3,743.36 ","$3,743.36 ","$918.36 ","$5,245.00 ","$0.00 ","$2,622.50 ","$4,154.04 ","$4,196.00 ","$0.00 ","$820.84 ","$0.00 ","$835.00 ","$0.00 "
"27801055","EAP","HCPCS C1875","","6x 40 Fluency Stent Graft Old","BOTH IP/OP","$7,656.00 ","$5,665.44 ","$0.00 ","$7,656.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,464.09 ","$0.00 ","$7,656.00 ","$0.00 ","$3,828.00 ","$6,063.55 ","$6,124.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801056","EAP","HCPCS C1876","","10 X 40   Luminexx Stent","BOTH IP/OP","$4,186.00 ","$3,097.64 ","$0.00 ","$4,186.00 ","$1,883.70 ","$0.00 ","$872.47 ","$2,987.55 ","$2,987.55 ","$732.94 ","$4,186.00 ","$0.00 ","$2,093.00 ","$3,315.31 ","$3,348.80 ","$0.00 ","$655.11 ","$0.00 ","$666.41 ","$0.00 "
"27801057","EAP","HCPCS C1880","","Simon Nitinol Filte","BOTH IP/OP","$2,836.00 ","$2,098.64 ","$0.00 ","$2,836.00 ","$1,276.20 ","$0.00 ","$591.09 ","$2,024.05 ","$2,024.05 ","$496.56 ","$2,836.00 ","$0.00 ","$1,418.00 ","$2,246.11 ","$2,268.80 ","$0.00 ","$443.83 ","$0.00 ","$451.49 ","$0.00 "
"27801058","EAP","HCPCS C1874","","Wall Stent 8fr/ 12x","BOTH IP/OP","$3,605.00 ","$2,667.70 ","$0.00 ","$3,605.00 ","$1,622.25 ","$0.00 ","$751.37 ","$2,572.89 ","$2,572.89 ","$631.21 ","$3,605.00 ","$0.00 ","$1,802.50 ","$2,855.16 ","$2,884.00 ","$0.00 ","$564.18 ","$0.00 ","$573.92 ","$0.00 "
"27801059","EAP","HCPCS C1874","","Wall Stent 8fr/ 12x","BOTH IP/OP","$5,778.00 ","$4,275.72 ","$0.00 ","$5,778.00 ","$2,600.10 ","$0.00 ","$1,204.28 ","$4,123.76 ","$4,123.76 ","$1,011.68 ","$5,778.00 ","$0.00 ","$2,889.00 ","$4,576.18 ","$4,622.40 ","$0.00 ","$904.26 ","$0.00 ","$919.86 ","$0.00 "
"27801060","EAP","HCPCS C1875","","10x40 Luminexx Sten","BOTH IP/OP","$7,321.00 ","$5,417.54 ","$0.00 ","$7,321.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,225.00 ","$0.00 ","$7,321.00 ","$0.00 ","$3,660.50 ","$5,798.23 ","$5,856.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801061","EAP","HCPCS C2625","","8.5fr-26cm Nephro-u","BOTH IP/OP","$361.00 ","$267.14 ","$0.00 ","$361.00 ","$162.45 ","$0.00 ","$75.24 ","$257.65 ","$257.65 ","$63.21 ","$361.00 ","$0.00 ","$180.50 ","$285.91 ","$288.80 ","$0.00 ","$56.50 ","$0.00 ","$57.47 ","$0.00 "
"27801062","EAP","HCPCS C1875","","8 X 40 Fluency Sten","BOTH IP/OP","$9,054.00 ","$6,699.96 ","$0.00 ","$9,054.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,461.84 ","$0.00 ","$9,054.00 ","$0.00 ","$4,527.00 ","$7,170.77 ","$7,243.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801063","EAP","HCPCS C1880","","Filter Recovery Femoral","BOTH IP/OP","$3,669.00 ","$2,715.06 ","$0.00 ","$3,669.00 ","$1,651.05 ","$0.00 ","$764.71 ","$2,618.57 ","$2,618.57 ","$642.41 ","$3,669.00 ","$0.00 ","$1,834.50 ","$2,905.85 ","$2,935.20 ","$0.00 ","$574.20 ","$0.00 ","$584.10 ","$0.00 "
"27801064","EAP","HCPCS C2625","","8fr-28cm Ureteral S","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$256.93 ","$256.93 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"27801065","EAP","HCPCS C1788","","Low Profile Port","BOTH IP/OP","$751.00 ","$555.74 ","$0.00 ","$751.00 ","$337.95 ","$0.00 ","$156.53 ","$535.99 ","$535.99 ","$131.49 ","$751.00 ","$0.00 ","$375.50 ","$594.79 ","$600.80 ","$0.00 ","$117.53 ","$0.00 ","$119.56 ","$0.00 "
"27801066","EAP","HCPCS C1880","","Filter-femoral","BOTH IP/OP","$3,156.00 ","$2,335.44 ","$0.00 ","$3,156.00 ","$1,420.20 ","$0.00 ","$657.79 ","$2,252.44 ","$2,252.44 ","$552.59 ","$3,156.00 ","$0.00 ","$1,578.00 ","$2,499.55 ","$2,524.80 ","$0.00 ","$493.91 ","$0.00 ","$502.44 ","$0.00 "
"27801067","EAP","HCPCS C1880","","Greenfield Filter-j","BOTH IP/OP","$3,156.00 ","$2,335.44 ","$0.00 ","$3,156.00 ","$1,420.20 ","$0.00 ","$657.79 ","$2,252.44 ","$2,252.44 ","$552.59 ","$3,156.00 ","$0.00 ","$1,578.00 ","$2,499.55 ","$2,524.80 ","$0.00 ","$493.91 ","$0.00 ","$502.44 ","$0.00 "
"27801068","EAP","HCPCS C2625","","Stent Ureteral 8fr 24cm","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$188.10 ","$0.00 ","$87.12 ","$298.33 ","$298.33 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"27801069","EAP","HCPCS C2625","","Stent Ureteral 8fr 22cm","BOTH IP/OP","$398.00 ","$294.52 ","$0.00 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$284.05 ","$284.05 ","$69.69 ","$398.00 ","$0.00 ","$199.00 ","$315.22 ","$318.40 ","$0.00 ","$62.29 ","$0.00 ","$63.36 ","$0.00 "
"27801070","EAP","HCPCS C1876","","80-6.0x40cm Stent","BOTH IP/OP","$5,245.00 ","$3,881.30 ","$0.00 ","$5,245.00 ","$2,360.25 ","$0.00 ","$1,093.19 ","$3,743.36 ","$3,743.36 ","$918.36 ","$5,245.00 ","$0.00 ","$2,622.50 ","$4,154.04 ","$4,196.00 ","$0.00 ","$820.84 ","$0.00 ","$835.00 ","$0.00 "
"27801071","EAP","HCPCS C1880","","Filter Birds Nest Vena Cava Fe","BOTH IP/OP","$3,442.00 ","$2,547.08 ","$0.00 ","$3,442.00 ","$1,548.90 ","$0.00 ","$717.40 ","$2,456.56 ","$2,456.56 ","$602.67 ","$3,442.00 ","$0.00 ","$1,721.00 ","$2,726.06 ","$2,753.60 ","$0.00 ","$538.67 ","$0.00 ","$547.97 ","$0.00 "
"27801072","EAP","HCPCS C1880","","Filter Birds Nest Vena Cava Ju","BOTH IP/OP","$3,442.00 ","$2,547.08 ","$0.00 ","$3,442.00 ","$1,548.90 ","$0.00 ","$717.40 ","$2,456.56 ","$2,456.56 ","$602.67 ","$3,442.00 ","$0.00 ","$1,721.00 ","$2,726.06 ","$2,753.60 ","$0.00 ","$538.67 ","$0.00 ","$547.97 ","$0.00 "
"27801073","EAP","HCPCS C1880","","Filter Gunther-tulip Femoral","BOTH IP/OP","$3,586.00 ","$2,653.64 ","$0.00 ","$3,586.00 ","$1,613.70 ","$0.00 ","$747.41 ","$2,559.33 ","$2,559.33 ","$627.88 ","$3,586.00 ","$0.00 ","$1,793.00 ","$2,840.11 ","$2,868.80 ","$0.00 ","$561.21 ","$0.00 ","$570.89 ","$0.00 "
"27801074","EAP","HCPCS C1880","","Filter Gunther-tulip Jugular","BOTH IP/OP","$3,216.00 ","$2,379.84 ","$0.00 ","$3,216.00 ","$1,447.20 ","$0.00 ","$670.29 ","$2,295.26 ","$2,295.26 ","$563.10 ","$3,216.00 ","$0.00 ","$1,608.00 ","$2,547.07 ","$2,572.80 ","$0.00 ","$503.30 ","$0.00 ","$511.99 ","$0.00 "
"27801075","EAP","HCPCS C1880","","Trapeaze Femoralve","BOTH IP/OP","$4,154.00 ","$3,073.96 ","$0.00 ","$4,154.00 ","$1,869.30 ","$0.00 ","$865.80 ","$2,964.71 ","$2,964.71 ","$727.33 ","$4,154.00 ","$0.00 ","$2,077.00 ","$3,289.97 ","$3,323.20 ","$0.00 ","$650.10 ","$0.00 ","$661.32 ","$0.00 "
"27801076","EAP","HCPCS C1875","","Covered Stent, 5mmx","BOTH IP/OP","$8,174.00 ","$6,048.76 ","$0.00 ","$8,174.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,833.78 ","$0.00 ","$8,174.00 ","$0.00 ","$4,087.00 ","$6,473.81 ","$6,539.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801077","EAP","HCPCS C1874","","Covered Stent, 6mmx","BOTH IP/OP","$8,174.00 ","$6,048.76 ","$0.00 ","$8,174.00 ","$3,678.30 ","$0.00 ","$1,703.67 ","$5,158.80 ","$5,833.78 ","$1,431.20 ","$8,174.00 ","$0.00 ","$4,087.00 ","$6,473.81 ","$6,539.20 ","$0.00 ","$1,279.23 ","$0.00 ","$1,301.30 ","$0.00 "
"27801078","EAP","HCPCS C1874","","Covered Stent, 8mmx","BOTH IP/OP","$8,174.00 ","$6,048.76 ","$0.00 ","$8,174.00 ","$3,678.30 ","$0.00 ","$1,703.67 ","$5,158.80 ","$5,833.78 ","$1,431.20 ","$8,174.00 ","$0.00 ","$4,087.00 ","$6,473.81 ","$6,539.20 ","$0.00 ","$1,279.23 ","$0.00 ","$1,301.30 ","$0.00 "
"27801079","EAP","HCPCS C1874","","Covered Stent, 9mmx","BOTH IP/OP","$8,174.00 ","$6,048.76 ","$0.00 ","$8,174.00 ","$3,678.30 ","$0.00 ","$1,703.67 ","$5,158.80 ","$5,833.78 ","$1,431.20 ","$8,174.00 ","$0.00 ","$4,087.00 ","$6,473.81 ","$6,539.20 ","$0.00 ","$1,279.23 ","$0.00 ","$1,301.30 ","$0.00 "
"27801080","EAP","HCPCS C1874","","Covered Stent, 10mm","BOTH IP/OP","$8,174.00 ","$6,048.76 ","$0.00 ","$8,174.00 ","$3,678.30 ","$0.00 ","$1,703.67 ","$5,158.80 ","$5,833.78 ","$1,431.20 ","$8,174.00 ","$0.00 ","$4,087.00 ","$6,473.81 ","$6,539.20 ","$0.00 ","$1,279.23 ","$0.00 ","$1,301.30 ","$0.00 "
"27801081","EAP","HCPCS C1874","","Covered Stent, 12mm","BOTH IP/OP","$18,351.00 ","$13,579.74 ","$0.00 ","$18,351.00 ","$8,257.95 ","$0.00 ","$3,824.81 ","$5,158.80 ","$13,097.11 ","$3,213.11 ","$18,351.00 ","$0.00 ","$9,175.50 ","$14,533.99 ","$14,680.80 ","$0.00 ","$2,871.93 ","$0.00 ","$2,921.48 ","$0.00 "
"27801082","EAP","HCPCS C1874","","Coil Complex Helica","BOTH IP/OP","$1,287.00 ","$952.38 ","$0.00 ","$1,287.00 ","$579.15 ","$0.00 ","$268.24 ","$918.53 ","$918.53 ","$225.34 ","$1,287.00 ","$0.00 ","$643.50 ","$1,019.30 ","$1,029.60 ","$0.00 ","$201.42 ","$0.00 ","$204.89 ","$0.00 "
"27801083","EAP","HCPCS C1760","","Closure Device Vasc","BOTH IP/OP","$5,062.00 ","$3,745.88 ","$0.00 ","$5,062.00 ","$2,277.90 ","$0.00 ","$1,055.05 ","$3,612.75 ","$3,612.75 ","$886.32 ","$5,062.00 ","$0.00 ","$2,531.00 ","$4,009.10 ","$4,049.60 ","$0.00 ","$792.20 ","$0.00 ","$805.87 ","$0.00 "
"27801084","EAP","HCPCS C1876","","Zilver Stent 10x40","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801085","EAP","HCPCS C1876","","Zilver Stent 10x30","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801086","EAP","HCPCS C1876","","Zilver Stent 8x60","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801087","EAP","HCPCS C1876","","Zilver Stent 8x40","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801088","EAP","HCPCS C1876","","Zilver Stent 8x30","BOTH IP/OP","$3,113.00 ","$2,303.62 ","$0.00 ","$3,113.00 ","$0.00 ","$0.00 ","$648.83 ","$2,221.75 ","$2,221.75 ","$545.06 ","$3,113.00 ","$0.00 ","$1,556.50 ","$2,465.50 ","$2,490.40 ","$0.00 ","$487.18 ","$0.00 ","$495.59 ","$0.00 "
"27801089","EAP","HCPCS C1876","","Zilver Stent 7x40","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801090","EAP","HCPCS C1876","","Zilver Stent 7x30","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801091","EAP","HCPCS C1876","","Zilver Stent 6x40","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801092","EAP","HCPCS C1876","","Zilver Stent 6x30","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27801093","EAP","HCPCS C1760","","Bmrang Cls Device5-","BOTH IP/OP","$5,004.00 ","$3,702.96 ","$0.00 ","$5,004.00 ","$2,251.80 ","$0.00 ","$1,042.96 ","$3,571.35 ","$3,571.35 ","$876.16 ","$5,004.00 ","$0.00 ","$2,502.00 ","$3,963.17 ","$4,003.20 ","$0.00 ","$783.13 ","$0.00 ","$796.64 ","$0.00 "
"27801094","EAP","HCPCS C1760","","Bmrang Cls Dvice 6-","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$50.85 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"27801095","EAP","HCPCS C1760","","6ft Proglide Closur","BOTH IP/OP","$863.00 ","$638.62 ","$0.00 ","$863.00 ","$388.35 ","$0.00 ","$179.87 ","$615.92 ","$615.92 ","$151.10 ","$863.00 ","$0.00 ","$431.50 ","$683.50 ","$690.40 ","$0.00 ","$135.06 ","$0.00 ","$137.39 ","$0.00 "
"27801096","EAP","Custom 27801096","","Coil Microplex 18re","BOTH IP/OP","$2,050.00 ","$1,517.00 ","$0.00 ","$2,050.00 ","$0.00 ","$0.00 ","$0.00 ","$1,463.09 ","$1,463.09 ","$0.00 ","$2,050.00 ","$0.00 ","$1,025.00 ","$1,623.60 ","$1,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801097","EAP","Custom 27801097","","Coil Microplex 18re","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801098","EAP","Custom 27801098","","Coil Microplex 18so","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801099","EAP","Custom 27801099","","Coil Microplex 18so","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801100","EAP","Custom 27801100","","Coil Microplex 18so","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801101","EAP","Custom 27801101","","Coil Microplex 18so","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801102","EAP","Custom 27801102","","Coil Microplex 18so","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801103","EAP","Custom 27801103","","Coil Microplex 18so","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801104","EAP","Custom 27801104","","Coil, Trufill Pusha","BOTH IP/OP","$466.00 ","$344.84 ","$0.00 ","$466.00 ","$0.00 ","$0.00 ","$0.00 ","$332.58 ","$332.58 ","$0.00 ","$466.00 ","$0.00 ","$233.00 ","$369.07 ","$372.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801105","EAP","Custom 27801105","","Coil Trufil Complx","BOTH IP/OP","$466.00 ","$344.84 ","$0.00 ","$466.00 ","$0.00 ","$0.00 ","$0.00 ","$332.58 ","$332.58 ","$0.00 ","$466.00 ","$0.00 ","$233.00 ","$369.07 ","$372.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801106","EAP","Custom 27801106","","Coil Trufil Complex","BOTH IP/OP","$466.00 ","$344.84 ","$0.00 ","$466.00 ","$0.00 ","$0.00 ","$0.00 ","$332.58 ","$332.58 ","$0.00 ","$466.00 ","$0.00 ","$233.00 ","$369.07 ","$372.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801107","EAP","Custom 27801107","","Coil Trufil Complex","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$164.15 ","$164.15 ","$0.00 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801108","EAP","Custom 27801108","","Coil Trufil Embolic","BOTH IP/OP","$7,924.00 ","$5,863.76 ","$0.00 ","$7,924.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,655.36 ","$0.00 ","$7,924.00 ","$0.00 ","$3,962.00 ","$6,275.81 ","$6,339.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801109","EAP","HCPCS C1874","","Wallstent Iliac Spv","BOTH IP/OP","$8,767.00 ","$6,487.58 ","$0.00 ","$8,767.00 ","$3,945.15 ","$0.00 ","$1,827.26 ","$5,158.80 ","$6,257.01 ","$1,535.03 ","$8,767.00 ","$0.00 ","$4,383.50 ","$6,943.46 ","$7,013.60 ","$0.00 ","$1,372.04 ","$0.00 ","$1,395.71 ","$0.00 "
"27801110","EAP","HCPCS C1874","","Stent, Biliary, Pal","BOTH IP/OP","$9,320.00 ","$6,896.80 ","$0.00 ","$9,320.00 ","$4,194.00 ","$0.00 ","$1,942.52 ","$5,158.80 ","$6,651.68 ","$1,631.86 ","$9,320.00 ","$0.00 ","$4,660.00 ","$7,381.44 ","$7,456.00 ","$0.00 ","$1,458.58 ","$0.00 ","$1,483.74 ","$0.00 "
"27801111","EAP","HCPCS C1874","","Wallstent, Tracheob","BOTH IP/OP","$8,767.00 ","$6,487.58 ","$0.00 ","$8,767.00 ","$3,945.15 ","$0.00 ","$1,827.26 ","$5,158.80 ","$6,257.01 ","$1,535.03 ","$8,767.00 ","$0.00 ","$4,383.50 ","$6,943.46 ","$7,013.60 ","$0.00 ","$1,372.04 ","$0.00 ","$1,395.71 ","$0.00 "
"27801112","EAP","HCPCS C1874","","Wallstent, Enteral","BOTH IP/OP","$8,767.00 ","$6,487.58 ","$0.00 ","$8,767.00 ","$3,945.15 ","$0.00 ","$1,827.26 ","$5,158.80 ","$6,257.01 ","$1,535.03 ","$8,767.00 ","$0.00 ","$4,383.50 ","$6,943.46 ","$7,013.60 ","$0.00 ","$1,372.04 ","$0.00 ","$1,395.71 ","$0.00 "
"27801113","EAP","HCPCS C1874","","Viatorr Sents 8mmx6","BOTH IP/OP","$12,472.00 ","$9,229.28 ","$0.00 ","$12,472.00 ","$5,612.40 ","$0.00 ","$2,599.48 ","$5,158.80 ","$8,901.27 ","$2,183.75 ","$12,472.00 ","$0.00 ","$6,236.00 ","$9,877.82 ","$9,977.60 ","$0.00 ","$1,951.87 ","$0.00 ","$1,985.54 ","$0.00 "
"27801114","EAP","HCPCS C1874","","Viatorr Sents 8mmx7","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801115","EAP","HCPCS C1874","","Viatorr Sents 8mmx8","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801116","EAP","HCPCS C1874","","Viatorr Sents 10mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801117","EAP","HCPCS C1874","","Viatorr Sents 10mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801118","EAP","HCPCS C1874","","Viatorr Sents 10mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801119","EAP","HCPCS C1874","","Viatorr Sents 10mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801120","EAP","HCPCS C1874","","Viatorr Sents 10mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801121","EAP","HCPCS C1874","","Viatorr Sents 12mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801122","EAP","HCPCS C1874","","Viatorr Sents 12mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801123","EAP","HCPCS C1874","","Viatorr Sents 12mmx","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801124","EAP","HCPCS C1874","","Viatorr Sents 8mmx4","BOTH IP/OP","$15,988.00 ","$11,831.12 ","$0.00 ","$15,988.00 ","$7,194.60 ","$0.00 ","$3,332.30 ","$5,158.80 ","$11,410.64 ","$2,799.37 ","$15,988.00 ","$0.00 ","$7,994.00 ","$12,662.50 ","$12,790.40 ","$0.00 ","$2,502.12 ","$0.00 ","$2,545.29 ","$0.00 "
"27801125","EAP","HCPCS C1874","","Viatorr Sents 8mmx5","BOTH IP/OP","$16,213.00 ","$11,997.62 ","$0.00 ","$16,213.00 ","$7,295.85 ","$0.00 ","$3,379.19 ","$5,158.80 ","$11,571.22 ","$2,838.77 ","$16,213.00 ","$0.00 ","$8,106.50 ","$12,840.70 ","$12,970.40 ","$0.00 ","$2,537.33 ","$0.00 ","$2,581.11 ","$0.00 "
"27801126","EAP","HCPCS C1876","","Wall Stent 18mmx40m","BOTH IP/OP","$3,972.00 ","$2,939.28 ","$0.00 ","$3,972.00 ","$1,787.40 ","$0.00 ","$827.86 ","$2,834.82 ","$2,834.82 ","$695.47 ","$3,972.00 ","$0.00 ","$1,986.00 ","$3,145.82 ","$3,177.60 ","$0.00 ","$621.62 ","$0.00 ","$632.34 ","$0.00 "
"27801127","EAP","HCPCS C1876","","Wall Stent 16mmx20m","BOTH IP/OP","$3,918.00 ","$2,899.32 ","$0.00 ","$3,918.00 ","$1,763.10 ","$0.00 ","$816.61 ","$2,796.28 ","$2,796.28 ","$686.01 ","$3,918.00 ","$0.00 ","$1,959.00 ","$3,103.06 ","$3,134.40 ","$0.00 ","$613.17 ","$0.00 ","$623.75 ","$0.00 "
"27801128","EAP","HCPCS C1874","","Viabhnend.cov.stent","BOTH IP/OP","$15,609.00 ","$11,550.66 ","$0.00 ","$15,609.00 ","$7,024.05 ","$0.00 ","$3,253.31 ","$5,158.80 ","$11,140.14 ","$2,733.01 ","$15,609.00 ","$0.00 ","$7,804.50 ","$12,362.33 ","$12,487.20 ","$0.00 ","$2,442.81 ","$0.00 ","$2,484.95 ","$0.00 "
"27801129","EAP","HCPCS C1874","","Viabhnend.cov.stent","BOTH IP/OP","$14,496.00 ","$10,727.04 ","$0.00 ","$14,496.00 ","$6,523.20 ","$0.00 ","$3,021.33 ","$5,158.80 ","$10,345.80 ","$2,538.13 ","$14,496.00 ","$0.00 ","$7,248.00 ","$11,480.83 ","$11,596.80 ","$0.00 ","$2,268.62 ","$0.00 ","$2,307.76 ","$0.00 "
"27801130","EAP","HCPCS C1874","","Viabhnend.cov.stent","BOTH IP/OP","$17,381.00 ","$12,861.94 ","$0.00 ","$17,381.00 ","$7,821.45 ","$0.00 ","$3,622.63 ","$5,158.80 ","$12,404.82 ","$3,043.27 ","$17,381.00 ","$0.00 ","$8,690.50 ","$13,765.75 ","$13,904.80 ","$0.00 ","$2,720.13 ","$0.00 ","$2,767.06 ","$0.00 "
"27801131","EAP","HCPCS C1874","","Viabhnend.cov.stent","BOTH IP/OP","$20,235.00 ","$14,973.90 ","$0.00 ","$20,235.00 ","$9,105.75 ","$0.00 ","$4,217.48 ","$5,158.80 ","$14,441.72 ","$3,542.99 ","$20,235.00 ","$0.00 ","$10,117.50 ","$16,026.12 ","$16,188.00 ","$0.00 ","$3,166.78 ","$0.00 ","$3,221.41 ","$0.00 "
"27801134","EAP","HCPCS C1874","","Percut(mmxcm)8x4cov","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801135","EAP","HCPCS C1874","","Percut(mmxcm)8x6cov","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801136","EAP","HCPCS C1874","","Percut(mmxcm)8x8cov","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801137","EAP","HCPCS C1874","","Percut(mmxcm)8x10co","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801138","EAP","HCPCS C1874","","Percut(mmxcm)10x4co","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801139","EAP","HCPCS C1874","","Percut(mmxcm)10x6 C","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801140","EAP","HCPCS C1875","","Percut(mmxcm)10x8 C","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,766.27 ","$0.00 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801141","EAP","HCPCS C1874","","Percut(mmxcm)10x10","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801142","EAP","HCPCS C1874","","Percut(mmxcm)8x6unc","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801143","EAP","HCPCS C1874","","Percut(mmxcm)8x10un","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801144","EAP","HCPCS C1874","","Percut(mmxcm)10x6un","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801145","EAP","HCPCS C1874","","Percut(mmxcm)10x8un","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801146","EAP","HCPCS C1874","","Percut(mmxcm)10x10u","BOTH IP/OP","$13,684.00 ","$10,126.16 ","$0.00 ","$13,684.00 ","$6,157.80 ","$0.00 ","$2,852.09 ","$5,158.80 ","$9,766.27 ","$2,395.96 ","$13,684.00 ","$0.00 ","$6,842.00 ","$10,837.73 ","$10,947.20 ","$0.00 ","$2,141.55 ","$0.00 ","$2,178.49 ","$0.00 "
"27801147","EAP","HCPCS C1874","","Endsc(mmxcm) 8x4 Co","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801148","EAP","HCPCS C1874","","Endsc(mmxcm) 8x6 Co","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801149","EAP","HCPCS C1874","","Endsc(mmxcm) 8x8 Co","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801150","EAP","HCPCS C1874","","Endsc(mmxcm) 8x10 C","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801151","EAP","HCPCS C1874","","Endsc(mmxcm) 10x4 C","BOTH IP/OP","$12,902.00 ","$9,547.48 ","$0.00 ","$12,902.00 ","$5,805.90 ","$0.00 ","$2,689.10 ","$5,158.80 ","$9,208.16 ","$2,259.04 ","$12,902.00 ","$0.00 ","$6,451.00 ","$10,218.38 ","$10,321.60 ","$0.00 ","$2,019.16 ","$0.00 ","$2,054.00 ","$0.00 "
"27801152","EAP","HCPCS C1874","","Endsc (mmxcm) 10x6","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801153","EAP","HCPCS C1874","","Endsc(mmxcm) 10x8 C","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801154","EAP","HCPCS C1874","","Endsc(mmxcm)10x10 C","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801155","EAP","HCPCS C1874","","Endsc(mmxcm) 8x6 Un","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801156","EAP","HCPCS C1874","","Endsc(mmxcm) 8x8 Un","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801157","EAP","HCPCS C1874","","Endsc(mmxcm)8x10 Un","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801158","EAP","HCPCS C1874","","Endsc(mmxcm)10x6 Un","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801159","EAP","HCPCS C1874","","Endsc(mmxcm)10x8 Un","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801160","EAP","HCPCS C1874","","Endsc(mmxcm)10x10un","BOTH IP/OP","$12,810.00 ","$9,479.40 ","$0.00 ","$12,810.00 ","$5,764.50 ","$0.00 ","$2,669.92 ","$5,158.80 ","$9,142.50 ","$2,242.93 ","$12,810.00 ","$0.00 ","$6,405.00 ","$10,145.52 ","$10,248.00 ","$0.00 ","$2,004.77 ","$0.00 ","$2,039.35 ","$0.00 "
"27801161","EAP","HCPCS C1874","","Stent,iliac,wallste","BOTH IP/OP","$6,980.00 ","$5,165.20 ","$0.00 ","$6,980.00 ","$3,141.00 ","$0.00 ","$1,454.81 ","$4,981.63 ","$4,981.63 ","$1,222.14 ","$6,980.00 ","$0.00 ","$3,490.00 ","$5,528.16 ","$5,584.00 ","$0.00 ","$1,092.37 ","$0.00 ","$1,111.22 ","$0.00 "
"27801162","EAP","HCPCS C1880","","Vena Cava Filter","BOTH IP/OP","$4,656.00 ","$3,445.44 ","$0.00 ","$4,656.00 ","$2,095.20 ","$0.00 ","$970.43 ","$3,322.99 ","$3,322.99 ","$815.23 ","$4,656.00 ","$0.00 ","$2,328.00 ","$3,687.55 ","$3,724.80 ","$0.00 ","$728.66 ","$0.00 ","$741.24 ","$0.00 "
"27801163","EAP","HCPCS C1874","","Ste.,bil Memmotherm","BOTH IP/OP","$6,980.00 ","$5,165.20 ","$0.00 ","$6,980.00 ","$3,141.00 ","$0.00 ","$1,454.81 ","$4,981.63 ","$4,981.63 ","$1,222.14 ","$6,980.00 ","$0.00 ","$3,490.00 ","$5,528.16 ","$5,584.00 ","$0.00 ","$1,092.37 ","$0.00 ","$1,111.22 ","$0.00 "
"27801164","EAP","HCPCS C1874","","Ste.,bil Wallstent,","BOTH IP/OP","$5,991.00 ","$4,433.34 ","$0.00 ","$5,991.00 ","$2,695.95 ","$0.00 ","$1,248.67 ","$4,275.78 ","$4,275.78 ","$1,048.98 ","$5,991.00 ","$0.00 ","$2,995.50 ","$4,744.87 ","$4,792.80 ","$0.00 ","$937.59 ","$0.00 ","$953.77 ","$0.00 "
"27801165","EAP","HCPCS C1874","","Ste,bil W/s Rp-20,4","BOTH IP/OP","$5,991.00 ","$4,433.34 ","$0.00 ","$5,991.00 ","$2,695.95 ","$0.00 ","$1,248.67 ","$4,275.78 ","$4,275.78 ","$1,048.98 ","$5,991.00 ","$0.00 ","$2,995.50 ","$4,744.87 ","$4,792.80 ","$0.00 ","$937.59 ","$0.00 ","$953.77 ","$0.00 "
"27801166","EAP","HCPCS C1874","","Ste.,bil Wallstent","BOTH IP/OP","$10,078.00 ","$7,457.72 ","$0.00 ","$10,078.00 ","$4,535.10 ","$0.00 ","$2,100.51 ","$5,158.80 ","$7,192.67 ","$1,764.58 ","$10,078.00 ","$0.00 ","$5,039.00 ","$7,981.78 ","$8,062.40 ","$0.00 ","$1,577.21 ","$0.00 ","$1,604.42 ","$0.00 "
"27801167","EAP","HCPCS C1874","","Ste.,ent W/stent,un","BOTH IP/OP","$10,078.00 ","$7,457.72 ","$0.00 ","$10,078.00 ","$4,535.10 ","$0.00 ","$2,100.51 ","$5,158.80 ","$7,192.67 ","$1,764.58 ","$10,078.00 ","$0.00 ","$5,039.00 ","$7,981.78 ","$8,062.40 ","$0.00 ","$1,577.21 ","$0.00 ","$1,604.42 ","$0.00 "
"27801168","EAP","HCPCS C1874","","St.,wallgraft Unist","BOTH IP/OP","$11,656.00 ","$8,625.44 ","$0.00 ","$11,656.00 ","$5,245.20 ","$0.00 ","$2,429.40 ","$5,158.80 ","$8,318.89 ","$2,040.87 ","$11,656.00 ","$0.00 ","$5,828.00 ","$9,231.55 ","$9,324.80 ","$0.00 ","$1,824.16 ","$0.00 ","$1,855.64 ","$0.00 "
"27801169","EAP","HCPCS C1874","","Ste., W/g Unistep-2","BOTH IP/OP","$11,656.00 ","$8,625.44 ","$0.00 ","$11,656.00 ","$5,245.20 ","$0.00 ","$2,429.40 ","$5,158.80 ","$8,318.89 ","$2,040.87 ","$11,656.00 ","$0.00 ","$5,828.00 ","$9,231.55 ","$9,324.80 ","$0.00 ","$1,824.16 ","$0.00 ","$1,855.64 ","$0.00 "
"27801170","EAP","HCPCS L8670","","Aortic Ext Endopros","BOTH IP/OP","$10,150.00 ","$7,511.00 ","$0.00 ","$10,150.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$7,244.06 ","$0.00 ","$10,150.00 ","$0.00 ","$5,075.00 ","$8,038.80 ","$8,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801171","EAP","Custom 27801171","","Pfo Implant","BOTH IP/OP","$24,270.00 ","$17,959.80 ","$0.00 ","$24,270.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$17,321.50 ","$0.00 ","$24,270.00 ","$0.00 ","$12,135.00 ","$19,221.84 ","$19,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801172","EAP","Custom 27801172","","Asd Implant","BOTH IP/OP","$14,800.00 ","$10,952.00 ","$0.00 ","$14,800.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$10,562.76 ","$0.00 ","$14,800.00 ","$0.00 ","$7,400.00 ","$11,721.60 ","$11,840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801173","EAP","HCPCS C1760","","Closure Device, Vas","BOTH IP/OP","$1,363.00 ","$1,008.62 ","$0.00 ","$1,363.00 ","$613.35 ","$0.00 ","$284.08 ","$972.77 ","$972.77 ","$238.65 ","$1,363.00 ","$0.00 ","$681.50 ","$1,079.50 ","$1,090.40 ","$0.00 ","$213.31 ","$0.00 ","$216.99 ","$0.00 "
"27801190","EAP","HCPCS C1876","","3.0x8mm Vision Rx S","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801191","EAP","HCPCS C1876","","3.5x8mm Vision Rx S","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801192","EAP","HCPCS C1876","","4.0x8mm Vision Rx S","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801193","EAP","HCPCS C1876","","3.0x12mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801194","EAP","HCPCS C1876","","3.5x12mm Vision Rx","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801195","EAP","HCPCS C1876","","4.0x12mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801196","EAP","HCPCS C1876","","3.0x15mm Vision Rx","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801197","EAP","HCPCS C1876","","3.5x15mm Vision Rx","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801198","EAP","HCPCS C1876","","4.0x15mm Vision Rx","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801199","EAP","HCPCS C1876","","3.0x18mm Vision Rx","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801200","EAP","HCPCS C1876","","3.5x18mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801201","EAP","HCPCS C1876","","4.0x18mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801202","EAP","HCPCS C1874","","3.0x23mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801203","EAP","HCPCS C1876","","3.5x23mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801204","EAP","HCPCS C1876","","4.0x23mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801205","EAP","HCPCS C1876","","3.0x28mm Vision Rx","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801206","EAP","HCPCS C1876","","3.5x28mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801207","EAP","HCPCS C1876","","4.0x28mm Vision Rx","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801214","EAP","HCPCS C1874","","3.0 X 12mm Graftmas","BOTH IP/OP","$17,938.00 ","$13,274.12 ","$0.00 ","$17,938.00 ","$8,072.10 ","$0.00 ","$3,738.73 ","$5,158.80 ","$12,802.35 ","$3,140.80 ","$17,938.00 ","$0.00 ","$8,969.00 ","$14,206.90 ","$14,350.40 ","$0.00 ","$2,807.30 ","$0.00 ","$2,855.73 ","$0.00 "
"27801215","EAP","HCPCS C1876","","2.50 X 8mm Mini-vis","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801216","EAP","HCPCS C1876","","2.50 X 12 Mm Mini V","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801217","EAP","HCPCS C1876","","2.5 X 15mm Mini-vis","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801218","EAP","HCPCS C1876","","2.5 X 18mm Mini-vis","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27801219","EAP","HCPCS C1876","","205 X 23mm Mini-vis","BOTH IP/OP","$7,782.00 ","$5,758.68 ","$0.00 ","$7,782.00 ","$3,501.90 ","$0.00 ","$1,621.96 ","$5,158.80 ","$5,554.01 ","$1,362.57 ","$7,782.00 ","$0.00 ","$3,891.00 ","$6,163.34 ","$6,225.60 ","$0.00 ","$1,217.88 ","$0.00 ","$1,238.89 ","$0.00 "
"27801220","EAP","HCPCS C1876","","2.5 X 28mm Mini-vis","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801221","EAP","HCPCS C1874","","3.0 X 12 Graftmaste","BOTH IP/OP","$17,938.00 ","$13,274.12 ","$0.00 ","$17,938.00 ","$8,072.10 ","$0.00 ","$3,738.73 ","$5,158.80 ","$12,802.35 ","$3,140.80 ","$17,938.00 ","$0.00 ","$8,969.00 ","$14,206.90 ","$14,350.40 ","$0.00 ","$2,807.30 ","$0.00 ","$2,855.73 ","$0.00 "
"27801222","EAP","HCPCS C1722","","Lumax 340 Vr Icd Sy","BOTH IP/OP","$49,886.00 ","$36,915.64 ","$0.00 ","$49,886.00 ","$22,448.70 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,603.64 ","$8,138.89 ","$49,886.00 ","$0.00 ","$24,943.00 ","$39,509.71 ","$39,908.80 ","$0.00 ","$7,751.33 ","$0.00 ","$7,941.85 ","$0.00 "
"27801223","EAP","HCPCS C1721","","Intrinsic Dr Dual I","BOTH IP/OP","$10,215.00 ","$7,559.10 ","$0.00 ","$10,215.00 ","$0.00 ","$0.00 ","$2,129.06 ","$5,158.80 ","$7,290.45 ","$1,788.56 ","$10,215.00 ","$0.00 ","$5,107.50 ","$8,090.28 ","$8,172.00 ","$0.00 ","$1,598.65 ","$0.00 ","$1,626.23 ","$0.00 "
"27801224","EAP","HCPCS C1721","","Gem Iii Dr Dual Icd","BOTH IP/OP","$3,890.00 ","$2,878.60 ","$0.00 ","$3,890.00 ","$0.00 ","$0.00 ","$810.77 ","$2,776.29 ","$2,776.29 ","$681.11 ","$3,890.00 ","$0.00 ","$1,945.00 ","$3,080.88 ","$3,112.00 ","$0.00 ","$608.79 ","$0.00 ","$619.29 ","$0.00 "
"27801225","EAP","HCPCS C1722","","Gem Iii Vr Single I","BOTH IP/OP","$11,351.00 ","$8,399.74 ","$0.00 ","$11,351.00 ","$5,107.95 ","$0.00 ","$2,365.83 ","$5,158.80 ","$8,101.21 ","$1,987.47 ","$11,351.00 ","$0.00 ","$5,675.50 ","$8,989.99 ","$9,080.80 ","$0.00 ","$1,776.43 ","$0.00 ","$1,807.08 ","$0.00 "
"27801226","EAP","HCPCS C1721","","Confient He Dual Ic","BOTH IP/OP","$15,364.00 ","$11,369.36 ","$0.00 ","$15,364.00 ","$0.00 ","$0.00 ","$3,202.24 ","$5,158.80 ","$10,965.29 ","$2,690.11 ","$15,364.00 ","$0.00 ","$7,682.00 ","$12,168.29 ","$12,291.20 ","$0.00 ","$2,404.47 ","$0.00 ","$2,445.95 ","$0.00 "
"27801227","EAP","HCPCS C1760","","Angioseal Vasc Clos","BOTH IP/OP","$1,906.00 ","$1,410.44 ","$0.00 ","$1,906.00 ","$857.70 ","$0.00 ","$397.26 ","$1,360.31 ","$1,360.31 ","$333.73 ","$1,906.00 ","$0.00 ","$953.00 ","$1,509.55 ","$1,524.80 ","$0.00 ","$298.29 ","$0.00 ","$303.44 ","$0.00 "
"27801228","EAP","HCPCS C1898","","Setrox S Lead","BOTH IP/OP","$2,869.00 ","$2,123.06 ","$0.00 ","$2,869.00 ","$1,291.05 ","$0.00 ","$597.97 ","$2,047.61 ","$2,047.61 ","$502.34 ","$2,869.00 ","$0.00 ","$1,434.50 ","$2,272.25 ","$2,295.20 ","$0.00 ","$449.00 ","$0.00 ","$456.74 ","$0.00 "
"27801229","EAP","HCPCS C1898","","Selox Sr Lead","BOTH IP/OP","$2,681.00 ","$1,983.94 ","$0.00 ","$2,681.00 ","$1,206.45 ","$0.00 ","$558.79 ","$1,913.43 ","$1,913.43 ","$469.42 ","$2,681.00 ","$0.00 ","$1,340.50 ","$2,123.35 ","$2,144.80 ","$0.00 ","$419.58 ","$0.00 ","$426.82 ","$0.00 "
"27801230","EAP","HCPCS C1722","","Ovatio Vr Single Ic","BOTH IP/OP","$14,505.00 ","$10,733.70 ","$0.00 ","$14,505.00 ","$6,527.25 ","$0.00 ","$3,023.20 ","$5,158.80 ","$10,352.22 ","$2,539.71 ","$14,505.00 ","$0.00 ","$7,252.50 ","$11,487.96 ","$11,604.00 ","$0.00 ","$2,270.03 ","$0.00 ","$2,309.20 ","$0.00 "
"27801231","EAP","HCPCS C1721","","Ovatio Dr Dual Icd","BOTH IP/OP","$61,398.00 ","$45,434.52 ","$0.00 ","$61,398.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,819.75 ","$8,138.89 ","$61,398.00 ","$0.00 ","$30,699.00 ","$48,627.22 ","$49,118.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801232","EAP","HCPCS C1721","","Vitality 2 El Dr Du","BOTH IP/OP","$19,454.00 ","$14,395.96 ","$0.00 ","$19,454.00 ","$0.00 ","$0.00 ","$4,054.70 ","$5,158.80 ","$13,884.32 ","$3,406.24 ","$19,454.00 ","$0.00 ","$9,727.00 ","$15,407.57 ","$15,563.20 ","$0.00 ","$3,044.55 ","$0.00 ","$3,097.08 ","$0.00 "
"27801233","EAP","HCPCS C1721","","Vitality 2 Dr Dual","BOTH IP/OP","$12,969.00 ","$9,597.06 ","$0.00 ","$12,969.00 ","$0.00 ","$0.00 ","$2,703.06 ","$5,158.80 ","$9,255.98 ","$2,270.77 ","$12,969.00 ","$0.00 ","$6,484.50 ","$10,271.45 ","$10,375.20 ","$0.00 ","$2,029.65 ","$0.00 ","$2,064.66 ","$0.00 "
"27801234","EAP","HCPCS C1721","","Vitality Avt Dr Dua","BOTH IP/OP","$19,454.00 ","$14,395.96 ","$0.00 ","$19,454.00 ","$0.00 ","$0.00 ","$4,054.70 ","$5,158.80 ","$13,884.32 ","$3,406.24 ","$19,454.00 ","$0.00 ","$9,727.00 ","$15,407.57 ","$15,563.20 ","$0.00 ","$3,044.55 ","$0.00 ","$3,097.08 ","$0.00 "
"27801235","EAP","HCPCS C1721","","Vitality He Dual Ic","BOTH IP/OP","$3,369.00 ","$2,493.06 ","$0.00 ","$3,369.00 ","$0.00 ","$0.00 ","$702.18 ","$2,404.46 ","$2,404.46 ","$589.88 ","$3,369.00 ","$0.00 ","$1,684.50 ","$2,668.25 ","$2,695.20 ","$0.00 ","$527.25 ","$0.00 ","$536.34 ","$0.00 "
"27801236","EAP","HCPCS C1721","","Vitality El Dual Ic","BOTH IP/OP","$3,243.00 ","$2,399.82 ","$0.00 ","$3,243.00 ","$0.00 ","$0.00 ","$675.92 ","$2,314.53 ","$2,314.53 ","$567.82 ","$3,243.00 ","$0.00 ","$1,621.50 ","$2,568.46 ","$2,594.40 ","$0.00 ","$507.53 ","$0.00 ","$516.29 ","$0.00 "
"27801237","EAP","HCPCS C1721","","Vitality Ds Dr Dual","BOTH IP/OP","$79,815.00 ","$59,063.10 ","$0.00 ","$79,815.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$56,963.97 ","$8,138.89 ","$79,815.00 ","$0.00 ","$39,907.50 ","$63,213.48 ","$63,852.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801238","EAP","HCPCS C1722","","Vitality 2 El Vr Sn","BOTH IP/OP","$3,243.00 ","$2,399.82 ","$0.00 ","$3,243.00 ","$1,459.35 ","$0.00 ","$675.92 ","$2,314.53 ","$2,314.53 ","$567.82 ","$3,243.00 ","$0.00 ","$1,621.50 ","$2,568.46 ","$2,594.40 ","$0.00 ","$507.53 ","$0.00 ","$516.29 ","$0.00 "
"27801239","EAP","HCPCS C1722","","Vitality 2 Vr Sngl","BOTH IP/OP","$79,815.00 ","$59,063.10 ","$0.00 ","$79,815.00 ","$35,916.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$56,963.97 ","$8,138.89 ","$79,815.00 ","$0.00 ","$39,907.50 ","$63,213.48 ","$63,852.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801240","EAP","HCPCS C1722","","Vitality Ds Vr Sngl","BOTH IP/OP","$16,836.00 ","$12,458.64 ","$0.00 ","$16,836.00 ","$7,576.20 ","$0.00 ","$3,509.04 ","$5,158.80 ","$12,015.85 ","$2,947.85 ","$16,836.00 ","$0.00 ","$8,418.00 ","$13,334.11 ","$13,468.80 ","$0.00 ","$2,634.83 ","$0.00 ","$2,680.29 ","$0.00 "
"27801241","EAP","HCPCS C1895","","Reliance G Active F","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$4,378.50 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801242","EAP","HCPCS C1895","","Reliance G Active F","BOTH IP/OP","$10,102.00 ","$7,475.48 ","$0.00 ","$10,102.00 ","$4,545.90 ","$0.00 ","$2,105.51 ","$5,158.80 ","$7,209.80 ","$1,768.78 ","$10,102.00 ","$0.00 ","$5,051.00 ","$8,000.78 ","$8,081.60 ","$0.00 ","$1,580.96 ","$0.00 ","$1,608.24 ","$0.00 "
"27801243","EAP","HCPCS C1895","","Reliance G Passive","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$4,378.50 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801244","EAP","HCPCS C1895","","Reliance G Passive","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$4,378.50 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801245","EAP","HCPCS C1895","","Reliance Active Fix","BOTH IP/OP","$6,985.00 ","$5,168.90 ","$0.00 ","$6,985.00 ","$3,143.25 ","$0.00 ","$1,455.85 ","$4,985.19 ","$4,985.19 ","$1,223.02 ","$6,985.00 ","$0.00 ","$3,492.50 ","$5,532.12 ","$5,588.00 ","$0.00 ","$1,093.15 ","$0.00 ","$1,112.01 ","$0.00 "
"27801246","EAP","HCPCS C1895","","Reliance Active Fix","BOTH IP/OP","$7,253.00 ","$5,367.22 ","$0.00 ","$7,253.00 ","$3,263.85 ","$0.00 ","$1,511.71 ","$5,158.80 ","$5,176.47 ","$1,269.94 ","$7,253.00 ","$0.00 ","$3,626.50 ","$5,744.38 ","$5,802.40 ","$0.00 ","$1,135.09 ","$0.00 ","$1,154.68 ","$0.00 "
"27801247","EAP","HCPCS C1895","","Reliance Passive Fi","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$4,378.50 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801248","EAP","HCPCS C1895","","Reliance Passive Fi","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$4,378.50 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801249","EAP","HCPCS C1721","","Atlas Dr Dual Icd","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$0.00 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801250","EAP","HCPCS C1895","","Riata Dual Coil Lea","BOTH IP/OP","$17,833.00 ","$13,196.42 ","$0.00 ","$17,833.00 ","$8,024.85 ","$0.00 ","$3,716.84 ","$5,158.80 ","$12,727.41 ","$3,122.42 ","$17,833.00 ","$0.00 ","$8,916.50 ","$14,123.74 ","$14,266.40 ","$0.00 ","$2,790.86 ","$0.00 ","$2,839.01 ","$0.00 "
"27801251","EAP","HCPCS C1895","","Riata Dual Coil Lea","BOTH IP/OP","$17,833.00 ","$13,196.42 ","$0.00 ","$17,833.00 ","$8,024.85 ","$0.00 ","$3,716.84 ","$5,158.80 ","$12,727.41 ","$3,122.42 ","$17,833.00 ","$0.00 ","$8,916.50 ","$14,123.74 ","$14,266.40 ","$0.00 ","$2,790.86 ","$0.00 ","$2,839.01 ","$0.00 "
"27801252","EAP","HCPCS C1895","","Riata I Dual Coil L","BOTH IP/OP","$17,833.00 ","$13,196.42 ","$0.00 ","$17,833.00 ","$8,024.85 ","$0.00 ","$3,716.84 ","$5,158.80 ","$12,727.41 ","$3,122.42 ","$17,833.00 ","$0.00 ","$8,916.50 ","$14,123.74 ","$14,266.40 ","$0.00 ","$2,790.86 ","$0.00 ","$2,839.01 ","$0.00 "
"27801253","EAP","HCPCS C1895","","Riata Single Coil L","BOTH IP/OP","$17,833.00 ","$13,196.42 ","$0.00 ","$17,833.00 ","$8,024.85 ","$0.00 ","$3,716.84 ","$5,158.80 ","$12,727.41 ","$3,122.42 ","$17,833.00 ","$0.00 ","$8,916.50 ","$14,123.74 ","$14,266.40 ","$0.00 ","$2,790.86 ","$0.00 ","$2,839.01 ","$0.00 "
"27801254","EAP","HCPCS C1895","","Riata Single Coil L","BOTH IP/OP","$17,833.00 ","$13,196.42 ","$0.00 ","$17,833.00 ","$8,024.85 ","$0.00 ","$3,716.84 ","$5,158.80 ","$12,727.41 ","$3,122.42 ","$17,833.00 ","$0.00 ","$8,916.50 ","$14,123.74 ","$14,266.40 ","$0.00 ","$2,790.86 ","$0.00 ","$2,839.01 ","$0.00 "
"27801255","EAP","HCPCS C1895","","Riata St Dual Coil","BOTH IP/OP","$13,714.00 ","$10,148.36 ","$0.00 ","$13,714.00 ","$6,171.30 ","$0.00 ","$2,858.34 ","$5,158.80 ","$9,787.68 ","$2,401.21 ","$13,714.00 ","$0.00 ","$6,857.00 ","$10,861.49 ","$10,971.20 ","$0.00 ","$2,146.24 ","$0.00 ","$2,183.27 ","$0.00 "
"27801256","EAP","HCPCS C1895","","Riata St Sngl Coil","BOTH IP/OP","$11,221.00 ","$8,303.54 ","$0.00 ","$11,221.00 ","$5,049.45 ","$0.00 ","$2,338.74 ","$5,158.80 ","$8,008.43 ","$1,964.71 ","$11,221.00 ","$0.00 ","$5,610.50 ","$8,887.03 ","$8,976.80 ","$0.00 ","$1,756.09 ","$0.00 ","$1,786.38 ","$0.00 "
"27801257","EAP","HCPCS C1895","","Spl Leads","BOTH IP/OP","$5,189.00 ","$3,839.86 ","$0.00 ","$5,189.00 ","$2,335.05 ","$0.00 ","$1,081.52 ","$3,703.39 ","$3,703.39 ","$908.55 ","$5,189.00 ","$0.00 ","$2,594.50 ","$4,109.69 ","$4,151.20 ","$0.00 ","$812.08 ","$0.00 ","$826.09 ","$0.00 "
"27801258","EAP","HCPCS C1895","","Tvl-adx Leads","BOTH IP/OP","$5,189.00 ","$3,839.86 ","$0.00 ","$5,189.00 ","$2,335.05 ","$0.00 ","$1,081.52 ","$3,703.39 ","$3,703.39 ","$908.55 ","$5,189.00 ","$0.00 ","$2,594.50 ","$4,109.69 ","$4,151.20 ","$0.00 ","$812.08 ","$0.00 ","$826.09 ","$0.00 "
"27801259","EAP","HCPCS C1895","","Bipolar Endocard Pa","BOTH IP/OP","$2,792.00 ","$2,066.08 ","$0.00 ","$2,792.00 ","$1,256.40 ","$0.00 ","$581.92 ","$1,992.65 ","$1,992.65 ","$488.86 ","$2,792.00 ","$0.00 ","$1,396.00 ","$2,211.26 ","$2,233.60 ","$0.00 ","$436.95 ","$0.00 ","$444.49 ","$0.00 "
"27801260","EAP","HCPCS C1721","","Lumax 300 Dr-t Dual","BOTH IP/OP","$3,243.00 ","$2,399.82 ","$0.00 ","$3,243.00 ","$0.00 ","$0.00 ","$675.92 ","$2,314.53 ","$2,314.53 ","$567.82 ","$3,243.00 ","$0.00 ","$1,621.50 ","$2,568.46 ","$2,594.40 ","$0.00 ","$507.53 ","$0.00 ","$516.29 ","$0.00 "
"27801261","EAP","HCPCS C1722","","Lumax 300 Vr-t Sing","BOTH IP/OP","$15,437.00 ","$11,423.38 ","$0.00 ","$15,437.00 ","$6,946.65 ","$0.00 ","$3,217.46 ","$5,158.80 ","$11,017.39 ","$2,702.90 ","$15,437.00 ","$0.00 ","$7,718.50 ","$12,226.10 ","$12,349.60 ","$0.00 ","$2,415.89 ","$0.00 ","$2,457.57 ","$0.00 "
"27801262","EAP","HCPCS C1895","","Riata Lead","BOTH IP/OP","$14,592.00 ","$10,798.08 ","$0.00 ","$14,592.00 ","$6,566.40 ","$0.00 ","$3,041.34 ","$5,158.80 ","$10,414.31 ","$2,554.94 ","$14,592.00 ","$0.00 ","$7,296.00 ","$11,556.86 ","$11,673.60 ","$0.00 ","$2,283.65 ","$0.00 ","$2,323.05 ","$0.00 "
"27801263","EAP","HCPCS C1895","","Riata St Lead","BOTH IP/OP","$14,592.00 ","$10,798.08 ","$0.00 ","$14,592.00 ","$6,566.40 ","$0.00 ","$3,041.34 ","$5,158.80 ","$10,414.31 ","$2,554.94 ","$14,592.00 ","$0.00 ","$7,296.00 ","$11,556.86 ","$11,673.60 ","$0.00 ","$2,283.65 ","$0.00 ","$2,323.05 ","$0.00 "
"27801264","EAP","HCPCS C1777","","Riata St Pkg","BOTH IP/OP","$14,592.00 ","$10,798.08 ","$0.00 ","$14,592.00 ","$6,566.40 ","$0.00 ","$3,041.34 ","$5,158.80 ","$10,414.31 ","$2,554.94 ","$14,592.00 ","$0.00 ","$7,296.00 ","$11,556.86 ","$11,673.60 ","$0.00 ","$2,283.65 ","$0.00 ","$2,323.05 ","$0.00 "
"27801265","EAP","HCPCS C1721","","Atlas Ii Dr Dual Ic","BOTH IP/OP","$9,730.00 ","$7,200.20 ","$0.00 ","$9,730.00 ","$0.00 ","$0.00 ","$2,027.98 ","$5,158.80 ","$6,944.30 ","$1,703.65 ","$9,730.00 ","$0.00 ","$4,865.00 ","$7,706.16 ","$7,784.00 ","$0.00 ","$1,522.75 ","$0.00 ","$1,549.02 ","$0.00 "
"27801266","EAP","HCPCS C1779","","4457 Fineline 11 Le","BOTH IP/OP","$2,973.00 ","$2,200.02 ","$0.00 ","$2,973.00 ","$0.00 ","$0.00 ","$0.00 ","$2,121.83 ","$2,121.83 ","$0.00 ","$2,973.00 ","$0.00 ","$1,486.50 ","$2,354.62 ","$2,378.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801267","EAP","HCPCS C1721","","Teligen Is Vr Sngl","BOTH IP/OP","$61,398.00 ","$45,434.52 ","$0.00 ","$61,398.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,819.75 ","$8,138.89 ","$61,398.00 ","$0.00 ","$30,699.00 ","$48,627.22 ","$49,118.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801268","EAP","HCPCS C1882","","Insync Maximo Dual","BOTH IP/OP","$68,113.00 ","$50,403.62 ","$0.00 ","$68,113.00 ","$30,650.85 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,612.25 ","$8,138.89 ","$68,113.00 ","$0.00 ","$34,056.50 ","$53,945.50 ","$54,490.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801269","EAP","HCPCS C1721","","Ovatio Oh60u Dr 655","BOTH IP/OP","$40,295.00 ","$29,818.30 ","$0.00 ","$40,295.00 ","$0.00 ","$0.00 ","$8,398.49 ","$5,158.80 ","$28,758.54 ","$7,055.33 ","$40,295.00 ","$0.00 ","$20,147.50 ","$31,913.64 ","$32,236.00 ","$0.00 ","$6,306.17 ","$0.00 ","$6,414.96 ","$0.00 "
"27801270","EAP","HCPCS C1722","","Ovatio Oh61u Vr Sys","BOTH IP/OP","$57,559.00 ","$42,593.66 ","$0.00 ","$57,559.00 ","$25,901.55 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,079.86 ","$8,138.89 ","$57,559.00 ","$0.00 ","$28,779.50 ","$45,586.73 ","$46,047.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801271","EAP","HCPCS C1882","","Ovatio Crt 6750 Sys","BOTH IP/OP","$46,048.00 ","$34,075.52 ","$0.00 ","$46,048.00 ","$20,721.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,864.46 ","$8,062.64 ","$46,048.00 ","$0.00 ","$23,024.00 ","$36,470.02 ","$36,838.40 ","$0.00 ","$7,206.51 ","$0.00 ","$7,330.84 ","$0.00 "
"27801272","EAP","HCPCS C1721","","Lumax 340 Dr-t Syst","BOTH IP/OP","$69,071.00 ","$51,112.54 ","$0.00 ","$69,071.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$49,295.97 ","$8,138.89 ","$69,071.00 ","$0.00 ","$34,535.50 ","$54,704.23 ","$55,256.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801273","EAP","HCPCS C1721","","Lumos Dr-t System","BOTH IP/OP","$65,235.00 ","$48,273.90 ","$0.00 ","$65,235.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$46,558.22 ","$8,138.89 ","$65,235.00 ","$0.00 ","$32,617.50 ","$51,666.12 ","$52,188.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801274","EAP","HCPCS C1722","","Lumax 340 Vr-t Syst","BOTH IP/OP","$61,398.00 ","$45,434.52 ","$0.00 ","$61,398.00 ","$27,629.10 ","$0.00 ","$9,417.94 ","$5,158.80 ","$43,819.75 ","$8,138.89 ","$61,398.00 ","$0.00 ","$30,699.00 ","$48,627.22 ","$49,118.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801275","EAP","HCPCS C1722","","Lumos Vr-t System","BOTH IP/OP","$57,559.00 ","$42,593.66 ","$0.00 ","$57,559.00 ","$25,901.55 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,079.86 ","$8,138.89 ","$57,559.00 ","$0.00 ","$28,779.50 ","$45,586.73 ","$46,047.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801276","EAP","HCPCS C1882","","Lumax 340 Hf-t Syst","BOTH IP/OP","$100,923.00 ","$74,683.02 ","$0.00 ","$100,923.00 ","$45,415.35 ","$0.00 ","$9,417.94 ","$5,158.80 ","$72,028.75 ","$8,138.89 ","$100,923.00 ","$0.00 ","$50,461.50 ","$79,931.02 ","$80,738.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801277","EAP","HCPCS C1876","","2.25 X 12mm Mini-vi","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27801278","EAP","HCPCS C1876","","4.5 X 13mm Ultra Rx","BOTH IP/OP","$2,586.00 ","$1,913.64 ","$0.00 ","$2,586.00 ","$1,163.70 ","$0.00 ","$538.99 ","$1,845.63 ","$1,845.63 ","$452.79 ","$2,586.00 ","$0.00 ","$1,293.00 ","$2,048.11 ","$2,068.80 ","$0.00 ","$404.71 ","$0.00 ","$411.69 ","$0.00 "
"27801279","EAP","HCPCS C1876","","4.5 X 18mm Ultra Rx","BOTH IP/OP","$9,175.00 ","$6,789.50 ","$0.00 ","$9,175.00 ","$4,128.75 ","$0.00 ","$1,912.30 ","$5,158.80 ","$6,548.20 ","$1,606.47 ","$9,175.00 ","$0.00 ","$4,587.50 ","$7,266.60 ","$7,340.00 ","$0.00 ","$1,435.89 ","$0.00 ","$1,460.66 ","$0.00 "
"27801280","EAP","HCPCS C1876","","4.5 X 28mm Ultra Rx","BOTH IP/OP","$9,175.00 ","$6,789.50 ","$0.00 ","$9,175.00 ","$4,128.75 ","$0.00 ","$1,912.30 ","$5,158.80 ","$6,548.20 ","$1,606.47 ","$9,175.00 ","$0.00 ","$4,587.50 ","$7,266.60 ","$7,340.00 ","$0.00 ","$1,435.89 ","$0.00 ","$1,460.66 ","$0.00 "
"27801282","EAP","HCPCS C1874","","3.0 X 16mm Graftmas","BOTH IP/OP","$7,990.00 ","$5,912.60 ","$0.00 ","$7,990.00 ","$3,595.50 ","$0.00 ","$1,665.32 ","$5,158.80 ","$5,702.46 ","$1,398.99 ","$7,990.00 ","$0.00 ","$3,995.00 ","$6,328.08 ","$6,392.00 ","$0.00 ","$1,250.44 ","$0.00 ","$1,272.01 ","$0.00 "
"27801283","EAP","HCPCS C1874","","3.5 X 16mm Graftmas","BOTH IP/OP","$7,990.00 ","$5,912.60 ","$0.00 ","$7,990.00 ","$3,595.50 ","$0.00 ","$1,665.32 ","$5,158.80 ","$5,702.46 ","$1,398.99 ","$7,990.00 ","$0.00 ","$3,995.00 ","$6,328.08 ","$6,392.00 ","$0.00 ","$1,250.44 ","$0.00 ","$1,272.01 ","$0.00 "
"27801284","EAP","HCPCS C1776","","2mm Mini Snare","BOTH IP/OP","$1,870.00 ","$1,383.80 ","$0.00 ","$1,870.00 ","$841.50 ","$0.00 ","$389.75 ","$1,334.62 ","$1,334.62 ","$327.42 ","$1,870.00 ","$0.00 ","$935.00 ","$1,481.04 ","$1,496.00 ","$0.00 ","$292.66 ","$0.00 ","$297.70 ","$0.00 "
"27801285","EAP","HCPCS C1776","","4mm Mini Snare","BOTH IP/OP","$1,870.00 ","$1,383.80 ","$0.00 ","$1,870.00 ","$841.50 ","$0.00 ","$389.75 ","$1,334.62 ","$1,334.62 ","$327.42 ","$1,870.00 ","$0.00 ","$935.00 ","$1,481.04 ","$1,496.00 ","$0.00 ","$292.66 ","$0.00 ","$297.70 ","$0.00 "
"27801357","EAP","HCPCS C1874","","Endeavor Sprint Des","BOTH IP/OP","$5,755.00 ","$4,258.70 ","$0.00 ","$5,755.00 ","$2,589.75 ","$0.00 ","$1,199.49 ","$4,107.34 ","$4,107.34 ","$1,007.65 ","$5,755.00 ","$0.00 ","$2,877.50 ","$4,557.96 ","$4,604.00 ","$0.00 ","$900.66 ","$0.00 ","$916.20 ","$0.00 "
"27801367","EAP","HCPCS C1760","","Mynx Vascular Closu","BOTH IP/OP","$5,839.00 ","$4,320.86 ","$0.00 ","$5,839.00 ","$2,627.55 ","$0.00 ","$1,216.99 ","$4,167.29 ","$4,167.29 ","$1,022.36 ","$5,839.00 ","$0.00 ","$2,919.50 ","$4,624.49 ","$4,671.20 ","$0.00 ","$913.80 ","$0.00 ","$929.57 ","$0.00 "
"27801369","EAP","HCPCS C1785","","Philos Ii Dr Pacema","BOTH IP/OP","$11,477.00 ","$8,492.98 ","$0.00 ","$11,477.00 ","$5,164.65 ","$0.00 ","$2,392.09 ","$5,158.80 ","$8,191.13 ","$2,009.53 ","$11,477.00 ","$0.00 ","$5,738.50 ","$9,089.78 ","$9,181.60 ","$0.00 ","$1,796.15 ","$0.00 ","$1,827.14 ","$0.00 "
"27801370","EAP","HCPCS C1882","","Insync Maximo","BOTH IP/OP","$63,656.00 ","$47,105.44 ","$0.00 ","$63,656.00 ","$28,645.20 ","$0.00 ","$9,417.94 ","$5,158.80 ","$45,431.29 ","$8,138.89 ","$63,656.00 ","$0.00 ","$31,828.00 ","$50,415.55 ","$50,924.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801371","EAP","Custom 27801371","","Coil Embl 14cm 3mm .018in Nst 14.9 Loop Sft Radopc","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801372","EAP","Custom 27801372","","Coil Embl 14cm 4mm Nst 11.1 Loop Sft Radopc .018in","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801373","EAP","Custom 27801373","","Coil Embl 14cm 5mm Nst 8.9 Loop Sft Enh Radopc","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801374","EAP","Custom 27801374","","Coil Embl 5cm 2mm Nst 8 Loop Sft Enh Radopc Mciol","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801375","EAP","Custom 27801375","","Coil Embl 5cm 5mm Nst Pltn Synth Fbr Acpt .018in","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801376","EAP","Custom 27801376","","Coil Embl 7cm 10mm Nst 2.2 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801377","EAP","Custom 27801377","","Coil Embl 7cm 2mm Nst 11.1 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801378","EAP","Custom 27801378","","Coil Embl 7cm 5mm Nst 4.5 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801379","EAP","Custom 27801379","","Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801381","EAP","Custom 27801381","","3 CM VERSATILE RNG FILL ADV COILS  1MM-3MM","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801382","EAP","Custom 27801382","","6cm Versatile Rng Fill Adv Coils  3mm-6mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801383","EAP","Custom 27801383","","10cm Versatile Rng Fill Adv Coils  3mm-6mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801384","EAP","Custom 27801384","","15cm Versatile Rng Fill Adv Coils  3mm-6mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801385","EAP","Custom 27801385","","20cm Versatile Rng Fill Adv Coils  6mm-10mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801386","EAP","Custom 27801386","","30cm Versatile Rng Fill Adv Coils  6mm-10mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801387","EAP","Custom 27801387","","30cm Versatile Rng Fill Adv Coils  10mm-15mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801388","EAP","Custom 27801388","","30cm Versatile Rng Fill Adv Coils  10mm-15mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801389","EAP","Custom 27801389","","40cm Versatile Rng Fill Adv Coils  15mm-20mm","BOTH IP/OP","$4,547.00 ","$3,364.78 ","$0.00 ","$4,547.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.19 ","$3,245.19 ","$0.00 ","$4,547.00 ","$0.00 ","$2,273.50 ","$3,601.22 ","$3,637.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801392","EAP","HCPCS C1757","","Catheter Thrombectomy Solitaire 6mm 40mm","BOTH IP/OP","$10,563.00 ","$7,816.62 ","$0.00 ","$10,563.00 ","$4,753.35 ","$0.00 ","$2,201.59 ","$5,158.80 ","$7,538.81 ","$0.00 ","$10,563.00 ","$0.00 ","$5,281.50 ","$8,365.90 ","$8,450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801400","EAP","Custom 27801400","","Coil Embl 7cm 8mm Nst 2.8 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801401","EAP","Custom 27801401","","Coil Embl 7cm 12mm Nst 1.9 Loop .035in Pltn Peri","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801403","EAP","Custom 27801403","","Coil Embl 7cm 14mm Nst 1.6 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801404","EAP","Custom 27801404","","Coil Embl 7cm 16mm Nst 1.4 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801405","EAP","Custom 27801405","","Coil Embl 7cm 18mm Nst 1.2 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801406","EAP","Custom 27801406","","Coil Embl 7cm 20mm Nst 1.1 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801407","EAP","Custom 27801407","","Coil Embl 7cm 5mm Nst Pltn Synth Fbr Acpt .035in","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801409","EAP","Custom 27801409","","Coil Embl 4cm 4-2mm Trnd Mcl Mlfrm Sft .018in Pltn","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801410","EAP","Custom 27801410","","Coil Embl 5cm 5-2mm Trnd Mcl Cath .018in Pltn Strl","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801411","EAP","Custom 27801411","","Coil Embl 9cm 7-3mm Trnd Mlfrm Sft Xsect Ideally","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801412","EAP","HCPCS C1887","","Cath, Sofia 6fr 131cm","BOTH IP/OP","$5,302.00 ","$3,923.48 ","$0.00 ","$5,302.00 ","$2,385.90 ","$0.00 ","$1,105.07 ","$3,784.04 ","$3,784.04 ","$928.34 ","$5,302.00 ","$0.00 ","$2,651.00 ","$4,199.18 ","$4,241.60 ","$0.00 ","$829.76 ","$0.00 ","$844.08 ","$0.00 "
"27801413","EAP","HCPCS C1887","","Cath, Sofia 6fr 125cm","BOTH IP/OP","$5,302.00 ","$3,923.48 ","$0.00 ","$5,302.00 ","$2,385.90 ","$0.00 ","$1,105.07 ","$3,784.04 ","$3,784.04 ","$928.34 ","$5,302.00 ","$0.00 ","$2,651.00 ","$4,199.18 ","$4,241.60 ","$0.00 ","$829.76 ","$0.00 ","$844.08 ","$0.00 "
"27801414","EAP","Custom 27801414","","Plug Cardio 7mm 10mm Amplzr Ntnl Type Ii Dlv Sys","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$0.00 ","$0.00 ","$0.00 ","$1,484.50 ","$1,484.50 ","$0.00 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801415","EAP","Custom 27801415","","Plug Cardio 9mm 12mm Amplzr Ntnl Type Ii Dlv Sys","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$0.00 ","$0.00 ","$0.00 ","$1,484.50 ","$1,484.50 ","$0.00 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801417","EAP","Custom 27801417","","Coil Embl 12.5cm 10-5mm Trnd Sm Std Pltn","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801418","EAP","Custom 27801418","","Coil Embl 5.8cm 6-3mm Trnd Sft .035in Std Sm Pltn","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801419","EAP","Custom 27801419","","Coil Embl 8cm 8-4mm Trnd .035in Std Sm Pltn","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801420","EAP","Custom 27801420","","Coil Embl 8.2cm 8-5mm Trnd Mlfrm Pltn","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801421","EAP","Custom 27801421","","Coil Embl 2cm 1mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801422","EAP","Custom 27801422","","Coil Embl 3cm 1mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801423","EAP","Custom 27801423","","Coil Embl 4cm 1mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801424","EAP","Custom 27801424","","Coil Embl 2cm 1.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801425","EAP","Custom 27801425","","Coil Embl 3cm 1.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801426","EAP","Custom 27801426","","Coil Embl 4cm 1.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801427","EAP","Custom 27801427","","Coil Embl 2cm 2mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801428","EAP","Custom 27801428","","Coil Embl 3cm 2mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801429","EAP","Custom 27801429","","Coil Embl 4cm 2mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801430","EAP","Custom 27801430","","Coil Embl 3cm 2.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801431","EAP","Custom 27801431","","Coil Embl 6cm 2.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801432","EAP","Custom 27801432","","Coil Embl 4cm 3mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801433","EAP","Custom 27801433","","Coil Embl 6cm 3mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801434","EAP","Custom 27801434","","Coil Embl 8cm 3mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801435","EAP","Custom 27801435","","Coil Embl 6cm 3.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801436","EAP","Custom 27801436","","Coil Embl 8cm 3.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801437","EAP","Custom 27801437","","Coil Embl 10cm 3.5mm Axium Prm X Sft 3d","BOTH IP/OP","$3,988.00 ","$2,951.12 ","$0.00 ","$3,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,846.24 ","$2,846.24 ","$0.00 ","$3,988.00 ","$0.00 ","$1,994.00 ","$3,158.50 ","$3,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801438","EAP","Custom 27801438","","Coil Embl 1cm 1mm Axium Prm X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801439","EAP","Custom 27801439","","Coil Embl 2cm 1mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801440","EAP","Custom 27801440","","Coil Embl 3cm 1mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801441","EAP","Custom 27801441","","Coil Embl 1cm 1.5mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801442","EAP","Custom 27801442","","Coil Embl 2cm 1.5mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801443","EAP","Custom 27801443","","Coil Embl 3cm 1.5mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801444","EAP","Custom 27801444","","Coil Embl 4cm 1.5mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801445","EAP","Custom 27801445","","Coil Embl 1cm 2mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801446","EAP","Custom 27801446","","Coil Embl 2cm 2mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801447","EAP","Custom 27801447","","Coil Embl 3cm 2mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801448","EAP","Custom 27801448","","Coil Embl 4cm 2mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801449","EAP","Custom 27801449","","Coil Embl 6cm 2mm Axium Prm X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801450","EAP","HCPCS C1877","","Stent, Non-coat/cov W/o Del","BOTH IP/OP","$12,969.00 ","$9,597.06 ","$0.00 ","$12,969.00 ","$5,836.05 ","$0.00 ","$2,703.06 ","$5,158.80 ","$9,255.98 ","$2,270.77 ","$12,969.00 ","$0.00 ","$6,484.50 ","$10,271.45 ","$10,375.20 ","$0.00 ","$2,029.65 ","$0.00 ","$2,064.66 ","$0.00 "
"27801451","EAP","HCPCS C1876","","Mini Vision Rx 2.75 X 08 Mm Us","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27801452","EAP","HCPCS C1876","","Mini Vision Rx 2.75 X 12 Mm Us","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27801453","EAP","HCPCS C1876","","Mini Vision Rx 2.75 X 15 Mm Us","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27801454","EAP","HCPCS C1876","","Mini Vision Rx 2.75 X 18 Mm Us","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27801455","EAP","HCPCS C1876","","Mini Vision Rx 2.75 X 23 Mm Us","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27801456","EAP","HCPCS C1876","","Mini Vision Rx 2.75 X 28 Mm Us","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"27801457","EAP","HCPCS C1721","","Ilesto Dr-t High Energy With Ti With Landline Hmtachycardia","BOTH IP/OP","$54,233.00 ","$40,132.42 ","$0.00 ","$54,233.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,706.09 ","$8,138.89 ","$54,233.00 ","$0.00 ","$27,116.50 ","$42,952.54 ","$43,386.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801458","EAP","HCPCS C1721","","Ilesto Dr-t High Energy With Ti With Cellular Gsm Hmtachycardia","BOTH IP/OP","$56,934.00 ","$42,131.16 ","$0.00 ","$56,934.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,633.80 ","$8,138.89 ","$56,934.00 ","$0.00 ","$28,467.00 ","$45,091.73 ","$45,547.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801459","EAP","HCPCS C1722","","Ilesto Dx High Energy With Atrial Diagnostics & Ti With Landline Hmtac","BOTH IP/OP","$54,233.00 ","$40,132.42 ","$0.00 ","$54,233.00 ","$24,404.85 ","$0.00 ","$9,417.94 ","$5,158.80 ","$38,706.09 ","$8,138.89 ","$54,233.00 ","$0.00 ","$27,116.50 ","$42,952.54 ","$43,386.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801460","EAP","HCPCS C1722","","Ilesto Dx High Energy With Atrial Diagnostics & Ti With Cellular Gsm H","BOTH IP/OP","$56,934.00 ","$42,131.16 ","$0.00 ","$56,934.00 ","$25,620.30 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,633.80 ","$8,138.89 ","$56,934.00 ","$0.00 ","$28,467.00 ","$45,091.73 ","$45,547.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801461","EAP","HCPCS C1722","","Ilesto Vr-t High Energy With Ti With Landline Hmtachycardia","BOTH IP/OP","$50,182.00 ","$37,134.68 ","$0.00 ","$50,182.00 ","$22,581.90 ","$0.00 ","$9,417.94 ","$5,158.80 ","$35,814.89 ","$8,138.89 ","$50,182.00 ","$0.00 ","$25,091.00 ","$39,744.14 ","$40,145.60 ","$0.00 ","$7,751.33 ","$0.00 ","$7,988.97 ","$0.00 "
"27801462","EAP","HCPCS C1722","","Ilesto Vr-t High Energy With Ti With Cellular Gsm Hmtachycardia","BOTH IP/OP","$52,883.00 ","$39,133.42 ","$0.00 ","$52,883.00 ","$23,797.35 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,742.60 ","$8,138.89 ","$52,883.00 ","$0.00 ","$26,441.50 ","$41,883.34 ","$42,306.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801463","EAP","HCPCS C1895","","Linoxsmart Sd Steroid 60/16tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801464","EAP","HCPCS C1895","","Linoxsmart Sd Steroid 65/16tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801465","EAP","HCPCS C1895","","Linoxsmart Sd Steroid 65/18tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801466","EAP","HCPCS C1895","","Linoxsmart Sd Steroid 75/18tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801467","EAP","HCPCS C1777","","Linoxsmart S Steroid 60tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801468","EAP","HCPCS C1777","","Linoxsmart S Steroid 65tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801469","EAP","HCPCS C1777","","Linoxsmart S Steroid 75tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801470","EAP","HCPCS C1777","","Linoxsmart S Dx 65/15tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801471","EAP","HCPCS C1895","","Linoxsmart Td Steroid 65/16 Cmtachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801472","EAP","HCPCS C1895","","Linoxsmart Td Steroid 65/18 Cmtachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801473","EAP","HCPCS C1777","","Linoxsmart T Steroid 65tachycardialead","BOTH IP/OP","$11,023.00 ","$8,157.02 ","$0.00 ","$11,023.00 ","$4,960.35 ","$0.00 ","$2,297.47 ","$5,158.80 ","$7,867.12 ","$1,930.04 ","$11,023.00 ","$0.00 ","$5,511.50 ","$8,730.22 ","$8,818.40 ","$0.00 ","$1,725.10 ","$0.00 ","$1,754.86 ","$0.00 "
"27801474","EAP","HCPCS C1882","","Ilesto Hf-t High Energy With Ti With Landline Hmcrt Heart Failure","BOTH IP/OP","$65,477.00 ","$48,452.98 ","$0.00 ","$65,477.00 ","$29,464.65 ","$0.00 ","$9,417.94 ","$5,158.80 ","$46,730.93 ","$8,138.89 ","$65,477.00 ","$0.00 ","$32,738.50 ","$51,857.78 ","$52,381.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801475","EAP","HCPCS C1882","","Ilesto Hf-t High Energy With Ti With Cellular Gsm Hmcrt Heart Failure","BOTH IP/OP","$68,178.00 ","$50,451.72 ","$0.00 ","$68,178.00 ","$30,680.10 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,658.64 ","$8,138.89 ","$68,178.00 ","$0.00 ","$34,089.00 ","$53,996.98 ","$54,542.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27801476","EAP","Custom 27801476","","Coil Embl 8cm 2mm Axium Prm X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801478","EAP","Custom 27801478","","Coil Embl 4cm 2.5mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801479","EAP","Custom 27801479","","Coil Embl 6cm 2.5mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801480","EAP","Custom 27801480","","Coil Embl 8cm 2.5mm Axium Prm X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801481","EAP","Custom 27801481","","Coil Embl 4cm 3mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801482","EAP","Custom 27801482","","Coil Embl 6cm 3mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801483","EAP","Custom 27801483","","Coil Embl 8cm 3mm Axium Prm Dtch X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801484","EAP","Custom 27801484","","Coil Embl 10cm 3mm Axium Prm X Sft Hlx","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801486","EAP","Custom 27801486","","Coil Embl 2cm 3mm Mreye 2.1 Loop Pltn A/v Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801487","EAP","Custom 27801487","","Coil Embl 3cm 2mm Mreye 4.8 Loop .035in Pltn Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801488","EAP","Custom 27801488","","Coil Embl 3cm 3mm Mreye 3.1 Loop Pltn A/v Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801489","EAP","Custom 27801489","","Coil Embl 4cm 3mm Mreye 4.2 Loop Pltn A/v Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801490","EAP","Custom 27801490","","Coil Embl 5cm 6mm Mreye 2.7 Loop End Hole Grt Radl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801491","EAP","Custom 27801491","","Coil Embl 5cm 7mm Mreye 2.3 Loop .035in Pltn Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801492","EAP","Custom 27801492","","Coil Embl 5cm 10mm Mreye 1.6 Loop Pltn Acpt .035in","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801493","EAP","Custom 27801493","","Coil Embl 8cm 5mm Mreye 5.1 Loop .035in Pltn Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801494","EAP","HCPCS C1752","","Tray Catheter Power-trialysis Straight L30 Cm Od13","BOTH IP/OP","$693.00 ","$512.82 ","$0.00 ","$693.00 ","$0.00 ","$0.00 ","$0.00 ","$494.59 ","$494.59 ","$0.00 ","$693.00 ","$0.00 ","$346.50 ","$548.86 ","$554.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801495","EAP","Custom 27801495","","Coil Embl 8cm 8mm Mreye 3.2 Loop .035in Pltn Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801496","EAP","Custom 27801496","","Coil Embl 8cm 10mm Mreye 2.5 Loop .035in Pltn Strl","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$139.89 ","$139.89 ","$0.00 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801497","EAP","HCPCS C1788","","Port Implinfn 11.4fr 12fr Vtx Peelpro 2 Dtch Cath","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$0.00 ","$1,455.00 ","$654.75 ","$0.00 ","$303.26 ","$1,038.43 ","$1,038.43 ","$254.76 ","$1,455.00 ","$0.00 ","$727.50 ","$1,152.36 ","$1,164.00 ","$0.00 ","$227.71 ","$0.00 ","$231.64 ","$0.00 "
"27801498","EAP","HCPCS C1757","","Solitaire Catheter Thrombectomy 6x40","BOTH IP/OP","$10,563.00 ","$7,816.62 ","$0.00 ","$10,563.00 ","$4,753.35 ","$0.00 ","$2,201.59 ","$5,158.80 ","$7,538.81 ","$0.00 ","$10,563.00 ","$0.00 ","$5,281.50 ","$8,365.90 ","$8,450.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801499","EAP","HCPCS C1777","","Lead Pcng 62cm Rv Trplr Scr In Xtd-retrac Hlx","BOTH IP/OP","$6,100.00 ","$4,514.00 ","$0.00 ","$6,100.00 ","$2,745.00 ","$0.00 ","$1,271.39 ","$4,353.57 ","$4,353.57 ","$1,068.06 ","$6,100.00 ","$0.00 ","$3,050.00 ","$4,831.20 ","$4,880.00 ","$0.00 ","$954.65 ","$0.00 ","$971.12 ","$0.00 "
"27801500","EAP","Custom 27801500","","Coil Embl .018in 2mm 2cm Azur Cx Hdrcl Dtch Loop S","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801501","EAP","Custom 27801501","","Coil Embl .018in 2mm 4cm Azur Cx Hdrcl Dtch Loop S","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801502","EAP","Custom 27801502","","Coil Embl .018in 3mm 4cm Azur Cx Hdrcl Dtch Loop S","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801503","EAP","Custom 27801503","","Coil Embl .018in 3mm 8cm Azur Cx Hdrcl Dtch Loop S","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801504","EAP","HCPCS C1752","","Catheter Hmdial Lg 12.5fr 16cm Grn Mhrkr Elt Dbl-d","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$127.04 ","$127.04 ","$0.00 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801505","EAP","HCPCS C1752","","Catheter Hmdial Lg 12.5fr 20cm Grn Mhrkr Elt Dbl-d","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$127.04 ","$127.04 ","$0.00 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801507","EAP","HCPCS C1764","","System Crd Monitr Rvl Linq Ins","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801508","EAP","Custom 27801508","","Device Perclose","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801509","EAP","HCPCS C1760","","Device Closure 8fr .038in 70cm Hemostatic Bioabsor","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27801510","EAP","HCPCS C1876","","Stent Vascular Taper 8-6mm 30mm Self Expandable Er","BOTH IP/OP","$6,113.00 ","$4,523.62 ","$0.00 ","$4,841.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,841.50 ","$0.00 ","$0.00 ","$956.68 ","$0.00 ","$0.00 ","$0.00 "
"27801520","EAP","HCPCS C1874","","Stent Eprsth 5mm 5cm Strl 120cm Vbhn Flxb Slf Xpd","BOTH IP/OP","$8,188.00 ","$6,059.12 ","$0.00 ","$8,188.00 ","$3,684.60 ","$0.00 ","$1,706.58 ","$5,158.80 ","$5,843.78 ","$1,433.65 ","$8,188.00 ","$0.00 ","$4,094.00 ","$6,484.90 ","$6,550.40 ","$0.00 ","$1,281.42 ","$0.00 ","$1,303.53 ","$0.00 "
"27801521","EAP","Custom 27801521","","Implant Ep Pack","BOTH IP/OP","$162.00 ","$119.88 ","$0.00 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$115.62 ","$115.62 ","$0.00 ","$162.00 ","$0.00 ","$81.00 ","$128.30 ","$129.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801522","EAP","Custom 27801522","","Coil Embl 15cm 12mm .038in Azur Dtch .035in Pltn","BOTH IP/OP","$2,975.00 ","$2,201.50 ","$0.00 ","$2,975.00 ","$0.00 ","$0.00 ","$0.00 ","$2,123.26 ","$2,123.26 ","$0.00 ","$2,975.00 ","$0.00 ","$1,487.50 ","$2,356.20 ","$2,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801523","EAP","Custom 27801523","","Coil Embl 20cm 10mm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,188.00 ","$2,359.12 ","$0.00 ","$3,188.00 ","$0.00 ","$0.00 ","$0.00 ","$2,275.28 ","$2,275.28 ","$0.00 ","$3,188.00 ","$0.00 ","$1,594.00 ","$2,524.90 ","$2,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801524","EAP","Custom 27801524","","Coil Embl 15cm 15mm Azur Hdrcl 18 Coils Dtch","BOTH IP/OP","$2,127.00 ","$1,573.98 ","$0.00 ","$2,127.00 ","$0.00 ","$0.00 ","$0.00 ","$1,518.04 ","$1,518.04 ","$0.00 ","$2,127.00 ","$0.00 ","$1,063.50 ","$1,684.58 ","$1,701.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801525","EAP","Custom 27801525","","Coil Embl 20cm 10mm Azur Hdrcl 18 Coils Dtch","BOTH IP/OP","$2,249.00 ","$1,664.26 ","$0.00 ","$2,249.00 ","$0.00 ","$0.00 ","$0.00 ","$1,605.11 ","$1,605.11 ","$0.00 ","$2,249.00 ","$0.00 ","$1,124.50 ","$1,781.21 ","$1,799.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801526","EAP","Custom 27801526","","Coil Embl 20cm 8mm .022in Azur Hdrcl Frme 6 Loop","BOTH IP/OP","$1,020.00 ","$754.80 ","$0.00 ","$1,020.00 ","$0.00 ","$0.00 ","$0.00 ","$727.97 ","$727.97 ","$0.00 ","$1,020.00 ","$0.00 ","$510.00 ","$807.84 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801527","EAP","Custom 27801527","","Coil Embl 34cm 14mm Azur Hdrcl Dtch Nonhydrogel","BOTH IP/OP","$2,975.00 ","$2,201.50 ","$0.00 ","$2,975.00 ","$0.00 ","$0.00 ","$0.00 ","$2,123.26 ","$2,123.26 ","$0.00 ","$2,975.00 ","$0.00 ","$1,487.50 ","$2,356.20 ","$2,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801528","EAP","Custom 27801528","","Coil Embl 4mm .018in 15cm  Azur Dtch Pltn","BOTH IP/OP","$2,127.00 ","$1,573.98 ","$0.00 ","$2,127.00 ","$0.00 ","$0.00 ","$0.00 ","$1,518.04 ","$1,518.04 ","$0.00 ","$2,127.00 ","$0.00 ","$1,063.50 ","$1,684.58 ","$1,701.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801529","EAP","Custom 27801529","","Coil Embl 3mm .018in 10cm  Azur Dtch Pltn","BOTH IP/OP","$1,987.00 ","$1,470.38 ","$0.00 ","$1,987.00 ","$0.00 ","$0.00 ","$0.00 ","$1,418.12 ","$1,418.12 ","$0.00 ","$1,987.00 ","$0.00 ","$993.50 ","$1,573.70 ","$1,589.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801530","EAP","Custom 27801530","","Coil Embl 6mm .018in 20cm  Azur Dtch Pltn","BOTH IP/OP","$2,244.00 ","$1,660.56 ","$0.00 ","$2,244.00 ","$0.00 ","$0.00 ","$0.00 ","$1,601.54 ","$1,601.54 ","$0.00 ","$2,244.00 ","$0.00 ","$1,122.00 ","$1,777.25 ","$1,795.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27801531","EAP","Custom 27801531","","Coil Embl 4mm .018in 20cm  Azur Dtch Pltn","BOTH IP/OP","$2,244.00 ","$1,660.56 ","$0.00 ","$2,244.00 ","$0.00 ","$0.00 ","$0.00 ","$1,601.54 ","$1,601.54 ","$0.00 ","$2,244.00 ","$0.00 ","$1,122.00 ","$1,777.25 ","$1,795.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802002","EAP","Custom 27802002","","Coil Embl 14cm 6mm Nst 7.4 Loop Sft Radopc .018in","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802003","EAP","Custom 27802003","","Coil Embl 14cm 8mm Nst 5.6 Loop Sft Radopc .018in","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802004","EAP","Custom 27802004","","Coil Embl 14cm 10mm Nst 4.5 Loop Sft Radopc .018in","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802005","EAP","Custom 27802005","","Coil Embl 14cm 8mm Nst 5.6 Loop Pltn Synth Fbr Art","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802006","EAP","Custom 27802006","","Coil Embl 14cm 10mm Nst 4.5 Loop Sft .035in Pltn","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802008","EAP","Custom 27802008","","Coil Embl 9.5cm 8-4mm Trnd Mcl Mciol Sft Spc Push","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802009","EAP","Custom 27802009","","Coil Embl 4.1cm 5-3mm Trnd Sft .035in Std Sm Pltn","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802010","EAP","Custom 27802010","","Coil Embl 8cm 7-3mm Trnd Pltn Arteriovenous Acpt","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802011","EAP","Custom 27802011","","Coil Embl 14cm 6mm Nst Sft Cath Xtd Embl Endhole","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802012","EAP","Custom 27802012","","Coil Embl 7cm 4mm Nst 5.6 Loop Sft Enh Radopc .035","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802013","EAP","Custom 27802013","","Coil Embolization .035in 10mm 7cm 2.2 Loop Soft Enhanced","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802014","EAP","Custom 27802014","","Coil Embl 14cm 20mm Nst 2.2 Loop Sft Enh Radopc","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802015","EAP","Custom 27802015","","Coil Embl 3cm 2mm Nst 4.8 Loop Sft Enh Radopc","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802016","EAP","Custom 27802016","","Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802017","EAP","Custom 27802017","","Coil Embl 5cm 3mm Nst 5.3 Loop Sft Enh Radopc","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$163.44 ","$163.44 ","$0.00 ","$229.00 ","$0.00 ","$114.50 ","$181.37 ","$183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802018","EAP","Custom 27802018","","Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc .035","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802020","EAP","Custom 27802020","","Coil Embl 14cm 16mm Nst 2.8 Loop Sft Xtd Enh","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802021","EAP","Custom 27802021","","Coil Embl 7cm 3mm Nst 7.4 Loop Sft Enh Radopc","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802022","EAP","Custom 27802022","","Coil Embl 7cm 4mm .018in Nst Cath Loop Sft Str Wg","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802023","EAP","Custom 27802023","","Coil Embl 2cm 3-2mm Trnd Mciol Mlfrm Sft .018in","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$192.70 ","$192.70 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802024","EAP","Custom 27802024","","Coil Embl 7cm 3mm Nst 7.4 Loop Pltn Synth Fbr Strl","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$0.00 ","$0.00 ","$0.00 ","$177.71 ","$177.71 ","$0.00 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27802025","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d","BOTH IP/OP","$42,750.00 ","$31,635.00 ","$0.00 ","$42,750.00 ","$19,237.50 ","$0.00 ","$8,910.17 ","$5,158.80 ","$30,510.68 ","$7,485.18 ","$42,750.00 ","$0.00 ","$21,375.00 ","$33,858.00 ","$34,200.00 ","$0.00 ","$6,690.38 ","$0.00 ","$6,805.80 ","$0.00 "
"27802026","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d Df4 Connector","BOTH IP/OP","$42,750.00 ","$31,635.00 ","$0.00 ","$42,750.00 ","$19,237.50 ","$0.00 ","$8,910.17 ","$5,158.80 ","$30,510.68 ","$7,485.18 ","$42,750.00 ","$0.00 ","$21,375.00 ","$33,858.00 ","$34,200.00 ","$0.00 ","$6,690.38 ","$0.00 ","$6,805.80 ","$0.00 "
"27802027","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d, Merlinpkg","BOTH IP/OP","$43,875.00 ","$32,467.50 ","$0.00 ","$43,875.00 ","$19,743.75 ","$0.00 ","$9,144.65 ","$5,158.80 ","$31,313.59 ","$7,682.16 ","$43,875.00 ","$0.00 ","$21,937.50 ","$34,749.00 ","$35,100.00 ","$0.00 ","$6,866.44 ","$0.00 ","$6,984.90 ","$0.00 "
"27802028","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d Df4, Merlinpkg","BOTH IP/OP","$43,875.00 ","$32,467.50 ","$0.00 ","$43,875.00 ","$19,743.75 ","$0.00 ","$9,144.65 ","$5,158.80 ","$31,313.59 ","$7,682.16 ","$43,875.00 ","$0.00 ","$21,937.50 ","$34,749.00 ","$35,100.00 ","$0.00 ","$6,866.44 ","$0.00 ","$6,984.90 ","$0.00 "
"27802029","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d System","BOTH IP/OP","$56,250.00 ","$41,625.00 ","$0.00 ","$56,250.00 ","$25,312.50 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,145.63 ","$8,138.89 ","$56,250.00 ","$0.00 ","$28,125.00 ","$44,550.00 ","$45,000.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27802030","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d Df4 Connector System","BOTH IP/OP","$56,250.00 ","$41,625.00 ","$0.00 ","$56,250.00 ","$25,312.50 ","$0.00 ","$9,417.94 ","$5,158.80 ","$40,145.63 ","$8,138.89 ","$56,250.00 ","$0.00 ","$28,125.00 ","$44,550.00 ","$45,000.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27802031","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d System, Merlinpkg","BOTH IP/OP","$58,500.00 ","$43,290.00 ","$0.00 ","$58,500.00 ","$26,325.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,751.45 ","$8,138.89 ","$58,500.00 ","$0.00 ","$29,250.00 ","$46,332.00 ","$46,800.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27802032","EAP","HCPCS C1882","","Quadra Assura Mp Crt-d Df4 System, Merlinpkg","BOTH IP/OP","$58,500.00 ","$43,290.00 ","$0.00 ","$58,500.00 ","$26,325.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,751.45 ","$8,138.89 ","$58,500.00 ","$0.00 ","$29,250.00 ","$46,332.00 ","$46,800.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27802033","EAP","HCPCS C1900","","Quartet, Small-s 75cm","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$3,836.14 ","$3,836.14 ","$0.00 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$0.00 ","$0.00 "
"27802034","EAP","HCPCS C1900","","Quartet, Small-s 86cm","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$3,836.14 ","$3,836.14 ","$0.00 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$0.00 ","$0.00 "
"27802035","EAP","HCPCS C1900","","Quartet, Wide Spacing 75cm","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$3,836.14 ","$3,836.14 ","$0.00 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$0.00 ","$0.00 "
"27802036","EAP","HCPCS C1900","","Quartet, Wide Spacing 86cm","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$3,836.14 ","$3,836.14 ","$0.00 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$0.00 ","$0.00 "
"27802040","EAP","HCPCS C1874","","Stent Vasc 80mm 6mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802041","EAP","HCPCS C1874","","Stent Vasc 60mm 5mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802042","EAP","HCPCS C1874","","Stent Vasc 80mm 5mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802044","EAP","HCPCS C1874","","Stent Vasc 40mm 6mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802045","EAP","HCPCS C1874","","Stent Vasc 60mm 6mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802046","EAP","HCPCS C1874","","Stent Coron 40mm 5mm Gore Tigris Vasc Cbas Ntnl","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802047","EAP","HCPCS C1874","","Stent Vasc 100mm 6mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802048","EAP","HCPCS C1874","","Stent Vasc 40mm 7mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802050","EAP","HCPCS C1874","","Stent Vasc 80mm 7mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27802051","EAP","HCPCS C1874","","Stent Vasc 100mm 7mm Gore Tigris Cbas Ntnl Flplmr","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"27803013","EAP","HCPCS C1781","","Mesh Implt","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$135.48 ","$463.91 ","$463.91 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"27803015","EAP","Custom 27803015","","Coil Embolization .018in Standard Length 2d 2mm 4c","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$943.00 ","$0.00 ","$0.00 ","$0.00 ","$673.02 ","$673.02 ","$0.00 ","$943.00 ","$0.00 ","$471.50 ","$746.86 ","$754.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803030","EAP","HCPCS C1897","","Sjm Percutaneous Lead","BOTH IP/OP","$2,869.00 ","$2,123.06 ","$0.00 ","$2,869.00 ","$0.00 ","$0.00 ","$0.00 ","$2,047.61 ","$2,047.61 ","$0.00 ","$2,869.00 ","$0.00 ","$1,434.50 ","$2,272.25 ","$2,295.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803050","EAP","Custom 27803050","","Biliary Metal Stents","BOTH IP/OP","$5,087.00 ","$3,764.38 ","$0.00 ","$5,087.00 ","$0.00 ","$0.00 ","$0.00 ","$3,630.59 ","$3,630.59 ","$0.00 ","$5,087.00 ","$0.00 ","$2,543.50 ","$4,028.90 ","$4,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803051","EAP","Custom 27803051","","Ultraflex Diamond Metal Stent","BOTH IP/OP","$9,045.00 ","$6,693.30 ","$0.00 ","$9,045.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,455.42 ","$0.00 ","$9,045.00 ","$0.00 ","$4,522.50 ","$7,163.64 ","$7,236.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803052","EAP","Custom 27803052","","Polyflex Esophageal Stent","BOTH IP/OP","$13,618.00 ","$10,077.32 ","$0.00 ","$13,618.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,719.17 ","$0.00 ","$13,618.00 ","$0.00 ","$6,809.00 ","$10,785.46 ","$10,894.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803053","EAP","Custom 27803053","","Stent Coron 8mm 2.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$0.00 ","$0.00 ","$0.00 ","$2,587.16 ","$2,587.16 ","$0.00 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803055","EAP","HCPCS C1874","","Stent Coron 12mm 2.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803056","EAP","HCPCS C1874","","Stent Coron 18mm 2.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803057","EAP","HCPCS C1874","","Stent Coron 23mm 2.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803058","EAP","HCPCS C1874","","Stent Coron 28mm 2.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803059","EAP","HCPCS C1874","","Stent Coron 8mm 3mm Abs Gt1 Poly L Lactd Pld Lactd","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803061","EAP","HCPCS C1874","","Stent Coron 12mm 3mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803062","EAP","HCPCS C1874","","Stent Coron 18mm 3mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803063","EAP","HCPCS C1874","","Stent Coron 23mm 3mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803064","EAP","HCPCS C1874","","Stent Coron 28mm 3mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803065","EAP","HCPCS C1874","","Stent Coron 12mm 3.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803066","EAP","HCPCS C1874","","Stent Coron 18mm 3.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803067","EAP","HCPCS C1874","","Stent Coron 23mm 3.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803068","EAP","HCPCS C1874","","Stent Coron 28mm 3.5mm Abs Gt1 Poly L Lactd Pld","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$2,587.16 ","$2,587.16 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"27803070","EAP","Custom 27803070","","Rx Stent 7x5 Cm","BOTH IP/OP","$169.00 ","$125.06 ","$0.00 ","$169.00 ","$0.00 ","$0.00 ","$0.00 ","$120.62 ","$120.62 ","$0.00 ","$169.00 ","$0.00 ","$84.50 ","$133.85 ","$135.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803071","EAP","Custom 27803071","","Rx Stent 7x7 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803072","EAP","Custom 27803072","","Rx Stent 7x12 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803073","EAP","Custom 27803073","","Rx Stent 10x5","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803074","EAP","Custom 27803074","","Rx Stent 10x7cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803075","EAP","Custom 27803075","","Rx Stent 10x10 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803076","EAP","Custom 27803076","","Rx Stent 10x12 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803077","EAP","Custom 27803077","","Rx Stent 8.5 X5 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803078","EAP","Custom 27803078","","Rx Stent 8.5 X7cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803079","EAP","Custom 27803079","","Rx Stent 8.5 X 10cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803080","EAP","Custom 27803080","","Rx Stent 8.5x12 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803081","EAP","Custom 27803081","","Rx Stent 7x10 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$0.00 ","$0.00 ","$0.00 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803082","EAP","HCPCS C1874","","Graft Evas 74mm 24mm 16fr Znth Sprlz Z-trk Abd","BOTH IP/OP","$7,713.00 ","$5,707.62 ","$0.00 ","$7,713.00 ","$3,470.85 ","$0.00 ","$1,607.58 ","$5,158.80 ","$5,504.77 ","$1,350.48 ","$7,713.00 ","$0.00 ","$3,856.50 ","$6,108.70 ","$6,170.40 ","$0.00 ","$1,207.08 ","$0.00 ","$1,227.91 ","$0.00 "
"27803083","EAP","HCPCS C1874","","Graft Evas 56mm 24mm 6mm 5.3mm Znth Sprlz Aaa Ilc","BOTH IP/OP","$7,713.00 ","$5,707.62 ","$0.00 ","$7,713.00 ","$3,470.85 ","$0.00 ","$1,607.58 ","$5,158.80 ","$5,504.77 ","$1,350.48 ","$7,713.00 ","$0.00 ","$3,856.50 ","$6,108.70 ","$6,170.40 ","$0.00 ","$1,207.08 ","$0.00 ","$1,227.91 ","$0.00 "
"27803090","EAP","HCPCS C1777","","7120 Durata Pkg Lead","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27803091","EAP","HCPCS C1777","","7121 Durata Pkg Lead","BOTH IP/OP","$15,063.00 ","$11,146.62 ","$0.00 ","$15,063.00 ","$6,778.35 ","$0.00 ","$3,139.51 ","$5,158.80 ","$10,750.46 ","$2,637.41 ","$15,063.00 ","$0.00 ","$7,531.50 ","$11,929.90 ","$12,050.40 ","$0.00 ","$2,357.36 ","$0.00 ","$2,398.03 ","$0.00 "
"27803092","EAP","HCPCS C1874","","Wallflex Esop Pcoverdstent Spv","BOTH IP/OP","$9,055.00 ","$6,700.70 ","$0.00 ","$9,055.00 ","$4,074.75 ","$0.00 ","$1,887.29 ","$5,158.80 ","$6,462.55 ","$1,585.46 ","$9,055.00 ","$0.00 ","$4,527.50 ","$7,171.56 ","$7,244.00 ","$0.00 ","$1,417.11 ","$0.00 ","$1,441.56 ","$0.00 "
"27803093","EAP","HCPCS C1896","","Subcutaneous Ld System 6996-sq","BOTH IP/OP","$8,967.00 ","$6,635.58 ","$0.00 ","$8,967.00 ","$0.00 ","$0.00 ","$1,868.95 ","$5,158.80 ","$6,399.75 ","$0.00 ","$8,967.00 ","$0.00 ","$4,483.50 ","$7,101.86 ","$7,173.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803094","EAP","HCPCS C1877","","Transhepatic Biliary Stent Spv","BOTH IP/OP","$6,456.00 ","$4,777.44 ","$0.00 ","$6,456.00 ","$2,905.20 ","$0.00 ","$1,345.59 ","$4,607.65 ","$4,607.65 ","$1,130.39 ","$6,456.00 ","$0.00 ","$3,228.00 ","$5,113.15 ","$5,164.80 ","$0.00 ","$1,010.36 ","$0.00 ","$1,027.80 ","$0.00 "
"27803095","EAP","HCPCS C1897","","Lead, Neurostim Test Kit","BOTH IP/OP","$3,411.00 ","$2,524.14 ","$0.00 ","$3,411.00 ","$0.00 ","$0.00 ","$0.00 ","$2,434.43 ","$2,434.43 ","$0.00 ","$3,411.00 ","$0.00 ","$1,705.50 ","$2,701.51 ","$2,728.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803096","EAP","HCPCS C1725","","Pta Dilatation Catheter 18 Spv","BOTH IP/OP","$1,435.00 ","$1,061.90 ","$0.00 ","$1,435.00 ","$645.75 ","$0.00 ","$299.09 ","$1,024.16 ","$1,024.16 ","$251.26 ","$1,435.00 ","$0.00 ","$717.50 ","$1,136.52 ","$1,148.00 ","$0.00 ","$224.58 ","$0.00 ","$228.45 ","$0.00 "
"27803097","EAP","HCPCS C1725","","Pta Dilatation Catheter 16 Spv","BOTH IP/OP","$1,435.00 ","$1,061.90 ","$0.00 ","$1,435.00 ","$645.75 ","$0.00 ","$299.09 ","$1,024.16 ","$1,024.16 ","$251.26 ","$1,435.00 ","$0.00 ","$717.50 ","$1,136.52 ","$1,148.00 ","$0.00 ","$224.58 ","$0.00 ","$228.45 ","$0.00 "
"27803098","EAP","HCPCS C1880","","80078352 - Filter Option Ivc","BOTH IP/OP","$1,429.00 ","$1,057.46 ","$0.00 ","$1,429.00 ","$643.05 ","$0.00 ","$297.84 ","$1,019.88 ","$1,019.88 ","$250.21 ","$1,429.00 ","$0.00 ","$714.50 ","$1,131.77 ","$1,143.20 ","$0.00 ","$223.64 ","$0.00 ","$227.50 ","$0.00 "
"27803099","EAP","HCPCS A4301","","Femoral Arterial Line Kit","BOTH IP/OP","$972.00 ","$719.28 ","$0.00 ","$972.00 ","$0.00 ","$0.00 ","$0.00 ","$693.72 ","$693.72 ","$0.00 ","$972.00 ","$0.00 ","$486.00 ","$769.82 ","$777.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803100","EAP","HCPCS C2625","","Rx Stent 7x5 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803101","EAP","HCPCS C2625","","Rx Stent 7x7 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803102","EAP","HCPCS C2625","","Rx Stent 7x10 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803103","EAP","HCPCS C2625","","Rx Stent 7x12 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803104","EAP","HCPCS C2625","","Rx Stent 10x5","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803105","EAP","HCPCS C2625","","Rx Stent 10x7cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803106","EAP","HCPCS C2625","","Rx Stent 10x10 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803107","EAP","HCPCS C2625","","Rx Stent 10x12 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803108","EAP","HCPCS C2625","","Rx Stent 8.5 X5 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803109","EAP","HCPCS C2625","","Rx Stent 8.5 X7cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803110","EAP","HCPCS C2625","","Rx Stent 8.5 X 10cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803111","EAP","HCPCS C2625","","Rx Stent 8.5x12 Cm","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$72.45 ","$0.00 ","$33.56 ","$114.91 ","$114.91 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"27803152","EAP","HCPCS C1760","","Starclose Se","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$129.60 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"27803160","EAP","HCPCS C2625","","3.0 Xmm Vision Rx Stent","BOTH IP/OP","$4,987.00 ","$3,690.38 ","$0.00 ","$4,987.00 ","$2,244.15 ","$0.00 ","$1,039.42 ","$3,559.22 ","$3,559.22 ","$873.18 ","$4,987.00 ","$0.00 ","$2,493.50 ","$3,949.70 ","$3,989.60 ","$0.00 ","$780.47 ","$0.00 ","$793.93 ","$0.00 "
"27803161","EAP","HCPCS C2625","","2.50 X 8mm Mini-vision Stent","BOTH IP/OP","$4,987.00 ","$3,690.38 ","$0.00 ","$4,987.00 ","$2,244.15 ","$0.00 ","$1,039.42 ","$3,559.22 ","$3,559.22 ","$873.18 ","$4,987.00 ","$0.00 ","$2,493.50 ","$3,949.70 ","$3,989.60 ","$0.00 ","$780.47 ","$0.00 ","$793.93 ","$0.00 "
"27803162","EAP","Custom 27803162","","Lc Bead 500-700","BOTH IP/OP","$4,654.00 ","$3,443.96 ","$0.00 ","$4,654.00 ","$0.00 ","$0.00 ","$0.00 ","$3,321.56 ","$3,321.56 ","$0.00 ","$4,654.00 ","$0.00 ","$2,327.00 ","$3,685.97 ","$3,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803163","EAP","Custom 27803163","","Lc Bead 300-500","BOTH IP/OP","$4,654.00 ","$3,443.96 ","$0.00 ","$4,654.00 ","$0.00 ","$0.00 ","$0.00 ","$3,321.56 ","$3,321.56 ","$0.00 ","$4,654.00 ","$0.00 ","$2,327.00 ","$3,685.97 ","$3,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803164","EAP","HCPCS C1880","","80078352 - Filter Option Ivc","BOTH IP/OP","$1,429.00 ","$1,057.46 ","$0.00 ","$1,429.00 ","$643.05 ","$0.00 ","$297.84 ","$1,019.88 ","$1,019.88 ","$250.21 ","$1,429.00 ","$0.00 ","$714.50 ","$1,131.77 ","$1,143.20 ","$0.00 ","$223.64 ","$0.00 ","$227.50 ","$0.00 "
"27803172","EAP","HCPCS C1874","","Vbh081502 Catheter Viabahn 8mm","BOTH IP/OP","$5,107.00 ","$3,779.18 ","$0.00 ","$5,107.00 ","$2,298.15 ","$0.00 ","$1,064.43 ","$3,644.87 ","$3,644.87 ","$894.19 ","$5,107.00 ","$0.00 ","$2,553.50 ","$4,044.74 ","$4,085.60 ","$0.00 ","$799.25 ","$0.00 ","$813.03 ","$0.00 "
"27803173","EAP","HCPCS C1874","","Vbh071502 Catheter Viabahn 8mm","BOTH IP/OP","$5,107.00 ","$3,779.18 ","$0.00 ","$5,107.00 ","$2,298.15 ","$0.00 ","$1,064.43 ","$3,644.87 ","$3,644.87 ","$894.19 ","$5,107.00 ","$0.00 ","$2,553.50 ","$4,044.74 ","$4,085.60 ","$0.00 ","$799.25 ","$0.00 ","$813.03 ","$0.00 "
"27803184","EAP","HCPCS C1894","","9fr-30 Tear-away Introducer","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$260.55 ","$0.00 ","$120.68 ","$413.23 ","$413.23 ","$101.38 ","$579.00 ","$0.00 ","$289.50 ","$458.57 ","$463.20 ","$0.00 ","$90.61 ","$0.00 ","$92.18 ","$0.00 "
"27803185","EAP","HCPCS C1894","","10fr-30cm Tear Away Introducer","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$260.55 ","$0.00 ","$120.68 ","$413.23 ","$413.23 ","$101.38 ","$579.00 ","$0.00 ","$289.50 ","$458.57 ","$463.20 ","$0.00 ","$90.61 ","$0.00 ","$92.18 ","$0.00 "
"27803186","EAP","HCPCS C1894","","16fr-3ocm Tear-away Introducer","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$260.55 ","$0.00 ","$120.68 ","$413.23 ","$413.23 ","$101.38 ","$579.00 ","$0.00 ","$289.50 ","$458.57 ","$463.20 ","$0.00 ","$90.61 ","$0.00 ","$92.18 ","$0.00 "
"27803187","EAP","HCPCS C1769","","Wire Guide Lunderquist Extra S","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$347.00 ","$156.15 ","$0.00 ","$72.32 ","$247.65 ","$247.65 ","$60.76 ","$347.00 ","$0.00 ","$173.50 ","$274.82 ","$277.60 ","$0.00 ","$54.31 ","$0.00 ","$55.24 ","$0.00 "
"27803188","EAP","HCPCS C1894","","Sheath Prelude","BOTH IP/OP","$277.00 ","$204.98 ","$0.00 ","$277.00 ","$124.65 ","$0.00 ","$57.73 ","$197.69 ","$197.69 ","$48.50 ","$277.00 ","$0.00 ","$138.50 ","$219.38 ","$221.60 ","$0.00 ","$43.35 ","$0.00 ","$44.10 ","$0.00 "
"27803189","EAP","HCPCS C2625","","3.0 X 8mm Vision Rx Stent","BOTH IP/OP","$2,920.00 ","$2,160.80 ","$0.00 ","$2,920.00 ","$1,314.00 ","$0.00 ","$608.60 ","$2,084.00 ","$2,084.00 ","$511.27 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$456.98 ","$0.00 ","$464.86 ","$0.00 "
"27803190","EAP","HCPCS C2625","","2.50 X 8mm Mini-vision Stent","BOTH IP/OP","$3,836.00 ","$2,838.64 ","$0.00 ","$3,836.00 ","$1,726.20 ","$0.00 ","$799.52 ","$2,737.75 ","$2,737.75 ","$671.65 ","$3,836.00 ","$0.00 ","$1,918.00 ","$3,038.11 ","$3,068.80 ","$0.00 ","$600.33 ","$0.00 ","$610.69 ","$0.00 "
"27803191","EAP","Custom 27803191","","Lc Bead 500-700","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$0.00 ","$0.00 ","$0.00 ","$952.79 ","$952.79 ","$0.00 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803192","EAP","HCPCS C1876","","Stent Microdelive Wingspan 4 1","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803193","EAP","HCPCS C1876","","Stent Microdelive Wingspan 4 2","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803194","EAP","HCPCS C1876","","Stent Microdelive Wingspan 3 1","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803195","EAP","HCPCS C1876","","Stent Microdelive Wingspan 3 2","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803196","EAP","HCPCS C1876","","Stent Microdelivery 3.0 X 15.0","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803197","EAP","HCPCS C1876","","Stent Microdelive Wingspan 3 3","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803198","EAP","HCPCS C1876","","Stent Microdelivery Wingspan","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803199","EAP","HCPCS C1876","","Stent Mircrodelivery Wingspan2","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$9,180.00 ","$0.00 ","$4,251.87 ","$5,158.80 ","$14,559.48 ","$3,571.88 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$3,192.60 ","$0.00 ","$3,247.68 ","$0.00 "
"27803200","EAP","HCPCS C1876","","Stent Microdelivery 4.5x30mm","BOTH IP/OP","$19,181.00 ","$14,193.94 ","$0.00 ","$19,181.00 ","$8,631.45 ","$0.00 ","$3,997.80 ","$5,158.80 ","$13,689.48 ","$3,358.44 ","$19,181.00 ","$0.00 ","$9,590.50 ","$15,191.35 ","$15,344.80 ","$0.00 ","$3,001.83 ","$0.00 ","$3,053.62 ","$0.00 "
"27803201","EAP","HCPCS C1876","","Stent Microdelivery 4.5x20mm","BOTH IP/OP","$19,181.00 ","$14,193.94 ","$0.00 ","$19,181.00 ","$8,631.45 ","$0.00 ","$3,997.80 ","$5,158.80 ","$13,689.48 ","$3,358.44 ","$19,181.00 ","$0.00 ","$9,590.50 ","$15,191.35 ","$15,344.80 ","$0.00 ","$3,001.83 ","$0.00 ","$3,053.62 ","$0.00 "
"27803202","EAP","HCPCS C1876","","Stent Micrdelivery 4.0 X20mm","BOTH IP/OP","$19,181.00 ","$14,193.94 ","$0.00 ","$19,181.00 ","$8,631.45 ","$0.00 ","$3,997.80 ","$5,158.80 ","$13,689.48 ","$3,358.44 ","$19,181.00 ","$0.00 ","$9,590.50 ","$15,191.35 ","$15,344.80 ","$0.00 ","$3,001.83 ","$0.00 ","$3,053.62 ","$0.00 "
"27803203","EAP","HCPCS C1876","","Stent Microdelivery 3.5x20mm","BOTH IP/OP","$19,181.00 ","$14,193.94 ","$0.00 ","$19,181.00 ","$8,631.45 ","$0.00 ","$3,997.80 ","$5,158.80 ","$13,689.48 ","$3,358.44 ","$19,181.00 ","$0.00 ","$9,590.50 ","$15,191.35 ","$15,344.80 ","$0.00 ","$3,001.83 ","$0.00 ","$3,053.62 ","$0.00 "
"27803204","EAP","HCPCS C1876","","Neuroform Atlas Stent System","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27803205","EAP","Custom 27803205","","Coil Tornado 5/3 .036","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$212.68 ","$212.68 ","$0.00 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803206","EAP","Custom 27803206","","Coil Tornado 4/3 .035","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$212.68 ","$212.68 ","$0.00 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803207","EAP","HCPCS C1874","","Cath.viabahn 8mm X 15cm 1","BOTH IP/OP","$5,107.00 ","$3,779.18 ","$0.00 ","$5,107.00 ","$2,298.15 ","$0.00 ","$1,064.43 ","$3,644.87 ","$3,644.87 ","$894.19 ","$5,107.00 ","$0.00 ","$2,553.50 ","$4,044.74 ","$4,085.60 ","$0.00 ","$799.25 ","$0.00 ","$813.03 ","$0.00 "
"27803208","EAP","HCPCS C1874","","Cath.viabahn 8mm X 15cm 2","BOTH IP/OP","$5,107.00 ","$3,779.18 ","$0.00 ","$5,107.00 ","$2,298.15 ","$0.00 ","$1,064.43 ","$3,644.87 ","$3,644.87 ","$894.19 ","$5,107.00 ","$0.00 ","$2,553.50 ","$4,044.74 ","$4,085.60 ","$0.00 ","$799.25 ","$0.00 ","$813.03 ","$0.00 "
"27803209","EAP","HCPCS C1876","","Microcatheter Enterprise 4.5x3","BOTH IP/OP","$17,347.00 ","$12,836.78 ","$0.00 ","$17,347.00 ","$7,806.15 ","$0.00 ","$3,615.55 ","$5,158.80 ","$12,380.55 ","$3,037.32 ","$17,347.00 ","$0.00 ","$8,673.50 ","$13,738.82 ","$13,877.60 ","$0.00 ","$2,714.81 ","$0.00 ","$2,761.64 ","$0.00 "
"27803210","EAP","HCPCS C1876","","Microcath.enterprise 4.5x2 1","BOTH IP/OP","$17,347.00 ","$12,836.78 ","$0.00 ","$17,347.00 ","$7,806.15 ","$0.00 ","$3,615.55 ","$5,158.80 ","$12,380.55 ","$3,037.32 ","$17,347.00 ","$0.00 ","$8,673.50 ","$13,738.82 ","$13,877.60 ","$0.00 ","$2,714.81 ","$0.00 ","$2,761.64 ","$0.00 "
"27803211","EAP","HCPCS C1876","","Microcath.enterprise 4.5x2 2","BOTH IP/OP","$17,347.00 ","$12,836.78 ","$0.00 ","$17,347.00 ","$7,806.15 ","$0.00 ","$3,615.55 ","$5,158.80 ","$12,380.55 ","$3,037.32 ","$17,347.00 ","$0.00 ","$8,673.50 ","$13,738.82 ","$13,877.60 ","$0.00 ","$2,714.81 ","$0.00 ","$2,761.64 ","$0.00 "
"27803212","EAP","HCPCS C1876","","Stent Icast 6mm X 22mm","BOTH IP/OP","$8,391.00 ","$6,209.34 ","$0.00 ","$8,391.00 ","$3,775.95 ","$0.00 ","$1,748.89 ","$5,158.80 ","$5,988.66 ","$1,469.20 ","$8,391.00 ","$0.00 ","$4,195.50 ","$6,645.67 ","$6,712.80 ","$0.00 ","$1,313.19 ","$0.00 ","$1,335.85 ","$0.00 "
"27803213","EAP","HCPCS C1876","","Stent Carot Protege Rx 40x13 1","BOTH IP/OP","$2,941.00 ","$2,176.34 ","$0.00 ","$2,941.00 ","$1,323.45 ","$0.00 ","$612.98 ","$2,098.99 ","$2,098.99 ","$514.95 ","$2,941.00 ","$0.00 ","$1,470.50 ","$2,329.27 ","$2,352.80 ","$0.00 ","$460.27 ","$0.00 ","$468.21 ","$0.00 "
"27803214","EAP","HCPCS C1876","","Stent Carotid Protege Rx 30x13","BOTH IP/OP","$6,843.00 ","$5,063.82 ","$0.00 ","$6,843.00 ","$3,079.35 ","$0.00 ","$1,426.25 ","$4,883.85 ","$4,883.85 ","$1,198.15 ","$6,843.00 ","$0.00 ","$3,421.50 ","$5,419.66 ","$5,474.40 ","$0.00 ","$1,070.93 ","$0.00 ","$1,089.41 ","$0.00 "
"27803215","EAP","HCPCS C1876","","Stent Carot Protege Rx 40x13 2","BOTH IP/OP","$2,941.00 ","$2,176.34 ","$0.00 ","$2,941.00 ","$1,323.45 ","$0.00 ","$612.98 ","$2,098.99 ","$2,098.99 ","$514.95 ","$2,941.00 ","$0.00 ","$1,470.50 ","$2,329.27 ","$2,352.80 ","$0.00 ","$460.27 ","$0.00 ","$468.21 ","$0.00 "
"27803216","EAP","HCPCS C1876","","Stent Carotid Protege Rx","BOTH IP/OP","$6,843.00 ","$5,063.82 ","$0.00 ","$6,843.00 ","$3,079.35 ","$0.00 ","$1,426.25 ","$4,883.85 ","$4,883.85 ","$1,198.15 ","$6,843.00 ","$0.00 ","$3,421.50 ","$5,419.66 ","$5,474.40 ","$0.00 ","$1,070.93 ","$0.00 ","$1,089.41 ","$0.00 "
"27803217","EAP","HCPCS C1760","","Sph100250-20 Microcoil Platinu","BOTH IP/OP","$3,169.00 ","$2,345.06 ","$0.00 ","$3,169.00 ","$1,426.05 ","$0.00 ","$660.50 ","$2,261.72 ","$2,261.72 ","$554.87 ","$3,169.00 ","$0.00 ","$1,584.50 ","$2,509.85 ","$2,535.20 ","$0.00 ","$495.95 ","$0.00 ","$504.50 ","$0.00 "
"27803218","EAP","HCPCS C1726","","Sph100300-20 Microcoil Platinu","BOTH IP/OP","$3,186.00 ","$2,357.64 ","$0.00 ","$3,186.00 ","$1,433.70 ","$0.00 ","$664.04 ","$2,273.85 ","$2,273.85 ","$557.84 ","$3,186.00 ","$0.00 ","$1,593.00 ","$2,523.31 ","$2,548.80 ","$0.00 ","$498.61 ","$0.00 ","$507.21 ","$0.00 "
"27803219","EAP","HCPCS C1894","","Sph100350-20 Microcoil Platinu","BOTH IP/OP","$3,198.00 ","$2,366.52 ","$0.00 ","$3,198.00 ","$1,439.10 ","$0.00 ","$666.54 ","$2,282.41 ","$2,282.41 ","$559.94 ","$3,198.00 ","$0.00 ","$1,599.00 ","$2,532.82 ","$2,558.40 ","$0.00 ","$500.49 ","$0.00 ","$509.12 ","$0.00 "
"27803220","EAP","HCPCS C1769","","Wire Guide Lunderquist Extra S","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$12.60 ","$0.00 ","$5.84 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$4.38 ","$0.00 ","$4.46 ","$0.00 "
"27803221","EAP","HCPCS C1894","","Prelude Sheath","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$23.35 ","$0.00 ","$8.96 ","$30.69 ","$30.69 ","$7.53 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$6.73 ","$0.00 ","$6.85 ","$0.00 "
"27803230","EAP","HCPCS C1729","","10.2fr 22cm  Nephroureterostom","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$249.80 ","$249.80 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"27803231","EAP","HCPCS C1729","","10.2fr 24cm Nephroureterostomy","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$249.80 ","$249.80 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"27803232","EAP","HCPCS C1892","","16fr Check-flo Sheath 30cm Rad","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$170.10 ","$0.00 ","$78.78 ","$269.78 ","$269.78 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$59.16 ","$0.00 ","$60.18 ","$0.00 "
"27803233","EAP","HCPCS C1751","","5fr/65cm Mpa Catheter","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$312.00 ","$140.40 ","$0.00 ","$65.03 ","$222.67 ","$222.67 ","$54.63 ","$312.00 ","$0.00 ","$156.00 ","$247.10 ","$249.60 ","$0.00 ","$48.83 ","$0.00 ","$49.67 ","$0.00 "
"27803234","EAP","HCPCS C1892","","7fr Tear-away Introducer","BOTH IP/OP","$462.00 ","$341.88 ","$0.00 ","$462.00 ","$207.90 ","$0.00 ","$96.29 ","$329.73 ","$329.73 ","$80.89 ","$462.00 ","$0.00 ","$231.00 ","$365.90 ","$369.60 ","$0.00 ","$72.30 ","$0.00 ","$73.55 ","$0.00 "
"27803235","EAP","HCPCS C1874","","8x60 Luminexx Stent","BOTH IP/OP","$4,186.00 ","$3,097.64 ","$0.00 ","$4,186.00 ","$1,883.70 ","$0.00 ","$872.47 ","$2,987.55 ","$2,987.55 ","$732.94 ","$4,186.00 ","$0.00 ","$2,093.00 ","$3,315.31 ","$3,348.80 ","$0.00 ","$655.11 ","$0.00 ","$666.41 ","$0.00 "
"27803236","EAP","HCPCS C1769","","Amplatz Super Stiff Guidewire","BOTH IP/OP","$92.00 ","$68.08 ","$0.00 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$65.66 ","$16.11 ","$92.00 ","$0.00 ","$46.00 ","$72.86 ","$73.60 ","$0.00 ","$14.40 ","$0.00 ","$14.65 ","$0.00 "
"27803237","EAP","HCPCS C1726","","Ballon Cather 4-2/5/75","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$916.00 ","$412.20 ","$0.00 ","$190.92 ","$653.75 ","$653.75 ","$160.38 ","$916.00 ","$0.00 ","$458.00 ","$725.47 ","$732.80 ","$0.00 ","$143.35 ","$0.00 ","$145.83 ","$0.00 "
"27803238","EAP","HCPCS C1726","","Balloon Bmq 10-4/5.8/75","BOTH IP/OP","$884.00 ","$654.16 ","$0.00 ","$884.00 ","$397.80 ","$0.00 ","$184.25 ","$630.91 ","$630.91 ","$154.78 ","$884.00 ","$0.00 ","$442.00 ","$700.13 ","$707.20 ","$0.00 ","$138.35 ","$0.00 ","$140.73 ","$0.00 "
"27803239","EAP","HCPCS C1726","","Balloon Udt 4-10/5/75","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$306.45 ","$0.00 ","$141.94 ","$486.03 ","$486.03 ","$119.24 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$106.58 ","$0.00 ","$108.42 ","$0.00 "
"27803240","EAP","HCPCS C1726","","Balloon Udt 5-10/5/75","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$306.45 ","$0.00 ","$141.94 ","$486.03 ","$486.03 ","$119.24 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$106.58 ","$0.00 ","$108.42 ","$0.00 "
"27803241","EAP","HCPCS C1751","","Cath 5fr 100cm Vertebral Curve","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"27803242","EAP","HCPCS C1751","","Cath Dbl Lumen 9fr","BOTH IP/OP","$517.00 ","$382.58 ","$0.00 ","$517.00 ","$0.00 ","$0.00 ","$0.00 ","$368.98 ","$368.98 ","$90.52 ","$517.00 ","$0.00 ","$258.50 ","$409.46 ","$413.60 ","$0.00 ","$80.91 ","$0.00 ","$82.31 ","$0.00 "
"27803243","EAP","HCPCS C1887","","Cath Guiding 7fr Sh","BOTH IP/OP","$186.00 ","$137.64 ","$0.00 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$132.75 ","$132.75 ","$32.57 ","$186.00 ","$0.00 ","$93.00 ","$147.31 ","$148.80 ","$0.00 ","$29.11 ","$0.00 ","$29.61 ","$0.00 "
"27803244","EAP","HCPCS C1751","","Cath Micro Mc 2.8f 130cm","BOTH IP/OP","$1,890.00 ","$1,398.60 ","$0.00 ","$1,890.00 ","$850.50 ","$0.00 ","$393.92 ","$1,348.89 ","$1,348.89 ","$330.92 ","$1,890.00 ","$0.00 ","$945.00 ","$1,496.88 ","$1,512.00 ","$0.00 ","$295.79 ","$0.00 ","$300.89 ","$0.00 "
"27803245","EAP","Custom 27803245","","Cytology Brushes 3x120x1.7","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803246","EAP","HCPCS C1751","","Dual Picc Line","BOTH IP/OP","$307.00 ","$227.18 ","$0.00 ","$307.00 ","$138.15 ","$0.00 ","$63.99 ","$219.11 ","$219.11 ","$53.75 ","$307.00 ","$0.00 ","$153.50 ","$243.14 ","$245.60 ","$0.00 ","$48.05 ","$0.00 ","$48.87 ","$0.00 "
"27803247","EAP","Custom 27803247","","Gasttostomy (peg Kit) Pull Typ","BOTH IP/OP","$271.00 ","$200.54 ","$0.00 ","$271.00 ","$0.00 ","$0.00 ","$0.00 ","$193.41 ","$193.41 ","$0.00 ","$271.00 ","$0.00 ","$135.50 ","$214.63 ","$216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803248","EAP","Custom 27803248","","Gelfoam, Sponge","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$73.51 ","$73.51 ","$0.00 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803249","EAP","HCPCS C1874","","Ic Ast Stent 5mm X 2mm","BOTH IP/OP","$8,391.00 ","$6,209.34 ","$0.00 ","$8,391.00 ","$3,775.95 ","$0.00 ","$1,748.89 ","$5,158.80 ","$5,988.66 ","$1,469.20 ","$8,391.00 ","$0.00 ","$4,195.50 ","$6,645.67 ","$6,712.80 ","$0.00 ","$1,313.19 ","$0.00 ","$1,335.85 ","$0.00 "
"27803250","EAP","HCPCS C1721","","Paradym Dr Dual Icd","BOTH IP/OP","$55,047.00 ","$40,734.78 ","$0.00 ","$55,047.00 ","$0.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$39,287.04 ","$8,138.89 ","$55,047.00 ","$0.00 ","$27,523.50 ","$43,597.22 ","$44,037.60 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27803251","EAP","HCPCS C1722","","Paradym Vr Single Icd","BOTH IP/OP","$46,706.00 ","$34,562.44 ","$0.00 ","$46,706.00 ","$21,017.70 ","$0.00 ","$9,417.94 ","$5,158.80 ","$33,334.07 ","$8,138.89 ","$46,706.00 ","$0.00 ","$23,353.00 ","$36,991.15 ","$37,364.80 ","$0.00 ","$7,309.49 ","$0.00 ","$7,435.60 ","$0.00 "
"27803252","EAP","Custom 27803252","","Lc Bead,100-300um","BOTH IP/OP","$4,887.00 ","$3,616.38 ","$0.00 ","$4,887.00 ","$0.00 ","$0.00 ","$0.00 ","$3,487.85 ","$3,487.85 ","$0.00 ","$4,887.00 ","$0.00 ","$2,443.50 ","$3,870.50 ","$3,909.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803253","EAP","","","Picc Line Tray W/o Device","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$134.00 ","$0.00 ","$0.00 ","$0.00 ","$95.64 ","$95.64 ","$0.00 ","$134.00 ","$0.00 ","$67.00 ","$106.13 ","$107.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803254","EAP","HCPCS C1769","","Pinnacle Guidewire 6fr Straigh","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$125.10 ","$0.00 ","$57.94 ","$198.41 ","$198.41 ","$48.68 ","$278.00 ","$0.00 ","$139.00 ","$220.18 ","$222.40 ","$0.00 ","$43.51 ","$0.00 ","$44.26 ","$0.00 "
"27803255","EAP","HCPCS C1894","","Sheath Gd Lima Crv 6fr 45cm 5cm Pn Dstn Xcut Vlv Radopq Ss","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"27803256","EAP","HCPCS A4300","","Port-a-cath Ii Low Profile Dua","BOTH IP/OP","$1,429.00 ","$1,057.46 ","$0.00 ","$1,429.00 ","$0.00 ","$0.00 ","$0.00 ","$1,019.88 ","$1,019.88 ","$0.00 ","$1,429.00 ","$0.00 ","$714.50 ","$1,131.77 ","$1,143.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803257","EAP","HCPCS C1752","","Set Schon Xl Temp Dialysis 15c","BOTH IP/OP","$1,635.00 ","$1,209.90 ","$0.00 ","$1,635.00 ","$0.00 ","$0.00 ","$0.00 ","$1,166.90 ","$1,166.90 ","$0.00 ","$1,635.00 ","$0.00 ","$817.50 ","$1,294.92 ","$1,308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803258","EAP","HCPCS C1751","","Single Picc Line","BOTH IP/OP","$216.00 ","$159.84 ","$0.00 ","$216.00 ","$97.20 ","$0.00 ","$45.02 ","$154.16 ","$154.16 ","$37.82 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$33.80 ","$0.00 ","$34.39 ","$0.00 "
"27803259","EAP","HCPCS C1751","","Triple Lumen Catheter Size 20","BOTH IP/OP","$384.00 ","$284.16 ","$0.00 ","$384.00 ","$172.80 ","$0.00 ","$80.04 ","$274.06 ","$274.06 ","$67.24 ","$384.00 ","$0.00 ","$192.00 ","$304.13 ","$307.20 ","$0.00 ","$60.10 ","$0.00 ","$61.13 ","$0.00 "
"27803260","EAP","HCPCS C1729","","Tube Gastrostomy 24fr","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$26.55 ","$0.00 ","$12.30 ","$42.11 ","$42.11 ","$10.33 ","$59.00 ","$0.00 ","$29.50 ","$46.73 ","$47.20 ","$0.00 ","$9.23 ","$0.00 ","$9.39 ","$0.00 "
"27803261","EAP","HCPCS C1751","","Uhf Pigtail Sizing Cath 5 Fr,1","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$141.75 ","$0.00 ","$65.65 ","$224.82 ","$224.82 ","$55.15 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$49.30 ","$0.00 ","$50.15 ","$0.00 "
"27803262","EAP","HCPCS C1751","","Uhf Pigtail Sizing Cath 5fr,2","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$31.95 ","$0.00 ","$14.80 ","$50.67 ","$50.67 ","$12.43 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$11.11 ","$0.00 ","$11.30 ","$0.00 "
"27803263","EAP","HCPCS C1751","","Venous Access","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$117.76 ","$117.76 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"27803264","EAP","HCPCS A4300","","Isp Port Plas Lumen","BOTH IP/OP","$734.00 ","$543.16 ","$0.00 ","$734.00 ","$0.00 ","$0.00 ","$0.00 ","$523.86 ","$523.86 ","$0.00 ","$734.00 ","$0.00 ","$367.00 ","$581.33 ","$587.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803265","EAP","Custom 27803265","","Jcd 12.0-38-20","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803270","EAP","Custom 27803270","","Tray Central Line Dressing Without Biopatch","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$72.80 ","$72.80 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803294","EAP","HCPCS C1725","","Band Tr  24cm","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$55.35 ","$0.00 ","$25.64 ","$87.79 ","$87.79 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"27803295","EAP","HCPCS C1725","","Band Tr 29cm","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$55.35 ","$0.00 ","$25.64 ","$87.79 ","$87.79 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"27803302","EAP","Custom 27803302","","Embolization Coil - Azur 35d System 10mm X 20cm","BOTH IP/OP","$3,754.00 ","$2,777.96 ","$0.00 ","$3,754.00 ","$0.00 ","$0.00 ","$0.00 ","$2,679.23 ","$2,679.23 ","$0.00 ","$3,754.00 ","$0.00 ","$1,877.00 ","$2,973.17 ","$3,003.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803303","EAP","Custom 27803303","","Embolization Coil - Azur 35d System 12mm X 20cm","BOTH IP/OP","$3,754.00 ","$2,777.96 ","$0.00 ","$3,754.00 ","$0.00 ","$0.00 ","$0.00 ","$2,679.23 ","$2,679.23 ","$0.00 ","$3,754.00 ","$0.00 ","$1,877.00 ","$2,973.17 ","$3,003.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803304","EAP","Custom 27803304","","Embolization Coil - Azur 35d System 15mm X 20cm","BOTH IP/OP","$3,754.00 ","$2,777.96 ","$0.00 ","$3,754.00 ","$0.00 ","$0.00 ","$0.00 ","$2,679.23 ","$2,679.23 ","$0.00 ","$3,754.00 ","$0.00 ","$1,877.00 ","$2,973.17 ","$3,003.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803305","EAP","Custom 27803305","","Embolization Coil - Azur 35d System 12mm X 30cm","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$0.00 ","$0.00 ","$0.00 ","$2,858.37 ","$2,858.37 ","$0.00 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803306","EAP","Custom 27803306","","Embolization Coil -azur 35d System 15mm X 30cm","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$0.00 ","$0.00 ","$0.00 ","$2,858.37 ","$2,858.37 ","$0.00 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803307","EAP","Custom 27803307","","Embolization Coil - Azur 35d System 20mm X 30cm","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$0.00 ","$0.00 ","$0.00 ","$2,858.37 ","$2,858.37 ","$0.00 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803308","EAP","HCPCS C1876","","Stent Bilinary Xpert Otw 5x30x120 Cm","BOTH IP/OP","$5,755.00 ","$4,258.70 ","$0.00 ","$5,755.00 ","$2,589.75 ","$0.00 ","$1,199.49 ","$4,107.34 ","$4,107.34 ","$1,007.65 ","$5,755.00 ","$0.00 ","$2,877.50 ","$4,557.96 ","$4,604.00 ","$0.00 ","$900.66 ","$0.00 ","$916.20 ","$0.00 "
"27803309","EAP","HCPCS C1876","","Stent Bilinary Xpert Otw 5x40x120 Cm","BOTH IP/OP","$5,755.00 ","$4,258.70 ","$0.00 ","$5,755.00 ","$2,589.75 ","$0.00 ","$1,199.49 ","$4,107.34 ","$4,107.34 ","$1,007.65 ","$5,755.00 ","$0.00 ","$2,877.50 ","$4,557.96 ","$4,604.00 ","$0.00 ","$900.66 ","$0.00 ","$916.20 ","$0.00 "
"27803310","EAP","HCPCS C1876","","Stent Bilinary Xpert Otw 6x30x120 Cm","BOTH IP/OP","$5,755.00 ","$4,258.70 ","$0.00 ","$5,755.00 ","$2,589.75 ","$0.00 ","$1,199.49 ","$4,107.34 ","$4,107.34 ","$1,007.65 ","$5,755.00 ","$0.00 ","$2,877.50 ","$4,557.96 ","$4,604.00 ","$0.00 ","$900.66 ","$0.00 ","$916.20 ","$0.00 "
"27803311","EAP","HCPCS C1876","","Stent Bilinary Xpert Otw 6x40x120 Cm","BOTH IP/OP","$5,755.00 ","$4,258.70 ","$0.00 ","$5,755.00 ","$2,589.75 ","$0.00 ","$1,199.49 ","$4,107.34 ","$4,107.34 ","$1,007.65 ","$5,755.00 ","$0.00 ","$2,877.50 ","$4,557.96 ","$4,604.00 ","$0.00 ","$900.66 ","$0.00 ","$916.20 ","$0.00 "
"27803312","EAP","HCPCS C1876","","Stent Corotid Straight Rx Acculink 6x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$2,965.50 ","$0.00 ","$1,373.52 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803313","EAP","HCPCS C1876","","Stent Corotid Straight Rx Acculink 7x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$2,965.50 ","$0.00 ","$1,373.52 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803314","EAP","HCPCS C1876","","Stent Corotid Straight Rx Acculink 8x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$2,965.50 ","$0.00 ","$1,373.52 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803315","EAP","HCPCS C1876","","Stent Corotid Straight Rx Acculink 9x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$2,965.50 ","$0.00 ","$1,373.52 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803316","EAP","HCPCS C1876","","Stent Corotid Straight Rx Acculink 10x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803317","EAP","HCPCS C1876","","Stent Corotid Tapped Rx Acculink 6-8x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$2,965.50 ","$0.00 ","$1,373.52 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803318","EAP","HCPCS C1876","","Stent Corotid Tapped Rx Acculink 7-10x40","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$2,965.50 ","$0.00 ","$1,373.52 ","$4,703.28 ","$4,703.28 ","$1,153.86 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$1,031.34 ","$0.00 ","$1,049.13 ","$0.00 "
"27803319","EAP","HCPCS C1882","","Defibrillator Crd Amplia Mri Crt-d Vntrc Left Df4","BOTH IP/OP","$52,375.00 ","$38,757.50 ","$0.00 ","$52,375.00 ","$23,568.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,380.04 ","$8,138.89 ","$52,375.00 ","$0.00 ","$26,187.50 ","$41,481.00 ","$41,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27803320","EAP","HCPCS C1882","","Defibrillator Crd Amplia Mri Crt-d 2 Plr Left","BOTH IP/OP","$52,375.00 ","$38,757.50 ","$0.00 ","$52,375.00 ","$23,568.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,380.04 ","$8,138.89 ","$52,375.00 ","$0.00 ","$26,187.50 ","$41,481.00 ","$41,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27803420","EAP","HCPCS C1769","","Guidewire Amplatz Super Stiff 0.038 X 260","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$35.69 ","$35.69 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"27803421","EAP","HCPCS C1769","","Guidewire Hydrophilic Nitinol","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$174.60 ","$0.00 ","$80.87 ","$276.92 ","$276.92 ","$67.94 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$60.72 ","$0.00 ","$61.77 ","$0.00 "
"27803441","EAP","Custom 27803441","","Stent Metal Bare Int35012ux","BOTH IP/OP","$2,422.00 ","$1,792.28 ","$0.00 ","$2,422.00 ","$0.00 ","$0.00 ","$0.00 ","$1,728.58 ","$1,728.58 ","$0.00 ","$2,422.00 ","$0.00 ","$1,211.00 ","$1,918.22 ","$1,937.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803450","EAP","Custom 27803450","","Target Detachable Colis 360 Soft 4mm X 6cm","BOTH IP/OP","$2,270.00 ","$1,679.80 ","$0.00 ","$2,270.00 ","$0.00 ","$0.00 ","$0.00 ","$1,620.10 ","$1,620.10 ","$0.00 ","$2,270.00 ","$0.00 ","$1,135.00 ","$1,797.84 ","$1,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803451","EAP","Custom 27803451","","Target Detachable Colis Ultra 3mmx8cm","BOTH IP/OP","$2,401.00 ","$1,776.74 ","$0.00 ","$2,401.00 ","$0.00 ","$0.00 ","$0.00 ","$1,713.59 ","$1,713.59 ","$0.00 ","$2,401.00 ","$0.00 ","$1,200.50 ","$1,901.59 ","$1,920.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803452","EAP","Custom 27803452","","Inzone Detachment System","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$185.56 ","$185.56 ","$0.00 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803490","EAP","HCPCS C2625","","Rx Stent/11.5 X 5","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$28.80 ","$0.00 ","$13.34 ","$45.68 ","$45.68 ","$11.21 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$10.02 ","$0.00 ","$10.19 ","$0.00 "
"27803491","EAP","HCPCS C2625","","Rx Stent/11.5 X 7","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$28.80 ","$0.00 ","$13.34 ","$45.68 ","$45.68 ","$11.21 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$10.02 ","$0.00 ","$10.19 ","$0.00 "
"27803492","EAP","HCPCS C2625","","Rx Stent/11.5 X 10","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$28.80 ","$0.00 ","$13.34 ","$45.68 ","$45.68 ","$11.21 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$10.02 ","$0.00 ","$10.19 ","$0.00 "
"27803493","EAP","HCPCS C2625","","Rx Stent/11.5 X 12","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$28.80 ","$0.00 ","$13.34 ","$45.68 ","$45.68 ","$11.21 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$10.02 ","$0.00 ","$10.19 ","$0.00 "
"27803494","EAP","HCPCS C2625","","Rx Stent/11.5 X 15","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$28.80 ","$0.00 ","$13.34 ","$45.68 ","$45.68 ","$11.21 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$10.02 ","$0.00 ","$10.19 ","$0.00 "
"27803496","EAP","HCPCS C1874","","Icast Covered Stent 6mm X16mm, 120 Cm Cath Length","BOTH IP/OP","$8,340.00 ","$6,171.60 ","$0.00 ","$8,340.00 ","$3,753.00 ","$0.00 ","$1,738.26 ","$5,158.80 ","$5,952.26 ","$1,460.27 ","$8,340.00 ","$0.00 ","$4,170.00 ","$6,605.28 ","$6,672.00 ","$0.00 ","$1,305.21 ","$0.00 ","$1,327.73 ","$0.00 "
"27803499","EAP","Custom 27803499","","Central Line Tray W /biopatch","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803510","EAP","HCPCS C2628","","Boston Scientific Occlusion Balloon Catheter 27mm X 100m","BOTH IP/OP","$885.00 ","$654.90 ","$0.00 ","$885.00 ","$398.25 ","$0.00 ","$184.46 ","$631.62 ","$631.62 ","$0.00 ","$885.00 ","$0.00 ","$442.50 ","$700.92 ","$708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803520","EAP","HCPCS C1876","","Wallflex Bil Uncovered 10x60","BOTH IP/OP","$6,005.00 ","$4,443.70 ","$0.00 ","$6,005.00 ","$2,702.25 ","$0.00 ","$1,251.59 ","$4,285.77 ","$4,285.77 ","$1,051.43 ","$6,005.00 ","$0.00 ","$3,002.50 ","$4,755.96 ","$4,804.00 ","$0.00 ","$939.78 ","$0.00 ","$956.00 ","$0.00 "
"27803521","EAP","HCPCS C1876","","Wallflex Bil Uncovered 10x80","BOTH IP/OP","$6,005.00 ","$4,443.70 ","$0.00 ","$6,005.00 ","$2,702.25 ","$0.00 ","$1,251.59 ","$4,285.77 ","$4,285.77 ","$1,051.43 ","$6,005.00 ","$0.00 ","$3,002.50 ","$4,755.96 ","$4,804.00 ","$0.00 ","$939.78 ","$0.00 ","$956.00 ","$0.00 "
"27803522","EAP","HCPCS C1876","","Wallflex Bil  Uncovered 10x100","BOTH IP/OP","$6,005.00 ","$4,443.70 ","$0.00 ","$6,005.00 ","$2,702.25 ","$0.00 ","$1,251.59 ","$4,285.77 ","$4,285.77 ","$1,051.43 ","$6,005.00 ","$0.00 ","$3,002.50 ","$4,755.96 ","$4,804.00 ","$0.00 ","$939.78 ","$0.00 ","$956.00 ","$0.00 "
"27803523","EAP","HCPCS C1876","","Wallflex Bil Uncovered 10x40","BOTH IP/OP","$6,005.00 ","$4,443.70 ","$0.00 ","$6,005.00 ","$2,702.25 ","$0.00 ","$1,251.59 ","$4,285.77 ","$4,285.77 ","$1,051.43 ","$6,005.00 ","$0.00 ","$3,002.50 ","$4,755.96 ","$4,804.00 ","$0.00 ","$939.78 ","$0.00 ","$956.00 ","$0.00 "
"27803524","EAP","HCPCS C1874","","Wallflex Bil Covered 10x40","BOTH IP/OP","$9,476.00 ","$7,012.24 ","$0.00 ","$9,476.00 ","$4,264.20 ","$0.00 ","$1,975.04 ","$5,158.80 ","$6,763.02 ","$1,659.17 ","$9,476.00 ","$0.00 ","$4,738.00 ","$7,504.99 ","$7,580.80 ","$0.00 ","$1,482.99 ","$0.00 ","$1,508.58 ","$0.00 "
"27803525","EAP","HCPCS C1874","","Wallflex Bil Covered 10x60","BOTH IP/OP","$9,476.00 ","$7,012.24 ","$0.00 ","$9,476.00 ","$4,264.20 ","$0.00 ","$1,975.04 ","$5,158.80 ","$6,763.02 ","$1,659.17 ","$9,476.00 ","$0.00 ","$4,738.00 ","$7,504.99 ","$7,580.80 ","$0.00 ","$1,482.99 ","$0.00 ","$1,508.58 ","$0.00 "
"27803526","EAP","HCPCS C1874","","Wallflex Bil Covered 10x80","BOTH IP/OP","$9,476.00 ","$7,012.24 ","$0.00 ","$9,476.00 ","$4,264.20 ","$0.00 ","$1,975.04 ","$5,158.80 ","$6,763.02 ","$1,659.17 ","$9,476.00 ","$0.00 ","$4,738.00 ","$7,504.99 ","$7,580.80 ","$0.00 ","$1,482.99 ","$0.00 ","$1,508.58 ","$0.00 "
"27803527","EAP","HCPCS C1874","","Wallflex Bil Pc Covered 10x40","BOTH IP/OP","$9,142.00 ","$6,765.08 ","$0.00 ","$9,142.00 ","$4,113.90 ","$0.00 ","$1,905.42 ","$5,158.80 ","$6,524.65 ","$1,600.69 ","$9,142.00 ","$0.00 ","$4,571.00 ","$7,240.46 ","$7,313.60 ","$0.00 ","$1,430.72 ","$0.00 ","$1,455.41 ","$0.00 "
"27803528","EAP","HCPCS C1874","","Wallflex Bil Pc Covered 10x60","BOTH IP/OP","$9,142.00 ","$6,765.08 ","$0.00 ","$9,142.00 ","$4,113.90 ","$0.00 ","$1,905.42 ","$5,158.80 ","$6,524.65 ","$1,600.69 ","$9,142.00 ","$0.00 ","$4,571.00 ","$7,240.46 ","$7,313.60 ","$0.00 ","$1,430.72 ","$0.00 ","$1,455.41 ","$0.00 "
"27803529","EAP","HCPCS C1874","","Wallflex Bil Pc Covered 10x80","BOTH IP/OP","$9,142.00 ","$6,765.08 ","$0.00 ","$9,142.00 ","$4,113.90 ","$0.00 ","$1,905.42 ","$5,158.80 ","$6,524.65 ","$1,600.69 ","$9,142.00 ","$0.00 ","$4,571.00 ","$7,240.46 ","$7,313.60 ","$0.00 ","$1,430.72 ","$0.00 ","$1,455.41 ","$0.00 "
"27803531","EAP","HCPCS C1876","","Wallflex Ent Duo 27/22x6 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803532","EAP","HCPCS C1876","","Wallflex Ent Duo 27/22x9 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803533","EAP","HCPCS C1876","","Wallflex Ent Duo 27/22x12 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803534","EAP","HCPCS C1876","","Wallflex Ent Col 30/25x6 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803535","EAP","HCPCS C1876","","Wallflex Ent Col 30/25x9 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803536","EAP","HCPCS C1876","","Wallflex Ent Col 30/25x12 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803537","EAP","HCPCS C1876","","Wallflex Ent Col 27/22x6 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803538","EAP","HCPCS C1876","","Wallflex Ent Col 27/22x9 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803539","EAP","HCPCS C1876","","Wallflex Ent Col 27/22x12 230cm","BOTH IP/OP","$8,756.00 ","$6,479.44 ","$0.00 ","$8,756.00 ","$3,940.20 ","$0.00 ","$1,824.97 ","$5,158.80 ","$6,249.16 ","$1,533.11 ","$8,756.00 ","$0.00 ","$4,378.00 ","$6,934.75 ","$7,004.80 ","$0.00 ","$1,370.31 ","$0.00 ","$1,393.96 ","$0.00 "
"27803541","EAP","HCPCS C1874","","Wallflex Esoph Full Cov 18/10","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803542","EAP","HCPCS C1874","","Wallflex Esoph Full Cov 18/12","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803543","EAP","HCPCS C1874","","Wallflex Esoph Full Cov 18/15","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803544","EAP","HCPCS C1874","","Wallflex Esoph Full Cov 23/10","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803545","EAP","HCPCS C1874","","Wallflex Esoph Full Cov 23/12","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803546","EAP","HCPCS C1874","","Wallflex Esoph Full Cov 23/15","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803547","EAP","HCPCS C1874","","Wallflex Esoph Part Cov 18/10","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803548","EAP","HCPCS C1874","","Wallflex Esoph Part Cov 18/12","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803549","EAP","HCPCS C1874","","Wallflex Esoph Part Cov 18/23x103","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803550","EAP","HCPCS C1874","","Wallflex Esoph Part Cov 23/128x105","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803551","EAP","HCPCS C1874","","Wallflex Esoph Part Cov 23/28x125","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803552","EAP","HCPCS C1874","","Wallflex Esoph Part Cov 23/28x155","BOTH IP/OP","$8,507.00 ","$6,295.18 ","$0.00 ","$8,507.00 ","$3,828.15 ","$0.00 ","$1,773.07 ","$5,158.80 ","$6,071.45 ","$1,489.51 ","$8,507.00 ","$0.00 ","$4,253.50 ","$6,737.54 ","$6,805.60 ","$0.00 ","$1,331.35 ","$0.00 ","$1,354.31 ","$0.00 "
"27803554","EAP","HCPCS C1874","","Polyflex Esoph 20/16mm X 90mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803555","EAP","HCPCS C1874","","Polyflex Esoph 20/16mm X 120mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803556","EAP","HCPCS C1874","","Polyflex Esoph 20/16mm X 150mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803557","EAP","HCPCS C1874","","Polyflex Esoph 23/18mm X 90mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803558","EAP","HCPCS C1874","","Polyflex Esoph 23/18mm X 120mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803559","EAP","HCPCS C1874","","Polyflex Esoph 23/18mm X 150mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803560","EAP","HCPCS C1874","","Polyflex Esoph 25/21mm X 90mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803561","EAP","HCPCS C1874","","Polyflex Esoph 25/21mm X 120mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803562","EAP","HCPCS C1874","","Polyflex Esoph 25/21mm X 150mm","BOTH IP/OP","$6,756.00 ","$4,999.44 ","$0.00 ","$6,756.00 ","$3,040.20 ","$0.00 ","$1,408.12 ","$4,821.76 ","$4,821.76 ","$1,182.92 ","$6,756.00 ","$0.00 ","$3,378.00 ","$5,350.75 ","$5,404.80 ","$0.00 ","$1,057.31 ","$0.00 ","$1,075.56 ","$0.00 "
"27803576","EAP","Custom 44697837","","Stent Bare Metal  Int30012ux","BOTH IP/OP","$2,422.00 ","$1,792.28 ","$0.00 ","$2,422.00 ","$0.00 ","$0.00 ","$0.00 ","$1,728.58 ","$1,728.58 ","$0.00 ","$2,422.00 ","$0.00 ","$1,211.00 ","$1,918.22 ","$1,937.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803585","EAP","Custom 44697928","","Stent Bare Metal  Int40015ux","BOTH IP/OP","$2,422.00 ","$1,792.28 ","$0.00 ","$2,422.00 ","$0.00 ","$0.00 ","$0.00 ","$1,728.58 ","$1,728.58 ","$0.00 ","$2,422.00 ","$0.00 ","$1,211.00 ","$1,918.22 ","$1,937.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803600","EAP","HCPCS C1713","","Plate Xlng 134mm Ss 2.7/3.5mm Scr 6 Hole Var Ang","BOTH IP/OP","$840.58 ","$622.03 ","$0.00 ","$840.58 ","$378.26 ","$0.00 ","$175.20 ","$599.92 ","$599.92 ","$147.18 ","$840.58 ","$0.00 ","$420.29 ","$665.74 ","$672.46 ","$0.00 ","$131.55 ","$0.00 ","$133.82 ","$0.00 "
"27803601","EAP","HCPCS C1713","","Screw Bone 3.5mm 30mm Lineum Ti Oct Spn Smth Shnk","BOTH IP/OP","$1,877.60 ","$1,389.42 ","$0.00 ","$1,877.60 ","$844.92 ","$0.00 ","$391.34 ","$1,340.04 ","$1,340.04 ","$328.75 ","$1,877.60 ","$0.00 ","$938.80 ","$1,487.06 ","$1,502.08 ","$0.00 ","$293.84 ","$0.00 ","$298.91 ","$0.00 "
"27803602","EAP","HCPCS C1713","","Rod Spnl 90mm 4.75mm Str Perc Ccm Plus","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"27803603","EAP","HCPCS C1713","","Screw Bone 1.5mm 8mm Hexalobe Pthrd Hand Lag","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$58.05 ","$0.00 ","$26.89 ","$92.07 ","$92.07 ","$22.59 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$20.19 ","$0.00 ","$20.54 ","$0.00 "
"27803604","EAP","HCPCS C1713","","Screw Bone 1.5mm 11mm Ti Hand Mtcrpl Phalanges","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$58.05 ","$0.00 ","$26.89 ","$92.07 ","$92.07 ","$22.59 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$20.19 ","$0.00 ","$20.54 ","$0.00 "
"27803605","EAP","HCPCS C1713","","Spacer Spnl 22mmx10mm Cpstn Cntrl 12d Peek Intrbd","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"27803606","EAP","HCPCS C1713","","Screw Bone 4.5mm 45mm Solera Cd Hzn Cocr Spn","BOTH IP/OP","$1,558.20 ","$1,153.07 ","$0.00 ","$1,558.20 ","$701.19 ","$0.00 ","$324.77 ","$1,112.09 ","$1,112.09 ","$272.83 ","$1,558.20 ","$0.00 ","$779.10 ","$1,234.09 ","$1,246.56 ","$0.00 ","$243.86 ","$0.00 ","$248.07 ","$0.00 "
"27803607","EAP","HCPCS C1713","","Screw Bone 5.5mm 35mm Ats Spn Multiax 4.75mm Rod","BOTH IP/OP","$1,558.20 ","$1,153.07 ","$0.00 ","$1,558.20 ","$701.19 ","$0.00 ","$324.77 ","$1,112.09 ","$1,112.09 ","$272.83 ","$1,558.20 ","$0.00 ","$779.10 ","$1,234.09 ","$1,246.56 ","$0.00 ","$243.86 ","$0.00 ","$248.07 ","$0.00 "
"27803608","EAP","HCPCS C1713","","Screw Bone 6.5mm 35mm Ats Spn Multiax 4.75mm Rod","BOTH IP/OP","$1,558.20 ","$1,153.07 ","$0.00 ","$1,558.20 ","$701.19 ","$0.00 ","$324.77 ","$1,112.09 ","$1,112.09 ","$272.83 ","$1,558.20 ","$0.00 ","$779.10 ","$1,234.09 ","$1,246.56 ","$0.00 ","$243.86 ","$0.00 ","$248.07 ","$0.00 "
"27803609","EAP","HCPCS C1713","","Cage Spnl 15-20mm 12mm","BOTH IP/OP","$4,498.00 ","$3,328.52 ","$0.00 ","$4,498.00 ","$2,442.41 ","$0.00 ","$937.50 ","$3,210.22 ","$3,210.22 ","$787.56 ","$4,498.00 ","$0.00 ","$2,249.00 ","$3,562.42 ","$3,598.40 ","$0.00 ","$703.94 ","$0.00 ","$716.08 ","$0.00 "
"27803610","EAP","HCPCS C1713","","Spacer Spnl 50x18x8mm Crnt Xl Peek Tlif Rdlcnt","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$3,211.65 ","$3,211.65 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"27803611","EAP","HCPCS C1713","","Cage Spnl 45x18x12mm Crnt Xl Peek-optm Lat Lmbr","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$3,211.65 ","$3,211.65 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"27803612","EAP","HCPCS C1713","","Spacer Spnl 38x16x28mm Brigade 12d Spn Ant","BOTH IP/OP","$5,513.00 ","$4,079.62 ","$0.00 ","$5,513.00 ","$2,480.85 ","$0.00 ","$1,149.05 ","$3,934.63 ","$3,934.63 ","$965.28 ","$5,513.00 ","$0.00 ","$2,756.50 ","$4,366.30 ","$4,410.40 ","$0.00 ","$862.78 ","$0.00 ","$877.67 ","$0.00 "
"27803613","EAP","HCPCS C1713","","Screw Bone 5mm 62.5mm Trgn Fem Lp","BOTH IP/OP","$259.20 ","$191.81 ","$0.00 ","$259.20 ","$116.64 ","$0.00 ","$54.02 ","$184.99 ","$184.99 ","$45.38 ","$259.20 ","$0.00 ","$129.60 ","$205.29 ","$207.36 ","$0.00 ","$40.56 ","$0.00 ","$41.26 ","$0.00 "
"27803614","EAP","HCPCS C1713","","Nail 10mm 38cm Right Troc Trgn Im 130d Set Antgrd","BOTH IP/OP","$2,280.00 ","$1,687.20 ","$0.00 ","$2,280.00 ","$1,026.00 ","$0.00 ","$475.21 ","$1,627.24 ","$1,627.24 ","$399.21 ","$2,280.00 ","$0.00 ","$1,140.00 ","$1,805.76 ","$1,824.00 ","$0.00 ","$356.82 ","$0.00 ","$362.98 ","$0.00 "
"27803616","EAP","HCPCS C1713","","Nail 10mm 38cm Tib Mt-nail Im Ti","BOTH IP/OP","$2,108.00 ","$1,559.92 ","$0.00 ","$2,108.00 ","$948.60 ","$0.00 ","$439.36 ","$1,504.48 ","$1,504.48 ","$369.09 ","$2,108.00 ","$0.00 ","$1,054.00 ","$1,669.54 ","$1,686.40 ","$0.00 ","$329.90 ","$0.00 ","$335.59 ","$0.00 "
"27803618","EAP","HCPCS C1713","","Screw Bone 11mm 30mm Intertan Troch Cmpr","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$174.60 ","$0.00 ","$80.87 ","$276.92 ","$276.92 ","$67.94 ","$388.00 ","$0.00 ","$194.00 ","$307.30 ","$310.40 ","$0.00 ","$60.72 ","$0.00 ","$61.77 ","$0.00 "
"27803620","EAP","HCPCS C1713","","Kit Scr 90mm 4.5mm Intertan Troch Ti Lag Cmpr","BOTH IP/OP","$836.00 ","$618.64 ","$0.00 ","$836.00 ","$376.20 ","$0.00 ","$174.24 ","$596.65 ","$596.65 ","$146.38 ","$836.00 ","$0.00 ","$418.00 ","$662.11 ","$668.80 ","$0.00 ","$130.83 ","$0.00 ","$133.09 ","$0.00 "
"27803621","EAP","HCPCS C1713","","Plate 2mm Str Frac Bone","BOTH IP/OP","$1,416.00 ","$1,047.84 ","$0.00 ","$1,416.00 ","$637.20 ","$0.00 ","$295.13 ","$1,010.60 ","$1,010.60 ","$247.93 ","$1,416.00 ","$0.00 ","$708.00 ","$1,121.47 ","$1,132.80 ","$0.00 ","$221.60 ","$0.00 ","$225.43 ","$0.00 "
"27803622","EAP","HCPCS C1713","","Nail 10mm 39cm Tib Mt-nail Im Ti","BOTH IP/OP","$2,108.00 ","$1,559.92 ","$0.00 ","$2,108.00 ","$948.60 ","$0.00 ","$439.36 ","$1,504.48 ","$1,504.48 ","$369.09 ","$2,108.00 ","$0.00 ","$1,054.00 ","$1,669.54 ","$1,686.40 ","$0.00 ","$329.90 ","$0.00 ","$335.59 ","$0.00 "
"27803788","EAP","HCPCS C1726","","Dfs100410-20microcoil Platinum Deltapapaq4m","BOTH IP/OP","$2,923.00 ","$2,163.02 ","$0.00 ","$2,923.00 ","$1,315.35 ","$0.00 ","$609.23 ","$2,086.15 ","$2,086.15 ","$511.79 ","$2,923.00 ","$0.00 ","$1,461.50 ","$2,315.02 ","$2,338.40 ","$0.00 ","$457.45 ","$0.00 ","$465.34 ","$0.00 "
"27803789","EAP","HCPCS C1717","","Brachytx, Non-str,hdr Ir-192","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$341.72 ","$145.90 ","$499.59 ","$499.59 ","$122.56 ","$700.00 ","$338.12 ","$350.00 ","$554.40 ","$560.00 ","$466.93 ","$109.55 ","$0.00 ","$111.44 ","$322.02 "
"27803795","EAP","HCPCS C1757","","Catheter Thrmb 6fr 65cm Cleanerxt Rot 2 Pwr Cell L","BOTH IP/OP","$1,488.00 ","$1,101.12 ","$0.00 ","$1,488.00 ","$669.60 ","$0.00 ","$310.14 ","$1,061.99 ","$1,061.99 ","$0.00 ","$1,488.00 ","$0.00 ","$744.00 ","$1,178.50 ","$1,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803803","EAP","HCPCS C1726","","Hel181830-20microcoil Platinum Helipaq18","BOTH IP/OP","$1,895.00 ","$1,402.30 ","$0.00 ","$1,895.00 ","$852.75 ","$0.00 ","$394.97 ","$1,352.46 ","$1,352.46 ","$331.80 ","$1,895.00 ","$0.00 ","$947.50 ","$1,500.84 ","$1,516.00 ","$0.00 ","$296.57 ","$0.00 ","$301.68 ","$0.00 "
"27803857","EAP","HCPCS C1726","","Dfs100250-20microcoil Platinum Deltapaq2","BOTH IP/OP","$2,923.00 ","$2,163.02 ","$0.00 ","$2,923.00 ","$1,315.35 ","$0.00 ","$609.23 ","$2,086.15 ","$2,086.15 ","$511.79 ","$2,923.00 ","$0.00 ","$1,461.50 ","$2,315.02 ","$2,338.40 ","$0.00 ","$457.45 ","$0.00 ","$465.34 ","$0.00 "
"27803858","EAP","HCPCS C1726","","Dfs100408-20 Microcoil Platinum Deltapaq4m","BOTH IP/OP","$2,923.00 ","$2,163.02 ","$0.00 ","$2,923.00 ","$1,315.35 ","$0.00 ","$609.23 ","$2,086.15 ","$2,086.15 ","$511.79 ","$2,923.00 ","$0.00 ","$1,461.50 ","$2,315.02 ","$2,338.40 ","$0.00 ","$457.45 ","$0.00 ","$465.34 ","$0.00 "
"27803860","EAP","HCPCS C1726","","Dfs100510-20microcoil Platinum Deltapaq5m","BOTH IP/OP","$2,923.00 ","$2,163.02 ","$0.00 ","$2,923.00 ","$1,315.35 ","$0.00 ","$609.23 ","$2,086.15 ","$2,086.15 ","$511.79 ","$2,923.00 ","$0.00 ","$1,461.50 ","$2,315.02 ","$2,338.40 ","$0.00 ","$457.45 ","$0.00 ","$465.34 ","$0.00 "
"27803861","EAP","HCPCS C1726","","Dfs100515-20 Microcoil Platinum Deltapaq5m","BOTH IP/OP","$2,923.00 ","$2,163.02 ","$0.00 ","$2,923.00 ","$1,315.35 ","$0.00 ","$609.23 ","$2,086.15 ","$2,086.15 ","$511.79 ","$2,923.00 ","$0.00 ","$1,461.50 ","$2,315.02 ","$2,338.40 ","$0.00 ","$457.45 ","$0.00 ","$465.34 ","$0.00 "
"27803863","EAP","HCPCS C1726","","Dpl 100153-20microcoil Platinum Deltaplush","BOTH IP/OP","$3,217.00 ","$2,380.58 ","$0.00 ","$3,217.00 ","$1,447.65 ","$0.00 ","$670.50 ","$2,295.97 ","$2,295.97 ","$563.27 ","$3,217.00 ","$0.00 ","$1,608.50 ","$2,547.86 ","$2,573.60 ","$0.00 ","$503.46 ","$0.00 ","$512.15 ","$0.00 "
"27803864","EAP","HCPCS C1726","","Dpl 100201-20 Microcoil Platinum Deltaplush","BOTH IP/OP","$3,654.00 ","$2,703.96 ","$0.00 ","$3,654.00 ","$1,644.30 ","$0.00 ","$761.58 ","$2,607.86 ","$2,607.86 ","$639.79 ","$3,654.00 ","$0.00 ","$1,827.00 ","$2,893.97 ","$2,923.20 ","$0.00 ","$571.85 ","$0.00 ","$581.72 ","$0.00 "
"27803865","EAP","HCPCS C1726","","Dpl100202-20 Microcoil Platinum Deltaplush","BOTH IP/OP","$3,654.00 ","$2,703.96 ","$0.00 ","$3,654.00 ","$1,644.30 ","$0.00 ","$761.58 ","$2,607.86 ","$2,607.86 ","$639.79 ","$3,654.00 ","$0.00 ","$1,827.00 ","$2,893.97 ","$2,923.20 ","$0.00 ","$571.85 ","$0.00 ","$581.72 ","$0.00 "
"27803866","EAP","HCPCS C1726","","Dpl 100203-20 Microcoil Platinum Deliaplush","BOTH IP/OP","$3,217.00 ","$2,380.58 ","$0.00 ","$3,217.00 ","$1,447.65 ","$0.00 ","$670.50 ","$2,295.97 ","$2,295.97 ","$563.27 ","$3,217.00 ","$0.00 ","$1,608.50 ","$2,547.86 ","$2,573.60 ","$0.00 ","$503.46 ","$0.00 ","$512.15 ","$0.00 "
"27803867","EAP","HCPCS C1726","","Dpl 100206-20micocoil Platinum Deltaplush","BOTH IP/OP","$3,654.00 ","$2,703.96 ","$0.00 ","$3,654.00 ","$1,644.30 ","$0.00 ","$761.58 ","$2,607.86 ","$2,607.86 ","$639.79 ","$3,654.00 ","$0.00 ","$1,827.00 ","$2,893.97 ","$2,923.20 ","$0.00 ","$571.85 ","$0.00 ","$581.72 ","$0.00 "
"27803868","EAP","HCPCS C1726","","Hel 180730-20 Microcoil Platinum Helipaq 7m","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$1,214.00 ","$1,214.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"27803869","EAP","HCPCS C1726","","Hel180930-20microcoil Platinum Helipaq9m","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$1,214.00 ","$1,214.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"27803870","EAP","HCPCS C1726","","Hel181030-20 Microcoil Platinum Helipaq10","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$1,214.00 ","$1,214.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"27803871","EAP","HCPCS C1726","","Hel181230-20 Microcoil Platinum Helipaq12","BOTH IP/OP","$2,051.00 ","$1,517.74 ","$0.00 ","$2,051.00 ","$922.95 ","$0.00 ","$427.48 ","$1,463.80 ","$1,463.80 ","$359.11 ","$2,051.00 ","$0.00 ","$1,025.50 ","$1,624.39 ","$1,640.80 ","$0.00 ","$320.98 ","$0.00 ","$326.52 ","$0.00 "
"27803872","EAP","HCPCS C1726","","Hel181430-20 Microcoil Platinum Helipaq14","BOTH IP/OP","$1,805.00 ","$1,335.70 ","$0.00 ","$1,805.00 ","$812.25 ","$0.00 ","$376.21 ","$1,288.23 ","$1,288.23 ","$316.04 ","$1,805.00 ","$0.00 ","$902.50 ","$1,429.56 ","$1,444.00 ","$0.00 ","$282.48 ","$0.00 ","$287.36 ","$0.00 "
"27803873","EAP","HCPCS C1726","","Hel181630-20 Microcoil Platinum Helipaq16","BOTH IP/OP","$1,601.00 ","$1,184.74 ","$0.00 ","$1,601.00 ","$720.45 ","$0.00 ","$333.69 ","$1,142.63 ","$1,142.63 ","$280.32 ","$1,601.00 ","$0.00 ","$800.50 ","$1,267.99 ","$1,280.80 ","$0.00 ","$250.56 ","$0.00 ","$254.88 ","$0.00 "
"27803875","EAP","HCPCS C1726","","Hel182030-20 Microcoil Platinum Helipaq 20","BOTH IP/OP","$1,895.00 ","$1,402.30 ","$0.00 ","$1,895.00 ","$852.75 ","$0.00 ","$394.97 ","$1,352.46 ","$1,352.46 ","$331.80 ","$1,895.00 ","$0.00 ","$947.50 ","$1,500.84 ","$1,516.00 ","$0.00 ","$296.57 ","$0.00 ","$301.68 ","$0.00 "
"27803876","EAP","HCPCS C1726","","Dpl 100152-20 Microcoil Platinum Deltaplush","BOTH IP/OP","$3,217.00 ","$2,380.58 ","$0.00 ","$3,217.00 ","$1,447.65 ","$0.00 ","$670.50 ","$2,295.97 ","$2,295.97 ","$563.27 ","$3,217.00 ","$0.00 ","$1,608.50 ","$2,547.86 ","$2,573.60 ","$0.00 ","$503.46 ","$0.00 ","$512.15 ","$0.00 "
"27803880","EAP","Custom 27803880","","Device Perclose","BOTH IP/OP","$789.00 ","$583.86 ","$0.00 ","$789.00 ","$0.00 ","$0.00 ","$0.00 ","$563.11 ","$563.11 ","$0.00 ","$789.00 ","$0.00 ","$394.50 ","$624.89 ","$631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803881","EAP","HCPCS C1760","","Sph100500-20 Mircrocoil Platin","BOTH IP/OP","$3,686.00 ","$2,727.64 ","$0.00 ","$3,686.00 ","$1,658.70 ","$0.00 ","$768.25 ","$2,630.70 ","$2,630.70 ","$645.39 ","$3,686.00 ","$0.00 ","$1,843.00 ","$2,919.31 ","$2,948.80 ","$0.00 ","$576.86 ","$0.00 ","$586.81 ","$0.00 "
"27803882","EAP","HCPCS C1760","","Sph100620-20 Microcoil Platinu","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$1,748.25 ","$0.00 ","$809.73 ","$2,772.72 ","$2,772.72 ","$680.23 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$608.00 ","$0.00 ","$618.49 ","$0.00 "
"27803883","EAP","HCPCS C1760","","Sph100700-20 Microcoil Platinu","BOTH IP/OP","$3,770.00 ","$2,789.80 ","$0.00 ","$3,770.00 ","$1,696.50 ","$0.00 ","$785.76 ","$2,690.65 ","$2,690.65 ","$660.10 ","$3,770.00 ","$0.00 ","$1,885.00 ","$2,985.84 ","$3,016.00 ","$0.00 ","$590.01 ","$0.00 ","$600.18 ","$0.00 "
"27803884","EAP","HCPCS C1760","","Sph100720-20 Microcoil Platinu","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$1,748.25 ","$0.00 ","$809.73 ","$2,772.72 ","$2,772.72 ","$680.23 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$608.00 ","$0.00 ","$618.49 ","$0.00 "
"27803885","EAP","HCPCS C1760","","Sph100800-20 Microil Platinum","BOTH IP/OP","$3,819.00 ","$2,826.06 ","$0.00 ","$3,819.00 ","$1,718.55 ","$0.00 ","$795.98 ","$2,725.62 ","$2,725.62 ","$668.68 ","$3,819.00 ","$0.00 ","$1,909.50 ","$3,024.65 ","$3,055.20 ","$0.00 ","$597.67 ","$0.00 ","$607.98 ","$0.00 "
"27803886","EAP","HCPCS C1760","","Sph100825-20 Microcoil Platinu","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$1,793.70 ","$0.00 ","$830.78 ","$2,844.81 ","$2,844.81 ","$697.92 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$623.81 ","$0.00 ","$634.57 ","$0.00 "
"27803887","EAP","HCPCS C1760","","Sph100925-20 Microcoil Platinu","BOTH IP/OP","$3,986.00 ","$2,949.64 ","$0.00 ","$3,986.00 ","$1,793.70 ","$0.00 ","$830.78 ","$2,844.81 ","$2,844.81 ","$697.92 ","$3,986.00 ","$0.00 ","$1,993.00 ","$3,156.91 ","$3,188.80 ","$0.00 ","$623.81 ","$0.00 ","$634.57 ","$0.00 "
"27803888","EAP","HCPCS C1760","","Sph101000-20 Microcoil Platinu","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$1,748.25 ","$0.00 ","$809.73 ","$2,772.72 ","$2,772.72 ","$680.23 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$608.00 ","$0.00 ","$618.49 ","$0.00 "
"27803889","EAP","HCPCS C1760","","Sph181100-20 Microcoil Platinu","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$1,748.25 ","$0.00 ","$809.73 ","$2,772.72 ","$2,772.72 ","$680.23 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$608.00 ","$0.00 ","$618.49 ","$0.00 "
"27803890","EAP","HCPCS C1760","","Sph181200-20 Microcoil Platinu","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$2,797.70 ","$2,797.70 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"27803891","EAP","HCPCS C1760","","Sph181300-20 Microcoil Platinu","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$2,797.70 ","$2,797.70 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"27803892","EAP","HCPCS C1760","","Sph181400-20 Microcoil Platinu","BOTH IP/OP","$3,955.00 ","$2,926.70 ","$0.00 ","$3,955.00 ","$1,779.75 ","$0.00 ","$824.32 ","$2,822.68 ","$2,822.68 ","$692.49 ","$3,955.00 ","$0.00 ","$1,977.50 ","$3,132.36 ","$3,164.00 ","$0.00 ","$618.96 ","$0.00 ","$629.64 ","$0.00 "
"27803893","EAP","HCPCS C1760","","Sph181500-20 Microcoil Platinu","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$1,802.25 ","$0.00 ","$834.74 ","$2,858.37 ","$2,858.37 ","$701.24 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$626.78 ","$0.00 ","$637.60 ","$0.00 "
"27803894","EAP","HCPCS C1760","","Sph181600-20 Microcoil Platinu","BOTH IP/OP","$4,020.00 ","$2,974.80 ","$0.00 ","$4,020.00 ","$1,809.00 ","$0.00 ","$837.87 ","$2,869.07 ","$2,869.07 ","$703.87 ","$4,020.00 ","$0.00 ","$2,010.00 ","$3,183.84 ","$3,216.00 ","$0.00 ","$629.13 ","$0.00 ","$639.98 ","$0.00 "
"27803895","EAP","HCPCS C1760","","Sph181700-20 Microcoil Platinu","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$1,831.95 ","$0.00 ","$848.50 ","$2,905.47 ","$2,905.47 ","$712.80 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$637.11 ","$0.00 ","$648.10 ","$0.00 "
"27803896","EAP","HCPCS C1760","","Sph181800-20 Microcoil Platinu","BOTH IP/OP","$4,071.00 ","$3,012.54 ","$0.00 ","$4,071.00 ","$1,831.95 ","$0.00 ","$848.50 ","$2,905.47 ","$2,905.47 ","$712.80 ","$4,071.00 ","$0.00 ","$2,035.50 ","$3,224.23 ","$3,256.80 ","$0.00 ","$637.11 ","$0.00 ","$648.10 ","$0.00 "
"27803897","EAP","HCPCS C1760","","Src140306-20 Microcoil Platinu","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$1,748.25 ","$0.00 ","$809.73 ","$2,772.72 ","$2,772.72 ","$680.23 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$608.00 ","$0.00 ","$618.49 ","$0.00 "
"27803898","EAP","HCPCS C1760","","Src140445-20microcoil Platinum","BOTH IP/OP","$3,885.00 ","$2,874.90 ","$0.00 ","$3,885.00 ","$1,748.25 ","$0.00 ","$809.73 ","$2,772.72 ","$2,772.72 ","$680.23 ","$3,885.00 ","$0.00 ","$1,942.50 ","$3,076.92 ","$3,108.00 ","$0.00 ","$608.00 ","$0.00 ","$618.49 ","$0.00 "
"27803899","EAP","HCPCS C1760","","Src140406-20 Microcoil Platinu","BOTH IP/OP","$3,903.00 ","$2,888.22 ","$0.00 ","$3,903.00 ","$1,756.35 ","$0.00 ","$813.48 ","$2,785.57 ","$2,785.57 ","$683.38 ","$3,903.00 ","$0.00 ","$1,951.50 ","$3,091.18 ","$3,122.40 ","$0.00 ","$610.82 ","$0.00 ","$621.36 ","$0.00 "
"27803900","EAP","HCPCS C1760","","Src140408-20 Microcoil Platinu","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$2,797.70 ","$2,797.70 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"27803901","EAP","HCPCS C1760","","Src140507-20 Microcoil Micrusp","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$2,797.70 ","$2,797.70 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"27803902","EAP","HCPCS C1760","","Src140512-20 Microcoil Platinu","BOTH IP/OP","$3,955.00 ","$2,926.70 ","$0.00 ","$3,955.00 ","$1,779.75 ","$0.00 ","$824.32 ","$2,822.68 ","$2,822.68 ","$692.49 ","$3,955.00 ","$0.00 ","$1,977.50 ","$3,132.36 ","$3,164.00 ","$0.00 ","$618.96 ","$0.00 ","$629.64 ","$0.00 "
"27803903","EAP","HCPCS C1760","","Src140609-20 Microcoil Platinu","BOTH IP/OP","$3,936.00 ","$2,912.64 ","$0.00 ","$3,936.00 ","$1,771.20 ","$0.00 ","$820.36 ","$2,809.12 ","$2,809.12 ","$689.16 ","$3,936.00 ","$0.00 ","$1,968.00 ","$3,117.31 ","$3,148.80 ","$0.00 ","$615.98 ","$0.00 ","$626.61 ","$0.00 "
"27803904","EAP","HCPCS C1760","","Src140615-20 Microcoil Plainum","BOTH IP/OP","$4,005.00 ","$2,963.70 ","$0.00 ","$4,005.00 ","$1,802.25 ","$0.00 ","$834.74 ","$2,858.37 ","$2,858.37 ","$701.24 ","$4,005.00 ","$0.00 ","$2,002.50 ","$3,171.96 ","$3,204.00 ","$0.00 ","$626.78 ","$0.00 ","$637.60 ","$0.00 "
"27803905","EAP","HCPCS C1760","","Src140711-20 Microcoil Platinu","BOTH IP/OP","$3,955.00 ","$2,926.70 ","$0.00 ","$3,955.00 ","$1,779.75 ","$0.00 ","$824.32 ","$2,822.68 ","$2,822.68 ","$692.49 ","$3,955.00 ","$0.00 ","$1,977.50 ","$3,132.36 ","$3,164.00 ","$0.00 ","$618.96 ","$0.00 ","$629.64 ","$0.00 "
"27803906","EAP","HCPCS C1760","","Src140717-20 Microcoil Platinu","BOTH IP/OP","$4,105.00 ","$3,037.70 ","$0.00 ","$4,105.00 ","$1,847.25 ","$0.00 ","$855.58 ","$2,929.74 ","$2,929.74 ","$718.75 ","$4,105.00 ","$0.00 ","$2,052.50 ","$3,251.16 ","$3,284.00 ","$0.00 ","$642.43 ","$0.00 ","$653.52 ","$0.00 "
"27803907","EAP","HCPCS C1760","","Src140812-20 Microcoil Platinu","BOTH IP/OP","$4,020.00 ","$2,974.80 ","$0.00 ","$4,020.00 ","$1,809.00 ","$0.00 ","$837.87 ","$2,869.07 ","$2,869.07 ","$703.87 ","$4,020.00 ","$0.00 ","$2,010.00 ","$3,183.84 ","$3,216.00 ","$0.00 ","$629.13 ","$0.00 ","$639.98 ","$0.00 "
"27803908","EAP","HCPCS C1760","","Src140820-20 Microcoil Platinu","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27803909","EAP","HCPCS C1760","","Src140922-20 Microcoil Platinu","BOTH IP/OP","$4,204.00 ","$3,110.96 ","$0.00 ","$4,204.00 ","$1,891.80 ","$0.00 ","$876.22 ","$3,000.39 ","$3,000.39 ","$736.09 ","$4,204.00 ","$0.00 ","$2,102.00 ","$3,329.57 ","$3,363.20 ","$0.00 ","$657.93 ","$0.00 ","$669.28 ","$0.00 "
"27803910","EAP","HCPCS C1760","","Src141016-20 Microcoil Platinu","BOTH IP/OP","$4,105.00 ","$3,037.70 ","$0.00 ","$4,105.00 ","$1,847.25 ","$0.00 ","$855.58 ","$2,929.74 ","$2,929.74 ","$718.75 ","$4,105.00 ","$0.00 ","$2,052.50 ","$3,251.16 ","$3,284.00 ","$0.00 ","$642.43 ","$0.00 ","$653.52 ","$0.00 "
"27803911","EAP","HCPCS C1760","","Src141025-20 Microcoil Platinu","BOTH IP/OP","$4,255.00 ","$3,148.70 ","$0.00 ","$4,255.00 ","$1,914.75 ","$0.00 ","$886.85 ","$3,036.79 ","$3,036.79 ","$745.02 ","$4,255.00 ","$0.00 ","$2,127.50 ","$3,369.96 ","$3,404.00 ","$0.00 ","$665.91 ","$0.00 ","$677.40 ","$0.00 "
"27803912","EAP","HCPCS C1760","","Src141118-20 Microcoil Platinu","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$4,170.00 ","$1,876.50 ","$0.00 ","$869.13 ","$2,976.13 ","$2,976.13 ","$730.13 ","$4,170.00 ","$0.00 ","$2,085.00 ","$3,302.64 ","$3,336.00 ","$0.00 ","$652.61 ","$0.00 ","$663.86 ","$0.00 "
"27803913","EAP","HCPCS C1760","","Src141127-20 Microcoil Platinu","BOTH IP/OP","$4,304.00 ","$3,184.96 ","$0.00 ","$4,304.00 ","$1,936.80 ","$0.00 ","$897.06 ","$3,071.76 ","$3,071.76 ","$753.60 ","$4,304.00 ","$0.00 ","$2,152.00 ","$3,408.77 ","$3,443.20 ","$0.00 ","$673.58 ","$0.00 ","$685.20 ","$0.00 "
"27803914","EAP","HCPCS C1760","","Src141219-20 Microcoil [platin","BOTH IP/OP","$4,204.00 ","$3,110.96 ","$0.00 ","$4,204.00 ","$1,891.80 ","$0.00 ","$876.22 ","$3,000.39 ","$3,000.39 ","$736.09 ","$4,204.00 ","$0.00 ","$2,102.00 ","$3,329.57 ","$3,363.20 ","$0.00 ","$657.93 ","$0.00 ","$669.28 ","$0.00 "
"27803915","EAP","HCPCS C1760","","Src141230-20 Microcoil Platinu","BOTH IP/OP","$4,355.00 ","$3,222.70 ","$0.00 ","$4,355.00 ","$1,959.75 ","$0.00 ","$907.69 ","$3,108.16 ","$3,108.16 ","$762.53 ","$4,355.00 ","$0.00 ","$2,177.50 ","$3,449.16 ","$3,484.00 ","$0.00 ","$681.56 ","$0.00 ","$693.32 ","$0.00 "
"27803916","EAP","HCPCS C1760","","Fsr100201-20 Microcoil Platinu","BOTH IP/OP","$3,135.00 ","$2,319.90 ","$0.00 ","$3,135.00 ","$1,410.75 ","$0.00 ","$653.41 ","$2,237.45 ","$2,237.45 ","$548.91 ","$3,135.00 ","$0.00 ","$1,567.50 ","$2,482.92 ","$2,508.00 ","$0.00 ","$490.63 ","$0.00 ","$499.09 ","$0.00 "
"27803917","EAP","HCPCS C1760","","Fsr100202-20 Microcoil Platinu","BOTH IP/OP","$3,169.00 ","$2,345.06 ","$0.00 ","$3,169.00 ","$1,426.05 ","$0.00 ","$660.50 ","$2,261.72 ","$2,261.72 ","$554.87 ","$3,169.00 ","$0.00 ","$1,584.50 ","$2,509.85 ","$2,535.20 ","$0.00 ","$495.95 ","$0.00 ","$504.50 ","$0.00 "
"27803918","EAP","HCPCS C1760","","Fsr100203-20 Microcoil Platinu","BOTH IP/OP","$3,186.00 ","$2,357.64 ","$0.00 ","$3,186.00 ","$1,433.70 ","$0.00 ","$664.04 ","$2,273.85 ","$2,273.85 ","$557.84 ","$3,186.00 ","$0.00 ","$1,593.00 ","$2,523.31 ","$2,548.80 ","$0.00 ","$498.61 ","$0.00 ","$507.21 ","$0.00 "
"27803919","EAP","HCPCS C1760","","Frs100204-20 Microcoil Platinu","BOTH IP/OP","$3,203.00 ","$2,370.22 ","$0.00 ","$3,203.00 ","$1,441.35 ","$0.00 ","$667.59 ","$2,285.98 ","$2,285.98 ","$560.82 ","$3,203.00 ","$0.00 ","$1,601.50 ","$2,536.78 ","$2,562.40 ","$0.00 ","$501.27 ","$0.00 ","$509.92 ","$0.00 "
"27803920","EAP","HCPCS C1760","","Fsr100206-20 Microcoil Platinu","BOTH IP/OP","$3,236.00 ","$2,394.64 ","$0.00 ","$3,236.00 ","$1,456.20 ","$0.00 ","$674.46 ","$2,309.53 ","$2,309.53 ","$566.60 ","$3,236.00 ","$0.00 ","$1,618.00 ","$2,562.91 ","$2,588.80 ","$0.00 ","$506.43 ","$0.00 ","$515.17 ","$0.00 "
"27803921","EAP","HCPCS C1760","","Fsr100208-20 Microcoil Platinu","BOTH IP/OP","$3,270.00 ","$2,419.80 ","$0.00 ","$3,270.00 ","$1,471.50 ","$0.00 ","$681.55 ","$2,333.80 ","$2,333.80 ","$572.55 ","$3,270.00 ","$0.00 ","$1,635.00 ","$2,589.84 ","$2,616.00 ","$0.00 ","$511.76 ","$0.00 ","$520.58 ","$0.00 "
"27803922","EAP","HCPCS C1760","","Fsr100252-20 Microcoil Platinu","BOTH IP/OP","$3,169.00 ","$2,345.06 ","$0.00 ","$3,169.00 ","$1,426.05 ","$0.00 ","$660.50 ","$2,261.72 ","$2,261.72 ","$554.87 ","$3,169.00 ","$0.00 ","$1,584.50 ","$2,509.85 ","$2,535.20 ","$0.00 ","$495.95 ","$0.00 ","$504.50 ","$0.00 "
"27803923","EAP","HCPCS C1760","","Fsr100254-20 Microcoil Platinu","BOTH IP/OP","$3,203.00 ","$2,370.22 ","$0.00 ","$3,203.00 ","$1,441.35 ","$0.00 ","$667.59 ","$2,285.98 ","$2,285.98 ","$560.82 ","$3,203.00 ","$0.00 ","$1,601.50 ","$2,536.78 ","$2,562.40 ","$0.00 ","$501.27 ","$0.00 ","$509.92 ","$0.00 "
"27803924","EAP","HCPCS C1760","","Fsr100256-20 Microcoil Platinu","BOTH IP/OP","$3,236.00 ","$2,394.64 ","$0.00 ","$3,236.00 ","$1,456.20 ","$0.00 ","$674.46 ","$2,309.53 ","$2,309.53 ","$566.60 ","$3,236.00 ","$0.00 ","$1,618.00 ","$2,562.91 ","$2,588.80 ","$0.00 ","$506.43 ","$0.00 ","$515.17 ","$0.00 "
"27803925","EAP","HCPCS C1760","","Fsr100258-20 Microcoil Platinu","BOTH IP/OP","$3,270.00 ","$2,419.80 ","$0.00 ","$3,270.00 ","$1,471.50 ","$0.00 ","$681.55 ","$2,333.80 ","$2,333.80 ","$572.55 ","$3,270.00 ","$0.00 ","$1,635.00 ","$2,589.84 ","$2,616.00 ","$0.00 ","$511.76 ","$0.00 ","$520.58 ","$0.00 "
"27803926","EAP","HCPCS C1760","","Fsr100306-20 Microcoil Platinu","BOTH IP/OP","$3,236.00 ","$2,394.64 ","$0.00 ","$3,236.00 ","$1,456.20 ","$0.00 ","$674.46 ","$2,309.53 ","$2,309.53 ","$566.60 ","$3,236.00 ","$0.00 ","$1,618.00 ","$2,562.91 ","$2,588.80 ","$0.00 ","$506.43 ","$0.00 ","$515.17 ","$0.00 "
"27803927","EAP","HCPCS C1760","","Fsr100308-20 Microcoil Platinu","BOTH IP/OP","$3,270.00 ","$2,419.80 ","$0.00 ","$3,270.00 ","$1,471.50 ","$0.00 ","$681.55 ","$2,333.80 ","$2,333.80 ","$572.55 ","$3,270.00 ","$0.00 ","$1,635.00 ","$2,589.84 ","$2,616.00 ","$0.00 ","$511.76 ","$0.00 ","$520.58 ","$0.00 "
"27803928","EAP","HCPCS C1760","","Fsr100406-20 Microcoil Platinu","BOTH IP/OP","$3,236.00 ","$2,394.64 ","$0.00 ","$3,236.00 ","$1,456.20 ","$0.00 ","$674.46 ","$2,309.53 ","$2,309.53 ","$566.60 ","$3,236.00 ","$0.00 ","$1,618.00 ","$2,562.91 ","$2,588.80 ","$0.00 ","$506.43 ","$0.00 ","$515.17 ","$0.00 "
"27803929","EAP","HCPCS C1760","","Fsr100408-20 Microcoil Platinu","BOTH IP/OP","$3,270.00 ","$2,419.80 ","$0.00 ","$3,270.00 ","$1,471.50 ","$0.00 ","$681.55 ","$2,333.80 ","$2,333.80 ","$572.55 ","$3,270.00 ","$0.00 ","$1,635.00 ","$2,589.84 ","$2,616.00 ","$0.00 ","$511.76 ","$0.00 ","$520.58 ","$0.00 "
"27803940","EAP","HCPCS C1888","","Endovascular Laser Catheter, Abl","BOTH IP/OP","$1,226.00 ","$907.24 ","$0.00 ","$1,226.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$875.00 ","$0.00 ","$1,226.00 ","$0.00 ","$613.00 ","$970.99 ","$980.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27803941","EAP","HCPCS C1874","","Viator Stent 10 X 4","BOTH IP/OP","$11,885.00 ","$8,794.90 ","$0.00 ","$11,885.00 ","$5,348.25 ","$0.00 ","$2,477.13 ","$5,158.80 ","$8,482.32 ","$2,080.97 ","$11,885.00 ","$0.00 ","$5,942.50 ","$9,412.92 ","$9,508.00 ","$0.00 ","$1,860.00 ","$0.00 ","$1,892.09 ","$0.00 "
"27803942","EAP","HCPCS C1874","","Viator Stent 10 X 5","BOTH IP/OP","$11,885.00 ","$8,794.90 ","$0.00 ","$11,885.00 ","$5,348.25 ","$0.00 ","$2,477.13 ","$5,158.80 ","$8,482.32 ","$2,080.97 ","$11,885.00 ","$0.00 ","$5,942.50 ","$9,412.92 ","$9,508.00 ","$0.00 ","$1,860.00 ","$0.00 ","$1,892.09 ","$0.00 "
"27803943","EAP","HCPCS C1874","","Viator Stent 10 X 6","BOTH IP/OP","$11,885.00 ","$8,794.90 ","$0.00 ","$11,885.00 ","$5,348.25 ","$0.00 ","$2,477.13 ","$5,158.80 ","$8,482.32 ","$2,080.97 ","$11,885.00 ","$0.00 ","$5,942.50 ","$9,412.92 ","$9,508.00 ","$0.00 ","$1,860.00 ","$0.00 ","$1,892.09 ","$0.00 "
"27803944","EAP","HCPCS C1874","","Viator Stent 10 X 7","BOTH IP/OP","$11,885.00 ","$8,794.90 ","$0.00 ","$11,885.00 ","$5,348.25 ","$0.00 ","$2,477.13 ","$5,158.80 ","$8,482.32 ","$2,080.97 ","$11,885.00 ","$0.00 ","$5,942.50 ","$9,412.92 ","$9,508.00 ","$0.00 ","$1,860.00 ","$0.00 ","$1,892.09 ","$0.00 "
"27803945","EAP","HCPCS C1874","","Viator Stent 10 X 8","BOTH IP/OP","$11,885.00 ","$8,794.90 ","$0.00 ","$11,885.00 ","$5,348.25 ","$0.00 ","$2,477.13 ","$5,158.80 ","$8,482.32 ","$2,080.97 ","$11,885.00 ","$0.00 ","$5,942.50 ","$9,412.92 ","$9,508.00 ","$0.00 ","$1,860.00 ","$0.00 ","$1,892.09 ","$0.00 "
"27803950","EAP","HCPCS V2790","","Prokera (amniograft) Ring 16mm","BOTH IP/OP","$3,167.00 ","$2,343.58 ","$0.00 ","$3,167.00 ","$1,425.15 ","$0.00 ","$660.08 ","$2,260.29 ","$2,260.29 ","$554.52 ","$3,167.00 ","$0.00 ","$1,583.50 ","$2,508.26 ","$2,533.60 ","$0.00 ","$495.64 ","$0.00 ","$504.19 ","$0.00 "
"27803951","EAP","HCPCS C1882","","Crt-d 40 Unify (icd)","BOTH IP/OP","$89,408.00 ","$66,161.92 ","$0.00 ","$89,408.00 ","$40,233.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$63,810.49 ","$8,138.89 ","$89,408.00 ","$0.00 ","$44,704.00 ","$70,811.14 ","$71,526.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27803952","EAP","HCPCS C1722","","Fortify Icd-vr40","BOTH IP/OP","$60,048.00 ","$44,435.52 ","$0.00 ","$60,048.00 ","$27,021.60 ","$0.00 ","$9,417.94 ","$5,158.80 ","$42,856.26 ","$8,138.89 ","$60,048.00 ","$0.00 ","$30,024.00 ","$47,558.02 ","$48,038.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27803960","EAP","HCPCS C1886","","Catheter, Ablation","BOTH IP/OP","$310.00 ","$229.40 ","$0.00 ","$310.00 ","$139.50 ","$0.00 ","$64.61 ","$221.25 ","$221.25 ","$54.28 ","$310.00 ","$0.00 ","$155.00 ","$245.52 ","$248.00 ","$0.00 ","$48.52 ","$0.00 ","$49.35 ","$0.00 "
"27803961","EAP","HCPCS C2617","","Gore Viatorr Tips Endoprosthesis 4cm X  2cm X12mm","BOTH IP/OP","$4,843.00 ","$3,583.82 ","$0.00 ","$4,843.00 ","$2,179.35 ","$0.00 ","$1,009.40 ","$3,456.45 ","$3,456.45 ","$847.97 ","$4,843.00 ","$0.00 ","$2,421.50 ","$3,835.66 ","$3,874.40 ","$0.00 ","$757.93 ","$0.00 ","$771.01 ","$0.00 "
"27803962","EAP","HCPCS C2617","","Gore Viatorr Tips Endoprosthesis 6cm X 2cm X 12mm","BOTH IP/OP","$4,843.00 ","$3,583.82 ","$0.00 ","$4,843.00 ","$2,179.35 ","$0.00 ","$1,009.40 ","$3,456.45 ","$3,456.45 ","$847.97 ","$4,843.00 ","$0.00 ","$2,421.50 ","$3,835.66 ","$3,874.40 ","$0.00 ","$757.93 ","$0.00 ","$771.01 ","$0.00 "
"27803963","EAP","HCPCS C2617","","Gore Viatorr Tips Endoprosthesis 8cm X 2cm X 12mm","BOTH IP/OP","$4,843.00 ","$3,583.82 ","$0.00 ","$4,843.00 ","$2,179.35 ","$0.00 ","$1,009.40 ","$3,456.45 ","$3,456.45 ","$847.97 ","$4,843.00 ","$0.00 ","$2,421.50 ","$3,835.66 ","$3,874.40 ","$0.00 ","$757.93 ","$0.00 ","$771.01 ","$0.00 "
"27803964","EAP","HCPCS C2617","","Gore Viabil Endoprosthesis 10mm X 4cm X 40cm","BOTH IP/OP","$3,216.00 ","$2,379.84 ","$0.00 ","$3,216.00 ","$1,447.20 ","$0.00 ","$670.29 ","$2,295.26 ","$2,295.26 ","$563.10 ","$3,216.00 ","$0.00 ","$1,608.00 ","$2,547.07 ","$2,572.80 ","$0.00 ","$503.30 ","$0.00 ","$511.99 ","$0.00 "
"27803965","EAP","HCPCS C2617","","Gore Viabil Endoprosthesis 10mm X 6cm X 40cm","BOTH IP/OP","$3,216.00 ","$2,379.84 ","$0.00 ","$3,216.00 ","$1,447.20 ","$0.00 ","$670.29 ","$2,295.26 ","$2,295.26 ","$563.10 ","$3,216.00 ","$0.00 ","$1,608.00 ","$2,547.07 ","$2,572.80 ","$0.00 ","$503.30 ","$0.00 ","$511.99 ","$0.00 "
"27803966","EAP","HCPCS C2617","","Gore Viabil Endoprosthesis 10mm X 8cm X 40cm","BOTH IP/OP","$3,216.00 ","$2,379.84 ","$0.00 ","$3,216.00 ","$1,746.29 ","$0.00 ","$670.29 ","$2,295.26 ","$2,295.26 ","$563.10 ","$3,216.00 ","$0.00 ","$1,608.00 ","$2,547.07 ","$2,572.80 ","$0.00 ","$503.30 ","$0.00 ","$511.99 ","$0.00 "
"27803967","EAP","HCPCS C2617","","Gore Viabil Endoprosthesis 10mm X 10cm X 40cm","BOTH IP/OP","$3,216.00 ","$2,379.84 ","$0.00 ","$3,216.00 ","$1,447.20 ","$0.00 ","$670.29 ","$2,295.26 ","$2,295.26 ","$563.10 ","$3,216.00 ","$0.00 ","$1,608.00 ","$2,547.07 ","$2,572.80 ","$0.00 ","$503.30 ","$0.00 ","$511.99 ","$0.00 "
"27803968","EAP","HCPCS C1713","","Amplatz Anchor System 8 X 30","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$52.65 ","$0.00 ","$24.39 ","$83.50 ","$83.50 ","$20.49 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$18.31 ","$0.00 ","$18.63 ","$0.00 "
"27803969","EAP","HCPCS C1713","","Amplatz Anchor System 10 X 30","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$52.65 ","$0.00 ","$24.39 ","$83.50 ","$83.50 ","$20.49 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$18.31 ","$0.00 ","$18.63 ","$0.00 "
"27803970","EAP","HCPCS C1876","","M001711300  Stent Wall 6fr 8/80/75cm","BOTH IP/OP","$4,931.00 ","$3,648.94 ","$0.00 ","$4,931.00 ","$2,218.95 ","$0.00 ","$1,027.74 ","$3,519.25 ","$3,519.25 ","$863.38 ","$4,931.00 ","$0.00 ","$2,465.50 ","$3,905.35 ","$3,944.80 ","$0.00 ","$771.70 ","$0.00 ","$785.02 ","$0.00 "
"27803971","EAP","HCPCS C1894","","Retriever Merci L6 90060","BOTH IP/OP","$10,536.00 ","$7,796.64 ","$0.00 ","$10,536.00 ","$4,741.20 ","$0.00 ","$2,195.97 ","$5,158.80 ","$7,519.54 ","$1,844.77 ","$10,536.00 ","$0.00 ","$5,268.00 ","$8,344.51 ","$8,428.80 ","$0.00 ","$1,648.88 ","$0.00 ","$1,677.33 ","$0.00 "
"27804055","EAP","HCPCS C1874","","Test Name New","BOTH IP/OP","$7,990.00 ","$5,912.60 ","$0.00 ","$7,990.00 ","$3,595.50 ","$0.00 ","$1,665.32 ","$5,158.80 ","$5,702.46 ","$1,398.99 ","$7,990.00 ","$0.00 ","$3,995.00 ","$6,328.08 ","$6,392.00 ","$0.00 ","$1,250.44 ","$0.00 ","$1,272.01 ","$0.00 "
"27804056","EAP","Custom 27804056","","Retriever Mercl L6, 90060","BOTH IP/OP","$10,536.00 ","$7,796.64 ","$0.00 ","$10,536.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$7,519.54 ","$0.00 ","$10,536.00 ","$0.00 ","$5,268.00 ","$8,344.51 ","$8,428.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804060","EAP","HCPCS C1764","","Implantable Cardiac Monitor, Confirm Ic","BOTH IP/OP","$11,676.00 ","$8,640.24 ","$0.00 ","$11,676.00 ","$5,254.20 ","$0.00 ","$2,433.57 ","$5,158.80 ","$8,333.16 ","$2,044.37 ","$11,676.00 ","$0.00 ","$5,838.00 ","$9,247.39 ","$9,340.80 ","$0.00 ","$1,827.29 ","$0.00 ","$1,858.82 ","$0.00 "
"27804067","EAP","HCPCS C1880","","Md800f Filter Peripheral Vena Cava Femoral","BOTH IP/OP","$2,933.00 ","$2,170.42 ","$0.00 ","$2,933.00 ","$1,319.85 ","$0.00 ","$611.31 ","$2,093.28 ","$2,093.28 ","$513.54 ","$2,933.00 ","$0.00 ","$1,466.50 ","$2,322.94 ","$2,346.40 ","$0.00 ","$459.01 ","$0.00 ","$466.93 ","$0.00 "
"27804068","EAP","HCPCS C1880","","Md800j Filter Peripheral Vena Cava Jugular","BOTH IP/OP","$3,080.00 ","$2,279.20 ","$0.00 ","$3,080.00 ","$1,386.00 ","$0.00 ","$641.95 ","$2,198.20 ","$2,198.20 ","$539.28 ","$3,080.00 ","$0.00 ","$1,540.00 ","$2,439.36 ","$2,464.00 ","$0.00 ","$482.02 ","$0.00 ","$490.34 ","$0.00 "
"27804070","EAP","HCPCS C1757","","Sfr-4-15 Device Thrombectomy Solitaire Fr 4x15","BOTH IP/OP","$18,930.00 ","$14,008.20 ","$0.00 ","$18,930.00 ","$8,518.50 ","$0.00 ","$3,945.49 ","$5,158.80 ","$13,510.34 ","$0.00 ","$18,930.00 ","$0.00 ","$9,465.00 ","$14,992.56 ","$15,144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804071","EAP","HCPCS C1757","","Sfr-4-20 Device Thrombectomy Solitaire Fr 4x20","BOTH IP/OP","$18,930.00 ","$14,008.20 ","$0.00 ","$18,930.00 ","$8,518.50 ","$0.00 ","$3,945.49 ","$5,158.80 ","$13,510.34 ","$0.00 ","$18,930.00 ","$0.00 ","$9,465.00 ","$14,992.56 ","$15,144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804072","EAP","HCPCS C1757","","Sfr-6-20 Device Thrombectomy Solitaire Fr 6x20","BOTH IP/OP","$18,930.00 ","$14,008.20 ","$0.00 ","$18,930.00 ","$8,518.50 ","$0.00 ","$3,945.49 ","$5,158.80 ","$13,510.34 ","$0.00 ","$18,930.00 ","$0.00 ","$9,465.00 ","$14,992.56 ","$15,144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804073","EAP","HCPCS C1757","","Sfr-6-30 Device Thrombectomy Solitaire Fr 6x30","BOTH IP/OP","$18,930.00 ","$14,008.20 ","$0.00 ","$18,930.00 ","$8,518.50 ","$0.00 ","$3,945.49 ","$5,158.80 ","$13,510.34 ","$0.00 ","$18,930.00 ","$0.00 ","$9,465.00 ","$14,992.56 ","$15,144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804080","EAP","Custom 27804080","","G08261 Embolization Coil","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$198.41 ","$198.41 ","$0.00 ","$278.00 ","$0.00 ","$139.00 ","$220.18 ","$222.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804088","EAP","HCPCS C1777","","Reliance Df4 Lead, Aicd, Endo Single Coil","BOTH IP/OP","$13,964.00 ","$10,333.36 ","$0.00 ","$13,964.00 ","$6,283.80 ","$0.00 ","$2,910.45 ","$5,158.80 ","$9,966.11 ","$2,444.98 ","$13,964.00 ","$0.00 ","$6,982.00 ","$11,059.49 ","$11,171.20 ","$0.00 ","$2,185.37 ","$0.00 ","$2,223.07 ","$0.00 "
"27804089","EAP","HCPCS C1777","","Reliance Gore Df4 Lead,aicd, Endo Single Coil","BOTH IP/OP","$13,964.00 ","$10,333.36 ","$0.00 ","$13,964.00 ","$6,283.80 ","$0.00 ","$2,910.45 ","$5,158.80 ","$9,966.11 ","$2,444.98 ","$13,964.00 ","$0.00 ","$6,982.00 ","$11,059.49 ","$11,171.20 ","$0.00 ","$2,185.37 ","$0.00 ","$2,223.07 ","$0.00 "
"27804090","EAP","HCPCS C1882","","Energen Df4 Crt-d Aicd, Other Than Sing/dual","BOTH IP/OP","$68,273.00 ","$50,522.02 ","$0.00 ","$68,273.00 ","$30,722.85 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,726.44 ","$8,138.89 ","$68,273.00 ","$0.00 ","$34,136.50 ","$54,072.22 ","$54,618.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27804091","EAP","HCPCS C1882","","Energen Crt-d Aicd, Other Than Sing/dual","BOTH IP/OP","$68,273.00 ","$50,522.02 ","$0.00 ","$68,273.00 ","$30,722.85 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,726.44 ","$8,138.89 ","$68,273.00 ","$0.00 ","$34,136.50 ","$54,072.22 ","$54,618.40 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27804092","EAP","HCPCS C1882","","Unify Quadra Aicd, Other Than Sing/dual","BOTH IP/OP","$89,376.00 ","$66,138.24 ","$0.00 ","$89,376.00 ","$40,219.20 ","$0.00 ","$9,417.94 ","$5,158.80 ","$63,787.65 ","$8,138.89 ","$89,376.00 ","$0.00 ","$44,688.00 ","$70,785.79 ","$71,500.80 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27804093","EAP","HCPCS C1898","","Tc-1888 Tendril Lead Pmkr, Other Than Trans","BOTH IP/OP","$1,551.00 ","$1,147.74 ","$0.00 ","$1,551.00 ","$697.95 ","$0.00 ","$323.27 ","$1,106.95 ","$1,106.95 ","$271.57 ","$1,551.00 ","$0.00 ","$775.50 ","$1,228.39 ","$1,240.80 ","$0.00 ","$242.73 ","$0.00 ","$246.92 ","$0.00 "
"27804094","EAP","HCPCS C1900","","Q-1458 Quartet Lead, Aicd, Endo Single Coil","BOTH IP/OP","$8,566.00 ","$6,338.84 ","$0.00 ","$8,566.00 ","$3,854.70 ","$0.00 ","$1,785.37 ","$5,158.80 ","$6,113.55 ","$0.00 ","$8,566.00 ","$0.00 ","$4,283.00 ","$6,784.27 ","$6,852.80 ","$0.00 ","$1,340.58 ","$0.00 ","$0.00 ","$0.00 "
"27804098","EAP","HCPCS C1876","","Enterprise 22mm Stent No-tip","BOTH IP/OP","$16,138.00 ","$11,942.12 ","$0.00 ","$16,138.00 ","$7,262.10 ","$0.00 ","$3,363.56 ","$5,158.80 ","$11,517.69 ","$2,825.63 ","$16,138.00 ","$0.00 ","$8,069.00 ","$12,781.30 ","$12,910.40 ","$0.00 ","$2,525.60 ","$0.00 ","$2,569.17 ","$0.00 "
"27804099","EAP","HCPCS C1876","","Enterprise 38mm Stent No-tip","BOTH IP/OP","$16,138.00 ","$11,942.12 ","$0.00 ","$16,138.00 ","$7,262.10 ","$0.00 ","$3,363.56 ","$5,158.80 ","$11,517.69 ","$2,825.63 ","$16,138.00 ","$0.00 ","$8,069.00 ","$12,781.30 ","$12,910.40 ","$0.00 ","$2,525.60 ","$0.00 ","$2,569.17 ","$0.00 "
"27804100","EAP","HCPCS C1876","","Enterprise 37mm Stent No-tip","BOTH IP/OP","$16,138.00 ","$11,942.12 ","$0.00 ","$16,138.00 ","$7,262.10 ","$0.00 ","$3,363.56 ","$5,158.80 ","$11,517.69 ","$2,825.63 ","$16,138.00 ","$0.00 ","$8,069.00 ","$12,781.30 ","$12,910.40 ","$0.00 ","$2,525.60 ","$0.00 ","$2,569.17 ","$0.00 "
"27804103","EAP","Custom 27804103","","Px 400,straight","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.96 ","$1,961.96 ","$0.00 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804104","EAP","Custom 27804104","","Px 400, 45","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.96 ","$1,961.96 ","$0.00 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804105","EAP","Custom 27804105","","Px 400, J","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.96 ","$1,961.96 ","$0.00 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804106","EAP","Custom 27804106","","Start Up Kit","BOTH IP/OP","$798.00 ","$590.52 ","$0.00 ","$798.00 ","$0.00 ","$0.00 ","$0.00 ","$569.53 ","$569.53 ","$0.00 ","$798.00 ","$0.00 ","$399.00 ","$632.02 ","$638.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804107","EAP","Custom 27804107","","Senor Flotrac","BOTH IP/OP","$993.00 ","$734.82 ","$0.00 ","$993.00 ","$0.00 ","$0.00 ","$0.00 ","$708.70 ","$708.70 ","$0.00 ","$993.00 ","$0.00 ","$496.50 ","$786.46 ","$794.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804108","EAP","Custom 27804108","","Coil 400 Complex Standard, 15mm X 57cm","BOTH IP/OP","$7,642.00 ","$5,655.08 ","$0.00 ","$7,642.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,454.10 ","$0.00 ","$7,642.00 ","$0.00 ","$3,821.00 ","$6,052.46 ","$6,113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804109","EAP","Custom 27804109","","Coil 400 Complex Standard, 16mm X 60cm","BOTH IP/OP","$7,685.00 ","$5,686.90 ","$0.00 ","$7,685.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,484.78 ","$0.00 ","$7,685.00 ","$0.00 ","$3,842.50 ","$6,086.52 ","$6,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804110","EAP","HCPCS C1752","","Cath. Schon(5615200) Xl Sil. 035 In L20 Cm Guidewire Inr","BOTH IP/OP","$571.00 ","$422.54 ","$0.00 ","$571.00 ","$0.00 ","$0.00 ","$0.00 ","$407.52 ","$407.52 ","$0.00 ","$571.00 ","$0.00 ","$285.50 ","$452.23 ","$456.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804111","EAP","HCPCS C1752","","Cath. Schon(5615150) Xl Silicone .035 In L15 Cm Guidewir","BOTH IP/OP","$544.00 ","$402.56 ","$0.00 ","$544.00 ","$0.00 ","$0.00 ","$0.00 ","$388.25 ","$388.25 ","$0.00 ","$544.00 ","$0.00 ","$272.00 ","$430.85 ","$435.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804112","EAP","HCPCS C1752","","Cath. Schon(5605300) 30cm Full Hemo","BOTH IP/OP","$571.00 ","$422.54 ","$0.00 ","$571.00 ","$0.00 ","$0.00 ","$0.00 ","$407.52 ","$407.52 ","$0.00 ","$571.00 ","$0.00 ","$285.50 ","$452.23 ","$456.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804113","EAP","HCPCS A4648","","Implantable Tissue Marker","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$520.00 ","$234.00 ","$0.00 ","$108.38 ","$371.12 ","$371.12 ","$91.05 ","$520.00 ","$0.00 ","$260.00 ","$411.84 ","$416.00 ","$0.00 ","$81.38 ","$0.00 ","$82.78 ","$0.00 "
"27804116","EAP","Custom 27804116","","Coil 400 Complex Standard, 18mm X 57cm","BOTH IP/OP","$7,642.00 ","$5,655.08 ","$0.00 ","$7,642.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,454.10 ","$0.00 ","$7,642.00 ","$0.00 ","$3,821.00 ","$6,052.46 ","$6,113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804117","EAP","Custom 27804117","","Coil 400 Complex Standard, 20mm X 60cm","BOTH IP/OP","$7,685.00 ","$5,686.90 ","$0.00 ","$7,685.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,484.78 ","$0.00 ","$7,685.00 ","$0.00 ","$3,842.50 ","$6,086.52 ","$6,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804118","EAP","Custom 27804118","","Coil 400 Complex Standard, 22mm X 60cm","BOTH IP/OP","$7,685.00 ","$5,686.90 ","$0.00 ","$7,685.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,484.78 ","$0.00 ","$7,685.00 ","$0.00 ","$3,842.50 ","$6,086.52 ","$6,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804119","EAP","Custom 27804119","","Coil 400 Complex Standard, 24mm X 57cm","BOTH IP/OP","$7,642.00 ","$5,655.08 ","$0.00 ","$7,642.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,454.10 ","$0.00 ","$7,642.00 ","$0.00 ","$3,821.00 ","$6,052.46 ","$6,113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804120","EAP","Custom 27804120","","Coil 400 Complex Standard, 28mm X 60 Cm","BOTH IP/OP","$8,572.00 ","$6,343.28 ","$0.00 ","$8,572.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,117.84 ","$0.00 ","$8,572.00 ","$0.00 ","$4,286.00 ","$6,789.02 ","$6,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804121","EAP","Custom 27804121","","Px 400 90","BOTH IP/OP","$2,749.00 ","$2,034.26 ","$0.00 ","$2,749.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.96 ","$1,961.96 ","$0.00 ","$2,749.00 ","$0.00 ","$1,374.50 ","$2,177.21 ","$2,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804122","EAP","Custom 27804122","","Coil 400 Complex Standard, 32mm X 60 Cm","BOTH IP/OP","$8,572.00 ","$6,343.28 ","$0.00 ","$8,572.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,117.84 ","$0.00 ","$8,572.00 ","$0.00 ","$4,286.00 ","$6,789.02 ","$6,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804123","EAP","Custom 27804123","","Coil 400 Complex Soft, 3 Mm X 3 Cm","BOTH IP/OP","$7,034.00 ","$5,205.16 ","$0.00 ","$7,034.00 ","$0.00 ","$0.00 ","$0.00 ","$5,020.17 ","$5,020.17 ","$0.00 ","$7,034.00 ","$0.00 ","$3,517.00 ","$5,570.93 ","$5,627.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804124","EAP","Custom 27804124","","Coil 400 Complex Extra Soft, 4mm X 10cm","BOTH IP/OP","$8,157.00 ","$6,036.18 ","$0.00 ","$8,157.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,821.65 ","$0.00 ","$8,157.00 ","$0.00 ","$4,078.50 ","$6,460.34 ","$6,525.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804125","EAP","Custom 27804125","","Coil 400 Complex Soft, 13mm X 35cm","BOTH IP/OP","$7,980.00 ","$5,905.20 ","$0.00 ","$7,980.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,695.33 ","$0.00 ","$7,980.00 ","$0.00 ","$3,990.00 ","$6,320.16 ","$6,384.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804126","EAP","Custom 27804126","","Coil 400 Complex Soft, 13mm X 48cm","BOTH IP/OP","$8,364.00 ","$6,189.36 ","$0.00 ","$8,364.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,969.39 ","$0.00 ","$8,364.00 ","$0.00 ","$4,182.00 ","$6,624.29 ","$6,691.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804127","EAP","Custom 27804127","","Coil 400 Complex Soft, 14mm X 40cm","BOTH IP/OP","$8,128.00 ","$6,014.72 ","$0.00 ","$8,128.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,800.95 ","$0.00 ","$8,128.00 ","$0.00 ","$4,064.00 ","$6,437.38 ","$6,502.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804128","EAP","Custom 27804128","","Coil 400 Complex Soft, 14mm X 50cm","BOTH IP/OP","$8,424.00 ","$6,233.76 ","$0.00 ","$8,424.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,012.21 ","$0.00 ","$8,424.00 ","$0.00 ","$4,212.00 ","$6,671.81 ","$6,739.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804129","EAP","Custom 27804129","","Coil 400 Complex Soft, 16mm X 45cm","BOTH IP/OP","$8,276.00 ","$6,124.24 ","$0.00 ","$8,276.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,906.58 ","$0.00 ","$8,276.00 ","$0.00 ","$4,138.00 ","$6,554.59 ","$6,620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804130","EAP","Custom 27804130","","Coil 400 J, 7cm","BOTH IP/OP","$6,680.00 ","$4,943.20 ","$0.00 ","$6,680.00 ","$0.00 ","$0.00 ","$0.00 ","$4,767.52 ","$4,767.52 ","$0.00 ","$6,680.00 ","$0.00 ","$3,340.00 ","$5,290.56 ","$5,344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804131","EAP","Custom 27804131","","Coil 400 J, 10cm","BOTH IP/OP","$7,448.00 ","$5,511.52 ","$0.00 ","$7,448.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,315.64 ","$0.00 ","$7,448.00 ","$0.00 ","$3,724.00 ","$5,898.82 ","$5,958.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804132","EAP","Custom 27804132","","Coil 400 J, 15cm","BOTH IP/OP","$7,743.00 ","$5,729.82 ","$0.00 ","$7,743.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,526.18 ","$0.00 ","$7,743.00 ","$0.00 ","$3,871.50 ","$6,132.46 ","$6,194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804133","EAP","Custom 27804133","","Coil 400 J, 25cm","BOTH IP/OP","$8,334.00 ","$6,167.16 ","$0.00 ","$8,334.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,947.98 ","$0.00 ","$8,334.00 ","$0.00 ","$4,167.00 ","$6,600.53 ","$6,667.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804134","EAP","Custom 27804134","","Coil 400 Complex Standard, 3 Mm X 6 Cm","BOTH IP/OP","$6,532.00 ","$4,833.68 ","$0.00 ","$6,532.00 ","$0.00 ","$0.00 ","$0.00 ","$4,661.89 ","$4,661.89 ","$0.00 ","$6,532.00 ","$0.00 ","$3,266.00 ","$5,173.34 ","$5,225.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804135","EAP","Custom 27804135","","Coil 400 Complex Standard, 3 Mm X 10 Cm","BOTH IP/OP","$6,651.00 ","$4,921.74 ","$0.00 ","$6,651.00 ","$0.00 ","$0.00 ","$0.00 ","$4,746.82 ","$4,746.82 ","$0.00 ","$6,651.00 ","$0.00 ","$3,325.50 ","$5,267.59 ","$5,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804136","EAP","Custom 27804136","","Coil 400 Complex Standard, 4 Mm X 8 Cm","BOTH IP/OP","$6,591.00 ","$4,877.34 ","$0.00 ","$6,591.00 ","$0.00 ","$0.00 ","$0.00 ","$4,704.00 ","$4,704.00 ","$0.00 ","$6,591.00 ","$0.00 ","$3,295.50 ","$5,220.07 ","$5,272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804137","EAP","Custom 27804137","","Coil 400 Complex Standard, 4 Mm X 12 Cm","BOTH IP/OP","$6,708.00 ","$4,963.92 ","$0.00 ","$6,708.00 ","$0.00 ","$0.00 ","$0.00 ","$4,787.50 ","$4,787.50 ","$0.00 ","$6,708.00 ","$0.00 ","$3,354.00 ","$5,312.74 ","$5,366.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804138","EAP","Custom 27804138","","Coil 400 Complex Standard, 5 Mm X 6 Cm","BOTH IP/OP","$6,532.00 ","$4,833.68 ","$0.00 ","$6,532.00 ","$0.00 ","$0.00 ","$0.00 ","$4,661.89 ","$4,661.89 ","$0.00 ","$6,532.00 ","$0.00 ","$3,266.00 ","$5,173.34 ","$5,225.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804139","EAP","Custom 27804139","","Coil 400 Complex Standard, 5mm X 10cm","BOTH IP/OP","$6,651.00 ","$4,921.74 ","$0.00 ","$6,651.00 ","$0.00 ","$0.00 ","$0.00 ","$4,746.82 ","$4,746.82 ","$0.00 ","$6,651.00 ","$0.00 ","$3,325.50 ","$5,267.59 ","$5,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804140","EAP","Custom 27804140","","Coil 400 Complex Standard, 6mm X 10cm","BOTH IP/OP","$6,651.00 ","$4,921.74 ","$0.00 ","$6,651.00 ","$0.00 ","$0.00 ","$0.00 ","$4,746.82 ","$4,746.82 ","$0.00 ","$6,651.00 ","$0.00 ","$3,325.50 ","$5,267.59 ","$5,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804141","EAP","Custom 27804141","","Coil 400 Complex Standard, 6mm X 15cm","BOTH IP/OP","$6,798.00 ","$5,030.52 ","$0.00 ","$6,798.00 ","$0.00 ","$0.00 ","$0.00 ","$4,851.73 ","$4,851.73 ","$0.00 ","$6,798.00 ","$0.00 ","$3,399.00 ","$5,384.02 ","$5,438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804142","EAP","Custom 27804142","","Coil 400 Complex Standard, 7mm X 10cm","BOTH IP/OP","$6,651.00 ","$4,921.74 ","$0.00 ","$6,651.00 ","$0.00 ","$0.00 ","$0.00 ","$4,746.82 ","$4,746.82 ","$0.00 ","$6,651.00 ","$0.00 ","$3,325.50 ","$5,267.59 ","$5,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804143","EAP","Custom 27804143","","Coil 400 Complex Soft, 3 Mm X 4 Cm","BOTH IP/OP","$7,063.00 ","$5,226.62 ","$0.00 ","$7,063.00 ","$0.00 ","$0.00 ","$0.00 ","$5,040.86 ","$5,040.86 ","$0.00 ","$7,063.00 ","$0.00 ","$3,531.50 ","$5,593.90 ","$5,650.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804144","EAP","Custom 27804144","","Coil 400 Complex Soft, 3 Mm X 6 Cm","BOTH IP/OP","$7,123.00 ","$5,271.02 ","$0.00 ","$7,123.00 ","$0.00 ","$0.00 ","$0.00 ","$5,083.69 ","$5,083.69 ","$0.00 ","$7,123.00 ","$0.00 ","$3,561.50 ","$5,641.42 ","$5,698.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804145","EAP","Custom 27804145","","Coil 400 Complex Soft, 3 Mm X 10 Cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804146","EAP","Custom 27804146","","Coil 400 Complex Soft, 4 Mm X 4 Cm","BOTH IP/OP","$7,063.00 ","$5,226.62 ","$0.00 ","$7,063.00 ","$0.00 ","$0.00 ","$0.00 ","$5,040.86 ","$5,040.86 ","$0.00 ","$7,063.00 ","$0.00 ","$3,531.50 ","$5,593.90 ","$5,650.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804147","EAP","Custom 27804147","","Coil 400 Complex Soft, 4 Mm X 6 Cm","BOTH IP/OP","$7,123.00 ","$5,271.02 ","$0.00 ","$7,123.00 ","$0.00 ","$0.00 ","$0.00 ","$5,083.69 ","$5,083.69 ","$0.00 ","$7,123.00 ","$0.00 ","$3,561.50 ","$5,641.42 ","$5,698.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804148","EAP","Custom 27804148","","Coil 400 Complex Soft, 4 Mm X 8 Cm","BOTH IP/OP","$7,182.00 ","$5,314.68 ","$0.00 ","$7,182.00 ","$0.00 ","$0.00 ","$0.00 ","$5,125.79 ","$5,125.79 ","$0.00 ","$7,182.00 ","$0.00 ","$3,591.00 ","$5,688.14 ","$5,745.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804149","EAP","Custom 27804149","","Coil 400 Complex Soft, 4 Mm X 12 Cm","BOTH IP/OP","$7,300.00 ","$5,402.00 ","$0.00 ","$7,300.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,210.01 ","$0.00 ","$7,300.00 ","$0.00 ","$3,650.00 ","$5,781.60 ","$5,840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804150","EAP","Custom 27804150","","Coil 400 Complex Soft, 5mm X 9cm","BOTH IP/OP","$7,211.00 ","$5,336.14 ","$0.00 ","$7,211.00 ","$0.00 ","$0.00 ","$0.00 ","$5,146.49 ","$5,146.49 ","$0.00 ","$7,211.00 ","$0.00 ","$3,605.50 ","$5,711.11 ","$5,768.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804151","EAP","Custom 27804151","","Coil 400 Complex Soft, 5mm X 13cm","BOTH IP/OP","$7,331.00 ","$5,424.94 ","$0.00 ","$7,331.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,232.13 ","$0.00 ","$7,331.00 ","$0.00 ","$3,665.50 ","$5,806.15 ","$5,864.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804152","EAP","Custom 27804152","","Coil 400 Complex Standard, 10mm X 30cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804153","EAP","Custom 27804153","","Coil 400 Complex Standard, 10mm X 40cm","BOTH IP/OP","$7,389.00 ","$5,467.86 ","$0.00 ","$7,389.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,273.53 ","$0.00 ","$7,389.00 ","$0.00 ","$3,694.50 ","$5,852.09 ","$5,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804154","EAP","Custom 27804154","","Coil 400 Complex Standard, 11mm X 35cm","BOTH IP/OP","$7,316.00 ","$5,413.84 ","$0.00 ","$7,316.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,221.43 ","$0.00 ","$7,316.00 ","$0.00 ","$3,658.00 ","$5,794.27 ","$5,852.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804155","EAP","Custom 27804155","","Coil 400 Complex Standard, 11mm X 45cm","BOTH IP/OP","$7,464.00 ","$5,523.36 ","$0.00 ","$7,464.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,327.06 ","$0.00 ","$7,464.00 ","$0.00 ","$3,732.00 ","$5,911.49 ","$5,971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804156","EAP","Custom 27804156","","Coil 400 Complex Standard, 12mm X 35cm","BOTH IP/OP","$7,316.00 ","$5,413.84 ","$0.00 ","$7,316.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,221.43 ","$0.00 ","$7,316.00 ","$0.00 ","$3,658.00 ","$5,794.27 ","$5,852.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804157","EAP","Custom 27804157","","Coil 400 Complex Standard, 12mm X 45cm","BOTH IP/OP","$7,464.00 ","$5,523.36 ","$0.00 ","$7,464.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,327.06 ","$0.00 ","$7,464.00 ","$0.00 ","$3,732.00 ","$5,911.49 ","$5,971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804158","EAP","Custom 27804158","","Coil 400 Complex Standard, 13mm X 35cm","BOTH IP/OP","$7,316.00 ","$5,413.84 ","$0.00 ","$7,316.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,221.43 ","$0.00 ","$7,316.00 ","$0.00 ","$3,658.00 ","$5,794.27 ","$5,852.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804159","EAP","Custom 27804159","","Coil 400 Complex Standard, 13mm X 48cm","BOTH IP/OP","$7,507.00 ","$5,555.18 ","$0.00 ","$7,507.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,357.75 ","$0.00 ","$7,507.00 ","$0.00 ","$3,753.50 ","$5,945.54 ","$6,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804160","EAP","Custom 27804160","","Coil 400 Complex Standard, 14mm X 50cm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,379.16 ","$0.00 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804161","EAP","Custom 27804161","","Coil 400 Complex Soft, 6mm X 10cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804162","EAP","Custom 27804162","","Coil 400 Complex Soft, 6mm X 15cm","BOTH IP/OP","$7,389.00 ","$5,467.86 ","$0.00 ","$7,389.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,273.53 ","$0.00 ","$7,389.00 ","$0.00 ","$3,694.50 ","$5,852.09 ","$5,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804163","EAP","Custom 27804163","","Coil 400 Complex Soft, 6mm X 20cm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,379.16 ","$0.00 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804164","EAP","Custom 27804164","","Coil 400 Complex Soft, 7 Mm X 10 Cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804165","EAP","Custom 27804165","","Coil 400 Complex Soft, 7mm X 15cm","BOTH IP/OP","$7,389.00 ","$5,467.86 ","$0.00 ","$7,389.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,273.53 ","$0.00 ","$7,389.00 ","$0.00 ","$3,694.50 ","$5,852.09 ","$5,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804166","EAP","Custom 27804166","","Coil 400 Complex Soft, 7mm X 20cm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,379.16 ","$0.00 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804167","EAP","Custom 27804167","","Coil 400 Complex Soft, 8mm X 15cm","BOTH IP/OP","$7,389.00 ","$5,467.86 ","$0.00 ","$7,389.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,273.53 ","$0.00 ","$7,389.00 ","$0.00 ","$3,694.50 ","$5,852.09 ","$5,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804168","EAP","Custom 27804168","","Coil 400 Complex Soft, 8mm X 20cm","BOTH IP/OP","$7,389.00 ","$5,467.86 ","$0.00 ","$7,389.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,273.53 ","$0.00 ","$7,389.00 ","$0.00 ","$3,694.50 ","$5,852.09 ","$5,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804169","EAP","Custom 27804169","","Coil 400 Complex Soft, 8mm X 30cm","BOTH IP/OP","$7,832.00 ","$5,795.68 ","$0.00 ","$7,832.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,589.70 ","$0.00 ","$7,832.00 ","$0.00 ","$3,916.00 ","$6,202.94 ","$6,265.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804170","EAP","Custom 27804170","","Coil 400 Curve Extra Soft, 3mm X 8cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804171","EAP","Custom 27804171","","Coil 400 Curve Extra Soft, 3mm X 10cm","BOTH IP/OP","$7,699.00 ","$5,697.26 ","$0.00 ","$7,699.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,494.78 ","$0.00 ","$7,699.00 ","$0.00 ","$3,849.50 ","$6,097.61 ","$6,159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804172","EAP","Custom 27804172","","Coil 400 Curve Extra Soft, 4mm X 4cm","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804173","EAP","Custom 27804173","","Coil 400 Curve Extra Soft, 4mm X 6cm","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804174","EAP","Custom 27804174","","Coil 400 Curve Extra Soft, 4mm X 8cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804175","EAP","Custom 27804175","","Coil 400 Curve Extra Soft, 4mm X 10cm","BOTH IP/OP","$7,699.00 ","$5,697.26 ","$0.00 ","$7,699.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,494.78 ","$0.00 ","$7,699.00 ","$0.00 ","$3,849.50 ","$6,097.61 ","$6,159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804176","EAP","Custom 27804176","","Coil 400 Complex Extra Soft, 2mm X 2cm","BOTH IP/OP","$5,674.00 ","$4,198.76 ","$0.00 ","$5,674.00 ","$0.00 ","$0.00 ","$0.00 ","$4,049.53 ","$4,049.53 ","$0.00 ","$5,674.00 ","$0.00 ","$2,837.00 ","$4,493.81 ","$4,539.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804177","EAP","Custom 27804177","","Coil 400 Complex Extra Soft, 2mm X 3cm","BOTH IP/OP","$5,986.00 ","$4,429.64 ","$0.00 ","$5,986.00 ","$0.00 ","$0.00 ","$0.00 ","$4,272.21 ","$4,272.21 ","$0.00 ","$5,986.00 ","$0.00 ","$2,993.00 ","$4,740.91 ","$4,788.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804178","EAP","Custom 27804178","","Coil 400 Complex Extra Soft, 2mm X 4cm","BOTH IP/OP","$6,296.00 ","$4,659.04 ","$0.00 ","$6,296.00 ","$0.00 ","$0.00 ","$0.00 ","$4,493.46 ","$4,493.46 ","$0.00 ","$6,296.00 ","$0.00 ","$3,148.00 ","$4,986.43 ","$5,036.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804179","EAP","Custom 27804179","","Coil 400 Complex Soft, 9mm X 25cm","BOTH IP/OP","$7,685.00 ","$5,686.90 ","$0.00 ","$7,685.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,484.78 ","$0.00 ","$7,685.00 ","$0.00 ","$3,842.50 ","$6,086.52 ","$6,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804180","EAP","Custom 27804180","","Coil 400 Complex Soft, 9mm X 35cm","BOTH IP/OP","$7,980.00 ","$5,905.20 ","$0.00 ","$7,980.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,695.33 ","$0.00 ","$7,980.00 ","$0.00 ","$3,990.00 ","$6,320.16 ","$6,384.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804181","EAP","Custom 27804181","","Coil 400 Complex Soft, 10mm X 20cm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,379.16 ","$0.00 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804182","EAP","Custom 27804182","","Coil 400 Complex Soft, 10mm X 30cm","BOTH IP/OP","$7,832.00 ","$5,795.68 ","$0.00 ","$7,832.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,589.70 ","$0.00 ","$7,832.00 ","$0.00 ","$3,916.00 ","$6,202.94 ","$6,265.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804183","EAP","Custom 27804183","","Coil 400 Complex Soft, 10mm X 40cm","BOTH IP/OP","$8,128.00 ","$6,014.72 ","$0.00 ","$8,128.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,800.95 ","$0.00 ","$8,128.00 ","$0.00 ","$4,064.00 ","$6,437.38 ","$6,502.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804184","EAP","Custom 27804184","","Coil 400 Complex Soft, 11mm X 35cm","BOTH IP/OP","$7,980.00 ","$5,905.20 ","$0.00 ","$7,980.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,695.33 ","$0.00 ","$7,980.00 ","$0.00 ","$3,990.00 ","$6,320.16 ","$6,384.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804185","EAP","Custom 27804185","","Coil 400 Complex Soft, 11mm X 45cm","BOTH IP/OP","$8,276.00 ","$6,124.24 ","$0.00 ","$8,276.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,906.58 ","$0.00 ","$8,276.00 ","$0.00 ","$4,138.00 ","$6,554.59 ","$6,620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804186","EAP","Custom 27804186","","Coil 400 Complex Soft, 12mm X 35cm","BOTH IP/OP","$7,980.00 ","$5,905.20 ","$0.00 ","$7,980.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,695.33 ","$0.00 ","$7,980.00 ","$0.00 ","$3,990.00 ","$6,320.16 ","$6,384.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804187","EAP","Custom 27804187","","Coil 400 Complex Soft, 12mm X 45cm","BOTH IP/OP","$8,276.00 ","$6,124.24 ","$0.00 ","$8,276.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,906.58 ","$0.00 ","$8,276.00 ","$0.00 ","$4,138.00 ","$6,554.59 ","$6,620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804188","EAP","Custom 27804188","","Coil 400 Curve Extra Soft, 2mm X 1cm","BOTH IP/OP","$5,070.00 ","$3,751.80 ","$0.00 ","$5,070.00 ","$0.00 ","$0.00 ","$0.00 ","$3,618.46 ","$3,618.46 ","$0.00 ","$5,070.00 ","$0.00 ","$2,535.00 ","$4,015.44 ","$4,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804189","EAP","Custom 27804189","","Coil 400 Curve Extra Soft, 2mm X 2cm","BOTH IP/OP","$5,379.00 ","$3,980.46 ","$0.00 ","$5,379.00 ","$0.00 ","$0.00 ","$0.00 ","$3,838.99 ","$3,838.99 ","$0.00 ","$5,379.00 ","$0.00 ","$2,689.50 ","$4,260.17 ","$4,303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804190","EAP","Custom 27804190","","Coil 400 Curve Extra Soft, 2mm X 3cm","BOTH IP/OP","$5,690.00 ","$4,210.60 ","$0.00 ","$5,690.00 ","$0.00 ","$0.00 ","$0.00 ","$4,060.95 ","$4,060.95 ","$0.00 ","$5,690.00 ","$0.00 ","$2,845.00 ","$4,506.48 ","$4,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804191","EAP","Custom 27804191","","Coil 400 Curve Extra Soft, 2mm X 4cm","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804192","EAP","Custom 27804192","","Coil 400 Curve Extra Soft, 3mm X 2cm","BOTH IP/OP","$5,379.00 ","$3,980.46 ","$0.00 ","$5,379.00 ","$0.00 ","$0.00 ","$0.00 ","$3,838.99 ","$3,838.99 ","$0.00 ","$5,379.00 ","$0.00 ","$2,689.50 ","$4,260.17 ","$4,303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804193","EAP","Custom 27804193","","Coil 400 Curve Extra Soft, 3mm X 3cm","BOTH IP/OP","$5,690.00 ","$4,210.60 ","$0.00 ","$5,690.00 ","$0.00 ","$0.00 ","$0.00 ","$4,060.95 ","$4,060.95 ","$0.00 ","$5,690.00 ","$0.00 ","$2,845.00 ","$4,506.48 ","$4,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804194","EAP","Custom 27804194","","Coil 400 Curve Extra Soft, 3mm X 4cm","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804195","EAP","Custom 27804195","","Coil 400 Curve Extra Soft, 3mm X 5cm","BOTH IP/OP","$6,310.00 ","$4,669.40 ","$0.00 ","$6,310.00 ","$0.00 ","$0.00 ","$0.00 ","$4,503.45 ","$4,503.45 ","$0.00 ","$6,310.00 ","$0.00 ","$3,155.00 ","$4,997.52 ","$5,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804196","EAP","Custom 27804196","","Coil 400 Curve Extra Soft, 3mm X 6cm","BOTH IP/OP","$6,620.00 ","$4,898.80 ","$0.00 ","$6,620.00 ","$0.00 ","$0.00 ","$0.00 ","$4,724.69 ","$4,724.69 ","$0.00 ","$6,620.00 ","$0.00 ","$3,310.00 ","$5,243.04 ","$5,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804197","EAP","Custom 27804197","","Coil 400 Complex Extra Soft, 3mm X 3cm","BOTH IP/OP","$5,986.00 ","$4,429.64 ","$0.00 ","$5,986.00 ","$0.00 ","$0.00 ","$0.00 ","$4,272.21 ","$4,272.21 ","$0.00 ","$5,986.00 ","$0.00 ","$2,993.00 ","$4,740.91 ","$4,788.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804198","EAP","Custom 27804198","","Coil 400 Complex Extra Soft, 3mm X 4cm","BOTH IP/OP","$6,296.00 ","$4,659.04 ","$0.00 ","$6,296.00 ","$0.00 ","$0.00 ","$0.00 ","$4,493.46 ","$4,493.46 ","$0.00 ","$6,296.00 ","$0.00 ","$3,148.00 ","$4,986.43 ","$5,036.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804199","EAP","Custom 27804199","","Coil 400 Complex Extra Soft, 3mm X 5cm","BOTH IP/OP","$6,606.00 ","$4,888.44 ","$0.00 ","$6,606.00 ","$0.00 ","$0.00 ","$0.00 ","$4,714.70 ","$4,714.70 ","$0.00 ","$6,606.00 ","$0.00 ","$3,303.00 ","$5,231.95 ","$5,284.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804200","EAP","Custom 27804200","","Coil 400 Complex Extra Soft, 3mm X 6cm","BOTH IP/OP","$6,916.00 ","$5,117.84 ","$0.00 ","$6,916.00 ","$0.00 ","$0.00 ","$0.00 ","$4,935.95 ","$4,935.95 ","$0.00 ","$6,916.00 ","$0.00 ","$3,458.00 ","$5,477.47 ","$5,532.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804201","EAP","Custom 27804201","","Coil 400 Complex Extra Soft, 3mm X 8cm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,379.16 ","$0.00 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804202","EAP","Custom 27804202","","Coil 400 Complex Extra Soft, 3mm X 10cm","BOTH IP/OP","$8,157.00 ","$6,036.18 ","$0.00 ","$8,157.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,821.65 ","$0.00 ","$8,157.00 ","$0.00 ","$4,078.50 ","$6,460.34 ","$6,525.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804203","EAP","Custom 27804203","","Coil 400 Complex Extra Soft, 4mm X 4cm","BOTH IP/OP","$6,296.00 ","$4,659.04 ","$0.00 ","$6,296.00 ","$0.00 ","$0.00 ","$0.00 ","$4,493.46 ","$4,493.46 ","$0.00 ","$6,296.00 ","$0.00 ","$3,148.00 ","$4,986.43 ","$5,036.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804204","EAP","Custom 27804204","","Coil 400 Complex Extra Soft, 4mm X 6cm","BOTH IP/OP","$6,916.00 ","$5,117.84 ","$0.00 ","$6,916.00 ","$0.00 ","$0.00 ","$0.00 ","$4,935.95 ","$4,935.95 ","$0.00 ","$6,916.00 ","$0.00 ","$3,458.00 ","$5,477.47 ","$5,532.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804205","EAP","Custom 27804205","","Coil 400 Complex Extra Soft, 4mm X 8cm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,379.16 ","$0.00 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804206","EAP","Custom 27804206","","Coil 400 Complex Standard, 7 Mm X 15 Cm","BOTH IP/OP","$6,798.00 ","$5,030.52 ","$0.00 ","$6,798.00 ","$0.00 ","$0.00 ","$0.00 ","$4,851.73 ","$4,851.73 ","$0.00 ","$6,798.00 ","$0.00 ","$3,399.00 ","$5,384.02 ","$5,438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804207","EAP","Custom 27804207","","Coil 400 Complex Standard, 7mm X 20cm","BOTH IP/OP","$6,946.00 ","$5,140.04 ","$0.00 ","$6,946.00 ","$0.00 ","$0.00 ","$0.00 ","$4,957.36 ","$4,957.36 ","$0.00 ","$6,946.00 ","$0.00 ","$3,473.00 ","$5,501.23 ","$5,556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804208","EAP","Custom 27804208","","Coil 400 Complex Standard, 8 Mm X 15 Cm","BOTH IP/OP","$6,798.00 ","$5,030.52 ","$0.00 ","$6,798.00 ","$0.00 ","$0.00 ","$0.00 ","$4,851.73 ","$4,851.73 ","$0.00 ","$6,798.00 ","$0.00 ","$3,399.00 ","$5,384.02 ","$5,438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804209","EAP","Custom 27804209","","Coil 400 Complex Standard, 8mm X 20cm","BOTH IP/OP","$6,798.00 ","$5,030.52 ","$0.00 ","$6,798.00 ","$0.00 ","$0.00 ","$0.00 ","$4,851.73 ","$4,851.73 ","$0.00 ","$6,798.00 ","$0.00 ","$3,399.00 ","$5,384.02 ","$5,438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804210","EAP","Custom 27804210","","Coil 400 Complex Standard, 8mm X 30cm","BOTH IP/OP","$7,241.00 ","$5,358.34 ","$0.00 ","$7,241.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,167.90 ","$0.00 ","$7,241.00 ","$0.00 ","$3,620.50 ","$5,734.87 ","$5,792.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804211","EAP","Custom 27804211","","Coil 400 Complex Standard, 9 Mm X 15 Cm","BOTH IP/OP","$6,798.00 ","$5,030.52 ","$0.00 ","$6,798.00 ","$0.00 ","$0.00 ","$0.00 ","$4,851.73 ","$4,851.73 ","$0.00 ","$6,798.00 ","$0.00 ","$3,399.00 ","$5,384.02 ","$5,438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804212","EAP","Custom 27804212","","Coil 400 Complex Standard, 9mm X 25cm","BOTH IP/OP","$7,094.00 ","$5,249.56 ","$0.00 ","$7,094.00 ","$0.00 ","$0.00 ","$0.00 ","$5,062.99 ","$5,062.99 ","$0.00 ","$7,094.00 ","$0.00 ","$3,547.00 ","$5,618.45 ","$5,675.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804213","EAP","Custom 27804213","","Coil 400 Complex Standard, 9mm X 35cm","BOTH IP/OP","$7,300.00 ","$5,402.00 ","$0.00 ","$7,300.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,210.01 ","$0.00 ","$7,300.00 ","$0.00 ","$3,650.00 ","$5,781.60 ","$5,840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804214","EAP","Custom 27804214","","Coil 400 Complex Standard, 10 Mm X 20 Cm","BOTH IP/OP","$6,946.00 ","$5,140.04 ","$0.00 ","$6,946.00 ","$0.00 ","$0.00 ","$0.00 ","$4,957.36 ","$4,957.36 ","$0.00 ","$6,946.00 ","$0.00 ","$3,473.00 ","$5,501.23 ","$5,556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804250","EAP","HCPCS C1751","","Catheter Central Venous Pro-fuse Triniflex Od8 Fr Attace","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$265.95 ","$0.00 ","$123.18 ","$421.80 ","$421.80 ","$103.48 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$92.49 ","$0.00 ","$94.09 ","$0.00 "
"27804251","EAP","CPT� C1751","","Catheter Powerglide 20 G  8 Cm Full Kit","BOTH IP/OP","$356.00 ","$263.44 ","$0.00 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$254.08 ","$254.08 ","$62.33 ","$356.00 ","$0.00 ","$178.00 ","$281.95 ","$284.80 ","$0.00 ","$55.71 ","$0.00 ","$56.68 ","$0.00 "
"27804252","EAP","CPT� C1751","","Catheter Powerglide 20 G  10 Cm Full Kit","BOTH IP/OP","$356.00 ","$263.44 ","$0.00 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$254.08 ","$254.08 ","$62.33 ","$356.00 ","$0.00 ","$178.00 ","$281.95 ","$284.80 ","$0.00 ","$55.71 ","$0.00 ","$56.68 ","$0.00 "
"27804254","EAP","HCPCS C1713","","Screw Bone Mini Long Post 7.5mm 55mm Polyax Mpa Ts","BOTH IP/OP","$1,550.00 ","$1,147.00 ","$0.00 ","$1,550.00 ","$697.50 ","$0.00 ","$323.06 ","$1,106.24 ","$1,106.24 ","$271.39 ","$1,550.00 ","$0.00 ","$775.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$242.58 ","$0.00 ","$246.76 ","$0.00 "
"27804260","EAP","HCPCS C1722","","Defibrillator Crd 12.7mm 83.1x69.1mm Eblm Pls","BOTH IP/OP","$53,750.00 ","$39,775.00 ","$0.00 ","$53,750.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$38,361.38 ","$8,138.89 ","$53,750.00 ","$0.00 ","$26,875.00 ","$42,570.00 ","$43,000.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27804261","EAP","HCPCS C1896","","Electrode Dfbr 45cm 3 Plr S-icd Coil Conctr Pin","BOTH IP/OP","$12,500.00 ","$9,250.00 ","$0.00 ","$12,500.00 ","$0.00 ","$0.00 ","$2,605.31 ","$5,158.80 ","$8,921.25 ","$0.00 ","$12,500.00 ","$0.00 ","$6,250.00 ","$9,900.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804870","EAP","HCPCS C1760","","Device Closure .035in 6fr 70cm Valuelink Gwire Insertion","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"27804871","EAP","Custom 27804871","","Coil Embolization .02in Complex 11mm 35cm Soft The Penumbra","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$0.00 ","$0.00 ","$0.00 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804872","EAP","Custom 27804872","","Coil Embolization .02in Complex 5mm 13cm Soft The Penumbra","BOTH IP/OP","$6,108.00 ","$4,519.92 ","$0.00 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$4,359.28 ","$4,359.28 ","$0.00 ","$6,108.00 ","$0.00 ","$3,054.00 ","$4,837.54 ","$4,886.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804880","EAP","Custom 27804880","","Coil Embolization .02in Complex 6mm 15cm Soft The Penumbra","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$4,460.63 ","$4,460.63 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804881","EAP","Custom 27804881","","Coil Embolization .02in Complex 7mm 20cm Soft The Penumbra","BOTH IP/OP","$6,375.00 ","$4,717.50 ","$0.00 ","$6,375.00 ","$0.00 ","$0.00 ","$0.00 ","$4,549.84 ","$4,549.84 ","$0.00 ","$6,375.00 ","$0.00 ","$3,187.50 ","$5,049.00 ","$5,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804882","EAP","Custom 27804882","","Coil Embolization .02in Complex 8mm 20cm Soft The Penumbra","BOTH IP/OP","$6,375.00 ","$4,717.50 ","$0.00 ","$6,375.00 ","$0.00 ","$0.00 ","$0.00 ","$4,549.84 ","$4,549.84 ","$0.00 ","$6,375.00 ","$0.00 ","$3,187.50 ","$5,049.00 ","$5,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804883","EAP","Custom 27804883","","Coil Embolization .02in Complex 9mm 25cm Soft The Penumbra","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$0.00 ","$0.00 ","$0.00 ","$4,639.05 ","$4,639.05 ","$0.00 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804884","EAP","Custom 27804884","","Coil Embolization .02in Standard Complex 11mm 35cm Complex","BOTH IP/OP","$6,188.00 ","$4,579.12 ","$0.00 ","$6,188.00 ","$0.00 ","$0.00 ","$0.00 ","$4,416.38 ","$4,416.38 ","$0.00 ","$6,188.00 ","$0.00 ","$3,094.00 ","$4,900.90 ","$4,950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804885","EAP","Custom 27804885","","Coil Embolization .02in Standard Complex 6mm 15cm Complex","BOTH IP/OP","$5,175.00 ","$3,829.50 ","$0.00 ","$5,175.00 ","$0.00 ","$0.00 ","$0.00 ","$3,693.40 ","$3,693.40 ","$0.00 ","$5,175.00 ","$0.00 ","$2,587.50 ","$4,098.60 ","$4,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27804886","EAP","Custom 27804886","","Coil Embolization .02in Standard Complex 7mm 20cm Complex","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$4,192.99 ","$4,192.99 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805011","EAP","Custom 27805011","","20 FR SAFETY PEG KIT PULL","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805012","EAP","Custom 27805012","","24 FR SAFETY PEG KIT PULL","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$101.35 ","$101.35 ","$0.00 ","$142.00 ","$0.00 ","$71.00 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805013","EAP","Custom 27805013","","18 FR Replacement G-Tube, Right An 18","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$29.98 ","$29.98 ","$0.00 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805014","EAP","Custom 27805014","","20 FR REPLACEMENT G-TUBE, RIGHT-AN 20","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805015","EAP","Custom 27805015","","22 FR REPLACEMENT G-TUBE, RIGHT-AN","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805016","EAP","HCPCS C2625","","Rx Stent 7x7cm","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$59.85 ","$0.00 ","$27.72 ","$94.92 ","$94.92 ","$23.29 ","$133.00 ","$0.00 ","$66.50 ","$105.34 ","$106.40 ","$0.00 ","$20.81 ","$0.00 ","$21.17 ","$0.00 "
"27805017","EAP","HCPCS C2625","","Rx Stent 7x10cm","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$59.85 ","$0.00 ","$27.72 ","$94.92 ","$94.92 ","$23.29 ","$133.00 ","$0.00 ","$66.50 ","$105.34 ","$106.40 ","$0.00 ","$20.81 ","$0.00 ","$21.17 ","$0.00 "
"27805018","EAP","HCPCS C2625","","Rx Stent 10x5cm","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$59.85 ","$0.00 ","$27.72 ","$94.92 ","$94.92 ","$23.29 ","$133.00 ","$0.00 ","$66.50 ","$105.34 ","$106.40 ","$0.00 ","$20.81 ","$0.00 ","$21.17 ","$0.00 "
"27805019","EAP","HCPCS C2625","","Rx Stent 10x10cm","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$59.85 ","$0.00 ","$27.72 ","$94.92 ","$94.92 ","$23.29 ","$133.00 ","$0.00 ","$66.50 ","$105.34 ","$106.40 ","$0.00 ","$20.81 ","$0.00 ","$21.17 ","$0.00 "
"27805020","EAP","Custom 27805020","","Pill Cam Capsule","BOTH IP/OP","$532.00 ","$393.68 ","$0.00 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$379.69 ","$379.69 ","$0.00 ","$532.00 ","$0.00 ","$266.00 ","$421.34 ","$425.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805021","EAP","HCPCS L8614","","Cochlear  Implant","BOTH IP/OP","$106,399.00 ","$78,735.26 ","$0.00 ","$106,399.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$75,936.97 ","$0.00 ","$106,399.00 ","$0.00 ","$53,199.50 ","$84,268.01 ","$85,119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805022","EAP","HCPCS C1878","","Radiesse Voice Material For Vocal Cord Medialization","BOTH IP/OP","$638.00 ","$472.12 ","$0.00 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$455.34 ","$455.34 ","$0.00 ","$638.00 ","$0.00 ","$319.00 ","$505.30 ","$510.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805040","EAP","Custom 27805040","","Sensor Monitor Flotrac Adult L60 In Vamp Latex Free","BOTH IP/OP","$961.00 ","$711.14 ","$0.00 ","$961.00 ","$0.00 ","$0.00 ","$0.00 ","$685.87 ","$685.87 ","$0.00 ","$961.00 ","$0.00 ","$480.50 ","$761.11 ","$768.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805041","EAP","Custom 27805041","","Sensor Monitor  Flotrac Adlt L60 In Vamp Bifurcated Pres","BOTH IP/OP","$961.00 ","$711.14 ","$0.00 ","$961.00 ","$0.00 ","$0.00 ","$0.00 ","$685.87 ","$685.87 ","$0.00 ","$961.00 ","$0.00 ","$480.50 ","$761.11 ","$768.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805044","EAP","Custom 27805044","","Accessory Kit, Slit Suture Sleeve, Ss-1056","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$51.39 ","$51.39 ","$0.00 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805045","EAP","Custom 27805045","","Coil Embl 14cm 6mm Nst Sft Cath Xtd Embl Endhole .035in4","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$228.38 ","$228.38 ","$0.00 ","$320.00 ","$0.00 ","$160.00 ","$253.44 ","$256.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805046","EAP","HCPCS C1751","","Cath Infus .038in 5fr 100cm 10cm Peri Vlv Crgg-mcnam","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$171.29 ","$171.29 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"27805048","EAP","HCPCS C1874","","Xience Xpedition Sv Des 2.25 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805049","EAP","HCPCS C1874","","Xience Xpedition Sv Des 2.25 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805050","EAP","HCPCS C1874","","Xience Xpedition Sv Des 2.25 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805051","EAP","HCPCS C1874","","Xience Xpedition Sv Des 2.25 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805052","EAP","HCPCS C1874","","Xience Xpedition Sv Des 2.25 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805053","EAP","HCPCS C1874","","Xience Xpedition Sv Des 2.25 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805054","EAP","HCPCS C1874","","Xience Xpedition Des 2.50 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805055","EAP","HCPCS C1874","","Xience Xpedition Des 2.50 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805056","EAP","HCPCS C1874","","Xience Xpedition Des 2.50 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805057","EAP","HCPCS C1874","","Xience Xpedition Des 2.50 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805058","EAP","HCPCS C1874","","Xience Xpedition Des 2.50 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805059","EAP","HCPCS C1874","","Xience Xpedition Des 2.50 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805060","EAP","HCPCS C1874","","Xience Xpedition Ll Des 2.50 Mm X 33 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805061","EAP","HCPCS C1874","","Xience Xpedition Ll Des 2.50 Mm X 38 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805062","EAP","HCPCS C1874","","Xience Xpedition Des 2.75 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805063","EAP","HCPCS C1874","","Xience Xpedition Des 2.75 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805064","EAP","HCPCS C1874","","Xience Xpedition Des 2.75 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805065","EAP","HCPCS C1874","","Xience Xpedition Des 2.75 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805066","EAP","HCPCS C1874","","Xience Xpedition Des 2.75 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805067","EAP","HCPCS C1874","","Xience Xpedition Des 2.75 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805068","EAP","HCPCS C1874","","Xience Xpedition Ll Des 2.75 Mm X 33 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805069","EAP","HCPCS C1874","","Xience Xpedition Ll Des 2.75 Mm X 38 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805070","EAP","HCPCS C1874","","Xience Xpedition Des 3.00 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805071","EAP","HCPCS C1874","","Xience Xpedition Des 3.00 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805072","EAP","HCPCS C1874","","Xience Xpedition Des 3.00 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805073","EAP","HCPCS C1874","","Xience Xpedition Des 3.00 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805074","EAP","HCPCS C1874","","Xience Xpedition Des 3.00 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805075","EAP","HCPCS C1874","","Xience Xpedition Des 3.00 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805076","EAP","HCPCS C1874","","Xience Xpedition Ll Des 3.00 Mm X 33 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805077","EAP","HCPCS C1874","","Xience Xpedition Ll Des 3.00 Mm X 38 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805078","EAP","HCPCS C1874","","Xience Xpedition Des 3.25 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805079","EAP","HCPCS C1874","","Xience Xpedition Des 3.25 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805080","EAP","HCPCS C1874","","Xience Xpedition Des 3.25 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805081","EAP","HCPCS C1874","","Xience Xpedition Des 3.25 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805082","EAP","HCPCS C1874","","Xience Xpedition Des 3.25 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805083","EAP","HCPCS C1874","","Xience Xpedition Des 3.25 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805084","EAP","HCPCS C1874","","Xience Xpedition Ll Des 3.25 Mm X 33 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805085","EAP","HCPCS C1874","","Xience Xpedition Ll Des 3.25 Mm X 38 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805086","EAP","HCPCS C1874","","Xience Xpedition Des 3.50 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805087","EAP","HCPCS C1874","","Xience Xpedition Des 3.50 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805088","EAP","HCPCS C1874","","Xience Xpedition Des 3.50 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805089","EAP","HCPCS C1874","","Xience Xpedition Des 3.50 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805090","EAP","HCPCS C1874","","Xience Xpedition Des 3.50 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805091","EAP","HCPCS C1874","","Xience Xpedition Des 3.50 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805092","EAP","HCPCS C1874","","Xience Xpedition Ll Des 3.50 Mm X 33 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805093","EAP","HCPCS C1874","","Xience Xpedition Ll Des 3.50 Mm X 38 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805094","EAP","HCPCS C1874","","Xience Xpedition Des 4.00 Mm X 8 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805095","EAP","HCPCS C1874","","Xience Xpedition Des 4.00 Mm X 12 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805096","EAP","HCPCS C1874","","Xience Xpedition Des 4.00 Mm X 15 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805097","EAP","HCPCS C1874","","Xience Xpedition Des 4.00 Mm X 18 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805098","EAP","HCPCS C1874","","Xience Xpedition Des 4.00 Mm X 23 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805099","EAP","HCPCS C1874","","Xience Xpedition Des 4.00 Mm X 28 Mm","BOTH IP/OP","$6,208.00 ","$4,593.92 ","$0.00 ","$6,208.00 ","$2,793.60 ","$0.00 ","$1,293.90 ","$4,430.65 ","$4,430.65 ","$1,086.97 ","$6,208.00 ","$0.00 ","$3,104.00 ","$4,916.74 ","$4,966.40 ","$0.00 ","$971.55 ","$0.00 ","$988.31 ","$0.00 "
"27805101","EAP","Custom 27805101","","Pipeline Embolization Device","BOTH IP/OP","$41,378.00 ","$30,619.72 ","$0.00 ","$41,378.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,531.48 ","$0.00 ","$41,378.00 ","$0.00 ","$20,689.00 ","$32,771.38 ","$33,102.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805102","EAP","HCPCS C1874","","Xience Xpedition Ll Des 4.00 Mm X 33 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805103","EAP","HCPCS C1874","","Xience Xpedition Ll Des 4.00 Mm X 38 Mm","BOTH IP/OP","$6,429.00 ","$4,757.46 ","$0.00 ","$6,429.00 ","$2,893.05 ","$0.00 ","$1,339.96 ","$4,588.38 ","$4,588.38 ","$1,125.67 ","$6,429.00 ","$0.00 ","$3,214.50 ","$5,091.77 ","$5,143.20 ","$0.00 ","$1,006.14 ","$0.00 ","$1,023.50 ","$0.00 "
"27805104","EAP","Custom 27805104","","Coil Embl 4.1cm 5-3mm Trnd .035in Std Sm Pltn Arterioves","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805106","EAP","HCPCS C1876","","Se Biliary Stent  6mmx40mmx120cm","BOTH IP/OP","$4,138.00 ","$3,062.12 ","$0.00 ","$4,138.00 ","$1,862.10 ","$0.00 ","$862.46 ","$2,953.29 ","$2,953.29 ","$724.53 ","$4,138.00 ","$0.00 ","$2,069.00 ","$3,277.30 ","$3,310.40 ","$0.00 ","$647.60 ","$0.00 ","$658.77 ","$0.00 "
"27805107","EAP","HCPCS C1876","","Se Peripheral Stent 7mmx80mmx120cm","BOTH IP/OP","$5,024.00 ","$3,717.76 ","$0.00 ","$5,024.00 ","$2,260.80 ","$0.00 ","$1,047.13 ","$3,585.63 ","$3,585.63 ","$879.66 ","$5,024.00 ","$0.00 ","$2,512.00 ","$3,979.01 ","$4,019.20 ","$0.00 ","$786.26 ","$0.00 ","$799.82 ","$0.00 "
"27805108","EAP","Custom 27805108","","Coil 400 Complex Standard, 22 Mm X 60 Cm","BOTH IP/OP","$7,685.00 ","$5,686.90 ","$0.00 ","$7,685.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,484.78 ","$0.00 ","$7,685.00 ","$0.00 ","$3,842.50 ","$6,086.52 ","$6,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805112","EAP","HCPCS Q4107","","Coil Embolization 7cm 3mm Nester 7.4 Loop Microcoil .018","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$0.00 ","$0.00 ","$0.00 ","$210.54 ","$210.54 ","$0.00 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805113","EAP","Custom 27805113","","Coil Embolization 7cm 4mm Nester 5.6 Loop Microcoil .018","BOTH IP/OP","$3,403.00 ","$2,518.22 ","$0.00 ","$3,403.00 ","$0.00 ","$0.00 ","$0.00 ","$2,428.72 ","$2,428.72 ","$0.00 ","$3,403.00 ","$0.00 ","$1,701.50 ","$2,695.18 ","$2,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805115","EAP","Custom 27805115","","Coil 400 Complex Standard, 24 Mm X 57 Cm","BOTH IP/OP","$7,642.00 ","$5,655.08 ","$0.00 ","$7,642.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,454.10 ","$0.00 ","$7,642.00 ","$0.00 ","$3,821.00 ","$6,052.46 ","$6,113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805116","EAP","Custom 27805116","","Coil 400 Complex Standard, 28 Mm X 60 Cm","BOTH IP/OP","$8,572.00 ","$6,343.28 ","$0.00 ","$8,572.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,117.84 ","$0.00 ","$8,572.00 ","$0.00 ","$4,286.00 ","$6,789.02 ","$6,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805118","EAP","Custom 27805118","","Coil Embl 2cm 1mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805119","EAP","Custom 27805119","","Coil Embl 3cm 1mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805120","EAP","Custom 27805120","","Coil Embl 2cm 1.5mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805121","EAP","Custom 27805121","","Coil Embl 3cm 1.5mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805122","EAP","Custom 27805122","","Coil Embl 4cm 1.5mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805123","EAP","Custom 27805123","","Coil Embl 3cm 2mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805124","EAP","Custom 27805124","","Coil Embl 4cm 2mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805125","EAP","Custom 27805125","","Coil Embl 6cm 2mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805126","EAP","Custom 27805126","","Coil Embl 4cm 2.5mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805127","EAP","Custom 27805127","","Coil Embl 4cm 3mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805128","EAP","Custom 27805128","","Coil Embl 6cm 3mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805129","EAP","Custom 27805129","","Coil Embl 8cm 3mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805130","EAP","Custom 27805130","","Coil Embl 10cm 3mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805131","EAP","Custom 27805131","","Coil Embl 6cm 4mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,352.00 ","$3,960.48 ","$0.00 ","$5,352.00 ","$0.00 ","$0.00 ","$0.00 ","$3,819.72 ","$3,819.72 ","$0.00 ","$5,352.00 ","$0.00 ","$2,676.00 ","$4,238.78 ","$4,281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805132","EAP","Custom 27805132","","Coil Embl 8cm 4mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805133","EAP","Custom 27805133","","Coil Embl 10cm 5mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805134","EAP","Custom 27805134","","Coil Embl 15cm 5mm Trgt Dtch Ult 360d","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805135","EAP","Custom CUSTOM","","System Embl Dtch Inzone","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805137","EAP","HCPCS C1898","","LEAD PCNG BRKWY DLV SYS IMPLTABLE HRT FAIL ACTY","BOTH IP/OP","$5,010.00 ","$3,707.40 ","$0.00 ","$5,010.00 ","$2,254.50 ","$0.00 ","$1,044.21 ","$3,575.64 ","$3,575.64 ","$877.21 ","$5,010.00 ","$0.00 ","$2,505.00 ","$3,967.92 ","$4,008.00 ","$0.00 ","$784.07 ","$0.00 ","$797.59 ","$0.00 "
"27805138","EAP","HCPCS C1900","","LEAD PCNG 59CM 9FR ECRDL BIPOL ACT FIX 1 COIL RTRCT HLX TIP","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$0.00 ","$0.00 "
"27805139","EAP","HCPCS C1777","","LEAD PCNG 64CM 9FR ECRDM 1 COIL ACT FIX BIPOL CARDVRT DFBR","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805140","EAP","HCPCS C1898","","LEAD PCNG 54CM MYOCRD BIPOL SUTLS INNOMEDICA SIL","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805141","EAP","HCPCS C1898","","LEAD PCNG 52CM 3.2MM ECRDM ATR VNTRC PCMKR FLXTND","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805142","EAP","HCPCS C1895","","LEAD PCNG 90CM ECRDM DUAL COIL PSV FIX CARDVRT DFBR","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805143","EAP","HCPCS C1898","","LEAD PCNG 64CM 9FR 18CM SPC ECRDM IS-1 CONCTR DUAL COIL","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805144","EAP","HCPCS C1898","","LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805145","EAP","HCPCS C1876","","STENT BIL 10MM 8FR 80MM 3.2MM .035IN RAPEX UNCVR GWIRE","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$461.00 ","$207.45 ","$0.00 ","$96.08 ","$329.02 ","$329.02 ","$80.72 ","$461.00 ","$0.00 ","$230.50 ","$365.11 ","$368.80 ","$0.00 ","$72.15 ","$0.00 ","$73.39 ","$0.00 "
"27805146","EAP","HCPCS C1876","","STENT BIL 10MM 8FR 60MM .035IN RAPEX UNCVR GWIRE DLV SYS","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$461.00 ","$207.45 ","$0.00 ","$96.08 ","$329.02 ","$329.02 ","$80.72 ","$461.00 ","$0.00 ","$230.50 ","$365.11 ","$368.80 ","$0.00 ","$72.15 ","$0.00 ","$73.39 ","$0.00 "
"27805147","EAP","HCPCS C1876","","STENT BIL 8MM 8FR 100MM .035IN RAPEX NCT UNCVR DLV SYS","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$461.00 ","$207.45 ","$0.00 ","$96.08 ","$329.02 ","$329.02 ","$80.72 ","$461.00 ","$0.00 ","$230.50 ","$365.11 ","$368.80 ","$0.00 ","$72.15 ","$0.00 ","$73.39 ","$0.00 "
"27805148","EAP","HCPCS C1777","","LEAD PCNG 64CM 9FR ECRDM 1 COIL PSV FIX BIPOL CARDVRT DFBR","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805149","EAP","HCPCS C1898","","LEAD PCNG 59CM 9FR 18CM SPC ECRDM 1 COIL PSV FIX BIPOL","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805150","EAP","HCPCS C1777","","ENDOTAK RELIANCE PF (Passive Fixation) LEADS","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805151","EAP","HCPCS C1777","","ENDOTAK RELIANCE S PF (Passive Fixation) LEADS","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805152","EAP","HCPCS C1898","","LEAD PCNG 90CM 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1 DF-1","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805153","EAP","HCPCS C1895","","LEAD PCNG ECRDM DUAL COIL ICD PSV FIX CARDVRT DFBR IMPLTABLE","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805154","EAP","HCPCS C1898","","LEAD PCNG 64CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805155","EAP","HCPCS C1875","","STENT BIL 8MM 8.5FR  80MM 70MM .035IN RAPEX PRT RMLM COVERED","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,053.00 ","$0.00 ","$0.00 ","$0.00 ","$751.53 ","$751.53 ","$0.00 ","$1,053.00 ","$0.00 ","$526.50 ","$833.98 ","$842.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805156","EAP","HCPCS C1898","","LEAD PCNG 59CM 9FR 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805157","EAP","HCPCS C1900","","LEAD PCNG 80CM 4.1-2.6FR SPRL LV CORON VNS ACTY","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27805158","EAP","HCPCS C1779","","LEAD PCNG 90CM 4.1-2.6FR SPRL LV CORON VNS IMPLTABLE ACTY","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$0.00 ","$0.00 ","$0.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805159","EAP","HCPCS C1777","","LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805160","EAP","HCPCS C1900","","LEAD PCNG 80CM CORON VNS STRBL BIPOL ACTY STRD ELUT","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$0.00 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$0.00 ","$0.00 "
"27805161","EAP","HCPCS C2625","","STENT BIL 7FR 5CM RAPEX NONCORONARY TEMP DLV SYS PLST DISP","BOTH IP/OP","$5,911.00 ","$4,374.14 ","$0.00 ","$5,911.00 ","$2,659.95 ","$0.00 ","$1,232.00 ","$4,218.68 ","$4,218.68 ","$1,034.97 ","$5,911.00 ","$0.00 ","$2,955.50 ","$4,681.51 ","$4,728.80 ","$0.00 ","$925.07 ","$0.00 ","$941.03 ","$0.00 "
"27805162","EAP","HCPCS C1777","","LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805163","EAP","HCPCS C1777","","Lead Dfbr Etak Rlnc G Act Fix","BOTH IP/OP","$13,300.00 ","$9,842.00 ","$0.00 ","$13,300.00 ","$5,985.00 ","$0.00 ","$2,772.05 ","$5,158.80 ","$9,492.21 ","$2,328.72 ","$13,300.00 ","$0.00 ","$6,650.00 ","$10,533.60 ","$10,640.00 ","$0.00 ","$2,081.45 ","$0.00 ","$2,117.36 ","$0.00 "
"27805164","EAP","HCPCS C1777","","Lead Dfbr Etak Rlnc G Psv Fix","BOTH IP/OP","$13,300.00 ","$9,842.00 ","$0.00 ","$13,300.00 ","$5,985.00 ","$0.00 ","$2,772.05 ","$5,158.80 ","$9,492.21 ","$2,328.72 ","$13,300.00 ","$0.00 ","$6,650.00 ","$10,533.60 ","$10,640.00 ","$0.00 ","$2,081.45 ","$0.00 ","$2,117.36 ","$0.00 "
"27805165","EAP","HCPCS C1898","","LEAD PCNG 90CM 18CM SPC ECRDM DUAL COIL ACT DISTAL TIP ELTRD","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805166","EAP","HCPCS C1785","","PCMKR CRD THK8MM 49X43MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$2,018.29 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$1,803.98 ","$0.00 ","$1,835.10 ","$0.00 "
"27805167","EAP","HCPCS C1786","","PCMKR CRD 8MM 43X49MM ALTRUA 40 IS-1 CONCTR","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$0.00 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805168","EAP","HCPCS C1785","","PCMKR CRD THK8MM 44X42MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2","BOTH IP/OP","$11,527.00 ","$8,529.98 ","$0.00 ","$11,527.00 ","$5,187.15 ","$0.00 ","$2,402.51 ","$5,158.80 ","$8,226.82 ","$2,018.29 ","$11,527.00 ","$0.00 ","$5,763.50 ","$9,129.38 ","$9,221.60 ","$0.00 ","$1,803.98 ","$0.00 ","$1,835.10 ","$0.00 "
"27805169","EAP","HCPCS C1786","","PCMKR CRD THK8MM 42X42MM ALTRUA 40SR 1 CHMBR RT RSPN","BOTH IP/OP","$10,049.00 ","$7,436.26 ","$0.00 ","$10,049.00 ","$4,522.05 ","$0.00 ","$2,094.46 ","$5,158.80 ","$7,171.97 ","$0.00 ","$10,049.00 ","$0.00 ","$5,024.50 ","$7,958.81 ","$8,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805170","EAP","HCPCS C1785","","Pcmkr Crd Altura 2 Lead Sys","BOTH IP/OP","$14,482.00 ","$10,716.68 ","$0.00 ","$14,482.00 ","$6,516.90 ","$0.00 ","$3,018.41 ","$5,158.80 ","$10,335.80 ","$2,535.68 ","$14,482.00 ","$0.00 ","$7,241.00 ","$11,469.74 ","$11,585.60 ","$0.00 ","$2,266.43 ","$0.00 ","$2,305.53 ","$0.00 "
"27805171","EAP","HCPCS C1898","","LEAD PCNG 70CM 9FR 18CM SPC ECRDM DUALCOIL XTD-RETRAC DF-1","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805172","EAP","HCPCS C1898","","LEAD PCNG 64CM 9FR ECRDM BIPOL ACT FIX DUAL COIL XTD-RETRAC","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805173","EAP","HCPCS C1898","","LEAD PCNG 59CM 18CM SPC ECRDM BIPOL ACT FIX XTD-RETRAC 2","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805174","EAP","HCPCS C1898","","LEAD PCNG 64CM HLX ECRDM 1 COIL BIPOL ACT FIX XTD-RETRAC","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805175","EAP","HCPCS C1777","","ENDOTAK RELIANCE G AF (Active Fixation) LEADS","BOTH IP/OP","$13,300.00 ","$9,842.00 ","$0.00 ","$13,300.00 ","$5,985.00 ","$0.00 ","$2,772.05 ","$5,158.80 ","$9,492.21 ","$2,328.72 ","$13,300.00 ","$0.00 ","$6,650.00 ","$10,533.60 ","$10,640.00 ","$0.00 ","$2,081.45 ","$0.00 ","$2,117.36 ","$0.00 "
"27805176","EAP","HCPCS C1777","","Lead Dfbr Etak Rlnc G Act Fix","BOTH IP/OP","$13,300.00 ","$9,842.00 ","$0.00 ","$13,300.00 ","$5,985.00 ","$0.00 ","$2,772.05 ","$5,158.80 ","$9,492.21 ","$2,328.72 ","$13,300.00 ","$0.00 ","$6,650.00 ","$10,533.60 ","$10,640.00 ","$0.00 ","$2,081.45 ","$0.00 ","$2,117.36 ","$0.00 "
"27805177","EAP","HCPCS C1876","","STENT TRCHBR 7MM 8MM 30MM SLF XPD ARWY DLV SYS PLFX SIL","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,478.00 ","$665.10 ","$0.00 ","$308.05 ","$1,054.85 ","$1,054.85 ","$258.79 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$231.31 ","$0.00 ","$235.30 ","$0.00 "
"27805178","EAP","HCPCS C1882","","COGNIS / ACUITY/ ENDOTAK - CARDIAC RESYNCHRONIZATION THERAPY","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27805179","EAP","HCPCS C1898","","LEAD PCNG 90CM 9FR 18CM SPC ECRDM DUAL COIL ACT FIX BIPOL","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805180","EAP","HCPCS C1898","","LEAD PCNG 64CM 9FR 18CM SPC ECRDL DUAL COIL IMPLTABLE","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805181","EAP","HCPCS C1898","","LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL ACT FIX 2 COIL","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805182","EAP","HCPCS C1896","","LEAD PCNG ECRDL 1 COIL ACT FIX CARDVRT DFBR IMPLTABLE ETAK","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$0.00 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$0.00 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805183","EAP","HCPCS C1898","","LEAD PCNG 45CM 6.7FR 10MM SPC RIGHT AV XTD-RETRAC ACT FIX","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805184","EAP","HCPCS C1777","","ENDOTAK RELIANCE AF (Active Fixation) LEADS","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805185","EAP","HCPCS C1898","","LEAD PCNG 60CM 6.7FR 10MM SPC RIGHT AV ECRDL IS-1 CONCTR","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805186","EAP","HCPCS C1900","","Easytrack 2","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$0.00 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$0.00 ","$0.00 "
"27805187","EAP","HCPCS C1898","","Lead Pcng Sm Act Fix Rlnc","BOTH IP/OP","$11,231.00 ","$8,310.94 ","$0.00 ","$11,231.00 ","$5,053.95 ","$0.00 ","$2,340.82 ","$5,158.80 ","$8,015.56 ","$1,966.46 ","$11,231.00 ","$0.00 ","$5,615.50 ","$8,894.95 ","$8,984.80 ","$0.00 ","$1,757.65 ","$0.00 ","$1,787.98 ","$0.00 "
"27805188","EAP","HCPCS C1887","","RAPIDO ADVANCE LEAD DELIVERY SYSTEM","BOTH IP/OP","$2,941.00 ","$2,176.34 ","$0.00 ","$2,941.00 ","$1,323.45 ","$0.00 ","$612.98 ","$2,098.99 ","$2,098.99 ","$514.95 ","$2,941.00 ","$0.00 ","$1,470.50 ","$2,329.27 ","$2,352.80 ","$0.00 ","$460.27 ","$0.00 ","$468.21 ","$0.00 "
"27805189","EAP","HCPCS C1900","","LEAD PCNG 80CM 5.4FR CORON VNS LV IS 1 BIPOL OTW EZTRK 2","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$0.00 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$0.00 ","$0.00 "
"27805190","EAP","HCPCS C1898","","LEAD PCNG CORON VNS IS 1 EZTRK 2","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27805191","EAP","HCPCS C1898","","LEAD PCNG 100CM 7-5FR 8.5MM .035IN CORON VNS LV IS-1 DUAL","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27805192","EAP","HCPCS C1898","","LEAD PCNG 80CM 8FR J ECRDL RIGHT ARTIAL BIPOL IS-1 LV-1 DUAL","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27805193","EAP","HCPCS C1898","","LEAD PCNG 90CM CORON VNS LV LV-1 DUAL ELTRD CONCTR BIPOL PSV","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27805194","EAP","HCPCS C1779","","LEAD PCNG 35CM MYOCARDIUM VNTRC IS-1 CONCTR SCR FIX UNPLR","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805195","EAP","HCPCS C1898","","LEAD PCNG 80CM 8FR CORON VNS BIPOL DUAL ELTRD SPRL FIX IS-1","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27805196","EAP","HCPCS C1898","","LEAD PCNG 90CM CORON VNS LV IS-1 EZTRK 3IS-1 STRD ELUT SIL","BOTH IP/OP","$4,433.00 ","$3,280.42 ","$0.00 ","$4,433.00 ","$1,994.85 ","$0.00 ","$923.95 ","$3,163.83 ","$3,163.83 ","$776.18 ","$4,433.00 ","$0.00 ","$2,216.50 ","$3,510.94 ","$3,546.40 ","$0.00 ","$693.76 ","$0.00 ","$705.73 ","$0.00 "
"27805197","EAP","HCPCS C1779","","LEAD PCNG 35CM MYOCARDIUM EPICARDIUM RV IS-1 CONCTR OTHR","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805198","EAP","HCPCS C1899","","LEAD PCNG 59CM ECRDL 4 ST DUAL COIL IMPLTABLE CARDVRT DFBR","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,437.36 ","$0.00 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805199","EAP","HCPCS C1898","","LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805200","EAP","HCPCS C1898","","LEAD PCNG 59CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805201","EAP","HCPCS C1898","","LEAD PCNG 64CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805202","EAP","HCPCS C1898","","LEAD PCNG 59CM ECRDM 4-ST DUAL COIL PSV DF4 TRM CONCTR","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805203","EAP","HCPCS C1898","","LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805204","EAP","HCPCS C1898","","LEAD PCNG 59CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805205","EAP","HCPCS C1898","","LEAD PCNG 64CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805206","EAP","HCPCS C1777","","LEAD PCNG 59CM ECRDM 4-ST 1 COIL ACT DF4 TRM CONCTR CARDVRT","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805207","EAP","HCPCS C1777","","LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805208","EAP","HCPCS C1777","","LEAD PCNG 59CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805209","EAP","HCPCS C1777","","LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805210","EAP","HCPCS C1900","","INVIVE / EASYTRAK or ACUITY / w RV or AV LEAD: CARDIAC RESYN","BOTH IP/OP","$26,452.00 ","$19,574.48 ","$0.00 ","$26,452.00 ","$11,903.40 ","$0.00 ","$5,513.26 ","$5,158.80 ","$18,878.79 ","$0.00 ","$26,452.00 ","$0.00 ","$13,226.00 ","$20,949.98 ","$21,161.60 ","$0.00 ","$4,139.74 ","$0.00 ","$0.00 ","$0.00 "
"27805211","EAP","HCPCS C1900","","INVIVE / EASYTRAK or ACUITY / w RV & AV LEAD: CARDIAC RESYNC","BOTH IP/OP","$26,452.00 ","$19,574.48 ","$0.00 ","$26,452.00 ","$11,903.40 ","$0.00 ","$5,513.26 ","$5,158.80 ","$18,878.79 ","$0.00 ","$26,452.00 ","$0.00 ","$13,226.00 ","$20,949.98 ","$21,161.60 ","$0.00 ","$4,139.74 ","$0.00 ","$0.00 ","$0.00 "
"27805212","EAP","HCPCS C1722","","INCEPTA LV-1 / EASYTRAK or ACUITY / ENDOTAK w ATRIAL LEAD: C","BOTH IP/OP","$71,524.00 ","$52,927.76 ","$0.00 ","$71,524.00 ","$32,185.80 ","$0.00 ","$9,417.94 ","$5,158.80 ","$51,046.68 ","$8,138.89 ","$71,524.00 ","$0.00 ","$35,762.00 ","$56,647.01 ","$57,219.20 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27805213","EAP","HCPCS C1898","","LEAD PCNG 59CM 2.4MM STR ATR VNTRC BIPOL ACT FIX RTRCT HLX","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805214","EAP","HCPCS C1898","","LEAD PCNG 45CM ECRDM ATR VNTRC IS-1 CONCTR ACT FIX BIPOL SIL","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805215","EAP","HCPCS C1898","","LEAD PCNG ECRDL RIGHT ATR RV IS-1 CONCTR BIPOL XTD-RETRAC","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$658.35 ","$0.00 ","$304.93 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"27805216","EAP","HCPCS C1898","","LEAD PCNG ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX SIL INSL FLN","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805217","EAP","HCPCS C1898","","LEAD PCNG 52CM 7FR RIGHT ATR VNTRC ECRDM IS-1 CONCTR BIPOL","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805218","EAP","HCPCS C1898","","LEAD PCNG 45CM 6FR ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805219","EAP","HCPCS C1898","","LEAD PCNG 58CM 5FR ECRDM AV BIPOL ACT FIX SCR IN IS-1 FLN2","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805220","EAP","HCPCS C1898","","LEAD PCNG 52CM 7FR STR ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805221","EAP","HCPCS C1779","","LEAD PCNG 45CM 7FR THK1.7MM STR ATR VNTRC BIPOL ACT FIX FLN2","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805222","EAP","HCPCS C1898","","LEAD PCNG 52CM OTHR THAN TRNVNS VDD 1 PASS IMPLTABLE FLN2","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805223","EAP","HCPCS C1898","","LEAD PCNG 45CM 8FR J ECRDM RIGHT ATR BIPOL IS-1 PSV FIX POLY","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805224","EAP","HCPCS C1900","","LEAD PCNG 58CM 6FR ECRDM VNTRC BIPOL IS-1 PSV FIX FLN2","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$0.00 ","$0.00 "
"27805225","EAP","HCPCS C1779","","LEAD PCNG 52CM 9FR RV ECRDM BIPOL IS-1 PSV FIX TRNVNS VDD 1","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805226","EAP","HCPCS C1898","","LEAD PCNG RV ECRDM BIPOL PSV FIX IS-1 FLN2 STRX PU","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27805227","EAP","HCPCS C1900","","LEAD PCNG 52CM VNTRC ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$949.22 ","$949.22 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$0.00 ","$0.00 "
"27805228","EAP","Custom 27805228","","Sensor Flotrac Vamp Adult 60in 152cm Sterile","BOTH IP/OP","$961.00 ","$711.14 ","$0.00 ","$961.00 ","$0.00 ","$0.00 ","$0.00 ","$685.87 ","$685.87 ","$0.00 ","$961.00 ","$0.00 ","$480.50 ","$761.11 ","$768.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805229","EAP","Custom 27805229","","Sensor Monitor  Flotrac Adlt L60 In Vamp Bifurcated Pres","BOTH IP/OP","$961.00 ","$711.14 ","$0.00 ","$961.00 ","$0.00 ","$0.00 ","$0.00 ","$685.87 ","$685.87 ","$0.00 ","$961.00 ","$0.00 ","$480.50 ","$761.11 ","$768.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805231","EAP","HCPCS C1874","","Stent Endoprsth 8mm 5cm 120cm .035in Dlv Sys Tip To Hubl","BOTH IP/OP","$7,966.00 ","$5,894.84 ","$0.00 ","$7,966.00 ","$3,584.70 ","$0.00 ","$1,660.31 ","$5,158.80 ","$5,685.33 ","$1,394.78 ","$7,966.00 ","$0.00 ","$3,983.00 ","$6,309.07 ","$6,372.80 ","$0.00 ","$1,246.68 ","$0.00 ","$1,268.19 ","$0.00 "
"27805232","EAP","HCPCS C1874","","Stent Endoprsth 8mm 10cm 120cm .035in Dlv Sys Tip To Hul","BOTH IP/OP","$9,148.00 ","$6,769.52 ","$0.00 ","$9,148.00 ","$4,116.60 ","$0.00 ","$1,906.67 ","$5,158.80 ","$6,528.93 ","$1,601.74 ","$9,148.00 ","$0.00 ","$4,574.00 ","$7,245.22 ","$7,318.40 ","$0.00 ","$1,431.66 ","$0.00 ","$1,456.36 ","$0.00 "
"27805233","EAP","HCPCS C1874","","Stent Endoprsth 10mm 5cm 120cm .035in Dlv Sys Tip To Hul","BOTH IP/OP","$7,966.00 ","$5,894.84 ","$0.00 ","$7,966.00 ","$3,584.70 ","$0.00 ","$1,660.31 ","$5,158.80 ","$5,685.33 ","$1,394.78 ","$7,966.00 ","$0.00 ","$3,983.00 ","$6,309.07 ","$6,372.80 ","$0.00 ","$1,246.68 ","$0.00 ","$1,268.19 ","$0.00 "
"27805234","EAP","HCPCS C1874","","Stent Endoprsth 10mm 10cm 120cm .035in Dlv Sys Tip To Hb","BOTH IP/OP","$9,148.00 ","$6,769.52 ","$0.00 ","$9,148.00 ","$4,116.60 ","$0.00 ","$1,906.67 ","$5,158.80 ","$6,528.93 ","$1,601.74 ","$9,148.00 ","$0.00 ","$4,574.00 ","$7,245.22 ","$7,318.40 ","$0.00 ","$1,431.66 ","$0.00 ","$1,456.36 ","$0.00 "
"27805235","EAP","HCPCS C1874","","Stent Endoprsth 6mm 7fr 5cm 120cm .035in Hep Bioactive C","BOTH IP/OP","$7,061.00 ","$5,225.14 ","$0.00 ","$7,061.00 ","$3,177.45 ","$0.00 ","$1,471.69 ","$5,039.44 ","$5,039.44 ","$1,236.32 ","$7,061.00 ","$0.00 ","$3,530.50 ","$5,592.31 ","$5,648.80 ","$0.00 ","$1,105.05 ","$0.00 ","$1,124.11 ","$0.00 "
"27805236","EAP","HCPCS C1874","","Stent Endoprsth 6mm 10cm 120cm .035in Dlv Sys Tip To Hul","BOTH IP/OP","$9,604.00 ","$7,106.96 ","$0.00 ","$9,604.00 ","$4,321.80 ","$0.00 ","$2,001.71 ","$5,158.80 ","$6,854.37 ","$1,681.58 ","$9,604.00 ","$0.00 ","$4,802.00 ","$7,606.37 ","$7,683.20 ","$0.00 ","$1,503.03 ","$0.00 ","$1,528.96 ","$0.00 "
"27805240","EAP","HCPCS V2790","","Graft Crnl 16mm Prokera Amnio Membr Crprs Ring Set","BOTH IP/OP","$2,646.00 ","$1,958.04 ","$0.00 ","$2,646.00 ","$1,190.70 ","$0.00 ","$551.49 ","$1,888.45 ","$1,888.45 ","$463.29 ","$2,646.00 ","$0.00 ","$1,323.00 ","$2,095.63 ","$2,116.80 ","$0.00 ","$414.10 ","$0.00 ","$421.24 ","$0.00 "
"27805252","EAP","Custom 27805252","","Pipeline  Embolization  Device  2.75 Cm 10mm","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805253","EAP","Custom 27805253","","Pipeline  Embolization  Device 2.75 Cm 12mm","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805254","EAP","Custom 27805254","","PIPELINE  EMBOLIZATION  DEVICE 2.75CM 16MM","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805255","EAP","Custom 27805255","","Pipeline  Embolization  Device 3.00cm 10mm","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805256","EAP","Custom 27805256","","Pipeline  Embolization  Device 3.00cm 12mm","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805257","EAP","Custom 27805257","","Pipeline  Embolization  Device  3.00cm 16mm","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805258","EAP","Custom 27805258","","Pipeline  Embolization  Device  3.50cm 10mm","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805259","EAP","Custom 27805259","","PIPELINE  EMBOLIZATION  DEVICE 3.5CM 12MM","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805260","EAP","Custom 27805260","","PIPELINE  EMBOLIZATION  DEVICE 3.5CM 16MM","BOTH IP/OP","$38,126.00 ","$28,213.24 ","$0.00 ","$38,126.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,210.53 ","$0.00 ","$38,126.00 ","$0.00 ","$19,063.00 ","$30,195.79 ","$30,500.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805265","EAP","HCPCS C1777","","Linox Smart Dx 65/17","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805266","EAP","HCPCS C1777","","Linox Smart Dx 65/15","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805267","EAP","HCPCS C1777","","Lumax 740 Vr-t Dx W/gsm Hm","BOTH IP/OP","$45,811.00 ","$33,900.14 ","$0.00 ","$45,811.00 ","$20,614.95 ","$0.00 ","$9,417.94 ","$5,158.80 ","$32,695.31 ","$8,021.14 ","$45,811.00 ","$0.00 ","$22,905.50 ","$36,282.31 ","$36,648.80 ","$0.00 ","$7,169.42 ","$0.00 ","$7,293.11 ","$0.00 "
"27805268","EAP","HCPCS C1777","","Lumax 740 Vr-t Dx System W/gsm Hm","BOTH IP/OP","$57,560.00 ","$42,594.40 ","$0.00 ","$57,560.00 ","$25,902.00 ","$0.00 ","$9,417.94 ","$5,158.80 ","$41,080.57 ","$8,138.89 ","$57,560.00 ","$0.00 ","$28,780.00 ","$45,587.52 ","$46,048.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27805269","EAP","HCPCS C1781","","Mesh Surg Craniocurve .6mm Occptl Crnm Etch Lbl Antm, 01-9520","BOTH IP/OP","$11,822.00 ","$8,748.28 ","$0.00 ","$11,822.00 ","$5,319.90 ","$0.00 ","$2,464.00 ","$5,158.80 ","$8,437.36 ","$2,069.94 ","$11,822.00 ","$0.00 ","$5,911.00 ","$9,363.02 ","$9,457.60 ","$0.00 ","$1,850.14 ","$0.00 ","$1,882.06 ","$0.00 "
"27805270","EAP","Custom 27805270","","Target Coils 360 Standard 3mm X 6cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805271","EAP","Custom 27805271","","Target Coils 360 Standard 3mm X 8cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805272","EAP","Custom 27805272","","Target Coils 360 Standard 4mm X 8cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805273","EAP","Custom 27805273","","Target Coils 360 Standard 4mm X 10cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805274","EAP","Custom 27805274","","Target Coils 360 Standard 4mm X 15cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805275","EAP","Custom 27805275","","Target Coils 360 Standard 5mm X 15cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805276","EAP","Custom 27805276","","Target Coils 360 Standard 5mm X 20cm","BOTH IP/OP","$4,559.00 ","$3,373.66 ","$0.00 ","$4,559.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.76 ","$3,253.76 ","$0.00 ","$4,559.00 ","$0.00 ","$2,279.50 ","$3,610.73 ","$3,647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805277","EAP","Custom 27805277","","Target Coils 360 Standard 6mm X 15cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805278","EAP","Custom 27805278","","Target Coils 360 Standard 6mm X 20cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805279","EAP","Custom 27805279","","Target Coils 360 Standard 6mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805280","EAP","Custom 27805280","","Target Coils 360 Standard 7mm X 15cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805281","EAP","Custom 27805281","","Target Coils 360 Standard 7mm X 20cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805282","EAP","Custom 27805282","","Target Coils 360 Standard 7mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805283","EAP","Custom 27805283","","Target Coils 360 Standard 8mm X 20cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805284","EAP","Custom 27805284","","Target Coils 360 Standard 8mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805285","EAP","Custom 27805285","","Target Coils 360 Standard 9mm X 20cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805286","EAP","Custom 27805286","","Target Coils 360 Standard 9mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805287","EAP","Custom 27805287","","Target Coils 360 Standard 10mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805288","EAP","Custom 27805288","","Target Coils 360 Standard 11mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805289","EAP","Custom 27805289","","Target Coils 360 Standard 12mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805290","EAP","Custom 27805290","","Target Coils 360 Standard 13mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805291","EAP","Custom 27805291","","Target Coils 360 Standard 14mm X 30cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805292","EAP","Custom 27805292","","Target Coils 360 Standard 15mm X 40cm","BOTH IP/OP","$5,097.00 ","$3,771.78 ","$0.00 ","$5,097.00 ","$0.00 ","$0.00 ","$0.00 ","$3,637.73 ","$3,637.73 ","$0.00 ","$5,097.00 ","$0.00 ","$2,548.50 ","$4,036.82 ","$4,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805293","EAP","Custom 27805293","","Target Coils 360 Soft 2mm X 4cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805294","EAP","Custom 27805294","","Target Coils 360 Soft 3mm X 6cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805295","EAP","Custom 27805295","","Target Coils 360 Soft 3mm X 8cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805296","EAP","Custom 27805296","","Target Coils 360 Soft 3mm X 10cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805297","EAP","Custom 27805297","","Target Coils 360 Soft 4mm X 6cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805298","EAP","Custom 27805298","","Target Coils 360 Soft 4mm X 8cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805299","EAP","Custom 27805299","","Target Coils 360 Soft 4mm X 10cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805300","EAP","Custom 27805300","","Target Coils 360 Soft 4mm X 15cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805301","EAP","Custom 27805301","","Target Coils 360 Soft 5mm X 10cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805302","EAP","Custom 27805302","","Target Coils 360 Soft 5mm X 15cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805303","EAP","Custom 27805303","","Target Coils 360 Soft 5mm X 20cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805304","EAP","Custom 27805304","","Target Coils 360 Soft 6mm X 10cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805305","EAP","Custom 27805305","","Target Coils 360 Soft 6mm X 15cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805306","EAP","Custom 27805306","","Target Coils 360 Soft 6mm X 20cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805307","EAP","Custom 27805307","","Target Coils 360 Soft 6mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805308","EAP","Custom 27805308","","Target Coils 360 Soft 7mm X 15cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805309","EAP","Custom 27805309","","Target Coils 360 Soft 7mm X 20cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805310","EAP","Custom 27805310","","Target Coils 360 Soft 7mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805311","EAP","Custom 27805311","","Target Coils 360 Soft 8mm X 20cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805312","EAP","Custom 27805312","","Target Coils 360 Soft 8mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805313","EAP","Custom 27805313","","Target Coils 360 Soft 9mm X 20cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805314","EAP","Custom 27805314","","Target Coils 360 Soft 9mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805315","EAP","Custom 27805315","","Target Coils 360 Soft 10mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805316","EAP","Custom 27805316","","Target Coils 360 Soft 11mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805317","EAP","Custom 27805317","","Target Coils 360 Soft 12mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805318","EAP","Custom 27805318","","Target Coils 360 Soft 13mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805319","EAP","Custom 27805319","","Target Coils 360 Soft 14mm X 30cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805320","EAP","Custom 27805320","","Target Coils Helical Ultra 1mm X 1cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805321","EAP","Custom 27805321","","Target Coils Helical Ultra 1mm X 2cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805322","EAP","Custom 27805322","","Target Coils Helical Ultra 1mm X 3cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805323","EAP","Custom 27805323","","Target Coils Helical Ultra 1.5mm X 1cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805324","EAP","Custom 27805324","","Target Coils Helical Ultra 1.5mm X 2cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805325","EAP","Custom 27805325","","Target Coils Helical Ultra 1.5mm X 3cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805326","EAP","Custom 27805326","","Target Coils Helical Ultra 1.5mm X 4cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805327","EAP","Custom 27805327","","Target Coils Helical Ultra 2mm X 1cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805328","EAP","Custom 27805328","","Target Coils Helical Ultra 2mm X 2cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805329","EAP","Custom 27805329","","Target Coils Helical Ultra 2mm X 3cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805330","EAP","Custom 27805330","","Target Coils Helical Ultra 2mm X 4cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805331","EAP","Custom 27805331","","Target Coils Helical Ultra 2mm X 6cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805332","EAP","Custom 27805332","","Target Coils Helical Ultra 2mm X 8cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805333","EAP","Custom 27805333","","Target Coils Helical Ultra 2.5mm X 3cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805334","EAP","Custom 27805334","","Target Coils Helical Ultra 2.5mm X 4cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805335","EAP","Custom 27805335","","Target Coils Helical Ultra 2.5mm X 6cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805336","EAP","Custom 27805336","","Target Coils Helical Ultra 3mm X 4cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805337","EAP","Custom 27805337","","Target Coils Helical Ultra 3mm X 6cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805338","EAP","Custom 27805338","","Target Coils Helical Ultra 3mm X 8cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805339","EAP","Custom 27805339","","Target Coils Helical Ultra 3mm X 10cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805340","EAP","Custom 27805340","","Target Coils Helical Ultra 4mm X 6cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805341","EAP","Custom 27805341","","Target Coils Helical Ultra 4mm X 8cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805342","EAP","Custom 27805342","","Target Coils Helical Ultra 4mm X 15cm","BOTH IP/OP","$3,483.00 ","$2,577.42 ","$0.00 ","$3,483.00 ","$0.00 ","$0.00 ","$0.00 ","$2,485.82 ","$2,485.82 ","$0.00 ","$3,483.00 ","$0.00 ","$1,741.50 ","$2,758.54 ","$2,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805343","EAP","Custom 27805343","","Target Xl Detachable Coils 360 Soft 6 X 20cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805344","EAP","Custom 27805344","","Target Xl Detachable Coils 360 Soft 7 X 20cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805345","EAP","Custom 27805345","","Target Xl Detachable Coils 360 Soft 8 X 30cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805346","EAP","Custom 27805346","","Target Xl Detachable Coils 360 Soft 9 X 30cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805347","EAP","Custom 27805347","","Target Xl Detachable Coils 360 Soft 10 X 40cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805348","EAP","Custom 27805348","","Target Xl Detachable Coils 360 Soft 12 X 45cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805349","EAP","Custom 27805349","","Target Xl Detachable Coils 360 Soft 14 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805350","EAP","Custom 27805350","","Target Xl Detachable Coils 360 Soft 16 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805351","EAP","Custom 27805351","","Target Xl Detachable Coils 360 Soft 18 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805352","EAP","Custom 27805352","","Target Xl Detachable Coils 360 Soft 20 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805353","EAP","Custom 27805353","","Target Xl Detachable Coils 360 Standard  6 X 20cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805354","EAP","Custom 27805354","","Target Xl Detachable Coils 360 Standard  7 X 20cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805355","EAP","Custom 27805355","","Target Xl Detachable Coils 360 Standard  8 X 30cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805356","EAP","Custom 27805356","","Target Xl Detachable Coils 360 Standard  9 X 30cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805357","EAP","Custom 27805357","","Target Xl Detachable Coils 360 Standard  10 X 40cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805358","EAP","Custom 27805358","","Target Xl Detachable Coils 360 Standard  12 X 45cm","BOTH IP/OP","$5,903.00 ","$4,368.22 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$0.00 ","$5,903.00 ","$0.00 ","$2,951.50 ","$4,675.18 ","$4,722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805359","EAP","Custom 27805359","","Target Xl Detachable Coils 360 Standard  14 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805360","EAP","Custom 27805360","","Target Xl Detachable Coils 360 Standard  16 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805361","EAP","Custom 27805361","","Target Xl Detachable Coils 360 Standard  18 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805362","EAP","Custom 27805362","","Target Xl Detachable Coils 360 Standard  20 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805363","EAP","Custom 27805363","","Target Xl Detachable Coils 360 Standard  22 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805364","EAP","Custom 27805364","","Target Xl Detachable Coils 360 Standard  24 X 50cm","BOTH IP/OP","$6,441.00 ","$4,766.34 ","$0.00 ","$6,441.00 ","$0.00 ","$0.00 ","$0.00 ","$4,596.94 ","$4,596.94 ","$0.00 ","$6,441.00 ","$0.00 ","$3,220.50 ","$5,101.27 ","$5,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805365","EAP","Custom 27805365","","Target Xl Detachable Coils Helical 10 X 40cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805366","EAP","Custom 27805366","","Target Xl Detachable Coils Helical 12 X 50cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805367","EAP","Custom 27805367","","Target Xl Detachable Coils Helical 14 X 50cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805368","EAP","Custom 27805368","","Target Xl Detachable Coils Helical 16 X 50cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805369","EAP","Custom 27805369","","Target Xl Detachable Coils Helical 18 X 50cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805370","EAP","Custom 27805370","","Target Xl Detachable Coils Helical 20 X 50cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805371","EAP","Custom 27805371","","Target Xl Detachable Coils Helical 22 X 50cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805372","EAP","Custom 27805372","","Target Xl Detachable Coils Helical 24 X 50cm","BOTH IP/OP","$4,827.00 ","$3,571.98 ","$0.00 ","$4,827.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.03 ","$3,445.03 ","$0.00 ","$4,827.00 ","$0.00 ","$2,413.50 ","$3,822.98 ","$3,861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805373","EAP","Custom 27805373","","Target Xl Detachable Coils Helical 5 X 15cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805374","EAP","Custom 27805374","","Target Xl Detachable Coils Helical 6 X 20cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805375","EAP","Custom 27805375","","Target Xl Detachable Coils Helical 7 X 20cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805376","EAP","Custom 27805376","","Target Xl Detachable Coils Helical 8 X 30cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805377","EAP","Custom 27805377","","Target Xl Detachable Coils Helical 9 X 30cm","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$0.00 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$3,061.77 ","$3,061.77 ","$0.00 ","$4,290.00 ","$0.00 ","$2,145.00 ","$3,397.68 ","$3,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805378","EAP","HCPCS C1781","","Mesh Surg Craniocurve .6mm Left Prtl Sm Crnm Etch Lbl Antm, 01-9521","BOTH IP/OP","$13,300.00 ","$9,842.00 ","$0.00 ","$13,300.00 ","$5,985.00 ","$0.00 ","$2,772.05 ","$5,158.80 ","$9,492.21 ","$2,328.72 ","$13,300.00 ","$0.00 ","$6,650.00 ","$10,533.60 ","$10,640.00 ","$0.00 ","$2,081.45 ","$0.00 ","$2,117.36 ","$0.00 "
"27805379","EAP","HCPCS C1781","","Mesh Surg Craniocurve .6mm Right Prtl Sm Crnm Etch Lbl Antm, 01-9522","BOTH IP/OP","$13,300.00 ","$9,842.00 ","$0.00 ","$13,300.00 ","$5,985.00 ","$0.00 ","$2,772.05 ","$5,158.80 ","$9,492.21 ","$2,328.72 ","$13,300.00 ","$0.00 ","$6,650.00 ","$10,533.60 ","$10,640.00 ","$0.00 ","$2,081.45 ","$0.00 ","$2,117.36 ","$0.00 "
"27805380","EAP","HCPCS C1781","","Mesh Surg Craniocurve .6mm Left Prtl Lg Crnm Etch Lbl Antm, 01-9523","BOTH IP/OP","$14,777.00 ","$10,934.98 ","$0.00 ","$14,777.00 ","$6,649.65 ","$0.00 ","$3,079.90 ","$5,158.80 ","$10,546.34 ","$2,587.33 ","$14,777.00 ","$0.00 ","$7,388.50 ","$11,703.38 ","$11,821.60 ","$0.00 ","$2,312.60 ","$0.00 ","$2,352.50 ","$0.00 "
"27805381","EAP","HCPCS C1781","","Mesh Surg Craniocurve .6mm Right Prtl Lg Crnm Etch Lbl Antm, 01-9524","BOTH IP/OP","$14,777.00 ","$10,934.98 ","$0.00 ","$14,777.00 ","$6,649.65 ","$0.00 ","$3,079.90 ","$5,158.80 ","$10,546.34 ","$2,587.33 ","$14,777.00 ","$0.00 ","$7,388.50 ","$11,703.38 ","$11,821.60 ","$0.00 ","$2,312.60 ","$0.00 ","$2,352.50 ","$0.00 "
"27805382","EAP","HCPCS C1876","","Protege Everflex Stent 6x40x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805383","EAP","HCPCS C1876","","Protege Everflex Stent 6x60x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805384","EAP","HCPCS C1876","","Protege Everflex Stent 6x80x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805385","EAP","HCPCS C1876","","Protege Everflex Stent 8x40x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805386","EAP","HCPCS C1876","","Protege Everflex Stent 8x60x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805387","EAP","HCPCS C1876","","Protege Everflex Stent 8x80x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805388","EAP","HCPCS C1876","","Protege Stent 10x40x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805389","EAP","HCPCS C1876","","Protege Stent 10x60x120","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805390","EAP","HCPCS C1876","","Protege Stent 12x40x80","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805391","EAP","HCPCS C1876","","Protege Stent 12x60x80","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805392","EAP","HCPCS C1876","","Protege Stent 14x40x80","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805393","EAP","HCPCS C1876","","Protege Stent 14x80x80","BOTH IP/OP","$3,990.00 ","$2,952.60 ","$0.00 ","$3,990.00 ","$1,795.50 ","$0.00 ","$831.62 ","$2,847.66 ","$2,847.66 ","$698.62 ","$3,990.00 ","$0.00 ","$1,995.00 ","$3,160.08 ","$3,192.00 ","$0.00 ","$624.44 ","$0.00 ","$635.21 ","$0.00 "
"27805394","EAP","HCPCS C1876","","Protege Everflex Stent 6x150x120","BOTH IP/OP","$5,319.00 ","$3,936.06 ","$0.00 ","$5,319.00 ","$2,393.55 ","$0.00 ","$1,108.61 ","$3,796.17 ","$3,796.17 ","$931.31 ","$5,319.00 ","$0.00 ","$2,659.50 ","$4,212.65 ","$4,255.20 ","$0.00 ","$832.42 ","$0.00 ","$846.78 ","$0.00 "
"27805395","EAP","HCPCS C1751","","Cath Art 8fr 110cm Td Co Sg Hep","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$0.00 ","$0.00 ","$0.00 ","$722.98 ","$722.98 ","$177.37 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$158.53 ","$0.00 ","$161.27 ","$0.00 "
"27805407","EAP","HCPCS C1876","","Stent Duodenal Wallflex .035 In L9 Cm L230 Cm Od22-27 Mm","BOTH IP/OP","$7,537.00 ","$5,577.38 ","$0.00 ","$7,537.00 ","$3,391.65 ","$0.00 ","$1,570.90 ","$5,158.80 ","$5,379.16 ","$1,319.67 ","$7,537.00 ","$0.00 ","$3,768.50 ","$5,969.30 ","$6,029.60 ","$0.00 ","$1,179.54 ","$0.00 ","$1,199.89 ","$0.00 "
"27805409","EAP","HCPCS L8699","","Onyx 18 Kit Avm Us","BOTH IP/OP","$6,984.00 ","$5,168.16 ","$0.00 ","$6,984.00 ","$0.00 ","$0.00 ","$0.00 ","$4,984.48 ","$4,984.48 ","$0.00 ","$6,984.00 ","$0.00 ","$3,492.00 ","$5,531.33 ","$5,587.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805410","EAP","HCPCS L8699","","Onyx 34 Kit Avm Us","BOTH IP/OP","$6,651.00 ","$4,921.74 ","$0.00 ","$6,651.00 ","$0.00 ","$0.00 ","$0.00 ","$4,746.82 ","$4,746.82 ","$0.00 ","$6,651.00 ","$0.00 ","$3,325.50 ","$5,267.59 ","$5,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805412","EAP","HCPCS C1874","","Stent Bil 8mm 8.5fr 60mm Flly Covered Trnshep Wallflex","BOTH IP/OP","$7,978.00 ","$5,903.72 ","$0.00 ","$7,978.00 ","$3,590.10 ","$0.00 ","$1,662.81 ","$5,158.80 ","$5,693.90 ","$1,396.88 ","$7,978.00 ","$0.00 ","$3,989.00 ","$6,318.58 ","$6,382.40 ","$0.00 ","$1,248.56 ","$0.00 ","$1,270.10 ","$0.00 "
"27805413","EAP","HCPCS C1874","","Stent Bil 8mm 8.5fr 80mm Flly Covered Trnshep Wallflex","BOTH IP/OP","$7,978.00 ","$5,903.72 ","$0.00 ","$7,978.00 ","$3,590.10 ","$0.00 ","$1,662.81 ","$5,158.80 ","$5,693.90 ","$1,396.88 ","$7,978.00 ","$0.00 ","$3,989.00 ","$6,318.58 ","$6,382.40 ","$0.00 ","$1,248.56 ","$0.00 ","$1,270.10 ","$0.00 "
"27805414","EAP","HCPCS C1874","","Stent Bil 10mm 8.5fr 40mm Flly Covered Trnshep Wallflex","BOTH IP/OP","$7,978.00 ","$5,903.72 ","$0.00 ","$7,978.00 ","$3,590.10 ","$0.00 ","$1,662.81 ","$5,158.80 ","$5,693.90 ","$1,396.88 ","$7,978.00 ","$0.00 ","$3,989.00 ","$6,318.58 ","$6,382.40 ","$0.00 ","$1,248.56 ","$0.00 ","$1,270.10 ","$0.00 "
"27805415","EAP","HCPCS C1876","","Stent Bil 10mm 8.5fr 60mm Flly Covered Trnshep Wallflex","BOTH IP/OP","$7,978.00 ","$5,903.72 ","$0.00 ","$7,978.00 ","$3,590.10 ","$0.00 ","$1,662.81 ","$5,158.80 ","$5,693.90 ","$1,396.88 ","$7,978.00 ","$0.00 ","$3,989.00 ","$6,318.58 ","$6,382.40 ","$0.00 ","$1,248.56 ","$0.00 ","$1,270.10 ","$0.00 "
"27805416","EAP","HCPCS C1876","","Stent Bil 10mm 8.5fr 80mm Flly Covered Trnshep Wallflex","BOTH IP/OP","$7,978.00 ","$5,903.72 ","$0.00 ","$7,978.00 ","$3,590.10 ","$0.00 ","$1,662.81 ","$5,158.80 ","$5,693.90 ","$1,396.88 ","$7,978.00 ","$0.00 ","$3,989.00 ","$6,318.58 ","$6,382.40 ","$0.00 ","$1,248.56 ","$0.00 ","$1,270.10 ","$0.00 "
"27805417","EAP","HCPCS C1876","","Stent Bil 10mm 80mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805418","EAP","HCPCS C1876","","Stent Bil 80mm 60mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805419","EAP","HCPCS C1876","","Stent Bil 80mm 80mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805420","EAP","HCPCS C1876","","Stent Bil 80mm 10mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805421","EAP","HCPCS C1876","","Stent Bil 10mm 80mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805422","EAP","HCPCS C1876","","Stent Bil 10mm 10mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805423","EAP","HCPCS C1876","","Stent Bil 10mm 40mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805424","EAP","HCPCS C1876","","Stent Bil 10mm 60mm Uncvr Wallflex","BOTH IP/OP","$5,395.00 ","$3,992.30 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$1,124.45 ","$3,850.41 ","$3,850.41 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"27805431","EAP","Custom 27805431","","Pipeline  Embolization  Device  3.00mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805432","EAP","Custom 27805432","","Bowtie Shape - 10g Mammomark - Biopsy Site Identtfier","BOTH IP/OP","$689.00 ","$509.86 ","$0.00 ","$689.00 ","$0.00 ","$0.00 ","$0.00 ","$491.74 ","$491.74 ","$0.00 ","$689.00 ","$0.00 ","$344.50 ","$545.69 ","$551.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805437","EAP"," C1817","","Amplatzer Septal Occluder 20 Mm","BOTH IP/OP","$16,714.00 ","$12,368.36 ","$0.00 ","$16,714.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,928.78 ","$0.00 ","$16,714.00 ","$0.00 ","$8,357.00 ","$13,237.49 ","$13,371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805438","EAP"," C1817","","Amplatzer Septal Occluder 22 Mm","BOTH IP/OP","$16,714.00 ","$12,368.36 ","$0.00 ","$16,714.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,928.78 ","$0.00 ","$16,714.00 ","$0.00 ","$8,357.00 ","$13,237.49 ","$13,371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805439","EAP","HCPCS C1817","","Amplatzer Septal Occluder 24 Mm","BOTH IP/OP","$16,714.00 ","$12,368.36 ","$0.00 ","$16,714.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,928.78 ","$0.00 ","$16,714.00 ","$0.00 ","$8,357.00 ","$13,237.49 ","$13,371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805440","EAP","CPT� C1817","","Amplatzer Septal Occluder 26 Mm","BOTH IP/OP","$16,714.00 ","$12,368.36 ","$0.00 ","$16,714.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,928.78 ","$0.00 ","$16,714.00 ","$0.00 ","$8,357.00 ","$13,237.49 ","$13,371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805441","EAP","CPT� C1896","","Q-trak Electrode","BOTH IP/OP","$13,779.00 ","$10,196.46 ","$0.00 ","$13,779.00 ","$0.00 ","$0.00 ","$2,871.89 ","$5,158.80 ","$9,834.07 ","$0.00 ","$13,779.00 ","$0.00 ","$6,889.50 ","$10,912.97 ","$11,023.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805442","EAP","HCPCS C1781","","Occluder Septal 15mm","BOTH IP/OP","$18,552.00 ","$13,728.48 ","$0.00 ","$18,552.00 ","$8,348.40 ","$0.00 ","$3,866.70 ","$5,158.80 ","$13,240.56 ","$3,248.31 ","$18,552.00 ","$0.00 ","$9,276.00 ","$14,693.18 ","$14,841.60 ","$0.00 ","$2,903.39 ","$0.00 ","$2,953.48 ","$0.00 "
"27805443","EAP","HCPCS C1781","","Occluder Septal 20mm","BOTH IP/OP","$18,552.00 ","$13,728.48 ","$0.00 ","$18,552.00 ","$8,348.40 ","$0.00 ","$3,866.70 ","$5,158.80 ","$13,240.56 ","$3,248.31 ","$18,552.00 ","$0.00 ","$9,276.00 ","$14,693.18 ","$14,841.60 ","$0.00 ","$2,903.39 ","$0.00 ","$2,953.48 ","$0.00 "
"27805444","EAP","HCPCS C1781","","Occluder Septal 25mm","BOTH IP/OP","$18,552.00 ","$13,728.48 ","$0.00 ","$18,552.00 ","$8,348.40 ","$0.00 ","$3,866.70 ","$5,158.80 ","$13,240.56 ","$3,248.31 ","$18,552.00 ","$0.00 ","$9,276.00 ","$14,693.18 ","$14,841.60 ","$0.00 ","$2,903.39 ","$0.00 ","$2,953.48 ","$0.00 "
"27805445","EAP","HCPCS C1781","","Occluder Septal 30mm","BOTH IP/OP","$18,552.00 ","$13,728.48 ","$0.00 ","$18,552.00 ","$8,348.40 ","$0.00 ","$3,866.70 ","$5,158.80 ","$13,240.56 ","$3,248.31 ","$18,552.00 ","$0.00 ","$9,276.00 ","$14,693.18 ","$14,841.60 ","$0.00 ","$2,903.39 ","$0.00 ","$2,953.48 ","$0.00 "
"27805446","EAP","HCPCS C1781","","Occluder Septal 35mm","BOTH IP/OP","$18,552.00 ","$13,728.48 ","$0.00 ","$18,552.00 ","$8,348.40 ","$0.00 ","$3,866.70 ","$5,158.80 ","$13,240.56 ","$3,248.31 ","$18,552.00 ","$0.00 ","$9,276.00 ","$14,693.18 ","$14,841.60 ","$0.00 ","$2,903.39 ","$0.00 ","$2,953.48 ","$0.00 "
"27805447","EAP","Custom 27805447","","Pipeline  Embolization  Device  3.00mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805448","EAP","Custom 27805448","","Pipeline  Embolization  Device  3.00mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805449","EAP","Custom 27805449","","Pipeline  Embolization  Device  3.25mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805450","EAP","Custom 27805450","","Pipeline  Embolization  Device  3.25mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805451","EAP","Custom 27805451","","Pipeline  Embolization  Device  3.25mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805452","EAP","Custom 27805452","","Pipeline  Embolization  Device  3.50mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805453","EAP","Custom 27805453","","Pipeline  Embolization  Device  3.50mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805454","EAP","Custom 27805454","","Pipeline  Embolization  Device  3.50mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805455","EAP","Custom 27805455","","Pipeline  Embolization  Device  3.75mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805456","EAP","Custom 27805456","","Pipeline  Embolization  Device  3.75mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805457","EAP","Custom 27805457","","Pipeline  Embolization  Device  3.75mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805458","EAP","Custom 27805458","","Pipeline  Embolization  Device  4.00mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805459","EAP","Custom 27805459","","Pipeline  Embolization  Device  4.00mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805460","EAP","Custom 27805460","","Pipeline  Embolization  Device  4.00mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805461","EAP","Custom 27805461","","Pipeline  Embolization  Device  4.25mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805462","EAP","Custom 27805462","","Pipeline  Embolization  Device  4.25mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805463","EAP","Custom 27805463","","Pipeline  Embolization  Device  4.25mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805464","EAP","Custom 27805464","","Pipeline  Embolization  Device  4.50mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805465","EAP","Custom 27805465","","Pipeline  Embolization  Device  4.50mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805466","EAP","Custom 27805466","","Pipeline  Embolization  Device  4.50mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805467","EAP","Custom 27805467","","Pipeline  Embolization  Device  4.75mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805468","EAP","Custom 27805468","","Pipeline  Embolization  Device  4.75mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805469","EAP","Custom 27805469","","Pipeline  Embolization  Device  4.75mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805470","EAP","Custom 27805470","","Pipeline  Embolization  Device  5.00mm X 25mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805471","EAP","Custom 27805471","","Pipeline  Embolization  Device  5.00mm X 30mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805472","EAP","Custom 27805472","","Pipeline  Embolization  Device  5.00mm X 35mm","BOTH IP/OP","$38,029.00 ","$28,141.46 ","$0.00 ","$38,029.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$27,141.30 ","$0.00 ","$38,029.00 ","$0.00 ","$19,014.50 ","$30,118.97 ","$30,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805473","EAP","Custom 27805473","","Pipeline  Embolization  Device  2.50mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805474","EAP","Custom 27805474","","Pipeline  Embolization  Device  2.50mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805475","EAP","Custom 27805475","","Pipeline  Embolization  Device  2.50mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805476","EAP","Custom 27805476","","Pipeline  Embolization  Device  2.50mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805477","EAP","Custom 27805477","","Pipeline  Embolization  Device  2.50mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805478","EAP","Custom 27805478","","Pipeline  Embolization  Device  2.50mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805479","EAP","Custom 27805479","","Pipeline  Embolization  Device  2.75mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805480","EAP","Custom 27805480","","Pipeline  Embolization  Device  2.75mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805481","EAP","Custom 27805481","","Pipeline  Embolization  Device  2.75mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805482","EAP","Custom 27805482","","Pipeline  Embolization  Device  3.00mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805483","EAP","Custom 27805483","","Pipeline  Embolization  Device  3.00mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805484","EAP","Custom 27805484","","Pipeline  Embolization  Device  3.00mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805485","EAP","Custom 27805485","","Pipeline  Embolization  Device  3.25mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805486","EAP","Custom 27805486","","Pipeline  Embolization  Device  3.25mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805487","EAP","Custom 27805487","","Pipeline  Embolization  Device  3.25mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805488","EAP","Custom 27805488","","Pipeline  Embolization  Device  3.25mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805489","EAP","Custom 27805489","","Pipeline  Embolization  Device  3.25mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805490","EAP","Custom 27805490","","Pipeline  Embolization  Device  3.25mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805491","EAP","Custom 27805491","","Pipeline  Embolization  Device  3.50mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805492","EAP","Custom 27805492","","Pipeline  Embolization  Device  3.50mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805493","EAP","Custom 27805493","","Pipeline  Embolization  Device  3.50mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805494","EAP","Custom 27805494","","Pipeline  Embolization  Device  3.75mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805495","EAP","Custom 27805495","","Pipeline  Embolization  Device  3.75mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805496","EAP","Custom 27805496","","Pipeline  Embolization  Device  3.75mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805497","EAP","Custom 27805497","","Pipeline  Embolization  Device  3.75mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805498","EAP","Custom 27805498","","Pipeline  Embolization  Device  3.75mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805499","EAP","Custom 27805499","","Pipeline  Embolization  Device  3.75mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805500","EAP","Custom 27805500","","Pipeline  Embolization  Device  4.00mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805501","EAP","Custom 27805501","","Pipeline  Embolization  Device  4.00mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805502","EAP","Custom 27805502","","Pipeline  Embolization  Device  4.00mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805503","EAP","Custom 27805503","","Pipeline  Embolization  Device  4.00mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805504","EAP","Custom 27805504","","Pipeline  Embolization  Device  4.00mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805505","EAP","Custom 27805505","","Pipeline  Embolization  Device  4.00mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805506","EAP","Custom 27805506","","Pipeline  Embolization  Device  4.25mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805507","EAP","Custom 27805507","","Pipeline  Embolization  Device  4.25mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805508","EAP","Custom 27805508","","Pipeline  Embolization  Device  4.25mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805509","EAP","Custom 27805509","","Pipeline  Embolization  Device  4.25mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805510","EAP","Custom 27805510","","Pipeline  Embolization  Device  4.25mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805511","EAP","Custom 27805511","","Pipeline  Embolization  Device  4.25mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805512","EAP","Custom 27805512","","Pipeline  Embolization  Device  4.50mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805513","EAP","Custom 27805513","","Pipeline  Embolization  Device  4.50mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805514","EAP","Custom 27805514","","Pipeline  Embolization  Device  4.50mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805515","EAP","Custom 27805515","","Pipeline  Embolization  Device  4.50mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805516","EAP","Custom 27805516","","Pipeline  Embolization  Device  4.50mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805517","EAP","Custom 27805517","","Pipeline  Embolization  Device  4.50mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805518","EAP","Custom 27805518","","Pipeline  Embolization  Device  4.75mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805519","EAP","Custom 27805519","","Pipeline  Embolization  Device  4.75mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805520","EAP","Custom 27805520","","Pipeline  Embolization  Device  4.75mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805521","EAP","Custom 27805521","","Pipeline  Embolization  Device  4.75mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805522","EAP","Custom 27805522","","Pipeline  Embolization  Device  4.75mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805523","EAP","Custom 27805523","","Pipeline  Embolization  Device  4.75mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805524","EAP","Custom 27805524","","Pipeline  Embolization  Device  5.00mm X 10mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805525","EAP","Custom 27805525","","Pipeline  Embolization  Device  5.00mm X 12mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805526","EAP","Custom 27805526","","Pipeline  Embolization  Device  5.00mm X 14mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805527","EAP","Custom 27805527","","Pipeline  Embolization  Device  5.00mm X 16mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805528","EAP","Custom 27805528","","Pipeline  Embolization  Device  5.00mm X 18mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805529","EAP","Custom 27805529","","Pipeline  Embolization  Device  5.00mm X 20mm","BOTH IP/OP","$35,550.00 ","$26,307.00 ","$0.00 ","$35,550.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,372.04 ","$0.00 ","$35,550.00 ","$0.00 ","$17,775.00 ","$28,155.60 ","$28,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805530","EAP","HCPCS C1876","","Stent Coron 4mm 18mm .014in Rapex Flxb Lp Mtlnk Vsn Cocr","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$322.65 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27805531","EAP","HCPCS C1876","","Stent Coron 4mm 28mm .014in Rapex Flxb Lp Mtlnk Vsn Cocr","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$322.65 ","$0.00 ","$149.44 ","$511.72 ","$511.72 ","$125.54 ","$717.00 ","$0.00 ","$358.50 ","$567.86 ","$573.60 ","$0.00 ","$112.21 ","$0.00 ","$114.15 ","$0.00 "
"27805532","EAP","HCPCS C1874","","Stent Coron 3.5mm 24mm Drg Eluding Endvr Sprnt Zotarolimus","BOTH IP/OP","$1,847.00 ","$1,366.78 ","$0.00 ","$1,847.00 ","$831.15 ","$0.00 ","$384.96 ","$1,318.20 ","$1,318.20 ","$323.39 ","$1,847.00 ","$0.00 ","$923.50 ","$1,462.82 ","$1,477.60 ","$0.00 ","$289.06 ","$0.00 ","$294.04 ","$0.00 "
"27805533","EAP","HCPCS C1874","","Stent Coron 3.5mm 12mm Drg Eluding Endvr Sprnt Zotarolimus","BOTH IP/OP","$1,847.00 ","$1,366.78 ","$0.00 ","$1,847.00 ","$831.15 ","$0.00 ","$384.96 ","$1,318.20 ","$1,318.20 ","$323.39 ","$1,847.00 ","$0.00 ","$923.50 ","$1,462.82 ","$1,477.60 ","$0.00 ","$289.06 ","$0.00 ","$294.04 ","$0.00 "
"27805534","EAP","HCPCS C1874","","Stent Coron 3.5mm 18mm Drg Eluding Endvr Sprnt Zotarolimus","BOTH IP/OP","$1,847.00 ","$1,366.78 ","$0.00 ","$1,847.00 ","$831.15 ","$0.00 ","$384.96 ","$1,318.20 ","$1,318.20 ","$323.39 ","$1,847.00 ","$0.00 ","$923.50 ","$1,462.82 ","$1,477.60 ","$0.00 ","$289.06 ","$0.00 ","$294.04 ","$0.00 "
"27805535","EAP","HCPCS C1874","","Stent Coron 2.5mm 12mm Drg Eluding Endvr Sprnt Zotarolimus","BOTH IP/OP","$1,847.00 ","$1,366.78 ","$0.00 ","$1,847.00 ","$831.15 ","$0.00 ","$384.96 ","$1,318.20 ","$1,318.20 ","$323.39 ","$1,847.00 ","$0.00 ","$923.50 ","$1,462.82 ","$1,477.60 ","$0.00 ","$289.06 ","$0.00 ","$294.04 ","$0.00 "
"27805536","EAP","Custom 27805536","","Coil Target 3d 3mm X 6cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805537","EAP","Custom 27805537","","Coil Target 3d 4mm X 8cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805538","EAP","Custom 27805538","","Coil Target 3d 5mm X 10cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805539","EAP","Custom 27805539","","Coil Target 3d 6mm X 15cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805540","EAP","Custom 27805540","","Coil Target 3d 7mm X 15cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805541","EAP","Custom 27805541","","Coil Target 3d 8mm X 25cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805542","EAP","Custom 27805542","","Coil Target 3d 10mm X 30cm","BOTH IP/OP","$4,502.00 ","$3,331.48 ","$0.00 ","$4,502.00 ","$0.00 ","$0.00 ","$0.00 ","$3,213.08 ","$3,213.08 ","$0.00 ","$4,502.00 ","$0.00 ","$2,251.00 ","$3,565.58 ","$3,601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805543","EAP","Custom 27805543","","Coil Embl 10cm 4mm Trgt Dtch Ult 360d","BOTH IP/OP","$4,752.00 ","$3,516.48 ","$0.00 ","$4,752.00 ","$0.00 ","$0.00 ","$0.00 ","$3,391.50 ","$3,391.50 ","$0.00 ","$4,752.00 ","$0.00 ","$2,376.00 ","$3,763.58 ","$3,801.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805544","EAP","Custom 27805544","","Coil Target 360 Ultra 3.5mm X 8cm","BOTH IP/OP","$5,401.00 ","$3,996.74 ","$0.00 ","$5,401.00 ","$0.00 ","$0.00 ","$0.00 ","$3,854.69 ","$3,854.69 ","$0.00 ","$5,401.00 ","$0.00 ","$2,700.50 ","$4,277.59 ","$4,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805545","EAP","Custom 27805545","","Coil Target 360 Ultra 4.5mm X 10cm","BOTH IP/OP","$5,671.00 ","$4,196.54 ","$0.00 ","$5,671.00 ","$0.00 ","$0.00 ","$0.00 ","$4,047.39 ","$4,047.39 ","$0.00 ","$5,671.00 ","$0.00 ","$2,835.50 ","$4,491.43 ","$4,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805546","EAP","Custom 27805546","","Coil Target 360 Nano 2mm X 3cm","BOTH IP/OP","$5,671.00 ","$4,196.54 ","$0.00 ","$5,671.00 ","$0.00 ","$0.00 ","$0.00 ","$4,047.39 ","$4,047.39 ","$0.00 ","$5,671.00 ","$0.00 ","$2,835.50 ","$4,491.43 ","$4,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805547","EAP","Custom 27805547","","Coil Target 360 Nano 2mm X 4cm","BOTH IP/OP","$5,671.00 ","$4,196.54 ","$0.00 ","$5,671.00 ","$0.00 ","$0.00 ","$0.00 ","$4,047.39 ","$4,047.39 ","$0.00 ","$5,671.00 ","$0.00 ","$2,835.50 ","$4,491.43 ","$4,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805548","EAP","Custom 27805548","","Coil Target 360 Nano 2.5mm X 4cm","BOTH IP/OP","$5,401.00 ","$3,996.74 ","$0.00 ","$5,401.00 ","$0.00 ","$0.00 ","$0.00 ","$3,854.69 ","$3,854.69 ","$0.00 ","$5,401.00 ","$0.00 ","$2,700.50 ","$4,277.59 ","$4,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805549","EAP","Custom 27805549","","Coil Target 360 Nano 3mm X 4cm","BOTH IP/OP","$5,671.00 ","$4,196.54 ","$0.00 ","$5,671.00 ","$0.00 ","$0.00 ","$0.00 ","$4,047.39 ","$4,047.39 ","$0.00 ","$5,671.00 ","$0.00 ","$2,835.50 ","$4,491.43 ","$4,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805550","EAP","Custom 27805550","","Coil Target 360 Nano 3mm X 6cm","BOTH IP/OP","$5,401.00 ","$3,996.74 ","$0.00 ","$5,401.00 ","$0.00 ","$0.00 ","$0.00 ","$3,854.69 ","$3,854.69 ","$0.00 ","$5,401.00 ","$0.00 ","$2,700.50 ","$4,277.59 ","$4,320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805551","EAP","Custom 27805551","","Coil Target 360 Nano 3.5mm X 6cm","BOTH IP/OP","$5,671.00 ","$4,196.54 ","$0.00 ","$5,671.00 ","$0.00 ","$0.00 ","$0.00 ","$4,047.39 ","$4,047.39 ","$0.00 ","$5,671.00 ","$0.00 ","$2,835.50 ","$4,491.43 ","$4,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805552","EAP","Custom 27805552","","Sensation Plus 40cc Iab 7.5","BOTH IP/OP","$3,004.00 ","$2,222.96 ","$0.00 ","$3,004.00 ","$0.00 ","$0.00 ","$0.00 ","$2,143.95 ","$2,143.95 ","$0.00 ","$3,004.00 ","$0.00 ","$1,502.00 ","$2,379.17 ","$2,403.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805553","EAP","Custom 27805553","","Sensation Plus 50cc Iab 8.0","BOTH IP/OP","$3,154.00 ","$2,333.96 ","$0.00 ","$3,154.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.01 ","$2,251.01 ","$0.00 ","$3,154.00 ","$0.00 ","$1,577.00 ","$2,497.97 ","$2,523.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805554","EAP","HCPCS C1760","","Vascade Vascular Closure Device 5fr","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$247.50 ","$0.00 ","$114.63 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27805555","EAP","HCPCS C1760","","Vascade Vascular Closure Device 6/7fr","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$247.50 ","$0.00 ","$114.63 ","$392.54 ","$392.54 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"27805556","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 20mm 80cm .035in 7.5-8.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805557","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 30mm 80cm .035in 7.5-8.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805558","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 40mm 80cm .035in Slf Xpd Flxb Lp Tntlm","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805559","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 60mm 80cm .35in 7.5-8.5mm Slf Expandable","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805560","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 80mm 80cm .035in 7.5-8.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805561","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 20mm 80cm .035in 8.5-9.5mm Slf Xpd Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805562","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 30mm 80cm .035in 8.5-9.5mm Slf Xpd Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805563","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 40mm 80cm 8.5-9.5mm .035in Slf Xpd Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805564","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 60mm 80cm .035in 8.5-9.5mm Slf Xpd Dlv","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805565","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 80mm 80cm .035in 8.5-9.5mm Slf Xpd Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805566","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 20mm 80cm .35in 9.5-11mm Slf Xpd Lp Prcs","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805567","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 30mm 80cm .035in 9.5-11mm Slf Xpd Lp Prcs","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805568","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 80mm 80cm .035in Otw Slf Xpd Lp Tntlm","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805569","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 20mm 80cm .035in 11.5-13mm Slf Xpd Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805570","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 30mm 80cm .035in 11.5-13mm Slf Xpd Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805571","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 60mm 80cm .035in Slf Xpd Cmpt Flxb Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805572","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 20mm 120cm .035in Slf Xpd Flxb Lp Tntlm","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805573","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 30mm 120cm Lg Dia Lp Slf Xpd Opn Ltc Dsgn","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805574","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 40mm 120cm .035in 7.5-8.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805575","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 60mm 120cm .035in 7.5-8.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805576","EAP","HCPCS C1876","","Stent Bil 9mm 6fr 80mm 120cm .035in 7.5-8.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805577","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 20mm 120cm .035in 8.5-9.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805578","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 30mm 120cm .018in 8.5-9.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805579","EAP","HCPCS C1876","","Stent Bil 10mm 6fr 80mm 120cm .035in 8.5-9.5mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805580","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 20mm 120cm Lg Dia Lp Slf Xpd Opn Ltc Dsgn","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805581","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 30mm 120cm .035in 9.5-11mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805582","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 40mm 120cm .035in 9.5-11mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805583","EAP","HCPCS C1876","","Stent Bil 12mm 6fr 60mm 120cm Lp Slf Xpd Flxb Radl Strth Gps","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805584","EAP","HCPCS C1876","","Stent Bil 12mm 9.5-11fr 80mm 120cm .035in Slf Xpd Flxb Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805585","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 20mm 120cm .035in Slf Xpd Cmpt Flxb Lp","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805586","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 30mm 120cm .035in 11.5-13mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805587","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 40mm 120cm .035in 11.5-13mm Gwire Lum Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805588","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 60mm 120cm .035in Slf Xpd Flxb Lp Tntlm","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805589","EAP","HCPCS C1876","","Stent Bil 14mm 6fr 80mm 120cm .035in Slf Xpd Flxb Lp Tntlm","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805590","EAP","CPT� C1876","","Integrity Rx Coronary Stent System Mm","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$868.50 ","$0.00 ","$402.26 ","$1,377.44 ","$1,377.44 ","$337.93 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$302.05 ","$0.00 ","$307.26 ","$0.00 "
"27805591","EAP","HCPCS C1876","","Stent Prtg Everflex 6mm 6fr 80cm 20mm .035in Peri Otw Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805592","EAP","HCPCS C1876","","Stent Everflex 6mm 6fr 80cm 30mm .035in Peri Otw Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805593","EAP","HCPCS C1876","","Stent Everflex 6mm 6fr 80cm 40mm .035in Peri Slf Xpd Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805594","EAP","HCPCS C1876","","Stent Bil 6mm 6fr 60mm 80cm .035in Slf Xpd Flxb Drblty Sprl","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805595","EAP","HCPCS C1876","","Stent Bil 6mm 6fr 80mm 80cm .035in 3 Wv Peak Dsgn Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805596","EAP","HCPCS C1876","","Stent Bil 6mm 6fr 100mm 80cm .035in Otw Slf Xpd Flxb Drble","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805597","EAP","HCPCS C1876","","Stent Bil 6mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805598","EAP","HCPCS C1876","","Stent Bil 6mm 6fr 150mm 80cm .035in Otw Slf Xpd Flxb Drble","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805599","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 20mm 80cm .035in Sprl 3 Wv Peak Dsgn Gwire","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805600","EAP","HCPCS C1876","","Stent Everflex Prtg 7mm 6fr 80cm 30mm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805601","EAP","HCPCS C1876","","Stent Everflex 7mm 6fr 80cm 40mm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805602","EAP","HCPCS C1876","","Stent Prtg Everflex 7mm 6fr 80cm 60mm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805603","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 80mm 80cm .035in 3 Wv Peak Introd Shth Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805604","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 100mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805605","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805606","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 150mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805607","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 20mm 80cm .035in 3 Wv Peak Dsgn Otw Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805608","EAP","HCPCS C1876","","Stent Prtg Everflex 8mm 6fr 80mm 30cm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805609","EAP","HCPCS C1876","","Stent Everflex 8mm 6fr 80cm 40mm .035in Peri Slf Xpd Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805610","EAP","HCPCS C1876","","Stent Vasc 8mm 6fr 60mm 80cm .035in Slf Xpd Gwire Drblty","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805611","EAP","HCPCS C1876","","Stent Prtg Everflex 8mm 6fr 80mm 80cm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805612","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 100mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805613","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805614","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 150mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805615","EAP","HCPCS C1876","","Stent Everflex 6mm 6fr 120cm 20mm .035in Peri Slf Xpd Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805616","EAP","HCPCS C1876","","Stent Bil 6mm 6fr 30mm 120cm .035in Slf Xpd Flxb Drblty Sprl","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805617","EAP","HCPCS C1876","","Stent Everflex 6mm 6fr 120cm 100mm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805618","EAP","HCPCS C1876","","Stent Everflex 6mm 6fr 120cm 120mm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805619","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 200mm 120cm .035in Slf Expandable Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805620","EAP","HCPCS C1876","","Stent Vasc 7mm 6fr 20mm 120cm .035in 3 Wv Peak Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805621","EAP","HCPCS C1876","","Stent Everflex 7mm 6fr 120cm 30mm .035in Peri 3 Wv Peak Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805622","EAP","HCPCS C1876","","Stent Vasc 7mm 6fr 40mm 120cm .035in Slf Expandable Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805623","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 60mm 120cm 3 Wv Peak Dsgn Slf Xpd Flxb","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805624","EAP","HCPCS C1876","","Stent Vasc 7mm 6fr 80mm 120cm .035in 3 Wv Peak Introd Shth","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805625","EAP","HCPCS C1876","","Stent Vasc 7mm 6fr 100mm 120cm .035in 3 Wv Peak Introd Shth","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805626","EAP","HCPCS C1876","","Stent Vasc 7mm 6fr 120mm 120cm .035in 3 Wv Peak Introd Shth","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805627","EAP","HCPCS C1876","","Stent Bil 7mm 6fr 150mm 120cm .035in 3 Wv Peak Dsgn Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805628","EAP","HCPCS C1876","","Stent Vasc 7mm 6fr 200mm 120cm .035in 5.5-6.5mm Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805629","EAP","HCPCS C1876","","Stent Prtg Everflex 8mm 6fr 120mm 20cm .035in Peri 3 Wv Peak","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805630","EAP","HCPCS C1876","","Stent Bil 8mm 6fr 30mm 120cm .035in Slf Xpd Flxb Drble Sprl","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805631","EAP","HCPCS C1876","","Stent Everflex Prtg 8mm 6fr 120cm 100mm .035in Peri 3 Wv","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805632","EAP","HCPCS C1876","","Stent Prtg Everflex 8mm 6fr 120cm 120mm .035in Peri Otw Slf","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805633","EAP","HCPCS C1876","","Stent Prtg Everflex 8mm 6fr 120cm 150mm .035in Peri 3 Wv","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805634","EAP","HCPCS C1876","","Stent Vasc 8mm 6fr 200mm 120cm .035in 6.5-7.5mm Slf Xpd Shth","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$1,674.45 ","$0.00 ","$775.55 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$0.00 ","$1,860.50 ","$2,947.03 ","$2,976.80 ","$0.00 ","$582.34 ","$0.00 ","$592.38 ","$0.00 "
"27805635","EAP","HCPCS C1876","","Stent Vasc 10-8mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd","BOTH IP/OP","$6,739.00 ","$4,986.86 ","$0.00 ","$6,739.00 ","$3,032.55 ","$0.00 ","$1,404.58 ","$4,809.62 ","$4,809.62 ","$1,179.94 ","$6,739.00 ","$0.00 ","$3,369.50 ","$5,337.29 ","$5,391.20 ","$0.00 ","$1,054.65 ","$0.00 ","$1,072.85 ","$0.00 "
"27805636","EAP","HCPCS C1876","","Stent Vasc 9-7mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd","BOTH IP/OP","$6,739.00 ","$4,986.86 ","$0.00 ","$6,739.00 ","$3,032.55 ","$0.00 ","$1,404.58 ","$4,809.62 ","$4,809.62 ","$1,179.94 ","$6,739.00 ","$0.00 ","$3,369.50 ","$5,337.29 ","$5,391.20 ","$0.00 ","$1,054.65 ","$0.00 ","$1,072.85 ","$0.00 "
"27805637","EAP","HCPCS C1876","","Stent Vasc 8-6mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd","BOTH IP/OP","$6,739.00 ","$4,986.86 ","$0.00 ","$6,739.00 ","$3,032.55 ","$0.00 ","$1,404.58 ","$4,809.62 ","$4,809.62 ","$1,179.94 ","$6,739.00 ","$0.00 ","$3,369.50 ","$5,337.29 ","$5,391.20 ","$0.00 ","$1,054.65 ","$0.00 ","$1,072.85 ","$0.00 "
"27805638","EAP","Custom 27805638","","Og Cmplx Fill Coil 2x1.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805639","EAP","Custom 27805639","","Og Cmplx Fill Coil 2x2","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805640","EAP","Custom 27805640","","Og Cmplx Fill Coil 3x4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805641","EAP","Custom 27805641","","Og Cmplx Fill Coil 3x6","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805642","EAP","Custom 27805642","","Og Cmplx Fill Coil 3x8","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805643","EAP","Custom 27805643","","Og Tdl Cmplx Fill Coil 4x4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805644","EAP","Custom 27805644","","Og Tdl Cmplx Fill Coil 4x7","BOTH IP/OP","$4,327.00 ","$3,201.98 ","$0.00 ","$4,327.00 ","$0.00 ","$0.00 ","$0.00 ","$3,088.18 ","$3,088.18 ","$0.00 ","$4,327.00 ","$0.00 ","$2,163.50 ","$3,426.98 ","$3,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805645","EAP","Custom 27805645","","Og Tdl Cmplx Fill Coil 4x10","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805646","EAP","Custom 27805646","","Og Tdl Cmplx Fill Coil 4x12","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805647","EAP","Custom 27805647","","Og Tdl Cmplx Fill Coil 5x5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805648","EAP","Custom 27805648","","Og Tdl Cmplx Fill Coil 5x10","BOTH IP/OP","$4,327.00 ","$3,201.98 ","$0.00 ","$4,327.00 ","$0.00 ","$0.00 ","$0.00 ","$3,088.18 ","$3,088.18 ","$0.00 ","$4,327.00 ","$0.00 ","$2,163.50 ","$3,426.98 ","$3,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805649","EAP","Custom 27805649","","Coil Embolization .012in 5mm 15cm Complex Fill Detachable","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805650","EAP","Custom 27805650","","Og Tdl Cmplx Fill Coil 6x10","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805651","EAP","Custom 27805651","","Og Tdl Cmplx Fill Coil 6x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805652","EAP","Custom 27805652","","Og Tdl Cmplx Fill Coil 6x20","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805653","EAP","Custom 27805653","","Og Tdl Cmplx Fill Coil 7x15","BOTH IP/OP","$4,327.00 ","$3,201.98 ","$0.00 ","$4,327.00 ","$0.00 ","$0.00 ","$0.00 ","$3,088.18 ","$3,088.18 ","$0.00 ","$4,327.00 ","$0.00 ","$2,163.50 ","$3,426.98 ","$3,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805654","EAP","Custom 27805654","","Og Tdl Cmplx Fill Coil 7x21","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805655","EAP","Custom 27805655","","Og Tdl Cmplx Fill Coil 8x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805656","EAP","Custom 27805656","","Og Tdl Cmplx Fill Coil 8x24","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805657","EAP","Custom 27805657","","Og Tdl Cmplx Fill Coil 9x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805658","EAP","Custom 27805658","","Og Tdl Cmplx Fill Coil 9x25","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805659","EAP","Custom 27805659","","Og Tdl Cmplx Fill Coil 10x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805660","EAP","Custom 27805660","","Og Tdl Cmplx Fill Coil 12x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805661","EAP","Custom 27805661","","Og Cmplx Fill Coil 3.5x7.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805662","EAP","Custom 27805662","","Og Tdl Cmplx Frame Coil 6x20","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805663","EAP","Custom 27805663","","Og Tdl Cmplx Frame Coil 7x25","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805664","EAP","Custom 27805664","","Og Tdl Cmplx Frame Coil 8x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805665","EAP","Custom 27805665","","Og Tdl Cmplx Frame Coil 9x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805666","EAP","Custom 27805666","","Og Tdl Cmplx Frame Coil 10x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805667","EAP","Custom 27805667","","Og Tdl Cmplx Frame Coil 12x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805668","EAP","Custom 27805668","","Og Tdl Cmplx Frame Coil 14x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805669","EAP","Custom 27805669","","Og Tdl Cmplx Frame Coil 16x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805670","EAP","Custom 27805670","","Og Tdl Cmplx Frame Coil 18x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805671","EAP","Custom 27805671","","Og Tdl Cmplx Frame Coil 20x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805672","EAP","Custom 27805672","","G2 Complex Fill Coil 2x1.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805673","EAP","Custom 27805673","","G2 Complex Fill Coil 2x2","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805674","EAP","Custom 27805674","","G2 Complex Fill Coil 3x4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805675","EAP","Custom 27805675","","G2 Complex Fill Coil 3x6","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805676","EAP","Custom 27805676","","G2 Complex Fill Coil 3x8","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805677","EAP","Custom 27805677","","G2 Tdl Complex Fill Coil 4x7","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805678","EAP","Custom 27805678","","G2 Tdl Complex Fill Coil 4x10","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805679","EAP","Custom 27805679","","G2 Tdl Complex Fill Coil 4x12","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805680","EAP","Custom 27805680","","G2 Tdl Complex Fill Coil 5x10","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805681","EAP","Custom 27805681","","G2 Tdl Complex Fill Coil 5x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805682","EAP","Custom 27805682","","G2 Tdl Complex Fill Coil 6x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805683","EAP","Custom 27805683","","G2 Tdl Complex Fill Coil 6x20","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805684","EAP","Custom 27805684","","G2 Tdl Complex Fill Coil 7x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805685","EAP","Custom 27805685","","G2 Tdl Complex Fill Coil 7x21","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805686","EAP","Custom 27805686","","G2 Tdl Complex Fill Coil 8x15","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805687","EAP","Custom 27805687","","G2 Tdl Complex Fill Coil 8x24","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805688","EAP","Custom 27805688","","G2 Tdl Complex Fill Coil 9x25","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805689","EAP","Custom 27805689","","G2 Tdl Complex Fill Coil 10x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805690","EAP","Custom 27805690","","G2 Tdl Complex Fill Coil 12x30","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805691","EAP","Custom 27805691","","G2 Complex Fill Coil 2.5x5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805692","EAP","Custom 27805692","","G2 Complex Fill Coil 2.5x3.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805693","EAP","Custom 27805693","","G2 Complex Fill Coil 3.5x9","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805694","EAP","Custom 27805694","","G2 Complex Fill Coil 3.5x7.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805695","EAP","Custom 27805695","","G2 Complex Xtrasoft Coil 2x1.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805696","EAP","Custom 27805696","","G2 Complex Xtrasoft Coil 2x2","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805697","EAP","Custom 27805697","","G2 Complex Xtrasoft Coil 3x4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805698","EAP","Custom 27805698","","G2 Complex Xtrasoft Coil 3x6","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805700","EAP","Custom 27805700","","G2 Tdl Complex Xtrasoft Coil 4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805701","EAP","Custom 27805701","","G2 Complex Xtrasoft Coil 2.5x5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805702","EAP","Custom 27805702","","G2 Complex Xtrasoft Coil 2.5x2","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805703","EAP","Custom 27805703","","G2 Complex Xtrasoft Coil 2.5x3","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805704","EAP","Custom 27805704","","G2 Complex Xtrasoft Coil 3.5x5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805705","EAP","Custom 27805705","","G2 Complex Xtrasoft Coil 3.5x9","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805706","EAP","Custom 27805706","","G2 Complex Xtrasoft Coil 3.5x7","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805707","EAP","Custom 27805707","","G2 Helical Xtrasoft Coil 2x4","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.73 ","$2,246.73 ","$0.00 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805708","EAP","Custom 27805708","","G2 Helical Xtrasoft Coil 2x6","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.73 ","$2,246.73 ","$0.00 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805709","EAP","Custom 27805709","","G2 Helical Xtrasoft Coil 2x8","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.73 ","$2,246.73 ","$0.00 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805710","EAP","Custom 27805710","","Og Cmplx Xtrasoft Coil 2x1.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805711","EAP","Custom 27805711","","Og Cmplx Xtrasoft Coil 2x2","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805712","EAP","Custom 27805712","","Og Cmplx Xtrasoft Coil 3x3","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805713","EAP","Custom 27805713","","Og Cmplx Xtrasoft Coil 3x4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805714","EAP","Custom 27805714","","Og Cmplx Xtrasoft Coil 3x6","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805715","EAP","Custom 27805715","","Og Cmplx Xtrasoft Coil 3x8","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805716","EAP","Custom 27805716","","Og Cmplx Xtrasoft Coil 4x4","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805717","EAP","Custom 27805717","","Og Cmplx Xtrasoft Coil 4x6","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805718","EAP","Custom 27805718","","Og Cmplx Xtrasoft Coil 4x8","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805719","EAP","Custom 27805719","","Og Cmplx Xtrasoft Coil 4x10","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805720","EAP","Custom 27805720","","Og Cmplx Xtrasoft Coil 2.5x5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805721","EAP","Custom 27805721","","Og Cmplx Xtrasoft Coil 2.5x2.5","BOTH IP/OP","$4,327.00 ","$3,201.98 ","$0.00 ","$4,327.00 ","$0.00 ","$0.00 ","$0.00 ","$3,088.18 ","$3,088.18 ","$0.00 ","$4,327.00 ","$0.00 ","$2,163.50 ","$3,426.98 ","$3,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805722","EAP","Custom 27805722","","Og Cmplx Xtrasoft Coil 2.5x3.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805723","EAP","Custom 27805723","","Og Cmplx Xtrasoft Coil 3.5x5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805724","EAP","Custom 27805724","","Og Cmplx Xtrasoft Coil 3.5x9","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805725","EAP","Custom 27805725","","Og Cmplx Xtrasoft Coil 3.5x7.5","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805726","EAP","Custom 27805726","","Og Helical Xtrsoft Coil 2x4","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.73 ","$2,246.73 ","$0.00 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805727","EAP","Custom 27805727","","Og Helical Xtrsoft Coil 2x6","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.73 ","$2,246.73 ","$0.00 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805728","EAP","Custom 27805728","","Og Helical Xtrsoft Coil 2x8","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.73 ","$2,246.73 ","$0.00 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805729","EAP","Custom 27805729","","G2 Tdl Complex Xtrasoft Coil 4x8","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805730","EAP","Custom 27805730","","G2 Tdl Complex Xtrasoft Coil 4x10","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$4,121.00 ","$0.00 ","$0.00 ","$0.00 ","$2,941.16 ","$2,941.16 ","$0.00 ","$4,121.00 ","$0.00 ","$2,060.50 ","$3,263.83 ","$3,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805731","EAP","Custom 27805731","","Kit Prss Monitr 14ga Cdmn Mcsnsr Basic Trndcr Tuo Ndl","BOTH IP/OP","$2,074.00 ","$1,534.76 ","$0.00 ","$2,074.00 ","$0.00 ","$0.00 ","$0.00 ","$1,480.21 ","$1,480.21 ","$0.00 ","$2,074.00 ","$0.00 ","$1,037.00 ","$1,642.61 ","$1,659.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805732","EAP","Custom 27805732","","Kit Prss Monitr Mcsnsr .7mm Sbdrl Inprench Skl Bolt","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$1,532.31 ","$1,532.31 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805733","EAP","Custom 27805733","","Kit Prss Monitr 38cm Cdmn Intrcran Vntrc Trndcr Cath Tnl","BOTH IP/OP","$2,235.00 ","$1,653.90 ","$0.00 ","$2,235.00 ","$0.00 ","$0.00 ","$0.00 ","$1,595.12 ","$1,595.12 ","$0.00 ","$2,235.00 ","$0.00 ","$1,117.50 ","$1,770.12 ","$1,788.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805734","EAP","Custom 27805734","","Stent Lvis 4.5 23mm","BOTH IP/OP","$17,913.00 ","$13,255.62 ","$0.00 ","$17,913.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,784.51 ","$0.00 ","$17,913.00 ","$0.00 ","$8,956.50 ","$14,187.10 ","$14,330.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805735","EAP","Custom 27805735","","Device Cmpr Gold Fmstp Pneum Dome Intgr Dgt Mnmtr Adj Belt","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$206.97 ","$206.97 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805736","EAP","Custom 27805736","","Prtcl Embl 2 Vl Lq Sys Trfl Nbca 1gm","BOTH IP/OP","$11,437.00 ","$8,463.38 ","$0.00 ","$11,437.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,162.59 ","$0.00 ","$11,437.00 ","$0.00 ","$5,718.50 ","$9,058.10 ","$9,149.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805737","EAP","Custom 27805737","","Prtcl Embl 1 Vl Lq Sys Trfl Nbca 1gm","BOTH IP/OP","$6,546.00 ","$4,844.04 ","$0.00 ","$6,546.00 ","$0.00 ","$0.00 ","$0.00 ","$4,671.88 ","$4,671.88 ","$0.00 ","$6,546.00 ","$0.00 ","$3,273.00 ","$5,184.43 ","$5,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805738","EAP","HCPCS C1760","","Device Clsr 8fr Angsl Vip Vasc Hmst Strl Latex Free Disp","BOTH IP/OP","$723.00 ","$535.02 ","$0.00 ","$723.00 ","$0.00 ","$0.00 ","$0.00 ","$516.01 ","$516.01 ","$126.59 ","$723.00 ","$0.00 ","$361.50 ","$572.62 ","$578.40 ","$0.00 ","$113.15 ","$0.00 ","$115.10 ","$0.00 "
"27805739","EAP","Custom 27805739","","Stent 3.5 X 19 Coil Assist Headway 21","BOTH IP/OP","$16,121.00 ","$11,929.54 ","$0.00 ","$16,121.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,505.56 ","$0.00 ","$16,121.00 ","$0.00 ","$8,060.50 ","$12,767.83 ","$12,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805740","EAP","Custom 27805740","","Stent 3.5 X 24 Coil Assist  Headway 21","BOTH IP/OP","$16,121.00 ","$11,929.54 ","$0.00 ","$16,121.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,505.56 ","$0.00 ","$16,121.00 ","$0.00 ","$8,060.50 ","$12,767.83 ","$12,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805741","EAP","Custom 27805741","","Stent 4.5 X 16 Coil Assist Headway 21","BOTH IP/OP","$16,121.00 ","$11,929.54 ","$0.00 ","$16,121.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,505.56 ","$0.00 ","$16,121.00 ","$0.00 ","$8,060.50 ","$12,767.83 ","$12,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805742","EAP","Custom 27805742","","Stent 4.5 X 34 Coil Assist Headway 21","BOTH IP/OP","$16,121.00 ","$11,929.54 ","$0.00 ","$16,121.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,505.56 ","$0.00 ","$16,121.00 ","$0.00 ","$8,060.50 ","$12,767.83 ","$12,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805743","EAP","Custom 27805743","","Stent 5.5 X 27 Coil Assist Headway 21","BOTH IP/OP","$16,121.00 ","$11,929.54 ","$0.00 ","$16,121.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,505.56 ","$0.00 ","$16,121.00 ","$0.00 ","$8,060.50 ","$12,767.83 ","$12,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805744","EAP","Custom 27805744","","Stent 5.5 X 34 Coil Assist Headway 21","BOTH IP/OP","$16,121.00 ","$11,929.54 ","$0.00 ","$16,121.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,505.56 ","$0.00 ","$16,121.00 ","$0.00 ","$8,060.50 ","$12,767.83 ","$12,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805745","EAP","Custom 27805745","","Stent 3.5 X 18 Coil Assist Headway 17","BOTH IP/OP","$18,980.00 ","$14,045.20 ","$0.00 ","$18,980.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,546.03 ","$0.00 ","$18,980.00 ","$0.00 ","$9,490.00 ","$15,032.16 ","$15,184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805746","EAP","Custom 27805746","","Stent 3.5 X 23 Coil Assist Headway 17","BOTH IP/OP","$18,980.00 ","$14,045.20 ","$0.00 ","$18,980.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,546.03 ","$0.00 ","$18,980.00 ","$0.00 ","$9,490.00 ","$15,032.16 ","$15,184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805747","EAP","Custom 27805747","","Stent 3.5 X 28 Coil Assist Headway 17","BOTH IP/OP","$18,981.00 ","$14,045.94 ","$0.00 ","$18,981.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,546.74 ","$0.00 ","$18,981.00 ","$0.00 ","$9,490.50 ","$15,032.95 ","$15,184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805748","EAP","Custom 27805748","","Stent 3.5 X 33 Coil Assist Headway 17","BOTH IP/OP","$18,981.00 ","$14,045.94 ","$0.00 ","$18,981.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$13,546.74 ","$0.00 ","$18,981.00 ","$0.00 ","$9,490.50 ","$15,032.95 ","$15,184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805750","EAP","HCPCS C1764","","System Crd Monitr Rvl Linq Ins","BOTH IP/OP","$14,592.00 ","$10,798.08 ","$0.00 ","$14,592.00 ","$6,566.40 ","$0.00 ","$3,041.34 ","$5,158.80 ","$10,414.31 ","$2,554.94 ","$14,592.00 ","$0.00 ","$7,296.00 ","$11,556.86 ","$11,673.60 ","$0.00 ","$2,283.65 ","$0.00 ","$2,323.05 ","$0.00 "
"27805751","EAP","HCPCS C1880","","Filter Embl Vc Femoral Navalign Dlv Set Strl Disp Pltn Celect","BOTH IP/OP","$3,032.00 ","$2,243.68 ","$0.00 ","$3,032.00 ","$1,364.40 ","$0.00 ","$631.94 ","$2,163.94 ","$2,163.94 ","$530.88 ","$3,032.00 ","$0.00 ","$1,516.00 ","$2,401.34 ","$2,425.60 ","$0.00 ","$474.51 ","$0.00 ","$482.69 ","$0.00 "
"27805752","EAP","HCPCS C1880","","Filter Embl Vc Jug Navalign Dlv Set Strl Disp Pltn Celect","BOTH IP/OP","$3,032.00 ","$2,243.68 ","$0.00 ","$3,032.00 ","$1,364.40 ","$0.00 ","$631.94 ","$2,163.94 ","$2,163.94 ","$530.88 ","$3,032.00 ","$0.00 ","$1,516.00 ","$2,401.34 ","$2,425.60 ","$0.00 ","$474.51 ","$0.00 ","$482.69 ","$0.00 "
"27805753","EAP","HCPCS C1880","","Filter Embl Navalign Dlv Uniset Strl Disp Pltn Celect","BOTH IP/OP","$3,032.00 ","$2,243.68 ","$0.00 ","$3,032.00 ","$1,364.40 ","$0.00 ","$631.94 ","$2,163.94 ","$2,163.94 ","$530.88 ","$3,032.00 ","$0.00 ","$1,516.00 ","$2,401.34 ","$2,425.60 ","$0.00 ","$474.51 ","$0.00 ","$482.69 ","$0.00 "
"27805754","EAP","Custom 27805754","","Syr Inflat Dfl Indfltr Embl Coil Trf Dcs 2 Pltn","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$582.38 ","$582.38 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805755","EAP","HCPCS C1876","","Stent Coron 8mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805756","EAP","HCPCS C1876","","Stent Coron 12mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805757","EAP","HCPCS C1876","","Stent Coron 15mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805758","EAP","HCPCS C1876","","Stent Coron 18mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805759","EAP","HCPCS C1876","","Stent Coron 23mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805760","EAP","HCPCS C1876","","Stent Coron 28mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805761","EAP","HCPCS C1876","","Stent Coron 15mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805762","EAP","HCPCS C1876","","Stent Coron 18mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805763","EAP","HCPCS C1876","","Stent Coron 23mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805764","EAP","HCPCS C1876","","Stent Coron 28mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln","BOTH IP/OP","$1,791.00 ","$1,325.34 ","$0.00 ","$1,791.00 ","$805.95 ","$0.00 ","$373.29 ","$1,278.24 ","$1,278.24 ","$313.59 ","$1,791.00 ","$0.00 ","$895.50 ","$1,418.47 ","$1,432.80 ","$0.00 ","$280.29 ","$0.00 ","$285.13 ","$0.00 "
"27805765","EAP","Custom 27805765","","Cath Angio 5fr 8mm 110cm 2 Lum Bln Syr Wdg Prss Strl Latex","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$98.49 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805766","EAP","HCPCS V2790","","Amniofix 16mm Disc","BOTH IP/OP","$971.00 ","$718.54 ","$0.00 ","$971.00 ","$436.95 ","$0.00 ","$202.38 ","$693.00 ","$693.00 ","$170.01 ","$971.00 ","$0.00 ","$485.50 ","$769.03 ","$776.80 ","$0.00 ","$151.96 ","$0.00 ","$154.58 ","$0.00 "
"27805767","EAP","HCPCS V2790","","Amniofix 2x3cm","BOTH IP/OP","$2,756.00 ","$2,039.44 ","$0.00 ","$2,756.00 ","$1,240.20 ","$0.00 ","$574.42 ","$1,966.96 ","$1,966.96 ","$482.55 ","$2,756.00 ","$0.00 ","$1,378.00 ","$2,182.75 ","$2,204.80 ","$0.00 ","$431.31 ","$0.00 ","$438.76 ","$0.00 "
"27805768","EAP","HCPCS V2790","","Amniofix 3x3cm","BOTH IP/OP","$3,662.00 ","$2,709.88 ","$0.00 ","$3,662.00 ","$1,647.90 ","$0.00 ","$763.25 ","$2,613.57 ","$2,613.57 ","$641.19 ","$3,662.00 ","$0.00 ","$1,831.00 ","$2,900.30 ","$2,929.60 ","$0.00 ","$573.10 ","$0.00 ","$582.99 ","$0.00 "
"27805769","EAP","HCPCS V2790","","Amniofix 4x4cm","BOTH IP/OP","$3,925.00 ","$2,904.50 ","$0.00 ","$3,925.00 ","$1,766.25 ","$0.00 ","$818.07 ","$2,801.27 ","$2,801.27 ","$687.24 ","$3,925.00 ","$0.00 ","$1,962.50 ","$3,108.60 ","$3,140.00 ","$0.00 ","$614.26 ","$0.00 ","$624.86 ","$0.00 "
"27805770","EAP","HCPCS V2790","","Amniofix 4x6cm","BOTH IP/OP","$5,629.00 ","$4,165.46 ","$0.00 ","$5,629.00 ","$2,533.05 ","$0.00 ","$1,173.22 ","$4,017.42 ","$4,017.42 ","$985.59 ","$5,629.00 ","$0.00 ","$2,814.50 ","$4,458.17 ","$4,503.20 ","$0.00 ","$880.94 ","$0.00 ","$896.14 ","$0.00 "
"27805771","EAP","HCPCS V2790","","Amniofix 2x12cm","BOTH IP/OP","$2,612.00 ","$1,932.88 ","$0.00 ","$2,612.00 ","$1,175.40 ","$0.00 ","$544.41 ","$1,864.18 ","$1,864.18 ","$457.34 ","$2,612.00 ","$0.00 ","$1,306.00 ","$2,068.70 ","$2,089.60 ","$0.00 ","$408.78 ","$0.00 ","$415.83 ","$0.00 "
"27805772","EAP","HCPCS V2790","","Amniofix 6x16cm","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$5,158.80 ","$6,426.87 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"27805773","EAP","HCPCS V2790","","Amniofix 9x20cm","BOTH IP/OP","$21,453.00 ","$15,875.22 ","$0.00 ","$21,453.00 ","$9,653.85 ","$0.00 ","$4,471.34 ","$5,158.80 ","$15,311.01 ","$3,756.25 ","$21,453.00 ","$0.00 ","$10,726.50 ","$16,990.78 ","$17,162.40 ","$0.00 ","$3,357.39 ","$0.00 ","$3,415.32 ","$0.00 "
"27805774","EAP","HCPCS V2790","","Amniofix Wrap 2x2 Cm","BOTH IP/OP","$1,903.00 ","$1,408.22 ","$0.00 ","$1,903.00 ","$856.35 ","$0.00 ","$396.63 ","$1,358.17 ","$1,358.17 ","$333.20 ","$1,903.00 ","$0.00 ","$951.50 ","$1,507.18 ","$1,522.40 ","$0.00 ","$297.82 ","$0.00 ","$302.96 ","$0.00 "
"27805775","EAP","HCPCS V2790","","Amniofix Wrap 2x4 Cm","BOTH IP/OP","$3,399.00 ","$2,515.26 ","$0.00 ","$3,399.00 ","$1,529.55 ","$0.00 ","$708.44 ","$2,425.87 ","$2,425.87 ","$595.14 ","$3,399.00 ","$0.00 ","$1,699.50 ","$2,692.01 ","$2,719.20 ","$0.00 ","$531.94 ","$0.00 ","$541.12 ","$0.00 "
"27805776","EAP","HCPCS V2790","","Amniofix Wrap 4x6 Cm","BOTH IP/OP","$5,772.00 ","$4,271.28 ","$0.00 ","$5,772.00 ","$2,597.40 ","$0.00 ","$1,203.03 ","$4,119.48 ","$4,119.48 ","$1,010.63 ","$5,772.00 ","$0.00 ","$2,886.00 ","$4,571.42 ","$4,617.60 ","$0.00 ","$903.32 ","$0.00 ","$918.90 ","$0.00 "
"27805777","EAP","HCPCS C1777","","Lead Dfbr 65cm 8fr Optisure Ecrdm Optim 1 Coil Df1is-1","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805778","EAP","HCPCS C1777","","Lead Dfbr 52cm 8fr Optisure Ecrdm 1 Coil Df4 Conctr True","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805779","EAP","HCPCS C1777","","Lead Dfbr 58cm 8fr Optisure Ecrdm Optim 1 Coil Df4 Conctr","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805780","EAP","HCPCS C1777","","Lead Dfbr 65cm 8fr Optisure Ecrdm 1 Coil Df4 Conctr True","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805781","EAP","HCPCS C1895","","Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df1 Df4 Conctr True","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805782","EAP","HCPCS C1895","","Lead Dfbr 52cm 8fr Optisure Ecrdm 2 Coil Df4 Conctr True","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805783","EAP","HCPCS C1895","","Lead Dfbr 58cm 8fr Optisure Ecrdm 2 Coil Df4 Conctr True","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805784","EAP","HCPCS C1895","","Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 220 Dual Shock","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805785","EAP","HCPCS C1895","","Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 230 Dual Shock","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805786","EAP","HCPCS C1895","","Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 Pass Dual Shock","BOTH IP/OP","$10,761.00 ","$7,963.14 ","$0.00 ","$10,761.00 ","$4,842.45 ","$0.00 ","$2,242.86 ","$5,158.80 ","$7,680.13 ","$1,884.17 ","$10,761.00 ","$0.00 ","$5,380.50 ","$8,522.71 ","$8,608.80 ","$0.00 ","$1,684.10 ","$0.00 ","$1,713.15 ","$0.00 "
"27805787","EAP","HCPCS C1777","","Lead Pcng 64cm 9fr Ecrdm 1 Coil Act Fix Bipol Cardvrt Dfbr","BOTH IP/OP","$9,175.00 ","$6,789.50 ","$0.00 ","$9,175.00 ","$4,128.75 ","$0.00 ","$1,912.30 ","$5,158.80 ","$6,548.20 ","$1,606.47 ","$9,175.00 ","$0.00 ","$4,587.50 ","$7,266.60 ","$7,340.00 ","$0.00 ","$1,435.89 ","$0.00 ","$1,460.66 ","$0.00 "
"27805788","EAP","HCPCS C1874","","Stent Coron 8mm 2.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805789","EAP","HCPCS C1874","","Stent Coron 12mm 2.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805790","EAP","HCPCS C1874","","Stent Coron 15mm 2.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805791","EAP","HCPCS C1874","","Stent Coron 18mm 2.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805792","EAP","HCPCS C1874","","Stent Coron 23mm 2.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805793","EAP","HCPCS C1874","","Stent Coron 28mm 2.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805794","EAP","HCPCS C1874","","Stent Coron 8mm 2.5mm .034-.029in 5fr Cocr","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805795","EAP","HCPCS C1874","","Stent Coron 12mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805796","EAP","HCPCS C1874","","Stent Coron 15mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805797","EAP","HCPCS C1874","","Stent Coron 18mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805798","EAP","HCPCS C1874","","Stent Coron 23mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805799","EAP","HCPCS C1874","","Stent Coron 28mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805800","EAP","HCPCS C1874","","Stent Coron 33mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805801","EAP","HCPCS C1874","","Stent Coron 38mm 2.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805802","EAP","HCPCS C1874","","Stent Coron 8mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805803","EAP","HCPCS C1874","","Stent Coron 12mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805804","EAP","HCPCS C1874","","Stent Coron 15mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805805","EAP","HCPCS C1874","","Stent Coron 18mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805806","EAP","HCPCS C1874","","Stent Coron 23mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805807","EAP","HCPCS C1874","","Stent Coron 28mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805808","EAP","HCPCS C1874","","Stent Coron 33mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805809","EAP","HCPCS C1874","","Stent Coron 38mm 2.75mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805810","EAP","HCPCS C1874","","Stent Coron 8mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805811","EAP","HCPCS C1874","","Stent Coron 12mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805812","EAP","HCPCS C1874","","Stent Coron 15mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805813","EAP","HCPCS C1874","","Stent Coron 18mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805814","EAP","HCPCS C1874","","Stent Coron 23mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805815","EAP","HCPCS C1874","","Stent Coron 28mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805816","EAP","HCPCS C1874","","Stent Coron 33mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805817","EAP","HCPCS C1874","","Stent Coron 38mm 3mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805818","EAP","HCPCS C1874","","Stent Coron 8mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805819","EAP","HCPCS C1874","","Stent Coron 12mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805820","EAP","HCPCS C1874","","Stent Coron 15mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805821","EAP","HCPCS C1874","","Stent Coron 18mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805822","EAP","HCPCS C1874","","Stent Coron 23mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805823","EAP","HCPCS C1874","","Stent Coron 28mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805824","EAP","HCPCS C1874","","Stent Coron 33mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805825","EAP","HCPCS C1874","","Stent Coron 38mm 3.25mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805826","EAP","HCPCS C1874","","Stent Coron 8mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805827","EAP","HCPCS C1874","","Stent Coron 12mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805828","EAP","HCPCS C1874","","Stent Coron 15mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805829","EAP","HCPCS C1874","","Stent Coron 18mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805830","EAP","HCPCS C1874","","Stent Coron 23mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805831","EAP","HCPCS C1874","","Stent Coron 28mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805832","EAP","HCPCS C1874","","Stent Coron 33mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,806.00 ","$2,816.44 ","$0.00 ","$3,806.00 ","$1,712.70 ","$0.00 ","$793.27 ","$2,716.34 ","$2,716.34 ","$666.40 ","$3,806.00 ","$0.00 ","$1,903.00 ","$3,014.35 ","$3,044.80 ","$0.00 ","$595.64 ","$0.00 ","$605.92 ","$0.00 "
"27805833","EAP","HCPCS C1874","","Stent Coron 38mm 3.5mm .034-.029in 5fr Everolimus","BOTH IP/OP","$3,996.00 ","$2,957.04 ","$0.00 ","$3,996.00 ","$1,798.20 ","$0.00 ","$832.87 ","$2,851.95 ","$2,851.95 ","$699.67 ","$3,996.00 ","$0.00 ","$1,998.00 ","$3,164.83 ","$3,196.80 ","$0.00 ","$625.37 ","$0.00 ","$636.16 ","$0.00 "
"27805834","EAP","HCPCS C1877","","Stent Trchbr 15mm 14fr 5cm Introd Slf Xpd Gnt Rsch","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$2,362.05 ","$0.00 ","$1,094.02 ","$3,746.21 ","$3,746.21 ","$919.06 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$821.47 ","$0.00 ","$835.64 ","$0.00 "
"27805836","EAP","HCPCS C1877","","Stent Trchbr 20mm 16fr 5cm Introd Slf Xpd Gnt Rsch","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$2,362.05 ","$0.00 ","$1,094.02 ","$3,746.21 ","$3,746.21 ","$919.06 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$821.47 ","$0.00 ","$835.64 ","$0.00 "
"27805837","EAP","HCPCS C1877","","Stent Trchbr 25mm 16fr 5cm Introd Slf Xpd Gnt Rsch","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$2,362.05 ","$0.00 ","$1,094.02 ","$3,746.21 ","$3,746.21 ","$919.06 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$821.47 ","$0.00 ","$835.64 ","$0.00 "
"27805838","EAP","HCPCS C1877","","Stent Trchbr 30mm 16fr 5cm Introd Slf Xpd Gnt Rsch","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$2,362.05 ","$0.00 ","$1,094.02 ","$3,746.21 ","$3,746.21 ","$919.06 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$821.47 ","$0.00 ","$835.64 ","$0.00 "
"27805839","EAP","HCPCS C1877","","Stent Trchbr 35mm 16fr 5cm Introd Slf Xpd Gnt Rsch","BOTH IP/OP","$5,249.00 ","$3,884.26 ","$0.00 ","$5,249.00 ","$2,362.05 ","$0.00 ","$1,094.02 ","$3,746.21 ","$3,746.21 ","$919.06 ","$5,249.00 ","$0.00 ","$2,624.50 ","$4,157.21 ","$4,199.20 ","$0.00 ","$821.47 ","$0.00 ","$835.64 ","$0.00 "
"27805841","EAP","HCPCS C1874","","Stent Coron 8mm 4mm 2.3-2.7fr Everolimus Elut Pltn","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805842","EAP","HCPCS C1874","","Stent Coron 12mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805843","EAP","HCPCS C1874","","Stent Coron 16mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805844","EAP","HCPCS C1874","","Stent Coron 20mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805845","EAP","HCPCS C1874","","Stent Coron 24mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805846","EAP","HCPCS C1874","","Stent Coron 28mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805847","EAP","HCPCS C1874","","Stent Coron 32mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805848","EAP","HCPCS C1874","","Stent Coron 38mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$3,412.00 ","$2,524.88 ","$0.00 ","$3,412.00 ","$1,535.40 ","$0.00 ","$711.15 ","$2,435.14 ","$2,435.14 ","$597.41 ","$3,412.00 ","$0.00 ","$1,706.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$533.98 ","$0.00 ","$543.19 ","$0.00 "
"27805850","EAP","HCPCS C1900","","Lead Pcng 78cm 5.3fr 5.1fr .014-.018in Lv Qdpl","BOTH IP/OP","$5,840.00 ","$4,321.60 ","$0.00 ","$5,840.00 ","$2,628.00 ","$0.00 ","$1,217.20 ","$4,168.01 ","$4,168.01 ","$0.00 ","$5,840.00 ","$0.00 ","$2,920.00 ","$4,625.28 ","$4,672.00 ","$0.00 ","$913.96 ","$0.00 ","$0.00 ","$0.00 "
"27805851","EAP","HCPCS C1900","","Lead Pcng Lv Atn Starfix","BOTH IP/OP","$5,840.00 ","$4,321.60 ","$0.00 ","$5,840.00 ","$2,628.00 ","$0.00 ","$1,217.20 ","$4,168.01 ","$4,168.01 ","$0.00 ","$5,840.00 ","$0.00 ","$2,920.00 ","$4,625.28 ","$4,672.00 ","$0.00 ","$913.96 ","$0.00 ","$0.00 ","$0.00 "
"27805852","EAP","HCPCS C1900","","Lead Pcng 78cm 5.3fr 5.1fr .014-.018in Offst S Lv","BOTH IP/OP","$5,840.00 ","$4,321.60 ","$0.00 ","$5,840.00 ","$2,628.00 ","$0.00 ","$1,217.20 ","$4,168.01 ","$4,168.01 ","$0.00 ","$5,840.00 ","$0.00 ","$2,920.00 ","$4,625.28 ","$4,672.00 ","$0.00 ","$913.96 ","$0.00 ","$0.00 ","$0.00 "
"27805853","EAP","HCPCS C1900","","Lead Pcng 88cm 5.3fr 5.1fr .014-.018in Offst S Lv","BOTH IP/OP","$5,840.00 ","$4,321.60 ","$0.00 ","$5,840.00 ","$2,628.00 ","$0.00 ","$1,217.20 ","$4,168.01 ","$4,168.01 ","$0.00 ","$5,840.00 ","$0.00 ","$2,920.00 ","$4,625.28 ","$4,672.00 ","$0.00 ","$913.96 ","$0.00 ","$0.00 ","$0.00 "
"27805856","EAP","HCPCS C1874","","Stent Coron 16mm 4mm 2.3-2.7fr Everolimus Elut","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$15,402.15 ","$0.00 ","$7,133.76 ","$5,158.80 ","$24,427.81 ","$5,992.87 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$5,356.53 ","$0.00 ","$5,448.94 ","$0.00 "
"27805860","EAP","HCPCS C1767","","Generator Esurg Demipulse Ncp","BOTH IP/OP","$57,141.00 ","$42,284.34 ","$0.00 ","$57,141.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$40,781.53 ","$0.00 ","$57,141.00 ","$0.00 ","$28,570.50 ","$45,255.67 ","$45,712.80 ","$0.00 ","$7,751.33 ","$0.00 ","$0.00 ","$0.00 "
"27805861","EAP","HCPCS C1778","","Lead Nrstm 43cm 3mm Perenniaflex Vagus Nrv Sil","BOTH IP/OP","$17,920.00 ","$13,260.80 ","$0.00 ","$17,920.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$12,789.50 ","$0.00 ","$17,920.00 ","$0.00 ","$8,960.00 ","$14,192.64 ","$14,336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805862","EAP","HCPCS C1876","","Stnt Trchbr 9mm 7fr 59mm 120cm .035"" Cvd Ult Lw Cx","BOTH IP/OP","$6,591.00 ","$4,877.34 ","$0.00 ","$6,591.00 ","$2,965.95 ","$0.00 ","$1,373.73 ","$4,704.00 ","$4,704.00 ","$1,154.03 ","$6,591.00 ","$0.00 ","$3,295.50 ","$5,220.07 ","$5,272.80 ","$0.00 ","$1,031.49 ","$0.00 ","$1,049.29 ","$0.00 "
"27805863","EAP","Custom 27805863","","Pipeline Embol. Device 3.00mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805864","EAP","Custom 27805864","","Pipeline Embol. Device 3.00mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805865","EAP","Custom 27805865","","Pipeline Embol. Device 3.00mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805866","EAP","Custom 27805866","","Pipeline Embol. Device 3.25mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805867","EAP","Custom 27805867","","Pipeline Embol. Device 3.25mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805868","EAP","Custom 27805868","","Pipeline Embol. Device 3.25mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805869","EAP","Custom 27805869","","Pipeline Embol. Device 3.50mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805870","EAP","Custom 27805870","","Pipeline Embol. Device 3.50mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805871","EAP","Custom 27805871","","Pipeline Embol. Device 3.50mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805872","EAP","Custom 27805872","","Pipeline Embol. Device 3.75mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805873","EAP","Custom 27805873","","Pipeline Embol. Device 3.75mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805874","EAP","Custom 27805874","","Pipeline Embol. Device 3.75mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805875","EAP","Custom 27805875","","Pipeline Embol. Device 4.00mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805876","EAP","Custom 27805876","","Pipeline Embol. Device 4.00mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805877","EAP","Custom 27805877","","Pipeline Embol. Device 4.00mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805878","EAP","Custom 27805878","","Pipeline Embol. Device 4.25mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805879","EAP","Custom 27805879","","Pipeline Embol. Device 4.25mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805880","EAP","Custom 27805880","","Pipeline Embol. Device 4.25mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805881","EAP","Custom 27805881","","Pipeline Embol. Device 4.50mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805882","EAP","Custom 27805882","","Pipeline Embol. Device 4.50mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805883","EAP","Custom 27805883","","Pipeline Embol. Device 4.50mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805884","EAP","Custom 27805884","","Pipeline Embol. Device 4.75mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805885","EAP","Custom 27805885","","Pipeline Embol. Device 4.75mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805886","EAP","Custom 27805886","","Pipeline Embol. Device 4.75mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805887","EAP","Custom 27805887","","Pipeline Embol. Device 5.00mm X 25mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805888","EAP","Custom 27805888","","Pipeline Embol. Device 5.00mm X 30mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805889","EAP","Custom 27805889","","Pipeline Embol. Device 5.00mm X 35mm","BOTH IP/OP","$36,219.00 ","$26,802.06 ","$0.00 ","$36,219.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,849.50 ","$0.00 ","$36,219.00 ","$0.00 ","$18,109.50 ","$28,685.45 ","$28,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805890","EAP","Custom 27805890","","Pipeline Embol. Device 2.50mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805891","EAP","Custom 27805891","","Pipeline Embol. Device 2.50mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805892","EAP","Custom 27805892","","Pipeline Embol. Device 2.50mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805893","EAP","Custom 27805893","","Pipeline Embol. Device 2.50mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805894","EAP","Custom 27805894","","Pipeline Embol. Device 2.50mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805895","EAP","Custom 27805895","","Pipeline Embol. Device 2.50mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805896","EAP","Custom 27805896","","Pipeline Embol. Device 2.75mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805897","EAP","Custom 27805897","","Pipeline Embol. Device 2.75mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805898","EAP","Custom 27805898","","Pipeline Embol. Device 2.75mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805899","EAP","Custom 27805899","","Pipeline Embol. Device 2.75mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805900","EAP","Custom 27805900","","Pipeline Embol. Device 2.75mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805901","EAP","Custom 27805901","","Pipeline Embol. Device 2.75mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805902","EAP","Custom 27805902","","Pipeline Embol. Device 3.00mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805903","EAP","Custom 27805903","","Pipeline Embol. Device 3.00mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805904","EAP","Custom 27805904","","Pipeline Embol. Device 3.00mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805905","EAP","Custom 27805905","","Pipeline Embol. Device 3.00mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805906","EAP","Custom 27805906","","Pipeline Embol. Device 3.00mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805907","EAP","Custom 27805907","","Pipeline Embol. Device 3.00mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805908","EAP","Custom 27805908","","Pipeline Embol. Device 3.25mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805909","EAP","Custom 27805909","","Pipeline Embol. Device 3.25mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805910","EAP","Custom 27805910","","Pipeline Embol. Device 3.25mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805911","EAP","Custom 27805911","","Pipeline Embol. Device 3.25mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805912","EAP","Custom 27805912","","Pipeline Embol. Device 3.25mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805913","EAP","Custom 27805913","","Pipeline Embol. Device 3.25mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805914","EAP","Custom 27805914","","Pipeline Embol. Device 3.50mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805915","EAP","Custom 27805915","","Pipeline Embol. Device 3.50mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805916","EAP","Custom 27805916","","Pipeline Embol. Device 3.50mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805917","EAP","Custom 27805917","","Pipeline Embol. Device 3.50mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805918","EAP","Custom 27805918","","Pipeline Embol. Device 3.50mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805919","EAP","Custom 27805919","","Pipeline Embol. Device 3.50mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805920","EAP","Custom 27805920","","Pipeline Embol. Device 3.75mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805921","EAP","Custom 27805921","","Pipeline Embol. Device 3.75mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805922","EAP","Custom 27805922","","Pipeline Embol. Device 3.75mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805923","EAP","Custom 27805923","","Pipeline Embol. Device 3.75mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805924","EAP","Custom 27805924","","Pipeline Embol. Device 3.75mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805925","EAP","Custom 27805925","","Pipeline Embol. Device 3.75mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805926","EAP","Custom 27805926","","Pipeline Embol. Device 4.00mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805927","EAP","Custom 27805927","","Pipeline Embol. Device 4.00mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805928","EAP","Custom 27805928","","Pipeline Embol. Device 4.00mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805929","EAP","Custom 27805929","","Pipeline Embol. Device 4.00mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805930","EAP","Custom 27805930","","Pipeline Embol. Device 4.00mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805931","EAP","Custom 27805931","","Pipeline Embol. Device 4.00mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805932","EAP","Custom 27805932","","Pipeline Embol. Device 4.25mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805933","EAP","Custom 27805933","","Pipeline Embol. Device 4.25mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805934","EAP","Custom 27805934","","Pipeline Embol. Device 4.25mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805935","EAP","Custom 27805935","","Pipeline Embol. Device 4.25mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805936","EAP","Custom 27805936","","Pipeline Embol. Device 4.25mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805937","EAP","Custom 27805937","","Pipeline Embol. Device 4.25mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805938","EAP","Custom 27805938","","Pipeline Embol. Device 4.50mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805939","EAP","Custom 27805939","","Pipeline Embol. Device 4.50mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805940","EAP","Custom 27805940","","Pipeline Embol. Device 4.50mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805941","EAP","Custom 27805941","","Pipeline Embol. Device 4.50mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805942","EAP","Custom 27805942","","Pipeline Embol. Device 4.50mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805943","EAP","Custom 27805943","","Pipeline Embol. Device 4.50mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805944","EAP","Custom 27805944","","Pipeline Embol. Device 4.75mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805945","EAP","Custom 27805945","","Pipeline Embol. Device 4.75mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805946","EAP","Custom 27805946","","Pipeline Embol. Device 4.75mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805947","EAP","Custom 27805947","","Pipeline Embol. Device 4.75mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805948","EAP","Custom 27805948","","Pipeline Embol. Device 4.75mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805949","EAP","Custom 27805949","","Pipeline Embol. Device 4.75mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805950","EAP","Custom 27805950","","Pipeline Embol. Device 5.00mm X 10mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805951","EAP","Custom 27805951","","Pipeline Embol. Device 5.00mm X 12mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805952","EAP","Custom 27805952","","Pipeline Embol. Device 5.00mm X 14mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805953","EAP","Custom 27805953","","Pipeline Embol. Device 5.00mm X 16mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805954","EAP","Custom 27805954","","Pipeline Embol. Device 5.00mm X 18mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805955","EAP","Custom 27805955","","Pipeline Embol. Device 5.00mm X 20mm","BOTH IP/OP","$33,856.00 ","$25,053.44 ","$0.00 ","$33,856.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,163.03 ","$0.00 ","$33,856.00 ","$0.00 ","$16,928.00 ","$26,813.95 ","$27,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805956","EAP","Custom 27805956","","Pipeline Flex, 3.00mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805957","EAP","Custom 27805957","","Pipeline Flex, 3.00mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805958","EAP","Custom 27805958","","Pipeline Flex, 3.00mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805959","EAP","Custom 27805959","","Pipeline Flex, 3.25mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805960","EAP","Custom 27805960","","Pipeline Flex, 3.25mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805961","EAP","Custom 27805961","","Pipeline Flex, 3.25mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805962","EAP","Custom 27805962","","Pipeline Flex, 3.50mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805963","EAP","Custom 27805963","","Pipeline Flex, 3.50mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805964","EAP","Custom 27805964","","Pipeline Flex, 3.50mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805965","EAP","Custom 27805965","","Pipeline Flex, 3.75mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805966","EAP","Custom 27805966","","Pipeline Flex, 3.75mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805967","EAP","Custom 27805967","","Pipeline Flex, 3.75mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805968","EAP","Custom 27805968","","Pipeline Flex, 4.00mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805969","EAP","Custom 27805969","","Pipeline Flex, 4.00mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805970","EAP","Custom 27805970","","Pipeline Flex, 4.00mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805971","EAP","Custom 27805971","","Pipeline Flex, 4.25mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805972","EAP","Custom 27805972","","Pipeline Flex, 4.25mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805973","EAP","Custom 27805973","","Pipeline Flex, 4.25mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805974","EAP","Custom 27805974","","Pipeline Flex, 4.50mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805975","EAP","Custom 27805975","","Pipeline Flex, 4.50mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805976","EAP","Custom 27805976","","Pipeline Flex, 4.50mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805977","EAP","Custom 27805977","","Pipeline Flex, 4.75mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805978","EAP","Custom 27805978","","Pipeline Flex, 4.75mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805979","EAP","Custom 27805979","","Pipeline Flex, 4.75mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805980","EAP","Custom 27805980","","Pipeline Flex, 5.00mm X 25mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805981","EAP","Custom 27805981","","Pipeline Flex, 5.00mm X 30mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805982","EAP","Custom 27805982","","Pipeline Flex, 5.00mm X 35mm","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805983","EAP","Custom 27805983","","Pipeline Flex, 2.50mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805984","EAP","Custom 27805984","","Pipeline Flex, 2.50mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805985","EAP","Custom 27805985","","Pipeline Flex, 2.50mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805986","EAP","Custom 27805986","","Pipeline Flex, 2.50mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805987","EAP","Custom 27805987","","Pipeline Flex, 2.50mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805988","EAP","Custom 27805988","","Pipeline Flex, 2.50mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805989","EAP","Custom 27805989","","Pipeline Flex, 2.75mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805990","EAP","Custom 27805990","","Pipeline Flex, 2.75mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805991","EAP","Custom 27805991","","Pipeline Flex, 2.75mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805992","EAP","Custom 27805992","","Pipeline Flex, 2.75mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805993","EAP","Custom 27805993","","Pipeline Flex, 2.75mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805994","EAP","Custom 27805994","","Pipeline Flex, 2.75mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805995","EAP","Custom 27805995","","Pipeline Flex, 3.00mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805996","EAP","Custom 27805996","","Pipeline Flex, 3.00mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805997","EAP","Custom 27805997","","Pipeline Flex, 3.00mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805998","EAP","Custom 27805998","","Pipeline Flex, 3.00mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27805999","EAP","Custom 27805999","","Pipeline Flex, 3.00mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806000","EAP","Custom 27806000","","Pipeline Flex, 3.00mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806001","EAP","Custom 27806001","","Pipeline Flex, 3.25mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806002","EAP","Custom 27806002","","Pipeline Flex, 3.25mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806003","EAP","Custom 27806003","","Pipeline Flex, 3.25mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806004","EAP","Custom 27806004","","Pipeline Flex, 3.25mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806005","EAP","Custom 27806005","","Pipeline Flex, 3.25mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806006","EAP","Custom 27806006","","Pipeline Flex, 3.25mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806007","EAP","Custom 27806007","","Pipeline Flex, 3.50mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806008","EAP","Custom 27806008","","Pipeline Flex, 3.50mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806009","EAP","Custom 27806009","","Pipeline Flex, 3.50mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806010","EAP","Custom 27806010","","Pipeline Flex, 3.50mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806011","EAP","Custom 27806011","","Pipeline Flex, 3.50mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806012","EAP","Custom 27806012","","Pipeline Flex, 3.50mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806013","EAP","Custom 27806013","","Pipeline Flex, 3.75mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806014","EAP","Custom 27806014","","Pipeline Flex, 3.75mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806015","EAP","Custom 27806015","","Pipeline Flex, 3.75mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806016","EAP","Custom 27806016","","Pipeline Flex, 3.75mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806017","EAP","Custom 27806017","","Pipeline Flex, 3.75mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806018","EAP","Custom 27806018","","Pipeline Flex, 3.75mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806019","EAP","Custom 27806019","","Pipeline Flex, 4.00mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806020","EAP","Custom 27806020","","Pipeline Flex, 4.00mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806021","EAP","Custom 27806021","","Pipeline Flex, 4.00mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806022","EAP","Custom 27806022","","Pipeline Flex, 4.00mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806023","EAP","Custom 27806023","","Pipeline Flex, 4.00mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806024","EAP","Custom 27806024","","Pipeline Flex, 4.00mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806025","EAP","Custom 27806025","","Pipeline Flex, 4.25mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806026","EAP","Custom 27806026","","Pipeline Flex, 4.25mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806027","EAP","Custom 27806027","","Pipeline Flex, 4.25mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806028","EAP","Custom 27806028","","Pipeline Flex, 4.25mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806029","EAP","Custom 27806029","","Pipeline Flex, 4.25mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806030","EAP","Custom 27806030","","Pipeline Flex, 4.25mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806031","EAP","Custom 27806031","","Pipeline Flex, 4.50mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806032","EAP","Custom 27806032","","Pipeline Flex, 4.50mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806033","EAP","Custom 27806033","","Pipeline Flex, 4.50mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806034","EAP","Custom 27806034","","Pipeline Flex, 4.50mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806035","EAP","Custom 27806035","","Pipeline Flex, 4.50mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806036","EAP","Custom 27806036","","Pipeline Flex, 4.50mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806037","EAP","Custom 27806037","","Pipeline Flex, 4.75mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806038","EAP","Custom 27806038","","Pipeline Flex, 4.75mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806039","EAP","Custom 27806039","","Pipeline Flex, 4.75mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806040","EAP","Custom 27806040","","Pipeline Flex, 4.75mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806041","EAP","Custom 27806041","","Pipeline Flex, 4.75mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806042","EAP","Custom 27806042","","Pipeline Flex, 4.75mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806043","EAP","Custom 27806043","","Pipeline Flex, 5.00mm X 10mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806044","EAP","Custom 27806044","","Pipeline Flex, 5.00mm X 12mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806045","EAP","Custom 27806045","","Pipeline Flex, 5.00mm X 14mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806046","EAP","Custom 27806046","","Pipeline Flex, 5.00mm X 16mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806047","EAP","Custom 27806047","","Pipeline Flex, 5.00mm X 18mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806048","EAP","Custom 27806048","","Pipeline Flex, 5.00mm X 20mm","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806050","EAP","Custom 27806050","","Device Embl  25mm 3mm  Pipeline Flx 55d Nrvsc 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806051","EAP","Custom 27806051","","DEVICE EMBL  30MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806052","EAP","Custom 27806052","","DEVICE EMBL  35MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806053","EAP","Custom 27806053","","DEVICE EMBL  25MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806054","EAP","Custom 27806054","","DEVICE EMBL  30MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806055","EAP","Custom 27806055","","DEVICE EMBL  35MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806056","EAP","Custom 27806056","","DEVICE EMBL  25MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806057","EAP","Custom 27806057","","DEVICE EMBL  30MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806058","EAP","Custom 27806058","","DEVICE EMBL  35MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806059","EAP","Custom 27806059","","DEVICE EMBL  25MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806060","EAP","Custom 27806060","","DEVICE EMBL  30MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806061","EAP","Custom 27806061","","DEVICE EMBL  35MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806062","EAP","Custom 27806062","","DEVICE EMBL  25MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806063","EAP","Custom 27806063","","DEVICE EMBL  30MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806064","EAP","Custom 27806064","","DEVICE EMBL  35MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806065","EAP","Custom 27806065","","DEVICE EMBL  25MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806066","EAP","Custom 27806066","","DEVICE EMBL  30MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806067","EAP","Custom 27806067","","DEVICE EMBL  35MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806068","EAP","Custom 27806068","","DEVICE EMBL  30MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806069","EAP","Custom 27806069","","DEVICE EMBL  35MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806070","EAP","Custom 27806070","","DEVICE EMBL  25MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806071","EAP","Custom 27806071","","DEVICE EMBL  30MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806072","EAP","Custom 27806072","","DEVICE EMBL  35MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806073","EAP","Custom 27806073","","DEVICE EMBL  25MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806074","EAP","Custom 27806074","","DEVICE EMBL  30MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806075","EAP","Custom 27806075","","DEVICE EMBL  35MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$36,689.00 ","$27,149.86 ","$0.00 ","$36,689.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$26,184.94 ","$0.00 ","$36,689.00 ","$0.00 ","$18,344.50 ","$29,057.69 ","$29,351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806076","EAP","Custom 27806076","","DEVICE EMBL  10MM 2.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806077","EAP","Custom 27806077","","DEVICE EMBL  12MM 2.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806078","EAP","Custom 27806078","","DEVICE EMBL  16MM 2.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806079","EAP","Custom 27806079","","DEVICE EMBL  18MM 2.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806080","EAP","Custom 27806080","","DEVICE EMBL  20MM 2.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806081","EAP","Custom 27806081","","DEVICE EMBL  10MM 2.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806082","EAP","Custom 27806082","","DEVICE EMBL  12MM 2.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806083","EAP","Custom 27806083","","DEVICE EMBL  14MM 2.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806084","EAP","Custom 27806084","","DEVICE EMBL  16MM 2.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$35,938.00 ","$26,594.12 ","$0.00 ","$35,938.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$25,648.95 ","$0.00 ","$35,938.00 ","$0.00 ","$17,969.00 ","$28,462.90 ","$28,750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806085","EAP","Custom 27806085","","DEVICE EMBL  18MM 2.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806086","EAP","Custom 27806086","","DEVICE EMBL  20MM 2.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806087","EAP","Custom 27806087","","DEVICE EMBL  10MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806088","EAP","Custom 27806088","","DEVICE EMBL  12MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806089","EAP","Custom 27806089","","DEVICE EMBL  14MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806090","EAP","Custom 27806090","","DEVICE EMBL  16MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806091","EAP","Custom 27806091","","DEVICE EMBL  18MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806092","EAP","Custom 27806092","","DEVICE EMBL  20MM 3MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806093","EAP","Custom 27806093","","DEVICE EMBL  10MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806094","EAP","Custom 27806094","","DEVICE EMBL  12MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806095","EAP","Custom 27806095","","DEVICE EMBL  14MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806096","EAP","Custom 27806096","","DEVICE EMBL  16MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806097","EAP","Custom 27806097","","DEVICE EMBL  18MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806098","EAP","Custom 27806098","","DEVICE EMBL  20MM 3.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806099","EAP","Custom 27806099","","DEVICE EMBL  10MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806100","EAP","Custom 27806100","","DEVICE EMBL  12MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806101","EAP","Custom 27806101","","DEVICE EMBL  14MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806102","EAP","Custom 27806102","","DEVICE EMBL  16MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806103","EAP","Custom 27806103","","DEVICE EMBL  18MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806104","EAP","Custom 27806104","","DEVICE EMBL  20MM 3.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806105","EAP","Custom 27806105","","DEVICE EMBL  10MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806106","EAP","Custom 27806106","","DEVICE EMBL  12MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806107","EAP","Custom 27806107","","DEVICE EMBL  14MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806108","EAP","Custom 27806108","","DEVICE EMBL  16MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806109","EAP","Custom 27806109","","DEVICE EMBL  18MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806110","EAP","Custom 27806110","","DEVICE EMBL  20MM 3.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806111","EAP","Custom 27806111","","DEVICE EMBL  10MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806112","EAP","Custom 27806112","","DEVICE EMBL  12MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806113","EAP","Custom 27806113","","DEVICE EMBL  14MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806114","EAP","Custom 27806114","","DEVICE EMBL  16MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806115","EAP","Custom 27806115","","DEVICE EMBL  18MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806116","EAP","Custom 27806116","","DEVICE EMBL  20MM 4MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806117","EAP","Custom 27806117","","DEVICE EMBL  10MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806118","EAP","Custom 27806118","","DEVICE EMBL  12MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806119","EAP","Custom 27806119","","DEVICE EMBL  14MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806120","EAP","Custom 27806120","","DEVICE EMBL  16MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806121","EAP","Custom 27806121","","DEVICE EMBL  18MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806122","EAP","Custom 27806122","","DEVICE EMBL  20MM 4.25MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806123","EAP","Custom 27806123","","DEVICE EMBL  10MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806124","EAP","Custom 27806124","","DEVICE EMBL  12MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806125","EAP","Custom 27806125","","DEVICE EMBL  14MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$27,107.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,107.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806126","EAP","Custom 27806126","","DEVICE EMBL  16MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806127","EAP","Custom 27806127","","DEVICE EMBL  18MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806128","EAP","Custom 27806128","","DEVICE EMBL  20MM 4.5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806129","EAP","Custom 27806129","","DEVICE EMBL  10MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806130","EAP","Custom 27806130","","DEVICE EMBL  12MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$32,603.00 ","$24,126.22 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806131","EAP","Custom 27806131","","DEVICE EMBL  14MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806132","EAP","Custom 27806132","","DEVICE EMBL  16MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806133","EAP","Custom 27806133","","DEVICE EMBL  18MM 4.75MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806134","EAP","Custom 27806134","","DEVICE EMBL  10MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806135","EAP","Custom 27806135","","DEVICE EMBL  12MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806136","EAP","Custom 27806136","","DEVICE EMBL  14MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806137","EAP","Custom 27806137","","DEVICE EMBL  16MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806138","EAP","Custom 27806138","","DEVICE EMBL  18MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806139","EAP","Custom 27806139","","DEVICE EMBL  20MM 5MM  PIPELINE FLX 55D NRVSC 75%","BOTH IP/OP","$34,227.00 ","$25,327.98 ","$0.00 ","$34,227.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$24,427.81 ","$0.00 ","$34,227.00 ","$0.00 ","$17,113.50 ","$27,107.78 ","$27,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806156","EAP","HCPCS C2625","","Stent Uret 10.2fr 28cm Pgtl Curve Lp Radiopq Sdprt","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$126.45 ","$0.00 ","$58.57 ","$200.55 ","$200.55 ","$49.20 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$43.98 ","$0.00 ","$44.74 ","$0.00 "
"27806157","EAP","HCPCS C1876","","Stent Vasc 4.5mm 6fr 20mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806158","EAP","HCPCS C1876","","Stent Vasc 4.5mm 6fr 30mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806159","EAP","HCPCS C1876","","Stent Bil 4.5mm 6fr 40mm 120cm Brd Slf Xpd Rapex","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806165","EAP","HCPCS C1769","","Coil Embl 8cm 4mm .0125in Axium 1 Hand Op Dtch","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$410.38 ","$410.38 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"27806166","EAP","HCPCS C1880","","Coil Embl 30cm 8mm Helipaq 18 Mciol Hlcl Loop Dtch","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$713.70 ","$713.70 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"27806167","EAP","HCPCS C1887","","Coil Embl 6cm 3mm .0115in Axium 1 Hand Op Dtch","BOTH IP/OP","$1,668.00 ","$1,234.32 ","$0.00 ","$1,668.00 ","$750.60 ","$0.00 ","$347.65 ","$1,190.45 ","$1,190.45 ","$292.05 ","$1,668.00 ","$0.00 ","$834.00 ","$1,321.06 ","$1,334.40 ","$0.00 ","$261.04 ","$0.00 ","$265.55 ","$0.00 "
"27806168","EAP","HCPCS C1887","","Coil Embl 50cm 25mm .0145in Axium 1 Hand Op Dtch","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$1,124.08 ","$1,124.08 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"27806169","EAP","Custom 27806169","","System Embolization Nonadhesive Delivery Syringe Lower","BOTH IP/OP","$5,908.00 ","$4,371.92 ","$0.00 ","$5,908.00 ","$0.00 ","$0.00 ","$0.00 ","$4,216.54 ","$4,216.54 ","$0.00 ","$5,908.00 ","$0.00 ","$2,954.00 ","$4,679.14 ","$4,726.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806170","EAP","Custom 27806170","","Coil Embolization Sphere 10mm 30cm 10 Microcoil Spherical","BOTH IP/OP","$2,830.00 ","$2,094.20 ","$0.00 ","$2,830.00 ","$0.00 ","$0.00 ","$0.00 ","$2,019.77 ","$2,019.77 ","$0.00 ","$2,830.00 ","$0.00 ","$1,415.00 ","$2,241.36 ","$2,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806171","EAP","Custom 27806171","","Coil Embolization 9mm 14cm 14 Microcoil 2 Helical Multiple","BOTH IP/OP","$2,960.00 ","$2,190.40 ","$0.00 ","$2,960.00 ","$0.00 ","$0.00 ","$0.00 ","$2,112.55 ","$2,112.55 ","$0.00 ","$2,960.00 ","$0.00 ","$1,480.00 ","$2,344.32 ","$2,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806172","EAP","Custom 27806172","","Coil Embl 10cm 2mm Deltapaq 10 Mciol Loop Dtch Sft Rst Dflc","BOTH IP/OP","$2,294.00 ","$1,697.56 ","$0.00 ","$2,294.00 ","$0.00 ","$0.00 ","$0.00 ","$1,637.23 ","$1,637.23 ","$0.00 ","$2,294.00 ","$0.00 ","$1,147.00 ","$1,816.85 ","$1,835.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806173","EAP","Custom 27806173","","Coil Embolization 4mm 6cm 10 Microcoil Stretch Resistant","BOTH IP/OP","$2,294.00 ","$1,697.56 ","$0.00 ","$2,294.00 ","$0.00 ","$0.00 ","$0.00 ","$1,637.23 ","$1,637.23 ","$0.00 ","$2,294.00 ","$0.00 ","$1,147.00 ","$1,816.85 ","$1,835.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806174","EAP","Custom 27806174","","Coil Embolization 8mm 30cm 18 Microcoil Helical Loop","BOTH IP/OP","$1,358.00 ","$1,004.92 ","$0.00 ","$1,358.00 ","$0.00 ","$0.00 ","$0.00 ","$969.20 ","$969.20 ","$0.00 ","$1,358.00 ","$0.00 ","$679.00 ","$1,075.54 ","$1,086.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806175","EAP","Custom 27806175","","Coil Embolization Helix 4mm .0125in 8cm 1 Hand Operation","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$0.00 ","$0.00 ","$0.00 ","$1,351.03 ","$1,351.03 ","$0.00 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806176","EAP","Custom 27806176","","Coil Embolization 3d 3mm .0115in 6cm 1 Hand Operation","BOTH IP/OP","$2,555.00 ","$1,890.70 ","$0.00 ","$2,555.00 ","$0.00 ","$0.00 ","$0.00 ","$1,823.50 ","$1,823.50 ","$0.00 ","$2,555.00 ","$0.00 ","$1,277.50 ","$2,023.56 ","$2,044.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806177","EAP","Custom 27806177","","Coil Embolization 3d 25mm .0145in 50cm 1 Hand Operation","BOTH IP/OP","$2,555.00 ","$1,890.70 ","$0.00 ","$2,555.00 ","$0.00 ","$0.00 ","$0.00 ","$1,823.50 ","$1,823.50 ","$0.00 ","$2,555.00 ","$0.00 ","$1,277.50 ","$2,023.56 ","$2,044.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806178","EAP","HCPCS C1757","","System Dlv Angjt Pwr Pls Y Spk Irr 1 Wy Stpck Thrmb Cath","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806179","EAP","HCPCS C1874","","Stent Vascular 4.5mm 28mm W/o Distal Tip Enterprise Nitinol","BOTH IP/OP","$13,910.00 ","$10,293.40 ","$0.00 ","$13,910.00 ","$6,259.50 ","$0.00 ","$2,899.19 ","$5,158.80 ","$9,927.57 ","$2,435.53 ","$13,910.00 ","$0.00 ","$6,955.00 ","$11,016.72 ","$11,128.00 ","$0.00 ","$2,176.92 ","$0.00 ","$2,214.47 ","$0.00 "
"27806180","EAP","HCPCS C1874","","Stent Vascular 4.5mm 37mm W/o Distal Tip Enterprise Nitinol","BOTH IP/OP","$13,910.00 ","$10,293.40 ","$0.00 ","$13,910.00 ","$6,259.50 ","$0.00 ","$2,899.19 ","$5,158.80 ","$9,927.57 ","$2,435.53 ","$13,910.00 ","$0.00 ","$6,955.00 ","$11,016.72 ","$11,128.00 ","$0.00 ","$2,176.92 ","$0.00 ","$2,214.47 ","$0.00 "
"27806181","EAP","HCPCS C1769","","Guidewire Vascular J .014in 205cm 42cm Soft Tip Steerable","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$239.69 ","$820.76 ","$820.76 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"27806182","EAP","HCPCS C1769","","Guidewire Vascular J .014in 205cm 43cm Soft Tip Steerable","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$239.69 ","$820.76 ","$820.76 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"27806183","EAP","HCPCS C1722","","Defibrillator Crd .99cm 5.37x7.36cm Dynagen","BOTH IP/OP","$33,750.00 ","$24,975.00 ","$0.00 ","$33,750.00 ","$15,187.50 ","$0.00 ","$7,034.34 ","$5,158.80 ","$24,087.38 ","$5,909.36 ","$33,750.00 ","$0.00 ","$16,875.00 ","$26,730.00 ","$27,000.00 ","$0.00 ","$5,281.88 ","$0.00 ","$5,373.00 ","$0.00 "
"27806184","EAP","HCPCS C1788","","Catheter Central Venous Pro-fuse Triniflex Od8 Fr Attachable","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"27806185","EAP","Custom 27806185","","Xpede Cement And Mixer With Size 2 Multi-tap","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$481.75 ","$481.75 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806189","EAP","Custom 27806189","","Graft Evas 10cm 12mm Xcldr Cntrlt Leg Stent Xtd","BOTH IP/OP","$11,275.00 ","$8,343.50 ","$0.00 ","$11,275.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,046.97 ","$0.00 ","$11,275.00 ","$0.00 ","$5,637.50 ","$8,929.80 ","$9,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806190","EAP","Custom 27806190","","Graft Evas 3.3cm 23mm 19-21mm Aorta","BOTH IP/OP","$7,938.00 ","$5,874.12 ","$0.00 ","$7,938.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,665.35 ","$0.00 ","$7,938.00 ","$0.00 ","$3,969.00 ","$6,286.90 ","$6,350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806195","EAP","HCPCS C1882","","Claria Mri Quad Crt-d Device","BOTH IP/OP","$52,375.00 ","$38,757.50 ","$0.00 ","$52,375.00 ","$23,568.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,380.04 ","$8,138.89 ","$52,375.00 ","$0.00 ","$26,187.50 ","$41,481.00 ","$41,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806196","EAP","HCPCS C1882","","Dfbr Crd 13mm 51x74mm Claria Mri Crt-d Surescan","BOTH IP/OP","$52,375.00 ","$38,757.50 ","$0.00 ","$52,375.00 ","$23,568.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,380.04 ","$8,138.89 ","$52,375.00 ","$0.00 ","$26,187.50 ","$41,481.00 ","$41,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806197","EAP","HCPCS C1882","","Dfbr Crd 13mm 51x71mm Surescan Claria Mri","BOTH IP/OP","$52,375.00 ","$38,757.50 ","$0.00 ","$52,375.00 ","$23,568.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$37,380.04 ","$8,138.89 ","$52,375.00 ","$0.00 ","$26,187.50 ","$41,481.00 ","$41,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806198","EAP","HCPCS C1882","","Dfbr Crd 13mm 51x73mm Claria Mri Crt-d Surescan","BOTH IP/OP","$52,375.00 ","$38,757.50 ","$0.00 ","$52,375.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$37,380.04 ","$8,138.89 ","$52,375.00 ","$0.00 ","$26,187.50 ","$41,481.00 ","$41,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806199","EAP","HCPCS C1882","","Claria Mri Crt-d System Mmam","BOTH IP/OP","$67,375.00 ","$49,857.50 ","$0.00 ","$67,375.00 ","$30,318.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,085.54 ","$8,138.89 ","$67,375.00 ","$0.00 ","$33,687.50 ","$53,361.00 ","$53,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806200","EAP","Custom 27806200","","Target Xl Soft 2mm X 3cm -coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806201","EAP","Custom 27806201","","Target Xl Soft 2mm X 6cm -coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806202","EAP","Custom 27806202","","Target Xl Soft 3mm X 6cm -coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806203","EAP","Custom 27806203","","Target Xl Soft 3mm X 9cm - Coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806204","EAP","Custom 27806204","","Target Xl Soft 4mm X 8cm - Coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806205","EAP","Custom 27806205","","Target Xl Soft 4mm X 12cm -coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806206","EAP","Custom 27806206","","Target Xl Soft 5mm X 10cm Coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806207","EAP","Custom 27806207","","Target Xl Soft 5mm X 15cm -coil","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806208","EAP","Custom 27806208","","Dev Emb  25mm 3mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806209","EAP","HCPCS C1725","","Pleurx Peritoneal Catheter Kit","BOTH IP/OP","$2,916.00 ","$2,157.84 ","$0.00 ","$2,916.00 ","$0.00 ","$0.00 ","$0.00 ","$2,081.15 ","$2,081.15 ","$510.57 ","$2,916.00 ","$0.00 ","$1,458.00 ","$2,309.47 ","$2,332.80 ","$0.00 ","$456.35 ","$0.00 ","$464.23 ","$0.00 "
"27806210","EAP","HCPCS C1882","","Claria Mri Quad Crtd System Mmqm","BOTH IP/OP","$67,375.00 ","$49,857.50 ","$0.00 ","$67,375.00 ","$30,318.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,085.54 ","$8,138.89 ","$67,375.00 ","$0.00 ","$33,687.50 ","$53,361.00 ","$53,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806211","EAP","HCPCS C1876","","Stent Vasc 4.5mm 6fr 60mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806212","EAP","HCPCS C1876","","Stent Vasc 4.5mm 6fr 80mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806213","EAP","HCPCS C1876","","Stent Vasc 4.5mm 6fr 100mm 120cm Otw Slf","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806214","EAP","HCPCS C1876","","Stent Vasc 4.5mm 6fr 120mm 120cm Otw Slf","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806215","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 20mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806216","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 30mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806217","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 40mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806218","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 60mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806219","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 80mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806220","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 100mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806221","EAP","HCPCS C1876","","Stent Vasc 5mm 6fr 120mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806222","EAP","HCPCS C1876","","Stent Vasc 5.5mm 6fr 20mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806223","EAP","HCPCS C1876","","Stent Vasc 5.5mm 6fr 30mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806224","EAP","HCPCS C1876","","Stent Vasc 5.5mm 6fr 40mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806225","EAP","HCPCS C1876","","Stent Vasc 5.5mm 6fr 60mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806227","EAP","HCPCS C1876","","Stent Bil 5.5mm 6fr 100mm 120cm Mimetic Dsgn Flxb","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806228","EAP","HCPCS C1876","","Stent Bil 5.5mm 6fr 120mm 120cm Mimetic Dsgn Flxb","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806229","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 20mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806230","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 30mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806231","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 40mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806232","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 60mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806233","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 80mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806234","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 100mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806235","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 120mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806236","EAP","HCPCS C1876","","Stent Vasc 6mm 6fr 150mm 120cm Peri Supera","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806237","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 20mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806238","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 30mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806239","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 40mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806240","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 60mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806241","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 120mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806242","EAP","HCPCS C1876","","Stent Vasc 6.5mm 6fr 150mm 120cm Otw Slf Expandable","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806243","EAP","HCPCS C1876","","Stent Bil 5.5mm 6fr 150mm 120cm Mimetic Dsgn Flxb","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$2,244.60 ","$0.00 ","$1,039.62 ","$3,559.94 ","$3,559.94 ","$873.36 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$780.62 ","$0.00 ","$794.09 ","$0.00 "
"27806244","EAP","Custom 27806244","","STENT VASC 6.5MM 6FR 80MM 120CM OTW SLF EXPANDABLE","BOTH IP/OP","$4,988.00 ","$3,691.12 ","$0.00 ","$4,988.00 ","$0.00 ","$0.00 ","$0.00 ","$3,559.94 ","$3,559.94 ","$0.00 ","$4,988.00 ","$0.00 ","$2,494.00 ","$3,950.50 ","$3,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806245","EAP","Custom 27806245","","Dev Emb  30mm 3mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806246","EAP","Custom 27806246","","Dev Emb  25mm 3.25","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806247","EAP","Custom 27806247","","Dev Emb  35mm 3mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806248","EAP","Custom 27806248","","Dev Emb  30mm 3.25","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806249","EAP","Custom 27806249","","Dev Emb  35mm 3.25","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806250","EAP","Custom 27806250","","Dev Emb  25mm 3.5m","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806251","EAP","Custom 27806251","","Dev Emb  30mm 3.5m","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806252","EAP","Custom 27806252","","Dev Emb 55d 3.5mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806253","EAP","Custom 27806253","","Dev Emb  25mm 3.75","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806254","EAP","Custom 27806254","","Dev Emb  30mm 3.75","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806255","EAP","Custom 27806255","","Dev Emb 55d 3.75mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806256","EAP","Custom 27806256","","Dev Emb  25mm 4mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806257","EAP","Custom 27806257","","Dev Emb  30mm 4mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806258","EAP","Custom 27806258","","Dev Emb 55d 4mm 35","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806259","EAP","Custom 27806259","","Dev Emb  25mm 4.25","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806260","EAP","Custom 27806260","","Dev Emb  30mm 4.25","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806261","EAP","Custom 27806261","","Dev Emb 55d 4.25mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806262","EAP","Custom 27806262","","Dev Emb  30mm 4.5m","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806263","EAP","Custom 27806263","","Dev Emb 55d 4.5mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806264","EAP","Custom 27806264","","Dev Emb  25mm 4.75","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806265","EAP","Custom 27806265","","Dev Emb  30mm 4.75","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806266","EAP","Custom 27806266","","Dev Emb 55d 4.75mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806267","EAP","Custom 27806267","","Dev Emb 55d 5mm 25","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806268","EAP","Custom 27806268","","Dev Emb  30mm 5mm","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806269","EAP","Custom 27806269","","Dev Emb 55d 5mm 33","BOTH IP/OP","$13,979.00 ","$10,344.46 ","$0.00 ","$13,979.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,976.81 ","$0.00 ","$13,979.00 ","$0.00 ","$6,989.50 ","$11,071.37 ","$11,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806270","EAP","Custom 27806270","","Dev Emb 55d 2.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806271","EAP","Custom 27806271","","Dev Emb  12mm 2.5m","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806272","EAP","Custom 27806272","","Dev Emb  16mm 2.5m","BOTH IP/OP","$32,603.00 ","$24,126.22 ","$0.00 ","$32,603.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$23,268.76 ","$0.00 ","$32,603.00 ","$0.00 ","$16,301.50 ","$25,821.58 ","$26,082.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806273","EAP","Custom 27806273","","Dev Emb  18mm 2.5m","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806274","EAP","Custom 27806274","","Dev Emb 55d 2.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806275","EAP","Custom 27806275","","Dev Emb  10mm 2.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806276","EAP","Custom 27806276","","Dev Emb  12mm 2.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806277","EAP","Custom 27806277","","Dev Emb  14mm 2.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806278","EAP","Custom 27806278","","Dev Emb 55d 2.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806279","EAP","Custom 27806279","","Dev Emb  18mm 2.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806280","EAP","Custom 27806280","","Dev Emb 55d 2.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806281","EAP","Custom 27806281","","Dev Emb  10mm 3mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806282","EAP","Custom 27806282","","Dev Emb  12mm 3mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806283","EAP","Custom 27806283","","Dev Emb 55d 3mm 14","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806284","EAP","Custom 27806284","","Dev Emb  16mm 3mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806285","EAP","Custom 27806285","","Dev Emb 55d 3mm 18","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806286","EAP","Custom 27806286","","Dev Emb 55d 3mm 20","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806287","EAP","Custom 27806287","","Dev Emb  10mm 3.25","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806288","EAP","Custom 27806288","","Dev Emb  12mm 3.25","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806289","EAP","Custom 27806289","","Dev Emb 55d 3.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806290","EAP","Custom 27806290","","Dev Emb  16mm 3.25","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806291","EAP","Custom 27806291","","Dev Emb 55d 3.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806292","EAP","Custom 27806292","","Dev Emb 55d 3.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806293","EAP","Custom 27806293","","Dev Emb  10mm 3.5m","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806294","EAP","Custom 27806294","","Dev Emb 55d 3.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806295","EAP","Custom 27806295","","Dev Emb 55d 3.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806296","EAP","Custom 27806296","","Dev Emb 55d 3.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806297","EAP","Custom 27806297","","Dev Emb 55d 3.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806298","EAP","Custom 27806298","","Dev Emb 55d 3.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806299","EAP","Custom 27806299","","Dev Emb  10mm 3.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806300","EAP","Custom 27806300","","Dev Emb  12mm 3.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806301","EAP","Custom 27806301","","Dev Emb 55d 3.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806302","EAP","Custom 27806302","","Dev Emb  16mm 3.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806303","EAP","Custom 27806303","","Dev Emb 55d 3.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806304","EAP","Custom 27806304","","Dev Emb 55d 3.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806305","EAP","Custom 27806305","","Dev Emb 55d 4mm 10","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806306","EAP","Custom 27806306","","Dev Emb 55d 4mm 12","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806307","EAP","Custom 27806307","","Dev Emb 55d 4mm 14","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806308","EAP","Custom 27806308","","Dev Emb 55d 4mm 16","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806309","EAP","Custom 27806309","","Dev Emb 55d 4mm 18","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806310","EAP","Custom 27806310","","Dev Emb 55d 4mm 20","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806311","EAP","Custom 27806311","","Dev Emb  10mm 4.25","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806312","EAP","Custom 27806312","","Dev Emb 55d 4.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806313","EAP","Custom 27806313","","Dev Emb 55d 4.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806314","EAP","Custom 27806314","","Dev Emb 55d 4.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806315","EAP","Custom 27806315","","Dev Emb 55d 4.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806316","EAP","Custom 27806316","","Dev Emb 55d 4.25mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806317","EAP","Custom 27806317","","Dev Emb  10mm 4.5m","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806318","EAP","Custom 27806318","","Dev Emb 55d 4.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806319","EAP","Custom 27806319","","Dev Emb 55d 4.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806320","EAP","Custom 27806320","","Dev Emb 55d 4.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806321","EAP","Custom 27806321","","Dev Emb 55d 4.5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806322","EAP","Custom 27806322","","Dev Emb  10mm 4.75","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806323","EAP","Custom 27806323","","Dev Emb 55d 4.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806324","EAP","Custom 27806324","","Dev Emb 55d 4.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806325","EAP","Custom 27806325","","Dev Emb 55d 4.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806326","EAP","Custom 27806326","","Dev Emb 55d 4.75mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806327","EAP","Custom 27806327","","Dev Emb  10mm 5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806328","EAP","Custom 27806328","","Dev Emb  12mm 5mm","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806329","EAP","Custom 27806329","","Dev Emb 55d 5mm 14","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806330","EAP","Custom 27806330","","Dev Emb 55d 5mm 16","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806331","EAP","Custom 27806331","","Dev Emb 55d 5mm 18","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806332","EAP","Custom 27806332","","Dev Emb 55d 5mm 20","BOTH IP/OP","$13,041.00 ","$9,650.34 ","$0.00 ","$13,041.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$9,307.36 ","$0.00 ","$13,041.00 ","$0.00 ","$6,520.50 ","$10,328.47 ","$10,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806333","EAP","","","Innova 5mm X 20mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806334","EAP","HCPCS C1876","","Innova 5mm X 40mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806335","EAP","HCPCS C1876","","Innova 5mm X 60mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806336","EAP","HCPCS C1876","","Innova 5mm X 80mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806337","EAP","HCPCS C1876","","Innova 5mm X 100mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806338","EAP","HCPCS C1876","","Innova 5mm X 120mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806339","EAP","HCPCS C1876","","Innova 6mm X 20mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806340","EAP","HCPCS C1876","","Stent Vasc Blue 40mm 6mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806341","EAP","HCPCS C1876","","Stent Vasc Blue 60mm 6mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806342","EAP","HCPCS C1876","","Stent Vasc Blue 80mm 6mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806343","EAP","HCPCS C1876","","Stent Vasc Blue 100mm 6mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806344","EAP","HCPCS C1876","","Innova 6mm X 120mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806345","EAP","HCPCS C1876","","Innova 7mm X 20mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806346","EAP","HCPCS C1876","","Stent Vasc Blue 40mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806347","EAP","HCPCS C1876","","Stent Vasc Blue 60mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806348","EAP","HCPCS C1876","","Stent Vasc Blue 80mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806349","EAP","HCPCS C1876","","Stent Vasc Blue 100mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806350","EAP","HCPCS C1876","","Innova 7mm X 120mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806351","EAP","HCPCS C1876","","Stent Vasc Blue 20mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806352","EAP","HCPCS C1876","","Stent Vasc Blue 40mm 8mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806353","EAP","HCPCS C1876","","Stent Vasc Blue 60mm 8mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806354","EAP","HCPCS C1876","","Stent Vasc Blue 80mm 8mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806355","EAP","HCPCS C1876","","Innova 8mm X 100mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806356","EAP","HCPCS C1876","","Innova 8mm X 120mm X 75cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806357","EAP","HCPCS C1876","","Innova 5mm X 20mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806358","EAP","HCPCS C1876","","Stent Vasc Blue 40mm 5mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806359","EAP","HCPCS C1876","","Stent Vasc Blue 60mm 5mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806360","EAP","HCPCS C1876","","Stent Vasc Blue 80mm 5mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806361","EAP","HCPCS C1876","","Stent Vasc Blue 100mm 5mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806362","EAP","HCPCS C1876","","Stent Vasc Blue 120mm 5mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806363","EAP","HCPCS C1876","","Innova 6mm X 20mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806364","EAP","HCPCS C1876","","Stent Vasc Blue 40mm 6mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806365","EAP","HCPCS C1876","","Stent Vasc 60mm 6mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806366","EAP","HCPCS C1876","","Stent Vasc Blue 80mm 6mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806367","EAP","HCPCS C1876","","Stent Vasc 100mm 6mm Innova Slf Xpd Radiopq","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806368","EAP","HCPCS C1876","","Stent Vasc Blue 120mm 6mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806369","EAP","HCPCS C1876","","Innova 7mm X 20mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806370","EAP","HCPCS C1876","","Stent Vasc Blue 40mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806371","EAP","HCPCS C1876","","Stent Vasc Blue 60mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806372","EAP","HCPCS C1876","","Stent Vasc Blue 80mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806373","EAP","HCPCS C1876","","Stent Vasc Blue 100mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806374","EAP","HCPCS C1876","","Stent Vasc Blue 120mm 7mm Innova Sprfc Fem Art Slf","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806375","EAP","HCPCS C1876","","Innova 8mm X 20mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806376","EAP","HCPCS C1876","","Innova 8mm X 40mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806377","EAP","HCPCS C1876","","Innova 8mm X 60mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806378","EAP","HCPCS C1876","","Innova 8mm X 80mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806379","EAP","HCPCS C1876","","Innova 8mm X 100mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806380","EAP","HCPCS C1876","","Innova 8mm X 120mm X 130cm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"27806381","EAP","Custom 27806381","","Coil Embl 18d .018in 2mm 2cm Azur Hdrcl Dtch Pltn Ddrgl Peri","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806382","EAP","Custom 27806382","","Coil Embl 18d .018in 2mm 4cm Azur Hdrcl Dtch Pltn Ddrgl Peri","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806383","EAP","Custom 27806383","","Coil Embl 3mm .018in 2cm Azur Hdrcl 18 Coil Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806384","EAP","Custom 27806384","","Coil Embl .018in 3mm .021in 5cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806385","EAP","Custom 27806385","","Coil Embl .018in 4mm 5cm Azur","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806386","EAP","Custom 27806386","","System Embl 5mm .018in 5cm Azur Hdrcl 18 Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806387","EAP","HCPCS C1882","","Claria Mri Crt-d System, Mmae","BOTH IP/OP","$67,375.00 ","$49,857.50 ","$0.00 ","$67,375.00 ","$30,318.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,085.54 ","$8,138.89 ","$67,375.00 ","$0.00 ","$33,687.50 ","$53,361.00 ","$53,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806388","EAP","HCPCS C1882","","Claria Mri Quad Crtd System, Mmqe","BOTH IP/OP","$67,375.00 ","$49,857.50 ","$0.00 ","$67,375.00 ","$30,318.75 ","$0.00 ","$9,417.94 ","$5,158.80 ","$48,085.54 ","$8,138.89 ","$67,375.00 ","$0.00 ","$33,687.50 ","$53,361.00 ","$53,900.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"27806389","EAP","Custom 27806389","","System Embl 5mm .018in 10cm Azur Hdrcl 18 Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806390","EAP","Custom 27806390","","System Embl 5mm .018in 15cm Azur 18 Dtch Hdrcl Peri","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806391","EAP","Custom 27806391","","System Embl 5mm .018in 20cm Azur 18 Dtch Hdrcl Peri","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806392","EAP","Custom 27806392","","Coil Embl 4mm .018in 10cm 135cm Azur Dtch Pltn Ddrgl Peri","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806393","EAP","Custom 27806393","","Coil Embl .018in 6mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806394","EAP","Custom 27806394","","Coil Embl .018in 8mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806395","EAP","Custom 27806395","","Coil Embl .018in 10mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806396","EAP","Custom 27806396","","Coil Embl 6mm .018in 15cm 135cm Azur 18 Coil Dtch Hdrcl Pltn","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806397","EAP","Custom 27806397","","Coil Embl .018in 8mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806398","EAP","Custom 27806398","","Coil Embl .018in 10mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806399","EAP","Custom 27806399","","Coil Embl .018in 12mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806400","EAP","HCPCS C2617","","Set Stent 2 Pigtail Curve 8fr 26cm Radiopq Graduat","BOTH IP/OP","$269.00 ","$199.06 ","$0.00 ","$269.00 ","$121.05 ","$0.00 ","$56.07 ","$191.99 ","$191.99 ","$47.10 ","$269.00 ","$0.00 ","$134.50 ","$213.05 ","$215.20 ","$0.00 ","$42.10 ","$0.00 ","$42.82 ","$0.00 "
"27806401","EAP","HCPCS C1874","","Graft Evas 106mm 12mm H&l-b 1-shot Znth Fenestrate","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27806405","EAP","Custom 27806405","","Coil Embl 8mm 20cm Azur Hdrcl 18 Coils Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806406","EAP","Custom 27806406","","Coil Embl .018in 12mm .021in 20cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806407","EAP","Custom 27806407","","Coil Embl 15mm 20cm Azur Hdrcl 18 Coils Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806408","EAP","Custom 27806408","","Coil Embl 20mm .018in 20cm Strl Azur Hdrcl Dtch Pltn Ddrgl","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806409","EAP","Custom 27806409","","Coil Embl 15mm .018in 30cm Strl Azur Hdrcl 18 Coil Dtch Pltn","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806410","EAP","Custom 27806410","","Coil Embl 20mm .018in 30cm Strl Azur 18 Coil Dtch Hdrcl Pltn","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806411","EAP","Custom 27806411","","Coil Embl .018in 4mm .021-.027in 13cm Strl Azur Cx Dtch Pltn","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806412","EAP","Custom 27806412","","Coil Embl .018in 5mm .021-.027in 16cm Azur Cx Dtch Sft Flxb","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806413","EAP","Custom 27806413","","Coil Embl .018in 6mm .021-.027in 20cm Azur Cx Dtch Sft Flxb","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806414","EAP","Custom 27806414","","Coil Embl .018in 7mm .021-.027in 24cm Azur Cx Dtch Sft Flxb","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806415","EAP","Custom 27806415","","Coil Embl .018in 8mm .021-.027in 28cm Azur Cx Hdrcl Dtch Sft","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806416","EAP","Custom 27806416","","Coil Embl .018in 9mm .021-.027in 28cm Azur Cx Hdrcl Dtch Sft","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806417","EAP","Custom 27806417","","Coil Embl .018in 10mm .021-.027in 32cm Azur Cx Hdrcl Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806418","EAP","Custom 27806418","","Coil Embl .018in 12mm .021-.027in 38cm Azur Cx Hdrcl Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806419","EAP","Custom 27806419","","Coil Embl .018in 14mm .021-.027in 34cm Azur Cx Hdrcl Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806420","EAP","Custom 27806420","","Coil Embl .018in 16mm .021-.027in 39cm Azur Cx Hdrcl Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806421","EAP","Custom 27806421","","Coil Embl .018in 18mm .021-.027in 36cm Azur Cx Hdrcl Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806422","EAP","Custom 27806422","","Coil Embl .018in 20mm .021-.027in 40cm Azur Cx Hdrcl Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806423","EAP","Custom 27806423","","Coil Embl .035in 4mm .038in 5cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806424","EAP","Custom 27806424","","Coil Embl 4mm 10cm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806425","EAP","Custom 27806425","","Coil Embl .035in 6mm .038in 10cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806426","EAP","Custom 27806426","","Coil Embl .035in 4mm 15cm Azur Dtch Ddrgl Peri","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806427","EAP","Custom 27806427","","Coil Embl .035in 6mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806428","EAP","Custom 27806428","","Coil Embl .035in 8mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806429","EAP","Custom 27806429","","Coil Embl .035in 10mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806430","EAP","Custom 27806430","","Coil Embl 6mm 20cm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806431","EAP","Custom 27806431","","Coil Embl .035in 8mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806432","EAP","Custom 27806432","","Coil Embl .035in 12mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806433","EAP","Custom 27806433","","Coil Embl .035in 15mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806434","EAP","Custom 27806434","","Coil Embl 20mm 20cm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806435","EAP","Custom 27806435","","Coil Embl 12mm 30cm Azur Dtch Ddrgl Peri 35 Sys","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806436","EAP","Custom 27806436","","Coil Embl .035in 4mm 7cm Azur Cx Dtch Sft Sld Cor Flxb Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806437","EAP","Custom 27806437","","Coil Embl .035in 5mm 11cm Azur Cx Dtch Sft Sld Cor Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806438","EAP","Custom 27806438","","Coil Embl .035in 6mm 9cm Azur Cx Dtch Sft Sld Cor Flxb Ddrgl","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806439","EAP","Custom 27806439","","Coil Embl .035in 6mm 17cm Azur Cx Dtch Cx Sect Cvrgls Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806440","EAP","Custom 27806440","","Coil Embl .035in 8mm 12cm Azur Cx Dtch Sft Sld Cor Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806441","EAP","Custom 27806441","","Coil Embl .035in 8mm 24cm Azur Cx Dtch Sft Sld Cor Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806442","EAP","Custom 27806442","","Coil Embl .035in 10mm 19cm Azur Cx Dtch Sft Sld Cor Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806443","EAP","Custom 27806443","","Coil Embl .035in 13mm 24cm Azur Cx Dtch Sft Sld Cor Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806444","EAP","Custom 27806444","","Coil Embl .035in 16mm 32cm Azur Cx Dtch Sft Sld Cor Flxb","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806445","EAP","Custom 27806445","","Coil Embl .035in 10mm .038in 26cm 150cm Azur Frme Elc Dtch","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806446","EAP","Custom 27806446","","Coil Embl 8mm 20cm Azur Frm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806447","EAP","Custom 27806447","","Coil Embl .018in 10mm .021in 26cm 150cm Azur Frme Elc Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806448","EAP","Custom 27806448","","Coil Embl .018in 14mm 34mm Azur Frme Nonhydrogel Dtch Loop","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806449","EAP","Custom 27806449","","Coil Embl .018in 20mm .021in 50cm 150cm Azur Frme Elc Dtch","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806450","EAP","Custom 27806450","","Coil Embl Azur Dtch Cntrlr","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27806451","EAP","HCPCS C1880","","Kit Aln Removal And/or Repositioning, 2in1 Rs","BOTH IP/OP","$1,063.00 ","$786.62 ","$0.00 ","$1,063.00 ","$0.00 ","$0.00 ","$0.00 ","$758.66 ","$758.66 ","$186.12 ","$1,063.00 ","$0.00 ","$531.50 ","$841.90 ","$850.40 ","$0.00 ","$166.36 ","$0.00 ","$169.23 ","$0.00 "
"27806493","EAP","HCPCS C1874","","Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27806494","EAP","HCPCS C1874","","Graft Evas 124mm 32mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27806596","EAP","HCPCS C1874","","Graft Evas 121mm 12mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27806798","EAP","HCPCS C1874","","Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27806899","EAP","HCPCS C1874","","Graft Evas 76mm 20fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807101","EAP","HCPCS C1874","","Graft Evas 91mm 16fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807202","EAP","HCPCS C1874","","Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807303","EAP","HCPCS C1874","","Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807404","EAP","HCPCS C1874","","Graft Evas 106mm 20fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807505","EAP","HCPCS C1874","","Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807606","EAP","HCPCS C1874","","Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807707","EAP","HCPCS C1874","","Graft Evas 76mm 12fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807808","EAP","HCPCS C1874","","Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27807909","EAP","HCPCS C1874","","Graft Evas 76mm 20fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808010","EAP","HCPCS C1874","","Graft Evas 76mm 24fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808111","EAP","HCPCS C1874","","Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808212","EAP","HCPCS C1874","","Graft Evas 91mm 16fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808313","EAP","HCPCS C1874","","Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808414","EAP","HCPCS C1874","","Graft Evas 91mm 24fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808515","EAP","HCPCS C1874","","Graft Evas 106mm 12fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808616","EAP","HCPCS C1874","","Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808717","EAP","HCPCS C1874","","Graft Evas 106mm 20fr Znth H&l-b 1-shot Vscr Fen","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808818","EAP","HCPCS C1874","","Graft Evas 106mm 24fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27808919","EAP","HCPCS C1874","","Graft Evas 121mm 12fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809020","EAP","HCPCS C1874","","Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809021","EAP","HCPCS C1876","","Tent Vasc Strg 10mm 30mm Xact Slf Xpd Cls Cell Fl","BOTH IP/OP","$4,938.00 ","$3,654.12 ","$0.00 ","$4,938.00 ","$2,222.10 ","$0.00 ","$1,029.20 ","$3,524.25 ","$3,524.25 ","$864.60 ","$4,938.00 ","$0.00 ","$2,469.00 ","$3,910.90 ","$3,950.40 ","$0.00 ","$772.80 ","$0.00 ","$786.13 ","$0.00 "
"27809121","EAP","HCPCS C1874","","Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809222","EAP","HCPCS C1874","","Graft Evas 121mm 24fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809323","EAP","HCPCS C1874","","Graft Evas 76mm 12fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809424","EAP","HCPCS C1874","","Graft Evas 76mm 20mm 8.1mm 20fr Znth Aaa Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809525","EAP","HCPCS C1874","","Graft Evas 76mm 24fr Znth 1-shot Aaa 2 Brch Vscr","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809626","EAP","HCPCS C1874","","Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809727","EAP","HCPCS C1874","","Graft Evas 91mm 16fr Znth Aaa Fenst Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809828","EAP","HCPCS C1874","","Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809929","EAP","HCPCS C1874","","Graft Evas 91mm 24fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27809930","EAP","HCPCS C1876","","Stent Endoth 12mm 8fr 40mm 100cm Flex Recons","BOTH IP/OP","$2,438.00 ","$1,804.12 ","$0.00 ","$2,438.00 ","$1,097.10 ","$0.00 ","$508.14 ","$1,740.00 ","$1,740.00 ","$426.87 ","$2,438.00 ","$0.00 ","$1,219.00 ","$1,930.90 ","$1,950.40 ","$0.00 ","$381.55 ","$0.00 ","$388.13 ","$0.00 "
"27809931","EAP","HCPCS C1788","","Set Hmdial 33ml Lf Aqdx Bld Crct Uf-500","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"27810030","EAP","HCPCS C1874","","Graft Evas 106mm 12fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810131","EAP","HCPCS C1874","","Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810232","EAP","HCPCS C1874","","Graft Evas 106mm 20fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810333","EAP","HCPCS C1874","","Graft Evas 106mm 24fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810434","EAP","HCPCS C1874","","Graft Evas 121mm 12fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810535","EAP","HCPCS C1874","","Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810636","EAP","HCPCS C1874","","Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810737","EAP","HCPCS C1874","","Graft Evas 121mm 24fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810838","EAP","HCPCS C1874","","Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27810939","EAP","HCPCS C1874","","Graft Evas 76mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27811040","EAP","HCPCS C1874","","Graft Evas 76mm 26mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811141","EAP","HCPCS C1874","","Graft Evas 76mm 28mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811242","EAP","HCPCS C1874","","Graft Evas 76mm 30mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811343","EAP","HCPCS C1874","","Graft Evas 76mm 32mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811444","EAP","HCPCS C1874","","Graft Evas 91mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811545","EAP","HCPCS C1874","","Graft Evas 91mm 26mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811646","EAP","HCPCS C1874","","Graft Evas 91mm 28mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811747","EAP","HCPCS C1874","","Graft Evas 91mm 30mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811848","EAP","HCPCS C1874","","Graft Evas 91mm 32mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27811949","EAP","HCPCS C1874","","Graft Evas 106mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812050","EAP","HCPCS C1874","","Graft Evas 106mm 26mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812151","EAP","HCPCS C1874","","Graft Evas 106mm 28mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812252","EAP","HCPCS C1874","","Graft Evas 106mm 30mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812353","EAP","HCPCS C1874","","Graft Evas 106mm 32mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812454","EAP","HCPCS C1874","","Graft Evas 121mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812555","EAP","HCPCS C1874","","Graft Evas 121mm 26mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812656","EAP","HCPCS C1874","","Graft Evas 121mm 28mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812757","EAP","HCPCS C1874","","Graft Evas 121mm 30mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812858","EAP","HCPCS C1874","","Graft Evas 121mm 32mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27812959","EAP","HCPCS C1874","","Graft Evas 84mm 34mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813060","EAP","HCPCS C1874","","Graft Evas 84mm 36mm 8.5mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813161","EAP","HCPCS C1874","","Graft Evas 99mm 34mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813262","EAP","HCPCS C1874","","Graft Evas 99mm 36mm 8.5mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813363","EAP","HCPCS C1874","","Graft Evas 114mm 34mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813464","EAP","HCPCS C1874","","Graft Evas 114mm 36mm 8.5mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813565","EAP","HCPCS C1874","","Graft Evas 129mm 34mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813666","EAP","HCPCS C1874","","Graft Evas 129mm 36mm 8.5mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813767","EAP","HCPCS C1874","","Graft Evas 94mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813868","EAP","HCPCS C1874","","Graft Evas 94mm 26mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27813969","EAP","HCPCS C1874","","Graft Evas 94mm 20fr Znth Aaa Vscr Fen Prox Bfur","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814070","EAP","HCPCS C1874","","Graft Evas 94mm 30mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814171","EAP","HCPCS C1874","","Graft Evas 94mm 32mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814272","EAP","HCPCS C1874","","Graft Evas 109mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814373","EAP","HCPCS C1874","","Graft Evas 109mm 26mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814474","EAP","HCPCS C1874","","Graft Evas 109mm 28mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814575","EAP","HCPCS C1874","","Graft Evas 109mm 30mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814676","EAP","HCPCS C1874","","Graft Evas 109mm 32mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814777","EAP","HCPCS C1874","","Graft Evas 124mm 24mm 7.7mm 20fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814878","EAP","HCPCS C1874","","Graft Evas 124mm 12fr Znth Aaa Vscr Fen Distal","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27814979","EAP","HCPCS C1874","","Graft Evas 124mm 2fr Znth Aaa Fenst Prox Body 28mm","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815080","EAP","HCPCS C1874","","Graft Evas 124mm 30mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815282","EAP","HCPCS C1874","","Graft Evas 107mm 34mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815383","EAP","HCPCS C1874","","Graft Evas 107mm 36mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815484","EAP","HCPCS C1874","","Graft Evas 122mm 34mm 20fr H L-b 1-shot Znth 2","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815585","EAP","HCPCS C1874","","Graft Evas 122mm 36mm 8.5mm 22fr Znth H&l-b 1-shot","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815686","EAP","HCPCS C1874","","Graft Evas 137mm 34mm H&l-b 1-shot Znth 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815787","EAP","HCPCS C1874","","Graft Evas 137mm 36mm Znth H&l-b 1-shot 2 Prox","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$5,158.80 ","$19,626.75 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"27815888","EAP","HCPCS C1874","","Graft Evas 109mm 20mm 7.7mm 20fr Znth Fenestrate 2","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$5,158.80 ","$6,616.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"27815889","EAP","HCPCS C1881","","Catheter Intvn Mic 2.7fr L130c","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$0.00 ","$0.00 ","$0.00 ","$583.90 ","$583.90 ","$0.00 ","$818.13 ","$0.00 ","$409.07 ","$647.96 ","$654.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815890","EAP","Custom 27815890","","Coil Embol L14cm Loop Od5mm 0.018in Platinum Hydrogel Polyme","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$0.00 ","$0.00 ","$0.00 ","$583.90 ","$583.90 ","$0.00 ","$818.13 ","$0.00 ","$409.07 ","$647.96 ","$654.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815891","EAP","Custom 27815891","","Coil Embol L20cm Od6mm 0.018in Hydrocoil Pushable Azur 18p","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$0.00 ","$0.00 ","$0.00 ","$583.90 ","$583.90 ","$0.00 ","$818.13 ","$0.00 ","$409.07 ","$647.96 ","$654.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815892","EAP","Custom 27815892","","Coil Embol L20cm Loop Od8mm 0.018in Platinum Hydrogel Polyme","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815893","EAP","Custom 27815893","","Coil Embol L14cm Loop Od6mm 0.035in Platinum Hydrogel Polyme","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815894","EAP","Custom 27815894","","Coil Embol L20cm Loop Od8mm 0.035in Platinum Hydrogel Polyme","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815895","EAP","Custom 27815895","","Coil Embol L20cm Loop Od10mm 0.035in Platinum Hydrogel Polym","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815896","EAP","Custom 27815896","","Coil Embol L20cm Loop Od15mm 0","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815897","EAP","Custom 27815897","","Coil Embol L20cm Loop Od16mm 0","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$0.00 ","$0.00 ","$0.00 ","$583.90 ","$583.90 ","$0.00 ","$818.13 ","$0.00 ","$409.07 ","$647.96 ","$654.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815898","EAP","Custom 27815898","","Coil Embl .018in 10mm 14cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$250.24 ","$250.24 ","$0.00 ","$350.63 ","$0.00 ","$175.32 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815899","EAP","Custom 27815899","","Coil Embl .018in 2mm 2cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$250.24 ","$250.24 ","$0.00 ","$350.63 ","$0.00 ","$175.32 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815900","EAP","Custom 27815900","","Coil Embl .018in 3mm 2cm Azur Hdrcl Psh Loop Pltn Ddrgl Peri","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$333.65 ","$333.65 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815901","EAP","Custom 27815901","","Coil Embl .018in 3mm 4cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$250.24 ","$250.24 ","$0.00 ","$350.63 ","$0.00 ","$175.32 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815902","EAP","Custom 27815902","","Coil Embl .018in 4mm 2cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$333.65 ","$333.65 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815903","EAP","Custom 27815903","","Coil Embl .018in 4mm 4cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$584.38 ","$432.44 ","$0.00 ","$584.38 ","$0.00 ","$0.00 ","$0.00 ","$417.07 ","$417.07 ","$0.00 ","$584.38 ","$0.00 ","$292.19 ","$462.83 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815904","EAP","Custom 27815904","","Coil Embl .018in 4mm 6cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$689.58 ","$510.29 ","$0.00 ","$689.58 ","$0.00 ","$0.00 ","$0.00 ","$492.15 ","$492.15 ","$0.00 ","$689.58 ","$0.00 ","$344.79 ","$546.15 ","$551.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815905","EAP","Custom 27815905","","Coil Embl .018in 4mm 6cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl","BOTH IP/OP","$701.25 ","$518.93 ","$0.00 ","$701.25 ","$0.00 ","$0.00 ","$0.00 ","$500.48 ","$500.48 ","$0.00 ","$701.25 ","$0.00 ","$350.63 ","$555.39 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815906","EAP","Custom 27815906","","Coil Embl .018in 5mm 10cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$333.65 ","$333.65 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815907","EAP","Custom 27815907","","Coil Embl .018in 5mm 4cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$584.38 ","$432.44 ","$0.00 ","$584.38 ","$0.00 ","$0.00 ","$0.00 ","$417.07 ","$417.07 ","$0.00 ","$584.38 ","$0.00 ","$292.19 ","$462.83 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815908","EAP","Custom 27815908","","Coil Embl .018in 5mm 6cm Azur Hdrcl Psh 18 Sys","BOTH IP/OP","$689.58 ","$510.29 ","$0.00 ","$689.58 ","$0.00 ","$0.00 ","$0.00 ","$492.15 ","$492.15 ","$0.00 ","$689.58 ","$0.00 ","$344.79 ","$546.15 ","$551.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815909","EAP","Custom 27815909","","Coil Embl .018in 5mm 6cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl","BOTH IP/OP","$701.25 ","$518.93 ","$0.00 ","$701.25 ","$0.00 ","$0.00 ","$0.00 ","$500.48 ","$500.48 ","$0.00 ","$701.25 ","$0.00 ","$350.63 ","$555.39 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815910","EAP","Custom 27815910","","Coil Embl .018in 6mm 10cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$0.00 ","$0.00 ","$0.00 ","$583.90 ","$583.90 ","$0.00 ","$818.13 ","$0.00 ","$409.07 ","$647.96 ","$654.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815911","EAP","Custom 27815911","","Coil Embl .018in 6mm 14cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$584.38 ","$432.44 ","$0.00 ","$584.38 ","$0.00 ","$0.00 ","$0.00 ","$417.07 ","$417.07 ","$0.00 ","$584.38 ","$0.00 ","$292.19 ","$462.83 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815912","EAP","Custom 27815912","","Coil Embl .018in 6mm 6cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$701.25 ","$518.93 ","$0.00 ","$701.25 ","$0.00 ","$0.00 ","$0.00 ","$500.48 ","$500.48 ","$0.00 ","$701.25 ","$0.00 ","$350.63 ","$555.39 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815913","EAP","Custom 27815913","","Coil Embl .018in 8mm 10cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$0.00 ","$0.00 ","$0.00 ","$583.90 ","$583.90 ","$0.00 ","$818.13 ","$0.00 ","$409.07 ","$647.96 ","$654.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815914","EAP","Custom 27815914","","Coil Embl .018in 8mm 14cm Azur Hdrcl Psh Peri 18 Sys","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815915","EAP","Custom 27815915","","Coil Embl .035in 10mm 14cm Azur Hdrcl Psh Peri 35 Sys","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815916","EAP","Custom 27815916","","Coil Embl .035in 15mm 14cm Azur Hdrcl Psh Loop Pltn Ddrgl","BOTH IP/OP","$572.70 ","$423.80 ","$0.00 ","$572.70 ","$0.00 ","$0.00 ","$0.00 ","$408.74 ","$408.74 ","$0.00 ","$572.70 ","$0.00 ","$286.35 ","$453.58 ","$458.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815917","EAP","Custom 27815917","","Coil Embl .035in 4mm 4cm Azur Hdrcl Psh Peri 35 Sys","BOTH IP/OP","$806.45 ","$596.77 ","$0.00 ","$806.45 ","$0.00 ","$0.00 ","$0.00 ","$575.56 ","$575.56 ","$0.00 ","$806.45 ","$0.00 ","$403.23 ","$638.71 ","$645.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815918","EAP","Custom 27815918","","Coil Embl .035in 5mm 10cm Azur Hdrcl Psh","BOTH IP/OP","$806.45 ","$596.77 ","$0.00 ","$806.45 ","$0.00 ","$0.00 ","$0.00 ","$575.56 ","$575.56 ","$0.00 ","$806.45 ","$0.00 ","$403.23 ","$638.71 ","$645.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815919","EAP","Custom 27815919","","Coil Embl .035in 6mm 10cm Azur Hdrcl Psh","BOTH IP/OP","$806.45 ","$596.77 ","$0.00 ","$806.45 ","$0.00 ","$0.00 ","$0.00 ","$575.56 ","$575.56 ","$0.00 ","$806.45 ","$0.00 ","$403.23 ","$638.71 ","$645.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815920","EAP","Custom 27815920","","Coil Embl .035in 8mm 10cm Azur Hdrcl Psh Peri 35 Sys","BOTH IP/OP","$923.33 ","$683.26 ","$0.00 ","$923.33 ","$0.00 ","$0.00 ","$0.00 ","$658.98 ","$658.98 ","$0.00 ","$923.33 ","$0.00 ","$461.67 ","$731.28 ","$738.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815922","EAP","Custom 27815922","","Coil Embol L20cm Od10mm 0.018in Hydrocoil Pushable Azur 18p","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$0.00 ","$0.00 ","$0.00 ","$553.12 ","$553.12 ","$0.00 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815923","EAP","HCPCS C1874","","Stent Endoprsth 29mm 7mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$6,725.00 ","$4,976.50 ","$0.00 ","$6,725.00 ","$3,026.25 ","$0.00 ","$1,401.66 ","$4,799.63 ","$4,799.63 ","$1,177.49 ","$6,725.00 ","$0.00 ","$3,362.50 ","$5,326.20 ","$5,380.00 ","$0.00 ","$1,052.46 ","$0.00 ","$1,070.62 ","$0.00 "
"27815924","EAP","HCPCS C1874","","Stent Endoprsth 29mm 8mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$6,725.00 ","$4,976.50 ","$0.00 ","$6,725.00 ","$3,026.25 ","$0.00 ","$1,401.66 ","$4,799.63 ","$4,799.63 ","$1,177.49 ","$6,725.00 ","$0.00 ","$3,362.50 ","$5,326.20 ","$5,380.00 ","$0.00 ","$1,052.46 ","$0.00 ","$1,070.62 ","$0.00 "
"27815925","EAP","HCPCS C1874","","Stent Endoprsth 29mm 11mm 16sq Mm 8fr Gore Vbhn","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"27815926","EAP","HCPCS C1874","","Stent Endoprsth 39mm 7mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"27815927","EAP","HCPCS C1874","","Stent Endoprsth 39mm 8mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"27815928","EAP","HCPCS c1874","","Stent Endoprsth 39mm 11mm 16sq Mm 8fr Gore Vbhn","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,808.09 ","$0.00 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815929","EAP","HCPCS C1874","","Stent Endoprsth 59mm 7mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"27815930","EAP","HCPCS C1874","","Stent Endoprsth 59mm 8mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"27815931","EAP","HCPCS C1874","","Stent Endoprsth 59mm 11mm 16sq Mm 8fr Gore Vbhn","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"27815932","EAP","","","Catheter Infus 18fr Trevo Pro Mic Nrvsc","BOTH IP/OP","$1,269.00 ","$939.06 ","$0.00 ","$1,269.00 ","$0.00 ","$0.00 ","$0.00 ","$905.69 ","$905.69 ","$0.00 ","$1,269.00 ","$0.00 ","$634.50 ","$1,005.05 ","$1,015.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815933","EAP","HCPCS C1874","","Stent Eprsth 8mm 7fr 10cm 120cm Vbhn Dlv Sys Hep Sprfc Fem","BOTH IP/OP","$8,738.00 ","$6,466.12 ","$0.00 ","$8,738.00 ","$3,932.10 ","$0.00 ","$1,821.22 ","$5,158.80 ","$6,236.31 ","$1,529.95 ","$8,738.00 ","$0.00 ","$4,369.00 ","$6,920.50 ","$6,990.40 ","$0.00 ","$1,367.50 ","$0.00 ","$1,391.09 ","$0.00 "
"27815934","EAP","","","Coil Embolization 4mm 12cm Complex Fill Trufill Dcs Orbit","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815935","EAP","HCPCS C1876","","Stent Cor .02in 2.5mm 19mm 140cm Tryton Rx Dlv Sys Radopq Sd","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27815936","EAP","HCPCS C1876","","Stent Cor .02in 2.5-3mm 19mm 140cm Tryton Rx Dlv Sys Radopq","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27815937","EAP","HCPCS C1876","","Stent Cor .02in 2.5-3.5mm 19mm 140cm Tryton Rx Dlv Sys","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27815939","EAP","HCPCS C1876","","Stent Cor .02in 3.5-4mm 15mm 140cm Tryton Rx Dlv Sys Radopq","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$927.81 ","$927.81 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"27815940","EAP","Custom 27815940","","Pin Half 5mm 4mm 300mm 50mm Tr","BOTH IP/OP","$256.00 ","$189.44 ","$0.00 ","$256.00 ","$0.00 ","$0.00 ","$0.00 ","$182.71 ","$182.71 ","$0.00 ","$256.00 ","$0.00 ","$128.00 ","$202.75 ","$204.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815941","EAP","HCPCS C1874","","System Cor Stnt 4.5mm 12mm 140cm Rslt Onyx Rx Dlv Sys Radopq","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27815942","EAP","Custom 27815942","","Coil Embl 3d 3mm 6cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815943","EAP","Custom 27815943","","Coil Embl 3d 3mm 8cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815944","EAP","Custom 27815944","","Coil Embl 3d 3mm 10cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815945","EAP","Custom 27815945","","Coil Embl 3d 3.5mm 6cm Axium Prm Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815946","EAP","Custom 27815946","","Coil Embl 3d 3.5mm 8cm Axium Frm Nrvsc V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815947","EAP","Custom 27815947","","Coil Embl 3d 3.5mm 10cm Axium Frm Nrvsc V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815948","EAP","Custom 27815948","","Coil Embl 3d 4mm 6cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815949","EAP","Custom 27815949","","Coil Embl 3d 4mm 8cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815950","EAP","Custom 27815950","","Coil Embl 3d 4mm 10cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815951","EAP","Custom 27815951","","Coil Embl 3d 4mm 12cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815952","EAP","Custom 27815952","","Coil Embl 3d 4mm 15cm Axium Frm Nrvsc V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815953","EAP","Custom 27815953","","Coil Embl 3d 5mm 8cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815954","EAP","Custom 27815954","","Coil Embl 3d 5mm 10cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815955","EAP","Custom 27815955","","Coil Embl 3d 5mm 15cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815956","EAP","Custom 27815956","","Coil Embl 3d 5mm 20cm Axium Frm Nrvsc V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815957","EAP","Custom 27815957","","Coil Embl 3d 6mm 10cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815958","EAP","Custom 27815958","","Coil Embl 3d 6mm 15cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815959","EAP","Custom 27815959","","Coil Embl 3d 6mm 20cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815960","EAP","Custom 27815960","","Coil Embl 3d 6mm 25cm Axium Frm Nrvsc V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815961","EAP","Custom 27815961","","Coil Embl 3d 7mm 12cm Axium Frm Nrvsc V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815962","EAP","Custom 27815962","","Coil Embl 3d 7mm 15cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815963","EAP","Custom 27815963","","Coil Embl 3d 7mm 20cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815964","EAP","Custom 27815964","","Coil Embl 3d 7mm 30cm Axium Frm V01","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815965","EAP","Custom 27815965","","Coil Embl 3d 8mm 15cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815966","EAP","Custom 27815966","","Coil Embl 3d 8mm 20cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815967","EAP","Custom 27815967","","Coil Embl 3d 8mm 30cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815968","EAP","Custom 27815968","","Coil Embl 3d 9mm 20cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815969","EAP","Custom 27815969","","Coil Embl 3d 9mm 30cm Axium Prm Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815970","EAP","Custom 27815970","","Coil Embl 3d 10mm 20cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815971","EAP","Custom 27815971","","Coil Embl 3d 10mm 30cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815972","EAP","Custom 27815972","","Coil Embl 3d 10mm 40cm Axium Frm Nrvsc V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815973","EAP","Custom 27815973","","Coil Embl 3d 12mm 30cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815974","EAP","Custom 27815974","","Coil Embl 3d 12mm 40cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815975","EAP","Custom 27815975","","Coil Embl 3d 12mm 50cm Axium Frm Nrvsc V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815976","EAP","Custom 27815976","","Coil Embl 3d 14mm 30cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815977","EAP","Custom 27815977","","Coil Embl 3d 14mm 40cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815978","EAP","Custom 27815978","","Coil Embl 3d 14mm 50cm Axium Frm Nrvsc V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815979","EAP","Custom 27815979","","Coil Embl 3d 16mm 40cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815980","EAP","Custom 27815980","","Coil Embl 3d 16mm 50cm Axium Frm Nrvsc V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815981","EAP","Custom 27815981","","Coil Embl 3d 18mm 40cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815982","EAP","Custom 27815982","","Coil Embl 3d 18mm 50cm Axium Frm Nrvsc V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815983","EAP","Custom 27815983","","Coil Embl 3d 20mm 50cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815984","EAP","Custom 27815984","","Coil Embl 3d 22mm 50cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815985","EAP","Custom 27815985","","Coil Embl 3d 25mm 50cm Axium Frm V01","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815986","EAP","HCPCS C1876","","Stent 4.5mm 30mm 5.0mm Neuroform Atlas","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$8,156.25 ","$0.00 ","$3,777.70 ","$5,158.80 ","$12,935.81 ","$3,173.54 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$2,836.56 ","$0.00 ","$2,885.50 ","$0.00 "
"27815987","EAP","HCPCS C1876","","Neuroform Atlas 4.5x21mm","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27815988","EAP","HCPCS C1876","","Neuroform Atlas 4.0x24mm","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27815989","EAP","HCPCS C1876","","Neuroform Atlas 4.0x21mm","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27815990","EAP","HCPCS C1876","","Neuroform Atlas 3.0x24mm","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27815991","EAP","HCPCS C1876","","Neuroform Atlas 3.0x21mm","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27815992","EAP","HCPCS C1876","","Neuroform Atlas 3.0x15mm","BOTH IP/OP","$17,038.00 ","$12,608.12 ","$0.00 ","$17,038.00 ","$7,667.10 ","$0.00 ","$3,551.15 ","$5,158.80 ","$12,160.02 ","$2,983.22 ","$17,038.00 ","$0.00 ","$8,519.00 ","$13,494.10 ","$13,630.40 ","$0.00 ","$2,666.45 ","$0.00 ","$2,712.45 ","$0.00 "
"27815993","EAP","HCPCS C1874","","Stent Trchbr 16mm 22fr 40mm 61cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27815994","EAP","HCPCS C1874","","Stent Trchbr 12mm 16fr 30mm 62cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27815995","EAP","HCPCS C1874","","Stent Trchbr 14mm 16fr 20mm 63cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27815996","EAP","HCPCS C1874","","Stent Trchbr 14mm 16fr 40mm 61cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27815997","EAP","HCPCS C1874","","Stent Trchbr 20mm 22fr 40mm 61cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27815998","EAP","HCPCS C1874","","Stent Trchbr 20mm 60mm Otw Flly Covered Aero","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27815999","EAP","HCPCS C1874","","Stent Trchbr 16mm 60mm Flly Covered Purse Stng Dir","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816000","EAP","HCPCS C1874","","Stent Trchbr 14mm 40mm Flly Covered Purse Stng Dir","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816001","EAP","Custom 27816001","","Sizer Surg Aerosizer Stent Msr Dev","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$267.64 ","$267.64 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816002","EAP","HCPCS C1874","","Stent Esph 16fr 18mm 67cm 70mm Full Cover Prox","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816003","EAP","HCPCS C1874","","Stent Esph 18mm 22fr 100cm Rem Covered Radiopq","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816004","EAP","HCPCS C1874","","Stent Esph 22fr 18mm 120cm Rem Covered Alimaxx-e","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816005","EAP","HCPCS C1874","","Stent Esph 22mm 22fr 70cm Rem Covered Radiopq","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816006","EAP","HCPCS C1874","","Stent Esph 22fr 100cm Sys Alimaxx-e Mtl","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816007","EAP","HCPCS C1874","","Stent Esph 22fr 120cm Slf Xpd Alimaxx-e Mtl Disp","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816008","EAP","HCPCS C1874","","Stent Esph 12mm 70cm Flly Covered Alimaxx-es","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816009","EAP","HCPCS C1874","","Stent Esph 22mm 100cm Pu Cover Antimigration Strut","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816010","EAP","HCPCS C1874","","Stent Esph 12mm 16fr 120mm 62cm Gmtr Flly Covered","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816011","EAP","HCPCS C1874","","Stent Esph 14mm 70cm Flly Covered Alimaxx-es","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816012","EAP","HCPCS C1874","","Stent Esph 14mm 16fr 100mm 64cm Flly Covered Smth","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816013","EAP","HCPCS C1874","","Stent Esph 14mm 16fr 62cm 120mm Flly Covered Gmtr","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816014","EAP","HCPCS C1874","","Stent Esph 16mm 70cm Gmtr Flly Covered Pu Cover","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816015","EAP","HCPCS C1874","","Stent Esph 16mm 16fr 100mm 64cm Flly Covered Smth","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816016","EAP","HCPCS C1874","","Stent Esph 16mm 62cm 120mm Flly Covered Gmtr Pu","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816017","EAP","HCPCS C1874","","Stent Trchbr 18mm 22fr 56mm Lp Otw Full Cover Flxb","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816018","EAP","HCPCS C1874","","Stent Trchbr 16mm 22fr 56mm Lp Otw Full Cover Flxb","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816019","EAP","HCPCS C1874","","Stent Trchbr 10mm 16fr 20mm 63cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816020","EAP","HCPCS C1874","","Stent Trchbr 10mm 16fr 40mm 61cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816021","EAP","HCPCS C1874","","Stent Trchbr 12mm 16fr 20mm 63cm Flly Cover","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816022","EAP","HCPCS C1874","","Stent Trchbr 14mm 16fr 30mm 62cm Gmtr Otw Flly","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816023","EAP","HCPCS C1874","","Stent Trch 20mm 80mm Flly Covered Aero","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816024","EAP","HCPCS C1874","","Stent Trchbr 18mm 40mm Flly Covered Dir Vis Sys","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816025","EAP","HCPCS C1874","","Stent Trchbr 18mm 60mm Flly Covered Dir Vis Sys","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816026","EAP","HCPCS C1874","","Stent Trchbr 18mm 80mm Flly Covered Dir Vsn Dlv","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816027","EAP","HCPCS C1874","","Stent Trchbr 16mm 30mm 40mm 39mm Otw Dir Vis Novel","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816028","EAP","HCPCS C1874","","Stent Trchbr 16mm 80mm Flly Covered Dir Vsn Dlv","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816029","EAP","HCPCS C1874","","Stent Trchbr 12mm 20mm Flly Covered Dir Vsn Dlv","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816030","EAP","HCPCS C1874","","Stent Trchbr 12mm 28fr 30mm 40cm Gmtr Lp Full","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816031","EAP","HCPCS C1874","","Stent Trchbr 28fr 12mm 40mm 39cm Gmtr Lp Full","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816032","EAP","HCPCS C1874","","Stent Trchbr 14mm 20mm Flly Covered Dir Vsn Dlv","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816033","EAP","HCPCS C1874","","Stent Trchbr 14mm 30mm Flly Covered Dir Vis Sys","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816034","EAP","HCPCS C1874","","Stent Trchbr 20mm 40mm Flly Covered Dir Vis Sys","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816036","EAP","HCPCS C1874","","Stent Trchbr 20mm 80mm Flly Covered Dir Vis Sys","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"27816037","EAP","HCPCS C1874","","Stent Esph 19mm 24mm 70mm Flly Covered","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816038","EAP","Custom 27816038","","Holder Tube 100mm Blue Tio Unq Oral Arwy Dsgn Cnv","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816039","EAP","Custom 27816039","","Block Bite Tio 110mm","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816040","EAP","Custom 27816040","","Holder Tube 90mm Ylw Tio Unq Oral Arwy Dsgn Cnv","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$14.27 ","$0.00 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816041","EAP","Custom 27816041","","Device Basixcompak 20ml Anlg Lmscnt Dspl Inflat","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$44.61 ","$44.61 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816042","EAP","HCPCS C1874","","Stent Esph 19mm 24fr 150mm 90cm Otw Flly Covered","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816043","EAP","HCPCS C1874","","Stent Esph 23mm 24fr 70mm 90cm 28mm Otw Flly Cover","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$4,103.78 ","$4,103.78 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"27816050","EAP","HCPCS C1876","","System Coron Stent 38mm 4.5mm Mtlnk Ul Xcelon","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816051","EAP","HCPCS C1876","","System Coron Stent 18mm 5mm Mtlnk Ul Xcelon Mcgld","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816052","EAP","HCPCS C1876","","System Coron Stent 38mm 5mm Mtlnk Ul Xcelon Mcgld","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816053","EAP","HCPCS C1876","","System Coron Stent 8mm 2.75mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816054","EAP","HCPCS C1876","","System Coron Stent 12mm 2.75mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816055","EAP","HCPCS C1876","","System Coron Stent 15mm 2.75mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816056","EAP","HCPCS C1876","","System Coron Stent 18mm 2.75mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816057","EAP","HCPCS C1876","","System Coron Stent 23mm 2.75mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816058","EAP","HCPCS C1876","","System Coron Stent 28mm 2.75mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816059","EAP","HCPCS C1876","","System Coron Stent 8mm 3mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816060","EAP","HCPCS C1876","","System Coron Stent 12mm 3mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816061","EAP","HCPCS C1876","","System Coron Stent 15mm 3mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816062","EAP","HCPCS C1876","","System Coron Stent 18mm 3mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816063","EAP","HCPCS C1876","","System Coron Stent 23mm 3mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816064","EAP","HCPCS C1876","","System Coron Stent 28mm 3mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816065","EAP","HCPCS C1876","","System Coron Stent 8mm 3.5mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816066","EAP","HCPCS C1876","","System Coron Stent 12mm 3.5mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816067","EAP","HCPCS C1876","","System Coron Stent 15mm 3.5mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816068","EAP","HCPCS C1876","","System Coron Stent 18mm 3.5mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816069","EAP","HCPCS C1876","","System Coron Stent 23mm 3.5mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816070","EAP","HCPCS C1876","","System Coron Stent 28mm 3.5mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816071","EAP","HCPCS C1876","","System Coron Stent 8mm 4mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816072","EAP","HCPCS C1876","","System Coron Stent 12mm 4mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816073","EAP","HCPCS C1876","","System Coron Stent 15mm 4mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816074","EAP","HCPCS C1876","","System Coron Stent 18mm 4mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816075","EAP","HCPCS C1876","","System Coron Stent 23mm 4mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816076","EAP","HCPCS C1876","","System Coron Stent 28mm 4mm Mtlnk Mvsn Cocr Otw","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"27816077","EAP","HCPCS C1874","","System Coron Stent 38mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816078","EAP","HCPCS C1874","","System Coron Stent 33mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816079","EAP","HCPCS C1874","","System Coron Stent 28mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816080","EAP","HCPCS C1874","","System Coron Stent 23mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816081","EAP","HCPCS C1874","","System Coron Stent 18mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816082","EAP","HCPCS C1874","","System Coron Stent 15mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816083","EAP","HCPCS C1874","","System Coron Stent 12mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816084","EAP","HCPCS C1874","","System Coron Stent 8mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816085","EAP","HCPCS C1874","","System Coron Stent 38mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816086","EAP","HCPCS C1874","","System Coron Stent 33mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816087","EAP","HCPCS C1874","","System Coron Stent 28mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816088","EAP","HCPCS C1874","","System Coron Stent 23mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816089","EAP","HCPCS C1874","","System Coron Stent 18mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816090","EAP","HCPCS C1874","","System Coron Stent 15mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816091","EAP","HCPCS C1874","","System Coron Stent 12mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816092","EAP","HCPCS C1874","","System Coron Stent 8mm 3.5mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816093","EAP","HCPCS C1874","","System Coron Stent 38mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816094","EAP","HCPCS C1874","","System Coron Stent 33mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816095","EAP","HCPCS C1874","","System Coron Stent 28mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816096","EAP","HCPCS C1874","","System Coron Stent 23mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816097","EAP","HCPCS C1874","","System Coron Stent 18mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816098","EAP","HCPCS C1874","","System Coron Stent 15mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816099","EAP","HCPCS C1874","","System Coron Stent 12mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816100","EAP","HCPCS C1874","","System Coron Stent 8mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816101","EAP","HCPCS C1874","","System Coron Stent 38mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816102","EAP","HCPCS C1874","","System Coron Stent 33mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816103","EAP","HCPCS C1874","","System Coron Stent 28mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816104","EAP","HCPCS C1874","","System Coron Stent 23mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816105","EAP","HCPCS C1874","","System Coron Stent 18mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816106","EAP","HCPCS C1874","","System Coron Stent 15mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816107","EAP","HCPCS C1874","","System Coron Stent 12mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816108","EAP","HCPCS C1874","","System Coron Stent 8mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816109","EAP","HCPCS C1874","","System Coron Stent 38mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816110","EAP","HCPCS C1874","","System Coron Stent 33mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816111","EAP","HCPCS C1874","","System Coron Stent 28mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816112","EAP","HCPCS C1874","","System Coron Stent 23mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816113","EAP","HCPCS C1874","","System Coron Stent 18mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816114","EAP","HCPCS C1874","","System Coron Stent 15mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816115","EAP","HCPCS C1874","","System Coron Stent 12mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816116","EAP","HCPCS C1874","","System Coron Stent 8mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816117","EAP","HCPCS C1874","","System Coron Stent 38mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816118","EAP","HCPCS C1874","","System Coron Stent 33mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816119","EAP","HCPCS C1874","","System Coron Stent 28mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816120","EAP","HCPCS C1874","","System Coron Stent 23mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816121","EAP","HCPCS C1874","","System Coron Stent 18mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816122","EAP","HCPCS C1874","","System Coron Stent 15mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816123","EAP","HCPCS C1874","","System Coron Stent 8mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816124","EAP","HCPCS C1874","","System Coron Stent 15mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816125","EAP","HCPCS C1874","","System Coron Stent 23mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816126","EAP","HCPCS C1874","","System Coron Stent 28mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816127","EAP","HCPCS C1874","","System Coron Stent 33mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816128","EAP","HCPCS C1874","","System Coron Stent 8mm 2.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816129","EAP","HCPCS C1874","","System Coron Stent 12mm 2.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816130","EAP","HCPCS C1874","","System Coron Stent 15mm 2.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816131","EAP","HCPCS C1874","","System Coron Stent 18mm 2.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816132","EAP","HCPCS C1874","","System Coron Stent 23mm 2.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816133","EAP","HCPCS C1874","","System Coron Stent 28mm 2.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816134","EAP","HCPCS C1874","","System Coron Stent 8mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816135","EAP","HCPCS C1874","","System Coron Stent 12mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816136","EAP","HCPCS C1874","","System Coron Stent 15mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816137","EAP","HCPCS C1874","","System Coron Stent 18mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816138","EAP","HCPCS C1874","","System Coron Stent 23mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816139","EAP","HCPCS C1874","","System Coron Stent 28mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816140","EAP","HCPCS C1874","","System Coron Stent 33mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816141","EAP","HCPCS C1874","","System Coron Stent 38mm 2.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816142","EAP","HCPCS C1874","","System Coron Stent 8mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816143","EAP","HCPCS C1874","","System Coron Stent 12mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816144","EAP","HCPCS C1874","","System Coron Stent 15mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816145","EAP","HCPCS C1874","","System Coron Stent 18mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816146","EAP","HCPCS C1874","","System Coron Stent 23mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816147","EAP","HCPCS C1874","","System Coron Stent 28mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816148","EAP","HCPCS C1874","","System Coron Stent 33mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816149","EAP","HCPCS C1874","","System Coron Stent 38mm 2.75mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816150","EAP","HCPCS C1874","","System Coron Stent 8mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816151","EAP","HCPCS C1874","","System Coron Stent 12mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816152","EAP","HCPCS C1874","","System Coron Stent 15mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816153","EAP","HCPCS C1874","","System Coron Stent 18mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816154","EAP","HCPCS C1874","","System Coron Stent 23mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816155","EAP","HCPCS C1874","","System Coron Stent 28mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816156","EAP","HCPCS C1874","","System Coron Stent 33mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816157","EAP","HCPCS C1874","","System Coron Stent 38mm 3mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816158","EAP","HCPCS C1874","","System Coron Stent 8mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816159","EAP","HCPCS C1874","","System Coron Stent 12mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816160","EAP","HCPCS C1874","","System Coron Stent 15mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816161","EAP","HCPCS C1874","","System Coron Stent 18mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816162","EAP","HCPCS C1874","","System Coron Stent 23mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816163","EAP","HCPCS C1874","","System Coron Stent 28mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816164","EAP","HCPCS C1874","","System Coron Stent 33mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816165","EAP","HCPCS C1874","","System Coron Stent 38mm 3.25mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816166","EAP","HCPCS C1874","","System Coron Stent 8mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816167","EAP","HCPCS C1874","","System Coron Stent 12mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816168","EAP","HCPCS C1874","","System Coron Stent 15mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816169","EAP","HCPCS C1874","","System Coron Stent 18mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816170","EAP","HCPCS C1874","","System Coron Stent 23mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816171","EAP","HCPCS C1874","","System Coron Stent 28mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816172","EAP","HCPCS C1874","","System Coron Stent 33mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816173","EAP","HCPCS C1874","","System Coron Stent 38mm 3.5mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816174","EAP","HCPCS C1874","","System Coron Stent 8mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816175","EAP","HCPCS C1874","","System Coron Stent 12mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816176","EAP","HCPCS C1874","","System Coron Stent 15mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816177","EAP","HCPCS C1874","","System Coron Stent 18mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816178","EAP","HCPCS C1874","","System Coron Stent 23mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816179","EAP","HCPCS C1874","","System Coron Stent 28mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816180","EAP","HCPCS C1874","","System Coron Stent 33mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816181","EAP","HCPCS C1874","","System Coron Stent 38mm 4mm Xience Alpine","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816182","EAP","HCPCS C1874","","System Coron Stent 12mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816183","EAP","HCPCS C1874","","System Coron Stent 8mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816184","EAP","HCPCS C1874","","System Coron Stent 12mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816185","EAP","HCPCS C1874","","System Coron Stent 15mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816186","EAP","HCPCS C1874","","System Coron Stent 18mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"27816187","EAP","","","Coil Embolization 360d 5mm 15cm Detachable Soft Target","BOTH IP/OP","$4,539.00 ","$3,358.86 ","$0.00 ","$4,539.00 ","$0.00 ","$0.00 ","$0.00 ","$3,239.48 ","$3,239.48 ","$0.00 ","$4,539.00 ","$0.00 ","$2,269.50 ","$3,594.89 ","$3,631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816188","EAP","","","Coil Embolization Standard Large 22mm 50cm Detachable Smooth","BOTH IP/OP","$5,904.00 ","$4,368.96 ","$0.00 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$4,213.68 ","$4,213.68 ","$0.00 ","$5,904.00 ","$0.00 ","$2,952.00 ","$4,675.97 ","$4,723.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816190","EAP","","","Coil Embl .02in Cmplx 4mm 10cm The Penumbra Coil 400 Xsft","BOTH IP/OP","$6,900.00 ","$5,106.00 ","$0.00 ","$6,900.00 ","$0.00 ","$0.00 ","$0.00 ","$4,924.53 ","$4,924.53 ","$0.00 ","$6,900.00 ","$0.00 ","$3,450.00 ","$5,464.80 ","$5,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816191","EAP","","","Coil Embl .02in Cmplx 4mm 8cm The Penumbra Coil 400 Sft","BOTH IP/OP","$6,075.00 ","$4,495.50 ","$0.00 ","$6,075.00 ","$0.00 ","$0.00 ","$0.00 ","$4,335.73 ","$4,335.73 ","$0.00 ","$6,075.00 ","$0.00 ","$3,037.50 ","$4,811.40 ","$4,860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816192","EAP","","","Coil Embl Crv 4mm 10cm The Penumbra Coil 400 Xsft","BOTH IP/OP","$6,513.00 ","$4,819.62 ","$0.00 ","$6,513.00 ","$0.00 ","$0.00 ","$0.00 ","$4,648.33 ","$4,648.33 ","$0.00 ","$6,513.00 ","$0.00 ","$3,256.50 ","$5,158.30 ","$5,210.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816193","EAP","","","Coil Embolization Curve 4mm 8cm Xsoft The Penumbra Coil 400","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$0.00 ","$0.00 ","$0.00 ","$4,371.41 ","$4,371.41 ","$0.00 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816194","EAP","","","Coil Embolization 10cm J Soft Fill Coil 400 Nitinol","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$0.00 ","$0.00 ","$0.00 ","$4,496.31 ","$4,496.31 ","$0.00 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816195","EAP","","","Coil Embolization 15cm J Coil 400","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$4,674.74 ","$4,674.74 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816196","EAP","Custom 27816196","","Graft Evas 26mm 22-23mm 3.3cm Aorta","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816197","EAP","Custom 27816197","","Graft Evas 28.5mm 24-26mm 3.3cm Aorta","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816198","EAP","Custom 27816198","","Graft Evas 32mm 27-29mm 4.5cm Xcldr Stnt Xtd Abrsn Rst","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816199","EAP","Custom 27816199","","Graft Evas 36mm 30-32mm 4.5cm Xcldr Sinusoidal Stnt Sl Cuf","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816200","EAP","Custom 27816200","","Graft Evas 12mm 10cm Gore Xcldr Cntrlt Lg","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816201","EAP","Custom 27816201","","Graft Evas 12mm 12cm Gore Xcldr Cntrlt Lg","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816202","EAP","Custom 27816202","","Graft Evas 12mm 14cm Gore Xcldr Cntrlt Lg","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816203","EAP","Custom 27816203","","Graft Evas 14.5mm 10cm Gore Xcldr Cntrlt Lg","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816204","EAP","Custom 27816204","","Graft Evas 14.5mm 12cm Gore Xcldr Cntrlt Lg","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816205","EAP","Custom 27816205","","Graft Evas 14.5mm 12-13.5mm 14cm Gore Xcldr Cntrlt Lg Aaa","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816206","EAP","Custom 27816206","","Graft Evas 16mm 13.5-14.5mm 11.5cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816207","EAP","Custom 27816207","","Graft Evas 16mm 13.5-14.5mm 13.5cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816208","EAP","Custom 27816208","","Graft Evas 18mm 14.5-16.5mm 9.5cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816209","EAP","Custom 27816209","","Graft Evas 18mm 14.5-16.5mm 11.5cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816210","EAP","Custom 27816210","","Graft Evas 18mm 14.5-16.5mm 13.5cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816211","EAP","Custom 27816211","","Graft Evas 20mm 16.5-18.5mm 9.5cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816212","EAP","Custom 27816212","","Graft Evas 20mm 16.5-18.5mm 13.5cm Grtx Xcldr Sinusoidal","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816213","EAP","Custom 27816213","","Graft Evas 23mm 18.5-21.5mm 12cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816214","EAP","Custom 27816214","","Graft Evas 23mm 18.5-21.5mm 14cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816215","EAP","Custom 27816215","","Graft Evas 27mm 21.5-25mm 10cm Grtx Xcldr Sinusoidal Stnt Sl","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816216","EAP","Custom 27816216","","Graft Evas 27mm 21.5-25mm 12cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816217","EAP","Custom 27816217","","Graft Evas 27mm 21.5-25mm 14cm Xcldr Stnt Abrsn Rst","BOTH IP/OP","$11,558.00 ","$8,552.92 ","$0.00 ","$11,558.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$8,248.94 ","$0.00 ","$11,558.00 ","$0.00 ","$5,779.00 ","$9,153.94 ","$9,246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816218","EAP","Custom 27816218","","Graft Stnt 10mm 7cm Gore Xcldr Xtd Ilc Aaa","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816219","EAP","Custom 27816219","","Graft Evas 12mm 7cm Xcldr Stnt Xtd Sl Cuf Ntnl Eptfe Ilc Aaa","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816220","EAP","Custom 27816220","","Graft Evas 14.5mm 12-13.5mm 7cm Gore Xcldr Xtd Ilc Art Acpt","BOTH IP/OP","$8,135.00 ","$6,019.90 ","$0.00 ","$8,135.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,805.95 ","$0.00 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816221","EAP","Custom 27816221","","Graft Evas 23mm 12mm 19-21mm 10-11mm 12cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816222","EAP","Custom 27816222","","Graft Evas 23mm 12mm 19-21mm 10-11mm 14cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816223","EAP","Custom 27816223","","Graft Evas 23mm 12mm 19-21mm 10-11mm 16cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816224","EAP","Custom 27816224","","Graft Evas 23mm 12mm 19-21mm 10-11mm 18cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816225","EAP","Custom 27816225","","Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 12cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816226","EAP","Custom 27816226","","Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 14cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816227","EAP","Custom 27816227","","Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 16cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816228","EAP","Custom 27816228","","Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 18cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816229","EAP","Custom 27816229","","Graft Evas 26mm 12mm 22-23mm 10-11mm 12cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816230","EAP","Custom 27816230","","Graft Evas 26mm 12mm 22-23mm 10-11mm 14cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816231","EAP","Custom 27816231","","Graft Evas 26mm 12mm 22-23mm 10-11mm 16cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816232","EAP","Custom 27816232","","Graft Evas 26mm 12mm 22-23mm 10-11mm 18cm Gore Xcldr C3 Bond","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816233","EAP","Custom 27816233","","Graft Evas 26mm 14.5mm 22-23mm 12-13.5mm 12cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816234","EAP","Custom 27816234","","Graft Evas 26mm 14.5mm 14cm Gore Xcldr C3 Trnkipsl Lg Aaa","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816235","EAP","Custom 27816235","","Graft Evas 26mm 14.5mm 16cm Gore Xcldr C3 Trnkipsl Lg Aaa","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816236","EAP","Custom 27816236","","Graft Evas 26mm 14.5mm 22-23mm 12-13.5mm 18cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816237","EAP","Custom 27816237","","Graft Evas 28.5mm 12mm 24-26mm 10-11mm 12cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816238","EAP","Custom 27816238","","Graft Evas 28.5mm 12mm 24-26mm 10-11mm 14cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816239","EAP","Custom 27816239","","Graft Evas 28.5mm 12mm 24-26mm 10-11mm 16cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816240","EAP","Custom 27816240","","Graft Evas 28.5mm 12mm 24-26mm 10-11mm 18cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816241","EAP","Custom 27816241","","Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 14cm Gore Xcldr C","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816242","EAP","Custom 27816242","","Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 16cm Gore Xcldr C","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816243","EAP","Custom 27816243","","Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 18cm Gore Xcldr C","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816244","EAP","Custom 27816244","","Graft Evas 31mm 14.5mm 13cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816245","EAP","Custom 27816245","","Graft Evas 31mm 14.5mm 15cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816246","EAP","Custom 27816246","","Graft Evas 31mm 14.5mm 17cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816247","EAP","Custom 27816247","","Graft Evas 35mm 14.5mm 30-32mm 12-13.5mm 14cm Strl Gore","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816248","EAP","Custom 27816248","","Graft Evas 35mm 14.5mm 16cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816249","EAP","Custom 27816249","","Graft Evas 35mm 14.5mm 30-32mm 12-13.5mm 18cm Gore Xcldr C3","BOTH IP/OP","$28,188.00 ","$20,859.12 ","$0.00 ","$28,188.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$20,117.78 ","$0.00 ","$28,188.00 ","$0.00 ","$14,094.00 ","$22,324.90 ","$22,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816250","EAP","HCPCS C1752","","Catheter Hmdial 20cm Schn Xl Kink Rst Tip Clip Sh Rem Sty","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$0.00 ","$0.00 ","$0.00 ","$84.93 ","$84.93 ","$0.00 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816251","EAP","HCPCS C1876","","Stent Intrcran T 2.7-3.5mm 8mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816252","EAP","HCPCS C1876","","Stent Intrcran T 3.5-4.5mm 8mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816253","EAP","HCPCS C1876","","Stent Intrcran T 2.7-3.5mm 10mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816254","EAP","HCPCS C1876","","Stent Intrcran Y 2.7-3.5mm 8mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816255","EAP","HCPCS C1876","","Stent Intrcran Y 3.5-4.5mm 8mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816256","EAP","HCPCS C1876","","Stent Intrcran Y 2.7-3.5mm 10mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816257","EAP","HCPCS C1876","","Stent Intrcran Y 3.5-4.5mm 10mm Pulserider Arch","BOTH IP/OP","$31,250.00 ","$23,125.00 ","$0.00 ","$31,250.00 ","$14,062.50 ","$0.00 ","$6,513.28 ","$5,158.80 ","$22,303.13 ","$5,471.63 ","$31,250.00 ","$0.00 ","$15,625.00 ","$24,750.00 ","$25,000.00 ","$0.00 ","$4,890.63 ","$0.00 ","$4,975.00 ","$0.00 "
"27816259","EAP","HCPCS C1874","","System Cor Stnt 4.5mm 15mm 140cm Rslt Onyx Rx Dlv Sys Radopq","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816260","EAP","HCPCS C1874","","System Cor Stnt 4.5mm 18mm 140cm Rslt Onyx Rx Dlv Sys Radopq","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816261","EAP","HCPCS C1874","","System Cor Stnt 4.5mm 22mm 140cm Rslt Onyx Rx Dlv Sys Radopq","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816262","EAP","HCPCS C1874","","System Cor Stnt 4.5mm 26mm 140cm Rslt Onyx Rx Dlv Sys Radopq","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816263","EAP","HCPCS C1874","","System Cor Stnt 4.5mm 30mm 140cm Rslt Onyx Rx Dlv Sys Radopq","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816264","EAP","HCPCS C1874","","System Cor Stnt 5mm 12mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816265","EAP","HCPCS C1874","","System Cor Stnt 5mm 15mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816266","EAP","HCPCS C1874","","System Cor Stnt 5mm 18mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816267","EAP","HCPCS C1874","","System Cor Stnt 5mm 22mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816268","EAP","HCPCS C1874","","System Cor Stnt 5mm 26mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816269","EAP","HCPCS C1874","","System Cor Stnt 5mm 30mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"27816270","EAP","HCPCS C1757","","Catheter Thrmb .044in 140cm Strl Lf Indg Sys Asp Kt Cor","BOTH IP/OP","$4,850.00 ","$3,589.00 ","$0.00 ","$4,850.00 ","$2,182.50 ","$0.00 ","$1,010.86 ","$3,461.45 ","$3,461.45 ","$0.00 ","$4,850.00 ","$0.00 ","$2,425.00 ","$3,841.20 ","$3,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816279","EAP","HCPCS C1874","","Stent Eprsth 8mm 10cm Strl 120cm Vbhn Flxb Slf Xpd Radopq","BOTH IP/OP","$9,160.00 ","$6,778.40 ","$0.00 ","$9,160.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$6,537.49 ","$1,603.84 ","$9,160.00 ","$0.00 ","$4,580.00 ","$7,254.72 ","$7,328.00 ","$0.00 ","$1,433.54 ","$0.00 ","$1,458.27 ","$0.00 "
"27816280","EAP","Custom 27816280","","Stent Eprsth 21mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816281","EAP","Custom 27816281","","Stent Eprsth 21-26mm 10cm Strl Gore Tag Cnfrm Flxb Radopq","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816282","EAP","Custom 27816282","","Stent Eprsth 26mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816283","EAP","Custom 27816283","","Stent Eprsth 28mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816284","EAP","Custom 27816284","","Stent Eprsth 28mm 15cm Strl Gore Tag Flxb Radopq Ntnl Fep","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816285","EAP","Custom 27816285","","Stent Eprsth 26-31mm 10cm Strl Gore Tag Cnfrm Flxb Radopq","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816286","EAP","Custom 27816286","","Stent Eprsth 31mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816287","EAP","Custom 27816287","","Stent Eprsth 31mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816288","EAP","Custom 27816288","","Stent Eprsth 34mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816289","EAP","Custom 27816289","","Stent Eprsth 34mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816290","EAP","Custom 27816290","","Stent Eprsth 34mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816291","EAP","Custom 27816291","","Stent Eprsth 37mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816292","EAP","Custom 27816292","","Stent Eprsth 37mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816293","EAP","Custom 27816293","","Stent Eprsth 37mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816294","EAP","Custom 27816294","","Stent Eprsth 40mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816295","EAP","Custom 27816295","","Stent Eprsth 40mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816296","EAP","Custom 27816296","","Stent Eprsth 40mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816297","EAP","Custom 27816297","","Stent Eprsth 45mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816298","EAP","Custom 27816298","","Stent Eprsth 45mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816299","EAP","Custom 27816299","","Stent Eprsth 45mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe","BOTH IP/OP","$41,640.00 ","$30,813.60 ","$0.00 ","$41,640.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$29,718.47 ","$0.00 ","$41,640.00 ","$0.00 ","$20,820.00 ","$32,978.88 ","$33,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816300","EAP","","","Plug Ocl 3mm 12x5.3mm Mvp Mech Dtch Full Resheathable Ntnl","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816301","EAP","","","Plug Ocl 5mm 12x6.5mm Strl Lf Mvp Mech Dtch Full","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816302","EAP","","","Plug Ocl Mic 7mm Strl Lf Mvp Mech Vasc Disp V03","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816303","EAP","","","Plug Ocl 9mm Strl Lf Mvp V03","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816304","EAP","Custom 27816304","","Graft Evas 10mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa","BOTH IP/OP","$27,548.00 ","$20,385.52 ","$0.00 ","$27,548.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$19,661.01 ","$0.00 ","$27,548.00 ","$0.00 ","$13,774.00 ","$21,818.02 ","$22,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816305","EAP","Custom 27816305","","Graft Evas 12mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa","BOTH IP/OP","$27,548.00 ","$20,385.52 ","$0.00 ","$27,548.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$19,661.01 ","$0.00 ","$27,548.00 ","$0.00 ","$13,774.00 ","$21,818.02 ","$22,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816306","EAP","Custom 27816306","","Graft Evas 14.5mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa","BOTH IP/OP","$27,548.00 ","$20,385.52 ","$0.00 ","$27,548.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$19,661.01 ","$0.00 ","$27,548.00 ","$0.00 ","$13,774.00 ","$21,818.02 ","$22,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816307","EAP","Custom 27816307","","Graft Evas 14.5mm 7cm Gore Xcldr Intnl Cmpnt Ilc Aaa","BOTH IP/OP","$7,688.00 ","$5,689.12 ","$0.00 ","$7,688.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,486.93 ","$0.00 ","$7,688.00 ","$0.00 ","$3,844.00 ","$6,088.90 ","$6,150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816308","EAP","HCPCS C1783","","Stent Opth 50um 230um 80um 360um Strl Istent Inj 2 Preld 1","BOTH IP/OP","$3,688.00 ","$2,729.12 ","$0.00 ","$3,688.00 ","$1,659.60 ","$0.00 ","$768.67 ","$2,632.13 ","$2,632.13 ","$645.74 ","$3,688.00 ","$0.00 ","$1,844.00 ","$2,920.90 ","$2,950.40 ","$0.00 ","$577.17 ","$0.00 ","$587.13 ","$0.00 "
"27816309","EAP","HCPCS C1874","","Axios Stent And Electrocautery 15x10","BOTH IP/OP","$11,625.00 ","$8,602.50 ","$0.00 ","$11,625.00 ","$5,231.25 ","$0.00 ","$2,422.94 ","$5,158.80 ","$8,296.76 ","$2,035.44 ","$11,625.00 ","$0.00 ","$5,812.50 ","$9,207.00 ","$9,300.00 ","$0.00 ","$1,819.31 ","$0.00 ","$1,850.70 ","$0.00 "
"27816310","EAP","HCPCS C1874","","Wallflex Biliary Stent","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$3,032.10 ","$0.00 ","$1,404.37 ","$4,808.91 ","$4,808.91 ","$1,179.77 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$1,054.50 ","$0.00 ","$1,072.69 ","$0.00 "
"27816311","EAP","HCPCS C1768","","Envelope Tiss 5x5.4cm Cormatrix Cangaroo Sm Sft","BOTH IP/OP","$12,063.00 ","$8,926.62 ","$0.00 ","$12,063.00 ","$5,428.35 ","$0.00 ","$2,514.23 ","$5,158.80 ","$8,609.36 ","$2,112.13 ","$12,063.00 ","$0.00 ","$6,031.50 ","$9,553.90 ","$9,650.40 ","$0.00 ","$1,887.86 ","$0.00 ","$1,920.43 ","$0.00 "
"27816312","EAP","HCPCS C1768","","Envelope Tiss 6.9x6.5cm Cormatrix Cangaroo Med Sft","BOTH IP/OP","$12,063.00 ","$8,926.62 ","$0.00 ","$12,063.00 ","$5,428.35 ","$0.00 ","$2,514.23 ","$5,158.80 ","$8,609.36 ","$2,112.13 ","$12,063.00 ","$0.00 ","$6,031.50 ","$9,553.90 ","$9,650.40 ","$0.00 ","$1,887.86 ","$0.00 ","$1,920.43 ","$0.00 "
"27816313","EAP","HCPCS C1768","","Envelope Tiss 8x6.9cm Cormatrix Cangaroo Lg Sft","BOTH IP/OP","$12,063.00 ","$8,926.62 ","$0.00 ","$12,063.00 ","$5,428.35 ","$0.00 ","$2,514.23 ","$5,158.80 ","$8,609.36 ","$2,112.13 ","$12,063.00 ","$0.00 ","$6,031.50 ","$9,553.90 ","$9,650.40 ","$0.00 ","$1,887.86 ","$0.00 ","$1,920.43 ","$0.00 "
"27816314","EAP","HCPCS C1768","","Envelope Tiss 9.5x6.9cm Cormatrix Cangaroo Xl Sft","BOTH IP/OP","$12,063.00 ","$8,926.62 ","$0.00 ","$12,063.00 ","$5,428.35 ","$0.00 ","$2,514.23 ","$5,158.80 ","$8,609.36 ","$2,112.13 ","$12,063.00 ","$0.00 ","$6,031.50 ","$9,553.90 ","$9,650.40 ","$0.00 ","$1,887.86 ","$0.00 ","$1,920.43 ","$0.00 "
"27816315","EAP","HCPCS C1768","","Envelope Tiss 10.8x8.9cm Cangaroo 2xl Sft Reinf","BOTH IP/OP","$16,563.00 ","$12,256.62 ","$0.00 ","$16,563.00 ","$7,453.35 ","$0.00 ","$3,452.14 ","$5,158.80 ","$11,821.01 ","$2,900.05 ","$16,563.00 ","$0.00 ","$8,281.50 ","$13,117.90 ","$13,250.40 ","$0.00 ","$2,592.11 ","$0.00 ","$2,636.83 ","$0.00 "
"27816316","EAP","HCPCS C1874","","Stent Endoprsth 2.5cm 5mm Hep Ntnl Eptfe Vbhn 120","BOTH IP/OP","$8,808.00 ","$6,517.92 ","$0.00 ","$8,808.00 ","$3,963.60 ","$0.00 ","$1,835.81 ","$5,158.80 ","$6,286.27 ","$1,542.21 ","$8,808.00 ","$0.00 ","$4,404.00 ","$6,975.94 ","$7,046.40 ","$0.00 ","$1,378.45 ","$0.00 ","$1,402.23 ","$0.00 "
"27816317","EAP","HCPCS C1874","","Stent Endoprsth 2.5cm 6mm Hep Ntnl Eptfe Vbhn 120","BOTH IP/OP","$8,808.00 ","$6,517.92 ","$0.00 ","$8,808.00 ","$3,963.60 ","$0.00 ","$1,835.81 ","$5,158.80 ","$6,286.27 ","$1,542.21 ","$8,808.00 ","$0.00 ","$4,404.00 ","$6,975.94 ","$7,046.40 ","$0.00 ","$1,378.45 ","$0.00 ","$1,402.23 ","$0.00 "
"27816318","EAP","HCPCS C1874","","Stent Endoprsth 2.5cm 8mm Hep Ntnl Eptfe Vbhn 120","BOTH IP/OP","$8,808.00 ","$6,517.92 ","$0.00 ","$8,808.00 ","$3,963.60 ","$0.00 ","$1,835.81 ","$5,158.80 ","$6,286.27 ","$1,542.21 ","$8,808.00 ","$0.00 ","$4,404.00 ","$6,975.94 ","$7,046.40 ","$0.00 ","$1,378.45 ","$0.00 ","$1,402.23 ","$0.00 "
"27816320","EAP","HCPCS C1874","","System Coron Stent 8mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816321","EAP","HCPCS C1874","","System Coron Stent 12mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816322","EAP","HCPCS C1874","","System Coron Stent 15mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816323","EAP","HCPCS C1874","","System Coron Stent 17mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816324","EAP","HCPCS C1874","","System Coron Stent 20mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816325","EAP","HCPCS C1874","","System Coron Stent 24mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816326","EAP","HCPCS C1874","","System Coron Stent 28mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816327","EAP","HCPCS C1874","","System Coron Stent 33mm 2.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816328","EAP","HCPCS C1874","","System Coron Stent 8mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816329","EAP","HCPCS C1874","","System Coron Stent 12mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816330","EAP","HCPCS C1874","","System Coron Stent 15mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816331","EAP","HCPCS C1874","","System Coron Stent 17mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816332","EAP","HCPCS C1874","","System Coron Stent 20mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816333","EAP","HCPCS C1874","","Stent Coron 24mm 2.75mm Carbosil 20 55d","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816334","EAP","HCPCS C1874","","System Coron Stent 28mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816335","EAP","HCPCS C1874","","System Coron Stent 33mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816336","EAP","HCPCS C1874","","System Coron Stent 38mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816337","EAP","HCPCS C1874","","System Coron Stent 44mm 2.75mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816338","EAP","HCPCS C1874","","System Coron Stent 8mm 3mm Elunir Thk90um Carbosil","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816339","EAP","HCPCS C1874","","System Coron Stent 12mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816340","EAP","HCPCS C1874","","System Coron Stent 15mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816341","EAP","HCPCS C1874","","System Coron Stent 17mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816342","EAP","HCPCS C1874","","System Coron Stent 20mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816343","EAP","HCPCS C1874","","System Coron Stent 24mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816344","EAP","HCPCS C1874","","System Coron Stent 28mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816345","EAP","HCPCS C1874","","System Coron Stent 33mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816346","EAP","HCPCS C1874","","System Coron Stent 38mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816347","EAP","HCPCS C1874","","System Coron Stent 44mm 3mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816348","EAP","HCPCS C1874","","System Coron Stent 8mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816349","EAP","HCPCS C1874","","System Coron Stent 12mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816350","EAP","HCPCS C1874","","System Coron Stent 15mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816351","EAP","HCPCS C1874","","System Coron Stent 17mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816352","EAP","HCPCS C1874","","System Coron Stent 20mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816353","EAP","HCPCS C1874","","System Coron Stent 24mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816354","EAP","HCPCS C1874","","System Coron Stent 28mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816355","EAP","HCPCS C1874","","System Coron Stent 33mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816356","EAP","HCPCS C1874","","System Coron Stent 38mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816357","EAP","HCPCS C1874","","System Coron Stent 44mm 3.5mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816358","EAP","HCPCS C1874","","System Coron Stent 8mm 4mm Elunir Thk90um Carbosil","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816359","EAP","HCPCS C1874","","System Coron Stent 12mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816360","EAP","HCPCS C1874","","System Coron Stent 15mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816361","EAP","HCPCS C1874","","System Coron Stent 17mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816362","EAP","HCPCS C1874","","System Coron Stent 20mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816363","EAP","HCPCS C1874","","System Coron Stent 24mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816364","EAP","HCPCS C1874","","System Coron Stent 28mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816365","EAP","HCPCS C1874","","System Coron Stent 33mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816366","EAP","HCPCS C1874","","System Coron Stent 38mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816367","EAP","HCPCS C1874","","System Coron Stent 44mm 4mm Elunir Thk90um","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"27816371","EAP","HCPCS C1874","","Stent Endoprosthesis Viabahn Heparin Nitinol Eptfe L25 Cm L120 Cm Od6 Mm","BOTH IP/OP","$15,988.00 ","$11,831.12 ","$0.00 ","$15,988.00 ","$7,194.60 ","$0.00 ","$3,332.30 ","$5,158.80 ","$11,410.64 ","$2,799.37 ","$15,988.00 ","$0.00 ","$7,994.00 ","$12,662.50 ","$12,790.40 ","$0.00 ","$2,502.12 ","$0.00 ","$2,545.29 ","$0.00 "
"28000001","EAP","CPT� 96522","","Refill/maint Implant Pump","BOTH IP/OP","$497.00 ","$367.78 ","$0.00 ","$497.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.00 ","$0.00 ","$248.50 ","$393.62 ","$397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000001","EAP","CPT� 36415","","PHLEBOTOMY,VEN-1OPC","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$3.00 ","$3.00 ","$7.53 ","$43.00 ","$3.15 ","$21.50 ","$34.06 ","$34.40 ","$4.35 ","$6.73 ","$3.00 ","$6.85 ","$3.00 "
"30000002","EAP","CPT� 80053","","Comp Metabolic Panel","BOTH IP/OP","$472.00 ","$349.28 ","$5.28 ","$477.00 ","$21.81 ","$5.28 ","$5.28 ","$15.44 ","$15.44 ","$15.61 ","$477.00 ","$11.09 ","$29.54 ","$377.78 ","$381.60 ","$15.31 ","$16.64 ","$10.56 ","$11.65 ","$10.56 "
"30000003","EAP","CPT� 81340","","T Cell Receptor (tcr) Beta Gene  Rearrang, Pcr (so)","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$285.02 ","$285.02 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000004","EAP","CPT� 84999","","Unlisted Chemistry Procedure (so)gene","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$141.00 ","$0.00 ","$25.45 ","$0.00 ","$100.63 ","$100.63 ","$24.69 ","$141.00 ","$0.00 ","$0.00 ","$111.67 ","$112.80 ","$0.00 ","$22.07 ","$0.00 ","$0.00 ","$0.00 "
"30000005","EAP","CPT� 81340","","T -cell Antigen  Receptor Beta  (so) Clon","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$285.02 ","$285.02 ","$0.00 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000006","EAP","CPT� 81342","","T -cell Antigen  Receptor Gamma (so) Clon","BOTH IP/OP","$954.00 ","$705.96 ","$0.00 ","$942.00 ","$415.93 ","$100.75 ","$100.75 ","$274.90 ","$274.90 ","$0.00 ","$942.00 ","$0.00 ","$471.00 ","$746.06 ","$753.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000007","EAP","CPT� 84999","","Unlisted Chemistry Procedure (so) Clon","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$141.00 ","$0.00 ","$25.45 ","$0.00 ","$100.63 ","$100.63 ","$24.69 ","$141.00 ","$0.00 ","$0.00 ","$111.67 ","$112.80 ","$0.00 ","$22.07 ","$0.00 ","$0.00 ","$0.00 "
"30000008","EAP","CPT� 81381","","HLA- B57:01 DETERMINATION-PCR (QUEST)","BOTH IP/OP","$370.00 ","$273.80 ","$35.05 ","$463.00 ","$195.23 ","$84.95 ","$76.46 ","$129.03 ","$129.03 ","$46.99 ","$463.00 ","$178.40 ","$231.50 ","$366.70 ","$370.40 ","$246.36 ","$50.07 ","$169.90 ","$35.05 ","$169.90 "
"30000009","EAP","CPT� 81380","","HLA -B HIGH RESOLUTION- PCR (QUEST)","BOTH IP/OP","$573.00 ","$424.02 ","$0.00 ","$579.00 ","$0.00 ","$0.00 ","$0.00 ","$241.81 ","$241.81 ","$0.00 ","$579.00 ","$0.00 ","$289.50 ","$458.57 ","$463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000010","EAP","CPT� 87798","","Ebola -cdc,rt-pcr,evd","BOTH IP/OP","$114.00 ","$84.36 ","$17.55 ","$137.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$137.00 ","$36.84 ","$54.82 ","$108.50 ","$109.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30000018","EAP","CPT� 80346","","Benzodiazpne,ur-eia","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$242.66 ","$242.66 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000019","EAP","CPT� 80353","","Cocain Metab.ur-eia","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$242.66 ","$242.66 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000020","EAP","CPT� 83992","","Phencyclidne,ur-eia","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$21.46 ","$21.46 ","$0.00 ","$340.00 ","$0.00 ","$41.08 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000021","EAP","CPT� 80361","","Opiates,ur-eia","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$450.00 ","$0.03 ","$12.01 ","$11.94 ","$321.17 ","$321.17 ","$30.51 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$270.00 ","$32.51 ","$0.00 ","$22.76 ","$0.00 "
"30000022","EAP","CPT� 80349","","Thc, Ur-eia","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$340.00 ","$0.03 ","$12.01 ","$0.00 ","$242.66 ","$242.66 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000023","EAP","CPT� 80345","","Barbiturate,ur-eia","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$314.00 ","$0.03 ","$12.01 ","$7.03 ","$224.10 ","$224.10 ","$0.00 ","$314.00 ","$0.00 ","$157.00 ","$248.69 ","$251.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000024","EAP","CPT� 80150","","Amikacin-random","BOTH IP/OP","$265.00 ","$196.10 ","$0.00 ","$265.00 ","$31.13 ","$7.54 ","$7.54 ","$22.01 ","$22.01 ","$0.00 ","$265.00 ","$0.00 ","$42.12 ","$209.88 ","$212.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000025","EAP","CPT� 80335","","Amitriptyline-random","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$66.37 ","$66.37 ","$0.00 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"30000026","EAP","CPT� 80159","","Clozapine (so)","BOTH IP/OP","$299.00 ","$221.26 ","$9.25 ","$299.00 ","$38.17 ","$10.08 ","$9.25 ","$25.23 ","$25.23 ","$23.71 ","$299.00 ","$21.16 ","$149.50 ","$236.81 ","$239.20 ","$29.22 ","$25.26 ","$20.15 ","$17.68 ","$20.15 "
"30000027","EAP","CPT� 80156","","Carbamazpine-random","BOTH IP/OP","$279.00 ","$206.46 ","$7.28 ","$279.00 ","$30.07 ","$7.29 ","$7.28 ","$21.26 ","$21.26 ","$21.51 ","$279.00 ","$15.30 ","$40.68 ","$220.97 ","$223.20 ","$21.13 ","$22.92 ","$14.57 ","$16.05 ","$14.57 "
"30000028","EAP","CPT� 80158","","Cyclosporine","BOTH IP/OP","$238.00 ","$176.12 ","$6.57 ","$238.00 ","$12.30 ","$9.03 ","$9.03 ","$8.70 ","$8.70 ","$8.81 ","$238.00 ","$18.95 ","$16.66 ","$188.50 ","$190.40 ","$26.17 ","$9.39 ","$18.05 ","$6.57 ","$18.05 "
"30000029","EAP","CPT� 80335","","Desipramine-random","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$0.00 ","$0.00 ","$0.00 ","$88.50 ","$88.50 ","$0.00 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"30000030","EAP","CPT� 80162","","Digoxin, Total","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$27.40 ","$6.64 ","$0.00 ","$19.39 ","$19.39 ","$19.61 ","$281.00 ","$13.94 ","$37.10 ","$222.55 ","$224.80 ","$19.26 ","$20.90 ","$13.28 ","$14.63 ","$13.28 "
"30000031","EAP","CPT� 80164","","Valproic Acid, Total","BOTH IP/OP","$319.00 ","$236.06 ","$6.77 ","$319.00 ","$23.44 ","$6.77 ","$6.77 ","$16.57 ","$16.57 ","$16.77 ","$319.00 ","$14.22 ","$31.72 ","$252.65 ","$255.20 ","$19.63 ","$17.87 ","$13.54 ","$12.51 ","$13.54 "
"30000032","EAP","CPT� 80335","","Doxepin-random","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$0.00 ","$0.00 ","$0.00 ","$87.79 ","$87.79 ","$0.00 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"30000033","EAP","CPT� 80168","","Ethosuximide-random","BOTH IP/OP","$86.00 ","$63.64 ","$0.00 ","$86.00 ","$0.00 ","$0.00 ","$0.00 ","$23.86 ","$23.86 ","$0.00 ","$86.00 ","$0.00 ","$45.66 ","$68.11 ","$68.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000034","EAP","CPT� 80170","","Gentamicin-random","BOTH IP/OP","$201.00 ","$148.74 ","$8.19 ","$201.00 ","$33.82 ","$8.19 ","$8.19 ","$23.93 ","$23.93 ","$24.21 ","$201.00 ","$17.20 ","$45.80 ","$159.19 ","$160.80 ","$23.75 ","$25.80 ","$16.38 ","$18.06 ","$16.38 "
"30000035","EAP","CPT� 80173","","Haloperidol","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$30.07 ","$7.89 ","$7.28 ","$21.26 ","$21.26 ","$0.00 ","$120.00 ","$0.00 ","$40.68 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000036","EAP","CPT� 80335","","Imipramine-random","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$96.35 ","$96.35 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"30000037","EAP","CPT� 80176","","Lidocaine-random","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$21.45 ","$21.45 ","$0.00 ","$160.00 ","$0.00 ","$41.04 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000038","EAP","CPT� 80178","","Lithium-random","BOTH IP/OP","$225.00 ","$166.50 ","$3.31 ","$225.00 ","$13.65 ","$3.31 ","$3.31 ","$9.65 ","$9.65 ","$9.78 ","$225.00 ","$6.94 ","$18.48 ","$178.20 ","$180.00 ","$9.58 ","$10.42 ","$6.61 ","$7.29 ","$6.61 "
"30000039","EAP","CPT� 80335","","Nortriptyline-random","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$0.00 ","$0.00 ","$0.00 ","$83.50 ","$83.50 ","$0.00 ","$117.00 ","$0.00 ","$58.50 ","$92.66 ","$93.60 ","$0.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"30000040","EAP","CPT� 80184","","Phenobarb-random","BOTH IP/OP","$236.00 ","$174.64 ","$6.89 ","$236.00 ","$23.02 ","$7.65 ","$6.89 ","$16.72 ","$16.72 ","$16.93 ","$236.00 ","$16.07 ","$32.02 ","$186.91 ","$188.80 ","$22.19 ","$18.04 ","$15.30 ","$12.62 ","$15.30 "
"30000041","EAP","CPT� 80185","","Dilantin-random","BOTH IP/OP","$287.00 ","$212.38 ","$6.63 ","$287.00 ","$27.35 ","$6.63 ","$6.63 ","$19.36 ","$19.36 ","$19.58 ","$287.00 ","$13.91 ","$37.04 ","$227.30 ","$229.60 ","$19.21 ","$20.87 ","$13.25 ","$14.61 ","$13.25 "
"30000042","EAP","CPT� 80186","","Phenytoin Free (so)","BOTH IP/OP","$205.00 ","$151.70 ","$6.88 ","$205.00 ","$28.41 ","$6.88 ","$6.88 ","$20.10 ","$20.10 ","$20.34 ","$205.00 ","$14.45 ","$38.46 ","$162.36 ","$164.00 ","$19.95 ","$21.67 ","$13.76 ","$15.17 ","$13.76 "
"30000043","EAP","CPT� 80188","","Primidone/myso-rand.","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$24.23 ","$24.23 ","$0.00 ","$188.00 ","$0.00 ","$46.36 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000044","EAP","CPT� 80192","","Procainamide-random","BOTH IP/OP","$191.00 ","$141.34 ","$0.00 ","$191.00 ","$0.00 ","$0.00 ","$0.00 ","$24.46 ","$24.46 ","$0.00 ","$191.00 ","$0.00 ","$46.82 ","$151.27 ","$152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000045","EAP","CPT� 80194","","Quinidine-random","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$21.31 ","$21.31 ","$0.00 ","$160.00 ","$0.00 ","$40.78 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000046","EAP","CPT� 80307","","Salicylate-quant","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$353.00 ","$0.00 ","$19.29 ","$80.87 ","$76.45 ","$76.45 ","$71.85 ","$353.00 ","$65.25 ","$176.50 ","$279.58 ","$282.40 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30000047","EAP","CPT� 80198","","Theophylline-random","BOTH IP/OP","$173.00 ","$128.02 ","$0.00 ","$173.00 ","$0.00 ","$0.00 ","$0.00 ","$20.66 ","$20.66 ","$20.90 ","$173.00 ","$14.85 ","$39.54 ","$137.02 ","$138.40 ","$20.50 ","$0.00 ","$14.14 ","$15.58 ","$14.14 "
"30000048","EAP","CPT� 80200","","Tobramycin-random","BOTH IP/OP","$263.00 ","$194.62 ","$0.00 ","$263.00 ","$0.00 ","$0.00 ","$0.00 ","$21.87 ","$21.87 ","$0.00 ","$263.00 ","$0.00 ","$41.86 ","$208.30 ","$210.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000049","EAP","CPT� 80201","","Topiramate/topamaz","BOTH IP/OP","$94.00 ","$69.56 ","$5.96 ","$94.00 ","$24.60 ","$5.96 ","$5.96 ","$17.40 ","$17.40 ","$17.61 ","$94.00 ","$12.52 ","$33.32 ","$74.45 ","$75.20 ","$17.28 ","$18.76 ","$11.92 ","$13.13 ","$11.92 "
"30000050","EAP","CPT� 80202","","Vancomycin-random","BOTH IP/OP","$292.00 ","$216.08 ","$6.77 ","$292.00 ","$23.44 ","$6.77 ","$6.77 ","$16.57 ","$16.57 ","$16.77 ","$292.00 ","$14.22 ","$31.72 ","$231.26 ","$233.60 ","$19.63 ","$17.87 ","$13.54 ","$12.51 ","$13.54 "
"30000051","EAP","CPT� 80299","","Methotrexate-random","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$17.58 ","$17.58 ","$17.79 ","$218.00 ","$19.57 ","$33.64 ","$172.66 ","$174.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30000052","EAP","CPT� 80171","","Gabapentin, Whl Bld/ser/plasma","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$433.00 ","$0.00 ","$0.00 ","$0.00 ","$18.09 ","$18.09 ","$0.00 ","$433.00 ","$0.00 ","$216.50 ","$342.94 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000053","EAP","CPT� 80299","","Amiodarone/cordarone","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$17.58 ","$17.58 ","$17.79 ","$218.00 ","$19.57 ","$33.64 ","$172.66 ","$174.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30000054","EAP","CPT� 80175","","Lamotrigine (so)","BOTH IP/OP","$431.00 ","$318.94 ","$6.63 ","$433.00 ","$27.35 ","$6.63 ","$6.63 ","$18.09 ","$18.09 ","$17.00 ","$433.00 ","$13.91 ","$216.50 ","$342.94 ","$346.40 ","$19.21 ","$18.11 ","$13.25 ","$12.68 ","$13.25 "
"30000055","EAP","CPT� 80299","","Olanzapine/zyprexa","BOTH IP/OP","$217.00 ","$160.58 ","$8.39 ","$218.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$218.00 ","$19.57 ","$33.64 ","$172.66 ","$174.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30000056","EAP","CPT� 82013","","Acetylcholinesterase-amnio","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$16.31 ","$16.31 ","$0.00 ","$37.00 ","$0.00 ","$31.22 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000057","EAP","CPT� 82017","","Carnitine, Ester","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$132.00 ","$0.00 ","$47.14 ","$104.54 ","$105.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000058","EAP","CPT� 82270","","Fecal Occult Blood Test","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$4.69 ","$4.69 ","$0.00 ","$58.00 ","$0.00 ","$8.98 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000060","EAP","CPT� 82330","","Calcium, Ionized","BOTH IP/OP","$375.00 ","$277.50 ","$6.84 ","$342.00 ","$28.22 ","$6.84 ","$6.84 ","$19.95 ","$19.95 ","$20.18 ","$342.00 ","$14.36 ","$38.18 ","$270.86 ","$273.60 ","$19.84 ","$21.50 ","$13.68 ","$15.05 ","$13.68 "
"30000062","EAP","CPT� 82948","","Glucose-2hr Pp,wb","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000063","EAP","CPT� 82948","","Glucose-fbs,wb","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000064","EAP","CPT� 82948","","Glucose-fbs,wb Micro","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000065","EAP","CPT� 82948","","Glucose-random,wb","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000066","EAP","CPT� 82948","","GLU-RANDOM,WB MICRO","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000067","EAP","CPT� 83020","","Newborn Screen","BOTH IP/OP","$204.00 ","$150.96 ","$6.44 ","$204.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$204.00 ","$13.51 ","$27.32 ","$161.57 ","$163.20 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30000068","EAP","CPT� 83516","","T-transglutamin Igg","BOTH IP/OP","$181.00 ","$133.94 ","$5.76 ","$176.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$176.00 ","$12.11 ","$29.88 ","$139.39 ","$140.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30000069","EAP","CPT� 83520","","Anti Gm1 Ab Titer","BOTH IP/OP","$477.00 ","$352.98 ","$7.77 ","$464.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$464.00 ","$18.13 ","$36.18 ","$367.49 ","$371.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000070","EAP","CPT� 83520","","Anti Asialo-gm-ab","BOTH IP/OP","$411.00 ","$304.14 ","$7.77 ","$464.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$464.00 ","$18.13 ","$36.18 ","$367.49 ","$371.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000071","EAP","CPT� 83520","","Anti Gq1b Ab Titer","BOTH IP/OP","$477.00 ","$352.98 ","$7.77 ","$464.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$464.00 ","$18.13 ","$36.18 ","$367.49 ","$371.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000072","EAP","CPT� 83520","","Anti Gd 1b Ab Titer","BOTH IP/OP","$411.00 ","$304.14 ","$7.77 ","$464.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$464.00 ","$18.13 ","$36.18 ","$367.49 ","$371.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000073","EAP","CPT� 83520","","Mitochondrial Ab","BOTH IP/OP","$477.00 ","$352.98 ","$7.77 ","$464.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$464.00 ","$18.13 ","$36.18 ","$367.49 ","$371.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000074","EAP","CPT� 83605","","Lactate, Plasma","BOTH IP/OP","$258.00 ","$190.92 ","$5.34 ","$311.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$311.00 ","$12.15 ","$29.84 ","$246.31 ","$248.80 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30000083","EAP","CPT� 84030","","Phenylalanine (pku), Blood","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$8.04 ","$8.04 ","$0.00 ","$48.00 ","$0.00 ","$15.38 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000084","EAP","CPT� 84066","","Prostatic Acid Phosphatase","BOTH IP/OP","$100.00 ","$74.00 ","$4.83 ","$95.00 ","$19.93 ","$4.83 ","$4.83 ","$14.10 ","$14.10 ","$14.27 ","$95.00 ","$10.14 ","$27.00 ","$75.24 ","$76.00 ","$14.01 ","$15.20 ","$9.66 ","$10.64 ","$9.66 "
"30000085","EAP","CPT� 84100","","Phosphorus, Serum","BOTH IP/OP","$128.00 ","$94.72 ","$2.37 ","$136.00 ","$9.79 ","$2.37 ","$2.37 ","$6.93 ","$6.93 ","$7.01 ","$136.00 ","$4.98 ","$13.26 ","$107.71 ","$108.80 ","$6.87 ","$7.47 ","$4.74 ","$5.23 ","$4.74 "
"30000086","EAP","CPT� 84152","","Psa, Total Screening","BOTH IP/OP","$237.00 ","$175.38 ","$0.00 ","$237.00 ","$37.96 ","$9.66 ","$9.20 ","$26.85 ","$26.85 ","$0.00 ","$237.00 ","$20.28 ","$51.40 ","$187.70 ","$189.60 ","$26.67 ","$0.00 ","$18.39 ","$20.27 ","$19.31 "
"30000087","EAP","CPT� 84163","","Preg Assoc Plasma Protein","BOTH IP/OP","$96.00 ","$71.04 ","$7.07 ","$94.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$94.00 ","$15.80 ","$17.94 ","$74.45 ","$75.20 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30000089","EAP","CPT� 84702","","D-HCG FREE & INTACT","BOTH IP/OP","$419.00 ","$310.06 ","$7.07 ","$381.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$381.00 ","$15.80 ","$17.94 ","$301.75 ","$304.80 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30000090","EAP","CPT� 85461","","Fetal Screen Rhig","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$9.69 ","$9.69 ","$0.00 ","$150.00 ","$0.00 ","$18.52 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000091","EAP","CPT� 85557","","Osmotic Fragility,erythrocytes","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$19.50 ","$19.50 ","$0.00 ","$264.00 ","$0.00 ","$37.32 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000092","EAP","CPT� 85660","","Donor Hgb S (arc)","BOTH IP/OP","$201.00 ","$148.74 ","$2.75 ","$183.00 ","$11.38 ","$2.76 ","$2.75 ","$8.06 ","$8.06 ","$8.15 ","$183.00 ","$5.79 ","$15.42 ","$144.94 ","$146.40 ","$7.99 ","$8.68 ","$5.51 ","$6.08 ","$5.51 "
"30000093","EAP","CPT� 86003","","Epicoccum Purpurascn","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30000095","EAP","CPT� 86022","","Platelet Ab Screen (arc)","BOTH IP/OP","$457.00 ","$338.18 ","$0.00 ","$420.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$420.00 ","$0.00 ","$51.32 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000096","EAP","CPT� 86147","","Antiphospholipid Igg","BOTH IP/OP","$581.00 ","$429.94 ","$12.73 ","$726.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$726.00 ","$26.72 ","$71.08 ","$574.99 ","$580.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30000097","EAP","CPT� 86147","","Antiphospholipid Igm","BOTH IP/OP","$581.00 ","$429.94 ","$12.73 ","$726.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$726.00 ","$26.72 ","$71.08 ","$574.99 ","$580.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30000098","EAP","CPT� 86235","","Antihistone Ab","BOTH IP/OP","$344.00 ","$254.56 ","$8.97 ","$332.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$332.00 ","$18.83 ","$50.12 ","$262.94 ","$265.60 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30000099","EAP","CPT� 86255","","Murine Typhus Igg","BOTH IP/OP","$59.00 ","$43.66 ","$6.03 ","$59.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$59.00 ","$12.65 ","$33.68 ","$46.73 ","$47.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30000100","EAP","CPT� 86331","","Pigeon Serum","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$17.50 ","$17.50 ","$0.00 ","$38.00 ","$0.00 ","$33.50 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000101","EAP","CPT� 86331","","T. Candidus","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$17.50 ","$17.50 ","$0.00 ","$38.00 ","$0.00 ","$33.50 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000102","EAP","CPT� 86331","","T.vulgaris","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$17.50 ","$17.50 ","$0.00 ","$38.00 ","$0.00 ","$33.50 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000103","EAP","CPT� 86331","","S. Viridis","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$17.50 ","$17.50 ","$0.00 ","$38.00 ","$0.00 ","$33.50 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000104","EAP","CPT� 86355","","Cd19,total B %","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$218.00 ","$39.62 ","$65.82 ","$172.66 ","$174.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000105","EAP","CPT� 86357","","Natural Killer (nk)cells,total","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$218.00 ","$39.62 ","$65.82 ","$172.66 ","$174.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000106","EAP","CPT� 86357","","Cd56+16,nk%","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$218.00 ","$39.62 ","$65.82 ","$172.66 ","$174.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000107","EAP","CPT� 86485","","Candida Skin Test","BOTH IP/OP","$262.00 ","$193.88 ","$0.00 ","$264.00 ","$29.73 ","$24.19 ","$54.61 ","$12.53 ","$12.53 ","$18.61 ","$264.00 ","$23.06 ","$132.00 ","$209.09 ","$211.20 ","$32.04 ","$19.83 ","$0.00 ","$13.88 ","$21.96 "
"30000108","EAP","CPT� 86603","","Adenovirus Ab","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$18.79 ","$18.79 ","$19.01 ","$65.00 ","$13.51 ","$35.96 ","$51.48 ","$52.00 ","$18.66 ","$0.00 ","$12.87 ","$14.18 ","$12.87 "
"30000109","EAP","CPT� 86612","","Blastomyces Ab","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$18.84 ","$18.84 ","$0.00 ","$100.00 ","$0.00 ","$36.06 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000110","EAP","CPT� 86635","","Coccidiodes Ab","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$141.00 ","$0.00 ","$0.00 ","$0.00 ","$16.75 ","$16.75 ","$0.00 ","$141.00 ","$0.00 ","$32.06 ","$111.67 ","$112.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000113","EAP","CPT� 86710","","Influenza A Ab","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$135.00 ","$27.98 ","$6.78 ","$6.78 ","$19.80 ","$19.80 ","$0.00 ","$135.00 ","$0.00 ","$37.88 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000114","EAP","CPT� 86710","","Influenza B Ab","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$135.00 ","$27.98 ","$6.78 ","$6.78 ","$19.80 ","$19.80 ","$0.00 ","$135.00 ","$0.00 ","$37.88 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000115","EAP","CPT� 86710","","Parainfluenza-1 Ab","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$135.00 ","$27.98 ","$6.78 ","$6.78 ","$19.80 ","$19.80 ","$0.00 ","$135.00 ","$0.00 ","$37.88 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000116","EAP","CPT� 86710","","Parainfluenza-2 Ab","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$135.00 ","$27.98 ","$6.78 ","$6.78 ","$19.80 ","$19.80 ","$0.00 ","$135.00 ","$0.00 ","$37.88 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000117","EAP","CPT� 86710","","Parainfluenza-3 Ab","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$135.00 ","$27.98 ","$6.78 ","$6.78 ","$19.80 ","$19.80 ","$0.00 ","$135.00 ","$0.00 ","$37.88 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000118","EAP","CPT� 86735","","Mumps Igm","BOTH IP/OP","$130.00 ","$96.20 ","$6.53 ","$131.00 ","$26.93 ","$6.53 ","$6.53 ","$19.06 ","$19.06 ","$19.28 ","$131.00 ","$13.70 ","$36.46 ","$103.75 ","$104.80 ","$18.92 ","$20.54 ","$13.05 ","$14.38 ","$13.05 "
"30000119","EAP","CPT� 86735","","Mumps Igg","BOTH IP/OP","$131.00 ","$96.94 ","$6.53 ","$131.00 ","$26.93 ","$6.53 ","$6.53 ","$19.06 ","$19.06 ","$19.28 ","$131.00 ","$13.70 ","$36.46 ","$103.75 ","$104.80 ","$18.92 ","$20.54 ","$13.05 ","$14.38 ","$13.05 "
"30000120","EAP","CPT� 86744","","Micropolyspora Faeni","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$40.00 ","$0.00 ","$36.86 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000121","EAP","CPT� 86756","","Rsv Ab","BOTH IP/OP","$186.00 ","$137.64 ","$0.00 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$18.82 ","$18.82 ","$0.00 ","$186.00 ","$0.00 ","$36.02 ","$147.31 ","$148.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000124","EAP","CPT� 86850","","Antibody Screen (arc)","BOTH IP/OP","$366.00 ","$270.84 ","$4.40 ","$334.00 ","$7.89 ","$48.66 ","$4.40 ","$15.95 ","$15.95 ","$17.89 ","$334.00 ","$49.62 ","$37.22 ","$264.53 ","$267.20 ","$68.93 ","$19.06 ","$9.77 ","$13.35 ","$47.25 "
"30000126","EAP","CPT� 86850","","Antibody Screen","BOTH IP/OP","$366.00 ","$270.84 ","$4.40 ","$334.00 ","$7.89 ","$48.66 ","$4.40 ","$15.95 ","$15.95 ","$17.89 ","$334.00 ","$49.62 ","$37.22 ","$264.53 ","$267.20 ","$68.93 ","$19.06 ","$9.77 ","$13.35 ","$47.25 "
"30000128","EAP","CPT� 86860","","Rbc Elution (arc)","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$514.00 ","$47.04 ","$146.06 ","$117.34 ","$18.99 ","$18.99 ","$7.19 ","$514.00 ","$143.92 ","$44.66 ","$407.09 ","$411.20 ","$199.96 ","$7.66 ","$0.00 ","$5.36 ","$137.07 "
"30000129","EAP","CPT� 86860","","Rbc Elution","BOTH IP/OP","$563.00 ","$416.62 ","$0.00 ","$514.00 ","$47.04 ","$146.06 ","$117.34 ","$18.99 ","$18.99 ","$7.19 ","$514.00 ","$143.92 ","$44.66 ","$407.09 ","$411.20 ","$199.96 ","$7.66 ","$0.00 ","$5.36 ","$137.07 "
"30000130","EAP","CPT� 86870","","Antibody Id","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$579.00 ","$64.34 ","$285.22 ","$132.14 ","$29.24 ","$29.24 ","$7.19 ","$579.00 ","$284.24 ","$69.46 ","$458.57 ","$463.20 ","$394.92 ","$7.66 ","$0.00 ","$5.36 ","$270.71 "
"30000131","EAP","CPT� 86870","","Antibody Id (arc)","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$579.00 ","$64.34 ","$285.22 ","$132.14 ","$29.24 ","$29.24 ","$7.19 ","$579.00 ","$284.24 ","$69.46 ","$458.57 ","$463.20 ","$394.92 ","$7.66 ","$0.00 ","$5.36 ","$270.71 "
"30000136","EAP","CPT� 86880","","Direct Coombs (arc)","BOTH IP/OP","$140.00 ","$103.60 ","$2.70 ","$141.00 ","$11.11 ","$54.51 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$141.00 ","$33.53 ","$15.00 ","$111.67 ","$112.80 ","$46.58 ","$8.45 ","$5.39 ","$5.91 ","$31.93 "
"30000146","EAP","CPT� 86900","","Blood Typing, Serologic, Abo (arc)","BOTH IP/OP","$165.00 ","$122.10 ","$1.49 ","$150.00 ","$6.18 ","$110.43 ","$1.49 ","$4.35 ","$4.35 ","$4.41 ","$150.00 ","$109.35 ","$8.34 ","$118.80 ","$120.00 ","$150.00 ","$4.70 ","$2.99 ","$3.29 ","$104.14 "
"30000149","EAP","CPT� 86901","","Blood Typing, Serologic, Rh (d) (arc)","BOTH IP/OP","$165.00 ","$122.10 ","$1.49 ","$150.00 ","$6.18 ","$33.15 ","$1.49 ","$4.35 ","$4.35 ","$17.04 ","$150.00 ","$33.53 ","$8.34 ","$118.80 ","$120.00 ","$46.58 ","$18.16 ","$2.99 ","$12.71 ","$31.93 "
"30000153","EAP","CPT� 86902","","Blood Type Ag Donor Ea","BOTH IP/OP","$828.00 ","$612.72 ","$2.86 ","$756.00 ","$7.89 ","$285.22 ","$2.86 ","$5.38 ","$5.38 ","$5.05 ","$756.00 ","$284.24 ","$378.00 ","$598.75 ","$604.80 ","$394.92 ","$5.38 ","$6.35 ","$3.77 ","$270.71 "
"30000154","EAP","CPT� 86902","","Blood Type Ag Donor Ea (arc)","BOTH IP/OP","$828.00 ","$612.72 ","$2.86 ","$756.00 ","$7.89 ","$285.22 ","$2.86 ","$5.38 ","$5.38 ","$5.05 ","$756.00 ","$284.24 ","$378.00 ","$598.75 ","$604.80 ","$394.92 ","$5.38 ","$6.35 ","$3.77 ","$270.71 "
"30000155","EAP","CPT� 86904","","Ag Screen Pt Serum Ea Unit (arc)","BOTH IP/OP","$2,572.00 ","$1,903.28 ","$0.00 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$13.88 ","$13.88 ","$0.00 ","$146.00 ","$0.00 ","$26.56 ","$115.63 ","$116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000160","EAP","CPT� 86905","","Patient Ag Typing (arc)","BOTH IP/OP","$353.00 ","$261.22 ","$1.91 ","$322.00 ","$7.89 ","$285.22 ","$1.91 ","$5.58 ","$5.58 ","$5.65 ","$322.00 ","$284.24 ","$10.68 ","$255.02 ","$257.60 ","$322.00 ","$6.02 ","$3.83 ","$4.21 ","$270.71 "
"30000161","EAP","CPT� 86905","","Patient Ag Typing","BOTH IP/OP","$353.00 ","$261.22 ","$1.91 ","$322.00 ","$7.89 ","$285.22 ","$1.91 ","$5.58 ","$5.58 ","$5.65 ","$322.00 ","$284.24 ","$10.68 ","$255.02 ","$257.60 ","$322.00 ","$6.02 ","$3.83 ","$4.21 ","$270.71 "
"30000179","EAP","CPT� 86906","","Rh Phenotype (arc)","BOTH IP/OP","$786.00 ","$581.64 ","$0.00 ","$715.00 ","$0.00 ","$0.00 ","$0.00 ","$11.31 ","$11.31 ","$0.00 ","$715.00 ","$0.00 ","$21.66 ","$566.28 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000180","EAP","CPT� 86920","","Crossmatch Is Ea Unit","BOTH IP/OP","$314.00 ","$232.36 ","$0.00 ","$286.00 ","$51.90 ","$146.06 ","$65.45 ","$26.20 ","$26.20 ","$50.08 ","$286.00 ","$143.92 ","$62.02 ","$226.51 ","$228.80 ","$199.96 ","$44.76 ","$0.00 ","$45.53 ","$137.07 "
"30000182","EAP","CPT� 86920","","COMPATIBILITY EA- MT","BOTH IP/OP","$263.00 ","$194.62 ","$0.00 ","$286.00 ","$51.90 ","$146.06 ","$54.82 ","$26.20 ","$26.20 ","$50.08 ","$286.00 ","$143.92 ","$62.02 ","$226.51 ","$228.80 ","$199.96 ","$44.76 ","$0.00 ","$45.53 ","$137.07 "
"30000185","EAP","CPT� 86921","","Crossmatch Incub Ea Unit","BOTH IP/OP","$502.00 ","$371.48 ","$0.00 ","$457.00 ","$0.00 ","$0.00 ","$0.00 ","$21.27 ","$21.27 ","$80.02 ","$457.00 ","$143.92 ","$50.44 ","$361.94 ","$365.60 ","$199.96 ","$71.52 ","$0.00 ","$72.75 ","$137.07 "
"30000187","EAP","CPT� 86921","","Platelet Crossmatch (arc)","BOTH IP/OP","$502.00 ","$371.48 ","$0.00 ","$457.00 ","$0.00 ","$0.00 ","$0.00 ","$21.27 ","$21.27 ","$80.02 ","$457.00 ","$143.92 ","$50.44 ","$361.94 ","$365.60 ","$199.96 ","$71.52 ","$0.00 ","$72.75 ","$137.07 "
"30000190","EAP","CPT� 86922","","Crossmatch Ahg (arc)","BOTH IP/OP","$528.00 ","$390.72 ","$0.00 ","$480.00 ","$55.68 ","$146.06 ","$110.05 ","$23.93 ","$23.93 ","$84.04 ","$480.00 ","$143.92 ","$56.24 ","$380.16 ","$384.00 ","$199.96 ","$75.12 ","$0.00 ","$76.42 ","$137.07 "
"30000191","EAP","CPT� 86922","","Crossmatch Ahg","BOTH IP/OP","$528.00 ","$390.72 ","$0.00 ","$480.00 ","$55.68 ","$146.06 ","$110.05 ","$23.93 ","$23.93 ","$84.04 ","$480.00 ","$143.92 ","$56.24 ","$380.16 ","$384.00 ","$199.96 ","$75.12 ","$0.00 ","$76.42 ","$137.07 "
"30000192","EAP","CPT� 86923","","Crossmatch Electronic","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$421.00 ","$41.63 ","$146.06 ","$96.50 ","$18.99 ","$18.99 ","$73.71 ","$421.00 ","$143.92 ","$44.66 ","$333.43 ","$336.80 ","$199.96 ","$65.89 ","$0.00 ","$67.02 ","$137.07 "
"30000195","EAP","CPT� 86940","","Hemolysins/agglutinins Auto Ea (arc)","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$11.97 ","$11.97 ","$0.00 ","$152.00 ","$0.00 ","$22.92 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000196","EAP","CPT� 86941","","Hemolysins/agglutinins Incubated (arc)","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$17.68 ","$17.68 ","$0.00 ","$152.00 ","$0.00 ","$33.84 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000198","EAP","CPT� 86970","","Rbc Pretx Chem (arc)","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$15.95 ","$15.95 ","$0.00 ","$740.00 ","$0.00 ","$37.22 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000199","EAP","CPT� 86971","","Rbc Pretx Enz (arc)","BOTH IP/OP","$383.00 ","$283.42 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$15.95 ","$15.95 ","$0.00 ","$350.00 ","$0.00 ","$37.22 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000200","EAP","CPT� 86972","","Rbc Pretx Dens Grad (arc)","BOTH IP/OP","$827.00 ","$611.98 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$25.45 ","$25.45 ","$0.00 ","$888.00 ","$0.00 ","$60.36 ","$703.30 ","$710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000201","EAP","CPT� 86975","","Rbc Pretx Drug (arc)","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$21.27 ","$21.27 ","$0.00 ","$740.00 ","$0.00 ","$50.44 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000202","EAP","CPT� 86976","","Rbc Dilution Of Serum, Per Aliquot (arc)","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$0.00 ","$23.93 ","$23.93 ","$0.00 ","$73.00 ","$0.00 ","$56.24 ","$57.82 ","$58.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000203","EAP","CPT� 86977","","Rbc Incubation With Inhibitors, Per Aliquot (arc)","BOTH IP/OP","$751.00 ","$555.74 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$21.27 ","$21.27 ","$0.00 ","$199.00 ","$0.00 ","$50.44 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000204","EAP","CPT� 86978","","Rbc Pretx Ab Id Diff Ea Absorp (arc)","BOTH IP/OP","$640.00 ","$473.60 ","$0.00 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$21.27 ","$21.27 ","$0.00 ","$584.00 ","$0.00 ","$50.44 ","$462.53 ","$467.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000205","EAP","CPT� 86985","","Aliquot Blood Products Ea","BOTH IP/OP","$376.00 ","$278.24 ","$0.00 ","$380.00 ","$38.39 ","$146.06 ","$78.37 ","$15.95 ","$15.95 ","$66.53 ","$380.00 ","$143.92 ","$37.22 ","$300.96 ","$304.00 ","$199.96 ","$0.00 ","$0.00 ","$60.50 ","$137.07 "
"30000208","EAP","CPT� 87015","","Concentration","BOTH IP/OP","$132.00 ","$97.68 ","$3.34 ","$120.00 ","$13.78 ","$3.34 ","$3.34 ","$9.75 ","$9.75 ","$9.87 ","$120.00 ","$7.01 ","$18.66 ","$95.04 ","$96.00 ","$9.69 ","$10.52 ","$6.68 ","$7.36 ","$6.68 "
"30000209","EAP","CPT� 87046","","Stool Cult, Aerobic-campy","BOTH IP/OP","$143.00 ","$105.82 ","$2.60 ","$144.00 ","$19.48 ","$4.72 ","$4.72 ","$13.77 ","$13.77 ","$3.49 ","$144.00 ","$9.91 ","$26.36 ","$114.05 ","$115.20 ","$13.69 ","$3.71 ","$9.44 ","$2.60 ","$9.44 "
"30000210","EAP","CPT� 87046","","Stool, Cult, Aerobic-yersinnia","BOTH IP/OP","$143.00 ","$105.82 ","$2.60 ","$144.00 ","$19.48 ","$4.72 ","$4.72 ","$13.77 ","$13.77 ","$3.49 ","$144.00 ","$9.91 ","$26.36 ","$114.05 ","$115.20 ","$13.69 ","$3.71 ","$9.44 ","$2.60 ","$9.44 "
"30000211","EAP","CPT� 87176","","Homogenization, Tissue","BOTH IP/OP","$101.00 ","$74.74 ","$2.94 ","$92.00 ","$12.14 ","$2.94 ","$2.94 ","$8.59 ","$8.59 ","$8.69 ","$92.00 ","$6.17 ","$16.44 ","$72.86 ","$73.60 ","$8.53 ","$9.26 ","$5.88 ","$6.48 ","$5.88 "
"30000212","EAP","CPT� 87177","","Wet Prep","BOTH IP/OP","$112.00 ","$82.88 ","$4.45 ","$109.00 ","$18.37 ","$4.45 ","$4.45 ","$12.99 ","$12.99 ","$13.15 ","$109.00 ","$9.35 ","$24.86 ","$86.33 ","$87.20 ","$12.91 ","$14.01 ","$8.90 ","$9.81 ","$8.90 "
"30000213","EAP","CPT� 87220","","Skin Prep: 10% Koh","BOTH IP/OP","$198.00 ","$146.52 ","$2.14 ","$184.00 ","$8.82 ","$2.14 ","$2.14 ","$6.23 ","$6.23 ","$6.30 ","$184.00 ","$4.48 ","$11.92 ","$145.73 ","$147.20 ","$6.19 ","$6.71 ","$4.27 ","$4.70 ","$4.27 "
"30000214","EAP","CPT� 87250","","Herpes Viral Culture","BOTH IP/OP","$367.00 ","$271.58 ","$9.78 ","$370.00 ","$40.37 ","$9.78 ","$9.78 ","$28.55 ","$28.55 ","$28.89 ","$370.00 ","$20.54 ","$54.64 ","$293.04 ","$296.00 ","$28.36 ","$30.78 ","$19.56 ","$21.54 ","$19.56 "
"30000215","EAP","CPT� 87497","","Cytomegalovirus, Dna","BOTH IP/OP","$1,040.00 ","$769.60 ","$21.42 ","$1,009.00 ","$88.41 ","$21.42 ","$21.42 ","$62.54 ","$62.54 ","$63.28 ","$1,009.00 ","$44.98 ","$119.70 ","$799.13 ","$807.20 ","$62.12 ","$67.43 ","$42.84 ","$47.20 ","$42.84 "
"30000217","EAP","CPT� 87536","","Hiv /rna Pcr Quant","BOTH IP/OP","$842.00 ","$623.08 ","$42.55 ","$817.00 ","$107.10 ","$42.55 ","$42.55 ","$75.77 ","$75.77 ","$66.37 ","$817.00 ","$89.36 ","$145.02 ","$647.06 ","$653.60 ","$123.40 ","$70.72 ","$85.10 ","$49.50 ","$85.10 "
"30000218","EAP","CPT� 87536","","Hiv-1 Rna Ultra, Qnt","BOTH IP/OP","$790.00 ","$584.60 ","$42.55 ","$817.00 ","$107.10 ","$42.55 ","$42.55 ","$75.77 ","$75.77 ","$66.37 ","$817.00 ","$89.36 ","$145.02 ","$647.06 ","$653.60 ","$123.40 ","$70.72 ","$85.10 ","$49.50 ","$85.10 "
"30000220","EAP","CPT� 87798","","Ebv Dna-pcr, Qual","BOTH IP/OP","$900.00 ","$666.00 ","$17.55 ","$907.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$907.00 ","$36.84 ","$54.82 ","$718.34 ","$725.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30000221","EAP","CPT� 89050","","Csf Exam-hematology","BOTH IP/OP","$227.00 ","$167.98 ","$2.36 ","$214.00 ","$9.74 ","$2.36 ","$2.36 ","$6.90 ","$6.90 ","$6.99 ","$214.00 ","$4.96 ","$13.22 ","$169.49 ","$171.20 ","$6.84 ","$7.45 ","$4.72 ","$5.22 ","$4.72 "
"30000222","EAP","CPT� 89050","","Fluid Exam-heme","BOTH IP/OP","$227.00 ","$167.98 ","$2.36 ","$214.00 ","$9.74 ","$2.36 ","$2.36 ","$6.90 ","$6.90 ","$6.99 ","$214.00 ","$4.96 ","$13.22 ","$169.49 ","$171.20 ","$6.84 ","$7.45 ","$4.72 ","$5.22 ","$4.72 "
"30000223","EAP","CPT� 89060","","Synovial Fluid Crystal Id","BOTH IP/OP","$150.00 ","$111.00 ","$3.58 ","$150.00 ","$14.76 ","$3.67 ","$3.58 ","$10.44 ","$10.44 ","$10.56 ","$150.00 ","$7.70 ","$19.98 ","$118.80 ","$120.00 ","$10.63 ","$11.26 ","$7.33 ","$7.88 ","$7.33 "
"30000225","EAP","CPT� 87081","","Pertussis,state Lab","BOTH IP/OP","$631.00 ","$466.94 ","$3.31 ","$579.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$579.00 ","$6.96 ","$18.52 ","$458.57 ","$463.20 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30000228","EAP","CPT� 88275","","Fish,aml, Aml1/eto,translocation8,21,probe","BOTH IP/OP","$435.00 ","$321.90 ","$23.04 ","$432.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$432.00 ","$53.75 ","$112.22 ","$342.14 ","$345.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000229","EAP","CPT� 88271","","Fish,aml, Aml1/eto,translocation8,21,100-300 Cells","BOTH IP/OP","$435.00 ","$321.90 ","$10.71 ","$432.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$432.00 ","$22.49 ","$59.86 ","$342.14 ","$345.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000230","EAP","CPT� 88275","","Fish,mll,11g23,gene Rearrang,probe","BOTH IP/OP","$397.00 ","$293.78 ","$23.04 ","$394.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$394.00 ","$53.75 ","$112.22 ","$312.05 ","$315.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000231","EAP","CPT� 88271","","Fish,mll,11g23,gene Rearrang,100-300 Cells","BOTH IP/OP","$397.00 ","$293.78 ","$10.71 ","$394.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$394.00 ","$22.49 ","$59.86 ","$312.05 ","$315.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000232","EAP","CPT� 88235","","Sc Anemia,dna Probe,fetus","BOTH IP/OP","$258.00 ","$190.92 ","$0.00 ","$261.00 ","$258.00 ","$75.15 ","$0.00 ","$215.00 ","$215.00 ","$217.53 ","$261.00 ","$157.82 ","$261.00 ","$206.71 ","$208.80 ","$217.94 ","$231.78 ","$150.30 ","$162.25 ","$150.30 "
"30000234","EAP","HCPCS 88271","","Fish,dup 22q11.2, Probe","BOTH IP/OP","$330.00 ","$244.20 ","$10.71 ","$328.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$328.00 ","$22.49 ","$59.86 ","$259.78 ","$262.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000235","EAP","CPT� 88271","","Fish,dup 22q11.2, 100-300 Cells","BOTH IP/OP","$364.00 ","$269.36 ","$10.71 ","$362.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$362.00 ","$22.49 ","$59.86 ","$286.70 ","$289.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000236","EAP","CPT� 84432","","Thyroglobulin Panel","BOTH IP/OP","$68.00 ","$50.32 ","$8.03 ","$68.00 ","$33.16 ","$8.03 ","$8.03 ","$23.45 ","$23.45 ","$23.73 ","$68.00 ","$16.86 ","$44.88 ","$53.86 ","$54.40 ","$23.29 ","$25.28 ","$16.06 ","$17.70 ","$16.06 "
"30000237","EAP","CPT� 86800","","Thyroglobulin Panel, Antibody","BOTH IP/OP","$69.00 ","$51.06 ","$7.95 ","$69.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$69.00 ","$16.71 ","$44.44 ","$54.65 ","$55.20 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30000240","EAP","CPT� 83520","","Vasc Endothelial Gf,elisa","BOTH IP/OP","$593.00 ","$438.82 ","$7.77 ","$577.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$577.00 ","$18.13 ","$36.18 ","$456.98 ","$461.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000241","EAP","CPT� 83605","","Poct Lactate Venous (meter)","BOTH IP/OP","$239.00 ","$176.86 ","$5.34 ","$218.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$218.00 ","$12.15 ","$29.84 ","$172.66 ","$174.40 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30000242","EAP","CPT� 84484","","Poct Troponin Venous (meter)","BOTH IP/OP","$283.00 ","$209.42 ","$5.61 ","$286.00 ","$20.33 ","$6.24 ","$5.61 ","$14.37 ","$14.37 ","$14.54 ","$286.00 ","$13.09 ","$27.50 ","$226.51 ","$228.80 ","$18.08 ","$15.50 ","$12.47 ","$10.85 ","$12.47 "
"30000251","EAP","CPT� 86828","","Hla I/ii Ab Scr Plt Trans (arc)","BOTH IP/OP","$587.00 ","$434.38 ","$0.00 ","$593.00 ","$0.00 ","$0.00 ","$0.00 ","$55.25 ","$55.25 ","$0.00 ","$593.00 ","$0.00 ","$296.50 ","$469.66 ","$474.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000300","EAP","CPT� 80358","","Methadone - Urine","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$341.00 ","$0.03 ","$12.01 ","$10.03 ","$243.37 ","$243.37 ","$0.00 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000302","EAP","CPT� 86885","","Abid Ea Selected Cell","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$8.35 ","$8.35 ","$8.44 ","$170.00 ","$143.92 ","$15.98 ","$134.64 ","$136.00 ","$170.00 ","$9.00 ","$5.72 ","$6.30 ","$137.07 "
"30000411","EAP","CPT� 86927","","Ffp Thawing Ea Unit","BOTH IP/OP","$318.00 ","$235.32 ","$0.00 ","$289.00 ","$0.00 ","$0.00 ","$66.28 ","$10.25 ","$10.25 ","$50.60 ","$289.00 ","$143.92 ","$24.80 ","$228.89 ","$231.20 ","$199.96 ","$45.23 ","$0.00 ","$46.01 ","$137.07 "
"30000412","EAP","CPT� 84702","","D-hcg Free & Intact","BOTH IP/OP","$214.00 ","$158.36 ","$7.07 ","$218.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$218.00 ","$15.80 ","$17.94 ","$172.66 ","$174.40 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30000413","EAP","CPT� 86920","","Charge: Xmatch, Saline","BOTH IP/OP","$263.00 ","$194.62 ","$0.00 ","$286.00 ","$51.90 ","$146.06 ","$54.82 ","$26.20 ","$26.20 ","$50.08 ","$286.00 ","$143.92 ","$62.02 ","$226.51 ","$228.80 ","$199.96 ","$44.76 ","$0.00 ","$45.53 ","$137.07 "
"30000420","EAP","CPT� 36415","","Venipuncture","BOTH IP/OP","$43.00 ","$31.82 ","$1.35 ","$43.00 ","$23.35 ","$1.50 ","$1.35 ","$3.00 ","$3.00 ","$7.53 ","$43.00 ","$3.15 ","$21.50 ","$34.06 ","$34.40 ","$4.35 ","$6.73 ","$3.00 ","$6.85 ","$3.00 "
"30000425","EAP","CPT� 86923","","Crossmatch - Mass Transfusion","BOTH IP/OP","$314.00 ","$232.36 ","$0.00 ","$286.00 ","$41.63 ","$146.06 ","$65.45 ","$18.99 ","$18.99 ","$50.08 ","$286.00 ","$143.92 ","$44.66 ","$226.51 ","$228.80 ","$199.96 ","$44.76 ","$0.00 ","$45.53 ","$137.07 "
"30000426","EAP","CPT� 86480","","Quantiferon-tb Gold","BOTH IP/OP","$315.00 ","$233.10 ","$30.99 ","$318.00 ","$127.93 ","$30.99 ","$30.99 ","$90.49 ","$90.49 ","$91.55 ","$318.00 ","$65.08 ","$173.18 ","$251.86 ","$254.40 ","$89.87 ","$97.55 ","$61.98 ","$68.28 ","$61.98 "
"30000427","EAP","CPT� 86022","","Serotonin Release Assay (sra) Unfractionated","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$290.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$290.00 ","$0.00 ","$51.32 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000428","EAP","CPT� 86022","","Serotonin Release Assay (sra) Lmwh","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$290.00 ","$0.00 ","$51.32 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000429","EAP","CPT� 81599","","MATERNI T21� PLUS","BOTH IP/OP","$1,153.00 ","$853.22 ","$0.00 ","$1,318.00 ","$0.00 ","$205.23 ","$240.31 ","$940.66 ","$940.66 ","$230.77 ","$1,318.00 ","$0.00 ","$659.00 ","$1,043.86 ","$1,054.40 ","$790.80 ","$0.00 ","$0.00 ","$209.83 ","$0.00 "
"30000502","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$68.00 ","$50.32 ","$5.76 ","$77.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$77.00 ","$12.11 ","$29.88 ","$60.98 ","$61.60 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30000503","EAP","CPT� 86235","","Nuclear Antigen Antibody","BOTH IP/OP","$71.00 ","$52.54 ","$8.97 ","$87.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$87.00 ","$18.83 ","$50.12 ","$68.90 ","$69.60 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30000504","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$32.00 ","$23.68 ","$2.61 ","$40.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$40.00 ","$5.48 ","$14.60 ","$31.68 ","$32.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30000505","EAP","CPT� 86735","","Mumps Antibody","BOTH IP/OP","$32.00 ","$23.68 ","$6.53 ","$32.00 ","$26.93 ","$6.53 ","$6.53 ","$19.06 ","$19.06 ","$19.28 ","$32.00 ","$13.70 ","$32.00 ","$25.34 ","$25.60 ","$18.92 ","$20.54 ","$13.05 ","$14.38 ","$13.05 "
"30000506","EAP","CPT� 86644","","Cmv Antibody","BOTH IP/OP","$24.00 ","$17.76 ","$7.20 ","$24.00 ","$24.00 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$24.00 ","$15.11 ","$24.00 ","$19.01 ","$19.20 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30000507","EAP","CPT� 86710","","Influenza Virus Antibody","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$25.00 ","$6.78 ","$6.78 ","$19.80 ","$19.80 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000508","EAP","CPT� 84702","","Chorionic Gonadotropin Test","BOTH IP/OP","$162.00 ","$119.88 ","$7.07 ","$147.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$147.00 ","$15.80 ","$17.94 ","$116.42 ","$117.60 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30000509","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$402.00 ","$297.48 ","$8.39 ","$404.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$404.00 ","$19.57 ","$33.64 ","$319.97 ","$323.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30000510","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$201.00 ","$148.74 ","$8.39 ","$201.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$201.00 ","$19.57 ","$33.64 ","$159.19 ","$160.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30000515","EAP","CPT� 86022","","Platelet Antibodies","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$347.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$347.00 ","$0.00 ","$51.32 ","$274.82 ","$277.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000519","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$378.00 ","$279.72 ","$2.61 ","$471.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$471.00 ","$5.48 ","$14.60 ","$373.03 ","$376.80 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30000521","EAP","CPT� 86235","","Nuclear Antigen Antibody","BOTH IP/OP","$144.00 ","$106.56 ","$8.97 ","$176.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$176.00 ","$18.83 ","$50.12 ","$139.39 ","$140.80 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30000525","EAP","CPT� 82962","","Blood Glucose Check","BOTH IP/OP","$58.00 ","$42.92 ","$1.48 ","$53.00 ","$4.83 ","$1.64 ","$1.48 ","$3.42 ","$3.42 ","$3.45 ","$53.00 ","$3.44 ","$6.54 ","$41.98 ","$42.40 ","$4.76 ","$3.68 ","$3.28 ","$2.58 ","$3.28 "
"30000526","EAP","CPT� 86003","","Allegen - Mosquito Q","BOTH IP/OP","$96.00 ","$71.04 ","$2.61 ","$120.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$120.00 ","$5.48 ","$14.60 ","$95.04 ","$96.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30000527","EAP","CPT� 83916","","Oligoclonal Bands,csf(so)","BOTH IP/OP","$56.00 ","$41.44 ","$12.33 ","$51.00 ","$41.53 ","$13.70 ","$12.33 ","$29.36 ","$29.36 ","$29.69 ","$51.00 ","$28.76 ","$51.00 ","$40.39 ","$40.80 ","$39.72 ","$31.64 ","$27.39 ","$22.15 ","$27.39 "
"30000528","EAP","CPT� 84157","","Protein,total And Electrophoresis,csf(so)","BOTH IP/OP","$103.00 ","$76.22 ","$1.83 ","$101.00 ","$7.58 ","$2.00 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$101.00 ","$4.20 ","$10.24 ","$79.99 ","$80.80 ","$5.80 ","$5.77 ","$4.00 ","$4.04 ","$4.00 "
"30000529","EAP","CPT� 84166","","Protein,total And Electrophoresis,qnt,csf(so)","BOTH IP/OP","$89.00 ","$65.86 ","$8.91 ","$87.00 ","$36.80 ","$8.92 ","$8.91 ","$26.04 ","$26.04 ","$26.34 ","$87.00 ","$18.72 ","$49.84 ","$68.90 ","$69.60 ","$25.85 ","$28.07 ","$17.83 ","$19.65 ","$17.83 "
"30000530","EAP","CPT� 85810","","Viscosity, Serum(so)","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$77.00 ","$0.00 ","$0.00 ","$0.00 ","$17.05 ","$17.05 ","$0.00 ","$77.00 ","$0.00 ","$32.64 ","$60.98 ","$61.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000570","EAP","CPT� 86341","","Ia-2 Islet Cell Ab (so)","BOTH IP/OP","$193.00 ","$142.82 ","$10.61 ","$193.00 ","$40.84 ","$11.79 ","$10.61 ","$28.89 ","$28.89 ","$29.24 ","$193.00 ","$24.75 ","$55.30 ","$152.86 ","$154.40 ","$34.18 ","$31.16 ","$23.57 ","$21.81 ","$23.57 "
"30000571","EAP","CPT� 86355","","Lymph Sub 1 B Cells Tot (so)","BOTH IP/OP","$206.00 ","$152.44 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$214.00 ","$39.62 ","$65.82 ","$169.49 ","$171.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000572","EAP","CPT� 86357","","Lymph Sub 1 Nk Cells Tot (so)","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$204.00 ","$39.62 ","$65.82 ","$161.57 ","$163.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000573","EAP","CPT� 86359","","Lymph Sub 1 T Cells Tot (so)","BOTH IP/OP","$210.00 ","$155.40 ","$18.86 ","$218.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$218.00 ","$39.62 ","$65.82 ","$172.66 ","$174.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000574","EAP","CPT� 86360","","Lymph Sub 1 T Cell Ratio (so)","BOTH IP/OP","$311.00 ","$230.14 ","$23.49 ","$323.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$323.00 ","$49.33 ","$131.30 ","$255.82 ","$258.40 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30000602","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$94.00 ","$69.56 ","$10.71 ","$94.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$94.00 ","$22.49 ","$59.86 ","$74.45 ","$75.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000604","EAP","CPT� 86603","","Adenovirus Antibody","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$18.79 ","$18.79 ","$19.01 ","$88.00 ","$13.51 ","$35.96 ","$69.70 ","$70.40 ","$18.66 ","$0.00 ","$12.87 ","$14.18 ","$12.87 "
"30000605","EAP","CPT� 84182","","Protein Western Blot Test","BOTH IP/OP","$513.00 ","$379.62 ","$13.14 ","$513.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$513.00 ","$30.67 ","$50.30 ","$406.30 ","$410.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30000610","EAP","CPT� 86316","","Immunoassay Tumor Other","BOTH IP/OP","$217.00 ","$160.58 ","$10.41 ","$219.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$219.00 ","$21.85 ","$58.14 ","$173.45 ","$175.20 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30000611","EAP","CPT� 88305","","Tissue Exam By Pathologist","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$205.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$205.00 ","$49.62 ","$140.98 ","$162.36 ","$164.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"30000612","EAP","CPT� 88311","","Decalcify Tissue","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$104.00 ","$34.06 ","$0.00 ","$9.89 ","$6.15 ","$6.15 ","$18.15 ","$104.00 ","$0.00 ","$12.30 ","$82.37 ","$83.20 ","$0.00 ","$19.34 ","$9.00 ","$13.54 ","$0.00 "
"30000613","EAP","CPT� 88313","","Special Stains Group 2","BOTH IP/OP","$146.00 ","$108.04 ","$31.93 ","$145.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$145.00 ","$33.53 ","$110.70 ","$114.84 ","$116.00 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"30000614","EAP","CPT� 85097","","Bone Marrow Interpretation","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$46.75 ","$46.75 ","$75.35 ","$700.00 ","$630.05 ","$213.48 ","$554.40 ","$560.00 ","$700.00 ","$80.29 ","$51.21 ","$56.20 ","$600.04 "
"30000615","EAP","CPT� 82507","","Assay Of Citrate","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$0.00 ","$0.00 ","$13.90 ","$40.60 ","$40.60 ","$0.00 ","$192.00 ","$0.00 ","$77.70 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000616","EAP","CPT� 82131","","Amino Acids Single Quant","BOTH IP/OP","$68.00 ","$50.32 ","$10.34 ","$68.00 ","$34.82 ","$11.49 ","$10.34 ","$24.63 ","$24.63 ","$24.92 ","$68.00 ","$24.13 ","$47.14 ","$53.86 ","$54.40 ","$33.32 ","$26.55 ","$22.98 ","$18.58 ","$22.98 "
"30000617","EAP","CPT� 86480","","Tb Test Cell Immun Measure","BOTH IP/OP","$500.00 ","$370.00 ","$30.99 ","$603.00 ","$127.93 ","$30.99 ","$30.99 ","$90.49 ","$90.49 ","$91.55 ","$603.00 ","$65.08 ","$173.18 ","$477.58 ","$482.40 ","$89.87 ","$97.55 ","$61.98 ","$68.28 ","$61.98 "
"30000618","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$2,073.00 ","$1,534.02 ","$5.76 ","$2,340.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$2,340.00 ","$12.11 ","$29.88 ","$1,853.28 ","$1,872.00 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30000621","EAP","CPT� 82943","","Assay Of Glucagon","BOTH IP/OP","$82.00 ","$60.68 ","$0.00 ","$82.00 ","$0.00 ","$0.00 ","$0.00 ","$20.86 ","$20.86 ","$0.00 ","$82.00 ","$0.00 ","$39.94 ","$64.94 ","$65.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000622","EAP","CPT� 82040","","Assay Of Serum Albumin","BOTH IP/OP","$10.00 ","$7.40 ","$2.48 ","$10.00 ","$5.94 ","$2.48 ","$2.48 ","$4.20 ","$4.20 ","$4.25 ","$10.00 ","$5.20 ","$8.04 ","$7.92 ","$8.00 ","$7.18 ","$4.53 ","$4.95 ","$3.17 ","$4.95 "
"30000623","EAP","CPT� 84270","","Assay Of Sex Hormone Globul","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$10.87 ","$31.73 ","$31.73 ","$0.00 ","$35.00 ","$0.00 ","$35.00 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000624","EAP","CPT� 84403","","Assay Of Total Testosterone","BOTH IP/OP","$50.00 ","$37.00 ","$12.91 ","$50.00 ","$50.00 ","$12.91 ","$12.91 ","$37.70 ","$37.70 ","$38.15 ","$50.00 ","$27.10 ","$50.00 ","$39.60 ","$40.00 ","$37.42 ","$40.65 ","$25.81 ","$28.45 ","$25.81 "
"30000625","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$996.00 ","$737.04 ","$7.77 ","$1,124.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$1,124.00 ","$18.13 ","$36.18 ","$890.21 ","$899.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000626","EAP","CPT� 87906","","Genotype Dna Hiv Reverse T","BOTH IP/OP","$159.00 ","$117.66 ","$43.01 ","$192.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$192.00 ","$135.17 ","$96.00 ","$152.06 ","$153.60 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30000627","EAP","CPT� 87903","","Phenotype Dna Hiv W/culture","BOTH IP/OP","$855.00 ","$632.70 ","$0.00 ","$884.00 ","$0.00 ","$0.00 ","$0.00 ","$493.83 ","$493.83 ","$0.00 ","$884.00 ","$0.00 ","$884.00 ","$700.13 ","$707.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000628","EAP","CPT� 87904","","Phenotype Dna Hiv W/clt Add","BOTH IP/OP","$172.00 ","$127.28 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$32.28 ","$32.28 ","$0.00 ","$178.00 ","$0.00 ","$61.78 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000629","EAP","CPT� 83785","","Assay Of Manganese","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$50.77 ","$13.33 ","$12.30 ","$35.90 ","$35.90 ","$0.00 ","$69.00 ","$0.00 ","$68.72 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000630","EAP","CPT� 82300","","Assay Of Cadmium","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$67.00 ","$47.78 ","$11.82 ","$11.57 ","$33.79 ","$33.79 ","$0.00 ","$67.00 ","$0.00 ","$64.66 ","$53.06 ","$53.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000631","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$77.00 ","$56.98 ","$2.59 ","$77.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$77.00 ","$5.44 ","$14.46 ","$60.98 ","$61.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30000632","EAP","CPT� 83885","","Assay Of Nickel","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$0.00 ","$35.77 ","$35.77 ","$0.00 ","$69.00 ","$0.00 ","$68.46 ","$54.65 ","$55.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000633","EAP","CPT� 83018","","Quantitative Screen Metals","BOTH IP/OP","$114.00 ","$84.36 ","$0.00 ","$114.00 ","$0.00 ","$0.00 ","$0.00 ","$32.06 ","$32.06 ","$0.00 ","$114.00 ","$0.00 ","$61.36 ","$90.29 ","$91.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000634","EAP","CPT� 83785","","Assay Of Manganese","BOTH IP/OP","$79.00 ","$58.46 ","$0.00 ","$79.00 ","$50.77 ","$13.33 ","$12.30 ","$35.90 ","$35.90 ","$0.00 ","$79.00 ","$0.00 ","$68.72 ","$62.57 ","$63.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000635","EAP","CPT� 82525","","Assay Of Copper","BOTH IP/OP","$61.00 ","$45.14 ","$6.21 ","$62.00 ","$25.61 ","$6.21 ","$6.21 ","$18.12 ","$18.12 ","$18.33 ","$62.00 ","$13.03 ","$34.68 ","$49.10 ","$49.60 ","$17.99 ","$19.53 ","$12.41 ","$13.67 ","$12.41 "
"30000636","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$974.00 ","$720.76 ","$7.77 ","$947.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$947.00 ","$18.13 ","$36.18 ","$750.02 ","$757.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30000637","EAP","CPT� 80361","","Assay Of Dihydrocodeinone","BOTH IP/OP","$257.00 ","$190.18 ","$0.00 ","$272.00 ","$0.03 ","$12.01 ","$11.94 ","$194.13 ","$194.13 ","$30.51 ","$272.00 ","$0.00 ","$136.00 ","$215.42 ","$217.60 ","$163.20 ","$32.51 ","$0.00 ","$22.76 ","$0.00 "
"30000706","EAP","CPT� 81479","","Rhd Variant By Snp (arc)","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,136.00 ","$0.00 ","$204.70 ","$239.69 ","$810.76 ","$810.76 ","$1,045.61 ","$1,136.00 ","$0.00 ","$568.00 ","$899.71 ","$908.80 ","$681.60 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"30000710","EAP","CPT� 81479","","Rhce Variant By Snp (arc)","BOTH IP/OP","$994.00 ","$735.56 ","$0.00 ","$1,114.12 ","$0.00 ","$176.93 ","$207.17 ","$700.85 ","$700.85 ","$1,045.61 ","$982.00 ","$0.00 ","$491.00 ","$777.74 ","$785.60 ","$589.20 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"30000715","EAP","CPT� 86355","","Cd19 B-cells (flow Cytometry) So","BOTH IP/OP","$81.00 ","$59.94 ","$0.00 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$84.00 ","$39.62 ","$65.82 ","$66.53 ","$67.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30000716","EAP","CPT� 81403","","Xhea Licensed Rbc Panel (arc)","BOTH IP/OP","$831.00 ","$614.94 ","$83.34 ","$821.00 ","$264.00 ","$92.60 ","$83.34 ","$585.95 ","$585.95 ","$220.85 ","$821.00 ","$194.46 ","$410.50 ","$650.23 ","$656.80 ","$268.54 ","$235.32 ","$185.20 ","$164.72 ","$185.20 "
"30000750","EAP","CPT� 85335","","Adamts 13 Inhibitor (so)","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$379.00 ","$0.00 ","$0.00 ","$0.00 ","$18.80 ","$18.80 ","$0.00 ","$379.00 ","$0.00 ","$35.98 ","$300.17 ","$303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000751","EAP","CPT� 87900","","Hiv Genotyping","BOTH IP/OP","$1,201.00 ","$888.74 ","$0.00 ","$1,355.00 ","$0.00 ","$0.00 ","$0.00 ","$161.40 ","$161.40 ","$0.00 ","$1,355.00 ","$0.00 ","$308.90 ","$1,073.16 ","$1,084.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000753","EAP","CPT� 86830","","Hla Ab Id (arc)","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$565.00 ","$0.00 ","$0.00 ","$0.00 ","$112.58 ","$112.58 ","$0.00 ","$565.00 ","$0.00 ","$282.50 ","$447.48 ","$452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000755","EAP","CPT� 81310","","Npm (exon 12) Mutation,gene Analy(so)","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$699.00 ","$0.00 ","$0.00 ","$0.00 ","$247.14 ","$247.14 ","$0.00 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000761","EAP","CPT� 81245","","FLT3 ITD and TKD Mutation,Variants(SO)","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$509.00 ","$0.00 ","$0.00 ","$0.00 ","$165.92 ","$165.92 ","$0.00 ","$509.00 ","$0.00 ","$254.50 ","$403.13 ","$407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000762","EAP","CPT� 81246","","CEBPA Mutation(SO)","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$658.00 ","$0.00 ","$0.00 ","$0.00 ","$469.61 ","$469.61 ","$0.00 ","$658.00 ","$0.00 ","$329.00 ","$521.14 ","$526.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000764","EAP","CPT� 81450","","Myeloproliferative Neoplasm Mut(SO)","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,891.00 ","$982.56 ","$379.77 ","$0.00 ","$1,349.61 ","$1,349.61 ","$0.00 ","$1,891.00 ","$0.00 ","$945.50 ","$1,497.67 ","$1,512.80 ","$0.00 ","$295.94 ","$0.00 ","$0.00 ","$0.00 "
"30000766","EAP","CPT� 81261","","Lympho Clonal Panel, IGK,PCR(SO)","BOTH IP/OP","$878.00 ","$649.72 ","$0.00 ","$1,003.00 ","$0.00 ","$0.00 ","$0.00 ","$270.11 ","$270.11 ","$286.64 ","$1,003.00 ","$0.00 ","$501.50 ","$794.38 ","$802.40 ","$0.00 ","$305.42 ","$0.00 ","$0.00 ","$0.00 "
"30000767","EAP","CPT� 81264","","Lympho Clonal Panel,TRB PCR(SO)","BOTH IP/OP","$913.00 ","$675.62 ","$0.00 ","$1,043.00 ","$0.00 ","$0.00 ","$0.00 ","$203.72 ","$203.72 ","$115.59 ","$1,043.00 ","$0.00 ","$521.50 ","$826.06 ","$834.40 ","$0.00 ","$123.17 ","$0.00 ","$0.00 ","$0.00 "
"30000768","EAP","CPT� 81340","","Lympho Clonal Panel,TRG PCR(SO)","BOTH IP/OP","$526.00 ","$389.24 ","$0.00 ","$601.00 ","$0.00 ","$0.00 ","$0.00 ","$285.02 ","$285.02 ","$0.00 ","$601.00 ","$0.00 ","$300.50 ","$475.99 ","$480.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000769","EAP","CPT� 81342","","Lympho Clonal Panel, PCR,Unlisted Proc(SO)","BOTH IP/OP","$624.00 ","$461.76 ","$0.00 ","$713.00 ","$415.93 ","$100.75 ","$100.75 ","$274.90 ","$274.90 ","$0.00 ","$713.00 ","$0.00 ","$356.50 ","$564.70 ","$570.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000770","EAP","CPT� 84999","","B-Cell Clonality Panel (IGH)(SO)","BOTH IP/OP","$517.00 ","$382.58 ","$0.00 ","$551.00 ","$0.00 ","$92.03 ","$0.00 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$0.00 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$0.00 ","$0.00 "
"30000771","EAP","CPT� 81261","","B-Cell Clonality Panel (IGK)(SO)","BOTH IP/OP","$755.00 ","$558.70 ","$0.00 ","$746.00 ","$0.00 ","$0.00 ","$0.00 ","$270.11 ","$270.11 ","$286.64 ","$746.00 ","$0.00 ","$373.00 ","$590.83 ","$596.80 ","$0.00 ","$305.42 ","$0.00 ","$0.00 ","$0.00 "
"30000772","EAP","CPT� 81264","","B-Cell Clonality Panel,Unlisted Proc(SO)","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$628.00 ","$0.00 ","$0.00 ","$0.00 ","$203.72 ","$203.72 ","$115.59 ","$628.00 ","$0.00 ","$314.00 ","$497.38 ","$502.40 ","$0.00 ","$123.17 ","$0.00 ","$0.00 ","$0.00 "
"30000773","EAP","CPT� 84999","","MYD88, Mutation Analysis(SO)","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$958.00 ","$0.00 ","$172.66 ","$0.00 ","$683.72 ","$683.72 ","$167.74 ","$958.00 ","$0.00 ","$0.00 ","$758.74 ","$766.40 ","$0.00 ","$149.93 ","$0.00 ","$0.00 ","$0.00 "
"30000774","EAP","CPT� 81479","","KIT D816, Mutation Analysis(SO)","BOTH IP/OP","$1,437.00 ","$1,063.38 ","$0.00 ","$1,420.00 ","$0.00 ","$255.79 ","$299.51 ","$1,013.45 ","$1,013.45 ","$1,045.61 ","$1,420.00 ","$0.00 ","$710.00 ","$1,124.64 ","$1,136.00 ","$852.00 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"30000777","EAP","CPT� 88271","","Fish, ALL, TEL/ AML1 Transl,100-300 Cells(SO)","BOTH IP/OP","$357.00 ","$264.18 ","$10.71 ","$357.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$357.00 ","$22.49 ","$59.86 ","$282.74 ","$285.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000778","EAP","CPT� 88275","","Chromosome Analysis, Lymph Node,BM(SO)","BOTH IP/OP","$1,347.00 ","$996.78 ","$23.04 ","$1,347.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$1,347.00 ","$53.75 ","$112.22 ","$1,066.82 ","$1,077.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000779","EAP","CPT� 88237","","ChromAnaly, Lymph Node,20-25 Cells(SO)","BOTH IP/OP","$1,567.00 ","$1,159.58 ","$64.69 ","$1,736.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$1,736.00 ","$150.94 ","$246.70 ","$1,374.91 ","$1,388.80 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30000780","EAP","CPT� 88264","","Fish, B-Cell Malignancy, IGH, 14q32(SO)","BOTH IP/OP","$460.00 ","$340.40 ","$65.07 ","$510.00 ","$257.29 ","$72.31 ","$65.07 ","$181.98 ","$181.98 ","$184.12 ","$510.00 ","$151.84 ","$348.28 ","$403.92 ","$408.00 ","$209.68 ","$196.18 ","$144.61 ","$137.33 ","$144.61 "
"30000781","EAP","CPT� 88271","","Fish, B-Cell Malig, IGH, 14q32,100-300 Cells(SO)","BOTH IP/OP","$398.00 ","$294.52 ","$10.71 ","$395.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$395.00 ","$22.49 ","$59.86 ","$312.84 ","$316.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000782","EAP","CPT� 88275","","ZAP -70(SO)","BOTH IP/OP","$233.00 ","$172.42 ","$23.04 ","$231.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$231.00 ","$53.75 ","$112.22 ","$182.95 ","$184.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000783","EAP","CPT� 88184","","ZAP -70,Add Marker(SO)","BOTH IP/OP","$303.00 ","$224.22 ","$30.49 ","$303.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$303.00 ","$284.24 ","$133.74 ","$239.98 ","$242.40 ","$303.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30000784","EAP","CPT� 88185","","CLL Prognostic Panel,First Marker(SO)","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$130.00 ","$0.00 ","$71.72 ","$102.96 ","$104.00 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000785","EAP","CPT� 88184","","CLL Prognostic Panel,Add Marker(SO)-1","BOTH IP/OP","$303.00 ","$224.22 ","$30.49 ","$303.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$303.00 ","$284.24 ","$133.74 ","$239.98 ","$242.40 ","$303.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30000786","EAP","CPT� 88185","","CLL Prognostic Panel,Add Marker(SO)-2","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$130.00 ","$0.00 ","$71.72 ","$102.96 ","$104.00 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000787","EAP","CPT� 88185","","CLL Prognostic Panel,IGH(SO)","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$463.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$463.00 ","$0.00 ","$71.72 ","$366.70 ","$370.40 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000788","EAP","CPT� 81263","","CLL Prognostic Panel,Beta-2(SO)","BOTH IP/OP","$559.00 ","$413.66 ","$86.22 ","$639.00 ","$559.00 ","$147.26 ","$147.26 ","$401.79 ","$401.79 ","$115.59 ","$639.00 ","$309.25 ","$319.50 ","$506.09 ","$511.20 ","$427.05 ","$123.17 ","$294.52 ","$86.22 ","$294.52 "
"30000789","EAP","CPT� 82232","","CLL Prognostic Panel,DNA Probe(SO)-1","BOTH IP/OP","$327.00 ","$241.98 ","$8.09 ","$409.00 ","$33.40 ","$8.09 ","$8.09 ","$23.62 ","$23.62 ","$23.91 ","$409.00 ","$16.99 ","$45.22 ","$323.93 ","$327.20 ","$23.46 ","$25.48 ","$16.18 ","$17.83 ","$16.18 "
"30000790","EAP","CPT� 88271","","CLL Prognostic Panel,DNA Probe(SO)-2","BOTH IP/OP","$218.00 ","$161.32 ","$10.71 ","$218.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$218.00 ","$22.49 ","$59.86 ","$172.66 ","$174.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000791","EAP","CPT� 88271","","CLL Prognostic Panel,DNA Probe(SO)-3","BOTH IP/OP","$218.00 ","$161.32 ","$10.71 ","$218.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$218.00 ","$22.49 ","$59.86 ","$172.66 ","$174.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000792","EAP","CPT� 88271","","CLL Prognostic Panel,DNA Probe(SO)-4","BOTH IP/OP","$218.00 ","$161.32 ","$10.71 ","$218.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$218.00 ","$22.49 ","$59.86 ","$172.66 ","$174.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000793","EAP","CPT� 88271","","CLL Prognostic Panel,DNA Probe(SO)-5","BOTH IP/OP","$218.00 ","$161.32 ","$10.71 ","$218.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$218.00 ","$22.49 ","$59.86 ","$172.66 ","$174.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000794","EAP","CPT� 88271","","CLL Prognostic Panel,100-300 Cells(SO)-1","BOTH IP/OP","$218.00 ","$161.32 ","$10.71 ","$218.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$218.00 ","$22.49 ","$59.86 ","$172.66 ","$174.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000795","EAP","CPT� 88275","","CLL Prognostic Panel,100-300 Cells(SO)-2","BOTH IP/OP","$218.00 ","$161.32 ","$23.04 ","$218.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$218.00 ","$53.75 ","$112.22 ","$172.66 ","$174.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000796","EAP","CPT� 88275","","CLL Prognostic Panel,100-300 Cells(SO)-3","BOTH IP/OP","$218.00 ","$161.32 ","$23.04 ","$218.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$218.00 ","$53.75 ","$112.22 ","$172.66 ","$174.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000797","EAP","CPT� 88275","","CLL Prognostic Panel,100-300 Cells(SO)-4","BOTH IP/OP","$218.00 ","$161.32 ","$23.04 ","$218.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$218.00 ","$53.75 ","$112.22 ","$172.66 ","$174.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000798","EAP","CPT� 88275","","CLL Prognostic Panel,100-300 Cells(SO)-5","BOTH IP/OP","$218.00 ","$161.32 ","$23.04 ","$218.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$218.00 ","$53.75 ","$112.22 ","$172.66 ","$174.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000799","EAP","CPT� 88275","","CLL Prognostic Panel,BM(SO)","BOTH IP/OP","$233.00 ","$172.42 ","$23.04 ","$233.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$233.00 ","$53.75 ","$112.22 ","$184.54 ","$186.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000800","EAP","CPT� 88237","","CLL Prognostic Panel,20-25 Cells(SO)","BOTH IP/OP","$382.00 ","$282.68 ","$64.69 ","$423.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$423.00 ","$150.94 ","$246.70 ","$335.02 ","$338.40 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30000801","EAP","CPT� 88264","","CHROM, CLL/LPD,BM(SO)","BOTH IP/OP","$592.00 ","$438.08 ","$65.07 ","$656.00 ","$257.29 ","$72.31 ","$65.07 ","$181.98 ","$181.98 ","$184.12 ","$656.00 ","$151.84 ","$348.28 ","$519.55 ","$524.80 ","$209.68 ","$196.18 ","$144.61 ","$137.33 ","$144.61 "
"30000802","EAP","CPT� 88237","","CHROM, CLL/LPD, 20-25 Cells(SO)","BOTH IP/OP","$592.00 ","$438.08 ","$64.69 ","$656.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$656.00 ","$150.94 ","$246.70 ","$519.55 ","$524.80 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30000803","EAP","CPT� 88264","","CHROM, CLL/LPD,Interp(SO)","BOTH IP/OP","$592.00 ","$438.08 ","$65.07 ","$656.00 ","$257.29 ","$72.31 ","$65.07 ","$181.98 ","$181.98 ","$184.12 ","$656.00 ","$151.84 ","$348.28 ","$519.55 ","$524.80 ","$209.68 ","$196.18 ","$144.61 ","$137.33 ","$144.61 "
"30000805","EAP","CPT� 88271","","Fish, ALL, Pre-B,100-300 Cells(SO)","BOTH IP/OP","$1,002.00 ","$741.48 ","$10.71 ","$1,002.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$1,002.00 ","$22.49 ","$59.86 ","$793.58 ","$801.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000806","EAP","CPT� 88275","","Fish, MALT Lymph, rea18q21,DNA Probe(SO)-1","BOTH IP/OP","$303.00 ","$224.22 ","$23.04 ","$303.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$303.00 ","$53.75 ","$112.22 ","$239.98 ","$242.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000807","EAP","CPT� 88271","","Fish, MALT Lymph, rea18q21,DNA Probe(SO)-2","BOTH IP/OP","$303.00 ","$224.22 ","$10.71 ","$303.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$303.00 ","$22.49 ","$59.86 ","$239.98 ","$242.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000808","EAP","CPT� 88271","","Fish, MALT Lymph, rea18q21100-300 Cells(SO)","BOTH IP/OP","$303.00 ","$224.22 ","$10.71 ","$303.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$303.00 ","$22.49 ","$59.86 ","$239.98 ","$242.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000809","EAP","CPT� 88275","","Fish, TCL1, 14q32.1,DNA Probe(SO)-1","BOTH IP/OP","$231.00 ","$170.94 ","$23.04 ","$231.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$231.00 ","$53.75 ","$112.22 ","$182.95 ","$184.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000810","EAP","CPT� 88271","","Fish, TCL1, 14q32.1,DNA Probe(SO)-2","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000811","EAP","CPT� 88271","","Fish, TCL1, 14q32.1,100-300 Cells(SO)","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000812","EAP","CPT� 88275","","Fish, T-Cell Receptor Alpha/ Delta,DNA Probe(SO)-1","BOTH IP/OP","$231.00 ","$170.94 ","$23.04 ","$231.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$231.00 ","$53.75 ","$112.22 ","$182.95 ","$184.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000813","EAP","CPT� 88271","","Fish, T-Cell Receptor Alpha/ Delta,DNA Probe(SO)-2","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000814","EAP","CPT� 88271","","Fish, T-Cell Receptor Alpha/ Delta,100-300 Cells(SO)","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000815","EAP","CPT� 88275","","Chrom. Microarray, Hematologic Malig.(SO)","BOTH IP/OP","$2,718.00 ","$2,011.32 ","$23.04 ","$2,718.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$2,718.00 ","$53.75 ","$112.22 ","$2,152.66 ","$2,174.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000816","EAP","CPT� 81406","","Fish, Mult Myel, IGH/ MAFB,DNA Probe(SO)-1","BOTH IP/OP","$283.00 ","$209.42 ","$0.00 ","$323.00 ","$237.60 ","$141.44 ","$127.30 ","$230.53 ","$230.53 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30000817","EAP","CPT� 88271","","Fish, Mult Myel, IGH/ MAFB,DNA Probe(SO)-2","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000818","EAP","CPT� 88271","","Fish, Mult Myel, IGH/ MAFB,100-300 Cells(SO)","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000819","EAP","CPT� 88275","","Fish, Mult Myel, 1q21,DNA Probe(SO)-1","BOTH IP/OP","$231.00 ","$170.94 ","$23.04 ","$231.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$231.00 ","$53.75 ","$112.22 ","$182.95 ","$184.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000820","EAP","CPT� 88271","","Fish, Mult Myel, 1q21,DNA Probe(SO)-2","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000821","EAP","CPT� 88271","","Fish, Mult Myel, 1q21,100-300 Cells(SO)","BOTH IP/OP","$231.00 ","$170.94 ","$10.71 ","$231.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$231.00 ","$22.49 ","$59.86 ","$182.95 ","$184.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000822","EAP","CPT� 88275","","Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-1","BOTH IP/OP","$251.00 ","$185.74 ","$23.04 ","$251.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$251.00 ","$53.75 ","$112.22 ","$198.79 ","$200.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000823","EAP","CPT� 88271","","Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-2","BOTH IP/OP","$251.00 ","$185.74 ","$10.71 ","$251.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$251.00 ","$22.49 ","$59.86 ","$198.79 ","$200.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000824","EAP","CPT� 88271","","Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-3","BOTH IP/OP","$251.00 ","$185.74 ","$10.71 ","$251.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$251.00 ","$22.49 ","$59.86 ","$198.79 ","$200.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000825","EAP","CPT� 88271","","Fish, Myeloid Neoplasms, MECOM,100-300 Cells(SO)","BOTH IP/OP","$251.00 ","$185.74 ","$10.71 ","$251.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$251.00 ","$22.49 ","$59.86 ","$198.79 ","$200.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000826","EAP","CPT� 88275","","Fish, High-Grade LymphPanel,DNA Probe(SO)-1","BOTH IP/OP","$312.00 ","$230.88 ","$23.04 ","$312.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$312.00 ","$53.75 ","$112.22 ","$247.10 ","$249.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000827","EAP","CPT� 88271","","Fish, High-Grade LymphPanel,DNA Probe(SO)-2","BOTH IP/OP","$314.00 ","$232.36 ","$10.71 ","$312.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$312.00 ","$22.49 ","$59.86 ","$247.10 ","$249.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000828","EAP","CPT� 88271","","Fish, High-Grade LymphPanel,DNA Probe(SO)-3","BOTH IP/OP","$314.00 ","$232.36 ","$10.71 ","$312.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$312.00 ","$22.49 ","$59.86 ","$247.10 ","$249.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000829","EAP","CPT� 88271","","Fish, High-Grade LymphPanel,DNA Probe(SO)-4","BOTH IP/OP","$314.00 ","$232.36 ","$10.71 ","$312.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$312.00 ","$22.49 ","$59.86 ","$247.10 ","$249.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000830","EAP","CPT� 88271","","Fish, High-Grade LymphPanel,DNA Probe(SO)-5","BOTH IP/OP","$314.00 ","$232.36 ","$10.71 ","$312.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$312.00 ","$22.49 ","$59.86 ","$247.10 ","$249.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000831","EAP","CPT� 88271","","Fish, High-Grade LymphPanel,DNA Probe(SO)-6","BOTH IP/OP","$314.00 ","$232.36 ","$10.71 ","$312.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$312.00 ","$22.49 ","$59.86 ","$247.10 ","$249.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000832","EAP","CPT� 88271","","Fish, High-Grade LymphPanel,100-300 Cells(SO)-1","BOTH IP/OP","$314.00 ","$232.36 ","$10.71 ","$312.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$312.00 ","$22.49 ","$59.86 ","$247.10 ","$249.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000833","EAP","CPT� 88275","","Fish, High-Grade LymphPanel,100-300 Cells(SO)-2","BOTH IP/OP","$314.00 ","$232.36 ","$23.04 ","$312.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$312.00 ","$53.75 ","$112.22 ","$247.10 ","$249.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000834","EAP","CPT� 88275","","Fish, High-Grade LymphPanel,100-300 Cells(SO)-3","BOTH IP/OP","$314.00 ","$232.36 ","$23.04 ","$312.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$312.00 ","$53.75 ","$112.22 ","$247.10 ","$249.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000835","EAP","CPT� 88275","","CLL Prognostic Panel, Comp,First Marker(SO)","BOTH IP/OP","$130.00 ","$96.20 ","$23.04 ","$129.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$129.00 ","$53.75 ","$112.22 ","$102.17 ","$103.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000836","EAP","CPT� 88184","","CLL Prognostic Panel, Comp,Add  Marker(SO)-1","BOTH IP/OP","$500.00 ","$370.00 ","$30.49 ","$500.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$500.00 ","$284.24 ","$133.74 ","$396.00 ","$400.00 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30000837","EAP","CPT� 88185","","CLL Prognostic Panel, Comp,Add  Marker(SO)-2","BOTH IP/OP","$77.00 ","$56.98 ","$0.00 ","$77.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$77.00 ","$0.00 ","$71.72 ","$60.98 ","$61.60 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000838","EAP","CPT� 88185","","CLL Prognostic Panel,Comp,Beta-2(SO)","BOTH IP/OP","$77.00 ","$56.98 ","$0.00 ","$77.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$77.00 ","$0.00 ","$71.72 ","$60.98 ","$61.60 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000839","EAP","CPT� 82232","","CLL Prognostic Panel, Comp,DNA Probe(SO)-1","BOTH IP/OP","$194.00 ","$143.56 ","$8.09 ","$242.00 ","$33.40 ","$8.09 ","$8.09 ","$23.62 ","$23.62 ","$23.91 ","$242.00 ","$16.99 ","$45.22 ","$191.66 ","$193.60 ","$23.46 ","$25.48 ","$16.18 ","$17.83 ","$16.18 "
"30000840","EAP","CPT� 88271","","CLL Prognostic Panel, Comp,DNA Probe(SO)-2","BOTH IP/OP","$129.00 ","$95.46 ","$10.71 ","$129.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$129.00 ","$22.49 ","$59.86 ","$102.17 ","$103.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000841","EAP","CPT� 88271","","CLL Prognostic Panel, Comp,DNA Probe(SO)-3","BOTH IP/OP","$129.00 ","$95.46 ","$10.71 ","$129.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$129.00 ","$22.49 ","$59.86 ","$102.17 ","$103.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000842","EAP","CPT� 88271","","CLL Prognostic Panel, Comp,DNA Probe(SO)-4","BOTH IP/OP","$129.00 ","$95.46 ","$10.71 ","$129.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$129.00 ","$22.49 ","$59.86 ","$102.17 ","$103.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000843","EAP","CPT� 88271","","CLL Prognostic Panel, Comp,DNA Probe(SO)-5","BOTH IP/OP","$129.00 ","$95.46 ","$10.71 ","$129.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$129.00 ","$22.49 ","$59.86 ","$102.17 ","$103.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000844","EAP","CPT� 88271","","CLL Prognostic Panel, Comp,100-300 Cells(SO)-1","BOTH IP/OP","$129.00 ","$95.46 ","$10.71 ","$129.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$129.00 ","$22.49 ","$59.86 ","$102.17 ","$103.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30000845","EAP","CPT� 88275","","CLL Prognostic Panel, Comp,100-300 Cells(SO)-2","BOTH IP/OP","$129.00 ","$95.46 ","$23.04 ","$129.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$129.00 ","$53.75 ","$112.22 ","$102.17 ","$103.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000846","EAP","CPT� 88275","","CLL Prognostic Panel, Comp,100-300 Cells(SO)-3","BOTH IP/OP","$129.00 ","$95.46 ","$23.04 ","$129.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$129.00 ","$53.75 ","$112.22 ","$102.17 ","$103.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000847","EAP","CPT� 88275","","CLL Prognostic Panel, Comp,100-300 Cells(SO)-4","BOTH IP/OP","$129.00 ","$95.46 ","$23.04 ","$129.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$129.00 ","$53.75 ","$112.22 ","$102.17 ","$103.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000848","EAP","CPT� 88275","","CLL Prognostic Panel, Comp,100-300 Cells(SO)-5","BOTH IP/OP","$129.00 ","$95.46 ","$23.04 ","$129.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$129.00 ","$53.75 ","$112.22 ","$102.17 ","$103.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000849","EAP","CPT� 88275","","CLL Lymphoma Follow-up Panel,First Marker(SO)","BOTH IP/OP","$119.00 ","$88.06 ","$23.04 ","$119.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$119.00 ","$53.75 ","$112.22 ","$94.25 ","$95.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30000850","EAP","CPT� 88184","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-1","BOTH IP/OP","$500.00 ","$370.00 ","$30.49 ","$500.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$500.00 ","$284.24 ","$133.74 ","$396.00 ","$400.00 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30000851","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-2","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000852","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-3","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000853","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-4","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000854","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-5","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000855","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-6","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000856","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-7","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000857","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-8","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000858","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-9","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000859","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-10","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000860","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-11","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000861","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-12","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000862","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-13","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000863","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,Add Marker(SO)-14","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000864","EAP","CPT� 88185","","CLL Lymphoma Follow-up Panel,9-15 Markers(SO)","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30000865","EAP","CPT� 88188","","Cll Lymphoma Follow-up Panel,9-15 Markers(so)","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$0.00 ","$0.00 ","$0.00 ","$50.67 ","$50.67 ","$0.00 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30005065","EAP","CPT� 82948","","Glu-random,wb Micro","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30040001","EAP","CPT� 86885","","Abid Ea Selected Cell (arc)","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$8.35 ","$8.35 ","$8.44 ","$150.00 ","$143.92 ","$15.98 ","$118.80 ","$120.00 ","$150.00 ","$9.00 ","$5.72 ","$6.30 ","$137.07 "
"30050138","EAP","CPT� 86880","","Direct Coombs","BOTH IP/OP","$140.00 ","$103.60 ","$2.70 ","$141.00 ","$11.11 ","$54.51 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$141.00 ","$33.53 ","$15.00 ","$111.67 ","$112.80 ","$46.58 ","$8.45 ","$5.39 ","$5.91 ","$31.93 "
"30050139","EAP","CPT� 86880","","Dct,anti-igg","BOTH IP/OP","$140.00 ","$103.60 ","$2.70 ","$141.00 ","$11.11 ","$54.51 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$141.00 ","$33.53 ","$15.00 ","$111.67 ","$112.80 ","$46.58 ","$8.45 ","$5.39 ","$5.91 ","$31.93 "
"30050140","EAP","CPT� 86880","","Dct,anti-c3d","BOTH IP/OP","$140.00 ","$103.60 ","$2.70 ","$141.00 ","$11.11 ","$54.51 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$141.00 ","$33.53 ","$15.00 ","$111.67 ","$112.80 ","$46.58 ","$8.45 ","$5.39 ","$5.91 ","$31.93 "
"30050141","EAP","CPT� 86886","","Antibody Titer","BOTH IP/OP","$146.00 ","$108.04 ","$2.59 ","$147.00 ","$9.58 ","$146.00 ","$2.59 ","$6.79 ","$6.79 ","$6.87 ","$147.00 ","$143.92 ","$13.00 ","$116.42 ","$117.60 ","$147.00 ","$7.32 ","$5.18 ","$5.12 ","$137.07 "
"30050148","EAP","CPT� 86900","","Blood Typing, Serologic, Abo","BOTH IP/OP","$165.00 ","$122.10 ","$1.49 ","$150.00 ","$6.18 ","$110.43 ","$1.49 ","$4.35 ","$4.35 ","$4.41 ","$150.00 ","$109.35 ","$8.34 ","$118.80 ","$120.00 ","$150.00 ","$4.70 ","$2.99 ","$3.29 ","$104.14 "
"30050149","EAP","CPT� 86901","","Blood Typing, Serologic, Rh (d)","BOTH IP/OP","$165.00 ","$122.10 ","$1.49 ","$150.00 ","$6.18 ","$33.15 ","$1.49 ","$4.35 ","$4.35 ","$17.04 ","$150.00 ","$33.53 ","$8.34 ","$118.80 ","$120.00 ","$46.58 ","$18.16 ","$2.99 ","$12.71 ","$31.93 "
"30050300","EAP","CPT� 80354","","Fentanyl - Urine","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$236.00 ","$0.00 ","$0.00 ","$0.00 ","$168.43 ","$168.43 ","$0.00 ","$236.00 ","$0.00 ","$118.00 ","$186.91 ","$188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050301","EAP","CPT� 80324","","Amphetamine - Urine","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$236.00 ","$0.00 ","$0.00 ","$9.54 ","$168.43 ","$168.43 ","$22.96 ","$236.00 ","$0.00 ","$118.00 ","$186.91 ","$188.80 ","$141.60 ","$24.47 ","$0.00 ","$17.13 ","$0.00 "
"30050302","EAP","CPT� 80307","","Methaqualone - Urine","BOTH IP/OP","$241.00 ","$178.34 ","$29.09 ","$219.00 ","$115.05 ","$31.07 ","$29.09 ","$76.45 ","$76.45 ","$71.85 ","$219.00 ","$65.25 ","$109.50 ","$173.45 ","$175.20 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30050303","EAP","CPT� 80367","","Propoxyphene - Urine","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$236.00 ","$0.03 ","$12.01 ","$11.94 ","$168.43 ","$168.43 ","$0.00 ","$236.00 ","$0.00 ","$118.00 ","$186.91 ","$188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050420","EAP","CPT� 85347","","Act","BOTH IP/OP","$103.00 ","$76.22 ","$2.13 ","$94.00 ","$8.79 ","$2.14 ","$2.13 ","$6.22 ","$6.22 ","$6.30 ","$94.00 ","$4.49 ","$11.90 ","$74.45 ","$75.20 ","$6.21 ","$6.71 ","$4.28 ","$4.70 ","$4.28 "
"30050421","EAP","CPT� 83018","","Quantitative Screen Metals","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$32.06 ","$32.06 ","$0.00 ","$210.00 ","$0.00 ","$61.36 ","$166.32 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050422","EAP","CPT� 84311","","Spectrophotometry","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$262.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$262.00 ","$8.51 ","$19.54 ","$207.50 ","$209.60 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30050423","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$1,284.00 ","$950.16 ","$8.28 ","$1,449.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$1,449.00 ","$19.32 ","$37.76 ","$1,147.61 ","$1,159.20 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30050424","EAP","CPT� 86765","","Rubeola Antibody","BOTH IP/OP","$100.00 ","$74.00 ","$6.44 ","$100.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$100.00 ","$13.52 ","$36.00 ","$79.20 ","$80.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30050425","EAP","CPT� 86022","","Platelet Antibodies","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$112.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$112.00 ","$0.00 ","$51.32 ","$88.70 ","$89.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050426","EAP","CPT� 82480","","Assay Serum Cholinesterase","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$11.51 ","$11.51 ","$0.00 ","$43.00 ","$0.00 ","$22.02 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050427","EAP","CPT� 82638","","Assay Of Dibucaine Number","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$17.88 ","$17.88 ","$0.00 ","$49.00 ","$0.00 ","$34.22 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050428","EAP","CPT� 88360","","Tumor Immunohistochem/manual","BOTH IP/OP","$911.00 ","$674.14 ","$58.38 ","$911.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$911.00 ","$143.92 ","$121.34 ","$721.51 ","$728.80 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30050435","EAP","CPT� 86790","","Virus Antibody Nos","BOTH IP/OP","$368.00 ","$272.32 ","$6.44 ","$336.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$336.00 ","$13.52 ","$36.00 ","$266.11 ","$268.80 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30050436","EAP","CPT� 87380","","Hepatitis Delta Ag Eia","BOTH IP/OP","$202.00 ","$149.48 ","$0.00 ","$202.00 ","$0.00 ","$0.00 ","$0.00 ","$23.98 ","$23.98 ","$0.00 ","$202.00 ","$0.00 ","$45.88 ","$159.98 ","$161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050437","EAP","CPT� 87502","","Influenza Dna Amp Probe","BOTH IP/OP","$627.00 ","$463.98 ","$43.11 ","$636.00 ","$107.10 ","$47.90 ","$43.11 ","$73.04 ","$73.04 ","$68.64 ","$636.00 ","$100.59 ","$318.00 ","$503.71 ","$508.80 ","$138.91 ","$73.14 ","$95.80 ","$51.20 ","$95.80 "
"30050438","EAP","CPT� 83520","","Immunoassay Auant Nos Nonab","BOTH IP/OP","$2,216.00 ","$1,639.84 ","$7.77 ","$2,501.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$2,501.00 ","$18.13 ","$36.18 ","$1,980.79 ","$2,000.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30050439","EAP","CPT� 84145","","Procalcitonin - Serum","BOTH IP/OP","$205.00 ","$151.70 ","$13.40 ","$207.00 ","$55.31 ","$13.61 ","$13.40 ","$27.76 ","$27.76 ","$28.27 ","$207.00 ","$28.58 ","$103.50 ","$163.94 ","$165.60 ","$39.47 ","$30.12 ","$27.22 ","$21.08 ","$27.22 "
"30050440","EAP","CPT� 85999","","Eosinophil Smear, Urine","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050441","EAP","HCPCS 89055","","Fecal Leukocyte Smear","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$3.43 ","$3.43 ","$0.00 ","$118.00 ","$0.00 ","$6.56 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050442","EAP","CPT� 87498","","Enterovirus Rna, Qual, Rt-pcr So","BOTH IP/OP","$114.00 ","$84.36 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$111.00 ","$0.00 ","$54.82 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050443","EAP","CPT� 89055","","Fecal Leukocyte Smear","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$3.43 ","$3.43 ","$0.00 ","$118.00 ","$0.00 ","$6.56 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050445","EAP","CPT� 81403","","JAK2-EXONS-12,13 SEQ","BOTH IP/OP","$846.00 ","$626.04 ","$0.00 ","$967.00 ","$0.00 ","$92.60 ","$176.33 ","$690.15 ","$690.15 ","$220.85 ","$967.00 ","$194.46 ","$483.50 ","$765.86 ","$773.60 ","$268.54 ","$235.32 ","$185.20 ","$164.72 ","$185.20 "
"30050446","EAP","CPT� 86021","","Proteinase -3 Antibody (so)","BOTH IP/OP","$163.00 ","$120.62 ","$7.53 ","$150.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$150.00 ","$15.80 ","$42.06 ","$118.80 ","$120.00 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30050447","EAP","CPT� 81261","","B-cell Recep Igh Gene Rearrangement , Pcr (so)","BOTH IP/OP","$607.00 ","$449.18 ","$0.00 ","$694.00 ","$0.00 ","$0.00 ","$0.00 ","$270.11 ","$270.11 ","$286.64 ","$694.00 ","$0.00 ","$347.00 ","$549.65 ","$555.20 ","$0.00 ","$305.42 ","$0.00 ","$0.00 ","$0.00 "
"30050448","EAP","CPT� 81264","","B-cell Recep Igk Gene Rearrangement , Pcr (so)","BOTH IP/OP","$607.00 ","$449.18 ","$0.00 ","$694.00 ","$0.00 ","$0.00 ","$0.00 ","$203.72 ","$203.72 ","$115.59 ","$694.00 ","$0.00 ","$347.00 ","$549.65 ","$555.20 ","$0.00 ","$123.17 ","$0.00 ","$0.00 ","$0.00 "
"30050449","EAP","CPT� 88271","","MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)","BOTH IP/OP","$1,071.00 ","$792.54 ","$10.71 ","$1,064.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$1,064.00 ","$22.49 ","$59.86 ","$842.69 ","$851.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050450","EAP","CPT� 88274","","Interphase In Situ Hybridization (25-99) Cells (so)","BOTH IP/OP","$537.00 ","$397.38 ","$0.00 ","$533.00 ","$0.00 ","$0.00 ","$19.07 ","$50.82 ","$50.82 ","$51.42 ","$533.00 ","$44.50 ","$97.26 ","$422.14 ","$426.40 ","$61.45 ","$54.79 ","$42.38 ","$38.35 ","$42.38 "
"30050451","EAP","CPT� 81342","","T - Cell Receptor Gamma Gene Rearrangement, Pcr (so)","BOTH IP/OP","$1,177.00 ","$870.98 ","$0.00 ","$1,163.00 ","$415.93 ","$100.75 ","$100.75 ","$274.90 ","$274.90 ","$0.00 ","$1,163.00 ","$0.00 ","$581.50 ","$921.10 ","$930.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050452","EAP","CPT� 88271","","Molecular Cytogenetics; Dna Probe( Fish) (so)","BOTH IP/OP","$504.00 ","$372.96 ","$10.71 ","$501.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$501.00 ","$22.49 ","$59.86 ","$396.79 ","$400.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050454","EAP","CPT� 88271","","MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)","BOTH IP/OP","$559.00 ","$413.66 ","$10.71 ","$555.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$555.00 ","$22.49 ","$59.86 ","$439.56 ","$444.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050455","EAP","CPT� 88275","","INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO)","BOTH IP/OP","$280.00 ","$207.20 ","$23.04 ","$278.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$278.00 ","$53.75 ","$112.22 ","$220.18 ","$222.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30050456","EAP","CPT� 81331","","Prader-willi/angelman Syndrome , Dna Methylation (so)","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$672.00 ","$0.00 ","$0.00 ","$0.00 ","$479.61 ","$479.61 ","$0.00 ","$672.00 ","$0.00 ","$336.00 ","$532.22 ","$537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050457","EAP","CPT� 88275","","Interphase In Situ Hybridization (100-300) Cells (so)","BOTH IP/OP","$253.00 ","$187.22 ","$23.04 ","$251.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$251.00 ","$53.75 ","$112.22 ","$198.79 ","$200.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30050458","EAP","CPT� 88271","","MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)","BOTH IP/OP","$481.00 ","$355.94 ","$10.71 ","$478.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$478.00 ","$22.49 ","$59.86 ","$378.58 ","$382.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050459","EAP","CPT� 88275","","INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO)","BOTH IP/OP","$242.00 ","$179.08 ","$23.04 ","$240.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$240.00 ","$53.75 ","$112.22 ","$190.08 ","$192.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30050460","EAP","CPT� 88271","","Molecular Cytogenetics; Dna Probe( Fish) (so)cml","BOTH IP/OP","$481.00 ","$355.94 ","$10.71 ","$478.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$478.00 ","$22.49 ","$59.86 ","$378.58 ","$382.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050461","EAP","CPT� 88275","","Interphase In Situ Hybridization (100-300) Cells (so)cml","BOTH IP/OP","$242.00 ","$179.08 ","$23.04 ","$240.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$240.00 ","$53.75 ","$112.22 ","$190.08 ","$192.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30050462","EAP","CPT� 81315","","Pml/rara T(15;17) Quant (pcr) (so)","BOTH IP/OP","$771.00 ","$570.54 ","$0.00 ","$762.00 ","$0.00 ","$0.00 ","$0.00 ","$282.83 ","$282.83 ","$0.00 ","$762.00 ","$0.00 ","$381.00 ","$603.50 ","$609.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050463","EAP","CPT� 81210","","Braf Mutation Analysis (so)","BOTH IP/OP","$1,079.00 ","$798.46 ","$78.93 ","$1,066.00 ","$271.21 ","$87.70 ","$78.93 ","$179.25 ","$179.25 ","$115.59 ","$1,066.00 ","$184.17 ","$533.00 ","$844.27 ","$852.80 ","$254.33 ","$123.17 ","$175.40 ","$86.22 ","$175.40 "
"30050464","EAP","CPT� 82172","","Apoliprotein (so)","BOTH IP/OP","$57.00 ","$42.18 ","$9.49 ","$57.00 ","$32.00 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$57.00 ","$22.14 ","$43.30 ","$45.14 ","$45.60 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30050465","EAP","CPT� 86738","","Mycoplasma Pneumoniae Antibody (igg), Ifa, Csf (so)","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$98.00 ","$0.00 ","$0.00 ","$6.62 ","$19.34 ","$19.34 ","$19.57 ","$98.00 ","$13.90 ","$37.02 ","$77.62 ","$78.40 ","$19.20 ","$20.85 ","$13.24 ","$14.60 ","$13.24 "
"30050466","EAP","CPT� 81401","","Cbfb/myh11 Inv(16) Quant Pcr (so)","BOTH IP/OP","$648.00 ","$479.52 ","$61.65 ","$640.00 ","$64.94 ","$68.50 ","$61.65 ","$456.77 ","$456.77 ","$131.58 ","$640.00 ","$143.85 ","$320.00 ","$506.88 ","$512.00 ","$198.65 ","$140.20 ","$137.00 ","$98.14 ","$137.00 "
"30050467","EAP","CPT� 81404","","C-kit Mutation Analysis (so)","BOTH IP/OP","$2,106.00 ","$1,558.44 ","$123.67 ","$2,080.00 ","$462.00 ","$137.42 ","$123.67 ","$1,484.50 ","$1,484.50 ","$286.64 ","$2,080.00 ","$288.57 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$398.50 ","$305.42 ","$274.83 ","$213.79 ","$274.83 "
"30050468","EAP","CPT� 87798","","Bordetella Pertussis/parapertussis Dna, Pcr (so)","BOTH IP/OP","$470.00 ","$347.80 ","$17.55 ","$566.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$566.00 ","$36.84 ","$54.82 ","$448.27 ","$452.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30050469","EAP","CPT� 86255","","Nmda- Receptor Antibody , Csf(mayo)","BOTH IP/OP","$371.00 ","$274.54 ","$6.03 ","$464.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$464.00 ","$12.65 ","$33.68 ","$367.49 ","$371.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050470","EAP","CPT� 87661","","Trichomonas Vaginalis Rna, Qualitative, Tma (so)","BOTH IP/OP","$153.00 ","$113.22 ","$17.55 ","$153.00 ","$40.50 ","$17.55 ","$17.55 ","$26.77 ","$26.77 ","$25.16 ","$153.00 ","$36.84 ","$76.50 ","$121.18 ","$122.40 ","$50.88 ","$26.81 ","$35.09 ","$18.76 ","$35.09 "
"30050471","EAP","CPT� 86256","","Agna-1 (mayo)","BOTH IP/OP","$86.00 ","$63.64 ","$6.03 ","$108.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$108.00 ","$12.65 ","$33.68 ","$85.54 ","$86.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050472","EAP","CPT� 86256","","Amphiphysin (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050473","EAP","CPT� 86256","","Anna-1 (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050474","EAP","CPT� 86256","","Anna-2 (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050475","EAP","CPT� 86256","","Anna-3 (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050476","EAP","CPT� 86256","","Crmp-5-igg","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050477","EAP","CPT� 86256","","Pca-1 (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050478","EAP","CPT� 86256","","Pca-2 (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050479","EAP","CPT� 86256","","Pca-tr (mayo)","BOTH IP/OP","$56.00 ","$41.44 ","$6.03 ","$70.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$70.00 ","$12.65 ","$33.68 ","$55.44 ","$56.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050481","EAP","CPT� 87912","","Hepatitis B Virus Drug Resistance, Genotype (so)","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$606.00 ","$180.02 ","$128.73 ","$128.72 ","$359.15 ","$359.15 ","$0.00 ","$606.00 ","$0.00 ","$303.00 ","$479.95 ","$484.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050482","EAP","CPT� 81402","","Follicular Lymphoma, Pcr (so)","BOTH IP/OP","$1,042.00 ","$771.08 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$850.02 ","$850.02 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050483","EAP","CPT� 81401","","Mantle Cell Lymphoma, Pcr (so)","BOTH IP/OP","$1,163.00 ","$860.62 ","$61.65 ","$1,329.00 ","$64.94 ","$68.50 ","$61.65 ","$948.51 ","$948.51 ","$131.58 ","$1,329.00 ","$143.85 ","$664.50 ","$1,052.57 ","$1,063.20 ","$198.65 ","$140.20 ","$137.00 ","$98.14 ","$137.00 "
"30050484","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Nhl","BOTH IP/OP","$514.00 ","$380.36 ","$10.71 ","$511.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$511.00 ","$22.49 ","$59.86 ","$404.71 ","$408.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050485","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Nhl","BOTH IP/OP","$258.00 ","$190.92 ","$23.04 ","$256.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$256.00 ","$53.75 ","$112.22 ","$202.75 ","$204.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30050486","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Fol","BOTH IP/OP","$617.00 ","$456.58 ","$10.71 ","$613.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$613.00 ","$22.49 ","$59.86 ","$485.50 ","$490.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30050487","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Fol","BOTH IP/OP","$309.00 ","$228.66 ","$23.04 ","$307.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$307.00 ","$53.75 ","$112.22 ","$243.14 ","$245.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30050488","EAP","CPT� 83520","","Ganglioside Gq1b Antibody (igg)(so)","BOTH IP/OP","$296.00 ","$219.04 ","$7.77 ","$288.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$288.00 ","$18.13 ","$36.18 ","$228.10 ","$230.40 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30050489","EAP","CPT� 81210","","Melanoma, Braf V600 Mutation (so)","BOTH IP/OP","$1,482.00 ","$1,096.68 ","$78.93 ","$1,464.00 ","$271.21 ","$87.70 ","$78.93 ","$179.25 ","$179.25 ","$115.59 ","$1,464.00 ","$184.17 ","$732.00 ","$1,159.49 ","$1,171.20 ","$254.33 ","$123.17 ","$175.40 ","$86.22 ","$175.40 "
"30050490","EAP","CPT� 81404","","Nras, Mutation Analysis (so)","BOTH IP/OP","$771.00 ","$570.54 ","$123.67 ","$762.00 ","$462.00 ","$137.42 ","$123.67 ","$543.84 ","$543.84 ","$286.64 ","$762.00 ","$288.57 ","$381.00 ","$603.50 ","$609.60 ","$398.50 ","$305.42 ","$274.83 ","$213.79 ","$274.83 "
"30050491","EAP","CPT� 83520","","Interleukin -2 (il-2) (so)","BOTH IP/OP","$284.00 ","$210.16 ","$7.77 ","$321.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$321.00 ","$18.13 ","$36.18 ","$254.23 ","$256.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30050492","EAP","CPT� 86255","","Nmo/aqp4-igg Cba (mayo)","BOTH IP/OP","$55.00 ","$40.70 ","$6.03 ","$69.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$69.00 ","$12.65 ","$33.68 ","$54.65 ","$55.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050493","EAP","CPT� 86341","","Gad65 Abs (mayo)","BOTH IP/OP","$66.00 ","$48.84 ","$10.61 ","$66.00 ","$40.84 ","$11.79 ","$10.61 ","$28.89 ","$28.89 ","$29.24 ","$66.00 ","$24.75 ","$55.30 ","$52.27 ","$52.80 ","$34.18 ","$31.16 ","$23.57 ","$21.81 ","$23.57 "
"30050495","EAP","CPT� 86255","","Nmo/aqp4-igg Cba, Csf (mayo)","BOTH IP/OP","$462.00 ","$341.88 ","$6.03 ","$578.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$578.00 ","$12.65 ","$33.68 ","$457.78 ","$462.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050496","EAP","CPT� 81170","","Abl Kinase Domain Mutation In Cml (so)","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,136.00 ","$0.00 ","$0.00 ","$135.00 ","$329.51 ","$329.51 ","$309.68 ","$1,136.00 ","$315.00 ","$568.00 ","$899.71 ","$908.80 ","$435.00 ","$329.97 ","$300.00 ","$230.98 ","$300.00 "
"30050497","EAP","CPT� 86003","","Allergen Specific (mold Group)","BOTH IP/OP","$247.00 ","$182.78 ","$2.61 ","$249.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$249.00 ","$5.48 ","$14.60 ","$197.21 ","$199.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30050500","EAP","CPT� 80361","","Monacetylmorphine-free-6","BOTH IP/OP","$516.00 ","$381.84 ","$0.00 ","$546.00 ","$0.03 ","$12.01 ","$11.94 ","$389.68 ","$389.68 ","$30.51 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$327.60 ","$32.51 ","$0.00 ","$22.76 ","$0.00 "
"30050501","EAP","CPT� 87902","","Hepatits C Viral Rna Ns3 Genotype (so)","BOTH IP/OP","$1,252.00 ","$926.48 ","$96.09 ","$1,294.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,294.00 ","$270.32 ","$243.70 ","$1,024.85 ","$1,035.20 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30050503","EAP","CPT� 88342","","Platelet Function Plavix( Clopidogrel)","BOTH IP/OP","$326.00 ","$241.24 ","$11.21 ","$296.00 ","$44.35 ","$12.46 ","$11.21 ","$57.65 ","$57.65 ","$84.08 ","$296.00 ","$143.92 ","$106.46 ","$234.43 ","$236.80 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"30050520","EAP","CPT� 86361","","T Cell; Absolute Cd4 Count","BOTH IP/OP","$114.00 ","$84.36 ","$13.39 ","$115.00 ","$53.91 ","$13.39 ","$13.39 ","$38.11 ","$38.11 ","$38.56 ","$115.00 ","$28.12 ","$72.94 ","$91.08 ","$92.00 ","$38.83 ","$41.08 ","$26.78 ","$28.76 ","$26.78 "
"30050521","EAP","CPT� 85004","","Automated Differential Wbc Count","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$9.45 ","$9.45 ","$0.00 ","$83.00 ","$0.00 ","$18.08 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30050550","EAP","CPT� 83520","","Phospholipase A2 Ab Quant (so)","BOTH IP/OP","$424.00 ","$313.76 ","$7.77 ","$412.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$412.00 ","$18.13 ","$36.18 ","$326.30 ","$329.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30050560","EAP","CPT� 86255","","Phospholipase A2 Scrn (so)","BOTH IP/OP","$263.00 ","$194.62 ","$6.03 ","$263.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$263.00 ","$12.65 ","$33.68 ","$208.30 ","$210.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30050561","EAP","CPT� 81162","","Brca1&2 Seq & Full Dup/del (so)","BOTH IP/OP","$3,730.00 ","$2,760.20 ","$912.44 ","$3,730.00 ","$3,730.00 ","$912.44 ","$912.44 ","$2,485.86 ","$2,485.86 ","$2,336.20 ","$3,685.00 ","$1,916.12 ","$1,842.50 ","$2,918.52 ","$2,948.00 ","$2,646.08 ","$2,489.27 ","$1,824.88 ","$1,742.49 ","$1,824.88 "
"30050562","EAP","HCPCS C9803","","Op Specimen Collection For (sars-cov-2) Covid-19","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$30.95 ","$24.19 ","$22.38 ","$40.68 ","$40.68 ","$9.98 ","$57.00 ","$23.06 ","$28.50 ","$45.14 ","$45.60 ","$32.04 ","$8.92 ","$0.00 ","$9.07 ","$21.96 "
"30100001","EAP","CPT� 80299","","Oxycarbazepine So","BOTH IP/OP","$122.00 ","$90.28 ","$8.39 ","$122.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$122.00 ","$19.57 ","$33.64 ","$96.62 ","$97.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100003","EAP","CPT� 80051","","Chem 4, Electrolyte Panel","BOTH IP/OP","$228.00 ","$168.72 ","$3.51 ","$230.00 ","$14.47 ","$3.51 ","$3.51 ","$10.24 ","$10.24 ","$10.36 ","$230.00 ","$7.36 ","$19.60 ","$182.16 ","$184.00 ","$10.16 ","$11.04 ","$7.01 ","$7.73 ","$7.01 "
"30100005","EAP","CPT� 80053","","Comprehensive Metabolic Panel, Evd","BOTH IP/OP","$472.00 ","$349.28 ","$5.28 ","$477.00 ","$21.81 ","$5.28 ","$5.28 ","$15.44 ","$15.44 ","$15.61 ","$477.00 ","$11.09 ","$29.54 ","$377.78 ","$381.60 ","$15.31 ","$16.64 ","$10.56 ","$11.65 ","$10.56 "
"30100006","EAP","CPT� 80047","","Basic Metabolic Panel, Evd","BOTH IP/OP","$370.00 ","$273.80 ","$0.00 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$12.36 ","$12.36 ","$0.00 ","$374.00 ","$0.00 ","$187.00 ","$296.21 ","$299.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100007","EAP","CPT� 80061","","Chem 3, Lipid Panel","BOTH IP/OP","$282.00 ","$208.68 ","$6.70 ","$285.00 ","$27.64 ","$6.70 ","$6.70 ","$19.57 ","$19.57 ","$19.79 ","$285.00 ","$14.06 ","$37.44 ","$225.72 ","$228.00 ","$19.42 ","$21.09 ","$13.39 ","$14.76 ","$13.39 "
"30100008","EAP","CPT� 80069","","RENAL FUNCTION PANEL, EVD","BOTH IP/OP","$230.00 ","$170.20 ","$4.34 ","$230.00 ","$17.93 ","$4.34 ","$4.34 ","$12.68 ","$12.68 ","$12.83 ","$230.00 ","$9.11 ","$24.26 ","$182.16 ","$184.00 ","$12.59 ","$13.67 ","$8.68 ","$9.57 ","$8.68 "
"30100009","EAP","CPT� 80069","","Renal Panel","BOTH IP/OP","$230.00 ","$170.20 ","$4.34 ","$230.00 ","$17.93 ","$4.34 ","$4.34 ","$12.68 ","$12.68 ","$12.83 ","$230.00 ","$9.11 ","$24.26 ","$182.16 ","$184.00 ","$12.59 ","$13.67 ","$8.68 ","$9.57 ","$8.68 "
"30100010","EAP","CPT� 83986","","Ph, Misc Fluids","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$64.00 ","$7.39 ","$1.79 ","$1.79 ","$5.22 ","$5.22 ","$5.28 ","$64.00 ","$3.76 ","$10.00 ","$50.69 ","$51.20 ","$5.19 ","$0.00 ","$3.58 ","$3.94 ","$3.58 "
"30100011","EAP","CPT� 80076","","HEPATIC PROFILE","BOTH IP/OP","$333.00 ","$246.42 ","$4.09 ","$333.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$333.00 ","$8.58 ","$22.84 ","$263.74 ","$266.40 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30100013","EAP","CPT� 80346","","Clonazepam/klonopin","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$179.85 ","$179.85 ","$0.00 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100014","EAP","CPT� 80197","","Tacrolimus","BOTH IP/OP","$393.00 ","$290.82 ","$0.00 ","$393.00 ","$28.35 ","$6.87 ","$0.00 ","$20.04 ","$20.04 ","$20.27 ","$393.00 ","$14.42 ","$38.34 ","$311.26 ","$314.40 ","$19.91 ","$21.59 ","$13.73 ","$15.11 ","$13.73 "
"30100015","EAP","CPT� 80299","","Digitoxin, Serum","BOTH IP/OP","$218.00 ","$161.32 ","$8.39 ","$218.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$218.00 ","$19.57 ","$33.64 ","$172.66 ","$174.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100016","EAP","CPT� 80299","","Felbamate-random","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$17.58 ","$17.58 ","$17.79 ","$218.00 ","$19.57 ","$33.64 ","$172.66 ","$174.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100017","EAP","CPT� 80299","","Bupropion/wellbutrin","BOTH IP/OP","$217.00 ","$160.58 ","$8.39 ","$218.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$218.00 ","$19.57 ","$33.64 ","$172.66 ","$174.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100018","EAP","CPT� 80307","","Acetaminophen","BOTH IP/OP","$585.00 ","$432.90 ","$29.09 ","$532.00 ","$115.05 ","$31.07 ","$29.09 ","$76.45 ","$76.45 ","$71.85 ","$532.00 ","$65.25 ","$266.00 ","$421.34 ","$425.60 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30100019","EAP","CPT� 80076","","Hepatic Function Panel, Evd","BOTH IP/OP","$333.00 ","$246.42 ","$4.09 ","$333.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$333.00 ","$8.58 ","$22.84 ","$263.74 ","$266.40 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30100020","EAP","CPT� 82009","","ACETOACETATE-QUALITATIVE","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$4.80 ","$4.80 ","$0.00 ","$64.00 ","$0.00 ","$9.18 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100021","EAP","CPT� 82010","","B-oh Butyric Acid","BOTH IP/OP","$192.00 ","$142.08 ","$4.09 ","$194.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$194.00 ","$8.58 ","$22.84 ","$153.65 ","$155.20 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30100022","EAP","CPT� 82024","","Acth, Plasma","BOTH IP/OP","$461.00 ","$341.14 ","$19.31 ","$466.00 ","$79.73 ","$19.31 ","$19.31 ","$56.40 ","$56.40 ","$57.06 ","$466.00 ","$40.55 ","$107.94 ","$369.07 ","$372.80 ","$56.00 ","$60.80 ","$38.62 ","$42.56 ","$38.62 "
"30100023","EAP","CPT� 82040","","Albumin (bcg)","BOTH IP/OP","$75.00 ","$55.50 ","$2.48 ","$76.00 ","$5.94 ","$2.48 ","$2.48 ","$4.20 ","$4.20 ","$4.25 ","$76.00 ","$5.20 ","$8.04 ","$60.19 ","$60.80 ","$7.18 ","$4.53 ","$4.95 ","$3.17 ","$4.95 "
"30100024","EAP","CPT� 82042","","Albumin,fluid","BOTH IP/OP","$128.00 ","$94.72 ","$3.50 ","$129.00 ","$10.69 ","$3.89 ","$3.50 ","$7.56 ","$7.56 ","$7.64 ","$129.00 ","$8.17 ","$14.46 ","$102.17 ","$103.20 ","$11.28 ","$8.14 ","$7.78 ","$5.70 ","$7.78 "
"30100025","EAP","CPT� 82043","","Microalbumin, Ur","BOTH IP/OP","$222.00 ","$164.28 ","$2.89 ","$224.00 ","$11.93 ","$2.89 ","$2.89 ","$8.45 ","$8.45 ","$8.55 ","$224.00 ","$6.07 ","$16.18 ","$177.41 ","$179.20 ","$8.38 ","$9.11 ","$5.78 ","$6.37 ","$5.78 "
"30100026","EAP","CPT� 83615","","Lactate Dehydrogenase (ldh), Evd","BOTH IP/OP","$139.00 ","$102.86 ","$3.02 ","$139.00 ","$12.46 ","$3.02 ","$3.02 ","$8.81 ","$8.81 ","$7.46 ","$139.00 ","$6.34 ","$16.88 ","$110.09 ","$111.20 ","$8.76 ","$7.94 ","$6.04 ","$5.56 ","$6.04 "
"30100027","EAP","CPT� 80320","","Ethanol","BOTH IP/OP","$399.00 ","$295.26 ","$0.03 ","$363.00 ","$0.03 ","$57.22 ","$6.63 ","$259.07 ","$259.07 ","$15.96 ","$363.00 ","$120.15 ","$181.50 ","$287.50 ","$290.40 ","$217.80 ","$17.01 ","$114.43 ","$11.90 ","$114.43 "
"30100028","EAP","CPT� 82085","","Aldolase, Serum","BOTH IP/OP","$122.00 ","$90.28 ","$4.86 ","$122.00 ","$20.04 ","$4.86 ","$4.86 ","$14.17 ","$14.17 ","$14.33 ","$122.00 ","$10.20 ","$27.12 ","$96.62 ","$97.60 ","$14.08 ","$15.27 ","$9.71 ","$10.69 ","$9.71 "
"30100029","EAP","CPT� 82088","","Aldosterone, Serum","BOTH IP/OP","$177.00 ","$130.98 ","$20.38 ","$177.00 ","$84.11 ","$20.38 ","$20.38 ","$59.50 ","$59.50 ","$60.21 ","$177.00 ","$42.79 ","$113.88 ","$140.18 ","$141.60 ","$59.09 ","$64.15 ","$40.75 ","$44.91 ","$40.75 "
"30100030","EAP","CPT� 82088","","Aldosterone, Ur-24hr","BOTH IP/OP","$177.00 ","$130.98 ","$20.38 ","$177.00 ","$84.11 ","$20.38 ","$20.38 ","$59.50 ","$59.50 ","$60.21 ","$177.00 ","$42.79 ","$113.88 ","$140.18 ","$141.60 ","$59.09 ","$64.15 ","$40.75 ","$44.91 ","$40.75 "
"30100031","EAP","CPT� 82103","","Alpha-1-antitrypsin","BOTH IP/OP","$299.00 ","$221.26 ","$6.72 ","$301.00 ","$27.75 ","$6.72 ","$6.72 ","$19.61 ","$19.61 ","$19.85 ","$301.00 ","$14.11 ","$37.54 ","$238.39 ","$240.80 ","$19.49 ","$21.15 ","$13.44 ","$14.80 ","$13.44 "
"30100032","EAP","CPT� 82104","","Alpha-1 At Phenotype","BOTH IP/OP","$137.00 ","$101.38 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$21.11 ","$21.11 ","$0.00 ","$138.00 ","$0.00 ","$40.40 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100033","EAP","CPT� 82105","","Alpha-fetoprotein","BOTH IP/OP","$258.00 ","$190.92 ","$8.39 ","$258.00 ","$34.64 ","$8.39 ","$8.39 ","$24.49 ","$24.49 ","$24.79 ","$258.00 ","$17.61 ","$46.88 ","$204.34 ","$206.40 ","$24.32 ","$26.41 ","$16.77 ","$18.49 ","$16.77 "
"30100034","EAP","CPT� 82105","","Afp,maternal Serum","BOTH IP/OP","$239.00 ","$176.86 ","$8.39 ","$239.00 ","$34.64 ","$8.39 ","$8.39 ","$24.49 ","$24.49 ","$24.79 ","$239.00 ","$17.61 ","$46.88 ","$189.29 ","$191.20 ","$24.32 ","$26.41 ","$16.77 ","$18.49 ","$16.77 "
"30100035","EAP","CPT� 82105","","Alpha-fetoprotein","BOTH IP/OP","$257.00 ","$190.18 ","$8.39 ","$258.00 ","$34.64 ","$8.39 ","$8.39 ","$24.49 ","$24.49 ","$24.79 ","$258.00 ","$17.61 ","$46.88 ","$204.34 ","$206.40 ","$24.32 ","$26.41 ","$16.77 ","$18.49 ","$16.77 "
"30100036","EAP","CPT� 82106","","Afp, Amniotic Fluid","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$239.00 ","$34.64 ","$8.50 ","$0.00 ","$24.49 ","$24.49 ","$24.79 ","$239.00 ","$17.85 ","$46.88 ","$189.29 ","$191.20 ","$24.65 ","$26.41 ","$17.00 ","$18.49 ","$17.00 "
"30100037","EAP","CPT� 82108","","Aluminum","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$34.80 ","$12.74 ","$12.74 ","$24.61 ","$24.61 ","$24.91 ","$88.00 ","$26.75 ","$47.10 ","$69.70 ","$70.40 ","$36.95 ","$0.00 ","$25.48 ","$18.58 ","$25.48 "
"30100038","EAP","CPT� 82128","","Metabolic Screen,ur","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$20.24 ","$20.24 ","$0.00 ","$278.00 ","$0.00 ","$38.74 ","$220.18 ","$222.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100039","EAP","CPT� 82128","","Amino Acid-scn,urine","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$20.24 ","$20.24 ","$0.00 ","$278.00 ","$0.00 ","$38.74 ","$220.18 ","$222.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100040","EAP","CPT� 82131","","Homocysteine","BOTH IP/OP","$158.00 ","$116.92 ","$10.34 ","$158.00 ","$34.82 ","$11.49 ","$10.34 ","$24.63 ","$24.63 ","$24.92 ","$158.00 ","$24.13 ","$47.14 ","$125.14 ","$126.40 ","$33.32 ","$26.55 ","$22.98 ","$18.58 ","$22.98 "
"30100041","EAP","CPT� 82131","","Cystine, Urine-24hr","BOTH IP/OP","$165.00 ","$122.10 ","$10.34 ","$165.00 ","$34.82 ","$11.49 ","$10.34 ","$24.63 ","$24.63 ","$24.92 ","$165.00 ","$24.13 ","$47.14 ","$130.68 ","$132.00 ","$33.32 ","$26.55 ","$22.98 ","$18.58 ","$22.98 "
"30100042","EAP","CPT� 82139","","Amino Acids-qnt,plas","BOTH IP/OP","$490.00 ","$362.60 ","$0.00 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$490.00 ","$0.00 ","$47.14 ","$388.08 ","$392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100043","EAP","CPT� 82139","","Amino Acids - Qnt","BOTH IP/OP","$490.00 ","$362.60 ","$0.00 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$490.00 ","$0.00 ","$47.14 ","$388.08 ","$392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100044","EAP","CPT� 82140","","Ammonia,blood","BOTH IP/OP","$317.00 ","$234.58 ","$7.29 ","$317.00 ","$20.41 ","$7.29 ","$7.29 ","$14.44 ","$14.44 ","$14.62 ","$317.00 ","$15.30 ","$27.64 ","$251.06 ","$253.60 ","$21.13 ","$15.57 ","$14.57 ","$10.90 ","$14.57 "
"30100045","EAP","CPT� 83605","","Lactate ( Lactic Acid),evd","BOTH IP/OP","$258.00 ","$190.92 ","$5.34 ","$311.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$311.00 ","$12.15 ","$29.84 ","$246.31 ","$248.80 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30100046","EAP","CPT� 82150","","Amylase,serum","BOTH IP/OP","$301.00 ","$222.74 ","$3.24 ","$304.00 ","$13.38 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$304.00 ","$6.80 ","$18.12 ","$240.77 ","$243.20 ","$9.40 ","$10.20 ","$6.48 ","$7.14 ","$6.48 "
"30100047","EAP","CPT� 82150","","Amylase,fluid","BOTH IP/OP","$301.00 ","$222.74 ","$3.24 ","$304.00 ","$13.38 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$304.00 ","$6.80 ","$18.12 ","$240.77 ","$243.20 ","$9.40 ","$10.20 ","$6.48 ","$7.14 ","$6.48 "
"30100048","EAP","CPT� 82150","","AMYLASE,URINE","BOTH IP/OP","$283.00 ","$209.42 ","$3.24 ","$304.00 ","$13.38 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$304.00 ","$6.80 ","$18.12 ","$240.77 ","$243.20 ","$9.40 ","$10.20 ","$6.48 ","$7.14 ","$6.48 "
"30100049","EAP","CPT� 82157","","Androstenedione","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$42.74 ","$42.74 ","$43.24 ","$253.00 ","$30.74 ","$81.80 ","$200.38 ","$202.40 ","$42.46 ","$46.07 ","$29.28 ","$32.25 ","$29.28 "
"30100050","EAP","CPT� 82164","","Angio-1 Convert Enz.","BOTH IP/OP","$325.00 ","$240.50 ","$7.30 ","$297.00 ","$30.15 ","$7.30 ","$7.30 ","$21.31 ","$21.31 ","$21.56 ","$297.00 ","$15.33 ","$40.78 ","$235.22 ","$237.60 ","$21.17 ","$22.97 ","$14.60 ","$16.08 ","$14.60 "
"30100051","EAP","CPT� 82164","","Angio-1 Conv Enz-csf","BOTH IP/OP","$325.00 ","$240.50 ","$7.30 ","$297.00 ","$30.15 ","$7.30 ","$7.30 ","$21.31 ","$21.31 ","$21.56 ","$297.00 ","$15.33 ","$40.78 ","$235.22 ","$237.60 ","$21.17 ","$22.97 ","$14.60 ","$16.08 ","$14.60 "
"30100052","EAP","CPT� 82175","","Arsenic,urine-24hr","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$9.49 ","$27.70 ","$27.70 ","$28.02 ","$97.00 ","$19.92 ","$53.02 ","$76.82 ","$77.60 ","$27.51 ","$0.00 ","$18.97 ","$20.90 ","$18.97 "
"30100053","EAP","CPT� 82180","","Vitamin C, Serum","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$12.90 ","$12.90 ","$13.05 ","$157.00 ","$10.38 ","$24.68 ","$124.34 ","$125.60 ","$14.34 ","$13.91 ","$9.89 ","$9.73 ","$9.89 "
"30100054","EAP","CPT� 80345","","Pentobarbital-quant","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$223.00 ","$0.03 ","$12.01 ","$7.03 ","$159.16 ","$159.16 ","$0.00 ","$223.00 ","$0.00 ","$111.50 ","$176.62 ","$178.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100055","EAP","CPT� 82232","","Beta-2 Microglobulin","BOTH IP/OP","$219.00 ","$162.06 ","$8.09 ","$201.00 ","$33.40 ","$8.09 ","$8.09 ","$23.62 ","$23.62 ","$23.91 ","$201.00 ","$16.99 ","$45.22 ","$159.19 ","$160.80 ","$23.46 ","$25.48 ","$16.18 ","$17.83 ","$16.18 "
"30100056","EAP","CPT� 82239","","Bile Acids, Serum","BOTH IP/OP","$261.00 ","$193.14 ","$8.56 ","$241.00 ","$35.35 ","$8.56 ","$8.56 ","$25.01 ","$25.01 ","$25.32 ","$241.00 ","$17.98 ","$47.88 ","$190.87 ","$192.80 ","$24.82 ","$26.97 ","$17.12 ","$18.88 ","$17.12 "
"30100057","EAP","CPT� 82247","","Bilirubin,total","BOTH IP/OP","$117.00 ","$86.58 ","$2.51 ","$118.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$118.00 ","$5.27 ","$14.04 ","$93.46 ","$94.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30100058","EAP","CPT� 82150","","Amylase, Evd","BOTH IP/OP","$283.00 ","$209.42 ","$3.24 ","$304.00 ","$13.38 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$304.00 ","$6.80 ","$18.12 ","$240.77 ","$243.20 ","$9.40 ","$10.20 ","$6.48 ","$7.14 ","$6.48 "
"30100059","EAP","CPT� 82247","","BILI, TOTAL-FLUID","BOTH IP/OP","$118.00 ","$87.32 ","$2.51 ","$118.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$118.00 ","$5.27 ","$14.04 ","$93.46 ","$94.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30100060","EAP","CPT� 82248","","Bilirubin,direct","BOTH IP/OP","$117.00 ","$86.58 ","$2.51 ","$118.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$118.00 ","$5.27 ","$14.04 ","$93.46 ","$94.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30100061","EAP","CPT� 82248","","Bili, Direct - Fluid","BOTH IP/OP","$117.00 ","$86.58 ","$2.51 ","$118.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$118.00 ","$5.27 ","$14.04 ","$93.46 ","$94.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30100062","EAP","CPT� 84100","","Phosphorus, Evd","BOTH IP/OP","$128.00 ","$94.72 ","$2.37 ","$136.00 ","$9.79 ","$2.37 ","$2.37 ","$6.93 ","$6.93 ","$7.01 ","$136.00 ","$4.98 ","$13.26 ","$107.71 ","$108.80 ","$6.87 ","$7.47 ","$4.74 ","$5.23 ","$4.74 "
"30100063","EAP","CPT� 83735","","Magnesium,evd","BOTH IP/OP","$160.00 ","$118.40 ","$3.35 ","$171.00 ","$13.83 ","$3.35 ","$3.35 ","$9.78 ","$9.78 ","$9.89 ","$171.00 ","$7.04 ","$18.72 ","$135.43 ","$136.80 ","$9.72 ","$10.54 ","$6.70 ","$7.38 ","$6.70 "
"30100064","EAP","CPT� 87536","","Hiv -1 Rna, Quant,rt-pcr (quest)","BOTH IP/OP","$269.00 ","$199.06 ","$42.55 ","$278.00 ","$107.10 ","$42.55 ","$42.55 ","$75.77 ","$75.77 ","$66.37 ","$278.00 ","$89.36 ","$145.02 ","$220.18 ","$222.40 ","$123.40 ","$70.72 ","$85.10 ","$49.50 ","$85.10 "
"30100065","EAP","CPT� 83519","","Pth-realated Protein So","BOTH IP/OP","$434.00 ","$321.16 ","$8.28 ","$422.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$422.00 ","$19.32 ","$37.76 ","$334.22 ","$337.60 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30100066","EAP","CPT� 82270","","OCCULT BLOOD, STOOL","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$4.69 ","$4.69 ","$0.00 ","$58.00 ","$0.00 ","$8.98 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100067","EAP","CPT� 82271","","Occult Blood, Gastric","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$4.69 ","$4.69 ","$0.00 ","$58.00 ","$5.59 ","$8.98 ","$45.94 ","$46.40 ","$7.71 ","$0.00 ","$5.32 ","$3.54 ","$5.32 "
"30100068","EAP","CPT� 82306","","Vitamin D, Serum","BOTH IP/OP","$279.00 ","$206.46 ","$14.80 ","$282.00 ","$61.12 ","$14.80 ","$14.80 ","$43.22 ","$43.22 ","$43.72 ","$282.00 ","$31.08 ","$82.72 ","$223.34 ","$225.60 ","$42.92 ","$46.59 ","$29.60 ","$32.61 ","$29.60 "
"30100069","EAP","CPT� 82308","","Calcitonin, Serum","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$139.00 ","$55.31 ","$13.40 ","$13.40 ","$39.10 ","$39.10 ","$39.55 ","$139.00 ","$28.13 ","$74.82 ","$110.09 ","$111.20 ","$38.85 ","$0.00 ","$26.79 ","$29.50 ","$26.79 "
"30100070","EAP","CPT� 82310","","Calcium","BOTH IP/OP","$102.00 ","$75.48 ","$2.58 ","$93.00 ","$10.67 ","$2.58 ","$2.58 ","$7.53 ","$7.53 ","$7.46 ","$93.00 ","$5.42 ","$14.40 ","$73.66 ","$74.40 ","$7.48 ","$7.94 ","$5.16 ","$5.56 ","$5.16 "
"30100071","EAP","CPT� 82310","","Calcium,synvl Fluid","BOTH IP/OP","$102.00 ","$75.48 ","$2.58 ","$93.00 ","$10.67 ","$2.58 ","$2.58 ","$7.53 ","$7.53 ","$7.46 ","$93.00 ","$5.42 ","$14.40 ","$73.66 ","$74.40 ","$7.48 ","$7.94 ","$5.16 ","$5.56 ","$5.16 "
"30100072","EAP","CPT� 82310","","CALCIUM, URINE","BOTH IP/OP","$90.00 ","$66.60 ","$2.58 ","$93.00 ","$10.67 ","$2.58 ","$2.58 ","$7.53 ","$7.53 ","$7.46 ","$93.00 ","$5.42 ","$14.40 ","$73.66 ","$74.40 ","$7.48 ","$7.94 ","$5.16 ","$5.56 ","$5.16 "
"30100073","EAP","CPT� 82330","","Calcium,ionized,wb","BOTH IP/OP","$375.00 ","$277.50 ","$6.84 ","$342.00 ","$28.22 ","$6.84 ","$6.84 ","$19.95 ","$19.95 ","$20.18 ","$342.00 ","$14.36 ","$38.18 ","$270.86 ","$273.60 ","$19.84 ","$21.50 ","$13.68 ","$15.05 ","$13.68 "
"30100074","EAP","CPT� 82365","","Stone Analysis","BOTH IP/OP","$399.00 ","$295.26 ","$6.45 ","$364.00 ","$26.61 ","$6.45 ","$6.45 ","$18.83 ","$18.83 ","$19.05 ","$364.00 ","$13.55 ","$36.02 ","$288.29 ","$291.20 ","$18.71 ","$20.30 ","$12.90 ","$14.21 ","$12.90 "
"30100075","EAP","CPT� 82374","","Co2 Content","BOTH IP/OP","$35.00 ","$25.90 ","$2.44 ","$35.00 ","$10.08 ","$2.44 ","$2.44 ","$7.14 ","$7.14 ","$7.22 ","$35.00 ","$5.12 ","$13.66 ","$27.72 ","$28.00 ","$7.08 ","$7.70 ","$4.88 ","$5.39 ","$4.88 "
"30100076","EAP","CPT� 82378","","Cea","BOTH IP/OP","$302.00 ","$223.48 ","$9.48 ","$305.00 ","$39.15 ","$9.48 ","$9.48 ","$27.70 ","$27.70 ","$28.02 ","$305.00 ","$19.91 ","$53.02 ","$241.56 ","$244.00 ","$27.49 ","$29.86 ","$18.96 ","$20.90 ","$18.96 "
"30100077","EAP","CPT� 82379","","Carnitine, Total","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$159.00 ","$34.82 ","$8.44 ","$8.43 ","$24.63 ","$24.63 ","$0.00 ","$159.00 ","$0.00 ","$47.14 ","$125.93 ","$127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100078","EAP","CPT� 82379","","Carnitine, Free","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$159.00 ","$34.82 ","$8.44 ","$8.43 ","$24.63 ","$24.63 ","$0.00 ","$159.00 ","$0.00 ","$47.14 ","$125.93 ","$127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100079","EAP","CPT� 82380","","Carotene, Serum","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$0.00 ","$13.47 ","$13.47 ","$0.00 ","$121.00 ","$0.00 ","$25.78 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100080","EAP","CPT� 82384","","Catecholamines,plasm","BOTH IP/OP","$173.00 ","$128.02 ","$12.63 ","$173.00 ","$52.11 ","$12.63 ","$12.63 ","$36.87 ","$36.87 ","$37.30 ","$173.00 ","$26.51 ","$70.56 ","$137.02 ","$138.40 ","$36.61 ","$39.74 ","$25.25 ","$27.82 ","$25.25 "
"30100081","EAP","CPT� 82384","","Catecholam.,ur Frac","BOTH IP/OP","$173.00 ","$128.02 ","$12.63 ","$173.00 ","$52.11 ","$12.63 ","$12.63 ","$36.87 ","$36.87 ","$37.30 ","$173.00 ","$26.51 ","$70.56 ","$137.02 ","$138.40 ","$36.61 ","$39.74 ","$25.25 ","$27.82 ","$25.25 "
"30100082","EAP","CPT� 82390","","Ceruloplasmin,serum","BOTH IP/OP","$236.00 ","$174.64 ","$5.37 ","$236.00 ","$22.18 ","$5.37 ","$5.37 ","$15.68 ","$15.68 ","$15.87 ","$236.00 ","$11.28 ","$30.02 ","$186.91 ","$188.80 ","$15.57 ","$16.91 ","$10.74 ","$11.83 ","$10.74 "
"30100083","EAP","CPT� 82415","","Chloramphen-peak","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$18.50 ","$18.50 ","$0.00 ","$145.00 ","$0.00 ","$35.40 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100084","EAP","CPT� 82435","","Chloride","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$9.50 ","$2.30 ","$2.30 ","$6.70 ","$6.70 ","$0.00 ","$117.00 ","$0.00 ","$12.84 ","$92.66 ","$93.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100085","EAP","CPT� 82436","","Chloride, Urine","BOTH IP/OP","$123.00 ","$91.02 ","$2.59 ","$123.00 ","$10.38 ","$2.88 ","$2.59 ","$7.34 ","$7.34 ","$7.42 ","$123.00 ","$6.04 ","$14.04 ","$97.42 ","$98.40 ","$8.34 ","$7.91 ","$5.75 ","$5.54 ","$5.75 "
"30100086","EAP","CPT� 82438","","Chloride,fluid","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$105.00 ","$0.00 ","$13.66 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100087","EAP","CPT� 87798","","Toxoplasma Gondii Dna,qual,pcr So","BOTH IP/OP","$422.00 ","$312.28 ","$17.55 ","$425.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$425.00 ","$36.84 ","$54.82 ","$336.60 ","$340.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30100088","EAP","CPT� 82465","","Cholesterol","BOTH IP/OP","$91.00 ","$67.34 ","$2.18 ","$92.00 ","$8.98 ","$2.18 ","$2.18 ","$6.36 ","$6.36 ","$6.43 ","$92.00 ","$4.57 ","$12.16 ","$72.86 ","$73.60 ","$6.31 ","$6.85 ","$4.35 ","$4.79 ","$4.35 "
"30100090","EAP","CPT� 82384","","Catacholamines,frac,ur So","BOTH IP/OP","$46.00 ","$34.04 ","$12.63 ","$46.00 ","$46.00 ","$12.63 ","$12.63 ","$36.87 ","$36.87 ","$37.30 ","$46.00 ","$26.51 ","$46.00 ","$36.43 ","$36.80 ","$36.61 ","$39.74 ","$25.25 ","$27.82 ","$25.25 "
"30100096","EAP","CPT� 82507","","Citric Acid, Ur-24hr","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$13.90 ","$40.60 ","$40.60 ","$0.00 ","$129.00 ","$0.00 ","$77.70 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100097","EAP","CPT� 82523","","Pyridinoline","BOTH IP/OP","$88.00 ","$65.12 ","$9.34 ","$88.00 ","$38.57 ","$9.34 ","$9.34 ","$27.29 ","$27.29 ","$27.60 ","$88.00 ","$19.61 ","$52.22 ","$69.70 ","$70.40 ","$27.09 ","$29.41 ","$18.68 ","$20.59 ","$18.68 "
"30100098","EAP","CPT� 82525","","Copper, Serum","BOTH IP/OP","$127.00 ","$93.98 ","$6.21 ","$128.00 ","$25.61 ","$6.21 ","$6.21 ","$18.12 ","$18.12 ","$18.33 ","$128.00 ","$13.03 ","$34.68 ","$101.38 ","$102.40 ","$17.99 ","$19.53 ","$12.41 ","$13.67 ","$12.41 "
"30100099","EAP","CPT� 82525","","Copper, Urine-24hr","BOTH IP/OP","$127.00 ","$93.98 ","$6.21 ","$128.00 ","$25.61 ","$6.21 ","$6.21 ","$18.12 ","$18.12 ","$18.33 ","$128.00 ","$13.03 ","$34.68 ","$101.38 ","$102.40 ","$17.99 ","$19.53 ","$12.41 ","$13.67 ","$12.41 "
"30100100","EAP","CPT� 82530","","Cortisol Free, Ur-24h","BOTH IP/OP","$302.00 ","$223.48 ","$8.36 ","$305.00 ","$34.48 ","$8.36 ","$8.36 ","$24.41 ","$24.41 ","$24.70 ","$305.00 ","$17.55 ","$46.70 ","$241.56 ","$244.00 ","$24.23 ","$26.31 ","$16.71 ","$18.42 ","$16.71 "
"30100101","EAP","CPT� 82533","","Cortisol,serum","BOTH IP/OP","$650.00 ","$481.00 ","$8.15 ","$657.00 ","$33.66 ","$8.15 ","$8.15 ","$23.81 ","$23.81 ","$24.09 ","$657.00 ","$17.12 ","$45.56 ","$520.34 ","$525.60 ","$23.64 ","$25.67 ","$16.30 ","$17.97 ","$16.30 "
"30100102","EAP","CPT� 82542","","Thiopurine Methyl Transferase, Qt","BOTH IP/OP","$791.00 ","$585.34 ","$6.62 ","$782.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$782.00 ","$25.29 ","$16.78 ","$619.34 ","$625.60 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30100103","EAP","CPT� 82550","","Cpk,total-serum","BOTH IP/OP","$176.00 ","$130.24 ","$3.25 ","$189.00 ","$13.44 ","$3.26 ","$3.25 ","$9.51 ","$9.51 ","$7.46 ","$189.00 ","$6.84 ","$18.20 ","$149.69 ","$151.20 ","$9.44 ","$7.94 ","$6.51 ","$5.56 ","$6.51 "
"30100104","EAP","CPT� 82656","","Pancreatic Elastase-1 So","BOTH IP/OP","$226.00 ","$167.24 ","$5.76 ","$224.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$39.22 ","$224.00 ","$12.11 ","$29.88 ","$177.41 ","$179.20 ","$16.72 ","$35.06 ","$11.53 ","$35.66 ","$11.53 "
"30100105","EAP","CPT� 82553","","Ckmb-meia","BOTH IP/OP","$355.00 ","$262.70 ","$5.77 ","$323.00 ","$23.84 ","$5.78 ","$5.77 ","$16.86 ","$16.86 ","$17.05 ","$323.00 ","$12.13 ","$32.26 ","$255.82 ","$258.40 ","$16.75 ","$18.17 ","$11.55 ","$12.72 ","$11.55 "
"30100106","EAP","CPT� 82565","","Creatinine","BOTH IP/OP","$139.00 ","$102.86 ","$2.56 ","$129.00 ","$10.59 ","$2.56 ","$2.56 ","$7.48 ","$7.48 ","$7.46 ","$129.00 ","$5.38 ","$14.32 ","$102.17 ","$103.20 ","$7.42 ","$7.94 ","$5.12 ","$5.56 ","$5.12 "
"30100107","EAP","CPT� 82570","","Creatinine,fluid","BOTH IP/OP","$122.00 ","$90.28 ","$2.59 ","$122.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$122.00 ","$5.44 ","$14.46 ","$96.62 ","$97.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30100108","EAP","CPT� 82570","","Creat,amniotic Fld","BOTH IP/OP","$129.00 ","$95.46 ","$2.59 ","$129.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$129.00 ","$5.44 ","$14.46 ","$102.17 ","$103.20 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30100109","EAP","CPT� 82570","","Creatinine, Urine","BOTH IP/OP","$122.00 ","$90.28 ","$2.59 ","$122.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$122.00 ","$5.44 ","$14.46 ","$96.62 ","$97.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30100110","EAP","CPT� 82108","","Aluminum, 24hr Urine So","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$34.80 ","$12.74 ","$12.74 ","$24.61 ","$24.61 ","$24.91 ","$69.00 ","$26.75 ","$47.10 ","$54.65 ","$55.20 ","$36.95 ","$0.00 ","$25.48 ","$18.58 ","$25.48 "
"30100111","EAP","CPT� 82575","","Creatinine Clearance","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$0.00 ","$0.00 ","$0.00 ","$13.79 ","$13.79 ","$0.00 ","$248.00 ","$0.00 ","$26.40 ","$196.42 ","$198.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100112","EAP","CPT� 82595","","Cryoglobulin,serum","BOTH IP/OP","$88.00 ","$65.12 ","$3.23 ","$89.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$9.57 ","$89.00 ","$6.79 ","$18.08 ","$70.49 ","$71.20 ","$9.38 ","$10.19 ","$6.47 ","$7.13 ","$6.47 "
"30100113","EAP","CPT� 82595","","Cryocrit,serum","BOTH IP/OP","$88.00 ","$65.12 ","$3.23 ","$89.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$9.57 ","$89.00 ","$6.79 ","$18.08 ","$70.49 ","$71.20 ","$9.38 ","$10.19 ","$6.47 ","$7.13 ","$6.47 "
"30100114","EAP","CPT� 82600","","Cyanide","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$28.33 ","$28.33 ","$0.00 ","$136.00 ","$0.00 ","$54.22 ","$107.71 ","$108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100115","EAP","CPT� 82607","","Vitamin B12,serum","BOTH IP/OP","$398.00 ","$294.52 ","$7.54 ","$402.00 ","$31.13 ","$7.54 ","$7.54 ","$22.01 ","$22.01 ","$22.26 ","$402.00 ","$15.83 ","$42.12 ","$318.38 ","$321.60 ","$21.87 ","$23.72 ","$15.08 ","$16.60 ","$15.08 "
"30100116","EAP","CPT� 82627","","Dhea-so4, Serum","BOTH IP/OP","$428.00 ","$316.72 ","$11.12 ","$432.00 ","$45.91 ","$11.12 ","$11.12 ","$32.46 ","$32.46 ","$32.84 ","$432.00 ","$23.34 ","$62.14 ","$342.14 ","$345.60 ","$32.23 ","$35.00 ","$22.23 ","$24.50 ","$22.23 "
"30100117","EAP","CPT� 82634","","Deoxycortisol,11-bld","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$42.74 ","$42.74 ","$0.00 ","$129.00 ","$0.00 ","$81.80 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100118","EAP","CPT� 80327","","Dihydrotestosterone","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$92.07 ","$92.07 ","$0.00 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100119","EAP","CPT� 82652","","Vit D,1,25-dihydroxy","BOTH IP/OP","$355.00 ","$262.70 ","$19.25 ","$358.00 ","$79.46 ","$19.25 ","$19.25 ","$56.20 ","$56.20 ","$56.86 ","$358.00 ","$40.43 ","$107.56 ","$283.54 ","$286.40 ","$55.83 ","$60.58 ","$38.50 ","$42.41 ","$38.50 "
"30100120","EAP","CPT� 82664","","Amylase, Isoenzymes","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$50.16 ","$50.75 ","$506.00 ","$64.58 ","$96.00 ","$400.75 ","$404.80 ","$89.18 ","$54.07 ","$61.50 ","$37.85 ","$61.50 "
"30100121","EAP","CPT� 82668","","Erythropoietin,serum","BOTH IP/OP","$246.00 ","$182.04 ","$9.40 ","$248.00 ","$38.78 ","$9.40 ","$9.40 ","$27.45 ","$27.45 ","$27.76 ","$248.00 ","$19.73 ","$52.52 ","$196.42 ","$198.40 ","$27.25 ","$29.58 ","$18.79 ","$20.71 ","$18.79 "
"30100122","EAP","CPT� 82670","","Estradiol","BOTH IP/OP","$405.00 ","$299.70 ","$13.97 ","$405.00 ","$57.66 ","$13.97 ","$13.97 ","$40.80 ","$40.80 ","$41.28 ","$405.00 ","$29.34 ","$78.08 ","$320.76 ","$324.00 ","$40.51 ","$43.98 ","$27.94 ","$30.79 ","$27.94 "
"30100123","EAP","CPT� 82677","","Estriol(free),serum","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$35.31 ","$35.31 ","$35.72 ","$139.00 ","$25.39 ","$67.58 ","$110.09 ","$111.20 ","$35.06 ","$38.06 ","$24.18 ","$26.64 ","$24.18 "
"30100124","EAP","CPT� 82677","","Estriol, Urine-ref","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$35.31 ","$35.31 ","$35.72 ","$139.00 ","$25.39 ","$67.58 ","$110.09 ","$111.20 ","$35.06 ","$38.06 ","$24.18 ","$26.64 ","$24.18 "
"30100125","EAP","CPT� 82677","","Estriol, Maternal Serum","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$35.31 ","$35.31 ","$35.72 ","$139.00 ","$25.39 ","$67.58 ","$110.09 ","$111.20 ","$35.06 ","$38.06 ","$24.18 ","$26.64 ","$24.18 "
"30100126","EAP","CPT� 82679","","Estrone, Serum","BOTH IP/OP","$118.00 ","$87.32 ","$12.48 ","$118.00 ","$51.51 ","$12.48 ","$12.48 ","$36.45 ","$36.45 ","$36.88 ","$118.00 ","$26.20 ","$69.76 ","$93.46 ","$94.40 ","$36.18 ","$39.29 ","$24.95 ","$27.50 ","$24.95 "
"30100127","EAP","CPT� 82693","","Ethylene Glycol,bld","BOTH IP/OP","$364.00 ","$269.36 ","$0.00 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$21.75 ","$21.75 ","$0.00 ","$368.00 ","$0.00 ","$41.64 ","$291.46 ","$294.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100128","EAP","CPT� 82705","","Stool Fat, Qual","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$65.00 ","$10.51 ","$2.55 ","$2.55 ","$7.43 ","$7.43 ","$0.00 ","$65.00 ","$0.00 ","$14.22 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100129","EAP","CPT� 82710","","Fecal Fat, Quant","BOTH IP/OP","$89.00 ","$65.86 ","$8.40 ","$90.00 ","$34.69 ","$8.40 ","$8.40 ","$24.53 ","$24.53 ","$24.81 ","$90.00 ","$17.64 ","$46.94 ","$71.28 ","$72.00 ","$24.36 ","$26.44 ","$16.80 ","$18.51 ","$16.80 "
"30100130","EAP","CPT� 82725","","Fatty Acids,ess-ser","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$19.44 ","$19.44 ","$0.00 ","$210.00 ","$0.00 ","$37.20 ","$166.32 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100131","EAP","CPT� 82728","","Ferritin,serum","BOTH IP/OP","$247.00 ","$182.78 ","$6.82 ","$249.00 ","$28.14 ","$6.82 ","$6.82 ","$19.89 ","$19.89 ","$20.13 ","$249.00 ","$14.31 ","$38.06 ","$197.21 ","$199.20 ","$19.76 ","$21.45 ","$13.63 ","$15.01 ","$13.63 "
"30100132","EAP","CPT� 82731","","Fetal Fibronectin","BOTH IP/OP","$614.00 ","$454.36 ","$32.21 ","$620.00 ","$132.98 ","$32.21 ","$32.21 ","$94.04 ","$94.04 ","$95.14 ","$620.00 ","$67.63 ","$179.98 ","$491.04 ","$496.00 ","$93.39 ","$101.37 ","$64.41 ","$70.96 ","$64.41 "
"30100133","EAP","CPT� 82746","","Folate,serum","BOTH IP/OP","$292.00 ","$216.08 ","$7.35 ","$294.00 ","$30.36 ","$7.35 ","$7.35 ","$21.47 ","$21.47 ","$21.72 ","$294.00 ","$15.44 ","$41.08 ","$232.85 ","$235.20 ","$21.32 ","$23.15 ","$14.70 ","$16.20 ","$14.70 "
"30100134","EAP","CPT� 82747","","Folate, Rbc","BOTH IP/OP","$434.00 ","$321.16 ","$8.66 ","$438.00 ","$35.75 ","$8.83 ","$8.66 ","$25.29 ","$25.29 ","$25.59 ","$438.00 ","$18.53 ","$48.40 ","$346.90 ","$350.40 ","$25.59 ","$27.27 ","$17.65 ","$19.09 ","$17.65 "
"30100135","EAP","CPT� 82775","","Galactose-1-put","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$30.75 ","$30.75 ","$0.00 ","$224.00 ","$0.00 ","$58.86 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100136","EAP","CPT� 82775","","Galactose-1-phos","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$30.75 ","$30.75 ","$0.00 ","$224.00 ","$0.00 ","$58.86 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100137","EAP","CPT� 82784","","Immunoglob-a,serum","BOTH IP/OP","$273.00 ","$202.02 ","$4.65 ","$276.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$276.00 ","$9.77 ","$25.98 ","$218.59 ","$220.80 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30100138","EAP","CPT� 82784","","Immunoglob-g,serum","BOTH IP/OP","$273.00 ","$202.02 ","$4.65 ","$276.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$276.00 ","$9.77 ","$25.98 ","$218.59 ","$220.80 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30100139","EAP","CPT� 82784","","Immunoglob-m,serum","BOTH IP/OP","$273.00 ","$202.02 ","$4.65 ","$276.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$276.00 ","$9.77 ","$25.98 ","$218.59 ","$220.80 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30100140","EAP","CPT� 82784","","Immuno-igg,csf","BOTH IP/OP","$165.00 ","$122.10 ","$4.65 ","$167.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$167.00 ","$9.77 ","$25.98 ","$132.26 ","$133.60 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30100141","EAP","CPT� 82784","","Immunoglob-igd,serum","BOTH IP/OP","$251.00 ","$185.74 ","$4.65 ","$253.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$253.00 ","$9.77 ","$25.98 ","$200.38 ","$202.40 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30100142","EAP","CPT� 82785","","Immunoglob-ige,serum","BOTH IP/OP","$202.00 ","$149.48 ","$8.23 ","$204.00 ","$33.98 ","$8.23 ","$8.23 ","$24.05 ","$24.05 ","$24.33 ","$204.00 ","$17.28 ","$46.02 ","$161.57 ","$163.20 ","$23.87 ","$25.92 ","$16.46 ","$18.15 ","$16.46 "
"30100143","EAP","CPT� 82800","","Ph, Ven.","BOTH IP/OP","$222.00 ","$164.28 ","$4.95 ","$202.00 ","$17.48 ","$5.50 ","$4.95 ","$12.37 ","$12.37 ","$12.52 ","$202.00 ","$11.55 ","$23.66 ","$159.98 ","$161.60 ","$15.95 ","$13.34 ","$11.00 ","$9.34 ","$11.00 "
"30100144","EAP","CPT� 82800","","Ph, Art.","BOTH IP/OP","$222.00 ","$164.28 ","$4.95 ","$202.00 ","$17.48 ","$5.50 ","$4.95 ","$12.37 ","$12.37 ","$12.52 ","$202.00 ","$11.55 ","$23.66 ","$159.98 ","$161.60 ","$15.95 ","$13.34 ","$11.00 ","$9.34 ","$11.00 "
"30100145","EAP","CPT� 82800","","Ph, Cord, Art.","BOTH IP/OP","$201.00 ","$148.74 ","$4.95 ","$202.00 ","$17.48 ","$5.50 ","$4.95 ","$12.37 ","$12.37 ","$12.52 ","$202.00 ","$11.55 ","$23.66 ","$159.98 ","$161.60 ","$15.95 ","$13.34 ","$11.00 ","$9.34 ","$11.00 "
"30100148","EAP","CPT� 82803","","Blood Gas-venous","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100149","EAP","CPT� 82803","","Blood Gas-arterial","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100150","EAP","CPT� 82803","","Blood Gas-micro","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100151","EAP","CPT� 82803","","Blood Gas-cord Art.","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100152","EAP","CPT� 82803","","BLOOD GAS-CORD VEN.","BOTH IP/OP","$462.00 ","$341.88 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100153","EAP","CPT� 82172","","Apolipoproteina 1 (so)","BOTH IP/OP","$176.00 ","$130.24 ","$9.49 ","$176.00 ","$32.00 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$176.00 ","$22.14 ","$43.30 ","$139.39 ","$140.80 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30100158","EAP","CPT� 82805","","Bld. Gas+sat. Prof, Art","BOTH IP/OP","$533.00 ","$394.42 ","$31.27 ","$485.00 ","$58.56 ","$39.39 ","$35.45 ","$41.43 ","$41.43 ","$41.93 ","$485.00 ","$82.71 ","$79.30 ","$384.12 ","$388.00 ","$114.22 ","$44.67 ","$78.77 ","$31.27 ","$78.77 "
"30100159","EAP","CPT� 82805","","Bld. Gas+sat. Prof, Ven","BOTH IP/OP","$533.00 ","$394.42 ","$31.27 ","$485.00 ","$58.56 ","$39.39 ","$35.45 ","$41.43 ","$41.43 ","$41.93 ","$485.00 ","$82.71 ","$79.30 ","$384.12 ","$388.00 ","$114.22 ","$44.67 ","$78.77 ","$31.27 ","$78.77 "
"30100160","EAP","CPT� 82805","","Bld. Gas+sat. Prof, Mcr","BOTH IP/OP","$483.00 ","$357.42 ","$31.27 ","$485.00 ","$58.56 ","$39.39 ","$35.45 ","$41.43 ","$41.43 ","$41.93 ","$485.00 ","$82.71 ","$79.30 ","$384.12 ","$388.00 ","$114.22 ","$44.67 ","$78.77 ","$31.27 ","$78.77 "
"30100161","EAP","CPT� 82810","","Saturation Prof, Ven.","BOTH IP/OP","$113.00 ","$83.62 ","$4.40 ","$103.00 ","$18.00 ","$4.89 ","$4.40 ","$12.74 ","$12.74 ","$12.89 ","$103.00 ","$10.26 ","$24.40 ","$81.58 ","$82.40 ","$14.17 ","$13.74 ","$9.77 ","$9.62 ","$9.77 "
"30100162","EAP","CPT� 82810","","Saturation Prof, Art.","BOTH IP/OP","$113.00 ","$83.62 ","$4.40 ","$103.00 ","$18.00 ","$4.89 ","$4.40 ","$12.74 ","$12.74 ","$12.89 ","$103.00 ","$10.26 ","$24.40 ","$81.58 ","$82.40 ","$14.17 ","$13.74 ","$9.77 ","$9.62 ","$9.77 "
"30100163","EAP","CPT� 82810","","Saturation Prof, Micro","BOTH IP/OP","$103.00 ","$76.22 ","$4.40 ","$103.00 ","$18.00 ","$4.89 ","$4.40 ","$12.74 ","$12.74 ","$12.89 ","$103.00 ","$10.26 ","$24.40 ","$81.58 ","$82.40 ","$14.17 ","$13.74 ","$9.77 ","$9.62 ","$9.77 "
"30100165","EAP","CPT� 82941","","Gastrin,serum","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$278.00 ","$36.41 ","$8.82 ","$8.82 ","$25.75 ","$25.75 ","$26.05 ","$278.00 ","$18.51 ","$49.28 ","$220.18 ","$222.40 ","$25.56 ","$0.00 ","$17.63 ","$19.43 ","$17.63 "
"30100167","EAP","CPT� 82945","","Glucose,fluid","BOTH IP/OP","$341.00 ","$252.34 ","$1.97 ","$311.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$311.00 ","$4.13 ","$10.96 ","$246.31 ","$248.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100168","EAP","CPT� 82945","","Glucose,csf","BOTH IP/OP","$341.00 ","$252.34 ","$1.97 ","$311.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$311.00 ","$4.13 ","$10.96 ","$246.31 ","$248.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100169","EAP","CPT� 82945","","GLUCOSE,URINE(QUANT)","BOTH IP/OP","$251.00 ","$185.74 ","$1.97 ","$311.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$311.00 ","$4.13 ","$10.96 ","$246.31 ","$248.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100171","EAP","CPT� 82947","","Glucose","BOTH IP/OP","$358.00 ","$264.92 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100173","EAP","CPT� 82947","","Glucose,fasting Bld","BOTH IP/OP","$358.00 ","$264.92 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100174","EAP","CPT� 82947","","Glucose-wb","BOTH IP/OP","$358.00 ","$264.92 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100176","EAP","CPT� 82947","","Gtt,oral-1hr Indiv","BOTH IP/OP","$263.00 ","$194.62 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100177","EAP","CPT� 82947","","GTT,ORAL-2HR INDIV","BOTH IP/OP","$263.00 ","$194.62 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100178","EAP","CPT� 82947","","Poct, Glucose (meter)","BOTH IP/OP","$92.00 ","$68.08 ","$1.97 ","$84.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$84.00 ","$4.13 ","$10.96 ","$66.53 ","$67.20 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100180","EAP","HCPCS G0480","","Drug Test Definitive 1-7 Classes","BOTH IP/OP","$293.00 ","$216.82 ","$0.00 ","$293.00 ","$0.00 ","$0.00 ","$0.00 ","$209.11 ","$209.11 ","$110.57 ","$293.00 ","$120.15 ","$146.50 ","$232.06 ","$234.40 ","$165.92 ","$117.81 ","$114.43 ","$82.47 ","$114.43 "
"30100181","EAP","HCPCS G0481","","Drug Test Definitive 8-14 Classes","BOTH IP/OP","$322.00 ","$238.28 ","$0.00 ","$322.00 ","$0.00 ","$0.00 ","$0.00 ","$229.81 ","$229.81 ","$0.00 ","$322.00 ","$0.00 ","$161.00 ","$255.02 ","$257.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100182","EAP","HCPCS G0482","","Drug Test Definitive 15-21 Classes","BOTH IP/OP","$354.00 ","$261.96 ","$0.00 ","$354.00 ","$0.00 ","$0.00 ","$0.00 ","$252.65 ","$252.65 ","$0.00 ","$354.00 ","$0.00 ","$177.00 ","$280.37 ","$283.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100183","EAP","HCPCS G0483","","Drug Test Definitive 22+ Classes","BOTH IP/OP","$389.00 ","$287.86 ","$0.00 ","$389.00 ","$0.00 ","$0.00 ","$0.00 ","$277.63 ","$277.63 ","$0.00 ","$389.00 ","$0.00 ","$194.50 ","$308.09 ","$311.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100186","EAP","CPT� 82948","","Glu-2hr Pp, Wb-micro","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$4.63 ","$4.63 ","$0.00 ","$311.00 ","$0.00 ","$8.86 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100187","EAP","CPT� 82950","","Glucose,bld-2hr Pp","BOTH IP/OP","$341.00 ","$252.34 ","$2.37 ","$311.00 ","$9.79 ","$2.38 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$311.00 ","$4.99 ","$13.28 ","$246.31 ","$248.80 ","$6.89 ","$7.48 ","$4.75 ","$5.24 ","$4.75 "
"30100188","EAP","CPT� 82950","","Glucose, 1hr (75gm)","BOTH IP/OP","$251.00 ","$185.74 ","$2.37 ","$311.00 ","$9.79 ","$2.38 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$311.00 ","$4.99 ","$13.28 ","$246.31 ","$248.80 ","$6.89 ","$7.48 ","$4.75 ","$5.24 ","$4.75 "
"30100189","EAP","CPT� 82950","","GLUCOSE,1HR (50GM)","BOTH IP/OP","$251.00 ","$185.74 ","$2.37 ","$311.00 ","$9.79 ","$2.38 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$311.00 ","$4.99 ","$13.28 ","$246.31 ","$248.80 ","$6.89 ","$7.48 ","$4.75 ","$5.24 ","$4.75 "
"30100192","EAP","CPT� 82951","","Gtt,prenatal(75 Gm)","BOTH IP/OP","$201.00 ","$148.74 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30100193","EAP","CPT� 82951","","Gtt,oral-3hr Gtt","BOTH IP/OP","$199.00 ","$147.26 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30100194","EAP","CPT� 82951","","Gtt,oral-4hr Gtt","BOTH IP/OP","$201.00 ","$148.74 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30100195","EAP","CPT� 82951","","Gtt,oral-5hr Gtt","BOTH IP/OP","$201.00 ","$148.74 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30100196","EAP","CPT� 82951","","Gtt,oral-6hr Gtt","BOTH IP/OP","$201.00 ","$148.74 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30100197","EAP","CPT� 82951","","GTT,PRENATAL(100GM)","BOTH IP/OP","$199.00 ","$147.26 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30100200","EAP","CPT� 82952","","3rd Hour-gtt Specimen","BOTH IP/OP","$102.00 ","$75.48 ","$1.96 ","$103.00 ","$8.10 ","$1.96 ","$1.96 ","$5.72 ","$5.72 ","$5.80 ","$103.00 ","$4.12 ","$10.96 ","$81.58 ","$82.40 ","$5.68 ","$6.18 ","$3.92 ","$4.32 ","$3.92 "
"30100201","EAP","CPT� 82952","","4th Hour-gtt Specimen","BOTH IP/OP","$103.00 ","$76.22 ","$1.96 ","$103.00 ","$8.10 ","$1.96 ","$1.96 ","$5.72 ","$5.72 ","$5.80 ","$103.00 ","$4.12 ","$10.96 ","$81.58 ","$82.40 ","$5.68 ","$6.18 ","$3.92 ","$4.32 ","$3.92 "
"30100202","EAP","CPT� 82952","","5TH HOUR GTT SPECIMEN","BOTH IP/OP","$103.00 ","$76.22 ","$1.96 ","$103.00 ","$8.10 ","$1.96 ","$1.96 ","$5.72 ","$5.72 ","$5.80 ","$103.00 ","$4.12 ","$10.96 ","$81.58 ","$82.40 ","$5.68 ","$6.18 ","$3.92 ","$4.32 ","$3.92 "
"30100203","EAP","CPT� 82955","","G6pd, Rbc Quant","BOTH IP/OP","$242.00 ","$179.08 ","$4.85 ","$244.00 ","$16.08 ","$4.85 ","$4.85 ","$11.40 ","$11.40 ","$11.54 ","$244.00 ","$10.19 ","$21.82 ","$193.25 ","$195.20 ","$14.07 ","$12.30 ","$9.70 ","$8.61 ","$9.70 "
"30100205","EAP","CPT� 82977","","GGTP,SERUM","BOTH IP/OP","$162.00 ","$119.88 ","$3.60 ","$162.00 ","$14.86 ","$3.60 ","$3.60 ","$10.51 ","$10.51 ","$7.46 ","$162.00 ","$7.56 ","$20.12 ","$128.30 ","$129.60 ","$10.44 ","$7.94 ","$7.20 ","$5.56 ","$7.20 "
"30100206","EAP","CPT� 83001","","Fsh,serum","BOTH IP/OP","$480.00 ","$355.20 ","$9.29 ","$465.00 ","$38.36 ","$9.29 ","$9.29 ","$27.14 ","$27.14 ","$27.46 ","$465.00 ","$19.51 ","$51.94 ","$368.28 ","$372.00 ","$26.94 ","$29.26 ","$18.58 ","$20.48 ","$18.58 "
"30100207","EAP","CPT� 83002","","Lh,serum","BOTH IP/OP","$532.00 ","$393.68 ","$9.26 ","$515.00 ","$38.23 ","$9.26 ","$9.26 ","$27.04 ","$27.04 ","$27.36 ","$515.00 ","$19.45 ","$51.76 ","$407.88 ","$412.00 ","$26.85 ","$29.16 ","$18.52 ","$20.41 ","$18.52 "
"30100208","EAP","CPT� 83003","","Growth Hormone","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$129.00 ","$29.38 ","$8.34 ","$8.33 ","$20.79 ","$20.79 ","$0.00 ","$129.00 ","$0.00 ","$39.78 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100209","EAP","CPT� 83010","","Haptoglobin,serum","BOTH IP/OP","$333.00 ","$246.42 ","$4.11 ","$336.00 ","$7.71 ","$6.29 ","$6.29 ","$5.44 ","$5.44 ","$5.51 ","$336.00 ","$13.21 ","$10.42 ","$266.11 ","$268.80 ","$18.24 ","$5.87 ","$12.58 ","$4.11 ","$12.58 "
"30100211","EAP","CPT� 83020","","Hgb Elect - Family","BOTH IP/OP","$218.00 ","$161.32 ","$6.44 ","$218.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$218.00 ","$13.51 ","$27.32 ","$172.66 ","$174.40 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30100212","EAP","CPT� 83020","","Hgb Electrophoresis","BOTH IP/OP","$218.00 ","$161.32 ","$6.44 ","$218.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$218.00 ","$13.51 ","$27.32 ","$172.66 ","$174.40 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30100213","EAP","CPT� 83020","","Citrate Agar Elect.","BOTH IP/OP","$217.00 ","$160.58 ","$6.44 ","$218.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$218.00 ","$13.51 ","$27.32 ","$172.66 ","$174.40 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30100214","EAP","CPT� 83020","","Hgb Elect. Quant","BOTH IP/OP","$217.00 ","$160.58 ","$6.44 ","$218.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$218.00 ","$13.51 ","$27.32 ","$172.66 ","$174.40 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30100215","EAP","CPT� 83020","","HGB ELECT. CORD BLD","BOTH IP/OP","$217.00 ","$160.58 ","$6.44 ","$218.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$218.00 ","$13.51 ","$27.32 ","$172.66 ","$174.40 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30100216","EAP","CPT� 83021","","Hgb Phenotyping, Family Member","BOTH IP/OP","$218.00 ","$161.32 ","$6.62 ","$218.00 ","$12.41 ","$9.03 ","$9.03 ","$8.77 ","$8.77 ","$8.87 ","$218.00 ","$18.96 ","$16.78 ","$172.66 ","$174.40 ","$26.19 ","$9.45 ","$18.06 ","$6.62 ","$18.06 "
"30100217","EAP","CPT� 83021","","Hgb A, S, And C Quant, Hplc","BOTH IP/OP","$217.00 ","$160.58 ","$6.62 ","$218.00 ","$12.41 ","$9.03 ","$9.03 ","$8.77 ","$8.77 ","$8.87 ","$218.00 ","$18.96 ","$16.78 ","$172.66 ","$174.40 ","$26.19 ","$9.45 ","$18.06 ","$6.62 ","$18.06 "
"30100218","EAP","CPT� 83021","","Hgb Phenotyping, Complete","BOTH IP/OP","$218.00 ","$161.32 ","$6.62 ","$218.00 ","$12.41 ","$9.03 ","$9.03 ","$8.77 ","$8.77 ","$8.87 ","$218.00 ","$18.96 ","$16.78 ","$172.66 ","$174.40 ","$26.19 ","$9.45 ","$18.06 ","$6.62 ","$18.06 "
"30100219","EAP","CPT� 83021","","Fetal Hgb Quant, Hplc","BOTH IP/OP","$217.00 ","$160.58 ","$6.62 ","$218.00 ","$12.41 ","$9.03 ","$9.03 ","$8.77 ","$8.77 ","$8.87 ","$218.00 ","$18.96 ","$16.78 ","$172.66 ","$174.40 ","$26.19 ","$9.45 ","$18.06 ","$6.62 ","$18.06 "
"30100221","EAP","CPT� 83036","","HGB GLUCOSE A1C","BOTH IP/OP","$219.00 ","$162.06 ","$4.86 ","$219.00 ","$20.04 ","$4.86 ","$4.86 ","$14.17 ","$14.17 ","$14.33 ","$219.00 ","$10.20 ","$27.12 ","$173.45 ","$175.20 ","$14.08 ","$15.27 ","$9.71 ","$10.69 ","$9.71 "
"30100222","EAP","CPT� 83051","","Hgb,plasma-quant","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$10.67 ","$10.67 ","$0.00 ","$165.00 ","$0.00 ","$20.42 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100223","EAP","CPT� 83060","","Sulfhemoglobin,bld","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$12.08 ","$12.08 ","$0.00 ","$164.00 ","$0.00 ","$23.12 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100224","EAP","CPT� 83065","","Hgb Denaturat.,heat","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$10.06 ","$10.06 ","$0.00 ","$146.00 ","$0.00 ","$19.24 ","$115.63 ","$116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100225","EAP","CPT� 83068","","Hgb Pp't,isopropanol","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$12.37 ","$12.37 ","$0.00 ","$176.00 ","$0.00 ","$23.66 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100226","EAP","CPT� 83069","","Hemoglobin,urine-qnt","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$5.76 ","$5.76 ","$0.00 ","$88.00 ","$0.00 ","$11.02 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100227","EAP","CPT� 83070","","Hemosiderin, Urine","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$6.93 ","$6.93 ","$0.00 ","$59.00 ","$0.00 ","$13.28 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100228","EAP","CPT� 83080","","Hexosaminidase-1","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$525.00 ","$0.00 ","$47.14 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100229","EAP","CPT� 83150","","Homovanillic Acid-24h","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$28.25 ","$28.25 ","$0.00 ","$94.00 ","$0.00 ","$54.08 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100230","EAP","CPT� 83491","","Steroids-17oh,24h Ur","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$25.57 ","$25.57 ","$0.00 ","$94.00 ","$0.00 ","$48.94 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100231","EAP","CPT� 83497","","Serotonin,urine-24","BOTH IP/OP","$154.00 ","$113.96 ","$6.45 ","$154.00 ","$26.61 ","$6.45 ","$6.45 ","$18.83 ","$18.83 ","$19.05 ","$154.00 ","$13.55 ","$36.02 ","$121.97 ","$123.20 ","$18.71 ","$20.30 ","$12.90 ","$14.21 ","$12.90 "
"30100232","EAP","CPT� 83498","","Progesterone,17a-oh","BOTH IP/OP","$286.00 ","$211.64 ","$13.59 ","$289.00 ","$56.07 ","$13.59 ","$13.59 ","$39.66 ","$39.66 ","$40.13 ","$289.00 ","$28.53 ","$75.90 ","$228.89 ","$231.20 ","$39.40 ","$42.76 ","$27.17 ","$29.93 ","$27.17 "
"30100233","EAP","CPT� 83516","","T-transglutaminase Iga","BOTH IP/OP","$181.00 ","$133.94 ","$5.76 ","$176.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$176.00 ","$12.11 ","$29.88 ","$139.39 ","$140.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100234","EAP","CPT� 83516","","Gliadin Ab Igg","BOTH IP/OP","$313.00 ","$231.62 ","$5.76 ","$304.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$304.00 ","$12.11 ","$29.88 ","$240.77 ","$243.20 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100235","EAP","CPT� 83516","","Gliadin Ab Iga","BOTH IP/OP","$269.00 ","$199.06 ","$5.76 ","$304.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$304.00 ","$12.11 ","$29.88 ","$240.77 ","$243.20 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100236","EAP","CPT� 83519","","Igf Binding Protein-3","BOTH IP/OP","$260.00 ","$192.40 ","$8.28 ","$253.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$253.00 ","$19.32 ","$37.76 ","$200.38 ","$202.40 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30100237","EAP","CPT� 83519","","Gad-65 Autoantibody","BOTH IP/OP","$260.00 ","$192.40 ","$8.28 ","$253.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$253.00 ","$19.32 ","$37.76 ","$200.38 ","$202.40 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30100238","EAP","CPT� 84490","","Trypsin,fecal","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$116.00 ","$15.71 ","$4.97 ","$0.00 ","$11.11 ","$11.11 ","$0.00 ","$116.00 ","$0.00 ","$21.26 ","$91.87 ","$92.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100239","EAP","CPT� 80155","","Caffeine (so)","BOTH IP/OP","$570.00 ","$421.80 ","$0.00 ","$554.00 ","$0.00 ","$0.00 ","$0.00 ","$19.30 ","$19.30 ","$0.00 ","$554.00 ","$0.00 ","$277.00 ","$438.77 ","$443.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100240","EAP","CPT� 83525","","Insulin, Serum","BOTH IP/OP","$324.00 ","$239.76 ","$5.72 ","$327.00 ","$23.60 ","$5.72 ","$5.72 ","$16.69 ","$16.69 ","$16.89 ","$327.00 ","$12.00 ","$31.96 ","$258.98 ","$261.60 ","$16.57 ","$18.00 ","$11.43 ","$12.60 ","$11.43 "
"30100241","EAP","CPT� 83540","","Iron-total,serum","BOTH IP/OP","$202.00 ","$149.48 ","$3.24 ","$200.00 ","$13.36 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$200.00 ","$6.79 ","$18.10 ","$158.40 ","$160.00 ","$9.38 ","$10.20 ","$6.47 ","$7.14 ","$6.47 "
"30100242","EAP","CPT� 83540","","Iron, Liver Tissue","BOTH IP/OP","$186.00 ","$137.64 ","$3.24 ","$186.00 ","$13.36 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$186.00 ","$6.79 ","$18.10 ","$147.31 ","$148.80 ","$9.38 ","$10.20 ","$6.47 ","$7.14 ","$6.47 "
"30100243","EAP","CPT� 83582","","Steroids-17kg,24h Ur","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$20.69 ","$20.69 ","$0.00 ","$93.00 ","$0.00 ","$39.60 ","$73.66 ","$74.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100244","EAP","CPT� 83593","","Steroids-17keto,24hr","BOTH IP/OP","$367.00 ","$271.58 ","$0.00 ","$367.00 ","$0.00 ","$0.00 ","$0.00 ","$38.40 ","$38.40 ","$0.00 ","$367.00 ","$0.00 ","$73.50 ","$290.66 ","$293.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100247","EAP","CPT� 83605","","Lactic Acid, Blood","BOTH IP/OP","$341.00 ","$252.34 ","$5.34 ","$311.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$311.00 ","$12.15 ","$29.84 ","$246.31 ","$248.80 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30100248","EAP","CPT� 83605","","Lactic Acid, Csf","BOTH IP/OP","$341.00 ","$252.34 ","$5.34 ","$311.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$311.00 ","$12.15 ","$29.84 ","$246.31 ","$248.80 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30100249","EAP","CPT� 83605","","LACTIC ACID, FLUID","BOTH IP/OP","$258.00 ","$190.92 ","$5.34 ","$311.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$311.00 ","$12.15 ","$29.84 ","$246.31 ","$248.80 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30100251","EAP","CPT� 83615","","Ldh,total-serum","BOTH IP/OP","$153.00 ","$113.22 ","$3.02 ","$139.00 ","$12.46 ","$3.02 ","$3.02 ","$8.81 ","$8.81 ","$7.46 ","$139.00 ","$6.34 ","$16.88 ","$110.09 ","$111.20 ","$8.76 ","$7.94 ","$6.04 ","$5.56 ","$6.04 "
"30100252","EAP","CPT� 83615","","Ldh,fluid","BOTH IP/OP","$153.00 ","$113.22 ","$3.02 ","$139.00 ","$12.46 ","$3.02 ","$3.02 ","$8.81 ","$8.81 ","$7.46 ","$139.00 ","$6.34 ","$16.88 ","$110.09 ","$111.20 ","$8.76 ","$7.94 ","$6.04 ","$5.56 ","$6.04 "
"30100253","EAP","CPT� 83615","","LDH,CSF","BOTH IP/OP","$139.00 ","$102.86 ","$3.02 ","$139.00 ","$12.46 ","$3.02 ","$3.02 ","$8.81 ","$8.81 ","$7.46 ","$139.00 ","$6.34 ","$16.88 ","$110.09 ","$111.20 ","$8.76 ","$7.94 ","$6.04 ","$5.56 ","$6.04 "
"30100254","EAP","CPT� 83655","","Lead,blood","BOTH IP/OP","$200.00 ","$148.00 ","$6.05 ","$200.00 ","$25.00 ","$6.06 ","$6.05 ","$17.67 ","$17.67 ","$11.75 ","$200.00 ","$12.72 ","$33.82 ","$158.40 ","$160.00 ","$17.56 ","$12.52 ","$12.11 ","$8.76 ","$12.11 "
"30100255","EAP","CPT� 83655","","Lead,urine-24hr","BOTH IP/OP","$195.00 ","$144.30 ","$6.05 ","$195.00 ","$25.00 ","$6.06 ","$6.05 ","$17.67 ","$17.67 ","$11.75 ","$195.00 ","$12.72 ","$33.82 ","$154.44 ","$156.00 ","$17.56 ","$12.52 ","$12.11 ","$8.76 ","$12.11 "
"30100256","EAP","CPT� 83661","","Fetal Lung Maturity","BOTH IP/OP","$262.00 ","$193.88 ","$0.00 ","$263.00 ","$0.00 ","$0.00 ","$0.00 ","$32.09 ","$32.09 ","$0.00 ","$263.00 ","$0.00 ","$61.42 ","$208.30 ","$210.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100258","EAP","CPT� 83690","","LIPASE, SERUM","BOTH IP/OP","$225.00 ","$166.50 ","$3.44 ","$251.00 ","$14.23 ","$3.45 ","$3.44 ","$10.06 ","$10.06 ","$10.17 ","$251.00 ","$7.23 ","$19.24 ","$198.79 ","$200.80 ","$9.99 ","$10.84 ","$6.89 ","$7.59 ","$6.89 "
"30100259","EAP","CPT� 83698","","Plac (lp-pla2) Test","BOTH IP/OP","$453.00 ","$335.22 ","$0.00 ","$453.00 ","$0.00 ","$0.00 ","$0.00 ","$49.56 ","$49.56 ","$0.00 ","$453.00 ","$0.00 ","$94.86 ","$358.78 ","$362.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100260","EAP","CPT� 83718","","CHOL,HDL","BOTH IP/OP","$118.00 ","$87.32 ","$4.10 ","$119.00 ","$16.92 ","$4.10 ","$4.10 ","$11.96 ","$11.96 ","$12.10 ","$119.00 ","$8.60 ","$22.88 ","$94.25 ","$95.20 ","$11.88 ","$12.89 ","$8.19 ","$9.02 ","$8.19 "
"30100262","EAP","CPT� 83721","","CHOL-LDL, DIRECT","BOTH IP/OP","$147.00 ","$108.78 ","$4.77 ","$149.00 ","$19.69 ","$5.25 ","$4.77 ","$13.93 ","$13.93 ","$14.10 ","$149.00 ","$11.03 ","$26.66 ","$118.01 ","$119.20 ","$15.23 ","$15.03 ","$10.50 ","$10.52 ","$10.50 "
"30100263","EAP","CPT� 83735","","Magnesium","BOTH IP/OP","$188.00 ","$139.12 ","$3.35 ","$171.00 ","$13.83 ","$3.35 ","$3.35 ","$9.78 ","$9.78 ","$9.89 ","$171.00 ","$7.04 ","$18.72 ","$135.43 ","$136.80 ","$9.72 ","$10.54 ","$6.70 ","$7.38 ","$6.70 "
"30100264","EAP","CPT� 83735","","MAGNESIUM, URINE","BOTH IP/OP","$160.00 ","$118.40 ","$3.35 ","$171.00 ","$13.83 ","$3.35 ","$3.35 ","$9.78 ","$9.78 ","$9.89 ","$171.00 ","$7.04 ","$18.72 ","$135.43 ","$136.80 ","$9.72 ","$10.54 ","$6.70 ","$7.38 ","$6.70 "
"30100266","EAP","CPT� 83825","","Mercury,urine-24hr","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$84.00 ","$17.07 ","$45.44 ","$66.53 ","$67.20 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30100267","EAP","CPT� 83835","","Metaneph.tot,ur","BOTH IP/OP","$508.00 ","$375.92 ","$8.47 ","$471.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$471.00 ","$17.79 ","$47.34 ","$373.03 ","$376.80 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30100268","EAP","CPT� 83835","","Metanephrines, Frac, Plasma","BOTH IP/OP","$544.00 ","$402.56 ","$8.47 ","$504.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$504.00 ","$17.79 ","$47.34 ","$399.17 ","$403.20 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30100269","EAP","CPT� 83835","","Metanephrines, Urine, Random","BOTH IP/OP","$504.00 ","$372.96 ","$8.47 ","$504.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$504.00 ","$17.79 ","$47.34 ","$399.17 ","$403.20 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30100270","EAP","CPT� 83864","","Mucopolysaccha","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$29.07 ","$29.07 ","$0.00 ","$388.00 ","$0.00 ","$55.64 ","$307.30 ","$310.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100271","EAP","CPT� 83874","","Myoglobin-qual,urine","BOTH IP/OP","$182.00 ","$134.68 ","$6.46 ","$182.00 ","$26.66 ","$6.46 ","$6.46 ","$18.86 ","$18.86 ","$19.08 ","$182.00 ","$13.57 ","$36.08 ","$144.14 ","$145.60 ","$18.73 ","$20.33 ","$12.92 ","$14.23 ","$12.92 "
"30100272","EAP","CPT� 83880","","B-type Natriurtic Peptide","BOTH IP/OP","$368.00 ","$272.32 ","$17.67 ","$372.00 ","$70.07 ","$19.63 ","$17.67 ","$49.56 ","$49.56 ","$50.15 ","$372.00 ","$41.22 ","$94.86 ","$294.62 ","$297.60 ","$56.93 ","$53.43 ","$39.26 ","$37.40 ","$39.26 "
"30100273","EAP","CPT� 83883","","Alpha2-macroglbulin","BOTH IP/OP","$178.00 ","$131.72 ","$6.80 ","$178.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$178.00 ","$14.28 ","$38.00 ","$140.98 ","$142.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100274","EAP","CPT� 83883","","Albumin-immuno,ser","BOTH IP/OP","$176.00 ","$130.24 ","$6.80 ","$178.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$178.00 ","$14.28 ","$38.00 ","$140.98 ","$142.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100275","EAP","CPT� 83883","","Albumin,csf-immuno","BOTH IP/OP","$176.00 ","$130.24 ","$6.80 ","$178.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$178.00 ","$14.28 ","$38.00 ","$140.98 ","$142.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100276","EAP","CPT� 83883","","Albumin,urine-immuno","BOTH IP/OP","$178.00 ","$131.72 ","$6.80 ","$178.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$178.00 ","$14.28 ","$38.00 ","$140.98 ","$142.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100277","EAP","CPT� 83883","","C-1 Esterase Inhib","BOTH IP/OP","$168.00 ","$124.32 ","$6.80 ","$168.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$168.00 ","$14.28 ","$38.00 ","$133.06 ","$134.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100278","EAP","CPT� 83883","","Free Kappa","BOTH IP/OP","$176.00 ","$130.24 ","$6.80 ","$178.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$178.00 ","$14.28 ","$38.00 ","$140.98 ","$142.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100279","EAP","CPT� 83883","","Free Lambda","BOTH IP/OP","$176.00 ","$130.24 ","$6.80 ","$178.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$178.00 ","$14.28 ","$38.00 ","$140.98 ","$142.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100280","EAP","CPT� 80323","","Nicotine","BOTH IP/OP","$422.00 ","$312.28 ","$0.00 ","$422.00 ","$0.03 ","$12.01 ","$18.43 ","$301.18 ","$301.18 ","$44.34 ","$422.00 ","$0.00 ","$211.00 ","$334.22 ","$337.60 ","$253.20 ","$47.25 ","$0.00 ","$33.07 ","$0.00 "
"30100296","EAP","CPT� 83915","","5'-nucleotidase","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$64.00 ","$23.02 ","$5.58 ","$5.58 ","$16.29 ","$16.29 ","$0.00 ","$64.00 ","$0.00 ","$31.16 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100297","EAP","CPT� 83921","","Methylmalonic Acid","BOTH IP/OP","$241.00 ","$178.34 ","$9.54 ","$243.00 ","$33.95 ","$10.61 ","$9.54 ","$24.04 ","$24.04 ","$24.32 ","$243.00 ","$22.27 ","$46.00 ","$192.46 ","$194.40 ","$30.75 ","$25.91 ","$21.21 ","$18.14 ","$21.21 "
"30100298","EAP","CPT� 83921","","Orotic Acid","BOTH IP/OP","$241.00 ","$178.34 ","$9.54 ","$243.00 ","$33.95 ","$10.61 ","$9.54 ","$24.04 ","$24.04 ","$24.32 ","$243.00 ","$22.27 ","$46.00 ","$192.46 ","$194.40 ","$30.75 ","$25.91 ","$21.21 ","$18.14 ","$21.21 "
"30100299","EAP","CPT� 83930","","Osmolality,crystal","BOTH IP/OP","$230.00 ","$170.20 ","$3.31 ","$241.00 ","$13.65 ","$3.31 ","$3.31 ","$9.65 ","$9.65 ","$9.78 ","$241.00 ","$6.94 ","$18.48 ","$190.87 ","$192.80 ","$9.58 ","$10.42 ","$6.61 ","$7.29 ","$6.61 "
"30100300","EAP","CPT� 83930","","Osmolality","BOTH IP/OP","$265.00 ","$196.10 ","$3.31 ","$241.00 ","$13.65 ","$3.31 ","$3.31 ","$9.65 ","$9.65 ","$9.78 ","$241.00 ","$6.94 ","$18.48 ","$190.87 ","$192.80 ","$9.58 ","$10.42 ","$6.61 ","$7.29 ","$6.61 "
"30100301","EAP","CPT� 83935","","Osmolality,fluid","BOTH IP/OP","$272.00 ","$201.28 ","$3.41 ","$247.00 ","$14.07 ","$3.41 ","$3.41 ","$9.95 ","$9.95 ","$10.07 ","$247.00 ","$7.16 ","$19.04 ","$195.62 ","$197.60 ","$9.89 ","$10.73 ","$6.82 ","$7.51 ","$6.82 "
"30100302","EAP","CPT� 83935","","Osmolality,urine","BOTH IP/OP","$272.00 ","$201.28 ","$3.41 ","$247.00 ","$14.07 ","$3.41 ","$3.41 ","$9.95 ","$9.95 ","$10.07 ","$247.00 ","$7.16 ","$19.04 ","$195.62 ","$197.60 ","$9.89 ","$10.73 ","$6.82 ","$7.51 ","$6.82 "
"30100303","EAP","CPT� 83945","","Oxalate, Urine-24hr","BOTH IP/OP","$53.00 ","$39.22 ","$0.00 ","$53.00 ","$26.58 ","$7.23 ","$6.50 ","$18.80 ","$18.80 ","$0.00 ","$53.00 ","$0.00 ","$35.98 ","$41.98 ","$42.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100304","EAP","CPT� 83970","","Parathormone Intact","BOTH IP/OP","$502.00 ","$371.48 ","$20.64 ","$502.00 ","$85.19 ","$20.64 ","$20.64 ","$60.27 ","$60.27 ","$60.97 ","$502.00 ","$43.34 ","$115.34 ","$397.58 ","$401.60 ","$59.86 ","$64.97 ","$41.28 ","$45.48 ","$41.28 "
"30100306","EAP","CPT� 83986","","Ph, Stool","BOTH IP/OP","$86.00 ","$63.64 ","$0.00 ","$78.00 ","$7.39 ","$1.79 ","$1.79 ","$5.22 ","$5.22 ","$5.28 ","$78.00 ","$3.76 ","$10.00 ","$61.78 ","$62.40 ","$5.19 ","$0.00 ","$3.58 ","$3.94 ","$3.58 "
"30100307","EAP","CPT� 84075","","Alk Phosphatase","BOTH IP/OP","$110.00 ","$81.40 ","$2.59 ","$105.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.46 ","$105.00 ","$5.44 ","$14.46 ","$83.16 ","$84.00 ","$7.51 ","$7.94 ","$5.18 ","$5.56 ","$5.18 "
"30100308","EAP","CPT� 84075","","Alk Phos,fluid","BOTH IP/OP","$110.00 ","$81.40 ","$2.59 ","$110.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.46 ","$110.00 ","$5.44 ","$14.46 ","$87.12 ","$88.00 ","$7.51 ","$7.94 ","$5.18 ","$5.56 ","$5.18 "
"30100309","EAP","CPT� 84080","","Alk Phos Isoenzymes","BOTH IP/OP","$316.00 ","$233.84 ","$7.39 ","$301.00 ","$30.52 ","$7.39 ","$7.39 ","$21.59 ","$21.59 ","$21.84 ","$301.00 ","$15.52 ","$41.32 ","$238.39 ","$240.80 ","$21.43 ","$23.27 ","$14.78 ","$16.29 ","$14.78 "
"30100310","EAP","CPT� 84081","","Pg Agglutinin Test","BOTH IP/OP","$194.00 ","$143.56 ","$0.00 ","$194.00 ","$0.00 ","$0.00 ","$0.00 ","$24.12 ","$24.12 ","$0.00 ","$194.00 ","$0.00 ","$46.18 ","$153.65 ","$155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100311","EAP","CPT� 84100","","Phosphorus","BOTH IP/OP","$150.00 ","$111.00 ","$2.37 ","$136.00 ","$9.79 ","$2.37 ","$2.37 ","$6.93 ","$6.93 ","$7.01 ","$136.00 ","$4.98 ","$13.26 ","$107.71 ","$108.80 ","$6.87 ","$7.47 ","$4.74 ","$5.23 ","$4.74 "
"30100312","EAP","CPT� 84100","","Phosporus, Serum","BOTH IP/OP","$128.00 ","$94.72 ","$2.37 ","$136.00 ","$9.79 ","$2.37 ","$2.37 ","$6.93 ","$6.93 ","$7.01 ","$136.00 ","$4.98 ","$13.26 ","$107.71 ","$108.80 ","$6.87 ","$7.47 ","$4.74 ","$5.23 ","$4.74 "
"30100313","EAP","CPT� 84105","","Phosphorus, Urine","BOTH IP/OP","$164.00 ","$121.36 ","$2.60 ","$149.00 ","$10.69 ","$2.89 ","$2.60 ","$7.56 ","$7.56 ","$7.64 ","$149.00 ","$6.07 ","$14.46 ","$118.01 ","$119.20 ","$8.38 ","$8.14 ","$5.78 ","$5.70 ","$5.78 "
"30100314","EAP","CPT� 84110","","Porphobilinogen-24hr","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$12.34 ","$12.34 ","$12.47 ","$75.00 ","$8.86 ","$23.60 ","$59.40 ","$60.00 ","$12.24 ","$13.29 ","$8.44 ","$9.30 ","$8.44 "
"30100315","EAP","CPT� 84120","","Porphyrins,ur-quant","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$7.36 ","$21.47 ","$21.47 ","$0.00 ","$109.00 ","$0.00 ","$41.10 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100316","EAP","CPT� 84132","","Potassium, Wb","BOTH IP/OP","$141.00 ","$104.34 ","$2.30 ","$141.00 ","$9.50 ","$2.38 ","$2.30 ","$6.70 ","$6.70 ","$6.79 ","$141.00 ","$5.00 ","$12.84 ","$111.67 ","$112.80 ","$6.90 ","$7.24 ","$4.76 ","$5.07 ","$4.76 "
"30100317","EAP","CPT� 84132","","Potassium","BOTH IP/OP","$141.00 ","$104.34 ","$2.30 ","$141.00 ","$9.50 ","$2.38 ","$2.30 ","$6.70 ","$6.70 ","$6.79 ","$141.00 ","$5.00 ","$12.84 ","$111.67 ","$112.80 ","$6.90 ","$7.24 ","$4.76 ","$5.07 ","$4.76 "
"30100318","EAP","CPT� 84132","","Potassium,plasma","BOTH IP/OP","$141.00 ","$104.34 ","$2.30 ","$141.00 ","$9.50 ","$2.38 ","$2.30 ","$6.70 ","$6.70 ","$6.79 ","$141.00 ","$5.00 ","$12.84 ","$111.67 ","$112.80 ","$6.90 ","$7.24 ","$4.76 ","$5.07 ","$4.76 "
"30100319","EAP","CPT� 84133","","Potassium,fluid","BOTH IP/OP","$106.00 ","$78.44 ","$2.16 ","$106.00 ","$8.90 ","$2.37 ","$2.16 ","$6.28 ","$6.28 ","$6.35 ","$106.00 ","$4.97 ","$12.02 ","$83.95 ","$84.80 ","$6.86 ","$6.77 ","$4.73 ","$4.74 ","$4.73 "
"30100320","EAP","CPT� 84133","","Potassium, Urine","BOTH IP/OP","$106.00 ","$78.44 ","$2.16 ","$106.00 ","$8.90 ","$2.37 ","$2.16 ","$6.28 ","$6.28 ","$6.35 ","$106.00 ","$4.97 ","$12.02 ","$83.95 ","$84.80 ","$6.86 ","$6.77 ","$4.73 ","$4.74 ","$4.73 "
"30100321","EAP","CPT� 84134","","Prealbumin","BOTH IP/OP","$282.00 ","$208.68 ","$7.29 ","$256.00 ","$30.12 ","$7.30 ","$7.29 ","$21.30 ","$21.30 ","$21.55 ","$256.00 ","$15.32 ","$40.76 ","$202.75 ","$204.80 ","$21.16 ","$22.96 ","$14.59 ","$16.07 ","$14.59 "
"30100322","EAP","CPT� 84135","","Pregnanediol,ur-24hr","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$27.94 ","$27.94 ","$0.00 ","$224.00 ","$0.00 ","$53.46 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100323","EAP","CPT� 84138","","Pregnanetriol,ur-24h","BOTH IP/OP","$209.00 ","$154.66 ","$0.00 ","$223.00 ","$0.00 ","$0.00 ","$0.00 ","$27.65 ","$27.65 ","$0.00 ","$223.00 ","$0.00 ","$52.92 ","$176.62 ","$178.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100324","EAP","CPT� 84144","","Progesterone, Serum","BOTH IP/OP","$222.00 ","$164.28 ","$10.43 ","$224.00 ","$42.06 ","$10.43 ","$10.43 ","$29.74 ","$29.74 ","$30.08 ","$224.00 ","$21.90 ","$56.92 ","$177.41 ","$179.20 ","$30.25 ","$32.05 ","$20.86 ","$22.44 ","$20.86 "
"30100325","EAP","CPT� 84146","","Prolactin,serum","BOTH IP/OP","$427.00 ","$315.98 ","$9.69 ","$427.00 ","$40.00 ","$9.69 ","$9.69 ","$28.30 ","$28.30 ","$28.63 ","$427.00 ","$20.35 ","$54.16 ","$338.18 ","$341.60 ","$28.10 ","$30.51 ","$19.38 ","$21.36 ","$19.38 "
"30100326","EAP","CPT� 84153","","Prostatic Antigen","BOTH IP/OP","$335.00 ","$247.90 ","$9.20 ","$335.00 ","$37.96 ","$9.20 ","$9.20 ","$26.85 ","$26.85 ","$27.17 ","$335.00 ","$19.31 ","$51.40 ","$265.32 ","$268.00 ","$26.67 ","$28.95 ","$18.39 ","$20.27 ","$18.39 "
"30100327","EAP","CPT� 84155","","Protein,total","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$132.00 ","$0.00 ","$10.24 ","$104.54 ","$105.60 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$0.00 "
"30100328","EAP","CPT� 84155","","Protein, Csf","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$132.00 ","$0.00 ","$10.24 ","$104.54 ","$105.60 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$0.00 "
"30100329","EAP","CPT� 84155","","Protein,total","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$132.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$132.00 ","$0.00 ","$10.24 ","$104.54 ","$105.60 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$0.00 "
"30100330","EAP","CPT� 84156","","Protein,ur (quant)","BOTH IP/OP","$132.00 ","$97.68 ","$1.83 ","$129.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$129.00 ","$3.85 ","$10.24 ","$102.17 ","$103.20 ","$5.32 ","$5.77 ","$3.67 ","$4.04 ","$3.67 "
"30100331","EAP","CPT� 84157","","Protein,fluid","BOTH IP/OP","$155.00 ","$114.70 ","$1.83 ","$152.00 ","$7.58 ","$2.00 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$152.00 ","$4.20 ","$10.24 ","$120.38 ","$121.60 ","$5.80 ","$5.77 ","$4.00 ","$4.04 ","$4.00 "
"30100332","EAP","CPT� 84157","","Protein, Csf","BOTH IP/OP","$155.00 ","$114.70 ","$1.83 ","$152.00 ","$7.58 ","$2.00 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$152.00 ","$4.20 ","$10.24 ","$120.38 ","$121.60 ","$5.80 ","$5.77 ","$4.00 ","$4.04 ","$4.00 "
"30100333","EAP","CPT� 84165","","Protein Elect, Serum","BOTH IP/OP","$357.00 ","$264.18 ","$5.37 ","$350.00 ","$22.18 ","$5.37 ","$5.37 ","$15.68 ","$15.68 ","$15.87 ","$350.00 ","$11.28 ","$30.02 ","$277.20 ","$280.00 ","$15.57 ","$16.91 ","$10.74 ","$11.83 ","$10.74 "
"30100334","EAP","CPT� 84166","","Protein Electrophoresis, Csf","BOTH IP/OP","$350.00 ","$259.00 ","$8.91 ","$350.00 ","$36.80 ","$8.92 ","$8.91 ","$26.04 ","$26.04 ","$26.34 ","$350.00 ","$18.72 ","$49.84 ","$277.20 ","$280.00 ","$25.85 ","$28.07 ","$17.83 ","$19.65 ","$17.83 "
"30100335","EAP","CPT� 84166","","Protein Elect, Urine","BOTH IP/OP","$357.00 ","$264.18 ","$8.91 ","$350.00 ","$36.80 ","$8.92 ","$8.91 ","$26.04 ","$26.04 ","$26.34 ","$350.00 ","$18.72 ","$49.84 ","$277.20 ","$280.00 ","$25.85 ","$28.07 ","$17.83 ","$19.65 ","$17.83 "
"30100336","EAP","CPT� 84202","","Protoporphyrin,rbc","BOTH IP/OP","$74.00 ","$54.76 ","$0.00 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$20.95 ","$20.95 ","$0.00 ","$74.00 ","$0.00 ","$40.10 ","$58.61 ","$59.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100337","EAP","CPT� 84207","","Vitamine B6; Pyridoxine","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$41.02 ","$41.02 ","$0.00 ","$800.00 ","$0.00 ","$78.50 ","$633.60 ","$640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100338","EAP","CPT� 84210","","Pyruvic Acid, Blood","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$15.85 ","$15.85 ","$0.00 ","$118.00 ","$15.20 ","$30.34 ","$93.46 ","$94.40 ","$21.00 ","$0.00 ","$14.48 ","$11.96 ","$14.48 "
"30100339","EAP","CPT� 84238","","Acetcholn Reptor Ad","BOTH IP/OP","$201.00 ","$148.74 ","$18.28 ","$203.00 ","$75.48 ","$18.29 ","$18.28 ","$53.39 ","$53.39 ","$54.01 ","$203.00 ","$38.40 ","$102.18 ","$160.78 ","$162.40 ","$53.03 ","$57.55 ","$36.57 ","$40.29 ","$36.57 "
"30100340","EAP","CPT� 84244","","Renin, Blood","BOTH IP/OP","$322.00 ","$238.28 ","$11.00 ","$325.00 ","$45.41 ","$11.00 ","$11.00 ","$32.12 ","$32.12 ","$32.50 ","$325.00 ","$23.09 ","$61.46 ","$257.40 ","$260.00 ","$31.89 ","$34.63 ","$21.99 ","$24.24 ","$21.99 "
"30100341","EAP","CPT� 84295","","Sodium, Wb","BOTH IP/OP","$220.00 ","$162.80 ","$2.41 ","$200.00 ","$9.93 ","$2.41 ","$2.41 ","$7.02 ","$7.02 ","$7.11 ","$200.00 ","$5.05 ","$13.44 ","$158.40 ","$160.00 ","$6.97 ","$7.57 ","$4.81 ","$5.30 ","$4.81 "
"30100342","EAP","CPT� 84295","","Sodium","BOTH IP/OP","$220.00 ","$162.80 ","$2.41 ","$200.00 ","$9.93 ","$2.41 ","$2.41 ","$7.02 ","$7.02 ","$7.11 ","$200.00 ","$5.05 ","$13.44 ","$158.40 ","$160.00 ","$6.97 ","$7.57 ","$4.81 ","$5.30 ","$4.81 "
"30100343","EAP","CPT� 84295","","Sodium-direct Ise","BOTH IP/OP","$190.00 ","$140.60 ","$2.41 ","$200.00 ","$9.93 ","$2.41 ","$2.41 ","$7.02 ","$7.02 ","$7.11 ","$200.00 ","$5.05 ","$13.44 ","$158.40 ","$160.00 ","$6.97 ","$7.57 ","$4.81 ","$5.30 ","$4.81 "
"30100344","EAP","CPT� 84300","","Sodium, Urine","BOTH IP/OP","$144.00 ","$106.56 ","$2.43 ","$131.00 ","$7.13 ","$2.53 ","$2.43 ","$5.05 ","$5.05 ","$5.11 ","$131.00 ","$5.31 ","$9.66 ","$103.75 ","$104.80 ","$7.34 ","$5.45 ","$5.06 ","$3.81 ","$5.06 "
"30100345","EAP","CPT� 84302","","Sodium,fluid","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$5.05 ","$5.05 ","$0.00 ","$131.00 ","$0.00 ","$9.66 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100346","EAP","CPT� 84305","","Igf-1(somatomedin C)","BOTH IP/OP","$283.00 ","$209.42 ","$10.63 ","$275.00 ","$43.90 ","$10.63 ","$10.63 ","$31.04 ","$31.04 ","$31.41 ","$275.00 ","$22.32 ","$59.40 ","$217.80 ","$220.00 ","$30.83 ","$33.46 ","$21.26 ","$23.42 ","$21.26 "
"30100347","EAP","CPT� 84375","","Oligosaccharide","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$134.00 ","$0.00 ","$0.00 ","$0.00 ","$28.62 ","$28.62 ","$0.00 ","$134.00 ","$0.00 ","$54.78 ","$106.13 ","$107.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100348","EAP","CPT� 84402","","Testosterone, Free","BOTH IP/OP","$95.00 ","$70.30 ","$12.74 ","$95.00 ","$52.59 ","$12.74 ","$12.74 ","$37.18 ","$37.18 ","$37.60 ","$95.00 ","$26.74 ","$71.14 ","$75.24 ","$76.00 ","$36.93 ","$40.06 ","$25.47 ","$28.04 ","$25.47 "
"30100349","EAP","CPT� 84403","","Testosterone, Total","BOTH IP/OP","$384.00 ","$284.16 ","$12.91 ","$384.00 ","$53.28 ","$12.91 ","$12.91 ","$37.70 ","$37.70 ","$38.15 ","$384.00 ","$27.10 ","$72.16 ","$304.13 ","$307.20 ","$37.42 ","$40.65 ","$25.81 ","$28.45 ","$25.81 "
"30100350","EAP","CPT� 84403","","Testosterone, Serum","BOTH IP/OP","$384.00 ","$284.16 ","$12.91 ","$384.00 ","$53.28 ","$12.91 ","$12.91 ","$37.70 ","$37.70 ","$38.15 ","$384.00 ","$27.10 ","$72.16 ","$304.13 ","$307.20 ","$37.42 ","$40.65 ","$25.81 ","$28.45 ","$25.81 "
"30100351","EAP","CPT� 84425","","Vitamine B1; Thyamin","BOTH IP/OP","$276.00 ","$204.24 ","$10.62 ","$276.00 ","$43.82 ","$10.62 ","$10.62 ","$31.01 ","$31.01 ","$31.36 ","$276.00 ","$22.29 ","$59.34 ","$218.59 ","$220.80 ","$30.78 ","$33.42 ","$21.23 ","$23.39 ","$21.23 "
"30100352","EAP","CPT� 84430","","Thiocyanate-quant","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$8.42 ","$8.42 ","$0.00 ","$199.00 ","$0.00 ","$16.12 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100353","EAP","CPT� 84432","","Thyroglobulin, Quant","BOTH IP/OP","$214.00 ","$158.36 ","$8.03 ","$214.00 ","$33.16 ","$8.03 ","$8.03 ","$23.45 ","$23.45 ","$23.73 ","$214.00 ","$16.86 ","$44.88 ","$169.49 ","$171.20 ","$23.29 ","$25.28 ","$16.06 ","$17.70 ","$16.06 "
"30100354","EAP","CPT� 84436","","Thyroxine,total(t4)","BOTH IP/OP","$322.00 ","$238.28 ","$3.43 ","$323.00 ","$14.18 ","$3.44 ","$3.43 ","$10.03 ","$10.03 ","$10.16 ","$323.00 ","$7.21 ","$19.22 ","$255.82 ","$258.40 ","$9.96 ","$10.83 ","$6.87 ","$7.58 ","$6.87 "
"30100355","EAP","CPT� 84439","","Free Thyroxine","BOTH IP/OP","$215.00 ","$159.10 ","$4.51 ","$215.00 ","$18.61 ","$4.51 ","$4.51 ","$13.17 ","$13.17 ","$13.32 ","$215.00 ","$9.47 ","$25.20 ","$170.28 ","$172.00 ","$13.08 ","$14.20 ","$9.02 ","$9.94 ","$9.02 "
"30100356","EAP","CPT� 84442","","Thyroxine Bind.glob.","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$63.00 ","$15.52 ","$32.52 ","$49.90 ","$50.40 ","$21.43 ","$18.31 ","$14.78 ","$12.82 ","$14.78 "
"30100357","EAP","CPT� 84443","","Tsh,serum-irma","BOTH IP/OP","$275.00 ","$203.50 ","$8.40 ","$275.00 ","$34.69 ","$8.40 ","$8.40 ","$24.53 ","$24.53 ","$24.81 ","$275.00 ","$17.64 ","$46.94 ","$217.80 ","$220.00 ","$24.36 ","$26.44 ","$16.80 ","$18.51 ","$16.80 "
"30100358","EAP","CPT� 84446","","Vitamin E, Serum","BOTH IP/OP","$178.00 ","$131.72 ","$7.09 ","$178.00 ","$29.28 ","$7.09 ","$7.09 ","$20.70 ","$20.70 ","$20.95 ","$178.00 ","$14.89 ","$39.62 ","$140.98 ","$142.40 ","$20.56 ","$22.32 ","$14.18 ","$15.62 ","$14.18 "
"30100359","EAP","CPT� 84450","","Sgot(ast),serum","BOTH IP/OP","$63.00 ","$46.62 ","$2.59 ","$64.00 ","$10.69 ","$2.59 ","$2.59 ","$7.55 ","$7.55 ","$7.46 ","$64.00 ","$5.44 ","$14.44 ","$50.69 ","$51.20 ","$7.51 ","$7.94 ","$5.18 ","$5.56 ","$5.18 "
"30100360","EAP","CPT� 84460","","Sgpt(alt)-rate","BOTH IP/OP","$63.00 ","$46.62 ","$2.65 ","$64.00 ","$10.93 ","$2.65 ","$2.65 ","$7.73 ","$7.73 ","$7.46 ","$64.00 ","$5.57 ","$14.80 ","$50.69 ","$51.20 ","$7.69 ","$7.94 ","$5.30 ","$5.56 ","$5.30 "
"30100361","EAP","CPT� 84466","","Transferrin","BOTH IP/OP","$340.00 ","$251.60 ","$6.38 ","$343.00 ","$26.35 ","$6.38 ","$6.38 ","$18.64 ","$18.64 ","$18.87 ","$343.00 ","$13.40 ","$35.68 ","$271.66 ","$274.40 ","$18.50 ","$20.10 ","$12.76 ","$14.07 ","$12.76 "
"30100362","EAP","CPT� 84478","","Triglyceride-serum","BOTH IP/OP","$131.00 ","$96.94 ","$2.87 ","$150.00 ","$11.85 ","$2.87 ","$2.87 ","$8.40 ","$8.40 ","$7.46 ","$150.00 ","$6.03 ","$16.08 ","$118.80 ","$120.00 ","$8.32 ","$7.94 ","$5.74 ","$5.56 ","$5.74 "
"30100363","EAP","CPT� 84478","","Triglyceride","BOTH IP/OP","$152.00 ","$112.48 ","$2.87 ","$150.00 ","$11.85 ","$2.87 ","$2.87 ","$8.40 ","$8.40 ","$7.46 ","$150.00 ","$6.03 ","$16.08 ","$118.80 ","$120.00 ","$8.32 ","$7.94 ","$5.74 ","$5.56 ","$5.74 "
"30100364","EAP","CPT� 84478","","Triglyceride,fluid","BOTH IP/OP","$152.00 ","$112.48 ","$2.87 ","$150.00 ","$11.85 ","$2.87 ","$2.87 ","$8.40 ","$8.40 ","$7.46 ","$150.00 ","$6.03 ","$16.08 ","$118.80 ","$120.00 ","$8.32 ","$7.94 ","$5.74 ","$5.56 ","$5.74 "
"30100365","EAP","CPT� 84478","","Triglyceride","BOTH IP/OP","$114.00 ","$84.36 ","$2.87 ","$131.00 ","$11.85 ","$2.87 ","$2.87 ","$8.40 ","$8.40 ","$7.46 ","$131.00 ","$6.03 ","$16.08 ","$103.75 ","$104.80 ","$8.32 ","$7.94 ","$5.74 ","$5.56 ","$5.74 "
"30100366","EAP","CPT� 84480","","T3-triiodothyronine","BOTH IP/OP","$302.00 ","$223.48 ","$7.09 ","$299.00 ","$26.35 ","$7.09 ","$7.09 ","$18.61 ","$18.61 ","$18.83 ","$299.00 ","$14.89 ","$35.62 ","$236.81 ","$239.20 ","$20.56 ","$20.06 ","$14.18 ","$14.04 ","$14.18 "
"30100367","EAP","CPT� 84484","","Troponin-1","BOTH IP/OP","$416.00 ","$307.84 ","$5.61 ","$420.00 ","$20.33 ","$6.24 ","$5.61 ","$14.37 ","$14.37 ","$14.54 ","$420.00 ","$13.09 ","$27.50 ","$332.64 ","$336.00 ","$18.08 ","$15.50 ","$12.47 ","$10.85 ","$12.47 "
"30100368","EAP","CPT� 84484","","Troponin-t","BOTH IP/OP","$416.00 ","$307.84 ","$5.61 ","$420.00 ","$20.33 ","$6.24 ","$5.61 ","$14.37 ","$14.37 ","$14.54 ","$420.00 ","$13.09 ","$27.50 ","$332.64 ","$336.00 ","$18.08 ","$15.50 ","$12.47 ","$10.85 ","$12.47 "
"30100369","EAP","CPT� 84520","","Urea Nitrogen","BOTH IP/OP","$147.00 ","$108.78 ","$0.00 ","$148.00 ","$8.16 ","$1.98 ","$1.98 ","$5.76 ","$5.76 ","$0.00 ","$148.00 ","$0.00 ","$11.02 ","$117.22 ","$118.40 ","$0.00 ","$6.21 ","$0.00 ","$0.00 ","$0.00 "
"30100370","EAP","CPT� 84540","","Urea Nitrogen,fluid","BOTH IP/OP","$171.00 ","$126.54 ","$2.50 ","$173.00 ","$9.79 ","$2.78 ","$2.50 ","$6.93 ","$6.93 ","$7.02 ","$173.00 ","$5.84 ","$13.28 ","$137.02 ","$138.40 ","$8.06 ","$7.48 ","$5.56 ","$5.24 ","$5.56 "
"30100371","EAP","CPT� 84540","","Urea Nitrogen,urine","BOTH IP/OP","$171.00 ","$126.54 ","$2.50 ","$173.00 ","$9.79 ","$2.78 ","$2.50 ","$6.93 ","$6.93 ","$7.02 ","$173.00 ","$5.84 ","$13.28 ","$137.02 ","$138.40 ","$8.06 ","$7.48 ","$5.56 ","$5.24 ","$5.56 "
"30100372","EAP","CPT� 84550","","Uric Acid - Serum","BOTH IP/OP","$141.00 ","$104.34 ","$2.26 ","$141.00 ","$9.32 ","$2.26 ","$2.26 ","$6.59 ","$6.59 ","$6.67 ","$141.00 ","$4.75 ","$12.62 ","$111.67 ","$112.80 ","$6.55 ","$7.10 ","$4.52 ","$4.97 ","$4.52 "
"30100373","EAP","CPT� 84550","","Uric Acid","BOTH IP/OP","$140.00 ","$103.60 ","$2.26 ","$141.00 ","$9.32 ","$2.26 ","$2.26 ","$6.59 ","$6.59 ","$6.67 ","$141.00 ","$4.75 ","$12.62 ","$111.67 ","$112.80 ","$6.55 ","$7.10 ","$4.52 ","$4.97 ","$4.52 "
"30100374","EAP","CPT� 84560","","Uric Acid,syn Fluid","BOTH IP/OP","$140.00 ","$103.60 ","$2.37 ","$141.00 ","$9.79 ","$2.54 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$141.00 ","$5.33 ","$13.28 ","$111.67 ","$112.80 ","$7.37 ","$7.48 ","$5.08 ","$5.24 ","$5.08 "
"30100375","EAP","CPT� 84560","","Uric Acid, Urine","BOTH IP/OP","$140.00 ","$103.60 ","$2.37 ","$141.00 ","$9.79 ","$2.54 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$141.00 ","$5.33 ","$13.28 ","$111.67 ","$112.80 ","$7.37 ","$7.48 ","$5.08 ","$5.24 ","$5.08 "
"30100376","EAP","CPT� 84585","","Vma, Urine-24hr","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$22.64 ","$22.64 ","$0.00 ","$85.00 ","$0.00 ","$43.32 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100377","EAP","CPT� 84586","","Vasoac Intes Polypep","BOTH IP/OP","$156.00 ","$115.44 ","$0.00 ","$156.00 ","$0.00 ","$0.00 ","$17.67 ","$51.59 ","$51.59 ","$52.20 ","$156.00 ","$37.10 ","$98.74 ","$123.55 ","$124.80 ","$51.23 ","$0.00 ","$35.33 ","$38.93 ","$35.33 "
"30100378","EAP","CPT� 84588","","Adh Result","BOTH IP/OP","$263.00 ","$194.62 ","$0.00 ","$263.00 ","$0.00 ","$0.00 ","$0.00 ","$49.56 ","$49.56 ","$0.00 ","$263.00 ","$0.00 ","$94.86 ","$208.30 ","$210.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100379","EAP","CPT� 84590","","Vitamin A, Serum","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$245.00 ","$23.94 ","$5.81 ","$5.81 ","$16.93 ","$16.93 ","$17.13 ","$245.00 ","$12.19 ","$32.40 ","$194.04 ","$196.00 ","$16.83 ","$0.00 ","$11.61 ","$12.77 ","$11.61 "
"30100380","EAP","CPT� 84600","","Volatile, Drug Screen","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$33.18 ","$8.56 ","$8.04 ","$23.47 ","$23.47 ","$0.00 ","$333.00 ","$0.00 ","$44.90 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100381","EAP","CPT� 84620","","D-xylose, Serum","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.29 ","$17.29 ","$0.00 ","$139.00 ","$0.00 ","$33.10 ","$110.09 ","$111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100382","EAP","CPT� 84620","","D-xylose, Urine","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.29 ","$17.29 ","$0.00 ","$139.00 ","$0.00 ","$33.10 ","$110.09 ","$111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100383","EAP","CPT� 84630","","Zinc, Serum","BOTH IP/OP","$81.00 ","$59.94 ","$5.69 ","$82.00 ","$23.50 ","$5.70 ","$5.69 ","$16.63 ","$16.63 ","$16.82 ","$82.00 ","$11.96 ","$31.82 ","$64.94 ","$65.60 ","$16.52 ","$17.92 ","$11.39 ","$12.55 ","$11.39 "
"30100384","EAP","CPT� 84681","","C-peptide, Random","BOTH IP/OP","$370.00 ","$273.80 ","$10.41 ","$374.00 ","$32.82 ","$10.41 ","$10.41 ","$23.20 ","$23.20 ","$23.47 ","$374.00 ","$21.85 ","$44.40 ","$296.21 ","$299.20 ","$30.17 ","$25.01 ","$20.81 ","$17.50 ","$20.81 "
"30100385","EAP","CPT� 84681","","C-peptide, Fasting","BOTH IP/OP","$374.00 ","$276.76 ","$10.41 ","$374.00 ","$32.82 ","$10.41 ","$10.41 ","$23.20 ","$23.20 ","$23.47 ","$374.00 ","$21.85 ","$44.40 ","$296.21 ","$299.20 ","$30.17 ","$25.01 ","$20.81 ","$17.50 ","$20.81 "
"30100386","EAP","CPT� 84681","","C-peptide, Stimulat.","BOTH IP/OP","$374.00 ","$276.76 ","$10.41 ","$374.00 ","$32.82 ","$10.41 ","$10.41 ","$23.20 ","$23.20 ","$23.47 ","$374.00 ","$21.85 ","$44.40 ","$296.21 ","$299.20 ","$30.17 ","$25.01 ","$20.81 ","$17.50 ","$20.81 "
"30100387","EAP","CPT� 84702","","*hcg, Serum, Quant","BOTH IP/OP","$419.00 ","$310.06 ","$7.07 ","$381.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$381.00 ","$15.80 ","$17.94 ","$301.75 ","$304.80 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30100388","EAP","CPT� 84702","","B-hcg,mat.serum","BOTH IP/OP","$204.00 ","$150.96 ","$7.07 ","$208.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$208.00 ","$15.80 ","$17.94 ","$164.74 ","$166.40 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30100389","EAP","CPT� 84702","","Hcg,serum-quant","BOTH IP/OP","$374.00 ","$276.76 ","$7.07 ","$381.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$381.00 ","$15.80 ","$17.94 ","$301.75 ","$304.80 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30100390","EAP","CPT� 84703","","Pregnancy Test","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$9.37 ","$9.37 ","$0.00 ","$61.00 ","$0.00 ","$17.94 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100392","EAP","CPT� 84999","","Lysosomal Enz.scrn","BOTH IP/OP","$2,308.00 ","$1,707.92 ","$0.00 ","$2,458.00 ","$0.00 ","$410.82 ","$0.00 ","$1,754.27 ","$1,754.27 ","$430.38 ","$2,458.00 ","$0.00 ","$0.00 ","$1,946.74 ","$1,966.40 ","$0.00 ","$384.68 ","$0.00 ","$0.00 ","$0.00 "
"30100393","EAP","CPT� 84466","","B-2 Transferrin, Fld","BOTH IP/OP","$483.00 ","$357.42 ","$6.38 ","$487.00 ","$26.35 ","$6.38 ","$6.38 ","$18.64 ","$18.64 ","$18.87 ","$487.00 ","$13.40 ","$35.68 ","$385.70 ","$389.60 ","$18.50 ","$20.10 ","$12.76 ","$14.07 ","$12.76 "
"30100395","EAP","CPT� 80048","","Basic Metabolic Panel","BOTH IP/OP","$383.00 ","$283.42 ","$4.23 ","$374.00 ","$17.45 ","$4.23 ","$4.23 ","$12.36 ","$12.36 ","$12.52 ","$374.00 ","$8.88 ","$23.66 ","$296.21 ","$299.20 ","$12.27 ","$13.34 ","$8.46 ","$9.34 ","$8.46 "
"30100396","EAP","CPT� 88720","","Bilirubin,total-transcutaneous","BOTH IP/OP","$56.00 ","$41.44 ","$2.51 ","$57.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$9.98 ","$57.00 ","$5.27 ","$28.50 ","$45.14 ","$45.60 ","$7.28 ","$8.92 ","$5.02 ","$9.07 ","$5.02 "
"30100401","EAP","CPT� 82274","","Fecal Occult Blood,fit","BOTH IP/OP","$133.00 ","$98.42 ","$7.95 ","$134.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$25.48 ","$134.00 ","$16.72 ","$44.44 ","$106.13 ","$107.20 ","$23.08 ","$27.15 ","$15.92 ","$19.01 ","$15.92 "
"30100403","EAP","CPT� 82306","","25-hydroxyvit D (d2,d3)(so)","BOTH IP/OP","$86.00 ","$63.64 ","$14.80 ","$86.00 ","$61.12 ","$14.80 ","$14.80 ","$43.22 ","$43.22 ","$43.72 ","$86.00 ","$31.08 ","$82.72 ","$68.11 ","$68.80 ","$42.92 ","$46.59 ","$29.60 ","$32.61 ","$29.60 "
"30100410","EAP","CPT� 82009","","Acetoacetate-qualitative","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$4.80 ","$4.80 ","$0.00 ","$64.00 ","$0.00 ","$9.18 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100411","EAP","CPT� 82043","","Microalbumin","BOTH IP/OP","$223.00 ","$165.02 ","$2.89 ","$224.00 ","$11.93 ","$2.89 ","$2.89 ","$8.45 ","$8.45 ","$8.55 ","$224.00 ","$6.07 ","$16.18 ","$177.41 ","$179.20 ","$8.38 ","$9.11 ","$5.78 ","$6.37 ","$5.78 "
"30100412","EAP","CPT� 82270","","Occult Blood, Stool","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$4.69 ","$4.69 ","$0.00 ","$58.00 ","$0.00 ","$8.98 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100413","EAP","CPT� 82465","","Cholesterol","BOTH IP/OP","$91.00 ","$67.34 ","$2.18 ","$92.00 ","$8.98 ","$2.18 ","$2.18 ","$6.36 ","$6.36 ","$6.43 ","$92.00 ","$4.57 ","$12.16 ","$72.86 ","$73.60 ","$6.31 ","$6.85 ","$4.35 ","$4.79 ","$4.35 "
"30100414","EAP","CPT� 82550","","Cpk,total-serum","BOTH IP/OP","$208.00 ","$153.92 ","$3.25 ","$189.00 ","$13.44 ","$3.26 ","$3.25 ","$9.51 ","$9.51 ","$7.46 ","$189.00 ","$6.84 ","$18.20 ","$149.69 ","$151.20 ","$9.44 ","$7.94 ","$6.51 ","$5.56 ","$6.51 "
"30100415","EAP","CPT� 82565","","Poct, Creatinine (meter)","BOTH IP/OP","$139.00 ","$102.86 ","$2.56 ","$129.00 ","$10.59 ","$2.56 ","$2.56 ","$7.48 ","$7.48 ","$7.46 ","$129.00 ","$5.38 ","$14.32 ","$102.17 ","$103.20 ","$7.42 ","$7.94 ","$5.12 ","$5.56 ","$5.12 "
"30100416","EAP","CPT� 82570","","Creatinine Urine","BOTH IP/OP","$122.00 ","$90.28 ","$2.59 ","$122.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$122.00 ","$5.44 ","$14.46 ","$96.62 ","$97.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30100417","EAP","CPT� 82947","","Gtt, Oral-2hr Indiv","BOTH IP/OP","$263.00 ","$194.62 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100420","EAP","CPT� 82950","","Glucose, Bld-2hr Pp","BOTH IP/OP","$251.00 ","$185.74 ","$2.37 ","$311.00 ","$9.79 ","$2.38 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$311.00 ","$4.99 ","$13.28 ","$246.31 ","$248.80 ","$6.89 ","$7.48 ","$4.75 ","$5.24 ","$4.75 "
"30100421","EAP","CPT� 83036","","Hgb Glycosy A1c-ddcl","BOTH IP/OP","$218.00 ","$161.32 ","$4.86 ","$219.00 ","$20.04 ","$4.86 ","$4.86 ","$14.17 ","$14.17 ","$14.33 ","$219.00 ","$10.20 ","$27.12 ","$173.45 ","$175.20 ","$14.08 ","$15.27 ","$9.71 ","$10.69 ","$9.71 "
"30100422","EAP","CPT� 83690","","Lipase, Serum","BOTH IP/OP","$248.00 ","$183.52 ","$3.44 ","$251.00 ","$14.23 ","$3.45 ","$3.44 ","$10.06 ","$10.06 ","$10.17 ","$251.00 ","$7.23 ","$19.24 ","$198.79 ","$200.80 ","$9.99 ","$10.84 ","$6.89 ","$7.59 ","$6.89 "
"30100423","EAP","CPT� 83718","","Chol,hdl","BOTH IP/OP","$118.00 ","$87.32 ","$4.10 ","$119.00 ","$16.92 ","$4.10 ","$4.10 ","$11.96 ","$11.96 ","$12.10 ","$119.00 ","$8.60 ","$22.88 ","$94.25 ","$95.20 ","$11.88 ","$12.89 ","$8.19 ","$9.02 ","$8.19 "
"30100424","EAP","CPT� 83718","","Chol, Hdl","BOTH IP/OP","$118.00 ","$87.32 ","$4.10 ","$119.00 ","$16.92 ","$4.10 ","$4.10 ","$11.96 ","$11.96 ","$12.10 ","$119.00 ","$8.60 ","$22.88 ","$94.25 ","$95.20 ","$11.88 ","$12.89 ","$8.19 ","$9.02 ","$8.19 "
"30100425","EAP","CPT� 83721","","Chol-ldl, Direct","BOTH IP/OP","$148.00 ","$109.52 ","$4.77 ","$149.00 ","$19.69 ","$5.25 ","$4.77 ","$13.93 ","$13.93 ","$14.10 ","$149.00 ","$11.03 ","$26.66 ","$118.01 ","$119.20 ","$15.23 ","$15.03 ","$10.50 ","$10.52 ","$10.50 "
"30100426","EAP","CPT� 83721","","Chol-ldl, Direct","BOTH IP/OP","$147.00 ","$108.78 ","$4.77 ","$149.00 ","$19.69 ","$5.25 ","$4.77 ","$13.93 ","$13.93 ","$14.10 ","$149.00 ","$11.03 ","$26.66 ","$118.01 ","$119.20 ","$15.23 ","$15.03 ","$10.50 ","$10.52 ","$10.50 "
"30100427","EAP","CPT� 83735","","Magneseum, Serum","BOTH IP/OP","$160.00 ","$118.40 ","$3.35 ","$171.00 ","$13.83 ","$3.35 ","$3.35 ","$9.78 ","$9.78 ","$9.89 ","$171.00 ","$7.04 ","$18.72 ","$135.43 ","$136.80 ","$9.72 ","$10.54 ","$6.70 ","$7.38 ","$6.70 "
"30100430","EAP","CPT� 80048","","Chem 8, Metabolic Panel","BOTH IP/OP","$383.00 ","$283.42 ","$4.23 ","$374.00 ","$17.45 ","$4.23 ","$4.23 ","$12.36 ","$12.36 ","$12.52 ","$374.00 ","$8.88 ","$23.66 ","$296.21 ","$299.20 ","$12.27 ","$13.34 ","$8.46 ","$9.34 ","$8.46 "
"30100431","EAP","CPT� 82270","","Occult Blood","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$4.69 ","$4.69 ","$0.00 ","$58.00 ","$0.00 ","$8.98 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100432","EAP","CPT� 82977","","Ggt-serum","BOTH IP/OP","$162.00 ","$119.88 ","$3.60 ","$162.00 ","$14.86 ","$3.60 ","$3.60 ","$10.51 ","$10.51 ","$7.46 ","$162.00 ","$7.56 ","$20.12 ","$128.30 ","$129.60 ","$10.44 ","$7.94 ","$7.20 ","$5.56 ","$7.20 "
"30100434","EAP","CPT� 80069","","Renal Panel","BOTH IP/OP","$228.00 ","$168.72 ","$4.34 ","$230.00 ","$17.93 ","$4.34 ","$4.34 ","$12.68 ","$12.68 ","$12.83 ","$230.00 ","$9.11 ","$24.26 ","$182.16 ","$184.00 ","$12.59 ","$13.67 ","$8.68 ","$9.57 ","$8.68 "
"30100435","EAP","CPT� 80076","","Hepatic Profile","BOTH IP/OP","$330.00 ","$244.20 ","$4.09 ","$333.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$333.00 ","$8.58 ","$22.84 ","$263.74 ","$266.40 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30100436","EAP","CPT� 80076","","Hepatic Profile","BOTH IP/OP","$333.00 ","$246.42 ","$4.09 ","$333.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$333.00 ","$8.58 ","$22.84 ","$263.74 ","$266.40 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30100437","EAP","CPT� 82465","","Cholesterol,fluid","BOTH IP/OP","$91.00 ","$67.34 ","$2.18 ","$92.00 ","$8.98 ","$2.18 ","$2.18 ","$6.36 ","$6.36 ","$6.43 ","$92.00 ","$4.57 ","$12.16 ","$72.86 ","$73.60 ","$6.31 ","$6.85 ","$4.35 ","$4.79 ","$4.35 "
"30100439","EAP","CPT� 82947","","Glucose,fasting Bld","BOTH IP/OP","$263.00 ","$194.62 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30100441","EAP","CPT� 82950","","Glucose,1hr (50gm)","BOTH IP/OP","$341.00 ","$252.34 ","$2.37 ","$311.00 ","$9.79 ","$2.38 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$311.00 ","$4.99 ","$13.28 ","$246.31 ","$248.80 ","$6.89 ","$7.48 ","$4.75 ","$5.24 ","$4.75 "
"30100442","EAP","CPT� 82977","","Ggtp,serum","BOTH IP/OP","$160.00 ","$118.40 ","$3.60 ","$162.00 ","$14.86 ","$3.60 ","$3.60 ","$10.51 ","$10.51 ","$7.46 ","$162.00 ","$7.56 ","$20.12 ","$128.30 ","$129.60 ","$10.44 ","$7.94 ","$7.20 ","$5.56 ","$7.20 "
"30100443","EAP","CPT� 83735","","Magnesium, Urine","BOTH IP/OP","$188.00 ","$139.12 ","$3.35 ","$171.00 ","$13.83 ","$3.35 ","$3.35 ","$9.78 ","$9.78 ","$9.89 ","$171.00 ","$7.04 ","$18.72 ","$135.43 ","$136.80 ","$9.72 ","$10.54 ","$6.70 ","$7.38 ","$6.70 "
"30100444","EAP","CPT� 80375","","Thiopurine Metabolites Serum (so)","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$230.53 ","$230.53 ","$21.44 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$193.80 ","$22.85 ","$0.00 ","$15.99 ","$0.00 "
"30100450","EAP","CPT� 82803","","Hemodynamics","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100451","EAP","CPT� 82803","","Abg Analysis","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100455","EAP","CPT� 82040","","Albumin (bcg)","BOTH IP/OP","$76.00 ","$56.24 ","$2.48 ","$76.00 ","$5.94 ","$2.48 ","$2.48 ","$4.20 ","$4.20 ","$4.25 ","$76.00 ","$5.20 ","$8.04 ","$60.19 ","$60.80 ","$7.18 ","$4.53 ","$4.95 ","$3.17 ","$4.95 "
"30100456","EAP","CPT� 81381","","HLA B5701","BOTH IP/OP","$458.00 ","$338.92 ","$35.05 ","$463.00 ","$195.23 ","$84.95 ","$76.46 ","$129.03 ","$129.03 ","$46.99 ","$463.00 ","$178.40 ","$231.50 ","$366.70 ","$370.40 ","$246.36 ","$50.07 ","$169.90 ","$35.05 ","$169.90 "
"30100475","EAP","CPT� 82172","","Apolipoprotein (so)","BOTH IP/OP","$181.00 ","$133.94 ","$9.49 ","$181.00 ","$32.00 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$181.00 ","$22.14 ","$43.30 ","$143.35 ","$144.80 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30100476","EAP","CPT� 82247","","Total Bilirubin (so)","BOTH IP/OP","$88.00 ","$65.12 ","$2.51 ","$88.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$88.00 ","$5.27 ","$14.04 ","$69.70 ","$70.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30100477","EAP","CPT� 82977","","Ggt (so)","BOTH IP/OP","$187.00 ","$138.38 ","$3.60 ","$187.00 ","$14.86 ","$3.60 ","$3.60 ","$10.51 ","$10.51 ","$7.46 ","$187.00 ","$7.56 ","$20.12 ","$148.10 ","$149.60 ","$10.44 ","$7.94 ","$7.20 ","$5.56 ","$7.20 "
"30100478","EAP","CPT� 83010","","Haptoglobin Quant (so)","BOTH IP/OP","$265.00 ","$196.10 ","$4.11 ","$265.00 ","$7.71 ","$6.29 ","$6.29 ","$5.44 ","$5.44 ","$5.51 ","$265.00 ","$13.21 ","$10.42 ","$209.88 ","$212.00 ","$18.24 ","$5.87 ","$12.58 ","$4.11 ","$12.58 "
"30100479","EAP","CPT� 83883","","Nephelometry (so)","BOTH IP/OP","$222.00 ","$164.28 ","$6.80 ","$222.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$222.00 ","$14.28 ","$38.00 ","$175.82 ","$177.60 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30100480","EAP","CPT� 84460","","Alt (s0)","BOTH IP/OP","$90.00 ","$66.60 ","$2.65 ","$90.00 ","$10.93 ","$2.65 ","$2.65 ","$7.73 ","$7.73 ","$7.46 ","$90.00 ","$5.57 ","$14.80 ","$71.28 ","$72.00 ","$7.69 ","$7.94 ","$5.30 ","$5.56 ","$5.30 "
"30100481","EAP","CPT� 88360","","Pd-l1 Ihc W/interp (s0)","BOTH IP/OP","$488.00 ","$361.12 ","$58.38 ","$485.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$485.00 ","$143.92 ","$121.34 ","$384.12 ","$388.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30100482","EAP","CPT� 88341","","Lynch Syn Pan Addl Slide (so)","BOTH IP/OP","$566.00 ","$418.84 ","$0.00 ","$572.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$572.00 ","$0.00 ","$286.00 ","$453.02 ","$457.60 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"30100483","EAP","CPT� 88342","","Lynch Syn Pan  1st Slide (so)","BOTH IP/OP","$645.00 ","$477.30 ","$48.82 ","$651.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$651.00 ","$143.92 ","$106.46 ","$515.59 ","$520.80 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"30100490","EAP","CPT� 80177","","Levetiracetam (so)","BOTH IP/OP","$333.00 ","$246.42 ","$6.63 ","$334.00 ","$27.35 ","$6.63 ","$6.63 ","$18.09 ","$18.09 ","$17.00 ","$334.00 ","$13.91 ","$167.00 ","$264.53 ","$267.20 ","$19.21 ","$18.11 ","$13.25 ","$12.68 ","$13.25 "
"30100499","EAP","CPT� 83520","","Anti Mag Q","BOTH IP/OP","$68.00 ","$50.32 ","$7.77 ","$77.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$77.00 ","$18.13 ","$36.18 ","$60.98 ","$61.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100500","EAP","CPT� 80342","","Fluphenazine, Serum","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$105.63 ","$105.63 ","$0.00 ","$148.00 ","$0.00 ","$74.00 ","$117.22 ","$118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100501","EAP","CPT� 82438","","Feces, Chloride (so)","BOTH IP/OP","$96.00 ","$71.04 ","$0.00 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$96.00 ","$0.00 ","$13.66 ","$76.03 ","$76.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100502","EAP","CPT� 84302","","Feces, Sodium (so)","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$5.05 ","$5.05 ","$0.00 ","$95.00 ","$0.00 ","$9.66 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100503","EAP","CPT� 84311","","Feces,electrophoresis (so)","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$200.00 ","$8.51 ","$19.54 ","$158.40 ","$160.00 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30100505","EAP","CPT� 84311","","Feces, Potassium (so)","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$200.00 ","$8.51 ","$19.54 ","$158.40 ","$160.00 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30100600","EAP","CPT� 82248","","Bilirubin,direct","BOTH IP/OP","$118.00 ","$87.32 ","$2.51 ","$118.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$118.00 ","$5.27 ","$14.04 ","$93.46 ","$94.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30100602","EAP","CPT� 80299","","Voriconazole Quant Assay (so)","BOTH IP/OP","$204.00 ","$150.96 ","$8.39 ","$204.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$204.00 ","$19.57 ","$33.64 ","$161.57 ","$163.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100622","EAP","CPT� 80203","","Zonisamide (so)","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$419.00 ","$0.00 ","$0.00 ","$0.00 ","$18.09 ","$18.09 ","$17.00 ","$419.00 ","$13.91 ","$209.50 ","$331.85 ","$335.20 ","$19.21 ","$18.11 ","$13.25 ","$12.68 ","$13.25 "
"30100634","EAP","CPT� 84181","","Western Blot Test","BOTH IP/OP","$1,387.00 ","$1,026.38 ","$0.00 ","$1,387.00 ","$0.00 ","$0.00 ","$0.00 ","$24.87 ","$24.87 ","$0.00 ","$1,387.00 ","$0.00 ","$47.60 ","$1,098.50 ","$1,109.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100635","EAP","CPT� 82530","","Cortisol;free","BOTH IP/OP","$200.00 ","$148.00 ","$8.36 ","$202.00 ","$34.48 ","$8.36 ","$8.36 ","$24.41 ","$24.41 ","$24.70 ","$202.00 ","$17.55 ","$46.70 ","$159.98 ","$161.60 ","$24.23 ","$26.31 ","$16.71 ","$18.42 ","$16.71 "
"30100636","EAP","CPT� 82570","","Other Source","BOTH IP/OP","$91.00 ","$67.34 ","$2.59 ","$91.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$91.00 ","$5.44 ","$14.46 ","$72.07 ","$72.80 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30100637","EAP","CPT� 83789","","Quantitative, Each Specimen","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$143.00 ","$0.00 ","$16.78 ","$113.26 ","$114.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100643","EAP","CPT� 83789","","Quantitative, Each Specimen","BOTH IP/OP","$241.00 ","$178.34 ","$0.00 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$242.00 ","$0.00 ","$16.78 ","$191.66 ","$193.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100644","EAP","CPT� 83520","","Quantitative, Not Otherwise Specified","BOTH IP/OP","$103.00 ","$76.22 ","$7.77 ","$116.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$116.00 ","$18.13 ","$36.18 ","$91.87 ","$92.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100645","EAP","CPT� 84999","","Unlisted Chemistry Procedure","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$62.00 ","$0.00 ","$10.32 ","$0.00 ","$44.25 ","$44.25 ","$10.86 ","$62.00 ","$0.00 ","$0.00 ","$49.10 ","$49.60 ","$0.00 ","$9.70 ","$0.00 ","$0.00 ","$0.00 "
"30100652","EAP","CPT� 82017","","Acylcarnities Quant","BOTH IP/OP","$187.00 ","$138.38 ","$0.00 ","$187.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$187.00 ","$0.00 ","$47.14 ","$148.10 ","$149.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100653","EAP","CPT� 82139","","Amino Acids,6 Or More Amino Acids,quantitative,each","BOTH IP/OP","$292.00 ","$216.08 ","$0.00 ","$292.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$292.00 ","$0.00 ","$47.14 ","$231.26 ","$233.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100654","EAP","CPT� 82379","","Carnitine(total And Free),quantitative,each Specimen","BOTH IP/OP","$223.00 ","$165.02 ","$0.00 ","$225.00 ","$34.82 ","$8.44 ","$8.43 ","$24.63 ","$24.63 ","$0.00 ","$225.00 ","$0.00 ","$47.14 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100656","EAP","CPT� 82542","","Quantitative,single Stationary & Mobile Phase, Qt","BOTH IP/OP","$296.00 ","$219.04 ","$6.62 ","$296.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$296.00 ","$25.29 ","$16.78 ","$234.43 ","$236.80 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30100660","EAP","CPT� 82962","","Poct Glucose Meter","BOTH IP/OP","$92.00 ","$68.08 ","$1.48 ","$84.00 ","$4.83 ","$1.64 ","$1.48 ","$3.42 ","$3.42 ","$3.45 ","$84.00 ","$3.44 ","$6.54 ","$66.53 ","$67.20 ","$4.76 ","$3.68 ","$3.28 ","$2.58 ","$3.28 "
"30100662","EAP","CPT� 84600","","Propylene Glycol (nms)","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$33.18 ","$8.56 ","$8.04 ","$23.47 ","$23.47 ","$0.00 ","$243.00 ","$0.00 ","$44.90 ","$192.46 ","$194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100665","EAP","CPT� 83825","","Mercury,blood(q)","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$41.00 ","$17.07 ","$41.00 ","$32.47 ","$32.80 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30100666","EAP","CPT� 80347","","Quantitative Benzo Panel(q)","BOTH IP/OP","$398.00 ","$294.52 ","$0.00 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$284.05 ","$284.05 ","$0.00 ","$398.00 ","$0.00 ","$199.00 ","$315.22 ","$318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100668","EAP","CPT� 86161","","C1 Inhibitor , Functional  (so)","BOTH IP/OP","$169.00 ","$125.06 ","$6.00 ","$171.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$171.00 ","$12.60 ","$33.56 ","$135.43 ","$136.80 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30100669","EAP","CPT� 86774","","Tetanus Antitoxoid   (so)","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$21.61 ","$21.61 ","$21.86 ","$83.00 ","$15.54 ","$41.36 ","$65.74 ","$66.40 ","$21.46 ","$23.29 ","$14.80 ","$16.31 ","$14.80 "
"30100670","EAP","CPT� 86343","","Histamine Release -cu  (so)","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$236.00 ","$25.71 ","$6.23 ","$6.23 ","$18.20 ","$18.20 ","$0.00 ","$236.00 ","$0.00 ","$34.82 ","$186.91 ","$188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100671","EAP","CPT� 83520","","Tryptase  (so)","BOTH IP/OP","$217.00 ","$160.58 ","$7.77 ","$211.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$211.00 ","$18.13 ","$36.18 ","$167.11 ","$168.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100672","EAP","CPT� 82106","","Alpha- Fetoprotein  Af (so)","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$34.64 ","$8.50 ","$0.00 ","$24.49 ","$24.49 ","$24.79 ","$41.00 ","$17.85 ","$41.00 ","$32.47 ","$32.80 ","$24.65 ","$26.41 ","$17.00 ","$18.49 ","$17.00 "
"30100673","EAP","CPT� 83033","","Fetal Hemoglobin  Af (so)","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$8.70 ","$8.70 ","$0.00 ","$76.00 ","$0.00 ","$16.66 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100674","EAP","CPT� 82664","","Acetylcholinesterase  Af (so)","BOTH IP/OP","$156.00 ","$115.44 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$50.16 ","$50.75 ","$168.00 ","$64.58 ","$96.00 ","$133.06 ","$134.40 ","$89.18 ","$54.07 ","$61.50 ","$37.85 ","$61.50 "
"30100680","EAP","CPT� 82105","","Maternal Serum Afp (so)","BOTH IP/OP","$47.00 ","$34.78 ","$8.39 ","$47.00 ","$34.64 ","$8.39 ","$8.39 ","$24.49 ","$24.49 ","$24.79 ","$47.00 ","$17.61 ","$46.88 ","$37.22 ","$37.60 ","$24.32 ","$26.41 ","$16.77 ","$18.49 ","$16.77 "
"30100681","EAP","CPT� 86160","","C1 Esterase Inhibitor  Protein (so)","BOTH IP/OP","$85.00 ","$62.90 ","$6.00 ","$86.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$86.00 ","$12.60 ","$33.56 ","$68.11 ","$68.80 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30100682","EAP","CPT� 84591","","Vitamin B-5( Pantothenic Acid) (so)","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$16.93 ","$16.93 ","$0.00 ","$178.00 ","$0.00 ","$32.40 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100683","EAP","CPT� 82397","","Leptin (so)","BOTH IP/OP","$232.00 ","$171.68 ","$7.06 ","$262.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$262.00 ","$14.83 ","$39.48 ","$207.50 ","$209.60 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30100684","EAP","CPT� 85415","","Plasminogen Activator Inhibitor-a (pai-1) (so)","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$25.10 ","$25.10 ","$0.00 ","$220.00 ","$0.00 ","$48.04 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100685","EAP","CPT� 83516","","Ribosomal P Antibody , Csf (so)","BOTH IP/OP","$240.00 ","$177.60 ","$5.76 ","$271.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$271.00 ","$12.11 ","$29.88 ","$214.63 ","$216.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100686","EAP","CPT� 83516","","Serine Protease 3 Antibody (so)arup","BOTH IP/OP","$302.00 ","$223.48 ","$5.76 ","$341.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$341.00 ","$12.11 ","$29.88 ","$270.07 ","$272.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100687","EAP","CPT� 82610","","Cystatin C (so)","BOTH IP/OP","$244.00 ","$180.56 ","$8.33 ","$246.00 ","$28.06 ","$9.26 ","$8.33 ","$19.85 ","$19.85 ","$20.09 ","$246.00 ","$19.45 ","$123.00 ","$194.83 ","$196.80 ","$26.85 ","$21.40 ","$18.52 ","$14.98 ","$18.52 "
"30100688","EAP","CPT� 80180","","Mycophenolic Acid (so)","BOTH IP/OP","$169.00 ","$125.06 ","$0.00 ","$169.00 ","$0.00 ","$0.00 ","$0.00 ","$8.12 ","$8.12 ","$0.00 ","$169.00 ","$0.00 ","$84.50 ","$133.85 ","$135.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100689","EAP","CPT� 83516","","Saccharmyces Cerevisiae Ab, Igg (arup)","BOTH IP/OP","$174.00 ","$128.76 ","$5.76 ","$196.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$196.00 ","$12.11 ","$29.88 ","$155.23 ","$156.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100690","EAP","CPT� 83516","","Laminaribioside Carbohydrate Ab, Igg (arup)","BOTH IP/OP","$174.00 ","$128.76 ","$5.76 ","$196.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$196.00 ","$12.11 ","$29.88 ","$155.23 ","$156.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100691","EAP","CPT� 83516","","Mannobioside Carbohydrate Ab, Igg (arup)","BOTH IP/OP","$174.00 ","$128.76 ","$5.76 ","$196.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$196.00 ","$12.11 ","$29.88 ","$155.23 ","$156.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30100692","EAP","CPT� 86671","","Chitobioside Carbohydrate Ab, Iga (arup)","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$80.00 ","$12.86 ","$34.26 ","$63.36 ","$64.00 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30100693","EAP","CPT� 83789","","Levamisole (so) Nms","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$298.00 ","$0.00 ","$16.78 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100702","EAP","CPT� 84182","","Zic4 Ab Protein West Blot (so)","BOTH IP/OP","$441.00 ","$326.34 ","$13.14 ","$441.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$441.00 ","$30.67 ","$50.30 ","$349.27 ","$352.80 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30100703","EAP","CPT� 83789","","Diurectics Screen Urine (so)","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$228.00 ","$0.00 ","$16.78 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100704","EAP","CPT� 82785","","Abpa  Ige (so)","BOTH IP/OP","$191.00 ","$141.34 ","$8.23 ","$191.00 ","$33.98 ","$8.23 ","$8.23 ","$24.05 ","$24.05 ","$24.33 ","$191.00 ","$17.28 ","$46.02 ","$151.27 ","$152.80 ","$23.87 ","$25.92 ","$16.46 ","$18.15 ","$16.46 "
"30100705","EAP","CPT� 84146","","Macroprolactin (so)","BOTH IP/OP","$322.00 ","$238.28 ","$9.69 ","$322.00 ","$40.00 ","$9.69 ","$9.69 ","$28.30 ","$28.30 ","$28.63 ","$322.00 ","$20.35 ","$54.16 ","$255.02 ","$257.60 ","$28.10 ","$30.51 ","$19.38 ","$21.36 ","$19.38 "
"30100706","EAP","CPT� 82570","","Thiosulfate Urine","BOTH IP/OP","$280.00 ","$207.20 ","$2.59 ","$280.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$280.00 ","$5.44 ","$14.46 ","$221.76 ","$224.00 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30100708","EAP","CPT� 83921","","Succinlylacetone Urine (so)","BOTH IP/OP","$250.00 ","$185.00 ","$9.54 ","$250.00 ","$33.95 ","$10.61 ","$9.54 ","$24.04 ","$24.04 ","$24.32 ","$250.00 ","$22.27 ","$46.00 ","$198.00 ","$200.00 ","$30.75 ","$25.91 ","$21.21 ","$18.14 ","$21.21 "
"30100709","EAP","CPT� 83520","","Vwf Propeptide (so)","BOTH IP/OP","$365.00 ","$270.10 ","$7.77 ","$412.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$412.00 ","$18.13 ","$36.18 ","$326.30 ","$329.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100710","EAP","CPT� 80061","","Nmr Lipoprofile Panel  (so)","BOTH IP/OP","$239.00 ","$176.86 ","$6.70 ","$285.00 ","$27.64 ","$6.70 ","$6.70 ","$19.57 ","$19.57 ","$19.79 ","$285.00 ","$14.06 ","$37.44 ","$225.72 ","$228.00 ","$19.42 ","$21.09 ","$13.39 ","$14.76 ","$13.39 "
"30100711","EAP","CPT� 83704","","Nmr Lipoprofile Bld (so)","BOTH IP/OP","$239.00 ","$176.86 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$46.07 ","$46.07 ","$0.00 ","$285.00 ","$0.00 ","$88.16 ","$225.72 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100712","EAP","CPT� 83520","","Factor H Comp (so)","BOTH IP/OP","$365.00 ","$270.10 ","$7.77 ","$412.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$412.00 ","$18.13 ","$36.18 ","$326.30 ","$329.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100714","EAP","CPT� 82542","","Thiosulfate Chromotography","BOTH IP/OP","$221.00 ","$163.54 ","$6.62 ","$221.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$221.00 ","$25.29 ","$16.78 ","$175.03 ","$176.80 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30100715","EAP","CPT� 82656","","Pancreatitic Elastase Serum (so)","BOTH IP/OP","$326.00 ","$241.24 ","$5.76 ","$326.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$57.08 ","$326.00 ","$12.11 ","$29.88 ","$258.19 ","$260.80 ","$16.72 ","$51.02 ","$11.53 ","$51.90 ","$11.53 "
"30100716","EAP","CPT� 80299","","Itraconazole (so)","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$17.58 ","$17.58 ","$17.79 ","$204.00 ","$19.57 ","$33.64 ","$161.57 ","$163.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100717","EAP","CPT� 80365","","Oxycodone And Metabolite Total, Urine (so)","BOTH IP/OP","$136.00 ","$100.64 ","$0.00 ","$124.00 ","$0.03 ","$57.22 ","$11.94 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$120.15 ","$62.00 ","$98.21 ","$99.20 ","$74.40 ","$19.41 ","$0.00 ","$19.74 ","$114.43 "
"30100718","EAP","CPT� 80361","","Hydromorphone Opi 1 Urine (so)","BOTH IP/OP","$484.00 ","$358.16 ","$0.00 ","$512.00 ","$0.03 ","$12.01 ","$11.94 ","$365.41 ","$365.41 ","$30.51 ","$512.00 ","$0.00 ","$256.00 ","$405.50 ","$409.60 ","$307.20 ","$32.51 ","$0.00 ","$22.76 ","$0.00 "
"30100719","EAP","CPT� 83520","","Thrombin-antithrom Quant (so)","BOTH IP/OP","$421.00 ","$311.54 ","$7.77 ","$409.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$409.00 ","$18.13 ","$36.18 ","$323.93 ","$327.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100720","EAP","CPT� 84182","","Redombx (antirecoverin Ab) (so)","BOTH IP/OP","$441.00 ","$326.34 ","$13.14 ","$441.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$441.00 ","$30.67 ","$50.30 ","$349.27 ","$352.80 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30100721","EAP","CPT� 80299","","Baclofin Quant","BOTH IP/OP","$430.00 ","$318.20 ","$8.39 ","$430.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$430.00 ","$19.57 ","$33.64 ","$340.56 ","$344.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100722","EAP","CPT� 82726","","Very Long Fatty Acids (so)","BOTH IP/OP","$411.00 ","$304.14 ","$0.00 ","$407.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$407.00 ","$0.00 ","$16.78 ","$322.34 ","$325.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100723","EAP","CPT� 83051","","Hgb Free Plasma (so)","BOTH IP/OP","$181.00 ","$133.94 ","$0.00 ","$181.00 ","$0.00 ","$0.00 ","$0.00 ","$10.67 ","$10.67 ","$0.00 ","$181.00 ","$0.00 ","$20.42 ","$143.35 ","$144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100724","EAP","CPT� 83789","","Levamisole","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$298.00 ","$0.00 ","$16.78 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100725","EAP","CPT� 83520","","Interleuk 2 Rec Cd25 (so)","BOTH IP/OP","$424.00 ","$313.76 ","$7.77 ","$412.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$412.00 ","$18.13 ","$36.18 ","$326.30 ","$329.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100726","EAP","CPT� 82542","","Cannabinoid Quant (so)","BOTH IP/OP","$221.00 ","$163.54 ","$6.62 ","$221.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$221.00 ","$25.29 ","$16.78 ","$175.03 ","$176.80 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30100729","EAP","CPT� 82378","","Cea Cyst Fluid (so)","BOTH IP/OP","$283.00 ","$209.42 ","$9.48 ","$286.00 ","$39.15 ","$9.48 ","$9.48 ","$27.70 ","$27.70 ","$28.02 ","$286.00 ","$19.91 ","$53.02 ","$226.51 ","$228.80 ","$27.49 ","$29.86 ","$18.96 ","$20.90 ","$18.96 "
"30100730","EAP","CPT� 83520","","Paraneo Autoab Quant Ria(so)","BOTH IP/OP","$124.00 ","$91.76 ","$7.77 ","$121.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$121.00 ","$18.13 ","$36.18 ","$95.83 ","$96.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100731","EAP","CPT� 82542","","Cc/ms Spec Anal-ghb, Ql (so)","BOTH IP/OP","$239.00 ","$176.86 ","$6.62 ","$239.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$239.00 ","$25.29 ","$16.78 ","$189.29 ","$191.20 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30100732","EAP","CPT� 83880","","Cardio Iq Nt Probnp (so)","BOTH IP/OP","$309.00 ","$228.66 ","$17.67 ","$312.00 ","$70.07 ","$19.63 ","$17.67 ","$49.56 ","$49.56 ","$50.15 ","$312.00 ","$41.22 ","$94.86 ","$247.10 ","$249.60 ","$56.93 ","$53.43 ","$39.26 ","$37.40 ","$39.26 "
"30100740","EAP","CPT� 80299","","Adalimumab Quant (so)","BOTH IP/OP","$210.00 ","$155.40 ","$8.39 ","$211.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$211.00 ","$19.57 ","$33.64 ","$167.11 ","$168.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100741","EAP","CPT� 82397","","Anti Adalimumab Ab (so)","BOTH IP/OP","$286.00 ","$211.64 ","$7.06 ","$278.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$278.00 ","$14.83 ","$39.48 ","$220.18 ","$222.40 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30100742","EAP","CPT� 80354","","Acetyl Fentanyl Qual (so)","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$94.21 ","$94.21 ","$0.00 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100750","EAP","CPT� 83088","","Histamine 24hr Urine (so)","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$0.00 ","$0.00 ","$0.00 ","$43.12 ","$43.12 ","$0.00 ","$243.00 ","$0.00 ","$82.52 ","$192.46 ","$194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100751","EAP","CPT� 80299","","Metoprolol Quant (so)","BOTH IP/OP","$211.00 ","$156.14 ","$8.39 ","$211.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$211.00 ","$19.57 ","$33.64 ","$167.11 ","$168.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30100752","EAP","CPT� 80361","","Morphine Glucuronide (so)","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$141.00 ","$0.03 ","$12.01 ","$11.94 ","$100.63 ","$100.63 ","$30.51 ","$141.00 ","$0.00 ","$70.50 ","$111.67 ","$112.80 ","$84.60 ","$32.51 ","$0.00 ","$22.76 ","$0.00 "
"30100755","EAP","CPT� 84182","","Recombx Mata Autoab (so)","BOTH IP/OP","$468.00 ","$346.32 ","$13.14 ","$468.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$468.00 ","$30.67 ","$50.30 ","$370.66 ","$374.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30100756","EAP","CPT� 83789","","Bile Acids Urine (so)","BOTH IP/OP","$236.00 ","$174.64 ","$0.00 ","$236.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$236.00 ","$0.00 ","$16.78 ","$186.91 ","$188.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100757","EAP","CPT� 84311","","Fluvoxamine (so)","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$197.00 ","$8.51 ","$19.54 ","$156.02 ","$157.60 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30100758","EAP","CPT� 84311","","Fungitell Serum (so)","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$197.00 ","$8.51 ","$19.54 ","$156.02 ","$157.60 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30100759","EAP","CPT� 83520","","Ganglioside Gd1b Ab (so)","BOTH IP/OP","$335.00 ","$247.90 ","$7.77 ","$326.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$326.00 ","$18.13 ","$36.18 ","$258.19 ","$260.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100760","EAP","CPT� 83520","","Ganglioside Gm-1 Ab (so)","BOTH IP/OP","$289.00 ","$213.86 ","$7.77 ","$326.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$326.00 ","$18.13 ","$36.18 ","$258.19 ","$260.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30100761","EAP","CPT� 83051","","Hemoglobin Free Plasma (so)","BOTH IP/OP","$104.00 ","$76.96 ","$0.00 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$10.67 ","$10.67 ","$0.00 ","$104.00 ","$0.00 ","$20.42 ","$82.37 ","$83.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100762","EAP","CPT� 83520","","Interleukin-6 Ruo","BOTH IP/OP","$228.00 ","$168.72 ","$7.77 ","$222.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$222.00 ","$18.13 ","$36.18 ","$175.82 ","$177.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30105004","EAP","CPT� 80053","","Comprehensive Metabolic Panel","BOTH IP/OP","$472.00 ","$349.28 ","$5.28 ","$477.00 ","$21.81 ","$5.28 ","$5.28 ","$15.44 ","$15.44 ","$15.61 ","$477.00 ","$11.09 ","$29.54 ","$377.78 ","$381.60 ","$15.31 ","$16.64 ","$10.56 ","$11.65 ","$10.56 "
"30105007","EAP","CPT� 80061","","Lipid Panel","BOTH IP/OP","$239.00 ","$176.86 ","$6.70 ","$285.00 ","$27.64 ","$6.70 ","$6.70 ","$19.57 ","$19.57 ","$19.79 ","$285.00 ","$14.06 ","$37.44 ","$225.72 ","$228.00 ","$19.42 ","$21.09 ","$13.39 ","$14.76 ","$13.39 "
"30105047","EAP","CPT� 82150","","Amylase,urine","BOTH IP/OP","$301.00 ","$222.74 ","$3.24 ","$304.00 ","$13.38 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$304.00 ","$6.80 ","$18.12 ","$240.77 ","$243.20 ","$9.40 ","$10.20 ","$6.48 ","$7.14 ","$6.48 "
"30105057","EAP","CPT� 82247","","Bili, Total-fluid","BOTH IP/OP","$117.00 ","$86.58 ","$2.51 ","$118.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$118.00 ","$5.27 ","$14.04 ","$93.46 ","$94.40 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30105071","EAP","CPT� 82310","","Calcium, Urine","BOTH IP/OP","$102.00 ","$75.48 ","$2.58 ","$93.00 ","$10.67 ","$2.58 ","$2.58 ","$7.53 ","$7.53 ","$7.46 ","$93.00 ","$5.42 ","$14.40 ","$73.66 ","$74.40 ","$7.48 ","$7.94 ","$5.16 ","$5.56 ","$5.16 "
"30105151","EAP","CPT� 82803","","Blood Gas-cord Ven.","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$39.94 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$367.49 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30105168","EAP","CPT� 82945","","Glucose,urine(quant)","BOTH IP/OP","$341.00 ","$252.34 ","$1.97 ","$311.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$311.00 ","$4.13 ","$10.96 ","$246.31 ","$248.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30105171","EAP","CPT� 82947","","Gtt,oral-2hr Indiv","BOTH IP/OP","$263.00 ","$194.62 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30105196","EAP","CPT� 82951","","Gtt,prenatal(100gm)","BOTH IP/OP","$201.00 ","$148.74 ","$6.44 ","$201.00 ","$26.58 ","$6.44 ","$6.44 ","$18.80 ","$18.80 ","$19.02 ","$201.00 ","$13.51 ","$35.98 ","$159.19 ","$160.80 ","$18.66 ","$20.26 ","$12.87 ","$14.18 ","$12.87 "
"30105201","EAP","CPT� 82952","","5th Hour Gtt Specimen","BOTH IP/OP","$103.00 ","$76.22 ","$1.96 ","$103.00 ","$8.10 ","$1.96 ","$1.96 ","$5.72 ","$5.72 ","$5.80 ","$103.00 ","$4.12 ","$10.96 ","$81.58 ","$82.40 ","$5.68 ","$6.18 ","$3.92 ","$4.32 ","$3.92 "
"30105214","EAP","CPT� 83020","","Hgb Elect. Cord Bld","BOTH IP/OP","$217.00 ","$160.58 ","$6.44 ","$218.00 ","$20.17 ","$6.44 ","$6.44 ","$14.27 ","$14.27 ","$14.44 ","$218.00 ","$13.51 ","$27.32 ","$172.66 ","$174.40 ","$18.66 ","$15.38 ","$12.87 ","$10.77 ","$12.87 "
"30105248","EAP","CPT� 83605","","Lactic Acid, Fluid","BOTH IP/OP","$341.00 ","$252.34 ","$5.34 ","$311.00 ","$22.04 ","$5.79 ","$5.34 ","$15.59 ","$15.59 ","$15.78 ","$311.00 ","$12.15 ","$29.84 ","$246.31 ","$248.80 ","$16.78 ","$16.82 ","$11.57 ","$11.77 ","$11.57 "
"30105252","EAP","CPT� 83615","","Ldh,csf","BOTH IP/OP","$153.00 ","$113.22 ","$3.02 ","$139.00 ","$12.46 ","$3.02 ","$3.02 ","$8.81 ","$8.81 ","$7.46 ","$139.00 ","$6.34 ","$16.88 ","$110.09 ","$111.20 ","$8.76 ","$7.94 ","$6.04 ","$5.56 ","$6.04 "
"30105255","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$1,127.00 ","$833.98 ","$8.28 ","$1,096.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$1,096.00 ","$19.32 ","$37.76 ","$868.03 ","$876.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30105256","EAP","CPT� 84260","","Assay Of Serotonin","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$45.23 ","$45.23 ","$0.00 ","$199.00 ","$0.00 ","$86.56 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30105257","EAP","CPT� 84252","","Assay Of Vitamin B-12","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$29.55 ","$29.55 ","$0.00 ","$284.00 ","$0.00 ","$56.56 ","$224.93 ","$227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30105258","EAP","CPT� 83018","","Quantitative, Each","BOTH IP/OP","$182.00 ","$134.68 ","$0.00 ","$182.00 ","$0.00 ","$0.00 ","$0.00 ","$32.06 ","$32.06 ","$0.00 ","$182.00 ","$0.00 ","$61.36 ","$144.14 ","$145.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30105261","EAP","CPT� 83519","","Quantitative, By Radioimmunoassay(eg:ria)","BOTH IP/OP","$743.00 ","$549.82 ","$8.28 ","$723.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$723.00 ","$19.32 ","$37.76 ","$572.62 ","$578.40 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30105262","EAP","CPT� 83519","","Quantitative, By Radioimmunoassay(eg:ria)","BOTH IP/OP","$716.00 ","$529.84 ","$8.28 ","$696.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$696.00 ","$19.32 ","$37.76 ","$551.23 ","$556.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30105263","EAP","CPT� 82378","","Cea Pancreatic Cyst Fluid (so)","BOTH IP/OP","$152.00 ","$112.48 ","$9.48 ","$158.00 ","$39.15 ","$9.48 ","$9.48 ","$27.70 ","$27.70 ","$28.02 ","$158.00 ","$19.91 ","$53.02 ","$125.14 ","$126.40 ","$27.49 ","$29.86 ","$18.96 ","$20.90 ","$18.96 "
"30105264","EAP","CPT� 84432","","Thyroglobulin (so) Th","BOTH IP/OP","$75.00 ","$55.50 ","$8.03 ","$75.00 ","$33.16 ","$8.03 ","$8.03 ","$23.45 ","$23.45 ","$23.73 ","$75.00 ","$16.86 ","$44.88 ","$59.40 ","$60.00 ","$23.29 ","$25.28 ","$16.06 ","$17.70 ","$16.06 "
"30105265","EAP","CPT� 86800","","Thyroglobulin  Antibody (so) Th","BOTH IP/OP","$54.00 ","$39.96 ","$7.95 ","$54.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$54.00 ","$16.71 ","$44.44 ","$42.77 ","$43.20 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30105268","EAP","CPT� 82108","","Aluminum, 24- Hour Urine (so)","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$34.80 ","$12.74 ","$12.74 ","$24.61 ","$24.61 ","$24.91 ","$69.00 ","$26.75 ","$47.10 ","$54.65 ","$55.20 ","$36.95 ","$0.00 ","$25.48 ","$18.58 ","$25.48 "
"30105269","EAP","CPT� 83789","","Ethambutol, Serum (nms)","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$211.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$211.00 ","$0.00 ","$16.78 ","$167.11 ","$168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30105270","EAP","CPT� 83789","","Pyrazinamide, Serum (nms)","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$507.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$507.00 ","$0.00 ","$16.78 ","$401.54 ","$405.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30105271","EAP","CPT� 84999","","Nephrocheck Acute Kidney Injury","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$297.00 ","$0.00 ","$53.58 ","$0.00 ","$211.97 ","$211.97 ","$52.00 ","$297.00 ","$0.00 ","$0.00 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$0.00 ","$0.00 "
"30105275","EAP","CPT� 80186","","Free Phenytoin","BOTH IP/OP","$157.00 ","$116.18 ","$6.88 ","$157.00 ","$28.41 ","$6.88 ","$6.88 ","$20.10 ","$20.10 ","$20.34 ","$157.00 ","$14.45 ","$38.46 ","$124.34 ","$125.60 ","$19.95 ","$21.67 ","$13.76 ","$15.17 ","$13.76 "
"30150004","EAP","CPT� 80053","","Comp, Metabolic Panel","BOTH IP/OP","$489.00 ","$361.86 ","$5.28 ","$477.00 ","$21.81 ","$5.28 ","$5.28 ","$15.44 ","$15.44 ","$15.61 ","$477.00 ","$11.09 ","$29.54 ","$377.78 ","$381.60 ","$15.31 ","$16.64 ","$10.56 ","$11.65 ","$10.56 "
"30150007","EAP","CPT� 80061","","Lipoprotein Profile","BOTH IP/OP","$239.00 ","$176.86 ","$6.70 ","$285.00 ","$27.64 ","$6.70 ","$6.70 ","$19.57 ","$19.57 ","$19.79 ","$285.00 ","$14.06 ","$37.44 ","$225.72 ","$228.00 ","$19.42 ","$21.09 ","$13.39 ","$14.76 ","$13.39 "
"30150171","EAP","CPT� 82947","","Glucose","BOTH IP/OP","$263.00 ","$194.62 ","$1.97 ","$326.00 ","$8.10 ","$1.97 ","$1.97 ","$5.73 ","$5.73 ","$5.80 ","$326.00 ","$4.13 ","$10.96 ","$258.19 ","$260.80 ","$5.70 ","$6.18 ","$3.93 ","$4.32 ","$3.93 "
"30150172","EAP","CPT� 82480","","Cholinesterase; Serum","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$11.51 ","$11.51 ","$0.00 ","$39.00 ","$0.00 ","$22.02 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150173","EAP","CPT� 82482","","Rbc","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$11.22 ","$11.22 ","$0.00 ","$40.00 ","$0.00 ","$21.48 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150174","EAP","CPT� 86255","","Fluor Noninfec Agnt Ab Scr,ea","BOTH IP/OP","$51.00 ","$37.74 ","$6.03 ","$64.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$64.00 ","$12.65 ","$33.68 ","$50.69 ","$51.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30150176","EAP","CPT� 86628","","Candida","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$17.53 ","$17.53 ","$0.00 ","$254.00 ","$0.00 ","$33.56 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150177","EAP","CPT� 83789","","Quantitative, Each Specimen","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$235.00 ","$0.00 ","$16.78 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150178","EAP","CPT� 86235","","Extractable Nuclear Antigen,antibody To, Any Method","BOTH IP/OP","$130.00 ","$96.20 ","$8.97 ","$159.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$159.00 ","$18.83 ","$50.12 ","$125.93 ","$127.20 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30150179","EAP","CPT� 87798","","Amplified Probe Technique,each Organism","BOTH IP/OP","$502.00 ","$371.48 ","$17.55 ","$605.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$605.00 ","$36.84 ","$54.82 ","$479.16 ","$484.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30150180","EAP","CPT� 86658","","Enterovirus - A","BOTH IP/OP","$51.00 ","$37.74 ","$6.51 ","$51.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$51.00 ","$13.68 ","$36.40 ","$40.39 ","$40.80 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30150181","EAP","CPT� 86658","","Enterovirus - B","BOTH IP/OP","$51.00 ","$37.74 ","$6.51 ","$51.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$51.00 ","$13.68 ","$36.40 ","$40.39 ","$40.80 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30150182","EAP","CPT� 86750","","Plasmodium(malaria)","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$60.00 ","$0.00 ","$36.86 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150183","EAP","CPT� 86750","","Plasmodium(malaria)","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$60.00 ","$0.00 ","$36.86 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150184","EAP","CPT� 83520","","Quantitative, Not Otherwise Specified","BOTH IP/OP","$638.00 ","$472.12 ","$7.77 ","$720.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$720.00 ","$18.13 ","$36.18 ","$570.24 ","$576.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30150185","EAP","CPT� 86635","","Coccidioides","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$16.75 ","$16.75 ","$0.00 ","$68.00 ","$0.00 ","$32.06 ","$53.86 ","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150193","EAP","CPT� 83519","","Quantitative, By Radioimmunoassay","BOTH IP/OP","$609.00 ","$450.66 ","$8.28 ","$687.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$687.00 ","$19.32 ","$37.76 ","$544.10 ","$549.60 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30150194","EAP","CPT� 88271","","Molecular Cytogenetics; Dna Probe, Each","BOTH IP/OP","$307.00 ","$227.18 ","$10.71 ","$307.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$307.00 ","$22.49 ","$59.86 ","$243.14 ","$245.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30150195","EAP","CPT� 88275","","Interphase Insitu Hybrid, Ana 10-30 Cells","BOTH IP/OP","$400.00 ","$296.00 ","$23.04 ","$400.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$400.00 ","$53.75 ","$112.22 ","$316.80 ","$320.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30150196","EAP","CPT� 86255","","Fluor Noninfect Agent Ab Scr, Ea Ab","BOTH IP/OP","$85.00 ","$62.90 ","$6.03 ","$106.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$106.00 ","$12.65 ","$33.68 ","$83.95 ","$84.80 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30150197","EAP","CPT� 83625","","Isoenzymes, Separation And Quantitation","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$16.90 ","$16.90 ","$0.00 ","$48.00 ","$0.00 ","$32.34 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150202","EAP","CPT� 82379","","Carnitine, Urine (quest 30338)","BOTH IP/OP","$321.00 ","$237.54 ","$0.00 ","$324.00 ","$34.82 ","$8.44 ","$8.43 ","$24.63 ","$24.63 ","$0.00 ","$324.00 ","$0.00 ","$47.14 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150203","EAP","CPT� 84143","","C17-HYDROXYPREGNENOLONE(QUEST 8352)","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$33.32 ","$33.32 ","$0.00 ","$150.00 ","$0.00 ","$63.78 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150204","EAP","CPT� 86332","","IMMUNE COMPLEX DETECTION BY C1Q BINDING(Q 36735)","BOTH IP/OP","$34.00 ","$25.16 ","$12.19 ","$38.36 ","$34.00 ","$12.19 ","$12.19 ","$35.59 ","$35.59 ","$36.00 ","$34.00 ","$25.59 ","$34.00 ","$26.93 ","$27.20 ","$34.00 ","$38.36 ","$24.37 ","$26.85 ","$24.37 "
"30150205","EAP","CPT� 81229","","CHROMOSOMAL MICROARRAY, PRENATAL (QUEST 90927)","BOTH IP/OP","$3,929.00 ","$2,907.46 ","$0.00 ","$3,881.00 ","$807.84 ","$580.00 ","$0.00 ","$2,769.87 ","$2,769.87 ","$2,725.40 ","$3,881.00 ","$1,218.00 ","$1,940.50 ","$3,073.75 ","$3,104.80 ","$1,682.00 ","$2,903.98 ","$1,160.00 ","$2,032.79 ","$1,160.00 "
"30150206","EAP","CPT� 86003","","ALLERGY PANEL,MOLD GROUP (QUEST 7911)","BOTH IP/OP","$252.00 ","$186.48 ","$2.61 ","$254.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$254.00 ","$5.48 ","$14.60 ","$201.17 ","$203.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30150207","EAP","CPT� 88271","","FISH,PDGFRB,5q331.(QUEST 90510)DNA PROBE","BOTH IP/OP","$511.00 ","$378.14 ","$10.71 ","$511.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$511.00 ","$22.49 ","$59.86 ","$404.71 ","$408.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30150208","EAP","CPT� 88275","","FISH,PDGFRB,5q331.(QUEST 90510)100-300cells","BOTH IP/OP","$256.00 ","$189.44 ","$23.04 ","$256.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$256.00 ","$53.75 ","$112.22 ","$202.75 ","$204.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30150209","EAP","CPT� 86235","","MYOSITIS ASSESS AUTOAB (Q10185)NUC AG AB","BOTH IP/OP","$429.00 ","$317.46 ","$8.97 ","$414.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$414.00 ","$18.83 ","$50.12 ","$327.89 ","$331.20 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30150210","EAP","CPT� 83516","","MYOSITIS ASSESS AUTOAB (Q10185)Non AB","BOTH IP/OP","$1,134.00 ","$839.16 ","$5.76 ","$1,103.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$1,103.00 ","$12.11 ","$29.88 ","$873.58 ","$882.40 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30150211","EAP","CPT� 80356","","MONOACETLYMORPNINE MAM (SO)","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$125.61 ","$125.61 ","$0.00 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30150212","EAP","CPT� 80377","","Hypoglycemic Mass Spec (so)","BOTH IP/OP","$428.00 ","$316.72 ","$0.00 ","$389.00 ","$0.00 ","$0.00 ","$0.00 ","$277.63 ","$277.63 ","$0.00 ","$389.00 ","$0.00 ","$194.50 ","$308.09 ","$311.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159005","EAP","CPT� 89055","","Fecal Leukocyte Smear","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$3.43 ","$3.43 ","$0.00 ","$118.00 ","$0.00 ","$6.56 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159016","EAP","CPT� 82570","","Urine Creatinine (so)","BOTH IP/OP","$79.00 ","$58.46 ","$2.59 ","$79.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$79.00 ","$5.44 ","$14.46 ","$62.57 ","$63.20 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30159017","EAP","CPT� 83918","","Organic Acids (so)","BOTH IP/OP","$660.00 ","$488.40 ","$0.00 ","$667.00 ","$33.95 ","$11.80 ","$10.62 ","$24.04 ","$24.04 ","$24.32 ","$667.00 ","$24.78 ","$46.00 ","$528.26 ","$533.60 ","$34.22 ","$0.00 ","$23.60 ","$18.14 ","$23.60 "
"30159018","EAP","CPT� 83018","","Cobalt, Plasma (so)","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$159.00 ","$0.00 ","$0.00 ","$0.00 ","$32.06 ","$32.06 ","$0.00 ","$159.00 ","$0.00 ","$61.36 ","$125.93 ","$127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159019","EAP","CPT� 84999","","Macroamylase","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$76.00 ","$0.00 ","$12.64 ","$0.00 ","$54.24 ","$54.24 ","$13.31 ","$76.00 ","$0.00 ","$0.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$0.00 "
"30159020","EAP","CPT� 81511","","Integrated Maternal Serum Screen (so)","BOTH IP/OP","$1,246.00 ","$922.04 ","$69.08 ","$1,231.00 ","$462.00 ","$76.75 ","$69.08 ","$878.56 ","$878.56 ","$144.26 ","$1,231.00 ","$161.18 ","$615.50 ","$974.95 ","$984.80 ","$222.58 ","$153.71 ","$153.50 ","$107.60 ","$153.50 "
"30159021","EAP","CPT� 84163","","Pregnancy Associated Plasma Protein (so)","BOTH IP/OP","$180.00 ","$133.20 ","$7.07 ","$180.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$180.00 ","$15.80 ","$17.94 ","$142.56 ","$144.00 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30159024","EAP","CPT� 82172","","Apolipoprotein (so)","BOTH IP/OP","$155.00 ","$114.70 ","$9.49 ","$155.00 ","$32.00 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$155.00 ","$22.14 ","$43.30 ","$122.76 ","$124.00 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30159025","EAP","CPT� 82247","","Bilirubin, Total (so)","BOTH IP/OP","$80.00 ","$59.20 ","$2.51 ","$80.00 ","$10.35 ","$2.51 ","$2.51 ","$7.33 ","$7.33 ","$7.42 ","$80.00 ","$5.27 ","$14.04 ","$63.36 ","$64.00 ","$7.28 ","$7.91 ","$5.02 ","$5.54 ","$5.02 "
"30159026","EAP","CPT� 82977","","Gamma - Ggt (so)","BOTH IP/OP","$144.00 ","$106.56 ","$3.60 ","$144.00 ","$14.86 ","$3.60 ","$3.60 ","$10.51 ","$10.51 ","$7.46 ","$144.00 ","$7.56 ","$20.12 ","$114.05 ","$115.20 ","$10.44 ","$7.94 ","$7.20 ","$5.56 ","$7.20 "
"30159027","EAP","CPT� 83010","","Haptoglobin, Quant (so)","BOTH IP/OP","$125.00 ","$92.50 ","$4.11 ","$125.00 ","$7.71 ","$6.29 ","$6.29 ","$5.44 ","$5.44 ","$5.51 ","$125.00 ","$13.21 ","$10.42 ","$99.00 ","$100.00 ","$18.24 ","$5.87 ","$12.58 ","$4.11 ","$12.58 "
"30159028","EAP","CPT� 83883","","Nephelometry, Each Analyte (so)","BOTH IP/OP","$145.00 ","$107.30 ","$6.80 ","$145.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$145.00 ","$14.28 ","$38.00 ","$114.84 ","$116.00 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30159029","EAP","CPT� 84460","","Alt (alanine Aminotransferase) (so)","BOTH IP/OP","$80.00 ","$59.20 ","$2.65 ","$80.00 ","$10.93 ","$2.65 ","$2.65 ","$7.73 ","$7.73 ","$7.46 ","$80.00 ","$5.57 ","$14.80 ","$63.36 ","$64.00 ","$7.69 ","$7.94 ","$5.30 ","$5.56 ","$5.30 "
"30159062","EAP","CPT� 84210","","Pyruvate, Csf (so)","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$15.85 ","$15.85 ","$0.00 ","$254.00 ","$15.20 ","$30.34 ","$201.17 ","$203.20 ","$21.00 ","$0.00 ","$14.48 ","$11.96 ","$14.48 "
"30159063","EAP","CPT� 86787","","Varicella - Zoster Virus Antibody , Csf (so)","BOTH IP/OP","$109.00 ","$80.66 ","$6.44 ","$109.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$109.00 ","$13.52 ","$36.00 ","$86.33 ","$87.20 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30159064","EAP","CPT� 80350","","Cannabinoids, Synthetic, 1-3","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$105.63 ","$105.63 ","$0.00 ","$148.00 ","$0.00 ","$74.00 ","$117.22 ","$118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159065","EAP","CPT� 80335","","Clomipramine, Serum (nms), Qt","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"30159066","EAP","CPT� 82657","","Alpha - Galactosidase, Leukocytes (mayo)","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$385.00 ","$0.00 ","$16.78 ","$304.92 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159067","EAP","CPT� 80307","","Hypoglycemic Agent Screen, Serum (mayo)","BOTH IP/OP","$397.00 ","$293.78 ","$29.09 ","$361.00 ","$115.05 ","$31.07 ","$29.09 ","$76.45 ","$76.45 ","$71.85 ","$361.00 ","$65.25 ","$180.50 ","$285.91 ","$288.80 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30159068","EAP","CPT� 80347","","Benzodiazepines (so)nms","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$116.33 ","$116.33 ","$0.00 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159069","EAP","CPT� 80320","","Alcohol( Ethanol), (so)nms","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$120.15 ","$0.03 ","$57.22 ","$6.63 ","$34.97 ","$34.97 ","$15.96 ","$49.00 ","$120.15 ","$24.50 ","$38.81 ","$39.20 ","$29.40 ","$17.01 ","$0.00 ","$11.90 ","$114.43 "
"30159070","EAP","CPT� 80307","","Drug Screen, Qualitative,(so)nms","BOTH IP/OP","$270.00 ","$199.80 ","$29.09 ","$286.00 ","$115.05 ","$31.07 ","$29.09 ","$76.45 ","$76.45 ","$71.85 ","$286.00 ","$65.25 ","$143.00 ","$226.51 ","$228.80 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30159071","EAP","CPT� 80307","","Single Drug Class (elisa), (so)nms","BOTH IP/OP","$204.00 ","$150.96 ","$29.09 ","$216.00 ","$115.05 ","$31.07 ","$29.09 ","$76.45 ","$76.45 ","$71.85 ","$216.00 ","$65.25 ","$108.00 ","$171.07 ","$172.80 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30159072","EAP","CPT� 83519","","Ach Receptor (muscle Binding Abs) Mayo","BOTH IP/OP","$145.00 ","$107.30 ","$8.28 ","$141.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$141.00 ","$19.32 ","$37.76 ","$111.67 ","$112.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159073","EAP","CPT� 83519","","Achr Ganglionic Neuronal Abs (mayo)","BOTH IP/OP","$125.00 ","$92.50 ","$8.28 ","$141.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$141.00 ","$19.32 ","$37.76 ","$111.67 ","$112.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159074","EAP","CPT� 83519","","Neuronal Vgkc Autoantibody (mayo)","BOTH IP/OP","$125.00 ","$92.50 ","$8.28 ","$141.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$141.00 ","$19.32 ","$37.76 ","$111.67 ","$112.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159075","EAP","CPT� 83519","","N-type Calcium Channel Abs (mayo)","BOTH IP/OP","$125.00 ","$92.50 ","$8.28 ","$141.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$141.00 ","$19.32 ","$37.76 ","$111.67 ","$112.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159076","EAP","CPT� 83519","","P/q -type Calcium Channel Abs (mayo)","BOTH IP/OP","$125.00 ","$92.50 ","$8.28 ","$141.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$141.00 ","$19.32 ","$37.76 ","$111.67 ","$112.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159077","EAP","CPT� 83519","","Ach Receptor (muscle) Modulating Abs (mayo)","BOTH IP/OP","$125.00 ","$92.50 ","$8.28 ","$141.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$141.00 ","$19.32 ","$37.76 ","$111.67 ","$112.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159078","EAP","CPT� 83520","","Striational (striated Muscle) Abs (mayo)","BOTH IP/OP","$125.00 ","$92.50 ","$7.77 ","$141.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$141.00 ","$18.13 ","$36.18 ","$111.67 ","$112.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30159079","EAP","CPT� 84182","","Amphiphysin Western Blot (mayo)","BOTH IP/OP","$63.00 ","$46.62 ","$13.14 ","$63.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$63.00 ","$30.67 ","$50.30 ","$49.90 ","$50.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30159080","EAP","CPT� 84182","","Crmp-5-igg Western Blot (mayo)","BOTH IP/OP","$63.00 ","$46.62 ","$13.14 ","$63.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$63.00 ","$30.67 ","$50.30 ","$49.90 ","$50.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30159081","EAP","CPT� 84182","","Paraneoplastic Autoantibody Western Blot (mayo)","BOTH IP/OP","$63.00 ","$46.62 ","$13.14 ","$63.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$63.00 ","$30.67 ","$50.30 ","$49.90 ","$50.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30159082","EAP","CPT� 83519","","Alpha Subunit (so)","BOTH IP/OP","$216.00 ","$159.84 ","$8.28 ","$244.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$244.00 ","$19.32 ","$37.76 ","$193.25 ","$195.20 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159083","EAP","CPT� 80299","","Metformin  Quantitative, Serum (arup)","BOTH IP/OP","$308.00 ","$227.92 ","$8.39 ","$308.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$308.00 ","$19.57 ","$33.64 ","$243.94 ","$246.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30159084","EAP","CPT� 83872","","Mucin Clot, Synovial (so)","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$8.56 ","$8.56 ","$0.00 ","$60.00 ","$0.00 ","$16.38 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159085","EAP","CPT� 82379","","Carnitine, Urine (so)","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$34.82 ","$8.44 ","$8.43 ","$24.63 ","$24.63 ","$0.00 ","$324.00 ","$0.00 ","$47.14 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159086","EAP","CPT� 83519","","Musk  Quantitative , Antibody (so)","BOTH IP/OP","$1,583.00 ","$1,171.42 ","$8.28 ","$1,787.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$1,787.00 ","$19.32 ","$37.76 ","$1,415.30 ","$1,429.60 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30159087","EAP","CPT� 82542","","Cannabinoid Metabolite, Urine (nms), Qt","BOTH IP/OP","$284.00 ","$210.16 ","$6.62 ","$284.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$284.00 ","$25.29 ","$16.78 ","$224.93 ","$227.20 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30159088","EAP","CPT� 83520","","Tsh Receptor Binding Ab Trab (so)","BOTH IP/OP","$270.00 ","$199.80 ","$7.77 ","$263.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$263.00 ","$18.13 ","$36.18 ","$208.30 ","$210.40 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30159089","EAP","CPT� 84143","","Hydroxypregnenolone-17, Lc/ms/ms (so)","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$33.32 ","$33.32 ","$0.00 ","$150.00 ","$0.00 ","$63.78 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30159090","EAP","CPT� 80299","","Infliximab Drug Concentration","BOTH IP/OP","$399.00 ","$295.26 ","$8.39 ","$401.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$401.00 ","$19.57 ","$33.64 ","$317.59 ","$320.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30159091","EAP","CPT� 82397","","Anti-infliximab Ab","BOTH IP/OP","$738.00 ","$546.12 ","$7.06 ","$718.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$718.00 ","$14.83 ","$39.48 ","$568.66 ","$574.40 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30160020","EAP","CPT� 82172","","Apolipoprotein A1 (so)","BOTH IP/OP","$175.00 ","$129.50 ","$9.49 ","$175.00 ","$32.00 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$175.00 ","$22.14 ","$43.30 ","$138.60 ","$140.00 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30160023","EAP","CPT� 84182","","Redombx Car Antirecoverin (so)","BOTH IP/OP","$468.00 ","$346.32 ","$13.14 ","$468.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$468.00 ","$30.67 ","$50.30 ","$370.66 ","$374.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30160024","EAP","CPT� 83520","","Prothrom Frag 1.2 (so)","BOTH IP/OP","$367.00 ","$271.58 ","$7.77 ","$414.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$414.00 ","$18.13 ","$36.18 ","$327.89 ","$331.20 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30160025","EAP","CPT� 80369","","Baclofin (so)","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$402.00 ","$0.00 ","$0.00 ","$0.00 ","$286.91 ","$286.91 ","$0.00 ","$402.00 ","$0.00 ","$201.00 ","$318.38 ","$321.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160027","EAP","CPT� 82042","","Albumin, Csf (so)","BOTH IP/OP","$18.00 ","$13.32 ","$3.50 ","$18.00 ","$10.69 ","$3.89 ","$3.50 ","$7.56 ","$7.56 ","$7.64 ","$18.00 ","$8.17 ","$14.46 ","$14.26 ","$14.40 ","$11.28 ","$8.14 ","$7.78 ","$5.70 ","$7.78 "
"30160028","EAP","CPT� 82272","","Occult Blood Guaiac, Fecal","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$4.69 ","$4.69 ","$0.00 ","$65.00 ","$0.00 ","$8.98 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160029","EAP","CPT� 80365","","Oxycodone And Metabolite, Quant Serum (so-quest)","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$303.00 ","$0.03 ","$57.22 ","$11.94 ","$216.25 ","$216.25 ","$53.05 ","$303.00 ","$120.15 ","$151.50 ","$239.98 ","$242.40 ","$181.80 ","$47.42 ","$0.00 ","$48.24 ","$114.43 "
"30160030","EAP","CPT� 82397","","Anti-mullerian Hormone (amh), Male (so)","BOTH IP/OP","$255.00 ","$188.70 ","$7.06 ","$288.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$288.00 ","$14.83 ","$39.48 ","$228.10 ","$230.40 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30160031","EAP","CPT� 82397","","Anti-mullerian Hormone (amh), Female (so)","BOTH IP/OP","$296.00 ","$219.04 ","$7.06 ","$288.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$288.00 ","$14.83 ","$39.48 ","$228.10 ","$230.40 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30160032","EAP","CPT� 83520","","Infliximab Ab - Rd (so)","BOTH IP/OP","$425.00 ","$314.50 ","$7.77 ","$480.00 ","$26.72 ","$57.22 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$480.00 ","$120.15 ","$36.18 ","$380.16 ","$384.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$114.43 "
"30160033","EAP","CPT� 80299","","Infliximab Rd (so)","BOTH IP/OP","$423.00 ","$313.02 ","$8.39 ","$425.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$425.00 ","$19.57 ","$33.64 ","$336.60 ","$340.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30160034","EAP","CPT� 83520","","Infliximab Ab Ibd (so)","BOTH IP/OP","$494.00 ","$365.56 ","$7.77 ","$480.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$480.00 ","$18.13 ","$36.18 ","$380.16 ","$384.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30160035","EAP","CPT� 80299","","Infliximab Ibd (so)","BOTH IP/OP","$423.00 ","$313.02 ","$8.39 ","$425.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$425.00 ","$19.57 ","$33.64 ","$336.60 ","$340.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30160036","EAP","CPT� 80050","","Champva General Health Panel","BOTH IP/OP","$836.00 ","$618.64 ","$0.00 ","$830.00 ","$70.80 ","$22.64 ","$22.10 ","$42.54 ","$42.54 ","$145.33 ","$830.00 ","$0.00 ","$91.78 ","$657.36 ","$664.00 ","$0.00 ","$129.90 ","$0.00 ","$0.00 ","$0.00 "
"30160040","EAP","CPT� 82570","","Urine Creatinine Qd (so)","BOTH IP/OP","$27.00 ","$19.98 ","$2.59 ","$27.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$27.00 ","$5.44 ","$14.46 ","$21.38 ","$21.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30160041","EAP","CPT� 84156","","Urine Protein Qd (so","BOTH IP/OP","$28.00 ","$20.72 ","$1.83 ","$27.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$27.00 ","$3.85 ","$10.24 ","$21.38 ","$21.60 ","$5.32 ","$5.77 ","$3.67 ","$4.04 ","$3.67 "
"30160042","EAP","CPT� 83001","","Follicle Stimulating Hormone (so)","BOTH IP/OP","$56.00 ","$41.44 ","$9.29 ","$54.00 ","$38.36 ","$9.29 ","$9.29 ","$27.14 ","$27.14 ","$27.46 ","$54.00 ","$19.51 ","$51.94 ","$42.77 ","$43.20 ","$26.94 ","$29.26 ","$18.58 ","$20.48 ","$18.58 "
"30160043","EAP","CPT� 83002","","Luteinizing Hormone (so)","BOTH IP/OP","$56.00 ","$41.44 ","$9.26 ","$54.00 ","$38.23 ","$9.26 ","$9.26 ","$27.04 ","$27.04 ","$27.36 ","$54.00 ","$19.45 ","$51.76 ","$42.77 ","$43.20 ","$26.85 ","$29.16 ","$18.52 ","$20.41 ","$18.52 "
"30160044","EAP","CPT� 84182","","Myositis Specific 11 Ab Protein Western Blot  (so)","BOTH IP/OP","$103.00 ","$76.22 ","$13.14 ","$103.00 ","$37.14 ","$14.61 ","$13.14 ","$26.28 ","$26.28 ","$26.60 ","$103.00 ","$30.67 ","$50.30 ","$81.58 ","$82.40 ","$42.35 ","$28.34 ","$29.21 ","$19.84 ","$29.21 "
"30160050","EAP","CPT� 83520","","Interleukin-6 (il-6) (so)","BOTH IP/OP","$257.00 ","$190.18 ","$7.77 ","$250.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$250.00 ","$18.13 ","$36.18 ","$198.00 ","$200.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30160055","EAP","CPT� 82140","","Stone Risk Profile - Ammonia (so)","BOTH IP/OP","$21.00 ","$15.54 ","$7.29 ","$21.00 ","$20.41 ","$7.29 ","$7.29 ","$14.44 ","$14.44 ","$14.62 ","$21.00 ","$15.30 ","$21.00 ","$16.63 ","$16.80 ","$21.00 ","$15.57 ","$14.57 ","$10.90 ","$14.57 "
"30160056","EAP","CPT� 82340","","Stone Risk Profile - Calcium Urine Quant (so)","BOTH IP/OP","$23.00 ","$17.02 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$8.81 ","$8.81 ","$0.00 ","$21.00 ","$0.00 ","$16.86 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160057","EAP","CPT� 82507","","Stone Risk Profile - Citrate (so)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$40.60 ","$0.00 ","$0.00 ","$13.90 ","$40.60 ","$40.60 ","$0.00 ","$21.00 ","$0.00 ","$21.00 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160058","EAP","CPT� 82570","","Stone Risk Profile - Creatinine (so)","BOTH IP/OP","$21.00 ","$15.54 ","$2.59 ","$21.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$21.00 ","$5.44 ","$14.46 ","$16.63 ","$16.80 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30160059","EAP","CPT� 83735","","Stone Risk Profile - Magnesium (so)","BOTH IP/OP","$23.00 ","$17.02 ","$3.35 ","$21.00 ","$13.83 ","$3.35 ","$3.35 ","$9.78 ","$9.78 ","$9.89 ","$21.00 ","$7.04 ","$18.72 ","$16.63 ","$16.80 ","$9.72 ","$10.54 ","$6.70 ","$7.38 ","$6.70 "
"30160060","EAP","CPT� 83945","","Stone Risk Profile - Oxalate (so)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$21.00 ","$7.23 ","$6.50 ","$18.80 ","$18.80 ","$0.00 ","$21.00 ","$0.00 ","$21.00 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160061","EAP","CPT� 83986","","Stone Risk Profile - Ph Body Fluid (so)","BOTH IP/OP","$23.00 ","$17.02 ","$0.00 ","$21.00 ","$7.39 ","$1.79 ","$1.79 ","$5.22 ","$5.22 ","$5.28 ","$21.00 ","$3.76 ","$10.00 ","$16.63 ","$16.80 ","$5.19 ","$0.00 ","$3.58 ","$3.94 ","$3.58 "
"30160062","EAP","CPT� 84105","","Stone Risk Profile - Phosphate Urine (so)","BOTH IP/OP","$23.00 ","$17.02 ","$2.60 ","$21.00 ","$10.69 ","$2.89 ","$2.60 ","$7.56 ","$7.56 ","$7.64 ","$21.00 ","$6.07 ","$14.46 ","$16.63 ","$16.80 ","$8.38 ","$8.14 ","$5.78 ","$5.70 ","$5.78 "
"30160063","EAP","CPT� 84133","","Stone Risk Profile - Potassium Urine (so)","BOTH IP/OP","$21.00 ","$15.54 ","$2.16 ","$21.00 ","$8.90 ","$2.37 ","$2.16 ","$6.28 ","$6.28 ","$6.35 ","$21.00 ","$4.97 ","$12.02 ","$16.63 ","$16.80 ","$6.86 ","$6.77 ","$4.73 ","$4.74 ","$4.73 "
"30160064","EAP","CPT� 84300","","Stone Risk Profile - Sodium Urine (so)","BOTH IP/OP","$23.00 ","$17.02 ","$2.43 ","$21.00 ","$7.13 ","$2.53 ","$2.43 ","$5.05 ","$5.05 ","$5.11 ","$21.00 ","$5.31 ","$9.66 ","$16.63 ","$16.80 ","$7.34 ","$5.45 ","$5.06 ","$3.81 ","$5.06 "
"30160065","EAP","CPT� 84392","","Stone Risk Profile - Sulfate Urine (so)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$6.93 ","$6.93 ","$0.00 ","$21.00 ","$0.00 ","$13.28 ","$16.63 ","$16.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160066","EAP","CPT� 84560","","Stone Risk Profile - Uric Acid (so)","BOTH IP/OP","$21.00 ","$15.54 ","$2.37 ","$21.00 ","$9.79 ","$2.54 ","$2.37 ","$6.93 ","$6.93 ","$7.02 ","$21.00 ","$5.33 ","$13.28 ","$16.63 ","$16.80 ","$7.37 ","$7.48 ","$5.08 ","$5.24 ","$5.08 "
"30160070","EAP","CPT� 84155","","Assay Protein, Serum (so)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$32.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$32.00 ","$0.00 ","$10.24 ","$25.34 ","$25.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30160071","EAP","CPT� 84165","","Protein Electrophoresis Urine (so)","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$32.00 ","$21.00 ","$5.37 ","$5.37 ","$15.68 ","$15.68 ","$15.87 ","$32.00 ","$11.28 ","$30.02 ","$25.34 ","$25.60 ","$15.57 ","$0.00 ","$10.74 ","$11.83 ","$10.74 "
"30160072","EAP","CPT� 82570","","Assay Creatinine Urine (so)","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$35.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$35.00 ","$5.44 ","$14.46 ","$27.72 ","$28.00 ","$7.51 ","$0.00 ","$5.18 ","$5.70 ","$5.18 "
"30160073","EAP","CPT� 84156","","Assay Protein Urine (so)","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$35.00 ","$7.58 ","$1.84 ","$1.83 ","$5.35 ","$5.35 ","$5.42 ","$35.00 ","$3.85 ","$10.24 ","$27.72 ","$28.00 ","$5.32 ","$0.00 ","$3.67 ","$4.04 ","$3.67 "
"30160074","EAP","CPT� 84166","","Protein Electrophoresis, Urine (so)","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$36.00 ","$8.92 ","$8.91 ","$26.04 ","$26.04 ","$26.34 ","$35.00 ","$18.72 ","$35.00 ","$27.72 ","$28.00 ","$25.85 ","$0.00 ","$17.83 ","$19.65 ","$17.83 "
"30200001","EAP","CPT� 86000","","Proteus Ox-19 Ab","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$399.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$10.19 ","$0.00 ","$399.00 ","$0.00 ","$19.50 ","$316.01 ","$319.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200002","EAP","CPT� 86000","","Typhoid O Antibody","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$399.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$10.19 ","$0.00 ","$399.00 ","$0.00 ","$19.50 ","$316.01 ","$319.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200003","EAP","CPT� 86000","","Typhoid H Antibody","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$399.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$10.19 ","$0.00 ","$399.00 ","$0.00 ","$19.50 ","$316.01 ","$319.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200004","EAP","CPT� 86003","","*alternaria Alternata Ige","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200005","EAP","CPT� 86003","","*penicillium Notatum Ige","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200006","EAP","CPT� 86003","","*kentucky/june Bluegrass Ige","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200007","EAP","CPT� 86003","","*mouse Epithelia Ige","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200008","EAP","CPT� 86003","","*clam Ige","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200009","EAP","CPT� 86003","","*walnut (food) Ige","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200010","EAP","CPT� 86003","","*scallop Ige","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200011","EAP","CPT� 86003","","Ige Allergen Sesame Seed","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200012","EAP","CPT� 86003","","Ige Allergen Nettle","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200013","EAP","CPT� 86003","","Ige Allergen Sheep Sorrel","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200014","EAP","CPT� 86003","","Mk82 Latex-rst","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200015","EAP","CPT� 86003","","Curvularia Lunato","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200016","EAP","CPT� 86003","","Heluminthosporium I.","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200017","EAP","CPT� 86003","","Egg, Chicken","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200018","EAP","CPT� 86003","","Milk, Cow's","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200019","EAP","CPT� 86003","","Wheat","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200020","EAP","CPT� 86003","","Oat","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200021","EAP","CPT� 86003","","Corn","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200022","EAP","CPT� 86003","","Soybean","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200023","EAP","CPT� 86003","","Peanut","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200024","EAP","CPT� 86003","","Tuna","BOTH IP/OP","$180.00 ","$133.20 ","$2.61 ","$224.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$224.00 ","$5.48 ","$14.60 ","$177.41 ","$179.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200025","EAP","CPT� 86003","","Codfish","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200026","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$180.00 ","$133.20 ","$2.61 ","$224.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$224.00 ","$5.48 ","$14.60 ","$177.41 ","$179.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200027","EAP","CPT� 86003","","Shrimp","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200028","EAP","CPT� 86003","","Beef","BOTH IP/OP","$180.00 ","$133.20 ","$2.61 ","$224.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$224.00 ","$5.48 ","$14.60 ","$177.41 ","$179.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200029","EAP","CPT� 86003","","Rice","BOTH IP/OP","$180.00 ","$133.20 ","$2.61 ","$224.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$224.00 ","$5.48 ","$14.60 ","$177.41 ","$179.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200030","EAP","CPT� 86003","","White Potato","BOTH IP/OP","$180.00 ","$133.20 ","$2.61 ","$224.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$224.00 ","$5.48 ","$14.60 ","$177.41 ","$179.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200031","EAP","CPT� 86003","","Yellow Onion","BOTH IP/OP","$180.00 ","$133.20 ","$2.61 ","$224.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$224.00 ","$5.48 ","$14.60 ","$177.41 ","$179.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200032","EAP","CPT� 86003","","Honey Bee","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200033","EAP","CPT� 86003","","White Faced Hornet","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200034","EAP","CPT� 86003","","Yellow Jacket","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200035","EAP","CPT� 86003","","Paper Wasp","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200036","EAP","CPT� 86003","","Yellow Faced Hornet","BOTH IP/OP","$207.00 ","$153.18 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200037","EAP","CPT� 86003","","Short Ragweed","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200038","EAP","CPT� 86003","","Yellow Dock","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200039","EAP","CPT� 86003","","Lamb's Quarters","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200040","EAP","CPT� 86003","","Pigweed","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200041","EAP","CPT� 86003","","Marsh Elder","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200042","EAP","CPT� 86003","","English Plantain","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200043","EAP","CPT� 86003","","Cocklebur","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200044","EAP","CPT� 86003","","Bermuda Grass","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200045","EAP","CPT� 86003","","Perennial Ryegrass","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200046","EAP","CPT� 86003","","Timothy","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200047","EAP","CPT� 86003","","Johnson Grass","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200048","EAP","CPT� 86003","","Bahia Grass","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200049","EAP","CPT� 86003","","White Oak","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200050","EAP","CPT� 86003","","Elm","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200051","EAP","CPT� 86003","","Black Walnut","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200052","EAP","CPT� 86003","","White Ash","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200053","EAP","CPT� 86003","","White Pine","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200054","EAP","CPT� 86003","","Pecan","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200055","EAP","CPT� 86003","","Cottonwood","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200056","EAP","CPT� 86003","","Sycamore","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200057","EAP","CPT� 86003","","Birch","BOTH IP/OP","$209.00 ","$154.66 ","$0.00 ","$209.00 ","$0.00 ","$0.00 ","$0.00 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200058","EAP","CPT� 86003","","Eucalyptus","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200059","EAP","CPT� 86003","","Red Cedar","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200060","EAP","CPT� 86003","","Red Maple","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200061","EAP","CPT� 86003","","Cat Hair","BOTH IP/OP","$209.00 ","$154.66 ","$0.00 ","$209.00 ","$0.00 ","$0.00 ","$0.00 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200062","EAP","CPT� 86003","","Dog Hair","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200063","EAP","CPT� 86003","","Horse Hair","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200064","EAP","CPT� 86003","","Feather Mix","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200065","EAP","CPT� 86003","","D.pteronyssinus","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200066","EAP","CPT� 86003","","D.farinae Mite","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200067","EAP","CPT� 86003","","Cockroach","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200068","EAP","CPT� 86003","","Pen. Brevicomp","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200069","EAP","CPT� 86003","","Clado, Herbarium","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200070","EAP","CPT� 86003","","Candida Albicans","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200071","EAP","CPT� 86003","","Alternaria Tenuis","BOTH IP/OP","$168.00 ","$124.32 ","$2.61 ","$209.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$209.00 ","$5.48 ","$14.60 ","$165.53 ","$167.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200072","EAP","CPT� 86021","","Perinuclear Ab Scrn","BOTH IP/OP","$326.00 ","$241.24 ","$7.53 ","$326.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$326.00 ","$15.80 ","$42.06 ","$258.19 ","$260.80 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200073","EAP","CPT� 86021","","Cytoplasmic Ab Scrn","BOTH IP/OP","$355.00 ","$262.70 ","$7.53 ","$326.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$326.00 ","$15.80 ","$42.06 ","$258.19 ","$260.80 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200074","EAP","CPT� 86022","","Plt Ab: Hla Class 1","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$420.00 ","$0.00 ","$51.32 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200075","EAP","CPT� 86022","","Plt Ab: Gp Iib/iiia","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$420.00 ","$0.00 ","$51.32 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200076","EAP","CPT� 86022","","Plt Ab: Gp Ib/ix","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$420.00 ","$0.00 ","$51.32 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200077","EAP","CPT� 86022","","Plt Ab: Gp Ia/iib","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$420.00 ","$0.00 ","$51.32 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200078","EAP","CPT� 86022","","Plt Ab: Gp Iv","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$420.00 ","$0.00 ","$51.32 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200079","EAP","CPT� 86038","","Ana Screen","BOTH IP/OP","$291.00 ","$215.34 ","$6.04 ","$276.00 ","$24.95 ","$6.05 ","$6.04 ","$17.65 ","$17.65 ","$17.86 ","$276.00 ","$12.69 ","$33.78 ","$218.59 ","$220.80 ","$17.53 ","$19.03 ","$12.09 ","$13.32 ","$12.09 "
"30200080","EAP","CPT� 86060","","Strep Aso","BOTH IP/OP","$79.00 ","$58.46 ","$3.65 ","$76.00 ","$14.44 ","$3.65 ","$3.65 ","$10.21 ","$10.21 ","$10.32 ","$76.00 ","$7.67 ","$19.54 ","$60.19 ","$60.80 ","$10.59 ","$11.00 ","$7.30 ","$7.70 ","$7.30 "
"30200081","EAP","CPT� 86140","","C-reactive Protein","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$7.56 ","$7.56 ","$0.00 ","$235.00 ","$0.00 ","$14.46 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200082","EAP","CPT� 86141","","C-reactive Protein-hs","BOTH IP/OP","$248.00 ","$183.52 ","$6.48 ","$250.00 ","$26.72 ","$6.48 ","$6.48 ","$18.91 ","$18.91 ","$19.12 ","$250.00 ","$13.60 ","$36.18 ","$198.00 ","$200.00 ","$18.78 ","$20.37 ","$12.95 ","$14.26 ","$12.95 "
"30200083","EAP","CPT� 86141","","Crp-hs,micro","BOTH IP/OP","$250.00 ","$185.00 ","$6.48 ","$250.00 ","$26.72 ","$6.48 ","$6.48 ","$18.91 ","$18.91 ","$19.12 ","$250.00 ","$13.60 ","$36.18 ","$198.00 ","$200.00 ","$18.78 ","$20.37 ","$12.95 ","$14.26 ","$12.95 "
"30200084","EAP","CPT� 86160","","Complement-3c","BOTH IP/OP","$337.00 ","$249.38 ","$6.00 ","$340.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$340.00 ","$12.60 ","$33.56 ","$269.28 ","$272.00 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30200085","EAP","CPT� 86160","","Complement-4","BOTH IP/OP","$337.00 ","$249.38 ","$6.00 ","$340.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$340.00 ","$12.60 ","$33.56 ","$269.28 ","$272.00 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30200086","EAP","CPT� 86160","","Complement-c3,synvl","BOTH IP/OP","$337.00 ","$249.38 ","$6.00 ","$340.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$340.00 ","$12.60 ","$33.56 ","$269.28 ","$272.00 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30200087","EAP","CPT� 86160","","Complement-c4,synvl","BOTH IP/OP","$337.00 ","$249.38 ","$6.00 ","$340.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$340.00 ","$12.60 ","$33.56 ","$269.28 ","$272.00 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30200088","EAP","CPT� 86162","","Complement Tot,ch50","BOTH IP/OP","$227.00 ","$167.98 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$29.67 ","$29.67 ","$30.02 ","$229.00 ","$21.34 ","$56.78 ","$181.37 ","$183.20 ","$29.46 ","$31.99 ","$20.32 ","$22.39 ","$20.32 "
"30200089","EAP","CPT� 86162","","Complemnt Tot,ch100","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$29.67 ","$29.67 ","$30.02 ","$229.00 ","$21.34 ","$56.78 ","$181.37 ","$183.20 ","$29.46 ","$31.99 ","$20.32 ","$22.39 ","$20.32 "
"30200090","EAP","CPT� 86171","","Fungal Serology","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$10.21 ","$10.21 ","$0.00 ","$157.00 ","$0.00 ","$19.54 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200091","EAP","CPT� 86171","","Parasitic Serology","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$10.21 ","$10.21 ","$0.00 ","$157.00 ","$0.00 ","$19.54 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200092","EAP","CPT� 86171","","Viral Serology","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$10.21 ","$10.21 ","$0.00 ","$157.00 ","$0.00 ","$19.54 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200093","EAP","CPT� 86171","","Misc. Serology","BOTH IP/OP","$157.00 ","$116.18 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$10.21 ","$10.21 ","$0.00 ","$157.00 ","$0.00 ","$19.54 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200094","EAP","CPT� 86215","","Strep Antid-nase B","BOTH IP/OP","$190.00 ","$140.60 ","$6.62 ","$182.00 ","$27.35 ","$6.63 ","$6.62 ","$19.35 ","$19.35 ","$19.57 ","$182.00 ","$13.91 ","$37.02 ","$144.14 ","$145.60 ","$19.21 ","$20.85 ","$13.25 ","$14.60 ","$13.25 "
"30200095","EAP","CPT� 86225","","Ds-dna Ab,crithidia","BOTH IP/OP","$291.00 ","$215.34 ","$6.87 ","$303.00 ","$28.35 ","$6.87 ","$6.87 ","$20.06 ","$20.06 ","$20.30 ","$303.00 ","$14.43 ","$38.40 ","$239.98 ","$242.40 ","$19.92 ","$21.63 ","$13.74 ","$15.14 ","$13.74 "
"30200096","EAP","CPT� 86225","","Ds-dna Ab,eia","BOTH IP/OP","$325.00 ","$240.50 ","$6.87 ","$328.00 ","$28.35 ","$6.87 ","$6.87 ","$20.06 ","$20.06 ","$20.30 ","$328.00 ","$14.43 ","$38.40 ","$259.78 ","$262.40 ","$19.92 ","$21.63 ","$13.74 ","$15.14 ","$13.74 "
"30200097","EAP","CPT� 86235","","Jo-1 Ab Screen, Eia","BOTH IP/OP","$344.00 ","$254.56 ","$8.97 ","$332.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$332.00 ","$18.83 ","$50.12 ","$262.94 ","$265.60 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200098","EAP","CPT� 86235","","Scl-70 Ab Screen, Eia","BOTH IP/OP","$344.00 ","$254.56 ","$8.97 ","$332.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$332.00 ","$18.83 ","$50.12 ","$262.94 ","$265.60 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200099","EAP","CPT� 86235","","Anticentromere Scrn","BOTH IP/OP","$344.00 ","$254.56 ","$8.97 ","$332.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$332.00 ","$18.83 ","$50.12 ","$262.94 ","$265.60 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200100","EAP","CPT� 86235","","Smith (sm) Ab Screen","BOTH IP/OP","$325.00 ","$240.50 ","$8.97 ","$314.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$314.00 ","$18.83 ","$50.12 ","$248.69 ","$251.20 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200101","EAP","CPT� 86235","","Rnp Ab Screen","BOTH IP/OP","$325.00 ","$240.50 ","$8.97 ","$314.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$314.00 ","$18.83 ","$50.12 ","$248.69 ","$251.20 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200102","EAP","CPT� 86235","","Ssa (ro) Ab Screen","BOTH IP/OP","$325.00 ","$240.50 ","$8.97 ","$314.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$314.00 ","$18.83 ","$50.12 ","$248.69 ","$251.20 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200103","EAP","CPT� 86235","","Ssb (la) Ab Screen","BOTH IP/OP","$325.00 ","$240.50 ","$8.97 ","$314.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$314.00 ","$18.83 ","$50.12 ","$248.69 ","$251.20 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30200104","EAP","CPT� 86255","","Perinuclear Ab","BOTH IP/OP","$50.00 ","$37.00 ","$6.03 ","$63.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$63.00 ","$12.65 ","$33.68 ","$49.90 ","$50.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200105","EAP","CPT� 86255","","Smooth Muscle Ab","BOTH IP/OP","$59.00 ","$43.66 ","$6.03 ","$59.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$59.00 ","$12.65 ","$33.68 ","$46.73 ","$47.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200106","EAP","CPT� 86255","","Parietal Cell Ab","BOTH IP/OP","$59.00 ","$43.66 ","$6.03 ","$59.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$59.00 ","$12.65 ","$33.68 ","$46.73 ","$47.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200107","EAP","CPT� 86256","","Adrenal Ab Screen","BOTH IP/OP","$88.00 ","$65.12 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200108","EAP","CPT� 86256","","Basement Mem Ab Scrn","BOTH IP/OP","$88.00 ","$65.12 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200109","EAP","CPT� 86256","","Rmsf Antibody Igg","BOTH IP/OP","$88.00 ","$65.12 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200110","EAP","CPT� 86256","","Rmsf Antibody Igm","BOTH IP/OP","$88.00 ","$65.12 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200111","EAP","CPT� 86300","","Cancer Antigen 15-3","BOTH IP/OP","$143.00 ","$105.82 ","$10.41 ","$144.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$144.00 ","$21.85 ","$58.14 ","$114.05 ","$115.20 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200112","EAP","CPT� 86300","","Cancer Ag 27-29","BOTH IP/OP","$143.00 ","$105.82 ","$10.41 ","$144.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$144.00 ","$21.85 ","$58.14 ","$114.05 ","$115.20 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200113","EAP","CPT� 86301","","Carbohydrate Ag 19-9","BOTH IP/OP","$206.00 ","$152.44 ","$10.41 ","$208.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$208.00 ","$21.85 ","$58.14 ","$164.74 ","$166.40 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200114","EAP","CPT� 86308","","Infect Mono Screen","BOTH IP/OP","$203.00 ","$150.22 ","$2.59 ","$205.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$205.00 ","$5.44 ","$14.46 ","$162.36 ","$164.00 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30200115","EAP","CPT� 86316","","Cancer Antigen 125","BOTH IP/OP","$529.00 ","$391.46 ","$10.41 ","$533.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$533.00 ","$21.85 ","$58.14 ","$422.14 ","$426.40 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200116","EAP","CPT� 86317","","Diphtheria Ab","BOTH IP/OP","$248.00 ","$183.52 ","$7.49 ","$225.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$225.00 ","$15.74 ","$33.54 ","$178.20 ","$180.00 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30200117","EAP","CPT� 86317","","Dnp Antibody","BOTH IP/OP","$225.00 ","$166.50 ","$7.49 ","$225.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$225.00 ","$15.74 ","$33.54 ","$178.20 ","$180.00 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30200118","EAP","CPT� 86329","","Hypersens Pneumo Scr","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$206.00 ","$28.99 ","$7.03 ","$0.00 ","$20.51 ","$20.51 ","$20.75 ","$206.00 ","$14.75 ","$39.24 ","$163.15 ","$164.80 ","$20.37 ","$22.11 ","$14.05 ","$15.48 ","$14.05 "
"30200119","EAP","CPT� 86332","","Immune Complex(c1q)","BOTH IP/OP","$116.00 ","$85.84 ","$12.19 ","$117.00 ","$50.32 ","$12.19 ","$12.19 ","$35.59 ","$35.59 ","$36.00 ","$117.00 ","$25.59 ","$68.10 ","$92.66 ","$93.60 ","$35.34 ","$38.36 ","$24.37 ","$26.85 ","$24.37 "
"30200120","EAP","CPT� 86334","","Immunofixation,ser","BOTH IP/OP","$439.00 ","$324.86 ","$11.17 ","$417.00 ","$46.12 ","$11.17 ","$11.17 ","$32.62 ","$32.62 ","$33.00 ","$417.00 ","$23.46 ","$62.42 ","$330.26 ","$333.60 ","$32.39 ","$35.16 ","$22.34 ","$24.61 ","$22.34 "
"30200121","EAP","CPT� 86335","","Immunofixation,urine","BOTH IP/OP","$462.00 ","$341.88 ","$14.67 ","$439.00 ","$60.59 ","$14.68 ","$14.67 ","$42.85 ","$42.85 ","$43.34 ","$439.00 ","$30.82 ","$82.00 ","$347.69 ","$351.20 ","$42.56 ","$46.18 ","$29.35 ","$32.33 ","$29.35 "
"30200122","EAP","CPT� 86336","","Inhibin-a","BOTH IP/OP","$77.00 ","$56.98 ","$7.79 ","$77.00 ","$26.74 ","$7.80 ","$7.79 ","$18.90 ","$18.90 ","$19.12 ","$77.00 ","$16.37 ","$36.18 ","$60.98 ","$61.60 ","$22.61 ","$20.37 ","$15.59 ","$14.26 ","$15.59 "
"30200123","EAP","CPT� 86337","","Insulin Auto Ab","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$237.00 ","$44.19 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.64 ","$237.00 ","$22.48 ","$59.84 ","$187.70 ","$189.60 ","$31.04 ","$0.00 ","$21.41 ","$23.60 ","$21.41 "
"30200124","EAP","CPT� 86340","","Intrinsic Factor Ab","BOTH IP/OP","$230.00 ","$170.20 ","$7.54 ","$228.00 ","$31.13 ","$7.54 ","$7.54 ","$22.01 ","$22.01 ","$22.26 ","$228.00 ","$15.83 ","$42.12 ","$180.58 ","$182.40 ","$21.87 ","$23.72 ","$15.08 ","$16.60 ","$15.08 "
"30200125","EAP","CPT� 86341","","Pancreatic Islet Ab","BOTH IP/OP","$81.00 ","$59.94 ","$10.61 ","$80.00 ","$40.84 ","$11.79 ","$10.61 ","$28.89 ","$28.89 ","$29.24 ","$80.00 ","$24.75 ","$55.30 ","$63.36 ","$64.00 ","$34.18 ","$31.16 ","$23.57 ","$21.81 ","$23.57 "
"30200126","EAP","CPT� 86344","","Phagocytic Charge","BOTH IP/OP","$517.00 ","$382.58 ","$0.00 ","$522.00 ","$0.00 ","$0.00 ","$0.00 ","$11.66 ","$11.66 ","$0.00 ","$522.00 ","$0.00 ","$22.32 ","$413.42 ","$417.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200127","EAP","CPT� 86359","","Cd3, Total T%","BOTH IP/OP","$230.00 ","$170.20 ","$18.86 ","$232.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$232.00 ","$39.62 ","$65.82 ","$183.74 ","$185.60 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200128","EAP","CPT� 86360","","Lymph Subsets:cd4&cd8","BOTH IP/OP","$495.00 ","$366.30 ","$23.49 ","$500.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$500.00 ","$49.33 ","$131.30 ","$396.00 ","$400.00 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30200129","EAP","CPT� 86376","","L-k Microsomal Ab","BOTH IP/OP","$295.00 ","$218.30 ","$7.28 ","$298.00 ","$30.04 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$298.00 ","$15.28 ","$40.66 ","$236.02 ","$238.40 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30200130","EAP","CPT� 86376","","Microsomal Ab","BOTH IP/OP","$315.00 ","$233.10 ","$7.28 ","$315.00 ","$30.04 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$315.00 ","$15.28 ","$40.66 ","$249.48 ","$252.00 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30200131","EAP","CPT� 86403","","Rapid Strep Test","BOTH IP/OP","$204.00 ","$150.96 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200132","EAP","CPT� 86403","","Crypto.antigen Scrn","BOTH IP/OP","$204.00 ","$150.96 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200133","EAP","CPT� 86403","","Crypto.ag,csf-qual","BOTH IP/OP","$204.00 ","$150.96 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200134","EAP","CPT� 86403","","H.flu Ag,urine","BOTH IP/OP","$196.00 ","$145.04 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200135","EAP","CPT� 86403","","N.mening Ag,urine","BOTH IP/OP","$196.00 ","$145.04 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200136","EAP","CPT� 86403","","St.pneumo Ag,urine","BOTH IP/OP","$196.00 ","$145.04 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200137","EAP","CPT� 86403","","Strep-b Ag,urine","BOTH IP/OP","$196.00 ","$145.04 ","$5.19 ","$196.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$196.00 ","$12.12 ","$28.48 ","$155.23 ","$156.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30200138","EAP","CPT� 86406","","Crypto.ag,csf-quant","BOTH IP/OP","$244.00 ","$180.56 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$5.32 ","$15.53 ","$15.53 ","$15.72 ","$237.00 ","$11.17 ","$29.74 ","$187.70 ","$189.60 ","$15.43 ","$16.75 ","$10.64 ","$11.72 ","$10.64 "
"30200139","EAP","CPT� 86406","","Crypto.ag,bld-quant","BOTH IP/OP","$244.00 ","$180.56 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$5.32 ","$15.53 ","$15.53 ","$15.72 ","$237.00 ","$11.17 ","$29.74 ","$187.70 ","$189.60 ","$15.43 ","$16.75 ","$10.64 ","$11.72 ","$10.64 "
"30200140","EAP","CPT� 86431","","Rheumatoid Factor, Bld","BOTH IP/OP","$183.00 ","$135.42 ","$2.84 ","$166.00 ","$11.70 ","$2.84 ","$2.84 ","$8.29 ","$8.29 ","$8.39 ","$166.00 ","$5.95 ","$15.86 ","$131.47 ","$132.80 ","$8.22 ","$8.94 ","$5.67 ","$6.26 ","$5.67 "
"30200141","EAP","CPT� 86431","","Rheumatoid Factor, Syn Fld","BOTH IP/OP","$183.00 ","$135.42 ","$2.84 ","$166.00 ","$11.70 ","$2.84 ","$2.84 ","$8.29 ","$8.29 ","$8.39 ","$166.00 ","$5.95 ","$15.86 ","$131.47 ","$132.80 ","$8.22 ","$8.94 ","$5.67 ","$6.26 ","$5.67 "
"30200145","EAP","CPT� 86357","","Natural Killer Cellls So","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$86.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$86.00 ","$39.62 ","$65.82 ","$68.11 ","$68.80 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200146","EAP","CPT� 86341","","Ia-2 Ab (so)","BOTH IP/OP","$193.00 ","$142.82 ","$10.61 ","$193.00 ","$40.84 ","$11.79 ","$10.61 ","$28.89 ","$28.89 ","$29.24 ","$193.00 ","$24.75 ","$55.30 ","$152.86 ","$154.40 ","$34.18 ","$31.16 ","$23.57 ","$21.81 ","$23.57 "
"30200147","EAP","CPT� 86355","","Lymph Subset B Cell Tot (so)","BOTH IP/OP","$206.00 ","$152.44 ","$0.00 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$214.00 ","$39.62 ","$65.82 ","$169.49 ","$171.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200148","EAP","CPT� 86357","","Lymph Subset Nk Cell Tot (so)","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$204.00 ","$39.62 ","$65.82 ","$161.57 ","$163.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200149","EAP","CPT� 86580","","PPD, TB SKIN","BOTH IP/OP","$89.00 ","$65.86 ","$3.89 ","$90.00 ","$12.43 ","$24.19 ","$3.89 ","$7.19 ","$7.19 ","$9.56 ","$90.00 ","$23.06 ","$20.46 ","$71.28 ","$72.00 ","$32.04 ","$10.18 ","$9.36 ","$7.13 ","$21.96 "
"30200150","EAP","CPT� 86780","","Fta - Abs","BOTH IP/OP","$215.00 ","$159.10 ","$6.62 ","$196.00 ","$27.32 ","$6.62 ","$6.62 ","$18.97 ","$18.97 ","$34.32 ","$196.00 ","$13.90 ","$98.00 ","$155.23 ","$156.80 ","$19.20 ","$30.67 ","$13.24 ","$31.20 ","$13.24 "
"30200157","EAP","CPT� 86592","","Rpr (qual)","BOTH IP/OP","$153.00 ","$113.22 ","$2.14 ","$139.00 ","$8.82 ","$2.14 ","$2.14 ","$6.23 ","$6.23 ","$5.46 ","$139.00 ","$4.48 ","$11.92 ","$110.09 ","$111.20 ","$6.19 ","$5.82 ","$4.27 ","$4.07 ","$4.27 "
"30200158","EAP","CPT� 86592","","Rpr(qual),capillary","BOTH IP/OP","$139.00 ","$102.86 ","$2.14 ","$139.00 ","$8.82 ","$2.14 ","$2.14 ","$6.23 ","$6.23 ","$5.46 ","$139.00 ","$4.48 ","$11.92 ","$110.09 ","$111.20 ","$6.19 ","$5.82 ","$4.27 ","$4.07 ","$4.27 "
"30200159","EAP","CPT� 86592","","Vdrl,csf","BOTH IP/OP","$153.00 ","$113.22 ","$2.14 ","$139.00 ","$8.82 ","$2.14 ","$2.14 ","$6.23 ","$6.23 ","$5.46 ","$139.00 ","$4.48 ","$11.92 ","$110.09 ","$111.20 ","$6.19 ","$5.82 ","$4.27 ","$4.07 ","$4.27 "
"30200160","EAP","CPT� 86593","","Vdrl-csf,quant","BOTH IP/OP","$153.00 ","$113.22 ","$2.20 ","$139.00 ","$9.08 ","$2.20 ","$2.20 ","$6.43 ","$6.43 ","$24.34 ","$139.00 ","$4.62 ","$12.32 ","$110.09 ","$111.20 ","$6.38 ","$21.75 ","$4.40 ","$22.13 ","$4.40 "
"30200161","EAP","CPT� 86593","","Rpr (quant)","BOTH IP/OP","$153.00 ","$113.22 ","$2.20 ","$139.00 ","$9.08 ","$2.20 ","$2.20 ","$6.43 ","$6.43 ","$24.34 ","$139.00 ","$4.62 ","$12.32 ","$110.09 ","$111.20 ","$6.38 ","$21.75 ","$4.40 ","$22.13 ","$4.40 "
"30200162","EAP","CPT� 86606","","Aspergillus Fumigatus","BOTH IP/OP","$47.00 ","$34.78 ","$7.53 ","$47.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$47.00 ","$15.80 ","$42.06 ","$37.22 ","$37.60 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200163","EAP","CPT� 86611","","B.henselae Igg","BOTH IP/OP","$80.00 ","$59.20 ","$5.09 ","$79.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$79.00 ","$10.69 ","$28.44 ","$62.57 ","$63.20 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30200164","EAP","CPT� 86611","","B.henselae Igm","BOTH IP/OP","$80.00 ","$59.20 ","$5.09 ","$79.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$79.00 ","$10.69 ","$28.44 ","$62.57 ","$63.20 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30200165","EAP","CPT� 86611","","B.quintana Igg","BOTH IP/OP","$80.00 ","$59.20 ","$5.09 ","$79.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$79.00 ","$10.69 ","$28.44 ","$62.57 ","$63.20 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30200166","EAP","CPT� 86611","","B.quintana Igm","BOTH IP/OP","$80.00 ","$59.20 ","$5.09 ","$79.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$79.00 ","$10.69 ","$28.44 ","$62.57 ","$63.20 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30200167","EAP","CPT� 86617","","Lyme Ab Westernblot","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$22.61 ","$22.61 ","$0.00 ","$103.00 ","$0.00 ","$43.28 ","$81.58 ","$82.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200168","EAP","CPT� 86618","","Lyme Ab Total","BOTH IP/OP","$357.00 ","$264.18 ","$8.51 ","$361.00 ","$35.16 ","$8.52 ","$8.51 ","$24.87 ","$24.87 ","$25.16 ","$361.00 ","$17.88 ","$47.60 ","$285.91 ","$288.80 ","$24.69 ","$26.81 ","$17.03 ","$18.76 ","$17.03 "
"30200169","EAP","CPT� 86618","","Lyme Ab-igm","BOTH IP/OP","$361.00 ","$267.14 ","$8.51 ","$361.00 ","$35.16 ","$8.52 ","$8.51 ","$24.87 ","$24.87 ","$25.16 ","$361.00 ","$17.88 ","$47.60 ","$285.91 ","$288.80 ","$24.69 ","$26.81 ","$17.03 ","$18.76 ","$17.03 "
"30200170","EAP","CPT� 86622","","B. Abortus Igg","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$13.05 ","$13.05 ","$13.19 ","$132.00 ","$9.38 ","$24.96 ","$104.54 ","$105.60 ","$12.95 ","$14.05 ","$8.93 ","$9.84 ","$8.93 "
"30200171","EAP","CPT� 86622","","B. Abortus Igm","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$13.05 ","$13.05 ","$13.19 ","$132.00 ","$9.38 ","$24.96 ","$104.54 ","$105.60 ","$12.95 ","$14.05 ","$8.93 ","$9.84 ","$8.93 "
"30200172","EAP","CPT� 86631","","Chlam Pnuemo Igg","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$123.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$123.00 ","$0.00 ","$33.04 ","$97.42 ","$98.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200173","EAP","CPT� 86631","","Chlam Pnuemo Iga","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$123.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$123.00 ","$0.00 ","$33.04 ","$97.42 ","$98.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200174","EAP","CPT� 86631","","Chlam Trach Igg","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$123.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$123.00 ","$0.00 ","$33.04 ","$97.42 ","$98.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200175","EAP","CPT� 86631","","Chlam Trach Iga","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$123.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$123.00 ","$0.00 ","$33.04 ","$97.42 ","$98.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200176","EAP","CPT� 86631","","Chlam Psittaci Icg","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$123.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$123.00 ","$0.00 ","$33.04 ","$97.42 ","$98.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200177","EAP","CPT� 86631","","Chlam Psittaci Iga","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$123.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$123.00 ","$0.00 ","$33.04 ","$97.42 ","$98.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200178","EAP","CPT� 86632","","Chlam Pnuemo Igm","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$18.53 ","$18.53 ","$0.00 ","$130.00 ","$0.00 ","$35.48 ","$102.96 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200179","EAP","CPT� 86632","","Chlam Trach Igm","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$18.53 ","$18.53 ","$0.00 ","$130.00 ","$0.00 ","$35.48 ","$102.96 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200180","EAP","CPT� 86638","","Q Fever Igg, Acute","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$253.00 ","$0.00 ","$33.88 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200181","EAP","CPT� 86638","","Q Fever Igg, Conval.","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$253.00 ","$0.00 ","$33.88 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200182","EAP","CPT� 86644","","Cmv Igg","BOTH IP/OP","$209.00 ","$154.66 ","$7.20 ","$190.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$190.00 ","$15.11 ","$32.52 ","$150.48 ","$152.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200183","EAP","CPT� 86644","","Cmv Igg Ab-eia","BOTH IP/OP","$222.00 ","$164.28 ","$7.20 ","$202.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$202.00 ","$15.11 ","$32.52 ","$159.98 ","$161.60 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200184","EAP","CPT� 86645","","Cmv Igm","BOTH IP/OP","$141.00 ","$104.34 ","$8.42 ","$128.00 ","$34.77 ","$8.43 ","$8.42 ","$24.60 ","$24.60 ","$24.90 ","$128.00 ","$17.69 ","$47.08 ","$101.38 ","$102.40 ","$24.43 ","$26.53 ","$16.85 ","$18.57 ","$16.85 "
"30200185","EAP","CPT� 86645","","Cmv Igm Ab-eia","BOTH IP/OP","$138.00 ","$102.12 ","$8.42 ","$138.00 ","$34.77 ","$8.43 ","$8.42 ","$24.60 ","$24.60 ","$24.90 ","$138.00 ","$17.69 ","$47.08 ","$109.30 ","$110.40 ","$24.43 ","$26.53 ","$16.85 ","$18.57 ","$16.85 "
"30200186","EAP","CPT� 86651","","Encep, California, Csf, Igg","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200187","EAP","CPT� 86651","","Encep, California, Csf, Igm","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200188","EAP","CPT� 86651","","Calfornia Equine Igm","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200189","EAP","CPT� 86651","","Calif. Equine Encephalitis","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200190","EAP","CPT� 86652","","Encep, E. Equine, Csf,igg","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200191","EAP","CPT� 86652","","Encep, E. Equine, Csf,igm","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200192","EAP","CPT� 86652","","Eastern Equine Igm","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200193","EAP","CPT� 86652","","Eastern Equine Encephalitis","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200194","EAP","CPT� 86653","","Encep,st. Louis, Csf Igg","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200195","EAP","CPT� 86653","","Encep,st. Louis, Csf Igm","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200196","EAP","CPT� 86653","","St. Louis Equine Igm","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200197","EAP","CPT� 86653","","St. Louis Equine Encephalitis","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200198","EAP","CPT� 86654","","Encep, W. Equine, Csf,igg","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200199","EAP","CPT� 86654","","Encep, W. Equine, Csf,igm","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$125.00 ","$0.00 ","$36.86 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200200","EAP","CPT� 86654","","Western Equine Igm","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200201","EAP","CPT� 86654","","Western Equine Encephalitis","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$118.00 ","$0.00 ","$36.86 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200202","EAP","CPT� 86658","","Coxsackie B1 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200203","EAP","CPT� 86658","","Coxsackie B2 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200204","EAP","CPT� 86658","","Coxsackie B3 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200205","EAP","CPT� 86658","","Coxsackie B4 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200206","EAP","CPT� 86658","","Coxsackie B5 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200207","EAP","CPT� 86658","","Coxsackie B6 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200208","EAP","CPT� 86658","","Echovirus 4 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200209","EAP","CPT� 86658","","Echovirus 9 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200210","EAP","CPT� 86658","","Echovirus 11 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200211","EAP","CPT� 86658","","Coxsackie A2 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200212","EAP","CPT� 86658","","Coxsackie A4 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200213","EAP","CPT� 86658","","Coxsackie A10 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200214","EAP","CPT� 86658","","Coxsackie A16 Titer","BOTH IP/OP","$112.00 ","$82.88 ","$6.51 ","$113.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$113.00 ","$13.68 ","$36.40 ","$89.50 ","$90.40 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200215","EAP","CPT� 86664","","Ebv Nuclear Ab","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$206.00 ","$0.00 ","$0.00 ","$7.65 ","$22.34 ","$22.34 ","$22.61 ","$206.00 ","$16.05 ","$42.76 ","$163.15 ","$164.80 ","$22.17 ","$24.09 ","$15.29 ","$16.86 ","$15.29 "
"30200216","EAP","CPT� 86665","","Ebv Capsid Igg Ab","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$9.07 ","$26.48 ","$26.48 ","$26.81 ","$231.00 ","$19.05 ","$50.70 ","$182.95 ","$184.80 ","$26.30 ","$28.56 ","$18.14 ","$19.99 ","$18.14 "
"30200217","EAP","CPT� 86665","","Ebv Capsid Igm Ab","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$9.07 ","$26.48 ","$26.48 ","$26.81 ","$231.00 ","$19.05 ","$50.70 ","$182.95 ","$184.80 ","$26.30 ","$28.56 ","$18.14 ","$19.99 ","$18.14 "
"30200218","EAP","CPT� 86666","","Ehrlichia Igg","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$14.85 ","$14.85 ","$0.00 ","$157.00 ","$0.00 ","$28.44 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200219","EAP","CPT� 86666","","Ehrlichia Igm","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$157.00 ","$0.00 ","$0.00 ","$0.00 ","$14.85 ","$14.85 ","$0.00 ","$157.00 ","$0.00 ","$28.44 ","$124.34 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200220","EAP","CPT� 86668","","Tularemia Antibody","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$15.18 ","$15.18 ","$0.00 ","$72.00 ","$0.00 ","$29.06 ","$57.02 ","$57.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200221","EAP","CPT� 86671","","S.cerevisiae Igg","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$139.00 ","$12.86 ","$34.26 ","$110.09 ","$111.20 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30200222","EAP","CPT� 86671","","S.cerevisiae Iga","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$139.00 ","$12.86 ","$34.26 ","$110.09 ","$111.20 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30200223","EAP","CPT� 86671","","Sporothrix Igg","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$139.00 ","$12.86 ","$34.26 ","$110.09 ","$111.20 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30200224","EAP","CPT� 86671","","Sporothrix Igm","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$139.00 ","$12.86 ","$34.26 ","$110.09 ","$111.20 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30200225","EAP","CPT� 86671","","Sporothrix Iga","BOTH IP/OP","$139.00 ","$102.86 ","$0.00 ","$139.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$139.00 ","$12.86 ","$34.26 ","$110.09 ","$111.20 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30200226","EAP","CPT� 86677","","H. Pylori Igg","BOTH IP/OP","$207.00 ","$153.18 ","$7.58 ","$207.00 ","$29.94 ","$8.43 ","$7.58 ","$21.19 ","$21.19 ","$21.44 ","$207.00 ","$17.69 ","$40.56 ","$163.94 ","$165.60 ","$24.43 ","$22.85 ","$16.85 ","$15.99 ","$16.85 "
"30200227","EAP","CPT� 86677","","H.pylori Iga","BOTH IP/OP","$207.00 ","$153.18 ","$7.58 ","$207.00 ","$29.94 ","$8.43 ","$7.58 ","$21.19 ","$21.19 ","$21.44 ","$207.00 ","$17.69 ","$40.56 ","$163.94 ","$165.60 ","$24.43 ","$22.85 ","$16.85 ","$15.99 ","$16.85 "
"30200228","EAP","CPT� 86677","","H.pylori Igg Ab-eia","BOTH IP/OP","$220.00 ","$162.80 ","$7.58 ","$222.00 ","$29.94 ","$8.43 ","$7.58 ","$21.19 ","$21.19 ","$21.44 ","$222.00 ","$17.69 ","$40.56 ","$175.82 ","$177.60 ","$24.43 ","$22.85 ","$16.85 ","$15.99 ","$16.85 "
"30200229","EAP","CPT� 86682","","Cysticercus Igg","BOTH IP/OP","$127.00 ","$93.98 ","$6.50 ","$128.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$128.00 ","$13.66 ","$36.34 ","$101.38 ","$102.40 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30200230","EAP","CPT� 86682","","Echinococcus Igg","BOTH IP/OP","$127.00 ","$93.98 ","$6.50 ","$128.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$128.00 ","$13.66 ","$36.34 ","$101.38 ","$102.40 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30200231","EAP","CPT� 86682","","Filaria Ab","BOTH IP/OP","$127.00 ","$93.98 ","$6.50 ","$128.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$128.00 ","$13.66 ","$36.34 ","$101.38 ","$102.40 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30200232","EAP","CPT� 86682","","Strongyloides Igg","BOTH IP/OP","$127.00 ","$93.98 ","$6.50 ","$128.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$128.00 ","$13.66 ","$36.34 ","$101.38 ","$102.40 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30200233","EAP","CPT� 86682","","Schistosoma Igg","BOTH IP/OP","$127.00 ","$93.98 ","$6.50 ","$128.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$128.00 ","$13.66 ","$36.34 ","$101.38 ","$102.40 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30200235","EAP","CPT� 86689","","Hiv-ab Western Blot","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$401.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$401.00 ","$0.00 ","$54.10 ","$317.59 ","$320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200236","EAP","CPT� 86692","","Hepatitis Delta Ab","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$8.58 ","$25.06 ","$25.06 ","$25.35 ","$198.00 ","$18.02 ","$47.96 ","$156.82 ","$158.40 ","$24.88 ","$27.01 ","$17.16 ","$18.91 ","$17.16 "
"30200237","EAP","CPT� 86694","","Hsv 1/2 Igm","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$180.00 ","$15.11 ","$32.52 ","$142.56 ","$144.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200238","EAP","CPT� 86694","","Hsv Igm Ab Titer","BOTH IP/OP","$187.00 ","$138.38 ","$0.00 ","$193.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$193.00 ","$15.11 ","$32.52 ","$152.86 ","$154.40 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200239","EAP","CPT� 86694","","Hsv2 Igg/igm Ab,csf","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$180.00 ","$15.11 ","$32.52 ","$142.56 ","$144.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200240","EAP","CPT� 86694","","Hsv-2 Igm Ab,csf","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$180.00 ","$15.11 ","$32.52 ","$142.56 ","$144.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200241","EAP","CPT� 86694","","Hsv Igg","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$180.00 ","$15.11 ","$32.52 ","$142.56 ","$144.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200244","EAP","CPT� 86695","","HSV-I IGG","BOTH IP/OP","$133.00 ","$98.42 ","$6.59 ","$129.00 ","$27.22 ","$6.60 ","$6.59 ","$19.25 ","$19.25 ","$19.49 ","$129.00 ","$13.85 ","$36.86 ","$102.17 ","$103.20 ","$19.13 ","$20.76 ","$13.19 ","$14.54 ","$13.19 "
"30200245","EAP","CPT� 86696","","HSV - II IGG","BOTH IP/OP","$145.00 ","$107.30 ","$9.68 ","$141.00 ","$39.94 ","$9.68 ","$9.68 ","$28.26 ","$28.26 ","$28.60 ","$141.00 ","$20.32 ","$54.10 ","$111.67 ","$112.80 ","$28.06 ","$30.48 ","$19.35 ","$21.33 ","$19.35 "
"30200246","EAP","CPT� 86698","","Histoplasma Ab (s)","BOTH IP/OP","$74.00 ","$54.76 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$6.25 ","$18.25 ","$18.25 ","$18.46 ","$75.00 ","$14.48 ","$34.92 ","$59.40 ","$60.00 ","$20.00 ","$19.67 ","$13.79 ","$13.77 ","$13.79 "
"30200247","EAP","CPT� 86703","","Hiv-1/2","BOTH IP/OP","$255.00 ","$188.70 ","$6.85 ","$267.00 ","$28.30 ","$6.86 ","$6.85 ","$20.02 ","$20.02 ","$17.58 ","$267.00 ","$14.40 ","$38.34 ","$211.46 ","$213.60 ","$19.88 ","$18.73 ","$13.71 ","$13.11 ","$13.71 "
"30200248","EAP","CPT� 86704","","Hbv Core Ab","BOTH IP/OP","$285.00 ","$210.90 ","$6.03 ","$287.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$287.00 ","$12.65 ","$33.68 ","$227.30 ","$229.60 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200249","EAP","CPT� 86705","","Hepatitis-b Core M","BOTH IP/OP","$285.00 ","$210.90 ","$5.89 ","$287.00 ","$24.31 ","$5.89 ","$5.89 ","$17.18 ","$17.18 ","$17.39 ","$287.00 ","$12.36 ","$32.88 ","$227.30 ","$229.60 ","$17.07 ","$18.53 ","$11.77 ","$12.97 ","$11.77 "
"30200250","EAP","CPT� 86706","","Hbv Surface Ab","BOTH IP/OP","$257.00 ","$190.18 ","$5.37 ","$259.00 ","$22.18 ","$5.37 ","$5.37 ","$15.68 ","$15.68 ","$15.87 ","$259.00 ","$11.28 ","$30.02 ","$205.13 ","$207.20 ","$15.57 ","$16.91 ","$10.74 ","$11.83 ","$10.74 "
"30200251","EAP","CPT� 86707","","Hbv E Ab","BOTH IP/OP","$134.00 ","$99.16 ","$5.78 ","$135.00 ","$23.89 ","$5.79 ","$5.78 ","$16.89 ","$16.89 ","$17.08 ","$135.00 ","$12.15 ","$32.32 ","$106.92 ","$108.00 ","$16.78 ","$18.20 ","$11.57 ","$12.74 ","$11.57 "
"30200252","EAP","CPT� 86708","","Hav Ab, Total","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$304.00 ","$0.00 ","$0.00 ","$0.00 ","$18.09 ","$18.09 ","$0.00 ","$304.00 ","$0.00 ","$34.62 ","$240.77 ","$243.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200253","EAP","CPT� 86709","","Hav Igm Ab","BOTH IP/OP","$275.00 ","$203.50 ","$5.63 ","$277.00 ","$23.23 ","$5.63 ","$5.63 ","$16.44 ","$16.44 ","$16.63 ","$277.00 ","$11.82 ","$31.46 ","$219.38 ","$221.60 ","$16.33 ","$17.72 ","$11.26 ","$12.41 ","$11.26 "
"30200254","EAP","CPT� 86713","","L. Pneumoph. Ab - Total","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$147.00 ","$0.00 ","$0.00 ","$0.00 ","$22.35 ","$22.35 ","$0.00 ","$147.00 ","$0.00 ","$42.78 ","$116.42 ","$117.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200255","EAP","CPT� 86720","","Leptospirosis Ab","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$27.22 ","$8.10 ","$7.29 ","$19.25 ","$19.25 ","$0.00 ","$80.00 ","$17.01 ","$36.86 ","$63.36 ","$64.00 ","$23.49 ","$0.00 ","$16.20 ","$14.54 ","$16.20 "
"30200256","EAP","CPT� 86631","","Lgv Antibody Screen","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$193.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$193.00 ","$0.00 ","$33.04 ","$152.86 ","$154.40 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30200257","EAP","CPT� 86738","","Mycoplasma Igg","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$96.00 ","$0.00 ","$0.00 ","$6.62 ","$19.34 ","$19.34 ","$19.57 ","$96.00 ","$13.90 ","$37.02 ","$76.03 ","$76.80 ","$19.20 ","$20.85 ","$13.24 ","$14.60 ","$13.24 "
"30200258","EAP","CPT� 86738","","Mycoplasma Igm","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$96.00 ","$0.00 ","$0.00 ","$6.62 ","$19.34 ","$19.34 ","$19.57 ","$96.00 ","$13.90 ","$37.02 ","$76.03 ","$76.80 ","$19.20 ","$20.85 ","$13.24 ","$14.60 ","$13.24 "
"30200259","EAP","CPT� 86747","","Parvovirus Igg","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$21.95 ","$22.21 ","$125.00 ","$15.78 ","$42.00 ","$99.00 ","$100.00 ","$21.79 ","$0.00 ","$15.03 ","$16.56 ","$15.03 "
"30200260","EAP","CPT� 86747","","Parvovirus Igm","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$21.95 ","$22.21 ","$125.00 ","$15.78 ","$42.00 ","$99.00 ","$100.00 ","$21.79 ","$0.00 ","$15.03 ","$16.56 ","$15.03 "
"30200261","EAP","CPT� 86753","","Ent. Histolytica Ab","BOTH IP/OP","$96.00 ","$71.04 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$0.00 ","$18.09 ","$18.09 ","$0.00 ","$97.00 ","$0.00 ","$34.64 ","$76.82 ","$77.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200262","EAP","CPT� 86762","","Rubella Immune Scrn","BOTH IP/OP","$230.00 ","$170.20 ","$7.20 ","$232.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$232.00 ","$15.11 ","$32.52 ","$183.74 ","$185.60 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200263","EAP","CPT� 86762","","Rubella Igg","BOTH IP/OP","$216.00 ","$159.84 ","$7.20 ","$218.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$218.00 ","$15.11 ","$32.52 ","$172.66 ","$174.40 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200264","EAP","CPT� 86762","","Rubella Igm","BOTH IP/OP","$216.00 ","$159.84 ","$7.20 ","$218.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$218.00 ","$15.11 ","$32.52 ","$172.66 ","$174.40 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200265","EAP","CPT� 86765","","Rubeola (measles) Igm","BOTH IP/OP","$130.00 ","$96.20 ","$6.44 ","$131.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$131.00 ","$13.52 ","$36.00 ","$103.75 ","$104.80 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30200266","EAP","CPT� 86765","","Rubeola (measles) Igg","BOTH IP/OP","$130.00 ","$96.20 ","$6.44 ","$131.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$131.00 ","$13.52 ","$36.00 ","$103.75 ","$104.80 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30200267","EAP","CPT� 86777","","Toxoplasma Igg","BOTH IP/OP","$248.00 ","$183.52 ","$7.20 ","$251.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$251.00 ","$15.11 ","$32.52 ","$198.79 ","$200.80 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200268","EAP","CPT� 86777","","Toxo Ab-igg,csf","BOTH IP/OP","$248.00 ","$183.52 ","$7.20 ","$251.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$251.00 ","$15.11 ","$32.52 ","$198.79 ","$200.80 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200269","EAP","CPT� 86777","","Toxo Igg Ab-eia","BOTH IP/OP","$216.00 ","$159.84 ","$7.20 ","$270.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$270.00 ","$15.11 ","$32.52 ","$213.84 ","$216.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200270","EAP","CPT� 86778","","Toxoplasma Igm","BOTH IP/OP","$133.00 ","$98.42 ","$7.20 ","$134.00 ","$29.73 ","$7.21 ","$7.20 ","$21.03 ","$21.03 ","$21.27 ","$134.00 ","$15.13 ","$40.24 ","$106.13 ","$107.20 ","$20.89 ","$22.67 ","$14.41 ","$15.87 ","$14.41 "
"30200271","EAP","CPT� 86778","","Toxo Ab-igm,csf","BOTH IP/OP","$133.00 ","$98.42 ","$7.20 ","$134.00 ","$29.73 ","$7.21 ","$7.20 ","$21.03 ","$21.03 ","$21.27 ","$134.00 ","$15.13 ","$40.24 ","$106.13 ","$107.20 ","$20.89 ","$22.67 ","$14.41 ","$15.87 ","$14.41 "
"30200272","EAP","CPT� 86780","","Treponemal Igg, Csf","BOTH IP/OP","$215.00 ","$159.10 ","$6.62 ","$196.00 ","$27.32 ","$6.62 ","$6.62 ","$18.97 ","$18.97 ","$34.32 ","$196.00 ","$13.90 ","$98.00 ","$155.23 ","$156.80 ","$19.20 ","$30.67 ","$13.24 ","$31.20 ","$13.24 "
"30200273","EAP","CPT� 86780","","Treponemal-igg-eia","BOTH IP/OP","$215.00 ","$159.10 ","$6.62 ","$196.00 ","$27.32 ","$6.62 ","$6.62 ","$18.97 ","$18.97 ","$34.32 ","$196.00 ","$13.90 ","$98.00 ","$155.23 ","$156.80 ","$19.20 ","$30.67 ","$13.24 ","$31.20 ","$13.24 "
"30200274","EAP","CPT� 86780","","Treponemal -igm-eia","BOTH IP/OP","$158.00 ","$116.92 ","$6.62 ","$181.00 ","$27.32 ","$6.62 ","$6.62 ","$18.97 ","$18.97 ","$31.69 ","$181.00 ","$13.90 ","$90.50 ","$143.35 ","$144.80 ","$19.20 ","$28.33 ","$13.24 ","$28.82 ","$13.24 "
"30200275","EAP","CPT� 86787","","Varicella Zoster Igm","BOTH IP/OP","$237.00 ","$175.38 ","$6.44 ","$239.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$239.00 ","$13.52 ","$36.00 ","$189.29 ","$191.20 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30200276","EAP","CPT� 86787","","Varicella Zoster","BOTH IP/OP","$254.00 ","$187.96 ","$6.44 ","$257.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$257.00 ","$13.52 ","$36.00 ","$203.54 ","$205.60 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30200277","EAP","CPT� 86788","","W. Nile Ab, Igm","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$0.00 ","$0.00 ","$8.42 ","$24.60 ","$24.60 ","$0.00 ","$352.00 ","$0.00 ","$47.08 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200278","EAP","CPT� 86788","","W. Nile Ab, Igm, Csf","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$0.00 ","$0.00 ","$8.42 ","$24.60 ","$24.60 ","$0.00 ","$352.00 ","$0.00 ","$47.08 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200279","EAP","CPT� 86789","","W. Nile Ab, Igg","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$0.00 ","$352.00 ","$0.00 ","$32.52 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200280","EAP","CPT� 86789","","W. Nile Ab, Igg, Csf","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$0.00 ","$352.00 ","$0.00 ","$32.52 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200281","EAP","CPT� 86790","","Htlv I/ii Ab","BOTH IP/OP","$328.00 ","$242.72 ","$6.44 ","$300.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$300.00 ","$13.52 ","$36.00 ","$237.60 ","$240.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30200282","EAP","CPT� 86800","","Thyroglob Ab, Quant","BOTH IP/OP","$336.00 ","$248.64 ","$7.95 ","$337.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$337.00 ","$16.71 ","$44.44 ","$266.90 ","$269.60 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30200283","EAP","CPT� 86800","","Thyroglobulin Ab","BOTH IP/OP","$359.00 ","$265.66 ","$7.95 ","$359.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$359.00 ","$16.71 ","$44.44 ","$284.33 ","$287.20 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30200284","EAP","CPT� 86803","","Hcv Ab (2nd Gen)","BOTH IP/OP","$343.00 ","$253.82 ","$7.13 ","$346.00 ","$29.44 ","$7.14 ","$7.13 ","$20.84 ","$20.84 ","$11.75 ","$346.00 ","$14.98 ","$39.88 ","$274.03 ","$276.80 ","$20.69 ","$12.52 ","$14.27 ","$8.76 ","$14.27 "
"30200285","EAP","CPT� 86812","","Hla-b27","BOTH IP/OP","$582.00 ","$430.68 ","$12.90 ","$588.00 ","$53.28 ","$12.91 ","$12.90 ","$37.68 ","$37.68 ","$38.13 ","$588.00 ","$27.10 ","$72.12 ","$465.70 ","$470.40 ","$37.42 ","$40.62 ","$25.81 ","$28.44 ","$25.81 "
"30200286","EAP","CPT� 86922","","Charge: Xmatch, Coombs","BOTH IP/OP","$187.00 ","$138.38 ","$0.00 ","$204.00 ","$55.68 ","$146.06 ","$38.98 ","$23.93 ","$23.93 ","$35.72 ","$204.00 ","$143.92 ","$56.24 ","$161.57 ","$163.20 ","$199.96 ","$31.93 ","$0.00 ","$32.48 ","$137.07 "
"30200287","EAP","CPT� 86922","","Charge: Xmatch, Coombs","BOTH IP/OP","$187.00 ","$138.38 ","$0.00 ","$204.00 ","$55.68 ","$146.06 ","$38.98 ","$23.93 ","$23.93 ","$35.72 ","$204.00 ","$143.92 ","$56.24 ","$161.57 ","$163.20 ","$199.96 ","$31.93 ","$0.00 ","$32.48 ","$137.07 "
"30200289","EAP","CPT� 86359","","Lymph Subset T Cel Tot (so)","BOTH IP/OP","$210.00 ","$155.40 ","$18.86 ","$218.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$218.00 ","$39.62 ","$65.82 ","$172.66 ","$174.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200292","EAP","CPT� 86360","","Lymph Subset Abs Ct Ratio (so)","BOTH IP/OP","$310.00 ","$229.40 ","$23.49 ","$322.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$322.00 ","$49.33 ","$131.30 ","$255.02 ","$257.60 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30200310","EAP","CPT� 86256","","Smooth Muscle Ab Titer","BOTH IP/OP","$70.00 ","$51.80 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200315","EAP","CPT� 85027","","Cbc & Plat","BOTH IP/OP","$202.00 ","$149.48 ","$3.23 ","$184.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$9.57 ","$184.00 ","$6.79 ","$18.08 ","$145.73 ","$147.20 ","$9.38 ","$10.19 ","$6.47 ","$7.13 ","$6.47 "
"30200330","EAP","CPT� 86355","","Lymphocyte Sub 6  B Cells (so)","BOTH IP/OP","$217.00 ","$160.58 ","$0.00 ","$226.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$226.00 ","$39.62 ","$65.82 ","$178.99 ","$180.80 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200331","EAP","CPT� 86357","","Lymphocyte Sub 6 Nk Total (so)","BOTH IP/OP","$211.00 ","$156.14 ","$0.00 ","$219.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$219.00 ","$39.62 ","$65.82 ","$173.45 ","$175.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200332","EAP","CPT� 86359","","Lymphocyte Sub 6 T Cell Total (so)","BOTH IP/OP","$220.00 ","$162.80 ","$18.86 ","$229.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$229.00 ","$39.62 ","$65.82 ","$181.37 ","$183.20 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30200333","EAP","CPT� 86360","","Lymphocyte Sub 6 T Cells Abs(so)","BOTH IP/OP","$312.00 ","$230.88 ","$23.49 ","$324.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$324.00 ","$49.33 ","$131.30 ","$256.61 ","$259.20 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30200334","EAP","CPT� 86356","","Lymphocyte Sub 6 Ag (so)","BOTH IP/OP","$190.00 ","$140.60 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$38.11 ","$38.11 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200335","EAP","CPT� 86021","","Neutraphil Ab Id (so)","BOTH IP/OP","$244.00 ","$180.56 ","$7.53 ","$244.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$244.00 ","$15.80 ","$42.06 ","$193.25 ","$195.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200336","EAP","CPT� 86828","","Neutraphil Ab Id Hla I&ii (so)","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$591.00 ","$0.00 ","$0.00 ","$0.00 ","$55.25 ","$55.25 ","$0.00 ","$591.00 ","$0.00 ","$295.50 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200337","EAP","CPT� 86658","","Echovirus Ab Csf (so)","BOTH IP/OP","$183.00 ","$135.42 ","$6.51 ","$185.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$185.00 ","$13.68 ","$36.40 ","$146.52 ","$148.00 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30200338","EAP","CPT� 83519","","Enceph Auto Eval Csf Ria (so)","BOTH IP/OP","$434.00 ","$321.16 ","$8.28 ","$422.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$422.00 ","$19.32 ","$37.76 ","$334.22 ","$337.60 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30200339","EAP","CPT� 86255","","Enceph Ab Screen Csf (so)","BOTH IP/OP","$240.00 ","$177.60 ","$6.03 ","$240.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$240.00 ","$12.65 ","$33.68 ","$190.08 ","$192.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200340","EAP","CPT� 86341","","Enceph Islet Cell Ab Csf (so)","BOTH IP/OP","$196.00 ","$145.04 ","$10.61 ","$194.00 ","$40.84 ","$11.79 ","$10.61 ","$28.89 ","$28.89 ","$29.24 ","$194.00 ","$24.75 ","$55.30 ","$153.65 ","$155.20 ","$34.18 ","$31.16 ","$23.57 ","$21.81 ","$23.57 "
"30200341","EAP","CPT� 86606","","Aspergillus Ab (so)","BOTH IP/OP","$120.00 ","$88.80 ","$7.53 ","$120.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$120.00 ","$15.80 ","$42.06 ","$95.04 ","$96.00 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200342","EAP","CPT� 86612","","Blastomyces Ab (so)","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$18.84 ","$18.84 ","$0.00 ","$150.00 ","$0.00 ","$36.06 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200343","EAP","CPT� 86305","","Human Epididymis Prot 4 (so)","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$29.81 ","$29.81 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200344","EAP","CPT� 86635","","Coccidioides Ab (so)","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$16.75 ","$16.75 ","$0.00 ","$164.00 ","$0.00 ","$32.06 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200345","EAP","CPT� 86698","","Histoplasma Ab (so)","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$116.00 ","$0.00 ","$0.00 ","$6.25 ","$18.25 ","$18.25 ","$18.46 ","$116.00 ","$14.48 ","$34.92 ","$91.87 ","$92.80 ","$20.00 ","$19.67 ","$13.79 ","$13.77 ","$13.79 "
"30200346","EAP","CPT� 87449","","Fungitell Csf (so)","BOTH IP/OP","$182.00 ","$134.68 ","$0.00 ","$182.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$182.00 ","$0.00 ","$33.52 ","$144.14 ","$145.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200347","EAP","CPT� 86790","","Chikungunya Ab (so)","BOTH IP/OP","$188.00 ","$139.12 ","$6.44 ","$172.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$172.00 ","$13.52 ","$36.00 ","$136.22 ","$137.60 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30200349","EAP","CPT� 86580","","Tb Skin Test","BOTH IP/OP","$75.00 ","$55.50 ","$3.89 ","$90.00 ","$12.43 ","$24.19 ","$3.89 ","$7.19 ","$7.19 ","$9.56 ","$90.00 ","$23.06 ","$20.46 ","$71.28 ","$72.00 ","$32.04 ","$10.18 ","$9.36 ","$7.13 ","$21.96 "
"30200350","EAP","CPT� 86580","","Step 2 Ppd #1","BOTH IP/OP","$62.00 ","$45.88 ","$3.89 ","$75.00 ","$12.43 ","$24.19 ","$3.89 ","$7.19 ","$7.19 ","$9.56 ","$75.00 ","$23.06 ","$20.46 ","$59.40 ","$60.00 ","$32.04 ","$10.18 ","$9.36 ","$7.13 ","$21.96 "
"30200370","EAP","CPT� 86701","","Focus Hiv-1 Confirmation","BOTH IP/OP","$197.00 ","$145.78 ","$4.44 ","$198.00 ","$18.35 ","$4.45 ","$4.44 ","$12.96 ","$12.96 ","$11.39 ","$198.00 ","$9.33 ","$24.82 ","$156.82 ","$158.40 ","$12.89 ","$12.14 ","$8.89 ","$8.50 ","$8.89 "
"30200371","EAP","CPT� 86702","","Focus Hiv-2 Confirmation","BOTH IP/OP","$238.00 ","$176.12 ","$6.76 ","$240.00 ","$27.90 ","$6.76 ","$6.76 ","$19.74 ","$19.74 ","$17.33 ","$240.00 ","$14.20 ","$37.76 ","$190.08 ","$192.00 ","$19.60 ","$18.46 ","$13.52 ","$12.92 ","$13.52 "
"30200372","EAP","CPT� 83516","","Aquaporin 4 Recep Ab (so)","BOTH IP/OP","$259.00 ","$191.66 ","$5.76 ","$292.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$292.00 ","$12.11 ","$29.88 ","$231.26 ","$233.60 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30200373","EAP","CPT� 86003","","Abpa Allergen Spec Ige (so)","BOTH IP/OP","$110.00 ","$81.40 ","$2.61 ","$137.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$137.00 ","$5.48 ","$14.60 ","$108.50 ","$109.60 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200374","EAP","CPT� 86606","","Aspergillus Ab (so)","BOTH IP/OP","$113.00 ","$83.62 ","$7.53 ","$113.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$113.00 ","$15.80 ","$42.06 ","$89.50 ","$90.40 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200375","EAP","CPT� 86161","","C3 Nephritic Factor (so)","BOTH IP/OP","$231.00 ","$170.94 ","$6.00 ","$266.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$266.00 ","$12.60 ","$33.56 ","$210.67 ","$212.80 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30200376","EAP","CPT� 86406","","Toxo Titr Pregnancy (so)","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$5.32 ","$15.53 ","$15.53 ","$15.72 ","$152.00 ","$11.17 ","$29.74 ","$120.38 ","$121.60 ","$15.43 ","$16.75 ","$10.64 ","$11.72 ","$10.64 "
"30200377","EAP","CPT� 86777","","Toxoplasma Ab (so)","BOTH IP/OP","$152.00 ","$112.48 ","$7.20 ","$190.00 ","$24.02 ","$7.20 ","$7.20 ","$16.99 ","$16.99 ","$17.19 ","$190.00 ","$15.11 ","$32.52 ","$150.48 ","$152.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30200378","EAP","CPT� 86778","","Toxoplasma Ab Igm (so)","BOTH IP/OP","$155.00 ","$114.70 ","$7.20 ","$194.00 ","$29.73 ","$7.21 ","$7.20 ","$21.03 ","$21.03 ","$21.27 ","$194.00 ","$15.13 ","$40.24 ","$153.65 ","$155.20 ","$20.89 ","$22.67 ","$14.41 ","$15.87 ","$14.41 "
"30200379","EAP","CPT� 86038","","Ana Ifa With Reflex (so)","BOTH IP/OP","$201.00 ","$148.74 ","$6.04 ","$201.00 ","$24.95 ","$6.05 ","$6.04 ","$17.65 ","$17.65 ","$17.86 ","$201.00 ","$12.69 ","$33.78 ","$159.19 ","$160.80 ","$17.53 ","$19.03 ","$12.09 ","$13.32 ","$12.09 "
"30200380","EAP","CPT� 86021","","Wbc Ab Id (neutrophil) (so)","BOTH IP/OP","$236.00 ","$174.64 ","$7.53 ","$236.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$236.00 ","$15.80 ","$42.06 ","$186.91 ","$188.80 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200381","EAP","CPT� 86828","","Hla I & Ii Ab Qual (so)","BOTH IP/OP","$593.00 ","$438.82 ","$0.00 ","$593.00 ","$0.00 ","$0.00 ","$0.00 ","$55.25 ","$55.25 ","$0.00 ","$593.00 ","$0.00 ","$296.50 ","$469.66 ","$474.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200382","EAP","CPT� 86255","","Ampa Recept Fluor Ab Screen (so)","BOTH IP/OP","$429.00 ","$317.46 ","$6.03 ","$536.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$536.00 ","$12.65 ","$33.68 ","$424.51 ","$428.80 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200383","EAP","CPT� 86833","","Hla Ii Post Trans Dsa (so)","BOTH IP/OP","$326.00 ","$241.24 ","$0.00 ","$326.00 ","$0.00 ","$0.00 ","$0.00 ","$160.93 ","$160.93 ","$0.00 ","$326.00 ","$0.00 ","$163.00 ","$258.19 ","$260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200384","EAP","CPT� 86832","","Hla I Post Trans Dsa (so)","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$177.16 ","$177.16 ","$0.00 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200385","EAP","CPT� 86829","","Hla I/ii Post Trans Dsa (so)","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$41.44 ","$41.44 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200386","EAP","CPT� 86671","","Crohns Prognostic Fung Ab (so)","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$145.00 ","$12.86 ","$34.26 ","$114.84 ","$116.00 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30200387","EAP","CPT� 83516","","Crohns Prognostic Nonab (so)","BOTH IP/OP","$244.00 ","$180.56 ","$5.76 ","$275.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$275.00 ","$12.11 ","$29.88 ","$217.80 ","$220.00 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30200388","EAP","CPT� 83519","","Paraneo Autoab Eval Ria(so)","BOTH IP/OP","$124.00 ","$91.76 ","$8.28 ","$121.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$121.00 ","$19.32 ","$37.76 ","$95.83 ","$96.80 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30200389","EAP","CPT� 86256","","Paraneo Autoab Titer Ria(so)","BOTH IP/OP","$80.00 ","$59.20 ","$6.03 ","$80.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$80.00 ","$12.65 ","$33.68 ","$63.36 ","$64.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200390","EAP","CPT� 86255","","Nmda Recep Ab Serum","BOTH IP/OP","$184.00 ","$136.16 ","$6.03 ","$230.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$230.00 ","$12.65 ","$33.68 ","$182.16 ","$184.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200400","EAP","CPT� 82963","","Beta Glucosidase So","BOTH IP/OP","$1,282.00 ","$948.68 ","$0.00 ","$1,168.00 ","$0.00 ","$0.00 ","$0.00 ","$31.37 ","$31.37 ","$0.00 ","$1,168.00 ","$0.00 ","$60.02 ","$925.06 ","$934.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200401","EAP","CPT� 87389","","Hiv 1/2 Ag/ab 4th Generation So","BOTH IP/OP","$104.00 ","$76.96 ","$12.04 ","$101.00 ","$49.71 ","$12.04 ","$12.04 ","$34.12 ","$34.12 ","$32.07 ","$101.00 ","$25.28 ","$50.50 ","$79.99 ","$80.80 ","$34.92 ","$34.17 ","$24.08 ","$23.92 ","$24.08 "
"30200449","EAP","CPT� 86580","","Tb Skin Test","BOTH IP/OP","$75.00 ","$55.50 ","$3.89 ","$90.00 ","$12.43 ","$24.19 ","$3.89 ","$7.19 ","$7.19 ","$9.56 ","$90.00 ","$23.06 ","$20.46 ","$71.28 ","$72.00 ","$32.04 ","$10.18 ","$9.36 ","$7.13 ","$21.96 "
"30200450","EAP","CPT� 86021","","Proteinase-3 Antibody","BOTH IP/OP","$206.00 ","$152.44 ","$7.53 ","$206.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$206.00 ","$15.80 ","$42.06 ","$163.15 ","$164.80 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200451","EAP","CPT� 86021","","Myeloperoxidase Antibody","BOTH IP/OP","$200.00 ","$148.00 ","$7.53 ","$184.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$184.00 ","$15.80 ","$42.06 ","$145.73 ","$147.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200452","EAP","CPT� 86022","","Platelet Igg Ab,indirect","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$301.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$301.00 ","$0.00 ","$51.32 ","$238.39 ","$240.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200453","EAP","CPT� 86023","","Platelet Glycoprot. Ab","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$18.19 ","$18.19 ","$0.00 ","$438.00 ","$0.00 ","$34.80 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200454","EAP","CPT� 86200","","Cyclic Citurullinate Antibody","BOTH IP/OP","$387.00 ","$286.38 ","$6.48 ","$391.00 ","$26.72 ","$6.48 ","$6.48 ","$18.91 ","$18.91 ","$19.12 ","$391.00 ","$13.60 ","$36.18 ","$309.67 ","$312.80 ","$18.78 ","$20.37 ","$12.95 ","$14.26 ","$12.95 "
"30200455","EAP","CPT� 86256","","Parietal Antibody Titer","BOTH IP/OP","$88.00 ","$65.12 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30200480","EAP","CPT� 83789","","Tpmt Activity","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$690.00 ","$0.00 ","$16.78 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200481","EAP","CPT� 86689","","Htlv Ab. Western Blot","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$290.00 ","$0.00 ","$54.10 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200491","EAP","CPT� 86316","","Immunoassay, Tumor Antigen, Quant","BOTH IP/OP","$315.00 ","$233.10 ","$10.41 ","$315.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$315.00 ","$21.85 ","$58.14 ","$249.48 ","$252.00 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200492","EAP","CPT� 86651","","Encephal Antibody Calif","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$36.00 ","$0.00 ","$36.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200493","EAP","CPT� 86652","","Encephal Antibody East Equ","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$36.00 ","$0.00 ","$36.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200494","EAP","CPT� 86653","","Encephal Antibody St Louis","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$36.00 ","$0.00 ","$36.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200495","EAP","CPT� 86654","","Encephal Antibody West Equ","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$36.00 ","$0.00 ","$36.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200496","EAP","CPT� 88360","","Tumor Immunohistochem/manual","BOTH IP/OP","$1,842.00 ","$1,363.08 ","$58.38 ","$1,842.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$1,842.00 ","$143.92 ","$121.34 ","$1,458.86 ","$1,473.60 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30200498","EAP","CPT� 82787","","Igg1, 2, 3 Or 4, Each","BOTH IP/OP","$84.00 ","$62.16 ","$4.01 ","$84.00 ","$16.55 ","$4.01 ","$4.01 ","$11.71 ","$11.71 ","$11.84 ","$84.00 ","$8.42 ","$22.40 ","$66.53 ","$67.20 ","$11.63 ","$12.62 ","$8.02 ","$8.83 ","$8.02 "
"30200499","EAP","CPT� 86343","","Leukocyte Histamine Release","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$25.71 ","$6.23 ","$6.23 ","$18.20 ","$18.20 ","$0.00 ","$418.00 ","$0.00 ","$34.82 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200500","EAP","CPT� 86580","","Tb Intradermal Test","BOTH IP/OP","$106.00 ","$78.44 ","$3.89 ","$128.00 ","$12.43 ","$24.19 ","$3.89 ","$7.19 ","$7.19 ","$9.56 ","$128.00 ","$23.06 ","$20.46 ","$101.38 ","$102.40 ","$32.04 ","$10.18 ","$9.36 ","$7.13 ","$21.96 "
"30200501","EAP","CPT� 83789","","Mass Spectrometry Quant,nonspec","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$126.00 ","$0.00 ","$16.78 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200503","EAP","CPT� 88189","","Flowcytometry/read, 16 & > Markers","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$248.00 ","$0.00 ","$0.00 ","$0.00 ","$177.00 ","$177.00 ","$115.43 ","$248.00 ","$93.43 ","$210.82 ","$196.42 ","$198.40 ","$88.72 ","$122.99 ","$88.72 ","$86.09 ","$88.72 "
"30200504","EAP","CPT� 88188","","Flowcytometry/read, 9-15 Markers","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$198.41 ","$198.41 ","$0.00 ","$278.00 ","$0.00 ","$161.74 ","$220.18 ","$222.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200505","EAP","CPT� 88187","","Flowcytometry/read, 2-8 Markers","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$128.47 ","$128.47 ","$70.22 ","$180.00 ","$50.66 ","$130.50 ","$142.56 ","$144.00 ","$39.31 ","$74.83 ","$39.31 ","$52.38 ","$39.31 "
"30200506","EAP","CPT� 88368","","Insitu Hybridization, Manual","BOTH IP/OP","$1,076.00 ","$796.24 ","$58.22 ","$1,076.00 ","$178.36 ","$285.22 ","$58.22 ","$145.54 ","$145.54 ","$199.20 ","$1,076.00 ","$284.24 ","$207.74 ","$852.19 ","$860.80 ","$394.92 ","$212.25 ","$90.40 ","$148.57 ","$270.71 "
"30200507","EAP","CPT� 86480","","Tb Test,cell Immun Meas By Gamma Interfron","BOTH IP/OP","$572.00 ","$423.28 ","$30.99 ","$690.00 ","$127.93 ","$30.99 ","$30.99 ","$90.49 ","$90.49 ","$91.55 ","$690.00 ","$65.08 ","$173.18 ","$546.48 ","$552.00 ","$89.87 ","$97.55 ","$61.98 ","$68.28 ","$61.98 "
"30200508","EAP","CPT� 87799","","Jc Virus Pcr, Urine (q)","BOTH IP/OP","$743.00 ","$549.82 ","$0.00 ","$849.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$849.00 ","$0.00 ","$119.70 ","$672.41 ","$679.20 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$0.00 "
"30200509","EAP","CPT� 87799","","Bk Virus Pcr, Urine (q)","BOTH IP/OP","$635.00 ","$469.90 ","$0.00 ","$726.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$726.00 ","$0.00 ","$119.70 ","$574.99 ","$580.80 ","$0.00 ","$113.62 ","$0.00 ","$0.00 ","$0.00 "
"30200510","EAP","CPT� 83519","","Thyrotrpn Bndng Inhib Ab (q)","BOTH IP/OP","$225.00 ","$166.50 ","$8.28 ","$254.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$254.00 ","$19.32 ","$37.76 ","$201.17 ","$203.20 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30200511","EAP","CPT� 83520","","Prothrombin Fragment (e)","BOTH IP/OP","$232.00 ","$171.68 ","$7.77 ","$226.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$226.00 ","$18.13 ","$36.18 ","$178.99 ","$180.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30200512","EAP","CPT� 87912","","Heptis B Resist, Geno (q)","BOTH IP/OP","$606.00 ","$448.44 ","$0.00 ","$606.00 ","$180.02 ","$128.73 ","$128.72 ","$359.15 ","$359.15 ","$0.00 ","$606.00 ","$0.00 ","$303.00 ","$479.95 ","$484.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200600","EAP","CPT� 88184","","Flowcytometry/ Tc 1 Marker","BOTH IP/OP","$300.00 ","$222.00 ","$30.49 ","$300.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$300.00 ","$284.24 ","$133.74 ","$237.60 ","$240.00 ","$300.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30200601","EAP","CPT� 88185","","Flowcytometry/tc Add-on","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$47.05 ","$28.00 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$28.00 ","$0.00 ","$28.00 ","$22.18 ","$22.40 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30200602","EAP","CPT� 86813","","Hla Typing A B Or C","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$413.00 ","$0.00 ","$0.00 ","$0.00 ","$84.66 ","$84.66 ","$0.00 ","$413.00 ","$0.00 ","$162.04 ","$327.10 ","$330.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200603","EAP","CPT� 87252","","Virus Inoculation Tissue - Acyclovir","BOTH IP/OP","$496.00 ","$367.04 ","$13.04 ","$496.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$496.00 ","$27.37 ","$61.78 ","$392.83 ","$396.80 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30200604","EAP","CPT� 87253","","Virus Inoculate Tissue Addl - Acyclovir","BOTH IP/OP","$471.00 ","$348.54 ","$0.00 ","$471.00 ","$0.00 ","$0.00 ","$0.00 ","$23.78 ","$23.78 ","$0.00 ","$471.00 ","$0.00 ","$45.52 ","$373.03 ","$376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200605","EAP","CPT� 85246","","Blood Clot Factor Viii Test","BOTH IP/OP","$106.00 ","$78.44 ","$11.47 ","$106.00 ","$47.36 ","$11.47 ","$11.47 ","$33.51 ","$33.51 ","$33.89 ","$106.00 ","$24.09 ","$64.12 ","$83.95 ","$84.80 ","$33.26 ","$36.11 ","$22.94 ","$25.28 ","$22.94 "
"30200606","EAP","CPT� 83033","","Fetal Hemoglobin Assay Qual","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$8.70 ","$8.70 ","$0.00 ","$95.00 ","$0.00 ","$16.66 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200629","EAP","CPT� 80347","","Assay Of Benzodiazepines","BOTH IP/OP","$562.00 ","$415.88 ","$0.00 ","$562.00 ","$0.00 ","$0.00 ","$0.00 ","$401.10 ","$401.10 ","$0.00 ","$562.00 ","$0.00 ","$281.00 ","$445.10 ","$449.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200630","EAP","CPT� 88237","","Tissue Culture Bone Marrow","BOTH IP/OP","$507.00 ","$375.18 ","$64.69 ","$562.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$562.00 ","$150.94 ","$246.70 ","$445.10 ","$449.60 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30200631","EAP","CPT� 88264","","Chromosome Analysis 20-25","BOTH IP/OP","$624.00 ","$461.76 ","$65.07 ","$691.00 ","$257.29 ","$72.31 ","$65.07 ","$181.98 ","$181.98 ","$184.12 ","$691.00 ","$151.84 ","$348.28 ","$547.27 ","$552.80 ","$209.68 ","$196.18 ","$144.61 ","$137.33 ","$144.61 "
"30200633","EAP","CPT� 88237","","Tissue Culture Bone Marrow","BOTH IP/OP","$237.00 ","$175.38 ","$64.69 ","$263.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$263.00 ","$150.94 ","$246.70 ","$208.30 ","$210.40 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30200634","EAP","CPT� 88262","","Chromosome Analysis 15-20","BOTH IP/OP","$199.00 ","$147.26 ","$62.32 ","$220.00 ","$199.00 ","$62.75 ","$62.32 ","$181.98 ","$181.98 ","$184.12 ","$220.00 ","$131.76 ","$220.00 ","$174.24 ","$176.00 ","$181.96 ","$196.18 ","$125.49 ","$137.33 ","$125.49 "
"30200636","EAP","CPT� 86343","","Leukocyte Histamine Release","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$25.71 ","$6.23 ","$6.23 ","$18.20 ","$18.20 ","$0.00 ","$52.00 ","$0.00 ","$34.82 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200637","EAP","CPT� 83088","","Assay Of Histamine","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$43.12 ","$43.12 ","$0.00 ","$50.00 ","$0.00 ","$50.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200638","EAP","CPT� 86021","","Wbc Antibody Identification","BOTH IP/OP","$31.00 ","$22.94 ","$7.53 ","$31.00 ","$31.00 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$31.00 ","$15.80 ","$31.00 ","$24.55 ","$24.80 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200639","EAP","CPT� 86376","","Microsomal Antibody","BOTH IP/OP","$29.00 ","$21.46 ","$7.28 ","$29.00 ","$29.00 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$29.00 ","$15.28 ","$29.00 ","$22.97 ","$23.20 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30200640","EAP","CPT� 84443","","Assay Thyroid Stim Hormone","BOTH IP/OP","$42.00 ","$31.08 ","$8.40 ","$42.00 ","$34.69 ","$8.40 ","$8.40 ","$24.53 ","$24.53 ","$24.81 ","$42.00 ","$17.64 ","$42.00 ","$33.26 ","$33.60 ","$24.36 ","$26.44 ","$16.80 ","$18.51 ","$16.80 "
"30200641","EAP","CPT� 86800","","Thyroglobulin Antibody","BOTH IP/OP","$75.00 ","$55.50 ","$7.95 ","$75.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$75.00 ","$16.71 ","$44.44 ","$59.40 ","$60.00 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30200649","EAP","CPT� 88321","","Microslide Consultation","BOTH IP/OP","$364.00 ","$269.36 ","$0.00 ","$364.00 ","$0.00 ","$0.00 ","$0.00 ","$79.11 ","$79.11 ","$0.00 ","$364.00 ","$0.00 ","$180.64 ","$288.29 ","$291.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200650","EAP","CPT� 86343","","Leukocyte Histamine Release","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$25.71 ","$6.23 ","$6.23 ","$18.20 ","$18.20 ","$0.00 ","$48.00 ","$0.00 ","$34.82 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200651","EAP","CPT� 83088","","Assay Of Histamine","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$43.12 ","$43.12 ","$0.00 ","$49.00 ","$0.00 ","$49.00 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200652","EAP","CPT� 86021","","Wbc Antibody Identification","BOTH IP/OP","$29.00 ","$21.46 ","$7.53 ","$29.00 ","$29.00 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$29.00 ","$15.80 ","$29.00 ","$22.97 ","$23.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30200653","EAP","CPT� 86376","","Microsomal Antibody","BOTH IP/OP","$27.00 ","$19.98 ","$7.28 ","$27.00 ","$27.00 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$27.00 ","$15.28 ","$27.00 ","$21.38 ","$21.60 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30200654","EAP","CPT� 84443","","Assay Thyroid Stim Hormone","BOTH IP/OP","$39.00 ","$28.86 ","$8.40 ","$39.00 ","$34.69 ","$8.40 ","$8.40 ","$24.53 ","$24.53 ","$24.81 ","$39.00 ","$17.64 ","$39.00 ","$30.89 ","$31.20 ","$24.36 ","$26.44 ","$16.80 ","$18.51 ","$16.80 "
"30200655","EAP","CPT� 86800","","Thyroglobulin Antibody","BOTH IP/OP","$69.00 ","$51.06 ","$7.95 ","$69.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$69.00 ","$16.71 ","$44.44 ","$54.65 ","$55.20 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30200656","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$77.00 ","$56.98 ","$10.71 ","$77.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$77.00 ","$22.49 ","$59.86 ","$60.98 ","$61.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200657","EAP","CPT� 88273","","Cytogenetics 10-30","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$46.91 ","$46.91 ","$0.00 ","$107.00 ","$0.00 ","$89.78 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200660","EAP","CPT� 88182","","Cell Marker Study","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$66.30 ","$66.30 ","$0.00 ","$93.00 ","$0.00 ","$93.00 ","$73.66 ","$74.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200661","EAP","CPT� 86817","","Hla Typing Dr/dq","BOTH IP/OP","$743.00 ","$549.82 ","$0.00 ","$743.00 ","$0.00 ","$0.00 ","$0.00 ","$94.00 ","$94.00 ","$0.00 ","$743.00 ","$0.00 ","$179.90 ","$588.46 ","$594.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200671","EAP","CPT� 88360","","Tumor Immunohistochem/manual","BOTH IP/OP","$310.00 ","$229.40 ","$58.38 ","$310.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$310.00 ","$143.92 ","$121.34 ","$245.52 ","$248.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30200672","EAP","CPT� 88321","","Microslide Consultation","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$79.11 ","$79.11 ","$0.00 ","$84.00 ","$0.00 ","$84.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200673","EAP","CPT� 84600","","Assay Of Volatiles","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$33.18 ","$8.56 ","$8.04 ","$23.47 ","$23.47 ","$0.00 ","$324.00 ","$0.00 ","$44.90 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200674","EAP","CPT� 84600","","Assay Of Volatiles","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$33.18 ","$8.56 ","$8.04 ","$23.47 ","$23.47 ","$0.00 ","$324.00 ","$0.00 ","$44.90 ","$256.61 ","$259.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200675","EAP","CPT� 85210","","Blood Clot Factor Ii Test","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$18.96 ","$18.96 ","$0.00 ","$111.00 ","$0.00 ","$36.28 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200676","EAP","CPT� 85210","","Blood Clot Factor Ii Test","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$18.96 ","$18.96 ","$0.00 ","$126.00 ","$0.00 ","$36.28 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200677","EAP","CPT� 85260","","Blood Clot Factor X Test","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$26.14 ","$0.00 ","$105.00 ","$0.00 ","$50.04 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200679","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$101.00 ","$74.74 ","$10.71 ","$101.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$101.00 ","$22.49 ","$59.86 ","$79.99 ","$80.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200680","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$117.00 ","$86.58 ","$23.04 ","$117.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$117.00 ","$53.75 ","$112.22 ","$92.66 ","$93.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30200681","EAP","CPT� 88184","","Flowcytometry/ Tc 1 Marker","BOTH IP/OP","$561.00 ","$415.14 ","$30.49 ","$565.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$565.00 ","$284.24 ","$133.74 ","$237.60 ","$452.00 ","$300.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30200682","EAP","CPT� 88185","","Flowcytometry/tc Add-on","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$47.05 ","$33.00 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$33.00 ","$0.00 ","$33.00 ","$23.76 ","$26.40 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30200683","EAP","CPT� 88184","","Flowcytometry/ Tc 1 Marker","BOTH IP/OP","$300.00 ","$222.00 ","$30.49 ","$300.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$300.00 ","$284.24 ","$133.74 ","$237.60 ","$240.00 ","$300.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30200684","EAP","CPT� 88185","","Flowcytometry/tc Add-on","BOTH IP/OP","$14.00 ","$10.36 ","$0.00 ","$47.05 ","$14.00 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$14.00 ","$0.00 ","$14.00 ","$11.09 ","$11.20 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30200685","EAP","CPT� 88182","","Cell Marker Study","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$66.30 ","$66.30 ","$0.00 ","$93.00 ","$0.00 ","$93.00 ","$73.66 ","$74.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200686","EAP","CPT� 85520","","Heparin Assay","BOTH IP/OP","$199.00 ","$147.26 ","$6.55 ","$210.00 ","$27.03 ","$6.55 ","$6.55 ","$19.11 ","$19.11 ","$19.34 ","$210.00 ","$13.74 ","$36.58 ","$166.32 ","$168.00 ","$18.98 ","$20.61 ","$13.09 ","$14.43 ","$13.09 "
"30200687","EAP","CPT� 87252","","Virus Inoculation Tissue","BOTH IP/OP","$496.00 ","$367.04 ","$13.04 ","$496.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$496.00 ","$27.37 ","$61.78 ","$392.83 ","$396.80 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30200688","EAP","CPT� 87253","","Virus Inoculate Tissue Addl","BOTH IP/OP","$476.00 ","$352.24 ","$0.00 ","$476.00 ","$0.00 ","$0.00 ","$0.00 ","$23.78 ","$23.78 ","$0.00 ","$476.00 ","$0.00 ","$45.52 ","$376.99 ","$380.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200693","EAP","CPT� 87449","","Ag Detect Nos Eia Mult","BOTH IP/OP","$317.00 ","$234.58 ","$0.00 ","$317.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$317.00 ","$0.00 ","$33.52 ","$251.06 ","$253.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200694","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$165.00 ","$122.10 ","$2.59 ","$165.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$165.00 ","$5.44 ","$14.46 ","$130.68 ","$132.00 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30200695","EAP","CPT� 84378","","Sugars Single Quant","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$16.83 ","$16.83 ","$0.00 ","$224.00 ","$0.00 ","$32.20 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200696","EAP","CPT� 80500","","Lab Pathology Consultation","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$18.15 ","$18.15 ","$0.00 ","$112.00 ","$0.00 ","$43.34 ","$88.70 ","$89.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200697","EAP","CPT� 87252","","Virus Inoculation Tissue","BOTH IP/OP","$496.00 ","$367.04 ","$13.04 ","$496.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$496.00 ","$27.37 ","$61.78 ","$392.83 ","$396.80 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30200698","EAP","CPT� 87253","","Virus Inoculate Tissue Addl","BOTH IP/OP","$476.00 ","$352.24 ","$0.00 ","$476.00 ","$0.00 ","$0.00 ","$0.00 ","$23.78 ","$23.78 ","$0.00 ","$476.00 ","$0.00 ","$45.52 ","$376.99 ","$380.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200708","EAP","CPT� 88368","","Insitu Hybridization Manual","BOTH IP/OP","$501.00 ","$370.74 ","$58.22 ","$501.00 ","$178.36 ","$285.22 ","$58.22 ","$145.54 ","$145.54 ","$199.20 ","$501.00 ","$284.24 ","$207.74 ","$396.79 ","$400.80 ","$394.92 ","$212.25 ","$90.40 ","$148.57 ","$270.71 "
"30200711","EAP","CPT� 80307","","Drug Screen, Any Number Drug Classes","BOTH IP/OP","$451.00 ","$333.74 ","$29.09 ","$410.00 ","$115.05 ","$31.07 ","$29.09 ","$76.45 ","$76.45 ","$71.85 ","$410.00 ","$65.25 ","$205.00 ","$324.72 ","$328.00 ","$90.10 ","$76.56 ","$62.14 ","$53.59 ","$62.14 "
"30200712","EAP","CPT� 87252","","Virus Inoculation Tissue","BOTH IP/OP","$345.00 ","$255.30 ","$13.04 ","$345.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$345.00 ","$27.37 ","$61.78 ","$273.24 ","$276.00 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30200713","EAP","CPT� 88184","","Flowcytometry/ Tc 1 Marker","BOTH IP/OP","$500.00 ","$370.00 ","$30.49 ","$500.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$500.00 ","$284.24 ","$133.74 ","$396.00 ","$400.00 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30200714","EAP","CPT� 88185","","Flowcytometry/tc Add-on","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$58.00 ","$0.00 ","$58.00 ","$45.94 ","$46.40 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30200719","EAP","CPT� 88360","","Tumor Immunohistochem/manual","BOTH IP/OP","$310.00 ","$229.40 ","$58.38 ","$310.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$310.00 ","$143.92 ","$121.34 ","$245.52 ","$248.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30200720","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$131.00 ","$96.94 ","$23.04 ","$131.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$131.00 ","$53.75 ","$112.22 ","$103.75 ","$104.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30200721","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$75.00 ","$55.50 ","$10.71 ","$75.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$75.00 ","$22.49 ","$59.86 ","$59.40 ","$60.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200732","EAP","CPT� 87530","","Hsv Dna Quant","BOTH IP/OP","$74.00 ","$54.76 ","$0.00 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$62.54 ","$62.54 ","$0.00 ","$76.00 ","$0.00 ","$76.00 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200740","EAP","CPT� 87556","","M.tuberculo Dna Amp Probe","BOTH IP/OP","$220.00 ","$162.80 ","$18.76 ","$227.00 ","$40.50 ","$20.84 ","$18.76 ","$28.64 ","$28.64 ","$39.75 ","$227.00 ","$43.76 ","$54.82 ","$179.78 ","$181.60 ","$60.44 ","$35.53 ","$41.68 ","$36.14 ","$41.68 "
"30200746","EAP","CPT� 83018","","Quantitative Screen Metals","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$32.06 ","$32.06 ","$0.00 ","$61.00 ","$0.00 ","$61.00 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200747","EAP","CPT� 83655","","Assay Of Lead","BOTH IP/OP","$46.00 ","$34.04 ","$6.05 ","$46.00 ","$25.00 ","$6.06 ","$6.05 ","$17.67 ","$17.67 ","$11.75 ","$46.00 ","$12.72 ","$33.82 ","$36.43 ","$36.80 ","$17.56 ","$12.52 ","$12.11 ","$8.76 ","$12.11 "
"30200748","EAP","CPT� 83825","","Assay Of Mercury","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$41.00 ","$17.07 ","$41.00 ","$32.47 ","$32.80 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30200749","EAP","CPT� 84255","","Assay Of Selenium","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$52.69 ","$12.77 ","$12.77 ","$37.27 ","$37.27 ","$0.00 ","$55.00 ","$0.00 ","$55.00 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200750","EAP","CPT� 88182","","Cell Marker Study","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$66.30 ","$66.30 ","$0.00 ","$87.00 ","$0.00 ","$87.00 ","$68.90 ","$69.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200751","EAP","CPT� 88342","","Immunohistochemistry","BOTH IP/OP","$278.00 ","$205.72 ","$48.82 ","$278.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$278.00 ","$143.92 ","$106.46 ","$220.18 ","$222.40 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"30200752","EAP","CPT� 88230","","Tissue Culture Lymphocyte","BOTH IP/OP","$186.00 ","$137.64 ","$58.25 ","$206.00 ","$186.00 ","$58.25 ","$58.25 ","$170.10 ","$170.10 ","$172.08 ","$206.00 ","$122.31 ","$206.00 ","$163.15 ","$164.80 ","$168.91 ","$183.36 ","$116.49 ","$128.35 ","$116.49 "
"30200753","EAP","CPT� 88263","","Chromosome Analysis 45","BOTH IP/OP","$241.00 ","$178.34 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$219.42 ","$219.42 ","$0.00 ","$267.00 ","$0.00 ","$267.00 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200754","EAP","CPT� 88285","","Chromosome Count Additional","BOTH IP/OP","$31.00 ","$22.94 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$27.74 ","$27.74 ","$0.00 ","$34.00 ","$0.00 ","$34.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200756","EAP","CPT� 82441","","Test For Chlorohydrocarbons","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$183.00 ","$0.00 ","$0.00 ","$0.00 ","$8.76 ","$8.76 ","$0.00 ","$183.00 ","$0.00 ","$16.76 ","$144.94 ","$146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200757","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$83.00 ","$61.42 ","$2.59 ","$83.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$83.00 ","$5.44 ","$14.46 ","$65.74 ","$66.40 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30200758","EAP","CPT� 84600","","Assay Of Volatiles","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$33.18 ","$8.56 ","$8.04 ","$23.47 ","$23.47 ","$0.00 ","$100.00 ","$0.00 ","$44.90 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200759","EAP","CPT� 85576","","Blood Platelet Aggregation","BOTH IP/OP","$122.00 ","$90.28 ","$11.21 ","$151.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$151.00 ","$26.16 ","$60.02 ","$119.59 ","$120.80 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30200760","EAP","CPT� 85049","","Automated Platelet Count","BOTH IP/OP","$24.00 ","$17.76 ","$2.24 ","$24.00 ","$9.24 ","$2.24 ","$2.24 ","$6.53 ","$6.53 ","$6.62 ","$24.00 ","$4.70 ","$12.50 ","$19.01 ","$19.20 ","$6.50 ","$7.05 ","$4.48 ","$4.93 ","$4.48 "
"30200776","EAP","CPT� 88184","","Flowcytometry/ Tc 1 Marker","BOTH IP/OP","$303.00 ","$224.22 ","$30.49 ","$303.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$303.00 ","$284.24 ","$133.74 ","$239.98 ","$242.40 ","$303.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30200777","EAP","CPT� 88185","","Flowcytometry/tc Add-on","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$47.05 ","$26.00 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$26.00 ","$0.00 ","$26.00 ","$20.59 ","$20.80 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30200778","EAP","CPT� 88187","","Flowcytometry/read 2-8","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$128.47 ","$128.47 ","$70.22 ","$180.00 ","$50.66 ","$130.50 ","$142.56 ","$144.00 ","$39.31 ","$74.83 ","$39.31 ","$52.38 ","$39.31 "
"30200784","EAP","CPT� 80500","","Lab Pathology Consultation","BOTH IP/OP","$53.00 ","$39.22 ","$0.00 ","$53.00 ","$0.00 ","$0.00 ","$0.00 ","$18.15 ","$18.15 ","$0.00 ","$53.00 ","$0.00 ","$43.34 ","$41.98 ","$42.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200785","EAP","CPT� 82657","","Enzyme Cell Activity","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$25.00 ","$0.00 ","$16.78 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200790","EAP","CPT� 86022","","Platelet Antibodies","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$184.00 ","$0.00 ","$51.32 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200791","EAP","CPT� 86022","","Platelet Antibodies","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$106.00 ","$0.00 ","$51.32 ","$83.95 ","$84.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200792","EAP","CPT� 88239","","Tissue Culture Tumor","BOTH IP/OP","$276.00 ","$204.24 ","$73.76 ","$306.00 ","$276.00 ","$73.76 ","$73.76 ","$215.39 ","$215.39 ","$217.93 ","$306.00 ","$154.90 ","$306.00 ","$242.35 ","$244.80 ","$213.90 ","$232.21 ","$147.52 ","$162.54 ","$147.52 "
"30200793","EAP","CPT� 88237","","Tissue Culture Bone Marrow","BOTH IP/OP","$237.00 ","$175.38 ","$64.69 ","$263.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$263.00 ","$150.94 ","$246.70 ","$208.30 ","$210.40 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30200804","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$82.00 ","$60.68 ","$10.71 ","$82.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$82.00 ","$22.49 ","$59.86 ","$64.94 ","$65.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200805","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$146.00 ","$108.04 ","$23.04 ","$146.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$146.00 ","$53.75 ","$112.22 ","$115.63 ","$116.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30200806","EAP","CPT� 86780","","Treponema Pallidum","BOTH IP/OP","$179.00 ","$132.46 ","$6.62 ","$163.00 ","$27.32 ","$6.62 ","$6.62 ","$18.97 ","$18.97 ","$28.54 ","$163.00 ","$13.90 ","$81.50 ","$129.10 ","$130.40 ","$19.20 ","$25.51 ","$13.24 ","$25.95 ","$13.24 "
"30200818","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$362.00 ","$267.88 ","$2.61 ","$451.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$451.00 ","$5.48 ","$14.60 ","$357.19 ","$360.80 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200819","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$362.00 ","$267.88 ","$2.61 ","$451.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$451.00 ","$5.48 ","$14.60 ","$357.19 ","$360.80 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200820","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$362.00 ","$267.88 ","$2.61 ","$451.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$451.00 ","$5.48 ","$14.60 ","$357.19 ","$360.80 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200827","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$106.00 ","$78.44 ","$10.71 ","$106.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$106.00 ","$22.49 ","$59.86 ","$83.95 ","$84.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200828","EAP","CPT� 88272","","Cytogenetics 3-5","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$55.28 ","$20.35 ","$18.32 ","$39.09 ","$39.09 ","$0.00 ","$126.00 ","$0.00 ","$74.82 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200830","EAP","CPT� 88237","","Tissue Culture Bone Marrow","BOTH IP/OP","$376.00 ","$278.24 ","$64.69 ","$416.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$416.00 ","$150.94 ","$246.70 ","$329.47 ","$332.80 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30200831","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$342.00 ","$253.08 ","$10.71 ","$342.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$342.00 ","$22.49 ","$59.86 ","$270.86 ","$273.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200832","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$400.00 ","$296.00 ","$23.04 ","$400.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$400.00 ","$53.75 ","$112.22 ","$316.80 ","$320.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30200840","EAP","CPT� 88237","","Tissue Culture Bone Marrow","BOTH IP/OP","$262.00 ","$193.88 ","$64.69 ","$290.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$290.00 ","$150.94 ","$246.70 ","$229.68 ","$232.00 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"30200841","EAP","CPT� 88262","","Chromosome Analysis 15-20","BOTH IP/OP","$219.00 ","$162.06 ","$62.32 ","$243.00 ","$219.00 ","$62.75 ","$62.32 ","$181.98 ","$181.98 ","$184.12 ","$243.00 ","$131.76 ","$243.00 ","$192.46 ","$194.40 ","$181.96 ","$196.18 ","$125.49 ","$137.33 ","$125.49 "
"30200843","EAP","CPT� 87449","","Ag Detect Nos Eia Mult","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$253.00 ","$0.00 ","$33.52 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200844","EAP","CPT� 87449","","Ag Detect Nos Eia Mult","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$253.00 ","$0.00 ","$33.52 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200845","EAP","CPT� 88291","","Cyto/molecular Report","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$29.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.00 ","$0.00 ","$29.00 ","$22.97 ","$23.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200846","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$107.00 ","$79.18 ","$10.71 ","$107.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$107.00 ","$22.49 ","$59.86 ","$84.74 ","$85.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200847","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$136.00 ","$100.64 ","$23.04 ","$136.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$136.00 ","$53.75 ","$112.22 ","$107.71 ","$108.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30200848","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$80.00 ","$59.20 ","$10.71 ","$80.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$80.00 ","$22.49 ","$59.86 ","$63.36 ","$64.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200849","EAP","CPT� 88272","","Cytogenetics 3-5","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$55.28 ","$20.35 ","$18.32 ","$39.09 ","$39.09 ","$0.00 ","$106.00 ","$0.00 ","$74.82 ","$83.95 ","$84.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200856","EAP","CPT� 87186","","Microbe Susceptible Mic","BOTH IP/OP","$308.00 ","$227.92 ","$4.32 ","$308.00 ","$17.85 ","$4.33 ","$4.32 ","$12.62 ","$12.62 ","$12.77 ","$308.00 ","$9.08 ","$24.16 ","$243.94 ","$246.40 ","$12.54 ","$13.60 ","$8.65 ","$9.52 ","$8.65 "
"30200863","EAP","CPT� 82136","","Amino Acids Quant 2-5","BOTH IP/OP","$338.00 ","$250.12 ","$0.00 ","$338.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$338.00 ","$0.00 ","$47.14 ","$267.70 ","$270.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200864","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$80.00 ","$59.20 ","$10.71 ","$80.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$80.00 ","$22.49 ","$59.86 ","$63.36 ","$64.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30200865","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$139.00 ","$102.86 ","$23.04 ","$139.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$139.00 ","$53.75 ","$112.22 ","$110.09 ","$111.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30200867","EAP","CPT� 87385","","Histoplasma Capsul Ag Eia","BOTH IP/OP","$215.00 ","$159.10 ","$5.99 ","$215.00 ","$24.74 ","$6.63 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$215.00 ","$13.91 ","$33.52 ","$170.28 ","$172.00 ","$19.21 ","$18.87 ","$13.25 ","$13.21 ","$13.25 "
"30200868","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$386.00 ","$285.64 ","$17.55 ","$389.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$389.00 ","$36.84 ","$54.82 ","$308.09 ","$311.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30200869","EAP","CPT� 82175","","Assay Of Arsenic","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$9.49 ","$27.70 ","$27.70 ","$28.02 ","$34.00 ","$19.92 ","$34.00 ","$26.93 ","$27.20 ","$27.51 ","$0.00 ","$18.97 ","$20.90 ","$18.97 "
"30200895","EAP","CPT� 84481","","T3, Free","BOTH IP/OP","$150.00 ","$111.00 ","$8.47 ","$148.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$148.00 ","$17.79 ","$47.34 ","$117.22 ","$118.40 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30200896","EAP","CPT� 84481","","Free Assay(ft-3)","BOTH IP/OP","$137.00 ","$101.38 ","$8.47 ","$157.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$157.00 ","$17.79 ","$47.34 ","$124.34 ","$125.60 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30200898","EAP","CPT� 83789","","Mass Spectrometry Quant","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$118.00 ","$0.00 ","$16.78 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200900","EAP","CPT� 82154","","Androstanediol Glucuronide","BOTH IP/OP","$437.00 ","$323.38 ","$0.00 ","$437.00 ","$0.00 ","$0.00 ","$0.00 ","$42.10 ","$42.10 ","$0.00 ","$437.00 ","$0.00 ","$80.58 ","$346.10 ","$349.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200908","EAP","CPT� 82010","","Acetone Assay","BOTH IP/OP","$285.00 ","$210.90 ","$4.09 ","$285.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$285.00 ","$8.58 ","$22.84 ","$225.72 ","$228.00 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30200910","EAP","CPT� 82010","","Acetone Assay","BOTH IP/OP","$153.00 ","$113.22 ","$4.09 ","$153.00 ","$16.87 ","$4.09 ","$4.09 ","$11.93 ","$11.93 ","$12.08 ","$153.00 ","$8.58 ","$22.84 ","$121.18 ","$122.40 ","$11.85 ","$12.87 ","$8.17 ","$9.01 ","$8.17 "
"30200912","EAP","CPT� 87252","","Virus Inoculation Tissue","BOTH IP/OP","$488.00 ","$361.12 ","$13.04 ","$488.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$488.00 ","$27.37 ","$61.78 ","$386.50 ","$390.40 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30200913","EAP","CPT� 87253","","Virus Inoculate Tissue Addl","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$23.78 ","$23.78 ","$0.00 ","$488.00 ","$0.00 ","$45.52 ","$386.50 ","$390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200915","EAP","CPT� 82017","","Acylcarnities Quant","BOTH IP/OP","$247.00 ","$182.78 ","$0.00 ","$247.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$247.00 ","$0.00 ","$47.14 ","$195.62 ","$197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200919","EAP","CPT� 84311","","Spectrophotometry","BOTH IP/OP","$239.00 ","$176.86 ","$0.00 ","$241.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$241.00 ","$8.51 ","$19.54 ","$190.87 ","$192.80 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30200921","EAP","CPT� 84311","","Spectrophotometry","BOTH IP/OP","$239.00 ","$176.86 ","$0.00 ","$241.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$241.00 ","$8.51 ","$19.54 ","$190.87 ","$192.80 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30200923","EAP","CPT� 87260","","Adenovirus Ag If","BOTH IP/OP","$128.00 ","$94.72 ","$0.00 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$128.00 ","$0.00 ","$33.52 ","$101.38 ","$102.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200925","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$464.00 ","$343.36 ","$17.55 ","$559.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$559.00 ","$36.84 ","$54.82 ","$442.73 ","$447.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30200927","EAP","CPT� 86316","","Immunoassay Tumor Other","BOTH IP/OP","$178.00 ","$131.72 ","$10.41 ","$178.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$178.00 ","$21.85 ","$58.14 ","$140.98 ","$142.40 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200929","EAP","CPT� 82088","","Assay Of Aldosterone","BOTH IP/OP","$297.00 ","$219.78 ","$20.38 ","$297.00 ","$84.11 ","$20.38 ","$20.38 ","$59.50 ","$59.50 ","$60.21 ","$297.00 ","$42.79 ","$113.88 ","$235.22 ","$237.60 ","$59.09 ","$64.15 ","$40.75 ","$44.91 ","$40.75 "
"30200937","EAP","CPT� 82103","","Alpha-1-antitrypsin Total","BOTH IP/OP","$137.00 ","$101.38 ","$6.72 ","$137.00 ","$27.75 ","$6.72 ","$6.72 ","$19.61 ","$19.61 ","$19.85 ","$137.00 ","$14.11 ","$37.54 ","$108.50 ","$109.60 ","$19.49 ","$21.15 ","$13.44 ","$14.80 ","$13.44 "
"30200939","EAP","CPT� 86316","","Immunoassay Tumor Other","BOTH IP/OP","$177.00 ","$130.98 ","$10.41 ","$178.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$178.00 ","$21.85 ","$58.14 ","$140.98 ","$142.40 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30200941","EAP","CPT� 86147","","Cardiolipin Antibody","BOTH IP/OP","$53.00 ","$39.22 ","$12.73 ","$66.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$66.00 ","$26.72 ","$66.00 ","$52.27 ","$52.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30200943","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$293.00 ","$216.82 ","$7.77 ","$331.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$331.00 ","$18.13 ","$36.18 ","$262.15 ","$264.80 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30200945","EAP","CPT� 86146","","Glycoprotein Antibody","BOTH IP/OP","$107.00 ","$79.18 ","$12.73 ","$134.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$134.00 ","$26.72 ","$71.08 ","$106.13 ","$107.20 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30200946","EAP","CPT� 86147","","Cardiolipin Antibody","BOTH IP/OP","$147.00 ","$108.78 ","$12.73 ","$134.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$134.00 ","$26.72 ","$71.08 ","$106.13 ","$107.20 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30200947","EAP","CPT� 86148","","Phospholipid Antibody","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$23.45 ","$23.45 ","$0.00 ","$104.00 ","$0.00 ","$44.88 ","$82.37 ","$83.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200949","EAP","CPT� 85300","","Antithrombin Iii Test,activity","BOTH IP/OP","$588.00 ","$435.12 ","$5.93 ","$588.00 ","$24.47 ","$5.93 ","$5.93 ","$17.30 ","$17.30 ","$17.50 ","$588.00 ","$12.44 ","$33.10 ","$465.70 ","$470.40 ","$17.18 ","$18.65 ","$11.85 ","$13.06 ","$11.85 "
"30200950","EAP","CPT� 85301","","Antithrombin Iii Test,antigen Assay","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$0.00 ","$0.00 ","$5.40 ","$15.79 ","$15.79 ","$15.98 ","$588.00 ","$11.35 ","$30.22 ","$465.70 ","$470.40 ","$15.67 ","$17.03 ","$10.81 ","$11.92 ","$10.81 "
"30200952","EAP","CPT� 82172","","Assay Of Apolipoprotein","BOTH IP/OP","$41.00 ","$30.34 ","$9.49 ","$41.00 ","$32.00 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$41.00 ","$22.14 ","$41.00 ","$32.47 ","$32.80 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30200954","EAP","CPT� 86651","","Antibody Encephalitis, California (la Crosse)","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200955","EAP","CPT� 86652","","Antibody Encephalitis, Eastern Equine","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200956","EAP","CPT� 86653","","Antibody Encephalitis, St. Louis","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200957","EAP","CPT� 86654","","Antibody Encephalitis, Western Equine","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200959","EAP","CPT� 82175","","Assay Of Arsenic","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$117.00 ","$0.00 ","$0.00 ","$9.49 ","$27.70 ","$27.70 ","$28.02 ","$117.00 ","$19.92 ","$53.02 ","$92.66 ","$93.60 ","$27.51 ","$0.00 ","$18.97 ","$20.90 ","$18.97 "
"30200961","EAP","CPT� 84311","","Spectrophotometry","BOTH IP/OP","$286.00 ","$211.64 ","$0.00 ","$357.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$357.00 ","$8.51 ","$19.54 ","$282.74 ","$285.60 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30200963","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$124.00 ","$91.76 ","$2.61 ","$155.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$155.00 ","$5.48 ","$14.60 ","$122.76 ","$124.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30200965","EAP","CPT� 87305","","Aspergillus Ag Eia","BOTH IP/OP","$139.00 ","$102.86 ","$5.99 ","$139.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$139.00 ","$12.58 ","$33.52 ","$110.09 ","$111.20 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30200967","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$280.00 ","$207.20 ","$8.39 ","$280.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$280.00 ","$19.57 ","$33.64 ","$221.76 ","$224.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30200969","EAP","CPT� 86337","","Insulin Antibodies","BOTH IP/OP","$411.00 ","$304.14 ","$0.00 ","$411.00 ","$44.19 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.64 ","$411.00 ","$22.48 ","$59.84 ","$325.51 ","$328.80 ","$31.04 ","$0.00 ","$21.41 ","$23.60 ","$21.41 "
"30200976","EAP","CPT� 86753","","Protozoa Antibody Nos","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$18.09 ","$18.09 ","$0.00 ","$55.00 ","$0.00 ","$34.64 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200978","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$526.00 ","$389.24 ","$17.55 ","$530.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$530.00 ","$36.84 ","$54.82 ","$419.76 ","$424.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30200980","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$301.00 ","$222.74 ","$8.39 ","$301.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$301.00 ","$19.57 ","$33.64 ","$238.39 ","$240.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30200982","EAP","CPT� 87471","","Bartonella Dna Amp Probe","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$435.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$435.00 ","$0.00 ","$54.82 ","$344.52 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30200997","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$189.00 ","$139.86 ","$8.39 ","$189.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$189.00 ","$19.57 ","$33.64 ","$149.69 ","$151.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30200999","EAP","CPT� 86146","","Glycoprotein Antibody","BOTH IP/OP","$93.00 ","$68.82 ","$12.73 ","$116.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$116.00 ","$26.72 ","$71.08 ","$91.87 ","$92.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30201001","EAP","CPT� 82143","","Amniotic Fluid Scan","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$10.03 ","$10.03 ","$0.00 ","$50.00 ","$0.00 ","$19.22 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201003","EAP","CPT� 87799","","Detect Agent Nos Dna Quant","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,286.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$1,286.00 ","$0.00 ","$119.70 ","$1,018.51 ","$1,028.80 ","$0.00 ","$201.26 ","$0.00 ","$0.00 ","$0.00 "
"30201005","EAP","CPT� 86615","","Bordetella Antibody","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$77.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$77.00 ","$0.00 ","$36.86 ","$60.98 ","$61.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201007","EAP","CPT� 82523","","Collagen Crosslinks","BOTH IP/OP","$180.00 ","$133.20 ","$9.34 ","$180.00 ","$38.57 ","$9.34 ","$9.34 ","$27.29 ","$27.29 ","$27.60 ","$180.00 ","$19.61 ","$52.22 ","$142.56 ","$144.00 ","$27.09 ","$29.41 ","$18.68 ","$20.59 ","$18.68 "
"30201009","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$186.00 ","$137.64 ","$7.77 ","$210.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$210.00 ","$18.13 ","$36.18 ","$166.32 ","$168.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201011","EAP","CPT� 86160","","Complement Antigen","BOTH IP/OP","$224.00 ","$165.76 ","$6.00 ","$258.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$258.00 ","$12.60 ","$33.56 ","$204.34 ","$206.40 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30201013","EAP","CPT� 86329","","Immunodiffusion","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$150.00 ","$28.99 ","$7.03 ","$0.00 ","$20.51 ","$20.51 ","$20.75 ","$150.00 ","$14.75 ","$39.24 ","$118.80 ","$120.00 ","$20.37 ","$22.11 ","$14.05 ","$15.48 ","$14.05 "
"30201015","EAP","CPT� 86301","","Immunoassay Tumor Ca 19-9","BOTH IP/OP","$91.00 ","$67.34 ","$10.41 ","$92.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$92.00 ","$21.85 ","$58.14 ","$72.86 ","$73.60 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30201017","EAP","CPT� 86403","","Particle Agglutination Test","BOTH IP/OP","$216.00 ","$159.84 ","$5.19 ","$216.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$216.00 ","$12.12 ","$28.48 ","$171.07 ","$172.80 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30201019","EAP","CPT� 80157","","Assay Of Carbamazepine Free","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$155.00 ","$0.00 ","$0.00 ","$0.00 ","$19.36 ","$19.36 ","$0.00 ","$155.00 ","$0.00 ","$37.04 ","$122.76 ","$124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201021","EAP","CPT� 82375","","Assay Carboxyhb Quant","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$4.20 ","$4.20 ","$0.00 ","$60.00 ","$0.00 ","$8.04 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201023","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$172.00 ","$127.28 ","$5.76 ","$194.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$194.00 ","$12.11 ","$29.88 ","$153.65 ","$155.20 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201025","EAP","CPT� 86147","","Cariolipin Antibody","BOTH IP/OP","$53.00 ","$39.22 ","$12.73 ","$66.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$66.00 ","$26.72 ","$66.00 ","$52.27 ","$52.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30201027","EAP","CPT� 82384","","Assay Three Catecholamines","BOTH IP/OP","$86.00 ","$63.64 ","$12.63 ","$86.00 ","$52.11 ","$12.63 ","$12.63 ","$36.87 ","$36.87 ","$37.30 ","$86.00 ","$26.51 ","$70.56 ","$68.11 ","$68.80 ","$36.61 ","$39.74 ","$25.25 ","$27.82 ","$25.25 "
"30201028","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$34.00 ","$25.16 ","$2.59 ","$34.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$34.00 ","$5.44 ","$14.46 ","$26.93 ","$27.20 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201030","EAP","CPT� 88184","","Flowcytometry/tc 1 Marker","BOTH IP/OP","$500.00 ","$370.00 ","$30.49 ","$500.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$500.00 ","$284.24 ","$133.74 ","$396.00 ","$400.00 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"30201031","EAP","CPT� 88185","","Flowcytometry/tc Add-on","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$48.00 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$48.00 ","$0.00 ","$48.00 ","$38.02 ","$38.40 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"30201032","EAP","CPT� 88187","","Flowcytometry/read 2-8","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$128.47 ","$128.47 ","$70.22 ","$180.00 ","$50.66 ","$130.50 ","$142.56 ","$144.00 ","$39.31 ","$74.83 ","$39.31 ","$52.38 ","$39.31 "
"30201034","EAP","CPT� 82378","","Carcinoembryinic Antigen","BOTH IP/OP","$58.00 ","$42.92 ","$9.48 ","$60.00 ","$39.15 ","$9.48 ","$9.48 ","$27.70 ","$27.70 ","$28.02 ","$60.00 ","$19.91 ","$53.02 ","$47.52 ","$48.00 ","$27.49 ","$29.86 ","$18.96 ","$20.90 ","$18.96 "
"30201036","EAP","CPT� 82378","","Carcinoembryinic Antigen","BOTH IP/OP","$58.00 ","$42.92 ","$9.48 ","$60.00 ","$39.15 ","$9.48 ","$9.48 ","$27.70 ","$27.70 ","$28.02 ","$60.00 ","$19.91 ","$53.02 ","$47.52 ","$48.00 ","$27.49 ","$29.86 ","$18.96 ","$20.90 ","$18.96 "
"30201038","EAP","CPT� 86631","","Chlamydia Antibody","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$79.00 ","$24.42 ","$5.91 ","$5.91 ","$17.27 ","$17.27 ","$17.47 ","$79.00 ","$0.00 ","$33.04 ","$62.57 ","$63.20 ","$0.00 ","$18.62 ","$0.00 ","$0.00 ","$0.00 "
"30201039","EAP","CPT� 86632","","Chlamydia Igm Antibody","BOTH IP/OP","$82.00 ","$60.68 ","$0.00 ","$82.00 ","$0.00 ","$0.00 ","$0.00 ","$18.53 ","$18.53 ","$0.00 ","$82.00 ","$0.00 ","$35.48 ","$64.94 ","$65.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201041","EAP","CPT� 82480","","Assay Serum Cholinesterase","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$11.51 ","$11.51 ","$0.00 ","$58.00 ","$0.00 ","$22.02 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201043","EAP","CPT� 82495","","Assay Of Chromium","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$0.00 ","$29.61 ","$29.61 ","$0.00 ","$97.00 ","$0.00 ","$56.68 ","$76.82 ","$77.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201045","EAP","CPT� 86316","","Immunoassay Tumor Other","BOTH IP/OP","$293.00 ","$216.82 ","$10.41 ","$293.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$293.00 ","$21.85 ","$58.14 ","$232.06 ","$234.40 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30201049","EAP","CPT� 86157","","Cold Agglutinin Titer","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$11.77 ","$11.77 ","$0.00 ","$24.00 ","$0.00 ","$22.54 ","$19.01 ","$19.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201051","EAP","CPT� 82523","","Collagen Crosslinks","BOTH IP/OP","$99.00 ","$73.26 ","$9.34 ","$99.00 ","$38.57 ","$9.34 ","$9.34 ","$27.29 ","$27.29 ","$27.60 ","$99.00 ","$19.61 ","$52.22 ","$78.41 ","$79.20 ","$27.09 ","$29.41 ","$18.68 ","$20.59 ","$18.68 "
"30201053","EAP","CPT� 86160","","Complement Antigen","BOTH IP/OP","$224.00 ","$165.76 ","$6.00 ","$258.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$258.00 ","$12.60 ","$33.56 ","$204.34 ","$206.40 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30201055","EAP","CPT� 86160","","Complement Antigen","BOTH IP/OP","$200.00 ","$148.00 ","$6.00 ","$231.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$231.00 ","$12.60 ","$33.56 ","$182.95 ","$184.80 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30201057","EAP","CPT� 86160","","Complement Antigen","BOTH IP/OP","$230.00 ","$170.20 ","$6.00 ","$265.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$265.00 ","$12.60 ","$33.56 ","$209.88 ","$212.00 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30201059","EAP","CPT� 86160","","Complement Antigen","BOTH IP/OP","$230.00 ","$170.20 ","$6.00 ","$265.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$265.00 ","$12.60 ","$33.56 ","$209.88 ","$212.00 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30201061","EAP","CPT� 86160","","Complement Antigen","BOTH IP/OP","$224.00 ","$165.76 ","$6.00 ","$258.00 ","$24.76 ","$6.00 ","$6.00 ","$17.53 ","$17.53 ","$17.73 ","$258.00 ","$12.60 ","$33.56 ","$204.34 ","$206.40 ","$17.40 ","$18.90 ","$12.00 ","$13.23 ","$12.00 "
"30201063","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$686.00 ","$507.64 ","$8.28 ","$667.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$667.00 ","$19.32 ","$37.76 ","$528.26 ","$533.60 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201065","EAP","CPT� 82530","","Cortisol Free","BOTH IP/OP","$180.00 ","$133.20 ","$8.36 ","$182.00 ","$34.48 ","$8.36 ","$8.36 ","$24.41 ","$24.41 ","$24.70 ","$182.00 ","$17.55 ","$46.70 ","$144.14 ","$145.60 ","$24.23 ","$26.31 ","$16.71 ","$18.42 ","$16.71 "
"30201067","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$150.00 ","$111.00 ","$8.39 ","$151.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$151.00 ","$19.57 ","$33.64 ","$119.59 ","$120.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201069","EAP","CPT� 82552","","Assay Of Cpk In Blood","BOTH IP/OP","$61.00 ","$45.14 ","$0.00 ","$61.00 ","$0.00 ","$0.00 ","$0.00 ","$19.56 ","$19.56 ","$0.00 ","$61.00 ","$0.00 ","$37.42 ","$48.31 ","$48.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201071","EAP","CPT� 86343","","Leukocyte Histamine Release","BOTH IP/OP","$386.00 ","$285.64 ","$0.00 ","$386.00 ","$25.71 ","$6.23 ","$6.23 ","$18.20 ","$18.20 ","$0.00 ","$386.00 ","$0.00 ","$34.82 ","$305.71 ","$308.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201073","EAP","CPT� 84443","","Assay Thyroid Stim Hormone","BOTH IP/OP","$146.00 ","$108.04 ","$8.40 ","$146.00 ","$34.69 ","$8.40 ","$8.40 ","$24.53 ","$24.53 ","$24.81 ","$146.00 ","$17.64 ","$46.94 ","$115.63 ","$116.80 ","$24.36 ","$26.44 ","$16.80 ","$18.51 ","$16.80 "
"30201074","EAP","CPT� 86343","","Leukocyte Histamine Release","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$204.00 ","$25.71 ","$6.23 ","$6.23 ","$18.20 ","$18.20 ","$0.00 ","$204.00 ","$0.00 ","$34.82 ","$161.57 ","$163.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201075","EAP","CPT� 86376","","Microsomal Antibody","BOTH IP/OP","$108.00 ","$79.92 ","$7.28 ","$108.00 ","$30.04 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$108.00 ","$15.28 ","$40.66 ","$85.54 ","$86.40 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30201076","EAP","CPT� 86800","","Thyroglobulin Antibody","BOTH IP/OP","$272.00 ","$201.28 ","$7.95 ","$272.00 ","$32.84 ","$7.96 ","$7.95 ","$23.22 ","$23.22 ","$23.50 ","$272.00 ","$16.71 ","$44.44 ","$215.42 ","$217.60 ","$23.07 ","$25.04 ","$15.91 ","$17.53 ","$15.91 "
"30201078","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$227.00 ","$167.98 ","$8.39 ","$227.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$227.00 ","$19.57 ","$33.64 ","$179.78 ","$181.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201080","EAP","CPT� 86682","","Helminth Antibody","BOTH IP/OP","$179.00 ","$132.46 ","$6.50 ","$181.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$181.00 ","$13.66 ","$36.34 ","$143.35 ","$144.80 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30201082","EAP","CPT� 82135","","Assay Aminolevulinic Acid","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$24.04 ","$24.04 ","$0.00 ","$164.00 ","$0.00 ","$46.00 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201084","EAP","CPT� 82135","","Assay Aminolevulinic Acid","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$24.04 ","$24.04 ","$0.00 ","$164.00 ","$0.00 ","$46.00 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201086","EAP","CPT� 86790","","Virus Antibody Nos","BOTH IP/OP","$267.00 ","$197.58 ","$6.44 ","$244.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$244.00 ","$13.52 ","$36.00 ","$193.25 ","$195.20 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201088","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$201.00 ","$148.74 ","$8.39 ","$201.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$201.00 ","$19.57 ","$33.64 ","$159.19 ","$160.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201090","EAP","CPT� 82533","","Total Cortisol","BOTH IP/OP","$367.00 ","$271.58 ","$8.15 ","$367.00 ","$33.66 ","$8.15 ","$8.15 ","$23.81 ","$23.81 ","$24.09 ","$367.00 ","$17.12 ","$45.56 ","$290.66 ","$293.60 ","$23.64 ","$25.67 ","$16.30 ","$17.97 ","$16.30 "
"30201092","EAP","CPT� 86648","","Diptheria Antibody","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$0.00 ","$22.21 ","$22.21 ","$0.00 ","$97.00 ","$0.00 ","$42.50 ","$76.82 ","$77.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201093","EAP","CPT� 86774","","Tetanus Antibody","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$21.61 ","$21.61 ","$21.86 ","$87.00 ","$15.54 ","$41.36 ","$68.90 ","$69.60 ","$21.46 ","$23.29 ","$14.80 ","$16.31 ","$14.80 "
"30201097","EAP","CPT� 80307","","Drug Screen Single","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$76.56 ","$35.00 ","$6.23 ","$29.09 ","$76.45 ","$76.45 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$75.00 ","$76.56 ","$62.14 ","$53.59 ","$0.00 "
"30201105","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$282.00 ","$208.68 ","$8.39 ","$282.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$282.00 ","$19.57 ","$33.64 ","$223.34 ","$225.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201107","EAP","CPT� 82438","","Assay Other Fluid Chlorides","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$7.14 ","$7.14 ","$0.00 ","$110.00 ","$0.00 ","$13.66 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201108","EAP","CPT� 84302","","Assay Of Sweat Sodium","BOTH IP/OP","$114.00 ","$84.36 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$5.05 ","$5.05 ","$0.00 ","$120.00 ","$0.00 ","$9.66 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201109","EAP","CPT� 84311","","Spectrophotometry","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$90.00 ","$8.51 ","$19.54 ","$71.28 ","$72.00 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30201111","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$124.00 ","$91.76 ","$6.03 ","$155.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$155.00 ","$12.65 ","$33.68 ","$122.76 ","$124.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201113","EAP","CPT� 87337","","Entamoeb Hist Group Ag Eia","BOTH IP/OP","$89.00 ","$65.86 ","$5.99 ","$89.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$89.00 ","$12.58 ","$33.52 ","$70.49 ","$71.20 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30201115","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$311.00 ","$230.14 ","$17.55 ","$375.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$375.00 ","$36.84 ","$54.82 ","$297.00 ","$300.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201117","EAP","CPT� 87799","","Detect Agent Nos Dna Quant","BOTH IP/OP","$779.00 ","$576.46 ","$0.00 ","$890.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$890.00 ","$0.00 ","$119.70 ","$704.88 ","$712.00 ","$0.00 ","$139.29 ","$0.00 ","$0.00 ","$0.00 "
"30201119","EAP","CPT� 84202","","Assay Rbc Protoporphyrin","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$20.95 ","$20.95 ","$0.00 ","$24.00 ","$0.00 ","$24.00 ","$19.01 ","$19.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201121","EAP","CPT� 82672","","Assay Of Estrogen","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$24.32 ","$24.32 ","$0.00 ","$131.00 ","$0.00 ","$46.54 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201129","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$178.00 ","$131.72 ","$10.71 ","$178.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$178.00 ","$22.49 ","$59.86 ","$140.98 ","$142.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201130","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$235.00 ","$173.90 ","$23.04 ","$235.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$235.00 ","$53.75 ","$112.22 ","$186.12 ","$188.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201133","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$230.00 ","$170.20 ","$10.71 ","$230.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$230.00 ","$22.49 ","$59.86 ","$182.16 ","$184.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201134","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$293.00 ","$216.82 ","$23.04 ","$293.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$293.00 ","$53.75 ","$112.22 ","$232.06 ","$234.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201137","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$218.00 ","$161.32 ","$10.71 ","$218.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$218.00 ","$22.49 ","$59.86 ","$172.66 ","$174.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201138","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$282.00 ","$208.68 ","$23.04 ","$282.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$282.00 ","$53.75 ","$112.22 ","$223.34 ","$225.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201147","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$279.00 ","$206.46 ","$8.39 ","$279.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$279.00 ","$19.57 ","$33.64 ","$220.97 ","$223.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201151","EAP","CPT� 83789","","Mass Spectrometry Quant","BOTH IP/OP","$104.00 ","$76.96 ","$0.00 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$104.00 ","$0.00 ","$16.78 ","$82.37 ","$83.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201153","EAP","CPT� 86001","","Allergen Specific Igg","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$244.00 ","$0.00 ","$0.00 ","$0.00 ","$7.62 ","$7.62 ","$0.00 ","$244.00 ","$0.00 ","$14.60 ","$193.25 ","$195.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201155","EAP","CPT� 82679","","Assay Of Estrone","BOTH IP/OP","$35.00 ","$25.90 ","$12.48 ","$39.29 ","$35.00 ","$12.48 ","$12.48 ","$36.45 ","$36.45 ","$36.88 ","$35.00 ","$26.20 ","$35.00 ","$27.72 ","$28.00 ","$35.00 ","$39.29 ","$24.95 ","$27.50 ","$24.95 "
"30201156","EAP","CPT� 82670","","Assay Of Estradiol","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$40.80 ","$40.80 ","$41.28 ","$198.00 ","$29.34 ","$78.08 ","$156.82 ","$158.40 ","$40.51 ","$43.98 ","$27.94 ","$30.79 ","$27.94 "
"30201157","EAP","CPT� 82677","","Assay Of Estriol","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$38.06 ","$0.00 ","$0.00 ","$0.00 ","$35.31 ","$35.31 ","$35.72 ","$35.00 ","$25.39 ","$35.00 ","$27.72 ","$28.00 ","$35.00 ","$38.06 ","$24.18 ","$26.64 ","$24.18 "
"30201159","EAP","CPT� 83883","","Assay Nephelometry Not Spec","BOTH IP/OP","$213.00 ","$157.62 ","$6.80 ","$213.00 ","$28.06 ","$6.80 ","$6.80 ","$19.85 ","$19.85 ","$20.09 ","$213.00 ","$14.28 ","$38.00 ","$168.70 ","$170.40 ","$19.72 ","$21.40 ","$13.60 ","$14.98 ","$13.60 "
"30201165","EAP","CPT� 83727","","Assay Of Irh Hormone","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$25.10 ","$25.10 ","$0.00 ","$1,260.00 ","$0.00 ","$48.04 ","$997.92 ","$1,008.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201167","EAP","CPT� 87338","","Hpylori Stool Eia","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$21.00 ","$21.00 ","$0.00 ","$175.00 ","$0.00 ","$40.20 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201169","EAP","CPT� 86684","","Hemophilus Influenza","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$23.13 ","$23.13 ","$0.00 ","$198.00 ","$0.00 ","$44.28 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201171","EAP","CPT� 84702","","Chorionic Gonadotropin Test","BOTH IP/OP","$162.00 ","$119.88 ","$7.07 ","$147.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$147.00 ","$15.80 ","$17.94 ","$116.42 ","$117.60 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30201173","EAP","CPT� 82175","","Assay Of Arsenic","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$9.49 ","$27.70 ","$27.70 ","$28.02 ","$43.00 ","$19.92 ","$43.00 ","$34.06 ","$34.40 ","$27.51 ","$0.00 ","$18.97 ","$20.90 ","$18.97 "
"30201174","EAP","CPT� 83655","","Assay Of Lead","BOTH IP/OP","$54.00 ","$39.96 ","$6.05 ","$54.00 ","$25.00 ","$6.06 ","$6.05 ","$17.67 ","$17.67 ","$11.75 ","$54.00 ","$12.72 ","$33.82 ","$42.77 ","$43.20 ","$17.56 ","$12.52 ","$12.11 ","$8.76 ","$12.11 "
"30201175","EAP","CPT� 83825","","Assay Of Mercury","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$38.00 ","$17.07 ","$38.00 ","$30.10 ","$30.40 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30201177","EAP","CPT� 82175","","Assay Of Arsenic","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$0.00 ","$0.00 ","$9.49 ","$27.70 ","$27.70 ","$28.02 ","$69.00 ","$19.92 ","$53.02 ","$54.65 ","$55.20 ","$27.51 ","$0.00 ","$18.97 ","$20.90 ","$18.97 "
"30201178","EAP","CPT� 82300","","Assay Of Cadmium","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$47.78 ","$11.82 ","$11.57 ","$33.79 ","$33.79 ","$0.00 ","$75.00 ","$0.00 ","$64.66 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201179","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$91.00 ","$67.34 ","$2.59 ","$91.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$91.00 ","$5.44 ","$14.46 ","$72.07 ","$72.80 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201180","EAP","CPT� 83655","","Assay Of Lead","BOTH IP/OP","$76.00 ","$56.24 ","$6.05 ","$76.00 ","$25.00 ","$6.06 ","$6.05 ","$17.67 ","$17.67 ","$11.75 ","$76.00 ","$12.72 ","$33.82 ","$60.19 ","$60.80 ","$17.56 ","$12.52 ","$12.11 ","$8.76 ","$12.11 "
"30201181","EAP","CPT� 83825","","Assay Of Mercury","BOTH IP/OP","$62.00 ","$45.88 ","$0.00 ","$62.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$62.00 ","$17.07 ","$45.44 ","$49.10 ","$49.60 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30201183","EAP","CPT� 86804","","Hep C Ab Test Confirm","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$413.00 ","$0.00 ","$0.00 ","$0.00 ","$22.61 ","$22.61 ","$0.00 ","$413.00 ","$0.00 ","$43.28 ","$327.10 ","$330.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201185","EAP","CPT� 87299","","Antibody Detection Nos If","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$88.00 ","$0.00 ","$33.52 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201187","EAP","CPT� 86970","","Rbc Pretreatment","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$15.95 ","$15.95 ","$0.00 ","$548.00 ","$0.00 ","$37.22 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201189","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$436.00 ","$322.64 ","$17.55 ","$525.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$525.00 ","$36.84 ","$54.82 ","$415.80 ","$420.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201191","EAP","CPT� 86698","","Histoplasma","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$6.25 ","$18.25 ","$18.25 ","$18.46 ","$72.00 ","$14.48 ","$34.92 ","$57.02 ","$57.60 ","$20.00 ","$19.67 ","$13.79 ","$13.77 ","$13.79 "
"30201193","EAP","CPT� 86689","","Htlv/hiv Confirmatory Test","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$148.00 ","$0.00 ","$54.10 ","$117.22 ","$118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201195","EAP","CPT� 86702","","Hiv-2","BOTH IP/OP","$135.00 ","$99.90 ","$6.76 ","$141.00 ","$27.90 ","$6.76 ","$6.76 ","$19.74 ","$19.74 ","$17.33 ","$141.00 ","$14.20 ","$37.76 ","$111.67 ","$112.80 ","$19.60 ","$18.46 ","$13.52 ","$12.92 ","$13.52 "
"30201202","EAP","CPT� 83090","","Assay Of Homocystine","BOTH IP/OP","$231.00 ","$170.94 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$231.00 ","$0.00 ","$47.14 ","$182.95 ","$184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201204","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$54.00 ","$39.96 ","$2.59 ","$54.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$54.00 ","$5.44 ","$14.46 ","$42.77 ","$43.20 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201205","EAP","CPT� 82150","","Assay Of Amylase","BOTH IP/OP","$101.00 ","$74.74 ","$3.24 ","$109.00 ","$13.38 ","$3.24 ","$3.24 ","$9.46 ","$9.46 ","$9.58 ","$109.00 ","$6.80 ","$18.12 ","$86.33 ","$87.20 ","$9.40 ","$10.20 ","$6.48 ","$7.14 ","$6.48 "
"30201207","EAP","CPT� 87529","","Hsv Dna Amp Probe","BOTH IP/OP","$188.00 ","$139.12 ","$17.55 ","$194.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$194.00 ","$36.84 ","$54.82 ","$153.65 ","$155.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201209","EAP","CPT� 87530","","Hsv Dna Quant","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$256.00 ","$0.00 ","$0.00 ","$0.00 ","$62.54 ","$62.54 ","$0.00 ","$256.00 ","$0.00 ","$119.70 ","$202.75 ","$204.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201211","EAP","CPT� 87532","","Hhv-6 Dna Amp Probe","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$333.00 ","$0.00 ","$54.82 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201213","EAP","CPT� 83632","","Placental Lactogen","BOTH IP/OP","$484.00 ","$358.16 ","$0.00 ","$441.00 ","$0.00 ","$0.00 ","$0.00 ","$29.51 ","$29.51 ","$0.00 ","$441.00 ","$0.00 ","$56.48 ","$349.27 ","$352.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201220","EAP","CPT� 86331","","Immunodiffusion Ouchterlony","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$17.50 ","$17.50 ","$0.00 ","$19.00 ","$0.00 ","$19.00 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201221","EAP","CPT� 86606","","Aspergillus Antibody","BOTH IP/OP","$27.00 ","$19.98 ","$7.53 ","$27.00 ","$27.00 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$27.00 ","$15.80 ","$27.00 ","$21.38 ","$21.60 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30201222","EAP","CPT� 86744","","Nocardia Antibody","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$24.00 ","$0.00 ","$24.00 ","$19.01 ","$19.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201224","EAP","CPT� 86341","","Islet Cell Antibody","BOTH IP/OP","$195.00 ","$144.30 ","$10.61 ","$193.00 ","$40.84 ","$11.79 ","$10.61 ","$28.89 ","$28.89 ","$29.24 ","$193.00 ","$24.75 ","$55.30 ","$152.86 ","$154.40 ","$34.18 ","$31.16 ","$23.57 ","$21.81 ","$23.57 "
"30201226","EAP","CPT� 82784","","Assay Iga/igd/igg/igm Each","BOTH IP/OP","$34.00 ","$25.16 ","$4.65 ","$34.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$34.00 ","$9.77 ","$25.98 ","$26.93 ","$27.20 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30201227","EAP","CPT� 82787","","Igg 1 2 3 Or 4 Each","BOTH IP/OP","$28.00 ","$20.72 ","$4.01 ","$28.00 ","$16.55 ","$4.01 ","$4.01 ","$11.71 ","$11.71 ","$11.84 ","$28.00 ","$8.42 ","$22.40 ","$22.18 ","$22.40 ","$11.63 ","$12.62 ","$8.02 ","$8.83 ","$8.02 "
"30201229","EAP","CPT� 86336","","Inhibin A","BOTH IP/OP","$128.00 ","$94.72 ","$7.79 ","$128.00 ","$26.74 ","$7.80 ","$7.79 ","$18.90 ","$18.90 ","$19.12 ","$128.00 ","$16.37 ","$36.18 ","$101.38 ","$102.40 ","$22.61 ","$20.37 ","$15.59 ","$14.26 ","$15.59 "
"30201231","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$383.00 ","$283.42 ","$7.77 ","$432.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$432.00 ","$18.13 ","$36.18 ","$342.14 ","$345.60 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201233","EAP","CPT� 83789","","Mass Spectrometry Quant","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$116.00 ","$0.00 ","$16.78 ","$91.87 ","$92.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201235","EAP","CPT� 86886","","Coombs Test Indirect Titer","BOTH IP/OP","$163.00 ","$120.62 ","$2.59 ","$163.00 ","$9.58 ","$146.06 ","$2.59 ","$6.79 ","$6.79 ","$6.87 ","$163.00 ","$143.92 ","$13.00 ","$129.10 ","$130.40 ","$163.00 ","$7.32 ","$5.18 ","$5.12 ","$137.07 "
"30201236","EAP","CPT� 86900","","Blood Typing, Serologic, Abo","BOTH IP/OP","$312.00 ","$230.88 ","$1.49 ","$328.00 ","$6.18 ","$110.43 ","$1.49 ","$4.35 ","$4.35 ","$4.41 ","$328.00 ","$109.35 ","$8.34 ","$259.78 ","$262.40 ","$151.93 ","$4.70 ","$2.99 ","$3.29 ","$104.14 "
"30201238","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$209.00 ","$154.66 ","$8.39 ","$210.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$210.00 ","$19.57 ","$33.64 ","$166.32 ","$168.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201248","EAP","CPT� 83630","","Lactoferrin Fecal (qual)","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$28.66 ","$28.66 ","$0.00 ","$164.00 ","$0.00 ","$54.84 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201250","EAP","CPT� 87278","","Legion Pneumophilia Ag If","BOTH IP/OP","$148.00 ","$109.52 ","$0.00 ","$148.00 ","$24.74 ","$7.80 ","$7.02 ","$17.52 ","$17.52 ","$0.00 ","$148.00 ","$0.00 ","$33.52 ","$117.22 ","$118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201252","EAP","CPT� 86717","","Leishmania Antibody","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$151.00 ","$0.00 ","$0.00 ","$0.00 ","$17.89 ","$17.89 ","$0.00 ","$151.00 ","$0.00 ","$34.24 ","$119.59 ","$120.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201254","EAP","CPT� 83690","","Assay Of Lipase","BOTH IP/OP","$83.00 ","$61.42 ","$3.44 ","$84.00 ","$14.23 ","$3.45 ","$3.44 ","$10.06 ","$10.06 ","$10.17 ","$84.00 ","$7.23 ","$19.24 ","$66.53 ","$67.20 ","$9.99 ","$10.84 ","$6.89 ","$7.59 ","$6.89 "
"30201256","EAP","CPT� 83695","","Assay Of Lipoprotein(a)","BOTH IP/OP","$109.00 ","$80.66 ","$6.48 ","$109.00 ","$26.72 ","$7.16 ","$6.48 ","$18.91 ","$18.91 ","$19.12 ","$109.00 ","$15.04 ","$36.18 ","$86.33 ","$87.20 ","$20.76 ","$20.37 ","$14.32 ","$14.26 ","$14.32 "
"30201258","EAP","CPT� 82465","","Assay Bld/serum Cholesterol","BOTH IP/OP","$9.00 ","$6.66 ","$2.18 ","$9.00 ","$8.98 ","$2.18 ","$2.18 ","$6.36 ","$6.36 ","$6.43 ","$9.00 ","$4.57 ","$9.00 ","$7.13 ","$7.20 ","$6.31 ","$6.85 ","$4.35 ","$4.79 ","$4.35 "
"30201259","EAP","CPT� 82664","","Electrophoretic Test","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$50.16 ","$50.75 ","$189.00 ","$64.58 ","$96.00 ","$149.69 ","$151.20 ","$89.18 ","$54.07 ","$61.50 ","$37.85 ","$61.50 "
"30201260","EAP","CPT� 84478","","Assay Of Triglycerides","BOTH IP/OP","$16.00 ","$11.84 ","$2.87 ","$18.00 ","$11.85 ","$2.87 ","$2.87 ","$8.40 ","$8.40 ","$7.46 ","$18.00 ","$6.03 ","$16.08 ","$14.26 ","$14.40 ","$8.32 ","$7.94 ","$5.74 ","$5.56 ","$5.74 "
"30201261","EAP","CPT� 84999","","Clinical Chemistry Test","BOTH IP/OP","$23.00 ","$17.02 ","$0.00 ","$24.00 ","$0.00 ","$4.09 ","$0.00 ","$17.13 ","$17.13 ","$4.20 ","$24.00 ","$0.00 ","$0.00 ","$19.01 ","$19.20 ","$0.00 ","$3.76 ","$0.00 ","$0.00 ","$0.00 "
"30201263","EAP","CPT� 86609","","Bacterium Antibody","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$0.00 ","$175.00 ","$0.00 ","$36.00 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201265","EAP","CPT� 86376","","Microsomal Antibody","BOTH IP/OP","$205.00 ","$151.70 ","$7.28 ","$205.00 ","$30.04 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$205.00 ","$15.28 ","$40.66 ","$162.36 ","$164.00 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30201267","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$107.00 ","$79.18 ","$5.76 ","$121.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$121.00 ","$12.11 ","$29.88 ","$95.83 ","$96.80 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201268","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$118.00 ","$87.32 ","$7.77 ","$133.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$133.00 ","$18.13 ","$36.18 ","$105.34 ","$106.40 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201269","EAP","CPT� 86038","","Antinuclear Antibodies","BOTH IP/OP","$72.00 ","$53.28 ","$6.04 ","$72.00 ","$24.95 ","$6.05 ","$6.04 ","$17.65 ","$17.65 ","$17.86 ","$72.00 ","$12.69 ","$33.78 ","$57.02 ","$57.60 ","$17.53 ","$19.03 ","$12.09 ","$13.32 ","$12.09 "
"30201270","EAP","CPT� 84160","","Assay Of Protein Any Source","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$7.56 ","$7.56 ","$0.00 ","$129.00 ","$0.00 ","$14.46 ","$102.17 ","$103.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201271","EAP","CPT� 86235","","Nuclear Antigen Antibody","BOTH IP/OP","$76.00 ","$56.24 ","$8.97 ","$93.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$93.00 ","$18.83 ","$50.12 ","$73.66 ","$74.40 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30201272","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$61.00 ","$45.14 ","$6.03 ","$76.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$76.00 ","$12.65 ","$33.68 ","$60.19 ","$60.80 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201273","EAP","CPT� 86376","","Microsomal Antibody","BOTH IP/OP","$57.00 ","$42.18 ","$7.28 ","$57.00 ","$30.04 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$57.00 ","$15.28 ","$40.66 ","$45.14 ","$45.60 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30201274","EAP","CPT� 86431","","Rheumatoid Factor Quant","BOTH IP/OP","$97.00 ","$71.78 ","$2.84 ","$97.00 ","$11.70 ","$2.84 ","$2.84 ","$8.29 ","$8.29 ","$8.39 ","$97.00 ","$5.95 ","$15.86 ","$76.82 ","$77.60 ","$8.22 ","$8.94 ","$5.67 ","$6.26 ","$5.67 "
"30201276","EAP","CPT� 86618","","Lyme Disease Antibody","BOTH IP/OP","$69.00 ","$51.06 ","$8.51 ","$70.00 ","$35.16 ","$8.52 ","$8.51 ","$24.87 ","$24.87 ","$25.16 ","$70.00 ","$17.88 ","$47.60 ","$55.44 ","$56.00 ","$24.69 ","$26.81 ","$17.03 ","$18.76 ","$17.03 "
"30201278","EAP","CPT� 87476","","Lyme Dis Dna Amp Probe","BOTH IP/OP","$387.00 ","$286.38 ","$0.00 ","$387.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$387.00 ","$0.00 ","$54.82 ","$306.50 ","$309.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201280","EAP","CPT� 87476","","Lyme Dis Dna Amp Probe","BOTH IP/OP","$387.00 ","$286.38 ","$0.00 ","$387.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$387.00 ","$0.00 ","$54.82 ","$306.50 ","$309.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201282","EAP","CPT� 86355","","B Cells Total Count","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$115.00 ","$39.62 ","$65.82 ","$91.08 ","$92.00 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30201283","EAP","CPT� 86357","","Nk Cells Total Count","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$115.00 ","$39.62 ","$65.82 ","$91.08 ","$92.00 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30201284","EAP","CPT� 86359","","T Cells Total Count","BOTH IP/OP","$111.00 ","$82.14 ","$18.86 ","$115.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$115.00 ","$39.62 ","$65.82 ","$91.08 ","$92.00 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30201285","EAP","CPT� 86360","","T Cell Absolute Count/ratio","BOTH IP/OP","$152.00 ","$112.48 ","$23.49 ","$158.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$158.00 ","$49.33 ","$131.30 ","$125.14 ","$126.40 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30201286","EAP","Custom 30201286","","Mac Sensitivity","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201287","EAP","CPT� 87190","","Microbe Suscept Mycobacteri","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$8.25 ","$8.25 ","$0.00 ","$32.00 ","$0.00 ","$15.80 ","$25.34 ","$25.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201289","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$266.00 ","$196.84 ","$10.71 ","$266.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$266.00 ","$22.49 ","$59.86 ","$210.67 ","$212.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201290","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$325.00 ","$240.50 ","$23.04 ","$325.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$325.00 ","$53.75 ","$112.22 ","$257.40 ","$260.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201295","EAP","CPT� 83825","","Assay Of Mercury","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$50.00 ","$17.07 ","$45.44 ","$39.60 ","$40.00 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30201297","EAP","CPT� 83825","","Assay Of Mercury","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.55 ","$8.13 ","$8.13 ","$23.74 ","$23.74 ","$24.02 ","$75.00 ","$17.07 ","$45.44 ","$59.40 ","$60.00 ","$23.58 ","$0.00 ","$16.26 ","$17.92 ","$16.26 "
"30201299","EAP","CPT� 83835","","Assay Of Metanephrines","BOTH IP/OP","$230.00 ","$170.20 ","$8.47 ","$230.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$230.00 ","$17.79 ","$47.34 ","$182.16 ","$184.00 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30201300","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$52.00 ","$38.48 ","$2.59 ","$52.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$52.00 ","$5.44 ","$14.46 ","$41.18 ","$41.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201302","EAP","CPT� 83835","","Assay Of Metanephrines","BOTH IP/OP","$573.00 ","$424.02 ","$8.47 ","$573.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$573.00 ","$17.79 ","$47.34 ","$453.82 ","$458.40 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30201304","EAP","CPT� 80358","","Assay Of Methadone","BOTH IP/OP","$187.00 ","$138.38 ","$0.00 ","$198.00 ","$0.03 ","$12.01 ","$10.03 ","$141.31 ","$141.31 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201306","EAP","CPT� 82542","","Column Chromotography Quant","BOTH IP/OP","$288.00 ","$213.12 ","$6.62 ","$288.00 ","$37.28 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$288.00 ","$25.29 ","$16.78 ","$228.10 ","$230.40 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30201310","EAP","CPT� 83921","","Organic Acid Single Quant","BOTH IP/OP","$289.00 ","$213.86 ","$9.54 ","$289.00 ","$33.95 ","$10.61 ","$9.54 ","$24.04 ","$24.04 ","$24.32 ","$289.00 ","$22.27 ","$46.00 ","$228.89 ","$231.20 ","$30.75 ","$25.91 ","$21.21 ","$18.14 ","$21.21 "
"30201312","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$1,254.00 ","$927.96 ","$8.28 ","$1,415.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$1,415.00 ","$19.32 ","$37.76 ","$1,120.68 ","$1,132.00 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201314","EAP","CPT� 87190","","Microbe Suscept Mycobacteri","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$0.00 ","$0.00 ","$0.00 ","$8.25 ","$8.25 ","$0.00 ","$41.00 ","$0.00 ","$15.80 ","$32.47 ","$32.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201316","EAP","CPT� 87581","","M.pneumon Dna Probe","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$522.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$0.00 ","$522.00 ","$0.00 ","$54.82 ","$413.42 ","$417.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201318","EAP","CPT� 83873","","Assay Of Csf Protein","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$0.00 ","$0.00 ","$0.00 ","$25.12 ","$25.12 ","$0.00 ","$54.00 ","$0.00 ","$48.08 ","$42.77 ","$43.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201320","EAP","CPT� 83874","","Assay Of Myoglobin","BOTH IP/OP","$54.00 ","$39.96 ","$6.46 ","$54.00 ","$26.66 ","$6.46 ","$6.46 ","$18.86 ","$18.86 ","$19.08 ","$54.00 ","$13.57 ","$36.08 ","$42.77 ","$43.20 ","$18.73 ","$20.33 ","$12.92 ","$14.23 ","$12.92 "
"30201322","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$367.00 ","$271.58 ","$6.03 ","$368.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$368.00 ","$12.65 ","$33.68 ","$291.46 ","$294.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201324","EAP","CPT� 80323","","Assay Of Nicotine","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$212.00 ","$0.03 ","$12.01 ","$18.43 ","$151.30 ","$151.30 ","$44.34 ","$212.00 ","$0.00 ","$106.00 ","$167.90 ","$169.60 ","$127.20 ","$47.25 ","$0.00 ","$33.07 ","$0.00 "
"30201326","EAP","CPT� 84999","","Clinical Chemistry Test","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$132.00 ","$0.00 ","$22.07 ","$0.00 ","$94.21 ","$94.21 ","$23.11 ","$132.00 ","$0.00 ","$0.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$0.00 ","$0.00 "
"30201328","EAP","CPT� 83945","","Assay Of Oxalate","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$26.58 ","$7.23 ","$6.50 ","$18.80 ","$18.80 ","$0.00 ","$48.00 ","$0.00 ","$35.98 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201330","EAP","CPT� 87279","","Parainfluenza Ag If","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$42.00 ","$0.00 ","$33.52 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201334","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$241.00 ","$178.34 ","$0.00 ","$241.00 ","$0.00 ","$0.00 ","$0.00 ","$17.60 ","$17.60 ","$17.81 ","$241.00 ","$12.65 ","$33.68 ","$190.87 ","$192.80 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201335","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$171.00 ","$126.54 ","$6.03 ","$214.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$214.00 ","$12.65 ","$33.68 ","$169.49 ","$171.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201336","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$133.00 ","$98.42 ","$6.03 ","$166.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$166.00 ","$12.65 ","$33.68 ","$131.47 ","$132.80 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201338","EAP","CPT� 87799","","Detect Agent Nos Dna Quant","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$626.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$626.00 ","$0.00 ","$119.70 ","$495.79 ","$500.80 ","$0.00 ","$97.97 ","$0.00 ","$0.00 ","$0.00 "
"30201340","EAP","CPT� 82657","","Enzyme Cell Activity","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$8.77 ","$8.77 ","$0.00 ","$228.00 ","$0.00 ","$16.78 ","$180.58 ","$182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201342","EAP","CPT� 83992","","Assay For Phencyclidine","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$269.00 ","$0.00 ","$0.00 ","$0.00 ","$21.46 ","$21.46 ","$0.00 ","$269.00 ","$0.00 ","$41.08 ","$213.05 ","$215.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201344","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$84.00 ","$62.16 ","$2.59 ","$84.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$84.00 ","$5.44 ","$14.46 ","$66.53 ","$67.20 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201345","EAP","CPT� 84600","","Assay Of Volatiles","BOTH IP/OP","$101.00 ","$74.74 ","$0.00 ","$101.00 ","$33.18 ","$8.56 ","$8.04 ","$23.47 ","$23.47 ","$0.00 ","$101.00 ","$0.00 ","$44.90 ","$79.99 ","$80.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201354","EAP","CPT� 84110","","Assay Of Porphobilinogen","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$0.00 ","$0.00 ","$0.00 ","$12.34 ","$12.34 ","$12.47 ","$54.00 ","$8.86 ","$23.60 ","$42.77 ","$43.20 ","$12.24 ","$13.29 ","$8.44 ","$9.30 ","$8.44 "
"30201358","EAP","CPT� 84120","","Assay Of Urine Porphyrins","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$7.36 ","$21.47 ","$21.47 ","$0.00 ","$55.00 ","$0.00 ","$41.10 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201362","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$414.00 ","$306.36 ","$8.39 ","$414.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$414.00 ","$19.57 ","$33.64 ","$327.89 ","$331.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201363","EAP","CPT� 84206","","Proinsulin So","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$26.01 ","$26.01 ","$26.31 ","$488.00 ","$28.02 ","$49.78 ","$386.50 ","$390.40 ","$38.70 ","$28.04 ","$26.69 ","$19.63 ","$26.69 "
"30201364","EAP","CPT� 84206","","Assay Of Proinsulin","BOTH IP/OP","$644.00 ","$476.56 ","$0.00 ","$644.00 ","$0.00 ","$0.00 ","$0.00 ","$26.01 ","$26.01 ","$26.31 ","$644.00 ","$28.02 ","$49.78 ","$510.05 ","$515.20 ","$38.70 ","$28.04 ","$26.69 ","$19.63 ","$26.69 "
"30201368","EAP","CPT� 85303","","Blood Clot Inhibitor Test;protein C,activity","BOTH IP/OP","$428.00 ","$316.72 ","$6.92 ","$428.00 ","$28.56 ","$6.92 ","$6.92 ","$20.19 ","$20.19 ","$20.43 ","$428.00 ","$14.53 ","$38.64 ","$338.98 ","$342.40 ","$20.07 ","$21.77 ","$13.84 ","$15.24 ","$13.84 "
"30201369","EAP","CPT� 85306","","Blood Clot Inhibitor Test;protein S,free","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$22.37 ","$22.37 ","$0.00 ","$513.00 ","$0.00 ","$42.82 ","$406.30 ","$410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201371","EAP","CPT� 85305","","Blood Clot Inhibitor Assay;protein S,total","BOTH IP/OP","$493.00 ","$364.82 ","$0.00 ","$493.00 ","$0.00 ","$0.00 ","$0.00 ","$16.93 ","$16.93 ","$0.00 ","$493.00 ","$0.00 ","$32.40 ","$390.46 ","$394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201373","EAP","CPT� 84153","","Assay Of Psa Total","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$32.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.47 ","$0.00 ","$0.00 ","$28.95 ","$0.00 ","$0.00 ","$0.00 "
"30201374","EAP","CPT� 84154","","Assay Of Psa Free","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$26.85 ","$26.85 ","$0.00 ","$42.00 ","$0.00 ","$42.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201376","EAP","CPT� 83970","","Assay Of Parathormone","BOTH IP/OP","$177.00 ","$130.98 ","$20.64 ","$177.00 ","$85.19 ","$20.64 ","$20.64 ","$60.27 ","$60.27 ","$60.97 ","$177.00 ","$43.34 ","$115.34 ","$140.18 ","$141.60 ","$59.86 ","$64.97 ","$41.28 ","$45.48 ","$41.28 "
"30201378","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$483.00 ","$357.42 ","$8.28 ","$545.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$545.00 ","$19.32 ","$37.76 ","$431.64 ","$436.00 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201380","EAP","CPT� 84220","","Assay Of Pyruvate Kinase","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$13.77 ","$13.77 ","$0.00 ","$232.00 ","$0.00 ","$26.36 ","$183.74 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201382","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$255.00 ","$188.70 ","$8.39 ","$255.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$255.00 ","$19.57 ","$33.64 ","$201.96 ","$204.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201384","EAP","CPT� 86317","","Immunoassay Infectious Agent","BOTH IP/OP","$143.00 ","$105.82 ","$7.49 ","$143.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$143.00 ","$15.74 ","$33.54 ","$113.26 ","$114.40 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30201386","EAP","CPT� 80195","","Assay Of Sirolimus","BOTH IP/OP","$279.00 ","$206.46 ","$0.00 ","$279.00 ","$0.00 ","$0.00 ","$0.00 ","$20.04 ","$20.04 ","$0.00 ","$279.00 ","$0.00 ","$38.34 ","$220.97 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201388","EAP","CPT� 87299","","Antibody Detection Nos If","BOTH IP/OP","$91.00 ","$67.34 ","$0.00 ","$91.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$91.00 ","$0.00 ","$33.52 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201390","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$96.00 ","$71.04 ","$2.61 ","$120.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$120.00 ","$5.48 ","$14.60 ","$95.04 ","$96.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201392","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$104.00 ","$76.96 ","$2.61 ","$130.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$130.00 ","$5.48 ","$14.60 ","$102.96 ","$104.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201478","EAP","CPT� 82480","","Assay Serum Cholinesterase","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$11.51 ","$11.51 ","$0.00 ","$42.00 ","$0.00 ","$22.02 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201479","EAP","CPT� 82482","","Assay Rbc Cholinesterase","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$11.22 ","$11.22 ","$0.00 ","$42.00 ","$0.00 ","$21.48 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201481","EAP","CPT� 85635","","Reptilase Test","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$14.38 ","$14.38 ","$0.00 ","$178.00 ","$0.00 ","$27.52 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201483","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$309.00 ","$228.66 ","$17.55 ","$372.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$372.00 ","$36.84 ","$54.82 ","$294.62 ","$297.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201485","EAP","CPT� 84482","","T3 Reverse","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$148.00 ","$32.52 ","$7.88 ","$7.88 ","$23.01 ","$23.01 ","$0.00 ","$148.00 ","$16.55 ","$44.04 ","$117.22 ","$118.40 ","$22.85 ","$0.00 ","$15.76 ","$17.36 ","$15.76 "
"30201487","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$199.00 ","$147.26 ","$5.76 ","$194.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$194.00 ","$12.11 ","$29.88 ","$153.65 ","$155.20 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201489","EAP","CPT� 86757","","Rickettsia Antibody","BOTH IP/OP","$78.00 ","$57.72 ","$0.00 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$98.00 ","$0.00 ","$54.10 ","$77.62 ","$78.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201493","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$171.00 ","$126.54 ","$8.39 ","$172.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$172.00 ","$19.57 ","$33.64 ","$136.22 ","$137.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201495","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$211.00 ","$156.14 ","$7.77 ","$205.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$205.00 ","$18.13 ","$36.18 ","$162.36 ","$164.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201497","EAP","CPT� 86671","","Fungus Antibody","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$100.00 ","$12.86 ","$34.26 ","$79.20 ","$80.00 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30201499","EAP","CPT� 86671","","Fungus Antibody","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$47.00 ","$12.86 ","$34.26 ","$37.22 ","$37.60 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30201501","EAP","CPT� 86682","","Helminth Antibody","BOTH IP/OP","$192.00 ","$142.08 ","$6.50 ","$192.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$192.00 ","$13.66 ","$36.34 ","$152.06 ","$153.60 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30201503","EAP","CPT� 84255","","Assay Of Selenium","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$98.00 ","$52.69 ","$12.77 ","$12.77 ","$37.27 ","$37.27 ","$0.00 ","$98.00 ","$0.00 ","$71.34 ","$77.62 ","$78.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201505","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$72.00 ","$53.28 ","$2.59 ","$72.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$72.00 ","$5.44 ","$14.46 ","$57.02 ","$57.60 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201506","EAP","CPT� 84255","","Assay Of Selenium","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$52.69 ","$12.77 ","$12.77 ","$37.27 ","$37.27 ","$0.00 ","$71.00 ","$0.00 ","$71.00 ","$56.23 ","$56.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201508","EAP","CPT� 84270","","Assay Of Sex Hormone Globul","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$10.87 ","$31.73 ","$31.73 ","$0.00 ","$42.00 ","$0.00 ","$42.00 ","$33.26 ","$33.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201510","EAP","CPT� 86609","","Bacterium Antibody","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$24.00 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$0.00 ","$24.00 ","$0.00 ","$24.00 ","$19.01 ","$19.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201512","EAP","CPT� 86403","","Particle Agglutination Test","BOTH IP/OP","$203.00 ","$150.22 ","$5.19 ","$203.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$203.00 ","$12.12 ","$28.48 ","$160.78 ","$162.40 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30201514","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$198.00 ","$146.52 ","$8.39 ","$198.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$198.00 ","$19.57 ","$33.64 ","$156.82 ","$158.40 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201516","EAP","CPT� 87186","","Microbe Susceptible Mic","BOTH IP/OP","$323.00 ","$239.02 ","$4.32 ","$323.00 ","$17.85 ","$4.33 ","$4.32 ","$12.62 ","$12.62 ","$12.77 ","$323.00 ","$9.08 ","$24.16 ","$255.82 ","$258.40 ","$12.54 ","$13.60 ","$8.65 ","$9.52 ","$8.65 "
"30201522","EAP","CPT� 86780","","Treponema Pallidum","BOTH IP/OP","$93.00 ","$68.82 ","$6.62 ","$107.00 ","$27.32 ","$6.62 ","$6.62 ","$18.97 ","$18.97 ","$18.73 ","$107.00 ","$13.90 ","$53.50 ","$84.74 ","$85.60 ","$19.20 ","$16.75 ","$13.24 ","$17.03 ","$13.24 "
"30201524","EAP","CPT� 84482","","T3 Reverse","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$148.00 ","$32.52 ","$7.88 ","$7.88 ","$23.01 ","$23.01 ","$0.00 ","$148.00 ","$16.55 ","$44.04 ","$117.22 ","$118.40 ","$22.85 ","$0.00 ","$15.76 ","$17.36 ","$15.76 "
"30201531","EAP","CPT� 82040","","Assay Of Serum Albumin","BOTH IP/OP","$8.00 ","$5.92 ","$2.48 ","$8.00 ","$5.94 ","$2.48 ","$2.48 ","$4.20 ","$4.20 ","$4.25 ","$8.00 ","$5.20 ","$8.00 ","$6.34 ","$6.40 ","$7.18 ","$4.53 ","$4.95 ","$3.17 ","$4.95 "
"30201532","EAP","CPT� 84270","","Assay Of Sex Hormone Globul","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$0.00 ","$0.00 ","$10.87 ","$31.73 ","$31.73 ","$0.00 ","$38.00 ","$0.00 ","$38.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201533","EAP","CPT� 84403","","Assay Of Total Testosterone","BOTH IP/OP","$52.00 ","$38.48 ","$12.91 ","$52.00 ","$52.00 ","$12.91 ","$12.91 ","$37.70 ","$37.70 ","$38.15 ","$52.00 ","$27.10 ","$52.00 ","$41.18 ","$41.60 ","$37.42 ","$40.65 ","$25.81 ","$28.45 ","$25.81 "
"30201535","EAP","CPT� 84402","","Assay Of Testosterone","BOTH IP/OP","$50.00 ","$37.00 ","$12.74 ","$50.00 ","$50.00 ","$12.74 ","$12.74 ","$37.18 ","$37.18 ","$37.60 ","$50.00 ","$26.74 ","$50.00 ","$39.60 ","$40.00 ","$36.93 ","$40.06 ","$25.47 ","$28.04 ","$25.47 "
"30201536","EAP","CPT� 84403","","Assay Of Total Testosterone","BOTH IP/OP","$50.00 ","$37.00 ","$12.91 ","$50.00 ","$50.00 ","$12.91 ","$12.91 ","$37.70 ","$37.70 ","$38.15 ","$50.00 ","$27.10 ","$50.00 ","$39.60 ","$40.00 ","$37.42 ","$40.65 ","$25.81 ","$28.45 ","$25.81 "
"30201538","EAP","CPT� 84402","","Assay Of Testosterone","BOTH IP/OP","$50.00 ","$37.00 ","$12.74 ","$50.00 ","$50.00 ","$12.74 ","$12.74 ","$37.18 ","$37.18 ","$37.60 ","$50.00 ","$26.74 ","$50.00 ","$39.60 ","$40.00 ","$36.93 ","$40.06 ","$25.47 ","$28.04 ","$25.47 "
"30201540","EAP","CPT� 86744","","Nocardia Antibody","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$93.00 ","$0.00 ","$36.86 ","$73.66 ","$74.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201542","EAP","CPT� 83018","","Quantitative Screen Metals","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$0.00 ","$0.00 ","$0.00 ","$32.06 ","$32.06 ","$0.00 ","$259.00 ","$0.00 ","$61.36 ","$205.13 ","$207.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201544","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$101.00 ","$74.74 ","$2.59 ","$101.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$101.00 ","$5.44 ","$14.46 ","$79.99 ","$80.80 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201545","EAP","CPT� 84430","","Assay Of Thiocyanate","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$0.00 ","$0.00 ","$0.00 ","$8.42 ","$8.42 ","$0.00 ","$133.00 ","$0.00 ","$16.12 ","$105.34 ","$106.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201546","EAP","CPT� 84445","","Thyroid Stimulating Immunoglobulin So","BOTH IP/OP","$135.00 ","$99.90 ","$9.34 ","$135.00 ","$17.48 ","$25.43 ","$25.43 ","$12.36 ","$12.36 ","$12.52 ","$135.00 ","$53.40 ","$23.66 ","$106.92 ","$108.00 ","$73.75 ","$13.34 ","$50.86 ","$9.34 ","$50.86 "
"30201547","EAP","CPT� 84445","","Assay Of Tsi","BOTH IP/OP","$172.00 ","$127.28 ","$9.34 ","$172.00 ","$17.48 ","$25.43 ","$25.43 ","$12.36 ","$12.36 ","$12.52 ","$172.00 ","$53.40 ","$23.66 ","$136.22 ","$137.60 ","$73.75 ","$13.34 ","$50.86 ","$9.34 ","$50.86 "
"30201549","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$416.00 ","$307.84 ","$8.28 ","$405.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$405.00 ","$19.32 ","$37.76 ","$320.76 ","$324.00 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201551","EAP","CPT� 86682","","Helminth Antibody","BOTH IP/OP","$69.00 ","$51.06 ","$6.50 ","$70.00 ","$26.85 ","$6.51 ","$6.50 ","$18.99 ","$18.99 ","$19.20 ","$70.00 ","$13.66 ","$36.34 ","$55.44 ","$56.00 ","$18.86 ","$20.46 ","$13.01 ","$14.32 ","$13.01 "
"30201553","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$442.00 ","$327.08 ","$17.55 ","$533.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$533.00 ","$36.84 ","$54.82 ","$422.14 ","$426.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201555","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$242.00 ","$179.08 ","$8.39 ","$242.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$242.00 ","$19.57 ","$33.64 ","$191.66 ","$193.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201559","EAP","CPT� 86753","","Prorozoa Antibody Nos","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$18.09 ","$18.09 ","$0.00 ","$39.00 ","$0.00 ","$34.64 ","$30.89 ","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201561","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$211.00 ","$156.14 ","$7.77 ","$238.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$238.00 ","$18.13 ","$36.18 ","$188.50 ","$190.40 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201563","EAP","CPT� 87799","","Detect Agent Nos Dna Quant","BOTH IP/OP","$968.00 ","$716.32 ","$0.00 ","$956.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$956.00 ","$0.00 ","$119.70 ","$757.15 ","$764.80 ","$0.00 ","$149.61 ","$0.00 ","$0.00 ","$0.00 "
"30201565","EAP","CPT� 84425","","Assay Of Vitamin B-1","BOTH IP/OP","$102.00 ","$75.48 ","$10.62 ","$102.00 ","$43.82 ","$10.62 ","$10.62 ","$31.01 ","$31.01 ","$31.36 ","$102.00 ","$22.29 ","$59.34 ","$80.78 ","$81.60 ","$30.78 ","$33.42 ","$21.23 ","$23.39 ","$21.23 "
"30201566","EAP","CPT� 84425","","Vitamin B1 Plasma (thiamine) So","BOTH IP/OP","$65.00 ","$48.10 ","$10.62 ","$65.00 ","$43.82 ","$10.62 ","$10.62 ","$31.01 ","$31.01 ","$31.36 ","$65.00 ","$22.29 ","$59.34 ","$51.48 ","$52.00 ","$30.78 ","$33.42 ","$21.23 ","$23.39 ","$21.23 "
"30201567","EAP","CPT� 84425","","Assay Of Vitamin B-1","BOTH IP/OP","$157.00 ","$116.18 ","$10.62 ","$157.00 ","$43.82 ","$10.62 ","$10.62 ","$31.01 ","$31.01 ","$31.36 ","$157.00 ","$22.29 ","$59.34 ","$124.34 ","$125.60 ","$30.78 ","$33.42 ","$21.23 ","$23.39 ","$21.23 "
"30201569","EAP","CPT� 84597","","Assay Of Vitamin K","BOTH IP/OP","$566.00 ","$418.84 ","$0.00 ","$566.00 ","$0.00 ","$0.00 ","$0.00 ","$20.01 ","$20.01 ","$0.00 ","$566.00 ","$0.00 ","$38.30 ","$448.27 ","$452.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201571","EAP","CPT� 84591","","Assay Of Nos Vitamin","BOTH IP/OP","$121.00 ","$89.54 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$0.00 ","$16.93 ","$16.93 ","$0.00 ","$121.00 ","$0.00 ","$32.40 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201573","EAP","CPT� 84207","","Assay Of Vtamin B-6","BOTH IP/OP","$452.00 ","$334.48 ","$0.00 ","$452.00 ","$0.00 ","$0.00 ","$0.00 ","$41.02 ","$41.02 ","$0.00 ","$452.00 ","$0.00 ","$78.50 ","$357.98 ","$361.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201575","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$24.00 ","$17.76 ","$2.59 ","$24.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$24.00 ","$5.44 ","$14.46 ","$19.01 ","$19.20 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201576","EAP","CPT� 84585","","Assay Of Urine Vma","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$22.64 ","$22.64 ","$0.00 ","$30.00 ","$0.00 ","$30.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201578","EAP","CPT� 85247","","Blood Clot Factor Viii Test","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$33.51 ","$33.51 ","$0.00 ","$298.00 ","$0.00 ","$64.12 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201580","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$402.00 ","$297.48 ","$8.39 ","$404.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$404.00 ","$19.57 ","$33.64 ","$319.97 ","$323.20 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201581","EAP","CPT� 86788","","West Nile Ab Csf So","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$8.42 ","$24.60 ","$24.60 ","$0.00 ","$176.00 ","$0.00 ","$47.08 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201582","EAP","CPT� 86788","","West Nile Virus Ag Igm","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$8.42 ","$24.60 ","$24.60 ","$0.00 ","$300.00 ","$0.00 ","$47.08 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201583","EAP","CPT� 86789","","West Nile Virus Antibody","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$0.00 ","$300.00 ","$0.00 ","$32.52 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201584","EAP","CPT� 86788","","West Nile Ab Serum So","BOTH IP/OP","$162.00 ","$119.88 ","$0.00 ","$148.00 ","$0.00 ","$0.00 ","$8.42 ","$24.60 ","$24.60 ","$0.00 ","$148.00 ","$0.00 ","$47.08 ","$117.22 ","$118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201585","EAP","CPT� 86788","","West Nile Virus Ag Igm","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$8.42 ","$24.60 ","$24.60 ","$0.00 ","$120.00 ","$0.00 ","$47.08 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201586","EAP","CPT� 86789","","West Nile Virus Antibody","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$0.00 ","$120.00 ","$0.00 ","$32.52 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201588","EAP","CPT� 84311","","Spectrophotometry","BOTH IP/OP","$239.00 ","$176.86 ","$0.00 ","$241.00 ","$0.00 ","$0.00 ","$0.00 ","$10.20 ","$10.20 ","$10.32 ","$241.00 ","$8.51 ","$19.54 ","$190.87 ","$192.80 ","$11.75 ","$11.00 ","$8.10 ","$7.70 ","$8.10 "
"30201590","EAP","CPT� 82570","","Assay Of Urine Creatinine","BOTH IP/OP","$68.00 ","$50.32 ","$2.59 ","$68.00 ","$10.69 ","$2.59 ","$2.59 ","$7.56 ","$7.56 ","$7.64 ","$68.00 ","$5.44 ","$14.46 ","$53.86 ","$54.40 ","$7.51 ","$8.14 ","$5.18 ","$5.70 ","$5.18 "
"30201591","EAP","CPT� 83497","","Assay Of 5-hiaa","BOTH IP/OP","$147.00 ","$108.78 ","$6.45 ","$147.00 ","$26.61 ","$6.45 ","$6.45 ","$18.83 ","$18.83 ","$19.05 ","$147.00 ","$13.55 ","$36.02 ","$116.42 ","$117.60 ","$18.71 ","$20.30 ","$12.90 ","$14.21 ","$12.90 "
"30201593","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$288.00 ","$213.12 ","$5.76 ","$280.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$280.00 ","$12.11 ","$29.88 ","$221.76 ","$224.00 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201601","EAP","CPT� 88360","","Tumor Immunohistochem/manual","BOTH IP/OP","$310.00 ","$229.40 ","$58.38 ","$310.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$310.00 ","$143.92 ","$121.34 ","$245.52 ","$248.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30201612","EAP","CPT� 88381","","Microdissection Manual","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$210.18 ","$29.00 ","$0.00 ","$70.38 ","$155.30 ","$155.30 ","$197.25 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$210.18 ","$156.67 ","$147.12 ","$0.00 "
"30201614","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$272.00 ","$201.28 ","$5.76 ","$265.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$265.00 ","$12.11 ","$29.88 ","$209.88 ","$212.00 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201616","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$408.00 ","$301.92 ","$5.76 ","$460.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$460.00 ","$12.11 ","$29.88 ","$364.32 ","$368.00 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201618","EAP","CPT� 87538","","Hiv-2 Dna Amp Probe","BOTH IP/OP","$521.00 ","$385.54 ","$17.55 ","$506.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$88.60 ","$506.00 ","$36.84 ","$54.82 ","$400.75 ","$404.80 ","$50.88 ","$79.19 ","$35.09 ","$80.56 ","$35.09 "
"30201620","EAP","CPT� 84432","","Assay Of Thyroglobulin","BOTH IP/OP","$213.00 ","$157.62 ","$8.03 ","$213.00 ","$33.16 ","$8.03 ","$8.03 ","$23.45 ","$23.45 ","$23.73 ","$213.00 ","$16.86 ","$44.88 ","$168.70 ","$170.40 ","$23.29 ","$25.28 ","$16.06 ","$17.70 ","$16.06 "
"30201628","EAP","CPT� 86317","","Immunoassay Infectious Agent","BOTH IP/OP","$36.00 ","$26.64 ","$7.49 ","$33.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$33.00 ","$15.74 ","$33.00 ","$26.14 ","$26.40 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30201630","EAP","CPT� 86382","","Neutralization Test Viral","BOTH IP/OP","$46.00 ","$34.04 ","$0.00 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$24.69 ","$24.69 ","$0.00 ","$46.00 ","$0.00 ","$46.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201632","EAP","CPT� 83088","","Assay Of Histamine","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$43.12 ","$43.12 ","$0.00 ","$76.00 ","$0.00 ","$76.00 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201634","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$69.00 ","$51.06 ","$10.71 ","$69.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$69.00 ","$22.49 ","$59.86 ","$54.65 ","$55.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201635","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$137.00 ","$101.38 ","$23.04 ","$137.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$137.00 ","$53.75 ","$112.22 ","$108.50 ","$109.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201638","EAP","CPT� 88272","","Cytogenetics 3-5","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$55.28 ","$20.35 ","$18.32 ","$39.09 ","$39.09 ","$0.00 ","$508.00 ","$0.00 ","$74.82 ","$402.34 ","$406.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201640","EAP","CPT� 86787","","Varicella-zoster Antibody","BOTH IP/OP","$183.00 ","$135.42 ","$6.44 ","$185.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$185.00 ","$13.52 ","$36.00 ","$146.52 ","$148.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201642","EAP","CPT� 88360","","Tumor Immunohistoche/manual","BOTH IP/OP","$297.00 ","$219.78 ","$58.38 ","$297.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$297.00 ","$143.92 ","$121.34 ","$235.22 ","$237.60 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30201650","EAP","CPT� 86694","","Herpes Simplex Test","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$16.99 ","$16.99 ","$17.19 ","$150.00 ","$15.11 ","$32.52 ","$118.80 ","$120.00 ","$20.87 ","$18.31 ","$14.39 ","$12.82 ","$14.39 "
"30201652","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$62.00 ","$45.88 ","$10.71 ","$62.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$62.00 ","$22.49 ","$59.86 ","$49.10 ","$49.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201653","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$151.00 ","$111.74 ","$23.04 ","$151.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$151.00 ","$53.75 ","$112.22 ","$119.59 ","$120.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201656","EAP","CPT� 86382","","Neutralization Test Viral","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$24.69 ","$24.69 ","$0.00 ","$47.00 ","$0.00 ","$47.00 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201658","EAP","CPT� 86317","","Immunoassay Infectious Agent","BOTH IP/OP","$33.00 ","$24.42 ","$7.49 ","$33.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$33.00 ","$15.74 ","$33.00 ","$26.14 ","$26.40 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30201660","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$77.00 ","$56.98 ","$10.71 ","$77.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$77.00 ","$22.49 ","$59.86 ","$60.98 ","$61.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201661","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$117.00 ","$86.58 ","$23.04 ","$117.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$117.00 ","$53.75 ","$112.22 ","$92.66 ","$93.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201664","EAP","CPT� 83516","","Immunoassay Nonantibody","BOTH IP/OP","$256.00 ","$189.44 ","$5.76 ","$289.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$289.00 ","$12.11 ","$29.88 ","$228.89 ","$231.20 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201665","EAP","CPT� 82784","","Assay Iga/igd/igg/igm Each","BOTH IP/OP","$28.00 ","$20.72 ","$4.65 ","$28.00 ","$19.19 ","$4.65 ","$4.65 ","$13.58 ","$13.58 ","$13.73 ","$28.00 ","$9.77 ","$25.98 ","$22.18 ","$22.40 ","$13.49 ","$14.63 ","$9.30 ","$10.24 ","$9.30 "
"30201667","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$85.00 ","$62.90 ","$10.71 ","$85.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$85.00 ","$22.49 ","$59.86 ","$67.32 ","$68.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201668","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$139.00 ","$102.86 ","$23.04 ","$139.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$139.00 ","$53.75 ","$112.22 ","$110.09 ","$111.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201671","EAP","CPT� 86817","","Hla Typing Dr/dq","BOTH IP/OP","$1,108.00 ","$819.92 ","$0.00 ","$1,108.00 ","$0.00 ","$0.00 ","$0.00 ","$94.00 ","$94.00 ","$0.00 ","$1,108.00 ","$0.00 ","$179.90 ","$877.54 ","$886.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201672","EAP","CPT� 86813","","Hla Typing A B Or C","BOTH IP/OP","$1,254.00 ","$927.96 ","$0.00 ","$1,254.00 ","$0.00 ","$0.00 ","$0.00 ","$84.66 ","$84.66 ","$0.00 ","$1,254.00 ","$0.00 ","$162.04 ","$993.17 ","$1,003.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201673","EAP","CPT� 86808","","Cytotoxic Antibody Screening","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$349.00 ","$0.00 ","$0.00 ","$0.00 ","$43.33 ","$43.33 ","$0.00 ","$349.00 ","$0.00 ","$82.94 ","$276.41 ","$279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201687","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$102.00 ","$75.48 ","$10.71 ","$102.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$102.00 ","$22.49 ","$59.86 ","$80.78 ","$81.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201688","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$176.00 ","$130.24 ","$23.04 ","$176.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$176.00 ","$53.75 ","$112.22 ","$139.39 ","$140.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201691","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$659.00 ","$487.66 ","$6.03 ","$660.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$660.00 ","$12.65 ","$33.68 ","$522.72 ","$528.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201693","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$1,170.00 ","$865.80 ","$8.28 ","$1,320.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$1,320.00 ","$19.32 ","$37.76 ","$1,045.44 ","$1,056.00 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201706","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$182.00 ","$134.68 ","$7.77 ","$205.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$205.00 ","$18.13 ","$36.18 ","$162.36 ","$164.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201707","EAP","CPT� 86021","","Wbc Antibody Identification","BOTH IP/OP","$92.00 ","$68.08 ","$7.53 ","$92.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$92.00 ","$15.80 ","$42.06 ","$72.86 ","$73.60 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30201708","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$83.00 ","$61.42 ","$6.03 ","$104.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$104.00 ","$12.65 ","$33.68 ","$82.37 ","$83.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201709","EAP","CPT� 86609","","Bacterium Antibody","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$0.00 ","$84.00 ","$0.00 ","$36.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201710","EAP","CPT� 86671","","Fungus Antibody","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$17.90 ","$17.90 ","$18.11 ","$83.00 ","$12.86 ","$34.26 ","$65.74 ","$66.40 ","$17.76 ","$19.30 ","$12.25 ","$13.51 ","$12.25 "
"30201711","EAP","CPT� 86689","","Hiv-2 Wb","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$207.00 ","$0.00 ","$54.10 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201712","EAP","CPT� 86038","","Antinuclear Antibodies","BOTH IP/OP","$24.00 ","$17.76 ","$6.04 ","$24.00 ","$24.00 ","$6.05 ","$6.04 ","$17.65 ","$17.65 ","$17.86 ","$24.00 ","$12.69 ","$24.00 ","$19.01 ","$19.20 ","$17.53 ","$19.03 ","$12.09 ","$13.32 ","$12.09 "
"30201713","EAP","CPT� 86376","","Microsomal Antibody","BOTH IP/OP","$49.00 ","$36.26 ","$7.28 ","$49.00 ","$30.04 ","$7.28 ","$7.28 ","$21.25 ","$21.25 ","$21.49 ","$49.00 ","$15.28 ","$40.66 ","$38.81 ","$39.20 ","$21.10 ","$22.90 ","$14.55 ","$16.03 ","$14.55 "
"30201714","EAP","CPT� 86658","","Enterovirus Antibody","BOTH IP/OP","$27.00 ","$19.98 ","$6.51 ","$27.00 ","$26.90 ","$6.52 ","$6.51 ","$19.03 ","$19.03 ","$19.25 ","$27.00 ","$13.68 ","$27.00 ","$21.38 ","$21.60 ","$18.89 ","$20.51 ","$13.03 ","$14.36 ","$13.03 "
"30201715","EAP","CPT� 86652","","Antibody Encephalitis, Eastern Equine","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201718","EAP","CPT� 86765","","Rubeola Antibody","BOTH IP/OP","$31.00 ","$22.94 ","$6.44 ","$31.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$31.00 ","$13.52 ","$31.00 ","$24.55 ","$24.80 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201719","EAP","CPT� 86653","","Encephalitis Antibody","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201720","EAP","CPT� 86787","","Varicella-zoster Antibody","BOTH IP/OP","$29.00 ","$21.46 ","$6.44 ","$29.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$29.00 ","$13.52 ","$29.00 ","$22.97 ","$23.20 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201721","EAP","CPT� 86654","","Encephalitis Antibody","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$25.00 ","$0.00 ","$25.00 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201722","EAP","CPT� 86645","","Cmv Antibody Igm","BOTH IP/OP","$35.00 ","$25.90 ","$8.42 ","$35.00 ","$34.77 ","$8.43 ","$8.42 ","$24.60 ","$24.60 ","$24.90 ","$35.00 ","$17.69 ","$35.00 ","$27.72 ","$28.00 ","$24.43 ","$26.53 ","$16.85 ","$18.57 ","$16.85 "
"30201724","EAP","CPT� 86403","","Particle Agglutination Test","BOTH IP/OP","$90.00 ","$66.60 ","$5.19 ","$90.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$90.00 ","$12.12 ","$28.48 ","$71.28 ","$72.00 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30201725","EAP","CPT� 86406","","Particle Agglutination Test","BOTH IP/OP","$136.00 ","$100.64 ","$0.00 ","$136.00 ","$0.00 ","$0.00 ","$5.32 ","$15.53 ","$15.53 ","$15.72 ","$136.00 ","$11.17 ","$29.74 ","$107.71 ","$108.80 ","$15.43 ","$16.75 ","$10.64 ","$11.72 ","$10.64 "
"30201726","EAP","CPT� 86403","","Particle Agglutination Test","BOTH IP/OP","$99.00 ","$73.26 ","$5.19 ","$99.00 ","$21.04 ","$5.77 ","$5.19 ","$14.88 ","$14.88 ","$11.75 ","$99.00 ","$12.12 ","$28.48 ","$78.41 ","$79.20 ","$16.73 ","$12.52 ","$11.54 ","$8.76 ","$11.54 "
"30201727","EAP","CPT� 88342","","Immunohistochemistry","BOTH IP/OP","$275.00 ","$203.50 ","$48.82 ","$278.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$278.00 ","$143.92 ","$106.46 ","$220.18 ","$222.40 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"30201728","EAP","CPT� 88360","","Tumor Immunohistochem/manual","BOTH IP/OP","$638.00 ","$472.12 ","$58.38 ","$638.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$638.00 ","$143.92 ","$121.34 ","$505.30 ","$510.40 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"30201729","EAP","CPT� 86256","","Fluorescent Antibody Titer","BOTH IP/OP","$131.00 ","$96.94 ","$6.03 ","$131.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$131.00 ","$12.65 ","$33.68 ","$103.75 ","$104.80 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201730","EAP","CPT� 88368","","Insitu Hybridization Manual","BOTH IP/OP","$454.00 ","$335.96 ","$58.22 ","$454.00 ","$178.36 ","$285.22 ","$58.22 ","$145.54 ","$145.54 ","$199.20 ","$454.00 ","$284.24 ","$207.74 ","$359.57 ","$363.20 ","$394.92 ","$212.25 ","$90.40 ","$148.57 ","$270.71 "
"30201731","EAP","CPT� 88342","","Immunohistochemistry","BOTH IP/OP","$556.00 ","$411.44 ","$48.82 ","$556.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$556.00 ","$143.92 ","$106.46 ","$440.35 ","$444.80 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"30201735","EAP","CPT� 86022","","Nait Platelet Ab (so)","BOTH IP/OP","$361.00 ","$267.14 ","$0.00 ","$361.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$361.00 ","$0.00 ","$51.32 ","$285.91 ","$288.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201736","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$27.00 ","$19.98 ","$6.03 ","$34.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$34.00 ","$12.65 ","$33.68 ","$26.93 ","$27.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201737","EAP","CPT� 86727","","Lymph Choriomeningitis Ab","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$18.79 ","$18.79 ","$0.00 ","$19.00 ","$0.00 ","$19.00 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201738","EAP","CPT� 84181","","Western Blot Test","BOTH IP/OP","$316.00 ","$233.84 ","$0.00 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$24.87 ","$24.87 ","$0.00 ","$316.00 ","$0.00 ","$47.60 ","$250.27 ","$252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201750","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$337.00 ","$249.38 ","$8.39 ","$337.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$337.00 ","$19.57 ","$33.64 ","$266.90 ","$269.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201754","EAP","CPT� 82985","","Glycated Protein","BOTH IP/OP","$148.00 ","$109.52 ","$7.54 ","$149.00 ","$31.13 ","$8.38 ","$7.54 ","$22.01 ","$22.01 ","$22.26 ","$149.00 ","$17.60 ","$42.12 ","$118.01 ","$119.20 ","$24.30 ","$23.72 ","$16.76 ","$16.60 ","$16.76 "
"30201758","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$82.00 ","$60.68 ","$8.28 ","$93.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$93.00 ","$19.32 ","$37.76 ","$73.66 ","$74.40 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201759","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$35.00 ","$25.90 ","$6.03 ","$44.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$44.00 ","$12.65 ","$33.68 ","$34.85 ","$35.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201760","EAP","CPT� 86256","","Fluorescent Antibody Titer","BOTH IP/OP","$35.00 ","$25.90 ","$6.03 ","$44.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$44.00 ","$12.65 ","$33.68 ","$34.85 ","$35.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201761","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$104.00 ","$76.96 ","$2.61 ","$130.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$130.00 ","$5.48 ","$14.60 ","$102.96 ","$104.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201762","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$359.00 ","$265.66 ","$8.28 ","$349.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$349.00 ","$19.32 ","$37.76 ","$276.41 ","$279.20 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201766","EAP","CPT� 87186","","Microbe Susceptible Mic","BOTH IP/OP","$271.00 ","$200.54 ","$4.32 ","$271.00 ","$17.85 ","$4.33 ","$4.32 ","$12.62 ","$12.62 ","$12.77 ","$271.00 ","$9.08 ","$24.16 ","$214.63 ","$216.80 ","$12.54 ","$13.60 ","$8.65 ","$9.52 ","$8.65 "
"30201767","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$504.00 ","$372.96 ","$7.77 ","$490.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$490.00 ","$18.13 ","$36.18 ","$388.08 ","$392.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201768","EAP","CPT� 82107","","Alpha-fetoprotein 13","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$94.04 ","$94.04 ","$0.00 ","$276.00 ","$0.00 ","$179.98 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201769","EAP","CPT� 87496","","Cytomeg Dna Amp Probe","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$206.00 ","$0.00 ","$0.00 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$206.00 ","$36.84 ","$54.82 ","$163.15 ","$164.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201770","EAP","CPT� 82374","","Assay Blood Carbon Dioxide","BOTH IP/OP","$91.00 ","$67.34 ","$2.44 ","$91.00 ","$10.08 ","$2.44 ","$2.44 ","$7.14 ","$7.14 ","$7.22 ","$91.00 ","$5.12 ","$13.66 ","$72.07 ","$72.80 ","$7.08 ","$7.70 ","$4.88 ","$5.39 ","$4.88 "
"30201771","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$55.00 ","$40.70 ","$6.03 ","$69.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$69.00 ","$12.65 ","$33.68 ","$54.65 ","$55.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201772","EAP","CPT� 86256","","Fluorescent Antibody Titer","BOTH IP/OP","$55.00 ","$40.70 ","$6.03 ","$69.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$69.00 ","$12.65 ","$33.68 ","$54.65 ","$55.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201773","EAP","CPT� 82310","","Assay Of Calcium","BOTH IP/OP","$35.00 ","$25.90 ","$2.58 ","$36.00 ","$10.67 ","$2.58 ","$2.58 ","$7.53 ","$7.53 ","$7.46 ","$36.00 ","$5.42 ","$14.40 ","$28.51 ","$28.80 ","$7.48 ","$7.94 ","$5.16 ","$5.56 ","$5.16 "
"30201774","EAP","CPT� 83970","","Assay Of Parathormone","BOTH IP/OP","$71.00 ","$52.54 ","$20.64 ","$71.00 ","$71.00 ","$20.64 ","$20.64 ","$60.27 ","$60.27 ","$60.97 ","$71.00 ","$43.34 ","$71.00 ","$56.23 ","$56.80 ","$59.86 ","$64.97 ","$41.28 ","$45.48 ","$41.28 "
"30201786","EAP","CPT� 84146","","Assay Of Prolactin","BOTH IP/OP","$73.00 ","$54.02 ","$9.69 ","$73.00 ","$40.00 ","$9.69 ","$9.69 ","$28.30 ","$28.30 ","$28.63 ","$73.00 ","$20.35 ","$54.16 ","$57.82 ","$58.40 ","$28.10 ","$30.51 ","$19.38 ","$21.36 ","$19.38 "
"30201789","EAP","CPT� 83520","","Immunoassay Quant Nos Nonab","BOTH IP/OP","$346.00 ","$256.04 ","$7.77 ","$390.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$390.00 ","$18.13 ","$36.18 ","$308.88 ","$312.00 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30201790","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$262.00 ","$193.88 ","$17.55 ","$316.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$316.00 ","$36.84 ","$54.82 ","$250.27 ","$252.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201793","EAP","CPT� 86698","","Histoplasma","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$6.25 ","$18.25 ","$18.25 ","$18.46 ","$26.00 ","$14.48 ","$26.00 ","$20.59 ","$20.80 ","$20.00 ","$19.67 ","$13.79 ","$13.77 ","$13.79 "
"30201797","EAP","CPT� 86611","","Bartonella Antibody","BOTH IP/OP","$78.00 ","$57.72 ","$5.09 ","$98.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$98.00 ","$10.69 ","$28.44 ","$77.62 ","$78.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30201798","EAP","CPT� 86768","","Salmonella Antibody","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$19.25 ","$19.25 ","$0.00 ","$47.00 ","$0.00 ","$36.86 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201801","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$212.00 ","$156.88 ","$8.39 ","$212.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$212.00 ","$19.57 ","$33.64 ","$167.90 ","$169.60 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201802","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$438.00 ","$324.12 ","$17.55 ","$441.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$441.00 ","$36.84 ","$54.82 ","$349.27 ","$352.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201816","EAP","CPT� 83519","","Ria Nonantibody","BOTH IP/OP","$496.00 ","$367.04 ","$8.28 ","$560.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$560.00 ","$19.32 ","$37.76 ","$443.52 ","$448.00 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30201817","EAP","CPT� 80299","","Quantitative Assay Drug","BOTH IP/OP","$369.00 ","$273.06 ","$8.39 ","$370.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$370.00 ","$19.57 ","$33.64 ","$293.04 ","$296.00 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30201818","EAP","CPT� 87906","","Genotype Dna Hiv Reverse T","BOTH IP/OP","$679.00 ","$502.46 ","$43.01 ","$818.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$818.00 ","$135.17 ","$409.00 ","$647.86 ","$654.40 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30201819","EAP","CPT� 86727","","Lymph Choriomeningitis Ab","BOTH IP/OP","$96.00 ","$71.04 ","$0.00 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$18.79 ","$18.79 ","$0.00 ","$96.00 ","$0.00 ","$35.96 ","$76.03 ","$76.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201820","EAP","CPT� 87906","","Genotype Dna Hiv Reverse T","BOTH IP/OP","$1,376.00 ","$1,018.24 ","$43.01 ","$1,658.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$1,658.00 ","$135.17 ","$829.00 ","$1,313.14 ","$1,326.40 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30201821","EAP","CPT� 88365","","Ebv Ish W/interp (so)","BOTH IP/OP","$574.00 ","$424.76 ","$0.00 ","$574.00 ","$0.00 ","$0.00 ","$0.00 ","$98.25 ","$98.25 ","$103.59 ","$574.00 ","$143.92 ","$156.90 ","$454.61 ","$459.20 ","$199.96 ","$110.38 ","$137.95 ","$77.27 ","$137.07 "
"30201822","EAP","CPT� 88365","","Ebv Ish W/o Interp (so)","BOTH IP/OP","$574.00 ","$424.76 ","$0.00 ","$574.00 ","$0.00 ","$0.00 ","$0.00 ","$98.25 ","$98.25 ","$103.59 ","$574.00 ","$143.92 ","$156.90 ","$454.61 ","$459.20 ","$199.96 ","$110.38 ","$137.95 ","$77.27 ","$137.07 "
"30201823","EAP","CPT� 88275","","Fish Burkitt Nhl T(8;14)(so)","BOTH IP/OP","$620.00 ","$458.80 ","$23.04 ","$620.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$620.00 ","$53.75 ","$112.22 ","$491.04 ","$496.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30201824","EAP","CPT� 88271","","Fish Burkitt Dna Probe (so)","BOTH IP/OP","$404.00 ","$298.96 ","$10.71 ","$404.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$404.00 ","$22.49 ","$59.86 ","$319.97 ","$323.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30201825","EAP","CPT� 87902","","Hcv Rna Genotype 1 Ns5b (so)","BOTH IP/OP","$1,200.00 ","$888.00 ","$96.09 ","$1,241.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,241.00 ","$270.32 ","$243.70 ","$982.87 ","$992.80 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30201834","EAP","CPT� 82656","","Pancreatic Elastase Fecal","BOTH IP/OP","$273.00 ","$202.02 ","$5.76 ","$273.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$47.80 ","$273.00 ","$12.11 ","$29.88 ","$216.22 ","$218.40 ","$16.72 ","$42.72 ","$11.53 ","$43.46 ","$11.53 "
"30201835","EAP","CPT� 87798","","Detect Agent Nos Dna Amp","BOTH IP/OP","$252.00 ","$186.48 ","$17.55 ","$304.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$304.00 ","$36.84 ","$54.82 ","$240.77 ","$243.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30201836","EAP","CPT� 86356","","Mononuclear Cell Antigen","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$38.11 ","$38.11 ","$0.00 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201837","EAP","CPT� 86355","","Cells Total Count","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$49.00 ","$39.62 ","$49.00 ","$38.81 ","$39.20 ","$49.00 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30201838","EAP","CPT� 86359","","Cells Total Count","BOTH IP/OP","$49.00 ","$36.26 ","$18.86 ","$49.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$49.00 ","$39.62 ","$49.00 ","$38.81 ","$39.20 ","$49.00 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30201839","EAP","CPT� 88365","","Institu Hybridization (fish)","BOTH IP/OP","$262.00 ","$193.88 ","$0.00 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$98.25 ","$98.25 ","$103.59 ","$260.00 ","$143.92 ","$156.90 ","$205.92 ","$208.00 ","$199.96 ","$110.38 ","$137.95 ","$77.27 ","$137.07 "
"30201840","EAP","CPT� 86808","","Cytotoxic Antibody Screening","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$43.33 ","$43.33 ","$0.00 ","$325.00 ","$0.00 ","$82.94 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201841","EAP","CPT� 86816","","Hla Typing Dr/dq","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$40.67 ","$40.67 ","$0.00 ","$344.00 ","$0.00 ","$77.84 ","$272.45 ","$275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201842","EAP","CPT� 86255","","Fluorescent Antibody Screen","BOTH IP/OP","$25.00 ","$18.50 ","$6.03 ","$25.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$25.00 ","$12.65 ","$25.00 ","$19.80 ","$20.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201843","EAP","CPT� 86256","","Fluorescent Antibody Titer","BOTH IP/OP","$25.00 ","$18.50 ","$6.03 ","$25.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$25.00 ","$12.65 ","$25.00 ","$19.80 ","$20.00 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201844","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$407.00 ","$301.18 ","$2.61 ","$411.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$411.00 ","$5.48 ","$14.60 ","$325.51 ","$328.80 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201845","EAP","CPT� 86317","","Immunoassay For Infectious Agent,ab,quant","BOTH IP/OP","$31.00 ","$22.94 ","$7.49 ","$31.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$31.00 ","$15.74 ","$31.00 ","$24.55 ","$24.80 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30201846","EAP","CPT� 86001","","Allergen Specific Igg Quant","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$7.62 ","$7.62 ","$0.00 ","$175.00 ","$0.00 ","$14.60 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201847","EAP","CPT� 86003","","Allergen Specific Ige","BOTH IP/OP","$140.00 ","$103.60 ","$2.61 ","$175.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$175.00 ","$5.48 ","$14.60 ","$138.60 ","$140.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201848","EAP","CPT� 86147","","Anti-cardiolipin Igg","BOTH IP/OP","$581.00 ","$429.94 ","$12.73 ","$726.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$726.00 ","$26.72 ","$71.08 ","$574.99 ","$580.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30201849","EAP","CPT� 86147","","Anti-cardiolipin Igm","BOTH IP/OP","$581.00 ","$429.94 ","$12.73 ","$726.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$726.00 ","$26.72 ","$71.08 ","$574.99 ","$580.80 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30201850","EAP","CPT� 86757","","Rmsf Igm Titer","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$164.00 ","$0.00 ","$54.10 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201856","EAP","CPT� 81342","","T-CELL  REARRANGEMENT- PCR  (RQD)","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$762.00 ","$415.93 ","$100.75 ","$100.75 ","$274.90 ","$274.90 ","$0.00 ","$762.00 ","$0.00 ","$381.00 ","$603.50 ","$609.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201865","EAP","Custom 30201865","","Bcr/abl T(9;22) Fish (gen)","BOTH IP/OP","$663.00 ","$490.62 ","$0.00 ","$758.00 ","$0.00 ","$0.00 ","$0.00 ","$540.98 ","$540.98 ","$0.00 ","$758.00 ","$0.00 ","$379.00 ","$600.34 ","$606.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201869","EAP","CPT� 81275","","KRAS Gene Mutation Detection (RQD)","BOTH IP/OP","$952.00 ","$704.48 ","$86.96 ","$940.00 ","$298.80 ","$96.63 ","$86.96 ","$197.48 ","$197.48 ","$220.85 ","$940.00 ","$202.91 ","$470.00 ","$744.48 ","$752.00 ","$280.21 ","$235.32 ","$193.25 ","$164.72 ","$193.25 "
"30201879","EAP","CPT� 87906","","Integrase, Quest","BOTH IP/OP","$793.00 ","$586.82 ","$43.01 ","$956.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$956.00 ","$135.17 ","$478.00 ","$757.15 ","$764.80 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30201900","EAP","CPT� 87999","","Trofile, Dna Monogram -quest","BOTH IP/OP","$3,182.00 ","$2,354.68 ","$0.00 ","$3,182.00 ","$0.00 ","$0.00 ","$0.00 ","$2,270.99 ","$2,270.99 ","$0.00 ","$3,182.00 ","$0.00 ","$0.00 ","$2,520.14 ","$2,545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201914","EAP","CPT� 81342","","T-CELL  REARRANGEMENT-PCR QD","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$762.00 ","$415.93 ","$100.75 ","$100.75 ","$274.90 ","$274.90 ","$0.00 ","$762.00 ","$0.00 ","$381.00 ","$603.50 ","$609.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201926","EAP","CPT� 81275","","KRAS Gene Mutation Detect(RQD)","BOTH IP/OP","$823.00 ","$609.02 ","$86.96 ","$940.00 ","$298.80 ","$96.63 ","$86.96 ","$197.48 ","$197.48 ","$220.85 ","$940.00 ","$202.91 ","$470.00 ","$744.48 ","$752.00 ","$280.21 ","$235.32 ","$193.25 ","$164.72 ","$193.25 "
"30201933","EAP","CPT� 81270","","Jak2 V617f Mutation Quant (so)","BOTH IP/OP","$981.00 ","$725.94 ","$45.83 ","$969.00 ","$189.21 ","$45.83 ","$45.83 ","$125.06 ","$125.06 ","$84.58 ","$969.00 ","$96.24 ","$484.50 ","$767.45 ","$775.20 ","$132.91 ","$90.12 ","$91.66 ","$63.08 ","$91.66 "
"30201934","EAP","CPT� 87906","","INTEGRASE, QUEST","BOTH IP/OP","$649.00 ","$480.26 ","$43.01 ","$782.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$782.00 ","$135.17 ","$391.00 ","$619.34 ","$625.60 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30201936","EAP","CPT� 81402","","MPL ANAL Mutation Anal (RQD)","BOTH IP/OP","$1,430.00 ","$1,058.20 ","$0.00 ","$1,634.00 ","$0.00 ","$0.00 ","$0.00 ","$1,166.19 ","$1,166.19 ","$0.00 ","$1,634.00 ","$0.00 ","$817.00 ","$1,294.13 ","$1,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201955","EAP","CPT� 87999","","TROFILE, DNA Monogram -Quest","BOTH IP/OP","$3,030.00 ","$2,242.20 ","$0.00 ","$3,030.00 ","$0.00 ","$0.00 ","$0.00 ","$2,162.51 ","$2,162.51 ","$0.00 ","$3,030.00 ","$0.00 ","$0.00 ","$2,399.76 ","$2,424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201958","EAP","CPT� 86703","","Focus Hiv 1/2 Ab Scrn","BOTH IP/OP","$265.00 ","$196.10 ","$6.85 ","$267.00 ","$28.30 ","$9.15 ","$6.85 ","$20.02 ","$20.02 ","$17.58 ","$267.00 ","$19.20 ","$38.34 ","$211.46 ","$213.60 ","$19.88 ","$18.73 ","$18.29 ","$13.11 ","$18.29 "
"30201959","EAP","CPT� 86689","","Focus Hiv Wb","BOTH IP/OP","$388.00 ","$287.12 ","$0.00 ","$401.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$401.00 ","$0.00 ","$54.10 ","$317.59 ","$320.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201960","EAP","CPT� 86360","","Focus Lymphocyte Subsets","BOTH IP/OP","$495.00 ","$366.30 ","$23.49 ","$500.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$500.00 ","$49.33 ","$131.30 ","$396.00 ","$400.00 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30201961","EAP","CPT� 86317","","Strep Pneumoniae Igg Ab Panel (so)","BOTH IP/OP","$308.00 ","$227.92 ","$7.49 ","$280.00 ","$24.79 ","$7.50 ","$7.49 ","$17.52 ","$17.52 ","$17.72 ","$280.00 ","$15.74 ","$33.54 ","$221.76 ","$224.00 ","$21.74 ","$18.89 ","$14.99 ","$13.22 ","$14.99 "
"30201962","EAP","Custom 30201962","","Fragile X Southern Blot (so)","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$148.45 ","$148.45 ","$0.00 ","$208.00 ","$0.00 ","$104.00 ","$164.74 ","$166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201965","EAP","CPT� 81291","","Mthfr  Mutation Analysis (so)","BOTH IP/OP","$331.00 ","$244.94 ","$29.40 ","$327.00 ","$90.10 ","$32.67 ","$29.40 ","$59.55 ","$59.55 ","$46.99 ","$327.00 ","$68.61 ","$163.50 ","$258.98 ","$261.60 ","$94.74 ","$50.07 ","$65.34 ","$35.05 ","$65.34 "
"30201966","EAP","CPT� 81241","","FACTOR V LEIDEN MUTATION","BOTH IP/OP","$331.00 ","$244.94 ","$33.02 ","$327.00 ","$126.14 ","$36.69 ","$33.02 ","$83.37 ","$83.37 ","$46.99 ","$327.00 ","$77.04 ","$163.50 ","$258.98 ","$261.60 ","$106.39 ","$50.07 ","$73.37 ","$35.05 ","$73.37 "
"30201967","EAP","CPT� 81240","","FACTOR II (PT) GENE MUTATION","BOTH IP/OP","$331.00 ","$244.94 ","$29.56 ","$327.00 ","$101.59 ","$32.85 ","$29.56 ","$67.13 ","$67.13 ","$46.99 ","$327.00 ","$68.97 ","$163.50 ","$258.98 ","$261.60 ","$95.25 ","$50.07 ","$65.69 ","$35.05 ","$65.69 "
"30201968","EAP","CPT� 81220","","CYSTIC FIB 97 MUTATION RQD","BOTH IP/OP","$1,038.00 ","$768.12 ","$250.47 ","$1,201.65 ","$789.36 ","$278.30 ","$250.47 ","$731.54 ","$731.54 ","$1,127.75 ","$1,025.00 ","$584.43 ","$512.50 ","$811.80 ","$820.00 ","$807.07 ","$1,201.65 ","$556.60 ","$841.15 ","$556.60 "
"30201974","EAP","CPT� 81406","","MEN2 (RET) DNA SEQ(ATHENA)","BOTH IP/OP","$5,489.00 ","$4,061.86 ","$0.00 ","$6,272.00 ","$237.60 ","$141.44 ","$127.30 ","$4,476.33 ","$4,476.33 ","$0.00 ","$6,272.00 ","$0.00 ","$3,136.00 ","$4,967.42 ","$5,017.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201975","EAP","CPT� 81401","","Huntington's Dna (so)","BOTH IP/OP","$1,288.00 ","$953.12 ","$61.65 ","$1,272.00 ","$64.94 ","$68.50 ","$61.65 ","$907.83 ","$907.83 ","$131.58 ","$1,272.00 ","$143.85 ","$636.00 ","$1,007.42 ","$1,017.60 ","$198.65 ","$140.20 ","$137.00 ","$98.14 ","$137.00 "
"30201977","EAP","CPT� 81256","","HERED HEMOCHROM DNA ANAL RQD","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$89.17 ","$89.17 ","$46.99 ","$568.00 ","$68.63 ","$284.00 ","$449.86 ","$454.40 ","$94.77 ","$50.07 ","$65.36 ","$35.05 ","$65.36 "
"30201980","EAP","CPT� 86003","","Allergen Specific Ige (so)","BOTH IP/OP","$40.00 ","$29.60 ","$2.61 ","$40.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$40.00 ","$5.48 ","$14.60 ","$31.68 ","$32.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201983","EAP","CPT� 86003","","Allergen Specific (food) Ige (so)","BOTH IP/OP","$40.00 ","$29.60 ","$2.61 ","$40.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$40.00 ","$5.48 ","$14.60 ","$31.68 ","$32.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201984","EAP","CPT� 86003","","Allergen Specific (enviro) Ige (so)","BOTH IP/OP","$40.00 ","$29.60 ","$2.61 ","$40.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$40.00 ","$5.48 ","$14.60 ","$31.68 ","$32.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30201985","EAP","CPT� 80074","","Acute Hepatitis Panel","BOTH IP/OP","$890.00 ","$658.60 ","$0.00 ","$890.00 ","$0.00 ","$0.00 ","$0.00 ","$69.54 ","$69.54 ","$0.00 ","$890.00 ","$0.00 ","$133.08 ","$704.88 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201986","EAP","CPT� 86790","","Hantavirus Antibody (igg, Igm) (so)","BOTH IP/OP","$280.00 ","$207.20 ","$6.44 ","$280.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$280.00 ","$13.52 ","$36.00 ","$221.76 ","$224.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201987","EAP","CPT� 86332","","Immune Complex Detection By C1q Binding (so)","BOTH IP/OP","$34.00 ","$25.16 ","$12.19 ","$38.36 ","$34.00 ","$12.19 ","$12.19 ","$35.59 ","$35.59 ","$36.00 ","$34.00 ","$25.59 ","$34.00 ","$26.93 ","$27.20 ","$34.00 ","$38.36 ","$24.37 ","$26.85 ","$24.37 "
"30201988","EAP","CPT� 86255","","Ampa -receptor Antibody (so) Mayo","BOTH IP/OP","$379.00 ","$280.46 ","$6.03 ","$474.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$474.00 ","$12.65 ","$33.68 ","$375.41 ","$379.20 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201989","EAP","CPT� 86255","","Nmda -receptor Antibody, Serum (mml)","BOTH IP/OP","$358.00 ","$264.92 ","$6.03 ","$448.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$448.00 ","$12.65 ","$33.68 ","$354.82 ","$358.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30201990","EAP","CPT� 86790","","Chikungunya Antibodies (igg, Igm) (so)","BOTH IP/OP","$380.00 ","$281.20 ","$6.44 ","$380.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$380.00 ","$13.52 ","$36.00 ","$300.96 ","$304.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201991","EAP","CPT� 86790","","Chikungunya Antibodies (igg, Titration) (so)","BOTH IP/OP","$380.00 ","$281.20 ","$6.44 ","$380.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$380.00 ","$13.52 ","$36.00 ","$300.96 ","$304.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201992","EAP","CPT� 86790","","Chikungunya Antibodies (igm Titration) (so)","BOTH IP/OP","$380.00 ","$281.20 ","$6.44 ","$380.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$380.00 ","$13.52 ","$36.00 ","$300.96 ","$304.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30201993","EAP","CPT� 86357","","Natural Killer Cells (so)","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$86.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$86.00 ","$39.62 ","$65.82 ","$68.11 ","$68.80 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30201994","EAP","CPT� 83516","","Myositis Antibody Panel (mml)","BOTH IP/OP","$707.00 ","$523.18 ","$5.76 ","$798.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$798.00 ","$12.11 ","$29.88 ","$632.02 ","$638.40 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30201995","EAP","CPT� 82017","","Acylcarnitine,plasma(so)","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$24.63 ","$24.63 ","$0.00 ","$118.00 ","$0.00 ","$47.14 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30201996","EAP","CPT� 87305","","Aspergillus Antigen, Eia, Serum(so)","BOTH IP/OP","$114.00 ","$84.36 ","$5.99 ","$115.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$115.00 ","$12.58 ","$33.52 ","$91.08 ","$92.00 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30201997","EAP","CPT� 87254","","Viral Respiratory,rapid Culture With Reflex(so)","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$7.22 ","$428.00 ","$0.00 ","$54.64 ","$338.98 ","$342.40 ","$0.00 ","$7.70 ","$0.00 ","$0.00 ","$0.00 "
"30201998","EAP","CPT� 82397","","Anti-mullerian Hormone Assessr�(so)","BOTH IP/OP","$296.00 ","$219.04 ","$7.06 ","$288.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$288.00 ","$14.83 ","$39.48 ","$228.10 ","$230.40 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30201999","EAP","CPT� 87906","","Hiv-1 Integrase Genotype(so)","BOTH IP/OP","$225.00 ","$166.50 ","$43.01 ","$227.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$227.00 ","$135.17 ","$113.50 ","$179.78 ","$181.60 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30202000","EAP","CPT� 87798","","Hpv 8 Dna,qual(so)","BOTH IP/OP","$418.00 ","$309.32 ","$17.55 ","$421.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$421.00 ","$36.84 ","$54.82 ","$333.43 ","$336.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30202001","EAP","CPT� 86316","","Chromgranin A,ecl","BOTH IP/OP","$221.00 ","$163.54 ","$10.41 ","$223.00 ","$42.95 ","$10.41 ","$10.41 ","$30.38 ","$30.38 ","$30.73 ","$223.00 ","$21.85 ","$58.14 ","$176.62 ","$178.40 ","$30.17 ","$32.75 ","$20.81 ","$22.92 ","$20.81 "
"30202002","EAP","CPT� 83516","","Euromyelitis Optica(so)","BOTH IP/OP","$1,413.00 ","$1,045.62 ","$5.76 ","$1,374.00 ","$22.04 ","$5.77 ","$5.76 ","$15.61 ","$15.61 ","$15.80 ","$1,374.00 ","$12.11 ","$29.88 ","$1,088.21 ","$1,099.20 ","$16.72 ","$16.84 ","$11.53 ","$11.79 ","$11.53 "
"30202003","EAP","CPT� 86336","","Inhibin A(so)","BOTH IP/OP","$89.00 ","$65.86 ","$7.79 ","$90.00 ","$26.74 ","$7.80 ","$7.79 ","$18.90 ","$18.90 ","$19.12 ","$90.00 ","$16.37 ","$36.18 ","$71.28 ","$72.00 ","$22.61 ","$20.37 ","$15.59 ","$14.26 ","$15.59 "
"30202004","EAP","CPT� 82397","","Inhibin B(so)","BOTH IP/OP","$427.00 ","$315.98 ","$7.06 ","$415.00 ","$29.15 ","$7.06 ","$7.06 ","$20.63 ","$20.63 ","$20.87 ","$415.00 ","$14.83 ","$39.48 ","$328.68 ","$332.00 ","$20.47 ","$22.24 ","$14.12 ","$15.57 ","$14.12 "
"30202005","EAP","CPT� 88271","","Fish, Myeloma Chrom Cep 9,11,15 Dna Probe (so)","BOTH IP/OP","$638.00 ","$472.12 ","$10.71 ","$638.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$638.00 ","$22.49 ","$59.86 ","$505.30 ","$510.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30202006","EAP","CPT� 88275","","Fish, Myeloma Chrom Cep 9,11,15 Hybridization(so)","BOTH IP/OP","$354.00 ","$261.96 ","$23.04 ","$354.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$354.00 ","$53.75 ","$112.22 ","$280.37 ","$283.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30202007","EAP","CPT� 88271","","Fish, Myeloma 17p-,rea14q32 (so) Dna Probe (so)","BOTH IP/OP","$4,290.00 ","$3,174.60 ","$10.71 ","$4,261.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$4,261.00 ","$22.49 ","$59.86 ","$3,374.71 ","$3,408.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30202008","EAP","CPT� 88275","","Fish, Myeloma 17p-,rea14q32(so) Hybridization(so)","BOTH IP/OP","$601.00 ","$444.74 ","$23.04 ","$597.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$597.00 ","$53.75 ","$112.22 ","$472.82 ","$477.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30202009","EAP","CPT� 88271","","Fish, Myeloma Igh Panel(so) Dna Probe (so)","BOTH IP/OP","$2,092.00 ","$1,548.08 ","$10.71 ","$2,078.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$2,078.00 ","$22.49 ","$59.86 ","$1,645.78 ","$1,662.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"30202010","EAP","CPT� 88275","","Fish, Myeloma Igh Panel(so) Hybridization(so)","BOTH IP/OP","$1,046.00 ","$774.04 ","$23.04 ","$1,039.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$1,039.00 ","$53.75 ","$112.22 ","$822.89 ","$831.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"30202011","EAP","CPT� 81596","","Liver Fibrosis, Fibro Test-actitest Panel (so)","BOTH IP/OP","$1,021.00 ","$755.54 ","$32.49 ","$1,009.00 ","$108.64 ","$36.10 ","$32.49 ","$72.19 ","$72.19 ","$67.84 ","$1,009.00 ","$75.80 ","$504.50 ","$799.13 ","$807.20 ","$104.68 ","$72.29 ","$72.19 ","$50.60 ","$72.19 "
"30202012","EAP","CPT� 87535","","Hiv-1, Rna Qualitative Tma(so)","BOTH IP/OP","$347.00 ","$256.78 ","$17.55 ","$337.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$337.00 ","$36.84 ","$54.82 ","$266.90 ","$269.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30202013","EAP","CPT� 87140","","Viral Id, Respiratory(so)","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$349.00 ","$0.00 ","$0.00 ","$0.00 ","$8.14 ","$8.14 ","$0.00 ","$349.00 ","$0.00 ","$15.58 ","$276.41 ","$279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30202015","EAP","CPT� 81420","","Qnatal  Advanced(so)","BOTH IP/OP","$2,554.00 ","$1,889.96 ","$341.57 ","$2,523.00 ","$1,207.35 ","$379.53 ","$341.57 ","$1,800.67 ","$1,800.67 ","$754.02 ","$2,523.00 ","$797.00 ","$1,261.50 ","$1,998.22 ","$2,018.40 ","$1,100.62 ","$803.42 ","$759.05 ","$562.40 ","$759.05 "
"30202016","EAP","CPT� 83835","","Metanephrines,frac,ur(so)","BOTH IP/OP","$81.00 ","$59.94 ","$8.47 ","$75.00 ","$34.98 ","$8.47 ","$8.47 ","$24.74 ","$24.74 ","$25.02 ","$75.00 ","$17.79 ","$47.34 ","$59.40 ","$60.00 ","$24.56 ","$26.66 ","$16.94 ","$18.66 ","$16.94 "
"30202017","EAP","CPT� 87305","","Aspergillus Antigen,eia(so)","BOTH IP/OP","$103.00 ","$76.22 ","$5.99 ","$104.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$104.00 ","$12.58 ","$33.52 ","$82.37 ","$83.20 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30202018","EAP","CPT� 86701","","Hiv-1 Confirmation","BOTH IP/OP","$197.00 ","$145.78 ","$4.44 ","$198.00 ","$18.35 ","$4.45 ","$4.44 ","$12.96 ","$12.96 ","$11.39 ","$198.00 ","$9.33 ","$24.82 ","$156.82 ","$158.40 ","$12.89 ","$12.14 ","$8.89 ","$8.50 ","$8.89 "
"30202019","EAP","CPT� 86702","","Hiv-2 Confirmation","BOTH IP/OP","$238.00 ","$176.12 ","$6.76 ","$240.00 ","$27.90 ","$6.76 ","$6.76 ","$19.74 ","$19.74 ","$17.33 ","$240.00 ","$14.20 ","$37.76 ","$190.08 ","$192.00 ","$19.60 ","$18.46 ","$13.52 ","$12.92 ","$13.52 "
"30202020","EAP","CPT� 86666","","Anaplasma Phaggocytopilium Ab (so)","BOTH IP/OP","$398.00 ","$294.52 ","$0.00 ","$495.00 ","$0.00 ","$0.00 ","$0.00 ","$14.85 ","$14.85 ","$0.00 ","$495.00 ","$0.00 ","$28.44 ","$392.04 ","$396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30202021","EAP","CPT� 87798","","Pneumocysttis Jirovecii, Qual Rt Pcr (so)","BOTH IP/OP","$448.00 ","$331.52 ","$17.55 ","$452.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$452.00 ","$36.84 ","$54.82 ","$357.98 ","$361.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30202022","EAP","CPT� 86790","","Chikungunya Ab Reflex To Titer (so)","BOTH IP/OP","$219.00 ","$162.06 ","$6.44 ","$200.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$200.00 ","$13.52 ","$36.00 ","$158.40 ","$160.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30202024","EAP","CPT� 81255","","Tay-sachs Disease Mutation Anal (so)","BOTH IP/OP","$304.00 ","$224.96 ","$0.00 ","$347.00 ","$0.00 ","$0.00 ","$0.00 ","$247.65 ","$247.65 ","$0.00 ","$347.00 ","$0.00 ","$173.50 ","$274.82 ","$277.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30202025","EAP","CPT� 86738","","Mycoplasma Pneumoniae Ab Cf Csf (so)","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$6.62 ","$19.34 ","$19.34 ","$19.57 ","$121.00 ","$13.90 ","$37.02 ","$95.83 ","$96.80 ","$19.20 ","$20.85 ","$13.24 ","$14.60 ","$13.24 "
"30202026","EAP","CPT� 87902","","Hepatitis C Viral Rna Ns3 Genotype(so)","BOTH IP/OP","$339.00 ","$250.86 ","$96.09 ","$329.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$329.00 ","$270.32 ","$243.70 ","$260.57 ","$263.20 ","$329.00 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30202027","EAP","CPT� 87902","","Hepatitis C Viral Rna, (so)","BOTH IP/OP","$671.00 ","$496.54 ","$96.09 ","$651.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$651.00 ","$270.32 ","$243.70 ","$515.59 ","$520.80 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30250310","EAP","CPT� 86256","","Mitochondrial Ab Titer","BOTH IP/OP","$70.00 ","$51.80 ","$6.03 ","$88.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$88.00 ","$12.65 ","$33.68 ","$69.70 ","$70.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30250311","EAP","CPT� 83519","","Alp Sub Pit Glycoprotein Horm","BOTH IP/OP","$850.00 ","$629.00 ","$8.28 ","$959.00 ","$27.88 ","$9.20 ","$8.28 ","$19.73 ","$19.73 ","$19.96 ","$959.00 ","$19.32 ","$37.76 ","$759.53 ","$767.20 ","$26.68 ","$21.27 ","$18.40 ","$14.89 ","$18.40 "
"30250312","EAP","CPT� 87624","","mRNA","BOTH IP/OP","$101.00 ","$74.74 ","$15.99 ","$98.00 ","$40.50 ","$17.55 ","$17.55 ","$26.70 ","$26.70 ","$21.44 ","$98.00 ","$36.84 ","$49.00 ","$77.62 ","$78.40 ","$50.88 ","$22.85 ","$35.09 ","$15.99 ","$35.09 "
"30250313","EAP","CPT� 86021","","C-anca Titer","BOTH IP/OP","$34.00 ","$25.16 ","$7.53 ","$34.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$34.00 ","$15.80 ","$34.00 ","$26.93 ","$27.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30250314","EAP","CPT� 86021","","P-anca Titer","BOTH IP/OP","$34.00 ","$25.16 ","$7.53 ","$34.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$34.00 ","$15.80 ","$34.00 ","$26.93 ","$27.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30250315","EAP","CPT� 86021","","Atypical P-anca Titer","BOTH IP/OP","$80.00 ","$59.20 ","$7.53 ","$80.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$80.00 ","$15.80 ","$42.06 ","$63.36 ","$64.00 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30250316","EAP","CPT� 86638","","Q Fever Igg Phase I Titer","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30250317","EAP","CPT� 86638","","Q Fever Igg Phase Ii Titer","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30250318","EAP","CPT� 86638","","Q Fever Igm Phase I Titer","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30250320","EAP","CPT� 86611","","B.henselae Igg Titer","BOTH IP/OP","$50.00 ","$37.00 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30250321","EAP","CPT� 86611","","B.henselae Igm Titer","BOTH IP/OP","$50.00 ","$37.00 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30250322","EAP","CPT� 86611","","B.quintana Igg Titer","BOTH IP/OP","$50.00 ","$37.00 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30250323","EAP","CPT� 86611","","B.quintana Igm Titer","BOTH IP/OP","$50.00 ","$37.00 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30250325","EAP","CPT� 86003","","Allergen Specific Ige Tilapia (so)","BOTH IP/OP","$200.00 ","$148.00 ","$2.61 ","$249.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$249.00 ","$5.48 ","$14.60 ","$197.21 ","$199.20 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30250326","EAP","CPT� 86003","","Allergen Specific Ige Trout (so)","BOTH IP/OP","$136.00 ","$100.64 ","$2.61 ","$170.00 ","$10.77 ","$2.61 ","$2.61 ","$7.62 ","$7.62 ","$7.72 ","$170.00 ","$5.48 ","$14.60 ","$134.64 ","$136.00 ","$7.57 ","$8.22 ","$5.22 ","$5.76 ","$5.22 "
"30250327","EAP","CPT� 86790","","Hepatitis A  Igg","BOTH IP/OP","$328.00 ","$242.72 ","$6.44 ","$300.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$300.00 ","$13.52 ","$36.00 ","$237.60 ","$240.00 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30250328","EAP","CPT� 87389","","Hiv-1 Ag With Hiv-1/2 Ab","BOTH IP/OP","$306.00 ","$226.44 ","$12.04 ","$297.00 ","$49.71 ","$12.04 ","$12.04 ","$34.12 ","$34.12 ","$32.07 ","$297.00 ","$25.28 ","$148.50 ","$235.22 ","$237.60 ","$34.92 ","$34.17 ","$24.08 ","$23.92 ","$24.08 "
"30250329","EAP","CPT� 86255","","Ds-dna An, Crithidia Titer","BOTH IP/OP","$150.00 ","$111.00 ","$6.03 ","$188.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$188.00 ","$12.65 ","$33.68 ","$148.90 ","$150.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30250340","EAP","CPT� 86361","","Absolute Cd4 Count","BOTH IP/OP","$117.00 ","$86.58 ","$13.39 ","$122.00 ","$53.91 ","$13.39 ","$13.39 ","$38.11 ","$38.11 ","$38.56 ","$122.00 ","$28.12 ","$72.94 ","$96.62 ","$97.60 ","$38.83 ","$41.08 ","$26.78 ","$28.76 ","$26.78 "
"30250342","EAP","CPT� 86038","","Ana Ifa W/reflex (so)","BOTH IP/OP","$219.00 ","$162.06 ","$6.04 ","$208.00 ","$24.95 ","$6.05 ","$6.04 ","$17.65 ","$17.65 ","$17.86 ","$208.00 ","$12.69 ","$33.78 ","$164.74 ","$166.40 ","$17.53 ","$19.03 ","$12.09 ","$13.32 ","$12.09 "
"30250380","EAP","CPT� 86790","","Chikungunya Igg Titer(so)","BOTH IP/OP","$210.00 ","$155.40 ","$6.44 ","$192.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$192.00 ","$13.52 ","$36.00 ","$152.06 ","$153.60 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30250381","EAP","CPT� 86790","","Chikungunya Igm Titer(so)","BOTH IP/OP","$192.00 ","$142.08 ","$6.44 ","$192.00 ","$26.58 ","$6.44 ","$6.44 ","$18.81 ","$18.81 ","$19.03 ","$192.00 ","$13.52 ","$36.00 ","$152.06 ","$153.60 ","$18.68 ","$20.27 ","$12.88 ","$14.19 ","$12.88 "
"30250382","EAP","CPT� 86039","","Ana Screen Ifa, W/titer And Pattern","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$16.30 ","$16.30 ","$0.00 ","$142.00 ","$0.00 ","$31.20 ","$112.46 ","$113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30250383","EAP","CPT� 86713","","Legionella Pneumophila Ab (igg), Ifa (so)","BOTH IP/OP","$104.00 ","$76.96 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$22.35 ","$22.35 ","$0.00 ","$105.00 ","$0.00 ","$42.78 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30250384","EAP","CPT� 86255","","Copeptin (so)","BOTH IP/OP","$43.00 ","$31.82 ","$6.03 ","$43.00 ","$24.87 ","$6.03 ","$6.03 ","$17.60 ","$17.60 ","$17.81 ","$43.00 ","$12.65 ","$33.68 ","$34.06 ","$34.40 ","$17.47 ","$18.97 ","$12.05 ","$13.28 ","$12.05 "
"30250390","EAP","CPT� 86695","","Hsv 1 Igg (so)","BOTH IP/OP","$59.00 ","$43.66 ","$6.59 ","$57.00 ","$27.22 ","$6.60 ","$6.59 ","$19.25 ","$19.25 ","$19.49 ","$57.00 ","$13.85 ","$36.86 ","$45.14 ","$45.60 ","$19.13 ","$20.76 ","$13.19 ","$14.54 ","$13.19 "
"30250391","EAP","CPT� 86696","","Hsv 2 Igg (so)","BOTH IP/OP","$59.00 ","$43.66 ","$9.68 ","$57.00 ","$39.94 ","$9.68 ","$9.68 ","$28.26 ","$28.26 ","$28.60 ","$57.00 ","$20.32 ","$54.10 ","$45.14 ","$45.60 ","$28.06 ","$30.48 ","$19.35 ","$21.33 ","$19.35 "
"30250392","EAP","CPT� 86696","","Hsv 2 Igg Inhibition (so)","BOTH IP/OP","$400.00 ","$296.00 ","$9.68 ","$388.00 ","$39.94 ","$9.68 ","$9.68 ","$28.26 ","$28.26 ","$28.60 ","$388.00 ","$20.32 ","$54.10 ","$307.30 ","$310.40 ","$28.06 ","$30.48 ","$19.35 ","$21.33 ","$19.35 "
"30250395","EAP","CPT� 86235","","Myositis Specific 11 Ab Nuclear Ag (so)","BOTH IP/OP","$107.00 ","$79.18 ","$8.97 ","$103.00 ","$37.01 ","$8.97 ","$8.97 ","$26.18 ","$26.18 ","$26.49 ","$103.00 ","$18.83 ","$50.12 ","$81.58 ","$82.40 ","$26.00 ","$28.23 ","$17.93 ","$19.76 ","$17.93 "
"30250396","EAP","CPT� 88365","","KAPPA/LAMBDA ISH","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$98.25 ","$98.25 ","$103.59 ","$250.00 ","$143.92 ","$156.90 ","$198.00 ","$200.00 ","$199.96 ","$110.38 ","$137.95 ","$77.27 ","$137.07 "
"30250397","EAP","CPT� 88366","","KAPPA/LAMBDA ISH","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$149.94 ","$149.94 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30250400","EAP","CPT� 86328","","Ia Infectious Ag Ab Sars-cov2 Covid 19","BOTH IP/OP","$151.00 ","$111.74 ","$22.62 ","$150.00 ","$119.41 ","$22.62 ","$57.41 ","$107.06 ","$107.06 ","$26.26 ","$150.00 ","$47.49 ","$75.00 ","$118.80 ","$120.00 ","$65.58 ","$23.48 ","$45.23 ","$23.88 ","$45.23 "
"30250401","EAP","CPT� 86769","","Sars-cov-2 Covid-19 Antibody","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$57.41 ","$0.00 ","$0.00 ","$57.41 ","$39.25 ","$39.25 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500001","EAP","CPT� 85002","","Bleeding Time, Temp","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$0.00 ","$0.00 ","$0.00 ","$6.57 ","$6.57 ","$0.00 ","$109.00 ","$0.00 ","$12.58 ","$86.33 ","$87.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500002","EAP","CPT� 85007","","Misc. Smear","BOTH IP/OP","$102.00 ","$75.48 ","$1.72 ","$101.00 ","$7.08 ","$1.90 ","$1.72 ","$5.02 ","$5.02 ","$5.08 ","$101.00 ","$3.99 ","$9.62 ","$79.99 ","$80.80 ","$5.51 ","$5.41 ","$3.80 ","$3.79 ","$3.80 "
"30500003","EAP","CPT� 85576","","Bld Plat Agg - Teg","BOTH IP/OP","$442.00 ","$327.08 ","$11.21 ","$402.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$402.00 ","$26.16 ","$60.02 ","$318.38 ","$321.60 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500004","EAP","CPT� 85384","","Fibrinogen Act - Teg","BOTH IP/OP","$207.00 ","$153.18 ","$4.37 ","$188.00 ","$17.53 ","$4.86 ","$4.37 ","$12.40 ","$12.40 ","$12.55 ","$188.00 ","$10.21 ","$23.74 ","$148.90 ","$150.40 ","$14.09 ","$13.37 ","$9.72 ","$9.36 ","$9.72 "
"30500005","EAP","CPT� 85008","","Rbc Morphology Exam","BOTH IP/OP","$83.00 ","$61.42 ","$1.72 ","$83.00 ","$7.08 ","$1.72 ","$1.72 ","$5.02 ","$5.02 ","$5.08 ","$83.00 ","$3.60 ","$9.62 ","$65.74 ","$66.40 ","$4.97 ","$5.41 ","$3.43 ","$3.79 ","$3.43 "
"30500006","EAP","CPT� 85008","","Rbc, Schistocyte Cnt","BOTH IP/OP","$91.00 ","$67.34 ","$1.72 ","$83.00 ","$7.08 ","$1.72 ","$1.72 ","$5.02 ","$5.02 ","$5.08 ","$83.00 ","$3.60 ","$9.62 ","$65.74 ","$66.40 ","$4.97 ","$5.41 ","$3.43 ","$3.79 ","$3.43 "
"30500007","EAP","CPT� 85013","","Hematocrit Count","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$51.00 ","$0.00 ","$6.62 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500008","EAP","CPT� 85013","","Hematocrit, Fld - Spun","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$51.00 ","$0.00 ","$6.62 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500009","EAP","CPT� 85347","","Coag Time, Activated-teg","BOTH IP/OP","$293.00 ","$216.82 ","$2.13 ","$266.00 ","$8.79 ","$2.14 ","$2.13 ","$6.22 ","$6.22 ","$6.30 ","$266.00 ","$4.49 ","$11.90 ","$210.67 ","$212.80 ","$6.21 ","$6.71 ","$4.28 ","$4.70 ","$4.28 "
"30500010","EAP","CPT� 85013","","Hematocrit, Spun Cap","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$51.00 ","$0.00 ","$6.62 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500011","EAP","CPT� 85013","","Hematocrit,csf-spun","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$51.00 ","$0.00 ","$6.62 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500012","EAP","CPT� 85014","","Hematocrit","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$58.00 ","$0.00 ","$6.62 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500013","EAP","CPT� 85390","","Fibrinolysins Scrn -teg","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$122.00 ","$10.69 ","$7.74 ","$6.97 ","$7.54 ","$7.54 ","$0.00 ","$122.00 ","$0.00 ","$14.44 ","$96.62 ","$97.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500015","EAP","CPT� 85018","","Hemoglobin, Micro(meter)","BOTH IP/OP","$51.00 ","$37.74 ","$1.18 ","$51.00 ","$4.88 ","$1.19 ","$1.18 ","$3.46 ","$3.46 ","$3.50 ","$51.00 ","$2.49 ","$6.62 ","$40.39 ","$40.80 ","$3.44 ","$3.73 ","$2.37 ","$2.61 ","$2.37 "
"30500016","EAP","CPT� 86022","","Platelet Antibody Screen Indirect (so)","BOTH IP/OP","$362.00 ","$267.88 ","$0.00 ","$362.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$362.00 ","$0.00 ","$51.32 ","$286.70 ","$289.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500017","EAP","CPT� 85018","","Hgb & Hct","BOTH IP/OP","$51.00 ","$37.74 ","$1.18 ","$51.00 ","$4.88 ","$1.19 ","$1.18 ","$3.46 ","$3.46 ","$3.50 ","$51.00 ","$2.49 ","$6.62 ","$40.39 ","$40.80 ","$3.44 ","$3.73 ","$2.37 ","$2.61 ","$2.37 "
"30500018","EAP","CPT� 85018","","Hgb, Venous (meter)","BOTH IP/OP","$51.00 ","$37.74 ","$1.18 ","$51.00 ","$4.88 ","$1.19 ","$1.18 ","$3.46 ","$3.46 ","$3.50 ","$51.00 ","$2.49 ","$6.62 ","$40.39 ","$40.80 ","$3.44 ","$3.73 ","$2.37 ","$2.61 ","$2.37 "
"30500021","EAP","CPT� 85025","","CBC, PLAT & DIFF","BOTH IP/OP","$212.00 ","$156.88 ","$3.88 ","$222.00 ","$16.05 ","$3.89 ","$3.88 ","$9.59 ","$9.59 ","$11.48 ","$222.00 ","$8.16 ","$21.72 ","$175.82 ","$177.60 ","$11.27 ","$12.23 ","$7.77 ","$8.56 ","$7.77 "
"30500022","EAP","CPT� 85027","","CBC & PLAT","BOTH IP/OP","$175.00 ","$129.50 ","$3.23 ","$184.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$9.57 ","$184.00 ","$6.79 ","$18.08 ","$145.73 ","$147.20 ","$9.38 ","$10.19 ","$6.47 ","$7.13 ","$6.47 "
"30500024","EAP","CPT� 85046","","Reticulocytes, Automated","BOTH IP/OP","$154.00 ","$113.96 ","$2.79 ","$140.00 ","$11.48 ","$2.79 ","$2.79 ","$8.15 ","$8.15 ","$8.24 ","$140.00 ","$5.85 ","$15.60 ","$110.88 ","$112.00 ","$8.08 ","$8.78 ","$5.57 ","$6.15 ","$5.57 "
"30500026","EAP","CPT� 85048","","EOSINOPHIL COUNT, WB","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$3.71 ","$3.71 ","$0.00 ","$74.00 ","$0.00 ","$7.10 ","$58.61 ","$59.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500027","EAP","CPT� 85049","","Platelet Count (wb)","BOTH IP/OP","$127.00 ","$93.98 ","$2.24 ","$117.00 ","$9.24 ","$2.24 ","$2.24 ","$6.53 ","$6.53 ","$6.62 ","$117.00 ","$4.70 ","$12.50 ","$92.66 ","$93.60 ","$6.50 ","$7.05 ","$4.48 ","$4.93 ","$4.48 "
"30500028","EAP","CPT� 85097","","Bone Marrow Exam","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$781.00 ","$0.00 ","$0.00 ","$0.00 ","$46.75 ","$46.75 ","$75.35 ","$781.00 ","$630.05 ","$213.48 ","$618.55 ","$624.80 ","$781.00 ","$80.29 ","$51.21 ","$56.20 ","$600.04 "
"30500029","EAP","CPT� 85210","","Factor  Ii Assay","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$391.00 ","$0.00 ","$0.00 ","$0.00 ","$18.96 ","$18.96 ","$0.00 ","$391.00 ","$0.00 ","$36.28 ","$309.67 ","$312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500030","EAP","CPT� 85220","","Factor   V Assay","BOTH IP/OP","$568.00 ","$420.32 ","$0.00 ","$524.00 ","$0.00 ","$0.00 ","$8.82 ","$25.77 ","$25.77 ","$0.00 ","$524.00 ","$0.00 ","$49.32 ","$415.01 ","$419.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500031","EAP","CPT� 85230","","Factor Vii Assay","BOTH IP/OP","$584.00 ","$432.16 ","$0.00 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$26.14 ","$26.46 ","$538.00 ","$18.80 ","$50.04 ","$426.10 ","$430.40 ","$25.96 ","$28.19 ","$17.90 ","$19.74 ","$17.90 "
"30500032","EAP","CPT� 85240","","Factor Viii Assay","BOTH IP/OP","$584.00 ","$432.16 ","$8.95 ","$538.00 ","$36.96 ","$8.95 ","$8.95 ","$26.14 ","$26.14 ","$26.46 ","$538.00 ","$18.80 ","$50.04 ","$426.10 ","$430.40 ","$25.96 ","$28.19 ","$17.90 ","$19.74 ","$17.90 "
"30500033","EAP","CPT� 85245","","Vw Factor Activity","BOTH IP/OP","$680.00 ","$503.20 ","$11.47 ","$680.00 ","$47.36 ","$11.47 ","$11.47 ","$33.51 ","$33.51 ","$33.89 ","$680.00 ","$24.09 ","$64.12 ","$538.56 ","$544.00 ","$33.26 ","$36.11 ","$22.94 ","$25.28 ","$22.94 "
"30500034","EAP","CPT� 85245","","Ristocetin Cofactor","BOTH IP/OP","$738.00 ","$546.12 ","$11.47 ","$680.00 ","$47.36 ","$11.47 ","$11.47 ","$33.51 ","$33.51 ","$33.89 ","$680.00 ","$24.09 ","$64.12 ","$538.56 ","$544.00 ","$33.26 ","$36.11 ","$22.94 ","$25.28 ","$22.94 "
"30500035","EAP","CPT� 85246","","Von Willebrand Ag","BOTH IP/OP","$738.00 ","$546.12 ","$11.47 ","$680.00 ","$47.36 ","$11.47 ","$11.47 ","$33.51 ","$33.51 ","$33.89 ","$680.00 ","$24.09 ","$64.12 ","$538.56 ","$544.00 ","$33.26 ","$36.11 ","$22.94 ","$25.28 ","$22.94 "
"30500036","EAP","CPT� 85250","","Factor  Ix Assay","BOTH IP/OP","$613.00 ","$453.62 ","$0.00 ","$565.00 ","$0.00 ","$0.00 ","$0.00 ","$27.79 ","$27.79 ","$28.12 ","$565.00 ","$19.99 ","$53.20 ","$447.48 ","$452.00 ","$27.61 ","$29.96 ","$19.04 ","$20.97 ","$19.04 "
"30500037","EAP","CPT� 85260","","Factor   X Assay","BOTH IP/OP","$584.00 ","$432.16 ","$0.00 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$26.14 ","$0.00 ","$538.00 ","$0.00 ","$50.04 ","$426.10 ","$430.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500038","EAP","CPT� 85270","","Factor  Xi Assay","BOTH IP/OP","$584.00 ","$432.16 ","$0.00 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$26.14 ","$0.00 ","$538.00 ","$0.00 ","$50.04 ","$426.10 ","$430.40 ","$0.00 ","$28.19 ","$0.00 ","$0.00 ","$0.00 "
"30500039","EAP","CPT� 85280","","Factor Xii Assay","BOTH IP/OP","$621.00 ","$459.54 ","$0.00 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$28.25 ","$28.25 ","$28.59 ","$572.00 ","$0.00 ","$54.08 ","$453.02 ","$457.60 ","$0.00 ","$30.46 ","$0.00 ","$0.00 ","$0.00 "
"30500040","EAP","CPT� 85291","","Factor Xiii Screen","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$627.00 ","$0.00 ","$0.00 ","$0.00 ","$12.98 ","$12.98 ","$0.00 ","$627.00 ","$0.00 ","$24.84 ","$496.58 ","$501.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500041","EAP","CPT� 85300","","Protein S Activity","BOTH IP/OP","$493.00 ","$364.82 ","$5.93 ","$483.00 ","$24.47 ","$5.93 ","$5.93 ","$17.30 ","$17.30 ","$17.50 ","$483.00 ","$12.44 ","$33.10 ","$382.54 ","$386.40 ","$17.18 ","$18.65 ","$11.85 ","$13.06 ","$11.85 "
"30500042","EAP","CPT� 85300","","Factor At-iii Assay","BOTH IP/OP","$493.00 ","$364.82 ","$5.93 ","$483.00 ","$24.47 ","$5.93 ","$5.93 ","$17.30 ","$17.30 ","$17.50 ","$483.00 ","$12.44 ","$33.10 ","$382.54 ","$386.40 ","$17.18 ","$18.65 ","$11.85 ","$13.06 ","$11.85 "
"30500043","EAP","CPT� 85301","","At-iii Antigen","BOTH IP/OP","$971.00 ","$718.54 ","$0.00 ","$981.00 ","$0.00 ","$0.00 ","$5.40 ","$15.79 ","$15.79 ","$15.98 ","$981.00 ","$11.35 ","$30.22 ","$776.95 ","$784.80 ","$15.67 ","$17.03 ","$10.81 ","$11.92 ","$10.81 "
"30500044","EAP","CPT� 85303","","Protein C Activity","BOTH IP/OP","$466.00 ","$344.84 ","$6.92 ","$456.00 ","$28.56 ","$6.92 ","$6.92 ","$20.19 ","$20.19 ","$20.43 ","$456.00 ","$14.53 ","$38.64 ","$361.15 ","$364.80 ","$20.07 ","$21.77 ","$13.84 ","$15.24 ","$13.84 "
"30500045","EAP","CPT� 85307","","Act Prot-c Resist (fv-leiden)","BOTH IP/OP","$264.00 ","$195.36 ","$7.66 ","$259.00 ","$31.63 ","$7.66 ","$7.66 ","$22.37 ","$22.37 ","$22.64 ","$259.00 ","$16.09 ","$42.82 ","$205.13 ","$207.20 ","$22.21 ","$24.12 ","$15.32 ","$16.88 ","$15.32 "
"30500046","EAP","CPT� 85379","","D-dimer","BOTH IP/OP","$335.00 ","$247.90 ","$5.09 ","$338.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$338.00 ","$10.69 ","$28.44 ","$267.70 ","$270.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30500047","EAP","CPT� 85384","","Fibrinogen Quant.","BOTH IP/OP","$299.00 ","$221.26 ","$4.37 ","$272.00 ","$17.53 ","$4.86 ","$4.37 ","$12.40 ","$12.40 ","$12.55 ","$272.00 ","$10.21 ","$23.74 ","$215.42 ","$217.60 ","$14.09 ","$13.37 ","$9.72 ","$9.36 ","$9.72 "
"30500048","EAP","CPT� 85410","","Alpha-2-antiplasmin","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$183.00 ","$0.00 ","$0.00 ","$0.00 ","$11.26 ","$11.26 ","$0.00 ","$183.00 ","$0.00 ","$21.54 ","$144.94 ","$146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500049","EAP","CPT� 85420","","Plasminogen Activ.","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$9.55 ","$9.55 ","$0.00 ","$146.00 ","$0.00 ","$18.26 ","$115.63 ","$116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500050","EAP","CPT� 85441","","Heinz Body Direct","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$6.14 ","$6.14 ","$0.00 ","$57.00 ","$0.00 ","$11.76 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500051","EAP","CPT� 85445","","Heinz Body Induced","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$9.95 ","$9.95 ","$0.00 ","$83.00 ","$0.00 ","$19.04 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500052","EAP","CPT� 85460","","K-b Hgb Fetal Screen **","BOTH IP/OP","$51.00 ","$37.74 ","$2.66 ","$51.00 ","$4.99 ","$3.87 ","$3.87 ","$3.53 ","$3.53 ","$3.57 ","$51.00 ","$8.12 ","$6.76 ","$40.39 ","$40.80 ","$11.21 ","$3.80 ","$7.73 ","$2.66 ","$7.73 "
"30500053","EAP","CPT� 85475","","Hemolysis,acid-ham's","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$7.61 ","$0.00 ","$59.00 ","$0.00 ","$14.56 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500054","EAP","CPT� 85475","","Hemolysis, Sucrose","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$7.61 ","$0.00 ","$59.00 ","$0.00 ","$14.56 ","$46.73 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500055","EAP","CPT� 85520","","Heparin Assay","BOTH IP/OP","$400.00 ","$296.00 ","$6.55 ","$404.00 ","$27.03 ","$6.55 ","$6.55 ","$19.11 ","$19.11 ","$19.34 ","$404.00 ","$13.74 ","$36.58 ","$319.97 ","$323.20 ","$18.98 ","$20.61 ","$13.09 ","$14.43 ","$13.09 "
"30500056","EAP","CPT� 85536","","Iron Stores-bm","BOTH IP/OP","$186.00 ","$137.64 ","$0.00 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$9.45 ","$9.45 ","$0.00 ","$186.00 ","$0.00 ","$18.08 ","$147.31 ","$148.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500057","EAP","CPT� 85540","","Wbc Lap Stain","BOTH IP/OP","$154.00 ","$113.96 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$8.82 ","$8.82 ","$0.00 ","$168.00 ","$0.00 ","$16.88 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500058","EAP","CPT� 85549","","Lysozyme","BOTH IP/OP","$180.00 ","$133.20 ","$9.37 ","$182.00 ","$38.70 ","$9.38 ","$9.37 ","$27.39 ","$27.39 ","$27.71 ","$182.00 ","$19.69 ","$52.42 ","$144.14 ","$145.60 ","$27.19 ","$29.53 ","$18.75 ","$20.67 ","$18.75 "
"30500059","EAP","CPT� 85576","","Plt Agg, Thrombin","BOTH IP/OP","$465.00 ","$344.10 ","$11.21 ","$577.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$577.00 ","$26.16 ","$60.02 ","$456.98 ","$461.60 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500060","EAP","CPT� 85576","","Plt Agg, Adp","BOTH IP/OP","$465.00 ","$344.10 ","$11.21 ","$577.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$577.00 ","$26.16 ","$60.02 ","$456.98 ","$461.60 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500061","EAP","CPT� 85576","","Plt Agg, Collagen","BOTH IP/OP","$465.00 ","$344.10 ","$11.21 ","$577.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$577.00 ","$26.16 ","$60.02 ","$456.98 ","$461.60 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500062","EAP","CPT� 85576","","Plt Agg, Ristocetin","BOTH IP/OP","$465.00 ","$344.10 ","$11.21 ","$577.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$577.00 ","$26.16 ","$60.02 ","$456.98 ","$461.60 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500063","EAP","CPT� 85576","","Plt Agg, Aracdnc Acid","BOTH IP/OP","$465.00 ","$344.10 ","$11.21 ","$577.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$577.00 ","$26.16 ","$60.02 ","$456.98 ","$461.60 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500064","EAP","CPT� 85576","","Pfa-collagen/epi","BOTH IP/OP","$676.00 ","$500.24 ","$11.21 ","$615.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$615.00 ","$26.16 ","$60.02 ","$487.08 ","$492.00 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500065","EAP","CPT� 85576","","Pfa-collagen/adp","BOTH IP/OP","$676.00 ","$500.24 ","$11.21 ","$615.00 ","$44.35 ","$12.46 ","$11.21 ","$31.37 ","$31.37 ","$31.73 ","$615.00 ","$26.16 ","$60.02 ","$487.08 ","$492.00 ","$36.12 ","$33.81 ","$24.91 ","$23.67 ","$24.91 "
"30500066","EAP","CPT� 86022","","Platelet Agg-heprin","BOTH IP/OP","$536.00 ","$396.64 ","$0.00 ","$493.00 ","$37.91 ","$9.19 ","$9.18 ","$26.82 ","$26.82 ","$0.00 ","$493.00 ","$0.00 ","$51.32 ","$390.46 ","$394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500067","EAP","CPT� 85597","","Plat Neutralization","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$521.00 ","$0.00 ","$0.00 ","$0.00 ","$26.25 ","$26.25 ","$0.00 ","$521.00 ","$0.00 ","$50.24 ","$412.63 ","$416.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500068","EAP","CPT� 85610","","Pt(prothrombin Time)","BOTH IP/OP","$159.00 ","$117.66 ","$1.97 ","$146.00 ","$8.10 ","$2.15 ","$1.97 ","$5.74 ","$5.74 ","$5.81 ","$146.00 ","$4.50 ","$10.98 ","$115.63 ","$116.80 ","$6.22 ","$6.19 ","$4.29 ","$4.33 ","$4.29 "
"30500069","EAP","CPT� 85610","","Pt,coumadin Therapy","BOTH IP/OP","$159.00 ","$117.66 ","$1.97 ","$146.00 ","$8.10 ","$2.15 ","$1.97 ","$5.74 ","$5.74 ","$5.81 ","$146.00 ","$4.50 ","$10.98 ","$115.63 ","$116.80 ","$6.22 ","$6.19 ","$4.29 ","$4.33 ","$4.29 "
"30500070","EAP","CPT� 85610","","Pt, Coumatrak","BOTH IP/OP","$146.00 ","$108.04 ","$1.97 ","$146.00 ","$8.10 ","$2.15 ","$1.97 ","$5.74 ","$5.74 ","$5.81 ","$146.00 ","$4.50 ","$10.98 ","$115.63 ","$116.80 ","$6.22 ","$6.19 ","$4.29 ","$4.33 ","$4.29 "
"30500071","EAP","CPT� 85611","","Pt+normal Plasma","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$133.00 ","$0.00 ","$0.00 ","$0.00 ","$5.75 ","$5.75 ","$0.00 ","$133.00 ","$0.00 ","$11.02 ","$105.34 ","$106.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500072","EAP","CPT� 85611","","Pt, Hepzyme-treated","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$0.00 ","$0.00 ","$0.00 ","$5.75 ","$5.75 ","$0.00 ","$133.00 ","$0.00 ","$11.02 ","$105.34 ","$106.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500073","EAP","CPT� 85613","","Dilute Russell's Viper Venom","BOTH IP/OP","$302.00 ","$223.48 ","$4.79 ","$275.00 ","$19.77 ","$4.79 ","$4.79 ","$13.97 ","$13.97 ","$14.13 ","$275.00 ","$10.06 ","$26.74 ","$217.80 ","$220.00 ","$13.89 ","$15.06 ","$9.58 ","$10.54 ","$9.58 "
"30500074","EAP","CPT� 85651","","Sed Rate Westergren","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$123.00 ","$0.00 ","$0.00 ","$0.00 ","$5.18 ","$5.18 ","$0.00 ","$123.00 ","$0.00 ","$9.92 ","$97.42 ","$98.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500075","EAP","CPT� 85660","","DONOR HGB S-ARC","BOTH IP/OP","$166.00 ","$122.84 ","$2.75 ","$183.00 ","$11.38 ","$2.76 ","$2.75 ","$8.06 ","$8.06 ","$8.15 ","$183.00 ","$5.79 ","$15.42 ","$144.94 ","$146.40 ","$7.99 ","$8.68 ","$5.51 ","$6.08 ","$5.51 "
"30500076","EAP","CPT� 85660","","Donor Hgb S-gmh","BOTH IP/OP","$166.00 ","$122.84 ","$2.75 ","$183.00 ","$11.38 ","$2.76 ","$2.75 ","$8.06 ","$8.06 ","$8.15 ","$183.00 ","$5.79 ","$15.42 ","$144.94 ","$146.40 ","$7.99 ","$8.68 ","$5.51 ","$6.08 ","$5.51 "
"30500077","EAP","CPT� 85660","","Sickledex","BOTH IP/OP","$201.00 ","$148.74 ","$2.75 ","$183.00 ","$11.38 ","$2.76 ","$2.75 ","$8.06 ","$8.06 ","$8.15 ","$183.00 ","$5.79 ","$15.42 ","$144.94 ","$146.40 ","$7.99 ","$8.68 ","$5.51 ","$6.08 ","$5.51 "
"30500078","EAP","CPT� 85670","","Thrombin Time","BOTH IP/OP","$145.00 ","$107.30 ","$2.88 ","$132.00 ","$11.91 ","$2.89 ","$2.88 ","$8.44 ","$8.44 ","$8.53 ","$132.00 ","$6.06 ","$16.14 ","$104.54 ","$105.60 ","$8.37 ","$9.08 ","$5.77 ","$6.36 ","$5.77 "
"30500079","EAP","CPT� 85730","","Appt, Hepzyme-treated","BOTH IP/OP","$216.00 ","$159.84 ","$3.00 ","$196.00 ","$12.41 ","$3.01 ","$3.00 ","$8.76 ","$8.76 ","$8.86 ","$196.00 ","$6.31 ","$16.76 ","$155.23 ","$156.80 ","$8.71 ","$9.44 ","$6.01 ","$6.61 ","$6.01 "
"30500080","EAP","CPT� 85730","","Aptt","BOTH IP/OP","$216.00 ","$159.84 ","$3.00 ","$196.00 ","$12.41 ","$3.01 ","$3.00 ","$8.76 ","$8.76 ","$8.86 ","$196.00 ","$6.31 ","$16.76 ","$155.23 ","$156.80 ","$8.71 ","$9.44 ","$6.01 ","$6.61 ","$6.01 "
"30500082","EAP","CPT� 85730","","Aptt Heparin Therapy","BOTH IP/OP","$187.00 ","$138.38 ","$3.00 ","$196.00 ","$12.41 ","$3.01 ","$3.00 ","$8.76 ","$8.76 ","$8.86 ","$196.00 ","$6.31 ","$16.76 ","$155.23 ","$156.80 ","$8.71 ","$9.44 ","$6.01 ","$6.61 ","$6.01 "
"30500083","EAP","CPT� 85730","","Ptt-saline","BOTH IP/OP","$187.00 ","$138.38 ","$3.00 ","$196.00 ","$12.41 ","$3.01 ","$3.00 ","$8.76 ","$8.76 ","$8.86 ","$196.00 ","$6.31 ","$16.76 ","$155.23 ","$156.80 ","$8.71 ","$9.44 ","$6.01 ","$6.61 ","$6.01 "
"30500084","EAP","CPT� 85732","","Aptt + Apc","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$205.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$0.00 ","$205.00 ","$0.00 ","$18.08 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500085","EAP","CPT� 85732","","Factor Def Scrn-coag","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$205.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$0.00 ","$205.00 ","$0.00 ","$18.08 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500086","EAP","CPT� 85732","","Factor Inhib Screen","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$205.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$0.00 ","$205.00 ","$0.00 ","$18.08 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500087","EAP","CPT� 85810","","Viscosity, Serum","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$0.00 ","$0.00 ","$0.00 ","$17.05 ","$17.05 ","$0.00 ","$243.00 ","$0.00 ","$32.64 ","$192.46 ","$194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500088","EAP","CPT� 86078","","Transfusion Reaction","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$46.82 ","$46.82 ","$0.00 ","$470.00 ","$0.00 ","$103.62 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500090","EAP","CPT� 85048","","Eosinophil Count, Wb","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$3.71 ","$3.71 ","$0.00 ","$74.00 ","$0.00 ","$7.10 ","$58.61 ","$59.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500091","EAP","CPT� 85652","","Sed Rate, Capillary Photometry","BOTH IP/OP","$105.00 ","$77.70 ","$1.35 ","$106.00 ","$5.57 ","$1.35 ","$1.35 ","$3.94 ","$3.94 ","$3.98 ","$106.00 ","$2.84 ","$7.54 ","$83.95 ","$84.80 ","$3.92 ","$4.24 ","$2.70 ","$2.97 ","$2.70 "
"30500092","EAP","CPT� 85415","","Plasminogen Act Inhib (so)","BOTH IP/OP","$268.00 ","$198.32 ","$0.00 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$25.10 ","$25.10 ","$0.00 ","$268.00 ","$0.00 ","$48.04 ","$212.26 ","$214.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500102","EAP","CPT� 85008","","Rbc Morphology Exam","BOTH IP/OP","$91.00 ","$67.34 ","$1.72 ","$83.00 ","$7.08 ","$1.72 ","$1.72 ","$5.02 ","$5.02 ","$5.08 ","$83.00 ","$3.60 ","$9.62 ","$65.74 ","$66.40 ","$4.97 ","$5.41 ","$3.43 ","$3.79 ","$3.43 "
"30500103","EAP","CPT� 85013","","Hematocrit, Spun Cap","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$51.00 ","$0.00 ","$6.62 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500104","EAP","CPT� 85018","","Hgb & Hct","BOTH IP/OP","$51.00 ","$37.74 ","$1.18 ","$51.00 ","$4.88 ","$1.19 ","$1.18 ","$3.46 ","$3.46 ","$3.50 ","$51.00 ","$2.49 ","$6.62 ","$40.39 ","$40.80 ","$3.44 ","$3.73 ","$2.37 ","$2.61 ","$2.37 "
"30500105","EAP","CPT� 85025","","Cbc, Plat & Diff","BOTH IP/OP","$244.00 ","$180.56 ","$3.88 ","$222.00 ","$16.05 ","$3.89 ","$3.88 ","$9.59 ","$9.59 ","$11.48 ","$222.00 ","$8.16 ","$21.72 ","$175.82 ","$177.60 ","$11.27 ","$12.23 ","$7.77 ","$8.56 ","$7.77 "
"30500106","EAP","CPT� 85027","","Cbc & Plat","BOTH IP/OP","$175.00 ","$129.50 ","$3.23 ","$184.00 ","$13.36 ","$3.24 ","$3.23 ","$9.45 ","$9.45 ","$9.57 ","$184.00 ","$6.79 ","$18.08 ","$145.73 ","$147.20 ","$9.38 ","$10.19 ","$6.47 ","$7.13 ","$6.47 "
"30500108","EAP","CPT� 85008","","Rbc Morphology","BOTH IP/OP","$91.00 ","$67.34 ","$1.72 ","$83.00 ","$7.08 ","$1.72 ","$1.72 ","$5.02 ","$5.02 ","$5.08 ","$83.00 ","$3.60 ","$9.62 ","$65.74 ","$66.40 ","$4.97 ","$5.41 ","$3.43 ","$3.79 ","$3.43 "
"30500109","EAP","CPT� 85013","","Hematocrit, Spun","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$3.46 ","$3.46 ","$0.00 ","$51.00 ","$0.00 ","$6.62 ","$40.39 ","$40.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500110","EAP","CPT� 85660","","Sickledex","BOTH IP/OP","$166.00 ","$122.84 ","$2.75 ","$183.00 ","$11.38 ","$2.76 ","$2.75 ","$8.06 ","$8.06 ","$8.15 ","$183.00 ","$5.79 ","$15.42 ","$144.94 ","$146.40 ","$7.99 ","$8.68 ","$5.51 ","$6.08 ","$5.51 "
"30500112","EAP","CPT� 85025","","Cbc, Plat & Diff, Idp","BOTH IP/OP","$244.00 ","$180.56 ","$3.88 ","$222.00 ","$16.05 ","$3.89 ","$3.88 ","$9.59 ","$9.59 ","$11.48 ","$222.00 ","$8.16 ","$21.72 ","$175.82 ","$177.60 ","$11.27 ","$12.23 ","$7.77 ","$8.56 ","$7.77 "
"30500113","EAP","CPT� 86146","","Beta-2 Glycoprotein Antibodies","BOTH IP/OP","$327.00 ","$241.98 ","$12.73 ","$300.00 ","$52.54 ","$12.73 ","$12.73 ","$37.14 ","$37.14 ","$37.58 ","$300.00 ","$26.72 ","$71.08 ","$237.60 ","$240.00 ","$36.90 ","$40.04 ","$25.45 ","$28.03 ","$25.45 "
"30500114","EAP","CPT� 85397","","Von Willebran Protease Act Q","BOTH IP/OP","$471.00 ","$348.54 ","$13.89 ","$476.00 ","$47.36 ","$15.43 ","$13.89 ","$33.51 ","$33.51 ","$31.50 ","$476.00 ","$32.40 ","$238.00 ","$376.99 ","$380.80 ","$44.75 ","$33.56 ","$30.86 ","$23.49 ","$30.86 "
"30500115","EAP","CPT� 85730","","Silica Clotting Time","BOTH IP/OP","$187.00 ","$138.38 ","$3.00 ","$196.00 ","$12.41 ","$3.01 ","$3.00 ","$8.76 ","$8.76 ","$8.86 ","$196.00 ","$6.31 ","$16.76 ","$155.23 ","$156.80 ","$8.71 ","$9.44 ","$6.01 ","$6.61 ","$6.01 "
"30500117","EAP","CPT� 83520","","Thrombin Anti Thrmbon Complex (e)","BOTH IP/OP","$286.00 ","$211.64 ","$7.77 ","$323.00 ","$26.72 ","$8.64 ","$7.77 ","$18.91 ","$18.91 ","$19.12 ","$323.00 ","$18.13 ","$36.18 ","$255.82 ","$258.40 ","$25.04 ","$20.37 ","$17.27 ","$14.26 ","$17.27 "
"30500118","EAP","HCPCS 85999","","Eosinophil Smear, Urine","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500119","EAP","CPT� 85999","","Esoinophil Smear, Urine","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500121","EAP","CPT� 85362","","Fibrin Monomer (so)","BOTH IP/OP","$320.00 ","$236.80 ","$3.44 ","$291.00 ","$14.23 ","$3.45 ","$3.44 ","$10.06 ","$10.06 ","$10.17 ","$291.00 ","$7.23 ","$19.24 ","$230.47 ","$232.80 ","$9.99 ","$10.84 ","$6.89 ","$7.59 ","$6.89 "
"30500122","EAP","CPT� 85307","","Activated Protein C Resistance (so)","BOTH IP/OP","$125.00 ","$92.50 ","$7.66 ","$122.00 ","$31.63 ","$7.66 ","$7.66 ","$22.37 ","$22.37 ","$22.64 ","$122.00 ","$16.09 ","$42.82 ","$96.62 ","$97.60 ","$22.21 ","$24.12 ","$15.32 ","$16.88 ","$15.32 "
"30500123","EAP","CPT� 86355","","Lymphocyte Subset Bal - B Cells Total (so)","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$34.39 ","$34.39 ","$34.80 ","$118.00 ","$39.62 ","$65.82 ","$93.46 ","$94.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30500124","EAP","CPT� 86359","","Lymphocyte Subset Bal - T Cells Total (so)","BOTH IP/OP","$113.00 ","$83.62 ","$18.86 ","$118.00 ","$48.63 ","$18.87 ","$18.86 ","$34.39 ","$34.39 ","$34.80 ","$118.00 ","$39.62 ","$65.82 ","$93.46 ","$94.40 ","$54.71 ","$37.08 ","$37.73 ","$25.95 ","$37.73 "
"30500125","EAP","CPT� 86360","","Lymphocyte Subset Bal - Absolute Cd4/cd8 With Ratio (so)","BOTH IP/OP","$113.00 ","$83.62 ","$23.49 ","$118.00 ","$96.99 ","$23.49 ","$23.49 ","$68.60 ","$68.60 ","$69.42 ","$118.00 ","$49.33 ","$118.00 ","$93.46 ","$94.40 ","$68.12 ","$73.96 ","$46.98 ","$51.77 ","$46.98 "
"30500126","EAP","CPT� 85460","","Hemoglobin Fetal Stain Family Member","BOTH IP/OP","$51.00 ","$37.74 ","$2.66 ","$51.00 ","$4.99 ","$3.87 ","$3.87 ","$3.53 ","$3.53 ","$3.57 ","$51.00 ","$8.12 ","$6.76 ","$40.39 ","$40.80 ","$11.21 ","$3.80 ","$7.73 ","$2.66 ","$7.73 "
"30500130","EAP","CPT� 80299","","Apixaban Quantitative Assay","BOTH IP/OP","$155.00 ","$114.70 ","$8.39 ","$156.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$156.00 ","$19.57 ","$33.64 ","$123.55 ","$124.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30500131","EAP","CPT� 80299","","Rivaroxaban Quantitative Assay","BOTH IP/OP","$155.00 ","$114.70 ","$8.39 ","$156.00 ","$28.04 ","$9.32 ","$8.39 ","$17.58 ","$17.58 ","$17.79 ","$156.00 ","$19.57 ","$33.64 ","$123.55 ","$124.80 ","$27.03 ","$18.95 ","$18.64 ","$13.27 ","$18.64 "
"30600001","EAP","CPT� 87040","","Blood Cult. Routine","BOTH IP/OP","$476.00 ","$352.24 ","$5.16 ","$433.00 ","$21.30 ","$5.16 ","$5.16 ","$15.07 ","$15.07 ","$15.25 ","$433.00 ","$10.84 ","$28.84 ","$342.94 ","$346.40 ","$14.96 ","$16.24 ","$10.32 ","$11.37 ","$10.32 "
"30600002","EAP","CPT� 87045","","Stool Culture","BOTH IP/OP","$206.00 ","$152.44 ","$4.72 ","$208.00 ","$19.48 ","$4.72 ","$4.72 ","$13.77 ","$13.77 ","$36.42 ","$208.00 ","$9.91 ","$26.36 ","$164.74 ","$166.40 ","$13.69 ","$32.55 ","$9.44 ","$33.11 ","$9.44 "
"30600003","EAP","CPT� 87070","","Bone Marrow Culture","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600004","EAP","CPT� 87070","","Csf Culture","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600005","EAP","CPT� 87070","","Exudate Culture","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600006","EAP","CPT� 87070","","Fluid/tissue Cult.","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600007","EAP","CPT� 87070","","Genital Culture","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600008","EAP","CPT� 87070","","Misc Cult,referral","BOTH IP/OP","$338.00 ","$250.12 ","$4.31 ","$316.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$316.00 ","$9.05 ","$24.06 ","$250.27 ","$252.80 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600009","EAP","CPT� 87070","","Misc. Culture","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600010","EAP","CPT� 87070","","SPUTUM CULTURE","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30600011","EAP","CPT� 87081","","Throat Culture","BOTH IP/OP","$305.00 ","$225.70 ","$3.31 ","$280.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$280.00 ","$6.96 ","$18.52 ","$221.76 ","$224.00 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30600012","EAP","CPT� 87075","","Anaerobe Culture","BOTH IP/OP","$318.00 ","$235.32 ","$4.73 ","$289.00 ","$19.54 ","$4.74 ","$4.73 ","$13.81 ","$13.81 ","$13.98 ","$289.00 ","$9.94 ","$26.44 ","$228.89 ","$231.20 ","$13.73 ","$14.89 ","$9.47 ","$10.42 ","$9.47 "
"30600013","EAP","CPT� 87899","","Malaria Rapid Antigen Test,evd","BOTH IP/OP","$359.00 ","$265.66 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$405.00 ","$0.00 ","$33.52 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600014","EAP","CPT� 87076","","CULTURE I.D.-AEROBE BIOCHEM","BOTH IP/OP","$229.00 ","$169.46 ","$0.00 ","$237.00 ","$0.00 ","$0.00 ","$0.00 ","$11.80 ","$11.80 ","$0.00 ","$237.00 ","$0.00 ","$22.58 ","$187.70 ","$189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600015","EAP","CPT� 87801","","Ebola- Amplified Probe Technique, Evd","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$86.66 ","$86.66 ","$0.00 ","$572.00 ","$0.00 ","$109.64 ","$453.02 ","$457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600016","EAP","CPT� 87081","","Gc Cult,vag/cervix","BOTH IP/OP","$305.00 ","$225.70 ","$3.31 ","$280.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$280.00 ","$6.96 ","$18.52 ","$221.76 ","$224.00 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30600017","EAP","CPT� 87081","","Gc Cult,urethral","BOTH IP/OP","$305.00 ","$225.70 ","$3.31 ","$280.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$280.00 ","$6.96 ","$18.52 ","$221.76 ","$224.00 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30600018","EAP","CPT� 87081","","Gc Cult,anal","BOTH IP/OP","$305.00 ","$225.70 ","$3.31 ","$280.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$280.00 ","$6.96 ","$18.52 ","$221.76 ","$224.00 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30600019","EAP","CPT� 87081","","Gc Cult,throat","BOTH IP/OP","$305.00 ","$225.70 ","$3.31 ","$280.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$280.00 ","$6.96 ","$18.52 ","$221.76 ","$224.00 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30600020","EAP","CPT� 87081","","Gc Culture Eye","BOTH IP/OP","$305.00 ","$225.70 ","$3.31 ","$280.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$280.00 ","$6.96 ","$18.52 ","$221.76 ","$224.00 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30600021","EAP","CPT� 87086","","Urine Culture","BOTH IP/OP","$299.00 ","$221.26 ","$4.04 ","$302.00 ","$16.66 ","$4.04 ","$4.04 ","$11.79 ","$11.79 ","$11.93 ","$302.00 ","$8.47 ","$22.56 ","$239.18 ","$241.60 ","$11.70 ","$12.71 ","$8.07 ","$8.90 ","$8.07 "
"30600022","EAP","CPT� 87088","","Urine Culture-presump. Id","BOTH IP/OP","$302.00 ","$223.48 ","$0.00 ","$302.00 ","$0.00 ","$0.00 ","$0.00 ","$11.82 ","$11.82 ","$0.00 ","$302.00 ","$0.00 ","$22.62 ","$239.18 ","$241.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600023","EAP","CPT� 87101","","Fungus Cult. Derm.","BOTH IP/OP","$218.00 ","$161.32 ","$3.85 ","$199.00 ","$15.89 ","$3.86 ","$3.85 ","$11.26 ","$11.26 ","$11.38 ","$199.00 ","$8.10 ","$21.54 ","$157.61 ","$159.20 ","$11.18 ","$12.13 ","$7.71 ","$8.49 ","$7.71 "
"30600024","EAP","CPT� 87102","","Fungus Culture,misc.","BOTH IP/OP","$231.00 ","$170.94 ","$4.20 ","$211.00 ","$17.34 ","$4.21 ","$4.20 ","$12.26 ","$12.26 ","$12.42 ","$211.00 ","$8.83 ","$23.48 ","$167.11 ","$168.80 ","$12.19 ","$13.24 ","$8.41 ","$9.26 ","$8.41 "
"30600025","EAP","CPT� 87103","","Fungus Cult. Blood","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$229.00 ","$0.00 ","$0.00 ","$0.00 ","$13.17 ","$13.17 ","$13.32 ","$229.00 ","$0.00 ","$25.20 ","$181.37 ","$183.20 ","$0.00 ","$14.20 ","$0.00 ","$0.00 ","$0.00 "
"30600026","EAP","CPT� 87106","","Culture I.d.-yeast Biochem","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$0.00 ","$0.00 ","$0.00 ","$15.07 ","$15.07 ","$0.00 ","$261.00 ","$0.00 ","$28.84 ","$206.71 ","$208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600027","EAP","CPT� 87107","","Culture I.d.- Mold Biochem","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$0.00 ","$0.00 ","$0.00 ","$15.07 ","$15.07 ","$0.00 ","$261.00 ","$0.00 ","$28.84 ","$206.71 ","$208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600028","EAP","CPT� 87110","","Chlam Cult,referral","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$28.60 ","$28.60 ","$0.00 ","$128.00 ","$0.00 ","$54.74 ","$101.38 ","$102.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600029","EAP","CPT� 87116","","Afb Culture-misc","BOTH IP/OP","$270.00 ","$199.80 ","$5.40 ","$249.00 ","$15.02 ","$5.40 ","$5.40 ","$10.60 ","$10.60 ","$43.60 ","$249.00 ","$11.34 ","$20.28 ","$197.21 ","$199.20 ","$15.66 ","$38.97 ","$10.80 ","$39.64 ","$10.80 "
"30600030","EAP","CPT� 87116","","Afb Culture, Blood","BOTH IP/OP","$270.00 ","$199.80 ","$5.40 ","$249.00 ","$15.02 ","$5.40 ","$5.40 ","$10.60 ","$10.60 ","$43.60 ","$249.00 ","$11.34 ","$20.28 ","$197.21 ","$199.20 ","$15.66 ","$38.97 ","$10.80 ","$39.64 ","$10.80 "
"30600031","EAP","CPT� 87147","","Culture I.d.-immunologic","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$6.51 ","$6.51 ","$0.00 ","$105.00 ","$0.00 ","$12.46 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600032","EAP","CPT� 87149","","Culture I.d.-probe Biochem","BOTH IP/OP","$468.00 ","$346.32 ","$10.03 ","$473.00 ","$40.71 ","$10.03 ","$10.03 ","$28.79 ","$28.79 ","$29.14 ","$473.00 ","$21.05 ","$55.10 ","$374.62 ","$378.40 ","$29.07 ","$31.05 ","$20.05 ","$21.73 ","$20.05 "
"30600033","EAP","CPT� 87172","","Pinworm Exam","BOTH IP/OP","$134.00 ","$99.16 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$6.23 ","$6.23 ","$0.00 ","$135.00 ","$0.00 ","$11.92 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600034","EAP","CPT� 87177","","Ova & Parasites, Urn","BOTH IP/OP","$251.00 ","$185.74 ","$4.45 ","$244.00 ","$18.37 ","$4.45 ","$4.45 ","$12.99 ","$12.99 ","$13.15 ","$244.00 ","$9.35 ","$24.86 ","$193.25 ","$195.20 ","$12.91 ","$14.01 ","$8.90 ","$9.81 ","$8.90 "
"30600035","EAP","CPT� 87177","","O&p,ethylacetate","BOTH IP/OP","$229.00 ","$169.46 ","$4.45 ","$223.00 ","$18.37 ","$4.45 ","$4.45 ","$12.99 ","$12.99 ","$13.15 ","$223.00 ","$9.35 ","$24.86 ","$176.62 ","$178.40 ","$12.91 ","$14.01 ","$8.90 ","$9.81 ","$8.90 "
"30600036","EAP","CPT� 87186","","Sens.special Panel","BOTH IP/OP","$235.00 ","$173.90 ","$4.32 ","$214.00 ","$17.85 ","$4.33 ","$4.32 ","$12.62 ","$12.62 ","$12.77 ","$214.00 ","$9.08 ","$24.16 ","$169.49 ","$171.20 ","$12.54 ","$13.60 ","$8.65 ","$9.52 ","$8.65 "
"30600037","EAP","CPT� 87186","","Sens.gram Pos Cocci","BOTH IP/OP","$214.00 ","$158.36 ","$4.32 ","$214.00 ","$17.85 ","$4.33 ","$4.32 ","$12.62 ","$12.62 ","$12.77 ","$214.00 ","$9.08 ","$24.16 ","$169.49 ","$171.20 ","$12.54 ","$13.60 ","$8.65 ","$9.52 ","$8.65 "
"30600038","EAP","CPT� 87205","","Gram Stain","BOTH IP/OP","$61.00 ","$45.14 ","$2.14 ","$63.00 ","$4.83 ","$2.14 ","$2.14 ","$3.43 ","$3.43 ","$3.47 ","$63.00 ","$4.48 ","$6.56 ","$49.90 ","$50.40 ","$6.19 ","$3.69 ","$4.27 ","$2.58 ","$4.27 "
"30600039","EAP","CPT� 87502","","Influenza Virus -a/b  Amplified Probe","BOTH IP/OP","$272.00 ","$201.28 ","$43.11 ","$275.00 ","$107.10 ","$47.90 ","$43.11 ","$73.04 ","$73.04 ","$68.64 ","$275.00 ","$100.59 ","$137.50 ","$217.80 ","$220.00 ","$138.91 ","$73.14 ","$95.80 ","$51.20 ","$95.80 "
"30600040","EAP","CPT� 87150","","Group B Strep - Amplified Probe","BOTH IP/OP","$384.00 ","$284.16 ","$0.00 ","$384.00 ","$40.50 ","$17.55 ","$0.00 ","$28.10 ","$28.10 ","$0.00 ","$384.00 ","$0.00 ","$192.00 ","$304.13 ","$307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600041","EAP","CPT� 87503","","Influenza Virus (h1n1) (amplified Probe)","BOTH IP/OP","$271.00 ","$200.54 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$10.95 ","$10.95 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600042","EAP","CPT� 87206","","PAS/KOH PREP","BOTH IP/OP","$158.00 ","$116.92 ","$2.70 ","$154.00 ","$11.11 ","$2.70 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$154.00 ","$5.66 ","$15.00 ","$121.97 ","$123.20 ","$7.82 ","$8.45 ","$5.39 ","$5.91 ","$5.39 "
"30600044","EAP","CPT� 87328","","Cryptosporidium Scrn.","BOTH IP/OP","$195.00 ","$144.30 ","$6.22 ","$193.00 ","$24.74 ","$6.91 ","$6.22 ","$17.52 ","$17.52 ","$17.71 ","$193.00 ","$14.51 ","$33.52 ","$152.86 ","$154.40 ","$20.04 ","$18.87 ","$13.82 ","$13.21 ","$13.82 "
"30600045","EAP","CPT� 87207","","Malaria/parasite Smr","BOTH IP/OP","$229.00 ","$169.46 ","$3.00 ","$223.00 ","$12.38 ","$3.00 ","$3.00 ","$8.75 ","$8.75 ","$8.84 ","$223.00 ","$6.29 ","$16.74 ","$176.62 ","$178.40 ","$8.69 ","$9.42 ","$5.99 ","$6.59 ","$5.99 "
"30600046","EAP","CPT� 87207","","Rbc Inclusion Body","BOTH IP/OP","$216.00 ","$159.84 ","$3.00 ","$223.00 ","$12.38 ","$3.00 ","$3.00 ","$8.75 ","$8.75 ","$8.84 ","$223.00 ","$6.29 ","$16.74 ","$176.62 ","$178.40 ","$8.69 ","$9.42 ","$5.99 ","$6.59 ","$5.99 "
"30600047","EAP","CPT� 87209","","Microsporidium","BOTH IP/OP","$391.00 ","$289.34 ","$8.99 ","$381.00 ","$37.12 ","$8.99 ","$8.99 ","$26.24 ","$26.24 ","$26.54 ","$381.00 ","$18.88 ","$50.22 ","$301.75 ","$304.80 ","$26.07 ","$28.28 ","$17.98 ","$19.80 ","$17.98 "
"30600048","EAP","CPT� 87209","","O&p,pva/trichrome","BOTH IP/OP","$367.00 ","$271.58 ","$8.99 ","$357.00 ","$37.12 ","$8.99 ","$8.99 ","$26.24 ","$26.24 ","$26.54 ","$357.00 ","$18.88 ","$50.22 ","$282.74 ","$285.60 ","$26.07 ","$28.28 ","$17.98 ","$19.80 ","$17.98 "
"30600049","EAP","CPT� 87799","","Eb Virus Dna Quant Pcr (so)","BOTH IP/OP","$796.00 ","$589.04 ","$0.00 ","$786.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$786.00 ","$0.00 ","$119.70 ","$622.51 ","$628.80 ","$0.00 ","$123.01 ","$0.00 ","$0.00 ","$0.00 "
"30600050","EAP","CPT� 87252","","Cmv Culture Inoc Tissue (so)","BOTH IP/OP","$390.00 ","$288.60 ","$13.04 ","$390.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$390.00 ","$27.37 ","$61.78 ","$308.88 ","$312.00 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30600051","EAP","CPT� 87254","","Cmv Culture Inoc Shell (so)","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$7.22 ","$240.00 ","$0.00 ","$54.64 ","$190.08 ","$192.00 ","$0.00 ","$7.70 ","$0.00 ","$0.00 ","$0.00 "
"30600052","EAP","CPT� 87210","","O & P DIRECT, SMEAR","BOTH IP/OP","$216.00 ","$159.84 ","$2.62 ","$210.00 ","$8.82 ","$2.91 ","$2.62 ","$6.23 ","$6.23 ","$6.30 ","$210.00 ","$6.11 ","$11.92 ","$166.32 ","$168.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"30600053","EAP","CPT� 87220","","Koh Level","BOTH IP/OP","$198.00 ","$146.52 ","$2.14 ","$184.00 ","$8.82 ","$2.14 ","$2.14 ","$6.23 ","$6.23 ","$6.30 ","$184.00 ","$4.48 ","$11.92 ","$145.73 ","$147.20 ","$6.19 ","$6.71 ","$4.27 ","$4.70 ","$4.27 "
"30600055","EAP","CPT� 87252","","Viral Cult,referral","BOTH IP/OP","$238.00 ","$176.12 ","$13.04 ","$240.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$240.00 ","$27.37 ","$61.78 ","$190.08 ","$192.00 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30600056","EAP","CPT� 87320","","Chlamydia Screen","BOTH IP/OP","$718.00 ","$531.32 ","$0.00 ","$718.00 ","$24.74 ","$7.50 ","$6.75 ","$17.52 ","$17.52 ","$0.00 ","$718.00 ","$0.00 ","$33.52 ","$568.66 ","$574.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600057","EAP","CPT� 87324","","C.diff. Assay,stool","BOTH IP/OP","$195.00 ","$144.30 ","$5.99 ","$193.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$193.00 ","$12.58 ","$33.52 ","$152.86 ","$154.40 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30600059","EAP","CPT� 87329","","Eia Giardia Screen","BOTH IP/OP","$195.00 ","$144.30 ","$5.99 ","$193.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$193.00 ","$12.58 ","$33.52 ","$152.86 ","$154.40 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30600060","EAP","CPT� 87337","","H.pylori Ag -stool","BOTH IP/OP","$334.00 ","$247.16 ","$5.99 ","$330.00 ","$24.74 ","$5.99 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$330.00 ","$12.58 ","$33.52 ","$261.36 ","$264.00 ","$17.37 ","$18.87 ","$11.98 ","$13.21 ","$11.98 "
"30600061","EAP","CPT� 87340","","Hbv Surface Ag","BOTH IP/OP","$255.00 ","$188.70 ","$5.17 ","$257.00 ","$21.33 ","$5.17 ","$5.17 ","$15.08 ","$15.08 ","$15.26 ","$257.00 ","$10.85 ","$28.86 ","$203.54 ","$205.60 ","$14.98 ","$16.26 ","$10.33 ","$11.38 ","$10.33 "
"30600062","EAP","CPT� 87340","","Hbv Surf Ag-ob","BOTH IP/OP","$246.00 ","$182.04 ","$5.17 ","$257.00 ","$21.33 ","$5.17 ","$5.17 ","$15.08 ","$15.08 ","$15.26 ","$257.00 ","$10.85 ","$28.86 ","$203.54 ","$205.60 ","$14.98 ","$16.26 ","$10.33 ","$11.38 ","$10.33 "
"30600063","EAP","CPT� 87350","","Hbv E Ag","BOTH IP/OP","$87.00 ","$64.38 ","$5.76 ","$88.00 ","$23.79 ","$5.77 ","$5.76 ","$16.83 ","$16.83 ","$17.02 ","$88.00 ","$12.11 ","$32.20 ","$69.70 ","$70.40 ","$16.72 ","$18.14 ","$11.53 ","$12.70 ","$11.53 "
"30600064","EAP","CPT� 87385","","Histoplasma Ag","BOTH IP/OP","$318.00 ","$235.32 ","$5.99 ","$314.00 ","$24.74 ","$6.63 ","$5.99 ","$17.52 ","$17.52 ","$17.71 ","$314.00 ","$13.91 ","$33.52 ","$248.69 ","$251.20 ","$19.21 ","$18.87 ","$13.25 ","$13.21 ","$13.25 "
"30600065","EAP","CPT� 87390","","Hiv-ag-p24","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$233.00 ","$0.00 ","$0.00 ","$0.00 ","$25.76 ","$25.76 ","$0.00 ","$233.00 ","$0.00 ","$49.30 ","$184.54 ","$186.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600066","EAP","CPT� 87425","","Rotavirus Ag, Stool","BOTH IP/OP","$223.00 ","$165.02 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$225.00 ","$0.00 ","$33.52 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600068","EAP","CPT� 87430","","STREP A AG-THROAT","BOTH IP/OP","$162.00 ","$119.88 ","$7.56 ","$162.00 ","$24.74 ","$8.41 ","$7.56 ","$17.52 ","$17.52 ","$17.71 ","$162.00 ","$17.65 ","$33.52 ","$128.30 ","$129.60 ","$24.37 ","$18.87 ","$16.81 ","$13.21 ","$16.81 "
"30600070","EAP","CPT� 87450","","L. Pneumo-1 Ag, Urine","BOTH IP/OP","$271.00 ","$200.54 ","$7.02 ","$274.00 ","$24.74 ","$7.80 ","$7.02 ","$13.99 ","$13.99 ","$14.15 ","$274.00 ","$10.07 ","$26.78 ","$217.01 ","$219.20 ","$13.91 ","$15.08 ","$9.59 ","$10.56 ","$9.59 "
"30600071","EAP","CPT� 87491","","Chlamydia Detection","BOTH IP/OP","$374.00 ","$276.76 ","$17.55 ","$340.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$340.00 ","$36.84 ","$54.82 ","$269.28 ","$272.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600072","EAP","CPT� 87496","","Cmv Dna-pcr Fluids","BOTH IP/OP","$905.00 ","$669.70 ","$0.00 ","$878.00 ","$0.00 ","$0.00 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$878.00 ","$36.84 ","$54.82 ","$695.38 ","$702.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600073","EAP","CPT� 87516","","Hbv Dna-pcr","BOTH IP/OP","$319.00 ","$236.06 ","$0.00 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$330.00 ","$0.00 ","$54.82 ","$261.36 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600074","EAP","CPT� 87177","","Coccidia Smear","BOTH IP/OP","$229.00 ","$169.46 ","$4.45 ","$223.00 ","$18.37 ","$4.45 ","$4.45 ","$12.99 ","$12.99 ","$13.15 ","$223.00 ","$9.35 ","$24.86 ","$176.62 ","$178.40 ","$12.91 ","$14.01 ","$8.90 ","$9.81 ","$8.90 "
"30600075","EAP","CPT� 87521","","Hcv Rna-pcr","BOTH IP/OP","$706.00 ","$522.44 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$28.64 ","$28.64 ","$0.00 ","$730.00 ","$0.00 ","$54.82 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600076","EAP","CPT� 87522","","Hcv Rna-pcr, Quant","BOTH IP/OP","$1,023.00 ","$757.02 ","$21.42 ","$993.00 ","$88.41 ","$21.42 ","$21.42 ","$62.54 ","$62.54 ","$63.28 ","$993.00 ","$44.98 ","$119.70 ","$786.46 ","$794.40 ","$62.12 ","$67.43 ","$42.84 ","$47.20 ","$42.84 "
"30600077","EAP","CPT� 87529","","Hsv Dna-pcr","BOTH IP/OP","$901.00 ","$666.74 ","$17.55 ","$875.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$875.00 ","$36.84 ","$54.82 ","$693.00 ","$700.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600078","EAP","CPT� 87535","","Hiv-1 Dna-pcr","BOTH IP/OP","$675.00 ","$499.50 ","$17.55 ","$655.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$655.00 ","$36.84 ","$54.82 ","$518.76 ","$524.00 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600079","EAP","CPT� 87536","","Hiv-1 Rna B Dna, Quant","BOTH IP/OP","$742.00 ","$549.08 ","$42.55 ","$767.00 ","$107.10 ","$42.55 ","$42.55 ","$75.77 ","$75.77 ","$66.37 ","$767.00 ","$89.36 ","$145.02 ","$607.46 ","$613.60 ","$123.40 ","$70.72 ","$85.10 ","$49.50 ","$85.10 "
"30600080","EAP","CPT� 87556","","Direct M. Tb Test","BOTH IP/OP","$317.00 ","$234.58 ","$18.76 ","$308.00 ","$40.50 ","$20.84 ","$18.76 ","$28.64 ","$28.64 ","$53.93 ","$308.00 ","$43.76 ","$54.82 ","$243.94 ","$246.40 ","$60.44 ","$48.20 ","$41.68 ","$49.03 ","$41.68 "
"30600081","EAP","CPT� 87591","","Gc Detection","BOTH IP/OP","$374.00 ","$276.76 ","$17.55 ","$340.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$25.16 ","$340.00 ","$36.84 ","$54.82 ","$269.28 ","$272.00 ","$50.88 ","$26.81 ","$35.09 ","$18.76 ","$35.09 "
"30600082","EAP","CPT� 87798","","Enterovirus Pcr, Csf","BOTH IP/OP","$807.00 ","$597.18 ","$17.55 ","$972.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$972.00 ","$36.84 ","$54.82 ","$769.82 ","$777.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600083","EAP","CPT� 87798","","Thyroid Perox Ab; Tpo","BOTH IP/OP","$964.00 ","$713.36 ","$17.55 ","$972.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$972.00 ","$36.84 ","$54.82 ","$769.82 ","$777.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600084","EAP","CPT� 87798","","Jcv Dna-pcr,csf","BOTH IP/OP","$900.00 ","$666.00 ","$17.55 ","$907.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$907.00 ","$36.84 ","$54.82 ","$718.34 ","$725.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600085","EAP","CPT� 87798","","Vzv Dna-pcr,csf","BOTH IP/OP","$900.00 ","$666.00 ","$17.55 ","$907.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$907.00 ","$36.84 ","$54.82 ","$718.34 ","$725.60 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600086","EAP","CPT� 87804","","Influenza-a Ag","BOTH IP/OP","$359.00 ","$265.66 ","$7.45 ","$363.00 ","$24.74 ","$8.28 ","$7.45 ","$17.52 ","$17.52 ","$17.71 ","$363.00 ","$17.38 ","$33.52 ","$287.50 ","$290.40 ","$24.00 ","$18.87 ","$16.55 ","$13.21 ","$16.55 "
"30600087","EAP","CPT� 87804","","Influenza-b Ag","BOTH IP/OP","$359.00 ","$265.66 ","$7.45 ","$363.00 ","$24.74 ","$8.28 ","$7.45 ","$17.52 ","$17.52 ","$17.71 ","$363.00 ","$17.38 ","$33.52 ","$287.50 ","$290.40 ","$24.00 ","$18.87 ","$16.55 ","$13.21 ","$16.55 "
"30600088","EAP","CPT� 87807","","Rsv Assay","BOTH IP/OP","$656.00 ","$485.44 ","$0.00 ","$638.00 ","$24.74 ","$6.55 ","$0.00 ","$17.52 ","$17.52 ","$17.71 ","$638.00 ","$13.76 ","$33.52 ","$505.30 ","$510.40 ","$19.00 ","$18.87 ","$13.10 ","$13.21 ","$13.10 "
"30600089","EAP","CPT� 87901","","Hiv Genotyping","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$96.09 ","$1,776.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,776.00 ","$270.32 ","$243.70 ","$1,406.59 ","$1,420.80 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30600090","EAP","CPT� 87902","","Hcv Genotyping","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$96.09 ","$1,922.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,922.00 ","$270.32 ","$243.70 ","$1,522.22 ","$1,537.60 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30600094","EAP","CPT� 86757","","Richettsia Antibody Igm","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$48.00 ","$0.00 ","$48.00 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600095","EAP","CPT� 87798","","Parvovirus B19 Pcr, Qual","BOTH IP/OP","$311.00 ","$230.14 ","$17.55 ","$313.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$313.00 ","$36.84 ","$54.82 ","$247.90 ","$250.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600096","EAP","CPT� 87517","","Hbv Dna-pcr,quant","BOTH IP/OP","$355.00 ","$262.70 ","$21.42 ","$345.00 ","$88.41 ","$21.42 ","$21.42 ","$62.54 ","$62.54 ","$63.28 ","$345.00 ","$44.98 ","$119.70 ","$273.24 ","$276.00 ","$62.12 ","$67.43 ","$42.84 ","$47.20 ","$42.84 "
"30600100","EAP","CPT� 87046","","E.coli O157, Culture(so)","BOTH IP/OP","$63.00 ","$46.62 ","$2.60 ","$64.00 ","$19.48 ","$4.72 ","$4.72 ","$13.77 ","$13.77 ","$3.49 ","$64.00 ","$9.91 ","$26.36 ","$50.69 ","$51.20 ","$13.69 ","$3.71 ","$9.44 ","$2.60 ","$9.44 "
"30600105","EAP","CPT� 87497","","Cmv,dna,pcr, Quant","BOTH IP/OP","$659.00 ","$487.66 ","$21.42 ","$681.00 ","$88.41 ","$21.42 ","$21.42 ","$62.54 ","$62.54 ","$63.28 ","$681.00 ","$44.98 ","$119.70 ","$539.35 ","$544.80 ","$62.12 ","$67.43 ","$42.84 ","$47.20 ","$42.84 "
"30600106","EAP","CPT� 87252","","Cmv Inoc Tissue (so)","BOTH IP/OP","$390.00 ","$288.60 ","$13.04 ","$390.00 ","$45.65 ","$13.04 ","$13.04 ","$32.28 ","$32.28 ","$32.66 ","$390.00 ","$27.37 ","$61.78 ","$308.88 ","$312.00 ","$37.80 ","$34.79 ","$26.07 ","$24.36 ","$26.07 "
"30600107","EAP","CPT� 87254","","Cmv Inoc Shell Via (so)","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$28.55 ","$28.55 ","$7.22 ","$240.00 ","$0.00 ","$54.64 ","$190.08 ","$192.00 ","$0.00 ","$7.70 ","$0.00 ","$0.00 ","$0.00 "
"30600108","EAP","CPT� 87902","","Hep C Dna Geno Quant (so)","BOTH IP/OP","$1,193.00 ","$882.82 ","$96.09 ","$1,233.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,233.00 ","$270.32 ","$243.70 ","$976.54 ","$986.40 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30600109","EAP","CPT� 87799","","Ebv Dna Detect Nos (so)","BOTH IP/OP","$688.00 ","$509.12 ","$0.00 ","$786.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$786.00 ","$0.00 ","$119.70 ","$622.51 ","$628.80 ","$0.00 ","$123.01 ","$0.00 ","$0.00 ","$0.00 "
"30600200","EAP","CPT� 87205","","Gram Stain","BOTH IP/OP","$65.00 ","$48.10 ","$2.14 ","$63.00 ","$4.83 ","$2.14 ","$2.14 ","$3.43 ","$3.43 ","$3.47 ","$63.00 ","$4.48 ","$6.56 ","$49.90 ","$50.40 ","$6.19 ","$3.69 ","$4.27 ","$2.58 ","$4.27 "
"30600201","EAP","CPT� 87205","","Sezary Cell Prep","BOTH IP/OP","$61.00 ","$45.14 ","$2.14 ","$63.00 ","$4.83 ","$2.14 ","$2.14 ","$3.43 ","$3.43 ","$3.47 ","$63.00 ","$4.48 ","$6.56 ","$49.90 ","$50.40 ","$6.19 ","$3.69 ","$4.27 ","$2.58 ","$4.27 "
"30600202","EAP","CPT� 87206","","Pas/koh Prep","BOTH IP/OP","$158.00 ","$116.92 ","$2.70 ","$154.00 ","$11.11 ","$2.70 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$154.00 ","$5.66 ","$15.00 ","$121.97 ","$123.20 ","$7.82 ","$8.45 ","$5.39 ","$5.91 ","$5.39 "
"30600203","EAP","CPT� 87206","","Afb Stain","BOTH IP/OP","$158.00 ","$116.92 ","$2.70 ","$154.00 ","$11.11 ","$2.70 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$154.00 ","$5.66 ","$15.00 ","$121.97 ","$123.20 ","$7.82 ","$8.45 ","$5.39 ","$5.91 ","$5.39 "
"30600204","EAP","CPT� 87210","","O & P Direct, Smear","BOTH IP/OP","$210.00 ","$155.40 ","$2.62 ","$210.00 ","$8.82 ","$2.91 ","$2.62 ","$6.23 ","$6.23 ","$6.30 ","$210.00 ","$6.11 ","$11.92 ","$166.32 ","$168.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"30600205","EAP","CPT� 87210","","India Ink Prep","BOTH IP/OP","$216.00 ","$159.84 ","$2.62 ","$210.00 ","$8.82 ","$2.91 ","$2.62 ","$6.23 ","$6.23 ","$6.30 ","$210.00 ","$6.11 ","$11.92 ","$166.32 ","$168.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"30600206","EAP","CPT� 87210","","Vaginal Wet Prep","BOTH IP/OP","$216.00 ","$159.84 ","$2.62 ","$210.00 ","$8.82 ","$2.91 ","$2.62 ","$6.23 ","$6.23 ","$6.30 ","$210.00 ","$6.11 ","$11.92 ","$166.32 ","$168.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"30600207","EAP","CPT� 87430","","Strep A Ag-throat","BOTH IP/OP","$169.00 ","$125.06 ","$7.56 ","$162.00 ","$24.74 ","$8.41 ","$7.56 ","$17.52 ","$17.52 ","$17.71 ","$162.00 ","$17.65 ","$33.52 ","$128.30 ","$129.60 ","$24.37 ","$18.87 ","$16.81 ","$13.21 ","$16.81 "
"30600208","EAP","CPT� 87205","","Gram Stain For Gc","BOTH IP/OP","$65.00 ","$48.10 ","$2.14 ","$63.00 ","$4.83 ","$2.14 ","$2.14 ","$3.43 ","$3.43 ","$3.47 ","$63.00 ","$4.48 ","$6.56 ","$49.90 ","$50.40 ","$6.19 ","$3.69 ","$4.27 ","$2.58 ","$4.27 "
"30600209","EAP","CPT� 87206","","Koh Prep","BOTH IP/OP","$158.00 ","$116.92 ","$2.70 ","$154.00 ","$11.11 ","$2.70 ","$2.70 ","$7.84 ","$7.84 ","$7.93 ","$154.00 ","$5.66 ","$15.00 ","$121.97 ","$123.20 ","$7.82 ","$8.45 ","$5.39 ","$5.91 ","$5.39 "
"30600210","EAP","CPT� 87210","","Vaginal Wet Prep","BOTH IP/OP","$216.00 ","$159.84 ","$2.62 ","$210.00 ","$8.82 ","$2.91 ","$2.62 ","$6.23 ","$6.23 ","$6.30 ","$210.00 ","$6.11 ","$11.92 ","$166.32 ","$168.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"30600211","EAP","CPT� 87430","","Rapid Strep","BOTH IP/OP","$162.00 ","$119.88 ","$7.56 ","$162.00 ","$24.74 ","$8.41 ","$7.56 ","$17.52 ","$17.52 ","$17.71 ","$162.00 ","$17.65 ","$33.52 ","$128.30 ","$129.60 ","$24.37 ","$18.87 ","$16.81 ","$13.21 ","$16.81 "
"30600212","EAP","CPT� 87205","","Gram Stain","BOTH IP/OP","$61.00 ","$45.14 ","$2.14 ","$63.00 ","$4.83 ","$2.14 ","$2.14 ","$3.43 ","$3.43 ","$3.47 ","$63.00 ","$4.48 ","$6.56 ","$49.90 ","$50.40 ","$6.19 ","$3.69 ","$4.27 ","$2.58 ","$4.27 "
"30600213","EAP","CPT� 87188","","Microbe Suscept Macrobroth","BOTH IP/OP","$41.00 ","$30.34 ","$0.00 ","$41.00 ","$0.00 ","$0.00 ","$0.00 ","$9.69 ","$9.69 ","$0.00 ","$41.00 ","$0.00 ","$18.54 ","$32.47 ","$32.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600215","EAP","CPT� 87290","","Varicella Zoster Ag If","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$66.00 ","$0.00 ","$33.52 ","$52.27 ","$52.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600216","EAP","CPT� 87299","","Antibody Detection Nos If","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$83.00 ","$0.00 ","$33.52 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600218","EAP","CPT� 87015","","Pneumocycstis Carni Dfa-concen","BOTH IP/OP","$91.00 ","$67.34 ","$3.34 ","$91.00 ","$13.78 ","$3.34 ","$3.34 ","$9.75 ","$9.75 ","$9.87 ","$91.00 ","$7.01 ","$18.66 ","$72.07 ","$72.80 ","$9.69 ","$10.52 ","$6.68 ","$7.36 ","$6.68 "
"30600219","EAP","CPT� 87281","","Pneumocycstis Carni Dfa-id (q)","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$17.52 ","$0.00 ","$110.00 ","$0.00 ","$33.52 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600220","EAP","CPT� 87799","","Toxoplasma Gondii Dna , Quant Pcr (so)","BOTH IP/OP","$846.00 ","$626.04 ","$0.00 ","$967.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$967.00 ","$0.00 ","$119.70 ","$765.86 ","$773.60 ","$0.00 ","$151.34 ","$0.00 ","$0.00 ","$0.00 "
"30600221","EAP","CPT� 87798","","Bordetella Pertussis/parapertussis Qual/pcr(so)","BOTH IP/OP","$547.00 ","$404.78 ","$17.55 ","$551.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$551.00 ","$36.84 ","$54.82 ","$436.39 ","$440.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30600222","EAP","CPT� 87912","","Hepatitis B Virus Drug Resistance Genotype Bcp/precore (so)","BOTH IP/OP","$590.00 ","$436.60 ","$0.00 ","$590.00 ","$180.02 ","$128.73 ","$128.72 ","$359.15 ","$359.15 ","$0.00 ","$590.00 ","$0.00 ","$295.00 ","$467.28 ","$472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600223","EAP","CPT� 87902","","Hepatitis C Viral Genotype , Lipa (so)","BOTH IP/OP","$339.00 ","$250.86 ","$96.09 ","$350.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$350.00 ","$270.32 ","$243.70 ","$277.20 ","$280.00 ","$350.00 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30600224","EAP","CPT� 87661","","Trichomonas Vaginalis Rna, Qual","BOTH IP/OP","$253.00 ","$187.22 ","$17.55 ","$246.00 ","$40.50 ","$17.55 ","$17.55 ","$26.77 ","$26.77 ","$25.16 ","$246.00 ","$36.84 ","$123.00 ","$194.83 ","$196.80 ","$50.88 ","$26.81 ","$35.09 ","$18.76 ","$35.09 "
"30600225","EAP","CPT� 87493","","Clostridium Difficile Toxin, Gene ,pcr","BOTH IP/OP","$288.00 ","$213.12 ","$17.55 ","$262.00 ","$40.50 ","$18.64 ","$17.55 ","$28.10 ","$28.10 ","$45.87 ","$262.00 ","$39.13 ","$131.00 ","$207.50 ","$209.60 ","$54.04 ","$41.00 ","$37.27 ","$41.71 ","$37.27 "
"30600227","EAP","CPT� 87632","","Respiratory Pcr Panel Iv (so)","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$297.68 ","$297.68 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30600228","EAP","CPT� 87530","","Herpes Sim Pcr Quant (so)","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$62.54 ","$62.54 ","$0.00 ","$342.00 ","$0.00 ","$119.70 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30630620","EAP","CPT� 87798","","Jc Polyoma Quant Amp (so)","BOTH IP/OP","$326.00 ","$241.24 ","$17.55 ","$393.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$393.00 ","$36.84 ","$54.82 ","$311.26 ","$314.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30630621","EAP","CPT� 87799","","Jc Polyoma Quant Pcr (so)","BOTH IP/OP","$589.00 ","$435.86 ","$0.00 ","$582.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$582.00 ","$0.00 ","$119.70 ","$460.94 ","$465.60 ","$0.00 ","$91.08 ","$0.00 ","$0.00 ","$0.00 "
"30630622","EAP","CPT� 87798","","Aspergillus Dna Qual Pcr (so)","BOTH IP/OP","$326.00 ","$241.24 ","$17.55 ","$393.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$393.00 ","$36.84 ","$54.82 ","$311.26 ","$314.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30630623","EAP","CPT� 87081","","Brucella Screen (so)","BOTH IP/OP","$143.00 ","$105.82 ","$3.31 ","$143.00 ","$13.68 ","$3.32 ","$3.31 ","$9.69 ","$9.69 ","$9.79 ","$143.00 ","$6.96 ","$18.52 ","$113.26 ","$114.40 ","$9.61 ","$10.43 ","$6.63 ","$7.30 ","$6.63 "
"30630624","EAP","CPT� 87799","","Herpes Virus 8 Dna Pcr (so)","BOTH IP/OP","$509.00 ","$376.66 ","$0.00 ","$582.00 ","$0.00 ","$0.00 ","$21.42 ","$62.54 ","$62.54 ","$0.00 ","$582.00 ","$0.00 ","$119.70 ","$460.94 ","$465.60 ","$0.00 ","$91.08 ","$0.00 ","$0.00 ","$0.00 "
"30650009","EAP","CPT� 87070","","Sputum Culture","BOTH IP/OP","$371.00 ","$274.54 ","$4.31 ","$347.00 ","$17.79 ","$4.31 ","$4.31 ","$12.57 ","$12.57 ","$12.73 ","$347.00 ","$9.05 ","$24.06 ","$274.82 ","$277.60 ","$12.50 ","$13.56 ","$8.62 ","$9.49 ","$8.62 "
"30650014","EAP","CPT� 87077","","Culture I.d.-aerobe Biochem","BOTH IP/OP","$261.00 ","$193.14 ","$4.04 ","$237.00 ","$16.68 ","$4.04 ","$4.04 ","$11.80 ","$11.80 ","$11.94 ","$237.00 ","$8.48 ","$22.58 ","$187.70 ","$189.60 ","$11.72 ","$12.72 ","$8.08 ","$8.90 ","$8.08 "
"30650094","EAP","CPT� 86757","","Richettsia Antibody Igg","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$28.26 ","$28.26 ","$0.00 ","$48.00 ","$0.00 ","$48.00 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650206","EAP","CPT� 87210","","Trichomonas Prep","BOTH IP/OP","$204.00 ","$150.96 ","$2.62 ","$210.00 ","$8.82 ","$2.91 ","$2.62 ","$6.23 ","$6.23 ","$6.30 ","$210.00 ","$6.11 ","$11.92 ","$166.32 ","$168.00 ","$8.44 ","$6.71 ","$5.82 ","$4.70 ","$5.82 "
"30650311","EAP","CPT� 87530","","Hsv Dna Quant","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$62.54 ","$62.54 ","$0.00 ","$460.00 ","$0.00 ","$119.70 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650312","EAP","CPT� 87798","","T.pallidum Pcr Ql,csf Q","BOTH IP/OP","$401.00 ","$296.74 ","$17.55 ","$404.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$404.00 ","$36.84 ","$54.82 ","$319.97 ","$323.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30650313","EAP","CPT� 87624","","Papillomavirus Human","BOTH IP/OP","$90.00 ","$66.60 ","$15.99 ","$93.00 ","$40.50 ","$17.55 ","$17.55 ","$26.70 ","$26.70 ","$21.44 ","$93.00 ","$36.84 ","$46.50 ","$73.66 ","$74.40 ","$50.88 ","$22.85 ","$35.09 ","$15.99 ","$35.09 "
"30650315","EAP","CPT� 87798","","Ehrlichia Chaff Pcr (so)","BOTH IP/OP","$373.00 ","$276.02 ","$17.55 ","$449.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$449.00 ","$36.84 ","$54.82 ","$355.61 ","$359.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30650316","EAP","CPT� 87529","","Hsv Pcr Qual Amino (so)","BOTH IP/OP","$340.00 ","$251.60 ","$17.55 ","$351.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$351.00 ","$36.84 ","$54.82 ","$277.99 ","$280.80 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30650317","EAP","CPT� 87900","","Hcv Ns3/4 Pheno (so)","BOTH IP/OP","$1,201.00 ","$888.74 ","$0.00 ","$1,355.00 ","$0.00 ","$0.00 ","$0.00 ","$161.40 ","$161.40 ","$0.00 ","$1,355.00 ","$0.00 ","$308.90 ","$1,073.16 ","$1,084.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650318","EAP","CPT� 87902","","Hcv Ns3/4 Geno (so)","BOTH IP/OP","$1,193.00 ","$882.82 ","$96.09 ","$1,233.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,233.00 ","$270.32 ","$243.70 ","$976.54 ","$986.40 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30650319","EAP","CPT� 87798","","Jc Poly Qual Pcr (so)","BOTH IP/OP","$445.00 ","$329.30 ","$17.55 ","$449.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$449.00 ","$36.84 ","$54.82 ","$355.61 ","$359.20 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30650320","EAP","CPT� 87906","","Hiv Coreceptor Tropism Ultra (so)","BOTH IP/OP","$973.00 ","$720.02 ","$43.01 ","$1,172.00 ","$90.02 ","$64.37 ","$64.36 ","$61.36 ","$61.36 ","$57.67 ","$1,172.00 ","$135.17 ","$586.00 ","$928.22 ","$937.60 ","$186.66 ","$61.44 ","$128.73 ","$43.01 ","$128.73 "
"30650321","EAP","CPT� 87902","","Hcv Rna Ns5a Drug (so)","BOTH IP/OP","$1,270.00 ","$939.80 ","$96.09 ","$1,233.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,233.00 ","$270.32 ","$243.70 ","$976.54 ","$986.40 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30650322","EAP","CPT� 87902","","Hcv Rna Ns5b Resist (so)","BOTH IP/OP","$1,193.00 ","$882.82 ","$96.09 ","$1,233.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$1,233.00 ","$270.32 ","$243.70 ","$976.54 ","$986.40 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30650323","EAP","CPT� 87632","","Resp Virus Pcr Iv (6-11) (so)","BOTH IP/OP","$3,561.00 ","$2,635.14 ","$0.00 ","$3,561.00 ","$0.00 ","$0.00 ","$0.00 ","$297.68 ","$297.68 ","$0.00 ","$3,561.00 ","$0.00 ","$1,780.50 ","$2,820.31 ","$2,848.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650324","EAP","CPT� 87530","","Hsv Dna Pcr Quant (so)","BOTH IP/OP","$327.00 ","$241.98 ","$0.00 ","$338.00 ","$0.00 ","$0.00 ","$0.00 ","$62.54 ","$62.54 ","$0.00 ","$338.00 ","$0.00 ","$119.70 ","$267.70 ","$270.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650325","EAP","CPT� 87902","","Hcv Ns5a Drug Resist (so)","BOTH IP/OP","$747.00 ","$552.78 ","$96.09 ","$772.00 ","$180.02 ","$128.73 ","$128.72 ","$127.33 ","$127.33 ","$128.84 ","$772.00 ","$270.32 ","$243.70 ","$611.42 ","$617.60 ","$373.30 ","$137.28 ","$257.45 ","$96.09 ","$257.45 "
"30650326","EAP","CPT� 87625","","Hpv Genotyping","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$247.00 ","$0.00 ","$0.00 ","$0.00 ","$26.70 ","$26.70 ","$0.00 ","$247.00 ","$0.00 ","$123.50 ","$195.62 ","$197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650330","EAP","CPT� 87015","","Cyclospora & Isospora Concentration (so)","BOTH IP/OP","$77.00 ","$56.98 ","$3.34 ","$70.00 ","$13.78 ","$3.34 ","$3.34 ","$9.75 ","$9.75 ","$9.87 ","$70.00 ","$7.01 ","$18.66 ","$55.44 ","$56.00 ","$9.69 ","$10.52 ","$6.68 ","$7.36 ","$6.68 "
"30650331","EAP","CPT� 87207","","Cyclospora & Isospora Stain (so)","BOTH IP/OP","$72.00 ","$53.28 ","$3.00 ","$70.00 ","$12.38 ","$3.00 ","$3.00 ","$8.75 ","$8.75 ","$8.84 ","$70.00 ","$6.29 ","$16.74 ","$55.44 ","$56.00 ","$8.69 ","$9.42 ","$5.99 ","$6.59 ","$5.99 "
"30650340","EAP","CPT� 87635","","Covid-19 Lab Test Non-cdc","BOTH IP/OP","$242.00 ","$179.08 ","$51.31 ","$508.00 ","$131.41 ","$75.00 ","$111.88 ","$362.56 ","$362.56 ","$88.95 ","$508.00 ","$105.00 ","$254.00 ","$402.34 ","$406.40 ","$74.40 ","$79.50 ","$51.31 ","$80.87 ","$100.00 "
"30650341","EAP","CPT� 87635","","Sars-cov-2 Covid-19 Amp Prb (so)","BOTH IP/OP","$174.00 ","$128.76 ","$25.66 ","$173.00 ","$94.48 ","$25.66 ","$111.88 ","$123.47 ","$123.47 ","$30.29 ","$173.00 ","$53.88 ","$86.50 ","$137.02 ","$138.40 ","$74.40 ","$27.07 ","$51.31 ","$27.54 ","$51.31 "
"30650350","EAP","CPT� 87633","","Respiratory Virus Panel 12-25 Targets","BOTH IP/OP","$1,033.00 ","$764.42 ","$0.00 ","$1,043.00 ","$363.98 ","$208.39 ","$208.39 ","$514.55 ","$514.55 ","$0.00 ","$1,043.00 ","$0.00 ","$521.50 ","$826.06 ","$834.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650351","EAP","CPT� 87798","","Bordetella Pertussis","BOTH IP/OP","$87.00 ","$64.38 ","$17.55 ","$88.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$88.00 ","$36.84 ","$54.82 ","$69.70 ","$70.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30650352","EAP","CPT� 87486","","Chlamydophila/chlamydia Pneumoniae","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$88.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$0.00 ","$88.00 ","$0.00 ","$54.82 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650353","EAP","CPT� 87581","","Mycoplasma Pneumoniae","BOTH IP/OP","$91.00 ","$67.34 ","$0.00 ","$88.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$0.00 ","$88.00 ","$0.00 ","$54.82 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30650354","EAP","CPT� 87798","","Bordetella Parapertussis","BOTH IP/OP","$87.00 ","$64.38 ","$17.55 ","$88.00 ","$40.50 ","$17.55 ","$17.55 ","$28.64 ","$28.64 ","$28.98 ","$88.00 ","$36.84 ","$54.82 ","$69.70 ","$70.40 ","$50.88 ","$30.88 ","$35.09 ","$21.62 ","$35.09 "
"30700001","EAP","CPT� 81000","","PH, URINE-DIPSTICK","BOTH IP/OP","$103.00 ","$76.22 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700002","EAP","CPT� 85025","","Cbc, Plat, Wbcdiff, Evd","BOTH IP/OP","$212.00 ","$156.88 ","$3.88 ","$222.00 ","$16.05 ","$3.89 ","$3.88 ","$9.59 ","$9.59 ","$11.48 ","$222.00 ","$8.16 ","$21.72 ","$175.82 ","$177.60 ","$11.27 ","$12.23 ","$7.77 ","$8.56 ","$7.77 "
"30700004","EAP","CPT� 81002","","Urine Dip Stick","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$3.74 ","$3.74 ","$0.00 ","$95.00 ","$0.00 ","$7.14 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30700007","EAP","CPT� 81001","","Urinalysis Complete","BOTH IP/OP","$192.00 ","$142.08 ","$1.58 ","$205.00 ","$6.55 ","$1.59 ","$1.58 ","$4.63 ","$4.63 ","$4.68 ","$205.00 ","$3.33 ","$8.86 ","$162.36 ","$164.00 ","$4.60 ","$4.99 ","$3.17 ","$3.49 ","$3.17 "
"30700019","EAP","CPT� 81003","","Urinalysis","BOTH IP/OP","$157.00 ","$116.18 ","$1.12 ","$168.00 ","$4.65 ","$1.13 ","$1.12 ","$3.28 ","$3.28 ","$3.33 ","$168.00 ","$2.36 ","$6.28 ","$133.06 ","$134.40 ","$3.26 ","$3.55 ","$2.25 ","$2.48 ","$2.25 "
"30700027","EAP","CPT� 81005","","Ph, Urine(quant)","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30700035","EAP","CPT� 81015","","Urinalysis-micro Only","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$4.43 ","$4.43 ","$0.00 ","$192.00 ","$0.00 ","$8.48 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30700041","EAP","CPT� 81025","","PREGNANCY TEST-URINE","BOTH IP/OP","$33.00 ","$24.42 ","$3.87 ","$35.00 ","$13.04 ","$4.31 ","$3.87 ","$9.24 ","$9.24 ","$9.36 ","$35.00 ","$9.04 ","$17.68 ","$27.72 ","$28.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"30700042","EAP","CPT� 81050","","Urine, Timed Collect","BOTH IP/OP","$129.00 ","$95.46 ","$1.64 ","$119.00 ","$6.20 ","$1.82 ","$1.64 ","$4.37 ","$4.37 ","$4.43 ","$119.00 ","$3.82 ","$8.38 ","$94.25 ","$95.20 ","$5.28 ","$4.72 ","$3.64 ","$3.30 ","$3.64 "
"30700050","EAP","CPT� 81003","","Urinalysis-biochem","BOTH IP/OP","$157.00 ","$116.18 ","$1.12 ","$168.00 ","$4.65 ","$1.13 ","$1.12 ","$3.28 ","$3.28 ","$3.33 ","$168.00 ","$2.36 ","$6.28 ","$133.06 ","$134.40 ","$3.26 ","$3.55 ","$2.25 ","$2.48 ","$2.25 "
"30700080","EAP","CPT� 81000","","Ph, Urine-dipstick","BOTH IP/OP","$119.00 ","$88.06 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700081","EAP","CPT� 81001","","Urinalysis With Microscopy","BOTH IP/OP","$222.00 ","$164.28 ","$1.58 ","$205.00 ","$6.55 ","$1.59 ","$1.58 ","$4.63 ","$4.63 ","$4.68 ","$205.00 ","$3.33 ","$8.86 ","$162.36 ","$164.00 ","$4.60 ","$4.99 ","$3.17 ","$3.49 ","$3.17 "
"30700082","EAP","CPT� 81003","","Urinalysis","BOTH IP/OP","$182.00 ","$134.68 ","$1.12 ","$168.00 ","$4.65 ","$1.13 ","$1.12 ","$3.28 ","$3.28 ","$3.33 ","$168.00 ","$2.36 ","$6.28 ","$133.06 ","$134.40 ","$3.26 ","$3.55 ","$2.25 ","$2.48 ","$2.25 "
"30700083","EAP","CPT� 81003","","Urinalysis, Top","BOTH IP/OP","$182.00 ","$134.68 ","$1.12 ","$168.00 ","$4.65 ","$1.13 ","$1.12 ","$3.28 ","$3.28 ","$3.33 ","$168.00 ","$2.36 ","$6.28 ","$133.06 ","$134.40 ","$3.26 ","$3.55 ","$2.25 ","$2.48 ","$2.25 "
"30700084","EAP","CPT� 81025","","Pregnancy Test-urine","BOTH IP/OP","$38.00 ","$28.12 ","$3.87 ","$35.00 ","$13.04 ","$4.31 ","$3.87 ","$9.24 ","$9.24 ","$9.36 ","$35.00 ","$9.04 ","$17.68 ","$27.72 ","$28.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"30700085","EAP","CPT� 81025","","Preg Test,urine","BOTH IP/OP","$38.00 ","$28.12 ","$3.87 ","$35.00 ","$13.04 ","$4.31 ","$3.87 ","$9.24 ","$9.24 ","$9.36 ","$35.00 ","$9.04 ","$17.68 ","$27.72 ","$28.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"30700086","EAP","CPT� 81050","","Urine, Timed Collect","BOTH IP/OP","$117.00 ","$86.58 ","$1.64 ","$125.00 ","$6.20 ","$1.82 ","$1.64 ","$4.37 ","$4.37 ","$4.43 ","$125.00 ","$3.82 ","$8.38 ","$99.00 ","$100.00 ","$5.28 ","$4.72 ","$3.64 ","$3.30 ","$3.64 "
"30700090","EAP","CPT� 81000","","Urobilinogen, Qualitativ","BOTH IP/OP","$103.00 ","$76.22 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700091","EAP","CPT� 81001","","Urinalysis Comp","BOTH IP/OP","$192.00 ","$142.08 ","$1.58 ","$205.00 ","$6.55 ","$1.59 ","$1.58 ","$4.63 ","$4.63 ","$4.68 ","$205.00 ","$3.33 ","$8.86 ","$162.36 ","$164.00 ","$4.60 ","$4.99 ","$3.17 ","$3.49 ","$3.17 "
"30700092","EAP","CPT� 81003","","Urinalysis-biochem","BOTH IP/OP","$157.00 ","$116.18 ","$1.12 ","$168.00 ","$4.65 ","$1.13 ","$1.12 ","$3.28 ","$3.28 ","$3.33 ","$168.00 ","$2.36 ","$6.28 ","$133.06 ","$134.40 ","$3.26 ","$3.55 ","$2.25 ","$2.48 ","$2.25 "
"30700093","EAP","CPT� 81025","","Urine Pregnancy Test","BOTH IP/OP","$33.00 ","$24.42 ","$3.87 ","$35.00 ","$13.04 ","$4.31 ","$3.87 ","$9.24 ","$9.24 ","$9.36 ","$35.00 ","$9.04 ","$17.68 ","$27.72 ","$28.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"30700094","EAP","CPT� 81000","","Sugar, Clinitest","BOTH IP/OP","$103.00 ","$76.22 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700095","EAP","CPT� 81000","","Bile, Urine","BOTH IP/OP","$103.00 ","$76.22 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700096","EAP","CPT� 81000","","Specific Gravity","BOTH IP/OP","$119.00 ","$88.06 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700097","EAP","CPT� 81000","","Urobilinogen, Qualitativ","BOTH IP/OP","$103.00 ","$76.22 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30700120","EAP","CPT� 81025","","Urine Pregnancy Test","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$3.87 ","$9.24 ","$9.24 ","$9.36 ","$35.00 ","$9.04 ","$17.68 ","$27.72 ","$28.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"30750027","EAP","CPT� 81005","","Clinitest, Stool","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750028","EAP","CPT� 81005","","Spec.gravity,refrac","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750029","EAP","CPT� 81005","","Clinitest,urine","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750030","EAP","CPT� 81005","","Protein, Ur-qual","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750031","EAP","CPT� 81005","","Glucose, Ur-qual","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750032","EAP","CPT� 81005","","Ketones,ur","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750033","EAP","CPT� 81005","","Urobilinogen,ur-ql","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750034","EAP","CPT� 81005","","Glucose, Ur-qual","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750035","EAP","CPT� 81005","","Protein, Ur-qual","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750036","EAP","CPT� 81005","","Glucose, Ur-qual","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750037","EAP","CPT� 81005","","Ketones,ur","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$3.16 ","$3.16 ","$0.00 ","$115.00 ","$0.00 ","$6.06 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30750080","EAP","CPT� 81000","","Ph, Urine-dipstick","BOTH IP/OP","$103.00 ","$76.22 ","$1.81 ","$110.00 ","$6.55 ","$2.01 ","$1.81 ","$4.63 ","$4.63 ","$4.68 ","$110.00 ","$4.22 ","$8.86 ","$87.12 ","$88.00 ","$5.83 ","$4.99 ","$4.02 ","$3.49 ","$4.02 "
"30900004","EAP","CPT� 89060","","Crystals,fluid","BOTH IP/OP","$165.00 ","$122.10 ","$3.58 ","$150.00 ","$14.76 ","$3.67 ","$3.58 ","$10.44 ","$10.44 ","$10.56 ","$150.00 ","$7.70 ","$19.98 ","$118.80 ","$120.00 ","$10.63 ","$11.26 ","$7.33 ","$7.88 ","$7.33 "
"30900005","EAP","CPT� 89190","","Nasal Smear For Eos","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$6.93 ","$6.93 ","$0.00 ","$126.00 ","$0.00 ","$13.28 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30900006","EAP","CPT� 89320","","Semen Examination","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$8.42 ","$8.42 ","$0.00 ","$75.00 ","$0.00 ","$16.12 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30900009","EAP","CPT� 81511","","Mss Sequential Screen-2 (so)","BOTH IP/OP","$504.00 ","$372.96 ","$69.08 ","$498.00 ","$462.00 ","$76.75 ","$69.08 ","$355.42 ","$355.42 ","$144.26 ","$498.00 ","$161.18 ","$249.00 ","$394.42 ","$398.40 ","$222.58 ","$153.71 ","$153.50 ","$107.60 ","$153.50 "
"30900011","EAP","CPT� 84163","","Pregnancy Associated Plasma Protein (so)","BOTH IP/OP","$180.00 ","$133.20 ","$7.07 ","$180.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$180.00 ","$15.80 ","$17.94 ","$142.56 ","$144.00 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30900012","EAP","CPT� 84702","","Hcg,quantitative","BOTH IP/OP","$31.00 ","$22.94 ","$7.07 ","$32.00 ","$13.25 ","$7.53 ","$7.53 ","$9.37 ","$9.37 ","$9.48 ","$32.00 ","$15.80 ","$17.94 ","$25.34 ","$25.60 ","$21.82 ","$10.10 ","$15.05 ","$7.07 ","$15.05 "
"30900013","EAP","CPT� 86021","","C-anca Titer (so)","BOTH IP/OP","$34.00 ","$25.16 ","$7.53 ","$34.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$34.00 ","$15.80 ","$34.00 ","$26.93 ","$27.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30900014","EAP","CPT� 86021","","P-anca Titer (so)","BOTH IP/OP","$34.00 ","$25.16 ","$7.53 ","$34.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$34.00 ","$15.80 ","$34.00 ","$26.93 ","$27.20 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30900015","EAP","CPT� 86021","","Atypical P-anca Titer (so)","BOTH IP/OP","$80.00 ","$59.20 ","$7.53 ","$80.00 ","$31.07 ","$7.53 ","$7.53 ","$21.98 ","$21.98 ","$22.24 ","$80.00 ","$15.80 ","$42.06 ","$63.36 ","$64.00 ","$21.82 ","$23.70 ","$15.05 ","$16.59 ","$15.05 "
"30900020","EAP","CPT� 86638","","Q Fever Igg Phase I Titer (so)","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30900021","EAP","CPT� 86638","","Q Fever Igg Phase Ii Titer (so)","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30900022","EAP","CPT� 86638","","Q Fever Igg Phase I Titer (so)","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30900023","EAP","CPT� 86638","","Q Fever Igg Phase Ii (so)","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$17.70 ","$17.70 ","$0.00 ","$43.00 ","$0.00 ","$33.88 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30900024","EAP","CPT� 86611","","B.henselae Igg Titer (so)","BOTH IP/OP","$64.00 ","$47.36 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30900025","EAP","CPT� 86611","","B.henselae Igm Titer (so)","BOTH IP/OP","$64.00 ","$47.36 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30900026","EAP","CPT� 86611","","B.quintana Igg Titer (so)","BOTH IP/OP","$64.00 ","$47.36 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"30900027","EAP","CPT� 86611","","B.quintana Igm Titer (so)","BOTH IP/OP","$50.00 ","$37.00 ","$5.09 ","$63.00 ","$21.01 ","$5.09 ","$5.09 ","$14.85 ","$14.85 ","$15.04 ","$63.00 ","$10.69 ","$28.44 ","$49.90 ","$50.40 ","$14.76 ","$16.02 ","$10.18 ","$11.21 ","$10.18 "
"31000001","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$384.00 ","$284.16 ","$10.71 ","$384.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$384.00 ","$22.49 ","$59.86 ","$304.13 ","$307.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000002","EAP","CPT� 88305","","Level Iv Surgical Path Exam","BOTH IP/OP","$771.00 ","$570.54 ","$31.63 ","$771.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$771.00 ","$49.62 ","$140.98 ","$610.63 ","$616.80 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31000004","EAP","CPT� 88331","","Path Consult Inraop 1 Bloc","BOTH IP/OP","$160.00 ","$118.40 ","$29.37 ","$160.00 ","$148.63 ","$146.06 ","$44.60 ","$29.37 ","$29.37 ","$87.82 ","$160.00 ","$143.92 ","$57.46 ","$126.72 ","$128.00 ","$160.00 ","$93.58 ","$34.94 ","$65.50 ","$137.07 "
"31000006","EAP","CPT� 81314","","PDGFRA MUTATION ANALYSIS (QUEST)","BOTH IP/OP","$1,002.00 ","$741.48 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$329.51 ","$329.51 ","$0.00 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000007","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$447.00 ","$330.78 ","$23.04 ","$447.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$447.00 ","$53.75 ","$112.22 ","$354.02 ","$357.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000010","EAP","CPT� 88120","","Cytopath In Situ Hybridization,urinary Tract Spec W/mors","BOTH IP/OP","$930.00 ","$688.20 ","$0.00 ","$930.00 ","$930.00 ","$146.06 ","$0.00 ","$406.29 ","$406.29 ","$0.00 ","$930.00 ","$0.00 ","$465.00 ","$736.56 ","$744.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000011","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$62.00 ","$45.88 ","$10.71 ","$62.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$62.00 ","$22.49 ","$59.86 ","$49.10 ","$49.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000013","EAP","CPT� 88230","","Tissue Culture For Non-neoplastic Disorders;lymphocyte","BOTH IP/OP","$347.00 ","$256.78 ","$58.25 ","$384.00 ","$240.48 ","$58.25 ","$58.25 ","$170.10 ","$170.10 ","$172.08 ","$384.00 ","$122.31 ","$325.54 ","$304.13 ","$307.20 ","$168.91 ","$183.36 ","$116.49 ","$128.35 ","$116.49 "
"31000015","EAP","CPT� 88271","","Cytogenetics Dna Probe","BOTH IP/OP","$287.00 ","$212.38 ","$10.71 ","$287.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$287.00 ","$22.49 ","$59.86 ","$227.30 ","$229.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000016","EAP","CPT� 88275","","Cytogenetics 100-300","BOTH IP/OP","$349.00 ","$258.26 ","$23.04 ","$349.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$349.00 ","$53.75 ","$112.22 ","$276.41 ","$279.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000018","EAP","CPT� 88360","","Er/pr Her2 W/reflex To Her2 Fish (so)","BOTH IP/OP","$731.00 ","$540.94 ","$58.38 ","$727.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$727.00 ","$143.92 ","$121.34 ","$575.78 ","$581.60 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31000019","EAP","CPT� 88368","","Fish, Her-2/neu (so)","BOTH IP/OP","$741.00 ","$548.34 ","$58.22 ","$737.00 ","$178.36 ","$285.22 ","$58.22 ","$145.54 ","$145.54 ","$199.20 ","$737.00 ","$284.24 ","$207.74 ","$583.70 ","$589.60 ","$394.92 ","$212.25 ","$90.40 ","$148.57 ","$270.71 "
"31000020","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Pdgfrb","BOTH IP/OP","$511.00 ","$378.14 ","$10.71 ","$511.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$511.00 ","$22.49 ","$59.86 ","$404.71 ","$408.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000021","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Pdgfrb","BOTH IP/OP","$256.00 ","$189.44 ","$23.04 ","$256.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$256.00 ","$53.75 ","$112.22 ","$202.75 ","$204.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000022","EAP","CPT� 88342","","Lynch Syndrome Tumor Panel, Ihc  (so)","BOTH IP/OP","$700.00 ","$518.00 ","$48.82 ","$707.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$707.00 ","$143.92 ","$106.46 ","$559.94 ","$565.60 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31000025","EAP","CPT� 88368","","Fish, Mdm2 Gene Amphlification (arup)","BOTH IP/OP","$1,325.00 ","$980.50 ","$58.22 ","$1,325.00 ","$178.36 ","$285.22 ","$58.22 ","$145.54 ","$145.54 ","$199.20 ","$1,325.00 ","$284.24 ","$207.74 ","$1,049.40 ","$1,060.00 ","$394.92 ","$212.25 ","$90.40 ","$148.57 ","$270.71 "
"31000026","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Mn","BOTH IP/OP","$300.00 ","$222.00 ","$10.71 ","$298.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$298.00 ","$22.49 ","$59.86 ","$236.02 ","$238.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000027","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Mn","BOTH IP/OP","$128.00 ","$94.72 ","$23.04 ","$127.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$127.00 ","$53.75 ","$112.22 ","$100.58 ","$101.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000028","EAP","CPT� 88271","","Fish, Hes/leukemia, 4q12 Rea(fip1l-pdgfra","BOTH IP/OP","$665.00 ","$492.10 ","$10.71 ","$665.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$665.00 ","$22.49 ","$59.86 ","$526.68 ","$532.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000029","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Hes","BOTH IP/OP","$221.00 ","$163.54 ","$23.04 ","$221.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$221.00 ","$53.75 ","$112.22 ","$175.03 ","$176.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000030","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Fg","BOTH IP/OP","$499.00 ","$369.26 ","$10.71 ","$499.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$499.00 ","$22.49 ","$59.86 ","$395.21 ","$399.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000031","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Fg","BOTH IP/OP","$248.00 ","$183.52 ","$23.04 ","$248.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$248.00 ","$53.75 ","$112.22 ","$196.42 ","$198.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000032","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Ne","BOTH IP/OP","$714.00 ","$528.36 ","$10.71 ","$714.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$714.00 ","$22.49 ","$59.86 ","$565.49 ","$571.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000033","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Ne","BOTH IP/OP","$142.00 ","$105.08 ","$23.04 ","$142.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$142.00 ","$53.75 ","$112.22 ","$112.46 ","$113.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000034","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Eto","BOTH IP/OP","$563.00 ","$416.62 ","$10.71 ","$563.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$563.00 ","$22.49 ","$59.86 ","$445.90 ","$450.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000035","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Eto","BOTH IP/OP","$282.00 ","$208.68 ","$23.04 ","$282.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$282.00 ","$53.75 ","$112.22 ","$223.34 ","$225.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000036","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Mll","BOTH IP/OP","$511.00 ","$378.14 ","$10.71 ","$511.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$511.00 ","$22.49 ","$59.86 ","$404.71 ","$408.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000037","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Mll","BOTH IP/OP","$256.00 ","$189.44 ","$23.04 ","$256.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$256.00 ","$53.75 ","$112.22 ","$202.75 ","$204.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000038","EAP","CPT� 88184","","Flow Cytometry; First Marker (so) Pcn","BOTH IP/OP","$303.00 ","$224.22 ","$30.49 ","$303.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$303.00 ","$284.24 ","$133.74 ","$239.98 ","$242.40 ","$303.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31000039","EAP","CPT� 88185","","Flow Cytometry;each Add Marker (so) Pcn","BOTH IP/OP","$233.00 ","$172.42 ","$0.00 ","$233.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$233.00 ","$0.00 ","$71.72 ","$184.54 ","$186.40 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"31000042","EAP","CPT� 81200","","Canavan Disease Mutation Analysis (so)","BOTH IP/OP","$568.00 ","$420.32 ","$0.00 ","$649.00 ","$0.00 ","$0.00 ","$0.00 ","$463.19 ","$463.19 ","$0.00 ","$649.00 ","$0.00 ","$324.50 ","$514.01 ","$519.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000043","EAP","CPT� 88235","","Tissue Culture For  Am-fld Or Cv-cells (so) Sc","BOTH IP/OP","$236.00 ","$174.64 ","$0.00 ","$261.00 ","$236.00 ","$75.15 ","$0.00 ","$215.00 ","$215.00 ","$217.53 ","$261.00 ","$157.82 ","$261.00 ","$206.71 ","$208.80 ","$217.94 ","$231.78 ","$150.30 ","$162.25 ","$150.30 "
"31000045","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Dup","BOTH IP/OP","$350.00 ","$259.00 ","$10.71 ","$350.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$350.00 ","$22.49 ","$59.86 ","$277.20 ","$280.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000046","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Dup","BOTH IP/OP","$350.00 ","$259.00 ","$23.04 ","$350.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$350.00 ","$53.75 ","$112.22 ","$277.20 ","$280.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000051","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Mm","BOTH IP/OP","$499.00 ","$369.26 ","$10.71 ","$499.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$499.00 ","$22.49 ","$59.86 ","$395.21 ","$399.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000052","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Mm","BOTH IP/OP","$248.00 ","$183.52 ","$23.04 ","$248.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$248.00 ","$53.75 ","$112.22 ","$196.42 ","$198.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000055","EAP","CPT� 81401","","Eml4 Alk Gene Fusion, Pcr (so)","BOTH IP/OP","$1,030.00 ","$762.20 ","$61.65 ","$1,177.00 ","$64.94 ","$68.50 ","$61.65 ","$840.02 ","$840.02 ","$131.58 ","$1,177.00 ","$143.85 ","$588.50 ","$932.18 ","$941.60 ","$198.65 ","$140.20 ","$137.00 ","$98.14 ","$137.00 "
"31000060","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so)rara","BOTH IP/OP","$751.00 ","$555.74 ","$10.71 ","$751.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$751.00 ","$22.49 ","$59.86 ","$594.79 ","$600.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000061","EAP","CPT� 88275","","Interphase In Situ Hybridization(100-300) Cells (so) Rara","BOTH IP/OP","$374.00 ","$276.76 ","$23.04 ","$374.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$374.00 ","$53.75 ","$112.22 ","$296.21 ","$299.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31000062","EAP","CPT� 88271","","Molecular Cytogenetics: Dna Probe (fish) (so) Ros1","BOTH IP/OP","$687.00 ","$508.38 ","$10.71 ","$682.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$682.00 ","$22.49 ","$59.86 ","$540.14 ","$545.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000063","EAP","CPT� 88274","","Interphase In Situ Hybridization (25-99 Cells (so) Ros1","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$19.07 ","$50.82 ","$50.82 ","$51.42 ","$342.00 ","$44.50 ","$97.26 ","$270.86 ","$273.60 ","$61.45 ","$54.79 ","$42.38 ","$38.35 ","$42.38 "
"31000066","EAP","CPT� 88274","","Fanconi Anemia Tissue Cx (so)","BOTH IP/OP","$384.00 ","$284.16 ","$0.00 ","$384.00 ","$0.00 ","$0.00 ","$19.07 ","$50.82 ","$50.82 ","$51.42 ","$384.00 ","$44.50 ","$97.26 ","$304.13 ","$307.20 ","$61.45 ","$54.79 ","$42.38 ","$38.35 ","$42.38 "
"31000067","EAP","CPT� 88271","","Fanconi Anemia Chrom Anal (so)","BOTH IP/OP","$241.00 ","$178.34 ","$10.71 ","$241.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$241.00 ","$22.49 ","$59.86 ","$190.87 ","$192.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000068","EAP","CPT� 88271","","Fish Sry/x Centromere Dna (so)","BOTH IP/OP","$241.00 ","$178.34 ","$10.71 ","$241.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$241.00 ","$22.49 ","$59.86 ","$190.87 ","$192.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000069","EAP","CPT� 88273","","Fish Sry/x Centromere Ish (so)","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$0.00 ","$0.00 ","$0.00 ","$46.91 ","$46.91 ","$0.00 ","$392.00 ","$0.00 ","$89.78 ","$310.46 ","$313.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000070","EAP","CPT� 88291","","Fish Sry/x Centro Interp (so)","BOTH IP/OP","$222.00 ","$164.28 ","$0.00 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$158.44 ","$158.44 ","$0.00 ","$222.00 ","$0.00 ","$53.96 ","$175.82 ","$177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000071","EAP","CPT� 88274","","Fish Conception Prod Ish (so)","BOTH IP/OP","$387.00 ","$286.38 ","$0.00 ","$384.00 ","$0.00 ","$0.00 ","$19.07 ","$50.82 ","$50.82 ","$51.42 ","$384.00 ","$44.50 ","$97.26 ","$304.13 ","$307.20 ","$61.45 ","$54.79 ","$42.38 ","$38.35 ","$42.38 "
"31000072","EAP","CPT� 88271","","Fish Conception Prod Dna (so)","BOTH IP/OP","$243.00 ","$179.82 ","$10.71 ","$241.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$241.00 ","$22.49 ","$59.86 ","$190.87 ","$192.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31000099","EAP","CPT� 81275","","COLORECTAL CAN. MUT. PANEL KRA SO","BOTH IP/OP","$1,636.00 ","$1,210.64 ","$86.96 ","$1,616.00 ","$298.80 ","$96.63 ","$86.96 ","$197.48 ","$197.48 ","$220.85 ","$1,616.00 ","$202.91 ","$808.00 ","$1,279.87 ","$1,292.80 ","$280.21 ","$235.32 ","$193.25 ","$164.72 ","$193.25 "
"31000100","EAP","CPT� 81210","","COLORECTAL CAN. MUT. PANEL BRA SO","BOTH IP/OP","$1,636.00 ","$1,210.64 ","$78.93 ","$1,616.00 ","$271.21 ","$87.70 ","$78.93 ","$179.25 ","$179.25 ","$115.59 ","$1,616.00 ","$184.17 ","$808.00 ","$1,279.87 ","$1,292.80 ","$254.33 ","$123.17 ","$175.40 ","$86.22 ","$175.40 "
"31000101","EAP","CPT� 88304","","Seminal Vesicle","BOTH IP/OP","$299.00 ","$221.26 ","$18.49 ","$299.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$299.00 ","$49.62 ","$108.12 ","$236.81 ","$239.20 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31000102","EAP","CPT� 81382","","Hla Ii Typing 1 (so)","BOTH IP/OP","$935.00 ","$691.90 ","$0.00 ","$944.00 ","$0.00 ","$0.00 ","$0.00 ","$168.73 ","$168.73 ","$0.00 ","$944.00 ","$0.00 ","$472.00 ","$747.65 ","$755.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000103","EAP","CPT� 81379","","Hla I Typing Comp (so)","BOTH IP/OP","$2,608.00 ","$1,929.92 ","$0.00 ","$2,634.00 ","$0.00 ","$0.00 ","$0.00 ","$457.54 ","$457.54 ","$0.00 ","$2,634.00 ","$0.00 ","$1,317.00 ","$2,086.13 ","$2,107.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000118","EAP","CPT� 81331","","Congen Hyoptonia Ube3a (so)","BOTH IP/OP","$519.00 ","$384.06 ","$0.00 ","$593.00 ","$0.00 ","$0.00 ","$0.00 ","$423.22 ","$423.22 ","$0.00 ","$593.00 ","$0.00 ","$296.50 ","$469.66 ","$474.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000119","EAP","CPT� 81400","","Congen Hypotonia L1 (so)","BOTH IP/OP","$744.00 ","$550.56 ","$0.00 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$606.65 ","$606.65 ","$0.00 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000120","EAP","CPT� 81404","","Congen Hypotonia L5 (so)","BOTH IP/OP","$1,519.00 ","$1,124.06 ","$123.67 ","$1,736.00 ","$462.00 ","$137.42 ","$123.67 ","$1,238.98 ","$1,238.98 ","$286.64 ","$1,736.00 ","$288.57 ","$868.00 ","$1,374.91 ","$1,388.80 ","$398.50 ","$305.42 ","$274.83 ","$213.79 ","$274.83 "
"31000121","EAP","CPT� 88365","","Insitu Hybrid Fish (so)","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$0.00 ","$0.00 ","$0.00 ","$98.25 ","$98.25 ","$103.59 ","$579.00 ","$143.92 ","$156.90 ","$458.57 ","$463.20 ","$199.96 ","$110.38 ","$137.95 ","$77.27 ","$137.07 "
"31000122","EAP","CPT� 88381","","Mgmt Microdissection Pcr (so)","BOTH IP/OP","$506.00 ","$374.44 ","$0.00 ","$506.00 ","$185.41 ","$0.00 ","$70.38 ","$155.30 ","$155.30 ","$197.25 ","$506.00 ","$0.00 ","$253.00 ","$400.75 ","$404.80 ","$0.00 ","$210.18 ","$156.67 ","$147.12 ","$0.00 "
"31000123","EAP","CPT� 81287","","Mgmt Gene Analysis (so)","BOTH IP/OP","$591.00 ","$437.34 ","$0.00 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$416.80 ","$416.80 ","$0.00 ","$584.00 ","$0.00 ","$292.00 ","$462.53 ","$467.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000124","EAP","CPT� 81479","","Calr Mutation Analysis (so)","BOTH IP/OP","$954.00 ","$705.96 ","$0.00 ","$1,114.12 ","$0.00 ","$169.81 ","$198.84 ","$672.31 ","$672.31 ","$1,045.61 ","$942.00 ","$0.00 ","$471.00 ","$746.06 ","$753.60 ","$565.20 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"31000126","EAP","CPT� 81406","","CADASIL","BOTH IP/OP","$4,379.00 ","$3,240.46 ","$0.00 ","$4,326.00 ","$237.60 ","$141.44 ","$127.30 ","$3,087.47 ","$3,087.47 ","$0.00 ","$4,326.00 ","$0.00 ","$2,163.00 ","$3,426.19 ","$3,460.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000135","EAP","CPT� 81218","","Aml Prognostic Cebpa (so)","BOTH IP/OP","$529.00 ","$391.46 ","$0.00 ","$523.00 ","$0.00 ","$0.00 ","$0.00 ","$329.51 ","$329.51 ","$0.00 ","$523.00 ","$0.00 ","$261.50 ","$414.22 ","$418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000136","EAP","CPT� 81245","","Aml Prognostic Flt3 (so)","BOTH IP/OP","$381.00 ","$281.94 ","$0.00 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$165.92 ","$165.92 ","$0.00 ","$376.00 ","$0.00 ","$188.00 ","$297.79 ","$300.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000137","EAP","CPT� 81246","","Aml Prognostic Flt3 Anal (so)","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$194.13 ","$194.13 ","$0.00 ","$272.00 ","$0.00 ","$136.00 ","$215.42 ","$217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000138","EAP","CPT� 81310","","Aml Prognostic Npm1 (so)","BOTH IP/OP","$708.00 ","$523.92 ","$0.00 ","$699.00 ","$0.00 ","$0.00 ","$0.00 ","$247.14 ","$247.14 ","$0.00 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000139","EAP","CPT� 81450","","Myeloid Neo Mutation (so)","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,685.00 ","$982.56 ","$379.77 ","$0.00 ","$1,916.28 ","$1,916.28 ","$0.00 ","$2,685.00 ","$0.00 ","$1,342.50 ","$2,126.52 ","$2,148.00 ","$0.00 ","$420.20 ","$0.00 ","$0.00 ","$0.00 "
"31000145","EAP","CPT� 81275","","KRAS GENE ANALYSIS; VARIANTS IN EXON 2 (EG, CODONS 12 & 13)","BOTH IP/OP","$463.00 ","$342.62 ","$86.96 ","$457.00 ","$298.80 ","$96.63 ","$86.96 ","$197.48 ","$197.48 ","$220.85 ","$457.00 ","$202.91 ","$228.50 ","$361.94 ","$365.60 ","$280.21 ","$235.32 ","$193.25 ","$164.72 ","$193.25 "
"31000146","EAP","CPT� 81276","","KRAS GENE ANALYSIS; ADD'L VARIANT(S) (EG, CODON 61, CODON 146)","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$457.00 ","$0.00 ","$0.00 ","$0.00 ","$197.19 ","$197.19 ","$0.00 ","$457.00 ","$0.00 ","$228.50 ","$361.94 ","$365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000147","EAP","CPT� 81210","","Thyroseq - Braf Analysis (so)","BOTH IP/OP","$305.00 ","$225.70 ","$78.93 ","$301.00 ","$271.21 ","$87.70 ","$78.93 ","$179.25 ","$179.25 ","$115.59 ","$301.00 ","$184.17 ","$150.50 ","$238.39 ","$240.80 ","$254.33 ","$123.17 ","$175.40 ","$86.22 ","$175.40 "
"31000148","EAP","CPT� 81275","","Thyroseq - Kras Analysis (so)","BOTH IP/OP","$335.00 ","$247.90 ","$86.96 ","$331.00 ","$298.80 ","$96.63 ","$86.96 ","$197.48 ","$197.48 ","$220.85 ","$331.00 ","$202.91 ","$165.50 ","$262.15 ","$264.80 ","$280.21 ","$235.32 ","$193.25 ","$164.72 ","$193.25 "
"31000149","EAP","CPT� 81322","","Thyroseq - Pten Analysis (so)","BOTH IP/OP","$91.00 ","$67.34 ","$21.40 ","$123.17 ","$88.36 ","$23.30 ","$21.40 ","$58.40 ","$58.40 ","$115.59 ","$90.00 ","$48.93 ","$45.00 ","$71.28 ","$72.00 ","$67.57 ","$123.17 ","$46.60 ","$86.22 ","$46.60 "
"31000150","EAP","CPT� 81401","","Thryoseq - Mopath Level 2 (so)","BOTH IP/OP","$238.00 ","$176.12 ","$61.65 ","$235.00 ","$64.94 ","$68.50 ","$61.65 ","$167.72 ","$167.72 ","$131.58 ","$235.00 ","$143.85 ","$117.50 ","$186.12 ","$188.00 ","$198.65 ","$140.20 ","$137.00 ","$98.14 ","$137.00 "
"31000151","EAP","CPT� 81403","","Thryoseq - Mopath Level 4 (so)","BOTH IP/OP","$322.00 ","$238.28 ","$83.34 ","$318.00 ","$264.00 ","$92.60 ","$83.34 ","$226.96 ","$226.96 ","$220.85 ","$318.00 ","$194.46 ","$159.00 ","$251.86 ","$254.40 ","$268.54 ","$235.32 ","$185.20 ","$164.72 ","$185.20 "
"31000152","EAP","CPT� 81404","","Thryoseq - Mopath Level 5 (so)","BOTH IP/OP","$477.00 ","$352.98 ","$123.67 ","$471.00 ","$462.00 ","$137.42 ","$123.67 ","$336.15 ","$336.15 ","$286.64 ","$471.00 ","$288.57 ","$235.50 ","$373.03 ","$376.80 ","$398.50 ","$305.42 ","$274.83 ","$213.79 ","$274.83 "
"31000153","EAP","CPT� 81405","","Thryoseq - Mopath Level 6 (so)","BOTH IP/OP","$523.00 ","$387.02 ","$135.61 ","$517.00 ","$462.00 ","$150.68 ","$135.61 ","$368.98 ","$368.98 ","$422.91 ","$517.00 ","$316.42 ","$258.50 ","$409.46 ","$413.60 ","$436.96 ","$450.62 ","$301.35 ","$315.43 ","$301.35 "
"31000154","EAP","CPT� 81479","","Thryoseq - Unlisted Mopath (so)","BOTH IP/OP","$2.00 ","$1.48 ","$0.00 ","$1,114.12 ","$0.00 ","$0.36 ","$0.42 ","$1.43 ","$1.43 ","$1,045.61 ","$2.00 ","$0.00 ","$1.00 ","$1.58 ","$1.60 ","$1.20 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"31000155","EAP","CPT� 81219","","JAK2 R/X CALR (SO)","BOTH IP/OP","$436.00 ","$322.64 ","$0.00 ","$493.00 ","$251.06 ","$60.82 ","$60.81 ","$165.68 ","$165.68 ","$0.00 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000156","EAP","CPT� 81270","","Jak2 V617f (so)","BOTH IP/OP","$436.00 ","$322.64 ","$45.83 ","$493.00 ","$189.21 ","$45.83 ","$45.83 ","$125.06 ","$125.06 ","$84.58 ","$493.00 ","$96.24 ","$246.50 ","$390.46 ","$394.40 ","$132.91 ","$90.12 ","$91.66 ","$63.08 ","$91.66 "
"31000157","EAP","CPT� 81479","","JAK2 R/X-CSF3R (SO)","BOTH IP/OP","$436.00 ","$322.64 ","$0.00 ","$1,114.12 ","$0.00 ","$77.61 ","$90.87 ","$351.85 ","$351.85 ","$1,045.61 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$295.80 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"31000158","EAP","CPT� 81402","","JAK2 R/X-MPL (SO)","BOTH IP/OP","$436.00 ","$322.64 ","$0.00 ","$493.00 ","$0.00 ","$92.60 ","$90.87 ","$351.85 ","$351.85 ","$0.00 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000159","EAP","CPT� 81403","","JAK2 R/X-EXON12 (SO)","BOTH IP/OP","$431.00 ","$318.94 ","$83.34 ","$493.00 ","$264.00 ","$92.60 ","$83.34 ","$351.85 ","$351.85 ","$220.85 ","$493.00 ","$194.46 ","$246.50 ","$390.46 ","$394.40 ","$268.54 ","$235.32 ","$185.20 ","$164.72 ","$185.20 "
"31000160","EAP","CPT� 81311","","Nras Gene Analysis Variants Exon 2&3 (so)","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$457.00 ","$0.00 ","$0.00 ","$0.00 ","$295.79 ","$295.79 ","$0.00 ","$457.00 ","$0.00 ","$228.50 ","$361.94 ","$365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000161","EAP","CPT� 81403","","Hras Gene Analysis (so)","BOTH IP/OP","$463.00 ","$342.62 ","$83.34 ","$457.00 ","$264.00 ","$92.60 ","$83.34 ","$326.16 ","$326.16 ","$220.85 ","$457.00 ","$194.46 ","$228.50 ","$361.94 ","$365.60 ","$268.54 ","$235.32 ","$185.20 ","$164.72 ","$185.20 "
"31000162","EAP","CPT� 81450","","Leukovantage, Myloproliferative Neoplasm (so)","BOTH IP/OP","$4,269.00 ","$3,159.06 ","$0.00 ","$4,217.00 ","$982.56 ","$379.77 ","$0.00 ","$3,009.67 ","$3,009.67 ","$0.00 ","$4,217.00 ","$0.00 ","$2,108.50 ","$3,339.86 ","$3,373.60 ","$0.00 ","$659.96 ","$0.00 ","$0.00 ","$0.00 "
"31000163","EAP","CPT� 81450","","Leukovantage Acute Myeloid Leukemia (so)","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,445.00 ","$982.56 ","$379.77 ","$0.00 ","$3,172.40 ","$3,172.40 ","$0.00 ","$4,445.00 ","$0.00 ","$2,222.50 ","$3,520.44 ","$3,556.00 ","$0.00 ","$695.64 ","$0.00 ","$0.00 ","$0.00 "
"31000164","EAP","CPT� 81450","","Leukovantage Myelodysplastic Syndrome (so)","BOTH IP/OP","$4,425.00 ","$3,274.50 ","$0.00 ","$4,371.00 ","$982.56 ","$379.77 ","$0.00 ","$3,119.58 ","$3,119.58 ","$0.00 ","$4,371.00 ","$0.00 ","$2,185.50 ","$3,461.83 ","$3,496.80 ","$0.00 ","$684.06 ","$0.00 ","$0.00 ","$0.00 "
"31000165","EAP","CPT� 81270","","Jak2 V617f Mutation Analysis (so)","BOTH IP/OP","$520.00 ","$384.80 ","$45.83 ","$520.00 ","$189.21 ","$45.83 ","$45.83 ","$125.06 ","$125.06 ","$84.58 ","$520.00 ","$96.24 ","$260.00 ","$411.84 ","$416.00 ","$132.91 ","$90.12 ","$91.66 ","$63.08 ","$91.66 "
"31000170","EAP","CPT� 88360","","Pd-l1 Lung (pembrolizumab), Ihc (so)","BOTH IP/OP","$855.00 ","$632.70 ","$58.38 ","$850.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$850.00 ","$143.92 ","$121.34 ","$673.20 ","$680.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31000171","EAP","CPT� 88360","","Pd-l1 Lung (nivolumab), Ihc (so)","BOTH IP/OP","$855.00 ","$632.70 ","$58.38 ","$850.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$850.00 ","$143.92 ","$121.34 ","$673.20 ","$680.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31000172","EAP","CPT� 88360","","Pd-l1 Lung (atezolizumab), Ihc (so)","BOTH IP/OP","$855.00 ","$632.70 ","$58.38 ","$850.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$850.00 ","$143.92 ","$121.34 ","$673.20 ","$680.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31000173","EAP","CPT� 88360","","Pd-l1 Bladder (atezolizumab), Ihc (so)","BOTH IP/OP","$855.00 ","$632.70 ","$58.38 ","$850.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$850.00 ","$143.92 ","$121.34 ","$673.20 ","$680.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31000174","EAP","CPT� 88360","","Pd-l1 Non-lung (pembrolizumab), Ihc (so)","BOTH IP/OP","$944.00 ","$698.56 ","$58.38 ","$938.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$938.00 ","$143.92 ","$121.34 ","$742.90 ","$750.40 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31000175","EAP","CPT� 88184","","Pd-l1 Monocyte Expression, Sle Flare, 1st Marker (so)","BOTH IP/OP","$323.00 ","$239.02 ","$30.49 ","$325.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$325.00 ","$284.24 ","$133.74 ","$257.40 ","$260.00 ","$325.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31000176","EAP","CPT� 88185","","Pd-l1 Monocyte Expression, Sle Flare, Addl Marker (so)","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$325.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$325.00 ","$0.00 ","$71.72 ","$257.40 ","$260.00 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"31000180","EAP","HCPCS 0225U","","Nfct Ds Dna&rna 21 Targets Sars-cov-2 Amp Probe","BOTH IP/OP","$466.00 ","$344.84 ","$0.00 ","$463.00 ","$0.00 ","$0.00 ","$0.00 ","$330.44 ","$330.44 ","$0.00 ","$463.00 ","$0.00 ","$231.50 ","$366.70 ","$370.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000185","EAP","CPT� 81225","","CYP2C19 GENOTYPE","BOTH IP/OP","$744.00 ","$550.56 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$291.80 ","$291.80 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100001","EAP","CPT� 88289","","Add High Reso","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$510.00 ","$0.00 ","$0.00 ","$0.00 ","$50.28 ","$50.28 ","$0.00 ","$510.00 ","$0.00 ","$96.22 ","$403.92 ","$408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100002","EAP","CPT� 88283","","Addition Band Charge","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$504.00 ","$0.00 ","$0.00 ","$0.00 ","$52.06 ","$52.06 ","$0.00 ","$504.00 ","$0.00 ","$99.64 ","$399.17 ","$403.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100003","EAP","CPT� 88285","","Addition Cell Charge","BOTH IP/OP","$244.00 ","$180.56 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$27.74 ","$27.74 ","$0.00 ","$270.00 ","$0.00 ","$53.08 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100004","EAP","CPT� 88280","","Addition Karyo Charge","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$300.00 ","$51.80 ","$16.74 ","$0.00 ","$36.64 ","$36.64 ","$37.08 ","$300.00 ","$35.14 ","$70.14 ","$237.60 ","$240.00 ","$48.53 ","$39.50 ","$33.47 ","$27.65 ","$33.47 "
"31100005","EAP","CPT� 88267","","Ca - 15 Cells Charge","BOTH IP/OP","$2,037.00 ","$1,507.38 ","$0.00 ","$2,058.00 ","$371.10 ","$94.29 ","$0.00 ","$262.47 ","$262.47 ","$265.55 ","$2,058.00 ","$198.00 ","$502.34 ","$1,629.94 ","$1,646.40 ","$273.43 ","$282.94 ","$188.57 ","$198.06 ","$188.57 "
"31100006","EAP","CPT� 88248","","Ca - Fragile X Charge","BOTH IP/OP","$2,617.00 ","$1,936.58 ","$0.00 ","$2,643.00 ","$357.46 ","$86.59 ","$86.59 ","$252.84 ","$252.84 ","$0.00 ","$2,643.00 ","$0.00 ","$483.92 ","$2,093.26 ","$2,114.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100007","EAP","CPT� 88264","","Cell Analysis Chrg","BOTH IP/OP","$1,265.00 ","$936.10 ","$65.07 ","$1,401.00 ","$257.29 ","$72.31 ","$65.07 ","$181.98 ","$181.98 ","$184.12 ","$1,401.00 ","$151.84 ","$348.28 ","$1,109.59 ","$1,120.80 ","$209.68 ","$196.18 ","$144.61 ","$137.33 ","$144.61 "
"31100008","EAP","CPT� 88262","","Cell Cnt/karyo Typ","BOTH IP/OP","$1,886.00 ","$1,395.64 ","$62.32 ","$1,905.00 ","$257.29 ","$62.75 ","$62.32 ","$181.98 ","$181.98 ","$184.12 ","$1,905.00 ","$131.76 ","$348.28 ","$1,508.76 ","$1,524.00 ","$181.96 ","$196.18 ","$125.49 ","$137.33 ","$125.49 "
"31100009","EAP","CPT� 88164","","Cytology, Female Gen","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$15.42 ","$15.42 ","$0.00 ","$64.00 ","$0.00 ","$29.52 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100010","EAP","CPT� 88142","","Cytology, Gyn Lbp","BOTH IP/OP","$288.00 ","$213.12 ","$10.13 ","$291.00 ","$41.82 ","$10.13 ","$10.13 ","$29.58 ","$29.58 ","$29.94 ","$291.00 ","$21.27 ","$56.62 ","$230.47 ","$232.80 ","$29.38 ","$31.90 ","$20.26 ","$22.33 ","$20.26 "
"31100011","EAP","CPT� 88104","","Cytology,pulmonary","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31100017","EAP","CPT� 88172","","Cytopathology Eval Of Fina","BOTH IP/OP","$176.00 ","$130.24 ","$19.45 ","$178.00 ","$87.57 ","$146.06 ","$25.95 ","$22.55 ","$22.55 ","$66.47 ","$178.00 ","$143.92 ","$44.44 ","$140.98 ","$142.40 ","$178.00 ","$70.82 ","$19.45 ","$49.57 ","$137.07 "
"31100018","EAP","CPT� 88184","","Cytoplasmic Charge","BOTH IP/OP","$421.00 ","$311.54 ","$30.49 ","$424.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$424.00 ","$284.24 ","$133.74 ","$335.81 ","$339.20 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100019","EAP","CPT� 88172","","Fine Needle Aspiration","BOTH IP/OP","$176.00 ","$130.24 ","$19.45 ","$178.00 ","$87.57 ","$146.06 ","$25.95 ","$22.55 ","$22.55 ","$66.47 ","$178.00 ","$143.92 ","$44.44 ","$140.98 ","$142.40 ","$178.00 ","$70.82 ","$19.45 ","$49.57 ","$137.07 "
"31100020","EAP","CPT� 88185","","Flow Cytometry - Addt'l Marker","BOTH IP/OP","$169.00 ","$125.06 ","$0.00 ","$169.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$169.00 ","$0.00 ","$71.72 ","$133.85 ","$135.20 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"31100021","EAP","CPT� 88188","","Flow Cytometry, Interp.","BOTH IP/OP","$305.00 ","$225.70 ","$0.00 ","$305.00 ","$0.00 ","$0.00 ","$0.00 ","$217.68 ","$217.68 ","$0.00 ","$305.00 ","$0.00 ","$161.74 ","$241.56 ","$244.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100022","EAP","CPT� 88161","","Fna-breast,cyto","BOTH IP/OP","$207.00 ","$153.18 ","$21.96 ","$207.00 ","$100.00 ","$24.19 ","$30.33 ","$29.49 ","$29.49 ","$40.98 ","$207.00 ","$23.06 ","$66.78 ","$163.94 ","$165.60 ","$32.04 ","$43.67 ","$43.22 ","$30.57 ","$21.96 "
"31100023","EAP","CPT� 88104","","Fna-cell Blk,,misc","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31100024","EAP","CPT� 88104","","Fna-cell Blk,breast","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31100025","EAP","CPT� 88161","","Fna-misc,cyto","BOTH IP/OP","$205.00 ","$151.70 ","$21.96 ","$207.00 ","$100.00 ","$24.19 ","$30.33 ","$29.49 ","$29.49 ","$40.98 ","$207.00 ","$23.06 ","$66.78 ","$163.94 ","$165.60 ","$32.04 ","$43.67 ","$43.22 ","$30.57 ","$21.96 "
"31100026","EAP","CPT� 88104","","Fna-pulmonary,cyto","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31100027","EAP","CPT� 88184","","Hairy Cell Leukemia","BOTH IP/OP","$424.00 ","$313.76 ","$30.49 ","$424.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$424.00 ","$284.24 ","$133.74 ","$335.81 ","$339.20 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100029","EAP","CPT� 88280","","Karyo Typing Charge","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$51.80 ","$16.74 ","$0.00 ","$36.64 ","$36.64 ","$37.08 ","$300.00 ","$35.14 ","$70.14 ","$237.60 ","$240.00 ","$48.53 ","$39.50 ","$33.47 ","$27.65 ","$33.47 "
"31100030","EAP","CPT� 88184","","Lymphoma Prof-basic","BOTH IP/OP","$424.00 ","$313.76 ","$30.49 ","$424.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$424.00 ","$284.24 ","$133.74 ","$335.81 ","$339.20 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100031","EAP","CPT� 88184","","Nuclear Charge","BOTH IP/OP","$424.00 ","$313.76 ","$30.49 ","$424.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$424.00 ","$284.24 ","$133.74 ","$335.81 ","$339.20 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100032","EAP","CPT� 88142","","Pap Smear","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$291.00 ","$0.00 ","$0.00 ","$0.00 ","$29.58 ","$29.58 ","$29.94 ","$291.00 ","$21.27 ","$56.62 ","$230.47 ","$232.80 ","$29.38 ","$31.90 ","$20.26 ","$22.33 ","$20.26 "
"31100033","EAP","CPT� 88130","","Sex Chromatin:buccal","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$21.97 ","$21.97 ","$0.00 ","$166.00 ","$0.00 ","$42.04 ","$131.47 ","$132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100034","EAP","CPT� 88235","","Tis Cult, Amino Charg","BOTH IP/OP","$2,229.00 ","$1,649.46 ","$0.00 ","$2,252.00 ","$304.00 ","$75.15 ","$0.00 ","$215.00 ","$215.00 ","$217.53 ","$2,252.00 ","$157.82 ","$411.48 ","$1,783.58 ","$1,801.60 ","$217.94 ","$231.78 ","$150.30 ","$162.25 ","$150.30 "
"31100035","EAP","CPT� 88230","","Tis Cult, Lymph Charge","BOTH IP/OP","$1,765.00 ","$1,306.10 ","$58.25 ","$1,783.00 ","$240.48 ","$58.25 ","$58.25 ","$170.10 ","$170.10 ","$172.08 ","$1,783.00 ","$122.31 ","$325.54 ","$1,412.14 ","$1,426.40 ","$168.91 ","$183.36 ","$116.49 ","$128.35 ","$116.49 "
"31100036","EAP","CPT� 88239","","Tis Cult, Other Charge","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$73.76 ","$2,255.00 ","$304.52 ","$73.76 ","$73.76 ","$215.39 ","$215.39 ","$217.93 ","$2,255.00 ","$154.90 ","$412.24 ","$1,785.96 ","$1,804.00 ","$213.90 ","$232.21 ","$147.52 ","$162.54 ","$147.52 "
"31100037","EAP","CPT� 88237","","Tissue Culture, Chrg","BOTH IP/OP","$655.00 ","$484.70 ","$64.69 ","$726.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$726.00 ","$150.94 ","$246.70 ","$574.99 ","$580.80 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"31100038","EAP","CPT� 88184","","Plasma Cell Neo Flow Tc/marker 1 (so)","BOTH IP/OP","$500.00 ","$370.00 ","$30.49 ","$500.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$500.00 ","$284.24 ","$133.74 ","$396.00 ","$400.00 ","$394.92 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100039","EAP","CPT� 88185","","Plasma Cell Neo Flow Tc/add On (so)","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$90.00 ","$0.00 ","$71.72 ","$71.28 ","$72.00 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"31100040","EAP","CPT� 88187","","Plasma Cell Neo Flow Read 2 - 8(so)","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$64.23 ","$64.23 ","$70.22 ","$90.00 ","$50.66 ","$90.00 ","$71.28 ","$72.00 ","$39.31 ","$74.83 ","$39.31 ","$52.38 ","$39.31 "
"31100042","EAP","CPT� 88271","","Fish Aml M3 Rara Dna (so)","BOTH IP/OP","$407.00 ","$301.18 ","$10.71 ","$407.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$407.00 ","$22.49 ","$59.86 ","$322.34 ","$325.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100043","EAP","CPT� 88275","","Fish Aml M3 Rara 100-300 (so)","BOTH IP/OP","$615.00 ","$455.10 ","$23.04 ","$615.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$615.00 ","$53.75 ","$112.22 ","$487.08 ","$492.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100044","EAP","CPT� 88364","","Fish, Oligoden 1p/19q (so)","BOTH IP/OP","$566.00 ","$418.84 ","$0.00 ","$566.00 ","$0.00 ","$0.00 ","$0.00 ","$97.60 ","$97.60 ","$97.04 ","$566.00 ","$0.00 ","$283.00 ","$448.27 ","$452.80 ","$0.00 ","$103.40 ","$104.09 ","$72.38 ","$0.00 "
"31100046","EAP","CPT� 88299","","Fshd Cytogenetic Study (so)","BOTH IP/OP","$2,331.00 ","$1,724.94 ","$0.00 ","$2,331.00 ","$0.00 ","$0.00 ","$0.00 ","$1,663.63 ","$1,663.63 ","$0.00 ","$2,331.00 ","$0.00 ","$0.00 ","$1,846.15 ","$1,864.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100047","EAP","CPT� 88275","","Fish Hes 4qrea 100-300 (so)","BOTH IP/OP","$389.00 ","$287.86 ","$23.04 ","$389.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$389.00 ","$53.75 ","$112.22 ","$308.09 ","$311.20 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100048","EAP","CPT� 88271","","Fish Hes 4qrea Leuk Dna (so)","BOTH IP/OP","$389.00 ","$287.86 ","$10.71 ","$389.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$389.00 ","$22.49 ","$59.86 ","$308.09 ","$311.20 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100049","EAP","CPT� 88271","","Fish Fgfr1 8p11-12 Dna(so)","BOTH IP/OP","$225.00 ","$166.50 ","$10.71 ","$225.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$225.00 ","$22.49 ","$59.86 ","$178.20 ","$180.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100050","EAP","CPT� 88275","","Fish Fgfr1 8p11-12 Dna(so)","BOTH IP/OP","$225.00 ","$166.50 ","$23.04 ","$225.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$225.00 ","$53.75 ","$112.22 ","$178.20 ","$180.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100051","EAP","CPT� 88271","","Fish Neonatal Screen Dna (so)","BOTH IP/OP","$126.00 ","$93.24 ","$10.71 ","$126.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$126.00 ","$22.49 ","$59.86 ","$99.79 ","$100.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100052","EAP","CPT� 88275","","Fish Neonatal Screen (so)","BOTH IP/OP","$126.00 ","$93.24 ","$23.04 ","$126.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$126.00 ","$53.75 ","$112.22 ","$99.79 ","$100.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100053","EAP","CPT� 88275","","Fish Fgfr1 8p11-12 100-300 (so)","BOTH IP/OP","$615.00 ","$455.10 ","$23.04 ","$615.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$615.00 ","$53.75 ","$112.22 ","$487.08 ","$492.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100095","EAP","CPT� 88143","","Cytopatah C/v Thin Layer Redo","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$29.58 ","$29.58 ","$0.00 ","$110.00 ","$0.00 ","$56.62 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100096","EAP","CPT� 88173","","Cytopath Eval Fna Report","BOTH IP/OP","$405.00 ","$299.70 ","$47.25 ","$409.00 ","$234.59 ","$48.66 ","$70.06 ","$64.24 ","$64.24 ","$107.58 ","$409.00 ","$49.62 ","$137.06 ","$323.93 ","$327.20 ","$68.93 ","$114.63 ","$83.20 ","$80.24 ","$47.25 "
"31100097","EAP","CPT� 88174","","Cytopath C/v Auto In Fluid","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$31.19 ","$31.19 ","$0.00 ","$94.00 ","$0.00 ","$59.70 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100098","EAP","CPT� 88175","","Cytopath C/v Auto Fluid Redo","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$38.64 ","$38.64 ","$0.00 ","$116.00 ","$0.00 ","$73.96 ","$91.87 ","$92.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100110","EAP","Custom 31100110","","Fish, B-cell Cll Panel (so)","BOTH IP/OP","$369.00 ","$273.06 ","$0.00 ","$367.00 ","$0.00 ","$0.00 ","$0.00 ","$261.93 ","$261.93 ","$0.00 ","$367.00 ","$0.00 ","$183.50 ","$290.66 ","$293.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100111","EAP","CPT� 88271","","Molecular Cytogen; Dna Probe  (so)","BOTH IP/OP","$369.00 ","$273.06 ","$10.71 ","$367.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$367.00 ","$22.49 ","$59.86 ","$290.66 ","$293.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100112","EAP","CPT� 88275","","Interphase In Situ Hybird (so)","BOTH IP/OP","$369.00 ","$273.06 ","$23.04 ","$367.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$367.00 ","$53.75 ","$112.22 ","$290.66 ","$293.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100113","EAP","Custom 31100113","","Fish, Locus -specific Probe (x1) (so)","BOTH IP/OP","$367.00 ","$271.58 ","$0.00 ","$367.00 ","$0.00 ","$0.00 ","$0.00 ","$261.93 ","$261.93 ","$0.00 ","$367.00 ","$0.00 ","$183.50 ","$290.66 ","$293.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100114","EAP","CPT� 88271","","Molecular Cytogentics; Dna Probe (so)","BOTH IP/OP","$367.00 ","$271.58 ","$10.71 ","$367.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$367.00 ","$22.49 ","$59.86 ","$290.66 ","$293.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100115","EAP","Custom 31100115","","Chromosome Analysis Hem Malig (so)","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$343.00 ","$0.00 ","$0.00 ","$0.00 ","$244.80 ","$244.80 ","$0.00 ","$343.00 ","$0.00 ","$171.50 ","$271.66 ","$274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100116","EAP","CPT� 88237","","Tissue Culture For Neoplastic Disorder (so)","BOTH IP/OP","$340.00 ","$251.60 ","$64.69 ","$343.00 ","$182.24 ","$71.88 ","$64.69 ","$128.90 ","$128.90 ","$130.42 ","$343.00 ","$150.94 ","$246.70 ","$271.66 ","$274.40 ","$208.44 ","$138.97 ","$143.75 ","$97.28 ","$143.75 "
"31100117","EAP","CPT� 88264","","Chromosome Analysis  20-25 Cells (so)","BOTH IP/OP","$366.00 ","$270.84 ","$65.07 ","$370.00 ","$257.29 ","$72.31 ","$65.07 ","$181.98 ","$181.98 ","$184.12 ","$370.00 ","$151.84 ","$348.28 ","$293.04 ","$296.00 ","$209.68 ","$196.18 ","$144.61 ","$137.33 ","$144.61 "
"31100118","EAP","CPT� 88120","","Bladder Cancer,fish (so)","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$493.00 ","$488.00 ","$146.06 ","$0.00 ","$406.29 ","$406.29 ","$0.00 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100119","EAP","Custom 31100119","","Fish, Prenatal Screen (so)","BOTH IP/OP","$369.00 ","$273.06 ","$0.00 ","$367.00 ","$0.00 ","$0.00 ","$0.00 ","$261.93 ","$261.93 ","$0.00 ","$367.00 ","$0.00 ","$183.50 ","$290.66 ","$293.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100120","EAP","CPT� 88271","","Molecular Cytogen; Dna Probe (so)","BOTH IP/OP","$369.00 ","$273.06 ","$10.71 ","$367.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$367.00 ","$22.49 ","$59.86 ","$290.66 ","$293.60 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100121","EAP","CPT� 88275","","Interphase Insitu Hybird  (so)","BOTH IP/OP","$369.00 ","$273.06 ","$23.04 ","$367.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$367.00 ","$53.75 ","$112.22 ","$290.66 ","$293.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100122","EAP","CPT� 88275","","Interphase In Situ Hybirdization (so)","BOTH IP/OP","$367.00 ","$271.58 ","$23.04 ","$367.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$367.00 ","$53.75 ","$112.22 ","$290.66 ","$293.60 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100123","EAP","CPT� 88271","","Molecular Cytogenetics;dna Probe (fish) (so)","BOTH IP/OP","$325.00 ","$240.50 ","$10.71 ","$325.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$325.00 ","$22.49 ","$59.86 ","$257.40 ","$260.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100124","EAP","CPT� 88275","","Interphase In Situ Hybirdization (so)","BOTH IP/OP","$325.00 ","$240.50 ","$23.04 ","$325.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$325.00 ","$53.75 ","$112.22 ","$257.40 ","$260.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100126","EAP","CPT� 88184","","Pnh Flow Cytometry, 1st Mrk (so)","BOTH IP/OP","$93.00 ","$68.82 ","$30.49 ","$284.24 ","$92.98 ","$93.00 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$94.00 ","$284.24 ","$94.00 ","$74.45 ","$75.20 ","$94.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100127","EAP","CPT� 88185","","Pnh Flow Cytometry, Ea Addl Mrk (so)","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$94.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$94.00 ","$0.00 ","$71.72 ","$74.45 ","$75.20 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"31100130","EAP","CPT� 88184","","Flow Cytometry; First Marker (so)","BOTH IP/OP","$303.00 ","$224.22 ","$30.49 ","$303.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$303.00 ","$284.24 ","$133.74 ","$239.98 ","$242.40 ","$303.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100132","EAP","CPT� 88185","","Flow Cytometry;16 Or More Markers (so)","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$134.00 ","$56.76 ","$0.00 ","$11.19 ","$47.05 ","$47.05 ","$26.63 ","$134.00 ","$0.00 ","$71.72 ","$106.13 ","$107.20 ","$0.00 ","$28.37 ","$22.33 ","$19.86 ","$0.00 "
"31100133","EAP","Custom 31100133","","Fish  Aml M3-pml/rara Trans 15 17 (so)","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$343.00 ","$0.00 ","$0.00 ","$0.00 ","$244.80 ","$244.80 ","$0.00 ","$343.00 ","$0.00 ","$171.50 ","$271.66 ","$274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100134","EAP","CPT� 88271","","Molecular Cytogen Dna Probe (so)","BOTH IP/OP","$345.00 ","$255.30 ","$10.71 ","$343.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$343.00 ","$22.49 ","$59.86 ","$271.66 ","$274.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31100135","EAP","CPT� 88275","","Interphase In Situ Hybrid (so)","BOTH IP/OP","$343.00 ","$253.82 ","$23.04 ","$343.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$343.00 ","$53.75 ","$112.22 ","$271.66 ","$274.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31100136","EAP","Custom 31100136","","Cll - Lymphoma Diagnostic Panel (so)","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100137","EAP","CPT� 88184","","Flow Cytometry; First Marker (so)","BOTH IP/OP","$303.00 ","$224.22 ","$30.49 ","$303.00 ","$92.98 ","$285.22 ","$30.49 ","$79.23 ","$79.23 ","$54.16 ","$303.00 ","$284.24 ","$133.74 ","$239.98 ","$242.40 ","$303.00 ","$57.71 ","$68.07 ","$40.40 ","$270.71 "
"31100141","EAP","CPT� 88112","","Enriched Prep Surepath","BOTH IP/OP","$545.00 ","$403.30 ","$30.81 ","$551.00 ","$103.78 ","$48.66 ","$30.81 ","$45.22 ","$45.22 ","$124.75 ","$551.00 ","$49.62 ","$116.38 ","$436.39 ","$440.80 ","$68.93 ","$132.92 ","$39.62 ","$93.05 ","$47.25 "
"31100142","EAP","CPT� 80356","","6-mam Opiates (so)","BOTH IP/OP","$166.00 ","$122.84 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$125.61 ","$125.61 ","$0.00 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31150011","EAP","CPT� 88104","","Cytology, Urinary","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31150012","EAP","CPT� 88104","","Cytology,fluid","BOTH IP/OP","$349.00 ","$258.26 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31150013","EAP","CPT� 88104","","Cytology,breast","BOTH IP/OP","$349.00 ","$258.26 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31150014","EAP","CPT� 88104","","Cytology,cns","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31150015","EAP","CPT� 88104","","Cytology,misc","BOTH IP/OP","$353.00 ","$261.22 ","$31.93 ","$353.00 ","$113.52 ","$33.15 ","$32.11 ","$33.52 ","$33.52 ","$50.14 ","$353.00 ","$33.53 ","$60.16 ","$279.58 ","$282.40 ","$46.58 ","$53.42 ","$40.34 ","$37.40 ","$31.93 "
"31200001","EAP","CPT� 88300","","Tooth","BOTH IP/OP","$291.00 ","$215.34 ","$7.30 ","$288.00 ","$24.87 ","$24.19 ","$7.30 ","$18.95 ","$18.95 ","$16.80 ","$288.00 ","$23.06 ","$38.76 ","$228.10 ","$230.40 ","$32.04 ","$17.90 ","$11.16 ","$12.53 ","$21.96 "
"31200002","EAP","CPT� 88300","","Foreign Body","BOTH IP/OP","$291.00 ","$215.34 ","$7.30 ","$288.00 ","$24.87 ","$24.19 ","$7.30 ","$18.95 ","$18.95 ","$16.80 ","$288.00 ","$23.06 ","$38.76 ","$228.10 ","$230.40 ","$32.04 ","$17.90 ","$11.16 ","$12.53 ","$21.96 "
"31200003","EAP","CPT� 88300","","Cataract,os /od","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$0.00 ","$0.00 ","$0.00 ","$18.95 ","$18.95 ","$16.80 ","$288.00 ","$23.06 ","$38.76 ","$228.10 ","$230.40 ","$32.04 ","$17.90 ","$11.16 ","$12.53 ","$21.96 "
"31200004","EAP","CPT� 88300","","Intrauterine Device","BOTH IP/OP","$291.00 ","$215.34 ","$7.30 ","$288.00 ","$24.87 ","$24.19 ","$7.30 ","$18.95 ","$18.95 ","$16.80 ","$288.00 ","$23.06 ","$38.76 ","$228.10 ","$230.40 ","$32.04 ","$17.90 ","$11.16 ","$12.53 ","$21.96 "
"31200005","EAP","CPT� 88302","","Appendix,incidential","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200006","EAP","CPT� 88302","","Foreskin, Newborn","BOTH IP/OP","$389.00 ","$287.86 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200007","EAP","CPT� 88302","","Testis,castration","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200008","EAP","CPT� 88302","","Nerve","BOTH IP/OP","$389.00 ","$287.86 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200009","EAP","CPT� 88302","","Skin Plastic Repair","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200010","EAP","CPT� 88302","","Amput,digit-traumat.","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200011","EAP","CPT� 88302","","Hernia Sac","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200012","EAP","CPT� 88302","","Hydrocele","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200013","EAP","CPT� 88302","","Vas Deferens, Steril.","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200014","EAP","CPT� 88302","","Vaginal Mucosa","BOTH IP/OP","$393.00 ","$290.82 ","$14.11 ","$389.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$389.00 ","$23.06 ","$87.44 ","$308.09 ","$311.20 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200015","EAP","CPT� 88304","","Nasal Polyp","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200016","EAP","CPT� 88304","","Colostomy Stoma","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200017","EAP","CPT� 88304","","Foreskin,non-newborn","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200018","EAP","CPT� 88304","","Bone/frag,non-pathologic","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200019","EAP","CPT� 88304","","Cartilage Shavings","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200020","EAP","CPT� 88304","","Carpal Tunnel Tissue","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200021","EAP","CPT� 88304","","Dupuytren's Contrac.","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200022","EAP","CPT� 88304","","Femoral Head,n-fract","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200023","EAP","CPT� 88304","","Cyst,misc","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200024","EAP","CPT� 88304","","Cyst,synovial","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200025","EAP","CPT� 88304","","Cyst,ganglion","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200026","EAP","CPT� 88304","","Fissure / Fistula","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200027","EAP","CPT� 88304","","Intervertebral Disc","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200028","EAP","CPT� 88304","","Joint, Loose Body","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200029","EAP","CPT� 88304","","Tendon Sheath","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200030","EAP","CPT� 88304","","Cyst,dental","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200031","EAP","CPT� 88304","","Neuroma,traumatic","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200032","EAP","CPT� 88304","","Skin Biopsy,punch","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200033","EAP","CPT� 88304","","Skin Excision,debrid","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200034","EAP","CPT� 88304","","Cyst,pilonidal","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200035","EAP","CPT� 88304","","Soft Tissue,debrid","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200036","EAP","CPT� 88304","","Soft Tissue,lipoma","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200037","EAP","CPT� 88304","","Aneurysm","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200038","EAP","CPT� 88304","","Vein, Varicosity","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200039","EAP","CPT� 88304","","Embolis/thrombus","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200040","EAP","CPT� 88304","","Hematoma","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200041","EAP","CPT� 88304","","Hemorrhoids","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200042","EAP","CPT� 88304","","Artery/vein, Plaque","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200043","EAP","CPT� 88304","","Cholesteatoma","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200044","EAP","CPT� 88304","","Conjunctiva Biopsy","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200045","EAP","CPT� 88304","","Cornea","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200046","EAP","CPT� 88304","","Salivary Mucocele","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200047","EAP","CPT� 88304","","Tonsil/adenoids","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200048","EAP","CPT� 88304","","Gall Blad./bile Duct","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200049","EAP","CPT� 88304","","Spermatocele","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200050","EAP","CPT� 88304","","Varicocele","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200051","EAP","CPT� 88304","","Vas Deferens","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200052","EAP","CPT� 88304","","Cyst,bartholin","BOTH IP/OP","$500.00 ","$370.00 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200053","EAP","CPT� 88304","","Cyst,hydat-morgagni","BOTH IP/OP","$495.00 ","$366.30 ","$18.49 ","$495.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$495.00 ","$49.62 ","$108.12 ","$392.04 ","$396.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200054","EAP","CPT� 88305","","Breast Bx,core Img","BOTH IP/OP","$617.00 ","$456.58 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200055","EAP","CPT� 88305","","Bronchus Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200056","EAP","CPT� 88305","","Trachea, Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200057","EAP","CPT� 88305","","Larynx, Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200058","EAP","CPT� 88305","","Nasopharynx","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200059","EAP","CPT� 88305","","Nasal Mucosa Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200060","EAP","CPT� 88305","","Stomach Polyp","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200061","EAP","CPT� 88305","","Duodenum Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200062","EAP","CPT� 88305","","Colorectal Polyp","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200063","EAP","CPT� 88305","","Peritoneum Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200064","EAP","CPT� 88305","","Ur Bladder Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200065","EAP","CPT� 88305","","Prostate Chips","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200066","EAP","CPT� 88305","","Cell Block","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200067","EAP","CPT� 88305","","Femoral Head, Fract.","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200068","EAP","CPT� 88305","","Synovium","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200069","EAP","CPT� 88305","","Meninges Resection","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200070","EAP","CPT� 88305","","Skin Biopsy,shave","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200071","EAP","CPT� 88305","","Skin Excision,other","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200072","EAP","CPT� 88305","","Soft Tissue,other","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200073","EAP","CPT� 88305","","Breast Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200074","EAP","CPT� 88305","","Breast,reduction","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200075","EAP","CPT� 88305","","Artery/vein Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200076","EAP","CPT� 88305","","Lymph Node Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200077","EAP","CPT� 88305","","Bone Marrow Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200078","EAP","CPT� 88305","","Spleen","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200079","EAP","CPT� 88305","","Amput,extrm-traumat.","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200080","EAP","CPT� 88305","","Joint Resection","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200081","EAP","CPT� 88305","","Muscle Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200082","EAP","CPT� 88305","","Amput,digit-nontraum","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200083","EAP","CPT� 88305","","Heart Valve","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200084","EAP","CPT� 88305","","Lip, Wedge Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200085","EAP","CPT� 88305","","Tongue Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200086","EAP","CPT� 88305","","Tonsil Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200087","EAP","CPT� 88305","","Oral/gingiva Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200088","EAP","CPT� 88305","","Salivary Gland Bx","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200089","EAP","CPT� 88305","","Parathyroid Gland","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200090","EAP","CPT� 88305","","Pituitary Tumor","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200091","EAP","CPT� 88305","","Nerve Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200092","EAP","CPT� 88305","","Pleural Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200093","EAP","CPT� 88305","","Pericardium Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200094","EAP","CPT� 88305","","Thyroglossal Duct","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200095","EAP","CPT� 88305","","Esophagus Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200096","EAP","CPT� 88305","","Stomach Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200097","EAP","CPT� 88305","","Sm.intestine Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200098","EAP","CPT� 88305","","Colon Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200099","EAP","CPT� 88305","","Omentum Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200100","EAP","CPT� 88305","","Kidney Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200101","EAP","CPT� 88305","","Ureter Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200102","EAP","CPT� 88305","","Urethra Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200103","EAP","CPT� 88305","","Prostate Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200104","EAP","CPT� 88305","","Endocervical Scrape","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200105","EAP","CPT� 88305","","Endometrial Scrape","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200106","EAP","CPT� 88305","","Cervical Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200107","EAP","CPT� 88305","","Vagina, Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200108","EAP","CPT� 88305","","Vulva / Labia Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200109","EAP","CPT� 88305","","Ovary","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200110","EAP","CPT� 88305","","Endometrial Polyp","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200111","EAP","CPT� 88305","","Uterus, Prolapse","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200112","EAP","CPT� 88305","","Fallopian Tube Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200113","EAP","CPT� 88305","","Fallop. Tube,ectopic","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200114","EAP","CPT� 88305","","Ovary,wedge Biopsy","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200115","EAP","CPT� 88305","","POC, SPONTANEOUS","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200116","EAP","CPT� 88305","","Placenta, N-3rd Trim.","BOTH IP/OP","$624.00 ","$461.76 ","$31.63 ","$617.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$617.00 ","$49.62 ","$140.98 ","$488.66 ","$493.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200117","EAP","CPT� 88307","","Stomach Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200118","EAP","CPT� 88307","","Colon, Seg Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200119","EAP","CPT� 88307","","Pancreas, Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200120","EAP","CPT� 88307","","Liver Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200121","EAP","CPT� 88307","","Ureter Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200122","EAP","CPT� 88307","","Testis Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200123","EAP","CPT� 88307","","Prostate Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200124","EAP","CPT� 88307","","Bone Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200125","EAP","CPT� 88307","","Tumor,dental","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200126","EAP","CPT� 88307","","Meninges,tumor","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200127","EAP","CPT� 88307","","Breast,simple Mast.","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200128","EAP","CPT� 88307","","Lymph Node Resectn","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200129","EAP","CPT� 88307","","Liver Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200130","EAP","CPT� 88307","","Amput,extrm-non Traum","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200131","EAP","CPT� 88307","","Bone/frag,pathologic","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200132","EAP","CPT� 88307","","Mediastinum,mass","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200133","EAP","CPT� 88307","","Soft Tissue,bx/excis","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200134","EAP","CPT� 88307","","Eye, Enucleation","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200135","EAP","CPT� 88307","","Thyroid Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200136","EAP","CPT� 88307","","Adrenal Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200137","EAP","CPT� 88307","","Brain Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200138","EAP","CPT� 88307","","Lung, Wedge Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200139","EAP","CPT� 88307","","Myocardium Biopsy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200140","EAP","CPT� 88307","","Thymus Tumor","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200141","EAP","CPT� 88307","","Small Intes. Resectn","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200142","EAP","CPT� 88307","","Nephrectomy","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200143","EAP","CPT� 88307","","Testis Resection","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200144","EAP","CPT� 88307","","Uterus","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200145","EAP","CPT� 88307","","Cervical Cone","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200146","EAP","CPT� 88307","","Placenta, Third Trim.","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200147","EAP","CPT� 88307","","Ovary,tumor","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200148","EAP","CPT� 88309","","Small Intes. Tumor","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200149","EAP","CPT� 88309","","Colon, Seg Resec,tumor","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200150","EAP","CPT� 88309","","Ur Bladder Resection","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200151","EAP","CPT� 88309","","Testis Resect,tumor","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200152","EAP","CPT� 88309","","Bone Resection","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200153","EAP","CPT� 88309","","Soft Tissue,tumor","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200154","EAP","CPT� 88309","","Breast,mast.w/nodes","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200155","EAP","CPT� 88309","","Larynx, Resectn/node","BOTH IP/OP","$1,051.00 ","$777.74 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200156","EAP","CPT� 88309","","Tongue, Resectn,tumor","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200157","EAP","CPT� 88309","","Tonsil Resectn,tumor","BOTH IP/OP","$1,051.00 ","$777.74 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200158","EAP","CPT� 88309","","Lung Resection","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200159","EAP","CPT� 88309","","Esophagus Resection","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200160","EAP","CPT� 88309","","Colon, Total Resectn","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200161","EAP","CPT� 88309","","Pancreas","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200162","EAP","CPT� 88309","","Prostate,resectn Rad","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200163","EAP","CPT� 88309","","Uterus, Tumor","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200164","EAP","CPT� 88309","","Fetus, W/dissection","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200165","EAP","CPT� 88309","","Vulva  Resection","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200166","EAP","CPT� 88312","","STAIN GRP I - ACID FAST BACT","BOTH IP/OP","$419.00 ","$310.06 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200167","EAP","CPT� 88312","","STAIN GRP I - BIELSCHOWSKY","BOTH IP/OP","$415.00 ","$307.10 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200168","EAP","CPT� 88312","","STAIN GRP I - C E VIOLET","BOTH IP/OP","$415.00 ","$307.10 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200169","EAP","CPT� 88312","","STAIN GRP I - FITE STAIN","BOTH IP/OP","$419.00 ","$310.06 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200170","EAP","CPT� 88312","","STAIN GRP I - GRAM STAIN","BOTH IP/OP","$419.00 ","$310.06 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200171","EAP","CPT� 88312","","STAIN GRP I - GR METH SILVER","BOTH IP/OP","$419.00 ","$310.06 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200172","EAP","CPT� 88312","","SPECAL STAIN GROUP I","BOTH IP/OP","$415.00 ","$307.10 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200173","EAP","CPT� 88312","","STAIN GRP I - RETICUL STAIN","BOTH IP/OP","$419.00 ","$310.06 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200174","EAP","CPT� 88312","","STAIN GRP I - STEINER-SPIRO","BOTH IP/OP","$415.00 ","$307.10 ","$38.01 ","$415.00 ","$150.27 ","$48.66 ","$45.90 ","$72.35 ","$72.35 ","$50.97 ","$415.00 ","$49.62 ","$128.88 ","$328.68 ","$332.00 ","$68.93 ","$54.31 ","$79.24 ","$38.01 ","$47.25 "
"31200175","EAP","CPT� 88313","","STAIN GRP II - ALCIAN BLUE","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200176","EAP","CPT� 88313","","STAIN GRP II - COLLO IRON","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200177","EAP","CPT� 88313","","STAIN GRP II - COLLO IRON W HY","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200178","EAP","CPT� 88313","","STAIN GRP II - DIFF QUCK","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200179","EAP","CPT� 88313","","STAIN GRP II - CONGO RED","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200180","EAP","CPT� 88313","","STAIN GRP II - CRYSTAL VIOLET","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200181","EAP","CPT� 88313","","STAIN GRP II - ELASTIC","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200182","EAP","CPT� 88313","","STAIN GRP II - GIEMSA","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200183","EAP","CPT� 88313","","STAIN GRP II - IRON","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200184","EAP","CPT� 88313","","STAIN GRP II - LUXOL BLUE","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200185","EAP","CPT� 88313","","STAIN GRP II - MASSON TRI","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200186","EAP","CPT� 88313","","STAIN GRP II - MUCICARMINE","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200187","EAP","CPT� 88313","","STAIN GRP II - OIL RED O","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200188","EAP","CPT� 88313","","STAIN GRP II - PAS","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200189","EAP","CPT� 88313","","STAIN GRP II - PAS ALC BLUE","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200190","EAP","CPT� 88313","","STAIN GRP II - PAS W / WO DIAD","BOTH IP/OP","$366.00 ","$270.84 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200191","EAP","CPT� 88313","","STAIN GRP II - SUDAN BLK B","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200192","EAP","CPT� 88313","","STAIN GRP II - TOLU BLUE","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200193","EAP","CPT� 88313","","Stain Grp Ii - Sudan Black","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200194","EAP","CPT� 88313","","Stain Grp Ii - Nasd Cl-ac-est","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200195","EAP","CPT� 88313","","Stain Grp Ii - Nafl Inhi Nasd","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200196","EAP","CPT� 88313","","Stain Grp Ii - Pas","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200197","EAP","CPT� 88313","","Stain Grp Ii - Naphth Ester","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200198","EAP","CPT� 88313","","Stain Grp Ii - T Resist Ap","BOTH IP/OP","$363.00 ","$268.62 ","$31.93 ","$363.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$363.00 ","$33.53 ","$110.70 ","$287.50 ","$290.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200199","EAP","CPT� 88313","","Stain Grp Ii - Fontana Masson","BOTH IP/OP","$518.00 ","$383.32 ","$31.93 ","$513.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$513.00 ","$33.53 ","$110.70 ","$406.30 ","$410.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200200","EAP","CPT� 88313","","Stain Grp Ii - Bile Stain","BOTH IP/OP","$513.00 ","$379.62 ","$31.93 ","$513.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$513.00 ","$33.53 ","$110.70 ","$406.30 ","$410.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200201","EAP","CPT� 88313","","Stain Grp Ii - Calcium Stain","BOTH IP/OP","$518.00 ","$383.32 ","$31.93 ","$513.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$513.00 ","$33.53 ","$110.70 ","$406.30 ","$410.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200202","EAP","CPT� 88313","","Stain Grp Ii - Melanin (bleach)","BOTH IP/OP","$513.00 ","$379.62 ","$31.93 ","$513.00 ","$106.50 ","$33.15 ","$33.25 ","$60.64 ","$60.64 ","$52.76 ","$513.00 ","$33.53 ","$110.70 ","$406.30 ","$410.40 ","$46.58 ","$56.22 ","$64.47 ","$39.35 ","$31.93 "
"31200203","EAP","CPT� 88342","","A-1 Antitrypsin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200204","EAP","CPT� 88342","","Actin,muscle Spec.","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200205","EAP","CPT� 88342","","Alpha-fetoprotein","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200206","EAP","CPT� 88342","","B72.3-breast","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200207","EAP","CPT� 88342","","Ca 125-ovarian Ca","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200208","EAP","CPT� 88342","","Ca-19-9-carbohydrat","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200209","EAP","CPT� 88342","","Calcitonin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200210","EAP","CPT� 88342","","Cea-p","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200211","EAP","CPT� 88342","","Chromogranin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200212","EAP","CPT� 88342","","Cytokeratin-ae1/ae3","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200213","EAP","CPT� 88342","","Cytokeratin-cam5.2","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200214","EAP","CPT� 88342","","Cytomegalovirus","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200215","EAP","CPT� 88342","","Desmin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200216","EAP","CPT� 88342","","Ema","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200217","EAP","CPT� 88342","","Factor Viii","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200219","EAP","CPT� 88342","","*stain: Oncoprotein (bcl2)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200220","EAP","CPT� 88342","","*stain: Cd30/ber H2 (ki-1)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200221","EAP","CPT� 88342","","*stain: B-1 Glyco","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200222","EAP","CPT� 88342","","*stain: Calponin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200223","EAP","CPT� 88342","","*stain: Calretinin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200224","EAP","CPT� 88342","","*stain: A-1 Antichymotryps","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200225","EAP","CPT� 88342","","*stain: Cytokeratin 20","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200226","EAP","CPT� 88342","","*stain: Cd10","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200227","EAP","CPT� 88342","","*stain: Cd138","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200228","EAP","CPT� 88342","","*stain: Cd23","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200229","EAP","CPT� 88342","","*stain: Cd3","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200230","EAP","CPT� 88342","","*stain: Cd31","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200231","EAP","CPT� 88342","","*stain: Cd34","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200232","EAP","CPT� 88342","","*stain: Cd43","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200233","EAP","CPT� 88342","","*stain: Cd5","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200234","EAP","CPT� 88342","","*stain: Cd79","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200235","EAP","CPT� 88360","","*stain: Ki-67 (mib-1)","BOTH IP/OP","$642.00 ","$475.08 ","$58.38 ","$616.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$616.00 ","$143.92 ","$121.34 ","$487.87 ","$492.80 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200236","EAP","CPT� 88342","","*stain: Cytokeratin 7","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200237","EAP","CPT� 88342","","*stain: Hepatocyte","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200238","EAP","CPT� 88342","","*stain: Hi Mol Wt Keratin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200239","EAP","CPT� 88342","","*stain: Inhibin Alpha","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200240","EAP","CPT� 88342","","*stain: Myeloperoxidase","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200241","EAP","CPT� 88342","","*stain: P16","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200242","EAP","CPT� 88342","","*stain: P53","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200243","EAP","CPT� 88342","","*stain: Tdt","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200244","EAP","CPT� 88342","","*stain: Ttf-1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200245","EAP","CPT� 88342","","*stain: Villin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200246","EAP","CPT� 88342","","Immunoperoxidase","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200247","EAP","CPT� 88360","","Estrogen Receptor","BOTH IP/OP","$620.00 ","$458.80 ","$58.38 ","$616.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$616.00 ","$143.92 ","$121.34 ","$487.87 ","$492.80 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200248","EAP","CPT� 88360","","Progesterone Recep.","BOTH IP/OP","$620.00 ","$458.80 ","$58.38 ","$616.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$616.00 ","$143.92 ","$121.34 ","$487.87 ","$492.80 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200249","EAP","CPT� 88342","","Glial Fibrillary Ap","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200250","EAP","CPT� 88342","","Glucagon","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200251","EAP","CPT� 88342","","Hepatitis B Core","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200252","EAP","CPT� 88342","","Hepatitis B Surface","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200253","EAP","CPT� 88342","","Herpes Simplex Prob","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200254","EAP","CPT� 88342","","Human Chorionic Gon","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200255","EAP","CPT� 88342","","Human Growth Hormon","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200256","EAP","CPT� 88342","","Insulin","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200257","EAP","CPT� 88342","","Kappa","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200258","EAP","CPT� 88342","","L-26 B Cell Marker","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200259","EAP","CPT� 88342","","Lambda","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200260","EAP","CPT� 88342","","Leu M1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200261","EAP","CPT� 88342","","Leukocyte Common Ag","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200262","EAP","CPT� 88342","","Leuteinizing Hormon","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200263","EAP","CPT� 88342","","Macrophage-ham-56","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200264","EAP","CPT� 88342","","Melanoma-hmb-45","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200265","EAP","CPT� 88342","","Neuron Spec Enolase","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200266","EAP","CPT� 88342","","Placental Alk Phos","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200267","EAP","CPT� 88342","","Placental Lactogen","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200268","EAP","CPT� 88342","","Prolactin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200269","EAP","CPT� 88342","","Prostate Acid Phos","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200270","EAP","CPT� 88342","","Prostate Spec Ag","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200271","EAP","CPT� 88342","","S-100 Neural Ag","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200272","EAP","CPT� 88342","","Serotonin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200273","EAP","CPT� 88342","","Synatophysin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200274","EAP","CPT� 88342","","Thyroglobulin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200275","EAP","CPT� 88342","","Uchl-1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200276","EAP","CPT� 88342","","Vimentin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200277","EAP","CPT� 88342","","Em:kappa","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200278","EAP","CPT� 88342","","Em:lambda","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200279","EAP","CPT� 88346","","Em:igg","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200280","EAP","CPT� 88346","","Em:iga","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200281","EAP","CPT� 88346","","Em:igm","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200282","EAP","CPT� 88346","","Em:c3","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200283","EAP","CPT� 88346","","Em:c4","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200284","EAP","CPT� 88346","","Em:c1q","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200285","EAP","CPT� 88346","","Em:fibrogen","BOTH IP/OP","$764.00 ","$565.36 ","$50.44 ","$810.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$810.00 ","$284.24 ","$112.24 ","$641.52 ","$648.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200286","EAP","CPT� 88346","","Immunof,dir Charge","BOTH IP/OP","$794.00 ","$587.56 ","$50.44 ","$755.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$755.00 ","$284.24 ","$112.24 ","$597.96 ","$604.00 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200287","EAP","CPT� 88346","","Immunof, Ind Charge","BOTH IP/OP","$537.00 ","$397.38 ","$50.44 ","$511.00 ","$144.30 ","$285.22 ","$50.44 ","$57.29 ","$57.29 ","$83.33 ","$511.00 ","$284.24 ","$112.24 ","$404.71 ","$408.80 ","$394.92 ","$88.79 ","$90.76 ","$62.15 ","$270.71 "
"31200288","EAP","CPT� 88360","","*stain: Her2neu","BOTH IP/OP","$642.00 ","$475.08 ","$58.38 ","$616.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$616.00 ","$143.92 ","$121.34 ","$487.87 ","$492.80 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200290","EAP","CPT� 88342","","*stain: Ber Ep4","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200291","EAP","CPT� 88342","","*stain: Cd117 (c-kit)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200292","EAP","CPT� 88342","","*stain: Cdx2","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200293","EAP","CPT� 88342","","*stain: Cea (monoclonal)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200294","EAP","CPT� 88342","","*stain: Cyclin D1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200295","EAP","CPT� 88342","","*stain: Cytokeratin 19","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200296","EAP","CPT� 88342","","*stain: Cytokeratin 5","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200297","EAP","CPT� 88342","","*stain: Cytokeratin 5/6","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200298","EAP","CPT� 88342","","*stain: Cytokeratin 6","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200299","EAP","CPT� 88342","","*stain: E-cadherin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200300","EAP","CPT� 88342","","*stain: Egfr","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200301","EAP","CPT� 88342","","*stain: Galectin-3","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200302","EAP","CPT� 88342","","*stain: Gcdfp-15","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200303","EAP","CPT� 88342","","*stain: Hbme-1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200304","EAP","CPT� 88342","","*stain: Helicobacter Pylori","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200305","EAP","CPT� 88342","","*stain: Hhv-8 (human Herpes-8)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200306","EAP","CPT� 88342","","*stain: Melan A (mart-1)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200307","EAP","CPT� 88342","","*stain: P10","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200308","EAP","CPT� 88342","","*stain: P63","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200309","EAP","CPT� 88342","","*stain: Treponema","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200310","EAP","CPT� 88342","","*stain: Wt-1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200311","EAP","CPT� 88342","","*stain:pin Cocktail(p63=p504s)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200312","EAP","CPT� 88342","","*stain:sma(smooth Muscle Actin","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200313","EAP","CPT� 88342","","Stain: Cd56","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200314","EAP","CPT� 88342","","Stain: Cd99","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200315","EAP","CPT� 88342","","Stain: Glypican-3","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200316","EAP","CPT� 88342","","Stain: Moc-1","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200317","EAP","CPT� 88342","","Immunohisto Chemistry","BOTH IP/OP","$278.00 ","$205.72 ","$48.82 ","$278.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$278.00 ","$143.92 ","$106.46 ","$220.18 ","$222.40 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200320","EAP","CPT� 88342","","Ihc Marker (stain Only) (so)","BOTH IP/OP","$333.00 ","$246.42 ","$48.82 ","$333.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$333.00 ","$143.92 ","$106.46 ","$263.74 ","$266.40 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200321","EAP","CPT� 88361","","Inscape  Er/pr/her Quant-ihc  (so)","BOTH IP/OP","$736.00 ","$544.64 ","$0.00 ","$736.00 ","$0.00 ","$0.00 ","$0.00 ","$93.17 ","$93.17 ","$0.00 ","$736.00 ","$0.00 ","$212.60 ","$582.91 ","$588.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31200322","EAP","CPT� 88361","","Inscape Er/pr Quant -ihc  (so)","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$0.00 ","$0.00 ","$0.00 ","$93.17 ","$93.17 ","$0.00 ","$510.00 ","$0.00 ","$212.60 ","$403.92 ","$408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31200323","EAP","CPT� 88342","","Ercc1  Ihc With Interp (so)","BOTH IP/OP","$278.00 ","$205.72 ","$48.82 ","$278.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$278.00 ","$143.92 ","$106.46 ","$220.18 ","$222.40 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200330","EAP","CPT� 88305","","Accessort Digit  Diagnostic","BOTH IP/OP","$367.00 ","$271.58 ","$31.63 ","$367.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$367.00 ","$49.62 ","$140.98 ","$290.66 ","$293.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200331","EAP","CPT� 88305","","Acromioclavicular Joint","BOTH IP/OP","$367.00 ","$271.58 ","$31.63 ","$367.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$367.00 ","$49.62 ","$140.98 ","$290.66 ","$293.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200332","EAP","CPT� 88304","","Adhesions  Pelvic","BOTH IP/OP","$371.00 ","$274.54 ","$18.49 ","$367.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$367.00 ","$49.62 ","$108.12 ","$290.66 ","$293.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200333","EAP","CPT� 88304","","Adipose Tissue (fat/fatty Tissue)","BOTH IP/OP","$367.00 ","$271.58 ","$18.49 ","$367.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$367.00 ","$49.62 ","$108.12 ","$290.66 ","$293.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200334","EAP","CPT� 88305","","Ampulla Of Vater","BOTH IP/OP","$371.00 ","$274.54 ","$31.63 ","$367.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$367.00 ","$49.62 ","$140.98 ","$290.66 ","$293.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200335","EAP","CPT� 88307","","Amputation-extremity  Non-traumatic","BOTH IP/OP","$371.00 ","$274.54 ","$116.80 ","$371.00 ","$371.00 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$367.00 ","$284.24 ","$240.00 ","$290.66 ","$293.60 ","$367.00 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200336","EAP","CPT� 88307","","Arachnoid Mater-tumor Resection","BOTH IP/OP","$367.00 ","$271.58 ","$116.80 ","$367.00 ","$367.00 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$367.00 ","$284.24 ","$240.00 ","$290.66 ","$293.60 ","$367.00 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200337","EAP","CPT� 88305","","Arteriovenous Malformation (avm)","BOTH IP/OP","$474.00 ","$350.76 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200338","EAP","CPT� 88307","","Arteriovenous Malformation (avm)  Complex","BOTH IP/OP","$474.00 ","$350.76 ","$116.80 ","$469.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$469.00 ","$284.24 ","$240.00 ","$371.45 ","$375.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200339","EAP","CPT� 88307","","Axillary Tail/axilla - Lymph Nodes Resection","BOTH IP/OP","$474.00 ","$350.76 ","$116.80 ","$469.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$469.00 ","$284.24 ","$240.00 ","$371.45 ","$375.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200340","EAP","CPT� 88305","","Bone Marrow Particle Clot","BOTH IP/OP","$474.00 ","$350.76 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200341","EAP","CPT� 88305","","Breast Excision Of Discrete Lesion","BOTH IP/OP","$474.00 ","$350.76 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200342","EAP","CPT� 88305","","Breast Needle Core Tissue Biopsy","BOTH IP/OP","$474.00 ","$350.76 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200343","EAP","CPT� 88305","","Breast  Incisional Biopsy","BOTH IP/OP","$474.00 ","$350.76 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200344","EAP","CPT� 88307","","Breast  Quadrantectomy/partial Mastectomy/segmentectomy","BOTH IP/OP","$474.00 ","$350.76 ","$116.80 ","$469.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$469.00 ","$284.24 ","$240.00 ","$371.45 ","$375.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200345","EAP","CPT� 88307","","Cervix Amputation Without Uterus","BOTH IP/OP","$474.00 ","$350.76 ","$116.80 ","$469.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$469.00 ","$284.24 ","$240.00 ","$371.45 ","$375.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200346","EAP","CPT� 88305","","Colon ""donut""","BOTH IP/OP","$474.00 ","$350.76 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200347","EAP","CPT� 88304","","Colon Donut","BOTH IP/OP","$474.00 ","$350.76 ","$18.49 ","$469.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$469.00 ","$49.62 ","$108.12 ","$371.45 ","$375.20 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200348","EAP","CPT� 88307","","Cyst - Bone","BOTH IP/OP","$469.00 ","$347.06 ","$116.80 ","$469.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$469.00 ","$284.24 ","$240.00 ","$371.45 ","$375.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200349","EAP","CPT� 88305","","Cyst - Cervix","BOTH IP/OP","$469.00 ","$347.06 ","$31.63 ","$469.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$469.00 ","$49.62 ","$140.98 ","$371.45 ","$375.20 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200350","EAP","CPT� 88307","","Cyst - Dermoid Of Soft Tissue/ovary (eg Teratoma)","BOTH IP/OP","$474.00 ","$350.76 ","$116.80 ","$469.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$469.00 ","$284.24 ","$240.00 ","$371.45 ","$375.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200351","EAP","CPT� 88304","","Cyst - Dermoid Skin","BOTH IP/OP","$469.00 ","$347.06 ","$18.49 ","$469.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$469.00 ","$49.62 ","$108.12 ","$371.45 ","$375.20 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200352","EAP","CPT� 88304","","Cyst - Epidermoid","BOTH IP/OP","$591.00 ","$437.34 ","$18.49 ","$585.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$585.00 ","$49.62 ","$108.12 ","$463.32 ","$468.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200353","EAP","CPT� 88305","","Cyst - Ovarian  Non-neoplastic","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200354","EAP","CPT� 88307","","Cyst  Nos  Neoplastic","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200355","EAP","CPT� 88305","","Cyst  Nos  Nonneoplastic","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200356","EAP","CPT� 88302","","Cystocele","BOTH IP/OP","$585.00 ","$432.90 ","$14.11 ","$585.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$585.00 ","$23.06 ","$87.44 ","$463.32 ","$468.00 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200357","EAP","CPT� 88309","","Diaphragm - Resection For Tumor","BOTH IP/OP","$585.00 ","$432.90 ","$164.53 ","$630.05 ","$585.00 ","$585.00 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$585.00 ","$630.05 ","$328.48 ","$463.32 ","$468.00 ","$585.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200358","EAP","CPT� 88307","","Diaphragm - Resection Other Than For Tumor","BOTH IP/OP","$585.00 ","$432.90 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200359","EAP","CPT� 88307","","Dura Mater - Tumor Resection","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200360","EAP","CPT� 88305","","Endometrial Polyp","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200361","EAP","CPT� 88309","","Endoscopic Mucosal Resection (emr)","BOTH IP/OP","$591.00 ","$437.34 ","$164.53 ","$630.05 ","$591.00 ","$591.00 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$585.00 ","$630.05 ","$328.48 ","$463.32 ","$468.00 ","$585.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200362","EAP","CPT� 88305","","Epiglottis Biopsy/simple Excision","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200363","EAP","CPT� 88305","","Esophageal Polyp","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200364","EAP","CPT� 88304","","Fat/fatty Tissue Nos","BOTH IP/OP","$585.00 ","$432.90 ","$18.49 ","$585.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$585.00 ","$49.62 ","$108.12 ","$463.32 ","$468.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200365","EAP","CPT� 88305","","Gastric Polyp","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200366","EAP","CPT� 88305","","Mucosa Biopsy - Gingiva","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200367","EAP","CPT� 88305","","Mucosa Biopsy - Nasal","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200368","EAP","CPT� 88305","","Mucosa Biopsy - Nos","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200369","EAP","CPT� 88304","","Nasal Septum","BOTH IP/OP","$591.00 ","$437.34 ","$18.49 ","$585.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$585.00 ","$49.62 ","$108.12 ","$463.32 ","$468.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200370","EAP","CPT� 88307","","Omentum Resection","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200371","EAP","CPT� 88309","","Omentum Resection - For Tumor","BOTH IP/OP","$591.00 ","$437.34 ","$164.53 ","$630.05 ","$591.00 ","$591.00 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$585.00 ","$630.05 ","$328.48 ","$463.32 ","$468.00 ","$585.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200372","EAP","CPT� 88305","","Oral Cyst","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200373","EAP","CPT� 88305","","Panniculus","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200374","EAP","CPT� 88305","","Penis Biopsy","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200375","EAP","CPT� 88309","","Penis Resection For Tumor","BOTH IP/OP","$591.00 ","$437.34 ","$164.53 ","$630.05 ","$591.00 ","$591.00 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$585.00 ","$630.05 ","$328.48 ","$463.32 ","$468.00 ","$585.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200376","EAP","CPT� 88305","","Pericardiium Biopsy Or Tissue","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200377","EAP","CPT� 88309","","Pericardium Resection - For Tumor","BOTH IP/OP","$585.00 ","$432.90 ","$164.53 ","$630.05 ","$585.00 ","$585.00 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$585.00 ","$630.05 ","$328.48 ","$463.32 ","$468.00 ","$585.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200378","EAP","CPT� 88309","","Peritoneum Resection - For Tumor","BOTH IP/OP","$591.00 ","$437.34 ","$164.53 ","$630.05 ","$591.00 ","$591.00 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$585.00 ","$630.05 ","$328.48 ","$463.32 ","$468.00 ","$585.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200379","EAP","CPT� 88305","","Pia Mater - Other Than Tumor Resection","BOTH IP/OP","$585.00 ","$432.90 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200380","EAP","CPT� 88307","","Pia Mater - Tumor Resection","BOTH IP/OP","$585.00 ","$432.90 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200381","EAP","CPT� 88307","","Pleura Resection","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200382","EAP","CPT� 88305","","Retroperitoneal Biopsy","BOTH IP/OP","$585.00 ","$432.90 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200383","EAP","CPT� 88304","","Scar - Soft Tissue","BOTH IP/OP","$591.00 ","$437.34 ","$18.49 ","$585.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$585.00 ","$49.62 ","$108.12 ","$463.32 ","$468.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200384","EAP","CPT� 88305","","Skin  Wart (eg  Verruca Vulgaris)","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200385","EAP","CPT� 88305","","Spinal Cord Biopsy","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200386","EAP","CPT� 88307","","Spinal Cord Tumor Excision","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200387","EAP","CPT� 88304","","Stoma (any Site)","BOTH IP/OP","$591.00 ","$437.34 ","$18.49 ","$585.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$585.00 ","$49.62 ","$108.12 ","$463.32 ","$468.00 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200388","EAP","CPT� 88305","","Stomach Polyp","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200389","EAP","CPT� 88302","","Supernumerary Digit","BOTH IP/OP","$591.00 ","$437.34 ","$14.11 ","$585.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$585.00 ","$23.06 ","$87.44 ","$463.32 ","$468.00 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200390","EAP","CPT� 88305","","Supernumerary Digit Diagnostic","BOTH IP/OP","$585.00 ","$432.90 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200391","EAP","CPT� 88307","","Surgical Margin  Complicated Exam","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200392","EAP","CPT� 88302","","Thymus  Incidential","BOTH IP/OP","$591.00 ","$437.34 ","$14.11 ","$585.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$585.00 ","$23.06 ","$87.44 ","$463.32 ","$468.00 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200393","EAP","CPT� 88302","","Uvula - Incidental","BOTH IP/OP","$585.00 ","$432.90 ","$14.11 ","$585.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$585.00 ","$23.06 ","$87.44 ","$463.32 ","$468.00 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200394","EAP","CPT� 88305","","Vocal Cord Biopsy","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200395","EAP","CPT� 88307","","Vocal Cord Resection","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200396","EAP","CPT� 88307","","Bone Cyst","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200397","EAP","CPT� 88305","","Breast Biopsy  Without Margin Exam","BOTH IP/OP","$591.00 ","$437.34 ","$31.63 ","$585.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$585.00 ","$49.62 ","$140.98 ","$463.32 ","$468.00 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200398","EAP","CPT� 88307","","Cyst - Ovarian  Neoplastic","BOTH IP/OP","$591.00 ","$437.34 ","$116.80 ","$585.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$585.00 ","$284.24 ","$240.00 ","$463.32 ","$468.00 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200399","EAP","CPT� 88305","","Cyst - Sinsus","BOTH IP/OP","$737.00 ","$545.38 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200400","EAP","CPT� 88305","","Diaphragm Biopsy Or Tissue","BOTH IP/OP","$737.00 ","$545.38 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200401","EAP","CPT� 88304","","Diverticulum - Bladder/urethra","BOTH IP/OP","$745.00 ","$551.30 ","$18.49 ","$737.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$737.00 ","$49.62 ","$108.12 ","$583.70 ","$589.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200402","EAP","CPT� 88305","","Dura Mater","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200403","EAP","CPT� 88302","","Enterocele","BOTH IP/OP","$737.00 ","$545.38 ","$14.11 ","$737.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$737.00 ","$23.06 ","$87.44 ","$583.70 ","$589.60 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200404","EAP","CPT� 88305","","Ethmoid Tissue","BOTH IP/OP","$737.00 ","$545.38 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200405","EAP","CPT� 88305","","Fat Pad  Biopsy","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200406","EAP","CPT� 88305","","Leep Biopsy","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200407","EAP","CPT� 88304","","Ligament","BOTH IP/OP","$745.00 ","$551.30 ","$18.49 ","$737.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$737.00 ","$49.62 ","$108.12 ","$583.70 ","$589.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200408","EAP","CPT� 88307","","Lymph Node For Lymphoma Workup","BOTH IP/OP","$745.00 ","$551.30 ","$116.80 ","$737.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$737.00 ","$284.24 ","$240.00 ","$583.70 ","$589.60 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200409","EAP","CPT� 88304","","Meningematoma/meninghematoma","BOTH IP/OP","$737.00 ","$545.38 ","$18.49 ","$737.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$737.00 ","$49.62 ","$108.12 ","$583.70 ","$589.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200410","EAP","CPT� 88305","","Mucosa Biopsy - Oral","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200411","EAP","CPT� 88304","","Nail  Nail Bed Or Scrapping For Fungus","BOTH IP/OP","$745.00 ","$551.30 ","$18.49 ","$737.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$737.00 ","$49.62 ","$108.12 ","$583.70 ","$589.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200412","EAP","CPT� 88307","","Nerve Tumor","BOTH IP/OP","$745.00 ","$551.30 ","$116.80 ","$737.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$737.00 ","$284.24 ","$240.00 ","$583.70 ","$589.60 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200413","EAP","CPT� 88305","","Neurofibroma/neuroma","BOTH IP/OP","$737.00 ","$545.38 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200414","EAP","CPT� 88305","","Osteochondroma (exostosis)","BOTH IP/OP","$737.00 ","$545.38 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200415","EAP","CPT� 88307","","Pericardium Resection","BOTH IP/OP","$737.00 ","$545.38 ","$116.80 ","$737.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$737.00 ","$284.24 ","$240.00 ","$583.70 ","$589.60 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200416","EAP","CPT� 88307","","Peritoneum Resection","BOTH IP/OP","$737.00 ","$545.38 ","$116.80 ","$737.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$737.00 ","$284.24 ","$240.00 ","$583.70 ","$589.60 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200417","EAP","CPT� 88309","","Pleura Resection - For Tumor","BOTH IP/OP","$745.00 ","$551.30 ","$164.53 ","$737.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$737.00 ","$630.05 ","$328.48 ","$583.70 ","$589.60 ","$737.00 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200418","EAP","CPT� 88307","","Retroperitoneal Mass","BOTH IP/OP","$737.00 ","$545.38 ","$116.80 ","$737.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$737.00 ","$284.24 ","$240.00 ","$583.70 ","$589.60 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200419","EAP","CPT� 88305","","Rib  Marrow Squeeze","BOTH IP/OP","$737.00 ","$545.38 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200420","EAP","CPT� 88305","","Scar - Keloid","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200421","EAP","CPT� 88304","","Scar - Skin (simple/cicatrix)","BOTH IP/OP","$745.00 ","$551.30 ","$18.49 ","$737.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$737.00 ","$49.62 ","$108.12 ","$583.70 ","$589.60 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200422","EAP","CPT� 88305","","Scar - Skin (tumor Excision/re-excision","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200423","EAP","CPT� 88302","","Sinus Contents","BOTH IP/OP","$1,012.00 ","$748.88 ","$14.11 ","$1,001.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$1,001.00 ","$23.06 ","$87.44 ","$792.79 ","$800.80 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200424","EAP","CPT� 88305","","Sinus Mucosa Stripping","BOTH IP/OP","$1,001.00 ","$740.74 ","$31.63 ","$1,001.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$1,001.00 ","$49.62 ","$140.98 ","$792.79 ","$800.80 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200425","EAP","CPT� 88305","","Surgical Margin  Uncomplicated Exam","BOTH IP/OP","$1,012.00 ","$748.88 ","$31.63 ","$1,001.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$1,001.00 ","$49.62 ","$140.98 ","$792.79 ","$800.80 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200426","EAP","CPT� 88305","","Thyroid Biopsy","BOTH IP/OP","$1,012.00 ","$748.88 ","$31.63 ","$1,001.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$1,001.00 ","$49.62 ","$140.98 ","$792.79 ","$800.80 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200427","EAP","CPT� 88304","","Turbinates (nasal Conchae)","BOTH IP/OP","$1,012.00 ","$748.88 ","$18.49 ","$1,001.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$1,001.00 ","$49.62 ","$108.12 ","$792.79 ","$800.80 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200428","EAP","CPT� 88302","","Uvula Simple Excision","BOTH IP/OP","$1,012.00 ","$748.88 ","$14.11 ","$1,001.00 ","$47.04 ","$24.19 ","$14.11 ","$42.29 ","$42.29 ","$41.19 ","$1,001.00 ","$23.06 ","$87.44 ","$792.79 ","$800.80 ","$32.04 ","$43.89 ","$24.13 ","$30.72 ","$21.96 "
"31200429","EAP","CPT� 88305","","Vein Biopsy/segment","BOTH IP/OP","$1,012.00 ","$748.88 ","$31.63 ","$1,001.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$1,001.00 ","$49.62 ","$140.98 ","$792.79 ","$800.80 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200450","EAP","CPT� 88342","","P40 Protein, Ihc","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200455","EAP","CPT� 88309","","Teratoma , Extensive Resection","BOTH IP/OP","$1,001.00 ","$740.74 ","$164.53 ","$1,001.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,001.00 ","$630.05 ","$328.48 ","$792.79 ","$800.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200456","EAP","CPT� 88342","","Napsin-a,ihc","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200457","EAP","CPT� 88304","","Appendix, Non-incidental","BOTH IP/OP","$474.00 ","$350.76 ","$18.49 ","$469.00 ","$62.70 ","$48.66 ","$18.49 ","$51.07 ","$51.07 ","$35.46 ","$469.00 ","$49.62 ","$108.12 ","$371.45 ","$375.20 ","$68.93 ","$37.78 ","$29.89 ","$26.45 ","$47.25 "
"31200458","EAP","CPT� 88307","","Sentinel Lymph Node(s)","BOTH IP/OP","$745.00 ","$551.30 ","$116.80 ","$737.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$737.00 ","$284.24 ","$240.00 ","$583.70 ","$589.60 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200459","EAP","CPT� 88305","","Needle Core Biopsy","BOTH IP/OP","$745.00 ","$551.30 ","$31.63 ","$737.00 ","$104.86 ","$48.66 ","$31.63 ","$67.40 ","$67.40 ","$77.40 ","$737.00 ","$49.62 ","$140.98 ","$583.70 ","$589.60 ","$68.93 ","$82.47 ","$32.05 ","$57.73 ","$47.25 "
"31200460","EAP","CPT� 88300","","Tissue, Gross Only","BOTH IP/OP","$266.00 ","$196.84 ","$7.30 ","$263.00 ","$24.87 ","$24.19 ","$7.30 ","$18.95 ","$18.95 ","$16.80 ","$263.00 ","$23.06 ","$38.76 ","$208.30 ","$210.40 ","$32.04 ","$17.90 ","$11.16 ","$12.53 ","$21.96 "
"31200461","EAP","CPT� 88329","","Intra-operative Pathology Consult","BOTH IP/OP","$298.00 ","$220.52 ","$0.00 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$33.40 ","$33.40 ","$0.00 ","$298.00 ","$0.00 ","$101.94 ","$236.02 ","$238.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31200462","EAP","CPT� 88331","","First Tissue Block W Fs (single Spec)","BOTH IP/OP","$581.00 ","$429.94 ","$29.37 ","$533.00 ","$148.63 ","$146.06 ","$44.60 ","$29.37 ","$29.37 ","$87.82 ","$533.00 ","$143.92 ","$57.46 ","$422.14 ","$426.40 ","$199.96 ","$93.58 ","$34.94 ","$65.50 ","$137.07 "
"31200463","EAP","CPT� 88332","","Each Add Tissue Block W Frozen Section(s)","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$257.00 ","$80.52 ","$0.00 ","$24.49 ","$10.48 ","$10.48 ","$44.09 ","$257.00 ","$0.00 ","$20.46 ","$203.54 ","$205.60 ","$0.00 ","$46.98 ","$23.05 ","$32.88 ","$0.00 "
"31200464","EAP","CPT� 88360","","ER/PR QUANTITIATIVE IHC","BOTH IP/OP","$1,001.00 ","$740.74 ","$58.38 ","$995.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$995.00 ","$143.92 ","$121.34 ","$788.04 ","$796.00 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200466","EAP","CPT� 88342","","Human Herpesvirus , Type 8(hhv-8)","BOTH IP/OP","$510.00 ","$377.40 ","$48.82 ","$510.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$510.00 ","$143.92 ","$106.46 ","$403.92 ","$408.00 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200467","EAP","CPT� 88342","","Neuron Specific Enolase (nse), Ihc","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200468","EAP","CPT� 88342","","Cd20, L26, Ihc","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200469","EAP","CPT� 88307","","Salivary Gland","BOTH IP/OP","$774.00 ","$572.76 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200470","EAP","CPT� 88307","","Urinary Bladder, Tur","BOTH IP/OP","$782.00 ","$578.68 ","$116.80 ","$774.00 ","$406.48 ","$285.22 ","$123.09 ","$130.18 ","$130.18 ","$156.60 ","$774.00 ","$284.24 ","$240.00 ","$613.01 ","$619.20 ","$394.92 ","$166.86 ","$194.49 ","$116.80 ","$270.71 "
"31200471","EAP","CPT� 88333","","Intraoperative Cytologic Examination (touch Prep) Initial Site","BOTH IP/OP","$654.00 ","$483.96 ","$0.00 ","$641.78 ","$143.77 ","$641.78 ","$41.03 ","$31.56 ","$31.56 ","$0.00 ","$600.00 ","$0.00 ","$57.46 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31200472","EAP","CPT� 88334","","Intraoperative Cytologic Examination (touch Prep) Add Site","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$257.00 ","$0.00 ","$0.00 ","$25.62 ","$19.25 ","$19.25 ","$0.00 ","$257.00 ","$0.00 ","$34.52 ","$203.54 ","$205.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31200473","EAP","CPT� 88341","","Ihc Stain - Additional","BOTH IP/OP","$766.00 ","$566.84 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200474","EAP","CPT� 88341","","*stain: Melan A (mart-1)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200475","EAP","CPT� 88341","","*stain: P10","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200476","EAP","CPT� 88341","","*stain: P63","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200477","EAP","CPT� 88341","","*stain: Treponema","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200478","EAP","CPT� 88341","","*stain: Wt-1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200479","EAP","CPT� 88341","","*stain: Pin Cocktail(p63=p504s)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200480","EAP","CPT� 88341","","*stain: Sma(smooth Muscle Actin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200481","EAP","CPT� 88341","","Stain: Cd56","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200482","EAP","CPT� 88341","","Stain: Cd99","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200483","EAP","CPT� 88341","","Stain: Glypican-3","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200484","EAP","CPT� 88341","","Stain: Moc-1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200485","EAP","CPT� 88341","","Immunohisto Chemistry","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200486","EAP","CPT� 88341","","Ihc Marker (stain Only) (so)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200487","EAP","CPT� 88341","","Ercc1 Ihc With Interp (so)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200488","EAP","CPT� 88341","","P40 Protein, Ihc","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200489","EAP","CPT� 88341","","Napsin-a,ihc","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200490","EAP","CPT� 88341","","Neuron Specific Enolase (nse), Ihc","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200491","EAP","CPT� 88341","","Cd20, L26, Ihc","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200492","EAP","CPT� 88341","","Placental Lactogen","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200493","EAP","CPT� 88341","","Prolactin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200494","EAP","CPT� 88341","","Prostate Acid Phos","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200495","EAP","CPT� 88341","","Prostate Spec Ag","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200496","EAP","CPT� 88341","","S-100 Neural Ag","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200497","EAP","CPT� 88341","","Serotonin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200498","EAP","CPT� 88341","","Synatophysin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200499","EAP","CPT� 88341","","Thyroglobulin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200500","EAP","CPT� 88341","","Uchl-1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200501","EAP","CPT� 88341","","Vimentin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200502","EAP","CPT� 88341","","Em:kappa","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200503","EAP","CPT� 88341","","Em:lambda","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200504","EAP","CPT� 88341","","*stain: Ber Ep4","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200505","EAP","CPT� 88341","","*stain: Cd117 (c-kit)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200506","EAP","CPT� 88341","","*stain: Cdx2","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200507","EAP","CPT� 88341","","*stain: Cdx2","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200508","EAP","CPT� 88341","","*stain: Cea (monoclonal)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200509","EAP","CPT� 88341","","*stain: Cyclin D1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200510","EAP","CPT� 88341","","*stain: Cyclin D1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200511","EAP","CPT� 88341","","*stain: Cytokeratin 19","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200512","EAP","CPT� 88341","","*stain: Cytokeratin 5","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200513","EAP","CPT� 88341","","*stain: Cytokeratin 5/6","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200514","EAP","CPT� 88341","","*stain: Cytokeratin 6","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200515","EAP","CPT� 88341","","*stain: E-cadherin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200516","EAP","CPT� 88341","","*stain: Egfr","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200517","EAP","CPT� 88341","","*stain: Galectin-3","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200518","EAP","CPT� 88341","","*stain: Gcdfp-15","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200519","EAP","CPT� 88341","","*stain: Hbme-1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200520","EAP","CPT� 88341","","*stain: Helicobacter Pylori","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200521","EAP","CPT� 88341","","*stain: Hhv-8 (human Herpes-8)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200522","EAP","CPT� 88341","","*stain: Cd79","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200523","EAP","CPT� 88341","","*stain: Cytokeratin 7","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200524","EAP","CPT� 88341","","*stain: Hepatocyte","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200525","EAP","CPT� 88341","","*stain: Hi Mol Wt Keratin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200526","EAP","CPT� 88341","","*stain: Inhibin Alpha","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200527","EAP","CPT� 88341","","*stain: Myeloperoxidase","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200528","EAP","CPT� 88341","","*stain: P16","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200529","EAP","CPT� 88341","","*stain: P53","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200530","EAP","CPT� 88341","","*stain: Tdt","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200531","EAP","CPT� 88341","","*stain: Ttf-1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200532","EAP","CPT� 88341","","*stain: Villin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200533","EAP","CPT� 88341","","Immunoperoxidase","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200534","EAP","CPT� 88341","","Glial Fibrillary Ap","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200535","EAP","CPT� 88341","","Glucagon","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200536","EAP","CPT� 88341","","Hepatitis B Core","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200537","EAP","CPT� 88341","","Hepatitis B Surface","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200538","EAP","CPT� 88341","","Herpes Simplex Prob","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200539","EAP","CPT� 88341","","Human Chorionic Gon","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200540","EAP","CPT� 88341","","Human Growth Hormon","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200541","EAP","CPT� 88341","","Insulin","BOTH IP/OP","$766.00 ","$566.84 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200542","EAP","CPT� 88341","","Kappa","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200543","EAP","CPT� 88341","","L-26 B Cell Marker","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200544","EAP","CPT� 88341","","Lambda","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200545","EAP","CPT� 88341","","Leu M1","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200546","EAP","CPT� 88341","","Leukocyte Common Ag","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200547","EAP","CPT� 88341","","Leuteinizing Hormon","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200548","EAP","CPT� 88341","","Macrophage-ham-56","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200549","EAP","CPT� 88341","","Melanoma-hmb-45","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200550","EAP","CPT� 88341","","Neuron Spec Enolase","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200551","EAP","CPT� 88341","","Placental Alk Phos","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200552","EAP","CPT� 88341","","A-1 Antitrypsin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200553","EAP","CPT� 88341","","Actin,muscle Spec.","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200554","EAP","CPT� 88341","","Alpha-fetoprotein","BOTH IP/OP","$586.00 ","$433.64 ","$0.00 ","$586.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$586.00 ","$0.00 ","$293.00 ","$464.11 ","$468.80 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200555","EAP","CPT� 88341","","B72.3-breast","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200556","EAP","CPT� 88341","","Ca 125-ovarian Ca","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200557","EAP","CPT� 88341","","Ca-19-9-carbohydrat","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200558","EAP","CPT� 88341","","Calcitonin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200559","EAP","CPT� 88341","","Cea-p","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200560","EAP","CPT� 88341","","Chromogranin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200561","EAP","CPT� 88341","","Cytokeratin-ae1/ae3","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200562","EAP","CPT� 88341","","Cytokeratin-cam5.2","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200563","EAP","CPT� 88341","","Cytomegalovirus","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200564","EAP","CPT� 88341","","Desmin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200565","EAP","CPT� 88341","","Ema","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200566","EAP","CPT� 88341","","Factor Viii","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200567","EAP","CPT� 88341","","*stain:oncoprotein (bcl2)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200568","EAP","CPT� 88341","","*stain: Cd30/ber H2 (ki-1)","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200569","EAP","CPT� 88341","","*stain: B-1 Glyco","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200570","EAP","CPT� 88341","","*stain: Calponin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200571","EAP","CPT� 88341","","*stain: Calretinin","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200572","EAP","CPT� 88341","","*stain: A-1 Antichymotryps","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200573","EAP","CPT� 88341","","*stain: Cytokeratin 20","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200574","EAP","CPT� 88341","","*stain: Cd10","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200575","EAP","CPT� 88341","","*stain: Cd138","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200576","EAP","CPT� 88341","","*stain: Cd23","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200577","EAP","CPT� 88341","","*stain: Cd3","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200578","EAP","CPT� 88341","","*stain: Cd31","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200579","EAP","CPT� 88341","","*stain: Cd34","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200580","EAP","CPT� 88341","","*stain: Cd43","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200581","EAP","CPT� 88341","","*stain: Cd5","BOTH IP/OP","$773.00 ","$572.02 ","$0.00 ","$773.00 ","$138.92 ","$0.00 ","$42.49 ","$67.79 ","$67.79 ","$67.41 ","$773.00 ","$0.00 ","$386.50 ","$612.22 ","$618.40 ","$0.00 ","$71.83 ","$64.47 ","$50.28 ","$0.00 "
"31200582","EAP","CPT� 88342","","Stain:cd45(lca)","BOTH IP/OP","$549.00 ","$406.26 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200583","EAP","CPT� 88342","","Stain:cd15","BOTH IP/OP","$369.00 ","$273.06 ","$48.82 ","$369.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$369.00 ","$143.92 ","$106.46 ","$292.25 ","$295.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31200584","EAP","CPT� 88360","","Er/pr Paraffin (so)","BOTH IP/OP","$526.00 ","$389.24 ","$58.38 ","$523.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$523.00 ","$143.92 ","$121.34 ","$414.22 ","$418.40 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200585","EAP","CPT� 88360","","Her2 Ihc W/interpret (so)","BOTH IP/OP","$430.00 ","$318.20 ","$58.38 ","$427.00 ","$214.05 ","$146.06 ","$58.38 ","$65.70 ","$65.70 ","$114.71 ","$427.00 ","$143.92 ","$121.34 ","$338.18 ","$341.60 ","$199.96 ","$122.23 ","$83.20 ","$85.56 ","$137.07 "
"31200586","EAP","CPT� 88309","","Surg Path Fetus And Placenta","BOTH IP/OP","$1,062.00 ","$785.88 ","$164.53 ","$1,051.00 ","$623.22 ","$641.78 ","$186.99 ","$178.45 ","$178.45 ","$220.59 ","$1,051.00 ","$630.05 ","$328.48 ","$832.39 ","$840.80 ","$875.37 ","$235.05 ","$274.45 ","$164.53 ","$600.04 "
"31200600","EAP","CPT� 88342","","Ihc Stain - First","BOTH IP/OP","$544.00 ","$402.56 ","$48.82 ","$549.00 ","$163.26 ","$146.06 ","$48.82 ","$57.65 ","$57.65 ","$84.08 ","$549.00 ","$143.92 ","$106.46 ","$434.81 ","$439.20 ","$199.96 ","$89.59 ","$70.23 ","$62.72 ","$137.07 "
"31900001","EAP","CPT� 88348","","Em Processing Only","BOTH IP/OP","$3,624.00 ","$2,681.76 ","$0.00 ","$3,841.00 ","$0.00 ","$0.00 ","$0.00 ","$550.68 ","$550.68 ","$0.00 ","$3,841.00 ","$0.00 ","$906.38 ","$3,042.07 ","$3,072.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31900002","EAP","CPT� 88348","","Em: Non Kidney","BOTH IP/OP","$3,624.00 ","$2,681.76 ","$0.00 ","$3,841.00 ","$0.00 ","$0.00 ","$0.00 ","$550.68 ","$550.68 ","$0.00 ","$3,841.00 ","$0.00 ","$906.38 ","$3,042.07 ","$3,072.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31900003","EAP","CPT� 88348","","Em:kidney","BOTH IP/OP","$3,624.00 ","$2,681.76 ","$0.00 ","$3,841.00 ","$0.00 ","$0.00 ","$0.00 ","$550.68 ","$550.68 ","$0.00 ","$3,841.00 ","$0.00 ","$906.38 ","$3,042.07 ","$3,072.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31900004","EAP","CPT� 81229","","Chromosomal Microarray  Postnatal (so)","BOTH IP/OP","$1,401.00 ","$1,036.74 ","$0.00 ","$2,903.98 ","$807.84 ","$580.00 ","$0.00 ","$987.76 ","$987.76 ","$2,725.40 ","$1,384.00 ","$1,218.00 ","$692.00 ","$1,096.13 ","$1,107.20 ","$1,384.00 ","$2,903.98 ","$1,160.00 ","$2,032.79 ","$1,160.00 "
"31900005","EAP","CPT� 81263","","Cll-igvh Mutation Status  (so)","BOTH IP/OP","$1,310.00 ","$969.40 ","$86.22 ","$1,294.00 ","$607.94 ","$147.26 ","$147.26 ","$401.79 ","$401.79 ","$115.59 ","$1,294.00 ","$309.25 ","$647.00 ","$1,024.85 ","$1,035.20 ","$427.05 ","$123.17 ","$294.52 ","$86.22 ","$294.52 "
"31900007","EAP","CPT� 81301","","Microsatelite Instability (msi) (so)","BOTH IP/OP","$1,565.00 ","$1,158.10 ","$0.00 ","$1,546.00 ","$597.70 ","$174.28 ","$0.00 ","$395.04 ","$395.04 ","$0.00 ","$1,546.00 ","$0.00 ","$773.00 ","$1,224.43 ","$1,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31900009","EAP","CPT� 81206","","P210 Bcr-abl1 (so)","BOTH IP/OP","$630.00 ","$466.20 ","$81.98 ","$622.00 ","$338.45 ","$81.98 ","$81.98 ","$223.69 ","$223.69 ","$115.59 ","$622.00 ","$172.16 ","$311.00 ","$492.62 ","$497.60 ","$237.74 ","$123.17 ","$163.96 ","$86.22 ","$163.96 "
"31900011","EAP","CPT� 81235","","Egfr Mutation Analysis  (so)","BOTH IP/OP","$1,354.00 ","$1,001.96 ","$0.00 ","$1,338.00 ","$0.00 ","$0.00 ","$146.06 ","$330.01 ","$330.01 ","$115.59 ","$1,338.00 ","$340.81 ","$669.00 ","$1,059.70 ","$1,070.40 ","$470.64 ","$123.17 ","$324.58 ","$86.22 ","$324.58 "
"31900013","EAP","Custom 31900013","","Bcr-abl1 Gene Rear Quant Pcr (so)","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$443.92 ","$443.92 ","$0.00 ","$622.00 ","$0.00 ","$311.00 ","$492.62 ","$497.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31900014","EAP","CPT� 81207","","P190 Bcr-abl1 (so)","BOTH IP/OP","$556.00 ","$411.44 ","$72.42 ","$549.00 ","$298.98 ","$72.42 ","$72.42 ","$197.59 ","$197.59 ","$115.59 ","$549.00 ","$152.08 ","$274.50 ","$434.81 ","$439.20 ","$210.02 ","$123.17 ","$144.84 ","$86.22 ","$144.84 "
"31900015","EAP","CPT� 88271","","Fish Dna Probe, Each (so)","BOTH IP/OP","$555.00 ","$410.70 ","$10.71 ","$555.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$555.00 ","$22.49 ","$59.86 ","$439.56 ","$444.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900016","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$555.00 ","$410.70 ","$23.04 ","$555.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$555.00 ","$53.75 ","$112.22 ","$439.56 ","$444.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900017","EAP","CPT� 88271","","Fish Dna Probe, Each (so)","BOTH IP/OP","$555.00 ","$410.70 ","$10.71 ","$555.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$555.00 ","$22.49 ","$59.86 ","$439.56 ","$444.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900018","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$555.00 ","$410.70 ","$23.04 ","$555.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$555.00 ","$53.75 ","$112.22 ","$439.56 ","$444.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900019","EAP","CPT� 88271","","Fish Dna Probe, Each (so)","BOTH IP/OP","$411.00 ","$304.14 ","$10.71 ","$411.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$411.00 ","$22.49 ","$59.86 ","$325.51 ","$328.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900020","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$411.00 ","$304.14 ","$23.04 ","$411.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$411.00 ","$53.75 ","$112.22 ","$325.51 ","$328.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900021","EAP","CPT� 88271","","Fish Dna Probe, Each (so)","BOTH IP/OP","$411.00 ","$304.14 ","$10.71 ","$411.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$411.00 ","$22.49 ","$59.86 ","$325.51 ","$328.80 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900022","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$411.00 ","$304.14 ","$23.04 ","$411.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$411.00 ","$53.75 ","$112.22 ","$325.51 ","$328.80 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900023","EAP","CPT� 88271","","Fish Dna Probe, Each (so)","BOTH IP/OP","$1,105.00 ","$817.70 ","$10.71 ","$1,098.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$1,098.00 ","$22.49 ","$59.86 ","$869.62 ","$878.40 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900024","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$1,105.00 ","$817.70 ","$23.04 ","$1,098.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$1,098.00 ","$53.75 ","$112.22 ","$869.62 ","$878.40 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900025","EAP","CPT� 88271","","Fish, Dna Probe Each (so)","BOTH IP/OP","$555.00 ","$410.70 ","$10.71 ","$555.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$555.00 ","$22.49 ","$59.86 ","$439.56 ","$444.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900026","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$555.00 ","$410.70 ","$23.04 ","$555.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$555.00 ","$53.75 ","$112.22 ","$439.56 ","$444.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900027","EAP","CPT� 88271","","Fish, Dna Probe Each (so)","BOTH IP/OP","$690.00 ","$510.60 ","$10.71 ","$690.00 ","$44.22 ","$10.71 ","$10.71 ","$31.27 ","$31.27 ","$31.65 ","$690.00 ","$22.49 ","$59.86 ","$546.48 ","$552.00 ","$31.06 ","$33.72 ","$21.42 ","$23.60 ","$21.42 "
"31900028","EAP","CPT� 88275","","Interphase In Situ Hybridization (so)","BOTH IP/OP","$690.00 ","$510.60 ","$23.04 ","$690.00 ","$82.90 ","$25.60 ","$23.04 ","$58.64 ","$58.64 ","$59.33 ","$690.00 ","$53.75 ","$112.22 ","$546.48 ","$552.00 ","$74.23 ","$63.21 ","$51.19 ","$44.25 ","$51.19 "
"31900030","EAP","CPT� 81404","","Pancreatitis Press (so)","BOTH IP/OP","$1,757.00 ","$1,300.18 ","$123.67 ","$1,736.00 ","$462.00 ","$137.42 ","$123.67 ","$1,238.98 ","$1,238.98 ","$286.64 ","$1,736.00 ","$288.57 ","$868.00 ","$1,374.91 ","$1,388.80 ","$398.50 ","$305.42 ","$274.83 ","$213.79 ","$274.83 "
"31900031","EAP","CPT� 81404","","Pancreatitis Spink-1 (so)","BOTH IP/OP","$1,757.00 ","$1,300.18 ","$123.67 ","$1,736.00 ","$462.00 ","$137.42 ","$123.67 ","$1,238.98 ","$1,238.98 ","$286.64 ","$1,736.00 ","$288.57 ","$868.00 ","$1,374.91 ","$1,388.80 ","$398.50 ","$305.42 ","$274.83 ","$213.79 ","$274.83 "
"31900032","EAP","CPT� 81479","","Pancreatitis Ctrc (so)","BOTH IP/OP","$906.00 ","$670.44 ","$0.00 ","$1,114.12 ","$0.00 ","$161.27 ","$188.83 ","$638.76 ","$638.76 ","$1,045.61 ","$895.00 ","$0.00 ","$447.50 ","$708.84 ","$716.00 ","$537.00 ","$1,114.12 ","$0.00 ","$779.89 ","$0.00 "
"32000001","EAP","CPT� 77085","","Dual-energy X-ray Absorptiometry(dxa),bone Density Study","BOTH IP/OP","$668.00 ","$494.32 ","$0.00 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$98.56 ","$98.56 ","$0.00 ","$668.00 ","$0.00 ","$160.32 ","$529.06 ","$534.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000003","EAP","CPT� 70015","","Cisternography","BOTH IP/OP","$1,032.00 ","$763.68 ","$0.00 ","$1,032.00 ","$0.00 ","$0.00 ","$0.00 ","$192.50 ","$192.50 ","$0.00 ","$1,032.00 ","$0.00 ","$247.68 ","$817.34 ","$825.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000005","EAP","CPT� 70100","","MANDIBLE 1-3 VIEW RDG","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$262.00 ","$0.00 ","$0.00 ","$53.98 ","$50.30 ","$50.30 ","$0.00 ","$262.00 ","$0.00 ","$62.88 ","$207.50 ","$209.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000007","EAP","CPT� 70110","","MANDIBLE COMPL 4+ VIEW RDG","BOTH IP/OP","$303.00 ","$224.22 ","$0.00 ","$306.00 ","$86.25 ","$106.62 ","$0.00 ","$63.09 ","$63.09 ","$53.58 ","$306.00 ","$112.41 ","$73.44 ","$242.35 ","$244.80 ","$156.18 ","$36.22 ","$29.89 ","$48.72 ","$107.06 "
"32000013","EAP","CPT� 70160","","NASAL BONES COMPL 3+VIEW RDG","BOTH IP/OP","$455.00 ","$336.70 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$94.83 ","$54.67 ","$54.67 ","$0.00 ","$460.00 ","$0.00 ","$110.40 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000020","EAP","CPT� 70250","","SKULL 1-3VIEW W/WO STEREO RDG","BOTH IP/OP","$799.00 ","$591.26 ","$25.57 ","$807.00 ","$82.24 ","$106.62 ","$166.53 ","$56.99 ","$56.99 ","$141.30 ","$807.00 ","$112.41 ","$193.68 ","$639.14 ","$645.60 ","$156.18 ","$35.86 ","$25.57 ","$128.47 ","$107.06 "
"32000022","EAP","CPT� 70300","","Periapical X-ray","BOTH IP/OP","$307.00 ","$227.18 ","$0.00 ","$371.00 ","$0.00 ","$0.00 ","$0.00 ","$20.64 ","$20.64 ","$0.00 ","$371.00 ","$0.00 ","$89.04 ","$293.83 ","$296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000023","EAP","CPT� 70320","","X-ray Complete","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$85.62 ","$85.62 ","$0.00 ","$520.00 ","$0.00 ","$124.80 ","$411.84 ","$416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000024","EAP","CPT� 70355","","X-ray Panorex","BOTH IP/OP","$572.00 ","$423.28 ","$8.64 ","$520.00 ","$47.57 ","$79.21 ","$119.22 ","$29.94 ","$29.94 ","$91.05 ","$520.00 ","$80.04 ","$124.80 ","$411.84 ","$416.00 ","$111.21 ","$31.96 ","$8.64 ","$82.78 ","$76.23 "
"32000026","EAP","CPT� 70328","","TMJ UNILAT OPEN & CLOSED RDG","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$48.57 ","$48.57 ","$0.00 ","$252.00 ","$0.00 ","$60.48 ","$199.58 ","$201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000028","EAP","CPT� 70330","","TMJ BILAT OPEN & CLOSED RDG","BOTH IP/OP","$660.00 ","$488.40 ","$0.00 ","$667.00 ","$109.64 ","$79.21 ","$137.56 ","$82.14 ","$82.14 ","$0.00 ","$667.00 ","$0.00 ","$160.08 ","$528.26 ","$533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000031","EAP","CPT� 70360","","NECK SOFT TISSUE RDG","BOTH IP/OP","$746.00 ","$552.04 ","$21.61 ","$681.00 ","$63.70 ","$79.21 ","$155.49 ","$43.33 ","$43.33 ","$119.24 ","$681.00 ","$80.04 ","$163.44 ","$539.35 ","$544.80 ","$111.21 ","$24.86 ","$21.61 ","$108.42 ","$76.23 "
"32000033","EAP","CPT� 70370","","Pharyn/larynx Fluo &/magn Rdg","BOTH IP/OP","$1,216.00 ","$899.84 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$137.70 ","$137.70 ","$0.00 ","$1,360.00 ","$0.00 ","$326.40 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000035","EAP","CPT� 70390","","SIALOGRAPHY S&I RDG","BOTH IP/OP","$2,072.00 ","$1,533.28 ","$0.00 ","$2,317.00 ","$0.00 ","$0.00 ","$0.00 ","$189.43 ","$189.43 ","$0.00 ","$2,317.00 ","$0.00 ","$556.08 ","$1,835.06 ","$1,853.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000051","EAP","CPT� 71046","","Employee Health 2 View Chest","BOTH IP/OP","$653.00 ","$483.22 ","$21.97 ","$665.00 ","$69.46 ","$79.21 ","$136.10 ","$47.17 ","$47.17 ","$116.44 ","$665.00 ","$80.04 ","$159.60 ","$526.68 ","$532.00 ","$111.21 ","$29.30 ","$21.97 ","$105.87 ","$76.23 "
"32000058","EAP","CPT� 71110","","RIBS BILAT X-RAY 3VIEW RDG","BOTH IP/OP","$750.00 ","$555.00 ","$28.45 ","$724.00 ","$85.46 ","$106.62 ","$156.32 ","$64.69 ","$64.69 ","$126.77 ","$724.00 ","$112.41 ","$173.76 ","$573.41 ","$579.20 ","$156.18 ","$43.70 ","$28.45 ","$115.26 ","$107.06 "
"32000060","EAP","CPT� 71111","","RIBS BILAT X-RAY 4+VIEW RDG","BOTH IP/OP","$1,290.00 ","$954.60 ","$35.30 ","$1,246.00 ","$109.64 ","$106.62 ","$268.87 ","$85.48 ","$85.48 ","$218.16 ","$1,246.00 ","$112.41 ","$299.04 ","$986.83 ","$996.80 ","$156.18 ","$50.44 ","$35.30 ","$198.36 ","$107.06 "
"32000062","EAP","CPT� 71120","","STERNUM X-RAY 2+VIEW RDG","BOTH IP/OP","$508.00 ","$375.92 ","$22.69 ","$513.00 ","$66.92 ","$79.21 ","$105.88 ","$53.49 ","$53.49 ","$89.82 ","$513.00 ","$80.04 ","$123.12 ","$406.30 ","$410.40 ","$111.21 ","$34.82 ","$22.69 ","$81.67 ","$76.23 "
"32000064","EAP","CPT� 71130","","STERNOCLAVICU JNTS 3+VIEW RDG","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$62.22 ","$62.22 ","$0.00 ","$375.00 ","$0.00 ","$90.00 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000065","EAP","CPT� 73020","","SHOULDER 1 VIEW RDG","BOTH IP/OP","$1,417.00 ","$1,048.58 ","$13.69 ","$1,295.00 ","$52.40 ","$79.21 ","$295.34 ","$37.22 ","$37.22 ","$226.74 ","$1,295.00 ","$80.04 ","$310.80 ","$1,025.64 ","$1,036.00 ","$111.21 ","$25.94 ","$13.69 ","$206.16 ","$76.23 "
"32000071","EAP","CPT� 72020","","CERVICAL SPINE 1 VIEW RDG","BOTH IP/OP","$1,075.00 ","$795.50 ","$16.21 ","$992.00 ","$50.00 ","$79.21 ","$224.06 ","$37.22 ","$37.22 ","$173.69 ","$992.00 ","$80.04 ","$238.08 ","$785.66 ","$793.60 ","$111.21 ","$23.80 ","$16.21 ","$157.93 ","$76.23 "
"32000073","EAP","CPT� 72020","","LUMBAR SPINE 1 VIEW RDG","BOTH IP/OP","$1,075.00 ","$795.50 ","$16.21 ","$992.00 ","$50.00 ","$79.21 ","$224.06 ","$37.22 ","$37.22 ","$173.69 ","$992.00 ","$80.04 ","$238.08 ","$785.66 ","$793.60 ","$111.21 ","$23.80 ","$16.21 ","$157.93 ","$76.23 "
"32000075","EAP","CPT� 72020","","THORACIC SPINE 1 VIEW RDG","BOTH IP/OP","$1,075.00 ","$795.50 ","$16.21 ","$992.00 ","$50.00 ","$79.21 ","$224.06 ","$37.22 ","$37.22 ","$173.69 ","$992.00 ","$80.04 ","$238.08 ","$785.66 ","$793.60 ","$111.21 ","$23.80 ","$16.21 ","$157.93 ","$76.23 "
"32000078","EAP","CPT� 72040","","Rad Exam Spine 2 Or 3 Views","BOTH IP/OP","$1,040.00 ","$769.60 ","$27.01 ","$960.00 ","$74.98 ","$79.21 ","$216.76 ","$60.47 ","$60.47 ","$168.09 ","$960.00 ","$80.04 ","$230.40 ","$760.32 ","$768.00 ","$111.21 ","$34.09 ","$27.01 ","$152.83 ","$76.23 "
"32000080","EAP","CPT� 72050","","CERVICAL SPINE 4+VIEW RDG","BOTH IP/OP","$1,826.00 ","$1,351.24 ","$37.10 ","$1,685.00 ","$103.20 ","$106.62 ","$380.58 ","$86.36 ","$86.36 ","$295.03 ","$1,685.00 ","$112.41 ","$404.40 ","$1,334.52 ","$1,348.00 ","$156.18 ","$49.72 ","$37.10 ","$268.25 ","$107.06 "
"32000081","EAP","CPT� 72052","","CERVICAL SPINE COMPLETE W/ FLEX/EXT RDG","BOTH IP/OP","$1,837.00 ","$1,359.38 ","$44.66 ","$1,696.00 ","$127.38 ","$106.62 ","$382.88 ","$110.79 ","$110.79 ","$296.96 ","$1,696.00 ","$112.41 ","$407.04 ","$1,343.23 ","$1,356.80 ","$156.18 ","$61.14 ","$44.66 ","$270.00 ","$107.06 "
"32000084","EAP","CPT� 72070","","THORACIC SPINE 2 VIEW RDG","BOTH IP/OP","$1,158.00 ","$856.92 ","$21.61 ","$1,060.00 ","$77.40 ","$106.62 ","$241.36 ","$53.49 ","$53.49 ","$185.60 ","$1,060.00 ","$112.41 ","$254.40 ","$839.52 ","$848.00 ","$156.18 ","$35.88 ","$21.61 ","$168.75 ","$107.06 "
"32000088","EAP","CPT� 72080","","THORACOLUMBAR 2VIEW RDG","BOTH IP/OP","$1,173.00 ","$868.02 ","$23.41 ","$1,073.00 ","$69.33 ","$79.21 ","$244.48 ","$56.99 ","$56.99 ","$187.87 ","$1,073.00 ","$80.04 ","$257.52 ","$849.82 ","$858.40 ","$111.21 ","$36.61 ","$23.41 ","$170.82 ","$76.23 "
"32000092","EAP","CPT� 72100","","LUMBOSACRAL SPINE 2-3VIEW RDG","BOTH IP/OP","$1,018.00 ","$753.32 ","$27.01 ","$989.00 ","$79.81 ","$106.62 ","$212.18 ","$64.85 ","$64.85 ","$173.17 ","$989.00 ","$112.41 ","$237.36 ","$783.29 ","$791.20 ","$156.18 ","$36.61 ","$27.01 ","$157.45 ","$107.06 "
"32000095","EAP","CPT� 72110","","LUMBOSACRAL SPINE 4+VIEW RDG","BOTH IP/OP","$1,784.00 ","$1,320.16 ","$35.66 ","$1,733.00 ","$111.25 ","$106.62 ","$371.83 ","$90.72 ","$90.72 ","$303.43 ","$1,733.00 ","$112.41 ","$415.92 ","$1,372.54 ","$1,386.40 ","$156.18 ","$50.44 ","$35.66 ","$275.89 ","$107.06 "
"32000097","EAP","CPT� 72114","","Lumbosac Com + Bending 6 Views","BOTH IP/OP","$1,524.00 ","$1,127.76 ","$44.66 ","$1,480.00 ","$141.08 ","$106.62 ","$317.64 ","$123.00 ","$123.00 ","$259.14 ","$1,480.00 ","$112.41 ","$355.20 ","$1,172.16 ","$1,184.00 ","$156.18 ","$63.63 ","$44.66 ","$235.62 ","$107.06 "
"32000099","EAP","CPT� 72120","","Lumbosac Bending 2 Or 3 Views","BOTH IP/OP","$763.00 ","$564.62 ","$0.00 ","$852.00 ","$0.00 ","$0.00 ","$0.00 ","$88.10 ","$88.10 ","$0.00 ","$852.00 ","$0.00 ","$204.48 ","$674.78 ","$681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000109","EAP","CPT� 72170","","PELVIS X-RAY 1-2 VIEW RDG","BOTH IP/OP","$796.00 ","$589.04 ","$19.81 ","$724.00 ","$72.57 ","$106.62 ","$165.91 ","$40.71 ","$40.71 ","$126.77 ","$724.00 ","$112.41 ","$173.76 ","$573.41 ","$579.20 ","$156.18 ","$28.43 ","$19.81 ","$115.26 ","$107.06 "
"32000111","EAP","CPT� 72190","","PELVIS X-RAY COMPL 3+VIEW RDG","BOTH IP/OP","$805.00 ","$595.70 ","$28.09 ","$732.00 ","$86.28 ","$106.62 ","$167.78 ","$67.46 ","$67.46 ","$128.17 ","$732.00 ","$112.41 ","$175.68 ","$579.74 ","$585.60 ","$156.18 ","$36.26 ","$28.09 ","$116.53 ","$107.06 "
"32000117","EAP","CPT� 72200","","Sacroiliac Jnt 1-2 View Rdg","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$47.70 ","$47.70 ","$0.00 ","$375.00 ","$0.00 ","$90.00 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000119","EAP","CPT� 72202","","SACROILIAC JNT 3+VIEW RDG","BOTH IP/OP","$317.00 ","$234.58 ","$26.65 ","$320.00 ","$74.98 ","$106.62 ","$66.07 ","$59.59 ","$59.59 ","$56.03 ","$320.00 ","$112.41 ","$76.80 ","$253.44 ","$256.00 ","$156.18 ","$33.41 ","$26.65 ","$50.94 ","$107.06 "
"32000122","EAP","CPT� 72220","","SACRUM&COCCYX 2+VIEW RDG","BOTH IP/OP","$655.00 ","$484.70 ","$22.69 ","$610.00 ","$63.70 ","$79.21 ","$136.52 ","$49.14 ","$49.14 ","$106.81 ","$610.00 ","$80.04 ","$146.40 ","$483.12 ","$488.00 ","$111.21 ","$30.55 ","$22.69 ","$97.11 ","$76.23 "
"32000123","EAP","CPT� 72240","","MYELOGRAPHY CERVICAL S&I RDG","BOTH IP/OP","$1,372.00 ","$1,015.28 ","$0.00 ","$1,386.00 ","$0.00 ","$0.00 ","$0.00 ","$267.58 ","$267.58 ","$0.00 ","$1,386.00 ","$0.00 ","$332.64 ","$1,097.71 ","$1,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000124","EAP","CPT� 72255","","MYELOGRAPHY THORACIC S&I RDG","BOTH IP/OP","$1,317.00 ","$974.58 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$237.50 ","$0.00 ","$1,330.00 ","$0.00 ","$319.20 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000125","EAP","CPT� 72265","","MYELOGRAPHY LUMBAR S&I RDG","BOTH IP/OP","$1,372.00 ","$1,015.28 ","$0.00 ","$1,386.00 ","$210.41 ","$700.64 ","$0.00 ","$250.57 ","$250.57 ","$0.00 ","$1,386.00 ","$0.00 ","$332.64 ","$1,097.71 ","$1,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000126","EAP","CPT� 72270","","MYELOGRAPHY COMPLETE S&I RDG","BOTH IP/OP","$1,265.00 ","$936.10 ","$0.00 ","$1,278.00 ","$0.00 ","$0.00 ","$0.00 ","$385.91 ","$385.91 ","$223.77 ","$1,278.00 ","$693.78 ","$306.72 ","$1,012.18 ","$1,022.40 ","$963.92 ","$298.54 ","$75.28 ","$203.46 ","$660.75 "
"32000127","EAP","CPT� 72285","","Diskography Cervicl/thorac Spn","BOTH IP/OP","$3,367.00 ","$2,491.58 ","$0.00 ","$3,367.00 ","$0.00 ","$0.00 ","$0.00 ","$289.24 ","$289.24 ","$0.00 ","$3,367.00 ","$0.00 ","$808.08 ","$2,666.66 ","$2,693.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000128","EAP","CPT� 72295","","Diskography Lumbar Spn","BOTH IP/OP","$3,838.00 ","$2,840.12 ","$0.00 ","$3,838.00 ","$0.00 ","$0.00 ","$0.00 ","$279.24 ","$279.24 ","$0.00 ","$3,838.00 ","$0.00 ","$921.12 ","$3,039.70 ","$3,070.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000129","EAP","CPT� 73000","","Clavicle Complete Rdg","BOTH IP/OP","$754.00 ","$557.96 ","$23.05 ","$840.00 ","$62.88 ","$79.21 ","$157.15 ","$45.08 ","$45.08 ","$147.08 ","$840.00 ","$80.04 ","$201.60 ","$665.28 ","$672.00 ","$111.21 ","$27.72 ","$23.05 ","$133.73 ","$76.23 "
"32000131","EAP","CPT� 73000","","CLAVICLE COMPLETE LT RDG","BOTH IP/OP","$922.00 ","$682.28 ","$23.05 ","$840.00 ","$62.88 ","$79.21 ","$192.17 ","$45.08 ","$45.08 ","$147.08 ","$840.00 ","$80.04 ","$201.60 ","$665.28 ","$672.00 ","$111.21 ","$27.72 ","$23.05 ","$133.73 ","$76.23 "
"32000133","EAP","CPT� 73000","","CLAVICLE COMPLETE RT RDG","BOTH IP/OP","$922.00 ","$682.28 ","$23.05 ","$840.00 ","$62.88 ","$79.21 ","$192.17 ","$45.08 ","$45.08 ","$147.08 ","$840.00 ","$80.04 ","$201.60 ","$665.28 ","$672.00 ","$111.21 ","$27.72 ","$23.05 ","$133.73 ","$76.23 "
"32000135","EAP","CPT� 73000","","CLAVICLES COMPLETE BILAT RDG","BOTH IP/OP","$1,513.00 ","$1,119.62 ","$23.05 ","$1,686.00 ","$62.88 ","$79.21 ","$315.35 ","$45.08 ","$45.08 ","$295.21 ","$1,686.00 ","$80.04 ","$404.64 ","$1,335.31 ","$1,348.80 ","$111.21 ","$27.72 ","$23.05 ","$268.41 ","$76.23 "
"32000137","EAP","CPT� 73010","","Scapula Complete Rdg","BOTH IP/OP","$648.00 ","$479.52 ","$18.73 ","$650.00 ","$68.53 ","$106.62 ","$135.06 ","$45.95 ","$45.95 ","$113.81 ","$650.00 ","$112.41 ","$156.00 ","$514.80 ","$520.00 ","$156.18 ","$28.43 ","$18.73 ","$103.48 ","$107.06 "
"32000139","EAP","CPT� 73010","","SCAPULA COMPLETE LT RDG","BOTH IP/OP","$711.00 ","$526.14 ","$18.73 ","$650.00 ","$68.53 ","$106.62 ","$148.19 ","$45.95 ","$45.95 ","$113.81 ","$650.00 ","$112.41 ","$156.00 ","$514.80 ","$520.00 ","$156.18 ","$28.43 ","$18.73 ","$103.48 ","$107.06 "
"32000141","EAP","CPT� 73010","","SCAPULA COMPLETE RT RDG","BOTH IP/OP","$711.00 ","$526.14 ","$18.73 ","$650.00 ","$68.53 ","$106.62 ","$148.19 ","$45.95 ","$45.95 ","$113.81 ","$650.00 ","$112.41 ","$156.00 ","$514.80 ","$520.00 ","$156.18 ","$28.43 ","$18.73 ","$103.48 ","$107.06 "
"32000143","EAP","CPT� 73010","","SCAPULAS COMPLETE BILAT RDG","BOTH IP/OP","$1,291.00 ","$955.34 ","$18.73 ","$1,295.00 ","$68.53 ","$106.62 ","$269.08 ","$45.95 ","$45.95 ","$226.74 ","$1,295.00 ","$112.41 ","$310.80 ","$1,025.64 ","$1,036.00 ","$156.18 ","$28.43 ","$18.73 ","$206.16 ","$107.06 "
"32000153","EAP","CPT� 73030","","Shoulder 2+views Rdg","BOTH IP/OP","$1,291.00 ","$955.34 ","$23.77 ","$1,295.00 ","$66.11 ","$79.21 ","$269.08 ","$48.26 ","$48.26 ","$226.74 ","$1,295.00 ","$80.04 ","$310.80 ","$1,025.64 ","$1,036.00 ","$111.21 ","$30.90 ","$23.77 ","$206.16 ","$76.23 "
"32000154","EAP","CPT� 73030","","Shoulder Compl 2+view Exr","BOTH IP/OP","$1,291.00 ","$955.34 ","$23.77 ","$1,295.00 ","$66.11 ","$79.21 ","$269.08 ","$48.26 ","$48.26 ","$226.74 ","$1,295.00 ","$80.04 ","$310.80 ","$1,025.64 ","$1,036.00 ","$111.21 ","$30.90 ","$23.77 ","$206.16 ","$76.23 "
"32000156","EAP","CPT� 73030","","SHOULDER COMPL 2+VIEWS LT RDG","BOTH IP/OP","$1,417.00 ","$1,048.58 ","$23.77 ","$1,295.00 ","$66.11 ","$79.21 ","$295.34 ","$48.26 ","$48.26 ","$226.74 ","$1,295.00 ","$80.04 ","$310.80 ","$1,025.64 ","$1,036.00 ","$111.21 ","$30.90 ","$23.77 ","$206.16 ","$76.23 "
"32000158","EAP","CPT� 73030","","SHOULDER COMPL 2+VIEWS RT RDG","BOTH IP/OP","$1,417.00 ","$1,048.58 ","$23.77 ","$1,295.00 ","$66.11 ","$79.21 ","$295.34 ","$48.26 ","$48.26 ","$226.74 ","$1,295.00 ","$80.04 ","$310.80 ","$1,025.64 ","$1,036.00 ","$111.21 ","$30.90 ","$23.77 ","$206.16 ","$76.23 "
"32000161","EAP","CPT� 73030","","SHOULDERS 2+VIEW ECH BILAT RDG","BOTH IP/OP","$1,430.00 ","$1,058.20 ","$23.77 ","$1,307.00 ","$66.11 ","$79.21 ","$298.05 ","$48.26 ","$48.26 ","$228.85 ","$1,307.00 ","$80.04 ","$313.68 ","$1,035.14 ","$1,045.60 ","$111.21 ","$30.90 ","$23.77 ","$208.07 ","$76.23 "
"32000163","EAP","CPT� 73040","","SHOULDER ARTHROGRAPHY RT RDG","BOTH IP/OP","$1,335.00 ","$987.90 ","$94.00 ","$1,220.00 ","$227.33 ","$360.63 ","$278.25 ","$187.52 ","$187.52 ","$213.61 ","$1,220.00 ","$387.01 ","$292.80 ","$966.24 ","$976.00 ","$537.70 ","$107.06 ","$94.00 ","$194.22 ","$368.58 "
"32000164","EAP","CPT� 73040","","SHOULDER ARTHROGRAPHY LT RDG","BOTH IP/OP","$1,335.00 ","$987.90 ","$94.00 ","$1,220.00 ","$227.33 ","$360.63 ","$278.25 ","$187.52 ","$187.52 ","$213.61 ","$1,220.00 ","$387.01 ","$292.80 ","$966.24 ","$976.00 ","$537.70 ","$107.06 ","$94.00 ","$194.22 ","$368.58 "
"32000165","EAP","CPT� 73040","","Shoulder Arthrograph Bi Rdg","BOTH IP/OP","$2,432.00 ","$1,799.68 ","$94.00 ","$2,440.00 ","$227.33 ","$360.63 ","$506.89 ","$187.52 ","$187.52 ","$427.22 ","$2,440.00 ","$387.01 ","$585.60 ","$1,932.48 ","$1,952.00 ","$537.70 ","$107.06 ","$94.00 ","$388.45 ","$368.58 "
"32000167","EAP","CPT� 73050","","ACROMICLAVICULAR JNTS BI DRG","BOTH IP/OP","$864.00 ","$639.36 ","$0.00 ","$873.00 ","$0.00 ","$0.00 ","$0.00 ","$59.59 ","$59.59 ","$0.00 ","$873.00 ","$0.00 ","$209.52 ","$691.42 ","$698.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000169","EAP","CPT� 73060","","HUMERI 2+VIEW EACH BILAT RDG","BOTH IP/OP","$2,462.00 ","$1,821.88 ","$23.05 ","$2,240.00 ","$66.11 ","$79.21 ","$513.14 ","$48.26 ","$48.26 ","$392.21 ","$2,240.00 ","$80.04 ","$537.60 ","$1,774.08 ","$1,792.00 ","$111.21 ","$30.55 ","$23.05 ","$356.61 ","$76.23 "
"32000171","EAP","CPT� 73060","","Humerus 2+view Rdg","BOTH IP/OP","$1,122.00 ","$830.28 ","$23.05 ","$1,122.00 ","$66.11 ","$79.21 ","$233.85 ","$48.26 ","$48.26 ","$196.45 ","$1,122.00 ","$80.04 ","$269.28 ","$888.62 ","$897.60 ","$111.21 ","$30.55 ","$23.05 ","$178.62 ","$76.23 "
"32000173","EAP","CPT� 73060","","HUMERUS 2+VIEW LT RDG","BOTH IP/OP","$1,233.00 ","$912.42 ","$23.05 ","$1,122.00 ","$66.11 ","$79.21 ","$256.99 ","$48.26 ","$48.26 ","$196.45 ","$1,122.00 ","$80.04 ","$269.28 ","$888.62 ","$897.60 ","$111.21 ","$30.55 ","$23.05 ","$178.62 ","$76.23 "
"32000175","EAP","CPT� 73060","","HUMERUS 2+VIEW RT RDG","BOTH IP/OP","$1,233.00 ","$912.42 ","$23.05 ","$1,122.00 ","$66.11 ","$79.21 ","$256.99 ","$48.26 ","$48.26 ","$196.45 ","$1,122.00 ","$80.04 ","$269.28 ","$888.62 ","$897.60 ","$111.21 ","$30.55 ","$23.05 ","$178.62 ","$76.23 "
"32000177","EAP","CPT� 73070","","Elbow 2 View Rdg","BOTH IP/OP","$647.00 ","$478.78 ","$20.17 ","$727.00 ","$62.09 ","$79.21 ","$134.85 ","$45.08 ","$45.08 ","$127.29 ","$727.00 ","$80.04 ","$174.48 ","$575.78 ","$581.60 ","$111.21 ","$27.38 ","$20.17 ","$115.74 ","$76.23 "
"32000179","EAP","CPT� 73070","","ELBOW 2 VIEW LT RDG","BOTH IP/OP","$798.00 ","$590.52 ","$20.17 ","$727.00 ","$62.09 ","$79.21 ","$166.32 ","$45.08 ","$45.08 ","$127.29 ","$727.00 ","$80.04 ","$174.48 ","$575.78 ","$581.60 ","$111.21 ","$27.38 ","$20.17 ","$115.74 ","$76.23 "
"32000181","EAP","CPT� 73070","","ELBOW 2 VIEW RT RDG","BOTH IP/OP","$798.00 ","$590.52 ","$20.17 ","$727.00 ","$62.09 ","$79.21 ","$166.32 ","$45.08 ","$45.08 ","$127.29 ","$727.00 ","$80.04 ","$174.48 ","$575.78 ","$581.60 ","$111.21 ","$27.38 ","$20.17 ","$115.74 ","$76.23 "
"32000183","EAP","CPT� 73070","","ELBOWS 2 VIEW EACH BILAT RDG","BOTH IP/OP","$1,598.00 ","$1,182.52 ","$20.17 ","$1,456.00 ","$62.09 ","$79.21 ","$333.06 ","$45.08 ","$45.08 ","$254.93 ","$1,456.00 ","$80.04 ","$349.44 ","$1,153.15 ","$1,164.80 ","$111.21 ","$27.38 ","$20.17 ","$231.80 ","$76.23 "
"32000185","EAP","CPT� 73080","","Elbow 3+view Nwr","BOTH IP/OP","$689.00 ","$509.86 ","$22.33 ","$774.00 ","$70.96 ","$79.21 ","$143.60 ","$60.47 ","$60.47 ","$135.52 ","$774.00 ","$80.04 ","$185.76 ","$613.01 ","$619.20 ","$111.21 ","$30.55 ","$22.33 ","$123.22 ","$76.23 "
"32000186","EAP","CPT� 73080","","Elbow Compl 3+view Rdg","BOTH IP/OP","$689.00 ","$509.86 ","$22.33 ","$774.00 ","$70.96 ","$79.21 ","$143.60 ","$60.47 ","$60.47 ","$135.52 ","$774.00 ","$80.04 ","$185.76 ","$613.01 ","$619.20 ","$111.21 ","$30.55 ","$22.33 ","$123.22 ","$76.23 "
"32000188","EAP","CPT� 73080","","ELBOW COMPL 3+VIEW LT RDG","BOTH IP/OP","$850.00 ","$629.00 ","$22.33 ","$774.00 ","$70.96 ","$79.21 ","$177.16 ","$60.47 ","$60.47 ","$135.52 ","$774.00 ","$80.04 ","$185.76 ","$613.01 ","$619.20 ","$111.21 ","$30.55 ","$22.33 ","$123.22 ","$76.23 "
"32000190","EAP","CPT� 73080","","ELBOW COMPL 3+VIEW RT RDG","BOTH IP/OP","$850.00 ","$629.00 ","$22.33 ","$774.00 ","$70.96 ","$79.21 ","$177.16 ","$60.47 ","$60.47 ","$135.52 ","$774.00 ","$80.04 ","$185.76 ","$613.01 ","$619.20 ","$111.21 ","$30.55 ","$22.33 ","$123.22 ","$76.23 "
"32000192","EAP","CPT� 73080","","ELBOWS 3+VIEW EACH BILAT RDG","BOTH IP/OP","$1,376.00 ","$1,018.24 ","$22.33 ","$1,545.00 ","$70.96 ","$79.21 ","$286.79 ","$60.47 ","$60.47 ","$270.52 ","$1,545.00 ","$80.04 ","$370.80 ","$1,223.64 ","$1,236.00 ","$111.21 ","$30.55 ","$22.33 ","$245.96 ","$76.23 "
"32000195","EAP","CPT� 73085","","ELBOW ARTHROGRAPHY RT RDG","BOTH IP/OP","$2,432.00 ","$1,799.68 ","$0.00 ","$2,731.00 ","$0.00 ","$0.00 ","$0.00 ","$163.96 ","$163.96 ","$0.00 ","$2,731.00 ","$0.00 ","$655.44 ","$2,162.95 ","$2,184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000196","EAP","CPT� 73085","","ELBOW ARTHROGRAPHY LT RDG","BOTH IP/OP","$2,432.00 ","$1,799.68 ","$0.00 ","$2,731.00 ","$0.00 ","$0.00 ","$0.00 ","$163.96 ","$163.96 ","$0.00 ","$2,731.00 ","$0.00 ","$655.44 ","$2,162.95 ","$2,184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000197","EAP","CPT� 73085","","Elbow Arthrography Bilat Rdg","BOTH IP/OP","$4,867.00 ","$3,601.58 ","$0.00 ","$5,466.00 ","$0.00 ","$0.00 ","$0.00 ","$163.96 ","$163.96 ","$0.00 ","$5,466.00 ","$0.00 ","$1,311.84 ","$4,329.07 ","$4,372.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000198","EAP","CPT� 73090","","FOREARM X-RAY 2 VIEW RDG","BOTH IP/OP","$739.00 ","$546.86 ","$20.53 ","$781.00 ","$58.87 ","$79.21 ","$154.03 ","$45.08 ","$45.08 ","$136.75 ","$781.00 ","$80.04 ","$187.44 ","$618.55 ","$624.80 ","$111.21 ","$27.72 ","$20.53 ","$124.34 ","$76.23 "
"32000200","EAP","CPT� 73090","","FOREARM X-RAY 2 VIEW LT RDG","BOTH IP/OP","$859.00 ","$635.66 ","$20.53 ","$781.00 ","$58.87 ","$79.21 ","$179.04 ","$45.08 ","$45.08 ","$136.75 ","$781.00 ","$80.04 ","$187.44 ","$618.55 ","$624.80 ","$111.21 ","$27.72 ","$20.53 ","$124.34 ","$76.23 "
"32000202","EAP","CPT� 73090","","FOREARM X-RAY 2 VIEW RT RDG","BOTH IP/OP","$859.00 ","$635.66 ","$20.53 ","$781.00 ","$58.87 ","$79.21 ","$179.04 ","$45.08 ","$45.08 ","$136.75 ","$781.00 ","$80.04 ","$187.44 ","$618.55 ","$624.80 ","$111.21 ","$27.72 ","$20.53 ","$124.34 ","$76.23 "
"32000205","EAP","CPT� 73090","","FOREARMS 2 VIEW EACH BILAT RDG","BOTH IP/OP","$1,721.00 ","$1,273.54 ","$20.53 ","$1,565.00 ","$58.87 ","$79.21 ","$358.70 ","$45.08 ","$45.08 ","$274.02 ","$1,565.00 ","$80.04 ","$375.60 ","$1,239.48 ","$1,252.00 ","$111.21 ","$27.72 ","$20.53 ","$249.15 ","$76.23 "
"32000206","EAP","CPT� 73092","","Upp Ext Infant 2+view Rdg","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$523.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$523.00 ","$0.00 ","$125.52 ","$414.22 ","$418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000207","EAP","CPT� 73092","","UPP EXT INFANT 2+VIEW BI RDG","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$1,040.00 ","$0.00 ","$249.60 ","$823.68 ","$832.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000210","EAP","CPT� 73092","","UPP EXT INFANT 2+VIEW LT RDG","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$523.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$523.00 ","$0.00 ","$125.52 ","$414.22 ","$418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000212","EAP","CPT� 73092","","UPP EXT INFANT 2+VIEW RT RDG","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$523.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$523.00 ","$0.00 ","$125.52 ","$414.22 ","$418.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000214","EAP","CPT� 73100","","Wrist 2 View  Rdg","BOTH IP/OP","$628.00 ","$464.72 ","$24.49 ","$660.00 ","$66.11 ","$79.21 ","$130.89 ","$46.81 ","$46.81 ","$115.56 ","$660.00 ","$80.04 ","$158.40 ","$522.72 ","$528.00 ","$111.21 ","$27.37 ","$24.49 ","$105.07 ","$76.23 "
"32000216","EAP","CPT� 73100","","WRIST 2 VIEW  LT RDG","BOTH IP/OP","$725.00 ","$536.50 ","$24.49 ","$660.00 ","$66.11 ","$79.21 ","$151.11 ","$46.81 ","$46.81 ","$115.56 ","$660.00 ","$80.04 ","$158.40 ","$522.72 ","$528.00 ","$111.21 ","$27.37 ","$24.49 ","$105.07 ","$76.23 "
"32000218","EAP","CPT� 73100","","WRIST 2 VIEW  RT RDG","BOTH IP/OP","$725.00 ","$536.50 ","$24.49 ","$660.00 ","$66.11 ","$79.21 ","$151.11 ","$46.81 ","$46.81 ","$115.56 ","$660.00 ","$80.04 ","$158.40 ","$522.72 ","$528.00 ","$111.21 ","$27.37 ","$24.49 ","$105.07 ","$76.23 "
"32000220","EAP","CPT� 73100","","WRISTS 2 VIEW  BILAT RDG","BOTH IP/OP","$1,252.00 ","$926.48 ","$24.49 ","$1,317.00 ","$66.11 ","$79.21 ","$260.95 ","$46.81 ","$46.81 ","$230.60 ","$1,317.00 ","$80.04 ","$316.08 ","$1,043.06 ","$1,053.60 ","$111.21 ","$27.37 ","$24.49 ","$209.67 ","$76.23 "
"32000223","EAP","CPT� 73110","","WRIST 3+VIEW RDG","BOTH IP/OP","$675.00 ","$499.50 ","$28.79 ","$710.00 ","$80.63 ","$79.21 ","$140.69 ","$59.03 ","$59.03 ","$124.32 ","$710.00 ","$80.04 ","$170.40 ","$562.32 ","$568.00 ","$111.21 ","$28.79 ","$30.25 ","$113.03 ","$76.23 "
"32000225","EAP","CPT� 73110","","WRIST 3+VIEW LT RDG","BOTH IP/OP","$780.00 ","$577.20 ","$28.79 ","$710.00 ","$80.63 ","$79.21 ","$162.57 ","$59.03 ","$59.03 ","$124.32 ","$710.00 ","$80.04 ","$170.40 ","$562.32 ","$568.00 ","$111.21 ","$28.79 ","$30.25 ","$113.03 ","$76.23 "
"32000227","EAP","CPT� 73110","","WRIST 3+VIEW RT RDG","BOTH IP/OP","$780.00 ","$577.20 ","$28.79 ","$710.00 ","$80.63 ","$79.21 ","$162.57 ","$59.03 ","$59.03 ","$124.32 ","$710.00 ","$80.04 ","$170.40 ","$562.32 ","$568.00 ","$111.21 ","$28.79 ","$30.25 ","$113.03 ","$76.23 "
"32000229","EAP","CPT� 73110","","WRISTS 3+VIEW EACH BILAT RDG","BOTH IP/OP","$1,561.00 ","$1,155.14 ","$28.79 ","$1,421.00 ","$80.63 ","$79.21 ","$325.35 ","$59.03 ","$59.03 ","$248.81 ","$1,421.00 ","$80.04 ","$341.04 ","$1,125.43 ","$1,136.80 ","$111.21 ","$28.79 ","$30.25 ","$226.22 ","$76.23 "
"32000231","EAP","CPT� 73115","","Wrist Arthrography Bilat Rdg","BOTH IP/OP","$4,442.00 ","$3,287.08 ","$0.00 ","$4,671.00 ","$0.00 ","$0.00 ","$0.00 ","$176.51 ","$176.51 ","$0.00 ","$4,671.00 ","$0.00 ","$1,121.04 ","$3,699.43 ","$3,736.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000232","EAP","CPT� 73115","","WRIST ARTHROGRAPHY RT/LT RDG","BOTH IP/OP","$2,563.00 ","$1,896.62 ","$0.00 ","$2,333.00 ","$0.00 ","$0.00 ","$0.00 ","$176.51 ","$176.51 ","$0.00 ","$2,333.00 ","$0.00 ","$559.92 ","$1,847.74 ","$1,866.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000233","EAP","CPT� 73120","","Hand 2 View Rdg","BOTH IP/OP","$646.00 ","$478.04 ","$21.97 ","$682.00 ","$59.66 ","$106.62 ","$134.64 ","$44.19 ","$44.19 ","$119.41 ","$682.00 ","$112.41 ","$163.68 ","$540.14 ","$545.60 ","$156.18 ","$27.37 ","$21.97 ","$108.57 ","$107.06 "
"32000235","EAP","CPT� 73120","","HAND 2 VIEW LT RDG","BOTH IP/OP","$743.00 ","$549.82 ","$21.97 ","$682.00 ","$59.66 ","$106.62 ","$154.86 ","$44.19 ","$44.19 ","$119.41 ","$682.00 ","$112.41 ","$163.68 ","$540.14 ","$545.60 ","$156.18 ","$27.37 ","$21.97 ","$108.57 ","$107.06 "
"32000237","EAP","CPT� 73120","","HAND 2 VIEW RT RDG","BOTH IP/OP","$743.00 ","$549.82 ","$21.97 ","$682.00 ","$59.66 ","$106.62 ","$154.86 ","$44.19 ","$44.19 ","$119.41 ","$682.00 ","$112.41 ","$163.68 ","$540.14 ","$545.60 ","$156.18 ","$27.37 ","$21.97 ","$108.57 ","$107.06 "
"32000239","EAP","CPT� 73130","","HAND 3+VIEW RDG","BOTH IP/OP","$698.00 ","$516.52 ","$26.29 ","$737.00 ","$70.14 ","$79.21 ","$145.48 ","$52.06 ","$52.06 ","$129.04 ","$737.00 ","$80.04 ","$176.88 ","$583.70 ","$589.60 ","$111.21 ","$28.79 ","$26.29 ","$117.33 ","$76.23 "
"32000241","EAP","CPT� 73130","","HAND 3+VIEW LT RDG","BOTH IP/OP","$802.00 ","$593.48 ","$26.29 ","$737.00 ","$70.14 ","$79.21 ","$167.16 ","$52.06 ","$52.06 ","$129.04 ","$737.00 ","$80.04 ","$176.88 ","$583.70 ","$589.60 ","$111.21 ","$28.79 ","$26.29 ","$117.33 ","$76.23 "
"32000243","EAP","CPT� 73130","","HAND 3+VIEW RT RDG","BOTH IP/OP","$802.00 ","$593.48 ","$26.29 ","$737.00 ","$70.14 ","$79.21 ","$167.16 ","$52.06 ","$52.06 ","$129.04 ","$737.00 ","$80.04 ","$176.88 ","$583.70 ","$589.60 ","$111.21 ","$28.79 ","$26.29 ","$117.33 ","$76.23 "
"32000244","EAP","CPT� 73120","","HANDS 2 VIEW EACH BILAT RDG","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$21.97 ","$1,364.00 ","$59.66 ","$106.62 ","$309.51 ","$44.19 ","$44.19 ","$238.83 ","$1,364.00 ","$112.41 ","$327.36 ","$1,080.29 ","$1,091.20 ","$156.18 ","$27.37 ","$21.97 ","$217.15 ","$107.06 "
"32000246","EAP","CPT� 73130","","HANDS 3+VIEW EACH BILAT RDG","BOTH IP/OP","$1,609.00 ","$1,190.66 ","$26.29 ","$1,478.00 ","$70.14 ","$79.21 ","$335.36 ","$52.06 ","$52.06 ","$258.79 ","$1,478.00 ","$80.04 ","$354.72 ","$1,170.58 ","$1,182.40 ","$111.21 ","$28.79 ","$26.29 ","$235.30 ","$76.23 "
"32000248","EAP","CPT� 73140","","Finger  3 Views","BOTH IP/OP","$609.00 ","$450.66 ","$23.09 ","$689.00 ","$71.76 ","$79.21 ","$126.93 ","$51.19 ","$51.19 ","$120.64 ","$689.00 ","$80.04 ","$165.36 ","$545.69 ","$551.20 ","$111.21 ","$23.09 ","$28.81 ","$109.69 ","$76.23 "
"32000249","EAP","CPT� 73140","","Finger X-ray","BOTH IP/OP","$609.00 ","$450.66 ","$23.09 ","$689.00 ","$71.76 ","$79.21 ","$126.93 ","$51.19 ","$51.19 ","$120.64 ","$689.00 ","$80.04 ","$165.36 ","$545.69 ","$551.20 ","$111.21 ","$23.09 ","$28.81 ","$109.69 ","$76.23 "
"32000250","EAP","CPT� 73140","","FINGER(S) 2+VIEW RDG","BOTH IP/OP","$609.00 ","$450.66 ","$23.09 ","$689.00 ","$71.76 ","$79.21 ","$126.93 ","$51.19 ","$51.19 ","$120.64 ","$689.00 ","$80.04 ","$165.36 ","$545.69 ","$551.20 ","$111.21 ","$23.09 ","$28.81 ","$109.69 ","$76.23 "
"32000252","EAP","CPT� 73140","","FINGER(S) 2+VIEW EACH BILAT RD","BOTH IP/OP","$1,218.00 ","$901.32 ","$23.09 ","$1,378.00 ","$71.76 ","$79.21 ","$253.86 ","$51.19 ","$51.19 ","$241.28 ","$1,378.00 ","$80.04 ","$330.72 ","$1,091.38 ","$1,102.40 ","$111.21 ","$23.09 ","$28.81 ","$219.38 ","$76.23 "
"32000254","EAP","CPT� 73140","","FINGER(S) 2+VIEW LT RDG","BOTH IP/OP","$718.00 ","$531.32 ","$23.09 ","$689.00 ","$71.76 ","$79.21 ","$149.65 ","$51.19 ","$51.19 ","$120.64 ","$689.00 ","$80.04 ","$165.36 ","$545.69 ","$551.20 ","$111.21 ","$23.09 ","$28.81 ","$109.69 ","$76.23 "
"32000256","EAP","CPT� 73140","","FINGER(S) 2+VIEW RT RDG","BOTH IP/OP","$718.00 ","$531.32 ","$23.09 ","$689.00 ","$71.76 ","$79.21 ","$149.65 ","$51.19 ","$51.19 ","$120.64 ","$689.00 ","$80.04 ","$165.36 ","$545.69 ","$551.20 ","$111.21 ","$23.09 ","$28.81 ","$109.69 ","$76.23 "
"32000258","EAP","CPT� 36299","","Inject Vascular Unlstd Proc","BOTH IP/OP","$4,131.00 ","$3,056.94 ","$0.00 ","$3,478.00 ","$0.00 ","$0.00 ","$861.00 ","$0.00 ","$0.00 ","$0.00 ","$3,478.00 ","$0.00 ","$2,255.00 ","$2,754.58 ","$2,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000285","EAP","CPT� 73525","","HIP ARTHROGRAPHY RT RDG","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,181.00 ","$0.00 ","$0.00 ","$0.00 ","$162.23 ","$162.23 ","$206.78 ","$1,181.00 ","$387.01 ","$283.44 ","$935.35 ","$944.80 ","$537.70 ","$107.06 ","$94.73 ","$188.02 ","$368.58 "
"32000286","EAP","CPT� 73525","","HIP ARTHROGRAPHY LT RDG","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,181.00 ","$0.00 ","$0.00 ","$0.00 ","$162.23 ","$162.23 ","$206.78 ","$1,181.00 ","$387.01 ","$283.44 ","$935.35 ","$944.80 ","$537.70 ","$107.06 ","$94.73 ","$188.02 ","$368.58 "
"32000287","EAP","CPT� 73525","","Hips Arthrography Bilat Rdg","BOTH IP/OP","$1,891.00 ","$1,399.34 ","$0.00 ","$2,361.00 ","$0.00 ","$0.00 ","$0.00 ","$162.23 ","$162.23 ","$413.39 ","$2,361.00 ","$387.01 ","$566.64 ","$1,869.91 ","$1,888.80 ","$537.70 ","$107.06 ","$94.73 ","$375.87 ","$368.58 "
"32000303","EAP","CPT� 73560","","KNEE 1-2 VIEW RDG","BOTH IP/OP","$694.00 ","$513.56 ","$25.21 ","$766.00 ","$70.14 ","$79.21 ","$144.65 ","$45.95 ","$45.95 ","$134.12 ","$766.00 ","$80.04 ","$183.84 ","$606.67 ","$612.80 ","$111.21 ","$28.43 ","$25.21 ","$121.95 ","$76.23 "
"32000305","EAP","CPT� 73560","","KNEE 1-2 VIEW LT RDG","BOTH IP/OP","$835.00 ","$617.90 ","$25.21 ","$766.00 ","$70.14 ","$79.21 ","$174.03 ","$45.95 ","$45.95 ","$134.12 ","$766.00 ","$80.04 ","$183.84 ","$606.67 ","$612.80 ","$111.21 ","$28.43 ","$25.21 ","$121.95 ","$76.23 "
"32000307","EAP","CPT� 73560","","KNEE 1-2 VIEW RT RDG","BOTH IP/OP","$835.00 ","$617.90 ","$25.21 ","$766.00 ","$70.14 ","$79.21 ","$174.03 ","$45.95 ","$45.95 ","$134.12 ","$766.00 ","$80.04 ","$183.84 ","$606.67 ","$612.80 ","$111.21 ","$28.43 ","$25.21 ","$121.95 ","$76.23 "
"32000309","EAP","CPT� 73560","","KNEES 1-2 VIEW EACH BILAT RDG","BOTH IP/OP","$1,666.00 ","$1,232.84 ","$25.21 ","$1,528.00 ","$70.14 ","$79.21 ","$347.24 ","$45.95 ","$45.95 ","$267.54 ","$1,528.00 ","$80.04 ","$366.72 ","$1,210.18 ","$1,222.40 ","$111.21 ","$28.43 ","$25.21 ","$243.26 ","$76.23 "
"32000311","EAP","CPT� 73562","","Knee 3 View Rdg","BOTH IP/OP","$749.00 ","$554.26 ","$29.89 ","$826.00 ","$81.42 ","$79.21 ","$156.11 ","$57.87 ","$57.87 ","$144.63 ","$826.00 ","$80.04 ","$198.24 ","$654.19 ","$660.80 ","$111.21 ","$31.26 ","$29.89 ","$131.50 ","$76.23 "
"32000313","EAP","CPT� 73562","","KNEE 3 VIEW LT RDG","BOTH IP/OP","$901.00 ","$666.74 ","$29.89 ","$826.00 ","$81.42 ","$79.21 ","$187.79 ","$57.87 ","$57.87 ","$144.63 ","$826.00 ","$80.04 ","$198.24 ","$654.19 ","$660.80 ","$111.21 ","$31.26 ","$29.89 ","$131.50 ","$76.23 "
"32000315","EAP","CPT� 73562","","KNEE 3 VIEW RT RDG","BOTH IP/OP","$901.00 ","$666.74 ","$29.89 ","$826.00 ","$81.42 ","$79.21 ","$187.79 ","$57.87 ","$57.87 ","$144.63 ","$826.00 ","$80.04 ","$198.24 ","$654.19 ","$660.80 ","$111.21 ","$31.26 ","$29.89 ","$131.50 ","$76.23 "
"32000317","EAP","CPT� 73562","","KNEES 3 VIEW EACH BILAT RDG","BOTH IP/OP","$1,495.00 ","$1,106.30 ","$29.89 ","$1,649.00 ","$81.42 ","$79.21 ","$311.60 ","$57.87 ","$57.87 ","$288.73 ","$1,649.00 ","$80.04 ","$395.76 ","$1,306.01 ","$1,319.20 ","$111.21 ","$31.26 ","$29.89 ","$262.52 ","$76.23 "
"32000319","EAP","CPT� 73564","","KNEE 4+VIEW EXR","BOTH IP/OP","$699.00 ","$517.26 ","$32.78 ","$771.00 ","$90.29 ","$106.62 ","$145.69 ","$66.59 ","$66.59 ","$135.00 ","$771.00 ","$112.41 ","$185.04 ","$610.63 ","$616.80 ","$156.18 ","$34.81 ","$32.78 ","$122.74 ","$107.06 "
"32000320","EAP","CPT� 73564","","KNEE 4+VIEW LT RDG","BOTH IP/OP","$841.00 ","$622.34 ","$32.78 ","$771.00 ","$90.29 ","$106.62 ","$175.29 ","$66.59 ","$66.59 ","$135.00 ","$771.00 ","$112.41 ","$185.04 ","$610.63 ","$616.80 ","$156.18 ","$34.81 ","$32.78 ","$122.74 ","$107.06 "
"32000322","EAP","CPT� 73564","","KNEE 4+VIEW RT RDG","BOTH IP/OP","$841.00 ","$622.34 ","$32.78 ","$771.00 ","$90.29 ","$106.62 ","$175.29 ","$66.59 ","$66.59 ","$135.00 ","$771.00 ","$112.41 ","$185.04 ","$610.63 ","$616.80 ","$156.18 ","$34.81 ","$32.78 ","$122.74 ","$107.06 "
"32000324","EAP","CPT� 73564","","KNEES 4+VIEW BILAT RDG","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$32.78 ","$1,539.00 ","$90.29 ","$106.62 ","$290.75 ","$66.59 ","$66.59 ","$269.47 ","$1,539.00 ","$112.41 ","$369.36 ","$1,218.89 ","$1,231.20 ","$156.18 ","$34.81 ","$32.78 ","$245.01 ","$107.06 "
"32000327","EAP","CPT� 73565","","KNEES BOTH STANDING AP RDG","BOTH IP/OP","$826.00 ","$611.24 ","$0.00 ","$911.00 ","$0.00 ","$0.00 ","$0.00 ","$49.43 ","$49.43 ","$0.00 ","$911.00 ","$0.00 ","$218.64 ","$721.51 ","$728.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000329","EAP","CPT� 73580","","KNEE ARTHROGRAPHY RT RDG","BOTH IP/OP","$2,466.00 ","$1,824.84 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$218.63 ","$218.63 ","$0.00 ","$2,720.00 ","$0.00 ","$652.80 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000330","EAP","CPT� 73580","","KNEE ARTHROGRAPHY LT RDG","BOTH IP/OP","$2,466.00 ","$1,824.84 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$218.63 ","$218.63 ","$0.00 ","$2,720.00 ","$0.00 ","$652.80 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000331","EAP","CPT� 73580","","Knees Arthrography Bilat Rdg","BOTH IP/OP","$2,466.00 ","$1,824.84 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$218.63 ","$218.63 ","$0.00 ","$2,720.00 ","$0.00 ","$652.80 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000332","EAP","CPT� 73590","","TIBIA&FIBULA 2 VIEW RDG","BOTH IP/OP","$879.00 ","$650.46 ","$22.69 ","$799.00 ","$65.31 ","$79.21 ","$183.21 ","$43.33 ","$43.33 ","$139.90 ","$799.00 ","$80.04 ","$191.76 ","$632.81 ","$639.20 ","$111.21 ","$28.43 ","$22.69 ","$127.20 ","$76.23 "
"32000334","EAP","CPT� 73590","","TIBIA&FIBULA 2 VIEW LT RDG","BOTH IP/OP","$879.00 ","$650.46 ","$22.69 ","$799.00 ","$65.31 ","$79.21 ","$183.21 ","$43.33 ","$43.33 ","$139.90 ","$799.00 ","$80.04 ","$191.76 ","$632.81 ","$639.20 ","$111.21 ","$28.43 ","$22.69 ","$127.20 ","$76.23 "
"32000336","EAP","CPT� 73590","","TIBIA&FIBULA 2 VIEW RT RDG","BOTH IP/OP","$879.00 ","$650.46 ","$22.69 ","$799.00 ","$65.31 ","$79.21 ","$183.21 ","$43.33 ","$43.33 ","$139.90 ","$799.00 ","$80.04 ","$191.76 ","$632.81 ","$639.20 ","$111.21 ","$28.43 ","$22.69 ","$127.20 ","$76.23 "
"32000338","EAP","CPT� 73590","","TIBIA&FIBULA 2VW ECH BILAT RDG","BOTH IP/OP","$790.00 ","$584.60 ","$22.69 ","$799.00 ","$65.31 ","$79.21 ","$164.66 ","$43.33 ","$43.33 ","$139.90 ","$799.00 ","$80.04 ","$191.76 ","$632.81 ","$639.20 ","$111.21 ","$28.43 ","$22.69 ","$127.20 ","$76.23 "
"32000339","EAP","CPT� 73592","","Low Ext Infant 2+view Rdg","BOTH IP/OP","$372.00 ","$275.28 ","$0.00 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$376.00 ","$0.00 ","$90.24 ","$297.79 ","$300.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000340","EAP","CPT� 73592","","LOW EXT INFANT 2+VIEW BI RDG","BOTH IP/OP","$372.00 ","$275.28 ","$0.00 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$376.00 ","$0.00 ","$90.24 ","$297.79 ","$300.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000343","EAP","CPT� 73592","","LOW EXT INFANT 2+VIEW LT RDG","BOTH IP/OP","$372.00 ","$275.28 ","$0.00 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$376.00 ","$0.00 ","$90.24 ","$297.79 ","$300.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000345","EAP","CPT� 73592","","LOW EXT INFANT 2+VIEW RT RDG","BOTH IP/OP","$372.00 ","$275.28 ","$0.00 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$46.81 ","$46.81 ","$0.00 ","$376.00 ","$0.00 ","$90.24 ","$297.79 ","$300.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000347","EAP","CPT� 73600","","Ankle 2 View Rdg","BOTH IP/OP","$734.00 ","$543.16 ","$23.41 ","$892.00 ","$67.72 ","$79.21 ","$152.98 ","$44.19 ","$44.19 ","$156.18 ","$892.00 ","$80.04 ","$214.08 ","$706.46 ","$713.60 ","$111.21 ","$27.37 ","$23.41 ","$142.01 ","$76.23 "
"32000349","EAP","CPT� 73600","","ANKLE 2 VIEW LT RDG","BOTH IP/OP","$980.00 ","$725.20 ","$23.41 ","$892.00 ","$67.72 ","$79.21 ","$204.26 ","$44.19 ","$44.19 ","$156.18 ","$892.00 ","$80.04 ","$214.08 ","$706.46 ","$713.60 ","$111.21 ","$27.37 ","$23.41 ","$142.01 ","$76.23 "
"32000351","EAP","CPT� 73600","","ANKLE 2 VIEW RT RDG","BOTH IP/OP","$980.00 ","$725.20 ","$23.41 ","$892.00 ","$67.72 ","$79.21 ","$204.26 ","$44.19 ","$44.19 ","$156.18 ","$892.00 ","$80.04 ","$214.08 ","$706.46 ","$713.60 ","$111.21 ","$27.37 ","$23.41 ","$142.01 ","$76.23 "
"32000353","EAP","CPT� 73600","","ANKLES 2 VIEW EACH BILAT RDG","BOTH IP/OP","$1,958.00 ","$1,448.92 ","$23.41 ","$1,782.00 ","$67.72 ","$79.21 ","$408.10 ","$44.19 ","$44.19 ","$312.01 ","$1,782.00 ","$80.04 ","$427.68 ","$1,411.34 ","$1,425.60 ","$111.21 ","$27.37 ","$23.41 ","$283.69 ","$76.23 "
"32000357","EAP","CPT� 73610","","ANKLE 3+VIEW LT RDG","BOTH IP/OP","$1,060.00 ","$784.40 ","$26.29 ","$965.00 ","$71.76 ","$79.21 ","$220.93 ","$52.06 ","$52.06 ","$168.96 ","$965.00 ","$80.04 ","$231.60 ","$764.28 ","$772.00 ","$111.21 ","$28.79 ","$26.29 ","$153.63 ","$76.23 "
"32000359","EAP","CPT� 73610","","ANKLE 3+VIEW RT RDG","BOTH IP/OP","$1,060.00 ","$784.40 ","$26.29 ","$965.00 ","$71.76 ","$79.21 ","$220.93 ","$52.06 ","$52.06 ","$168.96 ","$965.00 ","$80.04 ","$231.60 ","$764.28 ","$772.00 ","$111.21 ","$28.79 ","$26.29 ","$153.63 ","$76.23 "
"32000362","EAP","CPT� 73615","","ANKLE ARTHROGRAPHY LT RDG","BOTH IP/OP","$2,593.00 ","$1,918.82 ","$0.00 ","$3,153.00 ","$0.00 ","$0.00 ","$0.00 ","$169.21 ","$169.21 ","$0.00 ","$3,153.00 ","$0.00 ","$756.72 ","$2,497.18 ","$2,522.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000363","EAP","CPT� 73615","","ANKLE ARTHROGRAPHY RT RDG","BOTH IP/OP","$2,593.00 ","$1,918.82 ","$0.00 ","$3,153.00 ","$0.00 ","$0.00 ","$0.00 ","$169.21 ","$169.21 ","$0.00 ","$3,153.00 ","$0.00 ","$756.72 ","$2,497.18 ","$2,522.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000364","EAP","CPT� 73610","","ANKLES 3+VIEW EACH BILAT RDG","BOTH IP/OP","$2,115.00 ","$1,565.10 ","$26.29 ","$1,925.00 ","$71.76 ","$79.21 ","$440.82 ","$52.06 ","$52.06 ","$337.05 ","$1,925.00 ","$80.04 ","$462.00 ","$1,524.60 ","$1,540.00 ","$111.21 ","$28.79 ","$26.29 ","$306.46 ","$76.23 "
"32000366","EAP","CPT� 73615","","Ankles Arthrography Bilat Rdg","BOTH IP/OP","$5,189.00 ","$3,839.86 ","$0.00 ","$6,309.00 ","$0.00 ","$0.00 ","$0.00 ","$169.21 ","$169.21 ","$0.00 ","$6,309.00 ","$0.00 ","$1,514.16 ","$4,996.73 ","$5,047.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000367","EAP","CPT� 73620","","FEET 2 VIEW EACH BILAT RDG","BOTH IP/OP","$1,600.00 ","$1,184.00 ","$20.17 ","$1,461.00 ","$58.87 ","$79.21 ","$333.48 ","$42.45 ","$42.45 ","$255.81 ","$1,461.00 ","$80.04 ","$350.64 ","$1,157.11 ","$1,168.80 ","$111.21 ","$27.37 ","$20.17 ","$232.59 ","$76.23 "
"32000369","EAP","CPT� 73620","","FOOT 2 VIEW LT RDG","BOTH IP/OP","$801.00 ","$592.74 ","$20.17 ","$732.00 ","$58.87 ","$79.21 ","$166.95 ","$42.45 ","$42.45 ","$128.17 ","$732.00 ","$80.04 ","$175.68 ","$579.74 ","$585.60 ","$111.21 ","$27.37 ","$20.17 ","$116.53 ","$76.23 "
"32000371","EAP","CPT� 73620","","FOOT 2 VIEW RT RDG","BOTH IP/OP","$801.00 ","$592.74 ","$20.17 ","$732.00 ","$58.87 ","$79.21 ","$166.95 ","$42.45 ","$42.45 ","$128.17 ","$732.00 ","$80.04 ","$175.68 ","$579.74 ","$585.60 ","$111.21 ","$27.37 ","$20.17 ","$116.53 ","$76.23 "
"32000373","EAP","CPT� 73620","","Foot 2 Views Rdg","BOTH IP/OP","$669.00 ","$495.06 ","$20.17 ","$732.00 ","$58.87 ","$79.21 ","$139.44 ","$42.45 ","$42.45 ","$128.17 ","$732.00 ","$80.04 ","$175.68 ","$579.74 ","$585.60 ","$111.21 ","$27.37 ","$20.17 ","$116.53 ","$76.23 "
"32000375","EAP","CPT� 73630","","FEET 3+VIEW EACH BILAT RDG","BOTH IP/OP","$1,730.00 ","$1,280.20 ","$24.49 ","$1,580.00 ","$66.11 ","$79.21 ","$360.58 ","$51.19 ","$51.19 ","$276.65 ","$1,580.00 ","$80.04 ","$379.20 ","$1,251.36 ","$1,264.00 ","$111.21 ","$28.79 ","$24.49 ","$251.54 ","$76.23 "
"32000377","EAP","CPT� 73630","","FOOT 3+VIEW RDG","BOTH IP/OP","$863.00 ","$638.62 ","$24.49 ","$788.00 ","$66.11 ","$79.21 ","$179.87 ","$51.19 ","$51.19 ","$137.97 ","$788.00 ","$80.04 ","$189.12 ","$624.10 ","$630.40 ","$111.21 ","$28.79 ","$24.49 ","$125.45 ","$76.23 "
"32000379","EAP","CPT� 73630","","FOOT 3+VIEW LT RDG","BOTH IP/OP","$863.00 ","$638.62 ","$24.49 ","$788.00 ","$66.11 ","$79.21 ","$179.87 ","$51.19 ","$51.19 ","$137.97 ","$788.00 ","$80.04 ","$189.12 ","$624.10 ","$630.40 ","$111.21 ","$28.79 ","$24.49 ","$125.45 ","$76.23 "
"32000381","EAP","CPT� 73630","","FOOT 3+VIEW RT RDG","BOTH IP/OP","$720.00 ","$532.80 ","$24.49 ","$788.00 ","$66.11 ","$79.21 ","$150.07 ","$51.19 ","$51.19 ","$137.97 ","$788.00 ","$80.04 ","$189.12 ","$624.10 ","$630.40 ","$111.21 ","$28.79 ","$24.49 ","$125.45 ","$76.23 "
"32000383","EAP","CPT� 73650","","CALCANEI 2+VIEW EACH BILAT RDG","BOTH IP/OP","$1,538.00 ","$1,138.12 ","$20.17 ","$1,458.00 ","$61.27 ","$79.21 ","$320.56 ","$43.33 ","$43.33 ","$255.28 ","$1,458.00 ","$80.04 ","$349.92 ","$1,154.74 ","$1,166.40 ","$111.21 ","$26.66 ","$20.17 ","$232.11 ","$76.23 "
"32000385","EAP","CPT� 73650","","CALCANEUS 2+VIEW RDG","BOTH IP/OP","$638.00 ","$472.12 ","$20.17 ","$730.00 ","$61.27 ","$79.21 ","$132.98 ","$43.33 ","$43.33 ","$127.82 ","$730.00 ","$80.04 ","$175.20 ","$578.16 ","$584.00 ","$111.21 ","$26.66 ","$20.17 ","$116.22 ","$76.23 "
"32000387","EAP","CPT� 73650","","CALCANEUS 2+VIEW LT RDG","BOTH IP/OP","$770.00 ","$569.80 ","$20.17 ","$730.00 ","$61.27 ","$79.21 ","$160.49 ","$43.33 ","$43.33 ","$127.82 ","$730.00 ","$80.04 ","$175.20 ","$578.16 ","$584.00 ","$111.21 ","$26.66 ","$20.17 ","$116.22 ","$76.23 "
"32000389","EAP","CPT� 73650","","CALCANEUS 2+VIEW RT RDG","BOTH IP/OP","$770.00 ","$569.80 ","$20.17 ","$730.00 ","$61.27 ","$79.21 ","$160.49 ","$43.33 ","$43.33 ","$127.82 ","$730.00 ","$80.04 ","$175.20 ","$578.16 ","$584.00 ","$111.21 ","$26.66 ","$20.17 ","$116.22 ","$76.23 "
"32000391","EAP","CPT� 73660","","Toe X-ray","BOTH IP/OP","$863.00 ","$638.62 ","$21.61 ","$863.00 ","$63.70 ","$79.21 ","$179.87 ","$48.57 ","$48.57 ","$151.10 ","$863.00 ","$80.04 ","$207.12 ","$683.50 ","$690.40 ","$111.21 ","$23.09 ","$21.61 ","$137.39 ","$76.23 "
"32000392","EAP","CPT� 73660","","TOE(S) 2+VIEW EACH BILAT RDG","BOTH IP/OP","$1,733.00 ","$1,282.42 ","$21.61 ","$1,733.00 ","$63.70 ","$79.21 ","$361.20 ","$48.57 ","$48.57 ","$303.43 ","$1,733.00 ","$80.04 ","$415.92 ","$1,372.54 ","$1,386.40 ","$111.21 ","$23.09 ","$21.61 ","$275.89 ","$76.23 "
"32000394","EAP","CPT� 73660","","TOE(S) X-RAY 2+VIEW RDG","BOTH IP/OP","$863.00 ","$638.62 ","$21.61 ","$863.00 ","$63.70 ","$79.21 ","$179.87 ","$48.57 ","$48.57 ","$151.10 ","$863.00 ","$80.04 ","$207.12 ","$683.50 ","$690.40 ","$111.21 ","$23.09 ","$21.61 ","$137.39 ","$76.23 "
"32000396","EAP","CPT� 73660","","TOE(S) X-RAY 2+VIEW LT RDG","BOTH IP/OP","$878.00 ","$649.72 ","$21.61 ","$863.00 ","$63.70 ","$79.21 ","$183.00 ","$48.57 ","$48.57 ","$151.10 ","$863.00 ","$80.04 ","$207.12 ","$683.50 ","$690.40 ","$111.21 ","$23.09 ","$21.61 ","$137.39 ","$76.23 "
"32000398","EAP","CPT� 73660","","TOE(S) X-RAY 2+VIEW RT RDG","BOTH IP/OP","$878.00 ","$649.72 ","$21.61 ","$863.00 ","$63.70 ","$79.21 ","$183.00 ","$48.57 ","$48.57 ","$151.10 ","$863.00 ","$80.04 ","$207.12 ","$683.50 ","$690.40 ","$111.21 ","$23.09 ","$21.61 ","$137.39 ","$76.23 "
"32000412","EAP","CPT� 74018","","KUB-KIDNEY,URETER,BLADDER RDG","BOTH IP/OP","$797.00 ","$589.78 ","$20.17 ","$727.00 ","$62.20 ","$79.21 ","$166.11 ","$43.76 ","$43.76 ","$127.29 ","$727.00 ","$80.04 ","$174.48 ","$575.78 ","$581.60 ","$111.21 ","$26.25 ","$20.17 ","$115.74 ","$76.23 "
"32000417","EAP","CPT� 74019","","ABDOMEN AP OBLIQ&CONE RDG","BOTH IP/OP","$704.00 ","$520.96 ","$24.49 ","$723.00 ","$75.90 ","$106.62 ","$146.73 ","$52.33 ","$52.33 ","$126.59 ","$723.00 ","$112.41 ","$173.52 ","$572.62 ","$578.40 ","$156.18 ","$32.02 ","$24.49 ","$115.10 ","$107.06 "
"32000419","EAP","CPT� 74019","","ABDOMEN W/DECUB&/ERECT RDG","BOTH IP/OP","$813.00 ","$601.62 ","$24.49 ","$742.00 ","$75.90 ","$106.62 ","$169.45 ","$52.33 ","$52.33 ","$129.92 ","$742.00 ","$112.41 ","$178.08 ","$587.66 ","$593.60 ","$156.18 ","$32.02 ","$24.49 ","$118.13 ","$107.06 "
"32000421","EAP","CPT� 74022","","Xr 2 Vw Abd W/ Single View Chest","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,090.00 ","$101.59 ","$106.62 ","$249.07 ","$76.04 ","$76.04 ","$190.85 ","$1,090.00 ","$112.41 ","$261.60 ","$863.28 ","$872.00 ","$156.18 ","$44.36 ","$32.78 ","$0.00 ","$107.06 "
"32000430","EAP","CPT� 74210","","Xr Pharynx/cerv Esoph Single Contrast","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$136.97 ","$136.97 ","$0.00 ","$665.00 ","$0.00 ","$159.60 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000432","EAP","CPT� 74220","","Xr Esophagus Single Contrast","BOTH IP/OP","$1,176.00 ","$870.24 ","$66.99 ","$1,188.00 ","$200.75 ","$174.93 ","$245.11 ","$150.06 ","$150.06 ","$208.01 ","$1,188.00 ","$202.33 ","$285.12 ","$940.90 ","$950.40 ","$281.11 ","$68.55 ","$66.99 ","$189.13 ","$192.70 "
"32000434","EAP","CPT� 74230","","Xr Swallow Function Single Contrast","BOTH IP/OP","$978.00 ","$723.72 ","$0.00 ","$988.00 ","$0.00 ","$0.00 ","$0.00 ","$147.27 ","$147.27 ","$0.00 ","$988.00 ","$0.00 ","$237.12 ","$782.50 ","$790.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000435","EAP","CPT� 74230","","Barium Swallow","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$988.00 ","$0.00 ","$0.00 ","$0.00 ","$147.27 ","$147.27 ","$0.00 ","$988.00 ","$0.00 ","$237.12 ","$782.50 ","$790.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000436","EAP","CPT� 74235","","ESOPHAGEAL FB REMOVAL  S&I SPV","BOTH IP/OP","$1,329.00 ","$983.46 ","$0.00 ","$1,342.00 ","$0.00 ","$0.00 ","$0.00 ","$286.87 ","$286.87 ","$0.00 ","$1,342.00 ","$0.00 ","$322.08 ","$1,062.86 ","$1,073.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000437","EAP","CPT� 74235","","FB REMOVAL ESOPHAGEAL S&I EXR","BOTH IP/OP","$1,342.00 ","$993.08 ","$0.00 ","$1,342.00 ","$0.00 ","$0.00 ","$0.00 ","$286.87 ","$286.87 ","$0.00 ","$1,342.00 ","$0.00 ","$322.08 ","$1,062.86 ","$1,073.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000439","EAP","CPT� 74235","","Rem. F.b. Esoph Xray Super/int","BOTH IP/OP","$1,329.00 ","$983.46 ","$0.00 ","$1,342.00 ","$0.00 ","$0.00 ","$0.00 ","$286.87 ","$286.87 ","$0.00 ","$1,342.00 ","$0.00 ","$322.08 ","$1,062.86 ","$1,073.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000441","EAP","CPT� 74240","","UGI W/O KUB RDG","BOTH IP/OP","$1,446.00 ","$1,070.04 ","$80.68 ","$1,361.00 ","$256.37 ","$174.93 ","$301.38 ","$170.71 ","$170.71 ","$238.30 ","$1,361.00 ","$202.33 ","$326.64 ","$1,077.91 ","$1,088.80 ","$281.11 ","$90.47 ","$80.68 ","$216.67 ","$192.70 "
"32000448","EAP","CPT� 74246","","UGI W/ AIR CON W/O KUB RDG","BOTH IP/OP","$1,369.00 ","$1,013.06 ","$94.36 ","$1,289.00 ","$288.60 ","$174.93 ","$285.33 ","$207.91 ","$207.91 ","$225.69 ","$1,289.00 ","$202.33 ","$309.36 ","$1,020.89 ","$1,031.20 ","$281.11 ","$97.60 ","$94.36 ","$205.21 ","$192.70 "
"32000449","EAP","CPT� 74246","","Ugi W/air Contrast","BOTH IP/OP","$1,369.00 ","$1,013.06 ","$94.36 ","$1,289.00 ","$288.60 ","$174.93 ","$285.33 ","$207.91 ","$207.91 ","$225.69 ","$1,289.00 ","$202.33 ","$309.36 ","$1,020.89 ","$1,031.20 ","$281.11 ","$97.60 ","$94.36 ","$205.21 ","$192.70 "
"32000457","EAP","CPT� 74250","","Xr Small Bowel Single Contrast","BOTH IP/OP","$656.00 ","$485.44 ","$0.00 ","$613.00 ","$236.20 ","$174.93 ","$0.00 ","$183.05 ","$183.05 ","$0.00 ","$613.00 ","$0.00 ","$147.12 ","$485.50 ","$490.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000462","EAP","CPT� 74270","","Xr Colon Single Contrast","BOTH IP/OP","$1,428.00 ","$1,056.72 ","$100.09 ","$1,733.00 ","$332.96 ","$174.93 ","$297.63 ","$260.12 ","$260.12 ","$303.43 ","$1,733.00 ","$202.33 ","$415.92 ","$1,372.54 ","$1,386.40 ","$281.11 ","$100.09 ","$103.37 ","$275.89 ","$192.70 "
"32000463","EAP","CPT� 74270","","Be (barium Enema) Routi","BOTH IP/OP","$1,716.00 ","$1,269.84 ","$100.09 ","$1,733.00 ","$332.96 ","$174.93 ","$357.66 ","$260.12 ","$260.12 ","$303.43 ","$1,733.00 ","$202.33 ","$415.92 ","$1,372.54 ","$1,386.40 ","$281.11 ","$100.09 ","$103.37 ","$275.89 ","$192.70 "
"32000465","EAP","CPT� 74280","","Xr Colon Double Contrast","BOTH IP/OP","$2,694.00 ","$1,993.56 ","$0.00 ","$2,721.00 ","$0.00 ","$0.00 ","$561.50 ","$355.81 ","$355.81 ","$476.43 ","$2,721.00 ","$202.33 ","$653.04 ","$2,155.03 ","$2,176.80 ","$281.11 ","$134.85 ","$160.64 ","$433.18 ","$192.70 "
"32000467","EAP","CPT� 74283","","THERAPEUTIC ENEMA CON/AIR RDG","BOTH IP/OP","$1,218.00 ","$901.32 ","$0.00 ","$1,478.00 ","$0.00 ","$0.00 ","$0.00 ","$246.57 ","$246.57 ","$0.00 ","$1,478.00 ","$0.00 ","$354.72 ","$1,170.58 ","$1,182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000468","EAP","CPT� 74290","","Cholecystography W/dye Rdg","BOTH IP/OP","$1,066.00 ","$788.84 ","$0.00 ","$1,294.00 ","$0.00 ","$0.00 ","$0.00 ","$114.42 ","$114.42 ","$0.00 ","$1,294.00 ","$0.00 ","$310.56 ","$1,024.85 ","$1,035.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000470","EAP","CPT� 74300","","CHOLANGIO INTRAOPERATIVE RDG","BOTH IP/OP","$1,122.00 ","$830.28 ","$0.00 ","$1,122.00 ","$0.00 ","$0.00 ","$0.00 ","$85.40 ","$85.40 ","$0.00 ","$1,122.00 ","$0.00 ","$269.28 ","$888.62 ","$897.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000471","EAP","CPT� 74300","","Xray Bile Ducts/pancreas","BOTH IP/OP","$1,122.00 ","$830.28 ","$0.00 ","$1,122.00 ","$0.00 ","$0.00 ","$0.00 ","$85.40 ","$85.40 ","$0.00 ","$1,122.00 ","$0.00 ","$269.28 ","$888.62 ","$897.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000477","EAP","CPT� 74328","","Radiological;biliary Ductal","BOTH IP/OP","$934.00 ","$691.16 ","$0.00 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$331.28 ","$331.28 ","$0.00 ","$934.00 ","$0.00 ","$224.16 ","$739.73 ","$747.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000478","EAP","CPT� 74329","","Radiological;pancreatic Ductal","BOTH IP/OP","$934.00 ","$691.16 ","$0.00 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$167.32 ","$167.32 ","$0.00 ","$934.00 ","$0.00 ","$224.16 ","$739.73 ","$747.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000479","EAP","CPT� 74330","","Radiological;biliary & Pancrea","BOTH IP/OP","$934.00 ","$691.16 ","$0.00 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$331.28 ","$331.28 ","$163.54 ","$934.00 ","$0.00 ","$224.16 ","$739.73 ","$747.20 ","$0.00 ","$163.52 ","$0.00 ","$0.00 ","$0.00 "
"32000481","EAP","CPT� 74340","","INTRO OF LONG GI TUBE S&I RDG","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$461.00 ","$0.00 ","$0.00 ","$0.00 ","$275.61 ","$275.61 ","$0.00 ","$461.00 ","$0.00 ","$110.64 ","$365.11 ","$368.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000482","EAP","CPT� 74340","","X-ray Guide For Gi Tube","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$461.00 ","$0.00 ","$0.00 ","$0.00 ","$275.61 ","$275.61 ","$0.00 ","$461.00 ","$0.00 ","$110.64 ","$365.11 ","$368.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000484","EAP","CPT� 74355","","Pl Enteroclysis Tube Perc Spv","BOTH IP/OP","$844.00 ","$624.56 ","$0.00 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$275.61 ","$275.61 ","$0.00 ","$844.00 ","$0.00 ","$202.56 ","$668.45 ","$675.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000485","EAP","CPT� 74360","","Eso-dil Intralu Dil Stric Xray","BOTH IP/OP","$976.00 ","$722.24 ","$0.00 ","$976.00 ","$268.62 ","$0.00 ","$203.42 ","$331.28 ","$331.28 ","$0.00 ","$976.00 ","$0.00 ","$234.24 ","$772.99 ","$780.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000486","EAP","CPT� 74360","","INTRALUMINAL DILAT STRICTU SPV","BOTH IP/OP","$976.00 ","$722.24 ","$0.00 ","$976.00 ","$268.62 ","$0.00 ","$203.42 ","$331.28 ","$331.28 ","$0.00 ","$976.00 ","$0.00 ","$234.24 ","$772.99 ","$780.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000487","EAP","CPT� 74363","","BILIARY STRICTURE SPV","BOTH IP/OP","$2,534.00 ","$1,875.16 ","$0.00 ","$2,534.00 ","$0.00 ","$0.00 ","$0.00 ","$210.40 ","$210.40 ","$0.00 ","$2,534.00 ","$0.00 ","$608.16 ","$2,006.93 ","$2,027.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000488","EAP","CPT� 74400","","Urography Hypertensive","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$200.78 ","$200.78 ","$0.00 ","$888.00 ","$0.00 ","$213.12 ","$703.30 ","$710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000490","EAP","CPT� 74400","","Urography W/wo Kub/tomog Rdg","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$200.78 ","$200.78 ","$0.00 ","$888.00 ","$0.00 ","$213.12 ","$703.30 ","$710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000493","EAP","CPT� 74410","","Urography Drip Infusion Rdg","BOTH IP/OP","$868.00 ","$642.32 ","$0.00 ","$868.00 ","$0.00 ","$0.00 ","$0.00 ","$213.85 ","$213.85 ","$0.00 ","$868.00 ","$0.00 ","$208.32 ","$687.46 ","$694.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000495","EAP","CPT� 74415","","Urography With Nephro Exr","BOTH IP/OP","$868.00 ","$642.32 ","$0.00 ","$868.00 ","$0.00 ","$0.00 ","$0.00 ","$254.73 ","$254.73 ","$0.00 ","$868.00 ","$0.00 ","$208.32 ","$687.46 ","$694.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000496","EAP","CPT� 74420","","Retrograde Urography","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$275.61 ","$275.61 ","$0.00 ","$888.00 ","$0.00 ","$213.12 ","$703.30 ","$710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000497","EAP","CPT� 74420","","Urogra Retro W/wo Kub Rdg","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$275.61 ","$275.61 ","$0.00 ","$888.00 ","$0.00 ","$213.12 ","$703.30 ","$710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000500","EAP","CPT� 74425","","Nephrostogram","BOTH IP/OP","$1,039.00 ","$768.86 ","$67.58 ","$1,039.00 ","$1,021.42 ","$360.63 ","$216.55 ","$137.30 ","$137.30 ","$181.92 ","$1,039.00 ","$387.01 ","$249.36 ","$822.89 ","$831.20 ","$537.70 ","$67.58 ","$106.25 ","$165.41 ","$368.58 "
"32000501","EAP","CPT� 74425","","Loopogram/pouchogram","BOTH IP/OP","$1,039.00 ","$768.86 ","$67.58 ","$1,039.00 ","$1,021.42 ","$360.63 ","$216.55 ","$137.30 ","$137.30 ","$181.92 ","$1,039.00 ","$387.01 ","$249.36 ","$822.89 ","$831.20 ","$537.70 ","$67.58 ","$106.25 ","$165.41 ","$368.58 "
"32000502","EAP","CPT� 74425","","UROGRAPHY ANTEGRADE EXR","BOTH IP/OP","$1,039.00 ","$768.86 ","$67.58 ","$1,039.00 ","$1,021.42 ","$360.63 ","$216.55 ","$137.30 ","$137.30 ","$181.92 ","$1,039.00 ","$387.01 ","$249.36 ","$822.89 ","$831.20 ","$537.70 ","$67.58 ","$106.25 ","$165.41 ","$368.58 "
"32000503","EAP","CPT� 74430","","CYSTOGRAPHY 3+VIEW S&I RDG","BOTH IP/OP","$1,235.00 ","$913.90 ","$0.00 ","$1,247.00 ","$0.00 ","$0.00 ","$257.40 ","$146.57 ","$146.57 ","$218.34 ","$1,247.00 ","$387.01 ","$299.28 ","$987.62 ","$997.60 ","$537.70 ","$56.52 ","$24.49 ","$198.52 ","$368.58 "
"32000504","EAP","CPT� 74430","","Contrast Xray Bladder","BOTH IP/OP","$1,247.00 ","$922.78 ","$0.00 ","$1,247.00 ","$0.00 ","$0.00 ","$259.91 ","$146.57 ","$146.57 ","$218.34 ","$1,247.00 ","$387.01 ","$299.28 ","$987.62 ","$997.60 ","$537.70 ","$56.52 ","$24.49 ","$198.52 ","$368.58 "
"32000505","EAP","CPT� 74440","","Vasography Vesicu'graphy Spv","BOTH IP/OP","$1,078.00 ","$797.72 ","$0.00 ","$1,078.00 ","$0.00 ","$0.00 ","$0.00 ","$153.55 ","$153.55 ","$0.00 ","$1,078.00 ","$0.00 ","$258.72 ","$853.78 ","$862.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000506","EAP","CPT� 74445","","CORPORA CAVERNO'GRAM S&I SPV","BOTH IP/OP","$1,078.00 ","$797.72 ","$0.00 ","$1,078.00 ","$0.00 ","$0.00 ","$0.00 ","$118.38 ","$118.38 ","$0.00 ","$1,078.00 ","$0.00 ","$258.72 ","$853.78 ","$862.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000508","EAP","CPT� 74450","","Retro Urethrocystography","BOTH IP/OP","$2,861.00 ","$2,117.14 ","$0.00 ","$2,632.00 ","$0.00 ","$0.00 ","$596.30 ","$153.20 ","$153.20 ","$460.84 ","$2,632.00 ","$233.72 ","$631.68 ","$2,084.54 ","$2,105.60 ","$324.73 ","$72.23 ","$0.00 ","$419.01 ","$222.60 "
"32000509","EAP","CPT� 74450","","RETROGRADE URETHROGRAM RDG","BOTH IP/OP","$2,861.00 ","$2,117.14 ","$0.00 ","$2,632.00 ","$0.00 ","$0.00 ","$596.30 ","$153.20 ","$153.20 ","$460.84 ","$2,632.00 ","$233.72 ","$631.68 ","$2,084.54 ","$2,105.60 ","$324.73 ","$72.23 ","$0.00 ","$419.01 ","$222.60 "
"32000511","EAP","CPT� 74455","","URETHROCYSTOGRAPHY VOID RDG","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$456.66 ","$174.74 ","$174.74 ","$352.81 ","$2,015.00 ","$233.72 ","$483.60 ","$1,595.88 ","$1,612.00 ","$324.73 ","$76.86 ","$82.12 ","$320.79 ","$222.60 "
"32000514","EAP","CPT� 74485","","NEPHRSTOMY/URETERAL DILAT SPV","BOTH IP/OP","$2,682.00 ","$1,984.68 ","$0.00 ","$2,682.00 ","$0.00 ","$0.00 ","$0.00 ","$215.57 ","$215.57 ","$0.00 ","$2,682.00 ","$0.00 ","$643.68 ","$2,124.14 ","$2,145.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000516","EAP","CPT� 74740","","HYSTEROSALPINGOGRAPHY RDG","BOTH IP/OP","$957.00 ","$708.18 ","$68.95 ","$874.00 ","$170.10 ","$225.34 ","$199.46 ","$138.56 ","$138.56 ","$153.03 ","$874.00 ","$233.72 ","$209.76 ","$692.21 ","$699.20 ","$324.73 ","$68.95 ","$72.03 ","$139.14 ","$222.60 "
"32000517","EAP","CPT� 74742","","TRANSCERVIC CATH FALLOPIAN SPV","BOTH IP/OP","$623.00 ","$461.02 ","$0.00 ","$623.00 ","$0.00 ","$0.00 ","$0.00 ","$143.89 ","$143.89 ","$0.00 ","$623.00 ","$0.00 ","$149.52 ","$493.42 ","$498.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000547","EAP","CPT� 75726","","ANGIO MESENTERIC SPV","BOTH IP/OP","$8,089.00 ","$5,985.86 ","$87.16 ","$8,171.00 ","$340.22 ","$4,670.08 ","$1,685.95 ","$538.95 ","$538.95 ","$1,430.68 ","$8,171.00 ","$4,609.70 ","$1,961.04 ","$6,471.43 ","$6,536.80 ","$6,404.56 ","$535.99 ","$87.16 ","$1,300.82 ","$4,390.19 "
"32000548","EAP","CPT� 75726","","ANGIO HEPATIC SPV","BOTH IP/OP","$8,089.00 ","$5,985.86 ","$87.16 ","$8,171.00 ","$340.22 ","$4,670.08 ","$1,685.95 ","$538.95 ","$538.95 ","$1,430.68 ","$8,171.00 ","$4,609.70 ","$1,961.04 ","$6,471.43 ","$6,536.80 ","$6,404.56 ","$535.99 ","$87.16 ","$1,300.82 ","$4,390.19 "
"32000555","EAP","CPT� 75746","","ANGIO PULMONARY NONSELE SPV","BOTH IP/OP","$2,391.00 ","$1,769.34 ","$0.00 ","$2,989.00 ","$349.06 ","$2,391.00 ","$498.34 ","$524.99 ","$524.99 ","$0.00 ","$2,989.00 ","$0.00 ","$717.36 ","$2,367.29 ","$2,391.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000556","EAP","CPT� 75756","","Artery Xray, Chest","BOTH IP/OP","$3,613.00 ","$2,673.62 ","$0.00 ","$3,649.00 ","$0.00 ","$0.00 ","$0.00 ","$555.53 ","$555.53 ","$0.00 ","$3,649.00 ","$0.00 ","$875.76 ","$2,890.01 ","$2,919.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000560","EAP","CPT� 75809","","Shuntogram Rdg","BOTH IP/OP","$853.00 ","$631.22 ","$53.15 ","$862.00 ","$224.93 ","$106.62 ","$177.79 ","$150.20 ","$150.20 ","$150.93 ","$862.00 ","$112.41 ","$206.88 ","$682.70 ","$689.60 ","$156.18 ","$53.15 ","$68.43 ","$137.23 ","$107.06 "
"32000561","EAP","CPT� 75810","","SPLENOPORTOGRAPHY SPV","BOTH IP/OP","$11,121.00 ","$8,229.54 ","$0.00 ","$11,121.00 ","$0.00 ","$0.00 ","$0.00 ","$1,322.48 ","$1,322.48 ","$0.00 ","$11,121.00 ","$0.00 ","$2,669.04 ","$8,807.83 ","$8,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000562","EAP","CPT� 75820","","EXTREMITY UNI VENOGRAM SPV","BOTH IP/OP","$1,483.00 ","$1,097.42 ","$71.50 ","$1,498.00 ","$262.84 ","$1,377.13 ","$309.09 ","$197.19 ","$197.19 ","$262.29 ","$1,498.00 ","$632.36 ","$359.52 ","$1,186.42 ","$1,198.40 ","$878.58 ","$71.50 ","$74.20 ","$238.48 ","$602.25 "
"32000563","EAP","CPT� 75822","","EXTREMITY BI VENOGRAM SPV","BOTH IP/OP","$1,616.00 ","$1,195.84 ","$75.28 ","$1,635.92 ","$312.02 ","$1,377.13 ","$336.81 ","$218.68 ","$218.68 ","$276.12 ","$1,577.00 ","$1,635.92 ","$378.48 ","$1,248.98 ","$1,261.60 ","$1,577.00 ","$109.07 ","$75.28 ","$251.06 ","$1,558.02 "
"32000564","EAP","CPT� 75825","","INFERIOR VENO CAVAGRAM SPV","BOTH IP/OP","$8,524.00 ","$6,307.76 ","$0.00 ","$8,435.00 ","$308.83 ","$2,803.47 ","$1,776.61 ","$487.46 ","$487.46 ","$0.00 ","$8,435.00 ","$0.00 ","$2,024.40 ","$6,680.52 ","$6,748.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000565","EAP","CPT� 75827","","SUPERIOR VENO CAVAGRAM SPV","BOTH IP/OP","$2,543.00 ","$1,881.82 ","$0.00 ","$2,516.00 ","$0.00 ","$0.00 ","$0.00 ","$489.22 ","$489.22 ","$0.00 ","$2,516.00 ","$0.00 ","$603.84 ","$1,992.67 ","$2,012.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000566","EAP","CPT� 75831","","RENAL VENOGRAPH UNI SELEC SPV","BOTH IP/OP","$7,721.00 ","$5,713.54 ","$0.00 ","$7,799.00 ","$319.28 ","$2,803.47 ","$1,609.25 ","$494.46 ","$494.46 ","$0.00 ","$7,799.00 ","$0.00 ","$1,871.76 ","$6,176.81 ","$6,239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000567","EAP","CPT� 75833","","RENAL VENOGRAM BI SELECT SPV","BOTH IP/OP","$8,009.00 ","$5,926.66 ","$0.00 ","$8,009.00 ","$0.00 ","$0.00 ","$0.00 ","$525.86 ","$525.86 ","$0.00 ","$8,009.00 ","$0.00 ","$1,922.16 ","$6,343.13 ","$6,407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000568","EAP","CPT� 75840","","ADRENAL VENO UNILAT SEL SPV","BOTH IP/OP","$5,361.00 ","$3,967.14 ","$0.00 ","$5,415.00 ","$0.00 ","$0.00 ","$0.00 ","$490.95 ","$490.95 ","$0.00 ","$5,415.00 ","$0.00 ","$1,299.60 ","$4,288.68 ","$4,332.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000569","EAP","CPT� 75842","","ADRENAL VENOGRPHY BI SELCT SPV","BOTH IP/OP","$5,630.00 ","$4,166.20 ","$0.00 ","$5,630.00 ","$0.00 ","$0.00 ","$0.00 ","$527.60 ","$527.60 ","$0.00 ","$5,630.00 ","$0.00 ","$1,351.20 ","$4,458.96 ","$4,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000570","EAP","CPT� 75860","","SINUS/JUGULAR VENOGRAM SPN","BOTH IP/OP","$3,267.00 ","$2,417.58 ","$0.00 ","$3,300.00 ","$327.33 ","$2,803.47 ","$680.92 ","$504.04 ","$504.04 ","$0.00 ","$3,300.00 ","$0.00 ","$792.00 ","$2,613.60 ","$2,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000571","EAP","CPT� 75870","","SUPER SAGG SINUS VENOGRAM SPN","BOTH IP/OP","$2,716.00 ","$2,009.84 ","$0.00 ","$2,716.00 ","$0.00 ","$0.00 ","$0.00 ","$502.30 ","$502.30 ","$0.00 ","$2,716.00 ","$0.00 ","$651.84 ","$2,151.07 ","$2,172.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000572","EAP","CPT� 75872","","EPIDURAL VENOGRAM SPN","BOTH IP/OP","$1,855.00 ","$1,372.70 ","$0.00 ","$1,855.00 ","$0.00 ","$0.00 ","$0.00 ","$552.05 ","$552.05 ","$0.00 ","$1,855.00 ","$0.00 ","$445.20 ","$1,469.16 ","$1,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000573","EAP","CPT� 75880","","ORBITAL VENOGRAM SPN","BOTH IP/OP","$1,855.00 ","$1,372.70 ","$0.00 ","$1,855.00 ","$0.00 ","$0.00 ","$0.00 ","$203.29 ","$203.29 ","$0.00 ","$1,855.00 ","$0.00 ","$445.20 ","$1,469.16 ","$1,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000574","EAP","CPT� 75885","","TRANS-HEP PORT W/HEMODYNAM SPV","BOTH IP/OP","$7,625.00 ","$5,642.50 ","$0.00 ","$7,702.00 ","$0.00 ","$0.00 ","$0.00 ","$496.19 ","$496.19 ","$0.00 ","$7,702.00 ","$0.00 ","$1,848.48 ","$6,099.98 ","$6,161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000575","EAP","CPT� 75887","","TRANS-HEP PORT W/O HEMODYN SPV","BOTH IP/OP","$4,003.00 ","$2,962.22 ","$0.00 ","$4,043.00 ","$0.00 ","$0.00 ","$0.00 ","$501.43 ","$501.43 ","$0.00 ","$4,043.00 ","$0.00 ","$970.32 ","$3,202.06 ","$3,234.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000576","EAP","CPT� 75889","","HEPATIC WEDGE VENO W/EVAL SPV","BOTH IP/OP","$7,625.00 ","$5,642.50 ","$0.00 ","$7,702.00 ","$0.00 ","$0.00 ","$0.00 ","$495.32 ","$495.32 ","$0.00 ","$7,702.00 ","$0.00 ","$1,848.48 ","$6,099.98 ","$6,161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000577","EAP","CPT� 75891","","HEPATIC WEDG VENO W/O EVAL SPV","BOTH IP/OP","$8,009.00 ","$5,926.66 ","$0.00 ","$8,009.00 ","$0.00 ","$0.00 ","$0.00 ","$495.32 ","$495.32 ","$0.00 ","$8,009.00 ","$0.00 ","$1,922.16 ","$6,343.13 ","$6,407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000578","EAP","CPT� 75893","","VENOUS SAMPLING W/WO ANGI SPV","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$494.46 ","$494.46 ","$0.00 ","$5,000.00 ","$0.00 ","$1,200.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000579","EAP","CPT� 75894","","Transcath Embolization","BOTH IP/OP","$11,713.00 ","$8,667.62 ","$0.00 ","$10,671.00 ","$0.00 ","$0.00 ","$0.00 ","$2,534.24 ","$2,534.24 ","$0.00 ","$10,671.00 ","$0.00 ","$2,561.04 ","$8,451.43 ","$8,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000580","EAP","CPT� 75894","","Transcath Embolization, S&i","BOTH IP/OP","$10,671.00 ","$7,896.54 ","$0.00 ","$10,671.00 ","$0.00 ","$0.00 ","$0.00 ","$2,534.24 ","$2,534.24 ","$0.00 ","$10,671.00 ","$0.00 ","$2,561.04 ","$8,451.43 ","$8,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000585","EAP","CPT� 75901","","Remove Cva Device Obstruct","BOTH IP/OP","$585.00 ","$432.90 ","$0.00 ","$591.00 ","$0.00 ","$0.00 ","$0.00 ","$347.69 ","$347.69 ","$0.00 ","$591.00 ","$0.00 ","$141.84 ","$468.07 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000592","EAP","CPT� 75956","","Endovasc Thor Ao Repr","BOTH IP/OP","$2,118.00 ","$1,567.32 ","$0.00 ","$2,118.00 ","$0.00 ","$0.00 ","$0.00 ","$1,511.62 ","$1,511.62 ","$0.00 ","$2,118.00 ","$0.00 ","$508.32 ","$1,677.46 ","$1,694.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000593","EAP","CPT� 75957","","Endovasc Thor Aor Repr","BOTH IP/OP","$2,287.00 ","$1,692.38 ","$0.00 ","$2,287.00 ","$0.00 ","$0.00 ","$0.00 ","$1,632.23 ","$1,632.23 ","$0.00 ","$2,287.00 ","$0.00 ","$548.88 ","$1,811.30 ","$1,829.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000594","EAP","CPT� 75958","","Place Prox Ext Thor Ao","BOTH IP/OP","$1,761.00 ","$1,303.14 ","$0.00 ","$1,761.00 ","$0.00 ","$0.00 ","$0.00 ","$1,256.83 ","$1,256.83 ","$0.00 ","$1,761.00 ","$0.00 ","$422.64 ","$1,394.71 ","$1,408.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000595","EAP","CPT� 75959","","Place Dist Ext Thor Ao","BOTH IP/OP","$1,693.00 ","$1,252.82 ","$0.00 ","$1,693.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.29 ","$1,208.29 ","$0.00 ","$1,693.00 ","$0.00 ","$406.32 ","$1,340.86 ","$1,354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000607","EAP","CPT� 75984","","CHNG DRN TUBE CATH W DYE SPV","BOTH IP/OP","$2,247.00 ","$1,662.78 ","$0.00 ","$2,270.00 ","$0.00 ","$0.00 ","$0.00 ","$184.19 ","$184.19 ","$0.00 ","$2,270.00 ","$0.00 ","$544.80 ","$1,797.84 ","$1,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000608","EAP","CPT� 75989","","Us Drain Percut S&i","BOTH IP/OP","$3,905.00 ","$2,889.70 ","$0.00 ","$3,905.00 ","$726.00 ","$0.00 ","$813.90 ","$755.50 ","$755.50 ","$0.00 ","$3,905.00 ","$0.00 ","$937.20 ","$3,092.76 ","$3,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000609","EAP","CPT� 75989","","Drain Of Abscess Perc S&i","BOTH IP/OP","$4,282.00 ","$3,168.68 ","$0.00 ","$3,905.00 ","$726.00 ","$0.00 ","$892.48 ","$755.50 ","$755.50 ","$0.00 ","$3,905.00 ","$0.00 ","$937.20 ","$3,092.76 ","$3,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000612","EAP","CPT� 76000","","Fluoro Modified Barium Swallow","BOTH IP/OP","$1,426.00 ","$1,055.24 ","$26.65 ","$1,440.00 ","$108.06 ","$225.34 ","$297.21 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000613","EAP","CPT� 76000","","FLUOROSCOPY MAX 1 HOUR RDG","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000614","EAP","CPT� 76000","","Fluoro Time Up To 1 Hr","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000615","EAP","CPT� 76000","","Prosthetic Valve Cine Fluoro","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000619","EAP","CPT� 76010","","NOSE TO RECTUM FBODY CHILD RDG","BOTH IP/OP","$370.00 ","$273.80 ","$0.00 ","$370.00 ","$0.00 ","$0.00 ","$0.00 ","$44.19 ","$44.19 ","$0.00 ","$370.00 ","$0.00 ","$88.80 ","$293.04 ","$296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000621","EAP","CPT� 76080","","ABSCESS/FISTULA/SINUS S&I BCT","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$874.00 ","$0.00 ","$0.00 ","$0.00 ","$85.48 ","$85.48 ","$0.00 ","$874.00 ","$0.00 ","$209.76 ","$692.21 ","$699.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000624","EAP","CPT� 76098","","RAD EXAM SURGICAL SPECMEN BIC","BOTH IP/OP","$1,550.00 ","$1,147.00 ","$27.37 ","$1,409.00 ","$37.91 ","$473.20 ","$323.06 ","$27.63 ","$27.63 ","$246.70 ","$1,409.00 ","$483.00 ","$338.16 ","$1,115.93 ","$1,127.20 ","$671.06 ","$220.51 ","$27.37 ","$224.31 ","$460.00 "
"32000625","EAP","CPT� 76098","","Rad Exam Surgical Specmen Cbc","BOTH IP/OP","$1,409.00 ","$1,042.66 ","$27.37 ","$1,409.00 ","$37.91 ","$473.20 ","$293.67 ","$27.63 ","$27.63 ","$246.70 ","$1,409.00 ","$483.00 ","$338.16 ","$1,115.93 ","$1,127.20 ","$671.06 ","$220.51 ","$27.37 ","$224.31 ","$460.00 "
"32000733","EAP","CPT� 77001","","FLUORO GUIDE CV ACCESS DEV SPV","BOTH IP/OP","$1,059.00 ","$783.66 ","$0.00 ","$1,070.00 ","$191.88 ","$0.00 ","$220.72 ","$203.54 ","$203.54 ","$187.35 ","$1,070.00 ","$0.00 ","$256.80 ","$847.44 ","$856.00 ","$0.00 ","$79.65 ","$78.52 ","$170.34 ","$0.00 "
"32000734","EAP","CPT� 77002","","Fluoro Guide Needle Place Rdg","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$724.00 ","$212.04 ","$0.00 ","$149.44 ","$105.40 ","$105.40 ","$126.77 ","$724.00 ","$0.00 ","$173.76 ","$573.41 ","$579.20 ","$0.00 ","$71.68 ","$81.40 ","$115.26 ","$0.00 "
"32000735","EAP","CPT� 77002","","FLUORO GUIDED BX/ASPIRAT  SPN","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$724.00 ","$0.00 ","$0.00 ","$149.44 ","$105.40 ","$105.40 ","$126.77 ","$724.00 ","$0.00 ","$173.76 ","$573.41 ","$579.20 ","$0.00 ","$71.68 ","$81.40 ","$115.26 ","$0.00 "
"32000736","EAP","CPT� 77002","","Fluoro Guidance For Needle Pla","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$724.00 ","$0.00 ","$0.00 ","$149.44 ","$105.40 ","$105.40 ","$126.77 ","$724.00 ","$0.00 ","$173.76 ","$573.41 ","$579.20 ","$0.00 ","$71.68 ","$81.40 ","$115.26 ","$0.00 "
"32000738","EAP","CPT� 77003","","Fluoroscopy For Spine Procedur","BOTH IP/OP","$924.00 ","$683.76 ","$0.00 ","$933.00 ","$214.45 ","$0.00 ","$192.58 ","$73.98 ","$73.98 ","$163.36 ","$933.00 ","$0.00 ","$223.92 ","$738.94 ","$746.40 ","$0.00 ","$69.40 ","$72.03 ","$148.53 ","$0.00 "
"32000739","EAP","CPT� 77003","","FLOURO GUIDE FOR SPINE RDG","BOTH IP/OP","$924.00 ","$683.76 ","$0.00 ","$933.00 ","$214.45 ","$0.00 ","$192.58 ","$73.98 ","$73.98 ","$163.36 ","$933.00 ","$0.00 ","$223.92 ","$738.94 ","$746.40 ","$0.00 ","$69.40 ","$72.03 ","$148.53 ","$0.00 "
"32000740","EAP","CPT� 77003","","Fluoroguide For Spine Inject","BOTH IP/OP","$924.00 ","$683.76 ","$0.00 ","$933.00 ","$214.45 ","$0.00 ","$192.58 ","$73.98 ","$73.98 ","$163.36 ","$933.00 ","$0.00 ","$223.92 ","$738.94 ","$746.40 ","$0.00 ","$69.40 ","$72.03 ","$148.53 ","$0.00 "
"32000751","EAP","CPT� 77053","","Galactogram Single Duct Bic","BOTH IP/OP","$1,073.00 ","$794.02 ","$0.00 ","$1,329.00 ","$0.00 ","$0.00 ","$0.00 ","$139.22 ","$139.22 ","$0.00 ","$1,329.00 ","$0.00 ","$318.96 ","$1,052.57 ","$1,063.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000752","EAP","CPT� 77054","","Galactogram Multi Duct Bic","BOTH IP/OP","$1,248.00 ","$923.52 ","$0.00 ","$1,546.00 ","$0.00 ","$0.00 ","$0.00 ","$191.70 ","$191.70 ","$0.00 ","$1,546.00 ","$0.00 ","$371.04 ","$1,224.43 ","$1,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000764","EAP","CPT� 77072","","BONE AGE STUDIES X-RAY RDG","BOTH IP/OP","$510.00 ","$377.40 ","$15.85 ","$515.00 ","$52.40 ","$106.62 ","$106.30 ","$32.85 ","$32.85 ","$90.17 ","$515.00 ","$112.41 ","$123.60 ","$407.88 ","$412.00 ","$156.18 ","$21.36 ","$15.85 ","$81.99 ","$107.06 "
"32000766","EAP","CPT� 77073","","BONE LENGTH STUDIES RDG","BOTH IP/OP","$629.00 ","$465.46 ","$30.61 ","$635.00 ","$81.44 ","$106.62 ","$131.10 ","$56.85 ","$56.85 ","$111.18 ","$635.00 ","$112.41 ","$152.40 ","$502.92 ","$508.00 ","$156.18 ","$40.42 ","$30.61 ","$101.09 ","$107.06 "
"32000768","EAP","CPT� 77074","","BONE SURVEY OSSEOUS LIMIT RDG","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$432.00 ","$0.00 ","$0.00 ","$0.00 ","$109.04 ","$109.04 ","$0.00 ","$432.00 ","$0.00 ","$103.68 ","$342.14 ","$345.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000770","EAP","CPT� 77075","","BONE SURVEY OSSEOUS COMPL RDG","BOTH IP/OP","$453.00 ","$335.22 ","$68.07 ","$455.00 ","$198.32 ","$106.62 ","$94.42 ","$172.43 ","$172.43 ","$79.67 ","$455.00 ","$112.41 ","$109.20 ","$360.36 ","$364.00 ","$156.18 ","$85.39 ","$68.07 ","$72.44 ","$107.06 "
"32000772","EAP","CPT� 77076","","BONE SURVEY OSSEOUS INFANT RDG","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$291.00 ","$0.00 ","$0.00 ","$0.00 ","$139.74 ","$139.74 ","$0.00 ","$291.00 ","$0.00 ","$69.84 ","$230.47 ","$232.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000773","EAP","CPT� 77080","","Bone Density Scan Axial","BOTH IP/OP","$866.00 ","$640.84 ","$29.89 ","$875.00 ","$93.51 ","$106.62 ","$180.50 ","$146.62 ","$146.62 ","$153.21 ","$875.00 ","$112.41 ","$210.00 ","$693.00 ","$700.00 ","$156.18 ","$108.31 ","$29.89 ","$139.30 ","$107.06 "
"32000774","EAP","CPT� 77081","","BONE DENSISTY SCAN PERIPH NUC","BOTH IP/OP","$162.00 ","$119.88 ","$22.33 ","$164.00 ","$63.70 ","$79.21 ","$33.76 ","$46.36 ","$46.36 ","$28.72 ","$164.00 ","$80.04 ","$39.36 ","$129.89 ","$131.20 ","$111.21 ","$38.50 ","$22.33 ","$26.11 ","$76.23 "
"32000784","EAP","CPT� 75860","","Sinus/jugular Venogram Nir","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$3,300.00 ","$327.33 ","$2,803.47 ","$655.50 ","$504.04 ","$504.04 ","$0.00 ","$3,300.00 ","$0.00 ","$792.00 ","$2,613.60 ","$2,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000785","EAP","CPT� 75870","","Super Sagg Sinus Venogram Nir","BOTH IP/OP","$2,716.00 ","$2,009.84 ","$0.00 ","$2,716.00 ","$0.00 ","$0.00 ","$0.00 ","$502.30 ","$502.30 ","$0.00 ","$2,716.00 ","$0.00 ","$651.84 ","$2,151.07 ","$2,172.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000786","EAP","CPT� 75872","","Epidural Venogram Nir","BOTH IP/OP","$1,855.00 ","$1,372.70 ","$0.00 ","$1,855.00 ","$0.00 ","$0.00 ","$0.00 ","$552.05 ","$552.05 ","$0.00 ","$1,855.00 ","$0.00 ","$445.20 ","$1,469.16 ","$1,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000787","EAP","CPT� 75894","","Transcath Embolization Nir","BOTH IP/OP","$10,671.00 ","$7,896.54 ","$0.00 ","$10,671.00 ","$0.00 ","$0.00 ","$0.00 ","$2,534.24 ","$2,534.24 ","$0.00 ","$10,671.00 ","$0.00 ","$2,561.04 ","$8,451.43 ","$8,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000790","EAP","CPT� 76000","","Fluoroscopy Max 1 Hour Nir","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$241.15 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000796","EAP","CPT� 74263","","Ct Colonography, Screen","BOTH IP/OP","$1,621.00 ","$1,199.54 ","$0.00 ","$1,621.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,621.00 ","$0.00 ","$389.04 ","$1,283.83 ","$1,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000797","EAP","CPT� 74261","","Ct Colonography, W/o Dye","BOTH IP/OP","$1,621.00 ","$1,199.54 ","$0.00 ","$1,621.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,621.00 ","$0.00 ","$389.04 ","$1,283.83 ","$1,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000798","EAP","CPT� 74262","","Ct Colonography, W/dye","BOTH IP/OP","$1,621.00 ","$1,199.54 ","$0.00 ","$1,621.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,621.00 ","$0.00 ","$389.04 ","$1,283.83 ","$1,296.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000800","EAP","CPT� 76000","","Fluoroscopy 1st Hour","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000801","EAP","CPT� 72072","","Throacic Spine 4 View Rdg","BOTH IP/OP","$1,196.00 ","$885.04 ","$0.00 ","$1,196.00 ","$0.00 ","$0.00 ","$0.00 ","$64.69 ","$64.69 ","$0.00 ","$1,196.00 ","$0.00 ","$287.04 ","$947.23 ","$956.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000802","EAP","CPT� 77071","","Manual Appl Stress Pfrmd Phys/qhp Joint Films","BOTH IP/OP","$433.00 ","$320.42 ","$26.91 ","$437.00 ","$110.48 ","$79.21 ","$90.25 ","$311.89 ","$311.89 ","$76.52 ","$437.00 ","$80.04 ","$104.88 ","$346.10 ","$349.60 ","$111.21 ","$26.91 ","$54.05 ","$69.57 ","$76.23 "
"32000810","EAP","CPT� 74190","","Peritoneogram, Radiological Supervision And Interpretation","BOTH IP/OP","$911.00 ","$674.14 ","$0.00 ","$911.00 ","$0.00 ","$0.00 ","$0.00 ","$137.30 ","$137.30 ","$0.00 ","$911.00 ","$0.00 ","$218.64 ","$721.51 ","$728.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000812","EAP","CPT� 74450","","Urethrocystography, Retrograde, Radiological Supervision","BOTH IP/OP","$2,150.00 ","$1,591.00 ","$0.00 ","$2,632.00 ","$0.00 ","$0.00 ","$448.11 ","$153.20 ","$153.20 ","$460.84 ","$2,632.00 ","$233.72 ","$631.68 ","$2,084.54 ","$2,105.60 ","$324.73 ","$72.23 ","$0.00 ","$419.01 ","$222.60 "
"32000813","EAP","CPT� 74455","","Urethrocystography, Voiding, Radiological Supervision","BOTH IP/OP","$2,191.00 ","$1,621.34 ","$76.86 ","$2,015.00 ","$186.23 ","$225.34 ","$456.66 ","$174.74 ","$174.74 ","$352.81 ","$2,015.00 ","$233.72 ","$483.60 ","$1,595.88 ","$1,612.00 ","$324.73 ","$76.86 ","$82.12 ","$320.79 ","$222.60 "
"32000814","EAP","CPT� 74470","","Radiologic Examination, Renal Cyst Study","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$1,135.00 ","$0.00 ","$0.00 ","$0.00 ","$131.29 ","$131.29 ","$0.00 ","$1,135.00 ","$0.00 ","$272.40 ","$898.92 ","$908.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000815","EAP","CPT� 75733","","Adrenal, Bilateral","BOTH IP/OP","$4,426.00 ","$3,275.24 ","$0.00 ","$4,471.00 ","$0.00 ","$0.00 ","$0.00 ","$622.72 ","$622.72 ","$0.00 ","$4,471.00 ","$0.00 ","$1,073.04 ","$3,541.03 ","$3,576.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000820","EAP","CPT� 75809","","Shuntogram For Investigation","BOTH IP/OP","$862.00 ","$637.88 ","$53.15 ","$862.00 ","$224.93 ","$106.62 ","$179.66 ","$150.20 ","$150.20 ","$150.93 ","$862.00 ","$112.41 ","$206.88 ","$682.70 ","$689.60 ","$156.18 ","$53.15 ","$68.43 ","$137.23 ","$107.06 "
"32000821","EAP","CPT� 75902","","Mechanical Removal Of Intraluminal (intracatheter) Frome","BOTH IP/OP","$1,027.00 ","$759.98 ","$0.00 ","$1,027.00 ","$0.00 ","$0.00 ","$0.00 ","$185.38 ","$185.38 ","$0.00 ","$1,027.00 ","$0.00 ","$246.48 ","$813.38 ","$821.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000822","EAP","CPT� 75970","","Transcatheter Biopsy, Radiological Supervision And Interpretation","BOTH IP/OP","$3,027.00 ","$2,239.98 ","$0.00 ","$3,058.00 ","$1,022.08 ","$0.00 ","$0.00 ","$1,210.95 ","$1,210.95 ","$0.00 ","$3,058.00 ","$0.00 ","$733.92 ","$2,421.94 ","$2,446.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000823","EAP","CPT� 75984","","Change Of Percutaneous Tube Or Drainage Catheter With Contrast","BOTH IP/OP","$2,247.00 ","$1,662.78 ","$0.00 ","$2,270.00 ","$0.00 ","$0.00 ","$0.00 ","$184.19 ","$184.19 ","$0.00 ","$2,270.00 ","$0.00 ","$544.80 ","$1,797.84 ","$1,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000824","EAP","CPT� 75989","","Radiological Guidance For Percutaneous Drainage","BOTH IP/OP","$4,282.00 ","$3,168.68 ","$0.00 ","$3,905.00 ","$726.00 ","$0.00 ","$892.48 ","$755.50 ","$755.50 ","$0.00 ","$3,905.00 ","$0.00 ","$937.20 ","$3,092.76 ","$3,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000825","EAP","CPT� 76080","","Abscess, Fistula, Sinus Tract Study","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$874.00 ","$0.00 ","$0.00 ","$0.00 ","$85.48 ","$85.48 ","$0.00 ","$874.00 ","$0.00 ","$209.76 ","$692.21 ","$699.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000826","EAP","CPT� 76940","","Ultrasound Guidance For, And Monitoring Of, Parenchymaln","BOTH IP/OP","$1,128.00 ","$834.72 ","$0.00 ","$1,139.00 ","$0.00 ","$0.00 ","$0.00 ","$177.84 ","$177.84 ","$0.00 ","$1,139.00 ","$0.00 ","$273.36 ","$902.09 ","$911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000828","EAP","CPT� 0075T","","Intravascular Stent, Perc, Initial Vessel","BOTH IP/OP","$14,320.00 ","$10,596.80 ","$0.00 ","$13,594.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,594.00 ","$0.00 ","$6,797.00 ","$10,766.45 ","$10,875.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000829","EAP","CPT� 0076T","","Intravascular Stent, Perc, Ea Add'l Vessel","BOTH IP/OP","$11,316.00 ","$8,373.84 ","$0.00 ","$12,953.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,953.00 ","$0.00 ","$6,476.50 ","$10,258.78 ","$10,362.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000840","EAP","CPT� 76496","","Fluroscopy Procedure","BOTH IP/OP","$528.00 ","$390.72 ","$0.00 ","$524.00 ","$0.00 ","$0.00 ","$0.00 ","$202.34 ","$202.34 ","$91.75 ","$524.00 ","$0.00 ","$125.76 ","$415.01 ","$419.20 ","$0.00 ","$82.01 ","$0.00 ","$0.00 ","$0.00 "
"32000843","EAP","CPT� 49422","","Removal Of Tunneled Intraperitoneal Catheter","BOTH IP/OP","$3,643.00 ","$2,695.82 ","$0.00 ","$3,415.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,415.00 ","$0.00 ","$2,255.00 ","$2,704.68 ","$2,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000854","EAP","CPT� 72081","","Xr T-l Spine Incl Skull 1 View","BOTH IP/OP","$424.00 ","$313.76 ","$28.45 ","$388.00 ","$88.70 ","$79.21 ","$88.37 ","$60.94 ","$60.94 ","$67.94 ","$388.00 ","$80.04 ","$93.12 ","$307.30 ","$310.40 ","$111.21 ","$37.03 ","$28.45 ","$61.77 ","$76.23 "
"32000855","EAP","CPT� 72083","","Xr T-l Spine 4 Or 5 Views","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,228.00 ","$0.00 ","$0.00 ","$0.00 ","$120.24 ","$120.24 ","$0.00 ","$1,228.00 ","$0.00 ","$294.72 ","$972.58 ","$982.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000856","EAP","CPT� 72084","","Xr T-l Spine Incl Skll 6+ View","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,228.00 ","$0.00 ","$0.00 ","$0.00 ","$144.30 ","$144.30 ","$0.00 ","$1,228.00 ","$0.00 ","$294.72 ","$972.58 ","$982.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000857","EAP","CPT� 73501","","Xr Hip Unilat W/pelvis 1 View","BOTH IP/OP","$378.00 ","$279.72 ","$22.33 ","$350.00 ","$67.72 ","$79.21 ","$78.78 ","$48.93 ","$48.93 ","$61.28 ","$350.00 ","$80.04 ","$84.00 ","$277.20 ","$280.00 ","$111.21 ","$28.22 ","$22.33 ","$55.72 ","$76.23 "
"32000858","EAP","CPT� 73502","","Xr Hip Unilat W/pelvis 2-3 Vw","BOTH IP/OP","$378.00 ","$279.72 ","$34.22 ","$350.00 ","$94.33 ","$79.21 ","$78.78 ","$72.12 ","$72.12 ","$61.28 ","$350.00 ","$80.04 ","$84.00 ","$277.20 ","$280.00 ","$111.21 ","$39.45 ","$34.22 ","$55.72 ","$76.23 "
"32000859","EAP","CPT� 73503","","Xr Hip Unilat W/pelvis 4+ Vw","BOTH IP/OP","$627.00 ","$463.98 ","$42.50 ","$581.00 ","$117.72 ","$106.62 ","$130.68 ","$89.32 ","$89.32 ","$101.73 ","$581.00 ","$112.41 ","$139.44 ","$460.15 ","$464.80 ","$156.18 ","$49.31 ","$42.50 ","$92.50 ","$107.06 "
"32000860","EAP","CPT� 73521","","Xr Hip Bilat W/pelvis 2 Views","BOTH IP/OP","$627.00 ","$463.98 ","$28.81 ","$581.00 ","$90.29 ","$106.62 ","$130.68 ","$67.83 ","$67.83 ","$101.73 ","$581.00 ","$112.41 ","$139.44 ","$460.15 ","$464.80 ","$156.18 ","$37.75 ","$28.81 ","$92.50 ","$107.06 "
"32000861","EAP","CPT� 73522","","Xr Hip Bilat W/pelvis 3-4 View","BOTH IP/OP","$627.00 ","$463.98 ","$37.46 ","$581.00 ","$111.25 ","$106.62 ","$130.68 ","$80.69 ","$80.69 ","$101.73 ","$581.00 ","$112.41 ","$139.44 ","$460.15 ","$464.80 ","$156.18 ","$46.58 ","$37.46 ","$92.50 ","$107.06 "
"32000862","EAP","CPT� 73523","","Xr Hip Bilat W/pelvis 5+ Views","BOTH IP/OP","$1,194.00 ","$883.56 ","$0.00 ","$1,106.00 ","$128.99 ","$106.62 ","$248.86 ","$97.04 ","$97.04 ","$0.00 ","$1,106.00 ","$0.00 ","$265.44 ","$875.95 ","$884.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000863","EAP","CPT� 73551","","Xr Femur 1 View","BOTH IP/OP","$361.00 ","$267.14 ","$0.00 ","$331.00 ","$63.70 ","$79.21 ","$0.00 ","$46.35 ","$46.35 ","$57.96 ","$331.00 ","$80.04 ","$79.44 ","$262.15 ","$264.80 ","$111.21 ","$26.17 ","$20.89 ","$52.70 ","$76.23 "
"32000864","EAP","CPT� 73552","","Xr Femur Min 2 Views","BOTH IP/OP","$361.00 ","$267.14 ","$25.57 ","$331.00 ","$74.18 ","$79.21 ","$75.24 ","$54.94 ","$54.94 ","$57.96 ","$331.00 ","$80.04 ","$79.44 ","$262.15 ","$264.80 ","$111.21 ","$30.93 ","$25.57 ","$52.70 ","$76.23 "
"32000865","EAP","CPT� 76499","","Radiographic Procedure","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$149.00 ","$0.00 ","$79.21 ","$31.26 ","$106.34 ","$106.34 ","$0.00 ","$149.00 ","$0.00 ","$35.76 ","$118.01 ","$119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000866","EAP","CPT� 77077","","Joint Survey Single View","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$63.66 ","$63.66 ","$0.00 ","$275.00 ","$0.00 ","$66.00 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000867","EAP","CPT� 76000","","Fluoro Additional Hour","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$208.35 ","$208.35 ","$252.13 ","$1,440.00 ","$233.72 ","$345.60 ","$1,140.48 ","$1,152.00 ","$324.73 ","$58.43 ","$26.65 ","$229.25 ","$222.60 "
"32000868","EAP","CPT� 75807","","Lymph Vessel X-ray Trunk","BOTH IP/OP","$3,673.00 ","$2,718.02 ","$0.00 ","$3,710.00 ","$0.00 ","$0.00 ","$0.00 ","$600.80 ","$600.80 ","$0.00 ","$3,710.00 ","$0.00 ","$890.40 ","$2,938.32 ","$2,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000869","EAP","CPT� 74248","","Xr Small Bowel Follow-through Add On","BOTH IP/OP","$2,246.00 ","$1,662.04 ","$0.00 ","$2,100.00 ","$187.57 ","$0.00 ","$468.12 ","$106.02 ","$106.02 ","$0.00 ","$2,100.00 ","$0.00 ","$504.00 ","$1,663.20 ","$1,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32000870","EAP","CPT� 72275","","Epidurography","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,334.00 ","$0.00 ","$0.00 ","$275.33 ","$161.56 ","$161.56 ","$233.57 ","$1,334.00 ","$0.00 ","$320.16 ","$1,056.53 ","$1,067.20 ","$0.00 ","$107.42 ","$92.56 ","$212.37 ","$0.00 "
"32200006","EAP","CPT� 73040","","Shoulder Arthrography Rdg","BOTH IP/OP","$1,216.00 ","$899.84 ","$94.00 ","$1,220.00 ","$227.33 ","$360.63 ","$253.44 ","$870.71 ","$870.71 ","$213.61 ","$1,220.00 ","$387.01 ","$292.80 ","$966.24 ","$976.00 ","$537.70 ","$107.06 ","$94.00 ","$194.22 ","$368.58 "
"32300001","EAP","CPT� 75605","","THORACIC ARCH ANGIO SPN","BOTH IP/OP","$5,612.00 ","$4,152.88 ","$0.00 ","$5,669.00 ","$0.00 ","$0.00 ","$0.00 ","$4,045.97 ","$4,045.97 ","$0.00 ","$5,669.00 ","$0.00 ","$1,360.56 ","$4,489.85 ","$4,535.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300002","EAP","CPT� 75625","","AORTOGRAM ABD CATHETER SPV","BOTH IP/OP","$5,567.00 ","$4,119.58 ","$69.51 ","$5,623.00 ","$312.87 ","$2,803.47 ","$1,160.30 ","$4,013.14 ","$4,013.14 ","$984.54 ","$5,623.00 ","$2,779.42 ","$1,349.52 ","$4,453.42 ","$4,498.40 ","$3,861.64 ","$536.35 ","$69.51 ","$895.18 ","$2,647.07 "
"32300003","EAP","CPT� 75630","","Aortography Bilat Lower","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,944.00 ","$0.00 ","$0.00 ","$0.00 ","$4,955.93 ","$4,955.93 ","$0.00 ","$6,944.00 ","$0.00 ","$1,666.56 ","$5,499.65 ","$5,555.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300013","EAP","CPT� 75705","","ANGIO SPINAL SELECTIVE SPN","BOTH IP/OP","$9,855.00 ","$7,292.70 ","$0.00 ","$9,955.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,955.00 ","$0.00 ","$2,389.20 ","$7,884.36 ","$7,964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300014","EAP","CPT� 75710","","ANGIO EXTREMITY UNILAT SPV","BOTH IP/OP","$8,204.00 ","$6,070.96 ","$78.52 ","$7,558.00 ","$369.31 ","$2,803.47 ","$1,709.92 ","$5,158.80 ","$5,158.80 ","$1,323.35 ","$7,558.00 ","$2,779.42 ","$1,813.92 ","$5,985.94 ","$6,046.40 ","$3,861.64 ","$536.72 ","$78.52 ","$1,203.23 ","$2,647.07 "
"32300015","EAP","CPT� 75716","","ANGIO EXTREMITY BILAT SPV","BOTH IP/OP","$8,615.00 ","$6,375.10 ","$80.32 ","$7,936.00 ","$424.93 ","$2,803.47 ","$1,795.58 ","$5,158.80 ","$5,158.80 ","$1,389.53 ","$7,936.00 ","$2,779.42 ","$1,904.64 ","$6,285.31 ","$6,348.80 ","$3,861.64 ","$544.44 ","$80.32 ","$1,263.41 ","$2,647.07 "
"32300018","EAP","CPT� 75726","","Angio Visceral","BOTH IP/OP","$8,089.00 ","$5,985.86 ","$87.16 ","$8,171.00 ","$340.22 ","$4,670.08 ","$1,685.95 ","$5,158.80 ","$5,158.80 ","$1,430.68 ","$8,171.00 ","$4,609.70 ","$1,961.04 ","$6,471.43 ","$6,536.80 ","$6,404.56 ","$535.99 ","$87.16 ","$1,300.82 ","$4,390.19 "
"32300019","EAP","CPT� 75731","","ANGIO ADRENAL UNILAT SPV","BOTH IP/OP","$4,162.00 ","$3,079.88 ","$0.00 ","$4,204.00 ","$0.00 ","$0.00 ","$0.00 ","$3,000.39 ","$3,000.39 ","$0.00 ","$4,204.00 ","$0.00 ","$1,008.96 ","$3,329.57 ","$3,363.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300021","EAP","CPT� 75736","","ANGIO PELVIC SELECTIVE SPV","BOTH IP/OP","$8,804.00 ","$6,514.96 ","$0.00 ","$8,004.00 ","$364.43 ","$4,670.08 ","$0.00 ","$5,158.80 ","$5,158.80 ","$1,401.44 ","$8,004.00 ","$4,609.70 ","$1,920.96 ","$6,339.17 ","$6,403.20 ","$6,404.56 ","$535.99 ","$97.61 ","$1,274.24 ","$4,390.19 "
"32300022","EAP","CPT� 75741","","ANGIO PULMONARY UNILAT SPV","BOTH IP/OP","$5,405.00 ","$3,999.70 ","$0.00 ","$5,460.00 ","$343.41 ","$2,803.47 ","$0.00 ","$3,896.80 ","$3,896.80 ","$0.00 ","$5,460.00 ","$0.00 ","$1,310.40 ","$4,324.32 ","$4,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300023","EAP","CPT� 75743","","ANGIO PULMONARY BILATERAL SPV","BOTH IP/OP","$5,466.00 ","$4,044.84 ","$0.00 ","$5,521.00 ","$0.00 ","$0.00 ","$0.00 ","$3,940.34 ","$3,940.34 ","$0.00 ","$5,521.00 ","$0.00 ","$1,325.04 ","$4,372.63 ","$4,416.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300024","EAP","CPT� 75774","","ANGIO SELECTIVE ADD'L VESS SPV","BOTH IP/OP","$3,796.00 ","$2,809.04 ","$0.00 ","$3,834.00 ","$196.71 ","$0.00 ","$791.18 ","$2,736.33 ","$2,736.33 ","$671.30 ","$3,834.00 ","$0.00 ","$920.16 ","$3,036.53 ","$3,067.20 ","$0.00 ","$497.07 ","$59.79 ","$610.37 ","$0.00 "
"32300026","EAP","CPT� 75898","","ANGIO W/EXIST CATH FU STDY SPV","BOTH IP/OP","$2,784.00 ","$2,060.16 ","$0.00 ","$2,531.00 ","$0.00 ","$0.00 ","$0.00 ","$1,806.37 ","$1,806.37 ","$0.00 ","$2,531.00 ","$0.00 ","$607.44 ","$2,004.55 ","$2,024.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300066","EAP","CPT� 75705","","Angio Spinal Selective Nir","BOTH IP/OP","$9,955.00 ","$7,366.70 ","$0.00 ","$9,955.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,955.00 ","$0.00 ","$2,389.20 ","$7,884.36 ","$7,964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32300071","EAP","CPT� 75716","","Inject: Illiac Angio","BOTH IP/OP","$7,936.00 ","$5,872.64 ","$0.00 ","$7,936.00 ","$0.00 ","$0.00 ","$1,795.58 ","$5,158.80 ","$5,158.80 ","$1,389.53 ","$7,936.00 ","$2,779.42 ","$1,904.64 ","$6,285.31 ","$6,348.80 ","$3,861.64 ","$544.44 ","$80.32 ","$1,263.41 ","$2,647.07 "
"32300072","EAP","CPT� 37197","","Transcatheter Retrieval,percutaneous Of Intravas Fb Inci","BOTH IP/OP","$34,751.00 ","$25,715.74 ","$0.00 ","$32,988.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$32,988.00 ","$2,779.42 ","$2,858.00 ","$26,126.50 ","$26,390.40 ","$3,861.64 ","$0.00 ","$315.16 ","$5,251.69 ","$2,647.07 "
"32400001","EAP","CPT� 71045","","Chest X-ray","BOTH IP/OP","$623.00 ","$461.02 ","$16.57 ","$635.00 ","$45.30 ","$79.21 ","$129.85 ","$25.77 ","$25.77 ","$111.18 ","$635.00 ","$80.04 ","$152.40 ","$502.92 ","$508.00 ","$111.21 ","$19.10 ","$16.57 ","$101.09 ","$76.23 "
"32400002","EAP","CPT� 71045","","CHEST X-RAY 1 VIEW RDG","BOTH IP/OP","$697.00 ","$515.78 ","$16.57 ","$635.00 ","$45.30 ","$79.21 ","$145.27 ","$25.77 ","$25.77 ","$111.18 ","$635.00 ","$80.04 ","$152.40 ","$502.92 ","$508.00 ","$111.21 ","$19.10 ","$16.57 ","$101.09 ","$76.23 "
"32400003","EAP","CPT� 71045","","Line Placement-chest","BOTH IP/OP","$623.00 ","$461.02 ","$16.57 ","$635.00 ","$45.30 ","$79.21 ","$129.85 ","$25.77 ","$25.77 ","$111.18 ","$635.00 ","$80.04 ","$152.40 ","$502.92 ","$508.00 ","$111.21 ","$19.10 ","$16.57 ","$101.09 ","$76.23 "
"32400006","EAP","CPT� 71046","","CHEST 2 VIEW(PA & LATERAL) RDG","BOTH IP/OP","$730.00 ","$540.20 ","$21.97 ","$665.00 ","$69.46 ","$79.21 ","$152.15 ","$47.17 ","$47.17 ","$116.44 ","$665.00 ","$80.04 ","$159.60 ","$526.68 ","$532.00 ","$111.21 ","$29.30 ","$21.97 ","$105.87 ","$76.23 "
"32400008","EAP","CPT� 71047","","CHEST 2VIEW W/APICAL LORDO RDG","BOTH IP/OP","$752.00 ","$556.48 ","$27.73 ","$685.00 ","$88.81 ","$79.21 ","$156.74 ","$60.04 ","$60.04 ","$119.94 ","$685.00 ","$80.04 ","$164.40 ","$542.52 ","$548.00 ","$111.21 ","$37.47 ","$27.73 ","$109.05 ","$76.23 "
"32400010","EAP","CPT� 71048","","CHEST X-RAY 4+VIEW RDG","BOTH IP/OP","$809.00 ","$598.66 ","$28.81 ","$737.00 ","$95.25 ","$106.62 ","$168.62 ","$61.73 ","$61.73 ","$129.04 ","$737.00 ","$112.41 ","$176.88 ","$583.70 ","$589.60 ","$156.18 ","$40.18 ","$28.81 ","$117.33 ","$107.06 "
"32400012","EAP","CPT� 71046","","CHEST X-RAY 3VW DECUBITUS RDG","BOTH IP/OP","$771.00 ","$570.54 ","$21.97 ","$702.00 ","$69.46 ","$79.21 ","$160.70 ","$47.17 ","$47.17 ","$122.91 ","$702.00 ","$80.04 ","$168.48 ","$555.98 ","$561.60 ","$111.21 ","$29.30 ","$21.97 ","$111.76 ","$76.23 "
"33100001","EAP","CPT� 96411","","Iv Chemo Push-ea Addtl Med","BOTH IP/OP","$478.00 ","$353.72 ","$55.87 ","$357.00 ","$183.66 ","$60.72 ","$99.63 ","$254.79 ","$254.79 ","$62.51 ","$357.00 ","$60.65 ","$178.50 ","$282.74 ","$285.60 ","$84.26 ","$55.87 ","$59.80 ","$56.83 ","$57.76 "
"33100002","EAP","CPT� 96409","","Iv Chemo Push-1st Med Initl1vs","BOTH IP/OP","$830.00 ","$614.20 ","$97.03 ","$620.00 ","$326.62 ","$200.34 ","$172.99 ","$442.49 ","$442.49 ","$108.56 ","$620.00 ","$184.28 ","$310.00 ","$491.04 ","$496.00 ","$256.03 ","$97.03 ","$109.86 ","$98.70 ","$175.50 "
"33100004","EAP","CPT� 96411","","Iv Chemo Push1st Med Dur Infus","BOTH IP/OP","$478.00 ","$353.72 ","$55.87 ","$357.00 ","$183.66 ","$60.72 ","$99.63 ","$254.79 ","$254.79 ","$62.51 ","$357.00 ","$60.65 ","$178.50 ","$282.74 ","$285.60 ","$84.26 ","$55.87 ","$59.80 ","$56.83 ","$57.76 "
"33100006","EAP","CPT� 96411","","Iv Chemo Push-1 Med Dur Infus","BOTH IP/OP","$357.00 ","$264.18 ","$55.87 ","$357.00 ","$183.66 ","$60.72 ","$74.41 ","$254.79 ","$254.79 ","$62.51 ","$357.00 ","$60.65 ","$178.50 ","$282.74 ","$285.60 ","$84.26 ","$55.87 ","$59.80 ","$56.83 ","$57.76 "
"33100007","EAP","CPT� 96401","","Inject Chemo-im/sq Non Hormona","BOTH IP/OP","$496.00 ","$367.04 ","$57.76 ","$370.00 ","$219.15 ","$60.72 ","$103.38 ","$264.07 ","$264.07 ","$64.78 ","$370.00 ","$60.65 ","$185.00 ","$293.04 ","$296.00 ","$84.26 ","$57.91 ","$79.97 ","$58.90 ","$57.76 "
"33100008","EAP","CPT� 96402","","Inject Chemo-im/sq Hormonal","BOTH IP/OP","$619.00 ","$458.06 ","$32.07 ","$462.00 ","$95.99 ","$60.72 ","$129.02 ","$329.73 ","$329.73 ","$80.89 ","$462.00 ","$60.65 ","$231.00 ","$365.90 ","$369.60 ","$84.26 ","$72.30 ","$32.07 ","$73.55 ","$57.76 "
"33300001","EAP","CPT� 77280","","Simulation-simple","BOTH IP/OP","$1,882.00 ","$1,392.68 ","$120.92 ","$1,408.00 ","$626.37 ","$124.26 ","$392.26 ","$1,004.89 ","$1,004.89 ","$246.53 ","$1,408.00 ","$126.96 ","$337.92 ","$1,115.14 ","$1,126.40 ","$176.40 ","$220.35 ","$244.20 ","$224.15 ","$120.92 "
"33300002","EAP","CPT� 77285","","Simulation-intermediat","BOTH IP/OP","$2,531.00 ","$1,872.94 ","$296.41 ","$1,894.00 ","$998.00 ","$331.64 ","$527.52 ","$1,351.75 ","$1,351.75 ","$331.62 ","$1,894.00 ","$336.15 ","$454.56 ","$1,500.05 ","$1,515.20 ","$467.03 ","$296.41 ","$414.20 ","$301.52 ","$320.14 "
"33300003","EAP","CPT� 77290","","Simulation-complex","BOTH IP/OP","$3,403.00 ","$2,518.22 ","$320.14 ","$2,546.00 ","$1,180.16 ","$331.64 ","$709.27 ","$1,817.08 ","$1,817.08 ","$445.78 ","$2,546.00 ","$336.15 ","$611.04 ","$2,016.43 ","$2,036.80 ","$467.03 ","$398.45 ","$422.12 ","$405.32 ","$320.14 "
"33300004","EAP","CPT� 77295","","3d Radiotherapy Plan W/ Vol Histo","BOTH IP/OP","$12,364.00 ","$9,149.36 ","$265.08 ","$9,251.00 ","$1,122.08 ","$1,236.66 ","$2,576.97 ","$5,158.80 ","$5,158.80 ","$1,619.78 ","$9,251.00 ","$1,249.00 ","$2,220.24 ","$7,326.79 ","$7,400.80 ","$1,735.32 ","$1,447.78 ","$265.08 ","$1,472.76 ","$1,189.52 "
"33300007","EAP","CPT� 77300","","Central Axis Calculation","BOTH IP/OP","$916.00 ","$677.84 ","$34.22 ","$685.00 ","$152.35 ","$124.26 ","$190.92 ","$488.88 ","$488.88 ","$119.94 ","$685.00 ","$126.96 ","$164.40 ","$542.52 ","$548.00 ","$176.40 ","$107.20 ","$34.22 ","$109.05 ","$120.92 "
"33300008","EAP","CPT� 77301","","Imrt","BOTH IP/OP","$7,048.00 ","$5,215.52 ","$825.22 ","$5,273.00 ","$4,469.34 ","$1,236.66 ","$1,468.98 ","$3,763.34 ","$3,763.34 ","$923.26 ","$5,273.00 ","$1,249.00 ","$1,265.52 ","$4,176.22 ","$4,218.40 ","$1,735.32 ","$825.22 ","$1,513.43 ","$839.46 ","$1,189.52 "
"33300012","EAP","CPT� 77321","","Telether Plan Special","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$44.30 ","$1,459.00 ","$212.81 ","$331.64 ","$406.43 ","$1,041.29 ","$1,041.29 ","$255.46 ","$1,459.00 ","$336.15 ","$350.16 ","$1,155.53 ","$1,167.20 ","$467.03 ","$228.33 ","$44.30 ","$232.27 ","$320.14 "
"33300014","EAP","CPT� 77331","","Tld/microdosimetry","BOTH IP/OP","$889.00 ","$657.86 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$474.61 ","$474.61 ","$0.00 ","$665.00 ","$0.00 ","$159.60 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300015","EAP","CPT� 77332","","Block Simple","BOTH IP/OP","$1,023.00 ","$757.02 ","$23.77 ","$765.00 ","$153.96 ","$124.26 ","$213.22 ","$545.98 ","$545.98 ","$133.95 ","$765.00 ","$126.96 ","$183.60 ","$605.88 ","$612.00 ","$176.40 ","$119.72 ","$23.77 ","$121.79 ","$120.92 "
"33300016","EAP","CPT� 77332","","Bolus Simple","BOTH IP/OP","$765.00 ","$566.10 ","$23.77 ","$765.00 ","$153.96 ","$124.26 ","$159.45 ","$545.98 ","$545.98 ","$133.95 ","$765.00 ","$126.96 ","$183.60 ","$605.88 ","$612.00 ","$176.40 ","$119.72 ","$23.77 ","$121.79 ","$120.92 "
"33300017","EAP","CPT� 77333","","Block Intermed","BOTH IP/OP","$1,426.00 ","$1,055.24 ","$0.00 ","$1,056.00 ","$0.00 ","$0.00 ","$220.10 ","$753.67 ","$753.67 ","$0.00 ","$1,056.00 ","$0.00 ","$253.44 ","$836.35 ","$844.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300018","EAP","CPT� 77333","","Bolus Inter.","BOTH IP/OP","$1,056.00 ","$781.44 ","$0.00 ","$1,056.00 ","$220.86 ","$124.26 ","$220.10 ","$753.67 ","$753.67 ","$0.00 ","$1,056.00 ","$0.00 ","$253.44 ","$836.35 ","$844.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300019","EAP","CPT� 77334","","Device Complex","BOTH IP/OP","$1,488.00 ","$1,101.12 ","$67.35 ","$1,113.00 ","$299.06 ","$331.64 ","$310.14 ","$794.35 ","$794.35 ","$194.88 ","$1,113.00 ","$336.15 ","$267.12 ","$881.50 ","$890.40 ","$467.03 ","$174.18 ","$67.35 ","$177.19 ","$320.14 "
"33300020","EAP","CPT� 77334","","Compensator Filter","BOTH IP/OP","$1,113.00 ","$823.62 ","$67.35 ","$1,113.00 ","$299.06 ","$331.64 ","$231.98 ","$794.35 ","$794.35 ","$194.88 ","$1,113.00 ","$336.15 ","$267.12 ","$881.50 ","$890.40 ","$467.03 ","$174.18 ","$67.35 ","$177.19 ","$320.14 "
"33300021","EAP","CPT� 77334","","Positioning Mold","BOTH IP/OP","$1,113.00 ","$823.62 ","$67.35 ","$1,113.00 ","$299.06 ","$331.64 ","$231.98 ","$794.35 ","$794.35 ","$194.88 ","$1,113.00 ","$336.15 ","$267.12 ","$881.50 ","$890.40 ","$467.03 ","$174.18 ","$67.35 ","$177.19 ","$320.14 "
"33300022","EAP","CPT� 77336","","Continuing Physics/wk","BOTH IP/OP","$962.00 ","$711.88 ","$81.03 ","$720.00 ","$181.47 ","$124.26 ","$200.50 ","$513.86 ","$513.86 ","$126.07 ","$720.00 ","$126.96 ","$172.80 ","$570.24 ","$576.00 ","$176.40 ","$112.68 ","$81.03 ","$114.62 ","$120.92 "
"33300023","EAP","CPT� 77370","","Spec Medical Physics Consult","BOTH IP/OP","$1,142.00 ","$845.08 ","$120.92 ","$855.00 ","$279.07 ","$124.26 ","$238.02 ","$610.21 ","$610.21 ","$149.70 ","$855.00 ","$126.96 ","$205.20 ","$677.16 ","$684.00 ","$176.40 ","$133.81 ","$126.41 ","$136.12 ","$120.92 "
"33300024","EAP","CPT� 77401","","Rad Delivery, Superf &/or Orthovolt, Per Day","BOTH IP/OP","$899.00 ","$665.26 ","$0.00 ","$899.00 ","$0.00 ","$0.00 ","$0.00 ","$641.62 ","$641.62 ","$0.00 ","$899.00 ","$0.00 ","$215.76 ","$712.01 ","$719.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300026","EAP","CPT� 77306","","Telether Plan Simple","BOTH IP/OP","$1,192.00 ","$882.08 ","$0.00 ","$892.00 ","$0.00 ","$0.00 ","$0.00 ","$636.62 ","$636.62 ","$156.18 ","$892.00 ","$336.15 ","$214.08 ","$706.46 ","$713.60 ","$467.03 ","$139.60 ","$76.36 ","$142.01 ","$320.14 "
"33300028","EAP","CPT� 77307","","Telether Plan Complex","BOTH IP/OP","$1,998.00 ","$1,478.52 ","$138.30 ","$1,495.00 ","$660.98 ","$331.64 ","$416.43 ","$1,066.98 ","$1,066.98 ","$261.76 ","$1,495.00 ","$336.15 ","$358.80 ","$1,184.04 ","$1,196.00 ","$467.03 ","$233.97 ","$138.30 ","$238.00 ","$320.14 "
"33300030","EAP","CPT� 77318","","Brachyther Plan Complex","BOTH IP/OP","$2,101.00 ","$1,554.74 ","$0.00 ","$1,572.00 ","$0.00 ","$0.00 ","$0.00 ","$1,121.94 ","$1,121.94 ","$0.00 ","$1,572.00 ","$0.00 ","$377.28 ","$1,245.02 ","$1,257.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300031","EAP","CPT� 77407","","Rad Tx Del >= 1 Mev, Intermed","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$866.43 ","$866.43 ","$0.00 ","$1,214.00 ","$0.00 ","$291.36 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300033","EAP","CPT� 77412","","Rad Tx Del >= 1 Mev, Complex","BOTH IP/OP","$1,771.00 ","$1,310.54 ","$0.00 ","$1,325.00 ","$615.91 ","$236.72 ","$369.12 ","$945.65 ","$945.65 ","$232.00 ","$1,325.00 ","$237.05 ","$318.00 ","$1,049.40 ","$1,060.00 ","$329.36 ","$207.36 ","$0.00 ","$210.94 ","$225.77 "
"33300035","EAP","CPT� 77385","","Imrt Tx Delivery Simple","BOTH IP/OP","$4,467.00 ","$3,305.58 ","$0.00 ","$3,342.00 ","$783.58 ","$531.35 ","$931.03 ","$2,385.19 ","$2,385.19 ","$585.16 ","$3,342.00 ","$540.41 ","$802.08 ","$2,646.86 ","$2,673.60 ","$750.83 ","$523.02 ","$0.00 ","$532.05 ","$514.68 "
"33300037","EAP","CPT� 77386","","Imrt Tx Delivery Complex","BOTH IP/OP","$4,467.00 ","$3,305.58 ","$0.00 ","$3,342.00 ","$786.03 ","$531.35 ","$931.03 ","$2,385.19 ","$2,385.19 ","$585.16 ","$3,342.00 ","$540.41 ","$802.08 ","$2,646.86 ","$2,673.60 ","$750.83 ","$523.02 ","$0.00 ","$532.05 ","$514.68 "
"33300040","EAP","CPT� 77387","","Guidance For Radiation Tx Dlvr","BOTH IP/OP","$1,005.00 ","$743.70 ","$0.00 ","$752.00 ","$146.70 ","$0.00 ","$209.47 ","$536.70 ","$536.70 ","$131.67 ","$752.00 ","$0.00 ","$180.48 ","$595.58 ","$601.60 ","$0.00 ","$117.69 ","$0.00 ","$119.72 ","$0.00 "
"33300047","EAP","CPT� 77417","","Port Image(s)","BOTH IP/OP","$631.00 ","$466.94 ","$0.00 ","$472.00 ","$25.00 ","$0.00 ","$131.52 ","$336.87 ","$336.87 ","$82.64 ","$472.00 ","$0.00 ","$113.28 ","$373.82 ","$377.60 ","$0.00 ","$73.87 ","$11.52 ","$75.14 ","$0.00 "
"33300049","EAP","CPT� 77402","","Rad Tx Del >= 1 Mev, Simple","BOTH IP/OP","$1,202.00 ","$889.48 ","$0.00 ","$899.00 ","$0.00 ","$0.00 ","$0.00 ","$641.62 ","$641.62 ","$157.41 ","$899.00 ","$123.07 ","$215.76 ","$712.01 ","$719.20 ","$170.99 ","$140.69 ","$0.00 ","$143.12 ","$117.21 "
"33300050","EAP","CPT� 77470","","Special Treatment","BOTH IP/OP","$6,620.00 ","$4,898.80 ","$25.93 ","$4,953.00 ","$329.68 ","$531.35 ","$1,379.77 ","$3,534.96 ","$3,534.96 ","$867.23 ","$4,953.00 ","$540.41 ","$1,188.72 ","$3,922.78 ","$3,962.40 ","$750.83 ","$775.14 ","$25.93 ","$788.52 ","$514.68 "
"33300052","EAP","CPT� 77763","","Intracavitary Complex","BOTH IP/OP","$2,833.00 ","$2,096.42 ","$0.00 ","$2,833.00 ","$0.00 ","$0.00 ","$0.00 ","$2,021.91 ","$2,021.91 ","$0.00 ","$2,833.00 ","$0.00 ","$679.92 ","$2,243.74 ","$2,266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300053","EAP","CPT� 77338","","Imrt Treatment Device","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$172.15 ","$1,160.81 ","$1,160.81 ","$331.64 ","$306.38 ","$785.07 ","$785.07 ","$192.60 ","$1,100.00 ","$336.15 ","$264.00 ","$871.20 ","$880.00 ","$467.03 ","$172.15 ","$264.36 ","$175.12 ","$320.14 "
"33300055","EAP","CPT� 77372","","Cranial Only X 1","BOTH IP/OP","$10,692.00 ","$7,912.08 ","$1,067.19 ","$8,000.00 ","$2,454.91 ","$7,616.52 ","$2,228.48 ","$5,158.80 ","$5,158.80 ","$1,400.74 ","$8,000.00 ","$7,965.75 ","$1,920.00 ","$6,336.00 ","$6,400.00 ","$8,000.00 ","$1,252.00 ","$1,067.19 ","$1,273.60 ","$7,586.43 "
"33300057","EAP","CPT� 77373","","Robt Lin-radsurg Fract 1-5","BOTH IP/OP","$7,072.00 ","$5,233.28 ","$828.04 ","$5,291.00 ","$3,115.99 ","$1,698.48 ","$1,473.98 ","$3,776.19 ","$3,776.19 ","$926.41 ","$5,291.00 ","$1,773.65 ","$1,269.84 ","$4,190.47 ","$4,232.80 ","$2,464.25 ","$828.04 ","$1,228.18 ","$842.33 ","$1,689.19 "
"33300067","EAP","CPT� 77014","","Cbct Infusion Radioactive Mat","BOTH IP/OP","$1,462.00 ","$1,081.88 ","$0.00 ","$1,404.90 ","$1,404.90 ","$0.00 ","$304.72 ","$780.79 ","$780.79 ","$191.55 ","$1,094.00 ","$0.00 ","$262.56 ","$866.45 ","$875.20 ","$0.00 ","$171.21 ","$78.16 ","$174.16 ","$0.00 "
"33300073","EAP","CPT� 57156","","Ins Vag Brachytx Device","BOTH IP/OP","$1,386.00 ","$1,025.64 ","$0.00 ","$1,386.00 ","$1,386.00 ","$276.20 ","$288.88 ","$812.19 ","$812.19 ","$0.00 ","$1,138.00 ","$0.00 ","$1,138.00 ","$901.30 ","$910.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33300088","EAP","CPT� 77293","","Resp Motion Mgmt Sim","BOTH IP/OP","$1,270.00 ","$939.80 ","$0.00 ","$1,066.51 ","$1,066.51 ","$0.00 ","$264.70 ","$678.02 ","$678.02 ","$166.34 ","$950.00 ","$0.00 ","$228.00 ","$752.40 ","$760.00 ","$0.00 ","$148.68 ","$350.81 ","$151.24 ","$0.00 "
"33500001","EAP","CPT� 96450","","Iv Chemo Into Cns W/spinal Pun","BOTH IP/OP","$1,346.00 ","$996.04 ","$0.00 ","$1,005.00 ","$535.21 ","$312.26 ","$280.54 ","$717.27 ","$717.27 ","$0.00 ","$1,005.00 ","$0.00 ","$502.50 ","$795.96 ","$804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33500002","EAP","CPT� 96413","","Chemo Tx Admn Iv Nfs Tq Up 1 Hr, Sng Or 1st Sbst/drug","BOTH IP/OP","$1,213.00 ","$897.62 ","$141.79 ","$906.00 ","$405.93 ","$312.26 ","$252.82 ","$646.61 ","$646.61 ","$158.63 ","$906.00 ","$310.51 ","$453.00 ","$717.55 ","$724.80 ","$431.41 ","$141.79 ","$142.28 ","$144.24 ","$295.72 "
"33500003","EAP","CPT� 96416","","Iv Chemo Inf Prolonged Gtr8hrs","BOTH IP/OP","$1,346.00 ","$996.04 ","$142.28 ","$1,005.00 ","$410.10 ","$312.26 ","$280.54 ","$717.27 ","$717.27 ","$175.97 ","$1,005.00 ","$310.51 ","$502.50 ","$795.96 ","$804.00 ","$431.41 ","$157.28 ","$142.28 ","$160.00 ","$295.72 "
"33500004","EAP","CPT� 96415","","Iv Chemo Inf Med Ea Addtl Hr","BOTH IP/OP","$337.00 ","$249.38 ","$30.63 ","$252.00 ","$83.48 ","$60.72 ","$70.24 ","$179.85 ","$179.85 ","$44.12 ","$252.00 ","$60.65 ","$126.00 ","$199.58 ","$201.60 ","$84.26 ","$39.44 ","$30.63 ","$40.12 ","$57.76 "
"33500005","EAP","CPT� 96417","","Iv Chemo Inf Ea New Med 16-90","BOTH IP/OP","$529.00 ","$391.46 ","$57.76 ","$395.00 ","$192.01 ","$60.72 ","$110.26 ","$281.91 ","$281.91 ","$69.16 ","$395.00 ","$60.65 ","$197.50 ","$312.84 ","$316.00 ","$84.26 ","$61.82 ","$69.16 ","$62.88 ","$57.76 "
"33500007","EAP","CPT� 96416","","Iv Chem Inf Prolong Gtr 8hr Pu","BOTH IP/OP","$1,346.00 ","$996.04 ","$142.28 ","$1,005.00 ","$410.10 ","$312.26 ","$280.54 ","$717.27 ","$717.27 ","$175.97 ","$1,005.00 ","$310.51 ","$502.50 ","$795.96 ","$804.00 ","$431.41 ","$157.28 ","$142.28 ","$160.00 ","$295.72 "
"34000004","EAP","CPT� 79440","","Nuclearrx Intra-articular Nuc","BOTH IP/OP","$1,139.00 ","$842.86 ","$0.00 ","$1,139.00 ","$0.00 ","$0.00 ","$0.00 ","$143.59 ","$143.59 ","$0.00 ","$1,139.00 ","$0.00 ","$273.36 ","$902.09 ","$911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34000005","EAP","CPT� 78265","","Nm Gastric Emptying Img Std","BOTH IP/OP","$832.00 ","$615.68 ","$0.00 ","$878.69 ","$832.00 ","$369.17 ","$0.00 ","$878.69 ","$878.69 ","$0.00 ","$832.00 ","$0.00 ","$199.68 ","$658.94 ","$665.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100005","EAP","CPT� 78018","","THYROID CA/METS IMAGE WHOL NUC","BOTH IP/OP","$1,629.00 ","$1,205.46 ","$250.40 ","$1,645.00 ","$738.46 ","$479.24 ","$339.52 ","$636.98 ","$636.98 ","$288.03 ","$1,645.00 ","$456.86 ","$394.80 ","$1,302.84 ","$1,316.00 ","$634.74 ","$250.40 ","$280.57 ","$261.88 ","$435.10 "
"34100006","EAP","CPT� 78020","","Thyroid Carcinoma Metatases Up","BOTH IP/OP","$1,082.00 ","$800.68 ","$0.00 ","$1,093.00 ","$0.00 ","$0.00 ","$0.00 ","$143.59 ","$143.59 ","$0.00 ","$1,093.00 ","$0.00 ","$262.32 ","$865.66 ","$874.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100007","EAP","CPT� 78070","","PARATHYROID SCAN NUC","BOTH IP/OP","$1,933.00 ","$1,430.42 ","$107.84 ","$1,953.00 ","$707.81 ","$369.17 ","$402.89 ","$308.97 ","$308.97 ","$341.95 ","$1,953.00 ","$354.53 ","$468.72 ","$1,546.78 ","$1,562.40 ","$492.57 ","$107.84 ","$265.80 ","$310.92 ","$337.65 "
"34100008","EAP","CPT� 78075","","ADRENAL SCAN CORTX&/MEDU NUC","BOTH IP/OP","$12,239.00 ","$9,056.86 ","$0.00 ","$12,363.00 ","$0.00 ","$0.00 ","$0.00 ","$873.47 ","$873.47 ","$0.00 ","$12,363.00 ","$0.00 ","$2,967.12 ","$9,791.50 ","$9,890.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100009","EAP","CPT� 78102","","BONE MARROW LIMITED NUC","BOTH IP/OP","$1,469.00 ","$1,087.06 ","$0.00 ","$1,469.00 ","$0.00 ","$0.00 ","$0.00 ","$313.20 ","$313.20 ","$0.00 ","$1,469.00 ","$0.00 ","$352.56 ","$1,163.45 ","$1,175.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100010","EAP","CPT� 78104","","BONE MARROW WHOLE BODY NUC","BOTH IP/OP","$1,469.00 ","$1,087.06 ","$0.00 ","$1,469.00 ","$0.00 ","$0.00 ","$0.00 ","$487.96 ","$487.96 ","$0.00 ","$1,469.00 ","$0.00 ","$352.56 ","$1,163.45 ","$1,175.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100011","EAP","CPT� 78140","","RBC LABELED SEQ LIVER NUC","BOTH IP/OP","$1,312.00 ","$970.88 ","$0.00 ","$1,312.00 ","$0.00 ","$0.00 ","$0.00 ","$277.78 ","$277.78 ","$0.00 ","$1,312.00 ","$0.00 ","$314.88 ","$1,039.10 ","$1,049.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100012","EAP","CPT� 78185","","SPLEEN SCAN W/ W/O FLOW NUC","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$392.47 ","$392.47 ","$0.00 ","$1,410.00 ","$0.00 ","$338.40 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100013","EAP","CPT� 78195","","LYMPHOSCINTIGRAPHY NUC","BOTH IP/OP","$1,629.00 ","$1,205.46 ","$211.12 ","$1,645.00 ","$840.05 ","$479.24 ","$339.52 ","$641.52 ","$641.52 ","$288.03 ","$1,645.00 ","$456.86 ","$394.80 ","$1,302.84 ","$1,316.00 ","$634.74 ","$211.12 ","$306.14 ","$261.88 ","$435.10 "
"34100015","EAP","CPT� 78215","","Liver & Spleen Imaging Static","BOTH IP/OP","$1,454.00 ","$1,075.96 ","$0.00 ","$1,469.00 ","$457.93 ","$369.17 ","$303.05 ","$375.72 ","$375.72 ","$0.00 ","$1,469.00 ","$0.00 ","$352.56 ","$1,163.45 ","$1,175.20 ","$0.00 ","$136.08 ","$0.00 ","$0.00 ","$0.00 "
"34100016","EAP","CPT� 78216","","LIVER/SPLEEN W/VASCU FLOW NUC","BOTH IP/OP","$1,469.00 ","$1,087.06 ","$0.00 ","$1,469.00 ","$0.00 ","$0.00 ","$0.00 ","$260.79 ","$260.79 ","$0.00 ","$1,469.00 ","$0.00 ","$352.56 ","$1,163.45 ","$1,175.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100019","EAP","CPT� 78262","","GI REFLUX NUC","BOTH IP/OP","$2,128.00 ","$1,574.72 ","$0.00 ","$2,128.00 ","$0.00 ","$0.00 ","$0.00 ","$480.95 ","$480.95 ","$0.00 ","$2,128.00 ","$0.00 ","$510.72 ","$1,685.38 ","$1,702.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100020","EAP","CPT� 78264","","GASTRIC EMPTYING NUC","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$196.51 ","$2,869.00 ","$793.29 ","$369.17 ","$649.24 ","$552.52 ","$552.52 ","$502.34 ","$2,869.00 ","$354.53 ","$688.56 ","$2,272.25 ","$2,295.20 ","$492.57 ","$196.51 ","$303.26 ","$456.74 ","$337.65 "
"34100021","EAP","CPT� 78278","","ACUTE GI BLEEDING IMAGING NUC","BOTH IP/OP","$2,498.00 ","$1,848.52 ","$0.00 ","$2,301.00 ","$0.00 ","$0.00 ","$0.00 ","$659.40 ","$659.40 ","$0.00 ","$2,301.00 ","$0.00 ","$552.24 ","$1,822.39 ","$1,840.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100022","EAP","CPT� 78290","","BOWEL IMAGING MECKLES SCAN NUC","BOTH IP/OP","$2,402.00 ","$1,777.48 ","$0.00 ","$2,213.00 ","$0.00 ","$0.00 ","$0.00 ","$613.67 ","$613.67 ","$0.00 ","$2,213.00 ","$0.00 ","$531.12 ","$1,752.70 ","$1,770.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100023","EAP","CPT� 78291","","SHUNT PATENCY LEVEEN/DENV  NUC","BOTH IP/OP","$2,255.00 ","$1,668.70 ","$0.00 ","$2,255.00 ","$0.00 ","$0.00 ","$0.00 ","$460.07 ","$460.07 ","$0.00 ","$2,255.00 ","$0.00 ","$541.20 ","$1,785.96 ","$1,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100024","EAP","CPT� 78300","","BONE IMAGING LIMITED NUC","BOTH IP/OP","$1,481.00 ","$1,095.94 ","$0.00 ","$1,496.00 ","$0.00 ","$0.00 ","$0.00 ","$323.37 ","$323.37 ","$0.00 ","$1,496.00 ","$0.00 ","$359.04 ","$1,184.83 ","$1,196.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100025","EAP","CPT� 78306","","Nm Bone Imaging Whole Body","BOTH IP/OP","$2,737.00 ","$2,025.38 ","$205.40 ","$2,765.00 ","$592.52 ","$369.17 ","$570.46 ","$482.71 ","$482.71 ","$484.13 ","$2,765.00 ","$354.53 ","$663.60 ","$2,189.88 ","$2,212.00 ","$492.57 ","$205.40 ","$266.89 ","$440.19 ","$337.65 "
"34100026","EAP","CPT� 78315","","Nm Bone Imaging 3 Phase Study","BOTH IP/OP","$2,737.00 ","$2,025.38 ","$0.00 ","$2,765.00 ","$0.00 ","$0.00 ","$0.00 ","$656.78 ","$656.78 ","$484.13 ","$2,765.00 ","$354.53 ","$663.60 ","$2,189.88 ","$2,212.00 ","$492.57 ","$232.73 ","$305.42 ","$440.19 ","$337.65 "
"34100028","EAP","CPT� 78445","","Ceretec Vascular Flow Imaging","BOTH IP/OP","$1,584.00 ","$1,172.16 ","$0.00 ","$1,584.00 ","$0.00 ","$0.00 ","$0.00 ","$329.06 ","$329.06 ","$0.00 ","$1,584.00 ","$0.00 ","$380.16 ","$1,254.53 ","$1,267.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100029","EAP","CPT� 78453","","Cardiac Scan Thallium (planar)","BOTH IP/OP","$5,102.00 ","$3,775.48 ","$0.00 ","$5,827.00 ","$0.00 ","$0.00 ","$0.00 ","$546.60 ","$546.60 ","$0.00 ","$5,827.00 ","$0.00 ","$1,398.48 ","$4,614.98 ","$4,661.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100030","EAP","CPT� 78451","","CARDIAC PERFUSION SINGLE NUC","BOTH IP/OP","$6,945.00 ","$5,139.30 ","$167.51 ","$7,015.00 ","$799.71 ","$1,279.77 ","$1,447.51 ","$609.93 ","$609.93 ","$1,228.27 ","$7,015.00 ","$1,232.99 ","$1,683.60 ","$5,555.88 ","$5,612.00 ","$1,713.08 ","$167.51 ","$278.41 ","$1,116.79 ","$1,174.28 "
"34100031","EAP","CPT� 78452","","Cardiac Scan","BOTH IP/OP","$9,411.00 ","$6,964.14 ","$286.29 ","$9,506.00 ","$1,110.89 ","$1,279.77 ","$1,961.49 ","$892.62 ","$892.62 ","$1,664.42 ","$9,506.00 ","$1,232.99 ","$2,281.44 ","$7,528.75 ","$7,604.80 ","$1,713.08 ","$286.29 ","$403.03 ","$1,513.36 ","$1,174.28 "
"34100032","EAP","CPT� 78472","","CARDIAC SCAN GATED NUC","BOTH IP/OP","$3,623.00 ","$2,681.02 ","$185.13 ","$3,660.00 ","$538.53 ","$369.17 ","$755.12 ","$499.80 ","$499.80 ","$640.84 ","$3,660.00 ","$354.53 ","$878.40 ","$2,898.72 ","$2,928.00 ","$492.57 ","$259.91 ","$185.13 ","$582.67 ","$337.65 "
"34100034","EAP","CPT� 78580","","Pulm (lung) Perfusion Imag","BOTH IP/OP","$2,905.00 ","$2,149.70 ","$167.63 ","$2,912.00 ","$563.53 ","$369.17 ","$605.47 ","$402.17 ","$402.17 ","$509.87 ","$2,912.00 ","$354.53 ","$698.88 ","$2,306.30 ","$2,329.60 ","$492.57 ","$167.63 ","$206.74 ","$463.59 ","$337.65 "
"34100038","EAP","CPT� 78606","","BRAIN SCAN W/VASCULAR FLO NUC","BOTH IP/OP","$2,511.00 ","$1,858.14 ","$0.00 ","$2,283.00 ","$0.00 ","$0.00 ","$0.00 ","$634.70 ","$634.70 ","$0.00 ","$2,283.00 ","$0.00 ","$547.92 ","$1,808.14 ","$1,826.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100040","EAP","CPT� 78630","","CISTERNOGRAPHY NUC","BOTH IP/OP","$1,521.00 ","$1,125.54 ","$0.00 ","$1,521.00 ","$0.00 ","$0.00 ","$0.00 ","$673.93 ","$673.93 ","$0.00 ","$1,521.00 ","$0.00 ","$365.04 ","$1,204.63 ","$1,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100041","EAP","CPT� 78701","","Kidney Imag W/vascul Flo Nuc","BOTH IP/OP","$4,099.00 ","$3,033.26 ","$0.00 ","$4,099.00 ","$0.00 ","$0.00 ","$0.00 ","$426.60 ","$426.60 ","$0.00 ","$4,099.00 ","$0.00 ","$983.76 ","$3,246.41 ","$3,279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100042","EAP","CPT� 78707","","Kid.img.mor.w/vas.singlew/o Ph","BOTH IP/OP","$3,679.00 ","$2,722.46 ","$191.97 ","$3,444.00 ","$548.20 ","$479.24 ","$766.80 ","$448.52 ","$448.52 ","$603.02 ","$3,444.00 ","$456.86 ","$826.56 ","$2,727.65 ","$2,755.20 ","$634.74 ","$218.15 ","$191.97 ","$548.28 ","$435.10 "
"34100043","EAP","CPT� 78708","","Kid.img.mor.w/vas.singlew/phar","BOTH IP/OP","$3,968.00 ","$2,936.32 ","$122.10 ","$3,715.00 ","$413.58 ","$479.24 ","$827.03 ","$312.40 ","$312.40 ","$650.47 ","$3,715.00 ","$456.86 ","$891.60 ","$2,942.28 ","$2,972.00 ","$634.74 ","$228.29 ","$122.10 ","$591.43 ","$435.10 "
"34100044","EAP","CPT� 78709","","Kid.img.mor.w/vas.multi W&w/o","BOTH IP/OP","$3,969.00 ","$2,937.06 ","$0.00 ","$3,716.00 ","$859.37 ","$479.24 ","$827.24 ","$659.70 ","$659.70 ","$0.00 ","$3,716.00 ","$0.00 ","$891.84 ","$2,943.07 ","$2,972.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100045","EAP","CPT� 78740","","Voiding Cystogram Nuc","BOTH IP/OP","$3,569.00 ","$2,641.06 ","$0.00 ","$3,569.00 ","$0.00 ","$0.00 ","$0.00 ","$411.81 ","$411.81 ","$0.00 ","$3,569.00 ","$0.00 ","$856.56 ","$2,826.65 ","$2,855.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100046","EAP","CPT� 78800","","Nm Rp Loclzj Tum Plnr 1 Area Single Day Imaging","BOTH IP/OP","$1,356.00 ","$1,003.44 ","$162.68 ","$1,370.00 ","$453.92 ","$369.17 ","$282.62 ","$353.30 ","$353.30 ","$239.88 ","$1,370.00 ","$354.53 ","$328.80 ","$1,085.04 ","$1,096.00 ","$492.57 ","$162.68 ","$233.75 ","$218.10 ","$337.65 "
"34100047","EAP","CPT� 78801","","Nm Rp Loclzj Tum Plnr 2+ Areas Or 2+ Days","BOTH IP/OP","$1,295.00 ","$958.30 ","$0.00 ","$1,295.00 ","$0.00 ","$0.00 ","$0.00 ","$482.71 ","$482.71 ","$0.00 ","$1,295.00 ","$0.00 ","$310.80 ","$1,025.64 ","$1,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100048","EAP","CPT� 78802","","TUMOR SINGLE DAY","BOTH IP/OP","$1,371.00 ","$1,014.54 ","$0.00 ","$1,385.00 ","$0.00 ","$0.00 ","$0.00 ","$654.28 ","$654.28 ","$0.00 ","$1,385.00 ","$0.00 ","$332.40 ","$1,096.92 ","$1,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100049","EAP","CPT� 78803","","NM TUMOR LOCALALIZATION SPECT","BOTH IP/OP","$4,783.00 ","$3,539.42 ","$0.00 ","$4,831.00 ","$0.00 ","$0.00 ","$0.00 ","$703.26 ","$703.26 ","$0.00 ","$4,831.00 ","$1,232.99 ","$1,159.44 ","$3,826.15 ","$3,864.80 ","$1,713.08 ","$0.00 ","$346.84 ","$769.10 ","$1,174.28 "
"34100057","EAP","CPT� 78451","","Myocardial Ejection Fraction","BOTH IP/OP","$6,142.00 ","$4,545.08 ","$167.51 ","$7,015.00 ","$799.71 ","$1,279.77 ","$1,280.15 ","$609.93 ","$609.93 ","$1,228.27 ","$7,015.00 ","$1,232.99 ","$1,683.60 ","$5,555.88 ","$5,612.00 ","$1,713.08 ","$167.51 ","$278.41 ","$1,116.79 ","$1,174.28 "
"34100060","EAP","CPT� 78804","","TUMOR IMAGING WHOLE BODY NUC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,525.00 ","$0.00 ","$0.00 ","$0.00 ","$1,204.94 ","$1,204.94 ","$442.11 ","$2,525.00 ","$1,232.99 ","$606.00 ","$1,999.80 ","$2,020.00 ","$1,713.08 ","$395.16 ","$629.22 ","$401.98 ","$1,174.28 "
"34100062","EAP","CPT� 78226","","Hepatobiliary Imag W Glbldr","BOTH IP/OP","$2,589.00 ","$1,915.86 ","$300.74 ","$2,615.00 ","$780.38 ","$369.17 ","$539.61 ","$710.47 ","$710.47 ","$457.87 ","$2,615.00 ","$354.53 ","$627.60 ","$2,071.08 ","$2,092.00 ","$492.57 ","$315.27 ","$300.74 ","$416.31 ","$337.65 "
"34100063","EAP","CPT� 78227","","Hepatobil Imag Pharma W Glbldr","BOTH IP/OP","$2,615.00 ","$1,935.10 ","$0.00 ","$2,615.00 ","$0.00 ","$0.00 ","$0.00 ","$986.60 ","$986.60 ","$0.00 ","$2,615.00 ","$0.00 ","$627.60 ","$2,071.08 ","$2,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100064","EAP","CPT� 78579","","Pulmonary Ventilation Imaging","BOTH IP/OP","$1,086.00 ","$803.64 ","$0.00 ","$1,089.00 ","$0.00 ","$0.00 ","$0.00 ","$366.73 ","$366.73 ","$0.00 ","$1,089.00 ","$0.00 ","$261.36 ","$862.49 ","$871.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100065","EAP","CPT� 78582","","Pulmon Vent Imag W Perfus","BOTH IP/OP","$1,696.00 ","$1,255.04 ","$270.64 ","$1,700.00 ","$789.25 ","$479.24 ","$353.49 ","$658.52 ","$658.52 ","$297.66 ","$1,700.00 ","$456.86 ","$408.00 ","$1,346.40 ","$1,360.00 ","$634.74 ","$308.89 ","$289.94 ","$270.64 ","$435.10 "
"34100066","EAP","CPT� 78598","","Quant Diff Pulm Perfu + Vent","BOTH IP/OP","$1,700.00 ","$1,258.00 ","$0.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$637.10 ","$637.10 ","$0.00 ","$1,700.00 ","$0.00 ","$408.00 ","$1,346.40 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100067","EAP","CPT� 78597","","Quant Diff Pulm Perfusion","BOTH IP/OP","$1,086.00 ","$803.64 ","$0.00 ","$1,089.00 ","$0.00 ","$0.00 ","$0.00 ","$393.13 ","$393.13 ","$0.00 ","$1,089.00 ","$0.00 ","$261.36 ","$862.49 ","$871.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100070","EAP","CPT� 78645","","Shunt Evaluation","BOTH IP/OP","$922.00 ","$682.28 ","$0.00 ","$922.00 ","$0.00 ","$0.00 ","$0.00 ","$627.32 ","$627.32 ","$0.00 ","$922.00 ","$0.00 ","$221.28 ","$730.22 ","$737.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100072","EAP","CPT� 78012","","Thyroid Uptake Sing/multi Inc Supres Disch","BOTH IP/OP","$4,484.00 ","$3,318.16 ","$0.00 ","$4,645.00 ","$0.00 ","$0.00 ","$0.00 ","$178.75 ","$178.75 ","$0.00 ","$4,645.00 ","$0.00 ","$1,114.80 ","$3,678.84 ","$3,716.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100073","EAP","CPT� 78013","","Thyroid Imaging","BOTH IP/OP","$2,280.00 ","$1,687.20 ","$0.00 ","$2,303.00 ","$0.00 ","$0.00 ","$0.00 ","$465.43 ","$465.43 ","$0.00 ","$2,303.00 ","$0.00 ","$552.72 ","$1,823.98 ","$1,842.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100074","EAP","CPT� 78014","","Thyroid Imaging W/multi Determ Inc Suprs/dc","BOTH IP/OP","$5,018.00 ","$3,713.32 ","$222.22 ","$5,069.00 ","$569.98 ","$369.17 ","$1,045.88 ","$529.70 ","$529.70 ","$887.54 ","$5,069.00 ","$354.53 ","$1,216.56 ","$4,014.65 ","$4,055.20 ","$492.57 ","$232.84 ","$222.22 ","$806.98 ","$337.65 "
"34100075","EAP","CPT� 78071","","Parathyrd Planar W/wo Subtrj","BOTH IP/OP","$1,132.00 ","$837.68 ","$0.00 ","$1,173.00 ","$0.00 ","$0.00 ","$0.00 ","$739.03 ","$739.03 ","$0.00 ","$1,173.00 ","$0.00 ","$281.52 ","$929.02 ","$938.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34100076","EAP","CPT� 78072","","Parathyrd Planar W/spect&ct","BOTH IP/OP","$3,095.00 ","$2,290.30 ","$74.44 ","$3,126.00 ","$726.00 ","$479.24 ","$645.08 ","$755.50 ","$755.50 ","$547.34 ","$3,126.00 ","$456.86 ","$750.24 ","$2,475.79 ","$2,500.80 ","$634.74 ","$74.44 ","$381.06 ","$497.66 ","$435.10 "
"34100077","EAP","CPT� 78831","","Nm Rp Loclzj Tum Spect 2 Area/1 Day Or 1 Area/2+ Day","BOTH IP/OP","$2,001.00 ","$1,480.74 ","$0.00 ","$2,021.00 ","$0.00 ","$0.00 ","$0.00 ","$1,423.76 ","$1,423.76 ","$0.00 ","$2,021.00 ","$0.00 ","$485.04 ","$1,600.63 ","$1,616.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34200013","EAP","CPT� 79005","","INIT HYPERTHYROID THERAPY NUC","BOTH IP/OP","$2,958.00 ","$2,188.92 ","$51.14 ","$2,988.00 ","$314.37 ","$247.80 ","$616.52 ","$149.70 ","$149.70 ","$523.17 ","$2,988.00 ","$238.10 ","$717.12 ","$2,366.50 ","$2,390.40 ","$330.81 ","$196.86 ","$51.14 ","$475.69 ","$226.76 "
"34200014","EAP","CPT� 77316","","Brachyther Plan Simple","BOTH IP/OP","$904.00 ","$668.96 ","$145.35 ","$913.00 ","$431.30 ","$331.64 ","$188.42 ","$274.23 ","$274.23 ","$159.86 ","$913.00 ","$336.15 ","$219.12 ","$723.10 ","$730.40 ","$467.03 ","$177.21 ","$146.23 ","$145.35 ","$320.14 "
"34200015","EAP","CPT� 77317","","Brachyther Plan Inter","BOTH IP/OP","$1,196.00 ","$885.04 ","$191.61 ","$1,208.00 ","$561.87 ","$331.64 ","$249.28 ","$357.34 ","$357.34 ","$211.51 ","$1,208.00 ","$336.15 ","$289.92 ","$956.74 ","$966.40 ","$467.03 ","$231.84 ","$191.61 ","$192.31 ","$320.14 "
"34200016","EAP","CPT� 79445","","Nuclear Rx Intra-arterial","BOTH IP/OP","$1,324.00 ","$979.76 ","$0.00 ","$1,324.00 ","$0.00 ","$0.00 ","$0.00 ","$252.71 ","$252.71 ","$0.00 ","$1,324.00 ","$0.00 ","$317.76 ","$1,048.61 ","$1,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34200017","EAP","CPT� 77770","","Hdr Brachytx 1 Channel","BOTH IP/OP","$4,521.00 ","$3,345.54 ","$236.63 ","$4,567.00 ","$733.58 ","$694.72 ","$942.29 ","$533.35 ","$533.35 ","$799.65 ","$4,567.00 ","$742.70 ","$1,096.08 ","$3,617.06 ","$3,653.60 ","$1,031.88 ","$308.15 ","$236.63 ","$727.07 ","$707.33 "
"34200018","EAP","CPT� 77771","","Hdr Brachytx 2-12 Channel","BOTH IP/OP","$5,523.00 ","$4,087.02 ","$405.91 ","$5,579.00 ","$1,366.38 ","$694.72 ","$1,151.13 ","$971.39 ","$971.39 ","$976.84 ","$5,579.00 ","$742.70 ","$1,338.96 ","$4,418.57 ","$4,463.20 ","$1,031.88 ","$573.41 ","$405.91 ","$888.18 ","$707.33 "
"34200019","EAP","CPT� 77772","","Hdr Brachytx Over 12 Chan","BOTH IP/OP","$6,877.00 ","$5,088.98 ","$0.00 ","$6,946.00 ","$0.00 ","$0.00 ","$0.00 ","$1,533.05 ","$1,533.05 ","$0.00 ","$6,946.00 ","$0.00 ","$1,667.04 ","$5,501.23 ","$5,556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300001","EAP","HCPCS A9500","","Tc-99m Sestambi/cardiolite Nu","BOTH IP/OP","$516.00 ","$381.84 ","$0.00 ","$516.00 ","$0.00 ","$0.00 ","$107.55 ","$368.27 ","$368.27 ","$90.35 ","$516.00 ","$0.00 ","$258.00 ","$408.67 ","$412.80 ","$0.00 ","$106.29 ","$0.00 ","$82.15 ","$0.00 "
"34300002","EAP","HCPCS A9502","","Tetrofosmin Myoview Nuc","BOTH IP/OP","$812.00 ","$600.88 ","$0.00 ","$812.00 ","$0.00 ","$0.00 ","$155.45 ","$579.52 ","$579.52 ","$131.76 ","$812.00 ","$0.00 ","$406.00 ","$643.10 ","$649.60 ","$0.00 ","$125.46 ","$0.00 ","$129.27 ","$0.00 "
"34300003","EAP","HCPCS A9503","","99mtc Mdp Nuc","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$312.00 ","$0.00 ","$0.00 ","$65.03 ","$222.67 ","$222.67 ","$54.63 ","$312.00 ","$0.00 ","$156.00 ","$247.10 ","$249.60 ","$0.00 ","$48.83 ","$0.00 ","$49.67 ","$0.00 "
"34300004","EAP","HCPCS A9505","","Ti-201 Thallous Chloride Nuc","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300005","EAP","HCPCS A9516","","I-123 Iodine Capsule Nuc","BOTH IP/OP","$2,008.00 ","$1,485.92 ","$0.00 ","$2,008.00 ","$0.00 ","$0.00 ","$418.52 ","$1,433.11 ","$1,433.11 ","$351.58 ","$2,008.00 ","$0.00 ","$1,004.00 ","$1,590.34 ","$1,606.40 ","$0.00 ","$314.25 ","$0.00 ","$319.67 ","$0.00 "
"34300006","EAP","HCPCS A9521","","99mtc Ceretec-labld - Wbc","BOTH IP/OP","$1,888.00 ","$1,397.12 ","$0.00 ","$1,888.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.47 ","$1,347.47 ","$0.00 ","$1,888.00 ","$0.00 ","$944.00 ","$1,495.30 ","$1,510.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300007","EAP","HCPCS A9537","","99mtc Hepat-biliary-unprep Nu","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$69.82 ","$239.09 ","$239.09 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.00 ","$0.00 ","$53.33 ","$0.00 "
"34300008","EAP","HCPCS A9539","","99mtc Dtpa","BOTH IP/OP","$409.00 ","$302.66 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$239.09 ","$239.09 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"34300009","EAP","HCPCS A9540","","99mtc Maauc","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"34300010","EAP","HCPCS A9541","","Tc-99m S Colloid Nuc","BOTH IP/OP","$523.00 ","$387.02 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$109.01 ","$239.09 ","$239.09 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$48.79 ","$0.00 ","$53.33 ","$0.00 "
"34300011","EAP","HCPCS A9521","","99mtc Ceretec-bd","BOTH IP/OP","$4,651.00 ","$3,441.74 ","$0.00 ","$809.00 ","$0.00 ","$0.00 ","$0.00 ","$577.38 ","$577.38 ","$0.00 ","$809.00 ","$0.00 ","$404.50 ","$640.73 ","$647.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300016","EAP","HCPCS A9582","","I123-mibg,10 Mci","BOTH IP/OP","$10,753.00 ","$7,957.22 ","$0.00 ","$8,951.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,951.00 ","$0.00 ","$4,475.50 ","$7,089.19 ","$7,160.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300020","EAP","HCPCS A9572","","Indium In-111 Pentetreotide","BOTH IP/OP","$12,489.00 ","$9,241.86 ","$0.00 ","$4,304.00 ","$0.00 ","$0.00 ","$0.00 ","$3,071.76 ","$3,071.76 ","$753.60 ","$4,304.00 ","$0.00 ","$2,152.00 ","$3,408.77 ","$3,443.20 ","$0.00 ","$673.58 ","$0.00 ","$685.20 ","$0.00 "
"34300021","EAP","HCPCS A9512","","Technetiumtc-99m Pertechnetate","BOTH IP/OP","$227.00 ","$167.98 ","$0.00 ","$227.00 ","$0.00 ","$0.00 ","$47.31 ","$162.01 ","$162.01 ","$39.75 ","$227.00 ","$0.00 ","$113.50 ","$179.78 ","$181.60 ","$0.00 ","$35.53 ","$0.00 ","$36.14 ","$0.00 "
"34300024","EAP","CPT� A9520","","Lymphoseek, Diag, Up To 0.5mci","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$0.00 ","$828.00 ","$0.00 ","$0.00 ","$327.44 ","$590.94 ","$590.94 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"34300025","EAP","HCPCS A9580","","Sodium Fluoride F-18, Diagnostic","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$312.00 ","$0.00 ","$0.00 ","$65.03 ","$222.67 ","$222.67 ","$54.63 ","$312.00 ","$0.00 ","$156.00 ","$247.10 ","$249.60 ","$0.00 ","$48.83 ","$0.00 ","$49.67 ","$0.00 "
"34300026","EAP","HCPCS A9587","","Gallium Ga-68, Dotatate, Diagnostic","BOTH IP/OP","$8,000.00 ","$5,920.00 ","$0.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,000.00 ","$0.00 ","$4,000.00 ","$6,336.00 ","$6,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300027","EAP","HCPCS A9588","","Fluciclovine F-18, Diagnostic","BOTH IP/OP","$11,015.00 ","$8,151.10 ","$0.00 ","$11,015.00 ","$5,981.15 ","$0.00 ","$2,295.80 ","$5,158.80 ","$5,158.80 ","$1,928.64 ","$11,015.00 ","$0.00 ","$5,507.50 ","$8,723.88 ","$8,812.00 ","$0.00 ","$1,723.85 ","$0.00 ","$1,753.59 ","$0.00 "
"34300028","EAP","HCPCS A9584","","Iodine 1-123 Ioflupane, Diagnostic","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34300029","EAP","HCPCS A9587","","Gallium Ga-68, Dotatate, Diagnostic, 0.1 Millicurie","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$0.00 ","$0.00 ","$0.00 ","$119.19 ","$119.19 ","$0.00 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34400001","EAP","HCPCS A9527","","Iodine I-125, Sodium Iodide, Per Millicurie","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$40.37 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$32.83 ","$103.50 ","$163.94 ","$165.60 ","$45.34 ","$32.40 ","$0.00 ","$32.95 ","$31.27 "
"35000001","EAP","CPT� 73200","","Upp Ext Ct W/o Dye Bilat Ect","BOTH IP/OP","$7,981.00 ","$5,905.94 ","$106.62 ","$8,046.00 ","$1,404.90 ","$106.62 ","$1,663.44 ","$755.50 ","$755.50 ","$1,408.79 ","$8,046.00 ","$112.41 ","$1,608.00 ","$6,372.43 ","$6,436.80 ","$156.18 ","$1,259.20 ","$130.02 ","$1,280.92 ","$107.06 "
"35000002","EAP","CPT� 73201","","Upp Ext Ct W/dye Bilat Ect","BOTH IP/OP","$8,891.00 ","$6,579.34 ","$166.40 ","$8,963.00 ","$1,404.90 ","$360.63 ","$1,853.11 ","$755.50 ","$755.50 ","$1,569.35 ","$8,963.00 ","$387.01 ","$774.00 ","$7,098.70 ","$7,170.40 ","$537.70 ","$1,402.71 ","$166.40 ","$1,426.91 ","$368.58 "
"35000003","EAP","CPT� 73202","","Upp Ext Ct W&wo Dye Bilat Ect","BOTH IP/OP","$9,863.00 ","$7,298.62 ","$0.00 ","$9,943.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,943.00 ","$0.00 ","$923.00 ","$7,874.86 ","$7,954.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000005","EAP","CPT� 73700","","LOW EXT CT W/O DYE RT ECT","BOTH IP/OP","$3,488.00 ","$2,581.12 ","$0.00 ","$3,488.00 ","$0.00 ","$0.00 ","$787.01 ","$755.50 ","$755.50 ","$610.72 ","$3,488.00 ","$112.41 ","$566.00 ","$2,762.50 ","$2,790.40 ","$156.18 ","$545.87 ","$105.89 ","$555.29 ","$107.06 "
"35000006","EAP","CPT� 73701","","LOW EXT CT W/DYE RT ECT","BOTH IP/OP","$4,789.00 ","$3,543.86 ","$0.00 ","$4,789.00 ","$0.00 ","$0.00 ","$1,080.68 ","$755.50 ","$755.50 ","$838.52 ","$4,789.00 ","$202.33 ","$1,149.36 ","$3,792.89 ","$3,831.20 ","$281.11 ","$749.48 ","$137.23 ","$762.41 ","$192.70 "
"35000007","EAP","CPT� 73702","","LOW EXT CT W&WO DYE LT ECT","BOTH IP/OP","$6,038.00 ","$4,468.12 ","$0.00 ","$5,577.00 ","$1,404.90 ","$0.00 ","$0.00 ","$755.50 ","$755.50 ","$976.49 ","$5,577.00 ","$202.33 ","$923.00 ","$4,416.98 ","$4,461.60 ","$281.11 ","$872.80 ","$174.32 ","$887.86 ","$192.70 "
"35000009","EAP","CPT� 75635","","ABD AORTA&ILLIOFEMORAL CTA ECT","BOTH IP/OP","$6,653.00 ","$4,923.22 ","$174.93 ","$6,159.00 ","$1,404.90 ","$174.93 ","$1,386.65 ","$755.50 ","$755.50 ","$1,078.39 ","$6,159.00 ","$202.33 ","$1,048.00 ","$4,877.93 ","$4,927.20 ","$281.11 ","$963.88 ","$329.20 ","$980.51 ","$192.70 "
"35000010","EAP","CPT� 76376","","3drendering W/o Postprocess","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,033.00 ","$1,404.90 ","$0.00 ","$458.54 ","$755.50 ","$755.50 ","$355.96 ","$2,033.00 ","$0.00 ","$487.92 ","$1,610.14 ","$1,626.40 ","$0.00 ","$318.16 ","$13.33 ","$323.65 ","$0.00 "
"35000011","EAP","CPT� 76377","","3d Rendering W/postprocess","BOTH IP/OP","$4,133.00 ","$3,058.42 ","$0.00 ","$3,820.00 ","$1,404.90 ","$0.00 ","$861.42 ","$755.50 ","$755.50 ","$668.85 ","$3,820.00 ","$0.00 ","$916.80 ","$3,025.44 ","$3,056.00 ","$0.00 ","$597.83 ","$32.41 ","$608.14 ","$0.00 "
"35000013","EAP","CPT� 77011","","CT GUIDED STEREOTAT LOC NCT","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$414.00 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000014","EAP","CPT� 77012","","CT GUIDANCE NEEDLE PLC BCT","BOTH IP/OP","$2,365.00 ","$1,750.10 ","$0.00 ","$2,389.00 ","$1,404.90 ","$0.00 ","$492.93 ","$755.50 ","$755.50 ","$418.29 ","$2,389.00 ","$0.00 ","$573.36 ","$1,892.09 ","$1,911.20 ","$0.00 ","$373.88 ","$77.80 ","$380.33 ","$0.00 "
"35000015","EAP","CPT� 77013","","Ct, Visceral Tissue Ablation","BOTH IP/OP","$2,734.00 ","$2,023.16 ","$0.00 ","$2,762.00 ","$1,404.90 ","$0.00 ","$569.83 ","$755.50 ","$755.50 ","$483.60 ","$2,762.00 ","$0.00 ","$662.88 ","$2,187.50 ","$2,209.60 ","$0.00 ","$432.25 ","$0.00 ","$439.71 ","$0.00 "
"35000104","EAP","CPT� 73206","","Upp Ext Cta W&wo Dye Rt Ect","BOTH IP/OP","$3,509.00 ","$2,596.66 ","$174.93 ","$3,537.00 ","$1,404.90 ","$174.93 ","$731.36 ","$755.50 ","$755.50 ","$619.30 ","$3,537.00 ","$202.33 ","$1,048.00 ","$2,801.30 ","$2,829.60 ","$281.11 ","$553.54 ","$241.31 ","$563.09 ","$192.70 "
"35000108","EAP","CPT� 20982","","Ablation Bone Tumor Perc W/img","BOTH IP/OP","$13,275.00 ","$9,823.50 ","$0.00 ","$12,445.00 ","$2,321.55 ","$6,134.13 ","$2,766.84 ","$0.00 ","$0.00 ","$0.00 ","$12,445.00 ","$0.00 ","$5,452.00 ","$9,856.44 ","$9,956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000202","EAP","CPT� 73201","","Upp Ext Ct W/dye Lt/rt Ect","BOTH IP/OP","$4,446.00 ","$3,290.04 ","$166.40 ","$4,482.00 ","$1,404.90 ","$360.63 ","$926.66 ","$755.50 ","$755.50 ","$784.76 ","$4,482.00 ","$387.01 ","$774.00 ","$3,549.74 ","$3,585.60 ","$537.70 ","$701.43 ","$166.40 ","$713.53 ","$368.58 "
"35000303","EAP","CPT� 73202","","Upp Ext Ct W&wo Dye Lt/rt Ect","BOTH IP/OP","$4,933.00 ","$3,650.42 ","$0.00 ","$4,973.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,973.00 ","$0.00 ","$923.00 ","$3,938.62 ","$3,978.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000305","EAP","CPT� 75571","","Ct Hrt W/o Dye W/ca Test","BOTH IP/OP","$125.00 ","$92.50 ","$19.72 ","$126.00 ","$125.00 ","$79.21 ","$84.41 ","$126.00 ","$126.00 ","$22.06 ","$126.00 ","$80.04 ","$30.24 ","$99.79 ","$100.80 ","$111.21 ","$19.72 ","$76.72 ","$20.06 ","$76.23 "
"35000306","EAP","CPT� 75572","","Ct Hrt W/3d Image","BOTH IP/OP","$1,534.00 ","$1,135.16 ","$0.00 ","$1,550.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$372.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000307","EAP","CPT� 75573","","Ct Hrt W/3d Image, Congen","BOTH IP/OP","$1,268.00 ","$938.32 ","$0.00 ","$1,281.00 ","$1,268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,281.00 ","$0.00 ","$307.44 ","$1,014.55 ","$1,024.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000308","EAP","CPT� 75574","","Ct Angio Hrt W/3d Image","BOTH IP/OP","$2,297.00 ","$1,699.78 ","$174.93 ","$2,127.00 ","$1,404.90 ","$174.93 ","$478.75 ","$755.50 ","$755.50 ","$372.42 ","$2,127.00 ","$202.33 ","$510.48 ","$1,684.58 ","$1,701.60 ","$281.11 ","$332.88 ","$244.20 ","$338.62 ","$192.70 "
"35000309","EAP","CPT� 75571","","Ct Heart W/o Dye;qual Calc Oct","BOTH IP/OP","$125.00 ","$92.50 ","$19.72 ","$126.00 ","$125.00 ","$79.21 ","$26.05 ","$126.00 ","$126.00 ","$22.06 ","$126.00 ","$80.04 ","$30.24 ","$99.79 ","$100.80 ","$111.21 ","$19.72 ","$76.72 ","$20.06 ","$76.23 "
"35000311","EAP","CPT� 73700","","Low Ext Ct W/o Dye Bilat Ect","BOTH IP/OP","$6,983.00 ","$5,167.42 ","$105.89 ","$6,983.00 ","$1,404.90 ","$106.62 ","$1,455.43 ","$755.50 ","$755.50 ","$1,222.67 ","$6,983.00 ","$112.41 ","$566.00 ","$5,530.54 ","$5,586.40 ","$156.18 ","$1,092.84 ","$105.89 ","$1,111.69 ","$107.06 "
"35000312","EAP","CPT� 73701","","Low Ext Ct W/dye Bilat Ect","BOTH IP/OP","$9,578.00 ","$7,087.72 ","$137.23 ","$9,578.00 ","$1,404.90 ","$174.93 ","$1,996.29 ","$755.50 ","$755.50 ","$1,677.03 ","$9,578.00 ","$202.33 ","$2,298.72 ","$7,585.78 ","$7,662.40 ","$281.11 ","$1,498.96 ","$137.23 ","$1,524.82 ","$192.70 "
"35000313","EAP","CPT� 73702","","Low Ext Ct W&wo Dye Bilat Ect","BOTH IP/OP","$11,163.00 ","$8,260.62 ","$0.00 ","$11,163.00 ","$1,404.90 ","$0.00 ","$0.00 ","$755.50 ","$755.50 ","$1,954.55 ","$11,163.00 ","$202.33 ","$923.00 ","$8,841.10 ","$8,930.40 ","$281.11 ","$1,747.01 ","$174.32 ","$1,777.15 ","$192.70 "
"35000314","EAP","CPT� 73706","","Low Ext Cta W&wo Dye Bilat Ect","BOTH IP/OP","$12,088.00 ","$8,945.12 ","$174.93 ","$12,088.00 ","$726.00 ","$174.93 ","$2,519.44 ","$755.50 ","$755.50 ","$2,116.51 ","$12,088.00 ","$202.33 ","$1,048.00 ","$9,573.70 ","$9,670.40 ","$281.11 ","$1,891.77 ","$264.37 ","$1,924.41 ","$192.70 "
"35000315","EAP","CPT� 73206","","Upp Ext Cta W&wo Dye Bilat Ect","BOTH IP/OP","$7,023.00 ","$5,197.02 ","$174.93 ","$7,080.00 ","$1,404.90 ","$174.93 ","$1,463.77 ","$755.50 ","$755.50 ","$1,239.65 ","$7,080.00 ","$202.33 ","$1,048.00 ","$5,607.36 ","$5,664.00 ","$281.11 ","$1,108.02 ","$241.31 ","$1,127.14 ","$192.70 "
"35000352","EAP","CPT� 74176","","Ct, Abd And Pelvis W/o Contrast","BOTH IP/OP","$7,437.00 ","$5,503.38 ","$113.81 ","$6,885.00 ","$1,404.90 ","$225.34 ","$1,550.06 ","$755.50 ","$755.50 ","$1,205.51 ","$6,885.00 ","$233.72 ","$1,652.40 ","$5,452.92 ","$5,508.00 ","$324.73 ","$1,077.50 ","$113.81 ","$1,096.09 ","$222.60 "
"35000353","EAP","CPT� 74177","","Ct, Abd And Pelvis W/contrast","BOTH IP/OP","$10,201.00 ","$7,548.74 ","$238.43 ","$9,444.00 ","$1,404.90 ","$360.63 ","$2,126.14 ","$755.50 ","$755.50 ","$1,653.57 ","$9,444.00 ","$387.01 ","$2,266.56 ","$7,479.65 ","$7,555.20 ","$537.70 ","$1,477.99 ","$238.43 ","$1,503.48 ","$368.58 "
"35000354","EAP","CPT� 37220","","Iliac Revasc","BOTH IP/OP","$11,190.00 ","$8,280.60 ","$0.00 ","$10,622.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,622.00 ","$0.00 ","$4,975.00 ","$8,412.62 ","$8,497.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000355","EAP","CPT� 37221","","Iliac Revasc W/stent","BOTH IP/OP","$32,950.00 ","$24,383.00 ","$0.00 ","$31,279.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,476.70 ","$31,279.00 ","$0.00 ","$6,105.00 ","$24,772.97 ","$25,023.20 ","$0.00 ","$4,457.60 ","$0.00 ","$0.00 ","$0.00 "
"35000356","EAP","CPT� 37222","","Iliac Revasc Add-on","BOTH IP/OP","$27,325.00 ","$20,220.50 ","$0.00 ","$31,279.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,279.00 ","$0.00 ","$15,639.50 ","$24,772.97 ","$25,023.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000357","EAP","CPT� 37223","","Iliac Revasc W/stent Add-on","BOTH IP/OP","$32,950.00 ","$24,383.00 ","$0.00 ","$31,279.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31,279.00 ","$0.00 ","$15,639.50 ","$24,772.97 ","$25,023.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000358","EAP","CPT� 37224","","Fem/popl Revas W/tla","BOTH IP/OP","$21,928.00 ","$16,226.72 ","$0.00 ","$21,504.00 ","$0.00 ","$0.00 ","$0.00 ","$15,347.40 ","$5,416.74 ","$3,765.18 ","$21,504.00 ","$4,968.47 ","$4,975.00 ","$17,031.17 ","$17,203.20 ","$6,903.03 ","$3,623.42 ","$466.92 ","$3,423.44 ","$4,731.88 "
"35000359","EAP","CPT� 37225","","Fem/popl Revas W/ather","BOTH IP/OP","$46,544.00 ","$34,442.56 ","$0.00 ","$45,644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45,644.00 ","$0.00 ","$6,105.00 ","$36,150.05 ","$36,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000360","EAP","CPT� 37226","","Fem/popl Revasc W/stent","BOTH IP/OP","$46,544.00 ","$34,442.56 ","$0.00 ","$45,644.00 ","$0.00 ","$0.00 ","$0.00 ","$32,576.12 ","$5,416.74 ","$7,991.90 ","$45,644.00 ","$9,937.60 ","$6,105.00 ","$36,150.05 ","$36,515.20 ","$13,806.97 ","$7,751.33 ","$545.88 ","$7,266.52 ","$9,464.38 "
"35000361","EAP","CPT� 37227","","Fem/popl Revasc Stnt & Ather","BOTH IP/OP","$80,612.00 ","$59,652.88 ","$0.00 ","$79,053.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79,053.00 ","$0.00 ","$6,105.00 ","$62,609.98 ","$63,242.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000362","EAP","CPT� 37228","","Tib/per Revasc W/tla","BOTH IP/OP","$21,928.00 ","$16,226.72 ","$0.00 ","$21,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,504.00 ","$0.00 ","$6,105.00 ","$17,031.17 ","$17,203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000363","EAP","CPT� 37229","","Tib/per Revasc W/ather","BOTH IP/OP","$41,457.00 ","$30,678.18 ","$0.00 ","$45,644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45,644.00 ","$0.00 ","$6,105.00 ","$36,150.05 ","$36,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000364","EAP","CPT� 37230","","Tib/per Revasc W/stent","BOTH IP/OP","$46,544.00 ","$34,442.56 ","$0.00 ","$45,644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45,644.00 ","$0.00 ","$6,105.00 ","$36,150.05 ","$36,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000365","EAP","CPT� 37231","","Tib/per Revasc Stent & Ather","BOTH IP/OP","$62,684.00 ","$46,386.16 ","$0.00 ","$61,472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61,472.00 ","$0.00 ","$6,105.00 ","$48,685.82 ","$49,177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000366","EAP","CPT� 37232","","Tib/per Revasc Add-on","BOTH IP/OP","$19,531.00 ","$14,452.94 ","$0.00 ","$21,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,504.00 ","$0.00 ","$10,752.00 ","$17,031.17 ","$17,203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000367","EAP","CPT� 37233","","Tibper Revasc W/ather Add-on","BOTH IP/OP","$41,457.00 ","$30,678.18 ","$0.00 ","$45,644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45,644.00 ","$0.00 ","$22,822.00 ","$36,150.05 ","$36,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000368","EAP","CPT� 37234","","Revsc Opn/prq Tib/pero Stent","BOTH IP/OP","$19,531.00 ","$14,452.94 ","$0.00 ","$21,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,504.00 ","$0.00 ","$10,752.00 ","$17,031.17 ","$17,203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000369","EAP","CPT� 37235","","Tib/per Revasc Stnt & Ather","BOTH IP/OP","$19,531.00 ","$14,452.94 ","$0.00 ","$21,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,504.00 ","$0.00 ","$10,752.00 ","$17,031.17 ","$17,203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35000381","EAP","CPT� 74178","","Ct, Abd And Pelvis W&w/o Contrast","BOTH IP/OP","$11,888.00 ","$8,797.12 ","$270.49 ","$11,006.00 ","$1,404.90 ","$360.63 ","$2,477.76 ","$755.50 ","$755.50 ","$1,927.06 ","$11,006.00 ","$387.01 ","$2,641.44 ","$8,716.75 ","$8,804.80 ","$537.70 ","$1,722.44 ","$270.49 ","$1,752.16 ","$368.58 "
"35100001","EAP","CPT� 70450","","HEAD/BRAIN CT W/O DYE ECT","BOTH IP/OP","$4,085.00 ","$3,022.90 ","$73.47 ","$3,714.00 ","$1,404.90 ","$106.62 ","$851.42 ","$755.50 ","$755.50 ","$650.29 ","$3,714.00 ","$112.41 ","$566.00 ","$2,941.49 ","$2,971.20 ","$156.18 ","$581.24 ","$73.47 ","$591.27 ","$107.06 "
"35100002","EAP","CPT� 70460","","HEAD/BRAIN CT W/ DYE ECT","BOTH IP/OP","$5,603.00 ","$4,146.22 ","$107.69 ","$5,094.00 ","$1,404.90 ","$174.93 ","$1,167.81 ","$755.50 ","$755.50 ","$891.92 ","$5,094.00 ","$202.33 ","$774.00 ","$4,034.45 ","$4,075.20 ","$281.11 ","$797.21 ","$107.69 ","$810.96 ","$192.70 "
"35100003","EAP","CPT� 70470","","HEAD/BRAIN CT W&WO DYE ECT","BOTH IP/OP","$6,525.00 ","$4,828.50 ","$0.00 ","$5,933.00 ","$1,404.90 ","$174.93 ","$0.00 ","$755.50 ","$755.50 ","$1,038.82 ","$5,933.00 ","$202.33 ","$923.00 ","$4,698.94 ","$4,746.40 ","$281.11 ","$928.51 ","$128.94 ","$944.53 ","$192.70 "
"35100004","EAP","CPT� 70480","","ORBIT/SELLA/EAR W/O DYE ECT","BOTH IP/OP","$4,725.00 ","$3,496.50 ","$106.62 ","$4,362.00 ","$1,404.90 ","$106.62 ","$984.81 ","$755.50 ","$755.50 ","$763.75 ","$4,362.00 ","$112.41 ","$566.00 ","$3,454.70 ","$3,489.60 ","$156.18 ","$682.65 ","$137.95 ","$694.43 ","$107.06 "
"35100005","EAP","CPT� 70481","","ORBIT/SELLA/EAR W/DYE ECT","BOTH IP/OP","$6,480.00 ","$4,795.20 ","$168.92 ","$5,982.00 ","$1,404.90 ","$174.93 ","$1,350.59 ","$755.50 ","$755.50 ","$1,047.40 ","$5,982.00 ","$202.33 ","$774.00 ","$4,737.74 ","$4,785.60 ","$281.11 ","$936.18 ","$168.92 ","$952.33 ","$192.70 "
"35100006","EAP","CPT� 70482","","ORB/SELLA/EAR W&WO DYE ECT","BOTH IP/OP","$7,547.00 ","$5,584.78 ","$0.00 ","$6,967.00 ","$1,404.90 ","$174.93 ","$1,572.98 ","$755.50 ","$755.50 ","$0.00 ","$6,967.00 ","$202.33 ","$923.00 ","$5,517.86 ","$5,573.60 ","$281.11 ","$0.00 ","$186.57 ","$1,109.15 ","$192.70 "
"35100007","EAP","CPT� 70486","","MAXILLOFAC CT W/O DYE ECT","BOTH IP/OP","$4,725.00 ","$3,496.50 ","$97.25 ","$4,362.00 ","$1,404.90 ","$106.62 ","$984.81 ","$755.50 ","$755.50 ","$763.75 ","$4,362.00 ","$112.41 ","$566.00 ","$3,454.70 ","$3,489.60 ","$156.18 ","$682.65 ","$97.25 ","$694.43 ","$107.06 "
"35100008","EAP","CPT� 70487","","MAXILLOFAC CT W/DYE ECT","BOTH IP/OP","$6,480.00 ","$4,795.20 ","$111.65 ","$5,982.00 ","$1,404.90 ","$174.93 ","$1,350.59 ","$755.50 ","$755.50 ","$1,047.40 ","$5,982.00 ","$202.33 ","$774.00 ","$4,737.74 ","$4,785.60 ","$281.11 ","$936.18 ","$111.65 ","$952.33 ","$192.70 "
"35100009","EAP","CPT� 70488","","MAXILLOFAC CT W&WO DYE ECT","BOTH IP/OP","$7,547.00 ","$5,584.78 ","$0.00 ","$6,967.00 ","$1,404.90 ","$174.93 ","$0.00 ","$755.50 ","$755.50 ","$1,219.87 ","$6,967.00 ","$202.33 ","$923.00 ","$5,517.86 ","$5,573.60 ","$281.11 ","$1,090.34 ","$141.55 ","$1,109.15 ","$192.70 "
"35100010","EAP","CPT� 70490","","SOFT TISS NECK CT W/O DYE ECT","BOTH IP/OP","$3,955.00 ","$2,926.70 ","$101.21 ","$3,597.00 ","$1,404.90 ","$106.62 ","$824.32 ","$755.50 ","$755.50 ","$629.81 ","$3,597.00 ","$112.41 ","$566.00 ","$2,848.82 ","$2,877.60 ","$156.18 ","$562.93 ","$101.21 ","$572.64 ","$107.06 "
"35100011","EAP","CPT� 70491","","SOFT TISS NECK CT W/DYE ECT","BOTH IP/OP","$5,424.00 ","$4,013.76 ","$134.70 ","$4,933.00 ","$1,404.90 ","$174.93 ","$1,130.50 ","$755.50 ","$755.50 ","$863.73 ","$4,933.00 ","$202.33 ","$774.00 ","$3,906.94 ","$3,946.40 ","$281.11 ","$772.01 ","$134.70 ","$785.33 ","$192.70 "
"35100012","EAP","CPT� 70492","","SOFT TISS NECK CT W&WO DYE ECT","BOTH IP/OP","$6,319.00 ","$4,676.06 ","$164.96 ","$5,747.00 ","$1,404.90 ","$174.93 ","$1,317.04 ","$755.50 ","$755.50 ","$1,006.25 ","$5,747.00 ","$202.33 ","$923.00 ","$4,551.62 ","$4,597.60 ","$281.11 ","$899.41 ","$164.96 ","$914.92 ","$192.70 "
"35100013","EAP","CPT� 70496","","HEAD CTA W & W/O DYE ECT","BOTH IP/OP","$6,849.00 ","$5,068.26 ","$174.93 ","$6,229.00 ","$1,404.90 ","$174.93 ","$1,427.50 ","$755.50 ","$755.50 ","$1,090.65 ","$6,229.00 ","$202.33 ","$1,048.00 ","$4,933.37 ","$4,983.20 ","$281.11 ","$974.84 ","$211.42 ","$991.66 ","$192.70 "
"35100014","EAP","CPT� 70498","","NECK CTA W & W/O DYE ECT","BOTH IP/OP","$6,849.00 ","$5,068.26 ","$174.93 ","$6,229.00 ","$1,404.90 ","$174.93 ","$1,427.50 ","$755.50 ","$755.50 ","$1,090.65 ","$6,229.00 ","$202.33 ","$1,048.00 ","$4,933.37 ","$4,983.20 ","$281.11 ","$974.84 ","$211.06 ","$991.66 ","$192.70 "
"35100015","EAP","CPT� 0042T","","BRAIN PERFUSION W/CONT CT, ECT","BOTH IP/OP","$6,102.00 ","$4,515.48 ","$0.00 ","$5,548.00 ","$1,404.90 ","$0.00 ","$1,271.81 ","$755.50 ","$755.50 ","$971.41 ","$5,548.00 ","$0.00 ","$2,774.00 ","$4,394.02 ","$4,438.40 ","$0.00 ","$868.26 ","$0.00 ","$883.24 ","$0.00 "
"35200001","EAP","CPT� 71250","","THORAX CT W/O DYE BCT","BOTH IP/OP","$3,675.00 ","$2,719.50 ","$101.21 ","$3,404.00 ","$1,404.90 ","$106.62 ","$765.96 ","$755.50 ","$755.50 ","$596.01 ","$3,404.00 ","$112.41 ","$816.96 ","$2,695.97 ","$2,723.20 ","$156.18 ","$532.73 ","$101.21 ","$541.92 ","$107.06 "
"35200002","EAP","CPT� 71260","","THORAX CT W/DYE BCT","BOTH IP/OP","$5,044.00 ","$3,732.56 ","$135.06 ","$4,672.00 ","$1,404.90 ","$174.93 ","$1,051.30 ","$755.50 ","$755.50 ","$818.03 ","$4,672.00 ","$202.33 ","$1,121.28 ","$3,700.22 ","$3,737.60 ","$281.11 ","$731.17 ","$135.06 ","$743.78 ","$192.70 "
"35200003","EAP","CPT� 71270","","THORAX CT W&WO DYE BCT","BOTH IP/OP","$5,874.00 ","$4,346.76 ","$0.00 ","$5,441.00 ","$1,404.90 ","$174.93 ","$1,224.29 ","$755.50 ","$755.50 ","$952.68 ","$5,441.00 ","$202.33 ","$1,305.84 ","$4,309.27 ","$4,352.80 ","$281.11 ","$0.00 ","$164.96 ","$866.21 ","$192.70 "
"35200004","EAP","CPT� 71275","","THORAX CTA W&WO DYE BCT","BOTH IP/OP","$6,367.00 ","$4,711.58 ","$174.93 ","$5,898.00 ","$1,404.90 ","$174.93 ","$1,327.04 ","$755.50 ","$755.50 ","$1,032.69 ","$5,898.00 ","$202.33 ","$1,415.52 ","$4,671.22 ","$4,718.40 ","$281.11 ","$923.04 ","$214.30 ","$938.96 ","$192.70 "
"35200005","EAP","CPT� 72125","","CERVICAL SPINE CT W/O DYE ECT","BOTH IP/OP","$7,128.00 ","$5,274.72 ","$106.61 ","$6,480.00 ","$1,404.90 ","$106.62 ","$1,485.65 ","$755.50 ","$755.50 ","$1,134.60 ","$6,480.00 ","$112.41 ","$566.00 ","$5,132.16 ","$5,184.00 ","$156.18 ","$1,014.12 ","$106.61 ","$1,031.62 ","$107.06 "
"35200006","EAP","CPT� 72126","","CERVICAL SPINE CT W/DYE ECT","BOTH IP/OP","$9,771.00 ","$7,230.54 ","$0.00 ","$8,883.00 ","$1,404.90 ","$360.63 ","$2,036.52 ","$755.50 ","$755.50 ","$1,555.34 ","$8,883.00 ","$387.01 ","$774.00 ","$7,035.34 ","$7,106.40 ","$537.70 ","$0.00 ","$135.78 ","$1,414.17 ","$368.58 "
"35200007","EAP","CPT� 72127","","CERVICAL SPINE CT W&WO DYE ECT","BOTH IP/OP","$10,974.00 ","$8,120.76 ","$0.00 ","$9,976.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,976.00 ","$0.00 ","$923.00 ","$7,900.99 ","$7,980.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200008","EAP","CPT� 72128","","THORACIC SPINE CT W/O DYE ECT","BOTH IP/OP","$4,233.00 ","$3,132.42 ","$106.61 ","$4,276.00 ","$1,404.90 ","$106.62 ","$882.26 ","$755.50 ","$755.50 ","$748.69 ","$4,276.00 ","$112.41 ","$566.00 ","$3,386.59 ","$3,420.80 ","$156.18 ","$669.19 ","$106.61 ","$680.74 ","$107.06 "
"35200009","EAP","CPT� 72129","","THORACIC SPINE CT W/DYE ECT","BOTH IP/OP","$5,804.00 ","$4,294.96 ","$0.00 ","$5,863.00 ","$1,404.90 ","$0.00 ","$0.00 ","$755.50 ","$755.50 ","$1,026.56 ","$5,863.00 ","$202.33 ","$774.00 ","$4,643.50 ","$4,690.40 ","$281.11 ","$917.56 ","$137.23 ","$933.39 ","$192.70 "
"35200010","EAP","CPT� 72130","","THORACIC SPINE CT W&WO DYE ECT","BOTH IP/OP","$6,518.00 ","$4,823.32 ","$0.00 ","$6,584.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,584.00 ","$0.00 ","$923.00 ","$5,214.53 ","$5,267.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200011","EAP","CPT� 72131","","LUMBAR SPINE CT W/O DYE ECT","BOTH IP/OP","$3,544.00 ","$2,622.56 ","$105.89 ","$3,580.00 ","$1,404.90 ","$106.62 ","$738.66 ","$755.50 ","$755.50 ","$626.83 ","$3,580.00 ","$112.41 ","$566.00 ","$2,835.36 ","$2,864.00 ","$156.18 ","$560.27 ","$105.89 ","$569.94 ","$107.06 "
"35200012","EAP","CPT� 72132","","LUMBAR SPINE CT W/DYE ECT","BOTH IP/OP","$4,861.00 ","$3,597.14 ","$0.00 ","$4,910.00 ","$1,404.90 ","$360.63 ","$1,013.15 ","$0.00 ","$0.00 ","$0.00 ","$4,910.00 ","$0.00 ","$774.00 ","$3,888.72 ","$3,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200013","EAP","CPT� 72133","","LUMBAR SPINE CT W&WO DYE ECT","BOTH IP/OP","$5,459.00 ","$4,039.66 ","$0.00 ","$5,514.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,514.00 ","$0.00 ","$923.00 ","$4,367.09 ","$4,411.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200014","EAP","CPT� 72191","","PELVIS CTA W&WO DYE BCT","BOTH IP/OP","$6,137.00 ","$4,541.38 ","$0.00 ","$6,199.00 ","$1,404.90 ","$174.93 ","$1,279.10 ","$0.00 ","$0.00 ","$0.00 ","$6,199.00 ","$0.00 ","$1,048.00 ","$4,909.61 ","$4,959.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200015","EAP","CPT� 72192","","ORTHO PELVIS CT W/O DYE BCT","BOTH IP/OP","$4,157.00 ","$3,076.18 ","$91.84 ","$3,889.00 ","$1,404.90 ","$106.62 ","$866.42 ","$755.50 ","$755.50 ","$680.93 ","$3,889.00 ","$112.41 ","$566.00 ","$3,080.09 ","$3,111.20 ","$156.18 ","$608.63 ","$91.84 ","$619.13 ","$107.06 "
"35200016","EAP","CPT� 72192","","PELVIS CT W/O DYE BCT","BOTH IP/OP","$3,889.00 ","$2,877.86 ","$0.00 ","$3,889.00 ","$0.00 ","$0.00 ","$866.42 ","$755.50 ","$755.50 ","$680.93 ","$3,889.00 ","$112.41 ","$566.00 ","$3,080.09 ","$3,111.20 ","$156.18 ","$608.63 ","$91.84 ","$619.13 ","$107.06 "
"35200017","EAP","CPT� 72193","","PELVIS CT W/DYE BCT","BOTH IP/OP","$5,705.00 ","$4,221.70 ","$174.93 ","$5,337.00 ","$1,404.90 ","$174.93 ","$1,189.06 ","$755.50 ","$755.50 ","$934.47 ","$5,337.00 ","$202.33 ","$774.00 ","$4,226.90 ","$4,269.60 ","$281.11 ","$835.24 ","$186.21 ","$849.65 ","$192.70 "
"35200018","EAP","CPT� 72194","","PELVIS CT W&WO DYE BCT","BOTH IP/OP","$6,641.00 ","$4,914.34 ","$0.00 ","$6,213.00 ","$1,404.90 ","$0.00 ","$1,384.15 ","$755.50 ","$755.50 ","$1,087.85 ","$6,213.00 ","$202.33 ","$923.00 ","$4,920.70 ","$4,970.40 ","$281.11 ","$972.33 ","$213.58 ","$989.11 ","$192.70 "
"35200019","EAP","CPT� 73200","","Upp Ext Ct W/o Dye Bilat Bct","BOTH IP/OP","$7,981.00 ","$5,905.94 ","$106.62 ","$8,046.00 ","$1,404.90 ","$106.62 ","$1,663.44 ","$755.50 ","$755.50 ","$1,408.79 ","$8,046.00 ","$112.41 ","$1,608.00 ","$6,372.43 ","$6,436.80 ","$156.18 ","$1,259.20 ","$130.02 ","$1,280.92 ","$107.06 "
"35200020","EAP","CPT� 73200","","UPP EXT CT W/O DYE LT BCT","BOTH IP/OP","$4,400.00 ","$3,256.00 ","$106.62 ","$4,022.00 ","$1,404.90 ","$106.62 ","$917.07 ","$755.50 ","$755.50 ","$704.22 ","$4,022.00 ","$112.41 ","$1,608.00 ","$3,185.42 ","$3,217.60 ","$156.18 ","$629.44 ","$130.02 ","$640.30 ","$107.06 "
"35200021","EAP","CPT� 73200","","UPP EXT CT W/O DYE RT BCT","BOTH IP/OP","$4,022.00 ","$2,976.28 ","$0.00 ","$4,022.00 ","$0.00 ","$0.00 ","$917.07 ","$755.50 ","$755.50 ","$704.22 ","$4,022.00 ","$112.41 ","$1,608.00 ","$3,185.42 ","$3,217.60 ","$156.18 ","$629.44 ","$130.02 ","$640.30 ","$107.06 "
"35200022","EAP","CPT� 73201","","Upp Ext Ct W/dye Bilat Bct","BOTH IP/OP","$8,891.00 ","$6,579.34 ","$166.40 ","$8,963.00 ","$1,404.90 ","$360.63 ","$1,853.11 ","$755.50 ","$755.50 ","$1,569.35 ","$8,963.00 ","$387.01 ","$774.00 ","$7,098.70 ","$7,170.40 ","$537.70 ","$1,402.71 ","$166.40 ","$1,426.91 ","$368.58 "
"35200023","EAP","CPT� 73201","","Upp Ext Ct W/dye Lt","BOTH IP/OP","$4,904.00 ","$3,628.96 ","$166.40 ","$4,482.00 ","$1,404.90 ","$360.63 ","$1,022.12 ","$755.50 ","$755.50 ","$784.76 ","$4,482.00 ","$387.01 ","$774.00 ","$3,549.74 ","$3,585.60 ","$537.70 ","$701.43 ","$166.40 ","$713.53 ","$368.58 "
"35200024","EAP","CPT� 73201","","UPP EXT CT W/DYE RT BCT","BOTH IP/OP","$4,482.00 ","$3,316.68 ","$0.00 ","$4,482.00 ","$0.00 ","$0.00 ","$1,022.12 ","$755.50 ","$755.50 ","$784.76 ","$4,482.00 ","$387.01 ","$774.00 ","$3,549.74 ","$3,585.60 ","$537.70 ","$701.43 ","$166.40 ","$713.53 ","$368.58 "
"35200025","EAP","CPT� 73202","","Upp Ext Ct W&wo Dye Bilat Bct","BOTH IP/OP","$9,863.00 ","$7,298.62 ","$0.00 ","$9,943.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,943.00 ","$0.00 ","$923.00 ","$7,874.86 ","$7,954.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200026","EAP","CPT� 73202","","UPP EXT CT W&WO DYE LT BCT","BOTH IP/OP","$4,933.00 ","$3,650.42 ","$0.00 ","$4,973.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,973.00 ","$0.00 ","$923.00 ","$3,938.62 ","$3,978.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200027","EAP","CPT� 73202","","UPP EXT CT W&WO DYE RT BCT","BOTH IP/OP","$5,441.00 ","$4,026.34 ","$0.00 ","$4,973.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,973.00 ","$0.00 ","$923.00 ","$3,938.62 ","$3,978.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200028","EAP","CPT� 73206","","UPP EXT CTA W&WO DYE BILAT BCT","BOTH IP/OP","$7,023.00 ","$5,197.02 ","$174.93 ","$7,080.00 ","$1,404.90 ","$174.93 ","$1,463.77 ","$755.50 ","$755.50 ","$1,239.65 ","$7,080.00 ","$202.33 ","$1,048.00 ","$5,607.36 ","$5,664.00 ","$281.11 ","$1,108.02 ","$241.31 ","$1,127.14 ","$192.70 "
"35200029","EAP","CPT� 73206","","UPP EXT CTA W&WO DYE LT BCT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$174.93 ","$3,537.00 ","$1,404.90 ","$174.93 ","$806.60 ","$755.50 ","$755.50 ","$619.30 ","$3,537.00 ","$202.33 ","$1,048.00 ","$2,801.30 ","$2,829.60 ","$281.11 ","$553.54 ","$241.31 ","$563.09 ","$192.70 "
"35200030","EAP","CPT� 73206","","UPP EXT CTA W&WO DYE RT BCT","BOTH IP/OP","$3,537.00 ","$2,617.38 ","$0.00 ","$3,537.00 ","$0.00 ","$0.00 ","$806.60 ","$755.50 ","$755.50 ","$619.30 ","$3,537.00 ","$202.33 ","$1,048.00 ","$2,801.30 ","$2,829.60 ","$281.11 ","$553.54 ","$241.31 ","$563.09 ","$192.70 "
"35200031","EAP","CPT� 73700","","Low Ext Ct W/o Dye Bilat Bct","BOTH IP/OP","$6,983.00 ","$5,167.42 ","$105.89 ","$6,983.00 ","$1,404.90 ","$106.62 ","$1,455.43 ","$755.50 ","$755.50 ","$1,222.67 ","$6,983.00 ","$112.41 ","$566.00 ","$5,530.54 ","$5,586.40 ","$156.18 ","$1,092.84 ","$105.89 ","$1,111.69 ","$107.06 "
"35200032","EAP","CPT� 73700","","LOW EXT CT W/O DYE LT BCT","BOTH IP/OP","$3,776.00 ","$2,794.24 ","$105.89 ","$3,488.00 ","$1,404.90 ","$106.62 ","$787.01 ","$755.50 ","$755.50 ","$610.72 ","$3,488.00 ","$112.41 ","$566.00 ","$2,762.50 ","$2,790.40 ","$156.18 ","$545.87 ","$105.89 ","$555.29 ","$107.06 "
"35200033","EAP","CPT� 73700","","LOW EXT CT W/O DYE RT BCT","BOTH IP/OP","$3,488.00 ","$2,581.12 ","$0.00 ","$3,488.00 ","$0.00 ","$0.00 ","$787.01 ","$755.50 ","$755.50 ","$610.72 ","$3,488.00 ","$112.41 ","$566.00 ","$2,762.50 ","$2,790.40 ","$156.18 ","$545.87 ","$105.89 ","$555.29 ","$107.06 "
"35200034","EAP","CPT� 73701","","Low Ext Ct W/dye Bilat Bct","BOTH IP/OP","$9,578.00 ","$7,087.72 ","$137.23 ","$9,578.00 ","$1,404.90 ","$174.93 ","$1,996.29 ","$755.50 ","$755.50 ","$1,677.03 ","$9,578.00 ","$202.33 ","$2,298.72 ","$7,585.78 ","$7,662.40 ","$281.11 ","$1,498.96 ","$137.23 ","$1,524.82 ","$192.70 "
"35200035","EAP","CPT� 73701","","LOW EXT CT W/DYE LT BCT","BOTH IP/OP","$5,185.00 ","$3,836.90 ","$137.23 ","$4,789.00 ","$1,404.90 ","$174.93 ","$1,080.68 ","$755.50 ","$755.50 ","$838.52 ","$4,789.00 ","$202.33 ","$1,149.36 ","$3,792.89 ","$3,831.20 ","$281.11 ","$749.48 ","$137.23 ","$762.41 ","$192.70 "
"35200036","EAP","CPT� 73701","","LOW EXT CT W/DYE RT BCT","BOTH IP/OP","$4,789.00 ","$3,543.86 ","$0.00 ","$4,789.00 ","$0.00 ","$0.00 ","$1,080.68 ","$755.50 ","$755.50 ","$838.52 ","$4,789.00 ","$202.33 ","$1,149.36 ","$3,792.89 ","$3,831.20 ","$281.11 ","$749.48 ","$137.23 ","$762.41 ","$192.70 "
"35200037","EAP","CPT� 73702","","Low Ext Ct W&wo Dye Bilat Bct","BOTH IP/OP","$11,163.00 ","$8,260.62 ","$0.00 ","$11,163.00 ","$1,404.90 ","$0.00 ","$0.00 ","$755.50 ","$755.50 ","$1,954.55 ","$11,163.00 ","$202.33 ","$923.00 ","$8,841.10 ","$8,930.40 ","$281.11 ","$1,747.01 ","$174.32 ","$1,777.15 ","$192.70 "
"35200038","EAP","CPT� 73702","","LOW EXT CT W&WO DYE LT BCT","BOTH IP/OP","$5,577.00 ","$4,126.98 ","$0.00 ","$5,577.00 ","$0.00 ","$0.00 ","$0.00 ","$755.50 ","$755.50 ","$976.49 ","$5,577.00 ","$202.33 ","$923.00 ","$4,416.98 ","$4,461.60 ","$281.11 ","$872.80 ","$174.32 ","$887.86 ","$192.70 "
"35200039","EAP","CPT� 73702","","LOW EXT CT W&WO DYE RT BCT","BOTH IP/OP","$6,038.00 ","$4,468.12 ","$0.00 ","$5,577.00 ","$1,404.90 ","$0.00 ","$0.00 ","$755.50 ","$755.50 ","$976.49 ","$5,577.00 ","$202.33 ","$923.00 ","$4,416.98 ","$4,461.60 ","$281.11 ","$872.80 ","$174.32 ","$887.86 ","$192.70 "
"35200040","EAP","CPT� 73706","","Low Ext Cta W&wo Dye Bilat Bct","BOTH IP/OP","$12,088.00 ","$8,945.12 ","$0.00 ","$12,088.00 ","$0.00 ","$0.00 ","$2,045.07 ","$755.50 ","$755.50 ","$2,116.51 ","$12,088.00 ","$202.33 ","$1,048.00 ","$9,573.70 ","$9,670.40 ","$281.11 ","$1,891.77 ","$264.37 ","$1,924.41 ","$192.70 "
"35200041","EAP","CPT� 73706","","LOW EXT CTA W&WO DYE LT BCT","BOTH IP/OP","$6,541.00 ","$4,840.34 ","$174.93 ","$6,042.00 ","$726.00 ","$174.93 ","$1,363.31 ","$755.50 ","$755.50 ","$1,057.91 ","$6,042.00 ","$202.33 ","$1,048.00 ","$4,785.26 ","$4,833.60 ","$281.11 ","$945.57 ","$264.37 ","$961.89 ","$192.70 "
"35200042","EAP","CPT� 73706","","LOW EXT CTA W&WO DYE RT BCT","BOTH IP/OP","$6,042.00 ","$4,471.08 ","$0.00 ","$6,042.00 ","$0.00 ","$0.00 ","$1,363.31 ","$755.50 ","$755.50 ","$1,057.91 ","$6,042.00 ","$202.33 ","$1,048.00 ","$4,785.26 ","$4,833.60 ","$281.11 ","$945.57 ","$264.37 ","$961.89 ","$192.70 "
"35200043","EAP","CPT� 74150","","ABDOMEN CT W/O DYE BCT","BOTH IP/OP","$3,994.00 ","$2,955.56 ","$90.40 ","$3,698.00 ","$1,404.90 ","$106.62 ","$832.45 ","$755.50 ","$755.50 ","$647.49 ","$3,698.00 ","$112.41 ","$566.00 ","$2,928.82 ","$2,958.40 ","$156.18 ","$578.74 ","$90.40 ","$588.72 ","$107.06 "
"35200044","EAP","CPT� 74150","","ABDOMEN CT W/O DYE LIMITED BCT","BOTH IP/OP","$3,661.00 ","$2,709.14 ","$90.40 ","$3,698.00 ","$1,404.90 ","$106.62 ","$763.04 ","$755.50 ","$755.50 ","$647.49 ","$3,698.00 ","$112.41 ","$566.00 ","$2,928.82 ","$2,958.40 ","$156.18 ","$578.74 ","$90.40 ","$588.72 ","$107.06 "
"35200045","EAP","CPT� 74150","","Stone Protocol, Bct","BOTH IP/OP","$3,661.00 ","$2,709.14 ","$90.40 ","$3,698.00 ","$1,404.90 ","$106.62 ","$763.04 ","$755.50 ","$755.50 ","$647.49 ","$3,698.00 ","$112.41 ","$566.00 ","$2,928.82 ","$2,958.40 ","$156.18 ","$578.74 ","$90.40 ","$588.72 ","$107.06 "
"35200046","EAP","CPT� 74160","","ABDOMEN CT W/DYE BCT","BOTH IP/OP","$5,483.00 ","$4,057.42 ","$174.93 ","$5,076.00 ","$1,404.90 ","$174.93 ","$1,142.79 ","$755.50 ","$755.50 ","$888.77 ","$5,076.00 ","$202.33 ","$774.00 ","$4,020.19 ","$4,060.80 ","$281.11 ","$794.39 ","$185.49 ","$808.10 ","$192.70 "
"35200047","EAP","CPT� 74160","","ABDOMEN CT W/DYE LIMITED BCT","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$174.93 ","$5,076.00 ","$1,404.90 ","$174.93 ","$1,047.34 ","$755.50 ","$755.50 ","$888.77 ","$5,076.00 ","$202.33 ","$774.00 ","$4,020.19 ","$4,060.80 ","$281.11 ","$794.39 ","$185.49 ","$808.10 ","$192.70 "
"35200048","EAP","CPT� 74170","","ABDOMEN CT W&WO DYE BCT","BOTH IP/OP","$6,385.00 ","$4,724.90 ","$174.93 ","$5,911.00 ","$1,404.90 ","$174.93 ","$1,330.79 ","$755.50 ","$755.50 ","$1,034.97 ","$5,911.00 ","$202.33 ","$923.00 ","$4,681.51 ","$4,728.80 ","$281.11 ","$925.07 ","$211.06 ","$941.03 ","$192.70 "
"35200049","EAP","CPT� 74175","","ABDOMEN CTA W&WO DYE BCT","BOTH IP/OP","$6,919.00 ","$5,120.06 ","$174.93 ","$6,406.00 ","$1,404.90 ","$174.93 ","$1,442.09 ","$755.50 ","$755.50 ","$1,121.64 ","$6,406.00 ","$202.33 ","$1,048.00 ","$5,073.55 ","$5,124.80 ","$281.11 ","$1,002.54 ","$235.19 ","$1,019.84 ","$192.70 "
"35200058","EAP","CPT� 75635","","Abd Aorta&illiofemor Cta Bct","BOTH IP/OP","$6,097.00 ","$4,511.78 ","$174.93 ","$6,159.00 ","$1,404.90 ","$174.93 ","$1,270.77 ","$755.50 ","$755.50 ","$1,078.39 ","$6,159.00 ","$202.33 ","$1,048.00 ","$4,877.93 ","$4,927.20 ","$281.11 ","$963.88 ","$329.20 ","$980.51 ","$192.70 "
"35200059","EAP","CPT� 76380","","FOLLOW UP STUDY CT LIMITED BCT","BOTH IP/OP","$1,494.00 ","$1,105.56 ","$0.00 ","$1,494.00 ","$1,404.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,494.00 ","$0.00 ","$358.56 ","$1,183.25 ","$1,195.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35200060","EAP","CPT� 74174","","Cta, Abdomen And Pelvis, W Dye","BOTH IP/OP","$8,464.00 ","$6,263.36 ","$298.94 ","$7,836.00 ","$1,404.90 ","$360.63 ","$1,764.11 ","$755.50 ","$755.50 ","$1,372.02 ","$7,836.00 ","$387.01 ","$1,880.64 ","$6,206.11 ","$6,268.80 ","$537.70 ","$1,226.33 ","$298.94 ","$1,247.49 ","$368.58 "
"35200063","EAP","HCPCS G0297","","Low Dose Ct Scan For Lung","BOTH IP/OP","$632.00 ","$467.68 ","$76.23 ","$632.00 ","$632.00 ","$106.62 ","$131.72 ","$627.00 ","$627.00 ","$109.78 ","$627.00 ","$80.04 ","$313.50 ","$496.58 ","$501.60 ","$111.21 ","$98.13 ","$189.09 ","$99.82 ","$76.23 "
"36000003","EAP","CPT� 58611","","Ligate Oviduct(s) Add-on","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.00 ","$0.00 ","$475.00 ","$376.20 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000027","EAP","CPT� 19499","","Breast Surgery Procedure Cbc","BOTH IP/OP","$6,169.00 ","$4,565.06 ","$0.00 ","$6,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,124.00 ","$0.00 ","$2,255.00 ","$4,850.21 ","$4,899.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000028","EAP","Custom 36000028","","L&d Level 1 1st 30 Min","BOTH IP/OP","$1,771.00 ","$1,310.54 ","$0.00 ","$1,470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000029","EAP","Custom 36000029","","L&d Level 2 1st 30 Min","BOTH IP/OP","$2,152.00 ","$1,592.48 ","$0.00 ","$1,786.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,786.00 ","$0.00 ","$893.00 ","$1,414.51 ","$1,428.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000038","EAP","Custom 36000038","","L&d Level 3 1st 30 Min","BOTH IP/OP","$2,404.00 ","$1,778.96 ","$0.00 ","$1,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,996.00 ","$0.00 ","$998.00 ","$1,580.83 ","$1,596.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000039","EAP","Custom 36000039","","L&d Level 4 1st 30 Min","BOTH IP/OP","$2,657.00 ","$1,966.18 ","$0.00 ","$2,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,206.00 ","$0.00 ","$1,103.00 ","$1,747.15 ","$1,764.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000040","EAP","Custom 36000040","","L&d Level 5 1st 30 Min","BOTH IP/OP","$1,957.00 ","$1,448.18 ","$0.00 ","$2,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,416.00 ","$0.00 ","$1,208.00 ","$1,913.47 ","$1,932.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000042","EAP","Custom 36000042","","L&d Level 6 1st 30 Min","BOTH IP/OP","$3,163.00 ","$2,340.62 ","$0.00 ","$2,626.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,626.00 ","$0.00 ","$1,313.00 ","$2,079.79 ","$2,100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000043","EAP","Custom 36000043","","L&d Level 1 Add 15 Min","BOTH IP/OP","$797.00 ","$589.78 ","$0.00 ","$662.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.00 ","$0.00 ","$331.00 ","$524.30 ","$529.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000044","EAP","Custom 36000044","","L&d Level 2 Add 15 Min","BOTH IP/OP","$969.00 ","$717.06 ","$0.00 ","$804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$804.00 ","$0.00 ","$402.00 ","$636.77 ","$643.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000045","EAP","Custom 36000045","","L&d Level 3 Add 15 Min","BOTH IP/OP","$1,081.00 ","$799.94 ","$0.00 ","$897.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.00 ","$0.00 ","$448.50 ","$710.42 ","$717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000046","EAP","Custom 36000046","","L&d Level 4 Add 15 Min","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$992.00 ","$0.00 ","$496.00 ","$785.66 ","$793.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000047","EAP","Custom 36000047","","L&d Level 5 Add 15 Min","BOTH IP/OP","$881.00 ","$651.94 ","$0.00 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,088.00 ","$0.00 ","$544.00 ","$861.70 ","$870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000048","EAP","Custom 36000048","","L&d Level 6 Add 15 Min","BOTH IP/OP","$1,422.00 ","$1,052.28 ","$0.00 ","$1,181.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,181.00 ","$0.00 ","$590.50 ","$935.35 ","$944.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000110","EAP","Custom 36000110","","Perfusionist","BOTH IP/OP","$3,589.00 ","$2,655.86 ","$0.00 ","$3,589.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,589.00 ","$0.00 ","$1,794.50 ","$2,842.49 ","$2,871.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000116","EAP","CPT� 36680","","Placement Of A Needle For Intraosseous Infusion","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$582.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$582.00 ","$0.00 ","$582.00 ","$460.94 ","$465.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000117","EAP","Custom 36000117","","Level 1 1st 30 Min","BOTH IP/OP","$11,028.00 ","$8,160.72 ","$0.00 ","$9,157.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,157.00 ","$0.00 ","$4,578.50 ","$7,252.34 ","$7,325.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000118","EAP","Custom 36000118","","Level 2 1st 30 Min","BOTH IP/OP","$13,392.00 ","$9,910.08 ","$0.00 ","$11,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,120.00 ","$0.00 ","$5,560.00 ","$8,807.04 ","$8,896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000119","EAP","Custom 36000119","","Level 3 1st 30 Min","BOTH IP/OP","$14,968.00 ","$11,076.32 ","$0.00 ","$12,428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,428.00 ","$0.00 ","$6,214.00 ","$9,842.98 ","$9,942.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000120","EAP","Custom 36000120","","Level 4 1st 30 Min","BOTH IP/OP","$16,545.00 ","$12,243.30 ","$0.00 ","$13,738.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,738.00 ","$0.00 ","$6,869.00 ","$10,880.50 ","$10,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000121","EAP","Custom 36000121","","Level 5 1st 30 Min","BOTH IP/OP","$18,117.00 ","$13,406.58 ","$0.00 ","$15,043.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,043.00 ","$0.00 ","$7,521.50 ","$11,914.06 ","$12,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000122","EAP","Custom 36000122","","Level 6 1st 30 Min","BOTH IP/OP","$19,694.00 ","$14,573.56 ","$0.00 ","$16,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,352.00 ","$0.00 ","$8,176.00 ","$12,950.78 ","$13,081.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000123","EAP","Custom 36000123","","Level 1 Add 15 Min","BOTH IP/OP","$4,964.00 ","$3,673.36 ","$0.00 ","$4,122.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,122.00 ","$0.00 ","$2,061.00 ","$3,264.62 ","$3,297.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000124","EAP","Custom 36000124","","Level 2 Add 15 Min","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$0.00 ","$5,007.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,007.00 ","$0.00 ","$2,503.50 ","$3,965.54 ","$4,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000125","EAP","Custom 36000125","","Level 3 Add 15 Min","BOTH IP/OP","$6,740.00 ","$4,987.60 ","$0.00 ","$5,596.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,596.00 ","$0.00 ","$2,798.00 ","$4,432.03 ","$4,476.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000126","EAP","Custom 36000126","","Level 4 Add 15 Min","BOTH IP/OP","$7,445.00 ","$5,509.30 ","$0.00 ","$6,182.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,182.00 ","$0.00 ","$3,091.00 ","$4,896.14 ","$4,945.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000127","EAP","Custom 36000127","","Level 5 Add 15 Min","BOTH IP/OP","$7,979.00 ","$5,904.46 ","$0.00 ","$6,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,625.00 ","$0.00 ","$3,312.50 ","$5,247.00 ","$5,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36000128","EAP","Custom 36000128","","Level 6 Add 15 Min","BOTH IP/OP","$8,864.00 ","$6,559.36 ","$0.00 ","$7,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,360.00 ","$0.00 ","$3,680.00 ","$5,829.12 ","$5,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100001","EAP","CPT� 10021","","Fna Bx W/o Img Gdn 1st Les","BOTH IP/OP","$1,308.00 ","$967.92 ","$0.00 ","$1,317.00 ","$1,308.00 ","$338.49 ","$272.62 ","$0.00 ","$0.00 ","$230.60 ","$1,317.00 ","$320.45 ","$1,317.00 ","$1,043.06 ","$1,053.60 ","$445.22 ","$93.38 ","$57.69 ","$209.67 ","$305.19 "
"36100002","EAP","CPT� 69100","","Biopsy Of External Ear","BOTH IP/OP","$2,056.00 ","$1,521.44 ","$0.00 ","$2,074.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,074.00 ","$0.00 ","$2,074.00 ","$1,642.61 ","$1,659.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100003","EAP","CPT� 22510","","Percut Vertebroplasty Thor","BOTH IP/OP","$7,794.00 ","$5,767.56 ","$0.00 ","$7,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,794.00 ","$0.00 ","$6,105.00 ","$6,172.85 ","$6,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100005","EAP","CPT� 22511","","Percut Vertebroplasty Lumb","BOTH IP/OP","$7,794.00 ","$5,767.56 ","$0.00 ","$7,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,794.00 ","$0.00 ","$6,105.00 ","$6,172.85 ","$6,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100006","EAP","CPT� 22512","","Percut Vertebroplasty Add'l","BOTH IP/OP","$7,794.00 ","$5,767.56 ","$0.00 ","$7,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,794.00 ","$0.00 ","$6,105.00 ","$6,172.85 ","$6,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100007","EAP","CPT� 22513","","Percut Kyphoplasty, Thor","BOTH IP/OP","$21,530.00 ","$15,932.20 ","$0.00 ","$21,747.00 ","$2,984.10 ","$6,134.13 ","$4,487.39 ","$0.00 ","$0.00 ","$0.00 ","$21,747.00 ","$0.00 ","$6,105.00 ","$17,223.62 ","$17,397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100008","EAP","CPT� 10040","","Acne Surgery","BOTH IP/OP","$568.00 ","$420.32 ","$0.00 ","$562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.00 ","$0.00 ","$562.00 ","$445.10 ","$449.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100009","EAP","CPT� 10060","","Drainage Abscess Simple/single","BOTH IP/OP","$1,334.00 ","$987.16 ","$74.65 ","$1,334.00 ","$1,334.00 ","$175.86 ","$278.04 ","$1,208.73 ","$1,208.73 ","$231.12 ","$1,320.00 ","$175.24 ","$1,320.00 ","$1,045.44 ","$1,056.00 ","$243.48 ","$74.65 ","$103.45 ","$210.14 ","$166.90 "
"36100010","EAP","CPT� 99291","","Hypothermia (critical Care) 1st 30-74 Min","BOTH IP/OP","$4,975.00 ","$3,681.50 ","$182.90 ","$4,975.00 ","$4,975.00 ","$729.47 ","$1,036.91 ","$3,136.01 ","$3,079.62 ","$755.52 ","$4,315.00 ","$668.62 ","$2,157.50 ","$3,417.48 ","$3,452.00 ","$928.96 ","$182.90 ","$226.49 ","$686.95 ","$636.78 "
"36100012","EAP","CPT� 99292","","Hypothermia (critical Care) Addl 30 Min","BOTH IP/OP","$1,110.00 ","$821.40 ","$0.00 ","$1,185.00 ","$1,110.00 ","$0.00 ","$231.35 ","$1,185.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$113.96 ","$188.65 ","$0.00 "
"36100013","EAP","CPT� 22514","","Percut Kyphoplasty, Lumb","BOTH IP/OP","$21,530.00 ","$15,932.20 ","$0.00 ","$21,747.00 ","$2,984.10 ","$6,134.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,747.00 ","$0.00 ","$6,105.00 ","$17,223.62 ","$17,397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100014","EAP","CPT� 22515","","Percut Kyphoplasty, Add-on","BOTH IP/OP","$21,530.00 ","$15,932.20 ","$0.00 ","$21,747.00 ","$2,321.55 ","$0.00 ","$4,487.39 ","$0.00 ","$0.00 ","$0.00 ","$21,747.00 ","$0.00 ","$10,873.50 ","$17,223.62 ","$17,397.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100016","EAP","CPT� 62302","","Myelography Via Lumbar Injection;cervical;including S&i","BOTH IP/OP","$764.00 ","$565.36 ","$0.00 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$764.00 ","$0.00 ","$382.00 ","$605.09 ","$611.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100017","EAP","CPT� 62303","","Myelography Via Lumbar Injection;thoracic;including S&i","BOTH IP/OP","$804.00 ","$594.96 ","$0.00 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$764.00 ","$0.00 ","$382.00 ","$605.09 ","$611.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100018","EAP","CPT� 62304","","Myelography Via Lumbar Injection;lumbosacral;including S&i","BOTH IP/OP","$1,729.00 ","$1,279.46 ","$0.00 ","$1,643.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,643.00 ","$0.00 ","$821.50 ","$1,301.26 ","$1,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100019","EAP","CPT� 62305","","Myelography Via Lumbar Injection' 2or More Regions;including S&i","BOTH IP/OP","$3,914.00 ","$2,896.36 ","$0.00 ","$3,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,720.00 ","$0.00 ","$1,860.00 ","$2,946.24 ","$2,976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100020","EAP","CPT� 10061","","Drainage Abscess Complex/multiple","BOTH IP/OP","$1,394.00 ","$1,031.56 ","$0.00 ","$1,394.00 ","$1,394.00 ","$338.49 ","$290.54 ","$1,208.73 ","$1,208.73 ","$0.00 ","$1,380.00 ","$320.45 ","$1,380.00 ","$1,092.96 ","$1,104.00 ","$445.22 ","$0.00 ","$187.80 ","$219.70 ","$305.19 "
"36100022","EAP","CPT� 20604","","Drain /inject-finger/toe With Us Guidance","BOTH IP/OP","$935.00 ","$691.90 ","$0.00 ","$936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.89 ","$936.00 ","$262.54 ","$936.00 ","$741.31 ","$748.80 ","$364.76 ","$69.40 ","$47.60 ","$149.01 ","$250.04 "
"36100023","EAP","CPT� 20606","","Drain/inject-wrist Elbow Ankle With Us Guidance","BOTH IP/OP","$935.00 ","$691.90 ","$0.00 ","$936.00 ","$935.00 ","$621.87 ","$194.88 ","$0.00 ","$0.00 ","$163.89 ","$936.00 ","$626.89 ","$936.00 ","$741.31 ","$748.80 ","$870.98 ","$76.82 ","$54.81 ","$149.01 ","$597.04 "
"36100024","EAP","CPT� 20611","","Drain/inject-shoulder Hip Knee With Us Guidance","BOTH IP/OP","$2,198.00 ","$1,626.52 ","$62.38 ","$2,200.00 ","$2,198.00 ","$255.86 ","$458.12 ","$1,570.14 ","$1,570.14 ","$385.20 ","$2,200.00 ","$262.54 ","$2,200.00 ","$1,742.40 ","$1,760.00 ","$364.76 ","$88.61 ","$62.38 ","$350.24 ","$250.04 "
"36100025","EAP","CPT� 20983","","Ablation Therapy Bone Tumor(s) Perq","BOTH IP/OP","$6,719.00 ","$4,972.06 ","$0.00 ","$6,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,299.00 ","$0.00 ","$5,452.00 ","$4,988.81 ","$5,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100026","EAP","CPT� 64566","","Percutaneous Tibial Nerve Stimulation","BOTH IP/OP","$617.00 ","$456.58 ","$0.00 ","$617.00 ","$617.00 ","$255.86 ","$128.60 ","$0.00 ","$0.00 ","$108.03 ","$617.00 ","$262.54 ","$617.00 ","$488.66 ","$493.60 ","$364.76 ","$122.82 ","$32.45 ","$98.23 ","$250.04 "
"36100027","EAP","CPT� 46607","","Anoscopy Hra W/biopsy","BOTH IP/OP","$3,451.00 ","$2,553.74 ","$0.00 ","$3,335.00 ","$2,321.55 ","$1,015.53 ","$719.27 ","$2,380.19 ","$2,380.19 ","$583.93 ","$3,335.00 ","$1,007.17 ","$2,255.00 ","$2,641.32 ","$2,668.00 ","$1,399.33 ","$0.00 ","$131.60 ","$530.93 ","$959.21 "
"36100028","EAP","CPT� 10080","","Drainage Of Pilonidal Cyst","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$712.00 ","$712.00 ","$609.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$705.00 ","$0.00 ","$705.00 ","$558.36 ","$564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100030","EAP","CPT� 10120","","Remove Foreign Body Sq Simple","BOTH IP/OP","$768.00 ","$568.32 ","$0.00 ","$768.00 ","$768.00 ","$338.49 ","$160.07 ","$0.00 ","$0.00 ","$0.00 ","$760.00 ","$0.00 ","$760.00 ","$601.92 ","$608.00 ","$0.00 ","$85.66 ","$0.00 ","$0.00 ","$0.00 "
"36100034","EAP","CPT� 10121","","Removal Of Fb, Sc Tissue Compl","BOTH IP/OP","$7,169.00 ","$5,305.06 ","$0.00 ","$7,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,095.00 ","$0.00 ","$2,327.00 ","$5,619.24 ","$5,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100035","EAP","CPT� 10140","","Drainage Of Hematoma/fluid","BOTH IP/OP","$6,515.00 ","$4,821.10 ","$0.00 ","$6,448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,448.00 ","$0.00 ","$2,255.00 ","$5,106.82 ","$5,158.40 ","$0.00 ","$89.99 ","$0.00 ","$0.00 ","$0.00 "
"36100036","EAP","CPT� 52204","","Cystoscopy W/diopsy (s)","BOTH IP/OP","$13,064.00 ","$9,667.36 ","$0.00 ","$13,103.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,103.00 ","$0.00 ","$2,327.00 ","$10,377.58 ","$10,482.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100037","EAP","CPT� 52354","","Cystouretero W/diopsy","BOTH IP/OP","$6,056.00 ","$4,481.44 ","$0.00 ","$6,074.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,074.00 ","$0.00 ","$3,606.00 ","$4,810.61 ","$4,859.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100041","EAP","CPT� 10160","","Aspiration Abscess Hematoma Bulla/cyst","BOTH IP/OP","$645.00 ","$477.30 ","$0.00 ","$645.00 ","$645.00 ","$338.49 ","$134.43 ","$0.00 ","$0.00 ","$111.71 ","$638.00 ","$320.45 ","$638.00 ","$505.30 ","$510.40 ","$445.22 ","$78.53 ","$97.69 ","$101.57 ","$305.19 "
"36100042","EAP","CPT� 31600","","Tracheostomy, Planned","BOTH IP/OP","$4,986.00 ","$3,689.64 ","$0.00 ","$4,879.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,879.00 ","$0.00 ","$2,327.00 ","$3,864.17 ","$3,903.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100044","EAP","CPT� 36473","","Endoven Abltj Incmptnt Vein Mchnchem 1st Vein","BOTH IP/OP","$8,848.00 ","$6,547.52 ","$186.78 ","$7,034.00 ","$2,984.10 ","$2,803.47 ","$1,844.14 ","$5,020.17 ","$5,020.17 ","$1,231.60 ","$7,034.00 ","$2,779.42 ","$2,858.00 ","$5,570.93 ","$5,627.20 ","$3,861.64 ","$1,443.33 ","$186.78 ","$1,119.81 ","$2,647.07 "
"36100045","EAP","CPT� 36474","","Endoven Abltj Incmptnt Vein Mchn Sbsq Veins-add On","BOTH IP/OP","$2,213.00 ","$1,637.62 ","$0.00 ","$1,759.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,759.00 ","$0.00 ","$879.50 ","$1,393.13 ","$1,407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100046","EAP","CPT� 64611","","Chemodenerv Parotid/subm Salivary Glands Bilateral","BOTH IP/OP","$469.00 ","$347.06 ","$0.00 ","$472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.64 ","$472.00 ","$262.54 ","$472.00 ","$373.82 ","$377.60 ","$364.76 ","$94.40 ","$108.82 ","$75.14 ","$250.04 "
"36100049","EAP","CPT� 10180","","I&d Complex Post Op Wound Inf","BOTH IP/OP","$6,264.00 ","$4,635.36 ","$0.00 ","$6,199.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,085.40 ","$6,199.00 ","$0.00 ","$2,327.00 ","$4,909.61 ","$4,959.20 ","$0.00 ","$130.53 ","$0.00 ","$0.00 ","$0.00 "
"36100050","EAP","CPT� 52315","","Cystoscopy And Treatment","BOTH IP/OP","$8,062.00 ","$5,965.88 ","$0.00 ","$8,143.00 ","$0.00 ","$0.00 ","$0.00 ","$5,811.66 ","$5,416.74 ","$1,425.77 ","$8,143.00 ","$1,776.76 ","$2,327.00 ","$6,449.26 ","$6,514.40 ","$2,468.57 ","$535.80 ","$285.23 ","$1,296.37 ","$1,692.15 "
"36100051","EAP","CPT� 11000","","Debridement Of Skin","BOTH IP/OP","$3,090.00 ","$2,286.60 ","$0.00 ","$2,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,938.00 ","$0.00 ","$2,255.00 ","$2,326.90 ","$2,350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100057","EAP","CPT� 11001","","Debride, Each Add 10% Of Body","BOTH IP/OP","$1,665.00 ","$1,232.10 ","$0.00 ","$1,671.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,671.00 ","$0.00 ","$1,671.00 ","$1,323.43 ","$1,336.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100058","EAP","CPT� 97597","","Debridement First 20 Sq Cm Or Less","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$740.00 ","$175.86 ","$154.23 ","$0.00 ","$0.00 ","$118.01 ","$674.00 ","$175.24 ","$674.00 ","$533.81 ","$539.20 ","$243.48 ","$48.15 ","$37.87 ","$107.30 ","$166.90 "
"36100060","EAP","CPT� 49418","","Insertion Of Tunneled Intraperitoneal Catheter","BOTH IP/OP","$8,783.00 ","$6,499.42 ","$0.00 ","$8,234.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,234.00 ","$0.00 ","$2,858.00 ","$6,521.33 ","$6,587.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100061","EAP","CPT� 97598","","Debridement Open Wound Ea Addl 20 Sq Cm","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$0.00 ","$0.00 ","$128.39 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$61.13 ","$26.68 ","$89.31 ","$0.00 "
"36100063","EAP","CPT� 11042","","Debridement Skin,and Subcutane","BOTH IP/OP","$2,172.00 ","$1,607.28 ","$63.09 ","$2,172.00 ","$2,172.00 ","$338.49 ","$452.70 ","$1,482.64 ","$1,482.64 ","$361.56 ","$2,065.00 ","$320.45 ","$2,065.00 ","$1,635.48 ","$1,652.00 ","$445.22 ","$70.00 ","$63.09 ","$328.75 ","$305.19 "
"36100065","EAP","CPT� 11043","","Debridement Skin/sq/muscle","BOTH IP/OP","$4,347.00 ","$3,216.78 ","$161.16 ","$4,133.00 ","$2,753.10 ","$512.91 ","$906.02 ","$2,949.72 ","$2,949.72 ","$723.66 ","$4,133.00 ","$498.48 ","$2,327.00 ","$3,273.34 ","$3,306.40 ","$692.57 ","$168.42 ","$161.16 ","$657.97 ","$474.74 "
"36100067","EAP","CPT� 11044","","Debridement, Bone","BOTH IP/OP","$5,344.00 ","$3,954.56 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$3,625.60 ","$3,625.60 ","$889.47 ","$5,080.00 ","$1,376.63 ","$2,327.00 ","$4,023.36 ","$4,064.00 ","$1,912.65 ","$0.00 ","$236.52 ","$808.74 ","$1,311.08 "
"36100070","EAP","CPT� 11055","","Pare Wart/callus/hyperkaratotic Lesion, Single","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$365.00 ","$175.86 ","$76.08 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$175.24 ","$365.00 ","$289.08 ","$292.00 ","$243.48 ","$21.20 ","$16.59 ","$58.11 ","$166.90 "
"36100073","EAP","CPT� 11056","","Pare Wart/callus, 2-4 Lesions","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$365.00 ","$175.86 ","$76.08 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$175.24 ","$365.00 ","$289.08 ","$292.00 ","$243.48 ","$28.23 ","$24.16 ","$58.11 ","$166.90 "
"36100074","EAP","CPT� 11057","","Pare Wart/callus, >4 Lesions","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$927.00 ","$927.00 ","$175.86 ","$193.21 ","$0.00 ","$0.00 ","$162.14 ","$926.00 ","$175.24 ","$926.00 ","$733.39 ","$740.80 ","$243.48 ","$31.34 ","$30.66 ","$147.42 ","$166.90 "
"36100078","EAP","CPT� 11200","","Removal Of Skin Tags (1-15)","BOTH IP/OP","$712.00 ","$526.88 ","$55.43 ","$712.00 ","$712.00 ","$175.86 ","$148.40 ","$711.00 ","$711.00 ","$124.49 ","$711.00 ","$175.24 ","$711.00 ","$563.11 ","$568.80 ","$243.48 ","$55.43 ","$75.69 ","$113.19 ","$166.90 "
"36100081","EAP","CPT� 11201","","Removal Of Skin Tags;ea Add 10","BOTH IP/OP","$1,016.00 ","$751.84 ","$0.00 ","$1,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,015.00 ","$0.00 ","$1,015.00 ","$803.88 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100082","EAP","CPT� 11300","","Shave Les Trunk Arm Leg <0.5cm","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.00 ","$0.00 ","$365.00 ","$289.08 ","$292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100083","EAP","CPT� 11301","","Shave Trunk Arm Leg 0.6-1.0cm","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.00 ","$0.00 ","$365.00 ","$289.08 ","$292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100084","EAP","CPT� 11302","","Shave Trunk Arm Leg 1.1-2.0cm","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$752.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100085","EAP","CPT� 11303","","Shave Trunk Arm Leg >2.0cm","BOTH IP/OP","$1,136.00 ","$840.64 ","$0.00 ","$1,135.00 ","$616.85 ","$338.49 ","$236.77 ","$0.00 ","$0.00 ","$0.00 ","$1,135.00 ","$0.00 ","$1,135.00 ","$898.92 ","$908.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100086","EAP","CPT� 11305","","Shave Skin Lesion 0.5 Cm/<","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$408.34 ","$175.86 ","$156.74 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$752.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100088","EAP","CPT� 11306","","Shave Scalp/neck/hnd/ft 0.6-1.","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$752.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100089","EAP","CPT� 11307","","Shave Scalp/neck/hnd/ft 1.1-2.","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$670.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100090","EAP","CPT� 11308","","Shave Scalp/neck/hnd/feet >2.0","BOTH IP/OP","$721.00 ","$533.54 ","$0.00 ","$720.00 ","$391.50 ","$338.49 ","$150.27 ","$0.00 ","$0.00 ","$126.07 ","$720.00 ","$320.45 ","$720.00 ","$570.24 ","$576.00 ","$445.22 ","$100.61 ","$76.09 ","$114.62 ","$305.19 "
"36100091","EAP","CPT� 11310","","Shaving Fac Ear Nos Lip <.5cm","BOTH IP/OP","$720.00 ","$532.80 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$720.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100092","EAP","CPT� 27570","","Manipulation Knee Joint Under General Anes","BOTH IP/OP","$4,221.00 ","$3,123.54 ","$0.00 ","$4,221.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,221.00 ","$0.00 ","$2,255.00 ","$3,343.03 ","$3,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100094","EAP","CPT� 11311","","Shav Fac/ear/eye/nos/lip 0.6-1","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$408.34 ","$175.86 ","$156.74 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$752.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100096","EAP","CPT� 11312","","Shav Fac/ear/eye/nos/lip 1.1-2","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$752.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100098","EAP","CPT� 11313","","Shav Face/ear/eye/nose/lip >2.","BOTH IP/OP","$1,483.00 ","$1,097.42 ","$0.00 ","$1,483.00 ","$805.27 ","$338.49 ","$309.09 ","$0.00 ","$0.00 ","$0.00 ","$1,483.00 ","$0.00 ","$1,483.00 ","$1,174.54 ","$1,186.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100099","EAP","CPT� 11400","","Exc Benign Lesion T/a/l  0.5 Cm/<","BOTH IP/OP","$2,074.00 ","$1,534.76 ","$0.00 ","$2,071.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,071.00 ","$0.00 ","$2,071.00 ","$1,640.23 ","$1,656.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100100","EAP","CPT� 64999","","Quadratus Lumborum-anes","BOTH IP/OP","$4,470.00 ","$3,307.80 ","$0.00 ","$4,438.00 ","$2,321.55 ","$255.86 ","$0.00 ","$3,167.40 ","$3,167.40 ","$777.06 ","$4,438.00 ","$262.54 ","$2,255.00 ","$3,514.90 ","$3,550.40 ","$364.76 ","$694.55 ","$0.00 ","$706.53 ","$250.04 "
"36100101","EAP","CPT� 11401","","Exc Benign Lesion  T/a/l 0.6-1.0 Cm","BOTH IP/OP","$2,327.00 ","$1,721.98 ","$0.00 ","$2,324.00 ","$2,321.55 ","$338.49 ","$485.00 ","$0.00 ","$0.00 ","$0.00 ","$2,324.00 ","$0.00 ","$2,255.00 ","$1,840.61 ","$1,859.20 ","$0.00 ","$105.27 ","$0.00 ","$0.00 ","$0.00 "
"36100103","EAP","CPT� 11402","","Exc Benign Lesion  T/a/l 1.1-2.0 Cm","BOTH IP/OP","$2,327.00 ","$1,721.98 ","$117.87 ","$2,324.00 ","$2,321.55 ","$609.42 ","$485.00 ","$1,658.64 ","$1,658.64 ","$406.91 ","$2,324.00 ","$611.80 ","$2,255.00 ","$1,840.61 ","$1,859.20 ","$850.02 ","$121.81 ","$117.87 ","$369.98 ","$582.67 "
"36100105","EAP","CPT� 11403","","Exc Benign Lesion  T/a/l 2.1-3.0 Cm","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$142.90 ","$6,022.00 ","$2,321.55 ","$609.42 ","$1,256.80 ","$4,297.90 ","$4,297.90 ","$1,054.40 ","$6,022.00 ","$611.80 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$850.02 ","$142.90 ","$152.47 ","$958.70 ","$582.67 "
"36100107","EAP","CPT� 11404","","Exc Benign Lesion T/a/l 3.1-4.0 Cm","BOTH IP/OP","$10,505.00 ","$7,773.70 ","$0.00 ","$10,492.00 ","$2,321.55 ","$1,377.93 ","$2,189.50 ","$7,488.14 ","$5,416.74 ","$0.00 ","$10,492.00 ","$1,376.63 ","$2,255.00 ","$8,309.66 ","$8,393.60 ","$1,912.65 ","$0.00 ","$167.97 ","$1,670.33 ","$1,311.08 "
"36100109","EAP","CPT� 11406","","Exc, Benign,>4.0 Cm, T/a/l","BOTH IP/OP","$11,772.00 ","$8,711.28 ","$197.38 ","$11,757.00 ","$2,753.10 ","$1,377.93 ","$2,453.58 ","$8,390.97 ","$5,416.74 ","$2,058.56 ","$11,757.00 ","$1,376.63 ","$2,327.00 ","$9,311.54 ","$9,405.60 ","$1,912.65 ","$197.38 ","$255.57 ","$1,871.71 ","$1,311.08 "
"36100110","EAP","CPT� 64505","","N Block Spenopalatine Gangl","BOTH IP/OP","$2,665.00 ","$1,972.10 ","$0.00 ","$2,571.00 ","$2,321.55 ","$255.86 ","$555.45 ","$0.00 ","$0.00 ","$0.00 ","$2,571.00 ","$0.00 ","$2,255.00 ","$2,036.23 ","$2,056.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100111","EAP","CPT� 11420","","Exc Benign Scalp Genit Hand Ft","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$0.00 ","$6,022.00 ","$0.00 ","$0.00 ","$1,256.80 ","$0.00 ","$0.00 ","$0.00 ","$6,022.00 ","$0.00 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100112","EAP","CPT� 30140","","Resect Inferior Turbinate Submucous Bilateral","BOTH IP/OP","$5,043.00 ","$3,731.82 ","$0.00 ","$5,043.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,043.00 ","$0.00 ","$2,327.00 ","$3,994.06 ","$4,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100115","EAP","CPT� 11421","","Exc Benign Scalp Genit Hnd Ft","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$0.00 ","$6,022.00 ","$0.00 ","$0.00 ","$1,256.80 ","$4,297.90 ","$4,297.90 ","$1,054.40 ","$6,022.00 ","$611.80 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$850.02 ","$111.86 ","$112.83 ","$958.70 ","$582.67 "
"36100118","EAP","CPT� 11422","","Exc Ben Scal Gent Hd Ft Neck","BOTH IP/OP","$5,541.00 ","$4,100.34 ","$127.73 ","$5,534.00 ","$2,321.55 ","$1,377.93 ","$1,154.88 ","$3,949.62 ","$3,949.62 ","$968.96 ","$5,534.00 ","$1,376.63 ","$2,255.00 ","$4,382.93 ","$4,427.20 ","$1,912.65 ","$127.73 ","$139.85 ","$881.01 ","$1,311.08 "
"36100120","EAP","CPT� 11423","","Exc Beng Scp Gent Hd Ft Nk","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$0.00 ","$6,022.00 ","$2,321.55 ","$1,377.93 ","$1,256.80 ","$0.00 ","$0.00 ","$0.00 ","$6,022.00 ","$0.00 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$0.00 ","$156.22 ","$0.00 ","$0.00 ","$0.00 "
"36100121","EAP","CPT� 31295","","Sinus Endo W/balloon Dil","BOTH IP/OP","$6,390.00 ","$4,728.60 ","$0.00 ","$6,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,390.00 ","$0.00 ","$3,902.00 ","$5,060.88 ","$5,112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100122","EAP","CPT� 11424","","Exc Beng Sc, Genit Hd Ft Neck","BOTH IP/OP","$4,851.00 ","$3,589.74 ","$0.00 ","$4,845.00 ","$2,753.10 ","$1,377.93 ","$1,011.07 ","$0.00 ","$0.00 ","$0.00 ","$4,845.00 ","$0.00 ","$2,327.00 ","$3,837.24 ","$3,876.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100123","EAP","CPT� 31513","","Injection Into Vocal Cord","BOTH IP/OP","$6,225.00 ","$4,606.50 ","$0.00 ","$6,511.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,511.00 ","$0.00 ","$2,327.00 ","$5,156.71 ","$5,208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100124","EAP","CPT� 11426","","Exc,benign,>4.0 Cm,sclp/h/f","BOTH IP/OP","$6,408.00 ","$4,741.92 ","$0.00 ","$6,400.00 ","$2,753.10 ","$2,322.02 ","$1,335.59 ","$0.00 ","$0.00 ","$0.00 ","$6,400.00 ","$0.00 ","$2,327.00 ","$5,068.80 ","$5,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100126","EAP","CPT� 11440","","Exc Benign Face Ear Nose Muc","BOTH IP/OP","$1,776.00 ","$1,314.24 ","$0.00 ","$1,774.00 ","$0.00 ","$0.00 ","$0.00 ","$1,266.10 ","$1,266.10 ","$310.61 ","$1,774.00 ","$611.80 ","$1,774.00 ","$1,405.01 ","$1,419.20 ","$850.02 ","$101.18 ","$105.96 ","$282.42 ","$582.67 "
"36100130","EAP","CPT� 11441","","Exc Benign Face Ear Nose Muc","BOTH IP/OP","$3,293.00 ","$2,436.82 ","$0.00 ","$3,289.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.36 ","$2,347.36 ","$0.00 ","$3,289.00 ","$611.80 ","$2,255.00 ","$2,604.89 ","$2,631.20 ","$850.02 ","$0.00 ","$134.44 ","$523.61 ","$582.67 "
"36100132","EAP","CPT� 11442","","Exc, Beng Fc, Er,nos,muc 1.1-2","BOTH IP/OP","$3,246.00 ","$2,402.04 ","$139.44 ","$3,242.00 ","$2,321.55 ","$609.42 ","$676.55 ","$2,313.82 ","$2,313.82 ","$567.65 ","$3,242.00 ","$611.80 ","$2,255.00 ","$2,567.66 ","$2,593.60 ","$850.02 ","$139.44 ","$149.22 ","$516.13 ","$582.67 "
"36100135","EAP","CPT� 11443","","Exc Benign Lesion  F/e/e/n/l/m 2.1-3.0cm","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$177.41 ","$6,022.00 ","$2,321.55 ","$1,377.93 ","$1,256.80 ","$4,297.90 ","$4,297.90 ","$1,054.40 ","$6,022.00 ","$1,376.63 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$1,912.65 ","$177.41 ","$183.11 ","$958.70 ","$1,311.08 "
"36100138","EAP","CPT� 11444","","Exc Benign Lesion  F/e/e/n/l/m 3.1-4.0cm","BOTH IP/OP","$2,484.00 ","$1,838.16 ","$0.00 ","$2,481.00 ","$2,321.55 ","$1,377.93 ","$517.73 ","$0.00 ","$0.00 ","$0.00 ","$2,481.00 ","$0.00 ","$2,255.00 ","$1,964.95 ","$1,984.80 ","$0.00 ","$220.76 ","$0.00 ","$0.00 ","$0.00 "
"36100141","EAP","CPT� 11446","","Exc Benign,>4.0 Cm,f/e/mem","BOTH IP/OP","$15,310.00 ","$11,329.40 ","$0.00 ","$15,291.00 ","$2,753.10 ","$2,322.02 ","$3,190.99 ","$0.00 ","$0.00 ","$0.00 ","$15,291.00 ","$0.00 ","$2,327.00 ","$12,110.47 ","$12,232.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100142","EAP","CPT� 11601","","Exc.malig,tr/a/l,0.6-1.0cm","BOTH IP/OP","$2,235.00 ","$1,653.90 ","$0.00 ","$2,235.00 ","$2,235.00 ","$609.42 ","$465.83 ","$0.00 ","$0.00 ","$0.00 ","$2,232.00 ","$0.00 ","$2,232.00 ","$1,767.74 ","$1,785.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100143","EAP","CPT� 11602","","Exc.malig,tr/a/l,1.1-2.0cm","BOTH IP/OP","$2,327.00 ","$1,721.98 ","$0.00 ","$2,324.00 ","$2,321.55 ","$338.49 ","$485.00 ","$0.00 ","$0.00 ","$0.00 ","$2,324.00 ","$0.00 ","$2,255.00 ","$1,840.61 ","$1,859.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100144","EAP","CPT� 11603","","Exc.malig Tr/a/l,2.1-3.0cm","BOTH IP/OP","$5,176.00 ","$3,830.24 ","$0.00 ","$5,169.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,169.00 ","$0.00 ","$2,255.00 ","$4,093.85 ","$4,135.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100145","EAP","CPT� 11604","","Exc Malign Tr Arm Leg 3.1-4.0","BOTH IP/OP","$5,176.00 ","$3,830.24 ","$0.00 ","$5,169.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,169.00 ","$0.00 ","$2,327.00 ","$4,093.85 ","$4,135.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100146","EAP","CPT� 11606","","Exc Malig>4.0 Cm,trnk/a/l","BOTH IP/OP","$10,505.00 ","$7,773.70 ","$0.00 ","$10,492.00 ","$0.00 ","$0.00 ","$0.00 ","$7,488.14 ","$5,416.74 ","$1,837.07 ","$10,492.00 ","$1,376.63 ","$2,327.00 ","$8,309.66 ","$8,393.60 ","$1,912.65 ","$252.57 ","$329.86 ","$1,670.33 ","$1,311.08 "
"36100147","EAP","CPT� 11621","","Exc Malign Scap Gent Hd,ft Nk","BOTH IP/OP","$3,293.00 ","$2,436.82 ","$0.00 ","$3,289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,289.00 ","$0.00 ","$2,255.00 ","$2,604.89 ","$2,631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100148","EAP","CPT� 11622","","Exc Malignant Lesion  S/n/h/f/g 1.1-2.0 Cm","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$0.00 ","$6,022.00 ","$2,321.55 ","$609.42 ","$1,256.80 ","$0.00 ","$0.00 ","$0.00 ","$6,022.00 ","$0.00 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100150","EAP","CPT� 11623","","Exc Malignant Lesion  S/n/h/f/g 2.1-3.0 Cm","BOTH IP/OP","$11,307.00 ","$8,367.18 ","$0.00 ","$11,307.00 ","$2,321.55 ","$1,377.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,307.00 ","$0.00 ","$2,255.00 ","$8,955.14 ","$9,045.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100152","EAP","CPT� 11624","","Exc Malign Scp Gent Hd Ft Nk","BOTH IP/OP","$10,091.00 ","$7,467.34 ","$0.00 ","$10,091.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,091.00 ","$0.00 ","$2,327.00 ","$7,992.07 ","$8,072.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100153","EAP","CPT� 11626","","Excis Malig,>4.0 Cm,scp/h/ft","BOTH IP/OP","$13,133.00 ","$9,718.42 ","$0.00 ","$13,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,133.00 ","$0.00 ","$2,327.00 ","$10,401.34 ","$10,506.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100154","EAP","CPT� 11640","","Exc Malignant Lesion  F/e/e/n/l 0.5 Cm/<","BOTH IP/OP","$3,168.00 ","$2,344.32 ","$0.00 ","$3,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,164.00 ","$0.00 ","$2,255.00 ","$2,505.89 ","$2,531.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100156","EAP","CPT� 11641","","Exc Malignant Lesion  F/e/e/n/l 0.6-1.0 Cm","BOTH IP/OP","$3,044.00 ","$2,252.56 ","$0.00 ","$3,044.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,044.00 ","$0.00 ","$2,255.00 ","$2,410.85 ","$2,435.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100159","EAP","CPT� 11642","","Exc Malignant Lesion  F/e/e/n/l 1.1-2.0 Cm","BOTH IP/OP","$6,030.00 ","$4,462.20 ","$0.00 ","$6,022.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,022.00 ","$0.00 ","$2,255.00 ","$4,769.42 ","$4,817.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100161","EAP","CPT� 11643","","Exc Malign Fc Ear Nose Mus Mem","BOTH IP/OP","$5,789.00 ","$4,283.86 ","$0.00 ","$5,789.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,789.00 ","$0.00 ","$2,255.00 ","$4,584.89 ","$4,631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100162","EAP","CPT� 11644","","Exc Malign Fc Ear Nose Muc Mem","BOTH IP/OP","$10,091.00 ","$7,467.34 ","$0.00 ","$10,091.00 ","$2,753.10 ","$1,377.93 ","$2,103.22 ","$0.00 ","$0.00 ","$0.00 ","$10,091.00 ","$0.00 ","$2,327.00 ","$7,992.07 ","$8,072.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100163","EAP","CPT� 11646","","Exc,malig,>4.0 Cm,f/e/mem","BOTH IP/OP","$13,656.00 ","$10,105.44 ","$0.00 ","$13,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,656.00 ","$0.00 ","$2,327.00 ","$10,815.55 ","$10,924.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100165","EAP","CPT� 11719","","Trim Of Nondystrophic Nail(s) Any","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.00 ","$0.00 ","$288.00 ","$228.10 ","$230.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100166","EAP","CPT� 11720","","Debridement Nail Any Method 1-5","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$201.00 ","$199.00 ","$54.51 ","$41.48 ","$0.00 ","$0.00 ","$35.19 ","$201.00 ","$55.17 ","$201.00 ","$159.19 ","$160.80 ","$76.65 ","$25.44 ","$15.15 ","$32.00 ","$52.54 "
"36100169","EAP","CPT� 11721","","Debridement Nail Any Method 6/>","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$201.00 ","$199.00 ","$54.51 ","$41.48 ","$0.00 ","$0.00 ","$35.19 ","$201.00 ","$55.17 ","$201.00 ","$159.19 ","$160.80 ","$76.65 ","$39.87 ","$25.97 ","$32.00 ","$52.54 "
"36100173","EAP","CPT� 11730","","Avulsion Nail Plate Partial/complete Simple 1st","BOTH IP/OP","$427.00 ","$315.98 ","$56.62 ","$431.00 ","$427.00 ","$175.86 ","$89.00 ","$431.00 ","$431.00 ","$75.46 ","$431.00 ","$175.24 ","$431.00 ","$341.35 ","$344.80 ","$243.48 ","$63.22 ","$56.62 ","$68.62 ","$166.90 "
"36100176","EAP","CPT� 11732","","Avulsion Nail Plate Partial/complete Simple Ea Addl","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$209.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$209.00 ","$165.53 ","$167.20 ","$0.00 ","$31.24 ","$18.03 ","$33.27 ","$0.00 "
"36100178","EAP","CPT� 11740","","Evacuation Subungual Hematoma","BOTH IP/OP","$248.00 ","$183.52 ","$0.00 ","$250.00 ","$248.00 ","$110.43 ","$51.69 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100180","EAP","CPT� 11750","","Excision Nail Matrix Permanent Removal","BOTH IP/OP","$1,397.00 ","$1,033.78 ","$0.00 ","$1,410.00 ","$1,397.00 ","$338.49 ","$291.17 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$1,410.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100183","EAP","CPT� 11765","","Wedge Excision Skin Nail Fold","BOTH IP/OP","$554.00 ","$409.96 ","$0.00 ","$559.00 ","$554.00 ","$338.49 ","$0.00 ","$559.00 ","$559.00 ","$97.88 ","$559.00 ","$320.45 ","$559.00 ","$442.73 ","$447.20 ","$445.22 ","$52.25 ","$95.17 ","$88.99 ","$305.19 "
"36100186","EAP","CPT� 11900","","Intralesional Inj Up To 7 Les","BOTH IP/OP","$338.00 ","$250.12 ","$0.00 ","$341.00 ","$338.00 ","$175.86 ","$70.45 ","$0.00 ","$0.00 ","$59.71 ","$341.00 ","$175.24 ","$341.00 ","$270.07 ","$272.80 ","$243.48 ","$36.36 ","$31.37 ","$54.29 ","$166.90 "
"36100188","EAP","CPT� 11901","","Injection Intralesional >7 Lesions","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$279.00 ","$276.00 ","$175.86 ","$57.53 ","$0.00 ","$0.00 ","$48.85 ","$279.00 ","$175.24 ","$279.00 ","$220.97 ","$223.20 ","$243.48 ","$51.85 ","$49.03 ","$44.42 ","$166.90 "
"36100190","EAP","CPT� 11952","","Saline Injection < 10.0cc","BOTH IP/OP","$556.00 ","$411.44 ","$0.00 ","$562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.00 ","$0.00 ","$562.00 ","$445.10 ","$449.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100191","EAP","CPT� 11954","","Saline Injection > 10.0cc","BOTH IP/OP","$562.00 ","$415.88 ","$0.00 ","$562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.00 ","$0.00 ","$562.00 ","$445.10 ","$449.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100192","EAP","CPT� 11960","","Insert Tissue Expander(s)","BOTH IP/OP","$5,416.00 ","$4,007.84 ","$0.00 ","$5,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,416.00 ","$0.00 ","$2,327.00 ","$4,289.47 ","$4,332.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100193","EAP","CPT� 11981","","Insert,implant Contraceptive","BOTH IP/OP","$286.00 ","$211.64 ","$0.00 ","$286.00 ","$286.00 ","$110.43 ","$59.61 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$109.35 ","$285.00 ","$225.72 ","$228.00 ","$151.93 ","$112.89 ","$67.06 ","$45.37 ","$104.14 "
"36100196","EAP","CPT� 12001","","Lac Repair, S,n,h,f <2.5cm","BOTH IP/OP","$704.00 ","$520.96 ","$0.00 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$704.00 ","$704.00 ","$123.26 ","$704.00 ","$175.24 ","$704.00 ","$557.57 ","$563.20 ","$243.48 ","$116.22 ","$46.87 ","$112.08 ","$166.90 "
"36100197","EAP","CPT� 12001","","Lac Repr Sclp Nck Hnd Ft <2.6c","BOTH IP/OP","$704.00 ","$520.96 ","$0.00 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$704.00 ","$704.00 ","$123.26 ","$704.00 ","$175.24 ","$704.00 ","$557.57 ","$563.20 ","$243.48 ","$116.22 ","$46.87 ","$112.08 ","$166.90 "
"36100198","EAP","CPT� 12001","","Lac Repr Sclp Nck Hnd Ft<2.6cm","BOTH IP/OP","$704.00 ","$520.96 ","$0.00 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$704.00 ","$704.00 ","$123.26 ","$704.00 ","$175.24 ","$704.00 ","$557.57 ","$563.20 ","$243.48 ","$116.22 ","$46.87 ","$112.08 ","$166.90 "
"36100199","EAP","CPT� 12002","","Lac Repair, S,n,h,f 2.6-7.5cm","BOTH IP/OP","$879.00 ","$650.46 ","$0.00 ","$879.00 ","$0.00 ","$0.00 ","$0.00 ","$879.00 ","$879.00 ","$153.91 ","$879.00 ","$175.24 ","$879.00 ","$696.17 ","$703.20 ","$243.48 ","$127.88 ","$62.38 ","$139.94 ","$166.90 "
"36100200","EAP","CPT� 12002","","Lac Repr Fce Ear Lp 2.6-5.0","BOTH IP/OP","$867.00 ","$641.58 ","$62.38 ","$879.00 ","$470.78 ","$175.86 ","$180.70 ","$879.00 ","$879.00 ","$153.91 ","$879.00 ","$175.24 ","$879.00 ","$696.17 ","$703.20 ","$243.48 ","$127.88 ","$62.38 ","$139.94 ","$166.90 "
"36100201","EAP","CPT� 12002","","Lac Repr Sclp Nck Hnd Ft 2.6-7","BOTH IP/OP","$938.00 ","$694.12 ","$62.38 ","$879.00 ","$509.33 ","$175.86 ","$195.50 ","$879.00 ","$879.00 ","$153.91 ","$879.00 ","$175.24 ","$879.00 ","$696.17 ","$703.20 ","$243.48 ","$127.88 ","$62.38 ","$139.94 ","$166.90 "
"36100202","EAP","CPT� 12004","","Rep Sc/nk/ax/gen/tk 7.6-12.5","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$970.00 ","$169.84 ","$970.00 ","$175.24 ","$970.00 ","$768.24 ","$776.00 ","$243.48 ","$152.49 ","$77.52 ","$154.42 ","$166.90 "
"36100203","EAP","CPT� 12011","","Lac Repr Fce Ear Eye Lp <2.6cm","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$0.00 ","$0.00 ","$0.00 ","$729.00 ","$729.00 ","$127.64 ","$729.00 ","$175.24 ","$729.00 ","$577.37 ","$583.20 ","$243.48 ","$123.67 ","$58.77 ","$116.06 ","$166.90 "
"36100206","EAP","CPT� 20552","","Bilat Inject Trigger Point 1-2 Musc","BOTH IP/OP","$961.00 ","$711.14 ","$0.00 ","$962.00 ","$961.00 ","$255.86 ","$200.30 ","$0.00 ","$0.00 ","$168.44 ","$962.00 ","$262.54 ","$962.00 ","$761.90 ","$769.60 ","$364.76 ","$66.56 ","$40.02 ","$153.15 ","$250.04 "
"36100207","EAP","CPT� 12013","","Lac Repr Fce Ear Eye Lp 2.6-5.","BOTH IP/OP","$894.00 ","$661.56 ","$0.00 ","$894.00 ","$0.00 ","$0.00 ","$0.00 ","$894.00 ","$894.00 ","$156.53 ","$894.00 ","$175.24 ","$894.00 ","$708.05 ","$715.20 ","$243.48 ","$140.24 ","$62.02 ","$142.32 ","$166.90 "
"36100208","EAP","CPT� 16036","","Escharotomy Each Addl Incision","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,198.00 ","$0.00 ","$1,198.00 ","$948.82 ","$958.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100209","EAP","CPT� 16035","","Escharotomy First Incision","BOTH IP/OP","$770.00 ","$569.80 ","$0.00 ","$732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$732.00 ","$0.00 ","$732.00 ","$579.74 ","$585.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100211","EAP","CPT� 12014","","Rp Si Fa Ear Nos Lip 5.1cm-7.5","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$970.00 ","$169.84 ","$970.00 ","$175.24 ","$970.00 ","$768.24 ","$776.00 ","$243.48 ","$166.21 ","$79.33 ","$154.42 ","$166.90 "
"36100214","EAP","CPT� 12015","","Smpl Rpr Sprfsl Face 7.6-12.5c","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$215.72 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100215","EAP","CPT� 12016","","Smpl Rpr Sprfsl Face 12.6-20cm","BOTH IP/OP","$957.00 ","$708.18 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100216","EAP","CPT� 12017","","Smpl Rpr Sprfsl Face 20.1-30.0","BOTH IP/OP","$1,559.00 ","$1,153.66 ","$0.00 ","$1,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,580.00 ","$0.00 ","$1,580.00 ","$1,251.36 ","$1,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100217","EAP","CPT� 12020","","Wound Dehiscence Simple Closur","BOTH IP/OP","$2,965.00 ","$2,194.10 ","$0.00 ","$2,778.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,778.00 ","$0.00 ","$2,255.00 ","$2,200.18 ","$2,222.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100219","EAP","CPT� 12021","","Packing Of Wound Dehisience","BOTH IP/OP","$3,923.00 ","$2,903.02 ","$117.17 ","$3,676.00 ","$2,321.55 ","$338.49 ","$817.65 ","$2,623.56 ","$2,623.56 ","$643.64 ","$3,676.00 ","$320.45 ","$2,255.00 ","$2,911.39 ","$2,940.80 ","$445.22 ","$117.17 ","$144.54 ","$585.22 ","$305.19 "
"36100221","EAP","CPT� 12031","","Int Rep Sclp Trnk Extrm <2.5cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$141.63 ","$157.16 ","$154.42 ","$305.19 "
"36100222","EAP","CPT� 12032","","Int Rep Sclp Trk Ext 2.6-7.5cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$161.36 ","$196.82 ","$154.42 ","$305.19 "
"36100223","EAP","CPT� 12034","","Int Rep Sclp Trk Ext7.6-12.5cm","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$465.00 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100224","EAP","CPT� 12041","","Int Repr N-hf/genit <2.6cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$970.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$157.82 ","$152.13 ","$154.42 ","$305.19 "
"36100225","EAP","CPT� 12042","","Int Repr Nck Hnd Ft 2.6-7.5 Cm","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$465.00 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100226","EAP","CPT� 12044","","Int Repr Nck Hnd Ft 7.6-12.5cm","BOTH IP/OP","$948.00 ","$701.52 ","$0.00 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$948.00 ","$0.00 ","$948.00 ","$750.82 ","$758.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100227","EAP","CPT� 12051","","Int Repr Fce Ear Eye Lp<2.5cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$0.00 ","$174.83 ","$154.42 ","$305.19 "
"36100228","EAP","CPT� 12052","","Int Repr F/e/l/mm 2.6-5.0cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$183.25 ","$206.92 ","$154.42 ","$305.19 "
"36100229","EAP","CPT� 12053","","Int Wnd Repr Face/mm 5.1-7.5cm","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.90 ","$1,610.00 ","$320.45 ","$1,610.00 ","$1,275.12 ","$1,288.00 ","$445.22 ","$204.98 ","$223.51 ","$256.31 ","$305.19 "
"36100230","EAP","CPT� 12054","","Int Rep Fce Ear Lp 7.6-12.5 Cm","BOTH IP/OP","$957.00 ","$708.18 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$199.46 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100231","EAP","CPT� 12055","","Rep Int Fce Ear Lp 12.6-20.0cm","BOTH IP/OP","$957.00 ","$708.18 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100232","EAP","CPT� 12056","","Rep Int Fce Ear Lp 20.1-30.0cm","BOTH IP/OP","$1,559.00 ","$1,153.66 ","$0.00 ","$1,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,580.00 ","$0.00 ","$1,580.00 ","$1,251.36 ","$1,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100233","EAP","CPT� 12057","","Lac Rep Inter Over 30.0cm","BOTH IP/OP","$4,870.00 ","$3,603.80 ","$0.00 ","$4,935.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,935.00 ","$0.00 ","$2,327.00 ","$3,908.52 ","$3,948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100234","EAP","CPT� 13100","","Repr Complex,1.1 To 2.5 Cm","BOTH IP/OP","$2,495.00 ","$1,846.30 ","$0.00 ","$2,338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,338.00 ","$0.00 ","$2,327.00 ","$1,851.70 ","$1,870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100235","EAP","CPT� 13101","","Repr Complex Trk 2.6-7.5cm","BOTH IP/OP","$2,602.00 ","$1,925.48 ","$0.00 ","$2,438.00 ","$0.00 ","$0.00 ","$542.32 ","$0.00 ","$0.00 ","$0.00 ","$2,438.00 ","$0.00 ","$2,438.00 ","$1,930.90 ","$1,950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100236","EAP","CPT� 13120","","Repr Comp Scalp Arms Lgs 1.1","BOTH IP/OP","$1,319.00 ","$976.06 ","$0.00 ","$1,337.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.00 ","$0.00 ","$1,337.00 ","$1,058.90 ","$1,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100237","EAP","CPT� 13121","","Repr Comp Scalp Arms Lgs 2.5-7","BOTH IP/OP","$1,442.00 ","$1,067.08 ","$0.00 ","$1,442.00 ","$0.00 ","$0.00 ","$0.00 ","$1,442.00 ","$1,442.00 ","$252.48 ","$1,442.00 ","$498.48 ","$1,442.00 ","$1,142.06 ","$1,153.60 ","$692.57 ","$0.00 ","$270.39 ","$229.57 ","$474.74 "
"36100238","EAP","CPT� 13131","","Repr Complex Mouth Neck Hds,ft","BOTH IP/OP","$1,337.00 ","$989.38 ","$0.00 ","$1,337.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.00 ","$0.00 ","$1,337.00 ","$1,058.90 ","$1,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100239","EAP","CPT� 13132","","Repr Comp Mouth,neck,hds,ft2.6","BOTH IP/OP","$1,337.00 ","$989.38 ","$0.00 ","$1,337.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.00 ","$1,337.00 ","$234.10 ","$1,337.00 ","$498.48 ","$1,337.00 ","$1,058.90 ","$1,069.60 ","$692.57 ","$0.00 ","$317.62 ","$212.85 ","$474.74 "
"36100241","EAP","CPT� 13151","","Repr Comp Eye Nose Ears Lips","BOTH IP/OP","$2,307.00 ","$1,707.18 ","$0.00 ","$2,338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,338.00 ","$0.00 ","$2,338.00 ","$1,851.70 ","$1,870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100242","EAP","CPT� 13151","","Rpr Complx Eyelid Etc.1.1-2.5c","BOTH IP/OP","$2,307.00 ","$1,707.18 ","$0.00 ","$2,338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,338.00 ","$0.00 ","$2,338.00 ","$1,851.70 ","$1,870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100243","EAP","CPT� 13152","","Repr Comp Eyel, Nose,ears Lips","BOTH IP/OP","$2,533.00 ","$1,874.42 ","$0.00 ","$2,533.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,533.00 ","$0.00 ","$2,533.00 ","$2,006.14 ","$2,026.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100244","EAP","CPT� 14000","","Tiss Tran,trnk,<10 Sq Cm","BOTH IP/OP","$8,323.00 ","$6,159.02 ","$0.00 ","$8,323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,323.00 ","$0.00 ","$2,327.00 ","$6,591.82 ","$6,658.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100245","EAP","CPT� 14020","","Tiss Trans,s/a/l/<10 Sq Cm","BOTH IP/OP","$8,323.00 ","$6,159.02 ","$0.00 ","$8,323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,323.00 ","$0.00 ","$2,858.00 ","$6,591.82 ","$6,658.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100246","EAP","CPT� 14040","","Tiss Xfr Head Mouth Chk Hnd <1","BOTH IP/OP","$8,323.00 ","$6,159.02 ","$0.00 ","$8,323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,323.00 ","$0.00 ","$2,327.00 ","$6,591.82 ","$6,658.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100247","EAP","CPT� 14060","","Tiss Trans E/n/e/l <10 Sq Cm","BOTH IP/OP","$9,690.00 ","$7,170.60 ","$0.00 ","$9,690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,690.00 ","$0.00 ","$2,858.00 ","$7,674.48 ","$7,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100248","EAP","CPT� 15788","","Chem Peel Face Epidermal","BOTH IP/OP","$529.00 ","$391.46 ","$0.00 ","$496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$496.00 ","$0.00 ","$496.00 ","$392.83 ","$396.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100249","EAP","CPT� 15820","","Blepharoplasty Lower Eyelid","BOTH IP/OP","$14,915.00 ","$11,037.10 ","$0.00 ","$15,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,114.00 ","$0.00 ","$2,858.00 ","$11,970.29 ","$12,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100250","EAP","CPT� 15822","","Blepharoplasty Upper Eyelid","BOTH IP/OP","$14,915.00 ","$11,037.10 ","$0.00 ","$15,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,114.00 ","$0.00 ","$2,858.00 ","$11,970.29 ","$12,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100251","EAP","CPT� 16000","","Init Trmnt Burn 1st Degree","BOTH IP/OP","$1,690.00 ","$1,250.60 ","$0.00 ","$1,607.00 ","$917.67 ","$175.86 ","$352.24 ","$0.00 ","$0.00 ","$281.37 ","$1,607.00 ","$175.24 ","$1,607.00 ","$1,272.74 ","$1,285.60 ","$243.48 ","$0.00 ","$47.96 ","$255.83 ","$166.90 "
"36100252","EAP","CPT� 16000","","Init. Treatment 1st Degree Bur","BOTH IP/OP","$1,607.00 ","$1,189.18 ","$0.00 ","$1,607.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.37 ","$1,607.00 ","$175.24 ","$1,607.00 ","$1,272.74 ","$1,285.60 ","$243.48 ","$0.00 ","$47.96 ","$255.83 ","$166.90 "
"36100253","EAP","CPT� 16000","","Inital Treatment, 1% Burn","BOTH IP/OP","$1,690.00 ","$1,250.60 ","$0.00 ","$1,607.00 ","$917.67 ","$175.86 ","$352.24 ","$0.00 ","$0.00 ","$281.37 ","$1,607.00 ","$175.24 ","$1,607.00 ","$1,272.74 ","$1,285.60 ","$243.48 ","$0.00 ","$47.96 ","$255.83 ","$166.90 "
"36100254","EAP","CPT� 16020","","PART THICK BURN DRESS/DEBRD;SM","BOTH IP/OP","$1,690.00 ","$1,250.60 ","$0.00 ","$1,690.00 ","$1,690.00 ","$175.86 ","$352.24 ","$0.00 ","$0.00 ","$281.37 ","$1,607.00 ","$175.24 ","$1,607.00 ","$1,272.74 ","$1,285.60 ","$243.48 ","$54.62 ","$56.23 ","$255.83 ","$166.90 "
"36100255","EAP","CPT� 16025","","Part Thick Burn Dress/debrd;md (tbsa 5%-10%)","BOTH IP/OP","$3,421.00 ","$2,531.54 ","$107.09 ","$3,252.00 ","$2,753.10 ","$175.86 ","$713.02 ","$2,320.95 ","$2,320.95 ","$569.40 ","$3,252.00 ","$175.24 ","$2,255.00 ","$2,575.58 ","$2,601.60 ","$243.48 ","$107.09 ","$114.64 ","$517.72 ","$166.90 "
"36100256","EAP","CPT� 16030","","Part Thick Burn Dress/debrd;lg (tbsa >10%)","BOTH IP/OP","$4,574.00 ","$3,384.76 ","$134.39 ","$4,348.00 ","$2,753.10 ","$338.49 ","$953.34 ","$3,103.17 ","$3,103.17 ","$761.30 ","$4,348.00 ","$320.45 ","$2,255.00 ","$3,443.62 ","$3,478.40 ","$445.22 ","$134.39 ","$138.43 ","$692.20 ","$305.19 "
"36100257","EAP","CPT� 17000","","Dest, Premalignant Lesion 1st","BOTH IP/OP","$389.00 ","$287.86 ","$48.44 ","$389.00 ","$389.00 ","$175.86 ","$81.08 ","$389.00 ","$389.00 ","$68.11 ","$389.00 ","$175.24 ","$389.00 ","$308.09 ","$311.20 ","$243.48 ","$48.44 ","$55.15 ","$61.93 ","$166.90 "
"36100258","EAP","CPT� 17000","","Destruc Lesion Benign, 1st","BOTH IP/OP","$389.00 ","$287.86 ","$0.00 ","$389.00 ","$0.00 ","$0.00 ","$81.08 ","$389.00 ","$389.00 ","$68.11 ","$389.00 ","$175.24 ","$389.00 ","$308.09 ","$311.20 ","$243.48 ","$48.44 ","$55.15 ","$61.93 ","$166.90 "
"36100259","EAP","CPT� 17003","","Dest, Premalignant Lesion 2-14","BOTH IP/OP","$389.00 ","$287.86 ","$0.00 ","$389.00 ","$389.00 ","$0.00 ","$81.08 ","$0.00 ","$0.00 ","$68.11 ","$389.00 ","$0.00 ","$389.00 ","$308.09 ","$311.20 ","$0.00 ","$12.73 ","$2.16 ","$61.93 ","$0.00 "
"36100260","EAP","CPT� 17004","","Les Dest, Benign Premal > 15","BOTH IP/OP","$807.00 ","$597.18 ","$0.00 ","$807.00 ","$807.00 ","$338.49 ","$168.20 ","$0.00 ","$0.00 ","$0.00 ","$806.00 ","$0.00 ","$806.00 ","$638.35 ","$644.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100261","EAP","CPT� 17004","","Lesion Destr Benign >15","BOTH IP/OP","$806.00 ","$596.44 ","$0.00 ","$806.00 ","$0.00 ","$0.00 ","$167.99 ","$0.00 ","$0.00 ","$0.00 ","$806.00 ","$0.00 ","$806.00 ","$638.35 ","$644.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100262","EAP","CPT� 17110","","Dest Flat Warts Mollu,milla","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$365.00 ","$175.86 ","$76.08 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$175.24 ","$365.00 ","$289.08 ","$292.00 ","$243.48 ","$49.09 ","$68.84 ","$58.11 ","$166.90 "
"36100263","EAP","CPT� 17110","","Dest Flat Warts, Up To 14 Les","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$175.24 ","$365.00 ","$289.08 ","$292.00 ","$243.48 ","$49.09 ","$68.84 ","$58.11 ","$166.90 "
"36100264","EAP","CPT� 17110","","Destr Flat Wart Mollu Milia <1","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$175.24 ","$365.00 ","$289.08 ","$292.00 ","$243.48 ","$49.09 ","$68.84 ","$58.11 ","$166.90 "
"36100266","EAP","CPT� 17111","","Dest. Flat Warts, >15 Lesions","BOTH IP/OP","$807.00 ","$597.18 ","$0.00 ","$807.00 ","$807.00 ","$175.86 ","$0.00 ","$0.00 ","$0.00 ","$141.12 ","$806.00 ","$175.24 ","$806.00 ","$638.35 ","$644.80 ","$243.48 ","$66.36 ","$84.34 ","$128.32 ","$166.90 "
"36100268","EAP","CPT� 17250","","Cauterization, Medical","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.67 ","$752.00 ","$175.24 ","$752.00 ","$595.58 ","$601.60 ","$243.48 ","$37.05 ","$38.57 ","$119.72 ","$166.90 "
"36100269","EAP","CPT� 17250","","Chemical Cautery Tissue","BOTH IP/OP","$753.00 ","$557.22 ","$0.00 ","$753.00 ","$753.00 ","$175.86 ","$156.94 ","$0.00 ","$0.00 ","$131.67 ","$752.00 ","$175.24 ","$752.00 ","$595.58 ","$601.60 ","$243.48 ","$37.05 ","$38.57 ","$119.72 ","$166.90 "
"36100270","EAP","CPT� 36569","","Mid Line Insertion","BOTH IP/OP","$6,447.00 ","$4,770.78 ","$98.45 ","$5,429.00 ","$2,321.55 ","$1,377.13 ","$1,343.72 ","$3,874.68 ","$3,874.68 ","$950.57 ","$5,429.00 ","$1,635.92 ","$2,255.00 ","$4,299.77 ","$4,343.20 ","$2,272.90 ","$346.84 ","$98.45 ","$864.30 ","$1,558.02 "
"36100272","EAP","CPT� 17260","","Lesion Dstr Malig Trnk Arm <.5","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$670.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100273","EAP","CPT� 17261","","Les Dstr Malig Trnk Arm 0.6-1.","BOTH IP/OP","$753.00 ","$557.22 ","$0.00 ","$753.00 ","$753.00 ","$175.86 ","$156.94 ","$0.00 ","$0.00 ","$131.67 ","$752.00 ","$175.24 ","$752.00 ","$595.58 ","$601.60 ","$243.48 ","$94.09 ","$89.76 ","$119.72 ","$166.90 "
"36100274","EAP","CPT� 17262","","Les Dstr Malig Trnk Arm 1.1-2.","BOTH IP/OP","$753.00 ","$557.22 ","$0.00 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$752.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100275","EAP","CPT� 17263","","Les Dstr Malig Trnk Arm 2.1-3.","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$645.00 ","$0.00 ","$645.00 ","$510.84 ","$516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100276","EAP","CPT� 17264","","Les Dstr Malig Trnk Arm 3.1-4.","BOTH IP/OP","$645.00 ","$477.30 ","$0.00 ","$645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$645.00 ","$0.00 ","$645.00 ","$510.84 ","$516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100277","EAP","CPT� 17266","","Les Dstr Malig Trnk Arm >4.0","BOTH IP/OP","$1,428.00 ","$1,056.72 ","$0.00 ","$1,428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,428.00 ","$0.00 ","$1,428.00 ","$1,130.98 ","$1,142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100278","EAP","CPT� 17271","","Les Dstr Malig Sclp Nck 0.6-1.","BOTH IP/OP","$946.00 ","$700.04 ","$0.00 ","$946.00 ","$946.00 ","$175.86 ","$197.17 ","$0.00 ","$0.00 ","$165.46 ","$945.00 ","$175.24 ","$945.00 ","$748.44 ","$756.00 ","$243.48 ","$115.27 ","$108.87 ","$150.44 ","$166.90 "
"36100279","EAP","CPT� 17272","","Les Dstr Malig Sclp Nck 1.1-2.","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$646.00 ","$646.00 ","$175.86 ","$134.64 ","$0.00 ","$0.00 ","$112.93 ","$645.00 ","$175.24 ","$645.00 ","$510.84 ","$516.00 ","$243.48 ","$136.47 ","$126.90 ","$102.68 ","$166.90 "
"36100280","EAP","CPT� 17273","","Les Dstr Malig Sclp Nck 2.1-3.","BOTH IP/OP","$974.00 ","$720.76 ","$0.00 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$974.00 ","$0.00 ","$974.00 ","$771.41 ","$779.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100281","EAP","CPT� 17274","","Les Dstr Malig Sclp Nck 3.1-4.","BOTH IP/OP","$1,430.00 ","$1,058.20 ","$0.00 ","$1,430.00 ","$1,430.00 ","$338.49 ","$298.05 ","$0.00 ","$0.00 ","$250.03 ","$1,428.00 ","$320.45 ","$1,428.00 ","$1,130.98 ","$1,142.40 ","$445.22 ","$192.94 ","$175.94 ","$227.34 ","$305.19 "
"36100282","EAP","CPT� 17280","","Lesion Dstr Malig Face Ear <.5","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$645.00 ","$0.00 ","$645.00 ","$510.84 ","$516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100283","EAP","CPT� 17281","","Les Dstr Malig Face Ear 0.6-1.","BOTH IP/OP","$1,726.00 ","$1,277.24 ","$0.00 ","$1,726.00 ","$1,726.00 ","$338.49 ","$359.74 ","$0.00 ","$0.00 ","$0.00 ","$1,724.00 ","$0.00 ","$1,724.00 ","$1,365.41 ","$1,379.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100284","EAP","CPT� 17282","","Les Dstr Malig Face Ear 1.1-2.","BOTH IP/OP","$974.00 ","$720.76 ","$0.00 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$974.00 ","$0.00 ","$974.00 ","$771.41 ","$779.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100285","EAP","CPT� 19000","","Punc Asp Cyst, Breast","BOTH IP/OP","$1,141.00 ","$844.34 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$1,141.00 ","$199.78 ","$1,141.00 ","$611.80 ","$1,141.00 ","$903.67 ","$912.80 ","$850.02 ","$59.58 ","$45.43 ","$181.65 ","$582.67 "
"36100288","EAP","CPT� 19000","","Puncture Aspiration Of Breast","BOTH IP/OP","$1,141.00 ","$844.34 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$1,141.00 ","$199.78 ","$1,141.00 ","$611.80 ","$1,141.00 ","$903.67 ","$912.80 ","$850.02 ","$59.58 ","$45.43 ","$181.65 ","$582.67 "
"36100289","EAP","CPT� 19001","","Each Additiona Cyst-breast","BOTH IP/OP","$921.00 ","$681.54 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$0.00 ","$1,141.00 ","$903.67 ","$912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100297","EAP","CPT� 19000","","Punc Aspiration Cyst Of Breast","BOTH IP/OP","$1,141.00 ","$844.34 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$1,141.00 ","$199.78 ","$1,141.00 ","$611.80 ","$1,141.00 ","$903.67 ","$912.80 ","$850.02 ","$59.58 ","$45.43 ","$181.65 ","$582.67 "
"36100298","EAP","CPT� 19000","","PUNCT ASPIR CYST BREAST BIC","BOTH IP/OP","$1,130.00 ","$836.20 ","$45.43 ","$1,141.00 ","$1,130.00 ","$609.42 ","$235.52 ","$1,141.00 ","$1,141.00 ","$199.78 ","$1,141.00 ","$611.80 ","$1,141.00 ","$903.67 ","$912.80 ","$850.02 ","$59.58 ","$45.43 ","$181.65 ","$582.67 "
"36100299","EAP","CPT� 54065","","Destruction Penis Lesion(s)","BOTH IP/OP","$7,192.00 ","$5,322.08 ","$0.00 ","$7,265.00 ","$2,321.55 ","$1,677.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,265.00 ","$0.00 ","$2,255.00 ","$5,753.88 ","$5,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100300","EAP","CPT� 19001","","Punc Aspir Ea Add'l Cyst Breas","BOTH IP/OP","$921.00 ","$681.54 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$0.00 ","$1,141.00 ","$903.67 ","$912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100301","EAP","CPT� 19001","","PUNCT ASPIR EA ADDT CYST BIC","BOTH IP/OP","$1,130.00 ","$836.20 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$0.00 ","$1,141.00 ","$903.67 ","$912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100303","EAP","CPT� 19020","","Incision Of Breast Lesion Rt","BOTH IP/OP","$7,031.00 ","$5,202.94 ","$0.00 ","$7,102.00 ","$0.00 ","$0.00 ","$1,465.44 ","$0.00 ","$0.00 ","$0.00 ","$7,102.00 ","$0.00 ","$2,327.00 ","$5,624.78 ","$5,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100304","EAP","CPT� 19030","","GALACTOGRAM INJECTION BIC","BOTH IP/OP","$764.00 ","$565.36 ","$0.00 ","$946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$946.00 ","$0.00 ","$946.00 ","$749.23 ","$756.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100306","EAP","CPT� 19100","","Breast Bx Needle W/0 Imaging","BOTH IP/OP","$1,927.00 ","$1,425.98 ","$0.00 ","$1,946.00 ","$1,927.00 ","$1,377.93 ","$401.63 ","$0.00 ","$0.00 ","$0.00 ","$1,946.00 ","$0.00 ","$1,946.00 ","$1,541.23 ","$1,556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100307","EAP","CPT� 19100","","Breast Bx, Needle","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$0.00 ","$1,946.00 ","$1,571.00 ","$1,377.93 ","$327.44 ","$0.00 ","$0.00 ","$0.00 ","$1,946.00 ","$0.00 ","$1,946.00 ","$1,541.23 ","$1,556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100318","EAP","CPT� 19296","","Place Po Breast Cath For Rad","BOTH IP/OP","$17,549.00 ","$12,986.26 ","$0.00 ","$21,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,736.00 ","$0.00 ","$6,105.00 ","$17,214.91 ","$17,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100319","EAP","CPT� 19297","","Br Cath For Rad Concur W/pt Ma","BOTH IP/OP","$17,549.00 ","$12,986.26 ","$0.00 ","$21,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,736.00 ","$0.00 ","$6,105.00 ","$17,214.91 ","$17,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100320","EAP","CPT� 19357","","Breast Reconst Tiss Expander","BOTH IP/OP","$11,975.00 ","$8,861.50 ","$0.00 ","$14,782.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,782.00 ","$0.00 ","$3,902.00 ","$11,707.34 ","$11,825.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100321","EAP","CPT� 19499","","Duct Lav Aspiration","BOTH IP/OP","$6,124.00 ","$4,531.76 ","$0.00 ","$6,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,124.00 ","$0.00 ","$2,255.00 ","$4,850.21 ","$4,899.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100322","EAP","CPT� 20103","","Explore Wound, Extremity","BOTH IP/OP","$3,502.00 ","$2,591.48 ","$0.00 ","$3,502.00 ","$0.00 ","$0.00 ","$0.00 ","$2,499.38 ","$2,499.38 ","$613.17 ","$3,502.00 ","$611.80 ","$2,255.00 ","$2,773.58 ","$2,801.60 ","$850.02 ","$323.52 ","$360.85 ","$557.52 ","$582.67 "
"36100323","EAP","CPT� 20206","","BX MUSCLE NEEDLE PERCUT BCT","BOTH IP/OP","$1,504.00 ","$1,112.96 ","$60.21 ","$1,504.00 ","$1,504.00 ","$1,377.93 ","$313.47 ","$1,208.73 ","$1,208.73 ","$262.64 ","$1,500.00 ","$1,376.63 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$1,500.00 ","$104.27 ","$60.21 ","$238.80 ","$1,311.08 "
"36100324","EAP","CPT� 20206","","Bx Muscle Needle Us","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$60.21 ","$1,500.00 ","$1,500.00 ","$1,377.93 ","$312.64 ","$1,208.73 ","$1,208.73 ","$262.64 ","$1,500.00 ","$1,376.63 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$1,500.00 ","$104.27 ","$60.21 ","$238.80 ","$1,311.08 "
"36100325","EAP","CPT� 20220","","Biopsy Bone Trcar/needl Sprfcl","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$2,013.00 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100326","EAP","CPT� 20220","","BX BONE TROCAR/NDLE SUPF BCT","BOTH IP/OP","$2,018.00 ","$1,493.32 ","$0.00 ","$2,018.00 ","$2,018.00 ","$1,377.93 ","$420.60 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$2,013.00 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100327","EAP","CPT� 20225","","Biopsy Bone Trocar/needle Deep","BOTH IP/OP","$3,050.00 ","$2,257.00 ","$0.00 ","$3,050.00 ","$0.00 ","$0.00 ","$0.00 ","$2,176.79 ","$2,176.79 ","$534.03 ","$3,050.00 ","$1,376.63 ","$2,327.00 ","$2,415.60 ","$2,440.00 ","$1,912.65 ","$126.60 ","$137.03 ","$485.56 ","$1,311.08 "
"36100328","EAP","CPT� 20225","","BX BONE TROCAR/NDLE DEEP BCT","BOTH IP/OP","$3,057.00 ","$2,262.18 ","$126.60 ","$3,050.00 ","$2,753.10 ","$1,377.93 ","$637.16 ","$2,176.79 ","$2,176.79 ","$534.03 ","$3,050.00 ","$1,376.63 ","$2,327.00 ","$2,415.60 ","$2,440.00 ","$1,912.65 ","$126.60 ","$137.03 ","$485.56 ","$1,311.08 "
"36100329","EAP","CPT� 20501","","Inject Sinus Tract Diagnostic","BOTH IP/OP","$1,226.00 ","$907.24 ","$0.00 ","$1,238.00 ","$1,226.00 ","$0.00 ","$255.53 ","$0.00 ","$0.00 ","$0.00 ","$1,238.00 ","$0.00 ","$1,238.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100330","EAP","CPT� 20520","","Remove Foreign Body (simple)","BOTH IP/OP","$1,594.00 ","$1,179.56 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100331","EAP","CPT� 20525","","Remove Foreign Body (compl.)","BOTH IP/OP","$2,653.00 ","$1,963.22 ","$0.00 ","$2,741.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,741.00 ","$0.00 ","$2,741.00 ","$2,170.87 ","$2,192.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100332","EAP","CPT� 20526","","Carpal Tunnel Injection","BOTH IP/OP","$903.00 ","$668.22 ","$0.00 ","$904.00 ","$903.00 ","$255.86 ","$188.21 ","$0.00 ","$0.00 ","$158.28 ","$904.00 ","$262.54 ","$904.00 ","$715.97 ","$723.20 ","$364.76 ","$141.48 ","$59.49 ","$143.92 ","$250.04 "
"36100333","EAP","CPT� 20550","","Inject Tendon Sheath Ligament","BOTH IP/OP","$719.00 ","$532.06 ","$40.75 ","$720.00 ","$719.00 ","$255.86 ","$149.86 ","$720.00 ","$720.00 ","$126.07 ","$720.00 ","$262.54 ","$720.00 ","$570.24 ","$576.00 ","$364.76 ","$70.34 ","$40.75 ","$114.62 ","$250.04 "
"36100336","EAP","CPT� 20551","","Inj Tendon Origin/insertion","BOTH IP/OP","$903.00 ","$668.22 ","$0.00 ","$904.00 ","$903.00 ","$255.86 ","$188.21 ","$0.00 ","$0.00 ","$158.28 ","$904.00 ","$262.54 ","$904.00 ","$715.97 ","$723.20 ","$364.76 ","$66.56 ","$41.47 ","$143.92 ","$250.04 "
"36100337","EAP","CPT� 20552","","Inject Trigger Point 1-2 Musc","BOTH IP/OP","$640.00 ","$473.60 ","$0.00 ","$641.00 ","$640.00 ","$255.86 ","$133.39 ","$0.00 ","$0.00 ","$112.23 ","$641.00 ","$262.54 ","$641.00 ","$507.67 ","$512.80 ","$364.76 ","$66.56 ","$40.02 ","$102.05 ","$250.04 "
"36100338","EAP","CPT� 20553","","Trigger Point Injections: Three Or More Muscles","BOTH IP/OP","$903.00 ","$668.22 ","$0.00 ","$904.00 ","$903.00 ","$255.86 ","$188.21 ","$0.00 ","$0.00 ","$158.28 ","$904.00 ","$262.54 ","$904.00 ","$715.97 ","$723.20 ","$364.76 ","$66.56 ","$45.07 ","$143.92 ","$250.04 "
"36100339","EAP","CPT� 20600","","Drain/inject-finger/toe Wo Us Guidance","BOTH IP/OP","$935.00 ","$691.90 ","$37.50 ","$936.00 ","$935.00 ","$255.86 ","$194.88 ","$936.00 ","$936.00 ","$163.89 ","$936.00 ","$262.54 ","$936.00 ","$741.31 ","$748.80 ","$364.76 ","$54.79 ","$37.50 ","$149.01 ","$250.04 "
"36100340","EAP","CPT� 50561","","Kindey Endoscopy & Treatment","BOTH IP/OP","$6,215.00 ","$4,599.10 ","$0.00 ","$6,215.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,215.00 ","$0.00 ","$2,255.00 ","$4,922.28 ","$4,972.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100345","EAP","CPT� 20605","","Drain/inject-wrist Elbow Ankle Wo Us Guidance","BOTH IP/OP","$935.00 ","$691.90 ","$0.00 ","$936.00 ","$935.00 ","$255.86 ","$194.88 ","$0.00 ","$0.00 ","$163.89 ","$936.00 ","$262.54 ","$936.00 ","$741.31 ","$748.80 ","$364.76 ","$60.50 ","$38.94 ","$149.01 ","$250.04 "
"36100348","EAP","CPT� 20610","","Drain/inject-shoulder Hip Knee Wo Us Guidance","BOTH IP/OP","$2,198.00 ","$1,626.52 ","$47.59 ","$2,200.00 ","$2,198.00 ","$255.86 ","$458.12 ","$1,570.14 ","$1,570.14 ","$385.20 ","$2,200.00 ","$262.54 ","$2,200.00 ","$1,742.40 ","$1,760.00 ","$364.76 ","$70.76 ","$47.59 ","$350.24 ","$250.04 "
"36100349","EAP","CPT� 41009","","Drainage Of Mouth Lesion","BOTH IP/OP","$6,979.00 ","$5,164.46 ","$0.00 ","$8,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,195.00 ","$0.00 ","$2,255.00 ","$6,490.44 ","$6,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100354","EAP","CPT� 20612","","Aspiration/inj.,gangion Cyst","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,051.00 ","$1,050.00 ","$255.86 ","$0.00 ","$0.00 ","$0.00 ","$184.02 ","$1,051.00 ","$262.54 ","$1,051.00 ","$832.39 ","$840.80 ","$364.76 ","$54.88 ","$42.90 ","$167.32 ","$250.04 "
"36100355","EAP","CPT� 20670","","Arch Bar Removal","BOTH IP/OP","$6,755.00 ","$4,998.70 ","$0.00 ","$6,755.00 ","$0.00 ","$0.00 ","$1,498.16 ","$4,821.04 ","$4,821.04 ","$1,182.75 ","$6,755.00 ","$1,376.63 ","$2,255.00 ","$5,349.96 ","$5,404.00 ","$1,912.65 ","$166.32 ","$150.66 ","$1,075.40 ","$1,311.08 "
"36100356","EAP","CPT� 20670","","Removal Implant; Superficial","BOTH IP/OP","$7,188.00 ","$5,319.12 ","$150.66 ","$6,755.00 ","$2,321.55 ","$1,377.93 ","$1,498.16 ","$4,821.04 ","$4,821.04 ","$1,182.75 ","$6,755.00 ","$1,376.63 ","$2,255.00 ","$5,349.96 ","$5,404.00 ","$1,912.65 ","$166.32 ","$150.66 ","$1,075.40 ","$1,311.08 "
"36100357","EAP","CPT� 21025","","Sequestrectomy, Mandible","BOTH IP/OP","$12,260.00 ","$9,072.40 ","$0.00 ","$12,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,260.00 ","$0.00 ","$2,327.00 ","$9,709.92 ","$9,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100358","EAP","CPT� 21026","","Sequestrectomy, Maxilla","BOTH IP/OP","$8,448.00 ","$6,251.52 ","$0.00 ","$8,448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,448.00 ","$0.00 ","$2,327.00 ","$6,690.82 ","$6,758.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100359","EAP","CPT� 21031","","Excision Of Torus Mandibularis","BOTH IP/OP","$3,080.00 ","$2,279.20 ","$0.00 ","$3,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,080.00 ","$0.00 ","$2,327.00 ","$2,439.36 ","$2,464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100360","EAP","CPT� 21032","","Excision Of Maxillary Torus","BOTH IP/OP","$4,910.00 ","$3,633.40 ","$0.00 ","$4,910.00 ","$2,321.55 ","$2,679.15 ","$1,023.37 ","$0.00 ","$0.00 ","$0.00 ","$4,910.00 ","$0.00 ","$2,327.00 ","$3,888.72 ","$3,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100361","EAP","CPT� 21208","","Osteoplasty, Facial Bones","BOTH IP/OP","$7,747.00 ","$5,732.78 ","$0.00 ","$7,747.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,747.00 ","$0.00 ","$4,975.00 ","$6,135.62 ","$6,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100362","EAP","CPT� 21320","","Closed Nasal Bone W/stabiliza","BOTH IP/OP","$4,482.00 ","$3,316.68 ","$0.00 ","$4,482.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,482.00 ","$0.00 ","$2,327.00 ","$3,549.74 ","$3,585.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100364","EAP","CPT� 21440","","Reduce Alveolar Ridge Fracture","BOTH IP/OP","$2,518.00 ","$1,863.32 ","$0.00 ","$2,543.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,543.00 ","$0.00 ","$2,327.00 ","$2,014.06 ","$2,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100365","EAP","CPT� 21453","","Reduce Mandibular Interdental","BOTH IP/OP","$7,522.00 ","$5,566.28 ","$0.00 ","$8,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,776.00 ","$0.00 ","$2,858.00 ","$6,950.59 ","$7,020.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100366","EAP","CPT� 21480","","Reduce Tmj Disloca, Ix Or Sub","BOTH IP/OP","$257.00 ","$190.18 ","$0.00 ","$257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.00 ","$0.00 ","$257.00 ","$203.54 ","$205.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100368","EAP","CPT� 21550","","Biopsy Neck","BOTH IP/OP","$4,410.00 ","$3,263.40 ","$0.00 ","$4,399.00 ","$0.00 ","$0.00 ","$0.00 ","$3,139.57 ","$3,139.57 ","$770.23 ","$4,399.00 ","$1,376.63 ","$2,255.00 ","$3,484.01 ","$3,519.20 ","$1,912.65 ","$132.10 ","$161.13 ","$700.32 ","$1,311.08 "
"36100369","EAP","CPT� 21550","","Biopsy, Neck/thorax","BOTH IP/OP","$4,399.00 ","$3,255.26 ","$0.00 ","$4,399.00 ","$0.00 ","$0.00 ","$0.00 ","$3,139.57 ","$3,139.57 ","$770.23 ","$4,399.00 ","$1,376.63 ","$2,255.00 ","$3,484.01 ","$3,519.20 ","$1,912.65 ","$132.10 ","$161.13 ","$700.32 ","$1,311.08 "
"36100376","EAP","CPT� 23350","","Injection Shoulder Arthrograph","BOTH IP/OP","$1,471.00 ","$1,088.54 ","$0.00 ","$1,486.00 ","$1,471.00 ","$0.00 ","$306.59 ","$0.00 ","$0.00 ","$260.19 ","$1,486.00 ","$0.00 ","$1,486.00 ","$1,176.91 ","$1,188.80 ","$0.00 ","$202.19 ","$53.01 ","$236.57 ","$0.00 "
"36100379","EAP","CPT� 24220","","Injection Elbow Arthrography","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$2,200.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100380","EAP","CPT� 25246","","Injection Wrist Arthrography","BOTH IP/OP","$1,633.00 ","$1,208.42 ","$0.00 ","$1,487.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,487.00 ","$0.00 ","$1,487.00 ","$1,177.70 ","$1,189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100382","EAP","CPT� 26010","","I&d Finger Abscess, Simple","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$1,407.00 ","$0.00 ","$1,407.00 ","$1,114.34 ","$1,125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100383","EAP","CPT� 26011","","Abscess Finger Complicated","BOTH IP/OP","$4,878.00 ","$3,609.72 ","$0.00 ","$4,877.00 ","$2,321.55 ","$1,377.93 ","$1,016.70 ","$0.00 ","$0.00 ","$0.00 ","$4,877.00 ","$0.00 ","$2,255.00 ","$3,862.58 ","$3,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100384","EAP","CPT� 26035","","Decompression Fingers, Hand","BOTH IP/OP","$3,306.00 ","$2,446.44 ","$0.00 ","$3,512.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,512.00 ","$0.00 ","$2,255.00 ","$2,781.50 ","$2,809.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100386","EAP","CPT� 27093","","Injection  Hip Arthro W/o Anes","BOTH IP/OP","$1,657.00 ","$1,226.18 ","$0.00 ","$1,674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.10 ","$1,674.00 ","$0.00 ","$1,674.00 ","$1,325.81 ","$1,339.20 ","$0.00 ","$243.74 ","$72.12 ","$266.50 ","$0.00 "
"36100388","EAP","CPT� 27095","","Injection Hip Arthro W Anes","BOTH IP/OP","$2,101.00 ","$1,554.74 ","$0.00 ","$2,101.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,101.00 ","$0.00 ","$2,101.00 ","$1,663.99 ","$1,680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100389","EAP","CPT� 27096","","Sacroiliac Jt Inj With Arthrography","BOTH IP/OP","$2,110.00 ","$1,561.40 ","$0.00 ","$2,131.00 ","$2,110.00 ","$621.87 ","$439.78 ","$1,520.89 ","$1,520.89 ","$373.12 ","$2,131.00 ","$0.00 ","$2,131.00 ","$1,687.75 ","$1,704.80 ","$86.18 ","$398.44 ","$86.18 ","$339.26 ","$0.00 "
"36100391","EAP","CPT� 27630","","Excision, Les Ankle/lower Leg","BOTH IP/OP","$7,251.00 ","$5,365.74 ","$0.00 ","$7,251.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,251.00 ","$0.00 ","$2,858.00 ","$5,742.79 ","$5,800.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100392","EAP","CPT� 27648","","Injection Ankle Arthrography","BOTH IP/OP","$1,873.00 ","$1,386.02 ","$0.00 ","$1,892.00 ","$1,873.00 ","$0.00 ","$390.38 ","$0.00 ","$0.00 ","$0.00 ","$1,892.00 ","$0.00 ","$1,892.00 ","$1,498.46 ","$1,513.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100393","EAP","CPT� 28080","","Excision,les. Interdigital Leg","BOTH IP/OP","$4,873.00 ","$3,606.02 ","$0.00 ","$5,159.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,159.00 ","$0.00 ","$2,858.00 ","$4,085.93 ","$4,127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100394","EAP","CPT� 28090","","Excision, Cyst Foot","BOTH IP/OP","$4,873.00 ","$3,606.02 ","$0.00 ","$5,159.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,159.00 ","$0.00 ","$2,858.00 ","$4,085.93 ","$4,127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100395","EAP","CPT� 28092","","Excision, Lesion, Toe(s) Each","BOTH IP/OP","$4,873.00 ","$3,606.02 ","$0.00 ","$5,159.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,159.00 ","$0.00 ","$2,858.00 ","$4,085.93 ","$4,127.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100396","EAP","CPT� 28190","","Removal Fb, Foot Sc","BOTH IP/OP","$1,304.00 ","$964.96 ","$0.00 ","$1,304.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$228.32 ","$1,304.00 ","$611.80 ","$1,304.00 ","$1,032.77 ","$1,043.20 ","$850.02 ","$173.39 ","$138.80 ","$207.60 ","$582.67 "
"36100397","EAP","CPT� 28192","","Removal Fb, Foot Deep","BOTH IP/OP","$5,468.00 ","$4,046.32 ","$0.00 ","$5,468.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,468.00 ","$0.00 ","$2,327.00 ","$4,330.66 ","$4,374.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100398","EAP","CPT� 28193","","Removal Fb, Foot, Complicated","BOTH IP/OP","$5,468.00 ","$4,046.32 ","$0.00 ","$5,468.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,468.00 ","$0.00 ","$3,606.00 ","$4,330.66 ","$4,374.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100399","EAP","CPT� 29130","","Splinting, Finger","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.00 ","$0.00 ","$859.00 ","$680.33 ","$687.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100402","EAP","CPT� 29260","","Splint Application, Wrist","BOTH IP/OP","$1,018.00 ","$753.32 ","$0.00 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.24 ","$1,018.00 ","$33.53 ","$1,018.00 ","$806.26 ","$814.40 ","$46.58 ","$44.15 ","$20.20 ","$162.07 ","$31.93 "
"36100403","EAP","CPT� 29515","","Splint Application Ankle","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$134.13 ","$888.00 ","$703.30 ","$710.40 ","$186.36 ","$80.51 ","$51.19 ","$141.37 ","$127.75 "
"36100404","EAP","CPT� 29515","","Splint Application, Ankle","BOTH IP/OP","$794.00 ","$587.56 ","$0.00 ","$888.00 ","$431.14 ","$138.36 ","$165.49 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$134.13 ","$888.00 ","$703.30 ","$710.40 ","$186.36 ","$80.51 ","$51.19 ","$141.37 ","$127.75 "
"36100405","EAP","CPT� 29530","","Wrapping, Knee","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$762.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$762.00 ","$0.00 ","$762.00 ","$603.50 ","$609.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100406","EAP","CPT� 29540","","Strapping Of Ankle And/or Ft","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$345.00 ","$273.24 ","$276.00 ","$0.00 ","$33.83 ","$0.00 ","$0.00 ","$0.00 "
"36100407","EAP","CPT� 29540","","Wrapping, Ankle","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$345.00 ","$198.74 ","$138.36 ","$76.28 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$345.00 ","$273.24 ","$276.00 ","$0.00 ","$33.83 ","$0.00 ","$0.00 ","$0.00 "
"36100408","EAP","CPT� 29550","","Splinting, Toes","BOTH IP/OP","$751.00 ","$555.74 ","$0.00 ","$707.00 ","$407.79 ","$54.51 ","$156.53 ","$0.00 ","$0.00 ","$0.00 ","$707.00 ","$0.00 ","$707.00 ","$559.94 ","$565.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100409","EAP","CPT� 29580","","Unna Boot","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$780.00 ","$449.60 ","$138.36 ","$172.58 ","$0.00 ","$0.00 ","$136.57 ","$780.00 ","$134.13 ","$780.00 ","$617.76 ","$624.00 ","$186.36 ","$54.52 ","$28.49 ","$124.18 ","$127.75 "
"36100411","EAP","CPT� 30100","","Biopsy, Intranasal","BOTH IP/OP","$1,837.00 ","$1,359.38 ","$0.00 ","$1,833.00 ","$0.00 ","$0.00 ","$0.00 ","$1,308.21 ","$1,308.21 ","$320.94 ","$1,833.00 ","$1,353.31 ","$1,833.00 ","$1,451.74 ","$1,466.40 ","$1,833.00 ","$68.81 ","$68.85 ","$291.81 ","$1,288.86 "
"36100412","EAP","CPT� 30300","","Remove Fb Intranasal","BOTH IP/OP","$272.00 ","$201.28 ","$0.00 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.00 ","$0.00 ","$272.00 ","$215.42 ","$217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100414","EAP","CPT� 30901","","Control Nasal Hemorr Ant Simpl","BOTH IP/OP","$348.00 ","$257.52 ","$0.00 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.00 ","$0.00 ","$348.00 ","$275.62 ","$278.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100416","EAP","CPT� 30903","","Control Nasal Hemorr Ant Compl","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$358.00 ","$0.00 ","$358.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100418","EAP","CPT� 30905","","Control Nasal Hemorr Post Init","BOTH IP/OP","$518.00 ","$383.32 ","$0.00 ","$518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$518.00 ","$0.00 ","$518.00 ","$410.26 ","$414.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100420","EAP","CPT� 31000","","Maxillary Sinus Irrigation","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.00 ","$0.00 ","$605.00 ","$479.16 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100422","EAP","CPT� 31231","","Nasal Endoscopy Dx Uni/bilat","BOTH IP/OP","$887.00 ","$656.38 ","$65.62 ","$887.00 ","$887.00 ","$161.21 ","$184.87 ","$822.00 ","$822.00 ","$143.93 ","$822.00 ","$157.01 ","$822.00 ","$651.02 ","$657.60 ","$218.14 ","$98.38 ","$65.62 ","$130.86 ","$149.53 "
"36100423","EAP","CPT� 31500","","Endotracheal Intubation","BOTH IP/OP","$2,893.00 ","$2,140.82 ","$0.00 ","$2,656.00 ","$0.00 ","$0.00 ","$0.00 ","$1,895.59 ","$1,895.59 ","$0.00 ","$2,656.00 ","$204.24 ","$2,255.00 ","$2,103.55 ","$2,124.80 ","$283.76 ","$0.00 ","$149.30 ","$422.84 ","$194.51 "
"36100428","EAP","CPT� 31502","","Et/trach Change","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$36.42 ","$1,571.00 ","$1,571.00 ","$207.19 ","$327.44 ","$1,029.16 ","$1,029.16 ","$252.48 ","$1,442.00 ","$204.24 ","$1,442.00 ","$1,142.06 ","$1,153.60 ","$283.76 ","$63.79 ","$36.42 ","$229.57 ","$194.51 "
"36100429","EAP","CPT� 31502","","Trach Set Change","BOTH IP/OP","$1,379.00 ","$1,020.46 ","$0.00 ","$1,442.00 ","$1,379.00 ","$207.19 ","$287.42 ","$0.00 ","$0.00 ","$252.48 ","$1,442.00 ","$204.24 ","$1,442.00 ","$1,142.06 ","$1,153.60 ","$283.76 ","$63.79 ","$36.42 ","$229.57 ","$194.51 "
"36100430","EAP","CPT� 31502","","Tracheotomy Tube Change","BOTH IP/OP","$1,442.00 ","$1,067.08 ","$0.00 ","$1,442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.48 ","$1,442.00 ","$204.24 ","$1,442.00 ","$1,142.06 ","$1,153.60 ","$283.76 ","$63.79 ","$36.42 ","$229.57 ","$194.51 "
"36100432","EAP","CPT� 31505","","Laryngoscopy, Indirect, Dx","BOTH IP/OP","$372.00 ","$275.28 ","$0.00 ","$648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$648.00 ","$0.00 ","$648.00 ","$513.22 ","$518.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100434","EAP","CPT� 31510","","Laryngoscopy, Indir, W Bx","BOTH IP/OP","$4,546.00 ","$3,364.04 ","$0.00 ","$4,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,755.00 ","$0.00 ","$2,327.00 ","$3,765.96 ","$3,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100435","EAP","CPT� 31528","","Laryngoscopy And Dilation","BOTH IP/OP","$9,657.00 ","$7,146.18 ","$0.00 ","$10,101.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,101.00 ","$0.00 ","$2,327.00 ","$7,999.99 ","$8,080.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100437","EAP","CPT� 31575","","Laryngoscopy, Fiberoptic, Dx","BOTH IP/OP","$745.00 ","$551.30 ","$0.00 ","$745.00 ","$745.00 ","$161.21 ","$155.28 ","$0.00 ","$0.00 ","$119.76 ","$684.00 ","$157.01 ","$684.00 ","$541.73 ","$547.20 ","$218.14 ","$103.39 ","$68.49 ","$108.89 ","$149.53 "
"36100438","EAP","CPT� 31605","","Tracheostomy-crico","BOTH IP/OP","$1,598.00 ","$1,182.52 ","$0.00 ","$1,598.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,598.00 ","$0.00 ","$1,598.00 ","$1,265.62 ","$1,278.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100442","EAP","CPT� 31612","","Trach Punc Percut  Aspir","BOTH IP/OP","$10,209.00 ","$7,554.66 ","$0.00 ","$9,989.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,989.00 ","$0.00 ","$2,255.00 ","$7,911.29 ","$7,991.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100444","EAP","CPT� 31615","","Tracheobronchoscopy","BOTH IP/OP","$3,046.00 ","$2,254.04 ","$0.00 ","$2,980.00 ","$0.00 ","$0.00 ","$634.86 ","$2,126.83 ","$2,126.83 ","$521.77 ","$2,980.00 ","$443.02 ","$2,255.00 ","$2,360.16 ","$2,384.00 ","$615.51 ","$0.00 ","$118.25 ","$474.42 ","$421.92 "
"36100446","EAP","CPT� 31622","","Bronchoscopy W Or W/o Washing","BOTH IP/OP","$4,212.00 ","$3,116.88 ","$0.00 ","$3,746.00 ","$2,753.10 ","$1,465.20 ","$877.89 ","$0.00 ","$0.00 ","$0.00 ","$3,746.00 ","$0.00 ","$2,255.00 ","$2,966.83 ","$2,996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100448","EAP","CPT� 31623","","Bronchoscopy W/brushing","BOTH IP/OP","$3,942.00 ","$2,917.08 ","$137.76 ","$3,104.00 ","$2,753.10 ","$1,465.20 ","$821.61 ","$2,215.32 ","$2,215.32 ","$543.49 ","$3,104.00 ","$1,434.81 ","$2,327.00 ","$2,458.37 ","$2,483.20 ","$1,993.48 ","$224.43 ","$137.76 ","$494.16 ","$1,366.49 "
"36100449","EAP","CPT� 31624","","Bronchoscopy W/bal","BOTH IP/OP","$3,942.00 ","$2,917.08 ","$139.56 ","$3,857.00 ","$2,753.10 ","$1,465.20 ","$821.61 ","$2,752.74 ","$2,752.74 ","$675.33 ","$3,857.00 ","$1,434.81 ","$2,327.00 ","$3,054.74 ","$3,085.60 ","$1,993.48 ","$217.26 ","$139.56 ","$614.03 ","$1,366.49 "
"36100450","EAP","CPT� 31625","","BRONCH DX /ENDOBRONCHIAL BX  SINGLE/MULTIPLE LOBE","BOTH IP/OP","$3,942.00 ","$2,917.08 ","$162.28 ","$3,857.00 ","$2,753.10 ","$1,465.20 ","$821.61 ","$2,752.74 ","$2,752.74 ","$675.33 ","$3,857.00 ","$1,434.81 ","$2,327.00 ","$3,054.74 ","$3,085.60 ","$1,993.48 ","$246.87 ","$162.28 ","$614.03 ","$1,366.49 "
"36100452","EAP","CPT� 31628","","Transbronch Bx W&w/o Fluo","BOTH IP/OP","$3,582.00 ","$2,650.68 ","$182.48 ","$3,505.00 ","$2,753.10 ","$3,033.56 ","$746.58 ","$2,501.52 ","$2,501.52 ","$613.70 ","$3,505.00 ","$2,945.54 ","$2,327.00 ","$2,775.96 ","$2,804.00 ","$3,505.00 ","$278.79 ","$182.48 ","$558.00 ","$2,805.28 "
"36100453","EAP","CPT� 31629","","Bron W/trans Needl Aspir","BOTH IP/OP","$4,091.00 ","$3,027.34 ","$193.66 ","$4,003.00 ","$2,753.10 ","$3,033.56 ","$852.67 ","$2,856.94 ","$2,856.94 ","$700.89 ","$4,003.00 ","$2,945.54 ","$2,327.00 ","$3,170.38 ","$3,202.40 ","$4,003.00 ","$211.89 ","$193.66 ","$637.28 ","$2,805.28 "
"36100454","EAP","CPT� 31630","","Bronchoscopy Dilate/fx Repr","BOTH IP/OP","$10,854.00 ","$8,031.96 ","$0.00 ","$10,620.00 ","$2,753.10 ","$3,033.56 ","$2,262.24 ","$0.00 ","$0.00 ","$0.00 ","$10,620.00 ","$0.00 ","$2,327.00 ","$8,411.04 ","$8,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100455","EAP","CPT� 31631","","Tracheal Broncial W&w/o Stent","BOTH IP/OP","$9,733.00 ","$7,202.42 ","$0.00 ","$9,733.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,733.00 ","$0.00 ","$2,327.00 ","$7,708.54 ","$7,786.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100456","EAP","CPT� 31635","","Bronch Tx, Fb Removal","BOTH IP/OP","$10,854.00 ","$8,031.96 ","$0.00 ","$10,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,620.00 ","$0.00 ","$2,327.00 ","$8,411.04 ","$8,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100457","EAP","CPT� 31635","","Bronchoscopy W/fb Removal","BOTH IP/OP","$10,854.00 ","$8,031.96 ","$0.00 ","$10,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,620.00 ","$0.00 ","$2,327.00 ","$8,411.04 ","$8,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100458","EAP","CPT� 31640","","Bronchoscopy W/ Tumor","BOTH IP/OP","$12,526.00 ","$9,269.24 ","$260.01 ","$12,256.00 ","$2,753.10 ","$3,033.56 ","$2,610.73 ","$8,747.11 ","$5,416.74 ","$2,145.93 ","$12,256.00 ","$2,945.54 ","$2,327.00 ","$9,706.75 ","$9,804.80 ","$4,092.44 ","$319.32 ","$260.01 ","$1,951.16 ","$2,805.28 "
"36100459","EAP","CPT� 31643","","Bronchoscopy Intracav Rad Addl","BOTH IP/OP","$10,051.00 ","$7,437.74 ","$0.00 ","$9,835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,835.00 ","$0.00 ","$2,327.00 ","$7,789.32 ","$7,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100460","EAP","CPT� 31645","","Bron W/aspir Trachbron Int","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$8,493.03 ","$5,416.74 ","$2,083.59 ","$11,900.00 ","$1,434.81 ","$2,255.00 ","$9,424.80 ","$9,520.00 ","$1,993.48 ","$199.84 ","$152.54 ","$1,894.48 ","$1,366.49 "
"36100461","EAP","CPT� 31645","","Bronchoscopy, Clear Airways","BOTH IP/OP","$12,162.00 ","$8,999.88 ","$152.54 ","$11,900.00 ","$2,753.10 ","$1,465.20 ","$2,534.86 ","$8,493.03 ","$5,416.74 ","$2,083.59 ","$11,900.00 ","$1,434.81 ","$2,255.00 ","$9,424.80 ","$9,520.00 ","$1,993.48 ","$199.84 ","$152.54 ","$1,894.48 ","$1,366.49 "
"36100462","EAP","CPT� 31646","","Bron W/asp Trachbron Sub","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,900.00 ","$0.00 ","$2,255.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100463","EAP","CPT� 31646","","Bronchoscopy, Reclear Airway","BOTH IP/OP","$12,162.00 ","$8,999.88 ","$0.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,900.00 ","$0.00 ","$2,255.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100464","EAP","CPT� 31720","","Cath Aspir Nasotracbronch","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100467","EAP","CPT� 31720","","Nasotreacheal Suction","BOTH IP/OP","$256.00 ","$189.44 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100468","EAP","CPT� 31720","","Suctioning Nasotracheal","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100469","EAP","CPT� 31899","","Bronchi Medication Injection","BOTH IP/OP","$4,452.00 ","$3,294.48 ","$0.00 ","$5,372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,372.00 ","$0.00 ","$2,255.00 ","$4,254.62 ","$4,297.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100470","EAP","CPT� 32400","","Biopsy Pleura Perc Needle","BOTH IP/OP","$4,094.00 ","$3,029.56 ","$0.00 ","$4,094.00 ","$0.00 ","$0.00 ","$0.00 ","$2,921.89 ","$2,921.89 ","$716.83 ","$4,094.00 ","$1,376.63 ","$2,255.00 ","$3,242.45 ","$3,275.20 ","$1,912.65 ","$123.21 ","$89.44 ","$651.76 ","$1,311.08 "
"36100471","EAP","CPT� 32400","","Pleural Biopsy","BOTH IP/OP","$4,104.00 ","$3,036.96 ","$0.00 ","$4,094.00 ","$0.00 ","$0.00 ","$0.00 ","$2,921.89 ","$2,921.89 ","$716.83 ","$4,094.00 ","$1,376.63 ","$2,255.00 ","$3,242.45 ","$3,275.20 ","$1,912.65 ","$123.21 ","$89.44 ","$651.76 ","$1,311.08 "
"36100472","EAP","CPT� 32405","","BX LUNG/MEDIAST PERCUT NDL BCT","BOTH IP/OP","$2,601.00 ","$1,924.74 ","$0.00 ","$2,601.00 ","$0.00 ","$0.00 ","$0.00 ","$1,856.33 ","$1,856.33 ","$455.41 ","$2,601.00 ","$1,376.63 ","$2,255.00 ","$2,059.99 ","$2,080.80 ","$1,912.65 ","$151.70 ","$93.40 ","$414.08 ","$1,311.08 "
"36100473","EAP","CPT� 32405","","Bx Lung/mediastinum Us","BOTH IP/OP","$2,601.00 ","$1,924.74 ","$0.00 ","$2,601.00 ","$0.00 ","$0.00 ","$0.00 ","$1,856.33 ","$1,856.33 ","$455.41 ","$2,601.00 ","$1,376.63 ","$2,255.00 ","$2,059.99 ","$2,080.80 ","$1,912.65 ","$151.70 ","$93.40 ","$414.08 ","$1,311.08 "
"36100474","EAP","CPT� 32405","","Lung/mediastinum Bx","BOTH IP/OP","$2,601.00 ","$1,924.74 ","$0.00 ","$2,601.00 ","$0.00 ","$0.00 ","$0.00 ","$1,856.33 ","$1,856.33 ","$455.41 ","$2,601.00 ","$1,376.63 ","$2,255.00 ","$2,059.99 ","$2,080.80 ","$1,912.65 ","$151.70 ","$93.40 ","$414.08 ","$1,311.08 "
"36100480","EAP","CPT� 32550","","Insert Indwelling Cath","BOTH IP/OP","$20,731.00 ","$15,340.94 ","$0.00 ","$19,618.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,618.00 ","$0.00 ","$2,858.00 ","$15,537.46 ","$15,694.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100481","EAP","CPT� 32550","","Insert/indwelling Tun Pleural","BOTH IP/OP","$16,257.00 ","$12,030.18 ","$0.00 ","$19,618.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,618.00 ","$0.00 ","$2,858.00 ","$15,537.46 ","$15,694.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100482","EAP","CPT� 32551","","Chest Tube Insertion","BOTH IP/OP","$2,893.00 ","$2,140.82 ","$0.00 ","$2,489.00 ","$0.00 ","$0.00 ","$602.97 ","$1,776.40 ","$1,776.40 ","$0.00 ","$2,489.00 ","$1,635.92 ","$2,255.00 ","$1,971.29 ","$1,991.20 ","$2,272.90 ","$0.00 ","$164.42 ","$396.25 ","$1,558.02 "
"36100485","EAP","CPT� 32560","","Chemical Pleurodesis","BOTH IP/OP","$2,169.00 ","$1,605.06 ","$0.00 ","$2,053.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,053.00 ","$0.00 ","$2,053.00 ","$1,625.98 ","$1,642.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100486","EAP","CPT� 32999","","Removal Of Pleural Catheter","BOTH IP/OP","$1,359.00 ","$1,005.66 ","$0.00 ","$1,373.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.40 ","$1,373.00 ","$632.36 ","$1,373.00 ","$1,087.42 ","$1,098.40 ","$878.58 ","$214.87 ","$0.00 ","$218.58 ","$602.25 "
"36100488","EAP","CPT� 33206","","Insrt New/repl Pcmkr/ld-atrial","BOTH IP/OP","$30,541.00 ","$22,600.34 ","$0.00 ","$30,541.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,541.00 ","$0.00 ","$6,105.00 ","$24,188.47 ","$24,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100489","EAP","CPT� 33207","","Insrt New/repl Pcmkr/ld-vent","BOTH IP/OP","$31,143.00 ","$23,045.82 ","$0.00 ","$30,541.00 ","$5,693.10 ","$10,182.87 ","$6,490.98 ","$0.00 ","$0.00 ","$0.00 ","$30,541.00 ","$0.00 ","$6,105.00 ","$24,188.47 ","$24,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100490","EAP","CPT� 33208","","Insrt New/repl Pcmkr/ld- A / V","BOTH IP/OP","$13,386.00 ","$9,905.64 ","$545.42 ","$13,127.00 ","$5,693.10 ","$10,182.87 ","$2,789.98 ","$9,368.74 ","$5,416.74 ","$2,298.43 ","$13,127.00 ","$10,282.07 ","$6,105.00 ","$10,396.58 ","$10,501.60 ","$13,127.00 ","$611.79 ","$545.42 ","$2,089.82 ","$9,792.45 "
"36100491","EAP","CPT� 33210","","Temp Pacemaker Wire","BOTH IP/OP","$25,023.00 ","$18,517.02 ","$0.00 ","$24,539.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,539.00 ","$0.00 ","$3,606.00 ","$19,434.89 ","$19,631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100492","EAP","CPT� 33212","","Insrt Pcmkr W Exist Sngl Ld","BOTH IP/OP","$19,776.00 ","$14,634.24 ","$0.00 ","$19,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,394.00 ","$0.00 ","$2,858.00 ","$15,360.05 ","$15,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100493","EAP","CPT� 33213","","Insrt Pcmkr W Exist Dual Lds","BOTH IP/OP","$22,852.00 ","$16,910.48 ","$0.00 ","$22,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,410.00 ","$0.00 ","$2,858.00 ","$17,748.72 ","$17,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100494","EAP","CPT� 33214","","Upgrade Pacemaker System","BOTH IP/OP","$11,993.00 ","$8,874.82 ","$0.00 ","$13,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,204.00 ","$0.00 ","$6,105.00 ","$10,457.57 ","$10,563.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100495","EAP","CPT� 33215","","Reposition Icd Lead","BOTH IP/OP","$14,372.00 ","$10,635.28 ","$0.00 ","$14,094.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,094.00 ","$0.00 ","$2,255.00 ","$11,162.45 ","$11,275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100496","EAP","CPT� 33216","","Insrt Sngl Icd Lead Transveno","BOTH IP/OP","$15,719.00 ","$11,632.06 ","$0.00 ","$15,415.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,415.00 ","$0.00 ","$6,105.00 ","$12,208.68 ","$12,332.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100497","EAP","CPT� 33217","","Insrt Dual Icd Lead Transveno","BOTH IP/OP","$30,222.00 ","$22,364.28 ","$0.00 ","$29,638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,638.00 ","$0.00 ","$6,105.00 ","$23,473.30 ","$23,710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100498","EAP","CPT� 33218","","Repair Sngl Lead Pcmkr / Icd","BOTH IP/OP","$26,919.00 ","$19,920.06 ","$0.00 ","$29,638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,638.00 ","$0.00 ","$3,902.00 ","$23,473.30 ","$23,710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100499","EAP","CPT� 33220","","Repair Dual Leads Pcmkr / Icd","BOTH IP/OP","$14,001.00 ","$10,360.74 ","$0.00 ","$15,415.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,415.00 ","$0.00 ","$3,902.00 ","$12,208.68 ","$12,332.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100500","EAP","CPT� 33223","","Relocation Skin  Pkt Cardiovert-defib","BOTH IP/OP","$6,168.00 ","$4,564.32 ","$0.00 ","$6,049.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,049.00 ","$0.00 ","$2,327.00 ","$4,790.81 ","$4,839.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100501","EAP","CPT� 33224","","Insert Lead To Prev Pcmkr / Icd","BOTH IP/OP","$13,464.00 ","$9,963.36 ","$0.00 ","$13,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,204.00 ","$0.00 ","$6,105.00 ","$10,457.57 ","$10,563.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100502","EAP","CPT� 33225","","L Ventr Pacing Lead Add +pock","BOTH IP/OP","$50,601.00 ","$37,444.74 ","$0.00 ","$49,623.00 ","$3,735.90 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$0.00 ","$49,623.00 ","$0.00 ","$24,811.50 ","$39,301.42 ","$39,698.40 ","$0.00 ","$418.74 ","$0.00 ","$0.00 ","$0.00 "
"36100503","EAP","CPT� 33226","","Reposition Lv Pcmkr Lead","BOTH IP/OP","$7,930.00 ","$5,868.20 ","$0.00 ","$7,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,930.00 ","$0.00 ","$2,255.00 ","$6,280.56 ","$6,344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100504","EAP","CPT� 33233","","Remove Pcmkr Only","BOTH IP/OP","$12,134.00 ","$8,979.16 ","$0.00 ","$13,359.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,359.00 ","$0.00 ","$6,105.00 ","$10,580.33 ","$10,687.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100505","EAP","CPT� 33234","","Remove Pcmkr Electrode","BOTH IP/OP","$7,315.00 ","$5,413.10 ","$0.00 ","$7,174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,174.00 ","$0.00 ","$2,255.00 ","$5,681.81 ","$5,739.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100506","EAP","CPT� 33241","","Remove Icd Generator Only","BOTH IP/OP","$6,919.00 ","$5,120.06 ","$0.00 ","$6,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,785.00 ","$0.00 ","$2,255.00 ","$5,373.72 ","$5,428.00 ","$0.00 ","$240.47 ","$0.00 ","$0.00 ","$0.00 "
"36100507","EAP","CPT� 33244","","Transvenous Removal Icd Lead","BOTH IP/OP","$11,879.00 ","$8,790.46 ","$0.00 ","$11,649.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,649.00 ","$0.00 ","$2,327.00 ","$9,226.01 ","$9,319.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100508","EAP","CPT� 33249","","Insrt/repl Sgl/dual Icd Ld/gen","BOTH IP/OP","$40,394.00 ","$29,891.56 ","$959.62 ","$39,613.00 ","$5,693.10 ","$32,168.25 ","$8,419.12 ","$28,271.80 ","$5,416.74 ","$6,935.92 ","$39,613.00 ","$32,377.52 ","$6,105.00 ","$31,373.50 ","$31,690.40 ","$39,613.00 ","$1,016.82 ","$959.62 ","$6,306.39 ","$30,835.73 "
"36100518","EAP","CPT� 33968","","Remove Intra-aortic Balloon","BOTH IP/OP","$1,998.00 ","$1,478.52 ","$0.00 ","$1,959.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,959.00 ","$0.00 ","$1,959.00 ","$1,551.53 ","$1,567.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100519","EAP","CPT� 34201","","Emb. Or Thromb; Femoropop","BOTH IP/OP","$13,033.00 ","$9,644.42 ","$0.00 ","$13,033.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,033.00 ","$0.00 ","$3,902.00 ","$10,322.14 ","$10,426.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100520","EAP","CPT� 34203","","Emb. Or Thromb;popliteal-tibio","BOTH IP/OP","$13,033.00 ","$9,644.42 ","$0.00 ","$13,033.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,033.00 ","$0.00 ","$3,902.00 ","$10,322.14 ","$10,426.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100535","EAP","CPT� 35286","","Repair Blood Vessel With Graft Other Than Vein Lower Exteremity","BOTH IP/OP","$13,185.00 ","$9,756.90 ","$0.00 ","$13,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,185.00 ","$0.00 ","$2,255.00 ","$10,442.52 ","$10,548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100536","EAP","CPT� 35355","","Thromb., Iliofemoral","BOTH IP/OP","$6,828.00 ","$5,052.72 ","$0.00 ","$6,828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,828.00 ","$0.00 ","$2,255.00 ","$5,407.78 ","$5,462.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100537","EAP","CPT� 35371","","Thromb., Common Femoral","BOTH IP/OP","$5,569.00 ","$4,121.06 ","$0.00 ","$5,569.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,569.00 ","$0.00 ","$2,255.00 ","$4,410.65 ","$4,455.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100538","EAP","CPT� 35372","","Thromb., Deep Femoral","BOTH IP/OP","$6,697.00 ","$4,955.78 ","$0.00 ","$6,697.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,697.00 ","$0.00 ","$2,255.00 ","$5,304.02 ","$5,357.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100556","EAP","CPT� 36002","","Pseudoaneurysm Inject/treat","BOTH IP/OP","$2,313.00 ","$1,711.62 ","$0.00 ","$2,313.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,313.00 ","$0.00 ","$2,255.00 ","$1,831.90 ","$1,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100557","EAP","CPT� 36005","","Injection Contrast Venography","BOTH IP/OP","$3,362.00 ","$2,487.88 ","$0.00 ","$3,191.00 ","$2,321.55 ","$0.00 ","$700.72 ","$2,277.42 ","$2,277.42 ","$558.72 ","$3,191.00 ","$0.00 ","$2,255.00 ","$2,527.27 ","$2,552.80 ","$0.00 ","$315.51 ","$49.76 ","$508.01 ","$0.00 "
"36100558","EAP","CPT� 36010","","Intro Cath, Sup/inf Vena Cava","BOTH IP/OP","$7,585.00 ","$5,612.90 ","$0.00 ","$7,200.00 ","$0.00 ","$0.00 ","$1,580.90 ","$5,138.64 ","$5,138.64 ","$0.00 ","$7,200.00 ","$0.00 ","$2,255.00 ","$5,702.40 ","$5,760.00 ","$0.00 ","$0.00 ","$115.03 ","$1,146.24 ","$0.00 "
"36100559","EAP","CPT� 36011","","Select Cath Venous 1st Order","BOTH IP/OP","$2,771.00 ","$2,050.54 ","$0.00 ","$2,630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,630.00 ","$0.00 ","$2,630.00 ","$2,082.96 ","$2,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100560","EAP","CPT� 36012","","Select Cath Venous 2nd Order","BOTH IP/OP","$16,258.00 ","$12,030.92 ","$0.00 ","$15,433.00 ","$2,321.55 ","$0.00 ","$3,388.57 ","$0.00 ","$0.00 ","$0.00 ","$15,433.00 ","$0.00 ","$2,255.00 ","$12,222.94 ","$12,346.40 ","$0.00 ","$197.99 ","$0.00 ","$0.00 ","$0.00 "
"36100561","EAP","CPT� 36013","","Intro Cath Rt Heart/main Pulm","BOTH IP/OP","$12,826.00 ","$9,491.24 ","$0.00 ","$14,682.00 ","$2,321.55 ","$0.00 ","$2,673.26 ","$0.00 ","$0.00 ","$0.00 ","$14,682.00 ","$0.00 ","$2,255.00 ","$11,628.14 ","$11,745.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100562","EAP","CPT� 36014","","Select Cath Lt/rt Pulm Artery","BOTH IP/OP","$14,945.00 ","$11,059.30 ","$0.00 ","$14,187.00 ","$2,321.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,187.00 ","$0.00 ","$2,255.00 ","$11,236.10 ","$11,349.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100563","EAP","CPT� 36015","","Select Cath Segmental Pulm Art","BOTH IP/OP","$2,294.00 ","$1,697.56 ","$0.00 ","$2,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,178.00 ","$0.00 ","$2,178.00 ","$1,724.98 ","$1,742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100565","EAP","CPT� 36140","","Intro Needle Extremity Artery","BOTH IP/OP","$5,160.00 ","$3,818.40 ","$0.00 ","$4,898.00 ","$0.00 ","$0.00 ","$0.00 ","$3,495.70 ","$3,495.70 ","$857.60 ","$4,898.00 ","$0.00 ","$2,255.00 ","$3,879.22 ","$3,918.40 ","$0.00 ","$113.12 ","$93.75 ","$779.76 ","$0.00 "
"36100567","EAP","CPT� 36160","","Intro Needle Aortic/translumba","BOTH IP/OP","$7,974.00 ","$5,900.76 ","$0.00 ","$9,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,128.00 ","$0.00 ","$2,255.00 ","$7,229.38 ","$7,302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100568","EAP","CPT� 36200","","Intro Catheter Aorta","BOTH IP/OP","$8,501.00 ","$6,290.74 ","$0.00 ","$8,070.00 ","$0.00 ","$0.00 ","$0.00 ","$5,759.56 ","$5,416.74 ","$1,412.99 ","$8,070.00 ","$0.00 ","$2,255.00 ","$6,391.44 ","$6,456.00 ","$0.00 ","$0.00 ","$146.39 ","$1,284.74 ","$0.00 "
"36100569","EAP","CPT� 36215","","Selct Art 1st Ord Thor/brach","BOTH IP/OP","$3,917.00 ","$2,898.58 ","$0.00 ","$3,298.00 ","$2,753.10 ","$0.00 ","$816.40 ","$0.00 ","$0.00 ","$0.00 ","$3,298.00 ","$0.00 ","$2,255.00 ","$2,612.02 ","$2,638.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100570","EAP","CPT� 36216","","Selct Art 2nd Ord Thor/brach","BOTH IP/OP","$3,917.00 ","$2,898.58 ","$0.00 ","$3,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,298.00 ","$0.00 ","$2,255.00 ","$2,612.02 ","$2,638.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100571","EAP","CPT� 36217","","Selct Art 3rd Ord Thor/brach","BOTH IP/OP","$3,917.00 ","$2,898.58 ","$0.00 ","$3,298.00 ","$0.00 ","$0.00 ","$0.00 ","$2,353.78 ","$2,353.78 ","$577.45 ","$3,298.00 ","$0.00 ","$2,255.00 ","$2,612.02 ","$2,638.40 ","$0.00 ","$342.41 ","$343.25 ","$525.04 ","$0.00 "
"36100572","EAP","CPT� 36218","","Selct Art Add'l 2nd/3rd Th/br","BOTH IP/OP","$1,886.00 ","$1,395.64 ","$0.00 ","$1,588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,588.00 ","$0.00 ","$1,588.00 ","$1,257.70 ","$1,270.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100573","EAP","Custom 36100573","","Selct Art 1st Ord Abd/pelv","BOTH IP/OP","$3,581.00 ","$2,649.94 ","$0.00 ","$4,099.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,099.00 ","$0.00 ","$2,049.50 ","$3,246.41 ","$3,279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100574","EAP","CPT� 36245","","Selct Art 1st Ord Abd/pelv/le","BOTH IP/OP","$3,917.00 ","$2,898.58 ","$0.00 ","$3,298.00 ","$2,753.10 ","$0.00 ","$816.40 ","$2,353.78 ","$2,353.78 ","$577.45 ","$3,298.00 ","$0.00 ","$2,255.00 ","$2,612.02 ","$2,638.40 ","$0.00 ","$264.78 ","$248.44 ","$525.04 ","$0.00 "
"36100575","EAP","CPT� 36246","","Selct Art 2nd Ord Abd/pelv/le","BOTH IP/OP","$4,056.00 ","$3,001.44 ","$0.00 ","$3,415.00 ","$2,753.10 ","$0.00 ","$845.37 ","$2,437.29 ","$2,437.29 ","$597.94 ","$3,415.00 ","$0.00 ","$2,255.00 ","$2,704.68 ","$2,732.00 ","$0.00 ","$288.99 ","$265.02 ","$543.67 ","$0.00 "
"36100576","EAP","CPT� 36247","","Selct Art 3rd Ord Abd/pelv/le","BOTH IP/OP","$4,335.00 ","$3,207.90 ","$0.00 ","$3,650.00 ","$2,753.10 ","$0.00 ","$903.52 ","$2,605.01 ","$2,605.01 ","$639.09 ","$3,650.00 ","$0.00 ","$2,255.00 ","$2,890.80 ","$2,920.00 ","$0.00 ","$341.72 ","$315.51 ","$581.08 ","$0.00 "
"36100577","EAP","CPT� 36248","","Selct Art, Addt'l, Abd/pelv/le","BOTH IP/OP","$4,056.00 ","$3,001.44 ","$0.00 ","$3,415.00 ","$2,753.10 ","$0.00 ","$845.37 ","$2,437.29 ","$2,437.29 ","$597.94 ","$3,415.00 ","$0.00 ","$2,255.00 ","$2,704.68 ","$2,732.00 ","$0.00 ","$56.19 ","$50.85 ","$543.67 ","$0.00 "
"36100582","EAP","CPT� 36406","","Phelb, Micro-10bopc","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.00 ","$0.00 ","$111.00 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100583","EAP","CPT� 36406","","Phelb,micro-ward 12 Midnight","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.00 ","$0.00 ","$111.00 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100584","EAP","CPT� 36406","","Phleb,cap-ward 12n","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.00 ","$0.00 ","$111.00 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100585","EAP","CPT� 36406","","Phleb,cap-ward 6pm","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.00 ","$0.00 ","$111.00 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100586","EAP","CPT� 36406","","Phleb,cap-ward 7am","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.00 ","$0.00 ","$111.00 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100587","EAP","CPT� 36406","","Phleb,nursery 1pm","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$111.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.00 ","$0.00 ","$111.00 ","$87.91 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100592","EAP","CPT� 36468","","Injection(s), Spider Vein","BOTH IP/OP","$447.00 ","$330.78 ","$0.00 ","$355.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.00 ","$0.00 ","$355.00 ","$281.16 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100594","EAP","CPT� 36470","","Injection Therapy Of Vein","BOTH IP/OP","$717.00 ","$530.58 ","$0.00 ","$717.00 ","$717.00 ","$338.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$570.00 ","$0.00 ","$570.00 ","$451.44 ","$456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100596","EAP","CPT� 36475","","Endovenous Rf, 1st Vein","BOTH IP/OP","$14,476.00 ","$10,712.24 ","$0.00 ","$14,386.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,386.00 ","$0.00 ","$6,105.00 ","$11,393.71 ","$11,508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100597","EAP","CPT� 36476","","Endovenous Rf, Vein Add On","BOTH IP/OP","$14,476.00 ","$10,712.24 ","$0.00 ","$14,386.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,386.00 ","$0.00 ","$6,105.00 ","$11,393.71 ","$11,508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100598","EAP","CPT� 36478","","Endovenous Laser, 1st Vein","BOTH IP/OP","$14,476.00 ","$10,712.24 ","$0.00 ","$14,386.00 ","$2,984.10 ","$2,803.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,386.00 ","$0.00 ","$6,105.00 ","$11,393.71 ","$11,508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100599","EAP","CPT� 36479","","Endovenous Laser Vein Add-on","BOTH IP/OP","$14,476.00 ","$10,712.24 ","$0.00 ","$14,386.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,386.00 ","$0.00 ","$6,105.00 ","$11,393.71 ","$11,508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100600","EAP","CPT� 36481","","Percut Portal Vein Cath","BOTH IP/OP","$6,954.00 ","$5,145.96 ","$0.00 ","$6,911.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,911.00 ","$0.00 ","$2,255.00 ","$5,473.51 ","$5,528.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100601","EAP","CPT� 36500","","Venous Cath Selct Org Bld Samp","BOTH IP/OP","$3,040.00 ","$2,249.60 ","$0.00 ","$2,857.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,857.00 ","$0.00 ","$2,255.00 ","$2,262.74 ","$2,285.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100602","EAP","CPT� 36555","","INS NON-TUN CVC <5 SPV","BOTH IP/OP","$6,197.00 ","$4,585.78 ","$0.00 ","$5,219.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,219.00 ","$0.00 ","$2,255.00 ","$4,133.45 ","$4,175.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100603","EAP","CPT� 36556","","Central Line Placement","BOTH IP/OP","$6,532.00 ","$4,833.68 ","$0.00 ","$5,501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$963.18 ","$5,501.00 ","$0.00 ","$2,255.00 ","$4,356.79 ","$4,400.80 ","$0.00 ","$311.35 ","$0.00 ","$0.00 ","$0.00 "
"36100607","EAP","CPT� 36557","","INS TUN CVC W/O PORT <5 SPV","BOTH IP/OP","$7,565.00 ","$5,598.10 ","$0.00 ","$8,660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,660.00 ","$0.00 ","$2,327.00 ","$6,858.72 ","$6,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100608","EAP","CPT� 36558","","INS TUN CVC W/O PORT >5 SPV","BOTH IP/OP","$11,867.00 ","$8,781.58 ","$0.00 ","$9,993.00 ","$0.00 ","$0.00 ","$2,473.38 ","$7,132.00 ","$5,416.74 ","$1,749.69 ","$9,993.00 ","$2,779.42 ","$2,327.00 ","$7,914.46 ","$7,994.40 ","$3,861.64 ","$693.87 ","$272.22 ","$1,590.89 ","$2,647.07 "
"36100609","EAP","CPT� 36560","","INS TUN CVC W/PORT <5 SPV","BOTH IP/OP","$16,153.00 ","$11,953.22 ","$0.00 ","$18,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,490.00 ","$0.00 ","$2,858.00 ","$14,644.08 ","$14,792.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100610","EAP","CPT� 36561","","INS TUN CVC W/PORT >5 SPV","BOTH IP/OP","$23,715.00 ","$17,549.10 ","$351.16 ","$19,970.00 ","$2,984.10 ","$2,803.47 ","$4,942.80 ","$14,252.59 ","$5,416.74 ","$3,496.59 ","$19,970.00 ","$2,779.42 ","$2,858.00 ","$15,816.24 ","$15,976.00 ","$3,861.64 ","$1,322.94 ","$351.16 ","$3,179.22 ","$2,647.07 "
"36100611","EAP","CPT� 36563","","INS TUN CVC W/PUMP SPV","BOTH IP/OP","$34,457.00 ","$25,498.18 ","$0.00 ","$39,443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,443.00 ","$0.00 ","$2,858.00 ","$31,238.86 ","$31,554.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100612","EAP","CPT� 36565","","Insert Tunneled Cv Cath","BOTH IP/OP","$22,459.00 ","$16,619.66 ","$0.00 ","$18,913.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,913.00 ","$0.00 ","$2,858.00 ","$14,979.10 ","$15,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100613","EAP","CPT� 36566","","Insert Tunneled Cv Cath W/port","BOTH IP/OP","$9,620.00 ","$7,118.80 ","$0.00 ","$11,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,012.00 ","$0.00 ","$2,858.00 ","$8,721.50 ","$8,809.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100614","EAP","CPT� 36568","","INS PERH CVC W/O PORT <5 SPV","BOTH IP/OP","$7,208.00 ","$5,333.92 ","$0.00 ","$6,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,394.00 ","$0.00 ","$2,255.00 ","$5,064.05 ","$5,115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100615","EAP","CPT� 36568","","Insert/picc Catheter Discontin","BOTH IP/OP","$7,208.00 ","$5,333.92 ","$0.00 ","$6,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,394.00 ","$0.00 ","$2,255.00 ","$5,064.05 ","$5,115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100616","EAP","CPT� 36568","","Insertion Of Picc Catheter","BOTH IP/OP","$7,593.00 ","$5,618.82 ","$0.00 ","$6,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,394.00 ","$0.00 ","$2,255.00 ","$5,064.05 ","$5,115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100618","EAP","CPT� 36569","","Cvc/picc Line Place Exchange","BOTH IP/OP","$6,120.00 ","$4,528.80 ","$0.00 ","$5,429.00 ","$0.00 ","$0.00 ","$0.00 ","$3,874.68 ","$3,874.68 ","$950.57 ","$5,429.00 ","$1,635.92 ","$2,255.00 ","$4,299.77 ","$4,343.20 ","$2,272.90 ","$346.84 ","$98.45 ","$864.30 ","$1,558.02 "
"36100619","EAP","CPT� 36569","","Insert Picc Wo Port/pump >5","BOTH IP/OP","$4,743.00 ","$3,509.82 ","$98.45 ","$5,429.00 ","$2,321.55 ","$1,377.13 ","$988.56 ","$3,874.68 ","$3,874.68 ","$950.57 ","$5,429.00 ","$1,635.92 ","$2,255.00 ","$4,299.77 ","$4,343.20 ","$2,272.90 ","$346.84 ","$98.45 ","$864.30 ","$1,558.02 "
"36100620","EAP","CPT� 36570","","Ins Perh Cvc W/port <5spv","BOTH IP/OP","$14,840.00 ","$10,981.60 ","$0.00 ","$16,987.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,987.00 ","$0.00 ","$2,858.00 ","$13,453.70 ","$13,589.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100621","EAP","CPT� 36571","","INS PERH CVC W/ PORT >5 SPV","BOTH IP/OP","$10,048.00 ","$7,435.52 ","$325.53 ","$9,538.00 ","$2,984.10 ","$2,803.47 ","$2,094.25 ","$6,807.27 ","$5,416.74 ","$1,670.03 ","$9,538.00 ","$2,779.42 ","$2,858.00 ","$7,554.10 ","$7,630.40 ","$3,861.64 ","$1,542.56 ","$325.53 ","$1,518.45 ","$2,647.07 "
"36100622","EAP","CPT� 36575","","Repair Cv Cath Wo Port/pump","BOTH IP/OP","$4,589.00 ","$3,395.86 ","$0.00 ","$5,253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,253.00 ","$0.00 ","$2,327.00 ","$4,160.38 ","$4,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100623","EAP","CPT� 36575","","REPAIR TUN/N-TUN CVC WO PT SPV","BOTH IP/OP","$4,589.00 ","$3,395.86 ","$0.00 ","$5,253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,253.00 ","$0.00 ","$2,327.00 ","$4,160.38 ","$4,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100624","EAP","CPT� 36576","","REPAIR CVC W/PORT/PUMP SPV","BOTH IP/OP","$4,589.00 ","$3,395.86 ","$0.00 ","$5,253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,253.00 ","$0.00 ","$2,327.00 ","$4,160.38 ","$4,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100626","EAP","CPT� 36578","","Replce Cat Cvc W/port/pump Spv","BOTH IP/OP","$12,764.00 ","$9,445.36 ","$0.00 ","$14,611.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,611.00 ","$0.00 ","$2,327.00 ","$11,571.91 ","$11,688.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100627","EAP","CPT� 36580","","Replace Cv Cath Non-tun Wo Por","BOTH IP/OP","$6,828.00 ","$5,052.72 ","$0.00 ","$7,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,816.00 ","$0.00 ","$2,255.00 ","$6,190.27 ","$6,252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100628","EAP","CPT� 36580","","REPLCE NON-TUN CVC WO PORT SPV","BOTH IP/OP","$8,234.00 ","$6,093.16 ","$0.00 ","$7,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,816.00 ","$0.00 ","$2,255.00 ","$6,190.27 ","$6,252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100629","EAP","CPT� 36581","","REPLCE TUN CVC W/O PORT SPV","BOTH IP/OP","$5,567.00 ","$4,119.58 ","$191.10 ","$5,285.00 ","$2,753.10 ","$2,803.47 ","$1,160.30 ","$3,771.90 ","$3,771.90 ","$925.36 ","$5,285.00 ","$2,779.42 ","$2,327.00 ","$4,185.72 ","$4,228.00 ","$3,861.64 ","$638.75 ","$191.10 ","$841.37 ","$2,647.07 "
"36100630","EAP","CPT� 36582","","REPLCE TUN CVC W/ PORT SPV","BOTH IP/OP","$22,026.00 ","$16,299.24 ","$0.00 ","$20,909.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,909.00 ","$0.00 ","$2,858.00 ","$16,559.93 ","$16,727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100631","EAP","CPT� 36583","","Replce Tun Cvc W/pump Spv","BOTH IP/OP","$34,457.00 ","$25,498.18 ","$0.00 ","$39,443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,443.00 ","$0.00 ","$2,858.00 ","$31,238.86 ","$31,554.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100632","EAP","CPT� 36584","","Replace Picc Wo Port/pump","BOTH IP/OP","$8,528.00 ","$6,310.72 ","$0.00 ","$9,762.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,762.00 ","$0.00 ","$2,255.00 ","$7,731.50 ","$7,809.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100633","EAP","CPT� 36584","","Replacement Of A Picc Catheter","BOTH IP/OP","$9,762.00 ","$7,223.88 ","$0.00 ","$9,762.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,762.00 ","$0.00 ","$2,255.00 ","$7,731.50 ","$7,809.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100634","EAP","CPT� 36584","","REPLCE COMP PICC W/O PORT SPV","BOTH IP/OP","$10,284.00 ","$7,610.16 ","$0.00 ","$9,762.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,762.00 ","$0.00 ","$2,255.00 ","$7,731.50 ","$7,809.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100635","EAP","CPT� 36585","","REPLCE COMP PICC W/PORT SPV","BOTH IP/OP","$17,895.00 ","$13,242.30 ","$283.37 ","$16,987.00 ","$2,984.10 ","$2,803.47 ","$3,729.77 ","$12,123.62 ","$5,416.74 ","$2,974.29 ","$16,987.00 ","$2,779.42 ","$2,858.00 ","$13,453.70 ","$13,589.60 ","$3,861.64 ","$1,518.02 ","$283.37 ","$2,704.33 ","$2,647.07 "
"36100636","EAP","CPT� 36589","","REMOVAL TUN CVC W/O PORT SPV","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$143.13 ","$4,657.00 ","$2,321.55 ","$529.35 ","$1,022.53 ","$3,323.70 ","$3,323.70 ","$815.40 ","$4,657.00 ","$632.36 ","$2,255.00 ","$3,688.34 ","$3,725.60 ","$878.58 ","$171.53 ","$143.13 ","$741.39 ","$602.25 "
"36100637","EAP","CPT� 36589","","Removal Venous Access Device","BOTH IP/OP","$4,657.00 ","$3,446.18 ","$0.00 ","$4,657.00 ","$0.00 ","$0.00 ","$0.00 ","$3,323.70 ","$3,323.70 ","$815.40 ","$4,657.00 ","$632.36 ","$2,255.00 ","$3,688.34 ","$3,725.60 ","$878.58 ","$171.53 ","$143.13 ","$741.39 ","$602.25 "
"36100638","EAP","CPT� 36590","","REMOVAL TUN CVC W/PORT SPV","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$198.64 ","$4,657.00 ","$2,321.55 ","$1,377.13 ","$1,022.53 ","$3,323.70 ","$3,323.70 ","$815.40 ","$4,657.00 ","$632.36 ","$2,255.00 ","$3,688.34 ","$3,725.60 ","$878.58 ","$371.18 ","$198.64 ","$741.39 ","$602.25 "
"36100639","EAP","CPT� 36590","","Remove Cv Cath","BOTH IP/OP","$4,068.00 ","$3,010.32 ","$198.64 ","$4,657.00 ","$2,321.55 ","$1,377.13 ","$847.87 ","$3,323.70 ","$3,323.70 ","$815.40 ","$4,657.00 ","$632.36 ","$2,255.00 ","$3,688.34 ","$3,725.60 ","$878.58 ","$371.18 ","$198.64 ","$741.39 ","$602.25 "
"36100640","EAP","CPT� 36591","","Blood Draw Central Line","BOTH IP/OP","$311.00 ","$230.14 ","$0.00 ","$262.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.87 ","$262.00 ","$109.35 ","$262.00 ","$207.50 ","$209.60 ","$151.93 ","$0.00 ","$25.21 ","$41.71 ","$104.14 "
"36100641","EAP","CPT� 36593","","Declot Vasc Cath By Thrombolyt","BOTH IP/OP","$2,030.00 ","$1,502.20 ","$0.00 ","$1,624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$284.35 ","$1,624.00 ","$310.51 ","$1,624.00 ","$1,286.21 ","$1,299.20 ","$431.41 ","$30.97 ","$32.05 ","$258.54 ","$295.72 "
"36100642","EAP","CPT� 36593","","Declot Vascular Access Device","BOTH IP/OP","$2,043.00 ","$1,511.82 ","$0.00 ","$2,043.00 ","$2,043.00 ","$312.26 ","$425.81 ","$0.00 ","$0.00 ","$284.35 ","$1,624.00 ","$310.51 ","$1,624.00 ","$1,286.21 ","$1,299.20 ","$431.41 ","$30.97 ","$32.05 ","$258.54 ","$295.72 "
"36100645","EAP","CPT� 36595","","MECH REMOVAL OBSTR CVC SPV","BOTH IP/OP","$16,371.00 ","$12,114.54 ","$0.00 ","$15,541.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,541.00 ","$0.00 ","$2,858.00 ","$12,308.47 ","$12,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100646","EAP","CPT� 36596","","MECH REMOVAL CATH OBST CVC SPV","BOTH IP/OP","$5,648.00 ","$4,179.52 ","$0.00 ","$6,465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,465.00 ","$0.00 ","$2,255.00 ","$5,120.28 ","$5,172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100647","EAP","CPT� 36597","","REPOSIT CVC W/ FLUORO GUID SPV","BOTH IP/OP","$8,057.00 ","$5,962.18 ","$0.00 ","$7,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,648.00 ","$0.00 ","$2,255.00 ","$6,057.22 ","$6,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100648","EAP","CPT� 36598","","Inj W/fluro, Eval Cv Device","BOTH IP/OP","$1,173.00 ","$868.02 ","$0.00 ","$1,173.00 ","$1,173.00 ","$200.34 ","$244.48 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$184.28 ","$1,100.00 ","$871.20 ","$880.00 ","$256.03 ","$126.13 ","$38.59 ","$175.12 ","$175.50 "
"36100649","EAP","CPT� 36600","","Arterial Puncture","BOTH IP/OP","$302.00 ","$223.48 ","$16.23 ","$302.00 ","$302.00 ","$110.43 ","$62.94 ","$202.69 ","$202.69 ","$49.73 ","$284.00 ","$109.35 ","$284.00 ","$224.93 ","$227.20 ","$151.93 ","$24.37 ","$16.23 ","$45.21 ","$104.14 "
"36100650","EAP","CPT� 20610","","Bilateral Drain/inject-shoulder Hip Knee Wo Us Guidance","BOTH IP/OP","$4,395.00 ","$3,252.30 ","$47.59 ","$4,400.00 ","$2,321.55 ","$255.86 ","$916.03 ","$3,140.28 ","$3,140.28 ","$770.40 ","$4,400.00 ","$262.54 ","$2,255.00 ","$3,484.80 ","$3,520.00 ","$364.76 ","$70.76 ","$47.59 ","$700.48 ","$250.04 "
"36100652","EAP","CPT� 36620","","Arterial Line Insert","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$1,575.00 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$234.45 ","$1,339.00 ","$0.00 ","$1,339.00 ","$1,060.49 ","$1,071.20 ","$0.00 ","$59.97 ","$46.17 ","$213.17 ","$0.00 "
"36100655","EAP","CPT� 36860","","Cannula Declot W/o Balloon","BOTH IP/OP","$9,536.00 ","$7,056.64 ","$0.00 ","$10,916.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,916.00 ","$0.00 ","$2,327.00 ","$8,645.47 ","$8,732.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100657","EAP","CPT� 37182","","Insert Hepatic Shunt (tips)","BOTH IP/OP","$15,415.00 ","$11,407.10 ","$0.00 ","$14,633.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,633.00 ","$0.00 ","$7,316.50 ","$11,589.34 ","$11,706.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100658","EAP","CPT� 37183","","Remove Hepatic Shunt (tips)","BOTH IP/OP","$61,100.00 ","$45,214.00 ","$0.00 ","$58,001.00 ","$5,965.05 ","$4,853.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58,001.00 ","$0.00 ","$4,975.00 ","$45,936.79 ","$46,400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100659","EAP","CPT� 37184","","Prim Art Mech Thrombectomy","BOTH IP/OP","$39,064.00 ","$28,907.36 ","$0.00 ","$37,082.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37,082.00 ","$0.00 ","$3,902.00 ","$29,368.94 ","$29,665.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100660","EAP","CPT� 37185","","Prim Art M-thrombect Add-on","BOTH IP/OP","$36,020.00 ","$26,654.80 ","$0.00 ","$39,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,140.00 ","$0.00 ","$19,570.00 ","$30,998.88 ","$31,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100661","EAP","CPT� 37186","","Sec Art Thrombect Add-on","BOTH IP/OP","$31,656.00 ","$23,425.44 ","$0.00 ","$36,236.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,236.00 ","$0.00 ","$18,118.00 ","$28,698.91 ","$28,988.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100662","EAP","CPT� 37187","","Venous Mech Thrombectomy","BOTH IP/OP","$19,167.00 ","$14,183.58 ","$0.00 ","$19,361.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,361.00 ","$0.00 ","$3,902.00 ","$15,333.91 ","$15,488.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100663","EAP","CPT� 37188","","Venous M-thrombectomy Add-on","BOTH IP/OP","$15,850.00 ","$11,729.00 ","$0.00 ","$16,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,010.00 ","$0.00 ","$3,902.00 ","$12,679.92 ","$12,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100664","EAP","CPT� 37195","","Thrombolytic Therapy, Stroke","BOTH IP/OP","$14,728.00 ","$10,898.72 ","$0.00 ","$13,981.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,981.00 ","$0.00 ","$2,255.00 ","$11,072.95 ","$11,184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100665","EAP","CPT� 37200","","Transcatheter Biopsy","BOTH IP/OP","$17,005.00 ","$12,583.70 ","$0.00 ","$16,964.00 ","$3,735.90 ","$4,670.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,964.00 ","$0.00 ","$2,255.00 ","$13,435.49 ","$13,571.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100681","EAP","CPT� 37215","","Transcath Stent, Cca W/eps","BOTH IP/OP","$18,633.00 ","$13,788.42 ","$0.00 ","$17,688.00 ","$0.00 ","$0.00 ","$0.00 ","$12,623.93 ","$5,416.74 ","$3,097.03 ","$17,688.00 ","$1,114.70 ","$8,844.00 ","$14,008.90 ","$14,150.40 ","$1,046.93 ","$1,065.02 ","$1,046.93 ","$2,815.93 ","$1,046.93 "
"36100682","EAP","CPT� 37216","","Transcath Stent, Cca W/o Eps","BOTH IP/OP","$21,388.00 ","$15,827.12 ","$0.00 ","$20,303.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,303.00 ","$0.00 ","$10,151.50 ","$16,079.98 ","$16,242.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100685","EAP","CPT� 37609","","Temporal Artery Biopsy","BOTH IP/OP","$10,925.00 ","$8,084.50 ","$214.12 ","$10,714.00 ","$2,753.10 ","$1,377.93 ","$2,277.04 ","$7,646.58 ","$5,416.74 ","$1,875.94 ","$10,714.00 ","$1,376.63 ","$2,327.00 ","$8,485.49 ","$8,571.20 ","$1,912.65 ","$242.02 ","$214.12 ","$1,705.67 ","$1,311.08 "
"36100687","EAP","CPT� 37765","","Phleb Veins-extrem-up To 20","BOTH IP/OP","$17,595.00 ","$13,020.30 ","$0.00 ","$17,773.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,773.00 ","$0.00 ","$2,327.00 ","$14,076.22 ","$14,218.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100688","EAP","CPT� 37766","","Phleb Veins-extrem-20+","BOTH IP/OP","$17,362.00 ","$12,847.88 ","$0.00 ","$17,537.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,537.00 ","$0.00 ","$2,327.00 ","$13,889.30 ","$14,029.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100689","EAP","CPT� 37799","","Vascular Surgery Procedure","BOTH IP/OP","$11,080.00 ","$8,199.20 ","$0.00 ","$11,192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,192.00 ","$0.00 ","$2,255.00 ","$8,864.06 ","$8,953.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100690","EAP","CPT� 38200","","Splenoportography Inj","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$1,250.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100691","EAP","CPT� 38220","","Diagnostic Bone Marrow; Aspiration(s)","BOTH IP/OP","$1,504.00 ","$1,112.96 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100692","EAP","CPT� 38220","","Diagnostic Bone Marrow; Aspiration(s)","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100693","EAP","CPT� 38221","","Diagnostic Bone Marrow; Biopsy(ies)","BOTH IP/OP","$1,527.00 ","$1,129.98 ","$0.00 ","$1,527.00 ","$1,527.00 ","$1,377.93 ","$318.26 ","$0.00 ","$0.00 ","$266.67 ","$1,523.00 ","$1,376.63 ","$1,523.00 ","$1,206.22 ","$1,218.40 ","$1,523.00 ","$245.12 ","$72.12 ","$242.46 ","$1,311.08 "
"36100694","EAP","CPT� 38500","","Biopsy Lymph Nodes Sprfcl Open","BOTH IP/OP","$4,110.00 ","$3,041.40 ","$0.00 ","$4,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,110.00 ","$0.00 ","$2,327.00 ","$3,255.12 ","$3,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100695","EAP","CPT� 38505","","BX LYMPH NODE(S) NDL BCT","BOTH IP/OP","$1,805.00 ","$1,335.70 ","$72.83 ","$1,805.00 ","$1,805.00 ","$1,377.93 ","$376.21 ","$1,285.37 ","$1,285.37 ","$315.34 ","$1,801.00 ","$1,376.63 ","$1,801.00 ","$1,426.39 ","$1,440.80 ","$1,801.00 ","$115.87 ","$72.83 ","$286.72 ","$1,311.08 "
"36100696","EAP","CPT� 38525","","Bx, Open Deep Ax Node","BOTH IP/OP","$5,701.00 ","$4,218.74 ","$0.00 ","$5,701.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,701.00 ","$0.00 ","$2,327.00 ","$4,515.19 ","$4,560.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100697","EAP","CPT� 38790","","Inj Lymphangiography","BOTH IP/OP","$4,411.00 ","$3,264.14 ","$0.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,400.00 ","$0.00 ","$2,200.00 ","$3,484.80 ","$3,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100698","EAP","CPT� 38792","","Identify Sentinel Node","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$485.00 ","$369.17 ","$101.09 ","$0.00 ","$0.00 ","$0.00 ","$484.00 ","$0.00 ","$484.00 ","$383.33 ","$387.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100699","EAP","CPT� 40490","","Biopsy Of Lip","BOTH IP/OP","$578.00 ","$427.72 ","$0.00 ","$577.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$577.00 ","$0.00 ","$577.00 ","$456.98 ","$461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100701","EAP","CPT� 40800","","I&d, Intra-oral, Simple","BOTH IP/OP","$698.00 ","$516.52 ","$0.00 ","$705.00 ","$379.01 ","$609.42 ","$145.48 ","$0.00 ","$0.00 ","$123.44 ","$705.00 ","$611.80 ","$705.00 ","$558.36 ","$564.00 ","$705.00 ","$87.87 ","$128.30 ","$112.24 ","$582.67 "
"36100702","EAP","CPT� 40801","","I&d Intra-oral, Complex","BOTH IP/OP","$1,566.00 ","$1,158.84 ","$0.00 ","$1,582.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,582.00 ","$0.00 ","$1,582.00 ","$1,252.94 ","$1,265.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100703","EAP","CPT� 40808","","Biopsy Vestibule Of Mouth","BOTH IP/OP","$874.00 ","$646.76 ","$0.00 ","$874.00 ","$874.00 ","$442.92 ","$182.16 ","$0.00 ","$0.00 ","$152.68 ","$872.00 ","$443.02 ","$872.00 ","$690.62 ","$697.60 ","$615.51 ","$81.68 ","$89.03 ","$138.82 ","$421.92 "
"36100704","EAP","CPT� 36593","","Declot Vascular Access Device","BOTH IP/OP","$2,030.00 ","$1,502.20 ","$0.00 ","$1,624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$284.35 ","$1,624.00 ","$310.51 ","$1,624.00 ","$1,286.21 ","$1,299.20 ","$431.41 ","$30.97 ","$32.05 ","$258.54 ","$295.72 "
"36100705","EAP","CPT� 40812","","Exc/les/mouth W/simple Repair","BOTH IP/OP","$6,659.00 ","$4,927.66 ","$0.00 ","$6,726.00 ","$0.00 ","$0.00 ","$0.00 ","$4,800.35 ","$4,800.35 ","$1,177.67 ","$6,726.00 ","$1,353.31 ","$2,255.00 ","$5,326.99 ","$5,380.80 ","$1,880.24 ","$161.83 ","$196.45 ","$1,070.78 ","$1,288.86 "
"36100706","EAP","CPT� 40814","","Exc/les/mouth W/complex Repair","BOTH IP/OP","$5,169.00 ","$3,825.06 ","$0.00 ","$5,221.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,221.00 ","$0.00 ","$2,327.00 ","$4,135.03 ","$4,176.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100707","EAP","CPT� 40819","","Exc Frenum Libial Buccal","BOTH IP/OP","$2,245.00 ","$1,661.30 ","$0.00 ","$2,636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,636.00 ","$0.00 ","$2,255.00 ","$2,087.71 ","$2,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100708","EAP","CPT� 40820","","Dest/les Vestibule Mouth","BOTH IP/OP","$5,179.00 ","$3,832.46 ","$0.00 ","$6,081.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,081.00 ","$0.00 ","$2,255.00 ","$4,816.15 ","$4,864.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100709","EAP","CPT� 41015","","I&d Extraoral Sublingual","BOTH IP/OP","$945.00 ","$699.30 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$955.00 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100710","EAP","CPT� 41016","","I&d,floor Of Mouth-submental","BOTH IP/OP","$5,296.00 ","$3,919.04 ","$0.00 ","$5,605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,605.00 ","$0.00 ","$2,255.00 ","$4,439.16 ","$4,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100711","EAP","CPT� 41017","","I&d,floor/mouth-submandibular","BOTH IP/OP","$2,620.00 ","$1,938.80 ","$0.00 ","$2,646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,646.00 ","$0.00 ","$2,255.00 ","$2,095.63 ","$2,116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100712","EAP","CPT� 41018","","I&d,floor Of Mouth-masticator","BOTH IP/OP","$2,215.00 ","$1,639.10 ","$0.00 ","$2,344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,344.00 ","$0.00 ","$2,255.00 ","$1,856.45 ","$1,875.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100713","EAP","CPT� 41100","","Biopsy Anterior 2/3 Of Tongue","BOTH IP/OP","$991.00 ","$733.34 ","$108.86 ","$991.00 ","$991.00 ","$442.92 ","$206.55 ","$989.00 ","$989.00 ","$173.17 ","$989.00 ","$443.02 ","$989.00 ","$783.29 ","$791.20 ","$615.51 ","$116.06 ","$108.86 ","$157.45 ","$421.92 "
"36100715","EAP","CPT� 41105","","Biopsy Posterior 1/3 Tongue","BOTH IP/OP","$2,240.00 ","$1,657.60 ","$0.00 ","$2,240.00 ","$2,240.00 ","$2,240.00 ","$466.87 ","$0.00 ","$0.00 ","$0.00 ","$2,235.00 ","$0.00 ","$2,235.00 ","$1,770.12 ","$1,788.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100717","EAP","CPT� 41108","","Biopsy, Floor Of Mouth","BOTH IP/OP","$1,504.00 ","$1,112.96 ","$0.00 ","$1,504.00 ","$1,504.00 ","$1,377.93 ","$313.47 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$1,376.63 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$1,500.00 ","$90.18 ","$90.83 ","$238.80 ","$1,311.08 "
"36100718","EAP","CPT� 41116","","Exc Lesion Floor Of Mouth","BOTH IP/OP","$4,520.00 ","$3,344.80 ","$0.00 ","$4,509.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,509.00 ","$0.00 ","$2,255.00 ","$3,571.13 ","$3,607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100719","EAP","CPT� 41822","","Excision Of Fibrous Tuberosity","BOTH IP/OP","$4,451.00 ","$3,293.74 ","$0.00 ","$4,493.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,493.00 ","$0.00 ","$2,255.00 ","$3,558.46 ","$3,594.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100720","EAP","CPT� 41823","","Excision Of Osseoustuberosity","BOTH IP/OP","$4,910.00 ","$3,633.40 ","$0.00 ","$4,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,910.00 ","$0.00 ","$2,327.00 ","$3,888.72 ","$3,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100721","EAP","CPT� 41826","","Exc W/simple Repair Dentoalveo","BOTH IP/OP","$3,486.00 ","$2,579.64 ","$0.00 ","$3,486.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,486.00 ","$0.00 ","$2,255.00 ","$2,760.91 ","$2,788.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100722","EAP","CPT� 41850","","Destruct Lesion, Dentoalveolar","BOTH IP/OP","$5,372.00 ","$3,975.28 ","$0.00 ","$5,372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,372.00 ","$0.00 ","$2,255.00 ","$4,254.62 ","$4,297.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100723","EAP","CPT� 41874","","Alveoloplasty, Each Quadrant","BOTH IP/OP","$3,051.00 ","$2,257.74 ","$0.00 ","$3,080.00 ","$2,321.55 ","$2,679.15 ","$635.90 ","$2,198.20 ","$2,198.20 ","$539.28 ","$3,080.00 ","$2,626.99 ","$3,080.00 ","$2,439.36 ","$2,464.00 ","$3,080.00 ","$0.00 ","$259.89 ","$490.34 ","$2,501.89 "
"36100724","EAP","CPT� 41899","","Completely Bony","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$0.00 ","$0.00 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"36100725","EAP","CPT� 42100","","Biopsy Palate, Uvula","BOTH IP/OP","$1,837.00 ","$1,359.38 ","$0.00 ","$1,833.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,833.00 ","$0.00 ","$1,833.00 ","$1,451.74 ","$1,466.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100727","EAP","CPT� 42104","","Exc Palate, Uvula,w/o Closure","BOTH IP/OP","$3,431.00 ","$2,538.94 ","$0.00 ","$3,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,466.00 ","$0.00 ","$2,255.00 ","$2,745.07 ","$2,772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100728","EAP","CPT� 42140","","Uvulectomy","BOTH IP/OP","$3,002.00 ","$2,221.48 ","$0.00 ","$3,002.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,002.00 ","$0.00 ","$2,327.00 ","$2,377.58 ","$2,401.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100729","EAP","CPT� 42160","","Dest Lesion, Palate Or Uvula","BOTH IP/OP","$7,516.00 ","$5,561.84 ","$0.00 ","$7,507.00 ","$2,321.55 ","$2,679.15 ","$1,566.52 ","$0.00 ","$0.00 ","$0.00 ","$7,507.00 ","$0.00 ","$2,255.00 ","$5,945.54 ","$6,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100730","EAP","CPT� 42400","","Biopsy Of Salivary Gland,needl","BOTH IP/OP","$4,676.00 ","$3,460.24 ","$0.00 ","$4,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,670.00 ","$0.00 ","$2,255.00 ","$3,698.64 ","$3,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100732","EAP","CPT� 42700","","I&d Peritonsillar Abscess","BOTH IP/OP","$436.00 ","$322.64 ","$70.05 ","$440.00 ","$436.00 ","$207.19 ","$90.87 ","$440.00 ","$440.00 ","$77.04 ","$440.00 ","$204.24 ","$440.00 ","$348.48 ","$352.00 ","$283.76 ","$122.16 ","$139.13 ","$70.05 ","$194.51 "
"36100733","EAP","CPT� 42405","","Biopsy Of Salivary Gland","BOTH IP/OP","$9,563.00 ","$7,076.62 ","$0.00 ","$9,551.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,551.00 ","$0.00 ","$2,327.00 ","$7,564.39 ","$7,640.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100734","EAP","CPT� 42800","","Biopsy, Oropharynx","BOTH IP/OP","$5,168.00 ","$3,824.32 ","$0.00 ","$5,168.00 ","$0.00 ","$0.00 ","$1,077.14 ","$0.00 ","$0.00 ","$0.00 ","$5,168.00 ","$0.00 ","$2,255.00 ","$4,093.06 ","$4,134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100735","EAP","CPT� 42804","","Biopsy, Nasopharynx","BOTH IP/OP","$3,142.00 ","$2,325.08 ","$0.00 ","$3,142.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,142.00 ","$0.00 ","$2,255.00 ","$2,488.46 ","$2,513.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100738","EAP","CPT� 43246","","G-tube Insertion","BOTH IP/OP","$5,939.00 ","$4,394.86 ","$0.00 ","$5,711.00 ","$2,753.10 ","$1,590.63 ","$1,237.84 ","$0.00 ","$0.00 ","$0.00 ","$5,711.00 ","$0.00 ","$2,327.00 ","$4,523.11 ","$4,568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100740","EAP","CPT� 43450","","Dil Eso/unguide Bougie 1>1 Pas","BOTH IP/OP","$2,096.00 ","$1,551.04 ","$0.00 ","$2,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,096.00 ","$0.00 ","$2,096.00 ","$1,660.03 ","$1,676.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100742","EAP","CPT� 43752","","Naso Gastric Tube Place","BOTH IP/OP","$2,134.00 ","$1,579.16 ","$42.55 ","$2,134.00 ","$2,134.00 ","$265.79 ","$444.78 ","$1,464.51 ","$1,464.51 ","$359.29 ","$2,052.00 ","$364.66 ","$2,052.00 ","$1,625.18 ","$1,641.60 ","$506.64 ","$321.14 ","$42.55 ","$326.68 ","$347.29 "
"36100747","EAP","CPT� 43761","","Reposition Gastrostomy Tube","BOTH IP/OP","$5,739.00 ","$4,246.86 ","$0.00 ","$5,519.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,519.00 ","$0.00 ","$2,255.00 ","$4,371.05 ","$4,415.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100748","EAP","CPT� 44015","","Jejunostomy Intra-op Ent Alime","BOTH IP/OP","$6,352.00 ","$4,700.48 ","$0.00 ","$6,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,567.00 ","$0.00 ","$2,255.00 ","$5,201.06 ","$5,253.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100749","EAP","CPT� 44373","","Peg Conversion To Pej","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,055.00 ","$0.00 ","$2,327.00 ","$3,211.56 ","$3,244.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100751","EAP","CPT� 44500","","Intro Of Long Gi Tube","BOTH IP/OP","$1,291.00 ","$955.34 ","$0.00 ","$1,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,304.00 ","$0.00 ","$1,304.00 ","$1,032.77 ","$1,043.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100754","EAP","CPT� 45000","","Drain Pelvic Abscess Us","BOTH IP/OP","$6,884.00 ","$5,094.16 ","$0.00 ","$6,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,884.00 ","$0.00 ","$2,255.00 ","$5,452.13 ","$5,507.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100757","EAP","CPT� 46040","","Perirectal Abscess","BOTH IP/OP","$2,951.00 ","$2,183.74 ","$0.00 ","$2,981.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,981.00 ","$0.00 ","$2,858.00 ","$2,360.95 ","$2,384.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100758","EAP","CPT� 46600","","Anoscopy, Diagnostic, Inc Spec Collect","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$561.00 ","$110.43 ","$116.93 ","$0.00 ","$0.00 ","$94.90 ","$542.00 ","$109.35 ","$542.00 ","$429.26 ","$433.60 ","$151.93 ","$37.41 ","$42.17 ","$86.29 ","$104.14 "
"36100759","EAP","CPT� 46606","","Anoscopy And Biopsy","BOTH IP/OP","$2,211.00 ","$1,636.14 ","$52.76 ","$2,211.00 ","$2,211.00 ","$1,015.53 ","$460.83 ","$1,525.18 ","$1,525.18 ","$374.17 ","$2,137.00 ","$1,007.17 ","$2,137.00 ","$1,692.50 ","$1,709.60 ","$1,399.33 ","$52.76 ","$78.23 ","$340.21 ","$959.21 "
"36100760","EAP","CPT� 46900","","Destr Condyloma Anal - Chemic","BOTH IP/OP","$945.00 ","$699.30 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$955.00 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100763","EAP","CPT� 46916","","Anal Cryo Surgery","BOTH IP/OP","$429.00 ","$317.46 ","$0.00 ","$433.00 ","$429.00 ","$175.86 ","$89.41 ","$0.00 ","$0.00 ","$75.81 ","$433.00 ","$175.24 ","$433.00 ","$342.94 ","$346.40 ","$243.48 ","$138.83 ","$146.36 ","$68.93 ","$166.90 "
"36100764","EAP","CPT� 47000","","Liver Biopsy, Needle, Percut","BOTH IP/OP","$2,078.00 ","$1,537.72 ","$92.31 ","$2,078.00 ","$2,078.00 ","$1,377.93 ","$433.11 ","$1,479.50 ","$1,479.50 ","$362.97 ","$2,073.00 ","$1,376.63 ","$2,073.00 ","$1,641.82 ","$1,658.40 ","$1,912.65 ","$233.09 ","$92.31 ","$330.02 ","$1,311.08 "
"36100769","EAP","CPT� 47001","","BX LIVER ADDTL PROC PERCUT BCT","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,713.00 ","$0.00 ","$0.00 ","$566.92 ","$0.00 ","$0.00 ","$0.00 ","$2,713.00 ","$0.00 ","$2,255.00 ","$2,148.70 ","$2,170.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100770","EAP","CPT� 47015","","Exploratory Laparotomy","BOTH IP/OP","$4,765.00 ","$3,526.10 ","$0.00 ","$4,813.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,813.00 ","$0.00 ","$2,255.00 ","$3,811.90 ","$3,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100771","EAP","CPT� 47380","","Ablation, Open Liver Tumor, Rf","BOTH IP/OP","$6,657.00 ","$4,926.18 ","$0.00 ","$6,657.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,657.00 ","$0.00 ","$2,255.00 ","$5,272.34 ","$5,325.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100773","EAP","CPT� 47382","","Ablation, Liver Tumor; Rf","BOTH IP/OP","$8,888.00 ","$6,577.12 ","$637.15 ","$8,978.00 ","$3,735.90 ","$4,955.30 ","$1,852.48 ","$6,407.60 ","$5,416.74 ","$1,571.98 ","$8,978.00 ","$4,847.92 ","$5,452.00 ","$7,110.58 ","$7,182.40 ","$6,735.53 ","$637.15 ","$774.64 ","$1,429.30 ","$4,617.06 "
"36100774","EAP","CPT� 47490","","DRAIN CHOLECYSTOSTOMY S&I BCT","BOTH IP/OP","$5,844.00 ","$4,324.56 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$1,033.57 ","$5,903.00 ","$3,118.48 ","$2,255.00 ","$4,675.18 ","$4,722.40 ","$4,332.71 ","$444.58 ","$345.72 ","$939.76 ","$2,969.98 "
"36100781","EAP","CPT� 47555","","DILAT BIL STRICT W/O STENT SPV","BOTH IP/OP","$4,136.00 ","$3,060.64 ","$0.00 ","$4,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,136.00 ","$0.00 ","$2,858.00 ","$3,275.71 ","$3,308.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100783","EAP","CPT� 47556","","Biliary Dil Strict W/stent","BOTH IP/OP","$8,728.00 ","$6,458.72 ","$0.00 ","$8,728.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,728.00 ","$0.00 ","$6,105.00 ","$6,912.58 ","$6,982.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100786","EAP","CPT� 48000","","PANCREATITIS PLACE DRAIN BCT","BOTH IP/OP","$9,260.00 ","$6,852.40 ","$0.00 ","$9,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,260.00 ","$0.00 ","$2,327.00 ","$7,333.92 ","$7,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100787","EAP","CPT� 48102","","BX PANCREAS PERCUT NDL BCT","BOTH IP/OP","$2,114.00 ","$1,564.36 ","$0.00 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,114.00 ","$0.00 ","$2,114.00 ","$1,674.29 ","$1,691.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100800","EAP","CPT� 37211","","Thrombolytic Art Therapy W/s/i Any Meth Init Day","BOTH IP/OP","$25,698.00 ","$19,016.52 ","$0.00 ","$24,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,394.00 ","$0.00 ","$2,255.00 ","$19,320.05 ","$19,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100802","EAP","CPT� 37212","","Thrombolytic Venous Therapy  W S/i Any Meth Init Day","BOTH IP/OP","$25,698.00 ","$19,016.52 ","$0.00 ","$24,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,394.00 ","$0.00 ","$2,255.00 ","$19,320.05 ","$19,515.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100804","EAP","CPT� 49180","","Ablation Abd Standard Bct","BOTH IP/OP","$2,922.00 ","$2,162.28 ","$0.00 ","$2,922.00 ","$0.00 ","$0.00 ","$649.66 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,376.63 ","$2,255.00 ","$2,314.22 ","$2,337.60 ","$1,912.65 ","$203.88 ","$87.64 ","$465.18 ","$1,311.08 "
"36100805","EAP","CPT� 49180","","Bx Abd/retroper Mass Us","BOTH IP/OP","$2,922.00 ","$2,162.28 ","$0.00 ","$2,922.00 ","$0.00 ","$0.00 ","$0.00 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,376.63 ","$2,255.00 ","$2,314.22 ","$2,337.60 ","$1,912.65 ","$203.88 ","$87.64 ","$465.18 ","$1,311.08 "
"36100806","EAP","CPT� 49180","","Bx Retroperitone Mass Perc Bct","BOTH IP/OP","$3,117.00 ","$2,306.58 ","$87.64 ","$2,922.00 ","$2,321.55 ","$1,377.93 ","$649.66 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,376.63 ","$2,255.00 ","$2,314.22 ","$2,337.60 ","$1,912.65 ","$203.88 ","$87.64 ","$465.18 ","$1,311.08 "
"36100807","EAP","CPT� 49419","","Insert. Of Intrperitoneal Cath","BOTH IP/OP","$11,483.00 ","$8,497.42 ","$0.00 ","$13,433.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,433.00 ","$0.00 ","$2,255.00 ","$10,638.94 ","$10,746.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100808","EAP","CPT� 49421","","Peritoneal Dialysis Cat.placem","BOTH IP/OP","$11,842.00 ","$8,763.08 ","$0.00 ","$13,853.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,853.00 ","$0.00 ","$2,255.00 ","$10,971.58 ","$11,082.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100809","EAP","CPT� 49423","","CATHETER EXCH RAD GUIDE BCT","BOTH IP/OP","$3,484.00 ","$2,578.16 ","$0.00 ","$4,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,076.00 ","$0.00 ","$3,606.00 ","$3,228.19 ","$3,260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100810","EAP","CPT� 37213","","Throm Art/ven Therapy  W S/i  Inc F/u Cath Subsq Day","BOTH IP/OP","$43,713.00 ","$32,347.62 ","$0.00 ","$41,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41,496.00 ","$0.00 ","$2,858.00 ","$32,864.83 ","$33,196.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100811","EAP","CPT� 49424","","Inj Dye Via Previous Drn Bct","BOTH IP/OP","$3,484.00 ","$2,578.16 ","$0.00 ","$4,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,076.00 ","$0.00 ","$2,255.00 ","$3,228.19 ","$3,260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100812","EAP","CPT� 49427","","Injection, Abdominal Shunt","BOTH IP/OP","$373.00 ","$276.02 ","$0.00 ","$436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$436.00 ","$0.00 ","$436.00 ","$345.31 ","$348.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100813","EAP","CPT� 49440","","Gastrostomy Tube Place S&i Spv","BOTH IP/OP","$5,144.00 ","$3,806.56 ","$213.84 ","$4,947.00 ","$2,753.10 ","$1,590.63 ","$1,072.14 ","$3,530.67 ","$3,530.67 ","$866.18 ","$4,947.00 ","$1,561.98 ","$2,255.00 ","$3,918.02 ","$3,957.60 ","$2,170.16 ","$774.21 ","$213.84 ","$787.56 ","$1,487.60 "
"36100814","EAP","CPT� 49446","","G Tube Check","BOTH IP/OP","$6,735.00 ","$4,983.90 ","$0.00 ","$6,477.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,477.00 ","$0.00 ","$2,255.00 ","$5,129.78 ","$5,181.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100815","EAP","CPT� 49450","","Replace G/c Tube Perc","BOTH IP/OP","$3,451.00 ","$2,553.74 ","$68.88 ","$3,319.00 ","$2,321.55 ","$792.43 ","$719.27 ","$2,368.77 ","$2,368.77 ","$581.13 ","$3,319.00 ","$788.23 ","$2,255.00 ","$2,628.65 ","$2,655.20 ","$1,095.14 ","$685.21 ","$68.88 ","$528.38 ","$750.70 "
"36100816","EAP","CPT� 49452","","Replace G-j Tube Perc","BOTH IP/OP","$3,451.00 ","$2,553.74 ","$144.98 ","$3,319.00 ","$2,321.55 ","$792.43 ","$719.27 ","$2,368.77 ","$2,368.77 ","$581.13 ","$3,319.00 ","$788.23 ","$2,255.00 ","$2,628.65 ","$2,655.20 ","$1,095.14 ","$885.13 ","$144.98 ","$528.38 ","$750.70 "
"36100818","EAP","CPT� 50200","","BX RENAL PERCUT TROCAR/NDL BCT","BOTH IP/OP","$2,343.00 ","$1,733.82 ","$133.42 ","$2,337.00 ","$2,321.55 ","$1,377.93 ","$488.34 ","$1,667.92 ","$1,667.92 ","$409.19 ","$2,337.00 ","$1,376.63 ","$2,255.00 ","$1,850.90 ","$1,869.60 ","$1,912.65 ","$161.61 ","$133.42 ","$372.05 ","$1,311.08 "
"36100819","EAP","CPT� 50200","","Percutaneous Kidney Biopsy","BOTH IP/OP","$2,337.00 ","$1,729.38 ","$0.00 ","$2,337.00 ","$0.00 ","$0.00 ","$487.09 ","$1,667.92 ","$1,667.92 ","$409.19 ","$2,337.00 ","$1,376.63 ","$2,255.00 ","$1,850.90 ","$1,869.60 ","$1,912.65 ","$161.61 ","$133.42 ","$372.05 ","$1,311.08 "
"36100821","EAP","CPT� 50382","","Change Urter Stent, Percut","BOTH IP/OP","$7,354.00 ","$5,441.96 ","$0.00 ","$7,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,360.00 ","$0.00 ","$2,327.00 ","$5,829.12 ","$5,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100822","EAP","CPT� 50384","","Remove Urter Stent, Percut","BOTH IP/OP","$6,508.00 ","$4,815.92 ","$0.00 ","$6,573.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,573.00 ","$0.00 ","$2,255.00 ","$5,205.82 ","$5,258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100823","EAP","CPT� 50387","","Change Ext/int Ureter Stent","BOTH IP/OP","$2,713.00 ","$2,007.62 ","$87.64 ","$2,740.00 ","$2,321.55 ","$1,753.49 ","$565.46 ","$1,955.54 ","$1,955.54 ","$479.75 ","$2,740.00 ","$1,776.76 ","$2,255.00 ","$2,170.08 ","$2,192.00 ","$2,468.57 ","$790.32 ","$87.64 ","$436.21 ","$1,692.15 "
"36100824","EAP","CPT� 50389","","Remove Renal Tube With Fluro","BOTH IP/OP","$987.00 ","$730.38 ","$0.00 ","$997.00 ","$987.00 ","$563.41 ","$205.72 ","$0.00 ","$0.00 ","$174.57 ","$997.00 ","$558.17 ","$997.00 ","$789.62 ","$797.60 ","$775.50 ","$541.78 ","$55.90 ","$158.72 ","$531.59 "
"36100825","EAP","CPT� 50390","","Aspir/inject Renal Cyst/pelvis","BOTH IP/OP","$4,429.00 ","$3,277.46 ","$0.00 ","$4,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,210.00 ","$0.00 ","$2,255.00 ","$3,334.32 ","$3,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100831","EAP","CPT� 50592","","Ablation, Renal Tumor, Rf","BOTH IP/OP","$16,043.00 ","$11,871.82 ","$0.00 ","$15,251.00 ","$0.00 ","$0.00 ","$0.00 ","$10,884.64 ","$5,416.74 ","$2,670.33 ","$15,251.00 ","$4,847.92 ","$5,452.00 ","$12,078.79 ","$12,200.80 ","$6,735.53 ","$6,100.60 ","$357.73 ","$2,427.96 ","$4,617.06 "
"36100832","EAP","CPT� 50684","","Injection For Ureter Xray","BOTH IP/OP","$774.00 ","$572.76 ","$0.00 ","$774.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$774.00 ","$0.00 ","$387.00 ","$613.01 ","$619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100833","EAP","CPT� 50688","","Change Of Ureter Tube/stent","BOTH IP/OP","$2,286.00 ","$1,691.64 ","$0.00 ","$2,173.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,173.00 ","$0.00 ","$2,173.00 ","$1,721.02 ","$1,738.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100834","EAP","CPT� 50690","","Inject For Ureter X-ray","BOTH IP/OP","$829.00 ","$613.46 ","$0.00 ","$829.00 ","$829.00 ","$0.00 ","$172.78 ","$788.00 ","$788.00 ","$137.97 ","$788.00 ","$0.00 ","$394.00 ","$624.10 ","$630.40 ","$0.00 ","$298.44 ","$72.83 ","$125.45 ","$0.00 "
"36100835","EAP","CPT� 51080","","DRN PERIVESIC/PREVESIC ABS BCT","BOTH IP/OP","$3,734.00 ","$2,763.16 ","$0.00 ","$3,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,734.00 ","$0.00 ","$2,255.00 ","$2,957.33 ","$2,987.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100836","EAP","CPT� 51100","","Drain Bladder By Needle","BOTH IP/OP","$647.00 ","$478.78 ","$0.00 ","$647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$647.00 ","$0.00 ","$647.00 ","$512.42 ","$517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100839","EAP","CPT� 51102","","Bladder Tap-suprapub W Cath In","BOTH IP/OP","$5,564.00 ","$4,117.36 ","$0.00 ","$5,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,564.00 ","$0.00 ","$2,255.00 ","$4,406.69 ","$4,451.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100840","EAP","CPT� 51102","","Drain Bl W/cath Insertion","BOTH IP/OP","$5,564.00 ","$4,117.36 ","$0.00 ","$5,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,564.00 ","$0.00 ","$2,255.00 ","$4,406.69 ","$4,451.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100841","EAP","CPT� 51102","","Drainage Of Bladder","BOTH IP/OP","$5,564.00 ","$4,117.36 ","$0.00 ","$5,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,564.00 ","$0.00 ","$2,255.00 ","$4,406.69 ","$4,451.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100842","EAP","CPT� 51600","","Inject Cystography/voiding","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,274.00 ","$692.33 ","$0.00 ","$265.74 ","$1,208.73 ","$1,208.73 ","$223.07 ","$1,274.00 ","$0.00 ","$637.00 ","$1,009.01 ","$1,019.20 ","$0.00 ","$280.11 ","$46.16 ","$202.82 ","$0.00 "
"36100844","EAP","CPT� 51610","","Inject Cystography/void Retro","BOTH IP/OP","$2,406.00 ","$1,780.44 ","$0.00 ","$2,404.00 ","$0.00 ","$0.00 ","$0.00 ","$1,715.73 ","$1,715.73 ","$420.92 ","$2,404.00 ","$0.00 ","$1,202.00 ","$1,903.97 ","$1,923.20 ","$0.00 ","$301.43 ","$66.70 ","$382.72 ","$0.00 "
"36100846","EAP","CPT� 51700","","Bladder Irrigation &/or Instil","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$504.00 ","$260.60 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$504.00 ","$399.17 ","$403.20 ","$0.00 ","$100.47 ","$0.00 ","$0.00 ","$0.00 "
"36100848","EAP","CPT� 51701","","Insert Straight Cath In & Out","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$865.00 ","$865.00 ","$110.43 ","$180.29 ","$0.00 ","$0.00 ","$151.28 ","$864.00 ","$109.35 ","$864.00 ","$684.29 ","$691.20 ","$151.93 ","$57.62 ","$27.40 ","$137.55 ","$104.14 "
"36100849","EAP","CPT� 51702","","Cath Insert Indwelling","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,070.00 ","$1,070.00 ","$110.43 ","$223.01 ","$0.00 ","$0.00 ","$187.17 ","$1,069.00 ","$109.35 ","$1,069.00 ","$846.65 ","$855.20 ","$151.93 ","$91.18 ","$26.68 ","$170.18 ","$104.14 "
"36100850","EAP","CPT� 51702","","Insert Foley Cath","BOTH IP/OP","$1,069.00 ","$791.06 ","$0.00 ","$1,069.00 ","$0.00 ","$0.00 ","$223.01 ","$0.00 ","$0.00 ","$187.17 ","$1,069.00 ","$109.35 ","$1,069.00 ","$846.65 ","$855.20 ","$151.93 ","$91.18 ","$26.68 ","$170.18 ","$104.14 "
"36100851","EAP","CPT� 51703","","Insert Complicated Cath","BOTH IP/OP","$1,809.00 ","$1,338.66 ","$0.00 ","$1,809.00 ","$1,809.00 ","$136.73 ","$0.00 ","$1,290.37 ","$1,290.37 ","$316.57 ","$1,808.00 ","$138.76 ","$1,808.00 ","$1,431.94 ","$1,446.40 ","$192.78 ","$170.19 ","$80.41 ","$287.83 ","$132.15 "
"36100852","EAP","CPT� 51705","","Change Cysto Tube Simple","BOTH IP/OP","$626.00 ","$463.24 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$235.59 ","$625.00 ","$495.00 ","$500.00 ","$327.32 ","$86.33 ","$54.08 ","$99.50 ","$224.37 "
"36100853","EAP","CPT� 51710","","Change Cysto Tube Complicated","BOTH IP/OP","$3,957.00 ","$2,928.18 ","$0.00 ","$3,954.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,954.00 ","$0.00 ","$2,255.00 ","$3,131.57 ","$3,163.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100854","EAP","CPT� 51720","","Instill Bladder Anticancer Age","BOTH IP/OP","$1,029.00 ","$761.46 ","$0.00 ","$1,029.00 ","$1,029.00 ","$260.60 ","$214.47 ","$0.00 ","$0.00 ","$179.99 ","$1,028.00 ","$235.59 ","$1,028.00 ","$814.18 ","$822.40 ","$327.32 ","$147.65 ","$45.44 ","$163.66 ","$224.37 "
"36100855","EAP","CPT� 51726","","Cystometrogram","BOTH IP/OP","$1,648.00 ","$1,219.52 ","$0.00 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,648.00 ","$0.00 ","$1,648.00 ","$1,305.22 ","$1,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100858","EAP","CPT� 51798","","Residual Urine By Ultrasound","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$55.17 ","$207.00 ","$163.94 ","$165.60 ","$76.65 ","$19.99 ","$10.44 ","$32.95 ","$52.54 "
"36100860","EAP","CPT� 52000","","Cystourethroscopy","BOTH IP/OP","$3,069.00 ","$2,271.06 ","$84.02 ","$3,100.00 ","$2,321.55 ","$563.41 ","$639.66 ","$2,212.47 ","$2,212.47 ","$542.79 ","$3,100.00 ","$558.17 ","$2,255.00 ","$2,455.20 ","$2,480.00 ","$775.50 ","$152.62 ","$84.02 ","$493.52 ","$531.59 "
"36100861","EAP","CPT� 52005","","Cystourethro W Ureteral Cath","BOTH IP/OP","$5,902.00 ","$4,367.48 ","$0.00 ","$5,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,962.00 ","$0.00 ","$2,327.00 ","$4,721.90 ","$4,769.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100862","EAP","CPT� 52281","","Perc Dilate Ureter W Balloon","BOTH IP/OP","$6,114.00 ","$4,524.36 ","$0.00 ","$6,176.00 ","$0.00 ","$0.00 ","$1,274.31 ","$4,407.81 ","$4,407.81 ","$1,081.37 ","$6,176.00 ","$1,776.76 ","$2,327.00 ","$4,891.39 ","$4,940.80 ","$2,468.57 ","$208.00 ","$157.57 ","$983.22 ","$1,692.15 "
"36100863","EAP","CPT� 52310","","Cysto W Stent Removal","BOTH IP/OP","$5,725.00 ","$4,236.50 ","$156.86 ","$5,783.00 ","$2,753.10 ","$1,753.49 ","$1,193.23 ","$4,127.33 ","$4,127.33 ","$1,012.56 ","$5,783.00 ","$1,776.76 ","$2,327.00 ","$4,580.14 ","$4,626.40 ","$2,468.57 ","$409.12 ","$156.86 ","$920.65 ","$1,692.15 "
"36100864","EAP","CPT� 52332","","Cysto W Ureter Stent Plcmnt","BOTH IP/OP","$10,798.00 ","$7,990.52 ","$0.00 ","$10,907.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,907.00 ","$0.00 ","$2,327.00 ","$8,638.34 ","$8,725.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100865","EAP","CPT� 53600","","Dilate Urethra Strict Male Ini","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$694.00 ","$235.59 ","$694.00 ","$549.65 ","$555.20 ","$327.32 ","$0.00 ","$65.99 ","$110.48 ","$224.37 "
"36100866","EAP","CPT� 53601","","Dilate Stricture Male Subseq","BOTH IP/OP","$314.00 ","$232.36 ","$0.00 ","$317.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$317.00 ","$0.00 ","$317.00 ","$251.06 ","$253.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100867","EAP","CPT� 53620","","Dilate Strict Male Filiform Ix","BOTH IP/OP","$4,447.00 ","$3,290.78 ","$0.00 ","$4,447.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,447.00 ","$0.00 ","$2,255.00 ","$3,522.02 ","$3,557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100868","EAP","CPT� 53621","","Dilate Strict Male Filiform Su","BOTH IP/OP","$804.00 ","$594.96 ","$0.00 ","$804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$804.00 ","$0.00 ","$804.00 ","$636.77 ","$643.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100869","EAP","CPT� 53660","","Dilate Urethra Strict Female I","BOTH IP/OP","$286.00 ","$211.64 ","$0.00 ","$286.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$286.00 ","$0.00 ","$286.00 ","$226.51 ","$228.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100870","EAP","CPT� 53661","","Dilate Urethra Strict Female S","BOTH IP/OP","$286.00 ","$211.64 ","$0.00 ","$286.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$286.00 ","$0.00 ","$286.00 ","$226.51 ","$228.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100871","EAP","CPT� 54001","","Dorsal Slit  Exc Newborn","BOTH IP/OP","$6,461.00 ","$4,781.14 ","$0.00 ","$6,453.00 ","$2,753.10 ","$1,753.49 ","$1,346.63 ","$0.00 ","$0.00 ","$0.00 ","$6,453.00 ","$0.00 ","$2,327.00 ","$5,110.78 ","$5,162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100872","EAP","CPT� 54015","","Incise And Drain Penis, Deep","BOTH IP/OP","$4,851.00 ","$3,589.74 ","$0.00 ","$4,851.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,851.00 ","$0.00 ","$3,606.00 ","$3,841.99 ","$3,880.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100873","EAP","CPT� 54050","","Les, Dest, Chem Penis, Simple","BOTH IP/OP","$755.00 ","$558.70 ","$0.00 ","$763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.60 ","$763.00 ","$320.45 ","$763.00 ","$604.30 ","$610.40 ","$445.22 ","$92.54 ","$107.78 ","$121.47 ","$305.19 "
"36100875","EAP","CPT� 54056","","Cryosurg Penis Lesion(s) Simpl","BOTH IP/OP","$304.00 ","$224.96 ","$0.00 ","$307.00 ","$165.07 ","$175.86 ","$63.36 ","$0.00 ","$0.00 ","$53.75 ","$307.00 ","$175.24 ","$307.00 ","$243.14 ","$245.60 ","$243.48 ","$104.42 ","$112.46 ","$48.87 ","$166.90 "
"36100876","EAP","CPT� 54100","","Biopsy Of Penis","BOTH IP/OP","$6,079.00 ","$4,498.46 ","$0.00 ","$6,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,140.00 ","$0.00 ","$2,255.00 ","$4,862.88 ","$4,912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100877","EAP","CPT� 54150","","Circumcision","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,079.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,079.00 ","$0.00 ","$2,079.00 ","$1,646.57 ","$1,663.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100878","EAP","CPT� 54200","","Treatment Of Penis Lesion","BOTH IP/OP","$590.00 ","$436.60 ","$0.00 ","$672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.00 ","$0.00 ","$672.00 ","$532.22 ","$537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100879","EAP","CPT� 54230","","Inject Corpora Cavernosography","BOTH IP/OP","$1,666.00 ","$1,232.84 ","$0.00 ","$1,897.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,897.00 ","$0.00 ","$1,897.00 ","$1,502.42 ","$1,517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100880","EAP","CPT� 54450","","Paraphimosis Reduction","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$624.00 ","$618.00 ","$260.60 ","$0.00 ","$624.00 ","$624.00 ","$109.26 ","$624.00 ","$235.59 ","$624.00 ","$494.21 ","$499.20 ","$327.32 ","$70.76 ","$59.86 ","$99.34 ","$224.37 "
"36100881","EAP","CPT� 54700","","Incise And Drain, Testes","BOTH IP/OP","$3,277.00 ","$2,424.98 ","$0.00 ","$3,277.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,277.00 ","$0.00 ","$2,327.00 ","$2,595.38 ","$2,621.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100882","EAP","CPT� 54860","","Removal Of Epididymis","BOTH IP/OP","$7,853.00 ","$5,811.22 ","$0.00 ","$7,853.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,853.00 ","$0.00 ","$2,858.00 ","$6,219.58 ","$6,282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100883","EAP","CPT� 55000","","Aspiration Of Hydrocele","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$998.00 ","$536.48 ","$609.42 ","$0.00 ","$0.00 ","$0.00 ","$174.74 ","$998.00 ","$611.80 ","$998.00 ","$790.42 ","$798.40 ","$850.02 ","$92.61 ","$87.97 ","$158.88 ","$582.67 "
"36100884","EAP","CPT� 55250","","Removal Of Sperm Duct(s)","BOTH IP/OP","$2,475.00 ","$1,831.50 ","$0.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,784.25 ","$1,784.25 ","$437.73 ","$2,500.00 ","$1,776.76 ","$2,327.00 ","$1,980.00 ","$2,000.00 ","$2,468.57 ","$321.77 ","$236.13 ","$398.00 ","$1,692.15 "
"36100885","EAP","CPT� 55700","","Biopsy Prostate Needle/punch","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$135.95 ","$4,494.00 ","$2,753.10 ","$1,753.49 ","$938.95 ","$3,207.37 ","$3,207.37 ","$786.86 ","$4,494.00 ","$1,776.76 ","$2,327.00 ","$3,559.25 ","$3,595.20 ","$2,468.57 ","$147.73 ","$135.95 ","$715.44 ","$1,692.15 "
"36100887","EAP","CPT� 56405","","I And D Vulva Perineal Absces","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$294.00 ","$291.00 ","$276.20 ","$60.65 ","$0.00 ","$0.00 ","$51.48 ","$294.00 ","$0.00 ","$294.00 ","$232.85 ","$235.20 ","$0.00 ","$107.63 ","$0.00 ","$0.00 ","$0.00 "
"36100898","EAP","CPT� 56420","","Bartholin Gland Abscess","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$672.00 ","$665.00 ","$166.84 ","$138.60 ","$0.00 ","$0.00 ","$117.66 ","$672.00 ","$166.54 ","$672.00 ","$532.22 ","$537.60 ","$231.38 ","$106.60 ","$107.06 ","$106.98 ","$158.61 "
"36100902","EAP","CPT� 37214","","Cess Therapy Cath Removalw/ Vess Close","BOTH IP/OP","$8,844.00 ","$6,544.56 ","$0.00 ","$8,844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,844.00 ","$0.00 ","$2,858.00 ","$7,004.45 ","$7,075.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100903","EAP","CPT� 56501","","Cryosurgery, Vulvar","BOTH IP/OP","$6,455.00 ","$4,776.70 ","$0.00 ","$6,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,520.00 ","$0.00 ","$2,255.00 ","$5,163.84 ","$5,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100904","EAP","CPT� 56501","","Destroy Lesion(s) Vulva Simple","BOTH IP/OP","$6,455.00 ","$4,776.70 ","$0.00 ","$6,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,520.00 ","$0.00 ","$2,255.00 ","$5,163.84 ","$5,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100906","EAP","CPT� 56515","","Destroy Lesion(s) Vulva Extens","BOTH IP/OP","$4,384.00 ","$3,244.16 ","$0.00 ","$4,428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,428.00 ","$0.00 ","$2,858.00 ","$3,506.98 ","$3,542.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100909","EAP","CPT� 56605","","Vulvar Biopsy, One Lesion","BOTH IP/OP","$641.00 ","$474.34 ","$63.10 ","$641.00 ","$641.00 ","$620.86 ","$133.60 ","$586.00 ","$586.00 ","$102.60 ","$586.00 ","$640.34 ","$586.00 ","$464.11 ","$468.80 ","$586.00 ","$84.36 ","$63.10 ","$93.29 ","$609.84 "
"36100914","EAP","CPT� 56606","","Vulvar Bx, Each Addl Lesion","BOTH IP/OP","$557.00 ","$412.18 ","$0.00 ","$557.00 ","$557.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.35 ","$556.00 ","$0.00 ","$556.00 ","$440.35 ","$444.80 ","$0.00 ","$53.12 ","$31.01 ","$88.52 ","$0.00 "
"36100920","EAP","CPT� 56820","","Colposcopy, Vulva","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$502.00 ","$501.00 ","$166.84 ","$104.42 ","$0.00 ","$0.00 ","$87.90 ","$502.00 ","$166.54 ","$502.00 ","$397.58 ","$401.60 ","$231.38 ","$116.33 ","$89.05 ","$79.92 ","$158.61 "
"36100921","EAP","CPT� 56821","","Colposcopy, Vulva + Vulva Bx","BOTH IP/OP","$1,623.00 ","$1,201.02 ","$0.00 ","$1,627.00 ","$1,623.00 ","$276.20 ","$338.27 ","$0.00 ","$0.00 ","$284.87 ","$1,627.00 ","$271.52 ","$1,627.00 ","$1,288.58 ","$1,301.60 ","$377.23 ","$150.61 ","$118.98 ","$259.02 ","$258.59 "
"36100923","EAP","CPT� 57020","","Colpocentesis","BOTH IP/OP","$3,281.00 ","$2,427.94 ","$0.00 ","$3,290.00 ","$2,753.10 ","$3,281.00 ","$683.84 ","$0.00 ","$0.00 ","$0.00 ","$3,290.00 ","$0.00 ","$2,327.00 ","$2,605.68 ","$2,632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100925","EAP","CPT� 57061","","Destroy Vaginal Lesion(s) Simp","BOTH IP/OP","$4,198.00 ","$3,106.52 ","$0.00 ","$4,240.00 ","$2,321.55 ","$2,569.43 ","$874.97 ","$0.00 ","$0.00 ","$0.00 ","$4,240.00 ","$0.00 ","$2,327.00 ","$3,358.08 ","$3,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100926","EAP","CPT� 57065","","Destroy Vaginal Lesion(s) Exte","BOTH IP/OP","$4,256.00 ","$3,149.44 ","$0.00 ","$4,256.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,256.00 ","$0.00 ","$2,255.00 ","$3,370.75 ","$3,404.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100929","EAP","CPT� 57100","","Vaginal Biopsy Simple","BOTH IP/OP","$3,448.00 ","$2,551.52 ","$68.51 ","$3,440.00 ","$2,321.55 ","$620.86 ","$718.65 ","$2,455.13 ","$2,455.13 ","$602.32 ","$3,440.00 ","$640.34 ","$3,440.00 ","$2,724.48 ","$2,752.00 ","$889.66 ","$71.96 ","$68.51 ","$547.65 ","$609.84 "
"36100930","EAP","CPT� 27096","","Bil Sacroiliac Jt Inj With Arthrography","BOTH IP/OP","$3,165.00 ","$2,342.10 ","$0.00 ","$3,197.00 ","$2,321.55 ","$0.00 ","$659.67 ","$2,281.70 ","$2,281.70 ","$559.77 ","$3,197.00 ","$0.00 ","$2,255.00 ","$2,532.02 ","$2,557.60 ","$86.18 ","$398.44 ","$86.18 ","$508.96 ","$0.00 "
"36100933","EAP","CPT� 57150","","Vaginal Irrigation","BOTH IP/OP","$472.00 ","$349.28 ","$0.00 ","$477.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.00 ","$0.00 ","$477.00 ","$377.78 ","$381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100934","EAP","CPT� 57155","","Insertion Of T&o","BOTH IP/OP","$4,229.00 ","$3,129.46 ","$0.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$2,327.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$410.73 ","$0.00 ","$0.00 ","$0.00 "
"36100935","EAP","CPT� 57160","","Pessary Insertion","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$338.00 ","$181.91 ","$166.84 ","$69.82 ","$0.00 ","$0.00 ","$59.18 ","$338.00 ","$166.54 ","$338.00 ","$267.70 ","$270.40 ","$231.38 ","$60.59 ","$48.68 ","$53.81 ","$158.61 "
"36100936","EAP","CPT� 57170","","Diaphragm  Cervical Cap Fittin","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$500.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100938","EAP","CPT� 57170","","Diaphragm Fitting","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$500.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100939","EAP","CPT� 57210","","Colpoperineorrhaphy","BOTH IP/OP","$10,423.00 ","$7,713.02 ","$0.00 ","$10,423.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,423.00 ","$0.00 ","$2,327.00 ","$8,255.02 ","$8,338.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100940","EAP","CPT� 57420","","Colposcopy Of Vagina","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,240.00 ","$1,237.00 ","$276.20 ","$257.82 ","$0.00 ","$0.00 ","$217.11 ","$1,240.00 ","$271.52 ","$1,240.00 ","$982.08 ","$992.00 ","$377.23 ","$121.31 ","$94.46 ","$197.41 ","$258.59 "
"36100941","EAP","CPT� 57420","","Colposcopy, Vagina With Cervix","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,240.00 ","$1,237.00 ","$276.20 ","$257.82 ","$0.00 ","$0.00 ","$217.11 ","$1,240.00 ","$271.52 ","$1,240.00 ","$982.08 ","$992.00 ","$377.23 ","$121.31 ","$94.46 ","$197.41 ","$258.59 "
"36100942","EAP","CPT� 57421","","Colposcopy Bx Of Vagina+cervix","BOTH IP/OP","$1,039.00 ","$768.86 ","$0.00 ","$1,042.00 ","$1,039.00 ","$620.86 ","$216.55 ","$0.00 ","$0.00 ","$182.45 ","$1,042.00 ","$640.34 ","$1,042.00 ","$825.26 ","$833.60 ","$889.66 ","$158.06 ","$128.00 ","$165.89 ","$609.84 "
"36100943","EAP","CPT� 57421","","COLPOSCOPY OF VAGINA W/BX","BOTH IP/OP","$1,039.00 ","$768.86 ","$0.00 ","$1,042.00 ","$1,039.00 ","$620.86 ","$216.55 ","$0.00 ","$0.00 ","$182.45 ","$1,042.00 ","$640.34 ","$1,042.00 ","$825.26 ","$833.60 ","$889.66 ","$158.06 ","$128.00 ","$165.89 ","$609.84 "
"36100944","EAP","CPT� 57421","","COLPOSCOPY, VAGINA W/ BX","BOTH IP/OP","$1,039.00 ","$768.86 ","$0.00 ","$1,042.00 ","$1,039.00 ","$620.86 ","$216.55 ","$0.00 ","$0.00 ","$182.45 ","$1,042.00 ","$640.34 ","$1,042.00 ","$825.26 ","$833.60 ","$889.66 ","$158.06 ","$128.00 ","$165.89 ","$609.84 "
"36100945","EAP","CPT� 57452","","Colposcopy Without Biopsy","BOTH IP/OP","$556.00 ","$411.44 ","$77.33 ","$557.00 ","$556.00 ","$166.84 ","$115.88 ","$557.00 ","$557.00 ","$97.53 ","$557.00 ","$166.54 ","$557.00 ","$441.14 ","$445.60 ","$231.38 ","$77.33 ","$95.18 ","$88.67 ","$158.61 "
"36100951","EAP","CPT� 57454","","Colposcopy W/bx & Ecc","BOTH IP/OP","$1,185.00 ","$876.90 ","$99.94 ","$1,188.00 ","$1,185.00 ","$276.20 ","$246.98 ","$1,188.00 ","$1,188.00 ","$208.01 ","$1,188.00 ","$271.52 ","$1,188.00 ","$940.90 ","$950.40 ","$377.23 ","$99.94 ","$140.25 ","$189.13 ","$258.59 "
"36100956","EAP","CPT� 57455","","Colposcopy + Cx Bx","BOTH IP/OP","$1,218.00 ","$901.32 ","$115.02 ","$1,221.00 ","$1,218.00 ","$276.20 ","$253.86 ","$1,208.73 ","$1,208.73 ","$213.79 ","$1,221.00 ","$271.52 ","$1,221.00 ","$967.03 ","$976.80 ","$377.23 ","$145.54 ","$115.02 ","$194.38 ","$258.59 "
"36100960","EAP","CPT� 57456","","Colposcopy + Ecc","BOTH IP/OP","$1,218.00 ","$901.32 ","$106.36 ","$1,221.00 ","$1,218.00 ","$276.20 ","$253.86 ","$1,208.73 ","$1,208.73 ","$213.79 ","$1,221.00 ","$271.52 ","$1,221.00 ","$967.03 ","$976.80 ","$377.23 ","$137.69 ","$106.36 ","$194.38 ","$258.59 "
"36100961","EAP","CPT� 57460","","Colposcopy W/leep Bx","BOTH IP/OP","$4,730.00 ","$3,500.20 ","$168.01 ","$4,743.00 ","$2,753.10 ","$2,569.43 ","$985.85 ","$3,385.08 ","$3,385.08 ","$830.46 ","$4,743.00 ","$2,505.44 ","$2,255.00 ","$3,756.46 ","$3,794.40 ","$3,480.98 ","$178.42 ","$168.01 ","$755.09 ","$2,386.14 "
"36100963","EAP","CPT� 57461","","Colposcopy W/leep Cone","BOTH IP/OP","$8,498.00 ","$6,288.52 ","$194.34 ","$8,521.00 ","$2,984.10 ","$2,569.43 ","$1,771.20 ","$6,081.44 ","$5,416.74 ","$1,491.96 ","$8,521.00 ","$2,505.44 ","$2,255.00 ","$6,748.63 ","$6,816.80 ","$3,480.98 ","$325.94 ","$194.34 ","$1,356.54 ","$2,386.14 "
"36100964","EAP","CPT� 57500","","Cervical Biopsy","BOTH IP/OP","$3,362.00 ","$2,487.88 ","$71.26 ","$3,354.00 ","$2,321.55 ","$620.86 ","$700.72 ","$2,393.75 ","$2,393.75 ","$587.26 ","$3,354.00 ","$640.34 ","$2,255.00 ","$2,656.37 ","$2,683.20 ","$889.66 ","$71.26 ","$78.23 ","$533.96 ","$609.84 "
"36100967","EAP","CPT� 57511","","Cryosurgery, Cervix","BOTH IP/OP","$785.00 ","$580.90 ","$0.00 ","$793.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$793.00 ","$0.00 ","$793.00 ","$628.06 ","$634.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100968","EAP","CPT� 57522","","Leep + Ecc + Cone","BOTH IP/OP","$8,652.00 ","$6,402.48 ","$255.93 ","$8,739.00 ","$2,753.10 ","$2,569.43 ","$1,803.29 ","$6,237.02 ","$5,416.74 ","$1,530.13 ","$8,739.00 ","$2,505.44 ","$2,327.00 ","$6,921.29 ","$6,991.20 ","$3,480.98 ","$255.93 ","$259.91 ","$1,391.25 ","$2,386.14 "
"36100969","EAP","CPT� 57720","","Revision Of Cervix","BOTH IP/OP","$6,223.00 ","$4,605.02 ","$0.00 ","$6,286.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,286.00 ","$0.00 ","$2,858.00 ","$4,978.51 ","$5,028.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100970","EAP","CPT� 58100","","Endometrial Biopsy","BOTH IP/OP","$343.00 ","$253.82 ","$55.08 ","$346.00 ","$343.00 ","$166.84 ","$71.49 ","$346.00 ","$346.00 ","$60.58 ","$346.00 ","$166.54 ","$346.00 ","$274.03 ","$276.80 ","$231.38 ","$59.72 ","$67.07 ","$55.08 ","$158.61 "
"36100971","EAP","CPT� 0237T","","Atherectomy, Branchiocephalic Artery","BOTH IP/OP","$12,918.00 ","$9,559.32 ","$0.00 ","$12,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,918.00 ","$0.00 ","$6,105.00 ","$10,231.06 ","$10,334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100972","EAP","CPT� 0236T","","Atherectomy, Aorta","BOTH IP/OP","$24,595.00 ","$18,200.30 ","$0.00 ","$24,595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,595.00 ","$0.00 ","$6,105.00 ","$19,479.24 ","$19,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100973","EAP","CPT� 0234T","","Atherectomy, Renal Artery","BOTH IP/OP","$24,595.00 ","$18,200.30 ","$0.00 ","$24,595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,595.00 ","$0.00 ","$6,105.00 ","$19,479.24 ","$19,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100974","EAP","CPT� 58110","","Endometrial Bx In Conj W/colp","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$240.00 ","$238.00 ","$0.00 ","$49.61 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$50.14 ","$42.91 ","$38.21 ","$0.00 "
"36100975","EAP","CPT� 0238T","","Atherectomy, Lilac Artery","BOTH IP/OP","$18,351.00 ","$13,579.74 ","$0.00 ","$18,351.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,351.00 ","$0.00 ","$6,105.00 ","$14,533.99 ","$14,680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100978","EAP","CPT� 58300","","Insertion Iud","BOTH IP/OP","$676.00 ","$500.24 ","$0.00 ","$676.00 ","$676.00 ","$51.66 ","$140.90 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$675.00 ","$534.60 ","$540.00 ","$405.00 ","$69.90 ","$0.00 ","$107.46 ","$0.00 "
"36100980","EAP","CPT� 37197","","Retrieve Fb Percut Intravascul W/ S And I","BOTH IP/OP","$28,818.00 ","$21,325.32 ","$0.00 ","$32,988.00 ","$0.00 ","$0.00 ","$0.00 ","$23,543.54 ","$5,416.74 ","$0.00 ","$32,988.00 ","$2,779.42 ","$2,858.00 ","$26,126.50 ","$26,390.40 ","$3,861.64 ","$0.00 ","$315.16 ","$5,251.69 ","$2,647.07 "
"36100981","EAP","CPT� 36221","","Non Sel Cath Plac Aort W Angio  Inc S/i","BOTH IP/OP","$67,249.00 ","$49,764.26 ","$0.00 ","$56,630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56,630.00 ","$0.00 ","$2,858.00 ","$44,850.96 ","$45,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100982","EAP","CPT� 36222","","Sel Cath Plac Ext Carotid Angio W S&i","BOTH IP/OP","$19,446.00 ","$14,390.04 ","$0.00 ","$16,376.00 ","$0.00 ","$0.00 ","$4,053.03 ","$0.00 ","$0.00 ","$0.00 ","$16,376.00 ","$0.00 ","$2,858.00 ","$12,969.79 ","$13,100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100983","EAP","CPT� 58301","","Iud, Removal","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$281.00 ","$276.20 ","$58.57 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$271.52 ","$280.00 ","$221.76 ","$224.00 ","$280.00 ","$81.66 ","$70.31 ","$44.58 ","$258.59 "
"36100984","EAP","CPT� 36223","","Sel Cath Plac Common/inom Intracranial Carotid","BOTH IP/OP","$18,704.00 ","$13,840.96 ","$330.96 ","$15,750.00 ","$2,753.10 ","$4,670.08 ","$3,898.38 ","$11,240.78 ","$5,416.74 ","$2,757.70 ","$15,750.00 ","$4,609.70 ","$2,858.00 ","$12,474.00 ","$12,600.00 ","$6,404.56 ","$1,513.65 ","$330.96 ","$2,507.40 ","$4,390.19 "
"36100985","EAP","CPT� 36224","","Sel Cath Plac Internalcarotid Intracranial Carotid","BOTH IP/OP","$21,402.00 ","$15,837.48 ","$376.00 ","$18,022.00 ","$2,984.10 ","$4,670.08 ","$4,460.71 ","$12,862.30 ","$5,416.74 ","$3,155.51 ","$18,022.00 ","$4,609.70 ","$4,975.00 ","$14,273.42 ","$14,417.60 ","$6,404.56 ","$1,644.17 ","$376.00 ","$2,869.10 ","$4,390.19 "
"36100986","EAP","CPT� 36225","","Sel Cath Plac Sub Clav,/innom Uni W/angio And S/i","BOTH IP/OP","$18,704.00 ","$13,840.96 ","$0.00 ","$15,750.00 ","$2,753.10 ","$2,803.47 ","$3,898.38 ","$0.00 ","$0.00 ","$0.00 ","$15,750.00 ","$0.00 ","$2,858.00 ","$12,474.00 ","$12,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100987","EAP","CPT� 36226","","Sel Cath Plac Sub Clav,/vert  W/angio And S/i","BOTH IP/OP","$60,254.00 ","$44,587.96 ","$370.60 ","$50,739.00 ","$2,984.10 ","$4,670.08 ","$9,417.94 ","$36,212.42 ","$5,416.74 ","$8,138.89 ","$50,739.00 ","$4,609.70 ","$4,975.00 ","$40,185.29 ","$40,591.20 ","$6,404.56 ","$1,676.21 ","$370.60 ","$8,077.65 ","$4,390.19 "
"36100988","EAP","CPT� 36227","","Sel Cath Plac Ext Carotid Angio W S&i","BOTH IP/OP","$18,704.00 ","$13,840.96 ","$0.00 ","$15,750.00 ","$2,321.55 ","$0.00 ","$3,898.38 ","$0.00 ","$0.00 ","$0.00 ","$15,750.00 ","$0.00 ","$7,875.00 ","$12,474.00 ","$12,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100989","EAP","CPT� 58340","","Inject Hysterosalpingography","BOTH IP/OP","$1,109.00 ","$820.66 ","$0.00 ","$1,109.00 ","$1,109.00 ","$0.00 ","$231.14 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$1,055.00 ","$835.56 ","$844.00 ","$0.00 ","$214.45 ","$59.48 ","$167.96 ","$0.00 "
"36100990","EAP","CPT� 58345","","Transcervical Intro Of Cathete","BOTH IP/OP","$6,236.00 ","$4,614.64 ","$0.00 ","$6,236.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,236.00 ","$0.00 ","$2,255.00 ","$4,938.91 ","$4,988.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100991","EAP","CPT� 58558","","Hysteroscopy, Biopsy","BOTH IP/OP","$5,957.00 ","$4,408.18 ","$0.00 ","$5,665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,665.00 ","$0.00 ","$2,858.00 ","$4,486.68 ","$4,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36100993","EAP","CPT� 59000","","Amniocentesis Us","BOTH IP/OP","$1,106.00 ","$818.44 ","$83.99 ","$1,117.00 ","$1,106.00 ","$620.86 ","$230.52 ","$1,117.00 ","$1,117.00 ","$195.58 ","$1,117.00 ","$640.34 ","$1,117.00 ","$884.66 ","$893.60 ","$889.66 ","$95.25 ","$83.99 ","$177.83 ","$609.84 "
"36100999","EAP","CPT� 59200","","Insert Cervical Dilator","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$768.00 ","$0.00 ","$768.00 ","$608.26 ","$614.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101000","EAP","CPT� 59300","","Episitomy/vaginal Repair","BOTH IP/OP","$6,453.00 ","$4,775.22 ","$0.00 ","$9,291.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,291.00 ","$0.00 ","$2,327.00 ","$7,358.47 ","$7,432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101001","EAP","CPT� 59414","","Delivery Of Placenta","BOTH IP/OP","$6,078.00 ","$4,497.72 ","$0.00 ","$6,078.00 ","$3,300.35 ","$2,569.43 ","$1,266.81 ","$0.00 ","$0.00 ","$0.00 ","$6,078.00 ","$0.00 ","$2,255.00 ","$4,813.78 ","$4,862.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101002","EAP","CPT� 59525","","Remove Uterus After Cesarean","BOTH IP/OP","$7,130.00 ","$5,276.20 ","$0.00 ","$8,801.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,801.00 ","$0.00 ","$2,255.00 ","$6,970.39 ","$7,040.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101003","EAP","CPT� 59812","","Trtmt Of Spontaneous Abortion","BOTH IP/OP","$3,629.00 ","$2,685.46 ","$267.54 ","$3,666.00 ","$3,629.00 ","$2,569.43 ","$756.37 ","$2,616.42 ","$2,616.42 ","$641.89 ","$3,666.00 ","$2,505.44 ","$3,666.00 ","$2,903.47 ","$2,932.80 ","$3,480.98 ","$267.54 ","$316.83 ","$583.63 ","$2,386.14 "
"36101004","EAP","CPT� 59820","","Trmt Of Missed Abort.-1st Trim","BOTH IP/OP","$3,769.00 ","$2,789.06 ","$0.00 ","$3,807.00 ","$3,769.00 ","$2,569.43 ","$785.55 ","$0.00 ","$0.00 ","$0.00 ","$3,807.00 ","$0.00 ","$3,807.00 ","$3,015.14 ","$3,045.60 ","$0.00 ","$302.12 ","$0.00 ","$0.00 ","$0.00 "
"36101005","EAP","CPT� 59840","","Ind/abortion/dilation&curettag","BOTH IP/OP","$3,706.00 ","$2,742.44 ","$0.00 ","$3,743.00 ","$3,706.00 ","$2,569.43 ","$772.42 ","$0.00 ","$0.00 ","$0.00 ","$3,743.00 ","$0.00 ","$3,743.00 ","$2,964.46 ","$2,994.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101007","EAP","CPT� 59855","","Abortion By Vag. Sup. Insert","BOTH IP/OP","$1,807.00 ","$1,337.18 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$1,825.00 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101008","EAP","CPT� 59855","","Induced Abortion After 16 Wks","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$1,825.00 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101009","EAP","CPT� 59871","","Removal Ceralage Suture","BOTH IP/OP","$3,549.00 ","$2,626.26 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$3,585.00 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101010","EAP","CPT� 59871","","Remove Cerclage Suture","BOTH IP/OP","$3,549.00 ","$2,626.26 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$3,585.00 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101011","EAP","CPT� 60100","","BX THYROID PERC NEEDLE BCT","BOTH IP/OP","$760.00 ","$562.40 ","$81.14 ","$760.00 ","$760.00 ","$609.42 ","$158.40 ","$760.00 ","$760.00 ","$133.07 ","$760.00 ","$611.80 ","$760.00 ","$601.92 ","$608.00 ","$760.00 ","$93.18 ","$81.14 ","$120.99 ","$582.67 "
"36101012","EAP","CPT� 60100","","Bx Thyroid Us","BOTH IP/OP","$762.00 ","$563.88 ","$81.14 ","$762.00 ","$762.00 ","$609.42 ","$158.82 ","$760.00 ","$760.00 ","$133.07 ","$760.00 ","$611.80 ","$760.00 ","$601.92 ","$608.00 ","$760.00 ","$93.18 ","$81.14 ","$120.99 ","$582.67 "
"36101013","EAP","CPT� 60100","","Thyroid Biopsy Perc Needle","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$760.00 ","$0.00 ","$0.00 ","$158.40 ","$760.00 ","$760.00 ","$133.07 ","$760.00 ","$611.80 ","$760.00 ","$601.92 ","$608.00 ","$760.00 ","$93.18 ","$81.14 ","$120.99 ","$582.67 "
"36101015","EAP","CPT� 61070","","PUNCT SHUNT TUBE/RESERVO BCT","BOTH IP/OP","$2,212.00 ","$1,636.88 ","$0.00 ","$2,271.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,271.00 ","$0.00 ","$2,255.00 ","$1,798.63 ","$1,816.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101016","EAP","CPT� 61624","","EMBOLIZA INTRACRAN/SP CORD SPN","BOTH IP/OP","$12,218.00 ","$9,041.32 ","$0.00 ","$11,291.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,291.00 ","$0.00 ","$2,255.00 ","$8,942.47 ","$9,032.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101019","EAP","CPT� 61626","","Embolization Extracranial","BOTH IP/OP","$27,904.00 ","$20,648.96 ","$0.00 ","$25,787.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,787.00 ","$0.00 ","$6,105.00 ","$20,423.30 ","$20,629.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101020","EAP","CPT� 61630","","Intracranial Angioplasty","BOTH IP/OP","$20,055.00 ","$14,840.70 ","$0.00 ","$18,533.00 ","$0.00 ","$0.00 ","$0.00 ","$13,227.00 ","$5,416.74 ","$3,244.98 ","$18,533.00 ","$1,522.96 ","$9,266.50 ","$14,678.14 ","$14,826.40 ","$1,424.57 ","$2,900.41 ","$1,424.57 ","$2,950.45 ","$1,424.57 "
"36101021","EAP","CPT� 61635","","Intracran Angioplasty W/stent","BOTH IP/OP","$31,953.00 ","$23,645.22 ","$0.00 ","$29,529.00 ","$0.00 ","$0.00 ","$0.00 ","$21,074.85 ","$5,416.74 ","$5,170.29 ","$29,529.00 ","$1,621.20 ","$14,764.50 ","$23,386.97 ","$23,623.20 ","$1,514.43 ","$1,268.01 ","$1,514.43 ","$4,701.02 ","$1,514.43 "
"36101022","EAP","CPT� 61640","","Dilate Ic Vasospasm, Init","BOTH IP/OP","$30,077.00 ","$22,256.98 ","$0.00 ","$27,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,795.00 ","$0.00 ","$13,897.50 ","$22,013.64 ","$22,236.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101023","EAP","CPT� 61642","","Dilate Ic Vasospasm Add-on","BOTH IP/OP","$26,318.00 ","$19,475.32 ","$0.00 ","$24,321.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,321.00 ","$0.00 ","$12,160.50 ","$19,262.23 ","$19,456.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101024","EAP","CPT� 61710","","Emblz Carotid Cavern Fistula","BOTH IP/OP","$13,680.00 ","$10,123.20 ","$0.00 ","$14,044.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,044.00 ","$0.00 ","$3,902.00 ","$11,122.85 ","$11,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101025","EAP","CPT� 62268","","SPINAL CORD CYST PERC ASPI BCT","BOTH IP/OP","$3,101.00 ","$2,294.74 ","$0.00 ","$3,094.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,094.00 ","$0.00 ","$2,255.00 ","$2,450.45 ","$2,475.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101026","EAP","CPT� 62269","","BX SPINAL CORD PERC NEEDLE BCT","BOTH IP/OP","$3,394.00 ","$2,511.56 ","$0.00 ","$3,386.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,386.00 ","$0.00 ","$2,255.00 ","$2,681.71 ","$2,708.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101027","EAP","CPT� 62270","","Dx Lumbar Puncture W/o Imaging","BOTH IP/OP","$835.00 ","$617.90 ","$64.55 ","$835.00 ","$835.00 ","$621.87 ","$174.03 ","$635.00 ","$635.00 ","$111.18 ","$635.00 ","$626.89 ","$635.00 ","$502.92 ","$508.00 ","$635.00 ","$120.04 ","$64.55 ","$101.09 ","$597.04 "
"36101032","EAP","CPT� 62272","","Therapeutic Lumbar Puncture W/o Imaging","BOTH IP/OP","$923.00 ","$683.02 ","$0.00 ","$923.00 ","$923.00 ","$621.87 ","$192.38 ","$0.00 ","$0.00 ","$0.00 ","$877.00 ","$0.00 ","$877.00 ","$694.58 ","$701.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101033","EAP","CPT� 55876","","Placement Of Prostate Fiducial Markers","BOTH IP/OP","$3,543.00 ","$2,621.82 ","$104.92 ","$3,534.00 ","$2,321.55 ","$1,236.66 ","$738.45 ","$2,522.22 ","$2,522.22 ","$618.78 ","$3,534.00 ","$1,249.00 ","$2,255.00 ","$2,798.93 ","$2,827.20 ","$1,735.32 ","$138.46 ","$104.92 ","$562.61 ","$1,189.52 "
"36101039","EAP","CPT� 62273","","Injection Epidural Blood Patch","BOTH IP/OP","$1,679.00 ","$1,242.46 ","$0.00 ","$1,596.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$279.45 ","$1,596.00 ","$626.89 ","$1,596.00 ","$1,264.03 ","$1,276.80 ","$870.98 ","$123.36 ","$117.56 ","$254.08 ","$597.04 "
"36101040","EAP","CPT� 62280","","Inject Subarachnoid Neurolytic","BOTH IP/OP","$1,845.00 ","$1,365.30 ","$0.00 ","$1,845.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,845.00 ","$0.00 ","$1,845.00 ","$1,461.24 ","$1,476.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101041","EAP","CPT� 62282","","Epidur Lumbar Sacral Neurolyti","BOTH IP/OP","$1,751.00 ","$1,295.74 ","$0.00 ","$1,751.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,751.00 ","$0.00 ","$1,751.00 ","$1,386.79 ","$1,400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101042","EAP","CPT� 62284","","Injection Myelo/ct Spinal","BOTH IP/OP","$1,572.00 ","$1,163.28 ","$0.00 ","$1,572.00 ","$1,572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$261.59 ","$1,494.00 ","$0.00 ","$1,494.00 ","$1,183.25 ","$1,195.20 ","$0.00 ","$158.11 ","$90.14 ","$237.84 ","$0.00 "
"36101043","EAP","CPT� 62287","","Aspir Perc Diskectomy","BOTH IP/OP","$6,339.00 ","$4,690.86 ","$0.00 ","$6,339.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,339.00 ","$0.00 ","$6,105.00 ","$5,020.49 ","$5,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101044","EAP","CPT� 62290","","Inject Diskography Ea Lev Lumb","BOTH IP/OP","$2,963.00 ","$2,192.62 ","$0.00 ","$2,963.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,963.00 ","$0.00 ","$2,327.00 ","$2,346.70 ","$2,370.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101045","EAP","CPT� 62291","","Inject Diskography Ea Lev Cerv","BOTH IP/OP","$2,594.00 ","$1,919.56 ","$0.00 ","$2,594.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,594.00 ","$0.00 ","$2,255.00 ","$2,054.45 ","$2,075.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101048","EAP","CPT� 63650","","Implant Neuroelectrodes","BOTH IP/OP","$16,380.00 ","$12,121.20 ","$0.00 ","$16,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,380.00 ","$0.00 ","$2,327.00 ","$12,972.96 ","$13,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101049","EAP","CPT� 64408","","Inj Anes/strd Cranial/vagus Nerve","BOTH IP/OP","$1,831.00 ","$1,354.94 ","$0.00 ","$2,005.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,005.00 ","$0.00 ","$2,005.00 ","$1,587.96 ","$1,604.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101051","EAP","CPT� 64425","","Inj Anes/strd Ilioinguinal/iliohypogastric Nerve","BOTH IP/OP","$3,566.00 ","$2,638.84 ","$0.00 ","$3,441.00 ","$2,321.55 ","$621.87 ","$743.24 ","$2,455.84 ","$2,455.84 ","$602.49 ","$3,441.00 ","$626.89 ","$2,255.00 ","$2,725.27 ","$2,752.80 ","$870.98 ","$0.00 ","$57.69 ","$547.81 ","$597.04 "
"36101052","EAP","CPT� 64450","","Inj Anes/strd Other Peripheral Nerve","BOTH IP/OP","$2,850.00 ","$2,109.00 ","$44.35 ","$2,750.00 ","$2,321.55 ","$621.87 ","$594.01 ","$1,962.68 ","$1,962.68 ","$481.50 ","$2,750.00 ","$626.89 ","$2,255.00 ","$2,178.00 ","$2,200.00 ","$870.98 ","$85.27 ","$44.35 ","$437.80 ","$597.04 "
"36101059","EAP","CPT� 64483","","Inject Anest Txforamen L/s Sng","BOTH IP/OP","$1,767.00 ","$1,307.58 ","$115.74 ","$1,767.00 ","$1,767.00 ","$806.18 ","$368.29 ","$1,216.86 ","$1,216.86 ","$298.53 ","$1,705.00 ","$814.44 ","$1,705.00 ","$1,350.36 ","$1,364.00 ","$1,131.55 ","$197.93 ","$115.74 ","$271.44 ","$775.65 "
"36101061","EAP","CPT� 64484","","Transfor Inj Lum/sac Addt Spn","BOTH IP/OP","$1,767.00 ","$1,307.58 ","$0.00 ","$1,767.00 ","$1,767.00 ","$0.00 ","$368.29 ","$1,216.86 ","$1,216.86 ","$298.53 ","$1,705.00 ","$0.00 ","$1,705.00 ","$1,350.36 ","$1,364.00 ","$0.00 ","$183.06 ","$54.09 ","$271.44 ","$0.00 "
"36101062","EAP","CPT� 64520","","Inject Anest Lumbar Thoracic","BOTH IP/OP","$5,436.00 ","$4,022.64 ","$0.00 ","$5,245.00 ","$2,321.55 ","$806.18 ","$1,133.00 ","$0.00 ","$0.00 ","$918.36 ","$5,245.00 ","$0.00 ","$2,255.00 ","$4,154.04 ","$4,196.00 ","$0.00 ","$125.32 ","$0.00 ","$0.00 ","$0.00 "
"36101064","EAP","CPT� 64530","","N Block Inj, Celiac Pelus","BOTH IP/OP","$8,849.00 ","$6,548.26 ","$0.00 ","$8,538.00 ","$2,321.55 ","$806.18 ","$1,844.35 ","$0.00 ","$0.00 ","$0.00 ","$8,538.00 ","$0.00 ","$2,255.00 ","$6,762.10 ","$6,830.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101065","EAP","CPT� 64612","","Chemodenerve Mus Inv Fac Nerve","BOTH IP/OP","$728.00 ","$538.72 ","$0.00 ","$732.00 ","$728.00 ","$255.86 ","$151.73 ","$0.00 ","$0.00 ","$128.17 ","$732.00 ","$262.54 ","$732.00 ","$579.74 ","$585.60 ","$364.76 ","$151.15 ","$120.74 ","$116.53 ","$250.04 "
"36101070","EAP","CPT� 64640","","Destr Peripheral Nerve","BOTH IP/OP","$2,501.00 ","$1,850.74 ","$0.00 ","$2,501.00 ","$0.00 ","$0.00 ","$0.00 ","$1,784.96 ","$1,784.96 ","$437.91 ","$2,501.00 ","$814.44 ","$2,255.00 ","$1,980.79 ","$2,000.80 ","$1,131.55 ","$198.96 ","$121.87 ","$398.16 ","$775.65 "
"36101072","EAP","CPT� 64680","","Destr Neurolyitc Celiac Plexus","BOTH IP/OP","$4,672.00 ","$3,457.28 ","$0.00 ","$4,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,672.00 ","$0.00 ","$2,327.00 ","$3,700.22 ","$3,737.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101075","EAP","CPT� 65205","","Fb Removal, Eye","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.00 ","$0.00 ","$382.00 ","$302.54 ","$305.60 ","$0.00 ","$132.91 ","$0.00 ","$0.00 ","$0.00 "
"36101076","EAP","CPT� 65205","","Remove Fb Eye Conj Superficial","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.00 ","$0.00 ","$382.00 ","$302.54 ","$305.60 ","$0.00 ","$132.91 ","$0.00 ","$0.00 ","$0.00 "
"36101077","EAP","CPT� 65222","","Remove Fb Eye Corneal W/sl","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$808.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101078","EAP","CPT� 65270","","Repair Laceration Conjunctiva","BOTH IP/OP","$4,186.00 ","$3,097.64 ","$0.00 ","$4,226.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,226.00 ","$0.00 ","$2,327.00 ","$3,346.99 ","$3,380.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101079","EAP","CPT� 65275","","Rpr Lacer Cornea Non-perfor","BOTH IP/OP","$8,972.00 ","$6,639.28 ","$0.00 ","$9,059.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,059.00 ","$0.00 ","$3,606.00 ","$7,174.73 ","$7,247.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101080","EAP","CPT� 65286","","Cornea Sclera Wound Tissue Glu","BOTH IP/OP","$3,275.00 ","$2,423.50 ","$433.21 ","$3,307.00 ","$2,753.10 ","$2,033.69 ","$682.59 ","$2,360.21 ","$2,360.21 ","$579.03 ","$3,307.00 ","$2,027.80 ","$2,255.00 ","$2,619.14 ","$2,645.60 ","$2,817.36 ","$433.21 ","$506.49 ","$526.47 ","$1,931.24 "
"36101081","EAP","CPT� 65290","","Repair Wound Extraocular Muscl","BOTH IP/OP","$4,425.00 ","$3,274.50 ","$0.00 ","$5,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,408.00 ","$0.00 ","$2,858.00 ","$4,283.14 ","$4,326.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101082","EAP","CPT� 65400","","Excise Lesn Cornea Not Pterygm","BOTH IP/OP","$5,997.00 ","$4,437.78 ","$0.00 ","$6,055.00 ","$2,321.55 ","$793.07 ","$1,249.92 ","$0.00 ","$0.00 ","$0.00 ","$6,055.00 ","$0.00 ","$2,255.00 ","$4,795.56 ","$4,844.00 ","$0.00 ","$484.61 ","$0.00 ","$0.00 ","$0.00 "
"36101083","EAP","CPT� 65410","","Biopsy Of Cornea","BOTH IP/OP","$3,307.00 ","$2,447.18 ","$0.00 ","$3,307.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,307.00 ","$0.00 ","$2,327.00 ","$2,619.14 ","$2,645.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101084","EAP","CPT� 65420","","Excise Pterygium W/o Graft","BOTH IP/OP","$2,706.00 ","$2,002.44 ","$0.00 ","$3,307.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,307.00 ","$0.00 ","$2,327.00 ","$2,619.14 ","$2,645.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101085","EAP","CPT� 65430","","Scraping Cornea Diagnostic","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$530.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101086","EAP","CPT� 65772","","Relax Cornea Incision Astigmat","BOTH IP/OP","$4,930.00 ","$3,648.20 ","$0.00 ","$6,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,025.00 ","$0.00 ","$3,606.00 ","$4,771.80 ","$4,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101087","EAP","CPT� 65800","","Paracentesis Ant Chamb Eye Wdx","BOTH IP/OP","$4,717.00 ","$3,490.58 ","$0.00 ","$4,717.00 ","$0.00 ","$0.00 ","$973.76 ","$3,366.52 ","$3,366.52 ","$825.91 ","$4,717.00 ","$2,027.80 ","$2,255.00 ","$3,735.86 ","$3,773.60 ","$2,817.36 ","$0.00 ","$93.03 ","$750.95 ","$1,931.24 "
"36101089","EAP","CPT� 65815","","Eye Paracentesis Ant Blood Rem","BOTH IP/OP","$7,374.00 ","$5,456.76 ","$0.00 ","$9,011.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,011.00 ","$0.00 ","$2,327.00 ","$7,136.71 ","$7,208.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101090","EAP","CPT� 65855","","Trabeculoplasty By Laser","BOTH IP/OP","$2,930.00 ","$2,168.20 ","$211.62 ","$2,960.00 ","$2,753.10 ","$492.86 ","$610.69 ","$2,472.24 ","$2,472.24 ","$518.27 ","$2,960.00 ","$508.42 ","$2,255.00 ","$2,344.32 ","$2,368.00 ","$706.38 ","$354.58 ","$211.62 ","$471.23 ","$484.21 "
"36101091","EAP","CPT� 65860","","Incise Inner Eye Adhesions","BOTH IP/OP","$1,369.00 ","$1,013.06 ","$0.00 ","$1,475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,475.00 ","$0.00 ","$1,475.00 ","$1,168.20 ","$1,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101092","EAP","CPT� 66250","","Repair Operative Wound Ant Eye","BOTH IP/OP","$3,567.00 ","$2,639.58 ","$0.00 ","$3,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,567.00 ","$0.00 ","$2,327.00 ","$2,825.06 ","$2,853.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101093","EAP","CPT� 66710","","Destruction Ciliary Body","BOTH IP/OP","$4,407.00 ","$3,261.18 ","$399.78 ","$4,452.00 ","$2,753.10 ","$1,959.70 ","$918.53 ","$3,177.39 ","$3,177.39 ","$779.51 ","$4,452.00 ","$1,940.89 ","$2,327.00 ","$3,525.98 ","$3,561.60 ","$2,696.60 ","$412.49 ","$399.78 ","$708.76 ","$1,848.46 "
"36101094","EAP","CPT� 66710","","Transscleral Cyclophotocoagula","BOTH IP/OP","$4,407.00 ","$3,261.18 ","$399.78 ","$4,452.00 ","$2,753.10 ","$1,959.70 ","$918.53 ","$3,177.39 ","$3,177.39 ","$779.51 ","$4,452.00 ","$1,940.89 ","$2,327.00 ","$3,525.98 ","$3,561.60 ","$2,696.60 ","$412.49 ","$399.78 ","$708.76 ","$1,848.46 "
"36101095","EAP","CPT� 66720","","Destroy Ciliary Body Cryother","BOTH IP/OP","$2,644.00 ","$1,956.56 ","$0.00 ","$2,723.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,723.00 ","$0.00 ","$2,327.00 ","$2,156.62 ","$2,178.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101096","EAP","CPT� 66761","","Iridotomy Laser Surgery","BOTH IP/OP","$7,642.00 ","$5,655.08 ","$240.80 ","$7,719.00 ","$2,321.55 ","$492.86 ","$1,592.78 ","$5,509.05 ","$5,416.74 ","$1,351.54 ","$7,719.00 ","$508.42 ","$2,255.00 ","$6,113.45 ","$6,175.20 ","$706.38 ","$315.03 ","$240.80 ","$1,228.86 ","$484.21 "
"36101097","EAP","CPT� 66762","","Iridoplasty Photocoagulation","BOTH IP/OP","$1,046.00 ","$774.04 ","$0.00 ","$1,057.00 ","$0.00 ","$0.00 ","$0.00 ","$1,057.00 ","$1,057.00 ","$185.07 ","$1,057.00 ","$508.42 ","$1,057.00 ","$837.14 ","$845.60 ","$706.38 ","$348.17 ","$432.93 ","$168.27 ","$484.21 "
"36101098","EAP","CPT� 66821","","Yag Laser Capsulotomy","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$188.16 ","$2,146.00 ","$2,125.00 ","$492.86 ","$442.90 ","$1,531.60 ","$1,531.60 ","$375.75 ","$2,146.00 ","$508.42 ","$2,146.00 ","$1,699.63 ","$1,716.80 ","$706.38 ","$188.16 ","$317.54 ","$341.64 ","$484.21 "
"36101099","EAP","CPT� 67015","","Posterior Sclerotomy","BOTH IP/OP","$15,938.00 ","$11,794.12 ","$0.00 ","$15,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,938.00 ","$0.00 ","$2,255.00 ","$12,622.90 ","$12,750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101100","EAP","CPT� 67025","","Inject Vitreous Pars Pla/limbl","BOTH IP/OP","$8,619.00 ","$6,378.06 ","$643.81 ","$8,706.00 ","$2,321.55 ","$2,033.69 ","$1,796.42 ","$6,213.47 ","$5,416.74 ","$1,524.35 ","$8,706.00 ","$2,027.80 ","$2,255.00 ","$6,895.15 ","$6,964.80 ","$2,817.36 ","$651.56 ","$643.81 ","$1,386.00 ","$1,931.24 "
"36101101","EAP","CPT� 67028","","Injection Intravitreal Drug","BOTH IP/OP","$2,178.00 ","$1,611.72 ","$100.58 ","$2,200.00 ","$2,178.00 ","$312.26 ","$453.95 ","$1,570.14 ","$1,570.14 ","$385.20 ","$2,200.00 ","$310.51 ","$2,200.00 ","$1,742.40 ","$1,760.00 ","$431.41 ","$307.74 ","$100.58 ","$350.24 ","$295.72 "
"36101102","EAP","CPT� 67031","","Sever Vitreous, Laser","BOTH IP/OP","$2,310.00 ","$1,709.40 ","$0.00 ","$2,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,310.00 ","$0.00 ","$2,310.00 ","$1,829.52 ","$1,848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101103","EAP","CPT� 67101","","Retinal Detach Rpr Cryo/diath","BOTH IP/OP","$7,769.00 ","$5,749.06 ","$0.00 ","$7,847.00 ","$3,735.90 ","$2,033.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,847.00 ","$0.00 ","$2,255.00 ","$6,214.82 ","$6,277.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101104","EAP","CPT� 67105","","Repair Retinal Detach Laser","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,387.00 ","$1,373.00 ","$492.86 ","$286.17 ","$0.00 ","$0.00 ","$0.00 ","$1,387.00 ","$0.00 ","$1,387.00 ","$1,098.50 ","$1,109.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101105","EAP","CPT� 67141","","Cryotherapy Retinal Tear","BOTH IP/OP","$1,917.00 ","$1,418.58 ","$0.00 ","$1,917.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.00 ","$0.00 ","$1,917.00 ","$1,518.26 ","$1,533.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101106","EAP","CPT� 67145","","Photocoagulation Retinal Tear","BOTH IP/OP","$1,043.00 ","$771.82 ","$0.00 ","$1,054.00 ","$1,043.00 ","$492.86 ","$217.39 ","$0.00 ","$0.00 ","$184.55 ","$1,054.00 ","$508.42 ","$1,054.00 ","$834.77 ","$843.20 ","$706.38 ","$412.94 ","$506.47 ","$167.80 ","$484.21 "
"36101107","EAP","CPT� 67208","","Destroy Lesion Retina Cryo/dia","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$0.00 ","$4,956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,956.00 ","$0.00 ","$2,255.00 ","$3,925.15 ","$3,964.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101108","EAP","CPT� 67210","","Destroy Lesion Retina Photocoa","BOTH IP/OP","$1,009.00 ","$746.66 ","$0.00 ","$1,019.00 ","$1,009.00 ","$492.86 ","$210.30 ","$0.00 ","$0.00 ","$0.00 ","$1,019.00 ","$0.00 ","$1,019.00 ","$807.05 ","$815.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101109","EAP","CPT� 67220","","Destr Choroid Lesion Phoptocoa","BOTH IP/OP","$1,514.00 ","$1,120.36 ","$0.00 ","$1,514.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,514.00 ","$0.00 ","$1,514.00 ","$1,199.09 ","$1,211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101110","EAP","CPT� 67227","","Destroy Retinopathy Cryo/diath","BOTH IP/OP","$4,468.00 ","$3,306.32 ","$0.00 ","$4,468.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,468.00 ","$0.00 ","$2,255.00 ","$3,538.66 ","$3,574.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101111","EAP","CPT� 67228","","Destroy Retinopathy Photocoag","BOTH IP/OP","$7,387.00 ","$5,466.38 ","$311.48 ","$7,462.00 ","$2,321.55 ","$492.86 ","$1,539.64 ","$5,325.63 ","$5,325.63 ","$1,306.54 ","$7,462.00 ","$508.42 ","$2,255.00 ","$5,909.90 ","$5,969.60 ","$706.38 ","$821.55 ","$311.48 ","$1,187.95 ","$484.21 "
"36101112","EAP","CPT� 67335","","Place Adjust Suture Strabismus","BOTH IP/OP","$6,484.00 ","$4,798.16 ","$0.00 ","$6,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,484.00 ","$0.00 ","$3,606.00 ","$5,135.33 ","$5,187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101113","EAP","CPT� 67345","","Chemodenerv Extraocular Muscle","BOTH IP/OP","$846.00 ","$626.04 ","$0.00 ","$851.00 ","$846.00 ","$256.18 ","$176.33 ","$0.00 ","$0.00 ","$0.00 ","$851.00 ","$0.00 ","$851.00 ","$673.99 ","$680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101114","EAP","CPT� 67415","","Fna Orbital Contents","BOTH IP/OP","$11,904.00 ","$8,808.96 ","$0.00 ","$11,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,904.00 ","$0.00 ","$2,255.00 ","$9,427.97 ","$9,523.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101115","EAP","CPT� 67500","","Inject Medication Retrobulbar","BOTH IP/OP","$703.00 ","$520.22 ","$0.00 ","$639.00 ","$381.73 ","$256.18 ","$146.52 ","$0.00 ","$0.00 ","$111.88 ","$639.00 ","$271.28 ","$639.00 ","$506.09 ","$511.20 ","$376.91 ","$179.43 ","$62.75 ","$101.73 ","$258.37 "
"36101116","EAP","CPT� 67505","","Inject Alcohol Retrobulbar","BOTH IP/OP","$843.00 ","$623.82 ","$0.00 ","$843.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$843.00 ","$0.00 ","$843.00 ","$667.66 ","$674.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101117","EAP","CPT� 67515","","Inject Medication Tenon's Caps","BOTH IP/OP","$2,002.00 ","$1,481.48 ","$0.00 ","$1,820.00 ","$0.00 ","$0.00 ","$417.27 ","$1,298.93 ","$1,298.93 ","$318.67 ","$1,820.00 ","$271.28 ","$1,820.00 ","$1,441.44 ","$1,456.00 ","$376.91 ","$137.37 ","$60.20 ","$289.74 ","$258.37 "
"36101118","EAP","CPT� 67700","","Blepharotomy Eyelid","BOTH IP/OP","$1,339.00 ","$990.86 ","$0.00 ","$1,339.00 ","$0.00 ","$0.00 ","$279.08 ","$0.00 ","$0.00 ","$0.00 ","$1,339.00 ","$0.00 ","$1,339.00 ","$1,060.49 ","$1,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101119","EAP","CPT� 67710","","Severing Of Tarsorrhaphy","BOTH IP/OP","$2,216.00 ","$1,639.84 ","$0.00 ","$2,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,216.00 ","$0.00 ","$2,216.00 ","$1,755.07 ","$1,772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101120","EAP","CPT� 67715","","Canthotomy","BOTH IP/OP","$9,511.00 ","$7,038.14 ","$0.00 ","$9,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,546.00 ","$0.00 ","$2,255.00 ","$7,560.43 ","$7,636.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101121","EAP","CPT� 67800","","Excise Chalazion Single","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,339.00 ","$1,334.00 ","$256.18 ","$0.00 ","$0.00 ","$0.00 ","$234.45 ","$1,339.00 ","$271.28 ","$1,339.00 ","$1,060.49 ","$1,071.20 ","$376.91 ","$174.52 ","$104.90 ","$213.17 ","$258.37 "
"36101122","EAP","CPT� 67801","","Excise Chalazion Multiple","BOTH IP/OP","$2,208.00 ","$1,633.92 ","$0.00 ","$2,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,216.00 ","$0.00 ","$2,216.00 ","$1,755.07 ","$1,772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101123","EAP","CPT� 67805","","Excise Chalazion,mult,diff Lid","BOTH IP/OP","$1,668.00 ","$1,234.32 ","$0.00 ","$1,674.00 ","$1,668.00 ","$256.18 ","$347.65 ","$0.00 ","$0.00 ","$0.00 ","$1,674.00 ","$0.00 ","$1,674.00 ","$1,325.81 ","$1,339.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101124","EAP","CPT� 67810","","Biopsy Of Eyelid","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.06 ","$1,154.00 ","$271.28 ","$1,154.00 ","$913.97 ","$923.20 ","$376.91 ","$152.92 ","$72.11 ","$183.72 ","$258.37 "
"36101125","EAP","CPT� 67825","","Correct Trichiasis Electrosurg","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,154.00 ","$0.00 ","$1,154.00 ","$913.97 ","$923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101126","EAP","CPT� 67840","","Excise Lesion Eyelid Smpl Clos","BOTH IP/OP","$2,572.00 ","$1,903.28 ","$160.78 ","$2,581.00 ","$2,572.00 ","$793.07 ","$536.07 ","$1,842.06 ","$1,842.06 ","$451.91 ","$2,581.00 ","$809.34 ","$2,255.00 ","$2,044.15 ","$2,064.80 ","$1,124.47 ","$209.29 ","$160.78 ","$410.90 ","$770.80 "
"36101127","EAP","CPT� 67875","","Temporary Tarsorraphy","BOTH IP/OP","$3,736.00 ","$2,764.64 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$778.68 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$2,255.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101128","EAP","CPT� 67880","","Construct Intemar Adhes Etc.","BOTH IP/OP","$7,543.00 ","$5,581.82 ","$0.00 ","$7,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,570.00 ","$0.00 ","$2,858.00 ","$5,995.44 ","$6,056.00 ","$0.00 ","$389.90 ","$0.00 ","$0.00 ","$0.00 "
"36101129","EAP","CPT� 67909","","Reduce Ptosis Overcorrection","BOTH IP/OP","$9,164.00 ","$6,781.36 ","$0.00 ","$9,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,164.00 ","$0.00 ","$3,606.00 ","$7,257.89 ","$7,331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101130","EAP","CPT� 67914","","Repair Ectropion By Suture","BOTH IP/OP","$5,265.00 ","$3,896.10 ","$0.00 ","$5,284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,284.00 ","$0.00 ","$2,858.00 ","$4,184.93 ","$4,227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101131","EAP","CPT� 67916","","Rpr Ectropion, Blephar Tarsal","BOTH IP/OP","$9,164.00 ","$6,781.36 ","$0.00 ","$9,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,164.00 ","$0.00 ","$3,606.00 ","$7,257.89 ","$7,331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101132","EAP","CPT� 67921","","Repair Entropion By Suture","BOTH IP/OP","$5,284.00 ","$3,910.16 ","$0.00 ","$5,284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,284.00 ","$0.00 ","$2,858.00 ","$4,184.93 ","$4,227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101133","EAP","CPT� 67923","","Rpr Entropion, Blephar Tarsal","BOTH IP/OP","$9,164.00 ","$6,781.36 ","$0.00 ","$9,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,164.00 ","$0.00 ","$3,606.00 ","$7,257.89 ","$7,331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101134","EAP","CPT� 67924","","Rpr Entropion, Blephar Extnsv","BOTH IP/OP","$9,164.00 ","$6,781.36 ","$0.00 ","$9,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,164.00 ","$0.00 ","$3,606.00 ","$7,257.89 ","$7,331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101135","EAP","CPT� 67930","","Suture Wound Eyelid Partial Th","BOTH IP/OP","$5,476.00 ","$4,052.24 ","$0.00 ","$5,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,496.00 ","$0.00 ","$2,255.00 ","$4,352.83 ","$4,396.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101136","EAP","CPT� 67935","","Suture Wound Eyelid Full Thick","BOTH IP/OP","$10,632.00 ","$7,867.68 ","$0.00 ","$10,671.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,671.00 ","$0.00 ","$2,327.00 ","$8,451.43 ","$8,536.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101138","EAP","CPT� 67938","","Remove Foreign Body Eyelid","BOTH IP/OP","$1,204.00 ","$890.96 ","$0.00 ","$1,208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.00 ","$0.00 ","$1,208.00 ","$956.74 ","$966.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101139","EAP","CPT� 67950","","Canthoplasty","BOTH IP/OP","$9,333.00 ","$6,906.42 ","$0.00 ","$9,427.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,427.00 ","$0.00 ","$2,327.00 ","$7,466.18 ","$7,541.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101140","EAP","CPT� 68020","","I & D Conjunctiva Cyst","BOTH IP/OP","$3,391.00 ","$2,509.34 ","$0.00 ","$3,391.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,391.00 ","$0.00 ","$2,255.00 ","$2,685.67 ","$2,712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101141","EAP","CPT� 68100","","Biopsy Of Conjunctiva","BOTH IP/OP","$2,389.00 ","$1,767.86 ","$0.00 ","$2,371.00 ","$2,321.55 ","$1,959.70 ","$497.93 ","$0.00 ","$0.00 ","$0.00 ","$2,371.00 ","$0.00 ","$2,255.00 ","$1,877.83 ","$1,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101142","EAP","CPT� 68110","","Excise Lesion Conjunctiva <1 C","BOTH IP/OP","$4,701.00 ","$3,478.74 ","$0.00 ","$4,665.00 ","$0.00 ","$0.00 ","$979.81 ","$0.00 ","$0.00 ","$0.00 ","$4,665.00 ","$0.00 ","$2,255.00 ","$3,694.68 ","$3,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101143","EAP","CPT� 68110","","Incision Conjunctival Lesion","BOTH IP/OP","$4,701.00 ","$3,478.74 ","$0.00 ","$4,665.00 ","$0.00 ","$0.00 ","$979.81 ","$0.00 ","$0.00 ","$0.00 ","$4,665.00 ","$0.00 ","$2,255.00 ","$3,694.68 ","$3,732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101144","EAP","CPT� 68115","","Excise Lesion Conjunctiva >1 C","BOTH IP/OP","$5,304.00 ","$3,924.96 ","$0.00 ","$5,304.00 ","$0.00 ","$0.00 ","$1,114.03 ","$0.00 ","$0.00 ","$0.00 ","$5,304.00 ","$0.00 ","$2,327.00 ","$4,200.77 ","$4,243.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101145","EAP","CPT� 68200","","Injection Subconjunctiva","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$262.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.00 ","$0.00 ","$262.00 ","$207.50 ","$209.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101146","EAP","CPT� 68400","","I & D Lacrimal Gland","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$850.00 ","$0.00 ","$850.00 ","$673.20 ","$680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101147","EAP","CPT� 68420","","I & D Lacrimal Sac","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,029.00 ","$0.00 ","$2,255.00 ","$2,398.97 ","$2,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101148","EAP","CPT� 68440","","Snip Incision Lacrimal Punctum","BOTH IP/OP","$661.00 ","$489.14 ","$0.00 ","$661.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.00 ","$0.00 ","$661.00 ","$523.51 ","$528.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101149","EAP","CPT� 68510","","Biopsy Of Lacrimal Gland","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,029.00 ","$0.00 ","$2,255.00 ","$2,398.97 ","$2,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101150","EAP","CPT� 68705","","Correct Everted Punctum Cauter","BOTH IP/OP","$661.00 ","$489.14 ","$0.00 ","$661.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.00 ","$0.00 ","$661.00 ","$523.51 ","$528.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101151","EAP","CPT� 68760","","Close Lacri Punct Laser Ligate","BOTH IP/OP","$623.00 ","$461.02 ","$0.00 ","$623.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$623.00 ","$0.00 ","$623.00 ","$493.42 ","$498.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101152","EAP","CPT� 68761","","Close Tear Duct Opening","BOTH IP/OP","$584.00 ","$432.16 ","$0.00 ","$579.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.00 ","$0.00 ","$579.00 ","$458.57 ","$463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101153","EAP","CPT� 68770","","Closure Lacrimal Fistula","BOTH IP/OP","$5,253.00 ","$3,887.22 ","$0.00 ","$5,253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,253.00 ","$0.00 ","$3,606.00 ","$4,160.38 ","$4,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101154","EAP","CPT� 68801","","Dilate Lacrimal Punctum","BOTH IP/OP","$523.00 ","$387.02 ","$0.00 ","$519.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$519.00 ","$0.00 ","$519.00 ","$411.05 ","$415.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101155","EAP","CPT� 68810","","Probe Nasolacrimal Duct","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$670.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101156","EAP","CPT� 68815","","Probe Nasolacrimal Duct W Tube","BOTH IP/OP","$5,253.00 ","$3,887.22 ","$0.00 ","$5,253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,253.00 ","$0.00 ","$2,327.00 ","$4,160.38 ","$4,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101157","EAP","CPT� 68840","","Probe Lacrimal Canaliculi","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$670.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101158","EAP","CPT� 69105","","Biopsy External Ear Canal","BOTH IP/OP","$3,660.00 ","$2,708.40 ","$64.16 ","$3,692.00 ","$1,987.38 ","$1,324.76 ","$762.84 ","$2,634.98 ","$2,634.98 ","$646.44 ","$3,692.00 ","$1,353.31 ","$2,255.00 ","$2,924.06 ","$2,953.60 ","$1,880.24 ","$69.63 ","$64.16 ","$587.77 ","$1,288.86 "
"36101160","EAP","CPT� 69145","","Excision Aural Mass","BOTH IP/OP","$14,091.00 ","$10,427.34 ","$0.00 ","$14,215.00 ","$2,753.10 ","$2,322.02 ","$2,936.92 ","$0.00 ","$0.00 ","$0.00 ","$14,215.00 ","$0.00 ","$2,327.00 ","$11,258.28 ","$11,372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101162","EAP","CPT� 69200","","Remove Fb Ear W/o Anes","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$412.00 ","$221.54 ","$110.43 ","$85.04 ","$0.00 ","$0.00 ","$72.14 ","$412.00 ","$109.35 ","$412.00 ","$326.30 ","$329.60 ","$151.93 ","$58.58 ","$48.67 ","$65.59 ","$104.14 "
"36101165","EAP","CPT� 69220","","Debridement,ear Wash Placement","BOTH IP/OP","$326.00 ","$241.24 ","$0.00 ","$329.00 ","$177.02 ","$175.86 ","$0.00 ","$0.00 ","$0.00 ","$57.61 ","$329.00 ","$175.24 ","$329.00 ","$260.57 ","$263.20 ","$243.48 ","$62.84 ","$52.64 ","$52.38 ","$166.90 "
"36101171","EAP","CPT� 69420","","Myringotomy W Aspir, E Tube In","BOTH IP/OP","$1,533.00 ","$1,134.42 ","$96.31 ","$1,547.00 ","$1,533.00 ","$207.19 ","$319.52 ","$1,482.64 ","$1,482.64 ","$270.87 ","$1,547.00 ","$204.24 ","$1,547.00 ","$1,225.22 ","$1,237.60 ","$283.76 ","$96.31 ","$122.18 ","$246.28 ","$194.51 "
"36101173","EAP","CPT� 69424","","Remove Ventilating Tube W Anes","BOTH IP/OP","$10,633.00 ","$7,868.42 ","$0.00 ","$10,633.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,633.00 ","$0.00 ","$2,255.00 ","$8,421.34 ","$8,506.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101176","EAP","CPT� 69433","","Tympanostomy Local Anes","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$116.53 ","$1,470.00 ","$1,455.00 ","$442.92 ","$303.26 ","$1,208.73 ","$1,208.73 ","$257.39 ","$1,470.00 ","$443.02 ","$1,470.00 ","$1,164.24 ","$1,176.00 ","$615.51 ","$116.53 ","$134.08 ","$234.02 ","$421.92 "
"36101177","EAP","CPT� 69540","","Excision Of Aural Polyp","BOTH IP/OP","$2,303.00 ","$1,704.22 ","$0.00 ","$2,303.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,303.00 ","$0.00 ","$2,255.00 ","$1,823.98 ","$1,842.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101179","EAP","CPT� 69610","","Tympanic Membrane Repair","BOTH IP/OP","$3,245.00 ","$2,401.30 ","$0.00 ","$3,245.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,245.00 ","$0.00 ","$2,255.00 ","$2,570.04 ","$2,596.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101181","EAP","CPT� 92977","","Thrombolytic By Iv For Ami","BOTH IP/OP","$3,599.00 ","$2,663.26 ","$0.00 ","$4,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,227.00 ","$0.00 ","$2,113.50 ","$3,347.78 ","$3,381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101183","EAP","CPT� 92978","","Ivus Initial Vessel","BOTH IP/OP","$8,205.00 ","$6,071.70 ","$0.00 ","$7,459.00 ","$4,455.32 ","$0.00 ","$1,710.13 ","$5,323.49 ","$5,323.49 ","$1,306.01 ","$7,459.00 ","$0.00 ","$3,729.50 ","$5,907.53 ","$5,967.20 ","$0.00 ","$273.18 ","$0.00 ","$1,187.47 ","$0.00 "
"36101184","EAP","CPT� 92979","","Ivus - Addit Vessel","BOTH IP/OP","$8,818.00 ","$6,525.32 ","$0.00 ","$7,459.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,459.00 ","$0.00 ","$3,729.50 ","$5,907.53 ","$5,967.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101185","EAP","CPT� 27096","","Inject Si Joint Arthrgrphy&/anes/steroid W/image","BOTH IP/OP","$2,110.00 ","$1,561.40 ","$86.18 ","$2,131.00 ","$2,110.00 ","$621.87 ","$439.78 ","$1,520.89 ","$1,520.89 ","$373.12 ","$2,131.00 ","$626.89 ","$2,131.00 ","$1,687.75 ","$1,704.80 ","$86.18 ","$398.44 ","$86.18 ","$339.26 ","$597.04 "
"36101186","EAP","CPT� 27096","","Bil Inject Si Joint Arthrgrphy&/anes/steroid W/image","BOTH IP/OP","$3,165.00 ","$2,342.10 ","$86.18 ","$3,197.00 ","$2,321.55 ","$621.87 ","$659.67 ","$2,281.70 ","$2,281.70 ","$559.77 ","$3,197.00 ","$626.89 ","$2,255.00 ","$2,532.02 ","$2,557.60 ","$86.18 ","$398.44 ","$86.18 ","$508.96 ","$597.04 "
"36101187","EAP","HCPCS G0269","","Closure Device Placement","BOTH IP/OP","$2,840.00 ","$2,101.60 ","$0.00 ","$2,845.00 ","$1,542.12 ","$0.00 ","$591.93 ","$2,030.48 ","$2,030.48 ","$498.14 ","$2,845.00 ","$0.00 ","$1,422.50 ","$2,253.24 ","$2,276.00 ","$0.00 ","$445.24 ","$0.00 ","$452.92 ","$0.00 "
"36101192","EAP","CPT� 41899","","Partially Bony","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$0.00 ","$0.00 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"36101193","EAP","CPT� 41899","","Soft Tissue","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$0.00 ","$0.00 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"36101198","EAP","CPT� 62320","","Njx Interlaminar Crv/thrc","BOTH IP/OP","$1,385.00 ","$1,024.90 ","$0.00 ","$1,385.00 ","$1,385.00 ","$621.87 ","$288.67 ","$0.00 ","$0.00 ","$0.00 ","$1,316.00 ","$0.00 ","$1,316.00 ","$1,042.27 ","$1,052.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101202","EAP","CPT� 15792","","Tca Peel","BOTH IP/OP","$1,056.00 ","$781.44 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$990.00 ","$0.00 ","$990.00 ","$784.08 ","$792.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101204","EAP","CPT� 17000","","Destruc Lesion Benign, 1st","BOTH IP/OP","$389.00 ","$287.86 ","$0.00 ","$389.00 ","$0.00 ","$0.00 ","$0.00 ","$389.00 ","$389.00 ","$68.11 ","$389.00 ","$175.24 ","$389.00 ","$308.09 ","$311.20 ","$243.48 ","$48.44 ","$55.15 ","$61.93 ","$166.90 "
"36101208","EAP","CPT� 36600","","Arterial Puncture","BOTH IP/OP","$227.00 ","$167.98 ","$0.00 ","$284.00 ","$227.00 ","$110.43 ","$47.31 ","$0.00 ","$0.00 ","$49.73 ","$284.00 ","$109.35 ","$284.00 ","$224.93 ","$227.20 ","$151.93 ","$24.37 ","$16.23 ","$45.21 ","$104.14 "
"36101209","EAP","CPT� 46611","","Hr Anoscopy W/ Bx","BOTH IP/OP","$2,999.00 ","$2,219.26 ","$0.00 ","$2,898.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,898.00 ","$0.00 ","$2,255.00 ","$2,295.22 ","$2,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101210","EAP","CPT� 46614","","Hr Ano/w Control Of Bleeding","BOTH IP/OP","$1,516.00 ","$1,121.84 ","$0.00 ","$1,516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.00 ","$0.00 ","$1,516.00 ","$1,200.67 ","$1,212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101211","EAP","CPT� 46615","","Hr Ano W/ablation Of Tumor","BOTH IP/OP","$6,197.00 ","$4,585.78 ","$0.00 ","$5,989.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,989.00 ","$0.00 ","$2,327.00 ","$4,743.29 ","$4,791.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101212","EAP","CPT� 51727","","Cystometrogram W/urethral Pres","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$790.00 ","$790.00 ","$563.41 ","$164.66 ","$0.00 ","$0.00 ","$0.00 ","$790.00 ","$0.00 ","$790.00 ","$625.68 ","$632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101213","EAP","CPT� 51728","","Cystometrogram W/voiding Press","BOTH IP/OP","$791.00 ","$585.34 ","$0.00 ","$791.00 ","$791.00 ","$563.41 ","$164.86 ","$0.00 ","$0.00 ","$0.00 ","$790.00 ","$0.00 ","$790.00 ","$625.68 ","$632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101214","EAP","CPT� 51729","","Cystometrogram W/vp&up","BOTH IP/OP","$791.00 ","$585.34 ","$0.00 ","$791.00 ","$791.00 ","$563.41 ","$164.86 ","$0.00 ","$0.00 ","$138.32 ","$790.00 ","$558.17 ","$790.00 ","$625.68 ","$632.00 ","$775.50 ","$235.63 ","$252.48 ","$125.77 ","$531.59 "
"36101216","EAP","CPT� 49429","","Removal Of Peritoneal-venous Shunt","BOTH IP/OP","$9,158.00 ","$6,776.92 ","$0.00 ","$10,713.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,713.00 ","$0.00 ","$2,255.00 ","$8,484.70 ","$8,570.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101217","EAP","CPT� 21040","","Excision Benign Tumor/cyst Mandible Encl & Curt","BOTH IP/OP","$4,993.00 ","$3,694.82 ","$0.00 ","$4,993.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,993.00 ","$0.00 ","$2,327.00 ","$3,954.46 ","$3,994.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101219","EAP","CPT� 57800","","Insert Smit Sleeve","BOTH IP/OP","$5,262.00 ","$3,893.88 ","$0.00 ","$5,262.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,262.00 ","$0.00 ","$2,255.00 ","$4,167.50 ","$4,209.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101225","EAP","CPT� 64415","","Inj Anes/strd Brachial Plexus","BOTH IP/OP","$2,280.00 ","$1,687.20 ","$66.00 ","$2,280.00 ","$2,280.00 ","$806.18 ","$475.21 ","$1,348.89 ","$1,348.89 ","$330.92 ","$1,890.00 ","$814.44 ","$1,890.00 ","$1,496.88 ","$1,512.00 ","$1,131.55 ","$107.25 ","$66.00 ","$300.89 ","$775.65 "
"36101226","EAP","CPT� 64417","","Inj Anes/strd Axillary Nerve","BOTH IP/OP","$1,969.00 ","$1,457.06 ","$63.11 ","$1,969.00 ","$1,969.00 ","$806.18 ","$410.39 ","$1,348.89 ","$1,348.89 ","$330.92 ","$1,890.00 ","$814.44 ","$1,890.00 ","$1,496.88 ","$1,512.00 ","$1,131.55 ","$106.55 ","$63.11 ","$300.89 ","$775.65 "
"36101227","EAP","CPT� 64420","","Inj Anes/strd Intercostal Nerve 1st Level","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,890.00 ","$0.00 ","$0.00 ","$0.00 ","$1,348.89 ","$1,348.89 ","$330.92 ","$1,890.00 ","$626.89 ","$1,890.00 ","$1,496.88 ","$1,512.00 ","$870.98 ","$95.79 ","$62.02 ","$300.89 ","$597.04 "
"36101228","EAP","CPT� 64421","","Inj Anes/strd Intercostal Nerve Addl Level","BOTH IP/OP","$3,789.00 ","$2,803.86 ","$0.00 ","$3,656.00 ","$0.00 ","$0.00 ","$0.00 ","$2,609.29 ","$2,609.29 ","$640.14 ","$3,656.00 ","$814.44 ","$2,255.00 ","$2,895.55 ","$2,924.80 ","$1,131.55 ","$124.25 ","$26.33 ","$582.04 ","$775.65 "
"36101229","EAP","CPT� 64445","","Inj Anes/strd Sciatic Nerve","BOTH IP/OP","$3,789.00 ","$2,803.86 ","$0.00 ","$3,656.00 ","$0.00 ","$0.00 ","$789.72 ","$2,609.29 ","$2,609.29 ","$640.14 ","$3,656.00 ","$626.89 ","$2,255.00 ","$2,895.55 ","$2,924.80 ","$870.98 ","$117.68 ","$55.89 ","$582.04 ","$597.04 "
"36101230","EAP","CPT� 64447","","Inj Anes/strd Femoral Nerve","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$55.18 ","$1,890.00 ","$1,294.51 ","$621.87 ","$496.89 ","$1,348.89 ","$1,348.89 ","$330.92 ","$1,890.00 ","$626.89 ","$1,890.00 ","$1,496.88 ","$1,512.00 ","$870.98 ","$74.36 ","$55.18 ","$300.89 ","$597.04 "
"36101231","EAP","CPT� 64490","","Bilat_inj Paravert F Jnt C/t 1 Lev","BOTH IP/OP","$5,684.00 ","$4,206.16 ","$0.00 ","$5,484.00 ","$2,321.55 ","$806.18 ","$0.00 ","$3,913.93 ","$3,913.93 ","$960.20 ","$5,484.00 ","$814.44 ","$2,255.00 ","$4,343.33 ","$4,387.20 ","$1,131.55 ","$122.58 ","$109.61 ","$873.05 ","$775.65 "
"36101232","EAP","CPT� 64491","","Bilat_inj Paravert F Jnt C/t 2 Lev","BOTH IP/OP","$2,740.00 ","$2,027.60 ","$0.00 ","$2,644.00 ","$2,321.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,644.00 ","$0.00 ","$1,322.00 ","$2,094.05 ","$2,115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101233","EAP","CPT� 64492","","Bilat_inj Paravert F Jnt C/t 3 Lev","BOTH IP/OP","$2,441.00 ","$1,806.34 ","$0.00 ","$2,355.00 ","$2,321.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,355.00 ","$0.00 ","$1,177.50 ","$1,865.16 ","$1,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101234","EAP","CPT� 64493","","Bilat_inj Paravert F Jnt L/s 1 Lev","BOTH IP/OP","$5,684.00 ","$4,206.16 ","$93.03 ","$5,484.00 ","$2,321.55 ","$806.18 ","$1,184.69 ","$3,913.93 ","$3,913.93 ","$960.20 ","$5,484.00 ","$814.44 ","$2,255.00 ","$4,343.33 ","$4,387.20 ","$1,131.55 ","$111.04 ","$93.03 ","$873.05 ","$775.65 "
"36101235","EAP","CPT� 64494","","Bilat_inj Paravert F Jnt L/s 2 Lev","BOTH IP/OP","$2,583.00 ","$1,911.42 ","$0.00 ","$2,492.00 ","$2,321.55 ","$0.00 ","$538.36 ","$1,778.54 ","$1,778.54 ","$436.33 ","$2,492.00 ","$0.00 ","$1,246.00 ","$1,973.66 ","$1,993.60 ","$0.00 ","$54.06 ","$53.73 ","$396.73 ","$0.00 "
"36101236","EAP","CPT� 64495","","Bilat_inj Paravert F Jnt L/s 3 Lev","BOTH IP/OP","$2,478.00 ","$1,833.72 ","$0.00 ","$2,391.00 ","$2,321.55 ","$0.00 ","$516.48 ","$1,706.46 ","$1,706.46 ","$0.00 ","$2,391.00 ","$0.00 ","$1,195.50 ","$1,893.67 ","$1,912.80 ","$0.00 ","$0.00 ","$54.45 ","$380.65 ","$0.00 "
"36101252","EAP","CPT� 19126","","Excision Addl Breast Lesion","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$508.00 ","$0.00 ","$508.00 ","$402.34 ","$406.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101253","EAP","CPT� 57520","","Conization Of Cervix","BOTH IP/OP","$2,862.00 ","$2,117.88 ","$0.00 ","$2,862.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,862.00 ","$0.00 ","$2,327.00 ","$2,266.70 ","$2,289.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101264","EAP","CPT� 69210","","Removal Impacted Cerumen Instrument Unilat","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$412.00 ","$408.00 ","$54.51 ","$85.04 ","$0.00 ","$0.00 ","$72.14 ","$412.00 ","$55.17 ","$412.00 ","$326.30 ","$329.60 ","$76.65 ","$47.34 ","$34.61 ","$65.59 ","$52.54 "
"36101266","EAP","CPT� 36569","","Picc W/o Port","BOTH IP/OP","$4,743.00 ","$3,509.82 ","$98.45 ","$5,429.00 ","$2,321.55 ","$1,377.13 ","$988.56 ","$3,874.68 ","$3,874.68 ","$950.57 ","$5,429.00 ","$1,635.92 ","$2,255.00 ","$4,299.77 ","$4,343.20 ","$2,272.90 ","$346.84 ","$98.45 ","$864.30 ","$1,558.02 "
"36101267","EAP","CPT� 67820","","Revised Eye Lashes","BOTH IP/OP","$316.00 ","$233.84 ","$0.00 ","$317.00 ","$171.59 ","$110.43 ","$65.86 ","$0.00 ","$0.00 ","$55.50 ","$317.00 ","$109.35 ","$317.00 ","$251.06 ","$253.60 ","$151.93 ","$67.50 ","$28.84 ","$50.47 ","$104.14 "
"36101270","EAP","CPT� 19000","","Drain Breast Cyst","BOTH IP/OP","$921.00 ","$681.54 ","$45.43 ","$1,141.00 ","$921.00 ","$609.42 ","$191.96 ","$1,141.00 ","$1,141.00 ","$199.78 ","$1,141.00 ","$611.80 ","$1,141.00 ","$903.67 ","$912.80 ","$850.02 ","$59.58 ","$45.43 ","$181.65 ","$582.67 "
"36101273","EAP","CPT� 21925","","Bx Soft Tissue Back/flank","BOTH IP/OP","$5,368.00 ","$3,972.32 ","$0.00 ","$5,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,368.00 ","$0.00 ","$2,327.00 ","$4,251.46 ","$4,294.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101274","EAP","CPT� 31535","","Laryngoscopy W/biopsy","BOTH IP/OP","$9,759.00 ","$7,221.66 ","$0.00 ","$8,960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,960.00 ","$0.00 ","$2,327.00 ","$7,096.32 ","$7,168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101275","EAP","CPT� 31577","","Removal Foreign Body, Larynx","BOTH IP/OP","$1,746.00 ","$1,292.04 ","$0.00 ","$1,826.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.00 ","$0.00 ","$1,826.00 ","$1,446.19 ","$1,460.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101280","EAP","CPT� 44370","","Small Bowel Endoscop/stent,spv","BOTH IP/OP","$7,753.00 ","$5,737.22 ","$0.00 ","$7,753.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,753.00 ","$0.00 ","$6,105.00 ","$6,140.38 ","$6,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101281","EAP","CPT� 49411","","Ins Mark Abd/pel For Rt Perq","BOTH IP/OP","$2,721.00 ","$2,013.54 ","$0.00 ","$3,183.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,183.00 ","$0.00 ","$2,255.00 ","$2,520.94 ","$2,546.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101284","EAP","CPT� 54161","","Circum 28 Days Or Older","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,283.00 ","$2,753.10 ","$1,753.49 ","$888.72 ","$0.00 ","$0.00 ","$0.00 ","$4,283.00 ","$0.00 ","$2,327.00 ","$3,392.14 ","$3,426.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101285","EAP","CPT� 58999","","Female Genital System Procedur","BOTH IP/OP","$263.00 ","$194.62 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101286","EAP","CPT� 59412","","Antepartum Manipulation","BOTH IP/OP","$4,901.00 ","$3,626.74 ","$0.00 ","$4,901.00 ","$2,661.24 ","$2,569.43 ","$1,021.49 ","$0.00 ","$0.00 ","$0.00 ","$4,901.00 ","$0.00 ","$2,255.00 ","$3,881.59 ","$3,920.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101287","EAP","CPT� 59870","","Evacuate Mole Of Uterus","BOTH IP/OP","$4,868.00 ","$3,602.32 ","$0.00 ","$4,917.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,917.00 ","$0.00 ","$3,902.00 ","$3,894.26 ","$3,933.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101288","EAP","CPT� 60300","","Aspir/inj Thyroid Cyst","BOTH IP/OP","$1,745.00 ","$1,291.30 ","$51.21 ","$1,745.00 ","$1,745.00 ","$609.42 ","$363.70 ","$1,242.55 ","$1,242.55 ","$304.84 ","$1,741.00 ","$611.80 ","$1,741.00 ","$1,378.87 ","$1,392.80 ","$850.02 ","$86.36 ","$51.21 ","$277.17 ","$582.67 "
"36101290","EAP","CPT� 61623","","Endovasc Tempry Vesel Ocl Nir","BOTH IP/OP","$17,372.00 ","$12,855.28 ","$0.00 ","$16,054.00 ","$4,778.55 ","$9,836.87 ","$3,620.76 ","$0.00 ","$0.00 ","$0.00 ","$16,054.00 ","$0.00 ","$6,105.00 ","$12,714.77 ","$12,843.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101292","EAP","CPT� 61641","","Dilate Ic Vasospasm Add-on","BOTH IP/OP","$13,302.00 ","$9,843.48 ","$0.00 ","$12,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,293.00 ","$0.00 ","$6,146.50 ","$9,736.06 ","$9,834.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101295","EAP","CPT� 65210","","Remove Foreign Body From Eye","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$611.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$611.00 ","$0.00 ","$611.00 ","$483.91 ","$488.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101296","EAP","CPT� 69200","","Removal Fb Ear W/o Anesth","BOTH IP/OP","$412.00 ","$304.88 ","$0.00 ","$412.00 ","$0.00 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$72.14 ","$412.00 ","$109.35 ","$412.00 ","$326.30 ","$329.60 ","$151.93 ","$58.58 ","$48.67 ","$65.59 ","$104.14 "
"36101298","EAP","CPT� 74220","","Contrast X-ray, Esophagus,spv","BOTH IP/OP","$1,126.00 ","$833.24 ","$0.00 ","$1,188.00 ","$200.75 ","$174.93 ","$234.69 ","$0.00 ","$0.00 ","$208.01 ","$1,188.00 ","$202.33 ","$285.12 ","$940.90 ","$950.40 ","$281.11 ","$68.55 ","$66.99 ","$189.13 ","$192.70 "
"36101302","EAP","CPT� 92953","","Temp Transcut Pacing","BOTH IP/OP","$2,499.00 ","$1,849.26 ","$0.00 ","$2,499.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,499.00 ","$0.00 ","$1,249.50 ","$1,979.21 ","$1,999.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101310","EAP","CPT� 31641","","Bronchoscopy Treat Blockage","BOTH IP/OP","$9,910.00 ","$7,333.40 ","$265.77 ","$9,697.00 ","$2,753.10 ","$3,033.56 ","$2,065.49 ","$6,920.75 ","$5,416.74 ","$1,697.87 ","$9,697.00 ","$2,945.54 ","$2,327.00 ","$7,680.02 ","$7,757.60 ","$4,092.44 ","$324.15 ","$265.77 ","$1,543.76 ","$2,805.28 "
"36101311","EAP","CPT� 64416","","Inj Anes/strd Brachial Plexus By Cont Infusion","BOTH IP/OP","$4,307.00 ","$3,187.18 ","$0.00 ","$4,307.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,307.00 ","$0.00 ","$2,255.00 ","$3,411.14 ","$3,445.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101312","EAP","CPT� 64446","","Inj Anes/strd Sicatic Nerve By Cont Infusion","BOTH IP/OP","$4,292.00 ","$3,176.08 ","$0.00 ","$4,699.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,699.00 ","$0.00 ","$2,255.00 ","$3,721.61 ","$3,759.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101313","EAP","CPT� 64448","","Inj Anes/strd Femoral Nerve By Cont Infusion","BOTH IP/OP","$3,481.00 ","$2,575.94 ","$0.00 ","$3,811.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,811.00 ","$0.00 ","$2,255.00 ","$3,018.31 ","$3,048.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101314","EAP","CPT� 64449","","Inj Anes/strd Lumbar Plexus By Cont Infusion","BOTH IP/OP","$3,355.00 ","$2,482.70 ","$0.00 ","$3,673.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,673.00 ","$0.00 ","$2,255.00 ","$2,909.02 ","$2,938.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101315","EAP","CPT� 64486","","Tap Block Unil By Injection","BOTH IP/OP","$1,767.00 ","$1,307.58 ","$0.00 ","$1,705.00 ","$0.00 ","$0.00 ","$0.00 ","$1,216.86 ","$1,216.86 ","$298.53 ","$1,705.00 ","$0.00 ","$852.50 ","$1,350.36 ","$1,364.00 ","$0.00 ","$119.70 ","$58.43 ","$271.44 ","$0.00 "
"36101316","EAP","CPT� 64487","","Tap Block Uni By Infusion","BOTH IP/OP","$1,557.00 ","$1,152.18 ","$0.00 ","$1,705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,705.00 ","$0.00 ","$852.50 ","$1,350.36 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101317","EAP","CPT� 64488","","Tap Block Bi Injection","BOTH IP/OP","$1,767.00 ","$1,307.58 ","$0.00 ","$1,767.00 ","$1,767.00 ","$0.00 ","$368.29 ","$1,216.86 ","$1,216.86 ","$298.53 ","$1,705.00 ","$0.00 ","$852.50 ","$1,350.36 ","$1,364.00 ","$0.00 ","$147.17 ","$72.14 ","$271.44 ","$0.00 "
"36101318","EAP","CPT� 64489","","Tap Block Bi By Infusion","BOTH IP/OP","$1,557.00 ","$1,152.18 ","$0.00 ","$1,705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,705.00 ","$0.00 ","$852.50 ","$1,350.36 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101350","EAP","CPT� 31525","","Dx Laryngoscopy, Except Nb","BOTH IP/OP","$6,130.00 ","$4,536.20 ","$0.00 ","$6,412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,412.00 ","$0.00 ","$2,255.00 ","$5,078.30 ","$5,129.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101351","EAP","CPT� 49451","","Replace Duod/jej Tube Perc,spv","BOTH IP/OP","$2,862.00 ","$2,117.88 ","$0.00 ","$2,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,752.00 ","$0.00 ","$2,255.00 ","$2,179.58 ","$2,201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101355","EAP","CPT� 69000","","Drain External Ear Lesion","BOTH IP/OP","$694.00 ","$513.56 ","$0.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$700.00 ","$0.00 ","$700.00 ","$554.40 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101370","EAP","CPT� 92511","","Nasopharyngoscopy W/endoscope","BOTH IP/OP","$606.00 ","$448.44 ","$0.00 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$157.01 ","$612.00 ","$484.70 ","$489.60 ","$218.14 ","$64.35 ","$38.94 ","$97.43 ","$149.53 "
"36101371","EAP","CPT� 77002","","Fluoro Guidance For Needle Pla","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$724.00 ","$0.00 ","$0.00 ","$149.44 ","$105.40 ","$105.40 ","$126.77 ","$724.00 ","$0.00 ","$173.76 ","$573.41 ","$579.20 ","$0.00 ","$71.68 ","$81.40 ","$115.26 ","$0.00 "
"36101375","EAP","CPT� 12021","","Wound Dehiscence With Packing","BOTH IP/OP","$3,676.00 ","$2,720.24 ","$0.00 ","$3,676.00 ","$0.00 ","$0.00 ","$0.00 ","$2,623.56 ","$2,623.56 ","$643.64 ","$3,676.00 ","$320.45 ","$2,255.00 ","$2,911.39 ","$2,940.80 ","$445.22 ","$117.17 ","$144.54 ","$585.22 ","$305.19 "
"36101390","EAP","CPT� 49180","","Ablation Abd Standa","BOTH IP/OP","$2,498.00 ","$1,848.52 ","$87.64 ","$2,922.00 ","$2,321.55 ","$1,377.93 ","$520.65 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,376.63 ","$2,255.00 ","$2,314.22 ","$2,337.60 ","$1,912.65 ","$203.88 ","$87.64 ","$465.18 ","$1,311.08 "
"36101396","EAP","CPT� 32555","","Aspirate Pleura W/ Imaging","BOTH IP/OP","$3,461.00 ","$2,561.14 ","$0.00 ","$3,461.00 ","$0.00 ","$0.00 ","$0.00 ","$2,470.12 ","$2,470.12 ","$605.99 ","$3,461.00 ","$632.36 ","$2,255.00 ","$2,741.11 ","$2,768.80 ","$878.58 ","$626.46 ","$116.13 ","$550.99 ","$602.25 "
"36101398","EAP","CPT� 31647","","Bronchial Valve Init Insert","BOTH IP/OP","$5,148.00 ","$3,809.52 ","$0.00 ","$5,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,148.00 ","$0.00 ","$2,858.00 ","$4,077.22 ","$4,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101399","EAP","CPT� 31648","","Bronchial Valve Addl Insert","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,029.00 ","$0.00 ","$2,858.00 ","$2,398.97 ","$2,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101400","EAP","CPT� 31649","","Bronchial Valve Remov Init","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101401","EAP","CPT� 31651","","Bronchial Valve Remov Addl","BOTH IP/OP","$947.00 ","$700.78 ","$0.00 ","$947.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$947.00 ","$0.00 ","$473.50 ","$750.02 ","$757.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101402","EAP","CPT� 32556","","Insert Cath Pleura W/o Image","BOTH IP/OP","$3,737.00 ","$2,765.38 ","$0.00 ","$3,536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,536.00 ","$0.00 ","$2,255.00 ","$2,800.51 ","$2,828.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101403","EAP","CPT� 32557","","Insert Cath Pleura W/ Image","BOTH IP/OP","$2,776.00 ","$2,054.24 ","$0.00 ","$2,753.10 ","$2,753.10 ","$1,377.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,627.00 ","$0.00 ","$2,255.00 ","$2,080.58 ","$2,101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101404","EAP","CPT� 31626","","Navigation Bronchoscopy W/markers","BOTH IP/OP","$5,560.00 ","$4,114.40 ","$205.55 ","$5,560.00 ","$2,984.10 ","$5,560.00 ","$1,158.84 ","$3,777.61 ","$3,777.61 ","$926.76 ","$5,293.00 ","$5,456.35 ","$2,858.00 ","$4,192.06 ","$4,234.40 ","$5,293.00 ","$317.84 ","$205.55 ","$842.65 ","$5,196.52 "
"36101405","EAP","CPT� 61650","","Endovasc Intracran Adm Rx 1st","BOTH IP/OP","$10,002.00 ","$7,401.48 ","$0.00 ","$9,243.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,243.00 ","$0.00 ","$4,621.50 ","$7,320.46 ","$7,394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101406","EAP","CPT� 61651","","Endovasc Intracran Adm Rx Add","BOTH IP/OP","$9,649.00 ","$7,140.26 ","$0.00 ","$8,917.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,917.00 ","$0.00 ","$4,458.50 ","$7,062.26 ","$7,133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101407","EAP","CPT� 37252","","Us Vascular Non-coronary Init","BOTH IP/OP","$15,412.00 ","$11,404.88 ","$0.00 ","$15,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,114.00 ","$0.00 ","$3,902.00 ","$11,970.29 ","$12,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101408","EAP","CPT� 37253","","Us Vascular Non-coron Add Ea","BOTH IP/OP","$11,429.00 ","$8,457.46 ","$0.00 ","$11,208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,208.00 ","$0.00 ","$3,902.00 ","$8,876.74 ","$8,966.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101409","EAP","CPT� 47532","","Xr Cholangiogram Transhepatic","BOTH IP/OP","$3,224.00 ","$2,385.76 ","$0.00 ","$3,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,257.00 ","$0.00 ","$2,858.00 ","$2,579.54 ","$2,605.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101410","EAP","CPT� 47531","","Xr Cholangiogram Thru Cath","BOTH IP/OP","$3,224.00 ","$2,385.76 ","$0.00 ","$3,257.00 ","$0.00 ","$0.00 ","$0.00 ","$2,324.52 ","$2,324.52 ","$570.27 ","$3,257.00 ","$3,118.48 ","$2,255.00 ","$2,579.54 ","$2,605.60 ","$3,257.00 ","$360.21 ","$73.56 ","$518.51 ","$2,969.98 "
"36101411","EAP","CPT� 47533","","Pl Bil Drn Cath Perc Ext Rad","BOTH IP/OP","$5,443.00 ","$4,027.82 ","$0.00 ","$5,443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,443.00 ","$0.00 ","$2,255.00 ","$4,310.86 ","$4,354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101412","EAP","CPT� 47534","","Pl Bil Drn Cath Perc Int/ext R","BOTH IP/OP","$6,143.00 ","$4,545.82 ","$0.00 ","$6,205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,205.00 ","$0.00 ","$2,255.00 ","$4,914.36 ","$4,964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101413","EAP","CPT� 47535","","Conv Ext Bil Drn Cath To Int/e","BOTH IP/OP","$5,443.00 ","$4,027.82 ","$0.00 ","$5,443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,443.00 ","$0.00 ","$2,255.00 ","$4,310.86 ","$4,354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101414","EAP","CPT� 47536","","Exch Bil Drn Cath Perc Rad","BOTH IP/OP","$6,143.00 ","$4,545.82 ","$0.00 ","$6,205.00 ","$0.00 ","$0.00 ","$1,280.35 ","$4,428.51 ","$4,428.51 ","$1,086.45 ","$6,205.00 ","$3,118.48 ","$2,255.00 ","$4,914.36 ","$4,964.00 ","$4,332.71 ","$789.54 ","$138.48 ","$987.84 ","$2,969.98 "
"36101415","EAP","CPT� 47537","","Rmvl Bil Drn Cath Perc Fluor G","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,207.00 ","$1,195.00 ","$792.43 ","$249.07 ","$0.00 ","$0.00 ","$211.34 ","$1,207.00 ","$788.23 ","$1,207.00 ","$955.94 ","$965.60 ","$1,095.14 ","$390.05 ","$100.61 ","$192.15 ","$750.70 "
"36101416","EAP","CPT� 47538","","PLMT STENT BILE DUCT PERC RAD EXIS ACCS","BOTH IP/OP","$10,193.00 ","$7,542.82 ","$0.00 ","$10,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,296.00 ","$0.00 ","$2,858.00 ","$8,154.43 ","$8,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101417","EAP","CPT� 47539","","PLMT STENT BILE DUCT PERC RAD NEW ACCS W/O CATH","BOTH IP/OP","$10,193.00 ","$7,542.82 ","$0.00 ","$10,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,296.00 ","$0.00 ","$2,858.00 ","$8,154.43 ","$8,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101418","EAP","CPT� 47540","","PLMT STENT BILE DUCT PERC RAD NEW ACCS W/ CATH","BOTH IP/OP","$10,296.00 ","$7,619.04 ","$0.00 ","$10,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,296.00 ","$0.00 ","$2,858.00 ","$8,154.43 ","$8,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101419","EAP","CPT� 47541","","Place Access Biliary Sm Bowel","BOTH IP/OP","$5,443.00 ","$4,027.82 ","$0.00 ","$5,443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,443.00 ","$0.00 ","$2,255.00 ","$4,310.86 ","$4,354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101420","EAP","CPT� 47542","","Dilation Biliary Duct/ampulla","BOTH IP/OP","$5,389.00 ","$3,987.86 ","$0.00 ","$5,443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,443.00 ","$0.00 ","$2,721.50 ","$4,310.86 ","$4,354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101421","EAP","CPT� 47543","","Endolumin Bx Biliary Tree Perq","BOTH IP/OP","$5,389.00 ","$3,987.86 ","$0.00 ","$5,443.00 ","$2,321.55 ","$0.00 ","$1,123.20 ","$3,884.67 ","$3,884.67 ","$953.03 ","$5,443.00 ","$0.00 ","$2,721.50 ","$4,310.86 ","$4,354.40 ","$0.00 ","$1,282.63 ","$151.83 ","$866.53 ","$0.00 "
"36101422","EAP","CPT� 47544","","Extract Stone Duct Biliary","BOTH IP/OP","$2,246.00 ","$1,662.04 ","$0.00 ","$2,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.00 ","$0.00 ","$2,246.00 ","$1,778.83 ","$1,796.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101423","EAP","CPT� 49185","","Sclerotx Fluid Collection Perq","BOTH IP/OP","$2,939.00 ","$2,174.86 ","$0.00 ","$2,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,755.00 ","$0.00 ","$1,377.50 ","$2,181.96 ","$2,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101424","EAP","CPT� 50432","","Ins Cath Drain Renal Pelvis","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,215.00 ","$0.00 ","$0.00 ","$1,362.68 ","$4,435.65 ","$4,435.65 ","$1,088.20 ","$6,215.00 ","$1,776.76 ","$2,255.00 ","$4,922.28 ","$4,972.00 ","$2,468.57 ","$817.36 ","$214.93 ","$989.43 ","$1,692.15 "
"36101425","EAP","CPT� 50693","","PLMT URETERAL STENT PRQ NEPH/URETEROGRAM PRE-EXIST","BOTH IP/OP","$5,609.00 ","$4,150.66 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,255.00 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101426","EAP","CPT� 50694","","PLMT URETERAL STENT PRQ NEPH/URETEROGRAM NEW ACCES","BOTH IP/OP","$5,609.00 ","$4,150.66 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,255.00 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101427","EAP","CPT� 50695","","PLMT URETERAL STENT PRQ NEP/URT NEW ACCES SEP CATH","BOTH IP/OP","$5,609.00 ","$4,150.66 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,255.00 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101428","EAP","CPT� 50430","","Inj Antegrade Neph/uret Comp","BOTH IP/OP","$1,379.00 ","$1,020.46 ","$0.00 ","$1,379.00 ","$1,379.00 ","$563.41 ","$287.42 ","$0.00 ","$0.00 ","$229.55 ","$1,311.00 ","$558.17 ","$1,311.00 ","$1,038.31 ","$1,048.80 ","$775.50 ","$503.90 ","$160.83 ","$208.71 ","$531.59 "
"36101429","EAP","CPT� 50431","","Inj Antegrade Neph/uret Comp","BOTH IP/OP","$1,379.00 ","$1,020.46 ","$0.00 ","$1,379.00 ","$1,379.00 ","$563.41 ","$287.42 ","$0.00 ","$0.00 ","$229.55 ","$1,311.00 ","$558.17 ","$1,311.00 ","$1,038.31 ","$1,048.80 ","$775.50 ","$156.69 ","$67.79 ","$208.71 ","$531.59 "
"36101430","EAP","CPT� 50433","","Place Nephroureteral Cath Prq","BOTH IP/OP","$3,960.00 ","$2,930.40 ","$0.00 ","$3,765.00 ","$2,753.10 ","$3,010.98 ","$825.36 ","$0.00 ","$0.00 ","$0.00 ","$3,765.00 ","$0.00 ","$2,255.00 ","$2,981.88 ","$3,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101431","EAP","CPT� 50434","","Convert Nephrostomy Cath","BOTH IP/OP","$2,023.00 ","$1,497.02 ","$200.50 ","$2,023.00 ","$2,023.00 ","$1,753.49 ","$421.64 ","$1,372.45 ","$1,372.45 ","$336.70 ","$1,923.00 ","$1,776.76 ","$1,923.00 ","$1,523.02 ","$1,538.40 ","$1,923.00 ","$870.58 ","$200.50 ","$306.14 ","$1,692.15 "
"36101432","EAP","CPT� 50435","","Chg Tube Nephro/pyelo","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$103.85 ","$2,275.00 ","$2,275.00 ","$1,753.49 ","$474.17 ","$1,543.73 ","$1,543.73 ","$378.72 ","$2,163.00 ","$1,776.76 ","$2,163.00 ","$1,713.10 ","$1,730.40 ","$2,163.00 ","$457.01 ","$103.85 ","$344.35 ","$1,692.15 "
"36101433","EAP","CPT� 50606","","Endoluminal Bx Ureter Renal","BOTH IP/OP","$5,609.00 ","$4,150.66 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,804.50 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101437","EAP","CPT� 50705","","Ureteral Embolization/occusion","BOTH IP/OP","$5,609.00 ","$4,150.66 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,804.50 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101438","EAP","CPT� 50706","","Ball Dilat Ureteral Stricture","BOTH IP/OP","$5,900.00 ","$4,366.00 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,804.50 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101439","EAP","CPT� 61645","","Perq Arterial Translum Thromec","BOTH IP/OP","$25,070.00 ","$18,551.80 ","$0.00 ","$23,168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,168.00 ","$0.00 ","$11,584.00 ","$18,349.06 ","$18,534.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101440","EAP","CPT� 62321","","Inj Of Sub Spinal Canal Upper/mid Back; W/image","BOTH IP/OP","$1,385.00 ","$1,024.90 ","$0.00 ","$1,385.00 ","$1,385.00 ","$621.87 ","$288.67 ","$0.00 ","$0.00 ","$230.42 ","$1,316.00 ","$626.89 ","$1,316.00 ","$1,042.27 ","$1,052.80 ","$870.98 ","$240.25 ","$111.42 ","$209.51 ","$597.04 "
"36101441","EAP","CPT� 62323","","Inj Of Sub Spinal Canal Lower Back/sacrum; W/image","BOTH IP/OP","$1,385.00 ","$1,024.90 ","$0.00 ","$1,385.00 ","$1,385.00 ","$621.87 ","$288.67 ","$0.00 ","$0.00 ","$230.42 ","$1,316.00 ","$626.89 ","$1,316.00 ","$1,042.27 ","$1,052.80 ","$870.98 ","$235.81 ","$103.13 ","$209.51 ","$597.04 "
"36101445","EAP","CPT� 31573","","Laryngoscopy Flexible Therapeutic Injection Uni","BOTH IP/OP","$3,859.00 ","$2,855.66 ","$0.00 ","$3,543.00 ","$2,753.10 ","$1,465.20 ","$804.31 ","$0.00 ","$0.00 ","$0.00 ","$3,543.00 ","$0.00 ","$2,255.00 ","$2,806.06 ","$2,834.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101501","EAP","CPT� 30020","","Drainage Of Nose Lesion","BOTH IP/OP","$2,343.00 ","$1,733.82 ","$0.00 ","$2,343.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,343.00 ","$0.00 ","$2,255.00 ","$1,855.66 ","$1,874.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101502","EAP","CPT� 31654","","Bronchoscopy Rigid/flex Ebus Interven Peri Lesion","BOTH IP/OP","$22,686.00 ","$16,787.64 ","$0.00 ","$22,915.00 ","$2,321.55 ","$0.00 ","$4,728.33 ","$16,354.44 ","$5,416.74 ","$4,012.23 ","$22,915.00 ","$0.00 ","$11,457.50 ","$18,148.68 ","$18,332.00 ","$0.00 ","$139.20 ","$69.97 ","$3,648.07 ","$0.00 "
"36101503","EAP","CPT� 31652","","Bronchoscopy Rigid/flex Ebus Sampling 1 Or 2 Node","BOTH IP/OP","$5,306.00 ","$3,926.44 ","$230.08 ","$5,360.00 ","$2,753.10 ","$3,033.56 ","$1,105.90 ","$3,825.43 ","$3,825.43 ","$938.49 ","$5,360.00 ","$2,945.54 ","$2,255.00 ","$4,245.12 ","$4,288.00 ","$4,092.44 ","$874.40 ","$230.08 ","$853.31 ","$2,805.28 "
"36101504","EAP","CPT� 31653","","Bronchoscopy Rigid/flex Ebus Sampling 3/> Node","BOTH IP/OP","$4,682.00 ","$3,464.68 ","$255.33 ","$4,729.00 ","$2,753.10 ","$3,033.56 ","$975.85 ","$3,375.09 ","$3,375.09 ","$828.01 ","$4,729.00 ","$2,945.54 ","$2,255.00 ","$3,745.37 ","$3,783.20 ","$4,092.44 ","$929.42 ","$255.33 ","$752.86 ","$2,805.28 "
"36101520","EAP","CPT� 42330","","Removal Of Salivary Stone","BOTH IP/OP","$6,425.00 ","$4,754.50 ","$0.00 ","$6,417.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,417.00 ","$0.00 ","$2,255.00 ","$5,082.26 ","$5,133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101961","EAP","CPT� 57460","","Colposcopy W/leep Bx","BOTH IP/OP","$4,743.00 ","$3,509.82 ","$168.01 ","$4,743.00 ","$2,753.10 ","$2,569.43 ","$988.56 ","$3,385.08 ","$3,385.08 ","$830.46 ","$4,743.00 ","$2,505.44 ","$2,255.00 ","$3,756.46 ","$3,794.40 ","$3,480.98 ","$178.42 ","$168.01 ","$755.09 ","$2,386.14 "
"36101970","EAP","CPT� 58100","","Endometrial Biopsy","BOTH IP/OP","$346.00 ","$256.04 ","$0.00 ","$346.00 ","$0.00 ","$0.00 ","$71.49 ","$346.00 ","$346.00 ","$60.58 ","$346.00 ","$166.54 ","$346.00 ","$274.03 ","$276.80 ","$231.38 ","$59.72 ","$67.07 ","$55.08 ","$158.61 "
"36101985","EAP","CPT� 46999","","Anus Surgery Procedure","BOTH IP/OP","$1,251.00 ","$925.74 ","$0.00 ","$1,264.00 ","$0.00 ","$0.00 ","$260.74 ","$0.00 ","$0.00 ","$0.00 ","$1,264.00 ","$0.00 ","$1,264.00 ","$1,001.09 ","$1,011.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101987","EAP","CPT� 57456","","Colposcopy + Ecc","BOTH IP/OP","$1,218.00 ","$901.32 ","$106.36 ","$1,221.00 ","$1,218.00 ","$276.20 ","$253.86 ","$1,208.73 ","$1,208.73 ","$213.79 ","$1,221.00 ","$271.52 ","$1,221.00 ","$967.03 ","$976.80 ","$377.23 ","$137.69 ","$106.36 ","$194.38 ","$258.59 "
"36101989","EAP","CPT� 23931","","Drainage Of Arm Bursa","BOTH IP/OP","$7,496.00 ","$5,547.04 ","$0.00 ","$7,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,290.00 ","$0.00 ","$2,327.00 ","$5,773.68 ","$5,832.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36101990","EAP","CPT� 91111","","Esophageal Capsule Endoscopy","BOTH IP/OP","$3,592.00 ","$2,658.08 ","$0.00 ","$3,284.00 ","$1,950.46 ","$0.00 ","$0.00 ","$2,343.79 ","$2,343.79 ","$575.00 ","$3,284.00 ","$788.23 ","$1,642.00 ","$2,600.93 ","$2,627.20 ","$1,095.14 ","$513.95 ","$828.40 ","$522.81 ","$750.70 "
"36101991","EAP","CPT� 91110","","Gi Tract Capsule Endoscopy","BOTH IP/OP","$4,034.00 ","$2,985.16 ","$588.72 ","$3,698.00 ","$2,190.46 ","$792.43 ","$840.79 ","$2,639.26 ","$2,639.26 ","$647.49 ","$3,698.00 ","$788.23 ","$1,849.00 ","$2,928.82 ","$2,958.40 ","$1,095.14 ","$923.73 ","$745.92 ","$588.72 ","$750.70 "
"36101992","EAP","CPT� 56405","","I & D, Vulva, Perineum","BOTH IP/OP","$294.00 ","$217.56 ","$0.00 ","$294.00 ","$294.00 ","$276.20 ","$61.28 ","$0.00 ","$0.00 ","$51.48 ","$294.00 ","$0.00 ","$294.00 ","$232.85 ","$235.20 ","$0.00 ","$107.63 ","$0.00 ","$0.00 ","$0.00 "
"36101994","EAP","CPT� 64425","","Inject Anest Ilioin","BOTH IP/OP","$3,143.00 ","$2,325.82 ","$0.00 ","$3,441.00 ","$2,321.55 ","$621.87 ","$655.08 ","$2,455.84 ","$2,455.84 ","$602.49 ","$3,441.00 ","$626.89 ","$2,255.00 ","$2,725.27 ","$2,752.80 ","$870.98 ","$0.00 ","$57.69 ","$547.81 ","$597.04 "
"36101995","EAP","CPT� 41899","","Rem Imp Tooth W Mucoper Fip","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$1,341.76 ","$1,341.76 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"36101997","EAP","CPT� 12001","","Repair Superficial Wound(s)","BOTH IP/OP","$704.00 ","$520.96 ","$0.00 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$704.00 ","$704.00 ","$123.26 ","$704.00 ","$175.24 ","$704.00 ","$557.57 ","$563.20 ","$243.48 ","$116.22 ","$46.87 ","$112.08 ","$166.90 "
"36101998","EAP","CPT� 36228","","Sel Cath Plc Intracrn Brnch Ic/vert Art W/angio","BOTH IP/OP","$73,169.00 ","$54,145.06 ","$0.00 ","$61,615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61,615.00 ","$0.00 ","$30,807.50 ","$48,799.08 ","$49,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102010","EAP","CPT� 29580","","Unna Booth","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.57 ","$780.00 ","$134.13 ","$780.00 ","$617.76 ","$624.00 ","$186.36 ","$54.52 ","$28.49 ","$124.18 ","$127.75 "
"36102050","EAP","CPT� 26010","","Abscess Finger Simple","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$1,407.00 ","$0.00 ","$1,407.00 ","$1,114.34 ","$1,125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102062","EAP","CPT� 29130","","Application Of Finger Splint","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.00 ","$0.00 ","$859.00 ","$680.33 ","$687.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102063","EAP","CPT� 38505","","Bx Lymph Node Ndl Bic","BOTH IP/OP","$1,805.00 ","$1,335.70 ","$72.83 ","$1,805.00 ","$1,805.00 ","$1,377.93 ","$376.21 ","$1,285.37 ","$1,285.37 ","$315.34 ","$1,801.00 ","$1,376.63 ","$1,801.00 ","$1,426.39 ","$1,440.80 ","$1,801.00 ","$115.87 ","$72.83 ","$286.72 ","$1,311.08 "
"36102064","EAP","CPT� 45005","","Drainage Of Rectal Abscess Ult","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,327.00 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102066","EAP","CPT� 49060","","Drain Open Retrop Abscess Ult","BOTH IP/OP","$5,398.00 ","$3,994.52 ","$0.00 ","$5,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,398.00 ","$0.00 ","$2,255.00 ","$4,275.22 ","$4,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102068","EAP","CPT� 52341","","Cysto W/ureter Stricture Tx","BOTH IP/OP","$9,570.00 ","$7,081.80 ","$0.00 ","$9,599.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,599.00 ","$0.00 ","$2,858.00 ","$7,602.41 ","$7,679.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102082","EAP","CPT� 57505","","Ecc Cervical Scrape","BOTH IP/OP","$2,043.00 ","$1,511.82 ","$86.47 ","$2,064.00 ","$2,043.00 ","$620.86 ","$425.81 ","$1,473.08 ","$1,473.08 ","$361.39 ","$2,064.00 ","$640.34 ","$2,064.00 ","$1,634.69 ","$1,651.20 ","$889.66 ","$86.47 ","$104.52 ","$328.59 ","$609.84 "
"36102090","EAP","CPT� 49421","","Perm Peritoneal Cath Insert","BOTH IP/OP","$11,842.00 ","$8,763.08 ","$0.00 ","$13,853.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,853.00 ","$0.00 ","$2,255.00 ","$10,971.58 ","$11,082.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102091","EAP","CPT� 49402","","Techoff Cath. Removal","BOTH IP/OP","$5,016.00 ","$3,711.84 ","$0.00 ","$5,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,868.00 ","$0.00 ","$2,327.00 ","$4,647.46 ","$4,694.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102095","EAP","CPT� 19120","","Excision Of Cyst,fibro Adrenoma","BOTH IP/OP","$5,508.00 ","$4,075.92 ","$0.00 ","$5,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,495.00 ","$0.00 ","$2,858.00 ","$4,352.04 ","$4,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102100","EAP","CPT� 64400","","Inj Anes/strd Trigeminal Nerve, Each Branch","BOTH IP/OP","$1,227.00 ","$907.98 ","$0.00 ","$1,227.00 ","$1,227.00 ","$255.86 ","$255.74 ","$0.00 ","$0.00 ","$0.00 ","$1,184.00 ","$0.00 ","$1,184.00 ","$937.73 ","$947.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102101","EAP","CPT� 64455","","N Block Inj Plantar Digit","BOTH IP/OP","$1,081.00 ","$799.94 ","$0.00 ","$1,081.00 ","$1,081.00 ","$255.86 ","$225.31 ","$0.00 ","$0.00 ","$182.62 ","$1,043.00 ","$262.54 ","$1,043.00 ","$826.06 ","$834.40 ","$364.76 ","$46.42 ","$36.07 ","$166.05 ","$250.04 "
"36102150","EAP","CPT� 19101","","Breast Biopsy, Open, Incisional","BOTH IP/OP","$3,347.00 ","$2,476.78 ","$0.00 ","$3,381.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,381.00 ","$0.00 ","$2,327.00 ","$2,677.75 ","$2,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102151","EAP","CPT� 19125","","Excision Breast Lesion","BOTH IP/OP","$3,037.00 ","$2,247.38 ","$0.00 ","$2,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,825.00 ","$0.00 ","$2,825.00 ","$2,237.40 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102152","EAP","CPT� 66020","","Injection Treatment Of Eye","BOTH IP/OP","$4,930.00 ","$3,648.20 ","$0.00 ","$5,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,312.00 ","$0.00 ","$2,255.00 ","$4,207.10 ","$4,249.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102153","EAP","CPT� 68530","","Clearance Of Tear Duct","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.00 ","$0.00 ","$579.00 ","$458.57 ","$463.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102155","EAP","CPT� 11600","","Exc Tr-emt Mlg+marg 0.5<cm","BOTH IP/OP","$3,699.00 ","$2,737.26 ","$0.00 ","$3,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,694.00 ","$0.00 ","$2,255.00 ","$2,925.65 ","$2,955.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102156","EAP","CPT� 64530","","INJECTION, ANESTHETIC AGENT,CELIAC","BOTH IP/OP","$7,798.00 ","$5,770.52 ","$0.00 ","$8,538.00 ","$2,321.55 ","$806.18 ","$1,625.30 ","$0.00 ","$0.00 ","$0.00 ","$8,538.00 ","$0.00 ","$2,255.00 ","$6,762.10 ","$6,830.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102157","EAP","CPT� 77012","","Ct Quidance For Needle Placement","BOTH IP/OP","$2,039.00 ","$1,508.86 ","$0.00 ","$2,039.00 ","$1,404.90 ","$0.00 ","$424.98 ","$1,455.23 ","$1,455.23 ","$357.01 ","$2,039.00 ","$0.00 ","$489.36 ","$1,614.89 ","$1,631.20 ","$0.00 ","$312.12 ","$77.80 ","$324.61 ","$0.00 "
"36102161","EAP","CPT� 19120","","Excision Of Cyst Or Other Benign/malignant  Tumor 1 Or S","BOTH IP/OP","$5,495.00 ","$4,066.30 ","$0.00 ","$5,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,495.00 ","$0.00 ","$2,858.00 ","$4,352.04 ","$4,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102172","EAP","CPT� 20500","","Sinogram, Therapeutic","BOTH IP/OP","$1,414.00 ","$1,046.36 ","$0.00 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,414.00 ","$0.00 ","$1,414.00 ","$1,119.89 ","$1,131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102183","EAP","CPT� 32561","","Fibrinolysis Via Chest Tube/catheter, Initial","BOTH IP/OP","$2,157.00 ","$1,596.18 ","$0.00 ","$2,041.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,041.00 ","$0.00 ","$2,041.00 ","$1,616.47 ","$1,632.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102184","EAP","CPT� 32562","","Fibrinolysis Via Chest Tube/cath Catheter, Subseq","BOTH IP/OP","$1,691.00 ","$1,251.34 ","$0.00 ","$2,041.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,041.00 ","$0.00 ","$2,041.00 ","$1,616.47 ","$1,632.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102185","EAP","CPT� 32998","","Percutaneous Rfa Lung Tumor(s)","BOTH IP/OP","$12,852.00 ","$9,510.48 ","$0.00 ","$12,982.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,982.00 ","$0.00 ","$5,452.00 ","$10,281.74 ","$10,385.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102189","EAP","CPT� 35226","","Repair Of Blood  Vessel Direct Lower  Extremity","BOTH IP/OP","$2,111.00 ","$1,562.14 ","$0.00 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,812.00 ","$0.00 ","$1,812.00 ","$1,435.10 ","$1,449.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102190","EAP","CPT� 35256","","Lower Extremity, Vein Graft","BOTH IP/OP","$7,768.00 ","$5,748.32 ","$0.00 ","$7,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,768.00 ","$0.00 ","$2,255.00 ","$6,152.26 ","$6,214.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102193","EAP","CPT� 35556","","Bypass Graft, With Vein; Femoral-popliteal","BOTH IP/OP","$12,248.00 ","$9,063.52 ","$0.00 ","$14,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,020.00 ","$0.00 ","$2,255.00 ","$11,103.84 ","$11,216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102194","EAP","CPT� 35565","","Bypass Graft, With Vein; Iliofemoral","BOTH IP/OP","$12,365.00 ","$9,150.10 ","$0.00 ","$14,154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,154.00 ","$0.00 ","$2,255.00 ","$11,209.97 ","$11,323.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102195","EAP","CPT� 36002","","Pseudoaneurysm Tx Injection (thrombin)","BOTH IP/OP","$2,437.00 ","$1,803.38 ","$0.00 ","$2,313.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,313.00 ","$0.00 ","$2,255.00 ","$1,831.90 ","$1,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102196","EAP","CPT� 36100","","Introduction Of Needle Or Intracatheter, Carotid Or Vertebral Artery","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,587.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,587.00 ","$0.00 ","$2,255.00 ","$2,048.90 ","$2,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102197","EAP","CPT� 36471","","Injection Of Sclerosing Solution; Multiple Veins, Same Leg","BOTH IP/OP","$786.00 ","$581.64 ","$0.00 ","$786.00 ","$786.00 ","$338.49 ","$163.82 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$625.00 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102198","EAP","CPT� 36620","","Arterial Catheterization Or Cannulation For Sampling, Mn","BOTH IP/OP","$1,480.00 ","$1,095.20 ","$0.00 ","$1,339.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$234.45 ","$1,339.00 ","$0.00 ","$1,339.00 ","$1,060.49 ","$1,071.20 ","$0.00 ","$59.97 ","$46.17 ","$213.17 ","$0.00 "
"36102200","EAP","CPT� 38505","","Lymph Nodes, Sup., Percut","BOTH IP/OP","$1,801.00 ","$1,332.74 ","$0.00 ","$1,801.00 ","$0.00 ","$0.00 ","$0.00 ","$1,285.37 ","$1,285.37 ","$315.34 ","$1,801.00 ","$1,376.63 ","$1,801.00 ","$1,426.39 ","$1,440.80 ","$1,801.00 ","$115.87 ","$72.83 ","$286.72 ","$1,311.08 "
"36102202","EAP","CPT� 43752","","Naso/oro Gastric Tube Placement","BOTH IP/OP","$2,134.00 ","$1,579.16 ","$42.55 ","$2,134.00 ","$2,134.00 ","$265.79 ","$444.78 ","$1,464.51 ","$1,464.51 ","$359.29 ","$2,052.00 ","$364.66 ","$2,052.00 ","$1,625.18 ","$1,641.60 ","$506.64 ","$321.14 ","$42.55 ","$326.68 ","$347.29 "
"36102205","EAP","CPT� 47380","","Open Rfa, Liver Tumor(s) Using U/s Guidance","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,657.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,657.00 ","$0.00 ","$2,255.00 ","$5,272.34 ","$5,325.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102208","EAP","CPT� 47490","","Perc. Cholecystostomy","BOTH IP/OP","$5,844.00 ","$4,324.56 ","$0.00 ","$5,903.00 ","$0.00 ","$0.00 ","$0.00 ","$4,212.97 ","$4,212.97 ","$1,033.57 ","$5,903.00 ","$3,118.48 ","$2,255.00 ","$4,675.18 ","$4,722.40 ","$4,332.71 ","$444.58 ","$345.72 ","$939.76 ","$2,969.98 "
"36102209","EAP","CPT� 47552","","Cholangioscopy, Perc., W/ Or W/o Brushing Or Washing","BOTH IP/OP","$5,467.00 ","$4,045.58 ","$0.00 ","$5,467.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,467.00 ","$0.00 ","$2,327.00 ","$4,329.86 ","$4,373.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102210","EAP","CPT� 47553","","Cholangioscopy, Perc., With Biopsy","BOTH IP/OP","$5,467.00 ","$4,045.58 ","$0.00 ","$5,467.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,467.00 ","$0.00 ","$2,858.00 ","$4,329.86 ","$4,373.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102211","EAP","CPT� 47554","","Cholangioscopy, Perc., With Calculus/calculi Removal","BOTH IP/OP","$5,467.00 ","$4,045.58 ","$0.00 ","$5,467.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,467.00 ","$0.00 ","$2,858.00 ","$4,329.86 ","$4,373.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102212","EAP","CPT� 48102","","Pancreas, Percutaneous","BOTH IP/OP","$2,114.00 ","$1,564.36 ","$0.00 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,114.00 ","$0.00 ","$2,114.00 ","$1,674.29 ","$1,691.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102215","EAP","CPT� 49180","","Abdomen/retrop., Percutaneous","BOTH IP/OP","$2,922.00 ","$2,162.28 ","$0.00 ","$2,922.00 ","$0.00 ","$0.00 ","$649.66 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,376.63 ","$2,255.00 ","$2,314.22 ","$2,337.60 ","$1,912.65 ","$203.88 ","$87.64 ","$465.18 ","$1,311.08 "
"36102216","EAP","CPT� 49400","","Peritoneogram (air And/or Contrast)","BOTH IP/OP","$2,781.00 ","$2,057.94 ","$0.00 ","$3,253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,253.00 ","$0.00 ","$1,626.50 ","$2,576.38 ","$2,602.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102217","EAP","CPT� 49423","","Change Of Abscess Drain (inc. Injection)","BOTH IP/OP","$4,348.00 ","$3,217.52 ","$0.00 ","$4,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,076.00 ","$0.00 ","$3,606.00 ","$3,228.19 ","$3,260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102218","EAP","CPT� 49424","","Abscessogram (tube Check)","BOTH IP/OP","$4,348.00 ","$3,217.52 ","$0.00 ","$4,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,076.00 ","$0.00 ","$2,255.00 ","$3,228.19 ","$3,260.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102219","EAP","CPT� 49441","","J-tube Placement Under Fluoro Guidance","BOTH IP/OP","$4,644.00 ","$3,436.56 ","$0.00 ","$4,801.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,801.00 ","$0.00 ","$2,255.00 ","$3,802.39 ","$3,840.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102220","EAP","CPT� 49442","","Duodenostomy Tube Placement Under Fluoro Guidance","BOTH IP/OP","$8,330.00 ","$6,164.20 ","$0.00 ","$8,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,612.00 ","$0.00 ","$2,255.00 ","$6,820.70 ","$6,889.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102222","EAP","CPT� 49465","","Contrast Injection For G-, J-, G-j, C Tube Radiological Evaluation","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$455.00 ","$0.00 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$79.67 ","$455.00 ","$233.72 ","$455.00 ","$360.36 ","$364.00 ","$324.73 ","$150.79 ","$32.10 ","$72.44 ","$222.60 "
"36102224","EAP","CPT� 50250","","Open Cryo, Renal Tumor(s) Includes Us Guidance","BOTH IP/OP","$5,535.00 ","$4,095.90 ","$0.00 ","$5,522.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,522.00 ","$0.00 ","$2,761.00 ","$4,373.42 ","$4,417.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102225","EAP","CPT� 50385","","Exchange, Transuretheral Approach Includes Imaging","BOTH IP/OP","$5,669.00 ","$4,195.06 ","$0.00 ","$5,673.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,673.00 ","$0.00 ","$2,327.00 ","$4,493.02 ","$4,538.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102226","EAP","CPT� 50386","","Removal, Transuretheral Approach Includes Imaging","BOTH IP/OP","$1,755.00 ","$1,298.70 ","$0.00 ","$1,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,740.00 ","$0.00 ","$1,740.00 ","$1,378.08 ","$1,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102229","EAP","CPT� 50592","","Percutaneous Rfa, Renal Tumor(s)","BOTH IP/OP","$15,251.00 ","$11,285.74 ","$0.00 ","$15,251.00 ","$0.00 ","$0.00 ","$0.00 ","$10,884.64 ","$5,416.74 ","$2,670.33 ","$15,251.00 ","$4,847.92 ","$5,452.00 ","$12,078.79 ","$12,200.80 ","$6,735.53 ","$6,100.60 ","$357.73 ","$2,427.96 ","$4,617.06 "
"36102230","EAP","CPT� 50593","","Percutaneous Cryoablation, Renal Tumor(s)","BOTH IP/OP","$11,130.00 ","$8,236.20 ","$479.98 ","$10,581.00 ","$5,965.05 ","$8,722.60 ","$2,319.77 ","$7,551.66 ","$5,416.74 ","$1,852.65 ","$10,581.00 ","$8,437.84 ","$5,452.00 ","$8,380.15 ","$8,464.80 ","$10,581.00 ","$4,167.31 ","$479.98 ","$1,684.50 ","$8,036.03 "
"36102231","EAP","CPT� 51101","","Aspirate Bladder (diagnostic) By Trocar/catheter","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.00 ","$0.00 ","$950.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102232","EAP","CPT� 51610","","Urethrocystogram, Retrograde","BOTH IP/OP","$2,406.00 ","$1,780.44 ","$0.00 ","$2,404.00 ","$0.00 ","$0.00 ","$0.00 ","$1,715.73 ","$1,715.73 ","$420.92 ","$2,404.00 ","$0.00 ","$1,202.00 ","$1,903.97 ","$1,923.20 ","$0.00 ","$301.43 ","$66.70 ","$382.72 ","$0.00 "
"36102233","EAP","CPT� 51705","","Change Bladder Tube","BOTH IP/OP","$626.00 ","$463.24 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$235.59 ","$625.00 ","$495.00 ","$500.00 ","$327.32 ","$86.33 ","$54.08 ","$99.50 ","$224.37 "
"36102235","EAP","CPT� 55700","","Biopsy, Prostate","BOTH IP/OP","$4,494.00 ","$3,325.56 ","$0.00 ","$4,494.00 ","$0.00 ","$0.00 ","$938.95 ","$3,207.37 ","$3,207.37 ","$786.86 ","$4,494.00 ","$1,776.76 ","$2,327.00 ","$3,559.25 ","$3,595.20 ","$2,468.57 ","$147.73 ","$135.95 ","$715.44 ","$1,692.15 "
"36102238","EAP","CPT� 61070","","puncture of shunt tubling injectio","BOTH IP/OP","$2,457.00 ","$1,818.18 ","$0.00 ","$2,271.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,271.00 ","$0.00 ","$2,255.00 ","$1,798.63 ","$1,816.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102239","EAP","CPT� 62269","","Biopsy, Spinal Cord","BOTH IP/OP","$3,386.00 ","$2,505.64 ","$0.00 ","$3,386.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,386.00 ","$0.00 ","$2,255.00 ","$2,681.71 ","$2,708.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102241","EAP","CPT� 62281","","Injection Cervical Or Thoracic Epidural","BOTH IP/OP","$1,751.00 ","$1,295.74 ","$0.00 ","$1,751.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,751.00 ","$0.00 ","$1,751.00 ","$1,386.79 ","$1,400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102244","EAP","CPT� 64479","","Injection Cervical/Thoracic sngl LEVel","BOTH IP/OP","$3,510.00 ","$2,597.40 ","$0.00 ","$3,387.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,387.00 ","$0.00 ","$2,255.00 ","$2,682.50 ","$2,709.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102245","EAP","CPT� 64480","","Injection Cervical/thoracic, Each Additional Level","BOTH IP/OP","$1,576.00 ","$1,166.24 ","$0.00 ","$1,726.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,726.00 ","$0.00 ","$1,726.00 ","$1,366.99 ","$1,380.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102249","EAP","CPT� 36593","","Declotting Vasc Device","BOTH IP/OP","$2,030.00 ","$1,502.20 ","$0.00 ","$1,624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$284.35 ","$1,624.00 ","$310.51 ","$1,624.00 ","$1,286.21 ","$1,299.20 ","$431.41 ","$30.97 ","$32.05 ","$258.54 ","$295.72 "
"36102255","EAP","CPT� 49460","","Mechanical Removal Obstructive Material G-, J-, G-j, C O","BOTH IP/OP","$3,566.00 ","$2,638.84 ","$50.85 ","$3,429.00 ","$2,321.55 ","$792.43 ","$743.24 ","$2,447.28 ","$2,447.28 ","$600.39 ","$3,429.00 ","$788.23 ","$2,255.00 ","$2,715.77 ","$2,743.20 ","$1,095.14 ","$727.94 ","$50.85 ","$545.90 ","$750.70 "
"36102260","EAP","CPT� 66030","","Injection Eye Treatment(medication)","BOTH IP/OP","$4,930.00 ","$3,648.20 ","$0.00 ","$5,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,312.00 ","$0.00 ","$2,255.00 ","$4,207.10 ","$4,249.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102262","EAP","CPT� 59830","","Treatment Of Septic Abortion, Completed","BOTH IP/OP","$3,807.00 ","$2,817.18 ","$0.00 ","$3,807.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,807.00 ","$0.00 ","$2,255.00 ","$3,015.14 ","$3,045.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102280","EAP","CPT� 41825","","Exc. Of Gum Lesion","BOTH IP/OP","$3,942.00 ","$2,917.08 ","$0.00 ","$3,979.00 ","$2,321.55 ","$2,679.15 ","$821.61 ","$0.00 ","$0.00 ","$0.00 ","$3,979.00 ","$0.00 ","$2,255.00 ","$3,151.37 ","$3,183.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102281","EAP","CPT� 41899","","Simple Tooth Extraction","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$1,341.76 ","$1,341.76 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"36102284","EAP","CPT� 51728","","Cystometrogram W/vp","BOTH IP/OP","$621.00 ","$459.54 ","$0.00 ","$790.00 ","$621.00 ","$563.41 ","$129.43 ","$0.00 ","$0.00 ","$0.00 ","$790.00 ","$0.00 ","$790.00 ","$625.68 ","$632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102285","EAP","CPT� 36002","","Thrombin Injection For Percutaneours Pseudoaneurysm","BOTH IP/OP","$2,021.00 ","$1,495.54 ","$0.00 ","$2,313.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,313.00 ","$0.00 ","$2,255.00 ","$1,831.90 ","$1,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102290","EAP","CPT� 41899","","Comp Bony W/surg.comp","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$0.00 ","$0.00 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"36102310","EAP","CPT� 37191","","Ins Endovas Vena Cava Filter","BOTH IP/OP","$25,113.00 ","$18,583.62 ","$0.00 ","$23,839.00 ","$2,984.10 ","$4,670.08 ","$5,234.18 ","$0.00 ","$0.00 ","$0.00 ","$23,839.00 ","$0.00 ","$2,858.00 ","$18,880.49 ","$19,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102311","EAP","CPT� 37192","","Reposition Endov Vena Cava Fil","BOTH IP/OP","$17,233.00 ","$12,752.42 ","$0.00 ","$16,359.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,359.00 ","$0.00 ","$2,858.00 ","$12,956.33 ","$13,087.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102312","EAP","CPT� 37193","","Replace Endovas Vena Cava Fil","BOTH IP/OP","$17,233.00 ","$12,752.42 ","$0.00 ","$16,359.00 ","$2,984.10 ","$2,803.47 ","$0.00 ","$11,675.42 ","$5,416.74 ","$2,864.33 ","$16,359.00 ","$2,779.42 ","$2,858.00 ","$12,956.33 ","$13,087.20 ","$3,861.64 ","$0.00 ","$365.30 ","$2,604.35 ","$2,647.07 "
"36102313","EAP","CPT� 36251","","Sel Cath Plmt Renal 1st Ord Uni","BOTH IP/OP","$15,451.00 ","$11,433.74 ","$0.00 ","$13,011.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,011.00 ","$0.00 ","$2,858.00 ","$10,304.71 ","$10,408.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102314","EAP","CPT� 36252","","Sel Cath Plmt Renal 1st Ord Bil","BOTH IP/OP","$15,451.00 ","$11,433.74 ","$0.00 ","$13,011.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,011.00 ","$0.00 ","$2,858.00 ","$10,304.71 ","$10,408.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102315","EAP","CPT� 36253","","Sprsel Cath Pl Rena 1st Ord Uni","BOTH IP/OP","$15,451.00 ","$11,433.74 ","$0.00 ","$13,011.00 ","$0.00 ","$0.00 ","$0.00 ","$9,285.95 ","$5,416.74 ","$2,278.12 ","$13,011.00 ","$4,609.70 ","$2,858.00 ","$10,304.71 ","$10,408.80 ","$6,404.56 ","$2,156.13 ","$373.25 ","$2,071.35 ","$4,390.19 "
"36102316","EAP","CPT� 36254","","Sprsel Cath Pl Rena 1st Ord Bil","BOTH IP/OP","$11,366.00 ","$8,410.84 ","$0.00 ","$13,011.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,011.00 ","$0.00 ","$2,858.00 ","$10,304.71 ","$10,408.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102317","EAP","CPT� 37619","","Ligate Inferior Vena Cava","BOTH IP/OP","$14,820.00 ","$10,966.80 ","$0.00 ","$15,783.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,783.00 ","$0.00 ","$2,327.00 ","$12,500.14 ","$12,626.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102318","EAP","CPT� 64633","","Dstr Cerv/thor Paravet Sngl","BOTH IP/OP","$1,742.00 ","$1,289.08 ","$0.00 ","$1,751.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,751.00 ","$0.00 ","$1,751.00 ","$1,386.79 ","$1,400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102319","EAP","CPT� 64634","","Dstr Cerv/thor Paravet Ea Addl","BOTH IP/OP","$577.00 ","$426.98 ","$0.00 ","$580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$580.00 ","$0.00 ","$290.00 ","$459.36 ","$464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102320","EAP","CPT� 64635","","Unilateral Dstr Lumb/sac Paravet; Sngl","BOTH IP/OP","$2,835.00 ","$2,097.90 ","$229.68 ","$2,850.00 ","$2,321.55 ","$1,719.60 ","$590.88 ","$2,034.05 ","$2,034.05 ","$499.01 ","$2,850.00 ","$1,724.40 ","$2,255.00 ","$2,257.20 ","$2,280.00 ","$2,395.83 ","$425.03 ","$229.68 ","$453.72 ","$1,642.29 "
"36102321","EAP","CPT� 64636","","Unilateral Dstr Lumb/sac Paravet; Ea Addl","BOTH IP/OP","$1,653.00 ","$1,223.22 ","$0.00 ","$1,662.00 ","$1,653.00 ","$0.00 ","$344.53 ","$0.00 ","$0.00 ","$291.00 ","$1,662.00 ","$0.00 ","$831.00 ","$1,316.30 ","$1,329.60 ","$0.00 ","$178.62 ","$62.03 ","$264.59 ","$0.00 "
"36102322","EAP","CPT� 36222","","Ir Sel Cath Plac Ext Carotid Angio W/s&i","BOTH IP/OP","$32,310.00 ","$23,909.40 ","$0.00 ","$28,662.00 ","$0.00 ","$0.00 ","$7,094.16 ","$0.00 ","$0.00 ","$0.00 ","$28,662.00 ","$0.00 ","$2,858.00 ","$22,700.30 ","$22,929.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102323","EAP","CPT� 36223","","Ir Sel Cath Plac Common Inom Intracranial Carotid","BOTH IP/OP","$31,070.00 ","$22,991.80 ","$0.00 ","$27,562.00 ","$0.00 ","$0.00 ","$6,821.75 ","$19,671.00 ","$5,416.74 ","$4,825.89 ","$27,562.00 ","$4,609.70 ","$2,858.00 ","$21,829.10 ","$22,049.60 ","$6,404.56 ","$1,513.65 ","$330.96 ","$4,387.87 ","$4,390.19 "
"36102324","EAP","CPT� 36224","","Ir Sel Cath Plac Internal Carotid Intracranial Carotid","BOTH IP/OP","$37,454.00 ","$27,715.96 ","$376.00 ","$31,540.00 ","$2,984.10 ","$4,670.08 ","$7,806.35 ","$22,510.10 ","$5,416.74 ","$5,522.40 ","$31,540.00 ","$4,609.70 ","$4,975.00 ","$24,979.68 ","$25,232.00 ","$6,404.56 ","$1,644.17 ","$376.00 ","$5,021.17 ","$4,390.19 "
"36102325","EAP","CPT� 36225","","Ir Sel Cath Plac Sub Clav, Innom, Bilat W/angio  S&i","BOTH IP/OP","$31,070.00 ","$22,991.80 ","$0.00 ","$27,562.00 ","$0.00 ","$0.00 ","$6,821.75 ","$0.00 ","$0.00 ","$0.00 ","$27,562.00 ","$0.00 ","$2,858.00 ","$21,829.10 ","$22,049.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102326","EAP","CPT� 36226","","Ir Sel Cath Plac Sub Calv, Vert W/angio S&i","BOTH IP/OP","$57,197.00 ","$42,325.78 ","$0.00 ","$50,739.00 ","$0.00 ","$0.00 ","$9,417.94 ","$36,212.42 ","$5,416.74 ","$8,138.89 ","$50,739.00 ","$4,609.70 ","$4,975.00 ","$40,185.29 ","$40,591.20 ","$6,404.56 ","$1,676.21 ","$370.60 ","$8,077.65 ","$4,390.19 "
"36102327","EAP","CPT� 36227","","Ir Sel Cath Plac Ext Carotid W/angio S&i","BOTH IP/OP","$31,070.00 ","$22,991.80 ","$0.00 ","$27,562.00 ","$0.00 ","$0.00 ","$6,821.75 ","$0.00 ","$0.00 ","$0.00 ","$27,562.00 ","$0.00 ","$13,781.00 ","$21,829.10 ","$22,049.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102328","EAP","CPT� 36228","","Ir Sel Cath Plac Intra Internal Carotid Or Vert W/angio S&i","BOTH IP/OP","$53,827.00 ","$39,831.98 ","$0.00 ","$61,615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61,615.00 ","$0.00 ","$30,807.50 ","$48,799.08 ","$49,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102329","EAP","CPT� 10035","","Placement Of Soft Tissue Localization Device; 1st","BOTH IP/OP","$1,630.00 ","$1,206.20 ","$0.00 ","$1,641.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,641.00 ","$0.00 ","$820.50 ","$1,299.67 ","$1,312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102330","EAP","CPT� 11045","","Excl Debride- Subq > 20sq Cm","BOTH IP/OP","$2,528.00 ","$1,870.72 ","$0.00 ","$2,403.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,403.00 ","$0.00 ","$1,201.50 ","$1,903.18 ","$1,922.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102331","EAP","CPT� 11046","","Excl Debride- Muscle > 20sq Cm","BOTH IP/OP","$2,528.00 ","$1,870.72 ","$0.00 ","$2,403.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,403.00 ","$0.00 ","$1,201.50 ","$1,903.18 ","$1,922.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102332","EAP","CPT� 11047","","Excl Debride-bone > 20 Sq Cm","BOTH IP/OP","$6,167.00 ","$4,563.58 ","$0.00 ","$6,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,188.00 ","$0.00 ","$3,094.00 ","$4,900.90 ","$4,950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102333","EAP","CPT� 11755","","Biopsy Of Nail Unit","BOTH IP/OP","$978.00 ","$723.72 ","$0.00 ","$987.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.00 ","$0.00 ","$987.00 ","$781.70 ","$789.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102334","EAP","CPT� 15004","","Site Prep-100 Sq Cm (hands, Feet)","BOTH IP/OP","$2,328.00 ","$1,722.72 ","$0.00 ","$2,328.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,328.00 ","$0.00 ","$2,327.00 ","$1,843.78 ","$1,862.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102341","EAP","CPT� 29581","","Apply Multlay Comprs Lwr Leg","BOTH IP/OP","$478.00 ","$353.72 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102342","EAP","CPT� 97602","","REM/DEBRIDE DEVITALIZED TISSUE W/O ANES","BOTH IP/OP","$386.00 ","$285.64 ","$0.00 ","$352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$352.00 ","$0.00 ","$176.00 ","$278.78 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102343","EAP","CPT� 10036","","Placement Of Soft Tissue Localization Device; Each","BOTH IP/OP","$1,630.00 ","$1,206.20 ","$0.00 ","$1,641.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,641.00 ","$0.00 ","$820.50 ","$1,299.67 ","$1,312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102344","EAP","CPT� 41110","","Exc. Of Tongue Lesion W/o  Closure","BOTH IP/OP","$3,523.00 ","$2,607.02 ","$0.00 ","$3,523.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,523.00 ","$0.00 ","$2,255.00 ","$2,790.22 ","$2,818.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102345","EAP","CPT� 41820","","Exc. Gum Each Quad(gingivectomy)","BOTH IP/OP","$2,596.00 ","$1,921.04 ","$0.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,300.00 ","$0.00 ","$2,255.00 ","$1,821.60 ","$1,840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102346","EAP","CPT� 30580","","Repair Upper Jaw Fistula,","BOTH IP/OP","$9,049.00 ","$6,696.26 ","$0.00 ","$9,049.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,049.00 ","$0.00 ","$3,606.00 ","$7,166.81 ","$7,239.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102347","EAP","CPT� 26605","","Treat Metacarpal Fx","BOTH IP/OP","$647.00 ","$478.78 ","$0.00 ","$647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$647.00 ","$0.00 ","$647.00 ","$512.42 ","$517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102360","EAP","CPT� 55100","","Drainage Of Scrotum Abcess","BOTH IP/OP","$2,572.00 ","$1,903.28 ","$0.00 ","$2,598.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,598.00 ","$0.00 ","$2,255.00 ","$2,057.62 ","$2,078.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102362","EAP","CPT� 19081","","Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese","BOTH IP/OP","$6,618.00 ","$4,897.32 ","$173.82 ","$6,685.00 ","$2,753.10 ","$1,377.93 ","$1,379.36 ","$4,771.08 ","$4,771.08 ","$1,170.49 ","$6,685.00 ","$1,376.63 ","$2,255.00 ","$5,294.52 ","$5,348.00 ","$1,912.65 ","$649.79 ","$173.82 ","$1,064.25 ","$1,311.08 "
"36102363","EAP","CPT� 19082","","Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'e","BOTH IP/OP","$4,964.00 ","$3,673.36 ","$0.00 ","$5,014.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,014.00 ","$0.00 ","$2,507.00 ","$3,971.09 ","$4,011.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102364","EAP","CPT� 19083","","Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese","BOTH IP/OP","$7,720.00 ","$5,712.80 ","$164.44 ","$7,798.00 ","$2,753.10 ","$1,377.93 ","$1,609.04 ","$5,565.43 ","$5,416.74 ","$1,365.37 ","$7,798.00 ","$1,376.63 ","$2,255.00 ","$6,176.02 ","$6,238.40 ","$1,912.65 ","$645.55 ","$164.44 ","$1,241.44 ","$1,311.08 "
"36102365","EAP","CPT� 19084","","Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'e","BOTH IP/OP","$5,433.00 ","$4,020.42 ","$0.00 ","$5,488.00 ","$2,321.55 ","$0.00 ","$1,132.37 ","$3,916.79 ","$3,916.79 ","$960.90 ","$5,488.00 ","$0.00 ","$2,744.00 ","$4,346.50 ","$4,390.40 ","$0.00 ","$518.83 ","$81.14 ","$873.69 ","$0.00 "
"36102366","EAP","CPT� 19085","","Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese","BOTH IP/OP","$7,925.00 ","$5,864.50 ","$0.00 ","$8,005.00 ","$0.00 ","$0.00 ","$0.00 ","$5,713.17 ","$5,416.74 ","$1,401.61 ","$8,005.00 ","$1,376.63 ","$2,255.00 ","$6,339.96 ","$6,404.00 ","$1,912.65 ","$0.00 ","$190.41 ","$1,274.40 ","$1,311.08 "
"36102367","EAP","CPT� 19086","","Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'l Lesion Inc Mri Guide","BOTH IP/OP","$4,847.00 ","$3,586.78 ","$0.00 ","$6,003.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,003.00 ","$0.00 ","$3,001.50 ","$4,754.38 ","$4,802.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102368","EAP","CPT� 19281","","Plce Breast Local Dev Percut 1st Lesion Inc Mammo Guide","BOTH IP/OP","$2,033.00 ","$1,504.42 ","$104.58 ","$2,033.00 ","$2,033.00 ","$609.42 ","$423.73 ","$1,447.38 ","$1,447.38 ","$355.09 ","$2,028.00 ","$611.80 ","$2,028.00 ","$1,606.18 ","$1,622.40 ","$850.02 ","$234.02 ","$104.58 ","$322.86 ","$582.67 "
"36102369","EAP","CPT� 19282","","Plce Breast Local Dev Percut Ea Add'l Lesion Inc Mammo Guide","BOTH IP/OP","$1,526.00 ","$1,129.24 ","$0.00 ","$1,522.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.49 ","$1,522.00 ","$0.00 ","$761.00 ","$1,205.42 ","$1,217.60 ","$0.00 ","$162.73 ","$52.65 ","$242.30 ","$0.00 "
"36102370","EAP","CPT� 19283","","Plce Breast Local Dev Percut 1st Lesion Inc Stereo Guide","BOTH IP/OP","$3,496.00 ","$2,587.04 ","$0.00 ","$3,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,496.00 ","$0.00 ","$2,255.00 ","$2,768.83 ","$2,796.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102371","EAP","CPT� 19284","","Plce Breast Local Dev Percut Ea Add'l Lesion Inc Stereo Guide","BOTH IP/OP","$2,623.00 ","$1,941.02 ","$0.00 ","$2,623.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,623.00 ","$0.00 ","$1,311.50 ","$2,077.42 ","$2,098.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102372","EAP","CPT� 19285","","Plce Breast Local Dev Percut 1st Lesion Inc Ultrsnd Guide","BOTH IP/OP","$1,641.00 ","$1,214.34 ","$0.00 ","$1,641.00 ","$1,641.00 ","$609.42 ","$342.03 ","$0.00 ","$0.00 ","$286.63 ","$1,637.00 ","$611.80 ","$1,637.00 ","$1,296.50 ","$1,309.60 ","$850.02 ","$450.73 ","$89.79 ","$260.61 ","$582.67 "
"36102373","EAP","CPT� 19286","","Plce Breast Local Dev Percut Ea Add'l Lesion Inc Ultrsnd Guide","BOTH IP/OP","$1,231.00 ","$910.94 ","$0.00 ","$1,228.00 ","$0.00 ","$0.00 ","$256.57 ","$0.00 ","$0.00 ","$215.01 ","$1,228.00 ","$0.00 ","$614.00 ","$972.58 ","$982.40 ","$0.00 ","$434.23 ","$45.44 ","$195.50 ","$0.00 "
"36102374","EAP","CPT� 19287","","Plce Breast Local Dev Percut 1st Lesion Inc Stereo Guide","BOTH IP/OP","$5,193.00 ","$3,842.82 ","$0.00 ","$5,193.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,193.00 ","$0.00 ","$2,255.00 ","$4,112.86 ","$4,154.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102375","EAP","CPT� 19288","","Plce Breast Local Dev Percut Ea Add'l Lesion Inc Mri Guide","BOTH IP/OP","$3,894.00 ","$2,881.56 ","$0.00 ","$3,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,894.00 ","$0.00 ","$1,947.00 ","$3,084.05 ","$3,115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36102376","EAP","CPT� 10030","","Perq Image-guided Catheter Fluid Collection","BOTH IP/OP","$1,213.00 ","$897.62 ","$0.00 ","$1,221.00 ","$0.00 ","$0.00 ","$252.82 ","$0.00 ","$0.00 ","$213.79 ","$1,221.00 ","$611.80 ","$1,221.00 ","$967.03 ","$976.80 ","$850.02 ","$754.70 ","$143.53 ","$194.38 ","$582.67 "
"36102380","EAP","CPT� 67028","","Injection Intravitreal Drug-both Eyes","BOTH IP/OP","$3,267.00 ","$2,417.58 ","$100.58 ","$3,300.00 ","$2,321.55 ","$312.26 ","$680.92 ","$2,355.21 ","$2,355.21 ","$577.80 ","$3,300.00 ","$310.51 ","$2,255.00 ","$2,613.60 ","$2,640.00 ","$431.41 ","$307.74 ","$100.58 ","$525.36 ","$295.72 "
"36103335","EAP","CPT� 57135","","Remove Vagina Lesion","BOTH IP/OP","$3,669.00 ","$2,715.06 ","$0.00 ","$3,706.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,706.00 ","$0.00 ","$2,327.00 ","$2,935.15 ","$2,964.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103340","EAP","CPT� 64642","","Chemodenerv 1 Extermity 1-4","BOTH IP/OP","$3,119.00 ","$2,308.06 ","$111.39 ","$3,136.00 ","$2,321.55 ","$621.87 ","$650.08 ","$2,238.16 ","$2,238.16 ","$549.09 ","$3,136.00 ","$626.89 ","$2,255.00 ","$2,483.71 ","$2,508.80 ","$870.98 ","$134.17 ","$111.39 ","$499.25 ","$597.04 "
"36103341","EAP","CPT� 64643","","Chemodenerv 1 Exterm  1-4 Ea","BOTH IP/OP","$2,339.00 ","$1,730.86 ","$0.00 ","$2,352.00 ","$2,321.55 ","$0.00 ","$487.51 ","$1,678.62 ","$1,678.62 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$88.23 ","$74.27 ","$374.44 ","$0.00 "
"36103342","EAP","CPT� 64644","","Chemodenerv 1 Exterm --5/>mus","BOTH IP/OP","$3,701.00 ","$2,738.74 ","$121.48 ","$3,721.00 ","$2,321.55 ","$621.87 ","$771.38 ","$2,655.68 ","$2,655.68 ","$651.52 ","$3,721.00 ","$626.89 ","$2,255.00 ","$2,947.03 ","$2,976.80 ","$870.98 ","$153.25 ","$121.48 ","$592.38 ","$597.04 "
"36103343","EAP","CPT� 64645","","Chemodenerv 1 Exterm --5/> Ea","BOTH IP/OP","$2,775.00 ","$2,053.50 ","$0.00 ","$2,790.00 ","$2,321.55 ","$0.00 ","$578.38 ","$1,991.22 ","$1,991.22 ","$488.51 ","$2,790.00 ","$0.00 ","$1,395.00 ","$2,209.68 ","$2,232.00 ","$0.00 ","$107.96 ","$85.44 ","$444.17 ","$0.00 "
"36103344","EAP","CPT� 64646","","Chemodenerv Trunk Musc 1-5","BOTH IP/OP","$3,119.00 ","$2,308.06 ","$119.68 ","$3,136.00 ","$2,321.55 ","$621.87 ","$650.08 ","$2,238.16 ","$2,238.16 ","$549.09 ","$3,136.00 ","$626.89 ","$2,255.00 ","$2,483.71 ","$2,508.80 ","$870.98 ","$144.35 ","$119.68 ","$499.25 ","$597.04 "
"36103345","EAP","CPT� 64647","","Chemodenerv Trunk Musc 6/>","BOTH IP/OP","$3,721.00 ","$2,753.54 ","$0.00 ","$3,721.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,721.00 ","$0.00 ","$2,255.00 ","$2,947.03 ","$2,976.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103352","EAP","CPT� 37239","","Open/peq Place Stent Ea Add","BOTH IP/OP","$20,475.00 ","$15,151.50 ","$0.00 ","$20,079.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,079.00 ","$0.00 ","$10,039.50 ","$15,902.57 ","$16,063.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103353","EAP","CPT� 37238","","Open/pero Place Stent Same","BOTH IP/OP","$45,270.00 ","$33,499.80 ","$0.00 ","$44,395.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44,395.00 ","$0.00 ","$6,105.00 ","$35,160.84 ","$35,516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103354","EAP","CPT� 37236","","Open/perq Place Stent 1st","BOTH IP/OP","$45,270.00 ","$33,499.80 ","$0.00 ","$44,395.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44,395.00 ","$0.00 ","$6,105.00 ","$35,160.84 ","$35,516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103355","EAP","CPT� 37237","","Open/perq Place Stent Ea Add","BOTH IP/OP","$18,237.00 ","$13,495.38 ","$0.00 ","$20,079.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,079.00 ","$0.00 ","$10,039.50 ","$15,902.57 ","$16,063.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103358","EAP","CPT� 37242","","Vasc Embolize/occlude Artery","BOTH IP/OP","$21,962.00 ","$16,251.88 ","$0.00 ","$21,537.00 ","$0.00 ","$0.00 ","$0.00 ","$15,370.96 ","$5,416.74 ","$3,770.96 ","$21,537.00 ","$9,937.60 ","$6,105.00 ","$17,057.30 ","$17,229.60 ","$13,806.97 ","$7,460.11 ","$499.45 ","$3,428.69 ","$9,464.38 "
"36103359","EAP","CPT� 37244","","Vasc Embolize/occlude Bleed","BOTH IP/OP","$21,962.00 ","$16,251.88 ","$0.00 ","$21,537.00 ","$2,984.10 ","$9,836.87 ","$4,577.43 ","$0.00 ","$0.00 ","$0.00 ","$21,537.00 ","$0.00 ","$6,105.00 ","$17,057.30 ","$17,229.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103361","EAP","CPT� 37241","","Vasc Embolize/occlude Venous","BOTH IP/OP","$21,962.00 ","$16,251.88 ","$0.00 ","$21,537.00 ","$2,984.10 ","$9,836.87 ","$4,577.43 ","$0.00 ","$0.00 ","$0.00 ","$21,537.00 ","$0.00 ","$6,105.00 ","$17,057.30 ","$17,229.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103374","EAP","CPT� 64616","","Chemodenerv  Musc Neck Dyston","BOTH IP/OP","$632.00 ","$467.68 ","$0.00 ","$635.00 ","$632.00 ","$255.86 ","$0.00 ","$0.00 ","$0.00 ","$111.18 ","$635.00 ","$262.54 ","$635.00 ","$502.92 ","$508.00 ","$364.76 ","$117.83 ","$113.17 ","$101.09 ","$250.04 "
"36103376","EAP","CPT� 37243","","Vasc Embolize/occlude Organ","BOTH IP/OP","$23,963.00 ","$17,732.62 ","$587.86 ","$23,500.00 ","$2,984.10 ","$9,836.87 ","$4,994.49 ","$16,771.95 ","$5,416.74 ","$4,114.66 ","$23,500.00 ","$9,937.60 ","$6,105.00 ","$18,612.00 ","$18,800.00 ","$13,806.97 ","$7,751.33 ","$587.86 ","$3,741.20 ","$9,464.38 "
"36103378","EAP","CPT� 34841","","Endovas Rp Vis A Dep Viscl Aort End, S/i,angio One","BOTH IP/OP","$19,007.00 ","$14,065.18 ","$0.00 ","$19,007.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,007.00 ","$0.00 ","$9,503.50 ","$15,053.54 ","$15,205.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103379","EAP","CPT� 34842","","Endovas Rp Vis A Dep Viscl Aort End S/i Angio Two","BOTH IP/OP","$20,567.00 ","$15,219.58 ","$0.00 ","$20,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,567.00 ","$0.00 ","$10,283.50 ","$16,289.06 ","$16,453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103380","EAP","CPT� 34843","","Endovas Rp Vis A Dep Viscl Aort End S/i Angio Three","BOTH IP/OP","$22,120.00 ","$16,368.80 ","$0.00 ","$22,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,120.00 ","$0.00 ","$11,060.00 ","$17,519.04 ","$17,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103381","EAP","CPT� 34844","","Endovas Rp Vis A Dep Viscl Aort End S/i Angio Four Or >","BOTH IP/OP","$23,672.00 ","$17,517.28 ","$0.00 ","$23,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,672.00 ","$0.00 ","$11,836.00 ","$18,748.22 ","$18,937.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103382","EAP","CPT� 34845","","Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio One","BOTH IP/OP","$23,049.00 ","$17,056.26 ","$0.00 ","$23,049.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,049.00 ","$0.00 ","$11,524.50 ","$18,254.81 ","$18,439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103383","EAP","CPT� 34846","","Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Two","BOTH IP/OP","$24,602.00 ","$18,205.48 ","$0.00 ","$24,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,602.00 ","$0.00 ","$12,301.00 ","$19,484.78 ","$19,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103384","EAP","CPT� 34847","","Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Three","BOTH IP/OP","$26,154.00 ","$19,353.96 ","$0.00 ","$26,154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26,154.00 ","$0.00 ","$13,077.00 ","$20,713.97 ","$20,923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103385","EAP","CPT� 34848","","Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Four Or >","BOTH IP/OP","$27,705.00 ","$20,501.70 ","$0.00 ","$27,705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,705.00 ","$0.00 ","$13,852.50 ","$21,942.36 ","$22,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103388","EAP","CPT� 20694","","Removal, Under Anesthesia, Of External Fix System","BOTH IP/OP","$5,413.00 ","$4,005.62 ","$0.00 ","$5,087.00 ","$0.00 ","$0.00 ","$0.00 ","$3,630.59 ","$3,630.59 ","$890.69 ","$5,087.00 ","$1,359.37 ","$2,255.00 ","$4,028.90 ","$4,069.60 ","$1,888.67 ","$337.82 ","$350.34 ","$809.85 ","$1,294.64 "
"36103390","EAP","CPT� 64617","","Chemodenervation Of Muscle(s); Larynx, Unilateral, Percd","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$855.00 ","$850.00 ","$255.86 ","$177.16 ","$0.00 ","$0.00 ","$0.00 ","$855.00 ","$0.00 ","$855.00 ","$677.16 ","$684.00 ","$0.00 ","$183.94 ","$0.00 ","$0.00 ","$0.00 "
"36103391","EAP","CPT� 66183","","Insertion Of Anterior Segment Aqueous Drainage Device, H","BOTH IP/OP","$6,247.00 ","$4,622.78 ","$0.00 ","$6,731.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,731.00 ","$0.00 ","$3,902.00 ","$5,330.95 ","$5,384.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103392","EAP","CPT� 49406","","Img-gde Fluid Collect Drain / Cath (eg, Abcss, Hema, Seu","BOTH IP/OP","$6,571.00 ","$4,862.54 ","$0.00 ","$6,160.00 ","$0.00 ","$0.00 ","$1,369.56 ","$0.00 ","$0.00 ","$0.00 ","$6,160.00 ","$0.00 ","$2,255.00 ","$4,878.72 ","$4,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103394","EAP","CPT� 52356","","Cysto, W/ Ureter And/or Pyelo; W/ Litho Inc Inst Of Ind ","BOTH IP/OP","$8,403.00 ","$6,218.22 ","$0.00 ","$8,488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,488.00 ","$0.00 ","$3,902.00 ","$6,722.50 ","$6,790.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103395","EAP","CPT� 49405","","Img-gde Fluid Collect Drain / Cath (eg, Abcss, Hema, Seu","BOTH IP/OP","$6,571.00 ","$4,862.54 ","$0.00 ","$6,160.00 ","$0.00 ","$0.00 ","$1,369.56 ","$0.00 ","$0.00 ","$0.00 ","$6,160.00 ","$0.00 ","$2,255.00 ","$4,878.72 ","$4,928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103396","EAP","CPT� 23333","","Removal Foreign Body Shoulder Deep Sub Fac/intra Musc","BOTH IP/OP","$2,755.00 ","$2,038.70 ","$0.00 ","$2,679.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,679.00 ","$0.00 ","$2,255.00 ","$2,121.77 ","$2,143.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103397","EAP","CPT� 31633","","Tranbronchial Needle Aspiration Biospy Ea Addtl  Lobe","BOTH IP/OP","$2,726.00 ","$2,017.24 ","$0.00 ","$2,726.00 ","$2,726.00 ","$0.00 ","$568.17 ","$1,903.44 ","$1,903.44 ","$466.97 ","$2,667.00 ","$0.00 ","$1,333.50 ","$2,112.26 ","$2,133.60 ","$0.00 ","$86.74 ","$65.64 ","$424.59 ","$0.00 "
"36103398","EAP","CPT� 31627","","Bronch With Computer-assisted, Image-guided Navigation","BOTH IP/OP","$3,577.00 ","$2,646.98 ","$0.00 ","$3,500.00 ","$2,321.55 ","$0.00 ","$745.54 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$879.48 ","$100.26 ","$557.20 ","$0.00 "
"36103399","EAP","HCPCS 64650","","Chemodenerv Eccrine Glands","BOTH IP/OP","$527.00 ","$389.98 ","$0.00 ","$530.00 ","$527.00 ","$255.86 ","$109.84 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$530.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103400","EAP","HCPCS 64653","","Chemodenerv Eccrine Other Scalp,face,neck","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$561.00 ","$0.00 ","$561.00 ","$444.31 ","$448.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103401","EAP","HCPCS 46221","","Ligation Of Hemorrhoid(s)","BOTH IP/OP","$2,229.00 ","$1,649.46 ","$119.76 ","$2,252.00 ","$2,229.00 ","$777.17 ","$464.58 ","$1,607.25 ","$1,607.25 ","$394.31 ","$2,252.00 ","$766.13 ","$2,252.00 ","$1,783.58 ","$1,801.60 ","$1,064.43 ","$119.76 ","$198.96 ","$358.52 ","$729.64 "
"36103402","EAP","CPT� 64450","","Adductor Canal","BOTH IP/OP","$2,850.00 ","$2,109.00 ","$44.35 ","$2,750.00 ","$2,321.55 ","$621.87 ","$594.01 ","$1,962.68 ","$1,962.68 ","$481.50 ","$2,750.00 ","$626.89 ","$2,255.00 ","$2,178.00 ","$2,200.00 ","$870.98 ","$85.27 ","$44.35 ","$437.80 ","$597.04 "
"36103404","EAP","CPT� 24200","","Removal Of Arm Foreign Body","BOTH IP/OP","$4,943.00 ","$3,657.82 ","$0.00 ","$4,807.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,807.00 ","$0.00 ","$2,255.00 ","$3,807.14 ","$3,845.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103405","EAP","CPT� 49425","","Insert Abdomen - Venous Drain","BOTH IP/OP","$24,132.00 ","$17,857.68 ","$0.00 ","$22,623.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,623.00 ","$0.00 ","$11,311.50 ","$17,917.42 ","$18,098.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103406","EAP","CPT� 54220","","Treatment Of Penis Lesion","BOTH IP/OP","$1,092.00 ","$808.08 ","$139.18 ","$1,103.00 ","$1,092.00 ","$260.60 ","$227.60 ","$1,103.00 ","$1,103.00 ","$193.13 ","$1,103.00 ","$235.59 ","$1,103.00 ","$873.58 ","$882.40 ","$327.32 ","$151.42 ","$139.18 ","$175.60 ","$224.37 "
"36103407","EAP","CPT� 17106","","Destruction Of Skin Lesions","BOTH IP/OP","$1,627.00 ","$1,203.98 ","$0.00 ","$1,627.00 ","$1,627.00 ","$338.49 ","$339.11 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$320.45 ","$1,625.00 ","$1,287.00 ","$1,300.00 ","$445.22 ","$0.00 ","$282.61 ","$258.70 ","$305.19 "
"36103410","EAP","CPT� 54205","","Injection For Peyronie Disease; W/surg Exp Plaque","BOTH IP/OP","$9,133.00 ","$6,758.42 ","$0.00 ","$10,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,398.00 ","$0.00 ","$3,606.00 ","$8,235.22 ","$8,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36103411","EAP","CPT� 55874","","Tprnl Plmt Biodegradable Matrl Periprostatic","BOTH IP/OP","$6,075.00 ","$4,495.50 ","$0.00 ","$6,060.00 ","$2,321.55 ","$4,320.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,060.00 ","$0.00 ","$5,452.00 ","$4,799.52 ","$4,848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191374","EAP","CPT� 64615","","Destroy Mucles Facial, Trigeminal, Cervical, Spinal ","BOTH IP/OP","$533.00 ","$394.42 ","$0.00 ","$536.00 ","$533.00 ","$255.86 ","$111.09 ","$0.00 ","$0.00 ","$93.85 ","$536.00 ","$262.54 ","$536.00 ","$424.51 ","$428.80 ","$364.76 ","$136.28 ","$127.95 ","$85.33 ","$250.04 "
"36191375","EAP","CPT� 58145","","Myomectomy Vag Method","BOTH IP/OP","$5,267.00 ","$3,897.58 ","$0.00 ","$5,009.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,009.00 ","$0.00 ","$3,902.00 ","$3,967.13 ","$4,007.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191376","EAP","CPT� 11982","","Remove Drug Implant Contraceptive","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$501.00 ","$265.79 ","$104.42 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$364.66 ","$500.00 ","$396.00 ","$400.00 ","$500.00 ","$128.55 ","$78.96 ","$79.60 ","$347.29 "
"36191377","EAP","CPT� 11983","","Remove With Reinsertion Of Drug Implant","BOTH IP/OP","$502.00 ","$371.48 ","$0.00 ","$502.00 ","$502.00 ","$265.79 ","$104.63 ","$0.00 ","$0.00 ","$87.72 ","$501.00 ","$364.66 ","$501.00 ","$396.79 ","$400.80 ","$501.00 ","$207.60 ","$108.53 ","$79.76 ","$347.29 "
"36191378","EAP","CPT� 64435","","Inj Anes/strd Paracervical Nerve","BOTH IP/OP","$1,923.00 ","$1,423.02 ","$0.00 ","$1,855.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,855.00 ","$0.00 ","$1,855.00 ","$1,469.16 ","$1,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191379","EAP","CPT� 65800","","Anterior Chamber Tap","BOTH IP/OP","$10,501.00 ","$7,770.74 ","$0.00 ","$10,501.00 ","$0.00 ","$0.00 ","$2,167.62 ","$7,494.56 ","$5,416.74 ","$1,838.64 ","$10,501.00 ","$2,027.80 ","$2,255.00 ","$8,316.79 ","$8,400.80 ","$2,817.36 ","$0.00 ","$93.03 ","$1,671.76 ","$1,931.24 "
"36191381","EAP","CPT� 31632","","Transbronchial Bx W/addl Lobe","BOTH IP/OP","$2,153.00 ","$1,593.22 ","$0.00 ","$2,153.00 ","$2,153.00 ","$0.00 ","$448.74 ","$1,503.77 ","$1,503.77 ","$368.92 ","$2,107.00 ","$0.00 ","$1,053.50 ","$1,668.74 ","$1,685.60 ","$0.00 ","$70.82 ","$51.57 ","$335.43 ","$0.00 "
"36191382","EAP","CPT� 31633","","Transbronchial Needle Bx W/addl Lobe","BOTH IP/OP","$2,667.00 ","$1,973.58 ","$0.00 ","$2,667.00 ","$2,667.00 ","$0.00 ","$555.87 ","$1,903.44 ","$1,903.44 ","$466.97 ","$2,667.00 ","$0.00 ","$1,333.50 ","$2,112.26 ","$2,133.60 ","$0.00 ","$86.74 ","$65.64 ","$424.59 ","$0.00 "
"36191383","EAP","CPT� 20950","","Compartment Pressure Measurement","BOTH IP/OP","$664.00 ","$491.36 ","$0.00 ","$664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.00 ","$0.00 ","$664.00 ","$525.89 ","$531.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191384","EAP","CPT� 23405","","Tenotomy, Shoulder Area; Single Tendon","BOTH IP/OP","$5,610.00 ","$4,151.40 ","$0.00 ","$5,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,700.00 ","$0.00 ","$2,327.00 ","$4,514.40 ","$4,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191385","EAP","CPT� 59151","","Treat Ectopic Pregnancy","BOTH IP/OP","$13,348.00 ","$9,877.52 ","$0.00 ","$13,348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,348.00 ","$0.00 ","$5,452.00 ","$10,571.62 ","$10,678.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191386","EAP","CPT� 24357","","Tenotomy, Elbow, Lateral Or Media; Percutaneous","BOTH IP/OP","$2,899.00 ","$2,145.26 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$2,858.00 ","$2,372.04 ","$2,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191387","EAP","CPT� 26055","","Tendon Sheath Incision","BOTH IP/OP","$2,440.00 ","$1,805.60 ","$0.00 ","$2,440.00 ","$2,440.00 ","$1,364.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,439.00 ","$0.00 ","$2,327.00 ","$1,931.69 ","$1,951.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191389","EAP","CPT� 64491","","Inj Paravert F Jnt C/t 2 Lev","BOTH IP/OP","$1,819.00 ","$1,346.06 ","$0.00 ","$1,819.00 ","$1,819.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,755.00 ","$0.00 ","$877.50 ","$1,389.96 ","$1,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191391","EAP","CPT� 27000","","Tenotomy, Adductor Of Hip, Percutaneous","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$1,575.00 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191392","EAP","CPT� 27005","","Tenotomy, Hip Flexor(s), Open","BOTH IP/OP","$1,961.00 ","$1,451.14 ","$0.00 ","$1,961.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.00 ","$0.00 ","$1,961.00 ","$1,553.11 ","$1,568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191393","EAP","CPT� 27006","","Tenotomy, Abductors And/or Extensor(s) Of Hip,open","BOTH IP/OP","$2,650.00 ","$1,961.00 ","$0.00 ","$2,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,650.00 ","$0.00 ","$2,255.00 ","$2,098.80 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191394","EAP","CPT� 27306","","Tenotomy, Percutaneous, Or Hamstring, Single Tendon","BOTH IP/OP","$5,757.00 ","$4,260.18 ","$0.00 ","$5,757.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,757.00 ","$0.00 ","$2,858.00 ","$4,559.54 ","$4,605.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191395","EAP","CPT� 27307","","Tenotomy, Percutaneous, Adductor Or Hamstring; Multiple Tendons","BOTH IP/OP","$8,511.00 ","$6,298.14 ","$0.00 ","$8,511.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,511.00 ","$0.00 ","$2,858.00 ","$6,740.71 ","$6,808.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191396","EAP","CPT� 27605","","Tenotomy, Percutaneous, Achilles Tendon ; Local Anesthesia","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$309.51 ","$1,208.73 ","$1,208.73 ","$262.64 ","$1,500.00 ","$1,359.37 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$1,500.00 ","$0.00 ","$192.52 ","$238.80 ","$1,294.64 "
"36191397","EAP","CPT� 28008","","Fasciotomy, Foot And/or Toe","BOTH IP/OP","$2,912.00 ","$2,154.88 ","$0.00 ","$3,083.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,083.00 ","$0.00 ","$2,858.00 ","$2,441.74 ","$2,466.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191398","EAP","CPT� 28899","","Unlisted Procedure, Foot Or Toes","BOTH IP/OP","$2,668.00 ","$1,974.32 ","$0.00 ","$2,649.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,649.00 ","$0.00 ","$2,255.00 ","$2,098.01 ","$2,119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191399","EAP","CPT� 64430","","Inj Anes/strd Pudendal Nerve","BOTH IP/OP","$995.00 ","$736.30 ","$0.00 ","$995.00 ","$995.00 ","$806.18 ","$207.38 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$960.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191400","EAP","CPT� 12037","","Intmd Wnd Repair S/tr/ext","BOTH IP/OP","$2,035.00 ","$1,505.90 ","$0.00 ","$1,907.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,907.00 ","$0.00 ","$1,907.00 ","$1,510.34 ","$1,525.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191401","EAP","CPT� 26070","","Arthrotomy W/expl,drain,rmvl Of Loose/fb Carpometacarpal Jnt","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191402","EAP","CPT� 26075","","Arthrotomy W/expl,drain,rmvl Of Loose/fb Metacarpophalangeal Jnt Ea","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,700.00 ","$0.00 ","$2,700.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191403","EAP","CPT� 26080","","Arthrotomy W/expl,drain,rmvl Of Loose/fb Interphalangeal Jnt Ea","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,575.00 ","$0.00 ","$2,575.00 ","$2,039.40 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191404","EAP","Custom 26320","","Removal Of Implant From Finger Or Hand","BOTH IP/OP","$1,581.00 ","$1,169.94 ","$0.00 ","$1,581.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,581.00 ","$0.00 ","$1,581.00 ","$1,252.15 ","$1,264.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191405","EAP","CPT� 26641","","Closed Treatment Of Carpometacarpal Dislocation,thumb,w/manipulation","BOTH IP/OP","$1,104.00 ","$816.96 ","$0.00 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,104.00 ","$0.00 ","$1,104.00 ","$874.37 ","$883.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191406","EAP","CPT� 26607","","Clsd Tx Of Metacarpal Fx, W/ Manip,w/external Fix Ea Bone","BOTH IP/OP","$3,176.00 ","$2,350.24 ","$0.00 ","$3,374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,374.00 ","$0.00 ","$2,327.00 ","$2,672.21 ","$2,699.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191407","EAP","CPT� 26645","","Clsd Tx Of Carpometacarpal Fx Disloc, Thumb  W/manip","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,593.00 ","$0.00 ","$1,593.00 ","$1,261.66 ","$1,274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191408","EAP","CPT� 26650","","Perc Skel Fix Of Carpometacarpal Fx Disloc Thumb W/ Manip","BOTH IP/OP","$5,811.00 ","$4,300.14 ","$0.00 ","$6,173.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,173.00 ","$0.00 ","$2,327.00 ","$4,889.02 ","$4,938.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191409","EAP","CPT� 26670","","Clsd Tx Of Carpometacarpal Disloc Not Thumb, W/manip Ea Jnt,w/o Anest","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,099.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,099.00 ","$0.00 ","$1,099.00 ","$870.41 ","$879.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191410","EAP","CPT� 26700","","Clsd Tx Of Metacarpophalangeal Disloc Single W/manip, W/o Anest","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$735.00 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191450","EAP","CPT� 69209","","Remove Cerumen Impacted Irrig/lavage Unilat","BOTH IP/OP","$274.00 ","$202.76 ","$0.00 ","$276.00 ","$274.00 ","$54.51 ","$57.11 ","$0.00 ","$0.00 ","$48.33 ","$276.00 ","$55.17 ","$276.00 ","$218.59 ","$220.80 ","$76.65 ","$12.24 ","$14.41 ","$43.94 ","$52.54 "
"36191451","EAP","CPT� 66761","","Iridotomy Laser Surgery-both Eyes","BOTH IP/OP","$11,463.00 ","$8,482.62 ","$240.80 ","$11,579.00 ","$2,321.55 ","$492.86 ","$2,389.18 ","$8,263.93 ","$5,416.74 ","$2,027.39 ","$11,579.00 ","$508.42 ","$2,255.00 ","$9,170.57 ","$9,263.20 ","$706.38 ","$315.03 ","$240.80 ","$1,843.38 ","$484.21 "
"36191452","EAP","CPT� 64405","","Inj Anes/strd Greater Occipital Nerve","BOTH IP/OP","$3,313.00 ","$2,451.62 ","$55.88 ","$3,197.00 ","$2,321.55 ","$255.86 ","$690.51 ","$2,281.70 ","$2,281.70 ","$559.77 ","$3,197.00 ","$262.54 ","$2,255.00 ","$2,532.02 ","$2,557.60 ","$364.76 ","$102.34 ","$55.88 ","$508.96 ","$250.04 "
"36191453","EAP","CPT� 64510","","Inject Stellate Ganglion","BOTH IP/OP","$1,767.00 ","$1,307.58 ","$0.00 ","$1,767.00 ","$1,767.00 ","$806.18 ","$368.29 ","$0.00 ","$0.00 ","$0.00 ","$1,705.00 ","$0.00 ","$1,705.00 ","$1,350.36 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191454","EAP","CPT� 64620","","Destroy Intercostal Neurolytic","BOTH IP/OP","$6,513.00 ","$4,819.62 ","$176.30 ","$6,548.00 ","$2,321.55 ","$806.18 ","$1,357.47 ","$4,673.31 ","$4,673.31 ","$1,146.50 ","$6,548.00 ","$814.44 ","$2,255.00 ","$5,186.02 ","$5,238.40 ","$1,131.55 ","$176.30 ","$181.36 ","$1,042.44 ","$775.65 "
"36191455","EAP","CPT� 64494","","Inj Paravert F Jnt L/s 2 Lev","BOTH IP/OP","$1,721.00 ","$1,273.54 ","$0.00 ","$1,721.00 ","$1,721.00 ","$0.00 ","$358.70 ","$0.00 ","$0.00 ","$290.83 ","$1,661.00 ","$0.00 ","$830.50 ","$1,315.51 ","$1,328.80 ","$0.00 ","$54.06 ","$53.73 ","$264.43 ","$0.00 "
"36191456","EAP","CPT� 64495","","Inj Paravert F Jnt L/s 3 Lev","BOTH IP/OP","$1,652.00 ","$1,222.48 ","$0.00 ","$1,652.00 ","$1,652.00 ","$0.00 ","$344.32 ","$0.00 ","$0.00 ","$0.00 ","$1,594.00 ","$0.00 ","$797.00 ","$1,262.45 ","$1,275.20 ","$0.00 ","$0.00 ","$54.45 ","$253.76 ","$0.00 "
"36191457","EAP","CPT� 64492","","Inj Paravert F Jnt C/t 3 Lev","BOTH IP/OP","$1,627.00 ","$1,203.98 ","$0.00 ","$1,627.00 ","$1,627.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,570.00 ","$0.00 ","$785.00 ","$1,243.44 ","$1,256.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191458","EAP","CPT� 64493","","Inj Paravert F Jnt L/s 1 Lev","BOTH IP/OP","$3,789.00 ","$2,803.86 ","$93.03 ","$3,656.00 ","$2,321.55 ","$806.18 ","$789.72 ","$2,609.29 ","$2,609.29 ","$640.14 ","$3,656.00 ","$814.44 ","$2,255.00 ","$2,895.55 ","$2,924.80 ","$1,131.55 ","$111.04 ","$93.03 ","$582.04 ","$775.65 "
"36191459","EAP","CPT� 64490","","Inj Paravert F Jnt C/t 1 Lev","BOTH IP/OP","$3,789.00 ","$2,803.86 ","$0.00 ","$3,656.00 ","$2,321.55 ","$806.18 ","$0.00 ","$2,609.29 ","$2,609.29 ","$640.14 ","$3,656.00 ","$814.44 ","$2,255.00 ","$2,895.55 ","$2,924.80 ","$1,131.55 ","$122.58 ","$109.61 ","$582.04 ","$775.65 "
"36191460","EAP","CPT� 64517","","Nblock Inj Hypogas Plxs","BOTH IP/OP","$3,493.00 ","$2,584.82 ","$0.00 ","$3,370.00 ","$2,753.10 ","$806.18 ","$728.03 ","$0.00 ","$0.00 ","$0.00 ","$3,370.00 ","$0.00 ","$2,327.00 ","$2,669.04 ","$2,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191461","EAP","CPT� 64418","","Inj Anes/strd Suprascapular","BOTH IP/OP","$3,173.00 ","$2,348.02 ","$59.14 ","$3,062.00 ","$2,321.55 ","$621.87 ","$661.33 ","$2,185.35 ","$2,185.35 ","$536.13 ","$3,062.00 ","$626.89 ","$2,255.00 ","$2,425.10 ","$2,449.60 ","$870.98 ","$104.21 ","$59.14 ","$487.47 ","$597.04 "
"36191462","EAP","CPT� 38222","","Bone Marrow Biopsy(ies) & Aspiration(s)","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$80.78 ","$2,325.71 ","$2,321.55 ","$2,322.02 ","$484.59 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$2,325.71 ","$2,000.00 ","$1,584.00 ","$1,600.00 ","$2,000.00 ","$164.87 ","$80.78 ","$318.40 ","$2,214.96 "
"36191464","EAP","CPT� 65855","","Argon Trabeculoplasty, Both Eyes","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$211.62 ","$4,441.00 ","$2,753.10 ","$492.86 ","$858.92 ","$3,169.54 ","$3,169.54 ","$777.58 ","$4,441.00 ","$508.42 ","$2,255.00 ","$3,517.27 ","$3,552.80 ","$706.38 ","$354.58 ","$211.62 ","$707.01 ","$484.21 "
"36191465","EAP","CPT� 67040","","Pan Retinal Photocoagulation, Both Eyes","BOTH IP/OP","$15,964.00 ","$11,813.36 ","$0.00 ","$16,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,125.00 ","$0.00 ","$4,975.00 ","$12,771.00 ","$12,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191466","EAP","CPT� 66821","","Yag Capsulotomy, Both Eyes","BOTH IP/OP","$3,181.00 ","$2,353.94 ","$188.16 ","$3,213.00 ","$2,753.10 ","$492.86 ","$663.00 ","$2,293.12 ","$2,293.12 ","$562.57 ","$3,213.00 ","$508.42 ","$2,327.00 ","$2,544.70 ","$2,570.40 ","$706.38 ","$188.16 ","$317.54 ","$511.51 ","$484.21 "
"36191467","EAP","CPT� 65865","","Argon Laser Gonioplasty, One Eye","BOTH IP/OP","$4,345.00 ","$3,215.30 ","$0.00 ","$4,389.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,389.00 ","$0.00 ","$2,255.00 ","$3,476.09 ","$3,511.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191468","EAP","CPT� 46230","","Excision Of Multiple External Papillae Or Tags, Anus","BOTH IP/OP","$4,962.00 ","$3,671.88 ","$0.00 ","$4,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,962.00 ","$0.00 ","$2,255.00 ","$3,929.90 ","$3,969.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191469","EAP","CPT� 31574","","Laryngoscopy W/ Inj Augmentation Unilateral","BOTH IP/OP","$3,605.00 ","$2,667.70 ","$0.00 ","$3,310.00 ","$0.00 ","$0.00 ","$751.37 ","$0.00 ","$0.00 ","$0.00 ","$3,310.00 ","$0.00 ","$2,255.00 ","$2,621.52 ","$2,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191470","EAP","CPT� 31574","","Laryngoscopy W/ Inj Augmentation Bilateral","BOTH IP/OP","$4,748.00 ","$3,513.52 ","$0.00 ","$4,966.00 ","$0.00 ","$0.00 ","$989.60 ","$0.00 ","$0.00 ","$0.00 ","$4,966.00 ","$0.00 ","$2,255.00 ","$3,933.07 ","$3,972.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191471","EAP","CPT� 62355","","Remove Spinal Canal Catheter","BOTH IP/OP","$7,880.00 ","$5,831.20 ","$0.00 ","$7,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,880.00 ","$0.00 ","$2,327.00 ","$6,240.96 ","$6,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191472","EAP","CPT� 64561","","Implant Neuroelectrodes Sacral Nerve","BOTH IP/OP","$11,177.00 ","$8,270.98 ","$0.00 ","$10,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,784.00 ","$0.00 ","$2,858.00 ","$8,540.93 ","$8,627.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191473","EAP","CPT� 64461","","Pvb Thoracic Single Inj Site","BOTH IP/OP","$4,312.00 ","$3,190.88 ","$0.00 ","$4,161.00 ","$2,321.55 ","$621.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,161.00 ","$0.00 ","$2,255.00 ","$3,295.51 ","$3,328.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191474","EAP","CPT� 64462","","Pvb Thoracic 2nd+ Inj Site","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,737.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.00 ","$0.00 ","$1,368.50 ","$2,167.70 ","$2,189.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191475","EAP","CPT� 55920","","Place Needles Pelvic For Rt","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,001.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,001.00 ","$0.00 ","$2,858.00 ","$7,920.79 ","$8,000.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191476","EAP","CPT� 36660","","Insertion Catheter Artery","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$180.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191477","EAP","CPT� 46910","","Destruction Anal Lesion(s)","BOTH IP/OP","$5,868.00 ","$4,342.32 ","$138.42 ","$5,927.00 ","$2,753.10 ","$1,677.37 ","$1,223.04 ","$4,230.10 ","$4,230.10 ","$1,037.77 ","$5,927.00 ","$1,553.51 ","$2,255.00 ","$4,694.18 ","$4,741.60 ","$2,158.40 ","$144.75 ","$138.42 ","$943.58 ","$1,479.54 "
"36191478","EAP","CPT� 66500","","Iridotomy By Stab Incision; Except Transfixion","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,119.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,119.00 ","$0.00 ","$2,255.00 ","$3,262.25 ","$3,295.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191479","EAP","CPT� 65435","","Curette/treat Cornea","BOTH IP/OP","$2,421.00 ","$1,791.54 ","$0.00 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,444.00 ","$0.00 ","$2,255.00 ","$1,935.65 ","$1,955.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191480","EAP","CPT� 65810","","Paracentesis Ant Cham W/ Rmvl Vitreous W/wo Air Inj","BOTH IP/OP","$6,052.00 ","$4,478.48 ","$0.00 ","$6,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,110.00 ","$0.00 ","$2,858.00 ","$4,839.12 ","$4,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191481","EAP","CPT� 27369","","Njx Px Cntrst Kne Arthg Cntrst Enhncd Ct/mri Kne","BOTH IP/OP","$1,323.00 ","$979.02 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191482","EAP","CPT� 33285","","Insertion Subq Cardiac Rhythm Monitor W/prgrmg","BOTH IP/OP","$12,848.00 ","$9,507.52 ","$92.65 ","$12,600.00 ","$2,321.55 ","$7,989.91 ","$2,677.84 ","$8,992.62 ","$5,416.74 ","$2,206.16 ","$12,600.00 ","$7,664.31 ","$6,105.00 ","$9,979.20 ","$10,080.00 ","$10,648.54 ","$4,971.59 ","$92.65 ","$2,005.92 ","$7,299.34 "
"36191483","EAP","CPT� 33286","","Removal Subcutaneous Cardiac Rhythm Monitor","BOTH IP/OP","$13,427.00 ","$9,935.98 ","$91.21 ","$13,167.00 ","$2,321.55 ","$609.42 ","$2,798.52 ","$9,397.29 ","$5,416.74 ","$2,305.44 ","$13,167.00 ","$611.80 ","$2,255.00 ","$10,428.26 ","$10,533.60 ","$850.02 ","$130.54 ","$91.21 ","$2,096.19 ","$582.67 "
"36191484","EAP","CPT� 10005","","Fna Bx W/ Us Guide 1st Lesion","BOTH IP/OP","$1,535.00 ","$1,135.90 ","$0.00 ","$1,546.00 ","$1,535.00 ","$609.42 ","$319.93 ","$0.00 ","$0.00 ","$270.69 ","$1,546.00 ","$611.80 ","$1,546.00 ","$1,224.43 ","$1,236.80 ","$850.02 ","$42.95 ","$74.65 ","$246.12 ","$582.67 "
"36191485","EAP","CPT� 10006","","Fna Bx W/ Us Guide Ea Addtl","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$528.00 ","$0.00 ","$0.00 ","$109.21 ","$0.00 ","$0.00 ","$92.45 ","$528.00 ","$0.00 ","$264.00 ","$418.18 ","$422.40 ","$0.00 ","$58.60 ","$51.21 ","$84.06 ","$0.00 "
"36191486","EAP","CPT� 10007","","Fna Bx W/ Fluoro Guide 1st Lesion","BOTH IP/OP","$1,535.00 ","$1,135.90 ","$0.00 ","$1,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,546.00 ","$0.00 ","$1,546.00 ","$1,224.43 ","$1,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191487","EAP","CPT� 10008","","Fna Bx W/ Fluoro Guide Ea Addtl","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$528.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$528.00 ","$0.00 ","$264.00 ","$418.18 ","$422.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191488","EAP","CPT� 10009","","Fna Bx W/ Ct Guide 1st Lesion","BOTH IP/OP","$1,535.00 ","$1,135.90 ","$0.00 ","$1,546.00 ","$1,535.00 ","$609.42 ","$319.93 ","$0.00 ","$0.00 ","$270.69 ","$1,546.00 ","$611.80 ","$1,546.00 ","$1,224.43 ","$1,236.80 ","$850.02 ","$451.42 ","$118.28 ","$246.12 ","$582.67 "
"36191489","EAP","CPT� 10010","","Fna Bx W/ Ct Guide Ea Addtl","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$528.00 ","$0.00 ","$0.00 ","$109.21 ","$0.00 ","$0.00 ","$92.45 ","$528.00 ","$0.00 ","$264.00 ","$418.18 ","$422.40 ","$0.00 ","$272.43 ","$85.83 ","$84.06 ","$0.00 "
"36191490","EAP","CPT� 10011","","Fna Bx W/ Mr Guide 1st Lesion","BOTH IP/OP","$1,535.00 ","$1,135.90 ","$0.00 ","$1,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,546.00 ","$0.00 ","$1,546.00 ","$1,224.43 ","$1,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191491","EAP","CPT� 10012","","Fna Bx W/ Mr Guide Ea Addtl","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$528.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$528.00 ","$0.00 ","$264.00 ","$418.18 ","$422.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191492","EAP","CPT� 11102","","Tangential (shave) Bx Skin; 1st Lesion","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$313.00 ","$175.86 ","$65.24 ","$0.00 ","$0.00 ","$54.80 ","$313.00 ","$175.24 ","$313.00 ","$247.90 ","$250.40 ","$243.48 ","$95.62 ","$40.38 ","$49.83 ","$166.90 "
"36191493","EAP","CPT� 11104","","Punch Bx Skin; 1st Lesion","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$313.00 ","$313.00 ","$65.24 ","$0.00 ","$0.00 ","$54.80 ","$313.00 ","$175.24 ","$313.00 ","$247.90 ","$250.40 ","$243.48 ","$120.20 ","$50.48 ","$49.83 ","$166.90 "
"36191494","EAP","CPT� 11106","","Incisional (wedge) Bx Skin; 1st Lesion","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$375.00 ","$375.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$320.45 ","$375.00 ","$297.00 ","$300.00 ","$375.00 ","$145.49 ","$60.94 ","$59.70 ","$305.19 "
"36191495","EAP","CPT� 11103","","Tangential (shave) Bx Skin; Ea Addtl","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$300.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$51.58 ","$23.44 ","$47.76 ","$0.00 "
"36191496","EAP","CPT� 11105","","Punch Bx Skin; Ea Addtl","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$300.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$59.11 ","$27.40 ","$47.76 ","$0.00 "
"36191497","EAP","CPT� 11107","","Incisional (wedge) Bx Skin; Ea Addtl","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191498","EAP","CPT� 43762","","Perq Replacement Gtube Not Req Rev Gastro Tract","BOTH IP/OP","$1,668.00 ","$1,234.32 ","$0.00 ","$1,604.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,604.00 ","$0.00 ","$1,604.00 ","$1,270.37 ","$1,283.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191499","EAP","CPT� 43763","","Perq Replacement Gtube Requiring Rev Gastro Tract","BOTH IP/OP","$1,668.00 ","$1,234.32 ","$0.00 ","$1,604.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,604.00 ","$0.00 ","$1,604.00 ","$1,270.37 ","$1,283.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191500","EAP","CPT� 50436","","Perq Dilation Xst Trc Endourologic Px W/img","BOTH IP/OP","$9,134.00 ","$6,759.16 ","$0.00 ","$9,134.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,134.00 ","$0.00 ","$2,255.00 ","$7,234.13 ","$7,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191501","EAP","CPT� 50437","","Perq Dilation Xst Trc New Access Renal Coltj Sys","BOTH IP/OP","$9,134.00 ","$6,759.16 ","$0.00 ","$9,134.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,134.00 ","$0.00 ","$3,902.00 ","$7,234.13 ","$7,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191502","EAP","CPT� 65436","","Curettage/treatment Cornea","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$5,499.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,499.00 ","$0.00 ","$2,255.00 ","$4,355.21 ","$4,399.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191503","EAP","CPT� 10004","","Fna Bx W/o Img Gdn Ea Addl","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$528.00 ","$524.00 ","$0.00 ","$109.21 ","$0.00 ","$0.00 ","$92.45 ","$528.00 ","$0.00 ","$264.00 ","$418.18 ","$422.40 ","$0.00 ","$51.12 ","$45.07 ","$84.06 ","$0.00 "
"36191504","EAP","CPT� 27369","","Ct/mr Contrast Enhanced Arthrg Knee Inj Px Bilateral","BOTH IP/OP","$1,984.00 ","$1,468.16 ","$0.00 ","$1,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,886.00 ","$0.00 ","$943.00 ","$1,493.71 ","$1,508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191505","EAP","CPT� 64635","","Bilateral Destr Lumb/sac Facet Jnt; Single","BOTH IP/OP","$4,252.00 ","$3,146.48 ","$229.68 ","$4,275.00 ","$2,321.55 ","$1,719.60 ","$886.22 ","$3,051.07 ","$3,051.07 ","$748.52 ","$4,275.00 ","$1,724.40 ","$2,255.00 ","$3,385.80 ","$3,420.00 ","$2,395.83 ","$425.03 ","$229.68 ","$680.58 ","$1,642.29 "
"36191507","EAP","CPT� 69209","","Remove Impacted Ear Wax Irrig/lavage Bil","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$414.00 ","$410.00 ","$54.51 ","$85.45 ","$0.00 ","$0.00 ","$72.49 ","$414.00 ","$55.17 ","$414.00 ","$327.89 ","$331.20 ","$76.65 ","$12.24 ","$14.41 ","$65.91 ","$52.54 "
"36191508","EAP","CPT� 36573","","Ins Picc W/ Imaging 5 Yr+","BOTH IP/OP","$5,719.00 ","$4,232.06 ","$88.35 ","$5,429.00 ","$2,321.55 ","$1,377.13 ","$1,191.98 ","$3,874.68 ","$3,874.68 ","$950.57 ","$5,429.00 ","$1,635.92 ","$2,255.00 ","$4,299.77 ","$4,343.20 ","$2,272.90 ","$849.64 ","$88.35 ","$864.30 ","$1,558.02 "
"36191509","EAP","CPT� 27266","","Clsd Tx Post Hip Arthroplasty Disloc","BOTH IP/OP","$4,283.00 ","$3,169.42 ","$0.00 ","$4,326.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,326.00 ","$0.00 ","$2,327.00 ","$3,426.19 ","$3,460.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191510","EAP","CPT� 15793","","Chemical Peel (tca) Nonfacial","BOTH IP/OP","$1,268.00 ","$938.32 ","$0.00 ","$1,188.00 ","$688.52 ","$338.49 ","$264.28 ","$0.00 ","$0.00 ","$208.01 ","$1,188.00 ","$320.45 ","$1,188.00 ","$940.90 ","$950.40 ","$445.22 ","$185.92 ","$362.58 ","$189.13 ","$305.19 "
"36191511","EAP","CPT� 46922","","Simple Excision Of Anal Lesion(s)","BOTH IP/OP","$7,021.00 ","$5,195.54 ","$0.00 ","$7,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,092.00 ","$0.00 ","$2,255.00 ","$5,616.86 ","$5,673.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191512","EAP","CPT� 20526","","Bilateral Carpal Tunnel Inj","BOTH IP/OP","$1,355.00 ","$1,002.70 ","$0.00 ","$1,356.00 ","$1,355.00 ","$255.86 ","$282.42 ","$0.00 ","$0.00 ","$237.42 ","$1,356.00 ","$262.54 ","$1,356.00 ","$1,073.95 ","$1,084.80 ","$364.76 ","$212.21 ","$59.49 ","$215.88 ","$250.04 "
"36191513","EAP","CPT� 64483","","Bil Inject Txforamen Epi L/s Sngl","BOTH IP/OP","$2,651.00 ","$1,961.74 ","$115.74 ","$2,558.00 ","$2,321.55 ","$806.18 ","$552.53 ","$1,825.64 ","$1,825.64 ","$447.89 ","$2,558.00 ","$814.44 ","$2,255.00 ","$2,025.94 ","$2,046.40 ","$1,131.55 ","$197.93 ","$115.74 ","$407.23 ","$775.65 "
"36191514","EAP","CPT� 67110","","Repair Retinal Detachment Inj Px","BOTH IP/OP","$7,476.00 ","$5,532.24 ","$0.00 ","$7,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,552.00 ","$0.00 ","$2,255.00 ","$5,981.18 ","$6,041.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191515","EAP","CPT� 11450","","Removal Sweat Gland Lesion","BOTH IP/OP","$8,560.00 ","$6,334.40 ","$0.00 ","$8,549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,549.00 ","$0.00 ","$2,327.00 ","$6,770.81 ","$6,839.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191516","EAP","CPT� 69210","","Bil Removal Impacted Cerumen Instrument","BOTH IP/OP","$613.00 ","$453.62 ","$0.00 ","$618.00 ","$613.00 ","$54.51 ","$127.76 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$55.17 ","$618.00 ","$489.46 ","$494.40 ","$76.65 ","$47.34 ","$34.61 ","$98.39 ","$52.54 "
"36191517","EAP","CPT� 45100","","Biopsy Of Rectum","BOTH IP/OP","$5,621.00 ","$4,159.54 ","$0.00 ","$5,609.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,609.00 ","$0.00 ","$2,255.00 ","$4,442.33 ","$4,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191518","EAP","CPT� 11462","","Excision Hidradenitis Inguinal Simple/interm","BOTH IP/OP","$7,409.00 ","$5,482.66 ","$0.00 ","$7,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,400.00 ","$0.00 ","$2,327.00 ","$5,860.80 ","$5,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191519","EAP","CPT� 20611","","Bilateral Drain/inject-shoulder Hip Knee With Us Guidance","BOTH IP/OP","$4,395.00 ","$3,252.30 ","$62.38 ","$4,400.00 ","$2,321.55 ","$255.86 ","$916.03 ","$3,140.28 ","$3,140.28 ","$770.40 ","$4,400.00 ","$262.54 ","$2,255.00 ","$3,484.80 ","$3,520.00 ","$364.76 ","$88.61 ","$62.38 ","$700.48 ","$250.04 "
"36191520","EAP","CPT� 55899","","Genital Surgery Procedure Unlisted","BOTH IP/OP","$5,214.00 ","$3,858.36 ","$0.00 ","$5,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,214.00 ","$0.00 ","$2,255.00 ","$4,129.49 ","$4,171.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191521","EAP","CPT� 53020","","Incision Of Urethra","BOTH IP/OP","$6,761.00 ","$5,003.14 ","$0.00 ","$6,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,781.00 ","$0.00 ","$2,255.00 ","$5,370.55 ","$5,424.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191522","EAP","CPT� 31636","","Bronchoscopy Initial Bronch Stent","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,005.00 ","$0.00 ","$2,327.00 ","$7,131.96 ","$7,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191523","EAP","CPT� 31637","","Bronchoscopy Addl Bronch Stent","BOTH IP/OP","$4,558.00 ","$3,372.92 ","$0.00 ","$4,558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,558.00 ","$0.00 ","$2,255.00 ","$3,609.94 ","$3,646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191524","EAP","CPT� 31638","","Bronchoscopy Stent Revision Incl Dilation","BOTH IP/OP","$8,711.00 ","$6,446.14 ","$0.00 ","$8,711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,711.00 ","$0.00 ","$2,327.00 ","$6,899.11 ","$6,968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191525","EAP","CPT� 64788","","Remove Nf Or Nl; Cutaneous Nerve","BOTH IP/OP","$7,647.00 ","$5,658.78 ","$0.00 ","$7,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,647.00 ","$0.00 ","$2,858.00 ","$6,056.42 ","$6,117.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191526","EAP","CPT� 64999","","Unlisted Neuro Px","BOTH IP/OP","$5,528.00 ","$4,090.72 ","$0.00 ","$5,488.00 ","$2,321.55 ","$255.86 ","$0.00 ","$3,916.79 ","$3,916.79 ","$960.90 ","$5,488.00 ","$262.54 ","$2,255.00 ","$4,346.50 ","$4,390.40 ","$364.76 ","$858.87 ","$0.00 ","$873.69 ","$250.04 "
"36191527","EAP","CPT� 49999","","Unlisted Abdominal Px","BOTH IP/OP","$8,000.00 ","$5,920.00 ","$0.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,000.00 ","$0.00 ","$2,255.00 ","$6,336.00 ","$6,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191528","EAP","CPT� 67911","","Bil Correction Of Lid Retraction","BOTH IP/OP","$6,479.00 ","$4,794.46 ","$0.00 ","$6,503.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,503.00 ","$0.00 ","$2,858.00 ","$5,150.38 ","$5,202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191529","EAP","CPT� 38794","","Access Thoracic Lymph Duct","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$2,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191530","EAP","CPT� 67025","","Bil Inj Substitute Pars Plana/limbl W/wo Asp Spx","BOTH IP/OP","$13,059.00 ","$9,663.66 ","$643.81 ","$13,059.00 ","$2,321.55 ","$2,033.69 ","$2,721.82 ","$9,320.21 ","$5,416.74 ","$2,286.53 ","$13,059.00 ","$2,027.80 ","$2,255.00 ","$10,342.73 ","$10,447.20 ","$2,817.36 ","$651.56 ","$643.81 ","$2,078.99 ","$1,931.24 "
"36191531","EAP","CPT� 67505","","Bil Retrobulbar Injection Alcohol","BOTH IP/OP","$1,265.00 ","$936.10 ","$0.00 ","$1,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,265.00 ","$0.00 ","$1,265.00 ","$1,001.88 ","$1,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191532","EAP","CPT� 68200","","Bil Subconjunctival Injection","BOTH IP/OP","$393.00 ","$290.82 ","$0.00 ","$393.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$393.00 ","$0.00 ","$393.00 ","$311.26 ","$314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191533","EAP","CPT� 67515","","Bil Injection Medication/other Subst Tenon Capsule","BOTH IP/OP","$2,730.00 ","$2,020.20 ","$0.00 ","$2,730.00 ","$0.00 ","$0.00 ","$569.00 ","$1,948.40 ","$1,948.40 ","$478.00 ","$2,730.00 ","$271.28 ","$2,255.00 ","$2,162.16 ","$2,184.00 ","$376.91 ","$137.37 ","$60.20 ","$434.62 ","$258.37 "
"36191534","EAP","CPT� 36831","","Thrmbc Opn Arven Fstl W/o Revj Dial Grf","BOTH IP/OP","$14,743.00 ","$10,909.82 ","$0.00 ","$14,743.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,743.00 ","$0.00 ","$6,105.00 ","$11,676.46 ","$11,794.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191535","EAP","CPT� 33016","","Pericardiocentesis W/imaging","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,385.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,385.00 ","$0.00 ","$1,385.00 ","$1,096.92 ","$1,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191536","EAP","CPT� 33017","","Perq Prcrd Drg 6yr+ W/o Congenital Car Anomaly","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$402.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.00 ","$0.00 ","$201.00 ","$318.38 ","$321.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191537","EAP","CPT� 33018","","Perq Prcrd Drg 0-5yr/any Age W/cgen Car Anomaly","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$402.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.00 ","$0.00 ","$201.00 ","$318.38 ","$321.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191540","EAP","CPT� 62328","","Dx Lumbar Puncture W/fl Or Ct Guidance","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$0.00 ","$1,571.00 ","$1,571.00 ","$621.87 ","$327.44 ","$0.00 ","$0.00 ","$261.41 ","$1,493.00 ","$626.89 ","$1,493.00 ","$1,182.46 ","$1,194.40 ","$870.98 ","$252.51 ","$93.39 ","$237.69 ","$597.04 "
"36191541","EAP","CPT� 62329","","Therapeutic Lumbar Puncture W/fl Or Ct Guidance","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$0.00 ","$1,493.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,493.00 ","$0.00 ","$1,493.00 ","$1,182.46 ","$1,194.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191550","EAP","CPT� 64451","","Injection Aa&/strd Nerves Nrvtg Si Joint W/img","BOTH IP/OP","$1,547.00 ","$1,144.78 ","$0.00 ","$1,547.00 ","$1,547.00 ","$621.87 ","$0.00 ","$0.00 ","$0.00 ","$261.41 ","$1,493.00 ","$626.89 ","$1,493.00 ","$1,182.46 ","$1,194.40 ","$870.98 ","$204.40 ","$82.58 ","$237.69 ","$597.04 "
"36191551","EAP","CPT� 64454","","Injection Aa&/strd Genicular Nrv Branches W/img","BOTH IP/OP","$1,547.00 ","$1,144.78 ","$0.00 ","$1,547.00 ","$1,547.00 ","$621.87 ","$322.43 ","$0.00 ","$0.00 ","$261.41 ","$1,493.00 ","$626.89 ","$1,493.00 ","$1,182.46 ","$1,194.40 ","$870.98 ","$206.45 ","$85.10 ","$237.69 ","$597.04 "
"36191552","EAP","CPT� 64624","","Destruction Neurolytic Agt Genicular Nerve W/img","BOTH IP/OP","$4,084.00 ","$3,022.16 ","$0.00 ","$4,106.00 ","$2,321.55 ","$1,719.60 ","$851.21 ","$2,930.45 ","$2,930.45 ","$718.93 ","$4,106.00 ","$1,724.40 ","$2,255.00 ","$3,251.95 ","$3,284.80 ","$2,395.83 ","$0.00 ","$152.52 ","$653.68 ","$1,642.29 "
"36191553","EAP","CPT� 64625","","Radiofrequency Abltj Nrv Nrvtg Si Jt W/img Gdn","BOTH IP/OP","$4,084.00 ","$3,022.16 ","$0.00 ","$4,106.00 ","$3,735.90 ","$1,719.60 ","$851.21 ","$2,930.45 ","$2,930.45 ","$718.93 ","$4,106.00 ","$1,724.40 ","$2,255.00 ","$3,251.95 ","$3,284.80 ","$2,395.83 ","$0.00 ","$201.56 ","$653.68 ","$1,642.29 "
"36191555","EAP","CPT� 64405","","Bil Greater Occipital Nerve Inj","BOTH IP/OP","$4,971.00 ","$3,678.54 ","$55.88 ","$4,796.00 ","$2,321.55 ","$255.86 ","$1,036.08 ","$3,422.91 ","$3,422.91 ","$839.74 ","$4,796.00 ","$262.54 ","$2,255.00 ","$3,798.43 ","$3,836.80 ","$364.76 ","$102.34 ","$55.88 ","$763.52 ","$250.04 "
"36191556","EAP","CPT� 52224","","Cystourethroscopy W/ Fulguration <.5cm Lesn","BOTH IP/OP","$3,924.00 ","$2,903.76 ","$0.00 ","$3,964.00 ","$0.00 ","$0.00 ","$817.86 ","$2,829.11 ","$2,829.11 ","$694.06 ","$3,964.00 ","$1,776.76 ","$2,327.00 ","$3,139.49 ","$3,171.20 ","$2,468.57 ","$272.85 ","$212.40 ","$631.07 ","$1,692.15 "
"36191560","EAP","CPT� 41008","","Submandibular Abscess","BOTH IP/OP","$4,919.00 ","$3,640.06 ","$0.00 ","$4,969.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,969.00 ","$0.00 ","$2,255.00 ","$3,935.45 ","$3,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191561","EAP","CPT� 42000","","I&d Abscess Plate, Uvula","BOTH IP/OP","$283.00 ","$209.42 ","$0.00 ","$286.00 ","$0.00 ","$0.00 ","$58.98 ","$286.00 ","$286.00 ","$50.08 ","$286.00 ","$204.24 ","$286.00 ","$226.51 ","$228.80 ","$283.76 ","$95.00 ","$107.41 ","$45.53 ","$194.51 "
"36191562","EAP","CPT� 46050","","I & D Perianal Abcess","BOTH IP/OP","$3,991.00 ","$2,953.34 ","$0.00 ","$4,031.00 ","$2,321.55 ","$777.17 ","$831.82 ","$0.00 ","$0.00 ","$0.00 ","$4,031.00 ","$0.00 ","$2,255.00 ","$3,192.55 ","$3,224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191563","EAP","CPT� 31233","","Nasal/sinus Endoscopy, Dx","BOTH IP/OP","$661.00 ","$489.14 ","$0.00 ","$661.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.00 ","$0.00 ","$661.00 ","$523.51 ","$528.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191564","EAP","CPT� 45385","","Colonoscopy W/lesion Removal","BOTH IP/OP","$3,182.00 ","$2,354.68 ","$0.00 ","$2,922.00 ","$2,753.10 ","$1,015.53 ","$0.00 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,007.17 ","$2,327.00 ","$2,314.22 ","$2,337.60 ","$1,399.33 ","$450.95 ","$265.02 ","$465.18 ","$959.21 "
"36191565","EAP","CPT� 43235","","Upper Gi Endoscopy, Diagnostic","BOTH IP/OP","$4,485.00 ","$3,318.90 ","$0.00 ","$4,112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,112.00 ","$0.00 ","$2,255.00 ","$3,256.70 ","$3,289.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191566","EAP","CPT� 31515","","Laryngoscopy For Aspiration","BOTH IP/OP","$7,668.00 ","$5,674.32 ","$0.00 ","$7,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,040.00 ","$0.00 ","$2,255.00 ","$5,575.68 ","$5,632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191567","EAP","CPT� 45305","","Proctosigmoidoscopy W/bx Single/multiple","BOTH IP/OP","$5,063.00 ","$3,746.62 ","$0.00 ","$5,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,114.00 ","$0.00 ","$2,255.00 ","$4,050.29 ","$4,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191568","EAP","CPT� 45300","","Proctosigmoidoscopy Dx","BOTH IP/OP","$2,337.00 ","$1,729.38 ","$0.00 ","$2,361.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,361.00 ","$0.00 ","$2,255.00 ","$1,869.91 ","$1,888.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191569","EAP","CPT� 96373","","Iintra-arterial Injection","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191570","EAP","CPT� 24201","","REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP","BOTH IP/OP","$9,504.00 ","$7,032.96 ","$0.00 ","$9,504.00 ","$0.00 ","$0.00 ","$0.00 ","$6,783.00 ","$5,416.74 ","$1,664.07 ","$9,504.00 ","$2,325.71 ","$2,327.00 ","$7,527.17 ","$7,603.20 ","$3,231.26 ","$360.96 ","$376.65 ","$1,513.04 ","$2,214.96 "
"36191571","EAP","CPT� 42809","","REMOVE PHARYNX FOREIGN BODY","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$500.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191573","EAP","CPT� 43247","","Egd Flexible Foreign Body Removal","BOTH IP/OP","$4,228.00 ","$3,128.72 ","$0.00 ","$4,263.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,263.00 ","$0.00 ","$2,327.00 ","$3,376.30 ","$3,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191585","EAP","CPT� 26740","","Clsd Tx Artclr Fx Mtcrphlngl/iphal Jt W/o Manip","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$795.00 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36191586","EAP","CPT� 10081","","I&d Pilonidal Cyst Complex","BOTH IP/OP","$3,502.00 ","$2,591.48 ","$0.00 ","$3,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,466.00 ","$0.00 ","$2,255.00 ","$2,745.07 ","$2,772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000023","EAP","Custom 37000023","","Level 1 1st 30 Min","BOTH IP/OP","$1,003.00 ","$742.22 ","$0.00 ","$1,066.00 ","$0.00 ","$0.00 ","$0.00 ","$760.80 ","$760.80 ","$0.00 ","$1,066.00 ","$0.00 ","$533.00 ","$844.27 ","$852.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000024","EAP","Custom 37000024","","Level 2 1st 30 Min","BOTH IP/OP","$1,766.00 ","$1,306.84 ","$0.00 ","$1,473.00 ","$0.00 ","$0.00 ","$0.00 ","$1,051.28 ","$1,051.28 ","$0.00 ","$1,473.00 ","$0.00 ","$736.50 ","$1,166.62 ","$1,178.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000025","EAP","Custom 37000025","","Level 3 1st 30 Min","BOTH IP/OP","$2,608.00 ","$1,929.92 ","$0.00 ","$2,175.00 ","$0.00 ","$0.00 ","$0.00 ","$1,552.30 ","$1,552.30 ","$0.00 ","$2,175.00 ","$0.00 ","$1,087.50 ","$1,722.60 ","$1,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000026","EAP","Custom 37000026","","Level 4 1st 30 Min","BOTH IP/OP","$3,052.00 ","$2,258.48 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$1,816.37 ","$1,816.37 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000027","EAP","Custom 37000027","","Level 5 1st 30 Min","BOTH IP/OP","$3,572.00 ","$2,643.28 ","$0.00 ","$2,979.00 ","$0.00 ","$0.00 ","$0.00 ","$2,126.11 ","$2,126.11 ","$0.00 ","$2,979.00 ","$0.00 ","$1,489.50 ","$2,359.37 ","$2,383.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000028","EAP","Custom 37000028","","Level 1 Add 15 Min","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000029","EAP","Custom 37000029","","Level 2 Add 15 Min","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$556.00 ","$0.00 ","$0.00 ","$0.00 ","$396.82 ","$396.82 ","$0.00 ","$556.00 ","$0.00 ","$278.00 ","$440.35 ","$444.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000030","EAP","Custom 37000030","","Level 3 Add 15 Min","BOTH IP/OP","$1,085.00 ","$802.90 ","$0.00 ","$853.00 ","$0.00 ","$0.00 ","$0.00 ","$608.79 ","$608.79 ","$0.00 ","$853.00 ","$0.00 ","$426.50 ","$675.58 ","$682.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000031","EAP","Custom 37000031","","Level 4 Add 15 Min","BOTH IP/OP","$1,203.00 ","$890.22 ","$0.00 ","$1,004.00 ","$0.00 ","$0.00 ","$0.00 ","$716.55 ","$716.55 ","$0.00 ","$1,004.00 ","$0.00 ","$502.00 ","$795.17 ","$803.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000032","EAP","Custom 37000032","","Level 5 Add 15 Min","BOTH IP/OP","$1,376.00 ","$1,018.24 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$818.61 ","$818.61 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000033","EAP","CPT� 99151","","Mod Sed Same Phys/qhp Initial 15 Mins; <5 Yrs","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$420.00 ","$273.67 ","$0.00 ","$105.05 ","$299.75 ","$299.75 ","$73.54 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$74.17 ","$24.16 ","$66.86 ","$0.00 "
"37000034","EAP","CPT� 99152","","Mod Sed Same Phys/qhp Initial 15 Mins 5/> Yrs","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$420.00 ","$273.67 ","$0.00 ","$105.05 ","$299.75 ","$299.75 ","$73.54 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$49.33 ","$12.62 ","$66.86 ","$0.00 "
"37000035","EAP","CPT� 99153","","Mod Sed Same Phys/qhp Each Addl 15 Mins","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$115.00 ","$74.93 ","$0.00 ","$28.76 ","$82.08 ","$82.08 ","$20.14 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$10.55 ","$10.80 ","$18.31 ","$0.00 "
"37000036","EAP","CPT� 99155","","Mod Sed Other Phys/qhp Initial 15 Mins; <5 Yrs","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$299.75 ","$299.75 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000037","EAP","CPT� 99156","","Mod Sed Other Phys/qhp Initial 15 Mins 5/> Yrs","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$420.00 ","$273.67 ","$0.00 ","$105.05 ","$299.75 ","$299.75 ","$73.54 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$73.17 ","$80.07 ","$66.86 ","$0.00 "
"37000038","EAP","CPT� 99157","","Mod Sed Other Phys/qhp Each Addl 15 Mins","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$115.00 ","$74.93 ","$0.00 ","$28.76 ","$82.08 ","$82.08 ","$0.00 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000123","EAP","Custom 37000123","","Epidural Fee","BOTH IP/OP","$2,316.00 ","$1,713.84 ","$0.00 ","$1,932.00 ","$0.00 ","$0.00 ","$0.00 ","$1,378.87 ","$1,378.87 ","$0.00 ","$1,932.00 ","$0.00 ","$966.00 ","$1,530.14 ","$1,545.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37000124","EAP","","","Ea Add�l 60-90 Min","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37825171","EAP","CPT� 36430","","Transfusion, Blood","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,537.00 ","$0.00 ","$0.00 ","$0.00 ","$1,810.66 ","$1,810.66 ","$444.21 ","$2,537.00 ","$389.18 ","$2,255.00 ","$2,009.30 ","$2,029.60 ","$540.71 ","$38.59 ","$35.66 ","$403.89 ","$370.65 "
"39000001","EAP","HCPCS P9010","","Whole Blood Unit","BOTH IP/OP","$2,098.00 ","$1,552.52 ","$0.00 ","$1,912.00 ","$1,139.21 ","$153.17 ","$437.28 ","$1,364.59 ","$1,364.59 ","$334.78 ","$1,912.00 ","$133.56 ","$956.00 ","$1,514.30 ","$1,529.60 ","$184.44 ","$299.23 ","$0.00 ","$304.39 ","$127.20 "
"39000002","EAP","HCPCS P9012","","Pooled Cryo","BOTH IP/OP","$904.00 ","$668.96 ","$0.00 ","$824.00 ","$0.00 ","$0.00 ","$0.00 ","$588.09 ","$588.09 ","$0.00 ","$824.00 ","$0.00 ","$412.00 ","$652.61 ","$659.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000003","EAP","HCPCS P9016","","Rbc Leukored Unit","BOTH IP/OP","$1,327.00 ","$981.98 ","$0.00 ","$1,209.00 ","$720.56 ","$192.39 ","$276.58 ","$862.86 ","$862.86 ","$211.69 ","$1,209.00 ","$197.77 ","$604.50 ","$957.53 ","$967.20 ","$273.11 ","$189.21 ","$0.00 ","$192.47 ","$188.35 "
"39000004","EAP","HCPCS P9017","","Fresh Frozen Plasma Unit","BOTH IP/OP","$629.00 ","$465.46 ","$0.00 ","$573.00 ","$0.00 ","$84.40 ","$131.10 ","$408.95 ","$408.95 ","$0.00 ","$573.00 ","$0.00 ","$286.50 ","$453.82 ","$458.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000012","EAP","HCPCS P9035","","Platelet Pheresis Leukored Unit","BOTH IP/OP","$4,769.00 ","$3,529.06 ","$0.00 ","$4,346.00 ","$2,589.57 ","$496.91 ","$993.98 ","$3,101.74 ","$3,101.74 ","$0.00 ","$4,346.00 ","$0.00 ","$2,173.00 ","$3,442.03 ","$3,476.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000013","EAP","HCPCS P9037","","Platelet Pheresis Leukored Irr Unit","BOTH IP/OP","$5,621.00 ","$4,159.54 ","$0.00 ","$5,122.00 ","$3,052.20 ","$630.32 ","$1,171.56 ","$3,655.57 ","$3,655.57 ","$896.82 ","$5,122.00 ","$666.42 ","$2,561.00 ","$4,056.62 ","$4,097.60 ","$920.30 ","$801.59 ","$0.00 ","$815.42 ","$634.69 "
"39000016","EAP","HCPCS P9040","","Rbc Leukored Irr Unit","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,075.00 ","$1,236.41 ","$266.03 ","$474.58 ","$1,480.93 ","$1,480.93 ","$363.32 ","$2,075.00 ","$275.90 ","$1,037.50 ","$1,643.40 ","$1,660.00 ","$381.00 ","$324.74 ","$0.00 ","$330.34 ","$262.76 "
"39000017","EAP","HCPCS P9044","","Ffp-cryo Poor Plasma","BOTH IP/OP","$337.00 ","$249.38 ","$0.00 ","$307.00 ","$0.00 ","$0.00 ","$0.00 ","$219.11 ","$219.11 ","$0.00 ","$307.00 ","$0.00 ","$153.50 ","$243.14 ","$245.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000021","EAP","HCPCS P9054","","Blood Leukored Deglyc Washed Unit","BOTH IP/OP","$2,064.00 ","$1,527.36 ","$0.00 ","$2,064.00 ","$0.00 ","$0.00 ","$0.00 ","$1,473.08 ","$1,473.08 ","$0.00 ","$2,064.00 ","$0.00 ","$1,032.00 ","$1,634.69 ","$1,651.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000024","EAP","HCPCS P9057","","Blood Leukored Deglyc Washed Irr Unit","BOTH IP/OP","$2,718.00 ","$2,011.32 ","$0.00 ","$2,718.00 ","$0.00 ","$0.00 ","$0.00 ","$1,939.84 ","$1,939.84 ","$0.00 ","$2,718.00 ","$0.00 ","$1,359.00 ","$2,152.66 ","$2,174.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000026","EAP","HCPCS P9059","","Ffp-frozen 24 Hour","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$707.00 ","$0.00 ","$0.00 ","$0.00 ","$504.59 ","$504.59 ","$0.00 ","$707.00 ","$0.00 ","$353.50 ","$559.94 ","$565.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000040","EAP","HCPCS P9016","","Rbc-wbc Reduced","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$656.49 ","$192.39 ","$251.99 ","$862.86 ","$862.86 ","$211.69 ","$1,209.00 ","$197.77 ","$604.50 ","$957.53 ","$967.20 ","$273.11 ","$189.21 ","$0.00 ","$192.47 ","$188.35 "
"39000052","EAP","CPT� 86891","","Non Cardiac Cell Saver","BOTH IP/OP","$1,970.00 ","$1,457.80 ","$0.00 ","$1,970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,970.00 ","$0.00 ","$234.84 ","$1,560.24 ","$1,576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000060","EAP","HCPCS P9011","","Rbc Leukored Aliquot","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$361.00 ","$215.03 ","$150.69 ","$82.54 ","$257.65 ","$257.65 ","$63.21 ","$361.00 ","$141.20 ","$180.50 ","$285.91 ","$288.80 ","$195.00 ","$56.50 ","$0.00 ","$57.47 ","$134.48 "
"39000061","EAP","HCPCS P9011","","Rbc Leukored Irr Aliquot","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$361.00 ","$215.03 ","$150.69 ","$82.54 ","$257.65 ","$257.65 ","$63.21 ","$361.00 ","$141.20 ","$180.50 ","$285.91 ","$288.80 ","$195.00 ","$56.50 ","$0.00 ","$57.47 ","$134.48 "
"39000062","EAP","HCPCS P9011","","Platelet Pheresis, Lr Aliquot","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$729.00 ","$434.40 ","$150.69 ","$166.74 ","$520.29 ","$520.29 ","$127.64 ","$729.00 ","$141.20 ","$364.50 ","$577.37 ","$583.20 ","$195.00 ","$114.09 ","$0.00 ","$116.06 ","$134.48 "
"39000063","EAP","HCPCS P9011","","Platelet Pheresis Lr Irr Aliquot","BOTH IP/OP","$882.00 ","$652.68 ","$0.00 ","$804.00 ","$478.93 ","$150.69 ","$183.83 ","$573.81 ","$573.81 ","$140.77 ","$804.00 ","$141.20 ","$402.00 ","$636.77 ","$643.20 ","$195.00 ","$125.83 ","$0.00 ","$128.00 ","$134.48 "
"39000064","EAP","HCPCS P9012","","Single Cryo","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$361.00 ","$0.00 ","$0.00 ","$0.00 ","$257.65 ","$257.65 ","$0.00 ","$361.00 ","$0.00 ","$180.50 ","$285.91 ","$288.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39000065","EAP","HCPCS P9011","","Thawed Ffp Aliquot","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$361.00 ","$215.03 ","$150.69 ","$82.54 ","$257.65 ","$257.65 ","$63.21 ","$361.00 ","$141.20 ","$180.50 ","$285.91 ","$288.80 ","$195.00 ","$56.50 ","$0.00 ","$57.47 ","$134.48 "
"39100001","EAP","CPT� 36430","","TRANSFUSION, BLOOD","BOTH IP/OP","$3,057.00 ","$2,262.18 ","$35.66 ","$2,537.00 ","$2,321.55 ","$388.71 ","$637.16 ","$1,810.66 ","$1,810.66 ","$444.21 ","$2,537.00 ","$389.18 ","$2,255.00 ","$2,009.30 ","$2,029.60 ","$540.71 ","$38.59 ","$35.66 ","$403.89 ","$370.65 "
"39100005","EAP","CPT� 36430","","Transfusion, Blood Or Bld Comp","BOTH IP/OP","$2,537.00 ","$1,877.38 ","$0.00 ","$2,537.00 ","$0.00 ","$0.00 ","$0.00 ","$1,810.66 ","$1,810.66 ","$444.21 ","$2,537.00 ","$389.18 ","$2,255.00 ","$2,009.30 ","$2,029.60 ","$540.71 ","$38.59 ","$35.66 ","$403.89 ","$370.65 "
"40000002","EAP","CPT� 76376","","3d Rendering W/o Postproce Nir","BOTH IP/OP","$3,154.00 ","$2,333.96 ","$0.00 ","$3,864.00 ","$1,404.90 ","$0.00 ","$657.37 ","$2,757.74 ","$2,757.74 ","$676.56 ","$3,864.00 ","$0.00 ","$927.36 ","$3,060.29 ","$3,091.20 ","$0.00 ","$140.81 ","$13.33 ","$615.15 ","$0.00 "
"40000003","EAP","CPT� 76377","","3d Rendering W/postprocess Nir","BOTH IP/OP","$3,154.00 ","$2,333.96 ","$0.00 ","$3,864.00 ","$1,404.90 ","$0.00 ","$657.37 ","$2,757.74 ","$2,757.74 ","$676.56 ","$3,864.00 ","$0.00 ","$927.36 ","$3,060.29 ","$3,091.20 ","$0.00 ","$186.77 ","$32.41 ","$615.15 ","$0.00 "
"40100003","EAP","CPT� 77061","","Dx Digital Breast Tomosynthesis; Unilateral","BOTH IP/OP","$156.00 ","$115.44 ","$0.00 ","$287.19 ","$156.00 ","$55.28 ","$32.51 ","$287.19 ","$287.19 ","$26.26 ","$150.00 ","$26.75 ","$36.00 ","$118.80 ","$120.00 ","$90.00 ","$23.48 ","$0.00 ","$23.88 ","$25.21 "
"40100008","EAP","CPT� 77062","","Dx Digital Breast Tomosynthesis; Bilateral","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$275.00 ","$55.28 ","$48.56 ","$225.45 ","$225.45 ","$26.26 ","$150.00 ","$26.75 ","$36.00 ","$118.80 ","$120.00 ","$90.00 ","$23.48 ","$0.00 ","$23.88 ","$25.21 "
"40100012","EAP","CPT� 77065","","Dx Mammo Incl Cad Uni","BOTH IP/OP","$337.00 ","$249.38 ","$54.13 ","$340.00 ","$303.12 ","$111.20 ","$70.24 ","$227.19 ","$227.19 ","$59.53 ","$340.00 ","$100.65 ","$81.60 ","$269.28 ","$272.00 ","$94.36 ","$130.40 ","$94.36 ","$54.13 ","$94.36 "
"40100013","EAP","CPT� 77066","","Dx Mammo Incl Cad Bi","BOTH IP/OP","$416.00 ","$307.84 ","$66.86 ","$420.00 ","$384.54 ","$140.79 ","$86.70 ","$290.61 ","$290.61 ","$73.54 ","$420.00 ","$128.54 ","$100.80 ","$332.64 ","$336.00 ","$120.30 ","$163.40 ","$120.30 ","$66.86 ","$120.30 "
"40200001","EAP","CPT� 76506","","Ultrasound Cranial","BOTH IP/OP","$621.00 ","$459.54 ","$0.00 ","$621.00 ","$0.00 ","$0.00 ","$0.00 ","$197.74 ","$197.74 ","$0.00 ","$621.00 ","$0.00 ","$149.04 ","$491.83 ","$496.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200002","EAP","CPT� 76641","","Ultrasound, Breast,unilateal,complete","BOTH IP/OP","$1,344.00 ","$994.56 ","$0.00 ","$1,227.00 ","$0.00 ","$0.00 ","$0.00 ","$172.27 ","$172.27 ","$0.00 ","$1,227.00 ","$0.00 ","$294.48 ","$971.78 ","$981.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200003","EAP","CPT� 76506","","Us Cranial Complete","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$621.00 ","$0.00 ","$0.00 ","$0.00 ","$197.74 ","$197.74 ","$0.00 ","$621.00 ","$0.00 ","$149.04 ","$491.83 ","$496.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200005","EAP","CPT� 76512","","Ophth Us, B W/non-quant A","BOTH IP/OP","$759.00 ","$561.66 ","$21.61 ","$767.00 ","$211.15 ","$106.62 ","$158.19 ","$100.56 ","$100.56 ","$134.30 ","$767.00 ","$112.41 ","$184.08 ","$607.46 ","$613.60 ","$156.18 ","$93.72 ","$21.61 ","$122.11 ","$107.06 "
"40200006","EAP","CPT� 76514","","Echo Exam Of Eye, Thickness","BOTH IP/OP","$287.00 ","$212.38 ","$3.96 ","$280.00 ","$34.66 ","$24.19 ","$59.82 ","$8.57 ","$8.57 ","$49.03 ","$280.00 ","$23.06 ","$67.20 ","$221.76 ","$224.00 ","$32.04 ","$11.96 ","$3.96 ","$44.58 ","$21.96 "
"40200007","EAP","CPT� 76519","","Ultrasonography","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$767.00 ","$0.00 ","$0.00 ","$0.00 ","$104.53 ","$104.53 ","$134.30 ","$767.00 ","$112.41 ","$184.08 ","$607.46 ","$613.60 ","$156.18 ","$76.68 ","$36.02 ","$122.11 ","$107.06 "
"40200008","EAP","CPT� 76642","","Ultrasound, Breast,unilateal,limited","BOTH IP/OP","$1,265.00 ","$936.10 ","$54.39 ","$1,155.00 ","$202.36 ","$79.21 ","$263.66 ","$132.02 ","$132.02 ","$202.23 ","$1,155.00 ","$80.04 ","$277.20 ","$914.76 ","$924.00 ","$111.21 ","$85.51 ","$54.39 ","$183.88 ","$76.23 "
"40200009","EAP","CPT� 76536","","Soft Tiss/head&neck W/realtime","BOTH IP/OP","$1,100.00 ","$814.00 ","$82.37 ","$1,111.00 ","$266.85 ","$106.62 ","$229.27 ","$196.88 ","$196.88 ","$194.53 ","$1,111.00 ","$112.41 ","$266.64 ","$879.91 ","$888.80 ","$156.18 ","$82.37 ","$88.96 ","$176.87 ","$107.06 "
"40200011","EAP","CPT� 76536","","Us Thyroid","BOTH IP/OP","$1,100.00 ","$814.00 ","$82.37 ","$1,111.00 ","$266.85 ","$106.62 ","$229.27 ","$196.88 ","$196.88 ","$194.53 ","$1,111.00 ","$112.41 ","$266.64 ","$879.91 ","$888.80 ","$156.18 ","$82.37 ","$88.96 ","$176.87 ","$107.06 "
"40200012","EAP","CPT� 76604","","Ultrasound Exam, Chest","BOTH IP/OP","$1,206.00 ","$892.44 ","$50.78 ","$1,101.00 ","$202.36 ","$106.62 ","$251.36 ","$139.42 ","$139.42 ","$192.78 ","$1,101.00 ","$112.41 ","$264.24 ","$871.99 ","$880.80 ","$156.18 ","$77.40 ","$50.78 ","$175.28 ","$107.06 "
"40200014","EAP","CPT� 76604","","Us Chest, Rt W/image","BOTH IP/OP","$1,206.00 ","$892.44 ","$50.78 ","$1,101.00 ","$202.36 ","$106.62 ","$251.36 ","$139.42 ","$139.42 ","$192.78 ","$1,101.00 ","$112.41 ","$264.24 ","$871.99 ","$880.80 ","$156.18 ","$77.40 ","$50.78 ","$175.28 ","$107.06 "
"40200018","EAP","CPT� 76700","","Us Abd, Rt W/image","BOTH IP/OP","$1,489.00 ","$1,101.86 ","$83.20 ","$1,486.00 ","$280.53 ","$106.62 ","$310.34 ","$227.84 ","$227.84 ","$260.19 ","$1,486.00 ","$112.41 ","$356.64 ","$1,176.91 ","$1,188.80 ","$156.18 ","$115.39 ","$83.20 ","$236.57 ","$107.06 "
"40200020","EAP","CPT� 76705","","Bladder Ultrasound","BOTH IP/OP","$1,412.00 ","$1,044.88 ","$62.67 ","$1,412.00 ","$209.59 ","$106.62 ","$294.30 ","$175.05 ","$175.05 ","$247.23 ","$1,412.00 ","$112.41 ","$338.88 ","$1,118.30 ","$1,129.60 ","$156.18 ","$83.78 ","$62.67 ","$224.79 ","$107.06 "
"40200021","EAP","CPT� 76705","","Us Abdominal, Ltd","BOTH IP/OP","$1,415.00 ","$1,047.10 ","$62.67 ","$1,412.00 ","$209.59 ","$106.62 ","$294.92 ","$175.05 ","$175.05 ","$247.23 ","$1,412.00 ","$112.41 ","$338.88 ","$1,118.30 ","$1,129.60 ","$156.18 ","$83.78 ","$62.67 ","$224.79 ","$107.06 "
"40200022","EAP","CPT� 76641","","Ultrasound Breast Rt Complete","BOTH IP/OP","$1,168.00 ","$864.32 ","$0.00 ","$1,227.00 ","$0.00 ","$0.00 ","$0.00 ","$172.27 ","$172.27 ","$0.00 ","$1,227.00 ","$0.00 ","$294.48 ","$971.78 ","$981.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200023","EAP","CPT� 76770","","Us Retroperit, Rt W/image; Complete","BOTH IP/OP","$1,417.00 ","$1,048.58 ","$77.44 ","$1,431.00 ","$259.59 ","$106.62 ","$295.34 ","$222.59 ","$222.59 ","$250.56 ","$1,431.00 ","$112.41 ","$343.44 ","$1,133.35 ","$1,144.80 ","$156.18 ","$112.23 ","$77.44 ","$227.82 ","$107.06 "
"40200025","EAP","CPT� 76775","","Us Retroper, Rt W/image Ltd","BOTH IP/OP","$1,302.00 ","$963.48 ","$30.25 ","$1,315.00 ","$133.82 ","$106.62 ","$271.37 ","$194.25 ","$194.25 ","$230.25 ","$1,315.00 ","$112.41 ","$315.60 ","$1,041.48 ","$1,052.00 ","$156.18 ","$83.43 ","$30.25 ","$209.35 ","$107.06 "
"40200027","EAP","CPT� 76800","","Us Spine","BOTH IP/OP","$1,019.00 ","$754.06 ","$0.00 ","$1,019.00 ","$0.00 ","$0.00 ","$0.00 ","$163.73 ","$163.73 ","$0.00 ","$1,019.00 ","$0.00 ","$244.56 ","$807.05 ","$815.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200028","EAP","CPT� 76642","","Ultrasound Breast Rt Limited","BOTH IP/OP","$1,082.00 ","$800.68 ","$54.39 ","$988.00 ","$202.36 ","$79.21 ","$225.52 ","$132.02 ","$132.02 ","$172.99 ","$988.00 ","$80.04 ","$237.12 ","$782.50 ","$790.40 ","$111.21 ","$85.51 ","$54.39 ","$157.29 ","$76.23 "
"40200029","EAP","CPT� 76641","","Ultrasound Breast Rt Complete","BOTH IP/OP","$1,168.00 ","$864.32 ","$0.00 ","$1,227.00 ","$0.00 ","$0.00 ","$0.00 ","$172.27 ","$172.27 ","$0.00 ","$1,227.00 ","$0.00 ","$294.48 ","$971.78 ","$981.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200030","EAP","CPT� 76642","","Ultrasound Breast Rt Limited","BOTH IP/OP","$941.00 ","$696.34 ","$54.39 ","$988.00 ","$202.36 ","$79.21 ","$196.13 ","$132.02 ","$132.02 ","$172.99 ","$988.00 ","$80.04 ","$237.12 ","$782.50 ","$790.40 ","$111.21 ","$85.51 ","$54.39 ","$157.29 ","$76.23 "
"40200031","EAP","CPT� 76941","","Cordocentesis Us Guidance","BOTH IP/OP","$813.00 ","$601.62 ","$0.00 ","$1,015.00 ","$0.00 ","$0.00 ","$0.00 ","$142.08 ","$142.08 ","$0.00 ","$1,015.00 ","$0.00 ","$243.60 ","$803.88 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200034","EAP","CPT� 76801","","Ob Us <14 Wks, Single Fetus","BOTH IP/OP","$554.00 ","$409.96 ","$73.47 ","$555.00 ","$283.77 ","$106.62 ","$115.47 ","$193.63 ","$193.63 ","$97.18 ","$555.00 ","$112.41 ","$133.20 ","$439.56 ","$444.00 ","$156.18 ","$90.90 ","$73.47 ","$88.36 ","$107.06 "
"40200035","EAP","CPT� 76885","","Us Infant Hips Dynamic","BOTH IP/OP","$1,786.00 ","$1,321.64 ","$0.00 ","$2,232.00 ","$0.00 ","$0.00 ","$0.00 ","$234.97 ","$234.97 ","$0.00 ","$2,232.00 ","$0.00 ","$535.68 ","$1,767.74 ","$1,785.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200036","EAP","CPT� 76870","","Us Scrotum","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$74.20 ","$1,556.00 ","$156.39 ","$106.62 ","$320.97 ","$207.04 ","$207.04 ","$272.44 ","$1,556.00 ","$112.41 ","$373.44 ","$1,232.35 ","$1,244.80 ","$156.18 ","$90.49 ","$74.20 ","$247.72 ","$107.06 "
"40200037","EAP","CPT� 76872","","Ultrasound,transrectal","BOTH IP/OP","$615.00 ","$455.10 ","$93.31 ","$621.00 ","$217.64 ","$106.62 ","$128.18 ","$253.30 ","$253.30 ","$108.73 ","$621.00 ","$112.41 ","$149.04 ","$491.83 ","$496.80 ","$156.18 ","$93.31 ","$125.34 ","$98.86 ","$107.06 "
"40200038","EAP","CPT� 76881","","US EXTREMITY, NON-VASC RT W/IM COM","BOTH IP/OP","$1,000.00 ","$740.00 ","$46.82 ","$1,010.00 ","$270.86 ","$106.62 ","$208.43 ","$207.08 ","$207.08 ","$176.84 ","$1,010.00 ","$112.41 ","$242.40 ","$799.92 ","$808.00 ","$156.18 ","$109.54 ","$46.82 ","$160.79 ","$107.06 "
"40200039","EAP","CPT� 76805","","Ob Us >/= 14 Wks Sngl Fetus","BOTH IP/OP","$679.00 ","$502.46 ","$91.48 ","$681.00 ","$327.31 ","$106.62 ","$141.52 ","$230.29 ","$230.29 ","$119.24 ","$681.00 ","$112.41 ","$163.44 ","$539.35 ","$544.80 ","$156.18 ","$130.22 ","$91.48 ","$108.42 ","$107.06 "
"40200040","EAP","CPT� 76886","","Us Infant Hips Static","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$2,156.00 ","$0.00 ","$0.00 ","$0.00 ","$165.47 ","$165.47 ","$0.00 ","$2,156.00 ","$0.00 ","$517.44 ","$1,707.55 ","$1,724.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200042","EAP","CPT� 76937","","Us Guidance For Vascular Acess","BOTH IP/OP","$1,573.00 ","$1,164.02 ","$0.00 ","$1,514.00 ","$71.76 ","$0.00 ","$327.85 ","$49.08 ","$49.08 ","$265.09 ","$1,514.00 ","$0.00 ","$363.36 ","$1,199.09 ","$1,211.20 ","$0.00 ","$33.32 ","$22.33 ","$241.03 ","$0.00 "
"40200043","EAP","CPT� 76940","","Ult Guide For Mon. Par.tis.abl","BOTH IP/OP","$912.00 ","$674.88 ","$0.00 ","$1,139.00 ","$0.00 ","$0.00 ","$0.00 ","$177.84 ","$177.84 ","$0.00 ","$1,139.00 ","$0.00 ","$273.36 ","$902.09 ","$911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200044","EAP","CPT� 76810","","Ob Us >/= 14 Wks Additional Fetus","BOTH IP/OP","$666.00 ","$492.84 ","$0.00 ","$667.00 ","$214.45 ","$0.00 ","$138.81 ","$124.92 ","$124.92 ","$116.79 ","$667.00 ","$0.00 ","$160.08 ","$528.26 ","$533.60 ","$0.00 ","$258.70 ","$42.86 ","$106.19 ","$0.00 "
"40200045","EAP","CPT� 76942","","NEEDLE PLACEMENT US GUIDE BIC","BOTH IP/OP","$1,083.00 ","$801.42 ","$0.00 ","$1,094.00 ","$137.83 ","$0.00 ","$225.72 ","$360.62 ","$360.62 ","$191.55 ","$1,094.00 ","$0.00 ","$262.56 ","$866.45 ","$875.20 ","$0.00 ","$92.25 ","$25.93 ","$174.16 ","$0.00 "
"40200047","EAP","CPT� 76946","","Echo Guide Amniocentesis","BOTH IP/OP","$770.00 ","$569.80 ","$0.00 ","$752.00 ","$75.00 ","$0.00 ","$160.49 ","$62.17 ","$62.17 ","$131.67 ","$752.00 ","$0.00 ","$180.48 ","$595.58 ","$601.60 ","$0.00 ","$77.52 ","$0.00 ","$0.00 ","$0.00 "
"40200048","EAP","CPT� 76810","","Ob Us >/= 14 Wks Additional Fetus","BOTH IP/OP","$667.00 ","$493.58 ","$0.00 ","$667.00 ","$214.45 ","$0.00 ","$139.02 ","$124.92 ","$124.92 ","$116.79 ","$667.00 ","$0.00 ","$160.08 ","$528.26 ","$533.60 ","$0.00 ","$258.70 ","$42.86 ","$106.19 ","$0.00 "
"40200049","EAP","CPT� 76998","","Us Guidance Intraoperative","BOTH IP/OP","$864.00 ","$639.36 ","$0.00 ","$864.00 ","$0.00 ","$0.00 ","$0.00 ","$275.61 ","$275.61 ","$151.28 ","$864.00 ","$0.00 ","$207.36 ","$684.29 ","$691.20 ","$0.00 ","$135.22 ","$0.00 ","$137.55 ","$0.00 "
"40200052","EAP","CPT� 76811","","Us Preg Uterus 1st Gest","BOTH IP/OP","$1,414.00 ","$1,046.36 ","$83.92 ","$1,417.00 ","$422.48 ","$225.34 ","$294.71 ","$268.30 ","$268.30 ","$248.11 ","$1,417.00 ","$233.72 ","$340.08 ","$1,122.26 ","$1,133.60 ","$324.73 ","$237.77 ","$83.92 ","$225.59 ","$222.60 "
"40200054","EAP","CPT� 76813","","Ob Us Nuchal Meas, 1 Gest","BOTH IP/OP","$927.00 ","$685.98 ","$63.03 ","$929.00 ","$281.37 ","$106.62 ","$193.21 ","$168.03 ","$168.03 ","$162.66 ","$929.00 ","$112.41 ","$222.96 ","$735.77 ","$743.20 ","$156.18 ","$118.66 ","$63.03 ","$147.90 ","$107.06 "
"40200055","EAP","CPT� 76814","","Ob Us Nuchal Meas, Add-on","BOTH IP/OP","$555.00 ","$410.70 ","$0.00 ","$555.00 ","$0.00 ","$0.00 ","$0.00 ","$83.38 ","$83.38 ","$0.00 ","$555.00 ","$0.00 ","$133.20 ","$439.56 ","$444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200056","EAP","CPT� 76815","","Ob Us, Limited, Fetus(s)","BOTH IP/OP","$554.00 ","$409.96 ","$52.22 ","$555.00 ","$195.10 ","$106.62 ","$115.47 ","$139.29 ","$139.29 ","$97.18 ","$555.00 ","$112.41 ","$133.20 ","$439.56 ","$444.00 ","$156.18 ","$87.30 ","$52.22 ","$88.36 ","$107.06 "
"40200062","EAP","CPT� 76816","","Us Preg Uterus F/u","BOTH IP/OP","$554.00 ","$409.96 ","$71.66 ","$555.00 ","$266.85 ","$106.62 ","$115.47 ","$164.87 ","$164.87 ","$97.18 ","$555.00 ","$112.41 ","$133.20 ","$439.56 ","$444.00 ","$156.18 ","$71.66 ","$71.67 ","$88.36 ","$107.06 "
"40200064","EAP","CPT� 76817","","Transvaginal U/s Pregnant","BOTH IP/OP","$593.00 ","$438.82 ","$59.07 ","$594.00 ","$224.11 ","$106.62 ","$123.60 ","$152.67 ","$152.67 ","$104.00 ","$594.00 ","$112.41 ","$142.56 ","$470.45 ","$475.20 ","$156.18 ","$94.59 ","$59.07 ","$94.56 ","$107.06 "
"40200065","EAP","CPT� 76882","","Ultrasound, Extremity, Nonvascular, Limited","BOTH IP/OP","$649.00 ","$480.26 ","$0.00 ","$656.00 ","$82.24 ","$106.62 ","$10.15 ","$24.38 ","$24.38 ","$114.86 ","$656.00 ","$112.41 ","$157.44 ","$519.55 ","$524.80 ","$156.18 ","$28.65 ","$33.14 ","$0.00 ","$107.06 "
"40200067","EAP","CPT� 76818","","Biophysical Profile W/nst","BOTH IP/OP","$1,430.00 ","$1,058.20 ","$66.63 ","$1,319.00 ","$284.62 ","$106.62 ","$298.05 ","$164.27 ","$164.27 ","$230.95 ","$1,319.00 ","$112.41 ","$316.56 ","$1,044.65 ","$1,055.20 ","$156.18 ","$101.11 ","$66.63 ","$209.98 ","$107.06 "
"40200069","EAP","CPT� 76819","","Biophysical Profile W/o Nst","BOTH IP/OP","$1,063.00 ","$786.62 ","$48.98 ","$981.00 ","$208.01 ","$106.62 ","$221.56 ","$131.99 ","$131.99 ","$171.77 ","$981.00 ","$112.41 ","$235.44 ","$776.95 ","$784.80 ","$156.18 ","$96.45 ","$48.98 ","$156.18 ","$107.06 "
"40200071","EAP","CPT� 76820","","Fetal Dopp Velocimetry Umb Art","BOTH IP/OP","$1,583.00 ","$1,171.42 ","$21.97 ","$1,460.00 ","$111.28 ","$106.62 ","$329.94 ","$70.59 ","$70.59 ","$255.63 ","$1,460.00 ","$112.41 ","$350.40 ","$1,156.32 ","$1,168.00 ","$156.18 ","$92.68 ","$21.97 ","$232.43 ","$107.06 "
"40200072","EAP","CPT� 76821","","Fetal Dopp Velocimetry Mid Cer","BOTH IP/OP","$1,583.00 ","$1,171.42 ","$56.55 ","$1,460.00 ","$214.47 ","$106.62 ","$329.94 ","$150.00 ","$150.00 ","$255.63 ","$1,460.00 ","$112.41 ","$350.40 ","$1,156.32 ","$1,168.00 ","$156.18 ","$102.99 ","$56.55 ","$232.43 ","$107.06 "
"40200073","EAP","CPT� 76825","","Fetal Echo (2d)","BOTH IP/OP","$2,946.00 ","$2,180.04 ","$153.19 ","$2,678.00 ","$639.28 ","$473.20 ","$614.02 ","$299.39 ","$299.39 ","$468.90 ","$2,678.00 ","$483.00 ","$642.72 ","$2,120.98 ","$2,142.40 ","$671.06 ","$153.19 ","$193.77 ","$426.34 ","$460.00 "
"40200074","EAP","CPT� 76826","","Fetal Echo, F/u, Repeat","BOTH IP/OP","$1,629.00 ","$1,205.46 ","$0.00 ","$1,629.00 ","$0.00 ","$0.00 ","$0.00 ","$177.26 ","$177.26 ","$0.00 ","$1,629.00 ","$0.00 ","$390.96 ","$1,290.17 ","$1,303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200075","EAP","CPT� 76827","","Fetal Doppler Echo","BOTH IP/OP","$2,946.00 ","$2,180.04 ","$0.00 ","$2,678.00 ","$174.13 ","$106.62 ","$614.02 ","$103.76 ","$103.76 ","$468.90 ","$2,678.00 ","$112.41 ","$642.72 ","$2,120.98 ","$2,142.40 ","$156.18 ","$0.00 ","$45.38 ","$426.34 ","$107.06 "
"40200077","EAP","CPT� 76828","","Fetal Dopp Echo,repeat","BOTH IP/OP","$1,148.00 ","$849.52 ","$0.00 ","$1,148.00 ","$0.00 ","$0.00 ","$0.00 ","$60.75 ","$60.75 ","$0.00 ","$1,148.00 ","$0.00 ","$275.52 ","$909.22 ","$918.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200078","EAP","CPT� 76812","","Ob Us Detailed Addl Fetus","BOTH IP/OP","$289.00 ","$213.86 ","$0.00 ","$289.00 ","$289.00 ","$0.00 ","$60.23 ","$0.00 ","$0.00 ","$47.63 ","$272.00 ","$0.00 ","$65.28 ","$215.42 ","$217.60 ","$0.00 ","$139.72 ","$111.65 ","$43.30 ","$0.00 "
"40200079","EAP","CPT� 76830","","US TRANSVAGINAL","BOTH IP/OP","$1,612.00 ","$1,192.88 ","$89.68 ","$1,628.00 ","$280.55 ","$106.62 ","$335.98 ","$203.54 ","$203.54 ","$285.05 ","$1,628.00 ","$112.41 ","$390.72 ","$1,289.38 ","$1,302.40 ","$156.18 ","$92.96 ","$89.68 ","$259.18 ","$107.06 "
"40200083","EAP","CPT� 76831","","Us Hysterosono W/wo Doppler","BOTH IP/OP","$2,535.00 ","$1,875.90 ","$84.28 ","$2,561.00 ","$274.90 ","$225.34 ","$528.36 ","$201.80 ","$201.80 ","$448.41 ","$2,561.00 ","$233.72 ","$614.64 ","$2,028.31 ","$2,048.80 ","$324.73 ","$94.72 ","$84.28 ","$407.71 ","$222.60 "
"40200085","EAP","CPT� 76856","","Us Pelvis(non-ob)comp W/rt Img","BOTH IP/OP","$1,593.00 ","$1,178.82 ","$76.36 ","$1,609.00 ","$253.12 ","$106.62 ","$332.02 ","$204.41 ","$204.41 ","$281.72 ","$1,609.00 ","$112.41 ","$386.16 ","$1,274.33 ","$1,287.20 ","$156.18 ","$92.96 ","$76.36 ","$256.15 ","$107.06 "
"40200087","EAP","CPT� 76857","","Us Pelvis Ltd/fu Non-ob","BOTH IP/OP","$1,018.00 ","$753.32 ","$24.13 ","$1,028.00 ","$110.46 ","$106.62 ","$212.18 ","$192.80 ","$192.80 ","$179.99 ","$1,028.00 ","$112.41 ","$246.72 ","$814.18 ","$822.40 ","$156.18 ","$59.67 ","$24.13 ","$163.66 ","$107.06 "
"40200092","EAP","CPT� 76516","","Echo Exam Of Eye","BOTH IP/OP","$249.00 ","$184.26 ","$25.57 ","$243.00 ","$178.94 ","$106.62 ","$51.90 ","$94.06 ","$94.06 ","$42.55 ","$243.00 ","$112.41 ","$58.32 ","$192.46 ","$194.40 ","$156.18 ","$76.68 ","$25.57 ","$38.69 ","$107.06 "
"40200097","EAP","CPT� 76510","","Opth Us B & Quant A","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$162.11 ","$162.11 ","$0.00 ","$636.00 ","$0.00 ","$152.64 ","$503.71 ","$508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200125","EAP","CPT� 76802","","Us Preg Uterus Ea Addl Gest","BOTH IP/OP","$487.00 ","$360.38 ","$0.00 ","$488.00 ","$148.34 ","$0.00 ","$101.50 ","$77.56 ","$77.56 ","$85.44 ","$488.00 ","$0.00 ","$117.12 ","$386.50 ","$390.40 ","$0.00 ","$70.91 ","$21.97 ","$77.69 ","$0.00 "
"40200126","EAP","CPT� 93990","","Duplex Scan Of Hemodialysis Access","BOTH IP/OP","$1,058.00 ","$782.92 ","$106.62 ","$1,004.00 ","$300.62 ","$106.62 ","$220.51 ","$432.81 ","$432.81 ","$175.79 ","$1,004.00 ","$112.41 ","$502.00 ","$795.17 ","$803.20 ","$156.18 ","$112.81 ","$132.54 ","$159.84 ","$107.06 "
"40200127","EAP","CPT� 76529","","Ophthalmic Ultrasonic Foreign Body Localization","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$92.16 ","$92.16 ","$0.00 ","$220.00 ","$0.00 ","$52.80 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200128","EAP","CPT� 76932","","Us Guidance Endomyocardial Biopsy, Imaging S & I","BOTH IP/OP","$454.00 ","$335.96 ","$0.00 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$160.94 ","$160.94 ","$0.00 ","$454.00 ","$0.00 ","$108.96 ","$359.57 ","$363.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40200132","EAP","CPT� 76706","","Us Abdl Aorta Screen Aaa","BOTH IP/OP","$380.00 ","$281.20 ","$60.34 ","$379.00 ","$214.45 ","$106.62 ","$79.20 ","$160.30 ","$160.30 ","$66.36 ","$379.00 ","$112.41 ","$90.96 ","$300.17 ","$303.20 ","$156.18 ","$90.50 ","$87.52 ","$60.34 ","$107.06 "
"40200133","EAP","CPT� 76516","","Quantitative A-scan Us Both Eyes","BOTH IP/OP","$374.00 ","$276.76 ","$25.57 ","$365.00 ","$178.94 ","$106.62 ","$77.95 ","$94.06 ","$94.06 ","$63.91 ","$365.00 ","$112.41 ","$87.60 ","$289.08 ","$292.00 ","$156.18 ","$76.68 ","$25.57 ","$58.11 ","$107.06 "
"40200134","EAP","CPT� 76513","","B-scan Us High Resolution One Eye","BOTH IP/OP","$539.00 ","$398.86 ","$64.47 ","$544.00 ","$216.82 ","$106.62 ","$112.34 ","$120.63 ","$120.63 ","$95.25 ","$544.00 ","$112.41 ","$130.56 ","$430.85 ","$435.20 ","$156.18 ","$93.36 ","$64.47 ","$86.60 ","$107.06 "
"40200135","EAP","CPT� 76513","","B-scan Us, High Resolution Both Eyes","BOTH IP/OP","$808.00 ","$597.92 ","$64.47 ","$816.00 ","$216.82 ","$106.62 ","$168.41 ","$120.63 ","$120.63 ","$142.88 ","$816.00 ","$112.41 ","$195.84 ","$646.27 ","$652.80 ","$156.18 ","$93.36 ","$64.47 ","$129.91 ","$107.06 "
"40300003","EAP","CPT� 77063","","Scr Digital Breast Tomosynthesis, Bil","BOTH IP/OP","$149.00 ","$110.26 ","$23.88 ","$150.00 ","$126.56 ","$46.99 ","$31.06 ","$61.68 ","$61.68 ","$26.26 ","$150.00 ","$26.75 ","$36.00 ","$118.80 ","$120.00 ","$25.21 ","$53.24 ","$25.21 ","$23.88 ","$25.21 "
"40300004","EAP","CPT� 77063","","Scr Digital Breast Tomosynthesis, Uni","BOTH IP/OP","$149.00 ","$110.26 ","$23.88 ","$150.00 ","$126.56 ","$46.99 ","$31.06 ","$61.68 ","$61.68 ","$26.26 ","$150.00 ","$26.75 ","$36.00 ","$118.80 ","$120.00 ","$25.21 ","$53.24 ","$25.21 ","$23.88 ","$25.21 "
"40300010","EAP","CPT� 77067","","Scr Mammo Bi Incl Cad","BOTH IP/OP","$366.00 ","$270.84 ","$58.90 ","$370.00 ","$310.36 ","$113.86 ","$76.28 ","$240.02 ","$240.02 ","$64.78 ","$370.00 ","$106.31 ","$88.80 ","$293.04 ","$296.00 ","$99.77 ","$132.75 ","$99.77 ","$58.90 ","$99.77 "
"40300011","EAP","CPT� 77067","","Scr Mammo Unilateral Incl Cad","BOTH IP/OP","$366.00 ","$270.84 ","$58.90 ","$370.00 ","$310.36 ","$113.86 ","$76.28 ","$240.02 ","$240.02 ","$64.78 ","$370.00 ","$106.31 ","$88.80 ","$293.04 ","$296.00 ","$99.77 ","$132.75 ","$99.77 ","$58.90 ","$99.77 "
"40400005","EAP","CPT� 78814","","PET IMG RESTG THYROID CA PET","BOTH IP/OP","$10,583.00 ","$7,831.42 ","$0.00 ","$10,583.00 ","$0.00 ","$0.00 ","$0.00 ","$2,071.14 ","$2,071.14 ","$0.00 ","$10,583.00 ","$0.00 ","$2,539.92 ","$8,381.74 ","$8,466.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40400008","EAP","CPT� 78815","","Pet/ct Skull Base Mid-thigh","BOTH IP/OP","$10,477.00 ","$7,752.98 ","$0.00 ","$10,583.00 ","$3,960.00 ","$1,449.43 ","$2,183.67 ","$2,288.79 ","$2,288.79 ","$1,853.00 ","$10,583.00 ","$1,379.58 ","$2,539.92 ","$8,381.74 ","$8,466.40 ","$1,916.75 ","$2,380.22 ","$0.00 ","$1,684.81 ","$1,313.89 "
"40400055","EAP","CPT� 78816","","Pet/ct Whole Body","BOTH IP/OP","$10,477.00 ","$7,752.98 ","$0.00 ","$10,583.00 ","$3,960.00 ","$1,449.43 ","$2,183.67 ","$2,348.04 ","$2,348.04 ","$1,853.00 ","$10,583.00 ","$1,379.58 ","$2,539.92 ","$8,381.74 ","$8,466.40 ","$1,916.75 ","$1,656.24 ","$0.00 ","$1,684.81 ","$1,313.89 "
"40400056","EAP","CPT� 78608","","Brain Imaging, Positron Emission Tomo (pet); Metabolic Eval","BOTH IP/OP","$6,836.00 ","$5,058.64 ","$0.00 ","$6,905.00 ","$0.00 ","$0.00 ","$0.00 ","$571.95 ","$571.95 ","$1,209.01 ","$6,905.00 ","$1,379.58 ","$1,657.20 ","$5,468.76 ","$5,524.00 ","$1,916.75 ","$1,080.63 ","$0.00 ","$1,099.28 ","$1,313.89 "
"40400057","EAP","CPT� 78459","","Myocardial Imaging, Positron Emission Tomography (pet), Metabolic Eval","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$6,000.00 ","$3,960.00 ","$1,279.77 ","$1,238.04 ","$461.30 ","$461.30 ","$1,050.55 ","$6,000.00 ","$1,232.99 ","$1,440.00 ","$4,752.00 ","$4,800.00 ","$1,713.08 ","$939.00 ","$0.00 ","$955.20 ","$1,174.28 "
"40400058","EAP","CPT� 78429","","Pet/ct Cardiac Metabolic Eval","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$1,050.55 ","$6,000.00 ","$1,379.58 ","$1,440.00 ","$4,752.00 ","$4,800.00 ","$1,916.75 ","$939.00 ","$0.00 ","$955.20 ","$1,313.89 "
"41000001","EAP","CPT� 94002","","Ventilation Assist/mgt Initial","BOTH IP/OP","$6,841.00 ","$5,062.34 ","$77.15 ","$6,240.00 ","$3,714.66 ","$477.09 ","$1,425.84 ","$4,453.49 ","$4,453.49 ","$1,092.57 ","$6,240.00 ","$465.90 ","$3,120.00 ","$4,942.08 ","$4,992.00 ","$647.30 ","$77.15 ","$94.86 ","$993.41 ","$443.71 "
"41000009","EAP","CPT� 94003","","Mech Vent, Ea Subseq Day","BOTH IP/OP","$6,231.00 ","$4,610.94 ","$0.00 ","$5,684.00 ","$0.00 ","$0.00 ","$0.00 ","$4,056.67 ","$4,056.67 ","$995.22 ","$5,684.00 ","$465.90 ","$2,842.00 ","$4,501.73 ","$4,547.20 ","$647.30 ","$56.62 ","$68.52 ","$904.89 ","$443.71 "
"41000017","EAP","CPT� 94640","","Aerosal Rx Sub Admin (o2)","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000020","EAP","Custom 94640","","Aerosol Continuous Subsequent","BOTH IP/OP","$494.00 ","$365.56 ","$18.01 ","$414.00 ","$268.24 ","$184.08 ","$102.96 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000021","EAP","CPT� 94640","","Aerosol Treatment Initial","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000022","EAP","CPT� 94640","","Aersol Treatment Subsequent","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000027","EAP","CPT� 94640","","Delivery Assist","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000028","EAP","CPT� 94640","","High Humidity Aerosol Initial","BOTH IP/OP","$414.00 ","$306.36 ","$18.01 ","$414.00 ","$224.80 ","$184.08 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000029","EAP","CPT� 94640","","High Humidity Aerosol Subseq","BOTH IP/OP","$414.00 ","$306.36 ","$18.01 ","$414.00 ","$224.80 ","$184.08 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000031","EAP","CPT� 94640","","Incentive Spirometer Subsequen","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000034","EAP","CPT� 94640","","Init Inhala Trtmnt Airway Obs","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000040","EAP","CPT� 94640","","Mdi, Initial Rx","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000041","EAP","CPT� 94640","","Mdi, Subsequent Rx","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000042","EAP","CPT� 94640","","Micro Neb Subsequent","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000043","EAP","CPT� 94640","","Micro Neb, Setup","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000045","EAP","CPT� 94640","","Neo Micro Subsquent","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000050","EAP","CPT� 94640","","Sputum Induction Initial","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000055","EAP","CPT� 94644","","Micro Nebulizer, Cont; Initial","BOTH IP/OP","$983.00 ","$727.42 ","$0.00 ","$983.00 ","$533.77 ","$0.00 ","$204.88 ","$701.57 ","$701.57 ","$0.00 ","$983.00 ","$0.00 ","$491.50 ","$778.54 ","$786.40 ","$0.00 ","$0.00 ","$54.39 ","$0.00 ","$0.00 "
"41000059","EAP","CPT� 94645","","Repeat Neb Treatment","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$422.00 ","$0.00 ","$0.00 ","$0.00 ","$301.18 ","$301.18 ","$0.00 ","$422.00 ","$0.00 ","$211.00 ","$334.22 ","$337.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41000062","EAP","CPT� 94660","","Sleep Apnea/bipap","BOTH IP/OP","$2,079.00 ","$1,538.46 ","$39.31 ","$2,001.00 ","$1,128.90 ","$184.08 ","$433.32 ","$1,428.11 ","$1,428.11 ","$350.36 ","$2,001.00 ","$184.50 ","$1,000.50 ","$1,584.79 ","$1,600.80 ","$256.34 ","$52.24 ","$39.31 ","$318.56 ","$175.71 "
"41000063","EAP","CPT� 94660","","Neo Cpap","BOTH IP/OP","$2,079.00 ","$1,538.46 ","$39.31 ","$2,001.00 ","$1,128.90 ","$184.08 ","$433.32 ","$1,428.11 ","$1,428.11 ","$350.36 ","$2,001.00 ","$184.50 ","$1,000.50 ","$1,584.79 ","$1,600.80 ","$256.34 ","$52.24 ","$39.31 ","$318.56 ","$175.71 "
"41000064","EAP","CPT� 94660","","Cpap Prescription","BOTH IP/OP","$2,001.00 ","$1,480.74 ","$39.31 ","$2,001.00 ","$1,086.54 ","$184.08 ","$417.06 ","$1,428.11 ","$1,428.11 ","$350.36 ","$2,001.00 ","$184.50 ","$1,000.50 ","$1,584.79 ","$1,600.80 ","$256.34 ","$52.24 ","$39.31 ","$318.56 ","$175.71 "
"41000065","EAP","CPT� 94664","","Patient Assessment/education","BOTH IP/OP","$290.00 ","$214.60 ","$16.93 ","$220.00 ","$157.47 ","$184.08 ","$60.44 ","$157.01 ","$157.01 ","$38.52 ","$220.00 ","$184.50 ","$110.00 ","$174.24 ","$176.00 ","$220.00 ","$18.91 ","$16.93 ","$35.02 ","$175.71 "
"41000067","EAP","CPT� 94667","","Chest Pt, Inital Rx","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$331.87 ","$331.87 ","$81.42 ","$465.00 ","$109.35 ","$232.50 ","$368.28 ","$372.00 ","$151.93 ","$0.00 ","$25.21 ","$74.03 ","$104.14 "
"41000069","EAP","CPT� 94667","","Cpt/vest","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$331.87 ","$331.87 ","$81.42 ","$465.00 ","$109.35 ","$232.50 ","$368.28 ","$372.00 ","$151.93 ","$0.00 ","$25.21 ","$74.03 ","$104.14 "
"41000070","EAP","CPT� 94667","","Initial Chest Therapy","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$331.87 ","$331.87 ","$81.42 ","$465.00 ","$109.35 ","$232.50 ","$368.28 ","$372.00 ","$151.93 ","$0.00 ","$25.21 ","$74.03 ","$104.14 "
"41000072","EAP","CPT� 94667","","Pep/acpella Therapy","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$331.87 ","$331.87 ","$81.42 ","$465.00 ","$109.35 ","$232.50 ","$368.28 ","$372.00 ","$151.93 ","$0.00 ","$25.21 ","$74.03 ","$104.14 "
"41000073","EAP","CPT� 94667","","Sipap Setup","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$331.87 ","$331.87 ","$81.42 ","$465.00 ","$109.35 ","$232.50 ","$368.28 ","$372.00 ","$151.93 ","$0.00 ","$25.21 ","$74.03 ","$104.14 "
"41000074","EAP","CPT� 94668","","Chest Pt, Subsequent Rx","BOTH IP/OP","$373.00 ","$276.02 ","$0.00 ","$283.00 ","$0.00 ","$0.00 ","$0.00 ","$201.98 ","$201.98 ","$0.00 ","$283.00 ","$0.00 ","$141.50 ","$224.14 ","$226.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41000076","EAP","CPT� 94668","","Cpt/vest Sub","BOTH IP/OP","$283.00 ","$209.42 ","$0.00 ","$283.00 ","$0.00 ","$0.00 ","$0.00 ","$201.98 ","$201.98 ","$0.00 ","$283.00 ","$0.00 ","$141.50 ","$224.14 ","$226.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41000077","EAP","CPT� 94668","","Sipap Ea Shift","BOTH IP/OP","$373.00 ","$276.02 ","$0.00 ","$283.00 ","$0.00 ","$0.00 ","$0.00 ","$201.98 ","$201.98 ","$0.00 ","$283.00 ","$0.00 ","$141.50 ","$224.14 ","$226.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41000078","EAP","CPT� 94668","","Subsequent Chest Therapy","BOTH IP/OP","$373.00 ","$276.02 ","$0.00 ","$283.00 ","$0.00 ","$0.00 ","$0.00 ","$201.98 ","$201.98 ","$0.00 ","$283.00 ","$0.00 ","$141.50 ","$224.14 ","$226.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41000080","EAP","CPT� 94003","","Mech Vent, Ea Subseq Day","BOTH IP/OP","$5,771.00 ","$4,270.54 ","$0.00 ","$5,684.00 ","$0.00 ","$0.00 ","$0.00 ","$4,056.67 ","$4,056.67 ","$995.22 ","$5,684.00 ","$465.90 ","$2,842.00 ","$4,501.73 ","$4,547.20 ","$647.30 ","$56.62 ","$68.52 ","$904.89 ","$443.71 "
"41000081","EAP","CPT� 94664","","Asthma Teaching-nebulizer &mdi","BOTH IP/OP","$290.00 ","$214.60 ","$16.93 ","$220.00 ","$157.47 ","$184.08 ","$60.44 ","$157.01 ","$157.01 ","$38.52 ","$220.00 ","$184.50 ","$110.00 ","$174.24 ","$176.00 ","$220.00 ","$18.91 ","$16.93 ","$35.02 ","$175.71 "
"41000090","EAP","CPT� 94003","","Mech Vent, Ea Subseq Day","BOTH IP/OP","$5,771.00 ","$4,270.54 ","$0.00 ","$5,684.00 ","$0.00 ","$0.00 ","$0.00 ","$4,056.67 ","$4,056.67 ","$995.22 ","$5,684.00 ","$465.90 ","$2,842.00 ","$4,501.73 ","$4,547.20 ","$647.30 ","$56.62 ","$68.52 ","$904.89 ","$443.71 "
"41000110","EAP","CPT� 94002","","Spec Vent Initial","BOTH IP/OP","$6,841.00 ","$5,062.34 ","$77.15 ","$6,240.00 ","$3,714.66 ","$477.09 ","$1,425.84 ","$4,453.49 ","$4,453.49 ","$1,092.57 ","$6,240.00 ","$465.90 ","$3,120.00 ","$4,942.08 ","$4,992.00 ","$647.30 ","$77.15 ","$94.86 ","$993.41 ","$443.71 "
"41000111","EAP","CPT� 94002","","Neo Mech Vent Initial","BOTH IP/OP","$6,841.00 ","$5,062.34 ","$77.15 ","$6,240.00 ","$3,714.66 ","$477.09 ","$1,425.84 ","$4,453.49 ","$4,453.49 ","$1,092.57 ","$6,240.00 ","$465.90 ","$3,120.00 ","$4,942.08 ","$4,992.00 ","$647.30 ","$77.15 ","$94.86 ","$993.41 ","$443.71 "
"41000112","EAP","CPT� 94002","","Mech Vent Initial","BOTH IP/OP","$6,841.00 ","$5,062.34 ","$77.15 ","$6,240.00 ","$3,714.66 ","$477.09 ","$1,425.84 ","$4,453.49 ","$4,453.49 ","$1,092.57 ","$6,240.00 ","$465.90 ","$3,120.00 ","$4,942.08 ","$4,992.00 ","$647.30 ","$77.15 ","$94.86 ","$993.41 ","$443.71 "
"41000119","EAP","CPT� 94003","","Spec Vent, Ea Subseq Day","BOTH IP/OP","$6,231.00 ","$4,610.94 ","$0.00 ","$5,684.00 ","$0.00 ","$0.00 ","$0.00 ","$4,056.67 ","$4,056.67 ","$995.22 ","$5,684.00 ","$465.90 ","$2,842.00 ","$4,501.73 ","$4,547.20 ","$647.30 ","$56.62 ","$68.52 ","$904.89 ","$443.71 "
"41000120","EAP","CPT� 94003","","Neo Mech Vent Subseq","BOTH IP/OP","$6,231.00 ","$4,610.94 ","$0.00 ","$5,684.00 ","$0.00 ","$0.00 ","$0.00 ","$4,056.67 ","$4,056.67 ","$995.22 ","$5,684.00 ","$465.90 ","$2,842.00 ","$4,501.73 ","$4,547.20 ","$647.30 ","$56.62 ","$68.52 ","$904.89 ","$443.71 "
"41000121","EAP","CPT� 94640","","Neo Micro Neb, Setup","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000150","EAP","CPT� 94640","","Sputum Induction Subseq","BOTH IP/OP","$535.00 ","$395.90 ","$18.01 ","$414.00 ","$290.51 ","$184.08 ","$111.51 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$184.50 ","$207.00 ","$327.89 ","$331.20 ","$256.34 ","$19.30 ","$18.01 ","$65.91 ","$175.71 "
"41000190","EAP","CPT� 94003","","Neo Ventilation Subseq","BOTH IP/OP","$6,231.00 ","$4,610.94 ","$0.00 ","$5,684.00 ","$0.00 ","$0.00 ","$0.00 ","$4,056.67 ","$4,056.67 ","$995.22 ","$5,684.00 ","$465.90 ","$2,842.00 ","$4,501.73 ","$4,547.20 ","$647.30 ","$56.62 ","$68.52 ","$904.89 ","$443.71 "
"41000191","EAP","CPT� 94669","","Chest Vest  Mechanical Oscillat","BOTH IP/OP","$1,866.00 ","$1,380.84 ","$0.00 ","$1,866.00 ","$0.00 ","$0.00 ","$0.00 ","$1,331.76 ","$1,331.76 ","$0.00 ","$1,866.00 ","$0.00 ","$933.00 ","$1,477.87 ","$1,492.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41200001","EAP","CPT� 94642","","Aerosol Inhal. Of Pentamidine","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$202.69 ","$202.69 ","$49.73 ","$284.00 ","$184.50 ","$142.00 ","$224.93 ","$227.20 ","$256.34 ","$31.57 ","$0.00 ","$45.21 ","$175.71 "
"42000002","EAP","CPT� 92526","","Pediatric Feeding","BOTH IP/OP","$792.00 ","$586.08 ","$0.00 ","$728.00 ","$430.06 ","$87.06 ","$165.07 ","$427.63 ","$427.63 ","$127.47 ","$728.00 ","$88.84 ","$364.00 ","$576.58 ","$582.40 ","$122.68 ","$113.93 ","$84.61 ","$0.00 ","$84.61 "
"42000006","EAP","CPT� 97012","","Traction, Mechanical","BOTH IP/OP","$206.00 ","$152.44 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$206.00 ","$0.00 ","$103.00 ","$163.15 ","$164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000007","EAP","CPT� 97014","","Electrical Stim Unsupervised","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$427.63 ","$27.09 ","$14.03 ","$60.65 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$13.83 ","$150.50 ","$238.39 ","$240.80 ","$180.60 ","$14.50 ","$0.00 ","$0.00 ","$13.17 "
"42000009","EAP","CPT� 97018","","Paraffin Bath","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$427.63 ","$18.66 ","$11.16 ","$57.94 ","$427.63 ","$427.63 ","$44.30 ","$253.00 ","$5.91 ","$126.50 ","$200.38 ","$202.40 ","$8.16 ","$10.67 ","$5.63 ","$0.00 ","$5.63 "
"42000010","EAP","CPT� 97022","","Whirlpool","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$427.63 ","$40.34 ","$23.78 ","$68.36 ","$427.63 ","$427.63 ","$52.53 ","$300.00 ","$17.83 ","$150.00 ","$237.60 ","$240.00 ","$24.62 ","$14.51 ","$16.98 ","$0.00 ","$16.98 "
"42000011","EAP","CPT� 97032","","Elec Stim Cons Atten Ea 15 Min","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$427.63 ","$32.52 ","$19.43 ","$62.74 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$15.13 ","$150.50 ","$238.39 ","$240.80 ","$20.89 ","$16.22 ","$14.41 ","$0.00 ","$14.41 "
"42000012","EAP","CPT� 97035","","Ultrasound Ea 15 Min","BOTH IP/OP","$162.00 ","$119.88 ","$0.00 ","$427.63 ","$21.67 ","$12.94 ","$33.76 ","$427.63 ","$427.63 ","$28.72 ","$164.00 ","$14.63 ","$82.00 ","$129.89 ","$131.20 ","$20.20 ","$11.96 ","$13.93 ","$0.00 ","$13.93 "
"42000013","EAP","CPT� 97036","","Hubbard Tank Ea 15 Min","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000015","EAP","CPT� 97110","","Exercise Each 15 Minutes","BOTH IP/OP","$351.00 ","$259.74 ","$0.00 ","$427.63 ","$55.39 ","$32.74 ","$73.16 ","$427.63 ","$427.63 ","$55.85 ","$319.00 ","$31.06 ","$159.50 ","$252.65 ","$255.20 ","$42.89 ","$22.45 ","$29.58 ","$0.00 ","$29.58 "
"42000016","EAP","CPT� 97112","","Neuro-musc Re-ed Ea 15 Min","BOTH IP/OP","$332.00 ","$245.68 ","$0.00 ","$427.63 ","$57.82 ","$33.84 ","$69.20 ","$427.63 ","$427.63 ","$52.88 ","$302.00 ","$35.66 ","$151.00 ","$239.18 ","$241.60 ","$49.24 ","$23.53 ","$33.96 ","$0.00 ","$33.96 "
"42000017","EAP","CPT� 97116","","Gait Training Ea 15 Min","BOTH IP/OP","$332.00 ","$245.68 ","$0.00 ","$427.63 ","$48.15 ","$28.80 ","$69.20 ","$427.63 ","$427.63 ","$52.88 ","$302.00 ","$30.72 ","$151.00 ","$239.18 ","$241.60 ","$42.43 ","$21.09 ","$29.26 ","$0.00 ","$29.26 "
"42000018","EAP","CPT� 97139","","Tilt Table - Each 15 Min","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$427.63 ","$39.36 ","$13.61 ","$41.27 ","$427.63 ","$427.63 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$108.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"42000019","EAP","CPT� 97140","","Joint Mobilization Ea 15 Min","BOTH IP/OP","$468.00 ","$346.32 ","$0.00 ","$439.00 ","$51.16 ","$30.24 ","$97.54 ","$427.63 ","$427.63 ","$76.87 ","$439.00 ","$28.62 ","$219.50 ","$347.69 ","$351.20 ","$39.53 ","$25.71 ","$27.26 ","$0.00 ","$27.26 "
"42000020","EAP","CPT� 97150","","Group Activity/exercise","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$427.63 ","$29.49 ","$17.62 ","$29.80 ","$427.63 ","$427.63 ","$25.04 ","$143.00 ","$18.67 ","$71.50 ","$113.26 ","$114.40 ","$25.78 ","$18.34 ","$17.78 ","$0.00 ","$17.78 "
"42000021","EAP","CPT� 97530","","Functional Activities Ea 15 Mi","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$427.63 ","$59.61 ","$35.29 ","$68.99 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$39.44 ","$150.50 ","$238.39 ","$240.80 ","$54.46 ","$21.84 ","$37.56 ","$0.00 ","$37.56 "
"42000023","EAP","CPT� 97542","","W/c Management Training Ea 15m","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$427.63 ","$52.38 ","$30.95 ","$60.44 ","$427.63 ","$427.63 ","$46.22 ","$264.00 ","$33.55 ","$132.00 ","$209.09 ","$211.20 ","$46.33 ","$15.60 ","$31.95 ","$0.00 ","$31.95 "
"42000026","EAP","CPT� 97760","","Orthotic Fit/train Init Ea 15","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$427.63 ","$186.79 ","$38.52 ","$71.70 ","$427.63 ","$427.63 ","$54.80 ","$313.00 ","$49.13 ","$156.50 ","$247.90 ","$250.40 ","$67.85 ","$48.98 ","$46.79 ","$0.00 ","$46.79 "
"42000027","EAP","CPT� 97761","","Prosthetic Training Ea 15 Min","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$427.63 ","$89.05 ","$33.46 ","$0.00 ","$427.63 ","$427.63 ","$26.09 ","$149.00 ","$42.05 ","$74.50 ","$118.01 ","$119.20 ","$58.07 ","$23.32 ","$40.05 ","$0.00 ","$40.05 "
"42000028","EAP","CPT� 97763","","Orthotics/prosth Mgmt &/trainj Sbsq Enctr 15 Min","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$427.63 ","$186.79 ","$0.00 ","$71.70 ","$427.63 ","$427.63 ","$54.80 ","$313.00 ","$52.42 ","$156.50 ","$247.90 ","$250.40 ","$72.38 ","$46.64 ","$49.92 ","$0.00 ","$49.92 "
"42000034","EAP","CPT� 97545","","Work Hardening-pt","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000045","EAP","CPT� 97139","","Scar Management Ea 15 Min","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$427.63 ","$39.36 ","$13.61 ","$41.27 ","$427.63 ","$427.63 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$108.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"42000050","EAP","CPT� 97546","","Work Hardening Add-on","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000060","EAP","CPT� 29581","","Apply Multlay Comprs Lwr Leg-lt","BOTH IP/OP","$478.00 ","$353.72 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000068","EAP","CPT� 29584","","Apply Multlay Comprs  Arm/hand-lt","BOTH IP/OP","$427.00 ","$315.98 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000088","EAP","CPT� 97022","","FLUIDIOTHERAPY-GP","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$427.63 ","$40.34 ","$23.78 ","$68.36 ","$427.63 ","$427.63 ","$52.53 ","$300.00 ","$17.83 ","$150.00 ","$237.60 ","$240.00 ","$24.62 ","$14.51 ","$16.98 ","$0.00 ","$16.98 "
"42000090","EAP","CPT� 29581","","Apply Multlay Comprs Lwr Leg-rt","BOTH IP/OP","$478.00 ","$353.72 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000093","EAP","CPT� 29584","","Apply Multlay Comprs Arm/hand-rt","BOTH IP/OP","$427.00 ","$315.98 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000100","EAP","HCPCS G8978","","Mobility Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000101","EAP","HCPCS G8979","","Mobility Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000102","EAP","HCPCS G8980","","Mobility D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000103","EAP","HCPCS G8981","","Body Pos Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000104","EAP","HCPCS G8982","","Body Pos Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000105","EAP","HCPCS G8983","","Body Pos D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000106","EAP","HCPCS G8984","","Carry Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000107","EAP","HCPCS G8985","","Carry Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000108","EAP","HCPCS G8986","","Carry D/c  Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000109","EAP","HCPCS G8987","","Self-care Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000110","EAP","HCPCS G8988","","Self-care Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000111","EAP","HCPCS G8989","","Self-care D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000112","EAP","HCPCS G8990","","Other Pt/ot Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000113","EAP","HCPCS G8991","","Other Pt/ot Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000114","EAP","HCPCS G8992","","Other Pt/ot D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000115","EAP","HCPCS G8993","","Sub Pt/ot Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000116","EAP","HCPCS G8994","","Sub Pt/ot Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000117","EAP","HCPCS G8995","","Sub Pt/ot D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000125","EAP","CPT� 97597","","Debridement First 20 Sq Cm Or Less","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$740.00 ","$175.86 ","$154.23 ","$427.63 ","$427.63 ","$118.01 ","$674.00 ","$175.24 ","$674.00 ","$533.81 ","$539.20 ","$243.48 ","$48.15 ","$37.87 ","$0.00 ","$166.90 "
"42000126","EAP","CPT� 97610","","Pt Low Frequency Non Contrast/thermal Per Day","BOTH IP/OP","$514.00 ","$380.36 ","$0.00 ","$514.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$514.00 ","$0.00 ","$257.00 ","$407.09 ","$411.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42000226","EAP","CPT� 97598","","Debridement Open Wound Ea Addl 20 Sq Cm","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$616.00 ","$616.00 ","$0.00 ","$128.39 ","$427.63 ","$427.63 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$61.13 ","$26.68 ","$0.00 ","$0.00 "
"42000227","EAP","CPT� 97014","","Pt Electric Stim Ther Unsupervised Wound","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$427.63 ","$27.09 ","$13.56 ","$60.65 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$0.00 ","$150.50 ","$238.39 ","$240.80 ","$180.60 ","$14.50 ","$0.00 ","$0.00 ","$0.00 "
"42000228","EAP","CPT� 97014","","Pt Electric Stim Ther Unsupervised Non-wound","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$427.63 ","$27.09 ","$14.03 ","$62.74 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$13.83 ","$150.50 ","$238.39 ","$240.80 ","$180.60 ","$14.50 ","$0.00 ","$0.00 ","$13.17 "
"42400010","EAP","CPT� 97161","","Pt Eval Low Complex","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$660.00 ","$138.52 ","$0.00 ","$151.32 ","$427.63 ","$427.63 ","$115.56 ","$660.00 ","$86.56 ","$330.00 ","$522.72 ","$528.00 ","$119.54 ","$77.58 ","$82.44 ","$0.00 ","$82.44 "
"42400011","EAP","CPT� 97162","","Pt Eval Mod Complex","BOTH IP/OP","$743.00 ","$549.82 ","$0.00 ","$675.00 ","$138.52 ","$0.00 ","$154.86 ","$427.63 ","$427.63 ","$118.19 ","$675.00 ","$86.56 ","$337.50 ","$534.60 ","$540.00 ","$119.54 ","$77.58 ","$82.44 ","$0.00 ","$82.44 "
"42400012","EAP","CPT� 97163","","Pt Eval High Complex","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$690.00 ","$138.52 ","$0.00 ","$158.19 ","$427.63 ","$427.63 ","$120.81 ","$690.00 ","$86.56 ","$345.00 ","$546.48 ","$552.00 ","$119.54 ","$77.58 ","$82.44 ","$0.00 ","$82.44 "
"42400013","EAP","CPT� 97164","","Pt Re-eval","BOTH IP/OP","$528.00 ","$390.72 ","$0.00 ","$480.00 ","$93.38 ","$0.00 ","$110.05 ","$427.63 ","$427.63 ","$84.04 ","$480.00 ","$59.21 ","$240.00 ","$380.16 ","$384.00 ","$81.77 ","$52.74 ","$56.39 ","$0.00 ","$56.39 "
"43000002","EAP","CPT� 92526","","Dysphagia Treatment","BOTH IP/OP","$728.00 ","$538.72 ","$0.00 ","$728.00 ","$395.30 ","$87.06 ","$151.73 ","$427.63 ","$427.63 ","$127.47 ","$728.00 ","$88.84 ","$364.00 ","$576.58 ","$582.40 ","$122.68 ","$113.93 ","$84.61 ","$0.00 ","$84.61 "
"43000005","EAP","CPT� 95851","","Range Of Motion Measurement","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000008","EAP","CPT� 97014","","Electrical Stim Unsupervised","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$427.63 ","$27.09 ","$14.03 ","$60.65 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$13.83 ","$150.50 ","$238.39 ","$240.80 ","$180.60 ","$14.50 ","$0.00 ","$0.00 ","$13.17 "
"43000010","EAP","CPT� 97018","","Paraffin Bath","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$427.63 ","$18.66 ","$11.16 ","$57.94 ","$427.63 ","$427.63 ","$44.30 ","$253.00 ","$5.91 ","$126.50 ","$200.38 ","$202.40 ","$8.16 ","$10.67 ","$5.63 ","$0.00 ","$5.63 "
"43000011","EAP","CPT� 97022","","Whirlpool","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$427.63 ","$40.34 ","$23.78 ","$68.36 ","$427.63 ","$427.63 ","$52.53 ","$300.00 ","$17.83 ","$150.00 ","$237.60 ","$240.00 ","$24.62 ","$14.51 ","$16.98 ","$0.00 ","$16.98 "
"43000012","EAP","CPT� 97032","","Elec Stim Cons Atten Ea 15 Min","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$427.63 ","$32.52 ","$19.43 ","$62.74 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$15.13 ","$150.50 ","$238.39 ","$240.80 ","$20.89 ","$16.22 ","$14.41 ","$0.00 ","$14.41 "
"43000013","EAP","CPT� 97035","","Ultrasound Heat Ea 15 Min","BOTH IP/OP","$162.00 ","$119.88 ","$0.00 ","$427.63 ","$21.67 ","$12.94 ","$33.76 ","$427.63 ","$427.63 ","$28.72 ","$164.00 ","$14.63 ","$82.00 ","$129.89 ","$131.20 ","$20.20 ","$11.96 ","$13.93 ","$0.00 ","$13.93 "
"43000014","EAP","CPT� 97022","","Fluidiotherapy","BOTH IP/OP","$328.00 ","$242.72 ","$0.00 ","$427.63 ","$40.34 ","$23.78 ","$68.36 ","$427.63 ","$427.63 ","$52.53 ","$300.00 ","$17.83 ","$150.00 ","$237.60 ","$240.00 ","$24.62 ","$14.51 ","$16.98 ","$0.00 ","$16.98 "
"43000015","EAP","CPT� 97110","","Therapeutic Exercise Ea 15min","BOTH IP/OP","$351.00 ","$259.74 ","$0.00 ","$427.63 ","$55.39 ","$32.74 ","$73.16 ","$427.63 ","$427.63 ","$55.85 ","$319.00 ","$31.06 ","$159.50 ","$252.65 ","$255.20 ","$42.89 ","$22.45 ","$29.58 ","$0.00 ","$29.58 "
"43000016","EAP","CPT� 97112","","Neuromuscular Re-ed Ea. 15 Min","BOTH IP/OP","$332.00 ","$245.68 ","$0.00 ","$427.63 ","$57.82 ","$33.84 ","$69.20 ","$427.63 ","$427.63 ","$52.88 ","$302.00 ","$35.66 ","$151.00 ","$239.18 ","$241.60 ","$49.24 ","$23.53 ","$33.96 ","$0.00 ","$33.96 "
"43000018","EAP","CPT� 97139","","Scar Management Ea 15 Min","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$427.63 ","$39.36 ","$13.61 ","$41.27 ","$427.63 ","$427.63 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$108.00 ","$28.17 ","$0.00 ","$0.00 ","$0.00 "
"43000019","EAP","CPT� 97140","","Joint Mobilization Ea 15 Min","BOTH IP/OP","$468.00 ","$346.32 ","$0.00 ","$439.00 ","$51.16 ","$30.24 ","$97.54 ","$427.63 ","$427.63 ","$76.87 ","$439.00 ","$28.62 ","$219.50 ","$347.69 ","$351.20 ","$39.53 ","$25.71 ","$27.26 ","$0.00 ","$27.26 "
"43000020","EAP","CPT� 97150","","Group Activity/exercise","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$427.63 ","$29.49 ","$17.62 ","$29.80 ","$427.63 ","$427.63 ","$25.04 ","$143.00 ","$18.67 ","$71.50 ","$113.26 ","$114.40 ","$25.78 ","$18.34 ","$17.78 ","$0.00 ","$17.78 "
"43000021","EAP","CPT� 97530","","Activ.to Increase Func.ea 15mi","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$427.63 ","$59.61 ","$35.29 ","$68.99 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$39.44 ","$150.50 ","$238.39 ","$240.80 ","$54.46 ","$21.84 ","$37.56 ","$0.00 ","$37.56 "
"43000023","EAP","CPT� 97533","","Sensory Integrat Tech Ea 15min","BOTH IP/OP","$191.00 ","$141.34 ","$0.00 ","$427.63 ","$49.98 ","$29.51 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000024","EAP","CPT� 97535","","Adl Training Each 15 Mins","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$427.63 ","$59.61 ","$35.29 ","$57.94 ","$427.63 ","$427.63 ","$44.30 ","$253.00 ","$34.43 ","$126.50 ","$200.38 ","$202.40 ","$47.55 ","$23.39 ","$32.79 ","$0.00 ","$32.79 "
"43000028","EAP","CPT� 97760","","Splint/ort-fab,fit/tra/q 15min","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$427.63 ","$186.79 ","$38.52 ","$71.70 ","$427.63 ","$427.63 ","$54.80 ","$313.00 ","$49.13 ","$156.50 ","$247.90 ","$250.40 ","$67.85 ","$48.98 ","$46.79 ","$0.00 ","$46.79 "
"43000029","EAP","CPT� 97761","","Prosth/training Ea 15 Min","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$427.63 ","$89.05 ","$33.46 ","$0.00 ","$427.63 ","$427.63 ","$26.09 ","$149.00 ","$42.05 ","$74.50 ","$118.01 ","$119.20 ","$58.07 ","$23.32 ","$40.05 ","$0.00 ","$40.05 "
"43000030","EAP","CPT� 97763","","Orthotics/prosth Mgmt &/trainj Sbsq Enctr 15 Min","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$427.63 ","$186.79 ","$0.00 ","$71.70 ","$427.63 ","$427.63 ","$54.80 ","$313.00 ","$52.42 ","$156.50 ","$247.90 ","$250.40 ","$72.38 ","$46.64 ","$49.92 ","$0.00 ","$49.92 "
"43000044","EAP","CPT� 97545","","Work Hardening-ot","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000051","EAP","CPT� 97598","","WOUND CARE,EACH ADDITIONAL 20 SQ CEMENT &PULSED LAVAGE)","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$616.00 ","$616.00 ","$0.00 ","$128.39 ","$427.63 ","$427.63 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$61.13 ","$26.68 ","$0.00 ","$0.00 "
"43000060","EAP","CPT� 97546","","Work Hardening Add-on-ot","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000062","EAP","CPT� 29581","","Apply Multlay Comprs Lwr Leg-lt","BOTH IP/OP","$478.00 ","$353.72 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000065","EAP","CPT� 29584","","Apply Multlay Comprs  Arm/hand-lt","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000070","EAP","CPT� 29581","","Apply Multlay Comprs Lwr Leg-rt","BOTH IP/OP","$478.00 ","$353.72 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000080","EAP","CPT� 97129","","Occ Ther Ivntj Cog Funcj Cntct 1st 15 Minutes","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$427.63 ","$41.10 ","$18.64 ","$78.99 ","$427.63 ","$427.63 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$24.17 ","$23.23 ","$24.17 ","$0.00 ","$24.17 "
"43000081","EAP","CPT� 97130","","Occ Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$427.63 ","$39.28 ","$17.80 ","$78.99 ","$427.63 ","$427.63 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$23.44 ","$22.20 ","$23.44 ","$0.00 ","$23.44 "
"43000093","EAP","CPT� 29584","","Apply Multlay Comprs  Arm/hand-rt","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000100","EAP","HCPCS G8978","","Mobility Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000101","EAP","HCPCS G8979","","Mobility Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000102","EAP","HCPCS G8980","","Mobility D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000103","EAP","HCPCS G8981","","Body Pos Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000104","EAP","HCPCS G8982","","Body Pos Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000106","EAP","HCPCS G8984","","Carry Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000107","EAP","HCPCS G8985","","Carry Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000108","EAP","HCPCS G8986","","Carry D/c  Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000109","EAP","HCPCS G8987","","Self-care Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000110","EAP","HCPCS G8988","","Self-care Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000111","EAP","HCPCS G8989","","Self-care D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000112","EAP","HCPCS G8990","","Other Pt/ot Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000113","EAP","HCPCS G8991","","Other Pt/ot Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000114","EAP","HCPCS G8992","","Other Pt/ot D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000115","EAP","HCPCS G8993","","Sub Pt/ot Current Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000116","EAP","HCPCS G8994","","Sub Pt/ot Goal Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000117","EAP","HCPCS G8995","","Sub Pt/ot D/c Status","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43000118","EAP","CPT� 97014","","Ot Electric Stim Ther Unsupervised Wound","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$427.63 ","$27.09 ","$13.56 ","$60.65 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$0.00 ","$150.50 ","$238.39 ","$240.80 ","$180.60 ","$14.50 ","$0.00 ","$0.00 ","$0.00 "
"43000119","EAP","CPT� 97014","","Ot Electric Stim Ther Unsupervised Non-wound","BOTH IP/OP","$301.00 ","$222.74 ","$0.00 ","$427.63 ","$27.09 ","$14.03 ","$62.74 ","$427.63 ","$427.63 ","$52.70 ","$301.00 ","$13.83 ","$150.50 ","$238.39 ","$240.80 ","$180.60 ","$14.50 ","$0.00 ","$0.00 ","$13.17 "
"43400001","EAP","CPT� 92610","","Nicu/ped/swallowing Evaluation","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$643.46 ","$56.49 ","$246.98 ","$427.63 ","$427.63 ","$207.48 ","$1,185.00 ","$77.89 ","$592.50 ","$938.52 ","$948.00 ","$74.65 ","$42.12 ","$74.65 ","$0.00 ","$74.65 "
"43400060","EAP","CPT� 97165","","Ot Eval Low Complex","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$660.00 ","$157.79 ","$0.00 ","$151.32 ","$427.63 ","$427.63 ","$115.56 ","$660.00 ","$91.61 ","$330.00 ","$522.72 ","$528.00 ","$126.51 ","$75.19 ","$87.25 ","$0.00 ","$87.25 "
"43400061","EAP","CPT� 97166","","Ot Eval Mod Complex","BOTH IP/OP","$743.00 ","$549.82 ","$0.00 ","$675.00 ","$157.79 ","$0.00 ","$154.86 ","$427.63 ","$427.63 ","$118.19 ","$675.00 ","$91.28 ","$337.50 ","$534.60 ","$540.00 ","$126.05 ","$75.19 ","$86.93 ","$0.00 ","$86.93 "
"43400062","EAP","CPT� 97167","","Ot Eval High Complex","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$690.00 ","$157.79 ","$0.00 ","$158.19 ","$427.63 ","$427.63 ","$120.81 ","$690.00 ","$91.28 ","$345.00 ","$546.48 ","$552.00 ","$126.05 ","$75.19 ","$86.93 ","$0.00 ","$86.93 "
"43400063","EAP","CPT� 97168","","Ot Re-eval","BOTH IP/OP","$528.00 ","$390.72 ","$0.00 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$84.04 ","$480.00 ","$62.92 ","$240.00 ","$380.16 ","$384.00 ","$86.88 ","$49.67 ","$59.92 ","$0.00 ","$59.92 "
"44000001","EAP","CPT� 92507","","Individual Speech Therapy","BOTH IP/OP","$629.00 ","$465.46 ","$44.25 ","$572.00 ","$148.00 ","$80.21 ","$131.10 ","$427.63 ","$427.63 ","$100.15 ","$572.00 ","$80.92 ","$286.00 ","$453.02 ","$457.60 ","$111.75 ","$44.25 ","$77.07 ","$91.06 ","$77.07 "
"44000004","EAP","CPT� 92526","","Treatmet Of Swallow & Oral Fun","BOTH IP/OP","$792.00 ","$586.08 ","$84.61 ","$728.00 ","$430.06 ","$87.06 ","$165.07 ","$427.63 ","$427.63 ","$127.47 ","$728.00 ","$88.84 ","$364.00 ","$576.58 ","$582.40 ","$122.68 ","$113.93 ","$84.61 ","$115.90 ","$84.61 "
"44000007","EAP","CPT� 92609","","Ther Ser/speech-generating Dev","BOTH IP/OP","$509.00 ","$376.66 ","$0.00 ","$509.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$509.00 ","$0.00 ","$254.50 ","$403.13 ","$407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44000044","EAP","CPT� 92524","","Behavioral And Qualitative Analysis Of Voice And Resonae","BOTH IP/OP","$920.00 ","$680.80 ","$87.62 ","$846.00 ","$166.61 ","$91.21 ","$191.75 ","$427.63 ","$427.63 ","$148.13 ","$846.00 ","$92.00 ","$423.00 ","$670.03 ","$676.80 ","$127.05 ","$91.88 ","$87.62 ","$134.68 ","$87.62 "
"44000050","EAP","CPT� 97129","","Speech Ther Ivntj Cog Funcj Cntct 1st 15 Minutes","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$427.63 ","$41.10 ","$18.64 ","$78.99 ","$427.63 ","$427.63 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$24.17 ","$23.23 ","$24.17 ","$54.92 ","$24.17 "
"44000051","EAP","CPT� 97130","","Speech Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$427.63 ","$39.28 ","$17.80 ","$78.99 ","$427.63 ","$427.63 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$23.44 ","$22.20 ","$23.44 ","$54.92 ","$23.44 "
"44300005","EAP","CPT� 92508","","Group Speech Ther Each 15min","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400003","EAP","CPT� 92597","","Evaluation For Voice Prosthesi","BOTH IP/OP","$1,176.00 ","$870.24 ","$71.39 ","$1,082.00 ","$638.57 ","$72.95 ","$245.11 ","$427.63 ","$427.63 ","$189.45 ","$1,082.00 ","$74.96 ","$541.00 ","$856.94 ","$865.60 ","$103.52 ","$169.33 ","$71.39 ","$172.25 ","$71.39 "
"44400005","EAP","CPT� 92607","","Eval Speech Device First Hour","BOTH IP/OP","$553.00 ","$409.22 ","$0.00 ","$553.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$553.00 ","$0.00 ","$276.50 ","$437.98 ","$442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400007","EAP","CPT� 92608","","Eval/speech Dvc (add'l 30 Min)","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400009","EAP","CPT� 92610","","Eval.of Swallow & Oral Func.","BOTH IP/OP","$1,288.00 ","$953.12 ","$42.12 ","$1,185.00 ","$699.38 ","$56.49 ","$268.45 ","$427.63 ","$427.63 ","$207.48 ","$1,185.00 ","$77.89 ","$592.50 ","$938.52 ","$948.00 ","$74.65 ","$42.12 ","$74.65 ","$188.65 ","$74.65 "
"44400012","EAP","CPT� 92611","","Motion Fluo Eval Of Swallowing","BOTH IP/OP","$1,288.00 ","$953.12 ","$45.81 ","$1,185.00 ","$699.38 ","$74.78 ","$268.45 ","$427.63 ","$427.63 ","$207.48 ","$1,185.00 ","$93.79 ","$592.50 ","$938.52 ","$948.00 ","$94.46 ","$45.81 ","$94.46 ","$188.65 ","$94.46 "
"44400014","EAP","CPT� 92612","","Flex Fib Endo Eval/swallowing","BOTH IP/OP","$2,142.00 ","$1,585.08 ","$0.00 ","$1,970.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$1,970.00 ","$0.00 ","$985.00 ","$1,560.24 ","$1,576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400017","EAP","CPT� 96105","","Assessment Of Aphasia","BOTH IP/OP","$607.00 ","$449.18 ","$0.00 ","$607.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$607.00 ","$0.00 ","$303.50 ","$480.74 ","$485.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400020","EAP","CPT� 92540","","Basic Vestibular Exam","BOTH IP/OP","$911.00 ","$674.14 ","$0.00 ","$838.00 ","$494.67 ","$136.73 ","$189.88 ","$427.63 ","$427.63 ","$0.00 ","$838.00 ","$0.00 ","$419.00 ","$663.70 ","$670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400030","EAP","CPT� 92570","","Acoustic Immittance Testing","BOTH IP/OP","$273.00 ","$202.02 ","$0.00 ","$427.63 ","$148.24 ","$136.73 ","$56.90 ","$427.63 ","$427.63 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$23.55 ","$0.00 ","$0.00 ","$0.00 "
"44400031","EAP","CPT� 92550","","Tympanometry And Reflex Thresh","BOTH IP/OP","$156.00 ","$115.44 ","$15.45 ","$427.63 ","$84.71 ","$136.73 ","$32.51 ","$427.63 ","$427.63 ","$27.66 ","$158.00 ","$138.76 ","$79.00 ","$125.14 ","$126.40 ","$158.00 ","$15.45 ","$22.71 ","$25.15 ","$132.15 "
"44400033","EAP","CPT� 92618","","Ex For Non-speech Dev Rx Add","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44400034","EAP","CPT� 92522","","Eval Of Only Speech Snd Prod (motor Speech, Artic, Etc)","BOTH IP/OP","$772.00 ","$571.28 ","$88.23 ","$710.00 ","$172.58 ","$93.49 ","$160.90 ","$427.63 ","$427.63 ","$124.32 ","$710.00 ","$94.02 ","$355.00 ","$562.32 ","$568.00 ","$129.83 ","$88.23 ","$89.54 ","$113.03 ","$89.54 "
"44400035","EAP","CPT� 92521","","Evaluation Of Speech Fluency (eg, Stuttering, Clutterin)","BOTH IP/OP","$811.00 ","$600.14 ","$0.00 ","$746.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$130.62 ","$746.00 ","$114.94 ","$373.00 ","$590.83 ","$596.80 ","$158.73 ","$108.68 ","$109.47 ","$118.76 ","$109.47 "
"44400036","EAP","CPT� 92523","","Eval Of Speech, Language & Cognition-communication","BOTH IP/OP","$1,188.00 ","$879.12 ","$174.01 ","$1,093.00 ","$368.39 ","$190.53 ","$247.61 ","$427.63 ","$427.63 ","$191.38 ","$1,093.00 ","$197.15 ","$546.50 ","$865.66 ","$874.40 ","$272.25 ","$183.27 ","$187.76 ","$174.01 ","$187.76 "
"44400056","EAP","CPT� 92523","","EVAL OF SPEECH, LANGUAGE & COGNITION-COMM","BOTH IP/OP","$1,188.00 ","$879.12 ","$174.01 ","$1,093.00 ","$368.39 ","$190.53 ","$247.61 ","$427.63 ","$427.63 ","$191.38 ","$1,093.00 ","$197.15 ","$546.50 ","$865.66 ","$874.40 ","$272.25 ","$183.27 ","$187.76 ","$174.01 ","$187.76 "
"45000003","EAP","CPT� 52310","","Cystoscopy And Treatament","BOTH IP/OP","$5,725.00 ","$4,236.50 ","$156.86 ","$5,783.00 ","$2,753.10 ","$1,753.49 ","$1,193.23 ","$1,482.64 ","$1,482.64 ","$1,012.56 ","$5,783.00 ","$1,776.76 ","$2,327.00 ","$4,580.14 ","$4,626.40 ","$2,468.57 ","$409.12 ","$156.86 ","$920.65 ","$1,692.15 "
"45000005","EAP","CPT� 45300","","Proctosigmidoscopy Dx","BOTH IP/OP","$2,361.00 ","$1,747.14 ","$0.00 ","$2,361.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,361.00 ","$0.00 ","$2,255.00 ","$1,869.91 ","$1,888.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000006","EAP","CPT� 24675","","Closed Tratment Of Proximal Ulna/w Manipulation","BOTH IP/OP","$1,594.00 ","$1,179.56 ","$0.00 ","$1,594.00 ","$1,594.00 ","$1,364.04 ","$332.23 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000009","EAP","CPT� 29126","","Applyfore Arm Splint","BOTH IP/OP","$732.00 ","$541.68 ","$0.00 ","$689.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$689.00 ","$0.00 ","$689.00 ","$545.69 ","$551.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000018","EAP","CPT� 11760","","Repair Of Nail Bed","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$759.00 ","$0.00 ","$0.00 ","$156.74 ","$0.00 ","$0.00 ","$0.00 ","$759.00 ","$0.00 ","$759.00 ","$601.13 ","$607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000020","EAP","CPT� 12001","","Lac Repr Sclp Nck Hnd Ft <2.6c","BOTH IP/OP","$751.00 ","$555.74 ","$46.87 ","$751.00 ","$751.00 ","$175.86 ","$156.53 ","$704.00 ","$704.00 ","$123.26 ","$704.00 ","$175.24 ","$704.00 ","$557.57 ","$563.20 ","$243.48 ","$116.22 ","$46.87 ","$112.08 ","$166.90 "
"45000021","EAP","CPT� 27550","","Treat Knee Dislocation,w/o Anesthesia","BOTH IP/OP","$902.00 ","$667.48 ","$0.00 ","$857.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$857.00 ","$0.00 ","$857.00 ","$678.74 ","$685.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000022","EAP","CPT� 12002","","Lac Repr Sclp Nck Hnd Ft 2.6-7","BOTH IP/OP","$938.00 ","$694.12 ","$62.38 ","$879.00 ","$509.33 ","$175.86 ","$195.50 ","$879.00 ","$879.00 ","$153.91 ","$879.00 ","$175.24 ","$879.00 ","$696.17 ","$703.20 ","$243.48 ","$127.88 ","$62.38 ","$139.94 ","$166.90 "
"45000023","EAP","CPT� 12004","","Rep Sc/nk/ax/gen/tk 7.6-12.5cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$970.00 ","$169.84 ","$970.00 ","$175.24 ","$970.00 ","$768.24 ","$776.00 ","$243.48 ","$152.49 ","$77.52 ","$154.42 ","$166.90 "
"45000025","EAP","CPT� 12005","","Rep Sc/nk/ax/gen/ 12.6-20.0 Cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$970.00 ","$338.49 ","$202.17 ","$0.00 ","$0.00 ","$0.00 ","$909.00 ","$0.00 ","$909.00 ","$719.93 ","$727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000027","EAP","CPT� 12006","","Rep Sc/nk/ax/gen/ 20.1-30.0 Cm","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$436.00 ","$0.00 ","$436.00 ","$345.31 ","$348.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000029","EAP","CPT� 12007","","Rep Sc/nk/ax/gen/tk > 30.0 Cm","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$909.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$909.00 ","$0.00 ","$909.00 ","$719.93 ","$727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000030","EAP","CPT� 12011","","Lac Rep.fac/ear/lid/nose<2.5cm","BOTH IP/OP","$778.00 ","$575.72 ","$58.77 ","$729.00 ","$422.45 ","$175.86 ","$162.15 ","$729.00 ","$729.00 ","$127.64 ","$729.00 ","$175.24 ","$729.00 ","$577.37 ","$583.20 ","$243.48 ","$123.67 ","$58.77 ","$116.06 ","$166.90 "
"45000031","EAP","CPT� 12013","","Lac Repr Fce Ear Eye Lp 2.6-5.","BOTH IP/OP","$954.00 ","$705.96 ","$62.02 ","$894.00 ","$518.02 ","$175.86 ","$198.84 ","$894.00 ","$894.00 ","$156.53 ","$894.00 ","$175.24 ","$894.00 ","$708.05 ","$715.20 ","$243.48 ","$140.24 ","$62.02 ","$142.32 ","$166.90 "
"45000032","EAP","CPT� 12014","","Lac Repr Fce Ear Eye Lp 5.1-7.","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$215.72 ","$970.00 ","$970.00 ","$169.84 ","$970.00 ","$175.24 ","$970.00 ","$768.24 ","$776.00 ","$243.48 ","$166.21 ","$79.33 ","$154.42 ","$166.90 "
"45000034","EAP","CPT� 12015","","Lac Rep Fce Ear Eye Lp 7.6-12.","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$215.72 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000035","EAP","CPT� 27510","","Treatment Of Thigh Fracture,w Manipulation","BOTH IP/OP","$1,589.00 ","$1,175.86 ","$0.00 ","$1,589.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,589.00 ","$0.00 ","$1,589.00 ","$1,258.49 ","$1,271.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000036","EAP","CPT� 12016","","Lac Rep Fce Ear Eye Lp12.6-20.","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000038","EAP","CPT� 12017","","Rp Si Fa Ear Nos Lip 20.1-30.0","BOTH IP/OP","$1,686.00 ","$1,247.64 ","$0.00 ","$1,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,580.00 ","$0.00 ","$1,580.00 ","$1,251.36 ","$1,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000041","EAP","CPT� 12031","","Int Rep Sclp Trnk Extrm <2.5cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$215.72 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$141.63 ","$157.16 ","$154.42 ","$305.19 "
"45000042","EAP","CPT� 12032","","Int Rep Sclp Trk Ext 2.6-7.5cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$1,035.00 ","$338.49 ","$215.72 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$161.36 ","$196.82 ","$154.42 ","$305.19 "
"45000043","EAP","CPT� 12034","","Int Rep Sclp Trk Ext7.6-12.5cm","BOTH IP/OP","$496.00 ","$367.04 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$103.38 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$465.00 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000044","EAP","CPT� 12035","","Int Rep Sclp Trk Extrm12.6-20.","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$909.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$909.00 ","$0.00 ","$909.00 ","$719.93 ","$727.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000045","EAP","CPT� 28455","","Treatment Of Tarsal Bone Fracture","BOTH IP/OP","$6,532.00 ","$4,833.68 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000046","EAP","CPT� 12036","","Int Rep S/tr/ext/20.1-30.0cm","BOTH IP/OP","$894.00 ","$661.56 ","$0.00 ","$838.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$838.00 ","$0.00 ","$838.00 ","$663.70 ","$670.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000047","EAP","CPT� 56440","","Marsupialization Of Bartholin Cyst","BOTH IP/OP","$7,879.00 ","$5,830.46 ","$0.00 ","$7,879.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,879.00 ","$0.00 ","$2,327.00 ","$6,240.17 ","$6,303.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000048","EAP","CPT� 12037","","Intmd Wnd Repair S/tr/ext","BOTH IP/OP","$1,882.00 ","$1,392.68 ","$0.00 ","$1,907.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,907.00 ","$0.00 ","$1,907.00 ","$1,510.34 ","$1,525.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000049","EAP","CPT� 12041","","Int Repr N-hf/genit <2.6cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$970.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$157.82 ","$152.13 ","$154.42 ","$305.19 "
"45000051","EAP","CPT� 12042","","Int Repr Nck Hnd Ft 2.6-7.5 Cm","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$615.00 ","$338.49 ","$128.18 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$465.00 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000052","EAP","CPT� 12044","","Int Repr Nck Hnd Ft 7.6-12.5cm","BOTH IP/OP","$1,012.00 ","$748.88 ","$0.00 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$948.00 ","$0.00 ","$948.00 ","$750.82 ","$758.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000053","EAP","CPT� 12045","","Int Rep Nck Hnd Ft 12.6-20.0cm","BOTH IP/OP","$2,196.00 ","$1,625.04 ","$0.00 ","$2,058.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,058.00 ","$0.00 ","$2,058.00 ","$1,629.94 ","$1,646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000054","EAP","CPT� 12046","","Int Rep Nck Hnd Ft 20.1-30.0cm","BOTH IP/OP","$1,314.00 ","$972.36 ","$0.00 ","$1,332.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,332.00 ","$0.00 ","$1,332.00 ","$1,054.94 ","$1,065.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000055","EAP","CPT� 12051","","Int Repr Fce Ear Eye Lp<2.5cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$1,035.00 ","$338.49 ","$215.72 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$0.00 ","$174.83 ","$154.42 ","$305.19 "
"45000056","EAP","CPT� 12052","","Int Repr F/e/l/mm 2.6-5.0cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$1,035.00 ","$338.49 ","$215.72 ","$0.00 ","$0.00 ","$169.84 ","$970.00 ","$320.45 ","$970.00 ","$768.24 ","$776.00 ","$445.22 ","$183.25 ","$206.92 ","$154.42 ","$305.19 "
"45000057","EAP","CPT� 12053","","Int Wnd Repr Face/mm 5.1-7.5cm","BOTH IP/OP","$1,718.00 ","$1,271.32 ","$0.00 ","$1,718.00 ","$1,718.00 ","$338.49 ","$0.00 ","$0.00 ","$0.00 ","$281.90 ","$1,610.00 ","$320.45 ","$1,610.00 ","$1,275.12 ","$1,288.00 ","$445.22 ","$204.98 ","$223.51 ","$256.31 ","$305.19 "
"45000058","EAP","CPT� 12054","","Int Rep Fce Ear Lp 7.6-12.5 Cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$215.72 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000059","EAP","CPT� 12055","","Rep Int Fce Ear Lp 12.6-20.0cm","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$970.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000060","EAP","CPT� 16000","","Init Trmnt Burn 1st Degree","BOTH IP/OP","$1,690.00 ","$1,250.60 ","$0.00 ","$1,607.00 ","$917.67 ","$175.86 ","$352.24 ","$0.00 ","$0.00 ","$281.37 ","$1,607.00 ","$175.24 ","$1,607.00 ","$1,272.74 ","$1,285.60 ","$243.48 ","$0.00 ","$47.96 ","$255.83 ","$166.90 "
"45000061","EAP","CPT� 16020","","Part Thick Burn Dress/debrd;sm (tbsa<5%)","BOTH IP/OP","$1,607.00 ","$1,189.18 ","$0.00 ","$1,607.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.37 ","$1,607.00 ","$175.24 ","$1,607.00 ","$1,272.74 ","$1,285.60 ","$243.48 ","$54.62 ","$56.23 ","$255.83 ","$166.90 "
"45000062","EAP","CPT� 16030","","Part Thick Burn Dress/debrd;lg (tbsa >10%)","BOTH IP/OP","$4,348.00 ","$3,217.52 ","$0.00 ","$4,348.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$761.30 ","$4,348.00 ","$320.45 ","$2,255.00 ","$3,443.62 ","$3,478.40 ","$445.22 ","$134.39 ","$138.43 ","$692.20 ","$305.19 "
"45000063","EAP","CPT� 19020","","Incision Of Breast Lesion","BOTH IP/OP","$7,031.00 ","$5,202.94 ","$0.00 ","$7,102.00 ","$0.00 ","$0.00 ","$1,465.44 ","$0.00 ","$0.00 ","$0.00 ","$7,102.00 ","$0.00 ","$2,327.00 ","$5,624.78 ","$5,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000067","EAP","CPT� 24565","","Treat Humerus Fracture","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000069","EAP","CPT� 25535","","Clsd Fracture Ulna W Manip","BOTH IP/OP","$662.00 ","$489.88 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$625.00 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000070","EAP","CPT� 25600","","Treat Fracture Radius/ulna","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,180.00 ","$0.00 ","$1,180.00 ","$934.56 ","$944.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000071","EAP","CPT� 26010","","I&d Finger Abscess, Simple","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.00 ","$0.00 ","$1,407.00 ","$1,114.34 ","$1,125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000072","EAP","CPT� 27760","","Clsd Tx Medial Malleolus Fx","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$720.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000073","EAP","CPT� 27780","","Clsd Fracture Fibula W/o Manip","BOTH IP/OP","$1,057.00 ","$782.18 ","$0.00 ","$1,119.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,119.00 ","$0.00 ","$1,119.00 ","$886.25 ","$895.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000075","EAP","CPT� 27786","","Clsd Tx Distal Fibular Fx","BOTH IP/OP","$1,204.00 ","$890.96 ","$0.00 ","$1,153.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,153.00 ","$0.00 ","$1,153.00 ","$913.18 ","$922.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000077","EAP","CPT� 28400","","Clsd Fracture Heel W/o Manip","BOTH IP/OP","$811.00 ","$600.14 ","$0.00 ","$811.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$811.00 ","$0.00 ","$811.00 ","$642.31 ","$648.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000078","EAP","CPT� 28430","","Treatment Of Ankle Fracture","BOTH IP/OP","$820.00 ","$606.80 ","$0.00 ","$811.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$811.00 ","$0.00 ","$811.00 ","$642.31 ","$648.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000079","EAP","CPT� 28515","","Clsd Fracture Toe W Manip","BOTH IP/OP","$547.00 ","$404.78 ","$0.00 ","$541.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$541.00 ","$0.00 ","$541.00 ","$428.47 ","$432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000080","EAP","CPT� 28540","","Treat Foot Dislocation","BOTH IP/OP","$398.00 ","$294.52 ","$0.00 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398.00 ","$0.00 ","$398.00 ","$315.22 ","$318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000081","EAP","CPT� 28630","","Closed Tx Metatarsophal Jt Dis","BOTH IP/OP","$547.00 ","$404.78 ","$0.00 ","$541.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$541.00 ","$0.00 ","$541.00 ","$428.47 ","$432.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000082","EAP","CPT� 29105","","App'l Long Arm Splint","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.40 ","$859.00 ","$134.13 ","$859.00 ","$680.33 ","$687.20 ","$186.36 ","$94.27 ","$43.63 ","$136.75 ","$127.75 "
"45000083","EAP","CPT� 29240","","Strapping Of Shoulder","BOTH IP/OP","$727.00 ","$537.98 ","$0.00 ","$813.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$813.00 ","$0.00 ","$813.00 ","$643.90 ","$650.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000084","EAP","CPT� 29240","","Apply Shoulder Immobilizer","BOTH IP/OP","$727.00 ","$537.98 ","$0.00 ","$813.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$813.00 ","$0.00 ","$813.00 ","$643.90 ","$650.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000087","EAP","CPT� 36600","","Arterial Puncture","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.73 ","$284.00 ","$109.35 ","$284.00 ","$224.93 ","$227.20 ","$151.93 ","$24.37 ","$16.23 ","$45.21 ","$104.14 "
"45000088","EAP","CPT� 41250","","Repair Tongue Laceration","BOTH IP/OP","$794.00 ","$587.56 ","$0.00 ","$802.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$802.00 ","$0.00 ","$802.00 ","$635.18 ","$641.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000089","EAP","CPT� 41800","","Drainage Of Gum Lesion","BOTH IP/OP","$634.00 ","$469.16 ","$87.50 ","$640.00 ","$634.00 ","$110.43 ","$132.14 ","$640.00 ","$640.00 ","$112.06 ","$640.00 ","$109.35 ","$640.00 ","$506.88 ","$512.00 ","$151.93 ","$87.50 ","$157.47 ","$101.89 ","$104.14 "
"45000090","EAP","CPT� 42700","","I&d Peritonsillar Abscess","BOTH IP/OP","$436.00 ","$322.64 ","$70.05 ","$440.00 ","$436.00 ","$207.19 ","$90.87 ","$440.00 ","$440.00 ","$77.04 ","$440.00 ","$204.24 ","$440.00 ","$348.48 ","$352.00 ","$283.76 ","$122.16 ","$139.13 ","$70.05 ","$194.51 "
"45000093","EAP","CPT� 46050","","I & D Perianal Abcess","BOTH IP/OP","$4,031.00 ","$2,982.94 ","$0.00 ","$4,031.00 ","$2,321.55 ","$777.17 ","$840.16 ","$0.00 ","$0.00 ","$0.00 ","$4,031.00 ","$0.00 ","$2,255.00 ","$3,192.55 ","$3,224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000094","EAP","CPT� 56420","","I & D Bartholin Abscess","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$672.00 ","$665.00 ","$166.84 ","$138.60 ","$0.00 ","$0.00 ","$117.66 ","$672.00 ","$166.54 ","$672.00 ","$532.22 ","$537.60 ","$231.38 ","$106.60 ","$107.06 ","$106.98 ","$158.61 "
"45000096","EAP","CPT� 69000","","Drain External Ear Lesion","BOTH IP/OP","$694.00 ","$513.56 ","$0.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$700.00 ","$0.00 ","$700.00 ","$554.40 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000112","EAP","CPT� 12056","","Rep Int Fce Ear Lp 20.1-30.0cm","BOTH IP/OP","$1,559.00 ","$1,153.66 ","$0.00 ","$1,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,580.00 ","$0.00 ","$1,580.00 ","$1,251.36 ","$1,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000113","EAP","CPT� 13120","","Cmplx Rpr Sclp Arm Lgs 1.1-2.5","BOTH IP/OP","$1,427.00 ","$1,055.98 ","$0.00 ","$1,337.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.00 ","$0.00 ","$1,337.00 ","$1,058.90 ","$1,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000114","EAP","CPT� 13121","","Repr Comp Scalp Arms Lgs 2.5-7","BOTH IP/OP","$1,539.00 ","$1,138.86 ","$0.00 ","$1,442.00 ","$0.00 ","$0.00 ","$0.00 ","$1,442.00 ","$1,442.00 ","$252.48 ","$1,442.00 ","$498.48 ","$1,442.00 ","$1,142.06 ","$1,153.60 ","$692.57 ","$0.00 ","$270.39 ","$229.57 ","$474.74 "
"45000115","EAP","CPT� 13122","","Cmplx Rpr Sclp Arm Lgs Ea Add","BOTH IP/OP","$1,378.00 ","$1,019.72 ","$0.00 ","$1,291.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,291.00 ","$0.00 ","$1,291.00 ","$1,022.47 ","$1,032.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000116","EAP","CPT� 13131","","Repr Complex Mouth Neck Hds,ft","BOTH IP/OP","$1,427.00 ","$1,055.98 ","$0.00 ","$1,337.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.00 ","$0.00 ","$1,337.00 ","$1,058.90 ","$1,069.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000117","EAP","CPT� 13132","","Repr Comp Mouth,neck,hds,ft2.6","BOTH IP/OP","$1,427.00 ","$1,055.98 ","$0.00 ","$1,337.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.00 ","$1,337.00 ","$234.10 ","$1,337.00 ","$498.48 ","$1,337.00 ","$1,058.90 ","$1,069.60 ","$692.57 ","$0.00 ","$317.62 ","$212.85 ","$474.74 "
"45000118","EAP","CPT� 13133","","Repair Wound/lesion Add-on","BOTH IP/OP","$1,336.00 ","$988.64 ","$0.00 ","$1,252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,252.00 ","$0.00 ","$1,252.00 ","$991.58 ","$1,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000120","EAP","CPT� 13151","","Cmplx Rpr Eye Nose Ear 1.1-2.5","BOTH IP/OP","$2,495.00 ","$1,846.30 ","$0.00 ","$2,338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,338.00 ","$0.00 ","$2,338.00 ","$1,851.70 ","$1,870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000121","EAP","CPT� 13152","","Repr Comp Eyel, Nose,ears Lips","BOTH IP/OP","$2,703.00 ","$2,000.22 ","$0.00 ","$2,533.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,533.00 ","$0.00 ","$2,533.00 ","$2,006.14 ","$2,026.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000122","EAP","CPT� 13153","","Cmplx Rpr Eye Nose Ear Add-on","BOTH IP/OP","$1,378.00 ","$1,019.72 ","$0.00 ","$1,291.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,291.00 ","$0.00 ","$1,291.00 ","$1,022.47 ","$1,032.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000123","EAP","CPT� 13160","","Second Closr Surg Wound; Comp","BOTH IP/OP","$10,207.00 ","$7,553.18 ","$0.00 ","$10,343.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,343.00 ","$0.00 ","$2,327.00 ","$8,191.66 ","$8,274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000124","EAP","CPT� 16025","","Part Thick Burn Dress/debrd;md (tbsa 5%-10%)","BOTH IP/OP","$3,252.00 ","$2,406.48 ","$0.00 ","$3,252.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$569.40 ","$3,252.00 ","$175.24 ","$2,255.00 ","$2,575.58 ","$2,601.60 ","$243.48 ","$107.09 ","$114.64 ","$517.72 ","$166.90 "
"45000125","EAP","CPT� 26675","","Treat Hand Dislocation","BOTH IP/OP","$3,905.00 ","$2,889.70 ","$0.00 ","$4,148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,148.00 ","$0.00 ","$2,327.00 ","$3,285.22 ","$3,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000126","EAP","CPT� 19000","","Punc Aspiration Cyst Of Breast","BOTH IP/OP","$1,141.00 ","$844.34 ","$0.00 ","$1,141.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.00 ","$1,141.00 ","$199.78 ","$1,141.00 ","$611.80 ","$1,141.00 ","$903.67 ","$912.80 ","$850.02 ","$59.58 ","$45.43 ","$181.65 ","$582.67 "
"45000128","EAP","CPT� 20102","","Explore Wound, Abdomen","BOTH IP/OP","$4,018.00 ","$2,973.32 ","$0.00 ","$4,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,018.00 ","$0.00 ","$2,255.00 ","$3,182.26 ","$3,214.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000129","EAP","CPT� 20103","","Explore Wound, Extremity","BOTH IP/OP","$3,502.00 ","$2,591.48 ","$0.00 ","$3,502.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$613.17 ","$3,502.00 ","$611.80 ","$2,255.00 ","$2,773.58 ","$2,801.60 ","$850.02 ","$323.52 ","$360.85 ","$557.52 ","$582.67 "
"45000133","EAP","CPT� 20612","","Aspiration/inj.,gangion Cyst","BOTH IP/OP","$1,051.00 ","$777.74 ","$0.00 ","$1,051.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.02 ","$1,051.00 ","$262.54 ","$1,051.00 ","$832.39 ","$840.80 ","$364.76 ","$54.88 ","$42.90 ","$167.32 ","$250.04 "
"45000134","EAP","CPT� 20822","","Replantation Digit, Complete","BOTH IP/OP","$9,548.00 ","$7,065.52 ","$0.00 ","$9,548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,548.00 ","$0.00 ","$2,327.00 ","$7,562.02 ","$7,638.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000135","EAP","CPT� 21110","","Interdental Fixation","BOTH IP/OP","$1,478.00 ","$1,093.72 ","$0.00 ","$1,389.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,389.00 ","$0.00 ","$1,389.00 ","$1,100.09 ","$1,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000136","EAP","CPT� 21310","","Nasal Bone Fx Wo Manip","BOTH IP/OP","$506.00 ","$374.44 ","$0.00 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$506.00 ","$0.00 ","$506.00 ","$400.75 ","$404.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000138","EAP","CPT� 21315","","Treatment Of Nose Fracture","BOTH IP/OP","$4,285.00 ","$3,170.90 ","$0.00 ","$4,328.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,328.00 ","$0.00 ","$2,327.00 ","$3,427.78 ","$3,462.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000140","EAP","CPT� 21421","","Maxillary Fracture","BOTH IP/OP","$9,532.00 ","$7,053.68 ","$0.00 ","$9,628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,628.00 ","$0.00 ","$3,606.00 ","$7,625.38 ","$7,702.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000141","EAP","CPT� 21450","","Mandibular Fx Wo Manip","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$818.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$818.00 ","$0.00 ","$818.00 ","$647.86 ","$654.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000142","EAP","CPT� 21480","","Reset Dislocated Jaw","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.00 ","$0.00 ","$257.00 ","$203.54 ","$205.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000148","EAP","CPT� 23500","","Clavicular Fx Wo Manip","BOTH IP/OP","$1,101.00 ","$814.74 ","$0.00 ","$1,037.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.00 ","$0.00 ","$1,037.00 ","$821.30 ","$829.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000150","EAP","CPT� 23540","","Acromioclavicular Disloca","BOTH IP/OP","$815.00 ","$603.10 ","$0.00 ","$815.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$815.00 ","$0.00 ","$815.00 ","$645.48 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000154","EAP","CPT� 23605","","CLSD TXT PROXIMAL HUMERUS W/MANIPU","BOTH IP/OP","$6,187.00 ","$4,578.38 ","$0.00 ","$6,017.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,017.00 ","$0.00 ","$2,327.00 ","$4,765.46 ","$4,813.60 ","$0.00 ","$410.41 ","$0.00 ","$0.00 ","$0.00 "
"45000156","EAP","CPT� 23615","","Treat Humerus Fracture","BOTH IP/OP","$36,769.00 ","$27,209.06 ","$0.00 ","$35,756.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,756.00 ","$0.00 ","$3,606.00 ","$28,318.75 ","$28,604.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000158","EAP","CPT� 23650","","Shoulder Disloca W Manip","BOTH IP/OP","$1,131.00 ","$836.94 ","$0.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$1,100.00 ","$1,100.00 ","$192.60 ","$1,100.00 ","$216.27 ","$1,100.00 ","$871.20 ","$880.00 ","$300.48 ","$251.06 ","$301.31 ","$175.12 ","$205.98 "
"45000160","EAP","CPT� 23655","","Shoulder Disloca W Humeral","BOTH IP/OP","$5,598.00 ","$4,142.52 ","$0.00 ","$5,444.00 ","$2,321.55 ","$1,364.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,444.00 ","$0.00 ","$2,255.00 ","$4,311.65 ","$4,355.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000162","EAP","CPT� 23675","","Shoulder Disloca W Neck Fx","BOTH IP/OP","$1,594.00 ","$1,179.56 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000163","EAP","CPT� 24201","","Removal Of Arm Foreign Body","BOTH IP/OP","$9,773.00 ","$7,232.02 ","$0.00 ","$9,504.00 ","$2,753.10 ","$2,322.02 ","$0.00 ","$1,482.64 ","$1,482.64 ","$1,664.07 ","$9,504.00 ","$2,325.71 ","$2,327.00 ","$7,527.17 ","$7,603.20 ","$3,231.26 ","$360.96 ","$376.65 ","$1,513.04 ","$2,214.96 "
"45000164","EAP","CPT� 24341","","Repair Tendon/muscle Upper Arm","BOTH IP/OP","$17,367.00 ","$12,851.58 ","$0.00 ","$17,941.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,941.00 ","$0.00 ","$2,858.00 ","$14,209.27 ","$14,352.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000165","EAP","CPT� 24500","","Clsd Txt Humeral Shaft Fx W/out Manip","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.00 ","$0.00 ","$712.00 ","$563.90 ","$569.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000167","EAP","CPT� 24500","","Apply Humeral Splint","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.00 ","$0.00 ","$712.00 ","$563.90 ","$569.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000168","EAP","CPT� 24505","","Clsd Txt Humeral Shaft W/manipulation","BOTH IP/OP","$1,594.00 ","$1,179.56 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000174","EAP","CPT� 24577","","Treat Humerus Fracture","BOTH IP/OP","$2,383.00 ","$1,763.42 ","$0.00 ","$2,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,462.00 ","$0.00 ","$2,255.00 ","$1,949.90 ","$1,969.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000175","EAP","CPT� 24600","","Elbow Disloca Wo Anes","BOTH IP/OP","$879.00 ","$650.46 ","$0.00 ","$855.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$855.00 ","$0.00 ","$855.00 ","$677.16 ","$684.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000176","EAP","CPT� 24605","","Treat Elbow Dislocation","BOTH IP/OP","$9,171.00 ","$6,786.54 ","$0.00 ","$8,918.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$1,561.47 ","$8,918.00 ","$1,359.37 ","$2,327.00 ","$7,063.06 ","$7,134.40 ","$1,888.67 ","$330.49 ","$491.61 ","$1,419.75 ","$1,294.64 "
"45000177","EAP","CPT� 24620","","Treat Elbow Fracture","BOTH IP/OP","$8,190.00 ","$6,060.60 ","$0.00 ","$7,964.00 ","$2,753.10 ","$1,364.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,964.00 ","$0.00 ","$2,327.00 ","$6,307.49 ","$6,371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000179","EAP","CPT� 24650","","Radial Hd/neck Fx Wo Manip","BOTH IP/OP","$1,128.00 ","$834.72 ","$0.00 ","$1,097.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,097.00 ","$0.00 ","$1,097.00 ","$868.82 ","$877.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000181","EAP","CPT� 24655","","CLSD TXT RADIAL HD/NECK FX W/OUT M","BOTH IP/OP","$2,532.00 ","$1,873.68 ","$0.00 ","$2,462.00 ","$2,321.55 ","$1,364.04 ","$527.73 ","$0.00 ","$0.00 ","$0.00 ","$2,462.00 ","$0.00 ","$2,255.00 ","$1,949.90 ","$1,969.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000184","EAP","CPT� 25500","","Radial Shaft Fx Wo Manip","BOTH IP/OP","$1,047.00 ","$774.78 ","$0.00 ","$1,061.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,061.00 ","$0.00 ","$1,061.00 ","$840.31 ","$848.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000186","EAP","CPT� 25505","","CLSD TXT RADIAL SHAFT FX W/MANIPUL","BOTH IP/OP","$2,452.00 ","$1,814.48 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$2,255.00 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000189","EAP","CPT� 25520","","Treat Fracture Of Radius","BOTH IP/OP","$2,483.00 ","$1,837.42 ","$0.00 ","$2,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,345.00 ","$0.00 ","$2,255.00 ","$1,857.24 ","$1,876.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000190","EAP","CPT� 25530","","Ulnar Shaft Fx Wo Manip","BOTH IP/OP","$1,274.00 ","$942.76 ","$0.00 ","$1,203.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,203.00 ","$0.00 ","$1,203.00 ","$952.78 ","$962.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000192","EAP","CPT� 25560","","Radial/ulner Fx Wo Manip","BOTH IP/OP","$891.00 ","$659.34 ","$0.00 ","$903.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$903.00 ","$0.00 ","$903.00 ","$715.18 ","$722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000194","EAP","CPT� 25565","","Treat Fracture Radius & Ulna","BOTH IP/OP","$2,483.00 ","$1,837.42 ","$373.32 ","$2,483.00 ","$2,483.00 ","$1,364.04 ","$517.52 ","$1,482.64 ","$1,482.64 ","$410.59 ","$2,345.00 ","$1,359.37 ","$2,327.00 ","$1,857.24 ","$1,876.00 ","$1,888.67 ","$473.67 ","$482.25 ","$373.32 ","$1,294.64 "
"45000196","EAP","CPT� 25605","","Treat Fracture Radius/ulna","BOTH IP/OP","$2,483.00 ","$1,837.42 ","$373.32 ","$2,483.00 ","$2,483.00 ","$1,364.04 ","$517.52 ","$1,756.53 ","$1,756.53 ","$410.59 ","$2,345.00 ","$1,359.37 ","$2,345.00 ","$1,857.24 ","$1,876.00 ","$1,888.67 ","$469.11 ","$530.90 ","$373.32 ","$1,294.64 "
"45000200","EAP","CPT� 25635","","Treat Wrist Bone Fracture","BOTH IP/OP","$2,483.00 ","$1,837.42 ","$0.00 ","$2,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,345.00 ","$0.00 ","$2,255.00 ","$1,857.24 ","$1,876.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000203","EAP","CPT� 25650","","Treat Wrist Bone Fracture","BOTH IP/OP","$992.00 ","$734.08 ","$0.00 ","$937.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.00 ","$0.00 ","$937.00 ","$742.10 ","$749.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000205","EAP","CPT� 25675","","Treat Wrist Dislocation","BOTH IP/OP","$509.00 ","$376.66 ","$0.00 ","$487.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.00 ","$0.00 ","$487.00 ","$385.70 ","$389.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000206","EAP","CPT� 25680","","Trans-scapoperilunar Fx Disloc","BOTH IP/OP","$1,085.00 ","$802.90 ","$0.00 ","$1,099.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,099.00 ","$0.00 ","$1,099.00 ","$870.41 ","$879.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000207","EAP","CPT� 25690","","Treat Wrist Dislocation","BOTH IP/OP","$8,034.00 ","$5,945.16 ","$0.00 ","$7,586.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,586.00 ","$0.00 ","$2,255.00 ","$6,008.11 ","$6,068.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000209","EAP","CPT� 26410","","Repair Hand Tendon","BOTH IP/OP","$3,718.00 ","$2,751.32 ","$0.00 ","$3,717.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,717.00 ","$0.00 ","$2,858.00 ","$2,943.86 ","$2,973.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000210","EAP","CPT� 26418","","Repair Finger Tendon","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,564.00 ","$0.00 ","$3,606.00 ","$3,614.69 ","$3,651.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000211","EAP","CPT� 26600","","Metacarpal Fx, Single,wo Manip","BOTH IP/OP","$1,078.00 ","$797.72 ","$0.00 ","$1,078.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,078.00 ","$0.00 ","$1,078.00 ","$853.78 ","$862.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000213","EAP","CPT� 26605","","Treat Metacarpal Fracture","BOTH IP/OP","$647.00 ","$478.78 ","$0.00 ","$647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$647.00 ","$0.00 ","$647.00 ","$512.42 ","$517.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000215","EAP","CPT� 26641","","Treat Thumb Disolcation","BOTH IP/OP","$1,104.00 ","$816.96 ","$0.00 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,104.00 ","$0.00 ","$1,104.00 ","$874.37 ","$883.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000216","EAP","CPT� 26645","","Treat Thumb Fracture","BOTH IP/OP","$1,593.00 ","$1,178.82 ","$0.00 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,593.00 ","$0.00 ","$1,593.00 ","$1,261.66 ","$1,274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000217","EAP","CPT� 26670","","Treat Hand Dislocation","BOTH IP/OP","$1,099.00 ","$813.26 ","$0.00 ","$1,099.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,099.00 ","$0.00 ","$1,099.00 ","$870.41 ","$879.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000218","EAP","CPT� 26700","","Metacarpophlangeal Disloc,sing","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$399.11 ","$201.85 ","$153.19 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$735.00 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000219","EAP","CPT� 26705","","Treat Knuckle Dislocation","BOTH IP/OP","$1,593.00 ","$1,178.82 ","$0.00 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,593.00 ","$0.00 ","$1,593.00 ","$1,261.66 ","$1,274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000220","EAP","CPT� 26720","","Phalangeal Shaft Fx, Wo Manip","BOTH IP/OP","$678.00 ","$501.72 ","$0.00 ","$678.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$678.00 ","$0.00 ","$678.00 ","$536.98 ","$542.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000223","EAP","CPT� 26725","","Closd Fracture Finger W Manip","BOTH IP/OP","$1,116.00 ","$825.84 ","$0.00 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,116.00 ","$0.00 ","$1,116.00 ","$883.87 ","$892.80 ","$0.00 ","$234.57 ","$0.00 ","$0.00 ","$0.00 "
"45000224","EAP","CPT� 26746","","Treat Finger Fracture, Each","BOTH IP/OP","$7,420.00 ","$5,490.80 ","$0.00 ","$7,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,418.00 ","$0.00 ","$3,902.00 ","$5,875.06 ","$5,934.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000227","EAP","CPT� 26755","","Treat Finger Fracture, Each","BOTH IP/OP","$649.00 ","$480.26 ","$0.00 ","$649.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$649.00 ","$0.00 ","$649.00 ","$514.01 ","$519.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000229","EAP","CPT� 26756","","Pin Finger Fracture, Each","BOTH IP/OP","$6,983.00 ","$5,167.42 ","$0.00 ","$7,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,418.00 ","$0.00 ","$2,327.00 ","$5,875.06 ","$5,934.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000230","EAP","CPT� 26765","","Treat Finger Fracture, Each","BOTH IP/OP","$7,322.00 ","$5,418.28 ","$0.00 ","$7,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,320.00 ","$0.00 ","$3,606.00 ","$5,797.44 ","$5,856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000231","EAP","CPT� 26770","","Interphalan Jt Disloca W Manip","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$650.00 ","$0.00 ","$650.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000233","EAP","CPT� 26775","","Treat Finger Dislocation","BOTH IP/OP","$4,733.00 ","$3,502.42 ","$0.00 ","$5,028.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,028.00 ","$0.00 ","$2,255.00 ","$3,982.18 ","$4,022.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000235","EAP","CPT� 26785","","Dislocation Of Finger","BOTH IP/OP","$16,294.00 ","$12,057.56 ","$0.00 ","$16,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,290.00 ","$0.00 ","$2,327.00 ","$12,901.68 ","$13,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000236","EAP","CPT� 26951","","Amputation Of Finger/thumb","BOTH IP/OP","$7,787.00 ","$5,762.38 ","$0.00 ","$7,113.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,113.00 ","$0.00 ","$2,327.00 ","$5,633.50 ","$5,690.40 ","$0.00 ","$412.92 ","$0.00 ","$0.00 ","$0.00 "
"45000238","EAP","CPT� 27230","","Femoral Fx Neck Wo Manip","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.00 ","$0.00 ","$612.00 ","$484.70 ","$489.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000239","EAP","CPT� 27232","","Treat Thigh Fracture","BOTH IP/OP","$3,641.00 ","$2,694.34 ","$0.00 ","$3,641.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,641.00 ","$0.00 ","$2,255.00 ","$2,883.67 ","$2,912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000240","EAP","CPT� 27246","","Trochanteric Fx Wo Manip","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.00 ","$0.00 ","$612.00 ","$484.70 ","$489.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000241","EAP","CPT� 27250","","Hip Disloca Wo Anes","BOTH IP/OP","$572.00 ","$423.28 ","$0.00 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$578.00 ","$0.00 ","$578.00 ","$457.78 ","$462.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000244","EAP","CPT� 27256","","Treat Hip Dislocation","BOTH IP/OP","$941.00 ","$696.34 ","$0.00 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$568.00 ","$0.00 ","$568.00 ","$449.86 ","$454.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000245","EAP","CPT� 69020","","Er Drain Absc Ext Auditory Can","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$600.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000246","EAP","CPT� 27500","","Femoral Shaft Fx Wo Manip","BOTH IP/OP","$1,560.00 ","$1,154.40 ","$0.00 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,560.00 ","$0.00 ","$1,560.00 ","$1,235.52 ","$1,248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000248","EAP","CPT� 27508","","Femoral Fx,distal End,wo Manip","BOTH IP/OP","$1,091.00 ","$807.34 ","$0.00 ","$1,091.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,091.00 ","$0.00 ","$1,091.00 ","$864.07 ","$872.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000250","EAP","CPT� 27520","","Patellar Fx Wo Manip","BOTH IP/OP","$1,494.00 ","$1,105.56 ","$0.00 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,494.00 ","$0.00 ","$1,494.00 ","$1,183.25 ","$1,195.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000252","EAP","CPT� 27530","","Tibial Fx Wo Manip","BOTH IP/OP","$1,494.00 ","$1,105.56 ","$0.00 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,494.00 ","$0.00 ","$1,494.00 ","$1,183.25 ","$1,195.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000254","EAP","CPT� 27535","","Treat Knee Fracture","BOTH IP/OP","$5,367.00 ","$3,971.58 ","$0.00 ","$5,367.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,367.00 ","$0.00 ","$2,683.50 ","$4,250.66 ","$4,293.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000255","EAP","CPT� 27560","","Treat Kneecap Dislocation","BOTH IP/OP","$1,047.00 ","$774.78 ","$0.00 ","$995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$995.00 ","$0.00 ","$995.00 ","$788.04 ","$796.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000259","EAP","CPT� 27750","","Tibial Shaft Fx Wo Manip","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,133.00 ","$0.00 ","$1,133.00 ","$897.34 ","$906.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000261","EAP","CPT� 27752","","Treatment Of Tibia Fracture","BOTH IP/OP","$7,594.00 ","$5,619.56 ","$0.00 ","$7,275.00 ","$2,321.55 ","$1,364.04 ","$1,582.78 ","$0.00 ","$0.00 ","$0.00 ","$7,275.00 ","$0.00 ","$2,255.00 ","$5,761.80 ","$5,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000264","EAP","CPT� 27762","","Treatment Of Ankle Fracture","BOTH IP/OP","$7,594.00 ","$5,619.56 ","$0.00 ","$7,275.00 ","$2,321.55 ","$1,364.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,275.00 ","$0.00 ","$2,255.00 ","$5,761.80 ","$5,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000267","EAP","CPT� 27788","","Treatment Of Ankle Fracture","BOTH IP/OP","$1,028.00 ","$760.72 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$275.00 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000269","EAP","CPT� 29125","","App'l Short Arm Splint","BOTH IP/OP","$952.00 ","$704.48 ","$0.00 ","$952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.69 ","$952.00 ","$109.35 ","$952.00 ","$753.98 ","$761.60 ","$151.93 ","$72.40 ","$40.73 ","$151.56 ","$104.14 "
"45000270","EAP","CPT� 27808","","Clsd Frac Bimall Ankle Wo Mani","BOTH IP/OP","$1,135.00 ","$839.90 ","$0.00 ","$1,087.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,087.00 ","$0.00 ","$1,087.00 ","$860.90 ","$869.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000272","EAP","CPT� 27810","","Closed Tx Bimal Ankle Fx W/man","BOTH IP/OP","$2,348.00 ","$1,737.52 ","$0.00 ","$2,249.00 ","$0.00 ","$0.00 ","$489.38 ","$0.00 ","$0.00 ","$0.00 ","$2,249.00 ","$0.00 ","$2,249.00 ","$1,781.21 ","$1,799.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000273","EAP","CPT� 27816","","Clsd Fx Trimall Ankle Wo Mani","BOTH IP/OP","$902.00 ","$667.48 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$955.00 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000275","EAP","CPT� 27818","","Trimalleolar Ankle Fx With Man","BOTH IP/OP","$2,348.00 ","$1,737.52 ","$358.04 ","$2,321.55 ","$2,321.55 ","$1,364.04 ","$489.38 ","$1,208.73 ","$1,208.73 ","$393.78 ","$2,249.00 ","$1,359.37 ","$2,249.00 ","$1,781.21 ","$1,799.20 ","$1,888.67 ","$492.83 ","$451.99 ","$358.04 ","$1,294.64 "
"45000277","EAP","CPT� 27825","","Treat Lower Leg Fracture","BOTH IP/OP","$7,594.00 ","$5,619.56 ","$0.00 ","$7,275.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$0.00 ","$7,275.00 ","$1,359.37 ","$2,327.00 ","$5,761.80 ","$5,820.00 ","$1,888.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000278","EAP","CPT� 27840","","Ankle Disloca Wo Anes","BOTH IP/OP","$2,348.00 ","$1,737.52 ","$0.00 ","$2,249.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,249.00 ","$0.00 ","$2,249.00 ","$1,781.21 ","$1,799.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000283","EAP","CPT� 28470","","Clsd Tx Metatar Fx Wo Manip Ea","BOTH IP/OP","$981.00 ","$725.94 ","$0.00 ","$981.00 ","$981.00 ","$201.85 ","$0.00 ","$0.00 ","$0.00 ","$171.77 ","$981.00 ","$216.27 ","$981.00 ","$776.95 ","$784.80 ","$300.48 ","$214.80 ","$210.83 ","$0.00 ","$205.98 "
"45000285","EAP","CPT� 28475","","Clsd Tx Metatar Fx W/manip","BOTH IP/OP","$419.00 ","$310.06 ","$0.00 ","$415.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$415.00 ","$0.00 ","$415.00 ","$328.68 ","$332.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000286","EAP","CPT� 28490","","Clsd Tx Fx Grt Toe,phal/phalan","BOTH IP/OP","$898.00 ","$664.52 ","$0.00 ","$898.00 ","$898.00 ","$201.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$898.00 ","$0.00 ","$898.00 ","$711.22 ","$718.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000289","EAP","CPT� 28510","","Clsd Fx Toe W/o Manipulation","BOTH IP/OP","$991.00 ","$733.34 ","$0.00 ","$981.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$981.00 ","$0.00 ","$981.00 ","$776.95 ","$784.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000291","EAP","CPT� 28600","","Treat Foot Dislocation","BOTH IP/OP","$832.00 ","$615.68 ","$0.00 ","$832.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$832.00 ","$0.00 ","$832.00 ","$658.94 ","$665.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000292","EAP","CPT� 28660","","Treat Toe Dislocation","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$232.00 ","$201.85 ","$48.35 ","$0.00 ","$0.00 ","$0.00 ","$230.00 ","$0.00 ","$230.00 ","$182.16 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000296","EAP","CPT� 29130","","App'l Finger Splint","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$466.44 ","$110.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.00 ","$0.00 ","$859.00 ","$680.33 ","$687.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000298","EAP","CPT� 29200","","Apply Clavicle Strap","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$545.00 ","$0.00 ","$545.00 ","$431.64 ","$436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000299","EAP","CPT� 29280","","Strapping Hand Or Finger","BOTH IP/OP","$511.00 ","$378.14 ","$0.00 ","$481.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$481.00 ","$0.00 ","$481.00 ","$380.95 ","$384.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000300","EAP","CPT� 29345","","Apply Long Leg Cast","BOTH IP/OP","$705.00 ","$521.70 ","$0.00 ","$789.00 ","$705.00 ","$236.25 ","$146.94 ","$0.00 ","$0.00 ","$0.00 ","$789.00 ","$0.00 ","$789.00 ","$624.89 ","$631.20 ","$0.00 ","$170.33 ","$0.00 ","$0.00 ","$0.00 "
"45000301","EAP","CPT� 29358","","Long Leg Application","BOTH IP/OP","$1,062.00 ","$785.88 ","$0.00 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,188.00 ","$0.00 ","$1,188.00 ","$940.90 ","$950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000302","EAP","CPT� 29515","","Apply Short Leg Splint","BOTH IP/OP","$888.00 ","$657.12 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$134.13 ","$888.00 ","$703.30 ","$710.40 ","$186.36 ","$80.51 ","$51.19 ","$141.37 ","$127.75 "
"45000304","EAP","CPT� 29505","","App'l Long Leg Splint","BOTH IP/OP","$1,535.00 ","$1,135.90 ","$0.00 ","$1,535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.77 ","$1,535.00 ","$134.13 ","$1,535.00 ","$1,215.72 ","$1,228.00 ","$186.36 ","$94.49 ","$52.27 ","$244.37 ","$127.75 "
"45000310","EAP","CPT� 29530","","Apply Knee Immobilizer","BOTH IP/OP","$809.00 ","$598.66 ","$0.00 ","$762.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$762.00 ","$0.00 ","$762.00 ","$603.50 ","$609.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000313","EAP","CPT� 29580","","Strapping; Unna Boot","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.57 ","$780.00 ","$134.13 ","$780.00 ","$617.76 ","$624.00 ","$186.36 ","$54.52 ","$28.49 ","$124.18 ","$127.75 "
"45000315","EAP","CPT� 30300","","Remove Fb, Intranasal","BOTH IP/OP","$269.00 ","$199.06 ","$0.00 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.00 ","$0.00 ","$272.00 ","$215.42 ","$217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000317","EAP","CPT� 30901","","Control Nasal Hemorr Ant Simpl","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.00 ","$0.00 ","$348.00 ","$275.62 ","$278.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000319","EAP","CPT� 30903","","Control Nasal Hemorr Ant Compl","BOTH IP/OP","$354.00 ","$261.96 ","$0.00 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$358.00 ","$0.00 ","$358.00 ","$283.54 ","$286.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000320","EAP","CPT� 30905","","Control Nasal Hemorr Post Init","BOTH IP/OP","$518.00 ","$383.32 ","$0.00 ","$518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$518.00 ","$0.00 ","$518.00 ","$410.26 ","$414.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000322","EAP","CPT� 31233","","Nasal/sinus Endoscopy, Dx","BOTH IP/OP","$661.00 ","$489.14 ","$0.00 ","$661.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.00 ","$0.00 ","$661.00 ","$523.51 ","$528.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000323","EAP","CPT� 31500","","Endotracheal Intubation","BOTH IP/OP","$2,656.00 ","$1,965.44 ","$0.00 ","$2,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,656.00 ","$204.24 ","$2,255.00 ","$2,103.55 ","$2,124.80 ","$283.76 ","$0.00 ","$149.30 ","$422.84 ","$194.51 "
"45000326","EAP","CPT� 31515","","Laryngoscopy For Aspiration","BOTH IP/OP","$6,731.00 ","$4,980.94 ","$0.00 ","$7,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,040.00 ","$0.00 ","$2,255.00 ","$5,575.68 ","$5,632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000327","EAP","CPT� 31525","","Dx Laryngoscopy, Except Nb","BOTH IP/OP","$6,130.00 ","$4,536.20 ","$0.00 ","$6,412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,412.00 ","$0.00 ","$2,255.00 ","$5,078.30 ","$5,129.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000328","EAP","CPT� 31575","","Laryngoscopy, Fiberoptic, Dx","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$684.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$119.76 ","$684.00 ","$157.01 ","$684.00 ","$541.73 ","$547.20 ","$218.14 ","$103.39 ","$68.49 ","$108.89 ","$149.53 "
"45000330","EAP","CPT� 31605","","Tracheostomy, Cricothyroid","BOTH IP/OP","$1,598.00 ","$1,182.52 ","$0.00 ","$1,598.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,598.00 ","$0.00 ","$1,598.00 ","$1,265.62 ","$1,278.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000332","EAP","CPT� 31720","","Nasotreacheal Suction","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000333","EAP","CPT� 32160","","Thoracotomy W/cardiac Massage","BOTH IP/OP","$5,460.00 ","$4,040.40 ","$0.00 ","$5,167.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,167.00 ","$0.00 ","$2,255.00 ","$4,092.26 ","$4,133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000337","EAP","CPT� 35206","","Repair Blood Vessel Lesion","BOTH IP/OP","$8,232.00 ","$6,091.68 ","$0.00 ","$8,157.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,157.00 ","$0.00 ","$2,255.00 ","$6,460.34 ","$6,525.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000347","EAP","CPT� 36589","","Removal Venous Access Device","BOTH IP/OP","$4,657.00 ","$3,446.18 ","$0.00 ","$4,657.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$815.40 ","$4,657.00 ","$632.36 ","$2,255.00 ","$3,688.34 ","$3,725.60 ","$878.58 ","$171.53 ","$143.13 ","$741.39 ","$602.25 "
"45000348","EAP","CPT� 36593","","Declot Vascular Access Device","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,624.00 ","$1,299.00 ","$312.26 ","$270.74 ","$0.00 ","$0.00 ","$284.35 ","$1,624.00 ","$310.51 ","$1,624.00 ","$1,286.21 ","$1,299.20 ","$431.41 ","$30.97 ","$32.05 ","$258.54 ","$295.72 "
"45000352","EAP","CPT� 40800","","I & D Of Abscess Of Mouth","BOTH IP/OP","$705.00 ","$521.70 ","$0.00 ","$705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.44 ","$705.00 ","$611.80 ","$705.00 ","$558.36 ","$564.00 ","$705.00 ","$87.87 ","$128.30 ","$112.24 ","$582.67 "
"45000353","EAP","CPT� 40801","","Drainage Of Mouth Lesion","BOTH IP/OP","$1,582.00 ","$1,170.68 ","$0.00 ","$1,582.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,582.00 ","$0.00 ","$1,582.00 ","$1,252.94 ","$1,265.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000355","EAP","CPT� 41008","","Submandibular Abscess","BOTH IP/OP","$4,969.00 ","$3,677.06 ","$0.00 ","$4,969.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,969.00 ","$0.00 ","$2,255.00 ","$3,935.45 ","$3,975.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000356","EAP","CPT� 41252","","Repair Tongue Laceration 2.6cm","BOTH IP/OP","$2,783.00 ","$2,059.42 ","$0.00 ","$2,811.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,811.00 ","$0.00 ","$2,327.00 ","$2,226.31 ","$2,248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000357","EAP","CPT� 42000","","I&d Abscess Plate, Uvula","BOTH IP/OP","$283.00 ","$209.42 ","$0.00 ","$286.00 ","$0.00 ","$0.00 ","$58.98 ","$286.00 ","$286.00 ","$50.08 ","$286.00 ","$204.24 ","$286.00 ","$226.51 ","$228.80 ","$283.76 ","$95.00 ","$107.41 ","$45.53 ","$194.51 "
"45000358","EAP","CPT� 42809","","Remove Fb Pharynx","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$500.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000359","EAP","CPT� 43247","","Ugi Endo-rem Of Foreign Body","BOTH IP/OP","$4,263.00 ","$3,154.62 ","$0.00 ","$4,263.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,263.00 ","$0.00 ","$2,327.00 ","$3,376.30 ","$3,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000360","EAP","CPT� 43752","","N/g Tube Placement","BOTH IP/OP","$2,134.00 ","$1,579.16 ","$0.00 ","$2,134.00 ","$2,134.00 ","$265.79 ","$444.78 ","$0.00 ","$0.00 ","$359.29 ","$2,052.00 ","$364.66 ","$2,052.00 ","$1,625.18 ","$1,641.60 ","$506.64 ","$321.14 ","$42.55 ","$326.68 ","$347.29 "
"45000361","EAP","CPT� 44500","","Intro Of Long Gi Tube","BOTH IP/OP","$1,291.00 ","$955.34 ","$0.00 ","$1,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,304.00 ","$0.00 ","$1,304.00 ","$1,032.77 ","$1,043.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000362","EAP","CPT� 45300","","Proctosigmoidoscopy","BOTH IP/OP","$2,361.00 ","$1,747.14 ","$0.00 ","$2,361.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,361.00 ","$0.00 ","$2,255.00 ","$1,869.91 ","$1,888.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000363","EAP","CPT� 45305","","Proctosigmoidoscopy W/bx","BOTH IP/OP","$5,114.00 ","$3,784.36 ","$0.00 ","$5,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,114.00 ","$0.00 ","$2,255.00 ","$4,050.29 ","$4,091.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000364","EAP","CPT� 45385","","Lesion Removal Colonoscopy","BOTH IP/OP","$2,922.00 ","$2,162.28 ","$0.00 ","$2,922.00 ","$2,753.10 ","$1,015.53 ","$0.00 ","$2,085.43 ","$2,085.43 ","$511.62 ","$2,922.00 ","$1,007.17 ","$2,327.00 ","$2,314.22 ","$2,337.60 ","$1,399.33 ","$450.95 ","$265.02 ","$465.18 ","$959.21 "
"45000366","EAP","CPT� 46040","","Incision Of Rectal Abscess","BOTH IP/OP","$2,951.00 ","$2,183.74 ","$0.00 ","$2,981.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,981.00 ","$0.00 ","$2,858.00 ","$2,360.95 ","$2,384.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000367","EAP","CPT� 46083","","Incise External Hemorrhoid","BOTH IP/OP","$1,099.00 ","$813.26 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$1,110.00 ","$879.12 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000371","EAP","CPT� 51701","","Urinary Cath, Straight","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$865.00 ","$865.00 ","$110.43 ","$180.29 ","$0.00 ","$0.00 ","$151.28 ","$864.00 ","$109.35 ","$864.00 ","$684.29 ","$691.20 ","$151.93 ","$57.62 ","$27.40 ","$137.55 ","$104.14 "
"45000372","EAP","CPT� 51701","","Insert Straight Cath","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$865.00 ","$865.00 ","$110.43 ","$180.29 ","$0.00 ","$0.00 ","$151.28 ","$864.00 ","$109.35 ","$864.00 ","$684.29 ","$691.20 ","$151.93 ","$57.62 ","$27.40 ","$137.55 ","$104.14 "
"45000374","EAP","CPT� 51702","","Cath Insert Indwelling","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,070.00 ","$1,070.00 ","$110.43 ","$223.01 ","$0.00 ","$0.00 ","$187.17 ","$1,069.00 ","$109.35 ","$1,069.00 ","$846.65 ","$855.20 ","$151.93 ","$91.18 ","$26.68 ","$170.18 ","$104.14 "
"45000375","EAP","CPT� 51703","","Insert Bladder Cath, Complex","BOTH IP/OP","$1,809.00 ","$1,338.66 ","$0.00 ","$1,809.00 ","$1,809.00 ","$136.73 ","$0.00 ","$0.00 ","$0.00 ","$316.57 ","$1,808.00 ","$138.76 ","$1,808.00 ","$1,431.94 ","$1,446.40 ","$192.78 ","$170.19 ","$80.41 ","$287.83 ","$132.15 "
"45000376","EAP","CPT� 51705","","Cystostomy Tube","BOTH IP/OP","$626.00 ","$463.24 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$235.59 ","$625.00 ","$495.00 ","$500.00 ","$327.32 ","$86.33 ","$54.08 ","$99.50 ","$224.37 "
"45000377","EAP","CPT� 52000","","Cystoscopy","BOTH IP/OP","$3,069.00 ","$2,271.06 ","$84.02 ","$3,100.00 ","$2,321.55 ","$563.41 ","$639.66 ","$1,208.73 ","$1,208.73 ","$542.79 ","$3,100.00 ","$558.17 ","$2,255.00 ","$2,455.20 ","$2,480.00 ","$775.50 ","$152.62 ","$84.02 ","$493.52 ","$531.59 "
"45000378","EAP","CPT� 54220","","Treatment Of Penis Lesion","BOTH IP/OP","$1,092.00 ","$808.08 ","$139.18 ","$1,103.00 ","$1,092.00 ","$260.60 ","$227.60 ","$1,103.00 ","$1,103.00 ","$193.13 ","$1,103.00 ","$235.59 ","$1,103.00 ","$873.58 ","$882.40 ","$327.32 ","$151.42 ","$139.18 ","$175.60 ","$224.37 "
"45000380","EAP","CPT� 54700","","I & D Scrotum","BOTH IP/OP","$3,277.00 ","$2,424.98 ","$0.00 ","$3,277.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,277.00 ","$0.00 ","$2,327.00 ","$2,595.38 ","$2,621.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000381","EAP","CPT� 55100","","Drainage Of Scrotum Abscess","BOTH IP/OP","$2,572.00 ","$1,903.28 ","$0.00 ","$2,598.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,598.00 ","$0.00 ","$2,255.00 ","$2,057.62 ","$2,078.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000383","EAP","CPT� 56405","","I & D Of Vulva/perineum","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$294.00 ","$291.00 ","$276.20 ","$60.65 ","$0.00 ","$0.00 ","$51.48 ","$294.00 ","$0.00 ","$294.00 ","$232.85 ","$235.20 ","$0.00 ","$107.63 ","$0.00 ","$0.00 ","$0.00 "
"45000384","EAP","CPT� 57180","","Vag. Exam With Packing","BOTH IP/OP","$382.00 ","$282.68 ","$0.00 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.00 ","$0.00 ","$382.00 ","$302.54 ","$305.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000385","EAP","CPT� 57415","","Remove Vaginal Fb W/anesthesia","BOTH IP/OP","$8,477.00 ","$6,272.98 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,500.00 ","$0.00 ","$2,327.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000391","EAP","CPT� 62273","","Injection Epidural Blood Patch","BOTH IP/OP","$1,679.00 ","$1,242.46 ","$0.00 ","$1,596.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$279.45 ","$1,596.00 ","$626.89 ","$1,596.00 ","$1,264.03 ","$1,276.80 ","$870.98 ","$123.36 ","$117.56 ","$254.08 ","$597.04 "
"45000394","EAP","CPT� 64450","","Inject Anest Peripheral Nerve","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$594.01 ","$1,208.73 ","$1,208.73 ","$481.50 ","$2,750.00 ","$626.89 ","$2,255.00 ","$2,178.00 ","$2,200.00 ","$870.98 ","$85.27 ","$44.35 ","$437.80 ","$597.04 "
"45000395","EAP","CPT� 65205","","Remove Fb Eye Conj Superficial","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.00 ","$0.00 ","$382.00 ","$302.54 ","$305.60 ","$0.00 ","$132.91 ","$0.00 ","$0.00 ","$0.00 "
"45000398","EAP","CPT� 65220","","Eye Exam W/o Slit Lamp","BOTH IP/OP","$1,563.00 ","$1,156.62 ","$0.00 ","$1,578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,578.00 ","$0.00 ","$1,578.00 ","$1,249.78 ","$1,262.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000399","EAP","CPT� 65222","","Eye Exam Slit Lamp","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$808.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000400","EAP","CPT� 65800","","Paracentesis Ant Chamb Eye Wdx","BOTH IP/OP","$4,672.00 ","$3,457.28 ","$0.00 ","$4,717.00 ","$2,321.55 ","$2,033.69 ","$973.76 ","$1,208.73 ","$1,208.73 ","$825.91 ","$4,717.00 ","$2,027.80 ","$2,255.00 ","$3,735.86 ","$3,773.60 ","$2,817.36 ","$0.00 ","$93.03 ","$750.95 ","$1,931.24 "
"45000402","EAP","CPT� 66999","","Irrigation Eye","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$2,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000403","EAP","CPT� 67228","","Destroy Retinopathy Photocoag","BOTH IP/OP","$7,462.00 ","$5,521.88 ","$311.48 ","$7,462.00 ","$2,321.55 ","$492.86 ","$1,555.27 ","$1,208.73 ","$1,208.73 ","$1,306.54 ","$7,462.00 ","$508.42 ","$2,255.00 ","$5,909.90 ","$5,969.60 ","$706.38 ","$821.55 ","$311.48 ","$1,187.95 ","$484.21 "
"45000404","EAP","CPT� 67700","","Drainage Of Eyelid Abscess","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,339.00 ","$0.00 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$0.00 ","$1,339.00 ","$0.00 ","$1,339.00 ","$1,060.49 ","$1,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000405","EAP","CPT� 67715","","Incision Of Eye Lid Fold","BOTH IP/OP","$9,511.00 ","$7,038.14 ","$0.00 ","$9,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,546.00 ","$0.00 ","$2,255.00 ","$7,560.43 ","$7,636.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000406","EAP","CPT� 67840","","Excise Lesion Eyelid Smpl Clos","BOTH IP/OP","$2,581.00 ","$1,909.94 ","$160.78 ","$2,581.00 ","$2,581.00 ","$793.07 ","$537.94 ","$1,208.73 ","$1,208.73 ","$451.91 ","$2,581.00 ","$809.34 ","$2,255.00 ","$2,044.15 ","$2,064.80 ","$1,124.47 ","$209.29 ","$160.78 ","$410.90 ","$770.80 "
"45000407","EAP","CPT� 69005","","Drain External Ear Lesion","BOTH IP/OP","$9,524.00 ","$7,047.76 ","$0.00 ","$9,524.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,524.00 ","$0.00 ","$2,255.00 ","$7,543.01 ","$7,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000409","EAP","CPT� 69200","","Removal Fb Ear","BOTH IP/OP","$412.00 ","$304.88 ","$0.00 ","$412.00 ","$0.00 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$72.14 ","$412.00 ","$109.35 ","$412.00 ","$326.30 ","$329.60 ","$151.93 ","$58.58 ","$48.67 ","$65.59 ","$104.14 "
"45000412","EAP","CPT� 90945","","Peritoneal Dialysis","BOTH IP/OP","$1,724.00 ","$1,275.76 ","$0.00 ","$1,724.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,724.00 ","$0.00 ","$862.00 ","$1,365.41 ","$1,379.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000413","EAP","CPT� 92511","","Nasopharyngoscopy W/endoscope","BOTH IP/OP","$606.00 ","$448.44 ","$0.00 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$157.01 ","$612.00 ","$484.70 ","$489.60 ","$218.14 ","$64.35 ","$38.94 ","$97.43 ","$149.53 "
"45000426","EAP","CPT� 96373","","Inject-intra-arterial Only","BOTH IP/OP","$266.00 ","$196.84 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000443","EAP","CPT� 99281","","Minimal Care","BOTH IP/OP","$564.00 ","$417.36 ","$0.00 ","$564.00 ","$564.00 ","$71.04 ","$67.13 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$19.33 ","$0.00 ","$0.00 ","$0.00 "
"45000445","EAP","CPT� 99281","","Acute Visit Level 1","BOTH IP/OP","$564.00 ","$417.36 ","$0.00 ","$564.00 ","$564.00 ","$71.04 ","$67.13 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$19.33 ","$0.00 ","$0.00 ","$0.00 "
"45000447","EAP","CPT� 99282","","Limited Care","BOTH IP/OP","$1,060.00 ","$784.40 ","$30.21 ","$1,060.00 ","$1,060.00 ","$128.64 ","$220.93 ","$570.18 ","$570.18 ","$147.25 ","$841.00 ","$128.34 ","$420.50 ","$666.07 ","$672.80 ","$178.31 ","$30.21 ","$44.36 ","$133.89 ","$122.22 "
"45000449","EAP","CPT� 99282","","Acute Visit Level 2","BOTH IP/OP","$1,060.00 ","$784.40 ","$30.21 ","$1,060.00 ","$1,060.00 ","$128.64 ","$220.93 ","$570.18 ","$570.18 ","$147.25 ","$841.00 ","$128.34 ","$420.50 ","$666.07 ","$672.80 ","$178.31 ","$30.21 ","$44.36 ","$133.89 ","$122.22 "
"45000451","EAP","CPT� 99283","","Moderate Care","BOTH IP/OP","$1,580.00 ","$1,169.20 ","$61.31 ","$1,404.90 ","$1,404.90 ","$226.64 ","$329.31 ","$712.73 ","$712.73 ","$241.98 ","$1,382.00 ","$224.00 ","$691.00 ","$1,094.54 ","$1,105.60 ","$311.21 ","$61.31 ","$66.37 ","$220.01 ","$213.33 "
"45000453","EAP","CPT� 99283","","Acute Visit Level 3","BOTH IP/OP","$1,295.00 ","$958.30 ","$61.31 ","$1,382.00 ","$1,295.00 ","$226.64 ","$269.91 ","$712.73 ","$712.73 ","$241.98 ","$1,382.00 ","$224.00 ","$691.00 ","$1,094.54 ","$1,105.60 ","$311.21 ","$61.31 ","$66.37 ","$220.01 ","$213.33 "
"45000455","EAP","CPT� 99284","","Extended Care","BOTH IP/OP","$3,050.00 ","$2,257.00 ","$94.21 ","$2,566.20 ","$2,566.20 ","$356.25 ","$635.70 ","$2,161.00 ","$2,161.00 ","$378.37 ","$2,161.00 ","$352.82 ","$1,080.50 ","$1,711.51 ","$1,728.80 ","$490.20 ","$94.21 ","$121.91 ","$344.03 ","$336.02 "
"45000457","EAP","CPT� 99284","","Acute Visit Level 4","BOTH IP/OP","$3,050.00 ","$2,257.00 ","$94.21 ","$2,566.20 ","$2,566.20 ","$356.25 ","$635.70 ","$2,161.00 ","$2,161.00 ","$378.37 ","$2,161.00 ","$352.82 ","$1,080.50 ","$1,711.51 ","$1,728.80 ","$490.20 ","$94.21 ","$121.91 ","$344.03 ","$336.02 "
"45000459","EAP","CPT� 99285","","Comprehensive Care","BOTH IP/OP","$3,503.00 ","$2,592.22 ","$148.14 ","$3,503.00 ","$3,503.00 ","$511.35 ","$730.11 ","$3,060.00 ","$3,060.00 ","$535.78 ","$3,060.00 ","$505.99 ","$1,530.00 ","$2,423.52 ","$2,448.00 ","$703.01 ","$148.14 ","$177.09 ","$487.15 ","$481.90 "
"45000461","EAP","CPT� 99285","","Acute Visit Level 5","BOTH IP/OP","$2,866.00 ","$2,120.84 ","$148.14 ","$3,060.00 ","$2,866.00 ","$511.35 ","$597.35 ","$3,060.00 ","$3,060.00 ","$535.78 ","$3,060.00 ","$505.99 ","$1,530.00 ","$2,423.52 ","$2,448.00 ","$703.01 ","$148.14 ","$177.09 ","$487.15 ","$481.90 "
"45000462","EAP","CPT� 99291","","Critical Care 1st Hr","BOTH IP/OP","$4,975.00 ","$3,681.50 ","$182.90 ","$4,975.00 ","$4,975.00 ","$729.47 ","$1,036.91 ","$3,136.01 ","$3,136.01 ","$755.52 ","$4,315.00 ","$668.62 ","$2,157.50 ","$3,417.48 ","$3,452.00 ","$928.96 ","$182.90 ","$226.49 ","$686.95 ","$636.78 "
"45000464","EAP","CPT� 99292","","Critical Care Add'l 0.5 Hr","BOTH IP/OP","$1,359.00 ","$1,005.66 ","$0.00 ","$1,359.00 ","$1,359.00 ","$0.00 ","$283.25 ","$1,185.00 ","$1,185.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$113.96 ","$188.65 ","$0.00 "
"45000468","EAP","CPT� 99465","","Newborn Resuscitation","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000471","EAP","Custom 45000471","","Strapping","BOTH IP/OP","$68.00 ","$50.32 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.00 ","$0.00 ","$34.00 ","$53.86 ","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000473","EAP","CPT� 29131","","Application Finger Splint Dynamic","BOTH IP/OP","$517.00 ","$382.58 ","$0.00 ","$487.00 ","$0.00 ","$0.00 ","$107.76 ","$0.00 ","$0.00 ","$0.00 ","$487.00 ","$0.00 ","$487.00 ","$385.70 ","$389.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000476","EAP","CPT� 40830","","Repair Mouth Laceration","BOTH IP/OP","$1,099.00 ","$813.26 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$1,110.00 ","$879.12 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000477","EAP","CPT� 26775","","Treat Finger Dislocation","BOTH IP/OP","$5,029.00 ","$3,721.46 ","$0.00 ","$5,028.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,028.00 ","$0.00 ","$2,255.00 ","$3,982.18 ","$4,022.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000479","EAP","CPT� 28665","","Txt Toe Dislocation W/anesth","BOTH IP/OP","$4,530.00 ","$3,352.20 ","$0.00 ","$4,482.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,482.00 ","$0.00 ","$2,255.00 ","$3,549.74 ","$3,585.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000480","EAP","CPT� 27784","","Treatment Of Fibula Fracture","BOTH IP/OP","$16,355.00 ","$12,102.70 ","$0.00 ","$15,668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,668.00 ","$0.00 ","$2,858.00 ","$12,409.06 ","$12,534.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000481","EAP","CPT� 43235","","Upper Gi Endoscopy, Diagnosis","BOTH IP/OP","$4,485.00 ","$3,318.90 ","$0.00 ","$4,112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,112.00 ","$0.00 ","$2,255.00 ","$3,256.70 ","$3,289.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000491","EAP","CPT� 12020","","Wound Dehiscence Simple Closur","BOTH IP/OP","$2,965.00 ","$2,194.10 ","$0.00 ","$2,778.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,778.00 ","$0.00 ","$2,255.00 ","$2,200.18 ","$2,222.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000492","EAP","CPT� 26011","","Abscess Finger Complicated","BOTH IP/OP","$4,878.00 ","$3,609.72 ","$0.00 ","$4,877.00 ","$2,321.55 ","$1,377.93 ","$1,016.70 ","$0.00 ","$0.00 ","$0.00 ","$4,877.00 ","$0.00 ","$2,255.00 ","$3,862.58 ","$3,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000493","EAP","CPT� 29260","","Splint Application, Wrist","BOTH IP/OP","$1,081.00 ","$799.94 ","$0.00 ","$1,018.00 ","$586.98 ","$54.51 ","$225.31 ","$0.00 ","$0.00 ","$178.24 ","$1,018.00 ","$33.53 ","$1,018.00 ","$806.26 ","$814.40 ","$46.58 ","$44.15 ","$20.20 ","$162.07 ","$31.93 "
"45000494","EAP","CPT� 53600","","Dilate Urethra Strict Male Ini","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$694.00 ","$235.59 ","$694.00 ","$549.65 ","$555.20 ","$327.32 ","$0.00 ","$65.99 ","$110.48 ","$224.37 "
"45000495","EAP","CPT� 54001","","Dorsal Slit Except Newborn","BOTH IP/OP","$6,453.00 ","$4,775.22 ","$0.00 ","$6,453.00 ","$2,753.10 ","$1,753.49 ","$1,344.97 ","$0.00 ","$0.00 ","$0.00 ","$6,453.00 ","$0.00 ","$2,327.00 ","$5,110.78 ","$5,162.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000496","EAP","CPT� 58301","","Removal Iud","BOTH IP/OP","$281.00 ","$207.94 ","$0.00 ","$281.00 ","$281.00 ","$276.20 ","$58.57 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$271.52 ","$280.00 ","$221.76 ","$224.00 ","$280.00 ","$81.66 ","$70.31 ","$44.58 ","$258.59 "
"45000498","EAP","CPT� 27781","","Clsd Fracture Fibular","BOTH IP/OP","$6,322.00 ","$4,678.28 ","$0.00 ","$6,322.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,322.00 ","$0.00 ","$2,255.00 ","$5,007.02 ","$5,057.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000499","EAP","CPT� 69000","","Drain External Ear Lesion","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$700.00 ","$0.00 ","$700.00 ","$554.40 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000501","EAP","CPT� 28190","","Removal Of Foot Foreign Body","BOTH IP/OP","$1,318.00 ","$975.32 ","$0.00 ","$1,318.00 ","$1,318.00 ","$609.42 ","$0.00 ","$1,208.73 ","$1,208.73 ","$228.32 ","$1,304.00 ","$611.80 ","$1,304.00 ","$1,032.77 ","$1,043.20 ","$850.02 ","$173.39 ","$138.80 ","$207.60 ","$582.67 "
"45000502","EAP","CPT� 49451","","Replace Duod/jej Tube Perc","BOTH IP/OP","$2,862.00 ","$2,117.88 ","$0.00 ","$2,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,752.00 ","$0.00 ","$2,255.00 ","$2,179.58 ","$2,201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000505","EAP","CPT� 25260","","Repair Forearm Tendon/muscle","BOTH IP/OP","$6,859.00 ","$5,075.66 ","$0.00 ","$6,859.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,859.00 ","$0.00 ","$3,606.00 ","$5,432.33 ","$5,487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000506","EAP","CPT� 42960","","Control Throat Bleeding","BOTH IP/OP","$5,082.00 ","$3,760.68 ","$0.00 ","$5,082.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,082.00 ","$0.00 ","$2,255.00 ","$4,024.94 ","$4,065.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000508","EAP","CPT� 25270","","Repair Forearm Tendon/muscle","BOTH IP/OP","$5,401.00 ","$3,996.74 ","$0.00 ","$6,139.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,139.00 ","$0.00 ","$3,606.00 ","$4,862.09 ","$4,911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000512","EAP","CPT� 36425","","Vein Access Cutdown > 1 Yr","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$499.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$499.00 ","$0.00 ","$499.00 ","$395.21 ","$399.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000520","EAP","Custom 45000520","","Screened To Clinic","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.01 ","$0.01 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000525","EAP","CPT� 64420","","Intercostal Nerve Block","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,890.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$330.92 ","$1,890.00 ","$626.89 ","$1,890.00 ","$1,496.88 ","$1,512.00 ","$870.98 ","$95.79 ","$62.02 ","$300.89 ","$597.04 "
"45000526","EAP","CPT� 64421","","Intercostal Nerve Block/multi","BOTH IP/OP","$3,789.00 ","$2,803.86 ","$0.00 ","$3,656.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$640.14 ","$3,656.00 ","$814.44 ","$2,255.00 ","$2,895.55 ","$2,924.80 ","$1,131.55 ","$124.25 ","$26.33 ","$582.04 ","$775.65 "
"45000529","EAP","CPT� 64400","","Trigeminal Nerve Block","BOTH IP/OP","$1,227.00 ","$907.98 ","$0.00 ","$1,227.00 ","$1,227.00 ","$255.86 ","$255.74 ","$0.00 ","$0.00 ","$0.00 ","$1,184.00 ","$0.00 ","$1,184.00 ","$937.73 ","$947.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000535","EAP","CPT� 36569","","Insert Picc Cath","BOTH IP/OP","$4,743.00 ","$3,509.82 ","$98.45 ","$5,429.00 ","$2,321.55 ","$1,377.13 ","$988.56 ","$1,208.73 ","$1,208.73 ","$950.57 ","$5,429.00 ","$1,635.92 ","$2,255.00 ","$4,299.77 ","$4,343.20 ","$2,272.90 ","$346.84 ","$98.45 ","$864.30 ","$1,558.02 "
"45000536","EAP","CPT� 54235","","Penile Injection","BOTH IP/OP","$898.00 ","$664.52 ","$0.00 ","$907.00 ","$487.61 ","$260.60 ","$187.17 ","$0.00 ","$0.00 ","$158.81 ","$907.00 ","$235.59 ","$907.00 ","$718.34 ","$725.60 ","$327.32 ","$70.35 ","$75.71 ","$144.39 ","$224.37 "
"45000537","EAP","CPT� 46320","","Rem. Of Hemorrhoid Clot","BOTH IP/OP","$6,695.00 ","$4,954.30 ","$0.00 ","$6,695.00 ","$2,321.55 ","$1,015.53 ","$1,395.41 ","$0.00 ","$0.00 ","$0.00 ","$6,695.00 ","$0.00 ","$2,255.00 ","$5,302.44 ","$5,356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000538","EAP","CPT� 26735","","Open Tx Of Phalangeal Shaft Fx","BOTH IP/OP","$8,714.00 ","$6,448.36 ","$0.00 ","$8,712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,712.00 ","$0.00 ","$3,606.00 ","$6,899.90 ","$6,969.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000541","EAP","CPT� 23665","","Treat Dislocation /fx","BOTH IP/OP","$1,745.00 ","$1,291.30 ","$0.00 ","$1,697.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,697.00 ","$0.00 ","$1,697.00 ","$1,344.02 ","$1,357.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000542","EAP","CPT� 40654","","Repair Lip/complex","BOTH IP/OP","$1,515.00 ","$1,121.10 ","$0.00 ","$1,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,426.00 ","$0.00 ","$1,426.00 ","$1,129.39 ","$1,140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000543","EAP","CPT� 31530","","Laryngoscopy W/fb Rem","BOTH IP/OP","$7,908.00 ","$5,851.92 ","$0.00 ","$7,261.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,261.00 ","$0.00 ","$2,327.00 ","$5,750.71 ","$5,808.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000544","EAP","CPT� 28435","","Treatment Of Ankle Fx","BOTH IP/OP","$1,516.00 ","$1,121.84 ","$0.00 ","$1,516.00 ","$1,516.00 ","$1,364.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000545","EAP","CPT� 23625","","Treat Humerus Fx","BOTH IP/OP","$7,014.00 ","$5,190.36 ","$0.00 ","$6,821.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,821.00 ","$0.00 ","$2,327.00 ","$5,402.23 ","$5,456.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000546","EAP","CPT� 23545","","Treat Clavicle Dislocation","BOTH IP/OP","$1,245.00 ","$921.30 ","$0.00 ","$1,245.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,245.00 ","$0.00 ","$1,245.00 ","$986.04 ","$996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000550","EAP","CPT� 52332","","Cysto W Ureter Stent Plcmnt","BOTH IP/OP","$10,798.00 ","$7,990.52 ","$0.00 ","$10,907.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,907.00 ","$0.00 ","$2,327.00 ","$8,638.34 ","$8,725.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000560","EAP","CPT� 24535","","Treat Humerus Fx","BOTH IP/OP","$1,745.00 ","$1,291.30 ","$0.00 ","$1,697.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,697.00 ","$0.00 ","$1,697.00 ","$1,344.02 ","$1,357.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000561","EAP","CPT� 24640","","Treat Elbow Dis/nursemaid","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$499.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$499.00 ","$0.00 ","$499.00 ","$395.21 ","$399.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000562","EAP","CPT� 28405","","Treat Heel Fx","BOTH IP/OP","$5,013.00 ","$3,709.62 ","$0.00 ","$4,960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,960.00 ","$0.00 ","$2,327.00 ","$3,928.32 ","$3,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000563","EAP","CPT� 40831","","Repair Mouth Lacerations","BOTH IP/OP","$2,115.00 ","$1,565.10 ","$0.00 ","$2,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.00 ","$0.00 ","$2,136.00 ","$1,691.71 ","$1,708.80 ","$0.00 ","$170.53 ","$0.00 ","$0.00 ","$0.00 "
"45000564","EAP","CPT� 23675","","Treat Dislocation/fracture","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000565","EAP","CPT� 20101","","Exploration Of Penetrating Wound (chest)","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$2,255.00 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000571","EAP","CPT� 90792","","Psych Diag Eval W/med Srvcs","BOTH IP/OP","$482.00 ","$356.68 ","$0.00 ","$572.00 ","$261.73 ","$131.03 ","$100.46 ","$0.00 ","$0.00 ","$100.15 ","$572.00 ","$131.75 ","$286.00 ","$453.02 ","$457.60 ","$183.04 ","$117.89 ","$142.86 ","$91.06 ","$125.47 "
"45000572","EAP","CPT� 90863","","Pharma Mgmt Inc Prescpt/med Review W Psytx (add-on)","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$331.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.00 ","$0.00 ","$165.50 ","$262.15 ","$264.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000574","EAP","CPT� 32555","","Aspirate Pleura W/ Imaging","BOTH IP/OP","$3,461.00 ","$2,561.14 ","$0.00 ","$3,461.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.99 ","$3,461.00 ","$632.36 ","$2,255.00 ","$2,741.11 ","$2,768.80 ","$878.58 ","$626.46 ","$116.13 ","$550.99 ","$602.25 "
"45000575","EAP","CPT� 27781","","Treatment Fibula Fracture","BOTH IP/OP","$6,599.00 ","$4,883.26 ","$0.00 ","$6,322.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,322.00 ","$0.00 ","$2,255.00 ","$5,007.02 ","$5,057.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000576","EAP","CPT� 45900","","Reduction Of Rectal Prolapse","BOTH IP/OP","$1,534.00 ","$1,135.16 ","$0.00 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,534.00 ","$0.00 ","$1,534.00 ","$1,214.93 ","$1,227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000580","EAP","Custom 45000580","","I & D Complex Post Op Wound Inf","BOTH IP/OP","$6,628.00 ","$4,904.72 ","$0.00 ","$8,153.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,153.00 ","$0.00 ","$4,076.50 ","$6,457.18 ","$6,522.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000581","EAP","CPT� 21451","","Treata Lower Jaw Fracture","BOTH IP/OP","$5,346.00 ","$3,956.04 ","$0.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,400.00 ","$0.00 ","$3,606.00 ","$4,276.80 ","$4,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000584","EAP","Custom 45000584","","I & D Floor Mouth Sub Mandibular","BOTH IP/OP","$1,227.00 ","$907.98 ","$0.00 ","$1,441.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,441.00 ","$0.00 ","$720.50 ","$1,141.27 ","$1,152.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000585","EAP","CPT� 13102","","Repair,complex,trunk,each Additional 5cm Or Less","BOTH IP/OP","$3,100.00 ","$2,294.00 ","$0.00 ","$3,141.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,141.00 ","$0.00 ","$2,255.00 ","$2,487.67 ","$2,512.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000589","EAP","CPT� 41016","","I&d Mouth Floor Les, Abcess,cyst, Hemat","BOTH IP/OP","$5,296.00 ","$3,919.04 ","$0.00 ","$5,605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,605.00 ","$0.00 ","$2,255.00 ","$4,439.16 ","$4,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000590","EAP","CPT� 27265","","Treat Hip Dislocation","BOTH IP/OP","$891.00 ","$659.34 ","$0.00 ","$891.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$891.00 ","$0.00 ","$891.00 ","$705.67 ","$712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000592","EAP","CPT� 41016","","I&d,floor Of Mouth-submental","BOTH IP/OP","$5,549.00 ","$4,106.26 ","$0.00 ","$5,605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,605.00 ","$0.00 ","$2,255.00 ","$4,439.16 ","$4,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000593","EAP","CPT� 21320","","Closed Tx Nose Fx W/stabj","BOTH IP/OP","$4,437.00 ","$3,283.38 ","$0.00 ","$4,482.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,482.00 ","$0.00 ","$2,327.00 ","$3,549.74 ","$3,585.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000594","EAP","CPT� 21453","","Reduce Mandibular Interdental","BOTH IP/OP","$8,688.00 ","$6,429.12 ","$0.00 ","$8,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,776.00 ","$0.00 ","$2,858.00 ","$6,950.59 ","$7,020.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000595","EAP","CPT� 11012","","Deb Skin Bone At Fx Site","BOTH IP/OP","$8,257.00 ","$6,110.18 ","$0.00 ","$7,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,850.00 ","$0.00 ","$2,327.00 ","$6,217.20 ","$6,280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000598","EAP","CPT� 25624","","Closed Treatment Of Carpal Scaphoid Fracture With Manipulation","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$2,295.00 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000599","EAP","CPT� 28825","","Amputation Toe, Interphalangeal Joint","BOTH IP/OP","$5,435.00 ","$4,021.90 ","$0.00 ","$5,378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,378.00 ","$0.00 ","$2,327.00 ","$4,259.38 ","$4,302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000600","EAP","CPT� 28495","","Closed Fracture Treatment Of Great Toe Or Phalanx","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$588.00 ","$201.85 ","$122.55 ","$0.00 ","$0.00 ","$0.00 ","$582.00 ","$0.00 ","$582.00 ","$460.94 ","$465.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000606","EAP","CPT� 28505","","Open Tx, Internal Fixation Grt Toe Fx","BOTH IP/OP","$6,418.00 ","$4,749.32 ","$0.00 ","$6,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,418.00 ","$0.00 ","$2,858.00 ","$5,083.06 ","$5,134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000607","EAP","CPT� 40652","","Repair Lip","BOTH IP/OP","$2,180.00 ","$1,613.20 ","$0.00 ","$2,051.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,051.00 ","$0.00 ","$2,051.00 ","$1,624.39 ","$1,640.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000608","EAP","CPT� 26952","","Amputation Of Finger/thumb","BOTH IP/OP","$6,468.00 ","$4,786.32 ","$0.00 ","$5,908.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,908.00 ","$0.00 ","$3,606.00 ","$4,679.14 ","$4,726.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000609","EAP","CPT� 51102","","Drain Bl W/cath Insertion","BOTH IP/OP","$5,564.00 ","$4,117.36 ","$0.00 ","$5,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,564.00 ","$0.00 ","$2,255.00 ","$4,406.69 ","$4,451.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000610","EAP","CPT� 57200","","Repair Of Vagina","BOTH IP/OP","$5,461.00 ","$4,041.14 ","$0.00 ","$5,461.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,461.00 ","$0.00 ","$2,255.00 ","$4,325.11 ","$4,368.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000611","EAP","CPT� 27532","","Tx Fx Tibial Prox W/ Or W/o Manip W/tract Closed","BOTH IP/OP","$5,978.00 ","$4,423.72 ","$0.00 ","$5,978.00 ","$2,321.55 ","$2,773.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,978.00 ","$0.00 ","$2,255.00 ","$4,734.58 ","$4,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000612","EAP","Custom 45000612","","Level 3 Partial Trauma Activation W/o Prenotificat","BOTH IP/OP","$7,507.00 ","$5,555.18 ","$0.00 ","$4,690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,690.00 ","$0.00 ","$2,345.00 ","$3,714.48 ","$3,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000613","EAP","CPT� 41007","","Drainage Of Mouth Lesion","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,936.00 ","$0.00 ","$2,255.00 ","$2,325.31 ","$2,348.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000620","EAP","CPT� 20650","","Insert And Remove Bone Pin","BOTH IP/OP","$6,356.00 ","$4,703.44 ","$0.00 ","$6,356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,356.00 ","$0.00 ","$2,858.00 ","$5,033.95 ","$5,084.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45000634","EAP","CPT� 61107","","Twist Drill Hole Implt Ventricular Cath/device","BOTH IP/OP","$4,189.00 ","$3,099.86 ","$0.00 ","$3,871.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,871.00 ","$0.00 ","$2,255.00 ","$3,065.83 ","$3,096.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000001","EAP","CPT� 94010","","Spiro Lung Vol/pf","BOTH IP/OP","$685.00 ","$506.90 ","$27.37 ","$532.00 ","$371.96 ","$136.73 ","$142.77 ","$379.69 ","$379.69 ","$93.15 ","$532.00 ","$138.76 ","$266.00 ","$421.34 ","$425.60 ","$192.78 ","$28.79 ","$27.37 ","$84.69 ","$132.15 "
"46000006","EAP","CPT� 94060","","Bronchospasm Eval Pre And Post","BOTH IP/OP","$784.00 ","$580.16 ","$46.82 ","$609.00 ","$425.71 ","$259.18 ","$163.41 ","$434.64 ","$434.64 ","$106.63 ","$609.00 ","$253.05 ","$304.50 ","$482.33 ","$487.20 ","$351.58 ","$55.45 ","$46.82 ","$96.95 ","$241.00 "
"46000007","EAP","CPT� 94060","","Spirometry Pre & Post","BOTH IP/OP","$784.00 ","$580.16 ","$46.82 ","$609.00 ","$425.71 ","$259.18 ","$163.41 ","$434.64 ","$434.64 ","$106.63 ","$609.00 ","$253.05 ","$304.50 ","$482.33 ","$487.20 ","$351.58 ","$55.45 ","$46.82 ","$96.95 ","$241.00 "
"46000010","EAP","CPT� 94070","","Bronchoprovocation","BOTH IP/OP","$1,441.00 ","$1,066.34 ","$0.00 ","$1,399.00 ","$782.46 ","$259.18 ","$300.34 ","$998.47 ","$998.47 ","$0.00 ","$1,399.00 ","$0.00 ","$699.50 ","$1,108.01 ","$1,119.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000012","EAP","CPT� 94150","","Peak Flow Determination","BOTH IP/OP","$267.00 ","$197.58 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$0.00 ","$190.56 ","$190.56 ","$0.00 ","$267.00 ","$0.00 ","$133.50 ","$211.46 ","$213.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000015","EAP","CPT� 94200","","Max Volume Ventilation (mvv)","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$110.00 ","$59.19 ","$54.51 ","$22.72 ","$78.51 ","$78.51 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000019","EAP","CPT� 94250","","Expired Gas Analysis","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000027","EAP","CPT� 94375","","Maxflw-vol Curves, I+r","BOTH IP/OP","$266.00 ","$196.84 ","$24.49 ","$268.00 ","$144.44 ","$259.18 ","$55.44 ","$191.27 ","$191.27 ","$46.92 ","$268.00 ","$253.05 ","$134.00 ","$212.26 ","$214.40 ","$268.00 ","$35.48 ","$24.49 ","$42.67 ","$241.00 "
"46000028","EAP","CPT� 94400","","Breathing Response To Co2","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$196.27 ","$196.27 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000029","EAP","CPT� 94400","","Co2 Response Curve","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$196.27 ","$196.27 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000030","EAP","CPT� 94450","","Hypoxic Response Curve","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$0.00 ","$0.00 ","$0.00 ","$156.30 ","$156.30 ","$0.00 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000031","EAP","CPT� 94618","","Six Minute Walk(pulm Stress Simple)","BOTH IP/OP","$311.00 ","$230.14 ","$10.80 ","$314.00 ","$168.87 ","$110.43 ","$64.82 ","$224.10 ","$224.10 ","$54.98 ","$314.00 ","$109.35 ","$157.00 ","$248.69 ","$251.20 ","$151.93 ","$33.08 ","$10.80 ","$49.99 ","$104.14 "
"46000033","EAP","CPT� 94680","","02 Anal","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$107.06 ","$107.06 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000035","EAP","CPT� 94681","","Et/co2 Oxygen Uptake","BOTH IP/OP","$1,529.00 ","$1,131.46 ","$43.22 ","$1,390.00 ","$830.25 ","$259.18 ","$318.68 ","$992.04 ","$992.04 ","$243.38 ","$1,390.00 ","$253.05 ","$695.00 ","$1,100.88 ","$1,112.00 ","$351.58 ","$66.54 ","$43.22 ","$221.29 ","$241.00 "
"46000037","EAP","CPT� 94681","","Met Cart V02","BOTH IP/OP","$1,529.00 ","$1,131.46 ","$43.22 ","$1,390.00 ","$830.25 ","$259.18 ","$318.68 ","$992.04 ","$992.04 ","$243.38 ","$1,390.00 ","$253.05 ","$695.00 ","$1,100.88 ","$1,112.00 ","$351.58 ","$66.54 ","$43.22 ","$221.29 ","$241.00 "
"46000039","EAP","CPT� 94681","","O2 Uptake Incl Co2 Output","BOTH IP/OP","$279.00 ","$206.46 ","$43.22 ","$279.00 ","$151.50 ","$259.18 ","$58.15 ","$199.12 ","$199.12 ","$48.85 ","$279.00 ","$253.05 ","$139.50 ","$220.97 ","$223.20 ","$279.00 ","$66.54 ","$43.22 ","$44.42 ","$241.00 "
"46000042","EAP","CPT� 94750","","Pulmonary Compliance","BOTH IP/OP","$1,179.00 ","$872.46 ","$0.00 ","$1,179.00 ","$0.00 ","$0.00 ","$0.00 ","$841.45 ","$841.45 ","$206.43 ","$1,179.00 ","$138.76 ","$589.50 ","$933.77 ","$943.20 ","$192.78 ","$36.60 ","$78.16 ","$187.70 ","$132.15 "
"46000044","EAP","CPT� 94760","","Neo Pulse Oximetry Single","BOTH IP/OP","$440.00 ","$325.60 ","$0.00 ","$443.00 ","$0.00 ","$0.00 ","$0.00 ","$316.17 ","$316.17 ","$77.57 ","$443.00 ","$0.00 ","$221.50 ","$350.86 ","$354.40 ","$0.00 ","$10.16 ","$2.52 ","$70.53 ","$0.00 "
"46000046","EAP","CPT� 94760","","Pulse Oximetry","BOTH IP/OP","$440.00 ","$325.60 ","$0.00 ","$443.00 ","$0.00 ","$0.00 ","$0.00 ","$316.17 ","$316.17 ","$77.57 ","$443.00 ","$0.00 ","$221.50 ","$350.86 ","$354.40 ","$0.00 ","$10.16 ","$2.52 ","$70.53 ","$0.00 "
"46000049","EAP","CPT� 94761","","Adult Pulse Ox Multiple","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$507.44 ","$507.44 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000050","EAP","CPT� 94761","","Neo Pulse Ox Multiple","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$507.44 ","$507.44 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000051","EAP","CPT� 94761","","Oximetry, Multiple","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$507.44 ","$507.44 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000055","EAP","CPT� 94762","","Oximetry Continuous","BOTH IP/OP","$759.00 ","$561.66 ","$25.94 ","$764.00 ","$412.14 ","$136.73 ","$158.19 ","$545.27 ","$545.27 ","$133.77 ","$764.00 ","$138.76 ","$382.00 ","$605.09 ","$611.20 ","$192.78 ","$25.94 ","$26.65 ","$121.63 ","$132.15 "
"46000056","EAP","CPT� 94762","","Pulse Ox-overnight","BOTH IP/OP","$674.00 ","$498.76 ","$25.94 ","$679.00 ","$365.98 ","$136.73 ","$140.48 ","$484.60 ","$484.60 ","$118.89 ","$679.00 ","$138.76 ","$339.50 ","$537.77 ","$543.20 ","$192.78 ","$25.94 ","$26.65 ","$108.10 ","$132.15 "
"46000059","EAP","CPT� 94770","","Transcut Co2 Monitor","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$507.44 ","$507.44 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000060","EAP","CPT� 94799","","Breathing Exercise","BOTH IP/OP","$1,459.00 ","$1,079.66 ","$0.00 ","$1,327.00 ","$0.00 ","$0.00 ","$0.00 ","$947.08 ","$947.08 ","$0.00 ","$1,327.00 ","$0.00 ","$663.50 ","$1,050.98 ","$1,061.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000061","EAP","CPT� 94799","","Mini Bal Lavage","BOTH IP/OP","$1,459.00 ","$1,079.66 ","$0.00 ","$1,327.00 ","$0.00 ","$0.00 ","$0.00 ","$947.08 ","$947.08 ","$0.00 ","$1,327.00 ","$0.00 ","$663.50 ","$1,050.98 ","$1,061.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000066","EAP","CPT� 94610","","Surfactant Administration","BOTH IP/OP","$397.00 ","$293.78 ","$0.00 ","$397.00 ","$0.00 ","$0.00 ","$0.00 ","$283.34 ","$283.34 ","$0.00 ","$397.00 ","$0.00 ","$198.50 ","$314.42 ","$317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000070","EAP","CPT� 94681","","Met Cart Vco2","BOTH IP/OP","$1,529.00 ","$1,131.46 ","$43.22 ","$1,390.00 ","$830.25 ","$259.18 ","$318.68 ","$992.04 ","$992.04 ","$243.38 ","$1,390.00 ","$253.05 ","$695.00 ","$1,100.88 ","$1,112.00 ","$351.58 ","$66.54 ","$43.22 ","$221.29 ","$241.00 "
"46000071","EAP","CPT� 94726","","Plethysmo Lung Vol / Air Resist","BOTH IP/OP","$314.00 ","$232.36 ","$40.44 ","$259.18 ","$170.50 ","$259.18 ","$65.45 ","$181.28 ","$181.28 ","$44.47 ","$254.00 ","$253.05 ","$127.00 ","$201.17 ","$203.20 ","$254.00 ","$51.52 ","$41.78 ","$40.44 ","$241.00 "
"46000072","EAP","CPT� 94728","","Pul Func Oscillometry","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$181.28 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000075","EAP","CPT� 94726","","Pulm Func Test Plethysmogr","BOTH IP/OP","$1,167.00 ","$863.58 ","$40.44 ","$633.68 ","$633.68 ","$259.18 ","$243.23 ","$181.28 ","$181.28 ","$44.47 ","$254.00 ","$253.05 ","$127.00 ","$201.17 ","$203.20 ","$254.00 ","$51.52 ","$41.78 ","$40.44 ","$241.00 "
"46000076","EAP","CPT� 94727","","Pulm Func Test By Gas","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$254.00 ","$179.73 ","$136.73 ","$68.99 ","$181.28 ","$181.28 ","$44.47 ","$254.00 ","$138.76 ","$127.00 ","$201.17 ","$203.20 ","$192.78 ","$0.00 ","$31.69 ","$40.44 ","$132.15 "
"46000077","EAP","CPT� 94728","","Pulm Func Test Oscillometry","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$181.28 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000078","EAP","CPT� 94729","","C02/membrane Diffuse Capac","BOTH IP/OP","$379.00 ","$280.46 ","$0.00 ","$307.00 ","$205.80 ","$0.00 ","$78.99 ","$219.11 ","$219.11 ","$53.75 ","$307.00 ","$0.00 ","$153.50 ","$243.14 ","$245.60 ","$0.00 ","$51.25 ","$47.90 ","$48.87 ","$0.00 "
"46000082","EAP","CPT� 32554","","Aspirate Pleura W/o Imaging","BOTH IP/OP","$2,630.00 ","$1,946.20 ","$0.00 ","$2,489.00 ","$0.00 ","$0.00 ","$548.16 ","$1,776.40 ","$1,776.40 ","$435.80 ","$2,489.00 ","$632.36 ","$2,255.00 ","$1,971.29 ","$1,991.20 ","$878.58 ","$543.38 ","$93.40 ","$396.25 ","$602.25 "
"46000083","EAP","CPT� 32555","","Aspirate Pleura W/ Imaging","BOTH IP/OP","$3,657.00 ","$2,706.18 ","$116.13 ","$3,461.00 ","$2,321.55 ","$529.35 ","$762.21 ","$2,470.12 ","$2,470.12 ","$605.99 ","$3,461.00 ","$632.36 ","$2,255.00 ","$2,741.11 ","$2,768.80 ","$878.58 ","$626.46 ","$116.13 ","$550.99 ","$602.25 "
"46000084","EAP","CPT� 31647","","Bronchial Valve Init Insert","BOTH IP/OP","$5,261.00 ","$3,893.14 ","$0.00 ","$5,148.00 ","$0.00 ","$0.00 ","$0.00 ","$3,674.13 ","$3,674.13 ","$0.00 ","$5,148.00 ","$0.00 ","$2,858.00 ","$4,077.22 ","$4,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000085","EAP","CPT� 31648","","Bronchial Valve Addl Insert","BOTH IP/OP","$2,999.00 ","$2,219.26 ","$0.00 ","$3,029.00 ","$0.00 ","$0.00 ","$0.00 ","$2,161.80 ","$2,161.80 ","$0.00 ","$3,029.00 ","$0.00 ","$2,858.00 ","$2,398.97 ","$2,423.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000086","EAP","CPT� 31649","","Bronchial Valve Remov Init","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.55 ","$1,070.55 ","$0.00 ","$1,500.00 ","$0.00 ","$1,500.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000087","EAP","CPT� 31651","","Bronchial Valve Remov Addl","BOTH IP/OP","$947.00 ","$700.78 ","$0.00 ","$947.00 ","$0.00 ","$0.00 ","$0.00 ","$675.87 ","$675.87 ","$0.00 ","$947.00 ","$0.00 ","$473.50 ","$750.02 ","$757.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000088","EAP","CPT� 32556","","Insert Cath Pleura W/o Image","BOTH IP/OP","$2,930.00 ","$2,168.20 ","$0.00 ","$3,536.00 ","$0.00 ","$0.00 ","$0.00 ","$2,523.64 ","$2,523.64 ","$0.00 ","$3,536.00 ","$0.00 ","$2,255.00 ","$2,800.51 ","$2,828.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000089","EAP","CPT� 32557","","Insert Cath Pleura W/ Image","BOTH IP/OP","$2,627.00 ","$1,943.98 ","$0.00 ","$2,627.00 ","$0.00 ","$0.00 ","$0.00 ","$1,874.89 ","$1,874.89 ","$0.00 ","$2,627.00 ","$0.00 ","$2,255.00 ","$2,080.58 ","$2,101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000090","EAP","CPT� 94452","","High Altitude Simulation Testing(hast)","BOTH IP/OP","$447.00 ","$330.78 ","$0.00 ","$447.00 ","$0.00 ","$0.00 ","$0.00 ","$319.02 ","$319.02 ","$0.00 ","$447.00 ","$0.00 ","$223.50 ","$354.02 ","$357.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46000091","EAP","CPT� 94453","","High Altitude Simulation Testing(hast) O2 Titration","BOTH IP/OP","$500.00 ","$370.00 ","$53.67 ","$500.00 ","$271.50 ","$110.43 ","$104.21 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$109.35 ","$250.00 ","$396.00 ","$400.00 ","$151.93 ","$74.05 ","$53.67 ","$79.60 ","$104.14 "
"47000001","EAP","CPT� 92551","","Ipv Scr, 2 Ears, Pure Tone,air","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$11.81 ","$6.25 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$18.00 ","$9.01 ","$0.00 ","$4.78 ","$0.00 "
"47000006","EAP","CPT� 92592","","Hearing Aid Check, Monaural","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$147.00 ","$79.28 ","$22.24 ","$30.43 ","$104.91 ","$104.91 ","$25.74 ","$147.00 ","$0.00 ","$73.50 ","$116.42 ","$117.60 ","$88.20 ","$23.01 ","$0.00 ","$23.40 ","$0.00 "
"47000007","EAP","CPT� 92593","","Hearing Aid Check, Binaural","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$291.00 ","$156.38 ","$37.15 ","$60.03 ","$207.69 ","$207.69 ","$50.95 ","$291.00 ","$0.00 ","$145.50 ","$230.47 ","$232.80 ","$174.60 ","$45.54 ","$0.00 ","$46.33 ","$0.00 "
"47000022","EAP","CPT� 95992","","Canalith Repositioning Proc","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$21.26 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$40.49 ","$51.50 ","$81.58 ","$82.40 ","$38.95 ","$16.12 ","$38.95 ","$16.40 ","$38.95 "
"47000023","EAP","CPT� 92626","","Eval Aud Funcj Cand/po Surg Implt Dev 1st Hr","BOTH IP/OP","$508.00 ","$375.92 ","$0.00 ","$508.00 ","$0.00 ","$0.00 ","$0.00 ","$362.56 ","$362.56 ","$0.00 ","$508.00 ","$0.00 ","$254.00 ","$402.34 ","$406.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47000024","EAP","CPT� 92591","","Hearing Aid Examination & Selection Binaural","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$348.00 ","$187.34 ","$72.56 ","$71.91 ","$248.37 ","$248.37 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$208.80 ","$54.46 ","$0.00 ","$55.40 ","$0.00 "
"47000025","EAP","","","Electroacous Eval Hearing Aid Binaural","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$159.87 ","$159.87 ","$0.00 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100001","EAP","CPT� 92511","","Nasal Pharyngoscopy, Simple","BOTH IP/OP","$606.00 ","$448.44 ","$0.00 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$436.78 ","$436.78 ","$107.16 ","$612.00 ","$157.01 ","$612.00 ","$484.70 ","$489.60 ","$218.14 ","$64.35 ","$38.94 ","$97.43 ","$149.53 "
"47100002","EAP","CPT� 92541","","Spontaneous Nystagmus Test","BOTH IP/OP","$647.00 ","$478.78 ","$4.32 ","$654.00 ","$351.32 ","$110.43 ","$134.85 ","$466.76 ","$466.76 ","$114.51 ","$654.00 ","$109.35 ","$327.00 ","$517.97 ","$523.20 ","$151.93 ","$36.09 ","$4.32 ","$104.12 ","$104.14 "
"47100003","EAP","CPT� 92542","","POSITIONAL NYSTAGMUS TEST","BOTH IP/OP","$899.00 ","$665.26 ","$0.00 ","$908.00 ","$0.00 ","$0.00 ","$0.00 ","$648.04 ","$648.04 ","$0.00 ","$908.00 ","$0.00 ","$454.00 ","$719.14 ","$726.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100005","EAP","CPT� 92544","","Optokinetic Nystagmus Test","BOTH IP/OP","$654.00 ","$483.96 ","$0.00 ","$654.00 ","$0.00 ","$0.00 ","$0.00 ","$466.76 ","$466.76 ","$0.00 ","$654.00 ","$0.00 ","$327.00 ","$517.97 ","$523.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100006","EAP","CPT� 92545","","Oscillating Tracking Test","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$410.38 ","$410.38 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100007","EAP","CPT� 92551","","Hearing Screening","BOTH IP/OP","$164.00 ","$121.36 ","$0.00 ","$165.00 ","$89.05 ","$11.81 ","$34.18 ","$117.76 ","$117.76 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$99.00 ","$9.01 ","$0.00 ","$26.27 ","$0.00 "
"47100011","EAP","CPT� 92552","","Air Conduction (both)","BOTH IP/OP","$276.00 ","$204.24 ","$17.48 ","$276.00 ","$149.87 ","$110.43 ","$57.53 ","$196.98 ","$196.98 ","$48.33 ","$276.00 ","$109.35 ","$138.00 ","$218.59 ","$220.80 ","$151.93 ","$17.48 ","$32.05 ","$43.94 ","$104.14 "
"47100012","EAP","CPT� 92552","","Air Conduction (one)","BOTH IP/OP","$276.00 ","$204.24 ","$17.48 ","$276.00 ","$149.87 ","$110.43 ","$57.53 ","$196.98 ","$196.98 ","$48.33 ","$276.00 ","$109.35 ","$138.00 ","$218.59 ","$220.80 ","$151.93 ","$17.48 ","$32.05 ","$43.94 ","$104.14 "
"47100013","EAP","CPT� 92552","","Audiometry","BOTH IP/OP","$273.00 ","$202.02 ","$17.48 ","$276.00 ","$148.24 ","$110.43 ","$56.90 ","$196.98 ","$196.98 ","$48.33 ","$276.00 ","$109.35 ","$138.00 ","$218.59 ","$220.80 ","$151.93 ","$17.48 ","$32.05 ","$43.94 ","$104.14 "
"47100014","EAP","CPT� 92552","","Audiometry - Air Only","BOTH IP/OP","$273.00 ","$202.02 ","$17.48 ","$276.00 ","$148.24 ","$110.43 ","$56.90 ","$196.98 ","$196.98 ","$48.33 ","$276.00 ","$109.35 ","$138.00 ","$218.59 ","$220.80 ","$151.93 ","$17.48 ","$32.05 ","$43.94 ","$104.14 "
"47100015","EAP","CPT� 92552","","Audiometry-air Conduction","BOTH IP/OP","$276.00 ","$204.24 ","$17.48 ","$276.00 ","$149.87 ","$110.43 ","$57.53 ","$196.98 ","$196.98 ","$48.33 ","$276.00 ","$109.35 ","$138.00 ","$218.59 ","$220.80 ","$151.93 ","$17.48 ","$32.05 ","$43.94 ","$104.14 "
"47100017","EAP","CPT� 92553","","Air & Bone Conduction (both)","BOTH IP/OP","$622.00 ","$460.28 ","$0.00 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$443.92 ","$443.92 ","$108.91 ","$622.00 ","$138.76 ","$311.00 ","$492.62 ","$497.60 ","$192.78 ","$25.68 ","$38.90 ","$99.02 ","$132.15 "
"47100018","EAP","CPT� 92592","","Air And Bone Conduction (one)","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$298.00 ","$160.19 ","$22.24 ","$61.49 ","$212.68 ","$212.68 ","$52.18 ","$298.00 ","$0.00 ","$149.00 ","$236.02 ","$238.40 ","$178.80 ","$46.64 ","$0.00 ","$47.44 ","$0.00 "
"47100019","EAP","CPT� 92553","","Audiometry - Air And Bone","BOTH IP/OP","$616.00 ","$455.84 ","$0.00 ","$622.00 ","$334.49 ","$136.73 ","$0.00 ","$443.92 ","$443.92 ","$108.91 ","$622.00 ","$138.76 ","$311.00 ","$492.62 ","$497.60 ","$192.78 ","$25.68 ","$38.90 ","$99.02 ","$132.15 "
"47100020","EAP","CPT� 92555","","Speech Audiometry Threshold","BOTH IP/OP","$218.00 ","$161.32 ","$14.98 ","$220.00 ","$118.37 ","$33.15 ","$45.44 ","$157.01 ","$157.01 ","$38.52 ","$220.00 ","$33.53 ","$110.00 ","$174.24 ","$176.00 ","$46.58 ","$14.98 ","$24.13 ","$35.02 ","$31.93 "
"47100023","EAP","CPT� 92556","","Speech Audiometry, Complete","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$114.19 ","$114.19 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100026","EAP","CPT� 92557","","Audiometric Battery","BOTH IP/OP","$736.00 ","$544.64 ","$33.54 ","$743.00 ","$399.65 ","$136.73 ","$153.40 ","$530.28 ","$530.28 ","$130.09 ","$743.00 ","$138.76 ","$371.50 ","$588.46 ","$594.40 ","$192.78 ","$47.03 ","$33.54 ","$118.29 ","$132.15 "
"47100028","EAP","CPT� 92557","","Compre Audiometric Battery","BOTH IP/OP","$743.00 ","$549.82 ","$0.00 ","$743.00 ","$0.00 ","$0.00 ","$153.40 ","$530.28 ","$530.28 ","$130.09 ","$743.00 ","$138.76 ","$371.50 ","$588.46 ","$594.40 ","$192.78 ","$47.03 ","$33.54 ","$118.29 ","$132.15 "
"47100029","EAP","CPT� 92562","","Loudness Balance Test","BOTH IP/OP","$227.00 ","$167.98 ","$0.00 ","$227.00 ","$0.00 ","$0.00 ","$0.00 ","$162.01 ","$162.01 ","$0.00 ","$227.00 ","$0.00 ","$113.50 ","$179.78 ","$181.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100032","EAP","CPT� 92565","","Stenger Test, Pure Tone","BOTH IP/OP","$278.00 ","$205.72 ","$0.00 ","$281.00 ","$0.00 ","$0.00 ","$0.00 ","$200.55 ","$200.55 ","$0.00 ","$281.00 ","$0.00 ","$140.50 ","$222.55 ","$224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100033","EAP","CPT� 92567","","Tympanometry","BOTH IP/OP","$158.00 ","$116.92 ","$11.18 ","$160.00 ","$85.79 ","$33.15 ","$32.93 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$33.53 ","$80.00 ","$126.72 ","$128.00 ","$46.58 ","$20.66 ","$11.18 ","$25.47 ","$31.93 "
"47100034","EAP","CPT� 92567","","Tympanometry, Binaural","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$32.93 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$33.53 ","$80.00 ","$126.72 ","$128.00 ","$46.58 ","$20.66 ","$11.18 ","$25.47 ","$31.93 "
"47100036","EAP","CPT� 92568","","Acoustic Reflex Testing","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100038","EAP","CPT� 92568","","Acoustic Reflex Testing (bt)","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100040","EAP","CPT� 92568","","Acoustic Reflex(one)","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100044","EAP","CPT� 92570","","Acoustic Reflex Testing, Both","BOTH IP/OP","$273.00 ","$202.02 ","$0.00 ","$276.00 ","$148.24 ","$136.73 ","$56.90 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$23.55 ","$0.00 ","$0.00 ","$0.00 "
"47100045","EAP","CPT� 92570","","Acoustic Reflex Testing, One","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$149.87 ","$136.73 ","$57.53 ","$196.98 ","$196.98 ","$0.00 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$23.55 ","$0.00 ","$0.00 ","$0.00 "
"47100049","EAP","CPT� 92577","","Stenger Test, Speech","BOTH IP/OP","$495.00 ","$366.30 ","$14.05 ","$500.00 ","$268.79 ","$478.04 ","$103.17 ","$356.85 ","$356.85 ","$87.55 ","$500.00 ","$487.04 ","$250.00 ","$396.00 ","$400.00 ","$500.00 ","$28.15 ","$14.05 ","$79.60 ","$463.84 "
"47100052","EAP","CPT� 92579","","Visual Reinforcement Audiometr","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$234.81 ","$234.81 ","$0.00 ","$329.00 ","$0.00 ","$164.50 ","$260.57 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100053","EAP","CPT� 92582","","Conditioning Play Audiometry","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$0.00 ","$0.00 ","$0.00 ","$295.47 ","$295.47 ","$0.00 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100057","EAP","CPT� 92585","","Auditory Brainstern Response","BOTH IP/OP","$727.00 ","$537.98 ","$0.00 ","$727.00 ","$0.00 ","$0.00 ","$0.00 ","$518.86 ","$518.86 ","$0.00 ","$727.00 ","$0.00 ","$363.50 ","$575.78 ","$581.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100059","EAP","CPT� 92585","","Auditory Evok Potent, Compre","BOTH IP/OP","$727.00 ","$537.98 ","$0.00 ","$727.00 ","$0.00 ","$0.00 ","$0.00 ","$518.86 ","$518.86 ","$0.00 ","$727.00 ","$0.00 ","$363.50 ","$575.78 ","$581.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100061","EAP","CPT� 92587","","Evoke Otoacoustic Emission Ltd","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100064","EAP","CPT� 92588","","Evoke Otoacoustic Dx/compre","BOTH IP/OP","$442.00 ","$327.08 ","$0.00 ","$445.00 ","$0.00 ","$0.00 ","$0.00 ","$317.60 ","$317.60 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$40.93 ","$0.00 ","$0.00 ","$0.00 "
"47100066","EAP","CPT� 92567","","Tympanometry, Monoaural","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$33.35 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$33.53 ","$80.00 ","$126.72 ","$128.00 ","$46.58 ","$20.66 ","$11.18 ","$25.47 ","$31.93 "
"47100067","EAP","CPT� 92590","","Hearing Aid Eval 75 Min","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$291.00 ","$156.38 ","$56.60 ","$60.03 ","$207.69 ","$207.69 ","$50.95 ","$291.00 ","$0.00 ","$145.50 ","$230.47 ","$232.80 ","$174.60 ","$45.54 ","$0.00 ","$46.33 ","$0.00 "
"47100072","EAP","CPT� 92594","","Electroacoustic Eval Monaural","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$85.79 ","$21.19 ","$0.00 ","$112.76 ","$112.76 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100073","EAP","CPT� 92596","","Ear Protector Attenuation Meas","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$174.86 ","$174.86 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100086","EAP","CPT� 92551","","Hearing Test, Diagnostic","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$89.60 ","$11.81 ","$34.39 ","$117.76 ","$117.76 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$99.00 ","$9.01 ","$0.00 ","$26.27 ","$0.00 "
"47100088","EAP","CPT� 95885","","Ncs/emg <=4 Limb","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$236.00 ","$130.32 ","$0.00 ","$50.02 ","$168.43 ","$168.43 ","$41.32 ","$236.00 ","$0.00 ","$118.00 ","$186.91 ","$188.80 ","$0.00 ","$53.47 ","$44.66 ","$37.57 ","$0.00 "
"47100089","EAP","CPT� 95886","","Ncs/emg 5+limb","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$236.00 ","$130.32 ","$0.00 ","$50.02 ","$168.43 ","$168.43 ","$41.32 ","$236.00 ","$0.00 ","$118.00 ","$186.91 ","$188.80 ","$0.00 ","$83.61 ","$51.87 ","$37.57 ","$0.00 "
"47100098","EAP","CPT� 95887","","Muscl Test W/n Test Non-extr","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$125.00 ","$68.96 ","$0.00 ","$26.47 ","$89.21 ","$89.21 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100099","EAP","CPT� 95938","","Somatosensory Testing","BOTH IP/OP","$556.00 ","$411.44 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$410.38 ","$410.38 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100110","EAP","CPT� 92547","","Vertical Electrodes","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100132","EAP","CPT� 92537","","Caloric Vstblar Test W/rec,bilat","BOTH IP/OP","$1,168.00 ","$864.32 ","$10.08 ","$1,180.00 ","$634.22 ","$136.73 ","$243.44 ","$842.17 ","$842.17 ","$206.61 ","$1,180.00 ","$138.76 ","$590.00 ","$934.56 ","$944.00 ","$192.78 ","$38.69 ","$10.08 ","$187.86 ","$132.15 "
"47100133","EAP","CPT� 92538","","Caloric Vstblar Test W/rec,bilat;monothermal","BOTH IP/OP","$1,168.00 ","$864.32 ","$6.48 ","$1,180.00 ","$634.22 ","$136.73 ","$243.44 ","$842.17 ","$842.17 ","$206.61 ","$1,180.00 ","$138.76 ","$590.00 ","$934.56 ","$944.00 ","$192.78 ","$19.67 ","$6.48 ","$187.86 ","$132.15 "
"47100134","EAP","CPT� 92567","","Tympanometry, Monaural","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$33.35 ","$114.19 ","$114.19 ","$28.01 ","$160.00 ","$33.53 ","$80.00 ","$126.72 ","$128.00 ","$46.58 ","$20.66 ","$11.18 ","$25.47 ","$31.93 "
"47100135","EAP","CPT� 92602","","Reprogram Cochlear Implt <7","BOTH IP/OP","$676.00 ","$500.24 ","$0.00 ","$676.00 ","$0.00 ","$0.00 ","$0.00 ","$482.46 ","$482.46 ","$0.00 ","$676.00 ","$0.00 ","$338.00 ","$535.39 ","$540.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100137","EAP","","","Gll Fitting Visit","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$215.00 ","$0.00 ","$0.00 ","$0.00 ","$153.45 ","$153.45 ","$0.00 ","$215.00 ","$0.00 ","$107.50 ","$170.28 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47100138","EAP","","","Gll Visit - Post 4th Visit","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$17.84 ","$17.84 ","$0.00 ","$25.00 ","$0.00 ","$12.50 ","$19.80 ","$20.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47200002","EAP","CPT� 92603","","Cochlear Implt Exam 7 > Yrs","BOTH IP/OP","$267.00 ","$197.58 ","$42.98 ","$270.00 ","$144.98 ","$136.73 ","$55.65 ","$192.70 ","$192.70 ","$47.27 ","$270.00 ","$138.76 ","$135.00 ","$213.84 ","$216.00 ","$192.78 ","$88.28 ","$125.50 ","$42.98 ","$132.15 "
"47200003","EAP","CPT� 92604","","Reprogram Codhlear Implt 7 > Yrs","BOTH IP/OP","$631.00 ","$466.94 ","$0.00 ","$637.00 ","$342.63 ","$136.73 ","$131.52 ","$454.63 ","$454.63 ","$0.00 ","$637.00 ","$0.00 ","$318.50 ","$504.50 ","$509.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47200010","EAP","HCPCS C1887","","Maxc Catheter Reperfusion 4max","BOTH IP/OP","$4,108.00 ","$3,039.92 ","$0.00 ","$4,108.00 ","$2,230.64 ","$0.00 ","$856.21 ","$2,931.88 ","$2,931.88 ","$719.28 ","$4,108.00 ","$0.00 ","$2,054.00 ","$3,253.54 ","$3,286.40 ","$0.00 ","$642.90 ","$0.00 ","$653.99 ","$0.00 "
"47200011","EAP","HCPCS C1757","","Psc041 Catheter Thrmb 141cm 4.1fr .041in Reperfusion","BOTH IP/OP","$3,813.00 ","$2,821.62 ","$0.00 ","$3,813.00 ","$2,070.46 ","$0.00 ","$794.72 ","$2,721.34 ","$2,721.34 ","$0.00 ","$3,813.00 ","$0.00 ","$1,906.50 ","$3,019.90 ","$3,050.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47900001","EAP","CPT� 92586","","Hearing Screening (aabr)","BOTH IP/OP","$439.00 ","$324.86 ","$0.00 ","$439.00 ","$0.00 ","$0.00 ","$0.00 ","$313.31 ","$313.31 ","$0.00 ","$439.00 ","$0.00 ","$219.50 ","$347.69 ","$351.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47900003","EAP","CPT� 92587","","Hearing Screening (oae)","BOTH IP/OP","$431.00 ","$318.94 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$309.75 ","$309.75 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000001","EAP","CPT� 33967","","Perc Insertion Intraaortic Bal","BOTH IP/OP","$5,482.00 ","$4,056.68 ","$0.00 ","$4,891.00 ","$0.00 ","$0.00 ","$0.00 ","$3,490.71 ","$3,490.71 ","$0.00 ","$4,891.00 ","$0.00 ","$2,255.00 ","$3,873.67 ","$3,912.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000002","EAP","CPT� 92950","","Cardio Res - Cpr","BOTH IP/OP","$2,336.00 ","$1,728.64 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.61 ","$1,516.61 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000003","EAP","CPT� 92953","","Temp Transcut Pacing","BOTH IP/OP","$2,474.00 ","$1,830.76 ","$0.00 ","$2,499.00 ","$0.00 ","$0.00 ","$0.00 ","$1,783.54 ","$1,783.54 ","$0.00 ","$2,499.00 ","$0.00 ","$1,249.50 ","$1,979.21 ","$1,999.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000004","EAP","CPT� 92960","","Cardioversion","BOTH IP/OP","$2,742.00 ","$2,029.08 ","$112.51 ","$2,165.00 ","$1,488.91 ","$550.15 ","$571.50 ","$1,545.16 ","$1,545.16 ","$379.07 ","$2,165.00 ","$538.04 ","$1,082.50 ","$1,714.68 ","$1,732.00 ","$747.53 ","$154.62 ","$112.51 ","$344.67 ","$512.42 "
"48000005","EAP","CPT� 92971","","Circulatory Assist - External","BOTH IP/OP","$1,227.00 ","$907.98 ","$0.00 ","$1,227.00 ","$0.00 ","$0.00 ","$0.00 ","$875.71 ","$875.71 ","$0.00 ","$1,227.00 ","$0.00 ","$613.50 ","$971.78 ","$981.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000011","EAP","CPT� 92986","","Perc Balloon Vplasty, Aortic","BOTH IP/OP","$20,704.00 ","$15,320.96 ","$0.00 ","$20,704.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$20,704.00 ","$0.00 ","$2,255.00 ","$16,397.57 ","$16,563.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000012","EAP","CPT� 92987","","Perc Balloon Vplasty, Mitral","BOTH IP/OP","$20,704.00 ","$15,320.96 ","$0.00 ","$20,704.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$20,704.00 ","$0.00 ","$2,255.00 ","$16,397.57 ","$16,563.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000013","EAP","CPT� 92990","","Perc Balloon Vplasty, Pulm","BOTH IP/OP","$20,704.00 ","$15,320.96 ","$0.00 ","$20,704.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$20,704.00 ","$0.00 ","$2,255.00 ","$16,397.57 ","$16,563.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000014","EAP","CPT� 93282","","Single Lead Icd Programming / Evaluation In Person","BOTH IP/OP","$328.00 ","$242.72 ","$30.97 ","$264.00 ","$140.08 ","$36.47 ","$68.36 ","$188.42 ","$188.42 ","$46.22 ","$264.00 ","$36.36 ","$132.00 ","$209.09 ","$211.20 ","$50.51 ","$68.00 ","$30.97 ","$42.03 ","$34.63 "
"48000015","EAP","CPT� 93283","","Dual Lead Icd Program/ Eval In Person","BOTH IP/OP","$328.00 ","$242.72 ","$33.86 ","$264.00 ","$180.76 ","$36.47 ","$68.36 ","$188.42 ","$188.42 ","$46.22 ","$264.00 ","$36.36 ","$132.00 ","$209.09 ","$211.20 ","$50.51 ","$82.80 ","$33.86 ","$42.03 ","$34.63 "
"48000016","EAP","CPT� 93285","","Sq-cardiac Rhythm Monitor / Loop Recorder  Program / Eval In Person","BOTH IP/OP","$204.00 ","$150.96 ","$26.11 ","$164.00 ","$93.14 ","$36.47 ","$42.52 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$36.36 ","$82.00 ","$129.89 ","$131.20 ","$50.51 ","$45.96 ","$27.73 ","$26.11 ","$34.63 "
"48000017","EAP","CPT� 93289","","Pacemaker Interrog / Eval In Person","BOTH IP/OP","$328.00 ","$242.72 ","$28.81 ","$264.00 ","$145.54 ","$36.47 ","$68.36 ","$188.42 ","$188.42 ","$46.22 ","$264.00 ","$36.36 ","$132.00 ","$209.09 ","$211.20 ","$50.51 ","$63.29 ","$28.81 ","$42.03 ","$34.63 "
"48000019","EAP","CPT� 93307","","2d Echo","BOTH IP/OP","$3,555.00 ","$2,630.70 ","$0.00 ","$3,621.00 ","$0.00 ","$0.00 ","$0.00 ","$304.53 ","$304.53 ","$0.00 ","$3,621.00 ","$0.00 ","$1,810.50 ","$2,867.83 ","$2,896.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000020","EAP","CPT� 93312","","Transesophageal Echo","BOTH IP/OP","$4,858.00 ","$3,594.92 ","$138.31 ","$4,353.00 ","$544.66 ","$473.20 ","$1,012.53 ","$502.59 ","$502.59 ","$762.18 ","$4,353.00 ","$483.00 ","$2,176.50 ","$3,447.58 ","$3,482.40 ","$671.06 ","$268.29 ","$138.31 ","$693.00 ","$460.00 "
"48000021","EAP","CPT� 93320","","Echo Doppler Complete","BOTH IP/OP","$2,768.00 ","$2,048.32 ","$0.00 ","$2,480.00 ","$119.72 ","$0.00 ","$576.92 ","$137.78 ","$137.78 ","$434.23 ","$2,480.00 ","$0.00 ","$1,240.00 ","$1,964.16 ","$1,984.00 ","$0.00 ","$90.75 ","$35.66 ","$394.82 ","$0.00 "
"48000022","EAP","CPT� 93325","","Color Flow Mapping","BOTH IP/OP","$1,693.00 ","$1,252.82 ","$0.00 ","$1,669.00 ","$56.34 ","$0.00 ","$352.86 ","$118.09 ","$118.09 ","$292.23 ","$1,669.00 ","$0.00 ","$834.50 ","$1,321.85 ","$1,335.20 ","$0.00 ","$116.25 ","$21.97 ","$265.70 ","$0.00 "
"48000023","EAP","CPT� 93350","","Transthoracic Echo","BOTH IP/OP","$3,694.00 ","$2,733.56 ","$0.00 ","$3,694.00 ","$0.00 ","$0.00 ","$781.18 ","$315.67 ","$315.67 ","$646.79 ","$3,694.00 ","$483.00 ","$1,847.00 ","$2,925.65 ","$2,955.20 ","$671.06 ","$118.63 ","$120.30 ","$588.08 ","$460.00 "
"48000024","EAP","CPT� 93503","","Insertion Swan Ganz","BOTH IP/OP","$8,527.00 ","$6,309.98 ","$0.00 ","$8,613.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,613.00 ","$0.00 ","$2,255.00 ","$6,821.50 ","$6,890.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000025","EAP","CPT� 93580","","Perc Closure Atrial Septal Def","BOTH IP/OP","$19,473.00 ","$14,410.02 ","$0.00 ","$18,649.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,649.00 ","$0.00 ","$6,105.00 ","$14,770.01 ","$14,919.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000026","EAP","CPT� 33222","","Relocation Skin  Pkt For Pacemaker","BOTH IP/OP","$27,668.00 ","$20,474.32 ","$0.00 ","$27,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,133.00 ","$0.00 ","$2,327.00 ","$21,489.34 ","$21,706.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000027","EAP","CPT� 93640","","Ep Eval Icd Leads Init Implant","BOTH IP/OP","$5,142.00 ","$3,805.08 ","$0.00 ","$5,142.00 ","$0.00 ","$0.00 ","$0.00 ","$3,669.85 ","$3,669.85 ","$0.00 ","$5,142.00 ","$0.00 ","$2,571.00 ","$4,072.46 ","$4,113.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000028","EAP","CPT� 93641","","Test Icd Gen Initial Implant","BOTH IP/OP","$5,361.00 ","$3,967.14 ","$0.00 ","$5,361.00 ","$5,361.00 ","$0.00 ","$1,117.37 ","$3,537.81 ","$3,537.81 ","$0.00 ","$4,957.00 ","$0.00 ","$2,478.50 ","$3,925.94 ","$3,965.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000029","EAP","CPT� 93642","","Ep Eval Icd Gen & Programming","BOTH IP/OP","$5,562.00 ","$4,115.88 ","$0.00 ","$5,562.00 ","$5,562.00 ","$1,090.77 ","$0.00 ","$3,669.85 ","$3,669.85 ","$900.32 ","$5,142.00 ","$990.46 ","$2,571.00 ","$4,072.46 ","$4,113.60 ","$1,376.12 ","$590.04 ","$83.20 ","$818.61 ","$943.30 "
"48000030","EAP","CPT� 93660","","Tilt Table Evaluation","BOTH IP/OP","$1,423.00 ","$1,053.02 ","$0.00 ","$1,437.00 ","$772.69 ","$0.00 ","$296.59 ","$1,025.59 ","$1,025.59 ","$0.00 ","$1,437.00 ","$0.00 ","$718.50 ","$1,138.10 ","$1,149.60 ","$0.00 ","$173.19 ","$0.00 ","$0.00 ","$0.00 "
"48000040","EAP","CPT� 93788","","Ambulatory Bp Analysis","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$212.00 ","$0.00 ","$0.00 ","$0.00 ","$151.30 ","$151.30 ","$0.00 ","$212.00 ","$0.00 ","$106.00 ","$167.90 ","$169.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000045","EAP","CPT� 93458","","Lt Heart Cath Including V Gram","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$786.98 ","$18,092.00 ","$10,292.10 ","$2,839.80 ","$4,601.61 ","$5,345.48 ","$5,345.48 ","$3,167.76 ","$18,092.00 ","$2,858.33 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$3,971.26 ","$1,000.10 ","$786.98 ","$2,880.25 ","$2,722.22 "
"48000046","EAP","CPT� 93459","","Lhc W/ V Gram And Grafts","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$842.80 ","$18,092.00 ","$10,292.10 ","$2,839.80 ","$4,601.61 ","$5,345.48 ","$5,345.48 ","$3,167.76 ","$18,092.00 ","$2,858.33 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$3,971.26 ","$1,104.45 ","$842.80 ","$2,880.25 ","$2,722.22 "
"48000047","EAP","CPT� 93460","","R&lhc W/v Gram","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$10,292.10 ","$2,839.80 ","$4,601.61 ","$0.00 ","$0.00 ","$0.00 ","$18,092.00 ","$0.00 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000048","EAP","CPT� 93461","","R&lhc W/v Gram And Grafts","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,092.00 ","$0.00 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$0.00 ","$1,354.33 ","$0.00 ","$0.00 ","$0.00 "
"48000050","EAP","CPT� 33235","","Removal Pacemaker Electrodes","BOTH IP/OP","$9,098.00 ","$6,732.52 ","$0.00 ","$10,017.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,017.00 ","$0.00 ","$2,255.00 ","$7,933.46 ","$8,013.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000053","EAP","CPT� 94621","","Pulm Exer Stress Test; Complex","BOTH IP/OP","$1,097.00 ","$811.78 ","$0.00 ","$1,097.00 ","$0.00 ","$0.00 ","$0.00 ","$782.93 ","$782.93 ","$0.00 ","$1,097.00 ","$0.00 ","$548.50 ","$868.82 ","$877.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000054","EAP","Custom 48000054","","Cpet Patient Interface Kit","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$302.61 ","$302.61 ","$0.00 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000055","EAP","Custom 48000055","","Analyze/ind/term Tachycardia","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$181.28 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000057","EAP","CPT� 92920","","Prq Cardiac Angioplast 1 Art","BOTH IP/OP","$17,577.00 ","$13,006.98 ","$0.00 ","$17,039.00 ","$9,544.31 ","$4,853.85 ","$3,663.49 ","$5,158.80 ","$5,158.80 ","$0.00 ","$17,039.00 ","$0.00 ","$4,975.00 ","$13,494.89 ","$13,631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000058","EAP","CPT� 92921","","Prq Cardiac Angio Addl Art","BOTH IP/OP","$28,094.00 ","$20,789.56 ","$0.00 ","$27,233.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$4,768.28 ","$27,233.00 ","$0.00 ","$13,616.50 ","$21,568.54 ","$21,786.40 ","$0.00 ","$4,261.96 ","$0.00 ","$0.00 ","$0.00 "
"48000059","EAP","CPT� 92928","","Prq Card Stent W/angio 1 Vsl","BOTH IP/OP","$32,293.00 ","$23,896.82 ","$0.00 ","$31,304.00 ","$17,535.10 ","$9,836.87 ","$6,730.67 ","$5,158.80 ","$5,158.80 ","$0.00 ","$31,304.00 ","$0.00 ","$6,105.00 ","$24,792.77 ","$25,043.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000060","EAP","CPT� 92929","","Prq Card Stent W/angio Addl","BOTH IP/OP","$44,709.00 ","$33,084.66 ","$0.00 ","$43,340.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$43,340.00 ","$0.00 ","$21,670.00 ","$34,325.28 ","$34,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000061","EAP","CPT� 92937","","Prq Revasc Byp Graft 1 Vsl","BOTH IP/OP","$14,275.00 ","$10,563.50 ","$0.00 ","$13,838.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,838.00 ","$0.00 ","$6,105.00 ","$10,959.70 ","$11,070.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000062","EAP","CPT� 92938","","Prq Revasc Byp Graft Addl","BOTH IP/OP","$12,738.00 ","$9,426.12 ","$0.00 ","$12,348.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,348.00 ","$0.00 ","$6,174.00 ","$9,779.62 ","$9,878.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000063","EAP","CPT� 92941","","Prq Card Revasc Mi 1 Vsl","BOTH IP/OP","$39,045.00 ","$28,893.30 ","$0.00 ","$37,849.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$37,849.00 ","$0.00 ","$18,924.50 ","$29,976.41 ","$30,279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000064","EAP","CPT� 92943","","Prq Card Revasc Chronic 1vsl","BOTH IP/OP","$29,217.00 ","$21,620.58 ","$0.00 ","$28,322.00 ","$0.00 ","$0.00 ","$6,089.55 ","$5,158.80 ","$5,158.80 ","$0.00 ","$28,322.00 ","$0.00 ","$6,105.00 ","$22,431.02 ","$22,657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000065","EAP","CPT� 92944","","Prq Card Revasc Chronic Addl","BOTH IP/OP","$20,209.00 ","$14,954.66 ","$0.00 ","$19,590.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,590.00 ","$0.00 ","$9,795.00 ","$15,515.28 ","$15,672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000066","EAP","CPT� 33223","","Relocation Skin  Pkt Cardiovert-defib","BOTH IP/OP","$5,494.00 ","$4,065.56 ","$0.00 ","$6,049.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,049.00 ","$0.00 ","$2,327.00 ","$4,790.81 ","$4,839.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000067","EAP","CPT� 93261","","S-icd Interrog / Eval In Person","BOTH IP/OP","$208.00 ","$153.92 ","$26.59 ","$167.00 ","$132.26 ","$36.47 ","$43.35 ","$119.19 ","$119.19 ","$29.24 ","$167.00 ","$36.36 ","$83.50 ","$132.26 ","$133.60 ","$50.51 ","$58.66 ","$29.17 ","$26.59 ","$34.63 "
"48000070","EAP","CPT� 92933","","Prq Trluml Coronary Angio/athe","BOTH IP/OP","$20,912.00 ","$15,474.88 ","$0.00 ","$20,271.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$20,271.00 ","$0.00 ","$6,105.00 ","$16,054.63 ","$16,216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000071","EAP","CPT� 33999","","Insertion Of Impella Device - Rp","BOTH IP/OP","$13,372.00 ","$9,895.28 ","$0.00 ","$13,507.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,507.00 ","$0.00 ","$2,255.00 ","$10,697.54 ","$10,805.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000072","EAP","CPT� 93621","","Comp Ep Exam W/lt Atrial Pacing/record","BOTH IP/OP","$12,625.00 ","$9,342.50 ","$0.00 ","$11,071.00 ","$0.00 ","$0.00 ","$2,307.47 ","$5,158.80 ","$5,158.80 ","$1,938.44 ","$11,071.00 ","$0.00 ","$5,535.50 ","$8,768.23 ","$8,856.80 ","$0.00 ","$1,732.61 ","$0.00 ","$1,762.50 ","$0.00 "
"48000110","EAP","CPT� 93297","","Icm Interrog / Eval Remote Up To 30 Days","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$189.84 ","$189.84 ","$0.00 ","$266.00 ","$0.00 ","$133.00 ","$210.67 ","$212.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48000111","EAP","CPT� 93298","","S-icd/loop Recorder Interrog / Eval Remote Up To 30 Days","BOTH IP/OP","$204.00 ","$150.96 ","$28.13 ","$266.00 ","$59.48 ","$36.47 ","$42.52 ","$189.84 ","$189.84 ","$46.57 ","$266.00 ","$36.36 ","$133.00 ","$210.67 ","$212.80 ","$28.13 ","$28.19 ","$28.13 ","$42.35 ","$34.63 "
"48100001","EAP","CPT� 33240","","Insrt Icd Pulse Gen W Sngl Lead","BOTH IP/OP","$29,623.00 ","$21,921.02 ","$0.00 ","$29,050.00 ","$0.00 ","$0.00 ","$0.00 ","$2,108.20 ","$2,108.20 ","$5,086.42 ","$29,050.00 ","$22,779.64 ","$6,105.00 ","$23,007.60 ","$23,240.00 ","$29,050.00 ","$517.77 ","$381.75 ","$4,624.76 ","$21,694.90 "
"48100003","EAP","CPT� 33249","","Insrt/repl Sgl/dual Icd Ld/gen","BOTH IP/OP","$39,613.00 ","$29,313.62 ","$0.00 ","$39,613.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$6,935.92 ","$39,613.00 ","$32,377.52 ","$6,105.00 ","$31,373.50 ","$31,690.40 ","$39,613.00 ","$1,016.82 ","$959.62 ","$6,306.39 ","$30,835.73 "
"48100004","EAP","CPT� 92973","","Perc Coronary Thrombectomy","BOTH IP/OP","$9,050.00 ","$6,697.00 ","$0.00 ","$8,673.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,673.00 ","$0.00 ","$4,336.50 ","$6,869.02 ","$6,938.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100006","EAP","CPT� 93505","","Endomyocardial Biopsy","BOTH IP/OP","$3,290.00 ","$2,434.60 ","$0.00 ","$3,323.00 ","$3,290.00 ","$2,803.47 ","$685.72 ","$2,371.63 ","$2,371.63 ","$581.83 ","$3,323.00 ","$0.00 ","$2,255.00 ","$2,631.82 ","$2,658.40 ","$0.00 ","$339.35 ","$0.00 ","$0.00 ","$0.00 "
"48100020","EAP","CPT� 93561","","Therm Dilu Stdy Cardoutput Se","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$246.00 ","$0.00 ","$0.00 ","$0.00 ","$175.57 ","$175.57 ","$0.00 ","$246.00 ","$0.00 ","$246.00 ","$194.83 ","$196.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100021","EAP","CPT� 93562","","Measure Card Output","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$83.00 ","$0.00 ","$0.00 ","$0.00 ","$59.24 ","$59.24 ","$0.00 ","$83.00 ","$0.00 ","$83.00 ","$65.74 ","$66.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100022","EAP","CPT� 93571","","Intravasc Cornary Flow Measure","BOTH IP/OP","$5,647.00 ","$4,178.78 ","$0.00 ","$5,408.00 ","$3,066.32 ","$0.00 ","$1,176.98 ","$3,859.69 ","$3,859.69 ","$946.90 ","$5,408.00 ","$0.00 ","$2,704.00 ","$4,283.14 ","$4,326.40 ","$0.00 ","$261.34 ","$0.00 ","$860.95 ","$0.00 "
"48100023","EAP","CPT� 93572","","Intravasc Cor. Flow Addit Vess","BOTH IP/OP","$5,581.00 ","$4,129.94 ","$0.00 ","$5,344.00 ","$3,030.48 ","$0.00 ","$1,163.22 ","$3,814.01 ","$3,814.01 ","$935.69 ","$5,344.00 ","$0.00 ","$2,672.00 ","$4,232.45 ","$4,275.20 ","$0.00 ","$239.81 ","$0.00 ","$850.76 ","$0.00 "
"48100026","EAP","CPT� 33270","","Insert Subcutaneous Aicd","BOTH IP/OP","$129,402.00 ","$95,757.48 ","$574.64 ","$126,900.00 ","$2,984.10 ","$32,168.25 ","$9,417.94 ","$5,158.80 ","$5,158.80 ","$8,138.89 ","$126,900.00 ","$32,377.52 ","$6,105.00 ","$100,504.80 ","$101,520.00 ","$44,984.24 ","$574.64 ","$592.28 ","$8,138.89 ","$30,835.73 "
"48100029","EAP","CPT� 93462","","Left Heart Cath By Transeptal Puncture","BOTH IP/OP","$12,155.00 ","$8,994.70 ","$0.00 ","$9,960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,960.00 ","$0.00 ","$4,980.00 ","$7,888.32 ","$7,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100030","EAP","CPT� 93451","","Right Heart Cath","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$10,292.10 ","$2,839.80 ","$0.00 ","$5,345.48 ","$5,345.48 ","$3,167.76 ","$18,092.00 ","$2,858.33 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$3,971.26 ","$725.02 ","$725.39 ","$2,880.25 ","$2,722.22 "
"48100031","EAP","CPT� 93452","","Lhc W/v Gram","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$0.00 ","$0.00 ","$0.00 ","$5,345.48 ","$5,345.48 ","$3,167.76 ","$18,092.00 ","$2,858.33 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$3,971.26 ","$803.53 ","$686.49 ","$2,880.25 ","$2,722.22 "
"48100032","EAP","CPT� 93453","","R/lhc W/v Gram (s&i)","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,092.00 ","$0.00 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100033","EAP","CPT� 93454","","Coronary Angio W/o Lhc","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$685.77 ","$18,092.00 ","$10,292.10 ","$2,839.80 ","$4,601.61 ","$5,345.48 ","$5,345.48 ","$3,167.76 ","$18,092.00 ","$2,858.33 ","$2,255.00 ","$14,328.86 ","$14,473.60 ","$3,971.26 ","$828.78 ","$685.77 ","$2,880.25 ","$2,722.22 "
"48100034","EAP","CPT� 93455","","Coronary Angio W/o Lhc W/graft Inj","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$10,292.10 ","$2,839.80 ","$4,601.61 ","$0.00 ","$0.00 ","$0.00 ","$18,092.00 ","$0.00 ","$2,255.00 ","$14,328.86 ","$14,473.60 ","$0.00 ","$967.05 ","$0.00 ","$0.00 ","$0.00 "
"48100035","EAP","CPT� 93456","","Rhc/coronary Angio W/o Lhc","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,092.00 ","$0.00 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100036","EAP","CPT� 93457","","Rhc/coronary Angio W/o Lhc W/graft Inj","BOTH IP/OP","$22,078.00 ","$16,337.72 ","$0.00 ","$18,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,092.00 ","$0.00 ","$2,858.00 ","$14,328.86 ","$14,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100037","EAP","CPT� 33991","","Insert Vad Art&vein Access","BOTH IP/OP","$31,345.00 ","$23,195.30 ","$0.00 ","$34,511.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$34,511.00 ","$0.00 ","$17,255.50 ","$27,332.71 ","$27,608.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100040","EAP","CPT� 93567","","Inj. Supravalvular Aortography","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100042","EAP","HCPCS G0278","","Iliac/fem Angio W/cardiac Cath","BOTH IP/OP","$2,706.00 ","$2,002.44 ","$0.00 ","$2,733.00 ","$0.00 ","$0.00 ","$0.00 ","$1,950.54 ","$1,950.54 ","$0.00 ","$2,733.00 ","$0.00 ","$1,366.50 ","$2,164.54 ","$2,186.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100050","EAP","CPT� 33227","","Remove/repl Pcmkr W Sngl Ld","BOTH IP/OP","$39,256.00 ","$29,049.44 ","$0.00 ","$39,256.00 ","$0.00 ","$0.00 ","$7,431.39 ","$5,158.80 ","$5,158.80 ","$0.00 ","$39,256.00 ","$0.00 ","$6,105.00 ","$31,090.75 ","$31,404.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100051","EAP","CPT� 33229","","Remove/replac Pcmkr W Dual Ld","BOTH IP/OP","$43,902.00 ","$32,487.48 ","$0.00 ","$43,053.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$43,053.00 ","$0.00 ","$6,105.00 ","$34,097.98 ","$34,442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100052","EAP","CPT� 33229","","Remove/replac Pcmkr W Multi Ld","BOTH IP/OP","$43,053.00 ","$31,859.22 ","$0.00 ","$43,053.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$43,053.00 ","$0.00 ","$6,105.00 ","$34,097.98 ","$34,442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100053","EAP","CPT� 33230","","Insrt Icd W Exist Dual Lds","BOTH IP/OP","$77,559.00 ","$57,393.66 ","$0.00 ","$85,392.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$85,392.00 ","$0.00 ","$6,105.00 ","$67,630.46 ","$68,313.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100054","EAP","CPT� 33231","","Insrt Icd W Exist Multi Lds","BOTH IP/OP","$77,559.00 ","$57,393.66 ","$0.00 ","$85,392.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$85,392.00 ","$0.00 ","$6,105.00 ","$67,630.46 ","$68,313.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100055","EAP","CPT� 33262","","Remove/repl Icd W Sngl Ld","BOTH IP/OP","$87,076.00 ","$64,436.24 ","$351.54 ","$85,392.00 ","$2,984.10 ","$22,582.91 ","$9,417.94 ","$5,158.80 ","$5,158.80 ","$8,138.89 ","$85,392.00 ","$22,779.64 ","$6,105.00 ","$67,630.46 ","$68,313.60 ","$31,649.28 ","$351.54 ","$390.40 ","$8,138.89 ","$21,694.90 "
"48100056","EAP","CPT� 33263","","Remove/repl Icd W Dual Lds","BOTH IP/OP","$87,076.00 ","$64,436.24 ","$0.00 ","$85,392.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$8,138.89 ","$85,392.00 ","$22,779.64 ","$6,105.00 ","$67,630.46 ","$68,313.60 ","$31,649.28 ","$365.37 ","$405.90 ","$8,138.89 ","$21,694.90 "
"48100057","EAP","CPT� 33264","","Remove/repl Icd W Multi Lds","BOTH IP/OP","$87,076.00 ","$64,436.24 ","$0.00 ","$85,392.00 ","$2,984.10 ","$32,168.25 ","$9,417.94 ","$5,158.80 ","$5,158.80 ","$0.00 ","$85,392.00 ","$32,377.52 ","$6,105.00 ","$67,630.46 ","$68,313.60 ","$44,984.24 ","$0.00 ","$424.28 ","$8,138.89 ","$30,835.73 "
"48100058","EAP","CPT� 33221","","Insrt Pcmkr Gen Only Exist Multi","BOTH IP/OP","$39,104.00 ","$28,936.96 ","$0.00 ","$43,053.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$43,053.00 ","$0.00 ","$6,105.00 ","$34,097.98 ","$34,442.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100059","EAP","CPT� 33228","","Remv & Replc Pm Gen Dual Lead","BOTH IP/OP","$42,575.00 ","$31,505.50 ","$0.00 ","$41,752.00 ","$2,984.10 ","$10,182.87 ","$8,873.69 ","$5,158.80 ","$5,158.80 ","$7,310.44 ","$41,752.00 ","$10,282.07 ","$6,105.00 ","$33,067.58 ","$33,401.60 ","$14,285.57 ","$0.00 ","$370.57 ","$6,646.92 ","$9,792.45 "
"48100060","EAP","CPT� 93600","","Bundle Of Hils Recording","BOTH IP/OP","$5,320.00 ","$3,936.80 ","$0.00 ","$5,320.00 ","$0.00 ","$0.00 ","$0.00 ","$3,796.88 ","$3,796.88 ","$0.00 ","$5,320.00 ","$0.00 ","$2,660.00 ","$4,213.44 ","$4,256.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100061","EAP","CPT� 93602","","Intra-atrial Recording","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100062","EAP","CPT� 93603","","Right Ventricular Recording","BOTH IP/OP","$9,546.00 ","$7,064.04 ","$0.00 ","$9,546.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,546.00 ","$0.00 ","$4,773.00 ","$7,560.43 ","$7,636.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100063","EAP","CPT� 93610","","Intra-atrial Pacing","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100064","EAP","CPT� 93612","","Intra-ventricular Pacing","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,282.20 ","$4,282.20 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100065","EAP","CPT� 93618","","Induction Of Arrythmia By Electrial Pacing","BOTH IP/OP","$4,835.00 ","$3,577.90 ","$0.00 ","$4,835.00 ","$0.00 ","$0.00 ","$0.00 ","$3,450.74 ","$3,450.74 ","$0.00 ","$4,835.00 ","$0.00 ","$2,417.50 ","$3,829.32 ","$3,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100066","EAP","CPT� 93624","","Follow-up Ep Study W/pacing & Recording","BOTH IP/OP","$10,198.00 ","$7,546.52 ","$0.00 ","$10,198.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,198.00 ","$0.00 ","$5,099.00 ","$8,076.82 ","$8,158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100067","EAP","CPT� 93619","","Complete Eps W/oinduction Of Arrhythmia","BOTH IP/OP","$14,885.00 ","$11,014.90 ","$0.00 ","$13,999.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,999.00 ","$0.00 ","$6,999.50 ","$11,087.21 ","$11,199.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100068","EAP","CPT� 93620","","Complete Eps With Induction Arrhythmia","BOTH IP/OP","$16,933.00 ","$12,530.42 ","$0.00 ","$15,925.00 ","$5,693.10 ","$5,952.70 ","$3,529.26 ","$5,158.80 ","$5,158.80 ","$2,788.34 ","$15,925.00 ","$5,903.01 ","$7,962.50 ","$12,612.60 ","$12,740.00 ","$8,201.44 ","$1,092.52 ","$0.00 ","$2,535.26 ","$5,621.91 "
"48100069","EAP","CPT� 93621","","Left Atrial Or Coronary Sinus Pacing & Recording","BOTH IP/OP","$13,424.00 ","$9,933.76 ","$0.00 ","$12,625.00 ","$5,693.10 ","$0.00 ","$2,797.90 ","$5,158.80 ","$5,158.80 ","$2,210.54 ","$12,625.00 ","$0.00 ","$6,312.50 ","$9,999.00 ","$10,100.00 ","$0.00 ","$1,975.81 ","$0.00 ","$2,009.90 ","$0.00 "
"48100070","EAP","CPT� 93622","","Left Ventricular Pacing & Recording","BOTH IP/OP","$12,767.00 ","$9,447.58 ","$0.00 ","$12,007.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,007.00 ","$0.00 ","$6,003.50 ","$9,509.54 ","$9,605.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100071","EAP","CPT� 93609","","Catheter Mapping Of Tachycardia","BOTH IP/OP","$7,163.00 ","$5,300.62 ","$0.00 ","$7,163.00 ","$0.00 ","$0.00 ","$0.00 ","$5,112.23 ","$5,112.23 ","$0.00 ","$7,163.00 ","$0.00 ","$3,581.50 ","$5,673.10 ","$5,730.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100072","EAP","CPT� 93613","","Electrophys Map 3d","BOTH IP/OP","$13,202.00 ","$9,769.48 ","$0.00 ","$12,002.00 ","$7,168.69 ","$0.00 ","$2,751.63 ","$5,158.80 ","$5,158.80 ","$2,101.45 ","$12,002.00 ","$0.00 ","$6,001.00 ","$9,505.58 ","$9,601.60 ","$0.00 ","$373.18 ","$311.12 ","$1,910.72 ","$0.00 "
"48100073","EAP","CPT� 93623","","Program Stimulation And Pacing After Drug Infusion","BOTH IP/OP","$7,519.00 ","$5,564.06 ","$0.00 ","$7,071.00 ","$4,082.82 ","$0.00 ","$1,567.15 ","$5,046.57 ","$5,046.57 ","$1,238.08 ","$7,071.00 ","$0.00 ","$3,535.50 ","$5,600.23 ","$5,656.80 ","$0.00 ","$223.88 ","$0.00 ","$1,125.70 ","$0.00 "
"48100074","EAP","CPT� 93650","","Av Node Ablation","BOTH IP/OP","$11,950.00 ","$8,843.00 ","$0.00 ","$11,950.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,950.00 ","$0.00 ","$5,975.00 ","$9,464.40 ","$9,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100077","EAP","CPT� 93662","","Intracardiac Echocardiography","BOTH IP/OP","$5,649.00 ","$4,180.26 ","$0.00 ","$5,062.00 ","$0.00 ","$0.00 ","$0.00 ","$3,612.75 ","$3,612.75 ","$0.00 ","$5,062.00 ","$0.00 ","$2,531.00 ","$4,009.10 ","$4,049.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100078","EAP","CPT� 93631","","Heart Pacing Mapping","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$3,625.60 ","$3,625.60 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100079","EAP","CPT� 37197","","Trans Cath Retrval Fb Inc S/i","BOTH IP/OP","$28,818.00 ","$21,325.32 ","$0.00 ","$32,988.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$32,988.00 ","$2,779.42 ","$2,858.00 ","$26,126.50 ","$26,390.40 ","$3,861.64 ","$0.00 ","$315.16 ","$5,251.69 ","$2,647.07 "
"48100080","EAP","CPT� 93653","","Comp Ep Eval Inc Arrhyth Ind Ventric Pac, His Rec,  Cath Ablat","BOTH IP/OP","$40,706.00 ","$30,122.44 ","$777.53 ","$37,635.00 ","$5,693.10 ","$21,014.85 ","$8,484.15 ","$5,158.80 ","$5,158.80 ","$6,589.59 ","$37,635.00 ","$20,495.33 ","$18,817.50 ","$29,806.92 ","$30,108.00 ","$28,475.53 ","$777.53 ","$875.69 ","$5,991.49 ","$19,519.36 "
"48100081","EAP","CPT� 93654","","Comp Ep Eval Inc Arrhyth Ind Ventric Pac, His Rec,  Cath Ablat W/tx Ve","BOTH IP/OP","$40,706.00 ","$30,122.44 ","$0.00 ","$37,635.00 ","$5,693.10 ","$21,014.85 ","$0.00 ","$5,158.80 ","$5,158.80 ","$6,589.59 ","$37,635.00 ","$20,495.33 ","$18,817.50 ","$29,806.92 ","$30,108.00 ","$28,475.53 ","$0.00 ","$1,172.76 ","$5,991.49 ","$19,519.36 "
"48100082","EAP","CPT� 93655","","Ablatae Arrhythmia - Add On","BOTH IP/OP","$37,635.00 ","$27,849.90 ","$0.00 ","$37,635.00 ","$2,321.55 ","$0.00 ","$7,844.07 ","$5,158.80 ","$5,158.80 ","$0.00 ","$37,635.00 ","$0.00 ","$18,817.50 ","$29,806.92 ","$30,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100083","EAP","CPT� 93656","","Comp Ep Eval Inc  Trans Sept Cath, Insert Elect Cath, Induct Arrhyth,","BOTH IP/OP","$40,706.00 ","$30,122.44 ","$0.00 ","$37,635.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$37,635.00 ","$0.00 ","$18,817.50 ","$29,806.92 ","$30,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100084","EAP","CPT� 93657","","Tx L/r Atrial Fib Addl","BOTH IP/OP","$40,706.00 ","$30,122.44 ","$0.00 ","$37,635.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$37,635.00 ","$0.00 ","$18,817.50 ","$29,806.92 ","$30,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100085","EAP","CPT� 93530","","Rt Hearat Cath Congenital","BOTH IP/OP","$20,015.00 ","$14,811.10 ","$0.00 ","$20,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,015.00 ","$0.00 ","$2,255.00 ","$15,851.88 ","$16,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100086","EAP","CPT� 93463","","MED ADMIN & HEMODYNAMIC MEASURMENT (W/NITRIC OXIDE)","BOTH IP/OP","$3,396.00 ","$2,513.04 ","$0.00 ","$3,205.00 ","$1,844.03 ","$0.00 ","$0.00 ","$3,205.00 ","$3,205.00 ","$561.17 ","$3,205.00 ","$0.00 ","$1,602.50 ","$2,538.36 ","$2,564.00 ","$0.00 ","$101.49 ","$101.70 ","$510.24 ","$0.00 "
"48100090","EAP","CPT� 93581","","Percut Trans Cath Close Congent Ventric Sept Defect W/ T","BOTH IP/OP","$16,546.00 ","$12,244.04 ","$0.00 ","$19,260.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,260.00 ","$0.00 ","$6,105.00 ","$15,253.92 ","$15,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100091","EAP","CPT� 93582","","Percut Trans Cath Close Patent Duct Arteriosus","BOTH IP/OP","$18,778.00 ","$13,895.72 ","$0.00 ","$21,858.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,858.00 ","$0.00 ","$6,105.00 ","$17,311.54 ","$17,486.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100092","EAP","CPT� 93583","","Percut Trans Cath Septal Reduct Therpy (alcohol Sept Ab","BOTH IP/OP","$27,795.00 ","$20,568.30 ","$0.00 ","$32,354.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$32,354.00 ","$0.00 ","$16,177.00 ","$25,624.37 ","$25,883.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100095","EAP","CPT� 93566","","Inject R Ventr/atrial Angio","BOTH IP/OP","$3,057.00 ","$2,262.18 ","$0.00 ","$3,664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,664.00 ","$0.00 ","$1,832.00 ","$2,901.89 ","$2,931.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100096","EAP","CPT� 93568","","Inject Pulm Art Hrt Cath","BOTH IP/OP","$2,738.00 ","$2,026.12 ","$0.00 ","$3,281.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,281.00 ","$0.00 ","$1,640.50 ","$2,598.55 ","$2,624.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100097","EAP","CPT� 92998","","Pulmonary Artery Pta Add'l Vessel","BOTH IP/OP","$13,019.00 ","$9,634.06 ","$0.00 ","$13,019.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,019.00 ","$0.00 ","$2,255.00 ","$10,311.05 ","$10,415.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100098","EAP","CPT� 92924","","Coronary Atherectomy","BOTH IP/OP","$25,780.00 ","$19,077.20 ","$0.00 ","$24,330.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$24,330.00 ","$0.00 ","$6,105.00 ","$19,269.36 ","$19,464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100099","EAP","CPT� 92925","","Atherectomy Add'l Vessel","BOTH IP/OP","$22,259.00 ","$16,471.66 ","$0.00 ","$24,330.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$24,330.00 ","$0.00 ","$12,165.00 ","$19,269.36 ","$19,464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100100","EAP","CPT� 93568","","Inj. Proc During Cath Pulmonary Angiography","BOTH IP/OP","$3,441.00 ","$2,546.34 ","$0.00 ","$3,281.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,281.00 ","$0.00 ","$1,640.50 ","$2,598.55 ","$2,624.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100101","EAP","CPT� 93566","","Inject Pro. During Cath/rv/ra./s&i","BOTH IP/OP","$3,057.00 ","$2,262.18 ","$0.00 ","$3,664.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,664.00 ","$0.00 ","$1,832.00 ","$2,901.89 ","$2,931.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100102","EAP","CPT� 93565","","Inj. Pro During Cath/lv/la/s&i","BOTH IP/OP","$2,659.00 ","$1,967.66 ","$0.00 ","$2,686.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,686.00 ","$0.00 ","$1,343.00 ","$2,127.31 ","$2,148.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100103","EAP","CPT� 33990","","Insertion Of Impella Device - Cp","BOTH IP/OP","$35,191.00 ","$26,041.34 ","$0.00 ","$34,511.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$34,511.00 ","$0.00 ","$17,255.50 ","$27,332.71 ","$27,608.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100104","EAP","CPT� 33992","","Removal Of Impella","BOTH IP/OP","$12,888.00 ","$9,537.12 ","$0.00 ","$12,639.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$12,639.00 ","$0.00 ","$6,319.50 ","$10,010.09 ","$10,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100105","EAP","CPT� 33993","","Respositioning Of Impella","BOTH IP/OP","$17,220.00 ","$12,742.80 ","$0.00 ","$18,959.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$18,959.00 ","$0.00 ","$9,479.50 ","$15,015.53 ","$15,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100106","EAP","CPT� 34812","","Open Of Femoral Artery","BOTH IP/OP","$8,696.00 ","$6,435.04 ","$0.00 ","$8,696.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,696.00 ","$0.00 ","$2,255.00 ","$6,887.23 ","$6,956.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100107","EAP","HCPCS 93531","","R & L Heart Cath Congenital","BOTH IP/OP","$29,098.00 ","$21,532.52 ","$0.00 ","$29,098.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29,098.00 ","$0.00 ","$2,858.00 ","$23,045.62 ","$23,278.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100108","EAP","HCPCS 93563","","Inject Congenital Card Cath","BOTH IP/OP","$3,180.00 ","$2,353.20 ","$0.00 ","$3,811.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,811.00 ","$0.00 ","$1,905.50 ","$3,018.31 ","$3,048.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100109","EAP","CPT� 33947","","Ecmo/ecls Initiation Artery","BOTH IP/OP","$4,152.00 ","$3,072.48 ","$0.00 ","$4,571.00 ","$0.00 ","$0.00 ","$0.00 ","$3,262.32 ","$3,262.32 ","$0.00 ","$4,571.00 ","$0.00 ","$2,255.00 ","$3,620.23 ","$3,656.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100110","EAP","CPT� 33947","","Ecmo/ecls Insj Prph Cannula","BOTH IP/OP","$6,244.00 ","$4,620.56 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$4,906.69 ","$4,906.69 ","$0.00 ","$6,875.00 ","$0.00 ","$2,255.00 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100111","EAP","CPT� 36901","","Intro Cath Dialysis Circuit","BOTH IP/OP","$3,666.00 ","$2,712.84 ","$0.00 ","$3,087.00 ","$0.00 ","$0.00 ","$0.00 ","$2,203.19 ","$2,203.19 ","$0.00 ","$3,087.00 ","$0.00 ","$2,255.00 ","$2,444.90 ","$2,469.60 ","$0.00 ","$550.60 ","$0.00 ","$0.00 ","$0.00 "
"48100112","EAP","CPT� 36902","","Intro Cath Dialysis Circuit; W Angio","BOTH IP/OP","$18,144.00 ","$13,426.56 ","$0.00 ","$15,279.00 ","$5,693.10 ","$4,853.85 ","$3,781.66 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,279.00 ","$0.00 ","$4,975.00 ","$12,100.97 ","$12,223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100113","EAP","CPT� 36903","","Intro Cath Dialysis Circuit; W Trans Intra Stent","BOTH IP/OP","$36,671.00 ","$27,136.54 ","$0.00 ","$30,881.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$30,881.00 ","$0.00 ","$6,105.00 ","$24,457.75 ","$24,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100114","EAP","CPT� 36904","","Thrmbc/nfs Dialysis Circuit","BOTH IP/OP","$18,144.00 ","$13,426.56 ","$0.00 ","$15,279.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,279.00 ","$0.00 ","$4,975.00 ","$12,100.97 ","$12,223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100115","EAP","CPT� 36905","","Thrmbc/nfs Dialysis Circuit; W Angio","BOTH IP/OP","$36,671.00 ","$27,136.54 ","$0.00 ","$30,881.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$30,881.00 ","$0.00 ","$6,105.00 ","$24,457.75 ","$24,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100116","EAP","CPT� 36906","","Thrmbc/nfs Dialysis Circuit; W Trans Intra Stent","BOTH IP/OP","$55,585.00 ","$41,132.90 ","$0.00 ","$46,807.00 ","$5,693.10 ","$15,728.18 ","$9,417.94 ","$5,158.80 ","$5,158.80 ","$0.00 ","$46,807.00 ","$0.00 ","$6,105.00 ","$37,071.14 ","$37,445.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100117","EAP","CPT� 36907","","Balo Angiop Ctr Dialysis Seg","BOTH IP/OP","$3,666.00 ","$2,712.84 ","$0.00 ","$3,087.00 ","$0.00 ","$0.00 ","$0.00 ","$2,203.19 ","$2,203.19 ","$0.00 ","$3,087.00 ","$0.00 ","$1,543.50 ","$2,444.90 ","$2,469.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100118","EAP","CPT� 37246","","Trluml Balo Angiop 1st Art","BOTH IP/OP","$15,477.00 ","$11,452.98 ","$0.00 ","$15,178.00 ","$5,693.10 ","$4,853.85 ","$3,225.79 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,178.00 ","$0.00 ","$4,975.00 ","$12,020.98 ","$12,142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100119","EAP","CPT� 37247","","Trluml Balo Angiop Addl Art","BOTH IP/OP","$7,740.00 ","$5,727.60 ","$0.00 ","$7,590.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,590.00 ","$0.00 ","$3,795.00 ","$6,011.28 ","$6,072.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100120","EAP","CPT� 37248","","Trluml Balo Angiop 1st Vein","BOTH IP/OP","$15,477.00 ","$11,452.98 ","$0.00 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$15,178.00 ","$0.00 ","$4,975.00 ","$12,020.98 ","$12,142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100121","EAP","CPT� 37249","","Trluml Balo Angiop Addl Vein","BOTH IP/OP","$7,740.00 ","$5,727.60 ","$0.00 ","$7,590.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,590.00 ","$0.00 ","$3,795.00 ","$6,011.28 ","$6,072.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100122","EAP","CPT� 36908","","Tcat Plmt Iv Stent Ctr Dialysis Seg W/img S&i","BOTH IP/OP","$3,261.00 ","$2,413.14 ","$0.00 ","$2,746.00 ","$0.00 ","$0.00 ","$0.00 ","$1,959.82 ","$1,959.82 ","$0.00 ","$2,746.00 ","$0.00 ","$1,373.00 ","$2,174.83 ","$2,196.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100123","EAP","CPT� 36909","","Dialyis Circuit Vasc Emboli Occls Evasc Img S&i","BOTH IP/OP","$3,261.00 ","$2,413.14 ","$0.00 ","$2,746.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,746.00 ","$0.00 ","$1,373.00 ","$2,174.83 ","$2,196.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100124","EAP","CPT� 62321","","Njx Dx/ther Sbst Intrlmnr Crv/thrc W/img Gdn","BOTH IP/OP","$1,385.00 ","$1,024.90 ","$111.42 ","$1,385.00 ","$1,385.00 ","$621.87 ","$288.67 ","$939.23 ","$939.23 ","$230.42 ","$1,316.00 ","$626.89 ","$1,316.00 ","$1,042.27 ","$1,052.80 ","$870.98 ","$240.25 ","$111.42 ","$209.51 ","$597.04 "
"48100125","EAP","CPT� 62323","","Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/img Gdn","BOTH IP/OP","$1,385.00 ","$1,024.90 ","$103.13 ","$1,385.00 ","$1,385.00 ","$621.87 ","$288.67 ","$939.23 ","$939.23 ","$230.42 ","$1,316.00 ","$626.89 ","$1,316.00 ","$1,042.27 ","$1,052.80 ","$870.98 ","$235.81 ","$103.13 ","$209.51 ","$597.04 "
"48100126","EAP","HCPCS C9600","","Perc Drug-eluting Cor Stent; Single Vessel","BOTH IP/OP","$30,247.00 ","$22,382.78 ","$0.00 ","$23,352.00 ","$16,424.12 ","$9,836.87 ","$6,304.23 ","$5,158.80 ","$5,158.80 ","$4,088.75 ","$23,352.00 ","$9,937.60 ","$11,676.00 ","$18,494.78 ","$18,681.60 ","$13,806.97 ","$3,654.59 ","$0.00 ","$3,717.64 ","$9,464.38 "
"48100127","EAP","HCPCS C9601","","Perc Drug-eluting Cor Stent; Ea Addl Branch","BOTH IP/OP","$25,675.00 ","$18,999.50 ","$0.00 ","$19,822.00 ","$13,941.53 ","$0.00 ","$5,351.31 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,822.00 ","$0.00 ","$9,911.00 ","$15,699.02 ","$15,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100128","EAP","HCPCS C9602","","Perc Drug-eluting Cor Stent & Atherect; Singl Vess","BOTH IP/OP","$25,675.00 ","$18,999.50 ","$0.00 ","$19,822.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,822.00 ","$0.00 ","$9,911.00 ","$15,699.02 ","$15,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100129","EAP","HCPCS C9603","","Perc Drug-eluting Cor Stent & Atherect; Ea Addl Br","BOTH IP/OP","$28,009.00 ","$20,726.66 ","$0.00 ","$21,624.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,624.00 ","$0.00 ","$10,812.00 ","$17,126.21 ","$17,299.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100130","EAP","HCPCS C9604","","Perc Drug-eluting Cor Revasc Of Or Thro Cabg;sing","BOTH IP/OP","$26,434.00 ","$19,561.16 ","$0.00 ","$20,408.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$20,408.00 ","$0.00 ","$10,204.00 ","$16,163.14 ","$16,326.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100131","EAP","HCPCS C9605","","Perc Drug-eluting Cor Revasc Of Or Thr Cabg; Ea Ad","BOTH IP/OP","$25,675.00 ","$18,999.50 ","$0.00 ","$19,822.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,822.00 ","$0.00 ","$9,911.00 ","$15,699.02 ","$15,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100132","EAP","HCPCS C9606","","Perc Drug-eluting Cor W/ Ami;single Ves","BOTH IP/OP","$28,038.00 ","$20,748.12 ","$0.00 ","$21,646.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$21,646.00 ","$0.00 ","$10,823.00 ","$17,143.63 ","$17,316.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100133","EAP","HCPCS C9607","","Perc Drug-eluting Cor Revasc Cto;single Vess","BOTH IP/OP","$25,675.00 ","$18,999.50 ","$0.00 ","$19,822.00 ","$0.00 ","$0.00 ","$5,351.31 ","$5,158.80 ","$5,158.80 ","$0.00 ","$19,822.00 ","$0.00 ","$9,911.00 ","$15,699.02 ","$15,857.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100134","EAP","HCPCS C9608","","Perc Drug-eluting Cor Revasc Cto; Ea Addl Vessel","BOTH IP/OP","$26,553.00 ","$19,649.22 ","$0.00 ","$20,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$20,500.00 ","$0.00 ","$10,250.00 ","$16,236.00 ","$16,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100136","EAP","CPT� 33272","","Removal Sq Implant Defib Electrode","BOTH IP/OP","$10,938.00 ","$8,094.12 ","$0.00 ","$10,938.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$10,938.00 ","$0.00 ","$2,858.00 ","$8,662.90 ","$8,750.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48100140","EAP","CPT� 33274","","Transcath Insj/rpl Perm Leadless Pm Rv W/img","BOTH IP/OP","$43,271.00 ","$32,020.54 ","$0.00 ","$42,434.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$42,434.00 ","$0.00 ","$6,105.00 ","$33,607.73 ","$33,947.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48200001","EAP","CPT� 93017","","STRESS ECHO","BOTH IP/OP","$3,621.00 ","$2,679.54 ","$0.00 ","$3,621.00 ","$0.00 ","$0.00 ","$747.20 ","$2,584.31 ","$2,584.31 ","$634.01 ","$3,621.00 ","$253.05 ","$1,810.50 ","$2,867.83 ","$2,896.80 ","$351.58 ","$64.64 ","$34.22 ","$576.46 ","$241.00 "
"48200002","EAP","CPT� 93017","","Cardiac Stress Test","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$34.22 ","$3,621.00 ","$86.88 ","$259.18 ","$747.20 ","$2,584.31 ","$2,584.31 ","$634.01 ","$3,621.00 ","$253.05 ","$1,810.50 ","$2,867.83 ","$2,896.80 ","$351.58 ","$64.64 ","$34.22 ","$576.46 ","$241.00 "
"48300001","EAP","CPT� 93306","","Tte, Complete","BOTH IP/OP","$4,414.00 ","$3,266.36 ","$136.14 ","$3,955.00 ","$504.77 ","$473.20 ","$919.99 ","$2,822.68 ","$2,822.68 ","$692.49 ","$3,955.00 ","$483.00 ","$1,977.50 ","$3,132.36 ","$3,164.00 ","$671.06 ","$254.50 ","$136.14 ","$629.64 ","$460.00 "
"48300003","EAP","CPT� 93308","","Tte. Limited","BOTH IP/OP","$2,613.00 ","$1,933.62 ","$74.20 ","$2,342.00 ","$276.25 ","$225.34 ","$544.61 ","$197.85 ","$197.85 ","$410.07 ","$2,342.00 ","$233.72 ","$1,171.00 ","$1,854.86 ","$1,873.60 ","$324.73 ","$108.83 ","$74.20 ","$372.85 ","$222.60 "
"48300004","EAP","CPT� 93350","","Echo W/stress Test","BOTH IP/OP","$3,748.00 ","$2,773.52 ","$118.63 ","$3,694.00 ","$532.14 ","$473.20 ","$781.18 ","$315.67 ","$315.67 ","$646.79 ","$3,694.00 ","$483.00 ","$1,847.00 ","$2,925.65 ","$2,955.20 ","$671.06 ","$118.63 ","$120.30 ","$588.08 ","$460.00 "
"48300005","EAP","CPT� 93303","","Transthoracic Echo For Congenital Anomalies","BOTH IP/OP","$2,416.00 ","$1,787.84 ","$0.00 ","$2,461.00 ","$0.00 ","$0.00 ","$0.00 ","$357.76 ","$357.76 ","$0.00 ","$2,461.00 ","$0.00 ","$1,230.50 ","$1,949.11 ","$1,968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48300006","EAP","CPT� 93304","","Transthoracic Echo Follow-up Limited Study","BOTH IP/OP","$1,512.00 ","$1,118.88 ","$0.00 ","$1,540.00 ","$0.00 ","$0.00 ","$0.00 ","$230.14 ","$230.14 ","$0.00 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48300007","EAP","HCPCS C8924","","Tte 2d W Or W/o Fol W/contrast; Follow-up Or Ltd","BOTH IP/OP","$2,899.00 ","$2,145.26 ","$0.00 ","$2,597.00 ","$1,574.16 ","$360.63 ","$604.22 ","$1,853.48 ","$1,853.48 ","$454.71 ","$2,597.00 ","$387.01 ","$1,298.50 ","$2,056.82 ","$2,077.60 ","$537.70 ","$406.43 ","$0.00 ","$413.44 ","$368.58 "
"48300008","EAP","HCPCS C8929","","Tte 2d W Or W/o Fol W/contrast; Doppler","BOTH IP/OP","$4,697.00 ","$3,475.78 ","$0.00 ","$4,209.00 ","$2,550.47 ","$700.64 ","$978.97 ","$3,003.96 ","$3,003.96 ","$736.96 ","$4,209.00 ","$693.78 ","$2,104.50 ","$3,333.53 ","$3,367.20 ","$963.92 ","$658.71 ","$0.00 ","$670.07 ","$660.75 "
"48300009","EAP","CPT� 93321","","Doppler Echo Exam Heart (add-on)","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$63.36 ","$63.36 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"49000001","EAP","CPT� 59821","","Trmt Of Missed Abort.-2nd Trim","BOTH IP/OP","$3,666.00 ","$2,712.84 ","$0.00 ","$3,666.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,666.00 ","$0.00 ","$3,666.00 ","$2,903.47 ","$2,932.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000003","EAP","CPT� 19499","","Duct Lav Ea Brst, Sing Duct","BOTH IP/OP","$6,124.00 ","$4,531.76 ","$0.00 ","$6,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,124.00 ","$0.00 ","$2,255.00 ","$4,850.21 ","$4,899.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000004","EAP","CPT� 23500","","Shoulder-clavicular","BOTH IP/OP","$1,037.00 ","$767.38 ","$0.00 ","$1,037.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.00 ","$0.00 ","$1,037.00 ","$821.30 ","$829.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000005","EAP","CPT� 23540","","Treat Clavicle Dislocation","BOTH IP/OP","$815.00 ","$603.10 ","$0.00 ","$815.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$815.00 ","$0.00 ","$815.00 ","$645.48 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000006","EAP","CPT� 23620","","Humerus-proximal","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,069.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,069.00 ","$0.00 ","$1,069.00 ","$846.65 ","$855.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000007","EAP","CPT� 23675","","Humerus-neck","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,550.00 ","$0.00 ","$1,550.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000008","EAP","CPT� 24500","","Humerus-shaft","BOTH IP/OP","$689.00 ","$509.86 ","$0.00 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.00 ","$0.00 ","$712.00 ","$563.90 ","$569.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000009","EAP","CPT� 24530","","Humerus-condyle-supra","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,069.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,069.00 ","$0.00 ","$1,069.00 ","$846.65 ","$855.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000010","EAP","CPT� 24560","","Humerus-distal Closed","BOTH IP/OP","$978.00 ","$723.72 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,010.00 ","$0.00 ","$1,010.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000011","EAP","CPT� 24576","","Humerus-condyle-medial","BOTH IP/OP","$1,053.00 ","$779.22 ","$0.00 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,088.00 ","$0.00 ","$1,088.00 ","$861.70 ","$870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000012","EAP","CPT� 24650","","Elbow-radial Head","BOTH IP/OP","$1,062.00 ","$785.88 ","$0.00 ","$1,097.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,097.00 ","$0.00 ","$1,097.00 ","$868.82 ","$877.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000013","EAP","CPT� 24670","","Elbow-olecranon","BOTH IP/OP","$978.00 ","$723.72 ","$0.00 ","$1,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,010.00 ","$0.00 ","$1,010.00 ","$799.92 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000014","EAP","CPT� 25530","","Forearm-ulnar Shaft","BOTH IP/OP","$1,203.00 ","$890.22 ","$0.00 ","$1,203.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,203.00 ","$0.00 ","$1,203.00 ","$952.78 ","$962.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000015","EAP","CPT� 25560","","Forearm-both Bones","BOTH IP/OP","$891.00 ","$659.34 ","$0.00 ","$903.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$903.00 ","$0.00 ","$903.00 ","$715.18 ","$722.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000016","EAP","CPT� 25600","","Wrist-colles","BOTH IP/OP","$1,165.00 ","$862.10 ","$0.00 ","$1,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,180.00 ","$0.00 ","$1,180.00 ","$934.56 ","$944.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000017","EAP","CPT� 25622","","Wrist-scaphoid","BOTH IP/OP","$1,077.00 ","$796.98 ","$0.00 ","$1,091.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,091.00 ","$0.00 ","$1,091.00 ","$864.07 ","$872.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000018","EAP","CPT� 25630","","Wrist-capitate","BOTH IP/OP","$1,223.00 ","$905.02 ","$0.00 ","$1,223.00 ","$1,223.00 ","$201.85 ","$254.90 ","$0.00 ","$0.00 ","$202.23 ","$1,155.00 ","$216.27 ","$1,155.00 ","$914.76 ","$924.00 ","$300.48 ","$266.34 ","$293.00 ","$183.88 ","$205.98 "
"51000019","EAP","CPT� 26600","","Hand-metacarpal Bone","BOTH IP/OP","$1,078.00 ","$797.72 ","$0.00 ","$1,078.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,078.00 ","$0.00 ","$1,078.00 ","$853.78 ","$862.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000020","EAP","CPT� 26750","","Hand-phallax","BOTH IP/OP","$974.00 ","$720.76 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$1,035.00 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000021","EAP","CPT� 27750","","Tibia-proximal","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,133.00 ","$0.00 ","$1,133.00 ","$897.34 ","$906.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000022","EAP","CPT� 27760","","Ankle-medical Malleolus","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$720.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000023","EAP","CPT� 27780","","Tiba-distal","BOTH IP/OP","$1,057.00 ","$782.18 ","$0.00 ","$1,119.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,119.00 ","$0.00 ","$1,119.00 ","$886.25 ","$895.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000024","EAP","CPT� 27786","","Ankle-lateral Malleolus","BOTH IP/OP","$1,204.00 ","$890.96 ","$0.00 ","$1,153.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,153.00 ","$0.00 ","$1,153.00 ","$913.18 ","$922.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000025","EAP","CPT� 27808","","Treatment Of Ankle Fracture","BOTH IP/OP","$1,087.00 ","$804.38 ","$0.00 ","$1,087.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,087.00 ","$0.00 ","$1,087.00 ","$860.90 ","$869.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000026","EAP","CPT� 28470","","Foot-metatarsal","BOTH IP/OP","$981.00 ","$725.94 ","$0.00 ","$981.00 ","$981.00 ","$201.85 ","$0.00 ","$0.00 ","$0.00 ","$171.77 ","$981.00 ","$216.27 ","$981.00 ","$776.95 ","$784.80 ","$300.48 ","$214.80 ","$210.83 ","$156.18 ","$205.98 "
"51000027","EAP","CPT� 28510","","Treatment Of Toe Fracture","BOTH IP/OP","$981.00 ","$725.94 ","$0.00 ","$981.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$981.00 ","$0.00 ","$981.00 ","$776.95 ","$784.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000028","EAP","CPT� 29105","","Long Arm Splint","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.40 ","$859.00 ","$134.13 ","$859.00 ","$680.33 ","$687.20 ","$186.36 ","$94.27 ","$43.63 ","$136.75 ","$127.75 "
"51000029","EAP","CPT� 29125","","Splint, Short Arm","BOTH IP/OP","$952.00 ","$704.48 ","$0.00 ","$952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.69 ","$952.00 ","$109.35 ","$952.00 ","$753.98 ","$761.60 ","$151.93 ","$72.40 ","$40.73 ","$151.56 ","$104.14 "
"51000030","EAP","CPT� 29130","","Splint, Finger","BOTH IP/OP","$859.00 ","$635.66 ","$0.00 ","$859.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.00 ","$0.00 ","$859.00 ","$680.33 ","$687.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000031","EAP","CPT� 29505","","Long Leg Splint","BOTH IP/OP","$1,372.00 ","$1,015.28 ","$0.00 ","$1,535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.77 ","$1,535.00 ","$134.13 ","$1,535.00 ","$1,215.72 ","$1,228.00 ","$186.36 ","$94.49 ","$52.27 ","$244.37 ","$127.75 "
"51000032","EAP","CPT� 29515","","Splint, Short Leg","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$888.00 ","$512.05 ","$138.36 ","$196.54 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$134.13 ","$888.00 ","$703.30 ","$710.40 ","$186.36 ","$80.51 ","$51.19 ","$141.37 ","$127.75 "
"51000036","EAP","CPT� 51702","","Cath Insert Indwelling","BOTH IP/OP","$1,069.00 ","$791.06 ","$0.00 ","$1,069.00 ","$0.00 ","$0.00 ","$223.01 ","$0.00 ","$0.00 ","$187.17 ","$1,069.00 ","$109.35 ","$1,069.00 ","$846.65 ","$855.20 ","$151.93 ","$91.18 ","$26.68 ","$170.18 ","$104.14 "
"51000038","EAP","CPT� 59070","","Amnio Infusion (adb)","BOTH IP/OP","$439.00 ","$324.86 ","$0.00 ","$443.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$443.00 ","$0.00 ","$443.00 ","$350.86 ","$354.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000039","EAP","CPT� 59899","","Maternity Care Procedure","BOTH IP/OP","$183.00 ","$135.42 ","$0.00 ","$183.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$183.00 ","$0.00 ","$183.00 ","$144.94 ","$146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000041","EAP","CPT� 92002","","Ophalmol Exam, Inter, Np","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$299.34 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$42.90 ","$245.00 ","$116.27 ","$122.50 ","$194.04 ","$196.00 ","$161.54 ","$60.73 ","$48.33 ","$39.00 ","$110.73 "
"51000042","EAP","CPT� 92004","","Opthalmol Exam, Compre, Np","BOTH IP/OP","$411.00 ","$304.14 ","$0.00 ","$404.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$70.74 ","$404.00 ","$116.27 ","$202.00 ","$319.97 ","$323.20 ","$161.54 ","$101.46 ","$99.90 ","$64.32 ","$110.73 "
"51000043","EAP","CPT� 92012","","Opthalmol Exam, Inter, Ep","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$299.34 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$38.87 ","$222.00 ","$116.27 ","$111.00 ","$175.82 ","$177.60 ","$161.54 ","$51.64 ","$53.01 ","$35.34 ","$110.73 "
"51000044","EAP","CPT� 92014","","Opthalmol Exam, Compre, Ep","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$374.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$65.48 ","$374.00 ","$116.27 ","$187.00 ","$296.21 ","$299.20 ","$161.54 ","$74.47 ","$80.42 ","$59.54 ","$110.73 "
"51000046","EAP","CPT� 92020","","Gonioscopy Exam","BOTH IP/OP","$272.00 ","$201.28 ","$0.00 ","$299.34 ","$0.00 ","$110.43 ","$67.13 ","$299.34 ","$299.34 ","$46.92 ","$268.00 ","$109.35 ","$134.00 ","$212.26 ","$214.40 ","$151.93 ","$33.89 ","$21.28 ","$42.67 ","$104.14 "
"51000050","EAP","CPT� 96372","","Inject-im/sq Only","BOTH IP/OP","$260.00 ","$192.40 ","$14.42 ","$223.00 ","$141.18 ","$60.72 ","$54.19 ","$159.16 ","$159.16 ","$39.05 ","$223.00 ","$60.65 ","$111.50 ","$176.62 ","$178.40 ","$84.26 ","$20.00 ","$14.42 ","$35.50 ","$57.76 "
"51000057","EAP","CPT� 99201","","Visit Level 1 - Np","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$57.61 ","$329.00 ","$116.27 ","$164.50 ","$260.57 ","$263.20 ","$27.04 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000058","EAP","CPT� 99202","","Visit Level 2 - Np","BOTH IP/OP","$384.00 ","$284.16 ","$0.00 ","$378.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$66.18 ","$378.00 ","$116.27 ","$189.00 ","$299.38 ","$302.40 ","$51.57 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000059","EAP","CPT� 99203","","Visit Level 3 - Np","BOTH IP/OP","$449.00 ","$332.26 ","$0.00 ","$442.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$77.39 ","$442.00 ","$116.27 ","$221.00 ","$350.06 ","$353.60 ","$77.17 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000060","EAP","CPT� 99204","","Visit Level 4 - Np","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$569.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$99.63 ","$569.00 ","$116.27 ","$284.50 ","$450.65 ","$455.20 ","$131.98 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000061","EAP","CPT� 99205","","Visit Level 5-np","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$686.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$120.11 ","$686.00 ","$116.27 ","$343.00 ","$543.31 ","$548.80 ","$172.37 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000062","EAP","CPT� 99211","","Visit Level 1 - Ep","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$299.34 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$50.78 ","$290.00 ","$116.27 ","$145.00 ","$229.68 ","$232.00 ","$9.38 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000063","EAP","CPT� 99212","","Visit Level 2-ep","BOTH IP/OP","$348.00 ","$257.52 ","$0.00 ","$313.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$54.80 ","$313.00 ","$116.27 ","$156.50 ","$247.90 ","$250.40 ","$26.32 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000064","EAP","CPT� 99213","","Visit Level 3-ep","BOTH IP/OP","$434.00 ","$321.16 ","$0.00 ","$399.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$69.86 ","$399.00 ","$116.27 ","$199.50 ","$316.01 ","$319.20 ","$52.29 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000065","EAP","CPT� 99214","","Visit Level 4-ep","BOTH IP/OP","$526.00 ","$389.24 ","$0.00 ","$491.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$85.97 ","$491.00 ","$116.27 ","$245.50 ","$388.87 ","$392.80 ","$80.42 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000066","EAP","CPT� 99215","","Visit Level 5-ep","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$541.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$94.72 ","$541.00 ","$116.27 ","$270.50 ","$428.47 ","$432.80 ","$113.60 ","$108.52 ","$0.00 ","$99.16 ","$110.73 "
"51000086","EAP","HCPCS G0127","","Trim Of Dystrophic Nail(s)","BOTH IP/OP","$121.00 ","$89.54 ","$0.00 ","$122.00 ","$65.70 ","$54.51 ","$25.22 ","$0.00 ","$0.00 ","$21.36 ","$122.00 ","$55.17 ","$122.00 ","$96.62 ","$97.60 ","$76.65 ","$19.09 ","$7.94 ","$19.42 ","$52.54 "
"51000087","EAP","HCPCS G0402","","New Medicare Phys Exam","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$369.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$64.61 ","$369.00 ","$116.27 ","$184.50 ","$292.25 ","$295.20 ","$161.54 ","$57.75 ","$129.11 ","$58.74 ","$110.73 "
"51000090","EAP","Custom 51000090","","Annual Health Screen","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$299.34 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000157","EAP","CPT� 99201","","Visit Level Bccp 1 - Np","BOTH IP/OP","$329.00 ","$243.46 ","$0.00 ","$329.00 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$57.61 ","$329.00 ","$116.27 ","$164.50 ","$260.57 ","$263.20 ","$27.04 ","$108.52 ","$27.04 ","$99.16 ","$110.73 "
"51000158","EAP","CPT� 99202","","Visit Level Bccp 2 - Np","BOTH IP/OP","$384.00 ","$284.16 ","$0.00 ","$378.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$66.18 ","$378.00 ","$116.27 ","$189.00 ","$299.38 ","$302.40 ","$51.57 ","$108.52 ","$51.57 ","$99.16 ","$110.73 "
"51000159","EAP","CPT� 99203","","Visit Level Bccp 3 - Np","BOTH IP/OP","$449.00 ","$332.26 ","$0.00 ","$442.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$77.39 ","$442.00 ","$116.27 ","$221.00 ","$350.06 ","$353.60 ","$77.17 ","$108.52 ","$77.17 ","$99.16 ","$110.73 "
"51000161","EAP","CPT� 99205","","Visit Level Bccp 5-np","BOTH IP/OP","$697.00 ","$515.78 ","$0.00 ","$686.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$120.11 ","$686.00 ","$116.27 ","$343.00 ","$543.31 ","$548.80 ","$172.37 ","$108.52 ","$172.37 ","$99.16 ","$110.73 "
"51000162","EAP","CPT� 99211","","Visit Level Bccp 1 - Ep","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$299.34 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$50.78 ","$290.00 ","$116.27 ","$145.00 ","$229.68 ","$232.00 ","$9.38 ","$108.52 ","$9.38 ","$99.16 ","$110.73 "
"51000163","EAP","CPT� 99212","","Visit Level Bccp 2 - Ep","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$313.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$54.80 ","$313.00 ","$116.27 ","$156.50 ","$247.90 ","$250.40 ","$26.32 ","$108.52 ","$26.32 ","$99.16 ","$110.73 "
"51000164","EAP","CPT� 99213","","Visit Level Bccp 3 - Ep","BOTH IP/OP","$434.00 ","$321.16 ","$0.00 ","$399.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$69.86 ","$399.00 ","$116.27 ","$199.50 ","$316.01 ","$319.20 ","$52.29 ","$108.52 ","$52.29 ","$99.16 ","$110.73 "
"51000166","EAP","CPT� 99215","","Visit Level Bccp 5-ep","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$541.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$94.72 ","$541.00 ","$116.27 ","$270.50 ","$428.47 ","$432.80 ","$113.60 ","$108.52 ","$113.60 ","$99.16 ","$110.73 "
"51000190","EAP","CPT� 92133","","Cmptr Ophth Img Optic Nerve","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$336.00 ","$0.00 ","$54.51 ","$67.13 ","$299.34 ","$299.34 ","$58.83 ","$336.00 ","$55.17 ","$168.00 ","$266.11 ","$268.80 ","$76.65 ","$42.26 ","$15.13 ","$53.49 ","$52.54 "
"51000191","EAP","CPT� 92134","","Cptr Ophth Dx Img Post Segmt","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$336.00 ","$0.00 ","$54.51 ","$67.13 ","$299.34 ","$299.34 ","$58.83 ","$336.00 ","$55.17 ","$168.00 ","$266.11 ","$268.80 ","$76.65 ","$42.26 ","$15.49 ","$53.49 ","$52.54 "
"51000211","EAP","CPT� 99497","","Advance Care Planning First 30 Mins","BOTH IP/OP","$173.00 ","$128.02 ","$0.00 ","$299.34 ","$0.00 ","$73.28 ","$67.13 ","$299.34 ","$299.34 ","$29.77 ","$170.00 ","$78.77 ","$85.00 ","$134.64 ","$136.00 ","$109.44 ","$26.61 ","$80.42 ","$27.06 ","$75.02 "
"51000212","EAP","CPT� 99498","","Advance Care Planning Ea Addl 30 Mins (add-on)","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$299.34 ","$0.00 ","$0.00 ","$67.13 ","$299.34 ","$299.34 ","$0.00 ","$155.00 ","$0.00 ","$77.50 ","$122.76 ","$124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000260","EAP","CPT� 99204","","Visit Level Bccp 4 - Np","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$569.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$99.63 ","$569.00 ","$116.27 ","$284.50 ","$450.65 ","$455.20 ","$131.98 ","$108.52 ","$131.98 ","$99.16 ","$110.73 "
"51000265","EAP","CPT� 99214","","Visit Level Bccp 4-ep","BOTH IP/OP","$526.00 ","$389.24 ","$0.00 ","$491.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$85.97 ","$491.00 ","$116.27 ","$245.50 ","$388.87 ","$392.80 ","$80.42 ","$108.52 ","$80.42 ","$99.16 ","$110.73 "
"51000313","EAP","CPT� 99495","","DISCHARGE PHONE CALL AND F/U APPT WITHIN 14  DAYS","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$299.34 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$49.03 ","$280.00 ","$116.27 ","$140.00 ","$221.76 ","$224.00 ","$161.54 ","$43.82 ","$125.50 ","$44.58 ","$110.73 "
"51000314","EAP","CPT� 99496","","DISCHARGE PHONE CALL AND F/U APPT WITHIN 7  DAYS","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$410.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$71.79 ","$410.00 ","$116.27 ","$205.00 ","$324.72 ","$328.00 ","$161.54 ","$64.17 ","$165.53 ","$65.27 ","$110.73 "
"51000315","EAP","CPT� 99205","","Isolation Evaluation - Np","BOTH IP/OP","$1,700.00 ","$1,258.00 ","$0.00 ","$1,700.00 ","$0.00 ","$185.53 ","$67.13 ","$299.34 ","$299.34 ","$297.66 ","$1,700.00 ","$181.26 ","$850.00 ","$1,346.40 ","$1,360.00 ","$172.37 ","$108.52 ","$172.37 ","$99.16 ","$172.37 "
"51000316","EAP","CPT� 99215","","Isolation Evaluation - Ep","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$0.00 ","$147.16 ","$67.13 ","$299.34 ","$299.34 ","$231.12 ","$1,320.00 ","$118.93 ","$660.00 ","$1,045.44 ","$1,056.00 ","$113.60 ","$108.52 ","$113.60 ","$99.16 ","$113.60 "
"51000320","EAP","CPT� 97605","","Neg Press Wd Tx - 50 Sq Cm Or Less","BOTH IP/OP","$317.00 ","$234.58 ","$0.00 ","$308.00 ","$172.13 ","$175.86 ","$66.07 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$175.24 ","$154.00 ","$243.94 ","$246.40 ","$243.48 ","$33.92 ","$26.69 ","$49.03 ","$166.90 "
"51000321","EAP","CPT� 97606","","Neg Press Wd Tx-> Than 50 Sq Cm","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$509.00 ","$0.00 ","$0.00 ","$109.21 ","$0.00 ","$0.00 ","$0.00 ","$509.00 ","$0.00 ","$254.50 ","$403.13 ","$407.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000322","EAP","CPT� G0438","","Annual Wellness Visit, Initial Visit","BOTH IP/OP","$409.00 ","$302.66 ","$0.00 ","$402.00 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$70.39 ","$402.00 ","$116.27 ","$201.00 ","$318.38 ","$321.60 ","$172.69 ","$62.91 ","$172.69 ","$64.00 ","$110.73 "
"51000323","EAP","CPT� G0439","","Annual Wellness Visit, Subseq Visit","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$299.34 ","$0.00 ","$116.36 ","$67.13 ","$299.34 ","$299.34 ","$50.08 ","$286.00 ","$116.27 ","$143.00 ","$226.51 ","$228.80 ","$117.16 ","$44.76 ","$117.16 ","$45.53 ","$110.73 "
"51000324","EAP","CPT� 99487","","Complex Chronic Care Mgmt - 1st Hr Per Month","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$299.34 ","$0.00 ","$131.03 ","$67.13 ","$299.34 ","$299.34 ","$30.12 ","$172.00 ","$78.77 ","$86.00 ","$136.22 ","$137.60 ","$109.44 ","$26.92 ","$53.37 ","$27.38 ","$75.02 "
"51000325","EAP","CPT� 99490","","Chronic Care Mgmt - 20 Min. Per Month","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$299.34 ","$0.00 ","$73.28 ","$67.13 ","$299.34 ","$299.34 ","$30.12 ","$172.00 ","$78.77 ","$86.00 ","$136.22 ","$137.60 ","$109.44 ","$26.92 ","$32.82 ","$27.38 ","$75.02 "
"51000326","EAP","CPT� 99489","","Complex Chronic Care Mgmt � Ea Addl 30 Min Per Month","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$299.34 ","$0.00 ","$0.00 ","$67.13 ","$299.34 ","$299.34 ","$15.06 ","$86.00 ","$0.00 ","$43.00 ","$68.11 ","$68.80 ","$0.00 ","$13.46 ","$26.33 ","$13.69 ","$0.00 "
"51000327","EAP","CPT� 92230","","Eye Exam With Photos","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$700.00 ","$0.00 ","$478.04 ","$67.13 ","$299.34 ","$299.34 ","$0.00 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51000328","EAP","CPT� 92326","","Replacement Of Contact Lens","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$299.34 ","$0.00 ","$0.00 ","$0.00 ","$299.34 ","$299.34 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51100021","EAP","CPT� 64640","","Destr Peripheral Nerve","BOTH IP/OP","$2,488.00 ","$1,841.12 ","$0.00 ","$2,501.00 ","$0.00 ","$0.00 ","$518.56 ","$1,784.96 ","$1,784.96 ","$437.91 ","$2,501.00 ","$814.44 ","$2,255.00 ","$1,980.79 ","$2,000.80 ","$1,131.55 ","$198.96 ","$121.87 ","$398.16 ","$775.65 "
"61000001","EAP","CPT� 70336","","Mri Tmj Mri","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$222.60 ","$4,165.00 ","$2,060.10 ","$225.34 ","$859.34 ","$1,126.11 ","$1,126.11 ","$729.26 ","$4,165.00 ","$233.72 ","$1,043.00 ","$3,298.68 ","$3,332.00 ","$324.73 ","$651.82 ","$236.99 ","$663.07 ","$222.60 "
"61000002","EAP","CPT� 70540","","Mri:orbit/face/neckw/o Contr.","BOTH IP/OP","$5,561.00 ","$4,115.14 ","$195.93 ","$5,287.00 ","$2,060.10 ","$225.34 ","$1,159.05 ","$1,126.11 ","$1,126.11 ","$925.71 ","$5,287.00 ","$233.72 ","$1,043.00 ","$4,187.30 ","$4,229.60 ","$324.73 ","$827.42 ","$195.93 ","$841.69 ","$222.60 "
"61000003","EAP","CPT� 70542","","Mri Orbit/face/neck/w/dye Mri","BOTH IP/OP","$5,964.00 ","$4,413.36 ","$230.87 ","$5,670.00 ","$2,060.10 ","$360.63 ","$1,243.05 ","$1,126.11 ","$1,126.11 ","$992.77 ","$5,670.00 ","$387.01 ","$1,162.00 ","$4,490.64 ","$4,536.00 ","$537.70 ","$887.36 ","$230.87 ","$902.66 ","$368.58 "
"61000004","EAP","CPT� 70543","","Mri Orb/face/neck W&wo Dye Mri","BOTH IP/OP","$8,010.00 ","$5,927.40 ","$285.62 ","$7,615.00 ","$2,060.10 ","$360.63 ","$1,669.48 ","$1,126.11 ","$1,126.11 ","$1,333.33 ","$7,615.00 ","$387.01 ","$1,608.00 ","$6,031.08 ","$6,092.00 ","$537.70 ","$1,191.75 ","$285.62 ","$1,212.31 ","$368.58 "
"61000005","EAP","CPT� 70544","","Mra Head W/o Dye","BOTH IP/OP","$5,561.00 ","$4,115.14 ","$187.29 ","$5,287.00 ","$2,060.10 ","$225.34 ","$1,159.05 ","$1,126.11 ","$1,126.11 ","$925.71 ","$5,287.00 ","$233.72 ","$1,043.00 ","$4,187.30 ","$4,229.60 ","$324.73 ","$827.42 ","$187.29 ","$841.69 ","$222.60 "
"61000006","EAP","CPT� 70545","","Mra Head W/ Dye","BOTH IP/OP","$5,964.00 ","$4,413.36 ","$198.45 ","$5,670.00 ","$2,060.10 ","$360.63 ","$1,243.05 ","$1,126.11 ","$1,126.11 ","$992.77 ","$5,670.00 ","$387.01 ","$1,162.00 ","$4,490.64 ","$4,536.00 ","$537.70 ","$887.36 ","$198.45 ","$902.66 ","$368.58 "
"61000007","EAP","CPT� 70546","","Mra Head W & W/o Dye","BOTH IP/OP","$8,010.00 ","$5,927.40 ","$300.74 ","$7,615.00 ","$2,060.10 ","$360.63 ","$1,669.48 ","$1,126.11 ","$1,126.11 ","$1,333.33 ","$7,615.00 ","$387.01 ","$1,608.00 ","$6,031.08 ","$6,092.00 ","$537.70 ","$1,191.75 ","$300.74 ","$1,212.31 ","$368.58 "
"61000008","EAP","CPT� 70547","","Mra Neck W/o Dye","BOTH IP/OP","$5,561.00 ","$4,115.14 ","$188.01 ","$5,287.00 ","$2,060.10 ","$225.34 ","$1,159.05 ","$1,126.11 ","$1,126.11 ","$925.71 ","$5,287.00 ","$233.72 ","$1,043.00 ","$4,187.30 ","$4,229.60 ","$324.73 ","$827.42 ","$188.01 ","$841.69 ","$222.60 "
"61000009","EAP","CPT� 70548","","Mra Neck W/ Dye","BOTH IP/OP","$6,193.00 ","$4,582.82 ","$202.06 ","$5,888.00 ","$2,060.10 ","$360.63 ","$1,290.78 ","$1,126.11 ","$1,126.11 ","$1,030.94 ","$5,888.00 ","$387.01 ","$1,162.00 ","$4,663.30 ","$4,710.40 ","$537.70 ","$921.47 ","$202.06 ","$937.37 ","$368.58 "
"61000010","EAP","CPT� 70549","","Mra Neck W&wo Dye","BOTH IP/OP","$8,010.00 ","$5,927.40 ","$302.90 ","$7,615.00 ","$2,060.10 ","$360.63 ","$1,669.48 ","$1,126.11 ","$1,126.11 ","$1,333.33 ","$7,615.00 ","$387.01 ","$1,608.00 ","$6,031.08 ","$6,092.00 ","$537.70 ","$1,191.75 ","$302.90 ","$1,212.31 ","$368.58 "
"61000011","EAP","CPT� 71550","","Mri Chest W/o Dye","BOTH IP/OP","$4,941.00 ","$3,656.34 ","$0.00 ","$4,991.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,991.00 ","$0.00 ","$1,043.00 ","$3,952.87 ","$3,992.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000012","EAP","CPT� 71551","","Mri Chest W/dye","BOTH IP/OP","$3,511.00 ","$2,598.14 ","$0.00 ","$3,546.00 ","$2,060.10 ","$0.00 ","$0.00 ","$1,126.11 ","$1,126.11 ","$620.88 ","$3,546.00 ","$693.78 ","$1,162.00 ","$2,808.43 ","$2,836.80 ","$963.92 ","$554.95 ","$355.13 ","$564.52 ","$660.75 "
"61000013","EAP","CPT� 71552","","Mri Chest W&wo Dye","BOTH IP/OP","$6,183.00 ","$4,575.42 ","$360.63 ","$6,245.00 ","$2,060.10 ","$360.63 ","$1,288.69 ","$1,126.11 ","$1,126.11 ","$1,093.45 ","$6,245.00 ","$387.01 ","$1,608.00 ","$4,946.04 ","$4,996.00 ","$537.70 ","$977.34 ","$446.61 ","$994.20 ","$368.58 "
"61000014","EAP","CPT� 71555","","Mra Chest W&wo Dye","BOTH IP/OP","$5,145.00 ","$3,807.30 ","$0.00 ","$5,197.00 ","$2,060.10 ","$360.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,197.00 ","$0.00 ","$1,247.28 ","$4,116.02 ","$4,157.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000015","EAP","CPT� 72159","","Mra Spinal Canal W/wo Dye","BOTH IP/OP","$8,413.00 ","$6,225.62 ","$0.00 ","$8,498.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,498.00 ","$0.00 ","$2,039.52 ","$6,730.42 ","$6,798.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000016","EAP","CPT� 72198","","Mra  Pelvis W/wo Dye","BOTH IP/OP","$6,417.00 ","$4,748.58 ","$0.00 ","$6,414.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,414.00 ","$0.00 ","$1,539.36 ","$5,079.89 ","$5,131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000017","EAP","CPT� 73218","","Mri Upp Ext Nt Jt Wo Dye B Mri","BOTH IP/OP","$10,051.00 ","$7,437.74 ","$222.60 ","$10,051.00 ","$2,060.10 ","$225.34 ","$2,094.88 ","$1,126.11 ","$1,126.11 ","$1,759.85 ","$10,051.00 ","$233.72 ","$1,043.00 ","$7,960.39 ","$8,040.80 ","$324.73 ","$1,572.98 ","$288.50 ","$1,600.12 ","$222.60 "
"61000018","EAP","CPT� 73218","","Mri Upp Ext Nt Jt Wo Dye L Mri","BOTH IP/OP","$5,026.00 ","$3,719.24 ","$0.00 ","$5,026.00 ","$0.00 ","$0.00 ","$1,037.12 ","$1,126.11 ","$1,126.11 ","$880.01 ","$5,026.00 ","$233.72 ","$1,043.00 ","$3,980.59 ","$4,020.80 ","$324.73 ","$786.57 ","$288.50 ","$800.14 ","$222.60 "
"61000019","EAP","CPT� 73218","","Mri Upp Ext Nt Jt Wo Dye R Mri","BOTH IP/OP","$4,976.00 ","$3,682.24 ","$222.60 ","$5,026.00 ","$2,060.10 ","$225.34 ","$1,037.12 ","$1,126.11 ","$1,126.11 ","$880.01 ","$5,026.00 ","$233.72 ","$1,043.00 ","$3,980.59 ","$4,020.80 ","$324.73 ","$786.57 ","$288.50 ","$800.14 ","$222.60 "
"61000020","EAP","CPT� 73219","","Mri Upp Ext Not Jt W/dye B Mri","BOTH IP/OP","$10,778.00 ","$7,975.72 ","$0.00 ","$10,778.00 ","$2,060.10 ","$360.63 ","$2,246.40 ","$0.00 ","$0.00 ","$0.00 ","$10,778.00 ","$0.00 ","$1,162.00 ","$8,536.18 ","$8,622.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000021","EAP","CPT� 73219","","Mri Upp Ext Not Jt W/dye L Mri","BOTH IP/OP","$5,393.00 ","$3,990.82 ","$0.00 ","$5,393.00 ","$2,060.10 ","$360.63 ","$1,124.04 ","$0.00 ","$0.00 ","$0.00 ","$5,393.00 ","$0.00 ","$1,162.00 ","$4,271.26 ","$4,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000022","EAP","CPT� 73219","","Mri Upp Ext Not Jt W/dye R Mri","BOTH IP/OP","$5,339.00 ","$3,950.86 ","$0.00 ","$5,393.00 ","$2,060.10 ","$360.63 ","$1,112.78 ","$0.00 ","$0.00 ","$0.00 ","$5,393.00 ","$0.00 ","$1,162.00 ","$4,271.26 ","$4,314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000023","EAP","CPT� 73220","","Mri Upp Ext Nt Jt W&wo Bi Mri","BOTH IP/OP","$13,949.00 ","$10,322.26 ","$360.63 ","$13,949.00 ","$2,060.10 ","$360.63 ","$2,907.32 ","$1,126.11 ","$1,126.11 ","$2,442.36 ","$13,949.00 ","$387.01 ","$1,608.00 ","$11,047.61 ","$11,159.20 ","$537.70 ","$2,183.02 ","$376.02 ","$2,220.68 ","$368.58 "
"61000024","EAP","CPT� 73220","","Mri Upp Ext Nt Jt W&wo Lt Mri","BOTH IP/OP","$6,906.00 ","$5,110.44 ","$360.63 ","$6,976.00 ","$2,060.10 ","$360.63 ","$1,439.38 ","$1,126.11 ","$1,126.11 ","$1,221.44 ","$6,976.00 ","$387.01 ","$1,608.00 ","$5,524.99 ","$5,580.80 ","$537.70 ","$1,091.74 ","$376.02 ","$1,110.58 ","$368.58 "
"61000025","EAP","CPT� 73220","","Mri Upp Ext Nt Jt W&wo Rt Mri","BOTH IP/OP","$6,976.00 ","$5,162.24 ","$0.00 ","$6,976.00 ","$0.00 ","$0.00 ","$1,439.38 ","$1,126.11 ","$1,126.11 ","$1,221.44 ","$6,976.00 ","$387.01 ","$1,608.00 ","$5,524.99 ","$5,580.80 ","$537.70 ","$1,091.74 ","$376.02 ","$1,110.58 ","$368.58 "
"61000026","EAP","CPT� 73221","","Mri Upp Ext Jnt W/o Dye Bi Mri","BOTH IP/OP","$10,051.00 ","$7,437.74 ","$162.80 ","$10,051.00 ","$2,060.10 ","$225.34 ","$2,094.88 ","$1,126.11 ","$1,126.11 ","$1,759.85 ","$10,051.00 ","$233.72 ","$1,043.00 ","$7,960.39 ","$8,040.80 ","$324.73 ","$1,572.98 ","$162.80 ","$1,600.12 ","$222.60 "
"61000027","EAP","CPT� 73221","","Mri Upp Ext Jnt W/o Dye Lt Mri","BOTH IP/OP","$5,026.00 ","$3,719.24 ","$0.00 ","$5,026.00 ","$0.00 ","$0.00 ","$1,037.12 ","$1,126.11 ","$1,126.11 ","$880.01 ","$5,026.00 ","$233.72 ","$1,043.00 ","$3,980.59 ","$4,020.80 ","$324.73 ","$786.57 ","$162.80 ","$800.14 ","$222.60 "
"61000028","EAP","CPT� 73221","","Mri Upp Ext Jnt W/o Dye Rt Mri","BOTH IP/OP","$4,976.00 ","$3,682.24 ","$162.80 ","$5,026.00 ","$2,060.10 ","$225.34 ","$1,037.12 ","$1,126.11 ","$1,126.11 ","$880.01 ","$5,026.00 ","$233.72 ","$1,043.00 ","$3,980.59 ","$4,020.80 ","$324.73 ","$786.57 ","$162.80 ","$800.14 ","$222.60 "
"61000030","EAP","CPT� 73222","","Mri Upp Ext Jnt W/dye Bi Mri","BOTH IP/OP","$11,196.00 ","$8,285.04 ","$287.06 ","$11,196.00 ","$2,060.10 ","$700.64 ","$2,333.53 ","$1,126.11 ","$1,126.11 ","$1,960.33 ","$11,196.00 ","$693.78 ","$1,162.00 ","$8,867.23 ","$8,956.80 ","$963.92 ","$1,752.17 ","$287.06 ","$1,782.40 ","$660.75 "
"61000031","EAP","CPT� 73222","","Mri Upp Ext Jnt W/dye Lt Mri","BOTH IP/OP","$5,541.00 ","$4,100.34 ","$287.06 ","$5,597.00 ","$2,060.10 ","$700.64 ","$1,154.88 ","$1,126.11 ","$1,126.11 ","$979.99 ","$5,597.00 ","$693.78 ","$1,162.00 ","$4,432.82 ","$4,477.60 ","$963.92 ","$875.93 ","$287.06 ","$891.04 ","$660.75 "
"61000032","EAP","CPT� 73222","","Mri Upp Ext Jnt W/dye Rt Mri","BOTH IP/OP","$5,541.00 ","$4,100.34 ","$287.06 ","$5,597.00 ","$2,060.10 ","$700.64 ","$1,154.88 ","$1,126.11 ","$1,126.11 ","$979.99 ","$5,597.00 ","$693.78 ","$1,162.00 ","$4,432.82 ","$4,477.60 ","$963.92 ","$875.93 ","$287.06 ","$891.04 ","$660.75 "
"61000033","EAP","CPT� 73223","","Mri Upp Ext Jnt W&wo Dye B Mri","BOTH IP/OP","$13,949.00 ","$10,322.26 ","$0.00 ","$13,949.00 ","$2,060.10 ","$0.00 ","$2,907.32 ","$1,126.11 ","$1,126.11 ","$2,442.36 ","$13,949.00 ","$387.01 ","$1,608.00 ","$11,047.61 ","$11,159.20 ","$537.70 ","$2,183.02 ","$348.65 ","$2,220.68 ","$368.58 "
"61000034","EAP","CPT� 73223","","Mri Uppr Ext Jnt W&wo Dye Lt","BOTH IP/OP","$6,976.00 ","$5,162.24 ","$0.00 ","$6,976.00 ","$0.00 ","$0.00 ","$1,439.38 ","$1,126.11 ","$1,126.11 ","$1,221.44 ","$6,976.00 ","$387.01 ","$1,608.00 ","$5,524.99 ","$5,580.80 ","$537.70 ","$1,091.74 ","$348.65 ","$1,110.58 ","$368.58 "
"61000035","EAP","CPT� 73223","","Mri Uppr Ext Jnt W&wo Dye Rt","BOTH IP/OP","$6,906.00 ","$5,110.44 ","$0.00 ","$6,976.00 ","$2,060.10 ","$0.00 ","$1,439.38 ","$1,126.11 ","$1,126.11 ","$1,221.44 ","$6,976.00 ","$387.01 ","$1,608.00 ","$5,524.99 ","$5,580.80 ","$537.70 ","$1,091.74 ","$348.65 ","$1,110.58 ","$368.58 "
"61000036","EAP","CPT� 73225","","Mra Upp Ext W/wo Dye Bilat","BOTH IP/OP","$27,844.00 ","$20,604.56 ","$0.00 ","$27,844.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,844.00 ","$0.00 ","$6,682.56 ","$22,052.45 ","$22,275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000037","EAP","CPT� 73225","","Mra Upp Ext W/wo Dye Lt","BOTH IP/OP","$13,918.00 ","$10,299.32 ","$0.00 ","$13,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,918.00 ","$0.00 ","$3,340.32 ","$11,023.06 ","$11,134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000038","EAP","CPT� 73225","","Mra Upp Ext W/wo Dye Rt","BOTH IP/OP","$13,918.00 ","$10,299.32 ","$0.00 ","$13,918.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,918.00 ","$0.00 ","$3,340.32 ","$11,023.06 ","$11,134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000040","EAP","CPT� 73718","","Mri Low Ext Nt Jt Wo Dye B Mri","BOTH IP/OP","$11,745.00 ","$8,691.30 ","$192.33 ","$11,745.00 ","$2,060.10 ","$225.34 ","$2,447.95 ","$1,126.11 ","$1,126.11 ","$2,056.46 ","$11,745.00 ","$233.72 ","$1,043.00 ","$9,302.04 ","$9,396.00 ","$324.73 ","$1,838.09 ","$192.33 ","$1,869.80 ","$222.60 "
"61000041","EAP","CPT� 73718","","Mri Low Ext Nt Jt Wo Dye L Mri","BOTH IP/OP","$4,151.00 ","$3,071.74 ","$0.00 ","$4,151.00 ","$0.00 ","$0.00 ","$889.14 ","$1,126.11 ","$1,126.11 ","$726.81 ","$4,151.00 ","$233.72 ","$1,043.00 ","$3,287.59 ","$3,320.80 ","$324.73 ","$649.63 ","$192.33 ","$660.84 ","$222.60 "
"61000042","EAP","CPT� 73718","","Mri Low Ext Nt Jt Wo Dye R Mri","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$192.33 ","$4,151.00 ","$2,060.10 ","$225.34 ","$889.14 ","$1,126.11 ","$1,126.11 ","$726.81 ","$4,151.00 ","$233.72 ","$1,043.00 ","$3,287.59 ","$3,320.80 ","$324.73 ","$649.63 ","$192.33 ","$660.84 ","$222.60 "
"61000043","EAP","CPT� 73719","","Mri Low Ext Nt Jt W/dye B Mri","BOTH IP/OP","$9,248.00 ","$6,843.52 ","$0.00 ","$9,248.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,248.00 ","$0.00 ","$1,162.00 ","$7,324.42 ","$7,398.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000044","EAP","CPT� 73719","","Mri Low Ext Nt Jt W/dye L Mri","BOTH IP/OP","$4,759.00 ","$3,521.66 ","$0.00 ","$4,631.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,631.00 ","$0.00 ","$1,162.00 ","$3,667.75 ","$3,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000045","EAP","CPT� 73719","","Mri Low Ext Nt Jt W/dye R Mri","BOTH IP/OP","$4,759.00 ","$3,521.66 ","$0.00 ","$4,631.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,631.00 ","$0.00 ","$1,162.00 ","$3,667.75 ","$3,704.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000046","EAP","CPT� 73720","","Mri Low Ext Not Jnt W&wo B Mri","BOTH IP/OP","$11,957.00 ","$8,848.18 ","$286.34 ","$11,957.00 ","$2,060.10 ","$360.63 ","$2,492.14 ","$1,126.11 ","$1,126.11 ","$2,093.58 ","$11,957.00 ","$387.01 ","$1,608.00 ","$9,469.94 ","$9,565.60 ","$537.70 ","$1,871.27 ","$286.34 ","$1,903.55 ","$368.58 "
"61000047","EAP","CPT� 73720","","Mri Low Ext Not Jnt W&wo L Mri","BOTH IP/OP","$6,146.00 ","$4,548.04 ","$286.34 ","$5,981.00 ","$2,060.10 ","$360.63 ","$1,280.98 ","$1,126.11 ","$1,126.11 ","$1,047.23 ","$5,981.00 ","$387.01 ","$1,608.00 ","$4,736.95 ","$4,784.80 ","$537.70 ","$936.03 ","$286.34 ","$952.18 ","$368.58 "
"61000048","EAP","CPT� 73720","","Mri Low Ext Not Jnt W&wo R Mri","BOTH IP/OP","$5,981.00 ","$4,425.94 ","$0.00 ","$5,981.00 ","$0.00 ","$0.00 ","$1,280.98 ","$1,126.11 ","$1,126.11 ","$1,047.23 ","$5,981.00 ","$387.01 ","$1,608.00 ","$4,736.95 ","$4,784.80 ","$537.70 ","$936.03 ","$286.34 ","$952.18 ","$368.58 "
"61000050","EAP","CPT� 73721","","Mri Low Ext Jnt W/o Dye Bi Mri","BOTH IP/OP","$8,531.00 ","$6,312.94 ","$162.80 ","$8,302.00 ","$2,060.10 ","$225.34 ","$1,778.07 ","$1,126.11 ","$1,126.11 ","$1,453.61 ","$8,302.00 ","$233.72 ","$1,992.48 ","$6,575.18 ","$6,641.60 ","$324.73 ","$1,299.26 ","$162.80 ","$1,321.68 ","$222.60 "
"61000051","EAP","CPT� 73721","","Mri Low Ext Jnt W/o Dye Lt Mri","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$162.80 ","$4,151.00 ","$2,060.10 ","$225.34 ","$889.14 ","$1,126.11 ","$1,126.11 ","$726.81 ","$4,151.00 ","$233.72 ","$996.24 ","$3,287.59 ","$3,320.80 ","$324.73 ","$649.63 ","$162.80 ","$660.84 ","$222.60 "
"61000052","EAP","CPT� 73721","","Mri Low Ext Jnt W/o Dye Rt Mri","BOTH IP/OP","$4,151.00 ","$3,071.74 ","$0.00 ","$4,151.00 ","$0.00 ","$0.00 ","$889.14 ","$1,126.11 ","$1,126.11 ","$726.81 ","$4,151.00 ","$233.72 ","$996.24 ","$3,287.59 ","$3,320.80 ","$324.73 ","$649.63 ","$162.80 ","$660.84 ","$222.60 "
"61000053","EAP","CPT� 73722","","Mri Low Ext Jnt W/dye Bi Mri","BOTH IP/OP","$8,903.00 ","$6,588.22 ","$0.00 ","$8,903.00 ","$2,060.10 ","$0.00 ","$0.00 ","$1,126.11 ","$1,126.11 ","$1,558.84 ","$8,903.00 ","$693.78 ","$1,162.00 ","$7,051.18 ","$7,122.40 ","$963.92 ","$1,393.32 ","$287.78 ","$1,417.36 ","$660.75 "
"61000054","EAP","CPT� 73722","","Mri Low Ext Jnt W/dye Lt Mri","BOTH IP/OP","$4,578.00 ","$3,387.72 ","$0.00 ","$4,455.00 ","$2,060.10 ","$0.00 ","$0.00 ","$1,126.11 ","$1,126.11 ","$780.03 ","$4,455.00 ","$693.78 ","$1,162.00 ","$3,528.36 ","$3,564.00 ","$963.92 ","$697.21 ","$287.78 ","$709.24 ","$660.75 "
"61000055","EAP","CPT� 73722","","Mri Low Ext Jnt W/dye Rt Mri","BOTH IP/OP","$4,578.00 ","$3,387.72 ","$0.00 ","$4,455.00 ","$2,060.10 ","$0.00 ","$0.00 ","$1,126.11 ","$1,126.11 ","$780.03 ","$4,455.00 ","$693.78 ","$1,162.00 ","$3,528.36 ","$3,564.00 ","$963.92 ","$697.21 ","$287.78 ","$709.24 ","$660.75 "
"61000056","EAP","CPT� 73723","","Mri Low Ext Jnt W&wo Dye B Mri","BOTH IP/OP","$12,288.00 ","$9,093.12 ","$347.93 ","$11,957.00 ","$2,060.10 ","$360.63 ","$2,561.13 ","$1,126.11 ","$1,126.11 ","$2,093.58 ","$11,957.00 ","$387.01 ","$1,608.00 ","$9,469.94 ","$9,565.60 ","$537.70 ","$1,871.27 ","$347.93 ","$1,903.55 ","$368.58 "
"61000057","EAP","CPT� 73723","","Mri Low Ext Jnt W&wo Dye L Mri","BOTH IP/OP","$6,146.00 ","$4,548.04 ","$347.93 ","$5,981.00 ","$2,060.10 ","$360.63 ","$1,280.98 ","$1,126.11 ","$1,126.11 ","$1,047.23 ","$5,981.00 ","$387.01 ","$1,608.00 ","$4,736.95 ","$4,784.80 ","$537.70 ","$936.03 ","$347.93 ","$952.18 ","$368.58 "
"61000058","EAP","CPT� 73723","","Mri Low Ext Jnt W&wo Dye R Mri","BOTH IP/OP","$5,981.00 ","$4,425.94 ","$0.00 ","$5,981.00 ","$0.00 ","$0.00 ","$1,280.98 ","$1,126.11 ","$1,126.11 ","$1,047.23 ","$5,981.00 ","$387.01 ","$1,608.00 ","$4,736.95 ","$4,784.80 ","$537.70 ","$936.03 ","$347.93 ","$952.18 ","$368.58 "
"61000059","EAP","CPT� 74181","","Mri Abdomen W/o Dye","BOTH IP/OP","$5,552.00 ","$4,108.48 ","$153.43 ","$5,593.00 ","$2,060.10 ","$225.34 ","$1,157.18 ","$1,126.11 ","$1,126.11 ","$979.29 ","$5,593.00 ","$233.72 ","$1,043.00 ","$4,429.66 ","$4,474.40 ","$324.73 ","$875.30 ","$153.43 ","$890.41 ","$222.60 "
"61000060","EAP","CPT� 74182","","Mri Abdomen W/ Dye","BOTH IP/OP","$5,491.00 ","$4,063.34 ","$267.97 ","$5,532.00 ","$2,060.10 ","$360.63 ","$1,144.46 ","$1,126.11 ","$1,126.11 ","$968.61 ","$5,532.00 ","$387.01 ","$1,162.00 ","$4,381.34 ","$4,425.60 ","$537.70 ","$865.76 ","$267.97 ","$880.69 ","$368.58 "
"61000062","EAP","CPT� 74183","","Mri Abdomen W&wo Dye","BOTH IP/OP","$6,073.00 ","$4,494.02 ","$284.90 ","$6,118.00 ","$2,060.10 ","$360.63 ","$1,265.77 ","$1,126.11 ","$1,126.11 ","$1,071.21 ","$6,118.00 ","$387.01 ","$1,608.00 ","$4,845.46 ","$4,894.40 ","$537.70 ","$957.47 ","$284.90 ","$973.99 ","$368.58 "
"61000063","EAP","CPT� 74185","","Mra Abdomen Wo Cont","BOTH IP/OP","$3,369.00 ","$2,493.06 ","$0.00 ","$3,394.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,394.00 ","$0.00 ","$814.56 ","$2,688.05 ","$2,715.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000064","EAP","CPT� 75557","","Mri Card Morph W/o Cont","BOTH IP/OP","$3,922.00 ","$2,902.28 ","$0.00 ","$3,962.00 ","$2,060.10 ","$225.34 ","$817.44 ","$0.00 ","$0.00 ","$0.00 ","$3,962.00 ","$0.00 ","$950.88 ","$3,137.90 ","$3,169.60 ","$0.00 ","$620.05 ","$0.00 ","$0.00 ","$0.00 "
"61000065","EAP","CPT� 75559","","Mri Card Morph W/o W/stress","BOTH IP/OP","$3,112.00 ","$2,302.88 ","$0.00 ","$3,112.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,112.00 ","$0.00 ","$746.88 ","$2,464.70 ","$2,489.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000066","EAP","CPT� 75561","","Mri Card Morph W&w/o","BOTH IP/OP","$4,708.00 ","$3,483.92 ","$295.70 ","$4,756.00 ","$2,060.10 ","$360.63 ","$981.26 ","$1,126.11 ","$1,126.11 ","$832.74 ","$4,756.00 ","$387.01 ","$1,141.44 ","$3,766.75 ","$3,804.80 ","$537.70 ","$744.31 ","$295.70 ","$757.16 ","$368.58 "
"61000067","EAP","CPT� 75563","","Mri Card Morph W&w/o W/stress","BOTH IP/OP","$5,552.00 ","$4,108.48 ","$0.00 ","$5,552.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,552.00 ","$0.00 ","$1,332.48 ","$4,397.18 ","$4,441.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000068","EAP","CPT� 76390","","Mri Spectroscopy","BOTH IP/OP","$4,990.00 ","$3,692.60 ","$0.00 ","$4,612.00 ","$2,060.10 ","$0.00 ","$1,040.04 ","$1,126.11 ","$1,126.11 ","$807.52 ","$4,612.00 ","$0.00 ","$1,106.88 ","$3,652.70 ","$3,689.60 ","$2,767.20 ","$721.78 ","$0.00 ","$734.23 ","$0.00 "
"61000069","EAP","HCPCS C8900","","Mra Abdomen W Dye","BOTH IP/OP","$4,319.00 ","$3,196.06 ","$0.00 ","$4,351.00 ","$0.00 ","$360.63 ","$900.19 ","$1,126.11 ","$1,126.11 ","$761.83 ","$4,351.00 ","$387.01 ","$2,175.50 ","$3,445.99 ","$3,480.80 ","$537.70 ","$680.93 ","$0.00 ","$692.68 ","$368.58 "
"61000070","EAP","HCPCS C8901","","Mra Abdomen W/o Dye","BOTH IP/OP","$2,291.00 ","$1,695.34 ","$0.00 ","$2,308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,308.00 ","$0.00 ","$1,154.00 ","$1,827.94 ","$1,846.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000071","EAP","HCPCS C8909","","Mra Chest W Dye","BOTH IP/OP","$4,649.00 ","$3,440.26 ","$0.00 ","$4,696.00 ","$2,524.41 ","$360.63 ","$968.97 ","$1,126.11 ","$1,126.11 ","$822.23 ","$4,696.00 ","$387.01 ","$2,348.00 ","$3,719.23 ","$3,756.80 ","$537.70 ","$0.00 ","$0.00 ","$747.60 ","$368.58 "
"61000072","EAP","HCPCS C8910","","Mra Chest W/o Dye","BOTH IP/OP","$5,409.00 ","$4,002.66 ","$0.00 ","$5,464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,464.00 ","$0.00 ","$2,732.00 ","$4,327.49 ","$4,371.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000073","EAP","HCPCS C8914","","Mra Low Ext W&wo Dye Bi Mri","BOTH IP/OP","$4,133.00 ","$3,058.42 ","$0.00 ","$4,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,133.00 ","$0.00 ","$2,066.50 ","$3,273.34 ","$3,306.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000074","EAP","HCPCS C8914","","Mra Low Ext W&wo Dye Lt","BOTH IP/OP","$2,898.00 ","$2,144.52 ","$0.00 ","$2,898.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,898.00 ","$0.00 ","$1,449.00 ","$2,295.22 ","$2,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000075","EAP","HCPCS C8914","","Mra Low Ext W/wo Dye Rt","BOTH IP/OP","$2,898.00 ","$2,144.52 ","$0.00 ","$2,898.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,898.00 ","$0.00 ","$1,449.00 ","$2,295.22 ","$2,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000077","EAP","HCPCS C8903","","Mri W/cont, Brst, Uni, Mri","BOTH IP/OP","$1,389.00 ","$1,027.86 ","$0.00 ","$1,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,736.00 ","$0.00 ","$868.00 ","$1,374.91 ","$1,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000081","EAP","HCPCS C8905","","Mri W/ofol W/con,brst,uni,mri","BOTH IP/OP","$1,753.00 ","$1,297.22 ","$0.00 ","$2,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,191.00 ","$0.00 ","$1,095.50 ","$1,735.27 ","$1,752.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000082","EAP","HCPCS C8906","","Mri W/con, Brst, Bi,mri","BOTH IP/OP","$1,389.00 ","$1,027.86 ","$0.00 ","$1,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,736.00 ","$0.00 ","$868.00 ","$1,374.91 ","$1,388.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000087","EAP","HCPCS C8908","","Mri W/ofol W/con, Brst, Bi,mri","BOTH IP/OP","$4,339.00 ","$3,210.86 ","$0.00 ","$4,383.00 ","$1,122.00 ","$360.63 ","$904.36 ","$1,126.11 ","$1,126.11 ","$767.43 ","$4,383.00 ","$387.01 ","$2,191.50 ","$3,471.34 ","$3,506.40 ","$537.70 ","$685.94 ","$0.00 ","$697.77 ","$368.58 "
"61000090","EAP","CPT� 72220","","Cervical Spine Flex Ext Nir","BOTH IP/OP","$488.00 ","$361.12 ","$22.69 ","$610.00 ","$63.70 ","$79.21 ","$101.71 ","$610.00 ","$610.00 ","$106.81 ","$610.00 ","$80.04 ","$146.40 ","$483.12 ","$488.00 ","$111.21 ","$95.47 ","$22.69 ","$97.11 ","$76.23 "
"61000098","EAP","CPT� 76376","","3d Rendering W/o Postproce Mri","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$2,033.00 ","$1,404.90 ","$0.00 ","$345.78 ","$1,126.11 ","$1,126.11 ","$355.96 ","$2,033.00 ","$0.00 ","$487.92 ","$1,610.14 ","$1,626.40 ","$0.00 ","$318.16 ","$13.33 ","$323.65 ","$0.00 "
"61000099","EAP","CPT� 76377","","3d Rendering W/postprocess Mri","BOTH IP/OP","$2,033.00 ","$1,504.42 ","$0.00 ","$2,033.00 ","$0.00 ","$0.00 ","$458.54 ","$1,126.11 ","$1,126.11 ","$355.96 ","$2,033.00 ","$0.00 ","$487.92 ","$1,610.14 ","$1,626.40 ","$0.00 ","$318.16 ","$32.41 ","$323.65 ","$0.00 "
"61000110","EAP","CPT� 77021","","Mri Guide Needle Place, Cbc","BOTH IP/OP","$3,150.00 ","$2,331.00 ","$0.00 ","$3,150.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,150.00 ","$0.00 ","$756.00 ","$2,494.80 ","$2,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000116","EAP","HCPCS C8932","","Mra, W/o Dye, Spinal Canal","BOTH IP/OP","$4,243.00 ","$3,139.82 ","$0.00 ","$4,243.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,243.00 ","$0.00 ","$2,121.50 ","$3,360.46 ","$3,394.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000117","EAP","HCPCS C8933","","Mra, W/o&w/dye, Spinal Canal","BOTH IP/OP","$3,605.00 ","$2,667.70 ","$0.00 ","$3,605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,605.00 ","$0.00 ","$1,802.50 ","$2,855.16 ","$2,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000118","EAP","HCPCS C8934","","Mra, W/dye, Upper Extremity","BOTH IP/OP","$4,210.00 ","$3,115.40 ","$0.00 ","$4,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,210.00 ","$0.00 ","$2,105.00 ","$3,334.32 ","$3,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000119","EAP","HCPCS C8935","","Mra, W/odye, Upper Extremity","BOTH IP/OP","$4,210.00 ","$3,115.40 ","$0.00 ","$4,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,210.00 ","$0.00 ","$2,105.00 ","$3,334.32 ","$3,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000120","EAP","HCPCS C8936","","Mra, W/o&w/dye, Upper Extremity","BOTH IP/OP","$4,210.00 ","$3,115.40 ","$0.00 ","$4,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,210.00 ","$0.00 ","$2,105.00 ","$3,334.32 ","$3,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000121","EAP","CPT� 73725","","Mri Ang Lwr Ext W Or W/o Dye","BOTH IP/OP","$3,816.00 ","$2,823.84 ","$0.00 ","$3,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,816.00 ","$0.00 ","$915.84 ","$3,022.27 ","$3,052.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000122","EAP","CPT� 77021","","Mri Guidance For Needle Placement","BOTH IP/OP","$3,150.00 ","$2,331.00 ","$0.00 ","$3,150.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,150.00 ","$0.00 ","$756.00 ","$2,494.80 ","$2,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000124","EAP","CPT� 77048","","Mri Breast W And/or Wo Cont Incl Cad Uni","BOTH IP/OP","$491.00 ","$363.34 ","$0.00 ","$491.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$491.00 ","$0.00 ","$117.84 ","$388.87 ","$392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000125","EAP","CPT� 77049","","Mri Breast W And/or Wo Cont Incl Cad Bil","BOTH IP/OP","$491.00 ","$363.34 ","$0.00 ","$491.00 ","$491.00 ","$335.44 ","$102.34 ","$0.00 ","$0.00 ","$0.00 ","$491.00 ","$0.00 ","$117.84 ","$388.87 ","$392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61000126","EAP","CPT� 77047","","Mri Breast Without Contrast Material Bilateral","BOTH IP/OP","$2,874.00 ","$2,126.76 ","$173.24 ","$2,874.00 ","$1,122.00 ","$225.34 ","$599.01 ","$1,126.11 ","$1,126.11 ","$503.21 ","$2,874.00 ","$233.72 ","$689.76 ","$2,276.21 ","$2,299.20 ","$324.73 ","$449.78 ","$173.24 ","$457.54 ","$222.60 "
"61000127","EAP","CPT� 77046","","MRI BREAST WO CONTRAST UNI","BOTH IP/OP","$554.00 ","$409.96 ","$0.00 ","$554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$554.00 ","$0.00 ","$132.96 ","$438.77 ","$443.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61100001","EAP","CPT� 70551","","Mri Brain W/o Dye","BOTH IP/OP","$5,561.00 ","$4,115.14 ","$150.19 ","$5,287.00 ","$2,060.10 ","$225.34 ","$1,159.05 ","$1,126.11 ","$1,126.11 ","$925.71 ","$5,287.00 ","$233.72 ","$1,043.00 ","$4,187.30 ","$4,229.60 ","$324.73 ","$827.42 ","$150.19 ","$841.69 ","$222.60 "
"61100003","EAP","CPT� 70552","","Mri Brain W/dye","BOTH IP/OP","$6,193.00 ","$4,582.82 ","$0.00 ","$5,888.00 ","$2,060.10 ","$0.00 ","$1,290.78 ","$1,126.11 ","$1,126.11 ","$1,030.94 ","$5,888.00 ","$387.01 ","$1,162.00 ","$4,663.30 ","$4,710.40 ","$537.70 ","$921.47 ","$221.87 ","$937.37 ","$368.58 "
"61100005","EAP","CPT� 70553","","Mri Brain W&wo Dye","BOTH IP/OP","$8,010.00 ","$5,927.40 ","$252.84 ","$7,615.00 ","$2,060.10 ","$360.63 ","$1,669.48 ","$1,126.11 ","$1,126.11 ","$1,333.33 ","$7,615.00 ","$387.01 ","$1,608.00 ","$6,031.08 ","$6,092.00 ","$537.70 ","$1,191.75 ","$252.84 ","$1,212.31 ","$368.58 "
"61200001","EAP","CPT� 72141","","Mri Cervical Spine W/o Dye","BOTH IP/OP","$5,640.00 ","$4,173.60 ","$144.07 ","$5,319.00 ","$2,060.10 ","$225.34 ","$1,175.52 ","$1,126.11 ","$1,126.11 ","$931.31 ","$5,319.00 ","$233.72 ","$1,043.00 ","$4,212.65 ","$4,255.20 ","$324.73 ","$832.42 ","$144.07 ","$846.78 ","$222.60 "
"61200004","EAP","CPT� 72142","","Mri Cervical Spine W Contrast","BOTH IP/OP","$6,282.00 ","$4,648.68 ","$0.00 ","$5,924.00 ","$2,060.10 ","$0.00 ","$1,309.33 ","$0.00 ","$0.00 ","$0.00 ","$5,924.00 ","$0.00 ","$1,162.00 ","$4,691.81 ","$4,739.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61200005","EAP","CPT� 72146","","Mri Thoracic Spine W/o Dye","BOTH IP/OP","$4,510.00 ","$3,337.40 ","$144.07 ","$4,325.00 ","$2,060.10 ","$225.34 ","$940.00 ","$1,126.11 ","$1,126.11 ","$757.27 ","$4,325.00 ","$233.72 ","$1,038.00 ","$3,425.40 ","$3,460.00 ","$324.73 ","$676.86 ","$144.07 ","$688.54 ","$222.60 "
"61200006","EAP","CPT� 72147","","Mri Thoracic Spine W/dye","BOTH IP/OP","$5,023.00 ","$3,717.02 ","$0.00 ","$4,817.00 ","$2,060.10 ","$0.00 ","$0.00 ","$1,126.11 ","$1,126.11 ","$843.42 ","$4,817.00 ","$387.01 ","$1,162.00 ","$3,815.06 ","$3,853.60 ","$537.70 ","$753.86 ","$226.55 ","$766.87 ","$368.58 "
"61200007","EAP","CPT� 72148","","Mri Lumbar Spine W/o Dye","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$144.43 ","$4,307.00 ","$2,060.10 ","$225.34 ","$888.72 ","$1,126.11 ","$1,126.11 ","$754.12 ","$4,307.00 ","$233.72 ","$1,043.00 ","$3,411.14 ","$3,445.60 ","$324.73 ","$674.05 ","$144.43 ","$685.67 ","$222.60 "
"61200008","EAP","CPT� 72149","","Mri Lumbar Spine W/ Dye","BOTH IP/OP","$4,587.00 ","$3,394.38 ","$0.00 ","$4,633.00 ","$2,060.10 ","$0.00 ","$0.00 ","$1,126.11 ","$1,126.11 ","$811.20 ","$4,633.00 ","$387.01 ","$1,162.00 ","$3,669.34 ","$3,706.40 ","$537.70 ","$725.06 ","$223.67 ","$737.57 ","$368.58 "
"61200009","EAP","CPT� 72156","","Mri Cervical Spine W&wo Dye","BOTH IP/OP","$8,124.00 ","$6,011.76 ","$255.72 ","$7,662.00 ","$2,060.10 ","$360.63 ","$1,693.24 ","$1,126.11 ","$1,126.11 ","$1,341.55 ","$7,662.00 ","$387.01 ","$1,608.00 ","$6,068.30 ","$6,129.60 ","$537.70 ","$1,199.10 ","$255.72 ","$1,219.79 ","$368.58 "
"61200010","EAP","CPT� 72157","","Mri Thoracic Spine W&wo Dye","BOTH IP/OP","$6,499.00 ","$4,809.26 ","$256.44 ","$6,232.00 ","$2,060.10 ","$360.63 ","$1,354.55 ","$1,126.11 ","$1,126.11 ","$1,091.17 ","$6,232.00 ","$387.01 ","$1,495.68 ","$4,935.74 ","$4,985.60 ","$537.70 ","$975.31 ","$256.44 ","$992.13 ","$368.58 "
"61200011","EAP","CPT� 72158","","Mri Lumbar Spine W&wo Dye","BOTH IP/OP","$6,144.00 ","$4,546.56 ","$255.00 ","$6,206.00 ","$2,060.10 ","$360.63 ","$1,280.56 ","$1,126.11 ","$1,126.11 ","$1,086.62 ","$6,206.00 ","$387.01 ","$1,608.00 ","$4,915.15 ","$4,964.80 ","$537.70 ","$971.24 ","$255.00 ","$988.00 ","$368.58 "
"61200012","EAP","CPT� 72195","","Mri Pelvis W/o Dye","BOTH IP/OP","$4,089.00 ","$3,025.86 ","$194.85 ","$4,087.00 ","$2,060.10 ","$225.34 ","$852.25 ","$1,126.11 ","$1,126.11 ","$715.60 ","$4,087.00 ","$233.72 ","$1,043.00 ","$3,236.90 ","$3,269.60 ","$324.73 ","$639.62 ","$194.85 ","$650.65 ","$222.60 "
"61200013","EAP","CPT� 72196","","Mri Pelvis W/ Dye","BOTH IP/OP","$4,633.00 ","$3,428.42 ","$226.19 ","$4,631.00 ","$2,060.10 ","$360.63 ","$965.63 ","$1,126.11 ","$1,126.11 ","$810.85 ","$4,631.00 ","$387.01 ","$1,162.00 ","$3,667.75 ","$3,704.80 ","$537.70 ","$724.75 ","$226.19 ","$737.26 ","$368.58 "
"61200014","EAP","CPT� 72197","","Mri Pelvis W&wo Dye","BOTH IP/OP","$5,028.00 ","$3,720.72 ","$284.18 ","$5,025.00 ","$2,060.10 ","$360.63 ","$1,047.96 ","$1,126.11 ","$1,126.11 ","$879.84 ","$5,025.00 ","$387.01 ","$1,608.00 ","$3,979.80 ","$4,020.00 ","$537.70 ","$786.41 ","$284.18 ","$799.98 ","$368.58 "
"61400000","EAP","CPT� 75565","","Mr Cardiac Mri For Velocity Flow Mapping","BOTH IP/OP","$2,506.00 ","$1,854.44 ","$0.00 ","$2,506.00 ","$2,060.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,506.00 ","$0.00 ","$601.44 ","$1,984.75 ","$2,004.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61800010","EAP","HCPCS C8902","","Mra W/o Fol W/cont, Abd, Cbc","BOTH IP/OP","$1,744.00 ","$1,290.56 ","$0.00 ","$1,744.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,744.00 ","$0.00 ","$872.00 ","$1,381.25 ","$1,395.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62200001","EAP","Custom 62200001","","Intro Aortic Balloons","BOTH IP/OP","$5,547.00 ","$4,104.78 ","$0.00 ","$5,547.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,547.00 ","$0.00 ","$2,773.50 ","$4,393.22 ","$4,437.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62300002","EAP","HCPCS A6234","","Hydrocolloid Dsg 16 Sq In Or Less","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62300003","EAP","HCPCS A6235","","Hydrocolloid Dsg more than 16sq in","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.94 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$20.50 ","$0.00 ","$20.86 ","$0.00 "
"62300006","EAP","HCPCS A6196","","Alginate Dressing <= 16 Sq In","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.70 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$6.89 ","$0.00 ","$7.00 ","$0.00 "
"62400002","EAP","Custom 62400002","","Trevo Retriever-ide#g100056","BOTH IP/OP","$4,937.00 ","$3,653.38 ","$0.00 ","$4,937.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,937.00 ","$0.00 ","$2,468.50 ","$3,910.10 ","$3,949.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62400003","EAP","Custom 62400003","","Trevo 18 Microcatheter-ide#g100056","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600011","EAP","CPT� 90670","","PNEUMONIA VACCINE PREVNAR","BOTH IP/OP","$30.00 ","$22.20 ","$4.38 ","$252.18 ","$13.50 ","$230.14 ","$6.25 ","$21.41 ","$21.41 ","$252.18 ","$30.00 ","$4.38 ","$15.00 ","$23.76 ","$24.00 ","$4.38 ","$252.18 ","$7.80 ","$240.12 ","$7.80 "
"63600012","EAP","CPT� 90732","","PNEUMONIA VACCINE PNEUMOVAX","BOTH IP/OP","$30.00 ","$22.20 ","$4.38 ","$134.20 ","$13.50 ","$119.92 ","$9.40 ","$21.41 ","$21.41 ","$134.20 ","$30.00 ","$4.38 ","$15.00 ","$23.76 ","$24.00 ","$4.38 ","$134.20 ","$7.80 ","$127.78 ","$7.80 "
"63600022","EAP","CPT� 90651","","GARDASIL-9 VACCINE","BOTH IP/OP","$493.00 ","$364.82 ","$0.00 ","$493.00 ","$221.85 ","$229.60 ","$102.75 ","$351.85 ","$351.85 ","$267.82 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$295.80 ","$267.82 ","$0.00 ","$255.01 ","$0.00 "
"63600025","EAP","HCPCS J2182","","Rx Eap Nucala Charge","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$7,432.00 ","$36.00 ","$28.69 ","$16.67 ","$5,158.80 ","$5,304.22 ","$34.42 ","$7,432.00 ","$31.21 ","$3,716.00 ","$5,886.14 ","$5,945.60 ","$43.09 ","$34.42 ","$0.00 ","$32.77 ","$29.72 "
"63600101","EAP","HCPCS A9562","","Rad-99mtc Mag 3(ren)-pr","BOTH IP/OP","$784.00 ","$580.16 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$163.41 ","$249.80 ","$249.80 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"63600104","EAP","HCPCS J7197","","Anti-thrombin Iii","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$4.28 ","$4.28 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600112","EAP","HCPCS J0881","","Darbepoetin Alfa 1","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$3.09 ","$3.60 ","$11.42 ","$11.42 ","$4.49 ","$16.00 ","$4.04 ","$8.00 ","$12.67 ","$12.80 ","$5.59 ","$4.49 ","$0.00 ","$4.27 ","$3.79 "
"63600116","EAP","HCPCS J7189","","Factor 7a Novoseven","BOTH IP/OP","$5.00 ","$3.70 ","$0.00 ","$5.00 ","$0.00 ","$0.00 ","$0.00 ","$3.57 ","$3.57 ","$0.00 ","$5.00 ","$0.00 ","$2.50 ","$3.96 ","$4.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600119","EAP","HCPCS A9552","","Fdg Unit Dose (supp","BOTH IP/OP","$1,722.00 ","$1,274.28 ","$0.00 ","$1,722.00 ","$0.00 ","$0.00 ","$358.91 ","$1,228.99 ","$1,228.99 ","$301.51 ","$1,722.00 ","$0.00 ","$861.00 ","$1,363.82 ","$1,377.60 ","$0.00 ","$227.28 ","$0.00 ","$274.14 ","$0.00 "
"63600120","EAP","HCPCS A9556","","Ga-67 Gallium Citra","BOTH IP/OP","$169.00 ","$125.06 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$34.97 ","$34.97 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600122","EAP","HCPCS A9517","","I131 Therapy, 1mci","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$190.05 ","$190.05 ","$20.12 ","$72.95 ","$42.82 ","$42.82 ","$10.51 ","$60.00 ","$21.80 ","$30.00 ","$47.52 ","$48.00 ","$30.10 ","$9.39 ","$0.00 ","$9.55 ","$20.69 "
"63600133","EAP","HCPCS J1885","","Ketorolac 15mg Inj","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$15.30 ","$0.00 ","$0.32 ","$24.27 ","$24.27 ","$0.61 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"63600134","EAP","HCPCS J1885","","Ketorolac 30mg","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$15.30 ","$0.00 ","$0.32 ","$24.27 ","$24.27 ","$0.61 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"63600138","EAP","HCPCS J0561","","Penicillin G Benzathine Inj","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$13.50 ","$15.04 ","$6.25 ","$21.41 ","$21.41 ","$16.17 ","$30.00 ","$14.51 ","$15.00 ","$23.76 ","$24.00 ","$20.04 ","$16.17 ","$0.00 ","$15.39 ","$13.82 "
"63600146","EAP","HCPCS Q9967","","Locm 300-349mg/ml I","BOTH IP/OP","$2.00 ","$1.48 ","$0.00 ","$2.00 ","$0.90 ","$0.00 ","$0.42 ","$1.43 ","$1.43 ","$0.14 ","$2.00 ","$0.00 ","$1.00 ","$1.58 ","$1.60 ","$0.00 ","$0.13 ","$0.00 ","$0.32 ","$0.00 "
"63600170","EAP","HCPCS J0561","","Penicillin G Benz L","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$71.10 ","$15.04 ","$32.93 ","$112.76 ","$112.76 ","$16.17 ","$158.00 ","$14.51 ","$79.00 ","$125.14 ","$126.40 ","$20.04 ","$16.17 ","$0.00 ","$15.39 ","$13.82 "
"63600174","EAP","HCPCS J0561","","Penicillin G Benz L","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$159.00 ","$71.55 ","$15.04 ","$33.14 ","$113.48 ","$113.48 ","$16.17 ","$159.00 ","$14.51 ","$79.50 ","$125.93 ","$127.20 ","$20.04 ","$16.17 ","$0.00 ","$15.39 ","$13.82 "
"63600182","EAP","HCPCS J2820","","Sargramostim 50mcg","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$124.18 ","$124.18 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600209","EAP","HCPCS A9551","","Tc-99m Dmsa Nuc","BOTH IP/OP","$1,886.00 ","$1,395.64 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$438.93 ","$438.93 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600210","EAP","HCPCS A9600","","Sr-89 Therapy Radio","BOTH IP/OP","$3,784.00 ","$2,800.16 ","$0.00 ","$3,784.00 ","$0.00 ","$0.00 ","$0.00 ","$2,700.64 ","$2,700.64 ","$0.00 ","$3,784.00 ","$0.00 ","$1,892.00 ","$2,996.93 ","$3,027.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600211","EAP","HCPCS A9604","","Sm 153 Lexidronam 5","BOTH IP/OP","$48,815.00 ","$36,123.10 ","$0.00 ","$13,509.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,509.00 ","$0.00 ","$6,754.50 ","$10,699.13 ","$10,807.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600212","EAP","HCPCS A9548","","In 111pentetate Dtp","BOTH IP/OP","$7,022.00 ","$5,196.28 ","$0.00 ","$3,094.00 ","$0.00 ","$0.00 ","$0.00 ","$2,208.19 ","$2,208.19 ","$0.00 ","$3,094.00 ","$0.00 ","$1,547.00 ","$2,450.45 ","$2,475.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600324","EAP","CPT� 90632","","HEP A VACCINE","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$32.40 ","$0.00 ","$56.67 ","$51.39 ","$51.39 ","$70.39 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$0.00 ","$70.39 ","$0.00 ","$67.03 ","$0.00 "
"63600325","EAP","CPT� 90633","","HEPA VACCINE PED/ADOL 2 DOSE IM","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$32.40 ","$0.00 ","$9.40 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$0.00 ","$11.27 ","$0.00 ","$11.46 ","$0.00 "
"63600326","EAP","CPT� 90636","","HEP A/B TWINRX VACCINE","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$122.20 ","$44.10 ","$0.00 ","$107.88 ","$69.94 ","$69.94 ","$122.20 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$0.00 ","$122.20 ","$0.00 ","$116.36 ","$0.00 "
"63600327","EAP","CPT� 90647","","PEDVAXHIB VACCINE","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$17.10 ","$0.00 ","$0.00 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"63600335","EAP","CPT� 90675","","RABIES VACCINE","BOTH IP/OP","$1,011.00 ","$748.14 ","$0.00 ","$1,011.00 ","$454.95 ","$341.95 ","$174.76 ","$721.55 ","$721.55 ","$326.44 ","$1,011.00 ","$312.47 ","$505.50 ","$800.71 ","$808.80 ","$431.50 ","$326.44 ","$0.00 ","$310.83 ","$294.72 "
"63600336","EAP","CPT� 90680","","ROTAVIRUS 3 DOSE VACCINE","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$48.60 ","$0.00 ","$22.51 ","$77.08 ","$77.08 ","$18.91 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$16.90 ","$0.00 ","$17.19 ","$0.00 "
"63600337","EAP","CPT� 90698","","PENTACEL VACCINE","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$92.78 ","$92.78 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"63600338","EAP","CPT� 90700","","DTAP VACCINE","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$38.00 ","$17.10 ","$0.00 ","$7.92 ","$27.12 ","$27.12 ","$6.65 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$5.95 ","$0.00 ","$6.05 ","$0.00 "
"63600344","EAP","CPT� 90707","","MMR VACCINE","BOTH IP/OP","$83.00 ","$61.42 ","$0.00 ","$92.45 ","$37.35 ","$0.00 ","$11.75 ","$59.24 ","$59.24 ","$92.45 ","$83.00 ","$0.00 ","$41.50 ","$65.74 ","$66.40 ","$0.00 ","$92.45 ","$0.00 ","$88.03 ","$0.00 "
"63600346","EAP","CPT� 90710","","MMRV VACCINE","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$8.55 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$2.97 ","$0.00 ","$3.02 ","$0.00 "
"63600348","EAP","CPT� 90713","","POLIO VACCINE","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$32.00 ","$14.40 ","$0.00 ","$9.40 ","$22.84 ","$22.84 ","$0.00 ","$32.00 ","$0.00 ","$16.00 ","$25.34 ","$25.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600349","EAP","CPT� 90714","","TENIVAC VACCINE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$13.50 ","$0.00 ","$11.75 ","$21.41 ","$21.41 ","$29.50 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$29.50 ","$0.00 ","$28.09 ","$0.00 "
"63600350","EAP","CPT� 90715","","TDAP VACCINE","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$24.30 ","$0.00 ","$11.25 ","$38.54 ","$38.54 ","$39.53 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$39.53 ","$0.00 ","$37.64 ","$0.00 "
"63600351","EAP","CPT� 90716","","VARICELLA VACCINE","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$186.30 ","$136.66 ","$9.40 ","$295.47 ","$295.47 ","$159.48 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$248.40 ","$159.48 ","$0.00 ","$151.85 ","$0.00 "
"63600355","EAP","CPT� 90723","","DTAP HEPB VACCINE","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$108.00 ","$48.60 ","$79.00 ","$22.51 ","$77.08 ","$77.08 ","$18.91 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$64.80 ","$16.90 ","$0.00 ","$17.19 ","$0.00 "
"63600360","EAP","CPT� 90746","","HEP B VACCINE ADULT 3 DOSE","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$103.50 ","$69.65 ","$70.16 ","$164.15 ","$164.15 ","$78.80 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$138.00 ","$78.80 ","$59.80 ","$75.03 ","$59.80 "
"63600374","EAP","HCPCS J0561","","Penicillin G Benz La 1.2 Mu","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$159.00 ","$71.55 ","$15.04 ","$33.14 ","$113.48 ","$113.48 ","$16.17 ","$159.00 ","$14.51 ","$79.50 ","$125.93 ","$127.20 ","$20.04 ","$16.17 ","$0.00 ","$15.39 ","$13.82 "
"63600380","EAP","HCPCS J0131","","Acetaminophen, Iv 1000mg/100 Ml","BOTH IP/OP","$58.00 ","$42.92 ","$0.00 ","$58.00 ","$0.00 ","$0.00 ","$0.00 ","$41.39 ","$41.39 ","$0.00 ","$58.00 ","$0.00 ","$29.00 ","$45.94 ","$46.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600381","EAP","HCPCS J0461","","Atropine 0.4mg/ml,20 Ml","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$88.50 ","$88.50 ","$0.09 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$0.09 ","$0.00 ","$0.09 ","$0.00 "
"63600382","EAP","HCPCS J0690","","Cefazolin Sodium, 1 Gm Vial","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.69 ","$11.42 ","$11.42 ","$0.96 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"63600383","EAP","HCPCS S0077","","Clindamycin Phosphate, 300 Mg","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$17.55 ","$1.35 ","$3.54 ","$27.83 ","$27.83 ","$1.65 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$23.40 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"63600384","EAP","HCPCS J1100","","Dexamethasone,4mg/ml 5ml","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.11 ","$11.42 ","$11.42 ","$0.14 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.14 ","$0.00 ","$0.13 ","$0.00 "
"63600385","EAP","HCPCS J1200","","Diphenhydramine  Hci  Up To 50 Mg","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.86 ","$11.42 ","$11.42 ","$1.06 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$1.06 ","$0.00 ","$1.01 ","$0.00 "
"63600386","EAP","HCPCS J0171","","Epinephrine1 Mg/1 Ml, 30 Ml","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$12.15 ","$0.00 ","$5.63 ","$19.27 ","$19.27 ","$0.96 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"63600387","EAP","HCPCS J1940","","Furosemide, Up To 20 Mg","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.25 ","$11.42 ","$11.42 ","$0.69 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"63600388","EAP","HCPCS J1644","","Heparin Sodium, Per 1000 Units/ml, 10 Ml","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.24 ","$11.42 ","$11.42 ","$0.28 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"63600389","EAP","HCPCS J0360","","Hydralazine  Hci, Up To 20 Mg","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$21.15 ","$0.00 ","$5.77 ","$33.54 ","$33.54 ","$4.41 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$4.41 ","$0.00 ","$4.20 ","$0.00 "
"63600390","EAP","HCPCS J1720","","Hydrocortisone Sod Succ Up, To 100","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$8.55 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$15.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$15.33 ","$0.00 ","$14.60 ","$0.00 "
"63600391","EAP","HCPCS J1885","","Ketorolac 60mg/2ml","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.32 ","$11.42 ","$11.42 ","$0.61 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"63600392","EAP","HCPCS J2405","","Ondansetron Hci, Per 1mg","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.25 ","$11.42 ","$11.42 ","$0.11 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.11 ","$0.00 ","$0.10 ","$0.00 "
"63600393","EAP","HCPCS J2590","","Oxytocin, Up To 10 Units","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$1.47 ","$11.42 ","$11.42 ","$2.80 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$2.50 ","$0.00 ","$2.55 ","$0.00 "
"63600394","EAP","HCPCS J2370","","Phenylephrine 10mg/ml, 1ml","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$21.15 ","$0.00 ","$0.96 ","$33.54 ","$33.54 ","$4.31 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"63600395","EAP","HCPCS J0330","","Succinylcholine Chloride, Up To 20 Mg/ml,10 Ml","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$6.88 ","$23.55 ","$23.55 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"63600396","EAP","HCPCS J3370","","Vancomycin 1gm Vial","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$10.80 ","$0.00 ","$3.62 ","$17.13 ","$17.13 ","$3.98 ","$24.00 ","$0.00 ","$12.00 ","$19.01 ","$19.20 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"63600402","EAP","HCPCS J2791","","Njx, Rho(d) Immune Globulin (human), (rhophylac)","BOTH IP/OP","$534.00 ","$395.16 ","$0.00 ","$534.00 ","$240.30 ","$0.00 ","$111.30 ","$381.12 ","$381.12 ","$5.59 ","$534.00 ","$0.00 ","$267.00 ","$422.93 ","$427.20 ","$0.00 ","$0.00 ","$0.00 ","$5.33 ","$0.00 "
"63600404","EAP","HCPCS J7194","","Factor 9","BOTH IP/OP","$2.00 ","$1.48 ","$0.00 ","$2.00 ","$0.00 ","$0.00 ","$0.00 ","$1.43 ","$1.43 ","$0.00 ","$2.00 ","$0.00 ","$1.00 ","$1.58 ","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600405","EAP","HCPCS J2790","","Rh Immune Globulin- 300 Mcg","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$58.95 ","$0.00 ","$101.36 ","$93.49 ","$93.49 ","$87.71 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$87.71 ","$0.00 ","$83.52 ","$0.00 "
"63600460","EAP","HCPCS J7189","","Novoseven F7 1.0","BOTH IP/OP","$5,380.00 ","$3,981.20 ","$0.00 ","$5,380.00 ","$0.00 ","$0.00 ","$0.00 ","$3,839.71 ","$3,839.71 ","$0.00 ","$5,380.00 ","$0.00 ","$2,690.00 ","$4,260.96 ","$4,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600461","EAP","HCPCS J7189","","Novoseven F7 2.0","BOTH IP/OP","$10,222.00 ","$7,564.28 ","$0.00 ","$10,222.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$7,295.44 ","$0.00 ","$10,222.00 ","$0.00 ","$5,111.00 ","$8,095.82 ","$8,177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63600462","EAP","CPT� 90734","","MENVEO VACCINE","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$129.14 ","$9.40 ","$292.62 ","$292.62 ","$143.71 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$246.00 ","$143.71 ","$0.00 ","$136.84 ","$0.00 "
"63600467","EAP","CPT� 90620","","MENINGITIS VACCINE","BOTH IP/OP","$569.62 ","$421.52 ","$0.00 ","$569.62 ","$256.33 ","$171.96 ","$118.72 ","$406.54 ","$406.54 ","$200.63 ","$569.62 ","$0.00 ","$284.81 ","$451.14 ","$455.70 ","$341.77 ","$200.63 ","$0.00 ","$191.04 ","$0.00 "
"63600526","EAP","HCPCS C9250","","Kit Tiss Clsr 4ml Artiss Frzn Slnt","BOTH IP/OP","$811.00 ","$600.14 ","$0.00 ","$811.00 ","$364.95 ","$156.84 ","$169.03 ","$578.81 ","$578.81 ","$142.00 ","$811.00 ","$173.09 ","$405.50 ","$642.31 ","$648.80 ","$239.03 ","$126.92 ","$0.00 ","$129.11 ","$164.85 "
"63600527","EAP","HCPCS C9250","","Kit Tiss Clsr 10ml Artiss Frzn Slnt","BOTH IP/OP","$1,814.00 ","$1,342.36 ","$0.00 ","$1,814.00 ","$816.30 ","$156.84 ","$378.08 ","$1,294.65 ","$1,294.65 ","$317.62 ","$1,814.00 ","$173.09 ","$907.00 ","$1,436.69 ","$1,451.20 ","$239.03 ","$283.89 ","$0.00 ","$288.79 ","$164.85 "
"63600528","EAP","HCPCS C9250","","Kit Tiss Clsr 2ml Artiss Frzn Slnt","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$156.84 ","$99.00 ","$339.01 ","$339.01 ","$83.17 ","$475.00 ","$173.09 ","$237.50 ","$376.20 ","$380.00 ","$239.03 ","$74.34 ","$0.00 ","$75.62 ","$164.85 "
"63603027","EAP","HCPCS J1610","","Glucagon 1 Mg","BOTH IP/OP","$415.00 ","$307.10 ","$0.00 ","$415.00 ","$186.75 ","$166.77 ","$88.07 ","$296.19 ","$296.19 ","$255.63 ","$415.00 ","$209.24 ","$207.50 ","$328.68 ","$332.00 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"63603176","EAP","HCPCS J2792","","Rho(d) Immune Globulin H, Sd  Winrho","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$1,482.00 ","$0.00 ","$0.00 ","$0.00 ","$1,057.70 ","$1,057.70 ","$0.00 ","$1,482.00 ","$0.00 ","$741.00 ","$1,173.74 ","$1,185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63603287","EAP","CPT� 90634","","HEPA VACCINE PED/ADOL-3 DOSE-IM","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"63603296","EAP","CPT� 90696","","DTAP IPV VACCINE","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$83.25 ","$0.00 ","$38.56 ","$132.03 ","$132.03 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$28.95 ","$0.00 ","$29.45 ","$0.00 "
"63603300","EAP","CPT� 90747","","HEP B VACCINE IMMUNOSUPRESSED","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$157.59 ","$45.00 ","$140.76 ","$140.32 ","$71.37 ","$71.37 ","$157.59 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$60.00 ","$157.59 ","$26.00 ","$150.05 ","$26.00 "
"63603301","EAP","CPT� 90744","","HEP B VACCINE PED/ADULT 3 DOSE","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$45.00 ","$28.21 ","$20.84 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$60.00 ","$15.65 ","$26.00 ","$0.00 ","$26.00 "
"63604091","EAP","HCPCS C9250","","Kit Tiss Clsr Frzn Slnt Artiss 4ml","BOTH IP/OP","$836.00 ","$618.64 ","$0.00 ","$836.00 ","$376.20 ","$156.84 ","$174.24 ","$596.65 ","$596.65 ","$146.38 ","$836.00 ","$173.09 ","$418.00 ","$662.11 ","$668.80 ","$239.03 ","$130.83 ","$0.00 ","$133.09 ","$164.85 "
"63604093","EAP","CPT� 90648","","HIBERIX VACCINE","BOTH IP/OP","$87.19 ","$64.52 ","$0.00 ","$87.19 ","$39.24 ","$0.00 ","$18.17 ","$62.23 ","$62.23 ","$15.27 ","$87.19 ","$0.00 ","$43.60 ","$69.05 ","$69.75 ","$0.00 ","$13.65 ","$0.00 ","$13.88 ","$0.00 "
"63690324","EAP","HCPCS J1050","","Depo Provera Inject 1mg","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$35.69 ","$35.69 ","$0.66 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.66 ","$0.00 ","$0.63 ","$0.00 "
"63690325","EAP","HCPCS J0696","","Ceftriaxone Per 250 Mg","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$15.75 ","$0.00 ","$1.41 ","$24.98 ","$24.98 ","$0.71 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"63690332","EAP","HCPCS J0694","","Cefoxitin 1gm Vial","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$11.25 ","$0.00 ","$8.06 ","$17.84 ","$17.84 ","$6.22 ","$25.00 ","$0.00 ","$12.50 ","$19.80 ","$20.00 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"63690333","EAP","HCPCS J1200","","Diphenhydramine 50 Mg/ml","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.86 ","$11.42 ","$11.42 ","$1.06 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$1.06 ","$0.00 ","$1.01 ","$0.00 "
"63690334","EAP","HCPCS J0360","","Hydralazine 20mg/1ml","BOTH IP/OP","$47.00 ","$34.78 ","$0.00 ","$47.00 ","$21.15 ","$0.00 ","$5.77 ","$33.54 ","$33.54 ","$4.41 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$4.41 ","$0.00 ","$4.20 ","$0.00 "
"63690335","EAP","HCPCS J1720","","Hydrocortisone Sod Succ 100mg Vial","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$8.55 ","$0.00 ","$3.96 ","$13.56 ","$13.56 ","$15.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$15.33 ","$0.00 ","$14.60 ","$0.00 "
"63690336","EAP","HCPCS J1885","","Ketorolac 60 Mg/2ml","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$0.32 ","$11.42 ","$11.42 ","$0.61 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"63690337","EAP","HCPCS J2590","","Oxytocin 10unit/1ml","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$7.20 ","$0.00 ","$1.47 ","$11.42 ","$11.42 ","$2.80 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$2.50 ","$0.00 ","$2.55 ","$0.00 "
"63690341","EAP","CPT� 90656","","Flu Vaccine Pf > 18 Yrs 2018-2019","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$17.84 ","$17.84 ","$4.38 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$3.91 ","$6.50 ","$3.98 ","$6.50 "
"63690342","EAP","CPT� 90685","","Flu Vaccine Pf 6-35 Months 2018-2019","BOTH IP/OP","$25.00 ","$18.50 ","$3.65 ","$25.00 ","$11.25 ","$21.13 ","$5.21 ","$17.84 ","$17.84 ","$4.38 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$3.91 ","$6.50 ","$3.98 ","$6.50 "
"63690347","EAP","CPT� 90688","","Flu Iiv4 Vaccine Splt 0.5ml Im (2018-2019)","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$11.25 ","$19.17 ","$0.00 ","$17.84 ","$17.84 ","$0.00 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$0.00 ","$6.50 ","$19.96 ","$6.50 "
"63690350","EAP","CPT� 90685","","Flu Vaccine Pf 6m - 35m 2019-2020","BOTH IP/OP","$25.00 ","$18.50 ","$3.65 ","$25.00 ","$11.25 ","$21.13 ","$5.21 ","$17.84 ","$17.84 ","$4.38 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$3.91 ","$6.50 ","$3.98 ","$6.50 "
"63690351","EAP","CPT� 90686","","Flu Vaccine Pf 3 & Up 2019-2020","BOTH IP/OP","$25.00 ","$18.50 ","$3.65 ","$25.00 ","$11.25 ","$6.50 ","$5.21 ","$17.84 ","$17.84 ","$22.36 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$22.36 ","$6.50 ","$21.29 ","$6.50 "
"63690355","EAP","CPT� 90674","","2020-2021 FLU VACCINE","BOTH IP/OP","$25.00 ","$18.50 ","$3.65 ","$33.05 ","$11.25 ","$6.50 ","$5.21 ","$17.84 ","$17.84 ","$33.05 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$33.05 ","$6.50 ","$31.47 ","$6.50 "
"63690358","EAP","CPT� 90686","","2020-2021 FLU VACCINE","BOTH IP/OP","$25.00 ","$18.50 ","$3.65 ","$25.00 ","$11.25 ","$6.50 ","$5.21 ","$17.84 ","$17.84 ","$22.36 ","$25.00 ","$3.65 ","$12.50 ","$19.80 ","$20.00 ","$3.65 ","$22.36 ","$6.50 ","$21.29 ","$6.50 "
"63690360","EAP","CPT� 90681","","ROTAVIRUS 2 DOSE VACCINE","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$119.46 ","$48.60 ","$119.46 ","$22.51 ","$77.08 ","$77.08 ","$18.91 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$64.80 ","$0.00 ","$0.00 ","$17.19 ","$0.00 "
"63690370","EAP","CPT� 90648","","ACTHIB VACCINE","BOTH IP/OP","$71.00 ","$52.54 ","$0.00 ","$71.00 ","$31.95 ","$0.00 ","$14.80 ","$50.67 ","$50.67 ","$12.43 ","$71.00 ","$0.00 ","$35.50 ","$56.23 ","$56.80 ","$0.00 ","$11.11 ","$0.00 ","$11.30 ","$0.00 "
"68000010","EAP","Custom 68000010","","Level 2 Partial Trauma Activation W/o Prenotificat","BOTH IP/OP","$14,957.00 ","$11,068.18 ","$0.00 ","$12,363.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,363.00 ","$0.00 ","$6,181.50 ","$9,791.50 ","$9,890.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68000065","EAP","Custom 68000065","","Level 1 Full Trauma Activation W/o Prenotification","BOTH IP/OP","$27,981.00 ","$20,705.94 ","$0.00 ","$23,127.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,127.00 ","$0.00 ","$11,563.50 ","$18,316.58 ","$18,501.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68100003","EAP","Custom 68100003","","Level 1 Full Trauma Activation","BOTH IP/OP","$27,981.00 ","$20,705.94 ","$0.00 ","$23,127.00 ","$5,630.00 ","$0.00 ","$0.00 ","$4,276.38 ","$4,276.38 ","$0.00 ","$23,127.00 ","$0.00 ","$11,563.50 ","$18,316.58 ","$18,501.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68100004","EAP","Custom 68100004","","Level 2 Partial Trauma Activation","BOTH IP/OP","$14,957.00 ","$11,068.18 ","$0.00 ","$12,363.00 ","$5,630.00 ","$0.00 ","$0.00 ","$4,276.38 ","$4,276.38 ","$0.00 ","$12,363.00 ","$0.00 ","$6,181.50 ","$9,791.50 ","$9,890.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68100005","EAP","Custom 68100005","","Level 3 Partial Trauma Activation","BOTH IP/OP","$7,507.00 ","$5,555.18 ","$0.00 ","$6,204.00 ","$5,630.00 ","$0.00 ","$0.00 ","$4,276.38 ","$4,276.38 ","$0.00 ","$6,204.00 ","$0.00 ","$3,102.00 ","$4,913.57 ","$4,963.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000001","EAP","CPT� 29035","","Apply Body Cast, Shldr To Hips","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,578.00 ","$0.00 ","$1,578.00 ","$1,249.78 ","$1,262.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000002","EAP","CPT� 29040","","Apply Body Cast Risser/minerva","BOTH IP/OP","$1,062.00 ","$785.88 ","$0.00 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,188.00 ","$0.00 ","$1,188.00 ","$940.90 ","$950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000003","EAP","CPT� 29065","","Apply Long Arm Cast","BOTH IP/OP","$1,466.00 ","$1,084.84 ","$0.00 ","$1,380.00 ","$796.04 ","$236.25 ","$305.55 ","$0.00 ","$0.00 ","$241.63 ","$1,380.00 ","$230.50 ","$1,380.00 ","$1,092.96 ","$1,104.00 ","$320.24 ","$126.54 ","$70.29 ","$219.70 ","$219.52 "
"70000004","EAP","CPT� 29075","","Apply Short Arm Cast","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$888.00 ","$512.05 ","$236.25 ","$196.54 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$230.50 ","$888.00 ","$703.30 ","$710.40 ","$320.24 ","$110.88 ","$63.44 ","$141.37 ","$219.52 "
"70000005","EAP","CPT� 29105","","Apply Long Arm Splint","BOTH IP/OP","$912.00 ","$674.88 ","$0.00 ","$859.00 ","$495.22 ","$138.36 ","$190.08 ","$0.00 ","$0.00 ","$150.40 ","$859.00 ","$134.13 ","$859.00 ","$680.33 ","$687.20 ","$186.36 ","$94.27 ","$43.63 ","$136.75 ","$127.75 "
"70000006","EAP","CPT� 29125","","Apply Short Arm Splint Static","BOTH IP/OP","$1,011.00 ","$748.14 ","$0.00 ","$952.00 ","$548.97 ","$110.43 ","$210.72 ","$0.00 ","$0.00 ","$166.69 ","$952.00 ","$109.35 ","$952.00 ","$753.98 ","$761.60 ","$151.93 ","$72.40 ","$40.73 ","$151.56 ","$104.14 "
"70000007","EAP","CPT� 29305","","Apply Hip Spica Cast, One Leg","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$685.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$685.00 ","$0.00 ","$685.00 ","$542.52 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000008","EAP","CPT� 29325","","Apply Hip Spica Cast Both Legs","BOTH IP/OP","$1,104.00 ","$816.96 ","$0.00 ","$1,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,235.00 ","$0.00 ","$1,235.00 ","$978.12 ","$988.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000009","EAP","CPT� 29345","","Apply Long Leg Cast","BOTH IP/OP","$838.00 ","$620.12 ","$0.00 ","$838.00 ","$838.00 ","$236.25 ","$174.66 ","$0.00 ","$0.00 ","$0.00 ","$789.00 ","$0.00 ","$789.00 ","$624.89 ","$631.20 ","$0.00 ","$170.33 ","$0.00 ","$0.00 ","$0.00 "
"70000010","EAP","CPT� 29358","","Apply Long Leg Cast Brace","BOTH IP/OP","$1,062.00 ","$785.88 ","$0.00 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,188.00 ","$0.00 ","$1,188.00 ","$940.90 ","$950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000011","EAP","CPT� 29365","","Apply Cylinder Cast","BOTH IP/OP","$1,312.00 ","$970.88 ","$0.00 ","$1,235.00 ","$0.00 ","$0.00 ","$273.45 ","$0.00 ","$0.00 ","$216.24 ","$1,235.00 ","$230.50 ","$1,235.00 ","$978.12 ","$988.00 ","$320.24 ","$144.43 ","$90.11 ","$196.61 ","$219.52 "
"70000012","EAP","CPT� 29405","","Apply Short Leg Cast","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$888.00 ","$512.05 ","$236.25 ","$196.54 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$230.50 ","$888.00 ","$703.30 ","$710.40 ","$320.24 ","$118.65 ","$60.92 ","$141.37 ","$219.52 "
"70000013","EAP","CPT� 29425","","Apply Short Leg Cast Walking","BOTH IP/OP","$1,403.00 ","$1,038.22 ","$0.00 ","$1,321.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$231.30 ","$1,321.00 ","$230.50 ","$1,321.00 ","$1,046.23 ","$1,056.80 ","$320.24 ","$123.49 ","$57.32 ","$210.30 ","$219.52 "
"70000014","EAP","CPT� 29435","","Apply Short Leg Cast Ptb","BOTH IP/OP","$794.00 ","$587.56 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.00 ","$0.00 ","$888.00 ","$703.30 ","$710.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000015","EAP","CPT� 29445","","Long Leg Cast, Rigid","BOTH IP/OP","$1,935.00 ","$1,431.90 ","$106.00 ","$1,822.00 ","$1,050.71 ","$236.25 ","$403.30 ","$1,300.36 ","$1,300.36 ","$319.02 ","$1,822.00 ","$230.50 ","$1,822.00 ","$1,443.02 ","$1,457.60 ","$320.24 ","$206.12 ","$106.00 ","$290.06 ","$219.52 "
"70000016","EAP","CPT� 29505","","Apply Long Leg Splint","BOTH IP/OP","$1,630.00 ","$1,206.20 ","$0.00 ","$1,535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.77 ","$1,535.00 ","$134.13 ","$1,535.00 ","$1,215.72 ","$1,228.00 ","$186.36 ","$94.49 ","$52.27 ","$244.37 ","$127.75 "
"70000017","EAP","CPT� 29515","","Apply Short Leg Splint","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$888.00 ","$512.05 ","$138.36 ","$196.54 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$134.13 ","$888.00 ","$703.30 ","$710.40 ","$186.36 ","$80.51 ","$51.19 ","$141.37 ","$127.75 "
"70000018","EAP","CPT� 29705","","Removal Full Arm/leg Cast","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.48 ","$888.00 ","$230.50 ","$888.00 ","$703.30 ","$710.40 ","$320.24 ","$51.73 ","$47.23 ","$141.37 ","$219.52 "
"70000019","EAP","CPT� 29730","","Windowing Of Cast","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$685.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$685.00 ","$0.00 ","$685.00 ","$542.52 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000200","EAP","HCPCS C1725","","Catheter Angio 100cm 4fr Sfvu Pgtl Curve Brd Strl","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"70000217","EAP","HCPCS C1725","","Catheter Angio Cbr 2 Curve 5fr 65cm Vscr Radiopq","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"70000219","EAP","HCPCS C1757","","Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$0.00 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000220","EAP","HCPCS C1757","","Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$0.00 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70000224","EAP","HCPCS C1725","","Catheter Angio Ang Brnstn Curve 5fr 100cm 10cm","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"70000225","EAP","HCPCS C1725","","Catheter Angio Sos O2 Curve 5fr 80cm Vscr Radiopq","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$95.03 ","$0.00 ","$36.47 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"70000226","EAP","HCPCS C1725","","Catheter Angio Cbr 2 Curve 4fr 65cm Vscr Radiopq","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"70000584","EAP","HCPCS C1876","","Stent Endoprsth Trchbr 90mm 16mm 9fr Mtl Wlstnt","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"70000587","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Flxb Flpy Tip Fltwr","BOTH IP/OP","$2,653.00 ","$1,963.22 ","$0.00 ","$2,653.00 ","$1,440.58 ","$0.00 ","$552.95 ","$1,893.45 ","$1,893.45 ","$464.52 ","$2,653.00 ","$0.00 ","$1,326.50 ","$2,101.18 ","$2,122.40 ","$0.00 ","$415.19 ","$0.00 ","$422.36 ","$0.00 "
"70000602","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Intmd Tip Radiopq X","BOTH IP/OP","$1,075.00 ","$795.50 ","$0.00 ","$1,075.00 ","$583.73 ","$0.00 ","$224.06 ","$767.23 ","$767.23 ","$188.22 ","$1,075.00 ","$0.00 ","$537.50 ","$851.40 ","$860.00 ","$0.00 ","$168.24 ","$0.00 ","$171.14 ","$0.00 "
"70000603","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Flpy Intmd Tip Radiopq","BOTH IP/OP","$1,075.00 ","$795.50 ","$0.00 ","$1,075.00 ","$583.73 ","$0.00 ","$224.06 ","$767.23 ","$767.23 ","$188.22 ","$1,075.00 ","$0.00 ","$537.50 ","$851.40 ","$860.00 ","$0.00 ","$168.24 ","$0.00 ","$171.14 ","$0.00 "
"70000626","EAP","HCPCS C1769","","Guidewire Vasc 145cm .035in Flxb Flpy Tip Fltwr","BOTH IP/OP","$331.00 ","$244.94 ","$0.00 ","$331.00 ","$179.73 ","$0.00 ","$68.99 ","$236.23 ","$236.23 ","$57.96 ","$331.00 ","$0.00 ","$165.50 ","$262.15 ","$264.80 ","$0.00 ","$51.80 ","$0.00 ","$52.70 ","$0.00 "
"70000720","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Fix Core Flx Tp Hvdty","BOTH IP/OP","$74.00 ","$54.76 ","$0.00 ","$74.00 ","$0.00 ","$0.00 ","$15.42 ","$52.81 ","$52.81 ","$12.96 ","$74.00 ","$0.00 ","$37.00 ","$58.61 ","$59.20 ","$0.00 ","$11.58 ","$0.00 ","$11.78 ","$0.00 "
"70000762","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Trnb Ad Bcn Jb1 Curve Ss","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$11.03 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$9.86 ","$0.00 ","$10.03 ","$0.00 "
"70000764","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Trnb Ad Bcn Sim2 Curve Ss","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"70000820","EAP","HCPCS C1773","","Set Rtrvl 80cm 6.3fr 11fr Gnth Tlp Coons Vc 3w","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$130.27 ","$446.06 ","$446.06 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"70000823","EAP","HCPCS C1769","","Guidewire Vasc 60cm .018in Flpy Sftp Ang Tpr 7cm","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$95.00 ","$53.21 ","$0.00 ","$19.80 ","$67.80 ","$67.80 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"70000977","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Ar2","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"70000983","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Act Mp1 Curve Peri","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70000997","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Jr4st","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"70000998","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Ar1 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001000","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Std Jl3.5 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001001","EAP","HCPCS C1887","","Catheter Guid 7fr Shr Nx Bal Std Jr3.5 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001003","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Std Jl5 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001005","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Std Jr5 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001006","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Mp1 Curve Peri","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001013","EAP","HCPCS C1887","","Catheter Guid 7fr Shr Nx Bal Std Jr4 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001014","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Ima Curve Peri","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001028","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Ar1 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001029","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Std Jl4 Curve","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$64.07 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"70001030","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Std Jr4 Curve","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$64.07 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"70001041","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Std Jl4 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001043","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Std Jr4 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001045","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Al1 Curve Coron","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$64.07 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"70001047","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Al1 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001048","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Std Jl4 Curve","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$64.07 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"70001049","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Std Jr4 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001050","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Xb3","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"70001051","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Xb3.5","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"70001053","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Std Jl3.5 Curve","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"70001054","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Al2 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001055","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Std Jr3.5 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001056","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Al.75 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001057","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Al.75 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"70001234","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Sft Rbn Tip Kink Rst","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"70001408","EAP","HCPCS C1757","","Snare Vasc 120cm 9-15mm 6fr Ensnr Std 3 Prefrm","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$449.60 ","$0.00 ","$172.58 ","$590.94 ","$590.94 ","$0.00 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70001510","EAP","HCPCS L0625","","Support Orthopedic Universal Binder Velcro Closure Yellow","BOTH IP/OP","$538.00 ","$398.12 ","$0.00 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$383.97 ","$383.97 ","$0.00 ","$538.00 ","$0.00 ","$269.00 ","$426.10 ","$430.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000014","EAP","Custom 71000014","","PHASE II RECOVERY < 6HRS","BOTH IP/OP","$2,822.00 ","$2,088.28 ","$0.00 ","$2,491.00 ","$0.00 ","$0.00 ","$0.00 ","$1,777.83 ","$1,777.83 ","$0.00 ","$2,491.00 ","$0.00 ","$1,245.50 ","$1,972.87 ","$1,992.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000033","EAP","Custom 71000033","","Phase Ii Recovery > 6hrs","BOTH IP/OP","$4,229.00 ","$3,129.46 ","$0.00 ","$3,733.00 ","$0.00 ","$0.00 ","$0.00 ","$2,664.24 ","$2,664.24 ","$0.00 ","$3,733.00 ","$0.00 ","$1,866.50 ","$2,956.54 ","$2,986.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000040","EAP","Custom 71000040","","Level 1 1st 30 Min","BOTH IP/OP","$2,001.00 ","$1,480.74 ","$0.00 ","$1,766.00 ","$0.00 ","$0.00 ","$0.00 ","$1,260.39 ","$1,260.39 ","$0.00 ","$1,766.00 ","$0.00 ","$883.00 ","$1,398.67 ","$1,412.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000041","EAP","Custom 71000041","","Level 2 1st 30 Min","BOTH IP/OP","$2,403.00 ","$1,778.22 ","$0.00 ","$2,121.00 ","$0.00 ","$0.00 ","$0.00 ","$1,513.76 ","$1,513.76 ","$0.00 ","$2,121.00 ","$0.00 ","$1,060.50 ","$1,679.83 ","$1,696.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000042","EAP","Custom 71000042","","Level 3 1st 30 Min","BOTH IP/OP","$3,201.00 ","$2,368.74 ","$0.00 ","$2,825.00 ","$0.00 ","$0.00 ","$0.00 ","$2,016.20 ","$2,016.20 ","$0.00 ","$2,825.00 ","$0.00 ","$1,412.50 ","$2,237.40 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000043","EAP","Custom 71000043","","Level 4 1st 30 Min","BOTH IP/OP","$3,467.00 ","$2,565.58 ","$0.00 ","$3,060.00 ","$0.00 ","$0.00 ","$0.00 ","$2,183.92 ","$2,183.92 ","$0.00 ","$3,060.00 ","$0.00 ","$1,530.00 ","$2,423.52 ","$2,448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000044","EAP","Custom 71000044","","Level 5 1st 30 Min","BOTH IP/OP","$4,801.00 ","$3,552.74 ","$0.00 ","$4,237.00 ","$0.00 ","$0.00 ","$0.00 ","$3,023.95 ","$3,023.95 ","$0.00 ","$4,237.00 ","$0.00 ","$2,118.50 ","$3,355.70 ","$3,389.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000045","EAP","Custom 71000045","","Level 1 Add 15 Min","BOTH IP/OP","$1,049.00 ","$776.26 ","$0.00 ","$925.00 ","$0.00 ","$0.00 ","$0.00 ","$660.17 ","$660.17 ","$0.00 ","$925.00 ","$0.00 ","$462.50 ","$732.60 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000046","EAP","Custom 71000046","","Level 2 Add 15 Min","BOTH IP/OP","$1,261.00 ","$933.14 ","$0.00 ","$1,113.00 ","$0.00 ","$0.00 ","$0.00 ","$794.35 ","$794.35 ","$0.00 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000047","EAP","Custom 71000047","","Level 3 Add 15 Min","BOTH IP/OP","$1,678.00 ","$1,241.72 ","$0.00 ","$1,481.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.99 ","$1,056.99 ","$0.00 ","$1,481.00 ","$0.00 ","$740.50 ","$1,172.95 ","$1,184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000048","EAP","Custom 71000048","","Level 4 Add 15 Min","BOTH IP/OP","$1,823.00 ","$1,349.02 ","$0.00 ","$1,609.00 ","$0.00 ","$0.00 ","$0.00 ","$1,148.34 ","$1,148.34 ","$0.00 ","$1,609.00 ","$0.00 ","$804.50 ","$1,274.33 ","$1,287.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000049","EAP","Custom 71000049","","Level 5 Add 15 Min","BOTH IP/OP","$2,521.00 ","$1,865.54 ","$0.00 ","$2,225.00 ","$0.00 ","$0.00 ","$0.00 ","$1,587.98 ","$1,587.98 ","$0.00 ","$2,225.00 ","$0.00 ","$1,112.50 ","$1,762.20 ","$1,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000050","EAP","","","Gi Procedure Recovery","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$400.39 ","$400.39 ","$0.00 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000051","EAP","","","Cardiology Recovery","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$400.39 ","$400.39 ","$0.00 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000133","EAP","Custom 71000133","","Phase Ii Recovery > 6hrs","BOTH IP/OP","$3,435.00 ","$2,541.90 ","$0.00 ","$3,851.00 ","$0.00 ","$0.00 ","$0.00 ","$2,748.46 ","$2,748.46 ","$0.00 ","$3,851.00 ","$0.00 ","$1,925.50 ","$3,049.99 ","$3,080.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71000134","EAP","","","Ir Recovery","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$356.85 ","$356.85 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71900020","EAP","Custom 71900020","","Extended Recovery 1st 30 Mins","BOTH IP/OP","$1,308.00 ","$967.92 ","$0.00 ","$1,466.00 ","$0.00 ","$0.00 ","$0.00 ","$1,046.28 ","$1,046.28 ","$0.00 ","$1,466.00 ","$0.00 ","$733.00 ","$1,161.07 ","$1,172.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71900021","EAP","Custom 71900021","","Extended Recovery Ea Addtl 15 Mins","BOTH IP/OP","$739.00 ","$546.86 ","$0.00 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$590.94 ","$590.94 ","$0.00 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72000001","EAP","CPT� 59030","","Fetal Scalp Blood","BOTH IP/OP","$1,104.00 ","$816.96 ","$0.00 ","$1,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,115.00 ","$0.00 ","$1,115.00 ","$883.08 ","$892.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72000006","EAP","CPT� 59612","","Vaginal Delivery After Prior Cesarean Delivery","BOTH IP/OP","$8,307.00 ","$6,147.18 ","$0.00 ","$8,307.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,307.00 ","$0.00 ","$2,255.00 ","$6,579.14 ","$6,645.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72200001","EAP","CPT� 59409","","Vaginal Delivery Only Complica","BOTH IP/OP","$6,614.00 ","$4,894.36 ","$0.00 ","$5,316.00 ","$2,321.55 ","$2,569.43 ","$1,378.52 ","$0.00 ","$0.00 ","$0.00 ","$5,316.00 ","$0.00 ","$2,255.00 ","$4,210.27 ","$4,252.80 ","$0.00 ","$892.16 ","$0.00 ","$0.00 ","$0.00 "
"72200002","EAP","CPT� 59409","","Vaginal Delivery Only Uncompl.","BOTH IP/OP","$6,435.00 ","$4,761.90 ","$0.00 ","$4,261.00 ","$2,321.55 ","$2,569.43 ","$1,341.21 ","$0.00 ","$0.00 ","$0.00 ","$4,261.00 ","$0.00 ","$2,255.00 ","$3,374.71 ","$3,408.80 ","$0.00 ","$892.16 ","$0.00 ","$0.00 ","$0.00 "
"73000001","EAP","CPT� 93005","","Ekg","BOTH IP/OP","$606.00 ","$448.44 ","$8.64 ","$490.00 ","$18.80 ","$54.51 ","$126.31 ","$349.71 ","$349.71 ","$85.80 ","$490.00 ","$55.17 ","$245.00 ","$388.08 ","$392.00 ","$76.65 ","$17.51 ","$8.64 ","$78.01 ","$52.54 "
"73000007","EAP","CPT� 93041","","Rhythm Ecg, Tracing","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$40.68 ","$40.68 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73000010","EAP","CPT� 93041","","Ekg Rhythm Strip 3 Lead","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$40.68 ","$40.68 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73000011","EAP","CPT� 93017","","Cardiac Stress Test","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$34.22 ","$3,621.00 ","$86.88 ","$259.18 ","$747.20 ","$2,584.31 ","$2,584.31 ","$634.01 ","$3,621.00 ","$253.05 ","$1,810.50 ","$2,867.83 ","$2,896.80 ","$351.58 ","$64.64 ","$34.22 ","$576.46 ","$241.00 "
"73100001","EAP","CPT� 93225","","Ecg Monitoring, Continuous","BOTH IP/OP","$1,032.00 ","$763.68 ","$25.93 ","$1,026.00 ","$58.71 ","$110.43 ","$215.09 ","$732.26 ","$732.26 ","$179.64 ","$1,026.00 ","$109.35 ","$513.00 ","$812.59 ","$820.80 ","$151.93 ","$47.49 ","$25.93 ","$163.34 ","$104.14 "
"73100002","EAP","CPT� 93226","","Ecg Monitoring Analysis&report","BOTH IP/OP","$1,644.00 ","$1,216.56 ","$0.00 ","$1,644.00 ","$0.00 ","$0.00 ","$0.00 ","$1,173.32 ","$1,173.32 ","$0.00 ","$1,644.00 ","$0.00 ","$822.00 ","$1,302.05 ","$1,315.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73100003","EAP","CPT� 93270","","Cardiac Event Recording","BOTH IP/OP","$709.00 ","$524.66 ","$9.00 ","$716.00 ","$20.35 ","$36.47 ","$147.77 ","$511.01 ","$511.01 ","$125.37 ","$716.00 ","$36.36 ","$358.00 ","$567.07 ","$572.80 ","$50.51 ","$47.49 ","$9.00 ","$113.99 ","$34.63 "
"73100004","EAP","CPT� 93271","","Cardiac Event Analysis","BOTH IP/OP","$716.00 ","$529.84 ","$0.00 ","$716.00 ","$0.00 ","$0.00 ","$0.00 ","$511.01 ","$511.01 ","$0.00 ","$716.00 ","$0.00 ","$358.00 ","$567.07 ","$572.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73100005","EAP","CPT� 0296T","","Ext Ecg > 48hr To 21 Day Rcrd W/conect Intl Rcrd","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$656.00 ","$0.00 ","$0.00 ","$0.00 ","$468.19 ","$468.19 ","$0.00 ","$656.00 ","$0.00 ","$656.00 ","$519.55 ","$524.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000001","EAP","CPT� 95812","","Eeg Up To 1 Hour","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$625.00 ","$453.41 ","$259.18 ","$174.03 ","$446.06 ","$446.06 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000002","EAP","CPT� 95813","","Eeg Extended Monitoring 61-119 Minutes","BOTH IP/OP","$1,873.00 ","$1,386.02 ","$0.00 ","$1,709.00 ","$0.00 ","$0.00 ","$0.00 ","$1,219.71 ","$1,219.71 ","$299.23 ","$1,709.00 ","$0.00 ","$854.50 ","$1,353.53 ","$1,367.20 ","$0.00 ","$183.21 ","$0.00 ","$0.00 ","$0.00 "
"74000003","EAP","CPT� 95816","","Eeg, Awake And Drowsy","BOTH IP/OP","$1,050.00 ","$777.00 ","$124.97 ","$785.00 ","$570.15 ","$259.18 ","$218.85 ","$560.25 ","$560.25 ","$137.45 ","$785.00 ","$253.05 ","$392.50 ","$621.72 ","$628.00 ","$351.58 ","$128.39 ","$311.91 ","$124.97 ","$241.00 "
"74000004","EAP","CPT� 95819","","Eeg, W/awake & Asleep Record","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$110.11 ","$1,637.00 ","$974.14 ","$259.18 ","$373.91 ","$1,168.33 ","$1,168.33 ","$286.63 ","$1,637.00 ","$253.05 ","$818.50 ","$1,296.50 ","$1,309.60 ","$351.58 ","$110.11 ","$381.06 ","$260.61 ","$241.00 "
"74000005","EAP","CPT� 95822","","Eeg, Sleep Only","BOTH IP/OP","$1,752.00 ","$1,296.48 ","$0.00 ","$1,311.00 ","$0.00 ","$0.00 ","$0.00 ","$935.66 ","$935.66 ","$0.00 ","$1,311.00 ","$0.00 ","$655.50 ","$1,038.31 ","$1,048.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000009","EAP","CPT� 92585","","Ssep Ue","BOTH IP/OP","$1,264.00 ","$935.36 ","$0.00 ","$1,264.00 ","$0.00 ","$0.00 ","$0.00 ","$902.12 ","$902.12 ","$0.00 ","$1,264.00 ","$0.00 ","$632.00 ","$1,001.09 ","$1,011.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000011","EAP","CPT� 95930","","Vep","BOTH IP/OP","$1,158.00 ","$856.92 ","$0.00 ","$1,197.00 ","$0.00 ","$0.00 ","$0.00 ","$854.30 ","$854.30 ","$0.00 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000012","EAP","CPT� 95938","","Ssep 4 Ext","BOTH IP/OP","$768.00 ","$568.32 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$410.38 ","$410.38 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000013","EAP","CPT� 95929","","Cmep Lower Limbs","BOTH IP/OP","$981.00 ","$725.94 ","$0.00 ","$1,014.00 ","$0.00 ","$0.00 ","$0.00 ","$723.69 ","$723.69 ","$0.00 ","$1,014.00 ","$0.00 ","$507.00 ","$803.09 ","$811.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000014","EAP","CPT� 95939","","Cmep Upper Limbs","BOTH IP/OP","$1,351.00 ","$999.74 ","$0.00 ","$1,011.00 ","$0.00 ","$0.00 ","$0.00 ","$721.55 ","$721.55 ","$0.00 ","$1,011.00 ","$0.00 ","$505.50 ","$800.71 ","$808.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000015","EAP","CPT� 95940","","Intraoperative Monitoring Neuro In Or Ea 15 Min","BOTH IP/OP","$4,241.00 ","$3,138.34 ","$0.00 ","$3,870.00 ","$0.00 ","$0.00 ","$0.00 ","$2,762.02 ","$2,762.02 ","$0.00 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000017","EAP","CPT� 95961","","Functional Cortical Mapping By Intra Operative Stimulation Initial Hr","BOTH IP/OP","$905.00 ","$669.70 ","$0.00 ","$964.00 ","$0.00 ","$0.00 ","$0.00 ","$688.01 ","$688.01 ","$0.00 ","$964.00 ","$0.00 ","$482.00 ","$763.49 ","$771.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000018","EAP","CPT� 95962","","Functional Monitor By Stimulation Ea Add'l Hour","BOTH IP/OP","$661.00 ","$489.14 ","$0.00 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$502.44 ","$502.44 ","$0.00 ","$704.00 ","$0.00 ","$352.00 ","$557.57 ","$563.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000019","EAP","CPT� 92585","","Baer Auditory Evoked Potentials For Evoked Response Ans Or Testing Cns","BOTH IP/OP","$967.00 ","$715.58 ","$0.00 ","$967.00 ","$0.00 ","$0.00 ","$0.00 ","$690.15 ","$690.15 ","$0.00 ","$967.00 ","$0.00 ","$483.50 ","$765.86 ","$773.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000020","EAP","CPT� 95958","","Eeg Monitoring/function Test","BOTH IP/OP","$1,943.00 ","$1,437.82 ","$0.00 ","$2,009.00 ","$0.00 ","$0.00 ","$0.00 ","$1,433.82 ","$1,433.82 ","$0.00 ","$2,009.00 ","$0.00 ","$1,004.50 ","$1,591.13 ","$1,607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000021","EAP","CPT� 95958","","Eeg Hemisphere Function (wada)","BOTH IP/OP","$1,943.00 ","$1,437.82 ","$0.00 ","$2,009.00 ","$0.00 ","$0.00 ","$0.00 ","$1,433.82 ","$1,433.82 ","$0.00 ","$2,009.00 ","$0.00 ","$1,004.50 ","$1,591.13 ","$1,607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000030","EAP","CPT� 95941","","Ionm Remote/nearby/>1 Patient In Or Per Hour","BOTH IP/OP","$3,680.00 ","$2,723.20 ","$0.00 ","$3,358.00 ","$0.00 ","$0.00 ","$0.00 ","$2,396.60 ","$2,396.60 ","$0.00 ","$3,358.00 ","$0.00 ","$1,679.00 ","$2,659.54 ","$2,686.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000050","EAP","CPT� 95700","","EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS","BOTH IP/OP","$4,241.00 ","$3,138.34 ","$0.00 ","$3,870.00 ","$2,302.86 ","$259.18 ","$883.93 ","$2,762.02 ","$2,762.02 ","$677.61 ","$3,870.00 ","$253.05 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$351.58 ","$605.66 ","$0.00 ","$616.10 ","$241.00 "
"74000052","EAP","CPT� 95706","","Eeg W/o Video (ceribell) 2-12 Hr Intermittent Mntr","BOTH IP/OP","$4,241.00 ","$3,138.34 ","$0.00 ","$3,870.00 ","$0.00 ","$0.00 ","$0.00 ","$2,762.02 ","$2,762.02 ","$0.00 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000054","EAP","CPT� 95708","","Eeg W/o Vid By Tech Ea Incr 12-26hr Unmonitored","BOTH IP/OP","$6,903.00 ","$5,108.22 ","$0.00 ","$6,300.00 ","$3,748.33 ","$478.04 ","$1,438.76 ","$4,496.31 ","$4,496.31 ","$1,103.08 ","$6,300.00 ","$487.04 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$676.67 ","$985.95 ","$0.00 ","$1,002.96 ","$463.84 "
"74000055","EAP","CPT� 95709","","Eeg W/o Video (ceribell) Ea Incr 12-26 Hr Intmt Mntr","BOTH IP/OP","$10,349.00 ","$7,658.26 ","$0.00 ","$9,445.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,445.00 ","$0.00 ","$4,722.50 ","$7,480.44 ","$7,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000057","EAP","CPT� 95711","","Veeg By Tech 2-12 Hours Unmonitored","BOTH IP/OP","$4,241.00 ","$3,138.34 ","$0.00 ","$3,870.00 ","$0.00 ","$0.00 ","$0.00 ","$2,762.02 ","$2,762.02 ","$0.00 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74000058","EAP","CPT� 95712","","Veeg By Tech 2-12 Hr Intermittent Monitoring","BOTH IP/OP","$4,241.00 ","$3,138.34 ","$0.00 ","$3,870.00 ","$2,302.86 ","$259.18 ","$883.93 ","$2,762.02 ","$2,762.02 ","$677.61 ","$3,870.00 ","$253.05 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$351.58 ","$0.00 ","$0.00 ","$616.10 ","$241.00 "
"74000060","EAP","CPT� 95714","","Veeg By Tech Ea Incr 12-26 Hr Unmonitored","BOTH IP/OP","$6,903.00 ","$5,108.22 ","$0.00 ","$6,300.00 ","$0.00 ","$0.00 ","$0.00 ","$4,496.31 ","$4,496.31 ","$1,103.08 ","$6,300.00 ","$487.04 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$676.67 ","$985.95 ","$0.00 ","$1,002.96 ","$463.84 "
"74000061","EAP","CPT� 95715","","Veeg By Tech Ea Incr 12-26 Hr Intermittent Mntr","BOTH IP/OP","$10,349.00 ","$7,658.26 ","$0.00 ","$9,445.00 ","$5,619.51 ","$478.04 ","$2,156.99 ","$5,158.80 ","$5,158.80 ","$1,653.74 ","$9,445.00 ","$487.04 ","$4,722.50 ","$7,480.44 ","$7,556.00 ","$676.67 ","$0.00 ","$0.00 ","$1,503.64 ","$463.84 "
"74000065","EAP","CPT� 95955","","Eeg During (carotid) Surgery","BOTH IP/OP","$1,096.00 ","$811.04 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$713.70 ","$713.70 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000001","EAP","CPT� 31622","","Bronchoscopy","BOTH IP/OP","$4,121.00 ","$3,049.54 ","$0.00 ","$3,746.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,746.00 ","$0.00 ","$2,255.00 ","$2,966.83 ","$2,996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000029","EAP","CPT� 43260","","Ercp-w/wo Biopsy","BOTH IP/OP","$6,432.00 ","$4,759.68 ","$0.00 ","$6,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,432.00 ","$0.00 ","$2,327.00 ","$5,094.14 ","$5,145.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000046","EAP","CPT� 44360","","Sb Endoscop Excluding Ileum Dx","BOTH IP/OP","$3,384.00 ","$2,504.16 ","$0.00 ","$3,412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,412.00 ","$0.00 ","$2,327.00 ","$2,702.30 ","$2,729.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000047","EAP","CPT� 44361","","Sb Endo-bx Single Multiple","BOTH IP/OP","$2,728.00 ","$2,018.72 ","$0.00 ","$2,501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,501.00 ","$0.00 ","$2,327.00 ","$1,980.79 ","$2,000.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000050","EAP","CPT� 44366","","Sb Endo-ctrl Of Bleed Any Meth","BOTH IP/OP","$3,030.00 ","$2,242.20 ","$0.00 ","$2,777.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,777.00 ","$0.00 ","$2,327.00 ","$2,199.38 ","$2,221.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000051","EAP","CPT� 44369","","Sb Endo-ablat Of Tum,les Other","BOTH IP/OP","$3,030.00 ","$2,242.20 ","$256.01 ","$2,777.00 ","$2,753.10 ","$1,590.63 ","$631.53 ","$1,981.94 ","$1,981.94 ","$486.23 ","$2,777.00 ","$1,561.98 ","$2,327.00 ","$2,199.38 ","$2,221.60 ","$2,170.16 ","$328.65 ","$256.01 ","$442.10 ","$1,487.60 "
"75000076","EAP","CPT� 45334","","Sigmoid, Flex W Control Bleedi","BOTH IP/OP","$3,337.00 ","$2,469.38 ","$0.00 ","$3,337.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,337.00 ","$0.00 ","$2,255.00 ","$2,642.90 ","$2,669.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000089","EAP","CPT� 46600","","Anoscopy, Diagnostic, Inc Spec Collect","BOTH IP/OP","$542.00 ","$401.08 ","$0.00 ","$542.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.90 ","$542.00 ","$109.35 ","$542.00 ","$429.26 ","$433.60 ","$151.93 ","$37.41 ","$42.17 ","$86.29 ","$104.14 "
"75000091","EAP","CPT� 46606","","Anoscopy With Biopsy","BOTH IP/OP","$2,137.00 ","$1,581.38 ","$0.00 ","$2,137.00 ","$0.00 ","$0.00 ","$460.83 ","$1,525.18 ","$1,525.18 ","$374.17 ","$2,137.00 ","$1,007.17 ","$2,137.00 ","$1,692.50 ","$1,709.60 ","$1,399.33 ","$52.76 ","$78.23 ","$340.21 ","$959.21 "
"75000100","EAP","HCPCS G0121","","Colon Ca Scrn Not Hi Rsk Ind","BOTH IP/OP","$4,021.00 ","$2,975.54 ","$0.00 ","$4,021.00 ","$2,753.10 ","$777.17 ","$0.00 ","$2,869.79 ","$2,869.79 ","$704.04 ","$4,021.00 ","$766.13 ","$2,327.00 ","$3,184.63 ","$3,216.80 ","$1,064.43 ","$629.29 ","$193.26 ","$640.14 ","$729.64 "
"75000101","EAP","CPT� 45391","","Colonoscopy, Endoscopic Ultrasound Examination","BOTH IP/OP","$3,045.00 ","$2,253.30 ","$0.00 ","$2,796.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,796.00 ","$0.00 ","$2,327.00 ","$2,214.43 ","$2,236.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000102","EAP","CPT� 45341","","Sigmoidscopy W/ultrasound","BOTH IP/OP","$4,341.00 ","$3,212.34 ","$0.00 ","$3,986.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.81 ","$2,844.81 ","$697.92 ","$3,986.00 ","$766.13 ","$2,255.00 ","$3,156.91 ","$3,188.80 ","$1,064.43 ","$219.13 ","$128.72 ","$634.57 ","$729.64 "
"75000110","EAP","CPT� 45335","","Sigmoidoscopy W/submuc Inj","BOTH IP/OP","$2,361.00 ","$1,747.14 ","$0.00 ","$2,361.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,361.00 ","$0.00 ","$2,255.00 ","$1,869.91 ","$1,888.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000120","EAP","CPT� 43238","","Upper Gi Endoscopy W/us Fn Bx","BOTH IP/OP","$2,842.00 ","$2,103.08 ","$0.00 ","$2,605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,605.00 ","$0.00 ","$2,327.00 ","$2,063.16 ","$2,084.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000125","EAP","CPT� 43242","","Upper Gi Endoscopy W/us Fn Bx","BOTH IP/OP","$5,337.00 ","$3,949.38 ","$0.00 ","$4,893.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,893.00 ","$0.00 ","$2,327.00 ","$3,875.26 ","$3,914.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000127","EAP","CPT� 43242","","Transendoscopic Us W/ Fn Bx","BOTH IP/OP","$4,893.00 ","$3,620.82 ","$0.00 ","$4,893.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,893.00 ","$0.00 ","$2,327.00 ","$3,875.26 ","$3,914.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000128","EAP","CPT� 45327","","Proctosigmoidoscopy W/stent","BOTH IP/OP","$11,233.00 ","$8,312.42 ","$0.00 ","$11,233.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,233.00 ","$0.00 ","$2,255.00 ","$8,896.54 ","$8,986.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000130","EAP","CPT� 45335","","Sigmoidoscopy W/submuc Inj","BOTH IP/OP","$2,361.00 ","$1,747.14 ","$0.00 ","$2,361.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,361.00 ","$0.00 ","$2,255.00 ","$1,869.91 ","$1,888.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000132","EAP","CPT� 45340","","Sig W/balloon Dilation","BOTH IP/OP","$5,946.00 ","$4,400.04 ","$0.00 ","$5,946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,946.00 ","$0.00 ","$2,255.00 ","$4,709.23 ","$4,756.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000136","EAP","CPT� 91034","","Esoph, Gastroesoph Reflux Test W/rec, Anlys,rpt ","BOTH IP/OP","$2,483.00 ","$1,837.42 ","$0.00 ","$3,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,104.00 ","$0.00 ","$1,552.00 ","$2,458.37 ","$2,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000137","EAP","CPT� 91038","","Esoph Gastro Reflux Test, Prolonged 1-24 Hrs.","BOTH IP/OP","$2,693.00 ","$1,992.82 ","$0.00 ","$2,473.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,473.00 ","$0.00 ","$1,236.50 ","$1,958.62 ","$1,978.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000138","EAP","CPT� 91010","","Esophageal Motility Study W/ Interp & Report","BOTH IP/OP","$3,327.00 ","$2,461.98 ","$111.47 ","$3,055.00 ","$2,321.55 ","$478.04 ","$693.43 ","$2,180.35 ","$2,180.35 ","$534.91 ","$3,055.00 ","$487.04 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$676.67 ","$111.47 ","$137.22 ","$486.36 ","$463.84 "
"75000139","EAP","CPT� 91037","","Esoph  Gastroesoph Reflux Test Funct W/rec, Anlys,rpt  ","BOTH IP/OP","$2,254.00 ","$1,667.96 ","$0.00 ","$2,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,070.00 ","$0.00 ","$1,035.00 ","$1,639.44 ","$1,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000140","EAP","CPT� 91120","","Rectal Sensation Tone & Comply Balloon Distention","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,261.00 ","$745.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.79 ","$1,261.00 ","$138.76 ","$630.50 ","$998.71 ","$1,008.80 ","$192.78 ","$462.13 ","$445.89 ","$200.75 ","$132.15 "
"75000141","EAP","CPT� 91122","","Anorectal Manometry","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,261.00 ","$745.54 ","$260.60 ","$286.17 ","$0.00 ","$0.00 ","$220.79 ","$1,261.00 ","$235.59 ","$630.50 ","$998.71 ","$1,008.80 ","$327.32 ","$125.40 ","$164.96 ","$200.75 ","$224.37 "
"75000142","EAP","CPT� 51784","","Emg Anal Or Urethral Sphincter, Other Than Needle","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$212.00 ","$114.03 ","$136.73 ","$43.77 ","$0.00 ","$0.00 ","$37.12 ","$212.00 ","$138.76 ","$212.00 ","$167.90 ","$169.60 ","$192.78 ","$94.94 ","$29.53 ","$33.75 ","$132.15 "
"75000146","EAP","CPT� 91022","","Duodenal Motility Study","BOTH IP/OP","$1,128.00 ","$834.72 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000147","EAP","CPT� 91117","","Colon Motility 6hrs Or >inc Provoc Test W/ Interp& Repot","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$865.00 ","$0.00 ","$432.50 ","$685.08 ","$692.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000182","EAP","CPT� 46601","","Diagnostic Anoscopy","BOTH IP/OP","$637.00 ","$471.38 ","$0.00 ","$637.00 ","$637.00 ","$110.43 ","$132.77 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$109.35 ","$560.00 ","$443.52 ","$448.00 ","$151.93 ","$87.64 ","$97.71 ","$89.15 ","$104.14 "
"75000200","EAP","Custom 75000200","","Colonscopy Dx","BOTH IP/OP","$3,855.00 ","$2,852.70 ","$0.00 ","$3,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,540.00 ","$0.00 ","$1,770.00 ","$2,803.68 ","$2,832.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000201","EAP","Custom 75000201","","Colonscopy Thera 1 Intervention","BOTH IP/OP","$4,243.00 ","$3,139.82 ","$0.00 ","$3,896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,896.00 ","$0.00 ","$1,948.00 ","$3,085.63 ","$3,116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000202","EAP","Custom 75000202","","Colonscopy Thera 2 Intervention","BOTH IP/OP","$4,665.00 ","$3,452.10 ","$0.00 ","$4,284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,284.00 ","$0.00 ","$2,142.00 ","$3,392.93 ","$3,427.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000203","EAP","Custom 75000203","","Colonscopy Thera 3 Intervention","BOTH IP/OP","$5,132.00 ","$3,797.68 ","$0.00 ","$4,713.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,713.00 ","$0.00 ","$2,356.50 ","$3,732.70 ","$3,770.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000204","EAP","Custom 75000204","","Egd Dx","BOTH IP/OP","$3,286.00 ","$2,431.64 ","$0.00 ","$3,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,013.00 ","$0.00 ","$1,506.50 ","$2,386.30 ","$2,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000205","EAP","Custom 75000205","","Egd Thera 1 Intervention","BOTH IP/OP","$3,615.00 ","$2,675.10 ","$0.00 ","$3,314.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,314.00 ","$0.00 ","$1,657.00 ","$2,624.69 ","$2,651.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000206","EAP","Custom 75000206","","Egd Thera 2 Intervention","BOTH IP/OP","$3,977.00 ","$2,942.98 ","$0.00 ","$3,645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,645.00 ","$0.00 ","$1,822.50 ","$2,886.84 ","$2,916.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000207","EAP","Custom 75000207","","Egd Thera 3 Intervention","BOTH IP/OP","$4,374.00 ","$3,236.76 ","$0.00 ","$4,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,010.00 ","$0.00 ","$2,005.00 ","$3,175.92 ","$3,208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000208","EAP","Custom 75000208","","Ercp Dx","BOTH IP/OP","$6,193.00 ","$4,582.82 ","$0.00 ","$5,687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,687.00 ","$0.00 ","$2,843.50 ","$4,504.10 ","$4,549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000209","EAP","Custom 75000209","","Ercp Thera 1 Intervention","BOTH IP/OP","$6,810.00 ","$5,039.40 ","$0.00 ","$6,254.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,254.00 ","$0.00 ","$3,127.00 ","$4,953.17 ","$5,003.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000210","EAP","Custom 75000210","","Ercp Thera 2 Intervention","BOTH IP/OP","$7,493.00 ","$5,544.82 ","$0.00 ","$6,881.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,881.00 ","$0.00 ","$3,440.50 ","$5,449.75 ","$5,504.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000211","EAP","Custom 75000211","","Ercp Thera 3 Intervention","BOTH IP/OP","$8,242.00 ","$6,099.08 ","$0.00 ","$7,568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,568.00 ","$0.00 ","$3,784.00 ","$5,993.86 ","$6,054.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000212","EAP","Custom 75000212","","Sigmoidoscopy Dx","BOTH IP/OP","$3,919.00 ","$2,900.06 ","$0.00 ","$3,599.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,599.00 ","$0.00 ","$1,799.50 ","$2,850.41 ","$2,879.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000213","EAP","Custom 75000213","","Sigmoidoscopy Thera 1 Intervention","BOTH IP/OP","$4,311.00 ","$3,190.14 ","$0.00 ","$3,959.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,959.00 ","$0.00 ","$1,979.50 ","$3,135.53 ","$3,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000214","EAP","Custom 75000214","","Sigmoidoscopy Thera 2 Intervention","BOTH IP/OP","$4,741.00 ","$3,508.34 ","$0.00 ","$4,354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,354.00 ","$0.00 ","$2,177.00 ","$3,448.37 ","$3,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000215","EAP","Custom 75000215","","Sigmoidoscopy Thera 3 Intervention","BOTH IP/OP","$5,217.00 ","$3,860.58 ","$0.00 ","$4,791.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,791.00 ","$0.00 ","$2,395.50 ","$3,794.47 ","$3,832.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000216","EAP","Custom 75000216","","Colonscopy Via Stoma Dx","BOTH IP/OP","$3,081.00 ","$2,279.94 ","$0.00 ","$2,829.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,829.00 ","$0.00 ","$1,414.50 ","$2,240.57 ","$2,263.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000217","EAP","Custom 75000217","","Colonscopy Via Stoma 1 Intervention","BOTH IP/OP","$3,389.00 ","$2,507.86 ","$0.00 ","$3,112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,112.00 ","$0.00 ","$1,556.00 ","$2,464.70 ","$2,489.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000218","EAP","Custom 75000218","","Colonscopy Via Stoma 2 Intervention","BOTH IP/OP","$3,727.00 ","$2,757.98 ","$0.00 ","$3,423.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,423.00 ","$0.00 ","$1,711.50 ","$2,711.02 ","$2,738.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000219","EAP","Custom 75000219","","Colonscopy Via Stoma 3 Intervention","BOTH IP/OP","$4,101.00 ","$3,034.74 ","$0.00 ","$3,765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,765.00 ","$0.00 ","$1,882.50 ","$2,981.88 ","$3,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000220","EAP","CPT� 91112","","Gi Wireless Capsule Measure","BOTH IP/OP","$3,844.00 ","$2,844.56 ","$0.00 ","$3,844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,844.00 ","$0.00 ","$1,922.00 ","$3,044.45 ","$3,075.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000221","EAP","HCPCS 91299","","Patency Pill Placement","BOTH IP/OP","$1,081.00 ","$799.94 ","$0.00 ","$1,081.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,081.00 ","$0.00 ","$540.50 ","$856.15 ","$864.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000222","EAP","","","Egd Transoral Biopsy Single/multi-ip Bedside","BOTH IP/OP","$3,388.00 ","$2,507.12 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100002","EAP","CPT� 36511","","Leukopheresis","BOTH IP/OP","$6,450.00 ","$4,773.00 ","$0.00 ","$7,382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,382.00 ","$0.00 ","$2,255.00 ","$5,846.54 ","$5,905.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100003","EAP","CPT� 36512","","THERAPEUTIC APHERESIS RED BLOOD CELLS","BOTH IP/OP","$8,063.00 ","$5,966.62 ","$0.00 ","$7,654.00 ","$2,753.10 ","$1,335.77 ","$1,680.53 ","$0.00 ","$0.00 ","$1,340.15 ","$7,654.00 ","$1,327.51 ","$2,255.00 ","$6,061.97 ","$6,123.20 ","$1,844.40 ","$88.77 ","$112.51 ","$1,218.52 ","$1,264.30 "
"76100004","EAP","CPT� 36513","","Plateletpheresis","BOTH IP/OP","$8,063.00 ","$5,966.62 ","$0.00 ","$7,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,654.00 ","$0.00 ","$2,255.00 ","$6,061.97 ","$6,123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100005","EAP","CPT� 36514","","Plasmapheresis","BOTH IP/OP","$7,805.00 ","$5,775.70 ","$0.00 ","$8,933.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,933.00 ","$0.00 ","$2,255.00 ","$7,074.94 ","$7,146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100006","EAP","CPT� 51700","","Bladder Irrig/instill Simple","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$504.00 ","$260.60 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$504.00 ","$399.17 ","$403.20 ","$0.00 ","$100.47 ","$0.00 ","$0.00 ","$0.00 "
"76100007","EAP","CPT� 51700","","Badder Irrig/instill Simple","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$504.00 ","$260.60 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$504.00 ","$399.17 ","$403.20 ","$0.00 ","$100.47 ","$0.00 ","$0.00 ","$0.00 "
"76100009","EAP","CPT� 92136","","Iol Calculations (ophthalmic Biometry)","BOTH IP/OP","$416.00 ","$307.84 ","$0.00 ","$420.00 ","$225.89 ","$110.43 ","$86.70 ","$0.00 ","$0.00 ","$73.54 ","$420.00 ","$109.35 ","$210.00 ","$332.64 ","$336.00 ","$151.93 ","$90.57 ","$31.69 ","$66.86 ","$104.14 "
"76100011","EAP","CPT� 51701","","Insert Straight Cath","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$865.00 ","$865.00 ","$110.43 ","$180.29 ","$0.00 ","$0.00 ","$151.28 ","$864.00 ","$109.35 ","$864.00 ","$684.29 ","$691.20 ","$151.93 ","$57.62 ","$27.40 ","$137.55 ","$104.14 "
"76100013","EAP","CPT� 51703","","Urinary Cath, Indwelling","BOTH IP/OP","$1,809.00 ","$1,338.66 ","$0.00 ","$1,809.00 ","$1,809.00 ","$136.73 ","$0.00 ","$0.00 ","$0.00 ","$316.57 ","$1,808.00 ","$138.76 ","$1,808.00 ","$1,431.94 ","$1,446.40 ","$192.78 ","$170.19 ","$80.41 ","$287.83 ","$132.15 "
"76100014","EAP","CPT� 51702","","Cath Insert Indwelling","BOTH IP/OP","$1,069.00 ","$791.06 ","$0.00 ","$1,069.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.17 ","$1,069.00 ","$109.35 ","$1,069.00 ","$846.65 ","$855.20 ","$151.93 ","$91.18 ","$26.68 ","$170.18 ","$104.14 "
"76100016","EAP","CPT� 51703","","Cath Insertion Complicated","BOTH IP/OP","$1,808.00 ","$1,337.92 ","$0.00 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.57 ","$1,808.00 ","$138.76 ","$1,808.00 ","$1,431.94 ","$1,446.40 ","$192.78 ","$170.19 ","$80.41 ","$287.83 ","$132.15 "
"76100017","EAP","CPT� 51703","","Insert Bladder Cath, Complex","BOTH IP/OP","$1,808.00 ","$1,337.92 ","$0.00 ","$1,808.00 ","$1,808.00 ","$136.73 ","$0.00 ","$0.00 ","$0.00 ","$316.57 ","$1,808.00 ","$138.76 ","$1,808.00 ","$1,431.94 ","$1,446.40 ","$192.78 ","$170.19 ","$80.41 ","$287.83 ","$132.15 "
"76100020","EAP","CPT� 51701","","Bladder Irrig/instill Simple","BOTH IP/OP","$864.00 ","$639.36 ","$0.00 ","$864.00 ","$864.00 ","$110.43 ","$180.08 ","$0.00 ","$0.00 ","$151.28 ","$864.00 ","$109.35 ","$864.00 ","$684.29 ","$691.20 ","$151.93 ","$57.62 ","$27.40 ","$137.55 ","$104.14 "
"76100028","EAP","CPT� 40810","","Exc. Lesion Mucosa&sub W/o Repair","BOTH IP/OP","$5,204.00 ","$3,850.96 ","$0.00 ","$5,257.00 ","$2,321.55 ","$2,679.15 ","$1,084.64 ","$0.00 ","$0.00 ","$920.46 ","$5,257.00 ","$2,626.99 ","$2,255.00 ","$4,163.54 ","$4,205.60 ","$3,649.85 ","$822.72 ","$127.59 ","$836.91 ","$2,501.89 "
"76100029","EAP","CPT� 40804","","Rem Embedded Fb, Mouth Simple","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$939.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$939.00 ","$0.00 ","$939.00 ","$743.69 ","$751.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100030","EAP","CPT� 54520","","Orchiectomy Simple","BOTH IP/OP","$4,759.00 ","$3,521.66 ","$0.00 ","$4,807.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,807.00 ","$0.00 ","$2,858.00 ","$3,807.14 ","$3,845.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100031","EAP","CPT� 54535","","Orchiectomy Radical/tumor","BOTH IP/OP","$7,279.00 ","$5,386.46 ","$0.00 ","$7,279.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,279.00 ","$0.00 ","$2,255.00 ","$5,764.97 ","$5,823.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100032","EAP","CPT� 40799","","Lip Surgery Procedure","BOTH IP/OP","$244.00 ","$180.56 ","$0.00 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.00 ","$0.00 ","$230.00 ","$182.16 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100034","EAP","CPT� 53040","","Drainage Of Urethra Abscess","BOTH IP/OP","$6,748.00 ","$4,993.52 ","$0.00 ","$6,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,768.00 ","$0.00 ","$2,327.00 ","$5,360.26 ","$5,414.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100035","EAP","CPT� 42106","","Exc. Lesion Mouth Roof(palate)","BOTH IP/OP","$2,709.00 ","$2,004.66 ","$0.00 ","$2,709.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,709.00 ","$0.00 ","$2,255.00 ","$2,145.53 ","$2,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100040","EAP","CPT� 21497","","Indental Wiring","BOTH IP/OP","$4,596.00 ","$3,401.04 ","$0.00 ","$4,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,642.00 ","$0.00 ","$2,327.00 ","$3,676.46 ","$3,713.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100041","EAP","CPT� 41800","","Drainage Of Gum Lesion","BOTH IP/OP","$640.00 ","$473.60 ","$0.00 ","$640.00 ","$0.00 ","$0.00 ","$0.00 ","$640.00 ","$640.00 ","$112.06 ","$640.00 ","$109.35 ","$640.00 ","$506.88 ","$512.00 ","$151.93 ","$87.50 ","$157.47 ","$101.89 ","$104.14 "
"76100042","EAP","CPT� 29799","","Casting/strapping Procedure","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$198.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100043","EAP","CPT� 31820","","Closure Of Windpipe Lesion","BOTH IP/OP","$6,588.00 ","$4,875.12 ","$0.00 ","$7,950.00 ","$2,321.55 ","$2,679.15 ","$1,373.10 ","$0.00 ","$0.00 ","$0.00 ","$7,950.00 ","$0.00 ","$2,255.00 ","$6,296.40 ","$6,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100044","EAP","CPT� 40650","","Lip Repair","BOTH IP/OP","$1,705.00 ","$1,261.70 ","$0.00 ","$1,604.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,604.00 ","$0.00 ","$1,604.00 ","$1,270.37 ","$1,283.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100045","EAP","CPT� 41000","","Drainage Of Mouth Lesion","BOTH IP/OP","$3,430.00 ","$2,538.20 ","$98.48 ","$3,465.00 ","$2,321.55 ","$442.92 ","$714.90 ","$1,208.73 ","$1,208.73 ","$606.69 ","$3,465.00 ","$443.02 ","$2,255.00 ","$2,744.28 ","$2,772.00 ","$615.51 ","$98.48 ","$112.82 ","$551.63 ","$421.92 "
"76100046","EAP","CPT� 36511","","Leukopheresis","BOTH IP/OP","$7,776.00 ","$5,754.24 ","$0.00 ","$7,382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,382.00 ","$0.00 ","$2,255.00 ","$5,846.54 ","$5,905.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100047","EAP","CPT� 36513","","Plateletpheresis","BOTH IP/OP","$8,063.00 ","$5,966.62 ","$0.00 ","$7,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,654.00 ","$0.00 ","$2,255.00 ","$6,061.97 ","$6,123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100048","EAP","CPT� 36514","","Plasmapheresis","BOTH IP/OP","$9,881.00 ","$7,311.94 ","$0.00 ","$8,933.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,933.00 ","$0.00 ","$2,255.00 ","$7,074.94 ","$7,146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100055","EAP","CPT� 65778","","Cover Eye W/ Membrane","BOTH IP/OP","$3,166.00 ","$2,342.84 ","$0.00 ","$3,197.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,197.00 ","$0.00 ","$2,255.00 ","$2,532.02 ","$2,557.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100060","EAP","CPT� 54235","","Penile Injection","BOTH IP/OP","$898.00 ","$664.52 ","$0.00 ","$907.00 ","$487.61 ","$260.60 ","$187.17 ","$0.00 ","$0.00 ","$158.81 ","$907.00 ","$235.59 ","$907.00 ","$718.34 ","$725.60 ","$327.32 ","$70.35 ","$75.71 ","$144.39 ","$224.37 "
"76100061","EAP","CPT� 20240","","Bone Bx Exc.","BOTH IP/OP","$2,386.00 ","$1,765.64 ","$0.00 ","$2,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,380.00 ","$0.00 ","$2,327.00 ","$1,884.96 ","$1,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100062","EAP","CPT� 21337","","Treat Nasa Septal Fx","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,300.00 ","$0.00 ","$2,300.00 ","$1,821.60 ","$1,840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100063","EAP","CPT� 31579","","Direct Laryngoscopy","BOTH IP/OP","$1,660.00 ","$1,228.40 ","$0.00 ","$1,524.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,524.00 ","$0.00 ","$1,524.00 ","$1,207.01 ","$1,219.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100064","EAP","CPT� 31237","","Nasal/sinus Endoscopy","BOTH IP/OP","$7,080.00 ","$5,239.20 ","$163.68 ","$6,558.00 ","$2,753.10 ","$1,465.20 ","$1,475.65 ","$1,482.64 ","$1,482.64 ","$1,148.25 ","$6,558.00 ","$1,434.81 ","$2,327.00 ","$5,193.94 ","$5,246.40 ","$1,993.48 ","$226.31 ","$163.68 ","$1,044.03 ","$1,366.49 "
"76100070","EAP","CPT� 20615","","Treatment Of Bone Cyst","BOTH IP/OP","$919.00 ","$680.06 ","$0.00 ","$919.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$919.00 ","$0.00 ","$919.00 ","$727.85 ","$735.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100071","EAP","CPT� 41830","","Removal Of Gum Tissue","BOTH IP/OP","$3,478.00 ","$2,573.72 ","$0.00 ","$3,511.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,511.00 ","$0.00 ","$2,255.00 ","$2,780.71 ","$2,808.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100072","EAP","CPT� 31237","","Nasal/sinus Endoscopy","BOTH IP/OP","$6,558.00 ","$4,852.92 ","$0.00 ","$6,558.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$1,148.25 ","$6,558.00 ","$1,434.81 ","$2,327.00 ","$5,193.94 ","$5,246.40 ","$1,993.48 ","$226.31 ","$163.68 ","$1,044.03 ","$1,366.49 "
"76100073","EAP","CPT� 42310","","Drainage Of Salivary Gland","BOTH IP/OP","$1,573.00 ","$1,164.02 ","$0.00 ","$1,571.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,571.00 ","$0.00 ","$1,571.00 ","$1,244.23 ","$1,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100076","EAP","CPT� 53852","","Prostatic Rf Thermotx (tuna)","BOTH IP/OP","$15,721.00 ","$11,633.54 ","$0.00 ","$15,721.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,721.00 ","$0.00 ","$3,902.00 ","$12,451.03 ","$12,576.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100077","EAP","CPT� 53850","","Prostatic Microwave Thermotx (tumt)","BOTH IP/OP","$15,721.00 ","$11,633.54 ","$0.00 ","$15,721.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,721.00 ","$0.00 ","$2,255.00 ","$12,451.03 ","$12,576.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100078","EAP","CPT� 31571","","Laryngoscopy W/vc Inj+scope","BOTH IP/OP","$12,143.00 ","$8,985.82 ","$0.00 ","$11,149.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,149.00 ","$0.00 ","$2,327.00 ","$8,830.01 ","$8,919.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100086","EAP","CPT� 36512","","Therapetic Phlebotomy","BOTH IP/OP","$8,063.00 ","$5,966.62 ","$0.00 ","$7,654.00 ","$2,753.10 ","$1,335.77 ","$1,680.53 ","$0.00 ","$0.00 ","$1,340.15 ","$7,654.00 ","$1,327.51 ","$2,255.00 ","$6,061.97 ","$6,123.20 ","$1,844.40 ","$88.77 ","$112.51 ","$1,218.52 ","$1,264.30 "
"76100087","EAP","CPT� 21299","","Cranio/maxillofacial Proc.","BOTH IP/OP","$272.00 ","$201.28 ","$0.00 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.00 ","$0.00 ","$272.00 ","$215.42 ","$217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100088","EAP","CPT� 20527","","Inj Dupuytren Cord W Enzyme","BOTH IP/OP","$514.00 ","$380.36 ","$0.00 ","$514.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$514.00 ","$0.00 ","$514.00 ","$407.09 ","$411.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100089","EAP","CPT� 20615","","Nasal Surgery Proc","BOTH IP/OP","$919.00 ","$680.06 ","$0.00 ","$919.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$919.00 ","$0.00 ","$919.00 ","$727.85 ","$735.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100090","EAP","CPT� 15271","","Skin Sub Graft Trnk/arm/leg 25","BOTH IP/OP","$2,131.00 ","$1,576.94 ","$0.00 ","$1,997.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,997.00 ","$0.00 ","$1,997.00 ","$1,581.62 ","$1,597.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100091","EAP","CPT� 15272","","Skin Sub Graft T/a/l Addl 25","BOTH IP/OP","$622.00 ","$460.28 ","$0.00 ","$583.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$583.00 ","$0.00 ","$291.50 ","$461.74 ","$466.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100092","EAP","CPT� 15273","","Skin Sub Grft T/a/lg Child 100","BOTH IP/OP","$3,292.00 ","$2,436.08 ","$0.00 ","$3,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,292.00 ","$0.00 ","$2,858.00 ","$2,607.26 ","$2,633.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100093","EAP","CPT� 15274","","Skin Sub Grft T/a/lg Ch Addl 100","BOTH IP/OP","$1,578.00 ","$1,167.72 ","$0.00 ","$1,578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,578.00 ","$0.00 ","$789.00 ","$1,249.78 ","$1,262.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100094","EAP","CPT� 15275","","Skin Sub Grft Face/nk/hf/g 25","BOTH IP/OP","$2,179.00 ","$1,612.46 ","$0.00 ","$2,179.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,179.00 ","$0.00 ","$2,179.00 ","$1,725.77 ","$1,743.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100095","EAP","CPT� 15276","","Skin Sub Grft F/n/hf/g Addl 25","BOTH IP/OP","$583.00 ","$431.42 ","$0.00 ","$583.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$583.00 ","$0.00 ","$291.50 ","$461.74 ","$466.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100096","EAP","CPT� 15277","","Skin Sub Grft F/n/hf/g Child 100","BOTH IP/OP","$2,570.00 ","$1,901.80 ","$0.00 ","$2,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,408.00 ","$0.00 ","$2,255.00 ","$1,907.14 ","$1,926.40 ","$0.00 ","$283.67 ","$0.00 ","$0.00 ","$0.00 "
"76100097","EAP","CPT� 15278","","Skin Sub Grft F/n/hf/g Ch Add 100","BOTH IP/OP","$1,684.00 ","$1,246.16 ","$0.00 ","$1,578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,578.00 ","$0.00 ","$789.00 ","$1,249.78 ","$1,262.40 ","$0.00 ","$81.00 ","$0.00 ","$0.00 ","$0.00 "
"76100098","EAP","CPT� 29581","","Apply Multlay Comprs Lwr Leg","BOTH IP/OP","$453.00 ","$335.22 ","$0.00 ","$478.00 ","$245.98 ","$138.36 ","$94.42 ","$0.00 ","$0.00 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100102","EAP","CPT� 29584","","Apply Multlay Comprs  Arm/hand","BOTH IP/OP","$427.00 ","$315.98 ","$0.00 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$478.00 ","$0.00 ","$478.00 ","$378.58 ","$382.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100103","EAP","CPT� 46220","","Exc. Anal Ext. Tag/papilla","BOTH IP/OP","$4,310.00 ","$3,189.40 ","$0.00 ","$4,354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,354.00 ","$0.00 ","$2,255.00 ","$3,448.37 ","$3,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100104","EAP","CPT� 17999","","Skin Tissue Procedure","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$250.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100105","EAP","CPT� 31570","","Laryngoscope W/vc Inj","BOTH IP/OP","$8,010.00 ","$5,927.40 ","$235.43 ","$7,354.00 ","$2,753.10 ","$3,033.56 ","$1,669.48 ","$1,482.64 ","$1,482.64 ","$1,287.63 ","$7,354.00 ","$2,945.54 ","$2,327.00 ","$5,824.37 ","$5,883.20 ","$4,092.44 ","$296.20 ","$235.43 ","$1,170.76 ","$2,805.28 "
"76100106","EAP","CPT� 41899","","Bx Of Gum Mass","BOTH IP/OP","$1,862.00 ","$1,377.88 ","$0.00 ","$1,880.00 ","$1,862.00 ","$207.19 ","$388.09 ","$0.00 ","$0.00 ","$329.17 ","$1,880.00 ","$204.24 ","$1,880.00 ","$1,488.96 ","$1,504.00 ","$283.76 ","$294.22 ","$0.00 ","$299.30 ","$194.51 "
"76100107","EAP","CPT� 40899","","Vestibule Of Mouth (unlisted)","BOTH IP/OP","$262.00 ","$193.88 ","$0.00 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.00 ","$0.00 ","$308.00 ","$243.94 ","$246.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100110","EAP","CPT� 49082","","Abdom Paracentesis W/o Imag","BOTH IP/OP","$1,861.00 ","$1,377.14 ","$0.00 ","$1,861.00 ","$1,861.00 ","$792.43 ","$387.88 ","$0.00 ","$0.00 ","$309.74 ","$1,769.00 ","$788.23 ","$1,769.00 ","$1,401.05 ","$1,415.20 ","$1,095.14 ","$0.00 ","$77.15 ","$281.62 ","$750.70 "
"76100112","EAP","CPT� 49083","","Abdom Paracentesis W Imag","BOTH IP/OP","$1,861.00 ","$1,377.14 ","$0.00 ","$1,861.00 ","$1,861.00 ","$792.43 ","$387.88 ","$0.00 ","$0.00 ","$309.74 ","$1,769.00 ","$788.23 ","$1,769.00 ","$1,401.05 ","$1,415.20 ","$1,095.14 ","$296.18 ","$112.15 ","$281.62 ","$750.70 "
"76100113","EAP","CPT� 49084","","Peritoneal Lavage W Imag","BOTH IP/OP","$1,861.00 ","$1,377.14 ","$0.00 ","$1,769.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,769.00 ","$0.00 ","$1,769.00 ","$1,401.05 ","$1,415.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100114","EAP","CPT� 20680","","Removal Of Support Implant","BOTH IP/OP","$5,413.00 ","$4,005.62 ","$0.00 ","$5,087.00 ","$0.00 ","$0.00 ","$0.00 ","$3,630.59 ","$3,630.59 ","$0.00 ","$5,087.00 ","$2,325.71 ","$2,858.00 ","$4,028.90 ","$4,069.60 ","$3,231.26 ","$0.00 ","$437.25 ","$809.85 ","$2,214.96 "
"76100115","EAP","CPT� 25605","","Treat Fracture Radius Ulna","BOTH IP/OP","$2,345.00 ","$1,735.30 ","$0.00 ","$2,345.00 ","$0.00 ","$0.00 ","$0.00 ","$1,756.53 ","$1,756.53 ","$410.59 ","$2,345.00 ","$1,359.37 ","$2,345.00 ","$1,857.24 ","$1,876.00 ","$1,888.67 ","$469.11 ","$530.90 ","$373.32 ","$1,294.64 "
"76100116","EAP","CPT� 27825","","Treat Lower Leg Fracture","BOTH IP/OP","$6,872.00 ","$5,085.28 ","$0.00 ","$7,275.00 ","$0.00 ","$0.00 ","$0.00 ","$1,482.64 ","$1,482.64 ","$0.00 ","$7,275.00 ","$1,359.37 ","$2,327.00 ","$5,761.80 ","$5,820.00 ","$1,888.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100117","EAP","CPT� 41899","","Alveoplasty W/extractions","BOTH IP/OP","$2,369.00 ","$1,753.06 ","$0.00 ","$2,391.00 ","$2,321.55 ","$207.19 ","$493.76 ","$0.00 ","$0.00 ","$418.64 ","$2,391.00 ","$204.24 ","$2,327.00 ","$1,893.67 ","$1,912.80 ","$283.76 ","$374.19 ","$0.00 ","$380.65 ","$194.51 "
"76100118","EAP","CPT� 26705","","Treat Knuckle Dislocation","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,593.00 ","$0.00 ","$1,593.00 ","$1,261.66 ","$1,274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100119","EAP","CPT� 51784","","Anal/urinary Muscle Study","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$212.00 ","$114.03 ","$136.73 ","$43.77 ","$0.00 ","$0.00 ","$37.12 ","$212.00 ","$138.76 ","$212.00 ","$167.90 ","$169.60 ","$192.78 ","$94.94 ","$29.53 ","$33.75 ","$132.15 "
"76100120","EAP","CPT� 26951","","Amputation Of Finger Thumb","BOTH IP/OP","$7,787.00 ","$5,762.38 ","$0.00 ","$7,113.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,113.00 ","$0.00 ","$2,327.00 ","$5,633.50 ","$5,690.40 ","$0.00 ","$412.92 ","$0.00 ","$0.00 ","$0.00 "
"76100121","EAP","CPT� 26705","","Treat Knuckle Dislocation","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,593.00 ","$0.00 ","$1,593.00 ","$1,261.66 ","$1,274.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100122","EAP","CPT� 62273","","Injection Epidural Blood Patch","BOTH IP/OP","$1,679.00 ","$1,242.46 ","$0.00 ","$1,596.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$279.45 ","$1,596.00 ","$626.89 ","$1,596.00 ","$1,264.03 ","$1,276.80 ","$870.98 ","$123.36 ","$117.56 ","$254.08 ","$597.04 "
"76100123","EAP","CPT� 67904","","Blepharoptosis","BOTH IP/OP","$5,049.00 ","$3,736.26 ","$0.00 ","$5,067.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,067.00 ","$0.00 ","$3,606.00 ","$4,013.06 ","$4,053.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100124","EAP","CPT� 11760","","Repair Nail Bed","BOTH IP/OP","$759.00 ","$561.66 ","$0.00 ","$759.00 ","$0.00 ","$0.00 ","$158.19 ","$0.00 ","$0.00 ","$0.00 ","$759.00 ","$0.00 ","$759.00 ","$601.13 ","$607.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100125","EAP","CPT� 17270","","Destruction Malignant Lesion 0.5cm Or Less","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$477.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.00 ","$0.00 ","$477.00 ","$377.78 ","$381.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100126","EAP","CPT� 41599","","Tongue/mouth Unlisted Proc.","BOTH IP/OP","$271.00 ","$200.54 ","$0.00 ","$271.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$271.00 ","$0.00 ","$271.00 ","$214.63 ","$216.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100129","EAP","CPT� 28405","","Treat Heel Fx","BOTH IP/OP","$4,960.00 ","$3,670.40 ","$0.00 ","$4,960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,960.00 ","$0.00 ","$2,327.00 ","$3,928.32 ","$3,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100130","EAP","CPT� 31576","","Laryngoscopy, Fiberoptic W/bx","BOTH IP/OP","$7,908.00 ","$5,851.92 ","$0.00 ","$7,261.00 ","$0.00 ","$0.00 ","$0.00 ","$5,182.18 ","$5,182.18 ","$1,271.34 ","$7,261.00 ","$1,434.81 ","$2,327.00 ","$5,750.71 ","$5,808.80 ","$1,993.48 ","$149.37 ","$121.86 ","$1,155.95 ","$1,366.49 "
"76100131","EAP","CPT� 42999","","Throat Proc. ( Phary/ Aden/tons)","BOTH IP/OP","$206.00 ","$152.44 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$225.00 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100132","EAP","CPT� 59150","","Treat Ectopic Pregnancy","BOTH IP/OP","$21,864.00 ","$16,179.36 ","$0.00 ","$21,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,864.00 ","$0.00 ","$5,452.00 ","$17,316.29 ","$17,491.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100133","EAP","CPT� 24999","","Upper Arm/elbow Surg","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$483.00 ","$0.00 ","$483.00 ","$382.54 ","$386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100134","EAP","CPT� 52001","","Cysto Rem Of Clots","BOTH IP/OP","$5,099.00 ","$3,773.26 ","$0.00 ","$5,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,150.00 ","$0.00 ","$2,255.00 ","$4,078.80 ","$4,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100135","EAP","CPT� 92025","","Topography","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$291.00 ","$156.38 ","$54.51 ","$60.03 ","$0.00 ","$0.00 ","$50.95 ","$291.00 ","$55.17 ","$145.50 ","$230.47 ","$232.80 ","$76.65 ","$45.54 ","$17.29 ","$46.33 ","$52.54 "
"76100136","EAP","CPT� 59001","","Amniocentesis Therapeutic","BOTH IP/OP","$2,089.00 ","$1,545.86 ","$0.00 ","$2,089.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,089.00 ","$0.00 ","$2,089.00 ","$1,654.49 ","$1,671.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100138","EAP","CPT� 25111","","Removal Of Ganglion Cyst","BOTH IP/OP","$4,220.00 ","$3,122.80 ","$0.00 ","$4,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,220.00 ","$0.00 ","$2,858.00 ","$3,342.24 ","$3,376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100139","EAP","CPT� 92025","","Corneal Topography","BOTH IP/OP","$291.00 ","$215.34 ","$0.00 ","$291.00 ","$0.00 ","$0.00 ","$60.03 ","$0.00 ","$0.00 ","$50.95 ","$291.00 ","$55.17 ","$145.50 ","$230.47 ","$232.80 ","$76.65 ","$45.54 ","$17.29 ","$46.33 ","$52.54 "
"76100140","EAP","CPT� 27509","","Treatment Of Thigh Fracture","BOTH IP/OP","$16,329.00 ","$12,083.46 ","$0.00 ","$16,329.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,329.00 ","$0.00 ","$2,858.00 ","$12,932.57 ","$13,063.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76100141","EAP","CPT� 92504","","Ear Microscopy Examination","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$90.00 ","$48.33 ","$0.00 ","$18.55 ","$0.00 ","$0.00 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$25.24 ","$9.74 ","$14.33 ","$0.00 "
"76200002","EAP","HCPCS G0378","","Observation Room","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$141.00 ","$0.00 ","$29.39 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$80.60 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"76200028","EAP","HCPCS G0378","","Obs. Rm. Ecc","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$141.00 ","$0.00 ","$29.39 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$80.60 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"76200077","EAP","HCPCS G0378","","Observation Room Carveout","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$141.00 ","$0.00 ","$29.39 ","$88.50 ","$88.50 ","$21.71 ","$124.00 ","$0.00 ","$80.60 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"77000001","EAP","HCPCS G0101","","Pelvic/breast Exam","BOTH IP/OP","$282.00 ","$208.68 ","$29.20 ","$264.00 ","$153.13 ","$73.28 ","$58.78 ","$188.42 ","$188.42 ","$46.22 ","$264.00 ","$78.77 ","$132.00 ","$209.09 ","$211.20 ","$109.44 ","$41.32 ","$29.20 ","$42.03 ","$75.02 "
"77100006","EAP","CPT� 90471","","Immunization Admin 1st","BOTH IP/OP","$62.00 ","$45.88 ","$9.08 ","$60.72 ","$33.67 ","$60.72 ","$12.92 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$60.65 ","$29.00 ","$45.94 ","$46.40 ","$58.00 ","$9.08 ","$14.42 ","$9.23 ","$57.76 "
"77100007","EAP","CPT� 90471","","Administration Pneumo Vaccine","BOTH IP/OP","$62.00 ","$45.88 ","$9.08 ","$58.00 ","$33.67 ","$39.19 ","$12.92 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$38.22 ","$29.00 ","$45.94 ","$46.40 ","$58.00 ","$9.08 ","$14.42 ","$9.23 ","$36.40 "
"77100011","EAP","CPT� 90472","","Immunization Each Additional","BOTH IP/OP","$62.00 ","$45.88 ","$0.00 ","$58.00 ","$33.67 ","$0.00 ","$12.92 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$0.00 ","$29.00 ","$45.94 ","$46.40 ","$0.00 ","$9.08 ","$12.98 ","$9.23 ","$0.00 "
"77100018","EAP","HCPCS 90471","","Administration Flu Vaccine","BOTH IP/OP","$62.00 ","$45.88 ","$9.08 ","$58.00 ","$33.67 ","$39.19 ","$12.92 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$38.22 ","$29.00 ","$45.94 ","$46.40 ","$58.00 ","$9.08 ","$14.42 ","$9.23 ","$36.40 "
"77100035","EAP","CPT� 90471","","Immunization Admin. (ped)","BOTH IP/OP","$62.00 ","$45.88 ","$9.08 ","$60.72 ","$33.67 ","$60.72 ","$12.92 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$60.65 ","$29.00 ","$45.94 ","$46.40 ","$58.00 ","$9.08 ","$14.42 ","$9.23 ","$57.76 "
"77100040","EAP","CPT� 90471","","Administration Of Hepatitis B Vaccine","BOTH IP/OP","$62.00 ","$45.88 ","$9.08 ","$58.00 ","$33.67 ","$39.19 ","$12.92 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$38.22 ","$29.00 ","$45.94 ","$46.40 ","$58.00 ","$9.08 ","$14.42 ","$9.23 ","$36.40 "
"77100044","EAP","CPT� 90471","","R-immunization Administration-24","BOTH IP/OP","$66.00 ","$48.84 ","$9.08 ","$60.72 ","$35.84 ","$60.72 ","$13.76 ","$41.39 ","$41.39 ","$10.16 ","$58.00 ","$60.65 ","$29.00 ","$45.94 ","$46.40 ","$58.00 ","$9.08 ","$14.42 ","$9.23 ","$57.76 "
"78000010","EAP","HCPCS Q3014","","Telehealth Facility Fee","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$35.30 ","$26.81 ","$20.52 ","$0.00 ","$0.00 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$39.00 ","$22.96 ","$0.00 ","$10.35 ","$0.00 "
"80000611","EAP","HCPCS C1769","","Guidewire Vasc 150cm .035in Fix Core Flxb 3mm Rad","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$231.95 ","$231.95 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"80000635","EAP","HCPCS C1894","","Sheath Introd 10cm 6fr Pncl Peri Snpon Dilat Lock","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$118.92 ","$0.00 ","$45.65 ","$156.30 ","$156.30 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"80002673","EAP","HCPCS C1729","","Catheter Xtrn Drn 80cm Strl Edm Cls Tip Ba Imprg Sil Lmbr","BOTH IP/OP","$566.00 ","$418.84 ","$0.00 ","$566.00 ","$307.34 ","$0.00 ","$0.00 ","$403.95 ","$403.95 ","$99.10 ","$566.00 ","$0.00 ","$283.00 ","$448.27 ","$452.80 ","$0.00 ","$88.58 ","$0.00 ","$90.11 ","$0.00 "
"80003182","EAP","HCPCS C1751","","Catheter Art Ln 110cm 7fr Std Fem Vn 4 Lum S Tip","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$103.49 ","$103.49 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"80003186","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Jl4st","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"80003206","EAP","HCPCS C1725","","Catheter Pa 110cm 7fr 10mm Arw 1 Lum Bln Wdg Prss","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$91.22 ","$0.00 ","$35.02 ","$119.90 ","$119.90 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"80003226","EAP","HCPCS C1884","","System Embl Prtc 300cm .014in 110um 3.2fr Crtd","BOTH IP/OP","$4,188.00 ","$3,099.12 ","$0.00 ","$4,188.00 ","$2,274.08 ","$0.00 ","$872.88 ","$2,988.98 ","$2,988.98 ","$733.29 ","$4,188.00 ","$0.00 ","$2,094.00 ","$3,316.90 ","$3,350.40 ","$0.00 ","$655.42 ","$0.00 ","$666.73 ","$0.00 "
"80003239","EAP","HCPCS C1757","","Catheter Thrmb 140cm 6fr .07in Xprt Ap Aspirat","BOTH IP/OP","$1,238.00 ","$916.12 ","$0.00 ","$1,238.00 ","$672.23 ","$0.00 ","$258.03 ","$883.56 ","$883.56 ","$0.00 ","$1,238.00 ","$0.00 ","$619.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80006190","EAP","HCPCS C1769","","Guidewire Vasc 145cm .035in Fix Core Flpy Flx Tp","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$26.61 ","$0.00 ","$10.21 ","$34.97 ","$34.97 ","$8.58 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$7.67 ","$0.00 ","$7.80 ","$0.00 "
"80006520","EAP","HCPCS C1876","","System Coron Stent 8mm 3.5mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006521","EAP","HCPCS C1876","","System Coron Stent 8mm 4mm Mtlnk Vsn Cocr Rapex Lp","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006522","EAP","HCPCS C1876","","System Coron Stent 12mm 3mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006523","EAP","HCPCS C1874","","System Coron Stent 12mm 3.5mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006524","EAP","HCPCS C1876","","System Coron Stent 12mm 4mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006526","EAP","HCPCS C1876","","System Coron Stent 15mm 3.5mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006531","EAP","HCPCS C1876","","System Coron Stent 23mm 3mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006535","EAP","HCPCS C1874","","System Coron Stent 28mm 3.5mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006536","EAP","HCPCS C1876","","System Coron Stent 28mm 4mm Mtlnk Vsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80006635","EAP","HCPCS C1769","","Guidewire Vasc 145cm .038in Atrm Flpy Flx Tp Xstif","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$13.55 ","$46.39 ","$46.39 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"80006680","EAP","HCPCS C1894","","Sheath Introd 10cm 7fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$118.92 ","$0.00 ","$45.65 ","$156.30 ","$156.30 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"80006701","EAP","HCPCS C1773","","Kit Snr 120cm 15mm 6fr Agn Ntnl Cath Preform Loop","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$434.40 ","$0.00 ","$166.74 ","$570.96 ","$570.96 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"80008328","EAP","HCPCS C1876","","System Coron Stent 8mm 2.5mm Mtlnk Mvsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80008330","EAP","HCPCS C1876","","System Coron Stent 15mm 2.5mm Mtlnk Mvsn Cocr","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80008333","EAP","HCPCS C1876","","System Coron Stent 28mm 2.5mm Mtlnk Mvsn Cocr","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80008338","EAP","HCPCS A6198","","Dressing Brn 16x16in Strl Lf Actct Anbctrl Fst Act Brr Cntrl","BOTH IP/OP","$156.00 ","$115.44 ","$0.00 ","$185.00 ","$84.71 ","$0.00 ","$0.00 ","$132.03 ","$132.03 ","$0.00 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80008439","EAP","HCPCS C1894","","Sheath Guid 45cm 6fr Pn Dstn Hs Curve Ss Nyl","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$42.73 ","$146.31 ","$146.31 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"80008456","EAP","HCPCS C1894","","Introd Shth 6fr 4cm Radiopq Lg Bore Stpck Pinch","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"80008503","EAP","HCPCS C1725","","Catheter Angiographic Chuang C Curve 5fr 80cm Torcon Nb","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$34.21 ","$0.00 ","$13.13 ","$44.96 ","$44.96 ","$11.03 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$9.86 ","$0.00 ","$10.03 ","$0.00 "
"80008556","EAP","HCPCS C1894","","Introd Shth 10fr 2.5cm 25cm Dilat Kink Rst Pncl","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$499.00 ","$270.96 ","$0.00 ","$104.00 ","$356.14 ","$356.14 ","$87.37 ","$499.00 ","$0.00 ","$249.50 ","$395.21 ","$399.20 ","$0.00 ","$78.09 ","$0.00 ","$79.44 ","$0.00 "
"80008561","EAP","HCPCS C1894","","Sheath Introd 25cm 5fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$499.00 ","$270.96 ","$0.00 ","$104.00 ","$356.14 ","$356.14 ","$87.37 ","$499.00 ","$0.00 ","$249.50 ","$395.21 ","$399.20 ","$0.00 ","$78.09 ","$0.00 ","$79.44 ","$0.00 "
"80008562","EAP","HCPCS C1757","","Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80008565","EAP","HCPCS C1894","","Sheath Introd 25cm 6fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$499.00 ","$270.96 ","$0.00 ","$104.00 ","$356.14 ","$356.14 ","$87.37 ","$499.00 ","$0.00 ","$249.50 ","$395.21 ","$399.20 ","$0.00 ","$78.09 ","$0.00 ","$79.44 ","$0.00 "
"80008566","EAP","HCPCS C1894","","Introd Shth 8fr 2.5cm 25cm Dilat Mini Gwire Kink","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$499.00 ","$270.96 ","$0.00 ","$104.00 ","$356.14 ","$356.14 ","$87.37 ","$499.00 ","$0.00 ","$249.50 ","$395.21 ","$399.20 ","$0.00 ","$78.09 ","$0.00 ","$79.44 ","$0.00 "
"80008570","EAP","HCPCS C1894","","Sheath Introd 25cm 7fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$499.00 ","$369.26 ","$0.00 ","$499.00 ","$270.96 ","$0.00 ","$104.00 ","$356.14 ","$356.14 ","$87.37 ","$499.00 ","$0.00 ","$249.50 ","$395.21 ","$399.20 ","$0.00 ","$78.09 ","$0.00 ","$79.44 ","$0.00 "
"80008625","EAP","HCPCS C1894","","Sheath Introd 10cm 10fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$118.92 ","$0.00 ","$45.65 ","$156.30 ","$156.30 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"80008715","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Lcb Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80008870","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Mpa1","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$85.64 ","$85.64 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"80008873","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Jr3.5","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"80008874","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Ima Curve Peri","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80008930","EAP","HCPCS C1760","","Device Clsr 70cm 6fr Angsl Vip .035in Vasc Clgn","BOTH IP/OP","$1,600.00 ","$1,184.00 ","$0.00 ","$8,000.00 ","$868.80 ","$0.00 ","$333.48 ","$5,158.80 ","$5,158.80 ","$1,400.74 ","$8,000.00 ","$0.00 ","$4,000.00 ","$6,336.00 ","$6,400.00 ","$0.00 ","$1,252.00 ","$0.00 ","$1,273.60 ","$0.00 "
"80009063","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Gldcath Radifocus Ang","BOTH IP/OP","$607.00 ","$449.18 ","$0.00 ","$607.00 ","$0.00 ","$0.00 ","$0.00 ","$433.22 ","$433.22 ","$106.28 ","$607.00 ","$0.00 ","$303.50 ","$480.74 ","$485.60 ","$0.00 ","$95.00 ","$0.00 ","$96.63 ","$0.00 "
"80009071","EAP","HCPCS C1725","","Catheter Angio 65cm 5fr Gldcath Radifocus C2 Curve","BOTH IP/OP","$607.00 ","$449.18 ","$0.00 ","$607.00 ","$0.00 ","$0.00 ","$0.00 ","$433.22 ","$433.22 ","$106.28 ","$607.00 ","$0.00 ","$303.50 ","$480.74 ","$485.60 ","$0.00 ","$95.00 ","$0.00 ","$96.63 ","$0.00 "
"80009072","EAP","HCPCS C1769","","Guidewire Vasc Std Ang .035in 260cm 3cm Gldwr Gld Tch Flxb","BOTH IP/OP","$555.00 ","$410.70 ","$0.00 ","$555.00 ","$301.37 ","$0.00 ","$115.68 ","$396.10 ","$396.10 ","$97.18 ","$555.00 ","$0.00 ","$277.50 ","$439.56 ","$444.00 ","$0.00 ","$86.86 ","$0.00 ","$88.36 ","$0.00 "
"80009076","EAP","HCPCS C1769","","Guidewire Vasc 150cm .035in Radiopq Std Shft Flxb","BOTH IP/OP","$402.00 ","$297.48 ","$0.00 ","$363.00 ","$218.29 ","$0.00 ","$75.66 ","$259.07 ","$259.07 ","$63.56 ","$363.00 ","$0.00 ","$181.50 ","$287.50 ","$290.40 ","$0.00 ","$56.81 ","$0.00 ","$57.79 ","$0.00 "
"80009079","EAP","HCPCS C1894","","Sheath Introd 10cm 5fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$118.92 ","$0.00 ","$45.65 ","$156.30 ","$156.30 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"80009081","EAP","HCPCS C1894","","Sheath Introd 10cm 8fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$118.92 ","$0.00 ","$45.65 ","$156.30 ","$156.30 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"80009082","EAP","HCPCS C1894","","Sheath Introd 10cm 9fr Pncl Peri Ss Hydphi Ptfe","BOTH IP/OP","$272.00 ","$201.28 ","$0.00 ","$219.00 ","$147.70 ","$0.00 ","$45.65 ","$156.30 ","$156.30 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"80009106","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Sft Rbn Tip Kink Rst","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80009617","EAP","HCPCS B4087","","Tube Jjnstm 12fr 2-3ml Strl Lf Mc Slk Med Port Radopq Strp","BOTH IP/OP","$337.00 ","$249.38 ","$0.00 ","$337.00 ","$0.00 ","$0.00 ","$0.00 ","$240.52 ","$240.52 ","$0.00 ","$337.00 ","$0.00 ","$168.50 ","$266.90 ","$269.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80009798","EAP","HCPCS C1760","","Device Clsr 5-7fr Cardiva Ctlst Ii Fem Art Prtmn","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$2,676.38 ","$2,676.38 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"80009995","EAP","HCPCS C1894","","Sheath Guid 45cm 6fr Pn Dstn Str Ss Nyl Hydphi","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$112.40 ","$0.00 ","$43.14 ","$147.74 ","$147.74 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"80010072","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Shr Nx Bal Al1 Curve Coron","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$64.07 ","$0.00 ","$24.59 ","$84.22 ","$84.22 ","$20.66 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$18.47 ","$0.00 ","$18.79 ","$0.00 "
"80010120","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80010121","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80010122","EAP","HCPCS C1769","","Extension Gwire 145cm .014in Doc","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80010594","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Prfm Pgtl Curve Peri","BOTH IP/OP","$226.00 ","$167.24 ","$0.00 ","$226.00 ","$0.00 ","$0.00 ","$0.00 ","$161.30 ","$161.30 ","$39.57 ","$226.00 ","$0.00 ","$113.00 ","$178.99 ","$180.80 ","$0.00 ","$35.37 ","$0.00 ","$35.98 ","$0.00 "
"80010631","EAP","HCPCS C1874","","Stent Trchbr 5mm 6fr 22mm 120cm Cover Cath Introd","BOTH IP/OP","$6,288.00 ","$4,653.12 ","$0.00 ","$6,288.00 ","$2,829.60 ","$0.00 ","$1,310.58 ","$4,487.75 ","$4,487.75 ","$1,100.98 ","$6,288.00 ","$0.00 ","$3,144.00 ","$4,980.10 ","$5,030.40 ","$0.00 ","$984.07 ","$0.00 ","$1,001.05 ","$0.00 "
"80010639","EAP","HCPCS C1876","","System Coron Stent 13mm 4.5mm Mtlnk Ul Xcelon","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80016126","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Ebu3 Curve Coron Nyl","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$163.00 ","$65.16 ","$0.00 ","$25.01 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80016128","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Ebu4 Curve Coron Nyl","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"80016129","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Ebu3 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80016130","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Ebu3.5 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80016131","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Shr Nx Bal Ebu4 Curve","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80016135","EAP","HCPCS C1757","","Catheter Thrmb 145cm 7fr .080in Xprt Ap Aspirat","BOTH IP/OP","$1,238.00 ","$916.12 ","$0.00 ","$1,238.00 ","$0.00 ","$0.00 ","$0.00 ","$883.56 ","$883.56 ","$0.00 ","$1,238.00 ","$0.00 ","$619.00 ","$980.50 ","$990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80016142","EAP","HCPCS C1753","","Catheter Us 150cm 3.3-2.9fr 20mm Ee Pltn 20mhz","BOTH IP/OP","$1,813.00 ","$1,341.62 ","$0.00 ","$1,813.00 ","$984.46 ","$0.00 ","$377.87 ","$1,293.94 ","$1,293.94 ","$317.44 ","$1,813.00 ","$0.00 ","$906.50 ","$1,435.90 ","$1,450.40 ","$0.00 ","$283.73 ","$0.00 ","$288.63 ","$0.00 "
"80016144","EAP","HCPCS C1773","","Kit Snr Agn 90d Mic 175cm 2.3-3fr 2mm Cath Loop","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$760.20 ","$0.00 ","$291.80 ","$999.18 ","$999.18 ","$245.13 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$219.10 ","$0.00 ","$222.88 ","$0.00 "
"80017153","EAP","HCPCS C1752","","Catheter Sct Kt 2 Lum Coil Xtd Lgth","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$142.74 ","$142.74 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80017258","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80017262","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80017266","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80017278","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 25mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80017284","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 25mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80017293","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80017362","EAP","Custom 80017362","","Envelope Abs 2.7x2.5in Tyrx Polyarylate","BOTH IP/OP","$1,738.00 ","$1,286.12 ","$0.00 ","$1,738.00 ","$0.00 ","$0.00 ","$0.00 ","$1,240.41 ","$1,240.41 ","$0.00 ","$1,738.00 ","$0.00 ","$869.00 ","$1,376.50 ","$1,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80017977","EAP","Custom 80017977","","Envelope Abs 3.3x2.9in Anbctrl Tyrx Polyarylate","BOTH IP/OP","$2,238.00 ","$1,656.12 ","$0.00 ","$2,238.00 ","$0.00 ","$0.00 ","$0.00 ","$1,597.26 ","$1,597.26 ","$0.00 ","$2,238.00 ","$0.00 ","$1,119.00 ","$1,772.50 ","$1,790.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80018159","EAP","HCPCS C1894","","Tray Cath Lf A Neos 2 Tier Dsgn Fn Tip Fcp Ins Deph Fr Mgln","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$68.96 ","$0.00 ","$26.47 ","$90.64 ","$90.64 ","$22.24 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$19.88 ","$0.00 ","$20.22 ","$0.00 "
"80018208","EAP","HCPCS C1752","","Set Catheter .035in 24cm 70cm Sidehole Removable S","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$267.64 ","$267.64 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80018623","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 145cm 12mm Otw 2 Lum Ult","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018626","EAP","HCPCS C1725","","Catheter Baldilat 2mm 145cm 12mm Otw 2 Lum Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018627","EAP","HCPCS C1725","","Catheter Baldilat 2mm 145cm 15mm Otw 2 Lum Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018653","EAP","","","Dressing Foam 20x8in Gentle Adherence Polyurethane Foam Pad","BOTH IP/OP","$167.00 ","$123.58 ","$0.00 ","$167.00 ","$0.00 ","$0.00 ","$0.00 ","$119.19 ","$119.19 ","$0.00 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80018673","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018676","EAP","HCPCS C1725","","Catheter Baldilat 3mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018677","EAP","HCPCS C1725","","Catheter Baldilat 3mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018678","EAP","HCPCS C1725","","Catheter Baldilat 3mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018679","EAP","HCPCS C1725","","Catheter Baldilat 3mm 25mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018680","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$348.29 ","$348.29 ","$85.44 ","$488.00 ","$0.00 ","$244.00 ","$386.50 ","$390.40 ","$0.00 ","$76.37 ","$0.00 ","$77.69 ","$0.00 "
"80018683","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 8mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018684","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018685","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018686","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018689","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018690","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018691","EAP","HCPCS C1725","","Catheter Baldilat 4mm 8mm Coron Rapex Radiopq Smth","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018692","EAP","HCPCS C1725","","Catheter Baldilat 4mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018693","EAP","HCPCS C1725","","Catheter Baldilat 4mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018694","EAP","HCPCS C1725","","Catheter Baldilat 4mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80018696","EAP","HCPCS C1725","","Catheter Baldilat 5mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80074158","EAP","HCPCS C1898","","Lead Pacing 10mm Space Small Str 6.2fr 2mm 52cm 20","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$455.85 ","$0.00 ","$211.13 ","$722.98 ","$722.98 ","$177.37 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$158.53 ","$0.00 ","$161.27 ","$0.00 "
"80074159","EAP","HCPCS C1898","","Lead Pacing 10mm Space Small Str 6.2fr 2mm 58cm 20","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$455.85 ","$0.00 ","$211.13 ","$722.98 ","$722.98 ","$177.37 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$158.53 ","$0.00 ","$161.27 ","$0.00 "
"80078368","EAP","HCPCS C1884","","System Embl Prtc 320cm Crtd Lwr Xtrmt Cptr Wire","BOTH IP/OP","$3,488.00 ","$2,581.12 ","$0.00 ","$3,488.00 ","$1,893.98 ","$0.00 ","$726.99 ","$2,489.39 ","$2,489.39 ","$610.72 ","$3,488.00 ","$0.00 ","$1,744.00 ","$2,762.50 ","$2,790.40 ","$0.00 ","$545.87 ","$0.00 ","$555.29 ","$0.00 "
"80078369","EAP","HCPCS C1884","","System Embl Prtc 320cm Crtd Lwr Xtrmt Cptr Wire","BOTH IP/OP","$4,170.00 ","$3,085.80 ","$0.00 ","$3,488.00 ","$2,264.31 ","$0.00 ","$869.13 ","$2,489.39 ","$2,489.39 ","$610.72 ","$3,488.00 ","$0.00 ","$1,744.00 ","$2,762.50 ","$2,790.40 ","$0.00 ","$545.87 ","$0.00 ","$555.29 ","$0.00 "
"80078384","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Radiopq Flxb Core To","BOTH IP/OP","$623.00 ","$461.02 ","$0.00 ","$623.00 ","$338.29 ","$0.00 ","$129.85 ","$444.64 ","$444.64 ","$109.08 ","$623.00 ","$0.00 ","$311.50 ","$493.42 ","$498.40 ","$0.00 ","$97.50 ","$0.00 ","$99.18 ","$0.00 "
"80079016","EAP","HCPCS C1894","","Sheath Guid 80cm 6fr 2.2mm Flxr Sh Aq Radiopq Stf","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$205.25 ","$0.00 ","$78.78 ","$269.78 ","$269.78 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$59.16 ","$0.00 ","$60.18 ","$0.00 "
"80079147","EAP","HCPCS C1760","","Device Clsr 6fr Prgld Prcls Vasc Suture Mediate","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$135.48 ","$463.91 ","$463.91 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"80079222","EAP","HCPCS C1894","","Introducer Sheath Short 7fr 21ga 4cm Orange Hub Tubing","BOTH IP/OP","$48.00 ","$35.52 ","$0.00 ","$43.00 ","$26.06 ","$0.00 ","$8.96 ","$30.69 ","$30.69 ","$7.53 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$6.73 ","$0.00 ","$6.85 ","$0.00 "
"80079510","EAP","HCPCS C1769","","Guidewire Vasc 180cm .016in Str Tip Strbl","BOTH IP/OP","$744.00 ","$550.56 ","$0.00 ","$744.00 ","$403.99 ","$0.00 ","$155.07 ","$530.99 ","$530.99 ","$130.27 ","$744.00 ","$0.00 ","$372.00 ","$589.25 ","$595.20 ","$0.00 ","$116.44 ","$0.00 ","$118.44 ","$0.00 "
"80079568","EAP","Custom 80079568","","Coil Embl 15cm 4mm Intlk Fbr Idc 18 Coil 2d Std","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$943.00 ","$0.00 ","$0.00 ","$0.00 ","$673.02 ","$673.02 ","$0.00 ","$943.00 ","$0.00 ","$471.50 ","$746.86 ","$754.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80079570","EAP","Custom 80079570","","Coil Embl 15cm 5mm Intlk Fbr Idc 18 Coil 2d Std","BOTH IP/OP","$943.00 ","$697.82 ","$0.00 ","$943.00 ","$0.00 ","$0.00 ","$0.00 ","$673.02 ","$673.02 ","$0.00 ","$943.00 ","$0.00 ","$471.50 ","$746.86 ","$754.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80097224","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Imprs Sim2 Curve Crbrl Ss","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"80097225","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Crds Tmp Vert Curve Crbrl","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"80097341","EAP","Custom C1751","","Axium Coil Detacher","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$73.31 ","$0.00 ","$28.14 ","$96.35 ","$96.35 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"80097344","EAP","HCPCS C1769","","Guidewire Vascular Taper .018in 300cm 8cm Radiopq Str Tip","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$197.00 ","$106.97 ","$0.00 ","$41.06 ","$140.60 ","$140.60 ","$34.49 ","$197.00 ","$0.00 ","$98.50 ","$156.02 ","$157.60 ","$0.00 ","$30.83 ","$0.00 ","$31.36 ","$0.00 "
"80097387","EAP","HCPCS C1876","","System Cor Stnt 2.25mm 12mm Intgr Microtrac Rx 1 Strn Intgr","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"80097412","EAP","HCPCS C1876","","System Cor Stnt 3mm 9mm Intgr Microtrac Rx 1 Strn Intgr Tip","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"80097421","EAP","HCPCS C1876","","System Cor Stnt 4mm 12mm Intgr Microtrac Rx 1 Strn Intgr Tip","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"80097435","EAP","HCPCS C1757","","System Thrmb 135cm 4fr 2mm Angjt Ult Cx-strm","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$2,436.98 ","$0.00 ","$935.41 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80097440","EAP","Custom 80097440","","Pad Thrp Lg Arcticgel","BOTH IP/OP","$4,960.00 ","$3,670.40 ","$0.00 ","$4,960.00 ","$0.00 ","$0.00 ","$0.00 ","$3,539.95 ","$3,539.95 ","$0.00 ","$4,960.00 ","$0.00 ","$2,480.00 ","$3,928.32 ","$3,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80097469","EAP","HCPCS C1725","","Catheter Baldilat 2mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097470","EAP","HCPCS C1725","","Catheter Baldilat 2mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097471","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097472","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097473","EAP","HCPCS C1725","","Catheter Baldilat 3mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097474","EAP","HCPCS C1725","","Catheter Baldilat 3mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097475","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097476","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80097477","EAP","Custom 80097477","","Catheter Baldilat 4mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80100003","EAP","Custom 80100003","","Hemodialysis-acute-i/p","BOTH IP/OP","$3,300.00 ","$2,442.00 ","$0.00 ","$2,388.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,388.00 ","$0.00 ","$1,194.00 ","$1,891.30 ","$1,910.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80100234","EAP","HCPCS C1894","","Sheath Guid 70cm 6fr 2.2mm Flxr Chk-flo Str Tip Hi","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80100235","EAP","HCPCS C1894","","Sheath Guid 70cm 6fr 2.2mm Flxr Chk-flo Curve","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80100236","EAP","HCPCS C1894","","Introd Shth 8.8fr 7fr 110cm Gw Radiopq Band Hi Flx","BOTH IP/OP","$503.00 ","$372.22 ","$0.00 ","$503.00 ","$273.13 ","$0.00 ","$104.84 ","$358.99 ","$358.99 ","$88.07 ","$503.00 ","$0.00 ","$251.50 ","$398.38 ","$402.40 ","$0.00 ","$78.72 ","$0.00 ","$80.08 ","$0.00 "
"80100237","EAP","HCPCS C1894","","Sheath Guid 70cm 7fr 2.5mm Flxr Introd / Flxr Guid","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80100239","EAP","HCPCS C1894","","Sheath Guid 70cm 8fr 2.9mm Flxr Chk-flo Curve","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80100242","EAP","HCPCS C1894","","Sheath Guid 45cm 6fr .087in Flxr Chk-flo Anl0","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80100243","EAP","HCPCS C1894","","Sheath Guid 45cm 6fr 2.2mm Flxr Chk-flo Multpur","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80100244","EAP","HCPCS C1894","","Sheath Guid 45cm 6fr 2.2in Flxr Chk-flo Anl2 Curve","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80100245","EAP","HCPCS C1894","","Sheath Guid 45cm 7fr .1in Flxr Chk-flo Anl0 Curve","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80100246","EAP","HCPCS C1894","","Sheath Guid 45cm 7fr 2.5mm Flxr Chk-flo Anl3 Curve","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80100247","EAP","HCPCS C1894","","Sheath Guid .018/.038in Anl0 Curve 8fr .113in 45cm Radiopq","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$188.00 ","$110.23 ","$0.00 ","$0.00 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80100254","EAP","HCPCS C1769","","Guidewire Vasc 180cm .035in Flx Tp Fix Core Exch","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$23.35 ","$0.00 ","$8.96 ","$30.69 ","$30.69 ","$7.53 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$6.73 ","$0.00 ","$6.85 ","$0.00 "
"80100273","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Trnb Ad Bcn Kmp Curve Ss","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$11.03 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$9.86 ","$0.00 ","$10.03 ","$0.00 "
"80100275","EAP","HCPCS C1725","","Catheter Angio 65cm 5fr Trnb Ad Bcn Kmp Curve Ss","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$313.00 ","$176.48 ","$0.00 ","$65.24 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"80100322","EAP","HCPCS C1876","","Stent Bil 5mm 19mm 150cm Prmnt Bln Xpd Cath","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100329","EAP","HCPCS C1876","","Stent Bil 6mm 17mm 135cm 20mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100330","EAP","HCPCS C1876","","Stent Bil 6mm 37mm 135cm 40mm Radiopq Otw Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100331","EAP","HCPCS C1876","","Stent Bil 7mm 17mm 135cm 20mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100332","EAP","HCPCS C1876","","Stent Bil 7mm 37mm 135cm 40mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100333","EAP","HCPCS C1876","","Stent Bil 8mm 17mm 135cm 20mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100334","EAP","HCPCS C1876","","Stent Bil 8mm 37mm 135cm 40mm Otw Prmnt Bln Xpd","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100335","EAP","HCPCS C1876","","Stent Bil 9mm 25mm 135cm 30mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100336","EAP","HCPCS C1876","","Stent Bil 9mm 57mm 135cm 60mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100337","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 20mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100340","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 40mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100343","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 80mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100350","EAP","HCPCS C1725","","Catheter Baldilat 2mm 144cm 40mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100353","EAP","HCPCS C1725","","Catheter Baldilat 4mm 143cm 20mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100355","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 100mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100356","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 120mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100357","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 150mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100358","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 80mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100359","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 100mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100361","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 150mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100362","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 80mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100363","EAP","HCPCS C1725","","Catheter Baldilat 4mm 150cm 150mm Otw Infl Port Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100364","EAP","HCPCS C1725","","Catheter Baldilat 4mm 150cm 80mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100366","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 200mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100371","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 200mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100374","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 200mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100377","EAP","HCPCS C1725","","Catheter Baldilat 8mm 75cm 100mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100381","EAP","HCPCS C1726","","Catheter Baldilat 2mm 150cm 150mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100382","EAP","HCPCS C1726","","Catheter Baldilat 2mm 150cm 220mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100383","EAP","HCPCS C1726","","Catheter Baldilat 3mm 150cm 100mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100385","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 220mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100386","EAP","HCPCS C1726","","Catheter Baldilat 4mm 150cm 100mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100392","EAP","HCPCS C1876","","Stent Bil 10mm 37mm 75cm 40mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80100413","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 40mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100416","EAP","HCPCS C1725","","Catheter Baldilat 6mm 20mm 135cm Otw Tpr Tip Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100418","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 40mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100420","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100425","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100428","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 20mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100430","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 40mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100432","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 40mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100433","EAP","HCPCS C1725","","Catheter Baldilat 4mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$438.00 ","$233.49 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100434","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100435","EAP","HCPCS C1726","","Catheter Baldilat 4mm 75cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100436","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 120mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100437","EAP","HCPCS C1725","","Catheter Baldilat 5mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100438","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100439","EAP","HCPCS C1725","","Catheter Baldilat 5mm 75cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100440","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 100mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100441","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 150mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100443","EAP","HCPCS C1725","","Catheter Baldilat 6mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100444","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100445","EAP","HCPCS C1725","","Catheter Baldilat 6mm 75cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100446","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 100mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100447","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 150mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100448","EAP","HCPCS C1725","","Catheter Baldilat 7mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100449","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100450","EAP","HCPCS C1725","","Catheter Baldilat 7mm 75cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100451","EAP","HCPCS C1725","","Catheter Baldilat 8mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100453","EAP","HCPCS C1725","","Catheter Baldilat 8mm 75cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100454","EAP","HCPCS C1725","","Catheter Baldilat 8mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100456","EAP","HCPCS C1725","","Catheter Baldilat 10mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80100470","EAP","HCPCS C1757","","SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT","BOTH IP/OP","$4,225.00 ","$3,126.50 ","$0.00 ","$4,225.00 ","$2,294.18 ","$0.00 ","$880.60 ","$3,015.38 ","$3,015.38 ","$0.00 ","$4,225.00 ","$0.00 ","$2,112.50 ","$3,346.20 ","$3,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80100527","EAP","HCPCS C1768","","Graft Vascular Gore Heparin Propaten Ptfe Standard Wall","BOTH IP/OP","$3,148.00 ","$2,329.52 ","$0.00 ","$3,148.00 ","$1,416.60 ","$0.00 ","$656.12 ","$2,246.73 ","$2,246.73 ","$551.19 ","$3,148.00 ","$0.00 ","$1,574.00 ","$2,493.22 ","$2,518.40 ","$0.00 ","$492.66 ","$0.00 ","$501.16 ","$0.00 "
"80100552","EAP","HCPCS C1894","","Set Introd 30cm 14fr 4.6mm Chk-flo 41cm Acpt .038","BOTH IP/OP","$318.00 ","$235.32 ","$0.00 ","$318.00 ","$172.67 ","$0.00 ","$66.28 ","$226.96 ","$226.96 ","$55.68 ","$318.00 ","$0.00 ","$159.00 ","$251.86 ","$254.40 ","$0.00 ","$49.77 ","$0.00 ","$50.63 ","$0.00 "
"80100555","EAP","HCPCS C1726","","CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"80100582","EAP","HCPCS C1769","","GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEW","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$321.17 ","$321.17 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"80100584","EAP","HCPCS C1887","","Catheter Angiographic Angle 4fr .041in 100cm 15cm 2 Braid","BOTH IP/OP","$121.00 ","$89.54 ","$0.00 ","$121.00 ","$65.70 ","$0.00 ","$25.22 ","$86.36 ","$86.36 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"80100610","EAP","HCPCS C1726","","Catheter Baldilat 2.5mm 150cm 120mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100611","EAP","HCPCS C1726","","Catheter Baldilat 2.5mm 150cm 220mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80100614","EAP","HCPCS C1725","","Catheter Baldilat 4mm 150cm 220mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80200001","EAP","Custom 80200001","","Peritoneal Dialysis-inpat","BOTH IP/OP","$1,724.00 ","$1,275.76 ","$0.00 ","$917.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$917.00 ","$0.00 ","$458.50 ","$726.26 ","$733.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80200005","EAP","HCPCS C1751","","Catheter Cen Ven .032in 9.3fr 38cm 75cm 3 Infus Lumen Extn","BOTH IP/OP","$1,955.00 ","$1,446.70 ","$0.00 ","$1,955.00 ","$1,061.57 ","$0.00 ","$407.47 ","$1,395.28 ","$1,395.28 ","$342.30 ","$1,955.00 ","$0.00 ","$977.50 ","$1,548.36 ","$1,564.00 ","$0.00 ","$305.96 ","$0.00 ","$311.24 ","$0.00 "
"80200008","EAP","HCPCS C1769","","Guidewire Vasc 180cm .014in Atrm X Flpy Tip","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"80200010","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Optitorque Jacky Radl 3.5","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"80200013","EAP","HCPCS C1894","","Set Acces 10cm 5fr 21ga Mpnch Slht .018in Ss","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$20.84 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"80200098","EAP","HCPCS C1769","","Guidewire Vasc 260cm .018in Flpy Tip Radiopq Shrt","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$110.23 ","$0.00 ","$42.31 ","$144.88 ","$144.88 ","$35.54 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$31.77 ","$0.00 ","$32.32 ","$0.00 "
"80200103","EAP","HCPCS C1887","","Catheter Intvn 6fr 5.1fr .056in 150cm 25cm Rapex","BOTH IP/OP","$1,183.00 ","$875.42 ","$0.00 ","$1,183.00 ","$642.37 ","$0.00 ","$246.57 ","$844.31 ","$844.31 ","$207.13 ","$1,183.00 ","$0.00 ","$591.50 ","$936.94 ","$946.40 ","$0.00 ","$185.14 ","$0.00 ","$188.33 ","$0.00 "
"80200104","EAP","HCPCS C1725","","Catheter Guid 100cm 7fr Lnchr Ebu3.75 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80200105","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Optitorque Radl Tig 4.5","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"80200129","EAP","HCPCS C1725","","Catheter Baldilat 9mm 75cm 60mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80200207","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 100mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80200262","EAP","HCPCS C1753","","Catheter Us .018in 3.4fr 135cm Intvasc Exch Vsn Pv","BOTH IP/OP","$1,688.00 ","$1,249.12 ","$0.00 ","$1,688.00 ","$916.58 ","$0.00 ","$351.82 ","$1,204.73 ","$1,204.73 ","$295.56 ","$1,688.00 ","$0.00 ","$844.00 ","$1,336.90 ","$1,350.40 ","$0.00 ","$264.17 ","$0.00 ","$268.73 ","$0.00 "
"80202089","EAP","Custom 80202089","","SET TUBING 2.6MR 2 WAY COMMUNICATION IRRIGATION PUMP","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$89.21 ","$89.21 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202090","EAP","HCPCS C1733","","Catheter Ep 110cm 7fr Safire Tx 2-5-2mm Spc 1mm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$1,153.88 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80202091","EAP","HCPCS C1733","","Safire Tx Catheter 8mm Large Curl","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80202094","EAP","HCPCS C1733","","Catheter Ep 115cm 7fr Safire Comfortgrip 2-5-2mm","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"80202112","EAP","HCPCS C1893","","Introd Shth 8.5fr 180cm 63cm Hmsts Vlv Sdprt Dilat","BOTH IP/OP","$363.00 ","$268.62 ","$0.00 ","$363.00 ","$197.11 ","$0.00 ","$75.66 ","$259.07 ","$259.07 ","$63.56 ","$363.00 ","$0.00 ","$181.50 ","$287.50 ","$290.40 ","$0.00 ","$56.81 ","$0.00 ","$57.79 ","$0.00 "
"80202116","EAP","HCPCS C1894","","Introd Shth 8fr 50cm 12cm 2 Distal Gwire Hmsts Vlv","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$15.20 ","$0.00 ","$5.84 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$4.38 ","$0.00 ","$4.46 ","$0.00 "
"80202118","EAP","HCPCS C1894","","Introd Shth 6fr 50cm 12cm 2 Distal Gwire Hmsts Vlv","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$15.20 ","$0.00 ","$5.84 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$0.00 ","$4.38 ","$0.00 ","$4.46 ","$0.00 "
"80202121","EAP","HCPCS C1893","","Introd Shth 8fr 60cm Fstcth Strl Latex Free Disp","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$169.96 ","$0.00 ","$65.24 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"80202130","EAP","HCPCS C1766","","Introd Cath 40cm 8.5fr 17ga Epicardium Rspn Agilis","BOTH IP/OP","$2,638.00 ","$1,952.12 ","$0.00 ","$2,638.00 ","$1,432.43 ","$0.00 ","$549.83 ","$1,882.74 ","$1,882.74 ","$461.89 ","$2,638.00 ","$0.00 ","$1,319.00 ","$2,089.30 ","$2,110.40 ","$0.00 ","$412.85 ","$0.00 ","$419.97 ","$0.00 "
"80202131","EAP","HCPCS C1730","","Catheter Ep 120cm 5fr Rspn 5mm Spc Crnnd Curve","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"80202133","EAP","HCPCS C1730","","Catheter Ep 120cm 5fr Rspn 5mm Spc Jsphsn Curve","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"80202150","EAP","HCPCS C1731","","Catheter Ep 95cm 7fr Lvwr 2-10-2mm Spc Sup Lg Curl","BOTH IP/OP","$1,938.00 ","$1,434.12 ","$0.00 ","$1,938.00 ","$1,052.33 ","$0.00 ","$403.93 ","$1,383.15 ","$1,383.15 ","$339.33 ","$1,938.00 ","$0.00 ","$969.00 ","$1,534.90 ","$1,550.40 ","$0.00 ","$303.30 ","$0.00 ","$308.53 ","$0.00 "
"80202158","EAP","","","Kit Eltrd Ns Lf Ensite Navx Srfc Disp","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$1,605.83 ","$1,605.83 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202163","EAP","HCPCS C1898","","Lead Packing Tendril Sts Steroid Silicone Helix L46cm Od6fr","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"80202164","EAP","HCPCS C1898","","Lead Pacing Tendril Sts Optim Steroid L52 Cm Od6 Fr Endocard Is-1 Bipolar Con","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"80202165","EAP","HCPCS C1898","","Lead Pacing Tendril Sts Steroid Silicone Helix L58 Od6 Fr Endocard","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"80202189","EAP","HCPCS C1751","","Kit Cath .032in 8.5fr 18ga 16cm Lf 2.5in Blu Flxtp Arwg+ard","BOTH IP/OP","$349.00 ","$258.26 ","$0.00 ","$349.00 ","$189.51 ","$0.00 ","$72.74 ","$249.08 ","$249.08 ","$61.11 ","$349.00 ","$0.00 ","$174.50 ","$276.41 ","$279.20 ","$0.00 ","$54.62 ","$0.00 ","$55.56 ","$0.00 "
"80202203","EAP","HCPCS C1729","","Tray Catheterization 16fr 2 Conctr Temperature Sense","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"80202219","EAP","HCPCS C1726","","Catheter Blndil 11 Atm 8mm 180cm 4cm Hrcn Rx Loprfl Radopq","BOTH IP/OP","$603.00 ","$446.22 ","$0.00 ","$603.00 ","$327.43 ","$0.00 ","$125.68 ","$430.36 ","$430.36 ","$105.58 ","$603.00 ","$0.00 ","$301.50 ","$477.58 ","$482.40 ","$0.00 ","$94.37 ","$0.00 ","$96.00 ","$0.00 "
"80202586","EAP","","","Coil Embolization .02in Complex 14mm 40cm Soft The Penumbra","BOTH IP/OP","$6,188.00 ","$4,579.12 ","$0.00 ","$6,188.00 ","$0.00 ","$0.00 ","$0.00 ","$4,416.38 ","$4,416.38 ","$0.00 ","$6,188.00 ","$0.00 ","$3,094.00 ","$4,900.90 ","$4,950.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202609","EAP","","","Coil Embl .02in Cmplx 5mm 9cm The Penumbra Coil 400 Sft","BOTH IP/OP","$5,490.00 ","$4,062.60 ","$0.00 ","$5,490.00 ","$0.00 ","$0.00 ","$0.00 ","$3,918.21 ","$3,918.21 ","$0.00 ","$5,490.00 ","$0.00 ","$2,745.00 ","$4,348.08 ","$4,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202611","EAP","","","Coil Embolization .02in Standard Complex 10mm 30cm Complex","BOTH IP/OP","$5,513.00 ","$4,079.62 ","$0.00 ","$5,513.00 ","$0.00 ","$0.00 ","$0.00 ","$3,934.63 ","$3,934.63 ","$0.00 ","$5,513.00 ","$0.00 ","$2,756.50 ","$4,366.30 ","$4,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202615","EAP","","","Coil Embolization .02in Standard Complex 12mm 35cm Complex","BOTH IP/OP","$5,570.00 ","$4,121.80 ","$0.00 ","$5,570.00 ","$0.00 ","$0.00 ","$0.00 ","$3,975.31 ","$3,975.31 ","$0.00 ","$5,570.00 ","$0.00 ","$2,785.00 ","$4,411.44 ","$4,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202624","EAP","","","Coil Embl .02in Cmplx 7mm 15cm The Penumbra Coil 400 Sft","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$4,014.56 ","$4,014.56 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202641","EAP","","","Coil Embolization .02in Complex 10mm 30cm Soft The Penumbra","BOTH IP/OP","$5,963.00 ","$4,412.62 ","$0.00 ","$5,963.00 ","$0.00 ","$0.00 ","$0.00 ","$4,255.79 ","$4,255.79 ","$0.00 ","$5,963.00 ","$0.00 ","$2,981.50 ","$4,722.70 ","$4,770.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80202926","EAP","HCPCS C1887","","Set Interventional .038in 10fr 40cm 62.5cm Catheter Cannu","BOTH IP/OP","$1,131.00 ","$836.94 ","$0.00 ","$1,131.00 ","$614.13 ","$0.00 ","$235.73 ","$807.19 ","$807.19 ","$198.03 ","$1,131.00 ","$0.00 ","$565.50 ","$895.75 ","$904.80 ","$0.00 ","$177.00 ","$0.00 ","$180.06 ","$0.00 "
"80202933","EAP","HCPCS C1894","","Introd Cath 80cm 10fr 3.4mm Chk-flo Flxr Lg Vlv","BOTH IP/OP","$265.00 ","$196.10 ","$0.00 ","$265.00 ","$143.90 ","$0.00 ","$55.23 ","$189.13 ","$189.13 ","$46.40 ","$265.00 ","$0.00 ","$132.50 ","$209.88 ","$212.00 ","$0.00 ","$41.47 ","$0.00 ","$42.19 ","$0.00 "
"80202945","EAP","HCPCS C1894","","Sheath Guid 45cm 7fr 2.5mm Flxr Chk-flo Anl2 Curve","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80202946","EAP","HCPCS C1894","","Sheath Guid 90cm 6fr 2.2mm Flxr Chk-flo Anl1 Curve","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$205.25 ","$0.00 ","$78.78 ","$269.78 ","$269.78 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$59.16 ","$0.00 ","$60.18 ","$0.00 "
"80202963","EAP","HCPCS C1894","","Sheath Guid 45cm 8fr 2.9mm Flxr Chk-flo Anl1 Curve","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80203000","EAP","HCPCS C1751","","Kit Catheter 8.5fr 16cm 3 Lumen Expand Chloraprep Safety","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$588.80 ","$588.80 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"80206800","EAP","","","Kit Ndl Gd 21ga 96in Strt Us","BOTH IP/OP","$54.00 ","$39.96 ","$0.00 ","$54.00 ","$0.00 ","$0.00 ","$0.00 ","$38.54 ","$38.54 ","$0.00 ","$54.00 ","$0.00 ","$27.00 ","$42.77 ","$43.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80206851","EAP","Custom 27220128","","Dressing Gel 144x10in Effective Protection Knit Roll","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$84.22 ","$84.22 ","$0.00 ","$118.00 ","$0.00 ","$59.00 ","$93.46 ","$94.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80206898","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 120mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206901","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 120mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206904","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 120mm Hi-prs Nybax","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$438.00 ","$233.49 ","$0.00 ","$89.62 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206906","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 120mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206908","EAP","HCPCS C1725","","Catheter Baldilat 3mm 135cm 150mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206910","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 150mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206916","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 150mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206930","EAP","HCPCS C1725","","Catheter Baldilat 3mm 135cm 200mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206935","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 200mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206937","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 200mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206941","EAP","HCPCS C1726","","Catheter Baldilat 3mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206949","EAP","HCPCS C1725","","Catheter Baldilat 9mm 135cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206952","EAP","HCPCS C1725","","CAT BALD LP 5.8FR 10MM 135CM 20MM HIGH PRE","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206954","EAP","HCPCS C1725","","CAT BALD LP 5.8FR 12MM 135CM 20MM HIGH PRES","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206956","EAP","HCPCS C1725","","Catheter Baldilat 12mm 75cm 20mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206984","EAP","HCPCS C1725","","Catheter Baldilat 3mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206986","EAP","HCPCS C1725","","Catheter Baldilat 3mm 75cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206988","EAP","HCPCS C1725","","Catheter Baldilat 9mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206990","EAP","HCPCS C1725","","Catheter Baldilat 10mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206992","EAP","HCPCS C1725","","Catheter Baldilat 12mm 135cm 40mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206997","EAP","HCPCS C1753","","CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80206999","EAP","HCPCS C1725","","CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207000","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 60mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207002","EAP","HCPCS C1725","","Catheter Baldilat 5mm 75cm 60mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207003","EAP","HCPCS C1725","","CAT BALD LP 5.3FR 6MM 135CM 60MM HIGH PRES","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207005","EAP","HCPCS C1725","","CAT BALD .035IN 6MM 75CM 60MM HIGH PRES LP","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207009","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 60mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207011","EAP","HCPCS C1725","","CAT BALD .035IN 8MM 75CM 60MM HIGH PRE LP","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207012","EAP","HCPCS C1725","","CAT BALD LP 5.8FR 9MM 135CM 60MM HIGH PRES","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207014","EAP","HCPCS C1725","","Catheter Baldilat 10mm 135cm 60mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207016","EAP","HCPCS C1725","","MUSTANG 7FR 12.0MM X 60MM, 135CM","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207018","EAP","HCPCS C1725","","CAT BALD LP 5.8FR 12MM 75CM 60MM HIGH PRES","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207019","EAP","HCPCS C1725","","Catheter Baldilat 3mm 135cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207021","EAP","HCPCS C1725","","Catheter Baldilat 3mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207022","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207024","EAP","HCPCS C1725","","Catheter Baldilat 4mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207025","EAP","HCPCS C1725","","Catheter Balloon Dilatation Mustang Nybax L135cm L80mm Od5.3fr","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207027","EAP","HCPCS C1725","","Catheter Baldilat 5mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207028","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207030","EAP","HCPCS C1725","","Catheter Baldilat 6mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207031","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207033","EAP","HCPCS C1725","","Catheter Baldilat 7mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207039","EAP","HCPCS C1725","","Catheter Baldilat 10mm 135cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207041","EAP","HCPCS C1725","","Catheter Baldilat 10mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207044","EAP","HCPCS C1725","","Catheter Baldilat 12mm 75cm 80mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207045","EAP","HCPCS C1725","","Catheter Baldilat 3mm 135cm 100mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207048","EAP","HCPCS C1725","","Catheter Baldilat 4mm 135cm 100mm Hi-prs Nybax","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207050","EAP","HCPCS C1725","","Catheter Blndil 4mm 75cm 100mm Mustang","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207054","EAP","HCPCS C1725","","CAT BALD LP 5.3FR 7MM 135CM 100MM HIGH PRES","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80207066","EAP","HCPCS C1725","","Catheter Baldilat 4mm 30mm 135cm Otw Tpr Tip Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207067","EAP","Custom 80207067","","STERLING OTW 4MM X 60MM X 135CM","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80207074","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 30mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207075","EAP","HCPCS C1725","","Catheter Baldilat 5mm 135cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207077","EAP","HCPCS C1725","","STERLING OTW 5MM X 100MM X 135CM","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207083","EAP","HCPCS C1725","","Catheter Baldilat 6mm 135cm 30mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207084","EAP","HCPCS C1725","","STERLING OTW 6MM X 100MM X 135CM","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207089","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 30mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207090","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 80mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207091","EAP","HCPCS C1725","","Catheter Baldilat 7mm 135cm 100mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207096","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 30mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207101","EAP","HCPCS C1725","","Catheter Baldilat 9mm 135cm 20mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207102","EAP","HCPCS C1725","","Catheter Baldilat 9mm 135cm 30mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207103","EAP","HCPCS C1725","","Catheter Baldilat 9mm 135cm 60mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207104","EAP","HCPCS C1725","","Catheter Baldilat 9mm 135cm 80mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207111","EAP","HCPCS C1725","","Catheter Baldilat 10mm 135cm 30mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207113","EAP","HCPCS C1725","","Catheter Baldilat 10mm 135cm 60mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207114","EAP","HCPCS C1725","","Catheter Baldilat 10mm 135cm 80mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207119","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 150cm 80mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207125","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 80mm Otw Infl Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207145","EAP","HCPCS C1725","","CAT BALD 14 ATM ULT LP 6FR 2.5MM 143CM 20MM","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207168","EAP","HCPCS C1753","","Catheter Baldilat 2mm 150cm 60mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207169","EAP","HCPCS C1753","","Catheter Baldilat 2.5mm 150cm 60mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207170","EAP","HCPCS C1753","","Catheter Baldilat 3mm 150cm 60mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207171","EAP","HCPCS C1753","","Catheter Baldilat 3.5mm 150cm 60mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207172","EAP","HCPCS C1753","","Catheter Baldilat 4mm 150cm 60mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207173","EAP","HCPCS C1753","","Catheter Baldilat 2mm 150cm 80mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207174","EAP","HCPCS C1753","","Catheter Baldilat 2.5mm 150cm 80mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207177","EAP","HCPCS C1753","","Catheter Baldilat 4mm 150cm 80mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207178","EAP","HCPCS C1725","","CAT BALD ULT LP TAP 6FR 2.5MM 150CM 100MM OTW","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207190","EAP","HCPCS C1753","","Catheter Baldilat 3.5mm 150cm 120mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207191","EAP","HCPCS C1753","","Catheter Baldilat 2.5mm 150cm 150mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207192","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 150mm Otw Ult Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207193","EAP","HCPCS C1753","","Catheter Baldilat 4mm 150cm 150mm Otw Ult Lp Nybax","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207199","EAP","HCPCS C1725","","COYOTE 3.5MM X 220MM X 150CM","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80207206","EAP","HCPCS C1725","","Catheter Baldilat 14mm 75cm 60mm Peri Lv Scrch Rst","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$366.13 ","$366.13 ","$89.82 ","$513.00 ","$0.00 ","$256.50 ","$406.30 ","$410.40 ","$0.00 ","$80.28 ","$0.00 ","$81.67 ","$0.00 "
"80207210","EAP","HCPCS C1725","","Catheter Baldilat 16mm 75cm 60mm Peri Lv Scrch Rst","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$366.13 ","$366.13 ","$89.82 ","$513.00 ","$0.00 ","$256.50 ","$406.30 ","$410.40 ","$0.00 ","$80.28 ","$0.00 ","$81.67 ","$0.00 "
"80207214","EAP","HCPCS C1725","","Catheter Baldilat 18mm 75cm 60mm Peri Lv Scrch Rst","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$366.13 ","$366.13 ","$89.82 ","$513.00 ","$0.00 ","$256.50 ","$406.30 ","$410.40 ","$0.00 ","$80.28 ","$0.00 ","$81.67 ","$0.00 "
"80207556","EAP","HCPCS C1725","","Catheter Baldilat 8mm 135cm 20mm Otw Inflat Port","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$1,248.98 ","$1,248.98 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"80207580","EAP","HCPCS C1876","","Stent Bil 7mm 27mm 135cm 30mm Otw Radiopq Bln Xpd","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80207581","EAP","HCPCS C1876","","Stent Bil 8mm 27mm 135cm 30mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80207585","EAP","HCPCS C1876","","Stent Bil 7mm 57mm 135cm 60mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80207586","EAP","HCPCS C1876","","Stent Bil 8mm 57mm 135cm 60mm Otw Radiopq Nc Bln","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80207662","EAP","HCPCS C1876","","STENT ENDO 100CM 14MM 40MM 75CM UNCONSTRAIN FLEX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"80207663","EAP","HCPCS C1876","","Stent Endoprsth Trchbr 60mm 14mm 9fr Mtl Wlstnt","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"80207665","EAP","HCPCS C1876","","Stent Endoprsth Trchbr Vns 40mm 16mm Elgiloy","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"80207666","EAP","HCPCS C1876","","Stent Endoprsth Trchbr 60mm 16mm 9fr Mtl Wlstnt","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"80207668","EAP","HCPCS C1876","","Stent Endoprsth Trchbr 60mm 18mm 9fr Mtl Wlstnt","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"80207678","EAP","HCPCS C1876","","Stent Endoprsth Trchbr 90mm 14mm 9fr Mtl Wlstnt","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$1,605.83 ","$1,605.83 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"80207773","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Imgr2 Bern Curve Crbrl","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"80207912","EAP","HCPCS C1726","","Device Athrcm 165cm .018in Truepath .017in Peri","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$2,128.56 ","$0.00 ","$817.03 ","$2,797.70 ","$2,797.70 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"80207913","EAP","HCPCS C1769","","Wire Cath Extn Truepath Chrnc Tot Ocl Dev","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$114.03 ","$0.00 ","$43.77 ","$149.88 ","$149.88 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"80207925","EAP","HCPCS C1769","","GUI VAS ST STR .035IN 260CM FLEXIBLE TIP","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$20.84 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"80207926","EAP","HCPCS C1769","","Guidewire Vasc 260cm .038in Flpy Tip Fltwr Coil","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$20.84 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"80207935","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Flpy Tip Fltwr Coil 3","BOTH IP/OP","$104.00 ","$76.96 ","$0.00 ","$104.00 ","$56.47 ","$0.00 ","$21.68 ","$74.22 ","$74.22 ","$18.21 ","$104.00 ","$0.00 ","$52.00 ","$82.37 ","$83.20 ","$0.00 ","$16.28 ","$0.00 ","$16.56 ","$0.00 "
"80207943","EAP","HCPCS C1769","","Guidewire Vasc 260cm .018in Flpy Tip Radiopq Lng","BOTH IP/OP","$203.00 ","$150.22 ","$0.00 ","$203.00 ","$110.23 ","$0.00 ","$42.31 ","$144.88 ","$144.88 ","$35.54 ","$203.00 ","$0.00 ","$101.50 ","$160.78 ","$162.40 ","$0.00 ","$31.77 ","$0.00 ","$32.32 ","$0.00 "
"80207946","EAP","HCPCS C1769","","Guidewire Vasc 260cm .025in Flpy Tip Radiopq Shrt","BOTH IP/OP","$202.00 ","$149.48 ","$0.00 ","$202.00 ","$109.69 ","$0.00 ","$42.10 ","$144.17 ","$144.17 ","$35.37 ","$202.00 ","$0.00 ","$101.00 ","$159.98 ","$161.60 ","$0.00 ","$31.61 ","$0.00 ","$32.16 ","$0.00 "
"80207949","EAP","HCPCS C1769","","GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST","BOTH IP/OP","$319.00 ","$236.06 ","$0.00 ","$319.00 ","$173.22 ","$0.00 ","$66.49 ","$227.67 ","$227.67 ","$55.85 ","$319.00 ","$0.00 ","$159.50 ","$252.65 ","$255.20 ","$0.00 ","$49.92 ","$0.00 ","$50.78 ","$0.00 "
"80208087","EAP","HCPCS C1887","","Mcth Infus 150cm 3-2.8fr .027in Rngd Hfl Hydphi","BOTH IP/OP","$721.00 ","$533.54 ","$0.00 ","$721.00 ","$391.50 ","$0.00 ","$150.27 ","$514.58 ","$514.58 ","$126.24 ","$721.00 ","$0.00 ","$360.50 ","$571.03 ","$576.80 ","$0.00 ","$112.84 ","$0.00 ","$114.78 ","$0.00 "
"80208096","EAP","HCPCS C1887","","Mcth Infus 130cm 3-2.4fr Rngd Stc 18 90d Peri Hdr","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$572.87 ","$0.00 ","$219.89 ","$752.95 ","$752.95 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"80208101","EAP","HCPCS C1769","","Guidewire Vasc 180cm .016in Strbl Microfabricate","BOTH IP/OP","$744.00 ","$550.56 ","$0.00 ","$744.00 ","$403.99 ","$0.00 ","$155.07 ","$530.99 ","$530.99 ","$130.27 ","$744.00 ","$0.00 ","$372.00 ","$589.25 ","$595.20 ","$0.00 ","$116.44 ","$0.00 ","$118.44 ","$0.00 "
"80215246","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Optitorque Radl Tig 4","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"80284625","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Ebu3.75 Curve Coron","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80298657","EAP","HCPCS C1894","","Set Introd 25 5/8in 6fr 8fr S Arwflx Perc 3w Stpck","BOTH IP/OP","$257.00 ","$190.18 ","$0.00 ","$257.00 ","$139.55 ","$0.00 ","$53.57 ","$183.42 ","$183.42 ","$45.00 ","$257.00 ","$0.00 ","$128.50 ","$203.54 ","$205.60 ","$0.00 ","$40.22 ","$0.00 ","$40.91 ","$0.00 "
"80307573","EAP","HCPCS C1729","","Tray Surg 14fr 18ga 29cm 5cm 19 Sideport Catheter Echogenic","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$417.00 ","$244.35 ","$0.00 ","$172.99 ","$297.61 ","$297.61 ","$73.01 ","$417.00 ","$0.00 ","$208.50 ","$330.26 ","$333.60 ","$0.00 ","$65.26 ","$0.00 ","$66.39 ","$0.00 "
"80307582","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip Radiopq","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"80307684","EAP","HCPCS C1766","","Introd Shth 8.5fr Strbl Cath Agilis Nxt 22.4mm","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"80307685","EAP","HCPCS C1766","","Introd Shth 8.5fr 71cm 50mm Gwire Strbl Radiopq","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$1,427.40 ","$1,427.40 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"80307691","EAP","HCPCS C1730","","Catheter Ep 115cm 5fr Lvwr Crnnd-2 5mm Spc 1mm","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$802.91 ","$802.91 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"80307719","EAP","HCPCS C1894","","Sheath Guid 55cm 6fr 2.2mm Flxr Chk-flo Str","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"80307720","EAP","HCPCS C1894","","Sheath Guid 55cm 6fr 2.2mm Flxr Hi-flx Chk-flo","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$142.74 ","$142.74 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"80307775","EAP","Custom 80307775","","Coil Embolization 360d 5mm 10cm Detachable Soft Target","BOTH IP/OP","$4,755.00 ","$3,518.70 ","$0.00 ","$4,755.00 ","$0.00 ","$0.00 ","$0.00 ","$3,393.64 ","$3,393.64 ","$0.00 ","$4,755.00 ","$0.00 ","$2,377.50 ","$3,765.96 ","$3,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80307945","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307951","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307953","EAP","HCPCS C1725","","Catheter Baldilat 4mm 8mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307954","EAP","HCPCS C1725","","Catheter Baldilat 4mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307956","EAP","HCPCS C1725","","Catheter Baldilat 2mm 8mm Coron Rapex Radiopq Smth","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307957","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 8mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307959","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307960","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$250.00 ","$95.03 ","$0.00 ","$36.47 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307961","EAP","HCPCS C1725","","Catheter Baldilat 2.75mm 8mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307962","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 8mm Coron Rapex Radiopq","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$250.00 ","$115.66 ","$0.00 ","$44.39 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307963","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307964","EAP","HCPCS C1725","","Catheter Baldilat 3.75mm 8mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307965","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 8mm Coron Rapex Radiopq","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$250.00 ","$115.66 ","$0.00 ","$44.39 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307966","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80307967","EAP","HCPCS C1725","","Catheter Baldilat 5mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80308041","EAP","HCPCS C1724","","Catheter Athrcm 135cm 7fr 2.1mm Navitus Jetstream","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308043","EAP","HCPCS C1724","","Catheter Athrcm Jetstream Navitus Rot","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308065","EAP","HCPCS C1724","","Catheter Athrcm 120cm 7fr 2.4/3.4mm Jetstream","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308067","EAP","HCPCS C1894","","Introducer Sheath 6fr 25cm 2.5cm Dilat Kink Resistant","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$42.00 ","$23.35 ","$0.00 ","$8.96 ","$29.98 ","$29.98 ","$7.35 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$6.57 ","$0.00 ","$6.69 ","$0.00 "
"80308097","EAP","HCPCS C1725","","Kit Cath Ins 8fr Sns Plus Stlk Fo Bln Iab Dev 50cc","BOTH IP/OP","$2,614.00 ","$1,934.36 ","$0.00 ","$2,614.00 ","$1,419.40 ","$0.00 ","$544.82 ","$1,865.61 ","$1,865.61 ","$457.69 ","$2,614.00 ","$0.00 ","$1,307.00 ","$2,070.29 ","$2,091.20 ","$0.00 ","$409.09 ","$0.00 ","$416.15 ","$0.00 "
"80308098","EAP","HCPCS C1725","","Catheter Iab 6in 7.5fr 16mm Sns Plus .025in 2 Stlk","BOTH IP/OP","$2,725.00 ","$2,016.50 ","$0.00 ","$2,725.00 ","$1,479.68 ","$0.00 ","$567.96 ","$1,944.83 ","$1,944.83 ","$477.13 ","$2,725.00 ","$0.00 ","$1,362.50 ","$2,158.20 ","$2,180.00 ","$0.00 ","$426.46 ","$0.00 ","$433.82 ","$0.00 "
"80308211","EAP","HCPCS C1894","","Kit Introd 10cm 6fr 21ga Glidesheath Slndr .021in","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$74.93 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"80308259","EAP","HCPCS C1817","","Occluder Cardio 4mm 22mm 32-36mm Spt 2 Disc Slf","BOTH IP/OP","$15,163.00 ","$11,220.62 ","$0.00 ","$15,163.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$10,821.83 ","$0.00 ","$15,163.00 ","$0.00 ","$7,581.50 ","$12,009.10 ","$12,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308260","EAP","HCPCS C1817","","Occluder Cardio 4mm 24mm 34-38mm Spt 2 Disc Slf","BOTH IP/OP","$15,163.00 ","$11,220.62 ","$0.00 ","$15,163.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$10,821.83 ","$0.00 ","$15,163.00 ","$0.00 ","$7,581.50 ","$12,009.10 ","$12,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308262","EAP","Custom 80308262","","Catheter Dlv Sys 45d 10fr 80cm Lfric Radiopq Tip","BOTH IP/OP","$1,630.00 ","$1,206.20 ","$0.00 ","$1,630.00 ","$0.00 ","$0.00 ","$0.00 ","$1,163.33 ","$1,163.33 ","$0.00 ","$1,630.00 ","$0.00 ","$815.00 ","$1,290.96 ","$1,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308264","EAP","Custom 80308264","","Balloon Sz 70cm 40mm Amplzr 3 Lum Radiopq Sft","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$492.45 ","$492.45 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308265","EAP","HCPCS C1759","","Catheter Us Cnsl Viewflexxice Viewmate","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.90 ","$4,995.90 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308295","EAP","HCPCS C1753","","Catheter Us 20mhz Shrt Tpr 5fr 2.9fr 150cm 24cm","BOTH IP/OP","$1,813.00 ","$1,341.62 ","$0.00 ","$1,813.00 ","$984.46 ","$0.00 ","$377.87 ","$1,293.94 ","$1,293.94 ","$317.44 ","$1,813.00 ","$0.00 ","$906.50 ","$1,435.90 ","$1,450.40 ","$0.00 ","$283.73 ","$0.00 ","$288.63 ","$0.00 "
"80308611","EAP","HCPCS C1760","","Device Clsr 5fr Vascade Fem Art","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"80308612","EAP","HCPCS C1760","","System Cmpr 6/7fr Vascade Vasc Clgn Babsr","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$374.69 ","$374.69 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"80308880","EAP","HCPCS C1887","","Catheter Sprt 150cm 1.5fr .026-.039in Qkcrs 15mm","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$306.89 ","$306.89 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"80308883","EAP","Custom 80308883","","QUICK CROSS 4F .018IN X 150CM","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$306.89 ","$306.89 ","$0.00 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308885","EAP","HCPCS C1887","","CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING P","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$226.97 ","$0.00 ","$87.12 ","$298.33 ","$298.33 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"80308887","EAP","HCPCS C1887","","Catheter Sprt 150cm 3.1fr .05-.063in Qkcrs 50mm","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$226.97 ","$0.00 ","$87.12 ","$298.33 ","$298.33 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"80308888","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Core To Tip Radiopq","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"80308889","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip Radiopq","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"80308892","EAP","HCPCS C1729","","Kit Pressure Monitr 38cm Transducer Catheter Tunneling","BOTH IP/OP","$2,146.00 ","$1,588.04 ","$0.00 ","$2,028.00 ","$1,165.28 ","$0.00 ","$447.28 ","$1,447.38 ","$1,447.38 ","$355.09 ","$2,028.00 ","$0.00 ","$1,014.00 ","$1,606.18 ","$1,622.40 ","$0.00 ","$317.38 ","$0.00 ","$322.86 ","$0.00 "
"80308949","EAP","HCPCS C1724","","System Athrcm 135cm 1.25mm Rtbl Rtl+ Dmd Precnct","BOTH IP/OP","$3,092.00 ","$2,288.08 ","$0.00 ","$3,092.00 ","$0.00 ","$0.00 ","$0.00 ","$2,206.76 ","$2,206.76 ","$0.00 ","$3,092.00 ","$0.00 ","$1,546.00 ","$2,448.86 ","$2,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308950","EAP","HCPCS C1724","","System Athrcm 135cm 1.5mm Rtbl Rtl+ Dmd Precnct","BOTH IP/OP","$2,988.00 ","$2,211.12 ","$0.00 ","$2,988.00 ","$0.00 ","$0.00 ","$0.00 ","$2,132.54 ","$2,132.54 ","$0.00 ","$2,988.00 ","$0.00 ","$1,494.00 ","$2,366.50 ","$2,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308951","EAP","HCPCS C1724","","System Athrcm 135cm 1.75mm Rtbl Rtl+ Dmd Precnct","BOTH IP/OP","$3,092.00 ","$2,288.08 ","$0.00 ","$3,092.00 ","$0.00 ","$0.00 ","$0.00 ","$2,206.76 ","$2,206.76 ","$0.00 ","$3,092.00 ","$0.00 ","$1,546.00 ","$2,448.86 ","$2,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80308954","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Atrm X Flpy Tip","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"80308956","EAP","HCPCS C1887","","Catheter Guid 150cm 1.8-2.6fr Finecross Mg Coron","BOTH IP/OP","$1,063.00 ","$786.62 ","$0.00 ","$1,063.00 ","$577.21 ","$0.00 ","$221.56 ","$758.66 ","$758.66 ","$186.12 ","$1,063.00 ","$0.00 ","$531.50 ","$841.90 ","$850.40 ","$0.00 ","$166.36 ","$0.00 ","$169.23 ","$0.00 "
"80308957","EAP","HCPCS C1769","","Guidewire Vasc 330cm .014in Sprg Tip X Sprt Stf","BOTH IP/OP","$2,070.00 ","$1,531.80 ","$0.00 ","$2,070.00 ","$1,124.01 ","$0.00 ","$431.44 ","$1,477.36 ","$1,477.36 ","$362.44 ","$2,070.00 ","$0.00 ","$1,035.00 ","$1,639.44 ","$1,656.00 ","$0.00 ","$323.96 ","$0.00 ","$329.54 ","$0.00 "
"80308958","EAP","HCPCS C1769","","Guidewire Vasc 330cm .014in Flpy Flxb Sprg Tip 2.2","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$224.80 ","$0.00 ","$86.29 ","$295.47 ","$295.47 ","$72.49 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$64.79 ","$0.00 ","$65.91 ","$0.00 "
"80308964","EAP","HCPCS C1769","","Guidewire Vasc 180cm .035in Flxb Core To Tip","BOTH IP/OP","$496.00 ","$367.04 ","$0.00 ","$496.00 ","$269.33 ","$0.00 ","$103.38 ","$354.00 ","$354.00 ","$86.85 ","$496.00 ","$0.00 ","$248.00 ","$392.83 ","$396.80 ","$0.00 ","$77.62 ","$0.00 ","$78.96 ","$0.00 "
"80308966","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Kink Rst Radiopq Strbl","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80308967","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80308968","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80308971","EAP","HCPCS C1730","","Catheter Ep 65cm 6fr Rspn 5-5-5mm Spc Csl Curve Mp","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$475.13 ","$0.00 ","$182.37 ","$624.49 ","$624.49 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"80308973","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80309134","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 145cm 6mm Otw 2 Lum Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309137","EAP","HCPCS C1725","","Catheter Baldilat 2mm 145cm 20mm Otw 2 Lum Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309140","EAP","HCPCS C1725","","Catheter Baldilat 1.2mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309141","EAP","HCPCS C1725","","Catheter Baldilat 1.2mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"80309142","EAP","HCPCS C1725","","Catheter Baldilat 1.2mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"80309152","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 12mm Coron Rapex Ult Lp","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$250.00 ","$95.03 ","$0.00 ","$36.47 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309153","EAP","HCPCS C1725","","Catheter Baldilat 2.25mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"80309166","EAP","HCPCS C1725","","Catheter Baldilat 3mm 6mm Coron Rapex Ult Lp","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$169.96 ","$0.00 ","$65.24 ","$223.39 ","$223.39 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$48.98 ","$0.00 ","$49.83 ","$0.00 "
"80309172","EAP","HCPCS C1725","","Catheter Baldilat 3.25mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309175","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 6mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309176","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 30mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309185","EAP","HCPCS C1725","","Catheter Baldilat 4mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309186","EAP","HCPCS C1725","","Catheter Baldilat 4mm 25mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309187","EAP","HCPCS C1725","","Catheter Baldilat 4mm 30mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309188","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 6mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309192","EAP","HCPCS C1725","","Catheter Baldilat 1.5mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309193","EAP","HCPCS C1725","","Catheter Baldilat 2mm 15mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309197","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309198","EAP","HCPCS C1725","","Catheter Baldilat 5mm 20mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309200","EAP","HCPCS C1876","","System Coron Stent 12mm 2.75mm Mtlnk Vsn Cocr","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309201","EAP","HCPCS C1876","","System Coron Stent 15mm 2.75mm Mtlnk Vsn Cocr","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309203","EAP","HCPCS C1876","","System Coron Stent 23mm 2.75mm Mtlnk Vsn Cocr","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309206","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80309208","EAP","Custom 80309208","","Catheter Pcng Eltrd Bipol Distal Tip Bln Flw Ast","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$0.00 ","$1,950.00 ","$0.00 ","$0.00 ","$0.00 ","$1,391.72 ","$1,391.72 ","$0.00 ","$1,950.00 ","$0.00 ","$975.00 ","$1,544.40 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309257","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Std Jr5 Curve Coron","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"80309258","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Lcb Curve Coron Nyl","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"80309261","EAP","HCPCS C1887","","Catheter Guid 100cm 7fr Lnchr Al1 Curve Coron Peri","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80309262","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Radl Curve Peri Nyl","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80309263","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Lara Curve Coron Nyl","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"80309264","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr 30d Mac3 Curve Coron","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"80309265","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Std Ima Curve Coron","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$61.36 ","$0.00 ","$23.55 ","$80.65 ","$80.65 ","$19.79 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$17.68 ","$0.00 ","$17.99 ","$0.00 "
"80309266","EAP","HCPCS C1725","","Catheter Angio 125cm 5fr Stsr Jr4 Curve Peri Pebax","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"80309276","EAP","HCPCS C1769","","GUIDEWIRE HI-TORQUE COMM ES .014"" 300CM","BOTH IP/OP","$988.00 ","$731.12 ","$0.00 ","$988.00 ","$536.48 ","$0.00 ","$205.92 ","$705.14 ","$705.14 ","$172.99 ","$988.00 ","$0.00 ","$494.00 ","$782.50 ","$790.40 ","$0.00 ","$154.62 ","$0.00 ","$157.29 ","$0.00 "
"80309278","EAP","HCPCS C1725","","Catheter Baldilat 6mm 150cm 200mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80309279","EAP","HCPCS C1725","","Catheter Angio 110cm 6fr Langston 145d Pgtl Curve","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$40.68 ","$40.68 ","$9.98 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$8.92 ","$0.00 ","$9.07 ","$0.00 "
"80309287","EAP","HCPCS C1725","","Catheter Baldilat 3mm 8mm Coron Rapex Radiopq Smth","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309335","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 15mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309338","EAP","HCPCS C1725","","Catheter Baldilat 4.5mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$250.00 ","$115.66 ","$0.00 ","$44.39 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309343","EAP","HCPCS C1880","","Filter Embl 49mm 65cm Vc Radiopq Preld Flsh Sdprt","BOTH IP/OP","$2,313.00 ","$1,711.62 ","$0.00 ","$2,313.00 ","$1,040.85 ","$0.00 ","$482.09 ","$1,650.79 ","$1,650.79 ","$404.99 ","$2,313.00 ","$0.00 ","$1,156.50 ","$1,831.90 ","$1,850.40 ","$0.00 ","$361.98 ","$0.00 ","$368.23 ","$0.00 "
"80309345","EAP","HCPCS C1880","","Filter Embl Navalign Dlv Uniset Strl Disp Pltn","BOTH IP/OP","$2,313.00 ","$1,711.62 ","$0.00 ","$2,313.00 ","$1,040.85 ","$0.00 ","$482.09 ","$1,650.79 ","$1,650.79 ","$404.99 ","$2,313.00 ","$0.00 ","$1,156.50 ","$1,831.90 ","$1,850.40 ","$0.00 ","$361.98 ","$0.00 ","$368.23 ","$0.00 "
"80309346","EAP","HCPCS C1725","","Catheter Baldilat 2mm 12mm Coron Rapex Radiopq","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80309407","EAP","HCPCS C1876","","System Coron Stent 8mm 2mm Mtlnk Mvsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309409","EAP","HCPCS C1876","","System Coron Stent 15mm 2mm Mtlnk Mvsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309410","EAP","HCPCS C1876","","System Coron Stent 18mm 2mm Mtlnk Mvsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309411","EAP","HCPCS C1876","","System Coron Stent 23mm 2mm Mtlnk Mvsn Cocr Rapex","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80309438","EAP","HCPCS C1900","","Lead Pcng Lv Atn Starfix","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$2,944.01 ","$2,944.01 ","$0.00 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$0.00 ","$0.00 "
"80309448","EAP","HCPCS C1725","","Catheter Pa 110cm 5fr 8mm Arw 1 Lum Bln Wdg Prss","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"80309457","EAP","Custom 80309457","","System Drg Dlv Ekosonic Mach 4 Microsonic Tx Zn","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$0.00 ","$0.00 ","$0.00 ","$4,808.91 ","$4,808.91 ","$0.00 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309459","EAP","Custom 80309459","","Device Thrmb 135cm 5.4fr Ekosonic Mach 4 Evas","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$0.00 ","$0.00 ","$0.00 ","$4,808.91 ","$4,808.91 ","$0.00 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309461","EAP","Custom 80309461","","Device Drg Dlv Ekosonic Mach 4 Infus Cath Us Core","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$0.00 ","$0.00 ","$0.00 ","$4,808.91 ","$4,808.91 ","$0.00 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309462","EAP","Custom 80309462","","Device Drg Dlv Ekosonic Mach 4 Infus Cath Us Core","BOTH IP/OP","$6,738.00 ","$4,986.12 ","$0.00 ","$6,738.00 ","$0.00 ","$0.00 ","$0.00 ","$4,808.91 ","$4,808.91 ","$0.00 ","$6,738.00 ","$0.00 ","$3,369.00 ","$5,336.50 ","$5,390.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309492","EAP","HCPCS A6212","","Dressing 6x3.5in Anmc Wtprf Flxb N Linr Strp Ionic","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$64.00 ","$24.44 ","$0.00 ","$9.38 ","$45.68 ","$45.68 ","$11.21 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$10.02 ","$0.00 ","$10.19 ","$0.00 "
"80309550","EAP","Custom 80309550","","Set Vntrc Ast 17.4x13.8in Impella Cp 9.3in 10-40c","BOTH IP/OP","$62,500.00 ","$46,250.00 ","$0.00 ","$62,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$62,500.00 ","$0.00 ","$31,250.00 ","$49,500.00 ","$50,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309582","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Sft Rbn Tip Kink Rst","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80309672","EAP","HCPCS C1757","","Catheter Thrmb 10mm Flowtriever Strl Latex Free","BOTH IP/OP","$11,625.00 ","$8,602.50 ","$0.00 ","$11,625.00 ","$6,312.38 ","$0.00 ","$2,422.94 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,625.00 ","$0.00 ","$5,812.50 ","$9,207.00 ","$9,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309673","EAP","HCPCS C1757","","Catheter Thrmb 14mm Flowtriever Strl Latex Free","BOTH IP/OP","$11,625.00 ","$8,602.50 ","$0.00 ","$11,625.00 ","$6,312.38 ","$0.00 ","$2,422.94 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,625.00 ","$0.00 ","$5,812.50 ","$9,207.00 ","$9,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309674","EAP","HCPCS C1757","","Catheter Thrmb 18mm Flowtriever Strl Latex Free","BOTH IP/OP","$11,625.00 ","$8,602.50 ","$0.00 ","$11,625.00 ","$6,312.38 ","$0.00 ","$2,422.94 ","$5,158.80 ","$5,158.80 ","$0.00 ","$11,625.00 ","$0.00 ","$5,812.50 ","$9,207.00 ","$9,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309675","EAP","HCPCS C1757","","Catheter Guid 6.7mm Flowtriever 1 Ins Aspirate","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,875.00 ","$3,733.13 ","$0.00 ","$1,432.92 ","$4,906.69 ","$4,906.69 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309676","EAP","Custom 80309676","","FT RETRACTION ASPIRATOR DEVICE SE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80309726","EAP","HCPCS C1887","","Catheter Vasc 135cm 2.6-2.9fr 1.6fr Turnpike Ml Lr","BOTH IP/OP","$1,313.00 ","$971.62 ","$0.00 ","$1,313.00 ","$712.96 ","$0.00 ","$273.66 ","$937.09 ","$937.09 ","$229.90 ","$1,313.00 ","$0.00 ","$656.50 ","$1,039.90 ","$1,050.40 ","$0.00 ","$205.48 ","$0.00 ","$209.03 ","$0.00 "
"80309727","EAP","HCPCS C1887","","Catheter Vasc 150cm 2.6-3.1fr 1.6fr Turnpike Ml Lr","BOTH IP/OP","$1,488.00 ","$1,101.12 ","$0.00 ","$1,488.00 ","$807.98 ","$0.00 ","$310.14 ","$1,061.99 ","$1,061.99 ","$260.54 ","$1,488.00 ","$0.00 ","$744.00 ","$1,178.50 ","$1,190.40 ","$0.00 ","$232.87 ","$0.00 ","$236.89 ","$0.00 "
"80309751","EAP","HCPCS C1874","","System Coron Stent 12mm 4mm Promus Prmr Mnrl","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$1,912.50 ","$0.00 ","$885.81 ","$3,033.23 ","$3,033.23 ","$744.14 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$665.13 ","$0.00 ","$676.60 ","$0.00 "
"80309753","EAP","HCPCS C1874","","System Coron Stent 20mm 4mm Promus Prmr Mnrl","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$1,912.50 ","$0.00 ","$885.81 ","$3,033.23 ","$3,033.23 ","$744.14 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$665.13 ","$0.00 ","$676.60 ","$0.00 "
"80309754","EAP","HCPCS C1874","","System Coron Stent 24mm 4mm Promus Prmr Mnrl","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$1,912.50 ","$0.00 ","$885.81 ","$3,033.23 ","$3,033.23 ","$744.14 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$665.13 ","$0.00 ","$676.60 ","$0.00 "
"80310083","EAP","HCPCS C1884","","System Embl Prtc 190cm .014in 110um Crtd Gwire","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$2,029.73 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"80310085","EAP","HCPCS C1894","","Introd Shth Ped 5fr 21ga 40cm 7cm Gry Hub Dilat","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$55.93 ","$0.00 ","$21.47 ","$73.51 ","$73.51 ","$18.03 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$16.12 ","$0.00 ","$16.40 ","$0.00 "
"80310086","EAP","HCPCS C1894","","Introd Shth Ped 6fr 21ga 40cm 7cm Grn Hub Dilat","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$55.39 ","$0.00 ","$21.26 ","$72.80 ","$72.80 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"80310399","EAP","HCPCS C1876","","Stent Vasc Epic Nitinol L60mm L120cm Od9mm Iliac","BOTH IP/OP","$1,463.00 ","$1,082.62 ","$0.00 ","$1,463.00 ","$658.35 ","$0.00 ","$304.93 ","$1,044.14 ","$1,044.14 ","$256.16 ","$1,463.00 ","$0.00 ","$731.50 ","$1,158.70 ","$1,170.40 ","$0.00 ","$228.96 ","$0.00 ","$232.91 ","$0.00 "
"80310402","EAP","HCPCS C1876","","Stent Vasc 9mm 80mm 159cm 120cm Slf Xpd Ilc Art Ep","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80310534","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Flxb Sprg Coil Tip Std","BOTH IP/OP","$251.00 ","$185.74 ","$0.00 ","$251.00 ","$136.29 ","$0.00 ","$52.31 ","$179.14 ","$179.14 ","$43.95 ","$251.00 ","$0.00 ","$125.50 ","$198.79 ","$200.80 ","$0.00 ","$39.28 ","$0.00 ","$39.96 ","$0.00 "
"80310535","EAP","HCPCS C1769","","Guidewire Vasc 180cm .035in Flxb Sprg Coil Tip Std","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$70.59 ","$0.00 ","$27.10 ","$92.78 ","$92.78 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"80310536","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Flxb Sprg Coil Tip Std","BOTH IP/OP","$1,045.00 ","$773.30 ","$0.00 ","$1,045.00 ","$567.44 ","$0.00 ","$217.80 ","$745.82 ","$745.82 ","$182.97 ","$1,045.00 ","$0.00 ","$522.50 ","$827.64 ","$836.00 ","$0.00 ","$163.54 ","$0.00 ","$166.36 ","$0.00 "
"80310824","EAP","HCPCS C1733","","Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-j Curve","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$2,239.88 ","$0.00 ","$859.75 ","$2,944.01 ","$2,944.01 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"80315167","EAP","HCPCS C1894","","Sheath Introd 28cm 9.8mm 26fr Gore Dryseal Hydphi","BOTH IP/OP","$863.00 ","$638.62 ","$0.00 ","$863.00 ","$468.61 ","$0.00 ","$179.87 ","$615.92 ","$615.92 ","$151.10 ","$863.00 ","$0.00 ","$431.50 ","$683.50 ","$690.40 ","$0.00 ","$135.06 ","$0.00 ","$137.39 ","$0.00 "
"80315263","EAP","HCPCS C1725","","CATR BALD 14 ATM LP TAER 7FR 5MM 150CM 150MM","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80315264","EAP","HCPCS C1725","","Catheter Baldilat 5mm 150cm 200mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80315265","EAP","HCPCS C1725","","Catheter Baldilat 6mm 150cm 150mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80315266","EAP","HCPCS C1725","","Catheter Baldilat 6mm 150cm 220mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80315267","EAP","HCPCS C1725","","Catheter Baldilat 7mm 150cm 120mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80315268","EAP","HCPCS C1725","","Catheter Baldilat 7mm 150cm 150mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80316943","EAP","HCPCS C1757","","Set Thrmb 145cm 3-4fr 1.5mm Angjt Ult Solent Dista","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,715.00 ","$0.00 ","$1,042.13 ","$3,568.50 ","$3,568.50 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80317120","EAP","HCPCS C1760","","Device Clsr 6fr Strcls Se Vasc Ntnl Clip Strl Disp","BOTH IP/OP","$788.00 ","$583.12 ","$0.00 ","$788.00 ","$354.60 ","$0.00 ","$164.24 ","$562.40 ","$562.40 ","$137.97 ","$788.00 ","$0.00 ","$394.00 ","$624.10 ","$630.40 ","$0.00 ","$123.32 ","$0.00 ","$125.45 ","$0.00 "
"80318107","EAP","HCPCS C1894","","Introd Cath 90cm 6fr Chk-flo Flxr Raabe","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80318555","EAP","HCPCS C1725","","Catheter Guid 135cm 3.2fr Stingray Lp Hydphi Strl","BOTH IP/OP","$4,738.00 ","$3,506.12 ","$0.00 ","$4,738.00 ","$2,572.73 ","$0.00 ","$987.52 ","$3,381.51 ","$3,381.51 ","$829.59 ","$4,738.00 ","$0.00 ","$2,369.00 ","$3,752.50 ","$3,790.40 ","$0.00 ","$741.50 ","$0.00 ","$754.29 ","$0.00 "
"80318556","EAP","HCPCS C1769","","Guidewire Vasc 185cm .014in 20cm Stingray Hydphi","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,228.00 ","$666.80 ","$0.00 ","$255.95 ","$876.42 ","$876.42 ","$215.01 ","$1,228.00 ","$0.00 ","$614.00 ","$972.58 ","$982.40 ","$0.00 ","$192.18 ","$0.00 ","$195.50 ","$0.00 "
"80318557","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in 20cm Stingray Hydphi","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,228.00 ","$666.80 ","$0.00 ","$255.95 ","$876.42 ","$876.42 ","$215.01 ","$1,228.00 ","$0.00 ","$614.00 ","$972.58 ","$982.40 ","$0.00 ","$192.18 ","$0.00 ","$195.50 ","$0.00 "
"80318677","EAP","HCPCS C1764","","System Crd Monitr Rvl Linq Mycarelink Ins Loop","BOTH IP/OP","$11,613.00 ","$8,593.62 ","$0.00 ","$11,613.00 ","$5,225.85 ","$0.00 ","$2,420.44 ","$5,158.80 ","$8,288.20 ","$2,033.34 ","$11,613.00 ","$0.00 ","$5,806.50 ","$9,197.50 ","$9,290.40 ","$0.00 ","$1,817.43 ","$0.00 ","$1,848.79 ","$0.00 "
"80320653","EAP","HCPCS C1894","","Kit Introd 10cm 7fr 21ga Glidesheath Slndr .021in","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$74.93 ","$0.00 ","$28.76 ","$98.49 ","$98.49 ","$24.16 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$21.60 ","$0.00 ","$21.97 ","$0.00 "
"80320723","EAP","HCPCS C1769","","Guidewire Vasc 80cm .035in Flxb Core To Tip","BOTH IP/OP","$73.00 ","$54.02 ","$0.00 ","$73.00 ","$39.64 ","$0.00 ","$15.22 ","$52.10 ","$52.10 ","$12.78 ","$73.00 ","$0.00 ","$36.50 ","$57.82 ","$58.40 ","$0.00 ","$11.42 ","$0.00 ","$11.62 ","$0.00 "
"80320735","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 2.0X10 MM 5F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320736","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 2.0X15 MM 5F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320737","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 2.0X20 MM 5F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320738","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 2.5X10 MM 5F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320739","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 2.5X15 MM 5F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320740","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 2.5X20 MM 5F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320741","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 3.0X10 MM 6F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320742","EAP","HCPCS C1725","","Catheter Baldilat 3mm 140cm 15mm Rapex Ntnl Latex","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320743","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 3.0X20 MM 6F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320744","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 3.5X10 MM 6F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320745","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 3.5X15 MM 6F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320746","EAP","HCPCS C1725","","CHOCOLATE PTCA BALLOON CATHETER 3.5X20 MM 6F","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$1,018.13 ","$0.00 ","$390.80 ","$1,338.19 ","$1,338.19 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"80320748","EAP","HCPCS C1887","","CATHETER GUID EBU3.75 CURVE 8FR .09IN 90CM LEFT","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80320749","EAP","HCPCS C1887","","CATHETER GUID JR4 CURVE 8FR .088IN 90CM CORON SHR","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80320750","EAP","HCPCS C1887","","CATHETER GUID JL4 CURVE 8FR 90CM CORON SHR NX BAL","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80320781","EAP","","","Dressing 8x8in Anbctrl Latex Hydrofera Foam Blue","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$24.27 ","$24.27 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80320787","EAP","HCPCS C1729","","Set Drain .038in 18fr L 40cm 32 Side Port Luer Lock Lock","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$152.04 ","$0.00 ","$58.36 ","$199.84 ","$199.84 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"80320793","EAP","HCPCS C1894","","Introducer Sheath 9fr 25cm 2.5cm Dilat Kink Resistant","BOTH IP/OP","$429.00 ","$317.46 ","$0.00 ","$424.00 ","$232.95 ","$0.00 ","$89.41 ","$302.61 ","$302.61 ","$74.24 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$66.36 ","$0.00 ","$67.50 ","$0.00 "
"80320799","EAP","HCPCS C1896","","Electrode Dfbr 45cm Trplr Eblm S-icd 11.5fr Sbq","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$2,084.25 ","$5,158.80 ","$7,137.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80320811","EAP","HCPCS C1769","","Guidewire Vasc 300cm .035in Core To Tip Radiopq","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80320812","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Crds Infnt Jl3.5 Curve","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$52.67 ","$0.00 ","$20.22 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$15.18 ","$0.00 ","$15.44 ","$0.00 "
"80320813","EAP","HCPCS C1887","","CATHETER ANGIO JL 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$52.67 ","$0.00 ","$20.22 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$15.18 ","$0.00 ","$15.44 ","$0.00 "
"80320814","EAP","HCPCS C1725","","Catheter Angio 100cm 5fr Crds Infnt Jr4 Curve","BOTH IP/OP","$97.00 ","$71.78 ","$0.00 ","$97.00 ","$52.67 ","$0.00 ","$20.22 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$0.00 ","$48.50 ","$76.82 ","$77.60 ","$0.00 ","$15.18 ","$0.00 ","$15.44 ","$0.00 "
"80320817","EAP","HCPCS C1894","","SET INTROD 6FR 8FR 17.75IN 3 W","BOTH IP/OP","$249.00 ","$184.26 ","$0.00 ","$249.00 ","$135.21 ","$0.00 ","$51.90 ","$177.71 ","$177.71 ","$43.60 ","$249.00 ","$0.00 ","$124.50 ","$197.21 ","$199.20 ","$0.00 ","$38.97 ","$0.00 ","$39.64 ","$0.00 "
"80320820","EAP","HCPCS C1893","","Introd Shth 10fr 67cm 63cm Gwire Hmsts Vlv Sh","BOTH IP/OP","$638.00 ","$472.12 ","$0.00 ","$638.00 ","$346.43 ","$0.00 ","$132.98 ","$455.34 ","$455.34 ","$111.71 ","$638.00 ","$0.00 ","$319.00 ","$505.30 ","$510.40 ","$0.00 ","$99.85 ","$0.00 ","$101.57 ","$0.00 "
"80320821","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Sft Rbn Tip Kink Rst","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80320844","EAP","HCPCS C1876","","System Coron Stent 28mm 5mm Mtlnk Ul Xcelon Mcgld","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80320846","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 220mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320847","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 40mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320848","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 220mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320849","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 40mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320850","EAP","HCPCS C1725","","Catheter Baldilat 4mm 150cm 220mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320851","EAP","HCPCS C1725","","Catheter Baldilat 7mm 150cm 200mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320852","EAP","HCPCS C1725","","Catheter Baldilat 7mm 150cm 220mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80320854","EAP","HCPCS C1757","","Catheter Thrmb 135cm 4fr Unfs Flw-thru Hub Infus","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$237.83 ","$0.00 ","$91.29 ","$312.60 ","$312.60 ","$0.00 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80320860","EAP","HCPCS C1725","","Catheter Baldilat 26mm 100cm 4cm Flxb Distal Tip","BOTH IP/OP","$1,712.00 ","$1,266.88 ","$0.00 ","$1,712.00 ","$0.00 ","$0.00 ","$0.00 ","$1,221.85 ","$1,221.85 ","$299.76 ","$1,712.00 ","$0.00 ","$856.00 ","$1,355.90 ","$1,369.60 ","$0.00 ","$267.93 ","$0.00 ","$272.55 ","$0.00 "
"80320864","EAP","HCPCS C1876","","System Coron Stent 13mm 5mm Mtlnk Ul Xcelon Mcgld","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$847.88 ","$847.88 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"80320865","EAP","Custom 80320865","","Balloon Sz 70cm 27mm Amplzr 3 Lum Sft Distal Tip","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$815.00 ","$0.00 ","$0.00 ","$0.00 ","$581.67 ","$581.67 ","$0.00 ","$815.00 ","$0.00 ","$407.50 ","$645.48 ","$652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80320866","EAP","HCPCS C1887","","Catheter Guid 90cm 6fr Lnchr Ima Curve Peri Nyl Lg","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$163.00 ","$65.16 ","$0.00 ","$25.01 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80320868","EAP","HCPCS C1887","","Catheter Guid 100cm 5fr Lnchr Ebu5 Curve Coron Nyl","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$85.64 ","$85.64 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"80320869","EAP","HCPCS C1887","","Catheter Guid 100cm 6fr Lnchr Ebu3.5 Curve Peri","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80320870","EAP","HCPCS C1769","","CATHETER GUID EXTRA BACKUP 4.5 LEFT CURVE 6FR .071","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$85.64 ","$85.64 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"80321053","EAP","HCPCS C2617","","Zimmon Pancreatic Stent 7fr 12cm","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$80.10 ","$0.00 ","$37.10 ","$127.04 ","$127.04 ","$31.17 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$27.86 ","$0.00 ","$28.34 ","$0.00 "
"80321087","EAP","HCPCS C1757","","INDIGO CATHETER 8, XTORQ TIP 115CM","BOTH IP/OP","$7,225.00 ","$5,346.50 ","$0.00 ","$7,225.00 ","$3,923.18 ","$0.00 ","$1,505.87 ","$5,156.48 ","$5,156.48 ","$0.00 ","$7,225.00 ","$0.00 ","$3,612.50 ","$5,722.20 ","$5,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80321088","EAP","Custom 80321088","","INDIGO SEPARATOR 8","BOTH IP/OP","$4,700.00 ","$3,478.00 ","$0.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$3,354.39 ","$3,354.39 ","$0.00 ","$4,700.00 ","$0.00 ","$2,350.00 ","$3,722.40 ","$3,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80321095","EAP","HCPCS C1773","","Kit Snr Agn 90d 200cm 2.3-3fr 7mm Mcth Loop Coil","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"80321110","EAP","HCPCS C1769","","Guidewire Vasc 175cm .014in Radiopq Prox Conctr","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80321111","EAP","Custom 80321111","","Kit Cath 135cm 2.7fr Img 1 Syr Rapex Tip Radiopq","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$0.00 ","$0.00 ","$0.00 ","$1,338.19 ","$1,338.19 ","$0.00 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80321115","EAP","HCPCS C1887","","Catheter Intvn 5fr .056in .046in 150cm 25cm Rapex","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"80321116","EAP","HCPCS C1887","","CATHETER INTVN 7FR .078IN .062IN 150CM 25CM RAPEX","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"80321117","EAP","HCPCS C1887","","Catheter Intvn 8fr .088in .071in 150cm 25cm Rapex","BOTH IP/OP","$1,023.00 ","$757.02 ","$0.00 ","$1,023.00 ","$555.49 ","$0.00 ","$213.22 ","$730.12 ","$730.12 ","$179.12 ","$1,023.00 ","$0.00 ","$511.50 ","$810.22 ","$818.40 ","$0.00 ","$160.10 ","$0.00 ","$162.86 ","$0.00 "
"80321162","EAP","HCPCS C1887","","SHEATH GUID 65CM 8FR PN DSTN .038IN STR HYDPHI","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$121.63 ","$0.00 ","$46.69 ","$159.87 ","$159.87 ","$39.22 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$35.06 ","$0.00 ","$35.66 ","$0.00 "
"80321939","EAP","HCPCS C1773","","SEPARATOR THRMB INDG 6 LATEX FREE","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$1,466.10 ","$0.00 ","$562.75 ","$1,926.99 ","$1,926.99 ","$472.75 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$422.55 ","$0.00 ","$429.84 ","$0.00 "
"80321943","EAP","HCPCS C1757","","CATHETER THRMB 6FR INDG ASPIRAT LATEX FREE","BOTH IP/OP","$4,725.00 ","$3,496.50 ","$0.00 ","$4,725.00 ","$2,565.68 ","$0.00 ","$984.81 ","$3,372.23 ","$3,372.23 ","$0.00 ","$4,725.00 ","$0.00 ","$2,362.50 ","$3,742.20 ","$3,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80321958","EAP","","","Coloplast Fistula Wound Mgr.-small 14021","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$29.00 ","$0.00 ","$0.00 ","$0.00 ","$20.70 ","$20.70 ","$0.00 ","$29.00 ","$0.00 ","$14.50 ","$22.97 ","$23.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80321959","EAP","","","System 156-228mm Ost Midi Ctf 2 Spout Drain Port","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$0.00 ","$0.00 ","$0.00 ","$90.64 ","$90.64 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80321960","EAP","","","Coloplast Fistula Wound Mgr.-large 14041","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$92.78 ","$92.78 ","$0.00 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80322020","EAP","HCPCS C1753","","CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,357.50 ","$0.00 ","$521.06 ","$1,784.25 ","$1,784.25 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"80322156","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 30mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322157","EAP","HCPCS C1725","","Catheter Baldilat 2mm 25mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322159","EAP","HCPCS C1725","","CATHETER BALDILAT ULTRA LP 5FR 1.5MM 12MM 2 LUMEN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322160","EAP","HCPCS C1874","","Catheter Baldilat 1.5mm 8mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322163","EAP","HCPCS C1725","","Catheter Baldilat 3mm 25mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322164","EAP","HCPCS C1725","","Catheter Baldilat 3mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$250.00 ","$95.03 ","$0.00 ","$36.47 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322165","EAP","HCPCS C1725","","Catheter Baldilat 3mm 8mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322166","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 25mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322167","EAP","HCPCS C1725","","Trek Coronary Dilatation Catheter 2.50 Mm X 8 Mm / Rapid-exchange","BOTH IP/OP","$213.00 ","$157.62 ","$0.00 ","$213.00 ","$115.66 ","$0.00 ","$44.39 ","$152.02 ","$152.02 ","$37.29 ","$213.00 ","$0.00 ","$106.50 ","$168.70 ","$170.40 ","$0.00 ","$33.33 ","$0.00 ","$33.91 ","$0.00 "
"80322168","EAP","HCPCS C1725","","Catheter Baldilat 2mm 20mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322169","EAP","HCPCS C1725","","Catheter Baldilat 2mm 8mm Coron Rapex Ult Lp","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322170","EAP","HCPCS C1725","","CATHETER BALDILAT ULTRA LP 5FR 1.5MM 15MM 2 LUMEN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80322173","EAP","HCPCS C1769","","Guidewire Vasc 190cm .014in Jointless Sprg Coil","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80322174","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Core To Tip Radiopq","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80322178","EAP","HCPCS C1769","","Guidewire Vasc 300cm .014in Jointless Sprg Coil","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80322247","EAP","HCPCS A6213","","Dressing 6x6in Adh Hydrofera Foam Blue","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$239.80 ","$239.80 ","$0.00 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80322311","EAP","HCPCS C1769","","GUIDEWIRE VASC 180CM ASAHI PTCA SION BLUE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"80322312","EAP","HCPCS C1769","","GUIDEWIRE VASC 180CM .014IN STR 3CM SION ASAHI SS","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"80322313","EAP","HCPCS C1769","","GUIDEWIRE VASC 300CM .014IN 3 RADIOPQ SEG STR 3CM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"80322314","EAP","HCPCS C1769","","GUIDEWIRE VASC RG3","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$312.23 ","$0.00 ","$119.84 ","$410.38 ","$410.38 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"80322339","EAP","HCPCS C1887","","CATHETER GUID AL1 CURVE 8FR 90CM CORON SH LNCHR","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80322340","EAP","HCPCS C1887","","CATHETER GUID 3DRC CURVE 8FR 90CM CORON LNCHR","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80322342","EAP","HCPCS C1887","","CATHETER GUID AL1.5 CURVE 8FR .09IN 90CM CORON","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80322343","EAP","HCPCS C1887","","CATHETER GUID AL1.5 CURVE 8FR 90CM CORON SH LNCHR","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80322347","EAP","HCPCS C1887","","CATHETER GUID XB3.5 CURVE 8FR 90CM CORON SH LNCHR","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80322349","EAP","HCPCS C1887","","CATHETER GUID XB4 CURVE 8FR 90CM CORON SH LNCHR","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$129.10 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80322411","EAP","Custom 80322411","","OMNI FLUSH (VCF) 5FR 100CM","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$24.98 ","$24.98 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80322620","EAP","HCPCS C1750","","Kit Cath 61cm Palindrome Prcs Smtr Tip 44cm Chrnc","BOTH IP/OP","$1,445.00 ","$1,069.30 ","$0.00 ","$1,445.00 ","$784.64 ","$0.00 ","$301.17 ","$1,031.30 ","$1,031.30 ","$253.01 ","$1,445.00 ","$0.00 ","$722.50 ","$1,144.44 ","$1,156.00 ","$0.00 ","$226.14 ","$0.00 ","$230.04 ","$0.00 "
"80322779","EAP","Custom 80322779","","Set Ndl 15ga 45mm Strl Lf Ezio Ez-cnct Wrst Band Std Ll Cath","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$242.66 ","$242.66 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80323591","EAP","","","Stabilit First Fracture Kit With Powercurve","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.90 ","$4,995.90 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80323627","EAP","HCPCS C1874","","Stent Vascular  Zilver Ptx 125cm 80mm 100mm Od6 Fr","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$2,436.98 ","$0.00 ","$935.41 ","$3,203.09 ","$3,203.09 ","$785.81 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$702.37 ","$0.00 ","$714.49 ","$0.00 "
"80323828","EAP","HCPCS C1769","","GUIDEWIRE VASC 190CM .014IN STRBL RADIOPQ KINK RST","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80323833","EAP","Custom 80323833","","IMPELLA RP US HDE PUMP SET","BOTH IP/OP","$62,500.00 ","$46,250.00 ","$0.00 ","$62,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$62,500.00 ","$0.00 ","$31,250.00 ","$49,500.00 ","$50,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80324729","EAP","Custom 80324729","","TURNPIKE CATHETER LP 135CM","BOTH IP/OP","$1,313.00 ","$971.62 ","$0.00 ","$1,313.00 ","$0.00 ","$0.00 ","$0.00 ","$937.09 ","$937.09 ","$0.00 ","$1,313.00 ","$0.00 ","$656.50 ","$1,039.90 ","$1,050.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80324730","EAP","Custom 80324730","","TURNPIKE CATHETER LP 150CM","BOTH IP/OP","$1,488.00 ","$1,101.12 ","$0.00 ","$1,488.00 ","$0.00 ","$0.00 ","$0.00 ","$1,061.99 ","$1,061.99 ","$0.00 ","$1,488.00 ","$0.00 ","$744.00 ","$1,178.50 ","$1,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80324863","EAP","HCPCS C1874","","Stent Endoprsth Sprfc Fem Art Ilium 10cm 7mm 7fr","BOTH IP/OP","$8,950.00 ","$6,623.00 ","$0.00 ","$8,950.00 ","$4,027.50 ","$0.00 ","$1,865.40 ","$5,158.80 ","$6,387.62 ","$1,567.07 ","$8,950.00 ","$0.00 ","$4,475.00 ","$7,088.40 ","$7,160.00 ","$0.00 ","$1,400.68 ","$0.00 ","$1,424.84 ","$0.00 "
"80324866","EAP","HCPCS C1892","","Introd Shth 9fr 13cm Optiseal","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$70.59 ","$0.00 ","$27.10 ","$92.78 ","$92.78 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"80325074","EAP","HCPCS C1773","","Snare Vasc 47in .71-1.18in .055in .074in Ensnr","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$449.60 ","$0.00 ","$172.58 ","$590.94 ","$590.94 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"80325086","EAP","HCPCS C1817","","Occluder Cardio 25mm Spt Sft Wire Frm Flrscp Img","BOTH IP/OP","$19,778.00 ","$14,635.72 ","$0.00 ","$19,778.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$14,115.56 ","$0.00 ","$19,778.00 ","$0.00 ","$9,889.00 ","$15,664.18 ","$15,822.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80325087","EAP","HCPCS C1817","","Occluder Cardio 30mm Spt Sft Wire Frm Flrscp Img","BOTH IP/OP","$19,778.00 ","$14,635.72 ","$0.00 ","$19,778.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$14,115.56 ","$0.00 ","$19,778.00 ","$0.00 ","$9,889.00 ","$15,664.18 ","$15,822.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80325319","EAP","","","Spinestar Ablation Instr 17.5 Cm L15 Mm L10 Mm Od11 Ga Therm","BOTH IP/OP","$7,250.00 ","$5,365.00 ","$0.00 ","$7,250.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,250.00 ","$0.00 ","$3,625.00 ","$5,742.00 ","$5,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80325443","EAP","HCPCS C1887","","Sheath Guid 65cm 6fr .109in .087in Pn Dstn Str Ss","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$160.58 ","$160.58 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"80325494","EAP","HCPCS C1725","","Catheter Angio 125cm 6fr Crds St+ Jr4 Curve Coron","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$45.61 ","$0.00 ","$17.51 ","$59.95 ","$59.95 ","$14.71 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$13.15 ","$0.00 ","$13.37 ","$0.00 "
"80325495","EAP","HCPCS C1725","","Catheter Angio 125cm 6fr Crds St+ Jl4 Curve Coron","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$45.61 ","$0.00 ","$17.51 ","$59.95 ","$59.95 ","$14.71 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$13.15 ","$0.00 ","$13.37 ","$0.00 "
"80325526","EAP","HCPCS C1876","","INNOVA 5MM X 60MM X 75CM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80325555","EAP","HCPCS C1876","","STENT VASC BLUE 40MM 6MM INNOVA SPRFC FEM ART SLF","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80325566","EAP","HCPCS C1876","","INNOVA 8MM X 20MM X 130CM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80325567","EAP","HCPCS C1876","","INNOVA 8MM X 40MM X 130CM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80325568","EAP","HCPCS C1876","","INNOVA 8MM X 60MM X 130CM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80325569","EAP","HCPCS C1876","","INNOVA 8MM X 80MM X 130CM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80325650","EAP","HCPCS C1757","","SYSTEM THRMB ZELANTEDVT","BOTH IP/OP","$7,313.00 ","$5,411.62 ","$0.00 ","$7,313.00 ","$3,970.96 ","$0.00 ","$1,524.21 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,313.00 ","$0.00 ","$3,656.50 ","$5,791.90 ","$5,850.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80325671","EAP","HCPCS C1874","","STENT VASC 60MM 6MM GORE TIGRIS CBAS NTNL FLPLMR","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"80325673","EAP","HCPCS C1874","","STENT VASC 100MM 6MM GORE TIGRIS CBAS NTNL FLPLMR","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"80325675","EAP","HCPCS C1874","","STENT VASC 60MM 7MM GORE TIGRIS CBAS NTNL FLPLMR","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"80325676","EAP","HCPCS C1874","","STENT VASC 100MM 7MM GORE TIGRIS CBAS NTNL FLPLMR","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$779.09 ","$2,667.81 ","$2,667.81 ","$654.49 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$585.00 ","$0.00 ","$595.09 ","$0.00 "
"80326084","EAP","HCPCS C1887","","CATHETER ANGIO RADIALTIGER CURVE 6FR 4MM 110CM","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"80326288","EAP","HCPCS C1769","","Guidewire Vasc 325cm .012in Viperwire Adv Coron","BOTH IP/OP","$488.00 ","$361.12 ","$0.00 ","$488.00 ","$264.98 ","$0.00 ","$101.71 ","$348.29 ","$348.29 ","$85.44 ","$488.00 ","$0.00 ","$244.00 ","$386.50 ","$390.40 ","$0.00 ","$76.37 ","$0.00 ","$77.69 ","$0.00 "
"80326302","EAP","HCPCS C1724","","CATHETER ATHRCM 145CM STLTH 360 1.25MM ORBTL CLS","BOTH IP/OP","$9,488.00 ","$7,021.12 ","$0.00 ","$9,488.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$5,158.80 ","$0.00 ","$9,488.00 ","$0.00 ","$4,744.00 ","$7,514.50 ","$7,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80326668","EAP","HCPCS C1722","","Generator Pcmkr 83.1x69.1mm Eblm S-icd 12.7mm 59.5","BOTH IP/OP","$42,500.00 ","$31,450.00 ","$0.00 ","$42,500.00 ","$19,125.00 ","$0.00 ","$8,858.06 ","$5,158.80 ","$30,332.25 ","$7,441.41 ","$42,500.00 ","$0.00 ","$21,250.00 ","$33,660.00 ","$34,000.00 ","$0.00 ","$6,651.25 ","$0.00 ","$6,766.00 ","$0.00 "
"80332586","EAP","HCPCS C1751","","Catheter Angel","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$3,054.38 ","$0.00 ","$1,172.39 ","$4,014.56 ","$4,014.56 ","$984.89 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$880.31 ","$0.00 ","$895.50 ","$0.00 "
"80332596","EAP","HCPCS C1757","","Retriever Escp 3mm 20mm Trevo Xp Provue","BOTH IP/OP","$13,118.00 ","$9,707.32 ","$0.00 ","$13,118.00 ","$7,123.07 ","$0.00 ","$2,734.12 ","$5,158.80 ","$5,158.80 ","$0.00 ","$13,118.00 ","$0.00 ","$6,559.00 ","$10,389.46 ","$10,494.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80333053","EAP","HCPCS C1769","","GUIDEWIRE VASC 185CM STRL LF VERRATA + PRSS DISP","BOTH IP/OP","$1,688.00 ","$1,249.12 ","$0.00 ","$1,688.00 ","$916.58 ","$0.00 ","$351.82 ","$1,204.73 ","$1,204.73 ","$295.56 ","$1,688.00 ","$0.00 ","$844.00 ","$1,336.90 ","$1,350.40 ","$0.00 ","$264.17 ","$0.00 ","$268.73 ","$0.00 "
"80338397","EAP","HCPCS C1769","","Guidewire Vasc 180cm .035in Flx Tp Ang 25cm 5cm","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$285.48 ","$285.48 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"80339398","EAP","HCPCS C1874","","Stent Eprsth .035in 9mm 13mm 8","BOTH IP/OP","$6,725.00 ","$4,976.50 ","$0.00 ","$6,725.00 ","$3,026.25 ","$0.00 ","$1,401.66 ","$4,799.63 ","$4,799.63 ","$1,177.49 ","$6,725.00 ","$0.00 ","$3,362.50 ","$5,326.20 ","$5,380.00 ","$0.00 ","$1,052.46 ","$0.00 ","$1,070.62 ","$0.00 "
"80339402","EAP","HCPCS C1874","","Stent Endoprsth 29mm 11mm 16sq Mm 8fr Gore Vbhn","BOTH IP/OP","$8,548.00 ","$6,325.52 ","$0.00 ","$8,548.00 ","$3,846.60 ","$0.00 ","$1,781.62 ","$5,158.80 ","$6,100.71 ","$1,496.69 ","$8,548.00 ","$0.00 ","$4,274.00 ","$6,770.02 ","$6,838.40 ","$0.00 ","$1,337.76 ","$0.00 ","$1,360.84 ","$0.00 "
"80339410","EAP","HCPCS C1874","","Stent Endoprsth 39mm 7mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,548.00 ","$6,325.52 ","$0.00 ","$8,548.00 ","$3,846.60 ","$0.00 ","$1,781.62 ","$5,158.80 ","$6,100.71 ","$1,496.69 ","$8,548.00 ","$0.00 ","$4,274.00 ","$6,770.02 ","$6,838.40 ","$0.00 ","$1,337.76 ","$0.00 ","$1,360.84 ","$0.00 "
"80339412","EAP","HCPCS C1874","","Stent Endoprsth 39mm 8mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,548.00 ","$6,325.52 ","$0.00 ","$8,548.00 ","$3,846.60 ","$0.00 ","$1,781.62 ","$5,158.80 ","$6,100.71 ","$1,496.69 ","$8,548.00 ","$0.00 ","$4,274.00 ","$6,770.02 ","$6,838.40 ","$0.00 ","$1,337.76 ","$0.00 ","$1,360.84 ","$0.00 "
"80339426","EAP","HCPCS C1874","","Stent Endoprsth 59mm 7mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,548.00 ","$6,325.52 ","$0.00 ","$8,548.00 ","$3,846.60 ","$0.00 ","$1,781.62 ","$5,158.80 ","$6,100.71 ","$1,496.69 ","$8,548.00 ","$0.00 ","$4,274.00 ","$6,770.02 ","$6,838.40 ","$0.00 ","$1,337.76 ","$0.00 ","$1,360.84 ","$0.00 "
"80339428","EAP","HCPCS C1874","","Stent Endoprsth 59mm 8mm 11mm 7fr Gore Vbhn 135cm","BOTH IP/OP","$8,138.00 ","$6,022.12 ","$0.00 ","$8,138.00 ","$3,662.10 ","$0.00 ","$1,696.16 ","$5,158.80 ","$5,808.09 ","$1,424.90 ","$8,138.00 ","$0.00 ","$4,069.00 ","$6,445.30 ","$6,510.40 ","$0.00 ","$1,273.60 ","$0.00 ","$1,295.57 ","$0.00 "
"80339456","EAP","HCPCS C1887","","Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr 3drc","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$50.50 ","$0.00 ","$19.38 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$0.00 ","$14.55 ","$0.00 ","$14.81 ","$0.00 "
"80339903","EAP","","","Catheter Angio Tpr Loprfl Rc2 Crv 5fr 65cm Strl Trnb Ad","BOTH IP/OP","$313.00 ","$231.62 ","$0.00 ","$313.00 ","$0.00 ","$0.00 ","$0.00 ","$223.39 ","$223.39 ","$0.00 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80340523","EAP","HCPCS C1894","","Sheath Guid 90cm 2.5fr Chk-flo Flxr Raabe","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$102.08 ","$0.00 ","$39.18 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"80341173","EAP","HCPCS C1769","","Guidewire Vasc 260cm .035in Radiopq Flpy Flx Tp","BOTH IP/OP","$551.00 ","$407.74 ","$0.00 ","$551.00 ","$299.19 ","$0.00 ","$114.84 ","$393.25 ","$393.25 ","$96.48 ","$551.00 ","$0.00 ","$275.50 ","$436.39 ","$440.80 ","$0.00 ","$86.23 ","$0.00 ","$87.72 ","$0.00 "
"80341288","EAP","HCPCS C1769","","Guidewire Vasc Ang Shrt Tpr .018in 60cm 7cm Cp Mdrl Dist Tip","BOTH IP/OP","$106.00 ","$78.44 ","$0.00 ","$106.00 ","$57.56 ","$0.00 ","$22.09 ","$75.65 ","$75.65 ","$18.56 ","$106.00 ","$0.00 ","$53.00 ","$83.95 ","$84.80 ","$0.00 ","$16.59 ","$0.00 ","$16.88 ","$0.00 "
"80341936","EAP","HCPCS C1769","","Guidewire Vasc 15cm Strg 2 Crv Tpr .035in 180cm 7cm Lndrqs","BOTH IP/OP","$753.00 ","$557.22 ","$0.00 ","$753.00 ","$408.88 ","$0.00 ","$156.94 ","$537.42 ","$537.42 ","$131.84 ","$753.00 ","$0.00 ","$376.50 ","$596.38 ","$602.40 ","$0.00 ","$117.84 ","$0.00 ","$119.88 ","$0.00 "
"80349650","EAP","","","KIT MCTRDCR .018IN TPR 5FR 40CM 7CM VSI SMTH NDL GW REG DIL","BOTH IP/OP","$474.00 ","$350.76 ","$0.00 ","$474.00 ","$0.00 ","$0.00 ","$0.00 ","$338.29 ","$338.29 ","$0.00 ","$474.00 ","$0.00 ","$237.00 ","$375.41 ","$379.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80359050","EAP","HCPCS C1753","","Catheter Us Kodama","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$162.90 ","$0.00 ","$62.53 ","$214.11 ","$214.11 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"80359064","EAP","HCPCS A6198","","Dressing Brn 48x4in Strl Lf Actct Flx 3 Anmc Brr 1 Lyr Knit","BOTH IP/OP","$179.00 ","$132.46 ","$0.00 ","$211.00 ","$97.20 ","$0.00 ","$0.00 ","$150.59 ","$150.59 ","$0.00 ","$211.00 ","$0.00 ","$105.50 ","$167.11 ","$168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80370959","EAP","HCPCS C1874","","System Coron Stent 24mm 2.75mm Cbr Pzf Polyzene-f","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370960","EAP","HCPCS C1874","","System Coron Stent 30mm 2.75mm Cbr Pzf Polyzene-f","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370964","EAP","HCPCS C1874","","System Cor Stnt 3mm 18mm Cbr Pzf Rx Dlv Sys Polyzene-f Cocr","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370965","EAP","HCPCS C1874","","System Coron Stent 24mm 3mm Cbr Pzf Polyzene-f","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370966","EAP","HCPCS C1874","","System Coron Stent 30mm 3mm Cbr Pzf Cocr Hydphi","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370969","EAP","HCPCS C1876","","System Coronary Stent Cobra Pzf Polyzene-f L15mm","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370970","EAP","HCPCS C1876","","System Cor Stnt 3.5mm 18mm Cbr Pzf Rx Dlv Sys Polyzene-f","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370972","EAP","HCPCS C1876","","System Coronary Stent Cobra L30mm Id3.5mm Rapid Exchange","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370976","EAP","HCPCS C1876","","System Coronary Stent Cobra L18mm Id4mm Rapid Exchange","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80370978","EAP","HCPCS C1876","","System Coronary Stent Cobra L30 Mm Id4 Mm Rapid Exchange","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$1,516.61 ","$1,516.61 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"80371591","EAP","HCPCS C1874","","STENT EPRSTH 8MM 7FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM","BOTH IP/OP","$8,738.00 ","$6,466.12 ","$0.00 ","$8,738.00 ","$3,932.10 ","$0.00 ","$1,821.22 ","$5,158.80 ","$6,236.31 ","$1,529.95 ","$8,738.00 ","$0.00 ","$4,369.00 ","$6,920.50 ","$6,990.40 ","$0.00 ","$1,367.50 ","$0.00 ","$1,391.09 ","$0.00 "
"80379042","EAP","HCPCS C1752","","Kit Cath 13fr 20cm Strl Pwr-trialysis 3 Lum Shrt Term Dlys","BOTH IP/OP","$596.00 ","$441.04 ","$0.00 ","$596.00 ","$0.00 ","$0.00 ","$0.00 ","$425.37 ","$425.37 ","$0.00 ","$596.00 ","$0.00 ","$298.00 ","$472.03 ","$476.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80379099","EAP","HCPCS C2621","","Percepta Quad Crtp Mri Surescan","BOTH IP/OP","$16,500.00 ","$12,210.00 ","$0.00 ","$16,500.00 ","$0.00 ","$0.00 ","$0.00 ","$5,158.80 ","$11,776.05 ","$0.00 ","$16,500.00 ","$0.00 ","$8,250.00 ","$13,068.00 ","$13,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80379103","EAP","HCPCS C1729","","Catheter Primafit Sage","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$14.66 ","$0.00 ","$5.63 ","$19.27 ","$19.27 ","$4.73 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$4.23 ","$0.00 ","$4.30 ","$0.00 "
"80379488","EAP","HCPCS C1726","","Rigiflex Ii Single Use Achalasia Balloon Dilator","BOTH IP/OP","$1,690.00 ","$1,250.60 ","$0.00 ","$1,690.00 ","$917.67 ","$0.00 ","$352.24 ","$1,206.15 ","$1,206.15 ","$295.91 ","$1,690.00 ","$0.00 ","$845.00 ","$1,338.48 ","$1,352.00 ","$0.00 ","$264.49 ","$0.00 ","$269.05 ","$0.00 "
"80379641","EAP","HCPCS C1786","","SYSTEM DLV 3.2V 120MAH 6.7MM 25.9MM MICRA SURESCAN HBRD","BOTH IP/OP","$26,875.00 ","$19,887.50 ","$0.00 ","$26,875.00 ","$12,093.75 ","$0.00 ","$5,601.42 ","$5,158.80 ","$19,180.69 ","$0.00 ","$26,875.00 ","$0.00 ","$13,437.50 ","$21,285.00 ","$21,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80379642","EAP","HCPCS C1894","","INTRODUCER SHTH 23FR 55.7CM 69.9CM MICRA STPCK RADOPQ DIL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$312.64 ","$1,070.55 ","$1,070.55 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"80379742","EAP","Custom 80379742","","Set Hmdial 27x22x9cm 165ml Strl Lf Prismaflex Hmfltr Bg","BOTH IP/OP","$426.00 ","$315.24 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$285.48 ","$285.48 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80379801","EAP","HCPCS C2623","","CATHETER BLNDIL 7MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"80379803","EAP","HCPCS C2623","","CATHETER BLNDIL 8MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$0.00 ","$0.00 ","$0.00 ","$3,033.23 ","$3,033.23 ","$744.14 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$665.13 ","$0.00 ","$676.60 ","$0.00 "
"80379806","EAP","HCPCS C2623","","CATHETER BLNDIL 10MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$0.00 ","$0.00 ","$0.00 ","$3,033.23 ","$3,033.23 ","$744.14 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$665.13 ","$0.00 ","$676.60 ","$0.00 "
"80390076","EAP","HCPCS C2623","","Catheter Baldilat 4mm 130cm 100mm Pcltxl Latex","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"80390081","EAP","HCPCS C2623","","Catheter Baldilat 4mm 130cm 60mm Pcltxl Latex Free","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"80390085","EAP","HCPCS C2623","","Catheter Baldilat 5mm 130cm 100mm Pcltxl Latex","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"80390093","EAP","HCPCS C2623","","Catheter Baldilat 5mm 130cm 60mm Pcltxl Latex Free","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.95 ","$2,497.95 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"80390101","EAP","HCPCS C2623","","Catheter Blndil 5f 6mm 130cm 150mm Lutonix","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$0.00 ","$0.00 ","$0.00 ","$3,033.23 ","$3,033.23 ","$744.14 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$665.13 ","$0.00 ","$676.60 ","$0.00 "
"80397351","EAP","HCPCS C1898","","Lead Pacing Capsure Sense Steroid Eluting L52 Cm Atrium Right Vent","BOTH IP/OP","$1,013.00 ","$749.62 ","$0.00 ","$1,013.00 ","$455.85 ","$0.00 ","$211.13 ","$722.98 ","$722.98 ","$177.37 ","$1,013.00 ","$0.00 ","$506.50 ","$802.30 ","$810.40 ","$0.00 ","$158.53 ","$0.00 ","$161.27 ","$0.00 "
"80397520","EAP","HCPCS C1887","","Catheter Gd 9fr 7.2fr 45cm Atn Cmnd Surevalve Lh","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$319.28 ","$0.00 ","$122.55 ","$419.66 ","$419.66 ","$102.95 ","$588.00 ","$0.00 ","$294.00 ","$465.70 ","$470.40 ","$0.00 ","$92.02 ","$0.00 ","$93.61 ","$0.00 "
"80397527","EAP","HCPCS C1887","","Catheter Gd .035in Mp Rt Crv 9fr 7.2fr 45cm Atn Cmnd","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$319.28 ","$0.00 ","$122.55 ","$419.66 ","$419.66 ","$102.95 ","$588.00 ","$0.00 ","$294.00 ","$465.70 ","$470.40 ","$0.00 ","$92.02 ","$0.00 ","$93.61 ","$0.00 "
"80397542","EAP","HCPCS C1777","","Lead Pacing Sprint Quattro Secure L58 Cm 1 Coil Defib","BOTH IP/OP","$7,875.00 ","$5,827.50 ","$0.00 ","$7,875.00 ","$3,543.75 ","$0.00 ","$1,641.35 ","$5,158.80 ","$5,620.39 ","$1,378.85 ","$7,875.00 ","$0.00 ","$3,937.50 ","$6,237.00 ","$6,300.00 ","$0.00 ","$1,232.44 ","$0.00 ","$1,253.70 ","$0.00 "
"80397543","EAP","HCPCS C1777","","Lead Pacing Sprint Quattro Secure Steroid Eluting Silicone Helix L65","BOTH IP/OP","$7,875.00 ","$5,827.50 ","$0.00 ","$7,875.00 ","$3,543.75 ","$0.00 ","$1,641.35 ","$5,158.80 ","$5,620.39 ","$1,378.85 ","$7,875.00 ","$0.00 ","$3,937.50 ","$6,237.00 ","$6,300.00 ","$0.00 ","$1,232.44 ","$0.00 ","$1,253.70 ","$0.00 "
"80398493","EAP","HCPCS C1769","","GUIDEWIRE VASC 300CM .014IN RADIOPQ KINK RST STR 3","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$39.08 ","$133.82 ","$133.82 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"80398507","EAP","HCPCS C1769","","GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ WHSPR LS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$39.08 ","$133.82 ","$133.82 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"80398619","EAP","HCPCS C1874","","System Coron Stent 38mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398620","EAP","HCPCS C1874","","System Coron Stent 33mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398621","EAP","HCPCS C1874","","System Coron Stent 28mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398622","EAP","HCPCS C1874","","System Coron Stent 23mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398629","EAP","HCPCS C1874","","System Coron Stent 18mm 4mm Xience Srr Everolimus","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$3,000.00 ","$787.50 ","$0.00 ","$364.74 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398631","EAP","HCPCS C1874","","System Coron Stent 15mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398632","EAP","HCPCS C1874","","System Coron Stent 12mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398634","EAP","HCPCS C1874","","System Coron Stent 8mm 4mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398635","EAP","HCPCS C1874","","System Coron Stent 38mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398636","EAP","HCPCS C1874","","System Coron Stent 33mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398638","EAP","HCPCS C1874","","System Coron Stent 28mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398639","EAP","HCPCS C1874","","System Coron Stent 23mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398640","EAP","HCPCS C1874","","System Coron Stent 18mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398647","EAP","HCPCS C1874","","System Coron Stent 15mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398650","EAP","HCPCS C1874","","System Coron Stent 12mm 3.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398655","EAP","HCPCS C1874","","System Coron Stent 8mm 3.5mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398661","EAP","HCPCS C1874","","System Coron Stent 38mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398666","EAP","HCPCS C1874","","System Coron Stent 33mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398672","EAP","HCPCS C1874","","System Coron Stent 28mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398673","EAP","HCPCS C1874","","System Coron Stent 23mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398679","EAP","HCPCS C1874","","System Coron Stent 18mm 3.25mm Xience Srr","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$3,000.00 ","$787.50 ","$0.00 ","$364.74 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398680","EAP","HCPCS C1874","","System Coron Stent 15mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398682","EAP","HCPCS C1874","","System Coron Stent 12mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398683","EAP","HCPCS C1874","","System Coron Stent 8mm 3.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398684","EAP","HCPCS C1874","","System Coron Stent 38mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398685","EAP","HCPCS C1874","","System Coron Stent 33mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398686","EAP","HCPCS C1874","","System Coron Stent 28mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398687","EAP","HCPCS C1874","","System Coron Stent 23mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398688","EAP","HCPCS C1874","","System Coron Stent 18mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398689","EAP","HCPCS C1874","","System Coron Stent 15mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398690","EAP","HCPCS C1874","","System Coron Stent 12mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398691","EAP","HCPCS C1874","","System Coron Stent 8mm 3mm Xience Srr Everolimus","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398692","EAP","HCPCS C1874","","System Coron Stent 38mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398693","EAP","HCPCS C1874","","System Coron Stent 33mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398699","EAP","HCPCS C1874","","System Coron Stent 28mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398700","EAP","HCPCS C1874","","System Coron Stent 23mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398701","EAP","HCPCS C1874","","System Coron Stent 18mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398702","EAP","HCPCS C1874","","System Coron Stent 15mm 2.75mm Xience Srr","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$3,000.00 ","$787.50 ","$0.00 ","$364.74 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398703","EAP","HCPCS C1874","","System Coron Stent 12mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398704","EAP","HCPCS C1874","","System Coron Stent 8mm 2.75mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398705","EAP","HCPCS C1874","","System Coron Stent 38mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398706","EAP","HCPCS C1874","","System Coron Stent 33mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398707","EAP","HCPCS C1874","","System Coron Stent 28mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398708","EAP","HCPCS C1874","","System Coron Stent 23mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398709","EAP","HCPCS C1874","","System Coron Stent 18mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398710","EAP","HCPCS C1874","","System Coron Stent 15mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398770","EAP","HCPCS C1874","","System Coron Stent 12mm 2.5mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398771","EAP","HCPCS C1874","","System Coron Stent 8mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398772","EAP","HCPCS C1874","","System Coron Stent 12mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398773","EAP","HCPCS C1874","","System Coron Stent 15mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398774","EAP","HCPCS C1874","","System Coron Stent 18mm 2.25mm Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398775","EAP","HCPCS C1874","","System Coron Stent 23mm 2.25mm Xience Srr","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$3,000.00 ","$787.50 ","$0.00 ","$364.74 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398776","EAP","HCPCS C1874","","System Coron Stent 28mm 2.25mm Xience Srr","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$3,000.00 ","$787.50 ","$0.00 ","$364.74 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398777","EAP","HCPCS C1874","","Stent Coron 33mm 2.25mm Everolimus Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398778","EAP","HCPCS C1874","","Stent Coron 38mm 2.25mm Everolimus Xience Srr","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398779","EAP","HCPCS C1874","","System Coron Stent 8mm 2.5mm Xience Srr Everolimus","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$3,000.00 ","$787.50 ","$0.00 ","$364.74 ","$2,141.10 ","$2,141.10 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"80398790","EAP","HCPCS C1769","","GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$267.64 ","$267.64 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"80399090","EAP","","","Advance Capsule Endoscopy Delivery Device","BOTH IP/OP","$413.00 ","$305.62 ","$0.00 ","$413.00 ","$0.00 ","$0.00 ","$0.00 ","$294.76 ","$294.76 ","$0.00 ","$413.00 ","$0.00 ","$206.50 ","$327.10 ","$330.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80399207","EAP","HCPCS C1887","","Catheter Infus 10d 3.5fr 135cm Otw 2 Lum Brd Trq","BOTH IP/OP","$1,068.00 ","$790.32 ","$0.00 ","$1,068.00 ","$579.92 ","$0.00 ","$222.60 ","$762.23 ","$762.23 ","$187.00 ","$1,068.00 ","$0.00 ","$534.00 ","$845.86 ","$854.40 ","$0.00 ","$167.14 ","$0.00 ","$170.03 ","$0.00 "
"80399275","EAP","HCPCS C1887","","CATHETER INTVN 5.1FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"80399276","EAP","HCPCS C1887","","CATHETER INTVN 5.7FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"80399277","EAP","HCPCS C1887","","CATHETER INTVN 6.5FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"80405583","EAP","HCPCS C1757","","CATHETER THRMB .044IN 140CM STRL LF INDG SYS ASP KT COR","BOTH IP/OP","$4,850.00 ","$3,589.00 ","$0.00 ","$4,850.00 ","$2,182.50 ","$0.00 ","$1,010.86 ","$3,461.45 ","$3,461.45 ","$0.00 ","$4,850.00 ","$0.00 ","$2,425.00 ","$3,841.20 ","$3,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80405584","EAP","Custom 80405584","","SEPARATOR THRMB STRL LF INDG SYS 4 DISP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$1,570.14 ","$1,570.14 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80405589","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 8MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80405590","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 12MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80405591","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 15MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80405592","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 18MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80405593","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 22MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80405594","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 26MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80405595","EAP","HCPCS C1874","","SYSTEM COR STNT 2MM 30MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$2,444.42 ","$2,444.42 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"80406242","EAP","Custom 80406242","","PLUG OCL 3MM 12X5.3MM MVP MECH DTCH FULL RESHEATHABLE NTNL","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406243","EAP","Custom 80406243","","PLUG OCL 5MM 12X6.5MM STRL LF MVP MECH DTCH FULL","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406244","EAP","Custom 80406244","","PLUG OCL MIC 7MM STRL LF MVP MECH VASC DISP V03","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$1,682.10 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406245","EAP","Custom 80406245","","PLUG OCL 9MM STRL LF MVP V03","BOTH IP/OP","$3,738.00 ","$2,766.12 ","$0.00 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.81 ","$2,667.81 ","$0.00 ","$3,738.00 ","$0.00 ","$1,869.00 ","$2,960.50 ","$2,990.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406248","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 180CM STRL LF CNFNZ PRO 12 DISP","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"80406249","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 300CM STRL LF FIELDER FC DISP","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$107.51 ","$0.00 ","$41.27 ","$141.31 ","$141.31 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80406250","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 180CM STRL LF FIELDER FC DISP","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$107.51 ","$0.00 ","$41.27 ","$141.31 ","$141.31 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80406251","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 300CM STRL LF GRAND SLAM DISP","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$156.38 ","$0.00 ","$60.03 ","$205.55 ","$205.55 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"80406252","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 180CM STRL LF MRCLBRS 6 DISP","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"80406253","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 6 DISP","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"80406254","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 3 DISP","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$333.00 ","$180.82 ","$0.00 ","$69.41 ","$237.66 ","$237.66 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$52.11 ","$0.00 ","$53.01 ","$0.00 "
"80406255","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 180CM STRL LF P-H2O DISP","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$107.51 ","$0.00 ","$41.27 ","$141.31 ","$141.31 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80406256","EAP","HCPCS C1769","","GUIDEWIRE VASC .014IN 300CM STRL LF P-H2O DISP","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$141.31 ","$141.31 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80406275","EAP","HCPCS C1894","","Vascular Vein Kit","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$353.00 ","$191.68 ","$0.00 ","$73.57 ","$251.94 ","$251.94 ","$61.81 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$55.24 ","$0.00 ","$56.20 ","$0.00 "
"80406279","EAP","HCPCS C1785","","Pacemaker Assurity Mri 6mm X 50mm X 47mm 10.44 Cc 2 Chmbr  Is-1 Con","BOTH IP/OP","$12,225.00 ","$9,046.50 ","$0.00 ","$12,225.00 ","$5,501.25 ","$0.00 ","$2,548.00 ","$5,158.80 ","$8,724.98 ","$2,140.50 ","$12,225.00 ","$0.00 ","$6,112.50 ","$9,682.20 ","$9,780.00 ","$0.00 ","$1,913.21 ","$0.00 ","$1,946.22 ","$0.00 "
"80406478","EAP","","","Dressing Gel Strl Lf Isrb Abs Tube Nadh Cdxmr Iod 10gm","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$25.69 ","$25.69 ","$0.00 ","$36.00 ","$0.00 ","$18.00 ","$28.51 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406479","EAP","","","Dressing Gel Strl Iodoflex 3 In 1 Mode Abs Pd Nadh Cdxmr Iod","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$21.41 ","$21.41 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406513","EAP","","","Marker Endoscopic Spot Ex Tattoo Prefill Perm Syringe","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$678.02 ","$678.02 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80406525","EAP","HCPCS C1894","","Kit Triple Lumen Cvc,  Agb+ 7 French, Pressure Rated, 20cm","BOTH IP/OP","$366.00 ","$270.84 ","$0.00 ","$360.00 ","$198.74 ","$0.00 ","$76.28 ","$256.93 ","$256.93 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"80411625","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 20mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411627","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 30mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411630","EAP","HCPCS C1725","","Catheter Baldilat 2mm 150cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411635","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 150cm 30mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411637","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 150cm 40mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411639","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 150cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411641","EAP","HCPCS C1725","","Catheter Baldilat 2.5mm 150cm 220mm Otw Inflat","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411645","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 30mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411648","EAP","HCPCS C1725","","Catheter Baldilat 3mm 150cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411651","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 20mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411653","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 30mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411655","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 40mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411657","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 60mm Otw Inflat Port","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411659","EAP","HCPCS C1725","","Catheter Baldilat 3.5mm 150cm 220mm Otw Inflat","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411662","EAP","HCPCS C1725","","Catheter Baldilat 5mm 150cm 120mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411666","EAP","HCPCS C1725","","Catheter Baldilat 5mm 150cm 220mm Peri Otw Tpr Tip","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80411668","EAP","HCPCS C1725","","Catheter Baldilat 6mm 120mm 150cm Otw Tpr Tip Lp","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$303.32 ","$303.32 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"80412733","EAP","HCPCS C2630","","Catheter Ablation Tacticath 2-2-2 Mm Space Damato Type","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$0.00 ","$0.00 ","$0.00 ","$4,817.48 ","$4,817.48 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80416033","EAP","HCPCS C1895","","Lead Defibrillator Reliance 4-front, Dual Coil 59cm","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$4,639.05 ","$4,639.05 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"80416166","EAP","HCPCS C1722","","Dfbr Crd .99cm 5.37x7.79cm Momentum Heartlogic","BOTH IP/OP","$22,643.00 ","$16,755.82 ","$0.00 ","$22,643.00 ","$10,189.35 ","$0.00 ","$4,719.37 ","$5,158.80 ","$16,160.31 ","$3,964.61 ","$22,643.00 ","$0.00 ","$11,321.50 ","$17,933.26 ","$18,114.40 ","$0.00 ","$3,543.63 ","$0.00 ","$3,604.77 ","$0.00 "
"80416179","EAP","HCPCS C1721","","Resonate El Aicd Dual Chamber 5.37cm 7.68cm 0.99cm","BOTH IP/OP","$28,250.00 ","$20,905.00 ","$0.00 ","$28,250.00 ","$0.00 ","$0.00 ","$5,888.01 ","$5,158.80 ","$20,162.03 ","$4,946.35 ","$28,250.00 ","$0.00 ","$14,125.00 ","$22,374.00 ","$22,600.00 ","$0.00 ","$4,421.13 ","$0.00 ","$4,497.40 ","$0.00 "
"80416197","EAP","HCPCS C1786","","Pacemaker Crd .75cm 4.45x4.81cm Acld Pacesafe Ltd","BOTH IP/OP","$6,680.00 ","$4,943.20 ","$0.00 ","$6,680.00 ","$3,006.00 ","$0.00 ","$1,392.28 ","$4,767.52 ","$4,767.52 ","$0.00 ","$6,680.00 ","$0.00 ","$3,340.00 ","$5,290.56 ","$5,344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80416198","EAP","HCPCS C1785","","Pacemaker Crd .75cm 4.45x5.02cm Acld Pacesafe Ltd","BOTH IP/OP","$7,625.00 ","$5,642.50 ","$0.00 ","$7,625.00 ","$3,431.25 ","$0.00 ","$1,589.24 ","$5,158.80 ","$5,441.96 ","$1,335.08 ","$7,625.00 ","$0.00 ","$3,812.50 ","$6,039.00 ","$6,100.00 ","$0.00 ","$1,193.31 ","$0.00 ","$1,213.90 ","$0.00 "
"80435214","EAP","HCPCS C1887","","Kit Catheter Gd 9fr 80cm Strl Lf Mrc Bln Sil With Axs Catalyst","BOTH IP/OP","$7,979.00 ","$5,904.46 ","$0.00 ","$7,979.00 ","$4,332.60 ","$0.00 ","$1,663.02 ","$5,158.80 ","$5,158.80 ","$1,397.06 ","$7,979.00 ","$0.00 ","$3,989.50 ","$6,319.37 ","$6,383.20 ","$0.00 ","$1,248.71 ","$0.00 ","$1,270.26 ","$0.00 "
"80435215","EAP","HCPCS C1887","","Kit Catheter Gd 9fr 95cm Strl Lf Mrc Bln Sil With Axs Catalyst","BOTH IP/OP","$7,979.00 ","$5,904.46 ","$0.00 ","$7,979.00 ","$4,332.60 ","$0.00 ","$1,663.02 ","$5,158.80 ","$5,158.80 ","$1,397.06 ","$7,979.00 ","$0.00 ","$3,989.50 ","$6,319.37 ","$6,383.20 ","$0.00 ","$1,248.71 ","$0.00 ","$1,270.26 ","$0.00 "
"80436768","EAP","HCPCS C1817","","Plug Cardio 11mm 6mm 4fr Amplzr .038in Lp Ntnl","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$0.00 ","$0.00 ","$0.00 ","$1,695.04 ","$1,695.04 ","$0.00 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80436769","EAP","HCPCS C1817","","Plug Cardio 13.5mm 8mm 4fr Amplzr .038in Lp Ntnl","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$0.00 ","$0.00 ","$0.00 ","$1,695.04 ","$1,695.04 ","$0.00 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80436770","EAP","HCPCS C1769","","Kit Trevo 3x20 Packaged With Synchro2 Std Custom Grady","BOTH IP/OP","$14,432.00 ","$10,679.68 ","$0.00 ","$14,432.00 ","$7,836.58 ","$0.00 ","$3,007.99 ","$5,158.80 ","$5,158.80 ","$2,526.93 ","$14,432.00 ","$0.00 ","$7,216.00 ","$11,430.14 ","$11,545.60 ","$0.00 ","$2,258.61 ","$0.00 ","$2,297.57 ","$0.00 "
"80436771","EAP","HCPCS C1769","","Kit Trevo 4x20 Packaged With Synchro2 Std Custom Grady","BOTH IP/OP","$14,432.00 ","$10,679.68 ","$0.00 ","$14,432.00 ","$7,836.58 ","$0.00 ","$3,007.99 ","$5,158.80 ","$5,158.80 ","$2,526.93 ","$14,432.00 ","$0.00 ","$7,216.00 ","$11,430.14 ","$11,545.60 ","$0.00 ","$2,258.61 ","$0.00 ","$2,297.57 ","$0.00 "
"80436772","EAP","HCPCS C1769","","Kit Trevo 4x30 Packaged With Synchro2 Std Custom Grady","BOTH IP/OP","$14,432.00 ","$10,679.68 ","$0.00 ","$14,432.00 ","$7,836.58 ","$0.00 ","$3,007.99 ","$5,158.80 ","$5,158.80 ","$2,526.93 ","$14,432.00 ","$0.00 ","$7,216.00 ","$11,430.14 ","$11,545.60 ","$0.00 ","$2,258.61 ","$0.00 ","$2,297.57 ","$0.00 "
"80436773","EAP","HCPCS C1769","","Kit Trevo 6x25 Packaged With Synchro2 Std Custom Grady","BOTH IP/OP","$14,432.00 ","$10,679.68 ","$0.00 ","$14,432.00 ","$7,836.58 ","$0.00 ","$3,007.99 ","$5,158.80 ","$5,158.80 ","$2,526.93 ","$14,432.00 ","$0.00 ","$7,216.00 ","$11,430.14 ","$11,545.60 ","$0.00 ","$2,258.61 ","$0.00 ","$2,297.57 ","$0.00 "
"80436775","EAP","HCPCS C1884","","Kit Intvn Enroute Neuroprotection Transcarotid","BOTH IP/OP","$8,875.00 ","$6,567.50 ","$0.00 ","$8,875.00 ","$4,819.13 ","$0.00 ","$1,849.77 ","$5,158.80 ","$5,158.80 ","$1,553.94 ","$8,875.00 ","$0.00 ","$4,437.50 ","$7,029.00 ","$7,100.00 ","$0.00 ","$1,388.94 ","$0.00 ","$1,412.90 ","$0.00 "
"80436776","EAP","HCPCS C1894","","Kit Mctrdcr 21ga 7cm Ndl","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$2,375.63 ","$0.00 ","$911.86 ","$3,122.44 ","$3,122.44 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"80436777","EAP","HCPCS C1769","","Guidewire Vasc 5cm .014in 95cm 15cm Enroute Radopq Ptfe","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,289.63 ","$0.00 ","$495.01 ","$1,695.04 ","$1,695.04 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"80436779","EAP","HCPCS C1729","","Tray Cath 14fr 60in 350ml Ltx Bdx Lbr Adv Urmtr Drn Tube","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"80436780","EAP","HCPCS C1729","","Tray Cath 16fr 60in 350ml Strl Ltx Lbrcth Urmtr Drn Tube","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"80436781","EAP","HCPCS C1729","","Tray Cath 18fr 60in 350ml Ltx Bdx Lbr Adv Urmtr Drn Tube","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$0.00 ","$0.00 ","$0.00 ","$36.40 ","$36.40 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"80436783","EAP","HCPCS C1757","","Catheter Asp .074in 125cm Strl Lf Axs Vecta 74 Lum Disp","BOTH IP/OP","$7,375.00 ","$5,457.50 ","$0.00 ","$7,375.00 ","$4,004.63 ","$0.00 ","$1,537.13 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,375.00 ","$0.00 ","$3,687.50 ","$5,841.00 ","$5,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80436784","EAP","HCPCS C1757","","Catheter Asp .074in 132cm Strl Lf Axs Vecta 74 Lum Disp","BOTH IP/OP","$7,375.00 ","$5,457.50 ","$0.00 ","$7,375.00 ","$4,004.63 ","$0.00 ","$1,537.13 ","$5,158.80 ","$5,158.80 ","$0.00 ","$7,375.00 ","$0.00 ","$3,687.50 ","$5,841.00 ","$5,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80436791","EAP","HCPCS C1894","","Kit Intro .021in 80cm 6fr 21ga 25cm Strl 1.5in Glidesheath","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$85.64 ","$85.64 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"80436798","EAP","HCPCS C1894","","Sheath Intro 8.2mm 22fr 33cm Gore Dryseal Flx Hdrph","BOTH IP/OP","$1,585.00 ","$1,172.90 ","$0.00 ","$1,585.00 ","$860.66 ","$0.00 ","$330.35 ","$1,131.21 ","$1,131.21 ","$277.52 ","$1,585.00 ","$0.00 ","$792.50 ","$1,255.32 ","$1,268.00 ","$0.00 ","$248.05 ","$0.00 ","$252.33 ","$0.00 "
"80436802","EAP","HCPCS C1894","","Sheath Introducer Gore Dryseal Flex Hydro L33 Cm Od9.5 Mm Id26 Fr","BOTH IP/OP","$1,585.00 ","$1,172.90 ","$0.00 ","$1,585.00 ","$860.66 ","$0.00 ","$330.35 ","$1,131.21 ","$1,131.21 ","$277.52 ","$1,585.00 ","$0.00 ","$792.50 ","$1,255.32 ","$1,268.00 ","$0.00 ","$248.05 ","$0.00 ","$252.33 ","$0.00 "
"80436934","EAP","HCPCS C1876","","Stent Eprsth 14mm 90mm 100mm Vici Vns Stnt Cath Ntnl Acpt","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$3,746.93 ","$3,746.93 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80438566","EAP","HCPCS C1760","","Device Clsr 18fr Manta Vasc","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.31 ","$2,230.31 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"80438567","EAP","HCPCS C1760","","Device Clsr 14fr Manta Vasc","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$2,230.31 ","$2,230.31 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"80438594","EAP","HCPCS C1894","","Kit Intro .018in Mic 5fr 21ga 3fr 45cm Strl 15cm","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$135.75 ","$0.00 ","$52.11 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"80438603","EAP","Custom 80438603","","Sheath Gd Strg 6fr 119cm Strl Lf R2p Destination Slndr Disp","BOTH IP/OP","$754.00 ","$557.96 ","$0.00 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$538.13 ","$538.13 ","$0.00 ","$754.00 ","$0.00 ","$377.00 ","$597.17 ","$603.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80438604","EAP","HCPCS C1887","","Catheter Intvn 45d .014in Mic 2.1-2.5fr .017in .021in 150cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438605","EAP","HCPCS C1887","","Catheter Intvn 90d Mic 2.4fr .017in .018in 130cm 40cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438606","EAP","HCPCS C1887","","Catheter Intvn 90d .014in Mic 2.1-2.5fr .017in .021in 150cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438607","EAP","HCPCS C1887","","Catheter Intvn 120d Mic 2.4-3.2fr .017-.018in 130cm 80cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438608","EAP","HCPCS C1887","","Catheter Intvn 120d .014in Mic 2.1-2.5fr .017in .021in 150cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438609","EAP","HCPCS C1887","","Catheter Intvn 90d Mic 2.4fr .017in .018in 130cm 80cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438610","EAP","HCPCS C1887","","Catheter Intvn 45d .014in Mic 2.1-2.5fr .017in .021in 130cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438611","EAP","HCPCS C1887","","Catheter Intvn 120d Mic 3.2-2.4fr .018-.017in 150cm 80cm","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$863.58 ","$863.58 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"80438621","EAP","","","Bronchoscope Glidescope","BOTH IP/OP","$369.00 ","$273.06 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$26.41 ","$0.00 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80463074","EAP","HCPCS C1887","","Catheter Gd Mp1 Crv 6fr 100cm Strl Lf Lnchr Lg Lum Radopq","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$85.64 ","$85.64 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"80467372","EAP","HCPCS C1769","","Guidewire Vasc 220cm .007-.012in Distal Tip","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$0.00 ","$0.00 ","$0.00 ","$1,017.02 ","$1,017.02 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"80467373","EAP","HCPCS C1769","","Guidewire Vasc 220cm .007-.012in Distal Tip","BOTH IP/OP","$1,495.00 ","$1,106.30 ","$0.00 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$1,066.98 ","$1,066.98 ","$261.76 ","$1,495.00 ","$0.00 ","$747.50 ","$1,184.04 ","$1,196.00 ","$0.00 ","$233.97 ","$0.00 ","$238.00 ","$0.00 "
"80467374","EAP","HCPCS C1769","","Guidewire Vasc 220cm .008-.012in Hbrd Radiopq Str","BOTH IP/OP","$1,426.00 ","$1,055.24 ","$0.00 ","$1,425.00 ","$774.32 ","$0.00 ","$297.21 ","$1,017.02 ","$1,017.02 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"80467375","EAP","HCPCS C1769","","Guidewire Vasc 220cm .008-.012in Distal Tip","BOTH IP/OP","$1,495.00 ","$1,106.30 ","$0.00 ","$1,495.00 ","$811.79 ","$0.00 ","$311.60 ","$1,066.98 ","$1,066.98 ","$261.76 ","$1,495.00 ","$0.00 ","$747.50 ","$1,184.04 ","$1,196.00 ","$0.00 ","$233.97 ","$0.00 ","$238.00 ","$0.00 "
"80467376","EAP","HCPCS C1769","","Guidewire Vasc 200cm .012-.014in Hbrd Radiopq Str","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$562.01 ","$0.00 ","$215.72 ","$738.68 ","$738.68 ","$181.22 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$161.98 ","$0.00 ","$164.77 ","$0.00 "
"80467377","EAP","HCPCS C1769","","Guidewire Vasc 2 Ang .012-.014","BOTH IP/OP","$1,093.00 ","$808.82 ","$0.00 ","$1,093.00 ","$0.00 ","$0.00 ","$0.00 ","$780.07 ","$780.07 ","$191.38 ","$1,093.00 ","$0.00 ","$546.50 ","$865.66 ","$874.40 ","$0.00 ","$171.05 ","$0.00 ","$174.01 ","$0.00 "
"80467378","EAP","HCPCS C1769","","Guidewire Vasc 310cm .010in Radiopq Atrm Tip Str","BOTH IP/OP","$1,598.00 ","$1,182.52 ","$0.00 ","$1,598.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.49 ","$1,140.49 ","$279.80 ","$1,598.00 ","$0.00 ","$799.00 ","$1,265.62 ","$1,278.40 ","$0.00 ","$250.09 ","$0.00 ","$254.40 ","$0.00 "
"80467379","EAP","HCPCS C1769","","Guidewire Vasc 310cm .012in Radiopq Atrm Tip Str","BOTH IP/OP","$1,598.00 ","$1,182.52 ","$0.00 ","$1,598.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.49 ","$1,140.49 ","$279.80 ","$1,598.00 ","$0.00 ","$799.00 ","$1,265.62 ","$1,278.40 ","$0.00 ","$250.09 ","$0.00 ","$254.40 ","$0.00 "
"80467381","EAP","HCPCS C1894","","Introducer Sheath 088 80 Cm","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$597.30 ","$0.00 ","$0.00 ","$785.07 ","$785.07 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"80467382","EAP","HCPCS C1894","","Introducer Sheath 088 90 Cm","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$597.30 ","$0.00 ","$229.27 ","$785.07 ","$785.07 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"80467383","EAP","HCPCS C1894","","Introducer Sheath 088 100 Cm","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$785.07 ","$785.07 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"80467384","EAP","HCPCS C1769","","Guidewire Vasc 180cm .035in Std Tip Radiopq Strbl","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$175.00 ","$84.17 ","$0.00 ","$32.31 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"80467385","EAP","HCPCS C1769","","Guidewire Vasc 300cm .035in Std Tip Radiopq Strbl","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"80467387","EAP","HCPCS C1751","","Kit Cath 6fr 60cm Prln 2 Lum Basic Gwire Mini Scpl","BOTH IP/OP","$438.00 ","$324.12 ","$0.00 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$312.60 ","$76.69 ","$438.00 ","$0.00 ","$219.00 ","$346.90 ","$350.40 ","$0.00 ","$68.55 ","$0.00 ","$69.73 ","$0.00 "
"80467396","EAP","HCPCS C2628","","Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80467397","EAP","HCPCS C2628","","Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80467398","EAP","HCPCS C2628","","Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80467399","EAP","HCPCS C2628","","Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$3,203.09 ","$3,203.09 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80467400","EAP","HCPCS C2628","","Catheter Blnocc Thk.9mm 3cm 3mm 1.1in 6- Mm 2fr","BOTH IP/OP","$5,238.00 ","$3,876.12 ","$0.00 ","$5,238.00 ","$2,844.23 ","$0.00 ","$1,091.73 ","$3,738.36 ","$3,738.36 ","$0.00 ","$5,238.00 ","$0.00 ","$2,619.00 ","$4,148.50 ","$4,190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80469324","EAP","HCPCS C1895","","Lead Dfbr 64cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$4,639.05 ","$4,639.05 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"80469325","EAP","HCPCS C1777","","Lead Dfbr 64cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd 1 Coil","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$4,639.05 ","$4,639.05 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"80469326","EAP","HCPCS C1895","","Lead Dfbr 59cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd 2 Coil","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$4,639.05 ","$4,639.05 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"80472492","EAP","HCPCS C1887","","Catheter Dlv Sys 45d Mic .025in 135cm Lntrn Hflo","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$1,159.76 ","$1,159.76 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"80472499","EAP","","","Coil Embl Std .02in 3mm 20cm Penumbra Coil 400 Ruby Cmplx Lg","BOTH IP/OP","$2,475.00 ","$1,831.50 ","$0.00 ","$2,475.00 ","$0.00 ","$0.00 ","$0.00 ","$1,766.41 ","$1,766.41 ","$0.00 ","$2,475.00 ","$0.00 ","$1,237.50 ","$1,960.20 ","$1,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80472510","EAP","","","Coil Embl Std .02in 7mm 25cm Penumbra Coil 400 Ruby Cmplx Lg","BOTH IP/OP","$2,475.00 ","$1,831.50 ","$0.00 ","$2,475.00 ","$0.00 ","$0.00 ","$0.00 ","$1,766.41 ","$1,766.41 ","$0.00 ","$2,475.00 ","$0.00 ","$1,237.50 ","$1,960.20 ","$1,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80472512","EAP","","","COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG","BOTH IP/OP","$2,475.00 ","$1,831.50 ","$0.00 ","$2,475.00 ","$0.00 ","$0.00 ","$0.00 ","$1,766.41 ","$1,766.41 ","$0.00 ","$2,475.00 ","$0.00 ","$1,237.50 ","$1,960.20 ","$1,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80472530","EAP","","","Coil Embl .02in 2mm 4cm Penumbra Coil 400 Ruby Cmplx Lg","BOTH IP/OP","$1,975.00 ","$1,461.50 ","$0.00 ","$1,975.00 ","$0.00 ","$0.00 ","$0.00 ","$1,409.56 ","$1,409.56 ","$0.00 ","$1,975.00 ","$0.00 ","$987.50 ","$1,564.20 ","$1,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80472552","EAP","","","Coil Embl J-sft 30cm Strl Lf Pod Pk","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$0.00 ","$2,301.68 ","$2,301.68 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80472555","EAP","","","COIL EMBL J-SFT 60CM STRL LF POD PK","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$0.00 ","$2,301.68 ","$2,301.68 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80472556","EAP","","","Handle Inst Ruby Dtch Coil","BOTH IP/OP","$595.00 ","$440.30 ","$0.00 ","$595.00 ","$0.00 ","$0.00 ","$0.00 ","$424.65 ","$424.65 ","$0.00 ","$595.00 ","$0.00 ","$297.50 ","$471.24 ","$476.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80488974","EAP","HCPCS C1882","","Cobalt Hf Quad Crt-d Mri Surescan","BOTH IP/OP","$44,750.00 ","$33,115.00 ","$0.00 ","$44,750.00 ","$20,137.50 ","$0.00 ","$9,327.02 ","$5,158.80 ","$31,938.08 ","$7,835.37 ","$44,750.00 ","$0.00 ","$22,375.00 ","$35,442.00 ","$35,800.00 ","$0.00 ","$0.00 ","$0.00 ","$7,124.20 ","$0.00 "
"82000002","EAP","CPT� G0257","","Emergency Dialysis","BOTH IP/OP","$3,267.00 ","$2,417.58 ","$0.00 ","$2,388.00 ","$1,773.98 ","$641.42 ","$680.92 ","$0.00 ","$0.00 ","$418.12 ","$2,388.00 ","$641.91 ","$1,194.00 ","$1,891.30 ","$1,910.40 ","$891.85 ","$373.72 ","$0.00 ","$380.17 ","$611.34 "
"83100001","EAP","CPT� 90947","","Intpatient Dialysis Crrt","BOTH IP/OP","$3,267.00 ","$2,417.58 ","$0.00 ","$2,388.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,388.00 ","$0.00 ","$1,194.00 ","$1,891.30 ","$1,910.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83100005","EAP","CPT� 90945","","Peritoneal Dialysis Op","BOTH IP/OP","$1,724.00 ","$1,275.76 ","$0.00 ","$1,724.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,724.00 ","$0.00 ","$862.00 ","$1,365.41 ","$1,379.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90000011","EAP","CPT� 90882","","Brief Evaluation Management","BOTH IP/OP","$62.00 ","$45.88 ","$0.00 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$44.25 ","$44.25 ","$0.00 ","$62.00 ","$0.00 ","$31.00 ","$49.10 ","$49.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90000012","EAP","CPT� 90885","","Psych Eval Of Records","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$285.48 ","$285.48 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90000013","EAP","CPT� 90887","","Consultation With Family","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$171.29 ","$171.29 ","$0.00 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90000014","EAP","CPT� 90889","","Preparation Of Reports","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$171.29 ","$171.29 ","$0.00 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90000017","EAP","HCPCS H0004","","Group Outpatient Services","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$11.40 ","$2.97 ","$0.00 ","$0.00 ","$0.00 "
"90000020","EAP","HCPCS H0004","","Group Outpatient Services","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$85.00 ","$0.00 ","$3.38 ","$24.42 ","$60.66 ","$60.66 ","$14.88 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$51.00 ","$13.30 ","$0.00 ","$0.00 ","$0.00 "
"90000022","EAP","HCPCS H0004","","Group Outpatient Services","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$15.13 ","$24.42 ","$60.66 ","$60.66 ","$14.88 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$51.00 ","$13.30 ","$0.00 ","$0.00 ","$0.00 "
"90000023","EAP","HCPCS H0020","","Methadone Administration","BOTH IP/OP","$131.00 ","$96.94 ","$0.00 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$93.49 ","$93.49 ","$0.00 ","$131.00 ","$0.00 ","$65.50 ","$103.75 ","$104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90000024","EAP","HCPCS H0031","","Mh Assessment By A Non-physician","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$167.00 ","$0.00 ","$29.90 ","$27.68 ","$119.19 ","$119.19 ","$29.24 ","$167.00 ","$0.00 ","$83.50 ","$132.26 ","$133.60 ","$100.20 ","$26.14 ","$0.00 ","$0.00 ","$0.00 "
"90000026","EAP","HCPCS H0032","","Service Plan Development","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$15.13 ","$27.68 ","$60.66 ","$60.66 ","$14.88 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$51.00 ","$13.30 ","$0.00 ","$0.00 ","$0.00 "
"90000027","EAP","HCPCS H0038","","Peer Support","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$4.98 ","$1.80 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$16.80 ","$4.38 ","$0.00 ","$0.00 ","$0.00 "
"90000028","EAP","HCPCS H0039","","Assertive Community Treatment","BOTH IP/OP","$93.00 ","$68.82 ","$0.00 ","$93.00 ","$0.00 ","$16.55 ","$28.95 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$0.00 ","$46.50 ","$73.66 ","$74.40 ","$55.80 ","$14.55 ","$0.00 ","$0.00 ","$0.00 "
"90000030","EAP","HCPCS H2010","","Medication Administ Comp","BOTH IP/OP","$86.00 ","$63.64 ","$0.00 ","$85.00 ","$0.00 ","$15.31 ","$28.99 ","$60.66 ","$60.66 ","$14.88 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$51.00 ","$13.30 ","$0.00 ","$0.00 ","$0.00 "
"90000035","EAP","HCPCS H2014","","Group Skills Train/devl 15 Min","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$16.80 ","$0.00 ","$2.67 ","$16.80 ","$10.71 ","$10.71 ","$2.63 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$9.00 ","$2.35 ","$0.00 ","$0.00 ","$0.00 "
"90000045","EAP","HCPCS H2011","","Crisis Intervention","BOTH IP/OP","$137.00 ","$101.38 ","$0.00 ","$136.00 ","$0.00 ","$24.39 ","$28.15 ","$97.06 ","$97.06 ","$23.81 ","$136.00 ","$0.00 ","$68.00 ","$107.71 ","$108.80 ","$81.60 ","$21.28 ","$0.00 ","$0.00 ","$0.00 "
"90000048","EAP","HCPCS H2017","","Psychosocial Rehabilitation","BOTH IP/OP","$28.00 ","$20.72 ","$0.00 ","$28.00 ","$0.00 ","$4.98 ","$0.00 ","$19.98 ","$19.98 ","$4.90 ","$28.00 ","$0.00 ","$14.00 ","$22.18 ","$22.40 ","$16.80 ","$4.38 ","$0.00 ","$0.00 ","$0.00 "
"90000049","EAP","HCPCS H2014","","Grp/fam Skill Train W/pat15min","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$3.03 ","$16.80 ","$12.13 ","$12.13 ","$2.98 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$10.20 ","$2.66 ","$0.00 ","$0.00 ","$0.00 "
"90000051","EAP","HCPCS H2014","","Group Skills Training 15mins","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$3.03 ","$16.80 ","$12.13 ","$12.13 ","$2.98 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$10.20 ","$2.66 ","$0.00 ","$0.00 ","$0.00 "
"90000052","EAP","HCPCS H2014","","Family Training W/pat 15mins","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$12.82 ","$16.80 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$43.20 ","$11.27 ","$0.00 ","$0.00 ","$0.00 "
"90000053","EAP","HCPCS H2014","","Family Training W/o Pat 15mins","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$12.82 ","$16.80 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$43.20 ","$11.27 ","$0.00 ","$0.00 ","$0.00 "
"90000054","EAP","HCPCS T1001","","Nursing Assessment","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$98.00 ","$0.00 ","$17.62 ","$0.00 ","$69.94 ","$69.94 ","$17.16 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$58.80 ","$15.34 ","$0.00 ","$0.00 ","$0.00 "
"90000055","EAP","HCPCS T1001","","Nursing Assessment","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$69.94 ","$69.94 ","$17.16 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$58.80 ","$15.34 ","$0.00 ","$0.00 ","$0.00 "
"90000056","EAP","HCPCS T1002","","Rn Services 15mins","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$98.00 ","$0.00 ","$17.62 ","$0.00 ","$69.94 ","$69.94 ","$17.16 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$58.80 ","$15.34 ","$0.00 ","$0.00 ","$0.00 "
"90000057","EAP","HCPCS T1003","","Lpn Services 15mins","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$74.00 ","$0.00 ","$13.35 ","$0.00 ","$52.81 ","$52.81 ","$12.96 ","$74.00 ","$0.00 ","$37.00 ","$58.61 ","$59.20 ","$44.40 ","$11.58 ","$0.00 ","$0.00 ","$0.00 "
"90000058","EAP","HCPCS T2038","","Community Transitional Planning","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$69.00 ","$0.00 ","$12.46 ","$0.00 ","$49.25 ","$49.25 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$41.40 ","$10.80 ","$0.00 ","$0.00 ","$0.00 "
"90000060","EAP","HCPCS H0004","","Multi-group Family Couns 15min","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$13.56 ","$13.56 ","$3.33 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$11.40 ","$2.97 ","$0.00 ","$0.00 ","$0.00 "
"90000067","EAP","CPT� 90791","","Psych Dx Eval (no Med Service)","BOTH IP/OP","$576.00 ","$426.24 ","$91.06 ","$572.00 ","$312.77 ","$131.03 ","$120.05 ","$408.24 ","$408.24 ","$100.15 ","$572.00 ","$131.75 ","$286.00 ","$453.02 ","$457.60 ","$183.04 ","$143.47 ","$127.71 ","$91.06 ","$125.47 "
"90000068","EAP","CPT� 90792","","Psych Dx Eval (with Med Service)","BOTH IP/OP","$576.00 ","$426.24 ","$91.06 ","$572.00 ","$312.77 ","$131.03 ","$120.05 ","$408.24 ","$408.24 ","$100.15 ","$572.00 ","$131.75 ","$286.00 ","$453.02 ","$457.60 ","$183.04 ","$117.89 ","$142.86 ","$91.06 ","$125.47 "
"90000069","EAP","CPT� 90785","","Interactive Complexity","BOTH IP/OP","$321.00 ","$237.54 ","$0.00 ","$319.00 ","$174.30 ","$0.00 ","$66.90 ","$227.67 ","$227.67 ","$55.85 ","$319.00 ","$0.00 ","$159.50 ","$252.65 ","$255.20 ","$0.00 ","$49.92 ","$14.07 ","$50.78 ","$0.00 "
"90000070","EAP","HCPCS T1016","","Case Management","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$8.01 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000071","EAP","HCPCS T1016","","Case Management - Practitioner Level 5,","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$8.01 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000072","EAP","HCPCS T1016","","Case Management - Practitioner Level 4,","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$8.01 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000073","EAP","HCPCS T1016","","Case Management - Practitioner Level 5,","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$8.01 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000074","EAP","HCPCS T1016","","CASE MANAGEMENT-PRACTITIONER LEVEL 4, COLLATERAL CONTACT","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$8.01 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000075","EAP","HCPCS T1016","","Case Management-practitioner Level 5, Collateral Contact","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000076","EAP","HCPCS T1016","","CASE MANAGEMENT-PRACTITIONER LEVEL 4,COLLATERAL CONTACT","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$8.01 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000077","EAP","HCPCS T1016","","CASE MANAGEMENT-PREACTITIONER LEVEL 5,OUT-COLLATERAL","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$32.12 ","$32.12 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$27.00 ","$7.04 ","$0.00 ","$0.00 ","$0.00 "
"90000078","EAP","HCPCS H0025","","Peer Support Whole Health & Wellness","BOTH IP/OP","$34.00 ","$25.16 ","$0.00 ","$34.00 ","$0.00 ","$6.05 ","$0.00 ","$24.27 ","$24.27 ","$5.95 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$20.40 ","$5.32 ","$0.00 ","$0.00 ","$0.00 "
"90000080","EAP","CPT� G0447","","Behavior Counsel Obesity 15m","BOTH IP/OP","$101.00 ","$74.74 ","$15.65 ","$100.00 ","$54.84 ","$73.28 ","$21.05 ","$71.37 ","$71.37 ","$17.51 ","$100.00 ","$78.77 ","$50.00 ","$79.20 ","$80.00 ","$100.00 ","$15.65 ","$24.16 ","$15.92 ","$75.02 "
"90000081","EAP","HCPCS G0444","","Annual Depression Screening, 15 Minutes","BOTH IP/OP","$71.00 ","$52.54 ","$9.74 ","$70.00 ","$38.55 ","$25.74 ","$14.80 ","$49.96 ","$49.96 ","$12.26 ","$70.00 ","$27.40 ","$35.00 ","$55.44 ","$56.00 ","$38.07 ","$10.96 ","$9.74 ","$11.14 ","$26.10 "
"91400004","EAP","CPT� 90832","","Individual Psychotherapy 30 Mins","BOTH IP/OP","$541.00 ","$400.34 ","$59.54 ","$537.00 ","$293.76 ","$131.03 ","$112.76 ","$383.26 ","$383.26 ","$94.02 ","$537.00 ","$131.75 ","$268.50 ","$425.30 ","$429.60 ","$183.04 ","$59.54 ","$63.85 ","$85.49 ","$125.47 "
"91400006","EAP","CPT� 90837","","Individual Psychotherapy 60 Min","BOTH IP/OP","$658.00 ","$486.92 ","$103.96 ","$653.00 ","$357.29 ","$131.03 ","$137.14 ","$466.05 ","$466.05 ","$114.34 ","$653.00 ","$131.75 ","$326.50 ","$517.18 ","$522.40 ","$183.04 ","$124.37 ","$127.35 ","$103.96 ","$125.47 "
"91400024","EAP","CPT� 90834","","Individual Psychotherapy 45 Min","BOTH IP/OP","$541.00 ","$400.34 ","$84.04 ","$537.00 ","$293.76 ","$131.03 ","$112.76 ","$383.26 ","$383.26 ","$94.02 ","$537.00 ","$131.75 ","$268.50 ","$425.30 ","$429.60 ","$183.04 ","$84.04 ","$85.14 ","$85.49 ","$125.47 "
"91400061","EAP","CPT� 90833","","Psychotherapy W/pat W/e&m Srvcs 30 Min (add-on)","BOTH IP/OP","$382.00 ","$282.68 ","$0.00 ","$379.00 ","$0.00 ","$0.00 ","$69.65 ","$270.49 ","$270.49 ","$66.36 ","$379.00 ","$0.00 ","$189.50 ","$300.17 ","$303.20 ","$0.00 ","$39.40 ","$66.38 ","$0.00 ","$0.00 "
"91400062","EAP","CPT� 90836","","INDIVIDUAL COUNSELING 45 MIN ADD ON","BOTH IP/OP","$541.00 ","$400.34 ","$0.00 ","$537.00 ","$293.76 ","$0.00 ","$112.76 ","$383.26 ","$383.26 ","$94.02 ","$537.00 ","$0.00 ","$268.50 ","$425.30 ","$429.60 ","$0.00 ","$84.04 ","$84.05 ","$85.49 ","$0.00 "
"91400063","EAP","CPT� 90838","","Psychotherapy, 60min W/pat And Or Fam W  E/m(add-on)","BOTH IP/OP","$658.00 ","$486.92 ","$0.00 ","$653.00 ","$0.00 ","$0.00 ","$0.00 ","$466.05 ","$466.05 ","$114.34 ","$653.00 ","$0.00 ","$326.50 ","$517.18 ","$522.40 ","$0.00 ","$102.19 ","$110.39 ","$103.96 ","$0.00 "
"91400071","EAP","CPT� 90839","","Psychotherapy For Crisis First 60 Minutes","BOTH IP/OP","$682.00 ","$504.68 ","$0.00 ","$677.00 ","$0.00 ","$0.00 ","$142.15 ","$483.17 ","$483.17 ","$118.54 ","$677.00 ","$131.75 ","$338.50 ","$536.18 ","$541.60 ","$183.04 ","$105.95 ","$133.12 ","$107.78 ","$125.47 "
"91400072","EAP","CPT� 90840","","PSYCHOTHERAPY ADDITIONAL 30  MINUTES","BOTH IP/OP","$218.00 ","$161.32 ","$0.00 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$154.16 ","$154.16 ","$0.00 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91500001","EAP","CPT� 90853","","Psy Group Therapy","BOTH IP/OP","$247.00 ","$182.78 ","$25.25 ","$247.00 ","$134.12 ","$73.28 ","$51.48 ","$176.28 ","$176.28 ","$43.25 ","$247.00 ","$78.77 ","$123.50 ","$195.62 ","$197.60 ","$109.44 ","$34.39 ","$25.25 ","$39.32 ","$75.02 "
"91500006","EAP","HCPCS H2014","","Group Skills Training 15mins","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$17.00 ","$0.00 ","$3.03 ","$16.80 ","$12.13 ","$12.13 ","$2.98 ","$17.00 ","$0.00 ","$8.50 ","$13.46 ","$13.60 ","$10.20 ","$2.66 ","$0.00 ","$0.00 ","$0.00 "
"91600001","EAP","CPT� 90846","","Family Psychotherapy W/o Patient Present 50 Min","BOTH IP/OP","$1,054.00 ","$779.96 ","$102.82 ","$1,046.00 ","$572.32 ","$131.03 ","$219.68 ","$746.53 ","$746.53 ","$183.15 ","$1,046.00 ","$131.75 ","$523.00 ","$828.43 ","$836.80 ","$183.04 ","$163.70 ","$102.82 ","$166.52 ","$125.47 "
"91600009","EAP","CPT� 90847","","Psy Family Therapy W Pt","BOTH IP/OP","$1,054.00 ","$779.96 ","$105.59 ","$1,046.00 ","$572.32 ","$131.03 ","$219.68 ","$746.53 ","$746.53 ","$183.15 ","$1,046.00 ","$131.75 ","$523.00 ","$828.43 ","$836.80 ","$183.04 ","$105.59 ","$106.79 ","$166.52 ","$125.47 "
"91600010","EAP","CPT� 90849","","Multiple Family Group Therapy","BOTH IP/OP","$258.00 ","$190.92 ","$0.00 ","$258.00 ","$0.00 ","$0.00 ","$0.00 ","$184.13 ","$184.13 ","$0.00 ","$258.00 ","$0.00 ","$129.00 ","$204.34 ","$206.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91600012","EAP","HCPCS H2014","","Group Outpatient Services","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$12.82 ","$16.80 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$43.20 ","$11.27 ","$0.00 ","$0.00 ","$0.00 "
"91600013","EAP","HCPCS H2014","","Group Outpatient Services","BOTH IP/OP","$72.00 ","$53.28 ","$0.00 ","$72.00 ","$0.00 ","$12.82 ","$16.80 ","$51.39 ","$51.39 ","$12.61 ","$72.00 ","$0.00 ","$36.00 ","$57.02 ","$57.60 ","$43.20 ","$11.27 ","$0.00 ","$0.00 ","$0.00 "
"91800005","EAP","CPT� 96110","","NICU/PED/DEVELOP.TESTING,LIMI","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$0.00 ","$10.07 ","$0.00 ","$137.03 ","$137.03 ","$0.00 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800013","EAP","CPT� 96125","","Cognitive Testing","BOTH IP/OP","$702.00 ","$519.48 ","$0.00 ","$702.00 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$702.00 ","$0.00 ","$351.00 ","$555.98 ","$561.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800017","EAP","CPT� 96125","","Cognitive Testing_52","BOTH IP/OP","$353.00 ","$261.22 ","$0.00 ","$427.63 ","$0.00 ","$0.00 ","$0.00 ","$427.63 ","$427.63 ","$0.00 ","$353.00 ","$0.00 ","$176.50 ","$279.58 ","$282.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800019","EAP","CPT� 96130","","Psychological Tst Eval Svc Phys/qhp First Hour","BOTH IP/OP","$568.00 ","$420.32 ","$0.00 ","$564.00 ","$0.00 ","$0.00 ","$0.00 ","$402.53 ","$402.53 ","$98.75 ","$564.00 ","$138.76 ","$282.00 ","$446.69 ","$451.20 ","$192.78 ","$112.86 ","$111.11 ","$89.79 ","$132.15 "
"91800020","EAP","CPT� 96131","","Psychological Tst Eval Svc Phys/qhp Ea Addl Hour","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800021","EAP","CPT� 96112","","Developmental Tst Admin Phys/qhp 1st Hour","BOTH IP/OP","$699.00 ","$517.26 ","$0.00 ","$699.00 ","$0.00 ","$0.00 ","$0.00 ","$498.88 ","$498.88 ","$0.00 ","$699.00 ","$0.00 ","$349.50 ","$553.61 ","$559.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800022","EAP","CPT� 96113","","Developmental Tst Admin Phys/qhp Ea Addl 30 Min","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800023","EAP","CPT� 96116","","Neurobehavioral Status Xm Phys/qhp 1st Hour","BOTH IP/OP","$609.00 ","$450.66 ","$86.57 ","$605.00 ","$330.69 ","$255.04 ","$126.93 ","$431.79 ","$431.79 ","$105.93 ","$605.00 ","$239.36 ","$302.50 ","$479.16 ","$484.00 ","$332.56 ","$101.28 ","$86.57 ","$96.32 ","$227.96 "
"91800024","EAP","CPT� 96121","","Neurobehavioral Status Xm Phys/qhp Ea Addl Hour","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800025","EAP","CPT� 96132","","Neuropsychol Tst Eval Phys/qhp 1st Hour","BOTH IP/OP","$329.00 ","$243.46 ","$52.06 ","$327.00 ","$178.65 ","$255.04 ","$68.57 ","$233.38 ","$233.38 ","$57.26 ","$327.00 ","$138.76 ","$163.50 ","$258.98 ","$261.60 ","$192.78 ","$126.78 ","$109.67 ","$52.06 ","$132.15 "
"91800026","EAP","CPT� 96133","","Neuropsychol Tst Eval Physl/qph Ea Addl Hr","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$164.00 ","$89.60 ","$0.00 ","$34.39 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$0.00 ","$82.00 ","$129.89 ","$131.20 ","$0.00 ","$79.70 ","$84.42 ","$26.11 ","$0.00 "
"91800027","EAP","CPT� 96138","","Psycl/nrpsycl Tst Tech 2+ Tst 1st 30 Min","BOTH IP/OP","$41.00 ","$30.34 ","$6.53 ","$41.00 ","$22.26 ","$41.00 ","$8.55 ","$29.26 ","$29.26 ","$7.18 ","$41.00 ","$23.06 ","$20.50 ","$32.47 ","$32.80 ","$32.04 ","$36.79 ","$38.54 ","$6.53 ","$21.96 "
"91800028","EAP","CPT� 96139","","Psycl/nrpsyc Tst Tech 2+ Tst Ea Addl 30 Min","BOTH IP/OP","$20.00 ","$14.80 ","$0.00 ","$38.54 ","$10.86 ","$0.00 ","$4.17 ","$14.27 ","$14.27 ","$3.50 ","$20.00 ","$0.00 ","$10.00 ","$15.84 ","$16.00 ","$0.00 ","$36.79 ","$38.54 ","$3.18 ","$0.00 "
"91800029","EAP","CPT� 96136","","Psycl/nrpsycl Tst Phy/qhp Tst 1st 30 Min","BOTH IP/OP","$55.00 ","$40.70 ","$8.76 ","$55.00 ","$29.87 ","$55.00 ","$11.46 ","$39.25 ","$39.25 ","$9.63 ","$55.00 ","$23.06 ","$27.50 ","$43.56 ","$44.00 ","$32.04 ","$45.41 ","$25.25 ","$8.76 ","$21.96 "
"91800030","EAP","CPT� 96137","","Psycl/nrpsycl Tst Phy/qhp Tst Addl 30 Min","BOTH IP/OP","$21.00 ","$15.54 ","$0.00 ","$41.97 ","$11.40 ","$0.00 ","$4.38 ","$14.99 ","$14.99 ","$3.68 ","$21.00 ","$0.00 ","$10.50 ","$16.63 ","$16.80 ","$0.00 ","$41.97 ","$19.84 ","$3.34 ","$0.00 "
"91800031","EAP","CPT� 96156","","Health Behavior Assessment/re-assessment","BOTH IP/OP","$189.00 ","$139.86 ","$29.93 ","$188.00 ","$102.63 ","$73.28 ","$39.39 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$78.77 ","$94.00 ","$148.90 ","$150.40 ","$109.44 ","$94.62 ","$90.55 ","$29.93 ","$75.02 "
"91800032","EAP","CPT� 96158","","Health Behavior Ivntj Indiv F2f 1st 30 Min","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$134.18 ","$134.18 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800033","EAP","CPT� 96159","","Health Behavior Ivntj Indiv F2f Ea Addl 15 Min","BOTH IP/OP","$94.00 ","$69.56 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$67.09 ","$67.09 ","$0.00 ","$94.00 ","$0.00 ","$47.00 ","$74.45 ","$75.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800034","EAP","CPT� 96164","","Health Behavior Ivntj Group F2f 1st 30 Min","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$0.00 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800035","EAP","CPT� 96165","","Health Behavior Ivntj Group F2f Ea Addl 15 Min","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$0.00 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800036","EAP","CPT� 96167","","Health Behavior Invtj Fam W/pt F2f 1st 30 Min","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$0.00 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91800037","EAP","CPT� 96168","","Health Behavior Ivntj Fam W/pt F2f Ea Add 15 Min","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$0.00 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000001","EAP","CPT� 51725","","Cystometrogram, Simple","BOTH IP/OP","$1,683.00 ","$1,245.42 ","$0.00 ","$1,682.00 ","$0.00 ","$0.00 ","$0.00 ","$1,208.73 ","$1,208.73 ","$294.50 ","$1,682.00 ","$235.59 ","$1,682.00 ","$1,332.14 ","$1,345.60 ","$327.32 ","$92.84 ","$139.03 ","$267.77 ","$224.37 "
"92000002","EAP","CPT� 51726","","Cystometrogram, Complex","BOTH IP/OP","$1,649.00 ","$1,220.26 ","$0.00 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,648.00 ","$0.00 ","$1,648.00 ","$1,305.22 ","$1,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000003","EAP","CPT� 51736","","Uroflowmetry Simple","BOTH IP/OP","$293.00 ","$216.82 ","$0.00 ","$293.00 ","$0.00 ","$0.00 ","$0.00 ","$209.11 ","$209.11 ","$0.00 ","$293.00 ","$0.00 ","$293.00 ","$232.06 ","$234.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000004","EAP","CPT� 51741","","Uroflowmetry, Complex","BOTH IP/OP","$277.00 ","$204.98 ","$5.76 ","$280.00 ","$150.41 ","$136.73 ","$57.73 ","$199.84 ","$199.84 ","$49.03 ","$280.00 ","$138.76 ","$280.00 ","$221.76 ","$224.00 ","$192.78 ","$64.97 ","$5.76 ","$44.58 ","$132.15 "
"92000007","EAP","CPT� 51797","","Intra-abdominal Pressure Test","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$465.00 ","$460.00 ","$0.00 ","$95.88 ","$331.87 ","$331.87 ","$81.42 ","$465.00 ","$0.00 ","$465.00 ","$368.28 ","$372.00 ","$0.00 ","$97.70 ","$124.26 ","$74.03 ","$0.00 "
"92000009","EAP","CPT� 59020","","Fetal Contraction Stress Test","BOTH IP/OP","$2,603.00 ","$1,926.22 ","$0.00 ","$2,629.00 ","$1,413.43 ","$166.84 ","$0.00 ","$1,876.32 ","$1,876.32 ","$0.00 ","$2,629.00 ","$0.00 ","$2,255.00 ","$2,082.17 ","$2,103.20 ","$0.00 ","$65.30 ","$0.00 ","$0.00 ","$0.00 "
"92000010","EAP","CPT� 59025","","Fetal Non Stress Test","BOTH IP/OP","$427.00 ","$315.98 ","$19.09 ","$431.00 ","$231.86 ","$166.84 ","$89.00 ","$307.60 ","$307.60 ","$75.46 ","$431.00 ","$166.54 ","$431.00 ","$341.35 ","$344.80 ","$231.38 ","$40.51 ","$19.09 ","$68.62 ","$158.61 "
"92000011","EAP","CPT� 92081","","Vision Screen","BOTH IP/OP","$267.00 ","$197.58 ","$17.65 ","$269.00 ","$144.98 ","$54.51 ","$55.65 ","$191.99 ","$191.99 ","$47.10 ","$269.00 ","$55.17 ","$134.50 ","$213.05 ","$215.20 ","$76.65 ","$46.21 ","$17.65 ","$42.82 ","$52.54 "
"92000012","EAP","CPT� 92081","","Vision Test, Routine","BOTH IP/OP","$269.00 ","$199.06 ","$0.00 ","$269.00 ","$0.00 ","$0.00 ","$0.00 ","$191.99 ","$191.99 ","$47.10 ","$269.00 ","$55.17 ","$134.50 ","$213.05 ","$215.20 ","$76.65 ","$46.21 ","$17.65 ","$42.82 ","$52.54 "
"92000013","EAP","CPT� 92081","","Visual Exam Limited-lt","BOTH IP/OP","$269.00 ","$199.06 ","$17.65 ","$269.00 ","$146.07 ","$54.51 ","$56.07 ","$191.99 ","$191.99 ","$47.10 ","$269.00 ","$55.17 ","$134.50 ","$213.05 ","$215.20 ","$76.65 ","$46.21 ","$17.65 ","$42.82 ","$52.54 "
"92000014","EAP","CPT� 92081","","Visual Field Exam Unilat/bilat","BOTH IP/OP","$529.00 ","$391.46 ","$17.65 ","$534.00 ","$287.25 ","$54.51 ","$110.26 ","$381.12 ","$381.12 ","$93.50 ","$534.00 ","$55.17 ","$267.00 ","$422.93 ","$427.20 ","$76.65 ","$46.21 ","$17.65 ","$85.01 ","$52.54 "
"92000016","EAP","CPT� 92081","","Visual Field Exam Limited-lt","BOTH IP/OP","$269.00 ","$199.06 ","$17.65 ","$269.00 ","$146.07 ","$54.51 ","$56.07 ","$191.99 ","$191.99 ","$47.10 ","$269.00 ","$55.17 ","$134.50 ","$213.05 ","$215.20 ","$76.65 ","$46.21 ","$17.65 ","$42.82 ","$52.54 "
"92000017","EAP","CPT� 92081","","Visual Field Exam Limited-rt","BOTH IP/OP","$269.00 ","$199.06 ","$17.65 ","$269.00 ","$146.07 ","$54.51 ","$56.07 ","$191.99 ","$191.99 ","$47.10 ","$269.00 ","$55.17 ","$134.50 ","$213.05 ","$215.20 ","$76.65 ","$46.21 ","$17.65 ","$42.82 ","$52.54 "
"92000020","EAP","CPT� 92082","","Visual Field Exam Uni/bil Intermed","BOTH IP/OP","$570.00 ","$421.80 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$410.38 ","$410.38 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000028","EAP","CPT� 92083","","Visual Field Exam Uni/bil Extended","BOTH IP/OP","$578.00 ","$427.72 ","$36.02 ","$583.00 ","$313.85 ","$110.43 ","$120.47 ","$416.09 ","$416.09 ","$102.08 ","$583.00 ","$109.35 ","$291.50 ","$461.74 ","$466.40 ","$151.93 ","$56.79 ","$36.02 ","$92.81 ","$104.14 "
"92000032","EAP","CPT� 92235","","Flourescein Angioscopy W Photo","BOTH IP/OP","$959.00 ","$709.66 ","$61.59 ","$960.00 ","$520.74 ","$259.18 ","$199.88 ","$685.15 ","$685.15 ","$168.09 ","$960.00 ","$253.05 ","$480.00 ","$760.32 ","$768.00 ","$351.58 ","$100.45 ","$61.59 ","$152.83 ","$241.00 "
"92000033","EAP","CPT� 92235","","Flourescein Photo W Photo Both","BOTH IP/OP","$960.00 ","$710.40 ","$61.59 ","$960.00 ","$521.28 ","$259.18 ","$200.09 ","$685.15 ","$685.15 ","$168.09 ","$960.00 ","$253.05 ","$480.00 ","$760.32 ","$768.00 ","$351.58 ","$100.45 ","$61.59 ","$152.83 ","$241.00 "
"92000035","EAP","CPT� 92250","","Ophthalmoscopy W/ Fundus Photo","BOTH IP/OP","$407.00 ","$301.18 ","$23.77 ","$408.00 ","$221.00 ","$110.43 ","$84.83 ","$291.19 ","$291.19 ","$71.44 ","$408.00 ","$109.35 ","$204.00 ","$323.14 ","$326.40 ","$151.93 ","$59.03 ","$23.77 ","$64.95 ","$104.14 "
"92000036","EAP","CPT� 92285","","Slit Lamp Photography","BOTH IP/OP","$159.00 ","$117.66 ","$0.00 ","$161.00 ","$86.34 ","$54.51 ","$33.14 ","$114.91 ","$114.91 ","$0.00 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000037","EAP","CPT� 95810","","Polysomnography","BOTH IP/OP","$5,967.00 ","$4,415.58 ","$495.59 ","$6,027.00 ","$1,604.30 ","$900.99 ","$1,243.67 ","$3,242.91 ","$3,242.91 ","$1,055.28 ","$6,027.00 ","$911.62 ","$3,013.50 ","$4,773.38 ","$4,821.60 ","$1,266.58 ","$594.31 ","$495.59 ","$959.50 ","$868.21 "
"92000038","EAP","CPT� 95811","","Polysomnography W/cpap","BOTH IP/OP","$7,160.00 ","$5,298.40 ","$518.64 ","$7,232.00 ","$1,685.49 ","$900.99 ","$1,492.32 ","$2,779.64 ","$2,779.64 ","$1,266.27 ","$7,232.00 ","$911.62 ","$3,616.00 ","$5,727.74 ","$5,785.60 ","$1,266.58 ","$618.03 ","$518.64 ","$1,151.33 ","$868.21 "
"92000039","EAP","CPT� 95857","","Tensilon Test","BOTH IP/OP","$257.00 ","$190.18 ","$0.00 ","$257.00 ","$0.00 ","$0.00 ","$0.00 ","$183.42 ","$183.42 ","$0.00 ","$257.00 ","$0.00 ","$128.50 ","$203.54 ","$205.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000041","EAP","CPT� 95970","","Analyze Neurostim No Prog","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$262.64 ","$262.64 ","$0.00 ","$368.00 ","$0.00 ","$184.00 ","$291.46 ","$294.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000050","EAP","CPT� 95972","","Complex Programming, Up To 1 Hr","BOTH IP/OP","$443.00 ","$327.82 ","$0.00 ","$472.00 ","$0.00 ","$0.00 ","$0.00 ","$336.87 ","$336.87 ","$0.00 ","$472.00 ","$0.00 ","$236.00 ","$373.82 ","$377.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000054","EAP","CPT� 51728","","Cystometrogram W/vp","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$790.00 ","$790.00 ","$563.41 ","$164.66 ","$563.82 ","$563.82 ","$0.00 ","$790.00 ","$0.00 ","$790.00 ","$625.68 ","$632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000055","EAP","CPT� 95873","","Guide Nerv Destr Elec Stim","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$165.00 ","$91.22 ","$0.00 ","$35.02 ","$117.76 ","$117.76 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$27.56 ","$57.63 ","$26.27 ","$0.00 "
"92000056","EAP","CPT� 95874","","Guide Nerv Destr Needle Emg","BOTH IP/OP","$197.00 ","$145.78 ","$0.00 ","$194.00 ","$106.97 ","$0.00 ","$41.06 ","$138.46 ","$138.46 ","$33.97 ","$194.00 ","$0.00 ","$97.00 ","$153.65 ","$155.20 ","$0.00 ","$27.93 ","$60.15 ","$30.88 ","$0.00 "
"92000057","EAP","CPT� 95971","","Analyze Neurostim Simple","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$285.48 ","$285.48 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000058","EAP","CPT� 91200","","Liver Elastography","BOTH IP/OP","$305.00 ","$225.70 ","$23.41 ","$303.00 ","$165.62 ","$136.73 ","$63.57 ","$216.25 ","$216.25 ","$53.05 ","$303.00 ","$138.76 ","$151.50 ","$239.98 ","$242.40 ","$192.78 ","$34.27 ","$23.41 ","$48.24 ","$132.15 "
"92000059","EAP","CPT� 92132","","Cmptr Ophthalmic Dx Img Ant Segmt W/i&r Uni/bi","BOTH IP/OP","$210.00 ","$155.40 ","$15.13 ","$210.00 ","$114.03 ","$54.51 ","$43.77 ","$149.88 ","$149.88 ","$36.77 ","$210.00 ","$55.17 ","$105.00 ","$166.32 ","$168.00 ","$76.65 ","$34.49 ","$15.13 ","$33.43 ","$52.54 "
"92000060","EAP","CPT� 92240","","Icg Angiography - One Eye","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$0.00 ","$0.00 ","$0.00 ","$670.88 ","$670.88 ","$0.00 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000061","EAP","CPT� 92240","","Icg Angiography - Both Eyes","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$1,006.32 ","$1,006.32 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000062","EAP","CPT� 92060","","Sensormotor Xm W/mlt Meas Ocular Devij W/i&r Spx","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$142.74 ","$142.74 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000065","EAP","CPT� 92283","","Color Vision Examination","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$200.00 ","$107.51 ","$54.51 ","$41.27 ","$142.74 ","$142.74 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000066","EAP","CPT� 95976","","Elec Alys Implt Smpl Cn Npgt Prgrmg","BOTH IP/OP","$554.00 ","$409.96 ","$0.00 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$421.08 ","$421.08 ","$0.00 ","$590.00 ","$0.00 ","$295.00 ","$467.28 ","$472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000067","EAP","CPT� 95977","","Elec Alys Implt Cplx Cn Npgt Prgrmg","BOTH IP/OP","$554.00 ","$409.96 ","$0.00 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$421.08 ","$421.08 ","$0.00 ","$590.00 ","$0.00 ","$295.00 ","$467.28 ","$472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000068","EAP","CPT� 0509T","","Electroretinography (erg) W/i&r Pattern (perg)","BOTH IP/OP","$327.00 ","$241.98 ","$0.00 ","$327.00 ","$0.00 ","$0.00 ","$0.00 ","$233.38 ","$233.38 ","$0.00 ","$327.00 ","$0.00 ","$163.50 ","$258.98 ","$261.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000069","EAP","CPT� 92273","","Electroretinography (erg), W/i&r; Full Field","BOTH IP/OP","$606.00 ","$448.44 ","$0.00 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$432.50 ","$432.50 ","$0.00 ","$606.00 ","$0.00 ","$606.00 ","$479.95 ","$484.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000070","EAP","CPT� 92274","","Electroretinography (erg), W/i&r; Multifocal (mferg)","BOTH IP/OP","$327.00 ","$241.98 ","$0.00 ","$327.00 ","$0.00 ","$0.00 ","$0.00 ","$233.38 ","$233.38 ","$0.00 ","$327.00 ","$0.00 ","$163.50 ","$258.98 ","$261.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000071","EAP","CPT� 95249","","Cont Gluc Mntr Pt Prov Eqp","BOTH IP/OP","$155.00 ","$114.70 ","$0.00 ","$155.00 ","$0.00 ","$0.00 ","$0.00 ","$110.62 ","$110.62 ","$0.00 ","$155.00 ","$0.00 ","$155.00 ","$122.76 ","$124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000072","EAP","CPT� 95250","","Cont Gluc Mntr Phys/qhp Prov Eqp","BOTH IP/OP","$302.00 ","$223.48 ","$0.00 ","$300.00 ","$163.99 ","$116.36 ","$62.94 ","$214.11 ","$214.11 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000073","EAP","HCPCS G0399","","HOME SLEEP STUDY","BOTH IP/OP","$772.00 ","$571.28 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$556.69 ","$556.69 ","$0.00 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000074","EAP","CPT� 92201","","Ophthalmoscopy Ext Retinal Drawing Uni Or Bil","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$124.90 ","$124.90 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000075","EAP","CPT� 92202","","Ophthalmoscopy Ext Optic Nerve Drawing Uni Or Bil","BOTH IP/OP","$175.00 ","$129.50 ","$15.15 ","$175.00 ","$95.03 ","$54.51 ","$36.47 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$55.17 ","$87.50 ","$138.60 ","$140.00 ","$76.65 ","$15.37 ","$15.15 ","$27.86 ","$52.54 "
"92000080","EAP","CPT� 95800","","Slp Stdy Unattended W/hrt Rate/o2 Sat/resp/slp Time","BOTH IP/OP","$772.00 ","$571.28 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$556.69 ","$556.69 ","$0.00 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000081","EAP","CPT� 95801","","Slp Stdy Unatnd W/min Hrt Rate/o2 Sat/resp Analysis","BOTH IP/OP","$644.00 ","$476.56 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$463.91 ","$463.91 ","$0.00 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92000085","EAP","CPT� 99453","","Rem Mntr Physiol Param 1st Set Up Pt Educaj Eqp","BOTH IP/OP","$277.00 ","$204.98 ","$0.00 ","$277.00 ","$0.00 ","$0.00 ","$0.00 ","$197.69 ","$197.69 ","$48.50 ","$277.00 ","$116.27 ","$138.50 ","$219.38 ","$221.60 ","$161.54 ","$43.35 ","$18.73 ","$44.10 ","$110.73 "
"92000086","EAP","CPT� 99454","","Rem Mntr Physiol Param 1st Dev Supply Ea 30 D","BOTH IP/OP","$87.00 ","$64.38 ","$0.00 ","$87.00 ","$0.00 ","$0.00 ","$0.00 ","$62.09 ","$62.09 ","$15.23 ","$87.00 ","$36.36 ","$43.50 ","$68.90 ","$69.60 ","$50.51 ","$13.62 ","$62.31 ","$13.85 ","$34.63 "
"92100001","EAP","CPT� 93279","","Single Lead Pacemaker Program / Eval In Person","BOTH IP/OP","$204.00 ","$150.96 ","$26.11 ","$164.00 ","$111.12 ","$36.47 ","$42.52 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$36.36 ","$82.00 ","$129.89 ","$131.20 ","$50.51 ","$53.20 ","$28.81 ","$26.11 ","$34.63 "
"92100002","EAP","CPT� 93280","","Dual Lead Pacemaker Program / Eval In Person","BOTH IP/OP","$204.00 ","$150.96 ","$26.11 ","$164.00 ","$129.12 ","$36.47 ","$42.52 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$36.36 ","$82.00 ","$129.89 ","$131.20 ","$50.51 ","$62.94 ","$33.50 ","$26.11 ","$34.63 "
"92100003","EAP","CPT� 93288","","Pacemaker Sngl/dual/multi Interrog / Eval In Person","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$164.00 ","$82.95 ","$36.47 ","$42.52 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$0.00 ","$82.00 ","$129.89 ","$131.20 ","$0.00 ","$41.18 ","$0.00 ","$0.00 ","$0.00 "
"92100005","EAP","CPT� 93880","","US DUPLEX CA","BOTH IP/OP","$3,057.00 ","$2,262.18 ","$162.44 ","$2,836.00 ","$448.48 ","$225.34 ","$637.16 ","$520.86 ","$520.86 ","$496.56 ","$2,836.00 ","$233.72 ","$1,418.00 ","$2,246.11 ","$2,268.80 ","$324.73 ","$179.50 ","$162.44 ","$451.49 ","$222.60 "
"92100007","EAP","CPT� 93882","","US DUPLEX CA","BOTH IP/OP","$2,599.00 ","$1,923.26 ","$105.17 ","$2,411.00 ","$285.70 ","$106.62 ","$541.70 ","$343.08 ","$343.08 ","$422.15 ","$2,411.00 ","$112.41 ","$1,205.50 ","$1,909.51 ","$1,928.80 ","$156.18 ","$119.45 ","$105.17 ","$383.83 ","$107.06 "
"92100009","EAP","CPT� 93886","","Us Transcran Intracran Complete","BOTH IP/OP","$2,429.00 ","$1,797.46 ","$214.18 ","$2,693.00 ","$597.96 ","$225.34 ","$506.26 ","$600.55 ","$600.55 ","$471.52 ","$2,693.00 ","$233.72 ","$1,346.50 ","$2,132.86 ","$2,154.40 ","$324.73 ","$214.18 ","$228.71 ","$428.73 ","$222.60 "
"92100011","EAP","CPT� 93888","","Us Transcran Intracran Limited","BOTH IP/OP","$2,429.00 ","$1,797.46 ","$0.00 ","$2,693.00 ","$0.00 ","$0.00 ","$0.00 ","$409.52 ","$409.52 ","$0.00 ","$2,693.00 ","$0.00 ","$1,346.50 ","$2,132.86 ","$2,154.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100013","EAP","Custom 92100013","","Ankle/brachial Indices (abi)","BOTH IP/OP","$768.00 ","$568.32 ","$0.00 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$548.12 ","$548.12 ","$0.00 ","$768.00 ","$0.00 ","$384.00 ","$608.26 ","$614.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100014","EAP","CPT� 93922","","Abi -non-inv Doppler Test","BOTH IP/OP","$1,074.00 ","$794.76 ","$0.00 ","$1,085.00 ","$0.00 ","$0.00 ","$0.00 ","$258.93 ","$258.93 ","$0.00 ","$1,085.00 ","$0.00 ","$542.50 ","$859.32 ","$868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100015","EAP","CPT� 93923","","Ext Arterial Pvr Study","BOTH IP/OP","$1,355.00 ","$1,002.70 ","$112.01 ","$1,369.00 ","$305.26 ","$136.73 ","$282.42 ","$391.08 ","$391.08 ","$239.70 ","$1,369.00 ","$138.76 ","$684.50 ","$1,084.25 ","$1,095.20 ","$192.78 ","$115.78 ","$112.01 ","$217.94 ","$132.15 "
"92100017","EAP","CPT� 93925","","Us Low Ext Arteries Comp","BOTH IP/OP","$2,478.00 ","$1,833.72 ","$179.51 ","$2,325.00 ","$573.70 ","$225.34 ","$516.48 ","$669.22 ","$669.22 ","$407.09 ","$2,325.00 ","$233.72 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$324.73 ","$179.51 ","$218.26 ","$370.14 ","$222.60 "
"92100018","EAP","CPT� 93926","","Low Ext Arteries Ltd","BOTH IP/OP","$1,346.00 ","$996.04 ","$106.62 ","$1,263.00 ","$299.80 ","$106.62 ","$280.54 ","$424.07 ","$424.07 ","$221.14 ","$1,263.00 ","$112.41 ","$631.50 ","$1,000.30 ","$1,010.40 ","$156.18 ","$120.13 ","$127.86 ","$201.07 ","$107.06 "
"92100020","EAP","CPT� 93930","","Upper Ext Arteries Comp","BOTH IP/OP","$2,291.00 ","$1,695.34 ","$168.92 ","$2,150.00 ","$461.02 ","$225.34 ","$477.50 ","$527.55 ","$527.55 ","$376.45 ","$2,150.00 ","$233.72 ","$1,075.00 ","$1,702.80 ","$1,720.00 ","$324.73 ","$183.19 ","$168.92 ","$342.28 ","$222.60 "
"92100022","EAP","CPT� 93931","","Upper Ext Arteries Ltd","BOTH IP/OP","$1,346.00 ","$996.04 ","$105.89 ","$1,263.00 ","$284.91 ","$106.62 ","$280.54 ","$353.26 ","$353.26 ","$221.14 ","$1,263.00 ","$112.41 ","$631.50 ","$1,000.30 ","$1,010.40 ","$156.18 ","$121.65 ","$105.89 ","$201.07 ","$107.06 "
"92100025","EAP","CPT� 93970","","Us Ext Veins Doppler Comp","BOTH IP/OP","$2,823.00 ","$2,089.02 ","$163.16 ","$2,667.00 ","$436.74 ","$225.34 ","$588.38 ","$523.58 ","$523.58 ","$466.97 ","$2,667.00 ","$233.72 ","$1,333.50 ","$2,112.26 ","$2,133.60 ","$324.73 ","$199.35 ","$163.16 ","$424.59 ","$222.60 "
"92100026","EAP","CPT� 93970","","Periph.vas. Bil. W/mapping","BOTH IP/OP","$2,667.00 ","$1,973.58 ","$0.00 ","$2,667.00 ","$0.00 ","$0.00 ","$588.38 ","$523.58 ","$523.58 ","$466.97 ","$2,667.00 ","$233.72 ","$1,333.50 ","$2,112.26 ","$2,133.60 ","$324.73 ","$199.35 ","$163.16 ","$424.59 ","$222.60 "
"92100028","EAP","CPT� 93971","","Us Ext Veins Doppler Ltd","BOTH IP/OP","$2,071.00 ","$1,532.54 ","$101.21 ","$1,956.00 ","$266.11 ","$106.62 ","$431.65 ","$346.68 ","$346.68 ","$342.48 ","$1,956.00 ","$112.41 ","$978.00 ","$1,549.15 ","$1,564.80 ","$156.18 ","$132.53 ","$101.21 ","$311.40 ","$107.06 "
"92100029","EAP","CPT� 93971","","Periph.vas. Uni. & Ext Non-vas","BOTH IP/OP","$1,604.00 ","$1,186.96 ","$101.21 ","$1,956.00 ","$266.11 ","$106.62 ","$334.31 ","$346.68 ","$346.68 ","$342.48 ","$1,956.00 ","$112.41 ","$978.00 ","$1,549.15 ","$1,564.80 ","$156.18 ","$132.53 ","$101.21 ","$311.40 ","$107.06 "
"92100030","EAP","CPT� 93971","","Periph.vas. Uni. W/mapping","BOTH IP/OP","$1,604.00 ","$1,186.96 ","$101.21 ","$1,956.00 ","$266.11 ","$106.62 ","$334.31 ","$346.68 ","$346.68 ","$342.48 ","$1,956.00 ","$112.41 ","$978.00 ","$1,549.15 ","$1,564.80 ","$156.18 ","$132.53 ","$101.21 ","$311.40 ","$107.06 "
"92100032","EAP","CPT� 93975","","Abd/retroper Doppler Comp Us","BOTH IP/OP","$3,461.00 ","$2,561.14 ","$222.60 ","$3,326.00 ","$621.46 ","$225.34 ","$721.36 ","$683.69 ","$683.69 ","$582.36 ","$3,326.00 ","$233.72 ","$1,663.00 ","$2,634.19 ","$2,660.80 ","$324.73 ","$268.31 ","$223.31 ","$529.50 ","$222.60 "
"92100033","EAP","CPT� 93976","","Abd/retroper Doppler Ltd Us","BOTH IP/OP","$1,882.00 ","$1,392.68 ","$106.62 ","$1,809.00 ","$334.96 ","$106.62 ","$392.26 ","$375.03 ","$375.03 ","$316.74 ","$1,809.00 ","$112.41 ","$904.50 ","$1,432.73 ","$1,447.20 ","$156.18 ","$179.32 ","$126.42 ","$287.99 ","$107.06 "
"92100034","EAP","Custom 92100034","","Sngl Lead Pm Program Eval","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$145.59 ","$145.59 ","$0.00 ","$204.00 ","$0.00 ","$102.00 ","$161.57 ","$163.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100035","EAP","Custom 92100035","","Sngl Lead Icd Program Eval","BOTH IP/OP","$262.00 ","$193.88 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100036","EAP","CPT� 93286","","Pacemaker Sngl/dual/multi  Peri-procedure Eval In Person","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$188.00 ","$60.27 ","$0.00 ","$48.77 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$25.21 ","$29.93 ","$0.00 "
"92100037","EAP","CPT� 93287","","Icd Sngl/dual/multi Peri-procedure Eval In Person","BOTH IP/OP","$311.00 ","$230.14 ","$0.00 ","$250.00 ","$81.39 ","$0.00 ","$64.82 ","$178.43 ","$178.43 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$34.26 ","$25.21 ","$39.80 ","$0.00 "
"92100038","EAP","CPT� 93296","","Pacemaker/icd Interrog / Eval Remote Up To 90 Days","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$204.00 ","$57.92 ","$36.47 ","$52.73 ","$145.59 ","$145.59 ","$0.00 ","$204.00 ","$36.36 ","$102.00 ","$161.57 ","$163.20 ","$50.51 ","$0.00 ","$25.93 ","$32.48 ","$34.63 "
"92100039","EAP","Custom 92100039","","Mult Lead Pm Program Eval","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$117.05 ","$117.05 ","$0.00 ","$164.00 ","$0.00 ","$82.00 ","$129.89 ","$131.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100040","EAP","CPT� 93284","","Multi-lead Icd  Program / Eval In Person","BOTH IP/OP","$328.00 ","$242.72 ","$34.63 ","$264.00 ","$200.32 ","$36.47 ","$68.36 ","$188.42 ","$188.42 ","$46.22 ","$264.00 ","$36.36 ","$132.00 ","$209.09 ","$211.20 ","$50.51 ","$96.97 ","$36.38 ","$42.03 ","$34.63 "
"92100041","EAP","CPT� 93291","","Interrog / Eval Scrms Or Loop Recorder In Clinic","BOTH IP/OP","$203.00 ","$150.22 ","$21.96 ","$204.00 ","$81.39 ","$24.19 ","$42.31 ","$145.59 ","$145.59 ","$35.72 ","$204.00 ","$23.06 ","$102.00 ","$161.57 ","$163.20 ","$32.04 ","$39.45 ","$24.85 ","$32.48 ","$21.96 "
"92100043","EAP","Custom 92100043","","Icd Interrogation","BOTH IP/OP","$262.00 ","$193.88 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100044","EAP","Custom 92100044","","Dual Lead Pm Program Eval","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$145.59 ","$145.59 ","$0.00 ","$204.00 ","$0.00 ","$102.00 ","$161.57 ","$163.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100045","EAP","Custom 92100045","","Dual Lead Icd Program Eval","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100050","EAP","CPT� 93978","","Aorta Duplex","BOTH IP/OP","$1,539.00 ","$1,138.86 ","$151.27 ","$1,685.00 ","$422.69 ","$225.34 ","$320.77 ","$490.90 ","$490.90 ","$295.03 ","$1,685.00 ","$233.72 ","$842.50 ","$1,334.52 ","$1,348.00 ","$324.73 ","$187.25 ","$151.27 ","$268.25 ","$222.60 "
"92100052","EAP","CPT� 93880","","Carotid Duplex","BOTH IP/OP","$2,558.00 ","$1,892.92 ","$162.44 ","$2,836.00 ","$448.48 ","$225.34 ","$533.15 ","$520.86 ","$520.86 ","$496.56 ","$2,836.00 ","$233.72 ","$1,418.00 ","$2,246.11 ","$2,268.80 ","$324.73 ","$179.50 ","$162.44 ","$451.49 ","$222.60 "
"92100063","EAP","CPT� 93978","","Vascular Study Ult","BOTH IP/OP","$1,753.00 ","$1,297.22 ","$151.27 ","$1,685.00 ","$422.69 ","$225.34 ","$365.37 ","$490.90 ","$490.90 ","$295.03 ","$1,685.00 ","$233.72 ","$842.50 ","$1,334.52 ","$1,348.00 ","$324.73 ","$187.25 ","$151.27 ","$268.25 ","$222.60 "
"92100065","EAP","CPT� 93979","","Vascular Study Limited Ult","BOTH IP/OP","$965.00 ","$714.10 ","$0.00 ","$1,057.00 ","$0.00 ","$0.00 ","$0.00 ","$341.04 ","$341.04 ","$0.00 ","$1,057.00 ","$0.00 ","$528.50 ","$837.14 ","$845.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100072","EAP","CPT� 93281","","Multi-lead Pacemaker Program / Eval In Person","BOTH IP/OP","$204.00 ","$150.96 ","$26.11 ","$164.00 ","$151.80 ","$36.47 ","$42.52 ","$117.05 ","$117.05 ","$28.72 ","$164.00 ","$36.36 ","$82.00 ","$129.89 ","$131.20 ","$50.51 ","$73.61 ","$34.22 ","$26.11 ","$34.63 "
"92100080","EAP","CPT� 93886","","Transcran Doppler Comp Us","BOTH IP/OP","$2,903.00 ","$2,148.22 ","$214.18 ","$2,693.00 ","$597.96 ","$225.34 ","$605.06 ","$600.55 ","$600.55 ","$471.52 ","$2,693.00 ","$233.72 ","$1,346.50 ","$2,132.86 ","$2,154.40 ","$324.73 ","$214.18 ","$228.71 ","$428.73 ","$222.60 "
"92100081","EAP","CPT� 93888","","Transcran Doppler Ltd Us","BOTH IP/OP","$2,903.00 ","$2,148.22 ","$0.00 ","$2,693.00 ","$0.00 ","$0.00 ","$0.00 ","$409.52 ","$409.52 ","$0.00 ","$2,693.00 ","$0.00 ","$1,346.50 ","$2,132.86 ","$2,154.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100082","EAP","CPT� 93890","","Tcd. Vasoreactivity Study","BOTH IP/OP","$1,989.00 ","$1,471.86 ","$0.00 ","$1,845.00 ","$0.00 ","$0.00 ","$0.00 ","$506.27 ","$506.27 ","$0.00 ","$1,845.00 ","$0.00 ","$922.50 ","$1,461.24 ","$1,476.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100083","EAP","CPT� 93892","","Tcd. Emboli Detct W/o Inj","BOTH IP/OP","$967.00 ","$715.58 ","$0.00 ","$897.00 ","$0.00 ","$106.62 ","$201.55 ","$549.93 ","$549.93 ","$157.06 ","$897.00 ","$112.41 ","$448.50 ","$710.42 ","$717.60 ","$156.18 ","$256.10 ","$255.72 ","$142.80 ","$107.06 "
"92100084","EAP","CPT� 93893","","Tcd. Emboli Detect W/inj","BOTH IP/OP","$967.00 ","$715.58 ","$0.00 ","$897.00 ","$378.79 ","$106.62 ","$201.55 ","$547.32 ","$547.32 ","$157.06 ","$897.00 ","$112.41 ","$448.50 ","$710.42 ","$717.60 ","$156.18 ","$0.00 ","$302.18 ","$142.80 ","$107.06 "
"92100086","EAP","CPT� 93922","","Abi -non-inv Doppler Test","BOTH IP/OP","$1,085.00 ","$802.90 ","$0.00 ","$1,085.00 ","$0.00 ","$0.00 ","$0.00 ","$258.93 ","$258.93 ","$0.00 ","$1,085.00 ","$0.00 ","$542.50 ","$859.32 ","$868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100088","EAP","CPT� 93922","","Limited Bilateral Pvr Exam","BOTH IP/OP","$1,085.00 ","$802.90 ","$0.00 ","$1,085.00 ","$0.00 ","$0.00 ","$0.00 ","$258.93 ","$258.93 ","$0.00 ","$1,085.00 ","$0.00 ","$542.50 ","$859.32 ","$868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100089","EAP","CPT� 93980","","Penile Vascular Study","BOTH IP/OP","$1,392.00 ","$1,030.08 ","$0.00 ","$1,524.00 ","$0.00 ","$0.00 ","$0.00 ","$283.66 ","$283.66 ","$0.00 ","$1,524.00 ","$0.00 ","$762.00 ","$1,207.01 ","$1,219.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100090","EAP","CPT� 93924","","Vas Lab Pvr Lower Ext With Exercise","BOTH IP/OP","$1,188.00 ","$879.12 ","$127.08 ","$1,200.00 ","$380.40 ","$259.18 ","$247.61 ","$486.60 ","$486.60 ","$210.11 ","$1,200.00 ","$138.76 ","$600.00 ","$950.40 ","$960.00 ","$192.78 ","$127.08 ","$141.19 ","$191.04 ","$132.15 "
"92100091","EAP","CPT� 93985","","Vessel Mapping For Hd Access Bilateral","BOTH IP/OP","$580.00 ","$429.20 ","$88.67 ","$580.00 ","$580.00 ","$225.34 ","$120.89 ","$397.53 ","$397.53 ","$97.53 ","$557.00 ","$233.72 ","$278.50 ","$441.14 ","$445.60 ","$324.73 ","$256.89 ","$231.59 ","$88.67 ","$222.60 "
"92100092","EAP","CPT� 93986","","Vessel Mapping For Hd Access Unilateral","BOTH IP/OP","$279.00 ","$206.46 ","$42.67 ","$279.00 ","$279.00 ","$106.62 ","$58.15 ","$191.27 ","$191.27 ","$46.92 ","$268.00 ","$112.41 ","$134.00 ","$212.26 ","$214.40 ","$156.18 ","$130.33 ","$131.82 ","$42.67 ","$107.06 "
"92200001","EAP","CPT� 95860","","Electromyogram - 1 Extermity","BOTH IP/OP","$440.00 ","$325.60 ","$0.00 ","$432.00 ","$0.00 ","$0.00 ","$91.71 ","$308.32 ","$308.32 ","$75.64 ","$432.00 ","$109.35 ","$216.00 ","$342.14 ","$345.60 ","$151.93 ","$70.97 ","$68.79 ","$68.77 ","$104.14 "
"92200002","EAP","CPT� 95861","","Electromyorgam - 2 Extermities","BOTH IP/OP","$421.00 ","$311.54 ","$0.00 ","$421.00 ","$0.00 ","$0.00 ","$0.00 ","$300.47 ","$300.47 ","$0.00 ","$421.00 ","$0.00 ","$210.50 ","$333.43 ","$336.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92200003","EAP","CPT� 95869","","Emg Limited (thoracic Psp)","BOTH IP/OP","$186.00 ","$137.64 ","$0.00 ","$183.00 ","$0.00 ","$0.00 ","$0.00 ","$130.61 ","$130.61 ","$0.00 ","$183.00 ","$0.00 ","$91.50 ","$144.94 ","$146.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92200004","EAP","CPT� 95870","","Emg Limited Ext","BOTH IP/OP","$317.00 ","$234.58 ","$0.00 ","$311.00 ","$0.00 ","$0.00 ","$0.00 ","$221.96 ","$221.96 ","$0.00 ","$311.00 ","$0.00 ","$155.50 ","$246.31 ","$248.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92200010","EAP","CPT� 95937","","Rns","BOTH IP/OP","$192.00 ","$142.08 ","$27.86 ","$175.00 ","$104.26 ","$136.73 ","$40.02 ","$124.90 ","$124.90 ","$30.64 ","$175.00 ","$138.76 ","$87.50 ","$138.60 ","$140.00 ","$175.00 ","$50.14 ","$60.15 ","$27.86 ","$132.15 "
"92200011","EAP","CPT� 95907","","Nvr Cndj Tst 1-2 Studies","BOTH IP/OP","$706.00 ","$522.44 ","$0.00 ","$679.00 ","$0.00 ","$0.00 ","$0.00 ","$484.60 ","$484.60 ","$118.89 ","$679.00 ","$138.76 ","$339.50 ","$537.77 ","$543.20 ","$192.78 ","$90.38 ","$42.14 ","$108.10 ","$132.15 "
"92200012","EAP","CPT� 95908","","Nrv Cndj Tst 3-4 Studies","BOTH IP/OP","$1,040.00 ","$769.60 ","$54.75 ","$1,001.00 ","$564.72 ","$259.18 ","$216.76 ","$714.41 ","$714.41 ","$175.27 ","$1,001.00 ","$253.05 ","$500.50 ","$792.79 ","$800.80 ","$351.58 ","$111.50 ","$54.75 ","$159.36 ","$241.00 "
"92200013","EAP","CPT� 95909","","Nrv Cndj Tst 5-6 Studies","BOTH IP/OP","$1,374.00 ","$1,016.76 ","$65.55 ","$1,322.00 ","$746.08 ","$259.18 ","$286.38 ","$943.51 ","$943.51 ","$231.47 ","$1,322.00 ","$253.05 ","$661.00 ","$1,047.02 ","$1,057.60 ","$351.58 ","$133.60 ","$65.55 ","$210.46 ","$241.00 "
"92200014","EAP","CPT� 95910","","Nrv Cndj Test 7-8 Studies","BOTH IP/OP","$1,711.00 ","$1,266.14 ","$84.28 ","$1,646.00 ","$929.07 ","$259.18 ","$356.62 ","$1,174.75 ","$1,174.75 ","$288.20 ","$1,646.00 ","$253.05 ","$823.00 ","$1,303.63 ","$1,316.80 ","$351.58 ","$175.83 ","$84.28 ","$262.04 ","$241.00 "
"92200015","EAP","CPT� 95911","","Nrv Cndj Test 9-10 Studies","BOTH IP/OP","$2,045.00 ","$1,513.30 ","$96.53 ","$1,968.00 ","$1,110.44 ","$478.04 ","$426.23 ","$1,404.56 ","$1,404.56 ","$344.58 ","$1,968.00 ","$487.04 ","$984.00 ","$1,558.66 ","$1,574.40 ","$676.67 ","$212.84 ","$96.53 ","$313.31 ","$463.84 "
"92200016","EAP","CPT� 95912","","Nvr Cndj Tst 11-12 Studies","BOTH IP/OP","$2,380.00 ","$1,761.20 ","$104.09 ","$2,290.00 ","$1,292.34 ","$478.04 ","$496.05 ","$1,634.37 ","$1,634.37 ","$400.96 ","$2,290.00 ","$487.04 ","$1,145.00 ","$1,813.68 ","$1,832.00 ","$676.67 ","$249.19 ","$104.09 ","$364.57 ","$463.84 "
"92200017","EAP","CPT� 95913","","Nrv Cndj Tst 13- Or More Studies","BOTH IP/OP","$2,715.00 ","$2,009.10 ","$115.61 ","$2,612.00 ","$1,474.25 ","$478.04 ","$565.87 ","$1,864.18 ","$1,864.18 ","$457.34 ","$2,612.00 ","$487.04 ","$1,306.00 ","$2,068.70 ","$2,089.60 ","$676.67 ","$288.80 ","$115.61 ","$415.83 ","$463.84 "
"92200018","EAP","CPT� 95872","","Needle Emg W/1 Fiber Electrode Quan Meas Jitter","BOTH IP/OP","$647.00 ","$478.78 ","$0.00 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$453.91 ","$453.91 ","$111.36 ","$636.00 ","$138.76 ","$318.00 ","$503.71 ","$508.80 ","$192.78 ","$101.87 ","$47.18 ","$101.25 ","$132.15 "
"92200040","EAP","CPT� 95933","","Orbicularis Oculi Reflex","BOTH IP/OP","$461.00 ","$341.14 ","$0.00 ","$421.00 ","$0.00 ","$0.00 ","$0.00 ","$300.47 ","$300.47 ","$73.71 ","$421.00 ","$55.17 ","$210.50 ","$333.43 ","$336.80 ","$76.65 ","$65.19 ","$51.50 ","$67.02 ","$52.54 "
"92200041","EAP","CPT� 95925","","Short-latency Somatosens Ep Std Upr Limbs","BOTH IP/OP","$1,372.00 ","$1,015.28 ","$0.00 ","$1,372.00 ","$0.00 ","$0.00 ","$0.00 ","$979.20 ","$979.20 ","$0.00 ","$1,372.00 ","$0.00 ","$686.00 ","$1,086.62 ","$1,097.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92200042","EAP","CPT� 95926","","Short-latency Somatosens Ep Std Lwr Limbs","BOTH IP/OP","$1,372.00 ","$1,015.28 ","$0.00 ","$1,372.00 ","$0.00 ","$0.00 ","$0.00 ","$979.20 ","$979.20 ","$0.00 ","$1,372.00 ","$0.00 ","$686.00 ","$1,086.62 ","$1,097.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92200043","EAP","CPT� 95867","","Emg Cranial Nerve Unilateral","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$614.00 ","$0.00 ","$0.00 ","$0.00 ","$438.21 ","$438.21 ","$107.51 ","$614.00 ","$138.76 ","$307.00 ","$486.29 ","$491.20 ","$192.78 ","$68.25 ","$65.91 ","$97.75 ","$132.15 "
"92200044","EAP","CPT� 95868","","Emg Cranial Nerve Bilateral","BOTH IP/OP","$836.00 ","$618.64 ","$0.00 ","$836.00 ","$0.00 ","$0.00 ","$0.00 ","$596.65 ","$596.65 ","$0.00 ","$836.00 ","$0.00 ","$418.00 ","$662.11 ","$668.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92400001","EAP","CPT� 95004","","Perc. Allergy Test, Immed. Rea","BOTH IP/OP","$999.00 ","$739.26 ","$0.00 ","$1,009.00 ","$542.46 ","$900.99 ","$208.22 ","$720.12 ","$720.12 ","$0.00 ","$1,009.00 ","$0.00 ","$504.50 ","$799.13 ","$807.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92400002","EAP","CPT� 95004","","Allergy Testing, Extracts","BOTH IP/OP","$941.00 ","$696.34 ","$0.00 ","$950.00 ","$510.96 ","$900.99 ","$196.13 ","$678.02 ","$678.02 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92400011","EAP","CPT� 95028","","Intradermal Test #","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$117.76 ","$117.76 ","$28.89 ","$165.00 ","$33.53 ","$82.50 ","$130.68 ","$132.00 ","$46.58 ","$8.93 ","$12.97 ","$26.27 ","$31.93 "
"92400012","EAP","CPT� 95044","","Patch Tests - Each","BOTH IP/OP","$904.00 ","$668.96 ","$5.40 ","$913.00 ","$490.87 ","$900.99 ","$188.42 ","$651.61 ","$651.61 ","$159.86 ","$913.00 ","$911.62 ","$456.50 ","$723.10 ","$730.40 ","$913.00 ","$7.85 ","$5.40 ","$145.35 ","$868.21 "
"92400030","EAP","CPT� 95180","","Rapid Desensitization","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$0.00 ","$0.00 ","$0.00 ","$274.77 ","$274.77 ","$0.00 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92400034","EAP","CPT� 95076","","Ingest Challenge Ini 120 Min","BOTH IP/OP","$695.00 ","$514.30 ","$0.00 ","$702.00 ","$0.00 ","$0.00 ","$0.00 ","$501.02 ","$501.02 ","$0.00 ","$702.00 ","$0.00 ","$351.00 ","$555.98 ","$561.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92900002","EAP","CPT� 93293","","Transtelephonic Rhythm Strip Pm Eval / Sngl, Dual, Multi-lead","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$188.42 ","$188.42 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94000002","EAP","CPT� 95115","","Allergy Injection","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$21.72 ","$39.19 ","$8.34 ","$28.55 ","$28.55 ","$0.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94000003","EAP","CPT� 95117","","Allergy Injections, 2 Or More","BOTH IP/OP","$67.00 ","$49.58 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$44.96 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94000005","EAP","CPT� 96900","","Actinotherapy, Uvl","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$215.00 ","$0.00 ","$0.00 ","$44.81 ","$153.45 ","$153.45 ","$0.00 ","$215.00 ","$0.00 ","$107.50 ","$170.28 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94000006","EAP","CPT� 96910","","Photochemotherapy,uvb","BOTH IP/OP","$126.00 ","$93.24 ","$20.22 ","$127.00 ","$68.42 ","$54.51 ","$26.26 ","$90.64 ","$90.64 ","$22.24 ","$127.00 ","$55.17 ","$63.50 ","$100.58 ","$101.60 ","$76.65 ","$22.14 ","$118.14 ","$20.22 ","$52.54 "
"94000007","EAP","CPT� 96912","","Photochemotherapy, Puva","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$206.00 ","$0.00 ","$0.00 ","$0.00 ","$147.02 ","$147.02 ","$0.00 ","$206.00 ","$0.00 ","$103.00 ","$163.15 ","$164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94000021","EAP","CPT� 99195","","Phlebotomy","BOTH IP/OP","$189.00 ","$139.86 ","$17.15 ","$188.00 ","$102.63 ","$110.43 ","$39.39 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$109.35 ","$94.00 ","$148.90 ","$150.40 ","$151.93 ","$17.15 ","$102.65 ","$29.93 ","$104.14 "
"94000022","EAP","CPT� 99195","","Therapeutic Phlebotomy","BOTH IP/OP","$189.00 ","$139.86 ","$17.15 ","$188.00 ","$102.63 ","$110.43 ","$39.39 ","$134.18 ","$134.18 ","$32.92 ","$188.00 ","$109.35 ","$94.00 ","$148.90 ","$150.40 ","$151.93 ","$17.15 ","$102.65 ","$29.93 ","$104.14 "
"94000031","EAP","CPT� 95907","","Nerve conductionstudies 1-2 studie","BOTH IP/OP","$706.00 ","$522.44 ","$0.00 ","$679.00 ","$0.00 ","$0.00 ","$0.00 ","$484.60 ","$484.60 ","$118.89 ","$679.00 ","$138.76 ","$339.50 ","$537.77 ","$543.20 ","$192.78 ","$90.38 ","$42.14 ","$108.10 ","$132.15 "
"94200001","EAP","CPT� 97802","","Mnt - Individual, Initial Per 15 Min","BOTH IP/OP","$98.00 ","$72.52 ","$15.18 ","$97.00 ","$53.21 ","$33.05 ","$20.43 ","$69.23 ","$69.23 ","$16.98 ","$97.00 ","$29.55 ","$48.50 ","$76.82 ","$77.60 ","$34.61 ","$15.18 ","$34.61 ","$15.44 ","$34.61 "
"94200002","EAP","CPT� 97803","","Mnt - Individual, Follow-up Per 15 Min","BOTH IP/OP","$85.00 ","$62.90 ","$13.15 ","$84.00 ","$46.16 ","$28.17 ","$17.72 ","$59.95 ","$59.95 ","$14.71 ","$84.00 ","$25.06 ","$42.00 ","$66.53 ","$67.20 ","$29.21 ","$13.15 ","$29.21 ","$13.37 ","$29.21 "
"94200003","EAP","CPT� 97804","","Mnt - Group, Initial Or Follow-up Per 30 Min","BOTH IP/OP","$46.00 ","$34.04 ","$7.20 ","$46.00 ","$24.98 ","$15.66 ","$9.59 ","$32.83 ","$32.83 ","$8.05 ","$46.00 ","$13.82 ","$23.00 ","$36.43 ","$36.80 ","$16.23 ","$7.20 ","$16.23 ","$7.32 ","$16.23 "
"94200004","EAP","HCPCS G0108","","Dsmt - Individual, Initial Or Follow-up Per 30 Min","BOTH IP/OP","$155.00 ","$114.70 ","$24.10 ","$154.00 ","$84.17 ","$55.96 ","$32.31 ","$109.91 ","$109.91 ","$26.96 ","$154.00 ","$57.08 ","$77.00 ","$121.97 ","$123.20 ","$56.97 ","$24.10 ","$56.97 ","$24.52 ","$56.97 "
"94200005","EAP","HCPCS G0109","","Dsmt - Group, Initial Or Follow-up Per 30 Min","BOTH IP/OP","$118.00 ","$87.32 ","$15.50 ","$117.00 ","$64.07 ","$15.66 ","$24.59 ","$83.50 ","$83.50 ","$20.49 ","$117.00 ","$15.50 ","$58.50 ","$92.66 ","$93.60 ","$15.86 ","$18.31 ","$15.86 ","$18.63 ","$15.86 "
"94200012","EAP","HCPCS G0270","","Mnt - Individual (beyond Initial 3hrs Or Beyond 2hrs In Subq Yrs) - Per 15 Min","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$76.37 ","$76.37 ","$18.73 ","$107.00 ","$25.06 ","$53.50 ","$84.74 ","$85.60 ","$29.21 ","$16.75 ","$29.21 ","$17.03 ","$29.21 "
"94200013","EAP","HCPCS G0271","","Mnt - Group (beyond Initial 3hrs Or Beyond 2hrs In Sebq Yrs) - Per 30 Min","BOTH IP/OP","$59.00 ","$43.66 ","$0.00 ","$59.00 ","$0.00 ","$0.00 ","$12.30 ","$42.11 ","$42.11 ","$10.33 ","$59.00 ","$13.82 ","$29.50 ","$46.73 ","$47.20 ","$16.23 ","$9.23 ","$16.23 ","$0.00 ","$16.23 "
"94200014","EAP","CPT� 99412","","Childbirth Education Class","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$19.01 ","$12.84 ","$7.29 ","$24.98 ","$24.98 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$21.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"94200015","EAP","CPT� 99078","","Centering Preg Group Session","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$125.00 ","$68.42 ","$0.00 ","$26.26 ","$89.21 ","$89.21 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"94300001","EAP","CPT� 93797","","Cardiac Rehab - Regular","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$102.06 ","$102.06 ","$0.00 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94600011","EAP","Custom 94600011","","Kinair Iii W/o Scale","BOTH IP/OP","$178.00 ","$131.72 ","$0.00 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$127.04 ","$127.04 ","$0.00 ","$178.00 ","$0.00 ","$89.00 ","$140.98 ","$142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99900120","EAP","HCPCS G1004","","Cdsm National Decision Support Company, Medicare Auc Program","BOTH IP/OP","$0.01 ","$0.01 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99900132","EAP","Custom 99900132","","Trauma Protocol, Ect","BOTH IP/OP","$27,445.00 ","$20,309.30 ","$0.00 ","$25,279.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,279.00 ","$0.00 ","$12,639.50 ","$20,020.97 ","$20,223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99900529","EAP","Custom 99900529","","Head/neck Cta W&w/o Dye,nct","BOTH IP/OP","$13,698.00 ","$10,136.52 ","$0.00 ","$12,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,458.00 ","$0.00 ","$6,229.00 ","$9,866.74 ","$9,966.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0159T","EAP","CPT� 0159T","","Computer Aided Breast Mri","BOTH IP/OP","$118.00 ","$87.32 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.00 ","$0.00 ","$0.00 ","$93.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C9803","EAP","HCPCS C9803","","Hopd Covid-19 Spec Collect","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$40.68 ","$40.68 ","$9.98 ","$57.00 ","$23.06 ","$28.50 ","$45.14 ","$45.60 ","$32.04 ","$8.92 ","$0.00 ","$9.07 ","$21.96 "
"CMPR7501","EAP","","","Colonoscopy Procedure","BOTH IP/OP","$1,413.00 ","$1,045.62 ","$0.00 ","$1,413.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,413.00 ","$0.00 ","$706.50 ","$1,119.10 ","$1,130.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CMPR7502","EAP","","","Sigmoidoscopy Procedure","BOTH IP/OP","$761.00 ","$563.14 ","$0.00 ","$761.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$761.00 ","$0.00 ","$380.50 ","$602.71 ","$608.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CMPR7504","EAP","","","Dilation Of Esophagus Procedure","BOTH IP/OP","$3,267.00 ","$2,417.58 ","$0.00 ","$3,267.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,267.00 ","$0.00 ","$1,633.50 ","$2,587.46 ","$2,613.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CMPR7505","EAP","","","Endoscopic Cannulation Procedure","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G0008","EAP","HCPCS G0008","","ADMIN INFLUENZA VIRUS VAC","BOTH IP/OP","$73.00 ","$54.02 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$57.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G0009","EAP","HCPCS G0009","","ADMIN PNEUMOCOCCAL VACCINE","BOTH IP/OP","$73.00 ","$54.02 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$57.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G0010","EAP","HCPCS G0010","","ADMIN HEPATITIS B VACCINE","BOTH IP/OP","$73.00 ","$54.02 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.00 ","$0.00 ","$0.00 ","$57.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G0105","EAP","HCPCS G0105","","COLORECTAL SCRN; HI RISK IND","BOTH IP/OP","$1,187.00 ","$878.38 ","$0.00 ","$1,187.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.00 ","$0.00 ","$1,187.00 ","$940.10 ","$949.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G0121","EAP","HCPCS G0121","","COLON CA SCRN NOT HI RSK IND","BOTH IP/OP","$985.00 ","$728.90 ","$0.00 ","$1,189.00 ","$985.00 ","$777.17 ","$0.00 ","$1,189.00 ","$1,189.00 ","$208.18 ","$1,189.00 ","$766.13 ","$1,189.00 ","$941.69 ","$951.20 ","$1,064.43 ","$186.08 ","$193.26 ","$189.29 ","$729.64 "
"G0297","EAP","HCPCS G0297","","Ldct for lung ca screen","BOTH IP/OP","$662.00 ","$489.88 ","$0.00 ","$662.00 ","$0.00 ","$0.00 ","$0.00 ","$662.00 ","$662.00 ","$115.91 ","$662.00 ","$80.04 ","$331.00 ","$524.30 ","$529.60 ","$111.21 ","$103.60 ","$189.09 ","$105.39 ","$76.23 "
"G0438","EAP","HCPCS G0438","","FIRST ANNUAL WELLNESS VISIT","BOTH IP/OP","$468.00 ","$346.32 ","$0.00 ","$604.00 ","$0.00 ","$168.58 ","$67.13 ","$299.34 ","$299.34 ","$105.76 ","$604.00 ","$184.17 ","$302.00 ","$478.37 ","$483.20 ","$172.69 ","$0.00 ","$172.69 ","$96.16 ","$172.69 "
"G0447","EAP","HCPCS G0447","","Face-to-face Behavioral Counseling For Obesity, 15 Minus","BOTH IP/OP","$74.00 ","$54.76 ","$14.55 ","$93.00 ","$40.18 ","$73.28 ","$15.42 ","$66.37 ","$66.37 ","$16.28 ","$93.00 ","$78.77 ","$46.50 ","$73.66 ","$74.40 ","$93.00 ","$14.55 ","$24.16 ","$14.81 ","$75.02 "
"G2012","EAP","HCPCS G2012","","PR BRIEF CHECK IN BY MD/QHP BY TELEPHONE","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$13.34 ","$8.14 ","$13.34 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","00904-6719-60","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","00904-6773-61","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","49348-0973-10","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","50580-0600-02","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","57896-0102-10","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","63739-0440-01","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101","ERX","HCPCS 25000001","69618-0010-01","ACETAMINOPHEN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102","ERX","HCPCS 25000001","00904-6730-61","ACETAMINOPHEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102","ERX","HCPCS 25000001","49348-0042-14","ACETAMINOPHEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102","ERX","HCPCS 25000001","50580-0412-01","ACETAMINOPHEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102","ERX","HCPCS 25000001","50580-0412-02","ACETAMINOPHEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102","ERX","HCPCS 25000001","57896-0204-01","ACETAMINOPHEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103","ERX","HCPCS 25000001","45802-0732-00","ACETAMINOPHEN 120 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103","ERX","HCPCS 25000001","45802-0732-30","ACETAMINOPHEN 120 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104","ERX","HCPCS 25000001","","ACETAMINOPHEN 325 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$64.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"104","ERX","HCPCS 25000001","51672-2116-02","ACETAMINOPHEN 325 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$64.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"105","ERX","HCPCS 25000001","45802-0730-00","ACETAMINOPHEN 650 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$64.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"105","ERX","HCPCS 25000001","45802-0730-30","ACETAMINOPHEN 650 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$64.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"105","ERX","HCPCS 25000001","45802-0730-32","ACETAMINOPHEN 650 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$64.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"113","ERX","HCPCS 63700001","00527-1050-01","ACETAZOLAMIDE 250 MG PO TABS","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$10.96 ","","$2.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.96 ","$0.00 ","$5.48 ","$8.68 ","$8.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"113","ERX","HCPCS 63700001","51672-4023-01","ACETAZOLAMIDE 250 MG PO TABS","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$10.96 ","","$2.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.96 ","$0.00 ","$5.48 ","$8.68 ","$8.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"114","ERX","HCPCS J1120","00143-9503-01","ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$101.81 ","$75.34 ","$0.00 ","$92.32 ","$45.81 ","$0.00 ","$41.60 ","$0.00 ","$0.00 ","$16.61 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$16.61 ","$0.00 ","$15.82 ","$0.00 "
"114","ERX","HCPCS J1120","39822-0190-01","ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$101.81 ","$75.34 ","$0.00 ","$92.32 ","$45.81 ","$0.00 ","$41.60 ","$0.00 ","$0.00 ","$16.61 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$16.61 ","$0.00 ","$15.82 ","$0.00 "
"114","ERX","HCPCS J1120","39822-0190-07","ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$101.81 ","$75.34 ","$0.00 ","$92.32 ","$45.81 ","$0.00 ","$41.60 ","$0.00 ","$0.00 ","$16.61 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$16.61 ","$0.00 ","$15.82 ","$0.00 "
"114","ERX","HCPCS J1120","67457-0853-50","ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$101.81 ","$75.34 ","$0.00 ","$92.32 ","$45.81 ","$0.00 ","$41.60 ","$0.00 ","$0.00 ","$16.61 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$16.61 ","$0.00 ","$15.82 ","$0.00 "
"123","ERX","HCPCS J7608","00409-3308-03","ACETYLCYSTEINE 20 % IN SOLN","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.65 ","$21.16 ","$5.74 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.65 ","$0.00 ","$21.33 ","$33.78 ","$34.12 ","$0.00 ","$6.67 ","$0.00 ","$0.00 ","$0.00 "
"123","ERX","HCPCS J7608","00517-7604-01","ACETYLCYSTEINE 20 % IN SOLN","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.65 ","$21.16 ","$5.74 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.65 ","$0.00 ","$21.33 ","$33.78 ","$34.12 ","$0.00 ","$6.67 ","$0.00 ","$0.00 ","$0.00 "
"123","ERX","HCPCS J7608","00517-7604-25","ACETYLCYSTEINE 20 % IN SOLN","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.65 ","$21.16 ","$5.74 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.65 ","$0.00 ","$21.33 ","$33.78 ","$34.12 ","$0.00 ","$6.67 ","$0.00 ","$0.00 ","$0.00 "
"123","ERX","HCPCS J7608","63323-0690-30","ACETYLCYSTEINE 20 % IN SOLN","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.65 ","$21.16 ","$5.74 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.65 ","$0.00 ","$21.33 ","$33.78 ","$34.12 ","$0.00 ","$6.67 ","$0.00 ","$0.00 ","$0.00 "
"123","ERX","HCPCS J7608","63323-0694-04","ACETYLCYSTEINE 20 % IN SOLN","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.65 ","$21.16 ","$5.74 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.65 ","$0.00 ","$21.33 ","$33.78 ","$34.12 ","$0.00 ","$6.67 ","$0.00 ","$0.00 ","$0.00 "
"123","ERX","HCPCS J7608","99999-6005-92","ACETYLCYSTEINE 20 % IN SOLN","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.65 ","$21.16 ","$5.74 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.65 ","$0.00 ","$21.33 ","$33.78 ","$34.12 ","$0.00 ","$6.67 ","$0.00 ","$0.00 ","$0.00 "
"250","ERX","HCPCS 25000001","00378-6990-31","ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"250","ERX","HCPCS 25000001","00487-9501-01","ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"250","ERX","HCPCS 25000001","00487-9501-03","ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"250","ERX","HCPCS 25000001","00487-9501-25","ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"250","ERX","HCPCS 25000001","00591-3797-83","ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"250","ERX","HCPCS 25000001","76204-0200-01","ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"252","ERX","HCPCS 25000001","99999-6010-97","ALBUTEROL SULFATE 2 MG/5ML PO SYRP","BOTH IP/OP","$21.37 ","$15.81 ","$0.00 ","$71.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.40 ","$0.00 ","$35.70 ","$15.35 ","$57.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"252","ERX","HCPCS 25000001","99999-6004-59","ALBUTEROL SULFATE 2 MG/5ML PO SYRP","BOTH IP/OP","$21.37 ","$15.81 ","$0.00 ","$71.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.40 ","$0.00 ","$35.70 ","$56.55 ","$57.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"252","ERX","HCPCS 25000001","00472-0825-16","ALBUTEROL SULFATE 2 MG/5ML PO SYRP","BOTH IP/OP","$21.37 ","$15.81 ","$0.00 ","$85.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.40 ","$0.00 ","$35.70 ","$85.23 ","$57.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"253","ERX","HCPCS 63700001","51079-0657-20","ALBUTEROL SULFATE 2 MG PO TABS","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"253","ERX","HCPCS 63700001","68084-0949-95","ALBUTEROL SULFATE 2 MG PO TABS","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"254","ERX","HCPCS 63700001","00378-0572-01","ALBUTEROL SULFATE 4 MG PO TABS","BOTH IP/OP","$26.79 ","$19.82 ","$0.00 ","$26.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"254","ERX","HCPCS 63700001","53489-0177-01","ALBUTEROL SULFATE 4 MG PO TABS","BOTH IP/OP","$26.79 ","$19.82 ","$0.00 ","$26.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"254","ERX","HCPCS 63700001","69543-0291-10","ALBUTEROL SULFATE 4 MG PO TABS","BOTH IP/OP","$26.79 ","$19.82 ","$0.00 ","$26.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","00904-6571-61","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","16714-0041-10","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","16714-0041-12","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","51079-0205-20","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","62584-0988-01","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","62584-0988-11","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310","ERX","HCPCS 63700001","63739-0410-10","ALLOPURINOL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","00591-5544-01","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","00904-6572-61","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","50268-0064-11","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","50268-0064-15","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","51079-0206-01","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","51079-0206-20","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311","ERX","HCPCS 63700001","62584-0713-01","ALLOPURINOL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324","ERX","HCPCS 25000001","00228-2027-10","ALPRAZOLAM 0.25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324","ERX","HCPCS 25000001","59762-3719-01","ALPRAZOLAM 0.25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"326","ERX","HCPCS 25000001","00904-5860-61","ALPRAZOLAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"345","ERX","HCPCS 25000001","00395-0049-96","ALUM AMMONIUM POWD","BOTH IP/OP","$34.70 ","$25.68 ","$0.00 ","$30.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.78 ","$0.00 ","$15.39 ","$24.38 ","$24.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"346","ERX","HCPCS 25000001","49452-0370-01","ALUM POTASSIUM POWD","BOTH IP/OP","$384.30 ","$284.38 ","$0.00 ","$304.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.16 ","$0.00 ","$15.58 ","$304.37 ","$24.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"346","ERX","HCPCS 25000001","51927-1692-00","ALUM POTASSIUM POWD","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$31.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.16 ","$0.00 ","$15.58 ","$4.75 ","$24.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"353","ERX","HCPCS 63700001","99999-6009-93","ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP","BOTH IP/OP","$12.07 ","$8.93 ","$0.00 ","$11.00 ","","$2.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"353","ERX","HCPCS 63700001","00536-0091-85","ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP","BOTH IP/OP","$12.07 ","$8.93 ","$0.00 ","$18.51 ","","$2.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$18.51 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364","ERX","HCPCS 63700001","00904-6630-61","AMANTADINE HCL 100 MG PO CAPS","BOTH IP/OP","$8.13 ","$6.02 ","$0.00 ","$7.37 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.37 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364","ERX","HCPCS 63700001","42543-0493-01","AMANTADINE HCL 100 MG PO CAPS","BOTH IP/OP","$8.13 ","$6.02 ","$0.00 ","$7.37 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.37 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364","ERX","HCPCS 63700001","62332-0246-31","AMANTADINE HCL 100 MG PO CAPS","BOTH IP/OP","$8.13 ","$6.02 ","$0.00 ","$7.37 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.37 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365","ERX","HCPCS 63700001","00121-0646-16","AMANTADINE HCL 50 MG/5ML PO SYRP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365","ERX","HCPCS 63700001","50383-0807-16","AMANTADINE HCL 50 MG/5ML PO SYRP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365","ERX","HCPCS 63700001","60432-0093-16","AMANTADINE HCL 50 MG/5ML PO SYRP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365","ERX","HCPCS 63700001","99999-6008-86","AMANTADINE HCL 50 MG/5ML PO SYRP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"391","ERX","HCPCS 63700001","00574-0292-01","AMILORIDE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"391","ERX","HCPCS 63700001","49884-0117-01","AMILORIDE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"391","ERX","HCPCS 63700001","50268-0071-15","AMILORIDE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"403","ERX","HCPCS 25000001","00409-4346-16","AMINOCAPROIC ACID 250 MG/ML IV SOLN","BOTH IP/OP","$36.63 ","$27.11 ","$0.00 ","$32.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.68 ","$0.00 ","$16.34 ","$25.88 ","$26.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"403","ERX","HCPCS 25000001","00409-4346-73","AMINOCAPROIC ACID 250 MG/ML IV SOLN","BOTH IP/OP","$36.63 ","$27.11 ","$0.00 ","$32.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.68 ","$0.00 ","$16.34 ","$25.88 ","$26.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"403","ERX","HCPCS 25000001","00517-9120-25","AMINOCAPROIC ACID 250 MG/ML IV SOLN","BOTH IP/OP","$36.63 ","$27.11 ","$0.00 ","$32.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.68 ","$0.00 ","$16.34 ","$25.88 ","$26.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"407","ERX","HCPCS J0280","00409-5921-01","AMINOPHYLLINE 25 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.51 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"407","ERX","HCPCS J0280","00409-5922-01","AMINOPHYLLINE 25 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.51 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"407","ERX","HCPCS J0280","00409-5922-16","AMINOPHYLLINE 25 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.51 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"432","ERX","HCPCS 63700001","16714-0446-01","AMITRIPTYLINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"432","ERX","HCPCS 63700001","51079-0131-01","AMITRIPTYLINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"432","ERX","HCPCS 63700001","51079-0131-20","AMITRIPTYLINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"435","ERX","HCPCS 63700001","16714-0447-01","AMITRIPTYLINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"435","ERX","HCPCS 63700001","51079-0107-20","AMITRIPTYLINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"436","ERX","HCPCS 63700001","51079-0133-01","AMITRIPTYLINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"436","ERX","HCPCS 63700001","51079-0133-20","AMITRIPTYLINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"437","ERX","HCPCS 63700001","16714-0449-01","AMITRIPTYLINE HCL 75 MG PO TABS","BOTH IP/OP","$7.61 ","$5.63 ","$0.00 ","$6.90 ","","$1.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.90 ","$0.00 ","$3.45 ","$5.46 ","$5.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"449","ERX","HCPCS 63700001","00591-5714-01","AMOXAPINE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450","ERX","HCPCS 63700001","00781-2020-01","AMOXICILLIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450","ERX","HCPCS 63700001","00781-2020-05","AMOXICILLIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450","ERX","HCPCS 63700001","16714-0298-02","AMOXICILLIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"451","ERX","HCPCS 63700001","00781-2613-05","AMOXICILLIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"451","ERX","HCPCS 63700001","16714-0299-03","AMOXICILLIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"451","ERX","HCPCS 63700001","16714-0299-04","AMOXICILLIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"451","ERX","HCPCS 63700001","65862-0017-05","AMOXICILLIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"452","ERX","HCPCS 63700001","00093-2268-01","AMOXICILLIN 250 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"453","ERX","HCPCS 25000001","00143-9888-80","AMOXICILLIN 125 MG/5ML PO SUSR","BOTH IP/OP","$11.86 ","$8.78 ","$0.00 ","$11.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.86 ","$0.00 ","$5.93 ","$9.39 ","$9.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"453","ERX","HCPCS 25000001","00781-6039-58","AMOXICILLIN 125 MG/5ML PO SUSR","BOTH IP/OP","$11.86 ","$8.78 ","$0.00 ","$11.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.86 ","$0.00 ","$5.93 ","$9.39 ","$9.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"454","ERX","HCPCS 63700001","00093-4155-79","AMOXICILLIN 250 MG/5ML PO SUSR","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$15.90 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"454","ERX","HCPCS 63700001","00781-6041-58","AMOXICILLIN 250 MG/5ML PO SUSR","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$15.90 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"454","ERX","HCPCS 63700001","00093-4155-80","AMOXICILLIN 250 MG/5ML PO SUSR","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"454","ERX","HCPCS 63700001","00143-9889-15","AMOXICILLIN 250 MG/5ML PO SUSR","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"454","ERX","HCPCS 63700001","00781-6041-55","AMOXICILLIN 250 MG/5ML PO SUSR","BOTH IP/OP","$29.54 ","$21.86 ","$0.00 ","$26.79 ","","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.79 ","$0.00 ","$13.40 ","$21.22 ","$21.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"464","ERX","HCPCS J0285","39822-1055-05","AMPHOTERICIN B 50 MG IV SOLR","BOTH IP/OP","$189.57 ","$140.28 ","$0.00 ","$166.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.25 ","$0.00 ","$83.13 ","$131.67 ","$133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"466","ERX","HCPCS 63700001","00781-2145-01","AMPICILLIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"469","ERX","HCPCS J0290","00781-3404-85","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","00781-3404-95","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","00781-9404-95","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","25021-0136-10","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","44567-0102-10","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","55150-0113-10","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","67457-0351-01","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"469","ERX","HCPCS J0290","67457-0351-10","AMPICILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$36.19 ","$26.78 ","$0.00 ","$32.82 ","$16.29 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$32.82 ","$0.00 ","$16.41 ","$25.99 ","$26.26 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"471","ERX","HCPCS 25000001","00781-3400-78","AMPICILLIN SODIUM 125 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"471","ERX","HCPCS 25000001","00781-3400-95","AMPICILLIN SODIUM 125 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"472","ERX","HCPCS J0290","00781-3408-95","AMPICILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$70.20 ","$51.95 ","$0.00 ","$63.67 ","$31.59 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$63.67 ","$0.00 ","$31.84 ","$50.43 ","$50.94 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"472","ERX","HCPCS J0290","00781-9408-95","AMPICILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$70.20 ","$51.95 ","$0.00 ","$63.67 ","$31.59 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$63.67 ","$0.00 ","$31.84 ","$50.43 ","$50.94 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"472","ERX","HCPCS J0290","25021-0137-20","AMPICILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$70.20 ","$51.95 ","$0.00 ","$63.67 ","$31.59 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$63.67 ","$0.00 ","$31.84 ","$50.43 ","$50.94 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"472","ERX","HCPCS J0290","44567-0103-10","AMPICILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$70.20 ","$51.95 ","$0.00 ","$63.67 ","$31.59 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$63.67 ","$0.00 ","$31.84 ","$50.43 ","$50.94 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"472","ERX","HCPCS J0290","55150-0114-20","AMPICILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$70.20 ","$51.95 ","$0.00 ","$63.67 ","$31.59 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$63.67 ","$0.00 ","$31.84 ","$50.43 ","$50.94 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"474","ERX","HCPCS J0290","00781-3407-78","AMPICILLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$1.15 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.15 ","$0.00 ","$1.10 ","$0.00 "
"474","ERX","HCPCS J0290","00781-3407-95","AMPICILLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$1.15 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.15 ","$0.00 ","$1.10 ","$0.00 "
"474","ERX","HCPCS J0290","00781-9407-78","AMPICILLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$1.15 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.15 ","$0.00 ","$1.10 ","$0.00 "
"474","ERX","HCPCS J0290","00781-9407-95","AMPICILLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$1.15 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.15 ","$0.00 ","$1.10 ","$0.00 "
"474","ERX","HCPCS J0290","44567-0101-10","AMPICILLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$1.15 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.15 ","$0.00 ","$1.10 ","$0.00 "
"474","ERX","HCPCS J0290","55150-0112-10","AMPICILLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$1.15 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.15 ","$0.00 ","$1.10 ","$0.00 "
"612","ERX","HCPCS 63700001","72140-0452-31","AQUAPHOR EX OINT","BOTH IP/OP","$24.31 ","$17.99 ","$0.00 ","$154.00 ","","$4.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$154.00 ","$0.00 ","$77.00 ","$16.55 ","$123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"612","ERX","HCPCS 63700001","72140-0031-47","AQUAPHOR EX OINT","BOTH IP/OP","$24.31 ","$17.99 ","$0.00 ","$154.00 ","","$4.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$154.00 ","$0.00 ","$77.00 ","$121.97 ","$123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"654","ERX","HCPCS 25000001","67457-0118-50","ASCORBIC ACID 500 MG/ML IJ SOLN","BOTH IP/OP","$364.90 ","$270.03 ","$0.00 ","$331.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.23 ","$0.00 ","$165.62 ","$262.33 ","$264.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"680","ERX","HCPCS 25000001","00536-1008-36","ASPIRIN 81 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"680","ERX","HCPCS 25000001","00904-4040-73","ASPIRIN 81 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"680","ERX","HCPCS 25000001","00904-6794-80","ASPIRIN 81 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"680","ERX","HCPCS 25000001","63739-0434-01","ASPIRIN 81 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"680","ERX","HCPCS 25000001","66553-0002-01","ASPIRIN 81 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"681","ERX","HCPCS 25000001","66553-0001-01","ASPIRIN 325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"693","ERX","HCPCS 25000001","00574-7034-12","ASPIRIN 300 MG RECTAL SUPP","BOTH IP/OP","$6.11 ","$4.52 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"716","ERX","HCPCS 63700001","00781-1507-01","ATENOLOL 100 MG PO TABS","BOTH IP/OP","$6.26 ","$4.63 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"716","ERX","HCPCS 63700001","51079-0685-01","ATENOLOL 100 MG PO TABS","BOTH IP/OP","$6.26 ","$4.63 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"716","ERX","HCPCS 63700001","51079-0685-20","ATENOLOL 100 MG PO TABS","BOTH IP/OP","$6.26 ","$4.63 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"716","ERX","HCPCS 63700001","68382-0024-01","ATENOLOL 100 MG PO TABS","BOTH IP/OP","$6.26 ","$4.63 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"717","ERX","HCPCS 63700001","00093-0787-01","ATENOLOL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"717","ERX","HCPCS 63700001","00781-1078-01","ATENOLOL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"717","ERX","HCPCS 63700001","51079-0759-01","ATENOLOL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"717","ERX","HCPCS 63700001","51079-0759-20","ATENOLOL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"718","ERX","HCPCS 63700001","00781-1506-01","ATENOLOL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"718","ERX","HCPCS 63700001","51079-0684-20","ATENOLOL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"718","ERX","HCPCS 63700001","68382-0023-01","ATENOLOL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"731","ERX","HCPCS J0461","00517-0401-25","ATROPINE SULFATE 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.88 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.88 ","$0.00 ","$1.79 ","$0.00 "
"731","ERX","HCPCS J0461","99999-6008-06","ATROPINE SULFATE 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.88 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.88 ","$0.00 ","$1.79 ","$0.00 "
"734","ERX","HCPCS J0461","00517-1010-25","ATROPINE SULFATE 1 MG/ML IJ SOLN","BOTH IP/OP","$63.16 ","$46.74 ","$0.00 ","$55.09 ","$28.42 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$9.40 ","$55.09 ","$0.00 ","$27.55 ","$43.63 ","$44.07 ","$0.00 ","$9.40 ","$0.00 ","$8.95 ","$0.00 "
"735","ERX","HCPCS 25000001","24208-0825-55","ATROPINE SULFATE 1 % OP OINT","BOTH IP/OP","$81.11 ","$60.02 ","$0.00 ","$73.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.54 ","$0.00 ","$36.77 ","$58.24 ","$58.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"736","ERX","HCPCS 25000001","17478-0215-02","ATROPINE SULFATE 1 % OP SOLN","BOTH IP/OP","$184.74 ","$136.71 ","$0.00 ","$156.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.10 ","$0.00 ","$78.05 ","$123.63 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"736","ERX","HCPCS 25000001","00065-0303-55","ATROPINE SULFATE 1 % OP SOLN","BOTH IP/OP","$184.74 ","$136.71 ","$0.00 ","$156.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.10 ","$0.00 ","$78.05 ","$145.65 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"736","ERX","HCPCS 25000001","17478-0215-05","ATROPINE SULFATE 1 % OP SOLN","BOTH IP/OP","$184.74 ","$136.71 ","$0.00 ","$156.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.10 ","$0.00 ","$78.05 ","$145.65 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"850","ERX","HCPCS 25000001","45802-0060-70","BACITRACIN 500 UNIT/GM EX OINT","BOTH IP/OP","$14.52 ","$10.74 ","$0.00 ","$13.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.17 ","$0.00 ","$6.59 ","$10.43 ","$10.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"850","ERX","HCPCS 25000001","00713-0280-31","BACITRACIN 500 UNIT/GM EX OINT","BOTH IP/OP","$14.52 ","$10.74 ","$0.00 ","$13.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.17 ","$0.00 ","$6.59 ","$10.43 ","$10.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851","ERX","HCPCS 25000001","00009-0233-01","BACITRACIN 50000 UNITS IM SOLR","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851","ERX","HCPCS 25000001","00009-0233-03","BACITRACIN 50000 UNITS IM SOLR","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851","ERX","HCPCS 25000001","63323-0329-31","BACITRACIN 50000 UNITS IM SOLR","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851","ERX","HCPCS 25000001","70594-0026-01","BACITRACIN 50000 UNITS IM SOLR","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851","ERX","HCPCS 25000001","70594-0026-02","BACITRACIN 50000 UNITS IM SOLR","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"852","ERX","HCPCS 25000001","00574-4022-35","BACITRACIN 500 UNIT/GM OP OINT","BOTH IP/OP","$361.25 ","$267.33 ","$0.00 ","$361.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.25 ","$0.00 ","$180.63 ","$286.11 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"854","ERX","HCPCS 25000001","45802-0143-03","BACITRACIN-NEOMYCIN-POLYMYXIN 400-5-5000 EX OINT","BOTH IP/OP","$25.82 ","$19.11 ","$0.00 ","$23.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.41 ","$0.00 ","$11.71 ","$18.54 ","$18.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"856","ERX","HCPCS 25000001","24208-0555-55","BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","BOTH IP/OP","$110.60 ","$81.84 ","$0.00 ","$100.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.28 ","$0.00 ","$50.14 ","$79.42 ","$80.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"860","ERX","HCPCS 63700001","00904-6475-61","BACLOFEN 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"860","ERX","HCPCS 63700001","16714-0071-04","BACLOFEN 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"860","ERX","HCPCS 63700001","63739-0479-10","BACLOFEN 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"860","ERX","HCPCS 63700001","68084-0855-01","BACLOFEN 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"987","ERX","HCPCS 25000001","54162-0100-01","BENZOIN COMPOUND EX TINC","BOTH IP/OP","$41.74 ","$30.89 ","$0.00 ","$36.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.03 ","$0.00 ","$18.02 ","$11.09 ","$28.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"987","ERX","HCPCS 25000001","54162-0100-02","BENZOIN COMPOUND EX TINC","BOTH IP/OP","$41.74 ","$30.89 ","$0.00 ","$36.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.03 ","$0.00 ","$18.02 ","$16.06 ","$28.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"987","ERX","HCPCS 25000001","54162-0100-04","BENZOIN COMPOUND EX TINC","BOTH IP/OP","$41.74 ","$30.89 ","$0.00 ","$36.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.03 ","$0.00 ","$18.02 ","$28.42 ","$28.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"987","ERX","HCPCS 25000001","00395-0243-92","BENZOIN COMPOUND EX TINC","BOTH IP/OP","$41.74 ","$30.89 ","$0.00 ","$36.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.03 ","$0.00 ","$18.02 ","$28.54 ","$28.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","00904-6564-60","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","00904-6564-61","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","42291-0164-01","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","42291-0164-50","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","60687-0346-01","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","60687-0346-11","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","63739-0029-10","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","67877-0573-01","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"988","ERX","HCPCS 63700001","68382-0247-01","BENZONATATE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"989","ERX","HCPCS 25000001","00536-1056-56","BENZOYL PEROXIDE 10 % EX GEL","BOTH IP/OP","$29.03 ","$21.48 ","$0.00 ","$26.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.33 ","$0.00 ","$13.17 ","$20.85 ","$21.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"991","ERX","HCPCS 25000001","00536-1055-56","BENZOYL PEROXIDE 5 % EX GEL","BOTH IP/OP","$23.87 ","$17.66 ","$0.00 ","$21.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.65 ","$0.00 ","$10.83 ","$17.15 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"998","ERX","HCPCS 63700001","00603-2437-21","BENZTROPINE MESYLATE 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"998","ERX","HCPCS 63700001","60687-0356-01","BENZTROPINE MESYLATE 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"998","ERX","HCPCS 63700001","60687-0356-11","BENZTROPINE MESYLATE 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"998","ERX","HCPCS 63700001","69315-0136-01","BENZTROPINE MESYLATE 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"999","ERX","HCPCS 63700001","00603-2438-21","BENZTROPINE MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"999","ERX","HCPCS 63700001","10135-0607-01","BENZTROPINE MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"999","ERX","HCPCS 63700001","60687-0368-01","BENZTROPINE MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"999","ERX","HCPCS 63700001","60687-0368-11","BENZTROPINE MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"999","ERX","HCPCS 63700001","76385-0104-01","BENZTROPINE MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1000","ERX","HCPCS 63700001","00603-2439-21","BENZTROPINE MESYLATE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1000","ERX","HCPCS 63700001","69315-0138-01","BENZTROPINE MESYLATE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1029","ERX","HCPCS 63700001","00168-0056-15","BETAMETHASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$213.36 ","$157.89 ","$0.00 ","$193.68 ","","$37.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.68 ","$0.00 ","$96.84 ","$153.39 ","$154.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1029","ERX","HCPCS 63700001","00472-0381-15","BETAMETHASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$213.36 ","$157.89 ","$0.00 ","$193.68 ","","$37.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.68 ","$0.00 ","$96.84 ","$153.39 ","$154.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1044","ERX","HCPCS 63700001","00832-0512-01","BETHANECHOL CHLORIDE 25 MG PO TABS","BOTH IP/OP","$8.98 ","$6.65 ","$0.00 ","$8.14 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.14 ","$0.00 ","$4.07 ","$6.45 ","$6.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1044","ERX","HCPCS 63700001","00832-0512-89","BETHANECHOL CHLORIDE 25 MG PO TABS","BOTH IP/OP","$8.98 ","$6.65 ","$0.00 ","$8.14 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.14 ","$0.00 ","$4.07 ","$6.45 ","$6.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1044","ERX","HCPCS 63700001","65162-0573-10","BETHANECHOL CHLORIDE 25 MG PO TABS","BOTH IP/OP","$8.98 ","$6.65 ","$0.00 ","$8.14 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.14 ","$0.00 ","$4.07 ","$6.45 ","$6.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1079","ERX","HCPCS 63700001","00904-6407-61","BISACODYL 5 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1079","ERX","HCPCS 63700001","00904-7927-60","BISACODYL 5 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1079","ERX","HCPCS 63700001","49483-0003-01","BISACODYL 5 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1080","ERX","HCPCS 63700001","00574-7050-12","BISACODYL 10 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1080","ERX","HCPCS 63700001","00574-7050-50","BISACODYL 10 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1080","ERX","HCPCS 63700001","57896-0443-05","BISACODYL 10 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1080","ERX","HCPCS 63700001","57896-0444-05","BISACODYL 10 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1080","ERX","HCPCS 63700001","68784-0102-12","BISACODYL 10 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1080","ERX","HCPCS 63700001","81421-0021-01","BISACODYL 10 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1090","ERX","HCPCS 25000001","37000-0032-01","BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1259","ERX","HCPCS 25000001","46017-0018-16","CAFFEINE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1259","ERX","HCPCS 25000001","70677-0021-01","CAFFEINE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1262","ERX","HCPCS 25000001","00517-2502-10","CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN","BOTH IP/OP","$58.05 ","$42.96 ","$0.00 ","$47.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.95 ","$0.00 ","$23.98 ","$37.98 ","$38.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1306","ERX","HCPCS 25000001","00409-1631-10","CALCIUM CHLORIDE 10 % IV SOLN","BOTH IP/OP","$89.52 ","$66.24 ","$0.00 ","$81.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.17 ","$0.00 ","$40.59 ","$64.29 ","$64.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1306","ERX","HCPCS 25000001","00409-4928-34","CALCIUM CHLORIDE 10 % IV SOLN","BOTH IP/OP","$89.52 ","$66.24 ","$0.00 ","$81.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.17 ","$0.00 ","$40.59 ","$64.29 ","$64.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1306","ERX","HCPCS 25000001","00517-2710-25","CALCIUM CHLORIDE 10 % IV SOLN","BOTH IP/OP","$89.52 ","$66.24 ","$0.00 ","$81.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.17 ","$0.00 ","$40.59 ","$64.29 ","$64.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1306","ERX","HCPCS 25000001","00517-6710-01","CALCIUM CHLORIDE 10 % IV SOLN","BOTH IP/OP","$89.52 ","$66.24 ","$0.00 ","$81.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.17 ","$0.00 ","$40.59 ","$64.29 ","$64.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1306","ERX","HCPCS 25000001","00517-6710-10","CALCIUM CHLORIDE 10 % IV SOLN","BOTH IP/OP","$89.52 ","$66.24 ","$0.00 ","$81.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.17 ","$0.00 ","$40.59 ","$64.29 ","$64.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1306","ERX","HCPCS 25000001","76329-3304-01","CALCIUM CHLORIDE 10 % IV SOLN","BOTH IP/OP","$89.52 ","$66.24 ","$0.00 ","$81.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.17 ","$0.00 ","$40.59 ","$64.29 ","$64.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1308","ERX","HCPCS 63700001","00904-5062-60","CALCIUM CITRATE 950 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1312","ERX","HCPCS J0610","63323-0360-19","CALCIUM GLUCONATE 10 % IV SOLN","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$32.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.04 ","$32.00 ","$0.00 ","$16.00 ","$25.34 ","$25.60 ","$0.00 ","$4.04 ","$0.00 ","$0.00 ","$0.00 "
"1350","ERX","HCPCS 63700001","00536-2525-25","CAPSAICIN 0.025 % EX CREA","BOTH IP/OP","$41.74 ","$30.89 ","$0.00 ","$37.85 ","","$7.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.85 ","$0.00 ","$18.93 ","$29.98 ","$30.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1355","ERX","HCPCS 63700001","00904-3854-61","CARBAMAZEPINE 100 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1356","ERX","HCPCS 25000001","99999-6004-61","CARBAMAZEPINE 100 MG/5ML PO SUSP","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$97.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.02 ","$0.00 ","$48.51 ","$76.84 ","$77.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1356","ERX","HCPCS 25000001","00078-0508-83","CARBAMAZEPINE 100 MG/5ML PO SUSP","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$472.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.02 ","$0.00 ","$48.51 ","$472.86 ","$77.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1356","ERX","HCPCS 25000001","60432-0129-16","CARBAMAZEPINE 100 MG/5ML PO SUSP","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$472.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.02 ","$0.00 ","$48.51 ","$472.86 ","$77.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1357","ERX","HCPCS 63700001","00904-6172-61","CARBAMAZEPINE 200 MG PO TABS","BOTH IP/OP","$6.08 ","$4.50 ","$0.00 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.08 ","$0.00 ","$3.04 ","$4.82 ","$4.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1357","ERX","HCPCS 63700001","51079-0385-20","CARBAMAZEPINE 200 MG PO TABS","BOTH IP/OP","$6.08 ","$4.50 ","$0.00 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.08 ","$0.00 ","$3.04 ","$4.82 ","$4.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1395","ERX","HCPCS 63700001","42543-0700-01","CARISOPRODOL 350 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","00143-9262-25","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","00143-9924-90","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","00781-3451-96","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","25021-0101-10","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","44567-0707-25","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","60505-6142-05","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1445","ERX","HCPCS J0690","63323-0237-10","CEFAZOLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.93 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$0.00 "
"1446","ERX","HCPCS J0690","00143-9261-01","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1446","ERX","HCPCS J0690","00143-9261-10","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1446","ERX","HCPCS J0690","00143-9983-03","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1446","ERX","HCPCS J0690","00781-3452-95","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1446","ERX","HCPCS J0690","25021-0102-99","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1446","ERX","HCPCS J0690","44567-0708-10","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1446","ERX","HCPCS J0690","63323-0238-61","CEFAZOLIN SODIUM 10 G IJ SOLR","BOTH IP/OP","$60.34 ","$44.65 ","$0.00 ","$54.72 ","$27.15 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$19.27 ","$54.72 ","$0.00 ","$27.36 ","$43.34 ","$43.78 ","$0.00 ","$19.27 ","$0.00 ","$18.35 ","$0.00 "
"1448","ERX","HCPCS J0690","00143-9923-90","CEFAZOLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.69 ","$0.00 ","$0.00 ","$0.96 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"1448","ERX","HCPCS J0690","00781-3450-95","CEFAZOLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.69 ","$0.00 ","$0.00 ","$0.96 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"1448","ERX","HCPCS J0690","25021-0100-10","CEFAZOLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.69 ","$0.00 ","$0.00 ","$0.96 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"1448","ERX","HCPCS J0690","63323-0236-10","CEFAZOLIN SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.69 ","$0.00 ","$0.00 ","$0.96 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"1465","ERX","HCPCS J0697","00143-9979-22","CEFUROXIME SODIUM 750 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1465","ERX","HCPCS J0697","25021-0118-10","CEFUROXIME SODIUM 750 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1622","ERX","HCPCS 25000001","00555-0033-02","CHLORDIAZEPOXIDE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1622","ERX","HCPCS 25000001","51079-0375-01","CHLORDIAZEPOXIDE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1622","ERX","HCPCS 25000001","51079-0375-20","CHLORDIAZEPOXIDE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1623","ERX","HCPCS 25000001","51079-0141-01","CHLORDIAZEPOXIDE HCL 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1623","ERX","HCPCS 25000001","51079-0141-20","CHLORDIAZEPOXIDE HCL 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1624","ERX","HCPCS 25000001","00555-0158-02","CHLORDIAZEPOXIDE HCL 5 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1624","ERX","HCPCS 25000001","51079-0374-01","CHLORDIAZEPOXIDE HCL 5 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1624","ERX","HCPCS 25000001","51079-0374-20","CHLORDIAZEPOXIDE HCL 5 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1637","ERX","HCPCS 63700001","64980-0177-50","CHLOROQUINE PHOSPHATE 250 MG PO TABS","BOTH IP/OP","$38.53 ","$28.51 ","$0.00 ","$34.94 ","","$6.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.94 ","$0.00 ","$17.47 ","$27.67 ","$27.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1645","ERX","HCPCS 63700001","00904-0012-59","CHLORPHENIRAMINE MALEATE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1645","ERX","HCPCS 63700001","10135-0133-01","CHLORPHENIRAMINE MALEATE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1649","ERX","HCPCS J3230","00641-1397-31","CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$133.82 ","$99.03 ","$0.00 ","$121.34 ","$60.22 ","$0.00 ","$9.35 ","$0.00 ","$0.00 ","$37.08 ","$121.34 ","$0.00 ","$60.67 ","$96.10 ","$97.07 ","$0.00 ","$37.08 ","$0.00 ","$35.31 ","$0.00 "
"1649","ERX","HCPCS J3230","00641-1397-35","CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$133.82 ","$99.03 ","$0.00 ","$121.34 ","$60.22 ","$0.00 ","$9.35 ","$0.00 ","$0.00 ","$37.08 ","$121.34 ","$0.00 ","$60.67 ","$96.10 ","$97.07 ","$0.00 ","$37.08 ","$0.00 ","$35.31 ","$0.00 "
"1653","ERX","HCPCS Q0161","00781-5913-01","CHLORPROMAZINE HCL 10 MG PO TABS","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$25.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.41 ","$25.20 ","$0.00 ","$12.60 ","$19.96 ","$20.16 ","$0.00 ","$3.94 ","$0.00 ","$4.01 ","$0.00 "
"1653","ERX","HCPCS Q0161","00832-0300-00","CHLORPROMAZINE HCL 10 MG PO TABS","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$25.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.41 ","$25.20 ","$0.00 ","$12.60 ","$19.96 ","$20.16 ","$0.00 ","$3.94 ","$0.00 ","$4.01 ","$0.00 "
"1653","ERX","HCPCS Q0161","51079-0518-01","CHLORPROMAZINE HCL 10 MG PO TABS","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$25.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.41 ","$25.20 ","$0.00 ","$12.60 ","$19.96 ","$20.16 ","$0.00 ","$3.94 ","$0.00 ","$4.01 ","$0.00 "
"1653","ERX","HCPCS Q0161","51079-0518-20","CHLORPROMAZINE HCL 10 MG PO TABS","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$25.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.41 ","$25.20 ","$0.00 ","$12.60 ","$19.96 ","$20.16 ","$0.00 ","$3.94 ","$0.00 ","$4.01 ","$0.00 "
"1654","ERX","HCPCS Q0161","00832-0303-00","CHLORPROMAZINE HCL 100 MG PO TABS","BOTH IP/OP","$77.83 ","$57.59 ","$0.00 ","$77.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.63 ","$77.83 ","$0.00 ","$38.92 ","$61.64 ","$62.26 ","$0.00 ","$12.18 ","$0.00 ","$0.00 ","$0.00 "
"1654","ERX","HCPCS Q0161","51079-0516-01","CHLORPROMAZINE HCL 100 MG PO TABS","BOTH IP/OP","$77.83 ","$57.59 ","$0.00 ","$77.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.63 ","$77.83 ","$0.00 ","$38.92 ","$61.64 ","$62.26 ","$0.00 ","$12.18 ","$0.00 ","$0.00 ","$0.00 "
"1654","ERX","HCPCS Q0161","51079-0516-20","CHLORPROMAZINE HCL 100 MG PO TABS","BOTH IP/OP","$77.83 ","$57.59 ","$0.00 ","$77.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.63 ","$77.83 ","$0.00 ","$38.92 ","$61.64 ","$62.26 ","$0.00 ","$12.18 ","$0.00 ","$0.00 ","$0.00 "
"1655","ERX","HCPCS Q0161","00781-5917-01","CHLORPROMAZINE HCL 200 MG PO TABS","BOTH IP/OP","$92.82 ","$68.69 ","$0.00 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.25 ","$92.82 ","$0.00 ","$46.41 ","$73.51 ","$74.26 ","$0.00 ","$14.53 ","$0.00 ","$14.78 ","$0.00 "
"1655","ERX","HCPCS Q0161","00832-0304-00","CHLORPROMAZINE HCL 200 MG PO TABS","BOTH IP/OP","$92.82 ","$68.69 ","$0.00 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.25 ","$92.82 ","$0.00 ","$46.41 ","$73.51 ","$74.26 ","$0.00 ","$14.53 ","$0.00 ","$14.78 ","$0.00 "
"1655","ERX","HCPCS Q0161","51079-0517-01","CHLORPROMAZINE HCL 200 MG PO TABS","BOTH IP/OP","$92.82 ","$68.69 ","$0.00 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.25 ","$92.82 ","$0.00 ","$46.41 ","$73.51 ","$74.26 ","$0.00 ","$14.53 ","$0.00 ","$14.78 ","$0.00 "
"1655","ERX","HCPCS Q0161","51079-0517-20","CHLORPROMAZINE HCL 200 MG PO TABS","BOTH IP/OP","$92.82 ","$68.69 ","$0.00 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.25 ","$92.82 ","$0.00 ","$46.41 ","$73.51 ","$74.26 ","$0.00 ","$14.53 ","$0.00 ","$14.78 ","$0.00 "
"1656","ERX","HCPCS Q0161","00781-5914-01","CHLORPROMAZINE HCL 25 MG PO TABS","BOTH IP/OP","$36.34 ","$26.89 ","$0.00 ","$36.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.36 ","$36.34 ","$0.00 ","$18.17 ","$28.78 ","$29.07 ","$0.00 ","$5.69 ","$0.00 ","$5.79 ","$0.00 "
"1656","ERX","HCPCS Q0161","00832-0301-00","CHLORPROMAZINE HCL 25 MG PO TABS","BOTH IP/OP","$36.34 ","$26.89 ","$0.00 ","$36.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.36 ","$36.34 ","$0.00 ","$18.17 ","$28.78 ","$29.07 ","$0.00 ","$5.69 ","$0.00 ","$5.79 ","$0.00 "
"1656","ERX","HCPCS Q0161","51079-0519-01","CHLORPROMAZINE HCL 25 MG PO TABS","BOTH IP/OP","$36.34 ","$26.89 ","$0.00 ","$36.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.36 ","$36.34 ","$0.00 ","$18.17 ","$28.78 ","$29.07 ","$0.00 ","$5.69 ","$0.00 ","$5.79 ","$0.00 "
"1656","ERX","HCPCS Q0161","51079-0519-20","CHLORPROMAZINE HCL 25 MG PO TABS","BOTH IP/OP","$36.34 ","$26.89 ","$0.00 ","$36.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.36 ","$36.34 ","$0.00 ","$18.17 ","$28.78 ","$29.07 ","$0.00 ","$5.69 ","$0.00 ","$5.79 ","$0.00 "
"1657","ERX","HCPCS Q0161","00781-5915-01","CHLORPROMAZINE HCL 50 MG PO TABS","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","$19.57 ","$0.00 ","$9.06 ","$0.00 ","$0.00 ","$6.90 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$6.17 ","$0.00 ","$6.28 ","$0.00 "
"1657","ERX","HCPCS Q0161","00832-0302-00","CHLORPROMAZINE HCL 50 MG PO TABS","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","$19.57 ","$0.00 ","$9.06 ","$0.00 ","$0.00 ","$6.90 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$6.17 ","$0.00 ","$6.28 ","$0.00 "
"1657","ERX","HCPCS Q0161","00832-0302-89","CHLORPROMAZINE HCL 50 MG PO TABS","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","$19.57 ","$0.00 ","$9.06 ","$0.00 ","$0.00 ","$6.90 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$6.17 ","$0.00 ","$6.28 ","$0.00 "
"1657","ERX","HCPCS Q0161","51079-0130-01","CHLORPROMAZINE HCL 50 MG PO TABS","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","$19.57 ","$0.00 ","$9.06 ","$0.00 ","$0.00 ","$6.90 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$6.17 ","$0.00 ","$6.28 ","$0.00 "
"1657","ERX","HCPCS Q0161","51079-0130-20","CHLORPROMAZINE HCL 50 MG PO TABS","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","$19.57 ","$0.00 ","$9.06 ","$0.00 ","$0.00 ","$6.90 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$6.17 ","$0.00 ","$6.28 ","$0.00 "
"1661","ERX","HCPCS 63700001","00378-0222-01","CHLORTHALIDONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1661","ERX","HCPCS 63700001","16714-0800-01","CHLORTHALIDONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1661","ERX","HCPCS 63700001","43598-0719-01","CHLORTHALIDONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1661","ERX","HCPCS 63700001","57664-0648-88","CHLORTHALIDONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1661","ERX","HCPCS 63700001","68382-0970-01","CHLORTHALIDONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1662","ERX","HCPCS 63700001","00378-0213-01","CHLORTHALIDONE 50 MG PO TABS","BOTH IP/OP","$6.24 ","$4.62 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1662","ERX","HCPCS 63700001","57664-0649-88","CHLORTHALIDONE 50 MG PO TABS","BOTH IP/OP","$6.24 ","$4.62 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1662","ERX","HCPCS 63700001","64980-0304-01","CHLORTHALIDONE 50 MG PO TABS","BOTH IP/OP","$6.24 ","$4.62 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1662","ERX","HCPCS 63700001","66689-0346-99","CHLORTHALIDONE 50 MG PO TABS","BOTH IP/OP","$6.24 ","$4.62 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1664","ERX","HCPCS 63700001","00591-2520-01","CHLORZOXAZONE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1676","ERX","HCPCS J0725","55566-1501-01","CHORIONIC GONADOTROPIN 10000 UNITS IM SOLR","BOTH IP/OP","$75.45 ","$55.83 ","$0.00 ","$65.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.80 ","$0.00 ","$32.90 ","$52.11 ","$52.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1683","ERX","HCPCS 63700001","00904-4314-60","CHROMIUM 200 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$4.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1740","ERX","HCPCS 63700001","00904-5959-61","CLINDAMYCIN HCL 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1740","ERX","HCPCS 63700001","63739-0059-10","CLINDAMYCIN HCL 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1742","ERX","HCPCS 25000001","00168-0201-30","CLINDAMYCIN PHOSPHATE 1 % EX SOLN","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1742","ERX","HCPCS 25000001","45802-0562-01","CLINDAMYCIN PHOSPHATE 1 % EX SOLN","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1753","ERX","HCPCS 63700001","49884-0701-55","CLOMIPHENE CITRATE 50 MG PO TABS","BOTH IP/OP","$29.00 ","$21.46 ","$0.00 ","$26.30 ","","$5.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.30 ","$0.00 ","$13.15 ","$20.83 ","$21.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1754","ERX","HCPCS 63700001","00406-8807-01","CLOMIPRAMINE HCL 50 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1754","ERX","HCPCS 63700001","00781-2037-01","CLOMIPRAMINE HCL 50 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1754","ERX","HCPCS 63700001","51672-4012-06","CLOMIPRAMINE HCL 50 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1755","ERX","HCPCS 25000001","00597-0006-01","CLONIDINE HCL 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1755","ERX","HCPCS 25000001","29300-0135-01","CLONIDINE HCL 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1755","ERX","HCPCS 25000001","51079-0299-01","CLONIDINE HCL 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1755","ERX","HCPCS 25000001","51079-0299-20","CLONIDINE HCL 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1755","ERX","HCPCS 25000001","62332-0054-91","CLONIDINE HCL 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1755","ERX","HCPCS 25000001","63739-0060-10","CLONIDINE HCL 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1756","ERX","HCPCS 25000001","29300-0136-01","CLONIDINE HCL 0.2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1756","ERX","HCPCS 25000001","51079-0300-01","CLONIDINE HCL 0.2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1756","ERX","HCPCS 25000001","51079-0300-20","CLONIDINE HCL 0.2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1756","ERX","HCPCS 25000001","62332-0055-31","CLONIDINE HCL 0.2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1767","ERX","HCPCS 25000001","00904-7822-31","CLOTRIMAZOLE 1 % EX CREA","BOTH IP/OP","$35.96 ","$26.61 ","$0.00 ","$32.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.61 ","$0.00 ","$16.31 ","$25.83 ","$26.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1767","ERX","HCPCS 25000001","45802-0434-11","CLOTRIMAZOLE 1 % EX CREA","BOTH IP/OP","$35.96 ","$26.61 ","$0.00 ","$32.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.61 ","$0.00 ","$16.31 ","$25.83 ","$26.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1768","ERX","HCPCS 25000001","51672-1260-03","CLOTRIMAZOLE 1 % EX SOLN","BOTH IP/OP","$259.32 ","$191.90 ","$0.00 ","$235.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.40 ","$0.00 ","$117.70 ","$186.44 ","$188.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1768","ERX","HCPCS 25000001","70954-0036-20","CLOTRIMAZOLE 1 % EX SOLN","BOTH IP/OP","$259.32 ","$191.90 ","$0.00 ","$235.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.40 ","$0.00 ","$117.70 ","$186.44 ","$188.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1770","ERX","HCPCS 25000001","00395-1949-88","CLOVE OIL OIL","BOTH IP/OP","$27.20 ","$20.13 ","$0.00 ","$23.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.72 ","$0.00 ","$11.86 ","$18.79 ","$18.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1802","ERX","HCPCS 25000001","00054-0244-24","CODEINE SULFATE 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1821","ERX","HCPCS 63700001","00254-2008-01","COLCHICINE 0.6 MG PO TABS","BOTH IP/OP","$28.23 ","$20.89 ","$0.00 ","$25.60 ","","$5.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.60 ","$0.00 ","$12.80 ","$20.28 ","$20.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1821","ERX","HCPCS 63700001","64764-0119-01","COLCHICINE 0.6 MG PO TABS","BOTH IP/OP","$28.23 ","$20.89 ","$0.00 ","$25.60 ","","$5.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.60 ","$0.00 ","$12.80 ","$20.28 ","$20.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1821","ERX","HCPCS 63700001","65162-0710-09","COLCHICINE 0.6 MG PO TABS","BOTH IP/OP","$28.23 ","$20.89 ","$0.00 ","$25.60 ","","$5.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.60 ","$0.00 ","$12.80 ","$20.28 ","$20.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1821","ERX","HCPCS 63700001","66993-0165-02","COLCHICINE 0.6 MG PO TABS","BOTH IP/OP","$28.23 ","$20.89 ","$0.00 ","$25.60 ","","$5.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.60 ","$0.00 ","$12.80 ","$20.28 ","$20.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1985","ERX","HCPCS 25000001","00409-4092-01","CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","BOTH IP/OP","$98.36 ","$72.79 ","$0.00 ","$82.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.08 ","$0.00 ","$41.04 ","$65.01 ","$65.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2007","ERX","HCPCS J3420","00143-9621-01","CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.31 ","$0.00 ","$0.00 ","$2.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.60 ","$0.00 ","$2.47 ","$0.00 "
"2007","ERX","HCPCS J3420","00143-9621-25","CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.31 ","$0.00 ","$0.00 ","$2.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.60 ","$0.00 ","$2.47 ","$0.00 "
"2007","ERX","HCPCS J3420","00517-0031-25","CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.31 ","$0.00 ","$0.00 ","$2.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.60 ","$0.00 ","$2.47 ","$0.00 "
"2007","ERX","HCPCS J3420","63323-0044-00","CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.31 ","$0.00 ","$0.00 ","$2.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.60 ","$0.00 ","$2.47 ","$0.00 "
"2007","ERX","HCPCS J3420","63323-0044-01","CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.31 ","$0.00 ","$0.00 ","$2.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.60 ","$0.00 ","$2.47 ","$0.00 "
"2007","ERX","HCPCS J3420","70069-0005-10","CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.31 ","$0.00 ","$0.00 ","$2.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.60 ","$0.00 ","$2.47 ","$0.00 "
"2017","ERX","HCPCS 63700001","52817-0332-10","CYCLOBENZAPRINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2017","ERX","HCPCS 63700001","52817-0332-50","CYCLOBENZAPRINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2017","ERX","HCPCS 63700001","63739-0531-10","CYCLOBENZAPRINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2017","ERX","HCPCS 63700001","69097-0846-07","CYCLOBENZAPRINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","17478-0100-02","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$133.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$50.56 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","24208-0735-01","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$133.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$50.56 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","61314-0396-01","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$133.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$50.56 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","17478-0100-12","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$133.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$106.07 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","24208-0735-06","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$133.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$106.07 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","61314-0396-03","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$133.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$106.07 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025","ERX","HCPCS 25000001","00065-0396-05","CYCLOPENTOLATE HCL 1 % OP SOLN","BOTH IP/OP","$206.33 ","$152.68 ","$0.00 ","$148.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.93 ","$0.00 ","$66.97 ","$148.34 ","$107.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2033","ERX","HCPCS 63700001","51991-0838-01","CYPROHEPTADINE HCL 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2091","ERX","HCPCS J9130","00703-5075-01","DACARBAZINE 200 MG IV SOLR","BOTH IP/OP","$137.97 ","$102.10 ","$0.00 ","$137.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.56 ","$137.97 ","$0.00 ","$68.99 ","$109.27 ","$110.38 ","$0.00 ","$9.56 ","$0.00 ","$0.00 ","$0.00 "
"2091","ERX","HCPCS J9130","61703-0327-22","DACARBAZINE 200 MG IV SOLR","BOTH IP/OP","$137.97 ","$102.10 ","$0.00 ","$137.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.56 ","$137.97 ","$0.00 ","$68.99 ","$109.27 ","$110.38 ","$0.00 ","$9.56 ","$0.00 ","$0.00 ","$0.00 "
"2091","ERX","HCPCS J9130","63323-0128-20","DACARBAZINE 200 MG IV SOLR","BOTH IP/OP","$137.97 ","$102.10 ","$0.00 ","$137.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.56 ","$137.97 ","$0.00 ","$68.99 ","$109.27 ","$110.38 ","$0.00 ","$9.56 ","$0.00 ","$0.00 ","$0.00 "
"2120","ERX","HCPCS 25000001","00527-1369-01","DANAZOL 200 MG PO CAPS","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$34.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.47 ","$0.00 ","$17.24 ","$27.30 ","$27.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2120","ERX","HCPCS 25000001","00527-1369-06","DANAZOL 200 MG PO CAPS","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$34.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.47 ","$0.00 ","$17.24 ","$27.30 ","$27.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2120","ERX","HCPCS 25000001","00555-0635-02","DANAZOL 200 MG PO CAPS","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$34.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.47 ","$0.00 ","$17.24 ","$27.30 ","$27.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2120","ERX","HCPCS 25000001","00555-0635-09","DANAZOL 200 MG PO CAPS","BOTH IP/OP","$38.00 ","$28.12 ","$0.00 ","$34.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.47 ","$0.00 ","$17.24 ","$27.30 ","$27.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2131","ERX","HCPCS 63700001","47781-0334-31","DAPSONE 100 MG PO TABS","BOTH IP/OP","$11.32 ","$8.38 ","$0.00 ","$10.26 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.26 ","$0.00 ","$5.13 ","$8.13 ","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2131","ERX","HCPCS 63700001","69543-0151-30","DAPSONE 100 MG PO TABS","BOTH IP/OP","$11.32 ","$8.38 ","$0.00 ","$10.26 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.26 ","$0.00 ","$5.13 ","$8.13 ","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2131","ERX","HCPCS 63700001","70954-0136-10","DAPSONE 100 MG PO TABS","BOTH IP/OP","$11.32 ","$8.38 ","$0.00 ","$10.26 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.26 ","$0.00 ","$5.13 ","$8.13 ","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2131","ERX","HCPCS 63700001","70954-0136-20","DAPSONE 100 MG PO TABS","BOTH IP/OP","$11.32 ","$8.38 ","$0.00 ","$10.26 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.26 ","$0.00 ","$5.13 ","$8.13 ","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2132","ERX","HCPCS 63700001","47781-0333-31","DAPSONE 25 MG PO TABS","BOTH IP/OP","$11.48 ","$8.50 ","$0.00 ","$10.41 ","","$2.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.41 ","$0.00 ","$5.21 ","$8.24 ","$8.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2132","ERX","HCPCS 63700001","49938-0102-30","DAPSONE 25 MG PO TABS","BOTH IP/OP","$11.48 ","$8.50 ","$0.00 ","$10.41 ","","$2.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.41 ","$0.00 ","$5.21 ","$8.24 ","$8.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2132","ERX","HCPCS 63700001","70954-0135-20","DAPSONE 25 MG PO TABS","BOTH IP/OP","$11.48 ","$8.50 ","$0.00 ","$10.41 ","","$2.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.41 ","$0.00 ","$5.21 ","$8.24 ","$8.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2286","ERX","HCPCS 63700001","50742-0113-01","DESIPRAMINE HCL 25 MG PO TABS","BOTH IP/OP","$6.93 ","$5.13 ","$0.00 ","$6.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.93 ","$0.00 ","$3.47 ","$5.49 ","$5.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2286","ERX","HCPCS 63700001","69238-1055-01","DESIPRAMINE HCL 25 MG PO TABS","BOTH IP/OP","$6.93 ","$5.13 ","$0.00 ","$6.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.93 ","$0.00 ","$3.47 ","$5.49 ","$5.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2287","ERX","HCPCS 63700001","45963-0343-02","DESIPRAMINE HCL 50 MG PO TABS","BOTH IP/OP","$11.23 ","$8.31 ","$0.00 ","$10.18 ","","$2.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.18 ","$0.00 ","$5.09 ","$8.06 ","$8.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2287","ERX","HCPCS 63700001","50742-0114-01","DESIPRAMINE HCL 50 MG PO TABS","BOTH IP/OP","$11.23 ","$8.31 ","$0.00 ","$10.18 ","","$2.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.18 ","$0.00 ","$5.09 ","$8.06 ","$8.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2291","ERX","HCPCS 25000001","45802-0422-37","DESONIDE 0.05 % EX CREA","BOTH IP/OP","$299.81 ","$221.86 ","$0.00 ","$272.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.16 ","$0.00 ","$136.08 ","$215.55 ","$217.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2291","ERX","HCPCS 25000001","51672-1280-03","DESONIDE 0.05 % EX CREA","BOTH IP/OP","$299.81 ","$221.86 ","$0.00 ","$272.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.16 ","$0.00 ","$136.08 ","$215.55 ","$217.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2319","ERX","HCPCS J8540","54879-0003-08","DEXAMETHASONE 0.5 MG/5ML PO ELIX","BOTH IP/OP","$200.83 ","$148.61 ","$0.00 ","$162.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.50 ","$162.75 ","$0.00 ","$81.38 ","$159.06 ","$130.20 ","$0.00 ","$31.43 ","$0.00 ","$25.91 ","$0.00 "
"2319","ERX","HCPCS J8540","60432-0466-08","DEXAMETHASONE 0.5 MG/5ML PO ELIX","BOTH IP/OP","$200.83 ","$148.61 ","$0.00 ","$162.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.50 ","$162.75 ","$0.00 ","$81.38 ","$159.06 ","$130.20 ","$0.00 ","$31.43 ","$0.00 ","$25.91 ","$0.00 "
"2322","ERX","HCPCS J8540","00054-4179-25","DEXAMETHASONE 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$0.14 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"2322","ERX","HCPCS J8540","00054-8179-25","DEXAMETHASONE 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$0.14 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"2327","ERX","HCPCS 25000001","00054-4184-25","DEXAMETHASONE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2327","ERX","HCPCS 25000001","00054-8175-25","DEXAMETHASONE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2332","ERX","HCPCS J1100","00641-6145-25","DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.42 ","$0.00 ","$0.00 ","$0.56 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.56 ","$0.00 ","$0.54 ","$0.00 "
"2332","ERX","HCPCS J1100","55150-0237-01","DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.42 ","$0.00 ","$0.00 ","$0.56 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.56 ","$0.00 ","$0.54 ","$0.00 "
"2332","ERX","HCPCS J1100","63323-0165-01","DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.42 ","$0.00 ","$0.00 ","$0.56 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.56 ","$0.00 ","$0.54 ","$0.00 "
"2332","ERX","HCPCS J1100","63323-0165-02","DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.42 ","$0.00 ","$0.00 ","$0.56 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.56 ","$0.00 ","$0.54 ","$0.00 "
"2332","ERX","HCPCS J1100","67457-0423-12","DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.42 ","$0.00 ","$0.00 ","$0.56 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.56 ","$0.00 ","$0.54 ","$0.00 "
"2335","ERX","HCPCS 25000001","24208-0720-02","DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN","BOTH IP/OP","$224.44 ","$166.09 ","$0.00 ","$203.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.75 ","$0.00 ","$101.88 ","$161.37 ","$163.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2354","ERX","HCPCS 63700001","00406-8958-01","DEXTROAMPHETAMINE SULFATE 5 MG PO TABS","BOTH IP/OP","$12.16 ","$9.00 ","$0.00 ","$11.02 ","","$2.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.02 ","$0.00 ","$5.51 ","$8.73 ","$8.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2354","ERX","HCPCS 63700001","00555-0952-02","DEXTROAMPHETAMINE SULFATE 5 MG PO TABS","BOTH IP/OP","$12.16 ","$9.00 ","$0.00 ","$11.02 ","","$2.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.02 ","$0.00 ","$5.51 ","$8.73 ","$8.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2354","ERX","HCPCS 63700001","13107-0035-01","DEXTROAMPHETAMINE SULFATE 5 MG PO TABS","BOTH IP/OP","$12.16 ","$9.00 ","$0.00 ","$11.02 ","","$2.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.02 ","$0.00 ","$5.51 ","$8.73 ","$8.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00264-7520-20","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$17.42 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00338-0023-02","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$17.42 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00264-7520-10","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$18.06 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00338-0023-03","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$18.06 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00409-7930-03","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$18.06 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00338-0023-04","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$24.08 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2357","ERX","HCPCS 25000001","00409-7930-09","DEXTROSE 10 % IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$24.08 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2359","ERX","HCPCS 25000001","00990-7935-19","DEXTROSE 20 % IV SOLN","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$53.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2361","ERX","HCPCS 25000001","00409-1775-10","DEXTROSE 250 MG/ML IV SOLN","BOTH IP/OP","$53.13 ","$39.32 ","$0.00 ","$41.73 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.73 ","$0.00 ","$20.87 ","$33.05 ","$33.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2364","ERX","HCPCS J7060","00264-7510-20","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-02","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00264-1510-31","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-11","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-31","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-41","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0551-11","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00264-7510-10","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-03","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","63323-0624-75","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-04","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-18","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-38","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0017-48","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2364","ERX","HCPCS J7060","00338-0551-18","DEXTROSE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.80 ","$9.90 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$4.28 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$4.28 ","$0.00 ","$2.04 ","$0.00 "
"2365","ERX","HCPCS 25000001","00409-6648-02","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2365","ERX","HCPCS 25000001","00409-6648-16","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2365","ERX","HCPCS 25000001","00409-7517-16","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2365","ERX","HCPCS 25000001","00409-7936-19","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2365","ERX","HCPCS 25000001","69374-0953-50","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2365","ERX","HCPCS 25000001","76329-3301-01","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2365","ERX","HCPCS 25000001","99999-6007-48","DEXTROSE 50 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2367","ERX","HCPCS 25000001","00264-7387-50","DEXTROSE 70 % IV SOLN","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.40 ","$0.00 ","$34.20 ","$54.17 ","$54.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2367","ERX","HCPCS 25000001","00338-0719-06","DEXTROSE 70 % IV SOLN","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.40 ","$0.00 ","$34.20 ","$54.17 ","$54.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2401","ERX","HCPCS J3360","00409-1273-32","DIAZEPAM 5 MG/ML IJ SOLN","BOTH IP/OP","$34.97 ","$25.88 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2401","ERX","HCPCS J3360","69339-0136-02","DIAZEPAM 5 MG/ML IJ SOLN","BOTH IP/OP","$34.97 ","$25.88 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2401","ERX","HCPCS J3360","69339-0136-32","DIAZEPAM 5 MG/ML IJ SOLN","BOTH IP/OP","$34.97 ","$25.88 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2405","ERX","HCPCS 25000001","00172-3926-60","DIAZEPAM 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2405","ERX","HCPCS 25000001","00904-5880-61","DIAZEPAM 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2405","ERX","HCPCS 25000001","51079-0285-20","DIAZEPAM 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2405","ERX","HCPCS 25000001","63739-0073-10","DIAZEPAM 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2412","ERX","HCPCS 25000001","55741-0402-02","DIBUCAINE 1 % EX OINT","BOTH IP/OP","$83.21 ","$61.58 ","$0.00 ","$65.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.12 ","$0.00 ","$15.06 ","$65.90 ","$24.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2412","ERX","HCPCS 25000001","00536-1211-95","DIBUCAINE 1 % EX OINT","BOTH IP/OP","$30.12 ","$22.29 ","$0.00 ","$30.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.12 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2412","ERX","HCPCS 25000001","54162-0011-01","DIBUCAINE 1 % EX OINT","BOTH IP/OP","$30.12 ","$22.29 ","$0.00 ","$30.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.12 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2414","ERX","HCPCS 63700001","00093-3123-01","DICLOXACILLIN SODIUM 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2414","ERX","HCPCS 63700001","00781-2248-01","DICLOXACILLIN SODIUM 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2418","ERX","HCPCS 63700001","00378-1610-01","DICYCLOMINE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2418","ERX","HCPCS 63700001","00378-1610-05","DICYCLOMINE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2418","ERX","HCPCS 63700001","00527-0586-01","DICYCLOMINE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2418","ERX","HCPCS 63700001","00591-0794-01","DICYCLOMINE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2420","ERX","HCPCS J0500","00378-1620-01","DICYCLOMINE HCL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$59.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$59.65 ","$0.00 "
"2420","ERX","HCPCS J0500","00527-1282-01","DICYCLOMINE HCL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$59.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$59.65 ","$0.00 "
"2420","ERX","HCPCS J0500","00591-0795-01","DICYCLOMINE HCL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$59.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$59.65 ","$0.00 "
"2420","ERX","HCPCS J0500","51079-0119-20","DICYCLOMINE HCL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$59.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$59.65 ","$0.00 "
"2442","ERX","HCPCS J1160","00641-1410-31","DIGOXIN 0.25 MG/ML IJ SOLN","BOTH IP/OP","$27.66 ","$20.47 ","$0.00 ","$25.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2442","ERX","HCPCS J1160","00641-1410-35","DIGOXIN 0.25 MG/ML IJ SOLN","BOTH IP/OP","$27.66 ","$20.47 ","$0.00 ","$25.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2442","ERX","HCPCS J1160","00641-6184-01","DIGOXIN 0.25 MG/ML IJ SOLN","BOTH IP/OP","$27.66 ","$20.47 ","$0.00 ","$25.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2442","ERX","HCPCS J1160","00641-6184-25","DIGOXIN 0.25 MG/ML IJ SOLN","BOTH IP/OP","$27.66 ","$20.47 ","$0.00 ","$25.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2442","ERX","HCPCS J1160","00781-3059-72","DIGOXIN 0.25 MG/ML IJ SOLN","BOTH IP/OP","$27.66 ","$20.47 ","$0.00 ","$25.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2442","ERX","HCPCS J1160","00781-3059-95","DIGOXIN 0.25 MG/ML IJ SOLN","BOTH IP/OP","$27.66 ","$20.47 ","$0.00 ","$25.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2444","ERX","HCPCS 63700001","00143-1240-01","DIGOXIN 0.125 MG PO TABS","BOTH IP/OP","$8.83 ","$6.53 ","$0.00 ","$8.01 ","","$1.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.01 ","$0.00 ","$4.01 ","$6.34 ","$6.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2444","ERX","HCPCS 63700001","16714-0590-01","DIGOXIN 0.125 MG PO TABS","BOTH IP/OP","$8.83 ","$6.53 ","$0.00 ","$8.01 ","","$1.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.01 ","$0.00 ","$4.01 ","$6.34 ","$6.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2445","ERX","HCPCS 63700001","00527-1325-01","DIGOXIN 0.25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2445","ERX","HCPCS 63700001","00904-5922-61","DIGOXIN 0.25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2445","ERX","HCPCS 63700001","16714-0591-01","DIGOXIN 0.25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2474","ERX","HCPCS 63700001","00093-0321-01","DILTIAZEM HCL 120 MG PO TABS","BOTH IP/OP","$12.09 ","$8.95 ","$0.00 ","$10.96 ","","$2.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.96 ","$0.00 ","$5.48 ","$8.68 ","$8.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2475","ERX","HCPCS 63700001","00093-0318-01","DILTIAZEM HCL 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2475","ERX","HCPCS 63700001","63739-0079-10","DILTIAZEM HCL 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2475","ERX","HCPCS 63700001","68682-0006-10","DILTIAZEM HCL 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2476","ERX","HCPCS 63700001","00378-0045-05","DILTIAZEM HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2476","ERX","HCPCS 63700001","51079-0746-20","DILTIAZEM HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2476","ERX","HCPCS 63700001","63739-0080-10","DILTIAZEM HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2476","ERX","HCPCS 63700001","68682-0007-10","DILTIAZEM HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2477","ERX","HCPCS 63700001","00093-0320-01","DILTIAZEM HCL 90 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2508","ERX","HCPCS J1200","00641-0376-21","DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.86 ","$0.00 ","$0.00 ","$1.06 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.06 ","$0.00 ","$1.01 ","$0.00 "
"2508","ERX","HCPCS J1200","00641-0376-25","DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.86 ","$0.00 ","$0.00 ","$1.06 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.06 ","$0.00 ","$1.01 ","$0.00 "
"2508","ERX","HCPCS J1200","63323-0664-01","DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.86 ","$0.00 ","$0.00 ","$1.06 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.06 ","$0.00 ","$1.01 ","$0.00 "
"2509","ERX","HCPCS J3490","00904-5306-61","DIPHENHYDRAMINE HCL 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$3.26 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.96 ","$0.00 "
"2510","ERX","HCPCS Q0163","00904-2056-61","DIPHENHYDRAMINE HCL 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$3.26 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.96 ","$0.00 "
"2511","ERX","HCPCS Q0163","00121-0489-00","DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","BOTH IP/OP","$9.01 ","$6.67 ","$0.00 ","$8.17 ","$4.05 ","$0.00 ","$1.88 ","$0.00 ","$0.00 ","$1.43 ","$8.17 ","$0.00 ","$4.09 ","$6.47 ","$6.54 ","$0.00 ","$1.28 ","$0.00 ","$1.30 ","$0.00 "
"2511","ERX","HCPCS Q0163","00121-0489-05","DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","BOTH IP/OP","$9.01 ","$6.67 ","$0.00 ","$8.17 ","$4.05 ","$0.00 ","$1.88 ","$0.00 ","$0.00 ","$1.43 ","$8.17 ","$0.00 ","$4.09 ","$6.47 ","$6.54 ","$0.00 ","$1.28 ","$0.00 ","$1.30 ","$0.00 "
"2515","ERX","HCPCS 63700001","99999-6009-38","DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$11.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2516","ERX","HCPCS 63700001","00378-0415-01","DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2516","ERX","HCPCS 63700001","59762-1061-01","DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2528","ERX","HCPCS 63700001","64980-0133-01","DIPYRIDAMOLE 25 MG PO TABS","BOTH IP/OP","$11.91 ","$8.81 ","$0.00 ","$10.80 ","","$2.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.80 ","$0.00 ","$5.40 ","$8.55 ","$8.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2537","ERX","HCPCS 63700001","00025-2732-31","DISOPYRAMIDE PHOSPHATE ER 100 MG PO CP12","BOTH IP/OP","$21.08 ","$15.60 ","$0.00 ","$18.29 ","","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.29 ","$0.00 ","$9.15 ","$14.49 ","$14.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2551","ERX","HCPCS 63700001","00074-6212-13","DIVALPROEX SODIUM 125 MG PO TBEC","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2551","ERX","HCPCS 63700001","00832-7122-11","DIVALPROEX SODIUM 125 MG PO TBEC","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2552","ERX","HCPCS 63700001","00832-7123-15","DIVALPROEX SODIUM 250 MG PO TBEC","BOTH IP/OP","$9.08 ","$6.72 ","$0.00 ","$8.23 ","","$1.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.23 ","$0.00 ","$4.12 ","$6.52 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2552","ERX","HCPCS 63700001","68084-0776-01","DIVALPROEX SODIUM 250 MG PO TBEC","BOTH IP/OP","$9.08 ","$6.72 ","$0.00 ","$8.23 ","","$1.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.23 ","$0.00 ","$4.12 ","$6.52 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2553","ERX","HCPCS 63700001","00832-7124-01","DIVALPROEX SODIUM 500 MG PO TBEC","BOTH IP/OP","$13.47 ","$9.97 ","$0.00 ","$12.35 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2553","ERX","HCPCS 63700001","00832-7124-11","DIVALPROEX SODIUM 500 MG PO TBEC","BOTH IP/OP","$13.47 ","$9.97 ","$0.00 ","$12.35 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2553","ERX","HCPCS 63700001","62756-0798-13","DIVALPROEX SODIUM 500 MG PO TBEC","BOTH IP/OP","$13.47 ","$9.97 ","$0.00 ","$12.35 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2553","ERX","HCPCS 63700001","62756-0798-88","DIVALPROEX SODIUM 500 MG PO TBEC","BOTH IP/OP","$13.47 ","$9.97 ","$0.00 ","$12.35 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2553","ERX","HCPCS 63700001","68084-0782-61","DIVALPROEX SODIUM 500 MG PO TBEC","BOTH IP/OP","$13.47 ","$9.97 ","$0.00 ","$12.35 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2565","ERX","HCPCS 63700001","00904-6459-59","DOCUSATE CALCIUM 240 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2565","ERX","HCPCS 63700001","49348-0280-10","DOCUSATE CALCIUM 240 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2566","ERX","HCPCS 63700001","00904-6455-61","DOCUSATE SODIUM 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2566","ERX","HCPCS 63700001","00904-6457-60","DOCUSATE SODIUM 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2566","ERX","HCPCS 63700001","00904-6457-80","DOCUSATE SODIUM 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2566","ERX","HCPCS 63700001","69618-0044-10","DOCUSATE SODIUM 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2569","ERX","HCPCS 63700001","50383-0771-10","DOCUSATE SODIUM 150 MG/15ML PO LIQD","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2569","ERX","HCPCS 63700001","50383-0771-11","DOCUSATE SODIUM 150 MG/15ML PO LIQD","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2569","ERX","HCPCS 63700001","50383-0771-16","DOCUSATE SODIUM 150 MG/15ML PO LIQD","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2595","ERX","HCPCS J1265","00409-9104-20","DOPAMINE HCL 40 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2595","ERX","HCPCS J1265","00409-5820-01","DOPAMINE HCL 40 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2607","ERX","HCPCS 25000001","00641-6018-06","DOXAPRAM HCL 20 MG/ML IV SOLN","BOTH IP/OP","$221.60 ","$163.98 ","$0.00 ","$183.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$183.02 ","$0.00 ","$91.51 ","$144.95 ","$146.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2608","ERX","HCPCS 63700001","00378-1049-01","DOXEPIN HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2608","ERX","HCPCS 63700001","51079-0436-01","DOXEPIN HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2608","ERX","HCPCS 63700001","51079-0436-20","DOXEPIN HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2609","ERX","HCPCS 63700001","51079-0651-01","DOXEPIN HCL 100 MG PO CAPS","BOTH IP/OP","$8.37 ","$6.19 ","$0.00 ","$7.59 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.59 ","$0.00 ","$3.80 ","$6.01 ","$6.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2609","ERX","HCPCS 63700001","51079-0651-20","DOXEPIN HCL 100 MG PO CAPS","BOTH IP/OP","$8.37 ","$6.19 ","$0.00 ","$7.59 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.59 ","$0.00 ","$3.80 ","$6.01 ","$6.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2610","ERX","HCPCS 63700001","49884-0222-01","DOXEPIN HCL 150 MG PO CAPS","BOTH IP/OP","$13.95 ","$10.32 ","$0.00 ","$12.65 ","","$2.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.65 ","$0.00 ","$6.33 ","$10.02 ","$10.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2611","ERX","HCPCS 63700001","51079-0437-01","DOXEPIN HCL 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2611","ERX","HCPCS 63700001","51079-0437-20","DOXEPIN HCL 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2612","ERX","HCPCS 63700001","51079-0438-01","DOXEPIN HCL 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2612","ERX","HCPCS 63700001","51079-0438-20","DOXEPIN HCL 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2613","ERX","HCPCS 63700001","00378-5375-01","DOXEPIN HCL 75 MG PO CAPS","BOTH IP/OP","$7.59 ","$5.62 ","$0.00 ","$6.88 ","","$1.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.88 ","$0.00 ","$3.44 ","$5.45 ","$5.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2614","ERX","HCPCS 63700001","54838-0512-40","DOXEPIN HCL 10 MG/ML PO CONC","BOTH IP/OP","$246.93 ","$182.73 ","$0.00 ","$157.36 ","","$43.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.36 ","$0.00 ","$78.68 ","$65.86 ","$125.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2614","ERX","HCPCS 63700001","60432-0651-04","DOXEPIN HCL 10 MG/ML PO CONC","BOTH IP/OP","$246.93 ","$182.73 ","$0.00 ","$157.36 ","","$43.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.36 ","$0.00 ","$78.68 ","$124.63 ","$125.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2616","ERX","HCPCS J9000","00069-3034-20","DOXORUBICIN HCL 2 MG/ML IV SOLN","BOTH IP/OP","$564.48 ","$417.72 ","$0.00 ","$512.40 ","$254.02 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$67.45 ","$512.40 ","$0.00 ","$256.20 ","$405.82 ","$409.92 ","$0.00 ","$67.45 ","$0.00 ","$64.22 ","$0.00 "
"2616","ERX","HCPCS J9000","00069-4034-01","DOXORUBICIN HCL 2 MG/ML IV SOLN","BOTH IP/OP","$564.48 ","$417.72 ","$0.00 ","$512.40 ","$254.02 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$67.45 ","$512.40 ","$0.00 ","$256.20 ","$405.82 ","$409.92 ","$0.00 ","$67.45 ","$0.00 ","$64.22 ","$0.00 "
"2616","ERX","HCPCS J9000","00143-9546-01","DOXORUBICIN HCL 2 MG/ML IV SOLN","BOTH IP/OP","$564.48 ","$417.72 ","$0.00 ","$512.40 ","$254.02 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$67.45 ","$512.40 ","$0.00 ","$256.20 ","$405.82 ","$409.92 ","$0.00 ","$67.45 ","$0.00 ","$64.22 ","$0.00 "
"2616","ERX","HCPCS J9000","45963-0733-60","DOXORUBICIN HCL 2 MG/ML IV SOLN","BOTH IP/OP","$564.48 ","$417.72 ","$0.00 ","$512.40 ","$254.02 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$67.45 ","$512.40 ","$0.00 ","$256.20 ","$405.82 ","$409.92 ","$0.00 ","$67.45 ","$0.00 ","$64.22 ","$0.00 "
"2616","ERX","HCPCS J9000","70860-0208-51","DOXORUBICIN HCL 2 MG/ML IV SOLN","BOTH IP/OP","$564.48 ","$417.72 ","$0.00 ","$512.40 ","$254.02 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$67.45 ","$512.40 ","$0.00 ","$256.20 ","$405.82 ","$409.92 ","$0.00 ","$67.45 ","$0.00 ","$64.22 ","$0.00 "
"2622","ERX","HCPCS 25000001","63323-0130-11","DOXYCYCLINE HYCLATE 100 MG IV SOLR","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2622","ERX","HCPCS 25000001","63323-0130-13","DOXYCYCLINE HYCLATE 100 MG IV SOLR","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2622","ERX","HCPCS 25000001","68382-0910-01","DOXYCYCLINE HYCLATE 100 MG IV SOLR","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2622","ERX","HCPCS 25000001","68382-0910-10","DOXYCYCLINE HYCLATE 100 MG IV SOLR","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2654","ERX","HCPCS J1790","00517-9702-01","DROPERIDOL 2.5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$5.16 ","$0.00 "
"2654","ERX","HCPCS J1790","00517-9702-25","DROPERIDOL 2.5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$5.16 ","$0.00 "
"2805","ERX","HCPCS 25000001","00536-7415-51","ENEMA 7-19 GM/133ML RECTAL ENEM","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2887","ERX","HCPCS 25000001","45802-0038-46","ERYTHROMYCIN 2 % EX SOLN","BOTH IP/OP","$192.93 ","$142.77 ","$0.00 ","$166.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.74 ","$0.00 ","$83.37 ","$132.06 ","$133.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2887","ERX","HCPCS 25000001","60432-0671-60","ERYTHROMYCIN 2 % EX SOLN","BOTH IP/OP","$192.93 ","$142.77 ","$0.00 ","$166.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.74 ","$0.00 ","$83.37 ","$132.06 ","$133.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","00574-4024-11","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$72.21 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$57.19 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","00574-4024-50","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$72.21 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$57.19 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","17478-0070-31","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$72.21 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$57.19 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","24208-0910-19","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$72.21 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$57.19 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","00574-4024-35","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$105.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$105.35 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","17478-0070-35","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$105.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$105.35 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2888","ERX","HCPCS 25000001","24208-0910-55","ERYTHROMYCIN 5 MG/GM OP OINT","BOTH IP/OP","$146.70 ","$108.56 ","$0.00 ","$105.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.21 ","$0.00 ","$36.11 ","$105.35 ","$57.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2899","ERX","HCPCS 63700001","24338-0132-13","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR","BOTH IP/OP","$1,318.38 ","$975.60 ","$0.00 ","$1,196.48 ","","$234.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,196.48 ","$0.00 ","$598.24 ","$947.61 ","$957.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2899","ERX","HCPCS 63700001","24338-0134-02","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR","BOTH IP/OP","$1,318.38 ","$975.60 ","$0.00 ","$1,196.48 ","","$234.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,196.48 ","$0.00 ","$598.24 ","$947.61 ","$957.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2899","ERX","HCPCS 63700001","62559-0630-01","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR","BOTH IP/OP","$1,318.38 ","$975.60 ","$0.00 ","$1,196.48 ","","$234.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,196.48 ","$0.00 ","$598.24 ","$947.61 ","$957.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2899","ERX","HCPCS 63700001","69238-1503-01","ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR","BOTH IP/OP","$1,318.38 ","$975.60 ","$0.00 ","$1,196.48 ","","$234.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,196.48 ","$0.00 ","$598.24 ","$947.61 ","$957.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2903","ERX","HCPCS J1364","00409-6476-44","ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","BOTH IP/OP","$344.04 ","$254.59 ","$0.00 ","$307.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.68 ","$0.00 ","$153.84 ","$243.68 ","$246.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2903","ERX","HCPCS J1364","00409-6482-01","ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","BOTH IP/OP","$344.04 ","$254.59 ","$0.00 ","$307.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.68 ","$0.00 ","$153.84 ","$243.68 ","$246.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2931","ERX","HCPCS J1380","00574-0870-05","ESTRADIOL VALERATE 20 MG/ML IM OIL","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.66 ","$21.16 ","$0.00 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.66 ","$0.00 ","$21.33 ","$33.79 ","$34.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2931","ERX","HCPCS J1380","42023-0111-01","ESTRADIOL VALERATE 20 MG/ML IM OIL","BOTH IP/OP","$47.03 ","$34.80 ","$0.00 ","$42.66 ","$21.16 ","$0.00 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$42.66 ","$0.00 ","$21.33 ","$33.79 ","$34.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2938","ERX","HCPCS 63700001","00046-1104-81","ESTROGENS CONJUGATED 1.25 MG PO TABS","BOTH IP/OP","$32.11 ","$23.76 ","$0.00 ","$26.93 ","","$5.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.93 ","$0.00 ","$13.47 ","$21.33 ","$21.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3000","ERX","HCPCS 25000001","10119-0002-52","EYE WASH OP SOLN","BOTH IP/OP","$11.87 ","$8.78 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3059","ERX","HCPCS 63700001","48783-0112-08","FERRIC SUBSULFATE PASTE","BOTH IP/OP","$62.85 ","$46.51 ","$0.00 ","$57.00 ","","$11.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3069","ERX","HCPCS 63700001","99999-6004-65","FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3069","ERX","HCPCS 63700001","99999-6010-60","FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3069","ERX","HCPCS 63700001","50383-0778-16","FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$51.25 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$51.25 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3069","ERX","HCPCS 63700001","54838-0001-80","FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$51.25 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$51.25 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3074","ERX","HCPCS 63700001","00904-7590-60","FERROUS SULFATE 325 (65 FE) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3074","ERX","HCPCS 63700001","00904-7591-60","FERROUS SULFATE 325 (65 FE) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3074","ERX","HCPCS 63700001","00904-7591-61","FERROUS SULFATE 325 (65 FE) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3128","ERX","HCPCS 25000001","00132-0202-20","FLEET PEDIATRIC 3.5-9.5 GM/66ML RECTAL ENEM","BOTH IP/OP","$9.13 ","$6.76 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3177","ERX","HCPCS J9200","00143-9270-01","FLOXURIDINE 0.5 G IJ SOLR","BOTH IP/OP","$479.81 ","$355.06 ","$0.00 ","$435.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$435.54 ","$0.00 ","$217.77 ","$344.95 ","$348.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3177","ERX","HCPCS J9200","63323-0145-07","FLOXURIDINE 0.5 G IJ SOLR","BOTH IP/OP","$479.81 ","$355.06 ","$0.00 ","$435.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$435.54 ","$0.00 ","$217.77 ","$344.95 ","$348.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3184","ERX","HCPCS 25000001","00168-0060-15","FLUOCINOLONE ACETONIDE 0.025 % EX CREA","BOTH IP/OP","$130.34 ","$96.45 ","$0.00 ","$118.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.18 ","$0.00 ","$59.09 ","$93.60 ","$94.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3184","ERX","HCPCS 25000001","52565-0020-15","FLUOCINOLONE ACETONIDE 0.025 % EX CREA","BOTH IP/OP","$130.34 ","$96.45 ","$0.00 ","$118.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.18 ","$0.00 ","$59.09 ","$93.60 ","$94.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3185","ERX","HCPCS 25000001","00168-0064-15","FLUOCINOLONE ACETONIDE 0.025 % EX OINT","BOTH IP/OP","$130.34 ","$96.45 ","$0.00 ","$118.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.18 ","$0.00 ","$59.09 ","$93.60 ","$94.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3185","ERX","HCPCS 25000001","00713-0224-15","FLUOCINOLONE ACETONIDE 0.025 % EX OINT","BOTH IP/OP","$130.34 ","$96.45 ","$0.00 ","$118.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.18 ","$0.00 ","$59.09 ","$93.60 ","$94.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3186","ERX","HCPCS 25000001","00168-0059-60","FLUOCINOLONE ACETONIDE 0.01 % EX SOLN","BOTH IP/OP","$154.71 ","$114.49 ","$0.00 ","$549.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3186","ERX","HCPCS 25000001","51672-1365-04","FLUOCINOLONE ACETONIDE 0.01 % EX SOLN","BOTH IP/OP","$154.71 ","$114.49 ","$0.00 ","$549.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3186","ERX","HCPCS 25000001","52565-0012-59","FLUOCINOLONE ACETONIDE 0.01 % EX SOLN","BOTH IP/OP","$154.71 ","$114.49 ","$0.00 ","$549.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3187","ERX","HCPCS 25000001","00093-0262-15","FLUOCINONIDE 0.05 % EX CREA","BOTH IP/OP","$175.85 ","$130.13 ","$0.00 ","$159.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.45 ","$0.00 ","$79.73 ","$126.28 ","$127.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3187","ERX","HCPCS 25000001","51672-1253-01","FLUOCINONIDE 0.05 % EX CREA","BOTH IP/OP","$175.85 ","$130.13 ","$0.00 ","$159.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.45 ","$0.00 ","$79.73 ","$126.28 ","$127.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3187","ERX","HCPCS 25000001","51672-1386-01","FLUOCINONIDE 0.05 % EX CREA","BOTH IP/OP","$175.85 ","$130.13 ","$0.00 ","$159.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.45 ","$0.00 ","$79.73 ","$126.28 ","$127.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3187","ERX","HCPCS 25000001","00093-0262-30","FLUOCINONIDE 0.05 % EX CREA","BOTH IP/OP","$175.85 ","$130.13 ","$0.00 ","$227.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.45 ","$0.00 ","$79.73 ","$227.30 ","$127.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3187","ERX","HCPCS 25000001","51672-1253-02","FLUOCINONIDE 0.05 % EX CREA","BOTH IP/OP","$175.85 ","$130.13 ","$0.00 ","$227.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.45 ","$0.00 ","$79.73 ","$227.30 ","$127.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3187","ERX","HCPCS 25000001","51672-1386-02","FLUOCINONIDE 0.05 % EX CREA","BOTH IP/OP","$175.85 ","$130.13 ","$0.00 ","$227.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.45 ","$0.00 ","$79.73 ","$227.30 ","$127.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3188","ERX","HCPCS 25000001","51672-1279-01","FLUOCINONIDE 0.05 % EX GEL","BOTH IP/OP","$695.55 ","$514.71 ","$0.00 ","$631.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.23 ","$0.00 ","$315.62 ","$499.93 ","$504.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3188","ERX","HCPCS 25000001","51672-1279-02","FLUOCINONIDE 0.05 % EX GEL","BOTH IP/OP","$695.55 ","$514.71 ","$0.00 ","$631.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.23 ","$0.00 ","$315.62 ","$499.93 ","$504.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3188","ERX","HCPCS 25000001","00168-0135-60","FLUOCINONIDE 0.05 % EX GEL","BOTH IP/OP","$695.55 ","$514.71 ","$0.00 ","$631.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.23 ","$0.00 ","$315.62 ","$499.93 ","$504.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3188","ERX","HCPCS 25000001","51672-1279-03","FLUOCINONIDE 0.05 % EX GEL","BOTH IP/OP","$695.55 ","$514.71 ","$0.00 ","$631.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.23 ","$0.00 ","$315.62 ","$499.93 ","$504.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3189","ERX","HCPCS 25000001","00093-0264-15","FLUOCINONIDE 0.05 % EX OINT","BOTH IP/OP","$245.52 ","$181.68 ","$0.00 ","$222.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.88 ","$0.00 ","$111.44 ","$176.52 ","$178.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3189","ERX","HCPCS 25000001","16714-0502-01","FLUOCINONIDE 0.05 % EX OINT","BOTH IP/OP","$245.52 ","$181.68 ","$0.00 ","$222.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.88 ","$0.00 ","$111.44 ","$176.52 ","$178.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3189","ERX","HCPCS 25000001","51672-1264-01","FLUOCINONIDE 0.05 % EX OINT","BOTH IP/OP","$245.52 ","$181.68 ","$0.00 ","$222.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.88 ","$0.00 ","$111.44 ","$176.52 ","$178.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3190","ERX","HCPCS 25000001","00168-0134-60","FLUOCINONIDE 0.05 % EX SOLN","BOTH IP/OP","$337.29 ","$249.59 ","$0.00 ","$306.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.18 ","$0.00 ","$153.09 ","$242.49 ","$244.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3215","ERX","HCPCS J2680","00143-9529-01","FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","BOTH IP/OP","$77.92 ","$57.66 ","$0.00 ","$70.67 ","$35.06 ","$0.00 ","$4.27 ","$0.00 ","$0.00 ","$11.73 ","$70.67 ","$0.00 ","$35.34 ","$55.97 ","$56.54 ","$0.00 ","$11.73 ","$0.00 ","$11.17 ","$0.00 "
"3215","ERX","HCPCS J2680","42023-0129-01","FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","BOTH IP/OP","$77.92 ","$57.66 ","$0.00 ","$70.67 ","$35.06 ","$0.00 ","$4.27 ","$0.00 ","$0.00 ","$11.73 ","$70.67 ","$0.00 ","$35.34 ","$55.97 ","$56.54 ","$0.00 ","$11.73 ","$0.00 ","$11.17 ","$0.00 "
"3215","ERX","HCPCS J2680","55150-0267-05","FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","BOTH IP/OP","$77.92 ","$57.66 ","$0.00 ","$70.67 ","$35.06 ","$0.00 ","$4.27 ","$0.00 ","$0.00 ","$11.73 ","$70.67 ","$0.00 ","$35.34 ","$55.97 ","$56.54 ","$0.00 ","$11.73 ","$0.00 ","$11.17 ","$0.00 "
"3215","ERX","HCPCS J2680","63323-0272-05","FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","BOTH IP/OP","$77.92 ","$57.66 ","$0.00 ","$70.67 ","$35.06 ","$0.00 ","$4.27 ","$0.00 ","$0.00 ","$11.73 ","$70.67 ","$0.00 ","$35.34 ","$55.97 ","$56.54 ","$0.00 ","$11.73 ","$0.00 ","$11.17 ","$0.00 "
"3216","ERX","HCPCS 25000001","63323-0281-10","FLUPHENAZINE HCL 2.5 MG/ML IJ SOLN","BOTH IP/OP","$673.01 ","$498.03 ","$0.00 ","$581.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$581.68 ","$0.00 ","$290.84 ","$460.69 ","$465.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3218","ERX","HCPCS 63700001","00527-1788-01","FLUPHENAZINE HCL 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3219","ERX","HCPCS 63700001","00527-1791-01","FLUPHENAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3220","ERX","HCPCS 63700001","00527-1789-01","FLUPHENAZINE HCL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3221","ERX","HCPCS 63700001","00527-1790-01","FLUPHENAZINE HCL 5 MG PO TABS","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$34.96 ","","$6.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.96 ","$0.00 ","$17.48 ","$27.69 ","$27.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3232","ERX","HCPCS 25000001","63323-0184-10","FOLIC ACID 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3232","ERX","HCPCS 25000001","99999-6005-63","FOLIC ACID 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3233","ERX","HCPCS 63700001","62584-0897-01","FOLIC ACID 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3233","ERX","HCPCS 63700001","62584-0897-11","FOLIC ACID 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3233","ERX","HCPCS 63700001","63739-0537-10","FOLIC ACID 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3233","ERX","HCPCS 63700001","65162-0361-10","FOLIC ACID 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3233","ERX","HCPCS 63700001","65162-0361-11","FOLIC ACID 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3264","ERX","HCPCS 25000001","00264-9341-55","FREAMINE III 10 % IV SOLN","BOTH IP/OP","$164.05 ","$121.40 ","$0.00 ","$148.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-02","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-04","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-10","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-18","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-25","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-26","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-27","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-35","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-36","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","00409-6102-37","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","23155-0473-32","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","23155-0473-42","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","23155-0473-44","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","36000-0282-25","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","36000-0283-25","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","36000-0284-25","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","63323-0280-01","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","63323-0280-02","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","63323-0280-03","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","63323-0280-04","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3291","ERX","HCPCS J1940","63323-0280-10","FUROSEMIDE 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.69 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.69 ","$0.00 ","$0.66 ","$0.00 "
"3292","ERX","HCPCS 25000001","00054-3294-46","FUROSEMIDE 10 MG/ML PO SOLN","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$70.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.56 ","$0.00 ","$35.28 ","$31.24 ","$56.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3292","ERX","HCPCS 25000001","60432-0613-60","FUROSEMIDE 10 MG/ML PO SOLN","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$70.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.56 ","$0.00 ","$35.28 ","$31.24 ","$56.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3292","ERX","HCPCS 25000001","99999-6004-66","FUROSEMIDE 10 MG/ML PO SOLN","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$70.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.56 ","$0.00 ","$35.28 ","$31.24 ","$56.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3292","ERX","HCPCS 25000001","00054-3294-50","FUROSEMIDE 10 MG/ML PO SOLN","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$70.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.56 ","$0.00 ","$35.28 ","$55.88 ","$56.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3294","ERX","HCPCS 63700001","00054-8297-25","FUROSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3294","ERX","HCPCS 63700001","00378-0208-01","FUROSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3294","ERX","HCPCS 63700001","51079-0072-20","FUROSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3295","ERX","HCPCS 63700001","00054-8299-25","FUROSEMIDE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3295","ERX","HCPCS 63700001","00378-0216-01","FUROSEMIDE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3295","ERX","HCPCS 63700001","00781-1966-10","FUROSEMIDE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3295","ERX","HCPCS 63700001","51079-0073-01","FUROSEMIDE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3295","ERX","HCPCS 63700001","51079-0073-20","FUROSEMIDE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3296","ERX","HCPCS 63700001","00054-4301-25","FUROSEMIDE 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3296","ERX","HCPCS 63700001","00054-8301-25","FUROSEMIDE 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3296","ERX","HCPCS 63700001","51079-0527-01","FUROSEMIDE 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3296","ERX","HCPCS 63700001","51079-0527-20","FUROSEMIDE 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3378","ERX","HCPCS 63700001","16714-0101-05","GEMFIBROZIL 600 MG PO TABS","BOTH IP/OP","$9.24 ","$6.84 ","$0.00 ","$9.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.24 ","$0.00 ","$4.62 ","$7.32 ","$7.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3378","ERX","HCPCS 63700001","60687-0224-01","GEMFIBROZIL 600 MG PO TABS","BOTH IP/OP","$9.24 ","$6.84 ","$0.00 ","$9.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.24 ","$0.00 ","$4.62 ","$7.32 ","$7.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3423","ERX","HCPCS 25000001","45802-0056-35","GENTAMICIN SULFATE 0.1 % EX CREA","BOTH IP/OP","$342.70 ","$253.60 ","$0.00 ","$311.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$246.39 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3423","ERX","HCPCS 25000001","45802-0056-11","GENTAMICIN SULFATE 0.1 % EX CREA","BOTH IP/OP","$342.70 ","$253.60 ","$0.00 ","$311.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$246.39 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3424","ERX","HCPCS 25000001","45802-0046-35","GENTAMICIN SULFATE 0.1 % EX OINT","BOTH IP/OP","$342.70 ","$253.60 ","$0.00 ","$311.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$246.39 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3424","ERX","HCPCS 25000001","45802-0046-11","GENTAMICIN SULFATE 0.1 % EX OINT","BOTH IP/OP","$342.70 ","$253.60 ","$0.00 ","$311.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$246.39 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3424","ERX","HCPCS 25000001","52565-0090-30","GENTAMICIN SULFATE 0.1 % EX OINT","BOTH IP/OP","$342.70 ","$253.60 ","$0.00 ","$311.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$246.39 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3425","ERX","HCPCS J1580","63323-0173-02","GENTAMICIN SULFATE 10 MG/ML (NICU) IM INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$10.64 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"3426","ERX","HCPCS J1580","00409-1207-03","GENTAMICIN SULFATE 40 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"3426","ERX","HCPCS J1580","00409-1207-25","GENTAMICIN SULFATE 40 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"3426","ERX","HCPCS J1580","63323-0010-02","GENTAMICIN SULFATE 40 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"3426","ERX","HCPCS J1580","63323-0010-20","GENTAMICIN SULFATE 40 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"3427","ERX","HCPCS 63700001","17478-0284-35","GENTAMICIN SULFATE 0.3 % OP OINT","BOTH IP/OP","$150.36 ","$111.27 ","$0.00 ","$124.05 ","","$26.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.05 ","$0.00 ","$62.03 ","$98.25 ","$99.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3428","ERX","HCPCS 25000001","17478-0283-10","GENTAMICIN SULFATE 0.3 % OP SOLN","BOTH IP/OP","$83.77 ","$61.99 ","$0.00 ","$75.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.95 ","$0.00 ","$37.98 ","$60.15 ","$60.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3428","ERX","HCPCS 25000001","24208-0580-60","GENTAMICIN SULFATE 0.3 % OP SOLN","BOTH IP/OP","$83.77 ","$61.99 ","$0.00 ","$75.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.95 ","$0.00 ","$37.98 ","$60.15 ","$60.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3428","ERX","HCPCS 25000001","60758-0188-05","GENTAMICIN SULFATE 0.3 % OP SOLN","BOTH IP/OP","$83.77 ","$61.99 ","$0.00 ","$75.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.95 ","$0.00 ","$37.98 ","$60.15 ","$60.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3428","ERX","HCPCS 25000001","61314-0633-05","GENTAMICIN SULFATE 0.3 % OP SOLN","BOTH IP/OP","$83.77 ","$61.99 ","$0.00 ","$75.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.95 ","$0.00 ","$37.98 ","$60.15 ","$60.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3430","ERX","HCPCS 25000001","00395-1003-92","GENTIAN VIOLET 1 % EX SOLN","BOTH IP/OP","$34.86 ","$25.80 ","$0.00 ","$30.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.50 ","$0.00 ","$15.25 ","$24.16 ","$24.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3489","ERX","HCPCS 63700001","00093-8344-01","GLYBURIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3489","ERX","HCPCS 63700001","63739-0119-10","GLYBURIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","00143-9587-25","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","00143-9682-01","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","00143-9682-25","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","00517-4601-25","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","00781-3825-71","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","00781-3825-96","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","66794-0202-42","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","70069-0011-25","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3497","ERX","HCPCS 25000001","70121-1394-05","GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3578","ERX","HCPCS 25000001","00378-0351-01","HALOPERIDOL 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3578","ERX","HCPCS 25000001","00781-1391-01","HALOPERIDOL 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3578","ERX","HCPCS 25000001","51079-0733-01","HALOPERIDOL 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3578","ERX","HCPCS 25000001","51079-0733-20","HALOPERIDOL 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3579","ERX","HCPCS 25000001","51079-0734-20","HALOPERIDOL 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3580","ERX","HCPCS 63700001","51079-0431-20","HALOPERIDOL 10 MG PO TABS","BOTH IP/OP","$6.82 ","$5.05 ","$0.00 ","$6.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.82 ","$0.00 ","$3.41 ","$5.40 ","$5.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3580","ERX","HCPCS 63700001","68382-0080-01","HALOPERIDOL 10 MG PO TABS","BOTH IP/OP","$6.82 ","$5.05 ","$0.00 ","$6.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.82 ","$0.00 ","$3.41 ","$5.40 ","$5.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3581","ERX","HCPCS 63700001","00378-0214-01","HALOPERIDOL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3582","ERX","HCPCS 63700001","00378-0335-01","HALOPERIDOL 20 MG PO TABS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3582","ERX","HCPCS 63700001","00781-1398-01","HALOPERIDOL 20 MG PO TABS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3582","ERX","HCPCS 63700001","68382-0081-01","HALOPERIDOL 20 MG PO TABS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3583","ERX","HCPCS 63700001","00378-0327-01","HALOPERIDOL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3583","ERX","HCPCS 63700001","00781-1396-01","HALOPERIDOL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3583","ERX","HCPCS 63700001","51079-0736-20","HALOPERIDOL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3583","ERX","HCPCS 63700001","68382-0079-01","HALOPERIDOL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3584","ERX","HCPCS J1630","00143-9501-25","HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.80 ","$0.00 ","$0.00 ","$1.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.42 ","$0.00 ","$1.35 ","$0.00 "
"3584","ERX","HCPCS J1630","25021-0806-01","HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.80 ","$0.00 ","$0.00 ","$1.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.42 ","$0.00 ","$1.35 ","$0.00 "
"3584","ERX","HCPCS J1630","63323-0474-00","HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.80 ","$0.00 ","$0.00 ","$1.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.42 ","$0.00 ","$1.35 ","$0.00 "
"3584","ERX","HCPCS J1630","63323-0474-01","HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.80 ","$0.00 ","$0.00 ","$1.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.42 ","$0.00 ","$1.35 ","$0.00 "
"3584","ERX","HCPCS J1630","67457-0426-00","HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.80 ","$0.00 ","$0.00 ","$1.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.42 ","$0.00 ","$1.35 ","$0.00 "
"3584","ERX","HCPCS J1630","67457-0426-12","HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.80 ","$0.00 ","$0.00 ","$1.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.42 ","$0.00 ","$1.35 ","$0.00 "
"3585","ERX","HCPCS 25000001","00121-0581-04","HALOPERIDOL LACTATE 2 MG/ML PO CONC","BOTH IP/OP","$9.50 ","$7.03 ","$0.00 ","$8.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.61 ","$0.00 ","$4.31 ","$6.82 ","$6.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3585","ERX","HCPCS 25000001","00121-0581-05","HALOPERIDOL LACTATE 2 MG/ML PO CONC","BOTH IP/OP","$9.50 ","$7.03 ","$0.00 ","$8.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.61 ","$0.00 ","$4.31 ","$6.82 ","$6.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3585","ERX","HCPCS 25000001","99999-6007-06","HALOPERIDOL LACTATE 2 MG/ML PO CONC","BOTH IP/OP","$9.50 ","$7.03 ","$0.00 ","$8.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.61 ","$0.00 ","$4.31 ","$6.82 ","$6.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3697","ERX","HCPCS J0360","63323-0614-00","HYDRALAZINE HCL 20 MG/ML IJ SOLN","BOTH IP/OP","$65.77 ","$48.67 ","$0.00 ","$59.65 ","$32.40 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$4.41 ","$59.65 ","$0.00 ","$29.83 ","$47.24 ","$47.72 ","$0.00 ","$4.41 ","$0.00 ","$4.20 ","$0.00 "
"3697","ERX","HCPCS J0360","63323-0614-01","HYDRALAZINE HCL 20 MG/ML IJ SOLN","BOTH IP/OP","$65.77 ","$48.67 ","$0.00 ","$59.65 ","$32.40 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$4.41 ","$59.65 ","$0.00 ","$29.83 ","$47.24 ","$47.72 ","$0.00 ","$4.41 ","$0.00 ","$4.20 ","$0.00 "
"3697","ERX","HCPCS J0360","63323-0614-55","HYDRALAZINE HCL 20 MG/ML IJ SOLN","BOTH IP/OP","$65.77 ","$48.67 ","$0.00 ","$59.65 ","$32.40 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$4.41 ","$59.65 ","$0.00 ","$29.83 ","$47.24 ","$47.72 ","$0.00 ","$4.41 ","$0.00 ","$4.20 ","$0.00 "
"3697","ERX","HCPCS J0360","67457-0291-01","HYDRALAZINE HCL 20 MG/ML IJ SOLN","BOTH IP/OP","$65.77 ","$48.67 ","$0.00 ","$59.65 ","$32.40 ","$0.00 ","$5.77 ","$0.00 ","$0.00 ","$4.41 ","$59.65 ","$0.00 ","$29.83 ","$47.24 ","$47.72 ","$0.00 ","$4.41 ","$0.00 ","$4.20 ","$0.00 "
"3698","ERX","HCPCS 63700001","00904-6440-61","HYDRALAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3698","ERX","HCPCS 63700001","50111-0398-01","HYDRALAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3698","ERX","HCPCS 63700001","51079-0074-01","HYDRALAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3698","ERX","HCPCS 63700001","51079-0074-20","HYDRALAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3698","ERX","HCPCS 63700001","68084-0447-01","HYDRALAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3699","ERX","HCPCS 63700001","00904-6443-61","HYDRALAZINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3699","ERX","HCPCS 63700001","31722-0522-01","HYDRALAZINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3699","ERX","HCPCS 63700001","50111-0397-01","HYDRALAZINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","00904-6441-61","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","50111-0327-01","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","51079-0075-01","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","51079-0075-20","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","62584-0733-01","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","62584-0733-11","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","63739-0126-10","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3700","ERX","HCPCS 63700001","63739-0327-10","HYDRALAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","00904-6442-61","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","50111-0328-01","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","51079-0076-01","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","62584-0734-01","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","62584-0734-11","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","63739-0328-10","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3701","ERX","HCPCS 63700001","76282-0311-01","HYDRALAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3720","ERX","HCPCS 63700001","16729-0183-01","HYDROCHLOROTHIAZIDE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3720","ERX","HCPCS 63700001","16729-0183-17","HYDROCHLOROTHIAZIDE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3720","ERX","HCPCS 63700001","29300-0128-10","HYDROCHLOROTHIAZIDE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3720","ERX","HCPCS 63700001","63739-0128-10","HYDROCHLOROTHIAZIDE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3721","ERX","HCPCS 63700001","16729-0184-01","HYDROCHLOROTHIAZIDE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3721","ERX","HCPCS 63700001","43547-0398-10","HYDROCHLOROTHIAZIDE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3726","ERX","HCPCS 63700001","45802-0438-03","HYDROCORTISONE 1 % EX CREA","BOTH IP/OP","$30.18 ","$22.33 ","$0.00 ","$11.00 ","","$5.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3726","ERX","HCPCS 63700001","00168-0015-31","HYDROCORTISONE 1 % EX CREA","BOTH IP/OP","$30.18 ","$22.33 ","$0.00 ","$11.00 ","","$5.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3726","ERX","HCPCS 63700001","00168-0154-31","HYDROCORTISONE 1 % EX CREA","BOTH IP/OP","$30.18 ","$22.33 ","$0.00 ","$11.00 ","","$5.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3726","ERX","HCPCS 63700001","51672-2069-02","HYDROCORTISONE 1 % EX CREA","BOTH IP/OP","$30.18 ","$22.33 ","$0.00 ","$11.00 ","","$5.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3727","ERX","HCPCS 63700001","45802-0004-03","HYDROCORTISONE 2.5 % EX CREA","BOTH IP/OP","$46.14 ","$34.14 ","$0.00 ","$41.84 ","","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.84 ","$0.00 ","$20.92 ","$33.14 ","$33.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3727","ERX","HCPCS 63700001","00168-0080-31","HYDROCORTISONE 2.5 % EX CREA","BOTH IP/OP","$46.14 ","$34.14 ","$0.00 ","$41.84 ","","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.84 ","$0.00 ","$20.92 ","$33.14 ","$33.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3727","ERX","HCPCS 63700001","00472-0337-30","HYDROCORTISONE 2.5 % EX CREA","BOTH IP/OP","$46.14 ","$34.14 ","$0.00 ","$41.84 ","","$8.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.84 ","$0.00 ","$20.92 ","$33.14 ","$33.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3728","ERX","HCPCS 63700001","00394-0859-32","HYDROCORTISONE 1 % EX LOTN","BOTH IP/OP","$27.71 ","$20.51 ","$0.00 ","$25.13 ","","$4.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.13 ","$0.00 ","$12.57 ","$19.90 ","$20.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3731","ERX","HCPCS 63700001","00472-0345-56","HYDROCORTISONE 1 % EX OINT","BOTH IP/OP","$14.55 ","$10.77 ","$0.00 ","$13.20 ","","$2.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.20 ","$0.00 ","$6.60 ","$10.45 ","$10.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3731","ERX","HCPCS 63700001","45802-0276-03","HYDROCORTISONE 1 % EX OINT","BOTH IP/OP","$14.55 ","$10.77 ","$0.00 ","$13.20 ","","$2.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.20 ","$0.00 ","$6.60 ","$10.45 ","$10.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3731","ERX","HCPCS 63700001","00168-0020-16","HYDROCORTISONE 1 % EX OINT","BOTH IP/OP","$14.55 ","$10.77 ","$0.00 ","$147.26 ","","$2.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.20 ","$0.00 ","$6.60 ","$147.26 ","$10.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3732","ERX","HCPCS 63700001","45802-0014-02","HYDROCORTISONE 2.5 % EX OINT","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$41.80 ","","$8.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3732","ERX","HCPCS 63700001","00168-0146-30","HYDROCORTISONE 2.5 % EX OINT","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$41.80 ","","$8.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3733","ERX","HCPCS 63700001","59762-0074-01","HYDROCORTISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3734","ERX","HCPCS 63700001","00009-0044-01","HYDROCORTISONE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3734","ERX","HCPCS 63700001","42543-0142-01","HYDROCORTISONE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3734","ERX","HCPCS 63700001","59762-0075-01","HYDROCORTISONE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3734","ERX","HCPCS 63700001","72789-0062-01","HYDROCORTISONE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3738","ERX","HCPCS 25000001","00574-7090-12","HYDROCORTISONE ACETATE 25 MG RECTAL SUPP","BOTH IP/OP","$254.19 ","$188.10 ","$0.00 ","$198.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.20 ","$0.00 ","$99.10 ","$156.97 ","$158.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3738","ERX","HCPCS 25000001","00713-0503-12","HYDROCORTISONE ACETATE 25 MG RECTAL SUPP","BOTH IP/OP","$254.19 ","$188.10 ","$0.00 ","$198.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.20 ","$0.00 ","$99.10 ","$156.97 ","$158.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3738","ERX","HCPCS 25000001","00713-0503-24","HYDROCORTISONE ACETATE 25 MG RECTAL SUPP","BOTH IP/OP","$254.19 ","$188.10 ","$0.00 ","$198.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.20 ","$0.00 ","$99.10 ","$156.97 ","$158.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3738","ERX","HCPCS 25000001","16477-0201-24","HYDROCORTISONE ACETATE 25 MG RECTAL SUPP","BOTH IP/OP","$254.19 ","$188.10 ","$0.00 ","$198.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.20 ","$0.00 ","$99.10 ","$156.97 ","$158.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3738","ERX","HCPCS 25000001","65649-0411-12","HYDROCORTISONE ACETATE 25 MG RECTAL SUPP","BOTH IP/OP","$254.19 ","$188.10 ","$0.00 ","$198.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.20 ","$0.00 ","$99.10 ","$156.97 ","$158.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3738","ERX","HCPCS 25000001","65649-0411-24","HYDROCORTISONE ACETATE 25 MG RECTAL SUPP","BOTH IP/OP","$254.19 ","$188.10 ","$0.00 ","$198.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.20 ","$0.00 ","$99.10 ","$156.97 ","$158.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3747","ERX","HCPCS 25000001","51672-2010-02","HYDROCORTISONE-ALOE 0.5 % EX CREA","BOTH IP/OP","$23.09 ","$17.09 ","$0.00 ","$20.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.94 ","$0.00 ","$10.47 ","$16.58 ","$16.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3757","ERX","HCPCS J1170","00409-1283-03","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3757","ERX","HCPCS J1170","00409-1283-31","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3757","ERX","HCPCS J1170","00409-2552-01","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3757","ERX","HCPCS J1170","76045-0009-01","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3757","ERX","HCPCS J1170","76045-0009-10","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3757","ERX","HCPCS J1170","76045-0009-11","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3757","ERX","HCPCS J1170","99999-6010-70","HYDROMORPHONE HCL 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3758","ERX","HCPCS J1170","00409-1312-30","HYDROMORPHONE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3758","ERX","HCPCS J1170","00409-3365-01","HYDROMORPHONE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3758","ERX","HCPCS J1170","00409-3365-11","HYDROMORPHONE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3758","ERX","HCPCS J1170","00641-0121-25","HYDROMORPHONE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3758","ERX","HCPCS J1170","00641-6151-01","HYDROMORPHONE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3758","ERX","HCPCS J1170","00641-6151-25","HYDROMORPHONE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"3760","ERX","HCPCS 25000001","42858-0301-25","HYDROMORPHONE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3760","ERX","HCPCS 25000001","68084-0423-01","HYDROMORPHONE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3760","ERX","HCPCS 25000001","68084-0423-11","HYDROMORPHONE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3761","ERX","HCPCS 25000001","00054-0264-24","HYDROMORPHONE HCL 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3761","ERX","HCPCS 25000001","42858-0302-25","HYDROMORPHONE HCL 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3770","ERX","HCPCS J3410","00517-5602-25","HYDROXYZINE HCL 50 MG/ML IM SOLN","BOTH IP/OP","$86.30 ","$63.86 ","$0.00 ","$74.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.50 ","$74.23 ","$0.00 ","$37.12 ","$58.79 ","$59.38 ","$0.00 ","$16.50 ","$0.00 ","$15.71 ","$0.00 "
"3771","ERX","HCPCS 63700001","99999-6010-58","HYDROXYZINE HCL 10 MG/5ML PO SYRP","BOTH IP/OP","$42.24 ","$31.26 ","$0.00 ","$38.31 ","","$7.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.31 ","$0.00 ","$19.16 ","$15.17 ","$30.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3771","ERX","HCPCS 63700001","60432-0150-04","HYDROXYZINE HCL 10 MG/5ML PO SYRP","BOTH IP/OP","$42.24 ","$31.26 ","$0.00 ","$38.31 ","","$7.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.31 ","$0.00 ","$19.16 ","$30.34 ","$30.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3771","ERX","HCPCS 63700001","99999-6004-67","HYDROXYZINE HCL 10 MG/5ML PO SYRP","BOTH IP/OP","$42.24 ","$31.26 ","$0.00 ","$38.31 ","","$7.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.31 ","$0.00 ","$19.16 ","$30.34 ","$30.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3771","ERX","HCPCS 63700001","60432-0150-16","HYDROXYZINE HCL 10 MG/5ML PO SYRP","BOTH IP/OP","$42.24 ","$31.26 ","$0.00 ","$110.14 ","","$7.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.31 ","$0.00 ","$19.16 ","$110.14 ","$30.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3772","ERX","HCPCS 63700001","16714-0081-10","HYDROXYZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3772","ERX","HCPCS 63700001","68084-0253-01","HYDROXYZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3772","ERX","HCPCS 63700001","68084-0253-11","HYDROXYZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3774","ERX","HCPCS 63700001","16714-0082-10","HYDROXYZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3774","ERX","HCPCS 63700001","63739-0486-10","HYDROXYZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3774","ERX","HCPCS 63700001","68084-0254-01","HYDROXYZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3778","ERX","HCPCS Q0177","00185-0615-01","HYDROXYZINE PAMOATE 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"3778","ERX","HCPCS Q0177","00185-0615-05","HYDROXYZINE PAMOATE 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"3778","ERX","HCPCS Q0177","51079-0078-20","HYDROXYZINE PAMOATE 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"3781","ERX","HCPCS 25000001","39328-0048-16","HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX","BOTH IP/OP","$57.32 ","$42.42 ","$0.00 ","$51.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.99 ","$0.00 ","$26.00 ","$41.18 ","$41.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3781","ERX","HCPCS 25000001","54838-0511-80","HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX","BOTH IP/OP","$57.32 ","$42.42 ","$0.00 ","$51.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.99 ","$0.00 ","$26.00 ","$41.18 ","$41.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3781","ERX","HCPCS 25000001","58657-0427-16","HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX","BOTH IP/OP","$57.32 ","$42.42 ","$0.00 ","$51.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.99 ","$0.00 ","$26.00 ","$41.18 ","$41.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3781","ERX","HCPCS 25000001","99999-6008-10","HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX","BOTH IP/OP","$57.32 ","$42.42 ","$0.00 ","$51.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.99 ","$0.00 ","$26.00 ","$41.18 ","$41.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3783","ERX","HCPCS 63700001","42192-0340-01","HYOSCYAMINE SULFATE 0.125 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3841","ERX","HCPCS 25000001","00904-7914-59","IBUPROFEN 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3841","ERX","HCPCS 25000001","00904-7914-61","IBUPROFEN 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3841","ERX","HCPCS 25000001","63739-0134-01","IBUPROFEN 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3843","ERX","HCPCS 25000001","00904-5853-60","IBUPROFEN 400 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3843","ERX","HCPCS 25000001","00904-5853-61","IBUPROFEN 400 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3843","ERX","HCPCS 25000001","49483-0602-01","IBUPROFEN 400 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3843","ERX","HCPCS 25000001","60687-0446-01","IBUPROFEN 400 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3843","ERX","HCPCS 25000001","63739-0672-01","IBUPROFEN 400 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3843","ERX","HCPCS 25000001","63739-0672-10","IBUPROFEN 400 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3844","ERX","HCPCS 25000001","00904-5854-61","IBUPROFEN 600 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3844","ERX","HCPCS 25000001","11788-0009-05","IBUPROFEN 600 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3844","ERX","HCPCS 25000001","63739-0684-01","IBUPROFEN 600 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3844","ERX","HCPCS 25000001","63739-0684-10","IBUPROFEN 600 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3845","ERX","HCPCS 25000001","49483-0604-50","IBUPROFEN 800 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3845","ERX","HCPCS 25000001","63739-0691-01","IBUPROFEN 800 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3845","ERX","HCPCS 25000001","63739-0691-10","IBUPROFEN 800 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3860","ERX","HCPCS 63700001","00781-1762-01","IMIPRAMINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3860","ERX","HCPCS 63700001","49884-0054-01","IMIPRAMINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3860","ERX","HCPCS 63700001","53489-0330-01","IMIPRAMINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3861","ERX","HCPCS 63700001","00781-1764-01","IMIPRAMINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3861","ERX","HCPCS 63700001","00781-1764-13","IMIPRAMINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3862","ERX","HCPCS 63700001","00781-1766-01","IMIPRAMINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3862","ERX","HCPCS 63700001","00781-1766-13","IMIPRAMINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3862","ERX","HCPCS 63700001","49884-0056-01","IMIPRAMINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3879","ERX","HCPCS 63700001","00378-0080-01","INDAPAMIDE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3897","ERX","HCPCS 63700001","31722-0542-01","INDOMETHACIN 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3897","ERX","HCPCS 63700001","50268-0430-11","INDOMETHACIN 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3897","ERX","HCPCS 63700001","50268-0430-15","INDOMETHACIN 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3897","ERX","HCPCS 63700001","68462-0406-01","INDOMETHACIN 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3900","ERX","HCPCS 25000001","69344-0101-01","INDOMETHACIN 25 MG/5ML PO SUSP","BOTH IP/OP","$191.60 ","$141.78 ","$0.00 ","$173.73 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.73 ","$0.00 ","$86.87 ","$137.59 ","$138.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3900","ERX","HCPCS 25000001","99999-6012-44","INDOMETHACIN 25 MG/5ML PO SUSP","BOTH IP/OP","$191.60 ","$141.78 ","$0.00 ","$173.73 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.73 ","$0.00 ","$86.87 ","$137.59 ","$138.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3901","ERX","HCPCS 63700001","69344-0102-33","INDOMETHACIN 50 MG RECTAL SUPP","BOTH IP/OP","$594.12 ","$439.65 ","$0.00 ","$594.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$594.12 ","$0.00 ","$297.06 ","$470.54 ","$475.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3961","ERX","HCPCS 25000001","48433-0230-15","IODINE STRONG 5 % SOLN","BOTH IP/OP","$133.16 ","$98.54 ","$0.00 ","$120.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.74 ","$0.00 ","$60.37 ","$95.63 ","$96.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3961","ERX","HCPCS 25000001","00395-2775-16","IODINE STRONG 5 % SOLN","BOTH IP/OP","$133.16 ","$98.54 ","$0.00 ","$201.79 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.74 ","$0.00 ","$60.37 ","$201.79 ","$96.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3990","ERX","HCPCS J1750","00023-6082-01","IRON DEXTRAN 50 MG/ML IJ SOLN","BOTH IP/OP","$33.31 ","$24.65 ","$0.00 ","$33.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.90 ","$33.31 ","$15.13 ","$16.66 ","$26.38 ","$26.65 ","$20.89 ","$16.90 ","$0.00 ","$0.00 ","$0.00 "
"3990","ERX","HCPCS J1750","00023-6082-10","IRON DEXTRAN 50 MG/ML IJ SOLN","BOTH IP/OP","$33.31 ","$24.65 ","$0.00 ","$33.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.90 ","$33.31 ","$15.13 ","$16.66 ","$26.38 ","$26.65 ","$20.89 ","$16.90 ","$0.00 ","$0.00 ","$0.00 "
"4008","ERX","HCPCS 25000001","10019-0360-40","ISOFLURANE IN SOLN","BOTH IP/OP","$111.17 ","$82.27 ","$0.00 ","$100.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$79.83 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4008","ERX","HCPCS 25000001","66794-0017-10","ISOFLURANE IN SOLN","BOTH IP/OP","$111.17 ","$82.27 ","$0.00 ","$100.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$79.83 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4008","ERX","HCPCS 25000001","66794-0017-25","ISOFLURANE IN SOLN","BOTH IP/OP","$111.17 ","$82.27 ","$0.00 ","$103.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$103.95 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4024","ERX","HCPCS 25000001","00781-3056-70","ISONIAZID 100 MG/ML IJ SOLN","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$322.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.14 ","$0.00 ","$161.07 ","$255.13 ","$257.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4025","ERX","HCPCS 63700001","99999-6004-68","ISONIAZID 50 MG/5ML PO SYRP","BOTH IP/OP","$69.39 ","$51.35 ","$0.00 ","$62.93 ","","$12.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.93 ","$0.00 ","$31.47 ","$49.84 ","$50.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4025","ERX","HCPCS 63700001","46287-0009-01","ISONIAZID 50 MG/5ML PO SYRP","BOTH IP/OP","$69.39 ","$51.35 ","$0.00 ","$857.73 ","","$12.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.93 ","$0.00 ","$31.47 ","$857.73 ","$50.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4026","ERX","HCPCS 63700001","00555-0066-02","ISONIAZID 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4027","ERX","HCPCS 63700001","00555-0071-01","ISONIAZID 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4027","ERX","HCPCS 63700001","00555-0071-02","ISONIAZID 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4027","ERX","HCPCS 63700001","51079-0083-01","ISONIAZID 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4027","ERX","HCPCS 63700001","51079-0083-20","ISONIAZID 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4030","ERX","HCPCS 25000001","00574-0067-16","ISOPROPYL ALCOHOL 70 % SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4030","ERX","HCPCS 25000001","49348-0030-38","ISOPROPYL ALCOHOL 70 % SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","00187-4330-01","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","00187-4330-05","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","00548-9501-00","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","00548-9502-00","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","14789-0015-05","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","14789-0015-07","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","70121-1604-01","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","70121-1604-07","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","70121-1605-01","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4034","ERX","HCPCS 25000001","70121-1605-07","ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","BOTH IP/OP","$2,250.90 ","$1,665.67 ","$0.00 ","$2,250.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.90 ","$0.00 ","$1,125.45 ","$1,782.71 ","$1,800.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4064","ERX","HCPCS 63700001","00143-1771-01","ISOSORBIDE DINITRATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4064","ERX","HCPCS 63700001","00781-1556-01","ISOSORBIDE DINITRATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4064","ERX","HCPCS 63700001","00904-6619-61","ISOSORBIDE DINITRATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4064","ERX","HCPCS 63700001","50268-0448-15","ISOSORBIDE DINITRATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4064","ERX","HCPCS 63700001","63739-0569-10","ISOSORBIDE DINITRATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4064","ERX","HCPCS 63700001","68084-0082-01","ISOSORBIDE DINITRATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4065","ERX","HCPCS 63700001","00781-1695-01","ISOSORBIDE DINITRATE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4065","ERX","HCPCS 63700001","00904-6620-61","ISOSORBIDE DINITRATE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4065","ERX","HCPCS 63700001","63739-0367-10","ISOSORBIDE DINITRATE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4065","ERX","HCPCS 63700001","68084-0083-01","ISOSORBIDE DINITRATE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4068","ERX","HCPCS 63700001","00143-1769-01","ISOSORBIDE DINITRATE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4068","ERX","HCPCS 63700001","00781-1635-01","ISOSORBIDE DINITRATE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4201","ERX","HCPCS 25000001","99999-6005-50","KAYEXALATE PO POWD","BOTH IP/OP","$28.50 ","$21.09 ","$0.00 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4236","ERX","HCPCS J3490","42023-0113-10","KETAMINE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4236","ERX","HCPCS J3490","67457-0181-20","KETAMINE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4237","ERX","HCPCS 25000001","00143-9509-10","KETAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4238","ERX","HCPCS J3490","00143-9508-10","KETAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4238","ERX","HCPCS J3490","00409-2053-10","KETAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4238","ERX","HCPCS J3490","42023-0114-10","KETAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4238","ERX","HCPCS J3490","67457-0001-00","KETAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4238","ERX","HCPCS J3490","67457-0001-10","KETAMINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"4318","ERX","HCPCS J7120","00264-7750-00","LACTATED RINGERS IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"4318","ERX","HCPCS J7120","00338-0117-04","LACTATED RINGERS IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"4318","ERX","HCPCS J7120","00990-7953-09","LACTATED RINGERS IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"4318","ERX","HCPCS J7120","00264-7750-20","LACTATED RINGERS IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"4318","ERX","HCPCS J7120","00338-0117-03","LACTATED RINGERS IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.00 ","$0.00 ","$11.00 ","$19.56 ","$17.60 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"4318","ERX","HCPCS J7120","00409-7953-03","LACTATED RINGERS IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.00 ","$0.00 ","$11.00 ","$19.56 ","$17.60 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"4323","ERX","HCPCS 63700001","08290-2367-12","LACTINEX PO PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4393","ERX","HCPCS J0640","00143-9552-01","LEUCOVORIN CALCIUM 350 MG IJ SOLR","BOTH IP/OP","$120.44 ","$89.13 ","$0.00 ","$109.20 ","$54.20 ","$0.00 ","$7.32 ","$0.00 ","$0.00 ","$27.39 ","$109.20 ","$0.00 ","$54.60 ","$86.49 ","$87.36 ","$0.00 ","$27.39 ","$0.00 ","$26.08 ","$0.00 "
"4393","ERX","HCPCS J0640","00703-5145-01","LEUCOVORIN CALCIUM 350 MG IJ SOLR","BOTH IP/OP","$120.44 ","$89.13 ","$0.00 ","$109.20 ","$54.20 ","$0.00 ","$7.32 ","$0.00 ","$0.00 ","$27.39 ","$109.20 ","$0.00 ","$54.60 ","$86.49 ","$87.36 ","$0.00 ","$27.39 ","$0.00 ","$26.08 ","$0.00 "
"4393","ERX","HCPCS J0640","67457-0530-35","LEUCOVORIN CALCIUM 350 MG IJ SOLR","BOTH IP/OP","$120.44 ","$89.13 ","$0.00 ","$109.20 ","$54.20 ","$0.00 ","$7.32 ","$0.00 ","$0.00 ","$27.39 ","$109.20 ","$0.00 ","$54.60 ","$86.49 ","$87.36 ","$0.00 ","$27.39 ","$0.00 ","$26.08 ","$0.00 "
"4394","ERX","HCPCS J0640","00143-9555-01","LEUCOVORIN CALCIUM 50 MG IJ SOLR","BOTH IP/OP","$50.28 ","$37.21 ","$0.00 ","$45.60 ","$22.63 ","$0.00 ","$1.05 ","$0.00 ","$0.00 ","$3.91 ","$45.60 ","$0.00 ","$22.80 ","$36.12 ","$36.48 ","$0.00 ","$3.91 ","$0.00 ","$3.73 ","$0.00 "
"4394","ERX","HCPCS J0640","25021-0813-10","LEUCOVORIN CALCIUM 50 MG IJ SOLR","BOTH IP/OP","$50.28 ","$37.21 ","$0.00 ","$45.60 ","$22.63 ","$0.00 ","$1.05 ","$0.00 ","$0.00 ","$3.91 ","$45.60 ","$0.00 ","$22.80 ","$36.12 ","$36.48 ","$0.00 ","$3.91 ","$0.00 ","$3.73 ","$0.00 "
"4397","ERX","HCPCS 63700001","51079-0582-01","LEUCOVORIN CALCIUM 25 MG PO TABS","BOTH IP/OP","$57.36 ","$42.45 ","$0.00 ","$52.02 ","","$10.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.02 ","$0.00 ","$26.01 ","$41.20 ","$41.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397","ERX","HCPCS 63700001","51079-0582-05","LEUCOVORIN CALCIUM 25 MG PO TABS","BOTH IP/OP","$57.36 ","$42.45 ","$0.00 ","$52.02 ","","$10.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.02 ","$0.00 ","$26.01 ","$41.20 ","$41.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397","ERX","HCPCS 63700001","60687-0227-94","LEUCOVORIN CALCIUM 25 MG PO TABS","BOTH IP/OP","$57.36 ","$42.45 ","$0.00 ","$52.02 ","","$10.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.02 ","$0.00 ","$26.01 ","$41.20 ","$41.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4398","ERX","HCPCS 63700001","00054-8496-19","LEUCOVORIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$13.62 ","$10.08 ","$0.00 ","$12.35 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4398","ERX","HCPCS 63700001","00555-0484-01","LEUCOVORIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$13.62 ","$10.08 ","$0.00 ","$12.35 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4398","ERX","HCPCS 63700001","51079-0581-01","LEUCOVORIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$13.62 ","$10.08 ","$0.00 ","$12.35 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4398","ERX","HCPCS 63700001","51079-0581-06","LEUCOVORIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$13.62 ","$10.08 ","$0.00 ","$12.35 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.35 ","$0.00 ","$6.18 ","$9.78 ","$9.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4420","ERX","HCPCS 63700001","00378-1800-77","LEVOTHYROXINE SODIUM 25 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4420","ERX","HCPCS 63700001","00781-5180-92","LEVOTHYROXINE SODIUM 25 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4420","ERX","HCPCS 63700001","51079-0444-20","LEVOTHYROXINE SODIUM 25 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4421","ERX","HCPCS 63700001","00378-1803-77","LEVOTHYROXINE SODIUM 50 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4421","ERX","HCPCS 63700001","00781-5181-92","LEVOTHYROXINE SODIUM 50 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4421","ERX","HCPCS 63700001","51079-0440-20","LEVOTHYROXINE SODIUM 50 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4422","ERX","HCPCS 63700001","00378-1805-77","LEVOTHYROXINE SODIUM 75 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4422","ERX","HCPCS 63700001","00781-5182-92","LEVOTHYROXINE SODIUM 75 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4422","ERX","HCPCS 63700001","51079-0441-20","LEVOTHYROXINE SODIUM 75 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4423","ERX","HCPCS 63700001","00781-5184-92","LEVOTHYROXINE SODIUM 100 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4423","ERX","HCPCS 63700001","51079-0442-20","LEVOTHYROXINE SODIUM 100 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4424","ERX","HCPCS 63700001","00781-5186-92","LEVOTHYROXINE SODIUM 125 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4424","ERX","HCPCS 63700001","51079-0443-20","LEVOTHYROXINE SODIUM 125 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4425","ERX","HCPCS 63700001","00378-1815-77","LEVOTHYROXINE SODIUM 150 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4425","ERX","HCPCS 63700001","00781-5187-92","LEVOTHYROXINE SODIUM 150 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4426","ERX","HCPCS 63700001","00781-5189-92","LEVOTHYROXINE SODIUM 200 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450","ERX","HCPCS 25000001","00054-3505-47","LIDOCAINE HCL 4 % EX SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4451","ERX","HCPCS 25000001","00409-4275-01","LIDOCAINE HCL 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4451","ERX","HCPCS 25000001","63323-0484-57","LIDOCAINE HCL 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4452","ERX","HCPCS 25000001","00409-4276-01","LIDOCAINE HCL 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4452","ERX","HCPCS 25000001","00409-4276-16","LIDOCAINE HCL 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4452","ERX","HCPCS 25000001","55150-0252-20","LIDOCAINE HCL 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4452","ERX","HCPCS 25000001","63323-0485-27","LIDOCAINE HCL 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","00409-4277-01","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","00409-4277-16","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","55150-0254-10","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","55150-0255-20","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","63323-0202-02","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","63323-0486-17","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4454","ERX","HCPCS 25000001","63323-0486-27","LIDOCAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4498","ERX","HCPCS 25000001","60432-0834-60","LINDANE 1 % EX SHAM","BOTH IP/OP","$459.85 ","$340.29 ","$0.00 ","$417.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$417.43 ","$0.00 ","$208.72 ","$330.60 ","$333.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4504","ERX","HCPCS 63700001","59762-1207-01","LIOTHYRONINE SODIUM 25 MCG PO TABS","BOTH IP/OP","$13.24 ","$9.80 ","$0.00 ","$11.49 ","","$2.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.49 ","$0.00 ","$5.75 ","$9.10 ","$9.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4504","ERX","HCPCS 63700001","60793-0116-01","LIOTHYRONINE SODIUM 25 MCG PO TABS","BOTH IP/OP","$13.24 ","$9.80 ","$0.00 ","$11.49 ","","$2.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.49 ","$0.00 ","$5.75 ","$9.10 ","$9.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4526","ERX","HCPCS 63700001","00904-6799-61","LISINOPRIL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4526","ERX","HCPCS 63700001","43547-0354-10","LISINOPRIL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4526","ERX","HCPCS 63700001","60687-0333-01","LISINOPRIL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4526","ERX","HCPCS 63700001","63739-0350-10","LISINOPRIL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4529","ERX","HCPCS 63700001","00054-2527-25","LITHIUM CARBONATE 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4529","ERX","HCPCS 63700001","00054-8527-25","LITHIUM CARBONATE 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4560","ERX","HCPCS 63700001","00093-0311-01","LOPERAMIDE HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4560","ERX","HCPCS 63700001","51079-0690-01","LOPERAMIDE HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4560","ERX","HCPCS 63700001","51079-0690-20","LOPERAMIDE HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4560","ERX","HCPCS 63700001","60687-0229-01","LOPERAMIDE HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4571","ERX","HCPCS 25000001","00054-3532-44","LORAZEPAM 2 MG/ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4571","ERX","HCPCS 25000001","00121-0770-01","LORAZEPAM 2 MG/ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4571","ERX","HCPCS 25000001","50383-0705-30","LORAZEPAM 2 MG/ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4571","ERX","HCPCS 25000001","99999-6007-84","LORAZEPAM 2 MG/ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4572","ERX","HCPCS 25000001","69315-0904-01","LORAZEPAM 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4573","ERX","HCPCS 25000001","00591-0241-01","LORAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4573","ERX","HCPCS 25000001","00904-6008-60","LORAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4573","ERX","HCPCS 25000001","00904-6008-61","LORAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4573","ERX","HCPCS 25000001","69315-0905-01","LORAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4574","ERX","HCPCS 25000001","00591-0242-01","LORAZEPAM 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4574","ERX","HCPCS 25000001","00591-0242-05","LORAZEPAM 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4574","ERX","HCPCS 25000001","00904-6009-61","LORAZEPAM 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4574","ERX","HCPCS 25000001","60687-0367-01","LORAZEPAM 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4574","ERX","HCPCS 25000001","60687-0367-11","LORAZEPAM 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4599","ERX","HCPCS 63700001","00527-1395-01","LOXAPINE SUCCINATE 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4600","ERX","HCPCS 63700001","00591-0371-01","LOXAPINE SUCCINATE 25 MG PO CAPS","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$7.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$0.00 ","$3.66 ","$5.80 ","$5.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4602","ERX","HCPCS 63700001","00378-7050-01","LOXAPINE SUCCINATE 50 MG PO CAPS","BOTH IP/OP","$10.78 ","$7.98 ","$0.00 ","$9.78 ","","$1.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.78 ","$0.00 ","$4.89 ","$7.75 ","$7.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4602","ERX","HCPCS 63700001","00591-0372-01","LOXAPINE SUCCINATE 50 MG PO CAPS","BOTH IP/OP","$10.78 ","$7.98 ","$0.00 ","$9.78 ","","$1.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.78 ","$0.00 ","$4.89 ","$7.75 ","$7.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4711","ERX","HCPCS 63700001","00869-0686-38","MAGNESIUM CITRATE 58 MG/ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4711","ERX","HCPCS 63700001","00904-6787-44","MAGNESIUM CITRATE 58 MG/ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4711","ERX","HCPCS 63700001","49348-0504-49","MAGNESIUM CITRATE 58 MG/ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4711","ERX","HCPCS 63700001","49348-0696-49","MAGNESIUM CITRATE 58 MG/ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4711","ERX","HCPCS 63700001","70677-0051-01","MAGNESIUM CITRATE 58 MG/ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4711","ERX","HCPCS 63700001","70677-0053-01","MAGNESIUM CITRATE 58 MG/ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4715","ERX","HCPCS 63700001","59016-0420-17","MAGNESIUM LACTATE 84 MG (7MEQ) PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4720","ERX","HCPCS J3475","51754-1000-04","MAGNESIUM SULFATE 50 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$1.48 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.48 ","$0.00 ","$1.41 ","$0.00 "
"4720","ERX","HCPCS J3475","63323-0064-03","MAGNESIUM SULFATE 50 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$1.48 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.48 ","$0.00 ","$1.41 ","$0.00 "
"4720","ERX","HCPCS J3475","63323-0064-11","MAGNESIUM SULFATE 50 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$1.48 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.48 ","$0.00 ","$1.41 ","$0.00 "
"4720","ERX","HCPCS J3475","63323-0642-20","MAGNESIUM SULFATE 50 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$1.48 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.48 ","$0.00 ","$1.41 ","$0.00 "
"4720","ERX","HCPCS J3475","63323-0642-50","MAGNESIUM SULFATE 50 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$1.48 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.48 ","$0.00 ","$1.41 ","$0.00 "
"4744","ERX","HCPCS 25000001","00409-4091-01","MANGANESE CHLORIDE 0.1 MG/ML IV SOLN","BOTH IP/OP","$115.65 ","$85.58 ","$0.00 ","$96.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.46 ","$0.00 ","$48.23 ","$76.40 ","$77.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4749","ERX","HCPCS 25000001","00264-7578-10","MANNITOL 20 % IV SOLN","BOTH IP/OP","$108.57 ","$80.34 ","$0.00 ","$91.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.88 ","$0.00 ","$45.94 ","$72.77 ","$73.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4749","ERX","HCPCS 25000001","00338-0357-02","MANNITOL 20 % IV SOLN","BOTH IP/OP","$108.57 ","$80.34 ","$0.00 ","$91.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.88 ","$0.00 ","$45.94 ","$72.77 ","$73.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4749","ERX","HCPCS 25000001","00338-0357-03","MANNITOL 20 % IV SOLN","BOTH IP/OP","$108.57 ","$80.34 ","$0.00 ","$91.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.88 ","$0.00 ","$45.94 ","$72.77 ","$73.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4750","ERX","HCPCS J2150","00409-4031-01","MANNITOL 25 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4750","ERX","HCPCS J2150","63323-0024-25","MANNITOL 25 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4759","ERX","HCPCS 63700001","00378-0060-01","MAPROTILINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4760","ERX","HCPCS 63700001","00378-0087-01","MAPROTILINE HCL 50 MG PO TABS","BOTH IP/OP","$6.50 ","$4.81 ","$0.00 ","$6.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.50 ","$0.00 ","$3.25 ","$5.15 ","$5.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4822","ERX","HCPCS 63700001","00536-1018-01","MECLIZINE HCL 25 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4854","ERX","HCPCS 63700001","00555-0779-02","MEDROXYPROGESTERONE ACETATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4855","ERX","HCPCS 63700001","00555-0872-02","MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4856","ERX","HCPCS 63700001","00555-0873-02","MEDROXYPROGESTERONE ACETATE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4871","ERX","HCPCS 63700001","00904-3571-61","MEGESTROL ACETATE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4871","ERX","HCPCS 63700001","49884-0290-01","MEGESTROL ACETATE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4871","ERX","HCPCS 63700001","63739-0165-10","MEGESTROL ACETATE 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4903","ERX","HCPCS J2175","00409-1176-03","MEPERIDINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.67 ","$0.00 ","$0.00 ","$5.55 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.55 ","$0.00 ","$5.28 ","$0.00 "
"4903","ERX","HCPCS J2175","00409-1176-30","MEPERIDINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.67 ","$0.00 ","$0.00 ","$5.55 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.55 ","$0.00 ","$5.28 ","$0.00 "
"4903","ERX","HCPCS J2175","00641-6052-25","MEPERIDINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.67 ","$0.00 ","$0.00 ","$5.55 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.55 ","$0.00 ","$5.28 ","$0.00 "
"4904","ERX","HCPCS J2175","00641-6053-25","MEPERIDINE HCL 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.67 ","$0.00 ","$0.00 ","$5.55 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.55 ","$0.00 ","$5.28 ","$0.00 "
"4905","ERX","HCPCS J2175","00409-1179-03","MEPERIDINE HCL 75 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.67 ","$0.00 ","$0.00 ","$5.55 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.55 ","$0.00 ","$5.28 ","$0.00 "
"4905","ERX","HCPCS J2175","00409-1179-30","MEPERIDINE HCL 75 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.67 ","$0.00 ","$0.00 ","$5.55 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.55 ","$0.00 ","$5.28 ","$0.00 "
"4914","ERX","HCPCS J0670","00409-1038-50","MEPIVACAINE HCL 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4915","ERX","HCPCS J0670","00409-2047-50","MEPIVACAINE HCL 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4952","ERX","HCPCS 63700001","00054-3555-63","METHADONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$39.60 ","$29.30 ","$0.00 ","$35.91 ","","$7.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.91 ","$0.00 ","$17.96 ","$28.44 ","$28.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4952","ERX","HCPCS 63700001","66689-0711-16","METHADONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$39.60 ","$29.30 ","$0.00 ","$35.91 ","","$7.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.91 ","$0.00 ","$17.96 ","$28.44 ","$28.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4952","ERX","HCPCS 63700001","99999-6011-43","METHADONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$39.60 ","$29.30 ","$0.00 ","$35.91 ","","$7.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.91 ","$0.00 ","$17.96 ","$28.44 ","$28.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4953","ERX","HCPCS 63700001","00054-8554-24","METHADONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4953","ERX","HCPCS 63700001","00406-5771-62","METHADONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4954","ERX","HCPCS 63700001","00054-4570-25","METHADONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4954","ERX","HCPCS 63700001","00054-8553-24","METHADONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4954","ERX","HCPCS 63700001","00406-5755-23","METHADONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4954","ERX","HCPCS 63700001","00406-5755-62","METHADONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4962","ERX","HCPCS 63700001","00574-0791-01","METHAZOLAMIDE 50 MG PO TABS","BOTH IP/OP","$29.12 ","$21.55 ","$0.00 ","$29.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.12 ","$0.00 ","$14.56 ","$23.06 ","$23.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4962","ERX","HCPCS 63700001","00781-1071-01","METHAZOLAMIDE 50 MG PO TABS","BOTH IP/OP","$29.12 ","$21.55 ","$0.00 ","$29.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.12 ","$0.00 ","$14.56 ","$23.06 ","$23.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4962","ERX","HCPCS 63700001","62559-0241-01","METHAZOLAMIDE 50 MG PO TABS","BOTH IP/OP","$29.12 ","$21.55 ","$0.00 ","$29.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.12 ","$0.00 ","$14.56 ","$23.06 ","$23.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4966","ERX","HCPCS 63700001","13925-0107-01","METHENAMINE MANDELATE 1 G PO TABS","BOTH IP/OP","$9.94 ","$7.36 ","$0.00 ","$9.01 ","","$1.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.01 ","$0.00 ","$4.51 ","$7.14 ","$7.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4971","ERX","HCPCS 63700001","76385-0123-50","METHOCARBAMOL 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4972","ERX","HCPCS 63700001","31722-0534-01","METHOCARBAMOL 750 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4973","ERX","HCPCS J8610","00054-4550-25","METHOTREXATE 2.5 MG PO TABS","BOTH IP/OP","$78.44 ","$58.05 ","$0.00 ","$71.14 ","$35.30 ","$0.00 ","$16.35 ","$0.00 ","$0.00 ","$12.46 ","$71.14 ","$0.00 ","$35.57 ","$56.34 ","$56.91 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 "
"4973","ERX","HCPCS J8610","00054-8550-25","METHOTREXATE 2.5 MG PO TABS","BOTH IP/OP","$78.44 ","$58.05 ","$0.00 ","$71.14 ","$35.30 ","$0.00 ","$16.35 ","$0.00 ","$0.00 ","$12.46 ","$71.14 ","$0.00 ","$35.57 ","$56.34 ","$56.91 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 "
"4973","ERX","HCPCS J8610","00378-0014-01","METHOTREXATE 2.5 MG PO TABS","BOTH IP/OP","$78.44 ","$58.05 ","$0.00 ","$71.14 ","$35.30 ","$0.00 ","$16.35 ","$0.00 ","$0.00 ","$12.46 ","$71.14 ","$0.00 ","$35.57 ","$56.34 ","$56.91 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 "
"4973","ERX","HCPCS J8610","00555-0572-02","METHOTREXATE 2.5 MG PO TABS","BOTH IP/OP","$78.44 ","$58.05 ","$0.00 ","$71.14 ","$35.30 ","$0.00 ","$16.35 ","$0.00 ","$0.00 ","$12.46 ","$71.14 ","$0.00 ","$35.57 ","$56.34 ","$56.91 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 "
"4973","ERX","HCPCS J8610","51079-0670-01","METHOTREXATE 2.5 MG PO TABS","BOTH IP/OP","$78.44 ","$58.05 ","$0.00 ","$71.14 ","$35.30 ","$0.00 ","$16.35 ","$0.00 ","$0.00 ","$12.46 ","$71.14 ","$0.00 ","$35.57 ","$56.34 ","$56.91 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 "
"4973","ERX","HCPCS J8610","51079-0670-05","METHOTREXATE 2.5 MG PO TABS","BOTH IP/OP","$78.44 ","$58.05 ","$0.00 ","$71.14 ","$35.30 ","$0.00 ","$16.35 ","$0.00 ","$0.00 ","$12.46 ","$71.14 ","$0.00 ","$35.57 ","$56.34 ","$56.91 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 "
"4986","ERX","HCPCS 63700001","00406-1144-01","METHYLPHENIDATE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4986","ERX","HCPCS 63700001","10702-0101-01","METHYLPHENIDATE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4986","ERX","HCPCS 63700001","65580-0530-01","METHYLPHENIDATE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4988","ERX","HCPCS 63700001","00406-1142-01","METHYLPHENIDATE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4988","ERX","HCPCS 63700001","00781-5748-01","METHYLPHENIDATE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4988","ERX","HCPCS 63700001","16714-0821-01","METHYLPHENIDATE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4991","ERX","HCPCS J7509","00781-5022-07","METHYLPREDNISOLONE 4 MG PO TBPK","BOTH IP/OP","$115.92 ","$85.78 ","$0.00 ","$105.11 ","$52.16 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$18.40 ","$105.11 ","$0.00 ","$52.56 ","$83.25 ","$84.09 ","$0.00 ","$16.45 ","$0.00 ","$16.73 ","$0.00 "
"4992","ERX","HCPCS J7509","00009-0073-01","METHYLPREDNISOLONE 16 MG PO TABS","BOTH IP/OP","$14.46 ","$10.70 ","$0.00 ","$12.92 ","$6.51 ","$0.00 ","$3.01 ","$0.00 ","$0.00 ","$2.26 ","$12.92 ","$0.00 ","$6.46 ","$10.23 ","$10.34 ","$0.00 ","$2.02 ","$0.00 ","$2.06 ","$0.00 "
"4992","ERX","HCPCS J7509","59746-0003-14","METHYLPREDNISOLONE 16 MG PO TABS","BOTH IP/OP","$14.46 ","$10.70 ","$0.00 ","$12.92 ","$6.51 ","$0.00 ","$3.01 ","$0.00 ","$0.00 ","$2.26 ","$12.92 ","$0.00 ","$6.46 ","$10.23 ","$10.34 ","$0.00 ","$2.02 ","$0.00 ","$2.06 ","$0.00 "
"4992","ERX","HCPCS J7509","59762-0050-01","METHYLPREDNISOLONE 16 MG PO TABS","BOTH IP/OP","$14.46 ","$10.70 ","$0.00 ","$12.92 ","$6.51 ","$0.00 ","$3.01 ","$0.00 ","$0.00 ","$2.26 ","$12.92 ","$0.00 ","$6.46 ","$10.23 ","$10.34 ","$0.00 ","$2.02 ","$0.00 ","$2.06 ","$0.00 "
"4993","ERX","HCPCS J7509","00781-5022-01","METHYLPREDNISOLONE 4 MG PO TABS","BOTH IP/OP","$6.92 ","$5.12 ","$0.00 ","$6.27 ","$3.11 ","$0.00 ","$1.44 ","$0.00 ","$0.00 ","$1.10 ","$6.27 ","$0.00 ","$3.14 ","$4.97 ","$5.02 ","$0.00 ","$0.98 ","$0.00 ","$1.00 ","$0.00 "
"4993","ERX","HCPCS J7509","59746-0001-06","METHYLPREDNISOLONE 4 MG PO TABS","BOTH IP/OP","$6.92 ","$5.12 ","$0.00 ","$6.27 ","$3.11 ","$0.00 ","$1.44 ","$0.00 ","$0.00 ","$1.10 ","$6.27 ","$0.00 ","$3.14 ","$4.97 ","$5.02 ","$0.00 ","$0.98 ","$0.00 ","$1.00 ","$0.00 "
"4993","ERX","HCPCS J7509","68084-0149-01","METHYLPREDNISOLONE 4 MG PO TABS","BOTH IP/OP","$6.92 ","$5.12 ","$0.00 ","$6.27 ","$3.11 ","$0.00 ","$1.44 ","$0.00 ","$0.00 ","$1.10 ","$6.27 ","$0.00 ","$3.14 ","$4.97 ","$5.02 ","$0.00 ","$0.98 ","$0.00 ","$1.00 ","$0.00 "
"4993","ERX","HCPCS J7509","68084-0149-11","METHYLPREDNISOLONE 4 MG PO TABS","BOTH IP/OP","$6.92 ","$5.12 ","$0.00 ","$6.27 ","$3.11 ","$0.00 ","$1.44 ","$0.00 ","$0.00 ","$1.10 ","$6.27 ","$0.00 ","$3.14 ","$4.97 ","$5.02 ","$0.00 ","$0.98 ","$0.00 ","$1.00 ","$0.00 "
"4995","ERX","HCPCS J1030","00009-3073-01","METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","BOTH IP/OP","$26.70 ","$19.76 ","$0.00 ","$24.10 ","$12.02 ","$0.00 ","$4.86 ","$0.00 ","$0.00 ","$7.39 ","$24.10 ","$0.00 ","$12.05 ","$19.09 ","$19.28 ","$0.00 ","$7.39 ","$0.00 ","$7.04 ","$0.00 "
"4995","ERX","HCPCS J1030","00009-3073-03","METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","BOTH IP/OP","$26.70 ","$19.76 ","$0.00 ","$24.10 ","$12.02 ","$0.00 ","$4.86 ","$0.00 ","$0.00 ","$7.39 ","$24.10 ","$0.00 ","$12.05 ","$19.09 ","$19.28 ","$0.00 ","$7.39 ","$0.00 ","$7.04 ","$0.00 "
"5002","ERX","HCPCS J2765","00409-3414-01","METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"5002","ERX","HCPCS J2765","00409-3414-18","METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"5002","ERX","HCPCS J2765","00703-4502-04","METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"5005","ERX","HCPCS 25000001","00093-2203-01","METOCLOPRAMIDE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005","ERX","HCPCS 25000001","00093-2203-05","METOCLOPRAMIDE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005","ERX","HCPCS 25000001","51079-0888-20","METOCLOPRAMIDE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005","ERX","HCPCS 25000001","63739-0293-10","METOCLOPRAMIDE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005","ERX","HCPCS 25000001","68084-0676-01","METOCLOPRAMIDE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005","ERX","HCPCS 25000001","68084-0676-11","METOCLOPRAMIDE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5009","ERX","HCPCS 63700001","51079-0801-01","METOPROLOL TARTRATE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5009","ERX","HCPCS 63700001","51079-0801-20","METOPROLOL TARTRATE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5009","ERX","HCPCS 63700001","57664-0477-52","METOPROLOL TARTRATE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5009","ERX","HCPCS 63700001","62584-0266-01","METOPROLOL TARTRATE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5009","ERX","HCPCS 63700001","62584-0266-11","METOPROLOL TARTRATE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5009","ERX","HCPCS 63700001","65862-0063-01","METOPROLOL TARTRATE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5015","ERX","HCPCS 63700001","00904-1453-61","METRONIDAZOLE 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5015","ERX","HCPCS 63700001","50111-0333-01","METRONIDAZOLE 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5015","ERX","HCPCS 63700001","50111-0333-02","METRONIDAZOLE 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","29300-0227-01","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","29300-0227-05","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","29300-0227-46","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","50111-0334-01","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","50268-0535-11","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","50268-0535-15","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5016","ERX","HCPCS 63700001","60687-0550-01","METRONIDAZOLE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018","ERX","HCPCS 25000001","00338-1055-48","METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018","ERX","HCPCS 25000001","00409-7811-24","METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018","ERX","HCPCS 25000001","00409-7811-37","METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5039","ERX","HCPCS 63700001","00472-0735-56","MICONAZOLE NITRATE 2 % EX CREA","BOTH IP/OP","$22.13 ","$16.38 ","$0.00 ","$20.07 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.07 ","$0.00 ","$10.04 ","$15.90 ","$16.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5039","ERX","HCPCS 63700001","49348-0689-72","MICONAZOLE NITRATE 2 % EX CREA","BOTH IP/OP","$22.13 ","$16.38 ","$0.00 ","$20.07 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.07 ","$0.00 ","$10.04 ","$15.90 ","$16.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5039","ERX","HCPCS 63700001","51672-2001-02","MICONAZOLE NITRATE 2 % EX CREA","BOTH IP/OP","$22.13 ","$16.38 ","$0.00 ","$20.07 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.07 ","$0.00 ","$10.04 ","$15.90 ","$16.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5086","ERX","HCPCS 25000001","00869-0831-43","MINERAL OIL PO OIL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5086","ERX","HCPCS 25000001","00869-4206-10","MINERAL OIL PO OIL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5086","ERX","HCPCS 25000001","48433-0202-30","MINERAL OIL PO OIL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5086","ERX","HCPCS 25000001","54162-0190-16","MINERAL OIL PO OIL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5086","ERX","HCPCS 25000001","99999-6007-83","MINERAL OIL PO OIL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5110","ERX","HCPCS 63700001","00591-5695-50","MINOCYCLINE HCL 100 MG PO CAPS","BOTH IP/OP","$14.24 ","$10.54 ","$0.00 ","$12.91 ","","$2.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.91 ","$0.00 ","$6.46 ","$10.22 ","$10.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5110","ERX","HCPCS 63700001","65862-0211-50","MINOCYCLINE HCL 100 MG PO CAPS","BOTH IP/OP","$14.24 ","$10.54 ","$0.00 ","$12.91 ","","$2.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.91 ","$0.00 ","$6.46 ","$10.22 ","$10.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5111","ERX","HCPCS 63700001","00591-5694-01","MINOCYCLINE HCL 50 MG PO CAPS","BOTH IP/OP","$7.12 ","$5.27 ","$0.00 ","$6.46 ","","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.46 ","$0.00 ","$3.23 ","$5.12 ","$5.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5111","ERX","HCPCS 63700001","63304-0694-01","MINOCYCLINE HCL 50 MG PO CAPS","BOTH IP/OP","$7.12 ","$5.27 ","$0.00 ","$6.46 ","","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.46 ","$0.00 ","$3.23 ","$5.12 ","$5.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5111","ERX","HCPCS 63700001","65862-0209-01","MINOCYCLINE HCL 50 MG PO CAPS","BOTH IP/OP","$7.12 ","$5.27 ","$0.00 ","$6.46 ","","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.46 ","$0.00 ","$3.23 ","$5.12 ","$5.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5114","ERX","HCPCS 63700001","68084-0205-01","MINOXIDIL 10 MG PO TABS","BOTH IP/OP","$8.89 ","$6.58 ","$0.00 ","$8.06 ","","$1.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.06 ","$0.00 ","$4.03 ","$6.38 ","$6.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5114","ERX","HCPCS 63700001","68084-0205-11","MINOXIDIL 10 MG PO TABS","BOTH IP/OP","$8.89 ","$6.58 ","$0.00 ","$8.06 ","","$1.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.06 ","$0.00 ","$4.03 ","$6.38 ","$6.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5115","ERX","HCPCS 63700001","00591-5642-01","MINOXIDIL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5115","ERX","HCPCS 63700001","49884-0256-01","MINOXIDIL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5115","ERX","HCPCS 63700001","68084-0204-01","MINOXIDIL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5115","ERX","HCPCS 63700001","68084-0204-11","MINOXIDIL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5170","ERX","HCPCS J2270","76045-0004-10","MORPHINE SULFATE 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"5172","ERX","HCPCS J2270","76045-0005-10","MORPHINE SULFATE 4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$17.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.39 ","$0.00 ","$0.00 ","$0.00 ","$17.42 ","$0.00 ","$0.00 ","$2.39 ","$0.00 ","$0.00 ","$0.00 "
"5176","ERX","HCPCS 25000001","00054-0237-63","MORPHINE SULFATE 10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5176","ERX","HCPCS 25000001","66689-0032-50","MORPHINE SULFATE 10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5176","ERX","HCPCS 25000001","68094-0001-62","MORPHINE SULFATE 10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5176","ERX","HCPCS 25000001","99999-6007-18","MORPHINE SULFATE 10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5178","ERX","HCPCS 25000001","00054-0235-24","MORPHINE SULFATE 15 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5178","ERX","HCPCS 25000001","00054-0235-25","MORPHINE SULFATE 15 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5179","ERX","HCPCS 25000001","00054-0236-25","MORPHINE SULFATE 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5180","ERX","HCPCS 25000001","00574-7112-12","MORPHINE SULFATE 10 MG RECTAL SUPP","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5330","ERX","HCPCS 63700001","51079-0812-20","NADOLOL 20 MG PO TABS","BOTH IP/OP","$19.53 ","$14.45 ","$0.00 ","$17.71 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.71 ","$0.00 ","$8.86 ","$14.03 ","$14.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5330","ERX","HCPCS 63700001","69238-1123-09","NADOLOL 20 MG PO TABS","BOTH IP/OP","$19.53 ","$14.45 ","$0.00 ","$17.71 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.71 ","$0.00 ","$8.86 ","$14.03 ","$14.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5331","ERX","HCPCS 63700001","51079-0813-01","NADOLOL 40 MG PO TABS","BOTH IP/OP","$30.30 ","$22.42 ","$0.00 ","$27.48 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.48 ","$0.00 ","$13.74 ","$21.76 ","$21.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5331","ERX","HCPCS 63700001","51079-0813-20","NADOLOL 40 MG PO TABS","BOTH IP/OP","$30.30 ","$22.42 ","$0.00 ","$27.48 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.48 ","$0.00 ","$13.74 ","$21.76 ","$21.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5331","ERX","HCPCS 63700001","59762-0811-01","NADOLOL 40 MG PO TABS","BOTH IP/OP","$30.30 ","$22.42 ","$0.00 ","$27.48 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.48 ","$0.00 ","$13.74 ","$21.76 ","$21.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5331","ERX","HCPCS 63700001","69097-0868-07","NADOLOL 40 MG PO TABS","BOTH IP/OP","$30.30 ","$22.42 ","$0.00 ","$27.48 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.48 ","$0.00 ","$13.74 ","$21.76 ","$21.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5331","ERX","HCPCS 63700001","69238-1124-09","NADOLOL 40 MG PO TABS","BOTH IP/OP","$30.30 ","$22.42 ","$0.00 ","$27.48 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.48 ","$0.00 ","$13.74 ","$21.76 ","$21.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5332","ERX","HCPCS 63700001","69097-0869-07","NADOLOL 80 MG PO TABS","BOTH IP/OP","$31.39 ","$23.23 ","$0.00 ","$28.47 ","","$5.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.47 ","$0.00 ","$14.24 ","$22.55 ","$22.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5332","ERX","HCPCS 63700001","69238-1125-09","NADOLOL 80 MG PO TABS","BOTH IP/OP","$31.39 ","$23.23 ","$0.00 ","$28.47 ","","$5.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.47 ","$0.00 ","$14.24 ","$22.55 ","$22.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","00781-3124-85","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","00781-3124-95","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","25021-0139-10","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","44567-0221-10","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","55150-0122-15","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","63323-0327-10","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","70860-0116-26","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5333","ERX","HCPCS 25000001","70860-0116-41","NAFCILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$60.76 ","$44.96 ","$0.00 ","$55.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.10 ","$0.00 ","$27.55 ","$43.64 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","25021-0140-10","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","44567-0222-10","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","55150-0123-15","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","55150-0123-16","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","63323-0328-20","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","70860-0117-26","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5335","ERX","HCPCS 25000001","70860-0117-41","NAFCILLIN SODIUM 2 G IJ SOLR","BOTH IP/OP","$109.15 ","$80.77 ","$0.00 ","$98.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.97 ","$0.00 ","$49.49 ","$78.38 ","$79.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5339","ERX","HCPCS J2300","00409-1463-01","NALBUPHINE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"5339","ERX","HCPCS J2300","00409-1463-49","NALBUPHINE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"5339","ERX","HCPCS J2300","00409-1464-01","NALBUPHINE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"5339","ERX","HCPCS J2300","99999-6005-73","NALBUPHINE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"5340","ERX","HCPCS J2300","00409-1465-01","NALBUPHINE HCL 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"5340","ERX","HCPCS J2300","00409-1467-01","NALBUPHINE HCL 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"5373","ERX","HCPCS J2310","00409-1215-01","NALOXONE HCL 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.37 ","$0.00 ","$0.00 ","$15.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$15.60 ","$0.00 ","$14.86 ","$0.00 "
"5373","ERX","HCPCS J2310","00409-1215-21","NALOXONE HCL 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.37 ","$0.00 ","$0.00 ","$15.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$15.60 ","$0.00 ","$14.86 ","$0.00 "
"5373","ERX","HCPCS J2310","00641-6132-25","NALOXONE HCL 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.37 ","$0.00 ","$0.00 ","$15.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$15.60 ","$0.00 ","$14.86 ","$0.00 "
"5373","ERX","HCPCS J2310","67457-0292-00","NALOXONE HCL 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.37 ","$0.00 ","$0.00 ","$15.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$15.60 ","$0.00 ","$14.86 ","$0.00 "
"5373","ERX","HCPCS J2310","67457-0292-02","NALOXONE HCL 0.4 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.37 ","$0.00 ","$0.00 ","$15.60 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$15.60 ","$0.00 ","$14.86 ","$0.00 "
"5384","ERX","HCPCS 25000001","00065-0085-15","NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN","BOTH IP/OP","$62.85 ","$46.51 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5384","ERX","HCPCS 25000001","12547-0493-78","NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN","BOTH IP/OP","$62.85 ","$46.51 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5384","ERX","HCPCS 25000001","69968-0063-01","NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN","BOTH IP/OP","$62.85 ","$46.51 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5391","ERX","HCPCS 63700001","50268-0594-15","NAPROXEN 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5391","ERX","HCPCS 63700001","51079-0793-01","NAPROXEN 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5391","ERX","HCPCS 63700001","51079-0793-20","NAPROXEN 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5391","ERX","HCPCS 63700001","65162-0188-10","NAPROXEN 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5392","ERX","HCPCS 63700001","65162-0189-50","NAPROXEN 375 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5392","ERX","HCPCS 63700001","76282-0341-01","NAPROXEN 375 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5393","ERX","HCPCS 63700001","51079-0795-01","NAPROXEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5393","ERX","HCPCS 63700001","51079-0795-20","NAPROXEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5393","ERX","HCPCS 63700001","60687-0491-01","NAPROXEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5393","ERX","HCPCS 63700001","60687-0491-11","NAPROXEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5393","ERX","HCPCS 63700001","63739-0403-10","NAPROXEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5393","ERX","HCPCS 63700001","68462-0190-01","NAPROXEN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5472","ERX","HCPCS 63700001","00093-1177-01","NEOMYCIN SULFATE 500 MG PO TABS","BOTH IP/OP","$8.28 ","$6.13 ","$0.00 ","$7.51 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.51 ","$0.00 ","$3.76 ","$5.95 ","$6.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5472","ERX","HCPCS 63700001","39822-0310-05","NEOMYCIN SULFATE 500 MG PO TABS","BOTH IP/OP","$8.28 ","$6.13 ","$0.00 ","$7.51 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.51 ","$0.00 ","$3.76 ","$5.95 ","$6.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5472","ERX","HCPCS 63700001","50383-0565-10","NEOMYCIN SULFATE 500 MG PO TABS","BOTH IP/OP","$8.28 ","$6.13 ","$0.00 ","$7.51 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.51 ","$0.00 ","$3.76 ","$5.95 ","$6.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5472","ERX","HCPCS 63700001","51079-0015-01","NEOMYCIN SULFATE 500 MG PO TABS","BOTH IP/OP","$8.28 ","$6.13 ","$0.00 ","$7.51 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.51 ","$0.00 ","$3.76 ","$5.95 ","$6.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5472","ERX","HCPCS 63700001","51079-0015-20","NEOMYCIN SULFATE 500 MG PO TABS","BOTH IP/OP","$8.28 ","$6.13 ","$0.00 ","$7.51 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.51 ","$0.00 ","$3.76 ","$5.95 ","$6.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5474","ERX","HCPCS 25000001","24208-0790-62","NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN","BOTH IP/OP","$212.58 ","$157.31 ","$0.00 ","$192.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.97 ","$0.00 ","$96.49 ","$152.83 ","$154.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5539","ERX","HCPCS 63700001","54629-0071-01","NIACIN 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542","ERX","HCPCS 63700001","00536-4078-10","NIACIN 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5558","ERX","HCPCS 63700001","00228-2497-10","NIFEDIPINE 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5558","ERX","HCPCS 63700001","43386-0440-24","NIFEDIPINE 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5558","ERX","HCPCS 63700001","69315-0211-01","NIFEDIPINE 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5559","ERX","HCPCS 63700001","00228-2530-10","NIFEDIPINE 20 MG PO CAPS","BOTH IP/OP","$9.65 ","$7.14 ","$0.00 ","$8.76 ","","$1.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.76 ","$0.00 ","$4.38 ","$6.94 ","$7.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5559","ERX","HCPCS 63700001","23155-0195-01","NIFEDIPINE 20 MG PO CAPS","BOTH IP/OP","$9.65 ","$7.14 ","$0.00 ","$8.76 ","","$1.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.76 ","$0.00 ","$4.38 ","$6.94 ","$7.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5595","ERX","HCPCS 63700001","47781-0307-01","NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS","BOTH IP/OP","$9.52 ","$7.04 ","$0.00 ","$8.64 ","","$1.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.64 ","$0.00 ","$4.32 ","$6.84 ","$6.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5599","ERX","HCPCS 25000001","00517-4810-25","NITROGLYCERIN 5 MG/ML IV SOLN","BOTH IP/OP","$71.74 ","$53.09 ","$0.00 ","$65.06 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.06 ","$0.00 ","$32.53 ","$51.53 ","$52.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5603","ERX","HCPCS 25000001","00071-0417-24","NITROGLYCERIN 0.3 MG SL SUBL","BOTH IP/OP","$261.64 ","$193.61 ","$0.00 ","$226.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.49 ","$0.00 ","$113.25 ","$179.38 ","$181.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5603","ERX","HCPCS 25000001","59762-4921-01","NITROGLYCERIN 0.3 MG SL SUBL","BOTH IP/OP","$261.64 ","$193.61 ","$0.00 ","$226.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.49 ","$0.00 ","$113.25 ","$179.38 ","$181.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5604","ERX","HCPCS 25000001","00071-0418-13","NITROGLYCERIN 0.4 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5604","ERX","HCPCS 25000001","43598-0436-11","NITROGLYCERIN 0.4 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5604","ERX","HCPCS 25000001","43598-0436-35","NITROGLYCERIN 0.4 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5604","ERX","HCPCS 25000001","59762-3304-03","NITROGLYCERIN 0.4 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5604","ERX","HCPCS 25000001","68462-0639-45","NITROGLYCERIN 0.4 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5605","ERX","HCPCS 25000001","00071-0419-24","NITROGLYCERIN 0.6 MG SL SUBL","BOTH IP/OP","$261.64 ","$193.61 ","$0.00 ","$226.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.49 ","$0.00 ","$113.25 ","$179.38 ","$181.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5605","ERX","HCPCS 25000001","59762-0489-01","NITROGLYCERIN 0.6 MG SL SUBL","BOTH IP/OP","$261.64 ","$193.61 ","$0.00 ","$226.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.49 ","$0.00 ","$113.25 ","$179.38 ","$181.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5606","ERX","HCPCS 25000001","00281-0326-08","NITROGLYCERIN 2 % TD OINT","BOTH IP/OP","$11.55 ","$8.55 ","$0.00 ","$10.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.47 ","$0.00 ","$5.24 ","$8.29 ","$8.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5674","ERX","HCPCS 63700001","50268-0603-15","NORTRIPTYLINE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5674","ERX","HCPCS 63700001","60687-0281-01","NORTRIPTYLINE HCL 10 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5675","ERX","HCPCS 63700001","51672-4002-01","NORTRIPTYLINE HCL 25 MG PO CAPS","BOTH IP/OP","$6.15 ","$4.55 ","$0.00 ","$6.00 ","","$1.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5677","ERX","HCPCS 63700001","00093-0813-01","NORTRIPTYLINE HCL 75 MG PO CAPS","BOTH IP/OP","$17.68 ","$13.08 ","$0.00 ","$16.03 ","","$3.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.03 ","$0.00 ","$8.02 ","$12.70 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5677","ERX","HCPCS 63700001","51672-4004-01","NORTRIPTYLINE HCL 75 MG PO CAPS","BOTH IP/OP","$17.68 ","$13.08 ","$0.00 ","$16.03 ","","$3.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.03 ","$0.00 ","$8.02 ","$12.70 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5749","ERX","HCPCS 25000001","00168-0054-15","NYSTATIN 100000 UNIT/GM EX CREA","BOTH IP/OP","$101.68 ","$75.24 ","$0.00 ","$92.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.19 ","$0.00 ","$46.10 ","$73.01 ","$73.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5749","ERX","HCPCS 25000001","45802-0059-35","NYSTATIN 100000 UNIT/GM EX CREA","BOTH IP/OP","$101.68 ","$75.24 ","$0.00 ","$92.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.19 ","$0.00 ","$46.10 ","$73.01 ","$73.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5749","ERX","HCPCS 25000001","51672-1289-01","NYSTATIN 100000 UNIT/GM EX CREA","BOTH IP/OP","$101.68 ","$75.24 ","$0.00 ","$92.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.19 ","$0.00 ","$46.10 ","$73.01 ","$73.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5749","ERX","HCPCS 25000001","00168-0054-30","NYSTATIN 100000 UNIT/GM EX CREA","BOTH IP/OP","$101.68 ","$75.24 ","$0.00 ","$92.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.19 ","$0.00 ","$46.10 ","$73.01 ","$73.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5749","ERX","HCPCS 25000001","45802-0059-11","NYSTATIN 100000 UNIT/GM EX CREA","BOTH IP/OP","$101.68 ","$75.24 ","$0.00 ","$92.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.19 ","$0.00 ","$46.10 ","$73.01 ","$73.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5749","ERX","HCPCS 25000001","51672-1289-02","NYSTATIN 100000 UNIT/GM EX CREA","BOTH IP/OP","$101.68 ","$75.24 ","$0.00 ","$92.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.19 ","$0.00 ","$46.10 ","$73.01 ","$73.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750","ERX","HCPCS 25000001","00168-0007-15","NYSTATIN 100000 UNIT/GM EX OINT","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750","ERX","HCPCS 25000001","45802-0048-35","NYSTATIN 100000 UNIT/GM EX OINT","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750","ERX","HCPCS 25000001","00168-0007-30","NYSTATIN 100000 UNIT/GM EX OINT","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750","ERX","HCPCS 25000001","00472-0166-30","NYSTATIN 100000 UNIT/GM EX OINT","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750","ERX","HCPCS 25000001","45802-0048-11","NYSTATIN 100000 UNIT/GM EX OINT","BOTH IP/OP","$97.28 ","$71.99 ","$0.00 ","$88.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.20 ","$0.00 ","$44.10 ","$69.85 ","$70.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5751","ERX","HCPCS 25000001","50383-0587-16","NYSTATIN 100000 UNIT/ML MT SUSP","BOTH IP/OP","$353.45 ","$261.55 ","$0.00 ","$353.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.45 ","$0.00 ","$176.73 ","$279.93 ","$282.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5751","ERX","HCPCS 25000001","51672-4117-09","NYSTATIN 100000 UNIT/ML MT SUSP","BOTH IP/OP","$353.45 ","$261.55 ","$0.00 ","$353.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.45 ","$0.00 ","$176.73 ","$279.93 ","$282.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5751","ERX","HCPCS 25000001","60432-0537-16","NYSTATIN 100000 UNIT/ML MT SUSP","BOTH IP/OP","$353.45 ","$261.55 ","$0.00 ","$353.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.45 ","$0.00 ","$176.73 ","$279.93 ","$282.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5751","ERX","HCPCS 25000001","50383-0587-66","NYSTATIN 100000 UNIT/ML MT SUSP","BOTH IP/OP","$64.30 ","$47.58 ","$0.00 ","$353.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.45 ","$0.00 ","$176.73 ","$50.93 ","$282.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5751","ERX","HCPCS 25000001","51672-4117-04","NYSTATIN 100000 UNIT/ML MT SUSP","BOTH IP/OP","$64.30 ","$47.58 ","$0.00 ","$353.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.45 ","$0.00 ","$176.73 ","$50.93 ","$282.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5751","ERX","HCPCS 25000001","60432-0537-60","NYSTATIN 100000 UNIT/ML MT SUSP","BOTH IP/OP","$64.30 ","$47.58 ","$0.00 ","$353.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.45 ","$0.00 ","$176.73 ","$50.93 ","$282.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5755","ERX","HCPCS 25000001","51672-1272-01","NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT","BOTH IP/OP","$376.14 ","$278.34 ","$0.00 ","$341.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.44 ","$0.00 ","$170.72 ","$270.42 ","$273.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5851","ERX","HCPCS 25000001","99999-6006-21","ORA-PLUS PO LIQD","BOTH IP/OP","$21.12 ","$15.63 ","$0.00 ","$19.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.16 ","$0.00 ","$9.58 ","$15.17 ","$15.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5851","ERX","HCPCS 25000001","00574-0303-16","ORA-PLUS PO LIQD","BOTH IP/OP","$21.12 ","$15.63 ","$0.00 ","$61.63 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.16 ","$0.00 ","$9.58 ","$61.63 ","$15.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5852","ERX","HCPCS 25000001","00574-0304-16","ORA-SWEET PO SYRP","BOTH IP/OP","$85.82 ","$63.51 ","$0.00 ","$77.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.81 ","$0.00 ","$38.91 ","$61.63 ","$62.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5853","ERX","HCPCS 25000001","00574-0302-16","ORA-SWEET SF PO SYRP","BOTH IP/OP","$85.82 ","$63.51 ","$0.00 ","$77.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.81 ","$0.00 ","$38.91 ","$61.63 ","$62.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5924","ERX","HCPCS J2700","25021-0146-10","OXACILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$28.29 ","$20.93 ","$0.00 ","$25.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.65 ","$0.00 ","$12.83 ","$20.31 ","$20.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5924","ERX","HCPCS J2700","55150-0127-15","OXACILLIN SODIUM 1 G IJ SOLR","BOTH IP/OP","$28.29 ","$20.93 ","$0.00 ","$25.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.65 ","$0.00 ","$12.83 ","$20.31 ","$20.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","00603-4975-21","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","00832-0038-00","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","00832-0038-01","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","00832-0038-50","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","00904-2821-61","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","50111-0456-01","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5938","ERX","HCPCS 63700001","68084-0400-01","OXYBUTYNIN CHLORIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","00054-0551-25","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","00406-0512-01","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","00406-0512-05","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","00406-0512-23","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","00406-0512-62","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","00904-6437-61","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","13107-0044-01","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","68084-0355-01","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","68084-0355-11","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5940","ERX","HCPCS 25000001","99999-6006-78","OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5943","ERX","HCPCS 25000001","00904-6761-30","OXYMETAZOLINE HCL 0.05 % NA SOLN","BOTH IP/OP","$16.72 ","$12.37 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5944","ERX","HCPCS J2590","42023-0116-02","OXYTOCIN 10 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"5944","ERX","HCPCS J2590","42023-0116-25","OXYTOCIN 10 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"5944","ERX","HCPCS J2590","63323-0012-03","OXYTOCIN 10 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"5944","ERX","HCPCS J2590","63323-0012-10","OXYTOCIN 10 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"5944","ERX","HCPCS J2590","63323-0012-11","OXYTOCIN 10 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"5944","ERX","HCPCS J2590","63323-0012-12","OXYTOCIN 10 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"5955","ERX","HCPCS 63700001","00904-1883-61","OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5955","ERX","HCPCS 63700001","00904-1883-72","OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5955","ERX","HCPCS 63700001","51645-0827-99","OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6013","ERX","HCPCS 25000001","00409-4646-01","PANCURONIUM BROMIDE 1 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6030","ERX","HCPCS J2440","00517-4002-25","PAPAVERINE HCL 30 MG/ML IJ SOLN","BOTH IP/OP","$95.91 ","$70.97 ","$0.00 ","$86.97 ","$43.16 ","$0.00 ","$19.99 ","$0.00 ","$0.00 ","$15.23 ","$86.97 ","$0.00 ","$43.49 ","$68.88 ","$69.58 ","$0.00 ","$13.61 ","$0.00 ","$13.85 ","$0.00 "
"6040","ERX","HCPCS J7300","51285-0204-01","PARAGARD INTRAUTERINE COPPER IU IUD","BOTH IP/OP","$2,541.15 ","$1,880.45 ","$0.00 ","$2,175.87 ","$1,143.52 ","$849.12 ","$750.43 ","$0.00 ","$0.00 ","$1,039.29 ","$2,175.87 ","$0.00 ","$1,087.94 ","$1,723.29 ","$1,740.70 ","$1,305.52 ","$1,039.29 ","$0.00 ","$989.58 ","$0.00 "
"6040","ERX","HCPCS J7300","59365-5128-01","PARAGARD INTRAUTERINE COPPER IU IUD","BOTH IP/OP","$2,541.15 ","$1,880.45 ","$0.00 ","$2,175.87 ","$1,143.52 ","$849.12 ","$750.43 ","$0.00 ","$0.00 ","$1,039.29 ","$2,175.87 ","$0.00 ","$1,087.94 ","$1,723.29 ","$1,740.70 ","$1,305.52 ","$1,039.29 ","$0.00 ","$989.58 ","$0.00 "
"6085","ERX","HCPCS J2540","00049-0530-22","PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6085","ERX","HCPCS J2540","00049-0530-28","PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6085","ERX","HCPCS J2540","70860-0127-51","PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6086","ERX","HCPCS J2540","00049-0520-83","PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR","BOTH IP/OP","$63.97 ","$47.34 ","$0.00 ","$57.73 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.73 ","$0.00 ","$28.87 ","$45.72 ","$46.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6087","ERX","HCPCS 25000001","00781-6153-94","PENICILLIN G SODIUM 5000000 UNITS IJ SOLR","BOTH IP/OP","$28.97 ","$21.44 ","$0.00 ","$26.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.27 ","$0.00 ","$13.14 ","$20.81 ","$21.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6087","ERX","HCPCS 25000001","00781-6153-95","PENICILLIN G SODIUM 5000000 UNITS IJ SOLR","BOTH IP/OP","$28.97 ","$21.44 ","$0.00 ","$26.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.27 ","$0.00 ","$13.14 ","$20.81 ","$21.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6090","ERX","HCPCS 63700001","00093-4125-73","PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR","BOTH IP/OP","$38.13 ","$28.22 ","$0.00 ","$34.58 ","","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.58 ","$0.00 ","$17.29 ","$27.39 ","$27.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6090","ERX","HCPCS 63700001","00093-4125-74","PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR","BOTH IP/OP","$38.13 ","$28.22 ","$0.00 ","$40.33 ","","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.58 ","$0.00 ","$17.29 ","$40.33 ","$27.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6091","ERX","HCPCS 25000001","00093-4127-73","PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR","BOTH IP/OP","$42.74 ","$31.63 ","$0.00 ","$38.76 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.76 ","$0.00 ","$19.38 ","$30.70 ","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6091","ERX","HCPCS 25000001","00093-4127-74","PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR","BOTH IP/OP","$42.74 ","$31.63 ","$0.00 ","$44.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.76 ","$0.00 ","$19.38 ","$44.54 ","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6092","ERX","HCPCS 63700001","00093-1172-10","PENICILLIN V POTASSIUM 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6092","ERX","HCPCS 63700001","16714-0234-01","PENICILLIN V POTASSIUM 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6092","ERX","HCPCS 63700001","57237-0040-01","PENICILLIN V POTASSIUM 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6093","ERX","HCPCS 63700001","16714-0235-01","PENICILLIN V POTASSIUM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6097","ERX","HCPCS J2515","25021-0676-20","PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$3,796.80 ","$2,809.63 ","$0.00 ","$3,444.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,444.00 ","$0.00 ","$1,722.00 ","$2,727.65 ","$2,755.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6097","ERX","HCPCS J2515","76478-0501-20","PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$3,796.80 ","$2,809.63 ","$0.00 ","$3,444.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,444.00 ","$0.00 ","$1,722.00 ","$2,727.65 ","$2,755.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6116","ERX","HCPCS 25000001","00395-2015-91","PEPPERMINT OIL OIL","BOTH IP/OP","$98.78 ","$73.10 ","$0.00 ","$86.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.10 ","$0.00 ","$43.05 ","$68.19 ","$68.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6157","ERX","HCPCS Q0175","00781-1046-13","PERPHENAZINE 2 MG PO TABS","BOTH IP/OP","$8.24 ","$6.10 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.47 ","$0.00 ","$3.74 ","$5.92 ","$5.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6157","ERX","HCPCS Q0175","52536-0162-01","PERPHENAZINE 2 MG PO TABS","BOTH IP/OP","$8.24 ","$6.10 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.47 ","$0.00 ","$3.74 ","$5.92 ","$5.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6158","ERX","HCPCS Q0175","00603-5061-21","PERPHENAZINE 4 MG PO TABS","BOTH IP/OP","$11.26 ","$8.33 ","$0.00 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.22 ","$0.00 ","$5.11 ","$8.09 ","$8.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6158","ERX","HCPCS Q0175","00781-1047-01","PERPHENAZINE 4 MG PO TABS","BOTH IP/OP","$11.26 ","$8.33 ","$0.00 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.22 ","$0.00 ","$5.11 ","$8.09 ","$8.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6158","ERX","HCPCS Q0175","00781-1047-13","PERPHENAZINE 4 MG PO TABS","BOTH IP/OP","$11.26 ","$8.33 ","$0.00 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.22 ","$0.00 ","$5.11 ","$8.09 ","$8.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6158","ERX","HCPCS Q0175","00781-8047-01","PERPHENAZINE 4 MG PO TABS","BOTH IP/OP","$11.26 ","$8.33 ","$0.00 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.22 ","$0.00 ","$5.11 ","$8.09 ","$8.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6159","ERX","HCPCS Q0175","00378-5352-01","PERPHENAZINE 8 MG PO TABS","BOTH IP/OP","$13.67 ","$10.12 ","$0.00 ","$12.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.40 ","$0.00 ","$6.20 ","$9.82 ","$9.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6159","ERX","HCPCS Q0175","00603-5062-21","PERPHENAZINE 8 MG PO TABS","BOTH IP/OP","$13.67 ","$10.12 ","$0.00 ","$12.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.40 ","$0.00 ","$6.20 ","$9.82 ","$9.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6159","ERX","HCPCS Q0175","00781-1048-13","PERPHENAZINE 8 MG PO TABS","BOTH IP/OP","$13.67 ","$10.12 ","$0.00 ","$12.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.40 ","$0.00 ","$6.20 ","$9.82 ","$9.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6159","ERX","HCPCS Q0175","00781-8048-01","PERPHENAZINE 8 MG PO TABS","BOTH IP/OP","$13.67 ","$10.12 ","$0.00 ","$12.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.40 ","$0.00 ","$6.20 ","$9.82 ","$9.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6159","ERX","HCPCS Q0175","68084-0607-01","PERPHENAZINE 8 MG PO TABS","BOTH IP/OP","$13.67 ","$10.12 ","$0.00 ","$12.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.40 ","$0.00 ","$6.20 ","$9.82 ","$9.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6193","ERX","HCPCS 63700001","10135-0620-01","PHENAZOPYRIDINE HCL 100 MG PO TABS","BOTH IP/OP","$6.67 ","$4.94 ","$0.00 ","$6.05 ","","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.05 ","$0.00 ","$3.03 ","$4.79 ","$4.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6193","ERX","HCPCS 63700001","42937-0701-10","PHENAZOPYRIDINE HCL 100 MG PO TABS","BOTH IP/OP","$6.67 ","$4.94 ","$0.00 ","$6.05 ","","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.05 ","$0.00 ","$3.03 ","$4.79 ","$4.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6193","ERX","HCPCS 63700001","51293-0801-01","PHENAZOPYRIDINE HCL 100 MG PO TABS","BOTH IP/OP","$6.67 ","$4.94 ","$0.00 ","$6.05 ","","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.05 ","$0.00 ","$3.03 ","$4.79 ","$4.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6212","ERX","HCPCS 63700001","00603-1508-58","PHENOBARBITAL 20 MG/5ML PO ELIX","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6212","ERX","HCPCS 63700001","13517-0107-16","PHENOBARBITAL 20 MG/5ML PO ELIX","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6212","ERX","HCPCS 63700001","99999-6006-84","PHENOBARBITAL 20 MG/5ML PO ELIX","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6217","ERX","HCPCS 63700001","00904-6575-61","PHENOBARBITAL 32.4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6220","ERX","HCPCS 63700001","00603-5168-21","PHENOBARBITAL 97.2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6220","ERX","HCPCS 63700001","13517-0113-01","PHENOBARBITAL 97.2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6221","ERX","HCPCS J2560","00641-0477-21","PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","BOTH IP/OP","$199.57 ","$147.68 ","$0.00 ","$181.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.81 ","$181.17 ","$0.00 ","$90.59 ","$143.49 ","$144.94 ","$0.00 ","$49.81 ","$0.00 ","$47.43 ","$0.00 "
"6221","ERX","HCPCS J2560","00641-0477-25","PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","BOTH IP/OP","$199.57 ","$147.68 ","$0.00 ","$181.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.81 ","$181.17 ","$0.00 ","$90.59 ","$143.49 ","$144.94 ","$0.00 ","$49.81 ","$0.00 ","$47.43 ","$0.00 "
"6224","ERX","HCPCS J2560","00641-0476-25","PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","BOTH IP/OP","$111.08 ","$82.20 ","$0.00 ","$100.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.81 ","$100.72 ","$0.00 ","$50.36 ","$79.77 ","$80.58 ","$0.00 ","$49.81 ","$0.00 ","$47.43 ","$0.00 "
"6227","ERX","HCPCS 25000001","49452-5220-02","PHENOL EX LIQD","BOTH IP/OP","$1,370.11 ","$1,013.88 ","$0.00 ","$1,269.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,269.60 ","$0.00 ","$634.80 ","$1,005.52 ","$1,015.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6243","ERX","HCPCS 25000001","00225-0800-47","PHENYLEPHRINE HCL 0.25 % NA SOLN","BOTH IP/OP","$15.91 ","$11.77 ","$0.00 ","$14.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.43 ","$0.00 ","$7.22 ","$11.43 ","$11.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6244","ERX","HCPCS 25000001","00225-0805-47","PHENYLEPHRINE HCL 0.5 % NA SOLN","BOTH IP/OP","$15.91 ","$11.77 ","$0.00 ","$14.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.43 ","$0.00 ","$7.22 ","$11.43 ","$11.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6246","ERX","HCPCS 25000001","17478-0201-02","PHENYLEPHRINE HCL 2.5 % OP SOLN","BOTH IP/OP","$362.88 ","$268.53 ","$0.00 ","$343.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.13 ","$0.00 ","$171.57 ","$112.63 ","$274.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6246","ERX","HCPCS 25000001","17478-0201-15","PHENYLEPHRINE HCL 2.5 % OP SOLN","BOTH IP/OP","$362.88 ","$268.53 ","$0.00 ","$343.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.13 ","$0.00 ","$171.57 ","$271.76 ","$274.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6246","ERX","HCPCS 25000001","42702-0102-15","PHENYLEPHRINE HCL 2.5 % OP SOLN","BOTH IP/OP","$362.88 ","$268.53 ","$0.00 ","$343.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.13 ","$0.00 ","$171.57 ","$271.76 ","$274.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6255","ERX","HCPCS 63700001","99999-6010-65","PHENYTOIN 125 MG/5ML PO SUSP","BOTH IP/OP","$82.72 ","$61.21 ","$0.00 ","$138.18 ","","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.18 ","$0.00 ","$69.09 ","$59.42 ","$110.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6255","ERX","HCPCS 63700001","99999-6004-70","PHENYTOIN 125 MG/5ML PO SUSP","BOTH IP/OP","$82.72 ","$61.21 ","$0.00 ","$138.18 ","","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.18 ","$0.00 ","$69.09 ","$109.44 ","$110.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6255","ERX","HCPCS 63700001","00071-2214-20","PHENYTOIN 125 MG/5ML PO SUSP","BOTH IP/OP","$82.72 ","$61.21 ","$0.00 ","$427.28 ","","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.18 ","$0.00 ","$69.09 ","$427.28 ","$110.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6255","ERX","HCPCS 63700001","59762-0531-02","PHENYTOIN 125 MG/5ML PO SUSP","BOTH IP/OP","$82.72 ","$61.21 ","$0.00 ","$427.28 ","","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.18 ","$0.00 ","$69.09 ","$427.28 ","$110.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6256","ERX","HCPCS J1165","00641-0493-25","PHENYTOIN SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6256","ERX","HCPCS J1165","00641-2555-41","PHENYTOIN SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6256","ERX","HCPCS J1165","00641-2555-45","PHENYTOIN SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6256","ERX","HCPCS J1165","00641-6138-25","PHENYTOIN SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6256","ERX","HCPCS J1165","00641-6139-25","PHENYTOIN SODIUM 50 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6257","ERX","HCPCS 63700001","00071-0369-40","PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6257","ERX","HCPCS 63700001","00904-6187-61","PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6257","ERX","HCPCS 63700001","51079-0905-20","PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6257","ERX","HCPCS 63700001","51672-4111-01","PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6257","ERX","HCPCS 63700001","51672-4111-03","PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6257","ERX","HCPCS 63700001","68084-0376-01","PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6270","ERX","HCPCS 25000001","17478-0510-02","PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$181.32 ","$134.18 ","$0.00 ","$164.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.41 ","$0.00 ","$82.21 ","$130.21 ","$131.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6279","ERX","HCPCS 25000001","00998-0203-15","PILOCARPINE HCL 1 % OP SOLN","BOTH IP/OP","$342.03 ","$253.10 ","$0.00 ","$310.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.48 ","$0.00 ","$155.24 ","$245.90 ","$248.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6279","ERX","HCPCS 25000001","61314-0203-15","PILOCARPINE HCL 1 % OP SOLN","BOTH IP/OP","$342.03 ","$253.10 ","$0.00 ","$310.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.48 ","$0.00 ","$155.24 ","$245.90 ","$248.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6279","ERX","HCPCS 25000001","70069-0181-01","PILOCARPINE HCL 1 % OP SOLN","BOTH IP/OP","$342.03 ","$253.10 ","$0.00 ","$310.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.48 ","$0.00 ","$155.24 ","$245.90 ","$248.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280","ERX","HCPCS 25000001","00998-0204-15","PILOCARPINE HCL 2 % OP SOLN","BOTH IP/OP","$338.74 ","$250.67 ","$0.00 ","$307.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.49 ","$0.00 ","$153.75 ","$243.53 ","$245.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280","ERX","HCPCS 25000001","17478-0224-12","PILOCARPINE HCL 2 % OP SOLN","BOTH IP/OP","$338.74 ","$250.67 ","$0.00 ","$307.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.49 ","$0.00 ","$153.75 ","$243.53 ","$245.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280","ERX","HCPCS 25000001","61314-0204-15","PILOCARPINE HCL 2 % OP SOLN","BOTH IP/OP","$338.74 ","$250.67 ","$0.00 ","$307.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.49 ","$0.00 ","$153.75 ","$243.53 ","$245.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6282","ERX","HCPCS 25000001","00998-0206-15","PILOCARPINE HCL 4 % OP SOLN","BOTH IP/OP","$355.12 ","$262.79 ","$0.00 ","$322.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.36 ","$0.00 ","$161.18 ","$255.31 ","$257.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6282","ERX","HCPCS 25000001","61314-0206-15","PILOCARPINE HCL 4 % OP SOLN","BOTH IP/OP","$355.12 ","$262.79 ","$0.00 ","$322.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.36 ","$0.00 ","$161.18 ","$255.31 ","$257.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6296","ERX","HCPCS 63700001","00378-0127-01","PINDOLOL 10 MG PO TABS","BOTH IP/OP","$7.54 ","$5.58 ","$0.00 ","$6.84 ","","$1.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.84 ","$0.00 ","$3.42 ","$5.42 ","$5.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6296","ERX","HCPCS 63700001","57664-0656-88","PINDOLOL 10 MG PO TABS","BOTH IP/OP","$7.54 ","$5.58 ","$0.00 ","$6.84 ","","$1.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.84 ","$0.00 ","$3.42 ","$5.42 ","$5.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6297","ERX","HCPCS 63700001","00378-0052-01","PINDOLOL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6297","ERX","HCPCS 63700001","57664-0655-88","PINDOLOL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6331","ERX","HCPCS 25000001","00338-0221-04","PLASMA-LYTE A IV SOLN","BOTH IP/OP","$67.04 ","$49.61 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6393","ERX","HCPCS 25000001","55150-0234-10","POLYMYXIN B SULFATE 500000 UNITS IJ SOLR","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.30 ","$0.00 ","$25.65 ","$40.63 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6393","ERX","HCPCS 25000001","63323-0367-01","POLYMYXIN B SULFATE 500000 UNITS IJ SOLR","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.30 ","$0.00 ","$25.65 ","$40.63 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6393","ERX","HCPCS 25000001","63323-0367-11","POLYMYXIN B SULFATE 500000 UNITS IJ SOLR","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.30 ","$0.00 ","$25.65 ","$40.63 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6393","ERX","HCPCS 25000001","70860-0103-10","POLYMYXIN B SULFATE 500000 UNITS IJ SOLR","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.30 ","$0.00 ","$25.65 ","$40.63 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6393","ERX","HCPCS 25000001","70860-0103-41","POLYMYXIN B SULFATE 500000 UNITS IJ SOLR","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.30 ","$0.00 ","$25.65 ","$40.63 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6420","ERX","HCPCS 25000001","00409-8183-01","POTASSIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6429","ERX","HCPCS J3480","00264-1940-20","KCL 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"6429","ERX","HCPCS J3480","00409-6651-06","KCL 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"6429","ERX","HCPCS J3480","63323-0965-03","KCL 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"6429","ERX","HCPCS J3480","63323-0965-10","KCL 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"6429","ERX","HCPCS J3480","63323-0965-20","KCL 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"6458","ERX","HCPCS 25000001","49348-0622-37","POVIDONE-IODINE 10 % EX SOLN","BOTH IP/OP","$26.82 ","$19.85 ","$0.00 ","$24.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.32 ","$0.00 ","$12.16 ","$19.26 ","$19.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6462","ERX","HCPCS J2730","60977-0141-01","PRALIDOXIME CHLORIDE 1 G IV SOLR","BOTH IP/OP","$100.40 ","$74.30 ","$0.00 ","$91.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.04 ","$0.00 ","$45.52 ","$72.10 ","$72.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6462","ERX","HCPCS J2730","60977-0141-27","PRALIDOXIME CHLORIDE 1 G IV SOLR","BOTH IP/OP","$100.40 ","$74.30 ","$0.00 ","$91.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.04 ","$0.00 ","$45.52 ","$72.10 ","$72.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6468","ERX","HCPCS 63700001","00378-1101-01","PRAZOSIN HCL 1 MG PO CAPS","BOTH IP/OP","$7.60 ","$5.62 ","$0.00 ","$6.89 ","","$1.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.89 ","$0.00 ","$3.45 ","$5.46 ","$5.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6468","ERX","HCPCS 63700001","51079-0630-20","PRAZOSIN HCL 1 MG PO CAPS","BOTH IP/OP","$7.60 ","$5.62 ","$0.00 ","$6.89 ","","$1.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.89 ","$0.00 ","$3.45 ","$5.46 ","$5.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6469","ERX","HCPCS 63700001","00093-4068-01","PRAZOSIN HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6469","ERX","HCPCS 63700001","00378-2302-01","PRAZOSIN HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6469","ERX","HCPCS 63700001","51079-0631-20","PRAZOSIN HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6469","ERX","HCPCS 63700001","59762-5320-01","PRAZOSIN HCL 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6470","ERX","HCPCS 63700001","00093-4069-01","PRAZOSIN HCL 5 MG PO CAPS","BOTH IP/OP","$18.06 ","$13.36 ","$0.00 ","$16.38 ","","$3.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.38 ","$0.00 ","$8.19 ","$12.97 ","$13.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6470","ERX","HCPCS 63700001","51079-0632-20","PRAZOSIN HCL 5 MG PO CAPS","BOTH IP/OP","$18.06 ","$13.36 ","$0.00 ","$16.38 ","","$3.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.38 ","$0.00 ","$8.19 ","$12.97 ","$13.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6470","ERX","HCPCS 63700001","70954-0021-10","PRAZOSIN HCL 5 MG PO CAPS","BOTH IP/OP","$18.06 ","$13.36 ","$0.00 ","$16.38 ","","$3.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.38 ","$0.00 ","$8.19 ","$12.97 ","$13.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6487","ERX","HCPCS 25000001","60758-0119-10","PREDNISOLONE ACETATE 1 % OP SUSP","BOTH IP/OP","$354.82 ","$262.57 ","$0.00 ","$322.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.08 ","$0.00 ","$161.04 ","$255.09 ","$257.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6487","ERX","HCPCS 25000001","61314-0637-10","PREDNISOLONE ACETATE 1 % OP SUSP","BOTH IP/OP","$354.82 ","$262.57 ","$0.00 ","$322.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.08 ","$0.00 ","$161.04 ","$255.09 ","$257.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6487","ERX","HCPCS 25000001","11980-0180-05","PREDNISOLONE ACETATE 1 % OP SUSP","BOTH IP/OP","$354.82 ","$262.57 ","$0.00 ","$442.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.08 ","$0.00 ","$161.04 ","$442.81 ","$257.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6487","ERX","HCPCS 25000001","60758-0119-05","PREDNISOLONE ACETATE 1 % OP SUSP","BOTH IP/OP","$354.82 ","$262.57 ","$0.00 ","$442.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.08 ","$0.00 ","$161.04 ","$442.81 ","$257.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6487","ERX","HCPCS 25000001","61314-0637-05","PREDNISOLONE ACETATE 1 % OP SUSP","BOTH IP/OP","$354.82 ","$262.57 ","$0.00 ","$442.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.08 ","$0.00 ","$161.04 ","$442.81 ","$257.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6493","ERX","HCPCS 25000001","00054-4741-25","PREDNISONE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6493","ERX","HCPCS 25000001","00054-8739-25","PREDNISONE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6493","ERX","HCPCS 25000001","59746-0171-06","PREDNISONE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","00054-0017-20","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","00054-0017-29","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","00603-5338-21","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","00603-5338-28","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","00603-5338-32","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","59746-0173-06","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","60687-0134-01","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6494","ERX","HCPCS 25000001","63739-0519-10","PREDNISONE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6496","ERX","HCPCS 25000001","00054-0018-20","PREDNISONE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6496","ERX","HCPCS 25000001","59746-0175-06","PREDNISONE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6497","ERX","HCPCS 25000001","00054-8724-25","PREDNISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6497","ERX","HCPCS 25000001","00603-5337-21","PREDNISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6497","ERX","HCPCS 25000001","59746-0172-06","PREDNISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6497","ERX","HCPCS 25000001","60687-0122-01","PREDNISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6497","ERX","HCPCS 25000001","60687-0122-11","PREDNISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6497","ERX","HCPCS 25000001","63739-0518-10","PREDNISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6498","ERX","HCPCS 25000001","00054-0019-20","PREDNISONE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6498","ERX","HCPCS 25000001","00054-0019-25","PREDNISONE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6541","ERX","HCPCS 63700001","00024-1596-01","PRIMAQUINE PHOSPHATE 26.3 MG PO TABS","BOTH IP/OP","$8.10 ","$5.99 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6541","ERX","HCPCS 63700001","76385-0102-01","PRIMAQUINE PHOSPHATE 26.3 MG PO TABS","BOTH IP/OP","$8.10 ","$5.99 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6544","ERX","HCPCS 63700001","00591-5321-01","PRIMIDONE 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6544","ERX","HCPCS 63700001","68084-0203-01","PRIMIDONE 250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6561","ERX","HCPCS 63700001","00378-0156-01","PROBENECID 500 MG PO TABS","BOTH IP/OP","$8.24 ","$6.10 ","$0.00 ","$7.48 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.48 ","$0.00 ","$3.74 ","$5.92 ","$5.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6561","ERX","HCPCS 63700001","00591-5347-01","PROBENECID 500 MG PO TABS","BOTH IP/OP","$8.24 ","$6.10 ","$0.00 ","$7.48 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.48 ","$0.00 ","$3.74 ","$5.92 ","$5.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6562","ERX","HCPCS J2690","14789-0901-10","PROCAINAMIDE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$458.97 ","$339.64 ","$0.00 ","$458.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.97 ","$0.00 ","$229.49 ","$363.50 ","$367.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6582","ERX","HCPCS S0183","59746-0115-06","PROCHLORPERAZINE MALEATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$3.60 ","$0.94 ","$0.00 ","$0.00 ","$0.00 "
"6583","ERX","HCPCS S0183","00378-5105-01","PROCHLORPERAZINE MALEATE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$3.60 ","$0.94 ","$0.00 ","$0.00 ","$0.00 "
"6583","ERX","HCPCS S0183","59746-0113-06","PROCHLORPERAZINE MALEATE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$3.60 ","$0.94 ","$0.00 ","$0.00 ","$0.00 "
"6597","ERX","HCPCS J2675","00591-3128-79","PROGESTERONE 50 MG/ML IM OIL","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6618","ERX","HCPCS J2550","00641-0928-21","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6618","ERX","HCPCS J2550","00641-0928-25","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6618","ERX","HCPCS J2550","00641-0955-25","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6618","ERX","HCPCS J2550","00641-1495-31","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6618","ERX","HCPCS J2550","00641-1495-35","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6618","ERX","HCPCS J2550","00641-6084-25","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6618","ERX","HCPCS J2550","39822-5525-03","PROMETHAZINE HCL 25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.93 ","$0.00 ","$0.00 ","$2.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.42 ","$0.00 ","$2.30 ","$0.00 "
"6622","ERX","HCPCS Q0169","00904-6461-61","PROMETHAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"6622","ERX","HCPCS Q0169","10702-0003-01","PROMETHAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"6622","ERX","HCPCS Q0169","68084-0155-01","PROMETHAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"6643","ERX","HCPCS 63700001","00054-4721-25","PROPANTHELINE BROMIDE 15 MG PO TABS","BOTH IP/OP","$11.40 ","$8.44 ","$0.00 ","$11.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.40 ","$0.00 ","$5.70 ","$9.03 ","$9.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6644","ERX","HCPCS 25000001","24208-0730-06","PROPARACAINE HCL 0.5 % OP SOLN","BOTH IP/OP","$169.36 ","$125.33 ","$0.00 ","$153.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$153.57 ","$0.00 ","$76.79 ","$121.63 ","$122.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6644","ERX","HCPCS 25000001","61314-0016-01","PROPARACAINE HCL 0.5 % OP SOLN","BOTH IP/OP","$169.36 ","$125.33 ","$0.00 ","$153.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$153.57 ","$0.00 ","$76.79 ","$121.63 ","$122.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6654","ERX","HCPCS 25000001","99999-6010-68","PROPRANOLOL HCL 20 MG/5ML PO SOLN","BOTH IP/OP","$20.12 ","$14.89 ","$0.00 ","$36.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.48 ","$0.00 ","$18.24 ","$14.45 ","$29.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6654","ERX","HCPCS 25000001","99999-6004-71","PROPRANOLOL HCL 20 MG/5ML PO SOLN","BOTH IP/OP","$20.12 ","$14.89 ","$0.00 ","$36.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.48 ","$0.00 ","$18.24 ","$28.89 ","$29.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6654","ERX","HCPCS 25000001","00054-3727-63","PROPRANOLOL HCL 20 MG/5ML PO SOLN","BOTH IP/OP","$20.12 ","$14.89 ","$0.00 ","$164.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.48 ","$0.00 ","$18.24 ","$164.66 ","$29.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6656","ERX","HCPCS 63700001","00378-0182-01","PROPRANOLOL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6656","ERX","HCPCS 63700001","00378-0182-10","PROPRANOLOL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6656","ERX","HCPCS 63700001","00591-5554-01","PROPRANOLOL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6656","ERX","HCPCS 63700001","00603-5482-21","PROPRANOLOL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6656","ERX","HCPCS 63700001","00603-5482-32","PROPRANOLOL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6656","ERX","HCPCS 63700001","00904-6550-61","PROPRANOLOL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6658","ERX","HCPCS 63700001","00115-1661-01","PROPRANOLOL HCL 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6658","ERX","HCPCS 63700001","00378-0184-01","PROPRANOLOL HCL 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6658","ERX","HCPCS 63700001","00591-5556-01","PROPRANOLOL HCL 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6658","ERX","HCPCS 63700001","00603-5484-21","PROPRANOLOL HCL 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6659","ERX","HCPCS 63700001","00378-0187-01","PROPRANOLOL HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6659","ERX","HCPCS 63700001","00603-5485-21","PROPRANOLOL HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6660","ERX","HCPCS 63700001","00378-0185-01","PROPRANOLOL HCL 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6660","ERX","HCPCS 63700001","00603-5486-21","PROPRANOLOL HCL 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6662","ERX","HCPCS 63700001","00228-2348-10","PROPYLTHIOURACIL 50 MG PO TABS","BOTH IP/OP","$14.08 ","$10.42 ","$0.00 ","$12.77 ","","$2.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.77 ","$0.00 ","$6.39 ","$4.75 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6662","ERX","HCPCS 63700001","67253-0651-10","PROPYLTHIOURACIL 50 MG PO TABS","BOTH IP/OP","$14.08 ","$10.42 ","$0.00 ","$12.77 ","","$2.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.77 ","$0.00 ","$6.39 ","$4.75 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6662","ERX","HCPCS 63700001","67253-0651-11","PROPYLTHIOURACIL 50 MG PO TABS","BOTH IP/OP","$14.08 ","$10.42 ","$0.00 ","$12.77 ","","$2.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.77 ","$0.00 ","$6.39 ","$4.75 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6662","ERX","HCPCS 63700001","68084-0964-25","PROPYLTHIOURACIL 50 MG PO TABS","BOTH IP/OP","$14.08 ","$10.42 ","$0.00 ","$12.77 ","","$2.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.77 ","$0.00 ","$6.39 ","$4.75 ","$10.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6677","ERX","HCPCS J2720","63323-0229-05","PROTAMINE SULFATE 10 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.60 ","$0.00 ","$0.00 ","$1.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.28 ","$0.00 ","$1.22 ","$0.00 "
"6677","ERX","HCPCS J2720","63323-0229-15","PROTAMINE SULFATE 10 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.60 ","$0.00 ","$0.00 ","$1.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.28 ","$0.00 ","$1.22 ","$0.00 "
"6677","ERX","HCPCS J2720","63323-0229-30","PROTAMINE SULFATE 10 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.60 ","$0.00 ","$0.00 ","$1.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.28 ","$0.00 ","$1.22 ","$0.00 "
"6714","ERX","HCPCS 63700001","00904-5053-24","PSEUDOEPHEDRINE HCL 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6714","ERX","HCPCS 63700001","00904-5053-59","PSEUDOEPHEDRINE HCL 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6714","ERX","HCPCS 63700001","45802-0432-62","PSEUDOEPHEDRINE HCL 30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6715","ERX","HCPCS 63700001","00904-5125-59","PSEUDOEPHEDRINE HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6715","ERX","HCPCS 63700001","00904-6728-52","PSEUDOEPHEDRINE HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6738","ERX","HCPCS 63700001","61748-0012-01","PYRAZINAMIDE 500 MG PO TABS","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$9.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6738","ERX","HCPCS 63700001","61748-0012-11","PYRAZINAMIDE 500 MG PO TABS","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$9.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6744","ERX","HCPCS J3415","63323-0180-01","PYRIDOXINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$41.66 ","$30.83 ","$0.00 ","$34.66 ","$18.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.66 ","$0.00 ","$17.33 ","$27.45 ","$27.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6777","ERX","HCPCS 63700001","00185-4346-01","QUINIDINE SULFATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6781","ERX","HCPCS 63700001","00093-3002-56","QUININE SULFATE 324 MG PO CAPS","BOTH IP/OP","$26.85 ","$19.87 ","$0.00 ","$26.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.85 ","$0.00 ","$13.43 ","$21.27 ","$21.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6781","ERX","HCPCS 63700001","13310-0153-07","QUININE SULFATE 324 MG PO CAPS","BOTH IP/OP","$26.85 ","$19.87 ","$0.00 ","$26.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.85 ","$0.00 ","$13.43 ","$21.27 ","$21.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6781","ERX","HCPCS 63700001","53489-0700-07","QUININE SULFATE 324 MG PO CAPS","BOTH IP/OP","$26.85 ","$19.87 ","$0.00 ","$26.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.85 ","$0.00 ","$13.43 ","$21.27 ","$21.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6839","ERX","HCPCS 25000001","00327-0012-30","RENACIDIN IR SOLN","BOTH IP/OP","$28.92 ","$21.40 ","$0.00 ","$26.22 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.22 ","$0.00 ","$13.11 ","$20.77 ","$20.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6969","ERX","HCPCS 25000001","51801-0004-40","ROSE BENGAL 1.3 MG OP STRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7030","ERX","HCPCS 25000001","00904-3865-75","SALINE NASAL SPRAY 0.65 % NA SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7030","ERX","HCPCS 25000001","45802-0357-58","SALINE NASAL SPRAY 0.65 % NA SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7034","ERX","HCPCS 63700001","51293-0803-01","SALSALATE 500 MG PO TABS","BOTH IP/OP","$7.96 ","$5.89 ","$0.00 ","$7.22 ","","$1.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.22 ","$0.00 ","$3.61 ","$5.72 ","$5.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7035","ERX","HCPCS 63700001","10135-0493-01","SALSALATE 750 MG PO TABS","BOTH IP/OP","$8.50 ","$6.29 ","$0.00 ","$7.71 ","","$2.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.71 ","$0.00 ","$3.86 ","$6.11 ","$6.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7035","ERX","HCPCS 63700001","51293-0804-01","SALSALATE 750 MG PO TABS","BOTH IP/OP","$8.50 ","$6.29 ","$0.00 ","$7.71 ","","$2.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.71 ","$0.00 ","$3.86 ","$6.11 ","$6.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7222","ERX","HCPCS 25000001","62991-2927-03","SILVER NITRATE CRYS","BOTH IP/OP","$1,160.70 ","$858.92 ","$0.00 ","$1,053.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,053.38 ","$0.00 ","$526.69 ","$834.28 ","$842.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","43598-0210-50","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$45.44 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","43598-0210-55","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$45.44 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","61570-0131-50","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$45.44 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","67877-0124-05","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$45.44 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","67877-0124-50","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$45.44 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","43598-0210-40","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$291.80 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","61570-0131-40","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$291.80 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224","ERX","HCPCS 25000001","67877-0124-40","SILVER SULFADIAZINE 1 % EX CREA","BOTH IP/OP","$63.27 ","$46.82 ","$0.00 ","$368.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.44 ","$0.00 ","$184.22 ","$291.80 ","$294.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7227","ERX","HCPCS 63700001","00904-5068-60","SIMETHICONE 80 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7227","ERX","HCPCS 63700001","63739-0225-10","SIMETHICONE 80 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7227","ERX","HCPCS 63700001","69618-0033-01","SIMETHICONE 80 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7228","ERX","HCPCS 63700001","00536-2220-75","SIMETHICONE 40 MG/0.6ML PO SUSP","BOTH IP/OP","$22.58 ","$16.71 ","$0.00 ","$17.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.34 ","$0.00 ","$6.67 ","$17.88 ","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7228","ERX","HCPCS 63700001","00904-5894-30","SIMETHICONE 40 MG/0.6ML PO SUSP","BOTH IP/OP","$22.58 ","$16.71 ","$0.00 ","$17.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.34 ","$0.00 ","$6.67 ","$17.88 ","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7228","ERX","HCPCS 63700001","49348-0740-27","SIMETHICONE 40 MG/0.6ML PO SUSP","BOTH IP/OP","$22.58 ","$16.71 ","$0.00 ","$17.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.34 ","$0.00 ","$6.67 ","$17.88 ","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7228","ERX","HCPCS 63700001","56184-0120-41","SIMETHICONE 40 MG/0.6ML PO SUSP","BOTH IP/OP","$22.58 ","$16.71 ","$0.00 ","$17.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.34 ","$0.00 ","$6.67 ","$17.88 ","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7242","ERX","HCPCS 25000001","00395-2661-16","SIMPLE SYRUP PO SYRP","BOTH IP/OP","$83.99 ","$62.15 ","$0.00 ","$72.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.85 ","$0.00 ","$36.43 ","$57.70 ","$58.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7242","ERX","HCPCS 25000001","00802-3920-16","SIMPLE SYRUP PO SYRP","BOTH IP/OP","$83.99 ","$62.15 ","$0.00 ","$72.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.85 ","$0.00 ","$36.43 ","$57.70 ","$58.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7301","ERX","HCPCS 25000001","00409-3299-06","SODIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7301","ERX","HCPCS 25000001","00409-3299-15","SODIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7301","ERX","HCPCS 25000001","00409-3299-25","SODIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7301","ERX","HCPCS 25000001","00409-3299-45","SODIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7301","ERX","HCPCS 25000001","00409-7299-25","SODIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7301","ERX","HCPCS 25000001","00409-7299-73","SODIUM ACETATE 2 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7306","ERX","HCPCS 25000001","00409-5555-02","SODIUM BICARBONATE 4.2 % IV SOLN","BOTH IP/OP","$54.35 ","$40.22 ","$0.00 ","$49.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.29 ","$0.00 ","$24.65 ","$17.42 ","$39.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7306","ERX","HCPCS 25000001","00409-5555-12","SODIUM BICARBONATE 4.2 % IV SOLN","BOTH IP/OP","$54.35 ","$40.22 ","$0.00 ","$49.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.29 ","$0.00 ","$24.65 ","$17.42 ","$39.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7306","ERX","HCPCS 25000001","63323-0083-05","SODIUM BICARBONATE 4.2 % IV SOLN","BOTH IP/OP","$54.35 ","$40.22 ","$0.00 ","$49.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.29 ","$0.00 ","$24.65 ","$17.42 ","$39.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7306","ERX","HCPCS 25000001","00409-5534-34","SODIUM BICARBONATE 4.2 % IV SOLN","BOTH IP/OP","$54.35 ","$40.22 ","$0.00 ","$49.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.29 ","$0.00 ","$24.65 ","$39.04 ","$39.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7308","ERX","HCPCS 25000001","00409-4916-34","SODIUM BICARBONATE 7.5 % IV SOLN","BOTH IP/OP","$70.03 ","$51.82 ","$0.00 ","$70.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.03 ","$0.00 ","$35.02 ","$55.46 ","$56.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7309","ERX","HCPCS 25000001","00409-6625-02","SODIUM BICARBONATE 8.4 % IV SOLN","BOTH IP/OP","$22.14 ","$16.38 ","$0.00 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7309","ERX","HCPCS 25000001","00409-6625-25","SODIUM BICARBONATE 8.4 % IV SOLN","BOTH IP/OP","$22.14 ","$16.38 ","$0.00 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7309","ERX","HCPCS 25000001","00409-6637-34","SODIUM BICARBONATE 8.4 % IV SOLN","BOTH IP/OP","$22.14 ","$16.38 ","$0.00 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7309","ERX","HCPCS 25000001","51754-5001-05","SODIUM BICARBONATE 8.4 % IV SOLN","BOTH IP/OP","$22.14 ","$16.38 ","$0.00 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7309","ERX","HCPCS 25000001","63323-0089-50","SODIUM BICARBONATE 8.4 % IV SOLN","BOTH IP/OP","$22.14 ","$16.38 ","$0.00 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7309","ERX","HCPCS 25000001","76329-3352-01","SODIUM BICARBONATE 8.4 % IV SOLN","BOTH IP/OP","$22.14 ","$16.38 ","$0.00 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7313","ERX","HCPCS 63700001","64980-0294-10","SODIUM BICARBONATE 650 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7313","ERX","HCPCS 63700001","66553-0008-01","SODIUM BICARBONATE 650 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7313","ERX","HCPCS 63700001","77333-0831-10","SODIUM BICARBONATE 650 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7318","ERX","HCPCS 25000001","00990-7730-37","SODIUM CHLORIDE 0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7318","ERX","HCPCS 25000001","00264-7802-10","SODIUM CHLORIDE 0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7318","ERX","HCPCS 25000001","00338-0043-03","SODIUM CHLORIDE 0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7318","ERX","HCPCS 25000001","00409-7985-03","SODIUM CHLORIDE 0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7318","ERX","HCPCS 25000001","00264-7802-00","SODIUM CHLORIDE 0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7318","ERX","HCPCS 25000001","00338-0043-04","SODIUM CHLORIDE 0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7320","ERX","HCPCS J7131","00409-6660-75","SODIUM CHLORIDE 2.5 MEQ/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7321","ERX","HCPCS 25000001","00264-7805-10","SODIUM CHLORIDE 3 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7321","ERX","HCPCS 25000001","00338-0054-03","SODIUM CHLORIDE 3 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7322","ERX","HCPCS 25000001","00409-1141-02","SODIUM CHLORIDE 4 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7322","ERX","HCPCS 25000001","63323-0088-61","SODIUM CHLORIDE 4 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7322","ERX","HCPCS 25000001","63323-0088-63","SODIUM CHLORIDE 4 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7322","ERX","HCPCS 25000001","63323-0187-30","SODIUM CHLORIDE 4 MEQ/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7323","ERX","HCPCS 25000001","00264-7806-10","SODIUM CHLORIDE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7323","ERX","HCPCS 25000001","00338-0056-03","SODIUM CHLORIDE 5 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7325","ERX","HCPCS 25000001","00378-6985-01","SODIUM CHLORIDE 0.9 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7325","ERX","HCPCS 25000001","00487-9301-03","SODIUM CHLORIDE 0.9 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7325","ERX","HCPCS 25000001","00487-9301-33","SODIUM CHLORIDE 0.9 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7327","ERX","HCPCS 25000001","00378-6997-89","SODIUM CHLORIDE 3 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7328","ERX","HCPCS 63700001","00223-1760-02","SODIUM CHLORIDE 1000 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7331","ERX","HCPCS 25000001","17478-0622-35","SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT","BOTH IP/OP","$80.37 ","$59.47 ","$0.00 ","$72.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.89 ","$0.00 ","$36.45 ","$57.73 ","$58.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7331","ERX","HCPCS 25000001","24208-0385-55","SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT","BOTH IP/OP","$80.37 ","$59.47 ","$0.00 ","$72.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.89 ","$0.00 ","$36.45 ","$57.73 ","$58.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7332","ERX","HCPCS 25000001","17478-0623-12","SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN","BOTH IP/OP","$61.79 ","$45.72 ","$0.00 ","$46.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.00 ","$0.00 ","$23.00 ","$36.43 ","$36.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7356","ERX","HCPCS 25000001","10135-0146-17","SODIUM POLYSTYRENE SULFONATE PO POWD","BOTH IP/OP","$27.97 ","$20.70 ","$0.00 ","$25.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.37 ","$0.00 ","$12.69 ","$20.09 ","$20.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7356","ERX","HCPCS 25000001","10702-0036-45","SODIUM POLYSTYRENE SULFONATE PO POWD","BOTH IP/OP","$27.97 ","$20.70 ","$0.00 ","$25.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.37 ","$0.00 ","$12.69 ","$20.09 ","$20.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7356","ERX","HCPCS 25000001","11534-0166-15","SODIUM POLYSTYRENE SULFONATE PO POWD","BOTH IP/OP","$27.97 ","$20.70 ","$0.00 ","$25.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.37 ","$0.00 ","$12.69 ","$20.09 ","$20.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7356","ERX","HCPCS 25000001","24658-0760-16","SODIUM POLYSTYRENE SULFONATE PO POWD","BOTH IP/OP","$27.97 ","$20.70 ","$0.00 ","$25.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.37 ","$0.00 ","$12.69 ","$20.09 ","$20.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7356","ERX","HCPCS 25000001","99999-6007-33","SODIUM POLYSTYRENE SULFONATE PO POWD","BOTH IP/OP","$27.97 ","$20.70 ","$0.00 ","$25.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.37 ","$0.00 ","$12.69 ","$20.09 ","$20.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7359","ERX","HCPCS 25000001","24208-0670-04","SULFACETAMIDE SODIUM 10 % OP SOLN","BOTH IP/OP","$211.69 ","$156.65 ","$0.00 ","$192.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.17 ","$0.00 ","$96.09 ","$152.20 ","$153.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7359","ERX","HCPCS 25000001","61314-0701-01","SULFACETAMIDE SODIUM 10 % OP SOLN","BOTH IP/OP","$211.69 ","$156.65 ","$0.00 ","$192.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.17 ","$0.00 ","$96.09 ","$152.20 ","$153.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7359","ERX","HCPCS 25000001","11980-0011-05","SULFACETAMIDE SODIUM 10 % OP SOLN","BOTH IP/OP","$211.69 ","$156.65 ","$0.00 ","$385.51 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.17 ","$0.00 ","$96.09 ","$385.51 ","$153.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7364","ERX","HCPCS 25000001","60267-0705-50","SODIUM THIOSULFATE 25 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7413","ERX","HCPCS 25000001","54162-0700-16","SORBITOL 70 % PO SOLN","BOTH IP/OP","$18.02 ","$13.33 ","$0.00 ","$14.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7437","ERX","HCPCS 63700001","00378-2146-01","SPIRONOLACTONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7437","ERX","HCPCS 63700001","00904-6927-61","SPIRONOLACTONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7437","ERX","HCPCS 63700001","51079-0103-01","SPIRONOLACTONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7437","ERX","HCPCS 63700001","51079-0103-20","SPIRONOLACTONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7437","ERX","HCPCS 63700001","59746-0216-01","SPIRONOLACTONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7437","ERX","HCPCS 63700001","63739-0544-10","SPIRONOLACTONE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00409-4887-20","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$17.42 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00517-3020-25","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$17.42 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00409-4887-50","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$17.42 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","63323-0185-50","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$17.42 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00990-7990-09","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.06 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00409-4887-10","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00641-6147-01","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00641-6147-10","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","00641-6147-25","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7484","ERX","HCPCS 25000001","63323-0185-10","STERILE WATER FOR INJECTION IJ SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$23.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7485","ERX","HCPCS 25000001","00338-0004-04","STERILE WATER FOR IRRIGATION IR SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7508","ERX","HCPCS J3000","39822-0706-02","STREPTOMYCIN SULFATE 1 G IM SOLR","BOTH IP/OP","$325.32 ","$240.74 ","$0.00 ","$295.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.32 ","$0.00 ","$147.66 ","$233.89 ","$236.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7536","ERX","HCPCS J0330","00409-6629-02","SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7536","ERX","HCPCS J0330","00781-3411-70","SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7536","ERX","HCPCS J0330","00781-3411-95","SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7536","ERX","HCPCS J0330","70069-0301-25","SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7536","ERX","HCPCS J0330","70121-1581-01","SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7536","ERX","HCPCS J0330","70121-1581-05","SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7554","ERX","HCPCS 63700001","00185-0757-01","SULFADIAZINE 500 MG PO TABS","BOTH IP/OP","$21.15 ","$15.65 ","$0.00 ","$19.18 ","","$13.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.18 ","$0.00 ","$9.59 ","$15.19 ","$15.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7556","ERX","HCPCS 25000001","00703-9514-01","SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN","BOTH IP/OP","$63.06 ","$46.66 ","$0.00 ","$57.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.19 ","$0.00 ","$28.60 ","$45.29 ","$45.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7556","ERX","HCPCS 25000001","00703-9514-03","SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN","BOTH IP/OP","$63.06 ","$46.66 ","$0.00 ","$57.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.19 ","$0.00 ","$28.60 ","$45.29 ","$45.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7557","ERX","HCPCS 63700001","57237-0232-01","SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7557","ERX","HCPCS 63700001","65862-0419-01","SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7562","ERX","HCPCS 63700001","00591-0796-01","SULFASALAZINE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7562","ERX","HCPCS 63700001","50268-0730-11","SULFASALAZINE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7562","ERX","HCPCS 63700001","50268-0730-15","SULFASALAZINE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7579","ERX","HCPCS 63700001","00591-5660-01","SULINDAC 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7579","ERX","HCPCS 63700001","00591-5660-05","SULINDAC 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7579","ERX","HCPCS 63700001","42806-0011-01","SULINDAC 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7579","ERX","HCPCS 63700001","51079-0667-20","SULINDAC 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7711","ERX","HCPCS 63700001","00591-2472-60","TAMOXIFEN CITRATE 10 MG PO TABS","BOTH IP/OP","$7.94 ","$5.88 ","$0.00 ","$7.20 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.20 ","$0.00 ","$3.60 ","$5.70 ","$5.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7753","ERX","HCPCS 63700001","00378-4010-01","TEMAZEPAM 15 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7753","ERX","HCPCS 63700001","63739-0231-10","TEMAZEPAM 15 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7753","ERX","HCPCS 63700001","63739-0877-10","TEMAZEPAM 15 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7753","ERX","HCPCS 63700001","67877-0146-01","TEMAZEPAM 15 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7784","ERX","HCPCS J1071","00009-0417-01","TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","BOTH IP/OP","$26.40 ","$19.54 ","$0.00 ","$22.80 ","$11.88 ","$0.00 ","$5.50 ","$0.00 ","$0.00 ","$1.76 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$1.76 ","$0.00 ","$1.68 ","$0.00 "
"7784","ERX","HCPCS J1071","00143-9659-01","TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","BOTH IP/OP","$26.40 ","$19.54 ","$0.00 ","$22.80 ","$11.88 ","$0.00 ","$5.50 ","$0.00 ","$0.00 ","$1.76 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$1.76 ","$0.00 ","$1.68 ","$0.00 "
"7784","ERX","HCPCS J1071","00574-0820-10","TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","BOTH IP/OP","$26.40 ","$19.54 ","$0.00 ","$22.80 ","$11.88 ","$0.00 ","$5.50 ","$0.00 ","$0.00 ","$1.76 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$1.76 ","$0.00 ","$1.68 ","$0.00 "
"7784","ERX","HCPCS J1071","62756-0015-40","TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","BOTH IP/OP","$26.40 ","$19.54 ","$0.00 ","$22.80 ","$11.88 ","$0.00 ","$5.50 ","$0.00 ","$0.00 ","$1.76 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$1.76 ","$0.00 ","$1.68 ","$0.00 "
"7785","ERX","HCPCS J3121","00143-9750-01","TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.94 ","$0.00 ","$2.80 ","$0.00 "
"7785","ERX","HCPCS J3121","99999-6005-75","TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.94 ","$0.00 ","$2.80 ","$0.00 "
"7789","ERX","HCPCS J1670","13533-0634-02","TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM INJ","BOTH IP/OP","$1,602.44 ","$1,185.81 ","$0.00 ","$1,602.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,602.44 ","$0.00 ","$801.22 ","$1,269.13 ","$1,281.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7795","ERX","HCPCS 25000001","00065-0741-14","TETRACAINE HCL 0.5 % OP SOLN","BOTH IP/OP","$53.25 ","$39.41 ","$0.00 ","$48.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.30 ","$0.00 ","$24.15 ","$38.25 ","$38.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7796","ERX","HCPCS 63700001","23155-0017-01","TETRACYCLINE HCL 250 MG PO CAPS","BOTH IP/OP","$29.93 ","$22.15 ","$0.00 ","$29.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.93 ","$0.00 ","$14.97 ","$23.70 ","$23.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7821","ERX","HCPCS 63700001","00121-4794-15","THEOPHYLLINE 80 MG/15ML PO SOLN","BOTH IP/OP","$52.48 ","$38.84 ","$0.00 ","$47.60 ","","$9.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.60 ","$0.00 ","$23.80 ","$37.70 ","$38.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7821","ERX","HCPCS 63700001","00121-4820-40","THEOPHYLLINE 80 MG/15ML PO SOLN","BOTH IP/OP","$52.48 ","$38.84 ","$0.00 ","$47.60 ","","$9.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.60 ","$0.00 ","$23.80 ","$37.70 ","$38.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7821","ERX","HCPCS 63700001","27808-0033-01","THEOPHYLLINE 80 MG/15ML PO SOLN","BOTH IP/OP","$52.48 ","$38.84 ","$0.00 ","$47.60 ","","$9.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.60 ","$0.00 ","$23.80 ","$37.70 ","$38.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7825","ERX","HCPCS 63700001","00904-0539-61","THERA PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7876","ERX","HCPCS J3411","63323-0013-01","THIAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"7876","ERX","HCPCS J3411","63323-0013-02","THIAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"7876","ERX","HCPCS J3411","63323-0013-09","THIAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"7876","ERX","HCPCS J3411","63323-0013-21","THIAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"7876","ERX","HCPCS J3411","67457-0196-00","THIAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"7876","ERX","HCPCS J3411","67457-0196-02","THIAMINE HCL 100 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"7886","ERX","HCPCS 63700001","76388-0880-25","THIOGUANINE 40 MG PO TABS","BOTH IP/OP","$117.09 ","$86.65 ","$0.00 ","$106.17 ","","$20.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.17 ","$0.00 ","$53.09 ","$84.09 ","$84.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7894","ERX","HCPCS 63700001","51079-0565-01","THIORIDAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7894","ERX","HCPCS 63700001","51079-0565-20","THIORIDAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7894","ERX","HCPCS 63700001","53489-0148-01","THIORIDAZINE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7895","ERX","HCPCS 63700001","51079-0580-20","THIORIDAZINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7899","ERX","HCPCS 63700001","51079-0566-01","THIORIDAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7899","ERX","HCPCS 63700001","51079-0566-20","THIORIDAZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7900","ERX","HCPCS 63700001","00378-0616-01","THIORIDAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7900","ERX","HCPCS 63700001","51079-0567-01","THIORIDAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7900","ERX","HCPCS 63700001","53489-0150-01","THIORIDAZINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7902","ERX","HCPCS 63700001","00378-1001-01","THIOTHIXENE 1 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7903","ERX","HCPCS 63700001","00378-5010-01","THIOTHIXENE 10 MG PO CAPS","BOTH IP/OP","$14.07 ","$10.41 ","$0.00 ","$12.76 ","","$2.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.76 ","$0.00 ","$6.38 ","$10.11 ","$10.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906","ERX","HCPCS 63700001","00378-3005-01","THIOTHIXENE 5 MG PO CAPS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906","ERX","HCPCS 63700001","51079-0588-01","THIOTHIXENE 5 MG PO CAPS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906","ERX","HCPCS 63700001","51079-0588-20","THIOTHIXENE 5 MG PO CAPS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906","ERX","HCPCS 63700001","70954-0016-10","THIOTHIXENE 5 MG PO CAPS","BOTH IP/OP","$15.17 ","$11.23 ","$0.00 ","$13.76 ","","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.76 ","$0.00 ","$6.88 ","$10.90 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7940","ERX","HCPCS 63700001","00456-0457-01","THYROID 15 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7947","ERX","HCPCS 63700001","00456-0459-01","THYROID 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7993","ERX","HCPCS 25000001","63323-0305-02","TOBRAMYCIN SULFATE 10 MG/ML IJ SOLN","BOTH IP/OP","$26.55 ","$19.65 ","$0.00 ","$24.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.08 ","$0.00 ","$12.04 ","$19.07 ","$19.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7995","ERX","HCPCS 25000001","17478-0290-10","TOBRAMYCIN 0.3 % OP SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$52.67 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.67 ","$0.00 ","$26.34 ","$41.71 ","$42.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7995","ERX","HCPCS 25000001","24208-0290-05","TOBRAMYCIN 0.3 % OP SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$52.67 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.67 ","$0.00 ","$26.34 ","$41.71 ","$42.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7995","ERX","HCPCS 25000001","61314-0643-05","TOBRAMYCIN 0.3 % OP SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$52.67 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.67 ","$0.00 ","$26.34 ","$41.71 ","$42.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7995","ERX","HCPCS 25000001","70069-0131-01","TOBRAMYCIN 0.3 % OP SOLN","BOTH IP/OP","$26.19 ","$19.38 ","$0.00 ","$52.67 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.67 ","$0.00 ","$26.34 ","$41.71 ","$42.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8083","ERX","HCPCS 63700001","00904-6869-61","TRAZODONE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8083","ERX","HCPCS 63700001","50111-0434-01","TRAZODONE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8085","ERX","HCPCS 63700001","00904-6868-61","TRAZODONE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8085","ERX","HCPCS 63700001","50111-0433-01","TRAZODONE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8085","ERX","HCPCS 63700001","50111-0433-02","TRAZODONE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8112","ERX","HCPCS 63700001","45802-0063-35","TRIAMCINOLONE ACETONIDE 0.025 % EX CREA","BOTH IP/OP","$18.67 ","$13.82 ","$0.00 ","$16.93 ","","$3.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.93 ","$0.00 ","$8.47 ","$13.41 ","$13.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8113","ERX","HCPCS 63700001","00168-0004-15","TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","BOTH IP/OP","$15.09 ","$11.17 ","$0.00 ","$21.21 ","","$2.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.21 ","$0.00 ","$10.61 ","$16.80 ","$16.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8113","ERX","HCPCS 63700001","52565-0056-15","TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","BOTH IP/OP","$15.09 ","$11.17 ","$0.00 ","$21.21 ","","$2.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.21 ","$0.00 ","$10.61 ","$16.80 ","$16.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8113","ERX","HCPCS 63700001","00168-0004-80","TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","BOTH IP/OP","$15.09 ","$11.17 ","$0.00 ","$92.81 ","","$2.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.21 ","$0.00 ","$10.61 ","$92.81 ","$16.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8113","ERX","HCPCS 63700001","45802-0064-36","TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","BOTH IP/OP","$15.09 ","$11.17 ","$0.00 ","$92.81 ","","$2.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.21 ","$0.00 ","$10.61 ","$92.81 ","$16.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8114","ERX","HCPCS 63700001","00168-0002-15","TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","","$8.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8114","ERX","HCPCS 63700001","45802-0065-35","TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","","$8.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8117","ERX","HCPCS 25000001","45802-0054-35","TRIAMCINOLONE ACETONIDE 0.025 % EX OINT","BOTH IP/OP","$25.65 ","$18.98 ","$0.00 ","$23.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.26 ","$0.00 ","$11.63 ","$18.42 ","$18.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","45802-0055-35","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","45802-0055-05","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","52565-0014-26","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","00168-0006-80","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","45802-0055-36","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","51672-1284-08","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8118","ERX","HCPCS 63700001","52565-0014-80","TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","BOTH IP/OP","$159.48 ","$118.02 ","$0.00 ","$144.60 ","","$28.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.60 ","$0.00 ","$72.30 ","$114.52 ","$115.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8120","ERX","HCPCS J3301","00003-0293-05","TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","BOTH IP/OP","$42.74 ","$31.63 ","$0.00 ","$42.68 ","$19.23 ","$0.00 ","$7.10 ","$0.00 ","$0.00 ","$7.33 ","$42.68 ","$0.00 ","$21.34 ","$33.80 ","$34.14 ","$0.00 ","$7.33 ","$0.00 ","$6.98 ","$0.00 "
"8120","ERX","HCPCS J3301","00703-0241-01","TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","BOTH IP/OP","$42.74 ","$31.63 ","$0.00 ","$42.68 ","$19.23 ","$0.00 ","$7.10 ","$0.00 ","$0.00 ","$7.33 ","$42.68 ","$0.00 ","$21.34 ","$33.80 ","$34.14 ","$0.00 ","$7.33 ","$0.00 ","$6.98 ","$0.00 "
"8120","ERX","HCPCS J3301","70121-1049-01","TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","BOTH IP/OP","$42.74 ","$31.63 ","$0.00 ","$42.68 ","$19.23 ","$0.00 ","$7.10 ","$0.00 ","$0.00 ","$7.33 ","$42.68 ","$0.00 ","$21.34 ","$33.80 ","$34.14 ","$0.00 ","$7.33 ","$0.00 ","$6.98 ","$0.00 "
"8120","ERX","HCPCS J3301","70121-1049-05","TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","BOTH IP/OP","$42.74 ","$31.63 ","$0.00 ","$42.68 ","$19.23 ","$0.00 ","$7.10 ","$0.00 ","$0.00 ","$7.33 ","$42.68 ","$0.00 ","$21.34 ","$33.80 ","$34.14 ","$0.00 ","$7.33 ","$0.00 ","$6.98 ","$0.00 "
"8121","ERX","HCPCS 25000001","00713-0655-40","TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE","BOTH IP/OP","$279.65 ","$206.94 ","$0.00 ","$253.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.86 ","$0.00 ","$126.93 ","$201.06 ","$203.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8121","ERX","HCPCS 25000001","51672-1267-05","TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE","BOTH IP/OP","$279.65 ","$206.94 ","$0.00 ","$253.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.86 ","$0.00 ","$126.93 ","$201.06 ","$203.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8121","ERX","HCPCS 25000001","64980-0320-05","TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE","BOTH IP/OP","$279.65 ","$206.94 ","$0.00 ","$253.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.86 ","$0.00 ","$126.93 ","$201.06 ","$203.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8132","ERX","HCPCS 63700001","00378-1352-01","TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8132","ERX","HCPCS 63700001","00591-0424-01","TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8132","ERX","HCPCS 63700001","00591-0424-05","TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8132","ERX","HCPCS 63700001","00781-1123-01","TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8132","ERX","HCPCS 63700001","60505-2656-01","TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8134","ERX","HCPCS 63700001","51079-0433-01","TRIAMTERENE-HCTZ 75-50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8134","ERX","HCPCS 63700001","51079-0433-20","TRIAMTERENE-HCTZ 75-50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8134","ERX","HCPCS 63700001","60505-2657-01","TRIAMTERENE-HCTZ 75-50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8162","ERX","HCPCS 63700001","00378-2410-01","TRIFLUOPERAZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.26 ","$7.59 ","$0.00 ","$9.30 ","","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.30 ","$0.00 ","$4.65 ","$7.37 ","$7.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8163","ERX","HCPCS 63700001","00378-2402-01","TRIFLUOPERAZINE HCL 2 MG PO TABS","BOTH IP/OP","$8.38 ","$6.20 ","$0.00 ","$7.60 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.60 ","$0.00 ","$3.80 ","$6.02 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8163","ERX","HCPCS 63700001","51079-0573-01","TRIFLUOPERAZINE HCL 2 MG PO TABS","BOTH IP/OP","$8.38 ","$6.20 ","$0.00 ","$7.60 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.60 ","$0.00 ","$3.80 ","$6.02 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8163","ERX","HCPCS 63700001","51079-0573-20","TRIFLUOPERAZINE HCL 2 MG PO TABS","BOTH IP/OP","$8.38 ","$6.20 ","$0.00 ","$7.60 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.60 ","$0.00 ","$3.80 ","$6.02 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8164","ERX","HCPCS 63700001","00781-8034-01","TRIFLUOPERAZINE HCL 5 MG PO TABS","BOTH IP/OP","$6.81 ","$5.04 ","$0.00 ","$6.17 ","","$1.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.17 ","$0.00 ","$3.09 ","$4.89 ","$4.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8166","ERX","HCPCS 63700001","00591-5335-01","TRIHEXYPHENIDYL HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8167","ERX","HCPCS 63700001","00591-5337-01","TRIHEXYPHENIDYL HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8167","ERX","HCPCS 63700001","16571-0161-10","TRIHEXYPHENIDYL HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8182","ERX","HCPCS 63700001","43386-0330-01","TRIMETHOPRIM 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8249","ERX","HCPCS 25000001","17478-0101-12","TROPICAMIDE 0.5 % OP SOLN","BOTH IP/OP","$96.52 ","$71.42 ","$0.00 ","$87.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.52 ","$0.00 ","$43.76 ","$69.32 ","$70.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8249","ERX","HCPCS 25000001","24208-0590-64","TROPICAMIDE 0.5 % OP SOLN","BOTH IP/OP","$96.52 ","$71.42 ","$0.00 ","$87.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.52 ","$0.00 ","$43.76 ","$69.32 ","$70.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8249","ERX","HCPCS 25000001","61314-0354-01","TROPICAMIDE 0.5 % OP SOLN","BOTH IP/OP","$96.52 ","$71.42 ","$0.00 ","$87.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.52 ","$0.00 ","$43.76 ","$69.32 ","$70.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8250","ERX","HCPCS 25000001","17478-0102-12","TROPICAMIDE 1 % OP SOLN","BOTH IP/OP","$44.63 ","$33.03 ","$0.00 ","$40.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.47 ","$0.00 ","$20.24 ","$32.05 ","$32.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8250","ERX","HCPCS 25000001","61314-0355-02","TROPICAMIDE 1 % OP SOLN","BOTH IP/OP","$44.63 ","$33.03 ","$0.00 ","$40.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.47 ","$0.00 ","$20.24 ","$32.05 ","$32.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8250","ERX","HCPCS 25000001","24208-0585-59","TROPICAMIDE 1 % OP SOLN","BOTH IP/OP","$44.63 ","$33.03 ","$0.00 ","$40.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.47 ","$0.00 ","$20.24 ","$32.05 ","$32.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8250","ERX","HCPCS 25000001","61314-0355-01","TROPICAMIDE 1 % OP SOLN","BOTH IP/OP","$44.63 ","$33.03 ","$0.00 ","$40.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.47 ","$0.00 ","$20.24 ","$32.05 ","$32.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8259","ERX","HCPCS 25000001","42023-0104-01","TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8259","ERX","HCPCS 25000001","49281-0752-21","TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8259","ERX","HCPCS 25000001","49281-0752-22","TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8259","ERX","HCPCS 25000001","99999-6005-54","TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8443","ERX","HCPCS J3370","00409-4332-01","VANCOMYCIN HCL 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"8443","ERX","HCPCS J3370","00409-6534-01","VANCOMYCIN HCL 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"8443","ERX","HCPCS J3370","47781-0598-07","VANCOMYCIN HCL 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"8443","ERX","HCPCS J3370","47781-0598-91","VANCOMYCIN HCL 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"8443","ERX","HCPCS J3370","67457-0339-50","VANCOMYCIN HCL 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"8443","ERX","HCPCS J3370","70860-0104-10","VANCOMYCIN HCL 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"8527","ERX","HCPCS 25000001","00409-1144-05","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","42571-0313-75","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","42571-0313-87","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","42571-0313-97","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","51754-0203-04","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","70121-1585-05","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","72485-0108-05","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8527","ERX","HCPCS 25000001","72485-0108-25","VERAPAMIL HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$73.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.31 ","$0.00 ","$36.66 ","$58.06 ","$58.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8528","ERX","HCPCS 63700001","00904-2924-61","VERAPAMIL HCL 120 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8530","ERX","HCPCS 63700001","00591-0343-01","VERAPAMIL HCL 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8530","ERX","HCPCS 63700001","00904-2920-61","VERAPAMIL HCL 80 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8594","ERX","HCPCS J9360","63323-0278-10","VINBLASTINE SULFATE 1 MG/ML IV SOLN","BOTH IP/OP","$196.37 ","$145.31 ","$0.00 ","$162.80 ","$88.37 ","$0.00 ","$40.93 ","$0.00 ","$0.00 ","$45.71 ","$162.80 ","$0.00 ","$81.40 ","$128.94 ","$130.24 ","$0.00 ","$45.71 ","$0.00 ","$43.52 ","$0.00 "
"8597","ERX","HCPCS J9370","61703-0309-06","VINCRISTINE SULFATE 1 MG/ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.47 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$11.47 ","$0.00 ","$0.00 ","$0.00 "
"8597","ERX","HCPCS J9370","61703-0309-16","VINCRISTINE SULFATE 1 MG/ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.47 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$11.47 ","$0.00 ","$0.00 ","$0.00 "
"8597","ERX","HCPCS J9370","61703-0309-25","VINCRISTINE SULFATE 1 MG/ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.47 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$11.47 ","$0.00 ","$0.00 ","$0.00 "
"8597","ERX","HCPCS J9370","61703-0309-26","VINCRISTINE SULFATE 1 MG/ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.47 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$11.47 ","$0.00 ","$0.00 ","$0.00 "
"8639","ERX","HCPCS 63700001","00904-2085-60","VITAMIN A 3 MG (10000 UT) PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","31604-0012-81","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","37864-0905-99","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","48433-0108-01","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","51645-0905-99","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","54629-0057-01","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","77333-0934-10","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8647","ERX","HCPCS 63700001","77333-0934-25","VITAMIN B-1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8654","ERX","HCPCS 63700001","10006-0730-43","VITAMIN B-12 1000 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8654","ERX","HCPCS 63700001","74312-0013-80","VITAMIN B-12 1000 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8654","ERX","HCPCS 63700001","77333-0938-10","VITAMIN B-12 1000 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8654","ERX","HCPCS 63700001","77333-0938-25","VITAMIN B-12 1000 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8661","ERX","HCPCS 63700001","43292-0555-38","VITAMIN B-2 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8667","ERX","HCPCS 63700001","00904-0520-60","VITAMIN B-6 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8667","ERX","HCPCS 63700001","77333-0940-10","VITAMIN B-6 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8667","ERX","HCPCS 63700001","77333-0940-25","VITAMIN B-6 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8680","ERX","HCPCS 63700001","00904-0523-61","VITAMIN C 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8680","ERX","HCPCS 63700001","00904-0523-72","VITAMIN C 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8680","ERX","HCPCS 63700001","00904-0523-80","VITAMIN C 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8680","ERX","HCPCS 63700001","57896-0841-01","VITAMIN C 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8698","ERX","HCPCS 63700001","00904-0270-60","VITAMIN E 100 UNITS PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8701","ERX","HCPCS 63700001","00904-0274-60","VITAMIN E 400 UNITS PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8701","ERX","HCPCS 63700001","10006-0700-34","VITAMIN E 400 UNITS PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8718","ERX","HCPCS J3430","00409-9158-01","VITAMIN K1 10 MG/ML IJ SOLN","BOTH IP/OP","$49.25 ","$36.45 ","$0.00 ","$44.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8718","ERX","HCPCS J3430","00409-9158-31","VITAMIN K1 10 MG/ML IJ SOLN","BOTH IP/OP","$49.25 ","$36.45 ","$0.00 ","$44.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8718","ERX","HCPCS J3430","43598-0405-16","VITAMIN K1 10 MG/ML IJ SOLN","BOTH IP/OP","$49.25 ","$36.45 ","$0.00 ","$44.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8748","ERX","HCPCS 63700001","00832-1219-01","WARFARIN SODIUM 10 MG PO TABS","BOTH IP/OP","$14.59 ","$10.80 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.59 ","$0.00 ","$7.30 ","$11.56 ","$11.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8749","ERX","HCPCS 63700001","00832-1212-01","WARFARIN SODIUM 2 MG PO TABS","BOTH IP/OP","$9.81 ","$7.26 ","$0.00 ","$9.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.81 ","$0.00 ","$4.91 ","$7.77 ","$7.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8749","ERX","HCPCS 63700001","00832-1212-89","WARFARIN SODIUM 2 MG PO TABS","BOTH IP/OP","$9.81 ","$7.26 ","$0.00 ","$9.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.81 ","$0.00 ","$4.91 ","$7.77 ","$7.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8749","ERX","HCPCS 63700001","51672-4028-01","WARFARIN SODIUM 2 MG PO TABS","BOTH IP/OP","$9.81 ","$7.26 ","$0.00 ","$9.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.81 ","$0.00 ","$4.91 ","$7.77 ","$7.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8750","ERX","HCPCS 63700001","00832-1213-01","WARFARIN SODIUM 2.5 MG PO TABS","BOTH IP/OP","$10.13 ","$7.50 ","$0.00 ","$10.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.13 ","$0.00 ","$5.07 ","$8.02 ","$8.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8750","ERX","HCPCS 63700001","57237-0121-01","WARFARIN SODIUM 2.5 MG PO TABS","BOTH IP/OP","$10.13 ","$7.50 ","$0.00 ","$10.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.13 ","$0.00 ","$5.07 ","$8.02 ","$8.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8750","ERX","HCPCS 63700001","68084-0027-01","WARFARIN SODIUM 2.5 MG PO TABS","BOTH IP/OP","$10.13 ","$7.50 ","$0.00 ","$10.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.13 ","$0.00 ","$5.07 ","$8.02 ","$8.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8751","ERX","HCPCS 63700001","00832-1216-01","WARFARIN SODIUM 5 MG PO TABS","BOTH IP/OP","$10.55 ","$7.81 ","$0.00 ","$10.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.55 ","$0.00 ","$5.28 ","$8.36 ","$8.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8751","ERX","HCPCS 63700001","57237-0124-01","WARFARIN SODIUM 5 MG PO TABS","BOTH IP/OP","$10.55 ","$7.81 ","$0.00 ","$10.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.55 ","$0.00 ","$5.28 ","$8.36 ","$8.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8752","ERX","HCPCS 63700001","00832-1218-01","WARFARIN SODIUM 7.5 MG PO TABS","BOTH IP/OP","$14.06 ","$10.40 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.06 ","$0.00 ","$7.03 ","$11.14 ","$11.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8752","ERX","HCPCS 63700001","51672-4034-01","WARFARIN SODIUM 7.5 MG PO TABS","BOTH IP/OP","$14.06 ","$10.40 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.06 ","$0.00 ","$7.03 ","$11.14 ","$11.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8752","ERX","HCPCS 63700001","57237-0126-01","WARFARIN SODIUM 7.5 MG PO TABS","BOTH IP/OP","$14.06 ","$10.40 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.06 ","$0.00 ","$7.03 ","$11.14 ","$11.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8780","ERX","HCPCS 63700001","00168-0053-21","WHITE PETROLATUM EX OINT","BOTH IP/OP","$92.80 ","$68.67 ","$0.00 ","$84.15 ","","$16.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.15 ","$0.00 ","$42.08 ","$66.65 ","$67.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8780","ERX","HCPCS 63700001","00168-0053-16","WHITE PETROLATUM EX OINT","BOTH IP/OP","$92.80 ","$68.67 ","$0.00 ","$84.15 ","","$16.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.15 ","$0.00 ","$42.08 ","$66.65 ","$67.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8865","ERX","HCPCS 25000001","00409-4090-01","ZINC CHLORIDE 1 MG/ML IV SOLN","BOTH IP/OP","$97.82 ","$72.39 ","$0.00 ","$81.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.62 ","$0.00 ","$40.81 ","$64.64 ","$65.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8874","ERX","HCPCS 63700001","00536-5700-98","ZINC OXIDE 20 % EX OINT","BOTH IP/OP","$137.76 ","$101.94 ","$0.00 ","$109.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$109.11 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8874","ERX","HCPCS 63700001","00168-0062-31","ZINC OXIDE 20 % EX OINT","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8874","ERX","HCPCS 63700001","75834-0170-01","ZINC OXIDE 20 % EX OINT","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8874","ERX","HCPCS 63700001","00536-5700-28","ZINC OXIDE 20 % EX OINT","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8878","ERX","HCPCS 25000001","00517-6110-25","ZINC SULFATE 1 MG/ML IV SOLN","BOTH IP/OP","$111.65 ","$82.62 ","$0.00 ","$111.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.65 ","$0.00 ","$55.83 ","$88.43 ","$89.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8880","ERX","HCPCS 63700001","37864-0991-01","ZINC SULFATE 220 (50 ZN) MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8880","ERX","HCPCS 63700001","77333-0983-10","ZINC SULFATE 220 (50 ZN) MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8946","ERX","HCPCS 25000001","51672-2114-00","ACETAMINOPHEN 80 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8946","ERX","HCPCS 25000001","51672-2114-02","ACETAMINOPHEN 80 MG RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8958","ERX","HCPCS 63700001","00591-3369-01","BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS","BOTH IP/OP","$7.08 ","$5.24 ","$0.00 ","$6.42 ","","$1.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.42 ","$0.00 ","$3.21 ","$5.08 ","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8958","ERX","HCPCS 63700001","00603-2544-21","BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS","BOTH IP/OP","$7.08 ","$5.24 ","$0.00 ","$6.42 ","","$1.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.42 ","$0.00 ","$3.21 ","$5.08 ","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8958","ERX","HCPCS 63700001","10702-0253-01","BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS","BOTH IP/OP","$7.08 ","$5.24 ","$0.00 ","$6.42 ","","$1.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.42 ","$0.00 ","$3.21 ","$5.08 ","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8958","ERX","HCPCS 63700001","68084-0396-65","BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS","BOTH IP/OP","$7.08 ","$5.24 ","$0.00 ","$6.42 ","","$1.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.42 ","$0.00 ","$3.21 ","$5.08 ","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8962","ERX","HCPCS 63700001","29033-0030-01","ACETAZOLAMIDE ER 500 MG PO CP12","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$16.32 ","","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.32 ","$0.00 ","$8.16 ","$12.93 ","$13.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8962","ERX","HCPCS 63700001","50742-0233-01","ACETAZOLAMIDE ER 500 MG PO CP12","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$16.32 ","","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.32 ","$0.00 ","$8.16 ","$12.93 ","$13.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8963","ERX","HCPCS 25000001","00338-0656-04","ACETIC ACID 0.25 % IR SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$26.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8968","ERX","HCPCS 63700001","00378-8700-06","ACYCLOVIR 5 % EX OINT","BOTH IP/OP","$1,164.52 ","$861.74 ","$0.00 ","$1,056.84 ","","$207.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.84 ","$0.00 ","$528.42 ","$837.02 ","$845.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8968","ERX","HCPCS 63700001","13668-0515-01","ACYCLOVIR 5 % EX OINT","BOTH IP/OP","$1,164.52 ","$861.74 ","$0.00 ","$1,056.84 ","","$207.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.84 ","$0.00 ","$528.42 ","$837.02 ","$845.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8968","ERX","HCPCS 63700001","00187-0993-95","ACYCLOVIR 5 % EX OINT","BOTH IP/OP","$1,164.52 ","$861.74 ","$0.00 ","$1,516.10 ","","$207.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.84 ","$0.00 ","$528.42 ","$1,516.10 ","$845.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8969","ERX","HCPCS 63700001","00904-5789-61","ACYCLOVIR 200 MG PO CAPS","BOTH IP/OP","$6.41 ","$4.74 ","$0.00 ","$6.00 ","","$1.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8969","ERX","HCPCS 63700001","68084-0107-01","ACYCLOVIR 200 MG PO CAPS","BOTH IP/OP","$6.41 ","$4.74 ","$0.00 ","$6.00 ","","$1.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8970","ERX","HCPCS 63700001","99999-6004-74","ACYCLOVIR 200 MG/5ML PO SUSP","BOTH IP/OP","$181.76 ","$134.50 ","$0.00 ","$165.00 ","","$32.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8970","ERX","HCPCS 63700001","00378-8712-73","ACYCLOVIR 200 MG/5ML PO SUSP","BOTH IP/OP","$181.76 ","$134.50 ","$0.00 ","$934.16 ","","$32.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$934.16 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8970","ERX","HCPCS 63700001","00472-0082-16","ACYCLOVIR 200 MG/5ML PO SUSP","BOTH IP/OP","$181.76 ","$134.50 ","$0.00 ","$934.16 ","","$32.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$934.16 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8970","ERX","HCPCS 63700001","50383-0810-16","ACYCLOVIR 200 MG/5ML PO SUSP","BOTH IP/OP","$181.76 ","$134.50 ","$0.00 ","$934.16 ","","$32.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$934.16 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","00904-5790-61","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","31722-0777-01","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","31722-0777-05","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","50268-0061-15","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","60505-5306-01","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","60505-5306-08","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","61442-0112-05","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","63304-0504-01","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","63739-0682-10","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8971","ERX","HCPCS 63700001","68084-0108-01","ACYCLOVIR 400 MG PO TABS","BOTH IP/OP","$7.17 ","$5.31 ","$0.00 ","$7.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.17 ","$0.00 ","$3.59 ","$5.68 ","$5.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8972","ERX","HCPCS 63700001","31722-0778-01","ACYCLOVIR 800 MG PO TABS","BOTH IP/OP","$13.31 ","$9.85 ","$0.00 ","$13.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.31 ","$0.00 ","$6.66 ","$10.54 ","$10.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8972","ERX","HCPCS 63700001","60505-5307-01","ACYCLOVIR 800 MG PO TABS","BOTH IP/OP","$13.31 ","$9.85 ","$0.00 ","$13.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.31 ","$0.00 ","$6.66 ","$10.54 ","$10.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8972","ERX","HCPCS 63700001","68084-0109-01","ACYCLOVIR 800 MG PO TABS","BOTH IP/OP","$13.31 ","$9.85 ","$0.00 ","$13.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.31 ","$0.00 ","$6.66 ","$10.54 ","$10.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8979","ERX","HCPCS 63700001","00591-2712-02","ALBENDAZOLE 200 MG PO TABS","BOTH IP/OP","$373.28 ","$276.23 ","$0.00 ","$373.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$373.28 ","$0.00 ","$186.64 ","$295.64 ","$298.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8979","ERX","HCPCS 63700001","52054-0550-22","ALBENDAZOLE 200 MG PO TABS","BOTH IP/OP","$373.28 ","$276.23 ","$0.00 ","$373.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$373.28 ","$0.00 ","$186.64 ","$295.64 ","$298.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8979","ERX","HCPCS 63700001","69097-0237-72","ALBENDAZOLE 200 MG PO TABS","BOTH IP/OP","$373.28 ","$276.23 ","$0.00 ","$373.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$373.28 ","$0.00 ","$186.64 ","$295.64 ","$298.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8979","ERX","HCPCS 63700001","70710-1021-08","ALBENDAZOLE 200 MG PO TABS","BOTH IP/OP","$373.28 ","$276.23 ","$0.00 ","$373.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$373.28 ","$0.00 ","$186.64 ","$295.64 ","$298.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8981","ERX","HCPCS P9047","00944-0493-01","ALBUMIN HUMAN 25 % IV SOLN","BOTH IP/OP","$199.88 ","$147.91 ","$0.00 ","$181.44 ","$89.95 ","$52.45 ","$60.16 ","$0.00 ","$0.00 ","$61.63 ","$181.44 ","$55.07 ","$90.72 ","$143.70 ","$145.15 ","$76.05 ","$61.63 ","$0.00 ","$58.68 ","$52.45 "
"8981","ERX","HCPCS P9047","76125-0792-25","ALBUMIN HUMAN 25 % IV SOLN","BOTH IP/OP","$199.88 ","$147.91 ","$0.00 ","$181.44 ","$89.95 ","$52.45 ","$60.16 ","$0.00 ","$0.00 ","$61.63 ","$181.44 ","$55.07 ","$90.72 ","$143.70 ","$145.15 ","$76.05 ","$61.63 ","$0.00 ","$58.68 ","$52.45 "
"8982","ERX","HCPCS P9045","00944-0495-05","ALBUMIN HUMAN 5 % IV SOLN","BOTH IP/OP","$199.53 ","$147.65 ","$0.00 ","$181.13 ","$89.79 ","$52.45 ","$27.86 ","$0.00 ","$0.00 ","$31.71 ","$181.13 ","$55.07 ","$90.57 ","$143.45 ","$144.90 ","$76.05 ","$28.35 ","$0.00 ","$28.84 ","$52.45 "
"8982","ERX","HCPCS P9045","44206-0310-25","ALBUMIN HUMAN 5 % IV SOLN","BOTH IP/OP","$199.53 ","$147.65 ","$0.00 ","$181.13 ","$89.79 ","$52.45 ","$27.86 ","$0.00 ","$0.00 ","$31.71 ","$181.13 ","$55.07 ","$90.57 ","$143.45 ","$144.90 ","$76.05 ","$28.35 ","$0.00 ","$28.84 ","$52.45 "
"8982","ERX","HCPCS P9045","44206-0310-50","ALBUMIN HUMAN 5 % IV SOLN","BOTH IP/OP","$199.53 ","$147.65 ","$0.00 ","$181.13 ","$89.79 ","$52.45 ","$27.86 ","$0.00 ","$0.00 ","$31.71 ","$181.13 ","$55.07 ","$90.57 ","$143.45 ","$144.90 ","$76.05 ","$28.35 ","$0.00 ","$28.84 ","$52.45 "
"8982","ERX","HCPCS P9045","68516-5214-02","ALBUMIN HUMAN 5 % IV SOLN","BOTH IP/OP","$199.53 ","$147.65 ","$0.00 ","$181.13 ","$89.79 ","$52.45 ","$27.86 ","$0.00 ","$0.00 ","$31.71 ","$181.13 ","$55.07 ","$90.57 ","$143.45 ","$144.90 ","$76.05 ","$28.35 ","$0.00 ","$28.84 ","$52.45 "
"8982","ERX","HCPCS P9045","76125-0790-26","ALBUMIN HUMAN 5 % IV SOLN","BOTH IP/OP","$199.53 ","$147.65 ","$0.00 ","$181.13 ","$89.79 ","$52.45 ","$27.86 ","$0.00 ","$0.00 ","$31.71 ","$181.13 ","$55.07 ","$90.57 ","$143.45 ","$144.90 ","$76.05 ","$28.35 ","$0.00 ","$28.84 ","$52.45 "
"8982","ERX","HCPCS P9045","99999-6006-39","ALBUMIN HUMAN 5 % IV SOLN","BOTH IP/OP","$199.53 ","$147.65 ","$0.00 ","$181.13 ","$89.79 ","$52.45 ","$27.86 ","$0.00 ","$0.00 ","$31.71 ","$181.13 ","$55.07 ","$90.57 ","$143.45 ","$144.90 ","$76.05 ","$28.35 ","$0.00 ","$28.84 ","$52.45 "
"8985","ERX","HCPCS 25000001","00168-0263-15","ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA","BOTH IP/OP","$185.57 ","$137.32 ","$0.00 ","$168.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.27 ","$0.00 ","$84.14 ","$133.27 ","$134.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8985","ERX","HCPCS 25000001","51672-1306-01","ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA","BOTH IP/OP","$185.57 ","$137.32 ","$0.00 ","$168.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.27 ","$0.00 ","$84.14 ","$133.27 ","$134.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8985","ERX","HCPCS 25000001","68462-0300-17","ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA","BOTH IP/OP","$185.57 ","$137.32 ","$0.00 ","$168.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.27 ","$0.00 ","$84.14 ","$133.27 ","$134.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8985","ERX","HCPCS 25000001","51672-1306-06","ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA","BOTH IP/OP","$185.57 ","$137.32 ","$0.00 ","$348.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.27 ","$0.00 ","$84.14 ","$348.39 ","$134.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8985","ERX","HCPCS 25000001","51672-1306-03","ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA","BOTH IP/OP","$185.57 ","$137.32 ","$0.00 ","$464.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.27 ","$0.00 ","$84.14 ","$464.52 ","$134.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8985","ERX","HCPCS 25000001","68462-0300-65","ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA","BOTH IP/OP","$185.57 ","$137.32 ","$0.00 ","$464.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.27 ","$0.00 ","$84.14 ","$464.52 ","$134.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8986","ERX","HCPCS 25000001","00168-0264-15","ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$83.78 ","$62.00 ","$0.00 ","$75.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.99 ","$0.00 ","$38.00 ","$60.18 ","$60.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8986","ERX","HCPCS 25000001","51672-1316-01","ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$83.78 ","$62.00 ","$0.00 ","$75.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.99 ","$0.00 ","$38.00 ","$60.18 ","$60.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8986","ERX","HCPCS 25000001","68462-0299-17","ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$83.78 ","$62.00 ","$0.00 ","$75.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.99 ","$0.00 ","$38.00 ","$60.18 ","$60.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8986","ERX","HCPCS 25000001","00168-0264-45","ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$83.78 ","$62.00 ","$0.00 ","$149.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.99 ","$0.00 ","$38.00 ","$149.66 ","$60.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8986","ERX","HCPCS 25000001","00168-0264-60","ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT","BOTH IP/OP","$83.78 ","$62.00 ","$0.00 ","$199.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.99 ","$0.00 ","$38.00 ","$199.54 ","$60.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9001","ERX","HCPCS J0270","00009-3169-06","ALPROSTADIL 500 MCG/ML IJ SOLN","BOTH IP/OP","$436.84 ","$323.26 ","$0.00 ","$396.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$396.54 ","$0.00 ","$198.27 ","$314.06 ","$317.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9001","ERX","HCPCS J0270","00703-1501-01","ALPROSTADIL 500 MCG/ML IJ SOLN","BOTH IP/OP","$436.84 ","$323.26 ","$0.00 ","$396.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$396.54 ","$0.00 ","$198.27 ","$314.06 ","$317.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9002","ERX","HCPCS J2997","50242-0085-27","ALTEPLASE 100 MG IV SOLR","BOTH IP/OP","$2,386.66 ","$1,766.13 ","$0.00 ","$2,164.89 ","$1,074.00 ","$876.70 ","$497.44 ","$0.00 ","$0.00 ","$379.05 ","$2,164.89 ","$920.20 ","$1,082.45 ","$1,714.59 ","$1,731.91 ","$1,270.75 ","$338.81 ","$0.00 ","$344.65 ","$878.85 "
"9003","ERX","HCPCS J2997","50242-0044-13","ALTEPLASE 50 MG IV SOLR","BOTH IP/OP","$11,933.30 ","$8,830.64 ","$0.00 ","$10,824.46 ","$5,369.99 ","$4,383.50 ","$2,487.20 ","$0.00 ","$0.00 ","$1,895.28 ","$10,824.46 ","$4,601.00 ","$5,412.23 ","$8,572.97 ","$8,659.57 ","$6,353.76 ","$1,694.03 ","$0.00 ","$1,723.25 ","$4,394.25 "
"9009","ERX","HCPCS 25000001","00121-1761-30","ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP","BOTH IP/OP","$7.92 ","$5.86 ","$0.00 ","$7.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9009","ERX","HCPCS 25000001","00904-6833-14","ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP","BOTH IP/OP","$7.92 ","$5.86 ","$0.00 ","$7.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9009","ERX","HCPCS 25000001","49348-0019-39","ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP","BOTH IP/OP","$7.92 ","$5.86 ","$0.00 ","$7.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9009","ERX","HCPCS 25000001","57896-0629-12","ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP","BOTH IP/OP","$7.92 ","$5.86 ","$0.00 ","$7.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9020","ERX","HCPCS 25000001","51224-0162-12","ALUM SULFATE-CA ACETATE EX PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9028","ERX","HCPCS 25000001","00096-0707-37","ALUMINUM CHLORIDE 20 % EX SOLN","BOTH IP/OP","$35.04 ","$25.93 ","$0.00 ","$29.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$23.47 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9028","ERX","HCPCS 25000001","00096-0707-60","ALUMINUM CHLORIDE 20 % EX SOLN","BOTH IP/OP","$35.04 ","$25.93 ","$0.00 ","$35.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$35.04 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9063","ERX","HCPCS 63700001","49411-0050-30","AMINOCAPROIC ACID 500 MG PO TABS","BOTH IP/OP","$94.31 ","$69.79 ","$0.00 ","$85.51 ","","$16.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.51 ","$0.00 ","$42.76 ","$67.72 ","$68.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9063","ERX","HCPCS 63700001","69680-0115-30","AMINOCAPROIC ACID 500 MG PO TABS","BOTH IP/OP","$94.31 ","$69.79 ","$0.00 ","$85.51 ","","$16.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.51 ","$0.00 ","$42.76 ","$67.72 ","$68.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9066","ERX","HCPCS 63700001","00245-0147-01","AMIODARONE HCL 200 MG PO TABS","BOTH IP/OP","$12.85 ","$9.51 ","$0.00 ","$12.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9066","ERX","HCPCS 63700001","00245-0147-89","AMIODARONE HCL 200 MG PO TABS","BOTH IP/OP","$12.85 ","$9.51 ","$0.00 ","$12.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9066","ERX","HCPCS 63700001","16714-0844-01","AMIODARONE HCL 200 MG PO TABS","BOTH IP/OP","$12.85 ","$9.51 ","$0.00 ","$12.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9066","ERX","HCPCS 63700001","51672-4025-04","AMIODARONE HCL 200 MG PO TABS","BOTH IP/OP","$12.85 ","$9.51 ","$0.00 ","$12.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9066","ERX","HCPCS 63700001","63739-0387-10","AMIODARONE HCL 200 MG PO TABS","BOTH IP/OP","$12.85 ","$9.51 ","$0.00 ","$12.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9066","ERX","HCPCS 63700001","68382-0227-14","AMIODARONE HCL 200 MG PO TABS","BOTH IP/OP","$12.85 ","$9.51 ","$0.00 ","$12.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9069","ERX","HCPCS 63700001","00904-6371-61","AMLODIPINE BESYLATE 10 MG PO TABS","BOTH IP/OP","$9.02 ","$6.67 ","$0.00 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.02 ","$0.00 ","$4.51 ","$7.14 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9069","ERX","HCPCS 63700001","10135-0526-05","AMLODIPINE BESYLATE 10 MG PO TABS","BOTH IP/OP","$9.02 ","$6.67 ","$0.00 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.02 ","$0.00 ","$4.51 ","$7.14 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9069","ERX","HCPCS 63700001","63739-0631-10","AMLODIPINE BESYLATE 10 MG PO TABS","BOTH IP/OP","$9.02 ","$6.67 ","$0.00 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.02 ","$0.00 ","$4.51 ","$7.14 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9069","ERX","HCPCS 63700001","67877-0199-05","AMLODIPINE BESYLATE 10 MG PO TABS","BOTH IP/OP","$9.02 ","$6.67 ","$0.00 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.02 ","$0.00 ","$4.51 ","$7.14 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9069","ERX","HCPCS 63700001","68382-0123-16","AMLODIPINE BESYLATE 10 MG PO TABS","BOTH IP/OP","$9.02 ","$6.67 ","$0.00 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.02 ","$0.00 ","$4.51 ","$7.14 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9069","ERX","HCPCS 63700001","69097-0128-05","AMLODIPINE BESYLATE 10 MG PO TABS","BOTH IP/OP","$9.02 ","$6.67 ","$0.00 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.02 ","$0.00 ","$4.51 ","$7.14 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9070","ERX","HCPCS 63700001","00904-6369-61","AMLODIPINE BESYLATE 2.5 MG PO TABS","BOTH IP/OP","$6.58 ","$4.87 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9070","ERX","HCPCS 63700001","68382-0121-16","AMLODIPINE BESYLATE 2.5 MG PO TABS","BOTH IP/OP","$6.58 ","$4.87 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9071","ERX","HCPCS 63700001","00904-6370-61","AMLODIPINE BESYLATE 5 MG PO TABS","BOTH IP/OP","$6.58 ","$4.87 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9071","ERX","HCPCS 63700001","50268-0084-11","AMLODIPINE BESYLATE 5 MG PO TABS","BOTH IP/OP","$6.58 ","$4.87 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9071","ERX","HCPCS 63700001","50268-0084-15","AMLODIPINE BESYLATE 5 MG PO TABS","BOTH IP/OP","$6.58 ","$4.87 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9081","ERX","HCPCS 63700001","00555-0972-02","AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS","BOTH IP/OP","$7.19 ","$5.32 ","$0.00 ","$6.52 ","","$1.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.52 ","$0.00 ","$3.26 ","$5.16 ","$5.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","00049-0013-83","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","00641-6116-10","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","25021-0142-20","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","44567-0210-10","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","55150-0116-20","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","66794-0206-41","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9083","ERX","HCPCS J0295","67457-0348-10","AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 "
"9084","ERX","HCPCS J0295","00049-0014-83","AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","BOTH IP/OP","$80.20 ","$59.35 ","$0.00 ","$72.74 ","$36.09 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$72.74 ","$0.00 ","$36.37 ","$57.61 ","$58.19 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"9084","ERX","HCPCS J0295","00641-6117-10","AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","BOTH IP/OP","$80.20 ","$59.35 ","$0.00 ","$72.74 ","$36.09 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$72.74 ","$0.00 ","$36.37 ","$57.61 ","$58.19 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"9084","ERX","HCPCS J0295","44567-0211-10","AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","BOTH IP/OP","$80.20 ","$59.35 ","$0.00 ","$72.74 ","$36.09 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$72.74 ","$0.00 ","$36.37 ","$57.61 ","$58.19 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"9084","ERX","HCPCS J0295","55150-0117-20","AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","BOTH IP/OP","$80.20 ","$59.35 ","$0.00 ","$72.74 ","$36.09 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$72.74 ","$0.00 ","$36.37 ","$57.61 ","$58.19 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"9084","ERX","HCPCS J0295","67457-0349-10","AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","BOTH IP/OP","$80.20 ","$59.35 ","$0.00 ","$72.74 ","$36.09 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$72.74 ","$0.00 ","$36.37 ","$57.61 ","$58.19 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"9096","ERX","HCPCS 63700001","11086-0037-01","ANTHRALIN 1 % EX CREA","BOTH IP/OP","$1,226.40 ","$907.54 ","$0.00 ","$1,113.00 ","","$218.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9119","ERX","HCPCS 25000001","61314-0665-05","APRACLONIDINE HCL 0.5 % OP SOLN","BOTH IP/OP","$530.56 ","$392.61 ","$0.00 ","$530.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.56 ","$0.00 ","$265.28 ","$420.20 ","$424.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9120","ERX","HCPCS 25000001","00065-0660-10","APRACLONIDINE HCL 1 % OP SOLN","BOTH IP/OP","$2,068.25 ","$1,530.51 ","$0.00 ","$1,916.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,916.53 ","$0.00 ","$958.27 ","$1,517.89 ","$1,533.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9123","ERX","HCPCS 25000001","00009-0436-01","ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN","BOTH IP/OP","$157.30 ","$116.40 ","$0.00 ","$133.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.88 ","$0.00 ","$66.94 ","$106.03 ","$107.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9183","ERX","HCPCS J7500","60219-1076-01","AZATHIOPRINE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"9183","ERX","HCPCS J7500","68084-0229-01","AZATHIOPRINE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"9183","ERX","HCPCS J7500","68462-0502-01","AZATHIOPRINE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$2.70 ","$0.00 ","$1.25 ","$0.00 ","$0.00 ","$1.05 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.94 ","$0.00 ","$0.96 ","$0.00 "
"9185","ERX","HCPCS 25000001","63323-0401-20","AZTREONAM 1 G IJ SOLR","BOTH IP/OP","$83.57 ","$61.84 ","$0.00 ","$75.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.13 ","$0.00 ","$37.57 ","$59.50 ","$60.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9185","ERX","HCPCS 25000001","63323-0401-26","AZTREONAM 1 G IJ SOLR","BOTH IP/OP","$83.57 ","$61.84 ","$0.00 ","$75.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.13 ","$0.00 ","$37.57 ","$59.50 ","$60.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9186","ERX","HCPCS 25000001","00003-2570-16","AZTREONAM 2 G IJ SOLR","BOTH IP/OP","$84.90 ","$62.83 ","$0.00 ","$70.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.30 ","$0.00 ","$35.15 ","$55.68 ","$56.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9186","ERX","HCPCS 25000001","63323-0402-20","AZTREONAM 2 G IJ SOLR","BOTH IP/OP","$84.90 ","$62.83 ","$0.00 ","$70.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.30 ","$0.00 ","$35.15 ","$55.68 ","$56.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9186","ERX","HCPCS 25000001","63323-0402-30","AZTREONAM 2 G IJ SOLR","BOTH IP/OP","$84.90 ","$62.83 ","$0.00 ","$70.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.30 ","$0.00 ","$35.15 ","$55.68 ","$56.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9219","ERX","HCPCS 25000001","00574-7045-12","BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG RECTAL SUPP","BOTH IP/OP","$106.22 ","$78.60 ","$0.00 ","$96.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.32 ","$0.00 ","$48.16 ","$76.29 ","$77.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9254","ERX","HCPCS 25000001","00781-7054-49","BENZOYL PEROXIDE-ERYTHROMYCIN 5-3 % EX GEL","BOTH IP/OP","$605.59 ","$448.14 ","$0.00 ","$549.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.60 ","$0.00 ","$274.80 ","$435.28 ","$439.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9259","ERX","HCPCS J0515","00143-9729-01","BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$69.14 ","$51.16 ","$0.00 ","$62.70 ","$31.11 ","$0.00 ","$32.05 ","$0.00 ","$0.00 ","$20.83 ","$62.70 ","$0.00 ","$31.35 ","$49.66 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 "
"9259","ERX","HCPCS J0515","00143-9729-05","BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$69.14 ","$51.16 ","$0.00 ","$62.70 ","$31.11 ","$0.00 ","$32.05 ","$0.00 ","$0.00 ","$20.83 ","$62.70 ","$0.00 ","$31.35 ","$49.66 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 "
"9259","ERX","HCPCS J0515","63323-0970-02","BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$69.14 ","$51.16 ","$0.00 ","$62.70 ","$31.11 ","$0.00 ","$32.05 ","$0.00 ","$0.00 ","$20.83 ","$62.70 ","$0.00 ","$31.35 ","$49.66 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 "
"9259","ERX","HCPCS J0515","68382-0860-02","BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$69.14 ","$51.16 ","$0.00 ","$62.70 ","$31.11 ","$0.00 ","$32.05 ","$0.00 ","$0.00 ","$20.83 ","$62.70 ","$0.00 ","$31.35 ","$49.66 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 "
"9259","ERX","HCPCS J0515","68382-0860-10","BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$69.14 ","$51.16 ","$0.00 ","$62.70 ","$31.11 ","$0.00 ","$32.05 ","$0.00 ","$0.00 ","$20.83 ","$62.70 ","$0.00 ","$31.35 ","$49.66 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 "
"9260","ERX","HCPCS 25000001","49471-0001-05","BENZYLPENICILLOYL POLYLYSINE 0.25 ML ID SOLN","BOTH IP/OP","$599.16 ","$443.38 ","$0.00 ","$505.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.08 ","$0.00 ","$252.54 ","$400.02 ","$404.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9266","ERX","HCPCS J0702","00085-4320-01","BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","BOTH IP/OP","$52.71 ","$39.01 ","$0.00 ","$46.97 ","$23.72 ","$0.00 ","$7.14 ","$0.00 ","$0.00 ","$8.31 ","$46.97 ","$0.00 ","$23.49 ","$37.20 ","$37.58 ","$0.00 ","$8.31 ","$0.00 ","$7.91 ","$0.00 "
"9266","ERX","HCPCS J0702","00517-0720-01","BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","BOTH IP/OP","$52.71 ","$39.01 ","$0.00 ","$46.97 ","$23.72 ","$0.00 ","$7.14 ","$0.00 ","$0.00 ","$8.31 ","$46.97 ","$0.00 ","$23.49 ","$37.20 ","$37.58 ","$0.00 ","$8.31 ","$0.00 ","$7.91 ","$0.00 "
"9266","ERX","HCPCS J0702","51754-5060-01","BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","BOTH IP/OP","$52.71 ","$39.01 ","$0.00 ","$46.97 ","$23.72 ","$0.00 ","$7.14 ","$0.00 ","$0.00 ","$8.31 ","$46.97 ","$0.00 ","$23.49 ","$37.20 ","$37.58 ","$0.00 ","$8.31 ","$0.00 ","$7.91 ","$0.00 "
"9284","ERX","HCPCS 63700001","00904-1315-46","BISMUTH SUBSALICYLATE 262 MG PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9289","ERX","HCPCS J9040","00703-3154-01","BLEOMYCIN SULFATE 15 UNITS IJ SOLR","BOTH IP/OP","$159.81 ","$118.26 ","$0.00 ","$144.90 ","$71.91 ","$0.00 ","$37.40 ","$0.00 ","$0.00 ","$26.64 ","$144.90 ","$0.00 ","$72.45 ","$114.76 ","$115.92 ","$0.00 ","$26.64 ","$0.00 ","$25.36 ","$0.00 "
"9289","ERX","HCPCS J9040","61703-0332-18","BLEOMYCIN SULFATE 15 UNITS IJ SOLR","BOTH IP/OP","$159.81 ","$118.26 ","$0.00 ","$144.90 ","$71.91 ","$0.00 ","$37.40 ","$0.00 ","$0.00 ","$26.64 ","$144.90 ","$0.00 ","$72.45 ","$114.76 ","$115.92 ","$0.00 ","$26.64 ","$0.00 ","$25.36 ","$0.00 "
"9289","ERX","HCPCS J9040","63323-0136-10","BLEOMYCIN SULFATE 15 UNITS IJ SOLR","BOTH IP/OP","$159.81 ","$118.26 ","$0.00 ","$144.90 ","$71.91 ","$0.00 ","$37.40 ","$0.00 ","$0.00 ","$26.64 ","$144.90 ","$0.00 ","$72.45 ","$114.76 ","$115.92 ","$0.00 ","$26.64 ","$0.00 ","$25.36 ","$0.00 "
"9297","ERX","HCPCS 63700001","00574-0106-01","BROMOCRIPTINE MESYLATE 2.5 MG PO TABS","BOTH IP/OP","$17.34 ","$12.83 ","$0.00 ","$15.73 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.73 ","$0.00 ","$7.87 ","$12.46 ","$12.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9297","ERX","HCPCS 63700001","00574-0106-03","BROMOCRIPTINE MESYLATE 2.5 MG PO TABS","BOTH IP/OP","$17.34 ","$12.83 ","$0.00 ","$15.73 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.73 ","$0.00 ","$7.87 ","$12.46 ","$12.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9297","ERX","HCPCS 63700001","00781-5325-01","BROMOCRIPTINE MESYLATE 2.5 MG PO TABS","BOTH IP/OP","$17.34 ","$12.83 ","$0.00 ","$15.73 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.73 ","$0.00 ","$7.87 ","$12.46 ","$12.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9297","ERX","HCPCS 63700001","00781-5325-31","BROMOCRIPTINE MESYLATE 2.5 MG PO TABS","BOTH IP/OP","$17.34 ","$12.83 ","$0.00 ","$15.73 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.73 ","$0.00 ","$7.87 ","$12.46 ","$12.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9297","ERX","HCPCS 63700001","63304-0962-01","BROMOCRIPTINE MESYLATE 2.5 MG PO TABS","BOTH IP/OP","$17.34 ","$12.83 ","$0.00 ","$15.73 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.73 ","$0.00 ","$7.87 ","$12.46 ","$12.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9297","ERX","HCPCS 63700001","63304-0962-30","BROMOCRIPTINE MESYLATE 2.5 MG PO TABS","BOTH IP/OP","$17.34 ","$12.83 ","$0.00 ","$15.73 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.73 ","$0.00 ","$7.87 ","$12.46 ","$12.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9308","ERX","HCPCS S0171","00409-1412-10","BUMETANIDE 0.25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.21 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9308","ERX","HCPCS S0171","00641-6007-10","BUMETANIDE 0.25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.21 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9308","ERX","HCPCS S0171","00641-6008-01","BUMETANIDE 0.25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.21 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9308","ERX","HCPCS S0171","00641-6008-10","BUMETANIDE 0.25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.21 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9308","ERX","HCPCS S0171","00641-6161-10","BUMETANIDE 0.25 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$1.21 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9309","ERX","HCPCS 63700001","42799-0119-01","BUMETANIDE 0.5 MG PO TABS","BOTH IP/OP","$10.07 ","$7.45 ","$0.00 ","$9.14 ","","$1.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.14 ","$0.00 ","$4.57 ","$7.24 ","$7.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9310","ERX","HCPCS 63700001","16714-0832-01","BUMETANIDE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9310","ERX","HCPCS 63700001","42799-0120-01","BUMETANIDE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9316","ERX","HCPCS 25000001","00409-1761-02","BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9316","ERX","HCPCS 25000001","00409-3613-01","BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9320","ERX","HCPCS J0592","00143-9246-05","BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN","BOTH IP/OP","$76.28 ","$56.45 ","$0.00 ","$69.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.18 ","$0.00 ","$34.59 ","$54.79 ","$55.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9320","ERX","HCPCS J0592","00409-2012-32","BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN","BOTH IP/OP","$76.28 ","$56.45 ","$0.00 ","$69.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.18 ","$0.00 ","$34.59 ","$54.79 ","$55.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9321","ERX","HCPCS 63700001","23155-0192-01","BUPROPION HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9321","ERX","HCPCS 63700001","60505-0157-01","BUPROPION HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9322","ERX","HCPCS 63700001","23155-0191-01","BUPROPION HCL 75 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9323","ERX","HCPCS 63700001","00093-0054-01","BUSPIRONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9323","ERX","HCPCS 63700001","00378-1150-01","BUSPIRONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9323","ERX","HCPCS 63700001","51079-0986-01","BUSPIRONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9323","ERX","HCPCS 63700001","51079-0986-20","BUSPIRONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9323","ERX","HCPCS 63700001","64380-0742-06","BUSPIRONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9324","ERX","HCPCS 63700001","00093-0053-01","BUSPIRONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9324","ERX","HCPCS 63700001","51079-0985-01","BUSPIRONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9324","ERX","HCPCS 63700001","51079-0985-20","BUSPIRONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9324","ERX","HCPCS 63700001","64380-0741-06","BUSPIRONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9324","ERX","HCPCS 63700001","64380-0741-08","BUSPIRONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9325","ERX","HCPCS J8510","76388-0713-25","BUSULFAN 2 MG PO TABS","BOTH IP/OP","$108.50 ","$80.29 ","$0.00 ","$98.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.38 ","$0.00 ","$49.19 ","$77.92 ","$78.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9333","ERX","HCPCS J0595","00409-1623-01","BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9347","ERX","HCPCS J0630","67457-0675-02","CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN","BOTH IP/OP","$8,494.26 ","$6,285.75 ","$0.00 ","$6,649.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,649.55 ","$0.00 ","$3,324.78 ","$5,266.44 ","$5,319.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9348","ERX","HCPCS J0636","17478-0931-01","CALCITRIOL 1 MCG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9350","ERX","HCPCS 63700001","00054-0007-13","CALCITRIOL 0.25 MCG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9350","ERX","HCPCS 63700001","00054-0007-25","CALCITRIOL 0.25 MCG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9350","ERX","HCPCS 63700001","23155-0118-01","CALCITRIOL 0.25 MCG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9350","ERX","HCPCS 63700001","23155-0662-01","CALCITRIOL 0.25 MCG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9350","ERX","HCPCS 63700001","23155-0662-03","CALCITRIOL 0.25 MCG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9394","ERX","HCPCS 25000001","17478-0080-50","CAPREOMYCIN SULFATE 1 G IJ SOLR","BOTH IP/OP","$754.94 ","$558.66 ","$0.00 ","$685.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$685.14 ","$0.00 ","$342.57 ","$542.63 ","$548.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9400","ERX","HCPCS 63700001","00143-1174-01","CAPTOPRIL 100 MG PO TABS","BOTH IP/OP","$15.95 ","$11.80 ","$0.00 ","$14.47 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.47 ","$0.00 ","$7.24 ","$11.46 ","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9400","ERX","HCPCS 63700001","00378-3022-01","CAPTOPRIL 100 MG PO TABS","BOTH IP/OP","$15.95 ","$11.80 ","$0.00 ","$14.47 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.47 ","$0.00 ","$7.24 ","$11.46 ","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9400","ERX","HCPCS 63700001","00781-8080-01","CAPTOPRIL 100 MG PO TABS","BOTH IP/OP","$15.95 ","$11.80 ","$0.00 ","$14.47 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.47 ","$0.00 ","$7.24 ","$11.46 ","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9401","ERX","HCPCS 63700001","00143-1171-01","CAPTOPRIL 12.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9401","ERX","HCPCS 63700001","00378-3007-01","CAPTOPRIL 12.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9401","ERX","HCPCS 63700001","00781-8052-01","CAPTOPRIL 12.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9401","ERX","HCPCS 63700001","51079-0863-20","CAPTOPRIL 12.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9402","ERX","HCPCS 63700001","00143-1172-01","CAPTOPRIL 25 MG PO TABS","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9402","ERX","HCPCS 63700001","00378-3012-01","CAPTOPRIL 25 MG PO TABS","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9402","ERX","HCPCS 63700001","00781-8061-01","CAPTOPRIL 25 MG PO TABS","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9402","ERX","HCPCS 63700001","00904-5046-61","CAPTOPRIL 25 MG PO TABS","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9402","ERX","HCPCS 63700001","51079-0864-01","CAPTOPRIL 25 MG PO TABS","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9402","ERX","HCPCS 63700001","51079-0864-20","CAPTOPRIL 25 MG PO TABS","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9403","ERX","HCPCS 63700001","00143-1173-01","CAPTOPRIL 50 MG PO TABS","BOTH IP/OP","$9.87 ","$7.30 ","$0.00 ","$8.95 ","","$1.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.95 ","$0.00 ","$4.48 ","$7.09 ","$7.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9403","ERX","HCPCS 63700001","00781-8075-01","CAPTOPRIL 50 MG PO TABS","BOTH IP/OP","$9.87 ","$7.30 ","$0.00 ","$8.95 ","","$1.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.95 ","$0.00 ","$4.48 ","$7.09 ","$7.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9406","ERX","HCPCS 63700001","63739-0107-10","CARBIDOPA-LEVODOPA 10-100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9407","ERX","HCPCS 63700001","00228-2539-10","CARBIDOPA-LEVODOPA 25-100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9407","ERX","HCPCS 63700001","00228-2539-50","CARBIDOPA-LEVODOPA 25-100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9407","ERX","HCPCS 63700001","51079-0884-20","CARBIDOPA-LEVODOPA 25-100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9407","ERX","HCPCS 63700001","68084-0093-01","CARBIDOPA-LEVODOPA 25-100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9408","ERX","HCPCS 63700001","00904-6238-61","CARBIDOPA-LEVODOPA 25-250 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9413","ERX","HCPCS 25000001","00009-0856-08","CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","BOTH IP/OP","$1,117.75 ","$827.14 ","$0.00 ","$1,014.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.39 ","$0.00 ","$507.20 ","$803.40 ","$811.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9413","ERX","HCPCS 25000001","43598-0698-11","CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","BOTH IP/OP","$1,117.75 ","$827.14 ","$0.00 ","$1,014.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.39 ","$0.00 ","$507.20 ","$803.40 ","$811.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9413","ERX","HCPCS 25000001","43598-0698-58","CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","BOTH IP/OP","$1,117.75 ","$827.14 ","$0.00 ","$1,014.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.39 ","$0.00 ","$507.20 ","$803.40 ","$811.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9430","ERX","HCPCS 63700001","00143-9985-01","CEFACLOR 250 MG PO CAPS","BOTH IP/OP","$7.57 ","$5.60 ","$0.00 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.57 ","$0.00 ","$3.79 ","$6.00 ","$6.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9430","ERX","HCPCS 63700001","61442-0171-30","CEFACLOR 250 MG PO CAPS","BOTH IP/OP","$7.57 ","$5.60 ","$0.00 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.57 ","$0.00 ","$3.79 ","$6.00 ","$6.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9431","ERX","HCPCS 63700001","00143-9986-01","CEFACLOR 500 MG PO CAPS","BOTH IP/OP","$14.81 ","$10.96 ","$0.00 ","$14.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.81 ","$0.00 ","$7.41 ","$11.73 ","$11.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9431","ERX","HCPCS 63700001","61442-0172-30","CEFACLOR 500 MG PO CAPS","BOTH IP/OP","$14.81 ","$10.96 ","$0.00 ","$14.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.81 ","$0.00 ","$7.41 ","$11.73 ","$11.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9446","ERX","HCPCS 63700001","65862-0751-50","CEFIXIME 100 MG/5ML PO SUSR","BOTH IP/OP","$794.83 ","$588.17 ","$0.00 ","$721.33 ","","$141.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$721.33 ","$0.00 ","$360.67 ","$571.29 ","$577.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9446","ERX","HCPCS 63700001","68180-0202-03","CEFIXIME 100 MG/5ML PO SUSR","BOTH IP/OP","$794.83 ","$588.17 ","$0.00 ","$721.33 ","","$141.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$721.33 ","$0.00 ","$360.67 ","$571.29 ","$577.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9452","ERX","HCPCS J0698","","CEFOTAXIME SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9452","ERX","HCPCS J0698","00143-9931-25","CEFOTAXIME SODIUM 1 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9455","ERX","HCPCS 25000001","","CEFOTAXIME SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9455","ERX","HCPCS 25000001","00143-9930-10","CEFOTAXIME SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9461","ERX","HCPCS J0694","25021-0109-10","CEFOXITIN SODIUM 1 G IV SOLR","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$8.06 ","$0.00 ","$0.00 ","$6.22 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"9461","ERX","HCPCS J0694","44567-0245-25","CEFOXITIN SODIUM 1 G IV SOLR","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$8.06 ","$0.00 ","$0.00 ","$6.22 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"9461","ERX","HCPCS J0694","44567-0245-85","CEFOXITIN SODIUM 1 G IV SOLR","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$8.06 ","$0.00 ","$0.00 ","$6.22 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"9461","ERX","HCPCS J0694","63323-0341-25","CEFOXITIN SODIUM 1 G IV SOLR","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$8.06 ","$0.00 ","$0.00 ","$6.22 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"9463","ERX","HCPCS J0694","25021-0110-20","CEFOXITIN SODIUM 2 G IV SOLR","BOTH IP/OP","$92.41 ","$68.38 ","$0.00 ","$83.79 ","$41.58 ","$0.00 ","$16.12 ","$0.00 ","$0.00 ","$12.43 ","$83.79 ","$0.00 ","$41.90 ","$66.36 ","$67.03 ","$0.00 ","$12.43 ","$0.00 ","$11.84 ","$0.00 "
"9463","ERX","HCPCS J0694","44567-0246-25","CEFOXITIN SODIUM 2 G IV SOLR","BOTH IP/OP","$92.41 ","$68.38 ","$0.00 ","$83.79 ","$41.58 ","$0.00 ","$16.12 ","$0.00 ","$0.00 ","$12.43 ","$83.79 ","$0.00 ","$41.90 ","$66.36 ","$67.03 ","$0.00 ","$12.43 ","$0.00 ","$11.84 ","$0.00 "
"9463","ERX","HCPCS J0694","44567-0246-85","CEFOXITIN SODIUM 2 G IV SOLR","BOTH IP/OP","$92.41 ","$68.38 ","$0.00 ","$83.79 ","$41.58 ","$0.00 ","$16.12 ","$0.00 ","$0.00 ","$12.43 ","$83.79 ","$0.00 ","$41.90 ","$66.36 ","$67.03 ","$0.00 ","$12.43 ","$0.00 ","$11.84 ","$0.00 "
"9463","ERX","HCPCS J0694","63323-0342-25","CEFOXITIN SODIUM 2 G IV SOLR","BOTH IP/OP","$92.41 ","$68.38 ","$0.00 ","$83.79 ","$41.58 ","$0.00 ","$16.12 ","$0.00 ","$0.00 ","$12.43 ","$83.79 ","$0.00 ","$41.90 ","$66.36 ","$67.03 ","$0.00 ","$12.43 ","$0.00 ","$11.84 ","$0.00 "
"9468","ERX","HCPCS 63700001","16714-0394-01","CEFPODOXIME PROXETIL 100 MG PO TABS","BOTH IP/OP","$28.23 ","$20.89 ","$0.00 ","$25.61 ","","$5.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.61 ","$0.00 ","$12.81 ","$20.28 ","$20.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9469","ERX","HCPCS 63700001","65862-0096-20","CEFPODOXIME PROXETIL 200 MG PO TABS","BOTH IP/OP","$35.44 ","$26.23 ","$0.00 ","$32.14 ","","$6.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.14 ","$0.00 ","$16.07 ","$25.45 ","$25.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9474","ERX","HCPCS J0713","00409-5082-16","CEFTAZIDIME 1 G IJ SOLR","BOTH IP/OP","$22.63 ","$16.75 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9474","ERX","HCPCS J0713","25021-0127-20","CEFTAZIDIME 1 G IJ SOLR","BOTH IP/OP","$22.63 ","$16.75 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9474","ERX","HCPCS J0713","44567-0235-25","CEFTAZIDIME 1 G IJ SOLR","BOTH IP/OP","$22.63 ","$16.75 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9476","ERX","HCPCS J0713","00409-5084-11","CEFTAZIDIME 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9476","ERX","HCPCS J0713","25021-0128-50","CEFTAZIDIME 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9476","ERX","HCPCS J0713","44567-0236-10","CEFTAZIDIME 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"9487","ERX","HCPCS J0696","00409-7332-01","CEFTRIAXONE SODIUM 1 G IJ SOLR","BOTH IP/OP","$177.56 ","$131.39 ","$0.00 ","$161.00 ","$79.90 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"9487","ERX","HCPCS J0696","00409-7332-11","CEFTRIAXONE SODIUM 1 G IJ SOLR","BOTH IP/OP","$177.56 ","$131.39 ","$0.00 ","$161.00 ","$79.90 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"9487","ERX","HCPCS J0696","00781-3208-95","CEFTRIAXONE SODIUM 1 G IJ SOLR","BOTH IP/OP","$177.56 ","$131.39 ","$0.00 ","$161.00 ","$79.90 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"9487","ERX","HCPCS J0696","25021-0106-10","CEFTRIAXONE SODIUM 1 G IJ SOLR","BOTH IP/OP","$177.56 ","$131.39 ","$0.00 ","$161.00 ","$79.90 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"9487","ERX","HCPCS J0696","44567-0701-25","CEFTRIAXONE SODIUM 1 G IJ SOLR","BOTH IP/OP","$177.56 ","$131.39 ","$0.00 ","$161.00 ","$79.90 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"9488","ERX","HCPCS J0696","00143-9856-25","CEFTRIAXONE SODIUM 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$5.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.64 ","$0.00 ","$5.37 ","$0.00 "
"9488","ERX","HCPCS J0696","00409-7335-03","CEFTRIAXONE SODIUM 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$5.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.64 ","$0.00 ","$5.37 ","$0.00 "
"9488","ERX","HCPCS J0696","00409-7335-20","CEFTRIAXONE SODIUM 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$5.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.64 ","$0.00 ","$5.37 ","$0.00 "
"9488","ERX","HCPCS J0696","00409-7335-21","CEFTRIAXONE SODIUM 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$5.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.64 ","$0.00 ","$5.37 ","$0.00 "
"9488","ERX","HCPCS J0696","44567-0702-25","CEFTRIAXONE SODIUM 2 G IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$5.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.64 ","$0.00 ","$5.37 ","$0.00 "
"9489","ERX","HCPCS J0696","00409-7337-01","CEFTRIAXONE SODIUM 250 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.71 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"9489","ERX","HCPCS J0696","00409-7337-11","CEFTRIAXONE SODIUM 250 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.71 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"9490","ERX","HCPCS J0696","00143-9858-25","CEFTRIAXONE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"9490","ERX","HCPCS J0696","00409-7338-01","CEFTRIAXONE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"9490","ERX","HCPCS J0696","00409-7338-11","CEFTRIAXONE SODIUM 500 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"9491","ERX","HCPCS J0696","00409-7334-10","CEFTRIAXONE SODIUM 10 G IV SOLR","BOTH IP/OP","$80.22 ","$59.36 ","$0.00 ","$71.65 ","$36.10 ","$0.00 ","$56.40 ","$0.00 ","$0.00 ","$28.20 ","$71.65 ","$0.00 ","$35.83 ","$56.75 ","$57.32 ","$0.00 ","$28.20 ","$0.00 ","$26.85 ","$0.00 "
"9491","ERX","HCPCS J0696","00781-3210-46","CEFTRIAXONE SODIUM 10 G IV SOLR","BOTH IP/OP","$80.22 ","$59.36 ","$0.00 ","$71.65 ","$36.10 ","$0.00 ","$56.40 ","$0.00 ","$0.00 ","$28.20 ","$71.65 ","$0.00 ","$35.83 ","$56.75 ","$57.32 ","$0.00 ","$28.20 ","$0.00 ","$26.85 ","$0.00 "
"9491","ERX","HCPCS J0696","25021-0108-99","CEFTRIAXONE SODIUM 10 G IV SOLR","BOTH IP/OP","$80.22 ","$59.36 ","$0.00 ","$71.65 ","$36.10 ","$0.00 ","$56.40 ","$0.00 ","$0.00 ","$28.20 ","$71.65 ","$0.00 ","$35.83 ","$56.75 ","$57.32 ","$0.00 ","$28.20 ","$0.00 ","$26.85 ","$0.00 "
"9495","ERX","HCPCS 63700001","16714-0400-01","CEFUROXIME AXETIL 250 MG PO TABS","BOTH IP/OP","$18.44 ","$13.65 ","$0.00 ","$16.72 ","","$3.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.72 ","$0.00 ","$8.36 ","$13.24 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9495","ERX","HCPCS 63700001","57237-0058-20","CEFUROXIME AXETIL 250 MG PO TABS","BOTH IP/OP","$18.44 ","$13.65 ","$0.00 ","$16.72 ","","$3.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.72 ","$0.00 ","$8.36 ","$13.24 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9495","ERX","HCPCS 63700001","64679-0921-01","CEFUROXIME AXETIL 250 MG PO TABS","BOTH IP/OP","$18.44 ","$13.65 ","$0.00 ","$16.72 ","","$3.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.72 ","$0.00 ","$8.36 ","$13.24 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9495","ERX","HCPCS 63700001","64679-0921-02","CEFUROXIME AXETIL 250 MG PO TABS","BOTH IP/OP","$18.44 ","$13.65 ","$0.00 ","$16.72 ","","$3.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.72 ","$0.00 ","$8.36 ","$13.24 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9495","ERX","HCPCS 63700001","68180-0302-20","CEFUROXIME AXETIL 250 MG PO TABS","BOTH IP/OP","$18.44 ","$13.65 ","$0.00 ","$16.72 ","","$3.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.72 ","$0.00 ","$8.36 ","$13.24 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9499","ERX","HCPCS 63700001","50268-0151-11","CEPHALEXIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9499","ERX","HCPCS 63700001","50268-0151-15","CEPHALEXIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9499","ERX","HCPCS 63700001","60687-0152-01","CEPHALEXIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9499","ERX","HCPCS 63700001","67877-0220-01","CEPHALEXIN 250 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9500","ERX","HCPCS 63700001","00093-3147-05","CEPHALEXIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9500","ERX","HCPCS 63700001","60687-0163-01","CEPHALEXIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9500","ERX","HCPCS 63700001","60687-0163-11","CEPHALEXIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9500","ERX","HCPCS 63700001","65862-0019-05","CEPHALEXIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9500","ERX","HCPCS 63700001","68180-0122-02","CEPHALEXIN 500 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9501","ERX","HCPCS 63700001","00093-4175-73","CEPHALEXIN 125 MG/5ML PO SUSR","BOTH IP/OP","$83.30 ","$61.64 ","$0.00 ","$83.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.30 ","$0.00 ","$41.65 ","$65.97 ","$66.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9501","ERX","HCPCS 63700001","68180-0440-01","CEPHALEXIN 125 MG/5ML PO SUSR","BOTH IP/OP","$83.30 ","$61.64 ","$0.00 ","$83.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.30 ","$0.00 ","$41.65 ","$65.97 ","$66.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9502","ERX","HCPCS 63700001","00093-4177-73","CEPHALEXIN 250 MG/5ML PO SUSR","BOTH IP/OP","$177.67 ","$131.48 ","$0.00 ","$100.80 ","","$31.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$79.83 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9502","ERX","HCPCS 63700001","68180-0441-01","CEPHALEXIN 250 MG/5ML PO SUSR","BOTH IP/OP","$177.67 ","$131.48 ","$0.00 ","$100.80 ","","$31.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$79.83 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9502","ERX","HCPCS 63700001","00093-4177-74","CEPHALEXIN 250 MG/5ML PO SUSR","BOTH IP/OP","$177.67 ","$131.48 ","$0.00 ","$127.73 ","","$31.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$127.73 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","00378-3637-01","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","00904-6717-61","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","16571-0402-10","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","16714-0799-04","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","45802-0919-39","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","51079-0597-01","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9506","ERX","HCPCS 63700001","51079-0597-20","CETIRIZINE HCL 10 MG PO TABS","BOTH IP/OP","$10.45 ","$7.73 ","$0.00 ","$9.48 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.48 ","$0.00 ","$4.74 ","$7.51 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9513","ERX","HCPCS 63700001","76388-0635-25","CHLORAMBUCIL 2 MG PO TABS","BOTH IP/OP","$534.60 ","$395.60 ","$0.00 ","$445.20 ","","$95.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.20 ","$0.00 ","$222.60 ","$352.60 ","$356.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9516","ERX","HCPCS 25000001","00116-2001-16","CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9516","ERX","HCPCS 25000001","69339-0138-15","CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9516","ERX","HCPCS 25000001","69339-0138-17","CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9516","ERX","HCPCS 25000001","69339-0138-19","CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9516","ERX","HCPCS 25000001","99999-6004-28","CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","BOTH IP/OP","$8.93 ","$6.61 ","$0.00 ","$8.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$6.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9523","ERX","HCPCS J2400","63323-0475-37","CHLOROPROCAINE HCL 1 % IJ SOLN","BOTH IP/OP","$83.61 ","$61.87 ","$0.00 ","$75.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.81 ","$0.00 ","$37.91 ","$60.04 ","$60.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9525","ERX","HCPCS 25000001","65649-0311-12","CHLOROTHIAZIDE 250 MG/5ML PO SUSP","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$88.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.62 ","$0.00 ","$44.31 ","$5.26 ","$70.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9525","ERX","HCPCS 25000001","99999-6008-62","CHLOROTHIAZIDE 250 MG/5ML PO SUSP","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$88.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.62 ","$0.00 ","$44.31 ","$5.26 ","$70.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9525","ERX","HCPCS 25000001","99999-6012-04","CHLOROTHIAZIDE 250 MG/5ML PO SUSP","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$88.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.62 ","$0.00 ","$44.31 ","$5.26 ","$70.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9525","ERX","HCPCS 25000001","99999-6004-75","CHLOROTHIAZIDE 250 MG/5ML PO SUSP","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$88.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.62 ","$0.00 ","$44.31 ","$70.19 ","$70.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","00517-1820-01","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","17478-0419-40","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","25021-0305-20","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","25021-0305-66","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","47335-0330-40","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","63323-0658-20","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","63323-0658-27","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","67457-0263-30","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","ERX","HCPCS J1205","76478-0711-40","CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$126.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9578","ERX","HCPCS 63700001","00904-5351-24","CHLORPHENIRAMINE-PSEUDOEPH 4-60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9578","ERX","HCPCS 63700001","00904-5351-96","CHLORPHENIRAMINE-PSEUDOEPH 4-60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9598","ERX","HCPCS 25000001","45802-0138-35","CICLOPIROX OLAMINE 0.77 % EX CREA","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$110.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.62 ","$0.00 ","$55.31 ","$87.61 ","$88.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9598","ERX","HCPCS 25000001","51672-1318-01","CICLOPIROX OLAMINE 0.77 % EX CREA","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$110.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.62 ","$0.00 ","$55.31 ","$87.61 ","$88.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9598","ERX","HCPCS 25000001","68462-0297-17","CICLOPIROX OLAMINE 0.77 % EX CREA","BOTH IP/OP","$122.00 ","$90.28 ","$0.00 ","$110.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.62 ","$0.00 ","$55.31 ","$87.61 ","$88.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9603","ERX","HCPCS J0743","00006-3516-59","IMIPENEM-CILASTATIN 500 MG IV SOLR","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$137.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.14 ","$0.00 ","$68.57 ","$108.61 ","$109.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9603","ERX","HCPCS J0743","63323-0322-93","IMIPENEM-CILASTATIN 500 MG IV SOLR","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$137.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.14 ","$0.00 ","$68.57 ","$108.61 ","$109.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9607","ERX","HCPCS 63700001","00378-0541-01","CIMETIDINE 800 MG PO TABS","BOTH IP/OP","$21.03 ","$15.56 ","$0.00 ","$19.07 ","","$3.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.07 ","$0.00 ","$9.54 ","$15.10 ","$15.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9610","ERX","HCPCS 25000001","61314-0656-25","CIPROFLOXACIN HCL 0.3 % OP SOLN","BOTH IP/OP","$70.40 ","$52.10 ","$0.00 ","$47.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9610","ERX","HCPCS 25000001","69315-0308-02","CIPROFLOXACIN HCL 0.3 % OP SOLN","BOTH IP/OP","$70.40 ","$52.10 ","$0.00 ","$47.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9610","ERX","HCPCS 25000001","61314-0656-05","CIPROFLOXACIN HCL 0.3 % OP SOLN","BOTH IP/OP","$70.40 ","$52.10 ","$0.00 ","$50.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.88 ","$0.00 ","$23.94 ","$50.56 ","$38.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9610","ERX","HCPCS 25000001","69315-0308-05","CIPROFLOXACIN HCL 0.3 % OP SOLN","BOTH IP/OP","$70.40 ","$52.10 ","$0.00 ","$50.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.88 ","$0.00 ","$23.94 ","$50.56 ","$38.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9616","ERX","HCPCS 63700001","65862-0225-60","CLARITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$17.18 ","$12.71 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.18 ","$0.00 ","$8.59 ","$13.61 ","$13.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9617","ERX","HCPCS 63700001","00527-1932-06","CLARITHROMYCIN 500 MG PO TABS","BOTH IP/OP","$25.21 ","$18.66 ","$0.00 ","$22.86 ","","$4.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.86 ","$0.00 ","$11.43 ","$18.11 ","$18.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9617","ERX","HCPCS 63700001","00781-1962-60","CLARITHROMYCIN 500 MG PO TABS","BOTH IP/OP","$25.21 ","$18.66 ","$0.00 ","$22.86 ","","$4.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.86 ","$0.00 ","$11.43 ","$18.11 ","$18.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9617","ERX","HCPCS 63700001","57237-0045-60","CLARITHROMYCIN 500 MG PO TABS","BOTH IP/OP","$25.21 ","$18.66 ","$0.00 ","$22.86 ","","$4.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.86 ","$0.00 ","$11.43 ","$18.11 ","$18.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9617","ERX","HCPCS 63700001","65862-0226-60","CLARITHROMYCIN 500 MG PO TABS","BOTH IP/OP","$25.21 ","$18.66 ","$0.00 ","$22.86 ","","$4.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.86 ","$0.00 ","$11.43 ","$18.11 ","$18.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9623","ERX","HCPCS 25000001","00168-0202-30","CLINDAMYCIN PHOSPHATE 1 % EX GEL","BOTH IP/OP","$348.27 ","$257.72 ","$0.00 ","$316.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.14 ","$0.00 ","$158.07 ","$250.38 ","$252.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9623","ERX","HCPCS 25000001","59762-3743-01","CLINDAMYCIN PHOSPHATE 1 % EX GEL","BOTH IP/OP","$348.27 ","$257.72 ","$0.00 ","$316.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.14 ","$0.00 ","$158.07 ","$250.38 ","$252.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9624","ERX","HCPCS 25000001","00009-3448-01","CLINDAMYCIN PHOSPHATE 2 % VA CREA","BOTH IP/OP","$437.88 ","$324.03 ","$0.00 ","$397.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$397.48 ","$0.00 ","$198.74 ","$314.80 ","$317.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9624","ERX","HCPCS 25000001","00168-0277-40","CLINDAMYCIN PHOSPHATE 2 % VA CREA","BOTH IP/OP","$437.88 ","$324.03 ","$0.00 ","$397.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$397.48 ","$0.00 ","$198.74 ","$314.80 ","$317.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9624","ERX","HCPCS 25000001","59762-5009-01","CLINDAMYCIN PHOSPHATE 2 % VA CREA","BOTH IP/OP","$437.88 ","$324.03 ","$0.00 ","$397.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$397.48 ","$0.00 ","$198.74 ","$314.80 ","$317.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9626","ERX","HCPCS S0077","00781-3289-09","CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","BOTH IP/OP","$62.23 ","$46.05 ","$0.00 ","$56.43 ","$28.00 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$56.43 ","$0.00 ","$28.22 ","$44.69 ","$45.14 ","$33.86 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"9626","ERX","HCPCS S0077","00781-9221-09","CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","BOTH IP/OP","$62.23 ","$46.05 ","$0.00 ","$56.43 ","$28.00 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$56.43 ","$0.00 ","$28.22 ","$44.69 ","$45.14 ","$33.86 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"9626","ERX","HCPCS S0077","00781-9221-91","CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","BOTH IP/OP","$62.23 ","$46.05 ","$0.00 ","$56.43 ","$28.00 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$56.43 ","$0.00 ","$28.22 ","$44.69 ","$45.14 ","$33.86 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"9627","ERX","HCPCS S0077","00781-3290-09","CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","BOTH IP/OP","$75.84 ","$56.12 ","$0.00 ","$68.78 ","$34.13 ","$4.06 ","$10.61 ","$0.00 ","$0.00 ","$4.94 ","$68.78 ","$0.00 ","$34.39 ","$54.47 ","$55.02 ","$41.27 ","$4.94 ","$0.00 ","$4.70 ","$0.00 "
"9627","ERX","HCPCS S0077","00781-9222-09","CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","BOTH IP/OP","$75.84 ","$56.12 ","$0.00 ","$68.78 ","$34.13 ","$4.06 ","$10.61 ","$0.00 ","$0.00 ","$4.94 ","$68.78 ","$0.00 ","$34.39 ","$54.47 ","$55.02 ","$41.27 ","$4.94 ","$0.00 ","$4.70 ","$0.00 "
"9627","ERX","HCPCS S0077","00781-9222-91","CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","BOTH IP/OP","$75.84 ","$56.12 ","$0.00 ","$68.78 ","$34.13 ","$4.06 ","$10.61 ","$0.00 ","$0.00 ","$4.94 ","$68.78 ","$0.00 ","$34.39 ","$54.47 ","$55.02 ","$41.27 ","$4.94 ","$0.00 ","$4.70 ","$0.00 "
"9630","ERX","HCPCS 25000001","00168-0163-15","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$391.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$309.77 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","00472-0400-15","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$391.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$309.77 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","50383-0267-15","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$391.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$309.77 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","51672-1258-01","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$391.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$309.77 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","52565-0051-15","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$391.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$309.77 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","00472-0400-30","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$538.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$538.28 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","10337-0163-30","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$538.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$538.28 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","00472-0400-60","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$975.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$975.00 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9630","ERX","HCPCS 25000001","52565-0051-60","CLOBETASOL PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$430.87 ","$318.84 ","$0.00 ","$975.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.12 ","$0.00 ","$195.56 ","$975.00 ","$312.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","00168-0162-15","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$474.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$375.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","10337-0162-15","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$474.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$375.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","43386-0096-60","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$474.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$375.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","50383-0268-15","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$474.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$375.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","51672-1259-01","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$474.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$375.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","52565-0039-15","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$474.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$375.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","51672-1259-02","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$652.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$652.50 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9631","ERX","HCPCS 25000001","00168-0162-46","CLOBETASOL PROPIONATE 0.05 % EX OINT","BOTH IP/OP","$522.30 ","$386.50 ","$0.00 ","$978.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.11 ","$0.00 ","$237.06 ","$978.75 ","$379.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","00472-0402-25","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$314.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$249.17 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","50383-0266-25","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$314.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$249.17 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","51672-1293-02","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$314.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$249.17 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","60432-0133-25","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$314.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$249.17 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","00168-0269-50","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$432.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$432.99 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","51672-1293-03","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$432.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$432.99 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9632","ERX","HCPCS 25000001","60432-0133-50","CLOBETASOL PROPIONATE 0.05 % EX SOLN","BOTH IP/OP","$346.59 ","$256.48 ","$0.00 ","$432.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.61 ","$0.00 ","$157.31 ","$432.99 ","$251.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9635","ERX","HCPCS 63700001","00378-3025-01","CLOMIPRAMINE HCL 25 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9635","ERX","HCPCS 63700001","00781-2027-01","CLOMIPRAMINE HCL 25 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9635","ERX","HCPCS 63700001","51672-4011-05","CLOMIPRAMINE HCL 25 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9636","ERX","HCPCS 63700001","00406-9908-03","CLOMIPRAMINE HCL 75 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9636","ERX","HCPCS 63700001","51672-4013-05","CLOMIPRAMINE HCL 75 MG PO CAPS","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9637","ERX","HCPCS 25000001","00093-0832-01","CLONAZEPAM 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9637","ERX","HCPCS 25000001","00228-3003-11","CLONAZEPAM 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9637","ERX","HCPCS 25000001","16714-0752-01","CLONAZEPAM 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9637","ERX","HCPCS 25000001","16729-0136-00","CLONAZEPAM 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9637","ERX","HCPCS 25000001","63739-0263-10","CLONAZEPAM 0.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9638","ERX","HCPCS 25000001","00093-3212-01","CLONAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9638","ERX","HCPCS 25000001","00228-3004-11","CLONAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9638","ERX","HCPCS 25000001","16714-0750-01","CLONAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9638","ERX","HCPCS 25000001","16729-0137-00","CLONAZEPAM 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9644","ERX","HCPCS 63700001","00054-4146-22","CLOTRIMAZOLE 10 MG MT TROC","BOTH IP/OP","$13.48 ","$9.98 ","$0.00 ","$12.22 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.22 ","$0.00 ","$6.11 ","$9.68 ","$9.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9644","ERX","HCPCS 63700001","00574-0107-77","CLOTRIMAZOLE 10 MG MT TROC","BOTH IP/OP","$13.48 ","$9.98 ","$0.00 ","$12.22 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.22 ","$0.00 ","$6.11 ","$9.68 ","$9.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9647","ERX","HCPCS 63700001","00093-7772-93","CLOZAPINE 100 MG PO TABS","BOTH IP/OP","$14.33 ","$10.60 ","$0.00 ","$13.00 ","","$2.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9647","ERX","HCPCS 63700001","00378-0860-01","CLOZAPINE 100 MG PO TABS","BOTH IP/OP","$14.33 ","$10.60 ","$0.00 ","$13.00 ","","$2.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9647","ERX","HCPCS 63700001","51079-0922-20","CLOZAPINE 100 MG PO TABS","BOTH IP/OP","$14.33 ","$10.60 ","$0.00 ","$13.00 ","","$2.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9648","ERX","HCPCS 63700001","00093-4359-93","CLOZAPINE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9648","ERX","HCPCS 63700001","00378-0825-01","CLOZAPINE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9648","ERX","HCPCS 63700001","51079-0921-20","CLOZAPINE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9682","ERX","HCPCS 25000001","50484-0010-30","COLLAGENASE 250 UNIT/GM EX OINT","BOTH IP/OP","$960.98 ","$711.13 ","$0.00 ","$791.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$791.19 ","$0.00 ","$395.60 ","$626.62 ","$632.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9686","ERX","HCPCS J0834","00548-5900-00","COSYNTROPIN 0.25 MG IJ SOLR","BOTH IP/OP","$355.52 ","$263.08 ","$0.00 ","$322.72 ","$159.98 ","$0.00 ","$74.10 ","$0.00 ","$0.00 ","$44.56 ","$322.72 ","$0.00 ","$161.36 ","$255.59 ","$258.18 ","$0.00 ","$44.56 ","$0.00 ","$42.42 ","$0.00 "
"9686","ERX","HCPCS J0834","67457-0227-02","COSYNTROPIN 0.25 MG IJ SOLR","BOTH IP/OP","$355.52 ","$263.08 ","$0.00 ","$322.72 ","$159.98 ","$0.00 ","$74.10 ","$0.00 ","$0.00 ","$44.56 ","$322.72 ","$0.00 ","$161.36 ","$255.59 ","$258.18 ","$0.00 ","$44.56 ","$0.00 ","$42.42 ","$0.00 "
"9690","ERX","HCPCS J7631","00172-6406-49","CROMOLYN SODIUM 20 MG/2ML IN NEBU","BOTH IP/OP","$28.49 ","$21.08 ","$0.00 ","$25.84 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.84 ","$0.00 ","$12.92 ","$20.47 ","$20.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9691","ERX","HCPCS 25000001","17478-0291-11","CROMOLYN SODIUM 4 % OP SOLN","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$130.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.20 ","$0.00 ","$65.10 ","$103.12 ","$104.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9691","ERX","HCPCS 25000001","61314-0237-10","CROMOLYN SODIUM 4 % OP SOLN","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$130.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.20 ","$0.00 ","$65.10 ","$103.12 ","$104.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9699","ERX","HCPCS 25000001","00065-0395-15","CYCLOPENTOLATE HCL 0.5 % OP SOLN","BOTH IP/OP","$327.92 ","$242.66 ","$0.00 ","$297.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.68 ","$0.00 ","$148.84 ","$235.76 ","$238.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9699","ERX","HCPCS 25000001","17478-0096-15","CYCLOPENTOLATE HCL 0.5 % OP SOLN","BOTH IP/OP","$327.92 ","$242.66 ","$0.00 ","$297.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.68 ","$0.00 ","$148.84 ","$235.76 ","$238.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9700","ERX","HCPCS 25000001","00065-0397-02","CYCLOPENTOLATE HCL 2 % OP SOLN","BOTH IP/OP","$167.07 ","$123.63 ","$0.00 ","$151.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9700","ERX","HCPCS 25000001","17478-0097-02","CYCLOPENTOLATE HCL 2 % OP SOLN","BOTH IP/OP","$167.07 ","$123.63 ","$0.00 ","$151.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9700","ERX","HCPCS 25000001","17478-0097-10","CYCLOPENTOLATE HCL 2 % OP SOLN","BOTH IP/OP","$167.07 ","$123.63 ","$0.00 ","$151.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.48 ","$0.00 ","$75.74 ","$135.27 ","$121.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9701","ERX","HCPCS 25000001","00065-0359-02","CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN","BOTH IP/OP","$210.67 ","$155.90 ","$0.00 ","$120.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.96 ","$0.00 ","$60.48 ","$95.80 ","$96.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9701","ERX","HCPCS 25000001","00065-0359-05","CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN","BOTH IP/OP","$210.67 ","$155.90 ","$0.00 ","$151.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.96 ","$0.00 ","$60.48 ","$151.46 ","$96.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9704","ERX","HCPCS 63700001","13845-1202-02","CYCLOSERINE 250 MG PO CAPS","BOTH IP/OP","$290.10 ","$214.67 ","$0.00 ","$263.34 ","","$51.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$263.34 ","$0.00 ","$131.67 ","$208.57 ","$210.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9705","ERX","HCPCS j7516","00078-0109-01","CYCLOSPORINE 50 MG/ML IV SOLN","BOTH IP/OP","$181.14 ","$134.04 ","$0.00 ","$164.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.24 ","$0.00 ","$82.12 ","$130.08 ","$131.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9705","ERX","HCPCS j7516","00574-0866-10","CYCLOSPORINE 50 MG/ML IV SOLN","BOTH IP/OP","$181.14 ","$134.04 ","$0.00 ","$164.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.24 ","$0.00 ","$82.12 ","$130.08 ","$131.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9706","ERX","HCPCS J7502","00078-0241-15","CYCLOSPORINE 100 MG PO CAPS","BOTH IP/OP","$58.54 ","$43.32 ","$0.00 ","$53.09 ","$26.34 ","$0.00 ","$12.20 ","$0.00 ","$0.00 ","$9.30 ","$53.09 ","$0.00 ","$26.55 ","$42.05 ","$42.47 ","$0.00 ","$8.31 ","$0.00 ","$8.45 ","$0.00 "
"9706","ERX","HCPCS J7502","00078-0241-61","CYCLOSPORINE 100 MG PO CAPS","BOTH IP/OP","$58.54 ","$43.32 ","$0.00 ","$53.09 ","$26.34 ","$0.00 ","$12.20 ","$0.00 ","$0.00 ","$9.30 ","$53.09 ","$0.00 ","$26.55 ","$42.05 ","$42.47 ","$0.00 ","$8.31 ","$0.00 ","$8.45 ","$0.00 "
"9706","ERX","HCPCS J7502","60505-0134-00","CYCLOSPORINE 100 MG PO CAPS","BOTH IP/OP","$58.54 ","$43.32 ","$0.00 ","$53.09 ","$26.34 ","$0.00 ","$12.20 ","$0.00 ","$0.00 ","$9.30 ","$53.09 ","$0.00 ","$26.55 ","$42.05 ","$42.47 ","$0.00 ","$8.31 ","$0.00 ","$8.45 ","$0.00 "
"9707","ERX","HCPCS J7515","00078-0240-15","CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9707","ERX","HCPCS J7515","00078-0240-61","CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9707","ERX","HCPCS J7515","60505-0133-00","CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9708","ERX","HCPCS J7502","00078-0110-22","CYCLOSPORINE 100 MG/ML PO SOLN","BOTH IP/OP","$2,330.49 ","$1,724.56 ","$0.00 ","$2,159.52 ","$1,048.72 ","$0.00 ","$485.73 ","$0.00 ","$0.00 ","$378.11 ","$2,159.52 ","$0.00 ","$1,079.76 ","$1,710.34 ","$1,727.62 ","$0.00 ","$337.96 ","$0.00 ","$343.80 ","$0.00 "
"9715","ERX","HCPCS 63700001","00555-0633-02","DANAZOL 50 MG PO CAPS","BOTH IP/OP","$15.20 ","$11.25 ","$0.00 ","$13.79 ","","$2.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.79 ","$0.00 ","$6.90 ","$10.92 ","$11.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9716","ERX","HCPCS 25000001","00143-9297-01","DANTROLENE SODIUM 20 MG IV SOLR","BOTH IP/OP","$295.27 ","$218.50 ","$0.00 ","$268.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.04 ","$0.00 ","$134.02 ","$212.29 ","$214.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9716","ERX","HCPCS 25000001","27505-0003-67","DANTROLENE SODIUM 20 MG IV SOLR","BOTH IP/OP","$295.27 ","$218.50 ","$0.00 ","$268.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.04 ","$0.00 ","$134.02 ","$212.29 ","$214.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9716","ERX","HCPCS 25000001","42023-0123-06","DANTROLENE SODIUM 20 MG IV SOLR","BOTH IP/OP","$295.27 ","$218.50 ","$0.00 ","$268.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.04 ","$0.00 ","$134.02 ","$212.29 ","$214.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9717","ERX","HCPCS 63700001","00115-4433-01","DANTROLENE SODIUM 100 MG PO CAPS","BOTH IP/OP","$9.09 ","$6.73 ","$0.00 ","$8.24 ","","$1.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.24 ","$0.00 ","$4.12 ","$6.53 ","$6.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9718","ERX","HCPCS 63700001","00115-4411-01","DANTROLENE SODIUM 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9718","ERX","HCPCS 63700001","68084-0300-21","DANTROLENE SODIUM 25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9719","ERX","HCPCS 63700001","00115-4422-01","DANTROLENE SODIUM 50 MG PO CAPS","BOTH IP/OP","$7.25 ","$5.37 ","$0.00 ","$6.58 ","","$1.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9719","ERX","HCPCS 63700001","42023-0125-01","DANTROLENE SODIUM 50 MG PO CAPS","BOTH IP/OP","$7.25 ","$5.37 ","$0.00 ","$6.58 ","","$1.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.58 ","$0.00 ","$3.29 ","$5.21 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9722","ERX","HCPCS J0895","00409-2337-25","DEFEROXAMINE MESYLATE 2 G IJ SOLR","BOTH IP/OP","$148.48 ","$109.88 ","$0.00 ","$132.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.64 ","$0.00 ","$66.32 ","$105.05 ","$106.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9722","ERX","HCPCS J0895","63323-0599-30","DEFEROXAMINE MESYLATE 2 G IJ SOLR","BOTH IP/OP","$148.48 ","$109.88 ","$0.00 ","$132.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.64 ","$0.00 ","$66.32 ","$105.05 ","$106.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9723","ERX","HCPCS J0895","00078-0467-61","DEFEROXAMINE MESYLATE 500 MG IJ SOLR","BOTH IP/OP","$42.92 ","$31.76 ","$0.00 ","$42.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.92 ","$0.00 ","$21.46 ","$33.99 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9723","ERX","HCPCS J0895","00409-2336-10","DEFEROXAMINE MESYLATE 500 MG IJ SOLR","BOTH IP/OP","$42.92 ","$31.76 ","$0.00 ","$42.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.92 ","$0.00 ","$21.46 ","$33.99 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9723","ERX","HCPCS J0895","63323-0597-10","DEFEROXAMINE MESYLATE 500 MG IJ SOLR","BOTH IP/OP","$42.92 ","$31.76 ","$0.00 ","$42.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.92 ","$0.00 ","$21.46 ","$33.99 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9726","ERX","HCPCS 63700001","62584-0159-01","DEMECLOCYCLINE HCL 150 MG PO TABS","BOTH IP/OP","$44.55 ","$32.97 ","$0.00 ","$40.41 ","","$7.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.41 ","$0.00 ","$20.21 ","$32.00 ","$32.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9726","ERX","HCPCS 63700001","65162-0554-10","DEMECLOCYCLINE HCL 150 MG PO TABS","BOTH IP/OP","$44.55 ","$32.97 ","$0.00 ","$40.41 ","","$7.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.41 ","$0.00 ","$20.21 ","$32.00 ","$32.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9727","ERX","HCPCS 63700001","42806-0144-48","DEMECLOCYCLINE HCL 300 MG PO TABS","BOTH IP/OP","$131.77 ","$97.51 ","$0.00 ","$119.48 ","","$23.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$119.48 ","$0.00 ","$59.74 ","$94.63 ","$95.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9727","ERX","HCPCS 63700001","65162-0555-48","DEMECLOCYCLINE HCL 300 MG PO TABS","BOTH IP/OP","$131.77 ","$97.51 ","$0.00 ","$119.48 ","","$23.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$119.48 ","$0.00 ","$59.74 ","$94.63 ","$95.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","00703-5054-01","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","43598-0931-09","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","55566-2200-00","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","55566-2300-00","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","62756-0529-40","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","69918-0899-10","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9748","ERX","HCPCS J2597","69918-0901-10","DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","BOTH IP/OP","$66.00 ","$48.84 ","$0.00 ","$85.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9759","ERX","HCPCS 25000001","00409-7418-03","DEXTRAN 40 IN D5W 10 % IV SOLN","BOTH IP/OP","$135.10 ","$99.97 ","$0.00 ","$112.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.00 ","$0.00 ","$56.00 ","$88.70 ","$89.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9788","ERX","HCPCS J7120","00264-7751-10","DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"9788","ERX","HCPCS J7120","00338-0125-03","DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"9788","ERX","HCPCS J7120","00264-7751-00","DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"9788","ERX","HCPCS J7120","00338-0125-04","DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$1.13 ","$0.00 ","$0.00 ","$2.77 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$2.77 ","$0.00 ","$2.64 ","$0.00 "
"9823","ERX","HCPCS Q9958","00270-1410-30","DIATRIZOATE MEGLUMINE 18 % UR SOLN","BOTH IP/OP","$149.39 ","$110.55 ","$0.00 ","$135.45 ","$67.23 ","$0.00 ","$31.14 ","$0.00 ","$0.00 ","$0.00 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9828","ERX","HCPCS Q9963","00270-0445-40","DIATRIZOATE MEGLUMINE & SODIUM 66-10 % (37% IODINE) SOLN","BOTH IP/OP","$290.24 ","$214.78 ","$0.00 ","$263.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.97 ","$263.47 ","$0.00 ","$131.74 ","$208.67 ","$210.78 ","$0.00 ","$22.82 ","$0.00 ","$41.94 ","$0.00 "
"9859","ERX","HCPCS J1110","00574-0850-05","DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$273.48 ","$202.38 ","$0.00 ","$248.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$248.26 ","$0.00 ","$124.13 ","$196.62 ","$198.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9859","ERX","HCPCS J1110","00574-0850-10","DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN","BOTH IP/OP","$273.48 ","$202.38 ","$0.00 ","$248.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$248.26 ","$0.00 ","$124.13 ","$196.62 ","$198.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9872","ERX","HCPCS J0470","17478-0526-03","DIMERCAPROL 100 MG/ML IM SOLN","BOTH IP/OP","$646.90 ","$478.71 ","$0.00 ","$587.22 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$587.22 ","$0.00 ","$293.61 ","$465.08 ","$469.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9875","ERX","HCPCS 25000001","00009-0827-03","DINOPROSTONE 20 MG VA SUPP","BOTH IP/OP","$5,432.10 ","$4,019.75 ","$0.00 ","$5,432.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,432.10 ","$0.00 ","$2,716.05 ","$4,302.22 ","$4,345.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9891","ERX","HCPCS J1245","00641-2569-41","DIPYRIDAMOLE 5 MG/ML IV SOLN","BOTH IP/OP","$91.72 ","$67.87 ","$0.00 ","$83.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.16 ","$0.00 ","$41.58 ","$65.86 ","$66.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9891","ERX","HCPCS J1245","00641-2569-44","DIPYRIDAMOLE 5 MG/ML IV SOLN","BOTH IP/OP","$91.72 ","$67.87 ","$0.00 ","$83.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.16 ","$0.00 ","$41.58 ","$65.86 ","$66.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9894","ERX","HCPCS 63700001","00904-5522-61","DOXAZOSIN MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9894","ERX","HCPCS 63700001","16729-0211-01","DOXAZOSIN MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9894","ERX","HCPCS 63700001","68084-0836-25","DOXAZOSIN MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9894","ERX","HCPCS 63700001","68084-0836-95","DOXAZOSIN MESYLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9895","ERX","HCPCS 63700001","00378-4022-01","DOXAZOSIN MESYLATE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9895","ERX","HCPCS 63700001","51079-0958-01","DOXAZOSIN MESYLATE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9895","ERX","HCPCS 63700001","51079-0958-20","DOXAZOSIN MESYLATE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9896","ERX","HCPCS 63700001","00904-5524-61","DOXAZOSIN MESYLATE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9896","ERX","HCPCS 63700001","16729-0213-01","DOXAZOSIN MESYLATE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9897","ERX","HCPCS 63700001","16729-0415-01","DOXAZOSIN MESYLATE 8 MG PO TABS","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9897","ERX","HCPCS 63700001","68382-0786-01","DOXAZOSIN MESYLATE 8 MG PO TABS","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9900","ERX","HCPCS 63700001","49884-0727-03","DOXYCYCLINE MONOHYDRATE 100 MG PO CAPS","BOTH IP/OP","$9.93 ","$7.35 ","$0.00 ","$9.01 ","","$1.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.01 ","$0.00 ","$4.51 ","$7.14 ","$7.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9900","ERX","HCPCS 63700001","63304-0616-50","DOXYCYCLINE MONOHYDRATE 100 MG PO CAPS","BOTH IP/OP","$9.93 ","$7.35 ","$0.00 ","$9.01 ","","$1.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.01 ","$0.00 ","$4.51 ","$7.14 ","$7.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9902","ERX","HCPCS 25000001","69097-0228-43","DOXYCYCLINE MONOHYDRATE 25 MG/5ML PO SUSR","BOTH IP/OP","$92.82 ","$68.69 ","$0.00 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.82 ","$0.00 ","$46.41 ","$73.51 ","$74.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9904","ERX","HCPCS Q0167","00527-1450-06","DRONABINOL 2.5 MG PO CAPS","BOTH IP/OP","$22.40 ","$16.58 ","$0.00 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.40 ","$0.00 ","$11.20 ","$17.74 ","$17.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9904","ERX","HCPCS Q0167","17478-0761-06","DRONABINOL 2.5 MG PO CAPS","BOTH IP/OP","$22.40 ","$16.58 ","$0.00 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.40 ","$0.00 ","$11.20 ","$17.74 ","$17.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9904","ERX","HCPCS Q0167","42858-0867-06","DRONABINOL 2.5 MG PO CAPS","BOTH IP/OP","$22.40 ","$16.58 ","$0.00 ","$22.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.40 ","$0.00 ","$11.20 ","$17.74 ","$17.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9914","ERX","HCPCS 25000001","00046-1065-05","ECHOTHIOPHATE IODIDE 0.125 % OP SOLR","BOTH IP/OP","$324.52 ","$240.14 ","$0.00 ","$324.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$324.52 ","$0.00 ","$162.26 ","$257.02 ","$259.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9915","ERX","HCPCS 63700001","45802-0466-35","ECONAZOLE NITRATE 1 % EX CREA","BOTH IP/OP","$365.40 ","$270.40 ","$0.00 ","$331.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.69 ","$0.00 ","$165.85 ","$262.70 ","$265.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9915","ERX","HCPCS 63700001","52565-0022-15","ECONAZOLE NITRATE 1 % EX CREA","BOTH IP/OP","$365.40 ","$270.40 ","$0.00 ","$331.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.69 ","$0.00 ","$165.85 ","$262.70 ","$265.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9927","ERX","HCPCS 63700001","16714-0443-01","ENALAPRIL MALEATE 5 MG PO TABS","BOTH IP/OP","$6.36 ","$4.71 ","$0.00 ","$6.00 ","","$1.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9927","ERX","HCPCS 63700001","64679-0924-02","ENALAPRIL MALEATE 5 MG PO TABS","BOTH IP/OP","$6.36 ","$4.71 ","$0.00 ","$6.00 ","","$1.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9929","ERX","HCPCS 25000001","00143-9786-01","ENALAPRILAT 1.25 MG/ML IV INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9929","ERX","HCPCS 25000001","00143-9786-10","ENALAPRILAT 1.25 MG/ML IV INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9929","ERX","HCPCS 25000001","00409-2122-02","ENALAPRILAT 1.25 MG/ML IV INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9938","ERX","HCPCS J0885","59676-0310-00","EPOETIN ALFA 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$936.41 ","$692.94 ","$0.00 ","$849.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.80 ","$849.83 ","$0.00 ","$424.92 ","$673.07 ","$679.86 ","$0.00 ","$133.00 ","$0.00 ","$118.59 ","$0.00 "
"9938","ERX","HCPCS J0885","59676-0310-01","EPOETIN ALFA 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$936.41 ","$692.94 ","$0.00 ","$849.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.80 ","$849.83 ","$0.00 ","$424.92 ","$673.07 ","$679.86 ","$0.00 ","$133.00 ","$0.00 ","$118.59 ","$0.00 "
"9938","ERX","HCPCS J0885","59676-0310-02","EPOETIN ALFA 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$936.41 ","$692.94 ","$0.00 ","$849.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.80 ","$849.83 ","$0.00 ","$424.92 ","$673.07 ","$679.86 ","$0.00 ","$133.00 ","$0.00 ","$118.59 ","$0.00 "
"9939","ERX","HCPCS J0885","55513-0126-01","EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN","BOTH IP/OP","$153.59 ","$113.66 ","$0.00 ","$139.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.39 ","$139.27 ","$0.00 ","$69.64 ","$110.30 ","$111.42 ","$0.00 ","$21.80 ","$0.00 ","$23.72 ","$0.00 "
"9939","ERX","HCPCS J0885","55513-0126-10","EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN","BOTH IP/OP","$153.59 ","$113.66 ","$0.00 ","$139.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.39 ","$139.27 ","$0.00 ","$69.64 ","$110.30 ","$111.42 ","$0.00 ","$21.80 ","$0.00 ","$23.72 ","$0.00 "
"9941","ERX","HCPCS J0885","55513-0148-10","EPOETIN ALFA (EPOGEN) 4000 UNIT/ML IJ SOLN","BOTH IP/OP","$153.60 ","$113.66 ","$0.00 ","$139.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.39 ","$139.28 ","$0.00 ","$69.64 ","$110.31 ","$111.42 ","$0.00 ","$21.80 ","$0.00 ","$23.72 ","$0.00 "
"9949","ERX","HCPCS 63700001","00781-5405-01","ERGOTAMINE-CAFFEINE 1-100 MG PO TABS","BOTH IP/OP","$64.69 ","$47.87 ","$0.00 ","$58.67 ","","$11.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.67 ","$0.00 ","$29.34 ","$46.47 ","$46.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9963","ERX","HCPCS 63700001","61570-0072-01","ESTERIFIED ESTROGENS 0.3 MG PO TABS","BOTH IP/OP","$9.24 ","$6.84 ","$0.00 ","$8.01 ","","$1.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.01 ","$0.00 ","$4.01 ","$6.34 ","$6.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9964","ERX","HCPCS 63700001","61570-0073-01","ESTERIFIED ESTROGENS 0.625 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.38 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.38 ","$0.00 ","$5.69 ","$9.01 ","$9.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9965","ERX","HCPCS 63700001","61570-0074-01","ESTERIFIED ESTROGENS 1.25 MG PO TABS","BOTH IP/OP","$18.30 ","$13.54 ","$0.00 ","$15.88 ","","$3.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.88 ","$0.00 ","$7.94 ","$12.58 ","$12.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9967","ERX","HCPCS 63700001","00378-1454-01","ESTRADIOL 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9967","ERX","HCPCS 63700001","00555-0886-02","ESTRADIOL 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9968","ERX","HCPCS 63700001","00378-1458-01","ESTRADIOL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9968","ERX","HCPCS 63700001","00555-0887-02","ESTRADIOL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9968","ERX","HCPCS 63700001","00555-0887-04","ESTRADIOL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9969","ERX","HCPCS 25000001","00430-3754-14","ESTRADIOL 0.1 MG/GM VA CREA","BOTH IP/OP","$81.58 ","$60.37 ","$0.00 ","$73.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.99 ","$0.00 ","$37.00 ","$58.60 ","$59.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9971","ERX","HCPCS 63700001","00013-0132-02","ESTRAMUSTINE PHOSPHATE SODIUM 140 MG PO CAPS","BOTH IP/OP","$77.63 ","$57.45 ","$0.00 ","$73.12 ","","$13.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.12 ","$0.00 ","$36.56 ","$57.91 ","$58.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9972","ERX","HCPCS J1410","00046-0749-05","ESTROGENS CONJUGATED 25 MG IJ SOLR","BOTH IP/OP","$1,192.45 ","$882.41 ","$0.00 ","$991.03 ","$536.60 ","$341.50 ","$92.23 ","$0.00 ","$0.00 ","$0.00 ","$991.03 ","$0.00 ","$495.52 ","$784.90 ","$792.82 ","$0.00 ","$362.72 ","$0.00 ","$0.00 ","$0.00 "
"9973","ERX","HCPCS 63700001","00046-1100-81","ESTROGENS CONJUGATED 0.3 MG PO TABS","BOTH IP/OP","$32.11 ","$23.76 ","$0.00 ","$26.93 ","","$5.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.93 ","$0.00 ","$13.47 ","$21.33 ","$21.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9974","ERX","HCPCS 63700001","00046-1102-81","ESTROGENS CONJUGATED 0.625 MG PO TABS","BOTH IP/OP","$32.11 ","$23.76 ","$0.00 ","$26.93 ","","$5.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.93 ","$0.00 ","$13.47 ","$21.33 ","$21.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9977","ERX","HCPCS 63700001","00046-0872-21","ESTROGENS, CONJUGATED 0.625 MG/GM VA CREA","BOTH IP/OP","$1,458.11 ","$1,079.00 ","$0.00 ","$1,247.36 ","","$259.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.36 ","$0.00 ","$623.68 ","$987.91 ","$997.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9979","ERX","HCPCS 25000001","25010-0210-27","ETHACRYNATE SODIUM 50 MG IV SOLR","BOTH IP/OP","$13,599.76 ","$10,063.82 ","$0.00 ","$12,336.06 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,336.06 ","$0.00 ","$6,168.03 ","$9,770.16 ","$9,868.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9980","ERX","HCPCS 63700001","25010-0215-15","ETHACRYNIC ACID 25 MG PO TABS","BOTH IP/OP","$113.23 ","$83.79 ","$0.00 ","$102.67 ","","$20.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$102.67 ","$0.00 ","$51.34 ","$81.31 ","$82.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9982","ERX","HCPCS 63700001","54879-0001-01","ETHAMBUTOL HCL 100 MG PO TABS","BOTH IP/OP","$17.52 ","$12.96 ","$0.00 ","$17.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$0.00 ","$8.76 ","$13.88 ","$14.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9982","ERX","HCPCS 63700001","68180-0280-01","ETHAMBUTOL HCL 100 MG PO TABS","BOTH IP/OP","$17.52 ","$12.96 ","$0.00 ","$17.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.52 ","$0.00 ","$8.76 ","$13.88 ","$14.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9983","ERX","HCPCS 63700001","54879-0002-01","ETHAMBUTOL HCL 400 MG PO TABS","BOTH IP/OP","$11.27 ","$8.34 ","$0.00 ","$11.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.27 ","$0.00 ","$5.64 ","$8.93 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9983","ERX","HCPCS 63700001","68850-0012-02","ETHAMBUTOL HCL 400 MG PO TABS","BOTH IP/OP","$11.27 ","$8.34 ","$0.00 ","$11.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.27 ","$0.00 ","$5.64 ","$8.93 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9988","ERX","HCPCS 25000001","00008-4117-01","ETHIONAMIDE 250 MG PO TABS","BOTH IP/OP","$28.19 ","$20.86 ","$0.00 ","$25.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.18 ","$0.00 ","$12.59 ","$19.94 ","$20.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9989","ERX","HCPCS 63700001","00071-0237-24","ETHOSUXIMIDE 250 MG PO CAPS","BOTH IP/OP","$19.44 ","$14.39 ","$0.00 ","$16.87 ","","$3.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.87 ","$0.00 ","$8.44 ","$13.36 ","$13.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9989","ERX","HCPCS 63700001","23155-0532-01","ETHOSUXIMIDE 250 MG PO CAPS","BOTH IP/OP","$19.44 ","$14.39 ","$0.00 ","$16.87 ","","$3.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.87 ","$0.00 ","$8.44 ","$13.36 ","$13.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9989","ERX","HCPCS 63700001","61748-0025-01","ETHOSUXIMIDE 250 MG PO CAPS","BOTH IP/OP","$19.44 ","$14.39 ","$0.00 ","$16.87 ","","$3.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.87 ","$0.00 ","$8.44 ","$13.36 ","$13.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10001","ERX","HCPCS J8560","00378-3266-94","ETOPOSIDE 50 MG PO CAPS","BOTH IP/OP","$337.48 ","$249.74 ","$0.00 ","$306.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.34 ","$0.00 ","$153.17 ","$242.62 ","$245.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10010","ERX","HCPCS 63700001","68180-0150-01","FAMOTIDINE 40 MG/5ML PO SUSR","BOTH IP/OP","$594.56 ","$439.97 ","$0.00 ","$539.70 ","","$105.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$539.70 ","$0.00 ","$269.85 ","$427.44 ","$431.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10011","ERX","HCPCS 63700001","00172-5728-60","FAMOTIDINE 20 MG PO TABS","BOTH IP/OP","$10.15 ","$7.51 ","$0.00 ","$9.21 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.21 ","$0.00 ","$4.61 ","$7.29 ","$7.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10011","ERX","HCPCS 63700001","42291-0281-10","FAMOTIDINE 20 MG PO TABS","BOTH IP/OP","$10.15 ","$7.51 ","$0.00 ","$9.21 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.21 ","$0.00 ","$4.61 ","$7.29 ","$7.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10011","ERX","HCPCS 63700001","62332-0001-31","FAMOTIDINE 20 MG PO TABS","BOTH IP/OP","$10.15 ","$7.51 ","$0.00 ","$9.21 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.21 ","$0.00 ","$4.61 ","$7.29 ","$7.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10014","ERX","HCPCS 25000001","00338-0519-09","FAT EMULSION PLANT BASED 20 % IV EMUL","BOTH IP/OP","$173.25 ","$128.21 ","$0.00 ","$173.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$0.00 ","$0.00 ","$78.15 ","$0.00 "
"10023","ERX","HCPCS 25000001","99999-6004-76","FELBAMATE 600 MG/5ML PO SUSP","BOTH IP/OP","$313.55 ","$232.03 ","$0.00 ","$3,821.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,821.70 ","$0.00 ","$1,910.85 ","$225.43 ","$3,057.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10023","ERX","HCPCS 25000001","00037-0442-67","FELBAMATE 600 MG/5ML PO SUSP","BOTH IP/OP","$313.55 ","$232.03 ","$0.00 ","$3,821.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,821.70 ","$0.00 ","$1,910.85 ","$3,026.79 ","$3,057.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10025","ERX","HCPCS 63700001","00037-0431-01","FELBAMATE 600 MG PO TABS","BOTH IP/OP","$22.74 ","$16.83 ","$0.00 ","$22.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.74 ","$0.00 ","$11.37 ","$18.01 ","$18.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10025","ERX","HCPCS 63700001","51525-0431-01","FELBAMATE 600 MG PO TABS","BOTH IP/OP","$22.74 ","$16.83 ","$0.00 ","$22.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.74 ","$0.00 ","$11.37 ","$18.01 ","$18.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","00093-7355-56","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","00093-7355-98","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","16729-0090-01","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","50268-0323-15","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","57237-0062-30","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","65862-0149-90","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10037","ERX","HCPCS 63700001","76282-0412-90","FINASTERIDE 5 MG PO TABS","BOTH IP/OP","$13.12 ","$9.71 ","$0.00 ","$11.90 ","","$2.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.90 ","$0.00 ","$5.95 ","$9.42 ","$9.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10041","ERX","HCPCS 63700001","00054-0011-21","FLECAINIDE ACETATE 100 MG PO TABS","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$13.61 ","","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.61 ","$0.00 ","$6.81 ","$10.78 ","$10.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10041","ERX","HCPCS 63700001","00054-0011-25","FLECAINIDE ACETATE 100 MG PO TABS","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$13.61 ","","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.61 ","$0.00 ","$6.81 ","$10.78 ","$10.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10041","ERX","HCPCS 63700001","50268-0321-11","FLECAINIDE ACETATE 100 MG PO TABS","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$13.61 ","","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.61 ","$0.00 ","$6.81 ","$10.78 ","$10.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10041","ERX","HCPCS 63700001","50268-0321-15","FLECAINIDE ACETATE 100 MG PO TABS","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$13.61 ","","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.61 ","$0.00 ","$6.81 ","$10.78 ","$10.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10041","ERX","HCPCS 63700001","65162-0642-10","FLECAINIDE ACETATE 100 MG PO TABS","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$13.61 ","","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.61 ","$0.00 ","$6.81 ","$10.78 ","$10.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10042","ERX","HCPCS 63700001","00054-0012-21","FLECAINIDE ACETATE 150 MG PO TABS","BOTH IP/OP","$18.20 ","$13.47 ","$0.00 ","$16.51 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.51 ","$0.00 ","$8.26 ","$13.08 ","$13.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10042","ERX","HCPCS 63700001","00054-0012-25","FLECAINIDE ACETATE 150 MG PO TABS","BOTH IP/OP","$18.20 ","$13.47 ","$0.00 ","$16.51 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.51 ","$0.00 ","$8.26 ","$13.08 ","$13.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10042","ERX","HCPCS 63700001","53746-0643-01","FLECAINIDE ACETATE 150 MG PO TABS","BOTH IP/OP","$18.20 ","$13.47 ","$0.00 ","$16.51 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.51 ","$0.00 ","$8.26 ","$13.08 ","$13.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10042","ERX","HCPCS 63700001","65162-0643-10","FLECAINIDE ACETATE 150 MG PO TABS","BOTH IP/OP","$18.20 ","$13.47 ","$0.00 ","$16.51 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.51 ","$0.00 ","$8.26 ","$13.08 ","$13.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10043","ERX","HCPCS 63700001","00054-0010-20","FLECAINIDE ACETATE 50 MG PO TABS","BOTH IP/OP","$8.47 ","$6.27 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10043","ERX","HCPCS 63700001","00054-0010-21","FLECAINIDE ACETATE 50 MG PO TABS","BOTH IP/OP","$8.47 ","$6.27 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10043","ERX","HCPCS 63700001","00054-0010-25","FLECAINIDE ACETATE 50 MG PO TABS","BOTH IP/OP","$8.47 ","$6.27 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10043","ERX","HCPCS 63700001","65162-0641-10","FLECAINIDE ACETATE 50 MG PO TABS","BOTH IP/OP","$8.47 ","$6.27 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10044","ERX","HCPCS 63700001","00172-5411-46","FLUCONAZOLE 100 MG PO TABS","BOTH IP/OP","$33.46 ","$24.76 ","$0.00 ","$33.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.46 ","$0.00 ","$16.73 ","$26.50 ","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10044","ERX","HCPCS 63700001","16714-0691-01","FLUCONAZOLE 100 MG PO TABS","BOTH IP/OP","$33.46 ","$24.76 ","$0.00 ","$33.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.46 ","$0.00 ","$16.73 ","$26.50 ","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10044","ERX","HCPCS 63700001","16714-0691-02","FLUCONAZOLE 100 MG PO TABS","BOTH IP/OP","$33.46 ","$24.76 ","$0.00 ","$33.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.46 ","$0.00 ","$16.73 ","$26.50 ","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10044","ERX","HCPCS 63700001","55111-0144-01","FLUCONAZOLE 100 MG PO TABS","BOTH IP/OP","$33.46 ","$24.76 ","$0.00 ","$33.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.46 ","$0.00 ","$16.73 ","$26.50 ","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10044","ERX","HCPCS 63700001","55111-0144-30","FLUCONAZOLE 100 MG PO TABS","BOTH IP/OP","$33.46 ","$24.76 ","$0.00 ","$33.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.46 ","$0.00 ","$16.73 ","$26.50 ","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10044","ERX","HCPCS 63700001","68462-0102-30","FLUCONAZOLE 100 MG PO TABS","BOTH IP/OP","$33.46 ","$24.76 ","$0.00 ","$33.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.46 ","$0.00 ","$16.73 ","$26.50 ","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10045","ERX","HCPCS 63700001","00172-5413-46","FLUCONAZOLE 200 MG PO TABS","BOTH IP/OP","$68.49 ","$50.68 ","$0.00 ","$62.12 ","","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.12 ","$0.00 ","$31.06 ","$49.20 ","$49.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10045","ERX","HCPCS 63700001","00904-6501-61","FLUCONAZOLE 200 MG PO TABS","BOTH IP/OP","$68.49 ","$50.68 ","$0.00 ","$62.12 ","","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.12 ","$0.00 ","$31.06 ","$49.20 ","$49.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10045","ERX","HCPCS 63700001","16714-0693-01","FLUCONAZOLE 200 MG PO TABS","BOTH IP/OP","$68.49 ","$50.68 ","$0.00 ","$62.12 ","","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.12 ","$0.00 ","$31.06 ","$49.20 ","$49.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10045","ERX","HCPCS 63700001","68084-0735-01","FLUCONAZOLE 200 MG PO TABS","BOTH IP/OP","$68.49 ","$50.68 ","$0.00 ","$62.12 ","","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.12 ","$0.00 ","$31.06 ","$49.20 ","$49.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","00338-6046-48","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","00409-4688-18","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","25021-0113-82","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","25021-0184-66","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","25021-0184-82","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","70655-0002-06","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10049","ERX","HCPCS j1450","70655-0002-10","FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$41.04 ","$30.37 ","$0.00 ","$41.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","00338-6045-37","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","00409-4688-12","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","00409-4688-16","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","25021-0113-87","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","25021-0184-87","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","70655-0088-06","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10050","ERX","HCPCS J1450","70655-0088-10","FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","BOTH IP/OP","$63.84 ","$47.24 ","$0.00 ","$63.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.84 ","$0.00 ","$31.92 ","$50.56 ","$51.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10051","ERX","HCPCS 63700001","00054-0427-25","FLUCYTOSINE 250 MG PO CAPS","BOTH IP/OP","$144.75 ","$107.12 ","$0.00 ","$131.25 ","","$25.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.25 ","$0.00 ","$65.63 ","$103.95 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10051","ERX","HCPCS 63700001","42794-0009-08","FLUCYTOSINE 250 MG PO CAPS","BOTH IP/OP","$144.75 ","$107.12 ","$0.00 ","$131.25 ","","$25.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.25 ","$0.00 ","$65.63 ","$103.95 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10052","ERX","HCPCS 63700001","00054-0428-25","FLUCYTOSINE 500 MG PO CAPS","BOTH IP/OP","$245.80 ","$181.89 ","$0.00 ","$223.13 ","","$43.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.13 ","$0.00 ","$111.57 ","$176.72 ","$178.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10052","ERX","HCPCS 63700001","42494-0340-01","FLUCYTOSINE 500 MG PO CAPS","BOTH IP/OP","$245.80 ","$181.89 ","$0.00 ","$223.13 ","","$43.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.13 ","$0.00 ","$111.57 ","$176.72 ","$178.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10052","ERX","HCPCS 63700001","42794-0010-08","FLUCYTOSINE 500 MG PO CAPS","BOTH IP/OP","$245.80 ","$181.89 ","$0.00 ","$223.13 ","","$43.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.13 ","$0.00 ","$111.57 ","$176.72 ","$178.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10052","ERX","HCPCS 63700001","43386-0770-01","FLUCYTOSINE 500 MG PO CAPS","BOTH IP/OP","$245.80 ","$181.89 ","$0.00 ","$223.13 ","","$43.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.13 ","$0.00 ","$111.57 ","$176.72 ","$178.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10054","ERX","HCPCS 63700001","00115-7033-01","FLUDROCORTISONE ACETATE 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10054","ERX","HCPCS 63700001","00555-0997-02","FLUDROCORTISONE ACETATE 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10054","ERX","HCPCS 63700001","68084-0288-01","FLUDROCORTISONE ACETATE 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10054","ERX","HCPCS 63700001","68084-0288-11","FLUDROCORTISONE ACETATE 0.1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10061","ERX","HCPCS 25000001","59390-0218-05","FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN","BOTH IP/OP","$148.23 ","$109.69 ","$0.00 ","$134.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10063","ERX","HCPCS 25000001","00065-0096-05","FLUOROMETHOLONE ACETATE 0.1 % OP SUSP","BOTH IP/OP","$362.72 ","$268.41 ","$0.00 ","$329.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.25 ","$0.00 ","$164.63 ","$260.77 ","$263.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10065","ERX","HCPCS 25000001","66530-0249-40","FLUOROURACIL 5 % EX CREA","BOTH IP/OP","$751.61 ","$556.19 ","$0.00 ","$682.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.11 ","$0.00 ","$341.06 ","$540.23 ","$545.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10069","ERX","HCPCS 63700001","00904-5784-61","FLUOXETINE HCL 10 MG PO CAPS","BOTH IP/OP","$10.89 ","$8.06 ","$0.00 ","$9.88 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.88 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10069","ERX","HCPCS 63700001","65862-0192-01","FLUOXETINE HCL 10 MG PO CAPS","BOTH IP/OP","$10.89 ","$8.06 ","$0.00 ","$9.88 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.88 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10069","ERX","HCPCS 63700001","65862-0192-99","FLUOXETINE HCL 10 MG PO CAPS","BOTH IP/OP","$10.89 ","$8.06 ","$0.00 ","$9.88 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.88 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10070","ERX","HCPCS 63700001","00904-5785-61","FLUOXETINE HCL 20 MG PO CAPS","BOTH IP/OP","$10.41 ","$7.70 ","$0.00 ","$9.44 ","","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.44 ","$0.00 ","$4.72 ","$7.48 ","$7.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10070","ERX","HCPCS 63700001","68084-0605-01","FLUOXETINE HCL 20 MG PO CAPS","BOTH IP/OP","$10.41 ","$7.70 ","$0.00 ","$9.44 ","","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.44 ","$0.00 ","$4.72 ","$7.48 ","$7.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10072","ERX","HCPCS 63700001","00121-0654-02","FLUPHENAZINE HCL 2.5 MG/5ML PO ELIX","BOTH IP/OP","$110.01 ","$81.41 ","$0.00 ","$99.75 ","","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.75 ","$0.00 ","$49.88 ","$79.00 ","$79.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10078","ERX","HCPCS 63700001","00093-0711-01","FLURBIPROFEN 100 MG PO TABS","BOTH IP/OP","$7.94 ","$5.88 ","$0.00 ","$7.20 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.20 ","$0.00 ","$3.60 ","$5.70 ","$5.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10078","ERX","HCPCS 63700001","00378-0093-01","FLURBIPROFEN 100 MG PO TABS","BOTH IP/OP","$7.94 ","$5.88 ","$0.00 ","$7.20 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.20 ","$0.00 ","$3.60 ","$5.70 ","$5.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10082","ERX","HCPCS 25000001","45802-0222-11","FLUTICASONE PROPIONATE 0.05 % EX CREA","BOTH IP/OP","$132.36 ","$97.95 ","$0.00 ","$120.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.02 ","$0.00 ","$60.01 ","$95.06 ","$96.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10083","ERX","HCPCS 25000001","00713-0632-31","FLUTICASONE PROPIONATE 0.005 % EX OINT","BOTH IP/OP","$132.36 ","$97.95 ","$0.00 ","$120.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.02 ","$0.00 ","$60.01 ","$95.06 ","$96.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10083","ERX","HCPCS 25000001","45802-0221-11","FLUTICASONE PROPIONATE 0.005 % EX OINT","BOTH IP/OP","$132.36 ","$97.95 ","$0.00 ","$120.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.02 ","$0.00 ","$60.01 ","$95.06 ","$96.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10084","ERX","HCPCS 63700001","60505-0166-01","FLUVOXAMINE MALEATE 100 MG PO TABS","BOTH IP/OP","$11.07 ","$8.19 ","$0.00 ","$10.04 ","","$1.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.04 ","$0.00 ","$5.02 ","$7.95 ","$8.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10085","ERX","HCPCS 63700001","62559-0159-01","FLUVOXAMINE MALEATE 50 MG PO TABS","BOTH IP/OP","$9.79 ","$7.24 ","$0.00 ","$9.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.79 ","$0.00 ","$4.90 ","$7.75 ","$7.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10100","ERX","HCPCS A9579","00270-1111-01","GADOTERIDOL 279.3 MG/ML IV SOLN","BOTH IP/OP","$242.21 ","$179.24 ","$0.00 ","$219.87 ","$108.99 ","$0.00 ","$50.48 ","$0.00 ","$0.00 ","$38.50 ","$219.87 ","$0.00 ","$109.94 ","$174.14 ","$175.90 ","$0.00 ","$34.41 ","$0.00 ","$35.00 ","$0.00 "
"10100","ERX","HCPCS A9579","00270-1111-02","GADOTERIDOL 279.3 MG/ML IV SOLN","BOTH IP/OP","$242.21 ","$179.24 ","$0.00 ","$219.87 ","$108.99 ","$0.00 ","$50.48 ","$0.00 ","$0.00 ","$38.50 ","$219.87 ","$0.00 ","$109.94 ","$174.14 ","$175.90 ","$0.00 ","$34.41 ","$0.00 ","$35.00 ","$0.00 "
"10100","ERX","HCPCS A9579","00270-1111-03","GADOTERIDOL 279.3 MG/ML IV SOLN","BOTH IP/OP","$242.21 ","$179.24 ","$0.00 ","$219.87 ","$108.99 ","$0.00 ","$50.48 ","$0.00 ","$0.00 ","$38.50 ","$219.87 ","$0.00 ","$109.94 ","$174.14 ","$175.90 ","$0.00 ","$34.41 ","$0.00 ","$35.00 ","$0.00 "
"10101","ERX","HCPCS J1570","42023-0173-25","GANCICLOVIR SODIUM 500 MG IV SOLR","BOTH IP/OP","$392.20 ","$290.23 ","$0.00 ","$356.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.01 ","$0.00 ","$178.01 ","$281.96 ","$284.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10101","ERX","HCPCS J1570","63323-0315-10","GANCICLOVIR SODIUM 500 MG IV SOLR","BOTH IP/OP","$392.20 ","$290.23 ","$0.00 ","$356.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.01 ","$0.00 ","$178.01 ","$281.96 ","$284.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10116","ERX","HCPCS 63700001","51079-0811-01","GLIPIZIDE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10116","ERX","HCPCS 63700001","51079-0811-20","GLIPIZIDE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10117","ERX","HCPCS 63700001","00904-6637-61","GLIPIZIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10117","ERX","HCPCS 63700001","51079-0810-20","GLIPIZIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10126","ERX","HCPCS 63700001","00093-8343-01","GLYBURIDE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10126","ERX","HCPCS 63700001","00093-9433-01","GLYBURIDE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10126","ERX","HCPCS 63700001","51079-0872-01","GLYBURIDE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10126","ERX","HCPCS 63700001","51079-0872-20","GLYBURIDE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10126","ERX","HCPCS 63700001","65862-0029-01","GLYBURIDE 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10130","ERX","HCPCS 25000001","13107-0014-01","GLYCOPYRROLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10130","ERX","HCPCS 25000001","42291-0303-90","GLYCOPYRROLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10130","ERX","HCPCS 25000001","49884-0065-01","GLYCOPYRROLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10130","ERX","HCPCS 25000001","64980-0272-01","GLYCOPYRROLATE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10137","ERX","HCPCS J9202","70720-0950-36","GOSERELIN ACETATE 3.6 MG SC IMPL","BOTH IP/OP","$2,435.46 ","$1,802.24 ","$0.00 ","$2,010.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,010.65 ","$0.00 ","$1,005.33 ","$1,448.98 ","$1,608.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10149","ERX","HCPCS 63700001","00378-1160-01","GUANFACINE HCL 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10149","ERX","HCPCS 63700001","00591-0444-01","GUANFACINE HCL 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10162","ERX","HCPCS J1631","00143-9295-01","HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","BOTH IP/OP","$55.60 ","$41.14 ","$0.00 ","$50.43 ","$25.02 ","$0.00 ","$3.87 ","$0.00 ","$0.00 ","$19.36 ","$50.43 ","$0.00 ","$25.22 ","$39.94 ","$40.34 ","$0.00 ","$19.36 ","$0.00 ","$18.44 ","$0.00 "
"10162","ERX","HCPCS J1631","10147-0922-05","HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","BOTH IP/OP","$55.60 ","$41.14 ","$0.00 ","$50.43 ","$25.02 ","$0.00 ","$3.87 ","$0.00 ","$0.00 ","$19.36 ","$50.43 ","$0.00 ","$25.22 ","$39.94 ","$40.34 ","$0.00 ","$19.36 ","$0.00 ","$18.44 ","$0.00 "
"10162","ERX","HCPCS J1631","25021-0833-01","HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","BOTH IP/OP","$55.60 ","$41.14 ","$0.00 ","$50.43 ","$25.02 ","$0.00 ","$3.87 ","$0.00 ","$0.00 ","$19.36 ","$50.43 ","$0.00 ","$25.22 ","$39.94 ","$40.34 ","$0.00 ","$19.36 ","$0.00 ","$18.44 ","$0.00 "
"10176","ERX","HCPCS J1644","00069-0058-01","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","00069-0137-01","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","00069-0137-03","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","00409-2720-03","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","00409-2720-31","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","00409-2720-32","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","00641-2450-55","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","25021-0400-10","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","25021-0400-30","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","63323-0540-01","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","63323-0540-11","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","63323-0540-15","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","63323-0540-31","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","63323-0540-36","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","63323-0540-67","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","67457-0384-99","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","67457-0385-10","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10176","ERX","HCPCS J1644","67457-0385-99","HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"10177","ERX","HCPCS J1644","25021-0403-04","HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.35 ","$0.00 ","$0.00 ","$2.82 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"10177","ERX","HCPCS J1644","67457-0603-05","HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.35 ","$0.00 ","$0.00 ","$2.82 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"10177","ERX","HCPCS J1644","67457-0603-99","HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.35 ","$0.00 ","$0.00 ","$2.82 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"10181","ERX","HCPCS J1644","00069-0059-03","HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"10181","ERX","HCPCS J1644","00641-0400-12","HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"10181","ERX","HCPCS J1644","25021-0402-01","HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"10181","ERX","HCPCS J1644","63323-0262-01","HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"10181","ERX","HCPCS J1644","63739-0953-25","HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$0.00 "
"10203","ERX","HCPCS 25000001","51927-1647-00","HYDROCHLORIC ACID 37 % LIQD","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10209","ERX","HCPCS 63700001","00009-0012-01","HYDROCORTISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10209","ERX","HCPCS 63700001","42543-0140-50","HYDROCORTISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10209","ERX","HCPCS 63700001","59762-0073-01","HYDROCORTISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10209","ERX","HCPCS 63700001","72789-0095-50","HYDROCORTISONE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10210","ERX","HCPCS 25000001","62559-0138-07","HYDROCORTISONE 100 MG/60ML RECTAL ENEM","BOTH IP/OP","$46.06 ","$34.08 ","$0.00 ","$46.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.06 ","$0.00 ","$23.03 ","$36.48 ","$36.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10217","ERX","HCPCS 25000001","00574-0420-25","HYDROCORTISONE MICRONIZED POWD","BOTH IP/OP","$312.30 ","$231.10 ","$0.00 ","$283.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$283.50 ","$0.00 ","$141.75 ","$224.53 ","$226.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10230","ERX","HCPCS 25000001","42192-0151-01","HYDROQUINONE 4 % EX CREA","BOTH IP/OP","$359.12 ","$265.75 ","$0.00 ","$325.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.99 ","$0.00 ","$163.00 ","$258.18 ","$260.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","00378-0373-01","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","00591-3041-01","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","00781-5994-01","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","43598-0721-01","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","63739-0777-10","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","66993-0057-02","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","68084-0269-01","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10235","ERX","HCPCS 63700001","68084-0269-11","HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","BOTH IP/OP","$10.79 ","$7.98 ","$0.00 ","$10.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.79 ","$0.00 ","$5.40 ","$8.55 ","$8.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10236","ERX","HCPCS 63700001","00555-0882-02","HYDROXYUREA 500 MG PO CAPS","BOTH IP/OP","$6.18 ","$4.57 ","$0.00 ","$6.00 ","","$1.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10236","ERX","HCPCS 63700001","49884-0724-01","HYDROXYUREA 500 MG PO CAPS","BOTH IP/OP","$6.18 ","$4.57 ","$0.00 ","$6.00 ","","$1.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10236","ERX","HCPCS 63700001","68084-0284-01","HYDROXYUREA 500 MG PO CAPS","BOTH IP/OP","$6.18 ","$4.57 ","$0.00 ","$6.00 ","","$1.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10236","ERX","HCPCS 63700001","68084-0284-11","HYDROXYUREA 500 MG PO CAPS","BOTH IP/OP","$6.18 ","$4.57 ","$0.00 ","$6.00 ","","$1.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10246","ERX","HCPCS 25000001","45802-0140-26","IBUPROFEN 100 MG/5ML PO SUSP","BOTH IP/OP","$18.39 ","$13.61 ","$0.00 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$0.00 ","$9.20 ","$14.56 ","$14.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10246","ERX","HCPCS 25000001","49348-0229-34","IBUPROFEN 100 MG/5ML PO SUSP","BOTH IP/OP","$14.14 ","$10.46 ","$0.00 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$0.00 ","$9.20 ","$11.20 ","$14.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10246","ERX","HCPCS 25000001","51672-2130-08","IBUPROFEN 100 MG/5ML PO SUSP","BOTH IP/OP","$14.14 ","$10.46 ","$0.00 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$0.00 ","$9.20 ","$11.20 ","$14.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10246","ERX","HCPCS 25000001","00121-1836-05","IBUPROFEN 100 MG/5ML PO SUSP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$0.00 ","$9.20 ","$4.75 ","$14.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10246","ERX","HCPCS 25000001","00121-4774-40","IBUPROFEN 100 MG/5ML PO SUSP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$0.00 ","$9.20 ","$4.75 ","$14.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10246","ERX","HCPCS 25000001","68094-0494-61","IBUPROFEN 100 MG/5ML PO SUSP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$0.00 ","$9.20 ","$4.75 ","$14.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10248","ERX","HCPCS J9208","10019-0925-01","IFOSFAMIDE 1 G IV SOLR","BOTH IP/OP","$241.73 ","$178.88 ","$0.00 ","$219.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$219.43 ","$0.00 ","$109.72 ","$173.79 ","$175.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10248","ERX","HCPCS J9208","10019-0925-82","IFOSFAMIDE 1 G IV SOLR","BOTH IP/OP","$241.73 ","$178.88 ","$0.00 ","$219.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$219.43 ","$0.00 ","$109.72 ","$173.79 ","$175.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10248","ERX","HCPCS J9208","63323-0142-10","IFOSFAMIDE 1 G IV SOLR","BOTH IP/OP","$241.73 ","$178.88 ","$0.00 ","$219.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$219.43 ","$0.00 ","$109.72 ","$173.79 ","$175.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10266","ERX","HCPCS 25000001","17238-0424-06","INDOCYANINE GREEN 25 MG IV SOLR","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10266","ERX","HCPCS 25000001","17478-0701-02","INDOCYANINE GREEN 25 MG IV SOLR","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10266","ERX","HCPCS 25000001","66259-0701-25","INDOCYANINE GREEN 25 MG IV SOLR","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10266","ERX","HCPCS 25000001","70100-0424-02","INDOCYANINE GREEN 25 MG IV SOLR","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$31.18 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.18 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10267","ERX","HCPCS 25000001","00409-1113-01","INDOMETHACIN SODIUM 1 MG IV SOLR","BOTH IP/OP","$1,387.59 ","$1,026.82 ","$0.00 ","$1,259.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,259.28 ","$0.00 ","$629.64 ","$997.35 ","$1,007.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10267","ERX","HCPCS 25000001","63323-0659-03","INDOMETHACIN SODIUM 1 MG IV SOLR","BOTH IP/OP","$1,387.59 ","$1,026.82 ","$0.00 ","$1,259.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,259.28 ","$0.00 ","$629.64 ","$997.35 ","$1,007.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10267","ERX","HCPCS 25000001","63323-0659-09","INDOMETHACIN SODIUM 1 MG IV SOLR","BOTH IP/OP","$1,387.59 ","$1,026.82 ","$0.00 ","$1,259.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,259.28 ","$0.00 ","$629.64 ","$997.35 ","$1,007.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10267","ERX","HCPCS 25000001","68382-0470-01","INDOMETHACIN SODIUM 1 MG IV SOLR","BOTH IP/OP","$1,387.59 ","$1,026.82 ","$0.00 ","$1,259.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,259.28 ","$0.00 ","$629.64 ","$997.35 ","$1,007.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10284","ERX","HCPCS J1815","00002-8315-01","INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$201.38 ","$5.43 ","$0.00 ","$2.08 ","$0.00 ","$0.00 ","$1.75 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$201.38 ","$0.00 "
"10284","ERX","HCPCS J1815","00169-1834-11","INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$201.38 ","$5.43 ","$0.00 ","$2.08 ","$0.00 ","$0.00 ","$1.75 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$201.38 ","$0.00 "
"10289","ERX","HCPCS J1815","00002-8215-01","INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$5.43 ","$0.00 ","$2.08 ","$0.00 ","$0.00 ","$1.75 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$1.01 ","$0.00 "
"10289","ERX","HCPCS J1815","00169-1833-11","INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN","BOTH IP/OP","$10.00 ","$7.40 ","$0.00 ","$10.00 ","$5.43 ","$0.00 ","$2.08 ","$0.00 ","$0.00 ","$1.75 ","$10.00 ","$0.00 ","$5.00 ","$7.92 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$1.01 ","$0.00 "
"10321","ERX","HCPCS Q9966","00407-1412-30","IOHEXOL 240 MG/ML IJ SOLN","BOTH IP/OP","$235.53 ","$174.29 ","$0.00 ","$221.61 ","$105.99 ","$0.00 ","$49.09 ","$0.00 ","$0.00 ","$40.54 ","$221.61 ","$0.00 ","$110.81 ","$175.52 ","$177.29 ","$0.00 ","$38.60 ","$0.00 ","$35.28 ","$0.00 "
"10322","ERX","HCPCS Q9967","00407-1413-10","IOHEXOL 300 MG/ML IJ SOLN","BOTH IP/OP","$128.43 ","$95.04 ","$0.00 ","$116.45 ","$57.79 ","$0.00 ","$26.77 ","$0.00 ","$0.00 ","$4.23 ","$116.45 ","$0.00 ","$58.23 ","$92.23 ","$93.16 ","$0.00 ","$4.03 ","$0.00 ","$18.54 ","$0.00 "
"10322","ERX","HCPCS Q9967","00407-1413-61","IOHEXOL 300 MG/ML IJ SOLN","BOTH IP/OP","$128.43 ","$95.04 ","$0.00 ","$116.45 ","$57.79 ","$0.00 ","$26.77 ","$0.00 ","$0.00 ","$4.23 ","$116.45 ","$0.00 ","$58.23 ","$92.23 ","$93.16 ","$0.00 ","$4.03 ","$0.00 ","$18.54 ","$0.00 "
"10322","ERX","HCPCS Q9967","00407-1413-63","IOHEXOL 300 MG/ML IJ SOLN","BOTH IP/OP","$128.43 ","$95.04 ","$0.00 ","$116.45 ","$57.79 ","$0.00 ","$26.77 ","$0.00 ","$0.00 ","$4.23 ","$116.45 ","$0.00 ","$58.23 ","$92.23 ","$93.16 ","$0.00 ","$4.03 ","$0.00 ","$18.54 ","$0.00 "
"10322","ERX","HCPCS Q9967","00407-1413-65","IOHEXOL 300 MG/ML IJ SOLN","BOTH IP/OP","$128.43 ","$95.04 ","$0.00 ","$116.45 ","$57.79 ","$0.00 ","$26.77 ","$0.00 ","$0.00 ","$4.23 ","$116.45 ","$0.00 ","$58.23 ","$92.23 ","$93.16 ","$0.00 ","$4.03 ","$0.00 ","$18.54 ","$0.00 "
"10322","ERX","HCPCS Q9967","00407-1413-87","IOHEXOL 300 MG/ML IJ SOLN","BOTH IP/OP","$128.43 ","$95.04 ","$0.00 ","$116.45 ","$57.79 ","$0.00 ","$26.77 ","$0.00 ","$0.00 ","$4.23 ","$116.45 ","$0.00 ","$58.23 ","$92.23 ","$93.16 ","$0.00 ","$4.03 ","$0.00 ","$18.54 ","$0.00 "
"10322","ERX","HCPCS Q9967","00407-1413-88","IOHEXOL 300 MG/ML IJ SOLN","BOTH IP/OP","$128.43 ","$95.04 ","$0.00 ","$116.45 ","$57.79 ","$0.00 ","$26.77 ","$0.00 ","$0.00 ","$4.23 ","$116.45 ","$0.00 ","$58.23 ","$92.23 ","$93.16 ","$0.00 ","$4.03 ","$0.00 ","$18.54 ","$0.00 "
"10323","ERX","HCPCS Q9967","00407-1414-84","IOHEXOL 350 MG/ML IV SOLN","BOTH IP/OP","$314.39 ","$232.65 ","$0.00 ","$285.39 ","$141.48 ","$0.00 ","$65.53 ","$0.00 ","$0.00 ","$10.58 ","$285.39 ","$0.00 ","$142.70 ","$226.03 ","$228.31 ","$0.00 ","$10.07 ","$0.00 ","$45.43 ","$0.00 "
"10323","ERX","HCPCS Q9967","00407-1414-86","IOHEXOL 350 MG/ML IV SOLN","BOTH IP/OP","$314.39 ","$232.65 ","$0.00 ","$285.39 ","$141.48 ","$0.00 ","$65.53 ","$0.00 ","$0.00 ","$10.58 ","$285.39 ","$0.00 ","$142.70 ","$226.03 ","$228.31 ","$0.00 ","$10.07 ","$0.00 ","$45.43 ","$0.00 "
"10323","ERX","HCPCS Q9967","00407-1414-89","IOHEXOL 350 MG/ML IV SOLN","BOTH IP/OP","$314.39 ","$232.65 ","$0.00 ","$285.39 ","$141.48 ","$0.00 ","$65.53 ","$0.00 ","$0.00 ","$10.58 ","$285.39 ","$0.00 ","$142.70 ","$226.03 ","$228.31 ","$0.00 ","$10.07 ","$0.00 ","$45.43 ","$0.00 "
"10323","ERX","HCPCS Q9967","00407-1414-91","IOHEXOL 350 MG/ML IV SOLN","BOTH IP/OP","$314.39 ","$232.65 ","$0.00 ","$285.39 ","$141.48 ","$0.00 ","$65.53 ","$0.00 ","$0.00 ","$10.58 ","$285.39 ","$0.00 ","$142.70 ","$226.03 ","$228.31 ","$0.00 ","$10.07 ","$0.00 ","$45.43 ","$0.00 "
"10323","ERX","HCPCS Q9967","00407-1414-93","IOHEXOL 350 MG/ML IV SOLN","BOTH IP/OP","$314.39 ","$232.65 ","$0.00 ","$285.39 ","$141.48 ","$0.00 ","$65.53 ","$0.00 ","$0.00 ","$10.58 ","$285.39 ","$0.00 ","$142.70 ","$226.03 ","$228.31 ","$0.00 ","$10.07 ","$0.00 ","$45.43 ","$0.00 "
"10328","ERX","HCPCS Q9967","00270-1316-37","IOPAMIDOL 76 % IV SOLN","BOTH IP/OP","$167.07 ","$123.63 ","$0.00 ","$151.48 ","$75.18 ","$0.00 ","$34.82 ","$0.00 ","$0.00 ","$5.64 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$5.37 ","$0.00 ","$24.12 ","$0.00 "
"10358","ERX","HCPCS Q9968","55150-0240-05","ISOSULFAN BLUE 1 % SC SOLN","BOTH IP/OP","$1,903.65 ","$1,408.70 ","$0.00 ","$1,764.00 ","$856.64 ","$232.89 ","$396.77 ","$0.00 ","$0.00 ","$308.86 ","$1,764.00 ","$201.63 ","$882.00 ","$1,397.09 ","$1,411.20 ","$278.44 ","$276.07 ","$0.00 ","$280.83 ","$217.98 "
"10358","ERX","HCPCS Q9968","67457-0220-05","ISOSULFAN BLUE 1 % SC SOLN","BOTH IP/OP","$1,903.65 ","$1,408.70 ","$0.00 ","$1,764.00 ","$856.64 ","$232.89 ","$396.77 ","$0.00 ","$0.00 ","$308.86 ","$1,764.00 ","$201.63 ","$882.00 ","$1,397.09 ","$1,411.20 ","$278.44 ","$276.07 ","$0.00 ","$280.83 ","$217.98 "
"10359","ERX","HCPCS 63700001","00555-1054-86","ISOTRETINOIN 10 MG PO CAPS","BOTH IP/OP","$79.15 ","$58.57 ","$0.00 ","$71.77 ","","$14.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.77 ","$0.00 ","$35.89 ","$56.84 ","$57.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10360","ERX","HCPCS 63700001","00555-1055-86","ISOTRETINOIN 20 MG PO CAPS","BOTH IP/OP","$93.85 ","$69.45 ","$0.00 ","$85.10 ","","$16.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.10 ","$0.00 ","$42.55 ","$67.40 ","$68.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10361","ERX","HCPCS 63700001","55111-0137-81","ISOTRETINOIN 40 MG PO CAPS","BOTH IP/OP","$95.84 ","$70.92 ","$0.00 ","$86.91 ","","$17.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.91 ","$0.00 ","$43.46 ","$68.83 ","$69.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10364","ERX","HCPCS 63700001","10147-1700-07","ITRACONAZOLE 100 MG PO CAPS","BOTH IP/OP","$93.20 ","$68.97 ","$0.00 ","$84.51 ","","$16.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.51 ","$0.00 ","$42.26 ","$66.93 ","$67.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10364","ERX","HCPCS 63700001","67877-0454-30","ITRACONAZOLE 100 MG PO CAPS","BOTH IP/OP","$93.20 ","$68.97 ","$0.00 ","$84.51 ","","$16.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.51 ","$0.00 ","$42.26 ","$66.93 ","$67.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10368","ERX","HCPCS 63700001","00168-0099-15","KETOCONAZOLE 2 % EX CREA","BOTH IP/OP","$441.26 ","$326.53 ","$0.00 ","$108.15 ","","$78.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10368","ERX","HCPCS 63700001","51672-1298-01","KETOCONAZOLE 2 % EX CREA","BOTH IP/OP","$441.26 ","$326.53 ","$0.00 ","$108.15 ","","$78.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10368","ERX","HCPCS 63700001","51672-1298-02","KETOCONAZOLE 2 % EX CREA","BOTH IP/OP","$441.26 ","$326.53 ","$0.00 ","$154.18 ","","$78.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.15 ","$0.00 ","$54.08 ","$154.18 ","$86.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10369","ERX","HCPCS 63700001","00378-0261-01","KETOCONAZOLE 200 MG PO TABS","BOTH IP/OP","$14.41 ","$10.66 ","$0.00 ","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.41 ","$0.00 ","$7.21 ","$11.41 ","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10369","ERX","HCPCS 63700001","51672-4026-01","KETOCONAZOLE 200 MG PO TABS","BOTH IP/OP","$14.41 ","$10.66 ","$0.00 ","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.41 ","$0.00 ","$7.21 ","$11.41 ","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10369","ERX","HCPCS 63700001","51672-4026-06","KETOCONAZOLE 200 MG PO TABS","BOTH IP/OP","$14.41 ","$10.66 ","$0.00 ","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.41 ","$0.00 ","$7.21 ","$11.41 ","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10371","ERX","HCPCS 63700001","00093-0314-01","KETOROLAC TROMETHAMINE 10 MG PO TABS","BOTH IP/OP","$9.50 ","$7.03 ","$0.00 ","$8.61 ","","$1.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.61 ","$0.00 ","$4.31 ","$6.82 ","$6.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10371","ERX","HCPCS 63700001","00378-1134-01","KETOROLAC TROMETHAMINE 10 MG PO TABS","BOTH IP/OP","$9.50 ","$7.03 ","$0.00 ","$8.61 ","","$1.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.61 ","$0.00 ","$4.31 ","$6.82 ","$6.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10371","ERX","HCPCS 63700001","69543-0388-10","KETOROLAC TROMETHAMINE 10 MG PO TABS","BOTH IP/OP","$9.50 ","$7.03 ","$0.00 ","$8.61 ","","$1.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.61 ","$0.00 ","$4.31 ","$6.82 ","$6.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","00143-9622-01","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","00409-2267-20","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","00409-2267-54","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","00409-2339-34","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","17478-0420-40","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","47781-0586-29","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","47781-0586-56","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","72266-0102-01","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","72266-0103-01","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","99999-6007-13","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10372","ERX","HCPCS 25000001","99999-6011-99","LABETALOL HCL 5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10373","ERX","HCPCS 63700001","00185-0010-01","LABETALOL HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10373","ERX","HCPCS 63700001","00591-0605-01","LABETALOL HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10373","ERX","HCPCS 63700001","00904-5928-61","LABETALOL HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10373","ERX","HCPCS 63700001","10135-0641-01","LABETALOL HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10374","ERX","HCPCS 63700001","00185-0117-05","LABETALOL HCL 200 MG PO TABS","BOTH IP/OP","$13.26 ","$9.81 ","$0.00 ","$13.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.26 ","$0.00 ","$6.63 ","$10.50 ","$10.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10374","ERX","HCPCS 63700001","00904-5929-61","LABETALOL HCL 200 MG PO TABS","BOTH IP/OP","$13.26 ","$9.81 ","$0.00 ","$13.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.26 ","$0.00 ","$6.63 ","$10.50 ","$10.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10374","ERX","HCPCS 63700001","10135-0642-01","LABETALOL HCL 200 MG PO TABS","BOTH IP/OP","$13.26 ","$9.81 ","$0.00 ","$13.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.26 ","$0.00 ","$6.63 ","$10.50 ","$10.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10375","ERX","HCPCS 63700001","00185-0118-01","LABETALOL HCL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10375","ERX","HCPCS 63700001","00185-0118-05","LABETALOL HCL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10375","ERX","HCPCS 63700001","00591-0607-01","LABETALOL HCL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10375","ERX","HCPCS 63700001","00904-5930-61","LABETALOL HCL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10375","ERX","HCPCS 63700001","49884-0124-01","LABETALOL HCL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10375","ERX","HCPCS 63700001","49884-0124-05","LABETALOL HCL 300 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10380","ERX","HCPCS 63700001","92771-0612-08","AMMONIUM LACTATE 12 % EX LOTN","BOTH IP/OP","$127.67 ","$94.48 ","$0.00 ","$115.77 ","","$22.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.77 ","$0.00 ","$57.89 ","$22.72 ","$92.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10380","ERX","HCPCS 63700001","45802-0419-54","AMMONIUM LACTATE 12 % EX LOTN","BOTH IP/OP","$127.67 ","$94.48 ","$0.00 ","$115.77 ","","$22.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.77 ","$0.00 ","$57.89 ","$91.69 ","$92.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10380","ERX","HCPCS 63700001","00904-5984-26","AMMONIUM LACTATE 12 % EX LOTN","BOTH IP/OP","$127.67 ","$94.48 ","$0.00 ","$165.04 ","","$22.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.77 ","$0.00 ","$57.89 ","$165.04 ","$92.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10380","ERX","HCPCS 63700001","45802-0525-55","AMMONIUM LACTATE 12 % EX LOTN","BOTH IP/OP","$127.67 ","$94.48 ","$0.00 ","$165.04 ","","$22.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.77 ","$0.00 ","$57.89 ","$165.04 ","$92.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10392","ERX","HCPCS J9217","00074-3642-03","LEUPROLIDE ACETATE 7.5 MG IM KIT","BOTH IP/OP","$4,793.33 ","$3,547.06 ","$0.00 ","$4,094.10 ","$2,262.69 ","$200.73 ","$246.83 ","$0.00 ","$0.00 ","$270.33 ","$4,094.10 ","$235.93 ","$2,047.05 ","$3,242.53 ","$3,275.28 ","$325.81 ","$270.33 ","$0.00 ","$257.40 ","$205.89 "
"10394","ERX","HCPCS 25000001","24208-0505-05","LEVOBUNOLOL HCL 0.5 % OP SOLN","BOTH IP/OP","$93.34 ","$69.07 ","$0.00 ","$84.63 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.63 ","$0.00 ","$42.32 ","$67.03 ","$67.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10403","ERX","HCPCS 63700001","00781-5183-92","LEVOTHYROXINE SODIUM 88 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10404","ERX","HCPCS 63700001","00781-5185-92","LEVOTHYROXINE SODIUM 112 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10405","ERX","HCPCS 63700001","00378-1823-77","LEVOTHYROXINE SODIUM 137 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10405","ERX","HCPCS 63700001","00781-5191-92","LEVOTHYROXINE SODIUM 137 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10406","ERX","HCPCS 63700001","00781-5188-92","LEVOTHYROXINE SODIUM 175 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10426","ERX","HCPCS 25000001","00409-3177-01","LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10427","ERX","HCPCS 25000001","00409-3178-01","LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10427","ERX","HCPCS 25000001","00409-3178-02","LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10427","ERX","HCPCS 25000001","00409-3178-16","LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10427","ERX","HCPCS 25000001","63323-0482-03","LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10427","ERX","HCPCS 25000001","63323-0482-17","LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10427","ERX","HCPCS 25000001","63323-0482-27","LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10428","ERX","HCPCS 25000001","63323-0487-17","LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10428","ERX","HCPCS 25000001","63323-0487-31","LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10428","ERX","HCPCS 25000001","63323-0487-37","LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10429","ERX","HCPCS 25000001","00409-1209-01","LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10429","ERX","HCPCS 25000001","00409-1209-65","LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10430","ERX","HCPCS 25000001","00362-1095-60","LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10430","ERX","HCPCS 25000001","51004-1095-06","LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10430","ERX","HCPCS 25000001","00409-3182-01","LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10430","ERX","HCPCS 25000001","63323-0483-27","LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10431","ERX","HCPCS 25000001","00409-3183-01","LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10431","ERX","HCPCS 25000001","63323-0489-02","LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10431","ERX","HCPCS 25000001","63323-0489-17","LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10431","ERX","HCPCS 25000001","63323-0489-21","LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10431","ERX","HCPCS 25000001","63323-0489-27","LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10434","ERX","HCPCS 25000001","00115-1468-45","LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","BOTH IP/OP","$168.84 ","$124.94 ","$0.00 ","$168.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.84 ","$0.00 ","$84.42 ","$133.72 ","$135.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10434","ERX","HCPCS 25000001","00115-1468-53","LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","BOTH IP/OP","$30.56 ","$22.61 ","$0.00 ","$168.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.84 ","$0.00 ","$84.42 ","$24.20 ","$135.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10434","ERX","HCPCS 25000001","00115-1468-60","LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","BOTH IP/OP","$30.56 ","$22.61 ","$0.00 ","$168.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.84 ","$0.00 ","$84.42 ","$24.20 ","$135.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10434","ERX","HCPCS 25000001","00168-0357-55","LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","BOTH IP/OP","$30.56 ","$22.61 ","$0.00 ","$168.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.84 ","$0.00 ","$84.42 ","$24.20 ","$135.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10443","ERX","HCPCS 63700001","42794-0018-02","LIOTHYRONINE SODIUM 5 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10443","ERX","HCPCS 63700001","51862-0320-01","LIOTHYRONINE SODIUM 5 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10443","ERX","HCPCS 63700001","59762-1206-01","LIOTHYRONINE SODIUM 5 MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10449","ERX","HCPCS 63700001","00904-6798-61","LISINOPRIL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10449","ERX","HCPCS 63700001","43547-0353-10","LISINOPRIL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10449","ERX","HCPCS 63700001","60687-0325-01","LISINOPRIL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10449","ERX","HCPCS 63700001","60687-0325-11","LISINOPRIL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10449","ERX","HCPCS 63700001","68180-0980-01","LISINOPRIL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10450","ERX","HCPCS 63700001","00904-6800-61","LISINOPRIL 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10450","ERX","HCPCS 63700001","68084-0199-01","LISINOPRIL 40 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10451","ERX","HCPCS 63700001","00904-6797-61","LISINOPRIL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10451","ERX","HCPCS 63700001","43547-0352-10","LISINOPRIL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10451","ERX","HCPCS 63700001","68180-0513-01","LISINOPRIL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10452","ERX","HCPCS 63700001","00591-0861-01","LISINOPRIL-HCTZ 20-12.5 MG TABLET","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10452","ERX","HCPCS 63700001","68180-0519-01","LISINOPRIL-HCTZ 20-12.5 MG TABLET","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10453","ERX","HCPCS 63700001","68180-0520-01","LISINOPRIL-HCTZ 20-25 MG TABLET","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10454","ERX","HCPCS 63700001","00054-0021-25","LITHIUM CARBONATE ER 300 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10454","ERX","HCPCS 63700001","68462-0223-01","LITHIUM CARBONATE ER 300 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10455","ERX","HCPCS 63700001","00054-0020-25","LITHIUM CARBONATE ER 450 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10455","ERX","HCPCS 63700001","51079-0142-01","LITHIUM CARBONATE ER 450 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10455","ERX","HCPCS 63700001","51079-0142-20","LITHIUM CARBONATE ER 450 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10455","ERX","HCPCS 63700001","68462-0224-01","LITHIUM CARBONATE ER 450 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10460","ERX","HCPCS 63700001","58181-3042-05","LOMUSTINE 100 MG PO CAPS","BOTH IP/OP","$2,724.26 ","$2,015.95 ","$0.00 ","$2,471.12 ","","$484.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,471.12 ","$0.00 ","$1,235.56 ","$1,957.13 ","$1,976.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10461","ERX","HCPCS 63700001","58181-3041-05","LOMUSTINE 40 MG PO CAPS","BOTH IP/OP","$1,275.08 ","$943.56 ","$0.00 ","$1,157.18 ","","$226.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,157.18 ","$0.00 ","$578.59 ","$916.49 ","$925.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10466","ERX","HCPCS 63700001","00904-6852-61","LORATADINE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10466","ERX","HCPCS 63700001","45802-0650-87","LORATADINE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10466","ERX","HCPCS 63700001","51079-0246-20","LORATADINE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10466","ERX","HCPCS 63700001","68084-0248-01","LORATADINE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10466","ERX","HCPCS 63700001","68084-0248-11","LORATADINE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10467","ERX","HCPCS J2060","00409-1985-30","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00409-6778-02","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00409-6778-11","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00641-6044-01","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00641-6044-25","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00641-6046-10","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00641-6048-25","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","00641-6050-10","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","76329-8261-00","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10467","ERX","HCPCS J2060","76329-8261-01","LORAZEPAM 2 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"10475","ERX","HCPCS J7504","00009-7224-01","LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ","BOTH IP/OP","$7,764.17 ","$5,745.49 ","$0.00 ","$5,365.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,365.88 ","$0.00 ","$2,682.94 ","$4,249.78 ","$4,292.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10475","ERX","HCPCS J7504","00009-7224-02","LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ","BOTH IP/OP","$7,764.17 ","$5,745.49 ","$0.00 ","$5,365.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,365.88 ","$0.00 ","$2,682.94 ","$4,249.78 ","$4,292.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10478","ERX","HCPCS 25000001","51079-0623-81","MAFENIDE ACETATE 85 MG/GM EX CREA","BOTH IP/OP","$488.10 ","$361.19 ","$0.00 ","$577.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$577.43 ","$0.00 ","$288.72 ","$350.90 ","$461.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10478","ERX","HCPCS 25000001","51079-0623-82","MAFENIDE ACETATE 85 MG/GM EX CREA","BOTH IP/OP","$488.10 ","$361.19 ","$0.00 ","$577.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$577.43 ","$0.00 ","$288.72 ","$457.32 ","$461.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10521","ERX","HCPCS 63700001","99999-6005-55","MEGESTROL ACETATE 40 MG/ML PO SUSP","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$439.20 ","","$24.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.20 ","$0.00 ","$219.60 ","$99.79 ","$351.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10521","ERX","HCPCS 63700001","00054-3542-58","MEGESTROL ACETATE 40 MG/ML PO SUSP","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$439.20 ","","$24.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.20 ","$0.00 ","$219.60 ","$347.85 ","$351.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10521","ERX","HCPCS 63700001","49884-0907-38","MEGESTROL ACETATE 40 MG/ML PO SUSP","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$439.20 ","","$24.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.20 ","$0.00 ","$219.60 ","$347.85 ","$351.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10521","ERX","HCPCS 63700001","50383-0859-24","MEGESTROL ACETATE 40 MG/ML PO SUSP","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$439.20 ","","$24.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.20 ","$0.00 ","$219.60 ","$347.85 ","$351.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10521","ERX","HCPCS 63700001","60432-0126-08","MEGESTROL ACETATE 40 MG/ML PO SUSP","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$439.20 ","","$24.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.20 ","$0.00 ","$219.60 ","$347.85 ","$351.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10521","ERX","HCPCS 63700001","60432-0126-16","MEGESTROL ACETATE 40 MG/ML PO SUSP","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$601.44 ","","$24.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.20 ","$0.00 ","$219.60 ","$601.44 ","$351.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10523","ERX","HCPCS J8600","52609-0001-05","MELPHALAN 2 MG PO TABS","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10531","ERX","HCPCS 63700001","00054-4581-11","MERCAPTOPURINE 50 MG PO TABS","BOTH IP/OP","$17.14 ","$12.68 ","$0.00 ","$15.55 ","","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.55 ","$0.00 ","$7.78 ","$12.32 ","$12.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10531","ERX","HCPCS 63700001","00378-3547-52","MERCAPTOPURINE 50 MG PO TABS","BOTH IP/OP","$17.14 ","$12.68 ","$0.00 ","$15.55 ","","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.55 ","$0.00 ","$7.78 ","$12.32 ","$12.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10533","ERX","HCPCS 63700001","54092-0189-81","MESALAMINE ER 250 MG PO CPCR","BOTH IP/OP","$30.53 ","$22.59 ","$0.00 ","$27.69 ","","$5.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.69 ","$0.00 ","$13.85 ","$21.93 ","$22.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10535","ERX","HCPCS 25000001","45802-0098-28","MESALAMINE 4 G RECTAL ENEM","BOTH IP/OP","$93.80 ","$69.41 ","$0.00 ","$85.05 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.05 ","$0.00 ","$42.53 ","$67.36 ","$68.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10535","ERX","HCPCS 25000001","45802-0098-51","MESALAMINE 4 G RECTAL ENEM","BOTH IP/OP","$93.80 ","$69.41 ","$0.00 ","$85.05 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.05 ","$0.00 ","$42.53 ","$67.36 ","$68.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10535","ERX","HCPCS 25000001","62559-0420-07","MESALAMINE 4 G RECTAL ENEM","BOTH IP/OP","$93.80 ","$69.41 ","$0.00 ","$85.05 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.05 ","$0.00 ","$42.53 ","$67.36 ","$68.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10537","ERX","HCPCS J9209","00338-1305-01","MESNA 100 MG/ML IV SOLN","BOTH IP/OP","$92.64 ","$68.55 ","$0.00 ","$84.00 ","$41.69 ","$0.00 ","$34.25 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10537","ERX","HCPCS J9209","10019-0953-01","MESNA 100 MG/ML IV SOLN","BOTH IP/OP","$92.64 ","$68.55 ","$0.00 ","$84.00 ","$41.69 ","$0.00 ","$34.25 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10537","ERX","HCPCS J9209","25021-0201-10","MESNA 100 MG/ML IV SOLN","BOTH IP/OP","$92.64 ","$68.55 ","$0.00 ","$84.00 ","$41.69 ","$0.00 ","$34.25 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10537","ERX","HCPCS J9209","25021-0201-11","MESNA 100 MG/ML IV SOLN","BOTH IP/OP","$92.64 ","$68.55 ","$0.00 ","$84.00 ","$41.69 ","$0.00 ","$34.25 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10537","ERX","HCPCS J9209","63323-0733-10","MESNA 100 MG/ML IV SOLN","BOTH IP/OP","$92.64 ","$68.55 ","$0.00 ","$84.00 ","$41.69 ","$0.00 ","$34.25 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10537","ERX","HCPCS J9209","63323-0733-11","MESNA 100 MG/ML IV SOLN","BOTH IP/OP","$92.64 ","$68.55 ","$0.00 ","$84.00 ","$41.69 ","$0.00 ","$34.25 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10544","ERX","HCPCS 63700001","00904-6689-61","METFORMIN HCL 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10544","ERX","HCPCS 63700001","60687-0155-01","METFORMIN HCL 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10544","ERX","HCPCS 63700001","63739-0640-10","METFORMIN HCL 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10546","ERX","HCPCS J1230","17478-0380-20","METHADONE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$32.63 ","$24.15 ","$0.00 ","$29.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.60 ","$0.00 ","$14.80 ","$23.44 ","$23.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10546","ERX","HCPCS J1230","67457-0217-20","METHADONE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$32.63 ","$24.15 ","$0.00 ","$29.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.60 ","$0.00 ","$14.80 ","$23.44 ","$23.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10546","ERX","HCPCS J1230","99999-6005-49","METHADONE HCL 10 MG/ML IJ SOLN","BOTH IP/OP","$32.63 ","$24.15 ","$0.00 ","$29.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.60 ","$0.00 ","$14.80 ","$23.44 ","$23.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10552","ERX","HCPCS 63700001","49884-0641-01","METHIMAZOLE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10552","ERX","HCPCS 63700001","51293-0821-01","METHIMAZOLE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10552","ERX","HCPCS 63700001","60687-0370-01","METHIMAZOLE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10552","ERX","HCPCS 63700001","60687-0370-11","METHIMAZOLE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10552","ERX","HCPCS 63700001","64980-0261-01","METHIMAZOLE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10553","ERX","HCPCS 63700001","00185-0205-01","METHIMAZOLE 5 MG PO TABS","BOTH IP/OP","$9.33 ","$6.90 ","$0.00 ","$9.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10553","ERX","HCPCS 63700001","49884-0640-01","METHIMAZOLE 5 MG PO TABS","BOTH IP/OP","$9.33 ","$6.90 ","$0.00 ","$9.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10553","ERX","HCPCS 63700001","51293-0820-01","METHIMAZOLE 5 MG PO TABS","BOTH IP/OP","$9.33 ","$6.90 ","$0.00 ","$9.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10553","ERX","HCPCS 63700001","60687-0357-01","METHIMAZOLE 5 MG PO TABS","BOTH IP/OP","$9.33 ","$6.90 ","$0.00 ","$9.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10553","ERX","HCPCS 63700001","60687-0357-11","METHIMAZOLE 5 MG PO TABS","BOTH IP/OP","$9.33 ","$6.90 ","$0.00 ","$9.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10553","ERX","HCPCS 63700001","60793-0104-01","METHIMAZOLE 5 MG PO TABS","BOTH IP/OP","$9.33 ","$6.90 ","$0.00 ","$9.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10571","ERX","HCPCS J2210","00517-0740-01","METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$113.89 ","$61.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$113.89 ","$0.00 ","$56.95 ","$90.20 ","$91.11 ","$0.00 ","$21.20 ","$0.00 ","$20.18 ","$0.00 "
"10571","ERX","HCPCS J2210","00517-0740-20","METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$113.89 ","$61.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$113.89 ","$0.00 ","$56.95 ","$90.20 ","$91.11 ","$0.00 ","$21.20 ","$0.00 ","$20.18 ","$0.00 "
"10571","ERX","HCPCS J2210","51991-0144-17","METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$113.89 ","$61.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$113.89 ","$0.00 ","$56.95 ","$90.20 ","$91.11 ","$0.00 ","$21.20 ","$0.00 ","$20.18 ","$0.00 "
"10571","ERX","HCPCS J2210","51991-0144-99","METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$113.89 ","$61.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$113.89 ","$0.00 ","$56.95 ","$90.20 ","$91.11 ","$0.00 ","$21.20 ","$0.00 ","$20.18 ","$0.00 "
"10572","ERX","HCPCS 63700001","27437-0050-56","METHYLERGONOVINE MALEATE 0.2 MG PO TABS","BOTH IP/OP","$259.06 ","$191.70 ","$0.00 ","$235.17 ","","$46.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.17 ","$0.00 ","$117.59 ","$186.25 ","$188.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10572","ERX","HCPCS 63700001","43386-0140-28","METHYLERGONOVINE MALEATE 0.2 MG PO TABS","BOTH IP/OP","$259.06 ","$191.70 ","$0.00 ","$235.17 ","","$46.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.17 ","$0.00 ","$117.59 ","$186.25 ","$188.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10572","ERX","HCPCS 63700001","69238-1605-08","METHYLERGONOVINE MALEATE 0.2 MG PO TABS","BOTH IP/OP","$259.06 ","$191.70 ","$0.00 ","$235.17 ","","$46.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.17 ","$0.00 ","$117.59 ","$186.25 ","$188.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10573","ERX","HCPCS 63700001","00009-0020-01","METHYLPREDNISOLONE 2 MG PO TABS","BOTH IP/OP","$8.26 ","$6.11 ","$0.00 ","$7.38 ","","$1.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10576","ERX","HCPCS J7509","00009-0022-01","METHYLPREDNISOLONE 8 MG PO TABS","BOTH IP/OP","$8.99 ","$6.65 ","$0.00 ","$8.03 ","$4.05 ","$0.00 ","$1.87 ","$0.00 ","$0.00 ","$1.41 ","$8.03 ","$0.00 ","$4.02 ","$6.36 ","$6.42 ","$0.00 ","$1.26 ","$0.00 ","$1.28 ","$0.00 "
"10576","ERX","HCPCS J7509","59746-0002-04","METHYLPREDNISOLONE 8 MG PO TABS","BOTH IP/OP","$8.99 ","$6.65 ","$0.00 ","$8.03 ","$4.05 ","$0.00 ","$1.87 ","$0.00 ","$0.00 ","$1.41 ","$8.03 ","$0.00 ","$4.02 ","$6.36 ","$6.42 ","$0.00 ","$1.26 ","$0.00 ","$1.28 ","$0.00 "
"10576","ERX","HCPCS J7509","59762-0049-01","METHYLPREDNISOLONE 8 MG PO TABS","BOTH IP/OP","$8.99 ","$6.65 ","$0.00 ","$8.03 ","$4.05 ","$0.00 ","$1.87 ","$0.00 ","$0.00 ","$1.41 ","$8.03 ","$0.00 ","$4.02 ","$6.36 ","$6.42 ","$0.00 ","$1.26 ","$0.00 ","$1.28 ","$0.00 "
"10577","ERX","HCPCS J2930","00009-0698-01","METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.41 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$59.41 ","$0.00 ","$0.00 ","$0.00 "
"10577","ERX","HCPCS J2930","25021-0810-30","METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.41 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$59.41 ","$0.00 ","$0.00 ","$0.00 "
"10577","ERX","HCPCS J2930","63323-0265-30","METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.41 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$59.41 ","$0.00 ","$0.00 ","$0.00 "
"10578","ERX","HCPCS J2930","00009-0047-22","METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR","BOTH IP/OP","$31.33 ","$23.18 ","$0.00 ","$28.28 ","$14.10 ","$0.00 ","$3.71 ","$0.00 ","$0.00 ","$7.43 ","$28.28 ","$0.00 ","$14.14 ","$22.40 ","$22.62 ","$0.00 ","$7.43 ","$0.00 ","$7.07 ","$0.00 "
"10578","ERX","HCPCS J2930","00009-0047-26","METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR","BOTH IP/OP","$31.33 ","$23.18 ","$0.00 ","$28.28 ","$14.10 ","$0.00 ","$3.71 ","$0.00 ","$0.00 ","$7.43 ","$28.28 ","$0.00 ","$14.14 ","$22.40 ","$22.62 ","$0.00 ","$7.43 ","$0.00 ","$7.07 ","$0.00 "
"10578","ERX","HCPCS J2930","00009-0047-27","METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR","BOTH IP/OP","$31.33 ","$23.18 ","$0.00 ","$28.28 ","$14.10 ","$0.00 ","$3.71 ","$0.00 ","$0.00 ","$7.43 ","$28.28 ","$0.00 ","$14.14 ","$22.40 ","$22.62 ","$0.00 ","$7.43 ","$0.00 ","$7.07 ","$0.00 "
"10580","ERX","HCPCS J2920","00009-0039-28","METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.64 ","$0.00 ","$0.00 ","$5.38 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.38 ","$0.00 ","$5.12 ","$0.00 "
"10580","ERX","HCPCS J2920","00009-0039-32","METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.64 ","$0.00 ","$0.00 ","$5.38 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.38 ","$0.00 ","$5.12 ","$0.00 "
"10580","ERX","HCPCS J2920","00009-0039-33","METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.64 ","$0.00 ","$0.00 ","$5.38 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.38 ","$0.00 ","$5.12 ","$0.00 "
"10581","ERX","HCPCS J2930","00009-0003-02","METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR","BOTH IP/OP","$112.49 ","$83.24 ","$0.00 ","$97.09 ","$50.62 ","$0.00 ","$14.85 ","$0.00 ","$0.00 ","$29.70 ","$97.09 ","$0.00 ","$48.55 ","$76.90 ","$77.67 ","$0.00 ","$29.70 ","$0.00 ","$28.28 ","$0.00 "
"10581","ERX","HCPCS J2930","00009-0758-01","METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR","BOTH IP/OP","$112.49 ","$83.24 ","$0.00 ","$97.09 ","$50.62 ","$0.00 ","$14.85 ","$0.00 ","$0.00 ","$29.70 ","$97.09 ","$0.00 ","$48.55 ","$76.90 ","$77.67 ","$0.00 ","$29.70 ","$0.00 ","$28.28 ","$0.00 "
"10586","ERX","HCPCS 63700001","00185-5600-01","METOLAZONE 10 MG PO TABS","BOTH IP/OP","$11.82 ","$8.75 ","$0.00 ","$10.72 ","","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.72 ","$0.00 ","$5.36 ","$8.49 ","$8.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10586","ERX","HCPCS 63700001","00378-6174-01","METOLAZONE 10 MG PO TABS","BOTH IP/OP","$11.82 ","$8.75 ","$0.00 ","$10.72 ","","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.72 ","$0.00 ","$5.36 ","$8.49 ","$8.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10586","ERX","HCPCS 63700001","00527-2217-37","METOLAZONE 10 MG PO TABS","BOTH IP/OP","$11.82 ","$8.75 ","$0.00 ","$10.72 ","","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.72 ","$0.00 ","$5.36 ","$8.49 ","$8.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10586","ERX","HCPCS 63700001","65580-0645-71","METOLAZONE 10 MG PO TABS","BOTH IP/OP","$11.82 ","$8.75 ","$0.00 ","$10.72 ","","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.72 ","$0.00 ","$5.36 ","$8.49 ","$8.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10587","ERX","HCPCS 63700001","00185-5050-01","METOLAZONE 2.5 MG PO TABS","BOTH IP/OP","$10.27 ","$7.60 ","$0.00 ","$9.31 ","","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.31 ","$0.00 ","$4.66 ","$7.37 ","$7.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10587","ERX","HCPCS 63700001","00378-6172-01","METOLAZONE 2.5 MG PO TABS","BOTH IP/OP","$10.27 ","$7.60 ","$0.00 ","$9.31 ","","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.31 ","$0.00 ","$4.66 ","$7.37 ","$7.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10587","ERX","HCPCS 63700001","00527-2215-37","METOLAZONE 2.5 MG PO TABS","BOTH IP/OP","$10.27 ","$7.60 ","$0.00 ","$9.31 ","","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.31 ","$0.00 ","$4.66 ","$7.37 ","$7.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10588","ERX","HCPCS 63700001","00185-0055-01","METOLAZONE 5 MG PO TABS","BOTH IP/OP","$11.67 ","$8.64 ","$0.00 ","$10.58 ","","$2.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10588","ERX","HCPCS 63700001","00378-6173-01","METOLAZONE 5 MG PO TABS","BOTH IP/OP","$11.67 ","$8.64 ","$0.00 ","$10.58 ","","$2.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10588","ERX","HCPCS 63700001","00527-2216-37","METOLAZONE 5 MG PO TABS","BOTH IP/OP","$11.67 ","$8.64 ","$0.00 ","$10.58 ","","$2.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10592","ERX","HCPCS 63700001","00245-0860-70","METRONIDAZOLE 0.75 % VA GEL","BOTH IP/OP","$547.79 ","$405.36 ","$0.00 ","$497.25 ","","$97.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.25 ","$0.00 ","$248.63 ","$393.82 ","$397.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10592","ERX","HCPCS 63700001","00781-7077-87","METRONIDAZOLE 0.75 % VA GEL","BOTH IP/OP","$547.79 ","$405.36 ","$0.00 ","$497.25 ","","$97.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.25 ","$0.00 ","$248.63 ","$393.82 ","$397.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10594","ERX","HCPCS 63700001","25010-0305-15","METYROSINE 250 MG PO CAPS","BOTH IP/OP","$1,309.85 ","$969.29 ","$0.00 ","$1,171.76 ","","$233.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,171.76 ","$0.00 ","$585.88 ","$928.03 ","$937.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10595","ERX","HCPCS 63700001","00093-8739-01","MEXILETINE HCL 150 MG PO CAPS","BOTH IP/OP","$10.63 ","$7.87 ","$0.00 ","$9.64 ","","$1.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.64 ","$0.00 ","$4.82 ","$7.63 ","$7.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10595","ERX","HCPCS 63700001","62559-0820-01","MEXILETINE HCL 150 MG PO CAPS","BOTH IP/OP","$10.63 ","$7.87 ","$0.00 ","$9.64 ","","$1.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.64 ","$0.00 ","$4.82 ","$7.63 ","$7.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10596","ERX","HCPCS 63700001","00093-8740-01","MEXILETINE HCL 200 MG PO CAPS","BOTH IP/OP","$12.69 ","$9.39 ","$0.00 ","$11.51 ","","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.51 ","$0.00 ","$5.76 ","$9.12 ","$9.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10608","ERX","HCPCS J2250","00409-2308-49","MIDAZOLAM HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.94 ","$0.00 ","$0.00 ","$0.71 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"10608","ERX","HCPCS J2250","00641-6061-25","MIDAZOLAM HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.94 ","$0.00 ","$0.00 ","$0.71 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"10609","ERX","HCPCS 63700001","00245-0211-11","MIDODRINE HCL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10609","ERX","HCPCS 63700001","42291-0560-90","MIDODRINE HCL 2.5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10610","ERX","HCPCS 63700001","00245-0212-01","MIDODRINE HCL 5 MG PO TABS","BOTH IP/OP","$17.42 ","$12.89 ","$0.00 ","$15.80 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.80 ","$0.00 ","$7.90 ","$12.51 ","$12.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10610","ERX","HCPCS 63700001","00245-0212-11","MIDODRINE HCL 5 MG PO TABS","BOTH IP/OP","$17.42 ","$12.89 ","$0.00 ","$15.80 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.80 ","$0.00 ","$7.90 ","$12.51 ","$12.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10610","ERX","HCPCS 63700001","00378-1902-01","MIDODRINE HCL 5 MG PO TABS","BOTH IP/OP","$17.42 ","$12.89 ","$0.00 ","$15.80 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.80 ","$0.00 ","$7.90 ","$12.51 ","$12.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10610","ERX","HCPCS 63700001","42291-0561-90","MIDODRINE HCL 5 MG PO TABS","BOTH IP/OP","$17.42 ","$12.89 ","$0.00 ","$15.80 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.80 ","$0.00 ","$7.90 ","$12.51 ","$12.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10610","ERX","HCPCS 63700001","51079-0453-20","MIDODRINE HCL 5 MG PO TABS","BOTH IP/OP","$17.42 ","$12.89 ","$0.00 ","$15.80 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.80 ","$0.00 ","$7.90 ","$12.51 ","$12.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10610","ERX","HCPCS 63700001","60505-1321-01","MIDODRINE HCL 5 MG PO TABS","BOTH IP/OP","$17.42 ","$12.89 ","$0.00 ","$15.80 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.80 ","$0.00 ","$7.90 ","$12.51 ","$12.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10612","ERX","HCPCS J2265","70842-0160-01","MINOCYCLINE HCL 100 MG IV SOLR","BOTH IP/OP","$564.56 ","$417.77 ","$0.00 ","$564.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.56 ","$0.00 ","$282.28 ","$447.13 ","$451.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10612","ERX","HCPCS J2265","70842-0160-10","MINOCYCLINE HCL 100 MG IV SOLR","BOTH IP/OP","$564.56 ","$417.77 ","$0.00 ","$564.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.56 ","$0.00 ","$282.28 ","$447.13 ","$451.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10628","ERX","HCPCS 63700001","00025-1451-34","MISOPROSTOL 100 MCG PO TABS","BOTH IP/OP","$10.39 ","$7.69 ","$0.00 ","$9.43 ","","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.43 ","$0.00 ","$4.72 ","$7.47 ","$7.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10628","ERX","HCPCS 63700001","43386-0160-06","MISOPROSTOL 100 MCG PO TABS","BOTH IP/OP","$10.39 ","$7.69 ","$0.00 ","$9.43 ","","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.43 ","$0.00 ","$4.72 ","$7.47 ","$7.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10628","ERX","HCPCS 63700001","59762-5007-01","MISOPROSTOL 100 MCG PO TABS","BOTH IP/OP","$10.39 ","$7.69 ","$0.00 ","$9.43 ","","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.43 ","$0.00 ","$4.72 ","$7.47 ","$7.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10628","ERX","HCPCS 63700001","68084-0040-01","MISOPROSTOL 100 MCG PO TABS","BOTH IP/OP","$10.39 ","$7.69 ","$0.00 ","$9.43 ","","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.43 ","$0.00 ","$4.72 ","$7.47 ","$7.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10629","ERX","HCPCS 63700001","00025-1461-60","MISOPROSTOL 200 MCG PO TABS","BOTH IP/OP","$26.38 ","$19.52 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.38 ","$0.00 ","$13.19 ","$20.89 ","$21.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10629","ERX","HCPCS 63700001","43386-0161-01","MISOPROSTOL 200 MCG PO TABS","BOTH IP/OP","$26.38 ","$19.52 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.38 ","$0.00 ","$13.19 ","$20.89 ","$21.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10629","ERX","HCPCS 63700001","59762-5008-01","MISOPROSTOL 200 MCG PO TABS","BOTH IP/OP","$26.38 ","$19.52 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.38 ","$0.00 ","$13.19 ","$20.89 ","$21.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10629","ERX","HCPCS 63700001","59762-5008-02","MISOPROSTOL 200 MCG PO TABS","BOTH IP/OP","$26.38 ","$19.52 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.38 ","$0.00 ","$13.19 ","$20.89 ","$21.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10629","ERX","HCPCS 63700001","68084-0041-01","MISOPROSTOL 200 MCG PO TABS","BOTH IP/OP","$26.38 ","$19.52 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.38 ","$0.00 ","$13.19 ","$20.89 ","$21.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10630","ERX","HCPCS J9280","16729-0108-11","MITOMYCIN 20 MG IV SOLR","BOTH IP/OP","$1,033.42 ","$764.73 ","$0.00 ","$937.87 ","$465.04 ","$101.33 ","$35.96 ","$0.00 ","$0.00 ","$187.74 ","$937.87 ","$184.27 ","$468.94 ","$742.79 ","$750.30 ","$254.47 ","$187.74 ","$0.00 ","$178.76 ","$114.42 "
"10631","ERX","HCPCS J9280","16729-0116-38","MITOMYCIN 40 MG IV SOLR","BOTH IP/OP","$1,033.42 ","$764.73 ","$0.00 ","$937.87 ","$465.04 ","$101.33 ","$35.96 ","$0.00 ","$0.00 ","$187.74 ","$937.87 ","$184.27 ","$468.94 ","$742.79 ","$750.30 ","$254.47 ","$187.74 ","$0.00 ","$178.76 ","$114.42 "
"10632","ERX","HCPCS J9280","16729-0115-05","MITOMYCIN 5 MG IV SOLR","BOTH IP/OP","$1,411.35 ","$1,044.40 ","$0.00 ","$1,307.81 ","$635.11 ","$101.33 ","$35.96 ","$0.00 ","$0.00 ","$187.74 ","$1,307.81 ","$184.27 ","$653.91 ","$1,035.79 ","$1,046.25 ","$254.47 ","$187.74 ","$0.00 ","$178.76 ","$114.42 "
"10646","ERX","HCPCS 25000001","45802-0257-42","MOMETASONE FUROATE 0.1 % EX CREA","BOTH IP/OP","$183.64 ","$135.89 ","$0.00 ","$166.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.70 ","$0.00 ","$83.35 ","$132.03 ","$133.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10648","ERX","HCPCS 25000001","45802-0119-42","MOMETASONE FUROATE 0.1 % EX OINT","BOTH IP/OP","$172.14 ","$127.38 ","$0.00 ","$156.09 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.09 ","$0.00 ","$78.05 ","$123.62 ","$124.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10674","ERX","HCPCS 25000001","00093-1010-42","MUPIROCIN 2 % EX OINT","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10674","ERX","HCPCS 25000001","45802-0112-22","MUPIROCIN 2 % EX OINT","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10674","ERX","HCPCS 25000001","51672-1312-00","MUPIROCIN 2 % EX OINT","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10674","ERX","HCPCS 25000001","68462-0180-22","MUPIROCIN 2 % EX OINT","BOTH IP/OP","$47.11 ","$34.86 ","$0.00 ","$42.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.72 ","$0.00 ","$21.36 ","$33.83 ","$34.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10676","ERX","HCPCS 63700001","68462-0358-01","NABUMETONE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10685","ERX","HCPCS 63700001","00406-1170-03","DEPADE: NALTREXONE HCL 50 MG PO TABS","BOTH IP/OP","$17.92 ","$13.26 ","$0.00 ","$16.25 ","","$3.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.25 ","$0.00 ","$8.13 ","$12.87 ","$13.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10685","ERX","HCPCS 63700001","51224-0206-30","DEPADE: NALTREXONE HCL 50 MG PO TABS","BOTH IP/OP","$17.92 ","$13.26 ","$0.00 ","$16.25 ","","$3.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.25 ","$0.00 ","$8.13 ","$12.87 ","$13.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10692","ERX","HCPCS 25000001","00065-0645-15","NATAMYCIN 5 % OP SUSP","BOTH IP/OP","$1,046.74 ","$774.59 ","$0.00 ","$1,046.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,046.74 ","$0.00 ","$523.37 ","$829.02 ","$837.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10712","ERX","HCPCS 63700001","42806-0501-09","NICARDIPINE HCL 20 MG PO CAPS","BOTH IP/OP","$64.92 ","$48.04 ","$0.00 ","$58.88 ","","$11.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.88 ","$0.00 ","$29.44 ","$46.63 ","$47.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10722","ERX","HCPCS 63700001","23155-0512-00","NIMODIPINE 30 MG PO CAPS","BOTH IP/OP","$28.90 ","$21.39 ","$0.00 ","$26.21 ","","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.21 ","$0.00 ","$13.11 ","$20.76 ","$20.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10722","ERX","HCPCS 63700001","23155-0512-11","NIMODIPINE 30 MG PO CAPS","BOTH IP/OP","$28.90 ","$21.39 ","$0.00 ","$26.21 ","","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.21 ","$0.00 ","$13.11 ","$20.76 ","$20.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10722","ERX","HCPCS 63700001","23155-0512-30","NIMODIPINE 30 MG PO CAPS","BOTH IP/OP","$28.90 ","$21.39 ","$0.00 ","$26.21 ","","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.21 ","$0.00 ","$13.11 ","$20.76 ","$20.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10722","ERX","HCPCS 63700001","63739-0797-33","NIMODIPINE 30 MG PO CAPS","BOTH IP/OP","$28.90 ","$21.39 ","$0.00 ","$26.21 ","","$5.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.21 ","$0.00 ","$13.11 ","$20.76 ","$20.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10724","ERX","HCPCS 63700001","00185-0122-01","NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS","BOTH IP/OP","$14.82 ","$10.97 ","$0.00 ","$13.44 ","","$2.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.44 ","$0.00 ","$6.72 ","$10.64 ","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10724","ERX","HCPCS 63700001","16714-0439-01","NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS","BOTH IP/OP","$14.82 ","$10.97 ","$0.00 ","$13.44 ","","$2.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.44 ","$0.00 ","$6.72 ","$10.64 ","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10724","ERX","HCPCS 63700001","68084-0446-01","NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS","BOTH IP/OP","$14.82 ","$10.97 ","$0.00 ","$13.44 ","","$2.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.44 ","$0.00 ","$6.72 ","$10.64 ","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10747","ERX","HCPCS 63700001","00555-0211-10","NORETHINDRONE ACETATE 5 MG PO TABS","BOTH IP/OP","$11.10 ","$8.21 ","$0.00 ","$10.07 ","","$1.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.07 ","$0.00 ","$5.04 ","$7.98 ","$8.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10747","ERX","HCPCS 63700001","51285-0424-10","NORETHINDRONE ACETATE 5 MG PO TABS","BOTH IP/OP","$11.10 ","$8.21 ","$0.00 ","$10.07 ","","$1.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.07 ","$0.00 ","$5.04 ","$7.98 ","$8.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10747","ERX","HCPCS 63700001","65162-0475-05","NORETHINDRONE ACETATE 5 MG PO TABS","BOTH IP/OP","$11.10 ","$8.21 ","$0.00 ","$10.07 ","","$1.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.07 ","$0.00 ","$5.04 ","$7.98 ","$8.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10749","ERX","HCPCS 63700001","16714-0360-01","NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10749","ERX","HCPCS 63700001","16714-0360-04","NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10749","ERX","HCPCS 63700001","99999-6009-94","NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10752","ERX","HCPCS 63700001","16714-0365-04","NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG PO TABS","BOTH IP/OP","$117.81 ","$87.18 ","$0.00 ","$106.82 ","","$20.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.82 ","$0.00 ","$53.41 ","$84.60 ","$85.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10778","ERX","HCPCS Q0162","00904-6551-61","ONDANSETRON HCL 4 MG PO TABS","BOTH IP/OP","$86.73 ","$64.18 ","$0.00 ","$86.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.19 ","$86.73 ","$0.00 ","$43.37 ","$68.69 ","$69.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10778","ERX","HCPCS Q0162","55111-0153-30","ONDANSETRON HCL 4 MG PO TABS","BOTH IP/OP","$86.73 ","$64.18 ","$0.00 ","$86.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.19 ","$86.73 ","$0.00 ","$43.37 ","$68.69 ","$69.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10778","ERX","HCPCS Q0162","68084-0220-01","ONDANSETRON HCL 4 MG PO TABS","BOTH IP/OP","$86.73 ","$64.18 ","$0.00 ","$86.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.19 ","$86.73 ","$0.00 ","$43.37 ","$68.69 ","$69.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10778","ERX","HCPCS Q0162","68084-0220-11","ONDANSETRON HCL 4 MG PO TABS","BOTH IP/OP","$86.73 ","$64.18 ","$0.00 ","$86.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.19 ","$86.73 ","$0.00 ","$43.37 ","$68.69 ","$69.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10779","ERX","HCPCS Q0162","00904-6552-61","ONDANSETRON HCL 8 MG PO TABS","BOTH IP/OP","$144.41 ","$106.86 ","$0.00 ","$144.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.29 ","$144.41 ","$0.00 ","$72.21 ","$114.37 ","$115.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10779","ERX","HCPCS Q0162","55111-0154-30","ONDANSETRON HCL 8 MG PO TABS","BOTH IP/OP","$144.41 ","$106.86 ","$0.00 ","$144.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.29 ","$144.41 ","$0.00 ","$72.21 ","$114.37 ","$115.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10779","ERX","HCPCS Q0162","62756-0131-01","ONDANSETRON HCL 8 MG PO TABS","BOTH IP/OP","$144.41 ","$106.86 ","$0.00 ","$144.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.29 ","$144.41 ","$0.00 ","$72.21 ","$114.37 ","$115.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10779","ERX","HCPCS Q0162","63304-0459-30","ONDANSETRON HCL 8 MG PO TABS","BOTH IP/OP","$144.41 ","$106.86 ","$0.00 ","$144.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.29 ","$144.41 ","$0.00 ","$72.21 ","$114.37 ","$115.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10779","ERX","HCPCS Q0162","63739-0333-10","ONDANSETRON HCL 8 MG PO TABS","BOTH IP/OP","$144.41 ","$106.86 ","$0.00 ","$144.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.29 ","$144.41 ","$0.00 ","$72.21 ","$114.37 ","$115.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10779","ERX","HCPCS Q0162","68084-0221-01","ONDANSETRON HCL 8 MG PO TABS","BOTH IP/OP","$144.41 ","$106.86 ","$0.00 ","$144.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.29 ","$144.41 ","$0.00 ","$72.21 ","$114.37 ","$115.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10803","ERX","HCPCS 63700001","00245-0271-11","OXANDROLONE 2.5 MG PO TABS","BOTH IP/OP","$23.18 ","$17.15 ","$0.00 ","$21.02 ","","$4.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.02 ","$0.00 ","$10.51 ","$16.65 ","$16.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10803","ERX","HCPCS 63700001","49884-0301-01","OXANDROLONE 2.5 MG PO TABS","BOTH IP/OP","$23.18 ","$17.15 ","$0.00 ","$21.02 ","","$4.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.02 ","$0.00 ","$10.51 ","$16.65 ","$16.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10810","ERX","HCPCS 63700001","99999-6004-78","OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$163.90 ","","$9.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.90 ","$0.00 ","$81.95 ","$37.92 ","$131.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10810","ERX","HCPCS 63700001","54838-0510-80","OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$163.90 ","","$9.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.90 ","$0.00 ","$81.95 ","$129.81 ","$131.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10810","ERX","HCPCS 63700001","60432-0092-16","OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$163.90 ","","$9.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.90 ","$0.00 ","$81.95 ","$129.81 ","$131.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10811","ERX","HCPCS 25000001","00327-0001-10","OXYCHLOROSENE SODIUM POWD","BOTH IP/OP","$25.98 ","$19.23 ","$0.00 ","$23.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.56 ","$0.00 ","$11.78 ","$18.66 ","$18.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10812","ERX","HCPCS 25000001","00406-8557-30","OXYCODONE HCL 100 MG/5ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10812","ERX","HCPCS 25000001","66689-0025-30","OXYCODONE HCL 100 MG/5ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10812","ERX","HCPCS 25000001","68308-0020-03","OXYCODONE HCL 100 MG/5ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10812","ERX","HCPCS 25000001","99999-6005-57","OXYCODONE HCL 100 MG/5ML PO CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10813","ERX","HCPCS 25000001","00054-0390-63","OXYCODONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$36.14 ","$26.74 ","$0.00 ","$32.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.78 ","$0.00 ","$16.39 ","$25.96 ","$26.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10813","ERX","HCPCS 25000001","66689-0401-01","OXYCODONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$36.14 ","$26.74 ","$0.00 ","$32.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.78 ","$0.00 ","$16.39 ","$25.96 ","$26.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10813","ERX","HCPCS 25000001","66689-0401-50","OXYCODONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$36.14 ","$26.74 ","$0.00 ","$32.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.78 ","$0.00 ","$16.39 ","$25.96 ","$26.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10813","ERX","HCPCS 25000001","66689-0403-16","OXYCODONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$36.14 ","$26.74 ","$0.00 ","$32.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.78 ","$0.00 ","$16.39 ","$25.96 ","$26.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10813","ERX","HCPCS 25000001","99999-6004-35","OXYCODONE HCL 5 MG/5ML PO SOLN","BOTH IP/OP","$36.14 ","$26.74 ","$0.00 ","$32.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.78 ","$0.00 ","$16.39 ","$25.96 ","$26.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10814","ERX","HCPCS 25000001","00406-0552-23","OXYCODONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10814","ERX","HCPCS 25000001","00406-0552-62","OXYCODONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10814","ERX","HCPCS 25000001","42858-0001-10","OXYCODONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10814","ERX","HCPCS 25000001","57664-0223-88","OXYCODONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10814","ERX","HCPCS 25000001","68084-0354-01","OXYCODONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10814","ERX","HCPCS 25000001","68084-0354-11","OXYCODONE HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10839","ERX","HCPCS 63700001","52268-0100-01","PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR","BOTH IP/OP","$83.80 ","$62.01 ","$0.00 ","$76.00 ","","$14.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.00 ","$0.00 ","$38.00 ","$48.15 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10839","ERX","HCPCS 63700001","52268-0101-01","PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR","BOTH IP/OP","$83.80 ","$62.01 ","$0.00 ","$76.00 ","","$14.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.00 ","$0.00 ","$38.00 ","$48.15 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10845","ERX","HCPCS J2430","59923-0601-10","PAMIDRONATE DISODIUM 30 MG IV SOLR","BOTH IP/OP","$78.93 ","$58.41 ","$0.00 ","$78.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.82 ","$78.93 ","$0.00 ","$39.47 ","$62.51 ","$63.14 ","$0.00 ","$12.35 ","$0.00 ","$12.57 ","$0.00 "
"10854","ERX","HCPCS 63700001","23155-0038-01","PAROMOMYCIN SULFATE 250 MG PO CAPS","BOTH IP/OP","$23.76 ","$17.58 ","$0.00 ","$21.55 ","","$4.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.55 ","$0.00 ","$10.78 ","$17.07 ","$17.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","00904-5677-61","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","13107-0155-30","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","51079-0774-01","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","51079-0774-20","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","63739-0963-10","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","63874-0538-10","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","68084-0045-01","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","68084-0045-11","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10855","ERX","HCPCS 63700001","68382-0098-06","PAROXETINE HCL 20 MG PO TABS","BOTH IP/OP","$10.37 ","$7.67 ","$0.00 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.37 ","$0.00 ","$5.19 ","$8.21 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10856","ERX","HCPCS 63700001","13107-0156-30","PAROXETINE HCL 30 MG PO TABS","BOTH IP/OP","$10.38 ","$7.68 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.38 ","$0.00 ","$5.19 ","$8.22 ","$8.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10897","ERX","HCPCS J0561","60793-0700-10","PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSP","BOTH IP/OP","$440.87 ","$326.24 ","$0.00 ","$363.81 ","$198.39 ","$90.26 ","$91.89 ","$0.00 ","$0.00 ","$97.01 ","$363.81 ","$87.07 ","$181.91 ","$288.14 ","$291.05 ","$120.23 ","$97.01 ","$0.00 ","$92.37 ","$82.92 "
"10910","ERX","HCPCS J9268","00409-0801-01","PENTOSTATIN 10 MG IV SOLR","BOTH IP/OP","$6,614.75 ","$4,894.92 ","$0.00 ","$5,427.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,427.52 ","$0.00 ","$2,713.76 ","$4,298.60 ","$4,342.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10917","ERX","HCPCS 25000001","00472-0242-60","PERMETHRIN 5 % EX CREA","BOTH IP/OP","$415.91 ","$307.77 ","$0.00 ","$377.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$377.53 ","$0.00 ","$188.77 ","$299.00 ","$302.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10917","ERX","HCPCS 25000001","16714-0897-01","PERMETHRIN 5 % EX CREA","BOTH IP/OP","$415.91 ","$307.77 ","$0.00 ","$377.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$377.53 ","$0.00 ","$188.77 ","$299.00 ","$302.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10917","ERX","HCPCS 25000001","45802-0269-37","PERMETHRIN 5 % EX CREA","BOTH IP/OP","$415.91 ","$307.77 ","$0.00 ","$377.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$377.53 ","$0.00 ","$188.77 ","$299.00 ","$302.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10918","ERX","HCPCS 25000001","63736-0120-03","PERMETHRIN 1 % EX LIQD","BOTH IP/OP","$42.28 ","$31.29 ","$0.00 ","$38.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.34 ","$0.00 ","$19.17 ","$24.33 ","$30.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10933","ERX","HCPCS 63700001","59762-0119-01","PHENELZINE SULFATE 15 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10945","ERX","HCPCS 63700001","49884-0038-01","PHENOXYBENZAMINE HCL 10 MG PO CAPS","BOTH IP/OP","$434.94 ","$321.86 ","$0.00 ","$394.81 ","","$77.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$394.81 ","$0.00 ","$197.41 ","$312.69 ","$315.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10945","ERX","HCPCS 63700001","59212-0001-01","PHENOXYBENZAMINE HCL 10 MG PO CAPS","BOTH IP/OP","$434.94 ","$321.86 ","$0.00 ","$394.81 ","","$77.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$394.81 ","$0.00 ","$197.41 ","$312.69 ","$315.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10947","ERX","HCPCS J2760","00143-9564-01","PHENTOLAMINE MESYLATE 5 MG IJ SOLR","BOTH IP/OP","$1,385.60 ","$1,025.34 ","$0.00 ","$1,283.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,283.96 ","$0.00 ","$641.98 ","$1,016.90 ","$1,027.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10947","ERX","HCPCS J2760","00143-9564-10","PHENTOLAMINE MESYLATE 5 MG IJ SOLR","BOTH IP/OP","$1,385.60 ","$1,025.34 ","$0.00 ","$1,283.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,283.96 ","$0.00 ","$641.98 ","$1,016.90 ","$1,027.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11018","ERX","HCPCS 63700001","00071-0007-40","PHENYTOIN 50 MG PO CHEW","BOTH IP/OP","$9.55 ","$7.07 ","$0.00 ","$8.25 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.25 ","$0.00 ","$4.13 ","$6.53 ","$6.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11018","ERX","HCPCS 63700001","51672-4146-01","PHENYTOIN 50 MG PO CHEW","BOTH IP/OP","$9.55 ","$7.07 ","$0.00 ","$8.25 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.25 ","$0.00 ","$4.13 ","$6.53 ","$6.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11019","ERX","HCPCS 63700001","00071-3740-66","PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS","BOTH IP/OP","$6.19 ","$4.58 ","$0.00 ","$6.00 ","","$1.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11024","ERX","HCPCS 63700001","00187-1704-05","PHYTONADIONE 5 MG PO TABS","BOTH IP/OP","$244.68 ","$181.06 ","$0.00 ","$222.12 ","","$43.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.12 ","$0.00 ","$111.06 ","$175.92 ","$177.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11024","ERX","HCPCS 63700001","68682-0170-30","PHYTONADIONE 5 MG PO TABS","BOTH IP/OP","$244.68 ","$181.06 ","$0.00 ","$222.12 ","","$43.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.12 ","$0.00 ","$111.06 ","$175.92 ","$177.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11037","ERX","HCPCS 90732","00006-4837-01","PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ","BOTH IP/OP","$472.08 ","$349.34 ","$0.00 ","$385.01 ","$212.44 ","$119.92 ","$9.40 ","$0.00 ","$0.00 ","$134.20 ","$385.01 ","$56.21 ","$192.51 ","$304.93 ","$308.01 ","$56.21 ","$134.20 ","$105.11 ","$127.78 ","$105.11 "
"11037","ERX","HCPCS 90732","00006-4837-03","PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ","BOTH IP/OP","$472.08 ","$349.34 ","$0.00 ","$385.01 ","$212.44 ","$119.92 ","$9.40 ","$0.00 ","$0.00 ","$134.20 ","$385.01 ","$56.21 ","$192.51 ","$304.93 ","$308.01 ","$56.21 ","$134.20 ","$105.11 ","$127.78 ","$105.11 "
"11038","ERX","HCPCS 25000001","00574-0611-05","PODOFILOX 0.5 % EX SOLN","BOTH IP/OP","$363.39 ","$268.91 ","$0.00 ","$329.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.86 ","$0.00 ","$164.93 ","$261.25 ","$263.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11038","ERX","HCPCS 25000001","00591-3204-13","PODOFILOX 0.5 % EX SOLN","BOTH IP/OP","$363.39 ","$268.91 ","$0.00 ","$329.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.86 ","$0.00 ","$164.93 ","$261.25 ","$263.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11058","ERX","HCPCS 25000001","60258-0002-16","K & NA CIT-CIT AC 550-500-334 MG/5ML PO SYRP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11074","ERX","HCPCS J3480","00338-0709-48","POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","BOTH IP/OP","$24.31 ","$17.99 ","$0.00 ","$22.00 ","$10.94 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$0.82 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.82 ","$0.00 ","$0.78 ","$0.00 "
"11076","ERX","HCPCS J3480","00338-0705-48","POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"11076","ERX","HCPCS J3480","00990-7075-26","POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"11083","ERX","HCPCS 63700001","00245-0071-11","POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TBCR","BOTH IP/OP","$11.56 ","$8.55 ","$0.00 ","$10.49 ","","$2.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.49 ","$0.00 ","$5.25 ","$8.31 ","$8.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11087","ERX","HCPCS 25000001","00486-1111-01","POTASSIUM PHOSPHATE MONOBASIC 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11110","ERX","HCPCS 63700001","00093-0771-98","PRAVASTATIN SODIUM 10 MG PO TABS","BOTH IP/OP","$13.48 ","$9.98 ","$0.00 ","$12.22 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.22 ","$0.00 ","$6.11 ","$9.68 ","$9.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11110","ERX","HCPCS 63700001","00904-5891-61","PRAVASTATIN SODIUM 10 MG PO TABS","BOTH IP/OP","$13.48 ","$9.98 ","$0.00 ","$12.22 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.22 ","$0.00 ","$6.11 ","$9.68 ","$9.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11110","ERX","HCPCS 63700001","60505-0168-09","PRAVASTATIN SODIUM 10 MG PO TABS","BOTH IP/OP","$13.48 ","$9.98 ","$0.00 ","$12.22 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.22 ","$0.00 ","$6.11 ","$9.68 ","$9.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11110","ERX","HCPCS 63700001","68462-0195-90","PRAVASTATIN SODIUM 10 MG PO TABS","BOTH IP/OP","$13.48 ","$9.98 ","$0.00 ","$12.22 ","","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.22 ","$0.00 ","$6.11 ","$9.68 ","$9.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11111","ERX","HCPCS 63700001","00093-7201-98","PRAVASTATIN SODIUM 20 MG PO TABS","BOTH IP/OP","$10.46 ","$7.74 ","$0.00 ","$9.49 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11111","ERX","HCPCS 63700001","00904-5892-61","PRAVASTATIN SODIUM 20 MG PO TABS","BOTH IP/OP","$10.46 ","$7.74 ","$0.00 ","$9.49 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11111","ERX","HCPCS 63700001","16729-0009-15","PRAVASTATIN SODIUM 20 MG PO TABS","BOTH IP/OP","$10.46 ","$7.74 ","$0.00 ","$9.49 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11111","ERX","HCPCS 63700001","51079-0458-01","PRAVASTATIN SODIUM 20 MG PO TABS","BOTH IP/OP","$10.46 ","$7.74 ","$0.00 ","$9.49 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11111","ERX","HCPCS 63700001","51079-0458-20","PRAVASTATIN SODIUM 20 MG PO TABS","BOTH IP/OP","$10.46 ","$7.74 ","$0.00 ","$9.49 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11111","ERX","HCPCS 63700001","63739-0649-10","PRAVASTATIN SODIUM 20 MG PO TABS","BOTH IP/OP","$10.46 ","$7.74 ","$0.00 ","$9.49 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11112","ERX","HCPCS 63700001","00904-5893-61","PRAVASTATIN SODIUM 40 MG PO TABS","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$16.32 ","","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.32 ","$0.00 ","$8.16 ","$12.93 ","$13.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11112","ERX","HCPCS 63700001","55111-0231-05","PRAVASTATIN SODIUM 40 MG PO TABS","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$16.32 ","","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.32 ","$0.00 ","$8.16 ","$12.93 ","$13.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11112","ERX","HCPCS 63700001","68462-0197-90","PRAVASTATIN SODIUM 40 MG PO TABS","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$16.32 ","","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.32 ","$0.00 ","$8.16 ","$12.93 ","$13.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11113","ERX","HCPCS 63700001","50419-0747-01","PRAZIQUANTEL 600 MG PO TABS","BOTH IP/OP","$345.78 ","$255.88 ","$0.00 ","$313.89 ","","$61.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$313.89 ","$0.00 ","$156.95 ","$248.60 ","$251.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11129","ERX","HCPCS 63700001","53746-0544-01","PRIMIDONE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11129","ERX","HCPCS 63700001","68084-0202-01","PRIMIDONE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11129","ERX","HCPCS 63700001","68084-0202-11","PRIMIDONE 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11138","ERX","HCPCS 25000001","00574-7226-12","PROCHLORPERAZINE 25 MG RECTAL SUPP","BOTH IP/OP","$52.73 ","$39.02 ","$0.00 ","$47.82 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.82 ","$0.00 ","$23.91 ","$37.87 ","$38.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11143","ERX","HCPCS 25000001","00713-0536-06","PROMETHAZINE HCL 12.5 MG RECTAL SUPP","BOTH IP/OP","$74.19 ","$54.90 ","$0.00 ","$67.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.28 ","$0.00 ","$33.64 ","$53.29 ","$53.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11143","ERX","HCPCS 25000001","00713-0536-12","PROMETHAZINE HCL 12.5 MG RECTAL SUPP","BOTH IP/OP","$74.19 ","$54.90 ","$0.00 ","$67.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.28 ","$0.00 ","$33.64 ","$53.29 ","$53.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11143","ERX","HCPCS 25000001","45802-0758-30","PROMETHAZINE HCL 12.5 MG RECTAL SUPP","BOTH IP/OP","$74.19 ","$54.90 ","$0.00 ","$67.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.28 ","$0.00 ","$33.64 ","$53.29 ","$53.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11144","ERX","HCPCS 25000001","00713-0526-12","PROMETHAZINE HCL 25 MG RECTAL SUPP","BOTH IP/OP","$74.19 ","$54.90 ","$0.00 ","$67.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.28 ","$0.00 ","$33.64 ","$53.29 ","$53.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11144","ERX","HCPCS 25000001","45802-0759-30","PROMETHAZINE HCL 25 MG RECTAL SUPP","BOTH IP/OP","$74.19 ","$54.90 ","$0.00 ","$67.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.28 ","$0.00 ","$33.64 ","$53.29 ","$53.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11144","ERX","HCPCS 25000001","51672-5297-01","PROMETHAZINE HCL 25 MG RECTAL SUPP","BOTH IP/OP","$74.19 ","$54.90 ","$0.00 ","$67.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.28 ","$0.00 ","$33.64 ","$53.29 ","$53.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11146","ERX","HCPCS 63700001","00591-0582-01","PROPAFENONE HCL 150 MG PO TABS","BOTH IP/OP","$6.40 ","$4.74 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.40 ","$0.00 ","$3.20 ","$5.07 ","$5.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11146","ERX","HCPCS 63700001","53489-0551-01","PROPAFENONE HCL 150 MG PO TABS","BOTH IP/OP","$6.40 ","$4.74 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.40 ","$0.00 ","$3.20 ","$5.07 ","$5.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11146","ERX","HCPCS 63700001","62559-0230-01","PROPAFENONE HCL 150 MG PO TABS","BOTH IP/OP","$6.40 ","$4.74 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.40 ","$0.00 ","$3.20 ","$5.07 ","$5.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11146","ERX","HCPCS 63700001","63739-0509-10","PROPAFENONE HCL 150 MG PO TABS","BOTH IP/OP","$6.40 ","$4.74 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.40 ","$0.00 ","$3.20 ","$5.07 ","$5.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11147","ERX","HCPCS 63700001","00591-0583-01","PROPAFENONE HCL 225 MG PO TABS","BOTH IP/OP","$9.77 ","$7.23 ","$0.00 ","$8.86 ","","$1.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.86 ","$0.00 ","$4.43 ","$7.02 ","$7.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11147","ERX","HCPCS 63700001","00603-5449-21","PROPAFENONE HCL 225 MG PO TABS","BOTH IP/OP","$9.77 ","$7.23 ","$0.00 ","$8.86 ","","$1.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.86 ","$0.00 ","$4.43 ","$7.02 ","$7.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11147","ERX","HCPCS 63700001","53489-0552-01","PROPAFENONE HCL 225 MG PO TABS","BOTH IP/OP","$9.77 ","$7.23 ","$0.00 ","$8.86 ","","$1.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.86 ","$0.00 ","$4.43 ","$7.02 ","$7.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11164","ERX","HCPCS 63700001","00054-0210-25","PROTRIPTYLINE HCL 5 MG PO TABS","BOTH IP/OP","$24.03 ","$17.78 ","$0.00 ","$21.79 ","","$4.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.79 ","$0.00 ","$10.90 ","$17.26 ","$17.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11164","ERX","HCPCS 63700001","64980-0158-01","PROTRIPTYLINE HCL 5 MG PO TABS","BOTH IP/OP","$24.03 ","$17.78 ","$0.00 ","$21.79 ","","$4.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.79 ","$0.00 ","$10.90 ","$17.26 ","$17.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11217","ERX","HCPCS 63700001","37000-0023-04","PSYLLIUM 28 % PO PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11217","ERX","HCPCS 63700001","37000-0740-87","PSYLLIUM 28 % PO PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11239","ERX","HCPCS 63700001","00115-3511-01","PYRIDOSTIGMINE BROMIDE 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11239","ERX","HCPCS 63700001","68682-0302-10","PYRIDOSTIGMINE BROMIDE 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11240","ERX","HCPCS 63700001","00115-1404-08","PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR","BOTH IP/OP","$95.76 ","$70.86 ","$0.00 ","$86.83 ","","$17.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.83 ","$0.00 ","$43.42 ","$68.77 ","$69.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11240","ERX","HCPCS 63700001","00187-3013-30","PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR","BOTH IP/OP","$95.76 ","$70.86 ","$0.00 ","$86.83 ","","$17.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.83 ","$0.00 ","$43.42 ","$68.77 ","$69.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11240","ERX","HCPCS 63700001","47781-0335-30","PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR","BOTH IP/OP","$95.76 ","$70.86 ","$0.00 ","$86.83 ","","$17.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.83 ","$0.00 ","$43.42 ","$68.77 ","$69.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11240","ERX","HCPCS 63700001","64980-0220-03","PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR","BOTH IP/OP","$95.76 ","$70.86 ","$0.00 ","$86.83 ","","$17.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.83 ","$0.00 ","$43.42 ","$68.77 ","$69.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11246","ERX","HCPCS 63700001","69413-0330-10","PYRIMETHAMINE 25 MG PO TABS","BOTH IP/OP","$4,068.00 ","$3,010.32 ","$0.00 ","$3,690.00 ","","$724.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,690.00 ","$0.00 ","$1,845.00 ","$2,922.48 ","$2,952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11246","ERX","HCPCS 63700001","69413-0330-30","PYRIMETHAMINE 25 MG PO TABS","BOTH IP/OP","$4,068.00 ","$3,010.32 ","$0.00 ","$3,690.00 ","","$724.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,690.00 ","$0.00 ","$1,845.00 ","$2,922.48 ","$2,952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11257","ERX","HCPCS 90675","49281-0250-51","RABIES VIRUS VACCINE, HDC IM INJ","BOTH IP/OP","$1,419.71 ","$1,050.59 ","$0.00 ","$1,189.85 ","$0.00 ","$0.00 ","$174.76 ","$0.00 ","$0.00 ","$326.44 ","$1,189.85 ","$312.47 ","$594.93 ","$942.36 ","$951.88 ","$431.50 ","$326.44 ","$0.00 ","$310.83 ","$294.72 "
"11259","ERX","HCPCS 63700001","68180-0591-01","RAMIPRIL 10 MG PO CAPS","BOTH IP/OP","$9.29 ","$6.87 ","$0.00 ","$9.01 ","","$1.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.01 ","$0.00 ","$4.51 ","$7.14 ","$7.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11286","ERX","HCPCS 63700001","65862-0290-84","RIBAVIRIN 200 MG PO CAPS","BOTH IP/OP","$41.63 ","$30.81 ","$0.00 ","$37.75 ","","$7.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.75 ","$0.00 ","$18.88 ","$29.90 ","$30.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11286","ERX","HCPCS 63700001","68382-0260-12","RIBAVIRIN 200 MG PO CAPS","BOTH IP/OP","$41.63 ","$30.81 ","$0.00 ","$37.75 ","","$7.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.75 ","$0.00 ","$18.88 ","$29.90 ","$30.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11290","ERX","HCPCS 63700001","00013-5301-17","RIFABUTIN 150 MG PO CAPS","BOTH IP/OP","$90.12 ","$66.69 ","$0.00 ","$80.50 ","","$16.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.50 ","$0.00 ","$40.25 ","$63.76 ","$64.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11290","ERX","HCPCS 63700001","59762-1350-01","RIFABUTIN 150 MG PO CAPS","BOTH IP/OP","$90.12 ","$66.69 ","$0.00 ","$80.50 ","","$16.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.50 ","$0.00 ","$40.25 ","$63.76 ","$64.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11291","ERX","HCPCS 25000001","00068-0597-01","RIFAMPIN 600 MG IV SOLR","BOTH IP/OP","$359.98 ","$266.39 ","$0.00 ","$326.77 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.77 ","$0.00 ","$163.39 ","$258.80 ","$261.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11291","ERX","HCPCS 25000001","00068-0599-01","RIFAMPIN 600 MG IV SOLR","BOTH IP/OP","$359.98 ","$266.39 ","$0.00 ","$326.77 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.77 ","$0.00 ","$163.39 ","$258.80 ","$261.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11291","ERX","HCPCS 25000001","63323-0351-20","RIFAMPIN 600 MG IV SOLR","BOTH IP/OP","$359.98 ","$266.39 ","$0.00 ","$326.77 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.77 ","$0.00 ","$163.39 ","$258.80 ","$261.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11291","ERX","HCPCS 25000001","67457-0445-60","RIFAMPIN 600 MG IV SOLR","BOTH IP/OP","$359.98 ","$266.39 ","$0.00 ","$326.77 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.77 ","$0.00 ","$163.39 ","$258.80 ","$261.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11293","ERX","HCPCS 63700001","00527-1315-01","RIFAMPIN 300 MG PO CAPS","BOTH IP/OP","$7.97 ","$5.90 ","$0.00 ","$7.23 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.23 ","$0.00 ","$3.62 ","$5.73 ","$5.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11293","ERX","HCPCS 63700001","00527-1315-06","RIFAMPIN 300 MG PO CAPS","BOTH IP/OP","$7.97 ","$5.90 ","$0.00 ","$7.23 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.23 ","$0.00 ","$3.62 ","$5.73 ","$5.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11293","ERX","HCPCS 63700001","61748-0018-01","RIFAMPIN 300 MG PO CAPS","BOTH IP/OP","$7.97 ","$5.90 ","$0.00 ","$7.23 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.23 ","$0.00 ","$3.62 ","$5.73 ","$5.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11293","ERX","HCPCS 63700001","63739-0415-10","RIFAMPIN 300 MG PO CAPS","BOTH IP/OP","$7.97 ","$5.90 ","$0.00 ","$7.23 ","","$2.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.23 ","$0.00 ","$3.62 ","$5.73 ","$5.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11308","ERX","HCPCS 25000001","11086-0030-10","SALICYLIC ACID 6 % EX GEL","BOTH IP/OP","$213.06 ","$157.66 ","$0.00 ","$193.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.41 ","$0.00 ","$96.71 ","$153.18 ","$154.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11323","ERX","HCPCS 25000001","11017-0252-20","SALICYLIC ACID 17 % EX SOLN","BOTH IP/OP","$25.42 ","$18.81 ","$0.00 ","$23.06 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.06 ","$0.00 ","$11.53 ","$18.26 ","$18.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11340","ERX","HCPCS 63700001","60505-3438-03","SELEGILINE HCL 5 MG PO TABS","BOTH IP/OP","$8.81 ","$6.52 ","$0.00 ","$7.99 ","","$1.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.99 ","$0.00 ","$4.00 ","$6.33 ","$6.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11349","ERX","HCPCS 63700001","00904-6522-61","SENNOSIDES 8.6 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11349","ERX","HCPCS 63700001","57896-0451-01","SENNOSIDES 8.6 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11349","ERX","HCPCS 63700001","70677-0041-01","SENNOSIDES 8.6 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11349","ERX","HCPCS 63700001","70677-0058-01","SENNOSIDES 8.6 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11350","ERX","HCPCS 63700001","16714-0613-04","SERTRALINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11350","ERX","HCPCS 63700001","16714-0613-06","SERTRALINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11350","ERX","HCPCS 63700001","60687-0253-01","SERTRALINE HCL 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11351","ERX","HCPCS 63700001","60687-0242-01","SERTRALINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11351","ERX","HCPCS 63700001","60687-0242-11","SERTRALINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11351","ERX","HCPCS 63700001","69097-0834-02","SERTRALINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11351","ERX","HCPCS 63700001","76282-0213-60","SERTRALINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11351","ERX","HCPCS 63700001","76282-0213-90","SERTRALINE HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11359","ERX","HCPCS 25000001","12870-0001-01","SILVER NITRATE-POT NITRATE 75-25 % EX MISC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11359","ERX","HCPCS 25000001","12870-0001-02","SILVER NITRATE-POT NITRATE 75-25 % EX MISC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11364","ERX","HCPCS 63700001","16714-0682-02","SIMVASTATIN 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11364","ERX","HCPCS 63700001","63739-0571-10","SIMVASTATIN 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11365","ERX","HCPCS 63700001","16714-0683-01","SIMVASTATIN 20 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11365","ERX","HCPCS 63700001","63739-0572-10","SIMVASTATIN 20 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11365","ERX","HCPCS 63700001","68084-0512-01","SIMVASTATIN 20 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11366","ERX","HCPCS 63700001","60687-0210-01","SIMVASTATIN 40 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11366","ERX","HCPCS 63700001","60687-0210-11","SIMVASTATIN 40 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11366","ERX","HCPCS 63700001","63739-0573-10","SIMVASTATIN 40 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11366","ERX","HCPCS 63700001","68180-0464-09","SIMVASTATIN 40 MG PO TABS","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11367","ERX","HCPCS 63700001","63739-0570-10","SIMVASTATIN 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11394","ERX","HCPCS 25000001","00121-0595-16","SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11394","ERX","HCPCS 25000001","00121-1190-00","SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11400","ERX","HCPCS 25000001","00409-6609-25","SODIUM BICARBONATE 4 % IV SOLN","BOTH IP/OP","$34.79 ","$25.74 ","$0.00 ","$34.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.79 ","$0.00 ","$17.40 ","$27.55 ","$27.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11403","ERX","HCPCS 25000001","00338-0048-04","SODIUM CHLORIDE 0.9 % IR SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11403","ERX","HCPCS 25000001","00264-2201-10","SODIUM CHLORIDE 0.9 % IR SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11403","ERX","HCPCS 25000001","00338-0048-03","SODIUM CHLORIDE 0.9 % IR SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11403","ERX","HCPCS 25000001","99999-6011-64","SODIUM CHLORIDE 0.9 % IR SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11418","ERX","HCPCS J2941","00002-7335-11","SOMATROPIN (HUMATROPE) 5 MG IJ SOLR","BOTH IP/OP","$1,929.32 ","$1,427.70 ","$0.00 ","$1,929.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,929.32 ","$0.00 ","$964.66 ","$1,528.02 ","$1,543.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11420","ERX","HCPCS 63700001","00093-1063-01","SOTALOL HCL 240 MG PO TABS","BOTH IP/OP","$21.33 ","$15.78 ","$0.00 ","$19.35 ","","$3.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.35 ","$0.00 ","$9.68 ","$15.33 ","$15.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11420","ERX","HCPCS 63700001","60505-0082-00","SOTALOL HCL 240 MG PO TABS","BOTH IP/OP","$21.33 ","$15.78 ","$0.00 ","$19.35 ","","$3.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.35 ","$0.00 ","$9.68 ","$15.33 ","$15.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11421","ERX","HCPCS 63700001","60505-0080-00","SOTALOL HCL 80 MG PO TABS","BOTH IP/OP","$9.73 ","$7.20 ","$0.00 ","$8.82 ","","$1.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.82 ","$0.00 ","$4.41 ","$6.99 ","$7.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11421","ERX","HCPCS 63700001","68084-0654-01","SOTALOL HCL 80 MG PO TABS","BOTH IP/OP","$9.73 ","$7.20 ","$0.00 ","$8.82 ","","$1.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.82 ","$0.00 ","$4.41 ","$6.99 ","$7.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11425","ERX","HCPCS 63700001","53746-0515-01","SPIRONOLACTONE 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11425","ERX","HCPCS 63700001","59746-0218-01","SPIRONOLACTONE 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11425","ERX","HCPCS 63700001","60687-0487-01","SPIRONOLACTONE 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11425","ERX","HCPCS 63700001","60687-0487-11","SPIRONOLACTONE 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11436","ERX","HCPCS J9320","00703-4636-01","STREPTOZOCIN 1 G IV SOLR","BOTH IP/OP","$1,223.72 ","$905.55 ","$0.00 ","$1,110.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,110.57 ","$0.00 ","$555.29 ","$879.57 ","$888.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11438","ERX","HCPCS 63700001","55292-0201-11","SUCCIMER 100 MG PO CAPS","BOTH IP/OP","$103.11 ","$76.30 ","$0.00 ","$80.16 ","","$18.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.16 ","$0.00 ","$40.08 ","$63.49 ","$64.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11441","ERX","HCPCS 63700001","00121-0747-10","SUCRALFATE 1 GM/10ML PO SUSP","BOTH IP/OP","$58.71 ","$43.45 ","$0.00 ","$53.24 ","","$10.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.24 ","$0.00 ","$26.62 ","$42.17 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11441","ERX","HCPCS 63700001","00121-0747-40","SUCRALFATE 1 GM/10ML PO SUSP","BOTH IP/OP","$58.71 ","$43.45 ","$0.00 ","$53.24 ","","$10.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.24 ","$0.00 ","$26.62 ","$42.17 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11441","ERX","HCPCS 63700001","58914-0170-14","SUCRALFATE 1 GM/10ML PO SUSP","BOTH IP/OP","$58.71 ","$43.45 ","$0.00 ","$53.24 ","","$10.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.24 ","$0.00 ","$26.62 ","$42.17 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11441","ERX","HCPCS 63700001","66689-0790-01","SUCRALFATE 1 GM/10ML PO SUSP","BOTH IP/OP","$58.71 ","$43.45 ","$0.00 ","$53.24 ","","$10.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.24 ","$0.00 ","$26.62 ","$42.17 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11441","ERX","HCPCS 63700001","66689-0790-50","SUCRALFATE 1 GM/10ML PO SUSP","BOTH IP/OP","$58.71 ","$43.45 ","$0.00 ","$53.24 ","","$10.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.24 ","$0.00 ","$26.62 ","$42.17 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11442","ERX","HCPCS 63700001","00093-2210-01","SUCRALFATE 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11442","ERX","HCPCS 63700001","00093-2210-05","SUCRALFATE 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11442","ERX","HCPCS 63700001","00093-2210-98","SUCRALFATE 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11442","ERX","HCPCS 63700001","51079-0753-20","SUCRALFATE 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11442","ERX","HCPCS 63700001","59762-0401-01","SUCRALFATE 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11442","ERX","HCPCS 63700001","63739-0943-10","SUCRALFATE 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11498","ERX","HCPCS 25000001","00591-2473-19","TAMOXIFEN CITRATE 20 MG PO TABS","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11498","ERX","HCPCS 25000001","51862-0446-01","TAMOXIFEN CITRATE 20 MG PO TABS","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11498","ERX","HCPCS 25000001","51862-0446-30","TAMOXIFEN CITRATE 20 MG PO TABS","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11498","ERX","HCPCS 25000001","68382-0827-01","TAMOXIFEN CITRATE 20 MG PO TABS","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11501","ERX","HCPCS Q2017","44567-0507-01","TENIPOSIDE 10 MG/ML IV SOLN","BOTH IP/OP","$6,140.04 ","$4,543.63 ","$0.00 ","$6,140.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,140.04 ","$0.00 ","$3,070.02 ","$4,862.91 ","$4,912.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11507","ERX","HCPCS J3105","00143-9746-01","TERBUTALINE SULFATE 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$2.49 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.49 ","$0.00 ","$2.37 ","$0.00 "
"11507","ERX","HCPCS J3105","00143-9746-10","TERBUTALINE SULFATE 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$2.49 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.49 ","$0.00 ","$2.37 ","$0.00 "
"11507","ERX","HCPCS J3105","63323-0665-01","TERBUTALINE SULFATE 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$2.49 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.49 ","$0.00 ","$2.37 ","$0.00 "
"11507","ERX","HCPCS J3105","70860-0801-01","TERBUTALINE SULFATE 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$2.49 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.49 ","$0.00 ","$2.37 ","$0.00 "
"11508","ERX","HCPCS 63700001","00115-2611-01","TERBUTALINE SULFATE 2.5 MG PO TABS","BOTH IP/OP","$57.53 ","$42.57 ","$0.00 ","$52.18 ","","$10.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.18 ","$0.00 ","$26.09 ","$41.33 ","$41.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11508","ERX","HCPCS 63700001","00527-1318-01","TERBUTALINE SULFATE 2.5 MG PO TABS","BOTH IP/OP","$57.53 ","$42.57 ","$0.00 ","$52.18 ","","$10.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.18 ","$0.00 ","$26.09 ","$41.33 ","$41.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11508","ERX","HCPCS 63700001","10135-0579-01","TERBUTALINE SULFATE 2.5 MG PO TABS","BOTH IP/OP","$57.53 ","$42.57 ","$0.00 ","$52.18 ","","$10.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.18 ","$0.00 ","$26.09 ","$41.33 ","$41.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11508","ERX","HCPCS 63700001","62559-0721-01","TERBUTALINE SULFATE 2.5 MG PO TABS","BOTH IP/OP","$57.53 ","$42.57 ","$0.00 ","$52.18 ","","$10.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.18 ","$0.00 ","$26.09 ","$41.33 ","$41.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11509","ERX","HCPCS 63700001","00115-2622-01","TERBUTALINE SULFATE 5 MG PO TABS","BOTH IP/OP","$70.25 ","$51.99 ","$0.00 ","$63.72 ","","$12.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.72 ","$0.00 ","$31.86 ","$50.47 ","$50.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11509","ERX","HCPCS 63700001","00527-1311-01","TERBUTALINE SULFATE 5 MG PO TABS","BOTH IP/OP","$70.25 ","$51.99 ","$0.00 ","$63.72 ","","$12.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.72 ","$0.00 ","$31.86 ","$50.47 ","$50.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11509","ERX","HCPCS 63700001","10135-0580-01","TERBUTALINE SULFATE 5 MG PO TABS","BOTH IP/OP","$70.25 ","$51.99 ","$0.00 ","$63.72 ","","$12.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.72 ","$0.00 ","$31.86 ","$50.47 ","$50.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11509","ERX","HCPCS 63700001","62559-0722-01","TERBUTALINE SULFATE 5 MG PO TABS","BOTH IP/OP","$70.25 ","$51.99 ","$0.00 ","$63.72 ","","$12.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.72 ","$0.00 ","$31.86 ","$50.47 ","$50.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11510","ERX","HCPCS 63700001","00168-0346-46","TERCONAZOLE 0.4 % VA CREA","BOTH IP/OP","$171.97 ","$127.26 ","$0.00 ","$155.93 ","","$30.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.93 ","$0.00 ","$77.97 ","$123.50 ","$124.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11510","ERX","HCPCS 63700001","51672-1304-06","TERCONAZOLE 0.4 % VA CREA","BOTH IP/OP","$171.97 ","$127.26 ","$0.00 ","$155.93 ","","$30.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.93 ","$0.00 ","$77.97 ","$123.50 ","$124.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11511","ERX","HCPCS 63700001","51672-1302-00","TERCONAZOLE 0.8 % VA CREA","BOTH IP/OP","$158.03 ","$116.94 ","$0.00 ","$143.29 ","","$28.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.29 ","$0.00 ","$71.65 ","$113.49 ","$114.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11512","ERX","HCPCS 63700001","45802-0717-08","TERCONAZOLE 80 MG VA SUPP","BOTH IP/OP","$125.95 ","$93.20 ","$0.00 ","$114.20 ","","$22.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.20 ","$0.00 ","$57.10 ","$90.45 ","$91.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11517","ERX","HCPCS 25000001","17478-0045-32","TETRACAINE HCL 1 % IJ SOLN","BOTH IP/OP","$175.89 ","$130.16 ","$0.00 ","$159.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.48 ","$0.00 ","$79.74 ","$126.31 ","$127.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11562","ERX","HCPCS 25000001","17478-0288-10","TIMOLOL MALEATE 0.5 % OP SOLN","BOTH IP/OP","$71.23 ","$52.71 ","$0.00 ","$64.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.60 ","$0.00 ","$32.30 ","$51.16 ","$51.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11562","ERX","HCPCS 25000001","61314-0227-05","TIMOLOL MALEATE 0.5 % OP SOLN","BOTH IP/OP","$71.23 ","$52.71 ","$0.00 ","$64.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.60 ","$0.00 ","$32.30 ","$51.16 ","$51.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11562","ERX","HCPCS 25000001","64980-0514-05","TIMOLOL MALEATE 0.5 % OP SOLN","BOTH IP/OP","$71.23 ","$52.71 ","$0.00 ","$64.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.60 ","$0.00 ","$32.30 ","$51.16 ","$51.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11565","ERX","HCPCS J3260","39822-0412-01","TOBRAMYCIN SULFATE 1.2 G IJ SOLR","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$579.69 ","$156.15 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$579.69 ","$0.00 ","$289.85 ","$459.11 ","$463.75 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"11565","ERX","HCPCS J3260","39822-0412-06","TOBRAMYCIN SULFATE 1.2 G IJ SOLR","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$579.69 ","$156.15 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$579.69 ","$0.00 ","$289.85 ","$459.11 ","$463.75 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"11565","ERX","HCPCS J3260","63323-0303-51","TOBRAMYCIN SULFATE 1.2 G IJ SOLR","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$579.69 ","$156.15 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$579.69 ","$0.00 ","$289.85 ","$459.11 ","$463.75 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"11565","ERX","HCPCS J3260","63323-0303-55","TOBRAMYCIN SULFATE 1.2 G IJ SOLR","BOTH IP/OP","$347.00 ","$256.78 ","$0.00 ","$579.69 ","$156.15 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$579.69 ","$0.00 ","$289.85 ","$459.11 ","$463.75 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"11566","ERX","HCPCS 25000001","00065-0648-35","TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT","BOTH IP/OP","$725.71 ","$537.03 ","$0.00 ","$725.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$725.71 ","$0.00 ","$362.86 ","$574.76 ","$580.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11567","ERX","HCPCS 25000001","00065-0647-25","TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","BOTH IP/OP","$329.72 ","$243.99 ","$0.00 ","$299.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.32 ","$0.00 ","$149.66 ","$237.06 ","$239.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11567","ERX","HCPCS 25000001","61314-0647-25","TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","BOTH IP/OP","$329.72 ","$243.99 ","$0.00 ","$299.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.32 ","$0.00 ","$149.66 ","$237.06 ","$239.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11576","ERX","HCPCS 25000001","00472-0117-20","TRETINOIN 0.025 % EX CREA","BOTH IP/OP","$329.65 ","$243.94 ","$0.00 ","$389.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$389.12 ","$0.00 ","$194.56 ","$308.18 ","$311.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11577","ERX","HCPCS 25000001","00187-5162-20","TRETINOIN 0.05 % EX CREA","BOTH IP/OP","$329.65 ","$243.94 ","$0.00 ","$299.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.25 ","$0.00 ","$149.63 ","$237.01 ","$239.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11577","ERX","HCPCS 25000001","00574-2205-20","TRETINOIN 0.05 % EX CREA","BOTH IP/OP","$329.65 ","$243.94 ","$0.00 ","$299.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.25 ","$0.00 ","$149.63 ","$237.01 ","$239.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11578","ERX","HCPCS 25000001","00187-5164-20","TRETINOIN 0.1 % EX CREA","BOTH IP/OP","$329.65 ","$243.94 ","$0.00 ","$299.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.25 ","$0.00 ","$149.63 ","$237.01 ","$239.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11584","ERX","HCPCS J3301","00003-0494-20","TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.77 ","$0.00 ","$0.00 ","$1.83 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.83 ","$0.00 ","$1.75 ","$0.00 "
"11589","ERX","HCPCS 25000001","10481-3008-01","TRICHLOROACETIC ACID 80 % EX LIQD","BOTH IP/OP","$244.15 ","$180.67 ","$0.00 ","$244.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$244.15 ","$0.00 ","$122.08 ","$193.37 ","$195.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11595","ERX","HCPCS 25000001","61314-0044-75","TRIFLURIDINE 1 % OP SOLN","BOTH IP/OP","$650.98 ","$481.73 ","$0.00 ","$590.79 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$590.79 ","$0.00 ","$295.40 ","$467.91 ","$472.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11596","ERX","HCPCS 25000001","17478-0703-11","POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","BOTH IP/OP","$56.32 ","$41.68 ","$0.00 ","$51.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.08 ","$0.00 ","$25.54 ","$40.46 ","$40.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11596","ERX","HCPCS 25000001","24208-0315-10","POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","BOTH IP/OP","$56.32 ","$41.68 ","$0.00 ","$51.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.08 ","$0.00 ","$25.54 ","$40.46 ","$40.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11596","ERX","HCPCS 25000001","60758-0908-10","POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","BOTH IP/OP","$56.32 ","$41.68 ","$0.00 ","$51.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.08 ","$0.00 ","$25.54 ","$40.46 ","$40.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11596","ERX","HCPCS 25000001","61314-0628-10","POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","BOTH IP/OP","$56.32 ","$41.68 ","$0.00 ","$51.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.08 ","$0.00 ","$25.54 ","$40.46 ","$40.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11599","ERX","HCPCS 63700001","00904-2725-61","SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11599","ERX","HCPCS 63700001","57237-0233-05","SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11599","ERX","HCPCS 63700001","63739-0228-10","SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11624","ERX","HCPCS 63700001","00591-3159-01","URSODIOL 300 MG PO CAPS","BOTH IP/OP","$35.96 ","$26.61 ","$0.00 ","$29.04 ","","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.04 ","$0.00 ","$14.52 ","$23.00 ","$23.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11624","ERX","HCPCS 63700001","42806-0503-01","URSODIOL 300 MG PO CAPS","BOTH IP/OP","$35.96 ","$26.61 ","$0.00 ","$29.04 ","","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.04 ","$0.00 ","$14.52 ","$23.00 ","$23.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11624","ERX","HCPCS 63700001","51079-0383-01","URSODIOL 300 MG PO CAPS","BOTH IP/OP","$35.96 ","$26.61 ","$0.00 ","$29.04 ","","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.04 ","$0.00 ","$14.52 ","$23.00 ","$23.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11627","ERX","HCPCS J3370","00143-9359-01","VANCOMYCIN HCL 10 G IV SOLR","BOTH IP/OP","$680.55 ","$503.61 ","$0.00 ","$680.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.67 ","$680.55 ","$0.00 ","$340.28 ","$539.00 ","$544.44 ","$0.00 ","$79.67 ","$0.00 ","$75.85 ","$0.00 "
"11627","ERX","HCPCS J3370","00409-6510-01","VANCOMYCIN HCL 10 G IV SOLR","BOTH IP/OP","$680.55 ","$503.61 ","$0.00 ","$680.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.67 ","$680.55 ","$0.00 ","$340.28 ","$539.00 ","$544.44 ","$0.00 ","$79.67 ","$0.00 ","$75.85 ","$0.00 "
"11627","ERX","HCPCS J3370","25021-0158-99","VANCOMYCIN HCL 10 G IV SOLR","BOTH IP/OP","$680.55 ","$503.61 ","$0.00 ","$680.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.67 ","$680.55 ","$0.00 ","$340.28 ","$539.00 ","$544.44 ","$0.00 ","$79.67 ","$0.00 ","$75.85 ","$0.00 "
"11627","ERX","HCPCS J3370","63323-0314-61","VANCOMYCIN HCL 10 G IV SOLR","BOTH IP/OP","$680.55 ","$503.61 ","$0.00 ","$680.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.67 ","$680.55 ","$0.00 ","$340.28 ","$539.00 ","$544.44 ","$0.00 ","$79.67 ","$0.00 ","$75.85 ","$0.00 "
"11627","ERX","HCPCS J3370","67457-0342-10","VANCOMYCIN HCL 10 G IV SOLR","BOTH IP/OP","$680.55 ","$503.61 ","$0.00 ","$680.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.67 ","$680.55 ","$0.00 ","$340.28 ","$539.00 ","$544.44 ","$0.00 ","$79.67 ","$0.00 ","$75.85 ","$0.00 "
"11628","ERX","HCPCS 63700001","47781-0729-02","VANCOMYCIN HCL 125 MG PO CAPS","BOTH IP/OP","$109.64 ","$81.13 ","$0.00 ","$109.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.64 ","$0.00 ","$54.82 ","$86.83 ","$87.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","00409-1632-01","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","00409-1632-21","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","00703-2914-01","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","00703-2914-03","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","47335-0931-40","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","47335-0931-44","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","63323-0781-10","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","67457-0438-00","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11634","ERX","HCPCS 25000001","67457-0438-10","VECURONIUM BROMIDE 10 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11641","ERX","HCPCS 25000001","61703-0418-18","VITAMIN A 15 MG/ML IM SOLN","BOTH IP/OP","$422.73 ","$312.82 ","$0.00 ","$422.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$422.73 ","$0.00 ","$211.37 ","$334.80 ","$338.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11664","ERX","HCPCS 63700001","00832-1211-01","WARFARIN SODIUM 1 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$28.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.16 ","$0.00 ","$14.08 ","$22.30 ","$22.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11664","ERX","HCPCS 63700001","00832-1211-89","WARFARIN SODIUM 1 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$28.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.16 ","$0.00 ","$14.08 ","$22.30 ","$22.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11691","ERX","HCPCS J3485","49702-0213-26","ZIDOVUDINE 10 MG/ML IV SOLN","BOTH IP/OP","$135.18 ","$100.03 ","$0.00 ","$122.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.57 ","$0.00 ","$61.29 ","$97.08 ","$98.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11692","ERX","HCPCS 63700001","65862-0107-01","ZIDOVUDINE 100 MG PO CAPS","BOTH IP/OP","$8.46 ","$6.26 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11700","ERX","HCPCS 63700001","63739-0526-10","ZOLPIDEM TARTRATE 10 MG PO TABS","BOTH IP/OP","$19.47 ","$14.41 ","$0.00 ","$17.66 ","","$3.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.66 ","$0.00 ","$8.83 ","$13.99 ","$14.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11701","ERX","HCPCS 63700001","00904-6082-61","ZOLPIDEM TARTRATE 5 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11701","ERX","HCPCS 63700001","16714-0621-01","ZOLPIDEM TARTRATE 5 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11701","ERX","HCPCS 63700001","68084-0189-01","ZOLPIDEM TARTRATE 5 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11701","ERX","HCPCS 63700001","68084-0189-11","ZOLPIDEM TARTRATE 5 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11930","ERX","HCPCS 25000001","00065-0345-10","LODOXAMIDE TROMETHAMINE 0.1 % OP SOLN","BOTH IP/OP","$599.42 ","$443.57 ","$0.00 ","$544.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$544.00 ","$0.00 ","$272.00 ","$430.85 ","$435.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11931","ERX","HCPCS 90648","49281-0545-03","HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR","BOTH IP/OP","$83.91 ","$62.09 ","$0.00 ","$71.47 ","$37.76 ","$0.00 ","$17.49 ","$0.00 ","$0.00 ","$12.51 ","$71.47 ","$0.00 ","$35.74 ","$56.60 ","$57.18 ","$0.00 ","$11.19 ","$0.00 ","$11.38 ","$0.00 "
"11934","ERX","HCPCS 25000001","00168-0357-56","LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT","BOTH IP/OP","$191.38 ","$141.62 ","$0.00 ","$173.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.53 ","$0.00 ","$86.77 ","$137.44 ","$138.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12025","ERX","HCPCS 63700001","50268-0523-15","MECLIZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12025","ERX","HCPCS 63700001","68084-0491-01","MECLIZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12025","ERX","HCPCS 63700001","68084-0491-11","MECLIZINE HCL 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12203","ERX","HCPCS 63700001","16714-0311-01","VENLAFAXINE HCL 25 MG PO TABS","BOTH IP/OP","$7.39 ","$5.47 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.39 ","$0.00 ","$3.70 ","$5.85 ","$5.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12203","ERX","HCPCS 63700001","50268-0798-15","VENLAFAXINE HCL 25 MG PO TABS","BOTH IP/OP","$7.39 ","$5.47 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.39 ","$0.00 ","$3.70 ","$5.85 ","$5.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12203","ERX","HCPCS 63700001","68084-0896-25","VENLAFAXINE HCL 25 MG PO TABS","BOTH IP/OP","$7.39 ","$5.47 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.39 ","$0.00 ","$3.70 ","$5.85 ","$5.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12206","ERX","HCPCS 63700001","16714-0314-01","VENLAFAXINE HCL 75 MG PO TABS","BOTH IP/OP","$8.31 ","$6.15 ","$0.00 ","$8.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.31 ","$0.00 ","$4.16 ","$6.58 ","$6.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12207","ERX","HCPCS 63700001","16714-0656-01","VENLAFAXINE HCL 37.5 MG PO TABS","BOTH IP/OP","$8.38 ","$6.20 ","$0.00 ","$7.60 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.60 ","$0.00 ","$3.80 ","$6.02 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12207","ERX","HCPCS 63700001","68084-0844-01","VENLAFAXINE HCL 37.5 MG PO TABS","BOTH IP/OP","$8.38 ","$6.20 ","$0.00 ","$7.60 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.60 ","$0.00 ","$3.80 ","$6.02 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12207","ERX","HCPCS 63700001","68084-0844-11","VENLAFAXINE HCL 37.5 MG PO TABS","BOTH IP/OP","$8.38 ","$6.20 ","$0.00 ","$7.60 ","","$1.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.60 ","$0.00 ","$3.80 ","$6.02 ","$6.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12211","ERX","HCPCS J7639","50242-0100-39","DORNASE ALFA 1 MG/ML IN SOLN","BOTH IP/OP","$463.35 ","$342.88 ","$0.00 ","$420.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.60 ","$0.00 ","$210.30 ","$333.12 ","$336.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12211","ERX","HCPCS J7639","50242-0100-40","DORNASE ALFA 1 MG/ML IN SOLN","BOTH IP/OP","$463.35 ","$342.88 ","$0.00 ","$420.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.60 ","$0.00 ","$210.30 ","$333.12 ","$336.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12244","ERX","HCPCS 63700001","51672-4154-03","CALCIPOTRIENE 0.005 % EX OINT","BOTH IP/OP","$1,118.31 ","$827.55 ","$0.00 ","$1,014.90 ","","$199.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.90 ","$0.00 ","$507.45 ","$803.80 ","$811.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12244","ERX","HCPCS 63700001","51672-5278-03","CALCIPOTRIENE 0.005 % EX OINT","BOTH IP/OP","$1,118.31 ","$827.55 ","$0.00 ","$1,014.90 ","","$199.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.90 ","$0.00 ","$507.45 ","$803.80 ","$811.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12370","ERX","HCPCS 25000001","00143-9593-01","NICARDIPINE HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12370","ERX","HCPCS 25000001","00143-9593-10","NICARDIPINE HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12370","ERX","HCPCS 25000001","00143-9689-01","NICARDIPINE HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12370","ERX","HCPCS 25000001","00143-9689-10","NICARDIPINE HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12370","ERX","HCPCS 25000001","00517-0735-01","NICARDIPINE HCL 2.5 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12411","ERX","HCPCS 63700001","00378-8020-93","FLUVASTATIN SODIUM 20 MG PO CAPS","BOTH IP/OP","$20.98 ","$15.53 ","$0.00 ","$19.03 ","","$3.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.03 ","$0.00 ","$9.52 ","$15.07 ","$15.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12412","ERX","HCPCS 63700001","00093-7443-01","FLUVASTATIN SODIUM 40 MG PO CAPS","BOTH IP/OP","$20.94 ","$15.50 ","$0.00 ","$18.99 ","","$3.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.99 ","$0.00 ","$9.50 ","$15.04 ","$15.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12556","ERX","HCPCS Q0163","49348-0045-34","DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$12.96 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$1.93 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$1.72 ","$0.00 ","$0.00 ","$0.00 "
"12556","ERX","HCPCS Q0163","58602-0022-24","DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$12.96 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$1.93 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$1.72 ","$0.00 ","$0.00 ","$0.00 "
"12556","ERX","HCPCS Q0163","49348-0045-37","DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$20.69 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$1.93 ","$11.00 ","$0.00 ","$5.50 ","$20.69 ","$8.80 ","$0.00 ","$1.72 ","$0.00 ","$0.00 ","$0.00 "
"12556","ERX","HCPCS Q0163","54838-0135-70","DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$20.69 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$1.93 ","$11.00 ","$0.00 ","$5.50 ","$20.69 ","$8.80 ","$0.00 ","$1.72 ","$0.00 ","$0.00 ","$0.00 "
"12580","ERX","HCPCS 25000001","00487-9801-01","IPRATROPIUM BROMIDE 0.02 % IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12580","ERX","HCPCS 25000001","00487-9801-25","IPRATROPIUM BROMIDE 0.02 % IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12580","ERX","HCPCS 25000001","00781-7157-86","IPRATROPIUM BROMIDE 0.02 % IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12580","ERX","HCPCS 25000001","76204-0100-01","IPRATROPIUM BROMIDE 0.02 % IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12580","ERX","HCPCS 25000001","76204-0100-25","IPRATROPIUM BROMIDE 0.02 % IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12587","ERX","HCPCS J2543","63323-0304-74","PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR","BOTH IP/OP","$591.77 ","$437.91 ","$0.00 ","$537.17 ","$321.33 ","$0.00 ","$123.34 ","$0.00 ","$0.00 ","$94.05 ","$537.17 ","$0.00 ","$268.59 ","$425.44 ","$429.74 ","$0.00 ","$84.07 ","$0.00 ","$74.51 ","$0.00 "
"12587","ERX","HCPCS J2543","63323-0304-78","PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR","BOTH IP/OP","$591.77 ","$437.91 ","$0.00 ","$537.17 ","$321.33 ","$0.00 ","$123.34 ","$0.00 ","$0.00 ","$94.05 ","$537.17 ","$0.00 ","$268.59 ","$425.44 ","$429.74 ","$0.00 ","$84.07 ","$0.00 ","$74.51 ","$0.00 "
"12724","ERX","HCPCS 63700001","16714-0501-01","TERBINAFINE HCL 250 MG PO TABS","BOTH IP/OP","$48.15 ","$35.63 ","$0.00 ","$48.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.15 ","$0.00 ","$24.08 ","$38.13 ","$38.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12724","ERX","HCPCS 63700001","16714-0501-02","TERBINAFINE HCL 250 MG PO TABS","BOTH IP/OP","$48.15 ","$35.63 ","$0.00 ","$48.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.15 ","$0.00 ","$24.08 ","$38.13 ","$38.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12724","ERX","HCPCS 63700001","16714-0795-02","TERBINAFINE HCL 250 MG PO TABS","BOTH IP/OP","$48.15 ","$35.63 ","$0.00 ","$48.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.15 ","$0.00 ","$24.08 ","$38.13 ","$38.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12724","ERX","HCPCS 63700001","51991-0526-01","TERBINAFINE HCL 250 MG PO TABS","BOTH IP/OP","$48.15 ","$35.63 ","$0.00 ","$48.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.15 ","$0.00 ","$24.08 ","$38.13 ","$38.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12729","ERX","HCPCS 63700001","00007-3650-22","TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12729","ERX","HCPCS 63700001","00781-2074-10","TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12729","ERX","HCPCS 63700001","51079-0935-01","TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12729","ERX","HCPCS 63700001","51079-0935-20","TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12803","ERX","HCPCS 63700001","00527-1313-01","PILOCARPINE HCL 5 MG PO TABS","BOTH IP/OP","$7.61 ","$5.63 ","$0.00 ","$6.90 ","","$1.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.90 ","$0.00 ","$3.45 ","$5.46 ","$5.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12885","ERX","HCPCS 63700001","00781-6022-52","CLARITHROMYCIN 125 MG/5ML PO SUSR","BOTH IP/OP","$231.84 ","$171.56 ","$0.00 ","$231.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$231.84 ","$0.00 ","$115.92 ","$183.62 ","$185.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12886","ERX","HCPCS 63700001","00781-6023-52","CLARITHROMYCIN 250 MG/5ML PO SUSR","BOTH IP/OP","$666.96 ","$493.55 ","$0.00 ","$605.43 ","","$118.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.43 ","$0.00 ","$302.72 ","$258.83 ","$484.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12886","ERX","HCPCS 63700001","00781-6023-46","CLARITHROMYCIN 250 MG/5ML PO SUSR","BOTH IP/OP","$666.96 ","$493.55 ","$0.00 ","$605.43 ","","$118.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.43 ","$0.00 ","$302.72 ","$479.50 ","$484.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12933","ERX","HCPCS J7507","00378-2046-01","TACROLIMUS 1 MG PO CAPS","BOTH IP/OP","$18.69 ","$13.83 ","$0.00 ","$16.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.97 ","$16.95 ","$0.00 ","$8.48 ","$13.42 ","$13.56 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 "
"12933","ERX","HCPCS J7507","00469-0617-73","TACROLIMUS 1 MG PO CAPS","BOTH IP/OP","$18.69 ","$13.83 ","$0.00 ","$16.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.97 ","$16.95 ","$0.00 ","$8.48 ","$13.42 ","$13.56 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 "
"12933","ERX","HCPCS J7507","00781-2103-01","TACROLIMUS 1 MG PO CAPS","BOTH IP/OP","$18.69 ","$13.83 ","$0.00 ","$16.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.97 ","$16.95 ","$0.00 ","$8.48 ","$13.42 ","$13.56 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 "
"12933","ERX","HCPCS J7507","16729-0042-01","TACROLIMUS 1 MG PO CAPS","BOTH IP/OP","$18.69 ","$13.83 ","$0.00 ","$16.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.97 ","$16.95 ","$0.00 ","$8.48 ","$13.42 ","$13.56 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 "
"12933","ERX","HCPCS J7507","55111-0526-01","TACROLIMUS 1 MG PO CAPS","BOTH IP/OP","$18.69 ","$13.83 ","$0.00 ","$16.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.97 ","$16.95 ","$0.00 ","$8.48 ","$13.42 ","$13.56 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 "
"12933","ERX","HCPCS J7507","68084-0450-01","TACROLIMUS 1 MG PO CAPS","BOTH IP/OP","$18.69 ","$13.83 ","$0.00 ","$16.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.97 ","$16.95 ","$0.00 ","$8.48 ","$13.42 ","$13.56 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 "
"12934","ERX","HCPCS J7507","16729-0043-01","TACROLIMUS 5 MG PO CAPS","BOTH IP/OP","$126.69 ","$93.75 ","$0.00 ","$126.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.18 ","$126.69 ","$0.00 ","$63.35 ","$100.34 ","$101.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12934","ERX","HCPCS J7507","55111-0527-01","TACROLIMUS 5 MG PO CAPS","BOTH IP/OP","$126.69 ","$93.75 ","$0.00 ","$126.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.18 ","$126.69 ","$0.00 ","$63.35 ","$100.34 ","$101.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12934","ERX","HCPCS J7507","69452-0155-20","TACROLIMUS 5 MG PO CAPS","BOTH IP/OP","$126.69 ","$93.75 ","$0.00 ","$126.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.18 ","$126.69 ","$0.00 ","$63.35 ","$100.34 ","$101.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12935","ERX","HCPCS J7525","00469-3016-01","TACROLIMUS 5 MG/ML IV SOLN","BOTH IP/OP","$5,807.66 ","$4,297.67 ","$0.00 ","$661.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.16 ","$0.00 ","$330.58 ","$523.64 ","$528.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13073","ERX","HCPCS 63700001","68462-0260-01","VERAPAMIL HCL CR 240 MG PO TBCR","BOTH IP/OP","$9.62 ","$7.12 ","$0.00 ","$9.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.62 ","$0.00 ","$4.81 ","$7.62 ","$7.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13132","ERX","HCPCS 63700001","16714-0697-01","VALACYCLOVIR HCL 1 G PO TABS","BOTH IP/OP","$52.97 ","$39.20 ","$0.00 ","$48.04 ","","$9.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.04 ","$0.00 ","$24.02 ","$38.05 ","$38.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13132","ERX","HCPCS 63700001","57237-0043-30","VALACYCLOVIR HCL 1 G PO TABS","BOTH IP/OP","$52.97 ","$39.20 ","$0.00 ","$48.04 ","","$9.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.04 ","$0.00 ","$24.02 ","$38.05 ","$38.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13133","ERX","HCPCS 63700001","00378-4275-77","VALACYCLOVIR HCL 500 MG PO TABS","BOTH IP/OP","$30.27 ","$22.40 ","$0.00 ","$27.46 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.46 ","$0.00 ","$13.73 ","$21.75 ","$21.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13133","ERX","HCPCS 63700001","00781-5208-92","VALACYCLOVIR HCL 500 MG PO TABS","BOTH IP/OP","$30.27 ","$22.40 ","$0.00 ","$27.46 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.46 ","$0.00 ","$13.73 ","$21.75 ","$21.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13133","ERX","HCPCS 63700001","16714-0698-03","VALACYCLOVIR HCL 500 MG PO TABS","BOTH IP/OP","$30.27 ","$22.40 ","$0.00 ","$27.46 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.46 ","$0.00 ","$13.73 ","$21.75 ","$21.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13133","ERX","HCPCS 63700001","57237-0042-90","VALACYCLOVIR HCL 500 MG PO TABS","BOTH IP/OP","$30.27 ","$22.40 ","$0.00 ","$27.46 ","","$5.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.46 ","$0.00 ","$13.73 ","$21.75 ","$21.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13178","ERX","HCPCS 25000001","00019-1333-21","IOVERSOL 74 % IJ SOLN","BOTH IP/OP","$255.15 ","$188.81 ","$0.00 ","$255.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.15 ","$0.00 ","$127.58 ","$202.08 ","$204.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13178","ERX","HCPCS 25000001","00019-1333-06","IOVERSOL 74 % IJ SOLN","BOTH IP/OP","$79.80 ","$59.05 ","$0.00 ","$255.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.15 ","$0.00 ","$127.58 ","$63.20 ","$204.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13184","ERX","HCPCS 63700001","00378-2120-01","VERAPAMIL HCL ER 120 MG PO TBCR","BOTH IP/OP","$8.11 ","$6.00 ","$0.00 ","$8.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13184","ERX","HCPCS 63700001","68462-0292-01","VERAPAMIL HCL ER 120 MG PO TBCR","BOTH IP/OP","$8.11 ","$6.00 ","$0.00 ","$8.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13309","ERX","HCPCS 63700001","31722-0516-60","STAVUDINE 20 MG PO CAPS","BOTH IP/OP","$24.05 ","$17.80 ","$0.00 ","$24.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.05 ","$0.00 ","$12.03 ","$19.05 ","$19.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13309","ERX","HCPCS 63700001","65862-0112-60","STAVUDINE 20 MG PO CAPS","BOTH IP/OP","$24.05 ","$17.80 ","$0.00 ","$24.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.05 ","$0.00 ","$12.03 ","$19.05 ","$19.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13310","ERX","HCPCS 63700001","31722-0517-60","STAVUDINE 30 MG PO CAPS","BOTH IP/OP","$25.54 ","$18.90 ","$0.00 ","$25.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13310","ERX","HCPCS 63700001","65862-0046-60","STAVUDINE 30 MG PO CAPS","BOTH IP/OP","$25.54 ","$18.90 ","$0.00 ","$25.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13311","ERX","HCPCS 63700001","31722-0518-60","STAVUDINE 40 MG PO CAPS","BOTH IP/OP","$26.02 ","$19.25 ","$0.00 ","$26.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.02 ","$0.00 ","$13.01 ","$20.61 ","$20.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13311","ERX","HCPCS 63700001","65862-0047-60","STAVUDINE 40 MG PO CAPS","BOTH IP/OP","$26.02 ","$19.25 ","$0.00 ","$26.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.02 ","$0.00 ","$13.01 ","$20.61 ","$20.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13369","ERX","HCPCS 63700001","","SUMATRIPTAN SUCCINATE 100 MG PO TABS","BOTH IP/OP","$97.05 ","$71.82 ","$0.00 ","$87.99 ","","$17.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.99 ","$0.00 ","$44.00 ","$69.69 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13369","ERX","HCPCS 63700001","16714-0533-11","SUMATRIPTAN SUCCINATE 100 MG PO TABS","BOTH IP/OP","$97.05 ","$71.82 ","$0.00 ","$87.99 ","","$17.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.99 ","$0.00 ","$44.00 ","$69.69 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13369","ERX","HCPCS 63700001","62756-0522-69","SUMATRIPTAN SUCCINATE 100 MG PO TABS","BOTH IP/OP","$97.05 ","$71.82 ","$0.00 ","$87.99 ","","$17.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.99 ","$0.00 ","$44.00 ","$69.69 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13369","ERX","HCPCS 63700001","63304-0099-19","SUMATRIPTAN SUCCINATE 100 MG PO TABS","BOTH IP/OP","$97.05 ","$71.82 ","$0.00 ","$87.99 ","","$17.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.99 ","$0.00 ","$44.00 ","$69.69 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13393","ERX","HCPCS 25000001","00338-0520-13","FAT EMULSION PLANT BASED 30 % IV EMUL","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$204.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$204.75 ","$0.00 ","$102.38 ","$162.16 ","$163.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13444","ERX","HCPCS 63700001","00093-1024-06","NEFAZODONE HCL 100 MG PO TABS","BOTH IP/OP","$20.11 ","$14.88 ","$0.00 ","$18.24 ","","$3.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.24 ","$0.00 ","$9.12 ","$14.45 ","$14.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13445","ERX","HCPCS 63700001","00093-7113-06","NEFAZODONE HCL 150 MG PO TABS","BOTH IP/OP","$20.49 ","$15.16 ","$0.00 ","$18.59 ","","$3.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.59 ","$0.00 ","$9.30 ","$14.72 ","$14.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","00049-3500-79","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","00172-5412-11","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","00172-5412-79","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","16714-0692-10","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","16714-0692-11","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","55111-0145-12","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","59762-5017-01","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13577","ERX","HCPCS 63700001","68462-0103-40","FLUCONAZOLE 150 MG PO TABS","BOTH IP/OP","$56.96 ","$42.15 ","$0.00 ","$51.66 ","","$10.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.66 ","$0.00 ","$25.83 ","$40.91 ","$41.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13654","ERX","HCPCS 25000001","00904-6784-80","ASPIRIN EC 325 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13654","ERX","HCPCS 25000001","57896-0921-10","ASPIRIN EC 325 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13654","ERX","HCPCS 25000001","63739-0523-01","ASPIRIN EC 325 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13691","ERX","HCPCS J1950","00074-3641-03","LEUPROLIDE ACETATE 3.75 MG IM KIT","BOTH IP/OP","$4,022.42 ","$2,976.59 ","$0.00 ","$3,435.64 ","$1,898.78 ","$1,366.01 ","$549.12 ","$0.00 ","$0.00 ","$1,493.54 ","$3,435.64 ","$1,332.69 ","$1,717.82 ","$2,721.03 ","$2,748.51 ","$1,840.38 ","$1,493.54 ","$0.00 ","$1,422.11 ","$1,244.34 "
"13691","ERX","HCPCS J1950","00074-3641-04","LEUPROLIDE ACETATE 3.75 MG IM KIT","BOTH IP/OP","$4,022.42 ","$2,976.59 ","$0.00 ","$3,435.64 ","$1,898.78 ","$1,366.01 ","$549.12 ","$0.00 ","$0.00 ","$1,493.54 ","$3,435.64 ","$1,332.69 ","$1,717.82 ","$2,721.03 ","$2,748.51 ","$1,840.38 ","$1,493.54 ","$0.00 ","$1,422.11 ","$1,244.34 "
"13748","ERX","HCPCS 63700001","49348-0135-34","GUAIFENESIN 100 MG/5ML PO LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13748","ERX","HCPCS 63700001","61787-0063-04","GUAIFENESIN 100 MG/5ML PO LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13818","ERX","HCPCS 25000001","54162-0017-09","BACITRACIN ZINC 500 UNIT/GM EX OINT","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13884","ERX","HCPCS 63700001","59762-0450-01","COLESTIPOL HCL 1 G PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13979","ERX","HCPCS 63700001","00093-1136-56","ACITRETIN 25 MG PO CAPS","BOTH IP/OP","$134.46 ","$99.50 ","$0.00 ","$134.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.46 ","$0.00 ","$67.23 ","$106.49 ","$107.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13979","ERX","HCPCS 63700001","00145-0091-25","ACITRETIN 25 MG PO CAPS","BOTH IP/OP","$134.46 ","$99.50 ","$0.00 ","$134.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.46 ","$0.00 ","$67.23 ","$106.49 ","$107.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13979","ERX","HCPCS 63700001","42291-0088-30","ACITRETIN 25 MG PO CAPS","BOTH IP/OP","$134.46 ","$99.50 ","$0.00 ","$134.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.46 ","$0.00 ","$67.23 ","$106.49 ","$107.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13979","ERX","HCPCS 63700001","66993-0896-30","ACITRETIN 25 MG PO CAPS","BOTH IP/OP","$134.46 ","$99.50 ","$0.00 ","$134.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.46 ","$0.00 ","$67.23 ","$106.49 ","$107.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13980","ERX","HCPCS 63700001","00115-1750-08","ACITRETIN 10 MG PO CAPS","BOTH IP/OP","$120.44 ","$89.13 ","$0.00 ","$109.21 ","","$21.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.21 ","$0.00 ","$54.61 ","$86.49 ","$87.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13980","ERX","HCPCS 63700001","42291-0086-30","ACITRETIN 10 MG PO CAPS","BOTH IP/OP","$120.44 ","$89.13 ","$0.00 ","$109.21 ","","$21.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.21 ","$0.00 ","$54.61 ","$86.49 ","$87.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13981","ERX","HCPCS 63700001","16714-0700-01","LAMOTRIGINE 25 MG PO TABS","BOTH IP/OP","$15.81 ","$11.70 ","$0.00 ","$15.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.81 ","$0.00 ","$7.91 ","$12.52 ","$12.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13981","ERX","HCPCS 63700001","63739-0670-10","LAMOTRIGINE 25 MG PO TABS","BOTH IP/OP","$15.81 ","$11.70 ","$0.00 ","$15.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.81 ","$0.00 ","$7.91 ","$12.52 ","$12.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13981","ERX","HCPCS 63700001","68084-0318-01","LAMOTRIGINE 25 MG PO TABS","BOTH IP/OP","$15.81 ","$11.70 ","$0.00 ","$15.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.81 ","$0.00 ","$7.91 ","$12.52 ","$12.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13982","ERX","HCPCS 63700001","13668-0047-01","LAMOTRIGINE 100 MG PO TABS","BOTH IP/OP","$19.91 ","$14.73 ","$0.00 ","$18.05 ","","$3.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.05 ","$0.00 ","$9.03 ","$14.30 ","$14.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13982","ERX","HCPCS 63700001","16714-0701-01","LAMOTRIGINE 100 MG PO TABS","BOTH IP/OP","$19.91 ","$14.73 ","$0.00 ","$18.05 ","","$3.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.05 ","$0.00 ","$9.03 ","$14.30 ","$14.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13982","ERX","HCPCS 63700001","68084-0319-01","LAMOTRIGINE 100 MG PO TABS","BOTH IP/OP","$19.91 ","$14.73 ","$0.00 ","$18.05 ","","$3.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.05 ","$0.00 ","$9.03 ","$14.30 ","$14.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13983","ERX","HCPCS 63700001","00173-0644-60","LAMOTRIGINE 200 MG PO TABS","BOTH IP/OP","$25.71 ","$19.03 ","$0.00 ","$23.32 ","","$4.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.32 ","$0.00 ","$11.66 ","$18.47 ","$18.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13983","ERX","HCPCS 63700001","16714-0703-01","LAMOTRIGINE 200 MG PO TABS","BOTH IP/OP","$25.71 ","$19.03 ","$0.00 ","$23.32 ","","$4.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.32 ","$0.00 ","$11.66 ","$18.47 ","$18.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13983","ERX","HCPCS 63700001","51672-4133-04","LAMOTRIGINE 200 MG PO TABS","BOTH IP/OP","$25.71 ","$19.03 ","$0.00 ","$23.32 ","","$4.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.32 ","$0.00 ","$11.66 ","$18.47 ","$18.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13983","ERX","HCPCS 63700001","68382-0010-14","LAMOTRIGINE 200 MG PO TABS","BOTH IP/OP","$25.71 ","$19.03 ","$0.00 ","$23.32 ","","$4.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.32 ","$0.00 ","$11.66 ","$18.47 ","$18.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14087","ERX","HCPCS 25000001","00093-0150-01","ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14087","ERX","HCPCS 25000001","00406-0484-62","ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14087","ERX","HCPCS 25000001","00603-2338-21","ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14087","ERX","HCPCS 25000001","65162-0033-10","ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14087","ERX","HCPCS 25000001","68084-0372-01","ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14113","ERX","HCPCS 63700001","10939-0441-44","ASPIRIN EC 81 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14113","ERX","HCPCS 63700001","63739-0212-01","ASPIRIN EC 81 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14113","ERX","HCPCS 63700001","63739-0522-01","ASPIRIN EC 81 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14113","ERX","HCPCS 63700001","63739-0522-10","ASPIRIN EC 81 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14132","ERX","HCPCS 63700001","45802-0465-64","KETOCONAZOLE 2 % EX SHAM","BOTH IP/OP","$97.44 ","$72.11 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.44 ","$0.00 ","$48.72 ","$77.17 ","$77.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14190","ERX","HCPCS 25000001","00472-0339-56","HYDROCORTISONE-ALOE 1 % EX CREA","BOTH IP/OP","$14.55 ","$10.77 ","$0.00 ","$13.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.20 ","$0.00 ","$6.60 ","$10.45 ","$10.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14196","ERX","HCPCS 63700001","00046-1107-11","CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG PO TABS","BOTH IP/OP","$40.16 ","$29.72 ","$0.00 ","$33.03 ","","$7.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.03 ","$0.00 ","$16.52 ","$26.16 ","$26.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14232","ERX","HCPCS 63700001","16714-0695-01","FLUCONAZOLE 10 MG/ML PO SUSR","BOTH IP/OP","$133.35 ","$98.68 ","$0.00 ","$120.91 ","","$23.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.91 ","$0.00 ","$60.46 ","$95.76 ","$96.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14232","ERX","HCPCS 63700001","59762-5029-01","FLUCONAZOLE 10 MG/ML PO SUSR","BOTH IP/OP","$133.35 ","$98.68 ","$0.00 ","$120.91 ","","$23.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.91 ","$0.00 ","$60.46 ","$95.76 ","$96.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14232","ERX","HCPCS 63700001","99999-6004-82","FLUCONAZOLE 10 MG/ML PO SUSR","BOTH IP/OP","$133.35 ","$98.68 ","$0.00 ","$120.91 ","","$23.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.91 ","$0.00 ","$60.46 ","$95.76 ","$96.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14233","ERX","HCPCS 63700001","00049-3450-19","FLUCONAZOLE 40 MG/ML PO SUSR","BOTH IP/OP","$130.24 ","$96.38 ","$0.00 ","$116.26 ","","$23.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.26 ","$0.00 ","$58.13 ","$92.08 ","$93.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14233","ERX","HCPCS 63700001","00054-0003-85","FLUCONAZOLE 40 MG/ML PO SUSR","BOTH IP/OP","$130.24 ","$96.38 ","$0.00 ","$116.26 ","","$23.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.26 ","$0.00 ","$58.13 ","$92.08 ","$93.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14233","ERX","HCPCS 63700001","16714-0696-01","FLUCONAZOLE 40 MG/ML PO SUSR","BOTH IP/OP","$130.24 ","$96.38 ","$0.00 ","$116.26 ","","$23.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.26 ","$0.00 ","$58.13 ","$92.08 ","$93.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14233","ERX","HCPCS 63700001","59762-5030-01","FLUCONAZOLE 40 MG/ML PO SUSR","BOTH IP/OP","$130.24 ","$96.38 ","$0.00 ","$116.26 ","","$23.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.26 ","$0.00 ","$58.13 ","$92.08 ","$93.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14266","ERX","HCPCS 63700001","16714-0702-01","LAMOTRIGINE 150 MG PO TABS","BOTH IP/OP","$19.79 ","$14.64 ","$0.00 ","$19.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.79 ","$0.00 ","$9.90 ","$15.67 ","$15.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14266","ERX","HCPCS 63700001","29300-0113-16","LAMOTRIGINE 150 MG PO TABS","BOTH IP/OP","$19.79 ","$14.64 ","$0.00 ","$19.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.79 ","$0.00 ","$9.90 ","$15.67 ","$15.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14266","ERX","HCPCS 63700001","51672-4132-04","LAMOTRIGINE 150 MG PO TABS","BOTH IP/OP","$19.79 ","$14.64 ","$0.00 ","$19.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.79 ","$0.00 ","$9.90 ","$15.67 ","$15.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14468","ERX","HCPCS 25000001","99999-6007-11","ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$71.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.90 ","$0.00 ","$35.95 ","$4.75 ","$57.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14468","ERX","HCPCS 25000001","00121-0504-16","ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$71.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.90 ","$0.00 ","$35.95 ","$56.94 ","$57.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14468","ERX","HCPCS 25000001","50383-0079-16","ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$71.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.90 ","$0.00 ","$35.95 ","$56.94 ","$57.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14471","ERX","HCPCS 63700001","00006-3519-36","DORZOLAMIDE HCL 2 % OP SOLN","BOTH IP/OP","$216.03 ","$159.86 ","$0.00 ","$216.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.03 ","$0.00 ","$108.02 ","$171.10 ","$172.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14471","ERX","HCPCS 63700001","24208-0485-10","DORZOLAMIDE HCL 2 % OP SOLN","BOTH IP/OP","$216.03 ","$159.86 ","$0.00 ","$216.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.03 ","$0.00 ","$108.02 ","$171.10 ","$172.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14471","ERX","HCPCS 63700001","42571-0141-26","DORZOLAMIDE HCL 2 % OP SOLN","BOTH IP/OP","$216.03 ","$159.86 ","$0.00 ","$216.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.03 ","$0.00 ","$108.02 ","$171.10 ","$172.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14471","ERX","HCPCS 63700001","50383-0232-10","DORZOLAMIDE HCL 2 % OP SOLN","BOTH IP/OP","$216.03 ","$159.86 ","$0.00 ","$216.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.03 ","$0.00 ","$108.02 ","$171.10 ","$172.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14471","ERX","HCPCS 63700001","61314-0019-10","DORZOLAMIDE HCL 2 % OP SOLN","BOTH IP/OP","$216.03 ","$159.86 ","$0.00 ","$216.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.03 ","$0.00 ","$108.02 ","$171.10 ","$172.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14553","ERX","HCPCS 63700001","59746-0385-06","TERAZOSIN HCL 5 MG PO CAPS","BOTH IP/OP","$6.10 ","$4.51 ","$0.00 ","$6.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.10 ","$0.00 ","$3.05 ","$4.83 ","$4.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14626","ERX","HCPCS 63700001","68462-0293-01","VERAPAMIL HCL ER 180 MG PO TBCR","BOTH IP/OP","$9.47 ","$7.01 ","$0.00 ","$9.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.47 ","$0.00 ","$4.74 ","$7.50 ","$7.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","00378-4151-01","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","00378-4151-05","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","00904-6365-61","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","51079-0991-01","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","51079-0991-20","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","57664-0377-08","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","65162-0627-10","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14632","ERX","HCPCS 63700001","68084-0808-01","TRAMADOL HCL 50 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14633","ERX","HCPCS J9214","00085-1168-01","INTERFERON ALFA-2B 6000000 UNIT/ML IJ SOLN","BOTH IP/OP","$2,050.80 ","$1,517.59 ","$0.00 ","$2,050.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,050.80 ","$0.00 ","$1,025.40 ","$1,624.23 ","$1,640.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14643","ERX","HCPCS J0885","59676-0320-04","EPOETIN ALFA 20000 UNIT/ML IJ SOLN","BOTH IP/OP","$1,661.23 ","$1,229.31 ","$0.00 ","$1,539.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.53 ","$1,539.36 ","$0.00 ","$769.68 ","$1,219.17 ","$1,231.49 ","$0.00 ","$240.91 ","$0.00 ","$237.19 ","$0.00 "
"14678","ERX","HCPCS 25000001","49281-0790-51","TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN","BOTH IP/OP","$469.20 ","$347.21 ","$0.00 ","$385.59 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$385.59 ","$0.00 ","$192.80 ","$305.39 ","$308.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14719","ERX","HCPCS 63700001","23155-0103-05","METFORMIN HCL 850 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14719","ERX","HCPCS 63700001","57664-0435-51","METFORMIN HCL 850 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14719","ERX","HCPCS 63700001","60687-0143-01","METFORMIN HCL 850 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14719","ERX","HCPCS 63700001","60687-0143-11","METFORMIN HCL 850 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14719","ERX","HCPCS 63700001","63739-0702-10","METFORMIN HCL 850 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14792","ERX","HCPCS 63700001","00185-0034-51","TIZANIDINE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14792","ERX","HCPCS 63700001","42291-0808-15","TIZANIDINE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14792","ERX","HCPCS 63700001","55111-0179-15","TIZANIDINE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14792","ERX","HCPCS 63700001","57664-0502-89","TIZANIDINE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14792","ERX","HCPCS 63700001","60505-0251-03","TIZANIDINE HCL 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14793","ERX","HCPCS 63700001","00185-4400-51","TIZANIDINE HCL 4 MG PO TABS","BOTH IP/OP","$9.69 ","$7.17 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.69 ","$0.00 ","$4.85 ","$7.67 ","$7.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14793","ERX","HCPCS 63700001","55111-0180-15","TIZANIDINE HCL 4 MG PO TABS","BOTH IP/OP","$9.69 ","$7.17 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.69 ","$0.00 ","$4.85 ","$7.67 ","$7.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14793","ERX","HCPCS 63700001","60505-0252-03","TIZANIDINE HCL 4 MG PO TABS","BOTH IP/OP","$9.69 ","$7.17 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.69 ","$0.00 ","$4.85 ","$7.67 ","$7.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14820","ERX","HCPCS 63700001","55111-0338-01","AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS","BOTH IP/OP","$11.13 ","$8.24 ","$0.00 ","$10.09 ","","$1.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.09 ","$0.00 ","$5.05 ","$7.99 ","$8.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14820","ERX","HCPCS 63700001","65862-0582-01","AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS","BOTH IP/OP","$11.13 ","$8.24 ","$0.00 ","$10.09 ","","$1.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.09 ","$0.00 ","$5.05 ","$7.99 ","$8.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14821","ERX","HCPCS 63700001","55111-0339-01","AMLODIPINE-BENAZEPRIL HCL 5-10 MG PO CAPS","BOTH IP/OP","$11.35 ","$8.40 ","$0.00 ","$10.29 ","","$2.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.29 ","$0.00 ","$5.15 ","$8.15 ","$8.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14822","ERX","HCPCS 63700001","55111-0340-01","AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS","BOTH IP/OP","$11.98 ","$8.87 ","$0.00 ","$10.87 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.87 ","$0.00 ","$5.44 ","$8.61 ","$8.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14822","ERX","HCPCS 63700001","57237-0144-01","AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS","BOTH IP/OP","$11.98 ","$8.87 ","$0.00 ","$10.87 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.87 ","$0.00 ","$5.44 ","$8.61 ","$8.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14823","ERX","HCPCS 63700001","31722-0700-90","LOSARTAN POTASSIUM 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14823","ERX","HCPCS 63700001","63739-0673-10","LOSARTAN POTASSIUM 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14823","ERX","HCPCS 63700001","68084-0346-01","LOSARTAN POTASSIUM 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14823","ERX","HCPCS 63700001","68180-0376-09","LOSARTAN POTASSIUM 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","00006-0952-31","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","31722-0701-30","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","31722-0701-90","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","50268-0517-11","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","50268-0517-15","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","65862-0202-30","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","65862-0202-90","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","68084-0347-01","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14824","ERX","HCPCS 63700001","68180-0377-09","LOSARTAN POTASSIUM 50 MG PO TABS","BOTH IP/OP","$9.43 ","$6.98 ","$0.00 ","$8.55 ","","$1.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14825","ERX","HCPCS 63700001","00456-4300-01","FOSFOMYCIN TROMETHAMINE 3 G PO PACK","BOTH IP/OP","$367.99 ","$272.31 ","$0.00 ","$334.04 ","","$65.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$334.04 ","$0.00 ","$167.02 ","$264.56 ","$267.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14845","ERX","HCPCS J1265","00338-1007-03","DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","BOTH IP/OP","$84.92 ","$62.84 ","$0.00 ","$75.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.25 ","$0.00 ","$37.63 ","$59.60 ","$60.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14845","ERX","HCPCS J1265","00409-7809-24","DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN","BOTH IP/OP","$84.92 ","$62.84 ","$0.00 ","$75.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.25 ","$0.00 ","$37.63 ","$59.60 ","$60.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14868","ERX","HCPCS J2001","00264-9594-20","LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN","BOTH IP/OP","$28.29 ","$20.93 ","$0.00 ","$25.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.53 ","$25.65 ","$0.00 ","$12.83 ","$20.31 ","$20.52 ","$0.00 ","$3.53 ","$0.00 ","$3.36 ","$0.00 "
"14923","ERX","HCPCS 25000001","00409-1966-07","SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14952","ERX","HCPCS 63700001","80681-0104-00","CO-ENZYME Q-10 30 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14953","ERX","HCPCS 63700001","00173-0547-00","ATOVAQUONE 750 MG/5ML PO SUSP","BOTH IP/OP","$140.89 ","$104.26 ","$0.00 ","$127.75 ","","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$0.00 ","$63.88 ","$101.18 ","$102.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14953","ERX","HCPCS 63700001","16714-0900-01","ATOVAQUONE 750 MG/5ML PO SUSP","BOTH IP/OP","$140.89 ","$104.26 ","$0.00 ","$127.75 ","","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$0.00 ","$63.88 ","$101.18 ","$102.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14953","ERX","HCPCS 63700001","31722-0629-21","ATOVAQUONE 750 MG/5ML PO SUSP","BOTH IP/OP","$140.89 ","$104.26 ","$0.00 ","$127.75 ","","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$0.00 ","$63.88 ","$101.18 ","$102.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14953","ERX","HCPCS 63700001","66993-0062-72","ATOVAQUONE 750 MG/5ML PO SUSP","BOTH IP/OP","$140.89 ","$104.26 ","$0.00 ","$127.75 ","","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$0.00 ","$63.88 ","$101.18 ","$102.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14953","ERX","HCPCS 63700001","68180-0282-01","ATOVAQUONE 750 MG/5ML PO SUSP","BOTH IP/OP","$140.89 ","$104.26 ","$0.00 ","$127.75 ","","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$0.00 ","$63.88 ","$101.18 ","$102.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14953","ERX","HCPCS 63700001","99999-6008-29","ATOVAQUONE 750 MG/5ML PO SUSP","BOTH IP/OP","$140.89 ","$104.26 ","$0.00 ","$127.75 ","","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.75 ","$0.00 ","$63.88 ","$101.18 ","$102.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","00006-0717-31","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","00006-0717-54","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","00093-7367-98","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","16714-0226-01","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","16714-0226-02","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","62332-0048-90","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","65862-0468-90","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14958","ERX","HCPCS 63700001","68180-0215-09","LOSARTAN-HCTZ 50-12.5 MG PO TABS","BOTH IP/OP","$10.43 ","$7.72 ","$0.00 ","$9.46 ","","$1.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.46 ","$0.00 ","$4.73 ","$7.49 ","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14979","ERX","HCPCS 25000001","00409-3977-03","BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15113","ERX","HCPCS J7517","00093-7334-01","MYCOPHENOLATE MOFETIL 250 MG PO CAPS","BOTH IP/OP","$16.63 ","$12.31 ","$0.00 ","$15.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.64 ","$15.08 ","$0.00 ","$7.54 ","$11.94 ","$12.06 ","$0.00 ","$2.36 ","$0.00 ","$2.40 ","$0.00 "
"15113","ERX","HCPCS J7517","00093-7334-05","MYCOPHENOLATE MOFETIL 250 MG PO CAPS","BOTH IP/OP","$16.63 ","$12.31 ","$0.00 ","$15.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.64 ","$15.08 ","$0.00 ","$7.54 ","$11.94 ","$12.06 ","$0.00 ","$2.36 ","$0.00 ","$2.40 ","$0.00 "
"15113","ERX","HCPCS J7517","51079-0721-20","MYCOPHENOLATE MOFETIL 250 MG PO CAPS","BOTH IP/OP","$16.63 ","$12.31 ","$0.00 ","$15.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.64 ","$15.08 ","$0.00 ","$7.54 ","$11.94 ","$12.06 ","$0.00 ","$2.36 ","$0.00 ","$2.40 ","$0.00 "
"15119","ERX","HCPCS 25000001","00074-4456-04","SEVOFLURANE IN SOLN","BOTH IP/OP","$658.46 ","$487.26 ","$0.00 ","$597.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$597.58 ","$0.00 ","$298.79 ","$473.28 ","$478.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15168","ERX","HCPCS 63700001","99999-6009-06","SENNOSIDES 8.8 MG/5ML PO SYRP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15168","ERX","HCPCS 63700001","54162-0007-08","SENNOSIDES 8.8 MG/5ML PO SYRP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$38.36 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$38.36 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15235","ERX","HCPCS J1642","64253-0333-35","HEPARIN SODIUM LOCK FLUSH 100 UNIT/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$5.29 ","$0.00 ","$0.00 ","$18.80 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$18.80 ","$0.00 ","$17.90 ","$0.00 "
"15255","ERX","HCPCS 25000001","10956-0618-01","PYRANTEL PAMOATE 144 (50 BASE) MG/ML PO SUSP","BOTH IP/OP","$32.44 ","$24.01 ","$0.00 ","$27.82 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.82 ","$0.00 ","$13.91 ","$22.03 ","$22.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15327","ERX","HCPCS 63700001","16714-0531-11","SUMATRIPTAN SUCCINATE 25 MG PO TABS","BOTH IP/OP","$104.43 ","$77.28 ","$0.00 ","$94.69 ","","$18.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.69 ","$0.00 ","$47.35 ","$74.99 ","$75.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15327","ERX","HCPCS 63700001","55111-0291-09","SUMATRIPTAN SUCCINATE 25 MG PO TABS","BOTH IP/OP","$104.43 ","$77.28 ","$0.00 ","$94.69 ","","$18.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.69 ","$0.00 ","$47.35 ","$74.99 ","$75.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15328","ERX","HCPCS 63700001","00378-5631-59","SUMATRIPTAN SUCCINATE 50 MG PO TABS","BOTH IP/OP","$87.99 ","$65.11 ","$0.00 ","$87.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.99 ","$0.00 ","$44.00 ","$69.69 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15328","ERX","HCPCS 63700001","16714-0532-11","SUMATRIPTAN SUCCINATE 50 MG PO TABS","BOTH IP/OP","$87.99 ","$65.11 ","$0.00 ","$87.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.99 ","$0.00 ","$44.00 ","$69.69 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15330","ERX","HCPCS J0153","00409-1932-02","ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","BOTH IP/OP","$514.69 ","$380.87 ","$0.00 ","$467.20 ","$231.61 ","$0.00 ","$107.27 ","$0.00 ","$0.00 ","$65.57 ","$467.20 ","$0.00 ","$233.60 ","$370.02 ","$373.76 ","$0.00 ","$65.57 ","$0.00 ","$62.43 ","$0.00 "
"15330","ERX","HCPCS J0153","00703-8777-01","ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","BOTH IP/OP","$514.69 ","$380.87 ","$0.00 ","$467.20 ","$231.61 ","$0.00 ","$107.27 ","$0.00 ","$0.00 ","$65.57 ","$467.20 ","$0.00 ","$233.60 ","$370.02 ","$373.76 ","$0.00 ","$65.57 ","$0.00 ","$62.43 ","$0.00 "
"15330","ERX","HCPCS J0153","55150-0193-30","ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","BOTH IP/OP","$514.69 ","$380.87 ","$0.00 ","$467.20 ","$231.61 ","$0.00 ","$107.27 ","$0.00 ","$0.00 ","$65.57 ","$467.20 ","$0.00 ","$233.60 ","$370.02 ","$373.76 ","$0.00 ","$65.57 ","$0.00 ","$62.43 ","$0.00 "
"15330","ERX","HCPCS J0153","67457-0857-30","ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","BOTH IP/OP","$514.69 ","$380.87 ","$0.00 ","$467.20 ","$231.61 ","$0.00 ","$107.27 ","$0.00 ","$0.00 ","$65.57 ","$467.20 ","$0.00 ","$233.60 ","$370.02 ","$373.76 ","$0.00 ","$65.57 ","$0.00 ","$62.43 ","$0.00 "
"15340","ERX","HCPCS 63700001","00228-2550-11","DICLOFENAC SODIUM 50 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15340","ERX","HCPCS 63700001","61442-0102-01","DICLOFENAC SODIUM 50 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15341","ERX","HCPCS 63700001","00228-2551-06","DICLOFENAC SODIUM 75 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15341","ERX","HCPCS 63700001","00228-2551-11","DICLOFENAC SODIUM 75 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15341","ERX","HCPCS 63700001","68084-0333-01","DICLOFENAC SODIUM 75 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15341","ERX","HCPCS 63700001","68084-0333-11","DICLOFENAC SODIUM 75 MG PO TBEC","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15349","ERX","HCPCS 63700001","00378-3635-01","CETIRIZINE HCL 5 MG PO TABS","BOTH IP/OP","$9.49 ","$7.02 ","$0.00 ","$9.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15349","ERX","HCPCS 63700001","16571-0401-10","CETIRIZINE HCL 5 MG PO TABS","BOTH IP/OP","$9.49 ","$7.02 ","$0.00 ","$9.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15349","ERX","HCPCS 63700001","60505-2632-01","CETIRIZINE HCL 5 MG PO TABS","BOTH IP/OP","$9.49 ","$7.02 ","$0.00 ","$9.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.49 ","$0.00 ","$4.75 ","$7.52 ","$7.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15372","ERX","HCPCS 63700001","00225-0525-47","AYR SALINE NASAL NA GEL","BOTH IP/OP","$12.88 ","$9.53 ","$0.00 ","$11.69 ","","$2.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.69 ","$0.00 ","$5.85 ","$9.26 ","$9.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15661","ERX","HCPCS 63700001","16714-0631-01","ALENDRONATE SODIUM 10 MG PO TABS","BOTH IP/OP","$12.25 ","$9.07 ","$0.00 ","$11.11 ","","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$0.00 ","$5.56 ","$8.80 ","$8.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15661","ERX","HCPCS 63700001","16714-0631-02","ALENDRONATE SODIUM 10 MG PO TABS","BOTH IP/OP","$12.25 ","$9.07 ","$0.00 ","$11.11 ","","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$0.00 ","$5.56 ","$8.80 ","$8.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15661","ERX","HCPCS 63700001","64980-0340-01","ALENDRONATE SODIUM 10 MG PO TABS","BOTH IP/OP","$12.25 ","$9.07 ","$0.00 ","$11.11 ","","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$0.00 ","$5.56 ","$8.80 ","$8.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15738","ERX","HCPCS 63700001","60505-0823-06","CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","BOTH IP/OP","$398.30 ","$294.74 ","$0.00 ","$955.54 ","","$70.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.54 ","$0.00 ","$477.77 ","$756.79 ","$764.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15746","ERX","HCPCS 63700001","16714-0816-01","BICALUTAMIDE 50 MG PO TABS","BOTH IP/OP","$80.79 ","$59.78 ","$0.00 ","$80.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.79 ","$0.00 ","$40.40 ","$63.99 ","$64.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15746","ERX","HCPCS 63700001","16714-0816-02","BICALUTAMIDE 50 MG PO TABS","BOTH IP/OP","$80.79 ","$59.78 ","$0.00 ","$80.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.79 ","$0.00 ","$40.40 ","$63.99 ","$64.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15746","ERX","HCPCS 63700001","60429-0177-01","BICALUTAMIDE 50 MG PO TABS","BOTH IP/OP","$80.79 ","$59.78 ","$0.00 ","$80.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.79 ","$0.00 ","$40.40 ","$63.99 ","$64.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15747","ERX","HCPCS 63700001","00378-3632-01","CARVEDILOL 6.25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15747","ERX","HCPCS 63700001","00904-6301-61","CARVEDILOL 6.25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15747","ERX","HCPCS 63700001","51079-0930-01","CARVEDILOL 6.25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15747","ERX","HCPCS 63700001","51079-0930-20","CARVEDILOL 6.25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15747","ERX","HCPCS 63700001","68084-0854-01","CARVEDILOL 6.25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15748","ERX","HCPCS 63700001","00093-7296-01","CARVEDILOL 25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15748","ERX","HCPCS 63700001","00378-3634-01","CARVEDILOL 25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15748","ERX","HCPCS 63700001","00904-6303-61","CARVEDILOL 25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15748","ERX","HCPCS 63700001","51079-0932-01","CARVEDILOL 25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15748","ERX","HCPCS 63700001","51079-0932-20","CARVEDILOL 25 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15749","ERX","HCPCS 63700001","00093-7295-01","CARVEDILOL 12.5 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15749","ERX","HCPCS 63700001","00781-5223-01","CARVEDILOL 12.5 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15749","ERX","HCPCS 63700001","00904-6302-61","CARVEDILOL 12.5 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15749","ERX","HCPCS 63700001","51079-0931-01","CARVEDILOL 12.5 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15749","ERX","HCPCS 63700001","51079-0931-20","CARVEDILOL 12.5 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15749","ERX","HCPCS 63700001","68382-0094-01","CARVEDILOL 12.5 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15796","ERX","HCPCS 63700001","00069-3110-19","AZITHROMYCIN 100 MG/5ML PO SUSR","BOTH IP/OP","$122.98 ","$91.01 ","$0.00 ","$109.89 ","","$21.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.89 ","$0.00 ","$54.95 ","$87.03 ","$87.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15796","ERX","HCPCS 63700001","59762-3110-01","AZITHROMYCIN 100 MG/5ML PO SUSR","BOTH IP/OP","$122.98 ","$91.01 ","$0.00 ","$109.89 ","","$21.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.89 ","$0.00 ","$54.95 ","$87.03 ","$87.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15797","ERX","HCPCS 63700001","00093-2026-23","AZITHROMYCIN 200 MG/5ML PO SUSR","BOTH IP/OP","$134.62 ","$99.62 ","$0.00 ","$122.07 ","","$23.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.07 ","$0.00 ","$61.04 ","$96.68 ","$97.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15797","ERX","HCPCS 63700001","59762-3120-01","AZITHROMYCIN 200 MG/5ML PO SUSR","BOTH IP/OP","$134.62 ","$99.62 ","$0.00 ","$122.07 ","","$23.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.07 ","$0.00 ","$61.04 ","$96.68 ","$97.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15797","ERX","HCPCS 63700001","59762-3140-01","AZITHROMYCIN 200 MG/5ML PO SUSR","BOTH IP/OP","$134.62 ","$99.62 ","$0.00 ","$122.07 ","","$23.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.07 ","$0.00 ","$61.04 ","$96.72 ","$97.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15816","ERX","HCPCS 63700001","00121-1276-00","GUAIFENESIN-DM 100-10 MG/5ML PO SYRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15852","ERX","HCPCS J2274","00409-3815-12","MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15852","ERX","HCPCS J2274","00641-6019-01","MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15852","ERX","HCPCS J2274","00641-6019-10","MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15852","ERX","HCPCS J2274","99999-6012-28","MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15859","ERX","HCPCS 25000001","00338-1049-02","NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN","BOTH IP/OP","$95.54 ","$70.70 ","$0.00 ","$29.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.45 ","$0.00 ","$14.73 ","$23.32 ","$23.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15861","ERX","HCPCS J7042","00338-0085-03","DEXTROSE-NACL 5-0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15861","ERX","HCPCS J7042","00409-7926-03","DEXTROSE-NACL 5-0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15861","ERX","HCPCS J7042","00264-7612-00","DEXTROSE-NACL 5-0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15861","ERX","HCPCS J7042","00338-0085-04","DEXTROSE-NACL 5-0.45 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.80 ","$11.31 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15863","ERX","HCPCS J7042","00338-0077-03","DEXTROSE-NACL 5-0.2 % IV SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$22.80 ","$13.20 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$17.42 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15863","ERX","HCPCS J7042","00264-7616-00","DEXTROSE-NACL 5-0.2 % IV SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$22.80 ","$13.20 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15863","ERX","HCPCS J7042","00338-0077-04","DEXTROSE-NACL 5-0.2 % IV SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$22.80 ","$13.20 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15865","ERX","HCPCS J7042","00264-7623-20","DEXTROSE-NACL 10-0.2 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.36 ","$0.00 ","$0.00 ","$1.09 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.09 ","$0.00 ","$1.04 ","$0.00 "
"15880","ERX","HCPCS 63700001","50742-0623-60","LAMIVUDINE 150 MG PO TABS","BOTH IP/OP","$29.98 ","$22.19 ","$0.00 ","$27.19 ","","$5.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.19 ","$0.00 ","$13.60 ","$21.53 ","$21.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15880","ERX","HCPCS 63700001","60505-3251-06","LAMIVUDINE 150 MG PO TABS","BOTH IP/OP","$29.98 ","$22.19 ","$0.00 ","$27.19 ","","$5.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.19 ","$0.00 ","$13.60 ","$21.53 ","$21.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15880","ERX","HCPCS 63700001","64380-0710-03","LAMIVUDINE 150 MG PO TABS","BOTH IP/OP","$29.98 ","$22.19 ","$0.00 ","$27.19 ","","$5.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.19 ","$0.00 ","$13.60 ","$21.53 ","$21.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15880","ERX","HCPCS 63700001","65862-0025-60","LAMIVUDINE 150 MG PO TABS","BOTH IP/OP","$29.98 ","$22.19 ","$0.00 ","$27.19 ","","$5.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.19 ","$0.00 ","$13.60 ","$21.53 ","$21.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15881","ERX","HCPCS 63700001","99999-6010-41","LAMIVUDINE 10 MG/ML PO SOLN","BOTH IP/OP","$62.73 ","$46.42 ","$0.00 ","$192.41 ","","$11.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.41 ","$0.00 ","$96.21 ","$45.06 ","$153.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15881","ERX","HCPCS 63700001","99999-6004-86","LAMIVUDINE 10 MG/ML PO SOLN","BOTH IP/OP","$62.73 ","$46.42 ","$0.00 ","$192.41 ","","$11.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.41 ","$0.00 ","$96.21 ","$152.39 ","$153.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15881","ERX","HCPCS 63700001","49702-0205-48","LAMIVUDINE 10 MG/ML PO SOLN","BOTH IP/OP","$62.73 ","$46.42 ","$0.00 ","$321.18 ","","$11.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.41 ","$0.00 ","$96.21 ","$321.18 ","$153.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15881","ERX","HCPCS 63700001","54838-0566-70","LAMIVUDINE 10 MG/ML PO SOLN","BOTH IP/OP","$62.73 ","$46.42 ","$0.00 ","$321.18 ","","$11.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.41 ","$0.00 ","$96.21 ","$321.18 ","$153.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15882","ERX","HCPCS J7042","00338-0089-04","DEXTROSE-NACL 5-0.9 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15882","ERX","HCPCS J7042","00338-0089-03","DEXTROSE-NACL 5-0.9 % IV SOLN","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.73 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"15898","ERX","HCPCS J1325","66215-0402-01","EPOPROSTENOL SODIUM 1.5 MG IV SOLR","BOTH IP/OP","$195.05 ","$144.34 ","$0.00 ","$177.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.07 ","$0.00 ","$88.54 ","$140.24 ","$141.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15906","ERX","HCPCS J1580","00338-0503-48","GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"15908","ERX","HCPCS J1580","00338-0505-48","GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"15911","ERX","HCPCS J1580","00338-0509-41","GENTAMICIN IN SALINE 1.6-0.9 MG/ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"16005","ERX","HCPCS 63700001","00555-0808-02","TRETINOIN 10 MG PO CAPS","BOTH IP/OP","$627.52 ","$464.36 ","$0.00 ","$569.62 ","","$111.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.62 ","$0.00 ","$284.81 ","$451.14 ","$455.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16005","ERX","HCPCS 63700001","10370-0268-01","TRETINOIN 10 MG PO CAPS","BOTH IP/OP","$627.52 ","$464.36 ","$0.00 ","$569.62 ","","$111.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.62 ","$0.00 ","$284.81 ","$451.14 ","$455.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16005","ERX","HCPCS 63700001","68084-0075-21","TRETINOIN 10 MG PO CAPS","BOTH IP/OP","$627.52 ","$464.36 ","$0.00 ","$569.62 ","","$111.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.62 ","$0.00 ","$284.81 ","$451.14 ","$455.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16032","ERX","HCPCS 63700001","00046-2575-12","CONJ ESTROG-MEDROXYPROGEST ACE PO TABS","BOTH IP/OP","$40.16 ","$29.72 ","$0.00 ","$33.03 ","","$7.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.03 ","$0.00 ","$16.52 ","$26.16 ","$26.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16050","ERX","HCPCS 25000001","00904-6710-15","GLUCOSE 4 G PO CHEW","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16052","ERX","HCPCS 63700001","00591-2464-01","DESMOPRESSIN ACETATE 0.1 MG PO TABS","BOTH IP/OP","$22.15 ","$16.39 ","$0.00 ","$20.09 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.09 ","$0.00 ","$10.05 ","$15.91 ","$16.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16052","ERX","HCPCS 63700001","10702-0169-01","DESMOPRESSIN ACETATE 0.1 MG PO TABS","BOTH IP/OP","$22.15 ","$16.39 ","$0.00 ","$20.09 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.09 ","$0.00 ","$10.05 ","$15.91 ","$16.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16052","ERX","HCPCS 63700001","68084-0606-11","DESMOPRESSIN ACETATE 0.1 MG PO TABS","BOTH IP/OP","$22.15 ","$16.39 ","$0.00 ","$20.09 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.09 ","$0.00 ","$10.05 ","$15.91 ","$16.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16052","ERX","HCPCS 63700001","68084-0606-21","DESMOPRESSIN ACETATE 0.1 MG PO TABS","BOTH IP/OP","$22.15 ","$16.39 ","$0.00 ","$20.09 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.09 ","$0.00 ","$10.05 ","$15.91 ","$16.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16052","ERX","HCPCS 63700001","68462-0275-01","DESMOPRESSIN ACETATE 0.1 MG PO TABS","BOTH IP/OP","$22.15 ","$16.39 ","$0.00 ","$20.09 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.09 ","$0.00 ","$10.05 ","$15.91 ","$16.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16052","ERX","HCPCS 63700001","69918-0101-01","DESMOPRESSIN ACETATE 0.1 MG PO TABS","BOTH IP/OP","$22.15 ","$16.39 ","$0.00 ","$20.09 ","","$3.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.09 ","$0.00 ","$10.05 ","$15.91 ","$16.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16124","ERX","HCPCS 63700001","67877-0286-60","(RILUTEK) RILUZOLE 50 MG PO TABS","BOTH IP/OP","$126.22 ","$93.40 ","$0.00 ","$114.44 ","","$22.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.44 ","$0.00 ","$57.22 ","$90.64 ","$91.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16124","ERX","HCPCS 63700001","68462-0381-60","(RILUTEK) RILUZOLE 50 MG PO TABS","BOTH IP/OP","$126.22 ","$93.40 ","$0.00 ","$114.44 ","","$22.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.44 ","$0.00 ","$57.22 ","$90.64 ","$91.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16205","ERX","HCPCS 63700001","00093-7536-56","ANASTROZOLE 1 MG PO TABS","BOTH IP/OP","$73.45 ","$54.35 ","$0.00 ","$73.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.45 ","$0.00 ","$36.73 ","$58.17 ","$58.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16205","ERX","HCPCS 63700001","00904-6195-46","ANASTROZOLE 1 MG PO TABS","BOTH IP/OP","$73.45 ","$54.35 ","$0.00 ","$73.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.45 ","$0.00 ","$36.73 ","$58.17 ","$58.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16205","ERX","HCPCS 63700001","16729-0035-10","ANASTROZOLE 1 MG PO TABS","BOTH IP/OP","$73.45 ","$54.35 ","$0.00 ","$73.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.45 ","$0.00 ","$36.73 ","$58.17 ","$58.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16205","ERX","HCPCS 63700001","60505-2985-03","ANASTROZOLE 1 MG PO TABS","BOTH IP/OP","$73.45 ","$54.35 ","$0.00 ","$73.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.45 ","$0.00 ","$36.73 ","$58.17 ","$58.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16205","ERX","HCPCS 63700001","68382-0209-06","ANASTROZOLE 1 MG PO TABS","BOTH IP/OP","$73.45 ","$54.35 ","$0.00 ","$73.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.45 ","$0.00 ","$36.73 ","$58.17 ","$58.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16208","ERX","HCPCS 25000001","60258-0001-16","CYTRA-2 500-334 MG/5ML PO SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16218","ERX","HCPCS 63700001","00054-3120-41","CALCITRIOL 1 MCG/ML PO SOLN","BOTH IP/OP","$601.43 ","$445.06 ","$0.00 ","$545.94 ","","$107.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$545.94 ","$0.00 ","$272.97 ","$432.38 ","$436.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16218","ERX","HCPCS 63700001","30698-0911-15","CALCITRIOL 1 MCG/ML PO SOLN","BOTH IP/OP","$601.43 ","$445.06 ","$0.00 ","$545.94 ","","$107.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$545.94 ","$0.00 ","$272.97 ","$432.38 ","$436.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16218","ERX","HCPCS 63700001","63304-0241-59","CALCITRIOL 1 MCG/ML PO SOLN","BOTH IP/OP","$601.43 ","$445.06 ","$0.00 ","$545.94 ","","$107.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$545.94 ","$0.00 ","$272.97 ","$432.38 ","$436.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16355","ERX","HCPCS 63700001","55111-0320-01","GLIMEPIRIDE 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16356","ERX","HCPCS 63700001","68084-0326-01","GLIMEPIRIDE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16356","ERX","HCPCS 63700001","68084-0326-11","GLIMEPIRIDE 2 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16357","ERX","HCPCS 63700001","55111-0322-01","GLIMEPIRIDE 4 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16369","ERX","HCPCS J0692","25021-0121-20","CEFEPIME HCL 1 G IJ SOLR","BOTH IP/OP","$78.49 ","$58.08 ","$0.00 ","$71.17 ","$35.32 ","$0.00 ","$16.36 ","$0.00 ","$0.00 ","$12.46 ","$71.17 ","$0.00 ","$35.59 ","$56.37 ","$56.94 ","$0.00 ","$11.14 ","$0.00 ","$11.33 ","$0.00 "
"16369","ERX","HCPCS J0692","44567-0240-10","CEFEPIME HCL 1 G IJ SOLR","BOTH IP/OP","$78.49 ","$58.08 ","$0.00 ","$71.17 ","$35.32 ","$0.00 ","$16.36 ","$0.00 ","$0.00 ","$12.46 ","$71.17 ","$0.00 ","$35.59 ","$56.37 ","$56.94 ","$0.00 ","$11.14 ","$0.00 ","$11.33 ","$0.00 "
"16369","ERX","HCPCS J0692","60505-6144-04","CEFEPIME HCL 1 G IJ SOLR","BOTH IP/OP","$78.49 ","$58.08 ","$0.00 ","$71.17 ","$35.32 ","$0.00 ","$16.36 ","$0.00 ","$0.00 ","$12.46 ","$71.17 ","$0.00 ","$35.59 ","$56.37 ","$56.94 ","$0.00 ","$11.14 ","$0.00 ","$11.33 ","$0.00 "
"16369","ERX","HCPCS J0692","60505-6146-04","CEFEPIME HCL 1 G IJ SOLR","BOTH IP/OP","$78.49 ","$58.08 ","$0.00 ","$71.17 ","$35.32 ","$0.00 ","$16.36 ","$0.00 ","$0.00 ","$12.46 ","$71.17 ","$0.00 ","$35.59 ","$56.37 ","$56.94 ","$0.00 ","$11.14 ","$0.00 ","$11.33 ","$0.00 "
"16369","ERX","HCPCS J0692","63323-0326-20","CEFEPIME HCL 1 G IJ SOLR","BOTH IP/OP","$78.49 ","$58.08 ","$0.00 ","$71.17 ","$35.32 ","$0.00 ","$16.36 ","$0.00 ","$0.00 ","$12.46 ","$71.17 ","$0.00 ","$35.59 ","$56.37 ","$56.94 ","$0.00 ","$11.14 ","$0.00 ","$11.33 ","$0.00 "
"16371","ERX","HCPCS J0692","44567-0241-10","CEFEPIME HCL 2 G IJ SOLR","BOTH IP/OP","$155.79 ","$115.28 ","$0.00 ","$141.26 ","$70.11 ","$0.00 ","$32.47 ","$0.00 ","$0.00 ","$24.73 ","$141.26 ","$0.00 ","$70.63 ","$111.88 ","$113.01 ","$0.00 ","$22.11 ","$0.00 ","$22.49 ","$0.00 "
"16371","ERX","HCPCS J0692","60505-6145-04","CEFEPIME HCL 2 G IJ SOLR","BOTH IP/OP","$155.79 ","$115.28 ","$0.00 ","$141.26 ","$70.11 ","$0.00 ","$32.47 ","$0.00 ","$0.00 ","$24.73 ","$141.26 ","$0.00 ","$70.63 ","$111.88 ","$113.01 ","$0.00 ","$22.11 ","$0.00 ","$22.49 ","$0.00 "
"16371","ERX","HCPCS J0692","60505-6147-00","CEFEPIME HCL 2 G IJ SOLR","BOTH IP/OP","$155.79 ","$115.28 ","$0.00 ","$141.26 ","$70.11 ","$0.00 ","$32.47 ","$0.00 ","$0.00 ","$24.73 ","$141.26 ","$0.00 ","$70.63 ","$111.88 ","$113.01 ","$0.00 ","$22.11 ","$0.00 ","$22.49 ","$0.00 "
"16371","ERX","HCPCS J0692","60505-6147-04","CEFEPIME HCL 2 G IJ SOLR","BOTH IP/OP","$155.79 ","$115.28 ","$0.00 ","$141.26 ","$70.11 ","$0.00 ","$32.47 ","$0.00 ","$0.00 ","$24.73 ","$141.26 ","$0.00 ","$70.63 ","$111.88 ","$113.01 ","$0.00 ","$22.11 ","$0.00 ","$22.49 ","$0.00 "
"16440","ERX","HCPCS 63700001","99999-6004-87","RITONAVIR 80 MG/ML PO SOLN","BOTH IP/OP","$630.81 ","$466.80 ","$0.00 ","$3,542.90 ","","$112.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,542.90 ","$0.00 ","$1,771.45 ","$453.40 ","$2,834.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16440","ERX","HCPCS 63700001","00074-1940-63","RITONAVIR 80 MG/ML PO SOLN","BOTH IP/OP","$630.81 ","$466.80 ","$0.00 ","$3,542.90 ","","$112.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,542.90 ","$0.00 ","$1,771.45 ","$2,805.98 ","$2,834.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16632","ERX","HCPCS 63700001","00904-5676-61","PAROXETINE HCL 10 MG PO TABS","BOTH IP/OP","$11.80 ","$8.73 ","$0.00 ","$10.70 ","","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.70 ","$0.00 ","$5.35 ","$8.47 ","$8.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16632","ERX","HCPCS 63700001","13107-0154-30","PAROXETINE HCL 10 MG PO TABS","BOTH IP/OP","$11.80 ","$8.73 ","$0.00 ","$10.70 ","","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.70 ","$0.00 ","$5.35 ","$8.47 ","$8.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16633","ERX","HCPCS 63700001","60505-0101-02","PAROXETINE HCL 40 MG PO TABS","BOTH IP/OP","$12.72 ","$9.41 ","$0.00 ","$11.53 ","","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.53 ","$0.00 ","$5.77 ","$9.13 ","$9.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16633","ERX","HCPCS 63700001","68084-0047-01","PAROXETINE HCL 40 MG PO TABS","BOTH IP/OP","$12.72 ","$9.41 ","$0.00 ","$11.53 ","","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.53 ","$0.00 ","$5.77 ","$9.13 ","$9.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16633","ERX","HCPCS 63700001","68382-0001-16","PAROXETINE HCL 40 MG PO TABS","BOTH IP/OP","$12.72 ","$9.41 ","$0.00 ","$11.53 ","","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.53 ","$0.00 ","$5.77 ","$9.13 ","$9.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16639","ERX","HCPCS 25000001","00703-9258-09","GLYCINE DILUENT IV SOLN","BOTH IP/OP","$64.22 ","$47.52 ","$0.00 ","$64.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.22 ","$0.00 ","$32.11 ","$50.86 ","$51.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16644","ERX","HCPCS 63700001","00006-0571-43","INDINAVIR SULFATE 200 MG PO CAPS","BOTH IP/OP","$11.58 ","$8.57 ","$0.00 ","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.58 ","$0.00 ","$5.79 ","$9.17 ","$9.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16645","ERX","HCPCS 63700001","00006-0573-62","INDINAVIR SULFATE 400 MG PO CAPS","BOTH IP/OP","$11.58 ","$8.57 ","$0.00 ","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.58 ","$0.00 ","$5.79 ","$9.17 ","$9.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16825","ERX","HCPCS 25000001","00942-0641-03","ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16825","ERX","HCPCS 25000001","00942-0641-04","ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16830","ERX","HCPCS 63700001","07610-0226-40","MELATONIN 3 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16830","ERX","HCPCS 63700001","20555-0036-01","MELATONIN 3 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16830","ERX","HCPCS 63700001","31604-0027-41","MELATONIN 3 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16830","ERX","HCPCS 63700001","50268-0524-11","MELATONIN 3 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16830","ERX","HCPCS 63700001","50268-0524-15","MELATONIN 3 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16830","ERX","HCPCS 63700001","77333-0516-10","MELATONIN 3 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17010","ERX","HCPCS 63700001","43199-0014-01","HYOSCYAMINE SULFATE ER 0.375 MG PO TB12","BOTH IP/OP","$6.71 ","$4.97 ","$0.00 ","$6.08 ","","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.08 ","$0.00 ","$3.04 ","$4.82 ","$4.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17010","ERX","HCPCS 63700001","51525-0115-01","HYOSCYAMINE SULFATE ER 0.375 MG PO TB12","BOTH IP/OP","$6.71 ","$4.97 ","$0.00 ","$6.08 ","","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.08 ","$0.00 ","$3.04 ","$4.82 ","$4.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17010","ERX","HCPCS 63700001","68047-0255-01","HYOSCYAMINE SULFATE ER 0.375 MG PO TB12","BOTH IP/OP","$6.71 ","$4.97 ","$0.00 ","$6.08 ","","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.08 ","$0.00 ","$3.04 ","$4.82 ","$4.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17012","ERX","HCPCS J9040","00703-3155-01","BLEOMYCIN SULFATE 30 UNITS IJ SOLR","BOTH IP/OP","$377.47 ","$279.33 ","$0.00 ","$337.58 ","$169.86 ","$0.00 ","$74.80 ","$0.00 ","$0.00 ","$53.27 ","$337.58 ","$0.00 ","$168.79 ","$267.36 ","$270.06 ","$0.00 ","$53.27 ","$0.00 ","$50.73 ","$0.00 "
"17012","ERX","HCPCS J9040","61703-0323-22","BLEOMYCIN SULFATE 30 UNITS IJ SOLR","BOTH IP/OP","$377.47 ","$279.33 ","$0.00 ","$337.58 ","$169.86 ","$0.00 ","$74.80 ","$0.00 ","$0.00 ","$53.27 ","$337.58 ","$0.00 ","$168.79 ","$267.36 ","$270.06 ","$0.00 ","$53.27 ","$0.00 ","$50.73 ","$0.00 "
"17023","ERX","HCPCS 63700001","43199-0011-01","HYOSCYAMINE SULFATE 0.125 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17023","ERX","HCPCS 63700001","70156-0105-01","HYOSCYAMINE SULFATE 0.125 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17122","ERX","HCPCS J9201","25021-0235-50","GEMCITABINE HCL 1 G IV SOLR","BOTH IP/OP","$206.75 ","$153.00 ","$0.00 ","$811.87 ","$93.04 ","$0.00 ","$811.87 ","$0.00 ","$0.00 ","$24.44 ","$187.68 ","$0.00 ","$93.84 ","$148.64 ","$150.14 ","$0.00 ","$24.44 ","$0.00 ","$23.27 ","$0.00 "
"17122","ERX","HCPCS J9201","63323-0125-53","GEMCITABINE HCL 1 G IV SOLR","BOTH IP/OP","$206.75 ","$153.00 ","$0.00 ","$811.87 ","$93.04 ","$0.00 ","$811.87 ","$0.00 ","$0.00 ","$24.44 ","$187.68 ","$0.00 ","$93.84 ","$148.64 ","$150.14 ","$0.00 ","$24.44 ","$0.00 ","$23.27 ","$0.00 "
"17280","ERX","HCPCS 63700001","60505-0055-01","SELEGILINE HCL 5 MG PO CAPS","BOTH IP/OP","$8.76 ","$6.48 ","$0.00 ","$8.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.76 ","$0.00 ","$4.38 ","$6.94 ","$7.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17285","ERX","HCPCS J9351","16729-0151-31","TOPOTECAN HCL 4 MG IV SOLR","BOTH IP/OP","$823.44 ","$609.35 ","$0.00 ","$949.37 ","$370.55 ","$0.00 ","$171.63 ","$0.00 ","$0.00 ","$46.06 ","$949.37 ","$0.00 ","$474.69 ","$751.90 ","$759.50 ","$0.00 ","$46.06 ","$0.00 ","$43.86 ","$0.00 "
"17377","ERX","HCPCS 25000001","13668-0589-06","RISPERIDONE 1 MG/ML PO SOLN","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$465.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.28 ","$0.00 ","$232.64 ","$368.50 ","$372.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17377","ERX","HCPCS 25000001","51991-0716-41","RISPERIDONE 1 MG/ML PO SOLN","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$465.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.28 ","$0.00 ","$232.64 ","$368.50 ","$372.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17377","ERX","HCPCS 25000001","65162-0673-84","RISPERIDONE 1 MG/ML PO SOLN","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$465.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.28 ","$0.00 ","$232.64 ","$368.50 ","$372.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17378","ERX","HCPCS J0740","23155-0216-31","CIDOFOVIR 75 MG/ML IV SOLN","BOTH IP/OP","$2,299.92 ","$1,701.94 ","$0.00 ","$2,131.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,131.20 ","$0.00 ","$1,065.60 ","$1,687.91 ","$1,704.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17379","ERX","HCPCS J2185","00781-3000-95","MEROPENEM 500 MG IV SOLR","BOTH IP/OP","$100.36 ","$74.27 ","$0.00 ","$91.00 ","","$0.00 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17379","ERX","HCPCS J2185","55150-0207-20","MEROPENEM 500 MG IV SOLR","BOTH IP/OP","$100.36 ","$74.27 ","$0.00 ","$91.00 ","","$0.00 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17379","ERX","HCPCS J2185","63323-0507-20","MEROPENEM 500 MG IV SOLR","BOTH IP/OP","$100.36 ","$74.27 ","$0.00 ","$91.00 ","","$0.00 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17379","ERX","HCPCS J2185","63323-0507-21","MEROPENEM 500 MG IV SOLR","BOTH IP/OP","$100.36 ","$74.27 ","$0.00 ","$91.00 ","","$0.00 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17379","ERX","HCPCS J2185","70121-1454-01","MEROPENEM 500 MG IV SOLR","BOTH IP/OP","$100.36 ","$74.27 ","$0.00 ","$91.00 ","","$0.00 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17379","ERX","HCPCS J2185","70121-1454-07","MEROPENEM 500 MG IV SOLR","BOTH IP/OP","$100.36 ","$74.27 ","$0.00 ","$91.00 ","","$0.00 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$91.00 ","$0.00 ","$45.50 ","$72.07 ","$72.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","00069-0314-01","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","00069-0314-10","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","00781-3098-95","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","55150-0208-30","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","63323-0508-30","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","70121-1453-01","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17380","ERX","HCPCS J2185","70121-1453-07","MEROPENEM 1 G IV SOLR","BOTH IP/OP","$180.44 ","$133.53 ","$0.00 ","$163.80 ","","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17387","ERX","HCPCS 63700001","50111-0789-10","AZITHROMYCIN 600 MG PO TABS","BOTH IP/OP","$70.92 ","$52.48 ","$0.00 ","$70.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.92 ","$0.00 ","$35.46 ","$56.17 ","$56.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17387","ERX","HCPCS 63700001","60687-0314-25","AZITHROMYCIN 600 MG PO TABS","BOTH IP/OP","$70.92 ","$52.48 ","$0.00 ","$70.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.92 ","$0.00 ","$35.46 ","$56.17 ","$56.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17387","ERX","HCPCS 63700001","69452-0173-13","AZITHROMYCIN 600 MG PO TABS","BOTH IP/OP","$70.92 ","$52.48 ","$0.00 ","$70.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.92 ","$0.00 ","$35.46 ","$56.17 ","$56.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17403","ERX","HCPCS 63700001","00597-0046-60","NEVIRAPINE 200 MG PO TABS","BOTH IP/OP","$68.86 ","$50.96 ","$0.00 ","$68.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.86 ","$0.00 ","$34.43 ","$54.54 ","$55.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17403","ERX","HCPCS 63700001","31722-0505-60","NEVIRAPINE 200 MG PO TABS","BOTH IP/OP","$68.86 ","$50.96 ","$0.00 ","$68.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.86 ","$0.00 ","$34.43 ","$54.54 ","$55.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17405","ERX","HCPCS J1815","00002-7510-01","INSULIN LISPRO 100 UNIT/ML SC SOLN","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$8.15 ","$0.00 ","$3.13 ","$0.00 ","$0.00 ","$2.63 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$1.01 ","$0.00 "
"17464","ERX","HCPCS 63700001","00093-1003-01","BUSPIRONE HCL 15 MG PO TABS","BOTH IP/OP","$8.46 ","$6.26 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17464","ERX","HCPCS 63700001","68382-0182-01","BUSPIRONE HCL 15 MG PO TABS","BOTH IP/OP","$8.46 ","$6.26 ","$0.00 ","$7.68 ","","$1.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.68 ","$0.00 ","$3.84 ","$6.08 ","$6.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17465","ERX","HCPCS 63700001","00052-0107-30","MIRTAZAPINE 30 MG PO TABS","BOTH IP/OP","$25.08 ","$18.56 ","$0.00 ","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17465","ERX","HCPCS 63700001","51079-0087-20","MIRTAZAPINE 30 MG PO TABS","BOTH IP/OP","$25.08 ","$18.56 ","$0.00 ","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17465","ERX","HCPCS 63700001","68084-0120-01","MIRTAZAPINE 30 MG PO TABS","BOTH IP/OP","$25.08 ","$18.56 ","$0.00 ","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17465","ERX","HCPCS 63700001","68084-0120-11","MIRTAZAPINE 30 MG PO TABS","BOTH IP/OP","$25.08 ","$18.56 ","$0.00 ","$25.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.08 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17466","ERX","HCPCS 63700001","00904-6519-61","MIRTAZAPINE 15 MG PO TABS","BOTH IP/OP","$12.90 ","$9.55 ","$0.00 ","$12.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.90 ","$0.00 ","$6.45 ","$10.22 ","$10.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17466","ERX","HCPCS 63700001","51079-0086-20","MIRTAZAPINE 15 MG PO TABS","BOTH IP/OP","$12.90 ","$9.55 ","$0.00 ","$12.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.90 ","$0.00 ","$6.45 ","$10.22 ","$10.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17500","ERX","HCPCS 25000001","62991-2015-01","CAFFEINE ANHYDROUS POWD","BOTH IP/OP","$300.85 ","$222.63 ","$0.00 ","$273.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$273.11 ","$0.00 ","$136.56 ","$216.30 ","$218.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17524","ERX","HCPCS 25000001","59584-0138-01","CANDIDA ALBICANS SKN TST ANTGN ID SOLN","BOTH IP/OP","$112.56 ","$83.29 ","$0.00 ","$94.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.50 ","$0.00 ","$47.25 ","$74.84 ","$75.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17594","ERX","HCPCS Q9966","00407-2222-19","IODIXANOL 270 MG/ML IV SOLN","BOTH IP/OP","$208.90 ","$154.59 ","$0.00 ","$189.63 ","$94.01 ","$0.00 ","$43.54 ","$0.00 ","$0.00 ","$27.03 ","$189.63 ","$0.00 ","$94.82 ","$150.19 ","$151.70 ","$0.00 ","$25.73 ","$0.00 ","$30.19 ","$0.00 "
"17801","ERX","HCPCS 25000001","50383-0889-15","ACETIC ACID 2 % OT SOLN","BOTH IP/OP","$154.42 ","$114.27 ","$0.00 ","$140.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.02 ","$0.00 ","$70.01 ","$110.90 ","$112.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17837","ERX","HCPCS 25000001","00085-1132-04","ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","BOTH IP/OP","$591.08 ","$437.40 ","$0.00 ","$252.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.81 ","$0.00 ","$126.41 ","$200.23 ","$202.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17837","ERX","HCPCS 25000001","00173-0682-24","ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","BOTH IP/OP","$591.08 ","$437.40 ","$0.00 ","$252.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.81 ","$0.00 ","$126.41 ","$200.23 ","$202.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17837","ERX","HCPCS 25000001","59310-0579-22","ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","BOTH IP/OP","$591.08 ","$437.40 ","$0.00 ","$387.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.81 ","$0.00 ","$126.41 ","$387.74 ","$202.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17881","ERX","HCPCS 63700001","17478-0715-10","BRIMONIDINE TARTRATE 0.2 % OP SOLN","BOTH IP/OP","$52.38 ","$38.76 ","$0.00 ","$47.50 ","","$9.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17881","ERX","HCPCS 63700001","24208-0411-05","BRIMONIDINE TARTRATE 0.2 % OP SOLN","BOTH IP/OP","$52.38 ","$38.76 ","$0.00 ","$47.50 ","","$9.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17881","ERX","HCPCS 63700001","61314-0143-05","BRIMONIDINE TARTRATE 0.2 % OP SOLN","BOTH IP/OP","$52.38 ","$38.76 ","$0.00 ","$47.50 ","","$9.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17881","ERX","HCPCS 63700001","70069-0231-01","BRIMONIDINE TARTRATE 0.2 % OP SOLN","BOTH IP/OP","$52.38 ","$38.76 ","$0.00 ","$47.50 ","","$9.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17936","ERX","HCPCS 63700001","00904-6377-61","OLANZAPINE 5 MG PO TABS","BOTH IP/OP","$50.16 ","$37.12 ","$0.00 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17936","ERX","HCPCS 63700001","43598-0164-30","OLANZAPINE 5 MG PO TABS","BOTH IP/OP","$50.16 ","$37.12 ","$0.00 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17936","ERX","HCPCS 63700001","60505-3111-00","OLANZAPINE 5 MG PO TABS","BOTH IP/OP","$50.16 ","$37.12 ","$0.00 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17936","ERX","HCPCS 63700001","66993-0681-30","OLANZAPINE 5 MG PO TABS","BOTH IP/OP","$50.16 ","$37.12 ","$0.00 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17936","ERX","HCPCS 63700001","68084-0723-01","OLANZAPINE 5 MG PO TABS","BOTH IP/OP","$50.16 ","$37.12 ","$0.00 ","$50.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17937","ERX","HCPCS 63700001","00904-6376-61","OLANZAPINE 10 MG PO TABS","BOTH IP/OP","$75.68 ","$56.00 ","$0.00 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$0.00 ","$37.84 ","$59.94 ","$60.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17937","ERX","HCPCS 63700001","33342-0070-07","OLANZAPINE 10 MG PO TABS","BOTH IP/OP","$75.68 ","$56.00 ","$0.00 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$0.00 ","$37.84 ","$59.94 ","$60.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17937","ERX","HCPCS 63700001","43598-0166-30","OLANZAPINE 10 MG PO TABS","BOTH IP/OP","$75.68 ","$56.00 ","$0.00 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$0.00 ","$37.84 ","$59.94 ","$60.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17937","ERX","HCPCS 63700001","60505-3113-00","OLANZAPINE 10 MG PO TABS","BOTH IP/OP","$75.68 ","$56.00 ","$0.00 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$0.00 ","$37.84 ","$59.94 ","$60.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17937","ERX","HCPCS 63700001","68084-0740-01","OLANZAPINE 10 MG PO TABS","BOTH IP/OP","$75.68 ","$56.00 ","$0.00 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$0.00 ","$37.84 ","$59.94 ","$60.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17937","ERX","HCPCS 63700001","69543-0383-30","OLANZAPINE 10 MG PO TABS","BOTH IP/OP","$75.68 ","$56.00 ","$0.00 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$0.00 ","$37.84 ","$59.94 ","$60.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17938","ERX","HCPCS 63700001","60505-3112-00","OLANZAPINE 7.5 MG PO TABS","BOTH IP/OP","$67.39 ","$49.87 ","$0.00 ","$61.12 ","","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.12 ","$0.00 ","$30.56 ","$48.41 ","$48.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17946","ERX","HCPCS J8540","00054-3176-44","DEXAMETHASONE 1 MG/ML PO CONC","BOTH IP/OP","$124.14 ","$91.86 ","$0.00 ","$112.56 ","$55.86 ","$0.00 ","$8.46 ","$0.00 ","$0.00 ","$19.71 ","$112.56 ","$0.00 ","$56.28 ","$89.15 ","$90.05 ","$0.00 ","$17.62 ","$0.00 ","$17.92 ","$0.00 "
"17961","ERX","HCPCS 63700001","31722-0509-60","ZIDOVUDINE 300 MG PO TABS","BOTH IP/OP","$25.21 ","$18.66 ","$0.00 ","$22.87 ","","$4.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.87 ","$0.00 ","$11.44 ","$18.11 ","$18.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17961","ERX","HCPCS 63700001","65862-0024-60","ZIDOVUDINE 300 MG PO TABS","BOTH IP/OP","$25.21 ","$18.66 ","$0.00 ","$22.87 ","","$4.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.87 ","$0.00 ","$11.44 ","$18.11 ","$18.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18031","ERX","HCPCS 25000001","00187-0245-03","DIHYDROERGOTAMINE MESYLATE 4 MG/ML NA SOLN","BOTH IP/OP","$1,485.21 ","$1,099.06 ","$0.00 ","$1,376.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,376.26 ","$0.00 ","$688.13 ","$1,090.00 ","$1,101.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18192","ERX","HCPCS J2795","00409-9300-20","ROPIVACAINE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$24.35 ","$18.02 ","$0.00 ","$22.08 ","$10.96 ","$0.00 ","$5.08 ","$0.00 ","$0.00 ","$3.87 ","$22.08 ","$0.00 ","$11.04 ","$17.49 ","$17.66 ","$0.00 ","$3.46 ","$0.00 ","$3.52 ","$0.00 "
"18192","ERX","HCPCS J2795","00409-9300-21","ROPIVACAINE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$24.35 ","$18.02 ","$0.00 ","$22.08 ","$10.96 ","$0.00 ","$5.08 ","$0.00 ","$0.00 ","$3.87 ","$22.08 ","$0.00 ","$11.04 ","$17.49 ","$17.66 ","$0.00 ","$3.46 ","$0.00 ","$3.52 ","$0.00 "
"18192","ERX","HCPCS J2795","55150-0195-20","ROPIVACAINE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$24.35 ","$18.02 ","$0.00 ","$22.08 ","$10.96 ","$0.00 ","$5.08 ","$0.00 ","$0.00 ","$3.87 ","$22.08 ","$0.00 ","$11.04 ","$17.49 ","$17.66 ","$0.00 ","$3.46 ","$0.00 ","$3.52 ","$0.00 "
"18192","ERX","HCPCS J2795","63323-0285-07","ROPIVACAINE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$24.35 ","$18.02 ","$0.00 ","$22.08 ","$10.96 ","$0.00 ","$5.08 ","$0.00 ","$0.00 ","$3.87 ","$22.08 ","$0.00 ","$11.04 ","$17.49 ","$17.66 ","$0.00 ","$3.46 ","$0.00 ","$3.52 ","$0.00 "
"18192","ERX","HCPCS J2795","63323-0285-13","ROPIVACAINE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$24.35 ","$18.02 ","$0.00 ","$22.08 ","$10.96 ","$0.00 ","$5.08 ","$0.00 ","$0.00 ","$3.87 ","$22.08 ","$0.00 ","$11.04 ","$17.49 ","$17.66 ","$0.00 ","$3.46 ","$0.00 ","$3.52 ","$0.00 "
"18192","ERX","HCPCS J2795","63323-0285-23","ROPIVACAINE HCL 2 MG/ML IJ SOLN","BOTH IP/OP","$24.35 ","$18.02 ","$0.00 ","$22.08 ","$10.96 ","$0.00 ","$5.08 ","$0.00 ","$0.00 ","$3.87 ","$22.08 ","$0.00 ","$11.04 ","$17.49 ","$17.66 ","$0.00 ","$3.46 ","$0.00 ","$3.52 ","$0.00 "
"18193","ERX","HCPCS J2795","63323-0287-20","ROPIVACAINE HCL 7.5 MG/ML IJ SOLN","BOTH IP/OP","$93.80 ","$69.41 ","$0.00 ","$64.64 ","$42.21 ","$0.00 ","$19.55 ","$0.00 ","$0.00 ","$11.32 ","$64.64 ","$0.00 ","$32.32 ","$51.19 ","$51.71 ","$0.00 ","$10.12 ","$0.00 ","$10.29 ","$0.00 "
"18195","ERX","HCPCS J2795","55150-0197-20","ROPIVACAINE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$47.88 ","$23.76 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$8.38 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$7.49 ","$0.00 ","$7.62 ","$0.00 "
"18195","ERX","HCPCS J2795","55150-0198-30","ROPIVACAINE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$47.88 ","$23.76 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$8.38 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$7.49 ","$0.00 ","$7.62 ","$0.00 "
"18195","ERX","HCPCS J2795","63323-0286-23","ROPIVACAINE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$47.88 ","$23.76 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$8.38 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$7.49 ","$0.00 ","$7.62 ","$0.00 "
"18195","ERX","HCPCS J2795","63323-0286-31","ROPIVACAINE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$47.88 ","$23.76 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$8.38 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$7.49 ","$0.00 ","$7.62 ","$0.00 "
"18195","ERX","HCPCS J2795","63323-0286-35","ROPIVACAINE HCL 5 MG/ML IJ SOLN","BOTH IP/OP","$52.80 ","$39.07 ","$0.00 ","$47.88 ","$23.76 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$8.38 ","$47.88 ","$0.00 ","$23.94 ","$37.92 ","$38.30 ","$0.00 ","$7.49 ","$0.00 ","$7.62 ","$0.00 "
"18265","ERX","HCPCS 25000001","00517-9310-25","TRACE MINERALS CR-CU-MN-ZN 1-100-30-500 MCG/ML IV SOLN","BOTH IP/OP","$36.67 ","$27.14 ","$0.00 ","$33.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.25 ","$0.00 ","$16.63 ","$26.33 ","$26.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18266","ERX","HCPCS 2500003","00517-9203-25","TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN","BOTH IP/OP","$61.10 ","$45.21 ","$0.00 ","$51.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.07 ","$0.00 ","$25.54 ","$40.45 ","$40.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18287","ERX","HCPCS 63700001","29300-0127-13","BISOPROLOL FUMARATE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18288","ERX","HCPCS 63700001","00185-0771-01","BISOPROLOL FUMARATE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18292","ERX","HCPCS 63700001","50111-0916-01","TORSEMIDE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18292","ERX","HCPCS 63700001","50268-0755-11","TORSEMIDE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18292","ERX","HCPCS 63700001","50268-0755-15","TORSEMIDE 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","00054-0077-25","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","00054-0077-29","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","31722-0531-01","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","50111-0917-01","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","50268-0756-15","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","68084-0539-01","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18293","ERX","HCPCS 63700001","68084-0539-11","TORSEMIDE 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18294","ERX","HCPCS 63700001","31722-0532-01","TORSEMIDE 100 MG PO TABS","BOTH IP/OP","$12.75 ","$9.44 ","$0.00 ","$11.56 ","","$2.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.56 ","$0.00 ","$5.78 ","$9.16 ","$9.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18294","ERX","HCPCS 63700001","50111-0918-01","TORSEMIDE 100 MG PO TABS","BOTH IP/OP","$12.75 ","$9.44 ","$0.00 ","$11.56 ","","$2.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.56 ","$0.00 ","$5.78 ","$9.16 ","$9.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18295","ERX","HCPCS 63700001","31722-0529-01","TORSEMIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18295","ERX","HCPCS 63700001","50111-0915-01","TORSEMIDE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18302","ERX","HCPCS J2543","00781-3114-91","PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$81.85 ","$40.62 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$81.85 ","$0.00 ","$40.93 ","$64.83 ","$65.48 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"18302","ERX","HCPCS J2543","00781-3114-95","PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$81.85 ","$40.62 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$81.85 ","$0.00 ","$40.93 ","$64.83 ","$65.48 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"18302","ERX","HCPCS J2543","44567-0803-10","PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$81.85 ","$40.62 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$81.85 ","$0.00 ","$40.93 ","$64.83 ","$65.48 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"18302","ERX","HCPCS J2543","55150-0121-50","PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$81.85 ","$40.62 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$81.85 ","$0.00 ","$40.93 ","$64.83 ","$65.48 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"18302","ERX","HCPCS J2543","67457-0523-00","PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$81.85 ","$40.62 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$81.85 ","$0.00 ","$40.93 ","$64.83 ","$65.48 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"18302","ERX","HCPCS J2543","67457-0523-45","PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$81.85 ","$40.62 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$81.85 ","$0.00 ","$40.93 ","$64.83 ","$65.48 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"18303","ERX","HCPCS J2543","00409-3385-13","PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","BOTH IP/OP","$52.58 ","$38.91 ","$0.00 ","$46.98 ","$23.66 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$6.52 ","$46.98 ","$0.00 ","$23.49 ","$37.21 ","$37.58 ","$0.00 ","$6.52 ","$0.00 ","$6.21 ","$0.00 "
"18303","ERX","HCPCS J2543","00781-3113-95","PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","BOTH IP/OP","$52.58 ","$38.91 ","$0.00 ","$46.98 ","$23.66 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$6.52 ","$46.98 ","$0.00 ","$23.49 ","$37.21 ","$37.58 ","$0.00 ","$6.52 ","$0.00 ","$6.21 ","$0.00 "
"18303","ERX","HCPCS J2543","55150-0120-30","PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","BOTH IP/OP","$52.58 ","$38.91 ","$0.00 ","$46.98 ","$23.66 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$6.52 ","$46.98 ","$0.00 ","$23.49 ","$37.21 ","$37.58 ","$0.00 ","$6.52 ","$0.00 ","$6.21 ","$0.00 "
"18304","ERX","HCPCS J2543","00409-3383-02","PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","BOTH IP/OP","$35.05 ","$25.94 ","$0.00 ","$31.32 ","$15.77 ","$0.00 ","$13.09 ","$0.00 ","$0.00 ","$4.35 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$4.35 ","$0.00 ","$4.14 ","$0.00 "
"18304","ERX","HCPCS J2543","00781-3110-95","PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","BOTH IP/OP","$35.05 ","$25.94 ","$0.00 ","$31.32 ","$15.77 ","$0.00 ","$13.09 ","$0.00 ","$0.00 ","$4.35 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$4.35 ","$0.00 ","$4.14 ","$0.00 "
"18304","ERX","HCPCS J2543","44567-0801-10","PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","BOTH IP/OP","$35.05 ","$25.94 ","$0.00 ","$31.32 ","$15.77 ","$0.00 ","$13.09 ","$0.00 ","$0.00 ","$4.35 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$4.35 ","$0.00 ","$4.14 ","$0.00 "
"18304","ERX","HCPCS J2543","55150-0119-30","PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","BOTH IP/OP","$35.05 ","$25.94 ","$0.00 ","$31.32 ","$15.77 ","$0.00 ","$13.09 ","$0.00 ","$0.00 ","$4.35 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$4.35 ","$0.00 ","$4.14 ","$0.00 "
"18307","ERX","HCPCS 63700001","00904-6667-61","GABAPENTIN 400 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18307","ERX","HCPCS 63700001","16714-0505-02","GABAPENTIN 400 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18307","ERX","HCPCS 63700001","63739-0984-10","GABAPENTIN 400 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18307","ERX","HCPCS 63700001","68084-0774-01","GABAPENTIN 400 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18307","ERX","HCPCS 63700001","68084-0774-11","GABAPENTIN 400 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","00904-6666-61","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","16714-0662-01","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","49483-0606-50","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","50228-0180-05","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","63739-0236-10","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","63739-0689-10","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","65862-0199-01","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","67877-0223-01","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18308","ERX","HCPCS 63700001","68084-0762-01","GABAPENTIN 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.31 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.31 ","$0.00 ","$3.16 ","$5.00 ","$5.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18309","ERX","HCPCS 63700001","00904-6665-61","GABAPENTIN 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18309","ERX","HCPCS 63700001","16714-0503-01","GABAPENTIN 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18309","ERX","HCPCS 63700001","16714-0661-01","GABAPENTIN 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18309","ERX","HCPCS 63700001","63739-0591-10","GABAPENTIN 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18309","ERX","HCPCS 63700001","68084-0783-01","GABAPENTIN 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18309","ERX","HCPCS 63700001","69097-0813-07","GABAPENTIN 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18310","ERX","HCPCS 63700001","00904-6362-61","RISPERIDONE 4 MG PO TABS","BOTH IP/OP","$23.59 ","$17.46 ","$0.00 ","$23.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.59 ","$0.00 ","$11.80 ","$18.68 ","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18310","ERX","HCPCS 63700001","50458-0595-60","RISPERIDONE 4 MG PO TABS","BOTH IP/OP","$23.59 ","$17.46 ","$0.00 ","$23.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.59 ","$0.00 ","$11.80 ","$18.68 ","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18310","ERX","HCPCS 63700001","51079-0465-01","RISPERIDONE 4 MG PO TABS","BOTH IP/OP","$23.59 ","$17.46 ","$0.00 ","$23.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.59 ","$0.00 ","$11.80 ","$18.68 ","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18310","ERX","HCPCS 63700001","51079-0465-20","RISPERIDONE 4 MG PO TABS","BOTH IP/OP","$23.59 ","$17.46 ","$0.00 ","$23.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.59 ","$0.00 ","$11.80 ","$18.68 ","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18311","ERX","HCPCS 63700001","00904-6360-61","RISPERIDONE 2 MG PO TABS","BOTH IP/OP","$14.95 ","$11.06 ","$0.00 ","$14.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.95 ","$0.00 ","$7.48 ","$11.84 ","$11.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18311","ERX","HCPCS 63700001","51079-0463-01","RISPERIDONE 2 MG PO TABS","BOTH IP/OP","$14.95 ","$11.06 ","$0.00 ","$14.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.95 ","$0.00 ","$7.48 ","$11.84 ","$11.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18311","ERX","HCPCS 63700001","51079-0463-20","RISPERIDONE 2 MG PO TABS","BOTH IP/OP","$14.95 ","$11.06 ","$0.00 ","$14.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.95 ","$0.00 ","$7.48 ","$11.84 ","$11.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18312","ERX","HCPCS 63700001","00904-6361-61","RISPERIDONE 3 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18312","ERX","HCPCS 63700001","68084-0274-01","RISPERIDONE 3 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18312","ERX","HCPCS 63700001","68084-0274-11","RISPERIDONE 3 MG PO TABS","BOTH IP/OP","$17.56 ","$12.99 ","$0.00 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18313","ERX","HCPCS 63700001","00904-6359-61","RISPERIDONE 1 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.95 ","$0.00 ","$4.48 ","$7.09 ","$7.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18315","ERX","HCPCS J1250","00338-1075-02","DOBUTAMINE IN D5W 2 MG/ML IV SOLN","BOTH IP/OP","$172.74 ","$127.83 ","$0.00 ","$146.13 ","$77.73 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$14.29 ","$146.13 ","$0.00 ","$73.07 ","$115.73 ","$116.90 ","$0.00 ","$14.29 ","$0.00 ","$13.60 ","$0.00 "
"18315","ERX","HCPCS J1250","00409-2347-32","DOBUTAMINE IN D5W 2 MG/ML IV SOLN","BOTH IP/OP","$172.74 ","$127.83 ","$0.00 ","$146.13 ","$77.73 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$14.29 ","$146.13 ","$0.00 ","$73.07 ","$115.73 ","$116.90 ","$0.00 ","$14.29 ","$0.00 ","$13.60 ","$0.00 "
"18385","ERX","HCPCS 63700001","00591-3540-60","BUPROPION HCL ER (SR) 100 MG PO TB12","BOTH IP/OP","$6.98 ","$5.17 ","$0.00 ","$6.33 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.33 ","$0.00 ","$3.17 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18385","ERX","HCPCS 63700001","43547-0288-10","BUPROPION HCL ER (SR) 100 MG PO TB12","BOTH IP/OP","$6.98 ","$5.17 ","$0.00 ","$6.33 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.33 ","$0.00 ","$3.17 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18385","ERX","HCPCS 63700001","43598-0751-01","BUPROPION HCL ER (SR) 100 MG PO TB12","BOTH IP/OP","$6.98 ","$5.17 ","$0.00 ","$6.33 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.33 ","$0.00 ","$3.17 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18385","ERX","HCPCS 63700001","68084-0697-01","BUPROPION HCL ER (SR) 100 MG PO TB12","BOTH IP/OP","$6.98 ","$5.17 ","$0.00 ","$6.33 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.33 ","$0.00 ","$3.17 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","00173-0135-55","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","00185-0415-05","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","00185-0415-60","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","00591-3541-60","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","00904-6585-61","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","63739-0714-10","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18386","ERX","HCPCS 63700001","68084-0708-25","BUPROPION HCL ER (SR) 150 MG PO TB12","BOTH IP/OP","$38.44 ","$28.45 ","$0.00 ","$33.84 ","","$6.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$26.80 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18400","ERX","HCPCS 25000001","63323-0724-05","REMIFENTANIL HCL 2 MG IV SOLR","BOTH IP/OP","$494.25 ","$365.75 ","$0.00 ","$448.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$448.65 ","$0.00 ","$224.33 ","$355.33 ","$358.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18400","ERX","HCPCS 25000001","67457-0198-05","REMIFENTANIL HCL 2 MG IV SOLR","BOTH IP/OP","$494.25 ","$365.75 ","$0.00 ","$448.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$448.65 ","$0.00 ","$224.33 ","$355.33 ","$358.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18400","ERX","HCPCS 25000001","67457-0198-99","REMIFENTANIL HCL 2 MG IV SOLR","BOTH IP/OP","$494.25 ","$365.75 ","$0.00 ","$448.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$448.65 ","$0.00 ","$224.33 ","$355.33 ","$358.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18551","ERX","HCPCS 63700001","00093-0051-01","CARVEDILOL 3.125 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18551","ERX","HCPCS 63700001","00904-6300-61","CARVEDILOL 3.125 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18551","ERX","HCPCS 63700001","51079-0771-01","CARVEDILOL 3.125 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18551","ERX","HCPCS 63700001","51079-0771-20","CARVEDILOL 3.125 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18551","ERX","HCPCS 63700001","55111-0252-01","CARVEDILOL 3.125 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18551","ERX","HCPCS 63700001","68382-0092-01","CARVEDILOL 3.125 MG PO TABS","BOTH IP/OP","$8.95 ","$6.62 ","$0.00 ","$8.11 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.11 ","$0.00 ","$4.06 ","$6.42 ","$6.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18621","ERX","HCPCS 25000001","00013-8303-04","LATANOPROST 0.005 % OP SOLN","BOTH IP/OP","$785.75 ","$581.46 ","$0.00 ","$679.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.78 ","$0.00 ","$339.89 ","$538.39 ","$543.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18621","ERX","HCPCS 25000001","17478-0625-12","LATANOPROST 0.005 % OP SOLN","BOTH IP/OP","$785.75 ","$581.46 ","$0.00 ","$679.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.78 ","$0.00 ","$339.89 ","$538.39 ","$543.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18621","ERX","HCPCS 25000001","24208-0463-25","LATANOPROST 0.005 % OP SOLN","BOTH IP/OP","$785.75 ","$581.46 ","$0.00 ","$679.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.78 ","$0.00 ","$339.89 ","$538.39 ","$543.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18621","ERX","HCPCS 25000001","59762-0333-02","LATANOPROST 0.005 % OP SOLN","BOTH IP/OP","$785.75 ","$581.46 ","$0.00 ","$679.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.78 ","$0.00 ","$339.89 ","$538.39 ","$543.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18621","ERX","HCPCS 25000001","61314-0547-01","LATANOPROST 0.005 % OP SOLN","BOTH IP/OP","$785.75 ","$581.46 ","$0.00 ","$679.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.78 ","$0.00 ","$339.89 ","$538.39 ","$543.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18786","ERX","HCPCS 63700001","00904-6477-61","DONEPEZIL HCL 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18787","ERX","HCPCS 63700001","00904-6478-61","DONEPEZIL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18787","ERX","HCPCS 63700001","60687-0303-01","DONEPEZIL HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18908","ERX","HCPCS 25000001","00187-4302-02","NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18908","ERX","HCPCS 25000001","25021-0310-02","NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18918","ERX","HCPCS 63700001","00904-6351-61","LEVOFLOXACIN 250 MG PO TABS","BOTH IP/OP","$70.44 ","$52.13 ","$0.00 ","$63.89 ","","$12.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.89 ","$0.00 ","$31.95 ","$50.60 ","$51.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18918","ERX","HCPCS 63700001","65862-0536-50","LEVOFLOXACIN 250 MG PO TABS","BOTH IP/OP","$70.44 ","$52.13 ","$0.00 ","$63.89 ","","$12.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.89 ","$0.00 ","$31.95 ","$50.60 ","$51.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18918","ERX","HCPCS 63700001","68180-0240-01","LEVOFLOXACIN 250 MG PO TABS","BOTH IP/OP","$70.44 ","$52.13 ","$0.00 ","$63.89 ","","$12.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.89 ","$0.00 ","$31.95 ","$50.60 ","$51.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18919","ERX","HCPCS 63700001","00904-6352-61","LEVOFLOXACIN 500 MG PO TABS","BOTH IP/OP","$71.83 ","$53.15 ","$0.00 ","$71.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.83 ","$0.00 ","$35.92 ","$56.89 ","$57.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18919","ERX","HCPCS 63700001","65862-0537-50","LEVOFLOXACIN 500 MG PO TABS","BOTH IP/OP","$71.83 ","$53.15 ","$0.00 ","$71.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.83 ","$0.00 ","$35.92 ","$56.89 ","$57.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18920","ERX","HCPCS 63700001","68084-0342-01","TOPIRAMATE 25 MG PO TABS","BOTH IP/OP","$7.71 ","$5.71 ","$0.00 ","$7.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.71 ","$0.00 ","$3.86 ","$6.11 ","$6.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18921","ERX","HCPCS 63700001","47335-0712-86","TOPIRAMATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18921","ERX","HCPCS 63700001","62756-0712-86","TOPIRAMATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18921","ERX","HCPCS 63700001","68084-0345-11","TOPIRAMATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18921","ERX","HCPCS 63700001","68084-0345-21","TOPIRAMATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18921","ERX","HCPCS 63700001","68382-0141-14","TOPIRAMATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18921","ERX","HCPCS 63700001","69097-0125-03","TOPIRAMATE 200 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18922","ERX","HCPCS 63700001","62756-0711-86","TOPIRAMATE 100 MG PO TABS","BOTH IP/OP","$29.13 ","$21.56 ","$0.00 ","$26.41 ","","$5.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$0.00 ","$13.21 ","$20.92 ","$21.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18922","ERX","HCPCS 63700001","68084-0344-01","TOPIRAMATE 100 MG PO TABS","BOTH IP/OP","$29.13 ","$21.56 ","$0.00 ","$26.41 ","","$5.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.41 ","$0.00 ","$13.21 ","$20.92 ","$21.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18925","ERX","HCPCS J1956","17478-0107-20","LEVOFLOXACIN 25 MG/ML IV SOLN","BOTH IP/OP","$84.92 ","$62.84 ","$0.00 ","$77.00 ","$38.21 ","$0.00 ","$17.70 ","$0.00 ","$0.00 ","$13.48 ","$77.00 ","$0.00 ","$38.50 ","$60.98 ","$61.60 ","$0.00 ","$12.05 ","$0.00 ","$12.26 ","$0.00 "
"18925","ERX","HCPCS J1956","17478-0107-30","LEVOFLOXACIN 25 MG/ML IV SOLN","BOTH IP/OP","$84.92 ","$62.84 ","$0.00 ","$77.00 ","$38.21 ","$0.00 ","$17.70 ","$0.00 ","$0.00 ","$13.48 ","$77.00 ","$0.00 ","$38.50 ","$60.98 ","$61.60 ","$0.00 ","$12.05 ","$0.00 ","$12.26 ","$0.00 "
"18925","ERX","HCPCS J1956","55150-0156-20","LEVOFLOXACIN 25 MG/ML IV SOLN","BOTH IP/OP","$84.92 ","$62.84 ","$0.00 ","$77.00 ","$38.21 ","$0.00 ","$17.70 ","$0.00 ","$0.00 ","$13.48 ","$77.00 ","$0.00 ","$38.50 ","$60.98 ","$61.60 ","$0.00 ","$12.05 ","$0.00 ","$12.26 ","$0.00 "
"19176","ERX","HCPCS 63700001","00904-6290-61","ATORVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19176","ERX","HCPCS 63700001","50268-0093-11","ATORVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19176","ERX","HCPCS 63700001","50268-0093-15","ATORVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19176","ERX","HCPCS 63700001","60505-2578-09","ATORVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19176","ERX","HCPCS 63700001","62175-0890-46","ATORVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","00378-3952-77","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","00904-6292-61","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","51079-0210-01","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","51079-0210-20","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","55111-0123-90","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","60505-2580-09","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19177","ERX","HCPCS 63700001","68084-0099-01","ATORVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$24.20 ","$17.91 ","$0.00 ","$21.95 ","","$4.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.95 ","$0.00 ","$10.98 ","$17.38 ","$17.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19178","ERX","HCPCS 63700001","00904-6291-61","ATORVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19178","ERX","HCPCS 63700001","55111-0122-90","ATORVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19178","ERX","HCPCS 63700001","60505-2579-09","ATORVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19178","ERX","HCPCS 63700001","68084-0098-01","ATORVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19179","ERX","HCPCS 25000001","42291-0153-30","AZELASTINE HCL 0.1 % NA SOLN","BOTH IP/OP","$320.99 ","$237.53 ","$0.00 ","$320.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.99 ","$0.00 ","$160.50 ","$254.22 ","$256.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19179","ERX","HCPCS 25000001","60505-0833-05","AZELASTINE HCL 0.1 % NA SOLN","BOTH IP/OP","$320.99 ","$237.53 ","$0.00 ","$320.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.99 ","$0.00 ","$160.50 ","$254.22 ","$256.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19226","ERX","HCPCS 63700001","00093-5420-88","CABERGOLINE 0.5 MG PO TABS","BOTH IP/OP","$141.51 ","$104.72 ","$0.00 ","$128.31 ","","$25.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.31 ","$0.00 ","$64.16 ","$101.62 ","$102.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19226","ERX","HCPCS 63700001","49884-0673-14","CABERGOLINE 0.5 MG PO TABS","BOTH IP/OP","$141.51 ","$104.72 ","$0.00 ","$128.31 ","","$25.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.31 ","$0.00 ","$64.16 ","$101.62 ","$102.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19226","ERX","HCPCS 63700001","50742-0118-08","CABERGOLINE 0.5 MG PO TABS","BOTH IP/OP","$141.51 ","$104.72 ","$0.00 ","$128.31 ","","$25.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.31 ","$0.00 ","$64.16 ","$101.62 ","$102.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19226","ERX","HCPCS 63700001","59762-1005-01","CABERGOLINE 0.5 MG PO TABS","BOTH IP/OP","$141.51 ","$104.72 ","$0.00 ","$128.31 ","","$25.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.31 ","$0.00 ","$64.16 ","$101.62 ","$102.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19333","ERX","HCPCS J0735","00143-9724-01","CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","BOTH IP/OP","$39.90 ","$29.53 ","$0.00 ","$39.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.90 ","$0.00 ","$19.95 ","$31.60 ","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19333","ERX","HCPCS J0735","39822-2000-01","CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","BOTH IP/OP","$39.90 ","$29.53 ","$0.00 ","$39.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.90 ","$0.00 ","$19.95 ","$31.60 ","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19333","ERX","HCPCS J0735","67457-0218-10","CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","BOTH IP/OP","$39.90 ","$29.53 ","$0.00 ","$39.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.90 ","$0.00 ","$19.95 ","$31.60 ","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19451","ERX","HCPCS 90700","58160-0810-11","DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","BOTH IP/OP","$105.04 ","$77.73 ","$0.00 ","$105.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$105.04 ","$0.00 ","$52.52 ","$83.19 ","$84.03 ","$0.00 ","$16.44 ","$0.00 ","$16.72 ","$0.00 "
"19451","ERX","HCPCS 90700","58160-0810-52","DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","BOTH IP/OP","$105.04 ","$77.73 ","$0.00 ","$105.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.39 ","$105.04 ","$0.00 ","$52.52 ","$83.19 ","$84.03 ","$0.00 ","$16.44 ","$0.00 ","$16.72 ","$0.00 "
"19452","ERX","HCPCS 25000001","17478-0105-05","OLOPATADINE HCL 0.1 % OP SOLN","BOTH IP/OP","$924.14 ","$683.86 ","$0.00 ","$924.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$924.14 ","$0.00 ","$462.07 ","$731.92 ","$739.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19452","ERX","HCPCS 25000001","61314-0271-05","OLOPATADINE HCL 0.1 % OP SOLN","BOTH IP/OP","$924.14 ","$683.86 ","$0.00 ","$924.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$924.14 ","$0.00 ","$462.07 ","$731.92 ","$739.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19452","ERX","HCPCS 25000001","65862-0757-05","OLOPATADINE HCL 0.1 % OP SOLN","BOTH IP/OP","$924.14 ","$683.86 ","$0.00 ","$924.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$924.14 ","$0.00 ","$462.07 ","$731.92 ","$739.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19452","ERX","HCPCS 25000001","70069-0007-01","OLOPATADINE HCL 0.1 % OP SOLN","BOTH IP/OP","$924.14 ","$683.86 ","$0.00 ","$924.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$924.14 ","$0.00 ","$462.07 ","$731.92 ","$739.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19527","ERX","HCPCS 63700001","00904-5460-52","OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19527","ERX","HCPCS 63700001","00904-5460-72","OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19527","ERX","HCPCS 63700001","00904-5460-92","OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19691","ERX","HCPCS 25000001","61010-8100-01","BENZOCAINE 20 % MT GEL","BOTH IP/OP","$36.21 ","$26.80 ","$0.00 ","$32.84 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.84 ","$0.00 ","$16.42 ","$26.01 ","$26.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19691","ERX","HCPCS 25000001","00283-0293-31","BENZOCAINE 20 % MT GEL","BOTH IP/OP","$36.21 ","$26.80 ","$0.00 ","$32.84 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.84 ","$0.00 ","$16.42 ","$26.01 ","$26.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19691","ERX","HCPCS 25000001","00283-0871-31","BENZOCAINE 20 % MT GEL","BOTH IP/OP","$36.21 ","$26.80 ","$0.00 ","$32.84 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.84 ","$0.00 ","$16.42 ","$26.01 ","$26.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19703","ERX","HCPCS 63700001","00065-0246-10","BETAXOLOL HCL 0.25 % OP SUSP","BOTH IP/OP","$1,088.11 ","$805.20 ","$0.00 ","$987.50 ","","$193.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19704","ERX","HCPCS 25000001","00065-0023-15","CARBACHOL 0.01 % IO SOLN","BOTH IP/OP","$173.75 ","$128.58 ","$0.00 ","$152.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$152.97 ","$0.00 ","$76.49 ","$121.15 ","$122.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19711","ERX","HCPCS 25000001","00168-0203-60","CLINDAMYCIN PHOSPHATE 1 % EX LOTN","BOTH IP/OP","$403.81 ","$298.82 ","$0.00 ","$366.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.55 ","$0.00 ","$183.28 ","$290.31 ","$293.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19711","ERX","HCPCS 25000001","59762-3744-01","CLINDAMYCIN PHOSPHATE 1 % EX LOTN","BOTH IP/OP","$403.81 ","$298.82 ","$0.00 ","$366.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.55 ","$0.00 ","$183.28 ","$290.31 ","$293.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19713","ERX","HCPCS j1730","00575-6200-30","DIAZOXIDE 50 MG/ML PO SUSP","BOTH IP/OP","$1,320.31 ","$977.03 ","$0.00 ","$1,095.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,095.20 ","$0.00 ","$547.60 ","$867.40 ","$876.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19714","ERX","HCPCS 25000001","17478-0892-25","DICLOFENAC SODIUM 0.1 % OP SOLN","BOTH IP/OP","$253.42 ","$187.53 ","$0.00 ","$156.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.70 ","$0.00 ","$78.35 ","$124.11 ","$125.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19714","ERX","HCPCS 25000001","61314-0014-25","DICLOFENAC SODIUM 0.1 % OP SOLN","BOTH IP/OP","$253.42 ","$187.53 ","$0.00 ","$156.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.70 ","$0.00 ","$78.35 ","$124.11 ","$125.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19714","ERX","HCPCS 25000001","61314-0014-05","DICLOFENAC SODIUM 0.1 % OP SOLN","BOTH IP/OP","$253.42 ","$187.53 ","$0.00 ","$182.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.70 ","$0.00 ","$78.35 ","$182.20 ","$125.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19732","ERX","HCPCS 25000001","00037-6830-15","HYDROCORTISONE ACETATE 10 % EX FOAM","BOTH IP/OP","$1,395.30 ","$1,032.52 ","$0.00 ","$1,266.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,266.28 ","$0.00 ","$633.14 ","$1,002.89 ","$1,013.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19733","ERX","HCPCS 25000001","17478-0209-10","KETOROLAC TROMETHAMINE 0.5 % OP SOLN","BOTH IP/OP","$359.09 ","$265.73 ","$0.00 ","$556.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.50 ","$0.00 ","$278.25 ","$258.16 ","$445.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19733","ERX","HCPCS 25000001","60505-1003-01","KETOROLAC TROMETHAMINE 0.5 % OP SOLN","BOTH IP/OP","$359.09 ","$265.73 ","$0.00 ","$556.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.50 ","$0.00 ","$278.25 ","$258.16 ","$445.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19733","ERX","HCPCS 25000001","61314-0126-05","KETOROLAC TROMETHAMINE 0.5 % OP SOLN","BOTH IP/OP","$359.09 ","$265.73 ","$0.00 ","$556.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.50 ","$0.00 ","$278.25 ","$258.16 ","$445.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19733","ERX","HCPCS 25000001","61314-0126-10","KETOROLAC TROMETHAMINE 0.5 % OP SOLN","BOTH IP/OP","$359.09 ","$265.73 ","$0.00 ","$556.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.50 ","$0.00 ","$278.25 ","$440.75 ","$445.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19736","ERX","HCPCS J1050","00009-0746-30","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","00009-0746-35","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","00548-5400-00","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","00703-6801-01","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","59762-4537-01","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","59762-4537-02","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","67457-0887-00","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19736","ERX","HCPCS J1050","67457-0887-99","MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","BOTH IP/OP","$187.38 ","$138.66 ","$0.00 ","$308.23 ","$84.32 ","$0.00 ","$39.05 ","$0.00 ","$0.00 ","$98.70 ","$308.23 ","$0.00 ","$154.12 ","$244.12 ","$246.58 ","$0.00 ","$98.70 ","$0.00 ","$93.98 ","$0.00 "
"19741","ERX","HCPCS 63700001","00115-1474-46","METRONIDAZOLE 0.75 % EX GEL","BOTH IP/OP","$932.55 ","$690.09 ","$0.00 ","$846.32 ","","$165.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$846.32 ","$0.00 ","$423.16 ","$670.29 ","$677.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19741","ERX","HCPCS 63700001","00168-0275-45","METRONIDAZOLE 0.75 % EX GEL","BOTH IP/OP","$932.55 ","$690.09 ","$0.00 ","$846.32 ","","$165.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$846.32 ","$0.00 ","$423.16 ","$670.29 ","$677.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19741","ERX","HCPCS 63700001","51672-4116-06","METRONIDAZOLE 0.75 % EX GEL","BOTH IP/OP","$932.55 ","$690.09 ","$0.00 ","$846.32 ","","$165.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$846.32 ","$0.00 ","$423.16 ","$670.29 ","$677.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19741","ERX","HCPCS 63700001","66993-0962-45","METRONIDAZOLE 0.75 % EX GEL","BOTH IP/OP","$932.55 ","$690.09 ","$0.00 ","$846.32 ","","$165.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$846.32 ","$0.00 ","$423.16 ","$670.29 ","$677.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19743","ERX","HCPCS 63700001","00378-7272-53","MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO","BOTH IP/OP","$206.48 ","$152.80 ","$0.00 ","$206.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.48 ","$0.00 ","$103.24 ","$163.53 ","$165.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19743","ERX","HCPCS 63700001","00378-7272-85","MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO","BOTH IP/OP","$206.48 ","$152.80 ","$0.00 ","$206.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.48 ","$0.00 ","$103.24 ","$163.53 ","$165.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19743","ERX","HCPCS 63700001","50458-0194-06","MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO","BOTH IP/OP","$206.48 ","$152.80 ","$0.00 ","$206.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.48 ","$0.00 ","$103.24 ","$163.53 ","$165.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19769","ERX","HCPCS 25000001","00065-0644-35","TOBRAMYCIN 0.3 % OP OINT","BOTH IP/OP","$751.11 ","$555.82 ","$0.00 ","$681.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.66 ","$0.00 ","$340.83 ","$539.87 ","$545.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19776","ERX","HCPCS 25000001","00536-1109-45","UREA 20 % EX CREA","BOTH IP/OP","$60.91 ","$45.07 ","$0.00 ","$55.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.24 ","$0.00 ","$27.62 ","$43.75 ","$44.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19791","ERX","HCPCS 63700001","00065-0411-30","POVIDONE-IODINE 5 % OP SOLN","BOTH IP/OP","$72.16 ","$53.40 ","$0.00 ","$63.50 ","","$13.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.50 ","$0.00 ","$31.75 ","$50.29 ","$50.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19805","ERX","HCPCS 63700001","00168-0323-46","METRONIDAZOLE 0.75 % EX CREA","BOTH IP/OP","$1,943.71 ","$1,438.35 ","$0.00 ","$1,801.12 ","","$345.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,801.12 ","$0.00 ","$900.56 ","$1,426.49 ","$1,440.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19805","ERX","HCPCS 63700001","00299-3836-45","METRONIDAZOLE 0.75 % EX CREA","BOTH IP/OP","$1,943.71 ","$1,438.35 ","$0.00 ","$1,801.12 ","","$345.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,801.12 ","$0.00 ","$900.56 ","$1,426.49 ","$1,440.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19805","ERX","HCPCS 63700001","00713-0633-37","METRONIDAZOLE 0.75 % EX CREA","BOTH IP/OP","$1,943.71 ","$1,438.35 ","$0.00 ","$1,801.12 ","","$345.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,801.12 ","$0.00 ","$900.56 ","$1,426.49 ","$1,440.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19805","ERX","HCPCS 63700001","66993-0960-45","METRONIDAZOLE 0.75 % EX CREA","BOTH IP/OP","$1,943.71 ","$1,438.35 ","$0.00 ","$1,801.12 ","","$345.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,801.12 ","$0.00 ","$900.56 ","$1,426.49 ","$1,440.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19813","ERX","HCPCS J7195","70504-0270-01","COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR","BOTH IP/OP","$2,384.30 ","$1,764.38 ","$0.00 ","$2,162.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,162.75 ","$0.00 ","$1,081.38 ","$1,712.90 ","$1,730.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19813","ERX","HCPCS J7195","70504-0282-05","COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR","BOTH IP/OP","$2,384.30 ","$1,764.38 ","$0.00 ","$2,162.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,162.75 ","$0.00 ","$1,081.38 ","$1,712.90 ","$1,730.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19814","ERX","HCPCS J7195","70504-0271-01","COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR","BOTH IP/OP","$4,768.60 ","$3,528.76 ","$0.00 ","$4,325.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,325.50 ","$0.00 ","$2,162.75 ","$3,425.80 ","$3,460.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19814","ERX","HCPCS J7195","70504-0283-05","COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR","BOTH IP/OP","$4,768.60 ","$3,528.76 ","$0.00 ","$4,325.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,325.50 ","$0.00 ","$2,162.75 ","$3,425.80 ","$3,460.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19882","ERX","HCPCS 63700001","16714-0611-01","SERTRALINE HCL 25 MG PO TABS","BOTH IP/OP","$11.94 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19882","ERX","HCPCS 63700001","16714-0611-04","SERTRALINE HCL 25 MG PO TABS","BOTH IP/OP","$11.94 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19882","ERX","HCPCS 63700001","60687-0231-01","SERTRALINE HCL 25 MG PO TABS","BOTH IP/OP","$11.94 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19882","ERX","HCPCS 63700001","60687-0231-11","SERTRALINE HCL 25 MG PO TABS","BOTH IP/OP","$11.94 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19882","ERX","HCPCS 63700001","76282-0212-18","SERTRALINE HCL 25 MG PO TABS","BOTH IP/OP","$11.94 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19898","ERX","HCPCS J9214","00085-1133-01","INTERFERON ALFA-2B 10000000 UNIT/ML IJ SOLN","BOTH IP/OP","$982.82 ","$727.29 ","$0.00 ","$982.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$982.82 ","$0.00 ","$491.41 ","$778.39 ","$786.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19928","ERX","HCPCS 63700001","65162-0087-74","ITRACONAZOLE 10 MG/ML ORAL SOLUTION","BOTH IP/OP","$182.66 ","$135.17 ","$0.00 ","$165.62 ","","$32.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.62 ","$0.00 ","$82.81 ","$131.17 ","$132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19928","ERX","HCPCS 63700001","99999-6009-61","ITRACONAZOLE 10 MG/ML ORAL SOLUTION","BOTH IP/OP","$182.66 ","$135.17 ","$0.00 ","$165.62 ","","$32.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.62 ","$0.00 ","$82.81 ","$131.17 ","$132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20032","ERX","HCPCS 63700001","63010-0010-30","NELFINAVIR MESYLATE 250 MG PO TABS","BOTH IP/OP","$93.73 ","$69.36 ","$0.00 ","$84.98 ","","$16.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.98 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20039","ERX","HCPCS 25000001","00173-0523-00","SUMATRIPTAN 20 MG/ACT NA SOLN","BOTH IP/OP","$359.18 ","$265.79 ","$0.00 ","$307.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.32 ","$0.00 ","$153.66 ","$243.40 ","$245.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20077","ERX","HCPCS 63700001","67108-3565-09","MESNA 400 MG PO TABS","BOTH IP/OP","$633.76 ","$468.98 ","$0.00 ","$575.29 ","","$112.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$575.29 ","$0.00 ","$287.65 ","$455.63 ","$460.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20103","ERX","HCPCS 25000001","92771-0810-16","LUBRISKIN EX LOTN","BOTH IP/OP","$12.56 ","$9.29 ","$0.00 ","$9.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20103","ERX","HCPCS 25000001","92771-0810-08","LUBRISKIN EX LOTN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20140","ERX","HCPCS 63700001","54162-0500-02","HYDROPHOR EX OINT","BOTH IP/OP","$46.59 ","$34.48 ","$0.00 ","$46.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.59 ","$0.00 ","$23.30 ","$36.90 ","$37.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20140","ERX","HCPCS 63700001","54162-0500-01","HYDROPHOR EX OINT","BOTH IP/OP","$46.59 ","$34.48 ","$0.00 ","$46.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.59 ","$0.00 ","$23.30 ","$36.90 ","$37.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20140","ERX","HCPCS 63700001","10356-0101-10","HYDROPHOR EX OINT","BOTH IP/OP","$46.59 ","$34.48 ","$0.00 ","$46.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.59 ","$0.00 ","$23.30 ","$36.90 ","$37.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20156","ERX","HCPCS J9100","61703-0319-22","CYTARABINE (PF) 100 MG/ML IJ SOLN","BOTH IP/OP","$87.78 ","$64.96 ","$0.00 ","$87.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.78 ","$0.00 ","$43.89 ","$69.52 ","$70.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20156","ERX","HCPCS J9100","63323-0120-20","CYTARABINE (PF) 100 MG/ML IJ SOLN","BOTH IP/OP","$87.78 ","$64.96 ","$0.00 ","$87.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.78 ","$0.00 ","$43.89 ","$69.52 ","$70.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20156","ERX","HCPCS J9100","67457-0452-20","CYTARABINE (PF) 100 MG/ML IJ SOLN","BOTH IP/OP","$87.78 ","$64.96 ","$0.00 ","$87.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.78 ","$0.00 ","$43.89 ","$69.52 ","$70.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20330","ERX","HCPCS 25000001","00023-8335-03","TAZAROTENE 0.05 % EX GEL","BOTH IP/OP","$1,205.14 ","$891.80 ","$0.00 ","$1,205.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,205.14 ","$0.00 ","$602.57 ","$954.47 ","$964.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20446","ERX","HCPCS 63700001","00172-5241-60","ANAGRELIDE HCL 0.5 MG PO CAPS","BOTH IP/OP","$41.58 ","$30.77 ","$0.00 ","$37.71 ","","$7.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.71 ","$0.00 ","$18.86 ","$29.87 ","$30.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20446","ERX","HCPCS 63700001","54092-0063-01","ANAGRELIDE HCL 0.5 MG PO CAPS","BOTH IP/OP","$41.58 ","$30.77 ","$0.00 ","$37.71 ","","$7.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.71 ","$0.00 ","$18.86 ","$29.87 ","$30.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20447","ERX","HCPCS 63700001","00172-5240-60","ANAGRELIDE HCL 1 MG PO CAPS","BOTH IP/OP","$92.91 ","$68.75 ","$0.00 ","$84.25 ","","$16.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.25 ","$0.00 ","$42.13 ","$66.73 ","$67.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20472","ERX","HCPCS 25000001","00143-9310-10","ETOMIDATE 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20472","ERX","HCPCS 25000001","00143-9506-10","ETOMIDATE 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20472","ERX","HCPCS 25000001","55150-0221-10","ETOMIDATE 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20472","ERX","HCPCS 25000001","55150-0222-20","ETOMIDATE 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20472","ERX","HCPCS 25000001","68382-0545-07","ETOMIDATE 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20472","ERX","HCPCS 25000001","72266-0146-10","ETOMIDATE 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20566","ERX","HCPCS 63700001","50268-0525-15","MELOXICAM 7.5 MG PO TABS","BOTH IP/OP","$12.99 ","$9.61 ","$0.00 ","$11.78 ","","$2.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.78 ","$0.00 ","$5.89 ","$9.33 ","$9.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20566","ERX","HCPCS 63700001","68382-0050-01","MELOXICAM 7.5 MG PO TABS","BOTH IP/OP","$12.99 ","$9.61 ","$0.00 ","$11.78 ","","$2.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.78 ","$0.00 ","$5.89 ","$9.33 ","$9.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20580","ERX","HCPCS 63700001","50268-0526-15","MELOXICAM 15 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20580","ERX","HCPCS 63700001","68382-0051-01","MELOXICAM 15 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20638","ERX","HCPCS 63700001","00555-9045-58","FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB","BOTH IP/OP","$123.09 ","$91.09 ","$0.00 ","$123.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.09 ","$0.00 ","$61.55 ","$97.49 ","$98.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20638","ERX","HCPCS 63700001","16714-0359-04","FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB","BOTH IP/OP","$123.09 ","$91.09 ","$0.00 ","$123.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.09 ","$0.00 ","$61.55 ","$97.49 ","$98.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20718","ERX","HCPCS 63700001","68462-0536-70","IMIQUIMOD 5 % EX CREA","BOTH IP/OP","$140.20 ","$103.75 ","$0.00 ","$127.12 ","","$24.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.12 ","$0.00 ","$63.56 ","$100.68 ","$101.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","00069-3060-75","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","00781-5776-69","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","00904-6708-06","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","50111-0787-10","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","50111-0787-51","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","50268-0098-15","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","51224-0022-30","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","59762-2198-01","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","59762-2198-03","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","59762-2198-07","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","60687-0282-01","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","65862-0641-63","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20943","ERX","HCPCS 63700001","65862-0641-69","AZITHROMYCIN 250 MG PO TABS","BOTH IP/OP","$16.02 ","$11.85 ","$0.00 ","$16.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20954","ERX","HCPCS J1955","54482-0147-01","LEVOCARNITINE 200 MG/ML IV SOLN","BOTH IP/OP","$157.72 ","$116.71 ","$0.00 ","$139.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.11 ","$0.00 ","$69.56 ","$110.18 ","$111.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21044","ERX","HCPCS J1950","00074-3663-03","LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT","BOTH IP/OP","$12,067.34 ","$8,929.83 ","$0.00 ","$10,307.02 ","$5,696.39 ","$4,098.03 ","$1,647.37 ","$0.00 ","$0.00 ","$4,480.63 ","$10,307.02 ","$3,998.07 ","$5,153.51 ","$8,163.16 ","$8,245.62 ","$5,521.14 ","$4,480.63 ","$0.00 ","$4,266.32 ","$3,733.01 "
"21045","ERX","HCPCS J9217","00074-3346-03","LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT","BOTH IP/OP","$14,379.96 ","$10,641.17 ","$0.00 ","$12,282.27 ","$6,788.05 ","$602.20 ","$740.50 ","$0.00 ","$0.00 ","$811.00 ","$12,282.27 ","$707.80 ","$6,141.14 ","$9,727.56 ","$9,825.82 ","$977.44 ","$811.00 ","$0.00 ","$772.21 ","$617.66 "
"21057","ERX","HCPCS 63700001","00904-6283-61","OLANZAPINE 2.5 MG PO TABS","BOTH IP/OP","$46.92 ","$34.72 ","$0.00 ","$42.55 ","","$8.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.55 ","$0.00 ","$21.28 ","$33.70 ","$34.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21057","ERX","HCPCS 63700001","60505-3110-00","OLANZAPINE 2.5 MG PO TABS","BOTH IP/OP","$46.92 ","$34.72 ","$0.00 ","$42.55 ","","$8.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.55 ","$0.00 ","$21.28 ","$33.70 ","$34.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21057","ERX","HCPCS 63700001","68084-0525-01","OLANZAPINE 2.5 MG PO TABS","BOTH IP/OP","$46.92 ","$34.72 ","$0.00 ","$42.55 ","","$8.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.55 ","$0.00 ","$21.28 ","$33.70 ","$34.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21061","ERX","HCPCS 63700001","62756-0184-13","OXCARBAZEPINE 300 MG PO TABS","BOTH IP/OP","$10.60 ","$7.84 ","$0.00 ","$10.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.60 ","$0.00 ","$5.30 ","$8.40 ","$8.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21061","ERX","HCPCS 63700001","62756-0184-88","OXCARBAZEPINE 300 MG PO TABS","BOTH IP/OP","$10.60 ","$7.84 ","$0.00 ","$10.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.60 ","$0.00 ","$5.30 ","$8.40 ","$8.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21061","ERX","HCPCS 63700001","68084-0853-01","OXCARBAZEPINE 300 MG PO TABS","BOTH IP/OP","$10.60 ","$7.84 ","$0.00 ","$10.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.60 ","$0.00 ","$5.30 ","$8.40 ","$8.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21062","ERX","HCPCS 63700001","00904-6085-61","CITALOPRAM HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$11.29 ","$8.35 ","$0.00 ","$10.24 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.24 ","$0.00 ","$5.12 ","$8.11 ","$8.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21062","ERX","HCPCS 63700001","13668-0010-01","CITALOPRAM HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$11.29 ","$8.35 ","$0.00 ","$10.24 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.24 ","$0.00 ","$5.12 ","$8.11 ","$8.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21062","ERX","HCPCS 63700001","55111-0343-30","CITALOPRAM HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$11.29 ","$8.35 ","$0.00 ","$10.24 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.24 ","$0.00 ","$5.12 ","$8.11 ","$8.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21062","ERX","HCPCS 63700001","57664-0508-88","CITALOPRAM HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$11.29 ","$8.35 ","$0.00 ","$10.24 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.24 ","$0.00 ","$5.12 ","$8.11 ","$8.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21062","ERX","HCPCS 63700001","68084-0744-01","CITALOPRAM HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$11.29 ","$8.35 ","$0.00 ","$10.24 ","","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.24 ","$0.00 ","$5.12 ","$8.11 ","$8.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21063","ERX","HCPCS J0456","00069-3150-83","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","55150-0174-10","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","63323-0398-10","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","63323-0398-12","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","67457-0860-50","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","70860-0100-10","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","70860-0100-41","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21063","ERX","HCPCS J0456","70860-0125-66","AZITHROMYCIN 500 MG IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$27.36 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"21064","ERX","HCPCS 25000001","00904-6488-38","LUBRIFRESH P.M. OP OINT","BOTH IP/OP","$18.85 ","$13.95 ","$0.00 ","$18.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.85 ","$0.00 ","$9.43 ","$14.93 ","$15.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21108","ERX","HCPCS J9217","00074-3683-03","LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT","BOTH IP/OP","$19,173.30 ","$14,188.24 ","$0.00 ","$16,376.37 ","$9,050.75 ","$802.93 ","$987.33 ","$0.00 ","$0.00 ","$1,081.33 ","$16,376.37 ","$943.73 ","$8,188.19 ","$12,970.09 ","$13,101.10 ","$1,303.25 ","$1,081.33 ","$0.00 ","$1,029.61 ","$823.54 "
"21135","ERX","HCPCS 25000001","47335-0788-91","DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","BOTH IP/OP","$719.05 ","$532.10 ","$0.00 ","$652.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.57 ","$0.00 ","$326.29 ","$516.84 ","$522.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21135","ERX","HCPCS 25000001","68382-0384-01","DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","BOTH IP/OP","$719.05 ","$532.10 ","$0.00 ","$652.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.57 ","$0.00 ","$326.29 ","$516.84 ","$522.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21135","ERX","HCPCS 25000001","69918-0501-05","DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","BOTH IP/OP","$719.05 ","$532.10 ","$0.00 ","$652.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.57 ","$0.00 ","$326.29 ","$516.84 ","$522.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21157","ERX","HCPCS 63700001","62756-0185-88","OXCARBAZEPINE 600 MG PO TABS","BOTH IP/OP","$21.22 ","$15.70 ","$0.00 ","$19.24 ","","$3.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.24 ","$0.00 ","$9.62 ","$15.24 ","$15.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21157","ERX","HCPCS 63700001","68084-0867-01","OXCARBAZEPINE 600 MG PO TABS","BOTH IP/OP","$21.22 ","$15.70 ","$0.00 ","$19.24 ","","$3.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.24 ","$0.00 ","$9.62 ","$15.24 ","$15.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21157","ERX","HCPCS 63700001","68084-0867-11","OXCARBAZEPINE 600 MG PO TABS","BOTH IP/OP","$21.22 ","$15.70 ","$0.00 ","$19.24 ","","$3.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.24 ","$0.00 ","$9.62 ","$15.24 ","$15.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21284","ERX","HCPCS 63700001","13107-0068-01","AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS","BOTH IP/OP","$7.19 ","$5.32 ","$0.00 ","$6.52 ","","$1.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.52 ","$0.00 ","$3.26 ","$5.16 ","$5.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21284","ERX","HCPCS 63700001","42806-0339-01","AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS","BOTH IP/OP","$7.19 ","$5.32 ","$0.00 ","$6.52 ","","$1.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.52 ","$0.00 ","$3.26 ","$5.16 ","$5.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21285","ERX","HCPCS J0795","55566-0302-01","CORTICORELIN OVINE TRIFLUTATE 100 MCG IV SOLR","BOTH IP/OP","$2,244.90 ","$1,661.23 ","$0.00 ","$2,244.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,244.90 ","$0.00 ","$1,122.45 ","$1,777.96 ","$1,795.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21287","ERX","HCPCS 63700001","00597-0183-90","PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS","BOTH IP/OP","$32.02 ","$23.69 ","$0.00 ","$32.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.02 ","$0.00 ","$16.01 ","$25.36 ","$25.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21287","ERX","HCPCS 63700001","33342-0031-10","PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS","BOTH IP/OP","$32.02 ","$23.69 ","$0.00 ","$32.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.02 ","$0.00 ","$16.01 ","$25.36 ","$25.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21287","ERX","HCPCS 63700001","68382-0196-16","PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS","BOTH IP/OP","$32.02 ","$23.69 ","$0.00 ","$32.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.02 ","$0.00 ","$16.01 ","$25.36 ","$25.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21287","ERX","HCPCS 63700001","68462-0330-90","PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS","BOTH IP/OP","$32.02 ","$23.69 ","$0.00 ","$32.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.02 ","$0.00 ","$16.01 ","$25.36 ","$25.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21288","ERX","HCPCS 63700001","33342-0034-10","PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS","BOTH IP/OP","$33.62 ","$24.88 ","$0.00 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.62 ","$0.00 ","$16.81 ","$26.63 ","$26.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21288","ERX","HCPCS 63700001","68382-0199-16","PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS","BOTH IP/OP","$33.62 ","$24.88 ","$0.00 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.62 ","$0.00 ","$16.81 ","$26.63 ","$26.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21288","ERX","HCPCS 63700001","68462-0333-90","PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS","BOTH IP/OP","$33.62 ","$24.88 ","$0.00 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.62 ","$0.00 ","$16.81 ","$26.63 ","$26.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21289","ERX","HCPCS 63700001","00781-5252-92","PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS","BOTH IP/OP","$11.21 ","$8.30 ","$0.00 ","$11.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.21 ","$0.00 ","$5.61 ","$8.88 ","$8.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21289","ERX","HCPCS 63700001","33342-0035-10","PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS","BOTH IP/OP","$11.21 ","$8.30 ","$0.00 ","$11.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.21 ","$0.00 ","$5.61 ","$8.88 ","$8.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21289","ERX","HCPCS 63700001","68382-0200-16","PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS","BOTH IP/OP","$11.21 ","$8.30 ","$0.00 ","$11.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.21 ","$0.00 ","$5.61 ","$8.88 ","$8.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21289","ERX","HCPCS 63700001","68462-0334-90","PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS","BOTH IP/OP","$11.21 ","$8.30 ","$0.00 ","$11.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.21 ","$0.00 ","$5.61 ","$8.88 ","$8.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21290","ERX","HCPCS 63700001","13668-0092-90","PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS","BOTH IP/OP","$13.58 ","$10.05 ","$0.00 ","$12.32 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.32 ","$0.00 ","$6.16 ","$9.76 ","$9.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21290","ERX","HCPCS 63700001","33342-0032-10","PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS","BOTH IP/OP","$13.58 ","$10.05 ","$0.00 ","$12.32 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.32 ","$0.00 ","$6.16 ","$9.76 ","$9.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21290","ERX","HCPCS 63700001","68382-0197-16","PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS","BOTH IP/OP","$13.58 ","$10.05 ","$0.00 ","$12.32 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.32 ","$0.00 ","$6.16 ","$9.76 ","$9.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21290","ERX","HCPCS 63700001","68462-0331-90","PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS","BOTH IP/OP","$13.58 ","$10.05 ","$0.00 ","$12.32 ","","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.32 ","$0.00 ","$6.16 ","$9.76 ","$9.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21300","ERX","HCPCS 63700001","00904-5448-61","PENTOXIFYLLINE ER 400 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21321","ERX","HCPCS 63700001","52544-0256-12","PROGESTERONE 8 % VA GEL","BOTH IP/OP","$12.03 ","$8.90 ","$0.00 ","$10.91 ","","$2.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.91 ","$0.00 ","$5.46 ","$8.64 ","$8.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21321","ERX","HCPCS 63700001","52544-0256-54","PROGESTERONE 8 % VA GEL","BOTH IP/OP","$12.03 ","$8.90 ","$0.00 ","$10.91 ","","$2.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.91 ","$0.00 ","$5.46 ","$8.64 ","$8.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21374","ERX","HCPCS J7517","00004-0260-01","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","00054-0166-25","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","16729-0019-01","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","51079-0379-01","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","51079-0379-20","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","60687-0438-01","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","60687-0438-11","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","64380-0725-06","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","67877-0225-01","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21374","ERX","HCPCS J7517","67877-0225-05","MYCOPHENOLATE MOFETIL 500 MG PO TABS","BOTH IP/OP","$83.34 ","$61.67 ","$0.00 ","$75.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.23 ","$75.57 ","$0.00 ","$37.79 ","$59.85 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"21381","ERX","HCPCS 25000001","10858-0081-07","BARIUM SULFATE PO CAPS","BOTH IP/OP","$75.60 ","$55.94 ","$0.00 ","$75.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.60 ","$0.00 ","$37.80 ","$59.88 ","$60.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21381","ERX","HCPCS 25000001","10858-0081-10","BARIUM SULFATE PO CAPS","BOTH IP/OP","$75.60 ","$55.94 ","$0.00 ","$75.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.60 ","$0.00 ","$37.80 ","$59.88 ","$60.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21509","ERX","HCPCS 63700001","00078-0249-15","LETROZOLE 2.5 MG PO TABS","BOTH IP/OP","$108.41 ","$80.22 ","$0.00 ","$98.30 ","","$19.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.30 ","$0.00 ","$49.15 ","$77.85 ","$78.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21509","ERX","HCPCS 63700001","00093-7620-56","LETROZOLE 2.5 MG PO TABS","BOTH IP/OP","$108.41 ","$80.22 ","$0.00 ","$98.30 ","","$19.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.30 ","$0.00 ","$49.15 ","$77.85 ","$78.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21509","ERX","HCPCS 63700001","16729-0034-10","LETROZOLE 2.5 MG PO TABS","BOTH IP/OP","$108.41 ","$80.22 ","$0.00 ","$98.30 ","","$19.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.30 ","$0.00 ","$49.15 ","$77.85 ","$78.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21509","ERX","HCPCS 63700001","50268-0476-15","LETROZOLE 2.5 MG PO TABS","BOTH IP/OP","$108.41 ","$80.22 ","$0.00 ","$98.30 ","","$19.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.30 ","$0.00 ","$49.15 ","$77.85 ","$78.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21509","ERX","HCPCS 63700001","51991-0759-33","LETROZOLE 2.5 MG PO TABS","BOTH IP/OP","$108.41 ","$80.22 ","$0.00 ","$98.30 ","","$19.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.30 ","$0.00 ","$49.15 ","$77.85 ","$78.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21509","ERX","HCPCS 63700001","60505-3255-03","LETROZOLE 2.5 MG PO TABS","BOTH IP/OP","$108.41 ","$80.22 ","$0.00 ","$98.30 ","","$19.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.30 ","$0.00 ","$49.15 ","$77.85 ","$78.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21570","ERX","HCPCS J9030","00052-0602-02","BCG LIVE 50 MG IS SUSR","BOTH IP/OP","$633.30 ","$468.64 ","$0.00 ","$574.87 ","$284.99 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$166.26 ","$574.87 ","$148.10 ","$287.44 ","$455.30 ","$459.90 ","$204.52 ","$166.26 ","$0.00 ","$158.31 ","$141.05 "
"21688","ERX","HCPCS 63700001","00378-5525-01","ROPINIROLE HCL 0.25 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21688","ERX","HCPCS 63700001","43547-0268-10","ROPINIROLE HCL 0.25 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21688","ERX","HCPCS 63700001","62332-0030-31","ROPINIROLE HCL 0.25 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21689","ERX","HCPCS 63700001","00904-6374-61","ROPINIROLE HCL 1 MG PO TABS","BOTH IP/OP","$10.50 ","$7.77 ","$0.00 ","$9.52 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.52 ","$0.00 ","$4.76 ","$7.54 ","$7.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21689","ERX","HCPCS 63700001","43547-0270-10","ROPINIROLE HCL 1 MG PO TABS","BOTH IP/OP","$10.50 ","$7.77 ","$0.00 ","$9.52 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.52 ","$0.00 ","$4.76 ","$7.54 ","$7.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21689","ERX","HCPCS 63700001","68462-0255-01","ROPINIROLE HCL 1 MG PO TABS","BOTH IP/OP","$10.50 ","$7.77 ","$0.00 ","$9.52 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.52 ","$0.00 ","$4.76 ","$7.54 ","$7.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21690","ERX","HCPCS 63700001","43547-0271-10","ROPINIROLE HCL 2 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21690","ERX","HCPCS 63700001","62332-0033-31","ROPINIROLE HCL 2 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21690","ERX","HCPCS 63700001","68462-0256-01","ROPINIROLE HCL 2 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21691","ERX","HCPCS 63700001","43547-0274-10","ROPINIROLE HCL 5 MG PO TABS","BOTH IP/OP","$10.90 ","$8.07 ","$0.00 ","$9.88 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.88 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21800","ERX","HCPCS 63700001","43547-0269-10","ROPINIROLE HCL 0.5 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21810","ERX","HCPCS 63700001","31722-0506-60","COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS","BOTH IP/OP","$65.06 ","$48.14 ","$0.00 ","$59.01 ","","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.01 ","$0.00 ","$29.51 ","$46.74 ","$47.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21810","ERX","HCPCS 63700001","64380-0707-03","COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS","BOTH IP/OP","$65.06 ","$48.14 ","$0.00 ","$59.01 ","","$11.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.01 ","$0.00 ","$29.51 ","$46.74 ","$47.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21823","ERX","HCPCS 63700001","00054-0220-20","QUETIAPINE FUMARATE 25 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21823","ERX","HCPCS 63700001","00310-0275-10","QUETIAPINE FUMARATE 25 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21823","ERX","HCPCS 63700001","00904-6638-61","QUETIAPINE FUMARATE 25 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21823","ERX","HCPCS 63700001","16729-0145-01","QUETIAPINE FUMARATE 25 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21823","ERX","HCPCS 63700001","50268-0630-15","QUETIAPINE FUMARATE 25 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21823","ERX","HCPCS 63700001","60687-0327-01","QUETIAPINE FUMARATE 25 MG PO TABS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$17.72 ","","$3.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$8.86 ","$14.03 ","$14.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21824","ERX","HCPCS 63700001","00054-0221-20","QUETIAPINE FUMARATE 100 MG PO TABS","BOTH IP/OP","$26.07 ","$19.29 ","$0.00 ","$26.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.07 ","$0.00 ","$13.04 ","$20.65 ","$20.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21824","ERX","HCPCS 63700001","50268-0632-15","QUETIAPINE FUMARATE 100 MG PO TABS","BOTH IP/OP","$26.07 ","$19.29 ","$0.00 ","$26.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.07 ","$0.00 ","$13.04 ","$20.65 ","$20.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21824","ERX","HCPCS 63700001","63739-0665-10","QUETIAPINE FUMARATE 100 MG PO TABS","BOTH IP/OP","$26.07 ","$19.29 ","$0.00 ","$26.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.07 ","$0.00 ","$13.04 ","$20.65 ","$20.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21825","ERX","HCPCS 63700001","16714-0455-01","QUETIAPINE FUMARATE 200 MG PO TABS","BOTH IP/OP","$54.21 ","$40.12 ","$0.00 ","$49.17 ","","$9.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.17 ","$0.00 ","$24.59 ","$38.94 ","$39.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21825","ERX","HCPCS 63700001","47335-0905-88","QUETIAPINE FUMARATE 200 MG PO TABS","BOTH IP/OP","$54.21 ","$40.12 ","$0.00 ","$49.17 ","","$9.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.17 ","$0.00 ","$24.59 ","$38.94 ","$39.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21827","ERX","HCPCS 25000001","63459-0404-30","TIAGABINE HCL 4 MG PO TABS","BOTH IP/OP","$59.89 ","$44.32 ","$0.00 ","$45.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.38 ","$0.00 ","$22.69 ","$35.94 ","$36.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21867","ERX","HCPCS 63700001","76336-0455-18","METYRAPONE 250 MG PO CAPS","BOTH IP/OP","$149.19 ","$110.40 ","$0.00 ","$123.09 ","","$33.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.09 ","$0.00 ","$61.55 ","$97.49 ","$98.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21900","ERX","HCPCS J0289","00469-3051-30","AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","BOTH IP/OP","$936.59 ","$693.08 ","$0.00 ","$825.21 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.21 ","$0.00 ","$412.61 ","$653.57 ","$660.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21905","ERX","HCPCS 25000001","00085-1288-01","MOMETASONE FUROATE 50 MCG/ACT NA SUSP","BOTH IP/OP","$799.55 ","$591.67 ","$0.00 ","$799.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$799.55 ","$0.00 ","$399.78 ","$633.24 ","$639.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22120","ERX","HCPCS 90675","58160-0964-12","RABIES VACCINE, PCEC IM SUSR","BOTH IP/OP","$1,264.92 ","$936.04 ","$0.00 ","$1,103.81 ","$597.68 ","$341.95 ","$174.76 ","$0.00 ","$0.00 ","$326.44 ","$1,103.81 ","$312.47 ","$551.91 ","$874.22 ","$883.05 ","$431.50 ","$326.44 ","$0.00 ","$310.83 ","$294.72 "
"22142","ERX","HCPCS 25000001","00904-6294-61","CLOPIDOGREL BISULFATE 75 MG PO TABS","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22142","ERX","HCPCS 25000001","47335-0894-83","CLOPIDOGREL BISULFATE 75 MG PO TABS","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22142","ERX","HCPCS 25000001","55111-0196-30","CLOPIDOGREL BISULFATE 75 MG PO TABS","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22142","ERX","HCPCS 25000001","55111-0196-90","CLOPIDOGREL BISULFATE 75 MG PO TABS","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22142","ERX","HCPCS 25000001","65862-0357-30","CLOPIDOGREL BISULFATE 75 MG PO TABS","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22142","ERX","HCPCS 25000001","68084-0536-01","CLOPIDOGREL BISULFATE 75 MG PO TABS","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22143","ERX","HCPCS 63700001","00093-7290-01","RALOXIFENE HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22143","ERX","HCPCS 63700001","00093-7290-56","RALOXIFENE HCL 60 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22148","ERX","HCPCS 63700001","69543-0120-10","ACARBOSE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22220","ERX","HCPCS 25000001","50484-0810-15","BECAPLERMIN 0.01 % EX GEL","BOTH IP/OP","$3,344.71 ","$2,475.09 ","$0.00 ","$2,889.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,889.52 ","$0.00 ","$1,444.76 ","$2,288.50 ","$2,311.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22290","ERX","HCPCS 25000001","00093-4136-73","CEFDINIR 125 MG/5ML PO SUSR","BOTH IP/OP","$280.38 ","$207.48 ","$0.00 ","$254.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$254.52 ","$0.00 ","$127.26 ","$201.58 ","$203.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22290","ERX","HCPCS 25000001","00781-6077-46","CEFDINIR 125 MG/5ML PO SUSR","BOTH IP/OP","$280.38 ","$207.48 ","$0.00 ","$254.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$254.52 ","$0.00 ","$127.26 ","$201.58 ","$203.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22290","ERX","HCPCS 25000001","65862-0218-01","CEFDINIR 125 MG/5ML PO SUSR","BOTH IP/OP","$280.38 ","$207.48 ","$0.00 ","$254.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$254.52 ","$0.00 ","$127.26 ","$201.58 ","$203.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22456","ERX","HCPCS 63700001","59528-0331-02","CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22456","ERX","HCPCS 63700001","71321-0803-20","CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22469","ERX","HCPCS 63700001","00904-5224-52","LACTASE 3000 UNITS PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22472","ERX","HCPCS J1885","00338-0069-10","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","00409-3793-01","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","00641-6041-25","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","25021-0700-01","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","47781-0583-68","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","63323-0161-01","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","63323-0161-12","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","70860-0700-02","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","70860-0700-41","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22472","ERX","HCPCS J1885","72611-0719-25","KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.32 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","00338-0072-25","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","00409-3795-01","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","00641-6042-01","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","00641-6042-25","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","25021-0701-01","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","47781-0584-68","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","63323-0162-01","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","63323-0162-12","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","70860-0701-01","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","70860-0701-03","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22473","ERX","HCPCS J1885","72611-0722-25","KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.61 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.61 ","$0.00 ","$0.58 ","$0.00 "
"22509","ERX","HCPCS 63700001","00904-6808-61","MONTELUKAST SODIUM 10 MG PO TABS","BOTH IP/OP","$23.08 ","$17.08 ","$0.00 ","$20.93 ","","$4.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.93 ","$0.00 ","$10.47 ","$16.58 ","$16.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22509","ERX","HCPCS 63700001","50268-0575-15","MONTELUKAST SODIUM 10 MG PO TABS","BOTH IP/OP","$23.08 ","$17.08 ","$0.00 ","$20.93 ","","$4.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.93 ","$0.00 ","$10.47 ","$16.58 ","$16.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22509","ERX","HCPCS 63700001","65862-0574-90","MONTELUKAST SODIUM 10 MG PO TABS","BOTH IP/OP","$23.08 ","$17.08 ","$0.00 ","$20.93 ","","$4.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.93 ","$0.00 ","$10.47 ","$16.58 ","$16.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22509","ERX","HCPCS 63700001","68084-0875-01","MONTELUKAST SODIUM 10 MG PO TABS","BOTH IP/OP","$23.08 ","$17.08 ","$0.00 ","$20.93 ","","$4.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.93 ","$0.00 ","$10.47 ","$16.58 ","$16.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22510","ERX","HCPCS 63700001","50268-0574-15","MONTELUKAST SODIUM 5 MG PO CHEW","BOTH IP/OP","$21.08 ","$15.60 ","$0.00 ","$19.12 ","","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.12 ","$0.00 ","$9.56 ","$15.14 ","$15.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22510","ERX","HCPCS 63700001","57237-0213-30","MONTELUKAST SODIUM 5 MG PO CHEW","BOTH IP/OP","$21.08 ","$15.60 ","$0.00 ","$19.12 ","","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.12 ","$0.00 ","$9.56 ","$15.14 ","$15.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22510","ERX","HCPCS 63700001","65862-0568-90","MONTELUKAST SODIUM 5 MG PO CHEW","BOTH IP/OP","$21.08 ","$15.60 ","$0.00 ","$19.12 ","","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.12 ","$0.00 ","$9.56 ","$15.14 ","$15.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22560","ERX","HCPCS 63700001","99999-6005-56","SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","BOTH IP/OP","$85.47 ","$63.25 ","$0.00 ","$77.49 ","","$15.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.49 ","$0.00 ","$38.75 ","$61.37 ","$61.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22560","ERX","HCPCS 63700001","00121-0854-16","SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","BOTH IP/OP","$85.47 ","$63.25 ","$0.00 ","$451.69 ","","$15.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.49 ","$0.00 ","$38.75 ","$451.69 ","$61.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22560","ERX","HCPCS 63700001","50383-0823-16","SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","BOTH IP/OP","$85.47 ","$63.25 ","$0.00 ","$451.69 ","","$15.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.49 ","$0.00 ","$38.75 ","$451.69 ","$61.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22560","ERX","HCPCS 63700001","50383-0824-16","SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","BOTH IP/OP","$85.47 ","$63.25 ","$0.00 ","$451.69 ","","$15.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.49 ","$0.00 ","$38.75 ","$451.69 ","$61.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22560","ERX","HCPCS 63700001","65862-0496-47","SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","BOTH IP/OP","$85.47 ","$63.25 ","$0.00 ","$451.69 ","","$15.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.49 ","$0.00 ","$38.75 ","$451.69 ","$61.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","00006-0960-31","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","00904-6389-61","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","13668-0115-90","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","31722-0702-30","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","31722-0702-90","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","50268-0518-15","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","63739-0698-10","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","65862-0203-30","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","65862-0203-99","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22588","ERX","HCPCS 63700001","68084-0348-01","LOSARTAN POTASSIUM 100 MG PO TABS","BOTH IP/OP","$25.45 ","$18.83 ","$0.00 ","$23.08 ","","$4.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.08 ","$0.00 ","$11.54 ","$18.28 ","$18.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22953","ERX","HCPCS 63700001","00065-0275-10","BRINZOLAMIDE 1 % OP SUSP","BOTH IP/OP","$1,202.69 ","$889.99 ","$0.00 ","$1,034.59 ","","$214.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,034.59 ","$0.00 ","$517.30 ","$819.40 ","$827.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22959","ERX","HCPCS 25000001","99999-6004-88","PAROXETINE HCL 10 MG/5ML PO SUSP","BOTH IP/OP","$263.17 ","$194.75 ","$0.00 ","$238.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.90 ","$0.00 ","$119.45 ","$189.21 ","$191.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22959","ERX","HCPCS 25000001","60505-0402-05","PAROXETINE HCL 10 MG/5ML PO SUSP","BOTH IP/OP","$263.17 ","$194.75 ","$0.00 ","$925.05 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.90 ","$0.00 ","$119.45 ","$925.05 ","$191.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22981","ERX","HCPCS J0287","57665-0101-41","AMPHOTERICIN B LIPID 5 MG/ML IV SUSP","BOTH IP/OP","$423.36 ","$313.29 ","$0.00 ","$366.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22993","ERX","HCPCS J8520","00004-1100-20","CAPECITABINE 150 MG PO TABS","BOTH IP/OP","$68.17 ","$50.45 ","$0.00 ","$61.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.83 ","$0.00 ","$30.92 ","$48.97 ","$49.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22994","ERX","HCPCS J8521","00004-1101-50","CAPECITABINE 500 MG PO TABS","BOTH IP/OP","$188.16 ","$139.24 ","$0.00 ","$170.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$170.81 ","$0.00 ","$85.41 ","$135.28 ","$136.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22994","ERX","HCPCS J8521","72485-0205-12","CAPECITABINE 500 MG PO TABS","BOTH IP/OP","$188.16 ","$139.24 ","$0.00 ","$170.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$170.81 ","$0.00 ","$85.41 ","$135.28 ","$136.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23009","ERX","HCPCS 63700001","00003-6335-17","HYDROXYUREA 200 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23010","ERX","HCPCS 63700001","00003-6336-17","HYDROXYUREA 300 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23011","ERX","HCPCS 63700001","00003-6337-17","HYDROXYUREA 400 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23036","ERX","HCPCS 25000001","51552-0071-05","POTASSIUM HYDROXIDE 10 % SOLN","BOTH IP/OP","$220.35 ","$163.06 ","$0.00 ","$200.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.03 ","$0.00 ","$100.02 ","$158.42 ","$160.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23063","ERX","HCPCS 25000001","","CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23063","ERX","HCPCS 25000001","00536-1268-12","CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23063","ERX","HCPCS 25000001","54162-0550-07","CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23063","ERX","HCPCS 25000001","54162-0550-09","CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23065","ERX","HCPCS 63700001","19076-9022-00","ELTA EX CREA","BOTH IP/OP","$128.04 ","$94.75 ","$0.00 ","$116.10 ","","$22.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.10 ","$0.00 ","$58.05 ","$91.95 ","$92.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23128","ERX","HCPCS J0133","55150-0154-10","ACYCLOVIR SODIUM 50 MG/ML IV SOLN","BOTH IP/OP","$67.04 ","$49.61 ","$0.00 ","$60.80 ","$30.17 ","$0.00 ","$10.58 ","$0.00 ","$0.00 ","$0.00 ","$60.80 ","$0.00 ","$30.40 ","$48.15 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23128","ERX","HCPCS J0133","55150-0154-11","ACYCLOVIR SODIUM 50 MG/ML IV SOLN","BOTH IP/OP","$67.04 ","$49.61 ","$0.00 ","$60.80 ","$30.17 ","$0.00 ","$10.58 ","$0.00 ","$0.00 ","$0.00 ","$60.80 ","$0.00 ","$30.40 ","$48.15 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23128","ERX","HCPCS J0133","63323-0325-10","ACYCLOVIR SODIUM 50 MG/ML IV SOLN","BOTH IP/OP","$67.04 ","$49.61 ","$0.00 ","$60.80 ","$30.17 ","$0.00 ","$10.58 ","$0.00 ","$0.00 ","$0.00 ","$60.80 ","$0.00 ","$30.40 ","$48.15 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23128","ERX","HCPCS J0133","55150-0155-21","ACYCLOVIR SODIUM 50 MG/ML IV SOLN","BOTH IP/OP","$67.04 ","$49.61 ","$0.00 ","$116.42 ","$30.17 ","$0.00 ","$10.58 ","$0.00 ","$0.00 ","$0.00 ","$60.80 ","$0.00 ","$30.40 ","$116.42 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23128","ERX","HCPCS J0133","63323-0325-20","ACYCLOVIR SODIUM 50 MG/ML IV SOLN","BOTH IP/OP","$67.04 ","$49.61 ","$0.00 ","$116.42 ","$30.17 ","$0.00 ","$10.58 ","$0.00 ","$0.00 ","$0.00 ","$60.80 ","$0.00 ","$30.40 ","$116.42 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23233","ERX","HCPCS 25000001","49884-0902-78","MAFENIDE ACETATE 5 % EX PACK","BOTH IP/OP","$680.56 ","$503.61 ","$0.00 ","$617.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.64 ","$0.00 ","$308.82 ","$489.17 ","$494.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23233","ERX","HCPCS 25000001","50742-0310-25","MAFENIDE ACETATE 5 % EX PACK","BOTH IP/OP","$680.56 ","$503.61 ","$0.00 ","$617.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.64 ","$0.00 ","$308.82 ","$489.17 ","$494.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23233","ERX","HCPCS 25000001","50742-0310-50","MAFENIDE ACETATE 5 % EX PACK","BOTH IP/OP","$680.56 ","$503.61 ","$0.00 ","$617.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.64 ","$0.00 ","$308.82 ","$489.17 ","$494.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23233","ERX","HCPCS 25000001","51079-0624-85","MAFENIDE ACETATE 5 % EX PACK","BOTH IP/OP","$680.56 ","$503.61 ","$0.00 ","$617.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.64 ","$0.00 ","$308.82 ","$489.17 ","$494.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23365","ERX","HCPCS 63700001","00088-2102-01","RIFAPENTINE 150 MG PO TABS","BOTH IP/OP","$38.20 ","$28.27 ","$0.00 ","$69.29 ","","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.29 ","$0.00 ","$34.65 ","$54.88 ","$55.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23365","ERX","HCPCS 63700001","00088-2102-24","RIFAPENTINE 150 MG PO TABS","BOTH IP/OP","$38.20 ","$28.27 ","$0.00 ","$69.29 ","","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.29 ","$0.00 ","$34.65 ","$54.88 ","$55.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23449","ERX","HCPCS 63700001","16714-0685-01","SIMVASTATIN 80 MG PO TABS","BOTH IP/OP","$20.55 ","$15.21 ","$0.00 ","$18.64 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.64 ","$0.00 ","$9.32 ","$14.76 ","$14.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23449","ERX","HCPCS 63700001","16714-0685-02","SIMVASTATIN 80 MG PO TABS","BOTH IP/OP","$20.55 ","$15.21 ","$0.00 ","$18.64 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.64 ","$0.00 ","$9.32 ","$14.76 ","$14.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23449","ERX","HCPCS 63700001","65862-0054-30","SIMVASTATIN 80 MG PO TABS","BOTH IP/OP","$20.55 ","$15.21 ","$0.00 ","$18.64 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.64 ","$0.00 ","$9.32 ","$14.76 ","$14.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23458","ERX","HCPCS 63700001","00143-9285-01","AMOXICILLIN 875 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23458","ERX","HCPCS 63700001","57237-0029-01","AMOXICILLIN 875 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23458","ERX","HCPCS 63700001","65862-0015-01","AMOXICILLIN 875 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23461","ERX","HCPCS 25000001","00496-0882-05","LIDOCAINE 4 % EX CREA","BOTH IP/OP","$35.20 ","$26.05 ","$0.00 ","$31.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.92 ","$0.00 ","$15.96 ","$25.28 ","$25.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23461","ERX","HCPCS 25000001","00496-0882-06","LIDOCAINE 4 % EX CREA","BOTH IP/OP","$35.20 ","$26.05 ","$0.00 ","$31.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.92 ","$0.00 ","$15.96 ","$25.28 ","$25.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23461","ERX","HCPCS 25000001","52565-0122-07","LIDOCAINE 4 % EX CREA","BOTH IP/OP","$35.20 ","$26.05 ","$0.00 ","$31.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.92 ","$0.00 ","$15.96 ","$25.28 ","$25.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23490","ERX","HCPCS 63700001","13668-0011-01","CITALOPRAM HYDROBROMIDE 40 MG PO TABS","BOTH IP/OP","$9.54 ","$7.06 ","$0.00 ","$9.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.54 ","$0.00 ","$4.77 ","$7.56 ","$7.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23599","ERX","HCPCS 63700001","59572-0205-14","THALIDOMIDE 50 MG PO CAPS","BOTH IP/OP","$543.47 ","$402.17 ","$0.00 ","$543.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.47 ","$0.00 ","$271.74 ","$430.43 ","$434.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23599","ERX","HCPCS 63700001","59572-0205-94","THALIDOMIDE 50 MG PO CAPS","BOTH IP/OP","$543.47 ","$402.17 ","$0.00 ","$543.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.47 ","$0.00 ","$271.74 ","$430.43 ","$434.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23796","ERX","HCPCS J1745","57894-0030-01","INFLIXIMAB 100 MG IV SOLR","BOTH IP/OP","$3,167.12 ","$2,343.67 ","$0.00 ","$2,872.83 ","$1,425.20 ","$378.76 ","$668.93 ","$0.00 ","$0.00 ","$673.86 ","$2,872.83 ","$664.49 ","$1,436.42 ","$2,275.28 ","$2,298.26 ","$917.63 ","$673.86 ","$0.00 ","$641.63 ","$512.00 "
"23814","ERX","HCPCS 63700001","00173-0675-02","ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS","BOTH IP/OP","$34.53 ","$25.55 ","$0.00 ","$31.32 ","","$6.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23814","ERX","HCPCS 63700001","00378-4162-01","ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS","BOTH IP/OP","$34.53 ","$25.55 ","$0.00 ","$31.32 ","","$6.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23814","ERX","HCPCS 63700001","68462-0404-01","ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS","BOTH IP/OP","$34.53 ","$25.55 ","$0.00 ","$31.32 ","","$6.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23814","ERX","HCPCS 63700001","68462-0404-67","ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS","BOTH IP/OP","$34.53 ","$25.55 ","$0.00 ","$31.32 ","","$6.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.32 ","$0.00 ","$15.66 ","$24.81 ","$25.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23872","ERX","HCPCS 63700001","00088-2160-30","LEFLUNOMIDE 10 MG PO TABS","BOTH IP/OP","$188.87 ","$139.76 ","$0.00 ","$163.28 ","","$35.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.28 ","$0.00 ","$81.64 ","$129.32 ","$130.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23872","ERX","HCPCS 63700001","23155-0043-03","LEFLUNOMIDE 10 MG PO TABS","BOTH IP/OP","$188.87 ","$139.76 ","$0.00 ","$163.28 ","","$35.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.28 ","$0.00 ","$81.64 ","$129.32 ","$130.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23872","ERX","HCPCS 63700001","62332-0061-30","LEFLUNOMIDE 10 MG PO TABS","BOTH IP/OP","$188.87 ","$139.76 ","$0.00 ","$163.28 ","","$35.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.28 ","$0.00 ","$81.64 ","$129.32 ","$130.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23873","ERX","HCPCS 63700001","23155-0044-03","LEFLUNOMIDE 20 MG PO TABS","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$62.35 ","","$12.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.35 ","$0.00 ","$31.18 ","$49.38 ","$49.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23873","ERX","HCPCS 63700001","60505-2503-01","LEFLUNOMIDE 20 MG PO TABS","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$62.35 ","","$12.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.35 ","$0.00 ","$31.18 ","$49.38 ","$49.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23873","ERX","HCPCS 63700001","62332-0062-30","LEFLUNOMIDE 20 MG PO TABS","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$62.35 ","","$12.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.35 ","$0.00 ","$31.18 ","$49.38 ","$49.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23876","ERX","HCPCS 25000001","00409-7419-03","DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN","BOTH IP/OP","$138.96 ","$102.83 ","$0.00 ","$115.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23898","ERX","HCPCS 63700001","00056-0470-30","EFAVIRENZ 50 MG PO CAPS","BOTH IP/OP","$54.83 ","$40.57 ","$0.00 ","$49.72 ","","$9.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.72 ","$0.00 ","$24.86 ","$39.38 ","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23900","ERX","HCPCS 63700001","00056-0474-92","EFAVIRENZ 200 MG PO CAPS","BOTH IP/OP","$54.79 ","$40.54 ","$0.00 ","$49.69 ","","$9.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.69 ","$0.00 ","$24.85 ","$39.35 ","$39.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23968","ERX","HCPCS 25000001","00004-0298-09","MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR","BOTH IP/OP","$756.71 ","$559.97 ","$0.00 ","$686.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.74 ","$0.00 ","$343.37 ","$543.90 ","$549.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23968","ERX","HCPCS 25000001","17478-0422-40","MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR","BOTH IP/OP","$756.71 ","$559.97 ","$0.00 ","$686.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.74 ","$0.00 ","$343.37 ","$543.90 ","$549.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23968","ERX","HCPCS 25000001","42023-0172-04","MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR","BOTH IP/OP","$756.71 ","$559.97 ","$0.00 ","$686.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.74 ","$0.00 ","$343.37 ","$543.90 ","$549.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24119","ERX","HCPCS 25000001","00597-0047-24","NEVIRAPINE 50 MG/5ML PO SUSP","BOTH IP/OP","$623.92 ","$461.70 ","$0.00 ","$623.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$623.92 ","$0.00 ","$311.96 ","$494.14 ","$499.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24119","ERX","HCPCS 25000001","65862-0057-24","NEVIRAPINE 50 MG/5ML PO SUSP","BOTH IP/OP","$623.92 ","$461.70 ","$0.00 ","$623.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$623.92 ","$0.00 ","$311.96 ","$494.14 ","$499.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24176","ERX","HCPCS 25000001","00054-3566-99","MIDAZOLAM HCL 2 MG/ML PO SYRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24176","ERX","HCPCS 25000001","00574-0150-04","MIDAZOLAM HCL 2 MG/ML PO SYRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24176","ERX","HCPCS 25000001","68094-0762-59","MIDAZOLAM HCL 2 MG/ML PO SYRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24176","ERX","HCPCS 25000001","68094-0762-62","MIDAZOLAM HCL 2 MG/ML PO SYRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24188","ERX","HCPCS 25000001","00006-5424-02","ANTIVENIN LATRODECTUS MACTANS IJ KIT","BOTH IP/OP","$128.35 ","$94.98 ","$0.00 ","$116.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.38 ","$0.00 ","$58.19 ","$92.17 ","$93.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24190","ERX","HCPCS 63700001","00224-1801-84","PSYLLIUM 100 % PO PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24268","ERX","HCPCS 63700001","00143-2260-01","ISOSORBIDE MONONITRATE CR 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24268","ERX","HCPCS 63700001","00904-6450-61","ISOSORBIDE MONONITRATE CR 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24268","ERX","HCPCS 63700001","13668-0105-01","ISOSORBIDE MONONITRATE CR 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24268","ERX","HCPCS 63700001","62175-0119-37","ISOSORBIDE MONONITRATE CR 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24268","ERX","HCPCS 63700001","68084-0592-01","ISOSORBIDE MONONITRATE CR 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24325","ERX","HCPCS 25000001","57782-0397-26","CROMOLYN SODIUM 5.2 MG/ACT NA AERS","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24384","ERX","HCPCS 63700001","00006-0747-31","LOSARTAN-HCTZ 100-25 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$25.54 ","","$5.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24384","ERX","HCPCS 63700001","00093-7368-98","LOSARTAN-HCTZ 100-25 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$25.54 ","","$5.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24384","ERX","HCPCS 63700001","16714-0225-01","LOSARTAN-HCTZ 100-25 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$25.54 ","","$5.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24384","ERX","HCPCS 63700001","16714-0225-02","LOSARTAN-HCTZ 100-25 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$25.54 ","","$5.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24384","ERX","HCPCS 63700001","68180-0217-09","LOSARTAN-HCTZ 100-25 MG PO TABS","BOTH IP/OP","$28.16 ","$20.84 ","$0.00 ","$25.54 ","","$5.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.54 ","$0.00 ","$12.77 ","$20.23 ","$20.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24385","ERX","HCPCS 25000001","50383-0901-10","HYDROCORTISONE-ACETIC ACID 1-2 % OT SOLN","BOTH IP/OP","$638.89 ","$472.78 ","$0.00 ","$638.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$638.89 ","$0.00 ","$319.45 ","$506.00 ","$511.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24398","ERX","HCPCS 63700001","00904-6691-61","METFORMIN HCL 1000 MG PO TABS","BOTH IP/OP","$6.04 ","$4.47 ","$0.00 ","$6.00 ","","$1.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24398","ERX","HCPCS 63700001","23155-0104-05","METFORMIN HCL 1000 MG PO TABS","BOTH IP/OP","$6.04 ","$4.47 ","$0.00 ","$6.00 ","","$1.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24398","ERX","HCPCS 63700001","57664-0474-53","METFORMIN HCL 1000 MG PO TABS","BOTH IP/OP","$6.04 ","$4.47 ","$0.00 ","$6.00 ","","$1.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24398","ERX","HCPCS 63700001","57664-0474-58","METFORMIN HCL 1000 MG PO TABS","BOTH IP/OP","$6.04 ","$4.47 ","$0.00 ","$6.00 ","","$1.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24409","ERX","HCPCS J3240","58468-0030-02","THYROTROPIN ALFA 1.1 MG IM SOLR","BOTH IP/OP","$3,657.89 ","$2,706.84 ","$0.00 ","$3,657.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,997.98 ","$3,657.89 ","$1,779.87 ","$1,828.95 ","$2,897.05 ","$2,926.31 ","$2,457.92 ","$1,997.98 ","$0.00 ","$0.00 ","$0.00 "
"24435","ERX","HCPCS J2353","00078-0818-81","OCTREOTIDE ACETATE 20 MG IM KIT","BOTH IP/OP","$11,565.98 ","$8,558.83 ","$0.00 ","$8,697.31 ","$5,204.69 ","$4,131.24 ","$2,410.64 ","$0.00 ","$0.00 ","$4,843.12 ","$8,697.31 ","$4,337.87 ","$4,348.66 ","$6,888.27 ","$6,957.85 ","$5,990.39 ","$4,843.12 ","$0.00 ","$0.00 ","$0.00 "
"24438","ERX","HCPCS 63700001","00378-4105-91","ABACAVIR SULFATE 300 MG PO TABS","BOTH IP/OP","$42.09 ","$31.15 ","$0.00 ","$38.18 ","","$7.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.18 ","$0.00 ","$19.09 ","$30.24 ","$30.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24438","ERX","HCPCS 63700001","31722-0557-60","ABACAVIR SULFATE 300 MG PO TABS","BOTH IP/OP","$42.09 ","$31.15 ","$0.00 ","$38.18 ","","$7.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.18 ","$0.00 ","$19.09 ","$30.24 ","$30.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24438","ERX","HCPCS 63700001","60505-3583-06","ABACAVIR SULFATE 300 MG PO TABS","BOTH IP/OP","$42.09 ","$31.15 ","$0.00 ","$38.18 ","","$7.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.18 ","$0.00 ","$19.09 ","$30.24 ","$30.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24438","ERX","HCPCS 63700001","64380-0717-03","ABACAVIR SULFATE 300 MG PO TABS","BOTH IP/OP","$42.09 ","$31.15 ","$0.00 ","$38.18 ","","$7.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.18 ","$0.00 ","$19.09 ","$30.24 ","$30.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24438","ERX","HCPCS 63700001","65862-0073-60","ABACAVIR SULFATE 300 MG PO TABS","BOTH IP/OP","$42.09 ","$31.15 ","$0.00 ","$38.18 ","","$7.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.18 ","$0.00 ","$19.09 ","$30.24 ","$30.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24438","ERX","HCPCS 63700001","69097-0514-03","ABACAVIR SULFATE 300 MG PO TABS","BOTH IP/OP","$42.09 ","$31.15 ","$0.00 ","$38.18 ","","$7.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.18 ","$0.00 ","$19.09 ","$30.24 ","$30.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24439","ERX","HCPCS 63700001","99999-6005-00","ABACAVIR SULFATE 20 MG/ML PO SOLN","BOTH IP/OP","$305.64 ","$226.17 ","$0.00 ","$277.46 ","","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.46 ","$0.00 ","$138.73 ","$219.75 ","$221.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24439","ERX","HCPCS 63700001","31722-0562-24","ABACAVIR SULFATE 20 MG/ML PO SOLN","BOTH IP/OP","$305.64 ","$226.17 ","$0.00 ","$425.53 ","","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.46 ","$0.00 ","$138.73 ","$425.53 ","$221.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24439","ERX","HCPCS 63700001","49702-0222-48","ABACAVIR SULFATE 20 MG/ML PO SOLN","BOTH IP/OP","$305.64 ","$226.17 ","$0.00 ","$425.53 ","","$54.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.46 ","$0.00 ","$138.73 ","$425.53 ","$221.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24467","ERX","HCPCS 25000001","99999-6007-34","VITAMIN E 15 UNIT/0.3ML PO SOLN","BOTH IP/OP","$67.88 ","$50.23 ","$0.00 ","$61.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.56 ","$0.00 ","$30.78 ","$48.76 ","$49.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24467","ERX","HCPCS 25000001","54838-0005-30","VITAMIN E 15 UNIT/0.3ML PO SOLN","BOTH IP/OP","$67.88 ","$50.23 ","$0.00 ","$112.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.56 ","$0.00 ","$30.78 ","$112.27 ","$49.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24473","ERX","HCPCS 63700001","00093-2065-06","CILOSTAZOL 50 MG PO TABS","BOTH IP/OP","$6.94 ","$5.14 ","$0.00 ","$6.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.94 ","$0.00 ","$3.47 ","$5.50 ","$5.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24473","ERX","HCPCS 63700001","00185-0123-60","CILOSTAZOL 50 MG PO TABS","BOTH IP/OP","$6.94 ","$5.14 ","$0.00 ","$6.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.94 ","$0.00 ","$3.47 ","$5.50 ","$5.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24474","ERX","HCPCS 63700001","00093-2064-06","CILOSTAZOL 100 MG PO TABS","BOTH IP/OP","$7.65 ","$5.66 ","$0.00 ","$6.94 ","","$1.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.94 ","$0.00 ","$3.47 ","$5.50 ","$5.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24500","ERX","HCPCS 63700001","00025-1520-34","CELECOXIB 100 MG PO CAPS","BOTH IP/OP","$19.36 ","$14.33 ","$0.00 ","$17.56 ","","$3.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24500","ERX","HCPCS 63700001","00904-6502-61","CELECOXIB 100 MG PO CAPS","BOTH IP/OP","$19.36 ","$14.33 ","$0.00 ","$17.56 ","","$3.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24500","ERX","HCPCS 63700001","16714-0732-01","CELECOXIB 100 MG PO CAPS","BOTH IP/OP","$19.36 ","$14.33 ","$0.00 ","$17.56 ","","$3.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24500","ERX","HCPCS 63700001","60687-0436-01","CELECOXIB 100 MG PO CAPS","BOTH IP/OP","$19.36 ","$14.33 ","$0.00 ","$17.56 ","","$3.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.56 ","$0.00 ","$8.78 ","$13.91 ","$14.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24501","ERX","HCPCS 63700001","33342-0157-11","CELECOXIB 200 MG PO CAPS","BOTH IP/OP","$31.72 ","$23.47 ","$0.00 ","$28.77 ","","$5.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.77 ","$0.00 ","$14.39 ","$22.79 ","$23.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24501","ERX","HCPCS 63700001","65862-0909-01","CELECOXIB 200 MG PO CAPS","BOTH IP/OP","$31.72 ","$23.47 ","$0.00 ","$28.77 ","","$5.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.77 ","$0.00 ","$14.39 ","$22.79 ","$23.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24513","ERX","HCPCS J0885","59676-0340-01","EPOETIN ALFA 40000 UNIT/ML IJ SOLN","BOTH IP/OP","$2,899.13 ","$2,145.36 ","$0.00 ","$2,629.74 ","$1,574.23 ","$328.88 ","$604.25 ","$0.00 ","$0.00 ","$460.45 ","$2,629.74 ","$463.30 ","$1,314.87 ","$2,082.75 ","$2,103.79 ","$639.80 ","$411.55 ","$0.00 ","$472.58 ","$387.84 "
"24521","ERX","HCPCS 63700001","00143-2230-01","ISOSORBIDE MONONITRATE ER 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24521","ERX","HCPCS 63700001","00904-6449-61","ISOSORBIDE MONONITRATE ER 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24521","ERX","HCPCS 63700001","13668-0104-01","ISOSORBIDE MONONITRATE ER 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24521","ERX","HCPCS 63700001","62175-0128-37","ISOSORBIDE MONONITRATE ER 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24521","ERX","HCPCS 63700001","68084-0591-01","ISOSORBIDE MONONITRATE ER 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24521","ERX","HCPCS 63700001","68084-0591-11","ISOSORBIDE MONONITRATE ER 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24585","ERX","HCPCS J7511","58468-0080-01","ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR","BOTH IP/OP","$2,494.25 ","$1,845.75 ","$0.00 ","$2,152.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.71 ","$0.00 ","$1,076.36 ","$1,704.95 ","$1,722.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24702","ERX","HCPCS 63700001","49884-0534-11","MODAFINIL 100 MG PO TABS","BOTH IP/OP","$101.82 ","$75.35 ","$0.00 ","$92.32 ","","$18.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24702","ERX","HCPCS 63700001","60505-2526-03","MODAFINIL 100 MG PO TABS","BOTH IP/OP","$101.82 ","$75.35 ","$0.00 ","$92.32 ","","$18.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24702","ERX","HCPCS 63700001","65862-0601-30","MODAFINIL 100 MG PO TABS","BOTH IP/OP","$101.82 ","$75.35 ","$0.00 ","$92.32 ","","$18.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.32 ","$0.00 ","$46.16 ","$73.12 ","$73.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24711","ERX","HCPCS 63700001","68180-0518-01","LISINOPRIL-HCTZ 10-12.5 MG TABLET","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24711","ERX","HCPCS 63700001","68180-0518-02","LISINOPRIL-HCTZ 10-12.5 MG TABLET","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24914","ERX","HCPCS 63700001","00781-2102-01","TACROLIMUS 0.5 MG PO CAPS","BOTH IP/OP","$9.35 ","$6.92 ","$0.00 ","$8.48 ","","$1.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.48 ","$0.00 ","$4.24 ","$6.72 ","$6.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24914","ERX","HCPCS 63700001","16729-0041-01","TACROLIMUS 0.5 MG PO CAPS","BOTH IP/OP","$9.35 ","$6.92 ","$0.00 ","$8.48 ","","$1.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.48 ","$0.00 ","$4.24 ","$6.72 ","$6.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24914","ERX","HCPCS 63700001","51079-0817-01","TACROLIMUS 0.5 MG PO CAPS","BOTH IP/OP","$9.35 ","$6.92 ","$0.00 ","$8.48 ","","$1.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.48 ","$0.00 ","$4.24 ","$6.72 ","$6.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24914","ERX","HCPCS 63700001","51079-0817-20","TACROLIMUS 0.5 MG PO CAPS","BOTH IP/OP","$9.35 ","$6.92 ","$0.00 ","$8.48 ","","$1.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.48 ","$0.00 ","$4.24 ","$6.72 ","$6.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24914","ERX","HCPCS 63700001","68084-0449-01","TACROLIMUS 0.5 MG PO CAPS","BOTH IP/OP","$9.35 ","$6.92 ","$0.00 ","$8.48 ","","$1.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.48 ","$0.00 ","$4.24 ","$6.72 ","$6.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24915","ERX","HCPCS 25000001","00378-9691-52","LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","BOTH IP/OP","$8.39 ","$6.21 ","$0.00 ","$7.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$0.00 ","$3.81 ","$6.03 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24915","ERX","HCPCS 25000001","00378-9691-62","LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","BOTH IP/OP","$8.39 ","$6.21 ","$0.00 ","$7.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$0.00 ","$3.81 ","$6.03 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24915","ERX","HCPCS 25000001","43598-0410-25","LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","BOTH IP/OP","$8.39 ","$6.21 ","$0.00 ","$7.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$0.00 ","$3.81 ","$6.03 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24915","ERX","HCPCS 25000001","66993-0022-27","LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","BOTH IP/OP","$8.39 ","$6.21 ","$0.00 ","$7.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$0.00 ","$3.81 ","$6.03 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24915","ERX","HCPCS 25000001","76204-0800-01","LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","BOTH IP/OP","$8.39 ","$6.21 ","$0.00 ","$7.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$0.00 ","$3.81 ","$6.03 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24915","ERX","HCPCS 25000001","76204-0800-11","LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","BOTH IP/OP","$8.39 ","$6.21 ","$0.00 ","$7.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.61 ","$0.00 ","$3.81 ","$6.03 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24916","ERX","HCPCS J7614","43598-0409-25","LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","BOTH IP/OP","$26.98 ","$19.97 ","$0.00 ","$24.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.47 ","$0.00 ","$12.24 ","$19.38 ","$19.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24916","ERX","HCPCS J7614","76204-0900-01","LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","BOTH IP/OP","$26.98 ","$19.97 ","$0.00 ","$24.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.47 ","$0.00 ","$12.24 ","$19.38 ","$19.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24932","ERX","HCPCS J2916","00024-2792-10","NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","BOTH IP/OP","$147.30 ","$109.00 ","$0.00 ","$133.56 ","$66.29 ","$0.00 ","$27.85 ","$0.00 ","$0.00 ","$11.69 ","$133.56 ","$0.00 ","$66.78 ","$105.78 ","$106.85 ","$0.00 ","$11.69 ","$0.00 ","$11.13 ","$0.00 "
"24932","ERX","HCPCS J2916","00143-9298-01","NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","BOTH IP/OP","$147.30 ","$109.00 ","$0.00 ","$133.56 ","$66.29 ","$0.00 ","$27.85 ","$0.00 ","$0.00 ","$11.69 ","$133.56 ","$0.00 ","$66.78 ","$105.78 ","$106.85 ","$0.00 ","$11.69 ","$0.00 ","$11.13 ","$0.00 "
"24932","ERX","HCPCS J2916","00143-9298-10","NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","BOTH IP/OP","$147.30 ","$109.00 ","$0.00 ","$133.56 ","$66.29 ","$0.00 ","$27.85 ","$0.00 ","$0.00 ","$11.69 ","$133.56 ","$0.00 ","$66.78 ","$105.78 ","$106.85 ","$0.00 ","$11.69 ","$0.00 ","$11.13 ","$0.00 "
"24932","ERX","HCPCS J2916","00143-9570-10","NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","BOTH IP/OP","$147.30 ","$109.00 ","$0.00 ","$133.56 ","$66.29 ","$0.00 ","$27.85 ","$0.00 ","$0.00 ","$11.69 ","$133.56 ","$0.00 ","$66.78 ","$105.78 ","$106.85 ","$0.00 ","$11.69 ","$0.00 ","$11.13 ","$0.00 "
"24945","ERX","HCPCS 63700001","13107-0032-34","MIRTAZAPINE 45 MG PO TABS","BOTH IP/OP","$11.95 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24945","ERX","HCPCS 63700001","51079-0088-01","MIRTAZAPINE 45 MG PO TABS","BOTH IP/OP","$11.95 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24945","ERX","HCPCS 63700001","51079-0088-20","MIRTAZAPINE 45 MG PO TABS","BOTH IP/OP","$11.95 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24945","ERX","HCPCS 63700001","60505-0249-01","MIRTAZAPINE 45 MG PO TABS","BOTH IP/OP","$11.95 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24945","ERX","HCPCS 63700001","68084-0121-01","MIRTAZAPINE 45 MG PO TABS","BOTH IP/OP","$11.95 ","$8.84 ","$0.00 ","$10.83 ","","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.83 ","$0.00 ","$5.42 ","$8.58 ","$8.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25005","ERX","HCPCS J7517","00004-0261-29","MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR","BOTH IP/OP","$47.45 ","$35.11 ","$0.00 ","$43.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.54 ","$43.04 ","$0.00 ","$21.52 ","$34.09 ","$34.43 ","$0.00 ","$6.74 ","$0.00 ","$6.85 ","$0.00 "
"25005","ERX","HCPCS J7517","67877-0230-22","MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR","BOTH IP/OP","$47.45 ","$35.11 ","$0.00 ","$43.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.54 ","$43.04 ","$0.00 ","$21.52 ","$34.09 ","$34.43 ","$0.00 ","$6.74 ","$0.00 ","$6.85 ","$0.00 "
"25118","ERX","HCPCS 63700001","00143-9927-01","CIPROFLOXACIN HCL 250 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$17.23 ","","$3.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.23 ","$0.00 ","$8.62 ","$13.65 ","$13.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25118","ERX","HCPCS 63700001","16714-0651-02","CIPROFLOXACIN HCL 250 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$17.23 ","","$3.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.23 ","$0.00 ","$8.62 ","$13.65 ","$13.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25118","ERX","HCPCS 63700001","55111-0126-01","CIPROFLOXACIN HCL 250 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$17.23 ","","$3.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.23 ","$0.00 ","$8.62 ","$13.65 ","$13.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25118","ERX","HCPCS 63700001","63739-0700-10","CIPROFLOXACIN HCL 250 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$17.23 ","","$3.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.23 ","$0.00 ","$8.62 ","$13.65 ","$13.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25119","ERX","HCPCS 63700001","16714-0652-02","CIPROFLOXACIN HCL 500 MG PO TABS","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$12.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.08 ","$0.00 ","$6.04 ","$9.57 ","$9.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25119","ERX","HCPCS 63700001","63739-0559-10","CIPROFLOXACIN HCL 500 MG PO TABS","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$12.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.08 ","$0.00 ","$6.04 ","$9.57 ","$9.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25119","ERX","HCPCS 63700001","68084-0070-01","CIPROFLOXACIN HCL 500 MG PO TABS","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$12.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.08 ","$0.00 ","$6.04 ","$9.57 ","$9.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25119","ERX","HCPCS 63700001","68084-0070-11","CIPROFLOXACIN HCL 500 MG PO TABS","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$12.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.08 ","$0.00 ","$6.04 ","$9.57 ","$9.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25120","ERX","HCPCS 63700001","16571-0413-05","CIPROFLOXACIN HCL 750 MG PO TABS","BOTH IP/OP","$29.11 ","$21.54 ","$0.00 ","$29.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.11 ","$0.00 ","$14.56 ","$23.06 ","$23.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25120","ERX","HCPCS 63700001","16714-0653-01","CIPROFLOXACIN HCL 750 MG PO TABS","BOTH IP/OP","$29.11 ","$21.54 ","$0.00 ","$29.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.11 ","$0.00 ","$14.56 ","$23.06 ","$23.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25120","ERX","HCPCS 63700001","68084-0071-01","CIPROFLOXACIN HCL 750 MG PO TABS","BOTH IP/OP","$29.11 ","$21.54 ","$0.00 ","$29.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.11 ","$0.00 ","$14.56 ","$23.06 ","$23.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25174","ERX","HCPCS 25000001","00264-1965-10","HETASTARCH-NACL 6-0.9 % IV SOLN","BOTH IP/OP","$79.13 ","$58.56 ","$0.00 ","$71.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.75 ","$0.00 ","$35.88 ","$56.83 ","$57.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25238","ERX","HCPCS 63700001","00378-6320-01","VERAPAMIL HCL CR 120 MG PO CP24","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$6.64 ","","$1.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.64 ","$0.00 ","$3.32 ","$5.26 ","$5.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25238","ERX","HCPCS 63700001","00591-2880-01","VERAPAMIL HCL CR 120 MG PO CP24","BOTH IP/OP","$7.32 ","$5.42 ","$0.00 ","$6.64 ","","$1.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.64 ","$0.00 ","$3.32 ","$5.26 ","$5.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25246","ERX","HCPCS 25000001","00093-4161-73","AMOXICILLIN 400 MG/5ML PO SUSR","BOTH IP/OP","$37.24 ","$27.56 ","$0.00 ","$37.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.24 ","$0.00 ","$18.62 ","$29.49 ","$29.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25246","ERX","HCPCS 25000001","00143-9887-01","AMOXICILLIN 400 MG/5ML PO SUSR","BOTH IP/OP","$37.24 ","$27.56 ","$0.00 ","$37.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.24 ","$0.00 ","$18.62 ","$29.49 ","$29.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25246","ERX","HCPCS 25000001","00781-6157-46","AMOXICILLIN 400 MG/5ML PO SUSR","BOTH IP/OP","$37.24 ","$27.56 ","$0.00 ","$37.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.24 ","$0.00 ","$18.62 ","$29.49 ","$29.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25246","ERX","HCPCS 25000001","00143-9887-50","AMOXICILLIN 400 MG/5ML PO SUSR","BOTH IP/OP","$18.62 ","$13.78 ","$0.00 ","$37.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.24 ","$0.00 ","$18.62 ","$14.75 ","$29.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25246","ERX","HCPCS 25000001","00781-6157-52","AMOXICILLIN 400 MG/5ML PO SUSR","BOTH IP/OP","$18.62 ","$13.78 ","$0.00 ","$37.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.24 ","$0.00 ","$18.62 ","$14.75 ","$29.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25354","ERX","HCPCS 63700001","00955-1722-50","DOXERCALCIFEROL 2.5 MCG PO CAPS","BOTH IP/OP","$141.43 ","$104.66 ","$0.00 ","$141.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.43 ","$0.00 ","$70.72 ","$112.01 ","$113.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25408","ERX","HCPCS 25000001","67457-0187-50","ALLOPURINOL SODIUM 500 MG IV SOLR","BOTH IP/OP","$10,812.91 ","$8,001.55 ","$0.00 ","$9,808.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,808.17 ","$0.00 ","$4,904.09 ","$7,768.07 ","$7,846.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25471","ERX","HCPCS 25000001","24208-0601-10","KETOTIFEN FUMARATE 0.025 % OP SOLN","BOTH IP/OP","$51.08 ","$37.80 ","$0.00 ","$39.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.37 ","$0.00 ","$19.69 ","$31.18 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25471","ERX","HCPCS 25000001","17478-0717-10","KETOTIFEN FUMARATE 0.025 % OP SOLN","BOTH IP/OP","$51.08 ","$37.80 ","$0.00 ","$39.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.37 ","$0.00 ","$19.69 ","$36.69 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25471","ERX","HCPCS 25000001","49348-0107-17","KETOTIFEN FUMARATE 0.025 % OP SOLN","BOTH IP/OP","$51.08 ","$37.80 ","$0.00 ","$39.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.37 ","$0.00 ","$19.69 ","$36.69 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25518","ERX","HCPCS 25000001","63323-0011-15","CHLORAMPHENICOL SOD SUCCINATE 1 G IV SOLR","BOTH IP/OP","$180.28 ","$133.41 ","$0.00 ","$163.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.47 ","$0.00 ","$81.74 ","$129.47 ","$130.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25519","ERX","HCPCS 63700001","00904-6357-61","RISPERIDONE 0.25 MG PO TABS","BOTH IP/OP","$15.01 ","$11.11 ","$0.00 ","$13.61 ","","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.61 ","$0.00 ","$6.81 ","$10.78 ","$10.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25520","ERX","HCPCS 63700001","00904-6358-61","RISPERIDONE 0.5 MG PO TABS","BOTH IP/OP","$16.24 ","$12.02 ","$0.00 ","$16.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.24 ","$0.00 ","$8.12 ","$12.86 ","$12.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25520","ERX","HCPCS 63700001","68084-0271-01","RISPERIDONE 0.5 MG PO TABS","BOTH IP/OP","$16.24 ","$12.02 ","$0.00 ","$16.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.24 ","$0.00 ","$8.12 ","$12.86 ","$12.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25528","ERX","HCPCS 63700001","33342-0054-07","PIOGLITAZONE HCL 15 MG PO TABS","BOTH IP/OP","$65.13 ","$48.20 ","$0.00 ","$59.07 ","","$11.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.07 ","$0.00 ","$29.54 ","$46.78 ","$47.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25528","ERX","HCPCS 63700001","33342-0054-10","PIOGLITAZONE HCL 15 MG PO TABS","BOTH IP/OP","$65.13 ","$48.20 ","$0.00 ","$59.07 ","","$11.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.07 ","$0.00 ","$29.54 ","$46.78 ","$47.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25528","ERX","HCPCS 63700001","64764-0151-04","PIOGLITAZONE HCL 15 MG PO TABS","BOTH IP/OP","$65.13 ","$48.20 ","$0.00 ","$59.07 ","","$11.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.07 ","$0.00 ","$29.54 ","$46.78 ","$47.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25528","ERX","HCPCS 63700001","65862-0512-90","PIOGLITAZONE HCL 15 MG PO TABS","BOTH IP/OP","$65.13 ","$48.20 ","$0.00 ","$59.07 ","","$11.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.07 ","$0.00 ","$29.54 ","$46.78 ","$47.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25798","ERX","HCPCS 25000001","00264-9341-55","TROPHAMINE 10 % IV SOLN","BOTH IP/OP","$181.42 ","$134.25 ","$0.00 ","$148.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25820","ERX","HCPCS 63700001","00006-0032-20","IVERMECTIN 3 MG PO TABS","BOTH IP/OP","$23.40 ","$17.32 ","$0.00 ","$21.22 ","","$4.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.22 ","$0.00 ","$10.61 ","$16.81 ","$16.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25820","ERX","HCPCS 63700001","42799-0806-01","IVERMECTIN 3 MG PO TABS","BOTH IP/OP","$23.40 ","$17.32 ","$0.00 ","$21.22 ","","$4.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.22 ","$0.00 ","$10.61 ","$16.81 ","$16.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25855","ERX","HCPCS 63700001","50268-0351-15","GABAPENTIN 600 MG PO TABS","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25855","ERX","HCPCS 63700001","58657-0623-01","GABAPENTIN 600 MG PO TABS","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25855","ERX","HCPCS 63700001","63739-0560-10","GABAPENTIN 600 MG PO TABS","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25856","ERX","HCPCS 63700001","00228-2637-11","GABAPENTIN 800 MG PO TABS","BOTH IP/OP","$12.75 ","$9.44 ","$0.00 ","$11.56 ","","$2.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.56 ","$0.00 ","$5.78 ","$9.16 ","$9.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25856","ERX","HCPCS 63700001","00904-6586-61","GABAPENTIN 800 MG PO TABS","BOTH IP/OP","$12.75 ","$9.44 ","$0.00 ","$11.56 ","","$2.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.56 ","$0.00 ","$5.78 ","$9.16 ","$9.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25856","ERX","HCPCS 63700001","16714-0332-01","GABAPENTIN 800 MG PO TABS","BOTH IP/OP","$12.75 ","$9.44 ","$0.00 ","$11.56 ","","$2.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.56 ","$0.00 ","$5.78 ","$9.16 ","$9.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25856","ERX","HCPCS 63700001","16714-0332-02","GABAPENTIN 800 MG PO TABS","BOTH IP/OP","$12.75 ","$9.44 ","$0.00 ","$11.56 ","","$2.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.56 ","$0.00 ","$5.78 ","$9.16 ","$9.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25892","ERX","HCPCS J8700","00085-3004-03","TEMOZOLOMIDE 5 MG PO CAPS","BOTH IP/OP","$95.68 ","$70.80 ","$0.00 ","$95.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.68 ","$0.00 ","$47.84 ","$75.78 ","$76.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25892","ERX","HCPCS J8700","00085-3004-04","TEMOZOLOMIDE 5 MG PO CAPS","BOTH IP/OP","$95.68 ","$70.80 ","$0.00 ","$95.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.68 ","$0.00 ","$47.84 ","$75.78 ","$76.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25893","ERX","HCPCS J8700","65162-0802-51","TEMOZOLOMIDE 20 MG PO CAPS","BOTH IP/OP","$199.75 ","$147.82 ","$0.00 ","$181.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$181.33 ","$0.00 ","$90.67 ","$143.61 ","$145.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25894","ERX","HCPCS J8700","16729-0050-53","TEMOZOLOMIDE 100 MG PO CAPS","BOTH IP/OP","$840.26 ","$621.79 ","$0.00 ","$762.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$762.57 ","$0.00 ","$381.29 ","$603.96 ","$610.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25895","ERX","HCPCS J8700","65162-0806-51","TEMOZOLOMIDE 250 MG PO CAPS","BOTH IP/OP","$1,863.77 ","$1,379.19 ","$0.00 ","$1,727.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,727.04 ","$0.00 ","$863.52 ","$1,367.82 ","$1,381.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26224","ERX","HCPCS 63700001","50268-0636-15","PANTOPRAZOLE SODIUM 20 MG PO TBEC","BOTH IP/OP","$16.70 ","$12.36 ","$0.00 ","$15.15 ","","$2.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.15 ","$0.00 ","$7.58 ","$12.00 ","$12.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26224","ERX","HCPCS 63700001","65862-0559-90","PANTOPRAZOLE SODIUM 20 MG PO TBEC","BOTH IP/OP","$16.70 ","$12.36 ","$0.00 ","$15.15 ","","$2.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.15 ","$0.00 ","$7.58 ","$12.00 ","$12.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26224","ERX","HCPCS 63700001","68084-0643-01","PANTOPRAZOLE SODIUM 20 MG PO TBEC","BOTH IP/OP","$16.70 ","$12.36 ","$0.00 ","$15.15 ","","$2.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.15 ","$0.00 ","$7.58 ","$12.00 ","$12.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26224","ERX","HCPCS 63700001","68084-0643-11","PANTOPRAZOLE SODIUM 20 MG PO TBEC","BOTH IP/OP","$16.70 ","$12.36 ","$0.00 ","$15.15 ","","$2.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.15 ","$0.00 ","$7.58 ","$12.00 ","$12.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26225","ERX","HCPCS 63700001","55111-0333-90","PANTOPRAZOLE SODIUM 40 MG PO TBEC","BOTH IP/OP","$17.15 ","$12.69 ","$0.00 ","$15.55 ","","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.55 ","$0.00 ","$7.78 ","$12.32 ","$12.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26225","ERX","HCPCS 63700001","63739-0564-10","PANTOPRAZOLE SODIUM 40 MG PO TBEC","BOTH IP/OP","$17.15 ","$12.69 ","$0.00 ","$15.55 ","","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.55 ","$0.00 ","$7.78 ","$12.32 ","$12.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26225","ERX","HCPCS 63700001","66993-0068-80","PANTOPRAZOLE SODIUM 40 MG PO TBEC","BOTH IP/OP","$17.15 ","$12.69 ","$0.00 ","$15.55 ","","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.55 ","$0.00 ","$7.78 ","$12.32 ","$12.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26225","ERX","HCPCS 63700001","68084-0813-09","PANTOPRAZOLE SODIUM 40 MG PO TBEC","BOTH IP/OP","$17.15 ","$12.69 ","$0.00 ","$15.55 ","","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.55 ","$0.00 ","$7.78 ","$12.32 ","$12.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","00008-0923-55","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","00008-0923-60","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","00143-9284-10","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","00143-9300-01","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","00143-9300-10","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","55150-0202-00","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26226","ERX","HCPCS 25000001","55150-0202-10","PANTOPRAZOLE SODIUM 40 MG IV SOLR","BOTH IP/OP","$25.52 ","$18.88 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26335","ERX","HCPCS J2770","61570-0260-01","QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR","BOTH IP/OP","$1,448.36 ","$1,071.79 ","$0.00 ","$1,278.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,278.20 ","$0.00 ","$639.10 ","$1,012.33 ","$1,022.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26335","ERX","HCPCS J2770","61570-0260-10","QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR","BOTH IP/OP","$1,448.36 ","$1,071.79 ","$0.00 ","$1,278.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,278.20 ","$0.00 ","$639.10 ","$1,012.33 ","$1,022.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26336","ERX","HCPCS J7520","00008-1030-06","SIROLIMUS 1 MG/ML PO SOLN","BOTH IP/OP","$5,122.16 ","$3,790.40 ","$0.00 ","$4,445.22 ","$2,304.97 ","$0.00 ","$1,067.59 ","$0.00 ","$0.00 ","$0.00 ","$4,445.22 ","$0.00 ","$2,222.61 ","$3,520.61 ","$3,556.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26371","ERX","HCPCS 63700001","51079-0923-01","CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR","BOTH IP/OP","$7.30 ","$5.40 ","$0.00 ","$6.62 ","","$1.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.62 ","$0.00 ","$3.31 ","$5.24 ","$5.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26371","ERX","HCPCS 63700001","51079-0923-20","CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR","BOTH IP/OP","$7.30 ","$5.40 ","$0.00 ","$6.62 ","","$1.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.62 ","$0.00 ","$3.31 ","$5.24 ","$5.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26371","ERX","HCPCS 63700001","68084-0282-01","CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR","BOTH IP/OP","$7.30 ","$5.40 ","$0.00 ","$6.62 ","","$1.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.62 ","$0.00 ","$3.31 ","$5.24 ","$5.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26429","ERX","HCPCS 63700001","00378-5504-01","ROPINIROLE HCL 4 MG PO TABS","BOTH IP/OP","$10.88 ","$8.05 ","$0.00 ","$9.87 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.87 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26429","ERX","HCPCS 63700001","43547-0273-10","ROPINIROLE HCL 4 MG PO TABS","BOTH IP/OP","$10.88 ","$8.05 ","$0.00 ","$9.87 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.87 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26429","ERX","HCPCS 63700001","68462-0258-01","ROPINIROLE HCL 4 MG PO TABS","BOTH IP/OP","$10.88 ","$8.05 ","$0.00 ","$9.87 ","","$1.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.87 ","$0.00 ","$4.94 ","$7.82 ","$7.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26546","ERX","HCPCS 63700001","16714-0819-01","OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","BOTH IP/OP","$64.77 ","$47.93 ","$0.00 ","$58.74 ","","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.74 ","$0.00 ","$29.37 ","$46.52 ","$46.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26546","ERX","HCPCS 63700001","33342-0258-66","OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","BOTH IP/OP","$64.77 ","$47.93 ","$0.00 ","$58.74 ","","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.74 ","$0.00 ","$29.37 ","$46.52 ","$46.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26546","ERX","HCPCS 63700001","42291-0664-10","OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","BOTH IP/OP","$64.77 ","$47.93 ","$0.00 ","$58.74 ","","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.74 ","$0.00 ","$29.37 ","$46.52 ","$46.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26546","ERX","HCPCS 63700001","47781-0470-13","OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","BOTH IP/OP","$64.77 ","$47.93 ","$0.00 ","$58.74 ","","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.74 ","$0.00 ","$29.37 ","$46.52 ","$46.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26546","ERX","HCPCS 63700001","64380-0799-01","OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","BOTH IP/OP","$64.77 ","$47.93 ","$0.00 ","$58.74 ","","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.74 ","$0.00 ","$29.37 ","$46.52 ","$46.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26546","ERX","HCPCS 63700001","70710-1010-02","OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","BOTH IP/OP","$64.77 ","$47.93 ","$0.00 ","$58.74 ","","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.74 ","$0.00 ","$29.37 ","$46.52 ","$46.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26547","ERX","HCPCS 63700001","33342-0260-11","ENTACAPONE 200 MG PO TABS","BOTH IP/OP","$16.56 ","$12.25 ","$0.00 ","$15.01 ","","$2.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.01 ","$0.00 ","$7.51 ","$11.89 ","$12.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26547","ERX","HCPCS 63700001","64679-0781-02","ENTACAPONE 200 MG PO TABS","BOTH IP/OP","$16.56 ","$12.25 ","$0.00 ","$15.01 ","","$2.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.01 ","$0.00 ","$7.51 ","$11.89 ","$12.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26551","ERX","HCPCS 63700001","00009-7663-04","EXEMESTANE 25 MG PO TABS","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$70.81 ","","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.81 ","$0.00 ","$35.41 ","$56.08 ","$56.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26551","ERX","HCPCS 63700001","00054-0080-13","EXEMESTANE 25 MG PO TABS","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$70.81 ","","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.81 ","$0.00 ","$35.41 ","$56.08 ","$56.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26551","ERX","HCPCS 63700001","00832-0595-30","EXEMESTANE 25 MG PO TABS","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$70.81 ","","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.81 ","$0.00 ","$35.41 ","$56.08 ","$56.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26551","ERX","HCPCS 63700001","47781-0108-30","EXEMESTANE 25 MG PO TABS","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$70.81 ","","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.81 ","$0.00 ","$35.41 ","$56.08 ","$56.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26688","ERX","HCPCS 63700001","60258-0161-01","RENA-VITE RX 1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26816","ERX","HCPCS 63700001","00904-6051-61","LEVETIRACETAM 250 MG PO TABS","BOTH IP/OP","$10.93 ","$8.09 ","$0.00 ","$10.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.93 ","$0.00 ","$5.47 ","$8.66 ","$8.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26816","ERX","HCPCS 63700001","68084-0859-01","LEVETIRACETAM 250 MG PO TABS","BOTH IP/OP","$10.93 ","$8.09 ","$0.00 ","$10.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.93 ","$0.00 ","$5.47 ","$8.66 ","$8.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26816","ERX","HCPCS 63700001","68180-0112-16","LEVETIRACETAM 250 MG PO TABS","BOTH IP/OP","$10.93 ","$8.09 ","$0.00 ","$10.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.93 ","$0.00 ","$5.47 ","$8.66 ","$8.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","00904-6052-61","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","16714-0355-01","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","16714-0355-02","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","50268-0473-11","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","50268-0473-15","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","51079-0821-01","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","51079-0821-20","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","63739-0411-10","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26817","ERX","HCPCS 63700001","68084-0870-01","LEVETIRACETAM 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","00378-5617-78","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","00904-6053-61","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","16714-0356-01","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","50268-0474-11","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","50474-0596-40","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","63739-0787-10","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","68084-0882-01","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26818","ERX","HCPCS 63700001","68084-0882-11","LEVETIRACETAM 750 MG PO TABS","BOTH IP/OP","$19.95 ","$14.76 ","$0.00 ","$18.10 ","","$3.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.10 ","$0.00 ","$9.05 ","$14.34 ","$14.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26854","ERX","HCPCS 63700001","51991-0943-33","MOXIFLOXACIN HCL 400 MG PO TABS","BOTH IP/OP","$105.09 ","$77.77 ","$0.00 ","$95.29 ","","$18.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.29 ","$0.00 ","$47.65 ","$75.47 ","$76.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26854","ERX","HCPCS 63700001","65862-0603-30","MOXIFLOXACIN HCL 400 MG PO TABS","BOTH IP/OP","$105.09 ","$77.77 ","$0.00 ","$95.29 ","","$18.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.29 ","$0.00 ","$47.65 ","$75.47 ","$76.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26950","ERX","HCPCS 63700001","51285-0063-90","ESTRADIOL-NORGESTIMATE 1/1-0.09 MG (15/15) PO TABS","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$22.76 ","","$5.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.76 ","$0.00 ","$11.38 ","$18.03 ","$18.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26952","ERX","HCPCS 63700001","00904-6286-06","OLANZAPINE 15 MG PO TABS","BOTH IP/OP","$115.31 ","$85.33 ","$0.00 ","$104.56 ","","$20.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$104.56 ","$0.00 ","$52.28 ","$82.81 ","$83.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26952","ERX","HCPCS 63700001","55111-0167-30","OLANZAPINE 15 MG PO TABS","BOTH IP/OP","$115.31 ","$85.33 ","$0.00 ","$104.56 ","","$20.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$104.56 ","$0.00 ","$52.28 ","$82.81 ","$83.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26952","ERX","HCPCS 63700001","68084-0528-01","OLANZAPINE 15 MG PO TABS","BOTH IP/OP","$115.31 ","$85.33 ","$0.00 ","$104.56 ","","$20.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$104.56 ","$0.00 ","$52.28 ","$82.81 ","$83.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26965","ERX","HCPCS 63700001","00069-5800-43","DOFETILIDE 125 MCG PO CAPS","BOTH IP/OP","$54.62 ","$40.42 ","$0.00 ","$47.40 ","","$9.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.40 ","$0.00 ","$23.70 ","$37.54 ","$37.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26965","ERX","HCPCS 63700001","00069-5800-60","DOFETILIDE 125 MCG PO CAPS","BOTH IP/OP","$54.62 ","$40.42 ","$0.00 ","$47.40 ","","$9.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.40 ","$0.00 ","$23.70 ","$37.54 ","$37.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26965","ERX","HCPCS 63700001","42291-0411-60","DOFETILIDE 125 MCG PO CAPS","BOTH IP/OP","$54.62 ","$40.42 ","$0.00 ","$47.40 ","","$9.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.40 ","$0.00 ","$23.70 ","$37.54 ","$37.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26965","ERX","HCPCS 63700001","51862-0125-60","DOFETILIDE 125 MCG PO CAPS","BOTH IP/OP","$54.62 ","$40.42 ","$0.00 ","$47.40 ","","$9.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.40 ","$0.00 ","$23.70 ","$37.54 ","$37.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26965","ERX","HCPCS 63700001","69452-0131-17","DOFETILIDE 125 MCG PO CAPS","BOTH IP/OP","$54.62 ","$40.42 ","$0.00 ","$47.40 ","","$9.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.40 ","$0.00 ","$23.70 ","$37.54 ","$37.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26966","ERX","HCPCS 63700001","00069-5810-60","DOFETILIDE 250 MCG PO CAPS","BOTH IP/OP","$32.54 ","$24.08 ","$0.00 ","$32.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.54 ","$0.00 ","$16.27 ","$25.77 ","$26.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26966","ERX","HCPCS 63700001","59762-0038-02","DOFETILIDE 250 MCG PO CAPS","BOTH IP/OP","$32.54 ","$24.08 ","$0.00 ","$32.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.54 ","$0.00 ","$16.27 ","$25.77 ","$26.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26967","ERX","HCPCS 25000001","00069-5820-43","DOFETILIDE 500 MCG PO CAPS","BOTH IP/OP","$35.85 ","$26.53 ","$0.00 ","$32.51 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.51 ","$0.00 ","$16.26 ","$25.75 ","$26.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26967","ERX","HCPCS 25000001","00069-5820-60","DOFETILIDE 500 MCG PO CAPS","BOTH IP/OP","$35.85 ","$26.53 ","$0.00 ","$32.51 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.51 ","$0.00 ","$16.26 ","$25.75 ","$26.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26967","ERX","HCPCS 25000001","51862-0005-60","DOFETILIDE 500 MCG PO CAPS","BOTH IP/OP","$35.85 ","$26.53 ","$0.00 ","$32.51 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.51 ","$0.00 ","$16.26 ","$25.75 ","$26.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27022","ERX","HCPCS 25000001","00045-0646-12","BUDESONIDE 32 MCG/ACT NA SUSP","BOTH IP/OP","$72.59 ","$53.72 ","$0.00 ","$72.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.59 ","$0.00 ","$36.30 ","$57.49 ","$58.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27023","ERX","HCPCS 63700001","51672-2080-02","TERBINAFINE HCL 1 % EX CREA","BOTH IP/OP","$90.09 ","$66.67 ","$0.00 ","$71.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.61 ","$0.00 ","$16.31 ","$71.35 ","$26.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27023","ERX","HCPCS 63700001","51672-2080-01","TERBINAFINE HCL 1 % EX CREA","BOTH IP/OP","$65.21 ","$48.26 ","$0.00 ","$51.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.61 ","$0.00 ","$16.31 ","$51.65 ","$26.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27023","ERX","HCPCS 63700001","00067-8100-12","TERBINAFINE HCL 1 % EX CREA","BOTH IP/OP","$32.61 ","$24.13 ","$0.00 ","$32.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.61 ","$0.00 ","$16.31 ","$25.83 ","$26.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27027","ERX","HCPCS 63700001","00187-5526-75","BEXAROTENE 75 MG PO CAPS","BOTH IP/OP","$871.61 ","$644.99 ","$0.00 ","$791.02 ","","$155.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$791.02 ","$0.00 ","$395.51 ","$626.49 ","$632.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27032","ERX","HCPCS J7674","64281-0100-00","METHACHOLINE CHLORIDE 100 MG IN SOLR","BOTH IP/OP","$324.80 ","$240.35 ","$0.00 ","$283.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$283.50 ","$0.00 ","$141.75 ","$224.53 ","$226.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27032","ERX","HCPCS J7674","64281-0100-06","METHACHOLINE CHLORIDE 100 MG IN SOLR","BOTH IP/OP","$324.80 ","$240.35 ","$0.00 ","$283.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$283.50 ","$0.00 ","$141.75 ","$224.53 ","$226.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27049","ERX","HCPCS 63700001","62756-0183-88","OXCARBAZEPINE 150 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27049","ERX","HCPCS 63700001","68084-0845-01","OXCARBAZEPINE 150 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27099","ERX","HCPCS 25000001","00574-0121-08","CHARCOAL ACTIVATED PO LIQD","BOTH IP/OP","$156.57 ","$115.86 ","$0.00 ","$141.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.96 ","$0.00 ","$70.98 ","$112.43 ","$113.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27099","ERX","HCPCS 25000001","00574-0121-74","CHARCOAL ACTIVATED PO LIQD","BOTH IP/OP","$156.57 ","$115.86 ","$0.00 ","$141.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.96 ","$0.00 ","$70.98 ","$112.43 ","$113.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27099","ERX","HCPCS 25000001","00574-0121-76","CHARCOAL ACTIVATED PO LIQD","BOTH IP/OP","$156.57 ","$115.86 ","$0.00 ","$141.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.96 ","$0.00 ","$70.98 ","$112.43 ","$113.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27099","ERX","HCPCS 25000001","66689-0201-08","CHARCOAL ACTIVATED PO LIQD","BOTH IP/OP","$156.57 ","$115.86 ","$0.00 ","$141.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.96 ","$0.00 ","$70.98 ","$112.43 ","$113.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27099","ERX","HCPCS 25000001","66689-0202-04","CHARCOAL ACTIVATED PO LIQD","BOTH IP/OP","$156.57 ","$115.86 ","$0.00 ","$141.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.96 ","$0.00 ","$70.98 ","$112.43 ","$113.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27099","ERX","HCPCS 25000001","66689-0202-08","CHARCOAL ACTIVATED PO LIQD","BOTH IP/OP","$156.57 ","$115.86 ","$0.00 ","$141.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.96 ","$0.00 ","$70.98 ","$112.43 ","$113.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27112","ERX","HCPCS 63700001","00093-3099-56","RISEDRONATE SODIUM 5 MG PO TABS","BOTH IP/OP","$37.11 ","$27.46 ","$0.00 ","$33.66 ","","$6.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.66 ","$0.00 ","$16.83 ","$26.66 ","$26.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27181","ERX","HCPCS 63700001","62175-0320-46","NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR","BOTH IP/OP","$21.86 ","$16.18 ","$0.00 ","$19.83 ","","$3.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.83 ","$0.00 ","$9.92 ","$15.71 ","$15.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27181","ERX","HCPCS 63700001","65162-0321-09","NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR","BOTH IP/OP","$21.86 ","$16.18 ","$0.00 ","$19.83 ","","$3.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.83 ","$0.00 ","$9.92 ","$15.71 ","$15.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27182","ERX","HCPCS 63700001","47335-0614-81","NIACIN ER (ANTIHYPERLIPIDEMIC) 750 MG PO TBCR","BOTH IP/OP","$25.30 ","$18.72 ","$0.00 ","$22.95 ","","$4.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.95 ","$0.00 ","$11.48 ","$18.18 ","$18.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27183","ERX","HCPCS 63700001","47335-0613-81","NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR","BOTH IP/OP","$31.37 ","$23.21 ","$0.00 ","$41.69 ","","$5.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.69 ","$0.00 ","$20.85 ","$33.02 ","$33.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27183","ERX","HCPCS 63700001","65162-0323-09","NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR","BOTH IP/OP","$31.37 ","$23.21 ","$0.00 ","$41.69 ","","$5.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.69 ","$0.00 ","$20.85 ","$33.02 ","$33.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27234","ERX","HCPCS 63700001","00781-5554-31","MONTELUKAST SODIUM 4 MG PO CHEW","BOTH IP/OP","$23.71 ","$17.55 ","$0.00 ","$21.50 ","","$4.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.50 ","$0.00 ","$10.75 ","$17.03 ","$17.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27234","ERX","HCPCS 63700001","27241-0016-03","MONTELUKAST SODIUM 4 MG PO CHEW","BOTH IP/OP","$23.71 ","$17.55 ","$0.00 ","$21.50 ","","$4.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.50 ","$0.00 ","$10.75 ","$17.03 ","$17.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27234","ERX","HCPCS 63700001","42291-0622-90","MONTELUKAST SODIUM 4 MG PO CHEW","BOTH IP/OP","$23.71 ","$17.55 ","$0.00 ","$21.50 ","","$4.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.50 ","$0.00 ","$10.75 ","$17.03 ","$17.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27278","ERX","HCPCS 63700001","13668-0106-01","ISOSORBIDE MONONITRATE ER 120 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27278","ERX","HCPCS 63700001","62175-0129-37","ISOSORBIDE MONONITRATE ER 120 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27291","ERX","HCPCS J0713","00409-5093-11","CEFTAZIDIME 2 G IV SOLR","BOTH IP/OP","$24.02 ","$17.77 ","$0.00 ","$27.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.76 ","$27.17 ","$0.00 ","$13.59 ","$21.52 ","$21.74 ","$0.00 ","$4.25 ","$0.00 ","$4.33 ","$0.00 "
"27299","ERX","HCPCS J0697","00143-9977-22","CEFUROXIME SODIUM 1.5 G IV SOLR","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$26.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.66 ","$0.00 ","$13.33 ","$21.11 ","$21.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27314","ERX","HCPCS J2941","00013-2626-81","SOMATROPIN (ZOMACTON) 5 MG SC SOLR","BOTH IP/OP","$1,016.16 ","$751.96 ","$0.00 ","$922.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$922.20 ","$0.00 ","$461.10 ","$730.38 ","$737.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27314","ERX","HCPCS J2941","55566-1801-01","SOMATROPIN (ZOMACTON) 5 MG SC SOLR","BOTH IP/OP","$1,016.16 ","$751.96 ","$0.00 ","$922.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$922.20 ","$0.00 ","$461.10 ","$730.38 ","$737.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27325","ERX","HCPCS 90744","58160-0820-52","HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSP","BOTH IP/OP","$103.93 ","$76.91 ","$0.00 ","$103.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.20 ","$103.93 ","$0.00 ","$51.97 ","$82.31 ","$83.14 ","$62.36 ","$16.27 ","$27.02 ","$0.00 ","$27.02 "
"27326","ERX","HCPCS 90746","58160-0821-11","HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP","BOTH IP/OP","$233.36 ","$172.69 ","$0.00 ","$233.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.80 ","$233.36 ","$0.00 ","$116.68 ","$184.82 ","$186.69 ","$140.02 ","$78.80 ","$60.67 ","$75.03 ","$60.67 "
"27326","ERX","HCPCS 90746","58160-0821-43","HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP","BOTH IP/OP","$233.36 ","$172.69 ","$0.00 ","$233.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.80 ","$233.36 ","$0.00 ","$116.68 ","$184.82 ","$186.69 ","$140.02 ","$78.80 ","$60.67 ","$75.03 ","$60.67 "
"27326","ERX","HCPCS 90746","58160-0821-52","HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP","BOTH IP/OP","$233.36 ","$172.69 ","$0.00 ","$233.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.80 ","$233.36 ","$0.00 ","$116.68 ","$184.82 ","$186.69 ","$140.02 ","$78.80 ","$60.67 ","$75.03 ","$60.67 "
"27386","ERX","HCPCS 25000001","63323-0254-10","MINERAL OIL LIGHT OIL","BOTH IP/OP","$76.64 ","$56.71 ","$0.00 ","$63.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.46 ","$0.00 ","$31.73 ","$50.26 ","$50.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27393","ERX","HCPCS 63600001","00409-1134-03","MORPHINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$126.42 ","$93.55 ","$0.00 ","$57.76 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.76 ","$0.00 ","$28.88 ","$45.75 ","$46.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27393","ERX","HCPCS 63600001","00409-1134-05","MORPHINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$126.42 ","$93.55 ","$0.00 ","$89.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.76 ","$0.00 ","$28.88 ","$89.54 ","$46.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27430","ERX","HCPCS 25000001","13925-0515-10","PENTAMIDINE ISETHIONATE 300 MG IJ SOLR","BOTH IP/OP","$584.79 ","$432.74 ","$0.00 ","$530.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.72 ","$0.00 ","$265.36 ","$420.33 ","$424.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27430","ERX","HCPCS 25000001","63323-0113-10","PENTAMIDINE ISETHIONATE 300 MG IJ SOLR","BOTH IP/OP","$584.79 ","$432.74 ","$0.00 ","$530.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.72 ","$0.00 ","$265.36 ","$420.33 ","$424.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27431","ERX","HCPCS Q2050","43598-0283-35","DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ","BOTH IP/OP","$2,408.70 ","$1,782.44 ","$0.00 ","$2,383.74 ","$1,083.92 ","$401.03 ","$502.03 ","$0.00 ","$0.00 ","$694.47 ","$2,383.74 ","$745.65 ","$1,191.87 ","$1,887.92 ","$1,906.99 ","$1,029.70 ","$694.47 ","$0.00 ","$661.26 ","$635.41 "
"27431","ERX","HCPCS Q2050","47335-0049-40","DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ","BOTH IP/OP","$2,408.70 ","$1,782.44 ","$0.00 ","$2,383.74 ","$1,083.92 ","$401.03 ","$502.03 ","$0.00 ","$0.00 ","$694.47 ","$2,383.74 ","$745.65 ","$1,191.87 ","$1,887.92 ","$1,906.99 ","$1,029.70 ","$694.47 ","$0.00 ","$661.26 ","$635.41 "
"27459","ERX","HCPCS 63700001","00378-4642-26","ESTRADIOL 0.05 MG/24HR TD PTTW","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$43.08 ","","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.08 ","$0.00 ","$21.54 ","$34.12 ","$34.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27461","ERX","HCPCS 25000001","00378-4640-16","ESTRADIOL 0.1 MG/24HR TD PTTW","BOTH IP/OP","$67.23 ","$49.75 ","$0.00 ","$67.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.23 ","$0.00 ","$33.62 ","$53.25 ","$53.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27461","ERX","HCPCS 25000001","00378-4640-26","ESTRADIOL 0.1 MG/24HR TD PTTW","BOTH IP/OP","$67.23 ","$49.75 ","$0.00 ","$67.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.23 ","$0.00 ","$33.62 ","$53.25 ","$53.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27471","ERX","HCPCS 25000001","","NITROGLYCERIN 0.1 MG/HR TD PT24","BOTH IP/OP","$7.79 ","$5.76 ","$0.00 ","$7.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27471","ERX","HCPCS 25000001","00378-9102-93","NITROGLYCERIN 0.1 MG/HR TD PT24","BOTH IP/OP","$7.79 ","$5.76 ","$0.00 ","$7.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27471","ERX","HCPCS 25000001","47781-0296-03","NITROGLYCERIN 0.1 MG/HR TD PT24","BOTH IP/OP","$7.79 ","$5.76 ","$0.00 ","$7.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27472","ERX","HCPCS 25000001","00378-9104-93","NITROGLYCERIN 0.2 MG/HR TD PT24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27473","ERX","HCPCS 25000001","50742-0515-30","NITROGLYCERIN 0.3 MG/HR TD PT24","BOTH IP/OP","$181.82 ","$134.55 ","$0.00 ","$131.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.89 ","$0.00 ","$65.95 ","$104.46 ","$105.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27474","ERX","HCPCS 25000001","","NITROGLYCERIN 0.4 MG/HR TD PT24","BOTH IP/OP","$7.74 ","$5.73 ","$0.00 ","$7.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.02 ","$0.00 ","$3.51 ","$5.56 ","$5.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27474","ERX","HCPCS 25000001","00378-9112-93","NITROGLYCERIN 0.4 MG/HR TD PT24","BOTH IP/OP","$7.74 ","$5.73 ","$0.00 ","$7.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.02 ","$0.00 ","$3.51 ","$5.56 ","$5.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27474","ERX","HCPCS 25000001","47781-0298-03","NITROGLYCERIN 0.4 MG/HR TD PT24","BOTH IP/OP","$7.74 ","$5.73 ","$0.00 ","$7.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.02 ","$0.00 ","$3.51 ","$5.56 ","$5.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27475","ERX","HCPCS 25000001","","NITROGLYCERIN 0.6 MG/HR TD PT24","BOTH IP/OP","$10.04 ","$7.43 ","$0.00 ","$9.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.11 ","$0.00 ","$4.56 ","$7.22 ","$7.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27475","ERX","HCPCS 25000001","00378-9116-93","NITROGLYCERIN 0.6 MG/HR TD PT24","BOTH IP/OP","$10.04 ","$7.43 ","$0.00 ","$9.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.11 ","$0.00 ","$4.56 ","$7.22 ","$7.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27489","ERX","HCPCS 63700001","53489-0368-01","FELODIPINE ER 2.5 MG PO TB24","BOTH IP/OP","$6.34 ","$4.69 ","$0.00 ","$6.00 ","","$1.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27490","ERX","HCPCS 63700001","00603-3582-21","FELODIPINE ER 5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27490","ERX","HCPCS 63700001","53489-0369-01","FELODIPINE ER 5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27491","ERX","HCPCS 63700001","53489-0370-01","FELODIPINE ER 10 MG PO TB24","BOTH IP/OP","$10.32 ","$7.64 ","$0.00 ","$10.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.32 ","$0.00 ","$5.16 ","$8.17 ","$8.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27494","ERX","HCPCS 63700001","00378-2223-01","NISOLDIPINE ER 30 MG PO TB24","BOTH IP/OP","$75.18 ","$55.63 ","$0.00 ","$68.18 ","","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.18 ","$0.00 ","$34.09 ","$54.00 ","$54.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27495","ERX","HCPCS 63700001","00378-2224-01","NISOLDIPINE ER 40 MG PO TB24","BOTH IP/OP","$75.18 ","$55.63 ","$0.00 ","$68.18 ","","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.18 ","$0.00 ","$34.09 ","$54.00 ","$54.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27520","ERX","HCPCS 63700001","00573-2660-12","LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27520","ERX","HCPCS 63700001","00573-2660-24","LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27529","ERX","HCPCS 63700001","63824-0057-18","PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27529","ERX","HCPCS 63700001","63824-0057-36","PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27631","ERX","HCPCS 63700001","68084-0313-01","DIVALPROEX SODIUM 125 MG PO CSDR","BOTH IP/OP","$8.20 ","$6.07 ","$0.00 ","$8.20 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.20 ","$0.00 ","$4.10 ","$6.49 ","$6.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27631","ERX","HCPCS 63700001","68084-0313-11","DIVALPROEX SODIUM 125 MG PO CSDR","BOTH IP/OP","$8.20 ","$6.07 ","$0.00 ","$8.20 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.20 ","$0.00 ","$4.10 ","$6.49 ","$6.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27632","ERX","HCPCS 63700001","54092-0172-12","CARBAMAZEPINE ER 200 MG PO CP12","BOTH IP/OP","$8.92 ","$6.60 ","$0.00 ","$8.09 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.09 ","$0.00 ","$4.05 ","$6.41 ","$6.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27633","ERX","HCPCS 63700001","54092-0173-12","CARBAMAZEPINE ER 300 MG PO CP12","BOTH IP/OP","$8.92 ","$6.60 ","$0.00 ","$8.09 ","","$1.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.09 ","$0.00 ","$4.05 ","$6.41 ","$6.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27634","ERX","HCPCS 63700001","00078-0510-05","CARBAMAZEPINE ER 100 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27634","ERX","HCPCS 63700001","00781-8016-01","CARBAMAZEPINE ER 100 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27635","ERX","HCPCS 63700001","00078-0511-05","CARBAMAZEPINE ER 200 MG PO TB12","BOTH IP/OP","$8.72 ","$6.45 ","$0.00 ","$7.91 ","","$1.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.91 ","$0.00 ","$3.96 ","$6.26 ","$6.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27635","ERX","HCPCS 63700001","00781-5987-01","CARBAMAZEPINE ER 200 MG PO TB12","BOTH IP/OP","$8.72 ","$6.45 ","$0.00 ","$7.91 ","","$1.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.91 ","$0.00 ","$3.96 ","$6.26 ","$6.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27635","ERX","HCPCS 63700001","51672-4124-01","CARBAMAZEPINE ER 200 MG PO TB12","BOTH IP/OP","$8.72 ","$6.45 ","$0.00 ","$7.91 ","","$1.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.91 ","$0.00 ","$3.96 ","$6.26 ","$6.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27636","ERX","HCPCS 63700001","00078-0512-05","CARBAMAZEPINE ER 400 MG PO TB12","BOTH IP/OP","$27.21 ","$20.14 ","$0.00 ","$24.67 ","","$4.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.67 ","$0.00 ","$12.34 ","$19.54 ","$19.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27636","ERX","HCPCS 63700001","00781-5988-01","CARBAMAZEPINE ER 400 MG PO TB12","BOTH IP/OP","$27.21 ","$20.14 ","$0.00 ","$24.67 ","","$4.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.67 ","$0.00 ","$12.34 ","$19.54 ","$19.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27636","ERX","HCPCS 63700001","51672-4125-01","CARBAMAZEPINE ER 400 MG PO TB12","BOTH IP/OP","$27.21 ","$20.14 ","$0.00 ","$24.67 ","","$4.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.67 ","$0.00 ","$12.34 ","$19.54 ","$19.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27641","ERX","HCPCS 63700001","00093-7335-06","TOPIRAMATE 15 MG PO CPSP","BOTH IP/OP","$29.96 ","$22.17 ","$0.00 ","$26.64 ","","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.64 ","$0.00 ","$13.32 ","$21.10 ","$21.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27641","ERX","HCPCS 63700001","50458-0647-65","TOPIRAMATE 15 MG PO CPSP","BOTH IP/OP","$29.96 ","$22.17 ","$0.00 ","$26.64 ","","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.64 ","$0.00 ","$13.32 ","$21.10 ","$21.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27641","ERX","HCPCS 63700001","68382-0004-14","TOPIRAMATE 15 MG PO CPSP","BOTH IP/OP","$29.96 ","$22.17 ","$0.00 ","$26.64 ","","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.64 ","$0.00 ","$13.32 ","$21.10 ","$21.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27642","ERX","HCPCS 63700001","00093-7336-06","TOPIRAMATE 25 MG PO CPSP","BOTH IP/OP","$12.26 ","$9.07 ","$0.00 ","$11.12 ","","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.12 ","$0.00 ","$5.56 ","$8.81 ","$8.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27642","ERX","HCPCS 63700001","50458-0645-65","TOPIRAMATE 25 MG PO CPSP","BOTH IP/OP","$12.26 ","$9.07 ","$0.00 ","$11.12 ","","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.12 ","$0.00 ","$5.56 ","$8.81 ","$8.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27642","ERX","HCPCS 63700001","68382-0005-14","TOPIRAMATE 25 MG PO CPSP","BOTH IP/OP","$12.26 ","$9.07 ","$0.00 ","$11.12 ","","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.12 ","$0.00 ","$5.56 ","$8.81 ","$8.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27644","ERX","HCPCS 25000001","65162-0596-06","ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12","BOTH IP/OP","$35.01 ","$25.91 ","$0.00 ","$31.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.75 ","$0.00 ","$15.88 ","$25.15 ","$25.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27659","ERX","HCPCS 63700001","62175-0261-37","NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27659","ERX","HCPCS 63700001","71205-0964-00","NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27661","ERX","HCPCS 25000001","49938-0107-04","AMINOSALICYLIC ACID 4 G PO PACK","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$30.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.40 ","$0.00 ","$15.20 ","$24.08 ","$24.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27662","ERX","HCPCS 25000001","17478-0403-03","FLUORESCEIN SODIUM 0.6 MG OP STRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27663","ERX","HCPCS 25000001","17238-0900-11","FLUORESCEIN SODIUM 1 MG OP STRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27663","ERX","HCPCS 25000001","17238-0900-30","FLUORESCEIN SODIUM 1 MG OP STRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27663","ERX","HCPCS 25000001","17238-0900-99","FLUORESCEIN SODIUM 1 MG OP STRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27663","ERX","HCPCS 25000001","17478-0404-01","FLUORESCEIN SODIUM 1 MG OP STRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27667","ERX","HCPCS 25000001","45802-0050-03","DIBUCAINE (PERIANAL) 1 % EX OINT","BOTH IP/OP","$25.11 ","$18.58 ","$0.00 ","$22.77 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.77 ","$0.00 ","$11.39 ","$18.03 ","$18.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27691","ERX","HCPCS 63700001","00781-2147-31","LANSOPRAZOLE 15 MG PO CPDR","BOTH IP/OP","$23.75 ","$17.58 ","$0.00 ","$21.54 ","","$4.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.54 ","$0.00 ","$10.77 ","$17.06 ","$17.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27692","ERX","HCPCS 63700001","00093-7351-56","LANSOPRAZOLE 30 MG PO CPDR","BOTH IP/OP","$24.72 ","$18.29 ","$0.00 ","$22.42 ","","$4.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.42 ","$0.00 ","$11.21 ","$17.76 ","$17.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27692","ERX","HCPCS 63700001","00378-8030-93","LANSOPRAZOLE 30 MG PO CPDR","BOTH IP/OP","$24.72 ","$18.29 ","$0.00 ","$22.42 ","","$4.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.42 ","$0.00 ","$11.21 ","$17.76 ","$17.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27692","ERX","HCPCS 63700001","51079-0121-01","LANSOPRAZOLE 30 MG PO CPDR","BOTH IP/OP","$24.72 ","$18.29 ","$0.00 ","$22.42 ","","$4.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.42 ","$0.00 ","$11.21 ","$17.76 ","$17.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27694","ERX","HCPCS 63700001","16714-0747-01","OMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$16.52 ","$12.22 ","$0.00 ","$16.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.52 ","$0.00 ","$8.26 ","$13.08 ","$13.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27694","ERX","HCPCS 63700001","16714-0747-02","OMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$16.52 ","$12.22 ","$0.00 ","$16.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.52 ","$0.00 ","$8.26 ","$13.08 ","$13.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27694","ERX","HCPCS 63700001","63739-0358-10","OMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$16.52 ","$12.22 ","$0.00 ","$16.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.52 ","$0.00 ","$8.26 ","$13.08 ","$13.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27695","ERX","HCPCS 63700001","00781-2234-31","OMEPRAZOLE 40 MG PO CPDR","BOTH IP/OP","$7.72 ","$5.71 ","$0.00 ","$7.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.72 ","$0.00 ","$3.86 ","$6.11 ","$6.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27695","ERX","HCPCS 63700001","63739-0445-10","OMEPRAZOLE 40 MG PO CPDR","BOTH IP/OP","$7.72 ","$5.71 ","$0.00 ","$7.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.72 ","$0.00 ","$3.86 ","$6.11 ","$6.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27697","ERX","HCPCS Q0162","00781-5238-64","ONDANSETRON 4 MG PO TBDP","BOTH IP/OP","$78.03 ","$57.74 ","$0.00 ","$78.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.66 ","$78.03 ","$0.00 ","$39.02 ","$61.80 ","$62.42 ","$0.00 ","$0.00 ","$0.00 ","$12.42 ","$0.00 "
"27697","ERX","HCPCS Q0162","57237-0077-10","ONDANSETRON 4 MG PO TBDP","BOTH IP/OP","$78.03 ","$57.74 ","$0.00 ","$78.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.66 ","$78.03 ","$0.00 ","$39.02 ","$61.80 ","$62.42 ","$0.00 ","$0.00 ","$0.00 ","$12.42 ","$0.00 "
"27697","ERX","HCPCS Q0162","65862-0390-10","ONDANSETRON 4 MG PO TBDP","BOTH IP/OP","$78.03 ","$57.74 ","$0.00 ","$78.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.66 ","$78.03 ","$0.00 ","$39.02 ","$61.80 ","$62.42 ","$0.00 ","$0.00 ","$0.00 ","$12.42 ","$0.00 "
"27698","ERX","HCPCS Q0162","00781-5239-06","ONDANSETRON 8 MG PO TBDP","BOTH IP/OP","$129.97 ","$96.18 ","$0.00 ","$129.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.76 ","$129.97 ","$0.00 ","$64.99 ","$102.94 ","$103.98 ","$0.00 ","$0.00 ","$0.00 ","$20.69 ","$0.00 "
"27698","ERX","HCPCS Q0162","65862-0391-10","ONDANSETRON 8 MG PO TBDP","BOTH IP/OP","$129.97 ","$96.18 ","$0.00 ","$129.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.76 ","$129.97 ","$0.00 ","$64.99 ","$102.94 ","$103.98 ","$0.00 ","$0.00 ","$0.00 ","$20.69 ","$0.00 "
"27735","ERX","HCPCS Q9958","00270-0149-57","DIATRIZOATE MEGLUMINE 30 % UR SOLN","BOTH IP/OP","$230.07 ","$170.25 ","$0.00 ","$208.85 ","$103.53 ","$0.00 ","$47.95 ","$0.00 ","$0.00 ","$0.00 ","$208.85 ","$0.00 ","$104.43 ","$165.41 ","$167.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27770","ERX","HCPCS 25000001","24208-0342-05","DESMOPRESSIN ACE SPRAY REFRIG 0.01 % NA SOLN","BOTH IP/OP","$719.08 ","$532.12 ","$0.00 ","$652.59 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.59 ","$0.00 ","$326.30 ","$516.85 ","$522.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27780","ERX","HCPCS 63700001","50268-0816-15","ZONISAMIDE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27780","ERX","HCPCS 63700001","60687-0230-01","ZONISAMIDE 100 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27838","ERX","HCPCS J7040","00264-7800-00","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-04","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6008-99","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6009-26","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6008-17","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00264-1800-32","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-18","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-38","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-48","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0553-18","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00990-7984-37","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6010-80","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00264-7800-20","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-02","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00990-7983-02","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6008-15","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00264-1800-31","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-11","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-31","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-41","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0553-11","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00990-7984-13","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","00338-0049-03","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6008-16","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27838","ERX","HCPCS J7040","99999-6010-79","SODIUM CHLORIDE 0.9 % IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$3.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"27855","ERX","HCPCS 25000001","00013-2150-36","ESTRADIOL 2 MG VA RING","BOTH IP/OP","$1,568.04 ","$1,160.35 ","$0.00 ","$1,369.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,369.61 ","$0.00 ","$684.81 ","$1,084.73 ","$1,095.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27857","ERX","HCPCS 63700001","00093-7384-98","VENLAFAXINE HCL ER 37.5 MG PO CP24","BOTH IP/OP","$17.45 ","$12.91 ","$0.00 ","$15.83 ","","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.83 ","$0.00 ","$7.92 ","$12.54 ","$12.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27857","ERX","HCPCS 63700001","65862-0527-30","VENLAFAXINE HCL ER 37.5 MG PO CP24","BOTH IP/OP","$17.45 ","$12.91 ","$0.00 ","$15.83 ","","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.83 ","$0.00 ","$7.92 ","$12.54 ","$12.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27857","ERX","HCPCS 63700001","68382-0034-06","VENLAFAXINE HCL ER 37.5 MG PO CP24","BOTH IP/OP","$17.45 ","$12.91 ","$0.00 ","$15.83 ","","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.83 ","$0.00 ","$7.92 ","$12.54 ","$12.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27857","ERX","HCPCS 63700001","68382-0034-16","VENLAFAXINE HCL ER 37.5 MG PO CP24","BOTH IP/OP","$17.45 ","$12.91 ","$0.00 ","$15.83 ","","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.83 ","$0.00 ","$7.92 ","$12.54 ","$12.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27858","ERX","HCPCS 63700001","00008-0833-21","VENLAFAXINE HCL ER 75 MG PO CP24","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27858","ERX","HCPCS 63700001","00093-7385-56","VENLAFAXINE HCL ER 75 MG PO CP24","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27858","ERX","HCPCS 63700001","00093-7385-98","VENLAFAXINE HCL ER 75 MG PO CP24","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27858","ERX","HCPCS 63700001","65862-0528-90","VENLAFAXINE HCL ER 75 MG PO CP24","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27859","ERX","HCPCS 63700001","00093-7386-56","VENLAFAXINE HCL ER 150 MG PO CP24","BOTH IP/OP","$21.30 ","$15.76 ","$0.00 ","$19.32 ","","$3.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.32 ","$0.00 ","$9.66 ","$15.30 ","$15.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27859","ERX","HCPCS 63700001","00093-7386-98","VENLAFAXINE HCL ER 150 MG PO CP24","BOTH IP/OP","$21.30 ","$15.76 ","$0.00 ","$19.32 ","","$3.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.32 ","$0.00 ","$9.66 ","$15.30 ","$15.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27859","ERX","HCPCS 63700001","63739-0512-10","VENLAFAXINE HCL ER 150 MG PO CP24","BOTH IP/OP","$21.30 ","$15.76 ","$0.00 ","$19.32 ","","$3.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.32 ","$0.00 ","$9.66 ","$15.30 ","$15.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27860","ERX","HCPCS 63700001","00536-1106-88","NICOTINE 7 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27860","ERX","HCPCS 63700001","70677-0030-01","NICOTINE 7 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27862","ERX","HCPCS 63700001","","NICOTINE 14 MG/24HR TD PT24","BOTH IP/OP","$8.98 ","$6.65 ","$0.00 ","$8.14 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.14 ","$0.00 ","$4.07 ","$6.45 ","$6.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27862","ERX","HCPCS 63700001","00536-5895-88","NICOTINE 14 MG/24HR TD PT24","BOTH IP/OP","$8.98 ","$6.65 ","$0.00 ","$8.14 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.14 ","$0.00 ","$4.07 ","$6.45 ","$6.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27863","ERX","HCPCS 63700001","","NICOTINE 21 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27863","ERX","HCPCS 63700001","00536-5896-71","NICOTINE 21 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27863","ERX","HCPCS 63700001","00536-5896-88","NICOTINE 21 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27863","ERX","HCPCS 63700001","43598-0448-71","NICOTINE 21 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27863","ERX","HCPCS 63700001","49348-0144-46","NICOTINE 21 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27863","ERX","HCPCS 63700001","70677-0032-01","NICOTINE 21 MG/24HR TD PT24","BOTH IP/OP","$7.93 ","$5.87 ","$0.00 ","$7.19 ","","$1.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.19 ","$0.00 ","$3.60 ","$5.69 ","$5.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27898","ERX","HCPCS 25000001","00054-3500-49","LIDOCAINE VISCOUS HCL 2 % MT SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27898","ERX","HCPCS 25000001","50383-0775-04","LIDOCAINE VISCOUS HCL 2 % MT SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27898","ERX","HCPCS 25000001","50383-0775-17","LIDOCAINE VISCOUS HCL 2 % MT SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27898","ERX","HCPCS 25000001","63739-0694-57","LIDOCAINE VISCOUS HCL 2 % MT SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27898","ERX","HCPCS 25000001","99999-6007-04","LIDOCAINE VISCOUS HCL 2 % MT SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27905","ERX","HCPCS 63700001","00378-9121-98","FENTANYL 25 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$60.42 ","$44.71 ","$0.00 ","$54.80 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.80 ","$0.00 ","$27.40 ","$43.40 ","$43.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27905","ERX","HCPCS 63700001","47781-0424-47","FENTANYL 25 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$60.42 ","$44.71 ","$0.00 ","$54.80 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.80 ","$0.00 ","$27.40 ","$43.40 ","$43.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27905","ERX","HCPCS 63700001","60505-7006-02","FENTANYL 25 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$60.42 ","$44.71 ","$0.00 ","$54.80 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.80 ","$0.00 ","$27.40 ","$43.40 ","$43.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27905","ERX","HCPCS 63700001","60505-7081-02","FENTANYL 25 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$60.42 ","$44.71 ","$0.00 ","$54.80 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.80 ","$0.00 ","$27.40 ","$43.40 ","$43.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27905","ERX","HCPCS 63700001","67767-0120-08","FENTANYL 25 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$60.42 ","$44.71 ","$0.00 ","$54.80 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.80 ","$0.00 ","$27.40 ","$43.40 ","$43.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27906","ERX","HCPCS 63700001","47781-0426-47","FENTANYL 50 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$150.09 ","$111.07 ","$0.00 ","$136.09 ","","$26.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.09 ","$0.00 ","$68.05 ","$107.78 ","$108.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27906","ERX","HCPCS 63700001","60505-7007-02","FENTANYL 50 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$150.09 ","$111.07 ","$0.00 ","$136.09 ","","$26.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.09 ","$0.00 ","$68.05 ","$107.78 ","$108.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27907","ERX","HCPCS 63700001","47781-0427-47","FENTANYL 75 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$205.80 ","$152.29 ","$0.00 ","$186.82 ","","$36.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.82 ","$0.00 ","$93.41 ","$147.96 ","$149.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27907","ERX","HCPCS 63700001","60505-7008-02","FENTANYL 75 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$205.80 ","$152.29 ","$0.00 ","$186.82 ","","$36.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.82 ","$0.00 ","$93.41 ","$147.96 ","$149.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27907","ERX","HCPCS 63700001","60505-7013-02","FENTANYL 75 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$205.80 ","$152.29 ","$0.00 ","$186.82 ","","$36.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.82 ","$0.00 ","$93.41 ","$147.96 ","$149.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27908","ERX","HCPCS 63700001","47781-0428-11","FENTANYL 100 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$273.14 ","$202.12 ","$0.00 ","$247.95 ","","$48.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.95 ","$0.00 ","$123.98 ","$196.38 ","$198.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27908","ERX","HCPCS 63700001","47781-0428-47","FENTANYL 100 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$273.14 ","$202.12 ","$0.00 ","$247.95 ","","$48.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.95 ","$0.00 ","$123.98 ","$196.38 ","$198.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27908","ERX","HCPCS 63700001","60505-7009-02","FENTANYL 100 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$273.14 ","$202.12 ","$0.00 ","$247.95 ","","$48.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.95 ","$0.00 ","$123.98 ","$196.38 ","$198.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27999","ERX","HCPCS 25000001","00574-2002-02","SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP","BOTH IP/OP","$42.87 ","$31.72 ","$0.00 ","$42.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.87 ","$0.00 ","$21.44 ","$33.95 ","$34.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27999","ERX","HCPCS 25000001","00574-2002-16","SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP","BOTH IP/OP","$42.87 ","$31.72 ","$0.00 ","$42.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.87 ","$0.00 ","$21.44 ","$33.95 ","$34.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27999","ERX","HCPCS 25000001","46287-0006-01","SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP","BOTH IP/OP","$42.87 ","$31.72 ","$0.00 ","$42.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.87 ","$0.00 ","$21.44 ","$33.95 ","$34.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27999","ERX","HCPCS 25000001","46287-0006-60","SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP","BOTH IP/OP","$42.87 ","$31.72 ","$0.00 ","$42.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.87 ","$0.00 ","$21.44 ","$33.95 ","$34.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27999","ERX","HCPCS 25000001","99999-6010-75","SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP","BOTH IP/OP","$42.87 ","$31.72 ","$0.00 ","$42.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.87 ","$0.00 ","$21.44 ","$33.95 ","$34.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28001","ERX","HCPCS 25000001","00093-9614-13","SILVER NITRATE 0.5 % EX SOLN","BOTH IP/OP","$293.15 ","$216.93 ","$0.00 ","$266.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.12 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28158","ERX","HCPCS 63700001","00904-6287-06","OLANZAPINE 20 MG PO TABS","BOTH IP/OP","$153.75 ","$113.78 ","$0.00 ","$139.41 ","","$27.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.41 ","$0.00 ","$69.71 ","$110.41 ","$111.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28158","ERX","HCPCS 63700001","55111-0168-30","OLANZAPINE 20 MG PO TABS","BOTH IP/OP","$153.75 ","$113.78 ","$0.00 ","$139.41 ","","$27.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.41 ","$0.00 ","$69.71 ","$110.41 ","$111.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28158","ERX","HCPCS 63700001","60505-3140-00","OLANZAPINE 20 MG PO TABS","BOTH IP/OP","$153.75 ","$113.78 ","$0.00 ","$139.41 ","","$27.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.41 ","$0.00 ","$69.71 ","$110.41 ","$111.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","00002-4453-01","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","00002-4453-85","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","00093-5245-65","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","13668-0086-30","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","33342-0083-07","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","49884-0320-55","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","50268-0615-11","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","50268-0615-13","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","55111-0262-81","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","60505-3275-00","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28159","ERX","HCPCS 63700001","60505-3275-03","OLANZAPINE 5 MG PO TBDP","BOTH IP/OP","$58.66 ","$43.41 ","$0.00 ","$53.20 ","","$10.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.20 ","$0.00 ","$26.60 ","$42.13 ","$42.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","00002-4454-01","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","00002-4454-85","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","13668-0088-30","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","49884-0321-55","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","50268-0616-13","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","55111-0263-81","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","59746-0307-32","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","60505-3276-00","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28160","ERX","HCPCS 63700001","60505-3276-03","OLANZAPINE 10 MG PO TBDP","BOTH IP/OP","$79.78 ","$59.04 ","$0.00 ","$72.34 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.34 ","$0.00 ","$36.17 ","$57.29 ","$57.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28161","ERX","HCPCS 63700001","13668-0089-30","OLANZAPINE 15 MG PO TBDP","BOTH IP/OP","$117.09 ","$86.65 ","$0.00 ","$106.17 ","","$20.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.17 ","$0.00 ","$53.09 ","$84.09 ","$84.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28161","ERX","HCPCS 63700001","33342-0085-07","OLANZAPINE 15 MG PO TBDP","BOTH IP/OP","$117.09 ","$86.65 ","$0.00 ","$106.17 ","","$20.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.17 ","$0.00 ","$53.09 ","$84.09 ","$84.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28161","ERX","HCPCS 63700001","49884-0322-52","OLANZAPINE 15 MG PO TBDP","BOTH IP/OP","$117.09 ","$86.65 ","$0.00 ","$106.17 ","","$20.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.17 ","$0.00 ","$53.09 ","$84.09 ","$84.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","00002-4456-01","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","00002-4456-85","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","00093-5248-65","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","13668-0090-30","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","55111-0265-81","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","60505-3278-00","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28162","ERX","HCPCS 63700001","60505-3278-03","OLANZAPINE 20 MG PO TBDP","BOTH IP/OP","$154.40 ","$114.26 ","$0.00 ","$140.00 ","","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28188","ERX","HCPCS 25000001","67618-0200-08","CHLORHEXIDINE GLUCONATE 4 % EX LIQD","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$33.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.33 ","$0.00 ","$16.67 ","$26.40 ","$26.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28203","ERX","HCPCS 25000001","00378-9055-16","LIDOCAINE 5 % EX PTCH","BOTH IP/OP","$39.22 ","$29.02 ","$0.00 ","$35.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.79 ","$28.17 ","$28.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28203","ERX","HCPCS 25000001","00591-2679-30","LIDOCAINE 5 % EX PTCH","BOTH IP/OP","$39.22 ","$29.02 ","$0.00 ","$35.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.79 ","$28.17 ","$28.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28203","ERX","HCPCS 25000001","00591-3525-30","LIDOCAINE 5 % EX PTCH","BOTH IP/OP","$39.22 ","$29.02 ","$0.00 ","$35.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.79 ","$28.17 ","$28.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28203","ERX","HCPCS 25000001","00603-1880-10","LIDOCAINE 5 % EX PTCH","BOTH IP/OP","$39.22 ","$29.02 ","$0.00 ","$35.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.79 ","$28.17 ","$28.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28203","ERX","HCPCS 25000001","00603-1880-16","LIDOCAINE 5 % EX PTCH","BOTH IP/OP","$39.22 ","$29.02 ","$0.00 ","$35.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.79 ","$28.17 ","$28.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28205","ERX","HCPCS 25000001","00295-1201-31","PEPPERMINT SPIRIT SPRT","BOTH IP/OP","$40.73 ","$30.14 ","$0.00 ","$33.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.86 ","$0.00 ","$16.93 ","$26.82 ","$27.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28205","ERX","HCPCS 25000001","00395-2243-91","PEPPERMINT SPIRIT SPRT","BOTH IP/OP","$40.73 ","$30.14 ","$0.00 ","$33.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.86 ","$0.00 ","$16.93 ","$26.82 ","$27.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28224","ERX","HCPCS 63700001","00904-6553-04","LINEZOLID 600 MG PO TABS","BOTH IP/OP","$540.82 ","$400.21 ","$0.00 ","$540.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.82 ","$0.00 ","$270.41 ","$428.33 ","$432.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28224","ERX","HCPCS 63700001","59762-1307-02","LINEZOLID 600 MG PO TABS","BOTH IP/OP","$540.82 ","$400.21 ","$0.00 ","$540.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.82 ","$0.00 ","$270.41 ","$428.33 ","$432.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28224","ERX","HCPCS 63700001","65162-0777-02","LINEZOLID 600 MG PO TABS","BOTH IP/OP","$540.82 ","$400.21 ","$0.00 ","$540.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.82 ","$0.00 ","$270.41 ","$428.33 ","$432.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28224","ERX","HCPCS 63700001","67877-0419-20","LINEZOLID 600 MG PO TABS","BOTH IP/OP","$540.82 ","$400.21 ","$0.00 ","$540.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.82 ","$0.00 ","$270.41 ","$428.33 ","$432.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28225","ERX","HCPCS 25000001","00009-5136-01","LINEZOLID 100 MG/5ML PO SUSR","BOTH IP/OP","$2,119.27 ","$1,568.26 ","$0.00 ","$1,934.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.64 ","$0.00 ","$967.32 ","$1,532.23 ","$1,547.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28225","ERX","HCPCS 25000001","00054-0319-50","LINEZOLID 100 MG/5ML PO SUSR","BOTH IP/OP","$2,119.27 ","$1,568.26 ","$0.00 ","$1,934.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.64 ","$0.00 ","$967.32 ","$1,532.23 ","$1,547.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28225","ERX","HCPCS 25000001","59762-1308-01","LINEZOLID 100 MG/5ML PO SUSR","BOTH IP/OP","$2,119.27 ","$1,568.26 ","$0.00 ","$1,934.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.64 ","$0.00 ","$967.32 ","$1,532.23 ","$1,547.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28246","ERX","HCPCS 25000001","00173-0520-00","SALMETEROL XINAFOATE 50 MCG/DOSE IN AEPB","BOTH IP/OP","$1,316.09 ","$973.91 ","$0.00 ","$38.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.38 ","$0.00 ","$19.19 ","$30.40 ","$30.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28252","ERX","HCPCS 63700001","00115-5522-10","FENOFIBRATE 160 MG PO TABS","BOTH IP/OP","$9.96 ","$7.37 ","$0.00 ","$9.03 ","","$1.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.03 ","$0.00 ","$4.52 ","$7.15 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28252","ERX","HCPCS 63700001","42858-0660-45","FENOFIBRATE 160 MG PO TABS","BOTH IP/OP","$9.96 ","$7.37 ","$0.00 ","$9.03 ","","$1.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.03 ","$0.00 ","$4.52 ","$7.15 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28252","ERX","HCPCS 63700001","68180-0363-09","FENOFIBRATE 160 MG PO TABS","BOTH IP/OP","$9.96 ","$7.37 ","$0.00 ","$9.03 ","","$1.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.03 ","$0.00 ","$4.52 ","$7.15 ","$7.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28278","ERX","HCPCS 63700001","55111-0352-60","RIVASTIGMINE TARTRATE 1.5 MG PO CAPS","BOTH IP/OP","$17.79 ","$13.16 ","$0.00 ","$16.13 ","","$3.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.13 ","$0.00 ","$8.07 ","$12.77 ","$12.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28278","ERX","HCPCS 63700001","63739-0576-10","RIVASTIGMINE TARTRATE 1.5 MG PO CAPS","BOTH IP/OP","$17.79 ","$13.16 ","$0.00 ","$16.13 ","","$3.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.13 ","$0.00 ","$8.07 ","$12.77 ","$12.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28279","ERX","HCPCS 63700001","55111-0353-60","RIVASTIGMINE TARTRATE 3 MG PO CAPS","BOTH IP/OP","$15.33 ","$11.34 ","$0.00 ","$15.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.33 ","$0.00 ","$7.67 ","$12.14 ","$12.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28279","ERX","HCPCS 63700001","63739-0577-10","RIVASTIGMINE TARTRATE 3 MG PO CAPS","BOTH IP/OP","$15.33 ","$11.34 ","$0.00 ","$15.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.33 ","$0.00 ","$7.67 ","$12.14 ","$12.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28280","ERX","HCPCS 63700001","00781-2616-60","RIVASTIGMINE TARTRATE 4.5 MG PO CAPS","BOTH IP/OP","$17.69 ","$13.09 ","$0.00 ","$16.04 ","","$3.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.04 ","$0.00 ","$8.02 ","$12.70 ","$12.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28280","ERX","HCPCS 63700001","62756-0147-86","RIVASTIGMINE TARTRATE 4.5 MG PO CAPS","BOTH IP/OP","$17.69 ","$13.09 ","$0.00 ","$16.04 ","","$3.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.04 ","$0.00 ","$8.02 ","$12.70 ","$12.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28280","ERX","HCPCS 63700001","63739-0578-10","RIVASTIGMINE TARTRATE 4.5 MG PO CAPS","BOTH IP/OP","$17.69 ","$13.09 ","$0.00 ","$16.04 ","","$3.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.04 ","$0.00 ","$8.02 ","$12.70 ","$12.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28281","ERX","HCPCS 63700001","00781-2617-60","RIVASTIGMINE TARTRATE 6 MG PO CAPS","BOTH IP/OP","$26.14 ","$19.34 ","$0.00 ","$26.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$0.00 ","$13.07 ","$20.70 ","$20.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28281","ERX","HCPCS 63700001","51991-0796-06","RIVASTIGMINE TARTRATE 6 MG PO CAPS","BOTH IP/OP","$26.14 ","$19.34 ","$0.00 ","$26.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$0.00 ","$13.07 ","$20.70 ","$20.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28281","ERX","HCPCS 63700001","55111-0355-60","RIVASTIGMINE TARTRATE 6 MG PO CAPS","BOTH IP/OP","$26.14 ","$19.34 ","$0.00 ","$26.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.14 ","$0.00 ","$13.07 ","$20.70 ","$20.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28282","ERX","HCPCS J1815","00088-2220-33","INSULIN GLARGINE (LANTUS) 100 UNIT/ML SC SOLN","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$201.38 ","$6.79 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$201.38 ","$0.00 "
"28372","ERX","HCPCS 25000001","65597-0701-18","COLESEVELAM HCL 625 MG PO TABS","BOTH IP/OP","$18.71 ","$13.85 ","$0.00 ","$16.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.97 ","$0.00 ","$8.49 ","$13.44 ","$13.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28372","ERX","HCPCS 25000001","67877-0506-51","COLESEVELAM HCL 625 MG PO TABS","BOTH IP/OP","$18.71 ","$13.85 ","$0.00 ","$16.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.97 ","$0.00 ","$8.49 ","$13.44 ","$13.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28400","ERX","HCPCS 25000001","52919-0006-05","STERILE WATER FOR INJECTION IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$34.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.20 ","$0.00 ","$17.10 ","$17.42 ","$27.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28400","ERX","HCPCS 25000001","52919-0011-04","STERILE WATER FOR INJECTION IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$34.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.20 ","$0.00 ","$17.10 ","$17.42 ","$27.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28400","ERX","HCPCS 25000001","00264-7850-10","STERILE WATER FOR INJECTION IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$34.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.20 ","$0.00 ","$17.10 ","$17.42 ","$27.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28400","ERX","HCPCS 25000001","00264-7385-50","STERILE WATER FOR INJECTION IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$34.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.20 ","$0.00 ","$17.10 ","$18.06 ","$27.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28400","ERX","HCPCS 25000001","00264-7850-00","STERILE WATER FOR INJECTION IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$34.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.20 ","$0.00 ","$17.10 ","$27.09 ","$27.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28400","ERX","HCPCS 25000001","00338-0013-04","STERILE WATER FOR INJECTION IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$34.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.20 ","$0.00 ","$17.10 ","$27.09 ","$27.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28558","ERX","HCPCS 25000001","00023-5902-04","TRIPTORELIN PAMOATE 3.75 MG IM SUSR","BOTH IP/OP","$2,342.14 ","$1,733.18 ","$0.00 ","$2,342.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.14 ","$0.00 ","$1,171.07 ","$1,854.97 ","$1,873.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28643","ERX","HCPCS 63700001","50742-0260-01","NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28643","ERX","HCPCS 63700001","62175-0260-55","NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28643","ERX","HCPCS 63700001","71205-0963-00","NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28645","ERX","HCPCS 63700001","00378-3953-77","ATORVASTATIN CALCIUM 80 MG PO TABS","BOTH IP/OP","$8.14 ","$6.02 ","$0.00 ","$7.38 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28645","ERX","HCPCS 63700001","00904-6293-04","ATORVASTATIN CALCIUM 80 MG PO TABS","BOTH IP/OP","$8.14 ","$6.02 ","$0.00 ","$7.38 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28645","ERX","HCPCS 63700001","16714-0877-01","ATORVASTATIN CALCIUM 80 MG PO TABS","BOTH IP/OP","$8.14 ","$6.02 ","$0.00 ","$7.38 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28645","ERX","HCPCS 63700001","51079-0211-01","ATORVASTATIN CALCIUM 80 MG PO TABS","BOTH IP/OP","$8.14 ","$6.02 ","$0.00 ","$7.38 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28645","ERX","HCPCS 63700001","51079-0211-03","ATORVASTATIN CALCIUM 80 MG PO TABS","BOTH IP/OP","$8.14 ","$6.02 ","$0.00 ","$7.38 ","","$1.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$0.00 ","$3.69 ","$5.84 ","$5.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28686","ERX","HCPCS 63700001","68462-0402-01","ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS","BOTH IP/OP","$22.51 ","$16.66 ","$0.00 ","$20.41 ","","$4.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.41 ","$0.00 ","$10.21 ","$16.16 ","$16.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28774","ERX","HCPCS J7626","00487-9601-01","BUDESONIDE 0.25 MG/2ML IN SUSP","BOTH IP/OP","$24.94 ","$18.46 ","$0.00 ","$22.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.61 ","$0.00 ","$11.31 ","$17.91 ","$18.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28774","ERX","HCPCS J7626","00487-9601-30","BUDESONIDE 0.25 MG/2ML IN SUSP","BOTH IP/OP","$24.94 ","$18.46 ","$0.00 ","$22.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.61 ","$0.00 ","$11.31 ","$17.91 ","$18.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28774","ERX","HCPCS J7626","69097-0318-87","BUDESONIDE 0.25 MG/2ML IN SUSP","BOTH IP/OP","$24.94 ","$18.46 ","$0.00 ","$22.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.61 ","$0.00 ","$11.31 ","$17.91 ","$18.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","00093-6816-73","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","00186-1989-04","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","00487-9701-01","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","00487-9701-30","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","00781-7516-87","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","69097-0319-86","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28775","ERX","HCPCS J7626","69097-0319-87","BUDESONIDE 0.5 MG/2ML IN SUSP","BOTH IP/OP","$51.58 ","$38.17 ","$0.00 ","$46.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.78 ","$0.00 ","$23.39 ","$37.05 ","$37.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28810","ERX","HCPCS 25000001","24208-0635-62","NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","BOTH IP/OP","$338.29 ","$250.33 ","$0.00 ","$307.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28810","ERX","HCPCS 25000001","61314-0645-11","NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","BOTH IP/OP","$338.29 ","$250.33 ","$0.00 ","$307.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28824","ERX","HCPCS 25000001","10631-0407-01","HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","BOTH IP/OP","$303.00 ","$224.22 ","$0.00 ","$291.06 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$291.06 ","$0.00 ","$145.53 ","$217.85 ","$220.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28824","ERX","HCPCS 25000001","64980-0301-30","HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","BOTH IP/OP","$303.00 ","$224.22 ","$0.00 ","$291.06 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$291.06 ","$0.00 ","$145.53 ","$230.52 ","$220.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28836","ERX","HCPCS 63700001","00121-0431-30","MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28836","ERX","HCPCS 63700001","00536-2470-85","MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28836","ERX","HCPCS 63700001","99999-6006-91","MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28842","ERX","HCPCS J7515","00093-5740-65","CYCLOSPORINE MODIFIED (GENGRAF) 25 MG PO CAPS","BOTH IP/OP","$11.53 ","$8.53 ","$0.00 ","$10.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.45 ","$0.00 ","$5.23 ","$8.28 ","$8.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28843","ERX","HCPCS J7502","00093-5742-19","CYCLOSPORINE MODIFIED 100 MG PO CAPS","BOTH IP/OP","$23.03 ","$17.04 ","$0.00 ","$20.89 ","$10.36 ","$0.00 ","$4.80 ","$0.00 ","$0.00 ","$3.66 ","$20.89 ","$0.00 ","$10.45 ","$16.54 ","$16.71 ","$0.00 ","$3.27 ","$0.00 ","$3.33 ","$0.00 "
"28843","ERX","HCPCS J7502","00093-5742-65","CYCLOSPORINE MODIFIED 100 MG PO CAPS","BOTH IP/OP","$23.03 ","$17.04 ","$0.00 ","$20.89 ","$10.36 ","$0.00 ","$4.80 ","$0.00 ","$0.00 ","$3.66 ","$20.89 ","$0.00 ","$10.45 ","$16.54 ","$16.71 ","$0.00 ","$3.27 ","$0.00 ","$3.33 ","$0.00 "
"28844","ERX","HCPCS J7502","00172-7313-20","CYCLOSPORINE MODIFIED (GENGRAF) 100 MG/ML PO SOLN","BOTH IP/OP","$874.69 ","$647.27 ","$0.00 ","$793.81 ","$393.61 ","$0.00 ","$182.31 ","$0.00 ","$0.00 ","$138.99 ","$793.81 ","$0.00 ","$396.91 ","$628.70 ","$635.05 ","$0.00 ","$124.23 ","$0.00 ","$126.37 ","$0.00 "
"28849","ERX","HCPCS 25000001","00037-6822-10","HYDROCORT-PRAMOXINE (PERIANAL) 1-1 % EX FOAM","BOTH IP/OP","$633.30 ","$468.64 ","$0.00 ","$547.51 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$547.51 ","$0.00 ","$273.76 ","$433.63 ","$438.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28899","ERX","HCPCS 25000001","00406-8515-23","OXYCODONE HCL 15 MG PO TABS","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28899","ERX","HCPCS 25000001","00406-8515-62","OXYCODONE HCL 15 MG PO TABS","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28899","ERX","HCPCS 25000001","57664-0187-88","OXYCODONE HCL 15 MG PO TABS","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28899","ERX","HCPCS 25000001","68084-0184-01","OXYCODONE HCL 15 MG PO TABS","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28899","ERX","HCPCS 25000001","68094-0005-59","OXYCODONE HCL 15 MG PO TABS","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28899","ERX","HCPCS 25000001","68094-0005-61","OXYCODONE HCL 15 MG PO TABS","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28900","ERX","HCPCS 25000001","00406-8530-62","OXYCODONE HCL 30 MG PO TABS","BOTH IP/OP","$13.54 ","$10.02 ","$0.00 ","$13.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.54 ","$0.00 ","$6.77 ","$10.72 ","$10.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28900","ERX","HCPCS 25000001","68084-0185-01","OXYCODONE HCL 30 MG PO TABS","BOTH IP/OP","$13.54 ","$10.02 ","$0.00 ","$13.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.54 ","$0.00 ","$6.77 ","$10.72 ","$10.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28912","ERX","HCPCS J9120","55292-0811-55","DACTINOMYCIN 0.5 MG IV SOLR","BOTH IP/OP","$4,119.05 ","$3,048.10 ","$0.00 ","$3,736.31 ","$1,853.57 ","$838.88 ","$591.51 ","$0.00 ","$0.00 ","$0.00 ","$3,736.31 ","$0.00 ","$1,868.16 ","$2,959.16 ","$2,989.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28912","ERX","HCPCS J9120","66993-0489-83","DACTINOMYCIN 0.5 MG IV SOLR","BOTH IP/OP","$4,119.05 ","$3,048.10 ","$0.00 ","$3,736.31 ","$1,853.57 ","$838.88 ","$591.51 ","$0.00 ","$0.00 ","$0.00 ","$3,736.31 ","$0.00 ","$1,868.16 ","$2,959.16 ","$2,989.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28912","ERX","HCPCS J9120","67457-0513-05","DACTINOMYCIN 0.5 MG IV SOLR","BOTH IP/OP","$4,119.05 ","$3,048.10 ","$0.00 ","$3,736.31 ","$1,853.57 ","$838.88 ","$591.51 ","$0.00 ","$0.00 ","$0.00 ","$3,736.31 ","$0.00 ","$1,868.16 ","$2,959.16 ","$2,989.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28913","ERX","HCPCS 25000001","08065-1830-85","SODIUM HYALURONATE 10 MG/ML IO SOLN","BOTH IP/OP","$694.15 ","$513.67 ","$0.00 ","$611.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$611.62 ","$0.00 ","$305.81 ","$484.40 ","$489.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28917","ERX","HCPCS 25000001","08065-1831-50","NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT","BOTH IP/OP","$779.70 ","$576.98 ","$0.00 ","$687.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.02 ","$0.00 ","$343.51 ","$544.12 ","$549.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28923","ERX","HCPCS 25000001","08065-1839-05","NA CHONDROIT SULF-NA HYALURON 40-30 MG/ML IO SOLN","BOTH IP/OP","$568.80 ","$420.91 ","$0.00 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$568.80 ","$0.00 ","$284.40 ","$450.49 ","$455.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28929","ERX","HCPCS 63700001","99999-6004-92","KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN","BOTH IP/OP","$530.41 ","$392.50 ","$0.00 ","$1,474.95 ","","$94.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,474.95 ","$0.00 ","$737.48 ","$381.33 ","$1,179.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28929","ERX","HCPCS 63700001","00074-3956-46","KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN","BOTH IP/OP","$530.41 ","$392.50 ","$0.00 ","$1,474.95 ","","$94.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,474.95 ","$0.00 ","$737.48 ","$1,168.16 ","$1,179.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28929","ERX","HCPCS 63700001","00527-1947-48","KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN","BOTH IP/OP","$530.41 ","$392.50 ","$0.00 ","$1,474.95 ","","$94.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,474.95 ","$0.00 ","$737.48 ","$1,168.16 ","$1,179.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28947","ERX","HCPCS J0883","00143-9674-01","ARGATROBAN 250 MG/2.5ML IV SOLN","BOTH IP/OP","$1,585.08 ","$1,172.96 ","$0.00 ","$1,468.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,468.80 ","$0.00 ","$734.40 ","$1,163.29 ","$1,175.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28947","ERX","HCPCS J0883","00409-1140-01","ARGATROBAN 250 MG/2.5ML IV SOLN","BOTH IP/OP","$1,585.08 ","$1,172.96 ","$0.00 ","$1,468.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,468.80 ","$0.00 ","$734.40 ","$1,163.29 ","$1,175.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28947","ERX","HCPCS J0883","42023-0182-01","ARGATROBAN 250 MG/2.5ML IV SOLN","BOTH IP/OP","$1,585.08 ","$1,172.96 ","$0.00 ","$1,468.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,468.80 ","$0.00 ","$734.40 ","$1,163.29 ","$1,175.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28947","ERX","HCPCS J0883","63323-0526-03","ARGATROBAN 250 MG/2.5ML IV SOLN","BOTH IP/OP","$1,585.08 ","$1,172.96 ","$0.00 ","$1,468.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,468.80 ","$0.00 ","$734.40 ","$1,163.29 ","$1,175.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28947","ERX","HCPCS J0883","67457-0212-02","ARGATROBAN 250 MG/2.5ML IV SOLN","BOTH IP/OP","$1,585.08 ","$1,172.96 ","$0.00 ","$1,468.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,468.80 ","$0.00 ","$734.40 ","$1,163.29 ","$1,175.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28958","ERX","HCPCS J7520","00008-1041-10","SIROLIMUS 1 MG PO TABS","BOTH IP/OP","$71.44 ","$52.87 ","$0.00 ","$64.79 ","$32.15 ","$0.00 ","$14.89 ","$0.00 ","$0.00 ","$0.00 ","$64.79 ","$0.00 ","$32.40 ","$51.31 ","$51.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28958","ERX","HCPCS J7520","55111-0653-01","SIROLIMUS 1 MG PO TABS","BOTH IP/OP","$71.44 ","$52.87 ","$0.00 ","$64.79 ","$32.15 ","$0.00 ","$14.89 ","$0.00 ","$0.00 ","$0.00 ","$64.79 ","$0.00 ","$32.40 ","$51.31 ","$51.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28964","ERX","HCPCS 63700001","00904-6353-61","LEVOFLOXACIN 750 MG PO TABS","BOTH IP/OP","$123.89 ","$91.68 ","$0.00 ","$123.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.89 ","$0.00 ","$61.95 ","$98.12 ","$99.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28964","ERX","HCPCS 63700001","55111-0281-30","LEVOFLOXACIN 750 MG PO TABS","BOTH IP/OP","$123.89 ","$91.68 ","$0.00 ","$123.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.89 ","$0.00 ","$61.95 ","$98.12 ","$99.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28975","ERX","HCPCS 63700001","64875-0001-03","MIFEPRISTONE 200 MG PO TABS","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28995","ERX","HCPCS 63700001","67877-0159-01","METFORMIN HCL ER 500 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28995","ERX","HCPCS 63700001","70010-0491-01","METFORMIN HCL ER 500 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29048","ERX","HCPCS 63700001","16714-0633-01","ALENDRONATE SODIUM 70 MG PO TABS","BOTH IP/OP","$78.80 ","$58.31 ","$0.00 ","$71.45 ","","$14.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.45 ","$0.00 ","$35.73 ","$56.59 ","$57.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29071","ERX","HCPCS J9017","","ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","BOTH IP/OP","$1,846.16 ","$1,366.16 ","$0.00 ","$1,710.72 ","$830.77 ","$128.11 ","$384.79 ","$0.00 ","$0.00 ","$517.82 ","$1,710.72 ","$465.30 ","$855.36 ","$1,354.89 ","$1,368.58 ","$642.55 ","$517.82 ","$0.00 ","$493.06 ","$286.69 "
"29071","ERX","HCPCS J9017","50742-0438-10","ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","BOTH IP/OP","$1,846.16 ","$1,366.16 ","$0.00 ","$1,710.72 ","$830.77 ","$128.11 ","$384.79 ","$0.00 ","$0.00 ","$517.82 ","$1,710.72 ","$465.30 ","$855.36 ","$1,354.89 ","$1,368.58 ","$642.55 ","$517.82 ","$0.00 ","$493.06 ","$286.69 "
"29071","ERX","HCPCS J9017","63323-0637-10","ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","BOTH IP/OP","$1,846.16 ","$1,366.16 ","$0.00 ","$1,710.72 ","$830.77 ","$128.11 ","$384.79 ","$0.00 ","$0.00 ","$517.82 ","$1,710.72 ","$465.30 ","$855.36 ","$1,354.89 ","$1,368.58 ","$642.55 ","$517.82 ","$0.00 ","$493.06 ","$286.69 "
"29072","ERX","HCPCS 63700001","16714-0632-01","ALENDRONATE SODIUM 35 MG PO TABS","BOTH IP/OP","$71.63 ","$53.01 ","$0.00 ","$71.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.63 ","$0.00 ","$35.82 ","$56.73 ","$57.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29109","ERX","HCPCS 63700001","65862-0312-30","DIDANOSINE 250 MG PO CPDR","BOTH IP/OP","$29.91 ","$22.13 ","$0.00 ","$29.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.91 ","$0.00 ","$14.96 ","$23.69 ","$23.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29110","ERX","HCPCS 63700001","65862-0313-30","DIDANOSINE 400 MG PO CPDR","BOTH IP/OP","$46.71 ","$34.57 ","$0.00 ","$46.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.71 ","$0.00 ","$23.36 ","$36.99 ","$37.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29132","ERX","HCPCS J1756","00517-2340-01","IRON SUCROSE 20 MG/ML IV SOLN","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$189.00 ","$108.22 ","$0.00 ","$43.48 ","$0.00 ","$0.00 ","$24.68 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$24.68 ","$0.00 ","$23.49 ","$0.00 "
"29132","ERX","HCPCS J1756","00517-2340-10","IRON SUCROSE 20 MG/ML IV SOLN","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$189.00 ","$108.22 ","$0.00 ","$43.48 ","$0.00 ","$0.00 ","$24.68 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$24.68 ","$0.00 ","$23.49 ","$0.00 "
"29132","ERX","HCPCS J1756","00517-2340-25","IRON SUCROSE 20 MG/ML IV SOLN","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$189.00 ","$108.22 ","$0.00 ","$43.48 ","$0.00 ","$0.00 ","$24.68 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$24.68 ","$0.00 ","$23.49 ","$0.00 "
"29167","ERX","HCPCS 63700001","49702-0217-18","TRIZIVIR:ABACAVIR-LAMIVUDINE-ZIDOVUDINE PO TAB","BOTH IP/OP","$111.84 ","$82.76 ","$0.00 ","$101.41 ","","$19.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.41 ","$0.00 ","$50.71 ","$80.32 ","$81.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29167","ERX","HCPCS 63700001","68180-0286-07","TRIZIVIR:ABACAVIR-LAMIVUDINE-ZIDOVUDINE PO TAB","BOTH IP/OP","$111.84 ","$82.76 ","$0.00 ","$101.41 ","","$19.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.41 ","$0.00 ","$50.71 ","$80.32 ","$81.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29169","ERX","HCPCS 63700001","42192-0608-16","GABAPENTIN 250 MG/5ML PO SOLN","BOTH IP/OP","$9.51 ","$7.04 ","$0.00 ","$9.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.51 ","$0.00 ","$4.76 ","$7.53 ","$7.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29169","ERX","HCPCS 63700001","50383-0311-09","GABAPENTIN 250 MG/5ML PO SOLN","BOTH IP/OP","$9.51 ","$7.04 ","$0.00 ","$9.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.51 ","$0.00 ","$4.76 ","$7.53 ","$7.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29169","ERX","HCPCS 63700001","59762-5050-01","GABAPENTIN 250 MG/5ML PO SOLN","BOTH IP/OP","$9.51 ","$7.04 ","$0.00 ","$9.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.51 ","$0.00 ","$4.76 ","$7.53 ","$7.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29169","ERX","HCPCS 63700001","99999-6010-82","GABAPENTIN 250 MG/5ML PO SOLN","BOTH IP/OP","$9.51 ","$7.04 ","$0.00 ","$9.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.51 ","$0.00 ","$4.76 ","$7.53 ","$7.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29169","ERX","HCPCS 63700001","99999-6012-40","GABAPENTIN 250 MG/5ML PO SOLN","BOTH IP/OP","$9.51 ","$7.04 ","$0.00 ","$9.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.51 ","$0.00 ","$4.76 ","$7.53 ","$7.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29267","ERX","HCPCS 63700001","00904-6642-61","QUETIAPINE FUMARATE 300 MG PO TABS","BOTH IP/OP","$42.53 ","$31.47 ","$0.00 ","$38.57 ","","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.57 ","$0.00 ","$19.29 ","$30.55 ","$30.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29267","ERX","HCPCS 63700001","50268-0634-15","QUETIAPINE FUMARATE 300 MG PO TABS","BOTH IP/OP","$42.53 ","$31.47 ","$0.00 ","$38.57 ","","$7.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.57 ","$0.00 ","$19.29 ","$30.55 ","$30.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29270","ERX","HCPCS 63700001","60687-0195-01","DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29270","ERX","HCPCS 63700001","63739-0014-10","DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29272","ERX","HCPCS 63700001","60687-0206-01","DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24","BOTH IP/OP","$6.87 ","$5.08 ","$0.00 ","$6.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.87 ","$0.00 ","$3.44 ","$5.44 ","$5.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29272","ERX","HCPCS 63700001","63739-0015-10","DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24","BOTH IP/OP","$6.87 ","$5.08 ","$0.00 ","$6.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.87 ","$0.00 ","$3.44 ","$5.44 ","$5.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29274","ERX","HCPCS 63700001","10370-0831-11","DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24","BOTH IP/OP","$8.60 ","$6.36 ","$0.00 ","$7.80 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.80 ","$0.00 ","$3.90 ","$6.18 ","$6.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29274","ERX","HCPCS 63700001","60687-0217-01","DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24","BOTH IP/OP","$8.60 ","$6.36 ","$0.00 ","$7.80 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.80 ","$0.00 ","$3.90 ","$6.18 ","$6.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29274","ERX","HCPCS 63700001","60687-0217-11","DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24","BOTH IP/OP","$8.60 ","$6.36 ","$0.00 ","$7.80 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.80 ","$0.00 ","$3.90 ","$6.18 ","$6.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29274","ERX","HCPCS 63700001","63739-0016-10","DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24","BOTH IP/OP","$8.60 ","$6.36 ","$0.00 ","$7.80 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.80 ","$0.00 ","$3.90 ","$6.18 ","$6.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29276","ERX","HCPCS 63700001","60687-0228-01","DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24","BOTH IP/OP","$11.23 ","$8.31 ","$0.00 ","$10.19 ","","$2.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$0.00 ","$5.10 ","$8.07 ","$8.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29277","ERX","HCPCS 63700001","47335-0673-81","DILTIAZEM HCL ER BEADS 360 MG PO CP24","BOTH IP/OP","$9.83 ","$7.27 ","$0.00 ","$8.92 ","","$1.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.92 ","$0.00 ","$4.46 ","$7.06 ","$7.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29277","ERX","HCPCS 63700001","68682-0371-90","DILTIAZEM HCL ER BEADS 360 MG PO CP24","BOTH IP/OP","$9.83 ","$7.27 ","$0.00 ","$8.92 ","","$1.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.92 ","$0.00 ","$4.46 ","$7.06 ","$7.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29302","ERX","HCPCS J7510","99999-6005-14","PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN","BOTH IP/OP","$214.45 ","$158.69 ","$0.00 ","$194.67 ","","$0.00 ","$44.70 ","$0.00 ","$0.00 ","$0.00 ","$194.67 ","$0.00 ","$97.34 ","$154.18 ","$155.74 ","$0.00 ","$30.47 ","$0.00 ","$0.00 ","$0.00 "
"29302","ERX","HCPCS J7510","00121-0759-08","PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN","BOTH IP/OP","$214.45 ","$158.69 ","$0.00 ","$194.67 ","","$0.00 ","$44.70 ","$0.00 ","$0.00 ","$0.00 ","$194.67 ","$0.00 ","$97.34 ","$184.48 ","$155.74 ","$0.00 ","$30.47 ","$0.00 ","$0.00 ","$0.00 "
"29302","ERX","HCPCS J7510","60432-0212-08","PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN","BOTH IP/OP","$214.45 ","$158.69 ","$0.00 ","$194.67 ","","$0.00 ","$44.70 ","$0.00 ","$0.00 ","$0.00 ","$194.67 ","$0.00 ","$97.34 ","$184.48 ","$155.74 ","$0.00 ","$30.47 ","$0.00 ","$0.00 ","$0.00 "
"29313","ERX","HCPCS J0840","50633-0110-11","CROTALIDAE POLYVAL IMMUNE FAB IV SOLR","BOTH IP/OP","$17,345.96 ","$12,836.01 ","$0.00 ","$15,734.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,734.16 ","$0.00 ","$7,867.08 ","$12,461.45 ","$12,587.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29335","ERX","HCPCS J1800","00143-9872-01","PROPRANOLOL HCL 1 MG/ML IV SOLN","BOTH IP/OP","$40.23 ","$29.77 ","$0.00 ","$36.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.48 ","$0.00 ","$18.24 ","$28.89 ","$29.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29335","ERX","HCPCS J1800","00143-9872-10","PROPRANOLOL HCL 1 MG/ML IV SOLN","BOTH IP/OP","$40.23 ","$29.77 ","$0.00 ","$36.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.48 ","$0.00 ","$18.24 ","$28.89 ","$29.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29434","ERX","HCPCS 63700001","00093-7163-56","TOLTERODINE TARTRATE ER 2 MG PO CP24","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$30.54 ","","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.54 ","$0.00 ","$15.27 ","$24.19 ","$24.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29434","ERX","HCPCS 63700001","00093-7163-98","TOLTERODINE TARTRATE ER 2 MG PO CP24","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$30.54 ","","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.54 ","$0.00 ","$15.27 ","$24.19 ","$24.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29434","ERX","HCPCS 63700001","13668-0189-30","TOLTERODINE TARTRATE ER 2 MG PO CP24","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$30.54 ","","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.54 ","$0.00 ","$15.27 ","$24.19 ","$24.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29434","ERX","HCPCS 63700001","31722-0607-30","TOLTERODINE TARTRATE ER 2 MG PO CP24","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$30.54 ","","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.54 ","$0.00 ","$15.27 ","$24.19 ","$24.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29434","ERX","HCPCS 63700001","59762-0047-01","TOLTERODINE TARTRATE ER 2 MG PO CP24","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$30.54 ","","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.54 ","$0.00 ","$15.27 ","$24.19 ","$24.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29435","ERX","HCPCS 63700001","00093-7164-05","TOLTERODINE TARTRATE ER 4 MG PO CP24","BOTH IP/OP","$40.01 ","$29.61 ","$0.00 ","$36.28 ","","$7.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.28 ","$0.00 ","$18.14 ","$28.73 ","$29.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29435","ERX","HCPCS 63700001","00093-7164-56","TOLTERODINE TARTRATE ER 4 MG PO CP24","BOTH IP/OP","$40.01 ","$29.61 ","$0.00 ","$36.28 ","","$7.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.28 ","$0.00 ","$18.14 ","$28.73 ","$29.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29435","ERX","HCPCS 63700001","31722-0608-30","TOLTERODINE TARTRATE ER 4 MG PO CP24","BOTH IP/OP","$40.01 ","$29.61 ","$0.00 ","$36.28 ","","$7.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.28 ","$0.00 ","$18.14 ","$28.73 ","$29.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29435","ERX","HCPCS 63700001","59762-0048-01","TOLTERODINE TARTRATE ER 4 MG PO CP24","BOTH IP/OP","$40.01 ","$29.61 ","$0.00 ","$36.28 ","","$7.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.28 ","$0.00 ","$18.14 ","$28.73 ","$29.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29437","ERX","HCPCS 63700001","00078-0351-05","NATEGLINIDE 60 MG PO TABS","BOTH IP/OP","$6.97 ","$5.16 ","$0.00 ","$6.32 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.32 ","$0.00 ","$3.16 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29437","ERX","HCPCS 63700001","00591-3354-01","NATEGLINIDE 60 MG PO TABS","BOTH IP/OP","$6.97 ","$5.16 ","$0.00 ","$6.32 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.32 ","$0.00 ","$3.16 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29437","ERX","HCPCS 63700001","49884-0984-01","NATEGLINIDE 60 MG PO TABS","BOTH IP/OP","$6.97 ","$5.16 ","$0.00 ","$6.32 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.32 ","$0.00 ","$3.16 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29437","ERX","HCPCS 63700001","55111-0328-90","NATEGLINIDE 60 MG PO TABS","BOTH IP/OP","$6.97 ","$5.16 ","$0.00 ","$6.32 ","","$1.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.32 ","$0.00 ","$3.16 ","$5.01 ","$5.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29438","ERX","HCPCS 63700001","00078-0352-05","NATEGLINIDE 120 MG PO TABS","BOTH IP/OP","$7.24 ","$5.36 ","$0.00 ","$6.57 ","","$1.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.57 ","$0.00 ","$3.29 ","$5.20 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29438","ERX","HCPCS 63700001","49884-0985-01","NATEGLINIDE 120 MG PO TABS","BOTH IP/OP","$7.24 ","$5.36 ","$0.00 ","$6.57 ","","$1.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.57 ","$0.00 ","$3.29 ","$5.20 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29438","ERX","HCPCS 63700001","55111-0329-90","NATEGLINIDE 120 MG PO TABS","BOTH IP/OP","$7.24 ","$5.36 ","$0.00 ","$6.57 ","","$1.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.57 ","$0.00 ","$3.29 ","$5.20 ","$5.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29464","ERX","HCPCS J2274","00641-6020-10","MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","BOTH IP/OP","$48.61 ","$35.97 ","$0.00 ","$44.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.08 ","$0.00 ","$22.04 ","$34.91 ","$35.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29464","ERX","HCPCS J2274","15082-0248-70","MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","BOTH IP/OP","$48.61 ","$35.97 ","$0.00 ","$44.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.08 ","$0.00 ","$22.04 ","$34.91 ","$35.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29464","ERX","HCPCS J2274","42852-0248-70","MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","BOTH IP/OP","$48.61 ","$35.97 ","$0.00 ","$44.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.08 ","$0.00 ","$22.04 ","$34.91 ","$35.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29531","ERX","HCPCS 63700001","65862-0021-06","MIRTAZAPINE 15 MG PO TBDP","BOTH IP/OP","$9.87 ","$7.30 ","$0.00 ","$8.95 ","","$1.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.95 ","$0.00 ","$4.48 ","$7.09 ","$7.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29532","ERX","HCPCS 63700001","00052-0108-30","MIRTAZAPINE 30 MG PO TBDP","BOTH IP/OP","$10.17 ","$7.53 ","$0.00 ","$9.22 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.22 ","$0.00 ","$4.61 ","$7.30 ","$7.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29532","ERX","HCPCS 63700001","65862-0022-06","MIRTAZAPINE 30 MG PO TBDP","BOTH IP/OP","$10.17 ","$7.53 ","$0.00 ","$9.22 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.22 ","$0.00 ","$4.61 ","$7.30 ","$7.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29567","ERX","HCPCS J0637","00006-3822-10","CASPOFUNGIN ACETATE 50 MG IV SOLR","BOTH IP/OP","$1,183.33 ","$875.66 ","$0.00 ","$1,073.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,073.92 ","$0.00 ","$536.96 ","$850.54 ","$859.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29568","ERX","HCPCS J0637","00006-3823-10","CASPOFUNGIN ACETATE 70 MG IV SOLR","BOTH IP/OP","$1,229.50 ","$909.83 ","$0.00 ","$1,115.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,115.81 ","$0.00 ","$557.91 ","$883.72 ","$892.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29745","ERX","HCPCS 63700001","00093-6450-56","ESOMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$37.82 ","$27.99 ","$0.00 ","$34.30 ","","$6.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.30 ","$0.00 ","$17.15 ","$27.17 ","$27.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29745","ERX","HCPCS 63700001","00186-5020-31","ESOMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$37.82 ","$27.99 ","$0.00 ","$34.30 ","","$6.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.30 ","$0.00 ","$17.15 ","$27.17 ","$27.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29745","ERX","HCPCS 63700001","00378-2350-93","ESOMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$37.82 ","$27.99 ","$0.00 ","$34.30 ","","$6.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.30 ","$0.00 ","$17.15 ","$27.17 ","$27.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29745","ERX","HCPCS 63700001","31722-0572-30","ESOMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$37.82 ","$27.99 ","$0.00 ","$34.30 ","","$6.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.30 ","$0.00 ","$17.15 ","$27.17 ","$27.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29745","ERX","HCPCS 63700001","43598-0509-30","ESOMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$37.82 ","$27.99 ","$0.00 ","$34.30 ","","$6.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.30 ","$0.00 ","$17.15 ","$27.17 ","$27.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29745","ERX","HCPCS 63700001","65862-0783-30","ESOMEPRAZOLE 20 MG PO CPDR","BOTH IP/OP","$37.82 ","$27.99 ","$0.00 ","$34.30 ","","$6.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.30 ","$0.00 ","$17.15 ","$27.17 ","$27.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29746","ERX","HCPCS 63700001","00093-6451-98","ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR","BOTH IP/OP","$33.61 ","$24.87 ","$0.00 ","$33.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.61 ","$0.00 ","$16.81 ","$26.62 ","$26.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29746","ERX","HCPCS 63700001","00186-5040-31","ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR","BOTH IP/OP","$33.61 ","$24.87 ","$0.00 ","$33.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.61 ","$0.00 ","$16.81 ","$26.62 ","$26.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29746","ERX","HCPCS 63700001","16714-0736-01","ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR","BOTH IP/OP","$33.61 ","$24.87 ","$0.00 ","$33.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.61 ","$0.00 ","$16.81 ","$26.62 ","$26.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29746","ERX","HCPCS 63700001","43598-0510-10","ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR","BOTH IP/OP","$33.61 ","$24.87 ","$0.00 ","$33.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.61 ","$0.00 ","$16.81 ","$26.62 ","$26.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29746","ERX","HCPCS 63700001","65862-0784-30","ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR","BOTH IP/OP","$33.61 ","$24.87 ","$0.00 ","$33.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.61 ","$0.00 ","$16.81 ","$26.62 ","$26.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29778","ERX","HCPCS 63700001","00781-2164-60","ZIPRASIDONE HCL 20 MG PO CAPS","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$32.18 ","","$6.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.18 ","$0.00 ","$16.09 ","$25.49 ","$25.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29778","ERX","HCPCS 63700001","00904-6269-08","ZIPRASIDONE HCL 20 MG PO CAPS","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$32.18 ","","$6.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.18 ","$0.00 ","$16.09 ","$25.49 ","$25.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29778","ERX","HCPCS 63700001","00904-6269-45","ZIPRASIDONE HCL 20 MG PO CAPS","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$32.18 ","","$6.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.18 ","$0.00 ","$16.09 ","$25.49 ","$25.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29778","ERX","HCPCS 63700001","33342-0144-09","ZIPRASIDONE HCL 20 MG PO CAPS","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$32.18 ","","$6.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.18 ","$0.00 ","$16.09 ","$25.49 ","$25.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29778","ERX","HCPCS 63700001","65862-0702-60","ZIPRASIDONE HCL 20 MG PO CAPS","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$32.18 ","","$6.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.18 ","$0.00 ","$16.09 ","$25.49 ","$25.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29778","ERX","HCPCS 63700001","68084-0103-09","ZIPRASIDONE HCL 20 MG PO CAPS","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$32.18 ","","$6.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.18 ","$0.00 ","$16.09 ","$25.49 ","$25.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29779","ERX","HCPCS 63700001","16714-0836-01","ZIPRASIDONE HCL 40 MG PO CAPS","BOTH IP/OP","$37.56 ","$27.79 ","$0.00 ","$34.06 ","","$6.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.06 ","$0.00 ","$17.03 ","$26.98 ","$27.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29779","ERX","HCPCS 63700001","60505-2529-06","ZIPRASIDONE HCL 40 MG PO CAPS","BOTH IP/OP","$37.56 ","$27.79 ","$0.00 ","$34.06 ","","$6.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.06 ","$0.00 ","$17.03 ","$26.98 ","$27.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29779","ERX","HCPCS 63700001","65862-0703-60","ZIPRASIDONE HCL 40 MG PO CAPS","BOTH IP/OP","$37.56 ","$27.79 ","$0.00 ","$34.06 ","","$6.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.06 ","$0.00 ","$17.03 ","$26.98 ","$27.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29779","ERX","HCPCS 63700001","68084-0104-09","ZIPRASIDONE HCL 40 MG PO CAPS","BOTH IP/OP","$37.56 ","$27.79 ","$0.00 ","$34.06 ","","$6.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.06 ","$0.00 ","$17.03 ","$26.98 ","$27.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","00781-2167-60","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","00904-6271-08","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","33342-0146-09","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","55111-0258-60","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","59762-2003-01","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","65862-0704-60","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","68084-0105-09","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29780","ERX","HCPCS 63700001","68180-0333-07","ZIPRASIDONE HCL 60 MG PO CAPS","BOTH IP/OP","$41.34 ","$30.59 ","$0.00 ","$41.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29781","ERX","HCPCS 63700001","00781-2168-60","ZIPRASIDONE HCL 80 MG PO CAPS","BOTH IP/OP","$45.58 ","$33.73 ","$0.00 ","$41.34 ","","$8.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29781","ERX","HCPCS 63700001","00904-6272-08","ZIPRASIDONE HCL 80 MG PO CAPS","BOTH IP/OP","$45.58 ","$33.73 ","$0.00 ","$41.34 ","","$8.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29781","ERX","HCPCS 63700001","68084-0106-09","ZIPRASIDONE HCL 80 MG PO CAPS","BOTH IP/OP","$45.58 ","$33.73 ","$0.00 ","$41.34 ","","$8.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.34 ","$0.00 ","$20.67 ","$32.74 ","$33.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29805","ERX","HCPCS 25000001","10019-0055-61","ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN","BOTH IP/OP","$1,453.64 ","$1,075.69 ","$0.00 ","$1,347.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29805","ERX","HCPCS 25000001","10019-0672-10","ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN","BOTH IP/OP","$1,453.64 ","$1,075.69 ","$0.00 ","$1,347.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29805","ERX","HCPCS 25000001","25021-0308-84","ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN","BOTH IP/OP","$1,453.64 ","$1,075.69 ","$0.00 ","$1,347.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29822","ERX","HCPCS 63700001","00225-0295-15","HYOSCYAMINE SULFATE 0.125 MG PO TBDP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29858","ERX","HCPCS 63700001","00904-6322-61","METOPROLOL SUCCINATE ER 25 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29858","ERX","HCPCS 63700001","50742-0615-01","METOPROLOL SUCCINATE ER 25 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29858","ERX","HCPCS 63700001","51079-0169-20","METOPROLOL SUCCINATE ER 25 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29858","ERX","HCPCS 63700001","55111-0466-01","METOPROLOL SUCCINATE ER 25 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29904","ERX","HCPCS 63700001","68180-0429-01","BIMATOPROST 0.03 % OP SOLN","BOTH IP/OP","$452.36 ","$334.75 ","$0.00 ","$410.63 ","","$80.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.63 ","$0.00 ","$205.32 ","$325.22 ","$328.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29967","ERX","HCPCS 63700001","24689-0785-01","BUSPIRONE HCL 7.5 MG PO TABS","BOTH IP/OP","$6.63 ","$4.91 ","$0.00 ","$6.01 ","","$1.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.01 ","$0.00 ","$3.01 ","$4.76 ","$4.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29967","ERX","HCPCS 63700001","64380-0787-06","BUSPIRONE HCL 7.5 MG PO TABS","BOTH IP/OP","$6.63 ","$4.91 ","$0.00 ","$6.01 ","","$1.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.01 ","$0.00 ","$3.01 ","$4.76 ","$4.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","00904-6323-61","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","50268-0541-11","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","50268-0541-15","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","50742-0616-01","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","55111-0467-01","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","55111-0467-05","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30070","ERX","HCPCS 63700001","62037-0831-01","METOPROLOL SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30071","ERX","HCPCS 63700001","00904-6324-61","METOPROLOL SUCCINATE ER 100 MG PO TB24","BOTH IP/OP","$8.57 ","$6.34 ","$0.00 ","$7.78 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.78 ","$0.00 ","$3.89 ","$6.16 ","$6.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30071","ERX","HCPCS 63700001","50742-0617-01","METOPROLOL SUCCINATE ER 100 MG PO TB24","BOTH IP/OP","$8.57 ","$6.34 ","$0.00 ","$7.78 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.78 ","$0.00 ","$3.89 ","$6.16 ","$6.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30071","ERX","HCPCS 63700001","55111-0468-01","METOPROLOL SUCCINATE ER 100 MG PO TB24","BOTH IP/OP","$8.57 ","$6.34 ","$0.00 ","$7.78 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.78 ","$0.00 ","$3.89 ","$6.16 ","$6.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30071","ERX","HCPCS 63700001","63739-0454-10","METOPROLOL SUCCINATE ER 100 MG PO TB24","BOTH IP/OP","$8.57 ","$6.34 ","$0.00 ","$7.78 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.78 ","$0.00 ","$3.89 ","$6.16 ","$6.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30072","ERX","HCPCS 63700001","00378-4598-77","METOPROLOL SUCCINATE ER 200 MG PO TB24","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","","$1.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30072","ERX","HCPCS 63700001","50742-0618-01","METOPROLOL SUCCINATE ER 200 MG PO TB24","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","","$1.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30072","ERX","HCPCS 63700001","55111-0469-01","METOPROLOL SUCCINATE ER 200 MG PO TB24","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","","$1.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30072","ERX","HCPCS 63700001","55111-0469-05","METOPROLOL SUCCINATE ER 200 MG PO TB24","BOTH IP/OP","$10.56 ","$7.81 ","$0.00 ","$9.58 ","","$1.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30148","ERX","HCPCS 63700001","00004-0038-22","VALGANCICLOVIR HCL 450 MG PO TABS","BOTH IP/OP","$223.46 ","$165.36 ","$0.00 ","$202.86 ","","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.86 ","$0.00 ","$101.43 ","$160.67 ","$162.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30148","ERX","HCPCS 63700001","00603-6330-20","VALGANCICLOVIR HCL 450 MG PO TABS","BOTH IP/OP","$223.46 ","$165.36 ","$0.00 ","$202.86 ","","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.86 ","$0.00 ","$101.43 ","$160.67 ","$162.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30148","ERX","HCPCS 63700001","16714-0765-01","VALGANCICLOVIR HCL 450 MG PO TABS","BOTH IP/OP","$223.46 ","$165.36 ","$0.00 ","$202.86 ","","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.86 ","$0.00 ","$101.43 ","$160.67 ","$162.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30148","ERX","HCPCS 63700001","55111-0762-60","VALGANCICLOVIR HCL 450 MG PO TABS","BOTH IP/OP","$223.46 ","$165.36 ","$0.00 ","$202.86 ","","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.86 ","$0.00 ","$101.43 ","$160.67 ","$162.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30148","ERX","HCPCS 63700001","63739-0357-33","VALGANCICLOVIR HCL 450 MG PO TABS","BOTH IP/OP","$223.46 ","$165.36 ","$0.00 ","$202.86 ","","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.86 ","$0.00 ","$101.43 ","$160.67 ","$162.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30148","ERX","HCPCS 63700001","65862-0753-60","VALGANCICLOVIR HCL 450 MG PO TABS","BOTH IP/OP","$223.46 ","$165.36 ","$0.00 ","$202.86 ","","$39.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.86 ","$0.00 ","$101.43 ","$160.67 ","$162.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30183","ERX","HCPCS 25000001","47781-0570-89","LIDOCAINE-TRANSPARENT DRESSING 4 % EX KIT","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$105.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30213","ERX","HCPCS 63700001","51285-0369-01","METHOTREXATE SODIUM 15 MG PO TABS","BOTH IP/OP","$220.06 ","$162.84 ","$0.00 ","$182.60 ","","$39.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$182.60 ","$0.00 ","$91.30 ","$144.62 ","$146.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30264","ERX","HCPCS 63700001","00904-6084-61","CITALOPRAM HYDROBROMIDE 10 MG PO TABS","BOTH IP/OP","$10.17 ","$7.53 ","$0.00 ","$9.23 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.23 ","$0.00 ","$4.62 ","$7.31 ","$7.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30264","ERX","HCPCS 63700001","13668-0009-01","CITALOPRAM HYDROBROMIDE 10 MG PO TABS","BOTH IP/OP","$10.17 ","$7.53 ","$0.00 ","$9.23 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.23 ","$0.00 ","$4.62 ","$7.31 ","$7.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30264","ERX","HCPCS 63700001","68084-0737-01","CITALOPRAM HYDROBROMIDE 10 MG PO TABS","BOTH IP/OP","$10.17 ","$7.53 ","$0.00 ","$9.23 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.23 ","$0.00 ","$4.62 ","$7.31 ","$7.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30264","ERX","HCPCS 63700001","68084-0737-11","CITALOPRAM HYDROBROMIDE 10 MG PO TABS","BOTH IP/OP","$10.17 ","$7.53 ","$0.00 ","$9.23 ","","$1.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.23 ","$0.00 ","$4.62 ","$7.31 ","$7.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30433","ERX","HCPCS 63700001","50419-0402-03","DROSPIRENONE-ETHINYL ESTRADIOL 3-0.03 MG PO TABS","BOTH IP/OP","$504.18 ","$373.09 ","$0.00 ","$457.66 ","","$89.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.66 ","$0.00 ","$228.83 ","$362.47 ","$366.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30479","ERX","HCPCS 63700001","00054-0199-59","OXCARBAZEPINE 300 MG/5ML PO SUSP","BOTH IP/OP","$11.08 ","$8.20 ","$0.00 ","$10.05 ","","$1.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.05 ","$0.00 ","$5.03 ","$7.96 ","$8.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30479","ERX","HCPCS 63700001","00078-0357-52","OXCARBAZEPINE 300 MG/5ML PO SUSP","BOTH IP/OP","$11.08 ","$8.20 ","$0.00 ","$10.05 ","","$1.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.05 ","$0.00 ","$5.03 ","$7.96 ","$8.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30479","ERX","HCPCS 63700001","00781-6270-43","OXCARBAZEPINE 300 MG/5ML PO SUSP","BOTH IP/OP","$11.08 ","$8.20 ","$0.00 ","$10.05 ","","$1.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.05 ","$0.00 ","$5.03 ","$7.96 ","$8.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30479","ERX","HCPCS 63700001","65162-0649-78","OXCARBAZEPINE 300 MG/5ML PO SUSP","BOTH IP/OP","$11.08 ","$8.20 ","$0.00 ","$10.05 ","","$1.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.05 ","$0.00 ","$5.03 ","$7.96 ","$8.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30479","ERX","HCPCS 63700001","99999-6007-93","OXCARBAZEPINE 300 MG/5ML PO SUSP","BOTH IP/OP","$11.08 ","$8.20 ","$0.00 ","$10.05 ","","$1.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.05 ","$0.00 ","$5.03 ","$7.96 ","$8.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30699","ERX","HCPCS 63700001","43547-0272-10","ROPINIROLE HCL 3 MG PO TABS","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31086","ERX","HCPCS J0690","66288-1100-01","CEFAZOLIN SODIUM 100 G IJ SOLR","BOTH IP/OP","$403.20 ","$298.37 ","$0.00 ","$347.70 ","$181.44 ","$0.00 ","$138.65 ","$0.00 ","$0.00 ","$192.70 ","$347.70 ","$0.00 ","$173.85 ","$275.38 ","$278.16 ","$0.00 ","$192.70 ","$0.00 ","$183.48 ","$0.00 "
"31087","ERX","HCPCS J0690","66288-1300-01","CEFAZOLIN SODIUM 300 G IJ SOLR","BOTH IP/OP","$1,016.16 ","$751.96 ","$0.00 ","$922.20 ","$457.27 ","$0.00 ","$415.95 ","$0.00 ","$0.00 ","$578.10 ","$922.20 ","$0.00 ","$461.10 ","$730.38 ","$737.76 ","$0.00 ","$578.10 ","$0.00 ","$550.45 ","$0.00 "
"31097","ERX","HCPCS J9267","44567-0506-01","PACLITAXEL 300 MG/50ML IV CONC","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","$103.06 ","$0.00 ","$47.73 ","$0.00 ","$0.00 ","$49.35 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$49.35 ","$0.00 ","$46.99 ","$0.00 "
"31097","ERX","HCPCS J9267","47781-0595-07","PACLITAXEL 300 MG/50ML IV CONC","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","$103.06 ","$0.00 ","$47.73 ","$0.00 ","$0.00 ","$49.35 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$49.35 ","$0.00 ","$46.99 ","$0.00 "
"31097","ERX","HCPCS J9267","61703-0342-50","PACLITAXEL 300 MG/50ML IV CONC","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","$103.06 ","$0.00 ","$47.73 ","$0.00 ","$0.00 ","$49.35 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$49.35 ","$0.00 ","$46.99 ","$0.00 "
"31097","ERX","HCPCS J9267","63323-0763-50","PACLITAXEL 300 MG/50ML IV CONC","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","$103.06 ","$0.00 ","$47.73 ","$0.00 ","$0.00 ","$49.35 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$49.35 ","$0.00 ","$46.99 ","$0.00 "
"31097","ERX","HCPCS J9267","67457-0434-51","PACLITAXEL 300 MG/50ML IV CONC","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","$103.06 ","$0.00 ","$47.73 ","$0.00 ","$0.00 ","$49.35 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$49.35 ","$0.00 ","$46.99 ","$0.00 "
"31097","ERX","HCPCS J9267","70860-0200-50","PACLITAXEL 300 MG/50ML IV CONC","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","$103.06 ","$0.00 ","$47.73 ","$0.00 ","$0.00 ","$49.35 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$49.35 ","$0.00 ","$46.99 ","$0.00 "
"31177","ERX","HCPCS 63700001","00093-8675-78","AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR","BOTH IP/OP","$148.23 ","$109.69 ","$0.00 ","$253.97 ","","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.97 ","$0.00 ","$126.99 ","$106.44 ","$203.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31177","ERX","HCPCS 63700001","16714-0294-01","AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR","BOTH IP/OP","$148.23 ","$109.69 ","$0.00 ","$253.97 ","","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.97 ","$0.00 ","$126.99 ","$106.44 ","$203.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31177","ERX","HCPCS 63700001","16714-0294-02","AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR","BOTH IP/OP","$148.23 ","$109.69 ","$0.00 ","$253.97 ","","$26.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.97 ","$0.00 ","$126.99 ","$201.14 ","$203.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31209","ERX","HCPCS 63700001","00078-0358-34","VALSARTAN 80 MG PO TABS","BOTH IP/OP","$39.50 ","$29.23 ","$0.00 ","$35.82 ","","$7.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.82 ","$0.00 ","$17.91 ","$28.37 ","$28.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31209","ERX","HCPCS 63700001","00378-5813-77","VALSARTAN 80 MG PO TABS","BOTH IP/OP","$39.50 ","$29.23 ","$0.00 ","$35.82 ","","$7.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.82 ","$0.00 ","$17.91 ","$28.37 ","$28.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31209","ERX","HCPCS 63700001","33342-0063-10","VALSARTAN 80 MG PO TABS","BOTH IP/OP","$39.50 ","$29.23 ","$0.00 ","$35.82 ","","$7.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.82 ","$0.00 ","$17.91 ","$28.37 ","$28.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31209","ERX","HCPCS 63700001","59746-0361-90","VALSARTAN 80 MG PO TABS","BOTH IP/OP","$39.50 ","$29.23 ","$0.00 ","$35.82 ","","$7.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.82 ","$0.00 ","$17.91 ","$28.37 ","$28.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31210","ERX","HCPCS 63700001","00078-0359-34","VALSARTAN 160 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31210","ERX","HCPCS 63700001","33342-0064-10","VALSARTAN 160 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31210","ERX","HCPCS 63700001","59746-0362-90","VALSARTAN 160 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31210","ERX","HCPCS 63700001","65862-0572-90","VALSARTAN 160 MG PO TABS","BOTH IP/OP","$19.00 ","$14.06 ","$0.00 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31211","ERX","HCPCS 63700001","00078-0360-34","VALSARTAN 320 MG PO TABS","BOTH IP/OP","$53.72 ","$39.75 ","$0.00 ","$48.72 ","","$9.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.72 ","$0.00 ","$24.36 ","$38.59 ","$38.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31211","ERX","HCPCS 63700001","33342-0065-10","VALSARTAN 320 MG PO TABS","BOTH IP/OP","$53.72 ","$39.75 ","$0.00 ","$48.72 ","","$9.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.72 ","$0.00 ","$24.36 ","$38.59 ","$38.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31239","ERX","HCPCS 63700001","50580-0728-24","CETIRIZINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31270","ERX","HCPCS Q9957","11994-0011-04","PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP","BOTH IP/OP","$1,065.54 ","$788.50 ","$0.00 ","$844.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$844.71 ","$0.00 ","$422.36 ","$669.01 ","$675.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31310","ERX","HCPCS J2997","50242-0041-64","ALTEPLASE 2 MG IJ SOLR","BOTH IP/OP","$617.14 ","$456.68 ","$0.00 ","$560.20 ","$277.71 ","$175.34 ","$128.63 ","$0.00 ","$0.00 ","$98.09 ","$560.20 ","$184.04 ","$280.10 ","$443.68 ","$448.16 ","$254.15 ","$87.67 ","$0.00 ","$89.18 ","$175.77 "
"31336","ERX","HCPCS 63700001","00115-5511-10","FENOFIBRATE 54 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31336","ERX","HCPCS 63700001","42858-0454-45","FENOFIBRATE 54 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31415","ERX","HCPCS 63700001","00187-0650-42","METHOXSALEN RAPID 10 MG PO CAPS","BOTH IP/OP","$310.80 ","$229.99 ","$0.00 ","$310.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.80 ","$0.00 ","$155.40 ","$246.15 ","$248.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31432","ERX","HCPCS J1162","50633-0120-11","DIGOXIN IMMUNE FAB 40 MG IV SOLR","BOTH IP/OP","$112,086.96 ","$82,944.35 ","$0.00 ","$97,760.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97,760.40 ","$0.00 ","$48,880.20 ","$74,445.31 ","$78,208.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31530","ERX","HCPCS 25000001","00052-0273-01","ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING","BOTH IP/OP","$655.73 ","$485.24 ","$0.00 ","$595.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$595.23 ","$0.00 ","$297.62 ","$471.42 ","$476.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31530","ERX","HCPCS 25000001","00052-0273-03","ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING","BOTH IP/OP","$655.73 ","$485.24 ","$0.00 ","$595.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$595.23 ","$0.00 ","$297.62 ","$471.42 ","$476.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31576","ERX","HCPCS 63700001","00574-9850-10","BUDESONIDE 3 MG PO CPEP","BOTH IP/OP","$71.62 ","$53.00 ","$0.00 ","$71.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.62 ","$0.00 ","$35.81 ","$56.72 ","$57.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31576","ERX","HCPCS 63700001","16714-0829-01","BUDESONIDE 3 MG PO CPEP","BOTH IP/OP","$71.62 ","$53.00 ","$0.00 ","$71.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.62 ","$0.00 ","$35.81 ","$56.72 ","$57.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31684","ERX","HCPCS 63700001","42291-0800-30","TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS","BOTH IP/OP","$23.36 ","$17.29 ","$0.00 ","$21.18 ","","$4.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.18 ","$0.00 ","$10.59 ","$16.77 ","$16.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31684","ERX","HCPCS 63700001","61958-0401-01","TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS","BOTH IP/OP","$23.36 ","$17.29 ","$0.00 ","$21.18 ","","$4.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.18 ","$0.00 ","$10.59 ","$16.77 ","$16.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31684","ERX","HCPCS 63700001","64380-0714-04","TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS","BOTH IP/OP","$23.36 ","$17.29 ","$0.00 ","$21.18 ","","$4.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.18 ","$0.00 ","$10.59 ","$16.77 ","$16.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31684","ERX","HCPCS 63700001","65862-0421-30","TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS","BOTH IP/OP","$23.36 ","$17.29 ","$0.00 ","$21.18 ","","$4.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.18 ","$0.00 ","$10.59 ","$16.77 ","$16.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31688","ERX","HCPCS J2501","00074-4637-01","PARICALCITOL 2 MCG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.30 ","$0.00 ","$0.00 ","$0.90 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.90 ","$0.00 ","$0.86 ","$0.00 "
"31688","ERX","HCPCS J2501","55150-0212-01","PARICALCITOL 2 MCG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.30 ","$0.00 ","$0.00 ","$0.90 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.90 ","$0.00 ","$0.86 ","$0.00 "
"31688","ERX","HCPCS J2501","67457-0379-25","PARICALCITOL 2 MCG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.30 ","$0.00 ","$0.00 ","$0.90 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.90 ","$0.00 ","$0.86 ","$0.00 "
"31784","ERX","HCPCS 25000001","66658-0234-01","ANAKINRA 100 MG/0.67ML SC SOSY","BOTH IP/OP","$597.05 ","$441.82 ","$0.00 ","$567.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.34 ","$0.00 ","$283.67 ","$449.33 ","$453.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31784","ERX","HCPCS 25000001","66658-0234-07","ANAKINRA 100 MG/0.67ML SC SOSY","BOTH IP/OP","$597.05 ","$441.82 ","$0.00 ","$567.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.34 ","$0.00 ","$283.67 ","$449.33 ","$453.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31876","ERX","HCPCS 63700001","66215-0102-06","BOSENTAN 125 MG PO TABS","BOTH IP/OP","$679.29 ","$502.67 ","$0.00 ","$616.48 ","","$120.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$616.48 ","$0.00 ","$308.24 ","$488.25 ","$493.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31921","ERX","HCPCS J1650","00548-5607-00","ENOXAPARIN SODIUM 150 MG/ML SC SOLN","BOTH IP/OP","$409.82 ","$303.27 ","$0.00 ","$372.01 ","$184.42 ","$0.00 ","$85.42 ","$0.00 ","$0.00 ","$65.14 ","$372.01 ","$0.00 ","$186.01 ","$294.63 ","$297.61 ","$0.00 ","$58.22 ","$0.00 ","$59.22 ","$0.00 "
"31921","ERX","HCPCS J1650","00781-3655-69","ENOXAPARIN SODIUM 150 MG/ML SC SOLN","BOTH IP/OP","$409.82 ","$303.27 ","$0.00 ","$372.01 ","$184.42 ","$0.00 ","$85.42 ","$0.00 ","$0.00 ","$65.14 ","$372.01 ","$0.00 ","$186.01 ","$294.63 ","$297.61 ","$0.00 ","$58.22 ","$0.00 ","$59.22 ","$0.00 "
"31921","ERX","HCPCS J1650","00955-1015-10","ENOXAPARIN SODIUM 150 MG/ML SC SOLN","BOTH IP/OP","$409.82 ","$303.27 ","$0.00 ","$372.01 ","$184.42 ","$0.00 ","$85.42 ","$0.00 ","$0.00 ","$65.14 ","$372.01 ","$0.00 ","$186.01 ","$294.63 ","$297.61 ","$0.00 ","$58.22 ","$0.00 ","$59.22 ","$0.00 "
"31921","ERX","HCPCS J1650","63323-0537-84","ENOXAPARIN SODIUM 150 MG/ML SC SOLN","BOTH IP/OP","$409.82 ","$303.27 ","$0.00 ","$372.01 ","$184.42 ","$0.00 ","$85.42 ","$0.00 ","$0.00 ","$65.14 ","$372.01 ","$0.00 ","$186.01 ","$294.63 ","$297.61 ","$0.00 ","$58.22 ","$0.00 ","$59.22 ","$0.00 "
"31922","ERX","HCPCS J1335","00006-3843-71","ERTAPENEM SODIUM 1 G IJ SOLR","BOTH IP/OP","$243.74 ","$180.37 ","$0.00 ","$221.27 ","$109.68 ","$0.00 ","$50.80 ","$0.00 ","$0.00 ","$45.47 ","$221.27 ","$0.00 ","$110.64 ","$175.25 ","$177.02 ","$0.00 ","$45.47 ","$0.00 ","$43.30 ","$0.00 "
"31922","ERX","HCPCS J1335","42023-0221-10","ERTAPENEM SODIUM 1 G IJ SOLR","BOTH IP/OP","$243.74 ","$180.37 ","$0.00 ","$221.27 ","$109.68 ","$0.00 ","$50.80 ","$0.00 ","$0.00 ","$45.47 ","$221.27 ","$0.00 ","$110.64 ","$175.25 ","$177.02 ","$0.00 ","$45.47 ","$0.00 ","$43.30 ","$0.00 "
"31922","ERX","HCPCS J1335","55150-0282-20","ERTAPENEM SODIUM 1 G IJ SOLR","BOTH IP/OP","$243.74 ","$180.37 ","$0.00 ","$221.27 ","$109.68 ","$0.00 ","$50.80 ","$0.00 ","$0.00 ","$45.47 ","$221.27 ","$0.00 ","$110.64 ","$175.25 ","$177.02 ","$0.00 ","$45.47 ","$0.00 ","$43.30 ","$0.00 "
"32052","ERX","HCPCS 25000001","00187-5100-01","PIMECROLIMUS 1 % EX CREA","BOTH IP/OP","$939.08 ","$694.92 ","$0.00 ","$852.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$852.24 ","$0.00 ","$426.12 ","$674.97 ","$681.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32052","ERX","HCPCS 25000001","68462-0609-35","PIMECROLIMUS 1 % EX CREA","BOTH IP/OP","$939.08 ","$694.92 ","$0.00 ","$852.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$852.24 ","$0.00 ","$426.12 ","$674.97 ","$681.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32052","ERX","HCPCS 25000001","68682-0110-01","PIMECROLIMUS 1 % EX CREA","BOTH IP/OP","$939.08 ","$694.92 ","$0.00 ","$852.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$852.24 ","$0.00 ","$426.12 ","$674.97 ","$681.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32128","ERX","HCPCS 63700001","00093-7270-98","PRAVASTATIN SODIUM 80 MG PO TABS","BOTH IP/OP","$20.09 ","$14.87 ","$0.00 ","$18.22 ","","$3.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.22 ","$0.00 ","$9.11 ","$14.43 ","$14.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32128","ERX","HCPCS 63700001","16729-0011-15","PRAVASTATIN SODIUM 80 MG PO TABS","BOTH IP/OP","$20.09 ","$14.87 ","$0.00 ","$18.22 ","","$3.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.22 ","$0.00 ","$9.11 ","$14.43 ","$14.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32128","ERX","HCPCS 63700001","60505-1323-09","PRAVASTATIN SODIUM 80 MG PO TABS","BOTH IP/OP","$20.09 ","$14.87 ","$0.00 ","$18.22 ","","$3.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.22 ","$0.00 ","$9.11 ","$14.43 ","$14.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32128","ERX","HCPCS 63700001","68462-0198-90","PRAVASTATIN SODIUM 80 MG PO TABS","BOTH IP/OP","$20.09 ","$14.87 ","$0.00 ","$18.22 ","","$3.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.22 ","$0.00 ","$9.11 ","$14.43 ","$14.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32215","ERX","HCPCS J1652","55111-0678-02","FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","BOTH IP/OP","$189.65 ","$140.34 ","$0.00 ","$172.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.16 ","$0.00 ","$86.08 ","$136.35 ","$137.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32215","ERX","HCPCS J1652","55111-0678-10","FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","BOTH IP/OP","$189.65 ","$140.34 ","$0.00 ","$172.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.16 ","$0.00 ","$86.08 ","$136.35 ","$137.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32215","ERX","HCPCS J1652","55511-0678-11","FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","BOTH IP/OP","$189.65 ","$140.34 ","$0.00 ","$172.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.16 ","$0.00 ","$86.08 ","$136.35 ","$137.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32298","ERX","HCPCS 63700001","00056-0510-30","EFAVIRENZ 600 MG PO TABS","BOTH IP/OP","$151.41 ","$112.04 ","$0.00 ","$137.29 ","","$26.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.29 ","$0.00 ","$68.65 ","$108.73 ","$109.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32298","ERX","HCPCS 63700001","69097-0301-02","EFAVIRENZ 600 MG PO TABS","BOTH IP/OP","$151.41 ","$112.04 ","$0.00 ","$137.29 ","","$26.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.29 ","$0.00 ","$68.65 ","$108.73 ","$109.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32354","ERX","HCPCS 25000001","42192-0139-01","SULFACETAMIDE SODIUM-SULFUR 10-5 % EX CREA","BOTH IP/OP","$398.53 ","$294.91 ","$0.00 ","$361.76 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.76 ","$0.00 ","$180.88 ","$286.51 ","$289.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32375","ERX","HCPCS 25000001","24208-0344-25","FLUNISOLIDE 25 MCG/ACT (0.025%) NA SOLN","BOTH IP/OP","$249.67 ","$184.76 ","$0.00 ","$226.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.65 ","$0.00 ","$113.33 ","$179.51 ","$181.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32589","ERX","HCPCS J2430","61703-0324-18","PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN","BOTH IP/OP","$70.48 ","$52.16 ","$0.00 ","$62.97 ","$31.72 ","$0.00 ","$36.23 ","$0.00 ","$0.00 ","$11.03 ","$62.97 ","$0.00 ","$31.49 ","$49.87 ","$50.38 ","$0.00 ","$9.85 ","$0.00 ","$10.02 ","$0.00 "
"32589","ERX","HCPCS J2430","67457-0430-10","PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN","BOTH IP/OP","$70.48 ","$52.16 ","$0.00 ","$62.97 ","$31.72 ","$0.00 ","$36.23 ","$0.00 ","$0.00 ","$11.03 ","$62.97 ","$0.00 ","$31.49 ","$49.87 ","$50.38 ","$0.00 ","$9.85 ","$0.00 ","$10.02 ","$0.00 "
"32703","ERX","HCPCS 25000001","08212-4271-81","ILEX SKIN PROTECTANT 58.3 % EX PSTE","BOTH IP/OP","$26.15 ","$19.35 ","$0.00 ","$23.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.72 ","$0.00 ","$11.86 ","$18.79 ","$18.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32810","ERX","HCPCS 25000001","89141-0456-02","GELCLAIR MT GEL","BOTH IP/OP","$188.53 ","$139.51 ","$0.00 ","$171.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.14 ","$0.00 ","$85.57 ","$135.54 ","$136.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32810","ERX","HCPCS 25000001","89141-0456-03","GELCLAIR MT GEL","BOTH IP/OP","$188.53 ","$139.51 ","$0.00 ","$171.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.14 ","$0.00 ","$85.57 ","$135.54 ","$136.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32893","ERX","HCPCS J9217","62935-0753-75","LEUPROLIDE ACETATE 7.5 MG SC KIT","BOTH IP/OP","$1,403.86 ","$1,038.86 ","$0.00 ","$1,300.88 ","$631.74 ","$200.73 ","$246.83 ","$0.00 ","$0.00 ","$270.33 ","$1,300.88 ","$235.93 ","$650.44 ","$1,030.30 ","$1,040.70 ","$325.81 ","$270.33 ","$0.00 ","$257.40 ","$205.89 "
"32895","ERX","HCPCS 63700001","00430-0472-03","RISEDRONATE SODIUM 35 MG PO TABS","BOTH IP/OP","$343.72 ","$254.35 ","$0.00 ","$312.00 ","","$61.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.00 ","$0.00 ","$156.00 ","$247.10 ","$249.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32960","ERX","HCPCS J7192","00026-3783-35","ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 500 UNITS IV KIT","BOTH IP/OP","$2,364.00 ","$1,749.36 ","$0.00 ","$2,364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,364.00 ","$0.00 ","$1,182.00 ","$1,872.29 ","$1,891.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32961","ERX","HCPCS J7192","00026-3785-55","ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT","BOTH IP/OP","$4,452.20 ","$3,294.63 ","$0.00 ","$4,038.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,038.50 ","$0.00 ","$2,019.25 ","$3,198.49 ","$3,230.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32961","ERX","HCPCS J7192","00026-4785-01","ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT","BOTH IP/OP","$4,452.20 ","$3,294.63 ","$0.00 ","$4,038.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,038.50 ","$0.00 ","$2,019.25 ","$3,198.49 ","$3,230.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32979","ERX","HCPCS 63700001","00078-0401-34","IMATINIB MESYLATE 100 MG PO TABS","BOTH IP/OP","$1,312.44 ","$971.21 ","$0.00 ","$1,191.08 ","","$233.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33008","ERX","HCPCS 63700001","00049-3170-30","VORICONAZOLE 50 MG PO TABS","BOTH IP/OP","$14.97 ","$11.08 ","$0.00 ","$13.38 ","","$2.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.38 ","$0.00 ","$6.69 ","$10.60 ","$10.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33008","ERX","HCPCS 63700001","00781-5667-31","VORICONAZOLE 50 MG PO TABS","BOTH IP/OP","$14.97 ","$11.08 ","$0.00 ","$13.38 ","","$2.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.38 ","$0.00 ","$6.69 ","$10.60 ","$10.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33008","ERX","HCPCS 63700001","16714-0514-01","VORICONAZOLE 50 MG PO TABS","BOTH IP/OP","$14.97 ","$11.08 ","$0.00 ","$13.38 ","","$2.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.38 ","$0.00 ","$6.69 ","$10.60 ","$10.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33009","ERX","HCPCS 63700001","00049-3180-30","VORICONAZOLE 200 MG PO TABS","BOTH IP/OP","$18.73 ","$13.86 ","$0.00 ","$16.73 ","","$3.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.73 ","$0.00 ","$8.37 ","$13.25 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33009","ERX","HCPCS 63700001","00781-5668-31","VORICONAZOLE 200 MG PO TABS","BOTH IP/OP","$18.73 ","$13.86 ","$0.00 ","$16.73 ","","$3.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.73 ","$0.00 ","$8.37 ","$13.25 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33009","ERX","HCPCS 63700001","16714-0515-01","VORICONAZOLE 200 MG PO TABS","BOTH IP/OP","$18.73 ","$13.86 ","$0.00 ","$16.73 ","","$3.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.73 ","$0.00 ","$8.37 ","$13.25 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33009","ERX","HCPCS 63700001","51079-0165-03","VORICONAZOLE 200 MG PO TABS","BOTH IP/OP","$18.73 ","$13.86 ","$0.00 ","$16.73 ","","$3.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.73 ","$0.00 ","$8.37 ","$13.25 ","$13.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33010","ERX","HCPCS J3465","00049-3190-01","VORICONAZOLE 200 MG IV SOLR","BOTH IP/OP","$512.67 ","$379.38 ","$0.00 ","$465.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.37 ","$0.00 ","$232.69 ","$368.57 ","$372.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33010","ERX","HCPCS J3465","00049-3190-28","VORICONAZOLE 200 MG IV SOLR","BOTH IP/OP","$512.67 ","$379.38 ","$0.00 ","$465.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.37 ","$0.00 ","$232.69 ","$368.57 ","$372.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33010","ERX","HCPCS J3465","00781-3416-94","VORICONAZOLE 200 MG IV SOLR","BOTH IP/OP","$512.67 ","$379.38 ","$0.00 ","$465.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.37 ","$0.00 ","$232.69 ","$368.57 ","$372.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33010","ERX","HCPCS J3465","47781-0466-71","VORICONAZOLE 200 MG IV SOLR","BOTH IP/OP","$512.67 ","$379.38 ","$0.00 ","$465.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.37 ","$0.00 ","$232.69 ","$368.57 ","$372.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33083","ERX","HCPCS 63700001","00245-0213-11","MIDODRINE HCL 10 MG PO TABS","BOTH IP/OP","$36.62 ","$27.10 ","$0.00 ","$16.55 ","","$6.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.55 ","$0.00 ","$8.28 ","$13.11 ","$13.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33083","ERX","HCPCS 63700001","00378-1903-01","MIDODRINE HCL 10 MG PO TABS","BOTH IP/OP","$36.62 ","$27.10 ","$0.00 ","$16.55 ","","$6.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.55 ","$0.00 ","$8.28 ","$13.11 ","$13.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33083","ERX","HCPCS 63700001","42291-0562-90","MIDODRINE HCL 10 MG PO TABS","BOTH IP/OP","$36.62 ","$27.10 ","$0.00 ","$16.55 ","","$6.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.55 ","$0.00 ","$8.28 ","$13.11 ","$13.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33111","ERX","HCPCS 63700001","55111-0341-01","AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS","BOTH IP/OP","$13.92 ","$10.30 ","$0.00 ","$12.62 ","","$2.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.62 ","$0.00 ","$6.31 ","$10.00 ","$10.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33111","ERX","HCPCS 63700001","65862-0586-01","AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS","BOTH IP/OP","$13.92 ","$10.30 ","$0.00 ","$12.62 ","","$2.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.62 ","$0.00 ","$6.31 ","$10.00 ","$10.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33175","ERX","HCPCS J3486","00049-3920-83","ZIPRASIDONE MESYLATE 20 MG IM SOLR","BOTH IP/OP","$82.44 ","$61.01 ","$0.00 ","$74.77 ","$37.10 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$21.10 ","$74.77 ","$0.00 ","$37.39 ","$59.22 ","$59.82 ","$0.00 ","$21.10 ","$0.00 ","$20.09 ","$0.00 "
"33175","ERX","HCPCS J3486","43598-0848-58","ZIPRASIDONE MESYLATE 20 MG IM SOLR","BOTH IP/OP","$82.44 ","$61.01 ","$0.00 ","$74.77 ","$37.10 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$21.10 ","$74.77 ","$0.00 ","$37.39 ","$59.22 ","$59.82 ","$0.00 ","$21.10 ","$0.00 ","$20.09 ","$0.00 "
"33175","ERX","HCPCS J3486","72266-0160-01","ZIPRASIDONE MESYLATE 20 MG IM SOLR","BOTH IP/OP","$82.44 ","$61.01 ","$0.00 ","$74.77 ","$37.10 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$21.10 ","$74.77 ","$0.00 ","$37.39 ","$59.22 ","$59.82 ","$0.00 ","$21.10 ","$0.00 ","$20.09 ","$0.00 "
"33175","ERX","HCPCS J3486","72266-0160-10","ZIPRASIDONE MESYLATE 20 MG IM SOLR","BOTH IP/OP","$82.44 ","$61.01 ","$0.00 ","$74.77 ","$37.10 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$21.10 ","$74.77 ","$0.00 ","$37.39 ","$59.22 ","$59.82 ","$0.00 ","$21.10 ","$0.00 ","$20.09 ","$0.00 "
"33226","ERX","HCPCS 63700001","00093-2272-34","AMOXICILLIN-POT CLAVULANATE 400-57 MG PO CHEW","BOTH IP/OP","$22.59 ","$16.72 ","$0.00 ","$20.49 ","","$4.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.49 ","$0.00 ","$10.25 ","$16.23 ","$16.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33227","ERX","HCPCS 63700001","00093-2274-34","AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS","BOTH IP/OP","$15.86 ","$11.74 ","$0.00 ","$14.39 ","","$2.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.39 ","$0.00 ","$7.20 ","$11.40 ","$11.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33227","ERX","HCPCS 63700001","16714-0296-01","AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS","BOTH IP/OP","$15.86 ","$11.74 ","$0.00 ","$14.39 ","","$2.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.39 ","$0.00 ","$7.20 ","$11.40 ","$11.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33227","ERX","HCPCS 63700001","16714-0494-01","AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS","BOTH IP/OP","$15.86 ","$11.74 ","$0.00 ","$14.39 ","","$2.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.39 ","$0.00 ","$7.20 ","$11.40 ","$11.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33227","ERX","HCPCS 63700001","65862-0502-20","AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS","BOTH IP/OP","$15.86 ","$11.74 ","$0.00 ","$14.39 ","","$2.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.39 ","$0.00 ","$7.20 ","$11.40 ","$11.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33227","ERX","HCPCS 63700001","66685-1002-02","AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS","BOTH IP/OP","$15.86 ","$11.74 ","$0.00 ","$14.39 ","","$2.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.39 ","$0.00 ","$7.20 ","$11.40 ","$11.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","00093-2275-34","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","00781-1852-20","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","16714-0297-01","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","16714-0297-02","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","16714-0478-01","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","16714-0478-02","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","43598-0221-14","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","65862-0503-01","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","65862-0503-20","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33228","ERX","HCPCS 63700001","66685-1001-00","AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","BOTH IP/OP","$20.58 ","$15.23 ","$0.00 ","$18.66 ","","$3.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$0.00 ","$9.33 ","$14.78 ","$14.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33230","ERX","HCPCS 63700001","16714-0293-01","AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR","BOTH IP/OP","$180.65 ","$133.68 ","$0.00 ","$123.03 ","","$32.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.03 ","$0.00 ","$61.52 ","$97.44 ","$98.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33230","ERX","HCPCS 63700001","66685-1012-00","AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR","BOTH IP/OP","$180.65 ","$133.68 ","$0.00 ","$123.03 ","","$32.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.03 ","$0.00 ","$61.52 ","$97.44 ","$98.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33512","ERX","HCPCS 63700001","00093-5851-01","ESCITALOPRAM OXALATE 10 MG PO TABS","BOTH IP/OP","$18.15 ","$13.43 ","$0.00 ","$16.46 ","","$3.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.46 ","$0.00 ","$8.23 ","$13.04 ","$13.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33512","ERX","HCPCS 63700001","00904-6426-61","ESCITALOPRAM OXALATE 10 MG PO TABS","BOTH IP/OP","$18.15 ","$13.43 ","$0.00 ","$16.46 ","","$3.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.46 ","$0.00 ","$8.23 ","$13.04 ","$13.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33512","ERX","HCPCS 63700001","43547-0281-10","ESCITALOPRAM OXALATE 10 MG PO TABS","BOTH IP/OP","$18.15 ","$13.43 ","$0.00 ","$16.46 ","","$3.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.46 ","$0.00 ","$8.23 ","$13.04 ","$13.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33512","ERX","HCPCS 63700001","76282-0250-90","ESCITALOPRAM OXALATE 10 MG PO TABS","BOTH IP/OP","$18.15 ","$13.43 ","$0.00 ","$16.46 ","","$3.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.46 ","$0.00 ","$8.23 ","$13.04 ","$13.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33513","ERX","HCPCS 63700001","00456-2020-01","ESCITALOPRAM OXALATE 20 MG PO TABS","BOTH IP/OP","$18.94 ","$14.02 ","$0.00 ","$17.18 ","","$3.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.18 ","$0.00 ","$8.59 ","$13.61 ","$13.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33513","ERX","HCPCS 63700001","00904-6427-61","ESCITALOPRAM OXALATE 20 MG PO TABS","BOTH IP/OP","$18.94 ","$14.02 ","$0.00 ","$17.18 ","","$3.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.18 ","$0.00 ","$8.59 ","$13.61 ","$13.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33513","ERX","HCPCS 63700001","43547-0282-10","ESCITALOPRAM OXALATE 20 MG PO TABS","BOTH IP/OP","$18.94 ","$14.02 ","$0.00 ","$17.18 ","","$3.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.18 ","$0.00 ","$8.59 ","$13.61 ","$13.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33513","ERX","HCPCS 63700001","65862-0375-01","ESCITALOPRAM OXALATE 20 MG PO TABS","BOTH IP/OP","$18.94 ","$14.02 ","$0.00 ","$17.18 ","","$3.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.18 ","$0.00 ","$8.59 ","$13.61 ","$13.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33541","ERX","HCPCS 63700001","00378-5807-93","VALSARTAN 40 MG PO TABS","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$15.41 ","","$3.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.41 ","$0.00 ","$7.71 ","$12.20 ","$12.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33541","ERX","HCPCS 63700001","33342-0062-07","VALSARTAN 40 MG PO TABS","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$15.41 ","","$3.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.41 ","$0.00 ","$7.71 ","$12.20 ","$12.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33541","ERX","HCPCS 63700001","59746-0360-30","VALSARTAN 40 MG PO TABS","BOTH IP/OP","$17.00 ","$12.58 ","$0.00 ","$15.41 ","","$3.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.41 ","$0.00 ","$7.71 ","$12.20 ","$12.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33591","ERX","HCPCS J2783","00024-5150-10","RASBURICASE 1.5 MG IV SOLR","BOTH IP/OP","$2,598.18 ","$1,922.65 ","$0.00 ","$2,243.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,243.20 ","$0.00 ","$1,121.60 ","$1,776.61 ","$1,794.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33666","ERX","HCPCS J1815","00169-3685-12","INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUSP","BOTH IP/OP","$1,051.61 ","$778.19 ","$0.00 ","$954.38 ","$571.02 ","$0.00 ","$219.18 ","$0.00 ","$0.00 ","$167.10 ","$954.38 ","$0.00 ","$477.19 ","$755.87 ","$763.50 ","$0.00 ","$0.00 ","$0.00 ","$201.38 ","$0.00 "
"33669","ERX","HCPCS J9217","62935-0223-05","LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT","BOTH IP/OP","$3,674.95 ","$2,719.46 ","$0.00 ","$3,333.47 ","$1,653.73 ","$602.20 ","$740.50 ","$0.00 ","$0.00 ","$811.00 ","$3,333.47 ","$707.80 ","$1,666.74 ","$2,640.11 ","$2,666.78 ","$977.44 ","$811.00 ","$0.00 ","$772.21 ","$617.66 "
"33816","ERX","HCPCS 63700001","61958-0501-01","ADEFOVIR DIPIVOXIL 10 MG PO TABS","BOTH IP/OP","$226.29 ","$167.45 ","$0.00 ","$196.01 ","","$40.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.01 ","$0.00 ","$98.01 ","$155.24 ","$156.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33826","ERX","HCPCS 63700001","00245-0272-06","OXANDROLONE 10 MG PO TABS","BOTH IP/OP","$78.57 ","$58.14 ","$0.00 ","$71.26 ","","$13.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.26 ","$0.00 ","$35.63 ","$56.44 ","$57.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33826","ERX","HCPCS 63700001","49884-0302-02","OXANDROLONE 10 MG PO TABS","BOTH IP/OP","$78.57 ","$58.14 ","$0.00 ","$71.26 ","","$13.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.26 ","$0.00 ","$35.63 ","$56.44 ","$57.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33863","ERX","HCPCS J7192","00026-3786-65","ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT","BOTH IP/OP","$8,904.40 ","$6,589.26 ","$0.00 ","$8,077.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,077.00 ","$0.00 ","$4,038.50 ","$6,396.98 ","$6,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33863","ERX","HCPCS J7192","00026-4786-01","ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT","BOTH IP/OP","$8,904.40 ","$6,589.26 ","$0.00 ","$8,077.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,077.00 ","$0.00 ","$4,038.50 ","$6,396.98 ","$6,461.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33937","ERX","HCPCS 63700001","31722-0754-30","LAMIVUDINE 300 MG PO TABS","BOTH IP/OP","$59.95 ","$44.36 ","$0.00 ","$54.37 ","","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.37 ","$0.00 ","$27.19 ","$43.06 ","$43.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33937","ERX","HCPCS 63700001","60505-3252-03","LAMIVUDINE 300 MG PO TABS","BOTH IP/OP","$59.95 ","$44.36 ","$0.00 ","$54.37 ","","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.37 ","$0.00 ","$27.19 ","$43.06 ","$43.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33937","ERX","HCPCS 63700001","64380-0711-04","LAMIVUDINE 300 MG PO TABS","BOTH IP/OP","$59.95 ","$44.36 ","$0.00 ","$54.37 ","","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.37 ","$0.00 ","$27.19 ","$43.06 ","$43.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33937","ERX","HCPCS 63700001","65862-0553-30","LAMIVUDINE 300 MG PO TABS","BOTH IP/OP","$59.95 ","$44.36 ","$0.00 ","$54.37 ","","$10.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.37 ","$0.00 ","$27.19 ","$43.06 ","$43.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34153","ERX","HCPCS 63700001","00591-3713-19","EZETIMIBE 10 MG PO TABS","BOTH IP/OP","$10.96 ","$8.11 ","$0.00 ","$9.94 ","","$1.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.94 ","$0.00 ","$4.97 ","$7.87 ","$7.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34153","ERX","HCPCS 63700001","00781-5690-92","EZETIMIBE 10 MG PO TABS","BOTH IP/OP","$10.96 ","$8.11 ","$0.00 ","$9.94 ","","$1.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.94 ","$0.00 ","$4.97 ","$7.87 ","$7.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34153","ERX","HCPCS 63700001","59651-0052-90","EZETIMIBE 10 MG PO TABS","BOTH IP/OP","$10.96 ","$8.11 ","$0.00 ","$9.94 ","","$1.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.94 ","$0.00 ","$4.97 ","$7.87 ","$7.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34153","ERX","HCPCS 63700001","66582-0414-31","EZETIMIBE 10 MG PO TABS","BOTH IP/OP","$10.96 ","$8.11 ","$0.00 ","$9.94 ","","$1.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.94 ","$0.00 ","$4.97 ","$7.87 ","$7.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34153","ERX","HCPCS 63700001","68382-0773-16","EZETIMIBE 10 MG PO TABS","BOTH IP/OP","$10.96 ","$8.11 ","$0.00 ","$9.94 ","","$1.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.94 ","$0.00 ","$4.97 ","$7.87 ","$7.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34153","ERX","HCPCS 63700001","69238-1154-03","EZETIMIBE 10 MG PO TABS","BOTH IP/OP","$10.96 ","$8.11 ","$0.00 ","$9.94 ","","$1.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.94 ","$0.00 ","$4.97 ","$7.87 ","$7.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34369","ERX","HCPCS 63700001","16714-0785-01","ARIPIPRAZOLE 10 MG PO TABS","BOTH IP/OP","$123.03 ","$91.04 ","$0.00 ","$111.56 ","","$21.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.56 ","$0.00 ","$55.78 ","$88.36 ","$89.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34369","ERX","HCPCS 63700001","27241-0053-03","ARIPIPRAZOLE 10 MG PO TABS","BOTH IP/OP","$123.03 ","$91.04 ","$0.00 ","$111.56 ","","$21.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.56 ","$0.00 ","$55.78 ","$88.36 ","$89.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34369","ERX","HCPCS 63700001","43598-0556-30","ARIPIPRAZOLE 10 MG PO TABS","BOTH IP/OP","$123.03 ","$91.04 ","$0.00 ","$111.56 ","","$21.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.56 ","$0.00 ","$55.78 ","$88.36 ","$89.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34369","ERX","HCPCS 63700001","65162-0898-03","ARIPIPRAZOLE 10 MG PO TABS","BOTH IP/OP","$123.03 ","$91.04 ","$0.00 ","$111.56 ","","$21.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.56 ","$0.00 ","$55.78 ","$88.36 ","$89.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34369","ERX","HCPCS 63700001","65862-0663-30","ARIPIPRAZOLE 10 MG PO TABS","BOTH IP/OP","$123.03 ","$91.04 ","$0.00 ","$111.56 ","","$21.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.56 ","$0.00 ","$55.78 ","$88.36 ","$89.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34370","ERX","HCPCS 63700001","27241-0054-03","ARIPIPRAZOLE 15 MG PO TABS","BOTH IP/OP","$123.54 ","$91.42 ","$0.00 ","$112.02 ","","$21.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.02 ","$0.00 ","$56.01 ","$88.72 ","$89.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34370","ERX","HCPCS 63700001","31722-0828-30","ARIPIPRAZOLE 15 MG PO TABS","BOTH IP/OP","$123.54 ","$91.42 ","$0.00 ","$112.02 ","","$21.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.02 ","$0.00 ","$56.01 ","$88.72 ","$89.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34370","ERX","HCPCS 63700001","43598-0557-30","ARIPIPRAZOLE 15 MG PO TABS","BOTH IP/OP","$123.54 ","$91.42 ","$0.00 ","$112.02 ","","$21.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.02 ","$0.00 ","$56.01 ","$88.72 ","$89.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34370","ERX","HCPCS 63700001","65862-0664-30","ARIPIPRAZOLE 15 MG PO TABS","BOTH IP/OP","$123.54 ","$91.42 ","$0.00 ","$112.02 ","","$21.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.02 ","$0.00 ","$56.01 ","$88.72 ","$89.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34370","ERX","HCPCS 63700001","67877-0433-03","ARIPIPRAZOLE 15 MG PO TABS","BOTH IP/OP","$123.54 ","$91.42 ","$0.00 ","$112.02 ","","$21.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.02 ","$0.00 ","$56.01 ","$88.72 ","$89.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34371","ERX","HCPCS 63700001","16714-0787-01","ARIPIPRAZOLE 20 MG PO TABS","BOTH IP/OP","$174.20 ","$128.91 ","$0.00 ","$157.96 ","","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.96 ","$0.00 ","$78.98 ","$125.10 ","$126.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34371","ERX","HCPCS 63700001","31722-0829-30","ARIPIPRAZOLE 20 MG PO TABS","BOTH IP/OP","$174.20 ","$128.91 ","$0.00 ","$157.96 ","","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.96 ","$0.00 ","$78.98 ","$125.10 ","$126.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34371","ERX","HCPCS 63700001","43547-0306-03","ARIPIPRAZOLE 20 MG PO TABS","BOTH IP/OP","$174.20 ","$128.91 ","$0.00 ","$157.96 ","","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.96 ","$0.00 ","$78.98 ","$125.10 ","$126.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34371","ERX","HCPCS 63700001","67877-0434-03","ARIPIPRAZOLE 20 MG PO TABS","BOTH IP/OP","$174.20 ","$128.91 ","$0.00 ","$157.96 ","","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.96 ","$0.00 ","$78.98 ","$125.10 ","$126.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34372","ERX","HCPCS 63700001","65862-0666-30","ARIPIPRAZOLE 30 MG PO TABS","BOTH IP/OP","$175.28 ","$129.71 ","$0.00 ","$158.94 ","","$31.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.94 ","$0.00 ","$79.47 ","$125.88 ","$127.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34418","ERX","HCPCS 63700001","16714-0484-01","DIVALPROEX SODIUM ER 250 MG PO TB24","BOTH IP/OP","$10.29 ","$7.61 ","$0.00 ","$9.33 ","","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34418","ERX","HCPCS 63700001","65862-0594-01","DIVALPROEX SODIUM ER 250 MG PO TB24","BOTH IP/OP","$10.29 ","$7.61 ","$0.00 ","$9.33 ","","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.33 ","$0.00 ","$4.67 ","$7.39 ","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34447","ERX","HCPCS 63700001","00002-3229-30","ATOMOXETINE HCL 40 MG PO CAPS","BOTH IP/OP","$72.01 ","$53.29 ","$0.00 ","$65.30 ","","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.30 ","$0.00 ","$32.65 ","$51.72 ","$52.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34448","ERX","HCPCS 63700001","00002-3239-30","ATOMOXETINE HCL 60 MG PO CAPS","BOTH IP/OP","$72.01 ","$53.29 ","$0.00 ","$65.30 ","","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.30 ","$0.00 ","$32.65 ","$51.72 ","$52.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","00406-0123-23","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","00406-0123-62","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","13107-0019-01","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","51862-0585-01","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","53746-0109-01","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","57664-0126-13","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","57664-0126-88","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","63739-0704-10","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34505","ERX","HCPCS 63700001","68084-0895-11","HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34524","ERX","HCPCS J2543","00206-8861-02","PIPERACILLIN-TAZOBACTAM IN DEX 3-0.375 GM/50ML IV SOLN","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$99.00 ","$49.05 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$6.52 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$6.52 ","$0.00 ","$6.21 ","$0.00 "
"34550","ERX","HCPCS 90723","58160-0811-52","DTAP-HEPATITIS B RECOMB-IPV IM SUSP","BOTH IP/OP","$360.55 ","$266.81 ","$0.00 ","$311.08 ","$162.25 ","$79.00 ","$75.15 ","$0.00 ","$0.00 ","$54.47 ","$311.08 ","$0.00 ","$155.54 ","$246.38 ","$248.86 ","$186.65 ","$48.68 ","$0.00 ","$49.52 ","$0.00 "
"34683","ERX","HCPCS 63700001","","ELETRIPTAN HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$213.27 ","$157.82 ","$0.00 ","$193.60 ","","$37.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.60 ","$0.00 ","$96.80 ","$153.33 ","$154.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34683","ERX","HCPCS 63700001","00049-2330-45","ELETRIPTAN HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$213.27 ","$157.82 ","$0.00 ","$193.60 ","","$37.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.60 ","$0.00 ","$96.80 ","$153.33 ","$154.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34683","ERX","HCPCS 63700001","00093-8310-18","ELETRIPTAN HYDROBROMIDE 20 MG PO TABS","BOTH IP/OP","$213.27 ","$157.82 ","$0.00 ","$193.60 ","","$37.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.60 ","$0.00 ","$96.80 ","$153.33 ","$154.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34684","ERX","HCPCS 63700001","00049-2340-45","ELETRIPTAN HYDROBROMIDE 40 MG PO TABS","BOTH IP/OP","$285.38 ","$211.18 ","$0.00 ","$246.96 ","","$50.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$246.96 ","$0.00 ","$123.48 ","$195.59 ","$197.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34684","ERX","HCPCS 63700001","00049-2340-79","ELETRIPTAN HYDROBROMIDE 40 MG PO TABS","BOTH IP/OP","$285.38 ","$211.18 ","$0.00 ","$246.96 ","","$50.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$246.96 ","$0.00 ","$123.48 ","$195.59 ","$197.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34684","ERX","HCPCS 63700001","59762-2322-08","ELETRIPTAN HYDROBROMIDE 40 MG PO TABS","BOTH IP/OP","$285.38 ","$211.18 ","$0.00 ","$246.96 ","","$50.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$246.96 ","$0.00 ","$123.48 ","$195.59 ","$197.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34708","ERX","HCPCS 25000001","67546-0212-21","NITAZOXANIDE 100 MG/5ML PO SUSR","BOTH IP/OP","$1,622.38 ","$1,200.56 ","$0.00 ","$1,503.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,503.36 ","$0.00 ","$751.68 ","$1,190.66 ","$1,202.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34711","ERX","HCPCS 63700001","00054-0176-13","BUPRENORPHINE HCL 2 MG SL SUBL","BOTH IP/OP","$17.35 ","$12.84 ","$0.00 ","$15.74 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.74 ","$0.00 ","$7.87 ","$12.47 ","$12.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34711","ERX","HCPCS 63700001","42858-0501-03","BUPRENORPHINE HCL 2 MG SL SUBL","BOTH IP/OP","$17.35 ","$12.84 ","$0.00 ","$15.74 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.74 ","$0.00 ","$7.87 ","$12.47 ","$12.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34711","ERX","HCPCS 63700001","50383-0924-93","BUPRENORPHINE HCL 2 MG SL SUBL","BOTH IP/OP","$17.35 ","$12.84 ","$0.00 ","$15.74 ","","$3.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.74 ","$0.00 ","$7.87 ","$12.47 ","$12.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34712","ERX","HCPCS 63700001","42858-0502-03","BUPRENORPHINE HCL 8 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$31.62 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.62 ","$0.00 ","$15.81 ","$25.04 ","$25.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34712","ERX","HCPCS 63700001","50383-0930-93","BUPRENORPHINE HCL 8 MG SL SUBL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$31.62 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.62 ","$0.00 ","$15.81 ","$25.04 ","$25.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34713","ERX","HCPCS 25000001","00054-0188-13","BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL","BOTH IP/OP","$24.42 ","$18.07 ","$0.00 ","$22.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34713","ERX","HCPCS 25000001","62175-0452-32","BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL","BOTH IP/OP","$24.42 ","$18.07 ","$0.00 ","$22.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34713","ERX","HCPCS 25000001","62756-0969-83","BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL","BOTH IP/OP","$24.42 ","$18.07 ","$0.00 ","$22.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34713","ERX","HCPCS 25000001","65162-0416-03","BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL","BOTH IP/OP","$24.42 ","$18.07 ","$0.00 ","$22.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.14 ","$0.00 ","$11.07 ","$17.53 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34714","ERX","HCPCS 25000001","00054-0189-13","BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL","BOTH IP/OP","$43.67 ","$32.32 ","$0.00 ","$39.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.60 ","$0.00 ","$19.80 ","$31.36 ","$31.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34714","ERX","HCPCS 25000001","62175-0458-32","BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL","BOTH IP/OP","$43.67 ","$32.32 ","$0.00 ","$39.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.60 ","$0.00 ","$19.80 ","$31.36 ","$31.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34714","ERX","HCPCS 25000001","62756-0970-83","BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL","BOTH IP/OP","$43.67 ","$32.32 ","$0.00 ","$39.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.60 ","$0.00 ","$19.80 ","$31.36 ","$31.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"34814","ERX","HCPCS 25000001","61314-0646-10","NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN","BOTH IP/OP","$352.40 ","$260.78 ","$0.00 ","$319.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$319.89 ","$0.00 ","$159.95 ","$253.35 ","$255.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35134","ERX","HCPCS 63700001","27808-0156-01","ROSUVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35134","ERX","HCPCS 63700001","57237-0169-90","ROSUVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35134","ERX","HCPCS 63700001","57237-0169-99","ROSUVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35134","ERX","HCPCS 63700001","60505-4503-09","ROSUVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35134","ERX","HCPCS 63700001","68462-0262-90","ROSUVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35134","ERX","HCPCS 63700001","70377-0007-12","ROSUVASTATIN CALCIUM 10 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35135","ERX","HCPCS 63700001","16729-0286-15","ROSUVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35135","ERX","HCPCS 63700001","27808-0157-01","ROSUVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35135","ERX","HCPCS 63700001","57237-0170-90","ROSUVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35135","ERX","HCPCS 63700001","57237-0170-99","ROSUVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35135","ERX","HCPCS 63700001","60505-4504-09","ROSUVASTATIN CALCIUM 20 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$34.00 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.00 ","$0.00 ","$17.00 ","$26.93 ","$27.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","27808-0158-01","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","51407-0156-30","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","57237-0171-05","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","57237-0171-30","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","57237-0171-90","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","68462-0264-30","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","70377-0009-11","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35136","ERX","HCPCS 63700001","72205-0005-99","ROSUVASTATIN CALCIUM 40 MG PO TABS","BOTH IP/OP","$37.48 ","$27.74 ","$0.00 ","$33.99 ","","$6.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$17.00 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35184","ERX","HCPCS 63700001","50268-0190-15","CYCLOBENZAPRINE HCL 5 MG PO TABS","BOTH IP/OP","$6.88 ","$5.09 ","$0.00 ","$6.24 ","","$1.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.24 ","$0.00 ","$3.12 ","$4.94 ","$4.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35184","ERX","HCPCS 63700001","52817-0330-10","CYCLOBENZAPRINE HCL 5 MG PO TABS","BOTH IP/OP","$6.88 ","$5.09 ","$0.00 ","$6.24 ","","$1.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.24 ","$0.00 ","$3.12 ","$4.94 ","$4.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35184","ERX","HCPCS 63700001","69097-0845-07","CYCLOBENZAPRINE HCL 5 MG PO TABS","BOTH IP/OP","$6.88 ","$5.09 ","$0.00 ","$6.24 ","","$1.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.24 ","$0.00 ","$3.12 ","$4.94 ","$4.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35209","ERX","HCPCS 63700001","00023-9163-30","CYCLOSPORINE 0.05 % OP EMUL","BOTH IP/OP","$51.53 ","$38.13 ","$0.00 ","$44.51 ","","$9.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.51 ","$0.00 ","$22.26 ","$35.25 ","$35.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35262","ERX","HCPCS J7520","00008-1042-05","SIROLIMUS 2 MG PO TABS","BOTH IP/OP","$275.26 ","$203.69 ","$0.00 ","$239.07 ","$123.87 ","$0.00 ","$57.37 ","$0.00 ","$0.00 ","$0.00 ","$239.07 ","$0.00 ","$119.54 ","$189.34 ","$191.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35263","ERX","HCPCS 63700001","59572-0210-15","THALIDOMIDE 100 MG PO CAPS","BOTH IP/OP","$972.04 ","$719.31 ","$0.00 ","$882.16 ","","$173.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$882.16 ","$0.00 ","$441.08 ","$698.67 ","$705.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35264","ERX","HCPCS 63700001","59572-0220-16","THALIDOMIDE 200 MG PO CAPS","BOTH IP/OP","$1,004.37 ","$743.23 ","$0.00 ","$1,004.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.37 ","$0.00 ","$502.19 ","$795.46 ","$803.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35264","ERX","HCPCS 63700001","59572-0220-96","THALIDOMIDE 200 MG PO CAPS","BOTH IP/OP","$1,004.37 ","$743.23 ","$0.00 ","$1,004.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.37 ","$0.00 ","$502.19 ","$795.46 ","$803.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35439","ERX","HCPCS J2850","67066-0006-01","SECRETIN ACETATE 16 MCG IV SOLR","BOTH IP/OP","$26.72 ","$19.77 ","$0.00 ","$24.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.23 ","$0.00 ","$12.12 ","$19.19 ","$19.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35488","ERX","HCPCS J8501","","APREPITANT 80 MG PO CAPS","BOTH IP/OP","$594.98 ","$440.29 ","$0.00 ","$539.97 ","$267.74 ","$0.00 ","$125.02 ","$0.00 ","$0.00 ","$94.54 ","$539.97 ","$0.00 ","$269.99 ","$427.66 ","$431.98 ","$0.00 ","$84.51 ","$0.00 ","$85.96 ","$0.00 "
"35488","ERX","HCPCS J8501","68462-0584-76","APREPITANT 80 MG PO CAPS","BOTH IP/OP","$594.98 ","$440.29 ","$0.00 ","$539.97 ","$267.74 ","$0.00 ","$125.02 ","$0.00 ","$0.00 ","$94.54 ","$539.97 ","$0.00 ","$269.99 ","$427.66 ","$431.98 ","$0.00 ","$84.51 ","$0.00 ","$85.96 ","$0.00 "
"35489","ERX","HCPCS J8501","","APREPITANT 125 MG PO CAPS","BOTH IP/OP","$585.21 ","$433.06 ","$0.00 ","$531.22 ","$263.34 ","$0.00 ","$195.34 ","$0.00 ","$0.00 ","$93.01 ","$531.22 ","$0.00 ","$265.61 ","$420.73 ","$424.98 ","$0.00 ","$83.14 ","$0.00 ","$84.57 ","$0.00 "
"35489","ERX","HCPCS J8501","00781-2323-68","APREPITANT 125 MG PO CAPS","BOTH IP/OP","$585.21 ","$433.06 ","$0.00 ","$531.22 ","$263.34 ","$0.00 ","$195.34 ","$0.00 ","$0.00 ","$93.01 ","$531.22 ","$0.00 ","$265.61 ","$420.73 ","$424.98 ","$0.00 ","$83.14 ","$0.00 ","$84.57 ","$0.00 "
"35489","ERX","HCPCS J8501","68462-0585-76","APREPITANT 125 MG PO CAPS","BOTH IP/OP","$585.21 ","$433.06 ","$0.00 ","$531.22 ","$263.34 ","$0.00 ","$195.34 ","$0.00 ","$0.00 ","$93.01 ","$531.22 ","$0.00 ","$265.61 ","$420.73 ","$424.98 ","$0.00 ","$83.14 ","$0.00 ","$84.57 ","$0.00 "
"35490","ERX","HCPCS J8501","00006-3862-03","APREPITANT 80 & 125 MG PO MISC","BOTH IP/OP","$904.45 ","$669.29 ","$0.00 ","$820.82 ","$407.00 ","$0.00 ","$7.81 ","$0.00 ","$0.00 ","$143.72 ","$820.82 ","$0.00 ","$410.41 ","$650.09 ","$656.66 ","$0.00 ","$128.46 ","$0.00 ","$130.67 ","$0.00 "
"35639","ERX","HCPCS 25000001","10019-0075-87","ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN","BOTH IP/OP","$1,566.18 ","$1,158.97 ","$0.00 ","$1,451.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,451.28 ","$0.00 ","$725.64 ","$1,149.41 ","$1,161.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35639","ERX","HCPCS 25000001","25021-0309-82","ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN","BOTH IP/OP","$1,566.18 ","$1,158.97 ","$0.00 ","$1,451.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,451.28 ","$0.00 ","$725.64 ","$1,149.41 ","$1,161.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35640","ERX","HCPCS J3489","00409-4215-01","ZOLEDRONIC ACID 4 MG/5ML IV CONC","BOTH IP/OP","$183.22 ","$135.58 ","$0.00 ","$166.32 ","$82.45 ","$0.00 ","$38.19 ","$0.00 ","$0.00 ","$51.14 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$51.14 ","$0.00 ","$48.69 ","$0.00 "
"35640","ERX","HCPCS J3489","25021-0801-66","ZOLEDRONIC ACID 4 MG/5ML IV CONC","BOTH IP/OP","$183.22 ","$135.58 ","$0.00 ","$166.32 ","$82.45 ","$0.00 ","$38.19 ","$0.00 ","$0.00 ","$51.14 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$51.14 ","$0.00 ","$48.69 ","$0.00 "
"35640","ERX","HCPCS J3489","55111-0685-07","ZOLEDRONIC ACID 4 MG/5ML IV CONC","BOTH IP/OP","$183.22 ","$135.58 ","$0.00 ","$166.32 ","$82.45 ","$0.00 ","$38.19 ","$0.00 ","$0.00 ","$51.14 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$51.14 ","$0.00 ","$48.69 ","$0.00 "
"35640","ERX","HCPCS J3489","63323-0961-98","ZOLEDRONIC ACID 4 MG/5ML IV CONC","BOTH IP/OP","$183.22 ","$135.58 ","$0.00 ","$166.32 ","$82.45 ","$0.00 ","$38.19 ","$0.00 ","$0.00 ","$51.14 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$51.14 ","$0.00 ","$48.69 ","$0.00 "
"35640","ERX","HCPCS J3489","67457-0390-54","ZOLEDRONIC ACID 4 MG/5ML IV CONC","BOTH IP/OP","$183.22 ","$135.58 ","$0.00 ","$166.32 ","$82.45 ","$0.00 ","$38.19 ","$0.00 ","$0.00 ","$51.14 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$51.14 ","$0.00 ","$48.69 ","$0.00 "
"35687","ERX","HCPCS 63700001","00781-5311-08","RISPERIDONE 1 MG PO TBDP","BOTH IP/OP","$56.09 ","$41.51 ","$0.00 ","$56.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.09 ","$0.00 ","$28.05 ","$44.42 ","$44.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35687","ERX","HCPCS 63700001","49884-0315-91","RISPERIDONE 1 MG PO TBDP","BOTH IP/OP","$56.09 ","$41.51 ","$0.00 ","$56.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.09 ","$0.00 ","$28.05 ","$44.42 ","$44.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35688","ERX","HCPCS 63700001","49884-0401-91","RISPERIDONE 2 MG PO TBDP","BOTH IP/OP","$84.00 ","$62.16 ","$0.00 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.00 ","$0.00 ","$42.00 ","$66.53 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35699","ERX","HCPCS 25000001","00065-4013-03","MOXIFLOXACIN HCL 0.5 % OP SOLN","BOTH IP/OP","$585.75 ","$433.46 ","$0.00 ","$531.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$531.71 ","$0.00 ","$265.86 ","$421.11 ","$425.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35699","ERX","HCPCS 25000001","00781-7135-93","MOXIFLOXACIN HCL 0.5 % OP SOLN","BOTH IP/OP","$585.75 ","$433.46 ","$0.00 ","$531.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$531.71 ","$0.00 ","$265.86 ","$421.11 ","$425.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35699","ERX","HCPCS 25000001","60505-0582-04","MOXIFLOXACIN HCL 0.5 % OP SOLN","BOTH IP/OP","$585.75 ","$433.46 ","$0.00 ","$531.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$531.71 ","$0.00 ","$265.86 ","$421.11 ","$425.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35699","ERX","HCPCS 25000001","65862-0840-03","MOXIFLOXACIN HCL 0.5 % OP SOLN","BOTH IP/OP","$585.75 ","$433.46 ","$0.00 ","$531.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$531.71 ","$0.00 ","$265.86 ","$421.11 ","$425.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35780","ERX","HCPCS 63700001","00310-0482-30","GEFITINIB 250 MG PO TABS","BOTH IP/OP","$909.75 ","$673.22 ","$0.00 ","$825.63 ","","$161.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.63 ","$0.00 ","$412.82 ","$653.90 ","$660.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35942","ERX","HCPCS 63700001","00245-5317-01","KCL CRYS ER 10 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35942","ERX","HCPCS 63700001","00245-5317-89","KCL CRYS ER 10 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35942","ERX","HCPCS 63700001","63739-0446-10","KCL CRYS ER 10 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35942","ERX","HCPCS 63700001","66758-0170-13","KCL CRYS ER 10 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","00245-5319-01","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","00245-5319-89","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","00781-5720-01","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","00781-5720-10","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","63739-0447-10","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","66758-0190-13","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35943","ERX","HCPCS 63700001","68084-0360-09","POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35957","ERX","HCPCS 63700001","00046-1106-11","CONJ ESTROG-MEDROXYPROGEST ACE 0.45-1.5 MG PO TABS","BOTH IP/OP","$40.16 ","$29.72 ","$0.00 ","$33.03 ","","$7.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.03 ","$0.00 ","$16.52 ","$26.16 ","$26.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36046","ERX","HCPCS J3480","00338-0704-34","POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN","BOTH IP/OP","$33.52 ","$24.80 ","$0.00 ","$26.60 ","$15.08 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$1.65 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$1.65 ","$0.00 ","$1.57 ","$0.00 "
"36092","ERX","HCPCS 63700001","00078-0649-30","IMATINIB MESYLATE 400 MG PO TABS","BOTH IP/OP","$1,182.30 ","$874.90 ","$0.00 ","$1,072.98 ","","$210.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.98 ","$0.00 ","$536.49 ","$849.80 ","$858.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36092","ERX","HCPCS 63700001","16714-0705-01","IMATINIB MESYLATE 400 MG PO TABS","BOTH IP/OP","$1,182.30 ","$874.90 ","$0.00 ","$1,072.98 ","","$210.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.98 ","$0.00 ","$536.49 ","$849.80 ","$858.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36092","ERX","HCPCS 63700001","60505-2901-03","IMATINIB MESYLATE 400 MG PO TABS","BOTH IP/OP","$1,182.30 ","$874.90 ","$0.00 ","$1,072.98 ","","$210.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.98 ","$0.00 ","$536.49 ","$849.80 ","$858.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36149","ERX","HCPCS 63700001","00003-3624-12","ATAZANAVIR SULFATE 150 MG PO CAPS","BOTH IP/OP","$203.10 ","$150.29 ","$0.00 ","$184.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.37 ","$0.00 ","$92.19 ","$146.02 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36149","ERX","HCPCS 63700001","16714-0860-01","ATAZANAVIR SULFATE 150 MG PO CAPS","BOTH IP/OP","$203.10 ","$150.29 ","$0.00 ","$184.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.37 ","$0.00 ","$92.19 ","$146.02 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36150","ERX","HCPCS 63700001","00003-3631-12","ATAZANAVIR SULFATE 200 MG PO CAPS","BOTH IP/OP","$203.10 ","$150.29 ","$0.00 ","$184.37 ","","$36.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.37 ","$0.00 ","$92.19 ","$146.02 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36150","ERX","HCPCS 63700001","16714-0861-01","ATAZANAVIR SULFATE 200 MG PO CAPS","BOTH IP/OP","$203.10 ","$150.29 ","$0.00 ","$184.37 ","","$36.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.37 ","$0.00 ","$92.19 ","$146.02 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36150","ERX","HCPCS 63700001","65862-0712-60","ATAZANAVIR SULFATE 200 MG PO CAPS","BOTH IP/OP","$203.10 ","$150.29 ","$0.00 ","$184.37 ","","$36.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.37 ","$0.00 ","$92.19 ","$146.02 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36198","ERX","HCPCS 63700001","00046-1101-81","ESTROGENS CONJUGATED 0.45 MG PO TABS","BOTH IP/OP","$32.11 ","$23.76 ","$0.00 ","$26.93 ","","$5.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.93 ","$0.00 ","$13.47 ","$21.33 ","$21.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36252","ERX","HCPCS 63700001","61958-0601-01","EMTRICITABINE 200 MG PO CAPS","BOTH IP/OP","$80.93 ","$59.89 ","$0.00 ","$73.39 ","","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.39 ","$0.00 ","$36.70 ","$58.12 ","$58.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36252","ERX","HCPCS 63700001","69097-0642-02","EMTRICITABINE 200 MG PO CAPS","BOTH IP/OP","$80.93 ","$59.89 ","$0.00 ","$73.39 ","","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.39 ","$0.00 ","$36.70 ","$58.12 ","$58.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36438","ERX","HCPCS 63700001","00904-6656-40","ARIPIPRAZOLE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$111.39 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.39 ","$0.00 ","$55.70 ","$88.22 ","$89.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36438","ERX","HCPCS 63700001","16714-0784-01","ARIPIPRAZOLE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$111.39 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.39 ","$0.00 ","$55.70 ","$88.22 ","$89.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36438","ERX","HCPCS 63700001","33342-0123-07","ARIPIPRAZOLE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$111.39 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.39 ","$0.00 ","$55.70 ","$88.22 ","$89.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36438","ERX","HCPCS 63700001","43598-0555-30","ARIPIPRAZOLE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$111.39 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.39 ","$0.00 ","$55.70 ","$88.22 ","$89.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36438","ERX","HCPCS 63700001","65862-0662-30","ARIPIPRAZOLE 5 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$111.39 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.39 ","$0.00 ","$55.70 ","$88.22 ","$89.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36576","ERX","HCPCS 25000001","00065-8533-02","CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","BOTH IP/OP","$785.54 ","$581.30 ","$0.00 ","$712.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.90 ","$0.00 ","$356.45 ","$564.62 ","$570.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36576","ERX","HCPCS 25000001","00781-6186-67","CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","BOTH IP/OP","$785.54 ","$581.30 ","$0.00 ","$712.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.90 ","$0.00 ","$356.45 ","$564.62 ","$570.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36576","ERX","HCPCS 25000001","43598-0326-75","CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","BOTH IP/OP","$785.54 ","$581.30 ","$0.00 ","$712.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.90 ","$0.00 ","$356.45 ","$564.62 ","$570.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","00121-0799-16","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","00472-0235-16","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","16714-0358-01","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","50383-0241-16","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","50474-0001-48","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","51991-0651-16","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","99999-6012-25","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36590","ERX","HCPCS 25000001","99999-6004-94","LEVETIRACETAM 100 MG/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$106.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$106.78 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36612","ERX","HCPCS 63700001","00310-0755-90","ROSUVASTATIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$46.35 ","$34.30 ","$0.00 ","$42.04 ","","$8.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.04 ","$0.00 ","$21.02 ","$33.30 ","$33.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36612","ERX","HCPCS 63700001","16714-0988-01","ROSUVASTATIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$46.35 ","$34.30 ","$0.00 ","$42.04 ","","$8.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.04 ","$0.00 ","$21.02 ","$33.30 ","$33.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36612","ERX","HCPCS 63700001","27808-0155-01","ROSUVASTATIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$46.35 ","$34.30 ","$0.00 ","$42.04 ","","$8.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.04 ","$0.00 ","$21.02 ","$33.30 ","$33.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36612","ERX","HCPCS 63700001","60505-4502-09","ROSUVASTATIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$46.35 ","$34.30 ","$0.00 ","$42.04 ","","$8.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.04 ","$0.00 ","$21.02 ","$33.30 ","$33.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36612","ERX","HCPCS 63700001","68462-0261-90","ROSUVASTATIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$46.35 ","$34.30 ","$0.00 ","$42.04 ","","$8.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.04 ","$0.00 ","$21.02 ","$33.30 ","$33.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36612","ERX","HCPCS 63700001","70377-0006-12","ROSUVASTATIN CALCIUM 5 MG PO TABS","BOTH IP/OP","$46.35 ","$34.30 ","$0.00 ","$42.04 ","","$8.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.04 ","$0.00 ","$21.02 ","$33.30 ","$33.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36631","ERX","HCPCS 25000001","00023-9277-05","KETOROLAC TROMETHAMINE 0.4 % OP SOLN","BOTH IP/OP","$992.16 ","$734.20 ","$0.00 ","$857.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$857.54 ","$0.00 ","$428.77 ","$679.17 ","$686.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36631","ERX","HCPCS 25000001","60758-0773-05","KETOROLAC TROMETHAMINE 0.4 % OP SOLN","BOTH IP/OP","$992.16 ","$734.20 ","$0.00 ","$857.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$857.54 ","$0.00 ","$428.77 ","$679.17 ","$686.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36775","ERX","HCPCS 63700001","00187-0730-90","BUPROPION HCL ER (XL) 150 MG PO TB24","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$19.84 ","","$3.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 ","$9.92 ","$15.71 ","$15.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36775","ERX","HCPCS 63700001","10370-0101-03","BUPROPION HCL ER (XL) 150 MG PO TB24","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$19.84 ","","$3.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 ","$9.92 ","$15.71 ","$15.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36775","ERX","HCPCS 63700001","16729-0443-15","BUPROPION HCL ER (XL) 150 MG PO TB24","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$19.84 ","","$3.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 ","$9.92 ","$15.71 ","$15.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36775","ERX","HCPCS 63700001","69097-0875-02","BUPROPION HCL ER (XL) 150 MG PO TB24","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$19.84 ","","$3.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.84 ","$0.00 ","$9.92 ","$15.71 ","$15.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36776","ERX","HCPCS 63700001","10370-0102-03","BUPROPION HCL ER (XL) 300 MG PO TB24","BOTH IP/OP","$19.98 ","$14.79 ","$0.00 ","$18.12 ","","$3.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.12 ","$0.00 ","$9.06 ","$14.35 ","$14.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36776","ERX","HCPCS 63700001","16729-0444-10","BUPROPION HCL ER (XL) 300 MG PO TB24","BOTH IP/OP","$19.98 ","$14.79 ","$0.00 ","$18.12 ","","$3.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.12 ","$0.00 ","$9.06 ","$14.35 ","$14.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36776","ERX","HCPCS 63700001","68180-0320-09","BUPROPION HCL ER (XL) 300 MG PO TB24","BOTH IP/OP","$19.98 ","$14.79 ","$0.00 ","$18.12 ","","$3.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.12 ","$0.00 ","$9.06 ","$14.35 ","$14.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36962","ERX","HCPCS 63700001","00121-0544-10","DOCUSATE SODIUM 50 MG/5ML PO LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36962","ERX","HCPCS 63700001","50383-0771-16","DOCUSATE SODIUM 50 MG/5ML PO LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36962","ERX","HCPCS 63700001","99999-6006-70","DOCUSATE SODIUM 50 MG/5ML PO LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36966","ERX","HCPCS 63700001","00456-3210-63","MEMANTINE HCL 10 MG PO TABS","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36966","ERX","HCPCS 63700001","00904-6506-61","MEMANTINE HCL 10 MG PO TABS","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36966","ERX","HCPCS 63700001","55111-0597-60","MEMANTINE HCL 10 MG PO TABS","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36976","ERX","HCPCS 25000001","00904-6305-21","PHENOL 1.4 % MT LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36976","ERX","HCPCS 25000001","49348-0991-36","PHENOL 1.4 % MT LIQD","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36982","ERX","HCPCS 25000001","47335-0956-88","ALFUZOSIN HCL ER 10 MG PO TB24","BOTH IP/OP","$17.66 ","$13.07 ","$0.00 ","$16.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.02 ","$0.00 ","$8.01 ","$12.69 ","$12.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36983","ERX","HCPCS 63700001","00185-5368-30","EPLERENONE 25 MG PO TABS","BOTH IP/OP","$18.19 ","$13.46 ","$0.00 ","$16.49 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.49 ","$0.00 ","$8.25 ","$13.06 ","$13.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36983","ERX","HCPCS 63700001","00378-1030-93","EPLERENONE 25 MG PO TABS","BOTH IP/OP","$18.19 ","$13.46 ","$0.00 ","$16.49 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.49 ","$0.00 ","$8.25 ","$13.06 ","$13.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36984","ERX","HCPCS 63700001","00185-5369-30","EPLERENONE 50 MG PO TABS","BOTH IP/OP","$18.19 ","$13.46 ","$0.00 ","$16.50 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.50 ","$0.00 ","$8.25 ","$13.07 ","$13.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36984","ERX","HCPCS 63700001","00378-1031-93","EPLERENONE 50 MG PO TABS","BOTH IP/OP","$18.19 ","$13.46 ","$0.00 ","$16.50 ","","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.50 ","$0.00 ","$8.25 ","$13.07 ","$13.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36986","ERX","HCPCS 63700001","00002-4464-30","TADALAFIL 20 MG PO TABS","BOTH IP/OP","$560.45 ","$414.73 ","$0.00 ","$508.74 ","","$99.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$508.74 ","$0.00 ","$254.37 ","$402.92 ","$406.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36987","ERX","HCPCS 63700001","62756-0258-02","ZONISAMIDE 25 MG PO CAPS","BOTH IP/OP","$50.13 ","$37.10 ","$0.00 ","$50.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.13 ","$0.00 ","$25.07 ","$39.70 ","$40.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36987","ERX","HCPCS 63700001","68462-0128-01","ZONISAMIDE 25 MG PO CAPS","BOTH IP/OP","$50.13 ","$37.10 ","$0.00 ","$50.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.13 ","$0.00 ","$25.07 ","$39.70 ","$40.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36988","ERX","HCPCS 63700001","62756-0259-02","ZONISAMIDE 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36988","ERX","HCPCS 63700001","68462-0129-01","ZONISAMIDE 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36989","ERX","HCPCS J0878","00143-9378-01","DAPTOMYCIN 500 MG IV SOLR","BOTH IP/OP","$261.43 ","$193.46 ","$0.00 ","$459.55 ","$117.64 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$459.55 ","$173.25 ","$229.78 ","$363.96 ","$367.64 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"36989","ERX","HCPCS J0878","25021-0174-15","DAPTOMYCIN 500 MG IV SOLR","BOTH IP/OP","$261.43 ","$193.46 ","$0.00 ","$459.55 ","$117.64 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$459.55 ","$173.25 ","$229.78 ","$363.96 ","$367.64 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"36989","ERX","HCPCS J0878","63323-0371-10","DAPTOMYCIN 500 MG IV SOLR","BOTH IP/OP","$261.43 ","$193.46 ","$0.00 ","$459.55 ","$117.64 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$459.55 ","$173.25 ","$229.78 ","$363.96 ","$367.64 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"36989","ERX","HCPCS J0878","63323-0371-19","DAPTOMYCIN 500 MG IV SOLR","BOTH IP/OP","$261.43 ","$193.46 ","$0.00 ","$459.55 ","$117.64 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$459.55 ","$173.25 ","$229.78 ","$363.96 ","$367.64 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"36989","ERX","HCPCS J0878","63323-0871-15","DAPTOMYCIN 500 MG IV SOLR","BOTH IP/OP","$261.43 ","$193.46 ","$0.00 ","$459.55 ","$117.64 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$459.55 ","$173.25 ","$229.78 ","$363.96 ","$367.64 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"36989","ERX","HCPCS J0878","67919-0011-01","DAPTOMYCIN 500 MG IV SOLR","BOTH IP/OP","$261.43 ","$193.46 ","$0.00 ","$459.55 ","$117.64 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$459.55 ","$173.25 ","$229.78 ","$363.96 ","$367.64 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"37170","ERX","HCPCS 63700001","00456-3205-11","MEMANTINE HCL 5 MG PO TABS","BOTH IP/OP","$33.79 ","$25.00 ","$0.00 ","$33.79 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.79 ","$0.00 ","$16.90 ","$26.76 ","$27.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37170","ERX","HCPCS 63700001","00456-3205-60","MEMANTINE HCL 5 MG PO TABS","BOTH IP/OP","$33.79 ","$25.00 ","$0.00 ","$33.79 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.79 ","$0.00 ","$16.90 ","$26.76 ","$27.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37170","ERX","HCPCS 63700001","00456-3205-63","MEMANTINE HCL 5 MG PO TABS","BOTH IP/OP","$33.79 ","$25.00 ","$0.00 ","$33.79 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.79 ","$0.00 ","$16.90 ","$26.76 ","$27.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37170","ERX","HCPCS 63700001","53746-0173-60","MEMANTINE HCL 5 MG PO TABS","BOTH IP/OP","$33.79 ","$25.00 ","$0.00 ","$33.79 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.79 ","$0.00 ","$16.90 ","$26.76 ","$27.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37170","ERX","HCPCS 63700001","60687-0173-11","MEMANTINE HCL 5 MG PO TABS","BOTH IP/OP","$33.79 ","$25.00 ","$0.00 ","$33.79 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.79 ","$0.00 ","$16.90 ","$26.76 ","$27.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37170","ERX","HCPCS 63700001","60687-0173-57","MEMANTINE HCL 5 MG PO TABS","BOTH IP/OP","$33.79 ","$25.00 ","$0.00 ","$33.79 ","","$6.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.79 ","$0.00 ","$16.90 ","$26.76 ","$27.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37182","ERX","HCPCS 63700001","49702-0207-18","FOSAMPRENAVIR CALCIUM 700 MG PO TABS","BOTH IP/OP","$89.45 ","$66.19 ","$0.00 ","$81.10 ","","$15.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.10 ","$0.00 ","$40.55 ","$64.23 ","$64.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37459","ERX","HCPCS 63700001","00046-1105-11","CONJ ESTROG-MEDROXYPROGEST ACE 0.3-1.5 MG PO TABS","BOTH IP/OP","$783.51 ","$579.80 ","$0.00 ","$644.88 ","","$139.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$644.88 ","$0.00 ","$322.44 ","$510.74 ","$515.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37482","ERX","HCPCS 63700001","00245-0036-42","CHOLESTYRAMINE LIGHT 4 G PO PACK","BOTH IP/OP","$21.42 ","$15.85 ","$0.00 ","$19.42 ","","$3.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.42 ","$0.00 ","$9.71 ","$15.38 ","$15.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37482","ERX","HCPCS 63700001","00245-0036-89","CHOLESTYRAMINE LIGHT 4 G PO PACK","BOTH IP/OP","$21.42 ","$15.85 ","$0.00 ","$19.42 ","","$3.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.42 ","$0.00 ","$9.71 ","$15.38 ","$15.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37579","ERX","HCPCS 25000001","00065-0795-15","BSS IO SOLN","BOTH IP/OP","$51.35 ","$38.00 ","$0.00 ","$45.21 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.21 ","$0.00 ","$22.61 ","$35.81 ","$36.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37616","ERX","HCPCS 63700001","29300-0116-16","TOPIRAMATE 50 MG PO TABS","BOTH IP/OP","$19.38 ","$14.34 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.38 ","$0.00 ","$9.69 ","$15.35 ","$15.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37616","ERX","HCPCS 63700001","68382-0139-14","TOPIRAMATE 50 MG PO TABS","BOTH IP/OP","$19.38 ","$14.34 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.38 ","$0.00 ","$9.69 ","$15.35 ","$15.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37616","ERX","HCPCS 63700001","69097-0123-03","TOPIRAMATE 50 MG PO TABS","BOTH IP/OP","$19.38 ","$14.34 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.38 ","$0.00 ","$9.69 ","$15.35 ","$15.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37616","ERX","HCPCS 63700001","69097-0817-03","TOPIRAMATE 50 MG PO TABS","BOTH IP/OP","$19.38 ","$14.34 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.38 ","$0.00 ","$9.69 ","$15.35 ","$15.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37630","ERX","HCPCS 63700001","45802-0040-64","SELENIUM SULFIDE 2.5 % EX LOTN","BOTH IP/OP","$82.97 ","$61.40 ","$0.00 ","$75.34 ","","$14.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.34 ","$0.00 ","$37.67 ","$59.59 ","$60.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37630","ERX","HCPCS 63700001","60432-0528-04","SELENIUM SULFIDE 2.5 % EX LOTN","BOTH IP/OP","$82.97 ","$61.40 ","$0.00 ","$75.34 ","","$14.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.34 ","$0.00 ","$37.67 ","$59.67 ","$60.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37630","ERX","HCPCS 63700001","60432-0528-05","SELENIUM SULFIDE 2.5 % EX LOTN","BOTH IP/OP","$82.97 ","$61.40 ","$0.00 ","$75.34 ","","$14.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.34 ","$0.00 ","$37.67 ","$59.67 ","$60.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37635","ERX","HCPCS 63700001","43547-0280-10","ESCITALOPRAM OXALATE 5 MG PO TABS","BOTH IP/OP","$17.39 ","$12.87 ","$0.00 ","$15.77 ","","$3.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.77 ","$0.00 ","$7.89 ","$12.49 ","$12.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","00378-0018-01","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","51079-0255-01","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","51079-0255-20","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","52817-0360-10","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","57664-0506-52","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","62332-0112-31","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","62584-0265-01","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37637","ERX","HCPCS 63700001","62584-0265-11","METOPROLOL TARTRATE 25 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37642","ERX","HCPCS 63700001","00009-0760-04","CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$128.10 ","","$25.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.10 ","$0.00 ","$64.05 ","$101.46 ","$102.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37642","ERX","HCPCS 63700001","00574-0129-01","CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$128.10 ","","$25.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.10 ","$0.00 ","$64.05 ","$101.46 ","$102.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37642","ERX","HCPCS 63700001","16714-0483-01","CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$128.10 ","","$25.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.10 ","$0.00 ","$64.05 ","$101.46 ","$102.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37642","ERX","HCPCS 63700001","59762-0016-01","CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$128.10 ","","$25.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.10 ","$0.00 ","$64.05 ","$101.46 ","$102.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37642","ERX","HCPCS 63700001","64980-0511-10","CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$128.10 ","","$25.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.10 ","$0.00 ","$64.05 ","$101.46 ","$102.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37642","ERX","HCPCS 63700001","65862-0596-01","CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","BOTH IP/OP","$143.60 ","$106.26 ","$0.00 ","$128.10 ","","$25.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.10 ","$0.00 ","$64.05 ","$101.46 ","$102.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37643","ERX","HCPCS 63700001","00378-1258-91","PROPAFENONE HCL ER 225 MG PO CP12","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37643","ERX","HCPCS 63700001","49884-0113-02","PROPAFENONE HCL ER 225 MG PO CP12","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37644","ERX","HCPCS 63700001","49884-0210-02","PROPAFENONE HCL ER 325 MG PO CP12","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37644","ERX","HCPCS 63700001","66993-0115-60","PROPAFENONE HCL ER 325 MG PO CP12","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37644","ERX","HCPCS 63700001","68462-0409-60","PROPAFENONE HCL ER 325 MG PO CP12","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37645","ERX","HCPCS 63700001","49884-0211-02","PROPAFENONE HCL ER 425 MG PO CP12","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37645","ERX","HCPCS 63700001","66993-0116-60","PROPAFENONE HCL ER 425 MG PO CP12","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37645","ERX","HCPCS 63700001","68462-0410-60","PROPAFENONE HCL ER 425 MG PO CP12","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$7.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37648","ERX","HCPCS 63700001","00591-0900-30","GLIPIZIDE ER 2.5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37648","ERX","HCPCS 63700001","59762-0540-01","GLIPIZIDE ER 2.5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37648","ERX","HCPCS 63700001","68084-0295-21","GLIPIZIDE ER 2.5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37649","ERX","HCPCS 63700001","68084-0111-01","GLIPIZIDE ER 5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37649","ERX","HCPCS 63700001","68084-0111-11","GLIPIZIDE ER 5 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37650","ERX","HCPCS 63700001","00591-0845-10","GLIPIZIDE ER 10 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37650","ERX","HCPCS 63700001","68084-0112-01","GLIPIZIDE ER 10 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37650","ERX","HCPCS 63700001","68084-0112-11","GLIPIZIDE ER 10 MG PO TB24","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37651","ERX","HCPCS 63700001","63824-0008-15","GUAIFENESIN ER 600 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37651","ERX","HCPCS 63700001","70677-0055-01","GUAIFENESIN ER 600 MG PO TB12","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37662","ERX","HCPCS 63700001","50742-0622-01","NIFEDIPINE 90 MG PO TB24","BOTH IP/OP","$12.71 ","$9.41 ","$0.00 ","$11.53 ","","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.53 ","$0.00 ","$5.77 ","$9.13 ","$9.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37848","ERX","HCPCS 25000001","66689-0023-01","HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN","BOTH IP/OP","$14.88 ","$11.01 ","$0.00 ","$12.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.32 ","$0.00 ","$6.16 ","$9.76 ","$9.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37848","ERX","HCPCS 25000001","66689-0023-50","HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN","BOTH IP/OP","$14.88 ","$11.01 ","$0.00 ","$12.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.32 ","$0.00 ","$6.16 ","$9.76 ","$9.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37894","ERX","HCPCS J9305","00002-7623-01","PEMETREXED DISODIUM 500 MG IV SOLR","BOTH IP/OP","$10,436.55 ","$7,723.05 ","$0.00 ","$9,099.18 ","$4,837.34 ","$3,801.85 ","$2,832.93 ","$0.00 ","$0.00 ","$4,158.91 ","$9,099.18 ","$3,647.28 ","$4,549.59 ","$7,206.55 ","$7,279.34 ","$5,036.72 ","$4,158.91 ","$0.00 ","$3,959.99 ","$3,620.25 "
"37989","ERX","HCPCS J9055","66733-0948-23","CETUXIMAB 100 MG/50ML IV SOLN","BOTH IP/OP","$2,155.14 ","$1,594.80 ","$0.00 ","$1,919.52 ","$998.89 ","$676.18 ","$584.45 ","$0.00 ","$0.00 ","$742.72 ","$1,919.52 ","$651.50 ","$959.76 ","$1,520.26 ","$1,535.62 ","$899.70 ","$742.72 ","$0.00 ","$707.19 ","$647.13 "
"38062","ERX","HCPCS J7518","00078-0385-66","MYCOPHENOLATE SODIUM 180 MG PO TBEC","BOTH IP/OP","$19.15 ","$14.17 ","$0.00 ","$17.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.37 ","$0.00 ","$8.69 ","$13.76 ","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38062","ERX","HCPCS J7518","00378-4201-78","MYCOPHENOLATE SODIUM 180 MG PO TBEC","BOTH IP/OP","$19.15 ","$14.17 ","$0.00 ","$17.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.37 ","$0.00 ","$8.69 ","$13.76 ","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38062","ERX","HCPCS J7518","16729-0261-29","MYCOPHENOLATE SODIUM 180 MG PO TBEC","BOTH IP/OP","$19.15 ","$14.17 ","$0.00 ","$17.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.37 ","$0.00 ","$8.69 ","$13.76 ","$13.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38063","ERX","HCPCS 63700001","16729-0189-29","MYCOPHENOLATE SODIUM 360 MG PO TBEC","BOTH IP/OP","$38.29 ","$28.33 ","$0.00 ","$34.73 ","","$6.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.73 ","$0.00 ","$17.37 ","$27.51 ","$27.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38063","ERX","HCPCS 63700001","60505-2966-07","MYCOPHENOLATE SODIUM 360 MG PO TBEC","BOTH IP/OP","$38.29 ","$28.33 ","$0.00 ","$34.73 ","","$6.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.73 ","$0.00 ","$17.37 ","$27.51 ","$27.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38063","ERX","HCPCS 63700001","68084-0918-25","MYCOPHENOLATE SODIUM 360 MG PO TBEC","BOTH IP/OP","$38.29 ","$28.33 ","$0.00 ","$34.73 ","","$6.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.73 ","$0.00 ","$17.37 ","$27.51 ","$27.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38100","ERX","HCPCS 63700001","55513-0073-30","CINACALCET HCL 30 MG PO TABS","BOTH IP/OP","$118.31 ","$87.55 ","$0.00 ","$107.28 ","","$21.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.28 ","$0.00 ","$53.64 ","$84.97 ","$85.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38100","ERX","HCPCS 63700001","67877-0503-30","CINACALCET HCL 30 MG PO TABS","BOTH IP/OP","$118.31 ","$87.55 ","$0.00 ","$107.28 ","","$21.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.28 ","$0.00 ","$53.64 ","$84.97 ","$85.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38100","ERX","HCPCS 63700001","70436-0007-04","CINACALCET HCL 30 MG PO TABS","BOTH IP/OP","$118.31 ","$87.55 ","$0.00 ","$107.28 ","","$21.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.28 ","$0.00 ","$53.64 ","$84.97 ","$85.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38101","ERX","HCPCS 63700001","47335-0380-83","CINACALCET HCL 60 MG PO TABS","BOTH IP/OP","$214.61 ","$158.81 ","$0.00 ","$194.82 ","","$38.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$194.82 ","$0.00 ","$97.41 ","$154.30 ","$155.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38101","ERX","HCPCS 63700001","55513-0074-30","CINACALCET HCL 60 MG PO TABS","BOTH IP/OP","$214.61 ","$158.81 ","$0.00 ","$194.82 ","","$38.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$194.82 ","$0.00 ","$97.41 ","$154.30 ","$155.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38101","ERX","HCPCS 63700001","70436-0008-04","CINACALCET HCL 60 MG PO TABS","BOTH IP/OP","$214.61 ","$158.81 ","$0.00 ","$194.82 ","","$38.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$194.82 ","$0.00 ","$97.41 ","$154.30 ","$155.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38102","ERX","HCPCS 63700001","55513-0075-30","CINACALCET HCL 90 MG PO TABS","BOTH IP/OP","$335.91 ","$248.57 ","$0.00 ","$304.94 ","","$59.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$304.94 ","$0.00 ","$152.47 ","$241.51 ","$243.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38102","ERX","HCPCS 63700001","69097-0412-02","CINACALCET HCL 90 MG PO TABS","BOTH IP/OP","$335.91 ","$248.57 ","$0.00 ","$304.94 ","","$59.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$304.94 ","$0.00 ","$152.47 ","$241.51 ","$243.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38224","ERX","HCPCS 63700001","00228-2778-11","PROPRANOLOL HCL ER 60 MG PO CP24","BOTH IP/OP","$8.63 ","$6.39 ","$0.00 ","$7.76 ","","$1.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.76 ","$0.00 ","$3.88 ","$6.15 ","$6.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38224","ERX","HCPCS 63700001","42291-0522-01","PROPRANOLOL HCL ER 60 MG PO CP24","BOTH IP/OP","$8.63 ","$6.39 ","$0.00 ","$7.76 ","","$1.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.76 ","$0.00 ","$3.88 ","$6.15 ","$6.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38224","ERX","HCPCS 63700001","62559-0530-01","PROPRANOLOL HCL ER 60 MG PO CP24","BOTH IP/OP","$8.63 ","$6.39 ","$0.00 ","$7.76 ","","$1.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.76 ","$0.00 ","$3.88 ","$6.15 ","$6.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38225","ERX","HCPCS 63700001","00228-2779-11","PROPRANOLOL HCL ER 80 MG PO CP24","BOTH IP/OP","$9.56 ","$7.07 ","$0.00 ","$8.67 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.67 ","$0.00 ","$4.34 ","$6.87 ","$6.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38225","ERX","HCPCS 63700001","42291-0523-01","PROPRANOLOL HCL ER 80 MG PO CP24","BOTH IP/OP","$9.56 ","$7.07 ","$0.00 ","$8.67 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.67 ","$0.00 ","$4.34 ","$6.87 ","$6.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38225","ERX","HCPCS 63700001","42291-0523-10","PROPRANOLOL HCL ER 80 MG PO CP24","BOTH IP/OP","$9.56 ","$7.07 ","$0.00 ","$8.67 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.67 ","$0.00 ","$4.34 ","$6.87 ","$6.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38225","ERX","HCPCS 63700001","62559-0531-01","PROPRANOLOL HCL ER 80 MG PO CP24","BOTH IP/OP","$9.56 ","$7.07 ","$0.00 ","$8.67 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.67 ","$0.00 ","$4.34 ","$6.87 ","$6.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38226","ERX","HCPCS 63700001","00228-2780-11","PROPRANOLOL HCL ER 120 MG PO CP24","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$11.34 ","","$2.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.34 ","$0.00 ","$5.67 ","$8.98 ","$9.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38227","ERX","HCPCS 63700001","00228-2781-11","PROPRANOLOL HCL ER 160 MG PO CP24","BOTH IP/OP","$9.56 ","$7.07 ","$0.00 ","$9.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.56 ","$0.00 ","$4.78 ","$7.57 ","$7.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38227","ERX","HCPCS 63700001","62559-0533-01","PROPRANOLOL HCL ER 160 MG PO CP24","BOTH IP/OP","$9.56 ","$7.07 ","$0.00 ","$9.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.56 ","$0.00 ","$4.78 ","$7.57 ","$7.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38245","ERX","HCPCS 63700001","50383-0779-31","LACTULOSE 10 GM/15ML SOLN","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$6.00 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38245","ERX","HCPCS 63700001","50383-0779-16","LACTULOSE 10 GM/15ML SOLN","BOTH IP/OP","$6.23 ","$4.61 ","$0.00 ","$100.96 ","","$1.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$100.96 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38263","ERX","HCPCS 25000001","00002-7597-01","OLANZAPINE 10 MG IM SOLR","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38263","ERX","HCPCS 25000001","00517-0955-01","OLANZAPINE 10 MG IM SOLR","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38263","ERX","HCPCS 25000001","00781-3159-72","OLANZAPINE 10 MG IM SOLR","BOTH IP/OP","$43.48 ","$32.18 ","$0.00 ","$39.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.43 ","$0.00 ","$19.72 ","$31.23 ","$31.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38270","ERX","HCPCS J9070","00781-3244-94","CYCLOPHOSPHAMIDE 1 G IJ SOLR","BOTH IP/OP","$2,276.61 ","$1,684.69 ","$0.00 ","$2,109.60 ","$1,024.47 ","$274.73 ","$474.50 ","$0.00 ","$0.00 ","$390.57 ","$2,109.60 ","$358.46 ","$1,054.80 ","$1,670.80 ","$1,687.68 ","$495.02 ","$390.57 ","$0.00 ","$371.89 ","$345.66 "
"38270","ERX","HCPCS J9070","10019-0956-01","CYCLOPHOSPHAMIDE 1 G IJ SOLR","BOTH IP/OP","$2,276.61 ","$1,684.69 ","$0.00 ","$2,109.60 ","$1,024.47 ","$274.73 ","$474.50 ","$0.00 ","$0.00 ","$390.57 ","$2,109.60 ","$358.46 ","$1,054.80 ","$1,670.80 ","$1,687.68 ","$495.02 ","$390.57 ","$0.00 ","$371.89 ","$345.66 "
"38270","ERX","HCPCS J9070","16714-0857-01","CYCLOPHOSPHAMIDE 1 G IJ SOLR","BOTH IP/OP","$2,276.61 ","$1,684.69 ","$0.00 ","$2,109.60 ","$1,024.47 ","$274.73 ","$474.50 ","$0.00 ","$0.00 ","$390.57 ","$2,109.60 ","$358.46 ","$1,054.80 ","$1,670.80 ","$1,687.68 ","$495.02 ","$390.57 ","$0.00 ","$371.89 ","$345.66 "
"38270","ERX","HCPCS J9070","70121-1239-01","CYCLOPHOSPHAMIDE 1 G IJ SOLR","BOTH IP/OP","$2,276.61 ","$1,684.69 ","$0.00 ","$2,109.60 ","$1,024.47 ","$274.73 ","$474.50 ","$0.00 ","$0.00 ","$390.57 ","$2,109.60 ","$358.46 ","$1,054.80 ","$1,670.80 ","$1,687.68 ","$495.02 ","$390.57 ","$0.00 ","$371.89 ","$345.66 "
"38271","ERX","HCPCS J9070","00781-3233-94","CYCLOPHOSPHAMIDE 500 MG IJ SOLR","BOTH IP/OP","$1,283.34 ","$949.67 ","$0.00 ","$1,164.68 ","$577.50 ","$137.37 ","$267.48 ","$0.00 ","$0.00 ","$195.29 ","$1,164.68 ","$179.23 ","$582.34 ","$922.43 ","$931.74 ","$247.51 ","$195.29 ","$0.00 ","$185.94 ","$172.83 "
"38271","ERX","HCPCS J9070","10019-0955-01","CYCLOPHOSPHAMIDE 500 MG IJ SOLR","BOTH IP/OP","$1,283.34 ","$949.67 ","$0.00 ","$1,164.68 ","$577.50 ","$137.37 ","$267.48 ","$0.00 ","$0.00 ","$195.29 ","$1,164.68 ","$179.23 ","$582.34 ","$922.43 ","$931.74 ","$247.51 ","$195.29 ","$0.00 ","$185.94 ","$172.83 "
"38271","ERX","HCPCS J9070","16714-0859-01","CYCLOPHOSPHAMIDE 500 MG IJ SOLR","BOTH IP/OP","$1,283.34 ","$949.67 ","$0.00 ","$1,164.68 ","$577.50 ","$137.37 ","$267.48 ","$0.00 ","$0.00 ","$195.29 ","$1,164.68 ","$179.23 ","$582.34 ","$922.43 ","$931.74 ","$247.51 ","$195.29 ","$0.00 ","$185.94 ","$172.83 "
"38280","ERX","HCPCS J9070","00781-3255-94","CYCLOPHOSPHAMIDE 2 G IJ SOLR","BOTH IP/OP","$3,973.08 ","$2,940.08 ","$0.00 ","$3,603.90 ","$1,787.89 ","$549.46 ","$828.09 ","$0.00 ","$0.00 ","$781.14 ","$3,603.90 ","$716.92 ","$1,801.95 ","$2,854.29 ","$2,883.12 ","$990.03 ","$781.14 ","$0.00 ","$743.78 ","$691.32 "
"38280","ERX","HCPCS J9070","10019-0957-01","CYCLOPHOSPHAMIDE 2 G IJ SOLR","BOTH IP/OP","$3,973.08 ","$2,940.08 ","$0.00 ","$3,603.90 ","$1,787.89 ","$549.46 ","$828.09 ","$0.00 ","$0.00 ","$781.14 ","$3,603.90 ","$716.92 ","$1,801.95 ","$2,854.29 ","$2,883.12 ","$990.03 ","$781.14 ","$0.00 ","$743.78 ","$691.32 "
"38280","ERX","HCPCS J9070","10019-0957-11","CYCLOPHOSPHAMIDE 2 G IJ SOLR","BOTH IP/OP","$3,973.08 ","$2,940.08 ","$0.00 ","$3,603.90 ","$1,787.89 ","$549.46 ","$828.09 ","$0.00 ","$0.00 ","$781.14 ","$3,603.90 ","$716.92 ","$1,801.95 ","$2,854.29 ","$2,883.12 ","$990.03 ","$781.14 ","$0.00 ","$743.78 ","$691.32 "
"38280","ERX","HCPCS J9070","70121-1240-01","CYCLOPHOSPHAMIDE 2 G IJ SOLR","BOTH IP/OP","$3,973.08 ","$2,940.08 ","$0.00 ","$3,603.90 ","$1,787.89 ","$549.46 ","$828.09 ","$0.00 ","$0.00 ","$781.14 ","$3,603.90 ","$716.92 ","$1,801.95 ","$2,854.29 ","$2,883.12 ","$990.03 ","$781.14 ","$0.00 ","$743.78 ","$691.32 "
"38303","ERX","HCPCS J0132","00574-0805-30","ACETYLCYSTEINE 200 MG/ML IV SOLN","BOTH IP/OP","$755.55 ","$559.11 ","$0.00 ","$685.69 ","$340.00 ","$0.00 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$685.69 ","$0.00 ","$342.85 ","$543.07 ","$548.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38303","ERX","HCPCS J0132","00574-0815-30","ACETYLCYSTEINE 200 MG/ML IV SOLN","BOTH IP/OP","$755.55 ","$559.11 ","$0.00 ","$685.69 ","$340.00 ","$0.00 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$685.69 ","$0.00 ","$342.85 ","$543.07 ","$548.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38303","ERX","HCPCS J0132","17478-0660-30","ACETYLCYSTEINE 200 MG/ML IV SOLN","BOTH IP/OP","$755.55 ","$559.11 ","$0.00 ","$685.69 ","$340.00 ","$0.00 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$685.69 ","$0.00 ","$342.85 ","$543.07 ","$548.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38303","ERX","HCPCS J0132","25021-0812-30","ACETYLCYSTEINE 200 MG/ML IV SOLN","BOTH IP/OP","$755.55 ","$559.11 ","$0.00 ","$685.69 ","$340.00 ","$0.00 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$685.69 ","$0.00 ","$342.85 ","$543.07 ","$548.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38303","ERX","HCPCS J0132","63323-0963-30","ACETYLCYSTEINE 200 MG/ML IV SOLN","BOTH IP/OP","$755.55 ","$559.11 ","$0.00 ","$685.69 ","$340.00 ","$0.00 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$685.69 ","$0.00 ","$342.85 ","$543.07 ","$548.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38303","ERX","HCPCS J0132","66220-0207-30","ACETYLCYSTEINE 200 MG/ML IV SOLN","BOTH IP/OP","$755.55 ","$559.11 ","$0.00 ","$685.69 ","$340.00 ","$0.00 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$685.69 ","$0.00 ","$342.85 ","$543.07 ","$548.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38315","ERX","HCPCS 25000001","00597-0075-41","TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS","BOTH IP/OP","$1,485.63 ","$1,099.37 ","$0.00 ","$1,311.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,311.12 ","$0.00 ","$655.56 ","$1,038.41 ","$1,048.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38315","ERX","HCPCS 25000001","00597-0075-75","TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS","BOTH IP/OP","$1,485.63 ","$1,099.37 ","$0.00 ","$1,311.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,311.12 ","$0.00 ","$655.56 ","$1,038.41 ","$1,048.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38318","ERX","HCPCS 63700001","63010-0027-70","NELFINAVIR MESYLATE 625 MG PO TABS","BOTH IP/OP","$50.87 ","$37.64 ","$0.00 ","$46.14 ","","$9.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.14 ","$0.00 ","$23.07 ","$36.54 ","$36.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38421","ERX","HCPCS 63700001","13107-0001-30","MIRTAZAPINE 7.5 MG PO TABS","BOTH IP/OP","$10.01 ","$7.41 ","$0.00 ","$10.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.01 ","$0.00 ","$5.01 ","$7.93 ","$8.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38421","ERX","HCPCS 63700001","16714-0706-01","MIRTAZAPINE 7.5 MG PO TABS","BOTH IP/OP","$10.01 ","$7.41 ","$0.00 ","$10.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.01 ","$0.00 ","$5.01 ","$7.93 ","$8.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38479","ERX","HCPCS 63700001","00093-5417-84","CLOZAPINE 25 MG PO TBDP","BOTH IP/OP","$11.40 ","$8.44 ","$0.00 ","$11.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.40 ","$0.00 ","$5.70 ","$9.03 ","$9.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38480","ERX","HCPCS 63700001","00093-5419-19","CLOZAPINE 100 MG PO TBDP","BOTH IP/OP","$34.26 ","$25.35 ","$0.00 ","$31.07 ","","$6.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.07 ","$0.00 ","$15.54 ","$24.61 ","$24.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38480","ERX","HCPCS 63700001","00093-5419-84","CLOZAPINE 100 MG PO TBDP","BOTH IP/OP","$34.26 ","$25.35 ","$0.00 ","$31.07 ","","$6.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.07 ","$0.00 ","$15.54 ","$24.61 ","$24.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38488","ERX","HCPCS 63700001","00121-0721-04","FLUOXETINE HCL 20 MG/5ML PO SOLN","BOTH IP/OP","$14.33 ","$10.60 ","$0.00 ","$13.00 ","","$2.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38488","ERX","HCPCS 63700001","00121-4721-05","FLUOXETINE HCL 20 MG/5ML PO SOLN","BOTH IP/OP","$14.33 ","$10.60 ","$0.00 ","$13.00 ","","$2.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38488","ERX","HCPCS 63700001","54838-0523-40","FLUOXETINE HCL 20 MG/5ML PO SOLN","BOTH IP/OP","$14.33 ","$10.60 ","$0.00 ","$13.00 ","","$2.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.00 ","$0.00 ","$6.50 ","$10.30 ","$10.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38489","ERX","HCPCS 63700001","99999-6005-07","ETHOSUXIMIDE 250 MG/5ML PO SOLN","BOTH IP/OP","$105.15 ","$77.81 ","$0.00 ","$95.34 ","","$18.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.34 ","$0.00 ","$47.67 ","$75.51 ","$76.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38489","ERX","HCPCS 63700001","00121-0670-16","ETHOSUXIMIDE 250 MG/5ML PO SOLN","BOTH IP/OP","$105.15 ","$77.81 ","$0.00 ","$492.40 ","","$18.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.34 ","$0.00 ","$47.67 ","$492.40 ","$76.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38703","ERX","HCPCS J0153","17478-0542-02","ADENOSINE 6 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"38703","ERX","HCPCS J0153","17478-0953-02","ADENOSINE 6 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"38703","ERX","HCPCS J0153","25021-0301-67","ADENOSINE 6 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"38703","ERX","HCPCS J0153","63323-0651-21","ADENOSINE 6 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"38703","ERX","HCPCS J0153","63323-0651-89","ADENOSINE 6 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"38703","ERX","HCPCS J0153","67457-0855-02","ADENOSINE 6 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.19 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.19 ","$0.00 ","$2.08 ","$0.00 "
"38907","ERX","HCPCS 63700001","43386-0551-02","TINIDAZOLE 500 MG PO TABS","BOTH IP/OP","$88.80 ","$65.71 ","$0.00 ","$88.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.80 ","$0.00 ","$44.40 ","$70.33 ","$71.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39063","ERX","HCPCS 63700001","65649-0301-03","RIFAXIMIN 200 MG PO TABS","BOTH IP/OP","$134.02 ","$99.17 ","$0.00 ","$253.40 ","","$23.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.40 ","$0.00 ","$126.70 ","$200.69 ","$202.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39136","ERX","HCPCS 63700001","00574-2008-15","NYSTATIN 100000 UNIT/GM EX POWD","BOTH IP/OP","$106.02 ","$78.45 ","$0.00 ","$96.13 ","","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.13 ","$0.00 ","$48.07 ","$76.13 ","$76.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39136","ERX","HCPCS 63700001","16714-0769-01","NYSTATIN 100000 UNIT/GM EX POWD","BOTH IP/OP","$106.02 ","$78.45 ","$0.00 ","$96.13 ","","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.13 ","$0.00 ","$48.07 ","$76.13 ","$76.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39136","ERX","HCPCS 63700001","43386-0530-01","NYSTATIN 100000 UNIT/GM EX POWD","BOTH IP/OP","$106.02 ","$78.45 ","$0.00 ","$96.13 ","","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.13 ","$0.00 ","$48.07 ","$76.13 ","$76.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39136","ERX","HCPCS 63700001","68308-0152-15","NYSTATIN 100000 UNIT/GM EX POWD","BOTH IP/OP","$106.02 ","$78.45 ","$0.00 ","$96.13 ","","$18.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.13 ","$0.00 ","$48.07 ","$76.13 ","$76.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39254","ERX","HCPCS 63700001","67546-0111-12","NITAZOXANIDE 500 MG PO TABS","BOTH IP/OP","$542.85 ","$401.71 ","$0.00 ","$492.76 ","","$96.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$492.76 ","$0.00 ","$246.38 ","$390.27 ","$394.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39255","ERX","HCPCS 63700001","61958-0701-01","TRUVADA:EMTRICITABINE-TENOFOVIR 200-300 MG TAB PO","BOTH IP/OP","$255.71 ","$189.23 ","$0.00 ","$232.13 ","","$45.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.13 ","$0.00 ","$116.07 ","$183.85 ","$185.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39267","ERX","HCPCS J9045","00703-4248-01","CARBOPLATIN 450 MG/45ML IV SOLN","BOTH IP/OP","$270.61 ","$200.25 ","$0.00 ","$245.66 ","$121.77 ","$0.00 ","$60.81 ","$0.00 ","$0.00 ","$28.45 ","$245.66 ","$0.00 ","$122.83 ","$194.56 ","$196.53 ","$0.00 ","$28.45 ","$0.00 ","$27.09 ","$0.00 "
"39267","ERX","HCPCS J9045","61703-0339-50","CARBOPLATIN 450 MG/45ML IV SOLN","BOTH IP/OP","$270.61 ","$200.25 ","$0.00 ","$245.66 ","$121.77 ","$0.00 ","$60.81 ","$0.00 ","$0.00 ","$28.45 ","$245.66 ","$0.00 ","$122.83 ","$194.56 ","$196.53 ","$0.00 ","$28.45 ","$0.00 ","$27.09 ","$0.00 "
"39275","ERX","HCPCS 63700001","00002-3235-60","DULOXETINE HCL 20 MG PO CPEP","BOTH IP/OP","$39.53 ","$29.25 ","$0.00 ","$34.80 ","","$7.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39275","ERX","HCPCS 63700001","13668-0109-60","DULOXETINE HCL 20 MG PO CPEP","BOTH IP/OP","$39.53 ","$29.25 ","$0.00 ","$34.80 ","","$7.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39275","ERX","HCPCS 63700001","27241-0097-06","DULOXETINE HCL 20 MG PO CPEP","BOTH IP/OP","$39.53 ","$29.25 ","$0.00 ","$34.80 ","","$7.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39275","ERX","HCPCS 63700001","57237-0017-60","DULOXETINE HCL 20 MG PO CPEP","BOTH IP/OP","$39.53 ","$29.25 ","$0.00 ","$34.80 ","","$7.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39275","ERX","HCPCS 63700001","60505-2995-06","DULOXETINE HCL 20 MG PO CPEP","BOTH IP/OP","$39.53 ","$29.25 ","$0.00 ","$34.80 ","","$7.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39275","ERX","HCPCS 63700001","69097-0297-03","DULOXETINE HCL 20 MG PO CPEP","BOTH IP/OP","$39.53 ","$29.25 ","$0.00 ","$34.80 ","","$7.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39276","ERX","HCPCS 63700001","27241-0098-09","DULOXETINE HCL 30 MG PO CPEP","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$29.84 ","","$5.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.84 ","$0.00 ","$14.92 ","$23.63 ","$23.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39276","ERX","HCPCS 63700001","57237-0018-30","DULOXETINE HCL 30 MG PO CPEP","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$29.84 ","","$5.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.84 ","$0.00 ","$14.92 ","$23.63 ","$23.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39276","ERX","HCPCS 63700001","57237-0018-90","DULOXETINE HCL 30 MG PO CPEP","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$29.84 ","","$5.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.84 ","$0.00 ","$14.92 ","$23.63 ","$23.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39277","ERX","HCPCS 63700001","00228-2892-03","DULOXETINE HCL 60 MG PO CPEP","BOTH IP/OP","$29.80 ","$22.05 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.80 ","$0.00 ","$14.90 ","$23.60 ","$23.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39277","ERX","HCPCS 63700001","27241-0099-03","DULOXETINE HCL 60 MG PO CPEP","BOTH IP/OP","$29.80 ","$22.05 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.80 ","$0.00 ","$14.90 ","$23.60 ","$23.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39277","ERX","HCPCS 63700001","47335-0383-83","DULOXETINE HCL 60 MG PO CPEP","BOTH IP/OP","$29.80 ","$22.05 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.80 ","$0.00 ","$14.90 ","$23.60 ","$23.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39277","ERX","HCPCS 63700001","57237-0019-30","DULOXETINE HCL 60 MG PO CPEP","BOTH IP/OP","$29.80 ","$22.05 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.80 ","$0.00 ","$14.90 ","$23.60 ","$23.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39277","ERX","HCPCS 63700001","57237-0019-99","DULOXETINE HCL 60 MG PO CPEP","BOTH IP/OP","$29.80 ","$22.05 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.80 ","$0.00 ","$14.90 ","$23.60 ","$23.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39301","ERX","HCPCS 63700001","00093-5382-56","EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS","BOTH IP/OP","$179.30 ","$132.68 ","$0.00 ","$162.58 ","","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.58 ","$0.00 ","$81.29 ","$128.76 ","$130.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39301","ERX","HCPCS 63700001","35573-0402-30","EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS","BOTH IP/OP","$179.30 ","$132.68 ","$0.00 ","$162.58 ","","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.58 ","$0.00 ","$81.29 ","$128.76 ","$130.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39301","ERX","HCPCS 63700001","66993-0482-30","EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS","BOTH IP/OP","$179.30 ","$132.68 ","$0.00 ","$162.58 ","","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.58 ","$0.00 ","$81.29 ","$128.76 ","$130.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39301","ERX","HCPCS 63700001","68180-0288-06","EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS","BOTH IP/OP","$179.30 ","$132.68 ","$0.00 ","$162.58 ","","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.58 ","$0.00 ","$81.29 ","$128.76 ","$130.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39301","ERX","HCPCS 63700001","69097-0362-02","EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS","BOTH IP/OP","$179.30 ","$132.68 ","$0.00 ","$162.58 ","","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.58 ","$0.00 ","$81.29 ","$128.76 ","$130.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39522","ERX","HCPCS 25000001","00781-6078-46","CEFDINIR 250 MG/5ML PO SUSR","BOTH IP/OP","$529.20 ","$391.61 ","$0.00 ","$480.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$480.38 ","$0.00 ","$240.19 ","$380.46 ","$384.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39594","ERX","HCPCS 63700001","49411-0051-30","AMINOCAPROIC ACID 1000 MG PO TABS","BOTH IP/OP","$188.61 ","$139.57 ","$0.00 ","$171.02 ","","$33.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.02 ","$0.00 ","$85.51 ","$135.45 ","$136.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39700","ERX","HCPCS 25000001","00019-1323-16","IOVERSOL 68 % IJ SOLN","BOTH IP/OP","$189.48 ","$140.22 ","$0.00 ","$189.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.48 ","$0.00 ","$94.74 ","$150.07 ","$151.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39700","ERX","HCPCS 25000001","00019-1323-06","IOVERSOL 68 % IJ SOLN","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$189.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.48 ","$0.00 ","$94.74 ","$58.21 ","$151.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39720","ERX","HCPCS 63700001","00093-5352-86","ACAMPROSATE CALCIUM 333 MG PO TBEC","BOTH IP/OP","$7.37 ","$5.45 ","$0.00 ","$6.68 ","","$1.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.68 ","$0.00 ","$3.34 ","$5.29 ","$5.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39744","ERX","HCPCS 25000001","00143-9684-10","FLUMAZENIL 0.5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39744","ERX","HCPCS 25000001","00143-9784-10","FLUMAZENIL 0.5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39802","ERX","HCPCS 25000001","00386-0004-04","PENTAFLUOROPROP-TETRAFLUOROETH EX AERO","BOTH IP/OP","$129.41 ","$95.76 ","$0.00 ","$115.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.31 ","$0.00 ","$57.66 ","$91.33 ","$92.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39802","ERX","HCPCS 25000001","00386-0008-02","PENTAFLUOROPROP-TETRAFLUOROETH EX AERO","BOTH IP/OP","$129.41 ","$95.76 ","$0.00 ","$115.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.31 ","$0.00 ","$57.66 ","$91.33 ","$92.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39802","ERX","HCPCS 25000001","00386-0008-03","PENTAFLUOROPROP-TETRAFLUOROETH EX AERO","BOTH IP/OP","$129.41 ","$95.76 ","$0.00 ","$115.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.31 ","$0.00 ","$57.66 ","$91.33 ","$92.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39918","ERX","HCPCS J3260","00409-3578-01","TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.56 ","$0.00 ","$0.00 ","$4.34 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.34 ","$0.00 ","$4.13 ","$0.00 "
"39918","ERX","HCPCS J3260","36000-0244-01","TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.56 ","$0.00 ","$0.00 ","$4.34 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.34 ","$0.00 ","$4.13 ","$0.00 "
"39918","ERX","HCPCS J3260","36000-0244-25","TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.56 ","$0.00 ","$0.00 ","$4.34 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.34 ","$0.00 ","$4.13 ","$0.00 "
"39918","ERX","HCPCS J3260","63323-0306-02","TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.56 ","$0.00 ","$0.00 ","$4.34 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.34 ","$0.00 ","$4.13 ","$0.00 "
"39918","ERX","HCPCS J3260","67457-0473-22","TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$2.56 ","$0.00 ","$0.00 ","$4.34 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.34 ","$0.00 ","$4.13 ","$0.00 "
"39975","ERX","HCPCS 63700001","54092-0252-45","LANTHANUM CARBONATE 500 MG PO CHEW","BOTH IP/OP","$60.37 ","$44.67 ","$0.00 ","$54.76 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.76 ","$0.00 ","$27.38 ","$43.37 ","$43.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"39975","ERX","HCPCS 63700001","54092-0252-90","LANTHANUM CARBONATE 500 MG PO CHEW","BOTH IP/OP","$60.37 ","$44.67 ","$0.00 ","$54.76 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.76 ","$0.00 ","$27.38 ","$43.37 ","$43.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40055","ERX","HCPCS J9045","00703-4239-01","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40055","ERX","HCPCS J9045","16729-0295-12","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40055","ERX","HCPCS J9045","25021-0202-51","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40055","ERX","HCPCS J9045","25021-0205-51","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40055","ERX","HCPCS J9045","61703-0339-56","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40055","ERX","HCPCS J9045","63323-0172-60","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40055","ERX","HCPCS J9045","71288-0100-51","CARBOPLATIN 600 MG/60ML IV SOLN","BOTH IP/OP","$166.32 ","$123.08 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.93 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$37.93 ","$0.00 ","$36.11 ","$0.00 "
"40089","ERX","HCPCS 63700001","50242-0062-01","ERLOTINIB HCL 25 MG PO TABS","BOTH IP/OP","$365.63 ","$270.57 ","$0.00 ","$331.89 ","","$65.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.89 ","$0.00 ","$165.95 ","$262.86 ","$265.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40090","ERX","HCPCS 63700001","50242-0063-01","ERLOTINIB HCL 100 MG PO TABS","BOTH IP/OP","$872.74 ","$645.83 ","$0.00 ","$792.04 ","","$155.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$792.04 ","$0.00 ","$396.02 ","$627.30 ","$633.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40091","ERX","HCPCS 63700001","50242-0064-01","ERLOTINIB HCL 150 MG PO TABS","BOTH IP/OP","$987.13 ","$730.48 ","$0.00 ","$895.85 ","","$175.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$895.85 ","$0.00 ","$447.93 ","$709.51 ","$716.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40321","ERX","HCPCS 63700001","00378-5271-01","ESZOPICLONE 2 MG PO TABS","BOTH IP/OP","$48.87 ","$36.16 ","$0.00 ","$44.32 ","","$8.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.32 ","$0.00 ","$22.16 ","$35.10 ","$35.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40369","ERX","HCPCS 25000001","69918-0560-30","MESALAMINE 1000 MG RECTAL SUPP","BOTH IP/OP","$77.89 ","$57.64 ","$0.00 ","$70.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.64 ","$0.00 ","$35.32 ","$55.95 ","$56.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40401","ERX","HCPCS 63700001","00004-0244-51","SAQUINAVIR MESYLATE 500 MG PO TABS","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$84.12 ","","$16.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.12 ","$0.00 ","$42.06 ","$66.62 ","$67.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40413","ERX","HCPCS 63600001","66215-0302-00","ILOPROST 10 MCG/ML IN SOLN","BOTH IP/OP","$155.99 ","$115.43 ","$0.00 ","$141.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.44 ","$0.00 ","$70.72 ","$112.02 ","$113.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40413","ERX","HCPCS 63600001","66215-0302-30","ILOPROST 10 MCG/ML IN SOLN","BOTH IP/OP","$155.99 ","$115.43 ","$0.00 ","$141.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.44 ","$0.00 ","$70.72 ","$112.02 ","$113.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40449","ERX","HCPCS J3471","24208-0002-02","HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN","BOTH IP/OP","$296.65 ","$219.52 ","$0.00 ","$244.27 ","$133.49 ","$0.00 ","$17.63 ","$0.00 ","$0.00 ","$42.77 ","$244.27 ","$0.00 ","$122.14 ","$193.46 ","$195.42 ","$0.00 ","$38.23 ","$0.00 ","$38.89 ","$0.00 "
"40475","ERX","HCPCS J9264","68817-0134-50","NAB-PACLITAXEL 100 MG IV SUSR","BOTH IP/OP","$4,100.59 ","$3,034.44 ","$0.00 ","$3,559.40 ","$1,928.30 ","$1,404.40 ","$1,065.73 ","$0.00 ","$0.00 ","$1,474.63 ","$3,559.40 ","$1,313.87 ","$1,779.70 ","$2,819.04 ","$2,847.52 ","$1,814.39 ","$1,474.63 ","$0.00 ","$1,404.09 ","$1,326.90 "
"40540","ERX","HCPCS 90734","49281-0589-05","MENINGOCOCCAL A C Y&W-135 CONJ IM INJ","BOTH IP/OP","$469.43 ","$347.38 ","$0.00 ","$469.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.71 ","$469.43 ","$0.00 ","$234.72 ","$371.79 ","$375.54 ","$281.66 ","$143.71 ","$0.00 ","$136.84 ","$0.00 "
"40661","ERX","HCPCS J0202","58468-0357-01","ALEMTUZUMAB 30 MG/ML IV SOLN","BOTH IP/OP","$4,341.90 ","$3,213.01 ","$0.00 ","$4,341.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,341.90 ","$0.00 ","$2,170.95 ","$3,438.78 ","$3,473.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40661","ERX","HCPCS J0202","58468-0357-03","ALEMTUZUMAB 30 MG/ML IV SOLN","BOTH IP/OP","$4,341.90 ","$3,213.01 ","$0.00 ","$4,341.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,341.90 ","$0.00 ","$2,170.95 ","$3,438.78 ","$3,473.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40697","ERX","HCPCS 25000001","00173-0718-20","FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO","BOTH IP/OP","$716.73 ","$530.38 ","$0.00 ","$613.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$613.10 ","$0.00 ","$306.55 ","$485.58 ","$490.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40698","ERX","HCPCS 25000001","00173-0719-20","FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO","BOTH IP/OP","$959.51 ","$710.04 ","$0.00 ","$820.79 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$820.79 ","$0.00 ","$410.40 ","$650.07 ","$656.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40699","ERX","HCPCS 25000001","00173-0720-20","FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO","BOTH IP/OP","$1,321.93 ","$978.23 ","$0.00 ","$1,274.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,274.90 ","$0.00 ","$637.45 ","$1,009.72 ","$1,019.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40801","ERX","HCPCS J9217","62935-0453-45","LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT","BOTH IP/OP","$7,349.89 ","$5,438.92 ","$0.00 ","$6,666.93 ","$3,307.45 ","$1,204.40 ","$1,480.99 ","$0.00 ","$0.00 ","$1,621.99 ","$6,666.93 ","$1,415.60 ","$3,333.47 ","$5,280.21 ","$5,333.54 ","$1,954.87 ","$1,621.99 ","$0.00 ","$1,544.41 ","$1,235.32 "
"40872","ERX","HCPCS J2250","00641-6057-25","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40872","ERX","HCPCS J2250","23155-0600-31","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40872","ERX","HCPCS J2250","23155-0600-41","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40872","ERX","HCPCS J2250","47781-0588-46","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40872","ERX","HCPCS J2250","47781-0588-68","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40872","ERX","HCPCS J2250","70860-0600-02","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40872","ERX","HCPCS J2250","70860-0600-41","MIDAZOLAM HCL 2 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.38 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"40994","ERX","HCPCS 25000001","00132-0079-12","GLYCERIN (ADULT) 2 G RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40994","ERX","HCPCS 25000001","00132-0079-24","GLYCERIN (ADULT) 2 G RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41124","ERX","HCPCS 25000001","62991-2502-01","PHENOL LIQD","BOTH IP/OP","$963.60 ","$713.06 ","$0.00 ","$874.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$874.50 ","$0.00 ","$437.25 ","$692.60 ","$699.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41137","ERX","HCPCS A9577","00270-5164-13","GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","BOTH IP/OP","$242.21 ","$179.24 ","$0.00 ","$219.87 ","$108.99 ","$0.00 ","$50.48 ","$0.00 ","$0.00 ","$38.50 ","$219.87 ","$0.00 ","$109.94 ","$174.14 ","$175.90 ","$0.00 ","$34.41 ","$0.00 ","$35.00 ","$0.00 "
"41137","ERX","HCPCS A9577","00270-5164-14","GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","BOTH IP/OP","$242.21 ","$179.24 ","$0.00 ","$219.87 ","$108.99 ","$0.00 ","$50.48 ","$0.00 ","$0.00 ","$38.50 ","$219.87 ","$0.00 ","$109.94 ","$174.14 ","$175.90 ","$0.00 ","$34.41 ","$0.00 ","$35.00 ","$0.00 "
"41137","ERX","HCPCS A9577","00270-5164-15","GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","BOTH IP/OP","$242.21 ","$179.24 ","$0.00 ","$219.87 ","$108.99 ","$0.00 ","$50.48 ","$0.00 ","$0.00 ","$38.50 ","$219.87 ","$0.00 ","$109.94 ","$174.14 ","$175.90 ","$0.00 ","$34.41 ","$0.00 ","$35.00 ","$0.00 "
"41139","ERX","HCPCS 63700001","10147-0892-03","GALANTAMINE HYDROBROMIDE ER 16 MG PO CP24","BOTH IP/OP","$25.58 ","$18.93 ","$0.00 ","$23.20 ","","$4.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.20 ","$0.00 ","$11.60 ","$18.37 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41142","ERX","HCPCS 25000001","00597-0087-17","IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS","BOTH IP/OP","$2,320.66 ","$1,717.29 ","$0.00 ","$2,369.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,369.62 ","$0.00 ","$1,184.81 ","$1,876.74 ","$1,895.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41144","ERX","HCPCS J2248","00469-3250-10","MICAFUNGIN SODIUM 50 MG IV SOLR","BOTH IP/OP","$342.21 ","$253.24 ","$0.00 ","$342.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.21 ","$0.00 ","$171.11 ","$271.03 ","$273.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41147","ERX","HCPCS 63700001","65162-0446-03","ENTECAVIR 0.5 MG PO TABS","BOTH IP/OP","$155.36 ","$114.97 ","$0.00 ","$155.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.36 ","$0.00 ","$77.68 ","$123.05 ","$124.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41147","ERX","HCPCS 63700001","65862-0841-30","ENTECAVIR 0.5 MG PO TABS","BOTH IP/OP","$155.36 ","$114.97 ","$0.00 ","$155.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.36 ","$0.00 ","$77.68 ","$123.05 ","$124.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41147","ERX","HCPCS 63700001","68382-0920-06","ENTECAVIR 0.5 MG PO TABS","BOTH IP/OP","$155.36 ","$114.97 ","$0.00 ","$155.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.36 ","$0.00 ","$77.68 ","$123.05 ","$124.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41293","ERX","HCPCS 90715","58160-0842-52","TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP","BOTH IP/OP","$158.70 ","$117.44 ","$0.00 ","$158.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.53 ","$158.70 ","$0.00 ","$79.35 ","$125.69 ","$126.96 ","$0.00 ","$39.53 ","$0.00 ","$37.64 ","$0.00 "
"41294","ERX","HCPCS J9185","25021-0242-02","FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN","BOTH IP/OP","$762.12 ","$563.97 ","$0.00 ","$691.65 ","$342.95 ","$0.00 ","$233.27 ","$0.00 ","$0.00 ","$56.27 ","$691.65 ","$0.00 ","$345.83 ","$547.79 ","$553.32 ","$0.00 ","$0.00 ","$0.00 ","$53.58 ","$0.00 "
"41294","ERX","HCPCS J9185","63323-0192-02","FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN","BOTH IP/OP","$762.12 ","$563.97 ","$0.00 ","$691.65 ","$342.95 ","$0.00 ","$233.27 ","$0.00 ","$0.00 ","$56.27 ","$691.65 ","$0.00 ","$345.83 ","$547.79 ","$553.32 ","$0.00 ","$0.00 ","$0.00 ","$53.58 ","$0.00 "
"41382","ERX","HCPCS 63700001","00378-9119-98","FENTANYL 12 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$78.37 ","$57.99 ","$0.00 ","$71.06 ","","$13.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.06 ","$0.00 ","$35.53 ","$56.28 ","$56.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41382","ERX","HCPCS 63700001","47781-0423-11","FENTANYL 12 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$78.37 ","$57.99 ","$0.00 ","$71.06 ","","$13.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.06 ","$0.00 ","$35.53 ","$56.28 ","$56.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41382","ERX","HCPCS 63700001","47781-0423-47","FENTANYL 12 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$78.37 ","$57.99 ","$0.00 ","$71.06 ","","$13.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.06 ","$0.00 ","$35.53 ","$56.28 ","$56.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41382","ERX","HCPCS 63700001","60505-7080-02","FENTANYL 12 MCG/HR TD PATCH 72 HR","BOTH IP/OP","$78.37 ","$57.99 ","$0.00 ","$71.06 ","","$13.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.06 ","$0.00 ","$35.53 ","$56.28 ","$56.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41581","ERX","HCPCS J1610","00597-0053-45","GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR","BOTH IP/OP","$345.95 ","$256.00 ","$0.00 ","$314.03 ","$155.68 ","$166.77 ","$88.07 ","$0.00 ","$0.00 ","$255.63 ","$314.03 ","$209.24 ","$157.02 ","$248.71 ","$251.22 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"41581","ERX","HCPCS J1610","00597-0260-10","GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR","BOTH IP/OP","$345.95 ","$256.00 ","$0.00 ","$314.03 ","$155.68 ","$166.77 ","$88.07 ","$0.00 ","$0.00 ","$255.63 ","$314.03 ","$209.24 ","$157.02 ","$248.71 ","$251.22 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"41623","ERX","HCPCS 25000001","99999-6010-71","LEVOCARNITINE 1 GM/10ML PO SOLN","BOTH IP/OP","$49.28 ","$36.47 ","$0.00 ","$161.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.90 ","$0.00 ","$80.95 ","$35.39 ","$129.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41623","ERX","HCPCS 25000001","50383-0171-04","LEVOCARNITINE 1 GM/10ML PO SOLN","BOTH IP/OP","$49.28 ","$36.47 ","$0.00 ","$161.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.90 ","$0.00 ","$80.95 ","$128.22 ","$129.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41623","ERX","HCPCS 25000001","54482-0145-08","LEVOCARNITINE 1 GM/10ML PO SOLN","BOTH IP/OP","$49.28 ","$36.47 ","$0.00 ","$161.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.90 ","$0.00 ","$80.95 ","$128.22 ","$129.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41623","ERX","HCPCS 25000001","64980-0503-12","LEVOCARNITINE 1 GM/10ML PO SOLN","BOTH IP/OP","$49.28 ","$36.47 ","$0.00 ","$161.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.90 ","$0.00 ","$80.95 ","$128.22 ","$129.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41624","ERX","HCPCS J3430","00409-9157-01","VITAMIN K1 1 MG/0.5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41624","ERX","HCPCS J3430","00409-9157-31","VITAMIN K1 1 MG/0.5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41624","ERX","HCPCS J3430","00409-9157-50","VITAMIN K1 1 MG/0.5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41628","ERX","HCPCS 90715","49281-0400-10","TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP","BOTH IP/OP","$175.49 ","$129.86 ","$0.00 ","$175.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.53 ","$175.49 ","$0.00 ","$87.75 ","$138.99 ","$140.39 ","$0.00 ","$39.53 ","$0.00 ","$0.00 ","$0.00 "
"41628","ERX","HCPCS 90715","49281-0400-58","TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP","BOTH IP/OP","$175.49 ","$129.86 ","$0.00 ","$175.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.53 ","$175.49 ","$0.00 ","$87.75 ","$138.99 ","$140.39 ","$0.00 ","$39.53 ","$0.00 ","$0.00 ","$0.00 "
"41652","ERX","HCPCS J3243","00781-3481-70","TIGECYCLINE 50 MG IV SOLR","BOTH IP/OP","$525.84 ","$389.12 ","$0.00 ","$477.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.33 ","$0.00 ","$238.67 ","$378.05 ","$381.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41652","ERX","HCPCS J3243","00781-3481-92","TIGECYCLINE 50 MG IV SOLR","BOTH IP/OP","$525.84 ","$389.12 ","$0.00 ","$477.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.33 ","$0.00 ","$238.67 ","$378.05 ","$381.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41652","ERX","HCPCS J3243","63323-0960-10","TIGECYCLINE 50 MG IV SOLR","BOTH IP/OP","$525.84 ","$389.12 ","$0.00 ","$477.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.33 ","$0.00 ","$238.67 ","$378.05 ","$381.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41673","ERX","HCPCS J9390","64370-0532-02","VINORELBINE TARTRATE 50 MG/5ML IV SOLN","BOTH IP/OP","$311.10 ","$230.21 ","$0.00 ","$311.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$246.39 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41675","ERX","HCPCS 90378","60574-4113-01","PALIVIZUMAB 100 MG/ML IM SOLN","BOTH IP/OP","$8,338.46 ","$6,170.46 ","$0.00 ","$7,307.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,307.89 ","$0.00 ","$3,653.95 ","$5,787.85 ","$5,846.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41676","ERX","HCPCS 63700001","00597-0003-02","TIPRANAVIR 250 MG PO CAPS","BOTH IP/OP","$142.38 ","$105.36 ","$0.00 ","$124.14 ","","$26.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.14 ","$0.00 ","$62.07 ","$98.32 ","$99.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41793","ERX","HCPCS 25000001","67457-0163-02","SODIUM TETRADECYL SULFATE 3 % IV SOLN","BOTH IP/OP","$89.17 ","$65.99 ","$0.00 ","$80.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.85 ","$0.00 ","$40.43 ","$64.98 ","$64.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41822","ERX","HCPCS 63700001","00173-0884-08","OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS","BOTH IP/OP","$22.76 ","$16.84 ","$0.00 ","$22.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.76 ","$0.00 ","$11.38 ","$18.03 ","$18.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41822","ERX","HCPCS 63700001","42291-0657-12","OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS","BOTH IP/OP","$22.76 ","$16.84 ","$0.00 ","$22.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.76 ","$0.00 ","$11.38 ","$18.03 ","$18.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41822","ERX","HCPCS 63700001","60505-3170-07","OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS","BOTH IP/OP","$22.76 ","$16.84 ","$0.00 ","$22.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.76 ","$0.00 ","$11.38 ","$18.03 ","$18.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41828","ERX","HCPCS 25000001","00085-1341-06","MOMETASONE FUROATE 220 MCG/INH IN AEPB","BOTH IP/OP","$279.57 ","$206.88 ","$0.00 ","$279.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$279.57 ","$0.00 ","$139.79 ","$221.42 ","$223.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41828","ERX","HCPCS 25000001","00085-1341-07","MOMETASONE FUROATE 220 MCG/INH IN AEPB","BOTH IP/OP","$279.57 ","$206.88 ","$0.00 ","$279.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$279.57 ","$0.00 ","$139.79 ","$221.42 ","$223.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41831","ERX","HCPCS 25000001","50383-0933-35","LIDOCAINE 5 % EX OINT","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41831","ERX","HCPCS 25000001","52565-0008-14","LIDOCAINE 5 % EX OINT","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41831","ERX","HCPCS 25000001","68462-0418-20","LIDOCAINE 5 % EX OINT","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41832","ERX","HCPCS 63700001","00093-5517-98","SILDENAFIL CITRATE 20 MG PO TABS","BOTH IP/OP","$85.11 ","$62.98 ","$0.00 ","$77.17 ","","$15.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.17 ","$0.00 ","$38.59 ","$61.12 ","$61.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41832","ERX","HCPCS 63700001","52817-0295-90","SILDENAFIL CITRATE 20 MG PO TABS","BOTH IP/OP","$85.11 ","$62.98 ","$0.00 ","$77.17 ","","$15.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.17 ","$0.00 ","$38.59 ","$61.12 ","$61.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41893","ERX","HCPCS 63700001","24338-0010-18","ISOSORB DINITRATE-HYDRALAZINE 20-37.5 MG PO TABS","BOTH IP/OP","$16.98 ","$12.57 ","$0.00 ","$16.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.98 ","$0.00 ","$8.49 ","$13.45 ","$13.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41938","ERX","HCPCS 63700001","00054-4538-25","METHADONE HCL 40 MG PO TBSO","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42064","ERX","HCPCS 63700001","64764-0805-30","RAMELTEON 8 MG PO TABS","BOTH IP/OP","$65.21 ","$48.26 ","$0.00 ","$59.14 ","","$11.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.14 ","$0.00 ","$29.57 ","$46.84 ","$47.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42162","ERX","HCPCS 63700001","00071-1012-68","PREGABALIN 25 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42162","ERX","HCPCS 63700001","50228-0350-90","PREGABALIN 25 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42162","ERX","HCPCS 63700001","62332-0119-90","PREGABALIN 25 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42162","ERX","HCPCS 63700001","76282-0568-90","PREGABALIN 25 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42163","ERX","HCPCS 63700001","00071-1013-41","PREGABALIN 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42163","ERX","HCPCS 63700001","00071-1013-68","PREGABALIN 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42163","ERX","HCPCS 63700001","50228-0351-90","PREGABALIN 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42163","ERX","HCPCS 63700001","60687-0484-01","PREGABALIN 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42163","ERX","HCPCS 63700001","62332-0120-90","PREGABALIN 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42163","ERX","HCPCS 63700001","76282-0569-90","PREGABALIN 50 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42164","ERX","HCPCS 63700001","00071-1014-41","PREGABALIN 75 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42164","ERX","HCPCS 63700001","00071-1014-68","PREGABALIN 75 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42164","ERX","HCPCS 63700001","50228-0352-90","PREGABALIN 75 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42164","ERX","HCPCS 63700001","62332-0121-90","PREGABALIN 75 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42164","ERX","HCPCS 63700001","76282-0570-90","PREGABALIN 75 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42165","ERX","HCPCS 63700001","00071-1015-41","PREGABALIN 100 MG PO CAPS","BOTH IP/OP","$47.49 ","$35.14 ","$0.00 ","$41.06 ","","$8.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.06 ","$0.00 ","$20.53 ","$32.52 ","$32.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42165","ERX","HCPCS 63700001","00904-7001-61","PREGABALIN 100 MG PO CAPS","BOTH IP/OP","$47.49 ","$35.14 ","$0.00 ","$41.06 ","","$8.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.06 ","$0.00 ","$20.53 ","$32.52 ","$32.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42165","ERX","HCPCS 63700001","50228-0353-90","PREGABALIN 100 MG PO CAPS","BOTH IP/OP","$47.49 ","$35.14 ","$0.00 ","$41.06 ","","$8.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.06 ","$0.00 ","$20.53 ","$32.52 ","$32.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42165","ERX","HCPCS 63700001","60687-0506-01","PREGABALIN 100 MG PO CAPS","BOTH IP/OP","$47.49 ","$35.14 ","$0.00 ","$41.06 ","","$8.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.06 ","$0.00 ","$20.53 ","$32.52 ","$32.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42165","ERX","HCPCS 63700001","60687-0506-11","PREGABALIN 100 MG PO CAPS","BOTH IP/OP","$47.49 ","$35.14 ","$0.00 ","$41.06 ","","$8.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.06 ","$0.00 ","$20.53 ","$32.52 ","$32.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42165","ERX","HCPCS 63700001","62332-0122-90","PREGABALIN 100 MG PO CAPS","BOTH IP/OP","$47.49 ","$35.14 ","$0.00 ","$41.06 ","","$8.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.06 ","$0.00 ","$20.53 ","$32.52 ","$32.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","00071-1016-41","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","00071-1016-68","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","43598-0295-66","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","43598-0295-79","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","50228-0354-90","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","60687-0517-01","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","62332-0123-90","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42166","ERX","HCPCS 63700001","72205-0015-90","PREGABALIN 150 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42167","ERX","HCPCS 63700001","00071-1017-68","PREGABALIN 200 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42167","ERX","HCPCS 63700001","50228-0355-90","PREGABALIN 200 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42167","ERX","HCPCS 63700001","62332-0124-90","PREGABALIN 200 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42168","ERX","HCPCS 63700001","50228-0356-90","PREGABALIN 225 MG PO CAPS","BOTH IP/OP","$24.52 ","$18.14 ","$0.00 ","$22.24 ","","$4.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.24 ","$0.00 ","$11.12 ","$17.61 ","$17.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42168","ERX","HCPCS 63700001","62332-0125-90","PREGABALIN 225 MG PO CAPS","BOTH IP/OP","$24.52 ","$18.14 ","$0.00 ","$22.24 ","","$4.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.24 ","$0.00 ","$11.12 ","$17.61 ","$17.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42169","ERX","HCPCS 63700001","00071-1018-68","PREGABALIN 300 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42169","ERX","HCPCS 63700001","50228-0357-90","PREGABALIN 300 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42169","ERX","HCPCS 63700001","62332-0126-90","PREGABALIN 300 MG PO CAPS","BOTH IP/OP","$43.18 ","$31.95 ","$0.00 ","$37.33 ","","$7.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.67 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42219","ERX","HCPCS 63700001","00904-6836-20","LOPERAMIDE HCL 1 MG/7.5ML PO LIQD","BOTH IP/OP","$14.59 ","$10.80 ","$0.00 ","$11.00 ","","$2.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42219","ERX","HCPCS 63700001","70677-0054-01","LOPERAMIDE HCL 1 MG/7.5ML PO LIQD","BOTH IP/OP","$14.59 ","$10.80 ","$0.00 ","$11.00 ","","$2.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42918","ERX","HCPCS 63700001","99999-6005-12","ZIDOVUDINE 50 MG/5ML PO SYRP","BOTH IP/OP","$111.64 ","$82.61 ","$0.00 ","$101.22 ","","$19.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.22 ","$0.00 ","$50.61 ","$80.17 ","$80.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42918","ERX","HCPCS 63700001","65862-0048-24","ZIDOVUDINE 50 MG/5ML PO SYRP","BOTH IP/OP","$111.64 ","$82.61 ","$0.00 ","$144.30 ","","$19.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.22 ","$0.00 ","$50.61 ","$144.30 ","$80.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42939","ERX","HCPCS 25000001","65628-0063-01","PROGESTERONE 200 MG VA SUPP","BOTH IP/OP","$28.50 ","$21.09 ","$0.00 ","$25.84 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.84 ","$0.00 ","$12.92 ","$20.47 ","$20.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43010","ERX","HCPCS 63700001","00904-5313-46","PRENATAL 27-0.8 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43010","ERX","HCPCS 63700001","00904-5313-60","PRENATAL 27-0.8 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43230","ERX","HCPCS 63700001","13668-0117-30","LOSARTAN-HCTZ 100-12.5 MG PO TABS","BOTH IP/OP","$14.28 ","$10.57 ","$0.00 ","$12.96 ","","$2.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.96 ","$0.00 ","$6.48 ","$10.26 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43230","ERX","HCPCS 63700001","13668-0117-90","LOSARTAN-HCTZ 100-12.5 MG PO TABS","BOTH IP/OP","$14.28 ","$10.57 ","$0.00 ","$12.96 ","","$2.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.96 ","$0.00 ","$6.48 ","$10.26 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43230","ERX","HCPCS 63700001","16714-0224-01","LOSARTAN-HCTZ 100-12.5 MG PO TABS","BOTH IP/OP","$14.28 ","$10.57 ","$0.00 ","$12.96 ","","$2.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.96 ","$0.00 ","$6.48 ","$10.26 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43230","ERX","HCPCS 63700001","16714-0224-02","LOSARTAN-HCTZ 100-12.5 MG PO TABS","BOTH IP/OP","$14.28 ","$10.57 ","$0.00 ","$12.96 ","","$2.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.96 ","$0.00 ","$6.48 ","$10.26 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43230","ERX","HCPCS 63700001","62332-0049-90","LOSARTAN-HCTZ 100-12.5 MG PO TABS","BOTH IP/OP","$14.28 ","$10.57 ","$0.00 ","$12.96 ","","$2.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.96 ","$0.00 ","$6.48 ","$10.26 ","$10.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43391","ERX","HCPCS 63700001","00074-6799-22","KALETRA:LOPINAVIR-RITONAVIR 200-50 MG PO TABS","BOTH IP/OP","$79.07 ","$58.51 ","$0.00 ","$71.69 ","","$14.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.69 ","$0.00 ","$35.85 ","$56.78 ","$57.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43416","ERX","HCPCS 63700001","00078-0469-15","DEFERASIROX 250 MG PO TBSO","BOTH IP/OP","$340.53 ","$251.99 ","$0.00 ","$309.11 ","","$60.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$309.11 ","$0.00 ","$154.56 ","$244.82 ","$247.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43417","ERX","HCPCS 63700001","00078-0470-15","DEFERASIROX 500 MG PO TBSO","BOTH IP/OP","$591.85 ","$437.97 ","$0.00 ","$537.13 ","","$105.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.13 ","$0.00 ","$268.57 ","$425.41 ","$429.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43472","ERX","HCPCS 25000001","63402-0510-01","LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO","BOTH IP/OP","$284.15 ","$210.27 ","$0.00 ","$257.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.94 ","$0.00 ","$128.97 ","$204.29 ","$206.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43548","ERX","HCPCS 63700001","54092-0254-10","LANTHANUM CARBONATE 1000 MG PO CHEW","BOTH IP/OP","$60.37 ","$44.67 ","$0.00 ","$54.76 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.76 ","$0.00 ","$27.38 ","$43.37 ","$43.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43548","ERX","HCPCS 63700001","54092-0254-90","LANTHANUM CARBONATE 1000 MG PO CHEW","BOTH IP/OP","$60.37 ","$44.67 ","$0.00 ","$54.76 ","","$10.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.76 ","$0.00 ","$27.38 ","$43.37 ","$43.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43556","ERX","HCPCS 63700001","00054-0057-46","DIGOXIN 0.05 MG/ML PO SOLN","BOTH IP/OP","$564.48 ","$417.72 ","$0.00 ","$512.40 ","","$100.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.40 ","$0.00 ","$256.20 ","$405.82 ","$409.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43675","ERX","HCPCS 63700001","50419-0488-58","SORAFENIB TOSYLATE 200 MG PO TABS","BOTH IP/OP","$1,212.39 ","$897.17 ","$0.00 ","$1,059.01 ","","$230.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,059.01 ","$0.00 ","$529.51 ","$838.74 ","$847.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43718","ERX","HCPCS 63700001","59572-0405-00","LENALIDOMIDE 5 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43718","ERX","HCPCS 63700001","59572-0405-28","LENALIDOMIDE 5 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43719","ERX","HCPCS 63700001","59572-0410-00","LENALIDOMIDE 10 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43719","ERX","HCPCS 63700001","59572-0410-28","LENALIDOMIDE 10 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70257","ERX","HCPCS 63700001","49884-0402-91","RISPERIDONE 3 MG PO TBDP","BOTH IP/OP","$49.37 ","$36.53 ","$0.00 ","$44.77 ","","$8.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.77 ","$0.00 ","$22.39 ","$35.46 ","$35.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70261","ERX","HCPCS J1815","00169-3687-12","INSULIN DETEMIR (LEVEMIR) 100 UNIT/ML SC SOLN","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$201.38 ","$8.15 ","$0.00 ","$3.13 ","$0.00 ","$0.00 ","$2.63 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$201.38 ","$0.00 "
"70267","ERX","HCPCS J9261","00078-0683-06","NELARABINE 5 MG/ML IV SOLN","BOTH IP/OP","$2,117.88 ","$1,567.23 ","$0.00 ","$2,117.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.88 ","$0.00 ","$1,058.94 ","$1,677.36 ","$1,694.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70284","ERX","HCPCS 63700001","60258-0006-01","K & NA PHOSPHATES 280-160-250 MG PO PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70306","ERX","HCPCS 63700001","13668-0216-30","ARIPIPRAZOLE 2 MG PO TABS","BOTH IP/OP","$122.48 ","$90.64 ","$0.00 ","$111.06 ","","$21.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.06 ","$0.00 ","$55.53 ","$87.96 ","$88.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70306","ERX","HCPCS 63700001","16714-0783-01","ARIPIPRAZOLE 2 MG PO TABS","BOTH IP/OP","$122.48 ","$90.64 ","$0.00 ","$111.06 ","","$21.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.06 ","$0.00 ","$55.53 ","$87.96 ","$88.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70306","ERX","HCPCS 63700001","65862-0661-30","ARIPIPRAZOLE 2 MG PO TABS","BOTH IP/OP","$122.48 ","$90.64 ","$0.00 ","$111.06 ","","$21.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.06 ","$0.00 ","$55.53 ","$87.96 ","$88.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70324","ERX","HCPCS 63700001","00093-4405-93","CLOZAPINE 200 MG PO TABS","BOTH IP/OP","$27.29 ","$20.19 ","$0.00 ","$24.75 ","","$4.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.75 ","$0.00 ","$12.38 ","$19.60 ","$19.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70397","ERX","HCPCS 63700001","00904-6639-61","QUETIAPINE FUMARATE 50 MG PO TABS","BOTH IP/OP","$25.94 ","$19.20 ","$0.00 ","$23.52 ","","$4.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.52 ","$0.00 ","$11.76 ","$18.63 ","$18.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70397","ERX","HCPCS 63700001","50268-0631-15","QUETIAPINE FUMARATE 50 MG PO TABS","BOTH IP/OP","$25.94 ","$19.20 ","$0.00 ","$23.52 ","","$4.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.52 ","$0.00 ","$11.76 ","$18.63 ","$18.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70397","ERX","HCPCS 63700001","60687-0338-01","QUETIAPINE FUMARATE 50 MG PO TABS","BOTH IP/OP","$25.94 ","$19.20 ","$0.00 ","$23.52 ","","$4.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.52 ","$0.00 ","$11.76 ","$18.63 ","$18.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70398","ERX","HCPCS 63700001","16714-0457-01","QUETIAPINE FUMARATE 400 MG PO TABS","BOTH IP/OP","$83.22 ","$61.58 ","$0.00 ","$75.76 ","","$14.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.76 ","$0.00 ","$37.88 ","$60.00 ","$60.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70405","ERX","HCPCS J7187","63833-0616-02","ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70424","ERX","HCPCS 63700001","00069-0550-38","SUNITINIB MALATE 12.5 MG PO CAPS","BOTH IP/OP","$747.09 ","$552.85 ","$0.00 ","$612.06 ","","$132.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.06 ","$0.00 ","$306.03 ","$484.75 ","$489.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70425","ERX","HCPCS 63700001","00069-0770-38","SUNITINIB MALATE 25 MG PO CAPS","BOTH IP/OP","$1,325.32 ","$980.74 ","$0.00 ","$1,224.12 ","","$235.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,224.12 ","$0.00 ","$612.06 ","$969.50 ","$979.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70426","ERX","HCPCS 63700001","00069-0980-38","SUNITINIB MALATE 50 MG PO CAPS","BOTH IP/OP","$2,307.19 ","$1,707.32 ","$0.00 ","$1,929.98 ","","$410.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,929.98 ","$0.00 ","$964.99 ","$1,528.54 ","$1,543.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70434","ERX","HCPCS 63700001","50228-0423-60","RANOLAZINE ER 500 MG PO TB12","BOTH IP/OP","$34.46 ","$25.50 ","$0.00 ","$29.82 ","","$6.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.82 ","$0.00 ","$14.91 ","$23.62 ","$23.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70434","ERX","HCPCS 63700001","61958-1003-01","RANOLAZINE ER 500 MG PO TB12","BOTH IP/OP","$34.46 ","$25.50 ","$0.00 ","$29.82 ","","$6.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.82 ","$0.00 ","$14.91 ","$23.62 ","$23.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70472","ERX","HCPCS 63700001","64764-0240-60","LUBIPROSTONE 24 MCG PO CAPS","BOTH IP/OP","$31.10 ","$23.01 ","$0.00 ","$28.21 ","","$5.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.21 ","$0.00 ","$14.11 ","$22.34 ","$22.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70536","ERX","HCPCS 25000001","00054-3270-99","FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","BOTH IP/OP","$268.59 ","$198.76 ","$0.00 ","$268.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.59 ","$0.00 ","$134.30 ","$212.72 ","$214.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70536","ERX","HCPCS 25000001","50383-0700-16","FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","BOTH IP/OP","$268.59 ","$198.76 ","$0.00 ","$268.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.59 ","$0.00 ","$134.30 ","$212.72 ","$214.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70536","ERX","HCPCS 25000001","60432-0264-15","FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","BOTH IP/OP","$268.59 ","$198.76 ","$0.00 ","$268.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.59 ","$0.00 ","$134.30 ","$212.72 ","$214.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70536","ERX","HCPCS 25000001","60505-0829-01","FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","BOTH IP/OP","$268.59 ","$198.76 ","$0.00 ","$268.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.59 ","$0.00 ","$134.30 ","$212.72 ","$214.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70545","ERX","HCPCS 25000001","42023-0105-01","METHOHEXITAL SODIUM 0.5 G IJ SOLR","BOTH IP/OP","$340.76 ","$252.16 ","$0.00 ","$294.59 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$294.59 ","$0.00 ","$147.30 ","$233.32 ","$235.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70678","ERX","HCPCS 25000001","39822-1201-02","NEOMYCIN-POLYMYXIN B GU 40-200000 IR SOLN","BOTH IP/OP","$167.36 ","$123.85 ","$0.00 ","$167.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$167.36 ","$0.00 ","$83.68 ","$132.55 ","$133.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70693","ERX","HCPCS 25000001","00002-7511-01","HUMALOG MIX 75-25 VIAL","BOTH IP/OP","$997.59 ","$738.22 ","$0.00 ","$905.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$905.35 ","$0.00 ","$452.68 ","$717.04 ","$724.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70773","ERX","HCPCS 63700001","16714-0357-01","LEVETIRACETAM 1000 MG PO TABS","BOTH IP/OP","$6.39 ","$4.73 ","$0.00 ","$6.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.39 ","$0.00 ","$3.20 ","$5.06 ","$5.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70773","ERX","HCPCS 63700001","16729-0067-12","LEVETIRACETAM 1000 MG PO TABS","BOTH IP/OP","$6.39 ","$4.73 ","$0.00 ","$6.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.39 ","$0.00 ","$3.20 ","$5.06 ","$5.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70773","ERX","HCPCS 63700001","31722-0539-60","LEVETIRACETAM 1000 MG PO TABS","BOTH IP/OP","$6.39 ","$4.73 ","$0.00 ","$6.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.39 ","$0.00 ","$3.20 ","$5.06 ","$5.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70773","ERX","HCPCS 63700001","68084-0893-01","LEVETIRACETAM 1000 MG PO TABS","BOTH IP/OP","$6.39 ","$4.73 ","$0.00 ","$6.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.39 ","$0.00 ","$3.20 ","$5.06 ","$5.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70773","ERX","HCPCS 63700001","68180-0115-07","LEVETIRACETAM 1000 MG PO TABS","BOTH IP/OP","$6.39 ","$4.73 ","$0.00 ","$6.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.39 ","$0.00 ","$3.20 ","$5.06 ","$5.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70784","ERX","HCPCS 63700001","50419-0405-03","DROSPIRENONE-ETHINYL ESTRADIOL 3-0.02 MG PO TABS","BOTH IP/OP","$639.00 ","$472.86 ","$0.00 ","$552.80 ","","$119.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$552.80 ","$0.00 ","$276.40 ","$437.82 ","$442.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76364","ERX","HCPCS J0894","16714-0749-01","DECITABINE 50 MG IV SOLR","BOTH IP/OP","$1,314.00 ","$972.36 ","$0.00 ","$2,976.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.63 ","$2,976.60 ","$392.96 ","$1,488.30 ","$2,357.47 ","$2,381.28 ","$542.66 ","$252.63 ","$0.00 ","$240.54 ","$214.05 "
"76364","ERX","HCPCS J0894","16729-0224-05","DECITABINE 50 MG IV SOLR","BOTH IP/OP","$1,314.00 ","$972.36 ","$0.00 ","$2,976.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.63 ","$2,976.60 ","$392.96 ","$1,488.30 ","$2,357.47 ","$2,381.28 ","$542.66 ","$252.63 ","$0.00 ","$240.54 ","$214.05 "
"76364","ERX","HCPCS J0894","25021-0231-20","DECITABINE 50 MG IV SOLR","BOTH IP/OP","$1,314.00 ","$972.36 ","$0.00 ","$2,976.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.63 ","$2,976.60 ","$392.96 ","$1,488.30 ","$2,357.47 ","$2,381.28 ","$542.66 ","$252.63 ","$0.00 ","$240.54 ","$214.05 "
"76364","ERX","HCPCS J0894","47335-0361-41","DECITABINE 50 MG IV SOLR","BOTH IP/OP","$1,314.00 ","$972.36 ","$0.00 ","$2,976.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.63 ","$2,976.60 ","$392.96 ","$1,488.30 ","$2,357.47 ","$2,381.28 ","$542.66 ","$252.63 ","$0.00 ","$240.54 ","$214.05 "
"76364","ERX","HCPCS J0894","55111-0556-10","DECITABINE 50 MG IV SOLR","BOTH IP/OP","$1,314.00 ","$972.36 ","$0.00 ","$2,976.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.63 ","$2,976.60 ","$392.96 ","$1,488.30 ","$2,357.47 ","$2,381.28 ","$542.66 ","$252.63 ","$0.00 ","$240.54 ","$214.05 "
"76396","ERX","HCPCS 25000001","68968-5555-03","METHYLPHENIDATE 30 MG/9HR TD PTCH","BOTH IP/OP","$73.91 ","$54.69 ","$0.00 ","$60.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.25 ","$0.00 ","$30.13 ","$47.72 ","$48.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76437","ERX","HCPCS 63700001","55111-0587-01","AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE","BOTH IP/OP","$16.80 ","$12.43 ","$0.00 ","$15.24 ","","$2.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.24 ","$0.00 ","$7.62 ","$12.07 ","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76437","ERX","HCPCS 63700001","65862-0585-01","AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE","BOTH IP/OP","$16.80 ","$12.43 ","$0.00 ","$15.24 ","","$2.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.24 ","$0.00 ","$7.62 ","$12.07 ","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76438","ERX","HCPCS 63700001","55111-0586-01","AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS","BOTH IP/OP","$20.29 ","$15.01 ","$0.00 ","$18.40 ","","$3.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.40 ","$0.00 ","$9.20 ","$14.57 ","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76438","ERX","HCPCS 63700001","65862-0587-01","AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS","BOTH IP/OP","$20.29 ","$15.01 ","$0.00 ","$18.40 ","","$3.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.40 ","$0.00 ","$9.20 ","$14.57 ","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76444","ERX","HCPCS 63700001","00069-0468-56","VARENICLINE TARTRATE 0.5 MG PO TABS","BOTH IP/OP","$36.03 ","$26.66 ","$0.00 ","$36.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.03 ","$0.00 ","$18.02 ","$28.54 ","$28.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76445","ERX","HCPCS 63700001","00069-0469-56","VARENICLINE TARTRATE 1 MG PO TABS","BOTH IP/OP","$36.03 ","$26.66 ","$0.00 ","$36.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.03 ","$0.00 ","$18.02 ","$28.54 ","$28.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76446","ERX","HCPCS 63700001","00069-0471-03","VARENICLINE STARTING 0.5 MG X 11 & 1 MG X 42 PO MISC","BOTH IP/OP","$38.07 ","$28.17 ","$0.00 ","$38.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.07 ","$0.00 ","$19.04 ","$30.15 ","$30.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76472","ERX","HCPCS 25000001","49348-0636-34","LORATADINE 5 MG/5ML PO SYRP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76472","ERX","HCPCS 25000001","51672-2073-08","LORATADINE 5 MG/5ML PO SYRP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76618","ERX","HCPCS 25000001","00065-0356-10","OPTI-FREE REPLENISH SOLN","BOTH IP/OP","$40.23 ","$29.77 ","$0.00 ","$36.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.48 ","$0.00 ","$18.24 ","$28.89 ","$29.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76641","ERX","HCPCS 25000001","24208-0539-20","ACETYLCHOLINE CHLORIDE 20 MG IO SOLR","BOTH IP/OP","$461.64 ","$341.61 ","$0.00 ","$380.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.10 ","$0.00 ","$190.05 ","$301.04 ","$304.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76717","ERX","HCPCS 63700001","00003-0527-11","DASATINIB 20 MG PO TABS","BOTH IP/OP","$1,742.93 ","$1,289.77 ","$0.00 ","$1,545.53 ","","$324.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,545.53 ","$0.00 ","$772.77 ","$1,224.06 ","$1,236.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76718","ERX","HCPCS 63700001","00003-0528-11","DASATINIB 50 MG PO TABS","BOTH IP/OP","$1,742.93 ","$1,289.77 ","$0.00 ","$1,545.52 ","","$324.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,545.52 ","$0.00 ","$772.76 ","$1,224.05 ","$1,236.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76719","ERX","HCPCS 63700001","00003-0524-11","DASATINIB 70 MG PO TABS","BOTH IP/OP","$982.50 ","$727.05 ","$0.00 ","$853.26 ","","$182.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.26 ","$0.00 ","$426.63 ","$675.78 ","$682.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76780","ERX","HCPCS 25000001","66993-0490-36","IBUPROFEN LYSINE 10 MG/ML IV SOLN","BOTH IP/OP","$1,417.99 ","$1,049.31 ","$0.00 ","$1,313.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,313.97 ","$0.00 ","$656.99 ","$1,040.66 ","$1,051.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76783","ERX","HCPCS 63700001","59572-0415-21","LENALIDOMIDE 15 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76784","ERX","HCPCS 63700001","59572-0425-00","LENALIDOMIDE 25 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76784","ERX","HCPCS 63700001","59572-0425-21","LENALIDOMIDE 25 MG PO CAPS","BOTH IP/OP","$2,478.15 ","$1,833.83 ","$0.00 ","$2,197.47 ","","$460.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,197.47 ","$0.00 ","$1,098.74 ","$1,740.40 ","$1,757.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76829","ERX","HCPCS 63700001","00121-1744-00","GUAIFENESIN 100 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76829","ERX","HCPCS 63700001","00121-1744-05","GUAIFENESIN 100 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76829","ERX","HCPCS 63700001","99999-6007-12","GUAIFENESIN 100 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76835","ERX","HCPCS 63700001","15584-0101-01","ATRIPLA:EFAVIRENZ-EMTRICITAB-TENOFOV 600-200-300MGTAB","BOTH IP/OP","$402.49 ","$297.84 ","$0.00 ","$365.36 ","","$71.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.36 ","$0.00 ","$182.68 ","$289.37 ","$292.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76843","ERX","HCPCS J8501","00006-0464-05","APREPITANT 40 MG PO CAPS","BOTH IP/OP","$432.04 ","$319.71 ","$0.00 ","$432.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.65 ","$432.04 ","$0.00 ","$216.02 ","$342.18 ","$345.63 ","$0.00 ","$67.61 ","$0.00 ","$0.00 ","$0.00 "
"76843","ERX","HCPCS J8501","00781-2321-06","APREPITANT 40 MG PO CAPS","BOTH IP/OP","$432.04 ","$319.71 ","$0.00 ","$432.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.65 ","$432.04 ","$0.00 ","$216.02 ","$342.18 ","$345.63 ","$0.00 ","$67.61 ","$0.00 ","$0.00 ","$0.00 "
"76843","ERX","HCPCS J8501","00781-2321-51","APREPITANT 40 MG PO CAPS","BOTH IP/OP","$432.04 ","$319.71 ","$0.00 ","$432.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.65 ","$432.04 ","$0.00 ","$216.02 ","$342.18 ","$345.63 ","$0.00 ","$67.61 ","$0.00 ","$0.00 ","$0.00 "
"76843","ERX","HCPCS J8501","68462-0583-40","APREPITANT 40 MG PO CAPS","BOTH IP/OP","$432.04 ","$319.71 ","$0.00 ","$432.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.65 ","$432.04 ","$0.00 ","$216.02 ","$342.18 ","$345.63 ","$0.00 ","$67.61 ","$0.00 ","$0.00 ","$0.00 "
"76843","ERX","HCPCS J8501","68462-0583-85","APREPITANT 40 MG PO CAPS","BOTH IP/OP","$432.04 ","$319.71 ","$0.00 ","$432.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.65 ","$432.04 ","$0.00 ","$216.02 ","$342.18 ","$345.63 ","$0.00 ","$67.61 ","$0.00 ","$0.00 ","$0.00 "
"76913","ERX","HCPCS 25000001","00121-1680-16","KCL 20 MEQ/15ML (10%) PO SOLN","BOTH IP/OP","$97.97 ","$72.50 ","$0.00 ","$70.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.68 ","$0.00 ","$35.34 ","$4.75 ","$56.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76913","ERX","HCPCS 25000001","00603-1542-58","KCL 20 MEQ/15ML (10%) PO SOLN","BOTH IP/OP","$97.97 ","$72.50 ","$0.00 ","$70.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.68 ","$0.00 ","$35.34 ","$4.75 ","$56.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76913","ERX","HCPCS 25000001","43386-0168-01","KCL 20 MEQ/15ML (10%) PO SOLN","BOTH IP/OP","$97.97 ","$72.50 ","$0.00 ","$70.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.68 ","$0.00 ","$35.34 ","$4.75 ","$56.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76913","ERX","HCPCS 25000001","66689-0047-50","KCL 20 MEQ/15ML (10%) PO SOLN","BOTH IP/OP","$97.97 ","$72.50 ","$0.00 ","$70.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.68 ","$0.00 ","$35.34 ","$4.75 ","$56.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76913","ERX","HCPCS 25000001","99999-6006-99","KCL 20 MEQ/15ML (10%) PO SOLN","BOTH IP/OP","$97.97 ","$72.50 ","$0.00 ","$70.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.68 ","$0.00 ","$35.34 ","$4.75 ","$56.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76974","ERX","HCPCS 25000001","00713-0102-06","GLYCERIN (LAXATIVE) 1.2 G RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76997","ERX","HCPCS 63700001","00904-5824-60","CHOLECALCIFEROL-D3 1000 UNITS PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76997","ERX","HCPCS 63700001","00904-5824-93","CHOLECALCIFEROL-D3 1000 UNITS PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76997","ERX","HCPCS 63700001","20555-0033-00","CHOLECALCIFEROL-D3 1000 UNITS PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76997","ERX","HCPCS 63700001","80681-0169-00","CHOLECALCIFEROL-D3 1000 UNITS PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77006","ERX","HCPCS J2270","99999-6011-51","MORPHINE SULFATE PCA 5 MG/ML IV SOLN","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$275.63 ","$136.63 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$11.93 ","$275.63 ","$0.00 ","$137.82 ","$218.30 ","$220.50 ","$0.00 ","$11.93 ","$0.00 ","$11.36 ","$0.00 "
"77006","ERX","HCPCS J2270","99999-6007-23","MORPHINE SULFATE PCA 5 MG/ML IV SOLN","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$550.94 ","$136.63 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$11.93 ","$275.63 ","$0.00 ","$137.82 ","$550.94 ","$220.50 ","$0.00 ","$11.93 ","$0.00 ","$11.36 ","$0.00 "
"77007","ERX","HCPCS J1050","00009-0626-01","MEDROXYPROGESTERONE ACETATE 400 MG/ML IM SUSP","BOTH IP/OP","$685.44 ","$507.23 ","$0.00 ","$548.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$263.20 ","$0.00 ","$0.00 ","$0.00 ","$542.87 ","$548.35 ","$0.00 ","$263.20 ","$0.00 ","$0.00 ","$0.00 "
"77012","ERX","HCPCS J7307","00052-4330-01","ETONOGESTREL 68 MG SC IMPL","BOTH IP/OP","$2,795.11 ","$2,068.38 ","$0.00 ","$2,414.64 ","$1,257.80 ","$942.30 ","$827.51 ","$0.00 ","$0.00 ","$1,098.41 ","$2,414.64 ","$0.00 ","$1,207.32 ","$1,821.32 ","$1,931.71 ","$1,448.78 ","$1,098.41 ","$0.00 ","$1,045.88 ","$0.00 "
"77164","ERX","HCPCS 25000001","17238-0610-15","HYPROMELLOSE 2.5 % OP SOLN","BOTH IP/OP","$29.64 ","$21.93 ","$0.00 ","$29.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$23.47 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77164","ERX","HCPCS 25000001","17478-0064-12","HYPROMELLOSE 2.5 % OP SOLN","BOTH IP/OP","$29.64 ","$21.93 ","$0.00 ","$29.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$23.47 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77174","ERX","HCPCS 25000001","00173-0716-20","FLUTICASONE-SALMETEROL 115-21 MCG/ACT IN AERO","BOTH IP/OP","$1,421.75 ","$1,052.10 ","$0.00 ","$1,252.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,252.70 ","$0.00 ","$626.35 ","$992.14 ","$1,002.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77195","ERX","HCPCS J1953","00143-9574-25","LEVETIRACETAM 500 MG/5ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"77195","ERX","HCPCS J1953","00143-9673-25","LEVETIRACETAM 500 MG/5ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"77195","ERX","HCPCS J1953","00409-1886-02","LEVETIRACETAM 500 MG/5ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"77195","ERX","HCPCS J1953","25021-0780-05","LEVETIRACETAM 500 MG/5ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"77195","ERX","HCPCS J1953","50474-0002-63","LEVETIRACETAM 500 MG/5ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"77195","ERX","HCPCS J1953","55150-0177-05","LEVETIRACETAM 500 MG/5ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"77308","ERX","HCPCS 25000001","00517-6510-25","SELENIUM 40 MCG/ML IV SOLN","BOTH IP/OP","$77.56 ","$57.39 ","$0.00 ","$77.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.56 ","$0.00 ","$38.78 ","$61.43 ","$62.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77318","ERX","HCPCS J1250","00409-2344-01","DOBUTAMINE HCL 250 MG/20ML IV SOLN","BOTH IP/OP","$28.33 ","$20.96 ","$0.00 ","$25.31 ","$12.75 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$7.14 ","$25.31 ","$0.00 ","$12.66 ","$20.05 ","$20.25 ","$0.00 ","$7.14 ","$0.00 ","$6.80 ","$0.00 "
"77318","ERX","HCPCS J1250","00409-2344-02","DOBUTAMINE HCL 250 MG/20ML IV SOLN","BOTH IP/OP","$28.33 ","$20.96 ","$0.00 ","$25.31 ","$12.75 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$7.14 ","$25.31 ","$0.00 ","$12.66 ","$20.05 ","$20.25 ","$0.00 ","$7.14 ","$0.00 ","$6.80 ","$0.00 "
"77318","ERX","HCPCS J1250","00409-2344-88","DOBUTAMINE HCL 250 MG/20ML IV SOLN","BOTH IP/OP","$28.33 ","$20.96 ","$0.00 ","$25.31 ","$12.75 ","$0.00 ","$6.58 ","$0.00 ","$0.00 ","$7.14 ","$25.31 ","$0.00 ","$12.66 ","$20.05 ","$20.25 ","$0.00 ","$7.14 ","$0.00 ","$6.80 ","$0.00 "
"77371","ERX","HCPCS 25000001","00085-1328-01","POSACONAZOLE 40 MG/ML PO SUSP","BOTH IP/OP","$3,904.06 ","$2,889.00 ","$0.00 ","$3,541.30 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,541.30 ","$0.00 ","$1,770.65 ","$2,804.71 ","$2,833.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77411","ERX","HCPCS 25000001","63323-0406-03","CAFFEINE CITRATE 20 MG/ML PO SOLN","BOTH IP/OP","$1,414.48 ","$1,046.72 ","$0.00 ","$169.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.55 ","$0.00 ","$84.78 ","$134.28 ","$135.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77411","ERX","HCPCS 25000001","99999-6004-97","CAFFEINE CITRATE 20 MG/ML PO SOLN","BOTH IP/OP","$1,414.48 ","$1,046.72 ","$0.00 ","$1,016.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.55 ","$0.00 ","$84.78 ","$1,016.68 ","$135.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","25021-0601-03","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","42571-0244-69","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","47335-0289-40","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","51754-0500-01","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","51754-0502-01","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","55150-0187-03","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77412","ERX","HCPCS J0706","72485-0104-01","CAFFEINE CITRATE 60 MG/3ML IV SOLN","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77539","ERX","HCPCS 63700001","00006-0568-40","VORINOSTAT 100 MG PO CAPS","BOTH IP/OP","$1,314.85 ","$972.99 ","$0.00 ","$1,193.27 ","","$234.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,193.27 ","$0.00 ","$596.64 ","$945.07 ","$954.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77615","ERX","HCPCS 63700001","00006-0221-01","SITAGLIPTIN PHOSPHATE 25 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77615","ERX","HCPCS 63700001","00006-0221-28","SITAGLIPTIN PHOSPHATE 25 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77615","ERX","HCPCS 63700001","00006-0221-31","SITAGLIPTIN PHOSPHATE 25 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77615","ERX","HCPCS 63700001","00006-0221-54","SITAGLIPTIN PHOSPHATE 25 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77616","ERX","HCPCS 63700001","00006-0112-01","SITAGLIPTIN PHOSPHATE 50 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77616","ERX","HCPCS 63700001","00006-0112-28","SITAGLIPTIN PHOSPHATE 50 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77616","ERX","HCPCS 63700001","00006-0112-31","SITAGLIPTIN PHOSPHATE 50 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77616","ERX","HCPCS 63700001","00006-0112-54","SITAGLIPTIN PHOSPHATE 50 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77617","ERX","HCPCS 63700001","00006-0277-01","SITAGLIPTIN PHOSPHATE 100 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77617","ERX","HCPCS 63700001","00006-0277-28","SITAGLIPTIN PHOSPHATE 100 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77617","ERX","HCPCS 63700001","00006-0277-31","SITAGLIPTIN PHOSPHATE 100 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77617","ERX","HCPCS 63700001","00006-0277-54","SITAGLIPTIN PHOSPHATE 100 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77617","ERX","HCPCS 63700001","00006-0277-82","SITAGLIPTIN PHOSPHATE 100 MG PO TABS","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$14.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77648","ERX","HCPCS 63700001","00003-3622-12","ATAZANAVIR SULFATE 300 MG PO CAPS","BOTH IP/OP","$191.13 ","$141.44 ","$0.00 ","$173.50 ","","$34.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.50 ","$0.00 ","$86.75 ","$137.41 ","$138.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77648","ERX","HCPCS 63700001","00093-5528-56","ATAZANAVIR SULFATE 300 MG PO CAPS","BOTH IP/OP","$191.13 ","$141.44 ","$0.00 ","$173.50 ","","$34.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.50 ","$0.00 ","$86.75 ","$137.41 ","$138.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77648","ERX","HCPCS 63700001","65862-0713-30","ATAZANAVIR SULFATE 300 MG PO CAPS","BOTH IP/OP","$191.13 ","$141.44 ","$0.00 ","$173.50 ","","$34.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.50 ","$0.00 ","$86.75 ","$137.41 ","$138.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77685","ERX","HCPCS J2248","00469-3211-10","MICAFUNGIN SODIUM 100 MG IV SOLR","BOTH IP/OP","$594.66 ","$440.05 ","$0.00 ","$594.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$594.66 ","$0.00 ","$297.33 ","$470.97 ","$475.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77710","ERX","HCPCS 25000001","00121-1576-10","METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77822","ERX","HCPCS 63700001","00173-0388-79","BECLOMETHASONE DIPROP MONOHYD 42 MCG/SPRAY NA SUSP","BOTH IP/OP","$1,027.92 ","$760.66 ","$0.00 ","$932.87 ","","$182.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$932.87 ","$0.00 ","$466.44 ","$738.83 ","$746.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78003","ERX","HCPCS 63700001","50383-0087-07","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SYRP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78030","ERX","HCPCS 25000001","58914-0214-60","AQUADEKS PO LIQD","BOTH IP/OP","$96.81 ","$71.64 ","$0.00 ","$87.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.78 ","$0.00 ","$43.89 ","$69.52 ","$70.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78064","ERX","HCPCS 63700001","10147-0952-03","PALIPERIDONE ER 3 MG PO TB24","BOTH IP/OP","$168.31 ","$124.55 ","$0.00 ","$168.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.31 ","$0.00 ","$84.16 ","$133.30 ","$134.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78064","ERX","HCPCS 63700001","50458-0550-01","PALIPERIDONE ER 3 MG PO TB24","BOTH IP/OP","$168.31 ","$124.55 ","$0.00 ","$168.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.31 ","$0.00 ","$84.16 ","$133.30 ","$134.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78065","ERX","HCPCS 63700001","00378-3980-93","PALIPERIDONE ER 6 MG PO TB24","BOTH IP/OP","$168.31 ","$124.55 ","$0.00 ","$168.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.31 ","$0.00 ","$84.16 ","$133.30 ","$134.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78065","ERX","HCPCS 63700001","50458-0551-10","PALIPERIDONE ER 6 MG PO TB24","BOTH IP/OP","$168.31 ","$124.55 ","$0.00 ","$168.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.31 ","$0.00 ","$84.16 ","$133.30 ","$134.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78066","ERX","HCPCS 63700001","00591-3695-30","PALIPERIDONE ER 9 MG PO TB24","BOTH IP/OP","$177.16 ","$131.10 ","$0.00 ","$160.63 ","","$31.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.63 ","$0.00 ","$80.32 ","$127.22 ","$128.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78420","ERX","HCPCS J9025","59572-0102-01","AZACITIDINE 100 MG IJ SUSR","BOTH IP/OP","$1,818.94 ","$1,346.02 ","$0.00 ","$1,685.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,685.50 ","$0.00 ","$842.75 ","$1,334.92 ","$1,348.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78615","ERX","HCPCS 63700001","00186-4020-01","ESOMEPRAZOLE 20 MG PO PACK","BOTH IP/OP","$48.15 ","$35.63 ","$0.00 ","$43.67 ","","$8.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.67 ","$0.00 ","$21.84 ","$34.59 ","$34.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78616","ERX","HCPCS 63700001","00186-4040-01","ESOMEPRAZOLE 40 MG PO PACK","BOTH IP/OP","$48.15 ","$35.63 ","$0.00 ","$43.67 ","","$8.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.67 ","$0.00 ","$21.84 ","$34.59 ","$34.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78879","ERX","HCPCS 63700001","00904-2533-21","CALAMINE 8-8 % EX LOTN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$1.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79088","ERX","HCPCS 63700001","00121-0775-16","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79088","ERX","HCPCS 63700001","00121-1775-00","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79088","ERX","HCPCS 63700001","00121-1775-05","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79088","ERX","HCPCS 63700001","50383-0087-07","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79088","ERX","HCPCS 63700001","69543-0276-16","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79088","ERX","HCPCS 63700001","99999-6006-93","GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81426","ERX","HCPCS 63700001","00904-6364-61","DIVALPROEX SODIUM ER 500 MG PO TB24","BOTH IP/OP","$10.36 ","$7.67 ","$0.00 ","$9.39 ","","$1.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.39 ","$0.00 ","$4.70 ","$7.44 ","$7.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81426","ERX","HCPCS 63700001","16714-0485-01","DIVALPROEX SODIUM ER 500 MG PO TB24","BOTH IP/OP","$10.36 ","$7.67 ","$0.00 ","$9.39 ","","$1.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.39 ","$0.00 ","$4.70 ","$7.44 ","$7.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81426","ERX","HCPCS 63700001","16714-0485-02","DIVALPROEX SODIUM ER 500 MG PO TB24","BOTH IP/OP","$10.36 ","$7.67 ","$0.00 ","$9.39 ","","$1.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.39 ","$0.00 ","$4.70 ","$7.44 ","$7.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81426","ERX","HCPCS 63700001","65862-0595-01","DIVALPROEX SODIUM ER 500 MG PO TB24","BOTH IP/OP","$10.36 ","$7.67 ","$0.00 ","$9.39 ","","$1.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.39 ","$0.00 ","$4.70 ","$7.44 ","$7.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81453","ERX","HCPCS 63700001","00186-0372-20","BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO","BOTH IP/OP","$1,392.01 ","$1,030.09 ","$0.00 ","$1,239.79 ","","$247.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,239.79 ","$0.00 ","$619.90 ","$981.91 ","$991.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81453","ERX","HCPCS 63700001","00186-0372-28","BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO","BOTH IP/OP","$1,392.01 ","$1,030.09 ","$0.00 ","$1,239.79 ","","$247.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,239.79 ","$0.00 ","$619.90 ","$981.91 ","$991.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81454","ERX","HCPCS 63700001","00186-0370-28","BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","BOTH IP/OP","$902.67 ","$667.98 ","$0.00 ","$1,426.18 ","","$160.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,426.18 ","$0.00 ","$713.09 ","$623.60 ","$1,140.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81454","ERX","HCPCS 63700001","00186-0370-20","BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","BOTH IP/OP","$902.67 ","$667.98 ","$0.00 ","$1,426.18 ","","$160.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,426.18 ","$0.00 ","$713.09 ","$1,129.53 ","$1,140.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81461","ERX","HCPCS J8700","00781-2694-75","TEMOZOLOMIDE 140 MG PO CAPS","BOTH IP/OP","$1,032.53 ","$764.07 ","$0.00 ","$937.06 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.06 ","$0.00 ","$468.53 ","$742.15 ","$749.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81474","ERX","HCPCS 63700001","59417-0103-10","LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS","BOTH IP/OP","$56.15 ","$41.55 ","$0.00 ","$48.50 ","","$10.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.50 ","$0.00 ","$24.25 ","$38.41 ","$38.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81479","ERX","HCPCS 63700001","58914-0601-20","BIS SUBCIT-METRONID-TETRACYC 140-125-125 MG PO CAPS","BOTH IP/OP","$106.71 ","$78.97 ","$0.00 ","$96.76 ","","$18.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.76 ","$0.00 ","$48.38 ","$76.63 ","$77.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81540","ERX","HCPCS 63700001","00006-0577-61","JANUMET 50-1000 MG (SITAGLIPTIN-METFORMIN) PO TABS","BOTH IP/OP","$41.64 ","$30.81 ","$0.00 ","$35.98 ","","$7.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.98 ","$0.00 ","$17.99 ","$28.50 ","$28.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81541","ERX","HCPCS 63700001","00006-0575-61","JANUMET 50-500 MG (SITAGLIPTIN-METFORMIN) PO TABS","BOTH IP/OP","$41.64 ","$30.81 ","$0.00 ","$35.98 ","","$7.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.98 ","$0.00 ","$17.99 ","$28.50 ","$28.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81696","ERX","HCPCS J1300","25682-0001-01","ECULIZUMAB 300 MG/30ML IV SOLN","BOTH IP/OP","$17,690.38 ","$13,090.88 ","$0.00 ","$16,046.58 ","","$0.00 ","$3,687.12 ","$0.00 ","$0.00 ","$8,124.42 ","$16,046.58 ","$7,260.09 ","$8,023.29 ","$12,708.89 ","$12,837.26 ","$10,025.84 ","$8,124.42 ","$0.00 ","$7,735.83 ","$6,914.37 "
"81725","ERX","HCPCS 25000001","99073-0708-22","FREESTYLE LITE TEST VI STRP","BOTH IP/OP","$302.24 ","$223.66 ","$0.00 ","$274.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$274.37 ","$0.00 ","$137.19 ","$217.30 ","$219.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81823","ERX","HCPCS 25000001","00574-0069-15","GLUCOSE 40 % PO GEL","BOTH IP/OP","$16.56 ","$12.25 ","$0.00 ","$15.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.01 ","$0.00 ","$7.51 ","$11.89 ","$12.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81823","ERX","HCPCS 25000001","00574-0069-30","GLUCOSE 40 % PO GEL","BOTH IP/OP","$16.56 ","$12.25 ","$0.00 ","$15.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.01 ","$0.00 ","$7.51 ","$11.89 ","$12.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81823","ERX","HCPCS 25000001","00574-0070-30","GLUCOSE 40 % PO GEL","BOTH IP/OP","$16.56 ","$12.25 ","$0.00 ","$15.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.01 ","$0.00 ","$7.51 ","$11.89 ","$12.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82021","ERX","HCPCS 25000001","00121-0677-16","TRICITRATES 550-500-334 MG/5ML PO SOLN","BOTH IP/OP","$206.81 ","$153.04 ","$0.00 ","$187.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.74 ","$0.00 ","$93.87 ","$148.69 ","$150.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82085","ERX","HCPCS 25000001","10019-0120-01","ESMOLOL HCL 100 MG/10ML IV SOLN","BOTH IP/OP","$57.86 ","$42.82 ","$0.00 ","$52.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.48 ","$0.00 ","$26.24 ","$41.56 ","$41.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82085","ERX","HCPCS 25000001","25021-0314-10","ESMOLOL HCL 100 MG/10ML IV SOLN","BOTH IP/OP","$57.86 ","$42.82 ","$0.00 ","$52.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.48 ","$0.00 ","$26.24 ","$41.56 ","$41.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82085","ERX","HCPCS 25000001","55150-0194-10","ESMOLOL HCL 100 MG/10ML IV SOLN","BOTH IP/OP","$57.86 ","$42.82 ","$0.00 ","$52.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.48 ","$0.00 ","$26.24 ","$41.56 ","$41.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82085","ERX","HCPCS 25000001","63323-0652-10","ESMOLOL HCL 100 MG/10ML IV SOLN","BOTH IP/OP","$57.86 ","$42.82 ","$0.00 ","$52.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.48 ","$0.00 ","$26.24 ","$41.56 ","$41.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82085","ERX","HCPCS 25000001","67457-0182-00","ESMOLOL HCL 100 MG/10ML IV SOLN","BOTH IP/OP","$57.86 ","$42.82 ","$0.00 ","$52.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.48 ","$0.00 ","$26.24 ","$41.56 ","$41.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82085","ERX","HCPCS 25000001","67457-0182-10","ESMOLOL HCL 100 MG/10ML IV SOLN","BOTH IP/OP","$57.86 ","$42.82 ","$0.00 ","$52.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.48 ","$0.00 ","$26.24 ","$41.56 ","$41.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82100","ERX","HCPCS 63700001","50474-0802-03","ROTIGOTINE 2 MG/24HR TD PT24","BOTH IP/OP","$110.01 ","$81.41 ","$0.00 ","$98.76 ","","$20.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.76 ","$0.00 ","$49.38 ","$78.22 ","$79.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82134","ERX","HCPCS 25000001","83490-0307-60","SODIUM CHLORIDE 7 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82177","ERX","HCPCS Q9956","00407-2707-03","PERFLUTREN PROTEIN A MICROSPH IV SUSP","BOTH IP/OP","$108.39 ","$80.21 ","$0.00 ","$98.28 ","$48.78 ","$0.00 ","$22.59 ","$0.00 ","$0.00 ","$17.21 ","$98.28 ","$0.00 ","$49.14 ","$77.84 ","$78.62 ","$0.00 ","$15.38 ","$0.00 ","$15.65 ","$0.00 "
"82228","ERX","HCPCS J9330","00008-1179-01","TEMSIROLIMUS 25 MG/ML IV SOLN","BOTH IP/OP","$5,016.07 ","$3,711.89 ","$0.00 ","$4,353.20 ","$2,257.23 ","$868.70 ","$1,045.47 ","$0.00 ","$0.00 ","$1,407.94 ","$4,353.20 ","$1,394.79 ","$2,176.60 ","$3,447.73 ","$3,482.56 ","$1,926.14 ","$1,407.94 ","$0.00 ","$1,340.60 ","$1,112.85 "
"82301","ERX","HCPCS S0077","00009-0775-26","CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"82301","ERX","HCPCS S0077","63323-0282-04","CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"82302","ERX","HCPCS S0077","00009-0902-18","CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"82302","ERX","HCPCS S0077","25021-0115-06","CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"82302","ERX","HCPCS S0077","67457-0816-06","CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$2.70 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$13.20 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"82363","ERX","HCPCS 63700001","62332-0205-90","AMLODIPINE-VALSARTAN 5 MG-160 MG TABS","BOTH IP/OP","$22.91 ","$16.95 ","$0.00 ","$20.78 ","","$4.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.78 ","$0.00 ","$10.39 ","$16.46 ","$16.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82363","ERX","HCPCS 63700001","65862-0737-30","AMLODIPINE-VALSARTAN 5 MG-160 MG TABS","BOTH IP/OP","$22.91 ","$16.95 ","$0.00 ","$20.78 ","","$4.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.78 ","$0.00 ","$10.39 ","$16.46 ","$16.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82364","ERX","HCPCS 63700001","65862-0738-30","AMLODIPINE-VALSARTAN 5 MG-320 MG TABS","BOTH IP/OP","$29.06 ","$21.50 ","$0.00 ","$26.36 ","","$5.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.36 ","$0.00 ","$13.18 ","$20.88 ","$21.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82365","ERX","HCPCS 63700001","00378-1722-93","AMLODIPINE-VALSARTAN 10-160 MG TABLET","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$23.58 ","","$4.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.58 ","$0.00 ","$11.79 ","$18.68 ","$18.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82365","ERX","HCPCS 63700001","62332-0206-90","AMLODIPINE-VALSARTAN 10-160 MG TABLET","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$23.58 ","","$4.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.58 ","$0.00 ","$11.79 ","$18.68 ","$18.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82365","ERX","HCPCS 63700001","65862-0739-30","AMLODIPINE-VALSARTAN 10-160 MG TABLET","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$23.58 ","","$4.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.58 ","$0.00 ","$11.79 ","$18.68 ","$18.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82366","ERX","HCPCS 63700001","00078-0491-15","AMLODIPINE-VALSARTAN 10 MG-320 MG TABS","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$29.93 ","","$5.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.93 ","$0.00 ","$14.97 ","$23.70 ","$23.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82366","ERX","HCPCS 63700001","00378-1724-93","AMLODIPINE-VALSARTAN 10 MG-320 MG TABS","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$29.93 ","","$5.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.93 ","$0.00 ","$14.97 ","$23.70 ","$23.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82366","ERX","HCPCS 63700001","62332-0208-90","AMLODIPINE-VALSARTAN 10 MG-320 MG TABS","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$29.93 ","","$5.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.93 ","$0.00 ","$14.97 ","$23.70 ","$23.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82366","ERX","HCPCS 63700001","65862-0740-30","AMLODIPINE-VALSARTAN 10 MG-320 MG TABS","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$29.93 ","","$5.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.93 ","$0.00 ","$14.97 ","$23.70 ","$23.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82504","ERX","HCPCS 63700001","00078-0501-15","RIVASTIGMINE 4.6 MG/24HR TD PT24","BOTH IP/OP","$105.92 ","$78.38 ","$0.00 ","$96.04 ","","$18.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.04 ","$0.00 ","$48.02 ","$76.06 ","$76.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82504","ERX","HCPCS 63700001","00078-0501-61","RIVASTIGMINE 4.6 MG/24HR TD PT24","BOTH IP/OP","$105.92 ","$78.38 ","$0.00 ","$96.04 ","","$18.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.04 ","$0.00 ","$48.02 ","$76.06 ","$76.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87795","ERX","HCPCS 25000001","10702-0056-01","OXYCODONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87795","ERX","HCPCS 25000001","42858-0002-10","OXYCODONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87795","ERX","HCPCS 25000001","68084-0968-01","OXYCODONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87795","ERX","HCPCS 25000001","68084-0968-11","OXYCODONE HCL 10 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87801","ERX","HCPCS 25000001","67768-3063-06","CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87801","ERX","HCPCS 25000001","99999-6009-13","CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87822","ERX","HCPCS 25000001","42858-0004-01","OXYCODONE HCL 20 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87834","ERX","HCPCS 63700001","00023-9211-05","COMBIGAN: BRIMONIDINE-TIMOLOL 0.2-0.5 % OP SOLN","BOTH IP/OP","$681.21 ","$504.10 ","$0.00 ","$588.78 ","","$127.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$588.78 ","$0.00 ","$294.39 ","$466.31 ","$471.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87861","ERX","HCPCS J1930","15054-1120-03","LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN","BOTH IP/OP","$25,932.15 ","$19,189.79 ","$0.00 ","$21,539.76 ","$11,669.47 ","$7,941.96 ","$5,404.91 ","$0.00 ","$0.00 ","$8,138.89 ","$21,539.76 ","$7,852.82 ","$10,769.88 ","$17,059.49 ","$17,231.81 ","$10,844.38 ","$8,138.89 ","$0.00 ","$8,138.89 ","$8,450.04 "
"87861","ERX","HCPCS J1930","15054-1120-04","LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN","BOTH IP/OP","$25,932.15 ","$19,189.79 ","$0.00 ","$21,539.76 ","$11,669.47 ","$7,941.96 ","$5,404.91 ","$0.00 ","$0.00 ","$8,138.89 ","$21,539.76 ","$7,852.82 ","$10,769.88 ","$17,059.49 ","$17,231.81 ","$10,844.38 ","$8,138.89 ","$0.00 ","$8,138.89 ","$8,450.04 "
"87865","ERX","HCPCS 25000001","66490-0650-20","DIAZEPAM 2.5 MG RECTAL GEL","BOTH IP/OP","$1,036.08 ","$766.70 ","$0.00 ","$1,128.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,128.33 ","$0.00 ","$564.17 ","$893.64 ","$902.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87867","ERX","HCPCS 25000001","00187-0658-20","DIAZEPAM 10 MG RECTAL GEL","BOTH IP/OP","$1,229.03 ","$909.48 ","$0.00 ","$557.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$557.70 ","$0.00 ","$278.85 ","$441.70 ","$446.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87869","ERX","HCPCS 25000001","00187-0659-20","DIAZEPAM 20 MG RECTAL GEL","BOTH IP/OP","$1,229.03 ","$909.48 ","$0.00 ","$725.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$725.01 ","$0.00 ","$362.51 ","$574.21 ","$580.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87889","ERX","HCPCS 25000001","00088-2500-33","INSULIN GLULISINE 100 UNIT/ML IJ SOLN","BOTH IP/OP","$994.97 ","$736.28 ","$0.00 ","$902.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.97 ","$0.00 ","$451.49 ","$715.15 ","$722.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87912","ERX","HCPCS 63700001","51801-0011-17","POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87912","ERX","HCPCS 63700001","51801-0011-30","POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87912","ERX","HCPCS 63700001","51801-0012-30","POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87998","ERX","HCPCS 63700001","49702-0223-18","MARAVIROC 150 MG PO TABS","BOTH IP/OP","$126.08 ","$93.30 ","$0.00 ","$108.94 ","","$22.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.94 ","$0.00 ","$54.47 ","$86.28 ","$87.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87999","ERX","HCPCS 63700001","49702-0224-18","MARAVIROC 300 MG PO TABS","BOTH IP/OP","$126.08 ","$93.30 ","$0.00 ","$108.94 ","","$22.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.94 ","$0.00 ","$54.47 ","$86.28 ","$87.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88007","ERX","HCPCS 63700001","50228-0424-60","RANOLAZINE ER 1000 MG PO TB12","BOTH IP/OP","$56.57 ","$41.86 ","$0.00 ","$48.96 ","","$10.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.96 ","$0.00 ","$24.48 ","$38.78 ","$39.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88007","ERX","HCPCS 63700001","61958-1004-01","RANOLAZINE ER 1000 MG PO TB12","BOTH IP/OP","$56.57 ","$41.86 ","$0.00 ","$48.96 ","","$10.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.96 ","$0.00 ","$24.48 ","$38.78 ","$39.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88008","ERX","HCPCS J9178","00009-5091-01","EPIRUBICIN HCL 50 MG/25ML IV SOLN","BOTH IP/OP","$172.03 ","$127.30 ","$0.00 ","$172.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.03 ","$0.00 ","$86.02 ","$136.25 ","$137.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88010","ERX","HCPCS Q2009","00069-5474-02","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","00069-6001-21","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","00641-6137-01","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","00641-6137-10","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","63323-0403-10","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","67457-0517-00","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","67457-0517-01","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88010","ERX","HCPCS Q2009","70121-1390-07","FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","BOTH IP/OP","$197.79 ","$146.36 ","$0.00 ","$179.55 ","$89.01 ","$0.00 ","$41.22 ","$0.00 ","$0.00 ","$31.44 ","$179.55 ","$18.11 ","$89.78 ","$142.20 ","$143.64 ","$25.01 ","$28.10 ","$0.00 ","$28.58 ","$17.25 "
"88011","ERX","HCPCS Q2009","00069-5471-02","FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","$33.94 ","$0.00 ","$15.72 ","$0.00 ","$0.00 ","$11.98 ","$68.40 ","$3.62 ","$34.20 ","$54.17 ","$54.72 ","$5.00 ","$10.70 ","$0.00 ","$10.89 ","$3.45 "
"88011","ERX","HCPCS Q2009","00069-6001-25","FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","$33.94 ","$0.00 ","$15.72 ","$0.00 ","$0.00 ","$11.98 ","$68.40 ","$3.62 ","$34.20 ","$54.17 ","$54.72 ","$5.00 ","$10.70 ","$0.00 ","$10.89 ","$3.45 "
"88011","ERX","HCPCS Q2009","00641-6136-25","FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","$33.94 ","$0.00 ","$15.72 ","$0.00 ","$0.00 ","$11.98 ","$68.40 ","$3.62 ","$34.20 ","$54.17 ","$54.72 ","$5.00 ","$10.70 ","$0.00 ","$10.89 ","$3.45 "
"88011","ERX","HCPCS Q2009","70121-1381-05","FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","$33.94 ","$0.00 ","$15.72 ","$0.00 ","$0.00 ","$11.98 ","$68.40 ","$3.62 ","$34.20 ","$54.17 ","$54.72 ","$5.00 ","$10.70 ","$0.00 ","$10.89 ","$3.45 "
"88093","ERX","HCPCS J0348","00049-0116-28","ANIDULAFUNGIN 100 MG IV SOLR","BOTH IP/OP","$668.89 ","$494.98 ","$0.00 ","$572.40 ","$301.00 ","$0.00 ","$139.41 ","$0.00 ","$0.00 ","$61.10 ","$572.40 ","$0.00 ","$286.20 ","$453.34 ","$457.92 ","$0.00 ","$61.10 ","$0.00 ","$58.18 ","$0.00 "
"88241","ERX","HCPCS J9211","00703-4154-11","IDARUBICIN HCL 5 MG/5ML IV SOLN","BOTH IP/OP","$342.91 ","$253.75 ","$0.00 ","$311.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.29 ","$0.00 ","$155.65 ","$246.54 ","$249.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88242","ERX","HCPCS J9211","00013-2586-91","IDARUBICIN HCL 10 MG/10ML IV SOLN","BOTH IP/OP","$434.59 ","$321.60 ","$0.00 ","$388.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$388.64 ","$0.00 ","$194.32 ","$307.80 ","$310.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88242","ERX","HCPCS J9211","00703-4155-11","IDARUBICIN HCL 10 MG/10ML IV SOLN","BOTH IP/OP","$434.59 ","$321.60 ","$0.00 ","$388.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$388.64 ","$0.00 ","$194.32 ","$307.80 ","$310.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88243","ERX","HCPCS J9211","00703-4156-11","IDARUBICIN HCL 20 MG/20ML IV SOLN","BOTH IP/OP","$730.45 ","$540.53 ","$0.00 ","$730.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.45 ","$0.00 ","$365.23 ","$578.52 ","$584.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88317","ERX","HCPCS 25000001","68803-0612-10","TRYPAN BLUE 0.06 % OP SOLN","BOTH IP/OP","$290.65 ","$215.08 ","$0.00 ","$263.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$263.85 ","$0.00 ","$131.93 ","$208.97 ","$211.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88376","ERX","HCPCS J9060","00703-5747-11","CISPLATIN 50 MG/50ML IV SOLN","BOTH IP/OP","$83.57 ","$61.84 ","$0.00 ","$75.78 ","$37.61 ","$0.00 ","$13.10 ","$0.00 ","$0.00 ","$11.34 ","$75.78 ","$0.00 ","$37.89 ","$60.02 ","$60.62 ","$0.00 ","$11.34 ","$0.00 ","$10.80 ","$0.00 "
"88376","ERX","HCPCS J9060","63323-0103-51","CISPLATIN 50 MG/50ML IV SOLN","BOTH IP/OP","$83.57 ","$61.84 ","$0.00 ","$75.78 ","$37.61 ","$0.00 ","$13.10 ","$0.00 ","$0.00 ","$11.34 ","$75.78 ","$0.00 ","$37.89 ","$60.02 ","$60.62 ","$0.00 ","$11.34 ","$0.00 ","$10.80 ","$0.00 "
"88377","ERX","HCPCS J9060","00703-5748-11","CISPLATIN 100 MG/100ML IV SOLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.68 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$22.68 ","$0.00 ","$21.59 ","$0.00 "
"88377","ERX","HCPCS J9060","16729-0288-38","CISPLATIN 100 MG/100ML IV SOLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.68 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$22.68 ","$0.00 ","$21.59 ","$0.00 "
"88377","ERX","HCPCS J9060","44567-0510-01","CISPLATIN 100 MG/100ML IV SOLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.68 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$22.68 ","$0.00 ","$21.59 ","$0.00 "
"88377","ERX","HCPCS J9060","63323-0103-65","CISPLATIN 100 MG/100ML IV SOLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.68 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$22.68 ","$0.00 ","$21.59 ","$0.00 "
"88378","ERX","HCPCS J9060","63323-0103-64","CISPLATIN 200 MG/200ML IV SOLN","BOTH IP/OP","$300.51 ","$222.38 ","$0.00 ","$272.79 ","$135.23 ","$0.00 ","$52.41 ","$0.00 ","$0.00 ","$45.36 ","$272.79 ","$0.00 ","$136.40 ","$216.05 ","$218.23 ","$0.00 ","$45.36 ","$0.00 ","$43.19 ","$0.00 "
"88567","ERX","HCPCS 63700001","00597-0101-90","PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG PO TABS","BOTH IP/OP","$32.02 ","$23.69 ","$0.00 ","$32.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.02 ","$0.00 ","$16.01 ","$25.36 ","$25.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88567","ERX","HCPCS 63700001","13668-0184-90","PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG PO TABS","BOTH IP/OP","$32.02 ","$23.69 ","$0.00 ","$32.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.02 ","$0.00 ","$16.01 ","$25.36 ","$25.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88608","ERX","HCPCS 63700001","00006-0227-61","RALTEGRAVIR POTASSIUM 400 MG PO TABS","BOTH IP/OP","$133.96 ","$99.13 ","$0.00 ","$115.72 ","","$25.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.72 ","$0.00 ","$57.86 ","$91.65 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88704","ERX","HCPCS 63700001","00004-0802-85","OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","BOTH IP/OP","$47.07 ","$34.83 ","$0.00 ","$47.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.07 ","$0.00 ","$23.54 ","$37.28 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88704","ERX","HCPCS 63700001","16714-0817-01","OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","BOTH IP/OP","$47.07 ","$34.83 ","$0.00 ","$47.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.07 ","$0.00 ","$23.54 ","$37.28 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88704","ERX","HCPCS 63700001","31722-0630-31","OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","BOTH IP/OP","$47.07 ","$34.83 ","$0.00 ","$47.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.07 ","$0.00 ","$23.54 ","$37.28 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88704","ERX","HCPCS 63700001","47781-0468-13","OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","BOTH IP/OP","$47.07 ","$34.83 ","$0.00 ","$47.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.07 ","$0.00 ","$23.54 ","$37.28 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88704","ERX","HCPCS 63700001","63739-0038-07","OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","BOTH IP/OP","$47.07 ","$34.83 ","$0.00 ","$47.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.07 ","$0.00 ","$23.54 ","$37.28 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88704","ERX","HCPCS 63700001","68180-0675-11","OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","BOTH IP/OP","$47.07 ","$34.83 ","$0.00 ","$47.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.07 ","$0.00 ","$23.54 ","$37.28 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88705","ERX","HCPCS 63700001","00004-0801-85","OSELTAMIVIR PHOSPHATE 45 MG PO CAPS","BOTH IP/OP","$70.07 ","$51.85 ","$0.00 ","$63.54 ","","$12.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.54 ","$0.00 ","$31.77 ","$50.32 ","$50.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88720","ERX","HCPCS 63700001","00078-0526-51","NILOTINIB HCL 200 MG PO CAPS","BOTH IP/OP","$566.86 ","$419.48 ","$0.00 ","$480.90 ","","$106.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$480.90 ","$0.00 ","$240.45 ","$380.87 ","$384.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88806","ERX","HCPCS 63700001","00074-0522-60","KALETRA:LOPINAVIR-RITONAVIR 100-25 MG PO TABS","BOTH IP/OP","$21.46 ","$15.88 ","$0.00 ","$19.46 ","","$3.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.46 ","$0.00 ","$9.73 ","$15.41 ","$15.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88945","ERX","HCPCS 63700001","53191-0362-01","CHOLECALCIFEROL-D3 50000 UNITS PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89128","ERX","HCPCS J3300","00065-0543-01","TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP","BOTH IP/OP","$75.63 ","$55.97 ","$0.00 ","$68.59 ","","$0.00 ","$15.76 ","$0.00 ","$0.00 ","$12.01 ","$68.59 ","$0.00 ","$34.30 ","$54.32 ","$54.87 ","$0.00 ","$10.73 ","$0.00 ","$10.92 ","$0.00 "
"89201","ERX","HCPCS 63700001","00955-1050-27","SEVELAMER CARBONATE 800 MG PO TABS","BOTH IP/OP","$25.54 ","$18.90 ","$0.00 ","$23.17 ","","$4.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.17 ","$0.00 ","$11.59 ","$18.35 ","$18.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89201","ERX","HCPCS 63700001","16714-0814-01","SEVELAMER CARBONATE 800 MG PO TABS","BOTH IP/OP","$25.54 ","$18.90 ","$0.00 ","$23.17 ","","$4.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.17 ","$0.00 ","$11.59 ","$18.35 ","$18.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89201","ERX","HCPCS 63700001","65162-0058-27","SEVELAMER CARBONATE 800 MG PO TABS","BOTH IP/OP","$25.54 ","$18.90 ","$0.00 ","$23.17 ","","$4.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.17 ","$0.00 ","$11.59 ","$18.35 ","$18.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89201","ERX","HCPCS 63700001","65862-0921-27","SEVELAMER CARBONATE 800 MG PO TABS","BOTH IP/OP","$25.54 ","$18.90 ","$0.00 ","$23.17 ","","$4.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.17 ","$0.00 ","$11.59 ","$18.35 ","$18.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89284","ERX","HCPCS 63700001","00456-1405-30","NEBIVOLOL HCL 5 MG PO TABS","BOTH IP/OP","$26.47 ","$19.59 ","$0.00 ","$22.87 ","","$4.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.87 ","$0.00 ","$11.44 ","$18.11 ","$18.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89286","ERX","HCPCS 63700001","00456-1410-30","NEBIVOLOL HCL 10 MG PO TABS","BOTH IP/OP","$26.47 ","$19.59 ","$0.00 ","$22.87 ","","$4.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.87 ","$0.00 ","$11.44 ","$18.11 ","$18.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89346","ERX","HCPCS 25000001","00904-6467-07","CLOPIDOGREL BISULFATE 300 MG PO TABS","BOTH IP/OP","$108.29 ","$80.13 ","$0.00 ","$108.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.29 ","$0.00 ","$54.15 ","$85.77 ","$86.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89346","ERX","HCPCS 25000001","55111-0671-06","CLOPIDOGREL BISULFATE 300 MG PO TABS","BOTH IP/OP","$108.29 ","$80.13 ","$0.00 ","$108.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.29 ","$0.00 ","$54.15 ","$85.77 ","$86.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89346","ERX","HCPCS 25000001","55111-0671-31","CLOPIDOGREL BISULFATE 300 MG PO TABS","BOTH IP/OP","$108.29 ","$80.13 ","$0.00 ","$108.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.29 ","$0.00 ","$54.15 ","$85.77 ","$86.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89346","ERX","HCPCS 25000001","68084-0752-25","CLOPIDOGREL BISULFATE 300 MG PO TABS","BOTH IP/OP","$108.29 ","$80.13 ","$0.00 ","$108.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.29 ","$0.00 ","$54.15 ","$85.77 ","$86.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89346","ERX","HCPCS 25000001","68084-0752-95","CLOPIDOGREL BISULFATE 300 MG PO TABS","BOTH IP/OP","$108.29 ","$80.13 ","$0.00 ","$108.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.29 ","$0.00 ","$54.15 ","$85.77 ","$86.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89350","ERX","HCPCS J9305","00002-7640-01","PEMETREXED DISODIUM 100 MG IV SOLR","BOTH IP/OP","$2,392.10 ","$1,770.15 ","$0.00 ","$2,130.53 ","$1,108.74 ","$760.37 ","$566.59 ","$0.00 ","$0.00 ","$831.78 ","$2,130.53 ","$729.46 ","$1,065.27 ","$1,687.38 ","$1,704.42 ","$1,007.34 ","$831.78 ","$0.00 ","$792.00 ","$724.05 "
"89432","ERX","HCPCS 63700001","59676-0570-01","ETRAVIRINE 100 MG PO TABS","BOTH IP/OP","$108.97 ","$80.64 ","$0.00 ","$96.87 ","","$19.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.87 ","$0.00 ","$48.44 ","$76.72 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89570","ERX","HCPCS 25000001","00338-0322-01","THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR","BOTH IP/OP","$314.76 ","$232.92 ","$0.00 ","$314.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.76 ","$0.00 ","$157.38 ","$249.29 ","$251.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89570","ERX","HCPCS 25000001","65293-0006-41","THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR","BOTH IP/OP","$314.76 ","$232.92 ","$0.00 ","$314.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.76 ","$0.00 ","$157.38 ","$249.29 ","$251.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89740","ERX","HCPCS 63700001","60258-0171-01","MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89740","ERX","HCPCS 63700001","63739-0354-01","MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89740","ERX","HCPCS 63700001","63739-0354-10","MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89783","ERX","HCPCS 63700001","59417-0102-10","LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS","BOTH IP/OP","$56.15 ","$41.55 ","$0.00 ","$48.50 ","","$10.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.50 ","$0.00 ","$24.25 ","$38.41 ","$38.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89791","ERX","HCPCS 63700001","00008-0844-01","PANTOPRAZOLE SODIUM 40 MG PO PACK","BOTH IP/OP","$83.13 ","$61.52 ","$0.00 ","$72.14 ","","$14.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.14 ","$0.00 ","$36.07 ","$57.13 ","$57.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89791","ERX","HCPCS 63700001","00008-0844-02","PANTOPRAZOLE SODIUM 40 MG PO PACK","BOTH IP/OP","$83.13 ","$61.52 ","$0.00 ","$72.14 ","","$14.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.14 ","$0.00 ","$36.07 ","$57.13 ","$57.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90996","ERX","HCPCS 63600001","31382-0753-05","MEPIVACAINE HCL 3 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91001","ERX","HCPCS 63700001","10122-0901-12","ZILEUTON 600 MG PO TABS","BOTH IP/OP","$145.10 ","$107.37 ","$0.00 ","$131.57 ","","$25.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.57 ","$0.00 ","$65.79 ","$104.20 ","$105.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91018","ERX","HCPCS 25000001","00065-0474-01","HYPROMELLOSE 0.3 % OP GEL","BOTH IP/OP","$29.64 ","$21.93 ","$0.00 ","$29.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$23.47 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91018","ERX","HCPCS 25000001","00065-8064-01","HYPROMELLOSE 0.3 % OP GEL","BOTH IP/OP","$29.64 ","$21.93 ","$0.00 ","$29.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$23.47 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91018","ERX","HCPCS 25000001","00078-0429-47","HYPROMELLOSE 0.3 % OP GEL","BOTH IP/OP","$29.64 ","$21.93 ","$0.00 ","$29.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.64 ","$0.00 ","$14.82 ","$23.47 ","$23.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91033","ERX","HCPCS 90633","58160-0825-52","HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP","BOTH IP/OP","$160.84 ","$119.02 ","$0.00 ","$141.67 ","$72.38 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$24.81 ","$141.67 ","$0.00 ","$70.84 ","$112.20 ","$113.34 ","$0.00 ","$22.17 ","$0.00 ","$22.55 ","$0.00 "
"91034","ERX","HCPCS 90632","58160-0826-52","HEPATITIS A VACCINE 1440 EL U/ML IM SUSP","BOTH IP/OP","$318.74 ","$235.87 ","$0.00 ","$270.27 ","$143.43 ","$0.00 ","$56.67 ","$0.00 ","$0.00 ","$70.39 ","$270.27 ","$0.00 ","$135.14 ","$214.05 ","$216.22 ","$0.00 ","$70.39 ","$0.00 ","$67.03 ","$0.00 "
"91037","ERX","HCPCS J3470","00548-9090-10","HYALURONIDASE BOVINE 150 UNIT/ML IJ SOLN","BOTH IP/OP","$232.36 ","$171.95 ","$0.00 ","$210.93 ","$104.56 ","$0.00 ","$29.38 ","$0.00 ","$0.00 ","$36.93 ","$210.93 ","$0.00 ","$105.47 ","$167.06 ","$168.74 ","$0.00 ","$33.01 ","$0.00 ","$33.58 ","$0.00 "
"91047","ERX","HCPCS 90371","13533-0636-03","HEPATITIS B IMMUNE GLOBULIN IM SOLN","BOTH IP/OP","$323.73 ","$239.56 ","$0.00 ","$323.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.73 ","$0.00 ","$161.87 ","$256.39 ","$258.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91047","ERX","HCPCS 90371","13533-0636-05","HEPATITIS B IMMUNE GLOBULIN IM SOLN","BOTH IP/OP","$323.73 ","$239.56 ","$0.00 ","$323.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.73 ","$0.00 ","$161.87 ","$256.39 ","$258.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91047","ERX","HCPCS 90371","59730-4202-01","HEPATITIS B IMMUNE GLOBULIN IM SOLN","BOTH IP/OP","$323.73 ","$239.56 ","$0.00 ","$323.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.73 ","$0.00 ","$161.87 ","$256.39 ","$258.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91054","ERX","HCPCS J9206","00009-7529-03","IRINOTECAN HCL 100 MG/5ML IV SOLN","BOTH IP/OP","$157.49 ","$116.54 ","$0.00 ","$142.80 ","$70.87 ","$0.00 ","$127.61 ","$0.00 ","$0.00 ","$14.57 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$14.57 ","$0.00 ","$13.87 ","$0.00 "
"91054","ERX","HCPCS J9206","63323-0193-55","IRINOTECAN HCL 100 MG/5ML IV SOLN","BOTH IP/OP","$157.49 ","$116.54 ","$0.00 ","$142.80 ","$70.87 ","$0.00 ","$127.61 ","$0.00 ","$0.00 ","$14.57 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$14.57 ","$0.00 ","$13.87 ","$0.00 "
"91073","ERX","HCPCS 63700001","00008-1211-30","DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$73.41 ","$54.32 ","$0.00 ","$62.75 ","","$13.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.75 ","$0.00 ","$31.38 ","$49.70 ","$50.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91073","ERX","HCPCS 63700001","51991-0311-33","DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$73.41 ","$54.32 ","$0.00 ","$62.75 ","","$13.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.75 ","$0.00 ","$31.38 ","$49.70 ","$50.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91073","ERX","HCPCS 63700001","59762-1211-03","DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24","BOTH IP/OP","$73.41 ","$54.32 ","$0.00 ","$62.75 ","","$13.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.75 ","$0.00 ","$31.38 ","$49.70 ","$50.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91238","ERX","HCPCS J0744","00409-4777-02","CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"91238","ERX","HCPCS J0744","25021-0114-87","CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"91238","ERX","HCPCS J0744","36000-0009-24","CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"91278","ERX","HCPCS J2354","00641-6174-10","OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.10 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91278","ERX","HCPCS J2354","00703-3301-04","OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.10 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91278","ERX","HCPCS J2354","25021-0451-01","OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.10 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91278","ERX","HCPCS J2354","67457-0239-01","OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.10 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91279","ERX","HCPCS J2354","00078-0181-01","OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$45.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.42 ","$45.33 ","$0.00 ","$22.67 ","$35.90 ","$36.26 ","$0.00 ","$0.00 ","$0.00 ","$4.21 ","$0.00 "
"91279","ERX","HCPCS J2354","00703-3311-01","OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$45.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.42 ","$45.33 ","$0.00 ","$22.67 ","$35.90 ","$36.26 ","$0.00 ","$0.00 ","$0.00 ","$4.21 ","$0.00 "
"91279","ERX","HCPCS J2354","00703-3311-04","OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$45.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.42 ","$45.33 ","$0.00 ","$22.67 ","$35.90 ","$36.26 ","$0.00 ","$0.00 ","$0.00 ","$4.21 ","$0.00 "
"91279","ERX","HCPCS J2354","25021-0452-01","OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$45.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.42 ","$45.33 ","$0.00 ","$22.67 ","$35.90 ","$36.26 ","$0.00 ","$0.00 ","$0.00 ","$4.21 ","$0.00 "
"91279","ERX","HCPCS J2354","63323-0376-01","OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$45.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.42 ","$45.33 ","$0.00 ","$22.67 ","$35.90 ","$36.26 ","$0.00 ","$0.00 ","$0.00 ","$4.21 ","$0.00 "
"91279","ERX","HCPCS J2354","67457-0245-01","OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$45.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.42 ","$45.33 ","$0.00 ","$22.67 ","$35.90 ","$36.26 ","$0.00 ","$0.00 ","$0.00 ","$4.21 ","$0.00 "
"91281","ERX","HCPCS J2354","00641-6176-01","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91281","ERX","HCPCS J2354","00641-6176-10","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91281","ERX","HCPCS J2354","00703-3321-01","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91281","ERX","HCPCS J2354","00703-3321-04","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91281","ERX","HCPCS J2354","25021-0453-01","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91281","ERX","HCPCS J2354","63323-0377-01","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91281","ERX","HCPCS J2354","67457-0246-01","OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","BOTH IP/OP","$206.91 ","$153.11 ","$0.00 ","$187.83 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.09 ","$187.83 ","$0.00 ","$93.92 ","$148.76 ","$150.26 ","$0.00 ","$0.00 ","$0.00 ","$21.03 ","$0.00 "
"91363","ERX","HCPCS J1451","00517-0710-01","FOMEPIZOLE 1.5 GM/1.5ML IV SOLN","BOTH IP/OP","$2,644.50 ","$1,956.93 ","$0.00 ","$2,644.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,644.50 ","$0.00 ","$1,322.25 ","$2,094.44 ","$2,115.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91363","ERX","HCPCS J1451","67457-0211-02","FOMEPIZOLE 1.5 GM/1.5ML IV SOLN","BOTH IP/OP","$2,644.50 ","$1,956.93 ","$0.00 ","$2,644.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,644.50 ","$0.00 ","$1,322.25 ","$2,094.44 ","$2,115.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91363","ERX","HCPCS J1451","70710-1478-01","FOMEPIZOLE 1.5 GM/1.5ML IV SOLN","BOTH IP/OP","$2,644.50 ","$1,956.93 ","$0.00 ","$2,644.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,644.50 ","$0.00 ","$1,322.25 ","$2,094.44 ","$2,115.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91408","ERX","HCPCS J2785","00469-6501-89","REGADENOSON 0.4 MG/5ML IV SOLN","BOTH IP/OP","$876.88 ","$648.89 ","$0.00 ","$772.61 ","$394.60 ","$0.00 ","$182.76 ","$0.00 ","$0.00 ","$278.62 ","$772.61 ","$0.00 ","$386.31 ","$611.91 ","$618.09 ","$0.00 ","$278.62 ","$0.00 ","$265.29 ","$0.00 "
"91534","ERX","HCPCS 63700001","64764-0080-60","LUBIPROSTONE 8 MCG PO CAPS","BOTH IP/OP","$31.10 ","$23.01 ","$0.00 ","$28.21 ","","$5.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.21 ","$0.00 ","$14.11 ","$22.34 ","$22.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91651","ERX","HCPCS J2212","65649-0551-02","METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN","BOTH IP/OP","$585.22 ","$433.06 ","$0.00 ","$456.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$456.28 ","$0.00 ","$228.14 ","$361.37 ","$365.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91651","ERX","HCPCS J2212","65649-0551-07","METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN","BOTH IP/OP","$585.22 ","$433.06 ","$0.00 ","$456.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$456.28 ","$0.00 ","$228.14 ","$361.37 ","$365.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91870","ERX","HCPCS 63700001","67919-0020-10","ALVIMOPAN 12 MG PO CAPS","BOTH IP/OP","$637.17 ","$471.51 ","$0.00 ","$550.72 ","","$113.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.72 ","$0.00 ","$275.36 ","$436.17 ","$440.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91877","ERX","HCPCS 25000001","00085-1461-02","MOMETASONE FUROATE 110 MCG/INH IN AEPB","BOTH IP/OP","$621.59 ","$459.98 ","$0.00 ","$564.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.11 ","$0.00 ","$282.06 ","$446.78 ","$451.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92074","ERX","HCPCS 25000001","49281-0510-05","DTAP-IPV-HIB VACCINE IM SUSR","BOTH IP/OP","$425.59 ","$314.94 ","$0.00 ","$363.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$363.11 ","$0.00 ","$181.56 ","$287.58 ","$290.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92079","ERX","HCPCS 25000001","00143-9660-10","METOPROLOL TARTRATE 5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92079","ERX","HCPCS 25000001","00143-9873-25","METOPROLOL TARTRATE 5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92079","ERX","HCPCS 25000001","36000-0033-10","METOPROLOL TARTRATE 5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92079","ERX","HCPCS 25000001","47781-0587-17","METOPROLOL TARTRATE 5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92079","ERX","HCPCS 25000001","70860-0300-05","METOPROLOL TARTRATE 5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92079","ERX","HCPCS 25000001","70860-0300-41","METOPROLOL TARTRATE 5 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92788","ERX","HCPCS 90696","58160-0812-11","DTAP-IPV VACCINE IM SUSP","BOTH IP/OP","$200.78 ","$148.58 ","$0.00 ","$200.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.15 ","$200.78 ","$0.00 ","$100.39 ","$159.02 ","$160.62 ","$0.00 ","$31.42 ","$0.00 ","$31.96 ","$0.00 "
"92851","ERX","HCPCS 63700001","59676-0562-01","DARUNAVIR ETHANOLATE 600 MG PO TABS","BOTH IP/OP","$142.45 ","$105.41 ","$0.00 ","$123.61 ","","$26.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.61 ","$0.00 ","$61.81 ","$97.90 ","$98.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92854","ERX","HCPCS J7189","00169-7202-01","COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR","BOTH IP/OP","$12,158.80 ","$8,997.51 ","$0.00 ","$11,029.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,029.00 ","$0.00 ","$5,514.50 ","$8,734.97 ","$8,823.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92895","ERX","HCPCS J3370","00338-3552-48","VANCOMYCIN HCL IN DEXTROSE 1000 MG/200ML IV SOLN","BOTH IP/OP","$125.07 ","$92.55 ","$0.00 ","$113.40 ","$56.28 ","$0.00 ","$7.24 ","$0.00 ","$0.00 ","$7.97 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$7.97 ","$0.00 ","$7.59 ","$0.00 "
"92897","ERX","HCPCS 63700001","00003-0852-22","DASATINIB 100 MG PO TABS","BOTH IP/OP","$1,570.67 ","$1,162.30 ","$0.00 ","$1,392.77 ","","$292.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.77 ","$0.00 ","$696.39 ","$1,103.07 ","$1,114.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93084","ERX","HCPCS J0282","00143-9875-10","AMIODARONE HCL 150 MG/3ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"93084","ERX","HCPCS J0282","00143-9875-25","AMIODARONE HCL 150 MG/3ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"93084","ERX","HCPCS J0282","55150-0180-03","AMIODARONE HCL 150 MG/3ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"93084","ERX","HCPCS J0282","63323-0616-03","AMIODARONE HCL 150 MG/3ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"93084","ERX","HCPCS J0282","67457-0153-03","AMIODARONE HCL 150 MG/3ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"93106","ERX","HCPCS J1170","17478-0540-50","HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN","BOTH IP/OP","$428.40 ","$317.02 ","$0.00 ","$455.31 ","$192.78 ","$0.00 ","$195.34 ","$0.00 ","$0.00 ","$455.31 ","$388.88 ","$0.00 ","$194.44 ","$307.99 ","$311.10 ","$0.00 ","$455.31 ","$0.00 ","$433.54 ","$0.00 "
"93352","ERX","HCPCS 63700001","","FLORANEX PO PACK","BOTH IP/OP","$8.52 ","$6.30 ","$0.00 ","$7.73 ","","$1.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.73 ","$0.00 ","$3.87 ","$6.12 ","$6.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93352","ERX","HCPCS 63700001","64980-0146-12","FLORANEX PO PACK","BOTH IP/OP","$8.52 ","$6.30 ","$0.00 ","$7.73 ","","$1.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.73 ","$0.00 ","$3.87 ","$6.12 ","$6.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93523","ERX","HCPCS J2250","00409-2596-05","MIDAZOLAM HCL 50 MG/10ML IJ SOLN","BOTH IP/OP","$29.67 ","$21.96 ","$0.00 ","$26.91 ","$13.35 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$26.91 ","$0.00 ","$13.46 ","$21.31 ","$21.53 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"93523","ERX","HCPCS J2250","00641-6060-01","MIDAZOLAM HCL 50 MG/10ML IJ SOLN","BOTH IP/OP","$29.67 ","$21.96 ","$0.00 ","$26.91 ","$13.35 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$26.91 ","$0.00 ","$13.46 ","$21.31 ","$21.53 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"93523","ERX","HCPCS J2250","00641-6060-10","MIDAZOLAM HCL 50 MG/10ML IJ SOLN","BOTH IP/OP","$29.67 ","$21.96 ","$0.00 ","$26.91 ","$13.35 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$26.91 ","$0.00 ","$13.46 ","$21.31 ","$21.53 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"93523","ERX","HCPCS J2250","00641-6190-10","MIDAZOLAM HCL 50 MG/10ML IJ SOLN","BOTH IP/OP","$29.67 ","$21.96 ","$0.00 ","$26.91 ","$13.35 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$26.91 ","$0.00 ","$13.46 ","$21.31 ","$21.53 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"93523","ERX","HCPCS J2250","47781-0589-91","MIDAZOLAM HCL 50 MG/10ML IJ SOLN","BOTH IP/OP","$29.67 ","$21.96 ","$0.00 ","$26.91 ","$13.35 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$26.91 ","$0.00 ","$13.46 ","$21.31 ","$21.53 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"93523","ERX","HCPCS J2250","70860-0601-10","MIDAZOLAM HCL 50 MG/10ML IJ SOLN","BOTH IP/OP","$29.67 ","$21.96 ","$0.00 ","$26.91 ","$13.35 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$26.91 ","$0.00 ","$13.46 ","$21.31 ","$21.53 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"93566","ERX","HCPCS J2796","55513-0221-01","ROMIPLOSTIM 250 MCG SC SOLR","BOTH IP/OP","$5,599.43 ","$4,143.58 ","$0.00 ","$4,796.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,796.14 ","$0.00 ","$2,398.07 ","$3,798.54 ","$3,836.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93574","ERX","HCPCS A9581","50419-0320-05","GADOXETATE DISODIUM 0.25 MOL/L IV SOLN","BOTH IP/OP","$572.38 ","$423.56 ","$0.00 ","$519.57 ","$257.57 ","$0.00 ","$119.30 ","$0.00 ","$0.00 ","$90.97 ","$519.57 ","$0.00 ","$259.79 ","$411.50 ","$415.66 ","$0.00 ","$81.31 ","$0.00 ","$82.72 ","$0.00 "
"93748","ERX","HCPCS J9293","61703-0343-18","MITOXANTRONE HCL 20 MG/10ML IV CONC","BOTH IP/OP","$604.65 ","$447.44 ","$0.00 ","$540.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.60 ","$0.00 ","$270.30 ","$428.16 ","$432.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93748","ERX","HCPCS J9293","63323-0132-10","MITOXANTRONE HCL 20 MG/10ML IV CONC","BOTH IP/OP","$604.65 ","$447.44 ","$0.00 ","$540.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.60 ","$0.00 ","$270.30 ","$428.16 ","$432.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93823","ERX","HCPCS 63700001","00597-0002-01","TIPRANAVIR 100 MG/ML PO SOLN","BOTH IP/OP","$1,702.25 ","$1,259.67 ","$0.00 ","$1,702.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,702.25 ","$0.00 ","$851.13 ","$1,348.18 ","$1,361.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93927","ERX","HCPCS 25000001","46287-0500-30","SORBITOL 70 % SOLN","BOTH IP/OP","$12.32 ","$9.12 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$8.71 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93927","ERX","HCPCS 25000001","99999-6005-16","SORBITOL 70 % SOLN","BOTH IP/OP","$12.32 ","$9.12 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93927","ERX","HCPCS 25000001","46287-0500-01","SORBITOL 70 % SOLN","BOTH IP/OP","$12.32 ","$9.12 ","$0.00 ","$29.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$29.90 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93931","ERX","HCPCS 25000001","00487-0201-01","IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$6.65 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93931","ERX","HCPCS 25000001","00487-0201-60","IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$6.65 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93931","ERX","HCPCS 25000001","76204-0600-01","IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$6.65 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94096","ERX","HCPCS J2405","00409-4755-03","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","00641-6078-25","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","00641-6080-25","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","23155-0547-41","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","23155-0547-42","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","36000-0012-25","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","55150-0125-02","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","60505-6130-05","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94096","ERX","HCPCS J2405","70860-0776-02","ONDANSETRON HCL 4 MG/2ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94097","ERX","HCPCS J2405","00143-9890-01","ONDANSETRON HCL 40 MG/20ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94097","ERX","HCPCS J2405","63323-0374-20","ONDANSETRON HCL 40 MG/20ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.99 ","$0.00 ","$0.00 ","$0.42 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.42 ","$0.00 ","$0.40 ","$0.00 "
"94141","ERX","HCPCS 25000001","63824-0713-16","BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94141","ERX","HCPCS 25000001","63824-0715-16","BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94141","ERX","HCPCS 25000001","99999-6009-97","BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94219","ERX","HCPCS 25000001","10122-0313-10","NICARDIPINE HCL IN NACL 20-0.86 MG/200ML-% IV SOLN","BOTH IP/OP","$409.92 ","$303.34 ","$0.00 ","$372.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$372.10 ","$0.00 ","$186.05 ","$294.70 ","$297.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94576","ERX","HCPCS 25000001","10122-0325-10","NICARDIPINE HCL IN NACL 40-0.83 MG/200ML-% IV SOLN","BOTH IP/OP","$712.48 ","$527.24 ","$0.00 ","$646.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$646.60 ","$0.00 ","$323.30 ","$512.11 ","$517.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95687","ERX","HCPCS 63700001","65649-0103-02","MESALAMINE ER 0.375 G PO CP24","BOTH IP/OP","$78.80 ","$58.31 ","$0.00 ","$71.45 ","","$14.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.45 ","$0.00 ","$35.73 ","$56.59 ","$57.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95693","ERX","HCPCS 63700001","39328-0057-50","FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN","BOTH IP/OP","$36.67 ","$27.14 ","$0.00 ","$33.25 ","","$6.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.25 ","$0.00 ","$16.63 ","$26.33 ","$26.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95693","ERX","HCPCS 63700001","50383-0627-50","FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN","BOTH IP/OP","$36.67 ","$27.14 ","$0.00 ","$33.25 ","","$6.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.25 ","$0.00 ","$16.63 ","$26.33 ","$26.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95693","ERX","HCPCS 63700001","54838-0011-50","FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN","BOTH IP/OP","$36.67 ","$27.14 ","$0.00 ","$33.25 ","","$6.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.25 ","$0.00 ","$16.63 ","$26.33 ","$26.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95811","ERX","HCPCS 25000001","00409-9558-05","ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95811","ERX","HCPCS 25000001","00781-3220-95","ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95811","ERX","HCPCS 25000001","25021-0662-05","ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95811","ERX","HCPCS 25000001","39822-4200-02","ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95811","ERX","HCPCS 25000001","63323-0426-05","ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95811","ERX","HCPCS 25000001","67457-0228-05","ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00143-9251-01","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00143-9251-10","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00409-9558-10","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00409-9558-31","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00409-9558-50","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00409-9558-70","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00781-3220-70","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","00781-3220-92","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","25021-0662-10","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","39822-4200-05","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","39822-4200-06","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","67457-0228-10","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95812","ERX","HCPCS 25000001","70860-0651-10","ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","BOTH IP/OP","$36.00 ","$26.64 ","$0.00 ","$32.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.34 ","$0.00 ","$16.17 ","$25.61 ","$25.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96941","ERX","HCPCS 63700001","43598-0552-30","LAMOTRIGINE 100 MG PO TBDP","BOTH IP/OP","$42.81 ","$31.68 ","$0.00 ","$38.83 ","","$7.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.83 ","$0.00 ","$19.42 ","$30.75 ","$31.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96968","ERX","HCPCS 63700001","00131-2477-35","LACOSAMIDE 50 MG PO TABS","BOTH IP/OP","$50.06 ","$37.04 ","$0.00 ","$43.28 ","","$8.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.28 ","$0.00 ","$21.64 ","$34.28 ","$34.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96968","ERX","HCPCS 63700001","00131-2477-60","LACOSAMIDE 50 MG PO TABS","BOTH IP/OP","$50.06 ","$37.04 ","$0.00 ","$43.28 ","","$8.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.28 ","$0.00 ","$21.64 ","$34.28 ","$34.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96969","ERX","HCPCS 63700001","00131-2478-60","LACOSAMIDE 100 MG PO TABS","BOTH IP/OP","$79.32 ","$58.70 ","$0.00 ","$74.44 ","","$12.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.44 ","$0.00 ","$37.22 ","$58.96 ","$59.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96970","ERX","HCPCS 63700001","00131-2479-35","LACOSAMIDE 150 MG PO TABS","BOTH IP/OP","$82.89 ","$61.34 ","$0.00 ","$71.66 ","","$13.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.66 ","$0.00 ","$35.83 ","$56.75 ","$57.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96970","ERX","HCPCS 63700001","00131-2479-60","LACOSAMIDE 150 MG PO TABS","BOTH IP/OP","$82.89 ","$61.34 ","$0.00 ","$71.66 ","","$13.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.66 ","$0.00 ","$35.83 ","$56.75 ","$57.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96971","ERX","HCPCS 63700001","00131-2480-35","LACOSAMIDE 200 MG PO TABS","BOTH IP/OP","$82.91 ","$61.35 ","$0.00 ","$71.68 ","","$13.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.68 ","$0.00 ","$35.84 ","$56.77 ","$57.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96971","ERX","HCPCS 63700001","00131-2480-60","LACOSAMIDE 200 MG PO TABS","BOTH IP/OP","$82.91 ","$61.35 ","$0.00 ","$71.68 ","","$13.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.68 ","$0.00 ","$35.84 ","$56.77 ","$57.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96972","ERX","HCPCS C9254","00131-1810-67","LACOSAMIDE 200 MG/20ML IV SOLN","BOTH IP/OP","$94.63 ","$70.03 ","$0.00 ","$81.80 ","$45.52 ","$0.00 ","$19.72 ","$0.00 ","$0.00 ","$14.32 ","$81.80 ","$0.00 ","$40.90 ","$64.79 ","$65.44 ","$0.00 ","$12.80 ","$0.00 ","$13.02 ","$0.00 "
"96976","ERX","HCPCS 25000001","00186-0917-06","BUDESONIDE 90 MCG/ACT IN AEPB","BOTH IP/OP","$672.22 ","$497.44 ","$0.00 ","$589.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$589.44 ","$0.00 ","$294.72 ","$466.84 ","$471.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96977","ERX","HCPCS 25000001","00186-0916-12","BUDESONIDE 180 MCG/ACT IN AEPB","BOTH IP/OP","$900.15 ","$666.11 ","$0.00 ","$789.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$789.28 ","$0.00 ","$394.64 ","$625.11 ","$631.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96982","ERX","HCPCS J9100","61703-0305-38","CYTARABINE (PF) 20 MG/ML IJ SOLN","BOTH IP/OP","$127.38 ","$94.26 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96982","ERX","HCPCS J9100","61703-0303-46","CYTARABINE (PF) 20 MG/ML IJ SOLN","BOTH IP/OP","$127.38 ","$94.26 ","$0.00 ","$90.09 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$90.09 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96986","ERX","HCPCS J9155","55566-8303-01","DEGARELIX ACETATE 80 MG SC SOLR","BOTH IP/OP","$1,518.11 ","$1,123.40 ","$0.00 ","$1,406.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,406.74 ","$0.00 ","$703.37 ","$1,114.14 ","$1,125.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96988","ERX","HCPCS 25000001","66220-0160-10","CONIVAPTAN HCL IN DEXTROSE 20-5 MG/100ML-% IV SOLN","BOTH IP/OP","$2,518.10 ","$1,863.39 ","$0.00 ","$2,292.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.48 ","$0.00 ","$1,146.24 ","$1,815.64 ","$1,833.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97005","ERX","HCPCS 63700001","30768-0003-48","MILK THISTLE XTRA PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97053","ERX","HCPCS 63700001","59676-0563-01","DARUNAVIR ETHANOLATE 75 MG PO TABS","BOTH IP/OP","$142.45 ","$105.41 ","$0.00 ","$123.60 ","","$26.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.60 ","$0.00 ","$61.80 ","$97.89 ","$98.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97133","ERX","HCPCS 63700001","64764-0918-30","FEBUXOSTAT 40 MG PO TABS","BOTH IP/OP","$55.32 ","$40.94 ","$0.00 ","$50.17 ","","$9.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.17 ","$0.00 ","$25.09 ","$39.73 ","$40.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97134","ERX","HCPCS 63700001","64764-0677-30","FEBUXOSTAT 80 MG PO TABS","BOTH IP/OP","$55.32 ","$40.94 ","$0.00 ","$50.17 ","","$9.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.17 ","$0.00 ","$25.09 ","$39.73 ","$40.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97252","ERX","HCPCS J3490","99999-6010-51","DILTIAZEM HCL 25 MG/5ML IV SOLN","BOTH IP/OP","$811.76 ","$600.70 ","$0.00 ","$736.70 ","$365.29 ","$0.00 ","$169.19 ","$0.00 ","$0.00 ","$128.99 ","$736.70 ","$0.00 ","$368.35 ","$583.47 ","$589.36 ","$0.00 ","$115.29 ","$0.00 ","$117.28 ","$0.00 "
"97253","ERX","HCPCS 25000001","00641-6015-10","DILTIAZEM HCL 125 MG/25ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97254","ERX","HCPCS 25000001","00409-1171-02","DILTIAZEM HCL 50 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97254","ERX","HCPCS 25000001","00641-6014-01","DILTIAZEM HCL 50 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97254","ERX","HCPCS 25000001","00641-6014-10","DILTIAZEM HCL 50 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97254","ERX","HCPCS 25000001","00641-9218-10","DILTIAZEM HCL 50 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97254","ERX","HCPCS 25000001","17478-0937-10","DILTIAZEM HCL 50 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97266","ERX","HCPCS 63700001","00456-1420-90","NEBIVOLOL HCL 20 MG PO TABS","BOTH IP/OP","$26.47 ","$19.59 ","$0.00 ","$22.87 ","","$4.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.87 ","$0.00 ","$11.44 ","$18.11 ","$18.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97343","ERX","HCPCS 63700001","00781-3174-14","SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","BOTH IP/OP","$294.95 ","$218.26 ","$0.00 ","$267.75 ","","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97343","ERX","HCPCS 63700001","55150-0173-01","SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","BOTH IP/OP","$294.95 ","$218.26 ","$0.00 ","$267.75 ","","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97343","ERX","HCPCS 63700001","63323-0273-01","SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","BOTH IP/OP","$294.95 ","$218.26 ","$0.00 ","$267.75 ","","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97371","ERX","HCPCS J3370","00143-9355-10","VANCOMYCIN HCL 750 MG IV SOLR","BOTH IP/OP","$47.77 ","$35.35 ","$0.00 ","$43.32 ","$21.50 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$43.32 ","$0.00 ","$21.66 ","$34.31 ","$34.66 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"97371","ERX","HCPCS J3370","00409-6531-02","VANCOMYCIN HCL 750 MG IV SOLR","BOTH IP/OP","$47.77 ","$35.35 ","$0.00 ","$43.32 ","$21.50 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$43.32 ","$0.00 ","$21.66 ","$34.31 ","$34.66 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"97371","ERX","HCPCS J3370","63323-0203-20","VANCOMYCIN HCL 750 MG IV SOLR","BOTH IP/OP","$47.77 ","$35.35 ","$0.00 ","$43.32 ","$21.50 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.98 ","$43.32 ","$0.00 ","$21.66 ","$34.31 ","$34.66 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"97389","ERX","HCPCS J7527","00078-0566-51","EVEROLIMUS 5 MG PO TABS","BOTH IP/OP","$1,743.45 ","$1,290.15 ","$0.00 ","$1,615.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.55 ","$0.00 ","$807.78 ","$1,279.52 ","$1,292.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97390","ERX","HCPCS J7527","00078-0567-51","EVEROLIMUS 10 MG PO TABS","BOTH IP/OP","$1,743.45 ","$1,290.15 ","$0.00 ","$1,615.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.55 ","$0.00 ","$807.78 ","$1,279.52 ","$1,292.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97480","ERX","HCPCS J7510","99999-6010-77","PREDNISOLONE 15 MG/5ML PO SOLN","BOTH IP/OP","$119.28 ","$88.27 ","$0.00 ","$182.20 ","","$0.00 ","$24.86 ","$0.00 ","$0.00 ","$0.00 ","$182.20 ","$0.00 ","$91.10 ","$85.65 ","$145.76 ","$0.00 ","$28.51 ","$0.00 ","$0.00 ","$0.00 "
"97480","ERX","HCPCS J7510","99999-6004-79","PREDNISOLONE 15 MG/5ML PO SOLN","BOTH IP/OP","$119.28 ","$88.27 ","$0.00 ","$182.20 ","","$0.00 ","$24.86 ","$0.00 ","$0.00 ","$0.00 ","$182.20 ","$0.00 ","$91.10 ","$144.30 ","$145.76 ","$0.00 ","$28.51 ","$0.00 ","$0.00 ","$0.00 "
"97480","ERX","HCPCS J7510","50383-0042-24","PREDNISOLONE 15 MG/5ML PO SOLN","BOTH IP/OP","$119.28 ","$88.27 ","$0.00 ","$279.44 ","","$0.00 ","$24.86 ","$0.00 ","$0.00 ","$0.00 ","$182.20 ","$0.00 ","$91.10 ","$279.44 ","$145.76 ","$0.00 ","$28.51 ","$0.00 ","$0.00 ","$0.00 "
"97480","ERX","HCPCS J7510","50383-0042-48","PREDNISOLONE 15 MG/5ML PO SOLN","BOTH IP/OP","$119.28 ","$88.27 ","$0.00 ","$446.40 ","","$0.00 ","$24.86 ","$0.00 ","$0.00 ","$0.00 ","$182.20 ","$0.00 ","$91.10 ","$446.40 ","$145.76 ","$0.00 ","$28.51 ","$0.00 ","$0.00 ","$0.00 "
"97660","ERX","HCPCS 25000001","48582-0512-01","BIOTENE ORALBALANCE DRY MOUTH MT GEL","BOTH IP/OP","$23.76 ","$17.58 ","$0.00 ","$21.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.55 ","$0.00 ","$10.78 ","$17.07 ","$17.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97716","ERX","HCPCS J1885","00409-3796-01","KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.22 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.22 ","$0.00 ","$1.16 ","$0.00 "
"97716","ERX","HCPCS J1885","00641-6043-25","KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.22 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.22 ","$0.00 ","$1.16 ","$0.00 "
"97716","ERX","HCPCS J1885","25021-0701-02","KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.22 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.22 ","$0.00 ","$1.16 ","$0.00 "
"97716","ERX","HCPCS J1885","47781-0585-68","KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.22 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.22 ","$0.00 ","$1.16 ","$0.00 "
"97716","ERX","HCPCS J1885","63323-0162-02","KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.22 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.22 ","$0.00 ","$1.16 ","$0.00 "
"97716","ERX","HCPCS J1885","63323-0162-14","KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.22 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.22 ","$0.00 ","$1.16 ","$0.00 "
"97744","ERX","HCPCS 63700001","68180-0771-06","AMLOD/VALSA/HCTZ 5-160-12.5 MG TAB","BOTH IP/OP","$21.65 ","$16.02 ","$0.00 ","$21.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.65 ","$0.00 ","$10.83 ","$17.15 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97745","ERX","HCPCS 63700001","68180-0773-06","AMLOD/VALSA/HCTZ 5-160-25 MG TAB","BOTH IP/OP","$21.65 ","$16.02 ","$0.00 ","$21.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.65 ","$0.00 ","$10.83 ","$17.15 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97747","ERX","HCPCS 63700001","68180-0774-06","AMLOD/VALSA/HCTZ 10-160-25 MG TABS","BOTH IP/OP","$24.56 ","$18.17 ","$0.00 ","$24.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.56 ","$0.00 ","$12.28 ","$19.45 ","$19.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97748","ERX","HCPCS 63700001","68180-0775-06","AMLOD/VALSA/HCTZ 10-320-25 MG TABS","BOTH IP/OP","$31.17 ","$23.07 ","$0.00 ","$31.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.17 ","$0.00 ","$15.59 ","$24.69 ","$24.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97790","ERX","HCPCS J3260","63323-0306-30","TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN","BOTH IP/OP","$101.91 ","$75.41 ","$0.00 ","$92.40 ","$45.86 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$92.40 ","$0.00 ","$46.20 ","$73.18 ","$73.92 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"97790","ERX","HCPCS J3260","67457-0428-00","TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN","BOTH IP/OP","$101.91 ","$75.41 ","$0.00 ","$92.40 ","$45.86 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$92.40 ","$0.00 ","$46.20 ","$73.18 ","$73.92 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"97790","ERX","HCPCS J3260","67457-0428-30","TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN","BOTH IP/OP","$101.91 ","$75.41 ","$0.00 ","$92.40 ","$45.86 ","$0.00 ","$38.42 ","$0.00 ","$0.00 ","$65.04 ","$92.40 ","$0.00 ","$46.20 ","$73.18 ","$73.92 ","$0.00 ","$65.04 ","$0.00 ","$61.93 ","$0.00 "
"97830","ERX","HCPCS 63700001","00173-0772-02","LAMOTRIGINE 25 MG PO TBDP","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$33.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.73 ","$0.00 ","$16.87 ","$26.71 ","$26.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97893","ERX","HCPCS 63700001","59148-0020-50","TOLVAPTAN 15 MG PO TABS","BOTH IP/OP","$819.33 ","$606.30 ","$0.00 ","$743.57 ","","$145.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$743.57 ","$0.00 ","$371.79 ","$588.91 ","$594.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97893","ERX","HCPCS 63700001","99999-6011-58","TOLVAPTAN 15 MG PO TABS","BOTH IP/OP","$819.33 ","$606.30 ","$0.00 ","$743.57 ","","$145.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$743.57 ","$0.00 ","$371.79 ","$588.91 ","$594.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97894","ERX","HCPCS 25000001","59148-0021-50","TOLVAPTAN 30 MG PO TABS","BOTH IP/OP","$1,677.22 ","$1,241.14 ","$0.00 ","$1,480.17 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,480.17 ","$0.00 ","$740.09 ","$1,172.29 ","$1,184.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98035","ERX","HCPCS 63700001","00032-1212-01","PANCRELIPASE (LIP-PROT-AMYL) 12000 UNITS PO CPEP","BOTH IP/OP","$17.84 ","$13.20 ","$0.00 ","$15.24 ","","$3.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.24 ","$0.00 ","$7.62 ","$12.07 ","$12.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98127","ERX","HCPCS 25000001","08271-0361-00","LANCETS ULTRA THIN MISC","BOTH IP/OP","$11.32 ","$8.38 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98249","ERX","HCPCS J9190","16729-0276-38","FLUOROURACIL 5 GM/100ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.77 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$1.77 ","$0.00 ","$0.00 ","$0.00 "
"98249","ERX","HCPCS J9190","63323-0117-61","FLUOROURACIL 5 GM/100ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.77 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$1.77 ","$0.00 ","$0.00 ","$0.00 "
"98329","ERX","HCPCS 25000001","00024-4142-60","DRONEDARONE HCL 400 MG PO TABS","BOTH IP/OP","$57.94 ","$42.88 ","$0.00 ","$50.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.04 ","$0.00 ","$25.02 ","$39.63 ","$40.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98372","ERX","HCPCS 63700001","60505-4642-03","PRASUGREL HCL 5 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","00002-5123-30","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","00378-5186-93","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","16729-0273-10","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","60505-4643-03","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","65162-0002-03","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","65862-0830-30","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98373","ERX","HCPCS 63700001","67877-0605-30","PRASUGREL HCL 10 MG PO TABS","BOTH IP/OP","$69.17 ","$51.19 ","$0.00 ","$62.73 ","","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.73 ","$0.00 ","$31.37 ","$49.68 ","$50.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99404","ERX","HCPCS 25000001","42799-0217-01","OPIUM 10 MG/ML (1%) PO TINC","BOTH IP/OP","$1,916.55 ","$1,418.25 ","$0.00 ","$1,775.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,775.95 ","$0.00 ","$887.98 ","$1,406.55 ","$1,420.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99404","ERX","HCPCS 25000001","62559-0153-04","OPIUM 10 MG/ML (1%) PO TINC","BOTH IP/OP","$1,916.55 ","$1,418.25 ","$0.00 ","$1,775.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,775.95 ","$0.00 ","$887.98 ","$1,406.55 ","$1,420.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99438","ERX","HCPCS 63700001","16714-0809-01","LEVONORGESTREL 1.5 MG PO TABS","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99438","ERX","HCPCS 63700001","51285-0146-19","LEVONORGESTREL 1.5 MG PO TABS","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99438","ERX","HCPCS 63700001","51285-0162-88","LEVONORGESTREL 1.5 MG PO TABS","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99438","ERX","HCPCS 63700001","62756-0720-60","LEVONORGESTREL 1.5 MG PO TABS","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99438","ERX","HCPCS 63700001","68180-0852-11","LEVONORGESTREL 1.5 MG PO TABS","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99438","ERX","HCPCS 63700001","69536-0146-19","LEVONORGESTREL 1.5 MG PO TABS","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99452","ERX","HCPCS J7312","00023-3348-07","DEXAMETHASONE 0.7 MG INTRAVITREAL IMPL","BOTH IP/OP","$3,615.10 ","$2,675.17 ","$0.00 ","$3,279.18 ","$1,626.80 ","$1,399.97 ","$753.48 ","$0.00 ","$0.00 ","$1,645.82 ","$3,279.18 ","$1,470.19 ","$1,639.59 ","$2,597.11 ","$2,623.34 ","$2,030.26 ","$1,645.82 ","$0.00 ","$1,567.10 ","$1,400.55 "
"99602","ERX","HCPCS J9263","00703-3985-01","OXALIPLATIN 50 MG/10ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$1,124.48 ","$93.69 ","$0.00 ","$1,124.48 ","$0.00 ","$0.00 ","$17.63 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$17.63 ","$0.00 ","$16.78 ","$0.00 "
"99602","ERX","HCPCS J9263","00781-3315-70","OXALIPLATIN 50 MG/10ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$1,124.48 ","$93.69 ","$0.00 ","$1,124.48 ","$0.00 ","$0.00 ","$17.63 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$17.63 ","$0.00 ","$16.78 ","$0.00 "
"99602","ERX","HCPCS J9263","00781-9315-70","OXALIPLATIN 50 MG/10ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$1,124.48 ","$93.69 ","$0.00 ","$1,124.48 ","$0.00 ","$0.00 ","$17.63 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$17.63 ","$0.00 ","$16.78 ","$0.00 "
"99602","ERX","HCPCS J9263","25021-0233-10","OXALIPLATIN 50 MG/10ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$1,124.48 ","$93.69 ","$0.00 ","$1,124.48 ","$0.00 ","$0.00 ","$17.63 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$17.63 ","$0.00 ","$16.78 ","$0.00 "
"99602","ERX","HCPCS J9263","61703-0363-18","OXALIPLATIN 50 MG/10ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$1,124.48 ","$93.69 ","$0.00 ","$1,124.48 ","$0.00 ","$0.00 ","$17.63 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$17.63 ","$0.00 ","$16.78 ","$0.00 "
"99602","ERX","HCPCS J9263","67457-0469-10","OXALIPLATIN 50 MG/10ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$1,124.48 ","$93.69 ","$0.00 ","$1,124.48 ","$0.00 ","$0.00 ","$17.63 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$17.63 ","$0.00 ","$16.78 ","$0.00 "
"99604","ERX","HCPCS J9263","00703-3986-01","OXALIPLATIN 100 MG/20ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$2,248.95 ","$93.69 ","$0.00 ","$2,248.95 ","$0.00 ","$0.00 ","$35.25 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$35.25 ","$0.00 ","$33.56 ","$0.00 "
"99604","ERX","HCPCS J9263","00781-3317-80","OXALIPLATIN 100 MG/20ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$2,248.95 ","$93.69 ","$0.00 ","$2,248.95 ","$0.00 ","$0.00 ","$35.25 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$35.25 ","$0.00 ","$33.56 ","$0.00 "
"99604","ERX","HCPCS J9263","00955-1727-20","OXALIPLATIN 100 MG/20ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$2,248.95 ","$93.69 ","$0.00 ","$2,248.95 ","$0.00 ","$0.00 ","$35.25 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$35.25 ","$0.00 ","$33.56 ","$0.00 "
"99604","ERX","HCPCS J9263","25021-0233-20","OXALIPLATIN 100 MG/20ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$2,248.95 ","$93.69 ","$0.00 ","$2,248.95 ","$0.00 ","$0.00 ","$35.25 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$35.25 ","$0.00 ","$33.56 ","$0.00 "
"99604","ERX","HCPCS J9263","61703-0363-22","OXALIPLATIN 100 MG/20ML IV SOLN","BOTH IP/OP","$208.20 ","$154.07 ","$0.00 ","$2,248.95 ","$93.69 ","$0.00 ","$2,248.95 ","$0.00 ","$0.00 ","$35.25 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$35.25 ","$0.00 ","$33.56 ","$0.00 "
"99686","ERX","HCPCS 63700001","00955-1052-90","SEVELAMER CARBONATE 0.8 G PO PACK","BOTH IP/OP","$47.55 ","$35.19 ","$0.00 ","$43.12 ","","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.12 ","$0.00 ","$21.56 ","$34.15 ","$34.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99686","ERX","HCPCS 63700001","65862-0930-90","SEVELAMER CARBONATE 0.8 G PO PACK","BOTH IP/OP","$47.55 ","$35.19 ","$0.00 ","$43.12 ","","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.12 ","$0.00 ","$21.56 ","$34.15 ","$34.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99687","ERX","HCPCS 63700001","58468-0131-01","SEVELAMER CARBONATE 2.4 G PO PACK","BOTH IP/OP","$82.67 ","$61.18 ","$0.00 ","$74.96 ","","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.96 ","$0.00 ","$37.48 ","$59.37 ","$59.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99687","ERX","HCPCS 63700001","58468-0131-02","SEVELAMER CARBONATE 2.4 G PO PACK","BOTH IP/OP","$82.67 ","$61.18 ","$0.00 ","$74.96 ","","$14.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.96 ","$0.00 ","$37.48 ","$59.37 ","$59.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99744","ERX","HCPCS 25000001","58160-0818-11","HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR","BOTH IP/OP","$59.72 ","$44.19 ","$0.00 ","$50.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.29 ","$0.00 ","$25.15 ","$39.83 ","$40.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99746","ERX","HCPCS 63700001","00456-2405-60","ASENAPINE MALEATE 5 MG SL SUBL","BOTH IP/OP","$92.71 ","$68.61 ","$0.00 ","$84.06 ","","$16.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.06 ","$0.00 ","$42.03 ","$66.58 ","$67.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99765","ERX","HCPCS Q4074","66215-0303-00","ILOPROST 20 MCG/ML IN SOLN","BOTH IP/OP","$81.12 ","$60.03 ","$0.00 ","$73.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99765","ERX","HCPCS Q4074","66215-0303-30","ILOPROST 20 MCG/ML IN SOLN","BOTH IP/OP","$81.12 ","$60.03 ","$0.00 ","$73.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100004","ERX","HCPCS 63700001","16714-0866-01","PALIPERIDONE ER 1.5 MG PO TB24","BOTH IP/OP","$117.84 ","$87.20 ","$0.00 ","$106.85 ","","$20.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.85 ","$0.00 ","$53.43 ","$84.63 ","$85.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100004","ERX","HCPCS 63700001","50458-0554-01","PALIPERIDONE ER 1.5 MG PO TB24","BOTH IP/OP","$117.84 ","$87.20 ","$0.00 ","$106.85 ","","$20.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.85 ","$0.00 ","$53.43 ","$84.63 ","$85.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100055","ERX","HCPCS 25000001","00904-6422-81","PEG 3350 17 G PO PACK","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100055","ERX","HCPCS 25000001","00904-6422-86","PEG 3350 17 G PO PACK","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100055","ERX","HCPCS 25000001","00904-6931-81","PEG 3350 17 G PO PACK","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100055","ERX","HCPCS 25000001","00904-6931-86","PEG 3350 17 G PO PACK","BOTH IP/OP","$7.11 ","$5.26 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.11 ","$0.00 ","$3.56 ","$5.63 ","$5.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100212","ERX","HCPCS 25000001","24571-0105-06","PRISMASOL BGK 4/2.5 32-4-2.5 MEQ/L IV SOLN","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100215","ERX","HCPCS 25000001","24571-0103-06","PRISMASOL BGK 2/3.5 32-2-3.5 MEQ/L IV SOLN","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100258","ERX","HCPCS J9302","00078-0669-13","OFATUMUMAB 100 MG/5ML IV CONC","BOTH IP/OP","$1,875.28 ","$1,387.71 ","$0.00 ","$1,737.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,737.71 ","$0.00 ","$868.86 ","$1,376.27 ","$1,390.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100258","ERX","HCPCS J9302","00078-0669-61","OFATUMUMAB 100 MG/5ML IV CONC","BOTH IP/OP","$1,875.28 ","$1,387.71 ","$0.00 ","$1,737.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,737.71 ","$0.00 ","$868.86 ","$1,376.27 ","$1,390.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100265","ERX","HCPCS J0597","63833-0825-02","C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT","BOTH IP/OP","$4,631,757.00 ","$3,427,500.18 ","$0.00 ","$3,813,000.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,813,000.00 ","$0.00 ","$1,906,500.00 ","$3,019,896.00 ","$3,050,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100482","ERX","HCPCS 63700001","42291-0266-01","VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100482","ERX","HCPCS 63700001","64380-0737-06","VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100482","ERX","HCPCS 63700001","69452-0151-20","VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100597","ERX","HCPCS 25000001","63481-0684-47","DICLOFENAC SODIUM 1 % TD GEL","BOTH IP/OP","$172.62 ","$127.74 ","$0.00 ","$172.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.62 ","$0.00 ","$86.31 ","$136.72 ","$138.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100597","ERX","HCPCS 25000001","65162-0833-66","DICLOFENAC SODIUM 1 % TD GEL","BOTH IP/OP","$172.62 ","$127.74 ","$0.00 ","$172.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.62 ","$0.00 ","$86.31 ","$136.72 ","$138.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100597","ERX","HCPCS 25000001","76282-0663-39","DICLOFENAC SODIUM 1 % TD GEL","BOTH IP/OP","$172.62 ","$127.74 ","$0.00 ","$172.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.62 ","$0.00 ","$86.31 ","$136.72 ","$138.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101313","ERX","HCPCS 25000001","00132-0081-12","GLYCERIN (LAXATIVE) 1 G RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101316","ERX","HCPCS 63700001","99999-6012-26","VALGANCICLOVIR HCL 50 MG/ML PO SOLR","BOTH IP/OP","$343.74 ","$254.37 ","$0.00 ","$2,050.61 ","","$61.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,050.61 ","$0.00 ","$1,025.31 ","$247.13 ","$1,640.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101316","ERX","HCPCS 63700001","00591-2579-20","VALGANCICLOVIR HCL 50 MG/ML PO SOLR","BOTH IP/OP","$343.74 ","$254.37 ","$0.00 ","$2,050.61 ","","$61.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,050.61 ","$0.00 ","$1,025.31 ","$1,624.08 ","$1,640.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101316","ERX","HCPCS 63700001","27241-0159-19","VALGANCICLOVIR HCL 50 MG/ML PO SOLR","BOTH IP/OP","$343.74 ","$254.37 ","$0.00 ","$2,050.61 ","","$61.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,050.61 ","$0.00 ","$1,025.31 ","$1,624.08 ","$1,640.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101323","ERX","HCPCS J3490","55150-0166-13","SILDENAFIL CITRATE 10 MG/12.5ML IV SOLN","BOTH IP/OP","$642.40 ","$475.38 ","$0.00 ","$583.00 ","$289.08 ","$0.00 ","$133.89 ","$0.00 ","$0.00 ","$102.08 ","$583.00 ","$0.00 ","$291.50 ","$461.74 ","$466.40 ","$0.00 ","$91.24 ","$0.00 ","$92.81 ","$0.00 "
"101445","ERX","HCPCS J1742","00009-3794-01","IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","BOTH IP/OP","$1,412.69 ","$1,045.39 ","$0.00 ","$1,302.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.53 ","$0.00 ","$651.27 ","$1,031.60 ","$1,042.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101445","ERX","HCPCS J1742","00009-3794-22","IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","BOTH IP/OP","$1,412.69 ","$1,045.39 ","$0.00 ","$1,302.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.53 ","$0.00 ","$651.27 ","$1,031.60 ","$1,042.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101445","ERX","HCPCS J1742","67457-0366-10","IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","BOTH IP/OP","$1,412.69 ","$1,045.39 ","$0.00 ","$1,302.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.53 ","$0.00 ","$651.27 ","$1,031.60 ","$1,042.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101583","ERX","HCPCS 63700001","68462-0719-29","NORGESTIM-ETH ESTRAD TRIPHASIC 0.18/0.215/0.25 MG-25 MCG PO TABS","BOTH IP/OP","$541.06 ","$400.38 ","$0.00 ","$491.14 ","","$96.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$491.14 ","$0.00 ","$245.57 ","$388.98 ","$392.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101584","ERX","HCPCS 63700001","16714-0363-04","ORTHO TRI-CYCLEN,TRINESSA,0.18/0.215/0.25 MG-35 MCG PO TABS","BOTH IP/OP","$188.75 ","$139.68 ","$0.00 ","$188.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.75 ","$0.00 ","$94.38 ","$149.49 ","$151.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101700","ERX","HCPCS 63700001","00054-0407-13","RITONAVIR 100 MG PO TABS","BOTH IP/OP","$35.19 ","$26.04 ","$0.00 ","$35.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.19 ","$0.00 ","$17.60 ","$27.87 ","$28.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101700","ERX","HCPCS 63700001","00074-3333-30","RITONAVIR 100 MG PO TABS","BOTH IP/OP","$35.19 ","$26.04 ","$0.00 ","$35.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.19 ","$0.00 ","$17.60 ","$27.87 ","$28.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101700","ERX","HCPCS 63700001","31722-0597-30","RITONAVIR 100 MG PO TABS","BOTH IP/OP","$35.19 ","$26.04 ","$0.00 ","$35.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.19 ","$0.00 ","$17.60 ","$27.87 ","$28.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101700","ERX","HCPCS 63700001","65862-0687-30","RITONAVIR 100 MG PO TABS","BOTH IP/OP","$35.19 ","$26.04 ","$0.00 ","$35.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.19 ","$0.00 ","$17.60 ","$27.87 ","$28.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101739","ERX","HCPCS 90734","58160-0955-09","MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR","BOTH IP/OP","$580.85 ","$429.83 ","$0.00 ","$492.37 ","$261.38 ","$129.14 ","$9.40 ","$0.00 ","$0.00 ","$143.71 ","$492.37 ","$0.00 ","$246.19 ","$389.96 ","$393.90 ","$295.42 ","$143.71 ","$0.00 ","$136.84 ","$0.00 "
"101739","ERX","HCPCS 90734","58160-0958-01","MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR","BOTH IP/OP","$580.85 ","$429.83 ","$0.00 ","$492.37 ","$261.38 ","$129.14 ","$9.40 ","$0.00 ","$0.00 ","$143.71 ","$492.37 ","$0.00 ","$246.19 ","$389.96 ","$393.90 ","$295.42 ","$143.71 ","$0.00 ","$136.84 ","$0.00 "
"102036","ERX","HCPCS 63700001","00173-0695-04","FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN AEPB","BOTH IP/OP","$611.81 ","$452.74 ","$0.00 ","$555.36 ","","$108.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.36 ","$0.00 ","$277.68 ","$439.85 ","$444.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102037","ERX","HCPCS 25000001","00173-0696-04","FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN AEPB","BOTH IP/OP","$611.81 ","$452.74 ","$0.00 ","$555.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.36 ","$0.00 ","$277.68 ","$439.85 ","$444.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102038","ERX","HCPCS 25000001","00173-0697-00","FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB","BOTH IP/OP","$866.54 ","$641.24 ","$0.00 ","$786.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$786.41 ","$0.00 ","$393.21 ","$622.84 ","$629.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102038","ERX","HCPCS 25000001","00173-0697-04","FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB","BOTH IP/OP","$866.54 ","$641.24 ","$0.00 ","$786.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$786.41 ","$0.00 ","$393.21 ","$622.84 ","$629.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102040","ERX","HCPCS 63700001","00173-0526-00","LAMOTRIGINE 5 MG PO CHEW","BOTH IP/OP","$71.91 ","$53.21 ","$0.00 ","$58.05 ","","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.05 ","$0.00 ","$29.03 ","$45.98 ","$46.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102040","ERX","HCPCS 63700001","68462-0228-01","LAMOTRIGINE 5 MG PO CHEW","BOTH IP/OP","$71.91 ","$53.21 ","$0.00 ","$58.05 ","","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.05 ","$0.00 ","$29.03 ","$45.98 ","$46.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","00228-2996-11","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","00228-2996-50","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","00597-0058-01","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","00781-2076-01","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","00904-6401-61","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","50268-0740-11","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","50268-0740-15","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","57237-0014-01","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","63739-0567-10","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","65862-0598-01","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","65862-0598-05","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102053","ERX","HCPCS 63700001","68084-0299-01","TAMSULOSIN HCL 0.4 MG PO CAPS","BOTH IP/OP","$38.39 ","$28.41 ","$0.00 ","$38.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.39 ","$0.00 ","$19.20 ","$30.40 ","$30.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102058","ERX","HCPCS 90670","00005-1971-02","PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP","BOTH IP/OP","$792.98 ","$586.81 ","$0.00 ","$641.98 ","$356.84 ","$230.14 ","$165.28 ","$0.00 ","$0.00 ","$252.18 ","$641.98 ","$93.73 ","$320.99 ","$508.45 ","$513.58 ","$93.73 ","$252.18 ","$166.91 ","$240.12 ","$166.91 "
"102397","ERX","HCPCS 63700001","65649-0303-03","RIFAXIMIN 550 MG PO TABS","BOTH IP/OP","$206.49 ","$152.80 ","$0.00 ","$161.01 ","","$36.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.01 ","$0.00 ","$80.51 ","$127.52 ","$128.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102404","ERX","HCPCS 63700001","00173-0696-04","ADVAIR DISKUS 250-50 MCG/DOSE IN AEPB","BOTH IP/OP","$611.81 ","$452.74 ","$0.00 ","$555.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.36 ","$0.00 ","$277.68 ","$439.85 ","$444.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","00143-9595-01","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","00143-9595-25","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","00409-4279-02","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","00409-4279-16","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","00409-4713-25","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","00409-4713-42","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","55150-0161-02","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","55150-0162-05","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","63323-0492-09","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","63323-0492-27","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102415","ERX","HCPCS 25000001","63323-0492-57","LIDOCAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102416","ERX","HCPCS 25000001","00143-9594-01","LIDOCAINE HCL (PF) 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102416","ERX","HCPCS 25000001","00143-9594-25","LIDOCAINE HCL (PF) 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102416","ERX","HCPCS 25000001","55150-0165-05","LIDOCAINE HCL (PF) 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102416","ERX","HCPCS 25000001","63323-0495-07","LIDOCAINE HCL (PF) 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102429","ERX","HCPCS J0585","00023-1145-01","ONABOTULINUMTOXINA 100 UNITS IJ SOLR","BOTH IP/OP","$1,933.18 ","$1,430.55 ","$0.00 ","$1,730.88 ","$869.93 ","$618.50 ","$642.73 ","$0.00 ","$0.00 ","$719.10 ","$1,730.88 ","$642.92 ","$865.44 ","$1,370.86 ","$1,384.70 ","$887.84 ","$719.10 ","$0.00 ","$684.71 ","$609.50 "
"102430","ERX","HCPCS J3480","00264-7865-00","KCL IN NACL 20-0.9 MEQ/L-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$0.00 ","$0.00 "
"102430","ERX","HCPCS J3480","00338-0691-04","KCL IN NACL 20-0.9 MEQ/L-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.65 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.65 ","$0.00 ","$0.00 ","$0.00 "
"102431","ERX","HCPCS J3480","00338-0695-04","KCL IN NACL 40-0.9 MEQ/L-% IV SOLN","BOTH IP/OP","$50.28 ","$37.21 ","$0.00 ","$41.80 ","$22.63 ","$0.00 ","$0.47 ","$0.00 ","$0.00 ","$3.29 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"102431","ERX","HCPCS J3480","00990-7116-09","KCL IN NACL 40-0.9 MEQ/L-% IV SOLN","BOTH IP/OP","$50.28 ","$37.21 ","$0.00 ","$41.80 ","$22.63 ","$0.00 ","$0.47 ","$0.00 ","$0.00 ","$3.29 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"102452","ERX","HCPCS 25000001","00264-7652-00","KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102452","ERX","HCPCS 25000001","00338-0803-04","KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102453","ERX","HCPCS 25000001","00338-0807-04","KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102456","ERX","HCPCS 25000001","00264-7634-00","KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102456","ERX","HCPCS 25000001","00338-0669-04","KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102456","ERX","HCPCS 25000001","00409-7993-09","KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$46.09 ","$34.11 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102458","ERX","HCPCS 25000001","00338-0663-04","KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102459","ERX","HCPCS 25000001","00264-7635-00","KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102459","ERX","HCPCS 25000001","00338-0671-04","KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102464","ERX","HCPCS 25000001","00264-7638-00","KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102464","ERX","HCPCS 25000001","00338-0675-04","KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102609","ERX","HCPCS J3315","00023-5906-23","TRIPTORELIN PAMOATE 22.5 MG IM SUSR","BOTH IP/OP","$12,003.43 ","$8,882.54 ","$0.00 ","$9,602.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,506.72 ","$9,602.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103164","ERX","HCPCS 63700001","00591-3720-30","TRANEXAMIC ACID 650 MG PO TABS","BOTH IP/OP","$39.63 ","$29.33 ","$0.00 ","$39.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.63 ","$0.00 ","$19.82 ","$31.39 ","$31.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103164","ERX","HCPCS 63700001","60505-3638-03","TRANEXAMIC ACID 650 MG PO TABS","BOTH IP/OP","$39.63 ","$29.33 ","$0.00 ","$39.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.63 ","$0.00 ","$19.82 ","$31.39 ","$31.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103164","ERX","HCPCS 63700001","69918-0301-30","TRANEXAMIC ACID 650 MG PO TABS","BOTH IP/OP","$39.63 ","$29.33 ","$0.00 ","$39.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.63 ","$0.00 ","$19.82 ","$31.39 ","$31.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103332","ERX","HCPCS 25000001","54162-0185-16","MINERAL OIL LIGHT 100 % EX OIL","BOTH IP/OP","$14.35 ","$10.62 ","$0.00 ","$11.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103727","ERX","HCPCS 25000001","00143-9637-10","VALPROATE SODIUM 500 MG/5ML IV SOLN","BOTH IP/OP","$72.61 ","$53.73 ","$0.00 ","$72.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.61 ","$0.00 ","$36.31 ","$57.51 ","$58.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103727","ERX","HCPCS 25000001","00143-9785-10","VALPROATE SODIUM 500 MG/5ML IV SOLN","BOTH IP/OP","$72.61 ","$53.73 ","$0.00 ","$72.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.61 ","$0.00 ","$36.31 ","$57.51 ","$58.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103727","ERX","HCPCS 25000001","63323-0494-01","VALPROATE SODIUM 500 MG/5ML IV SOLN","BOTH IP/OP","$72.61 ","$53.73 ","$0.00 ","$72.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.61 ","$0.00 ","$36.31 ","$57.51 ","$58.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103727","ERX","HCPCS 25000001","63323-0494-05","VALPROATE SODIUM 500 MG/5ML IV SOLN","BOTH IP/OP","$72.61 ","$53.73 ","$0.00 ","$72.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.61 ","$0.00 ","$36.31 ","$57.51 ","$58.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103756","ERX","HCPCS 63700001","00078-0592-51","NILOTINIB HCL 150 MG PO CAPS","BOTH IP/OP","$566.86 ","$419.48 ","$0.00 ","$480.90 ","","$106.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$480.90 ","$0.00 ","$240.45 ","$380.87 ","$384.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104015","ERX","HCPCS J9043","00024-5824-11","CABAZITAXEL 60 MG/1.5ML IV SOLN","BOTH IP/OP","$32,884.41 ","$24,334.46 ","$0.00 ","$28,392.12 ","$15,286.32 ","$11,478.66 ","$6,853.93 ","$0.00 ","$0.00 ","$8,138.89 ","$28,392.12 ","$10,940.96 ","$14,196.06 ","$22,486.56 ","$22,713.70 ","$15,108.94 ","$8,138.89 ","$0.00 ","$8,138.89 ","$10,888.38 "
"104022","ERX","HCPCS 63700001","67618-0107-60","MAGNESIUM CHLORIDE DELAY RELEASE 71.5 MG PO TAB","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104100","ERX","HCPCS J7527","00078-0594-51","EVEROLIMUS 2.5 MG PO TABS","BOTH IP/OP","$1,666.80 ","$1,233.43 ","$0.00 ","$1,544.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.53 ","$0.00 ","$772.27 ","$1,223.27 ","$1,235.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104174","ERX","HCPCS J1650","00075-0624-30","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","00548-5601-00","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","00548-5631-00","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","00703-8530-23","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","00781-3133-63","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","00955-1003-01","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","00955-1003-10","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104174","ERX","HCPCS J1650","63323-0568-83","ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$27.23 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$4.77 ","$27.23 ","$0.00 ","$13.62 ","$21.57 ","$21.78 ","$0.00 ","$4.26 ","$0.00 ","$4.34 ","$0.00 "
"104175","ERX","HCPCS J1650","00548-5602-00","ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN","BOTH IP/OP","$42.94 ","$31.78 ","$0.00 ","$98.91 ","$19.32 ","$0.00 ","$8.95 ","$0.00 ","$0.00 ","$6.82 ","$38.94 ","$0.00 ","$19.47 ","$98.91 ","$31.15 ","$0.00 ","$19.55 ","$0.00 ","$6.20 ","$0.00 "
"104175","ERX","HCPCS J1650","00703-8540-23","ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN","BOTH IP/OP","$42.94 ","$31.78 ","$0.00 ","$98.91 ","$19.32 ","$0.00 ","$8.95 ","$0.00 ","$0.00 ","$6.82 ","$38.94 ","$0.00 ","$19.47 ","$98.91 ","$31.15 ","$0.00 ","$19.55 ","$0.00 ","$6.20 ","$0.00 "
"104175","ERX","HCPCS J1650","00781-3224-64","ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN","BOTH IP/OP","$42.94 ","$31.78 ","$0.00 ","$98.91 ","$19.32 ","$0.00 ","$8.95 ","$0.00 ","$0.00 ","$6.82 ","$38.94 ","$0.00 ","$19.47 ","$98.91 ","$31.15 ","$0.00 ","$19.55 ","$0.00 ","$6.20 ","$0.00 "
"104175","ERX","HCPCS J1650","00955-1004-01","ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN","BOTH IP/OP","$42.94 ","$31.78 ","$0.00 ","$98.91 ","$19.32 ","$0.00 ","$8.95 ","$0.00 ","$0.00 ","$6.82 ","$38.94 ","$0.00 ","$19.47 ","$98.91 ","$31.15 ","$0.00 ","$19.55 ","$0.00 ","$6.20 ","$0.00 "
"104175","ERX","HCPCS J1650","00955-1004-10","ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN","BOTH IP/OP","$42.94 ","$31.78 ","$0.00 ","$98.91 ","$19.32 ","$0.00 ","$8.95 ","$0.00 ","$0.00 ","$6.82 ","$38.94 ","$0.00 ","$19.47 ","$98.91 ","$31.15 ","$0.00 ","$19.55 ","$0.00 ","$6.20 ","$0.00 "
"104176","ERX","HCPCS J1650","00548-5603-00","ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN","BOTH IP/OP","$22.88 ","$16.93 ","$0.00 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.01 ","$22.88 ","$0.00 ","$11.44 ","$18.12 ","$18.30 ","$0.00 ","$3.58 ","$0.00 ","$0.00 ","$0.00 "
"104176","ERX","HCPCS J1650","00781-3356-66","ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN","BOTH IP/OP","$22.88 ","$16.93 ","$0.00 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.01 ","$22.88 ","$0.00 ","$11.44 ","$18.12 ","$18.30 ","$0.00 ","$3.58 ","$0.00 ","$0.00 ","$0.00 "
"104176","ERX","HCPCS J1650","00955-1006-01","ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN","BOTH IP/OP","$22.88 ","$16.93 ","$0.00 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.01 ","$22.88 ","$0.00 ","$11.44 ","$18.12 ","$18.30 ","$0.00 ","$3.58 ","$0.00 ","$0.00 ","$0.00 "
"104176","ERX","HCPCS J1650","00955-1006-10","ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN","BOTH IP/OP","$22.88 ","$16.93 ","$0.00 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.01 ","$22.88 ","$0.00 ","$11.44 ","$18.12 ","$18.30 ","$0.00 ","$3.58 ","$0.00 ","$0.00 ","$0.00 "
"104176","ERX","HCPCS J1650","63323-0607-88","ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN","BOTH IP/OP","$22.88 ","$16.93 ","$0.00 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.01 ","$22.88 ","$0.00 ","$11.44 ","$18.12 ","$18.30 ","$0.00 ","$3.58 ","$0.00 ","$0.00 ","$0.00 "
"104177","ERX","HCPCS J1650","00548-5604-00","ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.93 ","$0.00 ","$0.00 ","$0.00 "
"104177","ERX","HCPCS J1650","00781-3428-68","ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.93 ","$0.00 ","$0.00 ","$0.00 "
"104177","ERX","HCPCS J1650","00955-1008-01","ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.93 ","$0.00 ","$0.00 ","$0.00 "
"104177","ERX","HCPCS J1650","00955-1008-10","ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.93 ","$0.00 ","$0.00 ","$0.00 "
"104177","ERX","HCPCS J1650","63323-0531-90","ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.93 ","$0.00 ","$0.00 ","$0.00 "
"104178","ERX","HCPCS J1650","00955-1010-10","ENOXAPARIN SODIUM 100 MG/ML SC SOLN","BOTH IP/OP","$75.15 ","$55.61 ","$0.00 ","$75.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.16 ","$75.15 ","$0.00 ","$37.58 ","$59.52 ","$60.12 ","$0.00 ","$11.76 ","$0.00 ","$0.00 ","$0.00 "
"104178","ERX","HCPCS J1650","63323-0605-84","ENOXAPARIN SODIUM 100 MG/ML SC SOLN","BOTH IP/OP","$75.15 ","$55.61 ","$0.00 ","$75.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.16 ","$75.15 ","$0.00 ","$37.58 ","$59.52 ","$60.12 ","$0.00 ","$11.76 ","$0.00 ","$0.00 ","$0.00 "
"104179","ERX","HCPCS J1650","00548-5606-00","ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN","BOTH IP/OP","$100.17 ","$74.13 ","$0.00 ","$100.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.54 ","$100.17 ","$0.00 ","$50.09 ","$79.33 ","$80.14 ","$0.00 ","$15.68 ","$0.00 ","$0.00 ","$0.00 "
"104179","ERX","HCPCS J1650","00781-3612-68","ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN","BOTH IP/OP","$100.17 ","$74.13 ","$0.00 ","$100.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.54 ","$100.17 ","$0.00 ","$50.09 ","$79.33 ","$80.14 ","$0.00 ","$15.68 ","$0.00 ","$0.00 ","$0.00 "
"104179","ERX","HCPCS J1650","00955-1012-10","ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN","BOTH IP/OP","$100.17 ","$74.13 ","$0.00 ","$100.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.54 ","$100.17 ","$0.00 ","$50.09 ","$79.33 ","$80.14 ","$0.00 ","$15.68 ","$0.00 ","$0.00 ","$0.00 "
"104179","ERX","HCPCS J1650","16714-0056-01","ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN","BOTH IP/OP","$100.17 ","$74.13 ","$0.00 ","$100.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.54 ","$100.17 ","$0.00 ","$50.09 ","$79.33 ","$80.14 ","$0.00 ","$15.68 ","$0.00 ","$0.00 ","$0.00 "
"104179","ERX","HCPCS J1650","63323-0609-90","ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN","BOTH IP/OP","$100.17 ","$74.13 ","$0.00 ","$100.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.54 ","$100.17 ","$0.00 ","$50.09 ","$79.33 ","$80.14 ","$0.00 ","$15.68 ","$0.00 ","$0.00 ","$0.00 "
"104407","ERX","HCPCS J0588","00259-1610-01","INCOBOTULINUMTOXINA 100 UNITS IM SOLR","BOTH IP/OP","$1,498.06 ","$1,108.56 ","$0.00 ","$1,388.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,388.16 ","$0.00 ","$694.08 ","$1,099.42 ","$1,110.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104804","ERX","HCPCS 63700001","00023-3205-03","BIMATOPROST 0.01 % OP SOLN","BOTH IP/OP","$760.93 ","$563.09 ","$0.00 ","$657.68 ","","$142.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$657.68 ","$0.00 ","$328.84 ","$520.88 ","$526.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104817","ERX","HCPCS 25000001","00310-6512-01","EXENATIDE 5 MCG/0.02ML SC SOPN","BOTH IP/OP","$57.12 ","$42.27 ","$0.00 ","$57.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.12 ","$0.00 ","$28.56 ","$45.24 ","$45.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104818","ERX","HCPCS 25000001","00310-6524-01","EXENATIDE 10 MCG/0.04ML SC SOPN","BOTH IP/OP","$57.12 ","$42.27 ","$0.00 ","$57.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.12 ","$0.00 ","$28.56 ","$45.24 ","$45.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","00409-1746-10","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","00409-1746-30","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","00409-1746-71","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","00409-9042-01","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","00409-9042-17","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","63323-0468-01","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","63323-0468-02","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","63323-0468-17","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104822","ERX","HCPCS 25000001","63323-0468-37","BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","00409-9045-01","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","00409-9045-17","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","31382-0557-05","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","63323-0462-01","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","63323-0462-17","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","63323-0462-31","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104823","ERX","HCPCS 25000001","63323-0462-37","BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104825","ERX","HCPCS J0670","00409-1036-30","MEPIVACAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104825","ERX","HCPCS J0670","63323-0260-37","MEPIVACAINE HCL (PF) 1 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104826","ERX","HCPCS J0670","00409-1067-20","MEPIVACAINE HCL (PF) 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104826","ERX","HCPCS J0670","63323-0294-27","MEPIVACAINE HCL (PF) 2 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.27 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","00409-1159-02","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","00409-1559-10","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","00409-1559-30","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","55150-0167-10","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","55150-0168-30","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","63323-0464-01","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","63323-0464-17","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","63323-0464-31","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104827","ERX","HCPCS 25000001","63323-0464-37","BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","00409-1162-01","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","00409-1162-02","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","00409-1162-09","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","00409-1162-10","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","55150-0169-10","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","55150-0170-30","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","63323-0466-17","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104828","ERX","HCPCS 25000001","63323-0466-37","BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104858","ERX","HCPCS 25000001","12496-1202-01","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$22.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.85 ","$0.00 ","$11.43 ","$18.10 ","$18.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104858","ERX","HCPCS 25000001","12496-1202-03","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$22.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.85 ","$0.00 ","$11.43 ","$18.10 ","$18.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104859","ERX","HCPCS 25000001","12496-1208-01","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM","BOTH IP/OP","$45.16 ","$33.42 ","$0.00 ","$40.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.95 ","$0.00 ","$20.48 ","$32.43 ","$32.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104859","ERX","HCPCS 25000001","12496-1208-03","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM","BOTH IP/OP","$45.16 ","$33.42 ","$0.00 ","$40.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.95 ","$0.00 ","$20.48 ","$32.43 ","$32.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104955","ERX","HCPCS J0257","00944-2884-01","ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN","BOTH IP/OP","$1,813.00 ","$1,341.62 ","$0.00 ","$1,632.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,632.00 ","$0.00 ","$816.00 ","$1,292.54 ","$1,305.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104955","ERX","HCPCS J0257","00944-2884-02","ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN","BOTH IP/OP","$1,813.00 ","$1,341.62 ","$0.00 ","$1,632.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,632.00 ","$0.00 ","$816.00 ","$1,292.54 ","$1,305.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105032","ERX","HCPCS 25000001","00409-4278-01","LIDOCAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105032","ERX","HCPCS 25000001","63323-0491-57","LIDOCAINE HCL (PF) 0.5 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105342","ERX","HCPCS 63700001","00597-0360-82","DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS","BOTH IP/OP","$39.97 ","$29.58 ","$0.00 ","$34.86 ","","$7.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.86 ","$0.00 ","$17.43 ","$27.61 ","$27.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105514","ERX","HCPCS 63700001","00597-0355-09","DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS","BOTH IP/OP","$30.45 ","$22.53 ","$0.00 ","$30.45 ","","$7.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.45 ","$0.00 ","$15.23 ","$24.12 ","$24.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105737","ERX","HCPCS J9179","62856-0389-01","ERIBULIN MESYLATE 1 MG/2ML IV SOLN","BOTH IP/OP","$3,384.58 ","$2,504.59 ","$0.00 ","$2,902.80 ","$1,554.79 ","$1,274.36 ","$705.43 ","$0.00 ","$0.00 ","$1,365.82 ","$2,902.80 ","$1,199.88 ","$1,451.40 ","$2,299.02 ","$2,322.24 ","$1,656.97 ","$0.00 ","$0.00 ","$1,300.49 ","$1,174.22 "
"105747","ERX","HCPCS J1453","00006-3061-00","FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","BOTH IP/OP","$1,054.12 ","$780.05 ","$0.00 ","$956.65 ","$474.35 ","$0.00 ","$219.70 ","$0.00 ","$0.00 ","$348.98 ","$956.65 ","$310.12 ","$478.33 ","$757.67 ","$765.32 ","$428.26 ","$348.98 ","$0.00 ","$332.28 ","$161.25 "
"105747","ERX","HCPCS J1453","00006-3061-04","FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","BOTH IP/OP","$1,054.12 ","$780.05 ","$0.00 ","$956.65 ","$474.35 ","$0.00 ","$219.70 ","$0.00 ","$0.00 ","$348.98 ","$956.65 ","$310.12 ","$478.33 ","$757.67 ","$765.32 ","$428.26 ","$348.98 ","$0.00 ","$332.28 ","$161.25 "
"105747","ERX","HCPCS J1453","60505-6105-01","FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","BOTH IP/OP","$1,054.12 ","$780.05 ","$0.00 ","$956.65 ","$474.35 ","$0.00 ","$219.70 ","$0.00 ","$0.00 ","$348.98 ","$956.65 ","$310.12 ","$478.33 ","$757.67 ","$765.32 ","$428.26 ","$348.98 ","$0.00 ","$332.28 ","$161.25 "
"105747","ERX","HCPCS J1453","67457-0889-10","FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","BOTH IP/OP","$1,054.12 ","$780.05 ","$0.00 ","$956.65 ","$474.35 ","$0.00 ","$219.70 ","$0.00 ","$0.00 ","$348.98 ","$956.65 ","$310.12 ","$478.33 ","$757.67 ","$765.32 ","$428.26 ","$348.98 ","$0.00 ","$332.28 ","$161.25 "
"105747","ERX","HCPCS J1453","71288-0418-10","FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","BOTH IP/OP","$1,054.12 ","$780.05 ","$0.00 ","$956.65 ","$474.35 ","$0.00 ","$219.70 ","$0.00 ","$0.00 ","$348.98 ","$956.65 ","$310.12 ","$478.33 ","$757.67 ","$765.32 ","$428.26 ","$348.98 ","$0.00 ","$332.28 ","$161.25 "
"105747","ERX","HCPCS J1453","71839-0104-01","FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","BOTH IP/OP","$1,054.12 ","$780.05 ","$0.00 ","$956.65 ","$474.35 ","$0.00 ","$219.70 ","$0.00 ","$0.00 ","$348.98 ","$956.65 ","$310.12 ","$478.33 ","$757.67 ","$765.32 ","$428.26 ","$348.98 ","$0.00 ","$332.28 ","$161.25 "
"105768","ERX","HCPCS J0897","55513-0730-01","DENOSUMAB 120 MG/1.7ML SC SOLN","BOTH IP/OP","$6,755.71 ","$4,999.23 ","$0.00 ","$5,786.54 ","$3,219.43 ","$2,544.60 ","$1,408.06 ","$0.00 ","$0.00 ","$2,718.48 ","$5,786.54 ","$2,428.78 ","$2,893.27 ","$4,582.94 ","$4,629.23 ","$3,354.02 ","$2,718.48 ","$0.00 ","$2,588.46 ","$2,388.12 "
"106031","ERX","HCPCS 25000001","63402-0304-30","LURASIDONE HCL 40 MG PO TABS","BOTH IP/OP","$196.92 ","$145.72 ","$0.00 ","$161.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.71 ","$0.00 ","$80.86 ","$128.07 ","$129.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106032","ERX","HCPCS 25000001","63402-0308-10","LURASIDONE HCL 80 MG PO TABS","BOTH IP/OP","$186.89 ","$138.30 ","$0.00 ","$161.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.71 ","$0.00 ","$80.86 ","$128.07 ","$129.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106032","ERX","HCPCS 25000001","63402-0308-30","LURASIDONE HCL 80 MG PO TABS","BOTH IP/OP","$186.89 ","$138.30 ","$0.00 ","$161.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.71 ","$0.00 ","$80.86 ","$128.07 ","$129.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106033","ERX","HCPCS J0712","00456-0400-01","CEFTAROLINE FOSAMIL 400 MG IV SOLR","BOTH IP/OP","$742.20 ","$549.23 ","$0.00 ","$641.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.50 ","$0.00 ","$320.75 ","$508.07 ","$513.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106033","ERX","HCPCS J0712","00456-0400-10","CEFTAROLINE FOSAMIL 400 MG IV SOLR","BOTH IP/OP","$742.20 ","$549.23 ","$0.00 ","$641.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.50 ","$0.00 ","$320.75 ","$508.07 ","$513.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106034","ERX","HCPCS J0712","00456-0600-01","CEFTAROLINE FOSAMIL 600 MG IV SOLR","BOTH IP/OP","$742.20 ","$549.23 ","$0.00 ","$641.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.50 ","$0.00 ","$320.75 ","$508.07 ","$513.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106034","ERX","HCPCS J0712","00456-0600-10","CEFTAROLINE FOSAMIL 600 MG IV SOLR","BOTH IP/OP","$742.20 ","$549.23 ","$0.00 ","$641.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.50 ","$0.00 ","$320.75 ","$508.07 ","$513.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106035","ERX","HCPCS 25000001","64597-0301-60","DEXTROMETHORPHAN-QUINIDINE 20-10 MG PO CAPS","BOTH IP/OP","$110.01 ","$81.41 ","$0.00 ","$87.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.53 ","$0.00 ","$43.77 ","$69.32 ","$70.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106115","ERX","HCPCS J1561","13533-0800-20","IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN","BOTH IP/OP","$2,022.02 ","$1,496.29 ","$0.00 ","$1,759.44 ","$909.91 ","$465.09 ","$421.44 ","$0.00 ","$0.00 ","$474.11 ","$1,759.44 ","$410.97 ","$879.72 ","$1,359.45 ","$1,407.55 ","$567.53 ","$474.11 ","$0.00 ","$451.44 ","$416.91 "
"106116","ERX","HCPCS J1561","13533-0800-71","IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN","BOTH IP/OP","$3,528.77 ","$2,611.29 ","$0.00 ","$3,005.71 ","$1,587.95 ","$930.18 ","$735.48 ","$0.00 ","$0.00 ","$948.23 ","$3,005.71 ","$821.94 ","$1,502.86 ","$2,322.56 ","$2,404.57 ","$1,135.06 ","$948.23 ","$0.00 ","$902.87 ","$833.82 "
"106117","ERX","HCPCS J1561","13533-0800-24","IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN","BOTH IP/OP","$7,057.53 ","$5,222.57 ","$0.00 ","$6,011.42 ","$3,175.89 ","$1,860.36 ","$1,470.97 ","$0.00 ","$0.00 ","$1,896.45 ","$6,011.42 ","$1,643.88 ","$3,005.71 ","$4,645.12 ","$4,809.14 ","$2,270.12 ","$1,896.45 ","$0.00 ","$1,805.74 ","$1,667.64 "
"106117","ERX","HCPCS J1561","13533-0800-25","IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN","BOTH IP/OP","$7,057.53 ","$5,222.57 ","$0.00 ","$6,011.42 ","$3,175.89 ","$1,860.36 ","$1,470.97 ","$0.00 ","$0.00 ","$1,896.45 ","$6,011.42 ","$1,643.88 ","$3,005.71 ","$4,645.12 ","$4,809.14 ","$2,270.12 ","$1,896.45 ","$0.00 ","$1,805.74 ","$1,667.64 "
"106201","ERX","HCPCS 63700001","00121-4675-00","VALPROIC ACID 250 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106201","ERX","HCPCS 63700001","00121-4675-05","VALPROIC ACID 250 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106201","ERX","HCPCS 63700001","00121-4675-40","VALPROIC ACID 250 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106201","ERX","HCPCS 63700001","50383-0792-07","VALPROIC ACID 250 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106201","ERX","HCPCS 63700001","68094-0193-61","VALPROIC ACID 250 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106201","ERX","HCPCS 63700001","68094-0193-62","VALPROIC ACID 250 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106621","ERX","HCPCS 63700001","00003-0857-22","DASATINIB 140 MG PO TABS","BOTH IP/OP","$1,570.67 ","$1,162.30 ","$0.00 ","$1,392.77 ","","$292.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.77 ","$0.00 ","$696.39 ","$1,103.07 ","$1,114.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106632","ERX","HCPCS 63700001","59676-0571-01","ETRAVIRINE 200 MG PO TABS","BOTH IP/OP","$108.97 ","$80.64 ","$0.00 ","$96.87 ","","$19.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.87 ","$0.00 ","$48.44 ","$76.72 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106862","ERX","HCPCS J9351","00409-0302-01","TOPOTECAN HCL 4 MG/4ML IV SOLN","BOTH IP/OP","$558.64 ","$413.39 ","$0.00 ","$499.59 ","$251.39 ","$0.00 ","$116.43 ","$0.00 ","$0.00 ","$46.06 ","$499.59 ","$0.00 ","$249.80 ","$395.68 ","$399.67 ","$0.00 ","$46.06 ","$0.00 ","$43.86 ","$0.00 "
"106862","ERX","HCPCS J9351","67457-0662-05","TOPOTECAN HCL 4 MG/4ML IV SOLN","BOTH IP/OP","$558.64 ","$413.39 ","$0.00 ","$499.59 ","$251.39 ","$0.00 ","$116.43 ","$0.00 ","$0.00 ","$46.06 ","$499.59 ","$0.00 ","$249.80 ","$395.68 ","$399.67 ","$0.00 ","$46.06 ","$0.00 ","$43.86 ","$0.00 "
"107058","ERX","HCPCS J1652","55111-0679-10","FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN","BOTH IP/OP","$432.13 ","$319.78 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107058","ERX","HCPCS J1652","55111-0679-11","FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN","BOTH IP/OP","$432.13 ","$319.78 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107059","ERX","HCPCS J1652","55111-0680-02","FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107059","ERX","HCPCS J1652","55111-0680-10","FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107059","ERX","HCPCS J1652","55150-0232-00","FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107059","ERX","HCPCS J1652","55150-0232-10","FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107059","ERX","HCPCS J1652","67457-0584-00","FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$310.68 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107060","ERX","HCPCS J1652","55111-0681-02","FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$379.38 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107060","ERX","HCPCS J1652","55111-0681-10","FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$379.38 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107060","ERX","HCPCS J1652","55111-0681-11","FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN","BOTH IP/OP","$456.29 ","$337.65 ","$0.00 ","$392.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.27 ","$0.00 ","$196.14 ","$379.38 ","$313.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107068","ERX","HCPCS 25000001","00051-8450-30","TESTOSTERONE 50 MG/5GM (1%) TD GEL","BOTH IP/OP","$98.88 ","$73.17 ","$0.00 ","$89.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.66 ","$0.00 ","$44.83 ","$71.01 ","$71.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107078","ERX","HCPCS J0561","60793-0701-10","PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSP","BOTH IP/OP","$381.78 ","$282.52 ","$0.00 ","$315.05 ","$171.80 ","$90.26 ","$79.57 ","$0.00 ","$0.00 ","$97.01 ","$315.05 ","$87.07 ","$157.53 ","$249.52 ","$252.04 ","$120.23 ","$97.01 ","$0.00 ","$92.37 ","$82.92 "
"107084","ERX","HCPCS J9303","55513-0954-01","PANITUMUMAB 100 MG/5ML IV SOLN","BOTH IP/OP","$3,684.78 ","$2,726.74 ","$0.00 ","$3,156.16 ","$1,755.98 ","$1,304.07 ","$768.00 ","$0.00 ","$0.00 ","$1,392.61 ","$3,156.16 ","$1,250.25 ","$1,578.08 ","$2,499.68 ","$2,524.93 ","$1,726.53 ","$1,392.61 ","$0.00 ","$1,326.00 ","$1,228.01 "
"107086","ERX","HCPCS J9303","55513-0956-01","PANITUMUMAB 400 MG/20ML IV SOLN","BOTH IP/OP","$14,739.05 ","$10,906.90 ","$0.00 ","$12,624.64 ","$7,023.89 ","$5,216.28 ","$3,071.99 ","$0.00 ","$0.00 ","$5,570.44 ","$12,624.64 ","$5,000.98 ","$6,312.32 ","$9,998.71 ","$10,099.71 ","$6,906.12 ","$5,570.44 ","$0.00 ","$5,304.01 ","$4,912.04 "
"107089","ERX","HCPCS 90378","60574-4114-01","PALIVIZUMAB 50 MG/0.5ML IM SOLN","BOTH IP/OP","$4,415.91 ","$3,267.77 ","$0.00 ","$3,870.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,870.12 ","$0.00 ","$1,935.06 ","$3,065.14 ","$3,096.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107090","ERX","HCPCS J3262","50242-0135-01","TOCILIZUMAB 80 MG/4ML IV SOLN","BOTH IP/OP","$1,433.29 ","$1,060.63 ","$0.00 ","$1,328.15 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,328.15 ","$0.00 ","$664.08 ","$1,051.89 ","$1,062.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107091","ERX","HCPCS J3262","50242-0136-01","TOCILIZUMAB 200 MG/10ML IV SOLN","BOTH IP/OP","$3,126.67 ","$2,313.74 ","$0.00 ","$2,836.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,836.14 ","$0.00 ","$1,418.07 ","$2,246.22 ","$2,268.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107092","ERX","HCPCS J3262","50242-0137-01","TOCILIZUMAB 400 MG/20ML IV SOLN","BOTH IP/OP","$6,253.33 ","$4,627.46 ","$0.00 ","$5,672.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,672.27 ","$0.00 ","$2,836.14 ","$4,492.44 ","$4,537.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107094","ERX","HCPCS J9035","50242-0060-01","BEVACIZUMAB 100 MG/4ML IV SOLN","BOTH IP/OP","$2,476.90 ","$1,832.91 ","$0.00 ","$2,295.20 ","$1,114.61 ","$678.61 ","$674.22 ","$0.00 ","$0.00 ","$947.52 ","$2,295.20 ","$852.41 ","$1,147.60 ","$1,817.80 ","$1,836.16 ","$1,177.14 ","$947.52 ","$0.00 ","$902.20 ","$783.99 "
"107095","ERX","HCPCS J9035","50242-0061-01","BEVACIZUMAB 400 MG/16ML IV SOLN","BOTH IP/OP","$8,645.21 ","$6,397.46 ","$0.00 ","$7,841.89 ","$3,890.34 ","$2,714.44 ","$2,696.86 ","$0.00 ","$0.00 ","$3,790.08 ","$7,841.89 ","$3,409.64 ","$3,920.95 ","$6,210.78 ","$6,273.51 ","$4,708.56 ","$3,790.08 ","$0.00 ","$3,608.80 ","$3,135.96 "
"107101","ERX","HCPCS J9055","66733-0958-23","CETUXIMAB 200 MG/100ML IV SOLN","BOTH IP/OP","$3,761.10 ","$2,783.21 ","$0.00 ","$3,279.18 ","$1,743.24 ","$1,352.36 ","$1,168.89 ","$0.00 ","$0.00 ","$1,485.44 ","$3,279.18 ","$1,303.01 ","$1,639.59 ","$2,597.11 ","$2,623.34 ","$1,799.39 ","$1,485.44 ","$0.00 ","$1,414.39 ","$1,294.26 "
"107125","ERX","HCPCS J9395","00310-0720-10","FULVESTRANT 250 MG/5ML IM SOLN","BOTH IP/OP","$2,465.04 ","$1,824.13 ","$0.00 ","$2,235.99 ","$1,109.27 ","$156.46 ","$956.22 ","$0.00 ","$0.00 ","$998.28 ","$2,235.99 ","$996.18 ","$1,118.00 ","$1,888.95 ","$1,788.79 ","$1,375.67 ","$998.28 ","$0.00 ","$950.53 ","$494.81 "
"107125","ERX","HCPCS J9395","00310-7720-10","FULVESTRANT 250 MG/5ML IM SOLN","BOTH IP/OP","$2,465.04 ","$1,824.13 ","$0.00 ","$2,235.99 ","$1,109.27 ","$156.46 ","$956.22 ","$0.00 ","$0.00 ","$998.28 ","$2,235.99 ","$996.18 ","$1,118.00 ","$1,888.95 ","$1,788.79 ","$1,375.67 ","$998.28 ","$0.00 ","$950.53 ","$494.81 "
"107125","ERX","HCPCS J9395","00781-3079-12","FULVESTRANT 250 MG/5ML IM SOLN","BOTH IP/OP","$2,465.04 ","$1,824.13 ","$0.00 ","$2,235.99 ","$1,109.27 ","$156.46 ","$956.22 ","$0.00 ","$0.00 ","$998.28 ","$2,235.99 ","$996.18 ","$1,118.00 ","$1,888.95 ","$1,788.79 ","$1,375.67 ","$998.28 ","$0.00 ","$950.53 ","$494.81 "
"107125","ERX","HCPCS J9395","25021-0462-74","FULVESTRANT 250 MG/5ML IM SOLN","BOTH IP/OP","$2,465.04 ","$1,824.13 ","$0.00 ","$2,235.99 ","$1,109.27 ","$156.46 ","$956.22 ","$0.00 ","$0.00 ","$998.28 ","$2,235.99 ","$996.18 ","$1,118.00 ","$1,888.95 ","$1,788.79 ","$1,375.67 ","$998.28 ","$0.00 ","$950.53 ","$494.81 "
"107125","ERX","HCPCS J9395","67457-0311-05","FULVESTRANT 250 MG/5ML IM SOLN","BOTH IP/OP","$2,465.04 ","$1,824.13 ","$0.00 ","$2,235.99 ","$1,109.27 ","$156.46 ","$956.22 ","$0.00 ","$0.00 ","$998.28 ","$2,235.99 ","$996.18 ","$1,118.00 ","$1,888.95 ","$1,788.79 ","$1,375.67 ","$998.28 ","$0.00 ","$950.53 ","$494.81 "
"107142","ERX","HCPCS 90744","00006-4093-02","HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP","BOTH IP/OP","$118.01 ","$87.33 ","$0.00 ","$100.07 ","$53.10 ","$28.21 ","$24.60 ","$0.00 ","$0.00 ","$17.52 ","$100.07 ","$0.00 ","$50.04 ","$79.26 ","$80.06 ","$60.04 ","$15.66 ","$27.03 ","$0.00 ","$27.03 "
"107142","ERX","HCPCS 90744","00006-4981-00","HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP","BOTH IP/OP","$118.01 ","$87.33 ","$0.00 ","$100.07 ","$53.10 ","$28.21 ","$24.60 ","$0.00 ","$0.00 ","$17.52 ","$100.07 ","$0.00 ","$50.04 ","$79.26 ","$80.06 ","$60.04 ","$15.66 ","$27.03 ","$0.00 ","$27.03 "
"107142","ERX","HCPCS 90744","00006-4981-01","HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP","BOTH IP/OP","$118.01 ","$87.33 ","$0.00 ","$100.07 ","$53.10 ","$28.21 ","$24.60 ","$0.00 ","$0.00 ","$17.52 ","$100.07 ","$0.00 ","$50.04 ","$79.26 ","$80.06 ","$60.04 ","$15.66 ","$27.03 ","$0.00 ","$27.03 "
"107147","ERX","HCPCS J1956","00143-9722-01","LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$6.29 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"107147","ERX","HCPCS J1956","00143-9722-24","LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$6.29 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"107147","ERX","HCPCS J1956","36000-0046-24","LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","$13.58 ","$0.00 ","$6.29 ","$0.00 ","$0.00 ","$4.79 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$4.28 ","$0.00 ","$4.36 ","$0.00 "
"107148","ERX","HCPCS J1956","00143-9721-01","LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","BOTH IP/OP","$30.59 ","$22.64 ","$0.00 ","$27.74 ","$13.77 ","$0.00 ","$6.38 ","$0.00 ","$0.00 ","$4.86 ","$27.74 ","$0.00 ","$13.87 ","$21.97 ","$22.19 ","$0.00 ","$4.34 ","$0.00 ","$4.42 ","$0.00 "
"107148","ERX","HCPCS J1956","00143-9721-24","LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","BOTH IP/OP","$30.59 ","$22.64 ","$0.00 ","$27.74 ","$13.77 ","$0.00 ","$6.38 ","$0.00 ","$0.00 ","$4.86 ","$27.74 ","$0.00 ","$13.87 ","$21.97 ","$22.19 ","$0.00 ","$4.34 ","$0.00 ","$4.42 ","$0.00 "
"107148","ERX","HCPCS J1956","36000-0047-24","LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","BOTH IP/OP","$30.59 ","$22.64 ","$0.00 ","$27.74 ","$13.77 ","$0.00 ","$6.38 ","$0.00 ","$0.00 ","$4.86 ","$27.74 ","$0.00 ","$13.87 ","$21.97 ","$22.19 ","$0.00 ","$4.34 ","$0.00 ","$4.42 ","$0.00 "
"107149","ERX","HCPCS J1956","00143-9720-24","LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","BOTH IP/OP","$55.31 ","$40.93 ","$0.00 ","$50.16 ","$24.89 ","$0.00 ","$11.53 ","$0.00 ","$0.00 ","$8.78 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$7.85 ","$0.00 ","$7.99 ","$0.00 "
"107149","ERX","HCPCS J1956","25021-0132-83","LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","BOTH IP/OP","$55.31 ","$40.93 ","$0.00 ","$50.16 ","$24.89 ","$0.00 ","$11.53 ","$0.00 ","$0.00 ","$8.78 ","$50.16 ","$0.00 ","$25.08 ","$39.73 ","$40.13 ","$0.00 ","$7.85 ","$0.00 ","$7.99 ","$0.00 "
"107150","ERX","HCPCS J2543","00206-8862-02","PIPERACILLIN-TAZOBACTAM IN DEX 4-0.5 GM/100ML IV SOLN FROZEN","BOTH IP/OP","$117.73 ","$87.12 ","$0.00 ","$105.00 ","$52.98 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"107151","ERX","HCPCS J9171","00955-1021-04","DOCETAXEL 80 MG/4ML IV CONC","BOTH IP/OP","$2,486.40 ","$1,839.94 ","$0.00 ","$2,304.00 ","$1,118.88 ","$0.00 ","$518.23 ","$0.00 ","$0.00 ","$91.18 ","$2,304.00 ","$72.66 ","$1,152.00 ","$992.22 ","$1,843.20 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107151","ERX","HCPCS J9171","16729-0267-64","DOCETAXEL 80 MG/4ML IV CONC","BOTH IP/OP","$2,486.40 ","$1,839.94 ","$0.00 ","$2,304.00 ","$1,118.88 ","$0.00 ","$518.23 ","$0.00 ","$0.00 ","$91.18 ","$2,304.00 ","$72.66 ","$1,152.00 ","$992.22 ","$1,843.20 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107151","ERX","HCPCS J9171","43598-0259-40","DOCETAXEL 80 MG/4ML IV CONC","BOTH IP/OP","$2,486.40 ","$1,839.94 ","$0.00 ","$2,304.00 ","$1,118.88 ","$0.00 ","$518.23 ","$0.00 ","$0.00 ","$91.18 ","$2,304.00 ","$72.66 ","$1,152.00 ","$992.22 ","$1,843.20 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107151","ERX","HCPCS J9171","45963-0765-52","DOCETAXEL 80 MG/4ML IV CONC","BOTH IP/OP","$2,486.40 ","$1,839.94 ","$0.00 ","$2,304.00 ","$1,118.88 ","$0.00 ","$518.23 ","$0.00 ","$0.00 ","$91.18 ","$2,304.00 ","$72.66 ","$1,152.00 ","$992.22 ","$1,843.20 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107156","ERX","HCPCS 90713","49281-0860-10","POLIOVIRUS VACCINE INACTIVATED IJ INJ","BOTH IP/OP","$178.89 ","$132.38 ","$0.00 ","$147.17 ","$80.50 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$0.00 ","$147.17 ","$0.00 ","$73.59 ","$116.56 ","$117.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107157","ERX","HCPCS J0744","00409-4777-23","CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"107158","ERX","HCPCS J0278","00641-6167-10","AMIKACIN SULFATE 500 MG/2ML IJ SOLN","BOTH IP/OP","$61.62 ","$45.60 ","$0.00 ","$27.73 ","$27.73 ","$0.00 ","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107158","ERX","HCPCS J0278","00703-9032-01","AMIKACIN SULFATE 500 MG/2ML IJ SOLN","BOTH IP/OP","$61.62 ","$45.60 ","$0.00 ","$27.73 ","$27.73 ","$0.00 ","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107158","ERX","HCPCS J0278","00703-9032-03","AMIKACIN SULFATE 500 MG/2ML IJ SOLN","BOTH IP/OP","$61.62 ","$45.60 ","$0.00 ","$27.73 ","$27.73 ","$0.00 ","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107158","ERX","HCPCS J0278","23155-0290-41","AMIKACIN SULFATE 500 MG/2ML IJ SOLN","BOTH IP/OP","$61.62 ","$45.60 ","$0.00 ","$27.73 ","$27.73 ","$0.00 ","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107158","ERX","HCPCS J0278","25021-0173-02","AMIKACIN SULFATE 500 MG/2ML IJ SOLN","BOTH IP/OP","$61.62 ","$45.60 ","$0.00 ","$27.73 ","$27.73 ","$0.00 ","$3.11 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107159","ERX","HCPCS J0278","00703-9040-01","AMIKACIN SULFATE 1 GM/4ML IJ SOLN","BOTH IP/OP","$33.29 ","$24.63 ","$0.00 ","$33.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.29 ","$0.00 ","$16.65 ","$26.37 ","$26.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107159","ERX","HCPCS J0278","00703-9040-03","AMIKACIN SULFATE 1 GM/4ML IJ SOLN","BOTH IP/OP","$33.29 ","$24.63 ","$0.00 ","$33.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.29 ","$0.00 ","$16.65 ","$26.37 ","$26.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107159","ERX","HCPCS J0278","23155-0290-42","AMIKACIN SULFATE 1 GM/4ML IJ SOLN","BOTH IP/OP","$33.29 ","$24.63 ","$0.00 ","$33.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.29 ","$0.00 ","$16.65 ","$26.37 ","$26.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107159","ERX","HCPCS J0278","63323-0815-04","AMIKACIN SULFATE 1 GM/4ML IJ SOLN","BOTH IP/OP","$33.29 ","$24.63 ","$0.00 ","$33.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.29 ","$0.00 ","$16.65 ","$26.37 ","$26.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107160","ERX","HCPCS 25000001","63323-0282-60","CLINDAMYCIN PHOSPHATE 9 GM/60ML IJ SOLN","BOTH IP/OP","$108.63 ","$80.39 ","$0.00 ","$98.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.49 ","$0.00 ","$49.25 ","$78.00 ","$78.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107378","ERX","HCPCS J0490","49401-0101-01","BELIMUMAB 120 MG IV SOLR","BOTH IP/OP","$1,778.45 ","$1,316.05 ","$0.00 ","$1,560.63 ","$800.30 ","$578.80 ","$370.67 ","$0.00 ","$0.00 ","$0.00 ","$1,560.63 ","$0.00 ","$780.32 ","$1,236.02 ","$1,248.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107379","ERX","HCPCS J0490","49401-0102-01","BELIMUMAB 400 MG IV SOLR","BOTH IP/OP","$5,172.65 ","$3,827.76 ","$0.00 ","$4,443.28 ","$2,327.69 ","$1,929.32 ","$1,078.11 ","$0.00 ","$0.00 ","$0.00 ","$4,443.28 ","$0.00 ","$2,221.64 ","$3,519.08 ","$3,554.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107443","ERX","HCPCS J9171","00409-0201-10","DOCETAXEL 80 MG/8ML IV SOLN","BOTH IP/OP","$3,431.06 ","$2,538.98 ","$0.00 ","$3,112.25 ","$1,543.98 ","$0.00 ","$715.12 ","$0.00 ","$0.00 ","$91.18 ","$3,112.25 ","$72.66 ","$1,556.13 ","$2,464.90 ","$2,489.80 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107443","ERX","HCPCS J9171","66758-0050-02","DOCETAXEL 80 MG/8ML IV SOLN","BOTH IP/OP","$3,431.06 ","$2,538.98 ","$0.00 ","$3,112.25 ","$1,543.98 ","$0.00 ","$715.12 ","$0.00 ","$0.00 ","$91.18 ","$3,112.25 ","$72.66 ","$1,556.13 ","$2,464.90 ","$2,489.80 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107443","ERX","HCPCS J9171","67457-0532-08","DOCETAXEL 80 MG/8ML IV SOLN","BOTH IP/OP","$3,431.06 ","$2,538.98 ","$0.00 ","$3,112.25 ","$1,543.98 ","$0.00 ","$715.12 ","$0.00 ","$0.00 ","$91.18 ","$3,112.25 ","$72.66 ","$1,556.13 ","$2,464.90 ","$2,489.80 ","$100.34 ","$91.18 ","$0.00 ","$86.82 ","$69.44 "
"107446","ERX","HCPCS J9171","00409-0201-02","DOCETAXEL 20 MG/2ML IV SOLN","BOTH IP/OP","$290.58 ","$215.03 ","$0.00 ","$259.88 ","$0.00 ","$0.00 ","$60.56 ","$0.00 ","$0.00 ","$22.80 ","$259.88 ","$18.17 ","$129.94 ","$205.82 ","$207.90 ","$25.09 ","$22.80 ","$0.00 ","$21.70 ","$17.36 "
"107491","ERX","HCPCS J9228","00003-2327-11","IPILIMUMAB 50 MG/10ML IV SOLN","BOTH IP/OP","$20,958.73 ","$15,509.46 ","$0.00 ","$18,453.47 ","$9,620.05 ","$8,035.15 ","$4,368.32 ","$0.00 ","$0.00 ","$8,138.89 ","$18,453.47 ","$8,039.22 ","$9,226.74 ","$14,615.15 ","$14,762.78 ","$11,101.78 ","$8,138.89 ","$0.00 ","$8,138.89 ","$7,864.60 "
"107492","ERX","HCPCS J9228","00003-2328-22","IPILIMUMAB 200 MG/40ML IV SOLN","BOTH IP/OP","$83,834.70 ","$62,037.68 ","$0.00 ","$73,813.70 ","$38,480.11 ","$32,140.60 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$73,813.70 ","$32,156.88 ","$36,906.85 ","$58,460.45 ","$59,050.96 ","$44,407.12 ","$8,138.89 ","$0.00 ","$8,138.89 ","$31,458.40 "
"107815","ERX","HCPCS 63700001","00597-0123-30","NEVIRAPINE ER 400 MG PO TB24","BOTH IP/OP","$83.11 ","$61.50 ","$0.00 ","$75.37 ","","$14.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.37 ","$0.00 ","$37.69 ","$59.69 ","$60.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107815","ERX","HCPCS 63700001","33342-0238-07","NEVIRAPINE ER 400 MG PO TB24","BOTH IP/OP","$83.11 ","$61.50 ","$0.00 ","$75.37 ","","$14.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.37 ","$0.00 ","$37.69 ","$59.69 ","$60.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107815","ERX","HCPCS 63700001","47781-0317-30","NEVIRAPINE ER 400 MG PO TB24","BOTH IP/OP","$83.11 ","$61.50 ","$0.00 ","$75.37 ","","$14.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.37 ","$0.00 ","$37.69 ","$59.69 ","$60.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"107843","ERX","HCPCS 63700001","62103-0333-02","ZINC OXIDE 16 % EX OINT","BOTH IP/OP","$23.89 ","$17.68 ","$0.00 ","$15.17 ","","$4.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.17 ","$0.00 ","$7.59 ","$12.01 ","$12.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"108161","ERX","HCPCS 63700001","00456-1120-30","VILAZODONE HCL 20 MG PO TABS","BOTH IP/OP","$50.31 ","$37.23 ","$0.00 ","$43.45 ","","$9.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.45 ","$0.00 ","$21.73 ","$34.41 ","$34.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"108272","ERX","HCPCS 63600001","57894-0150-12","ABIRATERONE ACETATE 250 MG PO TABS","BOTH IP/OP","$1,073.22 ","$794.18 ","$0.00 ","$973.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$973.99 ","$0.00 ","$487.00 ","$771.40 ","$779.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"108272","ERX","HCPCS 63600001","57894-0155-12","ABIRATERONE ACETATE 250 MG PO TABS","BOTH IP/OP","$1,073.22 ","$794.18 ","$0.00 ","$973.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$973.99 ","$0.00 ","$487.00 ","$771.40 ","$779.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"108405","ERX","HCPCS 63700001","59676-0278-01","RILPIVIRINE HCL 25 MG PO TABS","BOTH IP/OP","$188.02 ","$139.13 ","$0.00 ","$163.15 ","","$31.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.15 ","$0.00 ","$81.58 ","$129.21 ","$130.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"108619","ERX","HCPCS J0282","43066-0150-10","AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$145.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.49 ","$145.60 ","$0.00 ","$72.80 ","$115.32 ","$116.48 ","$0.00 ","$22.79 ","$0.00 ","$23.18 ","$0.00 "
"108620","ERX","HCPCS J0282","43066-0360-20","AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN","BOTH IP/OP","$192.24 ","$142.26 ","$0.00 ","$174.51 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.56 ","$174.51 ","$0.00 ","$87.26 ","$138.21 ","$139.61 ","$0.00 ","$27.31 ","$0.00 ","$27.78 ","$0.00 "
"108708","ERX","HCPCS 63700001","52015-0080-01","FIDAXOMICIN 200 MG PO TABS","BOTH IP/OP","$746.74 ","$552.59 ","$0.00 ","$645.42 ","","$139.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$645.42 ","$0.00 ","$322.71 ","$511.17 ","$516.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109063","ERX","HCPCS J9217","00074-3473-03","LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT","BOTH IP/OP","$28,760.36 ","$21,282.67 ","$0.00 ","$24,564.91 ","$13,576.33 ","$1,204.40 ","$1,480.99 ","$0.00 ","$0.00 ","$1,621.99 ","$24,564.91 ","$1,415.60 ","$12,282.46 ","$19,455.41 ","$19,651.93 ","$1,954.87 ","$1,621.99 ","$0.00 ","$1,544.41 ","$1,235.32 "
"109481","ERX","HCPCS 63700001","50458-0580-10","RIVAROXABAN 10 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109481","ERX","HCPCS 63700001","50458-0580-30","RIVAROXABAN 10 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109484","ERX","HCPCS 63700001","00186-0777-39","TICAGRELOR 90 MG PO TABS","BOTH IP/OP","$35.65 ","$26.38 ","$0.00 ","$29.88 ","","$6.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.88 ","$0.00 ","$14.94 ","$23.66 ","$23.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109651","ERX","HCPCS 25000001","00004-0822-05","OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR","BOTH IP/OP","$612.47 ","$453.23 ","$0.00 ","$555.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.96 ","$0.00 ","$277.98 ","$440.32 ","$444.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109651","ERX","HCPCS 25000001","47781-0384-26","OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR","BOTH IP/OP","$612.47 ","$453.23 ","$0.00 ","$555.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.96 ","$0.00 ","$277.98 ","$440.32 ","$444.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110050","ERX","HCPCS 25000001","99999-6006-74","PENICILLIN G 100 UNITS/ML ID INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110052","ERX","HCPCS 25000001","99999-6006-75","PENICILLIN G 1000 UNITS/ML ID INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110156","ERX","HCPCS 63700001","00904-2137-61","FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110232","ERX","HCPCS 63700001","61958-1101-01","COMPLERA:EMTRICITAB-RILPIVIR-TENOFOVIR200-25-300MGTAB","BOTH IP/OP","$438.35 ","$324.38 ","$0.00 ","$359.55 ","","$78.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$359.55 ","$0.00 ","$179.78 ","$284.76 ","$287.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110284","ERX","HCPCS 63700001","50242-0090-02","VEMURAFENIB 240 MG PO TABS","BOTH IP/OP","$575.10 ","$425.57 ","$0.00 ","$575.10 ","","$112.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$575.10 ","$0.00 ","$287.55 ","$455.48 ","$460.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110289","ERX","HCPCS 63700001","27434-0010-17","COPPER GLUCONATE 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110289","ERX","HCPCS 63700001","66536-0014-44","COPPER GLUCONATE 2 MG PO CAPS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110307","ERX","HCPCS J9042","51144-0050-01","BRENTUXIMAB VEDOTIN 50 MG IV SOLR","BOTH IP/OP","$26,306.40 ","$19,466.74 ","$0.00 ","$21,136.32 ","$11,837.88 ","$9,827.35 ","$5,482.91 ","$0.00 ","$0.00 ","$8,138.89 ","$21,136.32 ","$8,527.94 ","$10,568.16 ","$16,739.97 ","$16,909.06 ","$11,776.68 ","$8,138.89 ","$0.00 ","$8,138.89 ","$8,793.05 "
"110346","ERX","HCPCS J1744","54092-0702-02","ICATIBANT ACETATE 30 MG/3ML SC SOLN","BOTH IP/OP","$5,424.00 ","$4,013.76 ","$0.00 ","$27,422.84 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,422.84 ","$0.00 ","$13,711.42 ","$21,718.89 ","$21,938.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110349","ERX","HCPCS 63700001","00069-8141-20","CRIZOTINIB 200 MG PO CAPS","BOTH IP/OP","$1,145.16 ","$847.42 ","$0.00 ","$938.19 ","","$203.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.19 ","$0.00 ","$469.10 ","$743.05 ","$750.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110350","ERX","HCPCS 63700001","00069-8140-20","CRIZOTINIB 250 MG PO CAPS","BOTH IP/OP","$1,145.16 ","$847.42 ","$0.00 ","$938.19 ","","$203.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.19 ","$0.00 ","$469.10 ","$743.05 ","$750.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110577","ERX","HCPCS 25000001","11704-0370-01","HYDROXOCOBALAMIN 5 G IV SOLR","BOTH IP/OP","$2,552.66 ","$1,888.97 ","$0.00 ","$2,365.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,365.40 ","$0.00 ","$1,182.70 ","$1,873.40 ","$1,892.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110604","ERX","HCPCS J3489","25021-0826-82","ZOLEDRONIC ACID 4 MG/100ML IV SOLN","BOTH IP/OP","$249.84 ","$184.88 ","$0.00 ","$572.40 ","$112.43 ","$0.00 ","$52.07 ","$0.00 ","$0.00 ","$51.14 ","$572.40 ","$0.00 ","$286.20 ","$453.34 ","$457.92 ","$0.00 ","$51.14 ","$0.00 ","$48.69 ","$0.00 "
"110863","ERX","HCPCS 25000001","00004-0357-30","PEGINTERFERON ALFA-2A 180 MCG/0.5ML SC SOLN","BOTH IP/OP","$2,512.87 ","$1,859.52 ","$0.00 ","$2,512.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,512.87 ","$0.00 ","$1,256.44 ","$1,990.19 ","$2,010.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111020","ERX","HCPCS 25000001","65702-0407-10","ACCU-CHEK AVIVA PLUS VI STRP","BOTH IP/OP","$325.14 ","$240.60 ","$0.00 ","$295.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.16 ","$0.00 ","$147.58 ","$233.77 ","$236.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111272","ERX","HCPCS 25000001","51991-0900-01","CLOBAZAM 10 MG PO TABS","BOTH IP/OP","$76.70 ","$56.76 ","$0.00 ","$92.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.52 ","$0.00 ","$46.26 ","$73.28 ","$74.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111272","ERX","HCPCS 25000001","67386-0314-01","CLOBAZAM 10 MG PO TABS","BOTH IP/OP","$76.70 ","$56.76 ","$0.00 ","$92.52 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.52 ","$0.00 ","$46.26 ","$73.28 ","$74.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111273","ERX","HCPCS 25000001","67386-0315-01","CLOBAZAM 20 MG PO TABS","BOTH IP/OP","$161.10 ","$119.21 ","$0.00 ","$166.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.54 ","$0.00 ","$83.27 ","$131.90 ","$133.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111314","ERX","HCPCS C9290","65250-0133-09","BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","BOTH IP/OP","$663.55 ","$491.03 ","$0.00 ","$573.52 ","$313.54 ","$0.00 ","$138.30 ","$0.00 ","$0.00 ","$100.42 ","$573.52 ","$0.00 ","$286.76 ","$454.23 ","$458.82 ","$0.00 ","$0.00 ","$0.00 ","$91.30 ","$0.00 "
"111314","ERX","HCPCS C9290","65250-0133-10","BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","BOTH IP/OP","$663.55 ","$491.03 ","$0.00 ","$573.52 ","$313.54 ","$0.00 ","$138.30 ","$0.00 ","$0.00 ","$100.42 ","$573.52 ","$0.00 ","$286.76 ","$454.23 ","$458.82 ","$0.00 ","$0.00 ","$0.00 ","$91.30 ","$0.00 "
"111314","ERX","HCPCS C9290","65250-0266-09","BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","BOTH IP/OP","$663.55 ","$491.03 ","$0.00 ","$573.52 ","$313.54 ","$0.00 ","$138.30 ","$0.00 ","$0.00 ","$100.42 ","$573.52 ","$0.00 ","$286.76 ","$454.23 ","$458.82 ","$0.00 ","$0.00 ","$0.00 ","$91.30 ","$0.00 "
"111314","ERX","HCPCS C9290","65250-0266-20","BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","BOTH IP/OP","$663.55 ","$491.03 ","$0.00 ","$573.52 ","$313.54 ","$0.00 ","$138.30 ","$0.00 ","$0.00 ","$100.42 ","$573.52 ","$0.00 ","$286.76 ","$454.23 ","$458.82 ","$0.00 ","$0.00 ","$0.00 ","$91.30 ","$0.00 "
"111320","ERX","HCPCS J9201","00409-0181-01","GEMCITABINE HCL 1 GM/26.3ML IV SOLN","BOTH IP/OP","$188.64 ","$139.59 ","$0.00 ","$811.87 ","$84.89 ","$0.00 ","$811.87 ","$0.00 ","$0.00 ","$24.44 ","$168.76 ","$0.00 ","$84.38 ","$133.66 ","$135.01 ","$0.00 ","$24.44 ","$0.00 ","$23.27 ","$0.00 "
"111320","ERX","HCPCS J9201","25021-0239-26","GEMCITABINE HCL 1 GM/26.3ML IV SOLN","BOTH IP/OP","$188.64 ","$139.59 ","$0.00 ","$811.87 ","$84.89 ","$0.00 ","$811.87 ","$0.00 ","$0.00 ","$24.44 ","$168.76 ","$0.00 ","$84.38 ","$133.66 ","$135.01 ","$0.00 ","$24.44 ","$0.00 ","$23.27 ","$0.00 "
"111320","ERX","HCPCS J9201","60505-6114-00","GEMCITABINE HCL 1 GM/26.3ML IV SOLN","BOTH IP/OP","$188.64 ","$139.59 ","$0.00 ","$811.87 ","$84.89 ","$0.00 ","$811.87 ","$0.00 ","$0.00 ","$24.44 ","$168.76 ","$0.00 ","$84.38 ","$133.66 ","$135.01 ","$0.00 ","$24.44 ","$0.00 ","$23.27 ","$0.00 "
"111367","ERX","HCPCS 63700001","50458-0578-10","RIVAROXABAN 15 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111367","ERX","HCPCS 63700001","50458-0578-30","RIVAROXABAN 15 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111368","ERX","HCPCS 63700001","50458-0579-01","RIVAROXABAN 20 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111368","ERX","HCPCS 63700001","50458-0579-10","RIVAROXABAN 20 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111368","ERX","HCPCS 63700001","50458-0579-90","RIVAROXABAN 20 MG PO TABS","BOTH IP/OP","$82.55 ","$61.09 ","$0.00 ","$71.44 ","","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.44 ","$0.00 ","$35.72 ","$56.58 ","$57.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111436","ERX","HCPCS 63700001","50881-0005-60","RUXOLITINIB PHOSPHATE 5 MG PO TABS","BOTH IP/OP","$883.19 ","$653.56 ","$0.00 ","$730.03 ","","$161.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.03 ","$0.00 ","$365.02 ","$578.18 ","$584.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111437","ERX","HCPCS 63700001","50881-0010-60","RUXOLITINIB PHOSPHATE 10 MG PO TABS","BOTH IP/OP","$883.19 ","$653.56 ","$0.00 ","$730.03 ","","$161.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.03 ","$0.00 ","$365.02 ","$578.18 ","$584.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111438","ERX","HCPCS 63700001","50881-0015-60","RUXOLITINIB PHOSPHATE 15 MG PO TABS","BOTH IP/OP","$883.19 ","$653.56 ","$0.00 ","$730.03 ","","$161.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.03 ","$0.00 ","$365.02 ","$578.18 ","$584.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111439","ERX","HCPCS 63700001","50881-0020-60","RUXOLITINIB PHOSPHATE 20 MG PO TABS","BOTH IP/OP","$883.19 ","$653.56 ","$0.00 ","$730.03 ","","$161.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.03 ","$0.00 ","$365.02 ","$578.18 ","$584.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111440","ERX","HCPCS 63700001","50881-0025-60","RUXOLITINIB PHOSPHATE 25 MG PO TABS","BOTH IP/OP","$883.19 ","$653.56 ","$0.00 ","$730.03 ","","$161.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.03 ","$0.00 ","$365.02 ","$578.18 ","$584.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111479","ERX","HCPCS J0178","61755-0005-02","AFLIBERCEPT 2 MG/0.05ML INTRAVITREAL SOLN","BOTH IP/OP","$5,017.20 ","$3,712.73 ","$0.00 ","$4,551.00 ","$2,257.74 ","$1,831.49 ","$1,045.71 ","$0.00 ","$0.00 ","$2,220.82 ","$4,551.00 ","$2,000.19 ","$2,275.50 ","$3,604.39 ","$3,640.80 ","$2,762.17 ","$2,220.82 ","$0.00 ","$2,114.60 ","$1,863.53 "
"111525","ERX","HCPCS J3490","63323-0648-10","LEVOTHYROXINE SODIUM 500 MCG IV SOLR","BOTH IP/OP","$425.71 ","$315.03 ","$0.00 ","$386.43 ","$191.57 ","$0.00 ","$88.73 ","$0.00 ","$0.00 ","$67.66 ","$386.43 ","$0.00 ","$193.22 ","$306.05 ","$309.14 ","$0.00 ","$60.48 ","$0.00 ","$61.52 ","$0.00 "
"111526","ERX","HCPCS 25000001","42023-0201-01","LEVOTHYROXINE SODIUM 100 MCG IV SOLR","BOTH IP/OP","$425.72 ","$315.03 ","$0.00 ","$386.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.44 ","$0.00 ","$193.22 ","$306.06 ","$309.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111526","ERX","HCPCS 25000001","63323-0649-07","LEVOTHYROXINE SODIUM 100 MCG IV SOLR","BOTH IP/OP","$425.72 ","$315.03 ","$0.00 ","$386.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.44 ","$0.00 ","$193.22 ","$306.06 ","$309.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111526","ERX","HCPCS 25000001","63323-0649-16","LEVOTHYROXINE SODIUM 100 MCG IV SOLR","BOTH IP/OP","$425.72 ","$315.03 ","$0.00 ","$386.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.44 ","$0.00 ","$193.22 ","$306.06 ","$309.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111526","ERX","HCPCS 25000001","70860-0451-10","LEVOTHYROXINE SODIUM 100 MCG IV SOLR","BOTH IP/OP","$425.72 ","$315.03 ","$0.00 ","$386.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.44 ","$0.00 ","$193.22 ","$306.06 ","$309.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111662","ERX","HCPCS 25000001","46783-0221-52","POLIDOCANOL 1 % IV SOLN","BOTH IP/OP","$101.91 ","$75.41 ","$0.00 ","$92.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.40 ","$0.00 ","$46.20 ","$73.18 ","$73.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112303","ERX","HCPCS J1953","55150-0246-47","LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","BOTH IP/OP","$128.54 ","$95.12 ","$0.00 ","$116.55 ","$57.84 ","$0.00 ","$26.79 ","$0.00 ","$0.00 ","$20.41 ","$116.55 ","$0.00 ","$58.28 ","$92.31 ","$93.24 ","$0.00 ","$18.24 ","$0.00 ","$18.55 ","$0.00 "
"112303","ERX","HCPCS J1953","67457-0255-10","LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","BOTH IP/OP","$128.54 ","$95.12 ","$0.00 ","$116.55 ","$57.84 ","$0.00 ","$26.79 ","$0.00 ","$0.00 ","$20.41 ","$116.55 ","$0.00 ","$58.28 ","$92.31 ","$93.24 ","$0.00 ","$18.24 ","$0.00 ","$18.55 ","$0.00 "
"112304","ERX","HCPCS J1953","43598-0636-10","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","43598-0636-52","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","43598-0757-10","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","43598-0757-52","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","55150-0247-47","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","67457-0265-00","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","67457-0265-10","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112304","ERX","HCPCS J1953","70860-0603-82","LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","BOTH IP/OP","$99.59 ","$73.70 ","$0.00 ","$187.43 ","$44.82 ","$0.00 ","$20.76 ","$0.00 ","$0.00 ","$32.82 ","$187.43 ","$0.00 ","$93.72 ","$148.44 ","$149.94 ","$0.00 ","$29.33 ","$0.00 ","$29.84 ","$0.00 "
"112305","ERX","HCPCS J1953","43598-0637-10","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112305","ERX","HCPCS J1953","43598-0637-52","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112305","ERX","HCPCS J1953","43598-0759-10","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112305","ERX","HCPCS J1953","43598-0759-52","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112305","ERX","HCPCS J1953","55150-0248-47","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112305","ERX","HCPCS J1953","67457-0266-00","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112305","ERX","HCPCS J1953","67457-0266-10","LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","BOTH IP/OP","$185.28 ","$137.11 ","$0.00 ","$168.00 ","$83.38 ","$0.00 ","$38.62 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"112380","ERX","HCPCS 25000001","63402-0302-30","LURASIDONE HCL 20 MG PO TABS","BOTH IP/OP","$196.92 ","$145.72 ","$0.00 ","$161.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.71 ","$0.00 ","$80.86 ","$128.07 ","$129.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112618","ERX","HCPCS J2212","65649-0552-04","METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN","BOTH IP/OP","$585.21 ","$433.06 ","$0.00 ","$456.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$456.28 ","$0.00 ","$228.14 ","$361.37 ","$365.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112638","ERX","HCPCS 63600001","50242-0140-01","VISMODEGIB 150 MG PO CAPS","BOTH IP/OP","$1,306.00 ","$966.44 ","$0.00 ","$1,297.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.34 ","$0.00 ","$648.67 ","$1,027.49 ","$1,037.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112683","ERX","HCPCS 25000001","00006-0078-82","JANUMET XR 50-500 MG (SITAGLIPTIN-METFORMIN ER) PO TB24","BOTH IP/OP","$41.64 ","$30.81 ","$0.00 ","$35.98 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.98 ","$0.00 ","$17.99 ","$28.50 ","$28.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112684","ERX","HCPCS 25000001","00006-0080-82","JANUMET XR 50-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24","BOTH IP/OP","$41.64 ","$30.81 ","$0.00 ","$35.98 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.98 ","$0.00 ","$17.99 ","$28.50 ","$28.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112685","ERX","HCPCS 25000001","00006-0081-31","JANUMET XR 100-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24","BOTH IP/OP","$83.27 ","$61.62 ","$0.00 ","$71.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.96 ","$0.00 ","$35.98 ","$56.99 ","$57.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112904","ERX","HCPCS 25000001","65702-0101-10","ACCU-CHEK AVIVA PLUS W/DEVICE KIT","BOTH IP/OP","$100.59 ","$74.44 ","$0.00 ","$100.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.59 ","$0.00 ","$50.30 ","$79.67 ","$80.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112975","ERX","HCPCS J7527","00078-0620-51","EVEROLIMUS 7.5 MG PO TABS","BOTH IP/OP","$1,743.45 ","$1,290.15 ","$0.00 ","$1,615.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.55 ","$0.00 ","$807.78 ","$1,279.52 ","$1,292.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"113303","ERX","HCPCS 63700001","00487-2784-01","RACEPINEPHRINE HCL 2.25 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"113303","ERX","HCPCS 63700001","00487-5901-99","RACEPINEPHRINE HCL 2.25 % IN NEBU","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"113304","ERX","HCPCS 90716","00006-4827-00","VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SC INJ","BOTH IP/OP","$608.24 ","$450.10 ","$0.00 ","$496.30 ","$273.71 ","$136.66 ","$9.40 ","$0.00 ","$0.00 ","$159.48 ","$496.30 ","$0.00 ","$248.15 ","$393.07 ","$397.04 ","$297.78 ","$159.48 ","$0.00 ","$151.85 ","$0.00 "
"113363","ERX","HCPCS 25000001","00054-3188-63","DIAZEPAM 5 MG/5ML PO SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"113624","ERX","HCPCS J1324","00004-0380-01","ENFUVIRTIDE 90 MG SC SOLR","BOTH IP/OP","$248.84 ","$184.14 ","$0.00 ","$225.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.89 ","$0.00 ","$112.95 ","$178.90 ","$180.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"113624","ERX","HCPCS J1324","00004-0381-40","ENFUVIRTIDE 90 MG SC SOLR","BOTH IP/OP","$248.84 ","$184.14 ","$0.00 ","$225.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.89 ","$0.00 ","$112.95 ","$178.90 ","$180.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"114621","ERX","HCPCS 25000001","49100-0400-08","CULTURELLE KIDS PO PACK","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115133","ERX","HCPCS 25000001","99999-6007-10","TRICHLOROACETIC ACID 40 % EX SOLN","BOTH IP/OP","$83.80 ","$62.01 ","$0.00 ","$76.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115145","ERX","HCPCS J7315","49771-0002-01","MITOMYCIN 0.2 MG OP KIT","BOTH IP/OP","$1,436.64 ","$1,063.11 ","$0.00 ","$1,141.62 ","$646.49 ","$0.00 ","$299.43 ","$0.00 ","$0.00 ","$199.89 ","$1,141.62 ","$0.00 ","$570.81 ","$904.16 ","$913.30 ","$0.00 ","$178.66 ","$0.00 ","$195.92 ","$0.00 "
"115145","ERX","HCPCS J7315","49771-0002-03","MITOMYCIN 0.2 MG OP KIT","BOTH IP/OP","$1,436.64 ","$1,063.11 ","$0.00 ","$1,141.62 ","$646.49 ","$0.00 ","$299.43 ","$0.00 ","$0.00 ","$199.89 ","$1,141.62 ","$0.00 ","$570.81 ","$904.16 ","$913.30 ","$0.00 ","$178.66 ","$0.00 ","$195.92 ","$0.00 "
"115244","ERX","HCPCS J9306","50242-0145-01","PERTUZUMAB 420 MG/14ML IV SOLN","BOTH IP/OP","$14,997.78 ","$11,098.36 ","$0.00 ","$13,018.35 ","$7,052.71 ","$5,693.10 ","$3,125.91 ","$0.00 ","$0.00 ","$6,227.97 ","$13,018.35 ","$5,419.89 ","$6,509.18 ","$10,310.53 ","$10,414.68 ","$7,484.61 ","$6,227.97 ","$0.00 ","$5,930.09 ","$5,435.64 "
"115824","ERX","HCPCS J9250","00143-9519-01","METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$2.94 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$2.94 ","$0.00 ","$2.80 ","$0.00 "
"115824","ERX","HCPCS J9250","00143-9519-10","METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$2.94 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$2.94 ","$0.00 ","$2.80 ","$0.00 "
"115824","ERX","HCPCS J9250","00703-3671-01","METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$2.94 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$2.94 ","$0.00 ","$2.80 ","$0.00 "
"115824","ERX","HCPCS J9250","16729-0277-30","METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$2.94 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$2.94 ","$0.00 ","$2.80 ","$0.00 "
"115826","ERX","HCPCS J9260","00703-3678-01","METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN","BOTH IP/OP","$170.15 ","$125.91 ","$0.00 ","$152.04 ","$76.57 ","$0.00 ","$54.05 ","$0.00 ","$0.00 ","$58.52 ","$152.04 ","$0.00 ","$76.02 ","$120.42 ","$121.63 ","$0.00 ","$58.52 ","$0.00 ","$55.72 ","$0.00 "
"115826","ERX","HCPCS J9260","61703-0408-41","METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN","BOTH IP/OP","$170.15 ","$125.91 ","$0.00 ","$152.04 ","$76.57 ","$0.00 ","$54.05 ","$0.00 ","$0.00 ","$58.52 ","$152.04 ","$0.00 ","$76.02 ","$120.42 ","$121.63 ","$0.00 ","$58.52 ","$0.00 ","$55.72 ","$0.00 "
"115839","ERX","HCPCS J9047","76075-0101-01","CARFILZOMIB 60 MG IV SOLR","BOTH IP/OP","$6,994.55 ","$5,175.97 ","$0.00 ","$5,991.13 ","$3,333.26 ","$2,466.66 ","$1,457.84 ","$0.00 ","$0.00 ","$2,646.57 ","$5,991.13 ","$2,368.74 ","$2,995.57 ","$4,744.97 ","$4,792.90 ","$3,271.11 ","$2,646.57 ","$0.00 ","$2,519.99 ","$2,338.32 "
"116010","ERX","HCPCS J2300","99999-6011-83","NALBUPHINE (NUBAIN) 10 MG/0.5 ML IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$1.22 ","$0.00 ","$0.00 ","$3.70 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$3.70 ","$0.00 ","$3.52 ","$0.00 "
"116012","ERX","HCPCS 63700001","61958-1201-01","STRIBILD:150-150-200-300 MG PO TABS","BOTH IP/OP","$505.27 ","$373.90 ","$0.00 ","$414.44 ","","$89.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$414.44 ","$0.00 ","$207.22 ","$328.24 ","$331.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116047","ERX","HCPCS J9302","00078-0690-61","OFATUMUMAB 1000 MG/50ML IV CONC","BOTH IP/OP","$16,363.42 ","$12,108.93 ","$0.00 ","$14,842.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,842.93 ","$0.00 ","$7,421.47 ","$11,755.60 ","$11,874.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116049","ERX","HCPCS 63700001","00006-0473-61","RALTEGRAVIR POTASSIUM 25 MG PO CHEW","BOTH IP/OP","$9.09 ","$6.73 ","$0.00 ","$7.86 ","","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.86 ","$0.00 ","$3.93 ","$6.23 ","$6.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116050","ERX","HCPCS 63700001","00006-0477-61","RALTEGRAVIR POTASSIUM 100 MG PO CHEW","BOTH IP/OP","$36.36 ","$26.91 ","$0.00 ","$31.42 ","","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.42 ","$0.00 ","$15.71 ","$24.88 ","$25.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116053","ERX","HCPCS J1100","63323-0506-01","DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.53 ","$0.00 ","$0.00 ","$0.71 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"116053","ERX","HCPCS J1100","70069-0021-25","DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.53 ","$0.00 ","$0.00 ","$0.71 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.71 ","$0.00 ","$0.67 ","$0.00 "
"116158","ERX","HCPCS 63600001","49281-0225-10","DIPHTHERIA-TETANUS TOXOIDS DT 25-5 LFU/0.5ML IM SUSP","BOTH IP/OP","$261.35 ","$193.40 ","$0.00 ","$215.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$215.46 ","$0.00 ","$107.73 ","$170.64 ","$172.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116294","ERX","HCPCS 25000001","63402-0312-30","LURASIDONE HCL 120 MG PO TABS","BOTH IP/OP","$293.94 ","$217.52 ","$0.00 ","$241.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$241.40 ","$0.00 ","$120.70 ","$191.19 ","$193.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116340","ERX","HCPCS 25000001","00054-0404-44","MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116340","ERX","HCPCS 25000001","00054-0404-50","MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116340","ERX","HCPCS 25000001","00406-8003-12","MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116340","ERX","HCPCS 25000001","99999-6005-51","MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116365","ERX","HCPCS J2270","00409-1891-01","MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"116365","ERX","HCPCS J2270","00409-1891-03","MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"116365","ERX","HCPCS J2270","00641-6125-01","MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"116365","ERX","HCPCS J2270","00641-6125-25","MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"116374","ERX","HCPCS J2270","00409-1893-01","MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$0.00 ","$0.00 "
"116374","ERX","HCPCS J2270","00641-6127-01","MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$0.00 ","$0.00 "
"116374","ERX","HCPCS J2270","00641-6127-25","MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$0.00 ","$0.00 "
"116385","ERX","HCPCS 63700001","00469-0125-99","ENZALUTAMIDE 40 MG PO CAPS","BOTH IP/OP","$716.91 ","$530.51 ","$0.00 ","$631.67 ","","$135.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.67 ","$0.00 ","$315.84 ","$500.28 ","$505.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116397","ERX","HCPCS J8999","00069-0135-01","BOSUTINIB 100 MG PO TABS","BOTH IP/OP","$583.36 ","$431.69 ","$0.00 ","$478.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$478.03 ","$0.00 ","$239.02 ","$378.60 ","$382.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116398","ERX","HCPCS 63600001","00069-0136-01","BOSUTINIB 500 MG PO TABS","BOTH IP/OP","$1,798.68 ","$1,331.02 ","$0.00 ","$1,504.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,504.61 ","$0.00 ","$752.31 ","$1,191.65 ","$1,203.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117006","ERX","HCPCS 25000001","12496-1204-01","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM","BOTH IP/OP","$45.16 ","$33.42 ","$0.00 ","$40.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.95 ","$0.00 ","$20.48 ","$32.43 ","$32.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117006","ERX","HCPCS 25000001","12496-1204-03","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM","BOTH IP/OP","$45.16 ","$33.42 ","$0.00 ","$40.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.95 ","$0.00 ","$20.48 ","$32.43 ","$32.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117007","ERX","HCPCS 25000001","12496-1212-01","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM","BOTH IP/OP","$83.20 ","$61.57 ","$0.00 ","$75.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.44 ","$0.00 ","$37.72 ","$59.75 ","$60.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117007","ERX","HCPCS 25000001","12496-1212-03","SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM","BOTH IP/OP","$83.20 ","$61.57 ","$0.00 ","$75.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.44 ","$0.00 ","$37.72 ","$59.75 ","$60.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117011","ERX","HCPCS 63700001","00456-1201-30","LINACLOTIDE 145 MCG PO CAPS","BOTH IP/OP","$78.32 ","$57.96 ","$0.00 ","$67.65 ","","$14.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.65 ","$0.00 ","$33.83 ","$53.58 ","$54.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117021","ERX","HCPCS 25000001","50419-0171-03","REGORAFENIB 40 MG PO TABS","BOTH IP/OP","$1,387.29 ","$1,026.59 ","$0.00 ","$1,237.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.25 ","$0.00 ","$618.63 ","$979.90 ","$989.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117385","ERX","HCPCS 63700001","59676-0566-30","DARUNAVIR ETHANOLATE 800 MG PO TABS","BOTH IP/OP","$256.12 ","$189.53 ","$0.00 ","$222.49 ","","$48.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.49 ","$0.00 ","$111.25 ","$176.21 ","$177.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117945","ERX","HCPCS 25000001","24208-0503-07","LOTEPREDNOL ETABONATE 0.5 % OP GEL","BOTH IP/OP","$795.97 ","$589.02 ","$0.00 ","$642.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$642.89 ","$0.00 ","$321.45 ","$509.17 ","$514.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118046","ERX","HCPCS 63700001","42937-0705-18","PRENATAL PLUS IRON 29-1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118105","ERX","HCPCS 63600001","76189-0535-30","PONATINIB HCL 15 MG PO TABS","BOTH IP/OP","$1,589.86 ","$1,176.50 ","$0.00 ","$1,589.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,589.86 ","$0.00 ","$794.93 ","$1,259.17 ","$1,271.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118189","ERX","HCPCS 25000001","54643-5649-01","INFUVITE ADULT IV INJ","BOTH IP/OP","$55.44 ","$41.03 ","$0.00 ","$46.14 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.14 ","$0.00 ","$23.07 ","$36.54 ","$36.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118319","ERX","HCPCS 63700001","00003-0893-21","APIXABAN 2.5 MG PO TABS","BOTH IP/OP","$41.83 ","$30.95 ","$0.00 ","$35.79 ","","$7.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.79 ","$0.00 ","$17.90 ","$28.35 ","$28.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118319","ERX","HCPCS 63700001","00003-0893-31","APIXABAN 2.5 MG PO TABS","BOTH IP/OP","$41.83 ","$30.95 ","$0.00 ","$35.79 ","","$7.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.79 ","$0.00 ","$17.90 ","$28.35 ","$28.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118352","ERX","HCPCS 63700001","00003-0894-21","APIXABAN 5 MG PO TABS","BOTH IP/OP","$41.83 ","$30.95 ","$0.00 ","$35.79 ","","$7.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.79 ","$0.00 ","$17.90 ","$28.35 ","$28.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118352","ERX","HCPCS 63700001","00003-0894-31","APIXABAN 5 MG PO TABS","BOTH IP/OP","$41.83 ","$30.95 ","$0.00 ","$35.79 ","","$7.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.79 ","$0.00 ","$17.90 ","$28.35 ","$28.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118810","ERX","HCPCS 63700001","00536-4085-01","PRENATAL VITAMINS 28-0.8 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118851","ERX","HCPCS 25000001","59572-0501-00","POMALIDOMIDE 1 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118851","ERX","HCPCS 25000001","59572-0501-21","POMALIDOMIDE 1 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118852","ERX","HCPCS 25000001","59572-0502-00","POMALIDOMIDE 2 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118852","ERX","HCPCS 25000001","59572-0502-21","POMALIDOMIDE 2 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118853","ERX","HCPCS 25000001","59572-0503-00","POMALIDOMIDE 3 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118853","ERX","HCPCS 25000001","59572-0503-21","POMALIDOMIDE 3 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118854","ERX","HCPCS 25000001","59572-0504-00","POMALIDOMIDE 4 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118854","ERX","HCPCS 25000001","59572-0504-21","POMALIDOMIDE 4 MG PO CAPS","BOTH IP/OP","$2,461.44 ","$1,821.47 ","$0.00 ","$2,136.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,136.58 ","$0.00 ","$1,068.29 ","$1,692.17 ","$1,709.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"118951","ERX","HCPCS J9354","50242-0087-01","ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR","BOTH IP/OP","$14,303.91 ","$10,584.89 ","$0.00 ","$12,416.08 ","$6,726.42 ","$5,464.16 ","$2,981.29 ","$0.00 ","$0.00 ","$6,036.68 ","$12,416.08 ","$5,269.15 ","$6,208.04 ","$9,833.54 ","$9,932.86 ","$7,276.45 ","$6,036.68 ","$0.00 ","$5,747.95 ","$5,250.88 "
"119091","ERX","HCPCS 63700001","00406-8330-23","MORPHINE SULFATE CR 30 MG PO TB12","BOTH IP/OP","$14.17 ","$10.49 ","$0.00 ","$12.85 ","","$2.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119091","ERX","HCPCS 63700001","00406-8330-62","MORPHINE SULFATE CR 30 MG PO TB12","BOTH IP/OP","$14.17 ","$10.49 ","$0.00 ","$12.85 ","","$2.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.85 ","$0.00 ","$6.43 ","$10.18 ","$10.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119102","ERX","HCPCS 63700001","00456-3407-33","MEMANTINE HCL ER 7 MG PO CP24","BOTH IP/OP","$77.90 ","$57.65 ","$0.00 ","$70.65 ","","$13.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.65 ","$0.00 ","$35.33 ","$55.95 ","$56.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119105","ERX","HCPCS 63700001","00456-3428-33","MEMANTINE HCL ER 28 MG PO CP24","BOTH IP/OP","$64.03 ","$47.38 ","$0.00 ","$58.07 ","","$11.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.07 ","$0.00 ","$29.04 ","$45.99 ","$46.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119105","ERX","HCPCS 63700001","10370-0349-11","MEMANTINE HCL ER 28 MG PO CP24","BOTH IP/OP","$64.03 ","$47.38 ","$0.00 ","$58.07 ","","$11.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.07 ","$0.00 ","$29.04 ","$45.99 ","$46.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119105","ERX","HCPCS 63700001","43975-0266-03","MEMANTINE HCL ER 28 MG PO CP24","BOTH IP/OP","$64.03 ","$47.38 ","$0.00 ","$58.07 ","","$11.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.07 ","$0.00 ","$29.04 ","$45.99 ","$46.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119111","ERX","HCPCS 63700001","99999-6007-75","DARUNAVIR ETHANOLATE 100 MG/ML PO SUSP","BOTH IP/OP","$136.30 ","$100.86 ","$0.00 ","$732.60 ","","$24.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$574.38 ","$0.00 ","$287.19 ","$732.60 ","$459.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119111","ERX","HCPCS 63700001","59676-0565-01","DARUNAVIR ETHANOLATE 100 MG/ML PO SUSP","BOTH IP/OP","$136.30 ","$100.86 ","$0.00 ","$1,910.98 ","","$24.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$574.38 ","$0.00 ","$287.19 ","$1,910.98 ","$459.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119120","ERX","HCPCS J2270","00409-1890-01","MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"119120","ERX","HCPCS J2270","00409-1890-03","MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.39 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.39 ","$0.00 ","$2.27 ","$0.00 "
"119123","ERX","HCPCS 25000001","00074-4380-10","CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$96.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.60 ","$0.00 ","$48.30 ","$76.51 ","$77.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119123","ERX","HCPCS 25000001","00074-4380-81","CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$96.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.60 ","$0.00 ","$48.30 ","$76.51 ","$77.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119123","ERX","HCPCS 25000001","00781-3152-95","CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$96.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.60 ","$0.00 ","$48.30 ","$76.51 ","$77.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119123","ERX","HCPCS 25000001","00781-9038-70","CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$96.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.60 ","$0.00 ","$48.30 ","$76.51 ","$77.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119123","ERX","HCPCS 25000001","00781-9038-95","CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$96.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.60 ","$0.00 ","$48.30 ","$76.51 ","$77.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119123","ERX","HCPCS 25000001","63323-0417-10","CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$96.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.60 ","$0.00 ","$48.30 ","$76.51 ","$77.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119129","ERX","HCPCS 63700001","00406-8315-01","MORPHINE SULFATE CR 15 MG PO TB12","BOTH IP/OP","$7.85 ","$5.81 ","$0.00 ","$7.12 ","","$1.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.12 ","$0.00 ","$3.56 ","$5.64 ","$5.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119129","ERX","HCPCS 63700001","00406-8315-23","MORPHINE SULFATE CR 15 MG PO TB12","BOTH IP/OP","$7.85 ","$5.81 ","$0.00 ","$7.12 ","","$1.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.12 ","$0.00 ","$3.56 ","$5.64 ","$5.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119129","ERX","HCPCS 63700001","00406-8315-62","MORPHINE SULFATE CR 15 MG PO TB12","BOTH IP/OP","$7.85 ","$5.81 ","$0.00 ","$7.12 ","","$1.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.12 ","$0.00 ","$3.56 ","$5.64 ","$5.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119131","ERX","HCPCS 63700001","00406-8390-01","MORPHINE SULFATE CR 100 MG PO TB12","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$29.02 ","","$5.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.02 ","$0.00 ","$14.51 ","$22.98 ","$23.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119131","ERX","HCPCS 63700001","00406-8390-62","MORPHINE SULFATE CR 100 MG PO TB12","BOTH IP/OP","$32.00 ","$23.68 ","$0.00 ","$29.02 ","","$5.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.02 ","$0.00 ","$14.51 ","$22.98 ","$23.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119134","ERX","HCPCS 25000001","00143-9680-25","GLYCOPYRROLATE 1 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119134","ERX","HCPCS 25000001","62295-3325-05","GLYCOPYRROLATE 1 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119134","ERX","HCPCS 25000001","70121-1396-05","GLYCOPYRROLATE 1 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119650","ERX","HCPCS 63700001","00065-4147-27","(SIMBRINZA) BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OP SUSP","BOTH IP/OP","$545.97 ","$404.02 ","$0.00 ","$436.78 ","","$118.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$432.41 ","$436.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"119955","ERX","HCPCS 63700001","50268-0851-15","VITAMIN B1 100 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120301","ERX","HCPCS 25000001","00904-6488-38","ARTIFICIAL TEARS 83-15 % OP OINT","BOTH IP/OP","$14.02 ","$10.37 ","$0.00 ","$14.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.02 ","$0.00 ","$7.01 ","$11.10 ","$11.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120319","ERX","HCPCS C9132","63833-0386-02","PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","BOTH IP/OP","$3,683.80 ","$2,726.01 ","$0.00 ","$3,218.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,218.50 ","$0.00 ","$1,609.25 ","$2,435.40 ","$2,574.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120319","ERX","HCPCS C9132","63833-0396-01","PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","BOTH IP/OP","$3,683.80 ","$2,726.01 ","$0.00 ","$3,218.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,218.50 ","$0.00 ","$1,609.25 ","$2,435.40 ","$2,574.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120606","ERX","HCPCS 63700001","00078-0681-66","DABRAFENIB MESYLATE 75 MG PO CAPS","BOTH IP/OP","$677.79 ","$501.56 ","$0.00 ","$583.05 ","","$127.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$583.05 ","$0.00 ","$291.53 ","$461.78 ","$466.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120607","ERX","HCPCS 63700001","00078-0666-15","TRAMETINIB DIMETHYL SULFOXIDE 0.5 MG PO TABS","BOTH IP/OP","$1,534.24 ","$1,135.34 ","$0.00 ","$1,347.57 ","","$288.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.57 ","$0.00 ","$673.79 ","$1,067.28 ","$1,078.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120608","ERX","HCPCS 63700001","00078-0668-15","TRAMETINIB DIMETHYL SULFOXIDE 2 MG PO TABS","BOTH IP/OP","$1,305.45 ","$966.03 ","$0.00 ","$1,266.06 ","","$245.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,266.06 ","$0.00 ","$633.03 ","$1,002.72 ","$1,012.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120650","ERX","HCPCS J2710","00641-6149-10","NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$2.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.03 ","$0.00 ","$1.94 ","$0.00 "
"120650","ERX","HCPCS J2710","63323-0415-10","NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$2.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.03 ","$0.00 ","$1.94 ","$0.00 "
"120650","ERX","HCPCS J2710","76014-0003-10","NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$2.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.03 ","$0.00 ","$1.94 ","$0.00 "
"120650","ERX","HCPCS J2710","76014-0003-33","NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$2.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.03 ","$0.00 ","$1.94 ","$0.00 "
"120829","ERX","HCPCS 63700001","99999-6011-84","NIMODIPINE 60 MG/20ML PO SOLN","BOTH IP/OP","$171.64 ","$127.01 ","$0.00 ","$171.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.64 ","$0.00 ","$85.82 ","$135.94 ","$137.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121069","ERX","HCPCS J1602","57894-0350-01","GOLIMUMAB 50 MG/4ML IV SOLN","BOTH IP/OP","$5,421.82 ","$4,012.15 ","$0.00 ","$4,692.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,692.74 ","$0.00 ","$2,346.37 ","$3,716.65 ","$3,754.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121091","ERX","HCPCS J1439","00517-0650-01","FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN","BOTH IP/OP","$3,279.05 ","$2,426.50 ","$0.00 ","$2,803.57 ","$1,475.57 ","$842.25 ","$683.44 ","$0.00 ","$0.00 ","$978.19 ","$2,803.57 ","$863.89 ","$1,401.79 ","$2,220.43 ","$2,242.86 ","$1,192.99 ","$978.19 ","$0.00 ","$931.40 ","$840.00 "
"121434","ERX","HCPCS 63700001","49702-0228-13","DOLUTEGRAVIR SODIUM 50 MG PO TABS","BOTH IP/OP","$279.18 ","$206.59 ","$0.00 ","$230.14 ","","$49.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.14 ","$0.00 ","$115.07 ","$182.27 ","$184.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121712","ERX","HCPCS 90680","00006-4047-41","ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN","BOTH IP/OP","$364.38 ","$269.64 ","$0.00 ","$308.93 ","$163.97 ","$0.00 ","$75.95 ","$0.00 ","$0.00 ","$54.09 ","$308.93 ","$0.00 ","$154.47 ","$244.67 ","$247.14 ","$0.00 ","$48.35 ","$0.00 ","$51.14 ","$0.00 "
"121715","ERX","HCPCS 25000001","00409-1165-01","BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121715","ERX","HCPCS 25000001","00409-1582-10","BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121715","ERX","HCPCS 25000001","55150-0171-10","BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121715","ERX","HCPCS 25000001","63323-0472-17","BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121718","ERX","HCPCS J2260","00143-9710-01","MILRINONE LACTATE 10 MG/10ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$3.60 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$3.60 ","$0.00 ","$3.42 ","$0.00 "
"121718","ERX","HCPCS J2260","00143-9710-10","MILRINONE LACTATE 10 MG/10ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$3.60 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$3.60 ","$0.00 ","$3.42 ","$0.00 "
"121718","ERX","HCPCS J2260","00409-0212-01","MILRINONE LACTATE 10 MG/10ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$3.60 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$3.60 ","$0.00 ","$3.42 ","$0.00 "
"121718","ERX","HCPCS J2260","63323-0617-10","MILRINONE LACTATE 10 MG/10ML IV SOLN","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$28.50 ","$14.14 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$3.60 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$3.60 ","$0.00 ","$3.42 ","$0.00 "
"121722","ERX","HCPCS J9181","00143-9511-01","ETOPOSIDE 500 MG/25ML IV SOLN","BOTH IP/OP","$197.27 ","$145.98 ","$0.00 ","$179.08 ","$88.77 ","$0.00 ","$41.12 ","$0.00 ","$0.00 ","$36.43 ","$179.08 ","$0.00 ","$89.54 ","$141.83 ","$143.26 ","$0.00 ","$36.43 ","$0.00 ","$34.68 ","$0.00 "
"121722","ERX","HCPCS J9181","16729-0114-08","ETOPOSIDE 500 MG/25ML IV SOLN","BOTH IP/OP","$197.27 ","$145.98 ","$0.00 ","$179.08 ","$88.77 ","$0.00 ","$41.12 ","$0.00 ","$0.00 ","$36.43 ","$179.08 ","$0.00 ","$89.54 ","$141.83 ","$143.26 ","$0.00 ","$36.43 ","$0.00 ","$34.68 ","$0.00 "
"121723","ERX","HCPCS J9181","00703-5657-01","ETOPOSIDE 1 GM/50ML IV SOLN","BOTH IP/OP","$501.48 ","$371.10 ","$0.00 ","$455.22 ","$225.67 ","$0.00 ","$104.52 ","$0.00 ","$0.00 ","$72.85 ","$455.22 ","$0.00 ","$227.61 ","$360.53 ","$364.18 ","$0.00 ","$72.85 ","$0.00 ","$69.37 ","$0.00 "
"121723","ERX","HCPCS J9181","63323-0104-50","ETOPOSIDE 1 GM/50ML IV SOLN","BOTH IP/OP","$501.48 ","$371.10 ","$0.00 ","$455.22 ","$225.67 ","$0.00 ","$104.52 ","$0.00 ","$0.00 ","$72.85 ","$455.22 ","$0.00 ","$227.61 ","$360.53 ","$364.18 ","$0.00 ","$72.85 ","$0.00 ","$69.37 ","$0.00 "
"121727","ERX","HCPCS 63700001","60258-0172-01","MAGNESIUM GLUCONATE 500 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121730","ERX","HCPCS 25000001","59011-0410-10","OXYCODONE HCL ER 10 MG PO T12A","BOTH IP/OP","$24.06 ","$17.80 ","$0.00 ","$19.79 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.79 ","$0.00 ","$9.90 ","$15.67 ","$15.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121730","ERX","HCPCS 25000001","59011-0410-20","OXYCODONE HCL ER 10 MG PO T12A","BOTH IP/OP","$24.06 ","$17.80 ","$0.00 ","$19.79 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.79 ","$0.00 ","$9.90 ","$15.67 ","$15.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121733","ERX","HCPCS 25000001","59011-0420-10","OXYCODONE HCL ER 20 MG PO T12A","BOTH IP/OP","$44.81 ","$33.16 ","$0.00 ","$36.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.86 ","$0.00 ","$18.43 ","$29.19 ","$29.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121733","ERX","HCPCS 25000001","59011-0420-20","OXYCODONE HCL ER 20 MG PO T12A","BOTH IP/OP","$44.81 ","$33.16 ","$0.00 ","$36.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.86 ","$0.00 ","$18.43 ","$29.19 ","$29.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121735","ERX","HCPCS 25000001","59011-0440-10","OXYCODONE HCL ER 40 MG PO T12A","BOTH IP/OP","$74.83 ","$55.37 ","$0.00 ","$61.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.55 ","$0.00 ","$30.78 ","$48.75 ","$49.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121735","ERX","HCPCS 25000001","59011-0440-20","OXYCODONE HCL ER 40 MG PO T12A","BOTH IP/OP","$74.83 ","$55.37 ","$0.00 ","$61.55 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.55 ","$0.00 ","$30.78 ","$48.75 ","$49.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121737","ERX","HCPCS 25000001","59011-0480-20","OXYCODONE HCL ER 80 MG PO T12A","BOTH IP/OP","$123.37 ","$91.29 ","$0.00 ","$101.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.46 ","$0.00 ","$50.73 ","$80.36 ","$81.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121854","ERX","HCPCS 25000001","63402-0306-30","LURASIDONE HCL 60 MG PO TABS","BOTH IP/OP","$196.92 ","$145.72 ","$0.00 ","$161.71 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.71 ","$0.00 ","$80.86 ","$128.07 ","$129.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","00143-9532-25","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","16729-0239-30","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","16729-0239-93","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","16729-0432-30","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","16729-0432-93","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","42023-0146-25","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","55150-0209-02","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","57664-0596-50","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","63323-0421-02","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","70860-0605-03","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121934","ERX","HCPCS 25000001","70860-0605-41","DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","BOTH IP/OP","$183.43 ","$135.74 ","$0.00 ","$166.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.32 ","$0.00 ","$83.16 ","$131.73 ","$133.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121955","ERX","HCPCS J9041","63020-0049-01","BORTEZOMIB 3.5 MG IJ SOLR","BOTH IP/OP","$4,347.34 ","$3,217.03 ","$0.00 ","$3,943.38 ","$1,956.30 ","$1,567.79 ","$1,491.60 ","$0.00 ","$0.00 ","$1,844.87 ","$3,943.38 ","$1,642.25 ","$1,971.69 ","$3,123.16 ","$3,154.70 ","$2,267.87 ","$1,844.87 ","$0.00 ","$1,756.63 ","$1,574.55 "
"122027","ERX","HCPCS 63700001","64764-0750-30","VORTIOXETINE HBR 20 MG PO TABS","BOTH IP/OP","$70.90 ","$52.47 ","$0.00 ","$61.24 ","","$13.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.24 ","$0.00 ","$30.62 ","$48.50 ","$48.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"122192","ERX","HCPCS J9301","50242-0070-01","OBINUTUZUMAB 1000 MG/40ML IV SOLN","BOTH IP/OP","$18,573.86 ","$13,744.66 ","$0.00 ","$16,357.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,357.20 ","$0.00 ","$8,178.60 ","$12,954.90 ","$13,085.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"122260","ERX","HCPCS 63700001","57962-0140-09","IBRUTINIB 140 MG PO CAPS","BOTH IP/OP","$1,161.80 ","$859.73 ","$0.00 ","$981.72 ","","$222.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$981.72 ","$0.00 ","$490.86 ","$777.52 ","$785.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"122260","ERX","HCPCS 63700001","57962-0140-12","IBRUTINIB 140 MG PO CAPS","BOTH IP/OP","$1,161.80 ","$859.73 ","$0.00 ","$981.72 ","","$222.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$981.72 ","$0.00 ","$490.86 ","$777.52 ","$785.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"122312","ERX","HCPCS 25000001","00085-4324-02","POSACONAZOLE 100 MG PO TBEC","BOTH IP/OP","$720.39 ","$533.09 ","$0.00 ","$653.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$653.78 ","$0.00 ","$326.89 ","$517.79 ","$523.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"122959","ERX","HCPCS 63700001","00310-6205-30","DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS","BOTH IP/OP","$84.74 ","$62.71 ","$0.00 ","$72.43 ","","$15.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.43 ","$0.00 ","$36.22 ","$57.36 ","$57.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"122960","ERX","HCPCS 63700001","00310-6210-30","DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS","BOTH IP/OP","$84.74 ","$62.71 ","$0.00 ","$72.43 ","","$15.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.43 ","$0.00 ","$36.22 ","$57.36 ","$57.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123430","ERX","HCPCS J9181","00703-5653-01","ETOPOSIDE 100 MG/5ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$7.29 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$7.29 ","$0.00 ","$6.94 ","$0.00 "
"123430","ERX","HCPCS J9181","16729-0114-31","ETOPOSIDE 100 MG/5ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$7.29 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$7.29 ","$0.00 ","$6.94 ","$0.00 "
"123430","ERX","HCPCS J9181","63323-0104-05","ETOPOSIDE 100 MG/5ML IV SOLN","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$7.29 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$7.29 ","$0.00 ","$6.94 ","$0.00 "
"123462","ERX","HCPCS 25000001","00169-4060-13","(VICTOZA) LIRAGLUTIDE 18 MG/3ML SC SOPN","BOTH IP/OP","$455.28 ","$336.91 ","$0.00 ","$393.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$393.60 ","$0.00 ","$196.80 ","$311.73 ","$314.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123464","ERX","HCPCS J1720","00009-0011-03","HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR","BOTH IP/OP","$34.43 ","$25.48 ","$0.00 ","$24.78 ","$15.49 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$15.33 ","$24.78 ","$0.00 ","$12.39 ","$19.63 ","$19.82 ","$0.00 ","$15.33 ","$0.00 ","$14.60 ","$0.00 "
"123464","ERX","HCPCS J1720","00009-0825-01","HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR","BOTH IP/OP","$34.43 ","$25.48 ","$0.00 ","$24.78 ","$15.49 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$15.33 ","$24.78 ","$0.00 ","$12.39 ","$19.63 ","$19.82 ","$0.00 ","$15.33 ","$0.00 ","$14.60 ","$0.00 "
"123468","ERX","HCPCS 25000001","00641-6022-25","FAMOTIDINE 20 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123468","ERX","HCPCS 25000001","63323-0739-11","FAMOTIDINE 20 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123468","ERX","HCPCS 25000001","63323-0739-12","FAMOTIDINE 20 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123468","ERX","HCPCS 25000001","67457-0433-22","FAMOTIDINE 20 MG/2ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123472","ERX","HCPCS J1100","55150-0238-05","DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.06 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"123472","ERX","HCPCS J1100","63323-0165-05","DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.06 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"123472","ERX","HCPCS J1100","67457-0422-00","DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.06 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"123472","ERX","HCPCS J1100","67457-0422-54","DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.06 ","$0.00 ","$0.00 ","$1.41 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.41 ","$0.00 ","$1.34 ","$0.00 "
"123476","ERX","HCPCS J0171","49502-0102-02","EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","BOTH IP/OP","$1,066.29 ","$789.05 ","$0.00 ","$967.69 ","$479.83 ","$0.00 ","$222.24 ","$0.00 ","$0.00 ","$2.89 ","$967.69 ","$0.00 ","$483.85 ","$766.41 ","$774.15 ","$0.00 ","$2.89 ","$0.00 ","$2.75 ","$0.00 "
"123476","ERX","HCPCS J0171","49502-0500-02","EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","BOTH IP/OP","$1,066.29 ","$789.05 ","$0.00 ","$967.69 ","$479.83 ","$0.00 ","$222.24 ","$0.00 ","$0.00 ","$2.89 ","$967.69 ","$0.00 ","$483.85 ","$766.41 ","$774.15 ","$0.00 ","$2.89 ","$0.00 ","$2.75 ","$0.00 "
"123622","ERX","HCPCS 25000001","00085-4331-01","POSACONAZOLE 300 MG/16.7ML IV SOLN","BOTH IP/OP","$1,648.64 ","$1,219.99 ","$0.00 ","$1,527.69 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.69 ","$0.00 ","$763.85 ","$1,209.93 ","$1,222.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123623","ERX","HCPCS C9132","63833-0387-02","PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT","BOTH IP/OP","$7,367.60 ","$5,452.02 ","$0.00 ","$6,437.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,437.00 ","$0.00 ","$3,218.50 ","$4,870.80 ","$5,149.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123623","ERX","HCPCS C9132","63833-0397-01","PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT","BOTH IP/OP","$7,367.60 ","$5,452.02 ","$0.00 ","$6,437.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,437.00 ","$0.00 ","$3,218.50 ","$4,870.80 ","$5,149.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123656","ERX","HCPCS 63700001","59572-0631-06","APREMILAST 30 MG PO TABS","BOTH IP/OP","$226.28 ","$167.45 ","$0.00 ","$226.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.28 ","$0.00 ","$113.14 ","$179.21 ","$181.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123657","ERX","HCPCS 25000001","59572-0632-55","APREMILAST 10 & 20 & 30 MG PO TBPK","BOTH IP/OP","$246.85 ","$182.67 ","$0.00 ","$246.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$246.85 ","$0.00 ","$123.43 ","$195.51 ","$197.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123886","ERX","HCPCS J0171","76329-9060-00","EPINEPHRINE 30 MG/30ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.89 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.89 ","$0.00 ","$0.00 ","$0.00 "
"123899","ERX","HCPCS 25000001","41167-0058-20","LIDOCAINE 4 % EX CREAM- LARGE TUBE","BOTH IP/OP","$41.35 ","$30.60 ","$0.00 ","$45.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.94 ","$0.00 ","$22.97 ","$36.38 ","$36.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"123951","ERX","HCPCS J7327","59676-0820-01","HYALURONAN 88 MG/4ML I-ARTICULAR SOSY","BOTH IP/OP","$89,496.00 ","$66,227.04 ","$0.00 ","$3,690.00 ","$1,830.60 ","$790.78 ","$847.87 ","$0.00 ","$0.00 ","$646.09 ","$3,690.00 ","$807.98 ","$1,845.00 ","$2,922.48 ","$2,952.00 ","$1,115.78 ","$577.49 ","$0.00 ","$587.45 ","$766.34 "
"123968","ERX","HCPCS J9308","00002-7669-01","RAMUCIRUMAB 100 MG/10ML IV SOLN","BOTH IP/OP","$3,407.05 ","$2,521.22 ","$0.00 ","$2,970.45 ","$1,579.16 ","$1,271.14 ","$710.11 ","$0.00 ","$0.00 ","$1,402.25 ","$2,970.45 ","$1,226.80 ","$1,485.23 ","$2,352.60 ","$2,376.36 ","$1,694.15 ","$1,402.25 ","$0.00 ","$1,335.18 ","$1,221.26 "
"124207","ERX","HCPCS 63700001","00378-0088-01","CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124207","ERX","HCPCS 63700001","51079-0978-01","CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124207","ERX","HCPCS 63700001","51079-0978-20","CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124207","ERX","HCPCS 63700001","62756-0461-88","CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124207","ERX","HCPCS 63700001","68084-0281-01","CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124207","ERX","HCPCS 63700001","68084-0281-11","CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124228","ERX","HCPCS J3380","64764-0300-20","VEDOLIZUMAB 300 MG IV SOLR","BOTH IP/OP","$19,734.23 ","$14,603.33 ","$0.00 ","$16,550.02 ","$9,413.23 ","$6,387.90 ","$4,113.11 ","$0.00 ","$0.00 ","$7,134.60 ","$16,550.02 ","$6,257.16 ","$8,275.01 ","$13,107.62 ","$13,240.02 ","$8,640.84 ","$7,134.60 ","$0.00 ","$6,793.35 ","$6,197.40 "
"124458","ERX","HCPCS 63700001","00069-0830-38","SUNITINIB MALATE 37.5 MG PO CAPS","BOTH IP/OP","$1,987.98 ","$1,471.11 ","$0.00 ","$1,662.96 ","","$353.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.96 ","$0.00 ","$831.48 ","$1,317.06 ","$1,330.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124486","ERX","HCPCS J0875","57970-0100-01","DALBAVANCIN HCL 500 MG IV SOLR","BOTH IP/OP","$4,415.57 ","$3,267.52 ","$0.00 ","$3,888.63 ","$2,046.61 ","$1,589.10 ","$920.32 ","$0.00 ","$0.00 ","$1,769.55 ","$3,888.63 ","$1,569.23 ","$1,944.32 ","$3,079.79 ","$3,110.90 ","$2,167.03 ","$1,769.55 ","$0.00 ","$1,684.91 ","$1,494.50 "
"124555","ERX","HCPCS 25000001","00536-1186-12","PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RECTAL SUPP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124599","ERX","HCPCS 63700001","00006-3603-61","RALTEGRAVIR POTASSIUM 100 MG PO PACK","BOTH IP/OP","$28.50 ","$21.09 ","$0.00 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124607","ERX","HCPCS J8530","00054-0383-25","CYCLOPHOSPHAMIDE 50 MG PO CAPS","BOTH IP/OP","$71.99 ","$53.27 ","$0.00 ","$65.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.29 ","$0.00 ","$32.65 ","$51.71 ","$52.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124728","ERX","HCPCS 25000001","00310-6530-04","EXENATIDE ER 2 MG SC PEN","BOTH IP/OP","$584.48 ","$432.52 ","$0.00 ","$584.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$584.48 ","$0.00 ","$292.24 ","$462.91 ","$467.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124810","ERX","HCPCS 25000001","69543-0268-10","VIRT-PHOS 250 NEUTRAL 155-852-130 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125122","ERX","HCPCS 63700001","49702-0231-13","TRIUMEQ:ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS","BOTH IP/OP","$448.77 ","$332.09 ","$0.00 ","$369.92 ","","$79.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$369.92 ","$0.00 ","$184.96 ","$292.98 ","$295.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125240","ERX","HCPCS 63600001","57894-0061-03","USTEKINUMAB 90 MG/ML SC SOSY","BOTH IP/OP","$65,605.50 ","$48,548.07 ","$0.00 ","$56,783.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56,783.80 ","$0.00 ","$28,391.90 ","$44,972.77 ","$45,427.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125241","ERX","HCPCS 63700001","58406-0435-01","ETANERCEPT 50 MG/ML SC SOSY","BOTH IP/OP","$3,417.54 ","$2,528.98 ","$0.00 ","$3,417.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,417.54 ","$0.00 ","$1,708.77 ","$2,706.69 ","$2,734.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125244","ERX","HCPCS 63600001","00006-4897-00","HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP","BOTH IP/OP","$129.34 ","$95.71 ","$0.00 ","$109.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.66 ","$0.00 ","$54.83 ","$86.85 ","$87.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125258","ERX","HCPCS J7321","89130-4444-01","SODIUM HYALURONATE 25 MG/2.5ML I-ARTICULAR SOSY","BOTH IP/OP","$831.18 ","$615.07 ","$0.00 ","$732.36 ","$374.03 ","$0.00 ","$173.24 ","$0.00 ","$0.00 ","$97.35 ","$732.36 ","$0.00 ","$366.18 ","$580.03 ","$585.89 ","$0.00 ","$97.35 ","$0.00 ","$92.69 ","$0.00 "
"125724","ERX","HCPCS J2370","00641-6142-25","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","00641-6188-01","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","00641-6188-10","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","42023-0213-25","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","42023-0214-01","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","42023-0214-10","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","63323-0751-01","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","70121-1577-01","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","70121-1577-05","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"125724","ERX","HCPCS J2370","76014-0004-10","PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"126034","ERX","HCPCS J7188","00944-5001-01","OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR","BOTH IP/OP","$3,672.50 ","$2,717.65 ","$0.00 ","$3,331.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,331.25 ","$0.00 ","$1,665.63 ","$2,638.35 ","$2,665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126034","ERX","HCPCS J7188","00944-5011-01","OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR","BOTH IP/OP","$3,672.50 ","$2,717.65 ","$0.00 ","$3,331.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,331.25 ","$0.00 ","$1,665.63 ","$2,638.35 ","$2,665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126056","ERX","HCPCS 25000001","00005-0100-05","MENINGOCOCCAL B VAC (RECOMB) IM SUSY","BOTH IP/OP","$588.78 ","$435.70 ","$0.00 ","$548.15 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.15 ","$0.00 ","$274.08 ","$434.13 ","$438.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126084","ERX","HCPCS 25000001","42023-0164-25","VASOPRESSIN 20 UNIT/ML IV SOLN","BOTH IP/OP","$197.44 ","$146.11 ","$0.00 ","$224.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$224.04 ","$0.00 ","$112.02 ","$177.44 ","$179.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126108","ERX","HCPCS 25000001","08317-5411-00","GLUCOCARD SHINE W/DEVICE KIT","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126110","ERX","HCPCS 25000001","08317-5400-50","GLUCOCARD SHINE TEST VI STRP","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.40 ","$0.00 ","$34.20 ","$54.17 ","$54.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126226","ERX","HCPCS J2547","61364-0181-03","PERAMIVIR 200 MG/20ML IV SOLN","BOTH IP/OP","$1,109.60 ","$821.10 ","$0.00 ","$1,007.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,007.00 ","$0.00 ","$503.50 ","$797.54 ","$805.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126226","ERX","HCPCS J2547","72769-0181-03","PERAMIVIR 200 MG/20ML IV SOLN","BOTH IP/OP","$1,109.60 ","$821.10 ","$0.00 ","$1,007.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,007.00 ","$0.00 ","$503.50 ","$797.54 ","$805.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126229","ERX","HCPCS 63700001","00173-0873-10","UMECLIDINIUM BROMIDE 62.5 MCG/INH IN AEPB","BOTH IP/OP","$1,240.77 ","$918.17 ","$0.00 ","$1,093.29 ","","$220.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,093.29 ","$0.00 ","$546.65 ","$865.89 ","$874.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126242","ERX","HCPCS J7313","68611-0190-02","FLUOCINOLONE ACETONIDE 0.19 MG INTRAVITREAL IMPL","BOTH IP/OP","$23,865.60 ","$17,660.54 ","$0.00 ","$21,648.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,648.00 ","$0.00 ","$10,824.00 ","$17,145.22 ","$17,318.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126317","ERX","HCPCS 90651","00006-4119-01","HPV 9-VALENT RECOMB VACCINE IM SUSP","BOTH IP/OP","$888.19 ","$657.26 ","$0.00 ","$724.43 ","$399.69 ","$229.60 ","$185.12 ","$0.00 ","$0.00 ","$267.82 ","$724.43 ","$0.00 ","$362.22 ","$573.75 ","$579.54 ","$434.66 ","$267.82 ","$0.00 ","$255.01 ","$0.00 "
"126317","ERX","HCPCS 90651","00006-4119-03","HPV 9-VALENT RECOMB VACCINE IM SUSP","BOTH IP/OP","$888.19 ","$657.26 ","$0.00 ","$724.43 ","$399.69 ","$229.60 ","$185.12 ","$0.00 ","$0.00 ","$267.82 ","$724.43 ","$0.00 ","$362.22 ","$573.75 ","$579.54 ","$434.66 ","$267.82 ","$0.00 ","$255.01 ","$0.00 "
"126371","ERX","HCPCS J0695","67919-0030-01","CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR","BOTH IP/OP","$504.89 ","$373.62 ","$0.00 ","$458.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.31 ","$0.00 ","$229.16 ","$362.98 ","$366.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126373","ERX","HCPCS J9299","00003-3772-11","NIVOLUMAB 40 MG/4ML IV SOLN","BOTH IP/OP","$3,064.28 ","$2,267.57 ","$0.00 ","$2,697.99 ","$1,406.51 ","$1,169.80 ","$638.67 ","$0.00 ","$0.00 ","$1,323.52 ","$2,697.99 ","$1,167.81 ","$1,349.00 ","$2,136.81 ","$2,158.39 ","$1,612.69 ","$1,323.52 ","$0.00 ","$1,260.22 ","$1,141.36 "
"126374","ERX","HCPCS J9299","00003-3774-12","NIVOLUMAB 100 MG/10ML IV SOLN","BOTH IP/OP","$7,660.64 ","$5,668.87 ","$0.00 ","$6,744.96 ","$3,516.24 ","$2,924.50 ","$1,596.67 ","$0.00 ","$0.00 ","$3,308.80 ","$6,744.96 ","$2,919.53 ","$3,372.48 ","$5,342.01 ","$5,395.97 ","$4,031.73 ","$3,308.80 ","$0.00 ","$3,150.54 ","$2,853.40 "
"126594","ERX","HCPCS 90620","58160-0976-02","MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY","BOTH IP/OP","$704.90 ","$521.63 ","$0.00 ","$587.89 ","$317.21 ","$171.96 ","$146.92 ","$0.00 ","$0.00 ","$200.63 ","$587.89 ","$0.00 ","$293.95 ","$465.61 ","$470.31 ","$352.73 ","$200.63 ","$0.00 ","$0.00 ","$0.00 "
"126594","ERX","HCPCS 90620","58160-0976-20","MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY","BOTH IP/OP","$704.90 ","$521.63 ","$0.00 ","$587.89 ","$317.21 ","$171.96 ","$146.92 ","$0.00 ","$0.00 ","$200.63 ","$587.89 ","$0.00 ","$293.95 ","$465.61 ","$470.31 ","$352.73 ","$200.63 ","$0.00 ","$0.00 ","$0.00 "
"126697","ERX","HCPCS J9271","00006-3026-02","PEMBROLIZUMAB 100 MG/4ML IV SOLN","BOTH IP/OP","$13,924.39 ","$10,304.05 ","$0.00 ","$12,140.01 ","$6,265.98 ","$5,230.00 ","$2,902.19 ","$0.00 ","$0.00 ","$5,905.55 ","$12,140.01 ","$5,185.85 ","$6,070.01 ","$9,472.82 ","$9,712.01 ","$7,161.41 ","$5,905.55 ","$0.00 ","$5,623.09 ","$5,092.70 "
"126882","ERX","HCPCS 63700001","59676-0575-30","PREZCOBIX:DARUNAVIR-COBICISTAT 800-150 MG PO TABS","BOTH IP/OP","$292.74 ","$216.63 ","$0.00 ","$254.30 ","","$55.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$254.30 ","$0.00 ","$127.15 ","$201.41 ","$203.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126886","ERX","HCPCS 63700002","68546-0317-30","GLATIRAMER ACETATE 20 MG/ML SC SOSY","BOTH IP/OP","$830.92 ","$614.88 ","$0.00 ","$754.09 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$754.09 ","$0.00 ","$377.05 ","$597.24 ","$603.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126887","ERX","HCPCS 25000001","00409-4093-01","CHROMIC CHLORIDE 40 MCG/10ML IV SOLN","BOTH IP/OP","$91.87 ","$67.98 ","$0.00 ","$82.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.08 ","$0.00 ","$41.04 ","$65.01 ","$65.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126888","ERX","HCPCS 25000001","63323-0086-05","POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","BOTH IP/OP","$74.46 ","$55.10 ","$0.00 ","$67.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.53 ","$0.00 ","$33.77 ","$53.48 ","$54.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126888","ERX","HCPCS 25000001","65219-0052-29","POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","BOTH IP/OP","$74.46 ","$55.10 ","$0.00 ","$67.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.53 ","$0.00 ","$33.77 ","$53.48 ","$54.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126893","ERX","HCPCS 25000001","00781-3040-95","PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN","BOTH IP/OP","$32.18 ","$23.81 ","$0.00 ","$29.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.19 ","$0.00 ","$14.60 ","$23.12 ","$23.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126894","ERX","HCPCS J0135 ","00074-4339-02","ADALIMUMAB 40 MG/0.8ML SC PNKT","BOTH IP/OP","$8,092.86 ","$5,988.72 ","$0.00 ","$6,835.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,835.07 ","$0.00 ","$3,417.54 ","$5,413.38 ","$5,468.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126894","ERX","HCPCS J0135 ","00074-4339-06","ADALIMUMAB 40 MG/0.8ML SC PNKT","BOTH IP/OP","$8,092.86 ","$5,988.72 ","$0.00 ","$6,835.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,835.07 ","$0.00 ","$3,417.54 ","$5,413.38 ","$5,468.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126894","ERX","HCPCS J0135 ","00074-4339-07","ADALIMUMAB 40 MG/0.8ML SC PNKT","BOTH IP/OP","$8,092.86 ","$5,988.72 ","$0.00 ","$6,835.07 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,835.07 ","$0.00 ","$3,417.54 ","$5,413.38 ","$5,468.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126921","ERX","HCPCS 25000001","00078-0639-68","SECUKINUMAB 150 MG/ML SC SOAJ","BOTH IP/OP","$16,080.36 ","$11,899.47 ","$0.00 ","$13,631.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,631.93 ","$0.00 ","$6,815.97 ","$10,796.49 ","$10,905.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126934","ERX","HCPCS 63700001","00003-3641-11","EVOTAZ:ATAZANAVIR-COBICISTAT 300-150 MG PO TABS","BOTH IP/OP","$222.84 ","$164.90 ","$0.00 ","$202.29 ","","$39.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.29 ","$0.00 ","$101.15 ","$160.21 ","$161.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126960","ERX","HCPCS 25000001","00069-0187-21","PALBOCICLIB 75 MG PO CAPS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126961","ERX","HCPCS 25000001","00069-0188-21","PALBOCICLIB 100 MG PO CAPS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"126962","ERX","HCPCS 25000001","00069-0189-21","PALBOCICLIB 125 MG PO CAPS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127008","ERX","HCPCS 63700001","62856-0720-05","LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK","BOTH IP/OP","$2,109.61 ","$1,561.11 ","$0.00 ","$1,826.02 ","","$385.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127008","ERX","HCPCS 63700001","62856-0720-30","LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK","BOTH IP/OP","$2,109.61 ","$1,561.11 ","$0.00 ","$1,826.02 ","","$385.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127009","ERX","HCPCS 63700001","62856-0714-05","LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK","BOTH IP/OP","$1,189.20 ","$880.01 ","$0.00 ","$1,008.12 ","","$217.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,008.12 ","$0.00 ","$504.06 ","$798.43 ","$806.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127009","ERX","HCPCS 63700001","62856-0714-30","LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK","BOTH IP/OP","$1,189.20 ","$880.01 ","$0.00 ","$1,008.12 ","","$217.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,008.12 ","$0.00 ","$504.06 ","$798.43 ","$806.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127013","ERX","HCPCS 63700001","62856-0710-05","LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK","BOTH IP/OP","$2,109.61 ","$1,561.11 ","$0.00 ","$1,826.02 ","","$385.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127013","ERX","HCPCS 63700001","62856-0710-30","LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK","BOTH IP/OP","$2,109.61 ","$1,561.11 ","$0.00 ","$1,826.02 ","","$385.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127014","ERX","HCPCS 63700001","62856-0724-05","LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK","BOTH IP/OP","$792.81 ","$586.68 ","$0.00 ","$672.08 ","","$144.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.08 ","$0.00 ","$336.04 ","$532.29 ","$537.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127014","ERX","HCPCS 63700001","62856-0724-30","LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK","BOTH IP/OP","$792.81 ","$586.68 ","$0.00 ","$672.08 ","","$144.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.08 ","$0.00 ","$336.04 ","$532.29 ","$537.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","00378-6470-16","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","00378-6470-99","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","10019-0553-03","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","10019-0553-04","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","45802-0580-84","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127054","ERX","HCPCS 25000001","66758-0208-58","SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE)","BOTH IP/OP","$82.61 ","$61.13 ","$0.00 ","$74.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.90 ","$0.00 ","$37.45 ","$59.32 ","$59.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127096","ERX","HCPCS 25000001","","PLENAMINE 15 % IV SOLN","BOTH IP/OP","$1,448.32 ","$1,071.76 ","$0.00 ","$1,314.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.40 ","$0.00 ","$657.20 ","$1,041.00 ","$1,051.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127096","ERX","HCPCS 25000001","00338-0502-06","PLENAMINE 15 % IV SOLN","BOTH IP/OP","$1,448.32 ","$1,071.76 ","$0.00 ","$1,314.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.40 ","$0.00 ","$657.20 ","$1,041.00 ","$1,051.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","00143-9318-01","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","00143-9318-10","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","00409-3375-04","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","00409-3375-14","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","36000-0162-10","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","67457-0852-00","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","67457-0852-04","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127226","ERX","HCPCS 25000001","70121-1576-07","NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","BOTH IP/OP","$94.65 ","$70.04 ","$0.00 ","$84.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.97 ","$0.00 ","$42.49 ","$67.30 ","$67.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127500","ERX","HCPCS J0714","00456-2700-10","CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR","BOTH IP/OP","$1,257.27 ","$930.38 ","$0.00 ","$1,141.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,141.02 ","$0.00 ","$570.51 ","$903.69 ","$912.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127503","ERX","HCPCS 25000001","00469-0520-14","ISAVUCONAZONIUM SULFATE 186 MG PO CAPS","BOTH IP/OP","$668.17 ","$494.45 ","$0.00 ","$588.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$588.72 ","$0.00 ","$294.36 ","$466.27 ","$470.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"127504","ERX","HCPCS J1833","00469-0420-99","ISAVUCONAZONIUM SULFATE 372 MG IV SOLR","BOTH IP/OP","$1,138.28 ","$842.33 ","$0.00 ","$1,002.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.61 ","$1,002.95 ","$306.23 ","$501.48 ","$794.34 ","$802.36 ","$422.89 ","$156.96 ","$0.00 ","$159.67 ","$294.25 "
"127505","ERX","HCPCS J7297","00023-5858-01","LEVONORGESTREL 19.5 MCG/DAY IU IUD","BOTH IP/OP","$2,266.18 ","$1,676.97 ","$0.00 ","$2,266.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$880.55 ","$2,266.18 ","$0.00 ","$1,133.09 ","$1,794.81 ","$1,812.94 ","$1,359.71 ","$880.55 ","$0.00 ","$838.43 ","$0.00 "
"127687","ERX","HCPCS 63700001","55513-0800-60","IVABRADINE HCL 5 MG PO TABS","BOTH IP/OP","$41.19 ","$30.48 ","$0.00 ","$35.28 ","","$7.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.28 ","$0.00 ","$17.64 ","$27.94 ","$28.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128092","ERX","HCPCS J1610","63323-0593-03","GLUCAGON HCL 1 MG IJ SOLR","BOTH IP/OP","$343.73 ","$254.36 ","$0.00 ","$312.02 ","$154.68 ","$166.77 ","$88.07 ","$0.00 ","$0.00 ","$255.63 ","$312.02 ","$209.24 ","$156.01 ","$247.12 ","$249.62 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"128092","ERX","HCPCS J1610","63323-0596-11","GLUCAGON HCL 1 MG IJ SOLR","BOTH IP/OP","$343.73 ","$254.36 ","$0.00 ","$312.02 ","$154.68 ","$166.77 ","$88.07 ","$0.00 ","$0.00 ","$255.63 ","$312.02 ","$209.24 ","$156.01 ","$247.12 ","$249.62 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"128092","ERX","HCPCS J1610","63323-0596-13","GLUCAGON HCL 1 MG IJ SOLR","BOTH IP/OP","$343.73 ","$254.36 ","$0.00 ","$312.02 ","$154.68 ","$166.77 ","$88.07 ","$0.00 ","$0.00 ","$255.63 ","$312.02 ","$209.24 ","$156.01 ","$247.12 ","$249.62 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"128092","ERX","HCPCS J1610","63323-0596-16","GLUCAGON HCL 1 MG IJ SOLR","BOTH IP/OP","$343.73 ","$254.36 ","$0.00 ","$312.02 ","$154.68 ","$166.77 ","$88.07 ","$0.00 ","$0.00 ","$255.63 ","$312.02 ","$209.24 ","$156.01 ","$247.12 ","$249.62 ","$288.94 ","$255.63 ","$0.00 ","$243.41 ","$199.13 "
"128482","ERX","HCPCS C9460","10122-0620-01","CANGRELOR TETRASODIUM 50 MG IV SOLR","BOTH IP/OP","$2,260.83 ","$1,673.01 ","$0.00 ","$2,157.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,157.12 ","$0.00 ","$1,078.56 ","$1,708.44 ","$1,725.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128482","ERX","HCPCS C9460","10122-0620-10","CANGRELOR TETRASODIUM 50 MG IV SOLR","BOTH IP/OP","$2,260.83 ","$1,673.01 ","$0.00 ","$2,157.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,157.12 ","$0.00 ","$1,078.56 ","$1,708.44 ","$1,725.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128545","ERX","HCPCS 25000001","00078-0659-20","SACUBITRIL-VALSARTAN 24-26 MG PO TABS","BOTH IP/OP","$35.21 ","$26.06 ","$0.00 ","$35.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.21 ","$0.00 ","$17.61 ","$27.89 ","$28.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128546","ERX","HCPCS 25000001","00078-0777-20","SACUBITRIL-VALSARTAN 49-51 MG PO TABS","BOTH IP/OP","$35.21 ","$26.06 ","$0.00 ","$35.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.21 ","$0.00 ","$17.61 ","$27.89 ","$28.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128547","ERX","HCPCS 25000001","00078-0696-20","SACUBITRIL-VALSARTAN 97-103 MG PO TABS","BOTH IP/OP","$48.85 ","$36.15 ","$0.00 ","$41.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.41 ","$0.00 ","$20.71 ","$32.80 ","$33.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128559","ERX","HCPCS 63700001","99999-6006-28","AMINOCAPROIC ACID 0.25 GM/ML PO SOLN","BOTH IP/OP","$338.69 ","$250.63 ","$0.00 ","$6,875.79 ","","$60.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.79 ","$0.00 ","$3,437.90 ","$243.49 ","$5,500.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128559","ERX","HCPCS 63700001","49411-0052-08","AMINOCAPROIC ACID 0.25 GM/ML PO SOLN","BOTH IP/OP","$338.69 ","$250.63 ","$0.00 ","$6,875.79 ","","$60.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.79 ","$0.00 ","$3,437.90 ","$5,445.63 ","$5,500.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"128685","ERX","HCPCS J2280","63323-0850-74","MOXIFLOXACIN HCL 400 MG/250ML IV SOLN","BOTH IP/OP","$191.72 ","$141.87 ","$0.00 ","$174.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.04 ","$0.00 ","$87.02 ","$137.84 ","$139.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129082","ERX","HCPCS Q5101","61314-0318-05","FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY","BOTH IP/OP","$961.37 ","$711.41 ","$0.00 ","$872.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.88 ","$872.48 ","$0.00 ","$436.24 ","$691.00 ","$697.98 ","$0.00 ","$193.88 ","$0.00 ","$0.00 ","$0.00 "
"129082","ERX","HCPCS Q5101","61314-0318-10","FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY","BOTH IP/OP","$961.37 ","$711.41 ","$0.00 ","$872.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.88 ","$872.48 ","$0.00 ","$436.24 ","$691.00 ","$697.98 ","$0.00 ","$193.88 ","$0.00 ","$0.00 ","$0.00 "
"129083","ERX","HCPCS Q5101","61314-0326-10","FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY","BOTH IP/OP","$1,264.28 ","$935.57 ","$0.00 ","$1,264.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.20 ","$1,264.28 ","$0.00 ","$632.14 ","$1,001.31 ","$1,011.42 ","$0.00 ","$310.20 ","$0.00 ","$0.00 ","$0.00 "
"129084","ERX","HCPCS J9310","50242-0051-21","RITUXIMAB 100 MG/10ML IV SOLN","BOTH IP/OP","$2,547.97 ","$1,885.50 ","$0.00 ","$2,311.22 ","$1,146.59 ","$856.33 ","$531.06 ","$0.00 ","$0.00 ","$1,109.32 ","$2,311.22 ","$994.00 ","$1,155.61 ","$1,830.49 ","$1,848.98 ","$1,372.67 ","$1,109.32 ","$0.00 ","$1,056.26 ","$946.67 "
"129085","ERX","HCPCS J9310","50242-0053-06","RITUXIMAB 500 MG/50ML IV SOLN","BOTH IP/OP","$12,739.85 ","$9,427.49 ","$0.00 ","$11,556.06 ","$5,732.93 ","$4,281.65 ","$2,655.30 ","$0.00 ","$0.00 ","$5,546.59 ","$11,556.06 ","$4,970.02 ","$5,778.03 ","$9,152.40 ","$9,244.85 ","$6,863.36 ","$5,546.59 ","$0.00 ","$5,281.30 ","$4,733.35 "
"129088","ERX","HCPCS J3475","00409-6729-23","MAGNESIUM SULFATE 4 GM/100ML IV SOLN","BOTH IP/OP","$36.88 ","$27.29 ","$0.00 ","$33.06 ","$16.60 ","$0.00 ","$0.47 ","$0.00 ","$0.00 ","$5.92 ","$33.06 ","$0.00 ","$16.53 ","$26.18 ","$26.45 ","$0.00 ","$5.92 ","$0.00 ","$5.64 ","$0.00 "
"129091","ERX","HCPCS J3475","00409-6730-13","MAGNESIUM SULFATE 4 GM/50ML IV SOLN","BOTH IP/OP","$52.71 ","$39.01 ","$0.00 ","$52.00 ","$23.72 ","$0.00 ","$0.47 ","$0.00 ","$0.00 ","$5.92 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$5.92 ","$0.00 ","$5.64 ","$0.00 "
"129092","ERX","HCPCS J2505","55513-0190-01","PEGFILGRASTIM 6 MG/0.6ML SC SOSY","BOTH IP/OP","$17,405.60 ","$12,880.14 ","$0.00 ","$15,328.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,002.09 ","$15,328.41 ","$4,654.18 ","$7,664.21 ","$12,140.10 ","$12,262.73 ","$6,427.20 ","$5,002.09 ","$0.00 ","$4,762.84 ","$3,807.30 "
"129102","ERX","HCPCS J3230","00641-1398-35","CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","BOTH IP/OP","$83.22 ","$61.58 ","$0.00 ","$75.48 ","$37.45 ","$0.00 ","$9.35 ","$0.00 ","$0.00 ","$37.08 ","$75.48 ","$0.00 ","$37.74 ","$59.78 ","$60.38 ","$0.00 ","$37.08 ","$0.00 ","$35.31 ","$0.00 "
"129103","ERX","HCPCS 63700001","62175-0310-37","METHYLPHENIDATE HCL ER 18 MG PO TB24","BOTH IP/OP","$26.08 ","$19.30 ","$0.00 ","$23.65 ","","$4.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.65 ","$0.00 ","$11.83 ","$18.73 ","$18.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129105","ERX","HCPCS 63700001","00406-0136-01","METHYLPHENIDATE HCL ER 36 MG PO TB24","BOTH IP/OP","$27.57 ","$20.40 ","$0.00 ","$25.01 ","","$4.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.01 ","$0.00 ","$12.51 ","$19.81 ","$20.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129106","ERX","HCPCS 63700001","00406-0154-01","METHYLPHENIDATE HCL ER 54 MG PO TB24","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$27.21 ","","$5.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.21 ","$0.00 ","$13.61 ","$21.55 ","$21.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129107","ERX","HCPCS J0881","55513-0057-04","DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY","BOTH IP/OP","$678.03 ","$501.74 ","$0.00 ","$615.33 ","$305.11 ","$77.35 ","$89.89 ","$0.00 ","$0.00 ","$112.21 ","$615.33 ","$101.12 ","$307.67 ","$487.34 ","$492.26 ","$139.64 ","$112.21 ","$0.00 ","$106.85 ","$94.65 "
"129109","ERX","HCPCS J0881","55513-0021-01","DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY","BOTH IP/OP","$1,084.84 ","$802.78 ","$0.00 ","$984.53 ","$488.18 ","$123.76 ","$143.82 ","$0.00 ","$0.00 ","$179.54 ","$984.53 ","$161.78 ","$492.27 ","$779.75 ","$787.62 ","$223.42 ","$179.54 ","$0.00 ","$170.95 ","$151.44 "
"129109","ERX","HCPCS J0881","55513-0021-04","DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY","BOTH IP/OP","$1,084.84 ","$802.78 ","$0.00 ","$984.53 ","$488.18 ","$123.76 ","$143.82 ","$0.00 ","$0.00 ","$179.54 ","$984.53 ","$161.78 ","$492.27 ","$779.75 ","$787.62 ","$223.42 ","$179.54 ","$0.00 ","$170.95 ","$151.44 "
"129111","ERX","HCPCS J0881","55513-0023-01","DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY","BOTH IP/OP","$1,443.36 ","$1,068.09 ","$0.00 ","$1,337.48 ","$649.51 ","$185.64 ","$215.73 ","$0.00 ","$0.00 ","$269.31 ","$1,337.48 ","$242.68 ","$668.74 ","$1,059.28 ","$1,069.98 ","$335.12 ","$269.31 ","$0.00 ","$256.43 ","$227.16 "
"129111","ERX","HCPCS J0881","55513-0023-04","DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY","BOTH IP/OP","$1,443.36 ","$1,068.09 ","$0.00 ","$1,337.48 ","$649.51 ","$185.64 ","$215.73 ","$0.00 ","$0.00 ","$269.31 ","$1,337.48 ","$242.68 ","$668.74 ","$1,059.28 ","$1,069.98 ","$335.12 ","$269.31 ","$0.00 ","$256.43 ","$227.16 "
"129113","ERX","HCPCS J0881","55513-0025-01","DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY","BOTH IP/OP","$2,405.60 ","$1,780.14 ","$0.00 ","$2,229.12 ","$1,082.52 ","$309.40 ","$359.55 ","$0.00 ","$0.00 ","$448.85 ","$2,229.12 ","$404.46 ","$1,114.56 ","$1,765.46 ","$1,783.30 ","$558.54 ","$448.85 ","$0.00 ","$427.38 ","$378.60 "
"129113","ERX","HCPCS J0881","55513-0025-04","DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY","BOTH IP/OP","$2,405.60 ","$1,780.14 ","$0.00 ","$2,229.12 ","$1,082.52 ","$309.40 ","$359.55 ","$0.00 ","$0.00 ","$448.85 ","$2,229.12 ","$404.46 ","$1,114.56 ","$1,765.46 ","$1,783.30 ","$558.54 ","$448.85 ","$0.00 ","$427.38 ","$378.60 "
"129115","ERX","HCPCS J0881","55513-0027-04","DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY","BOTH IP/OP","$3,148.64 ","$2,329.99 ","$0.00 ","$2,856.06 ","$1,416.89 ","$464.10 ","$539.33 ","$0.00 ","$0.00 ","$673.28 ","$2,856.06 ","$606.69 ","$1,428.03 ","$2,262.00 ","$2,284.85 ","$837.81 ","$673.28 ","$0.00 ","$641.07 ","$567.90 "
"129116","ERX","HCPCS J0881","55513-0028-01","DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY","BOTH IP/OP","$4,198.18 ","$3,106.65 ","$0.00 ","$3,808.08 ","$1,889.18 ","$618.80 ","$719.10 ","$0.00 ","$0.00 ","$897.70 ","$3,808.08 ","$808.92 ","$1,904.04 ","$3,016.00 ","$3,046.46 ","$1,117.08 ","$897.70 ","$0.00 ","$854.76 ","$757.20 "
"129117","ERX","HCPCS J0881","55513-0111-01","DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY","BOTH IP/OP","$6,297.27 ","$4,659.98 ","$0.00 ","$5,712.12 ","$2,833.77 ","$928.20 ","$1,078.65 ","$0.00 ","$0.00 ","$1,346.55 ","$5,712.12 ","$1,213.38 ","$2,856.06 ","$4,524.00 ","$4,569.70 ","$1,675.62 ","$1,346.55 ","$0.00 ","$1,282.14 ","$1,135.80 "
"129118","ERX","HCPCS J0881","55513-0032-01","DARBEPOETIN ALFA 500 MCG/ML IJ SOSY","BOTH IP/OP","$10,495.44 ","$7,766.63 ","$0.00 ","$9,520.20 ","$4,722.95 ","$1,547.00 ","$1,797.75 ","$0.00 ","$0.00 ","$2,244.25 ","$9,520.20 ","$2,022.30 ","$4,760.10 ","$7,540.00 ","$7,616.16 ","$2,792.70 ","$2,244.25 ","$0.00 ","$2,136.91 ","$1,893.00 "
"129167","ERX","HCPCS 63700001","00186-0776-60","TICAGRELOR 60 MG PO TABS","BOTH IP/OP","$35.65 ","$26.38 ","$0.00 ","$29.88 ","","$6.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.88 ","$0.00 ","$14.94 ","$23.66 ","$23.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129213","ERX","HCPCS J2710","62295-3324-05","NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.12 ","$0.00 ","$0.00 ","$2.03 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.03 ","$0.00 ","$1.94 ","$0.00 "
"129243","ERX","HCPCS 25000001","64842-1025-01","TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS","BOTH IP/OP","$628.00 ","$464.72 ","$0.00 ","$546.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$546.70 ","$0.00 ","$273.35 ","$432.99 ","$437.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129243","ERX","HCPCS 25000001","64842-1025-02","TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS","BOTH IP/OP","$628.00 ","$464.72 ","$0.00 ","$546.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$546.70 ","$0.00 ","$273.35 ","$432.99 ","$437.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129243","ERX","HCPCS 25000001","64842-1025-03","TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS","BOTH IP/OP","$628.00 ","$464.72 ","$0.00 ","$546.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$546.70 ","$0.00 ","$273.35 ","$432.99 ","$437.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129244","ERX","HCPCS 25000001","64842-1020-01","TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS","BOTH IP/OP","$837.34 ","$619.63 ","$0.00 ","$728.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$728.93 ","$0.00 ","$364.47 ","$577.31 ","$583.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129244","ERX","HCPCS 25000001","64842-1020-02","TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS","BOTH IP/OP","$837.34 ","$619.63 ","$0.00 ","$728.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$728.93 ","$0.00 ","$364.47 ","$577.31 ","$583.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129244","ERX","HCPCS 25000001","64842-1020-03","TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS","BOTH IP/OP","$837.34 ","$619.63 ","$0.00 ","$728.93 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$728.93 ","$0.00 ","$364.47 ","$577.31 ","$583.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129506","ERX","HCPCS J9352","59676-0610-01","TRABECTEDIN 1 MG IV SOLR","BOTH IP/OP","$8,399.84 ","$6,215.88 ","$0.00 ","$7,469.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,469.92 ","$0.00 ","$3,734.96 ","$5,916.18 ","$5,975.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129598","ERX","HCPCS J3490","00597-0197-05","IDARUCIZUMAB 2.5 GM/50ML IV SOLN","BOTH IP/OP","$11,605.33 ","$8,587.94 ","$0.00 ","$9,856.81 ","$5,431.29 ","$0.00 ","$2,418.84 ","$0.00 ","$0.00 ","$1,725.85 ","$9,856.81 ","$0.00 ","$4,928.41 ","$7,806.59 ","$7,885.45 ","$0.00 ","$1,542.59 ","$0.00 ","$1,569.20 ","$0.00 "
"129781","ERX","HCPCS 63700001","53436-0084-04","PATIROMER SORBITEX CALCIUM 8.4 G PO PACK","BOTH IP/OP","$174.79 ","$129.34 ","$0.00 ","$168.00 ","","$31.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129834","ERX","HCPCS 25000001","61958-1901-01","GENVOYA:150-150-200-10 MG PO TABLET","BOTH IP/OP","$481.67 ","$356.44 ","$0.00 ","$395.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$395.08 ","$0.00 ","$197.54 ","$312.90 ","$316.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129853","ERX","HCPCS 25000001","50242-0717-01","COBIMETINIB FUMARATE 20 MG PO TABS","BOTH IP/OP","$448.32 ","$331.76 ","$0.00 ","$406.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$406.96 ","$0.00 ","$203.48 ","$322.31 ","$325.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129873","ERX","HCPCS 63700001","00310-1349-30","OSIMERTINIB MESYLATE 40 MG PO TABS","BOTH IP/OP","$1,575.60 ","$1,165.94 ","$0.00 ","$1,460.02 ","","$280.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,460.02 ","$0.00 ","$730.01 ","$1,156.34 ","$1,168.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129874","ERX","HCPCS 63700001","00310-1350-30","OSIMERTINIB MESYLATE 80 MG PO TABS","BOTH IP/OP","$1,575.60 ","$1,165.94 ","$0.00 ","$1,460.02 ","","$280.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,460.02 ","$0.00 ","$730.01 ","$1,156.34 ","$1,168.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129889","ERX","HCPCS J9145","57894-0502-05","DARATUMUMAB 100 MG/5ML IV SOLN","BOTH IP/OP","$1,809.95 ","$1,339.36 ","$0.00 ","$1,600.37 ","$858.47 ","$572.22 ","$377.24 ","$0.00 ","$0.00 ","$634.85 ","$1,600.37 ","$566.45 ","$800.19 ","$1,267.49 ","$1,280.30 ","$782.25 ","$634.85 ","$0.00 ","$604.49 ","$539.48 "
"129890","ERX","HCPCS J9145","57894-0502-20","DARATUMUMAB 400 MG/20ML IV SOLN","BOTH IP/OP","$6,317.34 ","$4,674.83 ","$0.00 ","$5,467.89 ","$2,996.33 ","$2,288.88 ","$1,316.69 ","$0.00 ","$0.00 ","$2,539.41 ","$5,467.89 ","$2,265.82 ","$2,733.95 ","$4,330.57 ","$4,374.31 ","$3,128.98 ","$2,539.41 ","$0.00 ","$2,417.95 ","$2,157.92 "
"129908","ERX","HCPCS 25000001","69547-0353-02","NALOXONE HCL 4 MG/0.1ML NA LIQD","BOTH IP/OP","$260.25 ","$192.59 ","$0.00 ","$236.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129912","ERX","HCPCS 63700001","63020-0078-02","IXAZOMIB CITRATE 2.3 MG PO CAPS","BOTH IP/OP","$8,589.50 ","$6,356.23 ","$0.00 ","$8,589.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,589.50 ","$0.00 ","$4,294.75 ","$6,802.88 ","$6,871.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129913","ERX","HCPCS 63700001","63020-0079-02","IXAZOMIB CITRATE 3 MG PO CAPS","BOTH IP/OP","$8,589.50 ","$6,356.23 ","$0.00 ","$8,589.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,589.50 ","$0.00 ","$4,294.75 ","$6,802.88 ","$6,871.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129914","ERX","HCPCS 63700001","63020-0080-02","IXAZOMIB CITRATE 4 MG PO CAPS","BOTH IP/OP","$8,589.50 ","$6,356.23 ","$0.00 ","$8,589.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,589.50 ","$0.00 ","$4,294.75 ","$6,802.88 ","$6,871.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129989","ERX","HCPCS J1976","00003-2291-11","ELOTUZUMAB 300 MG IV SOLR","BOTH IP/OP","$5,425.79 ","$4,015.08 ","$0.00 ","$4,777.22 ","$2,478.23 ","$2,058.00 ","$1,130.87 ","$0.00 ","$0.00 ","$2,319.45 ","$4,777.22 ","$2,046.24 ","$2,388.61 ","$3,783.56 ","$3,821.78 ","$2,825.76 ","$2,319.45 ","$0.00 ","$2,208.51 ","$1,948.80 "
"129990","ERX","HCPCS J1976","00003-4522-11","ELOTUZUMAB 400 MG IV SOLR","BOTH IP/OP","$7,234.36 ","$5,353.43 ","$0.00 ","$6,369.60 ","$3,304.29 ","$2,744.00 ","$1,507.82 ","$0.00 ","$0.00 ","$3,092.60 ","$6,369.60 ","$2,728.32 ","$3,184.80 ","$5,044.72 ","$5,095.68 ","$3,767.68 ","$3,092.60 ","$0.00 ","$2,944.68 ","$2,598.40 "
"130051","ERX","HCPCS J9034","63459-0348-04","BENDAMUSTINE HCL 100 MG/4ML IV SOLN","BOTH IP/OP","$6,708.95 ","$4,964.62 ","$0.00 ","$6,085.55 ","$3,019.03 ","$1,907.60 ","$1,398.31 ","$0.00 ","$0.00 ","$2,553.28 ","$6,085.55 ","$2,399.15 ","$3,042.78 ","$4,819.76 ","$4,868.44 ","$3,313.11 ","$2,553.28 ","$0.00 ","$2,431.15 ","$2,284.90 "
"130073","ERX","HCPCS 25000001","50242-0130-01","ALECTINIB HCL 150 MG PO CAPS","BOTH IP/OP","$275.13 ","$203.60 ","$0.00 ","$242.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.49 ","$0.00 ","$121.25 ","$192.05 ","$193.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130409","ERX","HCPCS 25000001","00006-5423-12","SUGAMMADEX SODIUM 200 MG/2ML IV SOLN","BOTH IP/OP","$443.28 ","$328.03 ","$0.00 ","$383.28 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$383.28 ","$0.00 ","$191.64 ","$303.56 ","$306.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130411","ERX","HCPCS 25000001","00006-5423-15","SUGAMMADEX SODIUM 500 MG/5ML IV SOLN","BOTH IP/OP","$705.54 ","$522.10 ","$0.00 ","$609.93 ","$333.34 ","$0.00 ","$147.05 ","$0.00 ","$0.00 ","$0.00 ","$609.93 ","$0.00 ","$304.97 ","$483.06 ","$487.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130411","ERX","HCPCS 25000001","00006-5425-15","SUGAMMADEX SODIUM 500 MG/5ML IV SOLN","BOTH IP/OP","$705.54 ","$522.10 ","$0.00 ","$609.93 ","$333.34 ","$0.00 ","$147.05 ","$0.00 ","$0.00 ","$0.00 ","$609.93 ","$0.00 ","$304.97 ","$483.06 ","$487.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130462","ERX","HCPCS 63700001","63044-0150-05","PRENATAL VITAMIN PLUS LOW IRON 27-1 MG PO TABS","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$1.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130656","ERX","HCPCS 25000001","69468-0151-04","URIDINE TRIACETATE 10 G PO PACK","BOTH IP/OP","$10,883.26 ","$8,053.61 ","$0.00 ","$9,871.98 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,871.98 ","$0.00 ","$4,935.99 ","$7,818.61 ","$7,897.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130656","ERX","HCPCS 25000001","69468-0151-20","URIDINE TRIACETATE 10 G PO PACK","BOTH IP/OP","$10,883.26 ","$8,053.61 ","$0.00 ","$9,871.98 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,871.98 ","$0.00 ","$4,935.99 ","$7,818.61 ","$7,897.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130661","ERX","HCPCS 25000001","00006-3074-02","ELBASVIR-GRAZOPREVIR 50-100 MG PO TABS","BOTH IP/OP","$911.04 ","$674.17 ","$0.00 ","$826.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$826.80 ","$0.00 ","$413.40 ","$654.83 ","$661.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","00009-4992-01","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","00009-4992-02","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","00009-5140-04","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","00781-3433-95","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","25021-0169-87","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","55150-0242-51","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130884","ERX","HCPCS J2020","63323-0713-13","LINEZOLID 600 MG/300ML IV SOLN","BOTH IP/OP","$270.66 ","$200.29 ","$0.00 ","$245.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.70 ","$0.00 ","$122.85 ","$194.59 ","$196.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130886","ERX","HCPCS J9065","63323-0140-10","CLADRIBINE 10 MG/10ML IV SOLN","BOTH IP/OP","$1,351.98 ","$1,000.47 ","$0.00 ","$1,252.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,252.80 ","$0.00 ","$626.40 ","$992.22 ","$1,002.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130887","ERX","HCPCS 25000001","00074-4382-20","CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","BOTH IP/OP","$1,040.69 ","$770.11 ","$0.00 ","$944.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$944.46 ","$0.00 ","$472.23 ","$748.01 ","$755.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130887","ERX","HCPCS 25000001","00074-4382-93","CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","BOTH IP/OP","$1,040.69 ","$770.11 ","$0.00 ","$944.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$944.46 ","$0.00 ","$472.23 ","$748.01 ","$755.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130897","ERX","HCPCS J1455","76310-0024-01","FOSCARNET SODIUM 6000 MG/250ML IV SOLN","BOTH IP/OP","$1,469.18 ","$1,087.19 ","$0.00 ","$1,361.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,361.40 ","$0.00 ","$680.70 ","$1,078.23 ","$1,089.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130897","ERX","HCPCS J1455","76310-0024-11","FOSCARNET SODIUM 6000 MG/250ML IV SOLN","BOTH IP/OP","$1,469.18 ","$1,087.19 ","$0.00 ","$1,361.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,361.40 ","$0.00 ","$680.70 ","$1,078.23 ","$1,089.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130897","ERX","HCPCS J1455","76310-0024-15","FOSCARNET SODIUM 6000 MG/250ML IV SOLN","BOTH IP/OP","$1,469.18 ","$1,087.19 ","$0.00 ","$1,361.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,361.40 ","$0.00 ","$680.70 ","$1,078.23 ","$1,089.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130897","ERX","HCPCS J1455","76310-0024-25","FOSCARNET SODIUM 6000 MG/250ML IV SOLN","BOTH IP/OP","$1,469.18 ","$1,087.19 ","$0.00 ","$1,361.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,361.40 ","$0.00 ","$680.70 ","$1,078.23 ","$1,089.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","00013-1114-21","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","39822-1000-01","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","39822-1001-06","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","39822-1001-07","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","47781-0601-91","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","55150-0188-10","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","63323-0563-10","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","67850-0042-10","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","70860-0400-10","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130900","ERX","HCPCS 25000001","70860-0400-41","TRANEXAMIC ACID 1000 MG/10ML IV SOLN","BOTH IP/OP","$141.05 ","$104.38 ","$0.00 ","$189.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130905","ERX","HCPCS J2704","00409-4699-30","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","00409-4699-50","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","00591-2136-95","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","25021-0608-20","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","43598-0265-20","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","43598-0265-25","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","43598-0265-58","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"130905","ERX","HCPCS J2704","63323-0269-29","PROPOFOL 200 MG/20ML IV EMUL","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.60 ","$13.20 ","$0.00 ","$6.11 ","$0.00 ","$0.00 ","$4.66 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"131019","ERX","HCPCS 63700001","61958-2101-01","ODEFSEY:EMTRICIT-RILPIV-TENOFOV AF 200-25-25 MG TAB","BOTH IP/OP","$438.35 ","$324.38 ","$0.00 ","$359.55 ","","$78.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$359.55 ","$0.00 ","$179.78 ","$284.76 ","$287.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131430","ERX","HCPCS 25000001","00299-3921-08","CETAPHIL GENTLE CLEANSER EX LIQD","BOTH IP/OP","$26.82 ","$19.85 ","$0.00 ","$24.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.32 ","$0.00 ","$12.16 ","$19.26 ","$19.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131443","ERX","HCPCS J1815","00002-8824-27","INSULIN REGULAR HUMAN (CONC) 500 UNIT/ML SC SOPN","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$302.08 ","$8.15 ","$0.00 ","$3.13 ","$0.00 ","$0.00 ","$2.63 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$302.08 ","$0.00 "
"131448","ERX","HCPCS 63700001","50474-0470-66","BRIVARACETAM 25 MG PO TABS","BOTH IP/OP","$93.78 ","$69.40 ","$0.00 ","$82.56 ","","$17.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.56 ","$0.00 ","$41.28 ","$65.39 ","$66.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131449","ERX","HCPCS 25000001","50474-0570-09","BRIVARACETAM 50 MG PO TABS","BOTH IP/OP","$93.78 ","$69.40 ","$0.00 ","$82.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.56 ","$0.00 ","$41.28 ","$65.39 ","$66.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131451","ERX","HCPCS 25000001","50474-0770-09","BRIVARACETAM 100 MG PO TABS","BOTH IP/OP","$93.78 ","$69.40 ","$0.00 ","$82.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.56 ","$0.00 ","$41.28 ","$65.39 ","$66.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131458","ERX","HCPCS J2786","59310-0610-31","RESLIZUMAB 100 MG/10ML IV SOLN","BOTH IP/OP","$2,682.17 ","$1,984.81 ","$0.00 ","$2,339.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,339.46 ","$0.00 ","$1,169.73 ","$1,815.83 ","$1,871.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131469","ERX","HCPCS J0330","62295-3323-07","SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"131499","ERX","HCPCS 63700001","61958-2002-01","DESCOVY:EMTRICITABINE-TENOFOVIR AF 200-25 MG TAB","BOTH IP/OP","$282.99 ","$209.41 ","$0.00 ","$232.13 ","","$50.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.13 ","$0.00 ","$116.07 ","$183.85 ","$185.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131521","ERX","HCPCS J7183","68982-0182-02","WILATE:ANTIHEMOPHILIC FACTOR-VWF 1000-1000 UNITS IV KIT","BOTH IP/OP","$4,113.20 ","$3,043.77 ","$0.00 ","$3,444.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,444.00 ","$0.00 ","$1,722.00 ","$2,727.65 ","$2,755.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131529","ERX","HCPCS 25000001","00074-0576-22","VENETOCLAX 100 MG PO TABS","BOTH IP/OP","$433.72 ","$320.95 ","$0.00 ","$374.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.96 ","$0.00 ","$187.48 ","$296.97 ","$299.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131530","ERX","HCPCS 25000001","00074-0579-28","VENETOCLAX 10 & 50 & 100 MG PO TBPK","BOTH IP/OP","$7,555.64 ","$5,591.17 ","$0.00 ","$238.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.81 ","$0.00 ","$119.41 ","$189.14 ","$191.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131538","ERX","HCPCS 25000001","24571-0116-06","PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L IV SOLN","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131594","ERX","HCPCS 63700001","42388-0024-26","CABOZANTINIB S-MALATE 20 MG PO TABS","BOTH IP/OP","$2,244.27 ","$1,660.76 ","$0.00 ","$1,934.54 ","","$429.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.54 ","$0.00 ","$967.27 ","$1,532.16 ","$1,547.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131595","ERX","HCPCS 63700001","42388-0025-26","CABOZANTINIB S-MALATE 40 MG PO TABS","BOTH IP/OP","$2,244.27 ","$1,660.76 ","$0.00 ","$1,934.54 ","","$429.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.54 ","$0.00 ","$967.27 ","$1,532.16 ","$1,547.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131596","ERX","HCPCS 63700001","42388-0023-26","CABOZANTINIB S-MALATE 60 MG PO TABS","BOTH IP/OP","$2,244.27 ","$1,660.76 ","$0.00 ","$1,934.54 ","","$429.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,934.54 ","$0.00 ","$967.27 ","$1,532.16 ","$1,547.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131610","ERX","HCPCS 63700001","24510-0115-10","OXYCODONE ER 13.5 MG PO C12A","BOTH IP/OP","$39.84 ","$29.48 ","$0.00 ","$32.88 ","","$7.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.88 ","$0.00 ","$16.44 ","$26.04 ","$26.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131700","ERX","HCPCS J9022","50242-0917-01","ATEZOLIZUMAB 1200 MG/20ML IV SOLN","BOTH IP/OP","$25,682.24 ","$19,004.86 ","$0.00 ","$22,617.33 ","$12,019.29 ","$9,549.12 ","$5,352.82 ","$0.00 ","$0.00 ","$8,138.89 ","$22,617.33 ","$9,703.01 ","$11,308.67 ","$17,912.93 ","$18,093.86 ","$13,399.39 ","$8,138.89 ","$0.00 ","$8,138.89 ","$9,240.96 "
"131713","ERX","HCPCS 63700001","62856-0708-05","LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK","BOTH IP/OP","$1,189.20 ","$880.01 ","$0.00 ","$1,826.02 ","","$217.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131713","ERX","HCPCS 63700001","62856-0708-30","LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK","BOTH IP/OP","$1,189.20 ","$880.01 ","$0.00 ","$1,826.02 ","","$217.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131714","ERX","HCPCS 63700001","62856-0718-05","LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK","BOTH IP/OP","$792.81 ","$586.68 ","$0.00 ","$672.08 ","","$144.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.08 ","$0.00 ","$336.04 ","$532.29 ","$537.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131714","ERX","HCPCS 63700001","62856-0718-30","LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK","BOTH IP/OP","$792.81 ","$586.68 ","$0.00 ","$672.08 ","","$144.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.08 ","$0.00 ","$336.04 ","$532.29 ","$537.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131923","ERX","HCPCS 25000001","00781-3269-71","EPHEDRINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$25.35 ","$18.76 ","$0.00 ","$25.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.35 ","$0.00 ","$12.68 ","$20.08 ","$20.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131923","ERX","HCPCS 25000001","00781-3269-95","EPHEDRINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$25.35 ","$18.76 ","$0.00 ","$25.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.35 ","$0.00 ","$12.68 ","$20.08 ","$20.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131923","ERX","HCPCS 25000001","42023-0216-25","EPHEDRINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$25.35 ","$18.76 ","$0.00 ","$25.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.35 ","$0.00 ","$12.68 ","$20.08 ","$20.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131923","ERX","HCPCS 25000001","76014-0005-25","EPHEDRINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$25.35 ","$18.76 ","$0.00 ","$25.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.35 ","$0.00 ","$12.68 ","$20.08 ","$20.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131923","ERX","HCPCS 25000001","76014-0005-30","EPHEDRINE SULFATE 50 MG/ML IV SOLN","BOTH IP/OP","$25.35 ","$18.76 ","$0.00 ","$25.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.35 ","$0.00 ","$12.68 ","$20.08 ","$20.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132039","ERX","HCPCS J9047","76075-0102-01","CARFILZOMIB 30 MG IV SOLR","BOTH IP/OP","$3,497.29 ","$2,587.99 ","$0.00 ","$2,995.57 ","$1,666.63 ","$1,233.33 ","$728.92 ","$0.00 ","$0.00 ","$1,323.29 ","$2,995.57 ","$1,184.37 ","$1,497.79 ","$2,372.49 ","$2,396.46 ","$1,635.56 ","$1,323.29 ","$0.00 ","$1,259.99 ","$1,169.16 "
"132135","ERX","HCPCS 63700001","72626-2701-01","(EPCLUSA) SOFOSBUVIR-VELPATASVIR 400-100 MG PO TABS","BOTH IP/OP","$1,001.15 ","$740.85 ","$0.00 ","$908.58 ","","$178.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$908.58 ","$0.00 ","$454.29 ","$719.60 ","$726.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132336","ERX","HCPCS 25000001","00310-4600-39","BEVESPI:GLYCOPYRROLATE-FORMOTEROL 9-4.8 MCG/ACT IN AERO","BOTH IP/OP","$1,354.27 ","$1,002.16 ","$0.00 ","$1,218.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,218.33 ","$0.00 ","$609.17 ","$964.92 ","$974.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132337","ERX","HCPCS 90674","70461-0320-04","INFLUENZA VAC SUBUNIT QUAD 0.5 ML IM SUSY","BOTH IP/OP","$107.69 ","$79.69 ","$0.00 ","$107.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.86 ","$107.69 ","$15.72 ","$53.85 ","$85.29 ","$86.15 ","$15.72 ","$16.85 ","$28.00 ","$17.14 ","$28.00 "
"132344","ERX","HCPCS 25000001","00065-0426-36","GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132344","ERX","HCPCS 25000001","00065-0426-37","GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","BOTH IP/OP","$30.17 ","$22.33 ","$0.00 ","$27.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.36 ","$0.00 ","$13.68 ","$21.67 ","$21.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132810","ERX","HCPCS 25800001","63323-0820-74","FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL","BOTH IP/OP","$158.26 ","$117.11 ","$0.00 ","$109.38 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.38 ","$0.00 ","$54.69 ","$86.63 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132810","ERX","HCPCS 25800001","63323-0820-50","FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL","BOTH IP/OP","$158.26 ","$117.11 ","$0.00 ","$113.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.38 ","$0.00 ","$54.69 ","$113.65 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132815","ERX","HCPCS J3490","00517-0374-01","METHYLENE BLUE 50 MG/10ML IV SOLN","BOTH IP/OP","$833.84 ","$617.04 ","$0.00 ","$756.74 ","$410.65 ","$0.00 ","$173.79 ","$0.00 ","$0.00 ","$132.50 ","$756.74 ","$0.00 ","$378.37 ","$599.34 ","$605.39 ","$0.00 ","$118.43 ","$0.00 ","$120.47 ","$0.00 "
"132815","ERX","HCPCS J3490","00517-0374-05","METHYLENE BLUE 50 MG/10ML IV SOLN","BOTH IP/OP","$833.84 ","$617.04 ","$0.00 ","$756.74 ","$410.65 ","$0.00 ","$173.79 ","$0.00 ","$0.00 ","$132.50 ","$756.74 ","$0.00 ","$378.37 ","$599.34 ","$605.39 ","$0.00 ","$118.43 ","$0.00 ","$120.47 ","$0.00 "
"132818","ERX","HCPCS J2400","00143-9210-01","CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","BOTH IP/OP","$103.68 ","$76.72 ","$0.00 ","$94.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.01 ","$0.00 ","$47.01 ","$74.46 ","$75.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132818","ERX","HCPCS J2400","00143-9210-10","CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","BOTH IP/OP","$103.68 ","$76.72 ","$0.00 ","$94.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.01 ","$0.00 ","$47.01 ","$74.46 ","$75.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132818","ERX","HCPCS J2400","63323-0478-27","CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","BOTH IP/OP","$103.68 ","$76.72 ","$0.00 ","$94.01 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.01 ","$0.00 ","$47.01 ","$74.46 ","$75.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132822","ERX","HCPCS J3246","25208-0002-02","TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$837.31 ","$619.61 ","$0.00 ","$759.89 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$759.89 ","$0.00 ","$379.95 ","$601.83 ","$607.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132824","ERX","HCPCS J2310","00409-1219-01","NALOXONE HCL 4 MG/10ML IJ SOLN","BOTH IP/OP","$478.77 ","$354.29 ","$0.00 ","$434.60 ","$215.45 ","$0.00 ","$17.48 ","$0.00 ","$0.00 ","$62.42 ","$434.60 ","$0.00 ","$217.30 ","$344.20 ","$347.68 ","$0.00 ","$62.42 ","$0.00 ","$59.43 ","$0.00 "
"132824","ERX","HCPCS J2310","17478-0042-10","NALOXONE HCL 4 MG/10ML IJ SOLN","BOTH IP/OP","$478.77 ","$354.29 ","$0.00 ","$434.60 ","$215.45 ","$0.00 ","$17.48 ","$0.00 ","$0.00 ","$62.42 ","$434.60 ","$0.00 ","$217.30 ","$344.20 ","$347.68 ","$0.00 ","$62.42 ","$0.00 ","$59.43 ","$0.00 "
"132824","ERX","HCPCS J2310","67457-0299-10","NALOXONE HCL 4 MG/10ML IJ SOLN","BOTH IP/OP","$478.77 ","$354.29 ","$0.00 ","$434.60 ","$215.45 ","$0.00 ","$17.48 ","$0.00 ","$0.00 ","$62.42 ","$434.60 ","$0.00 ","$217.30 ","$344.20 ","$347.68 ","$0.00 ","$62.42 ","$0.00 ","$59.43 ","$0.00 "
"132826","ERX","HCPCS J7195","58394-0633-03","COAGULATION FACTOR IX (RECOMB) 250 UNITS IV KIT","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132827","ERX","HCPCS J7195","58394-0634-03","COAGULATION FACTOR IX (RECOMB) 500 UNITS IV KIT","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132828","ERX","HCPCS J7195","58394-0635-03","COAGULATION FACTOR IX (RECOMB BENEFIX) 1000 UNITS IV KIT","BOTH IP/OP","$3,706.40 ","$2,742.74 ","$0.00 ","$3,362.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,362.00 ","$0.00 ","$1,681.00 ","$2,662.70 ","$2,689.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132829","ERX","HCPCS J7195","58394-0636-03","COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132871","ERX","HCPCS 63700001","65649-0150-90","METHYLNALTREXONE BROMIDE 150 MG PO TABS","BOTH IP/OP","$112.06 ","$82.92 ","$0.00 ","$87.27 ","","$19.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.27 ","$0.00 ","$43.64 ","$69.12 ","$69.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"133343","ERX","HCPCS 25000001","61703-0421-53","M.V.I. PEDIATRIC IV SOLR","BOTH IP/OP","$28.73 ","$21.26 ","$0.00 ","$28.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.73 ","$0.00 ","$14.37 ","$22.75 ","$22.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"133367","ERX","HCPCS J3358","57894-0054-27","USTEKINUMAB 130 MG/26ML IV SOLN","BOTH IP/OP","$4,770.32 ","$3,530.04 ","$0.00 ","$4,128.89 ","$2,262.56 ","$1,509.95 ","$994.25 ","$0.00 ","$0.00 ","$1,822.31 ","$4,128.89 ","$1,643.05 ","$2,064.45 ","$3,270.08 ","$3,303.11 ","$2,268.97 ","$1,822.31 ","$0.00 ","$1,735.15 ","$1,564.81 "
"133767","ERX","HCPCS 63700001","59310-0302-40","BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB","BOTH IP/OP","$699.80 ","$517.85 ","$0.00 ","$604.87 ","","$124.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$604.87 ","$0.00 ","$302.44 ","$479.06 ","$483.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"133768","ERX","HCPCS 63700001","59310-0304-80","BECLOMETHASONE DIPROP HFA 80 MCG/ACT IN AERB","BOTH IP/OP","$937.01 ","$693.39 ","$0.00 ","$809.90 ","","$166.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$809.90 ","$0.00 ","$404.95 ","$641.44 ","$647.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"133781","ERX","HCPCS Q5103","00069-0809-01","INFLIXIMAB-DYYB 100 MG IV SOLR","BOTH IP/OP","$2,566.33 ","$1,899.08 ","$0.00 ","$2,327.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,327.86 ","$0.00 ","$1,163.93 ","$1,843.67 ","$1,862.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"133797","ERX","HCPCS J7999","42852-0862-25","NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$190.85 ","$141.23 ","$0.00 ","$173.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"133797","ERX","HCPCS J7999","70324-0676-01","NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$190.85 ","$141.23 ","$0.00 ","$173.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"133797","ERX","HCPCS J7999","76154-0475-15","NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$190.85 ","$141.23 ","$0.00 ","$173.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"133797","ERX","HCPCS J7999","99999-6011-03","NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$190.85 ","$141.23 ","$0.00 ","$173.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"133838","ERX","HCPCS J7296","50419-0424-01","LEVONORGESTREL 19.5 MG IU IUD","BOTH IP/OP","$2,710.06 ","$2,005.44 ","$0.00 ","$2,345.64 ","$1,280.50 ","$915.37 ","$564.84 ","$0.00 ","$0.00 ","$0.00 ","$2,345.64 ","$0.00 ","$1,172.82 ","$1,857.75 ","$1,876.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134020","ERX","HCPCS J9285","00002-8926-01","OLARATUMAB 500 MG/50ML IV SOLN","BOTH IP/OP","$6,041.76 ","$4,470.90 ","$0.00 ","$6,041.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,041.76 ","$0.00 ","$3,020.88 ","$4,785.07 ","$4,833.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134049","ERX","HCPCS J3246","25208-0001-04","TIROFIBAN HCL 3.75 MG/15ML IV CONC","BOTH IP/OP","$233.19 ","$172.56 ","$0.00 ","$211.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.68 ","$0.00 ","$105.84 ","$167.65 ","$169.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134129","ERX","HCPCS 63700001","61958-2301-01","TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS","BOTH IP/OP","$180.13 ","$133.30 ","$0.00 ","$164.17 ","","$32.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.17 ","$0.00 ","$82.09 ","$130.02 ","$131.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134529","ERX","HCPCS 25000001","62530-0000-11","UREA 15 G PO PACK","BOTH IP/OP","$17.60 ","$13.02 ","$0.00 ","$15.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.96 ","$0.00 ","$7.98 ","$12.64 ","$12.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134557","ERX","HCPCS 63600001","69660-0201-91","RUCAPARIB CAMSYLATE 200 MG PO TABS","BOTH IP/OP","$583.64 ","$431.89 ","$0.00 ","$509.42 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$509.42 ","$0.00 ","$254.71 ","$403.46 ","$407.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134558","ERX","HCPCS 63600001","69660-0203-91","RUCAPARIB CAMSYLATE 300 MG PO TABS","BOTH IP/OP","$583.64 ","$431.89 ","$0.00 ","$509.42 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$509.42 ","$0.00 ","$254.71 ","$403.46 ","$407.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134827","ERX","HCPCS J7999","71285-6044-01","OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN","BOTH IP/OP","$53.55 ","$39.63 ","$0.00 ","$48.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.50 ","$48.57 ","$0.00 ","$24.29 ","$38.47 ","$38.86 ","$0.00 ","$7.60 ","$0.00 ","$7.73 ","$0.00 "
"134827","ERX","HCPCS J7999","99999-6006-08","OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN","BOTH IP/OP","$53.55 ","$39.63 ","$0.00 ","$48.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.50 ","$48.57 ","$0.00 ","$24.29 ","$38.47 ","$38.86 ","$0.00 ","$7.60 ","$0.00 ","$7.73 ","$0.00 "
"134890","ERX","HCPCS 25000001","00283-0679-02","BENZOCAINE 20 % MT AERO","BOTH IP/OP","$116.62 ","$86.30 ","$0.00 ","$142.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.45 ","$0.00 ","$71.23 ","$112.82 ","$113.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134890","ERX","HCPCS 25000001","00283-0679-60","BENZOCAINE 20 % MT AERO","BOTH IP/OP","$116.62 ","$86.30 ","$0.00 ","$142.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.45 ","$0.00 ","$71.23 ","$112.82 ","$113.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134897","ERX","HCPCS 25000001","63323-0170-05","SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","BOTH IP/OP","$81.17 ","$60.07 ","$0.00 ","$73.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.61 ","$0.00 ","$36.81 ","$58.30 ","$58.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134898","ERX","HCPCS 25000001","00409-7391-72","SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","BOTH IP/OP","$152.92 ","$113.16 ","$0.00 ","$138.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.66 ","$0.00 ","$69.33 ","$109.82 ","$110.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134898","ERX","HCPCS 25000001","63323-0170-15","SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","BOTH IP/OP","$152.92 ","$113.16 ","$0.00 ","$138.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.66 ","$0.00 ","$69.33 ","$109.82 ","$110.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"134923","ERX","HCPCS J0461","00409-1630-10","ATROPINE SULFATE 1 MG/10ML IJ SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.94 ","$0.00 ","$0.90 ","$0.00 "
"134923","ERX","HCPCS J0461","00409-1630-15","ATROPINE SULFATE 1 MG/10ML IJ SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.94 ","$0.00 ","$0.90 ","$0.00 "
"134923","ERX","HCPCS J0461","00409-4911-11","ATROPINE SULFATE 1 MG/10ML IJ SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.94 ","$0.00 ","$0.90 ","$0.00 "
"134923","ERX","HCPCS J0461","00409-4911-34","ATROPINE SULFATE 1 MG/10ML IJ SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.94 ","$0.00 ","$0.90 ","$0.00 "
"134923","ERX","HCPCS J0461","76329-3339-01","ATROPINE SULFATE 1 MG/10ML IJ SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.94 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.94 ","$0.00 ","$0.90 ","$0.00 "
"134969","ERX","HCPCS J0461","00641-6006-01","ATROPINE SULFATE 8 MG/20ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.88 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.88 ","$0.00 ","$1.79 ","$0.00 "
"134969","ERX","HCPCS J0461","00641-6006-10","ATROPINE SULFATE 8 MG/20ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.88 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.88 ","$0.00 ","$1.79 ","$0.00 "
"135137","ERX","HCPCS 25000001","00121-1971-00","ACETAMINOPHEN 650 MG/20.3ML PO SOLN","BOTH IP/OP","$10.21 ","$7.56 ","$0.00 ","$9.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.26 ","$0.00 ","$4.63 ","$7.33 ","$7.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135137","ERX","HCPCS 25000001","00121-1971-21","ACETAMINOPHEN 650 MG/20.3ML PO SOLN","BOTH IP/OP","$10.21 ","$7.56 ","$0.00 ","$9.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.26 ","$0.00 ","$4.63 ","$7.33 ","$7.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135307","ERX","HCPCS J9285","00002-7190-01","OLARATUMAB 190 MG/19ML IV SOLN","BOTH IP/OP","$2,295.87 ","$1,698.94 ","$0.00 ","$2,295.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.87 ","$0.00 ","$1,147.94 ","$1,818.33 ","$1,836.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135334","ERX","HCPCS 25000001","61938-0456-03","CALFACTANT IN NACL 35-0.9 MG/ML-% INTRATRACHEA SUSP","BOTH IP/OP","$1,412.54 ","$1,045.28 ","$0.00 ","$1,234.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,234.80 ","$0.00 ","$617.40 ","$977.96 ","$987.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135357","ERX","HCPCS 25000001","70183-0125-84","TELOTRISTAT ETHYL(AS ETIPRATE) 250 MG PO TABS","BOTH IP/OP","$295.16 ","$218.42 ","$0.00 ","$295.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.16 ","$0.00 ","$147.58 ","$233.77 ","$236.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135365","ERX","HCPCS 25000001","49348-0274-72","SM DOUBLE ANTIBIOTIC 500-10000 UNIT/GM EX OINT","BOTH IP/OP","$13.93 ","$10.31 ","$0.00 ","$12.63 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.63 ","$0.00 ","$6.32 ","$10.00 ","$10.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135444","ERX","HCPCS 25000001","51754-1006-01","NITROPRUSSIDE SODIUM-NACL 50-0.9 MG/100ML-% IV SOLN","BOTH IP/OP","$229.02 ","$169.47 ","$0.00 ","$207.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135513","ERX","HCPCS C9399","44087-3535-01","AVELUMAB 200 MG/10ML IV SOLN","BOTH IP/OP","$4,617.41 ","$3,416.88 ","$0.00 ","$4,045.56 ","$2,109.00 ","$834.23 ","$962.38 ","$0.00 ","$0.00 ","$0.00 ","$4,045.56 ","$0.00 ","$2,022.78 ","$3,204.08 ","$3,236.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135585","ERX","HCPCS J2260","00143-9719-01","MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","BOTH IP/OP","$143.21 ","$105.98 ","$0.00 ","$121.45 ","$64.44 ","$0.00 ","$29.85 ","$0.00 ","$0.00 ","$7.19 ","$121.45 ","$0.00 ","$60.73 ","$96.19 ","$97.16 ","$0.00 ","$7.19 ","$0.00 ","$6.85 ","$0.00 "
"135585","ERX","HCPCS J2260","00143-9719-10","MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","BOTH IP/OP","$143.21 ","$105.98 ","$0.00 ","$121.45 ","$64.44 ","$0.00 ","$29.85 ","$0.00 ","$0.00 ","$7.19 ","$121.45 ","$0.00 ","$60.73 ","$96.19 ","$97.16 ","$0.00 ","$7.19 ","$0.00 ","$6.85 ","$0.00 "
"135585","ERX","HCPCS J2260","00338-6010-48","MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","BOTH IP/OP","$143.21 ","$105.98 ","$0.00 ","$121.45 ","$64.44 ","$0.00 ","$29.85 ","$0.00 ","$0.00 ","$7.19 ","$121.45 ","$0.00 ","$60.73 ","$96.19 ","$97.16 ","$0.00 ","$7.19 ","$0.00 ","$6.85 ","$0.00 "
"135585","ERX","HCPCS J2260","00409-2776-23","MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","BOTH IP/OP","$143.21 ","$105.98 ","$0.00 ","$121.45 ","$64.44 ","$0.00 ","$29.85 ","$0.00 ","$0.00 ","$7.19 ","$121.45 ","$0.00 ","$60.73 ","$96.19 ","$97.16 ","$0.00 ","$7.19 ","$0.00 ","$6.85 ","$0.00 "
"135586","ERX","HCPCS 25000001","00065-0092-65","FLUORESCEIN SODIUM 10 % IV SOLN","BOTH IP/OP","$38.24 ","$28.30 ","$0.00 ","$34.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.68 ","$0.00 ","$17.34 ","$27.47 ","$27.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135586","ERX","HCPCS 25000001","17478-0253-10","FLUORESCEIN SODIUM 10 % IV SOLN","BOTH IP/OP","$38.24 ","$28.30 ","$0.00 ","$34.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.68 ","$0.00 ","$17.34 ","$27.47 ","$27.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135587","ERX","HCPCS 25000001","17478-0250-20","FLUORESCEIN SODIUM 25 % IV SOLN","BOTH IP/OP","$176.12 ","$130.33 ","$0.00 ","$159.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.70 ","$0.00 ","$79.85 ","$126.48 ","$127.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"135612","ERX","HCPCS J2350","50242-0150-01","OCRELIZUMAB 300 MG/10ML IV SOLN","BOTH IP/OP","$46,186.47 ","$34,177.99 ","$0.00 ","$39,975.00 ","$21,719.20 ","$17,672.10 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$39,975.00 ","$18,086.36 ","$19,987.50 ","$31,660.20 ","$31,980.00 ","$24,976.40 ","$8,138.89 ","$0.00 ","$8,138.89 ","$17,225.10 "
"136063","ERX","HCPCS J8999","00069-0193-01","BOSUTINIB 400 MG PO TABS","BOTH IP/OP","$1,798.68 ","$1,331.02 ","$0.00 ","$1,504.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,504.61 ","$0.00 ","$752.31 ","$1,191.65 ","$1,203.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136139","ERX","HCPCS 63700001","69656-0103-90","NIRAPARIB TOSYLATE 100 MG PO CAPS","BOTH IP/OP","$591.01 ","$437.35 ","$0.00 ","$468.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$468.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136459","ERX","HCPCS J9355","50242-0132-01","TRASTUZUMAB 150 MG IV SOLR","BOTH IP/OP","$4,226.43 ","$3,127.56 ","$0.00 ","$3,833.71 ","$1,901.89 ","$1,296.15 ","$1,086.41 ","$0.00 ","$0.00 ","$1,865.78 ","$3,833.71 ","$1,679.30 ","$1,916.86 ","$3,036.30 ","$3,066.97 ","$2,319.03 ","$1,865.78 ","$0.00 ","$1,776.54 ","$1,534.76 "
"136518","ERX","HCPCS 63700001","00078-0698-51","MIDOSTAURIN 25 MG PO CAPS","BOTH IP/OP","$1,184.06 ","$876.20 ","$0.00 ","$1,018.56 ","","$222.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,018.56 ","$0.00 ","$509.28 ","$806.70 ","$814.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136518","ERX","HCPCS 63700001","00078-0698-99","MIDOSTAURIN 25 MG PO CAPS","BOTH IP/OP","$1,184.06 ","$876.20 ","$0.00 ","$1,018.56 ","","$222.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,018.56 ","$0.00 ","$509.28 ","$806.70 ","$814.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136524","ERX","HCPCS J9173","00310-4500-12","DURVALUMAB 120 MG/2.4ML IV SOLN","BOTH IP/OP","$2,457.60 ","$1,818.62 ","$0.00 ","$2,196.29 ","$1,105.92 ","$922.31 ","$512.23 ","$0.00 ","$0.00 ","$1,065.68 ","$2,196.29 ","$940.41 ","$1,098.15 ","$1,739.46 ","$1,757.03 ","$1,298.67 ","$1,065.68 ","$0.00 ","$1,014.71 ","$895.63 "
"136525","ERX","HCPCS J9173","00310-4611-50","DURVALUMAB 500 MG/10ML IV SOLN","BOTH IP/OP","$10,239.93 ","$7,577.55 ","$0.00 ","$9,151.16 ","$4,607.97 ","$3,842.95 ","$2,134.26 ","$0.00 ","$0.00 ","$4,440.33 ","$9,151.16 ","$3,918.39 ","$4,575.58 ","$7,247.72 ","$7,320.93 ","$5,411.11 ","$4,440.33 ","$0.00 ","$4,227.95 ","$3,731.80 "
"136642","ERX","HCPCS 25000001","56151-1625-01","GLUCOSE 15 GM/32ML PO GEL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136839","ERX","HCPCS J9017","63459-0601-06","ARSENIC TRIOXIDE 12 MG/6ML IV SOLN","BOTH IP/OP","$5,784.05 ","$4,280.20 ","$0.00 ","$2,191.86 ","$1,301.41 ","$153.73 ","$602.77 ","$0.00 ","$0.00 ","$621.39 ","$2,191.86 ","$558.36 ","$1,095.93 ","$1,735.95 ","$1,753.49 ","$771.06 ","$621.39 ","$0.00 ","$591.67 ","$344.03 "
"137000","ERX","HCPCS J9311","50242-0108-01","RITUXIMAB-HYALURONIDASE HUMAN 1400-23400 MG -UT/11.7ML SC SOLN","BOTH IP/OP","$17,835.69 ","$13,198.41 ","$0.00 ","$16,178.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,178.39 ","$0.00 ","$8,089.20 ","$12,813.28 ","$12,942.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137001","ERX","HCPCS J9311","50242-0109-01","RITUXIMAB-HYALURONIDASE HUMAN 1600-26800 MG -UT/13.4ML SC SOLN","BOTH IP/OP","$20,383.65 ","$15,083.90 ","$0.00 ","$18,489.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,489.60 ","$0.00 ","$9,244.80 ","$14,643.76 ","$14,791.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137149","ERX","HCPCS Q5104","00006-4305-01","INFLIXIMAB-ABDA 100 MG IV SOLR","BOTH IP/OP","$2,341.55 ","$1,732.75 ","$0.00 ","$2,169.77 ","$1,053.70 ","$395.84 ","$488.04 ","$0.00 ","$0.00 ","$608.06 ","$2,169.77 ","$560.65 ","$1,084.89 ","$1,718.46 ","$1,735.82 ","$774.23 ","$608.06 ","$0.00 ","$578.98 ","$533.95 "
"137149","ERX","HCPCS Q5104","00006-4305-02","INFLIXIMAB-ABDA 100 MG IV SOLR","BOTH IP/OP","$2,341.55 ","$1,732.75 ","$0.00 ","$2,169.77 ","$1,053.70 ","$395.84 ","$488.04 ","$0.00 ","$0.00 ","$608.06 ","$2,169.77 ","$560.65 ","$1,084.89 ","$1,718.46 ","$1,735.82 ","$774.23 ","$608.06 ","$0.00 ","$578.98 ","$533.95 "
"137213","ERX","HCPCS 25000001","70437-0240-26","NERATINIB MALEATE 40 MG PO TABS","BOTH IP/OP","$319.78 ","$236.64 ","$0.00 ","$290.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.29 ","$0.00 ","$145.15 ","$229.91 ","$232.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137683","ERX","HCPCS 25000001","99999-6004-60","CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137683","ERX","HCPCS 25000001","99999-6010-66","CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137683","ERX","HCPCS 25000001","00121-0766-16","CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$37.02 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$37.02 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137683","ERX","HCPCS 25000001","00054-3117-63","CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$37.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$37.62 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137687","ERX","HCPCS 25000001","00023-4554-30","CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137688","ERX","HCPCS J0401","59148-0045-80","ARIPIPRAZOLE ER 300 MG IM PRSY","BOTH IP/OP","$4,858.15 ","$3,595.03 ","$0.00 ","$2,337.01 ","$2,337.01 ","$1,797.00 ","$1,012.56 ","$0.00 ","$0.00 ","$0.00 ","$2,238.34 ","$0.00 ","$1,119.17 ","$1,772.77 ","$1,790.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137726","ERX","HCPCS J3490","70842-0120-06","MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR","BOTH IP/OP","$655.84 ","$485.32 ","$0.00 ","$566.68 ","$324.30 ","$0.00 ","$136.69 ","$0.00 ","$0.00 ","$99.22 ","$566.68 ","$0.00 ","$283.34 ","$448.81 ","$453.34 ","$0.00 ","$88.69 ","$0.00 ","$90.22 ","$0.00 "
"137728","ERX","HCPCS J9203","00008-4510-01","GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR","BOTH IP/OP","$24,670.39 ","$18,256.09 ","$0.00 ","$21,400.49 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,400.49 ","$0.00 ","$10,700.25 ","$16,949.19 ","$17,120.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137823","ERX","HCPCS 25000001","00409-4712-01","LIDOCAINE IN DEXTROSE 5-7.5 % INTRASPINAL SOLN","BOTH IP/OP","$46.57 ","$34.46 ","$0.00 ","$41.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.61 ","$0.00 ","$20.81 ","$32.96 ","$33.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"137829","ERX","HCPCS J0171","42023-0159-01","EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.96 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"137829","ERX","HCPCS J0171","42023-0159-25","EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$0.96 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.96 ","$0.00 ","$0.92 ","$0.00 "
"137999","ERX","HCPCS J3370","66288-7100-01","VANCOMYCIN HCL 100 G IV SOLR","BOTH IP/OP","$1,554.00 ","$1,149.96 ","$0.00 ","$1,440.00 ","$699.30 ","$0.00 ","$723.80 ","$0.00 ","$0.00 ","$796.65 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$796.65 ","$0.00 ","$758.55 ","$0.00 "
"138034","ERX","HCPCS 25000001","00002-4483-54","ABEMACICLIB 50 MG PO TABS","BOTH IP/OP","$817.07 ","$604.63 ","$0.00 ","$702.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"138035","ERX","HCPCS 25000001","00002-4815-54","ABEMACICLIB 100 MG PO TABS","BOTH IP/OP","$817.07 ","$604.63 ","$0.00 ","$702.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"138036","ERX","HCPCS 25000001","00002-5337-54","ABEMACICLIB 150 MG PO TABS","BOTH IP/OP","$817.07 ","$604.63 ","$0.00 ","$702.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"138037","ERX","HCPCS 25000001","00002-6216-54","ABEMACICLIB 200 MG PO TABS","BOTH IP/OP","$817.07 ","$604.63 ","$0.00 ","$702.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"138138","ERX","HCPCS J0171","42023-0168-01","EPINEPHRINE 30 MG/30ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$2.89 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.89 ","$0.00 ","$2.75 ","$0.00 "
"138195","ERX","HCPCS J7170","50242-0921-01","EMICIZUMAB-KXWH 60 MG/0.4ML SC SOLN","BOTH IP/OP","$16,711.21 ","$12,366.30 ","$0.00 ","$14,788.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,788.68 ","$0.00 ","$7,394.34 ","$11,712.63 ","$11,830.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"138537","ERX","HCPCS J3490","68547-0501-02","ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN","BOTH IP/OP","$4,068.00 ","$3,010.32 ","$0.00 ","$3,690.00 ","$1,830.60 ","$0.00 ","$847.87 ","$0.00 ","$0.00 ","$646.09 ","$3,690.00 ","$0.00 ","$1,845.00 ","$2,922.48 ","$2,952.00 ","$0.00 ","$577.49 ","$0.00 ","$587.45 ","$0.00 "
"138555","ERX","HCPCS J9299","00003-3734-13","NIVOLUMAB 240 MG/24ML IV SOLN","BOTH IP/OP","$18,385.58 ","$13,605.33 ","$0.00 ","$16,187.94 ","$8,438.99 ","$7,018.80 ","$3,832.01 ","$0.00 ","$0.00 ","$7,941.12 ","$16,187.94 ","$7,006.86 ","$8,093.97 ","$12,820.85 ","$12,950.35 ","$9,676.14 ","$7,941.12 ","$0.00 ","$7,561.30 ","$6,848.16 "
"138899","ERX","HCPCS J8499","61958-2501-01","BIKTARVY:BICTEGRAVIR-EMTRICITABINE-TENOFOVIR ALAFENAMIDE 50-200-25 PO TAB","BOTH IP/OP","$481.67 ","$356.44 ","$0.00 ","$395.08 ","$261.55 ","$85.74 ","$100.39 ","$0.00 ","$0.00 ","$69.18 ","$395.08 ","$0.00 ","$197.54 ","$312.90 ","$316.06 ","$237.05 ","$0.00 ","$0.00 ","$62.90 ","$0.00 "
"138939","ERX","HCPCS 25000001","59676-0600-12","APALUTAMIDE 60 MG PO TABS","BOTH IP/OP","$1,329.53 ","$983.85 ","$0.00 ","$1,298.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.03 ","$0.00 ","$649.02 ","$1,028.04 ","$1,038.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139004","ERX","HCPCS 63700001","57962-0070-28","IBRUTINIB 70 MG PO CAPS","BOTH IP/OP","$5,395.18 ","$3,992.43 ","$0.00 ","$4,556.66 ","","$1,031.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,556.66 ","$0.00 ","$2,278.33 ","$3,608.87 ","$3,645.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139005","ERX","HCPCS J8999","57962-0014-28","IBRUTINIB 140 MG PO TABS","BOTH IP/OP","$2,697.59 ","$1,996.22 ","$0.00 ","$2,278.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,278.33 ","$0.00 ","$1,139.17 ","$1,804.44 ","$1,822.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139006","ERX","HCPCS 63700001","57962-0280-28","IBRUTINIB 280 MG PO TABS","BOTH IP/OP","$2,697.59 ","$1,996.22 ","$0.00 ","$2,278.33 ","","$515.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,278.33 ","$0.00 ","$1,139.17 ","$1,804.44 ","$1,822.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139007","ERX","HCPCS 63700001","57962-0420-28","IBRUTINIB 420 MG PO TABS","BOTH IP/OP","$1,545.75 ","$1,143.86 ","$0.00 ","$1,333.66 ","","$295.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,333.66 ","$0.00 ","$666.83 ","$1,056.26 ","$1,066.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139008","ERX","HCPCS 63700001","57962-0560-28","IBRUTINIB 560 MG PO TABS","BOTH IP/OP","$1,545.75 ","$1,143.86 ","$0.00 ","$1,333.66 ","","$295.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,333.66 ","$0.00 ","$666.83 ","$1,056.26 ","$1,066.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139272","ERX","HCPCS J0690","00338-3503-41","CEFAZOLIN 1G IN 50ML DEXTROSE (ISO-OSMOTIC) PREMIXED SOLUTION","BOTH IP/OP","$26.40 ","$19.54 ","$0.00 ","$23.94 ","$11.88 ","$0.00 ","$1.39 ","$0.00 ","$0.00 ","$1.93 ","$23.94 ","$0.00 ","$11.97 ","$18.96 ","$19.15 ","$0.00 ","$1.93 ","$0.00 ","$1.83 ","$0.00 "
"139273","ERX","HCPCS 25000001","00781-3126-46","NAFCILLIN SODIUM 10 G IV SOLR","BOTH IP/OP","$466.27 ","$345.04 ","$0.00 ","$423.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$423.25 ","$0.00 ","$211.63 ","$335.21 ","$338.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139273","ERX","HCPCS 25000001","00781-3126-95","NAFCILLIN SODIUM 10 G IV SOLR","BOTH IP/OP","$466.27 ","$345.04 ","$0.00 ","$423.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$423.25 ","$0.00 ","$211.63 ","$335.21 ","$338.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139275","ERX","HCPCS 25000001","00065-0418-81","DEXTRAN 70-HYPROMELLOSE 0.1-0.3 % OP SOLN","BOTH IP/OP","$16.53 ","$12.23 ","$0.00 ","$16.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.53 ","$0.00 ","$8.27 ","$13.09 ","$13.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139276","ERX","HCPCS 25000001","00065-0416-63","DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139276","ERX","HCPCS 25000001","00065-8063-01","DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139283","ERX","HCPCS 25000001","00023-0506-01","POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139283","ERX","HCPCS 25000001","00023-0506-50","POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139285","ERX","HCPCS 25000001","71740-0112-30","POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN","BOTH IP/OP","$1,379.70 ","$1,020.98 ","$0.00 ","$78.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.96 ","$0.00 ","$39.48 ","$62.54 ","$63.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139286","ERX","HCPCS J0583","00409-8300-10","BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","BOTH IP/OP","$584.64 ","$432.63 ","$0.00 ","$530.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.70 ","$0.00 ","$265.35 ","$420.31 ","$424.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139286","ERX","HCPCS J0583","00781-3158-94","BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","BOTH IP/OP","$584.64 ","$432.63 ","$0.00 ","$530.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.70 ","$0.00 ","$265.35 ","$420.31 ","$424.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139286","ERX","HCPCS J0583","00781-3158-95","BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","BOTH IP/OP","$584.64 ","$432.63 ","$0.00 ","$530.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.70 ","$0.00 ","$265.35 ","$420.31 ","$424.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139286","ERX","HCPCS J0583","55111-0652-37","BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","BOTH IP/OP","$584.64 ","$432.63 ","$0.00 ","$530.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.70 ","$0.00 ","$265.35 ","$420.31 ","$424.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139286","ERX","HCPCS J0583","70860-0402-10","BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","BOTH IP/OP","$584.64 ","$432.63 ","$0.00 ","$530.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.70 ","$0.00 ","$265.35 ","$420.31 ","$424.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139292","ERX","HCPCS J0770","39822-0615-01","COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR","BOTH IP/OP","$99.75 ","$73.82 ","$0.00 ","$99.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.75 ","$0.00 ","$49.88 ","$79.00 ","$79.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139292","ERX","HCPCS J0770","42023-0131-01","COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR","BOTH IP/OP","$99.75 ","$73.82 ","$0.00 ","$99.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.75 ","$0.00 ","$49.88 ","$79.00 ","$79.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139292","ERX","HCPCS J0770","63323-0393-06","COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR","BOTH IP/OP","$99.75 ","$73.82 ","$0.00 ","$99.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.75 ","$0.00 ","$49.88 ","$79.00 ","$79.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139365","ERX","HCPCS J1746","62064-0122-02","IBALIZUMAB-UIYK 200 MG/1.33ML IV SOLN","BOTH IP/OP","$3,628.66 ","$2,685.21 ","$0.00 ","$3,043.40 ","$1,632.90 ","$1,325.06 ","$756.30 ","$0.00 ","$0.00 ","$1,333.63 ","$3,043.40 ","$1,263.26 ","$1,521.70 ","$2,410.37 ","$2,434.72 ","$1,744.50 ","$1,333.63 ","$0.00 ","$1,269.84 ","$1,203.10 "
"139459","ERX","HCPCS 25000001","00078-0951-66","NILOTINIB HCL 50 MG PO CAPS","BOTH IP/OP","$1,310.87 ","$970.04 ","$0.00 ","$480.90 ","","$247.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$480.90 ","$0.00 ","$240.45 ","$380.87 ","$384.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139649","ERX","HCPCS 25000001","62327-0222-02","TALC 2 G PL POWD","BOTH IP/OP","$427.40 ","$316.28 ","$0.00 ","$387.96 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.96 ","$0.00 ","$193.98 ","$307.26 ","$310.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139651","ERX","HCPCS 25000001","62327-0333-03","TALC 3 G PL POWD","BOTH IP/OP","$536.26 ","$396.83 ","$0.00 ","$486.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$486.78 ","$0.00 ","$243.39 ","$385.53 ","$389.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139651","ERX","HCPCS 25000001","62327-0333-43","TALC 3 G PL POWD","BOTH IP/OP","$536.26 ","$396.83 ","$0.00 ","$486.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$486.78 ","$0.00 ","$243.39 ","$385.53 ","$389.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139692","ERX","HCPCS 90375","13533-0318-05","RABIES IMMUNE GLOBULIN 1500 UNIT/5ML IJ SOLN","BOTH IP/OP","$9,091.15 ","$6,727.45 ","$0.00 ","$8,246.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.87 ","$8,246.40 ","$0.00 ","$4,123.20 ","$6,531.15 ","$6,597.12 ","$0.00 ","$325.87 ","$0.00 ","$0.00 ","$0.00 "
"139937","ERX","HCPCS 63700001","00074-3399-30","RITONAVIR 100 MG PO PACK","BOTH IP/OP","$43.11 ","$31.90 ","$0.00 ","$39.10 ","","$7.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.10 ","$0.00 ","$19.55 ","$30.97 ","$31.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139948","ERX","HCPCS 25000001","64950-0362-04","COCAINE HCL 40 MG/ML NA SOLN","BOTH IP/OP","$858.48 ","$635.28 ","$0.00 ","$779.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$779.10 ","$0.00 ","$389.55 ","$617.05 ","$623.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"139956","ERX","HCPCS J0171","70324-0077-01","EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$260.25 ","$192.59 ","$0.00 ","$236.25 ","$117.11 ","$0.00 ","$54.24 ","$0.00 ","$0.00 ","$77.08 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$77.08 ","$0.00 ","$73.39 ","$0.00 "
"139956","ERX","HCPCS J0171","76154-0814-15","EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN","BOTH IP/OP","$260.25 ","$192.59 ","$0.00 ","$236.25 ","$117.11 ","$0.00 ","$54.24 ","$0.00 ","$0.00 ","$77.08 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$77.08 ","$0.00 ","$73.39 ","$0.00 "
"140052","ERX","HCPCS Q5106","00069-1305-01","EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","BOTH IP/OP","$102.19 ","$75.62 ","$0.00 ","$92.66 ","$55.49 ","$0.00 ","$21.30 ","$0.00 ","$0.00 ","$16.22 ","$92.66 ","$20.22 ","$46.33 ","$73.39 ","$74.13 ","$27.93 ","$14.50 ","$0.00 ","$20.81 ","$19.26 "
"140052","ERX","HCPCS Q5106","00069-1305-10","EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","BOTH IP/OP","$102.19 ","$75.62 ","$0.00 ","$92.66 ","$55.49 ","$0.00 ","$21.30 ","$0.00 ","$0.00 ","$16.22 ","$92.66 ","$20.22 ","$46.33 ","$73.39 ","$74.13 ","$27.93 ","$14.50 ","$0.00 ","$20.81 ","$19.26 "
"140054","ERX","HCPCS Q5106","00069-1307-01","EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN","BOTH IP/OP","$183.72 ","$135.95 ","$0.00 ","$166.78 ","$99.76 ","$0.00 ","$38.29 ","$0.00 ","$0.00 ","$29.20 ","$166.78 ","$40.45 ","$83.39 ","$132.09 ","$133.42 ","$55.85 ","$26.10 ","$0.00 ","$41.62 ","$38.52 "
"140054","ERX","HCPCS Q5106","00069-1307-10","EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN","BOTH IP/OP","$183.72 ","$135.95 ","$0.00 ","$166.78 ","$99.76 ","$0.00 ","$38.29 ","$0.00 ","$0.00 ","$29.20 ","$166.78 ","$40.45 ","$83.39 ","$132.09 ","$133.42 ","$55.85 ","$26.10 ","$0.00 ","$41.62 ","$38.52 "
"140055","ERX","HCPCS Q5106","00069-1308-01","EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$444.73 ","$329.10 ","$0.00 ","$403.70 ","$241.49 ","$0.00 ","$92.69 ","$0.00 ","$0.00 ","$70.68 ","$403.70 ","$101.12 ","$201.85 ","$319.73 ","$322.96 ","$139.64 ","$63.18 ","$0.00 ","$104.05 ","$96.30 "
"140055","ERX","HCPCS Q5106","00069-1308-10","EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","BOTH IP/OP","$444.73 ","$329.10 ","$0.00 ","$403.70 ","$241.49 ","$0.00 ","$92.69 ","$0.00 ","$0.00 ","$70.68 ","$403.70 ","$101.12 ","$201.85 ","$319.73 ","$322.96 ","$139.64 ","$63.18 ","$0.00 ","$104.05 ","$96.30 "
"140089","ERX","HCPCS J9150","00703-5233-13","DAUNORUBICIN HCL 20 MG/4ML IV SOLN","BOTH IP/OP","$540.87 ","$400.24 ","$0.00 ","$490.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.97 ","$0.00 ","$245.49 ","$388.85 ","$392.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140312","ERX","HCPCS J0878","25021-0179-15","DAPTOMYCIN 350 MG IV SOLR","BOTH IP/OP","$970.61 ","$718.25 ","$0.00 ","$880.86 ","$436.77 ","$0.00 ","$156.28 ","$0.00 ","$0.00 ","$119.26 ","$880.86 ","$121.28 ","$440.43 ","$697.64 ","$704.69 ","$167.48 ","$119.26 ","$0.00 ","$113.56 ","$47.60 "
"140312","ERX","HCPCS J0878","25021-0179-16","DAPTOMYCIN 350 MG IV SOLR","BOTH IP/OP","$970.61 ","$718.25 ","$0.00 ","$880.86 ","$436.77 ","$0.00 ","$156.28 ","$0.00 ","$0.00 ","$119.26 ","$880.86 ","$121.28 ","$440.43 ","$697.64 ","$704.69 ","$167.48 ","$119.26 ","$0.00 ","$113.56 ","$47.60 "
"140359","ERX","HCPCS Q5108","67457-0833-06","PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY","BOTH IP/OP","$11,322.60 ","$8,378.72 ","$0.00 ","$10,270.50 ","$5,095.17 ","$2,449.66 ","$2,359.91 ","$0.00 ","$0.00 ","$1,798.28 ","$10,270.50 ","$4,125.40 ","$5,135.25 ","$8,134.24 ","$8,216.40 ","$5,696.99 ","$1,607.33 ","$0.00 ","$1,635.06 ","$3,928.96 "
"140422","ERX","HCPCS J1644","00409-7651-03","HEPARIN (PORCINE) 50 UNIT/ML 500 ML IV SOLN","BOTH IP/OP","$39.81 ","$29.46 ","$0.00 ","$34.20 ","$17.91 ","$0.00 ","$5.88 ","$0.00 ","$0.00 ","$7.05 ","$34.20 ","$0.00 ","$17.10 ","$27.09 ","$27.36 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"140467","ERX","HCPCS 63700001","70255-0010-02","BINIMETINIB 15 MG PO TABS","BOTH IP/OP","$303.55 ","$224.63 ","$0.00 ","$251.14 ","","$54.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.14 ","$0.00 ","$125.57 ","$198.90 ","$200.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140469","ERX","HCPCS 63700001","70255-0025-01","ENCORAFENIB 75 MG PO CAPS","BOTH IP/OP","$309.38 ","$228.94 ","$0.00 ","$255.97 ","","$55.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.97 ","$0.00 ","$127.99 ","$202.73 ","$204.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140469","ERX","HCPCS 63700001","70255-0025-02","ENCORAFENIB 75 MG PO CAPS","BOTH IP/OP","$309.38 ","$228.94 ","$0.00 ","$255.97 ","","$55.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.97 ","$0.00 ","$127.99 ","$202.73 ","$204.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140469","ERX","HCPCS 63700001","70255-0025-03","ENCORAFENIB 75 MG PO CAPS","BOTH IP/OP","$309.38 ","$228.94 ","$0.00 ","$255.97 ","","$55.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.97 ","$0.00 ","$127.99 ","$202.73 ","$204.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140469","ERX","HCPCS 63700001","70255-0025-04","ENCORAFENIB 75 MG PO CAPS","BOTH IP/OP","$309.38 ","$228.94 ","$0.00 ","$255.97 ","","$55.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.97 ","$0.00 ","$127.99 ","$202.73 ","$204.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140572","ERX","HCPCS 25000001","71334-0100-01","IVOSIDENIB 250 MG PO TABS","BOTH IP/OP","$1,470.09 ","$1,087.87 ","$0.00 ","$1,316.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,316.20 ","$0.00 ","$658.10 ","$1,042.43 ","$1,052.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140767","ERX","HCPCS J9047","76075-0103-01","CARFILZOMIB 10 MG IV SOLR","BOTH IP/OP","$1,335.98 ","$988.63 ","$0.00 ","$1,290.77 ","$636.66 ","$411.11 ","$278.45 ","$0.00 ","$0.00 ","$441.10 ","$1,290.77 ","$394.79 ","$645.39 ","$1,022.29 ","$1,032.62 ","$545.19 ","$441.10 ","$0.00 ","$420.00 ","$389.72 "
"140769","ERX","HCPCS 63600001","76329-3316-01","EPINEPHRINE 1 MG/10ML IJ SOSY","BOTH IP/OP","$44.00 ","$32.56 ","$0.00 ","$39.90 ","$22.29 ","$0.00 ","$9.17 ","$0.00 ","$0.00 ","$0.00 ","$39.90 ","$0.00 ","$19.95 ","$31.60 ","$31.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140776","ERX","HCPCS 25000001","00310-1105-30","SODIUM ZIRCONIUM CYCLOSILICATE 5 G PO PACK","BOTH IP/OP","$112.64 ","$83.35 ","$0.00 ","$94.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.46 ","$0.00 ","$47.23 ","$74.81 ","$75.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140796","ERX","HCPCS 90739","43528-0003-05","HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY","BOTH IP/OP","$510.05 ","$377.44 ","$0.00 ","$441.03 ","$242.04 ","$131.10 ","$106.31 ","$0.00 ","$0.00 ","$154.04 ","$441.03 ","$0.00 ","$220.52 ","$349.30 ","$352.82 ","$264.62 ","$154.04 ","$114.67 ","$146.67 ","$114.67 "
"140845","ERX","HCPCS J2370","69374-0957-10","PHENYLEPHRINE HCL 1 MG/10ML IV SOSY","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$12.15 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$4.31 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$4.31 ","$0.00 ","$4.11 ","$0.00 "
"140890","ERX","HCPCS J9204","42747-0761-01","MOGAMULIZUMAB-KPKC 20 MG/5ML IV SOLN","BOTH IP/OP","$10,909.21 ","$8,072.82 ","$0.00 ","$9,605.20 ","$4,982.78 ","$4,252.70 ","$2,273.75 ","$0.00 ","$0.00 ","$0.00 ","$9,605.20 ","$0.00 ","$4,802.60 ","$7,607.32 ","$7,684.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140942","ERX","HCPCS 63700001","62856-0712-05","LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK","BOTH IP/OP","$792.81 ","$586.68 ","$0.00 ","$1,826.02 ","","$144.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140942","ERX","HCPCS 63700001","62856-0712-30","LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK","BOTH IP/OP","$792.81 ","$586.68 ","$0.00 ","$1,826.02 ","","$144.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140943","ERX","HCPCS 63700001","62856-0704-05","LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK","BOTH IP/OP","$2,109.61 ","$1,561.11 ","$0.00 ","$1,826.02 ","","$385.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140943","ERX","HCPCS 63700001","62856-0704-30","LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK","BOTH IP/OP","$2,109.61 ","$1,561.11 ","$0.00 ","$1,826.02 ","","$385.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,826.02 ","$0.00 ","$913.01 ","$1,446.21 ","$1,460.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141226","ERX","HCPCS J2357","50242-0215-01","OMALIZUMAB 150 MG/ML SC SOSY","BOTH IP/OP","$47,284.06 ","$34,990.20 ","$0.00 ","$21,916.10 ","$21,916.10 ","$16,878.15 ","$9,417.94 ","$0.00 ","$0.00 ","$1,316.94 ","$2,776.07 ","$1,158.51 ","$1,388.04 ","$2,198.65 ","$2,220.86 ","$1,599.84 ","$1,316.94 ","$0.00 ","$1,253.95 ","$1,130.79 "
"141227","ERX","HCPCS J2357","50242-0214-01","OMALIZUMAB 75 MG/0.5ML SC SOSY","BOTH IP/OP","$3,152.25 ","$2,332.67 ","$0.00 ","$1,625.02 ","$837.20 ","$562.61 ","$348.98 ","$0.00 ","$0.00 ","$658.47 ","$1,625.02 ","$579.25 ","$812.51 ","$1,287.02 ","$1,300.02 ","$799.92 ","$658.47 ","$0.00 ","$626.98 ","$565.40 "
"141229","ERX","HCPCS J0841","66621-0790-02","CROTALIDAE IMMUNE FAB (EQUINE) IV SOLR","BOTH IP/OP","$13,234.56 ","$9,793.57 ","$0.00 ","$12,004.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,004.80 ","$0.00 ","$6,002.40 ","$9,507.80 ","$9,603.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141259","ERX","HCPCS 63700001","00378-0871-16","CLONIDINE 0.1 MG/24HR TD PTWK","BOTH IP/OP","$127.86 ","$94.62 ","$0.00 ","$115.94 ","","$22.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.94 ","$0.00 ","$57.97 ","$91.82 ","$92.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141259","ERX","HCPCS 63700001","00378-0871-99","CLONIDINE 0.1 MG/24HR TD PTWK","BOTH IP/OP","$127.86 ","$94.62 ","$0.00 ","$115.94 ","","$22.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.94 ","$0.00 ","$57.97 ","$91.82 ","$92.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141259","ERX","HCPCS 63700001","00591-3508-04","CLONIDINE 0.1 MG/24HR TD PTWK","BOTH IP/OP","$127.86 ","$94.62 ","$0.00 ","$115.94 ","","$22.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.94 ","$0.00 ","$57.97 ","$91.82 ","$92.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141260","ERX","HCPCS 63700001","00378-0872-16","CLONIDINE 0.2 MG/24HR TD PTWK","BOTH IP/OP","$193.51 ","$143.20 ","$0.00 ","$175.66 ","","$34.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.66 ","$0.00 ","$87.83 ","$139.12 ","$140.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141260","ERX","HCPCS 63700001","00378-0872-99","CLONIDINE 0.2 MG/24HR TD PTWK","BOTH IP/OP","$193.51 ","$143.20 ","$0.00 ","$175.66 ","","$34.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.66 ","$0.00 ","$87.83 ","$139.12 ","$140.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141261","ERX","HCPCS 63700001","00378-0873-99","CLONIDINE 0.3 MG/24HR TD PTWK","BOTH IP/OP","$268.44 ","$198.65 ","$0.00 ","$243.69 ","","$47.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.69 ","$0.00 ","$121.85 ","$193.00 ","$194.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141261","ERX","HCPCS 63700001","51862-0455-01","CLONIDINE 0.3 MG/24HR TD PTWK","BOTH IP/OP","$268.44 ","$198.65 ","$0.00 ","$243.69 ","","$47.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.69 ","$0.00 ","$121.85 ","$193.00 ","$194.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141261","ERX","HCPCS 63700001","51862-0455-04","CLONIDINE 0.3 MG/24HR TD PTWK","BOTH IP/OP","$268.44 ","$198.65 ","$0.00 ","$243.69 ","","$47.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.69 ","$0.00 ","$121.85 ","$193.00 ","$194.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141262","ERX","HCPCS 90710","00006-4171-00","MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR","BOTH IP/OP","$874.31 ","$646.99 ","$0.00 ","$713.71 ","$393.44 ","$0.00 ","$182.23 ","$0.00 ","$0.00 ","$124.96 ","$713.71 ","$0.00 ","$356.86 ","$565.26 ","$570.97 ","$0.00 ","$111.70 ","$0.00 ","$119.24 ","$0.00 "
"141263","ERX","HCPCS J3370","00409-6533-01","VANCOMYCIN HCL 1 G IV SOLR","BOTH IP/OP","$36.58 ","$27.07 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$36.58 ","$0.00 ","$18.29 ","$28.97 ","$29.26 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"141263","ERX","HCPCS J3370","00409-6533-31","VANCOMYCIN HCL 1 G IV SOLR","BOTH IP/OP","$36.58 ","$27.07 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$36.58 ","$0.00 ","$18.29 ","$28.97 ","$29.26 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"141263","ERX","HCPCS J3370","63323-0284-20","VANCOMYCIN HCL 1 G IV SOLR","BOTH IP/OP","$36.58 ","$27.07 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$36.58 ","$0.00 ","$18.29 ","$28.97 ","$29.26 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"141263","ERX","HCPCS J3370","67457-0340-00","VANCOMYCIN HCL 1 G IV SOLR","BOTH IP/OP","$36.58 ","$27.07 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$36.58 ","$0.00 ","$18.29 ","$28.97 ","$29.26 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"141263","ERX","HCPCS J3370","67457-0340-01","VANCOMYCIN HCL 1 G IV SOLR","BOTH IP/OP","$36.58 ","$27.07 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$36.58 ","$0.00 ","$18.29 ","$28.97 ","$29.26 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"141263","ERX","HCPCS J3370","70860-0105-20","VANCOMYCIN HCL 1 G IV SOLR","BOTH IP/OP","$36.58 ","$27.07 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$36.58 ","$0.00 ","$18.29 ","$28.97 ","$29.26 ","$0.00 ","$3.98 ","$0.00 ","$3.79 ","$0.00 "
"141264","ERX","HCPCS J3370","00409-6509-01","VANCOMYCIN HCL 5 G IV SOLR","BOTH IP/OP","$363.93 ","$269.31 ","$0.00 ","$325.50 ","$163.77 ","$0.00 ","$36.19 ","$0.00 ","$0.00 ","$39.83 ","$325.50 ","$0.00 ","$162.75 ","$257.80 ","$260.40 ","$0.00 ","$39.83 ","$0.00 ","$37.93 ","$0.00 "
"141264","ERX","HCPCS J3370","25021-0157-99","VANCOMYCIN HCL 5 G IV SOLR","BOTH IP/OP","$363.93 ","$269.31 ","$0.00 ","$325.50 ","$163.77 ","$0.00 ","$36.19 ","$0.00 ","$0.00 ","$39.83 ","$325.50 ","$0.00 ","$162.75 ","$257.80 ","$260.40 ","$0.00 ","$39.83 ","$0.00 ","$37.93 ","$0.00 "
"141264","ERX","HCPCS J3370","67457-0341-05","VANCOMYCIN HCL 5 G IV SOLR","BOTH IP/OP","$363.93 ","$269.31 ","$0.00 ","$325.50 ","$163.77 ","$0.00 ","$36.19 ","$0.00 ","$0.00 ","$39.83 ","$325.50 ","$0.00 ","$162.75 ","$257.80 ","$260.40 ","$0.00 ","$39.83 ","$0.00 ","$37.93 ","$0.00 "
"141306","ERX","HCPCS 63700001","00006-3069-01","DORAVIRINE 100 MG PO TABS","BOTH IP/OP","$211.16 ","$156.26 ","$0.00 ","$182.58 ","","$39.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$182.58 ","$0.00 ","$91.29 ","$144.60 ","$146.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141425","ERX","HCPCS J0713","00264-3145-11","CEFTAZIDIME AND DEXTROSE 2-5 GM-%(50ML) IV SOLR","BOTH IP/OP","$101.86 ","$75.38 ","$0.00 ","$92.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.17 ","$92.36 ","$0.00 ","$46.18 ","$73.15 ","$73.89 ","$0.00 ","$14.45 ","$0.00 ","$14.70 ","$0.00 "
"141430","ERX","HCPCS J0690","00264-3105-11","CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR","BOTH IP/OP","$64.21 ","$47.52 ","$0.00 ","$58.23 ","$28.89 ","$0.00 ","$2.77 ","$0.00 ","$0.00 ","$3.85 ","$58.23 ","$0.00 ","$29.12 ","$46.12 ","$46.58 ","$0.00 ","$3.85 ","$0.00 ","$3.67 ","$0.00 "
"141478","ERX","HCPCS J9119","61755-0008-01","CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN","BOTH IP/OP","$25,550.40 ","$18,907.30 ","$0.00 ","$22,386.00 ","$11,497.68 ","$9,685.90 ","$5,325.34 ","$0.00 ","$0.00 ","$8,138.89 ","$22,386.00 ","$10,086.77 ","$11,193.00 ","$17,729.71 ","$17,908.80 ","$13,929.35 ","$8,138.89 ","$0.00 ","$8,138.89 ","$9,606.45 "
"141582","ERX","HCPCS 25000001","00069-0296-30","TALAZOPARIB TOSYLATE 0.25 MG PO CAPS","BOTH IP/OP","$2,242.16 ","$1,659.20 ","$0.00 ","$1,959.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,959.56 ","$0.00 ","$979.78 ","$1,551.97 ","$1,567.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141584","ERX","HCPCS 25000001","00069-1195-30","TALAZOPARIB TOSYLATE 1 MG PO CAPS","BOTH IP/OP","$1,681.61 ","$1,244.39 ","$0.00 ","$1,469.67 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,469.67 ","$0.00 ","$734.84 ","$1,163.98 ","$1,175.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141712","ERX","HCPCS 63700001","00069-0227-01","LORLATINIB 25 MG PO TABS","BOTH IP/OP","$727.09 ","$538.05 ","$0.00 ","$595.68 ","","$129.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$595.68 ","$0.00 ","$297.84 ","$471.78 ","$476.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"141713","ERX","HCPCS 63700001","00069-0231-01","LORLATINIB 100 MG PO TABS","BOTH IP/OP","$1,934.75 ","$1,431.72 ","$0.00 ","$1,618.43 ","","$344.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,618.43 ","$0.00 ","$809.22 ","$1,281.80 ","$1,294.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"142188","ERX","HCPCS 63700001","00173-0889-39","TAFENOQUINE SUCCINATE 150 MG PO TABS","BOTH IP/OP","$80.45 ","$59.53 ","$0.00 ","$72.96 ","","$14.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.96 ","$0.00 ","$36.48 ","$57.78 ","$58.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"142198","ERX","HCPCS Q5111","70114-0101-01","PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY","BOTH IP/OP","$11,322.60 ","$8,378.72 ","$0.00 ","$10,270.50 ","$5,095.17 ","$2,425.19 ","$2,359.91 ","$0.00 ","$0.00 ","$4,744.93 ","$10,270.50 ","$4,372.91 ","$5,135.25 ","$8,134.24 ","$8,216.40 ","$6,038.77 ","$4,744.93 ","$0.00 ","$4,517.98 ","$4,164.67 "
"142286","ERX","HCPCS 25000001","67684-1901-02","LIPIODOL IJ OIL","BOTH IP/OP","$400.41 ","$296.30 ","$0.00 ","$447.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$447.99 ","$0.00 ","$224.00 ","$317.12 ","$358.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"142324","ERX","HCPCS J3490","00169-2662-11","INSULIN DEGLUDEC 100 UNIT/ML SC SOLN","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$0.00 ","$0.00 ","$1.99 ","$0.00 "
"142346","ERX","HCPCS 63700001","00078-0972-61","ELTROMBOPAG OLAMINE 12.5 MG PO PACK","BOTH IP/OP","$658.79 ","$487.50 ","$0.00 ","$558.77 ","","$125.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$558.77 ","$0.00 ","$279.39 ","$442.55 ","$447.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"142802","ERX","HCPCS C9047","58468-0225-01","CAPLACIZUMAB-YHDP 11 MG IJ KIT","BOTH IP/OP","$19,797.60 ","$14,650.22 ","$0.00 ","$17,958.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,958.00 ","$0.00 ","$8,979.00 ","$14,222.74 ","$14,366.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143112","ERX","HCPCS J0780","00641-6135-25","PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","$20.93 ","$0.00 ","$2.40 ","$0.00 ","$0.00 ","$10.15 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$10.15 ","$0.00 ","$9.67 ","$0.00 "
"143112","ERX","HCPCS J0780","23155-0294-41","PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","$20.93 ","$0.00 ","$2.40 ","$0.00 ","$0.00 ","$10.15 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$10.15 ","$0.00 ","$9.67 ","$0.00 "
"143112","ERX","HCPCS J0780","23155-0294-42","PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","$20.93 ","$0.00 ","$2.40 ","$0.00 ","$0.00 ","$10.15 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$10.15 ","$0.00 ","$9.67 ","$0.00 "
"143112","ERX","HCPCS J0780","23155-0497-42","PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","$20.93 ","$0.00 ","$2.40 ","$0.00 ","$0.00 ","$10.15 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$10.15 ","$0.00 ","$9.67 ","$0.00 "
"143112","ERX","HCPCS J0780","67457-0640-00","PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","$20.93 ","$0.00 ","$2.40 ","$0.00 ","$0.00 ","$10.15 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$10.15 ","$0.00 ","$9.67 ","$0.00 "
"143112","ERX","HCPCS J0780","67457-0640-02","PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","BOTH IP/OP","$46.51 ","$34.42 ","$0.00 ","$42.18 ","$20.93 ","$0.00 ","$2.40 ","$0.00 ","$0.00 ","$10.15 ","$42.18 ","$0.00 ","$21.09 ","$33.41 ","$33.74 ","$0.00 ","$10.15 ","$0.00 ","$9.67 ","$0.00 "
"143120","ERX","HCPCS J1190","47781-0578-07","DEXRAZOXANE HCL 500 MG IV SOLR","BOTH IP/OP","$1,352.93 ","$1,001.17 ","$0.00 ","$1,352.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,352.93 ","$0.00 ","$676.47 ","$1,071.52 ","$1,082.34 ","$0.00 ","$0.00 ","$0.00 ","$48.16 ","$0.00 "
"143121","ERX","HCPCS J2426","50458-0560-01","PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY","BOTH IP/OP","$1,522.82 ","$1,126.89 ","$0.00 ","$1,346.50 ","","$0.00 ","$317.39 ","$0.00 ","$0.00 ","$530.65 ","$1,346.50 ","$476.25 ","$673.25 ","$1,066.43 ","$1,077.20 ","$657.68 ","$530.65 ","$0.00 ","$505.27 ","$469.17 "
"143122","ERX","HCPCS J2426","50458-0561-01","PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY","BOTH IP/OP","$2,657.67 ","$1,966.68 ","$0.00 ","$2,300.33 ","","$0.00 ","$553.92 ","$0.00 ","$0.00 ","$1,061.31 ","$2,300.33 ","$952.50 ","$1,150.17 ","$1,821.86 ","$1,840.26 ","$1,315.35 ","$1,061.31 ","$0.00 ","$1,010.54 ","$938.34 "
"143139","ERX","HCPCS 25000001","76329-3390-01","LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143140","ERX","HCPCS 25000001","00409-1323-05","LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143142","ERX","HCPCS 90636","58160-0815-52","HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY","BOTH IP/OP","$469.89 ","$347.72 ","$0.00 ","$398.49 ","$211.45 ","$0.00 ","$107.88 ","$0.00 ","$0.00 ","$122.20 ","$398.49 ","$0.00 ","$199.25 ","$315.60 ","$318.79 ","$0.00 ","$122.20 ","$0.00 ","$116.36 ","$0.00 "
"143143","ERX","HCPCS J0897","55513-0710-01","DENOSUMAB 60 MG/ML SC SOSY","BOTH IP/OP","$3,672.71 ","$2,717.81 ","$0.00 ","$3,145.83 ","$1,750.23 ","$1,272.30 ","$765.48 ","$0.00 ","$0.00 ","$1,359.24 ","$3,145.83 ","$1,214.39 ","$1,572.92 ","$2,491.50 ","$2,516.66 ","$1,677.01 ","$1,359.24 ","$0.00 ","$1,294.23 ","$1,194.06 "
"143147","ERX","HCPCS 63600001","64193-0426-02","ANTIINHIBITOR COAGULANT CMPLX 500 UNITS IV SOLR","BOTH IP/OP","$3,051.00 ","$2,257.74 ","$0.00 ","$2,767.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,767.50 ","$0.00 ","$1,383.75 ","$2,191.86 ","$2,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143148","ERX","HCPCS J7198","64193-0324-01","ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR","BOTH IP/OP","$6,102.00 ","$4,515.48 ","$0.00 ","$5,535.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,535.00 ","$0.00 ","$2,767.50 ","$4,383.72 ","$4,428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143148","ERX","HCPCS J7198","64193-0424-02","ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR","BOTH IP/OP","$6,102.00 ","$4,515.48 ","$0.00 ","$5,535.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,535.00 ","$0.00 ","$2,767.50 ","$4,383.72 ","$4,428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143149","ERX","HCPCS J7198","64193-0325-01","ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR","BOTH IP/OP","$15,255.00 ","$11,288.70 ","$0.00 ","$13,837.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,837.50 ","$0.00 ","$6,918.75 ","$10,959.30 ","$11,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143149","ERX","HCPCS J7198","64193-0425-02","ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR","BOTH IP/OP","$15,255.00 ","$11,288.70 ","$0.00 ","$13,837.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,837.50 ","$0.00 ","$6,918.75 ","$10,959.30 ","$11,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143152","ERX","HCPCS 25000001","17478-0711-10","LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL","BOTH IP/OP","$35.20 ","$26.05 ","$0.00 ","$63.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.39 ","$0.00 ","$31.70 ","$25.28 ","$50.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143152","ERX","HCPCS 25000001","17478-0711-31","LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL","BOTH IP/OP","$35.20 ","$26.05 ","$0.00 ","$63.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.39 ","$0.00 ","$31.70 ","$25.28 ","$50.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143152","ERX","HCPCS 25000001","17478-0711-30","LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL","BOTH IP/OP","$35.20 ","$26.05 ","$0.00 ","$63.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.39 ","$0.00 ","$31.70 ","$50.20 ","$50.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143153","ERX","HCPCS J1644","00264-9872-10","HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"143157","ERX","HCPCS J3370","70594-0042-03","VANCOMYCIN HCL 1000 MG/200ML IV SOLN","BOTH IP/OP","$80.45 ","$59.53 ","$0.00 ","$126.00 ","$36.20 ","$0.00 ","$7.24 ","$0.00 ","$0.00 ","$7.97 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$7.97 ","$0.00 ","$7.59 ","$0.00 "
"143158","ERX","HCPCS J3370","70594-0043-02","VANCOMYCIN HCL 1500 MG/300ML IV SOLN","BOTH IP/OP","$106.54 ","$78.84 ","$0.00 ","$170.10 ","$47.94 ","$0.00 ","$10.86 ","$0.00 ","$0.00 ","$11.95 ","$170.10 ","$0.00 ","$85.05 ","$134.72 ","$136.08 ","$0.00 ","$11.95 ","$0.00 ","$11.38 ","$0.00 "
"143187","ERX","HCPCS 25000001","99999-6005-85","PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN","BOTH IP/OP","$4,078.16 ","$3,017.84 ","$0.00 ","$40.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.36 ","$0.00 ","$20.18 ","$31.97 ","$32.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143187","ERX","HCPCS 25000001","00187-3012-20","PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN","BOTH IP/OP","$4,078.16 ","$3,017.84 ","$0.00 ","$2,561.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.36 ","$0.00 ","$20.18 ","$2,561.16 ","$32.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143206","ERX","HCPCS J9022","50242-0918-01","ATEZOLIZUMAB 840 MG/14ML IV SOLN","BOTH IP/OP","$17,977.57 ","$13,303.40 ","$0.00 ","$15,832.10 ","$8,413.51 ","$6,684.38 ","$3,746.98 ","$0.00 ","$0.00 ","$7,684.78 ","$15,832.10 ","$6,792.11 ","$7,916.05 ","$12,539.02 ","$12,665.68 ","$9,379.57 ","$7,684.78 ","$0.00 ","$7,317.22 ","$6,468.67 "
"143520","ERX","HCPCS 63700001","49702-0246-13","DOVATO:DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS","BOTH IP/OP","$356.46 ","$263.78 ","$0.00 ","$303.46 ","","$63.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.46 ","$0.00 ","$151.73 ","$240.34 ","$242.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144008","ERX","HCPCS J9309","50242-0105-01","POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR","BOTH IP/OP","$40,680.00 ","$30,103.20 ","$0.00 ","$36,900.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,900.00 ","$0.00 ","$18,450.00 ","$29,224.80 ","$29,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144263","ERX","HCPCS Q5107","55513-0206-01","BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN","BOTH IP/OP","$2,168.56 ","$1,604.73 ","$0.00 ","$1,950.92 ","$975.85 ","$397.68 ","$451.98 ","$0.00 ","$0.00 ","$0.00 ","$1,950.92 ","$0.00 ","$975.46 ","$1,545.13 ","$1,560.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144264","ERX","HCPCS Q5107","55513-0207-01","BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN","BOTH IP/OP","$7,568.91 ","$5,600.99 ","$0.00 ","$6,665.62 ","$3,406.01 ","$1,590.72 ","$1,577.55 ","$0.00 ","$0.00 ","$0.00 ","$6,665.62 ","$0.00 ","$3,332.81 ","$5,279.17 ","$5,332.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144270","ERX","HCPCS J3370","70594-0044-02","VANCOMYCIN HCL 2000 MG/400ML IV SOLN","BOTH IP/OP","$129.70 ","$95.98 ","$0.00 ","$226.80 ","$58.37 ","$0.00 ","$14.48 ","$0.00 ","$0.00 ","$15.93 ","$226.80 ","$0.00 ","$113.40 ","$179.63 ","$181.44 ","$0.00 ","$15.93 ","$0.00 ","$15.17 ","$0.00 "
"144275","ERX","HCPCS Q5117","55513-0132-01","TRASTUZUMAB-ANNS 420 MG IV SOLR","BOTH IP/OP","$10,327.80 ","$7,642.57 ","$0.00 ","$9,095.26 ","$4,647.51 ","$1,991.18 ","$2,152.57 ","$0.00 ","$0.00 ","$0.00 ","$9,095.26 ","$0.00 ","$4,547.63 ","$7,203.45 ","$7,276.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144426","ERX","HCPCS 63700001","24338-0124-03","ERYTHROMYCIN 333 MG PO TBEC","BOTH IP/OP","$44.26 ","$32.75 ","$0.00 ","$40.14 ","","$7.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.14 ","$0.00 ","$20.07 ","$31.79 ","$32.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144426","ERX","HCPCS 63700001","24338-0124-13","ERYTHROMYCIN 333 MG PO TBEC","BOTH IP/OP","$44.26 ","$32.75 ","$0.00 ","$40.14 ","","$7.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.14 ","$0.00 ","$20.07 ","$31.79 ","$32.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144426","ERX","HCPCS 63700001","52536-0183-03","ERYTHROMYCIN 333 MG PO TBEC","BOTH IP/OP","$44.26 ","$32.75 ","$0.00 ","$40.14 ","","$7.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.14 ","$0.00 ","$20.07 ","$31.79 ","$32.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144767","ERX","HCPCS 25000001","50383-0261-61","DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN","BOTH IP/OP","$163.57 ","$121.04 ","$0.00 ","$148.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.32 ","$0.00 ","$74.16 ","$117.47 ","$118.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144767","ERX","HCPCS 25000001","65862-0947-15","DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN","BOTH IP/OP","$163.57 ","$121.04 ","$0.00 ","$148.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.32 ","$0.00 ","$74.16 ","$117.47 ","$118.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144767","ERX","HCPCS 25000001","65862-0947-60","DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN","BOTH IP/OP","$163.57 ","$121.04 ","$0.00 ","$148.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.32 ","$0.00 ","$74.16 ","$117.47 ","$118.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144934","ERX","HCPCS 90707","00006-4681-00","MEASLES, MUMPS & RUBELLA VAC IJ SOLR","BOTH IP/OP","$350.54 ","$259.40 ","$0.00 ","$295.99 ","$157.74 ","$0.00 ","$11.75 ","$0.00 ","$0.00 ","$92.45 ","$295.99 ","$0.00 ","$148.00 ","$234.42 ","$236.79 ","$0.00 ","$92.45 ","$0.00 ","$88.03 ","$0.00 "
"144934","ERX","HCPCS 90707","00006-4681-01","MEASLES, MUMPS & RUBELLA VAC IJ SOLR","BOTH IP/OP","$350.54 ","$259.40 ","$0.00 ","$295.99 ","$157.74 ","$0.00 ","$11.75 ","$0.00 ","$0.00 ","$92.45 ","$295.99 ","$0.00 ","$148.00 ","$234.42 ","$236.79 ","$0.00 ","$92.45 ","$0.00 ","$88.03 ","$0.00 "
"144938","ERX","HCPCS 25000001","00078-0639-41","SECUKINUMAB (300 MG DOSE) 150 MG/ML SC SOAJ","BOTH IP/OP","$8,040.18 ","$5,949.73 ","$0.00 ","$6,815.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,815.97 ","$0.00 ","$3,407.99 ","$5,398.25 ","$5,452.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144946","ERX","HCPCS J2794","50458-0306-11","RISPERIDONE MICROSPHERES ER 25 MG IM SRER","BOTH IP/OP","$1,656.28 ","$1,225.65 ","$0.00 ","$1,464.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,464.48 ","$0.00 ","$732.24 ","$1,159.87 ","$1,171.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144962","ERX","HCPCS 25000001","00409-4888-01","SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144962","ERX","HCPCS 25000001","00409-4888-10","SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144962","ERX","HCPCS 25000001","00409-4888-12","SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144962","ERX","HCPCS 25000001","63323-0186-01","SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144962","ERX","HCPCS 25000001","63323-0186-10","SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145128","ERX","HCPCS 63700001","99999-6009-67","ERGOCALCIFEROL 8000 UNIT/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145128","ERX","HCPCS 63700001","00091-4150-60","ERGOCALCIFEROL 8000 UNIT/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$248.93 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$248.93 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145128","ERX","HCPCS 63700001","39328-0357-60","ERGOCALCIFEROL 8000 UNIT/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$248.93 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$248.93 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145128","ERX","HCPCS 63700001","69543-0234-60","ERGOCALCIFEROL 8000 UNIT/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$248.93 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$248.93 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145128","ERX","HCPCS 63700001","75834-0010-60","ERGOCALCIFEROL 8000 UNIT/ML PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$248.93 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$248.93 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145154","ERX","HCPCS 25000001","76329-3011-05","LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","BOTH IP/OP","$32.23 ","$23.85 ","$0.00 ","$29.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.23 ","$0.00 ","$14.62 ","$20.77 ","$23.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145154","ERX","HCPCS 25000001","76329-3012-05","LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","BOTH IP/OP","$32.23 ","$23.85 ","$0.00 ","$29.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.23 ","$0.00 ","$14.62 ","$20.77 ","$23.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145154","ERX","HCPCS 25000001","76329-3013-05","LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","BOTH IP/OP","$32.23 ","$23.85 ","$0.00 ","$29.23 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.23 ","$0.00 ","$14.62 ","$23.15 ","$23.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145230","ERX","HCPCS 25000001","00087-0866-44","CHOLECALCIFEROL 400 UNIT/ML PO LIQD","BOTH IP/OP","$96.50 ","$71.41 ","$0.00 ","$87.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145230","ERX","HCPCS 25000001","54838-0006-50","CHOLECALCIFEROL 400 UNIT/ML PO LIQD","BOTH IP/OP","$96.50 ","$71.41 ","$0.00 ","$87.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145469","ERX","HCPCS q5114","67457-0847-44","TRASTUZUMAB-DKST 420 MG IV SOLR","BOTH IP/OP","$10,026.97 ","$7,419.96 ","$0.00 ","$9,095.26 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,095.26 ","$0.00 ","$4,547.63 ","$7,203.45 ","$7,276.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145473","ERX","HCPCS Q5114","67457-0991-15","TRASTUZUMAB-DKST 150 MG IV SOLR","BOTH IP/OP","$3,592.48 ","$2,658.44 ","$0.00 ","$3,258.66 ","$1,616.62 ","$835.73 ","$748.76 ","$0.00 ","$0.00 ","$0.00 ","$3,258.66 ","$0.00 ","$1,629.33 ","$2,580.86 ","$2,606.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145641","ERX","HCPCS Q5117","55513-0141-01","TRASTUZUMAB-ANNS 150 MG IV SOLR","BOTH IP/OP","$3,688.51 ","$2,729.50 ","$0.00 ","$3,248.31 ","$1,659.83 ","$711.14 ","$768.78 ","$0.00 ","$0.00 ","$0.00 ","$3,248.31 ","$0.00 ","$1,624.16 ","$2,572.66 ","$2,598.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145743","ERX","HCPCS Q5115","63459-0103-10","RITUXIMAB-ABBS 100 MG/10ML IV SOLN","BOTH IP/OP","$2,293.14 ","$1,696.92 ","$0.00 ","$2,080.06 ","$1,031.91 ","$573.47 ","$477.95 ","$0.00 ","$0.00 ","$364.20 ","$2,080.06 ","$0.00 ","$1,040.03 ","$1,647.41 ","$1,664.05 ","$0.00 ","$325.53 ","$0.00 ","$331.15 ","$0.00 "
"145744","ERX","HCPCS Q5115","63459-0104-50","RITUXIMAB-ABBS 500 MG/50ML IV SOLN","BOTH IP/OP","$11,465.66 ","$8,484.59 ","$0.00 ","$10,400.27 ","$5,159.55 ","$2,867.35 ","$2,389.73 ","$0.00 ","$0.00 ","$1,821.00 ","$10,400.27 ","$0.00 ","$5,200.14 ","$8,237.01 ","$8,320.22 ","$0.00 ","$1,627.64 ","$0.00 ","$1,655.72 ","$0.00 "
"145824","ERX","HCPCS C9053","00078-0883-61","CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN","BOTH IP/OP","$6,488.83 ","$4,801.73 ","$0.00 ","$5,798.57 ","$2,941.86 ","$2,482.44 ","$1,352.43 ","$0.00 ","$0.00 ","$1,015.28 ","$5,798.57 ","$0.00 ","$2,899.29 ","$4,592.47 ","$4,638.86 ","$0.00 ","$907.48 ","$0.00 ","$923.13 ","$0.00 "
"146009","ERX","HCPCS 25000001","44677-0102-02","LANSINOH LANOLIN EX CREA","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146059","ERX","HCPCS J9177","51144-0020-01","ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR","BOTH IP/OP","$6,413.88 ","$4,746.27 ","$0.00 ","$5,392.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,392.32 ","$0.00 ","$2,696.16 ","$4,110.96 ","$4,313.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146060","ERX","HCPCS J9177","51144-0030-01","ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR","BOTH IP/OP","$9,620.82 ","$7,119.41 ","$0.00 ","$8,088.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,088.48 ","$0.00 ","$4,044.24 ","$6,166.43 ","$6,470.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146089","ERX","HCPCS J9358","65597-0406-01","FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR","BOTH IP/OP","$6,414.88 ","$4,747.01 ","$0.00 ","$5,648.08 ","$2,958.86 ","$2,460.00 ","$1,337.02 ","$0.00 ","$0.00 ","$0.00 ","$5,648.08 ","$0.00 ","$2,824.04 ","$4,473.28 ","$4,518.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146213","ERX","HCPCS Q5118","00069-0315-01","BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN","BOTH IP/OP","$1,906.45 ","$1,410.77 ","$0.00 ","$1,766.60 ","$857.90 ","$505.89 ","$397.35 ","$0.00 ","$0.00 ","$0.00 ","$1,766.60 ","$0.00 ","$883.30 ","$1,399.15 ","$1,413.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146214","ERX","HCPCS Q5118","00069-0342-01","BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN","BOTH IP/OP","$6,654.17 ","$4,924.09 ","$0.00 ","$6,035.86 ","$2,994.38 ","$2,023.56 ","$1,386.90 ","$0.00 ","$0.00 ","$0.00 ","$6,035.86 ","$0.00 ","$3,017.93 ","$4,780.40 ","$4,828.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146561","ERX","HCPCS J3490","59630-0266-01","CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","BOTH IP/OP","$573.81 ","$424.62 ","$0.00 ","$503.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.12 ","$503.25 ","$0.00 ","$251.63 ","$398.57 ","$402.60 ","$0.00 ","$78.76 ","$0.00 ","$80.12 ","$0.00 "
"146561","ERX","HCPCS J3490","59630-0266-10","CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","BOTH IP/OP","$573.81 ","$424.62 ","$0.00 ","$503.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.12 ","$503.25 ","$0.00 ","$251.63 ","$398.57 ","$402.60 ","$0.00 ","$78.76 ","$0.00 ","$80.12 ","$0.00 "
"146761","ERX","HCPCS 25000001","00409-7295-01","POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","BOTH IP/OP","$140.24 ","$103.78 ","$0.00 ","$66.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.47 ","$0.00 ","$33.24 ","$52.64 ","$53.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"146761","ERX","HCPCS 25000001","63323-0086-15","POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","BOTH IP/OP","$140.24 ","$103.78 ","$0.00 ","$66.47 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.47 ","$0.00 ","$33.24 ","$52.64 ","$53.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147244","ERX","HCPCS Q5113","63459-0305-47","TRASTUZUMAB-PKRB 420 MG IV SOLR","BOTH IP/OP","$10,650.03 ","$7,881.02 ","$0.00 ","$9,660.42 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,660.42 ","$0.00 ","$4,830.21 ","$7,651.05 ","$7,728.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147295","ERX","HCPCS Q5113","63459-0303-43","TRASTUZUMAB-PKRB 150 MG IV SOLR","BOTH IP/OP","$3,803.58 ","$2,814.65 ","$0.00 ","$3,450.15 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,450.15 ","$0.00 ","$1,725.08 ","$2,732.52 ","$2,760.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147298","ERX","HCPCS J9155","55566-8403-01","DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR","BOTH IP/OP","$1,579.06 ","$1,168.50 ","$0.00 ","$1,463.22 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,463.22 ","$0.00 ","$731.61 ","$1,158.87 ","$1,170.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147299","ERX","HCPCS 25000001","39328-0064-12","SODIUM HYPOCHLORITE 0.125 % EX SOLN","BOTH IP/OP","$57.48 ","$42.54 ","$0.00 ","$52.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.13 ","$0.00 ","$26.07 ","$38.44 ","$41.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147300","ERX","HCPCS 25000001","39328-0063-25","SODIUM HYPOCHLORITE 0.25 % EX SOLN","BOTH IP/OP","$57.48 ","$42.54 ","$0.00 ","$52.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.13 ","$0.00 ","$26.07 ","$38.44 ","$41.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147301","ERX","HCPCS 25000001","39328-0062-50","SODIUM HYPOCHLORITE 0.5 % EX SOLN","BOTH IP/OP","$57.48 ","$42.54 ","$0.00 ","$52.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.13 ","$0.00 ","$26.07 ","$38.44 ","$41.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147303","ERX","HCPCS 25000001","00069-0284-03","PALBOCICLIB 75 MG PO TABS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147303","ERX","HCPCS 25000001","00069-0284-07","PALBOCICLIB 75 MG PO TABS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147304","ERX","HCPCS 25000001","00069-0486-03","PALBOCICLIB 100 MG PO TABS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147304","ERX","HCPCS 25000001","00069-0486-07","PALBOCICLIB 100 MG PO TABS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147305","ERX","HCPCS 25000001","00069-0688-03","PALBOCICLIB 125 MG PO TABS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147305","ERX","HCPCS 25000001","00069-0688-07","PALBOCICLIB 125 MG PO TABS","BOTH IP/OP","$2,068.13 ","$1,530.42 ","$0.00 ","$1,707.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.35 ","$0.00 ","$853.68 ","$1,352.22 ","$1,365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147467","ERX","HCPCS 25000001","62559-0430-01","HYDROCORTISONE (PERIANAL) 1 % EX CREA","BOTH IP/OP","$208.24 ","$154.10 ","$0.00 ","$189.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.03 ","$0.00 ","$94.52 ","$149.71 ","$151.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147467","ERX","HCPCS 25000001","64980-0302-30","HYDROCORTISONE (PERIANAL) 1 % EX CREA","BOTH IP/OP","$208.24 ","$154.10 ","$0.00 ","$189.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.03 ","$0.00 ","$94.52 ","$149.71 ","$151.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147467","ERX","HCPCS 25000001","65649-0501-30","HYDROCORTISONE (PERIANAL) 1 % EX CREA","BOTH IP/OP","$208.24 ","$154.10 ","$0.00 ","$189.03 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.03 ","$0.00 ","$94.52 ","$149.71 ","$151.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147827","ERX","HCPCS Q5112","00006-5033-02","TRASTUZUMAB-DTTB 150 MG IV SOLR","BOTH IP/OP","$3,592.48 ","$2,658.44 ","$0.00 ","$3,258.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,258.66 ","$0.00 ","$1,629.33 ","$2,580.86 ","$2,606.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147869","ERX","HCPCS J3490","61958-2901-01","REMDESIVIR 100 MG IV SOLR","BOTH IP/OP","$1,616.16 ","$1,195.96 ","$0.00 ","$727.27 ","$727.27 ","$0.00 ","$336.85 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$238.42 ","$0.00 "
"147917","ERX","HCPCS 63700001","24338-0230-05","NIMODIPINE 6 MG/ML PO SOLN","BOTH IP/OP","$180.55 ","$133.61 ","$0.00 ","$171.66 ","","$32.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.66 ","$0.00 ","$85.83 ","$135.95 ","$137.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147917","ERX","HCPCS 63700001","24338-0230-12","NIMODIPINE 6 MG/ML PO SOLN","BOTH IP/OP","$180.55 ","$133.61 ","$0.00 ","$171.66 ","","$32.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.66 ","$0.00 ","$85.83 ","$135.95 ","$137.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147933","ERX","HCPCS Q5112","00006-5034-02","TRASTUZUMAB-DTTB 420 MG IV SOLR","BOTH IP/OP","$10,058.93 ","$7,443.61 ","$0.00 ","$9,124.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,124.25 ","$0.00 ","$4,562.13 ","$7,226.41 ","$7,299.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147956","ERX","HCPCS 25000001","51144-0001-60","TUCATINIB 50 MG PO TABS","BOTH IP/OP","$360.53 ","$266.79 ","$0.00 ","$289.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.80 ","$0.00 ","$144.90 ","$229.52 ","$231.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147957","ERX","HCPCS 25000001","51144-0002-12","TUCATINIB 150 MG PO TABS","BOTH IP/OP","$630.02 ","$466.21 ","$0.00 ","$564.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.25 ","$0.00 ","$282.13 ","$446.89 ","$451.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147957","ERX","HCPCS 25000001","51144-0002-60","TUCATINIB 150 MG PO TABS","BOTH IP/OP","$630.02 ","$466.21 ","$0.00 ","$564.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.25 ","$0.00 ","$282.13 ","$446.89 ","$451.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147974","ERX","HCPCS C9066","55135-0132-01","SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR","BOTH IP/OP","$5,935.08 ","$4,391.96 ","$0.00 ","$4,950.75 ","$2,670.79 ","$2,250.58 ","$1,237.02 ","$0.00 ","$0.00 ","$0.00 ","$4,950.75 ","$0.00 ","$2,475.38 ","$3,920.99 ","$3,960.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"147993","ERX","HCPCS J2250","51754-9130-01","MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN","BOTH IP/OP","$75.34 ","$55.75 ","$0.00 ","$69.72 ","$33.90 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$69.72 ","$0.00 ","$34.86 ","$55.22 ","$55.78 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"147993","ERX","HCPCS J2250","51754-9130-05","MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN","BOTH IP/OP","$75.34 ","$55.75 ","$0.00 ","$69.72 ","$33.90 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$69.72 ","$0.00 ","$34.86 ","$55.22 ","$55.78 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"147994","ERX","HCPCS J2250","51754-9131-01","MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN","BOTH IP/OP","$116.91 ","$86.51 ","$0.00 ","$107.40 ","$52.61 ","$0.00 ","$18.80 ","$0.00 ","$0.00 ","$14.10 ","$107.40 ","$0.00 ","$53.70 ","$85.06 ","$85.92 ","$0.00 ","$14.10 ","$0.00 ","$13.43 ","$0.00 "
"147994","ERX","HCPCS J2250","51754-9131-05","MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN","BOTH IP/OP","$116.91 ","$86.51 ","$0.00 ","$107.40 ","$52.61 ","$0.00 ","$18.80 ","$0.00 ","$0.00 ","$14.10 ","$107.40 ","$0.00 ","$53.70 ","$85.06 ","$85.92 ","$0.00 ","$14.10 ","$0.00 ","$13.43 ","$0.00 "
"148482","ERX","HCPCS 25000001","70324-0326-03","SODIUM BICARBONATE-DEXTROSE 150-5 MEQ/L-% IV SOLN","BOTH IP/OP","$162.12 ","$119.97 ","$0.00 ","$147.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.00 ","$0.00 ","$73.50 ","$116.42 ","$117.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"148738","ERX","HCPCS 63700001","00087-0402-03","POLY-VI-SOL 50 MG/ML PO SOLN","BOTH IP/OP","$32.49 ","$24.04 ","$0.00 ","$32.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.49 ","$0.00 ","$16.25 ","$25.73 ","$25.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"148740","ERX","HCPCS 63700001","00087-0405-01","POLY-VI-SOL/IRON 11 MG/ML PO SOLN","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$32.49 ","","$6.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.49 ","$0.00 ","$16.25 ","$25.73 ","$25.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"149258","ERX","HCPCS J3370","70594-0057-01","VANCOMYCIN HCL 1250 MG/250ML IV SOLN","BOTH IP/OP","$87.82 ","$64.99 ","$0.00 ","$157.50 ","$39.52 ","$0.00 ","$7.24 ","$0.00 ","$0.00 ","$7.97 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$7.59 ","$0.00 "
"149258","ERX","HCPCS J3370","70594-0057-02","VANCOMYCIN HCL 1250 MG/250ML IV SOLN","BOTH IP/OP","$87.82 ","$64.99 ","$0.00 ","$157.50 ","$39.52 ","$0.00 ","$7.24 ","$0.00 ","$0.00 ","$7.97 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$7.59 ","$0.00 "
"149259","ERX","HCPCS J3370","70594-0058-01","VANCOMYCIN HCL 1750 MG/350ML IV SOLN","BOTH IP/OP","$120.24 ","$88.98 ","$0.00 ","$198.45 ","$54.11 ","$0.00 ","$10.86 ","$0.00 ","$0.00 ","$11.95 ","$198.45 ","$0.00 ","$99.23 ","$157.17 ","$158.76 ","$0.00 ","$0.00 ","$0.00 ","$11.38 ","$0.00 "
"149259","ERX","HCPCS J3370","70594-0058-02","VANCOMYCIN HCL 1750 MG/350ML IV SOLN","BOTH IP/OP","$120.24 ","$88.98 ","$0.00 ","$198.45 ","$54.11 ","$0.00 ","$10.86 ","$0.00 ","$0.00 ","$11.95 ","$198.45 ","$0.00 ","$99.23 ","$157.17 ","$158.76 ","$0.00 ","$0.00 ","$0.00 ","$11.38 ","$0.00 "
"400291","ERX","HCPCS J7040","00264-7800-10","SODIUM CHLORIDE 0.9 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.52 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.52 ","$0.00 ","$1.44 ","$0.00 "
"400291","ERX","HCPCS J7040","00338-0049-03","SODIUM CHLORIDE 0.9 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.52 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.52 ","$0.00 ","$1.44 ","$0.00 "
"400291","ERX","HCPCS J7040","00338-0049-04","SODIUM CHLORIDE 0.9 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.63 ","$0.00 ","$0.00 ","$1.52 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.52 ","$0.00 ","$1.44 ","$0.00 "
"400292","ERX","HCPCS 25000001","00338-0043-03","SODIUM CHLORIDE 0.45 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400292","ERX","HCPCS 25000001","00338-0043-04","SODIUM CHLORIDE 0.45 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400293","ERX","HCPCS 25000001","00338-0017-02","DEXTROSE 5 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400293","ERX","HCPCS 25000001","00338-0017-03","DEXTROSE 5 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400293","ERX","HCPCS 25000001","00338-0017-04","DEXTROSE 5 % IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400294","ERX","HCPCS 25000001","00338-0089-03","DEXTROSE 5 % AND 0.9 % NACL IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400294","ERX","HCPCS 25000001","00338-0089-04","DEXTROSE 5 % AND 0.9 % NACL IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400295","ERX","HCPCS 25000001","00338-0085-03","DEXTROSE 5 % AND 0.45 % NACL IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400295","ERX","HCPCS 25000001","00338-0085-04","DEXTROSE 5 % AND 0.45 % NACL IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400296","ERX","HCPCS 25000001","00264-7750-00","LACTATED RINGERS IV BOLUS ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400296","ERX","HCPCS 25000001","00264-7750-20","LACTATED RINGERS IV BOLUS ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400296","ERX","HCPCS 25000001","00338-0117-03","LACTATED RINGERS IV BOLUS ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400296","ERX","HCPCS 25000001","00338-0117-04","LACTATED RINGERS IV BOLUS ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400296","ERX","HCPCS 25000001","00409-7953-03","LACTATED RINGERS IV BOLUS ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400297","ERX","HCPCS 25000001","00264-7751-10","DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400297","ERX","HCPCS 25000001","00338-0125-04","DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600002","ERX","HCPCS 25000001","99999-6008-77","ACETIC ACID 6% SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$14.82 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.82 ","$0.00 ","$7.41 ","$8.71 ","$11.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600002","ERX","HCPCS 25000001","99999-6000-02","ACETIC ACID 6% SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$14.82 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.82 ","$0.00 ","$7.41 ","$11.74 ","$11.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600003","ERX","HCPCS 25000001","99999-6006-90","ADULT MAGIC MOUTHWASH(MLX:BEN:NYS:LIDO)","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$22.42 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.42 ","$0.00 ","$11.21 ","$17.76 ","$17.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600007","ERX","HCPCS J0290","99999-6000-07","AMPICILLIN 1 G/100ML NS MB PLUS","BOTH IP/OP","$69.81 ","$51.66 ","$0.00 ","$64.71 ","$31.41 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$64.71 ","$0.00 ","$32.36 ","$51.25 ","$51.77 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"600007","ERX","HCPCS J0290","99999-6010-85","AMPICILLIN 1 G/100ML NS MB PLUS","BOTH IP/OP","$69.81 ","$51.66 ","$0.00 ","$64.71 ","$31.41 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$64.71 ","$0.00 ","$32.36 ","$51.25 ","$51.77 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"600008","ERX","HCPCS J0290","99999-6000-08","AMPICILLIN 2 G/ NS 100ML MB PLUS","BOTH IP/OP","$80.07 ","$59.25 ","$0.00 ","$74.01 ","$36.03 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$74.01 ","$0.00 ","$37.01 ","$58.62 ","$59.21 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"600009","ERX","HCPCS J0713","99999-6011-20","CEFTAZIDIME 1G/D5W 100 ML MB PLUS","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$55.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.72 ","$55.54 ","$0.00 ","$27.77 ","$43.99 ","$44.43 ","$0.00 ","$8.69 ","$0.00 ","$8.84 ","$0.00 "
"600010","ERX","HCPCS J0713","99999-6000-10","CEFTAZIDIME 2 G/D5W 100ML MB PLUS","BOTH IP/OP","$115.98 ","$85.83 ","$0.00 ","$106.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.66 ","$106.56 ","$0.00 ","$53.28 ","$84.40 ","$85.25 ","$0.00 ","$16.68 ","$0.00 ","$16.96 ","$0.00 "
"600011","ERX","HCPCS 25000001","99999-6011-16","NAFCILLIN 1 G/D5W 100 ML MB PLUS","BOTH IP/OP","$106.26 ","$78.63 ","$0.00 ","$97.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.74 ","$0.00 ","$48.87 ","$77.41 ","$78.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600012","ERX","HCPCS 25000001","99999-6000-12","NAFCILLIN 2GM/D5W 100ML MB PLUS","BOTH IP/OP","$157.82 ","$116.79 ","$0.00 ","$144.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.50 ","$0.00 ","$72.25 ","$114.44 ","$115.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600013","ERX","HCPCS J0743","99999-6000-13","IMIPENEM-CILAST 500MG/NS 100ML MB PLUS","BOTH IP/OP","$203.22 ","$150.38 ","$0.00 ","$185.86 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.86 ","$0.00 ","$92.93 ","$147.20 ","$148.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600014","ERX","HCPCS J0696","99999-6011-31","CEFTRIAXONE 1 G/D5W 100 ML MB PLUS","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"600015","ERX","HCPCS J0295","99999-6000-15","AMPICILLIN-SULB 1.5 G/NS 50ML MB PLUS","BOTH IP/OP","$109.57 ","$81.08 ","$0.00 ","$100.75 ","$49.31 ","$0.00 ","$4.24 ","$0.00 ","$0.00 ","$3.03 ","$100.75 ","$0.00 ","$50.38 ","$79.79 ","$80.60 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"600016","ERX","HCPCS J0295","99999-6000-16","AMPICILLIN-SULB 3 G/NS 100ML MB PLUS","BOTH IP/OP","$142.11 ","$105.16 ","$0.00 ","$130.26 ","$63.95 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$130.26 ","$0.00 ","$65.13 ","$103.17 ","$104.21 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"600017","ERX","HCPCS j3370","99999-6000-17","VANCOMYCIN 1000 MG/250 ML D5W MB PLUS","BOTH IP/OP","$53.61 ","$39.67 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$31.20 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"600018","ERX","HCPCS J0697","99999-6000-18","CEFUROXIME 0.75 G/D5W 100 ML MB PLUS","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$91.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.16 ","$0.00 ","$45.58 ","$72.20 ","$72.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600018","ERX","HCPCS J0697","99999-6011-23","CEFUROXIME 0.75 G/D5W 100 ML MB PLUS","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$91.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.16 ","$0.00 ","$45.58 ","$72.20 ","$72.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600019","ERX","HCPCS J0697","99999-6000-19","CEFUROXIME 1.5 G/D5W 100ML MB PLUS","BOTH IP/OP","$126.71 ","$93.77 ","$0.00 ","$116.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.29 ","$0.00 ","$58.15 ","$92.10 ","$93.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600020","ERX","HCPCS J0690","99999-6000-20","CEFAZOLIN 1GM/D5W 50ML MB PLUS","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$1.39 ","$0.00 ","$0.00 ","$1.93 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$1.93 ","$0.00 ","$1.83 ","$0.00 "
"600021","ERX","HCPCS 25000001","99999-6000-21","DOXYCYCLINE 100MG/ NS 100ML MB PLUS","BOTH IP/OP","$109.78 ","$81.24 ","$0.00 ","$100.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.94 ","$0.00 ","$50.47 ","$79.94 ","$80.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600021","ERX","HCPCS 25000001","99999-6010-83","DOXYCYCLINE 100MG/ NS 100ML MB PLUS","BOTH IP/OP","$109.78 ","$81.24 ","$0.00 ","$100.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.94 ","$0.00 ","$50.47 ","$79.94 ","$80.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600022","ERX","HCPCS j3370","99999-6000-22","VANCOMYCIN 500MG/100 ML D5W MB PLUS","BOTH IP/OP","$58.60 ","$43.36 ","$0.00 ","$54.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.55 ","$54.54 ","$0.00 ","$27.27 ","$43.20 ","$43.63 ","$32.72 ","$8.54 ","$0.00 ","$8.68 ","$0.00 "
"600023","ERX","HCPCS J0694","99999-6011-24","CEFOXITIN 1 G/D5W 100 ML MB PLUS","BOTH IP/OP","$119.15 ","$88.17 ","$0.00 ","$109.43 ","$53.62 ","$0.00 ","$8.06 ","$0.00 ","$0.00 ","$6.22 ","$109.43 ","$0.00 ","$54.72 ","$86.67 ","$87.54 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"600027","ERX","HCPCS J0694","99999-6000-27","CEFOXITIN 2 G/D5W 100ML MB PLUS","BOTH IP/OP","$107.14 ","$79.28 ","$0.00 ","$98.55 ","$48.21 ","$0.00 ","$16.12 ","$0.00 ","$0.00 ","$12.43 ","$98.55 ","$0.00 ","$49.28 ","$78.05 ","$78.84 ","$0.00 ","$12.43 ","$0.00 ","$11.84 ","$0.00 "
"600028","ERX","HCPCS 25000001","99999-6000-28","UVC FLUID 100ML","BOTH IP/OP","$34.95 ","$25.86 ","$0.00 ","$31.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.70 ","$0.00 ","$15.85 ","$25.11 ","$25.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600029","ERX","HCPCS 25000001","99999-6000-29","UAC FLUID 100ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600030","ERX","HCPCS 25000001","99999-6000-30","PAL FLUID 100ML","BOTH IP/OP","$68.57 ","$50.74 ","$0.00 ","$62.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.19 ","$0.00 ","$31.10 ","$49.25 ","$49.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600031","ERX","HCPCS J0456","99999-6000-31","AZITHROMYCIN 500MG/D5W 250ML MB PLUS","BOTH IP/OP","$52.51 ","$38.86 ","$0.00 ","$52.00 ","$23.63 ","$0.00 ","$10.94 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"600032","ERX","HCPCS J0698","99999-6011-21","CEFOTAXIME 1 G/D5W 100 ML MB PLUS","BOTH IP/OP","$96.99 ","$71.77 ","$0.00 ","$89.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.34 ","$0.00 ","$44.67 ","$70.76 ","$71.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600033","ERX","HCPCS J2543","99999-6000-33","PIPERACIL-TAZO 2.25 G/D5W 50ML MB PLUS","BOTH IP/OP","$77.49 ","$57.34 ","$0.00 ","$71.68 ","$34.87 ","$0.00 ","$13.09 ","$0.00 ","$0.00 ","$4.35 ","$71.68 ","$0.00 ","$35.84 ","$56.77 ","$57.34 ","$0.00 ","$4.35 ","$0.00 ","$4.14 ","$0.00 "
"600034","ERX","HCPCS J2543","99999-6000-34","PIPERACIL-TAZ 3.375 G/D5W 50ML MB PLUS","BOTH IP/OP","$95.90 ","$70.97 ","$0.00 ","$88.37 ","$43.16 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$6.52 ","$88.37 ","$0.00 ","$44.19 ","$69.99 ","$70.70 ","$0.00 ","$6.52 ","$0.00 ","$6.21 ","$0.00 "
"600035","ERX","HCPCS J2543","99999-6000-35","PIPERACIL-TAZO 4.5 G/100 ML D5W MB PLUS","BOTH IP/OP","$103.43 ","$76.54 ","$0.00 ","$95.18 ","$46.54 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$95.18 ","$0.00 ","$47.59 ","$75.38 ","$76.14 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"600036","ERX","HCPCS J3010","99999-6000-36","FENTANYL 2000MCG/NS 100ML PREMIX","BOTH IP/OP","$239.43 ","$177.18 ","$0.00 ","$217.35 ","$107.74 ","$0.00 ","$49.90 ","$0.00 ","$0.00 ","$23.27 ","$217.35 ","$0.00 ","$108.68 ","$172.14 ","$173.88 ","$0.00 ","$23.27 ","$0.00 ","$22.15 ","$0.00 "
"600037","ERX","HCPCS J2250","99999-6000-37","MIDAZOLAM 50MG/NS 50ML PREMIX","BOTH IP/OP","$113.53 ","$84.01 ","$0.00 ","$102.94 ","$51.09 ","$0.00 ","$9.40 ","$0.00 ","$0.00 ","$7.05 ","$102.94 ","$0.00 ","$51.47 ","$81.53 ","$82.35 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"600038","ERX","HCPCS J1335","99999-6000-38","ERTAPENEM 1 G/NS 50ML MB PLUS","BOTH IP/OP","$481.37 ","$356.21 ","$0.00 ","$233.61 ","$115.12 ","$0.00 ","$100.33 ","$0.00 ","$0.00 ","$90.95 ","$233.61 ","$0.00 ","$116.81 ","$185.02 ","$186.89 ","$0.00 ","$90.95 ","$0.00 ","$86.60 ","$0.00 "
"600040","ERX","HCPCS J2185","99999-6000-40","MEROPENEM 1 G/NS 100 ML MB PLUS","BOTH IP/OP","$185.73 ","$137.44 ","$0.00 ","$169.81 ","","$0.00 ","$38.71 ","$0.00 ","$0.00 ","$0.00 ","$169.81 ","$0.00 ","$84.91 ","$134.49 ","$135.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600041","ERX","HCPCS J2700","99999-6000-41","OXACILLIN 2 G/D5W 100ML MB PLUS","BOTH IP/OP","$131.69 ","$97.45 ","$0.00 ","$120.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.81 ","$0.00 ","$60.41 ","$95.68 ","$96.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600042","ERX","HCPCS J2700","99999-6011-22","OXACILLIN 1 G/D5W 100 ML MB PLUS","BOTH IP/OP","$103.21 ","$76.38 ","$0.00 ","$94.98 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.98 ","$0.00 ","$47.49 ","$75.22 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600043","ERX","HCPCS J0696","99999-6011-32","CEFTRIAXONE 2 G/D5W 100 ML MB PLUS","BOTH IP/OP","$158.60 ","$117.36 ","$0.00 ","$145.20 ","$71.37 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$5.64 ","$145.20 ","$0.00 ","$72.60 ","$115.00 ","$116.16 ","$0.00 ","$5.64 ","$0.00 ","$5.37 ","$0.00 "
"600046","ERX","HCPCS 25000001","99999-6000-46","TOBRAMYCIN FORT 95MG/7ML OPHTH SOLN","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600048","ERX","HCPCS 25000001","99999-6000-48","CEFAZOLIN FORT OPHTH 50 MG/ML 10ML","BOTH IP/OP","$52.38 ","$38.76 ","$0.00 ","$47.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600049","ERX","HCPCS 25000001","99999-6000-49","VANCOMYCIN 30 MG/ML (3%) OPHTH SOLN","BOTH IP/OP","$87.52 ","$64.76 ","$0.00 ","$79.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.36 ","$0.00 ","$39.68 ","$62.85 ","$63.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600051","ERX","HCPCS 25000001","99999-6000-51","GENTAMICIN FORT 95MG/7ML OPHTH SOL","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600052","ERX","HCPCS 25000001","99999-6000-52","LEECH","BOTH IP/OP","$83.80 ","$62.01 ","$0.00 ","$76.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600053","ERX","HCPCS 25000001","99999-6000-53","BEER","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600054","ERX","HCPCS 25000001","99999-6000-54","L.E.T. TOPICAL GEL 3ML","BOTH IP/OP","$20.95 ","$15.50 ","$0.00 ","$19.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.00 ","$0.00 ","$9.50 ","$15.05 ","$15.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600055","ERX","HCPCS 25000001","99999-6000-55","MIDAZOLAM 2MG/1 ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600056","ERX","HCPCS 25000001","99999-6000-56","MIDAZOLAM 5MG/2.5ML ORAL SYRINGE","BOTH IP/OP","$12.57 ","$9.30 ","$0.00 ","$11.40 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.40 ","$0.00 ","$5.70 ","$9.03 ","$9.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600058","ERX","HCPCS 25000001","99999-6000-58","METHADONE 1MG/1ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600060","ERX","HCPCS 25000001","99999-6000-60","METHADONE 0.5MG/0.5ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600061","ERX","HCPCS 63700001","99999-6000-61","METHADONE 5MG/5ML ORAL SYRINGE","BOTH IP/OP","$10.48 ","$7.76 ","$0.00 ","$9.50 ","","$1.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.50 ","$0.00 ","$4.75 ","$7.52 ","$7.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600062","ERX","HCPCS 25000001","99999-6000-62","OXYCODONE LIQ 120MG/6ML ORAL SYRINGE","BOTH IP/OP","$28.85 ","$21.35 ","$0.00 ","$26.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.16 ","$0.00 ","$13.08 ","$20.72 ","$20.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600063","ERX","HCPCS 25000001","99999-6000-63","DIAZEPAM ELIXIR 1MG/ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600065","ERX","HCPCS 63700001","99999-6000-65","OXANDROLONE 1MG/1ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600066","ERX","HCPCS 63700001","99999-6000-66","OXANDROLONE 10MG/10ML ORAL SYRINGE","BOTH IP/OP","$644.22 ","$476.72 ","$0.00 ","$584.78 ","","$114.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$584.78 ","$0.00 ","$292.39 ","$463.15 ","$467.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600067","ERX","HCPCS 25000001","99999-6000-67","MORPHINE SULFATE 20MG/ML O/S 5ML","BOTH IP/OP","$11.53 ","$8.53 ","$0.00 ","$10.45 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.45 ","$0.00 ","$5.23 ","$8.28 ","$8.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600068","ERX","HCPCS 25000001","99999-6000-68","MORPHINE SULFATE 20MG/ML O/S 3ML","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600069","ERX","HCPCS 25000001","99999-6000-69","MORPHINE SULFATE 20MG/ML O/S 2ML","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600079","ERX","HCPCS 25000001","99999-6000-79","CALCITRIOL 1MCG/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$49.99 ","$36.99 ","$0.00 ","$45.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.34 ","$0.00 ","$22.67 ","$35.91 ","$36.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600107","ERX","HCPCS 63700001","99999-6001-07","FUROSEMIDE 10MG/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600109","ERX","HCPCS 25000001","99999-6001-09","NEVIRAPINE 10MG/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600112","ERX","HCPCS 25000001","99999-6001-12","ALUM-MG HYDRX-SIMETH 15ML ORAL SYRINGE","BOTH IP/OP","$18.86 ","$13.96 ","$0.00 ","$17.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.10 ","$0.00 ","$8.55 ","$13.54 ","$13.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600126","ERX","HCPCS 63700001","99999-6001-26","KALETRA 80MG/20MG/ML ORAL SYRINGE","BOTH IP/OP","$54.22 ","$40.12 ","$0.00 ","$49.18 ","","$9.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.18 ","$0.00 ","$24.59 ","$38.95 ","$39.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600134","ERX","HCPCS 63700001","99999-6001-34","POSACONAZOLE 200MG/5 ML ORAL SYRINGE","BOTH IP/OP","$110.21 ","$81.56 ","$0.00 ","$99.93 ","","$19.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.93 ","$0.00 ","$49.97 ","$79.14 ","$79.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600137","ERX","HCPCS 63700001","99999-6001-37","ERGOCALCIFEROL 8000 UNITS/ML (NICU) ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600138","ERX","HCPCS 25000001","99999-6001-38","PENICILLIN VK 50MG/ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600141","ERX","HCPCS 25000001","99999-6001-41","TRIFLUOPERAZINE 10MG/ML ORAL SYRINGE","BOTH IP/OP","$10.02 ","$7.41 ","$0.00 ","$9.09 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.09 ","$0.00 ","$4.55 ","$7.20 ","$7.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600144","ERX","HCPCS 63700001","99999-6001-44","ZIDOVUDINE 10MG/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600151","ERX","HCPCS 25000001","99999-6001-51","BACLOFEN 1MG/ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600152","ERX","HCPCS 25000001","99999-6001-52","BACLOFEN 10MG/ML ORAL SYRINGE HI CONC","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600153","ERX","HCPCS 25000001","99999-6001-53","SIMETHICONE 40MG/0.6ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600157","ERX","HCPCS 25000001","99999-6001-57","LANSOPRAZOLE 3MG/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$68.89 ","$50.98 ","$0.00 ","$62.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.48 ","$0.00 ","$31.24 ","$49.48 ","$49.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600159","ERX","HCPCS 63700001","99999-6001-59","MULTIPLE VIT W/IRON ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600162","ERX","HCPCS 25000001","99999-6001-62","PREDNISOLONE 9MG/3ML ORAL SYRINGE","BOTH IP/OP","$16.97 ","$12.56 ","$0.00 ","$15.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.39 ","$0.00 ","$7.70 ","$12.19 ","$12.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600163","ERX","HCPCS 25000001","99999-6001-63","PREDNISOLONE 30MG/10ML ORAL SYRINGE","BOTH IP/OP","$173.70 ","$128.54 ","$0.00 ","$157.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600164","ERX","HCPCS 25000001","99999-6001-64","PREDNISOLONE 15MG/5ML ORAL SYRINGE","BOTH IP/OP","$28.29 ","$20.93 ","$0.00 ","$25.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.65 ","$0.00 ","$12.83 ","$20.31 ","$20.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600166","ERX","HCPCS 25000001","99999-6001-66","CHLORHEXIDINE MTHWASH 0.12% 1ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600175","ERX","HCPCS 63700001","99999-6001-75","NYSTATIN 100000U/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600176","ERX","HCPCS 25000001","99999-6001-76","NYSTATIN 50000U/0.5ML ORAL SYRNGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600177","ERX","HCPCS 63700001","99999-6001-77","NYSTATIN 200000U/2ML ORAL SYRNGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600181","ERX","HCPCS 63700001","99999-6001-81","SODIUM CHLORIDE 4 MEQ/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600191","ERX","HCPCS 63700001","99999-6001-91","FLUOXETINE 4MG/ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600199","ERX","HCPCS 63700001","99999-6001-99","FLUPHENAZINE 2.5MG/5ML ORAL SYRINGE","BOTH IP/OP","$38.89 ","$28.78 ","$0.00 ","$35.27 ","","$6.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.27 ","$0.00 ","$17.64 ","$27.93 ","$28.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600200","ERX","HCPCS 63700001","99999-6002-00","FLUPHENAZINE 0.5MG/ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600206","ERX","HCPCS 63700001","99999-6002-06","SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 1","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600207","ERX","HCPCS 63700001","99999-6002-07","SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 2","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600208","ERX","HCPCS 63700001","99999-6002-08","SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 3","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600209","ERX","HCPCS 63700001","99999-6002-09","SULFAMETHOXAZOLE-TMP SUSP 5ML O/S DOSE # 5","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600210","ERX","HCPCS 63700001","99999-6002-10","SULFAMETHOXAZOLE-TMP SUSP 20ML O/S DOSE # 6","BOTH IP/OP","$10.06 ","$7.44 ","$0.00 ","$9.12 ","","$1.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.12 ","$0.00 ","$4.56 ","$7.22 ","$7.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600211","ERX","HCPCS 63700001","99999-6002-11","SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 4","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600220","ERX","HCPCS 63700001","99999-6002-20","MULTIPLE VITAMIN (NICU) ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600221","ERX","HCPCS 25000001","99999-6002-21","GUAIFENESIN DM 1ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600231","ERX","HCPCS 25000001","99999-6002-31","NITAZOXANIDE 100MG/5ML ORAL SYRNGE","BOTH IP/OP","$129.31 ","$95.69 ","$0.00 ","$117.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.25 ","$0.00 ","$58.63 ","$92.86 ","$93.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600232","ERX","HCPCS 25000001","99999-6002-32","BENADRYL/MAALOX 1:1","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600237","ERX","HCPCS 63700001","99999-6002-37","RISPERIDONE 2 MG/2 ML ORAL SYRINGE","BOTH IP/OP","$55.15 ","$40.81 ","$0.00 ","$50.01 ","","$9.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.01 ","$0.00 ","$25.01 ","$39.61 ","$40.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600240","ERX","HCPCS 25000001","99999-6002-40","HYDROMORPHONE 15000MCG/30ML NS PED","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600241","ERX","HCPCS 25000001","99999-6002-41","HYDROMORPHONE 30000MCG/30ML NS PED","BOTH IP/OP","$41.57 ","$30.76 ","$0.00 ","$37.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.70 ","$0.00 ","$18.85 ","$29.86 ","$30.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600245","ERX","HCPCS 25000001","99999-6010-93","AZTREONAM 1 G/100ML D5W MB PLUS","BOTH IP/OP","$195.23 ","$144.47 ","$0.00 ","$178.42 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.42 ","$0.00 ","$89.21 ","$141.31 ","$142.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600246","ERX","HCPCS 25000001","99999-6010-94","AZTREONAM 2 G/100ML D5W MB PLUS","BOTH IP/OP","$318.60 ","$235.76 ","$0.00 ","$290.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.60 ","$0.00 ","$145.30 ","$230.16 ","$232.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600247","ERX","HCPCS 25000001","99999-6002-47","KETAMINE 50MG/1 ML IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600253","ERX","HCPCS 25000001","99999-6002-53","AMPHOTERICIN B 5MCG/0.1ML OPHTH SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600255","ERX","HCPCS 25000001","99999-6002-55","GANCICLOVIR 2MG/0.1 ML OPHTH SYRINGE","BOTH IP/OP","$337.54 ","$249.78 ","$0.00 ","$306.41 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.41 ","$0.00 ","$153.21 ","$242.68 ","$245.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600263","ERX","HCPCS 25000001","99999-6002-63","NICARDIPINE 1MG/10ML NS","BOTH IP/OP","$160.97 ","$119.12 ","$0.00 ","$145.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.95 ","$0.00 ","$72.98 ","$115.59 ","$116.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600273","ERX","HCPCS 25000001","99999-6002-73","AMIKACIN 400MCG/0.1ML OPHTH SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600283","ERX","HCPCS 25000001","99999-6002-83","VORICONAZOLE 40MCG/0.1 ML NS OPHTH SYRINGE","BOTH IP/OP","$512.67 ","$379.38 ","$0.00 ","$465.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.37 ","$0.00 ","$232.69 ","$368.57 ","$372.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600285","ERX","HCPCS 25000001","99999-6002-85","COSYNTROPIN 1 MCG/1 ML (NICU) IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600297","ERX","HCPCS 25000001","99999-6002-97","NACL 0.45% FLUSH 2ML IV SYRINGE (NICU)","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600306","ERX","HCPCS 25000001","99999-6003-06","CEFTAZIDIME 2.25MG/0.1ML OPHTH SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600307","ERX","HCPCS 25000001","99999-6003-07","VITAMIN A 5000U/0.1ML IM SYRINGE (NICU)","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600313","ERX","HCPCS 25000001","99999-6003-13","VANCOMYCIN 0.75MG/0.1ML OPHTH SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600314","ERX","HCPCS 25000001","99999-6003-14","VANCOMYCIN 1MG/0.1ML OPHTH SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600316","ERX","HCPCS 25000001","99999-6003-16","VASOPRESSIN 4 UNITS/10 ML NS","BOTH IP/OP","$45.26 ","$33.49 ","$0.00 ","$41.04 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.04 ","$0.00 ","$20.52 ","$32.50 ","$32.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600328","ERX","HCPCS 25000001","99999-6003-28","HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600328","ERX","HCPCS 25000001","99999-6011-72","HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600333","ERX","HCPCS J2997","99999-6003-33","ALTEPLASE 1MG/1 ML SW IV SYRINGE(NICU)","BOTH IP/OP","$570.57 ","$422.22 ","$0.00 ","$517.93 ","$256.76 ","$87.67 ","$118.92 ","$0.00 ","$0.00 ","$90.69 ","$517.93 ","$92.02 ","$258.97 ","$410.20 ","$414.34 ","$127.08 ","$81.06 ","$0.00 ","$82.45 ","$87.89 "
"600340","ERX","HCPCS 25000001","99999-6003-40","EPHEDRINE 50MG/10ML NS IV SYRINGE","BOTH IP/OP","$63.53 ","$47.01 ","$0.00 ","$57.61 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.61 ","$0.00 ","$28.81 ","$45.63 ","$46.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600356","ERX","HCPCS 25000001","99999-6003-56","ON-Q PUMP 270 ML 2 ML/HR SINGLE LUMEN","BOTH IP/OP","$541.34 ","$400.59 ","$0.00 ","$491.39 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$491.39 ","$0.00 ","$245.70 ","$389.18 ","$393.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600357","ERX","HCPCS 25000001","99999-6003-57","ON-Q PUMP 400 ML 4 ML/HR DUAL LUMEN","BOTH IP/OP","$1,424.50 ","$1,054.13 ","$0.00 ","$1,320.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600358","ERX","HCPCS 25000001","99999-6003-58","ON-Q PUMP 400 ML 5 ML/HR SINGLE LUMEN","BOTH IP/OP","$766.50 ","$567.21 ","$0.00 ","$695.63 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$695.63 ","$0.00 ","$347.82 ","$550.94 ","$556.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600359","ERX","HCPCS 25000001","99999-6003-59","ON-Q C-BLOC PUMP 400ML","BOTH IP/OP","$876.00 ","$648.24 ","$0.00 ","$795.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600360","ERX","HCPCS 25000001","99999-6003-60","FOSCARNET SODIUM 2.4MG/0.1ML OPHTH SYRINGE","BOTH IP/OP","$826.36 ","$611.51 ","$0.00 ","$749.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$749.95 ","$0.00 ","$374.98 ","$593.96 ","$599.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600362","ERX","HCPCS J0690","99999-6003-62","CEFAZOLIN 1GM/NS 50ML MB PLUS-OR ONLY","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$1.39 ","$0.00 ","$0.00 ","$1.93 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$1.93 ","$0.00 ","$1.83 ","$0.00 "
"600364","ERX","HCPCS J2543","99999-6003-64","PIPERACIL-TAZ 3.375 G/NS 50ML MB PLUS","BOTH IP/OP","$95.90 ","$70.97 ","$0.00 ","$88.37 ","$43.16 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$6.52 ","$88.37 ","$0.00 ","$44.19 ","$69.99 ","$70.70 ","$0.00 ","$6.52 ","$0.00 ","$6.21 ","$0.00 "
"600365","ERX","HCPCS J2543","99999-6003-65","PIPERACIL-TAZO 4.5 G/NS 100ML MB PLUS","BOTH IP/OP","$103.43 ","$76.54 ","$0.00 ","$95.18 ","$46.54 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$95.18 ","$0.00 ","$47.59 ","$75.38 ","$76.14 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"600367","ERX","HCPCS J0694","99999-6011-25","CEFOXITIN 1 G/NS 100 ML MB PLUS-OR ONLY","BOTH IP/OP","$119.15 ","$88.17 ","$0.00 ","$109.43 ","$53.62 ","$0.00 ","$8.06 ","$0.00 ","$0.00 ","$6.22 ","$109.43 ","$0.00 ","$54.72 ","$86.67 ","$87.54 ","$0.00 ","$6.22 ","$0.00 ","$5.92 ","$0.00 "
"600368","ERX","HCPCS 25000001","99999-6003-68","PENICILLIN G 2 MU/NS 50ML-OR ONLY","BOTH IP/OP","$199.22 ","$147.42 ","$0.00 ","$180.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.85 ","$0.00 ","$90.43 ","$143.23 ","$144.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600369","ERX","HCPCS 25000001","99999-6003-69","DESMOPRESSIN 0.25MCG/0.5ML NS SYRINGE","BOTH IP/OP","$36.98 ","$27.37 ","$0.00 ","$33.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.54 ","$0.00 ","$16.77 ","$26.56 ","$26.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600378","ERX","HCPCS 25000001","99999-6003-78","KAOPECTATE AND BENADRYL 1:1 ORAL SOLUTION","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600380","ERX","HCPCS 25000001","99999-6003-80","GENTAMICIN 0.5ML (80MG/ML) WITH 0.5ML OF DEXAMETHASONE-OR","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600381","ERX","HCPCS 25000001","99999-6003-81","EPINEPHRINE 0.3ML (1:1000,1MG/ML) IN 500ML BSS PLUS-OR","BOTH IP/OP","$100.50 ","$74.37 ","$0.00 ","$92.53 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.53 ","$0.00 ","$46.27 ","$73.28 ","$74.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600382","ERX","HCPCS 25000001","99999-6003-82","LIDOCAINE 2% 3ML/.75% MARCAINE 3ML/200MG WYDASE 1ML","BOTH IP/OP","$233.03 ","$172.44 ","$0.00 ","$212.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.92 ","$0.00 ","$106.46 ","$168.63 ","$170.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600383","ERX","HCPCS 25000001","99999-6003-83","SUGARCAINE MIXTURE 5ML-OR","BOTH IP/OP","$48.63 ","$35.99 ","$0.00 ","$44.10 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.10 ","$0.00 ","$22.05 ","$34.93 ","$35.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600384","ERX","HCPCS 25000001","99999-6003-84","LIDOCAINE/BUPIVACAINE/HYALURONIDASE - OR EYE BLOCK","BOTH IP/OP","$241.22 ","$178.50 ","$0.00 ","$220.36 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.36 ","$0.00 ","$110.18 ","$174.53 ","$176.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600385","ERX","HCPCS 25000001","99999-6003-85","LIDOCAINE/EPI/NS-OR TUMESCENT MIXTURE","BOTH IP/OP","$62.73 ","$46.42 ","$0.00 ","$58.29 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.29 ","$0.00 ","$29.15 ","$46.17 ","$46.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600386","ERX","HCPCS 25000001","99999-6003-86","LIDOCAINE 1% 14 ML/PAPAVERINE (30 MG/ML) 2 ML-OR","BOTH IP/OP","$54.06 ","$40.00 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600388","ERX","HCPCS 25000001","99999-6003-88","BACITRACIN 50,000 UNITS IN 1000 ML NS - OR NEURO","BOTH IP/OP","$96.20 ","$71.19 ","$0.00 ","$96.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.20 ","$0.00 ","$48.10 ","$76.19 ","$76.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600389","ERX","HCPCS 25000001","99999-6003-89","IOHEXOL 300 MG/ML 50 ML MIXED WITH 50ML STERILE WATER-OR GU","BOTH IP/OP","$245.76 ","$181.86 ","$0.00 ","$224.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$224.48 ","$0.00 ","$112.24 ","$177.79 ","$179.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600390","ERX","HCPCS 25000001","99999-6003-90","VASOPRESSIN 20 UNITS IN 50 ML NS - OR GYN","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600391","ERX","HCPCS 25000001","99999-6003-91","VASOPRESSIN 20 UNITS IN 100 ML NS - OR GYN","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600392","ERX","HCPCS 25000001","99999-6003-92","VASOPRESSIN 20 UNITS IN 200 ML OF NS - OR GYN","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600393","ERX","HCPCS 25000001","99999-6003-93","INDIGO CARMINE 5 ML/100 ML 0.9% SODIUM CHLORIDE -OR","BOTH IP/OP","$94.61 ","$70.01 ","$0.00 ","$87.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.20 ","$0.00 ","$43.60 ","$69.06 ","$69.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600394","ERX","HCPCS 25000001","99999-6003-94","INDIGO CARMINE 5 ML/200 ML 0.9% SODIUM CHLORIDE -OR","BOTH IP/OP","$94.61 ","$70.01 ","$0.00 ","$87.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.20 ","$0.00 ","$43.60 ","$69.06 ","$69.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600395","ERX","HCPCS 25000001","99999-6003-95","INDIGO CARMINE 5 ML/250 ML 0.9% SODIUM CHLORIDE -OR","BOTH IP/OP","$94.61 ","$70.01 ","$0.00 ","$87.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.20 ","$0.00 ","$43.60 ","$69.06 ","$69.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600396","ERX","HCPCS 25000001","99999-6003-96","INDIGO CARMINE 5 ML/300 ML 0.9% SODIUM CHLORIDE -OR","BOTH IP/OP","$94.61 ","$70.01 ","$0.00 ","$87.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.20 ","$0.00 ","$43.60 ","$69.06 ","$69.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600397","ERX","HCPCS J3475","15082-0902-05","MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$2.96 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$2.96 ","$0.00 ","$2.82 ","$0.00 "
"600397","ERX","HCPCS J3475","42852-0902-05","MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$2.96 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$2.96 ","$0.00 ","$2.82 ","$0.00 "
"600397","ERX","HCPCS J3475","99999-6008-51","MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$2.96 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$2.96 ","$0.00 ","$2.82 ","$0.00 "
"600398","ERX","HCPCS J3475","15082-0903-05","MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.47 ","$0.00 ","$0.00 ","$5.92 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.92 ","$0.00 ","$5.64 ","$0.00 "
"600398","ERX","HCPCS J3475","99999-6006-44","MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$0.47 ","$0.00 ","$0.00 ","$5.92 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$5.92 ","$0.00 ","$5.64 ","$0.00 "
"600399","ERX","HCPCS J3475","24200-0015-13","MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX","BOTH IP/OP","$92.59 ","$68.52 ","$0.00 ","$85.35 ","$41.67 ","$0.00 ","$5.88 ","$0.00 ","$0.00 ","$74.03 ","$85.35 ","$0.00 ","$42.68 ","$67.60 ","$68.28 ","$0.00 ","$74.03 ","$0.00 ","$70.48 ","$0.00 "
"600399","ERX","HCPCS J3475","24200-1015-13","MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX","BOTH IP/OP","$92.59 ","$68.52 ","$0.00 ","$85.35 ","$41.67 ","$0.00 ","$5.88 ","$0.00 ","$0.00 ","$74.03 ","$85.35 ","$0.00 ","$42.68 ","$67.60 ","$68.28 ","$0.00 ","$74.03 ","$0.00 ","$70.48 ","$0.00 "
"600399","ERX","HCPCS J3475","99999-6006-77","MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX","BOTH IP/OP","$92.59 ","$68.52 ","$0.00 ","$85.35 ","$41.67 ","$0.00 ","$5.88 ","$0.00 ","$0.00 ","$74.03 ","$85.35 ","$0.00 ","$42.68 ","$67.60 ","$68.28 ","$0.00 ","$74.03 ","$0.00 ","$70.48 ","$0.00 "
"600403","ERX","HCPCS 25000001","15082-0211-10","FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600403","ERX","HCPCS 25000001","99999-6007-22","FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600420","ERX","HCPCS 25000001","99999-6008-76","ACETIC ACID 3% SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$219.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$219.72 ","$0.00 ","$109.86 ","$8.71 ","$175.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600420","ERX","HCPCS 25000001","99999-6004-23","ACETIC ACID 3% SOLN","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$219.72 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$219.72 ","$0.00 ","$109.86 ","$174.02 ","$175.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600421","ERX","HCPCS 25000001","535rf-p401-0j","NXSTAGE RFP 401 DIALYSIS SOLUTION","BOTH IP/OP","$91.68 ","$67.84 ","$0.00 ","$83.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.13 ","$0.00 ","$41.57 ","$65.84 ","$66.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600421","ERX","HCPCS 25000001","99999-6004-24","NXSTAGE RFP 401 DIALYSIS SOLUTION","BOTH IP/OP","$91.68 ","$67.84 ","$0.00 ","$83.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.13 ","$0.00 ","$41.57 ","$65.84 ","$66.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600422","ERX","HCPCS 25000001","535rf-p400-0i","NXSTAGE RFP 400 DIALYSIS SOLUTION","BOTH IP/OP","$91.68 ","$67.84 ","$0.00 ","$83.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.13 ","$0.00 ","$41.57 ","$65.84 ","$66.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600422","ERX","HCPCS 25000001","99999-6004-25","NXSTAGE RFP 400 DIALYSIS SOLUTION","BOTH IP/OP","$91.68 ","$67.84 ","$0.00 ","$83.13 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.13 ","$0.00 ","$41.57 ","$65.84 ","$66.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600423","ERX","HCPCS 25000001","99999-6004-27","CLINDAMYCIN 50MG/ML OPHTH SOLN 5 ML","BOTH IP/OP","$48.61 ","$35.97 ","$0.00 ","$44.08 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.08 ","$0.00 ","$22.04 ","$34.91 ","$35.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600426","ERX","HCPCS 25000001","99999-6004-26","MECHLORETHAMINE 0.01% OINT","BOTH IP/OP","$2,072.00 ","$1,533.28 ","$0.00 ","$1,920.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,920.00 ","$0.00 ","$960.00 ","$1,520.64 ","$1,536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600435","ERX","HCPCS 25000001","99999-6004-39","CHOCOLATE SYRUP","BOTH IP/OP","$11.00 ","$8.14 ","$0.00 ","$11.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$8.71 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600438","ERX","HCPCS 25000001","99999-6005-87","OR NEOMYCIN-POLYMYXIN B (NEOSPORIN GU) 3 ML/3000 ML NS IR","BOTH IP/OP","$238.80 ","$176.71 ","$0.00 ","$216.78 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.78 ","$0.00 ","$108.39 ","$171.69 ","$173.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600450","ERX","HCPCS 25000001","99999-6004-58","PENICILLIN 160 UNITS/ML D5W DESENSITIZATION","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600453","ERX","HCPCS J1644","15082-0747-99","HEPARIN 4000 UNITS/1000 ML NS IR","BOTH IP/OP","$131.24 ","$97.12 ","$0.00 ","$119.00 ","$59.06 ","$0.00 ","$0.94 ","$0.00 ","$0.00 ","$1.13 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$1.13 ","$0.00 ","$1.07 ","$0.00 "
"600453","ERX","HCPCS J1644","42852-0747-99","HEPARIN 4000 UNITS/1000 ML NS IR","BOTH IP/OP","$131.24 ","$97.12 ","$0.00 ","$119.00 ","$59.06 ","$0.00 ","$0.94 ","$0.00 ","$0.00 ","$1.13 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$1.13 ","$0.00 ","$1.07 ","$0.00 "
"600453","ERX","HCPCS J1644","71285-7022-01","HEPARIN 4000 UNITS/1000 ML NS IR","BOTH IP/OP","$131.24 ","$97.12 ","$0.00 ","$119.00 ","$59.06 ","$0.00 ","$0.94 ","$0.00 ","$0.00 ","$1.13 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$1.13 ","$0.00 ","$1.07 ","$0.00 "
"600456","ERX","HCPCS 25000001","99999-6005-64","DEXTROSE 5% FLUSH 2 ML IV SYRINGE (NICU)","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600457","ERX","HCPCS 25000001","00338-0023-03","DEXTROSE 10% (NICU) IV BOLUS SYRINGE","BOTH IP/OP","$27.24 ","$20.16 ","$0.00 ","$22.80 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.80 ","$0.00 ","$11.40 ","$18.06 ","$18.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600493","ERX","HCPCS 25000001","99999-6005-84","MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SYRINGE","BOTH IP/OP","$27.48 ","$20.34 ","$0.00 ","$24.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.92 ","$0.00 ","$12.46 ","$19.74 ","$19.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600494","ERX","HCPCS 25000001","99999-6005-83","MULTIVITAMIN (AQUADEKS) ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600496","ERX","HCPCS 63700001","99999-6005-77","VITAMIN K 1 MG/ML (NICU) ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600499","ERX","HCPCS 25000001","99999-6005-65","AMPHOTERICIN 1MG/ML (NICU) COMPOUNDING","BOTH IP/OP","$94.57 ","$69.98 ","$0.00 ","$85.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.75 ","$0.00 ","$42.88 ","$67.91 ","$68.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600501","ERX","HCPCS 25000001","99999-6005-66","OR ONLY-CEFAZOLIN 1G/NS 1000ML IRRIGATION SOLN","BOTH IP/OP","$67.23 ","$49.75 ","$0.00 ","$62.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.37 ","$0.00 ","$31.19 ","$49.40 ","$49.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600502","ERX","HCPCS 25000001","99999-6005-67","OR ONLY-CEFAZOLIN 1GM/NS 1500ML IRRIG","BOTH IP/OP","$90.27 ","$66.80 ","$0.00 ","$83.27 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.27 ","$0.00 ","$41.64 ","$65.95 ","$66.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600506","ERX","HCPCS C9257","99999-6005-71","BEVACIZUMAB 5 MG/0.2 ML OPHTH SYRINGE","BOTH IP/OP","$132.69 ","$98.19 ","$0.00 ","$120.32 ","$59.71 ","$8.49 ","$27.66 ","$0.00 ","$0.00 ","$21.07 ","$120.32 ","$42.63 ","$60.16 ","$95.29 ","$96.26 ","$58.87 ","$18.83 ","$0.00 ","$19.15 ","$39.20 "
"600511","ERX","HCPCS 25000001","99999-6005-80","HYDROXYPROGESTERONE-17 250 MG/ML IM INJ","BOTH IP/OP","$2,144.52 ","$1,586.94 ","$0.00 ","$1,987.20 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,987.20 ","$0.00 ","$993.60 ","$1,573.86 ","$1,589.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600521","ERX","HCPCS 25000001","99999-6005-97","OR BACITRACIN 50,000 UNITS IN 1500 ML NS IR-NEURO","BOTH IP/OP","$114.65 ","$84.84 ","$0.00 ","$103.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.95 ","$0.00 ","$51.98 ","$82.33 ","$83.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600522","ERX","HCPCS 25000001","99999-6005-98","OR NEOMYCIN-POLYMYXIN B 2 ML/1500 ML NS IR","BOTH IP/OP","$125.22 ","$92.66 ","$0.00 ","$113.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.54 ","$0.00 ","$56.77 ","$89.92 ","$90.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600523","ERX","HCPCS 25000001","99999-6005-99","OR CEFAZOLIN 1G+BACITRACIN 50,000UNITS+GENT80/1500 ML","BOTH IP/OP","$127.48 ","$94.34 ","$0.00 ","$115.59 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.59 ","$0.00 ","$57.80 ","$91.55 ","$92.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600524","ERX","HCPCS 25000001","99999-6006-06","CIDOFOVIR 1% CREAM 37.5G","BOTH IP/OP","$2,310.55 ","$1,709.81 ","$0.00 ","$2,141.05 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,141.05 ","$0.00 ","$1,070.53 ","$1,695.71 ","$1,712.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600531","ERX","HCPCS 25000001","99999-6006-16","OR CHLORHEXIDINE 0.12% 473 ML WITH 500 ML NSIR","BOTH IP/OP","$81.33 ","$60.18 ","$0.00 ","$73.76 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.76 ","$0.00 ","$36.88 ","$58.42 ","$59.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600534","ERX","HCPCS 25000001","99999-6006-19","CEFTRIAXONE +LIDOCAINE 1% IM INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600536","ERX","HCPCS 25000001","99999-6006-22","OXYCHLOROSENE 0.4% IRRIGATION SOLN (2 G/500 ML NS)","BOTH IP/OP","$14.25 ","$10.55 ","$0.00 ","$12.92 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.92 ","$0.00 ","$6.46 ","$10.23 ","$10.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600539","ERX","HCPCS 25000001","99999-6006-24","AMIKACIN 250 MG/ML NEBU SOLN","BOTH IP/OP","$18.61 ","$13.77 ","$0.00 ","$16.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.88 ","$0.00 ","$8.44 ","$13.37 ","$13.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600541","ERX","HCPCS 25000001","99999-6006-26","TOBRAMYCIN 40 MG/ML NEBU SOLN","BOTH IP/OP","$17.05 ","$12.62 ","$0.00 ","$15.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.46 ","$0.00 ","$7.73 ","$12.24 ","$12.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600543","ERX","HCPCS J0878","99999-6006-30","DAPTOMYCIN 500MG/NS 50ML MB PLUS","BOTH IP/OP","$941.23 ","$696.51 ","$0.00 ","$855.58 ","$423.55 ","$0.00 ","$223.25 ","$0.00 ","$0.00 ","$170.38 ","$855.58 ","$173.25 ","$427.79 ","$677.62 ","$684.46 ","$239.25 ","$170.38 ","$0.00 ","$162.23 ","$68.00 "
"600544","ERX","HCPCS 25000001","99999-6006-32","SODIUM BICARBONATE 1% ET IRRIGATION SOLUTION","BOTH IP/OP","$20.54 ","$15.20 ","$0.00 ","$18.62 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.62 ","$0.00 ","$9.31 ","$14.75 ","$14.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600548","ERX","HCPCS 25000001","99999-6006-38","PODOPHYLLUM 40% IN BENZOIN","BOTH IP/OP","$277.54 ","$205.38 ","$0.00 ","$251.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.94 ","$0.00 ","$125.97 ","$199.54 ","$201.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600550","ERX","HCPCS 25000001","99999-6006-43","VITAMIN K1 1 MG/0.1ML (NICU) >=1250 G","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600556","ERX","HCPCS 25000001","","PENICILLIN G 10,000 UNITS/ML ID INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600557","ERX","HCPCS 25000001","99999-6006-55","SQUARIC ACID 2% TOP SOLN","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$457.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.50 ","$0.00 ","$228.75 ","$362.34 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600559","ERX","HCPCS 25000001","99999-6006-58","HISTAMINE BASE 1 MG/ML ID SOLN","BOTH IP/OP","$32.84 ","$24.30 ","$0.00 ","$32.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.84 ","$0.00 ","$16.42 ","$26.01 ","$26.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600560","ERX","HCPCS J0640","99999-6006-60","LEUCOVORIN 50 MG/50 ML NS IVPB MB PLUS","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$1.05 ","$0.00 ","$0.00 ","$3.91 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$3.91 ","$0.00 ","$3.73 ","$0.00 "
"600561","ERX","HCPCS 25000001","99999-6006-59","POLYMYXIN B 10 MG/ML D5W DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600562","ERX","HCPCS 25000001","99999-6006-61","POLYMYXIN B 1 MG/ML D5W DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600563","ERX","HCPCS 25000001","99999-6006-62","POLYMYXIN B 0.1 MG/ML D5W DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600564","ERX","HCPCS 25000001","99999-6006-63","POLYMYXIN B 0.01 MG/ML D5W DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600565","ERX","HCPCS 25000001","99999-6006-64","POLYMYXIN B 0.001 MG/ML D5W DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600566","ERX","HCPCS 25000001","99999-6006-65","POLYMYXIN B 0.0001 MG/ML D5W DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600570","ERX","HCPCS 25000001","00002-1036-13","DOMPERIDONE 10 MG TABLET","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600571","ERX","HCPCS 25000001","99999-6006-72","VANCOMYCIN 15 MG/ML(1.5%) OPHTH SOLN","BOTH IP/OP","$58.65 ","$43.40 ","$0.00 ","$53.19 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.19 ","$0.00 ","$26.60 ","$42.13 ","$42.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600575","ERX","HCPCS J8530","99999-6006-76","CYCLOPHOSPHAMIDE 100 MG/10 ML ORAL SYRINGE","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$105.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600578","ERX","HCPCS 25000001","99999-6006-82","VANCOMYCIN 10MG-HEPARIN 5000 UNITS/2 ML FLUSH","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600589","ERX","HCPCS 25000001","99999-6007-00","STREPTOMYCIN 5 MG/ML NS (NICU) IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600595","ERX","HCPCS 25000001","99999-6007-08","TRICHLOROACETIC ACID 70 % EXTERNAL SOLN","BOTH IP/OP","$184.61 ","$136.61 ","$0.00 ","$167.58 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$167.58 ","$0.00 ","$83.79 ","$132.72 ","$134.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600603","ERX","HCPCS 25000001","99999-6007-15","DILTIAZEM 2% OINTMENT","BOTH IP/OP","$21.46 ","$15.88 ","$0.00 ","$19.46 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.46 ","$0.00 ","$9.73 ","$15.41 ","$15.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600608","ERX","HCPCS J0610","24200-0066-10","CALCIUM GLUCONATE 3 GM IN SODIUM CHLORIDE 250 ML","BOTH IP/OP","$62.85 ","$46.51 ","$0.00 ","$57.00 ","$28.28 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$12.13 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$12.13 ","$0.00 ","$11.55 ","$0.00 "
"600626","ERX","HCPCS 25000001","99999-6007-47","BOSENTAN 6.25 MG/ML (NICU) ORAL SYRINGE","BOTH IP/OP","$52.92 ","$39.16 ","$0.00 ","$48.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.00 ","$0.00 ","$24.00 ","$38.02 ","$38.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600627","ERX","HCPCS 25000001","99999-6007-49","CEFTAZIDIME 50MG/ML FORTIFIED OPHTH SOLN 10 ML","BOTH IP/OP","$41.90 ","$31.01 ","$0.00 ","$38.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.00 ","$0.00 ","$19.00 ","$30.10 ","$30.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600632","ERX","HCPCS 25000001","99999-6007-51","GENTAMICIN 40 MG/ML NEBU SOLN","BOTH IP/OP","$10.19 ","$7.54 ","$0.00 ","$9.24 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.24 ","$0.00 ","$4.62 ","$7.32 ","$7.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600633","ERX","HCPCS 63700001","99999-6007-52","AZATHIOPRINE 50 MG/ML ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600638","ERX","HCPCS 25000001","99999-6007-56","CYCLOSPORINE 2% OPHTH SOLN","BOTH IP/OP","$126.11 ","$93.32 ","$0.00 ","$114.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.35 ","$0.00 ","$57.18 ","$90.57 ","$91.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600639","ERX","HCPCS 25000001","99999-6007-57","DEXTROSE 5% FLUSH IV SYRINGE (ADULT)","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600640","ERX","HCPCS 25000001","99999-6007-58","PEDIATRACE ELEMENTS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600641","ERX","HCPCS 25000001","99999-6007-59","METRONIDAZOLE 0.005 MG/ML NS IV DESENSITIZATION","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600642","ERX","HCPCS 25000001","99999-6007-60","METRONIDAZOLE 0.05 MG/ML NS IV DESENSITIZATION","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600643","ERX","HCPCS 25000001","99999-6007-61","METRONIDAZOLE 0.5 MG/ML NS IV DESENSITIZATION","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600644","ERX","HCPCS 25000001","99999-6007-62","METRONIDAZOLE 5 MG/ML NS IV DESENSITIZATION","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600646","ERX","HCPCS 25000001","99999-6007-64","VANCOMYCIN 125 MG/5 ML ORAL SOLUTION UNIT-DOSE CUP","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600647","ERX","HCPCS 25000001","99999-6007-65","HEPARIN SODIUM NEBU 5000 UNITS/1 ML SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600658","ERX","HCPCS 25000001","99999-6007-79","ASPIRIN 1 MG/1 ML SUSP DESENSITIZATION BTL A","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600660","ERX","HCPCS 63600001","99999-6007-81","TERBUTALINE SULFATE 1 MG/ML NEBU SOLN","BOTH IP/OP","$83.33 ","$61.66 ","$0.00 ","$75.56 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.56 ","$0.00 ","$37.78 ","$59.84 ","$60.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600661","ERX","HCPCS 25000001","99999-6007-85","CLINDAMYCIN 1 MG/0.1 ML NS 0.5 ML INTRAVITREAL SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600668","ERX","HCPCS 25000001","99999-6007-92","OSELTAMIVIR PEDS 6 MG/ML ORAL SYRINGE","BOTH IP/OP","$9.28 ","$6.87 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600672","ERX","HCPCS 63700001","99999-6007-94","CHOLECALCIFEROL 400 UNIT/ML (NICU) ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600673","ERX","HCPCS 25000001","99999-6007-95","AMPHOTERICIN B ORAL SOLUTION 1MG/ML","BOTH IP/OP","$612.87 ","$453.52 ","$0.00 ","$556.32 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.32 ","$0.00 ","$278.16 ","$440.61 ","$445.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600676","ERX","HCPCS 25000001","99999-6007-97","MORPHINE SULF 0.4 MG/1 ML ORAL SYRINGE (NICU)","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600683","ERX","HCPCS Q4074","99999-6008-05","ILOPROST 5 MCG/0.25 ML NEB SYRINGE","BOTH IP/OP","$50.34 ","$37.25 ","$0.00 ","$45.65 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.65 ","$0.00 ","$22.83 ","$36.15 ","$36.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600686","ERX","HCPCS J0712","99999-6008-78","CEFTAROLINE FOSAMIL 400MG/NS 250 ML MB PLUS","BOTH IP/OP","$524.43 ","$388.08 ","$0.00 ","$477.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.43 ","$0.00 ","$238.72 ","$378.12 ","$381.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600689","ERX","HCPCS 25000001","99999-6008-11","DIGOXIN 2 MG (0.25 MG/ML)/8 ML SYRINGE INTRA-AMNIOTIC","BOTH IP/OP","$29.74 ","$22.01 ","$0.00 ","$26.97 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.97 ","$0.00 ","$13.49 ","$21.36 ","$21.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600690","ERX","HCPCS 25000001","85412-0034-62","STERILE EMPTY CONTAINER 1000 ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600690","ERX","HCPCS 25000001","99999-6009-23","STERILE EMPTY CONTAINER 1000 ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600692","ERX","HCPCS J2543","99999-6008-21","PIPERACIL-TAZ 2.25 G/NS 50 ML MB PLUS","BOTH IP/OP","$77.44 ","$57.31 ","$0.00 ","$71.62 ","$34.85 ","$0.00 ","$13.09 ","$0.00 ","$0.00 ","$4.35 ","$71.62 ","$0.00 ","$35.81 ","$56.72 ","$57.30 ","$0.00 ","$4.35 ","$0.00 ","$4.14 ","$0.00 "
"600698","ERX","HCPCS 25000001","99999-6008-27","LIDOCAINE HCL 0.1 % IJ SOLN-ALLERGY CLINIC","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600699","ERX","HCPCS 25000001","99999-6008-28","LIDOCAINE HCL 0.01 % IJ SOLN-ALLERGY CLINIC","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600700","ERX","HCPCS 25000001","99999-6008-30","ONDANSETRON 0.8 MG/ML ORAL SYRINGE (NICU)","BOTH IP/OP","$26.13 ","$19.34 ","$0.00 ","$23.70 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.70 ","$0.00 ","$11.85 ","$18.77 ","$18.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600701","ERX","HCPCS J0696","00409-7332-01","CEFTRIAXONE CUSTOM 1 G VIAL FOR DESENSITIZATION","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$5.64 ","$0.00 ","$0.00 ","$2.82 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$2.82 ","$0.00 ","$2.69 ","$0.00 "
"600706","ERX","HCPCS Q9967","00407-1413-58","IOHEXOL 300 MG/ML 30 ML PO SOLUTION","BOTH IP/OP","$192.35 ","$142.34 ","$0.00 ","$174.41 ","$86.56 ","$0.00 ","$40.09 ","$0.00 ","$0.00 ","$0.14 ","$174.41 ","$0.00 ","$87.21 ","$138.13 ","$139.53 ","$0.00 ","$0.13 ","$0.00 ","$27.77 ","$0.00 "
"600706","ERX","HCPCS Q9967","00407-1413-59","IOHEXOL 300 MG/ML 30 ML PO SOLUTION","BOTH IP/OP","$192.35 ","$142.34 ","$0.00 ","$174.41 ","$86.56 ","$0.00 ","$40.09 ","$0.00 ","$0.00 ","$0.14 ","$174.41 ","$0.00 ","$87.21 ","$138.13 ","$139.53 ","$0.00 ","$0.13 ","$0.00 ","$27.77 ","$0.00 "
"600707","ERX","HCPCS 95165","99999-6008-39","ALLERGEN EXTRACTS PREPARATION","BOTH IP/OP","$96.50 ","$71.41 ","$0.00 ","$87.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600710","ERX","HCPCS 25000001","99999-6008-42","METHOHEXITAL 1MG/ML SW IV SYRINGE-NEURO","BOTH IP/OP","$27.21 ","$20.14 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600714","ERX","HCPCS 25000001","99999-6008-45","KPHOS 0.05 MM/ML D5W (NICU) IV SYRINGE","BOTH IP/OP","$28.83 ","$21.33 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600715","ERX","HCPCS 25000001","99999-6008-46","SODIUM PHOSPHATE 0.05 MM/ML D5W (NICU) IV SYRINGE","BOTH IP/OP","$28.83 ","$21.33 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600722","ERX","HCPCS 25000001","00338-0221-04","PLASMA-LYTE A IV BOLUS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600725","ERX","HCPCS 25000001","99999-6008-55","VORICONAZOLE 100MCG/0.1 ML NS OPHTH SYRINGE","BOTH IP/OP","$512.67 ","$379.38 ","$0.00 ","$465.37 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.37 ","$0.00 ","$232.69 ","$368.57 ","$372.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600726","ERX","HCPCS 25000001","99999-6008-56","DEXTROSE 25% SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600727","ERX","HCPCS 25000001","99999-6008-57","AMPHOTERICIN B 0.15% OPHTHALMIC SOLN","BOTH IP/OP","$57.32 ","$42.42 ","$0.00 ","$51.99 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.99 ","$0.00 ","$26.00 ","$41.18 ","$41.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600732","ERX","HCPCS 25000001","99999-6008-64","ASCORBIC ACID OPHTH SOLN 100 MG/ML","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$27.33 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.33 ","$0.00 ","$13.67 ","$21.65 ","$21.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600733","ERX","HCPCS J9214","99999-6008-65","INTERFERON ALFA-2B OPHTH SOLN 1000000 UNITS/ML","BOTH IP/OP","$5,464.68 ","$4,043.86 ","$0.00 ","$4,956.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,956.90 ","$0.00 ","$2,478.45 ","$3,925.86 ","$3,965.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600735","ERX","HCPCS 25000001","99999-6008-66","METRONIDAZOLE 0.0005MG/ML ORAL SYRINGE DESENSITIZATIO","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600736","ERX","HCPCS 25000001","99999-6008-67","METRONIDAZOLE 0.005MG/ML ORAL SYRINGE DESENSITIZATION","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600737","ERX","HCPCS 25000001","99999-6008-68","METRONIDAZOLE 0.05MG/ML ORAL SYRINGE DESENSITIZATION","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600738","ERX","HCPCS 25000001","99999-6008-69","METRONIDAZOLE 0.5MG/ML ORAL SYRINGE DESENSITIZATION","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600739","ERX","HCPCS 25000001","99999-6008-70","METRONIDAZOLE 5MG/ML ORAL SYRINGE DESENSITIZATION","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600743","ERX","HCPCS 63700001","99999-6008-74","MERCAPTOPURINE 25 MG PO TAB","BOTH IP/OP","$8.57 ","$6.34 ","$0.00 ","$7.78 ","","$1.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.78 ","$0.00 ","$3.89 ","$6.16 ","$6.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600744","ERX","HCPCS 25000001","99999-6008-75","WHISKY (40% ABV)","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600745","ERX","HCPCS J0712","99999-6008-79","CEFTAROLINE FOSAMIL 600MG/NS 250 ML MB PLUS","BOTH IP/OP","$524.43 ","$388.08 ","$0.00 ","$477.43 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.43 ","$0.00 ","$238.72 ","$378.12 ","$381.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600747","ERX","HCPCS J3301","99999-6008-81","TRIAMCINOLONE 40MG/1 ML + LIDOCAINE 1% 1 ML","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$3.55 ","$0.00 ","$0.00 ","$3.67 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$3.67 ","$0.00 ","$3.49 ","$0.00 "
"600756","ERX","HCPCS 25000001","99999-6008-94","GENTIAN VIOLET 0.00165% SOLUTION ","BOTH IP/OP","$144.75 ","$107.12 ","$0.00 ","$131.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.25 ","$0.00 ","$65.63 ","$103.95 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600765","ERX","HCPCS 25000001","99999-6009-00","NALOXONE ORAL SYRINGE 0.4 MG/ML","BOTH IP/OP","$329.65 ","$243.94 ","$0.00 ","$299.25 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.25 ","$0.00 ","$149.63 ","$237.01 ","$239.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600767","ERX","HCPCS 25000001","99999-6009-02","GLYCOPYRROLATE 0.2 MG/ML NEBU SOLN","BOTH IP/OP","$6.00 ","$4.44 ","$0.00 ","$6.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$4.75 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600768","ERX","HCPCS J1580","99999-6009-04","GENTAMICIN 80 MG/500 ML NS FOR IRRIGATION","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$1.02 ","$0.00 ","$0.00 ","$2.31 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$2.31 ","$0.00 ","$2.20 ","$0.00 "
"600772","ERX","HCPCS 25000001","99999-6009-09","PEDIATRIC MAGIC MOUTH WASH","BOTH IP/OP","$594.72 ","$440.09 ","$0.00 ","$539.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$539.85 ","$0.00 ","$269.93 ","$427.56 ","$431.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600773","ERX","HCPCS 25000001","15082-0828-68","GLYCOPYRROLATE 0.6 MG/3 ML IV SYRINGE","BOTH IP/OP","$136.88 ","$101.29 ","$0.00 ","$124.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.11 ","$0.00 ","$62.06 ","$98.30 ","$99.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600774","ERX","HCPCS 25000001","99999-6009-11","WBC NUCLEAR ISOTOPE","BOTH IP/OP","$1,022.00 ","$756.28 ","$0.00 ","$927.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$927.50 ","$0.00 ","$463.75 ","$734.58 ","$742.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600779","ERX","HCPCS 25000001","99999-6009-17","DEXTROSE 5 % FLUSH-AMPHO PANEL","BOTH IP/OP","$1,787.10 ","$1,322.45 ","$0.00 ","$1,656.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,656.00 ","$0.00 ","$828.00 ","$1,311.55 ","$1,324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600779","ERX","HCPCS 25000001","99999-6010-37","DEXTROSE 5 % FLUSH-AMPHO PANEL","BOTH IP/OP","$1,787.10 ","$1,322.45 ","$0.00 ","$1,656.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,656.00 ","$0.00 ","$828.00 ","$1,311.55 ","$1,324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600789","ERX","HCPCS J0690","99999-6009-29","CEFAZOLIN 2 G/D5W 100 ML IVPB","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$2.77 ","$0.00 ","$0.00 ","$3.85 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$3.85 ","$0.00 ","$3.67 ","$0.00 "
"600798","ERX","HCPCS 25000001","99999-6009-41","RBC NUCLEAR ISOTOPE","BOTH IP/OP","$1,022.00 ","$756.28 ","$0.00 ","$927.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$927.50 ","$0.00 ","$463.75 ","$734.58 ","$742.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600799","ERX","HCPCS 25000001","99999-6009-42","METRONIDAZOLE 20MG/ML PEDIATRIC ORAL SUSPENSION","BOTH IP/OP","$348.60 ","$257.96 ","$0.00 ","$316.44 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.44 ","$0.00 ","$158.22 ","$250.62 ","$253.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600801","ERX","HCPCS 63700001","99999-6009-44","MISOPROSTOL 25 MCG PO TABLET","BOTH IP/OP","$13.92 ","$10.30 ","$0.00 ","$12.63 ","","$2.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.63 ","$0.00 ","$6.32 ","$10.00 ","$10.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600811","ERX","HCPCS 25000001","","NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600811","ERX","HCPCS 25000001","99999-6009-52","NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600814","ERX","HCPCS 25000001","99999-6009-55","ARGATROBAN 100 MCG/1000 ML NS","BOTH IP/OP","$1,138.80 ","$842.71 ","$0.00 ","$1,033.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,033.50 ","$0.00 ","$516.75 ","$818.53 ","$826.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600816","ERX","HCPCS 63700001","99999-6011-79","HYDROXYUREA ORAL SOLN 100 MG/ML","BOTH IP/OP","$9.52 ","$7.04 ","$0.00 ","$9.00 ","","$1.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600821","ERX","HCPCS J1956","99999-6009-64","LEVOFLOXACIN 7.5 MG/1.5 ML D5W PO SOLN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$4.05 ","$0.00 ","$1.88 ","$0.00 ","$0.00 ","$1.58 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$1.41 ","$0.00 ","$1.43 ","$0.00 "
"600822","ERX","HCPCS J1956","99999-6009-65","LEVOFLOXACIN 75 MG/15 ML D5W PO SOLN","BOTH IP/OP","$14.08 ","$10.42 ","$0.00 ","$12.77 ","$6.34 ","$0.00 ","$2.93 ","$0.00 ","$0.00 ","$2.24 ","$12.77 ","$0.00 ","$6.39 ","$10.11 ","$10.22 ","$0.00 ","$2.00 ","$0.00 ","$2.03 ","$0.00 "
"600824","ERX","HCPCS 25000001","","CANTHARIDIN 0.7% TOPICAL LIQUID","BOTH IP/OP","$670.32 ","$496.04 ","$0.00 ","$608.48 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$608.48 ","$0.00 ","$304.24 ","$481.92 ","$486.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600827","ERX","HCPCS C9132","99999-6009-70","PROTHROMBIN COMPLEX CONCENTRATE, 4-FACTOR (KCENTRA) IV 1500 UNITS/60ML","BOTH IP/OP","$5,989.00 ","$4,431.86 ","$0.00 ","$8,148.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,148.75 ","$0.00 ","$4,074.38 ","$6,453.81 ","$6,519.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600845","ERX","HCPCS J3370","99999-6009-81","VANCOMYCIN 1.5 G IN D5W 500 ML PREMIX","BOTH IP/OP","$86.23 ","$63.81 ","$0.00 ","$79.60 ","$38.80 ","$0.00 ","$10.86 ","$0.00 ","$0.00 ","$11.95 ","$79.60 ","$0.00 ","$39.80 ","$63.04 ","$63.68 ","$0.00 ","$11.95 ","$0.00 ","$11.38 ","$0.00 "
"600855","ERX","HCPCS J2543","99999-6009-85","PIPERACIL-TAZO 4.5 G/50 ML D5W MB PLUS","BOTH IP/OP","$103.43 ","$76.54 ","$0.00 ","$95.18 ","$46.54 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$95.18 ","$0.00 ","$47.59 ","$75.38 ","$76.14 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"600858","ERX","HCPCS 25000001","00264-7750-00","LACTATED RINGERS IV BOLUS ML/KG","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600858","ERX","HCPCS 25000001","00338-0117-04","LACTATED RINGERS IV BOLUS ML/KG","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600858","ERX","HCPCS 25000001","00264-7750-20","LACTATED RINGERS IV BOLUS ML/KG","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600858","ERX","HCPCS 25000001","00338-0117-03","LACTATED RINGERS IV BOLUS ML/KG","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600858","ERX","HCPCS 25000001","00409-7953-03","LACTATED RINGERS IV BOLUS ML/KG","BOTH IP/OP","$25.14 ","$18.60 ","$0.00 ","$22.00 ","$11.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600859","ERX","HCPCS 25000001","99999-6009-88","GENTAMICIN 160MG+POLYMIXIN B 200MG+NEOMYCIN 1000MG/2L  IRRIGATION SOLN","BOTH IP/OP","$672.00 ","$497.28 ","$0.00 ","$610.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600865","ERX","HCPCS 25000001","99999-6009-95","AMIKACIN 4 MG/ML OPHTH SOLN 10 ML","BOTH IP/OP","$18.61 ","$13.77 ","$0.00 ","$16.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.88 ","$0.00 ","$8.44 ","$13.37 ","$13.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600868","ERX","HCPCS J3301","99999-6009-98","TRIAMCINOLONE ACETONIDE 2.5 MG/ML IJ SUSP","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.77 ","$0.00 ","$0.00 ","$1.83 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.83 ","$0.00 ","$1.75 ","$0.00 "
"600869","ERX","HCPCS J3301","99999-6009-99","TRIAMCINOLONE ACETONIDE 5 MG/ML IJ SUSP","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.77 ","$0.00 ","$0.00 ","$1.83 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.83 ","$0.00 ","$1.75 ","$0.00 "
"600870","ERX","HCPCS J3301","99999-6010-00","TRIAMCINOLONE ACETONIDE 4 MG/ML IJ SUSP","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.77 ","$0.00 ","$0.00 ","$1.83 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.83 ","$0.00 ","$1.75 ","$0.00 "
"600871","ERX","HCPCS J3301","99999-6010-01","TRIAMCINOLONE ACETONIDE 20 MG/ML IJ SUSP","BOTH IP/OP","$22.78 ","$16.86 ","$0.00 ","$22.00 ","$10.25 ","$0.00 ","$3.55 ","$0.00 ","$0.00 ","$3.67 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.67 ","$0.00 ","$3.49 ","$0.00 "
"600878","ERX","HCPCS 25000001","68065-1134-72","ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR","BOTH IP/OP","$803.00 ","$594.22 ","$0.00 ","$728.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$728.75 ","$0.00 ","$364.38 ","$577.17 ","$583.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600878","ERX","HCPCS 25000001","99999-6010-06","ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR","BOTH IP/OP","$803.00 ","$594.22 ","$0.00 ","$728.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$728.75 ","$0.00 ","$364.38 ","$577.17 ","$583.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600878","ERX","HCPCS 25000001","99999-6011-27","ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR","BOTH IP/OP","$803.00 ","$594.22 ","$0.00 ","$728.75 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$728.75 ","$0.00 ","$364.38 ","$577.17 ","$583.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600879","ERX","HCPCS 25000001","","ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR","BOTH IP/OP","$968.28 ","$716.53 ","$0.00 ","$878.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$878.74 ","$0.00 ","$439.37 ","$695.96 ","$702.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600879","ERX","HCPCS 25000001","68065-1316-14","ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR","BOTH IP/OP","$968.28 ","$716.53 ","$0.00 ","$878.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$878.74 ","$0.00 ","$439.37 ","$695.96 ","$702.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600879","ERX","HCPCS 25000001","99999-6010-07","ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR","BOTH IP/OP","$968.28 ","$716.53 ","$0.00 ","$878.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$878.74 ","$0.00 ","$439.37 ","$695.96 ","$702.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600880","ERX","HCPCS J0692","99999-6011-00","CEFEPIME 1 G/100 ML NS MB PLUS","BOTH IP/OP","$54.14 ","$40.06 ","$0.00 ","$52.00 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"600881","ERX","HCPCS J0692","99999-6011-01","CEFEPIME 2 G/100 ML NS MB PLUS","BOTH IP/OP","$65.28 ","$48.31 ","$0.00 ","$60.60 ","$29.38 ","$0.00 ","$13.61 ","$0.00 ","$0.00 ","$10.61 ","$60.60 ","$0.00 ","$30.30 ","$48.00 ","$48.48 ","$0.00 ","$9.48 ","$0.00 ","$9.65 ","$0.00 "
"600885","ERX","HCPCS J0295","99999-6010-13","AMPICILLIN-SULB 3 G/D5W 100ML MB PLUS","BOTH IP/OP","$142.00 ","$105.08 ","$0.00 ","$130.15 ","$63.90 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$6.06 ","$130.15 ","$0.00 ","$65.08 ","$103.08 ","$104.12 ","$0.00 ","$6.06 ","$0.00 ","$5.77 ","$0.00 "
"600886","ERX","HCPCS J0290","99999-6012-11","AMPICILLIN 2 G/100ML D5W MB PLUS","BOTH IP/OP","$80.07 ","$59.25 ","$0.00 ","$74.01 ","$36.03 ","$0.00 ","$10.43 ","$0.00 ","$0.00 ","$4.61 ","$74.01 ","$0.00 ","$37.01 ","$58.62 ","$59.21 ","$0.00 ","$4.61 ","$0.00 ","$4.39 ","$0.00 "
"600889","ERX","HCPCS J3370","99999-6010-17","VANCOMYCIN 1.5 G IN NS 250 ML PREMIX","BOTH IP/OP","$309.95 ","$229.36 ","$0.00 ","$282.75 ","$139.48 ","$0.00 ","$10.86 ","$0.00 ","$0.00 ","$11.95 ","$282.75 ","$0.00 ","$141.38 ","$223.94 ","$226.20 ","$0.00 ","$11.95 ","$0.00 ","$11.38 ","$0.00 "
"600892","ERX","HCPCS J0740","","CIDOFOVIR INTRALESIONAL 15 MG/ML INJ","BOTH IP/OP","$596.74 ","$441.59 ","$0.00 ","$541.68 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$541.68 ","$0.00 ","$270.84 ","$429.01 ","$433.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600893","ERX","HCPCS 25000001","99999-6011-34","ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION","BOTH IP/OP","$24.73 ","$18.30 ","$0.00 ","$82.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.60 ","$0.00 ","$41.30 ","$17.76 ","$66.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600893","ERX","HCPCS 25000001","99999-6011-33","ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION","BOTH IP/OP","$24.73 ","$18.30 ","$0.00 ","$82.60 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.60 ","$0.00 ","$41.30 ","$65.42 ","$66.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600894","ERX","HCPCS 25000001","99999-6011-35","NITROFURANTOIN 10MG/ML ORAL SUSPENSION  ","BOTH IP/OP","$57.07 ","$42.23 ","$0.00 ","$51.76 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.76 ","$0.00 ","$25.88 ","$40.99 ","$41.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600895","ERX","HCPCS J3010","99999-6011-36","FENTANYL DRIP SYRINGE","BOTH IP/OP","$82.42 ","$60.99 ","$0.00 ","$74.73 ","$37.09 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$29.08 ","$74.73 ","$0.00 ","$37.37 ","$59.19 ","$59.78 ","$0.00 ","$29.08 ","$0.00 ","$27.69 ","$0.00 "
"600897","ERX","HCPCS J3010","99999-6011-36","FENTANYL CITRATE PF PCA 50 MCG/ML IV SOLN 50 ML","BOTH IP/OP","$82.42 ","$60.99 ","$0.00 ","$74.73 ","$37.09 ","$0.00 ","$17.18 ","$0.00 ","$0.00 ","$29.08 ","$74.73 ","$0.00 ","$37.37 ","$59.19 ","$59.78 ","$0.00 ","$29.08 ","$0.00 ","$27.69 ","$0.00 "
"600898","ERX","HCPCS J3010","99999-6011-38","FENTANYL 2500 MCG/50 ML PREMIX","BOTH IP/OP","$97.42 ","$72.09 ","$0.00 ","$89.73 ","$43.84 ","$0.00 ","$20.30 ","$0.00 ","$0.00 ","$29.08 ","$89.73 ","$0.00 ","$44.87 ","$71.07 ","$71.78 ","$0.00 ","$29.08 ","$0.00 ","$27.69 ","$0.00 "
"600900","ERX","HCPCS J3010","99999-6011-41","FENTANYL 5000 MCG/100 ML PREMIX","BOTH IP/OP","$179.83 ","$133.07 ","$0.00 ","$164.45 ","$80.92 ","$0.00 ","$37.48 ","$0.00 ","$0.00 ","$58.16 ","$164.45 ","$0.00 ","$82.23 ","$130.24 ","$131.56 ","$0.00 ","$58.16 ","$0.00 ","$55.38 ","$0.00 "
"600915","ERX","HCPCS J0834","99999-6011-50","COSYNTROPIN 2 MCG/ML SYRINGE- ENDOCRINOLOGY CLINIC","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$44.56 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$44.56 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$44.56 ","$0.00 ","$42.42 ","$0.00 "
"600925","ERX","HCPCS 25000001","99999-6011-65","GANCICLOVIR 5 MG/ML NS (NICU) IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600926","ERX","HCPCS J1561","99999-6011-67","IMMUNE GLOBULIN (HUMAN) 10 GM/100ML- MD","BOTH IP/OP","$3,154.06 ","$2,334.00 ","$0.00 ","$2,860.98 ","$1,419.33 ","$930.18 ","$657.38 ","$0.00 ","$0.00 ","$948.23 ","$2,860.98 ","$821.94 ","$1,430.49 ","$2,265.90 ","$2,288.78 ","$1,135.06 ","$948.23 ","$0.00 ","$902.87 ","$833.82 "
"600931","ERX","HCPCS J9250","99999-6011-73","METHOTREXATE PF OPHTHALMIC INJECTION 0.4 MG/0.1 ML","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$57.00 ","$25.65 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$0.29 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.29 ","$0.00 ","$0.28 ","$0.00 "
"600932","ERX","HCPCS 25000001","99999-6011-74","SELENIUM 4 MCG/ML IV SOLN- TPN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600975","ERX","HCPCS J3490","99999-6012-29","REMDESIVIR 100 MG/ NS 100 ML MB+ - EMERGENCY USE","BOTH IP/OP","$1,361.80 ","$1,007.73 ","$0.00 ","$1,263.00 ","$612.81 ","$0.00 ","$283.83 ","$0.00 ","$0.00 ","$221.14 ","$1,263.00 ","$0.00 ","$631.50 ","$1,000.30 ","$1,010.40 ","$0.00 ","$197.66 ","$0.00 ","$201.07 ","$0.00 "
"600981","ERX","HCPCS 25000001","99999-6012-35","TRANEXAMIC ACID - NEBULIZER 1000 MG/10 ML FOR HEMOPTYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600982","ERX","HCPCS 25000001","99999-6012-36","VANCOMYCIN 500 MG/20 ML ORAL SOLUTION UNIT-DOSE CUP","BOTH IP/OP","$10.06 ","$7.44 ","$0.00 ","$9.12 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.12 ","$0.00 ","$4.56 ","$7.22 ","$7.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600983","ERX","HCPCS 25000001","99999-6012-37","DEXMEDETOMIDINE 1000 MCG/ 250 ML NS PREMIXED","BOTH IP/OP","$708.80 ","$524.51 ","$0.00 ","$644.64 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$644.64 ","$0.00 ","$322.32 ","$510.55 ","$515.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600990","ERX","HCPCS J2543","99999-6010-18","PIPERACIL-TAZO 4.5 G/NS 70 ML IVPB","BOTH IP/OP","$103.43 ","$76.54 ","$0.00 ","$95.18 ","$46.54 ","$0.00 ","$26.18 ","$0.00 ","$0.00 ","$8.70 ","$95.18 ","$0.00 ","$47.59 ","$75.38 ","$76.14 ","$0.00 ","$8.70 ","$0.00 ","$8.28 ","$0.00 "
"600991","ERX","HCPCS 25000001","99999-6010-19","PEDIATRIC OPHTHALMIC DILATING DROPS-EYE CLINIC USE ONLY (CYCLOPENTOLATE/PHENYLEPHRINE/TETRACAINE/TROPICAMIDE)","BOTH IP/OP","$193.00 ","$142.82 ","$0.00 ","$175.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600995","ERX","HCPCS 25000001","99999-6010-28","UVC FLUID 250 ML","BOTH IP/OP","$80.49 ","$59.56 ","$0.00 ","$72.98 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.98 ","$0.00 ","$36.49 ","$57.80 ","$58.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600996","ERX","HCPCS 25000001","99999-6010-29","UAC FLUID 60 ML","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600997","ERX","HCPCS 25000001","99999-6010-30","PAL FLUID 60 ML","BOTH IP/OP","$62.85 ","$46.51 ","$0.00 ","$57.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$45.14 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601004","ERX","HCPCS J0697","00143-9979-22","CEFUROXIME SODIUM 750 MG IM SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601004","ERX","HCPCS J0697","25021-0118-10","CEFUROXIME SODIUM 750 MG IM SOLR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601005","ERX","HCPCS J0697","00143-9567-25","CEFUROXIME SODIUM 1.5 G IM SOLR","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$26.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.66 ","$0.00 ","$13.33 ","$21.11 ","$21.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601005","ERX","HCPCS J0697","00143-9977-22","CEFUROXIME SODIUM 1.5 G IM SOLR","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$26.66 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.66 ","$0.00 ","$13.33 ","$21.11 ","$21.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601007","ERX","HCPCS J2185","99999-6010-39","MEROPENEM 500 MG/NS 100ML MB PLUS     ","BOTH IP/OP","$189.43 ","$140.18 ","$0.00 ","$173.35 ","","$0.00 ","$39.48 ","$0.00 ","$0.00 ","$0.00 ","$173.35 ","$0.00 ","$86.68 ","$137.29 ","$138.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601009","ERX","HCPCS J0295","99999-6010-92","AMPICILLIN-SULB 1.5 G/D5W 100ML MB PLUS","BOTH IP/OP","$109.96 ","$81.37 ","$0.00 ","$101.10 ","$49.48 ","$0.00 ","$4.24 ","$0.00 ","$0.00 ","$3.03 ","$101.10 ","$0.00 ","$50.55 ","$80.07 ","$80.88 ","$0.00 ","$3.03 ","$0.00 ","$2.89 ","$0.00 "
"601010","ERX","HCPCS 25000001","42852-0301-67","KETAMINE 50MG/5ML IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601010","ERX","HCPCS 25000001","71286-3022-01","KETAMINE 50MG/5ML IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601010","ERX","HCPCS 25000001","99999-6010-44","KETAMINE 50MG/5ML IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601011","ERX","HCPCS J1335","99999-6010-45","ERTAPENEM 1 G/NS 100ML MB PLUS","BOTH IP/OP","$255.82 ","$189.31 ","$0.00 ","$233.61 ","$115.12 ","$0.00 ","$53.32 ","$0.00 ","$0.00 ","$90.95 ","$233.61 ","$0.00 ","$116.81 ","$185.02 ","$186.89 ","$0.00 ","$90.95 ","$0.00 ","$86.60 ","$0.00 "
"601016","ERX","HCPCS 25000001","99999-6010-53","MORPHINE 0.1% TOPICAL GEL 15G","BOTH IP/OP","$59.88 ","$44.31 ","$0.00 ","$54.31 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.31 ","$0.00 ","$27.16 ","$43.01 ","$43.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601018","ERX","HCPCS J1650","99999-6010-54","ENOXAPARIN SODIUM 10 MG/0.1ML SC SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"601019","ERX","HCPCS J1650","99999-6010-55","ENOXAPARIN SODIUM 20 MG/0.2ML SC SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"601020","ERX","HCPCS 25000001","99999-6010-57","ZINC (ELEMENTAL) 1 MG/ML (NICU) ORAL SYRINGE","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601021","ERX","HCPCS J2590","42852-0703-99","OXYTOCIN 20 UNITS IN 1000ML NS PREMIX ","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$190.00 ","$93.60 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$33.27 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$29.74 ","$0.00 ","$30.25 ","$0.00 "
"601021","ERX","HCPCS J2590","71285-6043-01","OXYTOCIN 20 UNITS IN 1000ML NS PREMIX ","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$190.00 ","$93.60 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$33.27 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$29.74 ","$0.00 ","$30.25 ","$0.00 "
"601021","ERX","HCPCS J2590","99999-6011-30","OXYTOCIN 20 UNITS IN 1000ML NS PREMIX ","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$190.00 ","$93.60 ","$0.00 ","$2.94 ","$0.00 ","$0.00 ","$33.27 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$29.74 ","$0.00 ","$30.25 ","$0.00 "
"601024","ERX","HCPCS 25000001","99999-6010-63","KETAMINE 10MG/1 ML IV SYRINGE","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601025","ERX","HCPCS 25000001","99999-6010-64","NITROGLYCERIN 0.2 % OINT","BOTH IP/OP","$173.99 ","$128.75 ","$0.00 ","$157.95 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.95 ","$0.00 ","$78.98 ","$125.10 ","$126.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601028","ERX","HCPCS P9041","99999-6010-76","ALBUMIN 5 % IV CONTINUOUS INFUSION SYRINGE (NICU)","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601030","ERX","HCPCS J1170","00409-1283-04","HYDROMORPHONE 0.5MG/0.5ML INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"601030","ERX","HCPCS J1170","00409-1283-05","HYDROMORPHONE 0.5MG/0.5ML INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"601030","ERX","HCPCS J1170","76045-0009-05","HYDROMORPHONE 0.5MG/0.5ML INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"601030","ERX","HCPCS J1170","76045-0009-06","HYDROMORPHONE 0.5MG/0.5ML INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"601030","ERX","HCPCS J1170","76045-0009-96","HYDROMORPHONE 0.5MG/0.5ML INJ","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$3.64 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.64 ","$0.00 ","$3.47 ","$0.00 "
"601033","ERX","HCPCS 25000001","","SYMTUZA:DARUNAVIR-COBICISTAT-TENOFOVIR AF-EMTRICITABINE 800-150-10-200MG TABLET","BOTH IP/OP","$467.99 ","$346.31 ","$0.00 ","$424.81 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$424.81 ","$0.00 ","$212.41 ","$336.45 ","$339.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601034","ERX","HCPCS 25000001","99999-6010-84","ESMOLOL DRIP (NICU) 10 MG/ML","BOTH IP/OP","$179.68 ","$132.96 ","$0.00 ","$163.11 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.11 ","$0.00 ","$81.56 ","$129.18 ","$130.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601034","ERX","HCPCS 25000001","99999-6010-90","ESMOLOL DRIP (NICU) 10 MG/ML","BOTH IP/OP","$179.68 ","$132.96 ","$0.00 ","$250.16 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.11 ","$0.00 ","$81.56 ","$250.16 ","$130.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601035","ERX","HCPCS 25000001","76154-0477-05","VASOPRESSIN 20 UNITS/100 ML NS PREMIX","BOTH IP/OP","$359.52 ","$266.04 ","$0.00 ","$326.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.35 ","$0.00 ","$163.18 ","$258.47 ","$261.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601036","ERX","HCPCS 25000001","76154-0477-05","VASOPRESSIN 20 UNITS/100 ML NS FOR DIABETES INSIPIDUS PREMIX","BOTH IP/OP","$359.52 ","$266.04 ","$0.00 ","$326.35 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.35 ","$0.00 ","$163.18 ","$258.47 ","$261.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601047","ERX","HCPCS j3370","99999-6011-04","VANCOMYCIN 500MG/NS 100ML MB PLUS","BOTH IP/OP","$58.60 ","$43.36 ","$0.00 ","$54.54 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.55 ","$54.54 ","$0.00 ","$27.27 ","$43.20 ","$43.63 ","$32.72 ","$8.54 ","$0.00 ","$8.68 ","$0.00 "
"601048","ERX","HCPCS J3370","99999-6011-05","VANCOMYCIN 750MG/D5W 250ML MB PLUS","BOTH IP/OP","$62.12 ","$45.97 ","$0.00 ","$49.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.20 ","$0.00 ","$0.00 ","$3.98 ","$0.00 ","$0.00 ","$0.00 "
"601049","ERX","HCPCS J3370","99999-6011-06","VANCOMYCIN 750MG/NS 250ML MB PLUS","BOTH IP/OP","$62.12 ","$45.97 ","$0.00 ","$49.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.20 ","$0.00 ","$0.00 ","$3.98 ","$0.00 ","$0.00 ","$0.00 "
"601050","ERX","HCPCS J1335","00006-3843-71","ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION","BOTH IP/OP","$472.03 ","$349.30 ","$0.00 ","$428.48 ","$212.41 ","$0.00 ","$98.38 ","$0.00 ","$0.00 ","$90.95 ","$428.48 ","$0.00 ","$214.24 ","$339.36 ","$342.78 ","$0.00 ","$90.95 ","$0.00 ","$86.60 ","$0.00 "
"601050","ERX","HCPCS J1335","42023-0221-10","ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION","BOTH IP/OP","$472.03 ","$349.30 ","$0.00 ","$428.48 ","$212.41 ","$0.00 ","$98.38 ","$0.00 ","$0.00 ","$90.95 ","$428.48 ","$0.00 ","$214.24 ","$339.36 ","$342.78 ","$0.00 ","$90.95 ","$0.00 ","$86.60 ","$0.00 "
"601050","ERX","HCPCS J1335","55150-0282-20","ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION","BOTH IP/OP","$472.03 ","$349.30 ","$0.00 ","$428.48 ","$212.41 ","$0.00 ","$98.38 ","$0.00 ","$0.00 ","$90.95 ","$428.48 ","$0.00 ","$214.24 ","$339.36 ","$342.78 ","$0.00 ","$90.95 ","$0.00 ","$86.60 ","$0.00 "
"601053","ERX","HCPCS 25000001","99999-6100-01","METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$105.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601053","ERX","HCPCS 25000001","99999-6011-09","METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$362.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$362.34 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601054","ERX","HCPCS 25000001","99999-6100-02","METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$105.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601054","ERX","HCPCS 25000001","99999-6011-10","METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$362.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$362.34 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601055","ERX","HCPCS 25000001","99999-6100-03","METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$457.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.50 ","$0.00 ","$228.75 ","$83.16 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601055","ERX","HCPCS 25000001","99999-6011-11","METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$457.50 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.50 ","$0.00 ","$228.75 ","$362.34 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601058","ERX","HCPCS 25000001","99999-6100-04","METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$105.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601058","ERX","HCPCS 25000001","99999-6011-14","METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$362.34 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$362.34 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601059","ERX","HCPCS 25000001","99999-6100-05","METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$105.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601059","ERX","HCPCS 25000001","99999-6011-15","METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A","BOTH IP/OP","$115.80 ","$85.69 ","$0.00 ","$149.69 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$149.69 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601060","ERX","HCPCS 25000001","99999-6011-17","NAFCILLIN 2 G/NS 100ML MB PLUS","BOTH IP/OP","$106.26 ","$78.63 ","$0.00 ","$97.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.74 ","$0.00 ","$48.87 ","$77.41 ","$78.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601061","ERX","HCPCS 25000001","99999-6011-18","NAFCILLIN 1 G/NS 100ML MB PLUS","BOTH IP/OP","$106.26 ","$78.63 ","$0.00 ","$97.74 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.74 ","$0.00 ","$48.87 ","$77.41 ","$78.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-04","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-18","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-38","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-48","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0551-18","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00264-7510-20","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-02","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00264-1510-31","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-11","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-31","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-41","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0551-11","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00264-7510-10","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","00338-0017-03","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601063","ERX","HCPCS 63600001","63323-0624-75","DEXTROSE 5% FLUID - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601064","ERX","HCPCS 63600001","99999-6006-29","SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601064","ERX","HCPCS 63600001","00264-7805-10","SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601064","ERX","HCPCS 63600001","00338-0054-03","SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601072","ERX","HCPCS J1940","00409-6102-10","FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.22 ","$13.20 ","$0.00 ","$1.23 ","$0.00 ","$0.00 ","$3.47 ","$26.22 ","$0.00 ","$13.11 ","$20.77 ","$20.98 ","$0.00 ","$3.47 ","$0.00 ","$3.30 ","$0.00 "
"601072","ERX","HCPCS J1940","00409-6102-27","FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.22 ","$13.20 ","$0.00 ","$1.23 ","$0.00 ","$0.00 ","$3.47 ","$26.22 ","$0.00 ","$13.11 ","$20.77 ","$20.98 ","$0.00 ","$3.47 ","$0.00 ","$3.30 ","$0.00 "
"601072","ERX","HCPCS J1940","00409-6102-37","FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.22 ","$13.20 ","$0.00 ","$1.23 ","$0.00 ","$0.00 ","$3.47 ","$26.22 ","$0.00 ","$13.11 ","$20.77 ","$20.98 ","$0.00 ","$3.47 ","$0.00 ","$3.30 ","$0.00 "
"601072","ERX","HCPCS J1940","23155-0473-44","FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY","BOTH IP/OP","$29.33 ","$21.70 ","$0.00 ","$26.22 ","$13.20 ","$0.00 ","$1.23 ","$0.00 ","$0.00 ","$3.47 ","$26.22 ","$0.00 ","$13.11 ","$20.77 ","$20.98 ","$0.00 ","$3.47 ","$0.00 ","$3.30 ","$0.00 "
"601073","ERX","HCPCS 25000001","99999-6012-08","DOXYCYCLINE 100MG/D5W 100ML MB PLUS","BOTH IP/OP","$109.78 ","$81.24 ","$0.00 ","$100.94 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.94 ","$0.00 ","$50.47 ","$79.94 ","$80.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"601074","ERX","HCPCS J0290","99999-6012-12","AMPICILLIN 1 G/50 ML NS MB PLUS","BOTH IP/OP","$69.81 ","$51.66 ","$0.00 ","$64.71 ","$31.41 ","$0.00 ","$5.22 ","$0.00 ","$0.00 ","$2.30 ","$64.71 ","$0.00 ","$32.36 ","$51.25 ","$51.77 ","$0.00 ","$2.30 ","$0.00 ","$2.19 ","$0.00 "
"900083","ERX","HCPCS 63700001","99999-9000-83","AMLODIPINE 1MG/ML ORAL SUSP","BOTH IP/OP","$36.13 ","$26.74 ","$0.00 ","$32.77 ","","$6.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.77 ","$0.00 ","$16.39 ","$25.95 ","$26.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900092","ERX","HCPCS 25000001","99999-9000-92","OMEPRAZOLE 2MG/ML ORAL SUSP 50ML","BOTH IP/OP","$56.10 ","$41.51 ","$0.00 ","$50.88 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.88 ","$0.00 ","$25.44 ","$40.30 ","$40.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900093","ERX","HCPCS 63700001","99999-9000-93","PYRAZINAMIDE 100MG/ML 120ML SUSP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$105.42 ","","$1.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.42 ","$0.00 ","$52.71 ","$83.49 ","$84.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900094","ERX","HCPCS 63700001","99999-9000-94","RIFABUTIN 1200MG/60ML SUSPENSION","BOTH IP/OP","$153.98 ","$113.95 ","$0.00 ","$139.62 ","","$27.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.62 ","$0.00 ","$69.81 ","$110.58 ","$111.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900095","ERX","HCPCS 63700001","99999-6010-59","RIFAMPIN 10MG/ML ORAL SUSP","BOTH IP/OP","$16.60 ","$12.28 ","$0.00 ","$60.20 ","","$2.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.20 ","$0.00 ","$30.10 ","$11.92 ","$48.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900095","ERX","HCPCS 63700001","99999-9000-95","RIFAMPIN 10MG/ML ORAL SUSP","BOTH IP/OP","$16.60 ","$12.28 ","$0.00 ","$60.20 ","","$2.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.20 ","$0.00 ","$30.10 ","$47.68 ","$48.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900097","ERX","HCPCS 25000001","99999-6006-02","DAKINS (1/8 STRENGTH) 0.0625% EX SOLN","BOTH IP/OP","$39.22 ","$29.02 ","$0.00 ","$35.57 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.79 ","$28.17 ","$28.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900098","ERX","HCPCS 25000001","99999-6008-14","URSODIOL 15MG/ML ORAL SOLUTION","BOTH IP/OP","$19.45 ","$14.39 ","$0.00 ","$52.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.90 ","$0.00 ","$26.45 ","$13.97 ","$42.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900098","ERX","HCPCS 25000001","99999-6008-54","URSODIOL 15MG/ML ORAL SOLUTION","BOTH IP/OP","$19.45 ","$14.39 ","$0.00 ","$52.90 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.90 ","$0.00 ","$26.45 ","$41.90 ","$42.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900131","ERX","HCPCS J1644","99999-6006-11","HEPARIN 1500 UNITS IN NS 500 ML IR USE ONLY","BOTH IP/OP","$75.42 ","$55.81 ","$0.00 ","$68.40 ","$33.94 ","$0.00 ","$0.24 ","$0.00 ","$0.00 ","$0.28 ","$68.40 ","$0.00 ","$34.20 ","$54.17 ","$54.72 ","$0.00 ","$0.28 ","$0.00 ","$0.27 ","$0.00 "
"900147","ERX","HCPCS 63700001","99999-6005-86","OPIUM TINCTURE 6MG/0.6ML ORAL SYRINGE","BOTH IP/OP","$11.55 ","$8.55 ","$0.00 ","$10.48 ","","$2.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.48 ","$0.00 ","$5.24 ","$8.30 ","$8.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900288","ERX","HCPCS 25000001","99999-6010-21","MAFENIDE 5% (PLUS NYSTATIN 500,000 UNITS) TOP SOL-50GM/1000ML SW","BOTH IP/OP","$185.11 ","$136.98 ","$0.00 ","$167.85 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$167.85 ","$0.00 ","$83.93 ","$132.94 ","$134.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900333","ERX","HCPCS J9201","00409-0181-01","GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY","BOTH IP/OP","$365.32 ","$270.34 ","$0.00 ","$1,623.73 ","$164.39 ","$0.00 ","$1,623.73 ","$0.00 ","$0.00 ","$48.88 ","$326.80 ","$0.00 ","$163.40 ","$258.83 ","$261.44 ","$0.00 ","$48.88 ","$0.00 ","$46.54 ","$0.00 "
"900333","ERX","HCPCS J9201","60505-6114-00","GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY","BOTH IP/OP","$365.32 ","$270.34 ","$0.00 ","$1,623.73 ","$164.39 ","$0.00 ","$1,623.73 ","$0.00 ","$0.00 ","$48.88 ","$326.80 ","$0.00 ","$163.40 ","$258.83 ","$261.44 ","$0.00 ","$48.88 ","$0.00 ","$46.54 ","$0.00 "
"900575","ERX","HCPCS 25000001","99999-6009-03","PHENYLEPHRINE BOLUS FROM IV BAG FOR CARDIAC NARRATOR","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900576","ERX","HCPCS 63600001","99999-6009-80","EPINEPHRINE 16000 MCG/500 ML NS - ANE","BOTH IP/OP","$167.91 ","$124.25 ","$0.00 ","$152.25 ","$75.56 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$152.25 ","$0.00 ","$76.13 ","$120.58 ","$121.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9093-35","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9093-37","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9093-45","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9094-12","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9094-22","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9094-25","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9094-31","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00409-9094-61","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6027-01","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6027-25","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6028-01","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6028-25","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6029-01","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6029-25","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","00641-6030-01","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","17478-0030-05","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","63323-0806-14","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"4083037","ERX","HCPCS J3010","63323-0806-50","FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$1.16 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$1.16 ","$0.00 ","$1.11 ","$0.00 "
"40811150","ERX","HCPCS J2704","00409-4699-33","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$52.82 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","25021-0608-50","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$52.82 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","43598-0548-21","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$52.82 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","43598-0548-50","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$52.82 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","00409-4699-24","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","00409-4699-54","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","00591-2136-57","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","25021-0608-51","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","43598-0549-10","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","43598-0549-52","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"40811150","ERX","HCPCS J2704","63323-0269-67","PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML","BOTH IP/OP","$132.02 ","$97.69 ","$0.00 ","$119.70 ","$59.41 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$20.96 ","$119.70 ","$0.00 ","$59.85 ","$94.80 ","$95.76 ","$0.00 ","$18.73 ","$0.00 ","$19.06 ","$0.00 "
"600015848","ERX","HCPCS J1644","00409-7651-03","HEPARIN IN NS 50-0.45 UNIT/ML-% IJ SOLN","BOTH IP/OP","$39.81 ","$29.46 ","$0.00 ","$34.20 ","$17.91 ","$0.00 ","$5.88 ","$0.00 ","$0.00 ","$7.05 ","$34.20 ","$0.00 ","$17.10 ","$27.09 ","$27.36 ","$0.00 ","$7.05 ","$0.00 ","$6.71 ","$0.00 "
"4.08E+12","ERX","HCPCS J1815","00002-7510-01","INSULIN LISPRO 100 UNIT/ML SC SOLN","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$8.15 ","$0.00 ","$3.13 ","$0.00 ","$0.00 ","$2.63 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$1.01 ","$0.00 "
"15","SUP","Custom 27203010","","00015  -  HANDGRIP CRCH CHLD GRY","BOTH IP/OP","$15.40 ","$11.40 ","$0.00 ","$15.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.40 ","$0.00 ","$7.70 ","$12.20 ","$12.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15.201","SUP","HCPCS C1713","","015.2010  -  PLATE SQ RECT GRID MESH 1.5 MM SCR CRANIAL TI TIMESH BONE","BOTH IP/OP","$1,010.00 ","$747.40 ","$0.00 ","$1,010.00 ","$454.50 ","$0.00 ","$210.51 ","$0.00 ","$0.00 ","$176.84 ","$1,010.00 ","$0.00 ","$505.00 ","$799.92 ","$808.00 ","$0.00 ","$158.07 ","$0.00 ","$160.79 ","$0.00 "
"76","SUP","Custom 27203010","","000076  -  PLUG CATH CAP STRL LATEX FREE","BOTH IP/OP","$0.78 ","$0.58 ","$0.00 ","$0.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.78 ","$0.00 ","$0.39 ","$0.62 ","$0.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86","SUP","HCPCS C1886","","0086  -  NOVASURE 2007 ENDOMETRIAL ABLATION SYSTEM","BOTH IP/OP","$3,050.00 ","$2,257.00 ","$0.00 ","$3,050.00 ","$1,656.15 ","$0.00 ","$635.70 ","$0.00 ","$0.00 ","$534.03 ","$3,050.00 ","$0.00 ","$1,525.00 ","$2,415.60 ","$2,440.00 ","$0.00 ","$477.33 ","$0.00 ","$485.56 ","$0.00 "
"90","SUP","Custom 27803010","","90  -  PLATE BN 152X152MM MESH PNL TI CRNM","BOTH IP/OP","$2,316.25 ","$1,714.03 ","$0.00 ","$2,316.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,316.25 ","$0.00 ","$1,158.13 ","$1,834.47 ","$1,853.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100","SUP","Custom 27203010","","CONTROL VRTRL 1 LOW POS IMMUN","BOTH IP/OP","$272.50 ","$201.65 ","$0.00 ","$272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.50 ","$0.00 ","$136.25 ","$215.82 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.107","SUP","Custom 27803010","","101.107  -  SPACER SPNL SM 22X10X7MM NS LF SUST RDLCNT PEEK LMBR INTRBD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.109","SUP","Custom 27803010","","101.109  -  SPACER SPNL SM 22X10X9MM NS LF SUST RDLCNT PEEK LMBR INTRBD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.111","SUP","Custom 27803010","","101.111  -  SPACER SPNL SM 22X10X11MM NS LF SUST RDLCNT PEEK LMBR INTRBD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.113","SUP","Custom 27803010","","101.113  -  SPACER SPNL SM 22X10X13MM NS LF SUST RDLCNT PEEK LMBR INTRBD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.115","SUP","Custom 27803010","","101.115  -  SPACER SPNL SM 22X10X15MM NS LF SUST RDLCNT PEEK LMBR INTRBD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.117","SUP","Custom 27803010","","101.117  -  SPACER SPNL SM 22X10X17MM NS LF SUST RDLCNT PEEK LMBR INTRBD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.205","SUP","Custom 27803010","","101.205  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.206","SUP","Custom 27803010","","101.206  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.207","SUP","Custom 27803010","","101.207  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.208","SUP","Custom 27803010","","101.208  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.209","SUP","Custom 27803010","","101.209  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.21","SUP","Custom 27803010","","101.210  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.211","SUP","Custom 27803010","","101.211  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.212","SUP","Custom 27803010","","101.212  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.225","SUP","Custom 27803010","","101.225  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.226","SUP","Custom 27803010","","101.226  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.227","SUP","Custom 27803010","","101.227  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.228","SUP","Custom 27803010","","101.228  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.229","SUP","Custom 27803010","","101.229  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.23","SUP","Custom 27803010","","101.230  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.231","SUP","Custom 27803010","","101.231  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.232","SUP","Custom 27803010","","101.232  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.245","SUP","Custom 27803010","","101.245  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.246","SUP","Custom 27803010","","101.246  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.247","SUP","Custom 27803010","","101.247  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.248","SUP","Custom 27803010","","101.248  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.249","SUP","Custom 27803010","","101.249  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.25","SUP","Custom 27803010","","101.250  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.251","SUP","Custom 27803010","","101.251  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.252","SUP","Custom 27803010","","101.252  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.309","SUP","Custom 27803010","","101.309  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.311","SUP","Custom 27803010","","101.311  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.313","SUP","Custom 27803010","","101.313  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.315","SUP","Custom 27803010","","101.315  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.317","SUP","Custom 27803010","","101.317  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.319","SUP","Custom 27803010","","101.319  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.321","SUP","Custom 27803010","","101.321  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.409","SUP","Custom 27803010","","101.409  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK LAT INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.411","SUP","Custom 27803010","","101.411  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.413","SUP","Custom 27803010","","101.413  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.415","SUP","Custom 27803010","","101.415  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.417","SUP","Custom 27803010","","101.417  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.419","SUP","Custom 27803010","","101.419  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.421","SUP","Custom 27803010","","101.421  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.509","SUP","Custom 27803010","","101.509  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.511","SUP","Custom 27803010","","101.511  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.513","SUP","Custom 27803010","","101.513  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.515","SUP","Custom 27803010","","101.515  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.517","SUP","Custom 27803010","","101.517  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.519","SUP","Custom 27803010","","101.519  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.521","SUP","Custom 27803010","","101.521  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.607","SUP","Custom 27803010","","101.607  -  SPACER SPNL ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.609","SUP","Custom 27803010","","101.609  -  SPACER SPNL ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.611","SUP","Custom 27803010","","101.611  -  SPACER SPNL ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.613","SUP","Custom 27803010","","101.613  -  SPACER SPNL ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.615","SUP","Custom 27803010","","101.615  -  SPACER SPNL ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.617","SUP","Custom 27803010","","101.617  -  SPACER SPNL ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.707","SUP","Custom 27803010","","101.707  -  SPACER SPNL SM NAR 22X8X7MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.709","SUP","Custom 27803010","","101.709  -  SPACER SPNL SM NAR 22X8X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.711","SUP","Custom 27803010","","101.711  -  SPACER SPNL SM NAR 22X8X11MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.713","SUP","Custom 27803010","","101.713  -  SPACER SPNL SM NAR 22X8X13MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.715","SUP","Custom 27803010","","101.715  -  SPACER SPNL SM NAR 22X8X15MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.717","SUP","Custom 27803010","","101.717  -  SPACER SPNL SM NAR 22X8X17MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.805","SUP","Custom 27803010","","101.805  -  SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.806","SUP","Custom 27803010","","101.806  -  SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.807","SUP","Custom 27803010","","101.807  -  SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.808","SUP","Custom 27803010","","101.808  -  SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.809","SUP","Custom 27803010","","101.809  -  SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.81","SUP","Custom 27803010","","101.810  -  SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.811","SUP","Custom 27803010","","101.811  -  SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.812","SUP","Custom 27803010","","101.812  -  SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.825","SUP","Custom 27803010","","101.825  -  SPACER SPNL 7D LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.826","SUP","Custom 27803010","","101.826  -  SPACER SPNL 7D LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.827","SUP","Custom 27803010","","101.827  -  SPACER SPNL 7D LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.828","SUP","Custom 27803010","","101.828  -  SPACER SPNL 7D LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.829","SUP","Custom 27803010","","101.829  -  SPACER SPNL 7D LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.83","SUP","Custom 27803010","","101.830  -  SPACER SPNL 7D LRDTC MED NAR 12X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.831","SUP","Custom 27803010","","101.831  -  SPACER SPNL 7D LRDTC MED NAR 12X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.832","SUP","Custom 27803010","","101.832  -  SPACER SPNL 7D LRDTC MED NAR 12X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.845","SUP","Custom 27803010","","101.845  -  SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.846","SUP","Custom 27803010","","101.846  -  SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.847","SUP","Custom 27803010","","101.847  -  SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.848","SUP","Custom 27803010","","101.848  -  SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.849","SUP","Custom 27803010","","101.849  -  SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.85","SUP","Custom 27803010","","101.850  -  SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.851","SUP","Custom 27803010","","101.851  -  SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101.852","SUP","Custom 27803010","","101.852  -  SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.041","SUP","HCPCS C1713","","102.041  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.042","SUP","HCPCS C1713","","102.042  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.043","SUP","HCPCS C1713","","102.043  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.044","SUP","HCPCS C1713","","102.044  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.045","SUP","HCPCS C1713","","102.045  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.051","SUP","HCPCS C1713","","102.051  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.052","SUP","HCPCS C1713","","102.052  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.053","SUP","HCPCS C1713","","102.053  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.054","SUP","HCPCS C1713","","102.054  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.055","SUP","HCPCS C1713","","102.055  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.061","SUP","HCPCS C1713","","102.061  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.062","SUP","HCPCS C1713","","102.062  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.063","SUP","HCPCS C1713","","102.063  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.064","SUP","HCPCS C1713","","102.064  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.065","SUP","HCPCS C1713","","102.065  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.071","SUP","HCPCS C1713","","102.071  -  7.0MM PROTEX PEDICLE SCREW 70MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.072","SUP","HCPCS C1713","","102.072  -  7.0MM PROTEX PEDICLE SCREW 75MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.073","SUP","HCPCS C1713","","102.073  -  7.0MM PROTEX PEDICLE SCREW 80MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.074","SUP","HCPCS C1713","","102.074  -  7.0MM PROTEX PEDICLE SCREW 85MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.075","SUP","HCPCS C1713","","102.075  -  7.0MM PROTEX PEDICLE SCREW 90MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.081","SUP","HCPCS C1713","","102.081  -  8.0MM PROTEX PEDICLE SCREW 70MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.082","SUP","HCPCS C1713","","102.082  -  8.0MM PROTEX PEDICLE SCREW 75MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.083","SUP","HCPCS C1713","","102.083  -  8.0MM PROTEX PEDICLE SCREW 80MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.084","SUP","HCPCS C1713","","102.084  -  8.0MM PROTEX PEDICLE SCREW 85MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.085","SUP","HCPCS C1713","","102.085  -  8.0MM PROTEX PEDICLE SCREW 90MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.091","SUP","HCPCS C1713","","102.091  -  9.0MM PROTEX PEDICLE SCREW 70MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.092","SUP","HCPCS C1713","","102.092  -  9.0MM PROTEX PEDICLE SCREW 75MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.093","SUP","HCPCS C1713","","102.093  -  9.0MM PROTEX PEDICLE SCREW 80MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.094","SUP","HCPCS C1713","","102.094  -  9.0MM PROTEX PEDICLE SCREW 85MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.095","SUP","HCPCS C1713","","102.095  -  9.0MM PROTEX PEDICLE SCREW 90MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.352","SUP","HCPCS C1713","","102.352  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.353","SUP","HCPCS C1713","","102.353  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.354","SUP","HCPCS C1713","","102.354  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.355","SUP","HCPCS C1713","","102.355  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.356","SUP","HCPCS C1713","","102.356  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.357","SUP","HCPCS C1713","","102.357  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.362","SUP","HCPCS C1713","","102.362  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.363","SUP","HCPCS C1713","","102.363  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.364","SUP","HCPCS C1713","","102.364  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.365","SUP","HCPCS C1713","","102.365  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.366","SUP","HCPCS C1713","","102.366  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.367","SUP","HCPCS C1713","","102.367  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.368","SUP","HCPCS C1713","","102.368  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.369","SUP","HCPCS C1713","","102.369  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.372","SUP","HCPCS C1713","","102.372  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.373","SUP","HCPCS C1713","","102.373  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.374","SUP","HCPCS C1713","","102.374  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.375","SUP","HCPCS C1713","","102.375  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.376","SUP","HCPCS C1713","","102.376  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.377","SUP","HCPCS C1713","","102.377  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.378","SUP","HCPCS C1713","","102.378  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.379","SUP","HCPCS C1713","","102.379  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.382","SUP","HCPCS C1713","","102.382  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.383","SUP","HCPCS C1713","","102.383  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.384","SUP","HCPCS C1713","","102.384  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.385","SUP","HCPCS C1713","","102.385  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.386","SUP","HCPCS C1713","","102.386  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.387","SUP","HCPCS C1713","","102.387  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.388","SUP","HCPCS C1713","","102.388  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.389","SUP","HCPCS C1713","","102.389  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.392","SUP","HCPCS C1713","","102.392  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.393","SUP","HCPCS C1713","","102.393  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.394","SUP","HCPCS C1713","","102.394  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.395","SUP","HCPCS C1713","","102.395  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.396","SUP","HCPCS C1713","","102.396  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.397","SUP","HCPCS C1713","","102.397  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.398","SUP","HCPCS C1713","","102.398  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.399","SUP","HCPCS C1713","","102.399  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM","BOTH IP/OP","$3,627.50 ","$2,684.35 ","$0.00 ","$3,627.50 ","$1,632.38 ","$0.00 ","$756.06 ","$0.00 ","$0.00 ","$635.15 ","$3,627.50 ","$0.00 ","$1,813.75 ","$2,872.98 ","$2,902.00 ","$0.00 ","$567.70 ","$0.00 ","$577.50 ","$0.00 "
"102.452","SUP","HCPCS C1713","","102.452  -  5.0MM PROTEX PEDICLE SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.453","SUP","HCPCS C1713","","102.453  -  5.0MM PROTEX PEDICLE SCREW 35MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.454","SUP","HCPCS C1713","","102.454  -  5.0MM PROTEX PEDICLE SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.455","SUP","HCPCS C1713","","102.455  -  5.0MM PROTEX PEDICLE SCREW 45MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.456","SUP","HCPCS C1713","","102.456  -  5.0MM PROTEX PEDICLE SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.457","SUP","HCPCS C1713","","102.457  -  5.0MM PROTEX PEDICLE SCREW 55MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.462","SUP","HCPCS C1713","","102.462  -  6.0MM PROTEX PEDICLE SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.463","SUP","HCPCS C1713","","102.463  -  6.0MM PROTEX PEDICLE SCREW 35MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.464","SUP","HCPCS C1713","","102.464  -  6.0MM PROTEX PEDICLE SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.465","SUP","HCPCS C1713","","102.465  -  6.0MM PROTEX PEDICLE SCREW 45MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.466","SUP","HCPCS C1713","","102.466  -  6.0MM PROTEX PEDICLE SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.467","SUP","HCPCS C1713","","102.467  -  6.0MM PROTEX PEDICLE SCREW 55MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.468","SUP","HCPCS C1713","","102.468  -  6.0MM PROTEX PEDICLE SCREW 60MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.469","SUP","HCPCS C1713","","102.469  -  6.0MM PROTEX PEDICLE SCREW 65MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.472","SUP","HCPCS C1713","","102.472  -  7.0MM PROTEX PEDICLE SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.473","SUP","HCPCS C1713","","102.473  -  7.0MM PROTEX PEDICLE SCREW 35MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.474","SUP","HCPCS C1713","","102.474  -  7.0MM PROTEX PEDICLE SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.475","SUP","HCPCS C1713","","102.475  -  7.0MM PROTEX PEDICLE SCREW 45MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.476","SUP","HCPCS C1713","","102.476  -  7.0MM PROTEX PEDICLE SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.477","SUP","HCPCS C1713","","102.477  -  7.0MM PROTEX PEDICLE SCREW 55MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.478","SUP","HCPCS C1713","","102.478  -  7.0MM PROTEX PEDICLE SCREW 60MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.479","SUP","HCPCS C1713","","102.479  -  7.0MM PROTEX PEDICLE SCREW 65MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.482","SUP","HCPCS C1713","","102.482  -  8.0MM PROTEX PEDICLE SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.483","SUP","HCPCS C1713","","102.483  -  8.0MM PROTEX PEDICLE SCREW 35MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.484","SUP","HCPCS C1713","","102.484  -  8.0MM PROTEX PEDICLE SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.485","SUP","HCPCS C1713","","102.485  -  8.0MM PROTEX PEDICLE SCREW 45MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.486","SUP","HCPCS C1713","","102.486  -  8.0MM PROTEX PEDICLE SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.487","SUP","HCPCS C1713","","102.487  -  8.0MM PROTEX PEDICLE SCREW 55MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.488","SUP","HCPCS C1713","","102.488  -  8.0MM PROTEX PEDICLE SCREW 60MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.489","SUP","HCPCS C1713","","102.489  -  8.0MM PROTEX PEDICLE SCREW 65MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.49","SUP","HCPCS C1713","","102.490  -  PROTEX LOCKING CAP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"102.492","SUP","HCPCS C1713","","102.492  -  9.0MM PROTEX PEDICLE SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.493","SUP","HCPCS C1713","","102.493  -  9.0MM PROTEX PEDICLE SCREW 35MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.494","SUP","HCPCS C1713","","102.494  -  9.0MM PROTEX PEDICLE SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.495","SUP","HCPCS C1713","","102.495  -  9.0MM PROTEX PEDICLE SCREW 45MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.496","SUP","HCPCS C1713","","102.496  -  9.0MM PROTEX PEDICLE SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.497","SUP","HCPCS C1713","","102.497  -  9.0MM PROTEX PEDICLE SCREW 55MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.498","SUP","HCPCS C1713","","102.498  -  9.0MM PROTEX PEDICLE SCREW 60MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.499","SUP","HCPCS C1713","","102.499  -  9.0MM PROTEX PEDICLE SCREW 65MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"102.51","SUP","Custom 27803010","","102.510  -  6.5MM STRAIGHT ROD, 100MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.512","SUP","Custom 27803010","","102.512  -  6.5MM STRAIGHT ROD, 125MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.515","SUP","Custom 27803010","","102.515  -  6.5MM STRAIGHT ROD, 150MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.517","SUP","Custom 27803010","","102.517  -  6.5MM STRAIGHT ROD, 200MM","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.519","SUP","Custom 27803010","","102.519  -  6.5MM STRAIGHT ROD, 300MM","BOTH IP/OP","$927.50 ","$686.35 ","$0.00 ","$927.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$927.50 ","$0.00 ","$463.75 ","$734.58 ","$742.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.52","SUP","Custom 27803010","","102.520  -  6.5MM STRAIGHT ROD, 400MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.521","SUP","Custom 27803010","","102.521  -  ROD SPNL STRG 6.5MM 500MM PRTX","BOTH IP/OP","$1,060.00 ","$784.40 ","$0.00 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.00 ","$0.00 ","$530.00 ","$839.52 ","$848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.53","SUP","Custom 27803010","","102.530  -  6.5MM STRAIGHT ROD, 30MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.535","SUP","Custom 27803010","","102.535  -  6.5MM STRAIGHT ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.54","SUP","Custom 27803010","","102.540  -  6.5MM STRAIGHT ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.545","SUP","Custom 27803010","","102.545  -  6.5MM STRAIGHT ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.55","SUP","Custom 27803010","","102.550  -  6.5MM STRAIGHT ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.555","SUP","Custom 27803010","","102.555  -  6.5MM STRAIGHT ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.56","SUP","Custom 27803010","","102.560  -  6.5MM STRAIGHT ROD, 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.565","SUP","Custom 27803010","","102.565  -  6.5MM STRAIGHT ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.57","SUP","Custom 27803010","","102.570  -  6.5MM STRAIGHT ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.575","SUP","Custom 27803010","","102.575  -  6.5MM STRAIGHT ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.58","SUP","Custom 27803010","","102.580  -  6.5MM STRAIGHT ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.585","SUP","Custom 27803010","","102.585  -  6.5MM STRAIGHT ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.61","SUP","Custom 27803010","","102.610  -  6.5MM CURVED ROD, 100MM","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.612","SUP","Custom 27803010","","102.612  -  6.5MM CURVED ROD, 120MM","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.615","SUP","Custom 27803010","","102.615  -  6.5MM CURVED ROD, 150MM","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.635","SUP","Custom 27803010","","102.635  -  6.5MM CURVED ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.64","SUP","Custom 27803010","","102.640  -  6.5MM CURVED ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.645","SUP","Custom 27803010","","102.645  -  6.5MM CURVED ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.65","SUP","Custom 27803010","","102.650  -  6.5MM CURVED ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.655","SUP","Custom 27803010","","102.655  -  6.5MM CURVED ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.66","SUP","Custom 27803010","","102.660  -  6.5MM CURVED ROD, 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.665","SUP","Custom 27803010","","102.665  -  6.5MM CURVED ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.67","SUP","Custom 27803010","","102.670  -  6.5MM CURVED ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.675","SUP","Custom 27803010","","102.675  -  6.5MM CURVED ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.68","SUP","Custom 27803010","","102.680  -  6.5MM CURVED ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.685","SUP","Custom 27803010","","102.685  -  6.5MM CURVED ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.911","SUP","Custom 27803010","","102.911  -  ADJUSTABLE T CONNECTOR, 28MM-40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.912","SUP","Custom 27803010","","102.912  -  ADJUSTABLE T CONNECTOR, 38MM-50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.913","SUP","Custom 27803010","","102.913  -  ADJUSTABLE T CONNECTOR, 48MM-60MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.914","SUP","Custom 27803010","","102.914  -  ADJUSTABLE T CONNECTOR, 58MM-70MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.915","SUP","Custom 27803010","","102.915  -  ADJUSTABLE T CONNECTOR, 68MM-80MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.916","SUP","Custom 27803010","","102.916  -  ADJUSTABLE T CONNECTOR, 78MM-90MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.921","SUP","Custom 27803010","","102.921  -  PROTEX LAMINA HOOK, SMALL","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.922","SUP","Custom 27803010","","102.922  -  PROTEX LAMINA HOOK, MEDIUM","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.923","SUP","Custom 27803010","","102.923  -  PROTEX LAMINA HOOK, LARGE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.925","SUP","Custom 27803010","","102.925  -  PROTEX ANGLED LAMINA HOOK, SMALL","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.926","SUP","Custom 27803010","","102.926  -  PROTEX ANGLED LAMINA HOOK, MEDIUM","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.927","SUP","Custom 27803010","","102.927  -  PROTEX ANGLED LAMINA HOOK, LARGE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.941","SUP","Custom 27803010","","102.941  -  PROTEX PEDICLE HOOK","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.951","SUP","Custom 27803010","","102.951  -  PROTEX TRANSVERSE PROCESS HOOK, RIGHT","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.952","SUP","Custom 27803010","","102.952  -  PROTEX TRANSVERSE PROCESS HOOK, LEFT","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.971","SUP","Custom 27803010","","102.971  -  PARALLEL CONNECTOR, 6.5MM TO 6.5MM","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.974","SUP","Custom 27803010","","102.974  -  OFFSET CONNECTOR, 15MM","BOTH IP/OP","$572.50 ","$423.65 ","$0.00 ","$572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.50 ","$0.00 ","$286.25 ","$453.42 ","$458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.975","SUP","Custom 27803010","","102.975  -  OFFSET CONNECTOR, 20MM","BOTH IP/OP","$572.50 ","$423.65 ","$0.00 ","$572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.50 ","$0.00 ","$286.25 ","$453.42 ","$458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.976","SUP","Custom 27803010","","102.976  -  OFFSET CONNECTOR, 25MM","BOTH IP/OP","$572.50 ","$423.65 ","$0.00 ","$572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.50 ","$0.00 ","$286.25 ","$453.42 ","$458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.99","SUP","Custom 27803010","","102.990  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 15MM","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.991","SUP","Custom 27803010","","102.991  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 20MM","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.992","SUP","Custom 27803010","","102.992  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 25MM","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.993","SUP","Custom 27803010","","102.993  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 30MM","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.994","SUP","Custom 27803010","","102.994  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 35MM","BOTH IP/OP","$1,325.00 ","$980.50 ","$0.00 ","$1,325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.995","SUP","Custom 27803010","","102.995  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 100MM","BOTH IP/OP","$1,457.50 ","$1,078.55 ","$0.00 ","$1,457.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,457.50 ","$0.00 ","$728.75 ","$1,154.34 ","$1,166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.996","SUP","Custom 27803010","","102.996  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 120MM","BOTH IP/OP","$1,457.50 ","$1,078.55 ","$0.00 ","$1,457.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,457.50 ","$0.00 ","$728.75 ","$1,154.34 ","$1,166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102.997","SUP","Custom 27803010","","102.997  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 150MM","BOTH IP/OP","$1,457.50 ","$1,078.55 ","$0.00 ","$1,457.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,457.50 ","$0.00 ","$728.75 ","$1,154.34 ","$1,166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103","SUP","HCPCS C1767","","103  -  GENERATOR ELECTROSURGICAL NCP DEMIPULSE","BOTH IP/OP","$54,430.00 ","$40,278.20 ","$0.00 ","$43,108.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$43,108.56 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104","SUP","HCPCS C1713","","104  -  PLATE 104 SINGLE T 3H X 3H","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$323.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$323.14 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"105","SUP","HCPCS C1713","","105  -  PLATE 105 SINGLE T 3H X 2H","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$323.14 ","$0.00 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$323.14 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$64.95 ","$0.00 "
"109.041","SUP","HCPCS C1713","","109.041  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.042","SUP","HCPCS C1713","","109.042  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.043","SUP","HCPCS C1713","","109.043  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.044","SUP","HCPCS C1713","","109.044  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.045","SUP","HCPCS C1713","","109.045  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.051","SUP","HCPCS C1713","","109.051  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.052","SUP","HCPCS C1713","","109.052  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.053","SUP","HCPCS C1713","","109.053  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.054","SUP","HCPCS C1713","","109.054  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.055","SUP","HCPCS C1713","","109.055  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.061","SUP","HCPCS C1713","","109.061  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.062","SUP","HCPCS C1713","","109.062  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.063","SUP","HCPCS C1713","","109.063  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.064","SUP","HCPCS C1713","","109.064  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.065","SUP","HCPCS C1713","","109.065  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.071","SUP","HCPCS C1713","","109.071  -  7.0MM PROTEX SOLID PEDICLE SCREW 70MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.072","SUP","HCPCS C1713","","109.072  -  7.0MM PROTEX SOLID PEDICLE SCREW 75MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.073","SUP","HCPCS C1713","","109.073  -  7.0MM PROTEX SOLID PEDICLE SCREW 80MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.074","SUP","HCPCS C1713","","109.074  -  7.0MM PROTEX SOLID PEDICLE SCREW 85MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.075","SUP","HCPCS C1713","","109.075  -  7.0MM PROTEX SOLID PEDICLE SCREW 90MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.081","SUP","HCPCS C1713","","109.081  -  8.0MM PROTEX SOLID PEDICLE SCREW 70MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.082","SUP","HCPCS C1713","","109.082  -  8.0MM PROTEX SOLID PEDICLE SCREW 75MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.083","SUP","HCPCS C1713","","109.083  -  8.0MM PROTEX SOLID PEDICLE SCREW 80MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.084","SUP","HCPCS C1713","","109.084  -  8.0MM PROTEX SOLID PEDICLE SCREW 85MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.085","SUP","HCPCS C1713","","109.085  -  8.0MM PROTEX SOLID PEDICLE SCREW 90MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.091","SUP","HCPCS C1713","","109.091  -  9.0MM PROTEX SOLID PEDICLE SCREW 70MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.092","SUP","HCPCS C1713","","109.092  -  9.0MM PROTEX SOLID PEDICLE SCREW 75MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.093","SUP","HCPCS C1713","","109.093  -  9.0MM PROTEX SOLID PEDICLE SCREW 80MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.094","SUP","HCPCS C1713","","109.094  -  9.0MM PROTEX SOLID PEDICLE SCREW 85MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.095","SUP","HCPCS C1713","","109.095  -  9.0MM PROTEX SOLID PEDICLE SCREW 90MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.351","SUP","HCPCS C1713","","109.351  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 25MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.352","SUP","HCPCS C1713","","109.352  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.353","SUP","HCPCS C1713","","109.353  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.354","SUP","HCPCS C1713","","109.354  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.355","SUP","HCPCS C1713","","109.355  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.356","SUP","HCPCS C1713","","109.356  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.357","SUP","HCPCS C1713","","109.357  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.358","SUP","HCPCS C1713","","109.358  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.359","SUP","HCPCS C1713","","109.359  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.362","SUP","HCPCS C1713","","109.362  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.363","SUP","HCPCS C1713","","109.363  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.364","SUP","HCPCS C1713","","109.364  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.365","SUP","HCPCS C1713","","109.365  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.366","SUP","HCPCS C1713","","109.366  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.367","SUP","HCPCS C1713","","109.367  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.368","SUP","HCPCS C1713","","109.368  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.369","SUP","HCPCS C1713","","109.369  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.372","SUP","HCPCS C1713","","109.372  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.373","SUP","HCPCS C1713","","109.373  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.374","SUP","HCPCS C1713","","109.374  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.375","SUP","HCPCS C1713","","109.375  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.376","SUP","HCPCS C1713","","109.376  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.377","SUP","HCPCS C1713","","109.377  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.378","SUP","HCPCS C1713","","109.378  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.379","SUP","HCPCS C1713","","109.379  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.382","SUP","HCPCS C1713","","109.382  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.383","SUP","HCPCS C1713","","109.383  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.384","SUP","HCPCS C1713","","109.384  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.385","SUP","HCPCS C1713","","109.385  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.386","SUP","HCPCS C1713","","109.386  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.387","SUP","HCPCS C1713","","109.387  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.388","SUP","HCPCS C1713","","109.388  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.389","SUP","HCPCS C1713","","109.389  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.392","SUP","HCPCS C1713","","109.392  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.393","SUP","HCPCS C1713","","109.393  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.394","SUP","HCPCS C1713","","109.394  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.395","SUP","HCPCS C1713","","109.395  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.396","SUP","HCPCS C1713","","109.396  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.397","SUP","HCPCS C1713","","109.397  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.398","SUP","HCPCS C1713","","109.398  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.399","SUP","HCPCS C1713","","109.399  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","BOTH IP/OP","$2,517.50 ","$1,862.95 ","$0.00 ","$2,517.50 ","$1,132.88 ","$0.00 ","$524.71 ","$0.00 ","$0.00 ","$440.79 ","$2,517.50 ","$0.00 ","$1,258.75 ","$1,993.86 ","$2,014.00 ","$0.00 ","$393.99 ","$0.00 ","$400.79 ","$0.00 "
"109.441","SUP","HCPCS C1713","","109.441  -  4.5MM PROTEX SOLID PEDICLE SCREW, 25MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.442","SUP","HCPCS C1713","","109.442  -  4.5MM PROTEX SOLID PEDICLE SCREW, 30MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.443","SUP","HCPCS C1713","","109.443  -  4.5MM PROTEX SOLID PEDICLE SCREW, 35MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.444","SUP","HCPCS C1713","","109.444  -  4.5MM PROTEX SOLID PEDICLE SCREW, 40MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.445","SUP","HCPCS C1713","","109.445  -  4.5MM PROTEX SOLID PEDICLE SCREW, 45MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.446","SUP","HCPCS C1713","","109.446  -  4.5MM PROTEX SOLID PEDICLE SCREW, 50MM","BOTH IP/OP","$4,580.00 ","$3,389.20 ","$0.00 ","$4,580.00 ","$2,061.00 ","$0.00 ","$954.59 ","$0.00 ","$0.00 ","$801.92 ","$4,580.00 ","$0.00 ","$2,290.00 ","$3,627.36 ","$3,664.00 ","$0.00 ","$716.77 ","$0.00 ","$729.14 ","$0.00 "
"109.452","SUP","HCPCS C1713","","109.452  -  5.0MM PROTEX SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.453","SUP","HCPCS C1713","","109.453  -  5.0MM PROTEX SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.454","SUP","HCPCS C1713","","109.454  -  5.0MM PROTEX SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.455","SUP","HCPCS C1713","","109.455  -  5.0MM PROTEX SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.456","SUP","HCPCS C1713","","109.456  -  5.0MM PROTEX SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.457","SUP","HCPCS C1713","","109.457  -  5.0MM PROTEX SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.462","SUP","HCPCS C1713","","109.462  -  6.0MM PROTEX SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.463","SUP","HCPCS C1713","","109.463  -  6.0MM PROTEX SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.464","SUP","HCPCS C1713","","109.464  -  6.0MM PROTEX SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.465","SUP","HCPCS C1713","","109.465  -  6.0MM PROTEX SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.466","SUP","HCPCS C1713","","109.466  -  6.0MM PROTEX SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.467","SUP","HCPCS C1713","","109.467  -  6.0MM PROTEX SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.468","SUP","HCPCS C1713","","109.468  -  6.0MM PROTEX SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.469","SUP","HCPCS C1713","","109.469  -  6.0MM PROTEX SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.472","SUP","HCPCS C1713","","109.472  -  7.0MM PROTEX SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.473","SUP","HCPCS C1713","","109.473  -  7.0MM PROTEX SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.474","SUP","HCPCS C1713","","109.474  -  7.0MM PROTEX SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.475","SUP","HCPCS C1713","","109.475  -  7.0MM PROTEX SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.476","SUP","HCPCS C1713","","109.476  -  7.0MM PROTEX SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.477","SUP","HCPCS C1713","","109.477  -  7.0MM PROTEX SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.478","SUP","HCPCS C1713","","109.478  -  7.0MM PROTEX SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.479","SUP","HCPCS C1713","","109.479  -  7.0MM PROTEX SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.482","SUP","HCPCS C1713","","109.482  -  8.0MM PROTEX SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.483","SUP","HCPCS C1713","","109.483  -  8.0MM PROTEX SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.484","SUP","HCPCS C1713","","109.484  -  8.0MM PROTEX SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.485","SUP","HCPCS C1713","","109.485  -  8.0MM PROTEX SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.486","SUP","HCPCS C1713","","109.486  -  8.0MM PROTEX SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.487","SUP","HCPCS C1713","","109.487  -  8.0MM PROTEX SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.488","SUP","HCPCS C1713","","109.488  -  8.0MM PROTEX SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.489","SUP","HCPCS C1713","","109.489  -  8.0MM PROTEX SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.492","SUP","HCPCS C1713","","109.492  -  9.0MM PROTEX SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.493","SUP","HCPCS C1713","","109.493  -  9.0MM PROTEX SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.494","SUP","HCPCS C1713","","109.494  -  9.0MM PROTEX SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.495","SUP","HCPCS C1713","","109.495  -  9.0MM PROTEX SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.496","SUP","HCPCS C1713","","109.496  -  9.0MM PROTEX SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.497","SUP","HCPCS C1713","","109.497  -  9.0MM PROTEX SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.498","SUP","HCPCS C1713","","109.498  -  9.0MM PROTEX SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.499","SUP","HCPCS C1713","","109.499  -  9.0MM PROTEX SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,311.75 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"109.51","SUP","HCPCS C1713","","109.510  -  6.00MM STRAIGHT ROD, 100MM","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$301.50 ","$0.00 ","$139.64 ","$0.00 ","$0.00 ","$117.31 ","$670.00 ","$0.00 ","$335.00 ","$530.64 ","$536.00 ","$0.00 ","$104.86 ","$0.00 ","$106.66 ","$0.00 "
"109.512","SUP","Custom 27803010","","109.512  -  6.00MM STRAIGHT ROD, 125MM","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$335.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.515","SUP","Custom 27803010","","109.515  -  6.00MM STRAIGHT ROD, 150MM","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$335.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.517","SUP","Custom 27803010","","109.517  -  6.00MM STRAIGHT ROD, 200MM","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.519","SUP","Custom 27803010","","109.519  -  6.00MM STRAIGHT ROD, 300MM","BOTH IP/OP","$927.50 ","$686.35 ","$0.00 ","$927.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$927.50 ","$0.00 ","$463.75 ","$734.58 ","$742.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.52","SUP","Custom 27803010","","109.520  -  6.00MM STRAIGHT ROD, 400MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.521","SUP","Custom 27803010","","109.521  -  6.00MM STRAIGHT ROD, 500MM","BOTH IP/OP","$1,060.00 ","$784.40 ","$0.00 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.00 ","$0.00 ","$530.00 ","$839.52 ","$848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.53","SUP","Custom 27803010","","109.530  -  6.00MM STRAIGHT ROD, 30MM","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$335.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.535","SUP","Custom 27803010","","109.535  -  6.00MM STRAIGHT ROD, 35MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.54","SUP","Custom 27803010","","109.540  -  6.00MM STRAIGHT ROD, 40MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.545","SUP","Custom 27803010","","109.545  -  6.00MM STRAIGHT ROD, 45MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.55","SUP","Custom 27803010","","109.550  -  6.00MM STRAIGHT ROD, 50MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.555","SUP","Custom 27803010","","109.555  -  6.00MM STRAIGHT ROD, 55MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.56","SUP","Custom 27803010","","109.560  -  6.00MM STRAIGHT ROD, 60MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.565","SUP","Custom 27803010","","109.565  -  6.00MM STRAIGHT ROD, 65MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.57","SUP","Custom 27803010","","109.570  -  6.00MM STRAIGHT ROD, 70MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.575","SUP","Custom 27803010","","109.575  -  6.00MM STRAIGHT ROD, 75MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.58","SUP","Custom 27803010","","109.580  -  6.00MM STRAIGHT ROD, 80MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.585","SUP","Custom 27803010","","109.585  -  6.00MM STRAIGHT ROD, 85MM","BOTH IP/OP","$465.00 ","$344.10 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.61","SUP","Custom 27803010","","109.610  -  6.00MM CURVED ROD, 100MM","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.612","SUP","Custom 27803010","","109.612  -  6.00MM CURVED ROD, 120MM","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.615","SUP","Custom 27803010","","109.615  -  6.00MM CURVED ROD, 150MM","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.635","SUP","Custom 27803010","","109.635  -  6.00MM CURVED ROD, 35MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.64","SUP","Custom 27803010","","109.640  -  6.00MM CURVED ROD, 40MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.645","SUP","Custom 27803010","","109.645  -  6.00MM CURVED ROD, 45MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.65","SUP","Custom 27803010","","109.650  -  6.00MM CURVED ROD, 50MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.655","SUP","Custom 27803010","","109.655  -  6.00MM CURVED ROD, 55MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.66","SUP","Custom 27803010","","109.660  -  6.00MM CURVED ROD, 60MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.665","SUP","Custom 27803010","","109.665  -  6.00MM CURVED ROD, 65MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.67","SUP","Custom 27803010","","109.670  -  6.00MM CURVED ROD, 70MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.675","SUP","Custom 27803010","","109.675  -  6.00MM CURVED ROD, 75MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.68","SUP","Custom 27803010","","109.680  -  6.00MM CURVED ROD, 80MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.685","SUP","Custom 27803010","","109.685  -  6.00MM CURVED ROD, 85MM","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.921","SUP","Custom 27803010","","109.921  -  PROTEX LAMINA HOOK, 6.0MM ROD, SMALL","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.922","SUP","Custom 27803010","","109.922  -  PROTEX LAMINA HOOK, 6.0MM ROD, MEDIUM","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.923","SUP","Custom 27803010","","109.923  -  PROTEX LAMINA HOOK, 6.0MM ROD, LARGE","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.925","SUP","Custom 27803010","","109.925  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, SMALL","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.926","SUP","Custom 27803010","","109.926  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, MEDIUM","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.927","SUP","Custom 27803010","","109.927  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, LARGE","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.941","SUP","Custom 27803010","","109.941  -  PROTEX PEDICLE HOOK, 6.0MM ROD","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.951","SUP","Custom 27803010","","109.951  -  PROTEX TRANSVERSE PROCESS HOOK, 6.0MM ROD, RIGHT","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"109.952","SUP","Custom 27803010","","109.952  -  PROTEX TRANSVERSE PROCESS HOOK, 6.0MM ROD, LEFT","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110.01","SUP","HCPCS C1713","","110.010  -  4.0MM RIGID SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.012","SUP","HCPCS C1713","","110.012  -  4.0MM RIGID SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.014","SUP","HCPCS C1713","","110.014  -  4.0MM RIGID SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.016","SUP","HCPCS C1713","","110.016  -  SCREW BONE 4MM 16MM ASR TI ANT CERV SPN SLFDRILL RGD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.026","SUP","HCPCS C1713","","110.026  -  4.0MM RIGID SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.028","SUP","HCPCS C1713","","110.028  -  4.0MM RIGID SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.03","SUP","HCPCS C1713","","110.030  -  4.0MM RIGID SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.032","SUP","HCPCS C1713","","110.032  -  4.0MM RIGID SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.034","SUP","HCPCS C1713","","110.034  -  SCREW BONE 4MM 14MM ASR TI ANT CERV SPN SLFTAP RGD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.036","SUP","HCPCS C1713","","110.036  -  SCREW BONE 4MM 16MM ASR TI ANT CERV SPN SLFTAP RGD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.038","SUP","HCPCS C1713","","110.038  -  SCREW BONE 4MM 18MM ASR SPNL SLFTAP RGD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.04","SUP","HCPCS C1713","","110.040  -  4.0MM RIGID SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.05","SUP","HCPCS C1713","","110.050  -  SCREW SET TI ANT CERV SPN RGD","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"110.11","SUP","HCPCS C1713","","110.110  -  ASSURE CERVICAL PLATE 1-LEVEL, 10MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.112","SUP","HCPCS C1713","","110.112  -  ASSURE CERVICAL PLATE 1-LEVEL, 12MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.114","SUP","HCPCS C1713","","110.114  -  PLATE 14MM TI 1 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.116","SUP","HCPCS C1713","","110.116  -  PLATE 16MM TI 1 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.118","SUP","HCPCS C1713","","110.118  -  ASSURE CERVICAL PLATE 1-LEVEL, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.12","SUP","HCPCS C1713","","110.120  -  ASSURE CERVICAL PLATE 1-LEVEL, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.122","SUP","HCPCS C1713","","110.122  -  ASSURE CERVICAL PLATE 1-LEVEL, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.124","SUP","HCPCS C1713","","110.124  -  PLATE 24MM TI 1 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.126","SUP","HCPCS C1713","","110.126  -  ASSURE CERVICAL PLATE 1-LEVEL, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"110.224","SUP","HCPCS C1713","","110.224  -  ASSURE CERVICAL PLATE 2-LEVEL, 24MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.226","SUP","HCPCS C1713","","110.226  -  ASSURE CERVICAL PLATE 2-LEVEL, 26MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.228","SUP","HCPCS C1713","","110.228  -  PLATE 28MM TI 2 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.23","SUP","HCPCS C1713","","110.230  -  PLATE 30MM TI 2 LVL ASR BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.232","SUP","HCPCS C1713","","110.232  -  PLATE 32MM TI 2 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.234","SUP","HCPCS C1713","","110.234  -  PLATE 34MM TI 2 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.236","SUP","HCPCS C1713","","110.236  -  PLATE 36MM TI 2 LVL ASR BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.238","SUP","HCPCS C1713","","110.238  -  ASSURE CERVICAL PLATE 2-LEVEL, 38MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.24","SUP","HCPCS C1713","","110.240  -  ASSURE CERVICAL PLATE 2-LEVEL, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.242","SUP","HCPCS C1713","","110.242  -  ASSURE CERVICAL PLATE 2-LEVEL, 42MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.244","SUP","HCPCS C1713","","110.244  -  ASSURE CERVICAL PLATE 2-LEVEL, 44MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.246","SUP","HCPCS C1713","","110.246  -  ASSURE CERVICAL PLATE 2-LEVEL, 46MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"110.339","SUP","HCPCS C1713","","110.339  -  ASSURE CERVICAL PLATE 3-LEVEL, 39MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.342","SUP","HCPCS C1713","","110.342  -  ASSURE CERVICAL PLATE 3-LEVEL, 42MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.345","SUP","HCPCS C1713","","110.345  -  ASSURE CERVICAL PLATE 3-LEVEL, 45MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.348","SUP","HCPCS C1713","","110.348  -  ASSURE CERVICAL PLATE 3-LEVEL, 48MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.351","SUP","HCPCS C1713","","110.351  -  ASSURE CERVICAL PLATE 3-LEVEL, 51MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.354","SUP","HCPCS C1713","","110.354  -  ASSURE CERVICAL PLATE 3-LEVEL, 54MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.357","SUP","HCPCS C1713","","110.357  -  ASSURE CERVICAL PLATE 3-LEVEL, 57MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.36","SUP","HCPCS C1713","","110.360  -  ASSURE CERVICAL PLATE 3-LEVEL, 60MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.363","SUP","HCPCS C1713","","110.363  -  ASSURE CERVICAL PLATE 3-LEVEL, 63MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.366","SUP","HCPCS C1713","","110.366  -  ASSURE CERVICAL PLATE 3-LEVEL, 66MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.369","SUP","HCPCS C1713","","110.369  -  ASSURE CERVICAL PLATE 3-LEVEL, 69MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"110.46","SUP","HCPCS C1713","","110.460  -  ASSURE CERVICAL PLATE 4-LEVEL, 60MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.464","SUP","HCPCS C1713","","110.464  -  ASSURE CERVICAL PLATE 4-LEVEL, 64MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.468","SUP","HCPCS C1713","","110.468  -  ASSURE CERVICAL PLATE 4-LEVEL, 68MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.472","SUP","HCPCS C1713","","110.472  -  ASSURE CERVICAL PLATE 4-LEVEL, 72MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.476","SUP","HCPCS C1713","","110.476  -  ASSURE CERVICAL PLATE 4-LEVEL, 76MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.48","SUP","HCPCS C1713","","110.480  -  ASSURE CERVICAL PLATE 4-LEVEL, 80MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.484","SUP","HCPCS C1713","","110.484  -  ASSURE CERVICAL PLATE 4-LEVEL, 84MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.488","SUP","HCPCS C1713","","110.488  -  ASSURE CERVICAL PLATE 4-LEVEL, 88MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.492","SUP","HCPCS C1713","","110.492  -  ASSURE CERVICAL PLATE 4-LEVEL, 92MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.496","SUP","HCPCS C1713","","110.496  -  ASSURE CERVICAL PLATE 4-LEVEL, 96MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.5","SUP","HCPCS C1713","","110.500  -  ASSURE CERVICAL PLATE 4-LEVEL, 100MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"110.512","SUP","HCPCS C1713","","110.512  -  4.5MM RIGID SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.514","SUP","HCPCS C1713","","110.514  -  4.5MM RIGID SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.516","SUP","HCPCS C1713","","110.516  -  4.5MM RIGID SCREW, SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.526","SUP","HCPCS C1713","","110.526  -  4.5MM RIGID SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.528","SUP","HCPCS C1713","","110.528  -  4.5MM RIGID SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.53","SUP","HCPCS C1713","","110.530  -  4.5MM RIGID SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.532","SUP","HCPCS C1713","","110.532  -  4.5MM RIGID SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.534","SUP","HCPCS C1713","","110.534  -  4.5MM RIGID SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.536","SUP","HCPCS C1713","","110.536  -  SCREW BONE 4.5MM 16MM ASR TI SPNL SLFTAP RGD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.538","SUP","HCPCS C1713","","110.538  -  4.5MM RIGID SCREW, SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.54","SUP","HCPCS C1713","","110.540  -  4.5MM RIGID SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.61","SUP","HCPCS C1713","","110.610  -  4.0MM STANDARD SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.612","SUP","HCPCS C1713","","110.612  -  4.0MM STANDARD SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.614","SUP","HCPCS C1713","","110.614  -  4.0MM STANDARD SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.616","SUP","HCPCS C1713","","110.616  -  SCREW BONE 4MM 16MM ASR TI STD SPNL SLFDRILL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.712","SUP","HCPCS C1713","","110.712  -  4.5MM STANDARD SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.714","SUP","HCPCS C1713","","110.714  -  4.5MM STANDARD SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.716","SUP","HCPCS C1713","","110.716  -  SCREW BONE 4.5MM 16MM ASR TI STD SPNL SLFDRILL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.806","SUP","HCPCS C1713","","110.806  -  SCREW BN STD 4MM 6MM PRTX CT ST SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.808","SUP","HCPCS C1713","","110.808  -  SCREW BONE 4MM 8MM TI STD SPNL SLFTAP","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"110.81","SUP","HCPCS C1713","","110.810  -  4.0MM STANDARD SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.812","SUP","HCPCS C1713","","110.812  -  4.0MM STANDARD SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.814","SUP","HCPCS C1713","","110.814  -  SCREW BONE 4MM 14MM ASR TI STD ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.816","SUP","HCPCS C1713","","110.816  -  SCREW BONE 4MM 16MM ASR TI STD SPNL SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.818","SUP","HCPCS C1713","","110.818  -  SCREW BONE 4MM 18MM ASR TI STD SPNL SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.82","SUP","HCPCS C1713","","110.820  -  4.0MM STANDARD SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.906","SUP","HCPCS C1713","","110.906  -  4.5MM STANDARD SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.908","SUP","HCPCS C1713","","110.908  -  4.5MM STANDARD SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.91","SUP","HCPCS C1713","","110.910  -  4.5MM STANDARD SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.912","SUP","HCPCS C1713","","110.912  -  SCREW BONE 4.5MM 12MM ASR TI STD ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.914","SUP","HCPCS C1713","","110.914  -  4.5MM STANDARD SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.916","SUP","HCPCS C1713","","110.916  -  SCREW BONE 4.5MM 16MM ASR TI STD ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.918","SUP","HCPCS C1713","","110.918  -  SCREW BONE 4.5MM 18MM ASR TI STD SPNL SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"110.92","SUP","HCPCS C1713","","110.920  -  SCREW BONE 4.5MM 20MM PRTX TI STD THORLMBR SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"111","SUP","Custom 27203010","","111  -  ADAPTER SUCTION 15MM 15MM CLOSE SYSTEM SWIVEL LATEX FREE","BOTH IP/OP","$79.68 ","$58.96 ","$0.00 ","$79.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.68 ","$0.00 ","$39.84 ","$63.11 ","$63.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115","SUP","HCPCS C1713","","115.000  -  SET SCREW, M4 X 0.75, ROUND TIP, 2.5MM HEX","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"115.222","SUP","HCPCS C1713","","115.222  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 22MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.224","SUP","HCPCS C1713","","115.224  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 24MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.226","SUP","HCPCS C1713","","115.226  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 26MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.228","SUP","HCPCS C1713","","115.228  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 28MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.23","SUP","HCPCS C1713","","115.230  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.232","SUP","HCPCS C1713","","115.232  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 32MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.234","SUP","HCPCS C1713","","115.234  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 34MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.236","SUP","HCPCS C1713","","115.236  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 36MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.308","SUP","HCPCS C1713","","115.308  -  SCREW BONE 3.5MM 8MM PRTX CTTI OCT SPN POLYAX","BOTH IP/OP","$3,097.50 ","$2,292.15 ","$0.00 ","$3,097.50 ","$1,393.88 ","$0.00 ","$645.60 ","$0.00 ","$0.00 ","$542.35 ","$3,097.50 ","$0.00 ","$1,548.75 ","$2,453.22 ","$2,478.00 ","$0.00 ","$484.76 ","$0.00 ","$493.12 ","$0.00 "
"115.31","SUP","HCPCS C1713","","115.310  -  SCREW BONE 3.5MM 10MM PRTX CTTI POST THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.312","SUP","HCPCS C1713","","115.312  -  SCREW BONE 3.5MM 12MM PRTX CTTI OCT SPN POLYAX","BOTH IP/OP","$3,097.50 ","$2,292.15 ","$0.00 ","$3,097.50 ","$1,393.88 ","$0.00 ","$645.60 ","$0.00 ","$0.00 ","$542.35 ","$3,097.50 ","$0.00 ","$1,548.75 ","$2,453.22 ","$2,478.00 ","$0.00 ","$484.76 ","$0.00 ","$493.12 ","$0.00 "
"115.314","SUP","HCPCS C1713","","115.314  -  SCREW BONE 3.5MM 14MM PRTX CTTI OCT SPN POLYAX","BOTH IP/OP","$3,097.50 ","$2,292.15 ","$0.00 ","$3,097.50 ","$1,393.88 ","$0.00 ","$645.60 ","$0.00 ","$0.00 ","$542.35 ","$3,097.50 ","$0.00 ","$1,548.75 ","$2,453.22 ","$2,478.00 ","$0.00 ","$484.76 ","$0.00 ","$493.12 ","$0.00 "
"115.316","SUP","HCPCS C1713","","115.316  -  SCREW BONE 3.5MM 16MM PRTX CTTI OCT SPN POLYAX","BOTH IP/OP","$3,097.50 ","$2,292.15 ","$0.00 ","$3,097.50 ","$1,393.88 ","$0.00 ","$645.60 ","$0.00 ","$0.00 ","$542.35 ","$3,097.50 ","$0.00 ","$1,548.75 ","$2,453.22 ","$2,478.00 ","$0.00 ","$484.76 ","$0.00 ","$493.12 ","$0.00 "
"115.318","SUP","HCPCS C1713","","115.318  -  3.5MM PROTEX CT POLYAXIAL SCREW 18MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.32","SUP","HCPCS C1713","","115.320  -  3.5MM PROTEX CT POLYAXIAL SCREW 20MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.322","SUP","HCPCS C1713","","115.322  -  3.5MM PROTEX CT POLYAXIAL SCREW 22MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.324","SUP","HCPCS C1713","","115.324  -  3.5MM PROTEX CT POLYAXIAL SCREW 24MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.326","SUP","HCPCS C1713","","115.326  -  3.5MM PROTEX CT POLYAXIAL SCREW 26MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.328","SUP","HCPCS C1713","","115.328  -  3.5MM PROTEX CT POLYAXIAL SCREW 28MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.33","SUP","HCPCS C1713","","115.330  -  3.5MM PROTEX CT POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.332","SUP","HCPCS C1713","","115.332  -  3.5MM PROTEX CT POLYAXIAL SCREW 32MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.334","SUP","HCPCS C1713","","115.334  -  3.5MM PROTEX CT POLYAXIAL SCREW 34MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.336","SUP","HCPCS C1713","","115.336  -  3.5MM PROTEX CT POLYAXIAL SCREW 36MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.338","SUP","HCPCS C1713","","115.338  -  3.5MM PROTEX CT POLYAXIAL SCREW 38MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.34","SUP","HCPCS C1713","","115.340  -  3.5MM PROTEX CT POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.342","SUP","HCPCS C1713","","115.342  -  3.5MM PROTEX CT POLYAXIAL SCREW 42MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.344","SUP","HCPCS C1713","","115.344  -  3.5MM PROTEX CT POLYAXIAL SCREW 44MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.346","SUP","HCPCS C1713","","115.346  -  3.5MM PROTEX CT POLYAXIAL SCREW 46MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.348","SUP","HCPCS C1713","","115.348  -  3.5MM PROTEX CT POLYAXIAL SCREW 48MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.35","SUP","HCPCS C1713","","115.350  -  3.5MM PROTEX CT POLYAXIAL SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.41","SUP","HCPCS C1713","","115.410  -  SCREW BONE 4MM 10MM PRTX CTTI OCT SPN POLYAX SLFTAP","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.412","SUP","HCPCS C1713","","115.412  -  SCREW BN 4MM 12MM PRTX CT PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.414","SUP","HCPCS C1713","","115.414  -  SCREW BN 4MM 14MM PRTX CT PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.416","SUP","HCPCS C1713","","115.416  -  4.0MM PROTEX CT POLYAXIAL SCREW 16MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.418","SUP","HCPCS C1713","","115.418  -  SCREW BN 4MM 18MM PRTX CT PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.42","SUP","HCPCS C1713","","115.420  -  4.0MM PROTEX CT POLYAXIAL SCREW 20MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.422","SUP","HCPCS C1713","","115.422  -  4.0MM PROTEX CT POLYAXIAL SCREW 22MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.424","SUP","HCPCS C1713","","115.424  -  4.0MM PROTEX CT POLYAXIAL SCREW 24MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.426","SUP","HCPCS C1713","","115.426  -  4.0MM PROTEX CT POLYAXIAL SCREW 26MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.428","SUP","HCPCS C1713","","115.428  -  4.0MM PROTEX CT POLYAXIAL SCREW 28MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.43","SUP","HCPCS C1713","","115.430  -  4.0MM PROTEX CT POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.432","SUP","HCPCS C1713","","115.432  -  4.0MM PROTEX CT POLYAXIAL SCREW 32MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.434","SUP","HCPCS C1713","","115.434  -  4.0MM PROTEX CT POLYAXIAL SCREW 34MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.436","SUP","HCPCS C1713","","115.436  -  4.0MM PROTEX CT POLYAXIAL SCREW 36MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.438","SUP","HCPCS C1713","","115.438  -  4.0MM PROTEX CT POLYAXIAL SCREW 38MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.44","SUP","HCPCS C1713","","115.440  -  4.0MM PROTEX CT POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.442","SUP","HCPCS C1713","","115.442  -  4.0MM PROTEX CT POLYAXIAL SCREW 42MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.444","SUP","HCPCS C1713","","115.444  -  4.0MM PROTEX CT POLYAXIAL SCREW 44MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.446","SUP","HCPCS C1713","","115.446  -  4.0MM PROTEX CT POLYAXIAL SCREW 46MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.448","SUP","HCPCS C1713","","115.448  -  4.0MM PROTEX CT POLYAXIAL SCREW 48MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.45","SUP","HCPCS C1713","","115.450  -  4.0MM PROTEX CT POLYAXIAL SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.5","SUP","Custom 27803010","","115.500  -  CAP LCK PRTX CTTI STD OCT SPN POLYAX","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.501","SUP","Custom 27803010","","115.501  -  PROTEX CT HOOK","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.503","SUP","Custom 27803010","","115.503  -  PROTEX CT HOOK, RIGHT","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.504","SUP","Custom 27803010","","115.504  -  PROTEX CT HOOK, LEFT","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.506","SUP","Custom 27803010","","115.506  -  PROTEX CT HOOK, 7MM OFFSET, LEFT","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.507","SUP","Custom 27803010","","115.507  -  PROTEX CT HOOK, 5MM OFFSET, LEFT","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.508","SUP","Custom 27803010","","115.508  -  PROTEX CT HOOK, 7MM OFFSET, RIGHT","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.509","SUP","Custom 27803010","","115.509  -  PROTEX CT HOOK, 5MM OFFSET, RIGHT","BOTH IP/OP","$955.00 ","$706.70 ","$0.00 ","$955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.00 ","$0.00 ","$477.50 ","$756.36 ","$764.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.51","SUP","HCPCS C1713","","115.510  -  4.5MM PROTEX CT POLYAXIAL SCREW 10MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.512","SUP","HCPCS C1713","","115.512  -  4.5MM PROTEX CT POLYAXIAL SCREW 12MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.514","SUP","HCPCS C1713","","115.514  -  4.5MM PROTEX CT POLYAXIAL SCREW 14MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.516","SUP","HCPCS C1713","","115.516  -  4.5MM PROTEX CT POLYAXIAL SCREW 16MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.518","SUP","HCPCS C1713","","115.518  -  4.5MM PROTEX CT POLYAXIAL SCREW 18MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.52","SUP","HCPCS C1713","","115.520  -  SCREW BONE 4.5MM 20MM PRTX CTTI OCT SPN SLFTAP","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.522","SUP","HCPCS C1713","","115.522  -  4.5MM PROTEX CT POLYAXIAL SCREW 22MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.524","SUP","HCPCS C1713","","115.524  -  SCREW BONE 4.5MM 24MM PRTX CTTI OCT SPN POLYAX","BOTH IP/OP","$3,365.00 ","$2,490.10 ","$0.00 ","$3,365.00 ","$1,514.25 ","$0.00 ","$701.35 ","$0.00 ","$0.00 ","$589.18 ","$3,365.00 ","$0.00 ","$1,682.50 ","$2,665.08 ","$2,692.00 ","$0.00 ","$526.62 ","$0.00 ","$535.71 ","$0.00 "
"115.526","SUP","HCPCS C1713","","115.526  -  SCREW BONE 4.5MM 26MM PRTX CT OCT SPN SLFTAP LP POLYAX","BOTH IP/OP","$3,365.00 ","$2,490.10 ","$0.00 ","$3,365.00 ","$1,514.25 ","$0.00 ","$701.35 ","$0.00 ","$0.00 ","$589.18 ","$3,365.00 ","$0.00 ","$1,682.50 ","$2,665.08 ","$2,692.00 ","$0.00 ","$526.62 ","$0.00 ","$535.71 ","$0.00 "
"115.528","SUP","HCPCS C1713","","115.528  -  4.5MM PROTEX CT POLYAXIAL SCREW 28MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.53","SUP","HCPCS C1713","","115.530  -  4.5MM PROTEX CT POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.532","SUP","HCPCS C1713","","115.532  -  4.5MM PROTEX CT POLYAXIAL SCREW 32MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.534","SUP","HCPCS C1713","","115.534  -  4.5MM PROTEX CT POLYAXIAL SCREW 34MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.536","SUP","HCPCS C1713","","115.536  -  4.5MM PROTEX CT POLYAXIAL SCREW 36MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.538","SUP","HCPCS C1713","","115.538  -  4.5MM PROTEX CT POLYAXIAL SCREW 38MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.54","SUP","HCPCS C1713","","115.540  -  4.5MM PROTEX CT POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.542","SUP","HCPCS C1713","","115.542  -  4.5MM PROTEX CT POLYAXIAL SCREW 42MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.544","SUP","HCPCS C1713","","115.544  -  4.5MM PROTEX CT POLYAXIAL SCREW 44MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.546","SUP","HCPCS C1713","","115.546  -  4.5MM PROTEX CT POLYAXIAL SCREW 46MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.548","SUP","HCPCS C1713","","115.548  -  4.5MM PROTEX CT POLYAXIAL SCREW 48MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.55","SUP","HCPCS C1713","","115.550  -  4.5MM PROTEX CT POLYAXIAL SCREW 50MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"115.701","SUP","Custom 27803010","","115.701  -  ROD SPNL 80MM CONNCTNG GLOBUS","BOTH IP/OP","$777.50 ","$575.35 ","$0.00 ","$777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$777.50 ","$0.00 ","$388.75 ","$615.78 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.702","SUP","Custom 27803010","","115.702  -  3.2MM STRAIGHT TI ROD, 120MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.703","SUP","Custom 27803010","","115.703  -  ROD SPNL STRG 3.2MM 240MM NS PRTX CTTI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.704","SUP","Custom 27803010","","115.704  -  3.2MM STRAIGHT TI ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.801","SUP","Custom 27803010","","115.801  -  ROD SPNL 80MM 3.7MM PRTX CTTI STR","BOTH IP/OP","$777.50 ","$575.35 ","$0.00 ","$777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$777.50 ","$0.00 ","$388.75 ","$615.78 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.802","SUP","Custom 27803010","","115.802  -  ROD SPNL 120MM 3.7MM PRTX CTTI STR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.803","SUP","Custom 27803010","","115.803  -  3.7MM STRAIGHT ROD, 240MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.804","SUP","Custom 27803010","","115.804  -  3.7MM STRAIGHT ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.911","SUP","Custom 27803010","","115.911  -  CONCTR ROD 20-41MM 3.7MM PRTX CTTI TRNSVRS ADJ OCT SPN","BOTH IP/OP","$3,482.50 ","$2,577.05 ","$0.00 ","$3,482.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,482.50 ","$0.00 ","$1,741.25 ","$2,758.14 ","$2,786.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.912","SUP","Custom 27803010","","115.912  -  ADJUSTABLE T-CONNECTOR FOR 3.7MM ROD, 41-56MM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.918","SUP","Custom 27803010","","115.918  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 21-33MM, STRAIGHT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.919","SUP","Custom 27803010","","115.919  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 26-46MM, CURVED","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.92","SUP","Custom 27803010","","115.920  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 26-46MM, STRAIGHT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.921","SUP","Custom 27803010","","115.921  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 36-56MM, CURVED","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.922","SUP","Custom 27803010","","115.922  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 36-56, STRAIGHT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.923","SUP","Custom 27803010","","115.923  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 21-33MM, STRAIGHT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.924","SUP","Custom 27803010","","115.924  -  CONCTR ROD 26-46MM CVD TOP LD T 3.7MM","BOTH IP/OP","$3,915.00 ","$2,897.10 ","$0.00 ","$3,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,915.00 ","$0.00 ","$1,957.50 ","$3,100.68 ","$3,132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.925","SUP","Custom 27803010","","115.925  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 26-46MM, STRAIGHT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.926","SUP","Custom 27803010","","115.926  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56MM, CURVED","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.927","SUP","Custom 27803010","","115.927  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56, STRAIGHT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.93","SUP","Custom 27803010","","115.930  -  CLAMP FOR T-CONNECTOR, LEFT","BOTH IP/OP","$1,832.50 ","$1,356.05 ","$0.00 ","$1,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,832.50 ","$0.00 ","$916.25 ","$1,451.34 ","$1,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.931","SUP","Custom 27803010","","115.931  -  CLAMP FOR T-CONNECTOR, RIGHT","BOTH IP/OP","$1,832.50 ","$1,356.05 ","$0.00 ","$1,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,832.50 ","$0.00 ","$916.25 ","$1,451.34 ","$1,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.949","SUP","Custom 27803010","","115.949  -  SET SCREW, M4.5X0.75, ROUND TIP, 2.5MM HEX","BOTH IP/OP","$192.50 ","$142.45 ","$0.00 ","$192.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.95","SUP","Custom 27803010","","115.950  -  OCCIPITAL CLAMP, SINGLE, SHORT","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.951","SUP","Custom 27803010","","115.951  -  OCCIPITAL CLAMP, SINGLE, LONG","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.952","SUP","HCPCS C1713","","115.952  -  SET SCREW, M4.5 X 0.75","BOTH IP/OP","$192.50 ","$142.45 ","$0.00 ","$192.50 ","$86.63 ","$0.00 ","$40.12 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"115.953","SUP","Custom 27803010","","115.953  -  3.7MM OCCIPITAL ROD, 240MM, 100 DEG","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.954","SUP","Custom 27803010","","115.954  -  3.7MM OCCIPITAL ROD, 240MM, 115 DEG","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.955","SUP","Custom 27803010","","115.955  -  ROD SPNL 240MM 3.7MM PRTX CTTI 130 OCCPTL","BOTH IP/OP","$1,547.50 ","$1,145.15 ","$0.00 ","$1,547.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,547.50 ","$0.00 ","$773.75 ","$1,225.62 ","$1,238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.956","SUP","Custom 27803010","","115.956  -  OCCIPITAL CLAMP, TRIPLE, SHORT","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.957","SUP","Custom 27803010","","115.957  -  OCCIPITAL CLAMP, TRIPLE, LONG","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.958","SUP","Custom 27803010","","115.958  -  OCCIPITAL CLAMP, DOUBLE, SHORT","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.959","SUP","Custom 27803010","","115.959  -  CLAMP SPNL LNG OCCPTL DBL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.96","SUP","Custom 27803010","","115.960  -  PARALLEL CONNECTOR, 3.7MM ROD TO 3.7MM ROD","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.961","SUP","Custom 27803010","","115.961  -  PARALLEL CONNECTOR, 3.7MM ROD TO 4.5MM ROD","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.962","SUP","Custom 27803010","","115.962  -  PARALLEL CONNECTOR, 3.7MM ROD TO 5.0MM ROD","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.963","SUP","Custom 27803010","","115.963  -  PARALLEL CONNECTOR, 3.7MM ROD TO 5.5MM ROD","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.964","SUP","Custom 27803010","","115.964  -  PARALLEL CONNECTOR, 3.7MM ROD TO 6.0MM ROD","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.965","SUP","Custom 27803010","","115.965  -  PARALLEL CONNECTOR, 3.7MM ROD TO 6.5MM ROD","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.966","SUP","Custom 27803010","","115.966  -  PARALLEL CONNECTOR, 3.7MM ROD TO 4.0MM ROD","BOTH IP/OP","$1,717.50 ","$1,270.95 ","$0.00 ","$1,717.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,717.50 ","$0.00 ","$858.75 ","$1,360.26 ","$1,374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.979","SUP","Custom 27803010","","115.979  -  TAPERED ROD, 3.2MM TO 3.7MM, 240MM","BOTH IP/OP","$1,620.00 ","$1,198.80 ","$0.00 ","$1,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,620.00 ","$0.00 ","$810.00 ","$1,283.04 ","$1,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.981","SUP","Custom 27803010","","115.981  -  TAPERED ROD, 3.7MM TO 6.5MM, 350MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.983","SUP","Custom 27803010","","115.983  -  TAPERED ROD, 3.7MM TO 6.0MM, 350MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.984","SUP","Custom 27803010","","115.984  -  TAPERED ROD, 3.7MM TO 5.5MM, 350MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.985","SUP","Custom 27803010","","115.985  -  TAPERED ROD, 3.7MM TO 5.0MM, 350MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.986","SUP","Custom 27803010","","115.986  -  TAPERED ROD, 3.7MM TO 4.5MM, 350MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.987","SUP","Custom 27803010","","115.987  -  TAPERED ROD, 3.7MM TO 4.0MM, 350MM","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.988","SUP","Custom 27803010","","115.988  -  TAPERED ROD, 3.2MM TO 5.5MM, 350MM","BOTH IP/OP","$1,620.00 ","$1,198.80 ","$0.00 ","$1,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,620.00 ","$0.00 ","$810.00 ","$1,283.04 ","$1,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.989","SUP","Custom 27803010","","115.989  -  TAPERED ROD, 3.7MM TO 5.5MM, 500MM","BOTH IP/OP","$1,060.00 ","$784.40 ","$0.00 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.00 ","$0.00 ","$530.00 ","$839.52 ","$848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.99","SUP","Custom 27803010","","115.990  -  LATERAL CONNECTOR","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"115.991","SUP","Custom 27803010","","115.991  -  LATERAL CONNECTOR, SHORT","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.001","SUP","Custom 27203010","","116.001  -  SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.002","SUP","Custom 27203010","","116.002  -  SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.003","SUP","Custom 27203010","","116.003  -  SPACER SPNL 0D 25MM LG 32X44MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.004","SUP","Custom 27203010","","116.004  -  SPACER SPNL 8D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.005","SUP","Custom 27203010","","116.005  -  SPACER SPNL 8D 25MM LG 32X40MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.006","SUP","Custom 27203010","","116.006  -  SPACER SPNL 8D 25MM LG 32X60MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.007","SUP","Custom 27203010","","116.007  -  SPACER SPNL 16D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.008","SUP","Custom 27203010","","116.008  -  SPACER SPNL 16D 25MM LG 32X57MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.009","SUP","Custom 27203010","","116.009  -  SPACER SPNL -8D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.01","SUP","Custom 27203010","","116.010  -  SPACER SPNL 8D 25MM LG 32X61MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.011","SUP","Custom 27203010","","116.011  -  SPACER SPNL 16D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.012","SUP","Custom 27203010","","116.012  -  SPACER SPNL 16D 25MM LG 32X58MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.013","SUP","Custom 27203010","","116.013  -  SPACER SPNL 16D 25MM LG 32X73MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.014","SUP","Custom 27203010","","116.014  -  SPACER SPNL 0D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.015","SUP","Custom 27203010","","116.015  -  SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.016","SUP","Custom 27203010","","116.016  -  SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.017","SUP","Custom 27803010","","116.017  -  SPACER SPNL 0D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.018","SUP","Custom 27203010","","116.018  -  SPACER SPNL 8D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.019","SUP","Custom 27203010","","116.019  -  SPACER SPNL 0D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.02","SUP","Custom 27203010","","116.020  -  SPACER SPNL 8D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.021","SUP","Custom 27203010","","116.021  -  SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.022","SUP","Custom 27203010","","116.022  -  SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.023","SUP","Custom 27203010","","116.023  -  SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.024","SUP","Custom 27203010","","116.024  -  SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,607.50 ","$13,769.55 ","$0.00 ","$18,607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,607.50 ","$0.00 ","$9,303.75 ","$14,737.14 ","$14,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.101","SUP","Custom 27203010","","116.101  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.102","SUP","Custom 27203010","","116.102  -  SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.103","SUP","Custom 27203010","","116.103  -  SPACER SPNL 0D 12MM SM 14X23MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.104","SUP","Custom 27203010","","116.104  -  SPACER SPNL 0D 12MM SM 14X32MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.105","SUP","Custom 27203010","","116.105  -  SPACER SPNL 0D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.106","SUP","Custom 27203010","","116.106  -  SPACER SPNL 0D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.107","SUP","Custom 27203010","","116.107  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.108","SUP","Custom 27203010","","116.108  -  SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.109","SUP","Custom 27203010","","116.109  -  SPACER SPNL 7D 12MM SM 14X26MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.11","SUP","Custom 27203010","","116.110  -  SPACER SPNL 7D 12MM SM 14X28MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.111","SUP","Custom 27203010","","116.111  -  SPACER SPNL 7D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.112","SUP","Custom 27203010","","116.112  -  SPACER SPNL 7D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.113","SUP","Custom 27203010","","116.113  -  SPACER SPNL 16D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.114","SUP","Custom 27203010","","116.114  -  SPACER SPNL 0D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.115","SUP","Custom 27203010","","116.115  -  SPACER SPNL 7D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.116","SUP","Custom 27203010","","116.116  -  SPACER SPNL 16D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.117","SUP","Custom 27203010","","116.117  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.118","SUP","Custom 27203010","","116.118  -  SPACER SPNL 7D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.119","SUP","Custom 27203010","","116.119  -  SPACER SPNL 0D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.12","SUP","Custom 27203010","","116.120  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.121","SUP","Custom 27203010","","116.121  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.122","SUP","Custom 27203010","","116.122  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.123","SUP","Custom 27203010","","116.123  -  SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.124","SUP","Custom 27203010","","116.124  -  SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.125","SUP","Custom 27203010","","116.125  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.126","SUP","Custom 27203010","","116.126  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$14,315.00 ","$10,593.10 ","$0.00 ","$14,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,315.00 ","$0.00 ","$7,157.50 ","$11,337.48 ","$11,452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.201","SUP","Custom 27203010","","116.201  -  SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.202","SUP","Custom 27203010","","116.202  -  SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.203","SUP","Custom 27203010","","116.203  -  SPACER SPNL -6D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$17,655.00 ","$13,064.70 ","$0.00 ","$17,655.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,655.00 ","$0.00 ","$8,827.50 ","$13,982.76 ","$14,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.204","SUP","Custom 27203010","","116.204  -  SPACER SPNL -6D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$20,040.00 ","$14,829.60 ","$0.00 ","$20,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,040.00 ","$0.00 ","$10,020.00 ","$15,871.68 ","$16,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.205","SUP","Custom 27203010","","116.205  -  SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.206","SUP","Custom 27203010","","116.206  -  SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.207","SUP","Custom 27203010","","116.207  -  SPACER SPNL 0D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$17,655.00 ","$13,064.70 ","$0.00 ","$17,655.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,655.00 ","$0.00 ","$8,827.50 ","$13,982.76 ","$14,124.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.208","SUP","Custom 27203010","","116.208  -  SPACER SPNL 0D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$20,040.00 ","$14,829.60 ","$0.00 ","$20,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,040.00 ","$0.00 ","$10,020.00 ","$15,871.68 ","$16,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.209","SUP","Custom 27203010","","116.209  -  SPACER SPNL 0D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.21","SUP","Custom 27203010","","116.210  -  SPACER SPNL -6D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.211","SUP","Custom 27203010","","116.211  -  SPACER SPNL 0D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.212","SUP","Custom 27203010","","116.212  -  SPACER SPNL -6D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.213","SUP","Custom 27203010","","116.213  -  SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.214","SUP","Custom 27203010","","116.214  -  SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.215","SUP","Custom 27203010","","116.215  -  SPACER SPNL 8D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.216","SUP","Custom 27203010","","116.216  -  SPACER SPNL 8D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.217","SUP","Custom 27203010","","116.217  -  SPACER SPNL 8D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.218","SUP","Custom 27203010","","116.218  -  SPACER SPNL 8D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.219","SUP","Custom 27203010","","116.219  -  SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.22","SUP","Custom 27203010","","116.220  -  SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.221","SUP","Custom 27203010","","116.221  -  SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.222","SUP","Custom 27203010","","116.222  -  SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.223","SUP","Custom 27203010","","116.223  -  SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.224","SUP","Custom 27203010","","116.224  -  SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH","BOTH IP/OP","$16,222.50 ","$12,004.65 ","$0.00 ","$16,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,222.50 ","$0.00 ","$8,111.25 ","$12,848.22 ","$12,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.301","SUP","Custom 27203010","","116.301  -  SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$15,267.50 ","$11,297.95 ","$0.00 ","$15,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,267.50 ","$0.00 ","$7,633.75 ","$12,091.86 ","$12,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.302","SUP","Custom 27203010","","116.302  -  SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$15,267.50 ","$11,297.95 ","$0.00 ","$15,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,267.50 ","$0.00 ","$7,633.75 ","$12,091.86 ","$12,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.303","SUP","Custom 27203010","","116.303  -  SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$15,267.50 ","$11,297.95 ","$0.00 ","$15,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,267.50 ","$0.00 ","$7,633.75 ","$12,091.86 ","$12,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.304","SUP","Custom 27203010","","116.304  -  SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$15,267.50 ","$11,297.95 ","$0.00 ","$15,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,267.50 ","$0.00 ","$7,633.75 ","$12,091.86 ","$12,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.305","SUP","Custom 27203010","","116.305  -  SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$15,267.50 ","$11,297.95 ","$0.00 ","$15,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,267.50 ","$0.00 ","$7,633.75 ","$12,091.86 ","$12,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.306","SUP","Custom 27203010","","116.306  -  SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$15,267.50 ","$11,297.95 ","$0.00 ","$15,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,267.50 ","$0.00 ","$7,633.75 ","$12,091.86 ","$12,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.401","SUP","Custom 27203010","","116.401  -  SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$17,412.50 ","$12,885.25 ","$0.00 ","$17,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,412.50 ","$0.00 ","$8,706.25 ","$13,790.70 ","$13,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.402","SUP","Custom 27203010","","116.402  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$17,412.50 ","$12,885.25 ","$0.00 ","$17,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,412.50 ","$0.00 ","$8,706.25 ","$13,790.70 ","$13,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.403","SUP","Custom 27203010","","116.403  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$18,130.00 ","$13,416.20 ","$0.00 ","$18,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,130.00 ","$0.00 ","$9,065.00 ","$14,358.96 ","$14,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.404","SUP","Custom 27203010","","116.404  -  SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$20,277.50 ","$15,005.35 ","$0.00 ","$20,277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,277.50 ","$0.00 ","$10,138.75 ","$16,059.78 ","$16,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.405","SUP","Custom 27203010","","116.405  -  SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$20,992.50 ","$15,534.45 ","$0.00 ","$20,992.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,992.50 ","$0.00 ","$10,496.25 ","$16,626.06 ","$16,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.406","SUP","Custom 27203010","","116.406  -  SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$17,417.50 ","$12,888.95 ","$0.00 ","$17,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,417.50 ","$0.00 ","$8,708.75 ","$13,794.66 ","$13,934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.407","SUP","Custom 27203010","","116.407  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$17,417.50 ","$12,888.95 ","$0.00 ","$17,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,417.50 ","$0.00 ","$8,708.75 ","$13,794.66 ","$13,934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.408","SUP","Custom 27203010","","116.408  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$18,130.00 ","$13,416.20 ","$0.00 ","$18,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,130.00 ","$0.00 ","$9,065.00 ","$14,358.96 ","$14,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.409","SUP","Custom 27203010","","116.409  -  SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$20,277.50 ","$15,005.35 ","$0.00 ","$20,277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,277.50 ","$0.00 ","$10,138.75 ","$16,059.78 ","$16,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.41","SUP","Custom 27203010","","116.410  -  SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$20,992.50 ","$15,534.45 ","$0.00 ","$20,992.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,992.50 ","$0.00 ","$10,496.25 ","$16,626.06 ","$16,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.411","SUP","Custom 27203010","","116.411  -  SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$19,202.50 ","$14,209.85 ","$0.00 ","$19,202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,202.50 ","$0.00 ","$9,601.25 ","$15,208.38 ","$15,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.412","SUP","Custom 27203010","","116.412  -  SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$19,202.50 ","$14,209.85 ","$0.00 ","$19,202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,202.50 ","$0.00 ","$9,601.25 ","$15,208.38 ","$15,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.413","SUP","Custom 27203010","","116.413  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$17,417.50 ","$12,888.95 ","$0.00 ","$17,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,417.50 ","$0.00 ","$8,708.75 ","$13,794.66 ","$13,934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.414","SUP","Custom 27203010","","116.414  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$17,417.50 ","$12,888.95 ","$0.00 ","$17,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,417.50 ","$0.00 ","$8,708.75 ","$13,794.66 ","$13,934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.415","SUP","Custom 27203010","","116.415  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$18,130.00 ","$13,416.20 ","$0.00 ","$18,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,130.00 ","$0.00 ","$9,065.00 ","$14,358.96 ","$14,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"116.416","SUP","Custom 27203010","","116.416  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT","BOTH IP/OP","$18,130.00 ","$13,416.20 ","$0.00 ","$18,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,130.00 ","$0.00 ","$9,065.00 ","$14,358.96 ","$14,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"117.112","SUP","HCPCS C1713","","117.112  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 12MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.114","SUP","HCPCS C1713","","117.114  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.116","SUP","HCPCS C1713","","117.116  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.118","SUP","HCPCS C1713","","117.118  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.12","SUP","HCPCS C1713","","117.120  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.122","SUP","HCPCS C1713","","117.122  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.124","SUP","HCPCS C1713","","117.124  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 24MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.126","SUP","HCPCS C1713","","117.126  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"117.226","SUP","HCPCS C1713","","117.226  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 26MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.228","SUP","HCPCS C1713","","117.228  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 28MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.23","SUP","HCPCS C1713","","117.230  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.232","SUP","HCPCS C1713","","117.232  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 32MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.234","SUP","HCPCS C1713","","117.234  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 34MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.236","SUP","HCPCS C1713","","117.236  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 36MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.238","SUP","HCPCS C1713","","117.238  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 38MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.24","SUP","HCPCS C1713","","117.240  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.242","SUP","HCPCS C1713","","117.242  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 42MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.244","SUP","HCPCS C1713","","117.244  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 44MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.246","SUP","HCPCS C1713","","117.246  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 46MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"117.345","SUP","HCPCS C1713","","117.345  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 45MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.348","SUP","HCPCS C1713","","117.348  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 48MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.351","SUP","HCPCS C1713","","117.351  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 51MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.354","SUP","HCPCS C1713","","117.354  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 54MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.357","SUP","HCPCS C1713","","117.357  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 57MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.36","SUP","HCPCS C1713","","117.360  -  PLATE BN 60MM NS ASR LVL 3 TRANSLATIONAL SPNE CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.363","SUP","HCPCS C1713","","117.363  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 63MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.366","SUP","HCPCS C1713","","117.366  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 66MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.369","SUP","HCPCS C1713","","117.369  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 69MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"117.46","SUP","HCPCS C1713","","117.460  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 60MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.464","SUP","HCPCS C1713","","117.464  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 64MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.468","SUP","HCPCS C1713","","117.468  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 68MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.472","SUP","HCPCS C1713","","117.472  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 72MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.476","SUP","HCPCS C1713","","117.476  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 76MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.48","SUP","HCPCS C1713","","117.480  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 80MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.484","SUP","HCPCS C1713","","117.484  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 84MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.488","SUP","HCPCS C1713","","117.488  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 88MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.492","SUP","HCPCS C1713","","117.492  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 92MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.496","SUP","HCPCS C1713","","117.496  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 96MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"117.5","SUP","HCPCS C1713","","117.500  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 100MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"124","SUP","HCPCS C1713","","124.000  -  LOCKING CAPS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"124.001","SUP","Custom 27803010","","124.001  -  5.5MM STRAIGHT ROD, CP, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.002","SUP","Custom 27803010","","124.002  -  5.5MM STRAIGHT ROD, CP, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.003","SUP","Custom 27803010","","124.003  -  5.5MM STRAIGHT ROD, CP, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.004","SUP","Custom 27803010","","124.004  -  5.5MM STRAIGHT ROD, CP2, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.005","SUP","Custom 27803010","","124.005  -  5.5MM STRAIGHT ROD, CP2, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.006","SUP","Custom 27803010","","124.006  -  5.5MM STRAIGHT ROD, CP2, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.012","SUP","Custom 27803010","","124.012  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 24MM-25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.013","SUP","Custom 27803010","","124.013  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 26MM-28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.014","SUP","Custom 27803010","","124.014  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 29MM-34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.051","SUP","HCPCS C1713","","124.051  -  5.0MM REVERE PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.052","SUP","HCPCS C1713","","124.052  -  5.0MM REVERE PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.053","SUP","HCPCS C1713","","124.053  -  5.0MM REVERE PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.054","SUP","HCPCS C1713","","124.054  -  5.0MM REVERE PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.055","SUP","HCPCS C1713","","124.055  -  5.0MM REVERE PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.056","SUP","HCPCS C1713","","124.056  -  5.0MM REVERE PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.057","SUP","HCPCS C1713","","124.057  -  5.0MM REVERE PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.071","SUP","HCPCS C1713","","124.071  -  7.5MM REVERE PEDICLE SCREW 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.072","SUP","HCPCS C1713","","124.072  -  7.5MM REVERE PEDICLE SCREW 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.073","SUP","HCPCS C1713","","124.073  -  7.5MM REVERE PEDICLE SCREW 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.074","SUP","HCPCS C1713","","124.074  -  7.5MM REVERE PEDICLE SCREW 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.075","SUP","HCPCS C1713","","124.075  -  7.5MM REVERE PEDICLE SCREW 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.081","SUP","HCPCS C1713","","124.081  -  8.5MM REVERE PEDICLE SCREW 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.082","SUP","HCPCS C1713","","124.082  -  8.5MM REVERE PEDICLE SCREW 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.083","SUP","HCPCS C1713","","124.083  -  8.5MM REVERE PEDICLE SCREW 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.084","SUP","HCPCS C1713","","124.084  -  8.5MM REVERE PEDICLE SCREW 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.085","SUP","HCPCS C1713","","124.085  -  8.5MM REVERE PEDICLE SCREW 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.111","SUP","HCPCS C1713","","124.111  -  5.5MM REVERE MONOAXIAL SCREW, 27MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.112","SUP","HCPCS C1713","","124.112  -  5.5MM REVERE MONOAXIAL SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.113","SUP","HCPCS C1713","","124.113  -  5.5MM REVERE MONOAXIAL SCREW, 37MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.114","SUP","HCPCS C1713","","124.114  -  5.5MM REVERE MONOAXIAL SCREW, 42MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.115","SUP","HCPCS C1713","","124.115  -  5.5MM REVERE MONOAXIAL SCREW, 47MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.121","SUP","HCPCS C1713","","124.121  -  6.5MM REVERE MONOAXIAL SCREW, 27MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.122","SUP","HCPCS C1713","","124.122  -  6.5MM REVERE MONOAXIAL SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.123","SUP","HCPCS C1713","","124.123  -  6.5MM REVERE MONOAXIAL SCREW, 37MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.124","SUP","HCPCS C1713","","124.124  -  6.5MM REVERE MONOAXIAL SCREW, 42MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.125","SUP","HCPCS C1713","","124.125  -  6.5MM REVERE MONOAXIAL SCREW, 47MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.131","SUP","HCPCS C1713","","124.131  -  7.5MM REVERE MONOAXIAL SCREW, 27MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.132","SUP","HCPCS C1713","","124.132  -  7.5MM REVERE MONOAXIAL SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.133","SUP","HCPCS C1713","","124.133  -  7.5MM REVERE MONOAXIAL SCREW, 37MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.134","SUP","HCPCS C1713","","124.134  -  7.5MM REVERE MONOAXIAL SCREW, 42MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.135","SUP","HCPCS C1713","","124.135  -  7.5MM REVERE MONOAXIAL SCREW, 47MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.171","SUP","HCPCS C1713","","124.171  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.172","SUP","HCPCS C1713","","124.172  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.173","SUP","HCPCS C1713","","124.173  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.174","SUP","HCPCS C1713","","124.174  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.175","SUP","HCPCS C1713","","124.175  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 95MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.176","SUP","HCPCS C1713","","124.176  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 100MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.181","SUP","HCPCS C1713","","124.181  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.182","SUP","HCPCS C1713","","124.182  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.183","SUP","HCPCS C1713","","124.183  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.184","SUP","HCPCS C1713","","124.184  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.185","SUP","HCPCS C1713","","124.185  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 95MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.186","SUP","HCPCS C1713","","124.186  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 100MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.2","SUP","HCPCS C1713","","124.200  -  4.0MM REVERE MONOAXIAL SCREW 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.201","SUP","HCPCS C1713","","124.201  -  4.0MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.202","SUP","HCPCS C1713","","124.202  -  4.0MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.203","SUP","HCPCS C1713","","124.203  -  4.0MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.204","SUP","HCPCS C1713","","124.204  -  4.0MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.241","SUP","HCPCS C1713","","124.241  -  4.5MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.242","SUP","HCPCS C1713","","124.242  -  4.5MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.243","SUP","HCPCS C1713","","124.243  -  4.5MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.244","SUP","HCPCS C1713","","124.244  -  4.5MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.245","SUP","HCPCS C1713","","124.245  -  4.5MM REVERE MONOAXIAL SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.251","SUP","HCPCS C1713","","124.251  -  5.5MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.252","SUP","HCPCS C1713","","124.252  -  5.5MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.253","SUP","HCPCS C1713","","124.253  -  5.5MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.254","SUP","HCPCS C1713","","124.254  -  5.5MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.255","SUP","HCPCS C1713","","124.255  -  5.5MM REVERE MONOAXIAL SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.256","SUP","HCPCS C1713","","124.256  -  5.5MM REVERE MONOAXIAL SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.257","SUP","HCPCS C1713","","124.257  -  5.5MM REVERE MONOAXIAL SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.258","SUP","HCPCS C1713","","124.258  -  5.5MM REVERE MONOAXIAL SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.259","SUP","HCPCS C1713","","124.259  -  5.5MM REVERE MONOAXIAL SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.261","SUP","HCPCS C1713","","124.261  -  6.5MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.262","SUP","HCPCS C1713","","124.262  -  6.5MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.263","SUP","HCPCS C1713","","124.263  -  6.5MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.264","SUP","HCPCS C1713","","124.264  -  6.5MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.265","SUP","HCPCS C1713","","124.265  -  6.5MM REVERE MONOAXIAL SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.266","SUP","HCPCS C1713","","124.266  -  6.5MM REVERE MONOAXIAL SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.267","SUP","HCPCS C1713","","124.267  -  6.5MM REVERE MONOAXIAL SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.268","SUP","HCPCS C1713","","124.268  -  6.5MM REVERE MONOAXIAL SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.269","SUP","HCPCS C1713","","124.269  -  6.5MM REVERE MONOAXIAL SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.271","SUP","HCPCS C1713","","124.271  -  7.5MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.272","SUP","HCPCS C1713","","124.272  -  7.5MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.273","SUP","HCPCS C1713","","124.273  -  7.5MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.274","SUP","HCPCS C1713","","124.274  -  7.5MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.275","SUP","HCPCS C1713","","124.275  -  7.5MM REVERE MONOAXIAL SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.276","SUP","HCPCS C1713","","124.276  -  7.5MM REVERE MONOAXIAL SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.277","SUP","HCPCS C1713","","124.277  -  7.5MM REVERE MONOAXIAL SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.278","SUP","HCPCS C1713","","124.278  -  7.5MM REVERE MONOAXIAL SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.279","SUP","HCPCS C1713","","124.279  -  7.5MM REVERE MONOAXIAL SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.281","SUP","HCPCS C1713","","124.281  -  8.5MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.282","SUP","HCPCS C1713","","124.282  -  8.5MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.283","SUP","HCPCS C1713","","124.283  -  8.5MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.284","SUP","HCPCS C1713","","124.284  -  8.5MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.285","SUP","HCPCS C1713","","124.285  -  8.5MM REVERE MONOAXIAL SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.286","SUP","HCPCS C1713","","124.286  -  8.5MM REVERE MONOAXIAL SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.287","SUP","HCPCS C1713","","124.287  -  8.5MM REVERE MONOAXIAL SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.288","SUP","HCPCS C1713","","124.288  -  8.5MM REVERE MONOAXIAL SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.289","SUP","HCPCS C1713","","124.289  -  8.5MM REVERE MONOAXIAL SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.351","SUP","HCPCS C1713","","124.351  -  5.5MM REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.352","SUP","HCPCS C1713","","124.352  -  5.5MM REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.353","SUP","HCPCS C1713","","124.353  -  5.5MM REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.354","SUP","HCPCS C1713","","124.354  -  5.5MM REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.355","SUP","HCPCS C1713","","124.355  -  5.5MM REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.356","SUP","HCPCS C1713","","124.356  -  5.5MM REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.357","SUP","HCPCS C1713","","124.357  -  5.5MM REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.361","SUP","HCPCS C1713","","124.361  -  6.5MM REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.362","SUP","HCPCS C1713","","124.362  -  6.5MM REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.363","SUP","HCPCS C1713","","124.363  -  6.5MM REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.364","SUP","HCPCS C1713","","124.364  -  6.5MM REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.365","SUP","HCPCS C1713","","124.365  -  6.5MM REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.366","SUP","HCPCS C1713","","124.366  -  6.5MM REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.367","SUP","HCPCS C1713","","124.367  -  6.5MM REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.368","SUP","HCPCS C1713","","124.368  -  6.5MM REVERE CANNULATED PEDICLE SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.369","SUP","HCPCS C1713","","124.369  -  6.5MM REVERE CANNULATED PEDICLE SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.371","SUP","HCPCS C1713","","124.371  -  7.5MM REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.372","SUP","HCPCS C1713","","124.372  -  7.5MM REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.373","SUP","HCPCS C1713","","124.373  -  7.5MM REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.374","SUP","HCPCS C1713","","124.374  -  7.5MM REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.375","SUP","HCPCS C1713","","124.375  -  7.5MM REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.376","SUP","HCPCS C1713","","124.376  -  7.5MM REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.377","SUP","HCPCS C1713","","124.377  -  7.5MM REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.378","SUP","HCPCS C1713","","124.378  -  7.5MM REVERE CANNULATED PEDICLE SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.379","SUP","HCPCS C1713","","124.379  -  7.5MM REVERE CANNULATED PEDICLE SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.381","SUP","HCPCS C1713","","124.381  -  8.5MM REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.382","SUP","HCPCS C1713","","124.382  -  8.5MM REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.383","SUP","HCPCS C1713","","124.383  -  8.5MM REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.384","SUP","HCPCS C1713","","124.384  -  8.5MM REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.385","SUP","HCPCS C1713","","124.385  -  8.5MM REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.386","SUP","HCPCS C1713","","124.386  -  8.5MM REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.387","SUP","HCPCS C1713","","124.387  -  8.5MM REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.388","SUP","HCPCS C1713","","124.388  -  8.5MM REVERE CANNULATED PEDICLE SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.389","SUP","HCPCS C1713","","124.389  -  8.5MM REVERE CANNULATED PEDICLE SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.441","SUP","HCPCS C1713","","124.441  -  4.5MM REVERE PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.442","SUP","HCPCS C1713","","124.442  -  SCREW BONE 4.5MM 30MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.443","SUP","HCPCS C1713","","124.443  -  SCREW BONE 4.5MM 35MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.444","SUP","HCPCS C1713","","124.444  -  SCREW BONE 4.5MM 40MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.445","SUP","HCPCS C1713","","124.445  -  4.5MM REVERE PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.451","SUP","HCPCS C1713","","124.451  -  5.5MM REVERE PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.452","SUP","HCPCS C1713","","124.452  -  SCREW BONE 5.5MM 30MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.453","SUP","HCPCS C1713","","124.453  -  SCREW BONE 5.5MM 35MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.454","SUP","HCPCS C1713","","124.454  -  SCREW BONE 5.5MM 40MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.455","SUP","HCPCS C1713","","124.455  -  SCREW BONE 5.5MM 45MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.456","SUP","HCPCS C1713","","124.456  -  5.5MM REVERE PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.457","SUP","HCPCS C1713","","124.457  -  5.5MM REVERE PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.461","SUP","HCPCS C1713","","124.461  -  6.5MM REVERE PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.462","SUP","HCPCS C1713","","124.462  -  6.5MM REVERE PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.463","SUP","HCPCS C1713","","124.463  -  6.5MM REVERE PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.464","SUP","HCPCS C1713","","124.464  -  SCREW BONE 6.5MM 40MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.465","SUP","HCPCS C1713","","124.465  -  SCREW BONE 6.5MM 45MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.466","SUP","HCPCS C1713","","124.466  -  SCREW BONE 6.5MM 50MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.467","SUP","HCPCS C1713","","124.467  -  6.5MM REVERE PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.468","SUP","HCPCS C1713","","124.468  -  6.5MM REVERE PEDICLE SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.469","SUP","HCPCS C1713","","124.469  -  6.5MM REVERE PEDICLE SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.471","SUP","HCPCS C1713","","124.471  -  7.5MM REVERE PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.472","SUP","HCPCS C1713","","124.472  -  7.5MM REVERE PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.473","SUP","HCPCS C1713","","124.473  -  7.5MM REVERE PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.474","SUP","HCPCS C1713","","124.474  -  7.5MM REVERE PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.475","SUP","HCPCS C1713","","124.475  -  SCREW BONE 7.5MM 45MM REVERE TI PDCL SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.476","SUP","HCPCS C1713","","124.476  -  7.5MM REVERE PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.477","SUP","HCPCS C1713","","124.477  -  7.5MM REVERE PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.478","SUP","HCPCS C1713","","124.478  -  7.5MM REVERE PEDICLE SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.479","SUP","HCPCS C1713","","124.479  -  7.5MM REVERE PEDICLE SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.481","SUP","HCPCS C1713","","124.481  -  8.5MM REVERE PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.482","SUP","HCPCS C1713","","124.482  -  8.5MM REVERE PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.483","SUP","HCPCS C1713","","124.483  -  8.5MM REVERE PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.484","SUP","HCPCS C1713","","124.484  -  8.5MM REVERE PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.485","SUP","HCPCS C1713","","124.485  -  8.5MM REVERE PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.486","SUP","HCPCS C1713","","124.486  -  8.5MM REVERE PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.487","SUP","HCPCS C1713","","124.487  -  8.5MM REVERE PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.488","SUP","HCPCS C1713","","124.488  -  8.5MM REVERE PEDICLE SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.489","SUP","HCPCS C1713","","124.489  -  8.5MM REVERE PEDICLE SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.51","SUP","Custom 27803010","","124.510  -  5.5MM STRAIGHT ROD, 100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.512","SUP","Custom 27803010","","124.512  -  5.5MM STRAIGHT ROD, 125MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.515","SUP","Custom 27803010","","124.515  -  ROD SPNL 150MM 5.5MM REVERE PDCL TI STR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.517","SUP","Custom 27803010","","124.517  -  ROD SPNL 200MM 5.5MM REVERE PDCL TI STR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.519","SUP","Custom 27803010","","124.519  -  ROD SPNL 350MM 5.5MM REVERE PDCL TI STR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.52","SUP","Custom 27803010","","124.520  -  5.5MM STRAIGHT ROD, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.521","SUP","Custom 27803010","","124.521  -  5.5MM STRAIGHT ROD, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.53","SUP","Custom 27803010","","124.530  -  5.5MM STRAIGHT ROD, 30MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.535","SUP","Custom 27803010","","124.535  -  5.5MM STRAIGHT ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.54","SUP","Custom 27803010","","124.540  -  ROD SPNL 40MM 5.5MM REVERE TI STR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.545","SUP","Custom 27803010","","124.545  -  5.5MM STRAIGHT ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.55","SUP","Custom 27803010","","124.550  -  5.5MM STRAIGHT ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.555","SUP","Custom 27803010","","124.555  -  5.5MM STRAIGHT ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.56","SUP","Custom 27803010","","124.560  -  5.5MM STRAIGHT ROD, 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.565","SUP","Custom 27803010","","124.565  -  5.5MM STRAIGHT ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.57","SUP","Custom 27803010","","124.570  -  5.5MM STRAIGHT ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.575","SUP","Custom 27803010","","124.575  -  5.5MM STRAIGHT ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.58","SUP","Custom 27803010","","124.580  -  5.5MM STRAIGHT ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.585","SUP","Custom 27803010","","124.585  -  ROD SPNL 85MM 5.5MM REVERE PDCL TI STR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.61","SUP","Custom 27803010","","124.610  -  5.5MM CURVED ROD, 100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.612","SUP","Custom 27803010","","124.612  -  5.5MM CURVED ROD, 125MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.615","SUP","Custom 27803010","","124.615  -  5.5MM CURVED ROD, 150MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.635","SUP","Custom 27803010","","124.635  -  5.5MM CURVED ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.64","SUP","Custom 27803010","","124.640  -  ROD SPNL 40MM 5.5MM REVERE PDCL TI CVD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.645","SUP","Custom 27803010","","124.645  -  ROD SPNL 45MM 5.5MM REVERE PDCL TI CVD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.65","SUP","Custom 27803010","","124.650  -  5.5MM CURVED ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.655","SUP","Custom 27803010","","124.655  -  ROD SPNL 55MM 5.5MM REVERE PDCL TI CVD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.66","SUP","Custom 27803010","","124.660  -  5.5MM CURVED ROD, 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.665","SUP","Custom 27803010","","124.665  -  ROD SPNL 65MM 5.5MM REVERE PDCL TI CVD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.67","SUP","Custom 27803010","","124.670  -  5.5MM CURVED ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.675","SUP","Custom 27803010","","124.675  -  5.5MM CURVED ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.68","SUP","Custom 27803010","","124.680  -  5.5MM CURVED ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.685","SUP","Custom 27803010","","124.685  -  5.5MM CURVED ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.69","SUP","Custom 27803010","","124.690  -  5.5MM CURVED ROD, 90MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.695","SUP","Custom 27803010","","124.695  -  5.5MM CURVED ROD, 95MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.751","SUP","HCPCS C1713","","124.751  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.752","SUP","HCPCS C1713","","124.752  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.753","SUP","HCPCS C1713","","124.753  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.754","SUP","HCPCS C1713","","124.754  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.755","SUP","HCPCS C1713","","124.755  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.756","SUP","HCPCS C1713","","124.756  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.757","SUP","HCPCS C1713","","124.757  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.758","SUP","HCPCS C1713","","124.758  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.761","SUP","HCPCS C1713","","124.761  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.762","SUP","HCPCS C1713","","124.762  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.763","SUP","HCPCS C1713","","124.763  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.764","SUP","HCPCS C1713","","124.764  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.765","SUP","HCPCS C1713","","124.765  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.766","SUP","HCPCS C1713","","124.766  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.767","SUP","HCPCS C1713","","124.767  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.768","SUP","HCPCS C1713","","124.768  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.771","SUP","HCPCS C1713","","124.771  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.772","SUP","HCPCS C1713","","124.772  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.773","SUP","HCPCS C1713","","124.773  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.774","SUP","HCPCS C1713","","124.774  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.775","SUP","HCPCS C1713","","124.775  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.776","SUP","HCPCS C1713","","124.776  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.777","SUP","HCPCS C1713","","124.777  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.778","SUP","HCPCS C1713","","124.778  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.779","SUP","HCPCS C1713","","124.779  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.781","SUP","HCPCS C1713","","124.781  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.782","SUP","HCPCS C1713","","124.782  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.783","SUP","HCPCS C1713","","124.783  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.784","SUP","HCPCS C1713","","124.784  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.785","SUP","HCPCS C1713","","124.785  -  SCREW BN 7MM 50MM NS REVERE 2 DIA PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.786","SUP","HCPCS C1713","","124.786  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.787","SUP","HCPCS C1713","","124.787  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.788","SUP","HCPCS C1713","","124.788  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.789","SUP","HCPCS C1713","","124.789  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"124.851","SUP","HCPCS C1713","","124.851  -  5.0MM REVERE MONOAXIAL SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.852","SUP","HCPCS C1713","","124.852  -  5.0MM REVERE MONOAXIAL SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.853","SUP","HCPCS C1713","","124.853  -  5.0MM REVERE MONOAXIAL SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.854","SUP","HCPCS C1713","","124.854  -  5.0MM REVERE MONOAXIAL SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.855","SUP","HCPCS C1713","","124.855  -  5.0MM REVERE MONOAXIAL SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.856","SUP","HCPCS C1713","","124.856  -  5.0MM REVERE MONOAXIAL SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.857","SUP","HCPCS C1713","","124.857  -  5.0MM REVERE MONOAXIAL SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.871","SUP","HCPCS C1713","","124.871  -  7.5MM REVERE MONOAXIAL SCREW 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.872","SUP","HCPCS C1713","","124.872  -  7.5MM REVERE MONOAXIAL SCREW 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.873","SUP","HCPCS C1713","","124.873  -  7.5MM REVERE MONOAXIAL SCREW 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.874","SUP","HCPCS C1713","","124.874  -  7.5MM REVERE MONOAXIAL SCREW 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.875","SUP","HCPCS C1713","","124.875  -  7.5MM REVERE MONOAXIAL SCREW 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.881","SUP","HCPCS C1713","","124.881  -  8.5MM REVERE MONOAXIAL SCREW 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.882","SUP","HCPCS C1713","","124.882  -  8.5MM REVERE MONOAXIAL SCREW 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.883","SUP","HCPCS C1713","","124.883  -  8.5MM REVERE MONOAXIAL SCREW 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.884","SUP","HCPCS C1713","","124.884  -  8.5MM REVERE MONOAXIAL SCREW 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.885","SUP","HCPCS C1713","","124.885  -  8.5MM REVERE MONOAXIAL SCREW 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"124.891","SUP","Custom 27803010","","124.891  -  REVERE LOW PROFILE PEDICLE HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.892","SUP","Custom 27803010","","124.892  -  REVERE LOW PROFILE PEDICLE HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.893","SUP","Custom 27803010","","124.893  -  REVERE LOW PROFILE PEDICLE HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.901","SUP","Custom 27803010","","124.901  -  REVERE THORACIC LAMINA HOOK, NARROW, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.902","SUP","Custom 27803010","","124.902  -  REVERE THORACIC LAMINA HOOK, NARROW, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.904","SUP","Custom 27803010","","124.904  -  REVERE THORACIC LAMINA HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.905","SUP","Custom 27803010","","124.905  -  REVERE THORACIC LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.907","SUP","Custom 27803010","","124.907  -  REVERE UPGOING THORACIC LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.908","SUP","Custom 27803010","","124.908  -  REVERE UPGOING THORACIC LAMINA HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.912","SUP","Custom 27803010","","124.912  -  CONCTR ROD 29-33MM REVERE TRNSVRS ADJ TI PDCL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.913","SUP","Custom 27803010","","124.913  -  REVERE ADJUSTABLE T CONNECTOR, 33MM-41MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.914","SUP","Custom 27803010","","124.914  -  CONCTR ROD 38-51MM REVERE TRNSVRS ADJ TI PDCL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.915","SUP","Custom 27803010","","124.915  -  CONCTR ROD 48-68MM REVERE TRNSVRS ADJ TI PDCL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.916","SUP","Custom 27803010","","124.916  -  CONCTR ROD 58-71MM REVERE TRNSVRS ADJ TI PDCL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.917","SUP","Custom 27803010","","124.917  -  REVERE ADJUSTABLE T CONNECTOR, 68MM-81MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.918","SUP","Custom 27803010","","124.918  -  REVERE ADJUSTABLE T CONNECTOR, 78MM-91MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.921","SUP","Custom 27803010","","124.921  -  REVERE OFFSET LAMINA HOOK, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.922","SUP","Custom 27803010","","124.922  -  REVERE OFFSET LAMINA HOOK, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.924","SUP","Custom 27803010","","124.924  -  REVERE TRANSVERSE PROCESS HOOK, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.925","SUP","Custom 27803010","","124.925  -  REVERE TRANSVERSE PROCESS HOOK, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.927","SUP","Custom 27803010","","124.927  -  REVERE PEDICLE HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.928","SUP","Custom 27803010","","124.928  -  REVERE PEDICLE HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.929","SUP","Custom 27803010","","124.929  -  REVERE PEDICLE HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.931","SUP","Custom 27803010","","124.931  -  REVERE LAMINA HOOK, TRANSVERSE, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.932","SUP","Custom 27803010","","124.932  -  REVERE LAMINA HOOK, TRANSVERSE, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.933","SUP","Custom 27803010","","124.933  -  REVERE LAMINA HOOK, TRANSVERSE, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.935","SUP","Custom 27803010","","124.935  -  REVERE PEDICLE HOOK, TRANSVERSE, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.936","SUP","Custom 27803010","","124.936  -  REVERE PEDICLE HOOK, TRANSVERSE, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.937","SUP","Custom 27803010","","124.937  -  REVERE PEDICLE HOOK, TRANSVERSE, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.94","SUP","Custom 27803010","","124.940  -  REVERE LAMINA HOOK, NARROW, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.941","SUP","Custom 27803010","","124.941  -  REVERE LAMINA HOOK, NARROW, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.942","SUP","Custom 27803010","","124.942  -  REVERE LAMINA HOOK, NARROW, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.944","SUP","Custom 27803010","","124.944  -  REVERE LAMINA HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.945","SUP","Custom 27803010","","124.945  -  REVERE LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.946","SUP","Custom 27803010","","124.946  -  REVERE LAMINA HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.948","SUP","Custom 27803010","","124.948  -  REVERE LAMINA HOOK, WIDE, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.949","SUP","Custom 27803010","","124.949  -  REVERE LAMINA HOOK, WIDE, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.95","SUP","Custom 27803010","","124.950  -  REVERE LAMINA HOOK, WIDE, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.952","SUP","Custom 27803010","","124.952  -  REVERE LAMINA HOOK, TALL BODY, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.953","SUP","Custom 27803010","","124.953  -  REVERE LAMINA HOOK, TALL BODY, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.954","SUP","Custom 27803010","","124.954  -  REVERE LAMINA HOOK, TALL BODY, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.955","SUP","Custom 27803010","","124.955  -  REVERE ANGLED LAMINA HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.956","SUP","Custom 27803010","","124.956  -  REVERE ANGLED LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.957","SUP","Custom 27803010","","124.957  -  REVERE ANGLED LAMINA HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.96","SUP","Custom 27803010","","124.960  -  PARALLEL CONNECTOR, 5.5MM TO 5.5MM","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.961","SUP","Custom 27803010","","124.961  -  PARALLEL CONNECTOR, 5.5MM TO 5.5MM, WIDE","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.962","SUP","Custom 27803010","","124.962  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.963","SUP","Custom 27803010","","124.963  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, WIDE","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.964","SUP","Custom 27803010","","124.964  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.965","SUP","Custom 27803010","","124.965  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM, WIDE","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.97","SUP","Custom 27803010","","124.970  -  5.5MM OFFSET CONNECTOR, 15MM","BOTH IP/OP","$1,145.00 ","$847.30 ","$0.00 ","$1,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,145.00 ","$0.00 ","$572.50 ","$906.84 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.971","SUP","Custom 27803010","","124.971  -  5.5MM OFFSET CONNECTOR, 20MM","BOTH IP/OP","$1,145.00 ","$847.30 ","$0.00 ","$1,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,145.00 ","$0.00 ","$572.50 ","$906.84 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.972","SUP","Custom 27803010","","124.972  -  5.5MM OFFSET CONNECTOR, 25MM","BOTH IP/OP","$1,145.00 ","$847.30 ","$0.00 ","$1,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,145.00 ","$0.00 ","$572.50 ","$906.84 ","$916.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.973","SUP","Custom 27803010","","124.973  -  5.5MM ROD CLAMP, 100MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.974","SUP","Custom 27803010","","124.974  -  5.5MM ROD CLAMP, 120MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.975","SUP","Custom 27803010","","124.975  -  5.5MM ROD CLAMP, 150MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.976","SUP","Custom 27803010","","124.976  -  5.5MM OFFSET CONNECTOR, 30MM","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.977","SUP","Custom 27803010","","124.977  -  5.5MM OFFSET CONNECTOR, 35MM","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.98","SUP","Custom 27803010","","124.980  -  IN-LINE CONNECTOR, 5.5MM TO 5.5MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.99","SUP","Custom 27803010","","124.990  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 15MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.991","SUP","Custom 27803010","","124.991  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 20MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.992","SUP","Custom 27803010","","124.992  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 25MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.993","SUP","Custom 27803010","","124.993  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 30MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.994","SUP","Custom 27803010","","124.994  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 35MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.995","SUP","Custom 27803010","","124.995  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 100MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.996","SUP","Custom 27803010","","124.996  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 120MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124.997","SUP","Custom 27803010","","124.997  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 150MM","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129.436","SUP","HCPCS C1713","","129.436  -  GATEWAY THORACOLUMBAR PLATE, 36MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.438","SUP","HCPCS C1713","","129.438  -  GATEWAY THORACOLUMBAR PLATE, 38MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.44","SUP","HCPCS C1713","","129.440  -  GATEWAY THORACOLUMBAR PLATE, 40MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.442","SUP","HCPCS C1713","","129.442  -  GATEWAY THORACOLUMBAR PLATE, 42MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.444","SUP","HCPCS C1713","","129.444  -  GATEWAY THORACOLUMBAR PLATE, 44MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.448","SUP","HCPCS C1713","","129.448  -  GATEWAY THORACOLUMBAR PLATE, 48MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.452","SUP","HCPCS C1713","","129.452  -  GATEWAY THORACOLUMBAR PLATE, 52MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.456","SUP","HCPCS C1713","","129.456  -  GATEWAY THORACOLUMBAR PLATE, 56MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.46","SUP","HCPCS C1713","","129.460  -  GATEWAY THORACOLUMBAR PLATE, 60MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.464","SUP","HCPCS C1713","","129.464  -  GATEWAY THORACOLUMBAR PLATE, 64MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.468","SUP","HCPCS C1713","","129.468  -  GATEWAY THORACOLUMBAR PLATE, 68MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.472","SUP","HCPCS C1713","","129.472  -  GATEWAY THORACOLUMBAR PLATE, 72MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.476","SUP","HCPCS C1713","","129.476  -  GATEWAY THORACOLUMBAR PLATE, 76MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.48","SUP","HCPCS C1713","","129.480  -  GATEWAY THORACOLUMBAR PLATE, 80MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.484","SUP","HCPCS C1713","","129.484  -  GATEWAY THORACOLUMBAR PLATE, 84MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.488","SUP","HCPCS C1713","","129.488  -  GATEWAY THORACOLUMBAR PLATE, 88MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.492","SUP","HCPCS C1713","","129.492  -  GATEWAY THORACOLUMBAR PLATE, 92MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.496","SUP","HCPCS C1713","","129.496  -  GATEWAY THORACOLUMBAR PLATE, 96MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.5","SUP","HCPCS C1713","","129.500  -  GATEWAY THORACOLUMBAR PLATE, 100MM","BOTH IP/OP","$14,030.00 ","$10,382.20 ","$0.00 ","$14,030.00 ","$6,313.50 ","$0.00 ","$2,924.20 ","$0.00 ","$0.00 ","$2,456.54 ","$14,030.00 ","$0.00 ","$7,015.00 ","$11,111.76 ","$11,224.00 ","$0.00 ","$2,195.70 ","$0.00 ","$2,233.58 ","$0.00 "
"129.65","SUP","Custom 27203010","","129.650  -  SINGLE STAPLE, 5.0MM","BOTH IP/OP","$1,772.50 ","$1,311.65 ","$0.00 ","$1,772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129.655","SUP","Custom 27203010","","129.655  -  SINGLE STAPLE, 5.5MM","BOTH IP/OP","$1,772.50 ","$1,311.65 ","$0.00 ","$1,772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129.665","SUP","Custom 27203010","","129.665  -  SINGLE STAPLE, 6.5MM","BOTH IP/OP","$1,772.50 ","$1,311.65 ","$0.00 ","$1,772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129.675","SUP","Custom 27203010","","129.675  -  SINGLE STAPLE, 7.5MM","BOTH IP/OP","$1,772.50 ","$1,311.65 ","$0.00 ","$1,772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"129.685","SUP","Custom 27203010","","129.685  -  SINGLE STAPLE, 8.5MM","BOTH IP/OP","$1,772.50 ","$1,311.65 ","$0.00 ","$1,772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"130.12","SUP","HCPCS C1713","","130.120  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 20MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.122","SUP","HCPCS C1713","","130.122  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 22MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.124","SUP","HCPCS C1713","","130.124  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 24MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.126","SUP","HCPCS C1713","","130.126  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 26MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.128","SUP","HCPCS C1713","","130.128  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 28MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.13","SUP","HCPCS C1713","","130.130  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 30MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.132","SUP","HCPCS C1713","","130.132  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 32MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.134","SUP","HCPCS C1713","","130.134  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 34MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.136","SUP","HCPCS C1713","","130.136  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 36MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.138","SUP","HCPCS C1713","","130.138  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 38MM","BOTH IP/OP","$11,635.00 ","$8,609.90 ","$0.00 ","$11,635.00 ","$5,235.75 ","$0.00 ","$2,425.02 ","$0.00 ","$0.00 ","$2,037.20 ","$11,635.00 ","$0.00 ","$5,817.50 ","$9,214.92 ","$9,308.00 ","$0.00 ","$1,820.88 ","$0.00 ","$1,852.29 ","$0.00 "
"130.142","SUP","HCPCS C1713","","130.142  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 42MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.148","SUP","HCPCS C1713","","130.148  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 48MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.154","SUP","HCPCS C1713","","130.154  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 54MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.16","SUP","HCPCS C1713","","130.160  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 60MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.163","SUP","HCPCS C1713","","130.163  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 63MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.166","SUP","HCPCS C1713","","130.166  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 66MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.169","SUP","HCPCS C1713","","130.169  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 69MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.172","SUP","HCPCS C1713","","130.172  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 72MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.175","SUP","HCPCS C1713","","130.175  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 75MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.178","SUP","HCPCS C1713","","130.178  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 78MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.181","SUP","HCPCS C1713","","130.181  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 81MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.184","SUP","HCPCS C1713","","130.184  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 84MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.187","SUP","HCPCS C1713","","130.187  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 87MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.19","SUP","HCPCS C1713","","130.190  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 90MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.193","SUP","HCPCS C1713","","130.193  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 93MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.196","SUP","HCPCS C1713","","130.196  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 96MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.199","SUP","HCPCS C1713","","130.199  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 99MM","BOTH IP/OP","$12,925.00 ","$9,564.50 ","$0.00 ","$12,925.00 ","$5,816.25 ","$0.00 ","$2,693.89 ","$0.00 ","$0.00 ","$2,263.06 ","$12,925.00 ","$0.00 ","$6,462.50 ","$10,236.60 ","$10,340.00 ","$0.00 ","$2,022.76 ","$0.00 ","$2,057.66 ","$0.00 "
"130.22","SUP","HCPCS C1713","","130.220  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 20MM","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.222","SUP","HCPCS C1713","","130.222  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 22MM","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.224","SUP","HCPCS C1713","","130.224  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 24MM","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.226","SUP","HCPCS C1713","","130.226  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 26MM","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.228","SUP","HCPCS C1713","","130.228  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 28MM","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.23","SUP","HCPCS C1713","","130.230  -  PLATE BN 30MM NS CITADEL LVL 1 SPNE LS ANT","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.232","SUP","HCPCS C1713","","130.232  -  PLATE BN 32MM NS CITADEL LVL 1 SPNE LS ANT","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.234","SUP","HCPCS C1713","","130.234  -  PLATE BN 34MM NS CITADEL LVL 1 SPNE LS ANT","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.236","SUP","HCPCS C1713","","130.236  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 36MM","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.238","SUP","HCPCS C1713","","130.238  -  PLATE BN 38MM NS CITADEL LVL 1 SPNE LS ANT","BOTH IP/OP","$12,277.50 ","$9,085.35 ","$0.00 ","$12,277.50 ","$5,524.88 ","$0.00 ","$2,558.94 ","$0.00 ","$0.00 ","$2,149.69 ","$12,277.50 ","$0.00 ","$6,138.75 ","$9,723.78 ","$9,822.00 ","$0.00 ","$1,921.43 ","$0.00 ","$1,954.58 ","$0.00 "
"130.263","SUP","HCPCS C1713","","130.263  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 63MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.266","SUP","HCPCS C1713","","130.266  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 66MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.269","SUP","HCPCS C1713","","130.269  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 69MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.272","SUP","HCPCS C1713","","130.272  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 72MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.275","SUP","HCPCS C1713","","130.275  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 75MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.278","SUP","HCPCS C1713","","130.278  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 78MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.281","SUP","HCPCS C1713","","130.281  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 81MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.284","SUP","HCPCS C1713","","130.284  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 84MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.287","SUP","HCPCS C1713","","130.287  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 87MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.29","SUP","HCPCS C1713","","130.290  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 90MM","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.501","SUP","HCPCS C1713","","130.501  -  CLAMPING SET SCREW, 2.25MM","BOTH IP/OP","$7.50 ","$5.55 ","$0.00 ","$7.50 ","$3.38 ","$0.00 ","$1.56 ","$0.00 ","$0.00 ","$1.31 ","$7.50 ","$0.00 ","$3.75 ","$5.94 ","$6.00 ","$0.00 ","$1.17 ","$0.00 ","$1.19 ","$0.00 "
"130.542","SUP","HCPCS C1713","","130.542  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 42","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.548","SUP","HCPCS C1713","","130.548  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 48","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.554","SUP","HCPCS C1713","","130.554  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 54","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.56","SUP","HCPCS C1713","","130.560  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 60","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.566","SUP","HCPCS C1713","","130.566  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 66","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.572","SUP","HCPCS C1713","","130.572  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 72","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.578","SUP","HCPCS C1713","","130.578  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 78","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.584","SUP","HCPCS C1713","","130.584  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 84","BOTH IP/OP","$13,572.50 ","$10,043.65 ","$0.00 ","$13,572.50 ","$6,107.63 ","$0.00 ","$2,828.85 ","$0.00 ","$0.00 ","$2,376.44 ","$13,572.50 ","$0.00 ","$6,786.25 ","$10,749.42 ","$10,858.00 ","$0.00 ","$2,124.10 ","$0.00 ","$2,160.74 ","$0.00 "
"130.622","SUP","HCPCS C1713","","130.622  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 22MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.624","SUP","HCPCS C1713","","130.624  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 24MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.626","SUP","HCPCS C1713","","130.626  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 26MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.628","SUP","HCPCS C1713","","130.628  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 28MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.63","SUP","HCPCS C1713","","130.630  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 30MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.633","SUP","HCPCS C1713","","130.633  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 33MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.636","SUP","HCPCS C1713","","130.636  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 36MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.639","SUP","HCPCS C1713","","130.639  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 39MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.642","SUP","HCPCS C1713","","130.642  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 42MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.645","SUP","HCPCS C1713","","130.645  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 45MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.648","SUP","HCPCS C1713","","130.648  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 48MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.651","SUP","HCPCS C1713","","130.651  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 51MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.654","SUP","HCPCS C1713","","130.654  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 54MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.657","SUP","HCPCS C1713","","130.657  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 57MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.822","SUP","HCPCS C1713","","130.822  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 22MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.824","SUP","HCPCS C1713","","130.824  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 24MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.826","SUP","HCPCS C1713","","130.826  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 26MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.828","SUP","HCPCS C1713","","130.828  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 28MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.83","SUP","HCPCS C1713","","130.830  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 30MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.833","SUP","HCPCS C1713","","130.833  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 33MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.836","SUP","HCPCS C1713","","130.836  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 36MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.839","SUP","HCPCS C1713","","130.839  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 39MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.842","SUP","HCPCS C1713","","130.842  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 42MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.845","SUP","HCPCS C1713","","130.845  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 45MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.848","SUP","HCPCS C1713","","130.848  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 48MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.851","SUP","HCPCS C1713","","130.851  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 51MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.854","SUP","HCPCS C1713","","130.854  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 54MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"130.857","SUP","HCPCS C1713","","130.857  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 57MM","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$873.00 ","$0.00 ","$404.34 ","$0.00 ","$0.00 ","$339.68 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$303.61 ","$0.00 ","$308.85 ","$0.00 "
"131.001","SUP","Custom 27203010","","131.001  -  DUAL STAPLE, SMALL, ROSTRAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.002","SUP","Custom 27203010","","131.002  -  DUAL STAPLE, SMALL, CAUDAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.003","SUP","Custom 27203010","","131.003  -  DUAL STAPLE, MEDIUM, ROSTRAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.004","SUP","Custom 27203010","","131.004  -  DUAL STAPLE, MEDIUM, CAUDAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.005","SUP","Custom 27203010","","131.005  -  DUAL STAPLE, LARGE, ROSTRAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.006","SUP","Custom 27203010","","131.006  -  DUAL STAPLE, LARGE, CAUDAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.007","SUP","Custom 27203010","","131.007  -  DUAL STAPLE, X-LARGE, ROSTRAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.008","SUP","Custom 27203010","","131.008  -  DUAL STAPLE, X-LARGE, CAUDAL","BOTH IP/OP","$2,712.50 ","$2,007.25 ","$0.00 ","$2,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,712.50 ","$0.00 ","$1,356.25 ","$2,148.30 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.011","SUP","Custom 27203010","","131.011  -  SINGLE STAPLE, SMALL","BOTH IP/OP","$1,945.00 ","$1,439.30 ","$0.00 ","$1,945.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,945.00 ","$0.00 ","$972.50 ","$1,540.44 ","$1,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.012","SUP","Custom 27203010","","131.012  -  SINGLE STAPLE, MEDIUM","BOTH IP/OP","$1,945.00 ","$1,439.30 ","$0.00 ","$1,945.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,945.00 ","$0.00 ","$972.50 ","$1,540.44 ","$1,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.013","SUP","Custom 27203010","","131.013  -  STAPLE BONE LG SGL","BOTH IP/OP","$1,945.00 ","$1,439.30 ","$0.00 ","$1,945.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,945.00 ","$0.00 ","$972.50 ","$1,540.44 ","$1,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.113","SUP","Custom 27803010","","131.113  -  CROSS CONNECTOR, 13MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.114","SUP","Custom 27803010","","131.114  -  CROSS CONNECTOR, 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.115","SUP","Custom 27803010","","131.115  -  CROSS CONNECTOR, 15MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.116","SUP","Custom 27803010","","131.116  -  CROSS CONNECTOR, 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.117","SUP","Custom 27803010","","131.117  -  CROSS CONNECTOR, 17MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.118","SUP","Custom 27803010","","131.118  -  CROSS CONNECTOR, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.119","SUP","Custom 27803010","","131.119  -  CROSS CONNECTOR, 19MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.12","SUP","Custom 27803010","","131.120  -  CROSS CONNECTOR, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.121","SUP","Custom 27803010","","131.121  -  CROSS CONNECTOR, 21MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.122","SUP","Custom 27803010","","131.122  -  CROSS CONNECTOR, 22MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.123","SUP","Custom 27803010","","131.123  -  CROSS CONNECTOR, 23MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.124","SUP","Custom 27803010","","131.124  -  CROSS CONNECTOR, 24MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.125","SUP","Custom 27803010","","131.125  -  CROSS CONNECTOR, 25MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.126","SUP","Custom 27803010","","131.126  -  CROSS CONNECTOR, 26MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.127","SUP","Custom 27803010","","131.127  -  CROSS CONNECTOR, 27MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.128","SUP","Custom 27803010","","131.128  -  CROSS CONNECTOR, 28MM","BOTH IP/OP","$2,545.00 ","$1,883.30 ","$0.00 ","$2,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,545.00 ","$0.00 ","$1,272.50 ","$2,015.64 ","$2,036.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131.201","SUP","HCPCS C1713","","131.201  -  STAPLE WASHER, SMALL","BOTH IP/OP","$722.50 ","$534.65 ","$0.00 ","$722.50 ","$325.13 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$126.50 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$113.07 ","$0.00 ","$115.02 ","$0.00 "
"131.202","SUP","HCPCS C1713","","131.202  -  STAPLE WASHER, MEDIUM","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$358.88 ","$0.00 ","$166.22 ","$0.00 ","$0.00 ","$139.64 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$124.81 ","$0.00 ","$126.96 ","$0.00 "
"131.203","SUP","HCPCS C1713","","131.203  -  STAPLE WASHER, LARGE","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$840.00 ","$378.00 ","$0.00 ","$175.08 ","$0.00 ","$0.00 ","$147.08 ","$840.00 ","$0.00 ","$420.00 ","$665.28 ","$672.00 ","$0.00 ","$131.46 ","$0.00 ","$133.73 ","$0.00 "
"131.351","SUP","HCPCS C1713","","131.351  -  5.5MM BONE SCREW, ANTERIOR PLATE, 25MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.352","SUP","HCPCS C1713","","131.352  -  5.5MM BONE SCREW, ANTERIOR PLATE, 30MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.353","SUP","HCPCS C1713","","131.353  -  5.5MM BONE SCREW, ANTERIOR PLATE, 35MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.354","SUP","HCPCS C1713","","131.354  -  5.5MM BONE SCREW, ANTERIOR PLATE, 40MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.355","SUP","HCPCS C1713","","131.355  -  5.5MM BONE SCREW, ANTERIOR PLATE, 45MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.356","SUP","HCPCS C1713","","131.356  -  5.5MM BONE SCREW, ANTERIOR PLATE, 50MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.361","SUP","HCPCS C1713","","131.361  -  6.5MM BONE SCREW, ANTERIOR PLATE, 25MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.362","SUP","HCPCS C1713","","131.362  -  6.5MM BONE SCREW, ANTERIOR PLATE, 30MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.363","SUP","HCPCS C1713","","131.363  -  6.5MM BONE SCREW, ANTERIOR PLATE, 35MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.364","SUP","HCPCS C1713","","131.364  -  6.5MM BONE SCREW, ANTERIOR PLATE, 40MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.365","SUP","HCPCS C1713","","131.365  -  6.5MM BONE SCREW, ANTERIOR PLATE, 45MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"131.366","SUP","HCPCS C1713","","131.366  -  6.5MM BONE SCREW, ANTERIOR PLATE, 50MM","BOTH IP/OP","$1,910.00 ","$1,413.40 ","$0.00 ","$1,910.00 ","$859.50 ","$0.00 ","$398.09 ","$0.00 ","$0.00 ","$334.43 ","$1,910.00 ","$0.00 ","$955.00 ","$1,512.72 ","$1,528.00 ","$0.00 ","$298.92 ","$0.00 ","$304.07 ","$0.00 "
"132.14","SUP","Custom 27803010","","132.140  -  5.5MM CURVED ROD, CONE TIP, 40MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.145","SUP","Custom 27803010","","132.145  -  5.5MM CURVED ROD, CONE TIP, 45MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.15","SUP","Custom 27803010","","132.150  -  5.5MM CURVED ROD, CONE TIP, 50MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.155","SUP","Custom 27803010","","132.155  -  5.5MM CURVED ROD, CONE TIP, 55MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.16","SUP","Custom 27803010","","132.160  -  5.5MM CURVED ROD, CONE TIP, 60MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.165","SUP","Custom 27803010","","132.165  -  5.5MM CURVED ROD, CONE TIP, 65MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.17","SUP","Custom 27803010","","132.170  -  5.5MM CURVED ROD, CONE TIP, 70MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.175","SUP","Custom 27803010","","132.175  -  5.5MM CURVED ROD, CONE TIP, 75MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.18","SUP","Custom 27803010","","132.180  -  5.5MM CURVED ROD, CONE TIP, 80MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132.185","SUP","Custom 27803010","","132.185  -  5.5MM CURVED ROD, CONE TIP, 85MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136.404","SUP","HCPCS C1713","","136.404  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 4MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.406","SUP","HCPCS C1713","","136.406  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 6MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.408","SUP","HCPCS C1713","","136.408  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 8MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.41","SUP","HCPCS C1713","","136.410  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.412","SUP","HCPCS C1713","","136.412  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.504","SUP","HCPCS C1713","","136.504  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 4MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.506","SUP","HCPCS C1713","","136.506  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.508","SUP","HCPCS C1713","","136.508  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.51","SUP","HCPCS C1713","","136.510  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.512","SUP","HCPCS C1713","","136.512  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"136.704","SUP","HCPCS C1713","","136.704  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 4MM","BOTH IP/OP","$527.50 ","$390.35 ","$0.00 ","$527.50 ","$237.38 ","$0.00 ","$109.94 ","$0.00 ","$0.00 ","$92.36 ","$527.50 ","$0.00 ","$263.75 ","$417.78 ","$422.00 ","$0.00 ","$82.55 ","$0.00 ","$83.98 ","$0.00 "
"136.706","SUP","HCPCS C1713","","136.706  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$527.50 ","$390.35 ","$0.00 ","$527.50 ","$237.38 ","$0.00 ","$109.94 ","$0.00 ","$0.00 ","$92.36 ","$527.50 ","$0.00 ","$263.75 ","$417.78 ","$422.00 ","$0.00 ","$82.55 ","$0.00 ","$83.98 ","$0.00 "
"136.708","SUP","HCPCS C1713","","136.708  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$527.50 ","$390.35 ","$0.00 ","$527.50 ","$237.38 ","$0.00 ","$109.94 ","$0.00 ","$0.00 ","$92.36 ","$527.50 ","$0.00 ","$263.75 ","$417.78 ","$422.00 ","$0.00 ","$82.55 ","$0.00 ","$83.98 ","$0.00 "
"136.71","SUP","HCPCS C1713","","136.710  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$527.50 ","$390.35 ","$0.00 ","$527.50 ","$237.38 ","$0.00 ","$109.94 ","$0.00 ","$0.00 ","$92.36 ","$527.50 ","$0.00 ","$263.75 ","$417.78 ","$422.00 ","$0.00 ","$82.55 ","$0.00 ","$83.98 ","$0.00 "
"136.712","SUP","HCPCS C1713","","136.712  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$527.50 ","$390.35 ","$0.00 ","$527.50 ","$237.38 ","$0.00 ","$109.94 ","$0.00 ","$0.00 ","$92.36 ","$527.50 ","$0.00 ","$263.75 ","$417.78 ","$422.00 ","$0.00 ","$82.55 ","$0.00 ","$83.98 ","$0.00 "
"141","SUP","Custom 27203010","","KIT OSOM STRP GRP A DPSTK CLIA WVD MCBLTST 50 TST","BOTH IP/OP","$174.90 ","$129.43 ","$0.00 ","$174.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.90 ","$0.00 ","$87.45 ","$138.52 ","$139.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"142","SUP","HCPCS A4624","","142  -  CATHETER SCT 16FR 12FR STRL LF HALYARD DRCT O2 PORT ATRM TIP","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$110.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.64 ","$0.00 ","$55.32 ","$87.63 ","$88.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"145","SUP","Custom 27203010","","CONTROL CARD MRKR LQCHK 3LVL 3ML IMMUN","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"150.01","SUP","HCPCS C1713","","150.010  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.011","SUP","HCPCS C1713","","150.011  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.012","SUP","HCPCS C1713","","150.012  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.013","SUP","HCPCS C1713","","150.013  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.014","SUP","HCPCS C1713","","150.014  -  SCREW BONE 4.2MM 14MM PRTX CTTI OCT SPN SLFDRILL FIXANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.015","SUP","HCPCS C1713","","150.015  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.016","SUP","HCPCS C1713","","150.016  -  SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.03","SUP","HCPCS C1713","","150.030  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.031","SUP","HCPCS C1713","","150.031  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.032","SUP","HCPCS C1713","","150.032  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.033","SUP","HCPCS C1713","","150.033  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.034","SUP","HCPCS C1713","","150.034  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.035","SUP","HCPCS C1713","","150.035  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.036","SUP","HCPCS C1713","","150.036  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.038","SUP","HCPCS C1713","","150.038  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.04","SUP","HCPCS C1713","","150.040  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.042","SUP","HCPCS C1713","","150.042  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.044","SUP","HCPCS C1713","","150.044  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.046","SUP","HCPCS C1713","","150.046  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.11","SUP","HCPCS C1713","","150.110  -  PLATE BN 10MM NS PRV LVL 1 SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.112","SUP","HCPCS C1713","","150.112  -  PLATE BN 12MM NS PRV LVL 1 SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.114","SUP","HCPCS C1713","","150.114  -  PLATE BN 14MM NS PRV LVL 1 SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.116","SUP","HCPCS C1713","","150.116  -  PLATE BN 16MM NS PRV LVL 1 SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.118","SUP","HCPCS C1713","","150.118  -  PLATE BN 18MM NS PRV LVL 1 SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.12","SUP","HCPCS C1713","","150.120  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.122","SUP","HCPCS C1713","","150.122  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.124","SUP","HCPCS C1713","","150.124  -  PLATE BN 24MM NS PRV LVL 1 SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.126","SUP","HCPCS C1713","","150.126  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.13","SUP","HCPCS C1713","","150.130  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.132","SUP","HCPCS C1713","","150.132  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.134","SUP","HCPCS C1713","","150.134  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"150.224","SUP","HCPCS C1713","","150.224  -  PLATE BN 24MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.226","SUP","HCPCS C1713","","150.226  -  PLATE BN 26MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.228","SUP","HCPCS C1713","","150.228  -  PLATE BN 28MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.23","SUP","HCPCS C1713","","150.230  -  PLATE BN 30MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.232","SUP","HCPCS C1713","","150.232  -  PLATE BN 32MM NS PRV 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.234","SUP","HCPCS C1713","","150.234  -  PLATE BN 34MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.236","SUP","HCPCS C1713","","150.236  -  PLATE BN 36MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.238","SUP","HCPCS C1713","","150.238  -  PLATE BN 38MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.24","SUP","HCPCS C1713","","150.240  -  PLATE BN 40MM NS PRV LVL 2 SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.242","SUP","HCPCS C1713","","150.242  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 42MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.244","SUP","HCPCS C1713","","150.244  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 44MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.246","SUP","HCPCS C1713","","150.246  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 46MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.254","SUP","HCPCS C1713","","150.254  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, EXTRA LORDOTIC,","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.256","SUP","HCPCS C1713","","150.256  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, EXTRA LORDOTIC,","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"150.339","SUP","HCPCS C1713","","150.339  -  PLATE BN 39MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.342","SUP","HCPCS C1713","","150.342  -  PLATE BN 42MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.345","SUP","HCPCS C1713","","150.345  -  PLATE BN 45MM NS PRV 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.348","SUP","HCPCS C1713","","150.348  -  PLATE BN 48MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.351","SUP","HCPCS C1713","","150.351  -  PLATE BN 51MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.354","SUP","HCPCS C1713","","150.354  -  PLATE BN 54MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.357","SUP","HCPCS C1713","","150.357  -  PLATE BN 57MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.36","SUP","HCPCS C1713","","150.360  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, 60MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.363","SUP","HCPCS C1713","","150.363  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, 63MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.366","SUP","HCPCS C1713","","150.366  -  PLATE BN 66MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.369","SUP","HCPCS C1713","","150.369  -  PLATE BN 69MM NS PRV LVL 3 SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.379","SUP","HCPCS C1713","","150.379  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, EXTRA LORDOTIC,","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"150.46","SUP","HCPCS C1713","","150.460  -  PLATE BN 60MM NS PRV LVL 4 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.463","SUP","HCPCS C1713","","150.463  -  PLATE BN 63MM NS PRV LVL 4 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.466","SUP","HCPCS C1713","","150.466  -  PLATE BN 66MM NS PRV LVL 4 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.469","SUP","HCPCS C1713","","150.469  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 69MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.472","SUP","HCPCS C1713","","150.472  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 72MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.475","SUP","HCPCS C1713","","150.475  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 75MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.478","SUP","HCPCS C1713","","150.478  -  PLATE BN 78MM NS PRV LVL 4 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.481","SUP","HCPCS C1713","","150.481  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 81MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.484","SUP","HCPCS C1713","","150.484  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 84MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.487","SUP","HCPCS C1713","","150.487  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 87MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.49","SUP","HCPCS C1713","","150.490  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 90MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.493","SUP","HCPCS C1713","","150.493  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 93MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.51","SUP","HCPCS C1713","","150.510  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.511","SUP","HCPCS C1713","","150.511  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.512","SUP","HCPCS C1713","","150.512  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.513","SUP","HCPCS C1713","","150.513  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.514","SUP","HCPCS C1713","","150.514  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.515","SUP","HCPCS C1713","","150.515  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.516","SUP","HCPCS C1713","","150.516  -  SCREW BN 4.6MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.53","SUP","HCPCS C1713","","150.530  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
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"150.532","SUP","HCPCS C1713","","150.532  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.533","SUP","HCPCS C1713","","150.533  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
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"150.535","SUP","HCPCS C1713","","150.535  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.536","SUP","HCPCS C1713","","150.536  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.538","SUP","HCPCS C1713","","150.538  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.54","SUP","HCPCS C1713","","150.540  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.542","SUP","HCPCS C1713","","150.542  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.544","SUP","HCPCS C1713","","150.544  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.546","SUP","HCPCS C1713","","150.546  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.58","SUP","HCPCS C1713","","150.580  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 80MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.583","SUP","HCPCS C1713","","150.583  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 83MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.586","SUP","HCPCS C1713","","150.586  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 86MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.589","SUP","HCPCS C1713","","150.589  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 89MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.592","SUP","HCPCS C1713","","150.592  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 92MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.595","SUP","HCPCS C1713","","150.595  -  PLATE BN 95MM NS PRV LVL 5 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.598","SUP","HCPCS C1713","","150.598  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 98MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.601","SUP","HCPCS C1713","","150.601  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 101MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.604","SUP","HCPCS C1713","","150.604  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 104MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"150.61","SUP","HCPCS C1713","","150.610  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.611","SUP","HCPCS C1713","","150.611  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.612","SUP","HCPCS C1713","","150.612  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.613","SUP","HCPCS C1713","","150.613  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.614","SUP","HCPCS C1713","","150.614  -  SCREW BONE 4.2MM 14MM PRTX CT SPNL SLFDRILL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.615","SUP","HCPCS C1713","","150.615  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.616","SUP","HCPCS C1713","","150.616  -  SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL VA SPNE OCT PRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.618","SUP","HCPCS C1713","","150.618  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.71","SUP","HCPCS C1713","","150.710  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.711","SUP","HCPCS C1713","","150.711  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.712","SUP","HCPCS C1713","","150.712  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.713","SUP","HCPCS C1713","","150.713  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.714","SUP","HCPCS C1713","","150.714  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.715","SUP","HCPCS C1713","","150.715  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.716","SUP","HCPCS C1713","","150.716  -  SCREW BONE 4.6MM 16MM PRTX CTTI OCT SPN SLFDRILL VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.81","SUP","HCPCS C1713","","150.810  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.811","SUP","HCPCS C1713","","150.811  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.812","SUP","HCPCS C1713","","150.812  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.813","SUP","HCPCS C1713","","150.813  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.814","SUP","HCPCS C1713","","150.814  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.815","SUP","HCPCS C1713","","150.815  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.816","SUP","HCPCS C1713","","150.816  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.818","SUP","HCPCS C1713","","150.818  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.82","SUP","HCPCS C1713","","150.820  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.822","SUP","HCPCS C1713","","150.822  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.824","SUP","HCPCS C1713","","150.824  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.826","SUP","HCPCS C1713","","150.826  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.91","SUP","HCPCS C1713","","150.910  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.911","SUP","HCPCS C1713","","150.911  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.912","SUP","HCPCS C1713","","150.912  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.913","SUP","HCPCS C1713","","150.913  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.914","SUP","HCPCS C1713","","150.914  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.915","SUP","HCPCS C1713","","150.915  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.916","SUP","HCPCS C1713","","150.916  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.918","SUP","HCPCS C1713","","150.918  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.92","SUP","HCPCS C1713","","150.920  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.922","SUP","HCPCS C1713","","150.922  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.924","SUP","HCPCS C1713","","150.924  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"150.926","SUP","HCPCS C1713","","150.926  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"151","SUP","Custom 27203010","","MARKER RAD A-SPOT LT IMG SEE THR PALPABLE MASS 3ANG MAMGR","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.001","SUP","Custom 27803010","","151.001  -  SPACER SPNL 0D 12MM 12X15MM NS LF FORTIFY NO SPK","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.002","SUP","Custom 27803010","","151.002  -  SPACER SPNL 0D 12MM 12X16MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.003","SUP","Custom 27803010","","151.003  -  SPACER SPNL 3.5D 12MM 12X16MM NS LF FORTIFY NO SPK","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.004","SUP","Custom 27803010","","151.004  -  SPACER SPNL 3.5D 12MM 12X17MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.05","SUP","Custom 27803010","","151.050  -  SPACER SPNL 12MM 12X18MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.051","SUP","Custom 27803010","","151.051  -  SPACER SPNL 12MM 12X19MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.052","SUP","Custom 27803010","","151.052  -  SPACER SPNL 12MM 12X21MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.053","SUP","Custom 27803010","","151.053  -  SPACER SPNL 12MM 12X25MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.054","SUP","Custom 27803010","","151.054  -  SPACER SPNL 12MM 12X33MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.055","SUP","Custom 27803010","","151.055  -  SPACER SPNL 12MM 12X48MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.056","SUP","Custom 27803010","","151.056  -  SPACER SPNL 12MM 12X67MM NS LF FORTIFY","BOTH IP/OP","$16,080.00 ","$11,899.20 ","$0.00 ","$16,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,080.00 ","$0.00 ","$8,040.00 ","$12,735.36 ","$12,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.15","SUP","Custom 27803010","","151.150  -  SPACER SPNL 20MM 20X23MM NS LF FORTIFY","BOTH IP/OP","$21,100.00 ","$15,614.00 ","$0.00 ","$21,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.00 ","$0.00 ","$10,550.00 ","$16,711.20 ","$16,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.151","SUP","Custom 27803010","","151.151  -  SPACER SPNL 20MM 20X26MM NS LF FORTIFY","BOTH IP/OP","$21,100.00 ","$15,614.00 ","$0.00 ","$21,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.00 ","$0.00 ","$10,550.00 ","$16,711.20 ","$16,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.152","SUP","Custom 27803010","","151.152  -  SPACER SPNL 20MM 20X31MM NS LF FORTIFY","BOTH IP/OP","$21,100.00 ","$15,614.00 ","$0.00 ","$21,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.00 ","$0.00 ","$10,550.00 ","$16,711.20 ","$16,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.153","SUP","Custom 27803010","","151.153  -  SPACER SPNL 20MM 20X41MM NS LF FORTIFY","BOTH IP/OP","$21,100.00 ","$15,614.00 ","$0.00 ","$21,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.00 ","$0.00 ","$10,550.00 ","$16,711.20 ","$16,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.154","SUP","Custom 27803010","","151.154  -  SPACER SPNL 20MM 20X62MM NS LF FORTIFY","BOTH IP/OP","$21,100.00 ","$15,614.00 ","$0.00 ","$21,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.00 ","$0.00 ","$10,550.00 ","$16,711.20 ","$16,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.155","SUP","Custom 27803010","","151.155  -  SPACER SPNL 20MM 20X90MM NS LF FORTIFY","BOTH IP/OP","$21,100.00 ","$15,614.00 ","$0.00 ","$21,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,100.00 ","$0.00 ","$10,550.00 ","$16,711.20 ","$16,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151.32","SUP","HCPCS C1713","","151.320  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.321","SUP","HCPCS C1713","","151.321  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.322","SUP","HCPCS C1713","","151.322  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.323","SUP","HCPCS C1713","","151.323  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.324","SUP","HCPCS C1713","","151.324  -  SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.331","SUP","HCPCS C1713","","151.331  -  SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.333","SUP","HCPCS C1713","","151.333  -  SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.334","SUP","HCPCS C1713","","151.334  -  SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.371","SUP","HCPCS C1713","","151.371  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.373","SUP","HCPCS C1713","","151.373  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.374","SUP","HCPCS C1713","","151.374  -  SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.381","SUP","HCPCS C1713","","151.381  -  SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.383","SUP","HCPCS C1713","","151.383  -  SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.384","SUP","HCPCS C1713","","151.384  -  SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.401","SUP","HCPCS C1713","","151.401  -  SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.403","SUP","HCPCS C1713","","151.403  -  SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.404","SUP","HCPCS C1713","","151.404  -  SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.411","SUP","HCPCS C1713","","151.411  -  SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.413","SUP","HCPCS C1713","","151.413  -  SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.414","SUP","HCPCS C1713","","151.414  -  SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.431","SUP","HCPCS C1713","","151.431  -  SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.433","SUP","HCPCS C1713","","151.433  -  SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.434","SUP","HCPCS C1713","","151.434  -  SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.451","SUP","HCPCS C1713","","151.451  -  SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.453","SUP","HCPCS C1713","","151.453  -  SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.454","SUP","HCPCS C1713","","151.454  -  SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.461","SUP","HCPCS C1713","","151.461  -  SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.463","SUP","HCPCS C1713","","151.463  -  SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.464","SUP","HCPCS C1713","","151.464  -  SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.481","SUP","HCPCS C1713","","151.481  -  SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.483","SUP","HCPCS C1713","","151.483  -  SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.484","SUP","HCPCS C1713","","151.484  -  SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.485","SUP","HCPCS C1713","","151.485  -  SPACER SPNL 12D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.486","SUP","HCPCS C1713","","151.486  -  SPACER SPNL 16D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.601","SUP","HCPCS C1713","","151.601  -  SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.603","SUP","HCPCS C1713","","151.603  -  SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.604","SUP","HCPCS C1713","","151.604  -  SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.605","SUP","HCPCS C1713","","151.605  -  SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.611","SUP","HCPCS C1713","","151.611  -  SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.613","SUP","HCPCS C1713","","151.613  -  SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.614","SUP","HCPCS C1713","","151.614  -  SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.615","SUP","HCPCS C1713","","151.615  -  SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.621","SUP","HCPCS C1713","","151.621  -  SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.623","SUP","HCPCS C1713","","151.623  -  SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.624","SUP","HCPCS C1713","","151.624  -  SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.625","SUP","HCPCS C1713","","151.625  -  SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.651","SUP","HCPCS C1713","","151.651  -  SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.653","SUP","HCPCS C1713","","151.653  -  SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.654","SUP","HCPCS C1713","","151.654  -  SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.655","SUP","HCPCS C1713","","151.655  -  SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.661","SUP","HCPCS C1713","","151.661  -  SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.663","SUP","HCPCS C1713","","151.663  -  SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.664","SUP","HCPCS C1713","","151.664  -  SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.665","SUP","HCPCS C1713","","151.665  -  SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.671","SUP","HCPCS C1713","","151.671  -  SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.673","SUP","HCPCS C1713","","151.673  -  SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.674","SUP","HCPCS C1713","","151.674  -  SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.675","SUP","HCPCS C1713","","151.675  -  SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"151.701","SUP","HCPCS C1713","","151.701  -  SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.703","SUP","HCPCS C1713","","151.703  -  SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.704","SUP","HCPCS C1713","","151.704  -  SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.751","SUP","HCPCS C1713","","151.751  -  SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.753","SUP","HCPCS C1713","","151.753  -  SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"151.754","SUP","HCPCS C1713","","151.754  -  SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"154.7","SUP","Custom 27803010","","154.700  -  REVERE IN-LINE EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, LEFT","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.705","SUP","Custom 27803010","","154.705  -  REVERE IN-LINE EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGH","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.71","SUP","Custom 27803010","","154.710  -  REVERE IN-LINE EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, LEFT","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.715","SUP","Custom 27803010","","154.715  -  REVERE IN-LINE EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, RIGH","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.72","SUP","Custom 27803010","","154.720  -  REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, LEFT,","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.725","SUP","Custom 27803010","","154.725  -  REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGHT","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.73","SUP","Custom 27803010","","154.730  -  REVERE OFFSET EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, LEFT,","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.735","SUP","Custom 27803010","","154.735  -  REVERE OFFSET EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, RIGHT","BOTH IP/OP","$10,800.00 ","$7,992.00 ","$0.00 ","$10,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,800.00 ","$0.00 ","$5,400.00 ","$8,553.60 ","$8,640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.74","SUP","Custom 27803010","","154.740  -  REVERE Y OFFSET CONNECTOR, 5.5MM-6.0MM","BOTH IP/OP","$2,620.00 ","$1,938.80 ","$0.00 ","$2,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,620.00 ","$0.00 ","$1,310.00 ","$2,075.04 ","$2,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.745","SUP","Custom 27803010","","154.745  -  REVERE Y OFFSET CONNECTOR, 6.0MM-6.5MM","BOTH IP/OP","$2,620.00 ","$1,938.80 ","$0.00 ","$2,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,620.00 ","$0.00 ","$1,310.00 ","$2,075.04 ","$2,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.754","SUP","Custom 27803010","","154.754  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 6.5MM, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.756","SUP","Custom 27803010","","154.756  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 6.5MM, 18MM WIDE, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.758","SUP","Custom 27803010","","154.758  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.76","SUP","Custom 27803010","","154.760  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, 18MM WIDE, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.854","SUP","Custom 27803010","","154.854  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.856","SUP","Custom 27803010","","154.856  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM, 18MM WIDE, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.858","SUP","Custom 27803010","","154.858  -  ROD TO ROD CLAMP, 6.5MM TO 6.5MM, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.86","SUP","Custom 27803010","","154.860  -  ROD TO ROD CLAMP, 6.5MM TO 6.5MM, 18MM WIDE, SINGLE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.862","SUP","Custom 27803010","","154.862  -  ROD TO ROD CLAMP, 5.5MM TO 6.5MM","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.864","SUP","Custom 27803010","","154.864  -  ROD TO ROD CLAMP, 5.5MM TO 6.5MM, WIDE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.865","SUP","Custom 27803010","","154.865  -  ROD TO ROD CLAMP ASSEMBLY, 5.5MM TO 6.5MM, 18MM WIDE","BOTH IP/OP","$1,445.00 ","$1,069.30 ","$0.00 ","$1,445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,445.00 ","$0.00 ","$722.50 ","$1,144.44 ","$1,156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.866","SUP","Custom 27803010","","154.866  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.868","SUP","Custom 27803010","","154.868  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM WIDE","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"154.869","SUP","Custom 27803010","","154.869  -  PARALLEL CONNECTOR CLAMP ASSEMBLY, 6.5MM TO 6.5MM, 18MM WIDE","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.051","SUP","HCPCS C1713","","155.051  -  BEACON 5.0MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.052","SUP","HCPCS C1713","","155.052  -  BEACON 5.0MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.053","SUP","HCPCS C1713","","155.053  -  BEACON 5.0MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.054","SUP","HCPCS C1713","","155.054  -  BEACON 5.0MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.055","SUP","HCPCS C1713","","155.055  -  BEACON 5.0MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.056","SUP","HCPCS C1713","","155.056  -  BEACON 5.0MM POSTED SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.057","SUP","HCPCS C1713","","155.057  -  BEACON 5.0MM POSTED SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.071","SUP","HCPCS C1713","","155.071  -  BEACON 7.5MM POSTED SCREW, 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.072","SUP","HCPCS C1713","","155.072  -  BEACON 7.5MM POSTED SCREW, 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.073","SUP","HCPCS C1713","","155.073  -  BEACON 7.5MM POSTED SCREW, 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.074","SUP","HCPCS C1713","","155.074  -  BEACON 7.5MM POSTED SCREW, 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.075","SUP","HCPCS C1713","","155.075  -  BEACON 7.5MM POSTED SCREW, 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.081","SUP","HCPCS C1713","","155.081  -  BEACON 8.5MM POSTED SCREW, 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.082","SUP","HCPCS C1713","","155.082  -  BEACON 8.5MM POSTED SCREW, 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.083","SUP","HCPCS C1713","","155.083  -  BEACON 8.5MM POSTED SCREW, 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.084","SUP","HCPCS C1713","","155.084  -  BEACON 8.5MM POSTED SCREW, 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.085","SUP","HCPCS C1713","","155.085  -  BEACON 8.5MM POSTED SCREW, 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.091","SUP","HCPCS C1713","","155.091  -  BEACON 9.5MM POSTED SCREW, 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.092","SUP","HCPCS C1713","","155.092  -  BEACON 9.5MM POSTED SCREW, 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.093","SUP","HCPCS C1713","","155.093  -  BEACON 9.5MM POSTED SCREW, 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.094","SUP","HCPCS C1713","","155.094  -  BEACON 9.5MM POSTED SCREW, 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.095","SUP","HCPCS C1713","","155.095  -  BEACON 9.5MM POSTED SCREW, 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.101","SUP","Custom 27803010","","155.101  -  BEACON 5.5MM STRAIGHT CLAMP, LARGE","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.102","SUP","Custom 27803010","","155.102  -  BEACON 5.5MM STRAIGHT CLAMP, MEDIUM","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.103","SUP","Custom 27803010","","155.103  -  BEACON 5.5MM STRAIGHT CLAMP, SMALL","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.104","SUP","Custom 27803010","","155.104  -  BEACON 5.5MM LEFT OFFSET CLAMP, LARGE","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.105","SUP","Custom 27803010","","155.105  -  BEACON 5.5MM LEFT OFFSET CLAMP, MEDIUM","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.106","SUP","Custom 27803010","","155.106  -  BEACON 5.5MM LEFT OFFSET CLAMP, SMALL","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.107","SUP","Custom 27803010","","155.107  -  BEACON 5.5MM RIGHT OFFSET CLAMP, LARGE","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.108","SUP","Custom 27803010","","155.108  -  BEACON 5.5MM RIGHT OFFSET CLAMP, MEDIUM","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.109","SUP","Custom 27803010","","155.109  -  BEACON 5.5MM RIGHT OFFSET CLAMP, SMALL","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.111","SUP","Custom 27803010","","155.111  -  BEACON 6.35MM STRAIGHT CLAMP, LARGE","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.112","SUP","Custom 27803010","","155.112  -  BEACON 6.35MM STRAIGHT CLAMP, MEDIUM","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.113","SUP","Custom 27803010","","155.113  -  BEACON 6.35MM STRAIGHT CLAMP, SMALL","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.114","SUP","Custom 27803010","","155.114  -  BEACON 6.35MM LEFT OFFSET CLAMP, LARGE","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.115","SUP","Custom 27803010","","155.115  -  BEACON 6.35MM LEFT OFFSET CLAMP, MEDIUM","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.116","SUP","Custom 27803010","","155.116  -  BEACON 6.35MM LEFT OFFSET CLAMP, SMALL","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.117","SUP","Custom 27803010","","155.117  -  BEACON 6.35MM RIGHT OFFSET CLAMP, LARGE","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.118","SUP","Custom 27803010","","155.118  -  BEACON 6.35MM RIGHT OFFSET CLAMP, MEDIUM","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.119","SUP","Custom 27803010","","155.119  -  BEACON 6.35MM RIGHT OFFSET CLAMP, SMALL","BOTH IP/OP","$4,995.00 ","$3,696.30 ","$0.00 ","$4,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,995.00 ","$0.00 ","$2,497.50 ","$3,956.04 ","$3,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.151","SUP","HCPCS C1713","","155.151  -  BEACON 5.0MM REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.152","SUP","HCPCS C1713","","155.152  -  BEACON 5.0MM REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.153","SUP","HCPCS C1713","","155.153  -  BEACON 5.0MM REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.154","SUP","HCPCS C1713","","155.154  -  BEACON 5.0MM REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.155","SUP","HCPCS C1713","","155.155  -  BEACON 5.0MM REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.156","SUP","HCPCS C1713","","155.156  -  BEACON 5.0MM REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.157","SUP","HCPCS C1713","","155.157  -  BEACON 5.0MM REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.171","SUP","HCPCS C1713","","155.171  -  BEACON 7.5MM REDUCTION SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.172","SUP","HCPCS C1713","","155.172  -  BEACON 7.5MM REDUCTION SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.173","SUP","HCPCS C1713","","155.173  -  BEACON 7.5MM REDUCTION SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.174","SUP","HCPCS C1713","","155.174  -  BEACON 7.5MM REDUCTION SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.175","SUP","HCPCS C1713","","155.175  -  BEACON 7.5MM REDUCTION SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.181","SUP","HCPCS C1713","","155.181  -  BEACON 8.5MM REDUCTION SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.182","SUP","HCPCS C1713","","155.182  -  BEACON 8.5MM REDUCTION SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.183","SUP","HCPCS C1713","","155.183  -  BEACON 8.5MM REDUCTION SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.184","SUP","HCPCS C1713","","155.184  -  BEACON 8.5MM REDUCTION SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.185","SUP","HCPCS C1713","","155.185  -  BEACON 8.5MM REDUCTION SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.341","SUP","HCPCS C1713","","155.341  -  BEACON 4.5MM REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.342","SUP","HCPCS C1713","","155.342  -  BEACON 4.5MM REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.343","SUP","HCPCS C1713","","155.343  -  BEACON 4.5MM REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.344","SUP","HCPCS C1713","","155.344  -  BEACON 4.5MM REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.345","SUP","HCPCS C1713","","155.345  -  BEACON 4.5MM REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.351","SUP","HCPCS C1713","","155.351  -  BEACON 5.5MM REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.352","SUP","HCPCS C1713","","155.352  -  BEACON 5.5MM REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.353","SUP","HCPCS C1713","","155.353  -  BEACON 5.5MM REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.354","SUP","HCPCS C1713","","155.354  -  BEACON 5.5MM REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.355","SUP","HCPCS C1713","","155.355  -  BEACON 5.5MM REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.356","SUP","HCPCS C1713","","155.356  -  BEACON 5.5MM REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.357","SUP","HCPCS C1713","","155.357  -  BEACON 5.5MM REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.361","SUP","HCPCS C1713","","155.361  -  BEACON 6.5MM REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.362","SUP","HCPCS C1713","","155.362  -  BEACON 6.5MM REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.363","SUP","HCPCS C1713","","155.363  -  BEACON 6.5MM REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.364","SUP","HCPCS C1713","","155.364  -  BEACON 6.5MM REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.365","SUP","HCPCS C1713","","155.365  -  BEACON 6.5MM REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.366","SUP","HCPCS C1713","","155.366  -  BEACON 6.5MM REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.367","SUP","HCPCS C1713","","155.367  -  BEACON 6.5MM REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.368","SUP","HCPCS C1713","","155.368  -  BEACON 6.5MM REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.369","SUP","HCPCS C1713","","155.369  -  BEACON 6.5MM REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.371","SUP","HCPCS C1713","","155.371  -  BEACON 7.5MM REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.372","SUP","HCPCS C1713","","155.372  -  BEACON 7.5MM REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.373","SUP","HCPCS C1713","","155.373  -  BEACON 7.5MM REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.374","SUP","HCPCS C1713","","155.374  -  BEACON 7.5MM REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.375","SUP","HCPCS C1713","","155.375  -  BEACON 7.5MM REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.376","SUP","HCPCS C1713","","155.376  -  BEACON 7.5MM REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.377","SUP","HCPCS C1713","","155.377  -  BEACON 7.5MM REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.378","SUP","HCPCS C1713","","155.378  -  BEACON 7.5MM REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.379","SUP","HCPCS C1713","","155.379  -  BEACON 7.5MM REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.381","SUP","HCPCS C1713","","155.381  -  BEACON 8.5MM REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.382","SUP","HCPCS C1713","","155.382  -  BEACON 8.5MM REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.383","SUP","HCPCS C1713","","155.383  -  BEACON 8.5MM REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.384","SUP","HCPCS C1713","","155.384  -  BEACON 8.5MM REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.385","SUP","HCPCS C1713","","155.385  -  BEACON 8.5MM REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.386","SUP","HCPCS C1713","","155.386  -  BEACON 8.5MM REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.387","SUP","HCPCS C1713","","155.387  -  BEACON 8.5MM REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.388","SUP","HCPCS C1713","","155.388  -  BEACON 8.5MM REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.389","SUP","HCPCS C1713","","155.389  -  BEACON 8.5MM REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"155.441","SUP","HCPCS C1713","","155.441  -  BEACON 4.5MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.442","SUP","HCPCS C1713","","155.442  -  BEACON 4.5MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.443","SUP","HCPCS C1713","","155.443  -  BEACON 4.5MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.444","SUP","HCPCS C1713","","155.444  -  BEACON 4.5MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.445","SUP","HCPCS C1713","","155.445  -  BEACON 4.5MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.451","SUP","HCPCS C1713","","155.451  -  BEACON 5.5MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.452","SUP","HCPCS C1713","","155.452  -  BEACON 5.5MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.453","SUP","HCPCS C1713","","155.453  -  BEACON 5.5MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.454","SUP","HCPCS C1713","","155.454  -  BEACON 5.5MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.455","SUP","HCPCS C1713","","155.455  -  BEACON 5.5MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.456","SUP","HCPCS C1713","","155.456  -  BEACON 5.5MM POSTED SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.457","SUP","HCPCS C1713","","155.457  -  BEACON 5.5MM POSTED SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.461","SUP","HCPCS C1713","","155.461  -  BEACON 6.5MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.462","SUP","HCPCS C1713","","155.462  -  BEACON 6.5MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.463","SUP","HCPCS C1713","","155.463  -  BEACON 6.5MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.464","SUP","HCPCS C1713","","155.464  -  BEACON 6.5MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.465","SUP","HCPCS C1713","","155.465  -  BEACON 6.5MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.466","SUP","HCPCS C1713","","155.466  -  BEACON 6.5MM POSTED SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.467","SUP","HCPCS C1713","","155.467  -  BEACON 6.5MM POSTED SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.468","SUP","HCPCS C1713","","155.468  -  BEACON 6.5MM POSTED SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.469","SUP","HCPCS C1713","","155.469  -  BEACON 6.5MM POSTED SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.471","SUP","HCPCS C1713","","155.471  -  BEACON 7.5MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.472","SUP","HCPCS C1713","","155.472  -  BEACON 7.5MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.473","SUP","HCPCS C1713","","155.473  -  BEACON 7.5MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.474","SUP","HCPCS C1713","","155.474  -  BEACON 7.5MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.475","SUP","HCPCS C1713","","155.475  -  BEACON 7.5MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.476","SUP","HCPCS C1713","","155.476  -  BEACON 7.5MM POSTED SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.477","SUP","HCPCS C1713","","155.477  -  BEACON 7.5MM POSTED SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.478","SUP","HCPCS C1713","","155.478  -  BEACON 7.5MM POSTED SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.479","SUP","HCPCS C1713","","155.479  -  BEACON 7.5MM POSTED SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.481","SUP","HCPCS C1713","","155.481  -  BEACON 8.5MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.482","SUP","HCPCS C1713","","155.482  -  BEACON 8.5MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.483","SUP","HCPCS C1713","","155.483  -  BEACON 8.5MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.484","SUP","HCPCS C1713","","155.484  -  BEACON 8.5MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.485","SUP","HCPCS C1713","","155.485  -  BEACON 8.5MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.486","SUP","HCPCS C1713","","155.486  -  BEACON 8.5MM POSTED SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.487","SUP","HCPCS C1713","","155.487  -  BEACON 8.5MM POSTED SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.488","SUP","HCPCS C1713","","155.488  -  BEACON 8.5MM POSTED SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.489","SUP","HCPCS C1713","","155.489  -  BEACON 8.5MM POSTED SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.491","SUP","HCPCS C1713","","155.491  -  BEACON 9.5MM POSTED SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.492","SUP","HCPCS C1713","","155.492  -  BEACON 9.5MM POSTED SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.493","SUP","HCPCS C1713","","155.493  -  BEACON 9.5MM POSTED SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.494","SUP","HCPCS C1713","","155.494  -  BEACON 9.5MM POSTED SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.495","SUP","HCPCS C1713","","155.495  -  BEACON 9.5MM POSTED SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.496","SUP","HCPCS C1713","","155.496  -  BEACON 9.5MM POSTED SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.497","SUP","HCPCS C1713","","155.497  -  BEACON 9.5MM POSTED SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.498","SUP","HCPCS C1713","","155.498  -  BEACON 9.5MM POSTED SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.499","SUP","HCPCS C1713","","155.499  -  BEACON 9.5MM POSTED SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.51","SUP","Custom 27803010","","155.510  -  6.35MM STRAIGHT ROD, 100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.512","SUP","Custom 27803010","","155.512  -  6.35MM STRAIGHT ROD, 125MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.515","SUP","Custom 27803010","","155.515  -  ROD SPNL STRG 6.35MM 150MM BCN HEX END","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.517","SUP","Custom 27803010","","155.517  -  6.35MM STRAIGHT ROD, HEX END, 200MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.519","SUP","Custom 27803010","","155.519  -  6.35MM STRAIGHT ROD, HEX END, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.52","SUP","Custom 27803010","","155.520  -  6.35MM STRAIGHT ROD, HEX END, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.521","SUP","Custom 27803010","","155.521  -  6.35MM STRAIGHT ROD, HEX END, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.53","SUP","Custom 27803010","","155.530  -  6.35MM STRAIGHT ROD, 30MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.535","SUP","Custom 27803010","","155.535  -  6.35MM STRAIGHT ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.54","SUP","Custom 27803010","","155.540  -  6.35MM STRAIGHT ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.545","SUP","Custom 27803010","","155.545  -  6.35MM STRAIGHT ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.55","SUP","Custom 27803010","","155.550  -  6.35MM STRAIGHT ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.555","SUP","Custom 27803010","","155.555  -  6.35MM STRAIGHT ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.56","SUP","Custom 27803010","","155.560  -  6.35MM STRAIGHT ROD, 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.565","SUP","Custom 27803010","","155.565  -  6.35MM STRAIGHT ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.57","SUP","Custom 27803010","","155.570  -  6.35MM STRAIGHT ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.575","SUP","Custom 27803010","","155.575  -  6.35MM STRAIGHT ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.58","SUP","Custom 27803010","","155.580  -  6.35MM STRAIGHT ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.585","SUP","Custom 27803010","","155.585  -  6.35MM STRAIGHT ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.61","SUP","Custom 27803010","","155.610  -  6.35MM CURVED ROD, 100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.635","SUP","Custom 27803010","","155.635  -  6.35MM CURVED ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.64","SUP","Custom 27803010","","155.640  -  6.35MM CURVED ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.645","SUP","Custom 27803010","","155.645  -  6.35MM CURVED ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.65","SUP","Custom 27803010","","155.650  -  6.35MM CURVED ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.655","SUP","Custom 27803010","","155.655  -  6.35MM CURVED ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.66","SUP","Custom 27803010","","155.660  -  6.35MM CURVED ROD, 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.665","SUP","Custom 27803010","","155.665  -  6.35MM CURVED ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.67","SUP","Custom 27803010","","155.670  -  6.35MM CURVED ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.675","SUP","Custom 27803010","","155.675  -  6.35MM CURVED ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.68","SUP","Custom 27803010","","155.680  -  6.35MM CURVED ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.685","SUP","Custom 27803010","","155.685  -  6.35MM CURVED ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.69","SUP","Custom 27803010","","155.690  -  6.35MM CURVED ROD, 90MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.695","SUP","HCPCS C1713","","155.695  -  6.35MM CURVED ROD, 95MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"155.761","SUP","HCPCS C1713","","155.761  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.762","SUP","HCPCS C1713","","155.762  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.763","SUP","HCPCS C1713","","155.763  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.764","SUP","HCPCS C1713","","155.764  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.765","SUP","HCPCS C1713","","155.765  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.766","SUP","HCPCS C1713","","155.766  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.767","SUP","HCPCS C1713","","155.767  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.768","SUP","HCPCS C1713","","155.768  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.769","SUP","HCPCS C1713","","155.769  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.771","SUP","HCPCS C1713","","155.771  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.772","SUP","HCPCS C1713","","155.772  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.773","SUP","HCPCS C1713","","155.773  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.774","SUP","HCPCS C1713","","155.774  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.775","SUP","HCPCS C1713","","155.775  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.776","SUP","HCPCS C1713","","155.776  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.777","SUP","HCPCS C1713","","155.777  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.778","SUP","HCPCS C1713","","155.778  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.779","SUP","HCPCS C1713","","155.779  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"155.95","SUP","Custom 27803010","","155.950  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 15MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.951","SUP","Custom 27803010","","155.951  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 20MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.952","SUP","Custom 27803010","","155.952  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 25MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.953","SUP","Custom 27803010","","155.953  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 30MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.954","SUP","Custom 27803010","","155.954  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 35MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.96","SUP","Custom 27803010","","155.960  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 15MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.961","SUP","Custom 27803010","","155.961  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 20MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.962","SUP","Custom 27803010","","155.962  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 25MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.963","SUP","Custom 27803010","","155.963  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 30MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.964","SUP","Custom 27803010","","155.964  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 35MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.97","SUP","Custom 27803010","","155.970  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 15MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.971","SUP","Custom 27803010","","155.971  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 20MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.972","SUP","Custom 27803010","","155.972  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 25MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.973","SUP","Custom 27803010","","155.973  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 30MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.974","SUP","Custom 27803010","","155.974  -  BEACON 6.35 OFFSET CONNECTOR, OPEN, 35MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.98","SUP","Custom 27803010","","155.980  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 15MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.981","SUP","Custom 27803010","","155.981  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 20MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.982","SUP","Custom 27803010","","155.982  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 25MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.983","SUP","Custom 27803010","","155.983  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 30MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"155.984","SUP","Custom 27803010","","155.984  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 35MM","BOTH IP/OP","$1,410.00 ","$1,043.40 ","$0.00 ","$1,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,410.00 ","$0.00 ","$705.00 ","$1,116.72 ","$1,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"170.051","SUP","HCPCS C1713","","170.051  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.052","SUP","HCPCS C1713","","170.052  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.053","SUP","HCPCS C1713","","170.053  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.054","SUP","HCPCS C1713","","170.054  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.055","SUP","HCPCS C1713","","170.055  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.056","SUP","HCPCS C1713","","170.056  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.057","SUP","HCPCS C1713","","170.057  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.141","SUP","HCPCS C1713","","170.141  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.142","SUP","HCPCS C1713","","170.142  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.143","SUP","HCPCS C1713","","170.143  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.144","SUP","HCPCS C1713","","170.144  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.145","SUP","HCPCS C1713","","170.145  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.146","SUP","HCPCS C1713","","170.146  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.147","SUP","HCPCS C1713","","170.147  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.151","SUP","HCPCS C1713","","170.151  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.152","SUP","HCPCS C1713","","170.152  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.153","SUP","HCPCS C1713","","170.153  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.154","SUP","HCPCS C1713","","170.154  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.155","SUP","HCPCS C1713","","170.155  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.156","SUP","HCPCS C1713","","170.156  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.157","SUP","HCPCS C1713","","170.157  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.161","SUP","HCPCS C1713","","170.161  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.162","SUP","HCPCS C1713","","170.162  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.163","SUP","HCPCS C1713","","170.163  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.164","SUP","HCPCS C1713","","170.164  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.165","SUP","HCPCS C1713","","170.165  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.166","SUP","HCPCS C1713","","170.166  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"170.167","SUP","HCPCS C1713","","170.167  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.012","SUP","HCPCS C1713","","171.012  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.014","SUP","HCPCS C1713","","171.014  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.016","SUP","HCPCS C1713","","171.016  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.113","SUP","HCPCS C1713","","171.113  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 13MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.115","SUP","HCPCS C1713","","171.115  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 15MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.117","SUP","HCPCS C1713","","171.117  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 17MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.119","SUP","HCPCS C1713","","171.119  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 19MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.121","SUP","HCPCS C1713","","171.121  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 21MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.123","SUP","HCPCS C1713","","171.123  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 23MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.125","SUP","HCPCS C1713","","171.125  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.163","SUP","HCPCS C1713","","171.163  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 13MM, EXTRA LORDOTIC","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.165","SUP","HCPCS C1713","","171.165  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 15MM, EXTRA LORDOTIC","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.167","SUP","HCPCS C1713","","171.167  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 17MM, EXTRA LORDOTIC","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.169","SUP","HCPCS C1713","","171.169  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 19MM, EXTRA LORDOTIC","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"171.226","SUP","HCPCS C1713","","171.226  -  VIP CERVICAL PLATE 2-LEVEL, 26MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.228","SUP","HCPCS C1713","","171.228  -  VIP CERVICAL PLATE 2-LEVEL, 28MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.23","SUP","HCPCS C1713","","171.230  -  VIP CERVICAL PLATE 2-LEVEL, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.232","SUP","HCPCS C1713","","171.232  -  VIP CERVICAL PLATE 2-LEVEL, 32MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.234","SUP","HCPCS C1713","","171.234  -  VIP CERVICAL PLATE 2-LEVEL, 34MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.236","SUP","HCPCS C1713","","171.236  -  VIP CERVICAL PLATE 2-LEVEL, 36MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.238","SUP","HCPCS C1713","","171.238  -  VIP CERVICAL PLATE 2-LEVEL, 38MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.24","SUP","HCPCS C1713","","171.240  -  VIP CERVICAL PLATE 2-LEVEL, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.242","SUP","HCPCS C1713","","171.242  -  VIP CERVICAL PLATE 2-LEVEL, 42MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.244","SUP","HCPCS C1713","","171.244  -  VIP CERVICAL PLATE 2-LEVEL, 44MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.246","SUP","HCPCS C1713","","171.246  -  VIP CERVICAL PLATE 2-LEVEL, 46MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.276","SUP","HCPCS C1713","","171.276  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 26MM, EXTRA LORDOTIC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.278","SUP","HCPCS C1713","","171.278  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 28MM, EXTRA LORDOTIC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.28","SUP","HCPCS C1713","","171.280  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 30MM, EXTRA LORDOTIC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.282","SUP","HCPCS C1713","","171.282  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 32MM, EXTRA LORDOTIC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"171.312","SUP","HCPCS C1713","","171.312  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.314","SUP","HCPCS C1713","","171.314  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.316","SUP","HCPCS C1713","","171.316  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.318","SUP","HCPCS C1713","","171.318  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.32","SUP","HCPCS C1713","","171.320  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.322","SUP","HCPCS C1713","","171.322  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.324","SUP","HCPCS C1713","","171.324  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.326","SUP","HCPCS C1713","","171.326  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.412","SUP","HCPCS C1713","","171.412  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.414","SUP","HCPCS C1713","","171.414  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.416","SUP","HCPCS C1713","","171.416  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.512","SUP","HCPCS C1713","","171.512  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.514","SUP","HCPCS C1713","","171.514  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.516","SUP","HCPCS C1713","","171.516  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.518","SUP","HCPCS C1713","","171.518  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.52","SUP","HCPCS C1713","","171.520  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.522","SUP","HCPCS C1713","","171.522  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.524","SUP","HCPCS C1713","","171.524  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.526","SUP","HCPCS C1713","","171.526  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.612","SUP","HCPCS C1713","","171.612  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.614","SUP","HCPCS C1713","","171.614  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.616","SUP","HCPCS C1713","","171.616  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.712","SUP","HCPCS C1713","","171.712  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.714","SUP","HCPCS C1713","","171.714  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.716","SUP","HCPCS C1713","","171.716  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.718","SUP","HCPCS C1713","","171.718  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.72","SUP","HCPCS C1713","","171.720  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.722","SUP","HCPCS C1713","","171.722  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.724","SUP","HCPCS C1713","","171.724  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.726","SUP","HCPCS C1713","","171.726  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.812","SUP","HCPCS C1713","","171.812  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.814","SUP","HCPCS C1713","","171.814  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.816","SUP","HCPCS C1713","","171.816  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.912","SUP","HCPCS C1713","","171.912  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.914","SUP","HCPCS C1713","","171.914  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.916","SUP","HCPCS C1713","","171.916  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.918","SUP","HCPCS C1713","","171.918  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.92","SUP","HCPCS C1713","","171.920  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.922","SUP","HCPCS C1713","","171.922  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 22MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.924","SUP","HCPCS C1713","","171.924  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 24MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"171.926","SUP","HCPCS C1713","","171.926  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 26MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"172.511","SUP","Custom 27803010","","172.511  -  H-LINK 05.5MM ROD, 38MM-51MM X 40MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.512","SUP","Custom 27803010","","172.512  -  H-LINK 05.5MM ROD, 48MM-61MM X 40MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.513","SUP","Custom 27803010","","172.513  -  H-LINK 05.5MM ROD, 58MM-71MM X 40MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.521","SUP","Custom 27803010","","172.521  -  H-LINK 05.5MM ROD, 38MM-51MM X 45MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.522","SUP","Custom 27803010","","172.522  -  H-LINK 05.5MM ROD, 48MM-61MM X 45MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.523","SUP","Custom 27803010","","172.523  -  H-LINK 05.5MM ROD, 58MM-71MM X 45MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.531","SUP","Custom 27803010","","172.531  -  H-LINK 05.5MM ROD, 38MM-51MM X 35MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.532","SUP","Custom 27803010","","172.532  -  H-LINK 05.5MM ROD, 48MM-61MM X 35MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.533","SUP","Custom 27803010","","172.533  -  H-LINK 05.5MM ROD, 58MM-71MM X 35MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.581","SUP","Custom 27803010","","172.581  -  H-LINK 05.5MM ROD, 38MM-51MM X 100MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.582","SUP","Custom 27803010","","172.582  -  H-LINK 05.5MM ROD, 48MM-61MM X 100MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.583","SUP","Custom 27803010","","172.583  -  H-LINK 05.5MM ROD, 58MM-71MM X 100MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.611","SUP","Custom 27803010","","172.611  -  H-LINK 06.35MM ROD, 38MM-51MM X 40MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.612","SUP","Custom 27803010","","172.612  -  H-LINK 06.35MM ROD, 48MM-61MM X 40MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.613","SUP","Custom 27803010","","172.613  -  H-LINK 06.35MM ROD, 58MM-71MM X 40MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.621","SUP","Custom 27803010","","172.621  -  H-LINK 06.35MM ROD, 38MM-51MM X 45MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.622","SUP","Custom 27803010","","172.622  -  H-LINK 06.35MM ROD, 48MM-61MM X 45MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.623","SUP","Custom 27803010","","172.623  -  H-LINK 06.35MM ROD, 58MM-71MM X 45MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.681","SUP","Custom 27803010","","172.681  -  H-LINK 06.35MM ROD, 38MM-51MM X 100MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.682","SUP","Custom 27803010","","172.682  -  H-LINK 06.35MM ROD, 48MM-61MM X 100MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"172.683","SUP","Custom 27803010","","172.683  -  H-LINK 06.35MM ROD, 58MM-71MM X 100MM","BOTH IP/OP","$5,527.50 ","$4,090.35 ","$0.00 ","$5,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,527.50 ","$0.00 ","$2,763.75 ","$4,377.78 ","$4,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"176.12","SUP","HCPCS C1713","","176.120  -  BONE SCREW, FIXED ANGLE 5.5MM, 20MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.125","SUP","HCPCS C1713","","176.125  -  BONE SCREW, FIXED ANGLE 5.5MM, 25MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.13","SUP","HCPCS C1713","","176.130  -  BONE SCREW, FIXED ANGLE 5.5MM, 30MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.135","SUP","HCPCS C1713","","176.135  -  BONE SCREW, FIXED ANGLE 5.5MM, 35MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.14","SUP","HCPCS C1713","","176.140  -  BONE SCREW, FIXED ANGLE 5.5MM, 40MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.145","SUP","HCPCS C1713","","176.145  -  BONE SCREW, FIXED ANGLE 5.5MM, 45MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.15","SUP","HCPCS C1713","","176.150  -  BONE SCREW, FIXED ANGLE 5.5MM, 50MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.22","SUP","HCPCS C1713","","176.220  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 20MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.225","SUP","HCPCS C1713","","176.225  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 25MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.23","SUP","HCPCS C1713","","176.230  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 30MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.235","SUP","HCPCS C1713","","176.235  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 35MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.24","SUP","HCPCS C1713","","176.240  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 40MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.245","SUP","HCPCS C1713","","176.245  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 45MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"176.25","SUP","HCPCS C1713","","176.250  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 50MM","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"182.222","SUP","HCPCS C1713","","182.222  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.224","SUP","HCPCS C1713","","182.224  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 24MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.226","SUP","HCPCS C1713","","182.226  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.228","SUP","HCPCS C1713","","182.228  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.23","SUP","HCPCS C1713","","182.230  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.232","SUP","HCPCS C1713","","182.232  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.234","SUP","HCPCS C1713","","182.234  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.236","SUP","HCPCS C1713","","182.236  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 36MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.308","SUP","HCPCS C1713","","182.308  -  3.5MM ELLIPSE POLYAXIAL SCREW, 8MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.31","SUP","HCPCS C1713","","182.310  -  3.5MM ELLIPSE POLYAXIAL SCREW, 10MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.312","SUP","HCPCS C1713","","182.312  -  3.5MM ELLIPSE POLYAXIAL SCREW, 12MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.314","SUP","HCPCS C1713","","182.314  -  3.5MM ELLIPSE POLYAXIAL SCREW, 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.316","SUP","HCPCS C1713","","182.316  -  3.5MM ELLIPSE POLYAXIAL SCREW, 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.318","SUP","HCPCS C1713","","182.318  -  3.5MM ELLIPSE POLYAXIAL SCREW, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.32","SUP","HCPCS C1713","","182.320  -  3.5MM ELLIPSE POLYAXIAL SCREW, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.322","SUP","HCPCS C1713","","182.322  -  3.5MM ELLIPSE POLYAXIAL SCREW, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.324","SUP","HCPCS C1713","","182.324  -  3.5MM ELLIPSE POLYAXIAL SCREW, 24MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.326","SUP","HCPCS C1713","","182.326  -  3.5MM ELLIPSE POLYAXIAL SCREW, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.328","SUP","HCPCS C1713","","182.328  -  3.5MM ELLIPSE POLYAXIAL SCREW, 28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.33","SUP","HCPCS C1713","","182.330  -  3.5MM ELLIPSE POLYAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.332","SUP","HCPCS C1713","","182.332  -  3.5MM ELLIPSE POLYAXIAL SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.334","SUP","HCPCS C1713","","182.334  -  3.5MM ELLIPSE POLYAXIAL SCREW, 34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.336","SUP","HCPCS C1713","","182.336  -  3.5MM ELLIPSE POLYAXIAL SCREW, 36MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.338","SUP","HCPCS C1713","","182.338  -  3.5MM ELLIPSE POLYAXIAL SCREW, 38MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.34","SUP","HCPCS C1713","","182.340  -  3.5MM ELLIPSE POLYAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.342","SUP","HCPCS C1713","","182.342  -  3.5MM ELLIPSE POLYAXIAL SCREW, 42MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.344","SUP","HCPCS C1713","","182.344  -  3.5MM ELLIPSE POLYAXIAL SCREW, 44MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.346","SUP","HCPCS C1713","","182.346  -  3.5MM ELLIPSE POLYAXIAL SCREW, 46MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.348","SUP","HCPCS C1713","","182.348  -  3.5MM ELLIPSE POLYAXIAL SCREW, 48MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.35","SUP","HCPCS C1713","","182.350  -  3.5MM ELLIPSE POLYAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.41","SUP","HCPCS C1713","","182.410  -  4.0MM ELLIPSE POLYAXIAL SCREW, 10MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.412","SUP","HCPCS C1713","","182.412  -  4.0MM ELLIPSE POLYAXIAL SCREW, 12MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.414","SUP","HCPCS C1713","","182.414  -  4.0MM ELLIPSE POLYAXIAL SCREW, 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.416","SUP","HCPCS C1713","","182.416  -  4.0MM ELLIPSE POLYAXIAL SCREW, 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.418","SUP","HCPCS C1713","","182.418  -  4.0MM ELLIPSE POLYAXIAL SCREW, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.42","SUP","HCPCS C1713","","182.420  -  4.0MM ELLIPSE POLYAXIAL SCREW, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.422","SUP","HCPCS C1713","","182.422  -  4.0MM ELLIPSE POLYAXIAL SCREW, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.424","SUP","HCPCS C1713","","182.424  -  4.0MM ELLIPSE POLYAXIAL SCREW, 24MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.426","SUP","HCPCS C1713","","182.426  -  4.0MM ELLIPSE POLYAXIAL SCREW, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.428","SUP","HCPCS C1713","","182.428  -  4.0MM ELLIPSE POLYAXIAL SCREW, 28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.43","SUP","HCPCS C1713","","182.430  -  4.0MM ELLIPSE POLYAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.432","SUP","HCPCS C1713","","182.432  -  4.0MM ELLIPSE POLYAXIAL SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.434","SUP","HCPCS C1713","","182.434  -  4.0MM ELLIPSE POLYAXIAL SCREW, 34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.436","SUP","HCPCS C1713","","182.436  -  4.0MM ELLIPSE POLYAXIAL SCREW, 36MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.438","SUP","HCPCS C1713","","182.438  -  4.0MM ELLIPSE POLYAXIAL SCREW, 38MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.44","SUP","HCPCS C1713","","182.440  -  4.0MM ELLIPSE POLYAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.442","SUP","HCPCS C1713","","182.442  -  4.0MM ELLIPSE POLYAXIAL SCREW, 42MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.444","SUP","HCPCS C1713","","182.444  -  4.0MM ELLIPSE POLYAXIAL SCREW, 44MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.446","SUP","HCPCS C1713","","182.446  -  4.0MM ELLIPSE POLYAXIAL SCREW, 46MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.448","SUP","HCPCS C1713","","182.448  -  4.0MM ELLIPSE POLYAXIAL SCREW, 48MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.45","SUP","HCPCS C1713","","182.450  -  4.0MM ELLIPSE POLYAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.5","SUP","HCPCS C1713","","182.500  -  ELLIPSE LOCKING CAP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"182.501","SUP","Custom 27803010","","182.501  -  ELLIPSE INLINE HOOK","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.503","SUP","Custom 27803010","","182.503  -  ELLIPSE INLINE HOOK, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.504","SUP","Custom 27803010","","182.504  -  ELLIPSE INLINE HOOK, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.506","SUP","Custom 27803010","","182.506  -  ELLIPSE OFFSET HOOK, LEFT, 7MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.507","SUP","Custom 27803010","","182.507  -  ELLIPSE OFFSET HOOK, LEFT, 5MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.508","SUP","Custom 27803010","","182.508  -  ELLIPSE OFFSET HOOK, RIGHT, 7MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.509","SUP","Custom 27803010","","182.509  -  ELLIPSE OFFSET HOOK, RIGHT, 5MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.51","SUP","HCPCS C1713","","182.510  -  4.5MM ELLIPSE POLYAXIAL SCREW, 10MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.512","SUP","HCPCS C1713","","182.512  -  4.5MM ELLIPSE POLYAXIAL SCREW, 12MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.514","SUP","HCPCS C1713","","182.514  -  4.5MM ELLIPSE POLYAXIAL SCREW, 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.516","SUP","HCPCS C1713","","182.516  -  4.5MM ELLIPSE POLYAXIAL SCREW, 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.518","SUP","HCPCS C1713","","182.518  -  4.5MM ELLIPSE POLYAXIAL SCREW, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.52","SUP","HCPCS C1713","","182.520  -  4.5MM ELLIPSE POLYAXIAL SCREW, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.522","SUP","HCPCS C1713","","182.522  -  4.5MM ELLIPSE POLYAXIAL SCREW, 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.524","SUP","HCPCS C1713","","182.524  -  4.5MM ELLIPSE POLYAXIAL SCREW, 24MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.526","SUP","HCPCS C1713","","182.526  -  4.5MM ELLIPSE POLYAXIAL SCREW, 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.528","SUP","HCPCS C1713","","182.528  -  4.5MM ELLIPSE POLYAXIAL SCREW, 28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.53","SUP","HCPCS C1713","","182.530  -  4.5MM ELLIPSE POLYAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.532","SUP","HCPCS C1713","","182.532  -  4.5MM ELLIPSE POLYAXIAL SCREW, 32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.534","SUP","HCPCS C1713","","182.534  -  4.5MM ELLIPSE POLYAXIAL SCREW, 34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.536","SUP","HCPCS C1713","","182.536  -  4.5MM ELLIPSE POLYAXIAL SCREW, 36MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.538","SUP","HCPCS C1713","","182.538  -  4.5MM ELLIPSE POLYAXIAL SCREW, 38MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.54","SUP","HCPCS C1713","","182.540  -  4.5MM ELLIPSE POLYAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.542","SUP","HCPCS C1713","","182.542  -  4.5MM ELLIPSE POLYAXIAL SCREW, 42MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.544","SUP","HCPCS C1713","","182.544  -  4.5MM ELLIPSE POLYAXIAL SCREW, 44MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.546","SUP","HCPCS C1713","","182.546  -  4.5MM ELLIPSE POLYAXIAL SCREW, 46MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.548","SUP","HCPCS C1713","","182.548  -  4.5MM ELLIPSE POLYAXIAL SCREW, 48MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.55","SUP","HCPCS C1713","","182.550  -  4.5MM ELLIPSE POLYAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"182.801","SUP","Custom 27803010","","182.801  -  3.5MM ELLIPSE ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.802","SUP","Custom 27803010","","182.802  -  3.5MM ELLIPSE ROD, 120MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.803","SUP","Custom 27803010","","182.803  -  3.5MM ELLIPSE ROD, 240MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.804","SUP","Custom 27803010","","182.804  -  3.5MM ELLIPSE ROD, 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.9","SUP","Custom 27803010","","182.900  -  ELLIPSE LOCKING CAP FOR HEAD-TO-HEAD T-CONNECTOR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.901","SUP","Custom 27803010","","182.901  -  ELLIPSE LOCKING NUT FOR HEAD-TO-HEAD T-CONNECTOR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.911","SUP","Custom 27803010","","182.911  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 21-27MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.912","SUP","Custom 27803010","","182.912  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 27-33MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.913","SUP","Custom 27803010","","182.913  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 33-39MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.914","SUP","Custom 27803010","","182.914  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 39-45MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.915","SUP","Custom 27803010","","182.915  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 45-51MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.916","SUP","Custom 27803010","","182.916  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 51-57MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.917","SUP","Custom 27803010","","182.917  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 57-63MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.923","SUP","Custom 27803010","","182.923  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 21-33, STRAIG","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.924","SUP","Custom 27803010","","182.924  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 26-46, CURVED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.925","SUP","Custom 27803010","","182.925  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 26-46, STRAIG","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.926","SUP","Custom 27803010","","182.926  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 36-56, CURVED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.927","SUP","Custom 27803010","","182.927  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 36-56, STRAIG","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.95","SUP","HCPCS C1713","","182.950  -  ELLIPSE OCCIPITAL PLATE, SMALL","BOTH IP/OP","$7,145.00 ","$5,287.30 ","$0.00 ","$7,145.00 ","$3,215.25 ","$0.00 ","$1,489.20 ","$0.00 ","$0.00 ","$1,251.03 ","$7,145.00 ","$0.00 ","$3,572.50 ","$5,658.84 ","$5,716.00 ","$0.00 ","$1,118.19 ","$0.00 ","$1,137.48 ","$0.00 "
"182.952","SUP","HCPCS C1713","","182.952  -  ELLIPSE OCCIPITAL PLATE, LARGE","BOTH IP/OP","$7,145.00 ","$5,287.30 ","$0.00 ","$7,145.00 ","$3,215.25 ","$0.00 ","$1,489.20 ","$0.00 ","$0.00 ","$1,251.03 ","$7,145.00 ","$0.00 ","$3,572.50 ","$5,658.84 ","$5,716.00 ","$0.00 ","$1,118.19 ","$0.00 ","$1,137.48 ","$0.00 "
"182.953","SUP","Custom 27803010","","182.953  -  ROD SPNL 100D 3.5MM 240MM ELLIPSE OCPTL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.954","SUP","Custom 27803010","","182.954  -  ROD SPNL 115D 3.5MM 240MM ELLIPSE OCPTL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.955","SUP","Custom 27803010","","182.955  -  ROD SPNL 130D 3.5MM 240MM ELLIPSE OCPTL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.96","SUP","Custom 27803010","","182.960  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 3.5MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.961","SUP","Custom 27803010","","182.961  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 4.0MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.962","SUP","Custom 27803010","","182.962  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 4.5MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.963","SUP","Custom 27803010","","182.963  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 5.0MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.964","SUP","Custom 27803010","","182.964  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 5.5MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.965","SUP","Custom 27803010","","182.965  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.0MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.966","SUP","Custom 27803010","","182.966  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.35MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.967","SUP","Custom 27803010","","182.967  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.5MM ROD","BOTH IP/OP","$1,357.50 ","$1,004.55 ","$0.00 ","$1,357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,357.50 ","$0.00 ","$678.75 ","$1,075.14 ","$1,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.975","SUP","Custom 27803010","","182.975  -  ELLIPSE LATERAL CONNECTOR","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.98","SUP","Custom 27803010","","182.980  -  ELLIPSE TAPERED ROD, 3.5MM TO 4.0MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.981","SUP","Custom 27803010","","182.981  -  ELLIPSE TAPERED ROD, 3.5MM TO 4.5MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.982","SUP","Custom 27803010","","182.982  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.0MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.983","SUP","Custom 27803010","","182.983  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.5MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.984","SUP","Custom 27803010","","182.984  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.0MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.985","SUP","Custom 27803010","","182.985  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.35MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.986","SUP","Custom 27803010","","182.986  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.5MM, 350MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.989","SUP","Custom 27803010","","182.989  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.5MM, 500MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.99","SUP","Custom 27803010","","182.990  -  ELLIPSE LATERAL CONNECTOR, LONG","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"182.991","SUP","Custom 27803010","","182.991  -  ELLIPSE LATERAL CONNECTOR, SHORT","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"184.012","SUP","HCPCS C1713","","184.012  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.014","SUP","HCPCS C1713","","184.014  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.016","SUP","HCPCS C1713","","184.016  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.018","SUP","HCPCS C1713","","184.018  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.02","SUP","HCPCS C1713","","184.020  -  SCREW BN 4.2MM 20MM VA ST SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.032","SUP","HCPCS C1713","","184.032  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.034","SUP","HCPCS C1713","","184.034  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.036","SUP","HCPCS C1713","","184.036  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.038","SUP","HCPCS C1713","","184.038  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.04","SUP","HCPCS C1713","","184.040  -  SCREW BN 4.2MM 20MM FX ANG ST SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.052","SUP","HCPCS C1713","","184.052  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.054","SUP","HCPCS C1713","","184.054  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.056","SUP","HCPCS C1713","","184.056  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.058","SUP","HCPCS C1713","","184.058  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.06","SUP","HCPCS C1713","","184.060  -  SCREW BN 4.2MM 20MM VA SLF DRL SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.072","SUP","HCPCS C1713","","184.072  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.074","SUP","HCPCS C1713","","184.074  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.076","SUP","HCPCS C1713","","184.076  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.078","SUP","HCPCS C1713","","184.078  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.08","SUP","HCPCS C1713","","184.080  -  SCREW BN 4.2MM 20MM FX ANG SLF DRL SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.112","SUP","HCPCS C1713","","184.112  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.114","SUP","HCPCS C1713","","184.114  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.116","SUP","HCPCS C1713","","184.116  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.118","SUP","HCPCS C1713","","184.118  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.12","SUP","HCPCS C1713","","184.120  -  SCREW BN 3.6MM 20MM VA ST SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.132","SUP","HCPCS C1713","","184.132  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.134","SUP","HCPCS C1713","","184.134  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.136","SUP","HCPCS C1713","","184.136  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.138","SUP","HCPCS C1713","","184.138  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.14","SUP","HCPCS C1713","","184.140  -  SCREW BN 3.6MM 20MM FX ANG ST SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.152","SUP","HCPCS C1713","","184.152  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.154","SUP","HCPCS C1713","","184.154  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.156","SUP","HCPCS C1713","","184.156  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.158","SUP","HCPCS C1713","","184.158  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.16","SUP","HCPCS C1713","","184.160  -  SCREW BN 3.6MM 20MM VA SLF DRL SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.172","SUP","HCPCS C1713","","184.172  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 12MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.174","SUP","HCPCS C1713","","184.174  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 14MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.176","SUP","HCPCS C1713","","184.176  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 16MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.178","SUP","HCPCS C1713","","184.178  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 18MM","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"184.18","SUP","HCPCS C1713","","184.180  -  SCREW BN 3.6MM 20MM FX ANG SLF DRL SPNE","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"185","SUP","HCPCS C1713","","185.000  -  REVOLVE LOCKING CAP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"185.081","SUP","HCPCS C1713","","185.081  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.082","SUP","HCPCS C1713","","185.082  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.083","SUP","HCPCS C1713","","185.083  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.084","SUP","HCPCS C1713","","185.084  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.085","SUP","HCPCS C1713","","185.085  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.24","SUP","Custom 27803010","","185.240  -  5.5MM REVOLVE ROD, 40MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.245","SUP","Custom 27803010","","185.245  -  5.5MM REVOLVE ROD, 45MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.25","SUP","Custom 27803010","","185.250  -  5.5MM REVOLVE ROD, 50MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.255","SUP","Custom 27803010","","185.255  -  5.5MM REVOLVE ROD, 55MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.26","SUP","Custom 27803010","","185.260  -  5.5MM REVOLVE ROD, 60MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.265","SUP","Custom 27803010","","185.265  -  5.5MM REVOLVE ROD, 65MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.27","SUP","Custom 27803010","","185.270  -  5.5MM REVOLVE ROD, 70MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.275","SUP","Custom 27803010","","185.275  -  5.5MM REVOLVE ROD, 75MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.28","SUP","Custom 27803010","","185.280  -  5.5MM REVOLVE ROD, 80MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.29","SUP","Custom 27803010","","185.290  -  5.5MM REVOLVE ROD, 90MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.3","SUP","Custom 27803010","","185.300  -  5.5MM REVOLVE ROD, 100MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.31","SUP","Custom 27803010","","185.310  -  5.5MM REVOLVE ROD, 110MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.32","SUP","Custom 27803010","","185.320  -  5.5MM REVOLVE ROD, 120MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.33","SUP","Custom 27803010","","185.330  -  5.5MM REVOLVE ROD, 130MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.34","SUP","Custom 27803010","","185.340  -  5.5MM REVOLVE ROD, 140MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.35","SUP","Custom 27803010","","185.350  -  5.5MM REVOLVE ROD, 150MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.36","SUP","Custom 27803010","","185.360  -  5.5MM REVOLVE ROD, 160MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.37","SUP","Custom 27803010","","185.370  -  5.5MM REVOLVE ROD, 170MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.38","SUP","Custom 27803010","","185.380  -  5.5MM REVOLVE ROD, 180MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.39","SUP","Custom 27803010","","185.390  -  5.5MM REVOLVE ROD, 190MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.4","SUP","Custom 27803010","","185.400  -  5.5MM REVOLVE ROD, 200MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.41","SUP","Custom 27803010","","185.410  -  5.5MM REVOLVE ROD, 210MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.42","SUP","Custom 27803010","","185.420  -  5.5MM REVOLVE ROD, 220MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.43","SUP","Custom 27803010","","185.430  -  5.5MM REVOLVE ROD, 230MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.44","SUP","Custom 27803010","","185.440  -  5.5MM REVOLVE ROD, 240MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"185.451","SUP","HCPCS C1713","","185.451  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.452","SUP","HCPCS C1713","","185.452  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.453","SUP","HCPCS C1713","","185.453  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.454","SUP","HCPCS C1713","","185.454  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.455","SUP","HCPCS C1713","","185.455  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.456","SUP","HCPCS C1713","","185.456  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.457","SUP","HCPCS C1713","","185.457  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.461","SUP","HCPCS C1713","","185.461  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.462","SUP","HCPCS C1713","","185.462  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.463","SUP","HCPCS C1713","","185.463  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.464","SUP","HCPCS C1713","","185.464  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.465","SUP","HCPCS C1713","","185.465  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.466","SUP","HCPCS C1713","","185.466  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.467","SUP","HCPCS C1713","","185.467  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.468","SUP","HCPCS C1713","","185.468  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.469","SUP","HCPCS C1713","","185.469  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.471","SUP","HCPCS C1713","","185.471  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.472","SUP","HCPCS C1713","","185.472  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.473","SUP","HCPCS C1713","","185.473  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.474","SUP","HCPCS C1713","","185.474  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.475","SUP","HCPCS C1713","","185.475  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.476","SUP","HCPCS C1713","","185.476  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.477","SUP","HCPCS C1713","","185.477  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.478","SUP","HCPCS C1713","","185.478  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.479","SUP","HCPCS C1713","","185.479  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.481","SUP","HCPCS C1713","","185.481  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.482","SUP","HCPCS C1713","","185.482  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.483","SUP","HCPCS C1713","","185.483  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.484","SUP","HCPCS C1713","","185.484  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.485","SUP","HCPCS C1713","","185.485  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.486","SUP","HCPCS C1713","","185.486  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.487","SUP","HCPCS C1713","","185.487  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.488","SUP","HCPCS C1713","","185.488  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.489","SUP","HCPCS C1713","","185.489  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"185.5","SUP","Custom 27803010","","185.500  -  5.5MM REVOLVE ROD, 300MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"192.142","SUP","HCPCS C1768","","STENT URET 7FR 24CM WO GUIDEWIRE DUAL DRMTR PLRS UL HDR+","BOTH IP/OP","$356.40 ","$263.74 ","$0.00 ","$356.40 ","$160.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.40 ","$356.40 ","$0.00 ","$178.20 ","$282.27 ","$285.12 ","$0.00 ","$55.78 ","$0.00 ","$56.74 ","$0.00 "
"198","SUP","Custom 27203010","","198  -  CATHETER SUCTION 8FR 2.6MM 12IN SOFT Y ADAPTER TACTILE","BOTH IP/OP","$32.35 ","$23.94 ","$0.00 ","$32.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.35 ","$0.00 ","$16.18 ","$25.62 ","$25.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.006","SUP","HCPCS C1713","","200.006  -  SCREW BONE STANDARD 1.5MM 3MM 6MM CRCIFRM RECESS DCP","BOTH IP/OP","$54.45 ","$40.29 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.35 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$7.04 ","$0.00 ","$8.42 ","$0.00 "
"200.007","SUP","HCPCS C1713","","200.007  -  SCREW BONE STANDARD 1.5MM 3MM 7MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.008","SUP","HCPCS C1713","","200.008  -  SCREW BONE STANDARD 1.5MM 3MM 8MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.009","SUP","HCPCS C1713","","200.009  -  SCREW BONE STANDARD 1.5MM 3MM 9MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.01","SUP","HCPCS C1713","","200.010  -  SCREW BONE STANDARD 1.5MM 10MM CRCIFRM RECESS DCP STAINLESS","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.011","SUP","HCPCS C1713","","200.011  -  SCREW BONE STANDARD 1.5MM 3MM 11MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.012","SUP","HCPCS C1713","","200.012  -  SCREW BONE STANDARD 1.5MM 3MM 12MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.014","SUP","HCPCS C1713","","200.014  -  SCREW BONE STANDARD 1.5MM 3MM 14MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.016","SUP","HCPCS C1713","","200.016  -  SCREW BONE STANDARD 1.5MM 3MM 16MM CRCIFRM RECESS DCP","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"200.018","SUP","HCPCS C1713","","200.018  -  SCREW BONE STANDARD 1.5MM 3MM 18MM CRCIFRM RECESS DCP","BOTH IP/OP","$51.33 ","$37.98 ","$0.00 ","$51.33 ","$23.10 ","$0.00 ","$10.70 ","$0.00 ","$0.00 ","$8.99 ","$51.33 ","$0.00 ","$25.66 ","$40.65 ","$41.06 ","$0.00 ","$8.03 ","$0.00 ","$8.17 ","$0.00 "
"200.02","SUP","HCPCS C1713","","200.020  -  SCREW BONE STANDARD 1.5MM 3MM 20MM CRCIFRM RECESS DCP","BOTH IP/OP","$51.33 ","$37.98 ","$0.00 ","$51.33 ","$23.10 ","$0.00 ","$10.70 ","$0.00 ","$0.00 ","$8.99 ","$51.33 ","$0.00 ","$25.66 ","$40.65 ","$41.06 ","$0.00 ","$8.03 ","$0.00 ","$8.17 ","$0.00 "
"200.19","SUP","Custom 27203010","","200.190  -  PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS LCP","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.191","SUP","Custom 27203010","","200.191  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.192","SUP","Custom 27203010","","200.192  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.193","SUP","Custom 27203010","","200.193  -  PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.195","SUP","Custom 27203010","","200.195  -  PIN FIX ROUND 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS SMOOTH","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.197","SUP","Custom 27203010","","200.197  -  PIN FIX 1.8MM 24MM BUTTRESS STARDRIVE STAINLESS STEEL","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.198","SUP","Custom 27203010","","200.198  -  PIN FIX 1.8MM 26MM BUTTRESS STARDRIVE STAINLESS STEEL","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.199","SUP","Custom 27203010","","200.199  -  PIN FIX 1.8MM 28MM BUTTRESS STARDRIVE STAINLESS STEEL","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200.526","SUP","HCPCS C1713","","200.526  -  SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM LP HEAD STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.527","SUP","HCPCS C1713","","200.527  -  SCREW BONE LP 1MM 1.6MM 7MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.528","SUP","HCPCS C1713","","200.528  -  SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM LP HEAD STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.529","SUP","HCPCS C1713","","200.529  -  SCREW BONE LP 1MM 1.6MM 9MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.53","SUP","HCPCS C1713","","200.530  -  SCREW BONE LP 1MM 1.6MM 10MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$133.05 ","$98.46 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$27.73 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.531","SUP","HCPCS C1713","","200.531  -  SCREW BONE LP 1MM 1.6MM 11MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.532","SUP","HCPCS C1713","","200.532  -  SCREW BONE LP 1MM 1.6MM 12MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.533","SUP","HCPCS C1713","","200.533  -  SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM LP HEAD STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.534","SUP","HCPCS C1713","","200.534  -  SCREW BONE LP 1MM 1.6MM 14MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"200.686","SUP","HCPCS C1713","","200.686  -  SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM RECESS LP HEAD","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.687","SUP","HCPCS C1713","","200.687  -  SCREW BONE LP 1.3MM 2.4MM 7MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.688","SUP","HCPCS C1713","","200.688  -  SCREW BONE LP 1.3MM 2.4MM 8MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.689","SUP","HCPCS C1713","","200.689  -  SCREW BONE LP 1.3MM 2.4MM 9MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.69","SUP","HCPCS C1713","","200.690  -  SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS LP HEAD","BOTH IP/OP","$139.20 ","$103.01 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.01 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.691","SUP","HCPCS C1713","","200.691  -  SCREW BONE LP 1.3MM 2.4MM 11MM SELF TAP CRCIFRM DCP","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.692","SUP","HCPCS C1713","","200.692  -  SCREW BONE LP 1.3MM 2.4MM 12MM SELF TAP CRCIFRM DCP","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.693","SUP","HCPCS C1713","","200.693  -  SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM LP HEAD","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.694","SUP","HCPCS C1713","","200.694  -  SCREW BONE LP 1.3MM 2.4MM 14MM SELF TAP CRCIFRM DCP","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.696","SUP","HCPCS C1713","","200.696  -  SCREW BONE LP 1.3MM 2.4MM 16MM SELF TAP CRCIFRM DCP","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.698","SUP","HCPCS C1713","","200.698  -  SCREW BONE LP 1.3MM 2.4MM 18MM SELF TAP CRCIFRM DCP","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"200.806","SUP","HCPCS C1713","","200.806  -  SCREW BONE LP 1.5MM 3MM 6MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.807","SUP","HCPCS C1713","","200.807  -  SCREW BONE LP 1.5MM 3MM 7MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.808","SUP","HCPCS C1713","","200.808  -  SCREW BONE LP 1.5MM 3MM 8MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.809","SUP","HCPCS C1713","","200.809  -  SCREW BONE LP 1.5MM 3MM 9MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.81","SUP","HCPCS C1713","","200.810  -  SCREW BONE LP 1.5MM 3MM 10MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.30 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.811","SUP","HCPCS C1713","","200.811  -  SCREW BONE LP 1.5MM 3MM 11MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.812","SUP","HCPCS C1713","","200.812  -  SCREW BONE LP 1.5MM 3MM 12MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.813","SUP","HCPCS C1713","","200.813  -  SCREW BONE LP 1.5MM 3MM 13MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.814","SUP","HCPCS C1713","","200.814  -  SCREW BONE LP 1.5MM 3MM 14MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.816","SUP","HCPCS C1713","","200.816  -  SCREW BONE LP 1.5MM 3MM 16MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.818","SUP","HCPCS C1713","","200.818  -  SCREW BONE LP 1.5MM 3MM 18MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.45 ","$0.00 ","$9.40 ","$0.00 "
"200.82","SUP","HCPCS C1713","","200.820  -  SCREW BONE LP 1.5MM 3MM 20MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.30 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.822","SUP","HCPCS C1713","","200.822  -  SCREW BONE LP 1.5MM 3MM 22MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"200.824","SUP","HCPCS C1713","","200.824  -  SCREW BONE LP 1.5MM 3MM 24MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.006","SUP","HCPCS C1713","","201.006  -  SCREW BN STD 2MM 3.5MM 6MM NS CRFRM SS CORT MN FRAG SET MDLR","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.04 ","$0.00 ","$8.31 ","$0.00 "
"201.008","SUP","HCPCS C1713","","201.008  -  SCREW BONE STANDARD 2MM 8MM CRCIFRM RECESS DCP STAINLESS","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.04 ","$0.00 ","$8.31 ","$0.00 "
"201.01","SUP","HCPCS C1713","","201.010  -  SCREW BONE STANDARD 2MM 10MM CRCIFRM HEAD DCP STAINLESS","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.04 ","$0.00 ","$8.31 ","$0.00 "
"201.012","SUP","HCPCS C1713","","201.012  -  SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM RECESS DCP","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.04 ","$0.00 ","$8.31 ","$0.00 "
"201.014","SUP","HCPCS C1713","","201.014  -  SCREW BONE STANDARD 2MM 3.5MM 14MM CRCIFRM DCP STAINLESS","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.04 ","$0.00 ","$8.31 ","$0.00 "
"201.016","SUP","HCPCS C1713","","201.016  -  SCREW BONE STANDARD 2MM 3.5MM 16MM CRCIFRM RECESS DCP","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.04 ","$0.00 ","$8.31 ","$0.00 "
"201.018","SUP","HCPCS C1713","","201.018  -  SCREW BONE STANDARD 2MM 18MM CRCIFRM RECESS DCP STAINLESS","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.02","SUP","HCPCS C1713","","201.020  -  SCREW BONE STANDARD 2MM 20MM CRCIFRM RECESS DCP STAINLESS","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.022","SUP","HCPCS C1713","","201.022  -  SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM DCP STAINLESS","BOTH IP/OP","$50.68 ","$37.50 ","$0.00 ","$50.68 ","$22.80 ","$0.00 ","$10.56 ","$0.00 ","$0.00 ","$8.87 ","$50.68 ","$0.00 ","$25.34 ","$40.14 ","$40.54 ","$0.00 ","$7.93 ","$0.00 ","$8.07 ","$0.00 "
"201.024","SUP","HCPCS C1713","","201.024  -  SCREW BONE 2MM 24MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$50.68 ","$37.50 ","$0.00 ","$50.68 ","$22.80 ","$0.00 ","$10.56 ","$0.00 ","$0.00 ","$8.87 ","$50.68 ","$0.00 ","$25.34 ","$40.14 ","$40.54 ","$0.00 ","$7.93 ","$0.00 ","$8.07 ","$0.00 "
"201.026","SUP","HCPCS C1713","","201.026  -  SCREW BONE 2MM 26MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.028","SUP","HCPCS C1713","","201.028  -  SCREW BONE 2MM 28MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.03","SUP","HCPCS C1713","","201.030  -  SCREW BONE 2MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.032","SUP","HCPCS C1713","","201.032  -  SCREW BONE 2MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.034","SUP","HCPCS C1713","","201.034  -  SCREW BONE 2MM 34MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.036","SUP","HCPCS C1713","","201.036  -  SCREW BONE 2MM 36MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.038","SUP","HCPCS C1713","","201.038  -  SCREW BONE 2MM 38MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.04","SUP","HCPCS C1713","","201.040  -  SCREW BONE 2MM 40MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.042","SUP","HCPCS C1713","","201.042  -  SCREW BONE 2MM 42MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.044","SUP","HCPCS C1713","","201.044  -  SCREW BONE 2MM 44MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.046","SUP","HCPCS C1713","","201.046  -  SCREW BONE 2MM 46MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$11.20 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"201.506","SUP","HCPCS C1713","","201.506  -  SCREW BONE 2.4MM 3.5MM 6MM SLFTAP STAINLESS STEEL MAXILLA","BOTH IP/OP","$91.25 ","$67.53 ","$0.00 ","$91.25 ","$41.06 ","$0.00 ","$19.02 ","$0.00 ","$0.00 ","$15.98 ","$91.25 ","$0.00 ","$45.63 ","$72.27 ","$73.00 ","$0.00 ","$14.28 ","$0.00 ","$14.53 ","$0.00 "
"201.508","SUP","HCPCS C1713","","201.508  -  SCREW BONE 2.4MM 3.5MM 8MM SLFTAP STAINLESS STEEL MAXILLA","BOTH IP/OP","$91.25 ","$67.53 ","$0.00 ","$91.25 ","$41.06 ","$0.00 ","$19.02 ","$0.00 ","$0.00 ","$15.98 ","$91.25 ","$0.00 ","$45.63 ","$72.27 ","$73.00 ","$0.00 ","$14.28 ","$0.00 ","$14.53 ","$0.00 "
"201.51","SUP","HCPCS C1713","","201.510  -  SCREW BONE 2.4MM 3.5MM 10MM SLFTAP STAINLESS STEEL MAXILLA","BOTH IP/OP","$91.25 ","$67.53 ","$0.00 ","$91.25 ","$41.06 ","$0.00 ","$19.02 ","$0.00 ","$0.00 ","$15.98 ","$91.25 ","$0.00 ","$45.63 ","$72.27 ","$73.00 ","$0.00 ","$14.28 ","$0.00 ","$14.53 ","$0.00 "
"201.512","SUP","HCPCS C1713","","201.512  -  SCREW SS 12MM 2.4MM CORT MAXL SLFTAP BONE NONSTRL","BOTH IP/OP","$75.38 ","$55.78 ","$0.00 ","$75.38 ","$33.92 ","$0.00 ","$15.71 ","$0.00 ","$0.00 ","$13.20 ","$75.38 ","$0.00 ","$37.69 ","$59.70 ","$60.30 ","$0.00 ","$11.80 ","$0.00 ","$12.00 ","$0.00 "
"201.514","SUP","HCPCS C1713","","201.514  -  SCREW BONE 2.4MM 14MM SLFTAP STAINLESS STEEL MAXILLA","BOTH IP/OP","$91.25 ","$67.53 ","$0.00 ","$91.25 ","$41.06 ","$0.00 ","$19.02 ","$0.00 ","$0.00 ","$15.98 ","$91.25 ","$0.00 ","$45.63 ","$72.27 ","$73.00 ","$0.00 ","$14.28 ","$0.00 ","$14.53 ","$0.00 "
"201.612","SUP","HCPCS C1713","","201.612  -  SCREW BONE 2.4MM 3.5MM 12MM SELF TAP CRCIFRM STAINLESS STEEL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.614","SUP","HCPCS C1713","","201.614  -  SCREW BONE 2.4MM 3.5MM 14MM SELF TAP STAINLESS STEEL CORTEX","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.616","SUP","HCPCS C1713","","201.616  -  SCREW BONE 2.4MM 3.5MM 16MM SELF TAP CRCIFRM LCP STAINLESS","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.618","SUP","HCPCS C1713","","201.618  -  SCREW BONE 2.4MM 3.5MM 18MM SELF TAP CRCIFRM STAINLESS STEEL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.62","SUP","HCPCS C1713","","201.620  -  SCREW BONE 2.4MM 20MM SLFTAP STAINLESS STEEL RAD CORTICAL","BOTH IP/OP","$87.35 ","$64.64 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.21 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.622","SUP","HCPCS C1713","","201.622  -  SCREW BONE 2.4MM 3.5MM 22MM SELF TAP CRCIFRM STAINLESS STEEL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.624","SUP","HCPCS C1713","","201.624  -  SCREW BONE 2.4MM 3.5MM 24MM SELF TAP CRCIFRM STAINLESS STEEL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.626","SUP","HCPCS C1713","","201.626  -  SCREW BONE 2.4MM 3.5MM 26MM SELF TAP CRCIFRM STAINLESS STEEL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.628","SUP","HCPCS C1713","","201.628  -  SCREW BONE 2.4MM 28MM SLFTAP STAINLESS STEEL RAD CORTICAL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.63","SUP","HCPCS C1713","","201.630  -  SCREW BONE 2.4MM 3.5MM 30MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$87.35 ","$64.64 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.21 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.636","SUP","HCPCS C1713","","201.636  -  SCREW BONE CONE LP 2.4MM 4.5MM 6MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$90.08 ","$40.53 ","$0.00 ","$19.34 ","$0.00 ","$0.00 ","$15.77 ","$90.08 ","$0.00 ","$45.04 ","$71.34 ","$72.06 ","$0.00 ","$13.69 ","$0.00 ","$14.34 ","$0.00 "
"201.637","SUP","HCPCS C1713","","201.637  -  SCREW BONE CONE LP 2.4MM 4.5MM 7MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$90.08 ","$40.53 ","$0.00 ","$19.34 ","$0.00 ","$0.00 ","$15.77 ","$90.08 ","$0.00 ","$45.04 ","$71.34 ","$72.06 ","$0.00 ","$13.69 ","$0.00 ","$14.34 ","$0.00 "
"201.638","SUP","HCPCS C1713","","201.638  -  SCREW BONE CONE LP 2.4MM 4.5MM 8MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.639","SUP","HCPCS C1713","","201.639  -  SCREW BONE CONE LP 2.4MM 4.5MM 9MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$90.08 ","$40.53 ","$0.00 ","$19.34 ","$0.00 ","$0.00 ","$15.77 ","$90.08 ","$0.00 ","$45.04 ","$71.34 ","$72.06 ","$0.00 ","$13.69 ","$0.00 ","$14.34 ","$0.00 "
"201.64","SUP","HCPCS C1713","","201.640  -  SCREW BONE CONE LP 2.4MM 4.5MM 10MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$87.35 ","$64.64 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.21 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.641","SUP","HCPCS C1713","","201.641  -  SCREW BONE CONE LP 2.4MM 4.5MM 11MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$90.08 ","$40.53 ","$0.00 ","$19.34 ","$0.00 ","$0.00 ","$15.77 ","$90.08 ","$0.00 ","$45.04 ","$71.34 ","$72.06 ","$0.00 ","$13.69 ","$0.00 ","$14.34 ","$0.00 "
"201.642","SUP","HCPCS C1713","","201.642  -  SCREW BONE CONE LP 2.4MM 4.5MM 12MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.643","SUP","HCPCS C1713","","201.643  -  SCREW BONE CONE LP 2.4MM 4.5MM 13MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$90.08 ","$40.53 ","$0.00 ","$19.34 ","$0.00 ","$0.00 ","$15.77 ","$90.08 ","$0.00 ","$45.04 ","$71.34 ","$72.06 ","$0.00 ","$13.69 ","$0.00 ","$14.34 ","$0.00 "
"201.644","SUP","HCPCS C1713","","201.644  -  SCREW BONE CONE LP 2.4MM 4.5MM 14MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.646","SUP","HCPCS C1713","","201.646  -  SCREW BONE CONE LP 2.4MM 4.5MM 16MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.648","SUP","HCPCS C1713","","201.648  -  SCREW BONE CONE LP 2.4MM 4.5MM 18MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.65","SUP","HCPCS C1713","","201.650  -  SCREW BONE CONE LP 2.4MM 4.5MM 20MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$87.35 ","$64.64 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.21 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.652","SUP","HCPCS C1713","","201.652  -  SCREW BONE CONE LP 2.4MM 4.5MM 22MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.654","SUP","HCPCS C1713","","201.654  -  SCREW BONE CONE LP 2.4MM 4.5MM 24MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.656","SUP","HCPCS C1713","","201.656  -  SCREW BONE CONE LP 2.4MM 4.5MM 26MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.658","SUP","HCPCS C1713","","201.658  -  SCREW BONE CONE LP 2.4MM 4.5MM 28MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.66","SUP","HCPCS C1713","","201.660  -  SCREW BONE CONE LP 2.4MM 4.5MM 30MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$87.35 ","$64.64 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.21 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.662","SUP","HCPCS C1713","","201.662  -  SCREW BONE CONE LP 2.4MM 4.5MM 32MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.664","SUP","HCPCS C1713","","201.664  -  SCREW BONE CONE LP 2.4MM 4.5MM 34MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.666","SUP","HCPCS C1713","","201.666  -  SCREW BONE 2.4MM 4MM 36MM SELF TAP STAINLESS STEEL SMALL","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.668","SUP","HCPCS C1713","","201.668  -  SCREW BONE CONE LP 2.4MM 4.5MM 38MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$89.98 ","$66.59 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.75 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.67","SUP","HCPCS C1713","","201.670  -  SCREW BONE CONE LP 2.4MM 4.5MM 40MM SELF TAP THREAD CRCIFRM","BOTH IP/OP","$87.35 ","$64.64 ","$0.00 ","$87.35 ","$39.31 ","$0.00 ","$18.21 ","$0.00 ","$0.00 ","$15.29 ","$87.35 ","$0.00 ","$43.68 ","$69.18 ","$69.88 ","$0.00 ","$13.27 ","$0.00 ","$13.91 ","$0.00 "
"201.676","SUP","HCPCS C1713","","201.676  -  SCREW BONE 3.5MM HEAD 2.4MM 6MM SLFTAP STAINLESS STEEL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.677","SUP","HCPCS C1713","","201.677  -  SCREW BONE 2.3MM 3.5MM 7MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.678","SUP","HCPCS C1713","","201.678  -  SCREW BONE 3.5MM HEAD 2.4MM 8MM SLFTAP STAINLESS STEEL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.679","SUP","HCPCS C1713","","201.679  -  SCREW BONE 2.3MM 3.5MM 9MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.68","SUP","HCPCS C1713","","201.680  -  CLIP ANEURYSM 10MM OPENING 20X1.88MM SUPER BAYONET LATEX","BOTH IP/OP","$113.28 ","$83.83 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.681","SUP","HCPCS C1713","","201.681  -  SCREW BONE 2.3MM 3.5MM 11MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.683","SUP","HCPCS C1713","","201.683  -  SCREW BONE 3.5MM HEAD 2.4MM 13MM SLFTAP STAINLESS STEEL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.685","SUP","HCPCS C1713","","201.685  -  SCREW BONE 3.5MM HEAD 2.3MM 15MM SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.686","SUP","HCPCS C1713","","201.686  -  SCREW BONE 2.3MM 3.5MM 32MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.687","SUP","HCPCS C1713","","201.687  -  SCREW BONE 2.3MM 3.5MM 34MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.688","SUP","HCPCS C1713","","201.688  -  SCREW BONE 2.3MM 3.5MM 36MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.689","SUP","HCPCS C1713","","201.689  -  SCREW BONE 2.3MM 3.5MM 38MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.69","SUP","HCPCS C1713","","201.690  -  SCREW BONE 3.5MM HEAD 2.3MM 40MM SLFTAP CORTICAL","BOTH IP/OP","$113.28 ","$83.83 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.691","SUP","HCPCS C1713","","201.691  -  SCREW BONE 2.3MM 3.5MM 42MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.692","SUP","HCPCS C1713","","201.692  -  SCREW BONE 2.4MM 44MM SLFTAP STAINLESS STEEL CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.693","SUP","HCPCS C1713","","201.693  -  SCREW BONE 2.3MM 3.5MM 46MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.694","SUP","HCPCS C1713","","201.694  -  SCREW BONE 2.3MM 3.5MM 48MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.695","SUP","HCPCS C1713","","201.695  -  SCREW BONE 3.5MM HEAD 2.3MM 50MM SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.696","SUP","HCPCS C1713","","201.696  -  SCREW BONE 3.5MM HEAD 2.4MM 52MM SLFTAP STAINLESS STEEL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.697","SUP","HCPCS C1713","","201.697  -  SCREW BONE 2.3MM 3.5MM 54MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.698","SUP","HCPCS C1713","","201.698  -  SCREW BONE 3.5MM HEAD 2.4MM 56MM SLFTAP STAINLESS STEEL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.699","SUP","HCPCS C1713","","201.699  -  SCREW BONE 2.3MM 3.5MM 58MM HEAD SLFTAP CORTICAL","BOTH IP/OP","$116.68 ","$86.34 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$24.32 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.7","SUP","HCPCS C1713","","201.700  -  SCREW BONE 2.4MM 3.5MM 60MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$113.28 ","$83.83 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"201.756","SUP","HCPCS C1713","","201.756  -  SCREW BONE T8 LP 2.4MM 4MM 6MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.757","SUP","HCPCS C1713","","201.757  -  SCREW BONE T8 LP 2.4MM 4MM 7MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.758","SUP","HCPCS C1713","","201.758  -  SCREW BONE T8 LP 2.4MM 4MM 8MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.759","SUP","HCPCS C1713","","201.759  -  SCREW BONE T8 LP 2.4MM 4MM 9MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.76","SUP","HCPCS C1713","","201.760  -  SCREW BONE T8 LP 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$102.35 ","$75.74 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.33 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.761","SUP","HCPCS C1713","","201.761  -  SCREW BONE T8 LP 2.4MM 4MM 11MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.762","SUP","HCPCS C1713","","201.762  -  SCREW BONE T8 LP 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.763","SUP","HCPCS C1713","","201.763  -  SCREW BONE T8 LP 2.4MM 4MM 13MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.764","SUP","HCPCS C1713","","201.764  -  SCREW BONE T8 LP 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.766","SUP","HCPCS C1713","","201.766  -  SCREW BONE 2.4MM 4MM 16MM T8 STARDRIVE SELF TAP LP HEAD VAR","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.768","SUP","HCPCS C1713","","201.768  -  SCREW BONE T8 LP 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.77","SUP","HCPCS C1713","","201.770  -  SCREW BONE T8 LP 2.4MM 4MM 20MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$102.35 ","$75.74 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.33 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.772","SUP","HCPCS C1713","","201.772  -  SCREW BONE T8 LP 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.774","SUP","HCPCS C1713","","201.774  -  SCREW BONE T8 LP 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.776","SUP","HCPCS C1713","","201.776  -  SCREW BONE T8 LP 2.4MM 4MM 26MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.778","SUP","HCPCS C1713","","201.778  -  SCREW BONE T8 LP 2.4MM 4MM 28MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.78","SUP","HCPCS C1713","","201.780  -  SCREW BONE T8 LP 2.4MM 4MM 30MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$102.35 ","$75.74 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.33 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.782","SUP","HCPCS C1713","","201.782  -  SCREW BONE 2.4MM 3.5MM 32MM SELF TAP CRCIFRM T8 STARDRIVE","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.784","SUP","HCPCS C1713","","201.784  -  SCREW BONE T8 LP 2.4MM 4MM 34MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.786","SUP","HCPCS C1713","","201.786  -  SCREW BONE T8 LP 2.4MM 4MM 36MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.788","SUP","HCPCS C1713","","201.788  -  SCREW BONE 2.4MM 4MM 38MM VARIABLESELF TAPPING T8 STARDRIVE","BOTH IP/OP","$105.43 ","$78.02 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.79","SUP","HCPCS C1713","","201.790  -  SCREW BONE T8 LP 2.4MM 4MM 40MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$102.35 ","$75.74 ","$0.00 ","$102.35 ","$46.06 ","$0.00 ","$21.33 ","$0.00 ","$0.00 ","$17.92 ","$102.35 ","$0.00 ","$51.18 ","$81.06 ","$81.88 ","$0.00 ","$15.55 ","$0.00 ","$16.29 ","$0.00 "
"201.806","SUP","HCPCS C1713","","201.806  -  SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.807","SUP","HCPCS C1713","","201.807  -  SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.808","SUP","HCPCS C1713","","201.808  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM STAINLESS STEEL FT","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.809","SUP","HCPCS C1713","","201.809  -  SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.81","SUP","HCPCS C1713","","201.810  -  SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.30 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.811","SUP","HCPCS C1713","","201.811  -  SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.812","SUP","HCPCS C1713","","201.812  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.813","SUP","HCPCS C1713","","201.813  -  SCREW BN 2MM 13MM NS ST SS CORT MDLR HND SYS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.814","SUP","HCPCS C1713","","201.814  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.816","SUP","HCPCS C1713","","201.816  -  SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.818","SUP","HCPCS C1713","","201.818  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.82","SUP","HCPCS C1713","","201.820  -  SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.30 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.822","SUP","HCPCS C1713","","201.822  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.824","SUP","HCPCS C1713","","201.824  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.826","SUP","HCPCS C1713","","201.826  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.828","SUP","HCPCS C1713","","201.828  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.83","SUP","HCPCS C1713","","201.830  -  SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.30 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.832","SUP","HCPCS C1713","","201.832  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.834","SUP","HCPCS C1713","","201.834  -  SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM LCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.836","SUP","HCPCS C1713","","201.836  -  SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.838","SUP","HCPCS C1713","","201.838  -  SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.84","SUP","HCPCS C1713","","201.840  -  SCREW BONE 2MM 3.5MM 40MM SELF TAP CRCIFRM LCP STAINLESS","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$26.56 ","$0.00 ","$12.30 ","$0.00 ","$0.00 ","$10.33 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$8.97 ","$0.00 ","$9.40 ","$0.00 "
"201.876","SUP","HCPCS C1713","","201.876  -  SCREW BONE T6 2MM 6MM SELF TAP STARDRIVE LCP STAINLESS STEEL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.877","SUP","HCPCS C1713","","201.877  -  SCREW BONE T6 2MM 7MM SELF TAP STARDRIVE LCP STAINLESS STEEL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.878","SUP","HCPCS C1713","","201.878  -  SCREW BONE T6 2MM 8MM SELF TAP STARDRIVE LCP STAINLESS STEEL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.879","SUP","HCPCS C1713","","201.879  -  SCREW BONE T6 2MM 9MM SELF TAP STARDRIVE LCP STAINLESS STEEL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.88","SUP","HCPCS C1713","","201.880  -  SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$208.80 ","$154.51 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$43.52 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.881","SUP","HCPCS C1713","","201.881  -  SCREW BONE T6 2MM 11MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.882","SUP","HCPCS C1713","","201.882  -  SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.883","SUP","HCPCS C1713","","201.883  -  SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.884","SUP","HCPCS C1713","","201.884  -  SCREW BONE T6 2MM 14MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.886","SUP","HCPCS C1713","","201.886  -  SCREW BONE T6 2MM 16MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.888","SUP","HCPCS C1713","","201.888  -  SCREW BONE T6 2MM 18MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.89","SUP","HCPCS C1713","","201.890  -  SCREW BONE T6 2MM 20MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$208.80 ","$154.51 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$43.52 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.892","SUP","HCPCS C1713","","201.892  -  SCREW BONE T6 2MM 22MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.894","SUP","HCPCS C1713","","201.894  -  SCREW BONE T6 2MM 24MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.896","SUP","HCPCS C1713","","201.896  -  SCREW BONE T6 2MM 26MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.898","SUP","HCPCS C1713","","201.898  -  SCREW BONE T6 2MM 28MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.9","SUP","HCPCS C1713","","201.900  -  SCREW BONE 2MM 30MM T6 STAR DRIVE RECESS SLFTAP LCP","BOTH IP/OP","$208.80 ","$154.51 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$43.52 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"201.928","SUP","HCPCS C1713","","201.928  -  SCREW BONE 8MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL","BOTH IP/OP","$205.88 ","$152.35 ","$0.00 ","$205.88 ","$92.64 ","$0.00 ","$42.91 ","$0.00 ","$0.00 ","$36.05 ","$205.88 ","$0.00 ","$102.94 ","$163.06 ","$164.70 ","$0.00 ","$32.22 ","$0.00 ","$32.78 ","$0.00 "
"201.962","SUP","Custom 27203010","","201.962  -  PIN FIX 1.8MM 12MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.964","SUP","Custom 27203010","","201.964  -  PIN FIX 1.8MM 14MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.966","SUP","Custom 27203010","","201.966  -  PIN FIX 1.8MM 16MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.968","SUP","Custom 27203010","","201.968  -  PIN FIX 1.8MM 18MM BUTTRESS LCP STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.972","SUP","Custom 27203010","","201.972  -  PIN FIX 1.8MM 22MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.974","SUP","Custom 27203010","","201.974  -  PIN FIX 1.8MM 24MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.976","SUP","Custom 27203010","","201.976  -  PIN FIX 1.8MM 26MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.978","SUP","Custom 27203010","","201.978  -  PIN FIX 1.8MM 28MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$117.35 ","$86.84 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.98","SUP","Custom 27203010","","201.980  -  PIN FIX 1.8MM 30MM BUTTRESS STAINLESS STEEL DISTAL RAD","BOTH IP/OP","$113.95 ","$84.32 ","$0.00 ","$113.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.95 ","$0.00 ","$56.98 ","$90.25 ","$91.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"202.006","SUP","HCPCS C1713","","202.006  -  SCREW BONE 2.5MM STANDARD 2.7MM 6MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.008","SUP","HCPCS C1713","","202.008  -  SCREW BONE STANDARD 2.7MM 5MM 8MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.01","SUP","HCPCS C1713","","202.010  -  SCREW BN STD FT 2.7MM 5MM 10MM NS 2.5MM SPHRCL HD SM HEX","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$6.67 ","$0.00 ","$8.74 ","$0.00 "
"202.012","SUP","HCPCS C1713","","202.012  -  SCREW BONE STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.014","SUP","HCPCS C1713","","202.014  -  SCREW BONE STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.016","SUP","HCPCS C1713","","202.016  -  SCREW BONE STANDARD 2.7MM 5MM 16MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.018","SUP","HCPCS C1713","","202.018  -  SCREW BONE STANDARD 2.7MM 5MM 18MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.02","SUP","HCPCS C1713","","202.020  -  SCREW BONE STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD SMALL","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.022","SUP","HCPCS C1713","","202.022  -  SCREW BONE STANDARD 2.7MM 5MM 22MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.024","SUP","HCPCS C1713","","202.024  -  SCREW BONE STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD SMALL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.026","SUP","HCPCS C1713","","202.026  -  SCREW BONE STANDARD 2.7MM 26MM DCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$56.58 ","$41.87 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.79 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.028","SUP","HCPCS C1713","","202.028  -  SCREW BONE 2.7MM 28MM DCP SS CORT NONSTRL SM FRAG","BOTH IP/OP","$42.60 ","$31.52 ","$0.00 ","$42.60 ","$19.17 ","$0.00 ","$8.88 ","$0.00 ","$0.00 ","$7.46 ","$42.60 ","$0.00 ","$21.30 ","$33.74 ","$34.08 ","$0.00 ","$6.67 ","$0.00 ","$6.78 ","$0.00 "
"202.03","SUP","HCPCS C1713","","202.030  -  SCREW BONE 2.7MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.032","SUP","HCPCS C1713","","202.032  -  SCREW BONE 2.7MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.034","SUP","HCPCS C1713","","202.034  -  SCREW BONE STANDARD 2.7MM 5MM 34MM 2.5MM SMALL HEXAGON","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$6.67 ","$0.00 ","$8.74 ","$0.00 "
"202.036","SUP","HCPCS C1713","","202.036  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 36MM","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.038","SUP","HCPCS C1713","","202.038  -  SCREW BONE STANDARD 2.7MM 5MM 38MM 2.5MM SMALL HEXAGON","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.04","SUP","HCPCS C1713","","202.040  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 40MM","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.045","SUP","HCPCS C1713","","202.045  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 45MM","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.05","SUP","HCPCS C1713","","202.050  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 50MM","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.055","SUP","HCPCS C1713","","202.055  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 55MM","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"202.208","SUP","HCPCS C1713","","202.208  -  SCREW BONE T8 2.7MM 2.1MM 8MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.21","SUP","HCPCS C1713","","202.210  -  SCREW BONE 2.7MM 10MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.212","SUP","HCPCS C1713","","202.212  -  SCREW BONE T8 2.7MM 2.1MM 12MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.214","SUP","HCPCS C1713","","202.214  -  SCREW BONE T8 2.7MM 2.1MM 14MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.216","SUP","HCPCS C1713","","202.216  -  SCREW BONE 2.7MM 2.1MM 16MM T8 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.218","SUP","HCPCS C1713","","202.218  -  SCREW BONE T8 2.7MM 2.1MM 18MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.22","SUP","HCPCS C1713","","202.220  -  SCREW BONE T8 2.7MM 2.1MM 20MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.222","SUP","HCPCS C1713","","202.222  -  SCREW BONE T8 2.7MM 2.1MM 22MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.224","SUP","HCPCS C1713","","202.224  -  SCREW BONE T8 2.7MM 2.1MM 24MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.226","SUP","HCPCS C1713","","202.226  -  SCREW BONE 2.7MM 26MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.228","SUP","HCPCS C1713","","202.228  -  SCREW BONE T8 2.7MM 2.1MM 28MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.23","SUP","HCPCS C1713","","202.230  -  SCREW BONE T8 2.7MM 2.1MM 30MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.232","SUP","HCPCS C1713","","202.232  -  SCREW BONE T8 2.7MM 2.1MM 32MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.234","SUP","HCPCS C1713","","202.234  -  SCREW BONE T8 2.7MM 2.1MM 34MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.236","SUP","HCPCS C1713","","202.236  -  SCREW BONE T8 2.7MM 2.1MM 36MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.238","SUP","HCPCS C1713","","202.238  -  SCREW BONE T8 2.7MM 2.1MM 38MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.24","SUP","HCPCS C1713","","202.240  -  SCREW BONE T8 2.7MM 2.1MM 40MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.242","SUP","HCPCS C1713","","202.242  -  SCREW BONE 2.7MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.244","SUP","HCPCS C1713","","202.244  -  SCREW BONE T8 2.7MM 2.1MM 44MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.246","SUP","HCPCS C1713","","202.246  -  SCREW BONE T8 2.7MM 2.1MM 46MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.248","SUP","HCPCS C1713","","202.248  -  SCREW BONE T8 2.7MM 2.1MM 48MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.25","SUP","HCPCS C1713","","202.250  -  SCREW BONE T8 2.7MM 2.1MM 50MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.255","SUP","HCPCS C1713","","202.255  -  SCREW BONE T8 2.7MM 2.1MM 55MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.26","SUP","HCPCS C1713","","202.260  -  SCREW BONE T8 2.7MM 2.1MM 60MM SELF TAP MODULAR STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"202.608","SUP","HCPCS C1713","","202.608  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 8MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.609","SUP","HCPCS C1713","","202.609  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 9MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.61","SUP","HCPCS C1713","","202.610  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 10MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.611","SUP","HCPCS C1713","","202.611  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 11MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.612","SUP","HCPCS C1713","","202.612  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 12MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.613","SUP","HCPCS C1713","","202.613  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 13MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.614","SUP","HCPCS C1713","","202.614  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.615","SUP","HCPCS C1713","","202.615  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.616","SUP","HCPCS C1713","","202.616  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.617","SUP","HCPCS C1713","","202.617  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.618","SUP","HCPCS C1713","","202.618  -  SCREW BONE SHORT THREAD 3MM 18MM CANN STAINLESS STEEL WRIST","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.619","SUP","HCPCS C1713","","202.619  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.62","SUP","HCPCS C1713","","202.620  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.621","SUP","HCPCS C1713","","202.621  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.622","SUP","HCPCS C1713","","202.622  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.623","SUP","HCPCS C1713","","202.623  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 23MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.624","SUP","HCPCS C1713","","202.624  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.625","SUP","HCPCS C1713","","202.625  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 25MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.626","SUP","HCPCS C1713","","202.626  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 26MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.627","SUP","HCPCS C1713","","202.627  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 27MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.628","SUP","HCPCS C1713","","202.628  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.629","SUP","HCPCS C1713","","202.629  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 29MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.63","SUP","HCPCS C1713","","202.630  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.632","SUP","HCPCS C1713","","202.632  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.634","SUP","HCPCS C1713","","202.634  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 34MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.636","SUP","HCPCS C1713","","202.636  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.638","SUP","HCPCS C1713","","202.638  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.64","SUP","HCPCS C1713","","202.640  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.714","SUP","HCPCS C1713","","202.714  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.715","SUP","HCPCS C1713","","202.715  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.716","SUP","HCPCS C1713","","202.716  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.717","SUP","HCPCS C1713","","202.717  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.718","SUP","HCPCS C1713","","202.718  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 18MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.719","SUP","HCPCS C1713","","202.719  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.72","SUP","HCPCS C1713","","202.720  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.721","SUP","HCPCS C1713","","202.721  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.722","SUP","HCPCS C1713","","202.722  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$75.48 ","$0.00 ","$57.57 ","$0.00 "
"202.723","SUP","HCPCS C1713","","202.723  -  SCREW BONE LNGTHRD 3MM 4MM 23MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.724","SUP","HCPCS C1713","","202.724  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.725","SUP","HCPCS C1713","","202.725  -  SCREW BONE LNGTHRD 3MM 4MM 25MM CANN CRCIFRM RECESS SLFDRILL","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.726","SUP","HCPCS C1713","","202.726  -  SCREW BONE LNGTHRD 3MM 26MM CANN STAINLESS STEEL WRIST HAND","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.727","SUP","HCPCS C1713","","202.727  -  SCREW BONE LNGTHRD 3MM 27MM CANN STAINLESS STEEL WRIST HAND","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.728","SUP","HCPCS C1713","","202.728  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.729","SUP","HCPCS C1713","","202.729  -  SCREW BONE LNGTHRD 3MM 29MM CANN STAINLESS STEEL WRIST HAND","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.73","SUP","HCPCS C1713","","202.730  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.732","SUP","HCPCS C1713","","202.732  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.734","SUP","HCPCS C1713","","202.734  -  SCREW BONE LNGTHRD 3MM 34MM CANN STAINLESS STEEL WRIST HAND","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.736","SUP","HCPCS C1713","","202.736  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.738","SUP","HCPCS C1713","","202.738  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.74","SUP","HCPCS C1713","","202.740  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"202.806","SUP","HCPCS C1713","","202.806  -  SCREW BONE 2.7MM 5MM 6MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.808","SUP","HCPCS C1713","","202.808  -  SCREW BONE 2.7MM 5MM 8MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.81","SUP","HCPCS C1713","","202.810  -  SCREW BONE 2.7MM 5MM 10MM SLFTAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.812","SUP","HCPCS C1713","","202.812  -  SCREW BONE SHORT THREAD 2.7MM 12MM SLFTAP DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.814","SUP","HCPCS C1713","","202.814  -  SCREW BONE 2.7MM 5MM 14MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.816","SUP","HCPCS C1713","","202.816  -  SCREW BONE 2.7MM 16MM SLFTAP LC-DCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.818","SUP","HCPCS C1713","","202.818  -  SCREW BN FT 2.7MM 5MM 18MM NS 2.5MM ST SPHRCL HD SM HEX SCKT","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.82","SUP","HCPCS C1713","","202.820  -  SCREW BONE SHORT THREAD 2.7MM 20MM SLFTAP DCP STAINLESS","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.822","SUP","HCPCS C1713","","202.822  -  SCREW BONE 2.7MM 22MM SLFTAP LCP DCP STAINLESS STEEL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.824","SUP","HCPCS C1713","","202.824  -  SCREW BN FT 2.7MM 5MM 24MM NS 2.5MM ST SPHRCL HD SM HEX SCKT","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.826","SUP","HCPCS C1713","","202.826  -  SCREW BONE SHORT THREAD 2.7MM 26MM SLFTAP DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.828","SUP","HCPCS C1713","","202.828  -  SCREW BONE FULTHD 2.7MM 5MM 28MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.83","SUP","HCPCS C1713","","202.83  -  SCREW BONE 2.7MM 30MM LCP DCP SS CORT DISTAL RADL/TIBIAL","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$39.62 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.83","SUP","HCPCS C1713","","202.830  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE 2.7MM 5MM 30MM SELF","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.832","SUP","HCPCS C1713","","202.832  -  SCREW BONE 2.7MM 5MM 32MM SLFTAP SPHERICAL HEAD SMALL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.834","SUP","HCPCS C1713","","202.834  -  SCREW BONE 2.7MM 5MM 34MM SLFTAP SPHERICAL HEAD SMALL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.836","SUP","HCPCS C1713","","202.836  -  SCREW BONE 2.7MM 5MM 36MM SLFTAP SPHERICAL HEAD SMALL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.838","SUP","HCPCS C1713","","202.838  -  SCREW BONE 2.7MM 5MM 38MM SLFTAP SPHERICAL HEAD SMALL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.84","SUP","HCPCS C1713","","202.84  -  SCREW BONE 2.7MM 40MM LCP DCP SS CORT DISTAL RADL/TIBIAL","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$39.58 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.84","SUP","HCPCS C1713","","202.840  -  SCREW BONE 2.7MM 40MM SLFTAP LCP DCP STAINLESS STEEL","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.842","SUP","HCPCS C1713","","202.842  -  SCREW BONE 2.7MM 5MM 42MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.844","SUP","HCPCS C1713","","202.844  -  SCREW BONE 2.7MM 5MM 44MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.845","SUP","HCPCS C1713","","202.845  -  SCREW BONE 2.7MM 5MM 45MM SLFTAP SPHERICAL HEAD SMALL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.846","SUP","HCPCS C1713","","202.846  -  SCREW BONE 2.7MM 5MM 46MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.848","SUP","HCPCS C1713","","202.848  -  SCREW BONE 2.7MM 5MM 48MM SELF TAP CRCIFRM DCP STAINLESS","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.85","SUP","HCPCS C1713","","202.85  -  SCREW BONE 2.7MM 50MM LCP DCP SS CORT DISTAL RADL/TIBIAL","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$39.58 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.85","SUP","HCPCS C1713","","202.850  -  SCREW BONE SHORT THREAD 2.7MM 50MM SLFTAP DCP STAINLESS","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.855","SUP","HCPCS C1713","","202.855  -  SCREW BONE 2.7MM 55MM SLFTAP LCP DCP STAINLESS STEEL","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"202.87","SUP","HCPCS C1713","","202.870  -  SCREW BONE T8 2.7MM 5MM 10MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$69.60 ","$51.50 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.51 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.872","SUP","HCPCS C1713","","202.872  -  SCREW BONE T8 2.7MM 5MM 12MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.874","SUP","HCPCS C1713","","202.874  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE SELF TAP LCP STAINLESS","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.876","SUP","HCPCS C1713","","202.876  -  SCREW BONE 2.7MM 16MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.878","SUP","HCPCS C1713","","202.878  -  SCREW BONE T8 2.7MM 5MM 18MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.88","SUP","HCPCS C1713","","202.880  -  SCREW BONE T8 2.7MM 5MM 20MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$69.60 ","$51.50 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.51 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.882","SUP","HCPCS C1713","","202.882  -  SCREW BONE T8 2.7MM 5MM 22MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.884","SUP","HCPCS C1713","","202.884  -  SCREW BONE T8 2.7MM 5MM 24MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.886","SUP","HCPCS C1713","","202.886  -  SCREW BONE T8 2.7MM 5MM 26MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.888","SUP","HCPCS C1713","","202.888  -  SCREW BONE T8 2.7MM 5MM 28MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.89","SUP","HCPCS C1713","","202.890  -  SCREW BONE T8 2.7MM 5MM 30MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$69.60 ","$51.50 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.51 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.892","SUP","HCPCS C1713","","202.892  -  SCREW BONE T8 2.7MM 5MM 32MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.894","SUP","HCPCS C1713","","202.894  -  SCREW BONE T8 2.7MM 5MM 34MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.896","SUP","HCPCS C1713","","202.896  -  SCREW BONE T8 2.7MM 5MM 36MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.898","SUP","HCPCS C1713","","202.898  -  SCREW BONE T8 2.7MM 5MM 38MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.9","SUP","HCPCS C1713","","202.900  -  SCREW BONE T8 2.7MM 5MM 40MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$69.60 ","$51.50 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.51 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.962","SUP","HCPCS C1713","","202.962  -  SCREW BONE T8 2.7MM 5MM 42MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.963","SUP","HCPCS C1713","","202.963  -  SCREW BONE T8 2.7MM 5MM 44MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.965","SUP","HCPCS C1713","","202.965  -  SCREW BONE T8 2.7MM 5MM 46MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.966","SUP","HCPCS C1713","","202.966  -  SCREW BONE T8 2.7MM 5MM 48MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.967","SUP","HCPCS C1713","","202.967  -  SCREW BONE T8 2.7MM 5MM 50MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.968","SUP","HCPCS C1713","","202.968  -  SCREW BONE T8 2.7MM 5MM 55MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"202.969","SUP","HCPCS C1713","","202.969  -  SCREW BONE T8 2.7MM 5MM 60MM VAR ANG SELF TAP MODULAR","BOTH IP/OP","$71.70 ","$53.06 ","$0.00 ","$69.60 ","$31.32 ","$0.00 ","$14.94 ","$0.00 ","$0.00 ","$12.19 ","$69.60 ","$0.00 ","$34.80 ","$55.12 ","$55.68 ","$0.00 ","$10.58 ","$0.00 ","$11.08 ","$0.00 "
"204.01","SUP","HCPCS C1713","","204.010  -  SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.012","SUP","HCPCS C1713","","204.012  -  SCREW BONE STANDARD 3.5MM 6MM 12MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.014","SUP","HCPCS C1713","","204.014  -  SCREW BONE 3.5MM 14MM SMALL HEXAGONAL SOCKET DCP LC-DCP","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.016","SUP","HCPCS C1713","","204.016  -  SCREW BONE STANDARD 3.5MM 6MM 16MM HEXAGONAL SOCKET LC-DCP","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.018","SUP","HCPCS C1713","","204.018  -  SCREW BONE STANDARD 3.5MM 6MM 18MM HEXAGONAL SOCKET LC-DCP","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.02","SUP","HCPCS C1713","","204.020  -  SCREW BONE STANDARD 3.5MM 6MM 20MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.022","SUP","HCPCS C1713","","204.022  -  SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 22MM SOCKET DCP","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$6.76 ","$0.00 ","$4.40 ","$0.00 "
"204.024","SUP","HCPCS C1713","","204.024  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 24MM SMALL HEXAGONAL","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.026","SUP","HCPCS C1713","","204.026  -  SCREW BONE 4MM 26MM LOCKING SLFTAP STARDRIVE RECESS LCP","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.028","SUP","HCPCS C1713","","204.028  -  SCREW BONE STANDARD 3.5MM 6MM 28MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.03","SUP","HCPCS C1713","","204.030  -  SCREW BONE SMALL STANDARD 3.5MM 6MM 30MM HEXAGONAL SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.032","SUP","HCPCS C1713","","204.032  -  SCREW BONE STANDARD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.034","SUP","HCPCS C1713","","204.034  -  SCREW BONE T25 3.5MM 2.4MM 34MM LOCKING SLFTAP STARDRIVE","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.036","SUP","HCPCS C1713","","204.036  -  SCREW BONE 3.5MM 36MM SMALL FRAGMENT LC-DCP STAINLESS STEEL","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.038","SUP","HCPCS C1713","","204.038  -  SCREW BONE STANDARD 3.5MM 6MM 38MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.04","SUP","HCPCS C1713","","204.040  -  SCREW BONE STANDARD 3.5MM 6MM 40MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.045","SUP","HCPCS C1713","","204.045  -  SCREW BONE 2.5MM SMALL STANDARD 3.5MM 45MM SMALL HEXAGONAL","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.05","SUP","HCPCS C1713","","204.050  -  SCREW BONE STANDARD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.055","SUP","HCPCS C1713","","204.055  -  SCREW BONE STANDARD 3.5MM 6MM 55MM HEXAGONAL SOCKET LC-DCP","BOTH IP/OP","$28.45 ","$21.05 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.93 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.06","SUP","HCPCS C1713","","204.060  -  SCREW BONE STANDARD 3.5MM 6MM 60MM SELF TAP SMALL HEXAGONAL","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"204.065","SUP","HCPCS C1713","","204.065  -  SCREW BONE STANDARD 3.5MM 6MM 65MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$46.03 ","$34.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.59 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.07","SUP","HCPCS C1713","","204.070  -  SCREW BONE STANDARD 3.5MM 6MM 70MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$44.68 ","$33.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.31 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$10.33 ","$0.00 ","$7.11 ","$0.00 "
"204.075","SUP","HCPCS C1713","","204.075  -  SCREW BONE STANDARD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$46.03 ","$34.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.59 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$10.33 ","$0.00 ","$7.11 ","$0.00 "
"204.08","SUP","HCPCS C1713","","204.080  -  SCREW BONE STANDARD 3.5MM 6MM 80MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$44.68 ","$33.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.31 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.085","SUP","HCPCS C1713","","204.085  -  SCREW BONE STANDARD 3.5MM 6MM 85MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$46.03 ","$34.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.59 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$10.33 ","$0.00 ","$7.11 ","$0.00 "
"204.09","SUP","HCPCS C1713","","204.090  -  SCREW BONE STANDARD 3.5MM 6MM 90MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$44.68 ","$33.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.31 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.095","SUP","HCPCS C1713","","204.095  -  SCREW BONE STANDARD 3.5MM 6MM 95MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$46.03 ","$34.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.59 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.1","SUP","HCPCS C1713","","204.100  -  SCREW BONE 3.5MM 100MM LC-DCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$44.68 ","$33.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.31 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.105","SUP","HCPCS C1713","","204.105  -  SCREW BONE STANDARD 3.5MM 6MM 105MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$46.03 ","$34.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.59 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.11","SUP","HCPCS C1713","","204.110  -  SCREW BONE STANDARD 3.5MM 6MM 110MM SLFTAP SMALL HEXAGON","BOTH IP/OP","$44.68 ","$33.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.31 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.115","SUP","HCPCS C1713","","204.115  -  SCREW BONE 3.5MM 115MM LC-DCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$46.03 ","$34.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.59 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.12","SUP","HCPCS C1713","","204.120  -  SCREW BONE STANDARD 3.5MM 6MM 120MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$44.68 ","$33.06 ","$0.00 ","$44.68 ","$20.10 ","$0.00 ","$9.31 ","$0.00 ","$0.00 ","$7.82 ","$44.68 ","$0.00 ","$22.34 ","$35.39 ","$35.74 ","$0.00 ","$6.79 ","$0.00 ","$7.11 ","$0.00 "
"204.216","SUP","HCPCS C1713","","204.216  -  SCREW BONE PTHRD 3.5MM 6MM 16MM 6MM SHAFT SMALL HEXAGONAL","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.218","SUP","HCPCS C1713","","204.218  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 18MM 6MM SELF TAP SOCKET","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.22","SUP","HCPCS C1713","","204.220  -  SCREW BONE PTHRD 3.5MM 6MM 20MM 6MM SHAFT SMALL HEXAGONAL","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.222","SUP","HCPCS C1713","","204.222  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 22MM 6MM SELF TAP SOCKET","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.224","SUP","HCPCS C1713","","204.224  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 24MM 10MM SELF TAP SOCKET","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.226","SUP","HCPCS C1713","","204.226  -  SCREW BONE PTHRD 3.5MM 6MM 26MM 10MM SHAFT SMALL HEXAGONAL","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.228","SUP","HCPCS C1713","","204.228  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 28MM 10MM SELF TAP SOCKET","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.23","SUP","HCPCS C1713","","204.230  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 30MM 10MM SELF TAP SOCKET","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.232","SUP","HCPCS C1713","","204.232  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 32MM 12MM SELF TAP SOCKET","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.234","SUP","HCPCS C1713","","204.234  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 34MM 12MM SELF TAP SOCKET","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.236","SUP","HCPCS C1713","","204.236  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 36MM 12MM SELF TAP SOCKET","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.238","SUP","HCPCS C1713","","204.238  -  SCREW BONE PTHRD 3.5MM 6MM 38MM 12MM SHAFT SMALL HEXAGONAL","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.24","SUP","HCPCS C1713","","204.240  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 40MM 12MM SELF TAP SOCKET","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"204.245","SUP","HCPCS C1713","","204.245  -  SCREW BONE 3.5MM 45MM SHAFT LC-DCP STAINLESS STEEL TIBIA","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"204.25","SUP","HCPCS C1713","","204.250  -  SCREW BONE 3.5MM 6MM 50MM SMALL HEXAGON SOCKET DCP LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"204.64","SUP","HCPCS C1713","","204.640  -  SCREW BONE 3.5MM 6MM 40MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.645","SUP","HCPCS C1713","","204.645  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 45MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.65","SUP","HCPCS C1713","","204.650  -  SCREW BONE 3.5MM 6MM 50MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.655","SUP","HCPCS C1713","","204.655  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 55MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.66","SUP","HCPCS C1713","","204.660  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 60MM SELF TAP SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.665","SUP","HCPCS C1713","","204.665  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 65MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.67","SUP","HCPCS C1713","","204.670  -  SCREW BONE 3.5MM 6MM 70MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.675","SUP","HCPCS C1713","","204.675  -  SCREW BONE 3.5MM 6MM 75MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.68","SUP","HCPCS C1713","","204.680  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 80MM SELF TAP SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.685","SUP","HCPCS C1713","","204.685  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 85MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.69","SUP","HCPCS C1713","","204.690  -  SCREW BONE 3.5MM 6MM 90MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.695","SUP","HCPCS C1713","","204.695  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 95MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.7","SUP","HCPCS C1713","","204.700  -  SCREW BONE 3.5MM 6MM 100MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.705","SUP","HCPCS C1713","","204.705  -  SCREW BONE 3.5MM 6MM 105MM SELF TAP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.71","SUP","HCPCS C1713","","204.710  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 110MM SELF TAP SOCKET","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.715","SUP","HCPCS C1713","","204.715  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 115MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.72","SUP","HCPCS C1713","","204.720  -  SCREW BONE 3.5MM 120MM SLFTAP LC-DCP STAINLESS STEEL CORTEX","BOTH IP/OP","$51.85 ","$38.37 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$10.81 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.725","SUP","HCPCS C1713","","204.725  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 125MM SELF TAP SOCKET","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$51.85 ","$23.33 ","$0.00 ","$11.14 ","$0.00 ","$0.00 ","$9.08 ","$51.85 ","$0.00 ","$25.93 ","$41.07 ","$41.48 ","$0.00 ","$7.88 ","$0.00 ","$8.25 ","$0.00 "
"204.73","SUP","HCPCS C1713","","204.730  -  SCREW BONE 3.5MM 6MM 130MM SLFTAP LP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$165.13 ","$122.20 ","$0.00 ","$165.13 ","$74.31 ","$0.00 ","$34.42 ","$0.00 ","$0.00 ","$28.91 ","$165.13 ","$0.00 ","$82.56 ","$130.78 ","$132.10 ","$0.00 ","$25.09 ","$0.00 ","$26.29 ","$0.00 "
"204.735","SUP","HCPCS C1713","","204.735  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 135MM SELF TAP SOCKET","BOTH IP/OP","$170.10 ","$125.87 ","$0.00 ","$165.13 ","$74.31 ","$0.00 ","$35.45 ","$0.00 ","$0.00 ","$28.91 ","$165.13 ","$0.00 ","$82.56 ","$130.78 ","$132.10 ","$0.00 ","$25.09 ","$0.00 ","$26.29 ","$0.00 "
"204.74","SUP","HCPCS C1713","","204.740  -  SCREW BONE 3.5MM 6MM 140MM SLFTAP LP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$165.13 ","$122.20 ","$0.00 ","$165.13 ","$74.31 ","$0.00 ","$34.42 ","$0.00 ","$0.00 ","$28.91 ","$165.13 ","$0.00 ","$82.56 ","$130.78 ","$132.10 ","$0.00 ","$25.09 ","$0.00 ","$26.29 ","$0.00 "
"204.745","SUP","HCPCS C1713","","204.745  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 145MM SELF TAP SOCKET","BOTH IP/OP","$170.10 ","$125.87 ","$0.00 ","$165.13 ","$74.31 ","$0.00 ","$35.45 ","$0.00 ","$0.00 ","$28.91 ","$165.13 ","$0.00 ","$82.56 ","$130.78 ","$132.10 ","$0.00 ","$25.09 ","$0.00 ","$26.29 ","$0.00 "
"204.75","SUP","HCPCS C1713","","204.750  -  SCREW BONE 3.5MM 6MM 150MM SLFTAP LP SMALL HEXAGONAL SOCKET","BOTH IP/OP","$165.13 ","$122.20 ","$0.00 ","$165.13 ","$74.31 ","$0.00 ","$34.42 ","$0.00 ","$0.00 ","$28.91 ","$165.13 ","$0.00 ","$82.56 ","$130.78 ","$132.10 ","$0.00 ","$25.09 ","$0.00 ","$26.29 ","$0.00 "
"204.81","SUP","HCPCS C1713","","204.810  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 10MM SELF TAP LC-DCP DCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.812","SUP","HCPCS C1713","","204.812  -  SCREW BONE FULTHD 3.5MM 6MM 12MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.814","SUP","HCPCS C1713","","204.814  -  SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.816","SUP","HCPCS C1713","","204.816  -  SCREW BONE FULTHD 3.5MM 6MM 16MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.818","SUP","HCPCS C1713","","204.818  -  SCREW BONE 3.5MM 18MM SLFTAP LCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.82","SUP","HCPCS C1713","","204.820  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP LC-DCP DCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.822","SUP","HCPCS C1713","","204.822  -  SCREW BONE 3.5MM 22MM SLFTAP LCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.824","SUP","HCPCS C1713","","204.824  -  SCREW BONE 3.5MM 24MM SLFTAP LCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.826","SUP","HCPCS C1713","","204.826  -  SCREW BONE 3.5MM 26MM SLFTAP LCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.828","SUP","HCPCS C1713","","204.828  -  SCREW BONE 3.5MM 28MM SLFTAP HEXAGONAL RECESS DCP LC-DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.83","SUP","HCPCS C1713","","204.830  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 30MM SELF TAP LC-DCP DCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.832","SUP","HCPCS C1713","","204.832  -  SCREW BONE FULTHD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.834","SUP","HCPCS C1713","","204.834  -  SCREW BONE FULTHD 3.5MM 6MM 34MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.836","SUP","HCPCS C1713","","204.836  -  SCREW BONE FULTHD 3.5MM 6MM 36MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.838","SUP","HCPCS C1713","","204.838  -  SCREW BONE 3.5MM 38MM SLFTAP HEXAGONAL RECESS DCP LC-DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.84","SUP","HCPCS C1713","","204.840  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 40MM SELF TAP LC-DCP DCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.842","SUP","HCPCS C1713","","204.842  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 42MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.844","SUP","HCPCS C1713","","204.844  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 44MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.845","SUP","HCPCS C1713","","204.845  -  SCREW BONE 3.5MM 45MM SLFTAP LCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.846","SUP","HCPCS C1713","","204.846  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 46MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.848","SUP","HCPCS C1713","","204.848  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 48MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.85","SUP","HCPCS C1713","","204.850  -  SCREW BONE FULTHD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.855","SUP","HCPCS C1713","","204.855  -  SCREW BONE 3.5MM 55MM SLFTAP HEXAGONAL RECESS DCP LC-DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.86","SUP","HCPCS C1713","","204.860  -  SCREW BONE FULTHD 3.5MM 6MM 60MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.865","SUP","HCPCS C1713","","204.865  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 65MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.87","SUP","HCPCS C1713","","204.870  -  SCREW BONE FULTHD 3.5MM 6MM 70MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.875","SUP","HCPCS C1713","","204.875  -  SCREW BONE FULTHD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGONAL","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.88","SUP","HCPCS C1713","","204.880  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 80MM SELF TAP SOCKET DCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.885","SUP","HCPCS C1713","","204.885  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 85MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.89","SUP","HCPCS C1713","","204.890  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 90MM SELF TAP SOCKET DCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$8.63 ","$0.00 ","$6.14 ","$0.00 "
"204.89","SUP","HCPCS C1713","","204.89  -  SCREW BONE 3.5MM 90MM LC DCP SS CORT PROX MDL PLVC TIBIAL","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$40.04 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$40.04 ","$30.84 ","$0.00 ","$8.63 ","$0.00 ","$6.14 ","$0.00 "
"204.895","SUP","HCPCS C1713","","204.895  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 95MM SELF TAP SOCKET DCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.9","SUP","HCPCS C1713","","204.900  -  SCREW BONE 3.5MM 100MM SLFTAP LC-DCP STAINLESS STEEL TIBIA","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.905","SUP","HCPCS C1713","","204.905  -  SCREW BONE 3.5MM 105MM SLFTAP LC-DCP STAINLESS STEEL TIBIA","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"204.91","SUP","HCPCS C1713","","204.910  -  SCREW BONE 3.5MM 110MM SLFTAP LC-DCP STAINLESS STEEL TIBIA","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"205.01","SUP","HCPCS C1713","","205.010  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$343.93 ","$254.51 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$71.68 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.012","SUP","HCPCS C1713","","205.012  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$70.23 ","$0.00 ","$54.75 ","$0.00 "
"205.014","SUP","HCPCS C1713","","205.014  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.016","SUP","HCPCS C1713","","205.016  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.018","SUP","HCPCS C1713","","205.018  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.02","SUP","HCPCS C1713","","205.020  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$343.93 ","$254.51 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$71.68 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.022","SUP","HCPCS C1713","","205.022  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.024","SUP","HCPCS C1713","","205.024  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.026","SUP","HCPCS C1713","","205.026  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.028","SUP","HCPCS C1713","","205.028  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.03","SUP","HCPCS C1713","","205.030  -  SCREW BONE PTHRD 3.5MM 30MM 10MM CANN HEMISPHERICAL HEAD","BOTH IP/OP","$343.93 ","$254.51 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$71.68 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.032","SUP","HCPCS C1713","","205.032  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.034","SUP","HCPCS C1713","","205.034  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.036","SUP","HCPCS C1713","","205.036  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.038","SUP","HCPCS C1713","","205.038  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.04","SUP","HCPCS C1713","","205.040  -  SCREW BONE PTHRD 3.5MM 40MM 13MM CANN HEMISPHERICAL HEAD","BOTH IP/OP","$343.93 ","$254.51 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$71.68 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.042","SUP","HCPCS C1713","","205.042  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.044","SUP","HCPCS C1713","","205.044  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.046","SUP","HCPCS C1713","","205.046  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.048","SUP","HCPCS C1713","","205.048  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5","BOTH IP/OP","$354.23 ","$262.13 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$73.83 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.05","SUP","HCPCS C1713","","205.050  -  SCREW BONE PTHRD 3.5MM 50MM 16MM CANN HEMISPHERICAL HEAD","BOTH IP/OP","$343.93 ","$254.51 ","$0.00 ","$343.93 ","$154.77 ","$0.00 ","$71.68 ","$0.00 ","$0.00 ","$60.22 ","$343.93 ","$0.00 ","$171.96 ","$272.39 ","$275.14 ","$0.00 ","$52.26 ","$0.00 ","$54.75 ","$0.00 "
"205.21","SUP","HCPCS C1713","","205.210  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$353.48 ","$261.58 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$73.67 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.212","SUP","HCPCS C1713","","205.212  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.214","SUP","HCPCS C1713","","205.214  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.216","SUP","HCPCS C1713","","205.216  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.218","SUP","HCPCS C1713","","205.218  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.22","SUP","HCPCS C1713","","205.220  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$353.48 ","$261.58 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$73.67 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$70.23 ","$0.00 ","$56.27 ","$0.00 "
"205.222","SUP","HCPCS C1713","","205.222  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$70.23 ","$0.00 ","$56.27 ","$0.00 "
"205.224","SUP","HCPCS C1713","","205.224  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.226","SUP","HCPCS C1713","","205.226  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.228","SUP","HCPCS C1713","","205.228  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$70.23 ","$0.00 ","$56.27 ","$0.00 "
"205.23","SUP","HCPCS C1713","","205.230  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$353.48 ","$261.58 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$73.67 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.232","SUP","HCPCS C1713","","205.232  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.234","SUP","HCPCS C1713","","205.234  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.236","SUP","HCPCS C1713","","205.236  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.238","SUP","HCPCS C1713","","205.238  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.24","SUP","HCPCS C1713","","205.240  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$353.48 ","$261.58 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$73.67 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.242","SUP","HCPCS C1713","","205.242  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.244","SUP","HCPCS C1713","","205.244  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.246","SUP","HCPCS C1713","","205.246  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.248","SUP","HCPCS C1713","","205.248  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$364.08 ","$269.42 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"205.25","SUP","HCPCS C1713","","205.250  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5","BOTH IP/OP","$353.48 ","$261.58 ","$0.00 ","$353.48 ","$159.06 ","$0.00 ","$73.67 ","$0.00 ","$0.00 ","$61.89 ","$353.48 ","$0.00 ","$176.74 ","$279.96 ","$282.78 ","$0.00 ","$53.71 ","$0.00 ","$56.27 ","$0.00 "
"206.01","SUP","HCPCS C1713","","206.010  -  SCREW BN FT 4MM 6MM 10MM NS SM HEX SCKT SS CANC SM FRAG SET","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.01","SUP","HCPCS C1713","","206.01  -  SCREW BONE 4MM 10MM LC DCP SS CANC PROX MDL TIBIAL FULTHD","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$33.17 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$33.17 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.012","SUP","HCPCS C1713","","206.012  -  SCREW BONE FULTHD 4MM 12MM FULTHRD LCP STAINLESS STEEL","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.014","SUP","HCPCS C1713","","206.014  -  SCREW BONE PTHRD 4MM 6MM 14MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.016","SUP","HCPCS C1713","","206.016  -  SCREW BONE PTHRD 4MM 6MM 16MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.018","SUP","HCPCS C1713","","206.018  -  SCREW BONE PTHRD 4MM 6MM 18MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.02","SUP","HCPCS C1713","","206.020  -  SCREW BONE PTHRD 4MM 6MM 20MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.02","SUP","HCPCS C1713","","206.02  -  SCREW BONE 4MM 20MM LC DCP SS CANC PROX MDL TIBIAL FULTHD","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$32.19 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$32.19 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.022","SUP","HCPCS C1713","","206.022  -  SCREW BONE FULTHD 4MM 22MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.024","SUP","HCPCS C1713","","206.024  -  SCREW BONE PTHRD 4MM 6MM 24MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.026","SUP","HCPCS C1713","","206.026  -  SCREW BONE 2.5MM FULTHD 4MM 26MM SELF TAP HEXAGONAL SHAFT","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.028","SUP","HCPCS C1713","","206.028  -  SCREW BONE 2.5MM FULTHD 4MM 28MM SELF TAP HEXAGONAL SHAFT","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.03","SUP","HCPCS C1713","","206.030  -  SCREW BONE FULTHD HEXAGON 4MM 6MM 30MM SELF TAP SOCKET LCP","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.03","SUP","HCPCS C1713","","206.03  -  SCREW BONE 4MM 30MM LC DCP SS CANC PROX MDL TIBIAL FULTHD","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$32.19 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$32.19 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.032","SUP","HCPCS C1713","","206.032  -  SCREW BONE FULTHD 4MM 32MM LOCK SELF TAP LCP STAINLESS STEEL","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.035","SUP","HCPCS C1713","","206.035  -  SCREW BONE 2.5MM FULTHD 4MM 35MM SELF TAP HEXAGONAL SHAFT","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.036","SUP","HCPCS C1713","","206.036  -  SCREW BONE 2.5MM FULTHD 4MM 36MM SELF TAP HEXAGONAL SHAFT","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.04","SUP","HCPCS C1713","","206.040  -  SCREW BONE 2.5MM FULTHD 4MM 40MM LOCKING HEXAGONAL SOCKET","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$39.53 ","$17.79 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$6.92 ","$39.53 ","$0.00 ","$19.76 ","$25.13 ","$31.62 ","$0.00 ","$6.19 ","$0.00 ","$6.29 ","$0.00 "
"206.04","SUP","HCPCS C1713","","206.04  -  SCREW BONE 4MM 40MM LC DCP SS CANC PROX MDL TIBIAL FULTHD","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$39.53 ","$17.79 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$6.92 ","$39.53 ","$0.00 ","$19.76 ","$31.31 ","$31.62 ","$0.00 ","$6.19 ","$0.00 ","$6.29 ","$0.00 "
"206.045","SUP","HCPCS C1713","","206.045  -  SCREW BONE FULTHD 4MM 45MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.05","SUP","HCPCS C1713","","206.050  -  SCREW BONE FULTHD 4MM 6MM 50MM 15MM SMALL HEXOGONAL SOCKET","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.055","SUP","HCPCS C1713","","206.055  -  SCREW BONE PTHRD 4MM 6MM 55MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"206.06","SUP","HCPCS C1713","","206.060  -  SCREW BONE FULTHD 4MM 60MM 15MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.23 ","$0.00 ","$5.05 ","$0.00 "
"206.06","SUP","HCPCS C1713","","206.06  -  SCREW BONE 4MM 60MM LC DCP SS CANC PROX MDL TIBIAL FULTHD","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$32.19 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$32.19 ","$25.38 ","$0.00 ","$7.23 ","$0.00 ","$5.05 ","$0.00 "
"206.065","SUP","HCPCS C1713","","206.065  -  SCREW BONE FULTHD 4MM 65MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.07","SUP","HCPCS C1713","","206.070  -  SCREW BONE FULTHD 4MM 70MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.08","SUP","HCPCS C1713","","206.080  -  SCREW BONE FULTHD 4MM 80MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.085","SUP","HCPCS C1713","","206.085  -  SCREW BONE FULTHD 4MM 85MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.09","SUP","HCPCS C1713","","206.090  -  SCREW BONE FULTHD 4MM 90MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.095","SUP","HCPCS C1713","","206.095  -  SCREW BONE FULTHD 4MM 95MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.1","SUP","HCPCS C1713","","206.100  -  SCREW BONE FULTHD 4MM 100MM LOCKING SLFTAP LCP STAINLESS","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"206.414","SUP","HCPCS C1713","","206.414  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 14MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.416","SUP","HCPCS C1713","","206.416  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 16MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.418","SUP","HCPCS C1713","","206.418  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 18MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.42","SUP","HCPCS C1713","","206.420  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 20MM SELF TAP","BOTH IP/OP","$47.78 ","$35.36 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$9.96 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.422","SUP","HCPCS C1713","","206.422  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 22MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.424","SUP","HCPCS C1713","","206.424  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 24MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.426","SUP","HCPCS C1713","","206.426  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 26MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.428","SUP","HCPCS C1713","","206.428  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 28MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.43","SUP","HCPCS C1713","","206.430  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 30MM SELF TAP","BOTH IP/OP","$47.78 ","$35.36 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$9.96 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.432","SUP","HCPCS C1713","","206.432  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 32MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.434","SUP","HCPCS C1713","","206.434  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 34MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.436","SUP","HCPCS C1713","","206.436  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 36MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.438","SUP","HCPCS C1713","","206.438  -  SCREW BONE FULTHD 4MM 6MM 38MM SLFTAP HEXAGON RECESS LCP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.44","SUP","HCPCS C1713","","206.440  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 40MM SELF TAP","BOTH IP/OP","$47.78 ","$35.36 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$9.96 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.442","SUP","HCPCS C1713","","206.442  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 42MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.444","SUP","HCPCS C1713","","206.444  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 44MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$10.24 ","$0.00 ","$7.61 ","$0.00 "
"206.446","SUP","HCPCS C1713","","206.446  -  SCREW BONE 2.5MM FULTHD 4MM 6MM 46MM SELF TAP SMALL","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.448","SUP","HCPCS C1713","","206.448  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 48MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.45","SUP","HCPCS C1713","","206.450  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 50MM SELF TAP","BOTH IP/OP","$47.78 ","$35.36 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$9.96 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.452","SUP","HCPCS C1713","","206.452  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 52MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.454","SUP","HCPCS C1713","","206.454  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 54MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.456","SUP","HCPCS C1713","","206.456  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 56MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.458","SUP","HCPCS C1713","","206.458  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 58MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.46","SUP","HCPCS C1713","","206.460  -  SCREW BONE FULTHD 4MM 6MM 60MM SLFTAP HEXAGON RECESS LCP","BOTH IP/OP","$47.78 ","$35.36 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$9.96 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.465","SUP","HCPCS C1713","","206.465  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 65MM SELF TAP","BOTH IP/OP","$49.20 ","$36.41 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$10.25 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.47","SUP","HCPCS C1713","","206.470  -  SCREW BONE FULTHD 4MM 6MM 70MM SELF TAP SMALL HEXAGONAL","BOTH IP/OP","$47.78 ","$35.36 ","$0.00 ","$47.78 ","$21.50 ","$0.00 ","$9.96 ","$0.00 ","$0.00 ","$8.37 ","$47.78 ","$0.00 ","$23.89 ","$37.84 ","$38.22 ","$0.00 ","$7.26 ","$0.00 ","$7.61 ","$0.00 "
"206.475","SUP","HCPCS C1713","","206.475  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 75MM SELF TAP","BOTH IP/OP","$87.85 ","$65.01 ","$0.00 ","$85.28 ","$38.37 ","$0.00 ","$18.31 ","$0.00 ","$0.00 ","$14.93 ","$85.28 ","$0.00 ","$42.64 ","$67.54 ","$68.22 ","$0.00 ","$12.96 ","$0.00 ","$13.58 ","$0.00 "
"206.48","SUP","HCPCS C1713","","206.480  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 80MM SELF TAP","BOTH IP/OP","$85.28 ","$63.11 ","$0.00 ","$85.28 ","$38.37 ","$0.00 ","$17.77 ","$0.00 ","$0.00 ","$14.93 ","$85.28 ","$0.00 ","$42.64 ","$67.54 ","$68.22 ","$0.00 ","$12.96 ","$0.00 ","$13.58 ","$0.00 "
"206.485","SUP","HCPCS C1713","","206.485  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 85MM SELF TAP","BOTH IP/OP","$87.85 ","$65.01 ","$0.00 ","$85.28 ","$38.37 ","$0.00 ","$18.31 ","$0.00 ","$0.00 ","$14.93 ","$85.28 ","$0.00 ","$42.64 ","$67.54 ","$68.22 ","$0.00 ","$12.96 ","$0.00 ","$13.58 ","$0.00 "
"206.49","SUP","HCPCS C1713","","206.490  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 90MM SELF TAP","BOTH IP/OP","$85.28 ","$63.11 ","$0.00 ","$85.28 ","$38.37 ","$0.00 ","$17.77 ","$0.00 ","$0.00 ","$14.93 ","$85.28 ","$0.00 ","$42.64 ","$67.54 ","$68.22 ","$0.00 ","$12.96 ","$0.00 ","$13.58 ","$0.00 "
"206.495","SUP","HCPCS C1713","","206.495  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 95MM SELF TAP","BOTH IP/OP","$87.85 ","$65.01 ","$0.00 ","$85.28 ","$38.37 ","$0.00 ","$18.31 ","$0.00 ","$0.00 ","$14.93 ","$85.28 ","$0.00 ","$42.64 ","$67.54 ","$68.22 ","$0.00 ","$12.96 ","$0.00 ","$13.58 ","$0.00 "
"206.5","SUP","HCPCS C1713","","206.500  -  SCREW BONE 4MM 100MM SLFTAP STAINLESS STEEL CORTICAL NONSTRL","BOTH IP/OP","$85.28 ","$63.11 ","$0.00 ","$85.28 ","$38.37 ","$0.00 ","$17.77 ","$0.00 ","$0.00 ","$14.93 ","$85.28 ","$0.00 ","$42.64 ","$67.54 ","$68.22 ","$0.00 ","$12.96 ","$0.00 ","$13.58 ","$0.00 "
"207.01","SUP","HCPCS C1713","","207.010  -  SCREW BONE PTHRD 4MM 2.5MM 10MM 7MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.012","SUP","HCPCS C1713","","207.012  -  SCREW BONE PTHRD 4MM 2.5MM 12MM 7MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$7.23 ","$0.00 ","$4.78 ","$0.00 "
"207.014","SUP","HCPCS C1713","","207.014  -  SCREW BONE PTHRD 4MM 14MM 5MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.016","SUP","HCPCS C1713","","207.016  -  SCREW BONE PTHRD 4MM 16MM 6MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.018","SUP","HCPCS C1713","","207.018  -  SCREW BONE PTHRD 4MM 2.5MM 18MM 7MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.02","SUP","HCPCS C1713","","207.020  -  SCREW BONE PTHRD 4MM 20MM LCP STAINLESS STEEL CANCELLOUS RAD","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.02","SUP","HCPCS C1713","","207.02  -  SCREW BONE 4MM 20MM LC DCP SS CANC PROX MDL TIBIAL P/T NSTRL","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$32.19 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$32.19 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.022","SUP","HCPCS C1713","","207.022  -  SCREW BONE PTHRD 4MM 22MM 9MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.024","SUP","HCPCS C1713","","207.024  -  SCREW BONE PTHRD 4MM 24MM 10MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.026","SUP","HCPCS C1713","","207.026  -  SCREW BONE PTHRD 4MM 26MM 12MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.028","SUP","HCPCS C1713","","207.028  -  SCREW BONE PTHRD 4MM 28MM 14MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.03","SUP","HCPCS C1713","","207.030  -  SCREW BONE PTHRD 4MM 30MM 6MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.035","SUP","HCPCS C1713","","207.035  -  SCREW BONE PTHRD 4MM 35MM LCP STAINLESS STEEL CANCELLOUS RAD","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.04","SUP","HCPCS C1713","","207.040  -  SCREW BONE PTHRD 4MM 40MM 14MM SMALL HEXAGONAL SOCKET LCP","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.045","SUP","HCPCS C1713","","207.045  -  SCREW BONE PTHRD 4MM 45MM SELF TAP HEXAGONAL SHAFT LC-DCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.05","SUP","HCPCS C1713","","207.050  -  SCREW BONE 4MM 50MM LCP SS PTHRD CANC TIB NONSTRL SM FRAG","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.055","SUP","HCPCS C1713","","207.055  -  SCREW BONE SMALL HEXAGON 4MM 6MM 55MM 15MM SOCKET LCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.06","SUP","HCPCS C1713","","207.060  -  SCREW BONE SMALL HEXAGON 4MM 6MM 60MM 15MM SOCKET LCP","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"207.065","SUP","HCPCS C1713","","207.065  -  SCREW BONE PTHRD 4MM 65MM PTHRD LCP STAINLESS STEEL","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.07","SUP","HCPCS C1713","","207.070  -  SCREW BONE PTHRD 4MM 70MM PTTHRD LCP STAINLESS STEEL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.075","SUP","HCPCS C1713","","207.075  -  SCREW BONE PTHRD 4MM 75MM PTHRD LCP STAINLESS STEEL","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.08","SUP","HCPCS C1713","","207.080  -  SCREW BONE PTHRD 4MM 80MM PTTHRD LCP STAINLESS STEEL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.085","SUP","HCPCS C1713","","207.085  -  SCREW BONE 4MM 85MM PTHRD LC-DCP DCP STAINLESS STEEL","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.09","SUP","HCPCS C1713","","207.090  -  SCREW BONE PTHRD 4MM 90MM PTTHRD LCP STAINLESS STEEL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.095","SUP","HCPCS C1713","","207.095  -  SCREW BONE PTHRD 4MM 95MM PTHRD LCP STAINLESS STEEL","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.1","SUP","HCPCS C1713","","207.100  -  SCREW BONE 4MM 100MM PTTHRD LC-DCP DCP STAINLESS STEEL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"207.61","SUP","HCPCS C1713","","207.610  -  SCREW BONE SHORT THREAD 4MM 10MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$73.99 ","$0.00 ","$56.93 ","$0.00 "
"207.612","SUP","HCPCS C1713","","207.612  -  SCREW BONE SHORT THREAD 4MM 12MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$73.99 ","$0.00 ","$56.93 ","$0.00 "
"207.614","SUP","HCPCS C1713","","207.614  -  SCREW BONE SHORT THREAD 4MM 14MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$73.99 ","$0.00 ","$56.93 ","$0.00 "
"207.616","SUP","HCPCS C1713","","207.616  -  SCREW BONE SHORT THREAD 4MM 16MM 1/3MM CANN LCP STAINLESS","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.618","SUP","HCPCS C1713","","207.618  -  SCREW BONE SHORT THREAD 4MM 18MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.622","SUP","HCPCS C1713","","207.622  -  SCREW BONE SHORT THREAD 4MM 22MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.624","SUP","HCPCS C1713","","207.624  -  SCREW BONE SHORT THREAD 4MM 24MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.626","SUP","HCPCS C1713","","207.626  -  SCREW BONE SHORT THREAD 4MM 26MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.628","SUP","HCPCS C1713","","207.628  -  SCREW BONE SHORT THREAD 4MM 28MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.63","SUP","HCPCS C1713","","207.630  -  SCREW BONE SHORT THREAD 4MM 30MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.63","SUP","HCPCS C1713","","207.63  -  SCREW BONE 4MM 30MM LCP SS ST ORTH CANN NSTRL SM FRAG SET","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$344.35 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.632","SUP","HCPCS C1713","","207.632  -  SCREW BONE SHORT THREAD 4MM 32MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.634","SUP","HCPCS C1713","","207.634  -  SCREW BONE SHORT THREAD 4MM 34MM 11MM CANN LCP STAINLESS","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.636","SUP","HCPCS C1713","","207.636  -  SCREW BONE SHORT THREAD 4MM 36MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.638","SUP","HCPCS C1713","","207.638  -  SCREW BONE SHORT THREAD 4MM 38MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.64","SUP","HCPCS C1713","","207.640  -  SCREW BONE SHORT THREAD 4MM 40MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.64","SUP","HCPCS C1713","","207.64  -  SCREW BONE 4MM 40MM LCP SS ST ORTH CANN NSTRL SM FRAG SET","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$329.46 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.642","SUP","HCPCS C1713","","207.642  -  SCREW BONE SHORT THREAD 4MM 42MM CANN SHORT THREAD LCP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.644","SUP","HCPCS C1713","","207.644  -  SCREW BONE SHORT THREAD 4MM 44MM 1/3MM CANN LCP STAINLESS","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.646","SUP","HCPCS C1713","","207.646  -  SCREW BONE SHORT THREAD 4MM 46MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.648","SUP","HCPCS C1713","","207.648  -  SCREW BONE SHORT THREAD 4MM 48MM CANN LCP STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.65","SUP","HCPCS C1713","","207.650  -  SCREW BONE SHORT THREAD HEXAGON LP 4MM 5MM 50MM SELF DRILL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.65","SUP","HCPCS C1713","","207.65  -  SCREW BONE 4MM 50MM LCP SS ST ORTH CANN NSTRL SM FRAG SET","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$329.46 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.652","SUP","HCPCS C1713","","207.652  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.654","SUP","HCPCS C1713","","207.654  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.656","SUP","HCPCS C1713","","207.656  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.658","SUP","HCPCS C1713","","207.658  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.66","SUP","HCPCS C1713","","207.660  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.664","SUP","HCPCS C1713","","207.664  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.668","SUP","HCPCS C1713","","207.668  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.672","SUP","HCPCS C1713","","207.672  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.716","SUP","HCPCS C1713","","207.716  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.718","SUP","HCPCS C1713","","207.718  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.72","SUP","HCPCS C1713","","207.720  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.722","SUP","HCPCS C1713","","207.722  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.724","SUP","HCPCS C1713","","207.724  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.726","SUP","HCPCS C1713","","207.726  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.728","SUP","HCPCS C1713","","207.728  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$73.99 ","$0.00 ","$56.93 ","$0.00 "
"207.73","SUP","HCPCS C1713","","207.730  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.732","SUP","HCPCS C1713","","207.732  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.734","SUP","HCPCS C1713","","207.734  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.736","SUP","HCPCS C1713","","207.736  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.738","SUP","HCPCS C1713","","207.738  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.74","SUP","HCPCS C1713","","207.740  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.74","SUP","HCPCS C1713","","207.74  -  SCREW BONE 4MM 40MM SS L/T ORTH CANN NSTRL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$344.35 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.742","SUP","HCPCS C1713","","207.742  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.744","SUP","HCPCS C1713","","207.744  -  SCREW BONE LNGTHRD 4MM 5MM 44MM CANN SLFDRILL SLFTAP SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.746","SUP","HCPCS C1713","","207.746  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.748","SUP","HCPCS C1713","","207.748  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.75","SUP","HCPCS C1713","","207.750  -  SCREW BONE LNGTHRD 4MM 5MM 50MM CANN SLFDRILL SLFTAP SMALL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.75","SUP","HCPCS C1713","","207.75  -  SCREW BONE 4MM 50MM SS L/T ORTH CANN NSTRL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$329.46 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.752","SUP","HCPCS C1713","","207.752  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.754","SUP","HCPCS C1713","","207.754  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.756","SUP","HCPCS C1713","","207.756  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.758","SUP","HCPCS C1713","","207.758  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.76","SUP","HCPCS C1713","","207.760  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.764","SUP","HCPCS C1713","","207.764  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.768","SUP","HCPCS C1713","","207.768  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.772","SUP","HCPCS C1713","","207.772  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"207.916","SUP","HCPCS C1713","","207.916  -  SCREW BONE 5MM 4MM 6MM 16MM 8MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.918","SUP","HCPCS C1713","","207.918  -  SCREW BONE 5MM 4MM 6MM 18MM 8MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.92","SUP","HCPCS C1713","","207.920  -  SCREW BONE 5MM 4MM 6MM 20MM 10MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.922","SUP","HCPCS C1713","","207.922  -  SCREW BONE 5MM 4MM 6MM 22MM 10MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.924","SUP","HCPCS C1713","","207.924  -  SCREW BONE 5MM 4MM 6MM 24MM 10MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.926","SUP","HCPCS C1713","","207.926  -  SCREW BONE 5MM 4MM 6MM 26MM 12MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.928","SUP","HCPCS C1713","","207.928  -  SCREW BONE 5MM 4MM 6MM 28MM 12MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.93","SUP","HCPCS C1713","","207.930  -  SCREW BONE 5MM 4MM 6MM 30MM 12MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.932","SUP","HCPCS C1713","","207.932  -  SCREW BONE 5MM 4MM 6MM 32MM 14MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.934","SUP","HCPCS C1713","","207.934  -  SCREW BONE 5MM 4MM 6MM 34MM 14MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.936","SUP","HCPCS C1713","","207.936  -  SCREW BONE 5MM 4MM 6MM 36MM 14MM DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.938","SUP","HCPCS C1713","","207.938  -  SCREW BONE 5MM HEAD 4MM 38MM PTHRD LC-DCP DCP STAINLESS","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.94","SUP","HCPCS C1713","","207.940  -  SCREW BONE 5MM HEAD 4MM 40MM PTHRD LC-DCP STAINLESS STEEL","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.942","SUP","HCPCS C1713","","207.942  -  SCREW BONE 5MM HEAD 4MM 42MM PTHRD LC-DCP DCP STAINLESS","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.944","SUP","HCPCS C1713","","207.944  -  SCREW BONE 5MM HEAD 4MM 44MM PTHRD LC-DCP DCP STAINLESS","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.946","SUP","HCPCS C1713","","207.946  -  SCREW BONE 5MM HEAD 4MM 46MM PTHRD LC-DCP STAINLESS STEEL","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.948","SUP","HCPCS C1713","","207.948  -  SCREW BONE 5MM HEAD 4MM 48MM PTHRD LC-DCP DCP STAINLESS","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.95","SUP","HCPCS C1713","","207.950  -  SCREW BONE 5MM HEAD 4MM 50MM PTHRD LC-DCP STAINLESS STEEL","BOTH IP/OP","$35.48 ","$26.26 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.39 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"207.952","SUP","HCPCS C1713","","207.952  -  SCREW BONE 5MM HEAD 4MM 52MM PTHRD LC-DCP DCP STAINLESS","BOTH IP/OP","$36.55 ","$27.05 ","$0.00 ","$35.48 ","$15.96 ","$0.00 ","$7.62 ","$0.00 ","$0.00 ","$6.21 ","$35.48 ","$0.00 ","$17.74 ","$28.10 ","$28.38 ","$0.00 ","$5.39 ","$0.00 ","$5.65 ","$0.00 "
"208.03","SUP","HCPCS C1713","","208.030  -  SCREW BONE 7MM 8MM 30MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.035","SUP","HCPCS C1713","","208.035  -  SCREW BONE 7MM 8MM 35MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.04","SUP","HCPCS C1713","","208.040  -  SCREW BONE 7MM 8MM 40MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.045","SUP","HCPCS C1713","","208.045  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.05","SUP","HCPCS C1713","","208.050  -  SCREW BONE 7MM 8MM 50MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.055","SUP","HCPCS C1713","","208.055  -  SCREW BONE 7MM 8MM 55MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.06","SUP","HCPCS C1713","","208.060  -  SCREW BONE 7MM 8MM 60MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.065","SUP","HCPCS C1713","","208.065  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.07","SUP","HCPCS C1713","","208.070  -  SCREW BONE 7MM 8MM 70MM 16MM CANN LARGE HEXAGONAL SOCKET","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.075","SUP","HCPCS C1713","","208.075  -  SCREW BONE 7MM 8MM 75MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.08","SUP","HCPCS C1713","","208.080  -  SCREW BONE 3.5MM 7MM 8MM 80MM 16MM CANN LARGE HEXAGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.085","SUP","HCPCS C1713","","208.085  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.09","SUP","HCPCS C1713","","208.090  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.095","SUP","HCPCS C1713","","208.095  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.1","SUP","HCPCS C1713","","208.100  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.105","SUP","HCPCS C1713","","208.105  -  SCREW BONE 7MM 8MM 105MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.11","SUP","HCPCS C1713","","208.110  -  SCREW BONE 7MM 8MM 110MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.115","SUP","HCPCS C1713","","208.115  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.12","SUP","HCPCS C1713","","208.120  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.125","SUP","HCPCS C1713","","208.125  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.13","SUP","HCPCS C1713","","208.130  -  SCREW BONE 7MM 8MM 130MM 16MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"208.135","SUP","HCPCS C1713","","208.135  -  SCREW BONE 7MM 135MM 16MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"208.14","SUP","HCPCS C1713","","208.140  -  SCREW BONE 7MM 140MM 16MM THREADED CANN STAINLESS STEEL","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"208.145","SUP","HCPCS C1713","","208.145  -  SCREW BONE 7MM 145MM 16MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"208.15","SUP","HCPCS C1713","","208.150  -  SCREW BONE 7MM 150MM 16MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"208.401","SUP","HCPCS C1713","","208.401  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 30","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.402","SUP","HCPCS C1713","","208.402  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 35","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.403","SUP","HCPCS C1713","","208.403  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 40","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.404","SUP","HCPCS C1713","","208.404  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.405","SUP","HCPCS C1713","","208.405  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.406","SUP","HCPCS C1713","","208.406  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.407","SUP","HCPCS C1713","","208.407  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.408","SUP","HCPCS C1713","","208.408  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.409","SUP","HCPCS C1713","","208.409  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.41","SUP","HCPCS C1713","","208.410  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.411","SUP","HCPCS C1713","","208.411  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.412","SUP","HCPCS C1713","","208.412  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.413","SUP","HCPCS C1713","","208.413  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.414","SUP","HCPCS C1713","","208.414  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.415","SUP","HCPCS C1713","","208.415  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.416","SUP","HCPCS C1713","","208.416  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.417","SUP","HCPCS C1713","","208.417  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.418","SUP","HCPCS C1713","","208.418  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.419","SUP","HCPCS C1713","","208.419  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.42","SUP","HCPCS C1713","","208.420  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.421","SUP","HCPCS C1713","","208.421  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.422","SUP","HCPCS C1713","","208.422  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.423","SUP","HCPCS C1713","","208.423  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.424","SUP","HCPCS C1713","","208.424  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.425","SUP","HCPCS C1713","","208.425  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.426","SUP","HCPCS C1713","","208.426  -  SCREW BONE 6.5MM 160MM 16MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.427","SUP","HCPCS C1713","","208.427  -  SCREW BONE 6.5MM 170MM 16MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.428","SUP","HCPCS C1713","","208.428  -  SCREW BONE 6.5MM 180MM 16MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.431","SUP","HCPCS C1713","","208.431  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.432","SUP","HCPCS C1713","","208.432  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.433","SUP","HCPCS C1713","","208.433  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.434","SUP","HCPCS C1713","","208.434  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.435","SUP","HCPCS C1713","","208.435  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.436","SUP","HCPCS C1713","","208.436  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.437","SUP","HCPCS C1713","","208.437  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.438","SUP","HCPCS C1713","","208.438  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.439","SUP","HCPCS C1713","","208.439  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.44","SUP","HCPCS C1713","","208.440  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.441","SUP","HCPCS C1713","","208.441  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.442","SUP","HCPCS C1713","","208.442  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.443","SUP","HCPCS C1713","","208.443  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.444","SUP","HCPCS C1713","","208.444  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.445","SUP","HCPCS C1713","","208.445  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.446","SUP","HCPCS C1713","","208.446  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.447","SUP","HCPCS C1713","","208.447  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.448","SUP","HCPCS C1713","","208.448  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.449","SUP","HCPCS C1713","","208.449  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.45","SUP","HCPCS C1713","","208.450  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.451","SUP","HCPCS C1713","","208.451  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.452","SUP","HCPCS C1713","","208.452  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.453","SUP","HCPCS C1713","","208.453  -  SCREW BONE 6.5MM 160MM 32MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.454","SUP","HCPCS C1713","","208.454  -  SCREW BONE 6.5MM 170MM 32MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.455","SUP","HCPCS C1713","","208.455  -  SCREW BONE 6.5MM 180MM 32MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.46","SUP","HCPCS C1713","","208.460  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.461","SUP","HCPCS C1713","","208.461  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.462","SUP","HCPCS C1713","","208.462  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.463","SUP","HCPCS C1713","","208.463  -  SCREW BONE 6.5MM 35MM FULTHRD STAINLESS STEEL CANN NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.464","SUP","HCPCS C1713","","208.464  -  SCREW BONE 6.5MM 40MM FULTHRD STAINLESS STEEL CANN NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.465","SUP","HCPCS C1713","","208.465  -  SCREW BONE FULTHD 6.5MM 45MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.466","SUP","HCPCS C1713","","208.466  -  SCREW BONE FULTHD 6.5MM 50MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.467","SUP","HCPCS C1713","","208.467  -  SCREW BONE FULTHD 6.5MM 55MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.468","SUP","HCPCS C1713","","208.468  -  SCREW BONE FULTHD 6.5MM 60MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.469","SUP","HCPCS C1713","","208.469  -  SCREW BONE FULTHD 6.5MM 65MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.47","SUP","HCPCS C1713","","208.470  -  SCREW BONE FULTHD 6.5MM 70MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.471","SUP","HCPCS C1713","","208.471  -  SCREW BONE FULTHD 6.5MM 75MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.472","SUP","HCPCS C1713","","208.472  -  SCREW BONE FULTHD 6.5MM 80MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.473","SUP","HCPCS C1713","","208.473  -  SCREW BONE FULTHD 6.5MM 85MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.474","SUP","HCPCS C1713","","208.474  -  SCREW BONE FULTHD 6.5MM 90MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.475","SUP","HCPCS C1713","","208.475  -  SCREW BONE FULTHD 6.5MM 95MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.476","SUP","HCPCS C1713","","208.476  -  SCREW BONE FULTHD 6.5MM 100MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.477","SUP","HCPCS C1713","","208.477  -  SCREW BONE FULTHD 6.5MM 105MM CANN FULTHRD STAINLESS STEEL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.478","SUP","HCPCS C1713","","208.478  -  SCREW BONE FULTHD 6.5MM 110MM CANN FULTHRD STAINLESS STEEL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.479","SUP","HCPCS C1713","","208.479  -  SCREW BONE 6.5MM 115MM CANN FULTHRD STAINLESS STEEL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.48","SUP","HCPCS C1713","","208.480  -  SCREW BONE 6.5MM 120MM FULTHRD STAINLESS STEEL CANN NONSTRL","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.481","SUP","HCPCS C1713","","208.481  -  SCREW BONE 6.5MM 125MM CANN FULTHRD STAINLESS STEEL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.482","SUP","HCPCS C1713","","208.482  -  SCREW BONE 6.5MM 130MM CANN FULTHRD STAINLESS STEEL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"208.483","SUP","HCPCS C1713","","208.483  -  SCREW BONE FULTHD 6.5MM 140MM CANN STAINLESS STEEL","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"208.484","SUP","HCPCS C1713","","208.484  -  SCREW BONE FULTHD 6.5MM 150MM CANN STAINLESS STEEL","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"208.485","SUP","HCPCS C1713","","208.485  -  SCREW BONE FULTHD 6.5MM 160MM CANN STAINLESS STEEL","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"208.486","SUP","HCPCS C1713","","208.486  -  SCREW BONE FULTHD 6.5MM 170MM CANN STAINLESS STEEL","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"208.487","SUP","HCPCS C1713","","208.487  -  SCREW BONE 6.5MM 180MM CANN FULTHD STAINLESS STEEL","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"208.83","SUP","HCPCS C1713","","208.830  -  SCREW BONE PTHRD 7.3MM 30MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$96.14 ","$0.00 ","$74.74 ","$0.00 "
"208.835","SUP","HCPCS C1713","","208.835  -  SCREW BONE PTHRD 7.3MM 35MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.84","SUP","HCPCS C1713","","208.840  -  SCREW BONE 7.3MM 40MM 16MM CANN STAINLESS STEEL FEMUR","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.845","SUP","HCPCS C1713","","208.845  -  SCREW BONE PTHRD 7.3MM 45MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.85","SUP","HCPCS C1713","","208.850  -  SCREW BONE 7.3MM 50MM 16MM CANN STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.855","SUP","HCPCS C1713","","208.855  -  SCREW BONE PTHRD 7.3MM 55MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.86","SUP","HCPCS C1713","","208.860  -  SCREW BONE PTHRD 7.3MM 60MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.865","SUP","HCPCS C1713","","208.865  -  SCREW BONE PTHRD 7.3MM 65MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.87","SUP","HCPCS C1713","","208.870  -  SCREW BONE PTHRD 7.3MM 70MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.875","SUP","HCPCS C1713","","208.875  -  SCREW BONE PTHRD 7.3MM 75MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.88","SUP","HCPCS C1713","","208.880  -  SCREW BONE PTHRD 7.3MM 80MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.885","SUP","HCPCS C1713","","208.885  -  SCREW BONE PTHRD 7.3MM 85MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.89","SUP","HCPCS C1713","","208.890  -  SCREW BONE 7.3MM 90MM 16MM CANN STAINLESS STEEL CANN NONSTRL","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.895","SUP","HCPCS C1713","","208.895  -  SCREW BONE PTHRD 7.3MM 95MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$96.14 ","$0.00 ","$74.74 ","$0.00 "
"208.9","SUP","HCPCS C1713","","208.900  -  SCREW BONE PTHRD 7.3MM 100MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.905","SUP","HCPCS C1713","","208.905  -  SCREW BONE PTHRD 7.3MM 105MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.91","SUP","HCPCS C1713","","208.910  -  SCREW BONE PTHRD 7.3MM 110MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.915","SUP","HCPCS C1713","","208.915  -  SCREW BONE PTHRD 7.3MM 115MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.92","SUP","HCPCS C1713","","208.920  -  SCREW BONE PTHRD 7.3MM 120MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.925","SUP","HCPCS C1713","","208.925  -  SCREW BONE PTHRD 7.3MM 125MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.93","SUP","HCPCS C1713","","208.930  -  SCREW BONE PTHRD 7.3MM 130MM 16MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.935","SUP","HCPCS C1713","","208.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.94","SUP","HCPCS C1713","","208.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.945","SUP","HCPCS C1713","","208.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.95","SUP","HCPCS C1713","","208.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"208.955","SUP","HCPCS C1713","","208.955  -  SCREW BONE 7.3MM 8.2MM 155MM 16X4MM CANNULARED SLFDRILL","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"208.96","SUP","HCPCS C1713","","208.960  -  SCREW BONE 7.3MM 8.2MM 160MM 16X4MM CANNULARED SLFDRILL","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"208.965","SUP","HCPCS C1713","","208.965  -  SCREW BONE 7.3MM 8.2MM 165MM 16X4MM CANNULARED SLFDRILL","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"208.97","SUP","HCPCS C1713","","208.970  -  SCREW BONE 7.3MM 8.2MM 170MM 16X4MM CANNULARED SLFDRILL","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"208.975","SUP","HCPCS C1713","","208.975  -  SCREW BONE 7.3MM 8.2MM 75MM 16X4MM L THREAD SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"208.98","SUP","HCPCS C1713","","208.980  -  SCREW BONE 7.3MM 8.2MM 80MM 16X4MM L THREAD SLFDRILL SLFTAP","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209","SUP","Custom 27203010","","MARKER RAD OSPT SKN SEM RDLCNT RING","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"209.045","SUP","HCPCS C1713","","209.045  -  SCREW BONE 7MM 8MM 45MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.05","SUP","HCPCS C1713","","209.050  -  SCREW BONE 7MM 8MM 50MM 32MM CANN LARGE HEXOGONAL SOCKET","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.055","SUP","HCPCS C1713","","209.055  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.06","SUP","HCPCS C1713","","209.060  -  SCREW BONE REVERSE CUT FLUTE 7MM 8MM 60MM 32MM CANN LARGE","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.065","SUP","HCPCS C1713","","209.065  -  SCREW BONE 7MM 8MM 65MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.07","SUP","HCPCS C1713","","209.070  -  SCREW BONE 7MM 8MM 70MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.075","SUP","HCPCS C1713","","209.075  -  SCREW BONE 7MM 8MM 75MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.08","SUP","HCPCS C1713","","209.080  -  SCREW BONE LARGE 7MM 8MM 80MM 32MM CANN THREADED LARGE","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.085","SUP","HCPCS C1713","","209.085  -  SCREW BONE 7MM 8MM 85MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.09","SUP","HCPCS C1713","","209.090  -  SCREW BONE 7MM 8MM 90MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.095","SUP","HCPCS C1713","","209.095  -  SCREW BONE 7MM 8MM 95MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.1","SUP","HCPCS C1713","","209.100  -  SCREW BONE 7MM 8MM 100MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.105","SUP","HCPCS C1713","","209.105  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.11","SUP","HCPCS C1713","","209.110  -  SCREW BONE 7MM 8MM 110MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.115","SUP","HCPCS C1713","","209.115  -  SCREW BONE 7MM 8MM 115MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.12","SUP","HCPCS C1713","","209.120  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.125","SUP","HCPCS C1713","","209.125  -  SCREW BONE 7MM 8MM 125MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.13","SUP","HCPCS C1713","","209.130  -  SCREW BONE 7MM 8MM 130MM 32MM CANN THREADED LARGE HEXOGONAL","BOTH IP/OP","$481.75 ","$356.50 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$100.41 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"209.135","SUP","HCPCS C1713","","209.135  -  SCREW BONE 7MM 135MM 32MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.14","SUP","HCPCS C1713","","209.140  -  SCREW BONE 7MM 140MM 32MM CANN THREADED","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.145","SUP","HCPCS C1713","","209.145  -  SCREW BONE 7MM 145MM 32MM CANN THREADED","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.15","SUP","HCPCS C1713","","209.150  -  SCREW BONE 7MM 150MM 32MM CANN THREADED","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.42","SUP","HCPCS C1713","","209.420  -  SCREW BONE 7MM 20MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.425","SUP","HCPCS C1713","","209.425  -  SCREW BONE FULTHD 7MM 25MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.43","SUP","HCPCS C1713","","209.430  -  SCREW ORTHOPEDIC 7MM 30MM CANN FULTHRD STAINLESS STEEL","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.435","SUP","HCPCS C1713","","209.435  -  SCREW BONE FULTHD 7MM 35MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.44","SUP","HCPCS C1713","","209.440  -  SCREW BONE 7MM 40MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.445","SUP","HCPCS C1713","","209.445  -  SCREW BONE FULTHD 7MM 45MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.45","SUP","HCPCS C1713","","209.450  -  SCREW BONE FULTHD 7MM 50MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.455","SUP","HCPCS C1713","","209.455  -  SCREW BONE FULTHD 7MM 55MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.46","SUP","HCPCS C1713","","209.460  -  SCREW BONE 7MM 60MM CANN FULTHRD STAINLESS STEEL NONSTRL","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.465","SUP","HCPCS C1713","","209.465  -  SCREW BONE FULTHD 7MM 65MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.47","SUP","HCPCS C1713","","209.470  -  SCREW BONE 7MM 70MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.475","SUP","HCPCS C1713","","209.475  -  SCREW BONE FULTHD 7MM 75MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.48","SUP","HCPCS C1713","","209.480  -  SCREW BONE 7MM 80MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.485","SUP","HCPCS C1713","","209.485  -  SCREW BONE 7MM 85MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.49","SUP","HCPCS C1713","","209.490  -  SCREW BONE 7MM 90MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.495","SUP","HCPCS C1713","","209.495  -  SCREW BONE 7MM 95MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.5","SUP","HCPCS C1713","","209.500  -  SCREW BONE 7MM 100MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.505","SUP","HCPCS C1713","","209.505  -  SCREW BONE FULTHD 7MM 105MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.51","SUP","HCPCS C1713","","209.510  -  SCREW BONE FULTHD 7MM 8MM 110MM CANN LARGE HEXAGONAL SOCKET","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.515","SUP","HCPCS C1713","","209.515  -  SCREW BONE FULTHD 7MM 115MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.52","SUP","HCPCS C1713","","209.520  -  SCREW BONE 7MM 120MM CANN FULTHRD STAINLESS STEEL CORTICAL","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.525","SUP","HCPCS C1713","","209.525  -  SCREW BONE FULTHD 7MM 125MM CANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$511.68 ","$378.64 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.53","SUP","HCPCS C1713","","209.530  -  SCREW BONE 7MM 130MM FULTHRD STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.78 ","$367.62 ","$0.00 ","$496.78 ","$223.55 ","$0.00 ","$103.54 ","$0.00 ","$0.00 ","$86.98 ","$496.78 ","$0.00 ","$248.39 ","$393.45 ","$397.42 ","$0.00 ","$75.48 ","$0.00 ","$79.09 ","$0.00 "
"209.62","SUP","HCPCS C1713","","209.620  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.625","SUP","HCPCS C1713","","209.625  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.63","SUP","HCPCS C1713","","209.630  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.635","SUP","HCPCS C1713","","209.635  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.64","SUP","HCPCS C1713","","209.640  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.645","SUP","HCPCS C1713","","209.645  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.65","SUP","HCPCS C1713","","209.650  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.655","SUP","HCPCS C1713","","209.655  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.66","SUP","HCPCS C1713","","209.660  -  SCREW BONE FULLY THREAD LARGE HEXAGON 7.3MM 4MM 60MM CANN","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.665","SUP","HCPCS C1713","","209.665  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.67","SUP","HCPCS C1713","","209.670  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.675","SUP","HCPCS C1713","","209.675  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.68","SUP","HCPCS C1713","","209.680  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.685","SUP","HCPCS C1713","","209.685  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.69","SUP","HCPCS C1713","","209.690  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.695","SUP","HCPCS C1713","","209.695  -  SCREW BONE FULTHD 7.3MM 8.2MM 95MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.7","SUP","HCPCS C1713","","209.700  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.705","SUP","HCPCS C1713","","209.705  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.71","SUP","HCPCS C1713","","209.710  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.715","SUP","HCPCS C1713","","209.715  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.72","SUP","HCPCS C1713","","209.720  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.725","SUP","HCPCS C1713","","209.725  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.73","SUP","HCPCS C1713","","209.730  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.735","SUP","HCPCS C1713","","209.735  -  SCREW BONE FULTHD 7.3MM 8.2MM 135MM 4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.74","SUP","HCPCS C1713","","209.740  -  SCREW BONE 4MM FULTHD 7.3MM 8.2MM 140MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.745","SUP","HCPCS C1713","","209.745  -  SCREW BONE FULTHD 7.3MM 8.2MM 145MM 4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.75","SUP","HCPCS C1713","","209.750  -  SCREW BONE FULTHD 7.3MM 50MM CANN NONSTRL","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.755","SUP","HCPCS C1713","","209.755  -  SCREW BONE FULTHD 7.3MM 55MM CANN NONSTRL","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.76","SUP","HCPCS C1713","","209.760  -  SCREW BONE 4MM FULTHD 7.3MM 8.2MM 160MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.765","SUP","HCPCS C1713","","209.765  -  SCREW BONE FULTHD 7.3MM 8.2MM 165MM 4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.77","SUP","HCPCS C1713","","209.770  -  SCREW BONE FULTHD 7.3MM 8.2MM 170MM 4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.775","SUP","HCPCS C1713","","209.775  -  SCREW BONE FULTHD 7.3MM 75MM CANN STAINLESS STEEL","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.78","SUP","HCPCS C1713","","209.780  -  SCREW BONE FULTHD 7.3MM 8.2MM 180MM 4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.845","SUP","HCPCS C1713","","209.845  -  SCREW BONE PTHRD 7.3MM 8.2MM 45MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.85","SUP","HCPCS C1713","","209.850  -  SCREW BONE 7.3MM 8.2MM 50MM 32MM CANN SHAFT LP HEAD SLFDRILL","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.855","SUP","HCPCS C1713","","209.855  -  SCREW BONE 4MM 7.3MM 8.2MM 55MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.86","SUP","HCPCS C1713","","209.860  -  SCREW BONE PTHRD 7.3MM 8.2MM 60MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.865","SUP","HCPCS C1713","","209.865  -  SCREW BONE 4MM 7.3MM 8.2MM 65MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.87","SUP","HCPCS C1713","","209.870  -  SCREW BONE PTHRD 7.3MM 8.2MM 70MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.875","SUP","HCPCS C1713","","209.875  -  SCREW BONE 4MM 7.3MM 8.2MM 75MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.88","SUP","HCPCS C1713","","209.880  -  SCREW BONE PTHRD 7.3MM 8.2MM 80MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.885","SUP","HCPCS C1713","","209.885  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 85MM 32MM CANN SHAFT LP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.89","SUP","HCPCS C1713","","209.890  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 90MM 32MM CANN SHAFT LP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.895","SUP","HCPCS C1713","","209.895  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 95MM 32MM CANN SHAFT LP","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.9","SUP","HCPCS C1713","","209.900  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 100MM 32MM CANN SHAFT LP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.905","SUP","HCPCS C1713","","209.905  -  SCREW BONE 4MM 7.3MM 8.2MM 105MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.91","SUP","HCPCS C1713","","209.910  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 110MM 32MM CANN SHAFT LP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.915","SUP","HCPCS C1713","","209.915  -  SCREW BONE 7.3MM 8.2MM 115MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.92","SUP","HCPCS C1713","","209.920  -  SCREW BONE 4MM 7.3MM 8.2MM 120MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.925","SUP","HCPCS C1713","","209.925  -  SCREW BONE 4MM 7.3MM 8.2MM 125MM 32MM CANN SHAFT LP HEAD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.93","SUP","HCPCS C1713","","209.930  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 130MM 32MM CANN SHAFT LP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.935","SUP","HCPCS C1713","","209.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.94","SUP","HCPCS C1713","","209.940  -  SCREW BONE HEXAGON 7.3MM 4MM 140MM 32MM CANN SELF DRILL SELF","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.945","SUP","HCPCS C1713","","209.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.95","SUP","HCPCS C1713","","209.950  -  SCREW BONE HEXAGON 7.3MM 4MM 150MM 32MM CANN SELF DRILL SELF","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"209.955","SUP","HCPCS C1713","","209.955  -  SCREW BONE 7.3MM 8.2MM 155MM 32X4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.96","SUP","HCPCS C1713","","209.960  -  SCREW BONE 7.3MM 160MM CANN THREADED STAINLESS STEEL NONSTRL","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.965","SUP","HCPCS C1713","","209.965  -  SCREW BONE 7.3MM 8.2MM 165MM 32X4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.97","SUP","HCPCS C1713","","209.970  -  SCREW BONE 7.3MM 8.2MM 170MM 32X4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.975","SUP","HCPCS C1713","","209.975  -  SCREW BONE 7.3MM 8.2MM 175MM 32X4MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$500.43 ","$370.32 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$104.30 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"209.98","SUP","HCPCS C1713","","209.980  -  SCREW BONE 7.3MM 180MM CANN STAINLESS STEEL NONSTRL","BOTH IP/OP","$485.85 ","$359.53 ","$0.00 ","$485.85 ","$218.63 ","$0.00 ","$101.26 ","$0.00 ","$0.00 ","$85.07 ","$485.85 ","$0.00 ","$242.93 ","$384.79 ","$388.68 ","$0.00 ","$73.82 ","$0.00 ","$77.35 ","$0.00 "
"211.81","SUP","HCPCS C1713","","211.810  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 10MM SELF DRILL SELF TAP","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.811","SUP","HCPCS C1713","","211.811  -  SCREW BONE LNGTHRD 2.4MM 11MM 5MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.812","SUP","HCPCS C1713","","211.812  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 12MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.813","SUP","HCPCS C1713","","211.813  -  SCREW BONE LNGTHRD 2.4MM 13MM 6MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.814","SUP","HCPCS C1713","","211.814  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 14MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.815","SUP","HCPCS C1713","","211.815  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 15MM 7MM CANN REVERSE CUTTING","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.816","SUP","HCPCS C1713","","211.816  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 16MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.817","SUP","HCPCS C1713","","211.817  -  SCREW BONE LNGTHRD 2.4MM 17MM 8MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.818","SUP","HCPCS C1713","","211.818  -  SCREW BONE LNGTHRD 2.4MM 35MM 18MM 8MM CANN T8 STARDRIVE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.819","SUP","HCPCS C1713","","211.819  -  SCREW BONE LNGTHRD 2.4MM 19MM 9MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.82","SUP","HCPCS C1713","","211.820  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 20MM 9MM CANN REVERSE CUTTING","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.822","SUP","HCPCS C1713","","211.822  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 22MM 10MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.824","SUP","HCPCS C1713","","211.824  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 24MM 10MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.826","SUP","HCPCS C1713","","211.826  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 26MM 12MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.828","SUP","HCPCS C1713","","211.828  -  SCREW BONE LNGTHRD 2.4MM 28MM 12MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.83","SUP","HCPCS C1713","","211.830  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 30MM 14MM CANN REVERSE","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.841","SUP","HCPCS C1713","","211.841  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 17MM 5MM CANN SLFDRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.842","SUP","HCPCS C1713","","211.842  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 18MM 5MM CANN T8","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.843","SUP","HCPCS C1713","","211.843  -  SCREW BONE SHORT THREAD 2.4MM 19MM 5MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.844","SUP","HCPCS C1713","","211.844  -  SCREW BONE SHORT THREAD 20MM 204MM 5MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.845","SUP","HCPCS C1713","","211.845  -  SCREW BONE SHORT THREAD 2.4MM 22MM 5MM CANN STAINLESS STEEL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.846","SUP","HCPCS C1713","","211.846  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 24MM 6MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.847","SUP","HCPCS C1713","","211.847  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 26MM 6MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.848","SUP","HCPCS C1713","","211.848  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 28MM 6MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.849","SUP","HCPCS C1713","","211.849  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 30MM 6MM CANN REVERSE","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"211.89","SUP","HCPCS C1713","","211.890  -  SCREW BONE 2.4MM 90MM COMPRESSION LCP DHHS STAINLESS STEEL","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"212.101","SUP","HCPCS C1713","","212.101  -  SCREW BONE FULTHD 3.5MM 2.9MM 10MM T15 STARDRIVE RECESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.102","SUP","HCPCS C1713","","212.102  -  SCREW BONE FULTHD 3.5MM 12MM STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.103","SUP","HCPCS C1713","","212.103  -  SCREW BONE FULTHD 3.5MM 14MM STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.104","SUP","HCPCS C1713","","212.104  -  SCREW BONE FULTHD 3.5MM 16MM STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.105","SUP","HCPCS C1713","","212.105  -  SCREW BONE 3.5MM 18MM LOCKING SLFTAP T15 STAR DRIVE RECESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.106","SUP","HCPCS C1713","","212.106  -  SCREW BONE 3.5MM 20MM LOCKING SLFTAP STARDRIVE RECESS LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.107","SUP","HCPCS C1713","","212.107  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 22MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.108","SUP","HCPCS C1713","","212.108  -  SCREW BONE 3.5MM 24MM T15 STARDRIVE RECESS ANGULAR STABILITY","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.109","SUP","HCPCS C1713","","212.109  -  SCREW BONE FULTHD 3.5MM 26MM STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.11","SUP","HCPCS C1713","","212.110  -  SCREW BONE 3.5MM 28MM LOCKING STARDRIVE SLFTAP LCP STAINLESS","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.11","SUP","HCPCS C1713","","212.11  -  SCREW BONE 3.5MM 28MM LCP SS PROX MDL PLVC TIBIAL SLFTAP LCK","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$197.35 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.111","SUP","HCPCS C1713","","212.111  -  SCREW BONE 3.5MM 30MM LOCKING SLFTAP STARDRIVE RECESS LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.112","SUP","HCPCS C1713","","212.112  -  SCREW BONE FULTHD 3.5MM 32MM STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.113","SUP","HCPCS C1713","","212.113  -  SCREW BONE 3.5MM 34MM T15 STARDRIVE RECESS ANGULAR STABILITY","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.114","SUP","HCPCS C1713","","212.114  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 35MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.115","SUP","HCPCS C1713","","212.115  -  SCREW BONE FULTHD 3.5MM 36MM T15 STARDRIVE SELF TAP FIX","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.116","SUP","HCPCS C1713","","212.116  -  SCREW BONE FULTHD 3.5MM 38MM T15 STARDRIVE SELF TAP FIX","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.117","SUP","HCPCS C1713","","212.117  -  SCREW BONE 3.5MM 40MM LOCKING STARDRIVE SLFTAP LCP STAINLESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.118","SUP","HCPCS C1713","","212.118  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 42MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.119","SUP","HCPCS C1713","","212.119  -  SCREW BONE FULTHD 3.5MM 45MM STARDRIVE SELF TAP LOCK LP LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.12","SUP","HCPCS C1713","","212.120  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 48MM FIX ANGLE SELF TAP","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.121","SUP","HCPCS C1713","","212.121  -  SCREW BONE 3.5MM 50MM LOCKING SLFTAP T15 STAR DRIVE RECESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.122","SUP","HCPCS C1713","","212.122  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 52MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.123","SUP","HCPCS C1713","","212.123  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 55MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.124","SUP","HCPCS C1713","","212.124  -  SCREW BONE FULTHD 3.5MM 60MM STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.125","SUP","HCPCS C1713","","212.125  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 65MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.126","SUP","HCPCS C1713","","212.126  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 70MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.127","SUP","HCPCS C1713","","212.127  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 75MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.128","SUP","HCPCS C1713","","212.128  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 80MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.129","SUP","HCPCS C1713","","212.129  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 85MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.13","SUP","HCPCS C1713","","212.130  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 90MM FIX ANGLE SELF TAP","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.131","SUP","HCPCS C1713","","212.131  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 95MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.134","SUP","HCPCS C1713","","212.134  -  SCREW BONE FULTHD CONE LP 3.5MM 44MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.136","SUP","HCPCS C1713","","212.136  -  SCREW BONE FULTHD CONE LP 3.5MM 46MM FIX ANGLE SELF TAP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"212.201","SUP","HCPCS C1713","","212.201  -  SCREW BONE FULTHD 5MM 14MM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.202","SUP","HCPCS C1713","","212.202  -  SCREW BONE T25 FULTHD CONE 5MM 16MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.203","SUP","HCPCS C1713","","212.203  -  SCREW BONE FULTHD 5MM 18MM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.205","SUP","HCPCS C1713","","212.205  -  SCREW BONE T25 FULTHD CONE 5MM 22MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.206","SUP","HCPCS C1713","","212.206  -  SCREW BONE FULTHD 5MM 24MM SLFTAP TIP LOCKING FIXANG CONICAL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.207","SUP","HCPCS C1713","","212.207  -  SCREW BONE FULTHD CONICAL 5MM 26MM SELF TAP LOCK FIX ANGLE T","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.208","SUP","HCPCS C1713","","212.208  -  SCREW BONE T25 FULTHD CONE 5MM 28MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.209","SUP","HCPCS C1713","","212.209  -  SCREW BONE T25 FULTHD CONE 5MM 30MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.21","SUP","HCPCS C1713","","212.210  -  SCREW BONE FULTHD 5MM 32MM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.211","SUP","HCPCS C1713","","212.211  -  SCREW BONE T25 FULTHD CONE 5MM 34MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.212","SUP","HCPCS C1713","","212.212  -  SCREW BONE T25 FULTHD CONE 5MM 36MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.213","SUP","HCPCS C1713","","212.213  -  SCREW BONE T25 FULTHD CONE 5MM 38MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.214","SUP","HCPCS C1713","","212.214  -  SCREW BONE T25 FULTHD CONE 5MM 40MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.215","SUP","HCPCS C1713","","212.215  -  SCREW BONE T25 FULTHD CONE 5MM 42MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.216","SUP","HCPCS C1713","","212.216  -  SCREW BONE FULTHD 5MM 44MM SLFTAP LOCKING FIXANG T25","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.217","SUP","HCPCS C1713","","212.217  -  SCREW BONE T25 FULTHD CONE 5MM 46MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.218","SUP","HCPCS C1713","","212.218  -  SCREW BONE T25 FULTHD CONE 5MM 48MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.219","SUP","HCPCS C1713","","212.219  -  SCREW BONE T25 FULTHD CONE 5MM 50MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.22","SUP","HCPCS C1713","","212.220  -  SCREW BONE T25 FULTHD CONE 5MM 55MM FIX ANGLE SELF TAP","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.221","SUP","HCPCS C1713","","212.221  -  SCREW BONE T25 FULTHD CONE 5MM 60MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.222","SUP","HCPCS C1713","","212.222  -  SCREW BONE FULTHD 5MM 65MM T25 STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.223","SUP","HCPCS C1713","","212.223  -  SCREW BONE T25 FULTHD CONE 5MM 70MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.224","SUP","HCPCS C1713","","212.224  -  SCREW BONE FULTHD 5MM 75MM SLFTAP TIP LOCKING FIXANG T25","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.225","SUP","HCPCS C1713","","212.225  -  SCREW BONE FULTHD 5MM 80MM T25 STARDRIVE SELF TAP LOCK FIX","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.226","SUP","HCPCS C1713","","212.226  -  SCREW BONE T25 FULTHD CONE 5MM 85MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.227","SUP","HCPCS C1713","","212.227  -  SCREW BONE T25 FULTHD CONE 5MM 90MM FIX ANGLE SELF TAP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"212.251","SUP","HCPCS C1713","","212.251  -  SCREW BONE 5MM 51MM SLFDRILL LOCKING THREADED LCP STAINLESS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.252","SUP","HCPCS C1713","","212.252  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.253","SUP","HCPCS C1713","","212.253  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.254","SUP","HCPCS C1713","","212.254  -  SCREW BONE 5MM 26MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.255","SUP","HCPCS C1713","","212.255  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.256","SUP","HCPCS C1713","","212.256  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.257","SUP","HCPCS C1713","","212.257  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.258","SUP","HCPCS C1713","","212.258  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.259","SUP","HCPCS C1713","","212.259  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.26","SUP","HCPCS C1713","","212.260  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.261","SUP","HCPCS C1713","","212.261  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.262","SUP","HCPCS C1713","","212.262  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.263","SUP","HCPCS C1713","","212.263  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.264","SUP","HCPCS C1713","","212.264  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.265","SUP","HCPCS C1713","","212.265  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.266","SUP","HCPCS C1713","","212.266  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.267","SUP","HCPCS C1713","","212.267  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"212.317","SUP","HCPCS C1713","","212.317  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.319","SUP","HCPCS C1713","","212.319  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.321","SUP","HCPCS C1713","","212.321  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.323","SUP","HCPCS C1713","","212.323  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.324","SUP","HCPCS C1713","","212.324  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.325","SUP","HCPCS C1713","","212.325  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.326","SUP","HCPCS C1713","","212.326  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.327","SUP","HCPCS C1713","","212.327  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.328","SUP","HCPCS C1713","","212.328  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.329","SUP","HCPCS C1713","","212.329  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.33","SUP","HCPCS C1713","","212.330  -  SCREW BONE FULTHD 3.5MM 2.9MM 90MM SLFTAP STARDRIVE RECESS","BOTH IP/OP","$249.75 ","$184.82 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$52.05 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.331","SUP","HCPCS C1713","","212.331  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.417","SUP","HCPCS C1713","","212.417  -  SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.419","SUP","HCPCS C1713","","212.419  -  SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.421","SUP","HCPCS C1713","","212.421  -  SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.423","SUP","HCPCS C1713","","212.423  -  SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.424","SUP","HCPCS C1713","","212.424  -  SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"212.425","SUP","HCPCS C1713","","212.425  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.426","SUP","HCPCS C1713","","212.426  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.427","SUP","HCPCS C1713","","212.427  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.428","SUP","HCPCS C1713","","212.428  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.429","SUP","HCPCS C1713","","212.429  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.43","SUP","HCPCS C1713","","212.430  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 90MM SELF TAP SMOOTH","BOTH IP/OP","$249.75 ","$184.82 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$52.05 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.431","SUP","HCPCS C1713","","212.431  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"212.504","SUP","HCPCS C1713","","212.504  -  SCREW BONE 5MM 20MM STARDRIVE SS PROX FEM LCK SLFTAP T25","BOTH IP/OP","$314.40 ","$232.66 ","$0.00 ","$314.40 ","$141.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.05 ","$314.40 ","$0.00 ","$157.20 ","$249.00 ","$251.52 ","$0.00 ","$49.20 ","$0.00 ","$50.05 ","$0.00 "
"212.806","SUP","HCPCS C1713","","212.806  -  SCREW BONE T8 CONE 2.4MM 1.9MM 6MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.807","SUP","HCPCS C1713","","212.807  -  SCREW BONE T8 CONE 2.4MM 1.9MM 7MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.808","SUP","HCPCS C1713","","212.808  -  SCREW BONE T8 CONE 2.4MM 1.9MM 8MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.809","SUP","HCPCS C1713","","212.809  -  SCREW BONE T8 CONE 2.4MM 1.9MM 9MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.81","SUP","HCPCS C1713","","212.810  -  SCREW BONE T8 CONE 2.4MM 1.9MM 10MM FIX ANGLE SELF TAP","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.811","SUP","HCPCS C1713","","212.811  -  SCREW BONE T8 CONE 2.4MM 1.9MM 11MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.812","SUP","HCPCS C1713","","212.812  -  SCREW BONE T8 2.4MM 12MM SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.813","SUP","HCPCS C1713","","212.813  -  SCREW BONE T8 CONE 2.4MM 1.9MM 13MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.814","SUP","HCPCS C1713","","212.814  -  SCREW BONE T8 2.4MM 14MM SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.816","SUP","HCPCS C1713","","212.816  -  SCREW BONE T8 CONE 2.4MM 1.9MM 16MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.818","SUP","HCPCS C1713","","212.818  -  SCREW BONE 2.4MM 1.9MM 18MM T8 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.82","SUP","HCPCS C1713","","212.820  -  SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.822","SUP","HCPCS C1713","","212.822  -  SCREW BONE 2.4MM 22MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.824","SUP","HCPCS C1713","","212.824  -  SCREW BONE T8 CONE 2.4MM 1.9MM 24MM FIX ANGLE SELF TAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.826","SUP","HCPCS C1713","","212.826  -  SCREW BONE 2.4MM 26MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.828","SUP","HCPCS C1713","","212.828  -  SCREW BONE 2.4MM 1.9MM 28MM FIX ANGLE SELF TAP T8 STARDRIVE","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"212.83","SUP","HCPCS C1713","","212.830  -  SCREW BONE T8 CONE 2.4MM 1.9MM 30MM FIX ANGLE SELF TAP","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"213.018","SUP","HCPCS C1713","","213.018  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 18MM SELF TAP THREAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.02","SUP","HCPCS C1713","","213.020  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 20MM SELF TAP THREAD","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.022","SUP","HCPCS C1713","","213.022  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 22MM SELF TAP THREAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.024","SUP","HCPCS C1713","","213.024  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 24MM SELF TAP THREAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.026","SUP","HCPCS C1713","","213.026  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 26MM SELF TAP THREAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.028","SUP","HCPCS C1713","","213.028  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 28MM SELF TAP THREAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.03","SUP","HCPCS C1713","","213.030  -  SCREW BONE 2.5MM 3.5MM 30MM SELF TAP LOCK SMALL HEXAGONAL","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.032","SUP","HCPCS C1713","","213.032  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 32MM SELF TAP THREAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.034","SUP","HCPCS C1713","","213.034  -  SCREW BONE 3.5MM 2.9MM 34MM SELF TAP LOCK SMALL HEXAGONAL","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.036","SUP","HCPCS C1713","","213.036  -  SCREW BONE 3.5MM 2.9MM 36MM SELF TAP LOCK SMALL HEXAGONAL","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.038","SUP","HCPCS C1713","","213.038  -  SCREW BONE 3.5MM 2.9MM 38MM SELF TAP LOCK SMALL HEXAGONAL","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.04","SUP","HCPCS C1713","","213.040  -  SCREW BONE 2.5MM 3.5MM 40MM SELF TAP SMALL HEXAGONAL RECESS","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.045","SUP","HCPCS C1713","","213.045  -  SCREW BONE 3.5MM 2.9MM 45MM SLFTAP LOCKING SMALL HEXAGONAL","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.05","SUP","HCPCS C1713","","213.050  -  SCREW BONE 3.5MM 2.9MM 50MM SLFTAP LOCKING SMALL HEXAGONAL","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"213.414","SUP","HCPCS C1713","","213.414  -  SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.418","SUP","HCPCS C1713","","213.418  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.422","SUP","HCPCS C1713","","213.422  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.426","SUP","HCPCS C1713","","213.426  -  SCREW BONE 5MM 26MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.43","SUP","HCPCS C1713","","213.430  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.435","SUP","HCPCS C1713","","213.435  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.44","SUP","HCPCS C1713","","213.440  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.445","SUP","HCPCS C1713","","213.445  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.45","SUP","HCPCS C1713","","213.450  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.455","SUP","HCPCS C1713","","213.455  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.465","SUP","HCPCS C1713","","213.465  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.47","SUP","HCPCS C1713","","213.470  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.475","SUP","HCPCS C1713","","213.475  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.48","SUP","HCPCS C1713","","213.480  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.485","SUP","HCPCS C1713","","213.485  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING LCP LISS STAINLESS","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"213.49","SUP","HCPCS C1713","","213.490  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STAINLESS STEEL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"213.508","SUP","HCPCS C1713","","213.508  -  SCREW BONE 4.5MM 8MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.509","SUP","HCPCS C1713","","213.509  -  SCREW BONE 4.5MM 9MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.51","SUP","HCPCS C1713","","213.510  -  SCREW BONE 4.5MM 10MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.511","SUP","HCPCS C1713","","213.511  -  SCREW BONE 4.5MM 11MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.512","SUP","HCPCS C1713","","213.512  -  SCREW BONE 4.5MM 12MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.513","SUP","HCPCS C1713","","213.513  -  SCREW BONE 4.5MM 13MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.514","SUP","HCPCS C1713","","213.514  -  SCREW BONE 4.5MM 14MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.515","SUP","HCPCS C1713","","213.515  -  SCREW BONE 4.5MM 15MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.516","SUP","HCPCS C1713","","213.516  -  SCREW BONE 4.5MM 16MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.517","SUP","HCPCS C1713","","213.517  -  SCREW BONE 4.5MM 17MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.518","SUP","HCPCS C1713","","213.518  -  SCREW BONE 4.5MM 18MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.519","SUP","HCPCS C1713","","213.519  -  SCREW BONE 4.5MM 19MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.52","SUP","HCPCS C1713","","213.520  -  SCREW BONE 4.5MM 20MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.521","SUP","HCPCS C1713","","213.521  -  SCREW BONE 4.5MM 21MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.522","SUP","HCPCS C1713","","213.522  -  SCREW BONE 4.5MM 22MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.523","SUP","HCPCS C1713","","213.523  -  SCREW BONE 4.5MM 23MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.524","SUP","HCPCS C1713","","213.524  -  SCREW BONE 4.5MM 24MM SS STRNL CANN NONSTRL","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.525","SUP","HCPCS C1713","","213.525  -  4.5MM STERNAL CANNULATED SCREW 25MM","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.526","SUP","HCPCS C1713","","213.526  -  4.5MM STERNAL CANNULATED SCREW 26MM","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.527","SUP","HCPCS C1713","","213.527  -  4.5MM STERNAL CANNULATED SCREW 27MM","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"213.528","SUP","HCPCS C1713","","213.528  -  4.5MM STERNAL CANNULATED SCREW 28MM","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$106.31 ","$0.00 ","$49.24 ","$0.00 ","$0.00 ","$41.37 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$36.97 ","$0.00 ","$37.61 ","$0.00 "
"214.014","SUP","HCPCS C1713","","214.014  -  SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.016","SUP","HCPCS C1713","","214.016  -  SCREW BONE STANDARD 4.5MM 8MM 16MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.018","SUP","HCPCS C1713","","214.018  -  SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET STAINLESS STEEL","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.02","SUP","HCPCS C1713","","214.020  -  SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.022","SUP","HCPCS C1713","","214.022  -  SCREW BONE STANDARD 4.5MM 8MM 22MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.024","SUP","HCPCS C1713","","214.024  -  SCREW BONE STANDARD 4.5MM 8MM 24MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.026","SUP","HCPCS C1713","","214.026  -  SCREW BONE STANDARD 4.5MM 8MM 26MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.028","SUP","HCPCS C1713","","214.028  -  SCREW BONE STANDARD 4.5MM 8MM 28MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.03","SUP","HCPCS C1713","","214.030  -  SCREW BONE STANDARD 4.5MM 8MM 30MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.032","SUP","HCPCS C1713","","214.032  -  SCREW BONE STANDARD 4.5MM 8MM 32MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.034","SUP","HCPCS C1713","","214.034  -  SCREW BONE STANDARD 4.5MM 8MM 34MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.036","SUP","HCPCS C1713","","214.036  -  SCREW BONE STANDARD 4.5MM 8MM 36MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.038","SUP","HCPCS C1713","","214.038  -  SCREW BONE STANDARD 4.5MM 8MM 38MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.04","SUP","HCPCS C1713","","214.040  -  SCREW BONE STANDARD 4.5MM 8MM 40MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.042","SUP","HCPCS C1713","","214.042  -  SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET STAINLESS STEEL","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.044","SUP","HCPCS C1713","","214.044  -  SCREW BONE STANDARD 4.5MM 8MM 44MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.046","SUP","HCPCS C1713","","214.046  -  SCREW BONE STANDARD 4.5MM 8MM 46MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.048","SUP","HCPCS C1713","","214.048  -  SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 48MM SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.05","SUP","HCPCS C1713","","214.050  -  SCREW BONE STANDARD 4.5MM 8MM 50MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.052","SUP","HCPCS C1713","","214.052  -  SCREW BONE STANDARD 4.5MM 8MM 52MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.054","SUP","HCPCS C1713","","214.054  -  SCREW BONE STANDARD 4.5MM 8MM 54MM LARGE HEXGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.056","SUP","HCPCS C1713","","214.056  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 56MM LARGE HEXAGONAL","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.058","SUP","HCPCS C1713","","214.058  -  SCREW BONE STANDARD 4.5MM 8MM 58MM CORTEX PROXIMAL MEDIAL","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.06","SUP","HCPCS C1713","","214.060  -  SCREW BONE STANDARD 4.5MM 8MM 60MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.062","SUP","HCPCS C1713","","214.062  -  SCREW BONE STANDARD 4.5MM 8MM 62MM NONSELF TAP LARGE HEXAGON","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.064","SUP","HCPCS C1713","","214.064  -  SCREW BONE STANDARD 4.5MM 8MM 64MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.066","SUP","HCPCS C1713","","214.066  -  SCREW BONE STANDARD 4.5MM 8MM 66MM NONSELF TAP LARGE HEXAGON","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.068","SUP","HCPCS C1713","","214.068  -  SCREW BONE STANDARD 4.5MM 8MM 68MM NONSELF TAP LARGE HEXAGON","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.07","SUP","HCPCS C1713","","214.070  -  SCREW BONE STANDARD 4.5MM 8MM 70MM NONSELF TAP LARGE HEXAGON","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.072","SUP","HCPCS C1713","","214.072  -  SCREW BONE STANDARD 4.5MM 8MM 72MM NONSELF TAPPING LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"214.076","SUP","HCPCS C1713","","214.076  -  SCREW BONE 4.5MM 76MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.08","SUP","HCPCS C1713","","214.080  -  SCREW BONE STANDARD 4.5MM 8MM 80MM NONSELF TAPPING LARGE","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.085","SUP","HCPCS C1713","","214.085  -  SCREW BONE STANDARD 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.09","SUP","HCPCS C1713","","214.090  -  SCREW BONE 4.5MM 90MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.095","SUP","HCPCS C1713","","214.095  -  SCREW BONE STANDARD 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.1","SUP","HCPCS C1713","","214.100  -  SCREW BONE 4.5MM 100MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.105","SUP","HCPCS C1713","","214.105  -  SCREW BONE 4.5MM 105MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.11","SUP","HCPCS C1713","","214.110  -  SCREW BONE 4.5MM 110MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.115","SUP","HCPCS C1713","","214.115  -  SCREW BONE 4.5MM 115MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.12","SUP","HCPCS C1713","","214.120  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 120MM LARGE HEXGONAL","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.125","SUP","HCPCS C1713","","214.125  -  SCREW BONE 4.5MM 125MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.13","SUP","HCPCS C1713","","214.130  -  SCREW BONE 4.5MM 130MM DHS/DCP LC-DCP DCS STAINLESS STEEL","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.135","SUP","HCPCS C1713","","214.135  -  SCREW BONE 4.5MM 135MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.14","SUP","HCPCS C1713","","214.140  -  SCREW BONE 4.5MM 140MM DHS/DCP LC-DCP DCS STAINLESS STEEL","BOTH IP/OP","$49.80 ","$36.85 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.38 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.145","SUP","HCPCS C1713","","214.145  -  SCREW BONE 4.5MM 145MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$51.30 ","$37.96 ","$0.00 ","$49.80 ","$22.41 ","$0.00 ","$10.69 ","$0.00 ","$0.00 ","$8.72 ","$49.80 ","$0.00 ","$24.90 ","$39.44 ","$39.84 ","$0.00 ","$7.57 ","$0.00 ","$7.93 ","$0.00 "
"214.15","SUP","HCPCS C1713","","214.150  -  SCREW BONE 4.5MM 150MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$68.90 ","$50.99 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.36 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"214.155","SUP","HCPCS C1713","","214.155  -  SCREW BONE 4.5MM 155MM LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"214.16","SUP","HCPCS C1713","","214.160  -  SCREW BONE 4.5MM 160MM NON SLFTAP STAINLESS STEEL CORTICAL","BOTH IP/OP","$68.90 ","$50.99 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.36 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"214.222","SUP","HCPCS C1713","","214.222  -  SCREW BONE 4.5MM 22MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.224","SUP","HCPCS C1713","","214.224  -  SCREW BONE 4.5MM 24MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.226","SUP","HCPCS C1713","","214.226  -  SCREW BONE 4.5MM 26MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.228","SUP","HCPCS C1713","","214.228  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 28MM 12MM SOCKET DCP","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.23","SUP","HCPCS C1713","","214.230  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM 12MM SOCKET DCP","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.232","SUP","HCPCS C1713","","214.232  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM 12MM SOCKET DCP","BOTH IP/OP","$31.03 ","$22.96 ","$0.00 ","$31.03 ","$13.96 ","$0.00 ","$6.47 ","$0.00 ","$0.00 ","$5.43 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$4.71 ","$0.00 ","$4.94 ","$0.00 "
"214.234","SUP","HCPCS C1713","","214.234  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 34MM 12MM SOCKET DCP","BOTH IP/OP","$31.03 ","$22.96 ","$0.00 ","$31.03 ","$13.96 ","$0.00 ","$6.47 ","$0.00 ","$0.00 ","$5.43 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$4.71 ","$0.00 ","$4.94 ","$0.00 "
"214.236","SUP","HCPCS C1713","","214.236  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM 12MM SOCKET DCP","BOTH IP/OP","$31.03 ","$22.96 ","$0.00 ","$31.03 ","$13.96 ","$0.00 ","$6.47 ","$0.00 ","$0.00 ","$5.43 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$4.71 ","$0.00 ","$4.94 ","$0.00 "
"214.238","SUP","HCPCS C1713","","214.238  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 38MM 12MM SOCKET DCP","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.24","SUP","HCPCS C1713","","214.240  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 40MM 12MM SOCKET DCP","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"214.242","SUP","HCPCS C1713","","214.242  -  SCREW BONE PTHRD 4.5MM 8MM 42MM 12MM LCP STAINLESS STEEL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.244","SUP","HCPCS C1713","","214.244  -  SCREW BONE PTHRD 4.5MM 8MM 44MM 12MM LCP STAINLESS STEEL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.246","SUP","HCPCS C1713","","214.246  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 46MM 12MM SOCKET DCP","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$34.45 ","$15.50 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$6.03 ","$34.45 ","$0.00 ","$17.23 ","$27.28 ","$27.56 ","$0.00 ","$5.23 ","$0.00 ","$5.48 ","$0.00 "
"214.248","SUP","HCPCS C1713","","214.248  -  SCREW BONE PTHRD 4.5MM 8MM 50MM 12MM LCP STAINLESS STEEL","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$34.45 ","$15.50 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$6.03 ","$34.45 ","$0.00 ","$17.23 ","$27.28 ","$27.56 ","$0.00 ","$5.23 ","$0.00 ","$5.48 ","$0.00 "
"214.25","SUP","HCPCS C1713","","214.250  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 50MM 12MM SOCKET DCP","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.252","SUP","HCPCS C1713","","214.252  -  SCREW BONE 4.5MM 52MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.254","SUP","HCPCS C1713","","214.254  -  SCREW BONE 4.5MM 54MM SHAFT LC-DCP STAINLESS STEEL CORTICAL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.256","SUP","HCPCS C1713","","214.256  -  SCREW BONE 4.5MM 8MM 56MM 15MM SHAFT LC-DCP DHS DCS","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.26","SUP","HCPCS C1713","","214.260  -  SCREW BONE 4.5MM 60MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.268","SUP","HCPCS C1713","","214.268  -  SCREW BONE 4.5MM 68MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.272","SUP","HCPCS C1713","","214.272  -  SCREW BONE 4.5MM 8MM 72MM 18MM SHAFT LC-DCP DHS DCS","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"214.276","SUP","HCPCS C1713","","214.276  -  SCREW BONE 4.5MM 76MM SHAFT LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"214.28","SUP","HCPCS C1713","","214.280  -  SCREW BONE 4.5MM 80MM SHAFT DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"214.29","SUP","HCPCS C1713","","214.290  -  SCREW BONE 4.5MM 90MM SHAFT LC-DCP STAINLESS STEEL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"214.295","SUP","HCPCS C1713","","214.295  -  SCREW BONE 4.5MM 95MM SHAFT LC-DCP STAINLESS STEEL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"214.3","SUP","HCPCS C1713","","214.300  -  SCREW BONE 4.5MM 100MM SHAFT LC-DCP DCP STAINLESS STEEL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"214.52","SUP","HCPCS C1713","","214.520  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.522","SUP","HCPCS C1713","","214.522  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.524","SUP","HCPCS C1713","","214.524  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.526","SUP","HCPCS C1713","","214.526  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.528","SUP","HCPCS C1713","","214.528  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.53","SUP","HCPCS C1713","","214.530  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.532","SUP","HCPCS C1713","","214.532  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.534","SUP","HCPCS C1713","","214.534  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.536","SUP","HCPCS C1713","","214.536  -  SCREW BONE PTHRD 4.5MM 6.5MM 36MM CANN SLFTAP SLFDRILL LARGE","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.538","SUP","HCPCS C1713","","214.538  -  SCREW BONE PTHRD 4.5MM 6.5MM 38MM CANN LARGE HEXAGONAL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$75.11 ","$0.00 ","$58.23 ","$0.00 "
"214.54","SUP","HCPCS C1713","","214.540  -  SCREW BONE PTHRD 4.5MM 6.5MM 40MM CANN REVERSE CUTTING FLUTE","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$75.11 ","$0.00 ","$58.23 ","$0.00 "
"214.542","SUP","HCPCS C1713","","214.542  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.544","SUP","HCPCS C1713","","214.544  -  SCREW BONE PTHRD 4.5MM 6.5MM 44MM CANN SLFTAP SLFDRILL LARGE","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$75.11 ","$0.00 ","$58.23 ","$0.00 "
"214.546","SUP","HCPCS C1713","","214.546  -  SCREW BONE PTHRD 4.5MM 6.5MM 46MM CANN LP HEMISPHERICAL HEAD","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.548","SUP","HCPCS C1713","","214.548  -  SCREW BONE PTHRD 4.5MM 6.5MM 48MM CANN SLFTAP SLFDRILL LARGE","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.55","SUP","HCPCS C1713","","214.550  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.552","SUP","HCPCS C1713","","214.552  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.554","SUP","HCPCS C1713","","214.554  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.556","SUP","HCPCS C1713","","214.556  -  SCREW BONE PTHRD 4.5MM 6.5MM 56MM CANN SLFTAP SLFDRILL LARGE","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.56","SUP","HCPCS C1713","","214.560  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.564","SUP","HCPCS C1713","","214.564  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.568","SUP","HCPCS C1713","","214.568  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.572","SUP","HCPCS C1713","","214.572  -  SCREW BONE 4.5MM 72MM 24MM CANN PTTHRD STAINLESS STEEL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"214.576","SUP","HCPCS C1713","","214.576  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.58","SUP","HCPCS C1713","","214.580  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.72","SUP","HCPCS C1713","","214.720  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.722","SUP","HCPCS C1713","","214.722  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.724","SUP","HCPCS C1713","","214.724  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.726","SUP","HCPCS C1713","","214.726  -  SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.728","SUP","HCPCS C1713","","214.728  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.73","SUP","HCPCS C1713","","214.730  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.732","SUP","HCPCS C1713","","214.732  -  SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.734","SUP","HCPCS C1713","","214.734  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.736","SUP","HCPCS C1713","","214.736  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.738","SUP","HCPCS C1713","","214.738  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.74","SUP","HCPCS C1713","","214.740  -  SCREW BONE 3.5MM FULTHD 4.5MM 6.5MM 40MM CANN SELF DRILL","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.742","SUP","HCPCS C1713","","214.742  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.744","SUP","HCPCS C1713","","214.744  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.746","SUP","HCPCS C1713","","214.746  -  SCREW BONE FULTHD 4.5MM 6.5MM 46MM CANN SELF TAP LARGE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.748","SUP","HCPCS C1713","","214.748  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.75","SUP","HCPCS C1713","","214.750  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.752","SUP","HCPCS C1713","","214.752  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.754","SUP","HCPCS C1713","","214.754  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.756","SUP","HCPCS C1713","","214.756  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.76","SUP","HCPCS C1713","","214.760  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.764","SUP","HCPCS C1713","","214.764  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.768","SUP","HCPCS C1713","","214.768  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.772","SUP","HCPCS C1713","","214.772  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.776","SUP","HCPCS C1713","","214.776  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.777","SUP","HCPCS C1713","","214.777  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"214.814","SUP","HCPCS C1713","","214.814  -  SCREW BONE 4.5MM 8MM 14MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.816","SUP","HCPCS C1713","","214.816  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 16MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.818","SUP","HCPCS C1713","","214.818  -  SCREW BONE 4.5MM 8MM 18MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.82","SUP","HCPCS C1713","","214.820  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 20MM SELF TAP SOCKET LCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.822","SUP","HCPCS C1713","","214.822  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 22MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.824","SUP","HCPCS C1713","","214.824  -  SCREW BONE 4.5MM 8MM 24MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.826","SUP","HCPCS C1713","","214.826  -  SCREW BONE 4.5MM 8MM 26MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.828","SUP","HCPCS C1713","","214.828  -  SCREW BONE 4.5MM 28MM SLFTAP LCP STAINLESS STEEL PEDIATRIC","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.83","SUP","HCPCS C1713","","214.830  -  SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.83","SUP","HCPCS C1713","","214.83  -  SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$89.69 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$89.69 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.832","SUP","HCPCS C1713","","214.832  -  SCREW BONE 4.5MM 8MM 32MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.834","SUP","HCPCS C1713","","214.834  -  SCREW BONE 4.5MM 8MM 34MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.836","SUP","HCPCS C1713","","214.836  -  SCREW BONE 4.5MM 8MM 36MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.838","SUP","HCPCS C1713","","214.838  -  SCREW BONE 4.5MM 38MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.84","SUP","HCPCS C1713","","214.840  -  SCREW BONE STANDARD 4.5MM 40MM SLFTAP TIP LCP STAINLESS","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$226.50 ","$101.93 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$39.66 ","$226.50 ","$0.00 ","$113.25 ","$30.79 ","$181.20 ","$0.00 ","$35.45 ","$0.00 ","$36.06 ","$0.00 "
"214.84","SUP","HCPCS C1713","","214.84  -  SCREW BN 4.5MM 8MM 40MM NS ST LG HEX SCKT SS CORT LG FRAG","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$226.50 ","$101.93 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$39.66 ","$226.50 ","$0.00 ","$113.25 ","$179.39 ","$181.20 ","$0.00 ","$35.45 ","$0.00 ","$36.06 ","$0.00 "
"214.842","SUP","HCPCS C1713","","214.842  -  SCREW BONE 4.5MM 8MM 42MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.844","SUP","HCPCS C1713","","214.844  -  SCREW BONE 4.5MM 8MM 44MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.846","SUP","HCPCS C1713","","214.846  -  SCREW BONE 4.5MM 46MM SLFTAP TIP LCP STAINLESS STEEL","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.848","SUP","HCPCS C1713","","214.848  -  SCREW BONE 4.5MM 48MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.85","SUP","HCPCS C1713","","214.850  -  SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$113.25 ","$50.96 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$19.83 ","$113.25 ","$0.00 ","$56.63 ","$30.79 ","$90.60 ","$0.00 ","$17.72 ","$0.00 ","$18.03 ","$0.00 "
"214.85","SUP","HCPCS C1713","","214.85  -  SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$113.25 ","$50.96 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$19.83 ","$113.25 ","$0.00 ","$56.63 ","$89.69 ","$90.60 ","$0.00 ","$17.72 ","$0.00 ","$18.03 ","$0.00 "
"214.852","SUP","HCPCS C1713","","214.852  -  SCREW BONE 4.5MM 52MM SELF TAP LC-DCP DHS DCS STAINLESS","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.854","SUP","HCPCS C1713","","214.854  -  SCREW BONE 4.5MM 54MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.856","SUP","HCPCS C1713","","214.856  -  SCREW BONE 4.5MM 56MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.858","SUP","HCPCS C1713","","214.858  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 58MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.86","SUP","HCPCS C1713","","214.860  -  SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.86","SUP","HCPCS C1713","","214.86  -  SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$59.80 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$59.80 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.862","SUP","HCPCS C1713","","214.862  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 62MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.864","SUP","HCPCS C1713","","214.864  -  SCREW BONE 4.5MM 8MM 64MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.866","SUP","HCPCS C1713","","214.866  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 66MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.868","SUP","HCPCS C1713","","214.868  -  SCREW BONE 4.5MM 8MM 68MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.87","SUP","HCPCS C1713","","214.870  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$75.50 ","$33.98 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$13.22 ","$75.50 ","$0.00 ","$37.75 ","$30.79 ","$60.40 ","$0.00 ","$11.82 ","$0.00 ","$12.02 ","$0.00 "
"214.87","SUP","HCPCS C1713","","214.87  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$75.50 ","$33.98 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$13.22 ","$75.50 ","$0.00 ","$37.75 ","$59.80 ","$60.40 ","$0.00 ","$11.82 ","$0.00 ","$12.02 ","$0.00 "
"214.872","SUP","HCPCS C1713","","214.872  -  SCREW BONE 4.5MM 8MM 72MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"214.876","SUP","HCPCS C1713","","214.876  -  SCREW BONE 4.5MM 8MM 76MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.88","SUP","HCPCS C1713","","214.880  -  SCREW BONE 4.5MM 80MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$14.27 ","$0.00 ","$10.21 ","$0.00 "
"214.885","SUP","HCPCS C1713","","214.885  -  SCREW BONE 4.5MM 8MM 85MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$14.27 ","$0.00 ","$10.21 ","$0.00 "
"214.89","SUP","HCPCS C1713","","214.890  -  SCREW BONE 4.5MM 8MM 90MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.895","SUP","HCPCS C1713","","214.895  -  SCREW BONE 4.5MM 8MM 95MM SELF TAP LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.9","SUP","HCPCS C1713","","214.900  -  SCREW BONE 4.5MM 8MM 100MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$14.27 ","$0.00 ","$10.21 ","$0.00 "
"214.905","SUP","HCPCS C1713","","214.905  -  SCREW BONE 4.5MM 8MM 105MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.91","SUP","HCPCS C1713","","214.910  -  SCREW BONE 4.5MM 8MM 110MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.915","SUP","HCPCS C1713","","214.915  -  SCREW BONE 4.5MM 8MM 115MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.92","SUP","HCPCS C1713","","214.920  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 120MM SELF TAP SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.925","SUP","HCPCS C1713","","214.925  -  SCREW BONE 4.5MM 8MM 125MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.93","SUP","HCPCS C1713","","214.930  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 130MM SELF TAP SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.935","SUP","HCPCS C1713","","214.935  -  SCREW BONE 4.5MM 8MM 135MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.94","SUP","HCPCS C1713","","214.940  -  SCREW BONE 4.5MM 8MM 140MM SLFTAP LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"214.945","SUP","HCPCS C1713","","214.945  -  SCREW BONE 4.5MM 8MM 145MM SELF TAP HEXAGONAL SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"215.025","SUP","HCPCS C1713","","215.025  -  SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 25MM 12MM DCP LC-DCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.03","SUP","HCPCS C1713","","215.030  -  SCREW BONE PTHRD 4.5MM 8MM 30MM 15MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.035","SUP","HCPCS C1713","","215.035  -  SCREW BONE 4.5MM 35MM IMPLANT LC-DCP DCP MALLEOLAR LARGE","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.04","SUP","HCPCS C1713","","215.040  -  SCREW BONE 4.5MM 40MM DCP LC-DCP STAINLESS STEEL MALLEOLAR","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.045","SUP","HCPCS C1713","","215.045  -  SCREW BONE 3.5MM 4.5MM 8MM 45MM 22MM HEXAGONAL SOCKET LC-DCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.05","SUP","HCPCS C1713","","215.050  -  SCREW BONE PTHRD 4.5MM 8MM 50MM 24MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.055","SUP","HCPCS C1713","","215.055  -  SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 55MM 26MM DCP LC-DCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.06","SUP","HCPCS C1713","","215.060  -  SCREW BONE 3.5MM 4.5MM 8MM 60MM 28MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.065","SUP","HCPCS C1713","","215.065  -  SCREW BONE 3.5MM 4.5MM 65MM 30MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.07","SUP","HCPCS C1713","","215.070  -  SCREW BONE 3.5MM 4.5MM 8MM 70MM 32MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.075","SUP","HCPCS C1713","","215.075  -  SCREW BONE 4.5MM 75MM LC-DCP STAINLESS STEEL MALLEOLAR","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.08","SUP","HCPCS C1713","","215.080  -  SCREW BONE 4.5MM 80MM LC-DCP STAINLESS STEEL MALLEOLAR","BOTH IP/OP","$56.30 ","$41.66 ","$0.00 ","$56.30 ","$25.34 ","$0.00 ","$11.73 ","$0.00 ","$0.00 ","$9.86 ","$56.30 ","$0.00 ","$28.15 ","$44.59 ","$45.04 ","$0.00 ","$8.81 ","$0.00 ","$8.96 ","$0.00 "
"215.222","SUP","HCPCS C1713","","215.222  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 22MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.224","SUP","HCPCS C1713","","215.224  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 24MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.226","SUP","HCPCS C1713","","215.226  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 26MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.228","SUP","HCPCS C1713","","215.228  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 28MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.23","SUP","HCPCS C1713","","215.230  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 30MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.232","SUP","HCPCS C1713","","215.232  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 32MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.234","SUP","HCPCS C1713","","215.234  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 34MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.236","SUP","HCPCS C1713","","215.236  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 36MM","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"215.308","SUP","HCPCS C1713","","215.308  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 8MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.31","SUP","HCPCS C1713","","215.310  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.312","SUP","HCPCS C1713","","215.312  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.314","SUP","HCPCS C1713","","215.314  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.316","SUP","HCPCS C1713","","215.316  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 16MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.318","SUP","HCPCS C1713","","215.318  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 18MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.32","SUP","HCPCS C1713","","215.320  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 20MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.322","SUP","HCPCS C1713","","215.322  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 22MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.324","SUP","HCPCS C1713","","215.324  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 24MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.326","SUP","HCPCS C1713","","215.326  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 26MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.328","SUP","HCPCS C1713","","215.328  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 28MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.33","SUP","HCPCS C1713","","215.330  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 30MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.335","SUP","HCPCS C1713","","215.335  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 35MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.34","SUP","HCPCS C1713","","215.340  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 40MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.345","SUP","HCPCS C1713","","215.345  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 45MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.35","SUP","HCPCS C1713","","215.350  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 50MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.41","SUP","HCPCS C1713","","215.410  -  4.0MM SS PROTEX? CT POLYAXIAL SCREW, 10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.412","SUP","HCPCS C1713","","215.412  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.414","SUP","HCPCS C1713","","215.414  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.416","SUP","HCPCS C1713","","215.416  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 16MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.418","SUP","HCPCS C1713","","215.418  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 18MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.42","SUP","HCPCS C1713","","215.420  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 20MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.422","SUP","HCPCS C1713","","215.422  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 22MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.424","SUP","HCPCS C1713","","215.424  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 24MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.426","SUP","HCPCS C1713","","215.426  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 26MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.428","SUP","HCPCS C1713","","215.428  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 28MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.43","SUP","HCPCS C1713","","215.430  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 30MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.435","SUP","HCPCS C1713","","215.435  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 35MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.44","SUP","HCPCS C1713","","215.440  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 40MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.445","SUP","HCPCS C1713","","215.445  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 45MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.45","SUP","HCPCS C1713","","215.450  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 50MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.5","SUP","HCPCS C1713","","215.500  -  SS PROTEX CT LOCKING CAP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"215.501","SUP","HCPCS C1713","","215.501  -  SS PROTEX HOOK","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"215.503","SUP","Custom 27803010","","215.503  -  SS PROTEX HOOK, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.504","SUP","Custom 27803010","","215.504  -  SS PROTEX HOOK, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.506","SUP","Custom 27803010","","215.506  -  SS PROTEX HOOK, 7MM OFFSET, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.507","SUP","Custom 27803010","","215.507  -  SS PROTEX HOOK, 5MM OFFSET, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.508","SUP","Custom 27803010","","215.508  -  SS PROTEX HOOK, 7MM OFFSET, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.509","SUP","Custom 27803010","","215.509  -  SS PROTEX HOOK, 5MM OFFSET, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.51","SUP","HCPCS C1713","","215.510  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.512","SUP","HCPCS C1713","","215.512  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.514","SUP","HCPCS C1713","","215.514  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.516","SUP","HCPCS C1713","","215.516  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 16MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.518","SUP","HCPCS C1713","","215.518  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 18MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.52","SUP","HCPCS C1713","","215.520  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 20MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.522","SUP","HCPCS C1713","","215.522  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 22MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.524","SUP","HCPCS C1713","","215.524  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 24MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.526","SUP","HCPCS C1713","","215.526  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 26MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.528","SUP","HCPCS C1713","","215.528  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 28MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.53","SUP","HCPCS C1713","","215.530  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 30MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.535","SUP","HCPCS C1713","","215.535  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 35MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.54","SUP","HCPCS C1713","","215.540  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 40MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.545","SUP","HCPCS C1713","","215.545  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 45MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.55","SUP","HCPCS C1713","","215.550  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 50MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.625","SUP","HCPCS C1713","","215.625  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 25MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.63","SUP","HCPCS C1713","","215.630  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 30MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.635","SUP","HCPCS C1713","","215.635  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 35MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.64","SUP","HCPCS C1713","","215.640  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 40MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.645","SUP","HCPCS C1713","","215.645  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 45MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.65","SUP","HCPCS C1713","","215.650  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 50MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"215.801","SUP","Custom 27803010","","215.801  -  3.7MM SS STRAIGHT ROD, 80MM","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.802","SUP","Custom 27803010","","215.802  -  3.7MM SS STRAIGHT ROD, 120MM","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.803","SUP","Custom 27803010","","215.803  -  3.7MM SS STRAIGHT ROD, 240MM","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.804","SUP","Custom 27803010","","215.804  -  3.7MM SS STRAIGHT ROD, 40MM","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.806","SUP","HCPCS C1713","","215.806  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.808","SUP","HCPCS C1713","","215.808  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.81","SUP","HCPCS C1713","","215.810  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.812","SUP","HCPCS C1713","","215.812  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.814","SUP","HCPCS C1713","","215.814  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.816","SUP","HCPCS C1713","","215.816  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 16MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.906","SUP","HCPCS C1713","","215.906  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 6MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.908","SUP","HCPCS C1713","","215.908  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 8MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.91","SUP","HCPCS C1713","","215.910  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 10MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.912","SUP","HCPCS C1713","","215.912  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 12MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.914","SUP","HCPCS C1713","","215.914  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 14MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.916","SUP","HCPCS C1713","","215.916  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 16MM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"215.923","SUP","Custom 27803010","","215.923  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 21-33MM, STRAIGHT","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.925","SUP","Custom 27803010","","215.925  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 26-46MM, STRAIGHT","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.927","SUP","Custom 27803010","","215.927  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56MM, STRAIGHT","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.949","SUP","HCPCS C1713","","215.949  -  SS SET SCREW, M4.5 X 0.75, ROUND TIP, 2.5MM HEX","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"215.95","SUP","Custom 27803010","","215.950  -  SS OCCIPITAL CLAMP, SINGLE, SHORT","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.951","SUP","Custom 27803010","","215.951  -  SS OCCIPITAL CLAMP, SINGLE, LONG","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.952","SUP","HCPCS C1713","","215.952  -  SS SET SCREW, M4.5 X 0.75","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"215.953","SUP","Custom 27803010","","215.953  -  SS 3.7MM OCCIPITAL ROD, 240MM, 100DEG","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.954","SUP","Custom 27803010","","215.954  -  SS 3.7MM OCCIPITAL ROD, 240MM, 115DEG","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.955","SUP","Custom 27803010","","215.955  -  SS 3.7MM OCCIPITAL ROD, 240MM, 130DEG","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.956","SUP","Custom 27803010","","215.956  -  SS OCCIPITAL CLAMP, TRIPLE, SHORT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.957","SUP","Custom 27803010","","215.957  -  SS OCCIPITAL CLAMP, TRIPLE, LONG","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.958","SUP","Custom 27803010","","215.958  -  SS OCCIPITAL CLAMP, DOUBLE, SHORT","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.959","SUP","Custom 27803010","","215.959  -  SS OCCIPITAL CLAMP, DOUBLE, LONG","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.96","SUP","Custom 27803010","","215.960  -  SS PARALLEL CONNECTOR, 3.7MM ROD TO 3.7MM ROD","BOTH IP/OP","$1,787.50 ","$1,322.75 ","$0.00 ","$1,787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,787.50 ","$0.00 ","$893.75 ","$1,415.70 ","$1,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.963","SUP","Custom 27803010","","215.963  -  SS PARALLEL CONNECTOR, 3.7MM ROD TO 5.5MM ROD","BOTH IP/OP","$1,787.50 ","$1,322.75 ","$0.00 ","$1,787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,787.50 ","$0.00 ","$893.75 ","$1,415.70 ","$1,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.984","SUP","Custom 27803010","","215.984  -  SS TAPERED ROD, 3.7MM TO 5.5MM, 350MM","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.99","SUP","Custom 27803010","","215.990  -  SS LATERAL CONNECTOR","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"215.991","SUP","Custom 27803010","","215.991  -  SS LATERAL CONNECTOR, SHORT","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"216.03","SUP","HCPCS C1713","","216.030  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LCP DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.035","SUP","HCPCS C1713","","216.035  -  SCREW BONE PTHRD 6.5MM 8MM 35MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"216.04","SUP","HCPCS C1713","","216.040  -  SCREW BONE PTHRD 6.5MM 8MM 40MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"216.045","SUP","HCPCS C1713","","216.045  -  SCREW BONE PTHRD 6.5MM 8MM 45MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.05","SUP","HCPCS C1713","","216.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LCP DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.055","SUP","HCPCS C1713","","216.055  -  SCREW BONE PTHRD 6.5MM 8MM 55MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.06","SUP","HCPCS C1713","","216.060  -  SCREW BONE PTHRD 6.5MM 8MM 60MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.065","SUP","HCPCS C1713","","216.065  -  SCREW BONE PTHRD 6.5MM 8MM 65MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.07","SUP","HCPCS C1713","","216.070  -  SCREW BONE PTHRD 6.5MM 8MM 70MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.075","SUP","HCPCS C1713","","216.075  -  SCREW BONE PTHRD 6.5MM 8MM 75MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.08","SUP","HCPCS C1713","","216.080  -  SCREW BONE PTHRD 6.5MM 8MM 80MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"216.085","SUP","HCPCS C1713","","216.085  -  SCREW BONE PTHRD 6.5MM 8MM 85MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"216.09","SUP","HCPCS C1713","","216.090  -  SCREW BONE PTHRD 6.5MM 8MM 90MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"216.095","SUP","HCPCS C1713","","216.095  -  SCREW BONE PTHRD 6.5MM 8MM 95MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"216.1","SUP","HCPCS C1713","","216.100  -  SCREW BONE PTHRD 6.5MM 8MM 100MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"216.105","SUP","HCPCS C1713","","216.105  -  SCREW BONE PTHRD 6.5MM 8MM 105MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"216.11","SUP","HCPCS C1713","","216.110  -  SCREW BONE PTHRD 6.5MM 110MM 16MM THREAD LCP STAINLESS STEEL","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"216.115","SUP","HCPCS C1713","","216.115  -  SCREW BONE PTHRD 6.5MM 8MM 115MM 16MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.12","SUP","HCPCS C1713","","216.120  -  SCREW BONE PTHRD 6.5MM 8MM 120MM 16MM HEXAGONAL SOCKET LCP","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.125","SUP","HCPCS C1713","","216.125  -  SCREW BONE 6.5MM 125MM 16MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.13","SUP","HCPCS C1713","","216.130  -  SCREW BONE PTHRD 6.5MM 8MM 130MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.135","SUP","HCPCS C1713","","216.135  -  SCREW BONE 6.5MM 135MM 16MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.14","SUP","HCPCS C1713","","216.140  -  SCREW BONE PTHRD 6.5MM 8MM 140MM 16MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.145","SUP","HCPCS C1713","","216.145  -  SCREW BONE 6.5MM 145MM 16MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.15","SUP","HCPCS C1713","","216.150  -  SCREW BONE 6.5MM 150MM 16MM LOCKING THREADED LC-DCP","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"216.24","SUP","HCPCS C1713","","216.240  -  SCREW BONE 6.5MM 40MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$57.63 ","$42.65 ","$0.00 ","$57.63 ","$25.93 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.63 ","$0.00 ","$28.81 ","$45.64 ","$46.10 ","$0.00 ","$9.02 ","$0.00 ","$9.17 ","$0.00 "
"216.25","SUP","HCPCS C1713","","216.250  -  SCREW BONE 6.5MM 8MM 50MM 24MM LARGE HEXAGONAL SOCKET DCP","BOTH IP/OP","$57.63 ","$42.65 ","$0.00 ","$57.63 ","$25.93 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.63 ","$0.00 ","$28.81 ","$45.64 ","$46.10 ","$0.00 ","$9.02 ","$0.00 ","$9.17 ","$0.00 "
"216.26","SUP","HCPCS C1713","","216.260  -  SCREW BONE 6.5MM 60MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$57.63 ","$42.65 ","$0.00 ","$57.63 ","$25.93 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.63 ","$0.00 ","$28.81 ","$45.64 ","$46.10 ","$0.00 ","$9.02 ","$0.00 ","$9.17 ","$0.00 "
"216.27","SUP","HCPCS C1713","","216.270  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 24MM SOCKET LCP DCP","BOTH IP/OP","$57.63 ","$42.65 ","$0.00 ","$57.63 ","$25.93 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.63 ","$0.00 ","$28.81 ","$45.64 ","$46.10 ","$0.00 ","$9.02 ","$0.00 ","$9.17 ","$0.00 "
"216.28","SUP","HCPCS C1713","","216.280  -  SCREW BONE 6.5MM 80MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$57.63 ","$42.65 ","$0.00 ","$57.63 ","$25.93 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.63 ","$0.00 ","$28.81 ","$45.64 ","$46.10 ","$0.00 ","$9.02 ","$0.00 ","$9.17 ","$0.00 "
"216.29","SUP","HCPCS C1713","","216.290  -  SCREW BONE 6.5MM 90MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$62.28 ","$46.09 ","$0.00 ","$62.28 ","$28.02 ","$0.00 ","$12.98 ","$0.00 ","$0.00 ","$10.90 ","$62.28 ","$0.00 ","$31.14 ","$49.33 ","$49.82 ","$0.00 ","$9.75 ","$0.00 ","$9.91 ","$0.00 "
"216.295","SUP","HCPCS C1713","","216.295  -  SCREW BONE 6.5MM 95MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$62.28 ","$46.09 ","$0.00 ","$62.28 ","$28.02 ","$0.00 ","$12.98 ","$0.00 ","$0.00 ","$10.90 ","$62.28 ","$0.00 ","$31.14 ","$49.33 ","$49.82 ","$0.00 ","$9.75 ","$0.00 ","$9.91 ","$0.00 "
"216.3","SUP","HCPCS C1713","","216.300  -  SCREW BONE 6.5MM 100MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$62.28 ","$46.09 ","$0.00 ","$62.28 ","$28.02 ","$0.00 ","$12.98 ","$0.00 ","$0.00 ","$10.90 ","$62.28 ","$0.00 ","$31.14 ","$49.33 ","$49.82 ","$0.00 ","$9.75 ","$0.00 ","$9.91 ","$0.00 "
"216.305","SUP","HCPCS C1713","","216.305  -  SCREW BONE 6.5MM 105MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$62.28 ","$46.09 ","$0.00 ","$62.28 ","$28.02 ","$0.00 ","$12.98 ","$0.00 ","$0.00 ","$10.90 ","$62.28 ","$0.00 ","$31.14 ","$49.33 ","$49.82 ","$0.00 ","$9.75 ","$0.00 ","$9.91 ","$0.00 "
"216.31","SUP","HCPCS C1713","","216.310  -  SCREW BONE 6.5MM 110MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$62.28 ","$46.09 ","$0.00 ","$62.28 ","$28.02 ","$0.00 ","$12.98 ","$0.00 ","$0.00 ","$10.90 ","$62.28 ","$0.00 ","$31.14 ","$49.33 ","$49.82 ","$0.00 ","$9.75 ","$0.00 ","$9.91 ","$0.00 "
"216.315","SUP","HCPCS C1713","","216.315  -  SCREW BONE 6.5MM 115MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$34.88 ","$0.00 ","$16.15 ","$0.00 ","$0.00 ","$13.57 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$12.13 ","$0.00 ","$12.34 ","$0.00 "
"216.32","SUP","HCPCS C1713","","216.320  -  SCREW BONE 6.5MM 120MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$34.88 ","$0.00 ","$16.15 ","$0.00 ","$0.00 ","$13.57 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$12.13 ","$0.00 ","$12.34 ","$0.00 "
"216.325","SUP","HCPCS C1713","","216.325  -  SCREW BONE 6.5MM 125MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$34.88 ","$0.00 ","$16.15 ","$0.00 ","$0.00 ","$13.57 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$12.13 ","$0.00 ","$12.34 ","$0.00 "
"216.33","SUP","HCPCS C1713","","216.330  -  SCREW BONE 6.5MM 130MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$34.88 ","$0.00 ","$16.15 ","$0.00 ","$0.00 ","$13.57 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$12.13 ","$0.00 ","$12.34 ","$0.00 "
"216.34","SUP","HCPCS C1713","","216.340  -  SCREW BONE 6.5MM 140MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$34.88 ","$0.00 ","$16.15 ","$0.00 ","$0.00 ","$13.57 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$12.13 ","$0.00 ","$12.34 ","$0.00 "
"216.35","SUP","HCPCS C1713","","216.350  -  SCREW BONE 6.5MM 150MM 24MM THREAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$34.88 ","$0.00 ","$16.15 ","$0.00 ","$0.00 ","$13.57 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$12.13 ","$0.00 ","$12.34 ","$0.00 "
"217.045","SUP","HCPCS C1713","","217.045  -  SCREW BONE PTHRD 6.5MM 8MM 45MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"217.05","SUP","HCPCS C1713","","217.050  -  SCREW BONE PTHRD 6.5MM 8MM 50MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"217.055","SUP","HCPCS C1713","","217.055  -  SCREW BONE PTHRD 6.5MM 55MM 32MM LCP STAINLESS STEEL HUMERUS","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"217.06","SUP","HCPCS C1713","","217.060  -  SCREW BONE PTHRD 6.5MM 60MM 32MM LCP STAINLESS STEEL HUMERUS","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"217.065","SUP","HCPCS C1713","","217.065  -  SCREW BONE PTHRD 6.5MM 8MM 65MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"217.07","SUP","HCPCS C1713","","217.070  -  SCREW BONE PTHRD 6.5MM 8MM 70MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"217.075","SUP","HCPCS C1713","","217.075  -  SCREW BONE PTHRD 6.5MM 8MM 75MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"217.08","SUP","HCPCS C1713","","217.080  -  SCREW BONE PTHRD 6.5MM 80MM 32MM LCP STAINLESS STEEL HUMERUS","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"217.08","SUP","HCPCS C1713","","217.08  -  SCREW BONE 6.5MM 80MM 32MM LC DCP SS CANC PERIART NSTRL LG","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$61.88 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$61.88 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"217.085","SUP","HCPCS C1713","","217.085  -  SCREW BONE PTHRD 6.5MM 8MM 85MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"217.09","SUP","HCPCS C1713","","217.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LCP DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"217.095","SUP","HCPCS C1713","","217.095  -  SCREW BONE PTHRD 6.5MM 8MM 95MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"217.1","SUP","HCPCS C1713","","217.100  -  SCREW BONE PTHRD 6.5MM 8MM 100MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$15.02 ","$0.00 ","$10.21 ","$0.00 "
"217.105","SUP","HCPCS C1713","","217.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LCP DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"217.11","SUP","HCPCS C1713","","217.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LCP DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"217.115","SUP","HCPCS C1713","","217.115  -  SCREW BONE 6.5MM 8MM 115MM 32MM HEXAGONAL SOCKET LC-DCP","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.12","SUP","HCPCS C1713","","217.120  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 120MM 32MM SOCKET LCP DCP","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.125","SUP","HCPCS C1713","","217.125  -  SCREW BONE 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.13","SUP","HCPCS C1713","","217.130  -  SCREW BONE 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.135","SUP","HCPCS C1713","","217.135  -  SCREW BONE 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET DCP","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.14","SUP","HCPCS C1713","","217.140  -  SCREW BONE 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.145","SUP","HCPCS C1713","","217.145  -  SCREW BONE 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"217.15","SUP","HCPCS C1713","","217.150  -  SCREW BONE 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET DCP","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.009","SUP","HCPCS C1713","","218.009  -  SCREW BONE 6.5MM 60MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.01","SUP","HCPCS C1713","","218.010  -  CASE STERILIZATION 2IN 11X7IN CASTANEDA RETRACTOR KIT","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.011","SUP","HCPCS C1713","","218.011  -  SCREW BONE 6.5MM 70MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.012","SUP","HCPCS C1713","","218.012  -  SCREW BONE 6.5MM 75MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.013","SUP","HCPCS C1713","","218.013  -  SCREW BONE 6.5MM 80MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.014","SUP","HCPCS C1713","","218.014  -  SCREW BONE 6.5MM 85MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.015","SUP","HCPCS C1713","","218.015  -  SCREW BONE 6.5MM 90MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.016","SUP","HCPCS C1713","","218.016  -  SCREW BONE 6.5MM 95MM LCP STAINLESS STEEL CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.017","SUP","HCPCS C1713","","218.017  -  SCREW BONE 6.5MM 100MM LCP STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.018","SUP","HCPCS C1713","","218.018  -  SCREW BONE 6.5MM 105MM LCP STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.019","SUP","HCPCS C1713","","218.019  -  SCREW BONE 6.5MM 110MM LCP STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.02","SUP","HCPCS C1713","","218.020  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 20MM SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.025","SUP","HCPCS C1713","","218.025  -  SCREW BONE 6.5MM 25MM FULTHD LC-DCP STAINLESS STEEL","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.03","SUP","HCPCS C1713","","218.030  -  SCREW BONE FULTHD 6.5MM 8MM 30MM LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"218.035","SUP","HCPCS C1713","","218.035  -  SCREW BONE FULTHD 6.5MM 8MM 35MM LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"218.04","SUP","HCPCS C1713","","218.040  -  SCREW BONE FULTHD 6.5MM 8MM 40MM LARGE HEXAGONAL SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.045","SUP","HCPCS C1713","","218.045  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$13.61 ","$0.00 ","$9.45 ","$0.00 "
"218.05","SUP","HCPCS C1713","","218.050  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.055","SUP","HCPCS C1713","","218.055  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.06","SUP","HCPCS C1713","","218.060  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.065","SUP","HCPCS C1713","","218.065  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 65MM SOCKET LCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.07","SUP","HCPCS C1713","","218.070  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 70MM SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.075","SUP","HCPCS C1713","","218.075  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 75MM SOCKET LCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.08","SUP","HCPCS C1713","","218.080  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 80MM SOCKET LCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"218.085","SUP","HCPCS C1713","","218.085  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 85MM SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"218.09","SUP","HCPCS C1713","","218.090  -  SCREW BONE FULTHD 6.5MM 8MM 90MM 3.5MM HEXAGONAL SOCKET DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"218.095","SUP","HCPCS C1713","","218.095  -  SCREW BONE FULTHD 6.5MM 8MM 95MM 3.5MM HEXAGONAL SOCKET DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"218.1","SUP","HCPCS C1713","","218.100  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 100MM SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"218.105","SUP","HCPCS C1713","","218.105  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 105MM SOCKET LCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"218.11","SUP","HCPCS C1713","","218.110  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 110MM SOCKET LCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"218.115","SUP","HCPCS C1713","","218.115  -  SCREW BONE FULTHD 6.5MM 8MM 115MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.12","SUP","HCPCS C1713","","218.120  -  SCREW BONE FULTHD 6.5MM 8MM 120MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.125","SUP","HCPCS C1713","","218.125  -  SCREW BONE FULTHD 6.5MM 8MM 125MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.13","SUP","HCPCS C1713","","218.130  -  SCREW BONE 6.5MM 130MM FULTHRD LC-DCP STAINLESS STEEL","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.135","SUP","HCPCS C1713","","218.135  -  SCREW BONE FULTHD 6.5MM 8MM 135MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.14","SUP","HCPCS C1713","","218.140  -  SCREW BONE 6.5MM 140MM FULTHRD DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.145","SUP","HCPCS C1713","","218.145  -  SCREW BONE FULTHD 6.5MM 8MM 145MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.15","SUP","HCPCS C1713","","218.150  -  SCREW BONE 6.5MM 150MM FULTHRD DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"218.215","SUP","HCPCS C1713","","218.215  -  SCREW BONE FULTHD 6.5MM 115MM LCP STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.22","SUP","HCPCS C1713","","218.220  -  SCREW BONE FULTHD LP 6.5MM 8MM 120MM HIGH BENDING STABILITY","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.225","SUP","HCPCS C1713","","218.225  -  SCREW BONE FULTHD 6.5MM 125MM LCP STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"218.23","SUP","HCPCS C1713","","218.230  -  SCREW BONE FULTHD LP 6.5MM 8MM 130MM HIGH BENDING STABILITY","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"219.89","SUP","Custom 27803010","","219.89  -  WASHER ORTHOPEDIC THREAD LCP STAINLESS STEEL NONSTRL 3 MM","BOTH IP/OP","$258.65 ","$191.40 ","$0.00 ","$251.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.91","SUP","Custom 27803010","","219.91  -  WASHER ORTHOPEDIC 10MM LCP STAINLESS STEEL NONSTRL 4.5MM","BOTH IP/OP","$49.90 ","$36.93 ","$0.00 ","$48.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.43 ","$0.00 ","$24.21 ","$38.36 ","$38.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.931","SUP","Custom 27803010","","219.931  -  WASHER ORTHOPEDIC 8MM 3.2MM SPIKE LCP STAINLESS STEEL","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.941","SUP","Custom 27803010","","219.941  -  WASHER ORTHOPEDIC 13.5MM 4MM SPIKE LCP STAINLESS STEEL","BOTH IP/OP","$229.13 ","$169.56 ","$0.00 ","$222.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.45 ","$0.00 ","$111.23 ","$176.18 ","$177.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.951","SUP","Custom 27803010","","219.951  -  WASHER ORTHOPEDIC 13.5MM 5.5MM SPIKE LC-DCP PEEK-OPTIMA 6%","BOTH IP/OP","$226.33 ","$167.48 ","$0.00 ","$219.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$219.73 ","$0.00 ","$109.86 ","$174.03 ","$175.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.96","SUP","Custom 27803010","","219.96  -  NUT ORTHOPEDIC LC-DCP STAINLESS STEEL NONSTRL 4.5 MM","BOTH IP/OP","$55.85 ","$41.33 ","$0.00 ","$54.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.23 ","$0.00 ","$27.11 ","$42.95 ","$43.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.97","SUP","Custom 27803010","","219.97  -  WASHER ORTHOPEDIC 4.5MM FRAGMENT DCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$42.85 ","$31.71 ","$0.00 ","$41.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.60 ","$0.00 ","$20.80 ","$32.95 ","$33.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.972","SUP","Custom 27803010","","219.972  -  WASHER ORTHOPEDIC 6.5MM 3.3MM LCP STAINLESS STEEL NONSTRL 3","BOTH IP/OP","$55.85 ","$41.33 ","$0.00 ","$54.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.23 ","$0.00 ","$27.11 ","$42.95 ","$43.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.98","SUP","Custom 27803010","","219.98  -  WASHER ORTHOPEDIC SMALL 7MM 3.6MM LCP STAINLESS STEEL","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.99","SUP","Custom 27803010","","219.99  -  WASHER ORTHOPEDIC 13MM 6.6MM LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$52.70 ","$39.00 ","$0.00 ","$51.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.18 ","$0.00 ","$25.59 ","$40.53 ","$40.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"221.306","SUP","HCPCS C1713","","221.306  -  PLATE BONE STR 6 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"221.312","SUP","HCPCS C1713","","221.312  -  PLATE BONE STR 12 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$451.73 ","$203.28 ","$0.00 ","$96.97 ","$0.00 ","$0.00 ","$79.09 ","$451.73 ","$0.00 ","$225.86 ","$357.77 ","$361.38 ","$0.00 ","$68.64 ","$0.00 ","$71.91 ","$0.00 "
"221.32","SUP","HCPCS C1713","","221.320  -  PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND RT","BOTH IP/OP","$431.25 ","$319.13 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$89.88 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"221.321","SUP","HCPCS C1713","","221.321  -  PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND LT","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"221.333","SUP","HCPCS C1713","","221.333  -  SCREW BONE 4MM 46MM T25 STARDRIVE RECESS LOCK SELF TAP LCP","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"221.334","SUP","HCPCS C1713","","221.334  -  PLATE BONE T 4X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"221.335","SUP","HCPCS C1713","","221.335  -  PLATE BONE Y 3X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"222.02","SUP","HCPCS C1713","","222.02  -  PLATE BN SMTB 39X12X1MM NS 2 HL SS 3.5/4.5MM SCR LG FRAG","BOTH IP/OP","$122.13 ","$90.38 ","$0.00 ","$122.13 ","$54.96 ","$0.00 ","$25.45 ","$0.00 ","$0.00 ","$21.38 ","$122.13 ","$0.00 ","$61.06 ","$96.73 ","$97.70 ","$0.00 ","$18.56 ","$0.00 ","$19.44 ","$0.00 "
"222.03","SUP","HCPCS C1713","","222.03  -  PLATE BN SMTB 55X12X1MM NS 3 HL SS 3.5/4.5MM SCR LG FRAG","BOTH IP/OP","$130.33 ","$96.44 ","$0.00 ","$130.33 ","$58.65 ","$0.00 ","$27.16 ","$0.00 ","$0.00 ","$22.82 ","$130.33 ","$0.00 ","$65.16 ","$103.22 ","$104.26 ","$0.00 ","$19.80 ","$0.00 ","$20.75 ","$0.00 "
"222.04","SUP","HCPCS C1713","","222.04  -  PLATE BONE SEMITUBULAR 71X12X1MM 4 HOLE SEMITUBULAR DCP","BOTH IP/OP","$140.58 ","$104.03 ","$0.00 ","$140.58 ","$63.26 ","$0.00 ","$29.30 ","$0.00 ","$0.00 ","$24.61 ","$140.58 ","$0.00 ","$70.29 ","$111.34 ","$112.46 ","$0.00 ","$21.36 ","$0.00 ","$22.38 ","$0.00 "
"222.05","SUP","HCPCS C1713","","222.05  -  PLATE BONE SEMITUBULAR 87X12X1MM 5 HOLE SEMITUBULAR DCP","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$22.60 ","$0.00 ","$23.68 ","$0.00 "
"222.06","SUP","HCPCS C1713","","222.06  -  PLATE BONE SEMITUBULAR 103X12X1MM 6 HOLE SEMITUBULAR DCP","BOTH IP/OP","$158.30 ","$117.14 ","$0.00 ","$158.30 ","$71.24 ","$0.00 ","$32.99 ","$0.00 ","$0.00 ","$27.72 ","$158.30 ","$0.00 ","$79.15 ","$125.37 ","$126.64 ","$0.00 ","$24.05 ","$0.00 ","$25.20 ","$0.00 "
"222.07","SUP","HCPCS C1713","","222.07  -  PLATE BONE SEMITUBULAR 119X12X1MM 7 HOLE SEMITUBULAR DCP","BOTH IP/OP","$169.23 ","$125.23 ","$0.00 ","$169.23 ","$76.15 ","$0.00 ","$35.27 ","$0.00 ","$0.00 ","$29.63 ","$169.23 ","$0.00 ","$84.61 ","$134.03 ","$135.38 ","$0.00 ","$25.71 ","$0.00 ","$26.94 ","$0.00 "
"222.08","SUP","HCPCS C1713","","222.08  -  PLATE BONE SEMITUBULAR 135X12X1MM 8 HOLE SEMITUBULAR DCP","BOTH IP/OP","$184.25 ","$136.35 ","$0.00 ","$184.25 ","$82.91 ","$0.00 ","$38.40 ","$0.00 ","$0.00 ","$32.26 ","$184.25 ","$0.00 ","$92.13 ","$145.93 ","$147.40 ","$0.00 ","$27.99 ","$0.00 ","$29.33 ","$0.00 "
"222.09","SUP","HCPCS C1713","","222.09  -  PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR DCP LC-DCP","BOTH IP/OP","$206.08 ","$152.50 ","$0.00 ","$206.08 ","$92.73 ","$0.00 ","$42.95 ","$0.00 ","$0.00 ","$36.08 ","$206.08 ","$0.00 ","$103.04 ","$163.22 ","$164.86 ","$0.00 ","$31.31 ","$0.00 ","$32.81 ","$0.00 "
"222.1","SUP","HCPCS C1713","","222.10  -  PLATE BONE TUBE 167X12X1MM 10 HOLE LOCK LCP STAINLESS STEEL","BOTH IP/OP","$201.98 ","$149.47 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$42.10 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"222.11","SUP","HCPCS C1713","","222.11  -  PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP STAINLESS","BOTH IP/OP","$229.13 ","$169.56 ","$0.00 ","$222.45 ","$100.10 ","$0.00 ","$47.76 ","$0.00 ","$0.00 ","$38.95 ","$222.45 ","$0.00 ","$111.23 ","$176.18 ","$177.96 ","$0.00 ","$33.80 ","$0.00 ","$35.41 ","$0.00 "
"222.12","SUP","HCPCS C1713","","222.12  -  PLATE BONE 199X12X1MM 12 HOLE SEMITUBULAR LC-DCP STAINLESS","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"222.22","SUP","HCPCS C1713","","222.220  -  ANCHOR SUTURE 2MM 2 END THREAD TAB TACIT","BOTH IP/OP","$2,763.63 ","$2,045.09 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$576.01 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"222.221","SUP","HCPCS C1713","","222.221  -  PLATE BONE 140MM 5 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,846.53 ","$2,106.43 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$593.29 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"222.222","SUP","HCPCS C1713","","222.222  -  PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,904.15 ","$2,149.07 ","$0.00 ","$2,819.58 ","$1,268.81 ","$0.00 ","$605.30 ","$0.00 ","$0.00 ","$493.69 ","$2,819.58 ","$0.00 ","$1,409.79 ","$2,233.11 ","$2,255.66 ","$0.00 ","$428.41 ","$0.00 ","$448.88 ","$0.00 "
"222.223","SUP","HCPCS C1713","","222.223  -  PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,904.15 ","$2,149.07 ","$0.00 ","$2,819.58 ","$1,268.81 ","$0.00 ","$605.30 ","$0.00 ","$0.00 ","$493.69 ","$2,819.58 ","$0.00 ","$1,409.79 ","$2,233.11 ","$2,255.66 ","$0.00 ","$428.41 ","$0.00 ","$448.88 ","$0.00 "
"222.224","SUP","HCPCS C1713","","222.224  -  PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,964.60 ","$2,193.80 ","$0.00 ","$2,878.25 ","$1,295.21 ","$0.00 ","$617.90 ","$0.00 ","$0.00 ","$503.96 ","$2,878.25 ","$0.00 ","$1,439.13 ","$2,279.57 ","$2,302.60 ","$0.00 ","$437.33 ","$0.00 ","$458.22 ","$0.00 "
"222.225","SUP","HCPCS C1713","","222.225  -  PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,964.60 ","$2,193.80 ","$0.00 ","$2,878.25 ","$1,295.21 ","$0.00 ","$617.90 ","$0.00 ","$0.00 ","$503.96 ","$2,878.25 ","$0.00 ","$1,439.13 ","$2,279.57 ","$2,302.60 ","$0.00 ","$437.33 ","$0.00 ","$458.22 ","$0.00 "
"222.226","SUP","HCPCS C1713","","222.226  -  PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$2,934.23 ","$1,320.40 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$513.76 ","$2,934.23 ","$0.00 ","$1,467.11 ","$2,323.91 ","$2,347.38 ","$0.00 ","$445.83 ","$0.00 ","$467.13 ","$0.00 "
"222.227","SUP","HCPCS C1713","","222.227  -  PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$2,934.23 ","$1,320.40 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$513.76 ","$2,934.23 ","$0.00 ","$1,467.11 ","$2,323.91 ","$2,347.38 ","$0.00 ","$445.83 ","$0.00 ","$467.13 ","$0.00 "
"222.228","SUP","HCPCS C1713","","222.228  -  PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"222.229","SUP","HCPCS C1713","","222.229  -  PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"222.25","SUP","HCPCS C1713","","222.250  -  PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL FEMUR RIGHT","BOTH IP/OP","$2,763.63 ","$2,045.09 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$576.01 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"222.251","SUP","HCPCS C1713","","222.251  -  PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL LEFT CNDYLR","BOTH IP/OP","$2,846.53 ","$2,106.43 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$593.29 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"222.252","SUP","HCPCS C1713","","222.252  -  PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR RIGHT","BOTH IP/OP","$2,904.15 ","$2,149.07 ","$0.00 ","$2,819.58 ","$1,268.81 ","$0.00 ","$605.30 ","$0.00 ","$0.00 ","$493.69 ","$2,819.58 ","$0.00 ","$1,409.79 ","$2,233.11 ","$2,255.66 ","$0.00 ","$428.41 ","$0.00 ","$448.88 ","$0.00 "
"222.253","SUP","HCPCS C1713","","222.253  -  PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR LEFT","BOTH IP/OP","$2,904.15 ","$2,149.07 ","$0.00 ","$2,819.58 ","$1,268.81 ","$0.00 ","$605.30 ","$0.00 ","$0.00 ","$493.69 ","$2,819.58 ","$0.00 ","$1,409.79 ","$2,233.11 ","$2,255.66 ","$0.00 ","$428.41 ","$0.00 ","$448.88 ","$0.00 "
"222.254","SUP","HCPCS C1713","","222.254  -  PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR RIGHT","BOTH IP/OP","$2,964.60 ","$2,193.80 ","$0.00 ","$2,878.25 ","$1,295.21 ","$0.00 ","$617.90 ","$0.00 ","$0.00 ","$503.96 ","$2,878.25 ","$0.00 ","$1,439.13 ","$2,279.57 ","$2,302.60 ","$0.00 ","$437.33 ","$0.00 ","$458.22 ","$0.00 "
"222.255","SUP","HCPCS C1713","","222.255  -  PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR LEFT","BOTH IP/OP","$2,964.60 ","$2,193.80 ","$0.00 ","$2,878.25 ","$1,295.21 ","$0.00 ","$617.90 ","$0.00 ","$0.00 ","$503.96 ","$2,878.25 ","$0.00 ","$1,439.13 ","$2,279.57 ","$2,302.60 ","$0.00 ","$437.33 ","$0.00 ","$458.22 ","$0.00 "
"222.256","SUP","HCPCS C1713","","222.256  -  PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR RIGHT","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$2,934.23 ","$1,320.40 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$513.76 ","$2,934.23 ","$0.00 ","$1,467.11 ","$2,323.91 ","$2,347.38 ","$0.00 ","$445.83 ","$0.00 ","$467.13 ","$0.00 "
"222.257","SUP","HCPCS C1713","","222.257  -  PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR LEFT","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$2,934.23 ","$1,320.40 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$513.76 ","$2,934.23 ","$0.00 ","$1,467.11 ","$2,323.91 ","$2,347.38 ","$0.00 ","$445.83 ","$0.00 ","$467.13 ","$0.00 "
"222.258","SUP","HCPCS C1713","","222.258  -  PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR RIGHT","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"222.259","SUP","HCPCS C1713","","222.259  -  PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR LEFT","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"222.402","SUP","HCPCS C1713","","222.402  -  SCREW BONE 5MM 14MM SLFTAP LOCKING LCP LISS STAINLESS STEEL","BOTH IP/OP","$404.85 ","$299.59 ","$0.00 ","$393.05 ","$176.87 ","$0.00 ","$84.38 ","$0.00 ","$0.00 ","$68.82 ","$393.05 ","$0.00 ","$196.53 ","$311.30 ","$314.44 ","$0.00 ","$59.72 ","$0.00 ","$62.57 ","$0.00 "
"222.404","SUP","HCPCS C1713","","222.404  -  SCREW BONE 5MM 18MM SLFTAP LOCKING LCP LISS STAINLESS STEEL","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"222.537","SUP","HCPCS C1713","","222.537  -  SCREW BONE 5MM 35MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.538","SUP","HCPCS C1713","","222.538  -  SCREW BONE 5MM 40MM LCP TI PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.541","SUP","HCPCS C1713","","222.541  -  SCREW BONE 5MM 55MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.542","SUP","HCPCS C1713","","222.542  -  SCREW BONE 5MM 60MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.543","SUP","HCPCS C1713","","222.543  -  SCREW BONE 5MM 65MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$387.78 ","$286.96 ","$0.00 ","$387.78 ","$174.50 ","$0.00 ","$80.82 ","$0.00 ","$0.00 ","$67.90 ","$387.78 ","$0.00 ","$193.89 ","$307.12 ","$310.22 ","$0.00 ","$60.69 ","$0.00 ","$61.73 ","$0.00 "
"222.545","SUP","HCPCS C1713","","222.545  -  SCREW BONE 5MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.546","SUP","HCPCS C1713","","222.546  -  SCREW BONE 5MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.547","SUP","HCPCS C1713","","222.547  -  SCREW BONE 5MM 85MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.548","SUP","HCPCS C1713","","222.548  -  SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.554","SUP","HCPCS C1713","","222.554  -  SCREW BONE 5MM 40MM LCP SS PROX PERIART FEM/TIB CANN CONICAL","BOTH IP/OP","$340.75 ","$252.16 ","$0.00 ","$340.75 ","$153.34 ","$0.00 ","$71.02 ","$0.00 ","$0.00 ","$59.66 ","$340.75 ","$0.00 ","$170.38 ","$269.87 ","$272.60 ","$0.00 ","$53.33 ","$0.00 ","$54.25 ","$0.00 "
"222.564","SUP","HCPCS C1713","","222.564  -  SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN CONICAL","BOTH IP/OP","$390.60 ","$289.04 ","$0.00 ","$390.60 ","$175.77 ","$0.00 ","$81.41 ","$0.00 ","$0.00 ","$68.39 ","$390.60 ","$0.00 ","$195.30 ","$309.36 ","$312.48 ","$0.00 ","$61.13 ","$0.00 ","$62.18 ","$0.00 "
"222.571","SUP","HCPCS C1713","","222.571  -  SCREW BONE 7.3MM 70MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$657.98 ","$486.91 ","$0.00 ","$657.98 ","$296.09 ","$0.00 ","$137.14 ","$0.00 ","$0.00 ","$115.21 ","$657.98 ","$0.00 ","$328.99 ","$521.12 ","$526.38 ","$0.00 ","$102.97 ","$0.00 ","$104.75 ","$0.00 "
"222.572","SUP","HCPCS C1713","","222.572  -  SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$657.98 ","$486.91 ","$0.00 ","$657.98 ","$296.09 ","$0.00 ","$137.14 ","$0.00 ","$0.00 ","$115.21 ","$657.98 ","$0.00 ","$328.99 ","$521.12 ","$526.38 ","$0.00 ","$102.97 ","$0.00 ","$104.75 ","$0.00 "
"222.573","SUP","HCPCS C1713","","222.573  -  SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$657.98 ","$486.91 ","$0.00 ","$657.98 ","$296.09 ","$0.00 ","$137.14 ","$0.00 ","$0.00 ","$115.21 ","$657.98 ","$0.00 ","$328.99 ","$521.12 ","$526.38 ","$0.00 ","$102.97 ","$0.00 ","$104.75 ","$0.00 "
"222.575","SUP","HCPCS C1713","","222.575  -  SCREW BONE 7.3MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$657.98 ","$486.91 ","$0.00 ","$657.98 ","$296.09 ","$0.00 ","$137.14 ","$0.00 ","$0.00 ","$115.21 ","$657.98 ","$0.00 ","$328.99 ","$521.12 ","$526.38 ","$0.00 ","$102.97 ","$0.00 ","$104.75 ","$0.00 "
"222.578","SUP","Custom 27803010","","222.578  -  NUT ORTHOPEDIC 4MM 12MM SELF CUTTING SERRATED TIP LCP","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$294.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$294.78 ","$0.00 ","$147.39 ","$233.47 ","$235.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"222.58","SUP","HCPCS C1713","","222.580  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 14MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.581","SUP","HCPCS C1713","","222.581  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 16MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.582","SUP","HCPCS C1713","","222.582  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 18MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.583","SUP","HCPCS C1713","","222.583  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 22MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.584","SUP","HCPCS C1713","","222.584  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 26MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.585","SUP","HCPCS C1713","","222.585  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 30MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.586","SUP","HCPCS C1713","","222.586  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 34MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.587","SUP","HCPCS C1713","","222.587  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 38MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.588","SUP","HCPCS C1713","","222.588  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 42MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.589","SUP","HCPCS C1713","","222.589  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 46MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.59","SUP","HCPCS C1713","","222.590  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 50MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.591","SUP","HCPCS C1713","","222.591  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 54MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.592","SUP","HCPCS C1713","","222.592  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 58MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.593","SUP","HCPCS C1713","","222.593  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 62MM SELF TAP LCP","BOTH IP/OP","$262.03 ","$193.90 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$54.61 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"222.608","SUP","HCPCS C1713","","222.608  -  SCREW BONE 7.3MM 85MM LCP SS FULTHD PROX PERIART FEM/TIB","BOTH IP/OP","$514.65 ","$380.84 ","$0.00 ","$514.65 ","$231.59 ","$0.00 ","$107.27 ","$0.00 ","$0.00 ","$90.11 ","$514.65 ","$0.00 ","$257.33 ","$407.60 ","$411.72 ","$0.00 ","$80.54 ","$0.00 ","$81.93 ","$0.00 "
"222.609","SUP","HCPCS C1713","","222.609  -  SCREW BONE 7.3MM 90MM LCP SS FULTHD PROX PERIART FEM/TIB","BOTH IP/OP","$534.23 ","$395.33 ","$0.00 ","$534.23 ","$240.40 ","$0.00 ","$111.35 ","$0.00 ","$0.00 ","$93.54 ","$534.23 ","$0.00 ","$267.11 ","$423.11 ","$427.38 ","$0.00 ","$83.61 ","$0.00 ","$85.05 ","$0.00 "
"222.645","SUP","HCPCS C1713","","222.645  -  SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN","BOTH IP/OP","$534.23 ","$395.33 ","$0.00 ","$534.23 ","$240.40 ","$0.00 ","$111.35 ","$0.00 ","$0.00 ","$93.54 ","$534.23 ","$0.00 ","$267.11 ","$423.11 ","$427.38 ","$0.00 ","$83.61 ","$0.00 ","$85.05 ","$0.00 "
"222.646","SUP","HCPCS C1713","","222.646  -  SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN","BOTH IP/OP","$588.23 ","$435.29 ","$0.00 ","$588.23 ","$264.70 ","$0.00 ","$122.60 ","$0.00 ","$0.00 ","$102.99 ","$588.23 ","$0.00 ","$294.11 ","$465.88 ","$470.58 ","$0.00 ","$92.06 ","$0.00 ","$93.65 ","$0.00 "
"222.656","SUP","HCPCS C1713","","222.656  -  PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"222.657","SUP","HCPCS C1713","","222.657  -  PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"222.658","SUP","HCPCS C1713","","222.658  -  PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT","BOTH IP/OP","$2,940.70 ","$2,176.12 ","$0.00 ","$2,855.05 ","$1,284.77 ","$0.00 ","$612.92 ","$0.00 ","$0.00 ","$499.90 ","$2,855.05 ","$0.00 ","$1,427.53 ","$2,261.20 ","$2,284.04 ","$0.00 ","$433.80 ","$0.00 ","$454.52 ","$0.00 "
"222.659","SUP","HCPCS C1713","","222.659  -  PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT","BOTH IP/OP","$2,940.70 ","$2,176.12 ","$0.00 ","$2,855.05 ","$1,284.77 ","$0.00 ","$612.92 ","$0.00 ","$0.00 ","$499.90 ","$2,855.05 ","$0.00 ","$1,427.53 ","$2,261.20 ","$2,284.04 ","$0.00 ","$433.80 ","$0.00 ","$454.52 ","$0.00 "
"222.66","SUP","HCPCS C1713","","222.660  -  PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT","BOTH IP/OP","$2,961.50 ","$2,191.51 ","$0.00 ","$2,961.50 ","$1,332.68 ","$0.00 ","$617.25 ","$0.00 ","$0.00 ","$518.53 ","$2,961.50 ","$0.00 ","$1,480.75 ","$2,345.51 ","$2,369.20 ","$0.00 ","$449.98 ","$0.00 ","$471.47 ","$0.00 "
"222.661","SUP","HCPCS C1713","","222.661  -  PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT","BOTH IP/OP","$3,050.35 ","$2,257.26 ","$0.00 ","$2,961.50 ","$1,332.68 ","$0.00 ","$635.77 ","$0.00 ","$0.00 ","$518.53 ","$2,961.50 ","$0.00 ","$1,480.75 ","$2,345.51 ","$2,369.20 ","$0.00 ","$449.98 ","$0.00 ","$471.47 ","$0.00 "
"222.662","SUP","HCPCS C1713","","222.662  -  PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT","BOTH IP/OP","$3,112.20 ","$2,303.03 ","$0.00 ","$3,021.55 ","$1,359.70 ","$0.00 ","$648.66 ","$0.00 ","$0.00 ","$529.05 ","$3,021.55 ","$0.00 ","$1,510.78 ","$2,393.07 ","$2,417.24 ","$0.00 ","$459.10 ","$0.00 ","$481.03 ","$0.00 "
"222.663","SUP","HCPCS C1713","","222.663  -  PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT","BOTH IP/OP","$3,112.20 ","$2,303.03 ","$0.00 ","$3,021.55 ","$1,359.70 ","$0.00 ","$648.66 ","$0.00 ","$0.00 ","$529.05 ","$3,021.55 ","$0.00 ","$1,510.78 ","$2,393.07 ","$2,417.24 ","$0.00 ","$459.10 ","$0.00 ","$481.03 ","$0.00 "
"222.664","SUP","HCPCS C1713","","222.664  -  PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT","BOTH IP/OP","$3,280.88 ","$2,427.85 ","$0.00 ","$3,185.33 ","$1,433.40 ","$0.00 ","$683.82 ","$0.00 ","$0.00 ","$557.72 ","$3,185.33 ","$0.00 ","$1,592.66 ","$2,522.78 ","$2,548.26 ","$0.00 ","$483.98 ","$0.00 ","$507.10 ","$0.00 "
"222.665","SUP","HCPCS C1713","","222.665  -  PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT","BOTH IP/OP","$3,280.88 ","$2,427.85 ","$0.00 ","$3,185.33 ","$1,433.40 ","$0.00 ","$683.82 ","$0.00 ","$0.00 ","$557.72 ","$3,185.33 ","$0.00 ","$1,592.66 ","$2,522.78 ","$2,548.26 ","$0.00 ","$483.98 ","$0.00 ","$507.10 ","$0.00 "
"222.666","SUP","HCPCS C1713","","222.666  -  PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD","BOTH IP/OP","$3,249.48 ","$2,404.62 ","$0.00 ","$3,249.48 ","$1,462.26 ","$0.00 ","$677.27 ","$0.00 ","$0.00 ","$568.96 ","$3,249.48 ","$0.00 ","$1,624.74 ","$2,573.59 ","$2,599.58 ","$0.00 ","$493.73 ","$0.00 ","$517.32 ","$0.00 "
"222.667","SUP","HCPCS C1713","","222.667  -  PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD","BOTH IP/OP","$3,249.48 ","$2,404.62 ","$0.00 ","$3,249.48 ","$1,462.26 ","$0.00 ","$677.27 ","$0.00 ","$0.00 ","$568.96 ","$3,249.48 ","$0.00 ","$1,624.74 ","$2,573.59 ","$2,599.58 ","$0.00 ","$493.73 ","$0.00 ","$517.32 ","$0.00 "
"222.668","SUP","HCPCS C1713","","222.668  -  PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD","BOTH IP/OP","$3,314.98 ","$2,453.09 ","$0.00 ","$3,314.98 ","$1,491.74 ","$0.00 ","$690.92 ","$0.00 ","$0.00 ","$580.43 ","$3,314.98 ","$0.00 ","$1,657.49 ","$2,625.46 ","$2,651.98 ","$0.00 ","$503.68 ","$0.00 ","$527.74 ","$0.00 "
"222.669","SUP","HCPCS C1713","","222.669  -  PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD","BOTH IP/OP","$3,314.98 ","$2,453.09 ","$0.00 ","$3,314.98 ","$1,491.74 ","$0.00 ","$690.92 ","$0.00 ","$0.00 ","$580.43 ","$3,314.98 ","$0.00 ","$1,657.49 ","$2,625.46 ","$2,651.98 ","$0.00 ","$503.68 ","$0.00 ","$527.74 ","$0.00 "
"222.675","SUP","HCPCS C1713","","222.675  -  SCREW BONE 4MM 30MM LCP SS PROX PERIART FEM/TIB CANN LCK","BOTH IP/OP","$318.53 ","$235.71 ","$0.00 ","$318.53 ","$143.34 ","$0.00 ","$66.39 ","$0.00 ","$0.00 ","$55.77 ","$318.53 ","$0.00 ","$159.26 ","$252.28 ","$254.82 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"222.676","SUP","HCPCS C1713","","222.676  -  SCREW BONE 4MM 34MM LCP SS PROX MDL TIB LCK SLFTAP STARDRIVE","BOTH IP/OP","$444.08 ","$328.62 ","$0.00 ","$444.08 ","$199.83 ","$0.00 ","$92.56 ","$0.00 ","$0.00 ","$77.75 ","$444.08 ","$0.00 ","$222.04 ","$351.71 ","$355.26 ","$0.00 ","$69.50 ","$0.00 ","$70.70 ","$0.00 "
"222.677","SUP","HCPCS C1713","","222.677  -  SCREW BONE 4MM 38MM LCP SS PROX MDL TIB LCK SLFTAP NONSTRL","BOTH IP/OP","$318.53 ","$235.71 ","$0.00 ","$318.53 ","$143.34 ","$0.00 ","$66.39 ","$0.00 ","$0.00 ","$55.77 ","$318.53 ","$0.00 ","$159.26 ","$252.28 ","$254.82 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"223.406","SUP","HCPCS C1713","","223.406  -  PLATE BONE 86X11X3.3MM 6 HOLE LOCKING TAPERED ROUNDED TIP","BOTH IP/OP","$1,672.78 ","$1,237.86 ","$0.00 ","$1,624.05 ","$730.82 ","$0.00 ","$348.65 ","$0.00 ","$0.00 ","$284.36 ","$1,624.05 ","$0.00 ","$812.03 ","$1,286.25 ","$1,299.24 ","$0.00 ","$246.76 ","$0.00 ","$258.55 ","$0.00 "
"223.407","SUP","HCPCS C1713","","223.407  -  PLATE BONE 99X11X3.3MM 7 HOLE LOCKING TAPERED ROUNDED TIP","BOTH IP/OP","$1,705.10 ","$1,261.77 ","$0.00 ","$1,655.45 ","$744.95 ","$0.00 ","$355.39 ","$0.00 ","$0.00 ","$289.86 ","$1,655.45 ","$0.00 ","$827.73 ","$1,311.12 ","$1,324.36 ","$0.00 ","$251.53 ","$0.00 ","$263.55 ","$0.00 "
"223.408","SUP","HCPCS C1713","","223.408  -  PLATE BONE 112X11X3.3MM 8 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"223.409","SUP","HCPCS C1713","","223.409  -  PLATE BONE 125MM 9 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$1,758.53 ","$1,301.31 ","$0.00 ","$1,707.30 ","$768.29 ","$0.00 ","$366.52 ","$0.00 ","$0.00 ","$298.93 ","$1,707.30 ","$0.00 ","$853.65 ","$1,352.18 ","$1,365.84 ","$0.00 ","$259.41 ","$0.00 ","$271.80 ","$0.00 "
"223.41","SUP","HCPCS C1713","","223.410  -  PLATE BN TPR 138X11X3.3MM NS LCP CMBN 10 HL RND TIP THN PRFL","BOTH IP/OP","$1,735.95 ","$1,284.60 ","$0.00 ","$1,735.95 ","$781.18 ","$0.00 ","$361.82 ","$0.00 ","$0.00 ","$303.95 ","$1,735.95 ","$0.00 ","$867.98 ","$1,374.87 ","$1,388.76 ","$0.00 ","$330.10 ","$0.00 ","$276.36 ","$0.00 "
"223.411","SUP","HCPCS C1713","","223.411  -  PLATE BONE 151MM 11 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$1,817.55 ","$1,344.99 ","$0.00 ","$1,764.63 ","$794.08 ","$0.00 ","$378.82 ","$0.00 ","$0.00 ","$308.97 ","$1,764.63 ","$0.00 ","$882.31 ","$1,397.59 ","$1,411.70 ","$0.00 ","$268.12 ","$0.00 ","$280.93 ","$0.00 "
"223.412","SUP","HCPCS C1713","","223.412  -  PLATE BONE 164MM 12 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,277.78 ","$1,025.00 ","$0.00 ","$488.99 ","$0.00 ","$0.00 ","$398.82 ","$2,277.78 ","$0.00 ","$1,138.89 ","$1,804.00 ","$1,822.22 ","$0.00 ","$346.09 ","$0.00 ","$362.62 ","$0.00 "
"223.414","SUP","HCPCS C1713","","223.414  -  PLATE BONE 190MM 14 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,422.00 ","$1,792.28 ","$0.00 ","$2,351.48 ","$1,058.16 ","$0.00 ","$504.81 ","$0.00 ","$0.00 ","$411.72 ","$2,351.48 ","$0.00 ","$1,175.74 ","$1,862.37 ","$1,881.18 ","$0.00 ","$357.29 ","$0.00 ","$374.35 ","$0.00 "
"223.416","SUP","HCPCS C1713","","223.416  -  PLATE BONE 216MM 16 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,474.03 ","$1,830.78 ","$0.00 ","$2,401.95 ","$1,080.88 ","$0.00 ","$515.65 ","$0.00 ","$0.00 ","$420.56 ","$2,401.95 ","$0.00 ","$1,200.98 ","$1,902.34 ","$1,921.56 ","$0.00 ","$364.96 ","$0.00 ","$382.39 ","$0.00 "
"223.418","SUP","HCPCS C1713","","223.418  -  PLATE BONE 242MM 18 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,422.00 ","$1,792.28 ","$0.00 ","$2,351.48 ","$1,058.16 ","$0.00 ","$504.81 ","$0.00 ","$0.00 ","$411.72 ","$2,351.48 ","$0.00 ","$1,175.74 ","$1,862.37 ","$1,881.18 ","$0.00 ","$357.29 ","$0.00 ","$374.35 ","$0.00 "
"223.506","SUP","HCPCS C1713","","223.506  -  PLATE BN 95MM 6 HL SS TIB RT DIST MDL 3.5MM SCR","BOTH IP/OP","$1,020.53 ","$755.19 ","$0.00 ","$990.80 ","$445.86 ","$0.00 ","$212.70 ","$0.00 ","$0.00 ","$173.48 ","$990.80 ","$0.00 ","$495.40 ","$784.71 ","$792.64 ","$0.00 ","$150.55 ","$0.00 ","$157.74 ","$0.00 "
"223.507","SUP","HCPCS C1713","","223.507  -  PLATE BN 95MM 6 HL SS TIB LT DIST MDL 3.5MM SCR","BOTH IP/OP","$1,020.53 ","$755.19 ","$0.00 ","$990.80 ","$445.86 ","$0.00 ","$212.70 ","$0.00 ","$0.00 ","$173.48 ","$990.80 ","$0.00 ","$495.40 ","$784.71 ","$792.64 ","$0.00 ","$150.55 ","$0.00 ","$157.74 ","$0.00 "
"223.508","SUP","HCPCS C1713","","223.508  -  PLATE BN 121MM 8 HL SS TIB RT DIST MDL 3.5MM SCR","BOTH IP/OP","$1,186.40 ","$877.94 ","$0.00 ","$1,151.85 ","$518.33 ","$0.00 ","$247.28 ","$0.00 ","$0.00 ","$201.68 ","$1,151.85 ","$0.00 ","$575.93 ","$912.27 ","$921.48 ","$0.00 ","$175.01 ","$0.00 ","$183.37 ","$0.00 "
"223.509","SUP","HCPCS C1713","","223.509  -  PLATE BN 121MM 8 HL SS TIB LT DIST MDL 3.5MM SCR","BOTH IP/OP","$1,186.40 ","$877.94 ","$0.00 ","$1,151.85 ","$518.33 ","$0.00 ","$247.28 ","$0.00 ","$0.00 ","$201.68 ","$1,151.85 ","$0.00 ","$575.93 ","$912.27 ","$921.48 ","$0.00 ","$175.01 ","$0.00 ","$183.37 ","$0.00 "
"223.51","SUP","HCPCS C1713","","223.510  -  PLATE BONE 147X10.2X2.2MM 10 HOLE LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,315.63 ","$973.57 ","$0.00 ","$1,315.63 ","$592.03 ","$0.00 ","$274.21 ","$0.00 ","$0.00 ","$230.36 ","$1,315.63 ","$0.00 ","$657.81 ","$1,041.98 ","$1,052.50 ","$0.00 ","$199.90 ","$0.00 ","$209.45 ","$0.00 "
"223.511","SUP","HCPCS C1713","","223.511  -  PLATE BN 147MM 10 HL SS TIB LT DIST MDL 3.5MM SCR","BOTH IP/OP","$1,355.10 ","$1,002.77 ","$0.00 ","$1,315.63 ","$592.03 ","$0.00 ","$282.44 ","$0.00 ","$0.00 ","$230.36 ","$1,315.63 ","$0.00 ","$657.81 ","$1,041.98 ","$1,052.50 ","$0.00 ","$199.90 ","$0.00 ","$209.45 ","$0.00 "
"223.512","SUP","HCPCS C1713","","223.512  -  PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS","BOTH IP/OP","$1,512.53 ","$1,119.27 ","$0.00 ","$1,468.48 ","$660.81 ","$0.00 ","$315.25 ","$0.00 ","$0.00 ","$257.12 ","$1,468.48 ","$0.00 ","$734.24 ","$1,163.04 ","$1,174.78 ","$0.00 ","$223.12 ","$0.00 ","$233.78 ","$0.00 "
"223.513","SUP","HCPCS C1713","","223.513  -  PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS","BOTH IP/OP","$1,512.53 ","$1,119.27 ","$0.00 ","$1,468.48 ","$660.81 ","$0.00 ","$315.25 ","$0.00 ","$0.00 ","$257.12 ","$1,468.48 ","$0.00 ","$734.24 ","$1,163.04 ","$1,174.78 ","$0.00 ","$223.12 ","$0.00 ","$233.78 ","$0.00 "
"223.514","SUP","HCPCS C1713","","223.514  -  PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS","BOTH IP/OP","$1,688.23 ","$1,249.29 ","$0.00 ","$1,639.08 ","$737.58 ","$0.00 ","$351.87 ","$0.00 ","$0.00 ","$286.99 ","$1,639.08 ","$0.00 ","$819.54 ","$1,298.15 ","$1,311.26 ","$0.00 ","$249.04 ","$0.00 ","$260.94 ","$0.00 "
"223.515","SUP","HCPCS C1713","","223.515  -  PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS","BOTH IP/OP","$1,688.23 ","$1,249.29 ","$0.00 ","$1,639.08 ","$737.58 ","$0.00 ","$351.87 ","$0.00 ","$0.00 ","$286.99 ","$1,639.08 ","$0.00 ","$819.54 ","$1,298.15 ","$1,311.26 ","$0.00 ","$249.04 ","$0.00 ","$260.94 ","$0.00 "
"223.516","SUP","HCPCS C1713","","223.516  -  PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL","BOTH IP/OP","$1,911.75 ","$1,414.70 ","$0.00 ","$1,856.05 ","$835.22 ","$0.00 ","$398.46 ","$0.00 ","$0.00 ","$324.98 ","$1,856.05 ","$0.00 ","$928.03 ","$1,469.99 ","$1,484.84 ","$0.00 ","$282.01 ","$0.00 ","$295.48 ","$0.00 "
"223.517","SUP","HCPCS C1713","","223.517  -  PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA LEFT DISTAL","BOTH IP/OP","$1,911.75 ","$1,414.70 ","$0.00 ","$1,856.05 ","$835.22 ","$0.00 ","$398.46 ","$0.00 ","$0.00 ","$324.98 ","$1,856.05 ","$0.00 ","$928.03 ","$1,469.99 ","$1,484.84 ","$0.00 ","$282.01 ","$0.00 ","$295.48 ","$0.00 "
"223.518","SUP","HCPCS C1713","","223.518  -  PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL","BOTH IP/OP","$2,087.45 ","$1,544.71 ","$0.00 ","$2,026.65 ","$911.99 ","$0.00 ","$435.08 ","$0.00 ","$0.00 ","$354.85 ","$2,026.65 ","$0.00 ","$1,013.33 ","$1,605.11 ","$1,621.32 ","$0.00 ","$307.93 ","$0.00 ","$322.64 ","$0.00 "
"223.519","SUP","HCPCS C1713","","223.519  -  PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA LEFT DISTAL","BOTH IP/OP","$2,087.45 ","$1,544.71 ","$0.00 ","$2,026.65 ","$911.99 ","$0.00 ","$435.08 ","$0.00 ","$0.00 ","$354.85 ","$2,026.65 ","$0.00 ","$1,013.33 ","$1,605.11 ","$1,621.32 ","$0.00 ","$307.93 ","$0.00 ","$322.64 ","$0.00 "
"223.52","SUP","HCPCS C1713","","223.52  -  PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP STAINLESS STEEL DISTAL","BOTH IP/OP","$231.95 ","$171.64 ","$0.00 ","$225.18 ","$101.33 ","$0.00 ","$48.34 ","$0.00 ","$0.00 ","$39.43 ","$225.18 ","$0.00 ","$112.59 ","$178.34 ","$180.14 ","$0.00 ","$34.21 ","$0.00 ","$35.85 ","$0.00 "
"223.521","SUP","HCPCS C1713","","223.521  -  PLATE BN 33MM NS LCP CMBN 2 HL LMT CNTCT TPR END SS 3.5MM","BOTH IP/OP","$490.58 ","$363.03 ","$0.00 ","$476.30 ","$214.34 ","$0.00 ","$102.25 ","$0.00 ","$0.00 ","$83.40 ","$476.30 ","$0.00 ","$238.15 ","$377.23 ","$381.04 ","$0.00 ","$72.37 ","$0.00 ","$75.83 ","$0.00 "
"223.53","SUP","HCPCS C1713","","223.53  -  PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP STAINLESS STEEL DISTAL","BOTH IP/OP","$236.15 ","$174.75 ","$0.00 ","$229.28 ","$103.17 ","$0.00 ","$49.22 ","$0.00 ","$0.00 ","$40.14 ","$229.28 ","$0.00 ","$114.64 ","$181.59 ","$183.42 ","$0.00 ","$34.84 ","$0.00 ","$36.50 ","$0.00 "
"223.531","SUP","HCPCS C1713","","223.531  -  PLATE BN 46X11X3.4MM NS LCP CMBN 3 HL LMT CNTCT TPR END SS","BOTH IP/OP","$510.28 ","$377.61 ","$0.00 ","$495.40 ","$222.93 ","$0.00 ","$106.35 ","$0.00 ","$0.00 ","$86.74 ","$495.40 ","$0.00 ","$247.70 ","$392.36 ","$396.32 ","$0.00 ","$75.27 ","$0.00 ","$78.87 ","$0.00 "
"223.54","SUP","HCPCS C1713","","223.54  -  PLATE BN 51MM NS LC DCP 4 HL SS 3.5MM SCR","BOTH IP/OP","$243.18 ","$179.95 ","$0.00 ","$236.10 ","$106.25 ","$0.00 ","$50.68 ","$0.00 ","$0.00 ","$41.34 ","$236.10 ","$0.00 ","$118.05 ","$186.99 ","$188.88 ","$0.00 ","$35.87 ","$0.00 ","$37.59 ","$0.00 "
"223.541","SUP","HCPCS C1713","","223.541  -  PLATE BN 59MM NS LCP CMBN 4 HL SS 3.5MM SCR SM FRAG","BOTH IP/OP","$532.75 ","$394.24 ","$0.00 ","$517.25 ","$232.76 ","$0.00 ","$111.04 ","$0.00 ","$0.00 ","$90.57 ","$517.25 ","$0.00 ","$258.63 ","$409.66 ","$413.80 ","$0.00 ","$78.59 ","$0.00 ","$82.35 ","$0.00 "
"223.55","SUP","HCPCS C1713","","223.55  -  PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP STAINLESS STEEL","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"223.551","SUP","HCPCS C1713","","223.551  -  PLATE BN 72X11X3.4MM NS LCP CMBN 5 HL LMT CNTCT TPR END SS","BOTH IP/OP","$549.63 ","$406.73 ","$0.00 ","$533.63 ","$240.13 ","$0.00 ","$114.56 ","$0.00 ","$0.00 ","$93.43 ","$533.63 ","$0.00 ","$266.81 ","$422.63 ","$426.90 ","$0.00 ","$81.08 ","$0.00 ","$84.95 ","$0.00 "
"223.56","SUP","HCPCS C1713","","223.56  -  PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP STAINLESS STEEL DISTAL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"223.561","SUP","HCPCS C1713","","223.561  -  PLATE BN 85X11X3.4MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS","BOTH IP/OP","$584.78 ","$432.74 ","$0.00 ","$567.73 ","$255.48 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$99.40 ","$567.73 ","$0.00 ","$283.86 ","$449.64 ","$454.18 ","$0.00 ","$86.26 ","$0.00 ","$90.38 ","$0.00 "
"223.57","SUP","HCPCS C1713","","223.57  -  PLATE BONE 90X11X3.3MM 7 HOLE LC-DCP STAINLESS STEEL DISTAL","BOTH IP/OP","$283.95 ","$210.12 ","$0.00 ","$275.68 ","$124.05 ","$0.00 ","$59.18 ","$0.00 ","$0.00 ","$48.27 ","$275.68 ","$0.00 ","$137.84 ","$218.34 ","$220.54 ","$0.00 ","$41.89 ","$0.00 ","$43.89 ","$0.00 "
"223.571","SUP","HCPCS C1713","","223.571  -  PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END SS","BOTH IP/OP","$608.68 ","$450.42 ","$0.00 ","$590.93 ","$265.92 ","$0.00 ","$126.86 ","$0.00 ","$0.00 ","$103.47 ","$590.93 ","$0.00 ","$295.46 ","$468.02 ","$472.74 ","$0.00 ","$89.79 ","$0.00 ","$94.08 ","$0.00 "
"223.58","SUP","HCPCS C1713","","223.58  -  PLATE BONE 103X11X3.3MM 8 HOLE LC-DCP STAINLESS STEEL DISTAL","BOTH IP/OP","$299.43 ","$221.58 ","$0.00 ","$290.70 ","$130.82 ","$0.00 ","$62.41 ","$0.00 ","$0.00 ","$50.90 ","$290.70 ","$0.00 ","$145.35 ","$230.23 ","$232.56 ","$0.00 ","$44.17 ","$0.00 ","$46.28 ","$0.00 "
"223.581","SUP","HCPCS C1713","","223.581  -  PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS","BOTH IP/OP","$639.60 ","$473.30 ","$0.00 ","$620.95 ","$279.43 ","$0.00 ","$133.31 ","$0.00 ","$0.00 ","$108.72 ","$620.95 ","$0.00 ","$310.48 ","$491.79 ","$496.76 ","$0.00 ","$94.35 ","$0.00 ","$98.86 ","$0.00 "
"223.59","SUP","HCPCS C1713","","223.59  -  PLATE BONE 116X11X3.3MM 9 HOLE LC-DCP STAINLESS STEEL DISTAL","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"223.591","SUP","HCPCS C1713","","223.591  -  PLATE BN 124X11X3.4MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS","BOTH IP/OP","$664.90 ","$492.03 ","$0.00 ","$645.53 ","$290.49 ","$0.00 ","$138.58 ","$0.00 ","$0.00 ","$113.03 ","$645.53 ","$0.00 ","$322.76 ","$511.26 ","$516.42 ","$0.00 ","$98.08 ","$0.00 ","$102.77 ","$0.00 "
"223.6","SUP","HCPCS C1713","","223.60  -  PLATE BONE 129X11X3.3MM 10 HOLE LOCK LC-DCP STAINLESS STEEL","BOTH IP/OP","$308.43 ","$228.24 ","$0.00 ","$308.43 ","$138.79 ","$0.00 ","$64.28 ","$0.00 ","$0.00 ","$54.00 ","$308.43 ","$0.00 ","$154.21 ","$244.28 ","$246.74 ","$0.00 ","$46.86 ","$0.00 ","$49.10 ","$0.00 "
"223.6","SUP","HCPCS C1713","","223.6  -  PLATE 129MM SS 3.5MM SCR SM FRAG SET 10 HOLE LC DCP LCP BONE","BOTH IP/OP","$308.43 ","$228.24 ","$0.00 ","$308.43 ","$138.79 ","$0.00 ","$64.28 ","$0.00 ","$0.00 ","$54.00 ","$308.43 ","$0.00 ","$154.21 ","$272.59 ","$246.74 ","$0.00 ","$46.86 ","$0.00 ","$49.10 ","$0.00 "
"223.601","SUP","HCPCS C1713","","223.601  -  PLATE BN 137X11X3.4MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS","BOTH IP/OP","$685.98 ","$507.63 ","$0.00 ","$666.00 ","$299.70 ","$0.00 ","$142.97 ","$0.00 ","$0.00 ","$116.61 ","$666.00 ","$0.00 ","$333.00 ","$527.47 ","$532.80 ","$0.00 ","$101.19 ","$0.00 ","$106.03 ","$0.00 "
"223.61","SUP","HCPCS C1713","","223.61  -  PLATE BN 142X11X3.3MM NS LC DCP 11 HL SS 3.5MM SCR SM FRAG","BOTH IP/OP","$344.40 ","$254.86 ","$0.00 ","$334.38 ","$150.47 ","$0.00 ","$71.78 ","$0.00 ","$0.00 ","$58.55 ","$334.38 ","$0.00 ","$167.19 ","$264.83 ","$267.50 ","$0.00 ","$50.80 ","$0.00 ","$53.23 ","$0.00 "
"223.611","SUP","HCPCS C1713","","223.611  -  PLATE BN 150MM NS LCP CMBN 11 HL LMT CNTCT TPR END SS 3.5MM","BOTH IP/OP","$715.50 ","$529.47 ","$0.00 ","$694.65 ","$312.59 ","$0.00 ","$149.13 ","$0.00 ","$0.00 ","$121.63 ","$694.65 ","$0.00 ","$347.33 ","$550.16 ","$555.72 ","$0.00 ","$105.55 ","$0.00 ","$110.59 ","$0.00 "
"223.62","SUP","HCPCS C1713","","223.62  -  PLATE BN 155X11X3.3MM NS LC DCP 12 HL SS 3.5MM SCR SM FRAG","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"223.621","SUP","HCPCS C1713","","223.621  -  PLATE BN 163X11X3.4MM NS LCP CMBN 12 HL LMT CNTCT TPR END SS","BOTH IP/OP","$756.28 ","$559.65 ","$0.00 ","$734.23 ","$330.40 ","$0.00 ","$157.63 ","$0.00 ","$0.00 ","$128.56 ","$734.23 ","$0.00 ","$367.11 ","$581.51 ","$587.38 ","$0.00 ","$111.56 ","$0.00 ","$116.89 ","$0.00 "
"223.631","SUP","HCPCS C1713","","223.631  -  PLATE BN 176X11X3.4MM NS LCP CMBN 13 HL SS 3.5MM SCR","BOTH IP/OP","$871.53 ","$644.93 ","$0.00 ","$846.15 ","$380.77 ","$0.00 ","$181.65 ","$0.00 ","$0.00 ","$148.15 ","$846.15 ","$0.00 ","$423.08 ","$670.15 ","$676.92 ","$0.00 ","$128.56 ","$0.00 ","$134.71 ","$0.00 "
"223.64","SUP","HCPCS C1713","","223.64  -  PLATE BN 181X11X3.3MM NS LC DCP 14 HL SS 3.5MM SCR SM FRAG","BOTH IP/OP","$681.75 ","$504.50 ","$0.00 ","$661.90 ","$297.86 ","$0.00 ","$142.09 ","$0.00 ","$0.00 ","$115.89 ","$661.90 ","$0.00 ","$330.95 ","$524.22 ","$529.52 ","$0.00 ","$100.57 ","$0.00 ","$105.37 ","$0.00 "
"223.641","SUP","HCPCS C1713","","223.641  -  PLATE BN 189X11X3.4MM NS LCP CMBN 14 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,134.40 ","$839.46 ","$0.00 ","$1,101.35 ","$495.61 ","$0.00 ","$236.44 ","$0.00 ","$0.00 ","$192.84 ","$1,101.35 ","$0.00 ","$550.68 ","$872.27 ","$881.08 ","$0.00 ","$167.34 ","$0.00 ","$175.33 ","$0.00 "
"223.65","SUP","HCPCS C1713","","223.65  -  PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP STAINLESS STEEL","BOTH IP/OP","$714.10 ","$528.43 ","$0.00 ","$693.30 ","$311.99 ","$0.00 ","$148.84 ","$0.00 ","$0.00 ","$121.39 ","$693.30 ","$0.00 ","$346.65 ","$549.09 ","$554.64 ","$0.00 ","$105.34 ","$0.00 ","$110.37 ","$0.00 "
"223.651","SUP","HCPCS C1713","","223.651  -  PLATE BONE 202X11X3.4MM 15 HOLE LCP STAINLESS STEEL PROXIMAL","BOTH IP/OP","$1,214.53 ","$898.75 ","$0.00 ","$1,179.15 ","$530.62 ","$0.00 ","$253.14 ","$0.00 ","$0.00 ","$206.46 ","$1,179.15 ","$0.00 ","$589.58 ","$933.89 ","$943.32 ","$0.00 ","$179.16 ","$0.00 ","$187.72 ","$0.00 "
"223.66","SUP","HCPCS C1713","","223.66  -  PLATE BONE 208X11X3.3MM 16 HOLE LC-DCP STAINLESS STEEL","BOTH IP/OP","$782.98 ","$579.41 ","$0.00 ","$760.18 ","$342.08 ","$0.00 ","$163.19 ","$0.00 ","$0.00 ","$133.10 ","$760.18 ","$0.00 ","$380.09 ","$602.06 ","$608.14 ","$0.00 ","$115.50 ","$0.00 ","$121.02 ","$0.00 "
"223.661","SUP","HCPCS C1713","","223.661  -  PLATE BN 215X11X3.4MM NS LCP CMBN 16 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,270.75 ","$940.36 ","$0.00 ","$1,233.73 ","$555.18 ","$0.00 ","$264.86 ","$0.00 ","$0.00 ","$216.02 ","$1,233.73 ","$0.00 ","$616.86 ","$977.11 ","$986.98 ","$0.00 ","$187.46 ","$0.00 ","$196.41 ","$0.00 "
"223.671","SUP","HCPCS C1713","","223.671  -  PLATE BN 241X11X3.4MM NS LCP CMBN 18 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"223.68","SUP","HCPCS C1713","","223.68  -  PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"223.681","SUP","HCPCS C1713","","223.681  -  PLATE BN 267X11X3.4MM NS LCP CMBN 20 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,582.80 ","$1,171.27 ","$0.00 ","$1,536.70 ","$691.52 ","$0.00 ","$329.90 ","$0.00 ","$0.00 ","$269.06 ","$1,536.70 ","$0.00 ","$768.35 ","$1,217.07 ","$1,229.36 ","$0.00 ","$233.49 ","$0.00 ","$244.64 ","$0.00 "
"223.691","SUP","HCPCS C1713","","223.691  -  PLATE BONE 293X11X3.4MM 22 HOLE LCP STAINLESS STEEL PROXIMAL","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"223.7","SUP","HCPCS C1713","","223.70  -  PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP STAINLESS STEEL","BOTH IP/OP","$941.68 ","$696.84 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$196.27 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"224","SUP","Custom 27803010","","224.000  -  STAINLESS STEEL REVERE LOCKING CAP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.001","SUP","Custom 27803010","","224.001  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.002","SUP","Custom 27803010","","224.002  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.003","SUP","Custom 27803010","","224.003  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.012","SUP","Custom 27803010","","224.012  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 24MM-25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.013","SUP","Custom 27803010","","224.013  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 26MM-28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.014","SUP","Custom 27803010","","224.014  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 29MM-34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.02","SUP","HCPCS C1713","","224.02  -  PLATE BN NAR 39X12X3.8MM NS DCP 2 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"224.04","SUP","HCPCS C1713","","224.04  -  PLATE BN NAR 71X12X3.8MM NS DCP 4 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"224.041","SUP","HCPCS C1713","","224.041  -  PLATE BONE 61MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$828.40 ","$613.02 ","$0.00 ","$828.40 ","$372.78 ","$0.00 ","$172.66 ","$0.00 ","$0.00 ","$145.05 ","$828.40 ","$0.00 ","$414.20 ","$656.09 ","$662.72 ","$0.00 ","$125.87 ","$0.00 ","$131.88 ","$0.00 "
"224.05","SUP","HCPCS C1713","","224.05  -  PLATE BN NAR 87X12X3.8MM NS DCP 5 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"224.051","SUP","HCPCS C1713","","224.051  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.052","SUP","HCPCS C1713","","224.052  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.053","SUP","HCPCS C1713","","224.053  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.054","SUP","HCPCS C1713","","224.054  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.055","SUP","HCPCS C1713","","224.055  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.056","SUP","HCPCS C1713","","224.056  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.057","SUP","HCPCS C1713","","224.057  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.06","SUP","HCPCS C1713","","224.06  -  PLATE BN NAR 103X12X3.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$312.08 ","$230.94 ","$0.00 ","$302.98 ","$136.34 ","$0.00 ","$65.04 ","$0.00 ","$0.00 ","$53.05 ","$302.98 ","$0.00 ","$151.49 ","$239.96 ","$242.38 ","$0.00 ","$46.03 ","$0.00 ","$48.23 ","$0.00 "
"224.061","SUP","HCPCS C1713","","224.061  -  7.5MM SS REVERE REDUCTION SCREW 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.062","SUP","HCPCS C1713","","224.062  -  7.5MM SS REVERE REDUCTION SCREW 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.063","SUP","HCPCS C1713","","224.063  -  7.5MM SS REVERE REDUCTION SCREW 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.064","SUP","HCPCS C1713","","224.064  -  7.5MM SS REVERE REDUCTION SCREW 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.065","SUP","HCPCS C1713","","224.065  -  7.5MM SS REVERE REDUCTION SCREW 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.07","SUP","HCPCS C1713","","224.07  -  PLATE BN NAR 119X12X3.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$312.08 ","$230.94 ","$0.00 ","$302.98 ","$136.34 ","$0.00 ","$65.04 ","$0.00 ","$0.00 ","$53.05 ","$302.98 ","$0.00 ","$151.49 ","$239.96 ","$242.38 ","$0.00 ","$46.03 ","$0.00 ","$48.23 ","$0.00 "
"224.071","SUP","HCPCS C1713","","224.071  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.072","SUP","HCPCS C1713","","224.072  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.073","SUP","HCPCS C1713","","224.073  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.074","SUP","HCPCS C1713","","224.074  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.075","SUP","HCPCS C1713","","224.075  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.08","SUP","HCPCS C1713","","224.08  -  PLATE BN NAR 135X12X3.8MM NS DCP 8 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$302.98 ","$224.21 ","$0.00 ","$302.98 ","$136.34 ","$0.00 ","$63.15 ","$0.00 ","$0.00 ","$53.05 ","$302.98 ","$0.00 ","$151.49 ","$239.96 ","$242.38 ","$0.00 ","$46.03 ","$0.00 ","$48.23 ","$0.00 "
"224.081","SUP","HCPCS C1713","","224.081  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.082","SUP","HCPCS C1713","","224.082  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.083","SUP","HCPCS C1713","","224.083  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.084","SUP","HCPCS C1713","","224.084  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.085","SUP","HCPCS C1713","","224.085  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.09","SUP","HCPCS C1713","","224.09  -  PLATE BN NAR 151X12X3.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$312.08 ","$230.94 ","$0.00 ","$302.98 ","$136.34 ","$0.00 ","$65.04 ","$0.00 ","$0.00 ","$53.05 ","$302.98 ","$0.00 ","$151.49 ","$239.96 ","$242.38 ","$0.00 ","$46.03 ","$0.00 ","$48.23 ","$0.00 "
"224.1","SUP","HCPCS C1713","","224.10  -  PLATE BN NAR 167X12X3.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$399.88 ","$295.91 ","$0.00 ","$399.88 ","$179.94 ","$0.00 ","$83.34 ","$0.00 ","$0.00 ","$70.01 ","$399.88 ","$0.00 ","$199.94 ","$316.70 ","$319.90 ","$0.00 ","$60.76 ","$0.00 ","$63.66 ","$0.00 "
"224.11","SUP","HCPCS C1713","","224.11  -  PLATE BONE NARROW 183X12X3.8MM 11 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$398.83 ","$295.13 ","$0.00 ","$398.83 ","$179.47 ","$0.00 ","$83.13 ","$0.00 ","$0.00 ","$69.83 ","$398.83 ","$0.00 ","$199.41 ","$315.87 ","$319.06 ","$0.00 ","$62.42 ","$0.00 ","$63.49 ","$0.00 "
"224.111","SUP","HCPCS C1713","","224.111  -  SCREW BN 5.5MM 27MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.112","SUP","HCPCS C1713","","224.112  -  SCREW BN 5.5MM 32MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.113","SUP","HCPCS C1713","","224.113  -  SCREW BN 5.5MM 37MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.114","SUP","HCPCS C1713","","224.114  -  SCREW BN 5.5MM 42MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.115","SUP","HCPCS C1713","","224.115  -  SCREW BN 5.5MM 47MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.12","SUP","HCPCS C1713","","224.12  -  PLATE BN NAR 199X12X3.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$399.88 ","$295.91 ","$0.00 ","$399.88 ","$179.94 ","$0.00 ","$83.34 ","$0.00 ","$0.00 ","$70.01 ","$399.88 ","$0.00 ","$199.94 ","$316.70 ","$319.90 ","$0.00 ","$60.76 ","$0.00 ","$63.66 ","$0.00 "
"224.121","SUP","HCPCS C1713","","224.121  -  SCREW BN 6.5MM 27MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.122","SUP","HCPCS C1713","","224.122  -  SCREW BN 6.5MM 32MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.123","SUP","HCPCS C1713","","224.123  -  SCREW BN 6.5MM 37MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.124","SUP","HCPCS C1713","","224.124  -  SCREW BN 6.5MM 42MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.125","SUP","HCPCS C1713","","224.125  -  SCREW BN 6.5MM 47MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.131","SUP","HCPCS C1713","","224.131  -  SCREW BN 7.5MM 27MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.132","SUP","HCPCS C1713","","224.132  -  SCREW BN 7.5MM 32MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.133","SUP","HCPCS C1713","","224.133  -  SCREW BN 7.5MM 37MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.134","SUP","HCPCS C1713","","224.134  -  SCREW BN 7.5MM 42MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.135","SUP","HCPCS C1713","","224.135  -  SCREW BN 7.5MM 47MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.14","SUP","HCPCS C1713","","224.14  -  PLATE NAR SS 4.5MM SCR LG FRAG SET 14 HOLE DCP BONE ORTH","BOTH IP/OP","$561.50 ","$415.51 ","$0.00 ","$561.50 ","$252.68 ","$0.00 ","$117.03 ","$0.00 ","$0.00 ","$98.31 ","$561.50 ","$0.00 ","$280.75 ","$444.71 ","$449.20 ","$0.00 ","$87.87 ","$0.00 ","$89.39 ","$0.00 "
"224.141","SUP","HCPCS C1713","","224.141  -  5.5MM SS REVERE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.142","SUP","HCPCS C1713","","224.142  -  5.5MM SS REVERE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.143","SUP","HCPCS C1713","","224.143  -  5.5MM SS REVERE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.144","SUP","HCPCS C1713","","224.144  -  5.5MM SS REVERE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.145","SUP","HCPCS C1713","","224.145  -  5.5MM SS REVERE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.146","SUP","HCPCS C1713","","224.146  -  5.5MM SS REVERE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.147","SUP","HCPCS C1713","","224.147  -  5.5MM SS REVERE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.151","SUP","HCPCS C1713","","224.151  -  6.5MM SS REVERE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.152","SUP","HCPCS C1713","","224.152  -  6.5MM SS REVERE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.153","SUP","HCPCS C1713","","224.153  -  6.5MM SS REVERE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.154","SUP","HCPCS C1713","","224.154  -  6.5MM SS REVERE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.155","SUP","HCPCS C1713","","224.155  -  6.5MM SS REVERE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.156","SUP","HCPCS C1713","","224.156  -  6.5MM SS REVERE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.157","SUP","HCPCS C1713","","224.157  -  6.5MM SS REVERE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.158","SUP","HCPCS C1713","","224.158  -  6.5MM SS REVERE REDUCTION SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.159","SUP","HCPCS C1713","","224.159  -  6.5MM SS REVERE REDUCTION SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.161","SUP","HCPCS C1713","","224.161  -  7.5MM SS REVERE REDUCTION SCREW 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.162","SUP","HCPCS C1713","","224.162  -  7.5MM SS REVERE REDUCTION SCREW 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.163","SUP","HCPCS C1713","","224.163  -  7.5MM SS REVERE REDUCTION SCREW 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.164","SUP","HCPCS C1713","","224.164  -  7.5MM SS REVERE REDUCTION SCREW 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.165","SUP","HCPCS C1713","","224.165  -  7.5MM SS REVERE REDUCTION SCREW 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.166","SUP","HCPCS C1713","","224.166  -  7.5MM SS REVERE REDUCTION SCREW 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.167","SUP","HCPCS C1713","","224.167  -  7.5MM SS REVERE REDUCTION SCREW 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.168","SUP","HCPCS C1713","","224.168  -  7.5MM SS REVERE REDUCTION SCREW 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.169","SUP","HCPCS C1713","","224.169  -  7.5MM SS REVERE REDUCTION SCREW 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.2","SUP","HCPCS C1713","","224.20  -  PLATE BN NAR 326X12X3.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$816.13 ","$603.94 ","$0.00 ","$816.13 ","$367.26 ","$0.00 ","$170.10 ","$0.00 ","$0.00 ","$142.90 ","$816.13 ","$0.00 ","$408.06 ","$646.37 ","$652.90 ","$0.00 ","$124.00 ","$0.00 ","$129.93 ","$0.00 "
"224.2","SUP","HCPCS C1713","","224.200  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 20MM","BOTH IP/OP","$816.13 ","$603.94 ","$0.00 ","$1,584.00 ","$367.26 ","$0.00 ","$170.10 ","$0.00 ","$0.00 ","$142.90 ","$816.13 ","$0.00 ","$408.06 ","$1,584.00 ","$652.90 ","$0.00 ","$124.00 ","$0.00 ","$129.93 ","$0.00 "
"224.201","SUP","HCPCS C1713","","224.201  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.202","SUP","HCPCS C1713","","224.202  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.203","SUP","HCPCS C1713","","224.203  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.204","SUP","HCPCS C1713","","224.204  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.241","SUP","HCPCS C1713","","224.241  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.242","SUP","HCPCS C1713","","224.242  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.243","SUP","HCPCS C1713","","224.243  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.244","SUP","HCPCS C1713","","224.244  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.245","SUP","HCPCS C1713","","224.245  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.251","SUP","HCPCS C1713","","224.251  -  SCREW BN 5.5MM 25MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.252","SUP","HCPCS C1713","","224.252  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.253","SUP","HCPCS C1713","","224.253  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.254","SUP","HCPCS C1713","","224.254  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.255","SUP","HCPCS C1713","","224.255  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.256","SUP","HCPCS C1713","","224.256  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.257","SUP","HCPCS C1713","","224.257  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.258","SUP","HCPCS C1713","","224.258  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.259","SUP","HCPCS C1713","","224.259  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.262","SUP","HCPCS C1713","","224.262  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.263","SUP","HCPCS C1713","","224.263  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.264","SUP","HCPCS C1713","","224.264  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.265","SUP","HCPCS C1713","","224.265  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.266","SUP","HCPCS C1713","","224.266  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.267","SUP","HCPCS C1713","","224.267  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.268","SUP","HCPCS C1713","","224.268  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.269","SUP","HCPCS C1713","","224.269  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.271","SUP","HCPCS C1713","","224.271  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.272","SUP","HCPCS C1713","","224.272  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.273","SUP","HCPCS C1713","","224.273  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.274","SUP","HCPCS C1713","","224.274  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.275","SUP","HCPCS C1713","","224.275  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.276","SUP","HCPCS C1713","","224.276  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.277","SUP","HCPCS C1713","","224.277  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.278","SUP","HCPCS C1713","","224.278  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.279","SUP","HCPCS C1713","","224.279  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.281","SUP","HCPCS C1713","","224.281  -  SCREW BN 8.5MM 25MM REVERE MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.282","SUP","HCPCS C1713","","224.282  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.283","SUP","HCPCS C1713","","224.283  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.284","SUP","HCPCS C1713","","224.284  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.285","SUP","HCPCS C1713","","224.285  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.286","SUP","HCPCS C1713","","224.286  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.287","SUP","HCPCS C1713","","224.287  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.288","SUP","HCPCS C1713","","224.288  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.289","SUP","HCPCS C1713","","224.289  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.351","SUP","HCPCS C1713","","224.351  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.352","SUP","HCPCS C1713","","224.352  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.353","SUP","HCPCS C1713","","224.353  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.354","SUP","HCPCS C1713","","224.354  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.355","SUP","HCPCS C1713","","224.355  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.356","SUP","HCPCS C1713","","224.356  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.357","SUP","HCPCS C1713","","224.357  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.361","SUP","HCPCS C1713","","224.361  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.362","SUP","HCPCS C1713","","224.362  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.363","SUP","HCPCS C1713","","224.363  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.364","SUP","HCPCS C1713","","224.364  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.365","SUP","HCPCS C1713","","224.365  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.366","SUP","HCPCS C1713","","224.366  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.367","SUP","HCPCS C1713","","224.367  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.368","SUP","HCPCS C1713","","224.368  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.369","SUP","HCPCS C1713","","224.369  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.371","SUP","HCPCS C1713","","224.371  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.372","SUP","HCPCS C1713","","224.372  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.373","SUP","HCPCS C1713","","224.373  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.374","SUP","HCPCS C1713","","224.374  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.375","SUP","HCPCS C1713","","224.375  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.376","SUP","HCPCS C1713","","224.376  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.377","SUP","HCPCS C1713","","224.377  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.378","SUP","HCPCS C1713","","224.378  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.379","SUP","HCPCS C1713","","224.379  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.381","SUP","HCPCS C1713","","224.381  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.382","SUP","HCPCS C1713","","224.382  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.383","SUP","HCPCS C1713","","224.383  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.384","SUP","HCPCS C1713","","224.384  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.385","SUP","HCPCS C1713","","224.385  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.386","SUP","HCPCS C1713","","224.386  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.387","SUP","HCPCS C1713","","224.387  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.388","SUP","HCPCS C1713","","224.388  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.389","SUP","HCPCS C1713","","224.389  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$2,368.13 ","$0.00 ","$1,096.84 ","$0.00 ","$0.00 ","$921.42 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$823.58 ","$0.00 ","$837.79 ","$0.00 "
"224.441","SUP","HCPCS C1713","","224.441  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.442","SUP","HCPCS C1713","","224.442  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.443","SUP","HCPCS C1713","","224.443  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.444","SUP","HCPCS C1713","","224.444  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.445","SUP","HCPCS C1713","","224.445  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.451","SUP","HCPCS C1713","","224.451  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.452","SUP","HCPCS C1713","","224.452  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.453","SUP","HCPCS C1713","","224.453  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.454","SUP","HCPCS C1713","","224.454  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.455","SUP","HCPCS C1713","","224.455  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.456","SUP","HCPCS C1713","","224.456  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.457","SUP","HCPCS C1713","","224.457  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.461","SUP","HCPCS C1713","","224.461  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.462","SUP","HCPCS C1713","","224.462  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.463","SUP","HCPCS C1713","","224.463  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.464","SUP","HCPCS C1713","","224.464  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.465","SUP","HCPCS C1713","","224.465  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.466","SUP","HCPCS C1713","","224.466  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.467","SUP","HCPCS C1713","","224.467  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.468","SUP","HCPCS C1713","","224.468  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.469","SUP","HCPCS C1713","","224.469  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.471","SUP","HCPCS C1713","","224.471  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.472","SUP","HCPCS C1713","","224.472  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.473","SUP","HCPCS C1713","","224.473  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.474","SUP","HCPCS C1713","","224.474  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.475","SUP","HCPCS C1713","","224.475  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.476","SUP","HCPCS C1713","","224.476  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.477","SUP","HCPCS C1713","","224.477  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.478","SUP","HCPCS C1713","","224.478  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.479","SUP","HCPCS C1713","","224.479  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.481","SUP","HCPCS C1713","","224.481  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.482","SUP","HCPCS C1713","","224.482  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.483","SUP","HCPCS C1713","","224.483  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.484","SUP","HCPCS C1713","","224.484  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.485","SUP","HCPCS C1713","","224.485  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.486","SUP","HCPCS C1713","","224.486  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.487","SUP","HCPCS C1713","","224.487  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.488","SUP","HCPCS C1713","","224.488  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.489","SUP","HCPCS C1713","","224.489  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.506","SUP","HCPCS C1713","","224.506  -  PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL","BOTH IP/OP","$1,149.85 ","$850.89 ","$0.00 ","$1,116.38 ","$502.37 ","$0.00 ","$239.66 ","$0.00 ","$0.00 ","$195.47 ","$1,116.38 ","$0.00 ","$558.19 ","$884.17 ","$893.10 ","$0.00 ","$169.62 ","$0.00 ","$177.73 ","$0.00 "
"224.507","SUP","HCPCS C1713","","224.507  -  PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA LEFT DISTAL","BOTH IP/OP","$1,149.85 ","$850.89 ","$0.00 ","$1,116.38 ","$502.37 ","$0.00 ","$239.66 ","$0.00 ","$0.00 ","$195.47 ","$1,116.38 ","$0.00 ","$558.19 ","$884.17 ","$893.10 ","$0.00 ","$169.62 ","$0.00 ","$177.73 ","$0.00 "
"224.508","SUP","HCPCS C1713","","224.508  -  PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"224.509","SUP","HCPCS C1713","","224.509  -  PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA LEFT DISTAL","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"224.51","SUP","HCPCS C1713","","224.510  -  PLATE BONE 197X14X3.8MM 10 HOLE DCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,434.35 ","$1,061.42 ","$0.00 ","$1,434.35 ","$645.46 ","$0.00 ","$298.95 ","$0.00 ","$0.00 ","$251.14 ","$1,434.35 ","$0.00 ","$717.18 ","$1,136.01 ","$1,147.48 ","$0.00 ","$217.94 ","$0.00 ","$228.35 ","$0.00 "
"224.511","SUP","HCPCS C1713","","224.511  -  PLATE BONE 197X14X3.8MM 10 HOLE STAINLESS STEEL LEFT MEDIAL","BOTH IP/OP","$1,477.38 ","$1,093.26 ","$0.00 ","$1,434.35 ","$645.46 ","$0.00 ","$307.92 ","$0.00 ","$0.00 ","$251.14 ","$1,434.35 ","$0.00 ","$717.18 ","$1,136.01 ","$1,147.48 ","$0.00 ","$217.94 ","$0.00 ","$228.35 ","$0.00 "
"224.512","SUP","Custom 27803010","","224.512  -  PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL RIGHT MEDIAL","BOTH IP/OP","$1,650.28 ","$1,221.21 ","$0.00 ","$1,602.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,602.23 ","$0.00 ","$801.11 ","$1,268.97 ","$1,281.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.513","SUP","HCPCS C1713","","224.513  -  PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL LEFT MEDIAL","BOTH IP/OP","$1,650.28 ","$1,221.21 ","$0.00 ","$1,602.23 ","$721.00 ","$0.00 ","$343.96 ","$0.00 ","$0.00 ","$280.54 ","$1,602.23 ","$0.00 ","$801.11 ","$1,268.97 ","$1,281.78 ","$0.00 ","$243.44 ","$0.00 ","$255.07 ","$0.00 "
"224.514","SUP","HCPCS C1713","","224.514  -  PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL RIGHT MEDIAL","BOTH IP/OP","$1,840.05 ","$1,361.64 ","$0.00 ","$1,786.45 ","$803.90 ","$0.00 ","$383.51 ","$0.00 ","$0.00 ","$312.79 ","$1,786.45 ","$0.00 ","$893.23 ","$1,414.87 ","$1,429.16 ","$0.00 ","$271.44 ","$0.00 ","$284.40 ","$0.00 "
"224.515","SUP","Custom 27803010","","224.515  -  PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL LEFT MEDIAL","BOTH IP/OP","$1,840.05 ","$1,361.64 ","$0.00 ","$1,786.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,786.45 ","$0.00 ","$893.23 ","$1,414.87 ","$1,429.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.517","SUP","Custom 27803010","","224.517  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 200MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.52","SUP","HCPCS C1713","","224.52  -  PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$300.78 ","$135.35 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$52.66 ","$300.78 ","$0.00 ","$150.39 ","$238.22 ","$240.62 ","$0.00 ","$47.07 ","$0.00 ","$47.88 ","$0.00 "
"224.52","SUP","Custom 27803010","","224.520  -  ROD SPNL 5.5MM 400MM REVERE STRG SS","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$396.00 ","$135.35 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$52.66 ","$300.78 ","$0.00 ","$150.39 ","$396.00 ","$240.62 ","$0.00 ","$47.07 ","$0.00 ","$47.88 ","$0.00 "
"224.521","SUP","Custom 27803010","","224.521  -  PLATE BN NAR 44X13.5X4.2MM NS LCP CMBN 2 HL LMT CNTCT TPR","BOTH IP/OP","$608.68 ","$450.42 ","$0.00 ","$590.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$590.93 ","$0.00 ","$295.46 ","$468.02 ","$472.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.53","SUP","HCPCS C1713","","224.53  -  PLATE BONE NARROW 62X13.5X4.2MM 3 HOLE LC-DCP STAINLESS","BOTH IP/OP","$310.05 ","$229.44 ","$0.00 ","$310.05 ","$139.52 ","$0.00 ","$64.62 ","$0.00 ","$0.00 ","$54.29 ","$310.05 ","$0.00 ","$155.03 ","$245.56 ","$248.04 ","$0.00 ","$48.52 ","$0.00 ","$49.36 ","$0.00 "
"224.53","SUP","Custom 27803010","","224.530  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 30MM","BOTH IP/OP","$310.05 ","$229.44 ","$0.00 ","$396.00 ","$139.52 ","$0.00 ","$64.62 ","$0.00 ","$0.00 ","$54.29 ","$310.05 ","$0.00 ","$155.03 ","$396.00 ","$248.04 ","$0.00 ","$48.52 ","$0.00 ","$49.36 ","$0.00 "
"224.531","SUP","HCPCS C1713","","224.531  -  PLATE BN NAR 62X13.5X4.2MM NS LCP CMBN 3 HL LMT CNTCT TPR","BOTH IP/OP","$615.70 ","$455.62 ","$0.00 ","$597.75 ","$268.99 ","$0.00 ","$128.33 ","$0.00 ","$0.00 ","$104.66 ","$597.75 ","$0.00 ","$298.88 ","$473.42 ","$478.20 ","$0.00 ","$90.82 ","$0.00 ","$95.16 ","$0.00 "
"224.535","SUP","Custom 27803010","","224.535  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.54","SUP","HCPCS C1713","","224.54  -  PLATE BN NAR 70X13.5X4.2MM NS LC DCP 4 HL SS 4.5MM SCR LG","BOTH IP/OP","$319.10 ","$236.13 ","$0.00 ","$309.80 ","$139.41 ","$0.00 ","$66.51 ","$0.00 ","$0.00 ","$54.24 ","$309.80 ","$0.00 ","$154.90 ","$245.36 ","$247.84 ","$0.00 ","$47.07 ","$0.00 ","$49.32 ","$0.00 "
"224.54","SUP","Custom 27803010","","224.540  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 40MM","BOTH IP/OP","$319.10 ","$236.13 ","$0.00 ","$396.00 ","$139.41 ","$0.00 ","$66.51 ","$0.00 ","$0.00 ","$54.24 ","$309.80 ","$0.00 ","$154.90 ","$396.00 ","$247.84 ","$0.00 ","$47.07 ","$0.00 ","$49.32 ","$0.00 "
"224.541","SUP","HCPCS C1713","","224.541  -  PLATE BN NAR 80X13.5X4.2MM NS LCP CMBN 4 HL LMT CNTCT TPR","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"224.545","SUP","Custom 27803010","","224.545  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.55","SUP","HCPCS C1713","","224.55  -  PLATE BN NAR 88X13.5X4.2MM NS LC DCP 5 HL SS 4.5MM SCR LG","BOTH IP/OP","$319.10 ","$236.13 ","$0.00 ","$309.80 ","$139.41 ","$0.00 ","$66.51 ","$0.00 ","$0.00 ","$54.24 ","$309.80 ","$0.00 ","$154.90 ","$245.36 ","$247.84 ","$0.00 ","$47.07 ","$0.00 ","$49.32 ","$0.00 "
"224.55","SUP","Custom 27803010","","224.550  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 50MM","BOTH IP/OP","$319.10 ","$236.13 ","$0.00 ","$396.00 ","$139.41 ","$0.00 ","$66.51 ","$0.00 ","$0.00 ","$54.24 ","$309.80 ","$0.00 ","$154.90 ","$396.00 ","$247.84 ","$0.00 ","$47.07 ","$0.00 ","$49.32 ","$0.00 "
"224.551","SUP","HCPCS C1713","","224.551  -  PLATE BN NAR 98X13.5X4.2MM NS LCP CMBN 5 HL LMT CNTCT TPR","BOTH IP/OP","$694.40 ","$513.86 ","$0.00 ","$674.18 ","$303.38 ","$0.00 ","$144.73 ","$0.00 ","$0.00 ","$118.04 ","$674.18 ","$0.00 ","$337.09 ","$533.95 ","$539.34 ","$0.00 ","$102.44 ","$0.00 ","$107.33 ","$0.00 "
"224.555","SUP","Custom 27803010","","224.555  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.56","SUP","HCPCS C1713","","224.56  -  PLATE BN NAR 106X13.5X4.2MM NS LC DCP 6 HL SS 4.5MM SCR LG","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$349.38 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$276.71 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.56","SUP","Custom 27803010","","224.560  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 60MM","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$396.00 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$396.00 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.561","SUP","HCPCS C1713","","224.561  -  PLATE BN NAR 116MM NS LCP CMBN 6 HL SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"224.565","SUP","Custom 27803010","","224.565  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.57","SUP","HCPCS C1713","","224.57  -  PLATE BN NAR 124X13.5X4.2MM NS LC DCP 7 HL SS 4.5MM SCR LG","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$349.38 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$276.71 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.57","SUP","Custom 27803010","","224.570  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 70MM","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$396.00 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$396.00 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.571","SUP","HCPCS C1713","","224.571  -  PLATE BN NAR 134X13.5X4.2MM NS LCP CMBN 7 HL LMT CNTCT TPR","BOTH IP/OP","$850.45 ","$629.33 ","$0.00 ","$825.68 ","$371.55 ","$0.00 ","$177.26 ","$0.00 ","$0.00 ","$144.57 ","$825.68 ","$0.00 ","$412.84 ","$653.94 ","$660.54 ","$0.00 ","$125.45 ","$0.00 ","$131.45 ","$0.00 "
"224.575","SUP","Custom 27803010","","224.575  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.58","SUP","HCPCS C1713","","224.58  -  PLATE BN NAR 142X13.5X4.2MM NS LC DCP 8 HL SS 4.5MM SCR LG","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$349.38 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$276.71 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.58","SUP","Custom 27803010","","224.580  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 80MM","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$396.00 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$396.00 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.581","SUP","HCPCS C1713","","224.581  -  PLATE BN NAR 152X13.5X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR","BOTH IP/OP","$899.65 ","$665.74 ","$0.00 ","$873.45 ","$393.05 ","$0.00 ","$187.51 ","$0.00 ","$0.00 ","$152.93 ","$873.45 ","$0.00 ","$436.73 ","$691.77 ","$698.76 ","$0.00 ","$132.71 ","$0.00 ","$139.05 ","$0.00 "
"224.585","SUP","Custom 27803010","","224.585  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.59","SUP","HCPCS C1713","","224.59  -  PLATE BN NAR 160X13.5X4.2MM NS LC DCP 9 HL SS 4.5MM SCR LG","BOTH IP/OP","$359.85 ","$266.29 ","$0.00 ","$349.38 ","$157.22 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$61.17 ","$349.38 ","$0.00 ","$174.69 ","$276.71 ","$279.50 ","$0.00 ","$53.08 ","$0.00 ","$55.62 ","$0.00 "
"224.591","SUP","HCPCS C1713","","224.591  -  PLATE BN NAR 170X13.5X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR","BOTH IP/OP","$941.83 ","$696.95 ","$0.00 ","$914.38 ","$411.47 ","$0.00 ","$196.30 ","$0.00 ","$0.00 ","$160.10 ","$914.38 ","$0.00 ","$457.19 ","$724.19 ","$731.50 ","$0.00 ","$138.93 ","$0.00 ","$145.57 ","$0.00 "
"224.6","SUP","HCPCS C1713","","224.60  -  PLATE BN NAR 178X13.5X4.2MM NS LC DCP 10 HL SS 4.5MM SCR LG","BOTH IP/OP","$454.45 ","$336.29 ","$0.00 ","$454.45 ","$204.50 ","$0.00 ","$94.72 ","$0.00 ","$0.00 ","$79.57 ","$454.45 ","$0.00 ","$227.23 ","$359.92 ","$363.56 ","$0.00 ","$69.05 ","$0.00 ","$72.35 ","$0.00 "
"224.601","SUP","HCPCS C1713","","224.601  -  PLATE BN NAR 188X13.5X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR","BOTH IP/OP","$1,023.35 ","$757.28 ","$0.00 ","$993.55 ","$447.10 ","$0.00 ","$213.29 ","$0.00 ","$0.00 ","$173.96 ","$993.55 ","$0.00 ","$496.78 ","$786.89 ","$794.84 ","$0.00 ","$150.96 ","$0.00 ","$158.17 ","$0.00 "
"224.61","SUP","HCPCS C1713","","224.61  -  PLATE BN NAR 196X13.5X4.2MM NS LC DCP 11 HL SS 4.5MM SCR LG","BOTH IP/OP","$468.10 ","$346.39 ","$0.00 ","$454.45 ","$204.50 ","$0.00 ","$97.56 ","$0.00 ","$0.00 ","$79.57 ","$454.45 ","$0.00 ","$227.23 ","$359.92 ","$363.56 ","$0.00 ","$69.05 ","$0.00 ","$72.35 ","$0.00 "
"224.61","SUP","Custom 27803010","","224.610  -  5.5MM STAINLESS STEEL CURVED ROD, 100MM","BOTH IP/OP","$468.10 ","$346.39 ","$0.00 ","$454.45 ","$204.50 ","$0.00 ","$97.56 ","$0.00 ","$0.00 ","$79.57 ","$454.45 ","$0.00 ","$227.23 ","$396.00 ","$363.56 ","$0.00 ","$69.05 ","$0.00 ","$72.35 ","$0.00 "
"224.611","SUP","HCPCS C1713","","224.611  -  PLATE BN NAR 206X13.5X4.2MM NS LCP CMBN 11 HL LMT CNTCT TPR","BOTH IP/OP","$1,102.08 ","$815.54 ","$0.00 ","$1,069.98 ","$481.49 ","$0.00 ","$229.70 ","$0.00 ","$0.00 ","$187.34 ","$1,069.98 ","$0.00 ","$534.99 ","$847.42 ","$855.98 ","$0.00 ","$162.57 ","$0.00 ","$170.34 ","$0.00 "
"224.612","SUP","Custom 27803010","","224.612  -  5.5MM STAINLESS STEEL CURVED ROD, 125MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.615","SUP","Custom 27803010","","224.615  -  5.5MM STAINLESS STEEL CURVED ROD, 150MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.62","SUP","HCPCS C1713","","224.62  -  PLATE BN NAR 214X13.5X4.2MM NS LC DCP 12 HL SS 4.5MM SCR LG","BOTH IP/OP","$468.10 ","$346.39 ","$0.00 ","$454.45 ","$204.50 ","$0.00 ","$97.56 ","$0.00 ","$0.00 ","$79.57 ","$454.45 ","$0.00 ","$227.23 ","$359.92 ","$363.56 ","$0.00 ","$69.05 ","$0.00 ","$72.35 ","$0.00 "
"224.621","SUP","HCPCS C1713","","224.621  -  PLATE BN NAR 224X13.5X4.2MM NS LCP CMBN 12 HL LMT CNTCT TPR","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"224.635","SUP","Custom 27803010","","224.635  -  5.5MM STAINLESS STEEL CURVED ROD, 35MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.64","SUP","HCPCS C1713","","224.64  -  PLATE BONE NARROW 250X13.5X4.2MM 14 HOLE LC-DCP STAINLESS","BOTH IP/OP","$441.23 ","$326.51 ","$0.00 ","$441.23 ","$198.55 ","$0.00 ","$91.96 ","$0.00 ","$0.00 ","$77.25 ","$441.23 ","$0.00 ","$220.61 ","$349.45 ","$352.98 ","$0.00 ","$69.05 ","$0.00 ","$70.24 ","$0.00 "
"224.64","SUP","Custom 27803010","","224.640  -  5.5MM STAINLESS STEEL CURVED ROD, 40MM","BOTH IP/OP","$441.23 ","$326.51 ","$0.00 ","$441.23 ","$198.55 ","$0.00 ","$91.96 ","$0.00 ","$0.00 ","$77.25 ","$441.23 ","$0.00 ","$220.61 ","$396.00 ","$352.98 ","$0.00 ","$69.05 ","$0.00 ","$70.24 ","$0.00 "
"224.641","SUP","HCPCS C1713","","224.641  -  PLATE BN NAR 260X13.5X4.2MM NS LCP CMBN 14 HL LMT CNTCT TPR","BOTH IP/OP","$1,328.38 ","$983.00 ","$0.00 ","$1,289.70 ","$580.37 ","$0.00 ","$276.87 ","$0.00 ","$0.00 ","$225.82 ","$1,289.70 ","$0.00 ","$644.85 ","$1,021.44 ","$1,031.76 ","$0.00 ","$195.96 ","$0.00 ","$205.32 ","$0.00 "
"224.645","SUP","Custom 27803010","","224.645  -  5.5MM STAINLESS STEEL CURVED ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.65","SUP","Custom 27803010","","224.650  -  5.5MM STAINLESS STEEL CURVED ROD, 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.655","SUP","Custom 27803010","","224.655  -  5.5MM STAINLESS STEEL CURVED ROD, 55MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.66","SUP","Custom 27803010","","224.660  -  5.5MM STAINLESS STEEL CURVED ROD, 60MM","BOTH IP/OP","$562.28 ","$416.09 ","$0.00 ","$545.90 ","$245.66 ","$0.00 ","$117.19 ","$0.00 ","$0.00 ","$95.58 ","$545.90 ","$0.00 ","$272.95 ","$396.00 ","$436.72 ","$0.00 ","$82.95 ","$0.00 ","$86.91 ","$0.00 "
"224.66","SUP","HCPCS C1713","","224.66  -  PLATE BONE NARROW 286X13.5X4.2MM 16 HOLE LC-DCP STAINLESS","BOTH IP/OP","$562.28 ","$416.09 ","$0.00 ","$545.90 ","$245.66 ","$0.00 ","$117.19 ","$0.00 ","$0.00 ","$95.58 ","$545.90 ","$0.00 ","$272.95 ","$432.35 ","$436.72 ","$0.00 ","$82.95 ","$0.00 ","$86.91 ","$0.00 "
"224.661","SUP","HCPCS C1713","","224.661  -  PLATE BN NAR 296X13.5X4.2MM NS LCP CMBN 16 HL LMT CNTCT TPR","BOTH IP/OP","$1,553.30 ","$1,149.44 ","$0.00 ","$1,508.05 ","$678.62 ","$0.00 ","$323.75 ","$0.00 ","$0.00 ","$264.05 ","$1,508.05 ","$0.00 ","$754.03 ","$1,194.38 ","$1,206.44 ","$0.00 ","$229.14 ","$0.00 ","$240.08 ","$0.00 "
"224.665","SUP","Custom 27803010","","224.665  -  5.5MM STAINLESS STEEL CURVED ROD, 65MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.67","SUP","Custom 27803010","","224.670  -  5.5MM STAINLESS STEEL CURVED ROD, 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.675","SUP","Custom 27803010","","224.675  -  5.5MM STAINLESS STEEL CURVED ROD, 75MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.68","SUP","Custom 27803010","","224.680  -  5.5MM STAINLESS STEEL CURVED ROD, 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.681","SUP","HCPCS C1713","","224.681  -  PLATE BONE NARROW 332MM 18 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$1,886.45 ","$1,395.97 ","$0.00 ","$1,831.50 ","$824.18 ","$0.00 ","$393.18 ","$0.00 ","$0.00 ","$320.68 ","$1,831.50 ","$0.00 ","$915.75 ","$1,450.55 ","$1,465.20 ","$0.00 ","$278.28 ","$0.00 ","$291.57 ","$0.00 "
"224.685","SUP","Custom 27803010","","224.685  -  5.5MM STAINLESS STEEL CURVED ROD, 85MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.7","SUP","HCPCS C1713","","224.70  -  PLATE BONE NARROW 358MM 20 HOLE LC-DCP STAINLESS STEEL","BOTH IP/OP","$1,155.95 ","$855.40 ","$0.00 ","$1,155.95 ","$520.18 ","$0.00 ","$240.93 ","$0.00 ","$0.00 ","$202.40 ","$1,155.95 ","$0.00 ","$577.98 ","$915.51 ","$924.76 ","$0.00 ","$175.64 ","$0.00 ","$184.03 ","$0.00 "
"224.701","SUP","HCPCS C1713","","224.701  -  PLATE BONE NARROW 368MM 20 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,398.10 ","$1,774.59 ","$0.00 ","$2,328.28 ","$1,047.72 ","$0.00 ","$499.82 ","$0.00 ","$0.00 ","$407.66 ","$2,328.28 ","$0.00 ","$1,164.14 ","$1,844.00 ","$1,862.62 ","$0.00 ","$353.76 ","$0.00 ","$370.66 ","$0.00 "
"224.702","SUP","HCPCS C1713","","224.702  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.703","SUP","HCPCS C1713","","224.703  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.704","SUP","HCPCS C1713","","224.704  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.705","SUP","HCPCS C1713","","224.705  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.706","SUP","HCPCS C1713","","224.706  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.707","SUP","HCPCS C1713","","224.707  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.711","SUP","HCPCS C1713","","224.711  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.712","SUP","HCPCS C1713","","224.712  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.713","SUP","HCPCS C1713","","224.713  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.714","SUP","HCPCS C1713","","224.714  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.715","SUP","HCPCS C1713","","224.715  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.716","SUP","HCPCS C1713","","224.716  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.717","SUP","HCPCS C1713","","224.717  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.721","SUP","HCPCS C1713","","224.721  -  PLATE BONE NARROW 404MM 22 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,618.80 ","$1,937.91 ","$0.00 ","$2,542.53 ","$1,144.14 ","$0.00 ","$545.82 ","$0.00 ","$0.00 ","$445.18 ","$2,542.53 ","$0.00 ","$1,271.26 ","$2,013.68 ","$2,034.02 ","$0.00 ","$386.32 ","$0.00 ","$404.77 ","$0.00 "
"224.722","SUP","HCPCS C1713","","224.722  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.723","SUP","HCPCS C1713","","224.723  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.724","SUP","HCPCS C1713","","224.724  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.725","SUP","HCPCS C1713","","224.725  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.726","SUP","HCPCS C1713","","224.726  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.727","SUP","HCPCS C1713","","224.727  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.731","SUP","HCPCS C1713","","224.731  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.732","SUP","HCPCS C1713","","224.732  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.733","SUP","HCPCS C1713","","224.733  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.734","SUP","HCPCS C1713","","224.734  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.735","SUP","HCPCS C1713","","224.735  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.736","SUP","HCPCS C1713","","224.736  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.737","SUP","HCPCS C1713","","224.737  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.753","SUP","HCPCS C1713","","224.753  -  PLATE BN 118X11X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"224.754","SUP","HCPCS C1713","","224.754  -  PLATE BN 136X11X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,758.53 ","$1,301.31 ","$0.00 ","$1,707.30 ","$768.29 ","$0.00 ","$366.52 ","$0.00 ","$0.00 ","$298.93 ","$1,707.30 ","$0.00 ","$853.65 ","$1,352.18 ","$1,365.84 ","$0.00 ","$259.41 ","$0.00 ","$271.80 ","$0.00 "
"224.755","SUP","HCPCS C1713","","224.755  -  PLATE BN 154X11X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,788.05 ","$1,323.16 ","$0.00 ","$1,735.95 ","$781.18 ","$0.00 ","$372.67 ","$0.00 ","$0.00 ","$303.95 ","$1,735.95 ","$0.00 ","$867.98 ","$1,374.87 ","$1,388.76 ","$0.00 ","$263.77 ","$0.00 ","$276.36 ","$0.00 "
"224.756","SUP","HCPCS C1713","","224.756  -  PLATE BONE 172MM 11 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$1,817.55 ","$1,344.99 ","$0.00 ","$1,764.63 ","$794.08 ","$0.00 ","$378.82 ","$0.00 ","$0.00 ","$308.97 ","$1,764.63 ","$0.00 ","$882.31 ","$1,397.59 ","$1,411.70 ","$0.00 ","$268.12 ","$0.00 ","$280.93 ","$0.00 "
"224.757","SUP","HCPCS C1713","","224.757  -  PLATE BONE 190MM 12 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,277.78 ","$1,025.00 ","$0.00 ","$488.99 ","$0.00 ","$0.00 ","$398.82 ","$2,277.78 ","$0.00 ","$1,138.89 ","$1,804.00 ","$1,822.22 ","$0.00 ","$346.09 ","$0.00 ","$362.62 ","$0.00 "
"224.758","SUP","HCPCS C1713","","224.758  -  PLATE BONE 208MM 8X5 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$2,370.00 ","$1,753.80 ","$0.00 ","$2,300.98 ","$1,035.44 ","$0.00 ","$493.97 ","$0.00 ","$0.00 ","$402.88 ","$2,300.98 ","$0.00 ","$1,150.49 ","$1,822.38 ","$1,840.78 ","$0.00 ","$349.61 ","$0.00 ","$366.32 ","$0.00 "
"224.759","SUP","HCPCS C1713","","224.759  -  PLATE BONE 226MM 9X5 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$2,422.00 ","$1,792.28 ","$0.00 ","$2,351.48 ","$1,058.16 ","$0.00 ","$504.81 ","$0.00 ","$0.00 ","$411.72 ","$2,351.48 ","$0.00 ","$1,175.74 ","$1,862.37 ","$1,881.18 ","$0.00 ","$357.29 ","$0.00 ","$374.35 ","$0.00 "
"224.761","SUP","HCPCS C1713","","224.761  -  PLATE BONE 262MM 11X5 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$2,542.90 ","$1,881.75 ","$0.00 ","$2,468.83 ","$1,110.97 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$432.27 ","$2,468.83 ","$0.00 ","$1,234.41 ","$1,955.31 ","$1,975.06 ","$0.00 ","$375.12 ","$0.00 ","$393.04 ","$0.00 "
"224.763","SUP","HCPCS C1713","","224.763  -  PLATE BONE 298MM 13X5 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$2,590.70 ","$1,917.12 ","$0.00 ","$2,515.23 ","$1,131.85 ","$0.00 ","$539.97 ","$0.00 ","$0.00 ","$440.40 ","$2,515.23 ","$0.00 ","$1,257.61 ","$1,992.06 ","$2,012.18 ","$0.00 ","$382.17 ","$0.00 ","$400.42 ","$0.00 "
"224.765","SUP","HCPCS C1713","","224.765  -  PLATE BONE 334MM 20 HOLE LCP STAINLESS STEEL METAPHYSEAL","BOTH IP/OP","$2,708.78 ","$2,004.50 ","$0.00 ","$2,629.88 ","$1,183.44 ","$0.00 ","$564.58 ","$0.00 ","$0.00 ","$460.47 ","$2,629.88 ","$0.00 ","$1,314.94 ","$2,082.86 ","$2,103.90 ","$0.00 ","$399.59 ","$0.00 ","$418.68 ","$0.00 "
"224.801","SUP","HCPCS C1713","","224.801  -  SS REVERE 4.5MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.802","SUP","HCPCS C1713","","224.802  -  SS REVERE 4.5MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.803","SUP","HCPCS C1713","","224.803  -  SS REVERE 4.5MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.804","SUP","HCPCS C1713","","224.804  -  SS REVERE 4.5MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.805","SUP","HCPCS C1713","","224.805  -  SS REVERE 4.5MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.806","SUP","HCPCS C1713","","224.806  -  SS REVERE 4.5MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.807","SUP","HCPCS C1713","","224.807  -  SS REVERE 4.5MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.811","SUP","HCPCS C1713","","224.811  -  SS REVERE 5.0MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.812","SUP","HCPCS C1713","","224.812  -  SS REVERE 5.0MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.813","SUP","HCPCS C1713","","224.813  -  SS REVERE 5.0MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.814","SUP","HCPCS C1713","","224.814  -  SS REVERE 5.0MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.815","SUP","HCPCS C1713","","224.815  -  SS REVERE 5.0MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.816","SUP","HCPCS C1713","","224.816  -  SS REVERE 5.0MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.817","SUP","HCPCS C1713","","224.817  -  SS REVERE 5.0MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.821","SUP","HCPCS C1713","","224.821  -  SS REVERE 5.5MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.822","SUP","HCPCS C1713","","224.822  -  SS REVERE 5.5MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.823","SUP","HCPCS C1713","","224.823  -  SS REVERE 5.5MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.824","SUP","HCPCS C1713","","224.824  -  SS REVERE 5.5MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.825","SUP","HCPCS C1713","","224.825  -  SS REVERE 5.5MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.826","SUP","HCPCS C1713","","224.826  -  SS REVERE 5.5MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.827","SUP","HCPCS C1713","","224.827  -  SS REVERE 5.5MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.831","SUP","HCPCS C1713","","224.831  -  SS REVERE 6.5MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.832","SUP","HCPCS C1713","","224.832  -  SS REVERE 6.5MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.833","SUP","HCPCS C1713","","224.833  -  SS REVERE 6.5MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.834","SUP","HCPCS C1713","","224.834  -  SS REVERE 6.5MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.835","SUP","HCPCS C1713","","224.835  -  SS REVERE 6.5MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.836","SUP","HCPCS C1713","","224.836  -  SS REVERE 6.5MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.837","SUP","HCPCS C1713","","224.837  -  SS REVERE 6.5MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"224.851","SUP","HCPCS C1713","","224.851  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.852","SUP","HCPCS C1713","","224.852  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.853","SUP","HCPCS C1713","","224.853  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.854","SUP","HCPCS C1713","","224.854  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.855","SUP","HCPCS C1713","","224.855  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.856","SUP","HCPCS C1713","","224.856  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.857","SUP","HCPCS C1713","","224.857  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.871","SUP","HCPCS C1713","","224.871  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.872","SUP","HCPCS C1713","","224.872  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.873","SUP","HCPCS C1713","","224.873  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.874","SUP","HCPCS C1713","","224.874  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.875","SUP","HCPCS C1713","","224.875  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.881","SUP","HCPCS C1713","","224.881  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.882","SUP","HCPCS C1713","","224.882  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 75MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.883","SUP","HCPCS C1713","","224.883  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 80MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.884","SUP","HCPCS C1713","","224.884  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 85MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.885","SUP","HCPCS C1713","","224.885  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 90MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"224.891","SUP","Custom 27803010","","224.891  -  SS REVERE LOW PROFILE PEDICLE HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.892","SUP","Custom 27803010","","224.892  -  SS REVERE LOW PROFILE PEDICLE HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.893","SUP","Custom 27803010","","224.893  -  SS REVERE LOW PROFILE PEDICLE HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.901","SUP","Custom 27803010","","224.901  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, NARROW, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.902","SUP","Custom 27803010","","224.902  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, NARROW, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.904","SUP","Custom 27803010","","224.904  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.905","SUP","Custom 27803010","","224.905  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.907","SUP","Custom 27803010","","224.907  -  STAINLESS STEEL REVERE UPGOING LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.908","SUP","Custom 27803010","","224.908  -  STAINLESS STEEL REVERE UPGOING LAMINA HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.912","SUP","Custom 27803010","","224.912  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 29MM-33MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.913","SUP","Custom 27803010","","224.913  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 33MM-41MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.914","SUP","Custom 27803010","","224.914  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 38MM-51MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.915","SUP","Custom 27803010","","224.915  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 48MM-61MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.916","SUP","Custom 27803010","","224.916  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 58MM-71MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.917","SUP","Custom 27803010","","224.917  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 68MM-81MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.918","SUP","Custom 27803010","","224.918  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 78MM-91MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.921","SUP","Custom 27803010","","224.921  -  STAINLESS STEEL REVERE OFFSET LAMINA HOOK, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.922","SUP","Custom 27803010","","224.922  -  STAINLESS STEEL REVERE OFFSET LAMINA HOOK, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.924","SUP","Custom 27803010","","224.924  -  STAINLESS STEEL REVERE TRANSVERSE PROCESS HOOK, RIGHT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.925","SUP","Custom 27803010","","224.925  -  STAINLESS STEEL REVERE TRANSVERSE PROCESS HOOK, LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.927","SUP","Custom 27803010","","224.927  -  STAINLESS STEEL REVERE PEDICLE HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.928","SUP","Custom 27803010","","224.928  -  STAINLESS STEEL REVERE PEDICLE HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.929","SUP","Custom 27803010","","224.929  -  STAINLESS STEEL REVERE PEDICLE HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.931","SUP","Custom 27803010","","224.931  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.932","SUP","Custom 27803010","","224.932  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.933","SUP","Custom 27803010","","224.933  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.935","SUP","Custom 27803010","","224.935  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.936","SUP","Custom 27803010","","224.936  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.937","SUP","Custom 27803010","","224.937  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.94","SUP","Custom 27803010","","224.940  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.941","SUP","Custom 27803010","","224.941  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.942","SUP","Custom 27803010","","224.942  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.944","SUP","Custom 27803010","","224.944  -  STAINLESS STEEL REVERE LAMINA HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.945","SUP","Custom 27803010","","224.945  -  STAINLESS STEEL REVERE LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.946","SUP","Custom 27803010","","224.946  -  STAINLESS STEEL REVERE LAMINA HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.948","SUP","Custom 27803010","","224.948  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.949","SUP","Custom 27803010","","224.949  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.95","SUP","Custom 27803010","","224.950  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.952","SUP","Custom 27803010","","224.952  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.953","SUP","Custom 27803010","","224.953  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.954","SUP","Custom 27803010","","224.954  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.955","SUP","Custom 27803010","","224.955  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, SMALL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.956","SUP","Custom 27803010","","224.956  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, MEDIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.957","SUP","Custom 27803010","","224.957  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, LARGE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.96","SUP","Custom 27803010","","224.960  -  STAINLESS STEEL PARALLEL CONNECTOR, 5.5MM TO 5.5MM","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.50 ","$0.00 ","$571.25 ","$904.86 ","$914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.961","SUP","Custom 27803010","","224.961  -  STAINLESS STEEL PARALLEL CONNECTOR, 5.5MM TO 5.5MM, WIDE","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.50 ","$0.00 ","$571.25 ","$904.86 ","$914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.962","SUP","Custom 27803010","","224.962  -  STAINLESS STEEL ROD TO ROD CLAMP, 5.5MM TO 5.5MM","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.50 ","$0.00 ","$571.25 ","$904.86 ","$914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.963","SUP","Custom 27803010","","224.963  -  STAINLESS STEEL ROD TO ROD CLAMP, 5.5MM TO 5.5MM, WIDE","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.50 ","$0.00 ","$571.25 ","$904.86 ","$914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.964","SUP","Custom 27803010","","224.964  -  STAINLESS STEEL PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.50 ","$0.00 ","$571.25 ","$904.86 ","$914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.965","SUP","Custom 27803010","","224.965  -  STAINLESS STEEL PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM, WI","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.50 ","$0.00 ","$571.25 ","$904.86 ","$914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.97","SUP","Custom 27803010","","224.970  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 15MM","BOTH IP/OP","$1,025.00 ","$758.50 ","$0.00 ","$1,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.00 ","$0.00 ","$512.50 ","$811.80 ","$820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.971","SUP","Custom 27803010","","224.971  -  5.5MMM STAINLESS STEEL OFFSET CONNECTOR, 20MM","BOTH IP/OP","$1,025.00 ","$758.50 ","$0.00 ","$1,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.00 ","$0.00 ","$512.50 ","$811.80 ","$820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.972","SUP","Custom 27803010","","224.972  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 25MM","BOTH IP/OP","$1,025.00 ","$758.50 ","$0.00 ","$1,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.00 ","$0.00 ","$512.50 ","$811.80 ","$820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.973","SUP","Custom 27803010","","224.973  -  5.5MM STAINLESS STEEL ROD CLAMP, 100MM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.974","SUP","Custom 27803010","","224.974  -  5.5MM STAINLESS STEEL ROD CLAMP, 120MM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.975","SUP","Custom 27803010","","224.975  -  5.5MM STAINLESS STEEL ROD CLAMP, 150MM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.976","SUP","Custom 27803010","","224.976  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 30MM","BOTH IP/OP","$1,132.50 ","$838.05 ","$0.00 ","$1,132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,132.50 ","$0.00 ","$566.25 ","$896.94 ","$906.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.977","SUP","Custom 27803010","","224.977  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 35MM","BOTH IP/OP","$1,132.50 ","$838.05 ","$0.00 ","$1,132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,132.50 ","$0.00 ","$566.25 ","$896.94 ","$906.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.98","SUP","Custom 27803010","","224.980  -  STAINLESS STEEL IN-LINE CONNECTOR, 5.5MM TO 5.5MM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.99","SUP","Custom 27803010","","224.990  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 15MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.991","SUP","Custom 27803010","","224.991  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 20MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.992","SUP","Custom 27803010","","224.992  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 25MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.993","SUP","Custom 27803010","","224.993  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 30MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.994","SUP","Custom 27803010","","224.994  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 35MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.995","SUP","Custom 27803010","","224.995  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 100MM","BOTH IP/OP","$1,450.00 ","$1,073.00 ","$0.00 ","$1,450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,450.00 ","$0.00 ","$725.00 ","$1,148.40 ","$1,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.996","SUP","Custom 27803010","","224.996  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 120MM","BOTH IP/OP","$1,450.00 ","$1,073.00 ","$0.00 ","$1,450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,450.00 ","$0.00 ","$725.00 ","$1,148.40 ","$1,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.997","SUP","Custom 27803010","","224.997  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 150MM","BOTH IP/OP","$1,450.00 ","$1,073.00 ","$0.00 ","$1,450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,450.00 ","$0.00 ","$725.00 ","$1,148.40 ","$1,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"225.007","SUP","HCPCS C1713","","225.007  -  PLATE BRD 90MM SS 3.5MM SCR 7 HOLE LC DCP BONE ORTH NONSTRL","BOTH IP/OP","$377.43 ","$279.30 ","$0.00 ","$377.43 ","$169.84 ","$0.00 ","$78.66 ","$0.00 ","$0.00 ","$66.08 ","$377.43 ","$0.00 ","$188.71 ","$298.92 ","$301.94 ","$0.00 ","$59.07 ","$0.00 ","$60.09 ","$0.00 "
"225.008","SUP","HCPCS C1713","","225.008  -  PLATE BRD 103MM SS 3.5MM SCR 8 HOLE LC DCP BONE ORTH NONSTRL","BOTH IP/OP","$393.73 ","$291.36 ","$0.00 ","$393.73 ","$177.18 ","$0.00 ","$82.06 ","$0.00 ","$0.00 ","$68.94 ","$393.73 ","$0.00 ","$196.86 ","$311.83 ","$314.98 ","$0.00 ","$61.62 ","$0.00 ","$62.68 ","$0.00 "
"225.009","SUP","HCPCS C1713","","225.009  -  PLATE BRD SS 3.5MM SCR 9 HOLE LCP BONE ORTH NONSTRL","BOTH IP/OP","$412.38 ","$305.16 ","$0.00 ","$412.38 ","$185.57 ","$0.00 ","$85.95 ","$0.00 ","$0.00 ","$72.20 ","$412.38 ","$0.00 ","$206.19 ","$326.60 ","$329.90 ","$0.00 ","$64.54 ","$0.00 ","$65.65 ","$0.00 "
"225.01","SUP","HCPCS C1713","","225.010  -  PLATE BRD 129MM SS 3.5MM SCR 10 HOLE LC DCP BONE ORTH","BOTH IP/OP","$417.05 ","$308.62 ","$0.00 ","$417.05 ","$187.67 ","$0.00 ","$86.92 ","$0.00 ","$0.00 ","$73.02 ","$417.05 ","$0.00 ","$208.53 ","$330.30 ","$333.64 ","$0.00 ","$65.27 ","$0.00 ","$66.39 ","$0.00 "
"225.011","SUP","HCPCS C1713","","225.011  -  PLATE BRD 142MM SS 3.5MM SCR 11 HOLE LC DCP BONE ORTH","BOTH IP/OP","$435.70 ","$322.42 ","$0.00 ","$435.70 ","$196.07 ","$0.00 ","$90.81 ","$0.00 ","$0.00 ","$76.29 ","$435.70 ","$0.00 ","$217.85 ","$345.07 ","$348.56 ","$0.00 ","$68.19 ","$0.00 ","$69.36 ","$0.00 "
"225.012","SUP","HCPCS C1713","","225.012  -  PLATE BRD 155MM SS 3.5MM SCR 12 HOLE LC DCP BONE ORTH","BOTH IP/OP","$465.95 ","$344.80 ","$0.00 ","$465.95 ","$209.68 ","$0.00 ","$97.12 ","$0.00 ","$0.00 ","$81.58 ","$465.95 ","$0.00 ","$232.98 ","$369.03 ","$372.76 ","$0.00 ","$72.92 ","$0.00 ","$74.18 ","$0.00 "
"225.013","SUP","HCPCS C1713","","225.013  -  PLATE BRD 168MM SS 3.5MM SCR 13 HOLE LC DCP BONE ORTH","BOTH IP/OP","$628.05 ","$464.76 ","$0.00 ","$628.05 ","$282.62 ","$0.00 ","$130.90 ","$0.00 ","$0.00 ","$109.97 ","$628.05 ","$0.00 ","$314.03 ","$497.42 ","$502.44 ","$0.00 ","$98.29 ","$0.00 ","$99.99 ","$0.00 "
"225.014","SUP","HCPCS C1713","","225.014  -  PLATE BRD 181MM SS 3.5MM SCR 14 HOLE LC DCP BONE RIGHT","BOTH IP/OP","$709.28 ","$524.87 ","$0.00 ","$709.28 ","$319.17 ","$0.00 ","$147.83 ","$0.00 ","$0.00 ","$124.19 ","$709.28 ","$0.00 ","$354.64 ","$561.75 ","$567.42 ","$0.00 ","$111.00 ","$0.00 ","$112.92 ","$0.00 "
"225.015","SUP","HCPCS C1713","","225.015  -  PLATE BRD 194MM SS 3.5MM SCR 15 HOLE LC DCP BONE ORTH","BOTH IP/OP","$788.35 ","$583.38 ","$0.00 ","$788.35 ","$354.76 ","$0.00 ","$164.31 ","$0.00 ","$0.00 ","$138.03 ","$788.35 ","$0.00 ","$394.18 ","$624.37 ","$630.68 ","$0.00 ","$123.38 ","$0.00 ","$125.51 ","$0.00 "
"225.016","SUP","HCPCS C1713","","225.016  -  PLATE BRD 207MM SS 3.5MM SCR 16 HOLE LC DCP BONE ORTH","BOTH IP/OP","$869.60 ","$643.50 ","$0.00 ","$869.60 ","$391.32 ","$0.00 ","$181.25 ","$0.00 ","$0.00 ","$152.26 ","$869.60 ","$0.00 ","$434.80 ","$688.72 ","$695.68 ","$0.00 ","$136.09 ","$0.00 ","$138.44 ","$0.00 "
"225.017","SUP","HCPCS C1713","","225.017  -  PLATE BRD 220MM SS 3.5MM SCR 17 HOLE LC DCP BONE ORTH","BOTH IP/OP","$948.65 ","$702.00 ","$0.00 ","$948.65 ","$426.89 ","$0.00 ","$197.72 ","$0.00 ","$0.00 ","$166.10 ","$948.65 ","$0.00 ","$474.33 ","$751.33 ","$758.92 ","$0.00 ","$148.46 ","$0.00 ","$151.03 ","$0.00 "
"225.018","SUP","HCPCS C1713","","225.018  -  PLATE BRD 233MM SS 3.5MM SCR 18 HOLE LC DCP BONE ORTH","BOTH IP/OP","$1,029.90 ","$762.13 ","$0.00 ","$1,029.90 ","$463.46 ","$0.00 ","$214.66 ","$0.00 ","$0.00 ","$180.33 ","$1,029.90 ","$0.00 ","$514.95 ","$815.68 ","$823.92 ","$0.00 ","$161.18 ","$0.00 ","$163.96 ","$0.00 "
"225.02","SUP","HCPCS C1713","","225.020  -  PLATE BRD 259MM SS 3.5MM SCR 20 HOLE LC DCP BONE ORTH","BOTH IP/OP","$1,169.53 ","$865.45 ","$0.00 ","$1,169.53 ","$526.29 ","$0.00 ","$243.76 ","$0.00 ","$0.00 ","$204.77 ","$1,169.53 ","$0.00 ","$584.76 ","$926.27 ","$935.62 ","$0.00 ","$183.03 ","$0.00 ","$186.19 ","$0.00 "
"225.022","SUP","HCPCS C1713","","225.022  -  PLATE BRD 285MM SS 3.5MM SCR 22 HOLE LC DCP BONE ORTH","BOTH IP/OP","$1,279.00 ","$946.46 ","$0.00 ","$1,279.00 ","$575.55 ","$0.00 ","$266.58 ","$0.00 ","$0.00 ","$223.94 ","$1,279.00 ","$0.00 ","$639.50 ","$1,012.97 ","$1,023.20 ","$0.00 ","$200.16 ","$0.00 ","$203.62 ","$0.00 "
"226.06","SUP","HCPCS C1713","","226.06  -  PLATE BN BRD 103X16X4.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$416.08 ","$307.90 ","$0.00 ","$403.98 ","$181.79 ","$0.00 ","$86.72 ","$0.00 ","$0.00 ","$70.73 ","$403.98 ","$0.00 ","$201.99 ","$319.95 ","$323.18 ","$0.00 ","$61.38 ","$0.00 ","$64.31 ","$0.00 "
"226.07","SUP","HCPCS C1713","","226.07  -  PLATE BN BRD 119X16X4.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$427.33 ","$316.22 ","$0.00 ","$414.88 ","$186.69 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$72.64 ","$414.88 ","$0.00 ","$207.44 ","$328.58 ","$331.90 ","$0.00 ","$63.04 ","$0.00 ","$66.05 ","$0.00 "
"226.08","SUP","HCPCS C1713","","226.08  -  PLATE BONE BROAD 135X16X4.8MM 8 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$503.60 ","$372.66 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$104.96 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"226.09","SUP","HCPCS C1713","","226.09  -  PLATE BN BRD 151X16X4.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"226.1","SUP","HCPCS C1713","","226.10  -  PLATE BN BRD 167X16X4.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$503.60 ","$372.66 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$104.96 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"226.12","SUP","HCPCS C1713","","226.12  -  PLATE BN BRD 199X16X4.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"226.14","SUP","HCPCS C1713","","226.14  -  PLATE BONE BROAD 231X16X4.8MM 14 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$530.90 ","$392.87 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$110.65 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"226.16","SUP","HCPCS C1713","","226.16  -  PLATE BONE BROAD 4.5MM 263X16X4.8MM 16 HOLE DCP STAINLESS","BOTH IP/OP","$563.13 ","$416.72 ","$0.00 ","$563.13 ","$253.41 ","$0.00 ","$117.37 ","$0.00 ","$0.00 ","$98.60 ","$563.13 ","$0.00 ","$281.56 ","$446.00 ","$450.50 ","$0.00 ","$88.13 ","$0.00 ","$89.65 ","$0.00 "
"226.2","SUP","HCPCS C1713","","226.20  -  PLATE BN BRD 326X16X4.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG","BOTH IP/OP","$918.48 ","$679.68 ","$0.00 ","$918.48 ","$413.31 ","$0.00 ","$191.43 ","$0.00 ","$0.00 ","$160.82 ","$918.48 ","$0.00 ","$459.24 ","$727.44 ","$734.78 ","$0.00 ","$139.55 ","$0.00 ","$146.22 ","$0.00 "
"226.22","SUP","HCPCS C1713","","226.22  -  PLATE BONE BROAD 358MM 22 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$968.58 ","$716.75 ","$0.00 ","$968.58 ","$435.86 ","$0.00 ","$201.88 ","$0.00 ","$0.00 ","$169.59 ","$968.58 ","$0.00 ","$484.29 ","$767.12 ","$774.86 ","$0.00 ","$151.58 ","$0.00 ","$154.20 ","$0.00 "
"226.24","SUP","HCPCS C1713","","226.24  -  PLATE BONE BROAD 390MM 24 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,037.48 ","$767.74 ","$0.00 ","$1,037.48 ","$466.86 ","$0.00 ","$216.24 ","$0.00 ","$0.00 ","$181.65 ","$1,037.48 ","$0.00 ","$518.74 ","$821.68 ","$829.98 ","$0.00 ","$162.36 ","$0.00 ","$165.17 ","$0.00 "
"226.56","SUP","HCPCS C1713","","226.56  -  PLATE BN BRD 106X17.5X5.2MM NS LC DCP 6 HL SS 4.5MM SCR LG","BOTH IP/OP","$489.18 ","$361.99 ","$0.00 ","$474.93 ","$213.72 ","$0.00 ","$101.96 ","$0.00 ","$0.00 ","$83.16 ","$474.93 ","$0.00 ","$237.46 ","$376.14 ","$379.94 ","$0.00 ","$72.16 ","$0.00 ","$75.61 ","$0.00 "
"226.561","SUP","HCPCS C1713","","226.561  -  PLATE BN BRD 116X17.5X5.2MM NS LCP CMBN 6 HL LMT CNTCT TPR","BOTH IP/OP","$784.38 ","$580.44 ","$0.00 ","$761.53 ","$342.69 ","$0.00 ","$163.48 ","$0.00 ","$0.00 ","$133.34 ","$761.53 ","$0.00 ","$380.76 ","$603.13 ","$609.22 ","$0.00 ","$115.71 ","$0.00 ","$121.23 ","$0.00 "
"226.57","SUP","HCPCS C1713","","226.57  -  PLATE BN BRD 124X17.5X5.2MM NS LC DCP 7 HL SS 4.5MM SCR LG","BOTH IP/OP","$529.95 ","$392.16 ","$0.00 ","$514.50 ","$231.53 ","$0.00 ","$110.45 ","$0.00 ","$0.00 ","$90.08 ","$514.50 ","$0.00 ","$257.25 ","$407.48 ","$411.60 ","$0.00 ","$78.18 ","$0.00 ","$81.91 ","$0.00 "
"226.571","SUP","HCPCS C1713","","226.571  -  PLATE BN BRD 134MM NS LCP CMBN 7 HL SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$833.58 ","$616.85 ","$0.00 ","$809.30 ","$364.19 ","$0.00 ","$173.74 ","$0.00 ","$0.00 ","$141.70 ","$809.30 ","$0.00 ","$404.65 ","$640.97 ","$647.44 ","$0.00 ","$122.97 ","$0.00 ","$128.84 ","$0.00 "
"226.58","SUP","HCPCS C1713","","226.58  -  PLATE BN BRD 142X17.5X5.2MM NS LC DCP 8 HL SS 4.5MM SCR LG","BOTH IP/OP","$588.98 ","$435.85 ","$0.00 ","$571.83 ","$257.32 ","$0.00 ","$122.76 ","$0.00 ","$0.00 ","$100.12 ","$571.83 ","$0.00 ","$285.91 ","$452.89 ","$457.46 ","$0.00 ","$86.88 ","$0.00 ","$91.03 ","$0.00 "
"226.581","SUP","HCPCS C1713","","226.581  -  PLATE BN BRD 152MM NS LCP CMBN 8 HL SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"226.59","SUP","HCPCS C1713","","226.59  -  PLATE BN BRD 160X17.5X5.2MM NS LC DCP 9 HL SS 4.5MM SCR LG","BOTH IP/OP","$588.98 ","$435.85 ","$0.00 ","$571.83 ","$257.32 ","$0.00 ","$122.76 ","$0.00 ","$0.00 ","$100.12 ","$571.83 ","$0.00 ","$285.91 ","$452.89 ","$457.46 ","$0.00 ","$86.88 ","$0.00 ","$91.03 ","$0.00 "
"226.591","SUP","HCPCS C1713","","226.591  -  PLATE BN BRD 170X17.5X5.2MM NS LCP CMBN 9 HL LMT CNTCT TPR","BOTH IP/OP","$1,102.08 ","$815.54 ","$0.00 ","$1,069.98 ","$481.49 ","$0.00 ","$229.70 ","$0.00 ","$0.00 ","$187.34 ","$1,069.98 ","$0.00 ","$534.99 ","$847.42 ","$855.98 ","$0.00 ","$162.57 ","$0.00 ","$170.34 ","$0.00 "
"226.6","SUP","HCPCS C1713","","226.60  -  PLATE BN BRD 178X17.5X5.2MM NS LC DCP 10 HL SS 4.5MM SCR LG","BOTH IP/OP","$571.83 ","$423.15 ","$0.00 ","$571.83 ","$257.32 ","$0.00 ","$119.18 ","$0.00 ","$0.00 ","$100.12 ","$571.83 ","$0.00 ","$285.91 ","$452.89 ","$457.46 ","$0.00 ","$86.88 ","$0.00 ","$91.03 ","$0.00 "
"226.601","SUP","HCPCS C1713","","226.601  -  PLATE BN BRD 188X17.5X5.2MM NS LCP CMBN 10 HL LMT CNTCT TPR","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"226.61","SUP","HCPCS C1713","","226.61  -  PLATE BN BRD 196X17.5X5.2MM NS LC DCP 11 HL SS 4.5MM SCR LG","BOTH IP/OP","$632.55 ","$468.09 ","$0.00 ","$614.15 ","$276.37 ","$0.00 ","$131.84 ","$0.00 ","$0.00 ","$107.53 ","$614.15 ","$0.00 ","$307.08 ","$486.41 ","$491.32 ","$0.00 ","$93.31 ","$0.00 ","$97.77 ","$0.00 "
"226.611","SUP","HCPCS C1713","","226.611  -  PLATE BN BRD 206X17.5X5.2MM NS LCP CMBN 11 HL LMT CNTCT TPR","BOTH IP/OP","$1,262.30 ","$934.10 ","$0.00 ","$1,225.55 ","$551.50 ","$0.00 ","$263.09 ","$0.00 ","$0.00 ","$214.58 ","$1,225.55 ","$0.00 ","$612.78 ","$970.64 ","$980.44 ","$0.00 ","$186.21 ","$0.00 ","$195.11 ","$0.00 "
"226.62","SUP","HCPCS C1713","","226.62  -  PLATE BN BRD 214X17.5X5.2MM NS LC DCP 12 HL SS 4.5MM SCR LG","BOTH IP/OP","$632.55 ","$468.09 ","$0.00 ","$614.15 ","$276.37 ","$0.00 ","$131.84 ","$0.00 ","$0.00 ","$107.53 ","$614.15 ","$0.00 ","$307.08 ","$486.41 ","$491.32 ","$0.00 ","$93.31 ","$0.00 ","$97.77 ","$0.00 "
"226.621","SUP","HCPCS C1713","","226.621  -  PLATE BN BRD 224X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT TPR","BOTH IP/OP","$1,339.63 ","$991.33 ","$0.00 ","$1,300.60 ","$585.27 ","$0.00 ","$279.21 ","$0.00 ","$0.00 ","$227.72 ","$1,300.60 ","$0.00 ","$650.30 ","$1,030.08 ","$1,040.48 ","$0.00 ","$197.62 ","$0.00 ","$207.06 ","$0.00 "
"226.622","SUP","HCPCS C1713","","226.622  -  PLATE BN BRD CRV 229X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT","BOTH IP/OP","$1,339.63 ","$991.33 ","$0.00 ","$1,300.60 ","$585.27 ","$0.00 ","$279.21 ","$0.00 ","$0.00 ","$227.72 ","$1,300.60 ","$0.00 ","$650.30 ","$1,030.08 ","$1,040.48 ","$0.00 ","$197.62 ","$0.00 ","$207.06 ","$0.00 "
"226.632","SUP","HCPCS C1713","","226.632  -  PLATE BONE BROAD CURVE 247MM 13 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$1,419.75 ","$1,050.62 ","$0.00 ","$1,378.40 ","$620.28 ","$0.00 ","$295.91 ","$0.00 ","$0.00 ","$241.35 ","$1,378.40 ","$0.00 ","$689.20 ","$1,091.69 ","$1,102.72 ","$0.00 ","$209.44 ","$0.00 ","$219.44 ","$0.00 "
"226.64","SUP","HCPCS C1713","","226.64  -  PLATE BN BRD 250X17.5X5.2MM NS LC DCP 14 HL SS 4.5MM SCR LG","BOTH IP/OP","$632.55 ","$468.09 ","$0.00 ","$614.15 ","$276.37 ","$0.00 ","$131.84 ","$0.00 ","$0.00 ","$107.53 ","$614.15 ","$0.00 ","$307.08 ","$486.41 ","$491.32 ","$0.00 ","$93.31 ","$0.00 ","$97.77 ","$0.00 "
"226.641","SUP","HCPCS C1713","","226.641  -  PLATE BN BRD 260X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT TPR","BOTH IP/OP","$1,491.45 ","$1,103.67 ","$0.00 ","$1,448.00 ","$651.60 ","$0.00 ","$310.86 ","$0.00 ","$0.00 ","$253.53 ","$1,448.00 ","$0.00 ","$724.00 ","$1,146.82 ","$1,158.40 ","$0.00 ","$220.01 ","$0.00 ","$230.52 ","$0.00 "
"226.642","SUP","HCPCS C1713","","226.642  -  PLATE BN BRD CRV 265X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT","BOTH IP/OP","$1,491.45 ","$1,103.67 ","$0.00 ","$1,448.00 ","$651.60 ","$0.00 ","$310.86 ","$0.00 ","$0.00 ","$253.53 ","$1,448.00 ","$0.00 ","$724.00 ","$1,146.82 ","$1,158.40 ","$0.00 ","$220.01 ","$0.00 ","$230.52 ","$0.00 "
"226.652","SUP","HCPCS C1713","","226.652  -  PLATE BONE BROAD CURVE 282MM 15 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$1,655.90 ","$1,225.37 ","$0.00 ","$1,607.68 ","$723.45 ","$0.00 ","$345.13 ","$0.00 ","$0.00 ","$281.49 ","$1,607.68 ","$0.00 ","$803.84 ","$1,273.28 ","$1,286.14 ","$0.00 ","$244.27 ","$0.00 ","$255.94 ","$0.00 "
"226.66","SUP","HCPCS C1713","","226.66  -  PLATE BN BRD 286X17.5X5.2MM NS LC DCP 16 HL SS 4.5MM SCR LG","BOTH IP/OP","$718.30 ","$531.54 ","$0.00 ","$697.38 ","$313.82 ","$0.00 ","$149.71 ","$0.00 ","$0.00 ","$122.10 ","$697.38 ","$0.00 ","$348.69 ","$552.32 ","$557.90 ","$0.00 ","$105.96 ","$0.00 ","$111.02 ","$0.00 "
"226.661","SUP","HCPCS C1713","","226.661  -  PLATE BN BRD 296X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT TPR","BOTH IP/OP","$1,811.95 ","$1,340.84 ","$0.00 ","$1,759.18 ","$791.63 ","$0.00 ","$377.66 ","$0.00 ","$0.00 ","$308.02 ","$1,759.18 ","$0.00 ","$879.59 ","$1,393.27 ","$1,407.34 ","$0.00 ","$267.29 ","$0.00 ","$280.06 ","$0.00 "
"226.662","SUP","HCPCS C1713","","226.662  -  PLATE BN BRD CRV 300X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT","BOTH IP/OP","$1,811.95 ","$1,340.84 ","$0.00 ","$1,759.18 ","$791.63 ","$0.00 ","$377.66 ","$0.00 ","$0.00 ","$308.02 ","$1,759.18 ","$0.00 ","$879.59 ","$1,393.27 ","$1,407.34 ","$0.00 ","$267.29 ","$0.00 ","$280.06 ","$0.00 "
"226.672","SUP","HCPCS C1713","","226.672  -  PLATE BONE BROAD CURVE 318MM 17 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$1,897.68 ","$1,404.28 ","$0.00 ","$1,842.43 ","$829.09 ","$0.00 ","$395.52 ","$0.00 ","$0.00 ","$322.59 ","$1,842.43 ","$0.00 ","$921.21 ","$1,459.20 ","$1,473.94 ","$0.00 ","$279.94 ","$0.00 ","$293.31 ","$0.00 "
"226.68","SUP","HCPCS C1713","","226.68  -  PLATE BN BRD 332X17.5X5.2MM NS LC DCP 18 HL SS 4.5MM SCR LG","BOTH IP/OP","$788.83 ","$583.73 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$164.41 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"226.681","SUP","HCPCS C1713","","226.681  -  PLATE BONE BROAD 332X17.5X5.2MM 18 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"226.682","SUP","HCPCS C1713","","226.682  -  PLATE BN BRD CRV 336X17.5X5.2MM NS LCP CMBN 18 HL LMT CNTCT","BOTH IP/OP","$2,067.78 ","$1,530.16 ","$0.00 ","$2,007.55 ","$903.40 ","$0.00 ","$430.98 ","$0.00 ","$0.00 ","$351.51 ","$2,007.55 ","$0.00 ","$1,003.78 ","$1,589.98 ","$1,606.04 ","$0.00 ","$305.03 ","$0.00 ","$319.60 ","$0.00 "
"226.7","SUP","HCPCS C1713","","226.70  -  PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP STAINLESS","BOTH IP/OP","$1,155.95 ","$855.40 ","$0.00 ","$1,155.95 ","$520.18 ","$0.00 ","$240.93 ","$0.00 ","$0.00 ","$202.40 ","$1,155.95 ","$0.00 ","$577.98 ","$915.51 ","$924.76 ","$0.00 ","$175.64 ","$0.00 ","$184.03 ","$0.00 "
"226.701","SUP","HCPCS C1713","","226.701  -  PLATE BONE BROAD 368MM 20 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,436.08 ","$1,802.70 ","$0.00 ","$2,365.10 ","$1,064.30 ","$0.00 ","$507.74 ","$0.00 ","$0.00 ","$414.11 ","$2,365.10 ","$0.00 ","$1,182.55 ","$1,873.16 ","$1,892.08 ","$0.00 ","$359.36 ","$0.00 ","$376.52 ","$0.00 "
"226.72","SUP","HCPCS C1713","","226.72  -  PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP STAINLESS","BOTH IP/OP","$1,209.73 ","$895.20 ","$0.00 ","$1,209.73 ","$544.38 ","$0.00 ","$252.14 ","$0.00 ","$0.00 ","$211.81 ","$1,209.73 ","$0.00 ","$604.86 ","$958.11 ","$967.78 ","$0.00 ","$189.32 ","$0.00 ","$192.59 ","$0.00 "
"226.721","SUP","HCPCS C1713","","226.721  -  PLATE BONE BROAD 404MM 22 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,669.40 ","$1,975.36 ","$0.00 ","$2,591.65 ","$1,166.24 ","$0.00 ","$556.37 ","$0.00 ","$0.00 ","$453.78 ","$2,591.65 ","$0.00 ","$1,295.83 ","$2,052.59 ","$2,073.32 ","$0.00 ","$393.78 ","$0.00 ","$412.59 ","$0.00 "
"227.11","SUP","HCPCS C1713","","227.11  -  PLATE BONE BROAD 179MM 10 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$695.63 ","$514.77 ","$0.00 ","$695.63 ","$313.03 ","$0.00 ","$144.99 ","$0.00 ","$0.00 ","$121.80 ","$695.63 ","$0.00 ","$347.81 ","$550.94 ","$556.50 ","$0.00 ","$108.87 ","$0.00 ","$110.74 ","$0.00 "
"227.13","SUP","HCPCS C1713","","227.13  -  PLATE BONE BROAD 199MM 10 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$777.78 ","$575.56 ","$0.00 ","$777.78 ","$350.00 ","$0.00 ","$162.11 ","$0.00 ","$0.00 ","$136.18 ","$777.78 ","$0.00 ","$388.89 ","$616.00 ","$622.22 ","$0.00 ","$121.72 ","$0.00 ","$123.82 ","$0.00 "
"227.14","SUP","HCPCS C1713","","227.14  -  PLATE BONE BROAD 209MM 10 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$777.78 ","$575.56 ","$0.00 ","$777.78 ","$350.00 ","$0.00 ","$162.11 ","$0.00 ","$0.00 ","$136.18 ","$777.78 ","$0.00 ","$388.89 ","$616.00 ","$622.22 ","$0.00 ","$121.72 ","$0.00 ","$123.82 ","$0.00 "
"227.18","SUP","HCPCS C1713","","227.18  -  PLATE BONE BROAD 249MM 10 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$809.58 ","$599.09 ","$0.00 ","$809.58 ","$364.31 ","$0.00 ","$168.74 ","$0.00 ","$0.00 ","$141.75 ","$809.58 ","$0.00 ","$404.79 ","$641.19 ","$647.66 ","$0.00 ","$126.70 ","$0.00 ","$128.88 ","$0.00 "
"227.81","SUP","HCPCS C1713","","227.81  -  PLATE BONE BROAD 135MM 8 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$674.43 ","$499.08 ","$0.00 ","$674.43 ","$303.49 ","$0.00 ","$140.57 ","$0.00 ","$0.00 ","$118.09 ","$674.43 ","$0.00 ","$337.21 ","$534.15 ","$539.54 ","$0.00 ","$105.55 ","$0.00 ","$107.37 ","$0.00 "
"227.83","SUP","HCPCS C1713","","227.83  -  PLATE BONE BROAD 155MM 8 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$674.43 ","$499.08 ","$0.00 ","$674.43 ","$303.49 ","$0.00 ","$140.57 ","$0.00 ","$0.00 ","$118.09 ","$674.43 ","$0.00 ","$337.21 ","$534.15 ","$539.54 ","$0.00 ","$105.55 ","$0.00 ","$107.37 ","$0.00 "
"227.84","SUP","HCPCS C1713","","227.84  -  PLATE BONE BROAD 185MM 8 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$674.43 ","$499.08 ","$0.00 ","$674.43 ","$303.49 ","$0.00 ","$140.57 ","$0.00 ","$0.00 ","$118.09 ","$674.43 ","$0.00 ","$337.21 ","$534.15 ","$539.54 ","$0.00 ","$105.55 ","$0.00 ","$107.37 ","$0.00 "
"228.85","SUP","HCPCS C1713","","228.85  -  PLATE BONE NARROW 175MM 8 HOLE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$502.18 ","$371.61 ","$0.00 ","$502.18 ","$225.98 ","$0.00 ","$104.67 ","$0.00 ","$0.00 ","$87.93 ","$502.18 ","$0.00 ","$251.09 ","$397.73 ","$401.74 ","$0.00 ","$78.59 ","$0.00 ","$79.95 ","$0.00 "
"229.33","SUP","HCPCS C1713","","229.33  -  PLATE BN STRG 45X12X3MM NS LC DCP 3 HL RECON SS 4.5MM CORT","BOTH IP/OP","$671.93 ","$497.23 ","$0.00 ","$652.35 ","$293.56 ","$0.00 ","$140.05 ","$0.00 ","$0.00 ","$114.22 ","$652.35 ","$0.00 ","$326.18 ","$516.66 ","$521.88 ","$0.00 ","$99.12 ","$0.00 ","$103.85 ","$0.00 "
"229.331","SUP","HCPCS C1713","","229.331  -  PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$802.65 ","$593.96 ","$0.00 ","$779.28 ","$350.67 ","$0.00 ","$167.29 ","$0.00 ","$0.00 ","$136.44 ","$779.28 ","$0.00 ","$389.64 ","$617.19 ","$623.42 ","$0.00 ","$118.40 ","$0.00 ","$124.06 ","$0.00 "
"229.34","SUP","HCPCS C1713","","229.34  -  PLATE BN STRG 61X12X3MM NS LC DCP 4 HL RECON SS 4.5MM CORT","BOTH IP/OP","$700.03 ","$518.02 ","$0.00 ","$679.65 ","$305.84 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$119.00 ","$679.65 ","$0.00 ","$339.83 ","$538.28 ","$543.72 ","$0.00 ","$103.27 ","$0.00 ","$108.20 ","$0.00 "
"229.341","SUP","HCPCS C1713","","229.341  -  PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$840.60 ","$622.04 ","$0.00 ","$816.13 ","$367.26 ","$0.00 ","$175.20 ","$0.00 ","$0.00 ","$142.90 ","$816.13 ","$0.00 ","$408.06 ","$646.37 ","$652.90 ","$0.00 ","$124.00 ","$0.00 ","$129.93 ","$0.00 "
"229.35","SUP","HCPCS C1713","","229.35  -  PLATE BONE STR 77X12X3MM 5 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$761.88 ","$563.79 ","$0.00 ","$739.70 ","$332.87 ","$0.00 ","$158.79 ","$0.00 ","$0.00 ","$129.52 ","$739.70 ","$0.00 ","$369.85 ","$585.84 ","$591.76 ","$0.00 ","$112.39 ","$0.00 ","$117.76 ","$0.00 "
"229.351","SUP","HCPCS C1713","","229.351  -  PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$908.08 ","$671.98 ","$0.00 ","$881.63 ","$396.73 ","$0.00 ","$189.27 ","$0.00 ","$0.00 ","$154.37 ","$881.63 ","$0.00 ","$440.81 ","$698.25 ","$705.30 ","$0.00 ","$133.96 ","$0.00 ","$140.35 ","$0.00 "
"229.36","SUP","HCPCS C1713","","229.36  -  PLATE BN 93X12X3MM NS LC DCP 6 HL RECON SS 4.5MM SCR","BOTH IP/OP","$808.28 ","$598.13 ","$0.00 ","$784.73 ","$353.13 ","$0.00 ","$168.46 ","$0.00 ","$0.00 ","$137.40 ","$784.73 ","$0.00 ","$392.36 ","$621.51 ","$627.78 ","$0.00 ","$119.23 ","$0.00 ","$124.93 ","$0.00 "
"229.361","SUP","HCPCS C1713","","229.361  -  PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$969.93 ","$717.75 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$202.16 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"229.37","SUP","HCPCS C1713","","229.37  -  PLATE BONE STR 109X12X3MM 7 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$844.83 ","$625.17 ","$0.00 ","$820.23 ","$369.10 ","$0.00 ","$176.08 ","$0.00 ","$0.00 ","$143.61 ","$820.23 ","$0.00 ","$410.11 ","$649.62 ","$656.18 ","$0.00 ","$124.62 ","$0.00 ","$130.58 ","$0.00 "
"229.371","SUP","HCPCS C1713","","229.371  -  PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,014.90 ","$751.03 ","$0.00 ","$985.35 ","$443.41 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$172.53 ","$985.35 ","$0.00 ","$492.68 ","$780.40 ","$788.28 ","$0.00 ","$149.72 ","$0.00 ","$156.87 ","$0.00 "
"229.38","SUP","HCPCS C1713","","229.38  -  PLATE BN STRG 125X12X3MM NS LC DCP 8 HL RECON SS 4.5MM CORT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"229.381","SUP","HCPCS C1713","","229.381  -  PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,066.93 ","$789.53 ","$0.00 ","$1,035.85 ","$466.13 ","$0.00 ","$222.37 ","$0.00 ","$0.00 ","$181.37 ","$1,035.85 ","$0.00 ","$517.93 ","$820.39 ","$828.68 ","$0.00 ","$157.39 ","$0.00 ","$164.91 ","$0.00 "
"229.39","SUP","HCPCS C1713","","229.39  -  PLATE BONE STR 141X12X3MM 9 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$954.48 ","$706.32 ","$0.00 ","$926.68 ","$417.00 ","$0.00 ","$198.94 ","$0.00 ","$0.00 ","$162.25 ","$926.68 ","$0.00 ","$463.34 ","$733.93 ","$741.34 ","$0.00 ","$140.80 ","$0.00 ","$147.53 ","$0.00 "
"229.391","SUP","HCPCS C1713","","229.391  -  PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,142.83 ","$845.69 ","$0.00 ","$1,109.55 ","$499.30 ","$0.00 ","$238.19 ","$0.00 ","$0.00 ","$194.27 ","$1,109.55 ","$0.00 ","$554.78 ","$878.76 ","$887.64 ","$0.00 ","$168.59 ","$0.00 ","$176.64 ","$0.00 "
"229.4","SUP","HCPCS C1713","","229.40  -  PLATE BN 157MM NS LC DCP 10 HL RECON 4.5MM SCR","BOTH IP/OP","$970.33 ","$718.04 ","$0.00 ","$970.33 ","$436.65 ","$0.00 ","$202.24 ","$0.00 ","$0.00 ","$169.90 ","$970.33 ","$0.00 ","$485.16 ","$768.50 ","$776.26 ","$0.00 ","$147.43 ","$0.00 ","$154.48 ","$0.00 "
"229.401","SUP","HCPCS C1713","","229.401  -  PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,197.65 ","$886.26 ","$0.00 ","$1,162.78 ","$523.25 ","$0.00 ","$249.62 ","$0.00 ","$0.00 ","$203.59 ","$1,162.78 ","$0.00 ","$581.39 ","$920.92 ","$930.22 ","$0.00 ","$176.67 ","$0.00 ","$185.11 ","$0.00 "
"229.41","SUP","HCPCS C1713","","229.41  -  PLATE BONE 173MM 11 HOLE STR RECONSTRUCTION LC-DCP DCP","BOTH IP/OP","$1,034.60 ","$765.60 ","$0.00 ","$1,004.45 ","$452.00 ","$0.00 ","$215.64 ","$0.00 ","$0.00 ","$175.87 ","$1,004.45 ","$0.00 ","$502.23 ","$795.52 ","$803.56 ","$0.00 ","$152.62 ","$0.00 ","$159.91 ","$0.00 "
"229.411","SUP","HCPCS C1713","","229.411  -  PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,200.98 ","$540.44 ","$0.00 ","$257.82 ","$0.00 ","$0.00 ","$210.28 ","$1,200.98 ","$0.00 ","$600.49 ","$951.18 ","$960.78 ","$0.00 ","$182.48 ","$0.00 ","$191.20 ","$0.00 "
"229.42","SUP","HCPCS C1713","","229.42  -  PLATE BONE STR 189X12X3MM 12 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$1,082.38 ","$800.96 ","$0.00 ","$1,050.85 ","$472.88 ","$0.00 ","$225.59 ","$0.00 ","$0.00 ","$184.00 ","$1,050.85 ","$0.00 ","$525.43 ","$832.27 ","$840.68 ","$0.00 ","$159.67 ","$0.00 ","$167.30 ","$0.00 "
"229.421","SUP","HCPCS C1713","","229.421  -  PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"229.43","SUP","HCPCS C1713","","229.43  -  PLATE BONE STR 205X12X3MM 13 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$1,152.68 ","$852.98 ","$0.00 ","$1,119.10 ","$503.60 ","$0.00 ","$240.25 ","$0.00 ","$0.00 ","$195.95 ","$1,119.10 ","$0.00 ","$559.55 ","$886.33 ","$895.28 ","$0.00 ","$170.04 ","$0.00 ","$178.16 ","$0.00 "
"229.431","SUP","HCPCS C1713","","229.431  -  PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,378.98 ","$1,020.45 ","$0.00 ","$1,338.83 ","$602.47 ","$0.00 ","$287.41 ","$0.00 ","$0.00 ","$234.42 ","$1,338.83 ","$0.00 ","$669.41 ","$1,060.35 ","$1,071.06 ","$0.00 ","$203.42 ","$0.00 ","$213.14 ","$0.00 "
"229.44","SUP","HCPCS C1713","","229.44  -  PLATE BONE 221MM 14 HOLE RECONSTRUCTION DCP LC-DCP STAINLESS","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"229.441","SUP","HCPCS C1713","","229.441  -  PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,416.95 ","$1,048.54 ","$0.00 ","$1,375.68 ","$619.05 ","$0.00 ","$295.33 ","$0.00 ","$0.00 ","$240.87 ","$1,375.68 ","$0.00 ","$687.84 ","$1,089.54 ","$1,100.54 ","$0.00 ","$209.02 ","$0.00 ","$219.01 ","$0.00 "
"229.451","SUP","HCPCS C1713","","229.451  -  PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,475.98 ","$1,092.23 ","$0.00 ","$1,433.00 ","$644.85 ","$0.00 ","$307.63 ","$0.00 ","$0.00 ","$250.91 ","$1,433.00 ","$0.00 ","$716.50 ","$1,134.94 ","$1,146.40 ","$0.00 ","$217.73 ","$0.00 ","$228.13 ","$0.00 "
"229.461","SUP","HCPCS C1713","","229.461  -  PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,515.33 ","$1,121.34 ","$0.00 ","$1,471.20 ","$662.04 ","$0.00 ","$315.83 ","$0.00 ","$0.00 ","$257.60 ","$1,471.20 ","$0.00 ","$735.60 ","$1,165.19 ","$1,176.96 ","$0.00 ","$223.54 ","$0.00 ","$234.22 ","$0.00 "
"231.001","SUP","Custom 27203010","","231.001  -  STAINLESS STEEL, DUAL STAPLE, SMALL, ROSTRAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.002","SUP","Custom 27203010","","231.002  -  STAINLESS STEEL, DUAL STAPLE, SMALL, CAUDAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.003","SUP","Custom 27203010","","231.003  -  STAINLESS STEEL, DUAL STAPLE, MEDIUM, ROSTRAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.004","SUP","Custom 27203010","","231.004  -  STAINLESS STEEL, DUAL STAPLE, MEDIUM, CAUDAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.005","SUP","Custom 27203010","","231.005  -  STAINLESS STEEL, DUAL STAPLE, LARGE, ROSTRAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.006","SUP","Custom 27203010","","231.006  -  STAINLESS STEEL, DUAL STAPLE, LARGE, CAUDAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.007","SUP","Custom 27203010","","231.007  -  STAINLESS STEEL, DUAL STAPLE, X-LARGE, ROSTRAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.008","SUP","Custom 27203010","","231.008  -  STAINLESS STEEL, DUAL STAPLE, X-LARGE, CAUDAL","BOTH IP/OP","$2,522.50 ","$1,866.65 ","$0.00 ","$2,522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,522.50 ","$0.00 ","$1,261.25 ","$1,997.82 ","$2,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.011","SUP","Custom 27203010","","231.011  -  STAINLESS STEEL SINGLE STAPLE, SMALL","BOTH IP/OP","$1,822.50 ","$1,348.65 ","$0.00 ","$1,822.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,822.50 ","$0.00 ","$911.25 ","$1,443.42 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.012","SUP","Custom 27203010","","231.012  -  STAINLESS STEEL SINGLE STAPLE, MEDIUM","BOTH IP/OP","$1,822.50 ","$1,348.65 ","$0.00 ","$1,822.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,822.50 ","$0.00 ","$911.25 ","$1,443.42 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.013","SUP","Custom 27203010","","231.013  -  STAINLESS STEEL SINGLE STAPLE, LARGE","BOTH IP/OP","$1,822.50 ","$1,348.65 ","$0.00 ","$1,822.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,822.50 ","$0.00 ","$911.25 ","$1,443.42 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.113","SUP","Custom 27803010","","231.113  -  STAINLESS STEEL CROSS CONNECTOR, 13MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.114","SUP","Custom 27803010","","231.114  -  STAINLESS STEEL CROSS CONNECTOR, 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.115","SUP","Custom 27803010","","231.115  -  STAINLESS STEEL CROSS CONNECTOR, 15MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.116","SUP","Custom 27803010","","231.116  -  STAINLESS STEEL CROSS CONNECTOR, 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.117","SUP","Custom 27803010","","231.117  -  STAINLESS STEEL CROSS CONNECTOR, 17MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.118","SUP","Custom 27803010","","231.118  -  STAINLESS STEEL CROSS CONNECTOR, 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.119","SUP","Custom 27803010","","231.119  -  STAINLESS STEEL CROSS CONNECTOR, 19MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.12","SUP","Custom 27803010","","231.120  -  STAINLESS STEEL CROSS CONNECTOR, 20MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231.201","SUP","HCPCS C1713","","231.201  -  STAINLESS STEEL WASHER, SMALL","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"231.202","SUP","HCPCS C1713","","231.202  -  STAINLESS STEEL WASHER, MEDIUM","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"231.203","SUP","HCPCS C1713","","231.203  -  STAINLESS STEEL WASHER, LARGE","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"232.006","SUP","HCPCS C1713","","232.006  -  PLATE BONE 90D 132MM 30X9.2MM 10 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,876.20 ","$1,388.39 ","$0.00 ","$1,876.20 ","$844.29 ","$0.00 ","$391.05 ","$0.00 ","$0.00 ","$328.51 ","$1,876.20 ","$0.00 ","$938.10 ","$1,485.95 ","$1,500.96 ","$0.00 ","$293.63 ","$0.00 ","$298.69 ","$0.00 "
"232.007","SUP","HCPCS C1713","","232.007  -  PLATE BONE 90D 132MM 35X9.2MM 10 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,876.20 ","$1,388.39 ","$0.00 ","$1,876.20 ","$844.29 ","$0.00 ","$391.05 ","$0.00 ","$0.00 ","$328.51 ","$1,876.20 ","$0.00 ","$938.10 ","$1,485.95 ","$1,500.96 ","$0.00 ","$293.63 ","$0.00 ","$298.69 ","$0.00 "
"232.008","SUP","HCPCS C1713","","232.008  -  PLATE BONE 90D 132MM 40X9.2MM 10 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,876.20 ","$1,388.39 ","$0.00 ","$1,876.20 ","$844.29 ","$0.00 ","$391.05 ","$0.00 ","$0.00 ","$328.51 ","$1,876.20 ","$0.00 ","$938.10 ","$1,485.95 ","$1,500.96 ","$0.00 ","$293.63 ","$0.00 ","$298.69 ","$0.00 "
"232.009","SUP","HCPCS C1713","","232.009  -  PLATE BONE 90D 132MM 45X9.2MM 10 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,876.20 ","$1,388.39 ","$0.00 ","$1,876.20 ","$844.29 ","$0.00 ","$391.05 ","$0.00 ","$0.00 ","$328.51 ","$1,876.20 ","$0.00 ","$938.10 ","$1,485.95 ","$1,500.96 ","$0.00 ","$293.63 ","$0.00 ","$298.69 ","$0.00 "
"232.046","SUP","HCPCS C1713","","232.046  -  PLATE BONE 90D 54MM 30X9.2MM 4 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,495.93 ","$1,106.99 ","$0.00 ","$1,495.93 ","$673.17 ","$0.00 ","$311.79 ","$0.00 ","$0.00 ","$261.92 ","$1,495.93 ","$0.00 ","$747.96 ","$1,184.78 ","$1,196.74 ","$0.00 ","$234.11 ","$0.00 ","$238.15 ","$0.00 "
"232.047","SUP","HCPCS C1713","","232.047  -  PLATE BONE 90D 54MM 35X9.2MM 4 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,495.93 ","$1,106.99 ","$0.00 ","$1,495.93 ","$673.17 ","$0.00 ","$311.79 ","$0.00 ","$0.00 ","$261.92 ","$1,495.93 ","$0.00 ","$747.96 ","$1,184.78 ","$1,196.74 ","$0.00 ","$234.11 ","$0.00 ","$238.15 ","$0.00 "
"232.048","SUP","HCPCS C1713","","232.048  -  PLATE BN 90D 40X9.2MM NS 4 HL LMT CNTCT ANG BLDE CNN SS 3.5","BOTH IP/OP","$1,495.93 ","$1,106.99 ","$0.00 ","$1,495.93 ","$673.17 ","$0.00 ","$311.79 ","$0.00 ","$0.00 ","$261.92 ","$1,495.93 ","$0.00 ","$747.96 ","$1,184.78 ","$1,196.74 ","$0.00 ","$234.11 ","$0.00 ","$238.15 ","$0.00 "
"232.049","SUP","HCPCS C1713","","232.049  -  PLATE BONE 90D 54MM 45X9.2MM 4 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,495.93 ","$1,106.99 ","$0.00 ","$1,495.93 ","$673.17 ","$0.00 ","$311.79 ","$0.00 ","$0.00 ","$261.92 ","$1,495.93 ","$0.00 ","$747.96 ","$1,184.78 ","$1,196.74 ","$0.00 ","$234.11 ","$0.00 ","$238.15 ","$0.00 "
"232.056","SUP","HCPCS C1713","","232.056  -  PLATE BONE 90D 67MM 30X9.2MM 5 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,582.05 ","$1,170.72 ","$0.00 ","$1,582.05 ","$711.92 ","$0.00 ","$329.74 ","$0.00 ","$0.00 ","$277.00 ","$1,582.05 ","$0.00 ","$791.03 ","$1,252.98 ","$1,265.64 ","$0.00 ","$247.59 ","$0.00 ","$251.86 ","$0.00 "
"232.057","SUP","HCPCS C1713","","232.057  -  PLATE BONE 90D 67MM 35X9.2MM 5 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,582.05 ","$1,170.72 ","$0.00 ","$1,582.05 ","$711.92 ","$0.00 ","$329.74 ","$0.00 ","$0.00 ","$277.00 ","$1,582.05 ","$0.00 ","$791.03 ","$1,252.98 ","$1,265.64 ","$0.00 ","$247.59 ","$0.00 ","$251.86 ","$0.00 "
"232.058","SUP","HCPCS C1713","","232.058  -  PLATE BONE 90D 67MM 40X9.2MM 5 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,582.05 ","$1,170.72 ","$0.00 ","$1,582.05 ","$711.92 ","$0.00 ","$329.74 ","$0.00 ","$0.00 ","$277.00 ","$1,582.05 ","$0.00 ","$791.03 ","$1,252.98 ","$1,265.64 ","$0.00 ","$247.59 ","$0.00 ","$251.86 ","$0.00 "
"232.059","SUP","HCPCS C1713","","232.059  -  PLATE BONE 90D 67MM 45X9.2MM 5 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,582.05 ","$1,170.72 ","$0.00 ","$1,582.05 ","$711.92 ","$0.00 ","$329.74 ","$0.00 ","$0.00 ","$277.00 ","$1,582.05 ","$0.00 ","$791.03 ","$1,252.98 ","$1,265.64 ","$0.00 ","$247.59 ","$0.00 ","$251.86 ","$0.00 "
"232.066","SUP","HCPCS C1713","","232.066  -  PLATE BONE 90D 80MM 30X9.2MM 6 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,649.63 ","$1,220.73 ","$0.00 ","$1,649.63 ","$742.33 ","$0.00 ","$343.82 ","$0.00 ","$0.00 ","$288.84 ","$1,649.63 ","$0.00 ","$824.81 ","$1,306.51 ","$1,319.70 ","$0.00 ","$258.17 ","$0.00 ","$262.62 ","$0.00 "
"232.067","SUP","HCPCS C1713","","232.067  -  PLATE BONE 90D 80MM 35X9.2MM 6 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,649.63 ","$1,220.73 ","$0.00 ","$1,649.63 ","$742.33 ","$0.00 ","$343.82 ","$0.00 ","$0.00 ","$288.84 ","$1,649.63 ","$0.00 ","$824.81 ","$1,306.51 ","$1,319.70 ","$0.00 ","$258.17 ","$0.00 ","$262.62 ","$0.00 "
"232.068","SUP","HCPCS C1713","","232.068  -  PLATE BONE 90D 80MM 40X9.2MM 6 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,649.63 ","$1,220.73 ","$0.00 ","$1,649.63 ","$742.33 ","$0.00 ","$343.82 ","$0.00 ","$0.00 ","$288.84 ","$1,649.63 ","$0.00 ","$824.81 ","$1,306.51 ","$1,319.70 ","$0.00 ","$258.17 ","$0.00 ","$262.62 ","$0.00 "
"232.069","SUP","HCPCS C1713","","232.069  -  PLATE BONE 90D 80MM 45X9.2MM 6 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,649.63 ","$1,220.73 ","$0.00 ","$1,649.63 ","$742.33 ","$0.00 ","$343.82 ","$0.00 ","$0.00 ","$288.84 ","$1,649.63 ","$0.00 ","$824.81 ","$1,306.51 ","$1,319.70 ","$0.00 ","$258.17 ","$0.00 ","$262.62 ","$0.00 "
"232.086","SUP","HCPCS C1713","","232.086  -  PLATE BONE 90D 106MM 30X9.2MM 8 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,770.20 ","$1,309.95 ","$0.00 ","$1,770.20 ","$796.59 ","$0.00 ","$368.95 ","$0.00 ","$0.00 ","$309.95 ","$1,770.20 ","$0.00 ","$885.10 ","$1,402.00 ","$1,416.16 ","$0.00 ","$277.04 ","$0.00 ","$281.82 ","$0.00 "
"232.087","SUP","HCPCS C1713","","232.087  -  PLATE BN 90D 35X9.2MM NS 8 HL LMT CNTCT ANG BLDE CNN SS 3.5","BOTH IP/OP","$1,770.20 ","$1,309.95 ","$0.00 ","$1,770.20 ","$796.59 ","$0.00 ","$368.95 ","$0.00 ","$0.00 ","$309.95 ","$1,770.20 ","$0.00 ","$885.10 ","$1,402.00 ","$1,416.16 ","$0.00 ","$277.04 ","$0.00 ","$281.82 ","$0.00 "
"232.088","SUP","HCPCS C1713","","232.088  -  PLATE BONE 90D 106MM 40X9.2MM 8 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,770.20 ","$1,309.95 ","$0.00 ","$1,770.20 ","$796.59 ","$0.00 ","$368.95 ","$0.00 ","$0.00 ","$309.95 ","$1,770.20 ","$0.00 ","$885.10 ","$1,402.00 ","$1,416.16 ","$0.00 ","$277.04 ","$0.00 ","$281.82 ","$0.00 "
"232.089","SUP","HCPCS C1713","","232.089  -  PLATE BONE 90D 106MM 45X9.2MM 8 HOLE LIMITED CONTACT ANGLED","BOTH IP/OP","$1,770.20 ","$1,309.95 ","$0.00 ","$1,770.20 ","$796.59 ","$0.00 ","$368.95 ","$0.00 ","$0.00 ","$309.95 ","$1,770.20 ","$0.00 ","$885.10 ","$1,402.00 ","$1,416.16 ","$0.00 ","$277.04 ","$0.00 ","$281.82 ","$0.00 "
"235","SUP","Custom 27803010","","235  -  PANEL 235 128MM X 79MM X .025","BOTH IP/OP","$1,623.50 ","$1,201.39 ","$0.00 ","$1,623.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,623.50 ","$0.00 ","$811.75 ","$1,285.81 ","$1,298.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"235.17","SUP","HCPCS C1713","","235.170  -  PLATE BONE 80D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.19","SUP","HCPCS C1713","","235.190  -  PLATE BONE 80D 8MM DISPLACEMENT 45MM ANGLED DCP CAPOS","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.27","SUP","HCPCS C1713","","235.270  -  PLATE BN 90D 8MM DSPL 35MMX74.5MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.29","SUP","HCPCS C1713","","235.290  -  PLATE BN 90D 8MM DSPL 45MMX74.5MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.37","SUP","HCPCS C1713","","235.370  -  PLATE BONE 100D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.39","SUP","HCPCS C1713","","235.390  -  PLATE BONE 100D 45MM 8MM DCP CAPOS STAINLESS STEEL PEDIATRIC","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.6","SUP","HCPCS C1713","","235.600  -  PLATE BN 90D 10MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.601","SUP","HCPCS C1713","","235.601  -  PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.68","SUP","HCPCS C1713","","235.680  -  PLATE BN 90D 10MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.681","SUP","HCPCS C1713","","235.681  -  PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.7","SUP","HCPCS C1713","","235.700  -  PLATE BN 90D 15MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.701","SUP","HCPCS C1713","","235.701  -  PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.72","SUP","HCPCS C1713","","235.720  -  PLATE BN 90D 15MM DSPL 60MMX78MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.721","SUP","HCPCS C1713","","235.721  -  PLATE BONE 100D 15MM DISPLACEMENT 60MM DCP CAPOS STAINLESS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.78","SUP","HCPCS C1713","","235.780  -  PLATE BN 90D 15MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"235.781","SUP","HCPCS C1713","","235.781  -  PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.001","SUP","HCPCS C1713","","236.001  -  PLATE BONE 90D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.002","SUP","HCPCS C1713","","236.002  -  PLATE BN 90D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.003","SUP","HCPCS C1713","","236.003  -  PLATE BONE 90D 4MM DISPLACEMENT 38MM DCP CAPOS STAINLESS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.011","SUP","HCPCS C1713","","236.011  -  PLATE BONE 90D 8MM DISPLACEMENT ANGLED 26MM DCP CAPOS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.012","SUP","HCPCS C1713","","236.012  -  PLATE BN 90D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.013","SUP","HCPCS C1713","","236.013  -  PLATE BN 90D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.101","SUP","HCPCS C1713","","236.101  -  PLATE BONE 100D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.102","SUP","HCPCS C1713","","236.102  -  PLATE BN 100D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.103","SUP","HCPCS C1713","","236.103  -  PLATE BN 100D 4MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.104","SUP","HCPCS C1713","","236.104  -  PLATE BN 100D 4MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.111","SUP","HCPCS C1713","","236.111  -  PLATE BONE 100D 8MM DISPLACEMENT 26MM CANN ANGLED BLADE DCP","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.112","SUP","HCPCS C1713","","236.112  -  PLATE BN 100D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.113","SUP","HCPCS C1713","","236.113  -  PLATE BN 100D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.114","SUP","HCPCS C1713","","236.114  -  PLATE BN 100D 8MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"236.25","SUP","HCPCS C1713","","236.250  -  PLATE BN 90D 7MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS 3 HL T","BOTH IP/OP","$805.20 ","$595.85 ","$0.00 ","$805.20 ","$362.34 ","$0.00 ","$167.82 ","$0.00 ","$0.00 ","$140.98 ","$805.20 ","$0.00 ","$402.60 ","$637.72 ","$644.16 ","$0.00 ","$122.34 ","$0.00 ","$128.19 ","$0.00 "
"236.26","SUP","HCPCS C1713","","236.260  -  PLATE BN 90D 7MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T","BOTH IP/OP","$805.20 ","$595.85 ","$0.00 ","$805.20 ","$362.34 ","$0.00 ","$167.82 ","$0.00 ","$0.00 ","$140.98 ","$805.20 ","$0.00 ","$402.60 ","$637.72 ","$644.16 ","$0.00 ","$122.34 ","$0.00 ","$128.19 ","$0.00 "
"236.35","SUP","HCPCS C1713","","236.350  -  PLATE BN 90D 12MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS SS INF","BOTH IP/OP","$805.20 ","$595.85 ","$0.00 ","$805.20 ","$362.34 ","$0.00 ","$167.82 ","$0.00 ","$0.00 ","$140.98 ","$805.20 ","$0.00 ","$402.60 ","$637.72 ","$644.16 ","$0.00 ","$122.34 ","$0.00 ","$128.19 ","$0.00 "
"236.36","SUP","HCPCS C1713","","236.360  -  PLATE BN 90D 12MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T","BOTH IP/OP","$805.20 ","$595.85 ","$0.00 ","$805.20 ","$362.34 ","$0.00 ","$167.82 ","$0.00 ","$0.00 ","$140.98 ","$805.20 ","$0.00 ","$402.60 ","$637.72 ","$644.16 ","$0.00 ","$122.34 ","$0.00 ","$128.19 ","$0.00 "
"236.4","SUP","HCPCS C1713","","236.400  -  PLATE BN 115D 5MM DSPL 2 BRCH 30MM NS DCP CAPOS 2 HL SS","BOTH IP/OP","$537.70 ","$397.90 ","$0.00 ","$537.70 ","$241.97 ","$0.00 ","$112.07 ","$0.00 ","$0.00 ","$94.15 ","$537.70 ","$0.00 ","$268.85 ","$425.86 ","$430.16 ","$0.00 ","$81.70 ","$0.00 ","$85.60 ","$0.00 "
"236.43","SUP","HCPCS C1713","","236.430  -  PLATE BN 115D 5MM DSPL 2 BRCH 35MM NS DCP CAPOS 2 HL SS","BOTH IP/OP","$537.70 ","$397.90 ","$0.00 ","$537.70 ","$241.97 ","$0.00 ","$112.07 ","$0.00 ","$0.00 ","$94.15 ","$537.70 ","$0.00 ","$268.85 ","$425.86 ","$430.16 ","$0.00 ","$81.70 ","$0.00 ","$85.60 ","$0.00 "
"236.502","SUP","HCPCS C1713","","236.502  -  PLATE BONE 86MM 2 HOLE LCP STAINLESS STEEL RIGHT OLECRANON","BOTH IP/OP","$1,644.65 ","$1,217.04 ","$0.00 ","$1,596.75 ","$718.54 ","$0.00 ","$342.79 ","$0.00 ","$0.00 ","$279.58 ","$1,596.75 ","$0.00 ","$798.38 ","$1,264.63 ","$1,277.40 ","$0.00 ","$242.61 ","$0.00 ","$254.20 ","$0.00 "
"236.503","SUP","HCPCS C1713","","236.503  -  PLATE BONE 86MM 2 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,644.65 ","$1,217.04 ","$0.00 ","$1,596.75 ","$718.54 ","$0.00 ","$342.79 ","$0.00 ","$0.00 ","$279.58 ","$1,596.75 ","$0.00 ","$798.38 ","$1,264.63 ","$1,277.40 ","$0.00 ","$242.61 ","$0.00 ","$254.20 ","$0.00 "
"236.504","SUP","HCPCS C1713","","236.504  -  PLATE BONE 112MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,716.35 ","$1,270.10 ","$0.00 ","$1,666.35 ","$749.86 ","$0.00 ","$357.73 ","$0.00 ","$0.00 ","$291.76 ","$1,666.35 ","$0.00 ","$833.18 ","$1,319.75 ","$1,333.08 ","$0.00 ","$253.19 ","$0.00 ","$265.28 ","$0.00 "
"236.505","SUP","HCPCS C1713","","236.505  -  PLATE BONE 112MM 4 HOLE LCP STAINLESS STEEL LEFT OLECRANON","BOTH IP/OP","$1,716.35 ","$1,270.10 ","$0.00 ","$1,666.35 ","$749.86 ","$0.00 ","$357.73 ","$0.00 ","$0.00 ","$291.76 ","$1,666.35 ","$0.00 ","$833.18 ","$1,319.75 ","$1,333.08 ","$0.00 ","$253.19 ","$0.00 ","$265.28 ","$0.00 "
"236.506","SUP","HCPCS C1713","","236.506  -  PLATE BONE 3.5MM 138MM 6 HOLE LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,771.18 ","$1,310.67 ","$0.00 ","$1,719.58 ","$773.81 ","$0.00 ","$369.16 ","$0.00 ","$0.00 ","$301.08 ","$1,719.58 ","$0.00 ","$859.79 ","$1,361.91 ","$1,375.66 ","$0.00 ","$348.13 ","$0.00 ","$273.76 ","$0.00 "
"236.507","SUP","HCPCS C1713","","236.507  -  PLATE BONE 138MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,771.18 ","$1,310.67 ","$0.00 ","$1,719.58 ","$773.81 ","$0.00 ","$369.16 ","$0.00 ","$0.00 ","$301.08 ","$1,719.58 ","$0.00 ","$859.79 ","$1,361.91 ","$1,375.66 ","$0.00 ","$261.28 ","$0.00 ","$273.76 ","$0.00 "
"236.508","SUP","HCPCS C1713","","236.508  -  PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL RIGHT OLECRANON","BOTH IP/OP","$1,826.00 ","$1,351.24 ","$0.00 ","$1,772.80 ","$797.76 ","$0.00 ","$380.58 ","$0.00 ","$0.00 ","$310.40 ","$1,772.80 ","$0.00 ","$886.40 ","$1,404.06 ","$1,418.24 ","$0.00 ","$269.36 ","$0.00 ","$282.23 ","$0.00 "
"236.509","SUP","HCPCS C1713","","236.509  -  PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL LEFT OLECRANON","BOTH IP/OP","$1,826.00 ","$1,351.24 ","$0.00 ","$1,772.80 ","$797.76 ","$0.00 ","$380.58 ","$0.00 ","$0.00 ","$310.40 ","$1,772.80 ","$0.00 ","$886.40 ","$1,404.06 ","$1,418.24 ","$0.00 ","$269.36 ","$0.00 ","$282.23 ","$0.00 "
"236.51","SUP","HCPCS C1713","","236.510  -  PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL RIGHT OLECRANON","BOTH IP/OP","$1,821.95 ","$1,348.24 ","$0.00 ","$1,821.95 ","$819.88 ","$0.00 ","$379.74 ","$0.00 ","$0.00 ","$319.01 ","$1,821.95 ","$0.00 ","$910.98 ","$1,442.98 ","$1,457.56 ","$0.00 ","$276.83 ","$0.00 ","$290.05 ","$0.00 "
"236.511","SUP","HCPCS C1713","","236.511  -  PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL LEFT OLECRANON","BOTH IP/OP","$1,876.60 ","$1,388.68 ","$0.00 ","$1,821.95 ","$819.88 ","$0.00 ","$391.13 ","$0.00 ","$0.00 ","$319.01 ","$1,821.95 ","$0.00 ","$910.98 ","$1,442.98 ","$1,457.56 ","$0.00 ","$276.83 ","$0.00 ","$290.05 ","$0.00 "
"236.512","SUP","HCPCS C1713","","236.512  -  PLATE BONE 216MM 12 HOLE LCP STAINLESS STEEL RIGHT OLECRANON","BOTH IP/OP","$1,910.33 ","$1,413.64 ","$0.00 ","$1,854.70 ","$834.62 ","$0.00 ","$398.16 ","$0.00 ","$0.00 ","$324.74 ","$1,854.70 ","$0.00 ","$927.35 ","$1,468.92 ","$1,483.76 ","$0.00 ","$281.81 ","$0.00 ","$295.27 ","$0.00 "
"236.513","SUP","HCPCS C1713","","236.513  -  PLATE BONE 215MM 12 HOLE LCP STAINLESS STEEL LEFT OLECRANON","BOTH IP/OP","$1,910.33 ","$1,413.64 ","$0.00 ","$1,854.70 ","$834.62 ","$0.00 ","$398.16 ","$0.00 ","$0.00 ","$324.74 ","$1,854.70 ","$0.00 ","$927.35 ","$1,468.92 ","$1,483.76 ","$0.00 ","$281.81 ","$0.00 ","$295.27 ","$0.00 "
"237.2","SUP","HCPCS C1713","","237.20  -  PLATE BONE 95D 50MM 12 HOLE ANGLED BLADE DCP STAINLESS STEEL","BOTH IP/OP","$1,177.78 ","$871.56 ","$0.00 ","$1,177.78 ","$530.00 ","$0.00 ","$245.48 ","$0.00 ","$0.00 ","$206.22 ","$1,177.78 ","$0.00 ","$588.89 ","$932.80 ","$942.22 ","$0.00 ","$178.95 ","$0.00 ","$187.50 ","$0.00 "
"237.22","SUP","HCPCS C1713","","237.22  -  PLATE BN 95D 60MM NS 204MM DCP 12 HL SS HIP CNDRL","BOTH IP/OP","$1,213.13 ","$897.72 ","$0.00 ","$1,177.78 ","$530.00 ","$0.00 ","$252.85 ","$0.00 ","$0.00 ","$206.22 ","$1,177.78 ","$0.00 ","$588.89 ","$932.80 ","$942.22 ","$0.00 ","$178.95 ","$0.00 ","$187.50 ","$0.00 "
"237.24","SUP","HCPCS C1713","","237.24  -  PLATE BN 95D 70MM NS 240MM DCP 12 HL SS HIP CNDRL","BOTH IP/OP","$1,213.13 ","$897.72 ","$0.00 ","$1,177.78 ","$530.00 ","$0.00 ","$252.85 ","$0.00 ","$0.00 ","$206.22 ","$1,177.78 ","$0.00 ","$588.89 ","$932.80 ","$942.22 ","$0.00 ","$178.95 ","$0.00 ","$187.50 ","$0.00 "
"237.26","SUP","HCPCS C1713","","237.26  -  PLATE BN 95D 70MM NS 204MM DCP 12 HL SS HIP CNDRL","BOTH IP/OP","$1,213.13 ","$897.72 ","$0.00 ","$1,177.78 ","$530.00 ","$0.00 ","$252.85 ","$0.00 ","$0.00 ","$206.22 ","$1,177.78 ","$0.00 ","$588.89 ","$932.80 ","$942.22 ","$0.00 ","$178.95 ","$0.00 ","$187.50 ","$0.00 "
"237.261","SUP","HCPCS C1713","","237.261  -  PLATE 95D SS 26 HOLE ANG DCP BONE 60MM CNDYLR NONSTRL","BOTH IP/OP","$2,689.95 ","$1,990.56 ","$0.00 ","$2,689.95 ","$1,210.48 ","$0.00 ","$560.65 ","$0.00 ","$0.00 ","$470.99 ","$2,689.95 ","$0.00 ","$1,344.98 ","$2,130.44 ","$2,151.96 ","$0.00 ","$420.98 ","$0.00 ","$428.24 ","$0.00 "
"237.262","SUP","HCPCS C1713","","237.262  -  PLATE 95D SS 26 HOLE ANG DCP BONE 70MM CNDYLR NONSTRL","BOTH IP/OP","$2,535.53 ","$1,876.29 ","$0.00 ","$2,535.53 ","$1,140.99 ","$0.00 ","$528.47 ","$0.00 ","$0.00 ","$443.95 ","$2,535.53 ","$0.00 ","$1,267.76 ","$2,008.14 ","$2,028.42 ","$0.00 ","$396.81 ","$0.00 ","$403.66 ","$0.00 "
"237.4","SUP","HCPCS C1713","","237.40  -  PLATE BONE 95D 50MM 235MM 14 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,764.63 ","$1,305.83 ","$0.00 ","$1,764.63 ","$794.08 ","$0.00 ","$367.79 ","$0.00 ","$0.00 ","$308.97 ","$1,764.63 ","$0.00 ","$882.31 ","$1,397.59 ","$1,411.70 ","$0.00 ","$268.12 ","$0.00 ","$280.93 ","$0.00 "
"237.42","SUP","HCPCS C1713","","237.42  -  PLATE BONE 95D 60MM 235MM 14 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,817.55 ","$1,344.99 ","$0.00 ","$1,764.63 ","$794.08 ","$0.00 ","$378.82 ","$0.00 ","$0.00 ","$308.97 ","$1,764.63 ","$0.00 ","$882.31 ","$1,397.59 ","$1,411.70 ","$0.00 ","$268.12 ","$0.00 ","$280.93 ","$0.00 "
"237.44","SUP","HCPCS C1713","","237.44  -  PLATE BN 95D 70MM NS 235MM DCP 14 HL SS HIP CNDRL","BOTH IP/OP","$1,817.55 ","$1,344.99 ","$0.00 ","$1,764.63 ","$794.08 ","$0.00 ","$378.82 ","$0.00 ","$0.00 ","$308.97 ","$1,764.63 ","$0.00 ","$882.31 ","$1,397.59 ","$1,411.70 ","$0.00 ","$268.12 ","$0.00 ","$280.93 ","$0.00 "
"237.46","SUP","HCPCS C1713","","237.46  -  PLATE BONE 95D 80MM 235MM 14 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,817.55 ","$1,344.99 ","$0.00 ","$1,764.63 ","$794.08 ","$0.00 ","$378.82 ","$0.00 ","$0.00 ","$308.97 ","$1,764.63 ","$0.00 ","$882.31 ","$1,397.59 ","$1,411.70 ","$0.00 ","$268.12 ","$0.00 ","$280.93 ","$0.00 "
"237.5","SUP","HCPCS C1713","","237.50  -  PLATE BN 95D 50MM NS 92MM DCP 5 HL SS HIP CNDRL","BOTH IP/OP","$978.53 ","$724.11 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$203.95 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"237.52","SUP","HCPCS C1713","","237.52  -  PLATE BONE 95D 60MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE","BOTH IP/OP","$1,007.88 ","$745.83 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$210.07 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"237.54","SUP","HCPCS C1713","","237.54  -  PLATE BN 95D 70MM NS 92MM DCP 5 HL SS HIP CNDRL","BOTH IP/OP","$1,007.88 ","$745.83 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$210.07 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"237.56","SUP","HCPCS C1713","","237.56  -  PLATE BONE 95D 80MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE","BOTH IP/OP","$1,007.88 ","$745.83 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$210.07 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"237.62","SUP","HCPCS C1713","","237.62  -  PLATE BONE 95D 60MM 267MM 16 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"237.64","SUP","HCPCS C1713","","237.64  -  PLATE BN 95D 70MM NS 267MM DCP 16 HL SS HIP CNDRL","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"237.66","SUP","HCPCS C1713","","237.66  -  PLATE BN 95D 80MM NS 267MM DCP 16 HL SS HIP CNDRL","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"237.7","SUP","HCPCS C1713","","237.70  -  PLATE BONE 95D 124MM 50MM 7 HOLE BLADE DCP STAINLESS STEEL","BOTH IP/OP","$1,031.75 ","$763.50 ","$0.00 ","$1,031.75 ","$464.29 ","$0.00 ","$215.04 ","$0.00 ","$0.00 ","$180.65 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$156.77 ","$0.00 ","$164.25 ","$0.00 "
"237.72","SUP","HCPCS C1713","","237.72  -  PLATE BN 95D 60MM NS 124MM DCP 7 HL SS HIP CNDRL","BOTH IP/OP","$1,062.70 ","$786.40 ","$0.00 ","$1,031.75 ","$464.29 ","$0.00 ","$221.49 ","$0.00 ","$0.00 ","$180.65 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$156.77 ","$0.00 ","$164.25 ","$0.00 "
"237.74","SUP","HCPCS C1713","","237.74  -  PLATE BN 95D 70MM NS 124MM DCP 7 HL SS HIP CNDRL","BOTH IP/OP","$1,062.70 ","$786.40 ","$0.00 ","$1,031.75 ","$464.29 ","$0.00 ","$221.49 ","$0.00 ","$0.00 ","$180.65 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$156.77 ","$0.00 ","$164.25 ","$0.00 "
"237.76","SUP","HCPCS C1713","","237.76  -  PLATE BN 95D 80MM NS 124MM DCP 7 HL SS HIP CNDRL","BOTH IP/OP","$1,062.70 ","$786.40 ","$0.00 ","$1,031.75 ","$464.29 ","$0.00 ","$221.49 ","$0.00 ","$0.00 ","$180.65 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$156.77 ","$0.00 ","$164.25 ","$0.00 "
"237.82","SUP","HCPCS C1713","","237.82  -  PLATE BONE 95D 299MM 60MM 18 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$2,126.83 ","$1,573.85 ","$0.00 ","$2,064.88 ","$929.19 ","$0.00 ","$443.28 ","$0.00 ","$0.00 ","$361.54 ","$2,064.88 ","$0.00 ","$1,032.44 ","$1,635.38 ","$1,651.90 ","$0.00 ","$313.74 ","$0.00 ","$328.73 ","$0.00 "
"237.84","SUP","HCPCS C1713","","237.84  -  PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL","BOTH IP/OP","$2,126.83 ","$1,573.85 ","$0.00 ","$2,064.88 ","$929.19 ","$0.00 ","$443.28 ","$0.00 ","$0.00 ","$361.54 ","$2,064.88 ","$0.00 ","$1,032.44 ","$1,635.38 ","$1,651.90 ","$0.00 ","$313.74 ","$0.00 ","$328.73 ","$0.00 "
"237.86","SUP","HCPCS C1713","","237.86  -  PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL","BOTH IP/OP","$2,126.83 ","$1,573.85 ","$0.00 ","$2,064.88 ","$929.19 ","$0.00 ","$443.28 ","$0.00 ","$0.00 ","$361.54 ","$2,064.88 ","$0.00 ","$1,032.44 ","$1,635.38 ","$1,651.90 ","$0.00 ","$313.74 ","$0.00 ","$328.73 ","$0.00 "
"237.9","SUP","HCPCS C1713","","237.90  -  PLATE BN 95D 50MM NS 156MM DCP 9 HL SS HIP CNDRL","BOTH IP/OP","$1,080.88 ","$799.85 ","$0.00 ","$1,080.88 ","$486.39 ","$0.00 ","$225.28 ","$0.00 ","$0.00 ","$189.25 ","$1,080.88 ","$0.00 ","$540.44 ","$856.06 ","$864.70 ","$0.00 ","$164.23 ","$0.00 ","$172.08 ","$0.00 "
"237.92","SUP","HCPCS C1713","","237.92  -  PLATE BN 95D 60MM NS 156MM DCP 9 HL SS HIP CNDRL","BOTH IP/OP","$1,113.30 ","$823.84 ","$0.00 ","$1,080.88 ","$486.39 ","$0.00 ","$232.04 ","$0.00 ","$0.00 ","$189.25 ","$1,080.88 ","$0.00 ","$540.44 ","$856.06 ","$864.70 ","$0.00 ","$164.23 ","$0.00 ","$172.08 ","$0.00 "
"237.94","SUP","HCPCS C1713","","237.94  -  PLATE BN 95D 70MM NS 156MM DCP 9 HL SS HIP CNDRL","BOTH IP/OP","$1,113.30 ","$823.84 ","$0.00 ","$1,080.88 ","$486.39 ","$0.00 ","$232.04 ","$0.00 ","$0.00 ","$189.25 ","$1,080.88 ","$0.00 ","$540.44 ","$856.06 ","$864.70 ","$0.00 ","$164.23 ","$0.00 ","$172.08 ","$0.00 "
"237.96","SUP","HCPCS C1713","","237.96  -  PLATE BN 95D 80MM NS 156MM DCP 9 HL SS HIP CNDRL","BOTH IP/OP","$1,113.30 ","$823.84 ","$0.00 ","$1,080.88 ","$486.39 ","$0.00 ","$232.04 ","$0.00 ","$0.00 ","$189.25 ","$1,080.88 ","$0.00 ","$540.44 ","$856.06 ","$864.70 ","$0.00 ","$164.23 ","$0.00 ","$172.08 ","$0.00 "
"237.995","SUP","HCPCS C1713","","237.995  -  PLATE BONE 90D 35MM 5 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$1,393.90 ","$1,031.49 ","$0.00 ","$1,393.90 ","$627.26 ","$0.00 ","$290.52 ","$0.00 ","$0.00 ","$244.06 ","$1,393.90 ","$0.00 ","$696.95 ","$1,103.97 ","$1,115.12 ","$0.00 ","$218.15 ","$0.00 ","$221.91 ","$0.00 "
"237.997","SUP","HCPCS C1713","","237.997  -  PLATE BONE 90D 35MM 7 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$1,393.90 ","$1,031.49 ","$0.00 ","$1,393.90 ","$627.26 ","$0.00 ","$290.52 ","$0.00 ","$0.00 ","$244.06 ","$1,393.90 ","$0.00 ","$696.95 ","$1,103.97 ","$1,115.12 ","$0.00 ","$218.15 ","$0.00 ","$221.91 ","$0.00 "
"238.24","SUP","HCPCS C1713","","238.24  -  PLATE BONE 130D 70MM 12 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$1,193.43 ","$883.14 ","$0.00 ","$1,158.68 ","$521.40 ","$0.00 ","$248.74 ","$0.00 ","$0.00 ","$202.87 ","$1,158.68 ","$0.00 ","$579.34 ","$917.67 ","$926.94 ","$0.00 ","$176.05 ","$0.00 ","$184.46 ","$0.00 "
"238.26","SUP","HCPCS C1713","","238.26  -  PLATE BONE 130D 80MM 12 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$1,193.43 ","$883.14 ","$0.00 ","$1,158.68 ","$521.40 ","$0.00 ","$248.74 ","$0.00 ","$0.00 ","$202.87 ","$1,158.68 ","$0.00 ","$579.34 ","$917.67 ","$926.94 ","$0.00 ","$176.05 ","$0.00 ","$184.46 ","$0.00 "
"238.28","SUP","HCPCS C1713","","238.28  -  PLATE BONE 130D 90MM 12 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$1,193.43 ","$883.14 ","$0.00 ","$1,158.68 ","$521.40 ","$0.00 ","$248.74 ","$0.00 ","$0.00 ","$202.87 ","$1,158.68 ","$0.00 ","$579.34 ","$917.67 ","$926.94 ","$0.00 ","$176.05 ","$0.00 ","$184.46 ","$0.00 "
"238.36","SUP","HCPCS C1713","","238.36  -  PLATE BONE 130D 50MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.38","SUP","HCPCS C1713","","238.38  -  PLATE BONE 130D 60MM 4 HOLE ANGLED BLADE DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.4","SUP","HCPCS C1713","","238.40  -  PLATE BONE 130D 100MM 60MM 4 HOLE DCP STAINLESS STEEL SMALL","BOTH IP/OP","$850.25 ","$629.19 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$177.21 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.41","SUP","HCPCS C1713","","238.41  -  PLATE BONE 130D 105MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.42","SUP","HCPCS C1713","","238.42  -  PLATE BONE 130D 110MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.44","SUP","HCPCS C1713","","238.44  -  PLATE BONE 130D 70MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.45","SUP","HCPCS C1713","","238.45  -  PLATE BONE 130D 75MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.46","SUP","HCPCS C1713","","238.46  -  PLATE BONE 130D 80MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.47","SUP","HCPCS C1713","","238.47  -  PLATE BONE 130D 85MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.48","SUP","HCPCS C1713","","238.48  -  PLATE BONE 130D 90MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.49","SUP","HCPCS C1713","","238.49  -  PLATE BONE 130D 95MM 4 HOLE ANGLED DCP STAINLESS STEEL","BOTH IP/OP","$875.75 ","$648.06 ","$0.00 ","$850.25 ","$382.61 ","$0.00 ","$182.53 ","$0.00 ","$0.00 ","$148.87 ","$850.25 ","$0.00 ","$425.13 ","$673.40 ","$680.20 ","$0.00 ","$129.19 ","$0.00 ","$135.36 ","$0.00 "
"238.6","SUP","HCPCS C1713","","238.60  -  PLATE BONE 130D 104MM 50MM 6 HOLE DCP STAINLESS STEEL SMALL","BOTH IP/OP","$913.03 ","$675.64 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$190.30 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"238.62","SUP","HCPCS C1713","","238.62  -  PLATE BONE 130D 104MM 60MM 6 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"238.64","SUP","HCPCS C1713","","238.64  -  PLATE BN 130D 70MM NS 104MM DCP 6 HL SS HIP CNDRL","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"238.66","SUP","HCPCS C1713","","238.66  -  PLATE BONE 130D 104MM 80MM 6 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"238.68","SUP","HCPCS C1713","","238.68  -  PLATE BN 130D 90MM NS 104MM DCP 6 HL SS HIP CNDRL","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"238.7","SUP","HCPCS C1713","","238.700  -  PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,606.68 ","$1,928.94 ","$0.00 ","$2,606.68 ","$1,173.00 ","$0.00 ","$543.30 ","$0.00 ","$0.00 ","$456.41 ","$2,606.68 ","$0.00 ","$1,303.34 ","$2,064.49 ","$2,085.34 ","$0.00 ","$396.06 ","$0.00 ","$414.98 ","$0.00 "
"238.701","SUP","HCPCS C1713","","238.701  -  PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,684.88 ","$1,986.81 ","$0.00 ","$2,606.68 ","$1,173.00 ","$0.00 ","$559.60 ","$0.00 ","$0.00 ","$456.41 ","$2,606.68 ","$0.00 ","$1,303.34 ","$2,064.49 ","$2,085.34 ","$0.00 ","$396.06 ","$0.00 ","$414.98 ","$0.00 "
"238.702","SUP","HCPCS C1713","","238.702  -  PLATE BONE 142MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$2,715.80 ","$2,009.69 ","$0.00 ","$2,636.70 ","$1,186.52 ","$0.00 ","$566.04 ","$0.00 ","$0.00 ","$461.67 ","$2,636.70 ","$0.00 ","$1,318.35 ","$2,088.27 ","$2,109.36 ","$0.00 ","$400.62 ","$0.00 ","$419.76 ","$0.00 "
"238.703","SUP","HCPCS C1713","","238.703  -  PLATE BONE 142MM 13.5X3.7MM 6 HOLE LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,715.80 ","$2,009.69 ","$0.00 ","$2,636.70 ","$1,186.52 ","$0.00 ","$566.04 ","$0.00 ","$0.00 ","$461.67 ","$2,636.70 ","$0.00 ","$1,318.35 ","$2,088.27 ","$2,109.36 ","$0.00 ","$400.62 ","$0.00 ","$419.76 ","$0.00 "
"238.704","SUP","HCPCS C1713","","238.704  -  PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,742.50 ","$2,029.45 ","$0.00 ","$2,662.63 ","$1,198.18 ","$0.00 ","$571.61 ","$0.00 ","$0.00 ","$466.20 ","$2,662.63 ","$0.00 ","$1,331.31 ","$2,108.80 ","$2,130.10 ","$0.00 ","$404.56 ","$0.00 ","$423.89 ","$0.00 "
"238.705","SUP","HCPCS C1713","","238.705  -  PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,742.50 ","$2,029.45 ","$0.00 ","$2,662.63 ","$1,198.18 ","$0.00 ","$571.61 ","$0.00 ","$0.00 ","$466.20 ","$2,662.63 ","$0.00 ","$1,331.31 ","$2,108.80 ","$2,130.10 ","$0.00 ","$404.56 ","$0.00 ","$423.89 ","$0.00 "
"238.706","SUP","HCPCS C1713","","238.706  -  PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,770.63 ","$2,050.27 ","$0.00 ","$2,689.93 ","$1,210.47 ","$0.00 ","$577.47 ","$0.00 ","$0.00 ","$470.98 ","$2,689.93 ","$0.00 ","$1,344.96 ","$2,130.42 ","$2,151.94 ","$0.00 ","$408.71 ","$0.00 ","$428.24 ","$0.00 "
"238.707","SUP","HCPCS C1713","","238.707  -  PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,770.63 ","$2,050.27 ","$0.00 ","$2,689.93 ","$1,210.47 ","$0.00 ","$577.47 ","$0.00 ","$0.00 ","$470.98 ","$2,689.93 ","$0.00 ","$1,344.96 ","$2,130.42 ","$2,151.94 ","$0.00 ","$408.71 ","$0.00 ","$428.24 ","$0.00 "
"238.708","SUP","HCPCS C1713","","238.708  -  PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$2,801.55 ","$2,073.15 ","$0.00 ","$2,719.95 ","$1,223.98 ","$0.00 ","$583.91 ","$0.00 ","$0.00 ","$476.24 ","$2,719.95 ","$0.00 ","$1,359.98 ","$2,154.20 ","$2,175.96 ","$0.00 ","$413.27 ","$0.00 ","$433.02 ","$0.00 "
"238.709","SUP","HCPCS C1713","","238.709  -  PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,801.55 ","$2,073.15 ","$0.00 ","$2,719.95 ","$1,223.98 ","$0.00 ","$583.91 ","$0.00 ","$0.00 ","$476.24 ","$2,719.95 ","$0.00 ","$1,359.98 ","$2,154.20 ","$2,175.96 ","$0.00 ","$413.27 ","$0.00 ","$433.02 ","$0.00 "
"238.71","SUP","HCPCS C1713","","238.710  -  PLATE BONE 246MM 14 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$2,755.43 ","$2,039.02 ","$0.00 ","$2,755.43 ","$1,239.94 ","$0.00 ","$574.30 ","$0.00 ","$0.00 ","$482.45 ","$2,755.43 ","$0.00 ","$1,377.71 ","$2,182.30 ","$2,204.34 ","$0.00 ","$418.66 ","$0.00 ","$438.66 ","$0.00 "
"238.711","SUP","HCPCS C1713","","238.711  -  PLATE BONE 246MM 13.5X3.7MM 14 HOLE LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,838.10 ","$2,100.19 ","$0.00 ","$2,755.43 ","$1,239.94 ","$0.00 ","$591.53 ","$0.00 ","$0.00 ","$482.45 ","$2,755.43 ","$0.00 ","$1,377.71 ","$2,182.30 ","$2,204.34 ","$0.00 ","$418.66 ","$0.00 ","$438.66 ","$0.00 "
"238.94","SUP","HCPCS C1713","","238.94  -  PLATE BONE 130D 152MM 70MM 9 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"238.96","SUP","HCPCS C1713","","238.96  -  PLATE BONE 130D 152MM 80MM 9 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"238.98","SUP","HCPCS C1713","","238.98  -  PLATE BONE 130D 154MM 90MM 9 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.2","SUP","HCPCS C1713","","239.20  -  PLATE BN 90D 10MM DSPL 50MM NS DCP SS ADLT OSTM","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.21","SUP","HCPCS C1713","","239.21  -  PLATE BN 90D 10MM DSPL 55MM NS DCP SS ADLT OSTM","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.22","SUP","HCPCS C1713","","239.22  -  PLATE BONE 90D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.23","SUP","HCPCS C1713","","239.23  -  PLATE BONE 90D 10MM 65MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.24","SUP","HCPCS C1713","","239.24  -  PLATE BONE 90D 10MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.28","SUP","HCPCS C1713","","239.28  -  PLATE BN 90D 10MM DSPL 40MM NS DCP SS ADLT OSTM","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.3","SUP","HCPCS C1713","","239.30  -  PLATE BONE 100D 10MM 50MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.32","SUP","HCPCS C1713","","239.32  -  PLATE BONE 100D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.43","SUP","HCPCS C1713","","239.43  -  PLATE BONE 110D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.45","SUP","HCPCS C1713","","239.45  -  PLATE BONE 110D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.47","SUP","HCPCS C1713","","239.47  -  PLATE BONE 110D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.53","SUP","HCPCS C1713","","239.53  -  PLATE BONE 120D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.55","SUP","HCPCS C1713","","239.55  -  PLATE BONE 120D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.57","SUP","HCPCS C1713","","239.57  -  PLATE BONE 120D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.6","SUP","HCPCS C1713","","239.60  -  PLATE BONE 90D 10MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.62","SUP","HCPCS C1713","","239.62  -  PLATE BONE 90D 20MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.64","SUP","HCPCS C1713","","239.64  -  PLATE BONE 90D 20MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.7","SUP","HCPCS C1713","","239.70  -  PLATE BONE 90D 15MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.71","SUP","HCPCS C1713","","239.71  -  PLATE BONE 90D 15MM 55MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.72","SUP","HCPCS C1713","","239.72  -  PLATE BONE 90D 15MM 60MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.73","SUP","HCPCS C1713","","239.73  -  PLATE BONE 90D 15MM 65MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.74","SUP","HCPCS C1713","","239.74  -  PLATE BONE 90D 15MM 70MMX94MM 4X1 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.78","SUP","HCPCS C1713","","239.78  -  PLATE BONE 90D 15MM 40MMX94MM 4X1 HOLE BLADE DCP STAINLESS","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.8","SUP","HCPCS C1713","","239.80  -  PLATE BONE 130D 100MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.81","SUP","HCPCS C1713","","239.81  -  PLATE BONE 130D 105MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$977.85 ","$723.61 ","$0.00 ","$977.85 ","$440.03 ","$0.00 ","$203.81 ","$0.00 ","$0.00 ","$171.21 ","$977.85 ","$0.00 ","$488.93 ","$774.46 ","$782.28 ","$0.00 ","$153.03 ","$0.00 ","$155.67 ","$0.00 "
"239.83","SUP","HCPCS C1713","","239.83  -  PLATE BONE 130D 65MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.84","SUP","HCPCS C1713","","239.84  -  PLATE BONE 130D 65MM 70MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.85","SUP","HCPCS C1713","","239.85  -  PLATE BONE 130D 75MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.86","SUP","HCPCS C1713","","239.86  -  PLATE BONE 130D 80MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.87","SUP","HCPCS C1713","","239.87  -  PLATE BONE 130D 85MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.88","SUP","HCPCS C1713","","239.88  -  PLATE BONE 130D 90MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.89","SUP","HCPCS C1713","","239.89  -  PLATE BONE 130D 95MMX94MM 4X1 HOLE: ANGLED BLADE DCP","BOTH IP/OP","$1,037.40 ","$767.68 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$216.22 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"239.9","SUP","HCPCS C1713","","239.900  -  PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,734.95 ","$2,023.86 ","$0.00 ","$2,734.95 ","$1,230.73 ","$0.00 ","$570.03 ","$0.00 ","$0.00 ","$478.87 ","$2,734.95 ","$0.00 ","$1,367.48 ","$2,166.08 ","$2,187.96 ","$0.00 ","$415.55 ","$0.00 ","$435.40 ","$0.00 "
"239.901","SUP","HCPCS C1713","","239.901  -  PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,734.95 ","$2,023.86 ","$0.00 ","$2,734.95 ","$1,230.73 ","$0.00 ","$570.03 ","$0.00 ","$0.00 ","$478.87 ","$2,734.95 ","$0.00 ","$1,367.48 ","$2,166.08 ","$2,187.96 ","$0.00 ","$415.55 ","$0.00 ","$435.40 ","$0.00 "
"239.904","SUP","HCPCS C1713","","239.904  -  PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,763.63 ","$2,045.09 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$576.01 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"239.905","SUP","HCPCS C1713","","239.905  -  PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,763.63 ","$2,045.09 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$576.01 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"239.908","SUP","HCPCS C1713","","239.908  -  PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS","BOTH IP/OP","$2,789.55 ","$2,064.27 ","$0.00 ","$2,789.55 ","$1,255.30 ","$0.00 ","$581.41 ","$0.00 ","$0.00 ","$488.43 ","$2,789.55 ","$0.00 ","$1,394.78 ","$2,209.32 ","$2,231.64 ","$0.00 ","$423.85 ","$0.00 ","$444.10 ","$0.00 "
"239.909","SUP","HCPCS C1713","","239.909  -  PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS","BOTH IP/OP","$2,789.55 ","$2,064.27 ","$0.00 ","$2,789.55 ","$1,255.30 ","$0.00 ","$581.41 ","$0.00 ","$0.00 ","$488.43 ","$2,789.55 ","$0.00 ","$1,394.78 ","$2,209.32 ","$2,231.64 ","$0.00 ","$423.85 ","$0.00 ","$444.10 ","$0.00 "
"239.912","SUP","HCPCS C1713","","239.912  -  PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,820.95 ","$2,087.50 ","$0.00 ","$2,820.95 ","$1,269.43 ","$0.00 ","$587.96 ","$0.00 ","$0.00 ","$493.93 ","$2,820.95 ","$0.00 ","$1,410.48 ","$2,234.19 ","$2,256.76 ","$0.00 ","$428.62 ","$0.00 ","$449.10 ","$0.00 "
"239.913","SUP","HCPCS C1713","","239.913  -  PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,820.95 ","$2,087.50 ","$0.00 ","$2,820.95 ","$1,269.43 ","$0.00 ","$587.96 ","$0.00 ","$0.00 ","$493.93 ","$2,820.95 ","$0.00 ","$1,410.48 ","$2,234.19 ","$2,256.76 ","$0.00 ","$428.62 ","$0.00 ","$449.10 ","$0.00 "
"239.916","SUP","HCPCS C1713","","239.916  -  PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,850.98 ","$2,109.73 ","$0.00 ","$2,850.98 ","$1,282.94 ","$0.00 ","$594.21 ","$0.00 ","$0.00 ","$499.18 ","$2,850.98 ","$0.00 ","$1,425.49 ","$2,257.98 ","$2,280.78 ","$0.00 ","$433.18 ","$0.00 ","$453.88 ","$0.00 "
"239.917","SUP","HCPCS C1713","","239.917  -  PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,850.98 ","$2,109.73 ","$0.00 ","$2,850.98 ","$1,282.94 ","$0.00 ","$594.21 ","$0.00 ","$0.00 ","$499.18 ","$2,850.98 ","$0.00 ","$1,425.49 ","$2,257.98 ","$2,280.78 ","$0.00 ","$433.18 ","$0.00 ","$453.88 ","$0.00 "
"239.92","SUP","HCPCS C1713","","239.920  -  PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,886.45 ","$2,135.97 ","$0.00 ","$2,886.45 ","$1,298.90 ","$0.00 ","$601.61 ","$0.00 ","$0.00 ","$505.39 ","$2,886.45 ","$0.00 ","$1,443.23 ","$2,286.07 ","$2,309.16 ","$0.00 ","$438.57 ","$0.00 ","$459.52 ","$0.00 "
"239.921","SUP","HCPCS C1713","","239.921  -  PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$2,886.45 ","$2,135.97 ","$0.00 ","$2,886.45 ","$1,298.90 ","$0.00 ","$601.61 ","$0.00 ","$0.00 ","$505.39 ","$2,886.45 ","$0.00 ","$1,443.23 ","$2,286.07 ","$2,309.16 ","$0.00 ","$438.57 ","$0.00 ","$459.52 ","$0.00 "
"239.934","SUP","HCPCS C1713","","239.934  -  PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT PROX","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"239.935","SUP","HCPCS C1713","","239.935  -  PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"239.936","SUP","HCPCS C1713","","239.936  -  PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"239.937","SUP","HCPCS C1713","","239.937  -  PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"239.938","SUP","HCPCS C1713","","239.938  -  PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"239.939","SUP","HCPCS C1713","","239.939  -  PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"239.94","SUP","HCPCS C1713","","239.940  -  PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,676.28 ","$1,980.45 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$557.80 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"239.941","SUP","HCPCS C1713","","239.941  -  PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,756.58 ","$2,039.87 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$574.54 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"239.942","SUP","HCPCS C1713","","239.942  -  PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,793.10 ","$2,066.89 ","$0.00 ","$2,711.75 ","$1,220.29 ","$0.00 ","$582.15 ","$0.00 ","$0.00 ","$474.81 ","$2,711.75 ","$0.00 ","$1,355.88 ","$2,147.71 ","$2,169.40 ","$0.00 ","$412.03 ","$0.00 ","$431.71 ","$0.00 "
"239.943","SUP","HCPCS C1713","","239.943  -  PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,793.10 ","$2,066.89 ","$0.00 ","$2,711.75 ","$1,220.29 ","$0.00 ","$582.15 ","$0.00 ","$0.00 ","$474.81 ","$2,711.75 ","$0.00 ","$1,355.88 ","$2,147.71 ","$2,169.40 ","$0.00 ","$412.03 ","$0.00 ","$431.71 ","$0.00 "
"239.944","SUP","HCPCS C1713","","239.944  -  PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,822.63 ","$2,088.75 ","$0.00 ","$2,740.43 ","$1,233.19 ","$0.00 ","$588.31 ","$0.00 ","$0.00 ","$479.83 ","$2,740.43 ","$0.00 ","$1,370.21 ","$2,170.42 ","$2,192.34 ","$0.00 ","$416.38 ","$0.00 ","$436.28 ","$0.00 "
"239.945","SUP","HCPCS C1713","","239.945  -  PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"239.946","SUP","HCPCS C1713","","239.946  -  PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$3,020.83 ","$2,235.41 ","$0.00 ","$2,932.85 ","$1,319.78 ","$0.00 ","$629.62 ","$0.00 ","$0.00 ","$513.52 ","$2,932.85 ","$0.00 ","$1,466.43 ","$2,322.82 ","$2,346.28 ","$0.00 ","$445.62 ","$0.00 ","$466.91 ","$0.00 "
"239.947","SUP","HCPCS C1713","","239.947  -  PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$3,020.83 ","$2,235.41 ","$0.00 ","$2,932.85 ","$1,319.78 ","$0.00 ","$629.62 ","$0.00 ","$0.00 ","$513.52 ","$2,932.85 ","$0.00 ","$1,466.43 ","$2,322.82 ","$2,346.28 ","$0.00 ","$445.62 ","$0.00 ","$466.91 ","$0.00 "
"239.954","SUP","HCPCS C1713","","239.954  -  PLATE 94MM SS 3.5MM SCR 4 HOLE LCP BONE RIGHT PROX TIB","BOTH IP/OP","$2,655.35 ","$1,964.96 ","$0.00 ","$3,263.43 ","$1,468.54 ","$0.00 ","$553.44 ","$0.00 ","$0.00 ","$571.40 ","$3,263.43 ","$0.00 ","$1,631.71 ","$2,584.64 ","$2,610.74 ","$0.00 ","$510.73 ","$0.00 ","$519.54 ","$0.00 "
"239.955","SUP","HCPCS C1713","","239.955  -  PLATE BN CNTR 93MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX","BOTH IP/OP","$2,502.93 ","$1,852.17 ","$0.00 ","$2,502.93 ","$1,126.32 ","$0.00 ","$521.67 ","$0.00 ","$0.00 ","$438.24 ","$2,502.93 ","$0.00 ","$1,251.46 ","$1,982.32 ","$2,002.34 ","$0.00 ","$391.71 ","$0.00 ","$398.47 ","$0.00 "
"239.956","SUP","HCPCS C1713","","239.956  -  PLATE 119MM SS 3.5MM SCR 6 HOLE LCP BONE RIGHT MDL PROX TIB","BOTH IP/OP","$2,690.50 ","$1,990.97 ","$0.00 ","$3,304.25 ","$1,486.91 ","$0.00 ","$560.77 ","$0.00 ","$0.00 ","$578.55 ","$3,304.25 ","$0.00 ","$1,652.13 ","$2,616.97 ","$2,643.40 ","$0.00 ","$517.12 ","$0.00 ","$526.04 ","$0.00 "
"239.957","SUP","HCPCS C1713","","239.957  -  PLATE BN CNTR 119MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,690.50 ","$1,990.97 ","$0.00 ","$2,612.13 ","$1,175.46 ","$0.00 ","$560.77 ","$0.00 ","$0.00 ","$457.36 ","$2,612.13 ","$0.00 ","$1,306.06 ","$2,068.81 ","$2,089.70 ","$0.00 ","$396.89 ","$0.00 ","$415.85 ","$0.00 "
"239.958","SUP","HCPCS C1713","","239.958  -  PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,722.83 ","$2,014.89 ","$0.00 ","$2,643.53 ","$1,189.59 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$462.86 ","$2,643.53 ","$0.00 ","$1,321.76 ","$2,093.68 ","$2,114.82 ","$0.00 ","$401.66 ","$0.00 ","$420.85 ","$0.00 "
"239.959","SUP","HCPCS C1713","","239.959  -  PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,722.83 ","$2,014.89 ","$0.00 ","$2,643.53 ","$1,189.59 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$462.86 ","$2,643.53 ","$0.00 ","$1,321.76 ","$2,093.68 ","$2,114.82 ","$0.00 ","$401.66 ","$0.00 ","$420.85 ","$0.00 "
"239.96","SUP","HCPCS C1713","","239.960  -  PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,673.55 ","$1,978.43 ","$0.00 ","$2,673.55 ","$1,203.10 ","$0.00 ","$557.23 ","$0.00 ","$0.00 ","$468.12 ","$2,673.55 ","$0.00 ","$1,336.78 ","$2,117.45 ","$2,138.84 ","$0.00 ","$406.22 ","$0.00 ","$425.63 ","$0.00 "
"239.961","SUP","HCPCS C1713","","239.961  -  PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,753.75 ","$2,037.78 ","$0.00 ","$2,673.55 ","$1,203.10 ","$0.00 ","$573.95 ","$0.00 ","$0.00 ","$468.12 ","$2,673.55 ","$0.00 ","$1,336.78 ","$2,117.45 ","$2,138.84 ","$0.00 ","$406.22 ","$0.00 ","$425.63 ","$0.00 "
"239.962","SUP","HCPCS C1713","","239.962  -  PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,783.28 ","$2,059.63 ","$0.00 ","$2,702.20 ","$1,215.99 ","$0.00 ","$580.10 ","$0.00 ","$0.00 ","$473.13 ","$2,702.20 ","$0.00 ","$1,351.10 ","$2,140.14 ","$2,161.76 ","$0.00 ","$410.58 ","$0.00 ","$430.19 ","$0.00 "
"239.963","SUP","HCPCS C1713","","239.963  -  PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,783.28 ","$2,059.63 ","$0.00 ","$2,702.20 ","$1,215.99 ","$0.00 ","$580.10 ","$0.00 ","$0.00 ","$473.13 ","$2,702.20 ","$0.00 ","$1,351.10 ","$2,140.14 ","$2,161.76 ","$0.00 ","$410.58 ","$0.00 ","$430.19 ","$0.00 "
"239.964","SUP","HCPCS C1713","","239.964  -  PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,817.00 ","$2,084.58 ","$0.00 ","$2,734.95 ","$1,230.73 ","$0.00 ","$587.13 ","$0.00 ","$0.00 ","$478.87 ","$2,734.95 ","$0.00 ","$1,367.48 ","$2,166.08 ","$2,187.96 ","$0.00 ","$415.55 ","$0.00 ","$435.40 ","$0.00 "
"239.965","SUP","HCPCS C1713","","239.965  -  PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$2,817.00 ","$2,084.58 ","$0.00 ","$2,734.95 ","$1,230.73 ","$0.00 ","$587.13 ","$0.00 ","$0.00 ","$478.87 ","$2,734.95 ","$0.00 ","$1,367.48 ","$2,166.08 ","$2,187.96 ","$0.00 ","$415.55 ","$0.00 ","$435.40 ","$0.00 "
"239.966","SUP","HCPCS C1713","","239.966  -  PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$3,013.80 ","$2,230.21 ","$0.00 ","$2,926.03 ","$1,316.71 ","$0.00 ","$628.15 ","$0.00 ","$0.00 ","$512.32 ","$2,926.03 ","$0.00 ","$1,463.01 ","$2,317.42 ","$2,340.82 ","$0.00 ","$444.59 ","$0.00 ","$465.82 ","$0.00 "
"239.967","SUP","HCPCS C1713","","239.967  -  PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$3,013.80 ","$2,230.21 ","$0.00 ","$2,926.03 ","$1,316.71 ","$0.00 ","$628.15 ","$0.00 ","$0.00 ","$512.32 ","$2,926.03 ","$0.00 ","$1,463.01 ","$2,317.42 ","$2,340.82 ","$0.00 ","$444.59 ","$0.00 ","$465.82 ","$0.00 "
"239.968","SUP","HCPCS C1713","","239.968  -  PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$3,122.05 ","$2,310.32 ","$0.00 ","$3,031.10 ","$1,364.00 ","$0.00 ","$650.71 ","$0.00 ","$0.00 ","$530.72 ","$3,031.10 ","$0.00 ","$1,515.55 ","$2,400.63 ","$2,424.88 ","$0.00 ","$460.55 ","$0.00 ","$482.55 ","$0.00 "
"239.969","SUP","HCPCS C1713","","239.969  -  PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$3,122.05 ","$2,310.32 ","$0.00 ","$3,031.10 ","$1,364.00 ","$0.00 ","$650.71 ","$0.00 ","$0.00 ","$530.72 ","$3,031.10 ","$0.00 ","$1,515.55 ","$2,400.63 ","$2,424.88 ","$0.00 ","$460.55 ","$0.00 ","$482.55 ","$0.00 "
"239.97","SUP","HCPCS C1713","","239.970  -  PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$3,130.73 ","$2,316.74 ","$0.00 ","$3,130.73 ","$1,408.83 ","$0.00 ","$652.52 ","$0.00 ","$0.00 ","$548.16 ","$3,130.73 ","$0.00 ","$1,565.36 ","$2,479.54 ","$2,504.58 ","$0.00 ","$475.69 ","$0.00 ","$498.41 ","$0.00 "
"239.971","SUP","HCPCS C1713","","239.971  -  PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB LT","BOTH IP/OP","$3,224.65 ","$2,386.24 ","$0.00 ","$3,130.73 ","$1,408.83 ","$0.00 ","$672.10 ","$0.00 ","$0.00 ","$548.16 ","$3,130.73 ","$0.00 ","$1,565.36 ","$2,479.54 ","$2,504.58 ","$0.00 ","$475.69 ","$0.00 ","$498.41 ","$0.00 "
"239.984","SUP","HCPCS C1713","","239.984  -  PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,665.20 ","$1,972.25 ","$0.00 ","$2,587.58 ","$1,164.41 ","$0.00 ","$555.49 ","$0.00 ","$0.00 ","$453.06 ","$2,587.58 ","$0.00 ","$1,293.79 ","$2,049.36 ","$2,070.06 ","$0.00 ","$393.16 ","$0.00 ","$411.94 ","$0.00 "
"239.985","SUP","HCPCS C1713","","239.985  -  PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,665.20 ","$1,972.25 ","$0.00 ","$2,587.58 ","$1,164.41 ","$0.00 ","$555.49 ","$0.00 ","$0.00 ","$453.06 ","$2,587.58 ","$0.00 ","$1,293.79 ","$2,049.36 ","$2,070.06 ","$0.00 ","$393.16 ","$0.00 ","$411.94 ","$0.00 "
"239.986","SUP","HCPCS C1713","","239.986  -  PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,697.53 ","$1,996.17 ","$0.00 ","$2,618.95 ","$1,178.53 ","$0.00 ","$562.23 ","$0.00 ","$0.00 ","$458.56 ","$2,618.95 ","$0.00 ","$1,309.48 ","$2,074.21 ","$2,095.16 ","$0.00 ","$397.93 ","$0.00 ","$416.94 ","$0.00 "
"239.987","SUP","HCPCS C1713","","239.987  -  PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,697.53 ","$1,996.17 ","$0.00 ","$2,618.95 ","$1,178.53 ","$0.00 ","$562.23 ","$0.00 ","$0.00 ","$458.56 ","$2,618.95 ","$0.00 ","$1,309.48 ","$2,074.21 ","$2,095.16 ","$0.00 ","$397.93 ","$0.00 ","$416.94 ","$0.00 "
"239.988","SUP","HCPCS C1713","","239.988  -  PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP","BOTH IP/OP","$2,728.45 ","$2,019.05 ","$0.00 ","$2,648.98 ","$1,192.04 ","$0.00 ","$568.68 ","$0.00 ","$0.00 ","$463.81 ","$2,648.98 ","$0.00 ","$1,324.49 ","$2,097.99 ","$2,119.18 ","$0.00 ","$402.49 ","$0.00 ","$421.72 ","$0.00 "
"239.989","SUP","HCPCS C1713","","239.989  -  PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP","BOTH IP/OP","$2,728.45 ","$2,019.05 ","$0.00 ","$2,648.98 ","$1,192.04 ","$0.00 ","$568.68 ","$0.00 ","$0.00 ","$463.81 ","$2,648.98 ","$0.00 ","$1,324.49 ","$2,097.99 ","$2,119.18 ","$0.00 ","$402.49 ","$0.00 ","$421.72 ","$0.00 "
"239.99","SUP","HCPCS C1713","","239.990  -  PLATE BONE 214MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,677.65 ","$1,981.46 ","$0.00 ","$2,677.65 ","$1,204.94 ","$0.00 ","$558.09 ","$0.00 ","$0.00 ","$468.84 ","$2,677.65 ","$0.00 ","$1,338.83 ","$2,120.70 ","$2,142.12 ","$0.00 ","$406.85 ","$0.00 ","$426.28 ","$0.00 "
"239.991","SUP","HCPCS C1713","","239.991  -  PLATE BONE 214MM 10 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,757.98 ","$2,040.91 ","$0.00 ","$2,677.65 ","$1,204.94 ","$0.00 ","$574.83 ","$0.00 ","$0.00 ","$468.84 ","$2,677.65 ","$0.00 ","$1,338.83 ","$2,120.70 ","$2,142.12 ","$0.00 ","$406.85 ","$0.00 ","$426.28 ","$0.00 "
"239.992","SUP","HCPCS C1713","","239.992  -  PLATE BONE 250MM 12 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"239.993","SUP","HCPCS C1713","","239.993  -  PLATE BONE 250MM 12 HOLE LIMITED CONTACT PROFILE LCP","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"239.994","SUP","HCPCS C1713","","239.994  -  PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"239.995","SUP","HCPCS C1713","","239.995  -  PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"239.996","SUP","HCPCS C1713","","239.996  -  PLATE BONE 322MM 16 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$2,947.73 ","$2,181.32 ","$0.00 ","$2,861.88 ","$1,287.84 ","$0.00 ","$614.38 ","$0.00 ","$0.00 ","$501.09 ","$2,861.88 ","$0.00 ","$1,430.94 ","$2,266.61 ","$2,289.50 ","$0.00 ","$434.84 ","$0.00 ","$455.61 ","$0.00 "
"239.997","SUP","HCPCS C1713","","239.997  -  PLATE BONE 322MM 16 HOLE LCP STAINLESS STEEL LEFT PROXIMAL","BOTH IP/OP","$2,947.73 ","$2,181.32 ","$0.00 ","$2,861.88 ","$1,287.84 ","$0.00 ","$614.38 ","$0.00 ","$0.00 ","$501.09 ","$2,861.88 ","$0.00 ","$1,430.94 ","$2,266.61 ","$2,289.50 ","$0.00 ","$434.84 ","$0.00 ","$455.61 ","$0.00 "
"240.002","SUP","HCPCS C1713","","240.002  -  PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,154.93 ","$1,594.65 ","$0.00 ","$2,092.15 ","$941.47 ","$0.00 ","$449.14 ","$0.00 ","$0.00 ","$366.32 ","$2,092.15 ","$0.00 ","$1,046.08 ","$1,656.98 ","$1,673.72 ","$0.00 ","$317.89 ","$0.00 ","$333.07 ","$0.00 "
"240.003","SUP","HCPCS C1713","","240.003  -  PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,154.93 ","$1,594.65 ","$0.00 ","$2,092.15 ","$941.47 ","$0.00 ","$449.14 ","$0.00 ","$0.00 ","$366.32 ","$2,092.15 ","$0.00 ","$1,046.08 ","$1,656.98 ","$1,673.72 ","$0.00 ","$317.89 ","$0.00 ","$333.07 ","$0.00 "
"240.004","SUP","HCPCS C1713","","240.004  -  PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,160.55 ","$1,598.81 ","$0.00 ","$2,097.63 ","$943.93 ","$0.00 ","$450.31 ","$0.00 ","$0.00 ","$367.28 ","$2,097.63 ","$0.00 ","$1,048.81 ","$1,661.32 ","$1,678.10 ","$0.00 ","$318.72 ","$0.00 ","$333.94 ","$0.00 "
"240.005","SUP","HCPCS C1713","","240.005  -  PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,160.55 ","$1,598.81 ","$0.00 ","$2,097.63 ","$943.93 ","$0.00 ","$450.31 ","$0.00 ","$0.00 ","$367.28 ","$2,097.63 ","$0.00 ","$1,048.81 ","$1,661.32 ","$1,678.10 ","$0.00 ","$318.72 ","$0.00 ","$333.94 ","$0.00 "
"240.006","SUP","HCPCS C1713","","240.006  -  PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,164.78 ","$1,601.94 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$451.19 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$319.34 ","$0.00 ","$334.59 ","$0.00 "
"240.007","SUP","HCPCS C1713","","240.007  -  PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,164.78 ","$1,601.94 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$451.19 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$319.34 ","$0.00 ","$334.59 ","$0.00 "
"240.008","SUP","HCPCS C1713","","240.008  -  PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,240.68 ","$1,658.10 ","$0.00 ","$2,175.40 ","$978.93 ","$0.00 ","$467.01 ","$0.00 ","$0.00 ","$380.90 ","$2,175.40 ","$0.00 ","$1,087.70 ","$1,722.92 ","$1,740.32 ","$0.00 ","$330.54 ","$0.00 ","$346.32 ","$0.00 "
"240.009","SUP","HCPCS C1713","","240.009  -  PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL LEFT PROXIMAL","BOTH IP/OP","$2,240.68 ","$1,658.10 ","$0.00 ","$2,175.40 ","$978.93 ","$0.00 ","$467.01 ","$0.00 ","$0.00 ","$380.90 ","$2,175.40 ","$0.00 ","$1,087.70 ","$1,722.92 ","$1,740.32 ","$0.00 ","$330.54 ","$0.00 ","$346.32 ","$0.00 "
"240.01","SUP","HCPCS C1713","","240.010  -  PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,180.88 ","$1,613.85 ","$0.00 ","$2,180.88 ","$981.39 ","$0.00 ","$454.55 ","$0.00 ","$0.00 ","$381.85 ","$2,180.88 ","$0.00 ","$1,090.44 ","$1,727.26 ","$1,744.70 ","$0.00 ","$331.37 ","$0.00 ","$347.20 ","$0.00 "
"240.011","SUP","HCPCS C1713","","240.011  -  PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL","BOTH IP/OP","$2,246.30 ","$1,662.26 ","$0.00 ","$2,180.88 ","$981.39 ","$0.00 ","$468.19 ","$0.00 ","$0.00 ","$381.85 ","$2,180.88 ","$0.00 ","$1,090.44 ","$1,727.26 ","$1,744.70 ","$0.00 ","$331.37 ","$0.00 ","$347.20 ","$0.00 "
"240.012","SUP","HCPCS C1713","","240.012  -  PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,402.33 ","$1,777.72 ","$0.00 ","$2,332.35 ","$1,049.56 ","$0.00 ","$500.70 ","$0.00 ","$0.00 ","$408.38 ","$2,332.35 ","$0.00 ","$1,166.18 ","$1,847.22 ","$1,865.88 ","$0.00 ","$354.38 ","$0.00 ","$371.31 ","$0.00 "
"240.013","SUP","HCPCS C1713","","240.013  -  PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,336.25 ","$1,728.83 ","$0.00 ","$2,268.23 ","$1,020.70 ","$0.00 ","$486.93 ","$0.00 ","$0.00 ","$397.15 ","$2,268.23 ","$0.00 ","$1,134.11 ","$1,796.44 ","$1,814.58 ","$0.00 ","$344.64 ","$0.00 ","$361.10 ","$0.00 "
"240.014","SUP","HCPCS C1713","","240.014  -  PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,386.88 ","$1,766.29 ","$0.00 ","$2,317.35 ","$1,042.81 ","$0.00 ","$497.48 ","$0.00 ","$0.00 ","$405.75 ","$2,317.35 ","$0.00 ","$1,158.68 ","$1,835.34 ","$1,853.88 ","$0.00 ","$352.10 ","$0.00 ","$368.92 ","$0.00 "
"240.015","SUP","HCPCS C1713","","240.015  -  PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL LEFT PROXIMAL","BOTH IP/OP","$2,386.88 ","$1,766.29 ","$0.00 ","$2,317.35 ","$1,042.81 ","$0.00 ","$497.48 ","$0.00 ","$0.00 ","$405.75 ","$2,317.35 ","$0.00 ","$1,158.68 ","$1,835.34 ","$1,853.88 ","$0.00 ","$352.10 ","$0.00 ","$368.92 ","$0.00 "
"240.019","SUP","Custom 27803010","","240.019  -  WASHER ORTHOPEDIC 4.5MM 3.5MM LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$99.10 ","$73.33 ","$0.00 ","$96.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.20 ","$0.00 ","$48.10 ","$76.19 ","$76.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"240.036","SUP","HCPCS C1713","","240.036  -  PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB","BOTH IP/OP","$2,666.60 ","$1,973.28 ","$0.00 ","$2,588.93 ","$1,165.02 ","$0.00 ","$555.79 ","$0.00 ","$0.00 ","$453.30 ","$2,588.93 ","$0.00 ","$1,294.46 ","$2,050.43 ","$2,071.14 ","$0.00 ","$393.37 ","$0.00 ","$412.16 ","$0.00 "
"240.037","SUP","HCPCS C1713","","240.037  -  PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB","BOTH IP/OP","$2,666.60 ","$1,973.28 ","$0.00 ","$2,588.93 ","$1,165.02 ","$0.00 ","$555.79 ","$0.00 ","$0.00 ","$453.30 ","$2,588.93 ","$0.00 ","$1,294.46 ","$2,050.43 ","$2,071.14 ","$0.00 ","$393.37 ","$0.00 ","$412.16 ","$0.00 "
"240.038","SUP","HCPCS C1713","","240.038  -  PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,698.93 ","$1,997.21 ","$0.00 ","$2,620.33 ","$1,179.15 ","$0.00 ","$562.52 ","$0.00 ","$0.00 ","$458.80 ","$2,620.33 ","$0.00 ","$1,310.16 ","$2,075.30 ","$2,096.26 ","$0.00 ","$398.14 ","$0.00 ","$417.16 ","$0.00 "
"240.039","SUP","HCPCS C1713","","240.039  -  PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,698.93 ","$1,997.21 ","$0.00 ","$2,620.33 ","$1,179.15 ","$0.00 ","$562.52 ","$0.00 ","$0.00 ","$458.80 ","$2,620.33 ","$0.00 ","$1,310.16 ","$2,075.30 ","$2,096.26 ","$0.00 ","$398.14 ","$0.00 ","$417.16 ","$0.00 "
"240.04","SUP","HCPCS C1713","","240.040  -  PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,650.35 ","$1,961.26 ","$0.00 ","$2,650.35 ","$1,192.66 ","$0.00 ","$552.40 ","$0.00 ","$0.00 ","$464.06 ","$2,650.35 ","$0.00 ","$1,325.18 ","$2,099.08 ","$2,120.28 ","$0.00 ","$402.70 ","$0.00 ","$421.94 ","$0.00 "
"240.041","SUP","HCPCS C1713","","240.041  -  PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,729.85 ","$2,020.09 ","$0.00 ","$2,650.35 ","$1,192.66 ","$0.00 ","$568.97 ","$0.00 ","$0.00 ","$464.06 ","$2,650.35 ","$0.00 ","$1,325.18 ","$2,099.08 ","$2,120.28 ","$0.00 ","$402.70 ","$0.00 ","$421.94 ","$0.00 "
"240.042","SUP","HCPCS C1713","","240.042  -  PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,759.38 ","$2,041.94 ","$0.00 ","$2,679.00 ","$1,205.55 ","$0.00 ","$575.12 ","$0.00 ","$0.00 ","$469.07 ","$2,679.00 ","$0.00 ","$1,339.50 ","$2,121.77 ","$2,143.20 ","$0.00 ","$407.05 ","$0.00 ","$426.50 ","$0.00 "
"240.043","SUP","HCPCS C1713","","240.043  -  PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,759.38 ","$2,041.94 ","$0.00 ","$2,679.00 ","$1,205.55 ","$0.00 ","$575.12 ","$0.00 ","$0.00 ","$469.07 ","$2,679.00 ","$0.00 ","$1,339.50 ","$2,121.77 ","$2,143.20 ","$0.00 ","$407.05 ","$0.00 ","$426.50 ","$0.00 "
"240.044","SUP","HCPCS C1713","","240.044  -  PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,791.70 ","$2,065.86 ","$0.00 ","$2,710.40 ","$1,219.68 ","$0.00 ","$581.86 ","$0.00 ","$0.00 ","$474.57 ","$2,710.40 ","$0.00 ","$1,355.20 ","$2,146.64 ","$2,168.32 ","$0.00 ","$411.82 ","$0.00 ","$431.50 ","$0.00 "
"240.045","SUP","HCPCS C1713","","240.045  -  PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,791.70 ","$2,065.86 ","$0.00 ","$2,710.40 ","$1,219.68 ","$0.00 ","$581.86 ","$0.00 ","$0.00 ","$474.57 ","$2,710.40 ","$0.00 ","$1,355.20 ","$2,146.64 ","$2,168.32 ","$0.00 ","$411.82 ","$0.00 ","$431.50 ","$0.00 "
"240.046","SUP","HCPCS C1713","","240.046  -  PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,821.23 ","$2,087.71 ","$0.00 ","$2,739.05 ","$1,232.57 ","$0.00 ","$588.01 ","$0.00 ","$0.00 ","$479.59 ","$2,739.05 ","$0.00 ","$1,369.53 ","$2,169.33 ","$2,191.24 ","$0.00 ","$416.18 ","$0.00 ","$436.06 ","$0.00 "
"240.047","SUP","HCPCS C1713","","240.047  -  PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$2,821.23 ","$2,087.71 ","$0.00 ","$2,739.05 ","$1,232.57 ","$0.00 ","$588.01 ","$0.00 ","$0.00 ","$479.59 ","$2,739.05 ","$0.00 ","$1,369.53 ","$2,169.33 ","$2,191.24 ","$0.00 ","$416.18 ","$0.00 ","$436.06 ","$0.00 "
"240.064","SUP","HCPCS C1713","","240.064  -  PLATE BONE 4 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$482.30 ","$356.90 ","$0.00 ","$482.30 ","$217.04 ","$0.00 ","$100.52 ","$0.00 ","$0.00 ","$84.45 ","$482.30 ","$0.00 ","$241.15 ","$381.98 ","$385.84 ","$0.00 ","$75.48 ","$0.00 ","$76.78 ","$0.00 "
"240.065","SUP","HCPCS C1713","","240.065  -  PLATE BONE 5 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$514.10 ","$380.43 ","$0.00 ","$514.10 ","$231.35 ","$0.00 ","$107.15 ","$0.00 ","$0.00 ","$90.01 ","$514.10 ","$0.00 ","$257.05 ","$407.17 ","$411.28 ","$0.00 ","$80.46 ","$0.00 ","$81.84 ","$0.00 "
"240.066","SUP","HCPCS C1713","","240.066  -  PLATE BONE 6 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$544.58 ","$402.99 ","$0.00 ","$544.58 ","$245.06 ","$0.00 ","$113.50 ","$0.00 ","$0.00 ","$95.35 ","$544.58 ","$0.00 ","$272.29 ","$431.31 ","$435.66 ","$0.00 ","$85.23 ","$0.00 ","$86.70 ","$0.00 "
"240.067","SUP","HCPCS C1713","","240.067  -  PLATE BONE 7 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$580.35 ","$429.46 ","$0.00 ","$580.35 ","$261.16 ","$0.00 ","$120.96 ","$0.00 ","$0.00 ","$101.61 ","$580.35 ","$0.00 ","$290.18 ","$459.64 ","$464.28 ","$0.00 ","$90.82 ","$0.00 ","$92.39 ","$0.00 "
"240.068","SUP","HCPCS C1713","","240.068  -  PLATE BONE 8 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$614.80 ","$454.95 ","$0.00 ","$614.80 ","$276.66 ","$0.00 ","$128.14 ","$0.00 ","$0.00 ","$107.65 ","$614.80 ","$0.00 ","$307.40 ","$486.92 ","$491.84 ","$0.00 ","$96.22 ","$0.00 ","$97.88 ","$0.00 "
"240.069","SUP","HCPCS C1713","","240.069  -  PLATE BONE 9 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$643.95 ","$476.52 ","$0.00 ","$643.95 ","$289.78 ","$0.00 ","$134.22 ","$0.00 ","$0.00 ","$112.75 ","$643.95 ","$0.00 ","$321.98 ","$510.01 ","$515.16 ","$0.00 ","$100.78 ","$0.00 ","$102.52 ","$0.00 "
"240.07","SUP","HCPCS C1713","","240.070  -  LASER SURG 20 BACKSTOP","BOTH IP/OP","$677.08 ","$501.04 ","$0.00 ","$677.08 ","$304.68 ","$0.00 ","$141.12 ","$0.00 ","$0.00 ","$118.55 ","$677.08 ","$0.00 ","$338.54 ","$536.25 ","$541.66 ","$0.00 ","$105.96 ","$0.00 ","$107.79 ","$0.00 "
"240.071","SUP","HCPCS C1713","","240.071  -  PLATE BONE 11 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$734.05 ","$543.20 ","$0.00 ","$734.05 ","$330.32 ","$0.00 ","$152.99 ","$0.00 ","$0.00 ","$128.53 ","$734.05 ","$0.00 ","$367.03 ","$581.37 ","$587.24 ","$0.00 ","$114.88 ","$0.00 ","$116.86 ","$0.00 "
"240.072","SUP","HCPCS C1713","","240.072  -  PLATE BONE 12 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$760.55 ","$562.81 ","$0.00 ","$760.55 ","$342.25 ","$0.00 ","$158.52 ","$0.00 ","$0.00 ","$133.17 ","$760.55 ","$0.00 ","$380.28 ","$602.36 ","$608.44 ","$0.00 ","$119.03 ","$0.00 ","$121.08 ","$0.00 "
"240.073","SUP","HCPCS C1713","","240.073  -  PLATE BONE 13 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$812.23 ","$601.05 ","$0.00 ","$812.23 ","$365.50 ","$0.00 ","$169.29 ","$0.00 ","$0.00 ","$142.21 ","$812.23 ","$0.00 ","$406.11 ","$643.29 ","$649.78 ","$0.00 ","$127.11 ","$0.00 ","$129.31 ","$0.00 "
"240.074","SUP","HCPCS C1713","","240.074  -  PLATE BONE 14 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$857.28 ","$634.39 ","$0.00 ","$857.28 ","$385.77 ","$0.00 ","$178.68 ","$0.00 ","$0.00 ","$150.10 ","$857.28 ","$0.00 ","$428.64 ","$678.97 ","$685.82 ","$0.00 ","$134.16 ","$0.00 ","$136.48 ","$0.00 "
"240.075","SUP","HCPCS C1713","","240.075  -  PLATE BONE 15 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$912.93 ","$675.57 ","$0.00 ","$912.93 ","$410.82 ","$0.00 ","$190.28 ","$0.00 ","$0.00 ","$159.85 ","$912.93 ","$0.00 ","$456.46 ","$723.04 ","$730.34 ","$0.00 ","$142.87 ","$0.00 ","$145.34 ","$0.00 "
"240.076","SUP","HCPCS C1713","","240.076  -  PLATE BONE 16 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL","BOTH IP/OP","$995.08 ","$736.36 ","$0.00 ","$995.08 ","$447.78 ","$0.00 ","$207.40 ","$0.00 ","$0.00 ","$174.23 ","$995.08 ","$0.00 ","$497.54 ","$788.10 ","$796.06 ","$0.00 ","$155.73 ","$0.00 ","$158.42 ","$0.00 "
"240.082","SUP","HCPCS C1713","","240.082  -  PLATE BONE 173MM 7 HOLE PILON LCP STAINLESS STEEL DISTAL","BOTH IP/OP","$3,212.00 ","$2,376.88 ","$0.00 ","$3,118.45 ","$1,403.30 ","$0.00 ","$669.46 ","$0.00 ","$0.00 ","$546.02 ","$3,118.45 ","$0.00 ","$1,559.23 ","$2,469.81 ","$2,494.76 ","$0.00 ","$599.36 ","$0.00 ","$496.46 ","$0.00 "
"240.083","SUP","HCPCS C1713","","240.083  -  PLATE BONE 173MM 9 HOLE PILON CNTOUR LCP STAINLESS STEEL","BOTH IP/OP","$3,380.70 ","$2,501.72 ","$0.00 ","$3,282.23 ","$1,477.00 ","$0.00 ","$704.62 ","$0.00 ","$0.00 ","$574.69 ","$3,282.23 ","$0.00 ","$1,641.11 ","$2,599.53 ","$2,625.78 ","$0.00 ","$498.71 ","$0.00 ","$522.53 ","$0.00 "
"240.13","SUP","HCPCS C1713","","240.13  -  PLATE BONE T 68MM 3 HOLE DCP LC-DCP STAINLESS STEEL FT","BOTH IP/OP","$490.25 ","$362.79 ","$0.00 ","$490.25 ","$220.61 ","$0.00 ","$102.18 ","$0.00 ","$0.00 ","$85.84 ","$490.25 ","$0.00 ","$245.13 ","$388.28 ","$392.20 ","$0.00 ","$76.72 ","$0.00 ","$78.05 ","$0.00 "
"240.14","SUP","HCPCS C1713","","240.14  -  PLATE BN T 84MM NS 4 HL SHFT SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$551.03 ","$407.76 ","$0.00 ","$534.98 ","$240.74 ","$0.00 ","$114.85 ","$0.00 ","$0.00 ","$93.67 ","$534.98 ","$0.00 ","$267.49 ","$423.70 ","$427.98 ","$0.00 ","$81.29 ","$0.00 ","$85.17 ","$0.00 "
"240.141","SUP","HCPCS C1713","","240.141  -  PLATE BN T 83MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS 4.5/5","BOTH IP/OP","$1,137.20 ","$841.53 ","$0.00 ","$1,104.08 ","$496.83 ","$0.00 ","$237.02 ","$0.00 ","$0.00 ","$193.31 ","$1,104.08 ","$0.00 ","$552.04 ","$874.43 ","$883.26 ","$0.00 ","$167.76 ","$0.00 ","$175.77 ","$0.00 "
"240.15","SUP","HCPCS C1713","","240.15  -  PLATE BONE 100MM 5 HOLE T DCP LC-DCP STAINLESS STEEL FT","BOTH IP/OP","$560.48 ","$414.76 ","$0.00 ","$560.48 ","$252.21 ","$0.00 ","$116.82 ","$0.00 ","$0.00 ","$98.13 ","$560.48 ","$0.00 ","$280.24 ","$443.90 ","$448.38 ","$0.00 ","$87.71 ","$0.00 ","$89.23 ","$0.00 "
"240.16","SUP","HCPCS C1713","","240.16  -  PLATE BN T 116MM NS 6 HL SHFT SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$638.70 ","$472.64 ","$0.00 ","$638.70 ","$287.42 ","$0.00 ","$133.12 ","$0.00 ","$0.00 ","$111.83 ","$638.70 ","$0.00 ","$319.35 ","$505.85 ","$510.96 ","$0.00 ","$97.05 ","$0.00 ","$101.68 ","$0.00 "
"240.161","SUP","HCPCS C1713","","240.161  -  PLATE BN T 115MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS 4.5/5","BOTH IP/OP","$1,304.48 ","$965.32 ","$0.00 ","$1,266.50 ","$569.93 ","$0.00 ","$271.89 ","$0.00 ","$0.00 ","$221.75 ","$1,266.50 ","$0.00 ","$633.25 ","$1,003.07 ","$1,013.20 ","$0.00 ","$192.43 ","$0.00 ","$201.63 ","$0.00 "
"240.18","SUP","HCPCS C1713","","240.18  -  PLATE BN T 148MM NS 8 HL SHFT SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$865.25 ","$640.29 ","$0.00 ","$865.25 ","$389.36 ","$0.00 ","$180.34 ","$0.00 ","$0.00 ","$151.50 ","$865.25 ","$0.00 ","$432.63 ","$685.28 ","$692.20 ","$0.00 ","$131.47 ","$0.00 ","$137.75 ","$0.00 "
"240.181","SUP","HCPCS C1713","","240.181  -  PLATE BN T 147MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS 4.5/5","BOTH IP/OP","$1,505.50 ","$1,114.07 ","$0.00 ","$1,461.65 ","$657.74 ","$0.00 ","$313.78 ","$0.00 ","$0.00 ","$255.92 ","$1,461.65 ","$0.00 ","$730.83 ","$1,157.63 ","$1,169.32 ","$0.00 ","$222.09 ","$0.00 ","$232.69 ","$0.00 "
"240.34","SUP","HCPCS C1713","","240.34  -  PLATE BN TBTRS 80MM NS DCP 4 HL SHFT SS 4.5MM SCR LG FRAG","BOTH IP/OP","$814.88 ","$603.01 ","$0.00 ","$814.88 ","$366.69 ","$0.00 ","$169.84 ","$0.00 ","$0.00 ","$142.68 ","$814.88 ","$0.00 ","$407.44 ","$645.38 ","$651.90 ","$0.00 ","$127.53 ","$0.00 ","$129.73 ","$0.00 "
"240.35","SUP","HCPCS C1713","","240.35  -  PLATE BONE T 96MM 5 HOLE BUTTRESS DCP LC-DCP STAINLESS STEEL","BOTH IP/OP","$857.28 ","$634.39 ","$0.00 ","$857.28 ","$385.77 ","$0.00 ","$178.68 ","$0.00 ","$0.00 ","$150.10 ","$857.28 ","$0.00 ","$428.64 ","$678.97 ","$685.82 ","$0.00 ","$134.16 ","$0.00 ","$136.48 ","$0.00 "
"240.36","SUP","HCPCS C1713","","240.36  -  PLATE BONE T 112MM 6 HOLE BUTTRESS DCP STAINLESS STEEL FT","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"240.403","SUP","HCPCS C1713","","240.403  -  PLATE BONE 87MM 3 HOLE BUTTRESS DCP STAINLESS STEEL TIBIAL","BOTH IP/OP","$1,057.35 ","$782.44 ","$0.00 ","$1,057.35 ","$475.81 ","$0.00 ","$220.38 ","$0.00 ","$0.00 ","$185.13 ","$1,057.35 ","$0.00 ","$528.68 ","$837.42 ","$845.88 ","$0.00 ","$165.48 ","$0.00 ","$168.33 ","$0.00 "
"240.406","SUP","HCPCS C1713","","240.406  -  PLATE BONE LEFT ANGLE L 115MM 6 HOLE BUTTRESS LC-DCP","BOTH IP/OP","$1,018.10 ","$753.39 ","$0.00 ","$1,018.10 ","$458.15 ","$0.00 ","$212.20 ","$0.00 ","$0.00 ","$178.26 ","$1,018.10 ","$0.00 ","$509.05 ","$806.34 ","$814.48 ","$0.00 ","$154.69 ","$0.00 ","$162.08 ","$0.00 "
"240.407","SUP","HCPCS C1713","","240.407  -  PLATE BONE LEFT ANGLE L 132MM 7 HOLE BUTTRESS LC-DCP","BOTH IP/OP","$1,075.90 ","$796.17 ","$0.00 ","$1,075.90 ","$484.16 ","$0.00 ","$224.24 ","$0.00 ","$0.00 ","$188.38 ","$1,075.90 ","$0.00 ","$537.95 ","$852.11 ","$860.72 ","$0.00 ","$168.38 ","$0.00 ","$171.28 ","$0.00 "
"240.408","SUP","HCPCS C1713","","240.408  -  PLATE BONE LEFT ANGLE L 148MM 8 HOLE BUTTRESS LC-DCP","BOTH IP/OP","$1,162.78 ","$860.46 ","$0.00 ","$1,162.78 ","$523.25 ","$0.00 ","$242.35 ","$0.00 ","$0.00 ","$203.59 ","$1,162.78 ","$0.00 ","$581.39 ","$920.92 ","$930.22 ","$0.00 ","$176.67 ","$0.00 ","$185.11 ","$0.00 "
"240.44","SUP","HCPCS C1713","","240.44  -  PLATE BN ANG LT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB","BOTH IP/OP","$734.23 ","$543.33 ","$0.00 ","$734.23 ","$330.40 ","$0.00 ","$153.03 ","$0.00 ","$0.00 ","$128.56 ","$734.23 ","$0.00 ","$367.11 ","$581.51 ","$587.38 ","$0.00 ","$111.56 ","$0.00 ","$116.89 ","$0.00 "
"240.46","SUP","HCPCS C1713","","240.46  -  PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD RL LG","BOTH IP/OP","$1,266.50 ","$937.21 ","$0.00 ","$1,266.50 ","$569.93 ","$0.00 ","$263.97 ","$0.00 ","$0.00 ","$221.75 ","$1,266.50 ","$0.00 ","$633.25 ","$1,003.07 ","$1,013.20 ","$0.00 ","$192.43 ","$0.00 ","$201.63 ","$0.00 "
"240.47","SUP","HCPCS C1713","","240.47  -  PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD RL LG","BOTH IP/OP","$1,401.48 ","$1,037.10 ","$0.00 ","$1,360.65 ","$612.29 ","$0.00 ","$292.10 ","$0.00 ","$0.00 ","$238.24 ","$1,360.65 ","$0.00 ","$680.33 ","$1,077.63 ","$1,088.52 ","$0.00 ","$206.74 ","$0.00 ","$216.62 ","$0.00 "
"240.48","SUP","HCPCS C1713","","240.48  -  PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD RL LG","BOTH IP/OP","$1,495.65 ","$1,106.78 ","$0.00 ","$1,452.10 ","$653.45 ","$0.00 ","$311.73 ","$0.00 ","$0.00 ","$254.25 ","$1,452.10 ","$0.00 ","$726.05 ","$1,150.06 ","$1,161.68 ","$0.00 ","$220.63 ","$0.00 ","$231.17 ","$0.00 "
"240.5","SUP","HCPCS C1713","","240.50  -  PLATE BONE 240MM 13 HOLE BUTTRESS DCP STAINLESS STEEL TIBIA","BOTH IP/OP","$1,604.95 ","$1,187.66 ","$0.00 ","$1,604.95 ","$722.23 ","$0.00 ","$334.51 ","$0.00 ","$0.00 ","$281.01 ","$1,604.95 ","$0.00 ","$802.48 ","$1,271.12 ","$1,283.96 ","$0.00 ","$243.86 ","$0.00 ","$255.51 ","$0.00 "
"240.505","SUP","HCPCS C1713","","240.505  -  PLATE BONE RIGHT ANG L 101MM 5 HOLE BUTTRESS LC-DCP","BOTH IP/OP","$983.15 ","$727.53 ","$0.00 ","$983.15 ","$442.42 ","$0.00 ","$204.91 ","$0.00 ","$0.00 ","$172.14 ","$983.15 ","$0.00 ","$491.58 ","$778.65 ","$786.52 ","$0.00 ","$153.86 ","$0.00 ","$156.52 ","$0.00 "
"240.506","SUP","HCPCS C1713","","240.506  -  PLATE BONE RIGHT ANG L 115MM 6 HOLE BUTTRESS LC-DCP","BOTH IP/OP","$1,018.10 ","$753.39 ","$0.00 ","$1,018.10 ","$458.15 ","$0.00 ","$212.20 ","$0.00 ","$0.00 ","$178.26 ","$1,018.10 ","$0.00 ","$509.05 ","$806.34 ","$814.48 ","$0.00 ","$154.69 ","$0.00 ","$162.08 ","$0.00 "
"240.508","SUP","HCPCS C1713","","240.508  -  PLATE BONE RIGHT ANG L 148MM 8 HOLE BUTTRESS LC-DCP","BOTH IP/OP","$1,162.78 ","$860.46 ","$0.00 ","$1,162.78 ","$523.25 ","$0.00 ","$242.35 ","$0.00 ","$0.00 ","$203.59 ","$1,162.78 ","$0.00 ","$581.39 ","$920.92 ","$930.22 ","$0.00 ","$176.67 ","$0.00 ","$185.11 ","$0.00 "
"240.509","SUP","HCPCS C1713","","240.509  -  PLATE BONE 162MM BUTTRESS L 9 HOLE LC-DCP TITANIUM LEFT","BOTH IP/OP","$1,175.28 ","$869.71 ","$0.00 ","$1,175.28 ","$528.87 ","$0.00 ","$244.96 ","$0.00 ","$0.00 ","$205.78 ","$1,175.28 ","$0.00 ","$587.64 ","$930.82 ","$940.22 ","$0.00 ","$183.93 ","$0.00 ","$187.10 ","$0.00 "
"240.54","SUP","HCPCS C1713","","240.54  -  PLATE BN ANG RT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB","BOTH IP/OP","$734.23 ","$543.33 ","$0.00 ","$734.23 ","$330.40 ","$0.00 ","$153.03 ","$0.00 ","$0.00 ","$128.56 ","$734.23 ","$0.00 ","$367.11 ","$581.51 ","$587.38 ","$0.00 ","$111.56 ","$0.00 ","$116.89 ","$0.00 "
"240.56","SUP","HCPCS C1713","","240.56  -  PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD L/L 4.5","BOTH IP/OP","$1,304.48 ","$965.32 ","$0.00 ","$1,266.50 ","$569.93 ","$0.00 ","$271.89 ","$0.00 ","$0.00 ","$221.75 ","$1,266.50 ","$0.00 ","$633.25 ","$1,003.07 ","$1,013.20 ","$0.00 ","$192.43 ","$0.00 ","$201.63 ","$0.00 "
"240.57","SUP","HCPCS C1713","","240.57  -  PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD L/L LG","BOTH IP/OP","$1,401.48 ","$1,037.10 ","$0.00 ","$1,360.65 ","$612.29 ","$0.00 ","$292.10 ","$0.00 ","$0.00 ","$238.24 ","$1,360.65 ","$0.00 ","$680.33 ","$1,077.63 ","$1,088.52 ","$0.00 ","$206.74 ","$0.00 ","$216.62 ","$0.00 "
"240.58","SUP","HCPCS C1713","","240.58  -  PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD L/L LG","BOTH IP/OP","$1,495.65 ","$1,106.78 ","$0.00 ","$1,452.10 ","$653.45 ","$0.00 ","$311.73 ","$0.00 ","$0.00 ","$254.25 ","$1,452.10 ","$0.00 ","$726.05 ","$1,150.06 ","$1,161.68 ","$0.00 ","$220.63 ","$0.00 ","$231.17 ","$0.00 "
"240.6","SUP","HCPCS C1713","","240.60  -  PLATE BONE 240X14X3.8MM 13 HOLE SHAFT BUTTRESS DCP STAINLESS","BOTH IP/OP","$1,604.95 ","$1,187.66 ","$0.00 ","$1,604.95 ","$722.23 ","$0.00 ","$334.51 ","$0.00 ","$0.00 ","$281.01 ","$1,604.95 ","$0.00 ","$802.48 ","$1,271.12 ","$1,283.96 ","$0.00 ","$243.86 ","$0.00 ","$255.51 ","$0.00 "
"240.7","SUP","HCPCS C1713","","240.70  -  PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS","BOTH IP/OP","$1,539.45 ","$1,139.19 ","$0.00 ","$1,539.45 ","$692.75 ","$0.00 ","$320.86 ","$0.00 ","$0.00 ","$269.55 ","$1,539.45 ","$0.00 ","$769.73 ","$1,219.24 ","$1,231.56 ","$0.00 ","$233.90 ","$0.00 ","$245.08 ","$0.00 "
"240.71","SUP","HCPCS C1713","","240.71  -  PLATE BONE BUTTRESS 253X16X5MM 11 HOLE SHAFT DCP STAINLESS","BOTH IP/OP","$1,582.05 ","$1,170.72 ","$0.00 ","$1,582.05 ","$711.92 ","$0.00 ","$329.74 ","$0.00 ","$0.00 ","$277.00 ","$1,582.05 ","$0.00 ","$791.03 ","$1,252.98 ","$1,265.64 ","$0.00 ","$247.59 ","$0.00 ","$251.86 ","$0.00 "
"240.72","SUP","HCPCS C1713","","240.72  -  PLATE BONE 285MM BUTTRESS 15 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,624.45 ","$1,202.09 ","$0.00 ","$1,624.45 ","$731.00 ","$0.00 ","$338.58 ","$0.00 ","$0.00 ","$284.43 ","$1,624.45 ","$0.00 ","$812.23 ","$1,286.56 ","$1,299.56 ","$0.00 ","$254.23 ","$0.00 ","$258.61 ","$0.00 "
"240.73","SUP","HCPCS C1713","","240.73  -  PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS","BOTH IP/OP","$1,537.00 ","$1,137.38 ","$0.00 ","$1,537.00 ","$691.65 ","$0.00 ","$320.35 ","$0.00 ","$0.00 ","$269.12 ","$1,537.00 ","$0.00 ","$768.50 ","$1,217.30 ","$1,229.60 ","$0.00 ","$240.54 ","$0.00 ","$244.69 ","$0.00 "
"240.75","SUP","HCPCS C1713","","240.75  -  PLATE BONE 285MM 15 HOLE BUTTRESS DCP STAINLESS STEEL","BOTH IP/OP","$1,624.45 ","$1,202.09 ","$0.00 ","$1,624.45 ","$731.00 ","$0.00 ","$338.58 ","$0.00 ","$0.00 ","$284.43 ","$1,624.45 ","$0.00 ","$812.23 ","$1,286.56 ","$1,299.56 ","$0.00 ","$254.23 ","$0.00 ","$258.61 ","$0.00 "
"240.8","SUP","HCPCS C1713","","240.80  -  PLATE BONE 128MM 4 HOLE HOOK BUTTRESS DCP STAINLESS STEEL","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,257.43 ","$565.84 ","$0.00 ","$262.08 ","$0.00 ","$0.00 ","$220.17 ","$1,257.43 ","$0.00 ","$628.71 ","$995.88 ","$1,005.94 ","$0.00 ","$196.79 ","$0.00 ","$200.18 ","$0.00 "
"240.9","SUP","HCPCS C1713","","240.90  -  PLATE 202MM SS LG FRAG SET 10 HOLE CBR HEAD DCP BONE ORTH","BOTH IP/OP","$1,158.05 ","$856.96 ","$0.00 ","$1,158.05 ","$521.12 ","$0.00 ","$241.37 ","$0.00 ","$0.00 ","$202.77 ","$1,158.05 ","$0.00 ","$579.03 ","$917.18 ","$926.44 ","$0.00 ","$181.23 ","$0.00 ","$184.36 ","$0.00 "
"240.91","SUP","HCPCS C1713","","240.91  -  PLATE BONE 218MM 11 HOLE COBRA HEAD LC-DCP STAINLESS STEEL","BOTH IP/OP","$1,220.33 ","$903.04 ","$0.00 ","$1,220.33 ","$549.15 ","$0.00 ","$254.35 ","$0.00 ","$0.00 ","$213.67 ","$1,220.33 ","$0.00 ","$610.16 ","$966.50 ","$976.26 ","$0.00 ","$190.98 ","$0.00 ","$194.28 ","$0.00 "
"240.92","SUP","HCPCS C1713","","240.92  -  PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM LT CNDRL","BOTH IP/OP","$1,356.55 ","$1,003.85 ","$0.00 ","$1,356.55 ","$610.45 ","$0.00 ","$282.74 ","$0.00 ","$0.00 ","$237.52 ","$1,356.55 ","$0.00 ","$678.28 ","$1,074.39 ","$1,085.24 ","$0.00 ","$206.12 ","$0.00 ","$215.96 ","$0.00 "
"240.93","SUP","HCPCS C1713","","240.93  -  PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM LT CNDRL","BOTH IP/OP","$1,467.10 ","$1,085.65 ","$0.00 ","$1,467.10 ","$660.20 ","$0.00 ","$305.78 ","$0.00 ","$0.00 ","$256.88 ","$1,467.10 ","$0.00 ","$733.55 ","$1,161.94 ","$1,173.68 ","$0.00 ","$222.91 ","$0.00 ","$233.56 ","$0.00 "
"240.94","SUP","HCPCS C1713","","240.94  -  PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM RT CNDRL","BOTH IP/OP","$1,356.55 ","$1,003.85 ","$0.00 ","$1,356.55 ","$610.45 ","$0.00 ","$282.74 ","$0.00 ","$0.00 ","$237.52 ","$1,356.55 ","$0.00 ","$678.28 ","$1,074.39 ","$1,085.24 ","$0.00 ","$206.12 ","$0.00 ","$215.96 ","$0.00 "
"240.95","SUP","HCPCS C1713","","240.95  -  PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM RT CNDRL","BOTH IP/OP","$1,467.10 ","$1,085.65 ","$0.00 ","$1,467.10 ","$660.20 ","$0.00 ","$305.78 ","$0.00 ","$0.00 ","$256.88 ","$1,467.10 ","$0.00 ","$733.55 ","$1,161.94 ","$1,173.68 ","$0.00 ","$222.91 ","$0.00 ","$233.56 ","$0.00 "
"240.98","SUP","HCPCS C1713","","240.98  -  PLATE BONE 170MM 8 HOLE COBRA HEAD DCP STAINLESS STEEL","BOTH IP/OP","$1,030.85 ","$762.83 ","$0.00 ","$1,030.85 ","$463.88 ","$0.00 ","$214.85 ","$0.00 ","$0.00 ","$180.49 ","$1,030.85 ","$0.00 ","$515.43 ","$816.43 ","$824.68 ","$0.00 ","$161.33 ","$0.00 ","$164.11 ","$0.00 "
"240.99","SUP","HCPCS C1713","","240.99  -  PLATE BONE 186MM 9 HOLE COBRA HEAD DCP STAINLESS STEEL","BOTH IP/OP","$1,098.43 ","$812.84 ","$0.00 ","$1,098.43 ","$494.29 ","$0.00 ","$228.94 ","$0.00 ","$0.00 ","$192.33 ","$1,098.43 ","$0.00 ","$549.21 ","$869.96 ","$878.74 ","$0.00 ","$171.90 ","$0.00 ","$174.87 ","$0.00 "
"241.004","SUP","HCPCS C1713","","241.004  -  PLATE BN 60MM NS 4 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG","BOTH IP/OP","$2,171.80 ","$1,607.13 ","$0.00 ","$2,108.55 ","$948.85 ","$0.00 ","$452.66 ","$0.00 ","$0.00 ","$369.19 ","$2,108.55 ","$0.00 ","$1,054.28 ","$1,669.97 ","$1,686.84 ","$0.00 ","$320.38 ","$0.00 ","$335.68 ","$0.00 "
"241.005","SUP","HCPCS C1713","","241.005  -  PLATE BONE 60MM 4 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,171.80 ","$1,607.13 ","$0.00 ","$2,108.55 ","$948.85 ","$0.00 ","$452.66 ","$0.00 ","$0.00 ","$369.19 ","$2,108.55 ","$0.00 ","$1,054.28 ","$1,669.97 ","$1,686.84 ","$0.00 ","$320.38 ","$0.00 ","$335.68 ","$0.00 "
"241.006","SUP","HCPCS C1713","","241.006  -  PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,180.23 ","$1,613.37 ","$0.00 ","$2,116.73 ","$952.53 ","$0.00 ","$454.41 ","$0.00 ","$0.00 ","$370.62 ","$2,116.73 ","$0.00 ","$1,058.36 ","$1,676.45 ","$1,693.38 ","$0.00 ","$321.62 ","$0.00 ","$336.98 ","$0.00 "
"241.007","SUP","HCPCS C1713","","241.007  -  PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,180.23 ","$1,613.37 ","$0.00 ","$2,116.73 ","$952.53 ","$0.00 ","$454.41 ","$0.00 ","$0.00 ","$370.62 ","$2,116.73 ","$0.00 ","$1,058.36 ","$1,676.45 ","$1,693.38 ","$0.00 ","$321.62 ","$0.00 ","$336.98 ","$0.00 "
"241.008","SUP","HCPCS C1713","","241.008  -  PLATE BN 111MM NS 8 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG","BOTH IP/OP","$2,250.53 ","$1,665.39 ","$0.00 ","$2,184.98 ","$983.24 ","$0.00 ","$469.07 ","$0.00 ","$0.00 ","$382.57 ","$2,184.98 ","$0.00 ","$1,092.49 ","$1,730.50 ","$1,747.98 ","$0.00 ","$331.99 ","$0.00 ","$347.85 ","$0.00 "
"241.009","SUP","HCPCS C1713","","241.009  -  PLATE BN 111MM NS 8 HL SHFT SS TIB LT PROX 3.5MM SCR SM FRAG","BOTH IP/OP","$2,250.53 ","$1,665.39 ","$0.00 ","$2,184.98 ","$983.24 ","$0.00 ","$469.07 ","$0.00 ","$0.00 ","$382.57 ","$2,184.98 ","$0.00 ","$1,092.49 ","$1,730.50 ","$1,747.98 ","$0.00 ","$331.99 ","$0.00 ","$347.85 ","$0.00 "
"241.01","SUP","HCPCS C1713","","241.010  -  PLATE BONE 137MM 10 HOLE STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,197.25 ","$1,625.97 ","$0.00 ","$2,197.25 ","$988.76 ","$0.00 ","$457.96 ","$0.00 ","$0.00 ","$384.72 ","$2,197.25 ","$0.00 ","$1,098.63 ","$1,740.22 ","$1,757.80 ","$0.00 ","$333.85 ","$0.00 ","$349.80 ","$0.00 "
"241.011","SUP","HCPCS C1713","","241.011  -  PLATE BN 137MM NS 10 HL SHFT SS TIB LT PROX 3.5MM SCR SM","BOTH IP/OP","$2,263.18 ","$1,674.75 ","$0.00 ","$2,197.25 ","$988.76 ","$0.00 ","$471.70 ","$0.00 ","$0.00 ","$384.72 ","$2,197.25 ","$0.00 ","$1,098.63 ","$1,740.22 ","$1,757.80 ","$0.00 ","$333.85 ","$0.00 ","$349.80 ","$0.00 "
"241.012","SUP","HCPCS C1713","","241.012  -  PLATE BN 137MM NS 12 HL SHFT SS TIB RT PROX 3.5MM SCR SM","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.013","SUP","HCPCS C1713","","241.013  -  PLATE BN 163MM NS 12 HL SHFT SS TIB LT PROX 3.5MM SCR SM","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.014","SUP","HCPCS C1713","","241.014  -  PLATE BONE 163MM 14 HOLE STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$2,398.10 ","$1,774.59 ","$0.00 ","$2,328.28 ","$1,047.72 ","$0.00 ","$499.82 ","$0.00 ","$0.00 ","$407.66 ","$2,328.28 ","$0.00 ","$1,164.14 ","$1,844.00 ","$1,862.62 ","$0.00 ","$353.76 ","$0.00 ","$370.66 ","$0.00 "
"241.015","SUP","HCPCS C1713","","241.015  -  PLATE BONE 189MM 14 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,398.10 ","$1,774.59 ","$0.00 ","$2,328.28 ","$1,047.72 ","$0.00 ","$499.82 ","$0.00 ","$0.00 ","$407.66 ","$2,328.28 ","$0.00 ","$1,164.14 ","$1,844.00 ","$1,862.62 ","$0.00 ","$353.76 ","$0.00 ","$370.66 ","$0.00 "
"241.016","SUP","HCPCS C1713","","241.016  -  PLATE BN 215MM NS 16 HL SHFT SS TIB RT PROX 3.5MM SCR SM","BOTH IP/OP","$2,447.30 ","$1,811.00 ","$0.00 ","$2,376.03 ","$1,069.21 ","$0.00 ","$510.08 ","$0.00 ","$0.00 ","$416.02 ","$2,376.03 ","$0.00 ","$1,188.01 ","$1,881.82 ","$1,900.82 ","$0.00 ","$361.02 ","$0.00 ","$378.26 ","$0.00 "
"241.017","SUP","HCPCS C1713","","241.017  -  PLATE BONE 215MM 16 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,447.30 ","$1,811.00 ","$0.00 ","$2,376.03 ","$1,069.21 ","$0.00 ","$510.08 ","$0.00 ","$0.00 ","$416.02 ","$2,376.03 ","$0.00 ","$1,188.01 ","$1,881.82 ","$1,900.82 ","$0.00 ","$361.02 ","$0.00 ","$378.26 ","$0.00 "
"241.031","SUP","HCPCS C1713","","241.031  -  PLATE BN OB R T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$662.08 ","$489.94 ","$0.00 ","$642.80 ","$289.26 ","$0.00 ","$137.99 ","$0.00 ","$0.00 ","$112.55 ","$642.80 ","$0.00 ","$321.40 ","$509.10 ","$514.24 ","$0.00 ","$97.67 ","$0.00 ","$102.33 ","$0.00 "
"241.041","SUP","HCPCS C1713","","241.041  -  PLATE BN OB R T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$693.00 ","$512.82 ","$0.00 ","$672.83 ","$302.77 ","$0.00 ","$144.44 ","$0.00 ","$0.00 ","$117.81 ","$672.83 ","$0.00 ","$336.41 ","$532.88 ","$538.26 ","$0.00 ","$102.23 ","$0.00 ","$107.11 ","$0.00 "
"241.051","SUP","HCPCS C1713","","241.051  -  PLATE BN OB R T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT","BOTH IP/OP","$723.93 ","$535.71 ","$0.00 ","$702.85 ","$316.28 ","$0.00 ","$150.88 ","$0.00 ","$0.00 ","$123.06 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$141.20 ","$0.00 ","$111.89 ","$0.00 "
"241.061","SUP","HCPCS C1713","","241.061  -  PLATE BONE T 85X10X1.5MM 3X6 HOLE OBLIQUE RIGHT LCP","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"241.062","SUP","HCPCS C1713","","241.062  -  PLATE BONE 15MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,272.00 ","$941.28 ","$0.00 ","$1,272.00 ","$572.40 ","$0.00 ","$265.12 ","$0.00 ","$0.00 ","$222.72 ","$1,272.00 ","$0.00 ","$636.00 ","$1,007.42 ","$1,017.60 ","$0.00 ","$199.07 ","$0.00 ","$202.50 ","$0.00 "
"241.063","SUP","HCPCS C1713","","241.063  -  PLATE BONE 15MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,272.00 ","$941.28 ","$0.00 ","$1,272.00 ","$572.40 ","$0.00 ","$265.12 ","$0.00 ","$0.00 ","$222.72 ","$1,272.00 ","$0.00 ","$636.00 ","$1,007.42 ","$1,017.60 ","$0.00 ","$199.07 ","$0.00 ","$202.50 ","$0.00 "
"241.064","SUP","HCPCS C1713","","241.064  -  PLATE BONE 18MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,272.00 ","$941.28 ","$0.00 ","$1,272.00 ","$572.40 ","$0.00 ","$265.12 ","$0.00 ","$0.00 ","$222.72 ","$1,272.00 ","$0.00 ","$636.00 ","$1,007.42 ","$1,017.60 ","$0.00 ","$199.07 ","$0.00 ","$202.50 ","$0.00 "
"241.065","SUP","HCPCS C1713","","241.065  -  PLATE BONE 18MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,272.00 ","$941.28 ","$0.00 ","$1,272.00 ","$572.40 ","$0.00 ","$265.12 ","$0.00 ","$0.00 ","$222.72 ","$1,272.00 ","$0.00 ","$636.00 ","$1,007.42 ","$1,017.60 ","$0.00 ","$199.07 ","$0.00 ","$202.50 ","$0.00 "
"241.066","SUP","HCPCS C1713","","241.066  -  PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,364.75 ","$1,009.92 ","$0.00 ","$1,364.75 ","$614.14 ","$0.00 ","$284.45 ","$0.00 ","$0.00 ","$238.96 ","$1,364.75 ","$0.00 ","$682.38 ","$1,080.88 ","$1,091.80 ","$0.00 ","$213.58 ","$0.00 ","$217.27 ","$0.00 "
"241.067","SUP","HCPCS C1713","","241.067  -  PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,364.75 ","$1,009.92 ","$0.00 ","$1,364.75 ","$614.14 ","$0.00 ","$284.45 ","$0.00 ","$0.00 ","$238.96 ","$1,364.75 ","$0.00 ","$682.38 ","$1,080.88 ","$1,091.80 ","$0.00 ","$213.58 ","$0.00 ","$217.27 ","$0.00 "
"241.068","SUP","HCPCS C1713","","241.068  -  PLATE BONE 18MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,364.75 ","$1,009.92 ","$0.00 ","$1,364.75 ","$614.14 ","$0.00 ","$284.45 ","$0.00 ","$0.00 ","$238.96 ","$1,364.75 ","$0.00 ","$682.38 ","$1,080.88 ","$1,091.80 ","$0.00 ","$213.58 ","$0.00 ","$217.27 ","$0.00 "
"241.069","SUP","HCPCS C1713","","241.069  -  PLATE BN 18MM 77X10X3.3MM NS LC DCP 8 HL HK PRECONTOUR SS","BOTH IP/OP","$1,364.75 ","$1,009.92 ","$0.00 ","$1,364.75 ","$614.14 ","$0.00 ","$284.45 ","$0.00 ","$0.00 ","$238.96 ","$1,364.75 ","$0.00 ","$682.38 ","$1,080.88 ","$1,091.80 ","$0.00 ","$213.58 ","$0.00 ","$217.27 ","$0.00 "
"241.071","SUP","HCPCS C1713","","241.071  -  PLATE BN OB R T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT","BOTH IP/OP","$785.78 ","$581.48 ","$0.00 ","$762.90 ","$343.31 ","$0.00 ","$163.78 ","$0.00 ","$0.00 ","$133.58 ","$762.90 ","$0.00 ","$381.45 ","$604.22 ","$610.32 ","$0.00 ","$153.59 ","$0.00 ","$121.45 ","$0.00 "
"241.081","SUP","HCPCS C1713","","241.081  -  PLATE BONE T 107X10X1.5MM 3X8 HOLE OBLIQUE RIGHT LCP","BOTH IP/OP","$853.25 ","$631.41 ","$0.00 ","$828.40 ","$372.78 ","$0.00 ","$177.84 ","$0.00 ","$0.00 ","$145.05 ","$828.40 ","$0.00 ","$414.20 ","$656.09 ","$662.72 ","$0.00 ","$125.87 ","$0.00 ","$131.88 ","$0.00 "
"241.13","SUP","HCPCS C1713","","241.13  -  PLATE BN RT ANG T 50X10X1.2MM NS LC DCP 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$233.38 ","$172.70 ","$0.00 ","$233.38 ","$105.02 ","$0.00 ","$48.64 ","$0.00 ","$0.00 ","$40.86 ","$233.38 ","$0.00 ","$116.69 ","$184.84 ","$186.70 ","$0.00 ","$35.46 ","$0.00 ","$37.15 ","$0.00 "
"241.131","SUP","HCPCS C1713","","241.131  -  PLATE BONE T RIGHT ANG 50X10X1.5MM 3X3 HOLE LCP STAINLESS","BOTH IP/OP","$591.80 ","$437.93 ","$0.00 ","$574.55 ","$258.55 ","$0.00 ","$123.35 ","$0.00 ","$0.00 ","$100.60 ","$574.55 ","$0.00 ","$287.28 ","$455.04 ","$459.64 ","$0.00 ","$87.30 ","$0.00 ","$91.47 ","$0.00 "
"241.132","SUP","HCPCS C1713","","241.132  -  PLATE BONE T RIGHT ANG 50X11X1.5MM 4X3 HOLE LCP STAINLESS","BOTH IP/OP","$607.25 ","$449.37 ","$0.00 ","$589.58 ","$265.31 ","$0.00 ","$126.57 ","$0.00 ","$0.00 ","$103.23 ","$589.58 ","$0.00 ","$294.79 ","$466.95 ","$471.66 ","$0.00 ","$89.58 ","$0.00 ","$93.86 ","$0.00 "
"241.14","SUP","HCPCS C1713","","241.14  -  PLATE BN RT ANG T 56X10X1.2MM NS LC DCP 4 HLE/HD 4 HL SHFT","BOTH IP/OP","$248.80 ","$184.11 ","$0.00 ","$241.55 ","$108.70 ","$0.00 ","$51.86 ","$0.00 ","$0.00 ","$42.29 ","$241.55 ","$0.00 ","$120.78 ","$191.31 ","$193.24 ","$0.00 ","$36.70 ","$0.00 ","$38.45 ","$0.00 "
"241.141","SUP","HCPCS C1713","","241.141  -  PLATE BN RT ANG T 56X11X1.5MM NS LCP CMBN 4 HLE/HD 4 HL SHFT","BOTH IP/OP","$610.08 ","$451.46 ","$0.00 ","$592.30 ","$266.54 ","$0.00 ","$127.15 ","$0.00 ","$0.00 ","$103.71 ","$592.30 ","$0.00 ","$296.15 ","$469.10 ","$473.84 ","$0.00 ","$90.00 ","$0.00 ","$94.29 ","$0.00 "
"241.142","SUP","HCPCS C1713","","241.142  -  PLATE BN RT ANG T 57X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$629.75 ","$466.02 ","$0.00 ","$611.40 ","$275.13 ","$0.00 ","$131.26 ","$0.00 ","$0.00 ","$107.05 ","$611.40 ","$0.00 ","$305.70 ","$484.23 ","$489.12 ","$0.00 ","$92.90 ","$0.00 ","$97.33 ","$0.00 "
"241.15","SUP","HCPCS C1713","","241.15  -  PLATE BN RT ANG T 67X10X1.2MM NS LC DCP 3 HLE/HD 5 HL SHFT","BOTH IP/OP","$267.50 ","$197.95 ","$0.00 ","$267.50 ","$120.38 ","$0.00 ","$55.75 ","$0.00 ","$0.00 ","$46.84 ","$267.50 ","$0.00 ","$133.75 ","$211.86 ","$214.00 ","$0.00 ","$40.64 ","$0.00 ","$42.59 ","$0.00 "
"241.151","SUP","HCPCS C1713","","241.151  -  PLATE BN RT ANG T 67X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT","BOTH IP/OP","$671.93 ","$497.23 ","$0.00 ","$652.35 ","$293.56 ","$0.00 ","$140.05 ","$0.00 ","$0.00 ","$114.22 ","$652.35 ","$0.00 ","$326.18 ","$516.66 ","$521.88 ","$0.00 ","$99.12 ","$0.00 ","$103.85 ","$0.00 "
"241.152","SUP","HCPCS C1713","","241.152  -  PLATE BONE 67MM 3X5 HOLE T RIGHT ANG LCP STAINLESS STEEL","BOTH IP/OP","$691.60 ","$511.78 ","$0.00 ","$671.45 ","$302.15 ","$0.00 ","$144.15 ","$0.00 ","$0.00 ","$117.57 ","$671.45 ","$0.00 ","$335.73 ","$531.79 ","$537.16 ","$0.00 ","$102.02 ","$0.00 ","$106.89 ","$0.00 "
"241.16","SUP","HCPCS C1713","","241.16  -  PLATE BONE ANGLE RIGHT T 75X10X1.2MM 4X6 HOLE LCP STAINLESS","BOTH IP/OP","$311.18 ","$230.27 ","$0.00 ","$311.18 ","$140.03 ","$0.00 ","$64.86 ","$0.00 ","$0.00 ","$54.48 ","$311.18 ","$0.00 ","$155.59 ","$246.45 ","$248.94 ","$0.00 ","$47.28 ","$0.00 ","$49.54 ","$0.00 "
"241.161","SUP","HCPCS C1713","","241.161  -  PLATE BN RT ANG T 78X11X1.5MM NS LCP CMBN 4 HLE/HD 6 HL SHFT","BOTH IP/OP","$782.98 ","$579.41 ","$0.00 ","$760.18 ","$342.08 ","$0.00 ","$163.19 ","$0.00 ","$0.00 ","$133.10 ","$760.18 ","$0.00 ","$380.09 ","$602.06 ","$608.14 ","$0.00 ","$115.50 ","$0.00 ","$121.02 ","$0.00 "
"241.162","SUP","HCPCS C1713","","241.162  -  PLATE BONE T RIGHT ANG 77X10X1.5MM 3X6 HOLE LCP STAINLESS","BOTH IP/OP","$804.05 ","$595.00 ","$0.00 ","$780.63 ","$351.28 ","$0.00 ","$167.58 ","$0.00 ","$0.00 ","$136.68 ","$780.63 ","$0.00 ","$390.31 ","$618.26 ","$624.50 ","$0.00 ","$118.61 ","$0.00 ","$124.28 ","$0.00 "
"241.17","SUP","HCPCS C1713","","241.17  -  PLATE BONE T RIGHT ANG 90X10X1.2MM 4X7 HOLE LCP STAINLESS","BOTH IP/OP","$399.88 ","$295.91 ","$0.00 ","$399.88 ","$179.94 ","$0.00 ","$83.34 ","$0.00 ","$0.00 ","$70.01 ","$399.88 ","$0.00 ","$199.94 ","$316.70 ","$319.90 ","$0.00 ","$60.76 ","$0.00 ","$63.66 ","$0.00 "
"241.171","SUP","HCPCS C1713","","241.171  -  PLATE BN RT ANG T 87X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT","BOTH IP/OP","$981.18 ","$726.07 ","$0.00 ","$952.60 ","$428.67 ","$0.00 ","$204.50 ","$0.00 ","$0.00 ","$166.79 ","$952.60 ","$0.00 ","$476.30 ","$754.46 ","$762.08 ","$0.00 ","$144.74 ","$0.00 ","$151.65 ","$0.00 "
"241.172","SUP","HCPCS C1713","","241.172  -  PLATE BONE T RIGHT ANG 89X11X1.5MM 4X7 HOLE LCP STAINLESS","BOTH IP/OP","$976.95 ","$722.94 ","$0.00 ","$948.50 ","$426.83 ","$0.00 ","$203.62 ","$0.00 ","$0.00 ","$166.07 ","$948.50 ","$0.00 ","$474.25 ","$751.21 ","$758.80 ","$0.00 ","$144.12 ","$0.00 ","$151.00 ","$0.00 "
"241.18","SUP","HCPCS C1713","","241.18  -  PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LC-DCP","BOTH IP/OP","$464.03 ","$343.38 ","$0.00 ","$464.03 ","$208.81 ","$0.00 ","$96.71 ","$0.00 ","$0.00 ","$81.25 ","$464.03 ","$0.00 ","$232.01 ","$367.51 ","$371.22 ","$0.00 ","$70.50 ","$0.00 ","$73.87 ","$0.00 "
"241.181","SUP","HCPCS C1713","","241.181  -  PLATE BONE T RIGHT ANG 97X10X1.5MM 3X8 HOLE LCP STAINLESS","BOTH IP/OP","$1,175.15 ","$869.61 ","$0.00 ","$1,140.93 ","$513.42 ","$0.00 ","$244.93 ","$0.00 ","$0.00 ","$199.77 ","$1,140.93 ","$0.00 ","$570.46 ","$903.62 ","$912.74 ","$0.00 ","$173.36 ","$0.00 ","$181.64 ","$0.00 "
"241.182","SUP","HCPCS C1713","","241.182  -  PLATE BONE T RIGHT ANG 100X10X1.5MM 4X8 HOLE LCP STAINLESS","BOTH IP/OP","$1,170.95 ","$866.50 ","$0.00 ","$1,136.83 ","$511.57 ","$0.00 ","$244.06 ","$0.00 ","$0.00 ","$199.05 ","$1,136.83 ","$0.00 ","$568.41 ","$900.37 ","$909.46 ","$0.00 ","$172.73 ","$0.00 ","$180.98 ","$0.00 "
"241.189","SUP","HCPCS C1713","","241.189  -  PLATE BONE 112MM 4 HOLE HEAD 9 HOLE SHAFT T RIGHT ANG LC-DCP","BOTH IP/OP","$517.30 ","$382.80 ","$0.00 ","$502.23 ","$226.00 ","$0.00 ","$107.82 ","$0.00 ","$0.00 ","$87.94 ","$502.23 ","$0.00 ","$251.11 ","$397.77 ","$401.78 ","$0.00 ","$76.31 ","$0.00 ","$79.95 ","$0.00 "
"241.23","SUP","HCPCS C1713","","241.23  -  PLATE BN OBLQ T 53X10X1.5MM NS LC DCP 3 HLE/HD 3 HL SHFT SS","BOTH IP/OP","$401.23 ","$296.91 ","$0.00 ","$401.23 ","$180.55 ","$0.00 ","$83.63 ","$0.00 ","$0.00 ","$70.25 ","$401.23 ","$0.00 ","$200.61 ","$317.77 ","$320.98 ","$0.00 ","$60.96 ","$0.00 ","$63.88 ","$0.00 "
"241.231","SUP","HCPCS C1713","","241.231  -  PLATE BONE 53MM 3X3 HOLE T OBLIQUE ANGLE LCP STAINLESS STEEL","BOTH IP/OP","$427.98 ","$316.71 ","$0.00 ","$427.98 ","$192.59 ","$0.00 ","$89.20 ","$0.00 ","$0.00 ","$74.93 ","$427.98 ","$0.00 ","$213.99 ","$338.96 ","$342.38 ","$0.00 ","$66.98 ","$0.00 ","$68.13 ","$0.00 "
"241.24","SUP","HCPCS C1713","","241.24  -  PLATE BN OBLQ T 63X10X1.5MM NS LC DCP 3 HLE/HD 4 HL SHFT SS","BOTH IP/OP","$424.43 ","$314.08 ","$0.00 ","$424.43 ","$190.99 ","$0.00 ","$88.46 ","$0.00 ","$0.00 ","$74.31 ","$424.43 ","$0.00 ","$212.21 ","$336.15 ","$339.54 ","$0.00 ","$64.49 ","$0.00 ","$67.57 ","$0.00 "
"241.241","SUP","HCPCS C1713","","241.241  -  PLATE BONE 63MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS","BOTH IP/OP","$449.18 ","$332.39 ","$0.00 ","$449.18 ","$202.13 ","$0.00 ","$93.62 ","$0.00 ","$0.00 ","$78.65 ","$449.18 ","$0.00 ","$224.59 ","$355.75 ","$359.34 ","$0.00 ","$70.30 ","$0.00 ","$71.51 ","$0.00 "
"241.25","SUP","HCPCS C1713","","241.25  -  PLATE BN OBLQ T 75X10X1.5MM NS LC DCP 3 HLE/HD 5 HL SHFT SS","BOTH IP/OP","$436.73 ","$323.18 ","$0.00 ","$436.73 ","$196.53 ","$0.00 ","$91.02 ","$0.00 ","$0.00 ","$76.47 ","$436.73 ","$0.00 ","$218.36 ","$345.89 ","$349.38 ","$0.00 ","$66.36 ","$0.00 ","$69.53 ","$0.00 "
"241.252","SUP","HCPCS C1713","","241.252  -  PLATE BONE 75MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS","BOTH IP/OP","$459.78 ","$340.24 ","$0.00 ","$459.78 ","$206.90 ","$0.00 ","$95.83 ","$0.00 ","$0.00 ","$80.50 ","$459.78 ","$0.00 ","$229.89 ","$364.15 ","$367.82 ","$0.00 ","$71.95 ","$0.00 ","$73.20 ","$0.00 "
"241.262","SUP","HCPCS C1713","","241.262  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,731.83 ","$1,281.55 ","$0.00 ","$1,681.38 ","$756.62 ","$0.00 ","$360.96 ","$0.00 ","$0.00 ","$294.40 ","$1,681.38 ","$0.00 ","$840.69 ","$1,331.65 ","$1,345.10 ","$0.00 ","$255.47 ","$0.00 ","$267.67 ","$0.00 "
"241.263","SUP","HCPCS C1713","","241.263  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,731.83 ","$1,281.55 ","$0.00 ","$1,681.38 ","$756.62 ","$0.00 ","$360.96 ","$0.00 ","$0.00 ","$294.40 ","$1,681.38 ","$0.00 ","$840.69 ","$1,331.65 ","$1,345.10 ","$0.00 ","$255.47 ","$0.00 ","$267.67 ","$0.00 "
"241.264","SUP","HCPCS C1713","","241.264  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"241.265","SUP","HCPCS C1713","","241.265  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"241.266","SUP","HCPCS C1713","","241.266  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,112.75 ","$1,563.44 ","$0.00 ","$2,051.23 ","$923.05 ","$0.00 ","$440.35 ","$0.00 ","$0.00 ","$359.15 ","$2,051.23 ","$0.00 ","$1,025.61 ","$1,624.57 ","$1,640.98 ","$0.00 ","$311.67 ","$0.00 ","$326.56 ","$0.00 "
"241.267","SUP","HCPCS C1713","","241.267  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,112.75 ","$1,563.44 ","$0.00 ","$2,051.23 ","$923.05 ","$0.00 ","$440.35 ","$0.00 ","$0.00 ","$359.15 ","$2,051.23 ","$0.00 ","$1,025.61 ","$1,624.57 ","$1,640.98 ","$0.00 ","$311.67 ","$0.00 ","$326.56 ","$0.00 "
"241.268","SUP","HCPCS C1713","","241.268  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,281.45 ","$1,688.27 ","$0.00 ","$2,215.00 ","$996.75 ","$0.00 ","$475.51 ","$0.00 ","$0.00 ","$387.83 ","$2,215.00 ","$0.00 ","$1,107.50 ","$1,754.28 ","$1,772.00 ","$0.00 ","$336.55 ","$0.00 ","$352.63 ","$0.00 "
"241.269","SUP","HCPCS C1713","","241.269  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,281.45 ","$1,688.27 ","$0.00 ","$2,215.00 ","$996.75 ","$0.00 ","$475.51 ","$0.00 ","$0.00 ","$387.83 ","$2,215.00 ","$0.00 ","$1,107.50 ","$1,754.28 ","$1,772.00 ","$0.00 ","$336.55 ","$0.00 ","$352.63 ","$0.00 "
"241.272","SUP","HCPCS C1713","","241.272  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,986.25 ","$1,469.83 ","$0.00 ","$1,928.40 ","$867.78 ","$0.00 ","$413.98 ","$0.00 ","$0.00 ","$337.65 ","$1,928.40 ","$0.00 ","$964.20 ","$1,527.29 ","$1,542.72 ","$0.00 ","$293.00 ","$0.00 ","$307.00 ","$0.00 "
"241.273","SUP","HCPCS C1713","","241.273  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,986.25 ","$1,469.83 ","$0.00 ","$1,928.40 ","$867.78 ","$0.00 ","$413.98 ","$0.00 ","$0.00 ","$337.65 ","$1,928.40 ","$0.00 ","$964.20 ","$1,527.29 ","$1,542.72 ","$0.00 ","$293.00 ","$0.00 ","$307.00 ","$0.00 "
"241.274","SUP","HCPCS C1713","","241.274  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,166.18 ","$1,602.97 ","$0.00 ","$2,103.08 ","$946.38 ","$0.00 ","$451.49 ","$0.00 ","$0.00 ","$368.23 ","$2,103.08 ","$0.00 ","$1,051.54 ","$1,665.64 ","$1,682.46 ","$0.00 ","$319.55 ","$0.00 ","$334.81 ","$0.00 "
"241.275","SUP","HCPCS C1713","","241.275  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,166.18 ","$1,602.97 ","$0.00 ","$2,103.08 ","$946.38 ","$0.00 ","$451.49 ","$0.00 ","$0.00 ","$368.23 ","$2,103.08 ","$0.00 ","$1,051.54 ","$1,665.64 ","$1,682.46 ","$0.00 ","$319.55 ","$0.00 ","$334.81 ","$0.00 "
"241.276","SUP","HCPCS C1713","","241.276  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.277","SUP","HCPCS C1713","","241.277  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.278","SUP","HCPCS C1713","","241.278  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,547.13 ","$1,884.88 ","$0.00 ","$2,472.93 ","$1,112.82 ","$0.00 ","$530.88 ","$0.00 ","$0.00 ","$432.99 ","$2,472.93 ","$0.00 ","$1,236.46 ","$1,958.56 ","$1,978.34 ","$0.00 ","$375.74 ","$0.00 ","$393.69 ","$0.00 "
"241.279","SUP","HCPCS C1713","","241.279  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,547.13 ","$1,884.88 ","$0.00 ","$2,472.93 ","$1,112.82 ","$0.00 ","$530.88 ","$0.00 ","$0.00 ","$432.99 ","$2,472.93 ","$0.00 ","$1,236.46 ","$1,958.56 ","$1,978.34 ","$0.00 ","$375.74 ","$0.00 ","$393.69 ","$0.00 "
"241.282","SUP","HCPCS C1713","","241.282  -  PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,731.83 ","$1,281.55 ","$0.00 ","$1,681.38 ","$756.62 ","$0.00 ","$360.96 ","$0.00 ","$0.00 ","$294.40 ","$1,681.38 ","$0.00 ","$840.69 ","$1,331.65 ","$1,345.10 ","$0.00 ","$255.47 ","$0.00 ","$267.67 ","$0.00 "
"241.283","SUP","HCPCS C1713","","241.283  -  PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,731.83 ","$1,281.55 ","$0.00 ","$1,681.38 ","$756.62 ","$0.00 ","$360.96 ","$0.00 ","$0.00 ","$294.40 ","$1,681.38 ","$0.00 ","$840.69 ","$1,331.65 ","$1,345.10 ","$0.00 ","$255.47 ","$0.00 ","$267.67 ","$0.00 "
"241.284","SUP","HCPCS C1713","","241.284  -  PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"241.285","SUP","HCPCS C1713","","241.285  -  PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,921.58 ","$1,421.97 ","$0.00 ","$1,865.63 ","$839.53 ","$0.00 ","$400.50 ","$0.00 ","$0.00 ","$326.66 ","$1,865.63 ","$0.00 ","$932.81 ","$1,477.58 ","$1,492.50 ","$0.00 ","$283.46 ","$0.00 ","$297.01 ","$0.00 "
"241.286","SUP","HCPCS C1713","","241.286  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,112.75 ","$1,563.44 ","$0.00 ","$2,051.23 ","$923.05 ","$0.00 ","$440.35 ","$0.00 ","$0.00 ","$359.15 ","$2,051.23 ","$0.00 ","$1,025.61 ","$1,624.57 ","$1,640.98 ","$0.00 ","$311.67 ","$0.00 ","$326.56 ","$0.00 "
"241.287","SUP","HCPCS C1713","","241.287  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,112.75 ","$1,563.44 ","$0.00 ","$2,051.23 ","$923.05 ","$0.00 ","$440.35 ","$0.00 ","$0.00 ","$359.15 ","$2,051.23 ","$0.00 ","$1,025.61 ","$1,624.57 ","$1,640.98 ","$0.00 ","$311.67 ","$0.00 ","$326.56 ","$0.00 "
"241.288","SUP","HCPCS C1713","","241.288  -  PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,281.45 ","$1,688.27 ","$0.00 ","$2,215.00 ","$996.75 ","$0.00 ","$475.51 ","$0.00 ","$0.00 ","$387.83 ","$2,215.00 ","$0.00 ","$1,107.50 ","$1,754.28 ","$1,772.00 ","$0.00 ","$336.55 ","$0.00 ","$352.63 ","$0.00 "
"241.289","SUP","HCPCS C1713","","241.289  -  PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,281.45 ","$1,688.27 ","$0.00 ","$2,215.00 ","$996.75 ","$0.00 ","$475.51 ","$0.00 ","$0.00 ","$387.83 ","$2,215.00 ","$0.00 ","$1,107.50 ","$1,754.28 ","$1,772.00 ","$0.00 ","$336.55 ","$0.00 ","$352.63 ","$0.00 "
"241.3","SUP","HCPCS C1713","","241.300  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,279.13 ","$1,686.56 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$475.03 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.301","SUP","HCPCS C1713","","241.301  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.302","SUP","HCPCS C1713","","241.302  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,481.05 ","$1,835.98 ","$0.00 ","$2,408.78 ","$1,083.95 ","$0.00 ","$517.11 ","$0.00 ","$0.00 ","$421.76 ","$2,408.78 ","$0.00 ","$1,204.39 ","$1,907.75 ","$1,927.02 ","$0.00 ","$365.99 ","$0.00 ","$383.48 ","$0.00 "
"241.303","SUP","HCPCS C1713","","241.303  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,481.05 ","$1,835.98 ","$0.00 ","$2,408.78 ","$1,083.95 ","$0.00 ","$517.11 ","$0.00 ","$0.00 ","$421.76 ","$2,408.78 ","$0.00 ","$1,204.39 ","$1,907.75 ","$1,927.02 ","$0.00 ","$365.99 ","$0.00 ","$383.48 ","$0.00 "
"241.304","SUP","HCPCS C1713","","241.304  -  PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.305","SUP","HCPCS C1713","","241.305  -  PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,279.13 ","$1,025.61 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$399.06 ","$2,279.13 ","$0.00 ","$1,139.56 ","$1,805.07 ","$1,823.30 ","$0.00 ","$346.30 ","$0.00 ","$362.84 ","$0.00 "
"241.32","SUP","HCPCS C1713","","241.32  -  PLATE BN 1/3 TBLR 12MM 25X9X1MM NS .5MM 2 HL COLR SS 3.5MM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"241.33","SUP","HCPCS C1713","","241.33  -  PLATE BN 1/3 TBLR 12MM 37X9X1MM NS .5MM 3 HL COLR SS 3.5MM","BOTH IP/OP","$107.53 ","$79.57 ","$0.00 ","$104.40 ","$46.98 ","$0.00 ","$22.41 ","$0.00 ","$0.00 ","$18.28 ","$104.40 ","$0.00 ","$52.20 ","$82.68 ","$83.52 ","$0.00 ","$15.86 ","$0.00 ","$16.62 ","$0.00 "
"241.331","SUP","HCPCS C1713","","241.331  -  PLATE BONE 33X9X1MM .7MM 1/3 TUBULAR 3 HOLE COLLAR LCP","BOTH IP/OP","$282.55 ","$209.09 ","$0.00 ","$274.33 ","$123.45 ","$0.00 ","$58.89 ","$0.00 ","$0.00 ","$48.03 ","$274.33 ","$0.00 ","$137.16 ","$217.27 ","$219.46 ","$0.00 ","$41.68 ","$0.00 ","$43.67 ","$0.00 "
"241.34","SUP","HCPCS C1713","","241.34  -  PLATE BN 1/3 TBLR 12MM 49X9X1MM NS .5MM 4 HL COLR SS 3.5MM","BOTH IP/OP","$123.70 ","$91.54 ","$0.00 ","$120.10 ","$54.05 ","$0.00 ","$25.78 ","$0.00 ","$0.00 ","$21.03 ","$120.10 ","$0.00 ","$60.05 ","$95.12 ","$96.08 ","$0.00 ","$18.25 ","$0.00 ","$19.12 ","$0.00 "
"241.341","SUP","HCPCS C1713","","241.341  -  PLATE BN 1/3 TBLR 12MM 45X9X1MM NS .7MM LCP 4 HL COLR SS","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"241.35","SUP","HCPCS C1713","","241.35  -  PLATE BN 1/3 TBLR 12MM 61X9X1MM NS .5MM 5 HL COLR SS 3.5MM","BOTH IP/OP","$123.70 ","$91.54 ","$0.00 ","$120.10 ","$54.05 ","$0.00 ","$25.78 ","$0.00 ","$0.00 ","$21.03 ","$120.10 ","$0.00 ","$60.05 ","$95.12 ","$96.08 ","$0.00 ","$18.25 ","$0.00 ","$19.12 ","$0.00 "
"241.351","SUP","HCPCS C1713","","241.351  -  PLATE BN 1/3 TBLR 12MM 57X9X1MM NS .7MM LCP 5 HL COLR SS","BOTH IP/OP","$316.28 ","$234.05 ","$0.00 ","$307.08 ","$138.18 ","$0.00 ","$65.92 ","$0.00 ","$0.00 ","$53.77 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$46.66 ","$0.00 ","$48.89 ","$0.00 "
"241.36","SUP","HCPCS C1713","","241.36  -  PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR SS 3.5MM","BOTH IP/OP","$128.60 ","$95.16 ","$0.00 ","$124.85 ","$56.18 ","$0.00 ","$26.80 ","$0.00 ","$0.00 ","$21.86 ","$124.85 ","$0.00 ","$62.43 ","$98.88 ","$99.88 ","$0.00 ","$18.97 ","$0.00 ","$19.88 ","$0.00 "
"241.361","SUP","HCPCS C1713","","241.361  -  PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR SS","BOTH IP/OP","$316.28 ","$234.05 ","$0.00 ","$307.08 ","$138.18 ","$0.00 ","$65.92 ","$0.00 ","$0.00 ","$53.77 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$46.66 ","$0.00 ","$48.89 ","$0.00 "
"241.37","SUP","HCPCS C1713","","241.37  -  PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR SS 3.5MM","BOTH IP/OP","$128.60 ","$95.16 ","$0.00 ","$124.85 ","$56.18 ","$0.00 ","$26.80 ","$0.00 ","$0.00 ","$21.86 ","$124.85 ","$0.00 ","$62.43 ","$98.88 ","$99.88 ","$0.00 ","$18.97 ","$0.00 ","$19.88 ","$0.00 "
"241.371","SUP","HCPCS C1713","","241.371  -  PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR SS","BOTH IP/OP","$323.30 ","$239.24 ","$0.00 ","$313.90 ","$141.26 ","$0.00 ","$67.38 ","$0.00 ","$0.00 ","$54.96 ","$313.90 ","$0.00 ","$156.95 ","$248.61 ","$251.12 ","$0.00 ","$47.69 ","$0.00 ","$49.97 ","$0.00 "
"241.38","SUP","HCPCS C1713","","241.38  -  PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR SS 3.5MM","BOTH IP/OP","$133.55 ","$98.83 ","$0.00 ","$129.65 ","$58.34 ","$0.00 ","$27.84 ","$0.00 ","$0.00 ","$22.70 ","$129.65 ","$0.00 ","$64.83 ","$102.68 ","$103.72 ","$0.00 ","$19.70 ","$0.00 ","$20.64 ","$0.00 "
"241.381","SUP","HCPCS C1713","","241.381  -  PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR SS","BOTH IP/OP","$340.18 ","$251.73 ","$0.00 ","$330.28 ","$148.62 ","$0.00 ","$70.90 ","$0.00 ","$0.00 ","$57.83 ","$330.28 ","$0.00 ","$165.14 ","$261.58 ","$264.22 ","$0.00 ","$50.18 ","$0.00 ","$52.58 ","$0.00 "
"241.39","SUP","HCPCS C1713","","241.39  -  PLATE BONE 1/3 TUBE 109X9X1MM .5MM 9 HOLE COLLAR DCP LC-DCP","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"241.391","SUP","HCPCS C1713","","241.391  -  PLATE BN 1/3 TBLR 12MM 105X9X1MM NS .7MM LCP 9 HL COLR SS","BOTH IP/OP","$340.18 ","$251.73 ","$0.00 ","$330.28 ","$148.62 ","$0.00 ","$70.90 ","$0.00 ","$0.00 ","$57.83 ","$330.28 ","$0.00 ","$165.14 ","$261.58 ","$264.22 ","$0.00 ","$50.18 ","$0.00 ","$52.58 ","$0.00 "
"241.4","SUP","HCPCS C1713","","241.40  -  PLATE BN 1/3 TBLR 12MM 121X9X1MM NS .5MM 10 HL COLR SS 3.5MM","BOTH IP/OP","$133.05 ","$98.46 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$27.73 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"241.4","SUP","HCPCS C1713","","241.4  -  PLATE 121MM SS SM FRAG SET 10 HOLE 1/3 TBLR COLLAR LC DCP","BOTH IP/OP","$133.05 ","$98.46 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$27.73 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$112.90 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"241.401","SUP","HCPCS C1713","","241.401  -  PLATE BN 1/3 TBLR 12MM 117X9X1MM NS .7MM LCP 10 HL COLR SS","BOTH IP/OP","$340.18 ","$251.73 ","$0.00 ","$330.28 ","$148.62 ","$0.00 ","$70.90 ","$0.00 ","$0.00 ","$57.83 ","$330.28 ","$0.00 ","$165.14 ","$261.58 ","$264.22 ","$0.00 ","$50.18 ","$0.00 ","$52.58 ","$0.00 "
"241.42","SUP","HCPCS C1713","","241.42  -  PLATE BN 1/3 TBLR 12MM 145X9X1MM NS .5MM 12 HL COLR SS 3.5MM","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"241.421","SUP","HCPCS C1713","","241.421  -  PLATE BN 1/3 TBLR 12MM 141X9X1MM NS .7MM LCP 12 HL COLR SS","BOTH IP/OP","$351.43 ","$260.06 ","$0.00 ","$341.20 ","$153.54 ","$0.00 ","$73.25 ","$0.00 ","$0.00 ","$59.74 ","$341.20 ","$0.00 ","$170.60 ","$270.23 ","$272.96 ","$0.00 ","$51.84 ","$0.00 ","$54.32 ","$0.00 "
"241.44","SUP","HCPCS C1713","","241.440  -  PLATE BONE 80MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$2,774.53 ","$2,053.15 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$578.28 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"241.441","SUP","HCPCS C1713","","241.441  -  PLATE BONE 80MM 5 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,857.78 ","$2,114.76 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$595.63 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"241.442","SUP","HCPCS C1713","","241.442  -  PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,795.93 ","$2,068.99 ","$0.00 ","$2,714.50 ","$1,221.53 ","$0.00 ","$582.74 ","$0.00 ","$0.00 ","$475.29 ","$2,714.50 ","$0.00 ","$1,357.25 ","$2,149.88 ","$2,171.60 ","$0.00 ","$412.44 ","$0.00 ","$432.15 ","$0.00 "
"241.443","SUP","HCPCS C1713","","241.443  -  PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,795.93 ","$2,068.99 ","$0.00 ","$2,714.50 ","$1,221.53 ","$0.00 ","$582.74 ","$0.00 ","$0.00 ","$475.29 ","$2,714.50 ","$0.00 ","$1,357.25 ","$2,149.88 ","$2,171.60 ","$0.00 ","$412.44 ","$0.00 ","$432.15 ","$0.00 "
"241.444","SUP","HCPCS C1713","","241.444  -  PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,824.03 ","$2,089.78 ","$0.00 ","$2,741.78 ","$1,233.80 ","$0.00 ","$588.60 ","$0.00 ","$0.00 ","$480.06 ","$2,741.78 ","$0.00 ","$1,370.89 ","$2,171.49 ","$2,193.42 ","$0.00 ","$416.59 ","$0.00 ","$436.49 ","$0.00 "
"241.445","SUP","HCPCS C1713","","241.445  -  PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,824.03 ","$2,089.78 ","$0.00 ","$2,741.78 ","$1,233.80 ","$0.00 ","$588.60 ","$0.00 ","$0.00 ","$480.06 ","$2,741.78 ","$0.00 ","$1,370.89 ","$2,171.49 ","$2,193.42 ","$0.00 ","$416.59 ","$0.00 ","$436.49 ","$0.00 "
"241.446","SUP","HCPCS C1713","","241.446  -  PLATE BONE 158MM 11 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,850.75 ","$2,109.56 ","$0.00 ","$2,767.73 ","$1,245.48 ","$0.00 ","$594.17 ","$0.00 ","$0.00 ","$484.61 ","$2,767.73 ","$0.00 ","$1,383.86 ","$2,192.04 ","$2,214.18 ","$0.00 ","$420.53 ","$0.00 ","$440.62 ","$0.00 "
"241.447","SUP","HCPCS C1713","","241.447  -  PLATE BONE 158MM 11 HOLE LCP STAINLESS STEEL LEFT DISTAL","BOTH IP/OP","$2,850.75 ","$2,109.56 ","$0.00 ","$2,767.73 ","$1,245.48 ","$0.00 ","$594.17 ","$0.00 ","$0.00 ","$484.61 ","$2,767.73 ","$0.00 ","$1,383.86 ","$2,192.04 ","$2,214.18 ","$0.00 ","$420.53 ","$0.00 ","$440.62 ","$0.00 "
"241.448","SUP","HCPCS C1713","","241.448  -  PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,883.08 ","$2,133.48 ","$0.00 ","$2,799.10 ","$1,259.60 ","$0.00 ","$600.90 ","$0.00 ","$0.00 ","$490.10 ","$2,799.10 ","$0.00 ","$1,399.55 ","$2,216.89 ","$2,239.28 ","$0.00 ","$425.30 ","$0.00 ","$445.62 ","$0.00 "
"241.449","SUP","HCPCS C1713","","241.449  -  PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS","BOTH IP/OP","$2,883.08 ","$2,133.48 ","$0.00 ","$2,799.10 ","$1,259.60 ","$0.00 ","$600.90 ","$0.00 ","$0.00 ","$490.10 ","$2,799.10 ","$0.00 ","$1,399.55 ","$2,216.89 ","$2,239.28 ","$0.00 ","$425.30 ","$0.00 ","$445.62 ","$0.00 "
"241.45","SUP","HCPCS C1713","","241.450  -  PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$2,835.95 ","$2,098.60 ","$0.00 ","$2,835.95 ","$1,276.18 ","$0.00 ","$591.08 ","$0.00 ","$0.00 ","$496.55 ","$2,835.95 ","$0.00 ","$1,417.98 ","$2,246.07 ","$2,268.76 ","$0.00 ","$430.90 ","$0.00 ","$451.48 ","$0.00 "
"241.451","SUP","HCPCS C1713","","241.451  -  PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$2,921.03 ","$2,161.56 ","$0.00 ","$2,835.95 ","$1,276.18 ","$0.00 ","$608.81 ","$0.00 ","$0.00 ","$496.55 ","$2,835.95 ","$0.00 ","$1,417.98 ","$2,246.07 ","$2,268.76 ","$0.00 ","$430.90 ","$0.00 ","$451.48 ","$0.00 "
"241.452","SUP","HCPCS C1713","","241.452  -  PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$3,047.55 ","$2,255.19 ","$0.00 ","$2,958.78 ","$1,331.45 ","$0.00 ","$635.19 ","$0.00 ","$0.00 ","$518.06 ","$2,958.78 ","$0.00 ","$1,479.39 ","$2,343.35 ","$2,367.02 ","$0.00 ","$449.56 ","$0.00 ","$471.04 ","$0.00 "
"241.453","SUP","HCPCS C1713","","241.453  -  PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,047.55 ","$2,255.19 ","$0.00 ","$2,958.78 ","$1,331.45 ","$0.00 ","$635.19 ","$0.00 ","$0.00 ","$518.06 ","$2,958.78 ","$0.00 ","$1,479.39 ","$2,343.35 ","$2,367.02 ","$0.00 ","$449.56 ","$0.00 ","$471.04 ","$0.00 "
"241.454","SUP","HCPCS C1713","","241.454  -  PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$3,071.45 ","$2,272.87 ","$0.00 ","$2,981.98 ","$1,341.89 ","$0.00 ","$640.17 ","$0.00 ","$0.00 ","$522.12 ","$2,981.98 ","$0.00 ","$1,490.99 ","$2,361.73 ","$2,385.58 ","$0.00 ","$453.09 ","$0.00 ","$474.73 ","$0.00 "
"241.455","SUP","HCPCS C1713","","241.455  -  PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,071.45 ","$2,272.87 ","$0.00 ","$2,981.98 ","$1,341.89 ","$0.00 ","$640.17 ","$0.00 ","$0.00 ","$522.12 ","$2,981.98 ","$0.00 ","$1,490.99 ","$2,361.73 ","$2,385.58 ","$0.00 ","$453.09 ","$0.00 ","$474.73 ","$0.00 "
"241.456","SUP","HCPCS C1713","","241.456  -  PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA RIGHT","BOTH IP/OP","$3,100.95 ","$2,294.70 ","$0.00 ","$3,010.65 ","$1,354.79 ","$0.00 ","$646.32 ","$0.00 ","$0.00 ","$527.14 ","$3,010.65 ","$0.00 ","$1,505.33 ","$2,384.43 ","$2,408.52 ","$0.00 ","$457.44 ","$0.00 ","$479.30 ","$0.00 "
"241.457","SUP","HCPCS C1713","","241.457  -  PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,100.95 ","$2,294.70 ","$0.00 ","$3,010.65 ","$1,354.79 ","$0.00 ","$646.32 ","$0.00 ","$0.00 ","$527.14 ","$3,010.65 ","$0.00 ","$1,505.33 ","$2,384.43 ","$2,408.52 ","$0.00 ","$457.44 ","$0.00 ","$479.30 ","$0.00 "
"241.61","SUP","HCPCS C1713","","241.61  -  PLATE BN 60MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM","BOTH IP/OP","$974.15 ","$720.87 ","$0.00 ","$945.78 ","$425.60 ","$0.00 ","$203.04 ","$0.00 ","$0.00 ","$165.60 ","$945.78 ","$0.00 ","$472.89 ","$749.06 ","$756.62 ","$0.00 ","$143.70 ","$0.00 ","$150.57 ","$0.00 "
"241.618","SUP","HCPCS C1713","","241.618  -  PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,152.68 ","$852.98 ","$0.00 ","$1,119.10 ","$503.60 ","$0.00 ","$240.25 ","$0.00 ","$0.00 ","$195.95 ","$1,119.10 ","$0.00 ","$559.55 ","$886.33 ","$895.28 ","$0.00 ","$170.04 ","$0.00 ","$178.16 ","$0.00 "
"241.619","SUP","HCPCS C1713","","241.619  -  PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL LEFT CALCANEAL","BOTH IP/OP","$1,152.68 ","$852.98 ","$0.00 ","$1,119.10 ","$503.60 ","$0.00 ","$240.25 ","$0.00 ","$0.00 ","$195.95 ","$1,119.10 ","$0.00 ","$559.55 ","$886.33 ","$895.28 ","$0.00 ","$170.04 ","$0.00 ","$178.16 ","$0.00 "
"241.62","SUP","HCPCS C1713","","241.62  -  PLATE BN 70MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM","BOTH IP/OP","$993.83 ","$735.43 ","$0.00 ","$964.88 ","$434.19 ","$0.00 ","$207.14 ","$0.00 ","$0.00 ","$168.94 ","$964.88 ","$0.00 ","$482.44 ","$764.18 ","$771.90 ","$0.00 ","$146.61 ","$0.00 ","$153.61 ","$0.00 "
"241.622","SUP","HCPCS C1713","","241.622  -  PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT","BOTH IP/OP","$1,291.83 ","$955.95 ","$0.00 ","$1,254.20 ","$564.39 ","$0.00 ","$269.25 ","$0.00 ","$0.00 ","$219.60 ","$1,254.20 ","$0.00 ","$627.10 ","$993.33 ","$1,003.36 ","$0.00 ","$190.57 ","$0.00 ","$199.67 ","$0.00 "
"241.623","SUP","HCPCS C1713","","241.623  -  PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT","BOTH IP/OP","$1,291.83 ","$955.95 ","$0.00 ","$1,254.20 ","$564.39 ","$0.00 ","$269.25 ","$0.00 ","$0.00 ","$219.60 ","$1,254.20 ","$0.00 ","$627.10 ","$993.33 ","$1,003.36 ","$0.00 ","$190.57 ","$0.00 ","$199.67 ","$0.00 "
"241.624","SUP","HCPCS C1713","","241.624  -  PLATE BN LNG 76MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT","BOTH IP/OP","$1,377.58 ","$1,019.41 ","$0.00 ","$1,337.45 ","$601.85 ","$0.00 ","$287.12 ","$0.00 ","$0.00 ","$234.18 ","$1,337.45 ","$0.00 ","$668.73 ","$1,059.26 ","$1,069.96 ","$0.00 ","$203.22 ","$0.00 ","$212.92 ","$0.00 "
"241.625","SUP","HCPCS C1713","","241.625  -  PLATE BONE LONG 76MM LOCKING BENDABLE TAB LCP STAINLESS","BOTH IP/OP","$1,377.58 ","$1,019.41 ","$0.00 ","$1,337.45 ","$601.85 ","$0.00 ","$287.12 ","$0.00 ","$0.00 ","$234.18 ","$1,337.45 ","$0.00 ","$668.73 ","$1,059.26 ","$1,069.96 ","$0.00 ","$203.22 ","$0.00 ","$212.92 ","$0.00 "
"241.626","SUP","HCPCS C1713","","241.626  -  PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT","BOTH IP/OP","$1,423.98 ","$1,053.75 ","$0.00 ","$1,382.50 ","$622.13 ","$0.00 ","$296.79 ","$0.00 ","$0.00 ","$242.06 ","$1,382.50 ","$0.00 ","$691.25 ","$1,094.94 ","$1,106.00 ","$0.00 ","$210.06 ","$0.00 ","$220.09 ","$0.00 "
"241.627","SUP","HCPCS C1713","","241.627  -  PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT","BOTH IP/OP","$1,423.98 ","$1,053.75 ","$0.00 ","$1,382.50 ","$622.13 ","$0.00 ","$296.79 ","$0.00 ","$0.00 ","$242.06 ","$1,382.50 ","$0.00 ","$691.25 ","$1,094.94 ","$1,106.00 ","$0.00 ","$210.06 ","$0.00 ","$220.09 ","$0.00 "
"241.65","SUP","HCPCS C1713","","241.65  -  PLATE BN Y 87MMX2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM","BOTH IP/OP","$993.83 ","$735.43 ","$0.00 ","$964.88 ","$434.19 ","$0.00 ","$207.14 ","$0.00 ","$0.00 ","$168.94 ","$964.88 ","$0.00 ","$482.44 ","$764.18 ","$771.90 ","$0.00 ","$146.61 ","$0.00 ","$153.61 ","$0.00 "
"241.68","SUP","HCPCS C1713","","241.680  -  PLATE BONE 34MM 2 HOLE LCP STAINLESS STEEL RIGHT RADIAL HEAD","BOTH IP/OP","$1,112.28 ","$823.09 ","$0.00 ","$1,112.28 ","$500.52 ","$0.00 ","$231.83 ","$0.00 ","$0.00 ","$194.75 ","$1,112.28 ","$0.00 ","$556.14 ","$880.93 ","$889.82 ","$0.00 ","$169.00 ","$0.00 ","$177.07 ","$0.00 "
"241.681","SUP","HCPCS C1713","","241.681  -  PLATE BN 34MM NS LCP CMBN 2 HL RIM PRECONTOUR LMT CNTCT SS","BOTH IP/OP","$1,145.65 ","$847.78 ","$0.00 ","$1,112.28 ","$500.52 ","$0.00 ","$238.78 ","$0.00 ","$0.00 ","$194.75 ","$1,112.28 ","$0.00 ","$556.14 ","$880.93 ","$889.82 ","$0.00 ","$169.00 ","$0.00 ","$177.07 ","$0.00 "
"241.682","SUP","HCPCS C1713","","241.682  -  PLATE BONE 46MM 3 HOLE HEAD LCP STAINLESS STEEL RIGHT RADIAL","BOTH IP/OP","$1,177.98 ","$871.71 ","$0.00 ","$1,143.65 ","$514.64 ","$0.00 ","$245.52 ","$0.00 ","$0.00 ","$200.24 ","$1,143.65 ","$0.00 ","$571.83 ","$905.77 ","$914.92 ","$0.00 ","$173.77 ","$0.00 ","$182.07 ","$0.00 "
"241.683","SUP","HCPCS C1713","","241.683  -  PLATE BONE 46MM 3 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL","BOTH IP/OP","$1,177.98 ","$871.71 ","$0.00 ","$1,143.65 ","$514.64 ","$0.00 ","$245.52 ","$0.00 ","$0.00 ","$200.24 ","$1,143.65 ","$0.00 ","$571.83 ","$905.77 ","$914.92 ","$0.00 ","$173.77 ","$0.00 ","$182.07 ","$0.00 "
"241.684","SUP","HCPCS C1713","","241.684  -  PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL RIGHT RADIAL","BOTH IP/OP","$1,199.05 ","$887.30 ","$0.00 ","$1,164.13 ","$523.86 ","$0.00 ","$249.91 ","$0.00 ","$0.00 ","$203.83 ","$1,164.13 ","$0.00 ","$582.06 ","$921.99 ","$931.30 ","$0.00 ","$176.88 ","$0.00 ","$185.33 ","$0.00 "
"241.685","SUP","HCPCS C1713","","241.685  -  PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL","BOTH IP/OP","$1,199.05 ","$887.30 ","$0.00 ","$1,164.13 ","$523.86 ","$0.00 ","$249.91 ","$0.00 ","$0.00 ","$203.83 ","$1,164.13 ","$0.00 ","$582.06 ","$921.99 ","$931.30 ","$0.00 ","$176.88 ","$0.00 ","$185.33 ","$0.00 "
"241.69","SUP","HCPCS C1713","","241.690  -  PLATE BN 28MM NS LCP CMBN 2 HL NK PRECONTOUR LMT CNTCT SS","BOTH IP/OP","$1,112.28 ","$823.09 ","$0.00 ","$1,112.28 ","$500.52 ","$0.00 ","$231.83 ","$0.00 ","$0.00 ","$194.75 ","$1,112.28 ","$0.00 ","$556.14 ","$880.93 ","$889.82 ","$0.00 ","$169.00 ","$0.00 ","$177.07 ","$0.00 "
"241.691","SUP","HCPCS C1713","","241.691  -  PLATE BN 40MM NS LCP CMBN 3 HL NK PRECONTOUR LMT CNTCT SS","BOTH IP/OP","$1,177.98 ","$871.71 ","$0.00 ","$1,143.65 ","$514.64 ","$0.00 ","$245.52 ","$0.00 ","$0.00 ","$200.24 ","$1,143.65 ","$0.00 ","$571.83 ","$905.77 ","$914.92 ","$0.00 ","$173.77 ","$0.00 ","$182.07 ","$0.00 "
"241.692","SUP","HCPCS C1713","","241.692  -  PLATE BONE 50MM 4 HOLE LCP STAINLESS STEEL RADIAL HEAD","BOTH IP/OP","$1,200.45 ","$888.33 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$250.20 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$177.09 ","$0.00 ","$185.55 ","$0.00 "
"241.83","SUP","HCPCS C1713","","241.83  -  PLATE BN CLVRLF 88X15X2MM NS 1.2MM LC DCP 3 HL THN BLDE","BOTH IP/OP","$552.73 ","$409.02 ","$0.00 ","$552.73 ","$248.73 ","$0.00 ","$115.20 ","$0.00 ","$0.00 ","$96.78 ","$552.73 ","$0.00 ","$276.36 ","$437.76 ","$442.18 ","$0.00 ","$83.98 ","$0.00 ","$87.99 ","$0.00 "
"241.84","SUP","HCPCS C1713","","241.84  -  PLATE BN CLVRLF 104X15X2MM NS 1.2MM LC DCP 4 HL THN BLDE","BOTH IP/OP","$590.93 ","$437.29 ","$0.00 ","$590.93 ","$265.92 ","$0.00 ","$123.16 ","$0.00 ","$0.00 ","$103.47 ","$590.93 ","$0.00 ","$295.46 ","$468.02 ","$472.74 ","$0.00 ","$89.79 ","$0.00 ","$94.08 ","$0.00 "
"241.85","SUP","HCPCS C1713","","241.85  -  PLATE BN CLVRLF 120X15X2MM NS 5 HL THN BLDE SS 3.5MM SCR","BOTH IP/OP","$768.35 ","$568.58 ","$0.00 ","$768.35 ","$345.76 ","$0.00 ","$160.14 ","$0.00 ","$0.00 ","$134.53 ","$768.35 ","$0.00 ","$384.18 ","$608.53 ","$614.68 ","$0.00 ","$116.75 ","$0.00 ","$122.32 ","$0.00 "
"241.86","SUP","HCPCS C1713","","241.86  -  PLATE BONE THIN CLOVERLEAF 136MM 6 HOLE LC-DCP STAINLESS","BOTH IP/OP","$833.85 ","$617.05 ","$0.00 ","$833.85 ","$375.23 ","$0.00 ","$173.80 ","$0.00 ","$0.00 ","$146.00 ","$833.85 ","$0.00 ","$416.93 ","$660.41 ","$667.08 ","$0.00 ","$126.70 ","$0.00 ","$132.75 ","$0.00 "
"241.87","SUP","HCPCS C1713","","241.87  -  PLATE BN CLVRLF 152X15X2MM NS 1.2MM LC DCP 7 HL THN BLDE","BOTH IP/OP","$898.00 ","$664.52 ","$0.00 ","$898.00 ","$404.10 ","$0.00 ","$187.17 ","$0.00 ","$0.00 ","$157.23 ","$898.00 ","$0.00 ","$449.00 ","$711.22 ","$718.40 ","$0.00 ","$136.44 ","$0.00 ","$142.96 ","$0.00 "
"241.88","SUP","HCPCS C1713","","241.88  -  PLATE BN CLVRLF 168X15X2MM NS 1.2MM LC DCP 8 HL THN BLDE","BOTH IP/OP","$953.95 ","$705.92 ","$0.00 ","$953.95 ","$429.28 ","$0.00 ","$198.83 ","$0.00 ","$0.00 ","$167.03 ","$953.95 ","$0.00 ","$476.98 ","$755.53 ","$763.16 ","$0.00 ","$144.95 ","$0.00 ","$151.87 ","$0.00 "
"241.89","SUP","HCPCS C1713","","241.89  -  PLATE BONE THIN 200X15X1.2MM 10 HOLE CLOVERLEAF THIN BLADE","BOTH IP/OP","$1,061.30 ","$785.36 ","$0.00 ","$1,030.38 ","$463.67 ","$0.00 ","$221.20 ","$0.00 ","$0.00 ","$180.41 ","$1,030.38 ","$0.00 ","$515.19 ","$816.06 ","$824.30 ","$0.00 ","$156.56 ","$0.00 ","$164.04 ","$0.00 "
"241.901","SUP","HCPCS C1713","","241.901  -  PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR","BOTH IP/OP","$2,857.78 ","$2,114.76 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$595.63 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"241.903","SUP","HCPCS C1713","","241.903  -  PLATE BN STD 114X12X2.5MM NS LCP CMBN PHLS 5 HL SHFT LCK","BOTH IP/OP","$2,947.73 ","$2,181.32 ","$0.00 ","$2,861.88 ","$1,287.84 ","$0.00 ","$614.38 ","$0.00 ","$0.00 ","$501.09 ","$2,861.88 ","$0.00 ","$1,430.94 ","$2,266.61 ","$2,289.50 ","$0.00 ","$434.84 ","$0.00 ","$455.61 ","$0.00 "
"241.918","SUP","HCPCS C1713","","241.918  -  PLATE BN 142X12X3.7MM NS LCP CMBN PHLS LNG 5 HL SHFT LCK","BOTH IP/OP","$2,975.85 ","$2,202.13 ","$0.00 ","$2,889.18 ","$1,300.13 ","$0.00 ","$620.24 ","$0.00 ","$0.00 ","$505.87 ","$2,889.18 ","$0.00 ","$1,444.59 ","$2,288.23 ","$2,311.34 ","$0.00 ","$438.99 ","$0.00 ","$459.96 ","$0.00 "
"241.919","SUP","HCPCS C1713","","241.919  -  PLATE LNG 160MM SS 3.5MM SCR SM FRAG SET 6 HOLE LCP BONE","BOTH IP/OP","$3,582.78 ","$2,651.26 ","$0.00 ","$3,582.78 ","$1,612.25 ","$0.00 ","$746.74 ","$0.00 ","$0.00 ","$627.32 ","$3,582.78 ","$0.00 ","$1,791.39 ","$2,837.56 ","$2,866.22 ","$0.00 ","$560.70 ","$0.00 ","$570.38 ","$0.00 "
"241.921","SUP","HCPCS C1713","","241.921  -  PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK","BOTH IP/OP","$3,213.43 ","$2,377.94 ","$0.00 ","$3,119.83 ","$1,403.92 ","$0.00 ","$669.76 ","$0.00 ","$0.00 ","$546.26 ","$3,119.83 ","$0.00 ","$1,559.91 ","$2,470.91 ","$2,495.86 ","$0.00 ","$474.03 ","$0.00 ","$496.68 ","$0.00 "
"241.923","SUP","HCPCS C1713","","241.923  -  PLATE BN 232X12X3.7MM NS LCP CMBN PHLS LNG 10 HL SHFT LCK","BOTH IP/OP","$3,332.90 ","$2,466.35 ","$0.00 ","$3,235.83 ","$1,456.12 ","$0.00 ","$694.66 ","$0.00 ","$0.00 ","$566.57 ","$3,235.83 ","$0.00 ","$1,617.91 ","$2,562.78 ","$2,588.66 ","$0.00 ","$491.66 ","$0.00 ","$515.14 ","$0.00 "
"241.925","SUP","HCPCS C1713","","241.925  -  PLATE BN 268X12X3.7MM NS LCP CMBN PHLS LNG 12 HL SHFT LCK","BOTH IP/OP","$3,448.18 ","$2,551.65 ","$0.00 ","$3,347.73 ","$1,506.48 ","$0.00 ","$718.69 ","$0.00 ","$0.00 ","$586.16 ","$3,347.73 ","$0.00 ","$1,673.86 ","$2,651.40 ","$2,678.18 ","$0.00 ","$508.66 ","$0.00 ","$532.96 ","$0.00 "
"241.931","SUP","HCPCS C1713","","241.931  -  PLATE BN OB L T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$663.48 ","$490.98 ","$0.00 ","$644.15 ","$289.87 ","$0.00 ","$138.28 ","$0.00 ","$0.00 ","$112.79 ","$644.15 ","$0.00 ","$322.08 ","$510.17 ","$515.32 ","$0.00 ","$97.88 ","$0.00 ","$102.55 ","$0.00 "
"241.941","SUP","HCPCS C1713","","241.941  -  PLATE BN OB L T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$695.83 ","$514.91 ","$0.00 ","$675.55 ","$304.00 ","$0.00 ","$145.03 ","$0.00 ","$0.00 ","$118.28 ","$675.55 ","$0.00 ","$337.78 ","$535.04 ","$540.44 ","$0.00 ","$102.64 ","$0.00 ","$107.55 ","$0.00 "
"241.951","SUP","HCPCS C1713","","241.951  -  PLATE BN OB L T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT","BOTH IP/OP","$726.75 ","$537.80 ","$0.00 ","$705.58 ","$317.51 ","$0.00 ","$151.47 ","$0.00 ","$0.00 ","$123.54 ","$705.58 ","$0.00 ","$352.79 ","$558.82 ","$564.46 ","$0.00 ","$107.21 ","$0.00 ","$112.33 ","$0.00 "
"241.961","SUP","HCPCS C1713","","241.961  -  PLATE BONE T THK1.5MM 85X10MM 3X6 HOLE LEFT OBLIQUE LOCKING","BOTH IP/OP","$778.75 ","$576.28 ","$0.00 ","$756.08 ","$340.23 ","$0.00 ","$162.31 ","$0.00 ","$0.00 ","$132.38 ","$756.08 ","$0.00 ","$378.04 ","$598.82 ","$604.86 ","$0.00 ","$114.88 ","$0.00 ","$120.37 ","$0.00 "
"241.971","SUP","HCPCS C1713","","241.971  -  PLATE BN OB L T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT","BOTH IP/OP","$787.20 ","$582.53 ","$0.00 ","$764.25 ","$343.91 ","$0.00 ","$164.07 ","$0.00 ","$0.00 ","$133.81 ","$764.25 ","$0.00 ","$382.13 ","$605.29 ","$611.40 ","$0.00 ","$116.12 ","$0.00 ","$121.67 ","$0.00 "
"241.981","SUP","HCPCS C1713","","241.981  -  PLATE BONE T THK1.5MM 107X10MM 3X8 HOLE LEFT OBLIQUE LOCKING","BOTH IP/OP","$856.08 ","$633.50 ","$0.00 ","$831.13 ","$374.01 ","$0.00 ","$178.43 ","$0.00 ","$0.00 ","$145.52 ","$831.13 ","$0.00 ","$415.56 ","$658.25 ","$664.90 ","$0.00 ","$126.28 ","$0.00 ","$132.32 ","$0.00 "
"242.03","SUP","HCPCS C1713","","242.03  -  PLATE BN .25 TBLR 23X7X1MM NS .3MM 3 HL COLR SS 2.7MM SCR MN","BOTH IP/OP","$146.20 ","$108.19 ","$0.00 ","$141.93 ","$63.87 ","$0.00 ","$30.47 ","$0.00 ","$0.00 ","$24.85 ","$141.93 ","$0.00 ","$70.96 ","$112.41 ","$113.54 ","$0.00 ","$21.57 ","$0.00 ","$22.59 ","$0.00 "
"242.04","SUP","HCPCS C1713","","242.04  -  PLATE BONE .25 TUBE LP 31X7X1MM .3MM 4 HOLE COLLAR STAINLESS","BOTH IP/OP","$156.03 ","$115.46 ","$0.00 ","$151.48 ","$68.16 ","$0.00 ","$32.52 ","$0.00 ","$0.00 ","$26.52 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$23.02 ","$0.00 ","$24.11 ","$0.00 "
"242.05","SUP","HCPCS C1713","","242.05  -  PLATE BONE 39X7X1MM .3MM 5 HOLE QUARTER TUBULAR COLLAR LCP","BOTH IP/OP","$165.88 ","$122.75 ","$0.00 ","$161.05 ","$72.47 ","$0.00 ","$34.57 ","$0.00 ","$0.00 ","$28.20 ","$161.05 ","$0.00 ","$80.53 ","$127.55 ","$128.84 ","$0.00 ","$24.47 ","$0.00 ","$25.64 ","$0.00 "
"242.06","SUP","HCPCS C1713","","242.06  -  PLATE BONE .25 TUBULAR 47X7X1MM .3MM 6 HOLE COLLAR DCP","BOTH IP/OP","$179.93 ","$133.15 ","$0.00 ","$174.70 ","$78.62 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$30.59 ","$174.70 ","$0.00 ","$87.35 ","$138.36 ","$139.76 ","$0.00 ","$26.54 ","$0.00 ","$27.81 ","$0.00 "
"242.07","SUP","HCPCS C1713","","242.07  -  PLATE BONE .75 TUBE 55X7X1MM .3MM 7 HOLE COLLAR STAINLESS","BOTH IP/OP","$191.18 ","$141.47 ","$0.00 ","$185.60 ","$83.52 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$32.50 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$28.20 ","$0.00 ","$29.55 ","$0.00 "
"242.08","SUP","HCPCS C1713","","242.08  -  PLATE BONE .25 TUBE 63MM .3MM 8 HOLE COLLAR DCP STAINLESS","BOTH IP/OP","$196.80 ","$145.63 ","$0.00 ","$191.08 ","$85.98 ","$0.00 ","$41.02 ","$0.00 ","$0.00 ","$33.46 ","$191.08 ","$0.00 ","$95.54 ","$151.34 ","$152.86 ","$0.00 ","$29.03 ","$0.00 ","$30.42 ","$0.00 "
"242.102","SUP","HCPCS C1713","","242.102  -  PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL FEMUR LEFT","BOTH IP/OP","$2,614.60 ","$1,934.80 ","$0.00 ","$2,538.43 ","$1,142.29 ","$0.00 ","$544.95 ","$0.00 ","$0.00 ","$444.46 ","$2,538.43 ","$0.00 ","$1,269.21 ","$2,010.44 ","$2,030.74 ","$0.00 ","$385.69 ","$0.00 ","$404.12 ","$0.00 "
"242.104","SUP","HCPCS C1713","","242.104  -  PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM LT PROX 4.5","BOTH IP/OP","$2,666.60 ","$1,973.28 ","$0.00 ","$2,588.93 ","$1,165.02 ","$0.00 ","$555.79 ","$0.00 ","$0.00 ","$453.30 ","$2,588.93 ","$0.00 ","$1,294.46 ","$2,050.43 ","$2,071.14 ","$0.00 ","$393.37 ","$0.00 ","$412.16 ","$0.00 "
"242.106","SUP","HCPCS C1713","","242.106  -  PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM LT PROX 4.5","BOTH IP/OP","$2,718.60 ","$2,011.76 ","$0.00 ","$2,639.43 ","$1,187.74 ","$0.00 ","$566.62 ","$0.00 ","$0.00 ","$462.14 ","$2,639.43 ","$0.00 ","$1,319.71 ","$2,090.43 ","$2,111.54 ","$0.00 ","$401.04 ","$0.00 ","$420.20 ","$0.00 "
"242.108","SUP","HCPCS C1713","","242.108  -  PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM LT PROX 4.5","BOTH IP/OP","$2,852.15 ","$2,110.59 ","$0.00 ","$2,769.08 ","$1,246.08 ","$0.00 ","$594.46 ","$0.00 ","$0.00 ","$484.84 ","$2,769.08 ","$0.00 ","$1,384.54 ","$2,193.11 ","$2,215.26 ","$0.00 ","$420.74 ","$0.00 ","$440.84 ","$0.00 "
"242.11","SUP","HCPCS C1713","","242.110  -  PLATE BN 283MM NS LCP CMBN 10 HL LMT CNTCT SS FEM LT PROX","BOTH IP/OP","$2,966.98 ","$2,195.57 ","$0.00 ","$2,966.98 ","$1,335.14 ","$0.00 ","$618.39 ","$0.00 ","$0.00 ","$519.49 ","$2,966.98 ","$0.00 ","$1,483.49 ","$2,349.85 ","$2,373.58 ","$0.00 ","$450.81 ","$0.00 ","$472.34 ","$0.00 "
"242.112","SUP","HCPCS C1713","","242.112  -  PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM LT PROX","BOTH IP/OP","$3,235.90 ","$2,394.57 ","$0.00 ","$3,141.65 ","$1,413.74 ","$0.00 ","$674.44 ","$0.00 ","$0.00 ","$550.08 ","$3,141.65 ","$0.00 ","$1,570.83 ","$2,488.19 ","$2,513.32 ","$0.00 ","$477.35 ","$0.00 ","$500.15 ","$0.00 "
"242.114","SUP","HCPCS C1713","","242.114  -  PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM LT PROX","BOTH IP/OP","$3,495.95 ","$2,587.00 ","$0.00 ","$3,394.13 ","$1,527.36 ","$0.00 ","$728.64 ","$0.00 ","$0.00 ","$594.28 ","$3,394.13 ","$0.00 ","$1,697.06 ","$2,688.15 ","$2,715.30 ","$0.00 ","$515.71 ","$0.00 ","$540.34 ","$0.00 "
"242.116","SUP","HCPCS C1713","","242.116  -  PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM LT PROX","BOTH IP/OP","$3,601.38 ","$2,665.02 ","$0.00 ","$3,496.50 ","$1,573.43 ","$0.00 ","$750.62 ","$0.00 ","$0.00 ","$612.21 ","$3,496.50 ","$0.00 ","$1,748.25 ","$2,769.23 ","$2,797.20 ","$0.00 ","$531.26 ","$0.00 ","$556.64 ","$0.00 "
"242.12","SUP","HCPCS C1713","","242.120  -  PLATE BONE 133MM 2 HOLE HOOK LCP STAINLESS STEEL PROXIMAL","BOTH IP/OP","$2,941.03 ","$2,176.36 ","$0.00 ","$2,941.03 ","$1,323.46 ","$0.00 ","$612.98 ","$0.00 ","$0.00 ","$514.95 ","$2,941.03 ","$0.00 ","$1,470.51 ","$2,329.30 ","$2,352.82 ","$0.00 ","$446.87 ","$0.00 ","$468.21 ","$0.00 "
"242.121","SUP","HCPCS C1713","","242.121  -  PLATE BONE 169MM 4 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,071.45 ","$2,272.87 ","$0.00 ","$2,981.98 ","$1,341.89 ","$0.00 ","$640.17 ","$0.00 ","$0.00 ","$522.12 ","$2,981.98 ","$0.00 ","$1,490.99 ","$2,361.73 ","$2,385.58 ","$0.00 ","$453.09 ","$0.00 ","$474.73 ","$0.00 "
"242.122","SUP","HCPCS C1713","","242.122  -  PLATE BONE 205MM 6 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,119.23 ","$2,308.23 ","$0.00 ","$3,028.38 ","$1,362.77 ","$0.00 ","$650.12 ","$0.00 ","$0.00 ","$530.24 ","$3,028.38 ","$0.00 ","$1,514.19 ","$2,398.48 ","$2,422.70 ","$0.00 ","$460.14 ","$0.00 ","$482.12 ","$0.00 "
"242.123","SUP","HCPCS C1713","","242.123  -  PLATE BONE 241MM 8 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,234.50 ","$2,393.53 ","$0.00 ","$3,140.30 ","$1,413.14 ","$0.00 ","$674.15 ","$0.00 ","$0.00 ","$549.84 ","$3,140.30 ","$0.00 ","$1,570.15 ","$2,487.12 ","$2,512.24 ","$0.00 ","$477.14 ","$0.00 ","$499.94 ","$0.00 "
"242.124","SUP","HCPCS C1713","","242.124  -  PLATE BONE 277MM 10 HOLE HOOK LCP STAINLESS STEEL PROXIMAL","BOTH IP/OP","$3,400.38 ","$2,516.28 ","$0.00 ","$3,301.33 ","$1,485.60 ","$0.00 ","$708.72 ","$0.00 ","$0.00 ","$578.04 ","$3,301.33 ","$0.00 ","$1,650.66 ","$2,614.65 ","$2,641.06 ","$0.00 ","$501.61 ","$0.00 ","$525.57 ","$0.00 "
"242.125","SUP","HCPCS C1713","","242.125  -  PLATE BONE 313MM 12 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,511.43 ","$2,598.46 ","$0.00 ","$3,409.15 ","$1,534.12 ","$0.00 ","$731.87 ","$0.00 ","$0.00 ","$596.91 ","$3,409.15 ","$0.00 ","$1,704.58 ","$2,700.05 ","$2,727.32 ","$0.00 ","$517.99 ","$0.00 ","$542.74 ","$0.00 "
"242.126","SUP","HCPCS C1713","","242.126  -  PLATE BONE 349MM 14 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,552.18 ","$2,628.61 ","$0.00 ","$3,448.73 ","$1,551.93 ","$0.00 ","$740.36 ","$0.00 ","$0.00 ","$603.84 ","$3,448.73 ","$0.00 ","$1,724.36 ","$2,731.39 ","$2,758.98 ","$0.00 ","$524.01 ","$0.00 ","$549.04 ","$0.00 "
"242.127","SUP","HCPCS C1713","","242.127  -  PLATE BONE 385MM 16 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,670.28 ","$2,716.01 ","$0.00 ","$3,563.35 ","$1,603.51 ","$0.00 ","$764.98 ","$0.00 ","$0.00 ","$623.91 ","$3,563.35 ","$0.00 ","$1,781.68 ","$2,822.17 ","$2,850.68 ","$0.00 ","$541.42 ","$0.00 ","$567.29 ","$0.00 "
"242.128","SUP","HCPCS C1713","","242.128  -  PLATE BONE 421MM 18 HOLE HOOK LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,788.35 ","$2,803.38 ","$0.00 ","$3,678.00 ","$1,655.10 ","$0.00 ","$789.59 ","$0.00 ","$0.00 ","$643.99 ","$3,678.00 ","$0.00 ","$1,839.00 ","$2,912.98 ","$2,942.40 ","$0.00 ","$558.84 ","$0.00 ","$585.54 ","$0.00 "
"242.204","SUP","HCPCS C1713","","242.204  -  PLATE BONE 41MMX2.6MM 4 HOLE LC-DCP STAINLESS STEEL FT","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"242.205","SUP","HCPCS C1713","","242.205  -  PLATE BONE 50MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"242.206","SUP","HCPCS C1713","","242.206  -  PLATE BONE 59MM 6 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"242.207","SUP","HCPCS C1713","","242.207  -  PLATE BONE 68MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$281.15 ","$208.05 ","$0.00 ","$272.95 ","$122.83 ","$0.00 ","$58.60 ","$0.00 ","$0.00 ","$47.79 ","$272.95 ","$0.00 ","$136.48 ","$216.18 ","$218.36 ","$0.00 ","$41.47 ","$0.00 ","$43.45 ","$0.00 "
"242.208","SUP","HCPCS C1713","","242.208  -  PLATE BONE 77MM 8 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7","BOTH IP/OP","$293.80 ","$217.41 ","$0.00 ","$285.23 ","$128.35 ","$0.00 ","$61.24 ","$0.00 ","$0.00 ","$49.94 ","$285.23 ","$0.00 ","$142.61 ","$225.90 ","$228.18 ","$0.00 ","$43.34 ","$0.00 ","$45.41 ","$0.00 "
"242.209","SUP","HCPCS C1713","","242.209  -  PLATE BONE 86MM 9 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$300.83 ","$222.61 ","$0.00 ","$292.05 ","$131.42 ","$0.00 ","$62.70 ","$0.00 ","$0.00 ","$51.14 ","$292.05 ","$0.00 ","$146.03 ","$231.30 ","$233.64 ","$0.00 ","$44.38 ","$0.00 ","$46.49 ","$0.00 "
"242.21","SUP","HCPCS C1713","","242.21  -  PLATE BONE 44MM 7 HOLE MULTIPLE FRAGMENT DCP STAINLESS STEEL","BOTH IP/OP","$126.93 ","$93.93 ","$0.00 ","$126.93 ","$57.12 ","$0.00 ","$26.45 ","$0.00 ","$0.00 ","$22.22 ","$126.93 ","$0.00 ","$63.46 ","$100.53 ","$101.54 ","$0.00 ","$19.28 ","$0.00 ","$20.21 ","$0.00 "
"242.22","SUP","HCPCS C1713","","242.220  -  PLATE BONE 95MM 10 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$308.43 ","$228.24 ","$0.00 ","$308.43 ","$138.79 ","$0.00 ","$64.28 ","$0.00 ","$0.00 ","$54.00 ","$308.43 ","$0.00 ","$154.21 ","$244.28 ","$246.74 ","$0.00 ","$46.86 ","$0.00 ","$49.10 ","$0.00 "
"242.221","SUP","HCPCS C1713","","242.221  -  PLATE BONE 104MM 11 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$331.75 ","$245.50 ","$0.00 ","$322.08 ","$144.93 ","$0.00 ","$69.14 ","$0.00 ","$0.00 ","$56.39 ","$322.08 ","$0.00 ","$161.04 ","$255.09 ","$257.66 ","$0.00 ","$48.94 ","$0.00 ","$51.27 ","$0.00 "
"242.222","SUP","HCPCS C1713","","242.222  -  PLATE BONE 113MM 12 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$344.40 ","$254.86 ","$0.00 ","$334.38 ","$150.47 ","$0.00 ","$71.78 ","$0.00 ","$0.00 ","$58.55 ","$334.38 ","$0.00 ","$167.19 ","$264.83 ","$267.50 ","$0.00 ","$50.80 ","$0.00 ","$53.23 ","$0.00 "
"242.31","SUP","HCPCS C1713","","242.31  -  PLATE BN L 32MM NS DCP 3 HLE/HD 2 HL SHFT SS FT LT 2.7MM SCR","BOTH IP/OP","$103.30 ","$76.44 ","$0.00 ","$100.30 ","$45.14 ","$0.00 ","$21.53 ","$0.00 ","$0.00 ","$17.56 ","$100.30 ","$0.00 ","$50.15 ","$79.44 ","$80.24 ","$0.00 ","$15.24 ","$0.00 ","$15.97 ","$0.00 "
"242.32","SUP","HCPCS C1713","","242.32  -  PLATE BONE L 32MM 2X3 HOLE DCP STAINLESS STEEL FT RIGHT","BOTH IP/OP","$103.30 ","$76.44 ","$0.00 ","$100.30 ","$45.14 ","$0.00 ","$21.53 ","$0.00 ","$0.00 ","$17.56 ","$100.30 ","$0.00 ","$50.15 ","$79.44 ","$80.24 ","$0.00 ","$15.24 ","$0.00 ","$15.97 ","$0.00 "
"242.33","SUP","HCPCS C1713","","242.33  -  PLATE BN OB L L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$50.05 ","$0.00 ","$23.88 ","$0.00 ","$0.00 ","$19.47 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$16.90 ","$0.00 ","$17.71 ","$0.00 "
"242.34","SUP","HCPCS C1713","","242.34  -  PLATE BN OB R L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$50.05 ","$0.00 ","$23.88 ","$0.00 ","$0.00 ","$19.47 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$16.90 ","$0.00 ","$17.71 ","$0.00 "
"242.41","SUP","HCPCS C1713","","242.41  -  PLATE BN T 32X7X1.2MM NS 3 HL SS 2.7MM SCR MN FRAG SET","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$50.05 ","$0.00 ","$23.88 ","$0.00 ","$0.00 ","$19.47 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$16.90 ","$0.00 ","$17.71 ","$0.00 "
"242.458","SUP","HCPCS C1713","","242.458  -  PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$226.65 ","$0.00 ","$237.47 ","$0.00 "
"242.459","SUP","HCPCS C1713","","242.459  -  PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"242.461","SUP","HCPCS C1713","","242.461  -  PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$226.65 ","$0.00 ","$237.47 ","$0.00 "
"242.462","SUP","HCPCS C1713","","242.462  -  PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"242.464","SUP","HCPCS C1713","","242.464  -  PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$226.65 ","$0.00 ","$237.47 ","$0.00 "
"242.465","SUP","HCPCS C1713","","242.465  -  PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"242.467","SUP","HCPCS C1713","","242.467  -  PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$226.65 ","$0.00 ","$237.47 ","$0.00 "
"242.468","SUP","HCPCS C1713","","242.468  -  PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"242.472","SUP","HCPCS C1713","","242.472  -  PLATE SS BONE RIGHT DISTAL DORSAL RAD NONSTRL","BOTH IP/OP","$1,868.43 ","$1,382.64 ","$0.00 ","$1,868.43 ","$840.79 ","$0.00 ","$389.43 ","$0.00 ","$0.00 ","$327.15 ","$1,868.43 ","$0.00 ","$934.21 ","$1,479.80 ","$1,494.74 ","$0.00 ","$292.41 ","$0.00 ","$297.45 ","$0.00 "
"242.473","SUP","HCPCS C1713","","242.473  -  PLATE SS LCP BONE RIGHT DISTAL VOLR RADL NONSTRL","BOTH IP/OP","$1,542.28 ","$1,141.29 ","$0.00 ","$1,542.28 ","$694.02 ","$0.00 ","$321.45 ","$0.00 ","$0.00 ","$270.04 ","$1,542.28 ","$0.00 ","$771.14 ","$1,221.49 ","$1,233.82 ","$0.00 ","$241.37 ","$0.00 ","$245.53 ","$0.00 "
"242.477","SUP","HCPCS C1713","","242.477  -  PLATE BN T 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$877.15 ","$649.09 ","$0.00 ","$851.60 ","$383.22 ","$0.00 ","$182.82 ","$0.00 ","$0.00 ","$149.11 ","$851.60 ","$0.00 ","$425.80 ","$674.47 ","$681.28 ","$0.00 ","$129.39 ","$0.00 ","$135.57 ","$0.00 "
"242.478","SUP","HCPCS C1713","","242.478  -  PLATE BN T 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$913.70 ","$676.14 ","$0.00 ","$887.10 ","$399.20 ","$0.00 ","$190.44 ","$0.00 ","$0.00 ","$155.32 ","$887.10 ","$0.00 ","$443.55 ","$702.58 ","$709.68 ","$0.00 ","$134.79 ","$0.00 ","$141.23 ","$0.00 "
"242.479","SUP","HCPCS C1713","","242.479  -  PLATE BN STRG 48X6.3X1.6MM NS LCP CMBN 5 HL LOPRFL RND EDG","BOTH IP/OP","$832.18 ","$615.81 ","$0.00 ","$807.93 ","$363.57 ","$0.00 ","$173.45 ","$0.00 ","$0.00 ","$141.46 ","$807.93 ","$0.00 ","$403.96 ","$639.88 ","$646.34 ","$0.00 ","$122.76 ","$0.00 ","$128.62 ","$0.00 "
"242.482","SUP","HCPCS C1713","","242.482  -  PLATE SS BONE LEFT DISTAL DORSAL RADL NONSTRL","BOTH IP/OP","$1,868.43 ","$1,382.64 ","$0.00 ","$1,868.43 ","$840.79 ","$0.00 ","$389.43 ","$0.00 ","$0.00 ","$327.15 ","$1,868.43 ","$0.00 ","$934.21 ","$1,479.80 ","$1,494.74 ","$0.00 ","$292.41 ","$0.00 ","$297.45 ","$0.00 "
"242.483","SUP","HCPCS C1713","","242.483  -  PLATE SS BONE LEFT DISTAL VOLR RADL NONSTRL","BOTH IP/OP","$1,542.28 ","$1,141.29 ","$0.00 ","$1,542.28 ","$694.02 ","$0.00 ","$321.45 ","$0.00 ","$0.00 ","$270.04 ","$1,542.28 ","$0.00 ","$771.14 ","$1,221.49 ","$1,233.82 ","$0.00 ","$241.37 ","$0.00 ","$245.53 ","$0.00 "
"242.49","SUP","HCPCS C1713","","242.490  -  PLATE BN STRG 57X6.3X1.6MM NS LCP CMBN 6 HL LOPRFL RND EDG","BOTH IP/OP","$851.60 ","$630.18 ","$0.00 ","$851.60 ","$383.22 ","$0.00 ","$177.49 ","$0.00 ","$0.00 ","$149.11 ","$851.60 ","$0.00 ","$425.80 ","$674.47 ","$681.28 ","$0.00 ","$129.39 ","$0.00 ","$135.57 ","$0.00 "
"242.491","SUP","HCPCS C1713","","242.491  -  PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$293.30 ","$0.00 ","$237.47 ","$0.00 "
"242.492","SUP","HCPCS C1713","","242.492  -  PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$310.94 ","$0.00 ","$251.38 ","$0.00 "
"242.493","SUP","HCPCS C1713","","242.493  -  PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$293.30 ","$0.00 ","$237.47 ","$0.00 "
"242.494","SUP","HCPCS C1713","","242.494  -  PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"242.5","SUP","HCPCS C1713","","242.500  -  PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT","BOTH IP/OP","$822.95 ","$608.98 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$171.52 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"242.501","SUP","HCPCS C1713","","242.501  -  PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"242.502","SUP","HCPCS C1713","","242.502  -  PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"242.503","SUP","HCPCS C1713","","242.503  -  PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"242.504","SUP","HCPCS C1713","","242.504  -  PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"242.505","SUP","HCPCS C1713","","242.505  -  PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"242.506","SUP","HCPCS C1713","","242.506  -  PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"242.507","SUP","HCPCS C1713","","242.507  -  PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"242.508","SUP","HCPCS C1713","","242.508  -  PLATE BN +20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"242.509","SUP","HCPCS C1713","","242.509  -  PLATE BN +20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"242.51","SUP","HCPCS C1713","","242.510  -  PLATE BONE STANDARD BEND 8 HOLE FUSION LCP STAINLESS STEEL","BOTH IP/OP","$1,973.43 ","$1,460.34 ","$0.00 ","$1,973.43 ","$888.04 ","$0.00 ","$411.31 ","$0.00 ","$0.00 ","$345.53 ","$1,973.43 ","$0.00 ","$986.71 ","$1,562.96 ","$1,578.74 ","$0.00 ","$299.85 ","$0.00 ","$314.17 ","$0.00 "
"242.511","SUP","HCPCS C1713","","242.511  -  PLATE BN -20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"242.512","SUP","HCPCS C1713","","242.512  -  PLATE BN -20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"242.52","SUP","HCPCS C1713","","242.520  -  PLATE BONE SHORT BEND 8 HOLE STAINLESS STEEL WRIST NONSTRL","BOTH IP/OP","$1,973.43 ","$1,460.34 ","$0.00 ","$1,973.43 ","$888.04 ","$0.00 ","$411.31 ","$0.00 ","$0.00 ","$345.53 ","$1,973.43 ","$0.00 ","$986.71 ","$1,562.96 ","$1,578.74 ","$0.00 ","$299.85 ","$0.00 ","$314.17 ","$0.00 "
"242.53","SUP","HCPCS C1713","","242.530  -  PLATE BONE 9 HOLE STR FUSION STAINLESS STEEL WRIST NONSTRL","BOTH IP/OP","$1,973.43 ","$1,460.34 ","$0.00 ","$1,973.43 ","$888.04 ","$0.00 ","$411.31 ","$0.00 ","$0.00 ","$345.53 ","$1,973.43 ","$0.00 ","$986.71 ","$1,562.96 ","$1,578.74 ","$0.00 ","$299.85 ","$0.00 ","$314.17 ","$0.00 "
"242.535","SUP","HCPCS C1713","","242.535  -  PLATE BN 31MMX1.2MM NS 5 HL MDLR SS HND/MDFT 2.7MM SCR","BOTH IP/OP","$449.83 ","$332.87 ","$0.00 ","$436.73 ","$196.53 ","$0.00 ","$93.75 ","$0.00 ","$0.00 ","$76.47 ","$436.73 ","$0.00 ","$218.36 ","$345.89 ","$349.38 ","$0.00 ","$66.36 ","$0.00 ","$69.53 ","$0.00 "
"242.536","SUP","HCPCS C1713","","242.536  -  PLATE BN 45MMX1.2MM NS 8 HL MDLR SS HND/MDFT 2.7MM SCR","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$451.73 ","$203.28 ","$0.00 ","$96.97 ","$0.00 ","$0.00 ","$79.09 ","$451.73 ","$0.00 ","$225.86 ","$357.77 ","$361.38 ","$0.00 ","$68.64 ","$0.00 ","$71.91 ","$0.00 "
"242.61","SUP","HCPCS C1713","","242.61  -  PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE LEFT","BOTH IP/OP","$532.75 ","$394.24 ","$0.00 ","$517.25 ","$232.76 ","$0.00 ","$111.04 ","$0.00 ","$0.00 ","$90.57 ","$517.25 ","$0.00 ","$258.63 ","$409.66 ","$413.80 ","$0.00 ","$78.59 ","$0.00 ","$82.35 ","$0.00 "
"242.62","SUP","HCPCS C1713","","242.62  -  PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE RIGHT","BOTH IP/OP","$532.75 ","$394.24 ","$0.00 ","$517.25 ","$232.76 ","$0.00 ","$111.04 ","$0.00 ","$0.00 ","$90.57 ","$517.25 ","$0.00 ","$258.63 ","$409.66 ","$413.80 ","$0.00 ","$78.59 ","$0.00 ","$82.35 ","$0.00 "
"242.802","SUP","HCPCS C1713","","242.802  -  PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,614.60 ","$1,934.80 ","$0.00 ","$2,538.43 ","$1,142.29 ","$0.00 ","$544.95 ","$0.00 ","$0.00 ","$444.46 ","$2,538.43 ","$0.00 ","$1,269.21 ","$2,010.44 ","$2,030.74 ","$0.00 ","$385.69 ","$0.00 ","$404.12 ","$0.00 "
"242.804","SUP","HCPCS C1713","","242.804  -  PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM RT PROX 4.5","BOTH IP/OP","$2,666.60 ","$1,973.28 ","$0.00 ","$2,588.93 ","$1,165.02 ","$0.00 ","$555.79 ","$0.00 ","$0.00 ","$453.30 ","$2,588.93 ","$0.00 ","$1,294.46 ","$2,050.43 ","$2,071.14 ","$0.00 ","$511.85 ","$0.00 ","$412.16 ","$0.00 "
"242.806","SUP","HCPCS C1713","","242.806  -  PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM RT PROX 4.5","BOTH IP/OP","$2,718.60 ","$2,011.76 ","$0.00 ","$2,639.43 ","$1,187.74 ","$0.00 ","$566.62 ","$0.00 ","$0.00 ","$462.14 ","$2,639.43 ","$0.00 ","$1,319.71 ","$2,090.43 ","$2,111.54 ","$0.00 ","$401.04 ","$0.00 ","$420.20 ","$0.00 "
"242.808","SUP","HCPCS C1713","","242.808  -  PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM RT PROX 4.5","BOTH IP/OP","$2,852.15 ","$2,110.59 ","$0.00 ","$2,769.08 ","$1,246.08 ","$0.00 ","$594.46 ","$0.00 ","$0.00 ","$484.84 ","$2,769.08 ","$0.00 ","$1,384.54 ","$2,193.11 ","$2,215.26 ","$0.00 ","$420.74 ","$0.00 ","$440.84 ","$0.00 "
"242.81","SUP","HCPCS C1713","","242.810  -  PLATE BONE 283MM 10 HOLE LCP STAINLESS STEEL FEMUR RIGHT","BOTH IP/OP","$2,966.98 ","$2,195.57 ","$0.00 ","$2,966.98 ","$1,335.14 ","$0.00 ","$618.39 ","$0.00 ","$0.00 ","$519.49 ","$2,966.98 ","$0.00 ","$1,483.49 ","$2,349.85 ","$2,373.58 ","$0.00 ","$450.81 ","$0.00 ","$472.34 ","$0.00 "
"242.812","SUP","HCPCS C1713","","242.812  -  PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM RT PROX","BOTH IP/OP","$3,235.90 ","$2,394.57 ","$0.00 ","$3,141.65 ","$1,413.74 ","$0.00 ","$674.44 ","$0.00 ","$0.00 ","$550.08 ","$3,141.65 ","$0.00 ","$1,570.83 ","$2,488.19 ","$2,513.32 ","$0.00 ","$477.35 ","$0.00 ","$500.15 ","$0.00 "
"242.814","SUP","HCPCS C1713","","242.814  -  PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM RT PROX","BOTH IP/OP","$3,495.95 ","$2,587.00 ","$0.00 ","$3,394.13 ","$1,527.36 ","$0.00 ","$728.64 ","$0.00 ","$0.00 ","$594.28 ","$3,394.13 ","$0.00 ","$1,697.06 ","$2,688.15 ","$2,715.30 ","$0.00 ","$515.71 ","$0.00 ","$540.34 ","$0.00 "
"242.816","SUP","HCPCS C1713","","242.816  -  PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM RT PROX","BOTH IP/OP","$3,601.38 ","$2,665.02 ","$0.00 ","$3,496.50 ","$1,573.43 ","$0.00 ","$750.62 ","$0.00 ","$0.00 ","$612.21 ","$3,496.50 ","$0.00 ","$1,748.25 ","$2,769.23 ","$2,797.20 ","$0.00 ","$531.26 ","$0.00 ","$556.64 ","$0.00 "
"243.091","SUP","HCPCS C1713","","243.091  -  PLATE BONE STR 12 HOLE ADAPTION STAINLESS STEEL HAND NONSTRL","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"243.13","SUP","HCPCS C1713","","243.13  -  PLATE BONE STR 17X5X1MM 3 HOLE DCP STAINLESS STEEL FT","BOTH IP/OP","$103.30 ","$76.44 ","$0.00 ","$100.30 ","$45.14 ","$0.00 ","$21.53 ","$0.00 ","$0.00 ","$17.56 ","$100.30 ","$0.00 ","$50.15 ","$79.44 ","$80.24 ","$0.00 ","$15.24 ","$0.00 ","$15.97 ","$0.00 "
"243.14","SUP","HCPCS C1713","","243.14  -  PLATE BONE STR 23X5X1MM 4 HOLE DCP STAINLESS STEEL FT","BOTH IP/OP","$113.85 ","$84.25 ","$0.00 ","$110.55 ","$49.75 ","$0.00 ","$23.73 ","$0.00 ","$0.00 ","$19.36 ","$110.55 ","$0.00 ","$55.28 ","$87.56 ","$88.44 ","$0.00 ","$16.80 ","$0.00 ","$17.60 ","$0.00 "
"243.15","SUP","HCPCS C1713","","243.15  -  PLATE BONE STR 29X5X1MM 5 HOLE DCP STAINLESS STEEL FT","BOTH IP/OP","$121.58 ","$89.97 ","$0.00 ","$118.05 ","$53.12 ","$0.00 ","$25.34 ","$0.00 ","$0.00 ","$20.67 ","$118.05 ","$0.00 ","$59.03 ","$93.50 ","$94.44 ","$0.00 ","$23.10 ","$0.00 ","$18.79 ","$0.00 "
"243.16","SUP","HCPCS C1713","","243.16  -  PLATE BN STRG 35X5X1MM NS 6 HL SS 2MM SCR MN FRAG SET","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"243.19","SUP","HCPCS C1713","","243.19  -  PLATE BONE 2MM 100MM 20 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$420.30 ","$311.02 ","$0.00 ","$408.05 ","$183.62 ","$0.00 ","$87.60 ","$0.00 ","$0.00 ","$71.45 ","$408.05 ","$0.00 ","$204.03 ","$323.18 ","$326.44 ","$0.00 ","$62.00 ","$0.00 ","$64.96 ","$0.00 "
"243.23","SUP","HCPCS C1713","","243.23  -  PLATE BONE 2MM 12 HOLE T DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$371.00 ","$166.95 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$64.96 ","$371.00 ","$0.00 ","$185.50 ","$293.83 ","$296.80 ","$0.00 ","$58.06 ","$0.00 ","$59.06 ","$0.00 "
"243.234","SUP","HCPCS C1713","","243.234  -  PLATE BN T 65MMX1.2MM NS DCP 3 HLE/HD 10 HL SHFT SS FT 2MM","BOTH IP/OP","$462.48 ","$342.24 ","$0.00 ","$449.00 ","$202.05 ","$0.00 ","$96.39 ","$0.00 ","$0.00 ","$78.62 ","$449.00 ","$0.00 ","$224.50 ","$355.61 ","$359.20 ","$0.00 ","$68.22 ","$0.00 ","$71.48 ","$0.00 "
"243.24","SUP","HCPCS C1713","","243.24  -  PLATE BONE 2MM 50MM T 4 HOLE HEAD 9 HOLE SHAFT DCP STAINLESS","BOTH IP/OP","$393.60 ","$291.26 ","$0.00 ","$382.13 ","$171.96 ","$0.00 ","$82.04 ","$0.00 ","$0.00 ","$66.91 ","$382.13 ","$0.00 ","$191.06 ","$302.65 ","$305.70 ","$0.00 ","$58.06 ","$0.00 ","$60.83 ","$0.00 "
"243.31","SUP","HCPCS C1713","","243.31  -  PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$46.68 ","$0.00 ","$21.62 ","$0.00 ","$0.00 ","$18.16 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$15.76 ","$0.00 ","$16.51 ","$0.00 "
"243.32","SUP","HCPCS C1713","","243.32  -  PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$46.68 ","$0.00 ","$21.62 ","$0.00 ","$0.00 ","$18.16 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$15.76 ","$0.00 ","$16.51 ","$0.00 "
"243.33","SUP","HCPCS C1713","","243.33  -  PLATE BN OB L L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET","BOTH IP/OP","$103.30 ","$76.44 ","$0.00 ","$100.30 ","$45.14 ","$0.00 ","$21.53 ","$0.00 ","$0.00 ","$17.56 ","$100.30 ","$0.00 ","$50.15 ","$79.44 ","$80.24 ","$0.00 ","$15.24 ","$0.00 ","$15.97 ","$0.00 "
"243.34","SUP","HCPCS C1713","","243.34  -  PLATE BN OB R L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET","BOTH IP/OP","$103.30 ","$76.44 ","$0.00 ","$100.30 ","$45.14 ","$0.00 ","$21.53 ","$0.00 ","$0.00 ","$17.56 ","$100.30 ","$0.00 ","$50.15 ","$79.44 ","$80.24 ","$0.00 ","$15.24 ","$0.00 ","$15.97 ","$0.00 "
"243.41","SUP","HCPCS C1713","","243.41  -  PLATE BONE T 18MM 2X2 HOLE DCP STAINLESS STEEL FT NONSTRL","BOTH IP/OP","$103.30 ","$76.44 ","$0.00 ","$100.30 ","$45.14 ","$0.00 ","$21.53 ","$0.00 ","$0.00 ","$17.56 ","$100.30 ","$0.00 ","$50.15 ","$79.44 ","$80.24 ","$0.00 ","$15.24 ","$0.00 ","$15.97 ","$0.00 "
"243.48","SUP","HCPCS C1713","","243.48  -  PLATE BONE H 6MM 4 HOLE DCP STAINLESS STEEL FT NONSTRL MINI","BOTH IP/OP","$301.60 ","$223.18 ","$0.00 ","$301.60 ","$135.72 ","$0.00 ","$62.86 ","$0.00 ","$0.00 ","$52.81 ","$301.60 ","$0.00 ","$150.80 ","$238.87 ","$241.28 ","$0.00 ","$45.83 ","$0.00 ","$48.01 ","$0.00 "
"243.54","SUP","HCPCS C1713","","243.54  -  PLATE BONE 2MM 22MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$305.70 ","$226.22 ","$0.00 ","$305.70 ","$137.57 ","$0.00 ","$63.72 ","$0.00 ","$0.00 ","$53.53 ","$305.70 ","$0.00 ","$152.85 ","$242.11 ","$244.56 ","$0.00 ","$46.45 ","$0.00 ","$48.67 ","$0.00 "
"243.55","SUP","HCPCS C1713","","243.55  -  PLATE BONE 27X5MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2MM","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$65.99 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"243.56","SUP","HCPCS C1713","","243.56  -  PLATE BONE 32MM 2MM 6 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$330.28 ","$244.41 ","$0.00 ","$330.28 ","$148.62 ","$0.00 ","$68.84 ","$0.00 ","$0.00 ","$57.83 ","$330.28 ","$0.00 ","$165.14 ","$261.58 ","$264.22 ","$0.00 ","$50.18 ","$0.00 ","$52.58 ","$0.00 "
"243.57","SUP","HCPCS C1713","","243.57  -  PLATE BONE 2MM 37MM 7 HOLE RECONSTRUCTION DCP STAINLESS","BOTH IP/OP","$348.00 ","$257.52 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$72.53 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"243.58","SUP","HCPCS C1713","","243.58  -  PLATE BONE 2MM 42MM 8 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"243.584","SUP","HCPCS C1713","","243.584  -  PLATE BN 27MMX1.2MM NS LC DCP 4 HL SS 2MM SCR MDLR HND SYS","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$383.50 ","$172.58 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$67.15 ","$383.50 ","$0.00 ","$191.75 ","$303.73 ","$306.80 ","$0.00 ","$58.27 ","$0.00 ","$61.05 ","$0.00 "
"243.585","SUP","HCPCS C1713","","243.585  -  PLATE BONE 33MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$420.30 ","$311.02 ","$0.00 ","$408.05 ","$183.62 ","$0.00 ","$87.60 ","$0.00 ","$0.00 ","$71.45 ","$408.05 ","$0.00 ","$204.03 ","$323.18 ","$326.44 ","$0.00 ","$62.00 ","$0.00 ","$64.96 ","$0.00 "
"243.586","SUP","HCPCS C1713","","243.586  -  PLATE BN 39MMX1.2MM NS LC DCP 6 HL SS 2MM SCR MDLR HND SYS","BOTH IP/OP","$463.88 ","$343.27 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$96.68 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$68.43 ","$0.00 ","$71.70 ","$0.00 "
"243.587","SUP","HCPCS C1713","","243.587  -  PLATE BONE 45MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$496.20 ","$367.19 ","$0.00 ","$481.75 ","$216.79 ","$0.00 ","$103.42 ","$0.00 ","$0.00 ","$84.35 ","$481.75 ","$0.00 ","$240.88 ","$381.55 ","$385.40 ","$0.00 ","$73.20 ","$0.00 ","$76.69 ","$0.00 "
"243.588","SUP","HCPCS C1713","","243.588  -  PLATE BN 51MMX1.2MM NS LC DCP 8 HL SS 2MM SCR MDLR HND SYS","BOTH IP/OP","$531.35 ","$393.20 ","$0.00 ","$515.88 ","$232.14 ","$0.00 ","$110.75 ","$0.00 ","$0.00 ","$90.33 ","$515.88 ","$0.00 ","$257.94 ","$408.58 ","$412.70 ","$0.00 ","$78.38 ","$0.00 ","$82.13 ","$0.00 "
"243.61","SUP","HCPCS C1713","","243.61  -  PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL LT 2MM SCR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"243.62","SUP","HCPCS C1713","","243.62  -  PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL RT 2MM SCR","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"244.02","SUP","HCPCS C1713","","244.02  -  PLATE BONE 20MM 2 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM","BOTH IP/OP","$218.35 ","$161.58 ","$0.00 ","$218.35 ","$98.26 ","$0.00 ","$45.51 ","$0.00 ","$0.00 ","$38.23 ","$218.35 ","$0.00 ","$109.18 ","$172.93 ","$174.68 ","$0.00 ","$33.18 ","$0.00 ","$34.76 ","$0.00 "
"244.04","SUP","HCPCS C1713","","244.04  -  PLATE BN 36X8X2MM NS DCP 4 HL SS 2.7MM SCR MN FRAG SET","BOTH IP/OP","$245.65 ","$181.78 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$51.20 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"244.05","SUP","HCPCS C1713","","244.05  -  PLATE BONE 44X8X2MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM","BOTH IP/OP","$279.78 ","$207.04 ","$0.00 ","$279.78 ","$125.90 ","$0.00 ","$58.31 ","$0.00 ","$0.00 ","$48.99 ","$279.78 ","$0.00 ","$139.89 ","$221.59 ","$223.82 ","$0.00 ","$42.51 ","$0.00 ","$44.54 ","$0.00 "
"244.06","SUP","HCPCS C1713","","244.06  -  PLATE BONE 52X8X2MM 6 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM","BOTH IP/OP","$302.98 ","$224.21 ","$0.00 ","$302.98 ","$136.34 ","$0.00 ","$63.15 ","$0.00 ","$0.00 ","$53.05 ","$302.98 ","$0.00 ","$151.49 ","$239.96 ","$242.38 ","$0.00 ","$46.03 ","$0.00 ","$48.23 ","$0.00 "
"244.07","SUP","HCPCS C1713","","244.07  -  PLATE BN 60X8X2.5MM NS DCP 7 HL SS 2.7MM SCR MN FRAG SET","BOTH IP/OP","$346.65 ","$256.52 ","$0.00 ","$346.65 ","$155.99 ","$0.00 ","$72.25 ","$0.00 ","$0.00 ","$60.70 ","$346.65 ","$0.00 ","$173.33 ","$274.55 ","$277.32 ","$0.00 ","$52.67 ","$0.00 ","$55.19 ","$0.00 "
"244.08","SUP","HCPCS C1713","","244.08  -  PLATE BONE 68X8X2.5MM 8 HOLE DCP STAINLESS STEEL NONSTRL 2.7","BOTH IP/OP","$384.85 ","$284.79 ","$0.00 ","$384.85 ","$173.18 ","$0.00 ","$80.21 ","$0.00 ","$0.00 ","$67.38 ","$384.85 ","$0.00 ","$192.43 ","$304.80 ","$307.88 ","$0.00 ","$58.48 ","$0.00 ","$61.27 ","$0.00 "
"244.09","SUP","HCPCS C1713","","244.09  -  PLATE BN 76X8X2.5MM NS DCP 9 HL SS 2.7MM SCR MN FRAG SET","BOTH IP/OP","$399.88 ","$295.91 ","$0.00 ","$399.88 ","$179.94 ","$0.00 ","$83.34 ","$0.00 ","$0.00 ","$70.01 ","$399.88 ","$0.00 ","$199.94 ","$316.70 ","$319.90 ","$0.00 ","$60.76 ","$0.00 ","$63.66 ","$0.00 "
"244.1","SUP","HCPCS C1713","","244.10  -  PLATE BONE 84X8X2.5MM 10 HOLE DCP STAINLESS STEEL FT NONSTRL","BOTH IP/OP","$443.55 ","$328.23 ","$0.00 ","$443.55 ","$199.60 ","$0.00 ","$92.45 ","$0.00 ","$0.00 ","$77.66 ","$443.55 ","$0.00 ","$221.78 ","$351.29 ","$354.84 ","$0.00 ","$67.39 ","$0.00 ","$70.61 ","$0.00 "
"244.12","SUP","HCPCS C1713","","244.12  -  PLATE BONE 100X8X2.5MM 12MM 12 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$499.50 ","$369.63 ","$0.00 ","$499.50 ","$224.78 ","$0.00 ","$104.11 ","$0.00 ","$0.00 ","$87.46 ","$499.50 ","$0.00 ","$249.75 ","$395.60 ","$399.60 ","$0.00 ","$75.89 ","$0.00 ","$79.52 ","$0.00 "
"244.22","SUP","HCPCS C1713","","244.22  -  PLATE BONE 2.7MM 26MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$259.30 ","$191.88 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$54.04 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"245","SUP","HCPCS C1713","","245.00  -  PLATE BONE STR 118MM 10 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$813.40 ","$601.92 ","$0.00 ","$813.40 ","$366.03 ","$0.00 ","$169.53 ","$0.00 ","$0.00 ","$142.42 ","$813.40 ","$0.00 ","$406.70 ","$644.21 ","$650.72 ","$0.00 ","$123.59 ","$0.00 ","$129.49 ","$0.00 "
"245","SUP","HCPCS C1713","","245  -  PLATE 118MM SS 3.5MM SCR SM FRAG SET 10 HOLE RECON LC DCP","BOTH IP/OP","$813.40 ","$601.92 ","$0.00 ","$813.40 ","$366.03 ","$0.00 ","$169.53 ","$0.00 ","$0.00 ","$142.42 ","$813.40 ","$0.00 ","$406.70 ","$749.45 ","$650.72 ","$0.00 ","$123.59 ","$0.00 ","$129.49 ","$0.00 "
"245.01","SUP","HCPCS C1713","","245.01  -  PLATE BONE 130MM 11 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$879.98 ","$651.19 ","$0.00 ","$854.33 ","$384.45 ","$0.00 ","$183.41 ","$0.00 ","$0.00 ","$149.59 ","$854.33 ","$0.00 ","$427.16 ","$676.63 ","$683.46 ","$0.00 ","$129.81 ","$0.00 ","$136.01 ","$0.00 "
"245.02","SUP","HCPCS C1713","","245.02  -  PLATE BONE STR 142MM 12 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$917.93 ","$679.27 ","$0.00 ","$891.18 ","$401.03 ","$0.00 ","$191.32 ","$0.00 ","$0.00 ","$156.04 ","$891.18 ","$0.00 ","$445.59 ","$705.81 ","$712.94 ","$0.00 ","$135.41 ","$0.00 ","$141.88 ","$0.00 "
"245.023","SUP","HCPCS C1713","","245.023  -  PLATE BN STRG 39X10.2X2.7MM NS LC DCP 3 HL LOPRFL RECON SS","BOTH IP/OP","$607.25 ","$449.37 ","$0.00 ","$589.58 ","$265.31 ","$0.00 ","$126.57 ","$0.00 ","$0.00 ","$103.23 ","$589.58 ","$0.00 ","$294.79 ","$466.95 ","$471.66 ","$0.00 ","$89.58 ","$0.00 ","$93.86 ","$0.00 "
"245.024","SUP","HCPCS C1713","","245.024  -  PLATE BONE 52X10.2X2.7MM 4 HOLE LP STAINLESS STEEL CALCANEUS","BOTH IP/OP","$635.38 ","$470.18 ","$0.00 ","$616.88 ","$277.59 ","$0.00 ","$132.43 ","$0.00 ","$0.00 ","$108.01 ","$616.88 ","$0.00 ","$308.44 ","$488.57 ","$493.50 ","$0.00 ","$93.73 ","$0.00 ","$98.21 ","$0.00 "
"245.025","SUP","HCPCS C1713","","245.025  -  PLATE BN STRG 65X10.2X2.7MM NS LC DCP 5 HL LOPRFL RECON SS","BOTH IP/OP","$662.08 ","$489.94 ","$0.00 ","$642.80 ","$289.26 ","$0.00 ","$137.99 ","$0.00 ","$0.00 ","$112.55 ","$642.80 ","$0.00 ","$321.40 ","$509.10 ","$514.24 ","$0.00 ","$97.67 ","$0.00 ","$102.33 ","$0.00 "
"245.026","SUP","HCPCS C1713","","245.026  -  PLATE BONE 78X10.2X2.7MM 6 HOLE LP RECONSTRUCTION STAINLESS","BOTH IP/OP","$733.78 ","$543.00 ","$0.00 ","$712.40 ","$320.58 ","$0.00 ","$152.94 ","$0.00 ","$0.00 ","$124.74 ","$712.40 ","$0.00 ","$356.20 ","$564.22 ","$569.92 ","$0.00 ","$108.24 ","$0.00 ","$113.41 ","$0.00 "
"245.027","SUP","HCPCS C1713","","245.027  -  PLATE BONE 91X10.2X2.7MM 7 HOLE LP RECONSTRUCTION STAINLESS","BOTH IP/OP","$770.33 ","$570.04 ","$0.00 ","$747.88 ","$336.54 ","$0.00 ","$160.55 ","$0.00 ","$0.00 ","$130.95 ","$747.88 ","$0.00 ","$373.94 ","$592.32 ","$598.30 ","$0.00 ","$113.63 ","$0.00 ","$119.06 ","$0.00 "
"245.028","SUP","HCPCS C1713","","245.028  -  PLATE BN STRG 104X10.2X2.7MM NS LC DCP 8 HL LOPRFL RECON SS","BOTH IP/OP","$801.25 ","$592.93 ","$0.00 ","$777.90 ","$350.06 ","$0.00 ","$167.00 ","$0.00 ","$0.00 ","$136.20 ","$777.90 ","$0.00 ","$388.95 ","$616.10 ","$622.32 ","$0.00 ","$118.20 ","$0.00 ","$123.84 ","$0.00 "
"245.029","SUP","HCPCS C1713","","245.029  -  PLATE BONE 11.7X1.02X.27CM 9 HOLE LP RECONSTRUCTION","BOTH IP/OP","$822.33 ","$608.52 ","$0.00 ","$798.38 ","$359.27 ","$0.00 ","$171.39 ","$0.00 ","$0.00 ","$139.79 ","$798.38 ","$0.00 ","$399.19 ","$632.32 ","$638.70 ","$0.00 ","$121.31 ","$0.00 ","$127.10 ","$0.00 "
"245.03","SUP","HCPCS C1713","","245.030  -  PLATE BONE 130MM 10 HOLE LP STAINLESS STEEL PELVIC NONSTRL","BOTH IP/OP","$826.55 ","$611.65 ","$0.00 ","$802.48 ","$361.11 ","$0.00 ","$172.27 ","$0.00 ","$0.00 ","$140.51 ","$802.48 ","$0.00 ","$401.24 ","$635.56 ","$641.98 ","$0.00 ","$121.93 ","$0.00 ","$127.75 ","$0.00 "
"245.03","SUP","HCPCS C1713","","245.03  -  PLATE BN 154MM NS LC DCP 13 HL RECON SS 3.5MM SCR SM FRAG","BOTH IP/OP","$826.55 ","$611.65 ","$0.00 ","$802.48 ","$361.11 ","$0.00 ","$172.27 ","$0.00 ","$0.00 ","$140.51 ","$802.48 ","$0.00 ","$401.24 ","$738.25 ","$641.98 ","$0.00 ","$121.93 ","$0.00 ","$127.75 ","$0.00 "
"245.031","SUP","HCPCS C1713","","245.031  -  PLATE BONE 143MM 11 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$872.93 ","$645.97 ","$0.00 ","$847.50 ","$381.38 ","$0.00 ","$181.94 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$128.77 ","$0.00 ","$134.92 ","$0.00 "
"245.032","SUP","HCPCS C1713","","245.032  -  PLATE BN STRG 156X10.2X2.7MM NS LC DCP 12 HL LOPRFL RECON SS","BOTH IP/OP","$906.68 ","$670.94 ","$0.00 ","$880.28 ","$396.12 ","$0.00 ","$188.97 ","$0.00 ","$0.00 ","$154.13 ","$880.28 ","$0.00 ","$440.14 ","$697.18 ","$704.22 ","$0.00 ","$133.75 ","$0.00 ","$140.14 ","$0.00 "
"245.033","SUP","HCPCS C1713","","245.033  -  PLATE BONE 169MM 13 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$950.25 ","$703.19 ","$0.00 ","$922.58 ","$415.16 ","$0.00 ","$198.06 ","$0.00 ","$0.00 ","$161.54 ","$922.58 ","$0.00 ","$461.29 ","$730.68 ","$738.06 ","$0.00 ","$140.18 ","$0.00 ","$146.87 ","$0.00 "
"245.034","SUP","HCPCS C1713","","245.034  -  PLATE BONE 182MM 14 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$985.40 ","$729.20 ","$0.00 ","$956.70 ","$430.52 ","$0.00 ","$205.38 ","$0.00 ","$0.00 ","$167.51 ","$956.70 ","$0.00 ","$478.35 ","$757.71 ","$765.36 ","$0.00 ","$145.36 ","$0.00 ","$152.31 ","$0.00 "
"245.035","SUP","HCPCS C1713","","245.035  -  PLATE BONE 195MM 15 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$1,034.60 ","$765.60 ","$0.00 ","$1,004.45 ","$452.00 ","$0.00 ","$215.64 ","$0.00 ","$0.00 ","$175.87 ","$1,004.45 ","$0.00 ","$502.23 ","$795.52 ","$803.56 ","$0.00 ","$152.62 ","$0.00 ","$159.91 ","$0.00 "
"245.036","SUP","HCPCS C1713","","245.036  -  PLATE BONE 208MM 16 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$1,080.98 ","$799.93 ","$0.00 ","$1,049.50 ","$472.28 ","$0.00 ","$225.30 ","$0.00 ","$0.00 ","$183.76 ","$1,049.50 ","$0.00 ","$524.75 ","$831.20 ","$839.60 ","$0.00 ","$159.46 ","$0.00 ","$167.08 ","$0.00 "
"245.038","SUP","HCPCS C1713","","245.038  -  PLATE BONE 234MM 18 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$1,127.38 ","$834.26 ","$0.00 ","$1,094.53 ","$492.54 ","$0.00 ","$234.97 ","$0.00 ","$0.00 ","$191.64 ","$1,094.53 ","$0.00 ","$547.26 ","$866.87 ","$875.62 ","$0.00 ","$166.30 ","$0.00 ","$174.25 ","$0.00 "
"245.039","SUP","HCPCS C1713","","245.039  -  PLATE BONE 260MM 20 HOLE LP RECONSTRUCTION STAINLESS STEEL","BOTH IP/OP","$1,353.68 ","$1,001.72 ","$0.00 ","$1,314.25 ","$591.41 ","$0.00 ","$282.14 ","$0.00 ","$0.00 ","$230.11 ","$1,314.25 ","$0.00 ","$657.13 ","$1,040.89 ","$1,051.40 ","$0.00 ","$199.69 ","$0.00 ","$209.23 ","$0.00 "
"245.04","SUP","HCPCS C1713","","245.04  -  PLATE BONE 3.5MM 166MM 14 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$996.63 ","$737.51 ","$0.00 ","$967.60 ","$435.42 ","$0.00 ","$207.72 ","$0.00 ","$0.00 ","$169.42 ","$967.60 ","$0.00 ","$483.80 ","$766.34 ","$774.08 ","$0.00 ","$147.02 ","$0.00 ","$154.04 ","$0.00 "
"245.041","SUP","HCPCS C1713","","245.041  -  PLATE BN 56MM NS LCP 4 HL RECON SS 3.5MM SCR SM FRAG SYS","BOTH IP/OP","$827.95 ","$612.68 ","$0.00 ","$803.85 ","$361.73 ","$0.00 ","$172.57 ","$0.00 ","$0.00 ","$140.75 ","$803.85 ","$0.00 ","$401.93 ","$636.65 ","$643.08 ","$0.00 ","$122.14 ","$0.00 ","$127.97 ","$0.00 "
"245.05","SUP","HCPCS C1713","","245.05  -  PLATE BONE 3.5MM 178MM 15 HOLE RECONSTRUCTION DCP LC-DCP","BOTH IP/OP","$1,034.60 ","$765.60 ","$0.00 ","$1,004.45 ","$452.00 ","$0.00 ","$215.64 ","$0.00 ","$0.00 ","$175.87 ","$1,004.45 ","$0.00 ","$502.23 ","$795.52 ","$803.56 ","$0.00 ","$152.62 ","$0.00 ","$159.91 ","$0.00 "
"245.051","SUP","HCPCS C1713","","245.051  -  PLATE BONE STR 70X10.1X3.5MM 5 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$809.68 ","$599.16 ","$0.00 ","$786.10 ","$353.75 ","$0.00 ","$168.76 ","$0.00 ","$0.00 ","$137.64 ","$786.10 ","$0.00 ","$393.05 ","$622.59 ","$628.88 ","$0.00 ","$119.44 ","$0.00 ","$125.15 ","$0.00 "
"245.06","SUP","HCPCS C1713","","245.06  -  PLATE BN 190MM NS LC DCP 16 HL RECON SS 3.5MM SCR SM FRAG","BOTH IP/OP","$1,079.58 ","$798.89 ","$0.00 ","$1,048.13 ","$471.66 ","$0.00 ","$225.01 ","$0.00 ","$0.00 ","$183.52 ","$1,048.13 ","$0.00 ","$524.06 ","$830.12 ","$838.50 ","$0.00 ","$159.25 ","$0.00 ","$166.86 ","$0.00 "
"245.061","SUP","HCPCS C1713","","245.061  -  PLATE BONE STR 84X10.1X3.5MM 6 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$936.20 ","$692.79 ","$0.00 ","$908.93 ","$409.02 ","$0.00 ","$195.13 ","$0.00 ","$0.00 ","$159.15 ","$908.93 ","$0.00 ","$454.46 ","$719.87 ","$727.14 ","$0.00 ","$138.10 ","$0.00 ","$144.70 ","$0.00 "
"245.071","SUP","HCPCS C1713","","245.071  -  PLATE BONE STR 98X10.1X3.5MM 7 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$982.58 ","$727.11 ","$0.00 ","$953.95 ","$429.28 ","$0.00 ","$204.79 ","$0.00 ","$0.00 ","$167.03 ","$953.95 ","$0.00 ","$476.98 ","$755.53 ","$763.16 ","$0.00 ","$192.28 ","$0.00 ","$151.87 ","$0.00 "
"245.08","SUP","HCPCS C1713","","245.08  -  PLATE BONE STR 214MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$1,128.78 ","$835.30 ","$0.00 ","$1,095.90 ","$493.16 ","$0.00 ","$235.26 ","$0.00 ","$0.00 ","$191.88 ","$1,095.90 ","$0.00 ","$547.95 ","$867.95 ","$876.72 ","$0.00 ","$166.51 ","$0.00 ","$174.47 ","$0.00 "
"245.081","SUP","HCPCS C1713","","245.081  -  PLATE BONE STR 112X10.1X3.5MM 8 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,024.75 ","$758.32 ","$0.00 ","$994.90 ","$447.71 ","$0.00 ","$213.58 ","$0.00 ","$0.00 ","$174.20 ","$994.90 ","$0.00 ","$497.45 ","$787.96 ","$795.92 ","$0.00 ","$151.17 ","$0.00 ","$158.39 ","$0.00 "
"245.091","SUP","HCPCS C1713","","245.091  -  PLATE BN 126X10.1X3.5MM NS LCP CMBN 9 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,079.58 ","$798.89 ","$0.00 ","$1,048.13 ","$471.66 ","$0.00 ","$225.01 ","$0.00 ","$0.00 ","$183.52 ","$1,048.13 ","$0.00 ","$524.06 ","$830.12 ","$838.50 ","$0.00 ","$159.25 ","$0.00 ","$166.86 ","$0.00 "
"245.1","SUP","HCPCS C1713","","245.10  -  PLATE BN 238MM NS LC DCP 20 HL RECON SS 3.5MM SCR SM FRAG","BOTH IP/OP","$1,329.28 ","$983.67 ","$0.00 ","$1,329.28 ","$598.17 ","$0.00 ","$277.05 ","$0.00 ","$0.00 ","$232.75 ","$1,329.28 ","$0.00 ","$664.64 ","$1,052.79 ","$1,063.42 ","$0.00 ","$201.97 ","$0.00 ","$211.62 ","$0.00 "
"245.101","SUP","HCPCS C1713","","245.101  -  PLATE BONE STR 140X10.1X3.5MM 10 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,062.70 ","$786.40 ","$0.00 ","$1,031.75 ","$464.29 ","$0.00 ","$221.49 ","$0.00 ","$0.00 ","$180.65 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$156.77 ","$0.00 ","$164.25 ","$0.00 "
"245.111","SUP","HCPCS C1713","","245.111  -  PLATE BN 154X10.1X3.5MM NS LCP CMBN 11 HL SHFT RECON SS 3.5","BOTH IP/OP","$1,149.85 ","$850.89 ","$0.00 ","$1,116.38 ","$502.37 ","$0.00 ","$239.66 ","$0.00 ","$0.00 ","$195.47 ","$1,116.38 ","$0.00 ","$558.19 ","$884.17 ","$893.10 ","$0.00 ","$169.62 ","$0.00 ","$177.73 ","$0.00 "
"245.12","SUP","HCPCS C1713","","245.12  -  PLATE BONE STR 3.5MM 263MM 22 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"245.121","SUP","HCPCS C1713","","245.121  -  PLATE BONE STR 168X10.1X3.5MM 12 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,176.58 ","$870.67 ","$0.00 ","$1,142.30 ","$514.04 ","$0.00 ","$245.23 ","$0.00 ","$0.00 ","$200.01 ","$1,142.30 ","$0.00 ","$571.15 ","$904.70 ","$913.84 ","$0.00 ","$173.56 ","$0.00 ","$181.85 ","$0.00 "
"245.131","SUP","HCPCS C1713","","245.131  -  PLATE BONE STR 182X10.1X3.5MM 13 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,273.55 ","$942.43 ","$0.00 ","$1,236.48 ","$556.41 ","$0.00 ","$265.44 ","$0.00 ","$0.00 ","$216.50 ","$1,236.48 ","$0.00 ","$618.24 ","$979.29 ","$989.18 ","$0.00 ","$187.87 ","$0.00 ","$196.85 ","$0.00 "
"245.14","SUP","HCPCS C1713","","245.14  -  PLATE BONE STR 46X10.1X3.5MM 4 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$635.38 ","$470.18 ","$0.00 ","$616.88 ","$277.59 ","$0.00 ","$132.43 ","$0.00 ","$0.00 ","$108.01 ","$616.88 ","$0.00 ","$308.44 ","$488.57 ","$493.50 ","$0.00 ","$93.73 ","$0.00 ","$98.21 ","$0.00 "
"245.141","SUP","HCPCS C1713","","245.141  -  PLATE BONE STR 196X10.1X3.5MM 14 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,322.75 ","$978.84 ","$0.00 ","$1,284.23 ","$577.90 ","$0.00 ","$275.69 ","$0.00 ","$0.00 ","$224.86 ","$1,284.23 ","$0.00 ","$642.11 ","$1,017.11 ","$1,027.38 ","$0.00 ","$195.13 ","$0.00 ","$204.45 ","$0.00 "
"245.15","SUP","HCPCS C1713","","245.15  -  PLATE BONE STR 58MM 5 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$646.63 ","$478.51 ","$0.00 ","$627.78 ","$282.50 ","$0.00 ","$134.77 ","$0.00 ","$0.00 ","$109.92 ","$627.78 ","$0.00 ","$313.89 ","$497.20 ","$502.22 ","$0.00 ","$95.39 ","$0.00 ","$99.94 ","$0.00 "
"245.16","SUP","HCPCS C1713","","245.16  -  PLATE BONE STR 70MM 6 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$742.20 ","$549.23 ","$0.00 ","$720.60 ","$324.27 ","$0.00 ","$154.69 ","$0.00 ","$0.00 ","$126.17 ","$720.60 ","$0.00 ","$360.30 ","$570.72 ","$576.48 ","$0.00 ","$109.49 ","$0.00 ","$114.72 ","$0.00 "
"245.161","SUP","HCPCS C1713","","245.161  -  PLATE BONE STR 224X10.1X3.5MM 16 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,433.80 ","$1,061.01 ","$0.00 ","$1,392.05 ","$626.42 ","$0.00 ","$298.84 ","$0.00 ","$0.00 ","$243.74 ","$1,392.05 ","$0.00 ","$696.03 ","$1,102.50 ","$1,113.64 ","$0.00 ","$211.51 ","$0.00 ","$221.61 ","$0.00 "
"245.17","SUP","HCPCS C1713","","245.17  -  PLATE BONE STR 82MM 7 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$778.75 ","$576.28 ","$0.00 ","$756.08 ","$340.23 ","$0.00 ","$162.31 ","$0.00 ","$0.00 ","$132.38 ","$756.08 ","$0.00 ","$378.04 ","$598.82 ","$604.86 ","$0.00 ","$142.33 ","$0.00 ","$120.37 ","$0.00 "
"245.18","SUP","HCPCS C1713","","245.18  -  PLATE BONE STR 94MM 8 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$811.08 ","$600.20 ","$0.00 ","$787.45 ","$354.35 ","$0.00 ","$169.05 ","$0.00 ","$0.00 ","$137.88 ","$787.45 ","$0.00 ","$393.73 ","$623.66 ","$629.96 ","$0.00 ","$119.65 ","$0.00 ","$125.36 ","$0.00 "
"245.181","SUP","HCPCS C1713","","245.181  -  PLATE BONE STR 252X10.1X3.5MM 18 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,501.28 ","$1,110.95 ","$0.00 ","$1,457.55 ","$655.90 ","$0.00 ","$312.90 ","$0.00 ","$0.00 ","$255.21 ","$1,457.55 ","$0.00 ","$728.78 ","$1,154.38 ","$1,166.04 ","$0.00 ","$221.46 ","$0.00 ","$232.04 ","$0.00 "
"245.19","SUP","HCPCS C1713","","245.19  -  PLATE BN 106MM NS LC DCP 9 HL RECON SS 3.5MM SCR SM FRAG SET","BOTH IP/OP","$830.78 ","$614.78 ","$0.00 ","$806.58 ","$362.96 ","$0.00 ","$173.15 ","$0.00 ","$0.00 ","$141.22 ","$806.58 ","$0.00 ","$403.29 ","$638.81 ","$645.26 ","$0.00 ","$122.55 ","$0.00 ","$128.41 ","$0.00 "
"245.2","SUP","HCPCS C1713","","245.20  -  PLATE BN 48X8X3.3MM NS 6 HL RECON 2.7MM SCR","BOTH IP/OP","$559.55 ","$414.07 ","$0.00 ","$559.55 ","$251.80 ","$0.00 ","$116.62 ","$0.00 ","$0.00 ","$97.97 ","$559.55 ","$0.00 ","$279.78 ","$443.16 ","$447.64 ","$0.00 ","$85.02 ","$0.00 ","$89.08 ","$0.00 "
"245.201","SUP","HCPCS C1713","","245.201  -  PLATE BONE STR 280X10.1X3.5MM 20 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$1,823.18 ","$1,349.15 ","$0.00 ","$1,770.08 ","$796.53 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$309.93 ","$1,770.08 ","$0.00 ","$885.04 ","$1,401.90 ","$1,416.06 ","$0.00 ","$268.95 ","$0.00 ","$281.80 ","$0.00 "
"245.21","SUP","HCPCS C1713","","245.21  -  PLATE BN 64X8X3.3MM NS 8 HL RECON 2.7MM SCR","BOTH IP/OP","$597.43 ","$442.10 ","$0.00 ","$580.03 ","$261.01 ","$0.00 ","$124.52 ","$0.00 ","$0.00 ","$101.56 ","$580.03 ","$0.00 ","$290.01 ","$459.38 ","$464.02 ","$0.00 ","$88.13 ","$0.00 ","$92.34 ","$0.00 "
"245.22","SUP","HCPCS C1713","","245.22  -  PLATE BN 80X8X3.3MM NS 10 HL RECON 2.7MM SCR","BOTH IP/OP","$638.18 ","$472.25 ","$0.00 ","$619.60 ","$278.82 ","$0.00 ","$133.01 ","$0.00 ","$0.00 ","$108.49 ","$619.60 ","$0.00 ","$309.80 ","$490.72 ","$495.68 ","$0.00 ","$94.14 ","$0.00 ","$98.64 ","$0.00 "
"245.221","SUP","HCPCS C1713","","245.221  -  PLATE BN 308X10.1X3.5MM NS LCP CMBN 22 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,893.48 ","$1,401.18 ","$0.00 ","$1,838.33 ","$827.25 ","$0.00 ","$394.65 ","$0.00 ","$0.00 ","$321.88 ","$1,838.33 ","$0.00 ","$919.16 ","$1,455.96 ","$1,470.66 ","$0.00 ","$279.32 ","$0.00 ","$292.66 ","$0.00 "
"245.23","SUP","HCPCS C1713","","245.23  -  PLATE BONE STR 96MM 12 HOLE RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$761.88 ","$563.79 ","$0.00 ","$739.70 ","$332.87 ","$0.00 ","$158.79 ","$0.00 ","$0.00 ","$129.52 ","$739.70 ","$0.00 ","$369.85 ","$585.84 ","$591.76 ","$0.00 ","$112.39 ","$0.00 ","$117.76 ","$0.00 "
"245.24","SUP","HCPCS C1713","","245.24  -  PLATE BN 112X8X3.3MM NS 14 HL RECON 2.7MM SCR","BOTH IP/OP","$811.08 ","$600.20 ","$0.00 ","$787.45 ","$354.35 ","$0.00 ","$169.05 ","$0.00 ","$0.00 ","$137.88 ","$787.45 ","$0.00 ","$393.73 ","$623.66 ","$629.96 ","$0.00 ","$119.65 ","$0.00 ","$125.36 ","$0.00 "
"245.25","SUP","HCPCS C1713","","245.25  -  PLATE BONE STR 128X8X3.3MM 16 HOLE RECONSTRUCTION LCP","BOTH IP/OP","$882.78 ","$653.26 ","$0.00 ","$857.08 ","$385.68 ","$0.00 ","$183.99 ","$0.00 ","$0.00 ","$150.07 ","$857.08 ","$0.00 ","$428.54 ","$678.81 ","$685.66 ","$0.00 ","$130.22 ","$0.00 ","$136.45 ","$0.00 "
"245.26","SUP","HCPCS C1713","","245.26  -  PLATE BONE 144MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS","BOTH IP/OP","$1,065.88 ","$788.75 ","$0.00 ","$1,065.88 ","$479.64 ","$0.00 ","$222.15 ","$0.00 ","$0.00 ","$186.63 ","$1,065.88 ","$0.00 ","$532.94 ","$844.18 ","$852.70 ","$0.00 ","$161.95 ","$0.00 ","$169.69 ","$0.00 "
"245.27","SUP","HCPCS C1713","","245.27  -  PLATE BONE 160MM 20 HOLE RECONSTRUCTION DCP STAINLESS STEEL","BOTH IP/OP","$1,109.03 ","$820.68 ","$0.00 ","$1,109.03 ","$499.06 ","$0.00 ","$231.15 ","$0.00 ","$0.00 ","$194.18 ","$1,109.03 ","$0.00 ","$554.51 ","$878.35 ","$887.22 ","$0.00 ","$173.56 ","$0.00 ","$176.56 ","$0.00 "
"245.28","SUP","HCPCS C1713","","245.28  -  PLATE BONE 176MM 22 HOLE RECONSTRUCTION DCP STAINLESS STEEL","BOTH IP/OP","$1,329.28 ","$983.67 ","$0.00 ","$1,329.28 ","$598.17 ","$0.00 ","$277.05 ","$0.00 ","$0.00 ","$232.75 ","$1,329.28 ","$0.00 ","$664.64 ","$1,052.79 ","$1,063.42 ","$0.00 ","$201.97 ","$0.00 ","$211.62 ","$0.00 "
"245.29","SUP","HCPCS C1713","","245.29  -  PLATE BONE 192MM 24 HOLE RECONSTRUCTION DCP STAINLESS STEEL","BOTH IP/OP","$1,497.13 ","$1,107.88 ","$0.00 ","$1,497.13 ","$673.71 ","$0.00 ","$312.04 ","$0.00 ","$0.00 ","$262.13 ","$1,497.13 ","$0.00 ","$748.56 ","$1,185.73 ","$1,197.70 ","$0.00 ","$227.48 ","$0.00 ","$238.34 ","$0.00 "
"245.3","SUP","HCPCS C1713","","245.30  -  PLATE BONE CURVE 70X10X3.6MM 6 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$780.63 ","$577.67 ","$0.00 ","$780.63 ","$351.28 ","$0.00 ","$162.70 ","$0.00 ","$0.00 ","$136.68 ","$780.63 ","$0.00 ","$390.31 ","$618.26 ","$624.50 ","$0.00 ","$118.61 ","$0.00 ","$124.28 ","$0.00 "
"245.31","SUP","HCPCS C1713","","245.31  -  PLATE BN CRV 94X10X3.6MM NS LC DCP 8 HL RECON SS 3.5MM CORT","BOTH IP/OP","$872.93 ","$645.97 ","$0.00 ","$847.50 ","$381.38 ","$0.00 ","$181.94 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$128.77 ","$0.00 ","$134.92 ","$0.00 "
"245.32","SUP","HCPCS C1713","","245.32  -  PLATE BN CRV 118X10X3.6MM NS LC DCP 10 HL RECON SS 3.5MM","BOTH IP/OP","$917.93 ","$679.27 ","$0.00 ","$891.18 ","$401.03 ","$0.00 ","$191.32 ","$0.00 ","$0.00 ","$156.04 ","$891.18 ","$0.00 ","$445.59 ","$705.81 ","$712.94 ","$0.00 ","$135.41 ","$0.00 ","$141.88 ","$0.00 "
"245.33","SUP","HCPCS C1713","","245.33  -  PLATE BONE CURVE 142X10X3.6MM 12 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$955.88 ","$707.35 ","$0.00 ","$928.03 ","$417.61 ","$0.00 ","$199.23 ","$0.00 ","$0.00 ","$162.49 ","$928.03 ","$0.00 ","$464.01 ","$735.00 ","$742.42 ","$0.00 ","$141.01 ","$0.00 ","$147.74 ","$0.00 "
"245.34","SUP","HCPCS C1713","","245.34  -  PLATE BONE CURVE 166X10X3.6MM 14 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$1,072.55 ","$793.69 ","$0.00 ","$1,041.30 ","$468.59 ","$0.00 ","$223.55 ","$0.00 ","$0.00 ","$182.32 ","$1,041.30 ","$0.00 ","$520.65 ","$824.71 ","$833.04 ","$0.00 ","$158.22 ","$0.00 ","$165.77 ","$0.00 "
"245.341","SUP","HCPCS C1713","","245.341  -  PLATE BONE 55MM 4 HOLE SHAFT CVD RECONSTRUCTION LCP","BOTH IP/OP","$1,291.83 ","$955.95 ","$0.00 ","$1,254.20 ","$564.39 ","$0.00 ","$269.25 ","$0.00 ","$0.00 ","$219.60 ","$1,254.20 ","$0.00 ","$627.10 ","$993.33 ","$1,003.36 ","$0.00 ","$190.57 ","$0.00 ","$199.67 ","$0.00 "
"245.35","SUP","HCPCS C1713","","245.35  -  PLATE BN CRV 190X10X3.6MM NS LC DCP 16 HL RECON SS 3.5MM","BOTH IP/OP","$1,141.43 ","$844.66 ","$0.00 ","$1,108.18 ","$498.68 ","$0.00 ","$237.90 ","$0.00 ","$0.00 ","$194.03 ","$1,108.18 ","$0.00 ","$554.09 ","$877.68 ","$886.54 ","$0.00 ","$168.38 ","$0.00 ","$176.42 ","$0.00 "
"245.36","SUP","HCPCS C1713","","245.36  -  PLATE BONE CURVE 214X10X3.6MM 18 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$1,229.98 ","$910.19 ","$0.00 ","$1,194.15 ","$537.37 ","$0.00 ","$256.36 ","$0.00 ","$0.00 ","$209.09 ","$1,194.15 ","$0.00 ","$597.08 ","$945.77 ","$955.32 ","$0.00 ","$181.44 ","$0.00 ","$190.11 ","$0.00 "
"245.361","SUP","HCPCS C1713","","245.361  -  PLATE BONE 82MM 6 HOLE SHAFT CVD RECONSTRUCTION LCP","BOTH IP/OP","$1,398.68 ","$1,035.02 ","$0.00 ","$1,357.93 ","$611.07 ","$0.00 ","$291.52 ","$0.00 ","$0.00 ","$237.76 ","$1,357.93 ","$0.00 ","$678.96 ","$1,075.48 ","$1,086.34 ","$0.00 ","$206.33 ","$0.00 ","$216.18 ","$0.00 "
"245.381","SUP","HCPCS C1713","","245.381  -  PLATE BN CRV 106X10.1X3.5MM NS LCP 8 HL SHFT RECON SS 3.5MM","BOTH IP/OP","$1,516.75 ","$1,122.40 ","$0.00 ","$1,472.58 ","$662.66 ","$0.00 ","$316.13 ","$0.00 ","$0.00 ","$257.84 ","$1,472.58 ","$0.00 ","$736.29 ","$1,166.28 ","$1,178.06 ","$0.00 ","$223.74 ","$0.00 ","$234.43 ","$0.00 "
"245.401","SUP","HCPCS C1713","","245.401  -  PLATE BONE 140MM 10 HOLE CVD RECONSTRUCTION LCP STAINLESS","BOTH IP/OP","$1,588.43 ","$1,175.44 ","$0.00 ","$1,542.18 ","$693.98 ","$0.00 ","$331.07 ","$0.00 ","$0.00 ","$270.02 ","$1,542.18 ","$0.00 ","$771.09 ","$1,221.41 ","$1,233.74 ","$0.00 ","$234.32 ","$0.00 ","$245.51 ","$0.00 "
"245.421","SUP","HCPCS C1713","","245.421  -  PLATE BONE 149MM 12 HOLE SHAFT CVD RECONSTRUCTION LCP","BOTH IP/OP","$1,662.93 ","$1,230.57 ","$0.00 ","$1,614.50 ","$726.53 ","$0.00 ","$346.60 ","$0.00 ","$0.00 ","$282.69 ","$1,614.50 ","$0.00 ","$807.25 ","$1,278.68 ","$1,291.60 ","$0.00 ","$245.31 ","$0.00 ","$257.03 ","$0.00 "
"245.441","SUP","HCPCS C1713","","245.441  -  PLATE BONE 166MM 14 HOLE SHAFT CVD RECONSTRUCTION LCP","BOTH IP/OP","$1,868.18 ","$1,382.45 ","$0.00 ","$1,813.75 ","$816.19 ","$0.00 ","$389.37 ","$0.00 ","$0.00 ","$317.57 ","$1,813.75 ","$0.00 ","$906.88 ","$1,436.49 ","$1,451.00 ","$0.00 ","$275.58 ","$0.00 ","$288.75 ","$0.00 "
"245.461","SUP","HCPCS C1713","","245.461  -  PLATE BONE 180MM 16 HOLE SHAFT CVD RECONSTRUCTION LCP","BOTH IP/OP","$1,996.08 ","$1,477.10 ","$0.00 ","$1,937.95 ","$872.08 ","$0.00 ","$416.03 ","$0.00 ","$0.00 ","$339.32 ","$1,937.95 ","$0.00 ","$968.98 ","$1,534.86 ","$1,550.36 ","$0.00 ","$294.45 ","$0.00 ","$308.52 ","$0.00 "
"245.481","SUP","HCPCS C1713","","245.481  -  PLATE BONE 190MM 18 HOLE SHAFT CVD RECONSTRUCTION LCP","BOTH IP/OP","$2,152.13 ","$1,592.58 ","$0.00 ","$2,089.43 ","$940.24 ","$0.00 ","$448.56 ","$0.00 ","$0.00 ","$365.84 ","$2,089.43 ","$0.00 ","$1,044.71 ","$1,654.83 ","$1,671.54 ","$0.00 ","$317.47 ","$0.00 ","$332.64 ","$0.00 "
"245.876","SUP","HCPCS C1713","","245.876  -  PLATE BONE 108MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"245.878","SUP","HCPCS C1713","","245.878  -  PLATE BN 108MM RDS CRV 104X10.2X2.7MM NS 8 HL LOPRFL RECON","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"245.88","SUP","HCPCS C1713","","245.880  -  PLATE BONE 108MM RAD CVD 130MM 8 HOLE LP RECONSTRUCTION","BOTH IP/OP","$926.68 ","$685.74 ","$0.00 ","$926.68 ","$417.00 ","$0.00 ","$193.14 ","$0.00 ","$0.00 ","$162.25 ","$926.68 ","$0.00 ","$463.34 ","$733.93 ","$741.34 ","$0.00 ","$140.80 ","$0.00 ","$147.53 ","$0.00 "
"245.882","SUP","HCPCS C1713","","245.882  -  PLATE BN 108MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"245.884","SUP","HCPCS C1713","","245.884  -  PLATE BONE 108MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION","BOTH IP/OP","$1,107.68 ","$819.68 ","$0.00 ","$1,075.43 ","$483.94 ","$0.00 ","$230.87 ","$0.00 ","$0.00 ","$188.30 ","$1,075.43 ","$0.00 ","$537.71 ","$851.74 ","$860.34 ","$0.00 ","$163.40 ","$0.00 ","$171.21 ","$0.00 "
"245.886","SUP","HCPCS C1713","","245.886  -  PLATE BONE 108MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"245.906","SUP","HCPCS C1713","","245.906  -  PLATE BONE 88MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"245.908","SUP","HCPCS C1713","","245.908  -  PLATE BN 88MM RDS CRV 104MMX10.2MMX2.7M NS 8 HL LOPRFL RECON","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"245.91","SUP","HCPCS C1713","","245.910  -  PLATE BONE 88MM RAD LP CURVE 130MM 10 HOLE RECONSTRUCTION","BOTH IP/OP","$926.68 ","$685.74 ","$0.00 ","$926.68 ","$417.00 ","$0.00 ","$193.14 ","$0.00 ","$0.00 ","$162.25 ","$926.68 ","$0.00 ","$463.34 ","$733.93 ","$741.34 ","$0.00 ","$140.80 ","$0.00 ","$147.53 ","$0.00 "
"245.912","SUP","HCPCS C1713","","245.912  -  PLATE BN 88MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"245.914","SUP","HCPCS C1713","","245.914  -  PLATE BONE 88MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION","BOTH IP/OP","$1,107.68 ","$819.68 ","$0.00 ","$1,075.43 ","$483.94 ","$0.00 ","$230.87 ","$0.00 ","$0.00 ","$188.30 ","$1,075.43 ","$0.00 ","$537.71 ","$851.74 ","$860.34 ","$0.00 ","$163.40 ","$0.00 ","$171.21 ","$0.00 "
"245.916","SUP","HCPCS C1713","","245.916  -  PLATE BONE 88MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"245.92","SUP","HCPCS C1713","","245.920  -  PLATE BONE J RIGHT 130X10X3.4MM 3.5MM 10 HOLE RECONSTRUCTION","BOTH IP/OP","$926.68 ","$685.74 ","$0.00 ","$926.68 ","$417.00 ","$0.00 ","$193.14 ","$0.00 ","$0.00 ","$162.25 ","$926.68 ","$0.00 ","$463.34 ","$733.93 ","$741.34 ","$0.00 ","$140.80 ","$0.00 ","$147.53 ","$0.00 "
"245.922","SUP","HCPCS C1713","","245.922  -  PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"245.924","SUP","HCPCS C1713","","245.924  -  PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION","BOTH IP/OP","$1,107.68 ","$819.68 ","$0.00 ","$1,075.43 ","$483.94 ","$0.00 ","$230.87 ","$0.00 ","$0.00 ","$188.30 ","$1,075.43 ","$0.00 ","$537.71 ","$851.74 ","$860.34 ","$0.00 ","$163.40 ","$0.00 ","$171.21 ","$0.00 "
"245.926","SUP","HCPCS C1713","","245.926  -  PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"245.93","SUP","HCPCS C1713","","245.930  -  PLATE BONE 88MM RAD J 130X10.2X2.7MM 10 HOLE LP","BOTH IP/OP","$926.68 ","$685.74 ","$0.00 ","$926.68 ","$417.00 ","$0.00 ","$193.14 ","$0.00 ","$0.00 ","$162.25 ","$926.68 ","$0.00 ","$463.34 ","$733.93 ","$741.34 ","$0.00 ","$140.80 ","$0.00 ","$147.53 ","$0.00 "
"245.932","SUP","HCPCS C1713","","245.932  -  PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"245.934","SUP","HCPCS C1713","","245.934  -  PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION","BOTH IP/OP","$1,107.68 ","$819.68 ","$0.00 ","$1,075.43 ","$483.94 ","$0.00 ","$230.87 ","$0.00 ","$0.00 ","$188.30 ","$1,075.43 ","$0.00 ","$537.71 ","$851.74 ","$860.34 ","$0.00 ","$163.40 ","$0.00 ","$171.21 ","$0.00 "
"245.936","SUP","HCPCS C1713","","245.936  -  PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"245.98","SUP","HCPCS C1713","","245.98  -  PLATE BN 64X8X2.5MM NS 8 HL RECON SS CALC 2.7MM SCR","BOTH IP/OP","$664.90 ","$492.03 ","$0.00 ","$645.53 ","$290.49 ","$0.00 ","$138.58 ","$0.00 ","$0.00 ","$113.03 ","$645.53 ","$0.00 ","$322.76 ","$511.26 ","$516.42 ","$0.00 ","$98.08 ","$0.00 ","$102.77 ","$0.00 "
"245.99","SUP","HCPCS C1713","","245.99  -  PLATE BN 72X8X2.5MM NS 9 HL RECON SS CALC 2.7MM SCR","BOTH IP/OP","$688.80 ","$509.71 ","$0.00 ","$668.73 ","$300.93 ","$0.00 ","$143.56 ","$0.00 ","$0.00 ","$117.09 ","$668.73 ","$0.00 ","$334.36 ","$529.63 ","$534.98 ","$0.00 ","$101.61 ","$0.00 ","$106.46 ","$0.00 "
"246.031","SUP","HCPCS C1713","","246.031  -  PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"246.19","SUP","HCPCS C1713","","246.19  -  PLATE BONE 100MM 20 HOLE STR DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$477.93 ","$353.67 ","$0.00 ","$464.03 ","$208.81 ","$0.00 ","$99.61 ","$0.00 ","$0.00 ","$81.25 ","$464.03 ","$0.00 ","$232.01 ","$367.51 ","$371.22 ","$0.00 ","$70.50 ","$0.00 ","$73.87 ","$0.00 "
"246.191","SUP","HCPCS C1713","","246.191  -  PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$451.73 ","$203.28 ","$0.00 ","$96.97 ","$0.00 ","$0.00 ","$79.09 ","$451.73 ","$0.00 ","$225.86 ","$357.77 ","$361.38 ","$0.00 ","$68.64 ","$0.00 ","$71.91 ","$0.00 "
"246.23","SUP","HCPCS C1713","","246.23  -  PLATE BN T 50MM NS DCP 3 HLE/HD 9 HL SHFT SS 1.5MM SCR","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$405.33 ","$182.40 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$70.97 ","$405.33 ","$0.00 ","$202.66 ","$321.02 ","$324.26 ","$0.00 ","$61.59 ","$0.00 ","$64.53 ","$0.00 "
"246.233","SUP","HCPCS C1713","","246.233  -  PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"246.234","SUP","HCPCS C1713","","246.234  -  PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"246.24","SUP","HCPCS C1713","","246.24  -  PLATE BONE 50MM 4 HOLE HEAD 9 HOLE SHAFT T DCP STAINLESS","BOTH IP/OP","$449.83 ","$332.87 ","$0.00 ","$436.73 ","$196.53 ","$0.00 ","$93.75 ","$0.00 ","$0.00 ","$76.47 ","$436.73 ","$0.00 ","$218.36 ","$345.89 ","$349.38 ","$0.00 ","$66.36 ","$0.00 ","$69.53 ","$0.00 "
"246.48","SUP","HCPCS C1713","","246.48  -  PLATE BONE 4 HOLE H LCP STAINLESS STEEL ORTHOPEDIC NONSTRL","BOTH IP/OP","$411.88 ","$304.79 ","$0.00 ","$399.88 ","$179.94 ","$0.00 ","$85.85 ","$0.00 ","$0.00 ","$70.01 ","$399.88 ","$0.00 ","$199.94 ","$316.70 ","$319.90 ","$0.00 ","$60.76 ","$0.00 ","$63.66 ","$0.00 "
"246.482","SUP","HCPCS C1713","","246.482  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS RT","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"246.483","SUP","HCPCS C1713","","246.483  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS LT","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"246.61","SUP","HCPCS C1713","","246.61  -  PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL LT 1.5MM SCR MDLR HND","BOTH IP/OP","$529.95 ","$392.16 ","$0.00 ","$514.50 ","$231.53 ","$0.00 ","$110.45 ","$0.00 ","$0.00 ","$90.08 ","$514.50 ","$0.00 ","$257.25 ","$407.48 ","$411.60 ","$0.00 ","$78.18 ","$0.00 ","$81.91 ","$0.00 "
"246.612","SUP","HCPCS C1713","","246.612  -  PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"246.62","SUP","HCPCS C1713","","246.62  -  PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL RT 1.5MM SCR MDLR HND","BOTH IP/OP","$529.95 ","$392.16 ","$0.00 ","$514.50 ","$231.53 ","$0.00 ","$110.45 ","$0.00 ","$0.00 ","$90.08 ","$514.50 ","$0.00 ","$257.25 ","$407.48 ","$411.60 ","$0.00 ","$78.18 ","$0.00 ","$81.91 ","$0.00 "
"247.031","SUP","HCPCS C1713","","247.031  -  PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR","BOTH IP/OP","$404.85 ","$299.59 ","$0.00 ","$393.05 ","$176.87 ","$0.00 ","$84.38 ","$0.00 ","$0.00 ","$68.82 ","$393.05 ","$0.00 ","$196.53 ","$311.30 ","$314.44 ","$0.00 ","$59.72 ","$0.00 ","$62.57 ","$0.00 "
"247.232","SUP","HCPCS C1713","","247.232  -  PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"247.233","SUP","HCPCS C1713","","247.233  -  PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"247.344","SUP","HCPCS C1713","","247.344  -  PLATE BN 31MM NS LCP PRO-PK 4 HL LOPRFL CUT TO LGTH SS 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"247.345","SUP","HCPCS C1713","","247.345  -  PLATE BN 38MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"247.346","SUP","HCPCS C1713","","247.346  -  PLATE BN 45MM NS LCP PRO-PK 6 HL LOPRFL CUT TO LGTH SS 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"247.347","SUP","HCPCS C1713","","247.347  -  PLATE BN 52MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"247.348","SUP","HCPCS C1713","","247.348  -  PLATE BN 59MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"247.349","SUP","HCPCS C1713","","247.349  -  PLATE BN 54MM NS LCP PRO-PK 7 HL SHFT LOPRFL CUT TO LGTH SS","BOTH IP/OP","$1,446.45 ","$1,070.37 ","$0.00 ","$1,404.33 ","$631.95 ","$0.00 ","$301.48 ","$0.00 ","$0.00 ","$245.89 ","$1,404.33 ","$0.00 ","$702.16 ","$1,112.23 ","$1,123.46 ","$0.00 ","$213.38 ","$0.00 ","$223.57 ","$0.00 "
"247.35","SUP","HCPCS C1713","","247.350  -  PLATE BN Y 55MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT","BOTH IP/OP","$788.83 ","$583.73 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$164.41 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"247.351","SUP","HCPCS C1713","","247.351  -  PLATE BN T 53MM NS LCP PRO-PK 2 HLE/HD 7 HL SHFT LOPRFL CUT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"247.36","SUP","HCPCS C1713","","247.360  -  PLATE BN 73MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2MM","BOTH IP/OP","$446.28 ","$330.25 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$93.01 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"247.362","SUP","HCPCS C1713","","247.362  -  PLATE BN 81MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS","BOTH IP/OP","$777.35 ","$575.24 ","$0.00 ","$754.70 ","$339.62 ","$0.00 ","$162.02 ","$0.00 ","$0.00 ","$132.14 ","$754.70 ","$0.00 ","$377.35 ","$597.72 ","$603.76 ","$0.00 ","$114.67 ","$0.00 ","$120.15 ","$0.00 "
"247.364","SUP","HCPCS C1713","","247.364  -  PLATE BN 84MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.4","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"247.366","SUP","HCPCS C1713","","247.366  -  PLATE BN 88MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS","BOTH IP/OP","$856.08 ","$633.50 ","$0.00 ","$831.13 ","$374.01 ","$0.00 ","$178.43 ","$0.00 ","$0.00 ","$145.52 ","$831.13 ","$0.00 ","$415.56 ","$658.25 ","$664.90 ","$0.00 ","$126.28 ","$0.00 ","$132.32 ","$0.00 "
"247.37","SUP","HCPCS C1713","","247.370  -  PLATE BN 97MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS","BOTH IP/OP","$831.13 ","$615.04 ","$0.00 ","$831.13 ","$374.01 ","$0.00 ","$173.23 ","$0.00 ","$0.00 ","$145.52 ","$831.13 ","$0.00 ","$415.56 ","$658.25 ","$664.90 ","$0.00 ","$166.74 ","$0.00 ","$132.32 ","$0.00 "
"247.372","SUP","HCPCS C1713","","247.372  -  PLATE BN 76MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2.7MM","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$150.97 ","$0.00 ","$119.93 ","$0.00 "
"247.374","SUP","HCPCS C1713","","247.374  -  PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.7","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"247.375","SUP","HCPCS C1713","","247.375  -  PLATE BN 44MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"247.377","SUP","HCPCS C1713","","247.377  -  PLATE BN 60MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"247.612","SUP","HCPCS C1713","","247.612  -  PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"247.615","SUP","HCPCS C1713","","247.615  -  PLATE BN T 53MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"247.702","SUP","HCPCS C1713","","247.702  -  PLATE BONE X SMALL 24X18MM LOCK STAINLESS STEEL ANKLE FT","BOTH IP/OP","$1,439.43 ","$1,065.18 ","$0.00 ","$1,397.50 ","$628.88 ","$0.00 ","$300.01 ","$0.00 ","$0.00 ","$244.69 ","$1,397.50 ","$0.00 ","$698.75 ","$1,106.82 ","$1,118.00 ","$0.00 ","$212.34 ","$0.00 ","$222.48 ","$0.00 "
"247.704","SUP","HCPCS C1713","","247.704  -  PLATE BN MED X 30X20MM NS LCK RND THRD HL SS FT/ANKL 2.4/2.7","BOTH IP/OP","$1,457.70 ","$1,078.70 ","$0.00 ","$1,415.25 ","$636.86 ","$0.00 ","$303.82 ","$0.00 ","$0.00 ","$247.80 ","$1,415.25 ","$0.00 ","$707.63 ","$1,120.88 ","$1,132.20 ","$0.00 ","$215.03 ","$0.00 ","$225.31 ","$0.00 "
"247.706","SUP","HCPCS C1713","","247.706  -  PLATE BONE LARGE 36MM LOCK STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$1,477.38 ","$1,093.26 ","$0.00 ","$1,434.35 ","$645.46 ","$0.00 ","$307.92 ","$0.00 ","$0.00 ","$251.14 ","$1,434.35 ","$0.00 ","$717.18 ","$1,136.01 ","$1,147.48 ","$0.00 ","$217.94 ","$0.00 ","$228.35 ","$0.00 "
"247.71","SUP","HCPCS C1713","","247.710  -  PLATE BONE 18MM 2 HOLE LOCKING STAINLESS STEEL ANKLE FT","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$306.45 ","$0.00 ","$141.94 ","$0.00 ","$0.00 ","$119.24 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$103.47 ","$0.00 ","$108.42 ","$0.00 "
"247.711","SUP","HCPCS C1713","","247.711  -  PLATE BONE XS 2.4MM 4MM","BOTH IP/OP","$1,460.53 ","$1,080.79 ","$0.00 ","$1,417.98 ","$638.09 ","$0.00 ","$304.41 ","$0.00 ","$0.00 ","$248.28 ","$1,417.98 ","$0.00 ","$708.99 ","$1,123.04 ","$1,134.38 ","$0.00 ","$215.45 ","$0.00 ","$225.74 ","$0.00 "
"248.02","SUP","HCPCS C1713","","248.02  -  PLATE BONE 25MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$238.83 ","$176.73 ","$0.00 ","$238.83 ","$107.47 ","$0.00 ","$49.78 ","$0.00 ","$0.00 ","$41.82 ","$238.83 ","$0.00 ","$119.41 ","$189.15 ","$191.06 ","$0.00 ","$36.29 ","$0.00 ","$38.02 ","$0.00 "
"248.03","SUP","HCPCS C1713","","248.03  -  PLATE BONE 3.5MM 37X10X3.3MM 3 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$245.65 ","$181.78 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$51.20 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"248.04","SUP","HCPCS C1713","","248.04  -  PLATE BN 49X10X3.3MM NS DCP 4 HL SS PLV 3.5MM CORT SCR SM","BOTH IP/OP","$261.45 ","$193.47 ","$0.00 ","$253.85 ","$114.23 ","$0.00 ","$54.49 ","$0.00 ","$0.00 ","$44.45 ","$253.85 ","$0.00 ","$126.93 ","$201.05 ","$203.08 ","$0.00 ","$38.57 ","$0.00 ","$40.41 ","$0.00 "
"248.05","SUP","HCPCS C1713","","248.05  -  PLATE BONE 61X10X3.3MM 5 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$272.95 ","$201.98 ","$0.00 ","$272.95 ","$122.83 ","$0.00 ","$56.89 ","$0.00 ","$0.00 ","$47.79 ","$272.95 ","$0.00 ","$136.48 ","$216.18 ","$218.36 ","$0.00 ","$41.47 ","$0.00 ","$43.45 ","$0.00 "
"248.06","SUP","HCPCS C1713","","248.06  -  PLATE BN 73X10X3.3MM NS DCP 6 HL SS PLV 3.5MM CORT SCR SM","BOTH IP/OP","$292.38 ","$216.36 ","$0.00 ","$283.88 ","$127.74 ","$0.00 ","$60.94 ","$0.00 ","$0.00 ","$49.70 ","$283.88 ","$0.00 ","$141.94 ","$224.83 ","$227.10 ","$0.00 ","$43.13 ","$0.00 ","$45.19 ","$0.00 "
"248.07","SUP","HCPCS C1713","","248.07  -  PLATE BONE 85X10X3.3MM 7 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$294.78 ","$132.65 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$51.61 ","$294.78 ","$0.00 ","$147.39 ","$233.47 ","$235.82 ","$0.00 ","$44.79 ","$0.00 ","$46.93 ","$0.00 "
"248.08","SUP","HCPCS C1713","","248.08  -  PLATE BN 97X10X3.3MM NS DCP 8 HL SS PLV 3.5MM CORT SCR SM","BOTH IP/OP","$316.28 ","$234.05 ","$0.00 ","$307.08 ","$138.18 ","$0.00 ","$65.92 ","$0.00 ","$0.00 ","$53.77 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$46.66 ","$0.00 ","$48.89 ","$0.00 "
"248.09","SUP","HCPCS C1713","","248.09  -  PLATE BN 109X10X3.3MM NS DCP 9 HL SS PLV 3.5MM CORT SCR SM","BOTH IP/OP","$335.95 ","$248.60 ","$0.00 ","$326.18 ","$146.78 ","$0.00 ","$70.02 ","$0.00 ","$0.00 ","$57.11 ","$326.18 ","$0.00 ","$163.09 ","$258.33 ","$260.94 ","$0.00 ","$49.56 ","$0.00 ","$51.93 ","$0.00 "
"248.1","SUP","HCPCS C1713","","248.10  -  PLATE BONE 121X10X3.3MM 10 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$328.90 ","$243.39 ","$0.00 ","$328.90 ","$148.01 ","$0.00 ","$68.55 ","$0.00 ","$0.00 ","$57.59 ","$328.90 ","$0.00 ","$164.45 ","$260.49 ","$263.12 ","$0.00 ","$49.97 ","$0.00 ","$52.36 ","$0.00 "
"248.12","SUP","HCPCS C1713","","248.12  -  PLATE BONE 145X10X3.3MM 12 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$393.60 ","$291.26 ","$0.00 ","$382.13 ","$171.96 ","$0.00 ","$82.04 ","$0.00 ","$0.00 ","$66.91 ","$382.13 ","$0.00 ","$191.06 ","$302.65 ","$305.70 ","$0.00 ","$58.06 ","$0.00 ","$60.83 ","$0.00 "
"248.14","SUP","HCPCS C1713","","248.14  -  PLATE BONE 169X10X3.3MM 14 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$723.93 ","$535.71 ","$0.00 ","$702.85 ","$316.28 ","$0.00 ","$150.88 ","$0.00 ","$0.00 ","$123.06 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$106.79 ","$0.00 ","$111.89 ","$0.00 "
"248.16","SUP","HCPCS C1713","","248.16  -  PLATE BONE 194X10X3.3MM 16 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$833.58 ","$616.85 ","$0.00 ","$809.30 ","$364.19 ","$0.00 ","$173.74 ","$0.00 ","$0.00 ","$141.70 ","$809.30 ","$0.00 ","$404.65 ","$640.97 ","$647.44 ","$0.00 ","$122.97 ","$0.00 ","$128.84 ","$0.00 "
"248.18","SUP","HCPCS C1713","","248.18  -  PLATE BONE 217X10X3.3MM 18 HOLE DCP STAINLESS STEEL PELVIS","BOTH IP/OP","$933.38 ","$690.70 ","$0.00 ","$906.20 ","$407.79 ","$0.00 ","$194.54 ","$0.00 ","$0.00 ","$158.67 ","$906.20 ","$0.00 ","$453.10 ","$717.71 ","$724.96 ","$0.00 ","$137.69 ","$0.00 ","$144.27 ","$0.00 "
"248.2","SUP","HCPCS C1713","","248.20  -  PLATE BONE 3.5MM 242X10X3.3MM 20 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$999.00 ","$739.26 ","$0.00 ","$999.00 ","$449.55 ","$0.00 ","$208.22 ","$0.00 ","$0.00 ","$174.92 ","$999.00 ","$0.00 ","$499.50 ","$791.21 ","$799.20 ","$0.00 ","$151.79 ","$0.00 ","$159.04 ","$0.00 "
"248.22","SUP","HCPCS C1713","","248.22  -  PLATE BONE 3.5MM 265X10X3.3MM 22 HOLE DCP STAINLESS STEEL","BOTH IP/OP","$1,090.43 ","$806.92 ","$0.00 ","$1,090.43 ","$490.69 ","$0.00 ","$227.27 ","$0.00 ","$0.00 ","$190.92 ","$1,090.43 ","$0.00 ","$545.21 ","$863.62 ","$872.34 ","$0.00 ","$165.68 ","$0.00 ","$173.60 ","$0.00 "
"249.615","SUP","HCPCS C1713","","249.615  -  PLATE BONE T 58MM 7X3 HOLE LCP STAINLESS STEEL SMALL BONE","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"249.669","SUP","HCPCS C1713","","249.669  -  PLATE BONE Y 60MM 3X7 HOLE LCP STAINLESS STEEL ANKLE FT","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"249.67","SUP","HCPCS C1713","","249.670  -  PLATE BONE T 58MM 2X7 HOLE LCP STAINLESS STEEL ANKLE FT","BOTH IP/OP","$1,311.53 ","$970.53 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$273.35 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"249.674","SUP","HCPCS C1713","","249.674  -  PLATE BONE 36MM 4 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"249.676","SUP","HCPCS C1713","","249.676  -  PLATE BONE 52MM 6 HOLE LP LCP STAINLESS STEEL SMALL BONE","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"249.678","SUP","HCPCS C1713","","249.678  -  PLATE BONE 68MM 8 HOLE LCP STAINLESS STEEL SMALL BONE","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"249.679","SUP","HCPCS C1713","","249.679  -  PLATE BONE 59MM 7 SHAFT HOLE LCP STAINLESS STEEL CONDYLE","BOTH IP/OP","$1,103.48 ","$816.58 ","$0.00 ","$1,071.33 ","$482.10 ","$0.00 ","$229.99 ","$0.00 ","$0.00 ","$187.58 ","$1,071.33 ","$0.00 ","$535.66 ","$848.49 ","$857.06 ","$0.00 ","$162.78 ","$0.00 ","$170.55 ","$0.00 "
"249.68","SUP","HCPCS C1713","","249.680  -  PLATE BN 40MM NS LCP 4 HL LOPRFL CUT TO LGTH SS 2.7MM SCR","BOTH IP/OP","$753.35 ","$557.48 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$157.02 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"249.681","SUP","HCPCS C1713","","249.681  -  PLATE BONE 49MM 5 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"249.682","SUP","HCPCS C1713","","249.682  -  PLATE BONE LP 58MM 6 HOLE CUT TO LENGTH LCP STAINLESS STEEL","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"249.683","SUP","HCPCS C1713","","249.683  -  PLATE BONE 6.7CM 7 HOLE LCP STAINLESS STEEL SMALL BONE","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"249.684","SUP","HCPCS C1713","","249.684  -  PLATE BONE 66MM 7 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL","BOTH IP/OP","$1,203.28 ","$890.43 ","$0.00 ","$1,168.23 ","$525.70 ","$0.00 ","$250.79 ","$0.00 ","$0.00 ","$204.55 ","$1,168.23 ","$0.00 ","$584.11 ","$925.24 ","$934.58 ","$0.00 ","$177.50 ","$0.00 ","$185.98 ","$0.00 "
"249.685","SUP","HCPCS C1713","","249.685  -  PLATE BONE T 32MM 2X3 HOLE LCP STAINLESS STEEL ANKLE FT","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"249.686","SUP","HCPCS C1713","","249.686  -  PLATE BN OB R L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"249.687","SUP","HCPCS C1713","","249.687  -  PLATE BN OB L L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$143.84 ","$0.00 ","$113.85 ","$0.00 "
"249.688","SUP","HCPCS C1713","","249.688  -  PLATE BONE L 32MM 2X3 HOLE RIGHT OBLIQUE LCP STAINLESS STEEL","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"249.689","SUP","HCPCS C1713","","249.689  -  PLATE BN L 32MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO LGTH","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"249.69","SUP","HCPCS C1713","","249.690  -  PLATE BONE 31MM 5 HOLE LOCKING HIND MIDFT NONSTRL 2.4-2.7MM","BOTH IP/OP","$1,454.83 ","$1,076.57 ","$0.00 ","$1,454.83 ","$654.67 ","$0.00 ","$303.22 ","$0.00 ","$0.00 ","$254.73 ","$1,454.83 ","$0.00 ","$727.41 ","$1,152.23 ","$1,163.86 ","$0.00 ","$221.05 ","$0.00 ","$231.61 ","$0.00 "
"249.691","SUP","HCPCS C1713","","249.691  -  PLATE BN 45MM NS 8 HL LCK SS HND/MDFT 2.4/2.7MM SCR","BOTH IP/OP","$1,529.40 ","$1,131.76 ","$0.00 ","$1,484.85 ","$668.18 ","$0.00 ","$318.77 ","$0.00 ","$0.00 ","$259.99 ","$1,484.85 ","$0.00 ","$742.43 ","$1,176.00 ","$1,187.88 ","$0.00 ","$225.61 ","$0.00 ","$236.39 ","$0.00 "
"249.697","SUP","HCPCS C1713","","249.697  -  PLATE BONE 32MM 2X4 HOLE T LCP STAINLESS STEEL CONDYLE","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"249.698","SUP","HCPCS C1713","","249.698  -  PLATE BONE 42MM 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP","BOTH IP/OP","$745.03 ","$551.32 ","$0.00 ","$723.33 ","$325.50 ","$0.00 ","$155.28 ","$0.00 ","$0.00 ","$126.65 ","$723.33 ","$0.00 ","$361.66 ","$572.88 ","$578.66 ","$0.00 ","$109.90 ","$0.00 ","$115.15 ","$0.00 "
"249.699","SUP","HCPCS C1713","","249.699  -  PLATE BONE T 42MM 2 HOLE HEAD 4 HOLE SHAFT LEFT OBLIQUE LCP","BOTH IP/OP","$745.03 ","$551.32 ","$0.00 ","$723.33 ","$325.50 ","$0.00 ","$155.28 ","$0.00 ","$0.00 ","$126.65 ","$723.33 ","$0.00 ","$361.66 ","$572.88 ","$578.66 ","$0.00 ","$109.90 ","$0.00 ","$115.15 ","$0.00 "
"249.701","SUP","HCPCS C1713","","249.701  -  PLATE BONE 40MM 2 HOLE HEAD 4 HOLE SHAFT L LCP STAINLESS","BOTH IP/OP","$745.03 ","$551.32 ","$0.00 ","$723.33 ","$325.50 ","$0.00 ","$155.28 ","$0.00 ","$0.00 ","$126.65 ","$723.33 ","$0.00 ","$361.66 ","$572.88 ","$578.66 ","$0.00 ","$109.90 ","$0.00 ","$115.15 ","$0.00 "
"249.702","SUP","HCPCS C1713","","249.702  -  PLATE BONE L 40MM 2X4 HOLE LCP STAINLESS STEEL LEFT SMALL","BOTH IP/OP","$745.03 ","$551.32 ","$0.00 ","$723.33 ","$325.50 ","$0.00 ","$155.28 ","$0.00 ","$0.00 ","$126.65 ","$723.33 ","$0.00 ","$361.66 ","$572.88 ","$578.66 ","$0.00 ","$109.90 ","$0.00 ","$115.15 ","$0.00 "
"249.906","SUP","HCPCS C1713","","249.906  -  PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"249.912","SUP","HCPCS C1713","","249.912  -  PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$522.93 ","$386.97 ","$0.00 ","$507.68 ","$228.45 ","$0.00 ","$108.99 ","$0.00 ","$0.00 ","$88.89 ","$507.68 ","$0.00 ","$253.84 ","$402.08 ","$406.14 ","$0.00 ","$77.14 ","$0.00 ","$80.82 ","$0.00 "
"249.913","SUP","HCPCS C1713","","249.913  -  PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"249.914","SUP","HCPCS C1713","","249.914  -  PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$517.30 ","$382.80 ","$0.00 ","$502.23 ","$226.00 ","$0.00 ","$107.82 ","$0.00 ","$0.00 ","$87.94 ","$502.23 ","$0.00 ","$251.11 ","$397.77 ","$401.78 ","$0.00 ","$76.31 ","$0.00 ","$79.95 ","$0.00 "
"249.915","SUP","HCPCS C1713","","249.915  -  PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$514.48 ","$380.72 ","$0.00 ","$499.50 ","$224.78 ","$0.00 ","$107.23 ","$0.00 ","$0.00 ","$87.46 ","$499.50 ","$0.00 ","$249.75 ","$395.60 ","$399.60 ","$0.00 ","$75.89 ","$0.00 ","$79.52 ","$0.00 "
"249.916","SUP","HCPCS C1713","","249.916  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH","BOTH IP/OP","$515.90 ","$381.77 ","$0.00 ","$500.88 ","$225.39 ","$0.00 ","$107.53 ","$0.00 ","$0.00 ","$87.70 ","$500.88 ","$0.00 ","$250.44 ","$396.70 ","$400.70 ","$0.00 ","$76.10 ","$0.00 ","$79.74 ","$0.00 "
"249.917","SUP","HCPCS C1713","","249.917  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH","BOTH IP/OP","$515.90 ","$381.77 ","$0.00 ","$500.88 ","$225.39 ","$0.00 ","$107.53 ","$0.00 ","$0.00 ","$87.70 ","$500.88 ","$0.00 ","$250.44 ","$396.70 ","$400.70 ","$0.00 ","$76.10 ","$0.00 ","$79.74 ","$0.00 "
"249.919","SUP","HCPCS C1713","","249.919  -  PLATE BN T 66MM NS 3 HLE/HD 10 HL SHFT LOPRFL CUT TO LGTH SS","BOTH IP/OP","$472.33 ","$349.52 ","$0.00 ","$458.55 ","$206.35 ","$0.00 ","$98.44 ","$0.00 ","$0.00 ","$80.29 ","$458.55 ","$0.00 ","$229.28 ","$363.17 ","$366.84 ","$0.00 ","$69.67 ","$0.00 ","$73.00 ","$0.00 "
"249.921","SUP","HCPCS C1713","","249.921  -  PLATE BN NS LOPRFL CUT TO LGTH SS CUBOID 2.4 MM SCR MODFT","BOTH IP/OP","$688.80 ","$509.71 ","$0.00 ","$668.73 ","$300.93 ","$0.00 ","$143.56 ","$0.00 ","$0.00 ","$117.09 ","$668.73 ","$0.00 ","$334.36 ","$529.63 ","$534.98 ","$0.00 ","$101.61 ","$0.00 ","$106.46 ","$0.00 "
"249.924","SUP","HCPCS C1713","","249.924  -  PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$548.23 ","$405.69 ","$0.00 ","$532.25 ","$239.51 ","$0.00 ","$114.26 ","$0.00 ","$0.00 ","$93.19 ","$532.25 ","$0.00 ","$266.13 ","$421.54 ","$425.80 ","$0.00 ","$80.87 ","$0.00 ","$84.73 ","$0.00 "
"249.926","SUP","HCPCS C1713","","249.926  -  PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$618.50 ","$457.69 ","$0.00 ","$600.50 ","$270.23 ","$0.00 ","$128.91 ","$0.00 ","$0.00 ","$105.14 ","$600.50 ","$0.00 ","$300.25 ","$475.60 ","$480.40 ","$0.00 ","$91.24 ","$0.00 ","$95.60 ","$0.00 "
"249.928","SUP","HCPCS C1713","","249.928  -  PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$667.70 ","$494.10 ","$0.00 ","$648.25 ","$291.71 ","$0.00 ","$139.17 ","$0.00 ","$0.00 ","$113.50 ","$648.25 ","$0.00 ","$324.13 ","$513.41 ","$518.60 ","$0.00 ","$98.50 ","$0.00 ","$103.20 ","$0.00 "
"254.862","SUP","Custom 27803010","","254.862  -  SS ROD TO ROD CLAMP, 5.5MM TO 6.5MM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"254.864","SUP","Custom 27803010","","254.864  -  SS ROD TO ROD CLAMP, 5.5MM TO 6.5MM, WIDE","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"254.866","SUP","Custom 27803010","","254.866  -  SS PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"254.868","SUP","Custom 27803010","","254.868  -  SS PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM WIDE","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"260.06","SUP","HCPCS C1713","","260.060  -  PLATE 80MM SS 4.5MM SCR 10 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$2,682.50 ","$1,985.05 ","$0.00 ","$2,682.50 ","$1,207.13 ","$0.00 ","$559.10 ","$0.00 ","$0.00 ","$469.68 ","$2,682.50 ","$0.00 ","$1,341.25 ","$2,124.54 ","$2,146.00 ","$0.00 ","$419.81 ","$0.00 ","$427.05 ","$0.00 "
"260.062","SUP","HCPCS C1713","","260.062  -  PLATE 96MM SS 4.5MM SCR 12 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$2,760.00 ","$2,042.40 ","$0.00 ","$2,760.00 ","$1,242.00 ","$0.00 ","$575.25 ","$0.00 ","$0.00 ","$483.25 ","$2,760.00 ","$0.00 ","$1,380.00 ","$2,185.92 ","$2,208.00 ","$0.00 ","$431.94 ","$0.00 ","$439.39 ","$0.00 "
"260.064","SUP","HCPCS C1713","","260.064  -  PLATE 112MM SS 4.5MM SCR 14 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$2,835.00 ","$2,097.90 ","$0.00 ","$2,835.00 ","$1,275.75 ","$0.00 ","$590.88 ","$0.00 ","$0.00 ","$496.39 ","$2,835.00 ","$0.00 ","$1,417.50 ","$2,245.32 ","$2,268.00 ","$0.00 ","$443.68 ","$0.00 ","$451.33 ","$0.00 "
"260.066","SUP","HCPCS C1713","","260.066  -  PLATE 128MM SS 4.5MM SCR 16 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$2,912.50 ","$2,155.25 ","$0.00 ","$2,912.50 ","$1,310.63 ","$0.00 ","$607.04 ","$0.00 ","$0.00 ","$509.96 ","$2,912.50 ","$0.00 ","$1,456.25 ","$2,306.70 ","$2,330.00 ","$0.00 ","$455.81 ","$0.00 ","$463.67 ","$0.00 "
"260.068","SUP","HCPCS C1713","","260.068  -  PLATE 144MM SS 4.5MM SCR 18 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$2,990.00 ","$2,212.60 ","$0.00 ","$2,990.00 ","$1,345.50 ","$0.00 ","$623.19 ","$0.00 ","$0.00 ","$523.53 ","$2,990.00 ","$0.00 ","$1,495.00 ","$2,368.08 ","$2,392.00 ","$0.00 ","$467.94 ","$0.00 ","$476.01 ","$0.00 "
"260.07","SUP","HCPCS C1713","","260.070  -  PLATE 160MM SS 4.5MM SCR 20 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$3,067.50 ","$2,269.95 ","$0.00 ","$3,067.50 ","$1,380.38 ","$0.00 ","$639.34 ","$0.00 ","$0.00 ","$537.09 ","$3,067.50 ","$0.00 ","$1,533.75 ","$2,429.46 ","$2,454.00 ","$0.00 ","$480.06 ","$0.00 ","$488.35 ","$0.00 "
"260.072","SUP","HCPCS C1713","","260.072  -  PLATE 176MM SS 4.5MM SCR 22 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"260.074","SUP","HCPCS C1713","","260.074  -  PLATE 192MM SS 4.5MM SCR 24 HOLE RECON BONE STRNL NONSTRL","BOTH IP/OP","$3,217.50 ","$2,380.95 ","$0.00 ","$3,217.50 ","$1,447.88 ","$0.00 ","$670.61 ","$0.00 ","$0.00 ","$563.36 ","$3,217.50 ","$0.00 ","$1,608.75 ","$2,548.26 ","$2,574.00 ","$0.00 ","$503.54 ","$0.00 ","$512.23 ","$0.00 "
"275.9","SUP","Custom 27803010","","275.900  -  CAP END 3-4MM STAINLESS STEEL ORTHOPEDIC ELSTIC NAIL","BOTH IP/OP","$151.48 ","$112.10 ","$0.00 ","$151.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"275.905","SUP","Custom 27803010","","275.905  -  CAP END STAINLESS STEEL NONSTRL 1.5-2.5 MM ELAST NAIL","BOTH IP/OP","$156.03 ","$115.46 ","$0.00 ","$151.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"275.915","SUP","HCPCS C1713","","275.915  -  NAIL INTRAMEDULLARY 1.5MM 300MM ELAST STAINLESS STEEL","BOTH IP/OP","$493.40 ","$365.12 ","$0.00 ","$479.03 ","$215.56 ","$0.00 ","$102.84 ","$0.00 ","$0.00 ","$83.87 ","$479.03 ","$0.00 ","$239.51 ","$379.39 ","$383.22 ","$0.00 ","$72.78 ","$0.00 ","$76.26 ","$0.00 "
"275.92","SUP","HCPCS C1713","","275.920  -  NAIL INTRAMEDULLARY 2MM 440MM ELAST STAINLESS STEEL","BOTH IP/OP","$513.15 ","$379.73 ","$0.00 ","$513.15 ","$230.92 ","$0.00 ","$106.95 ","$0.00 ","$0.00 ","$89.85 ","$513.15 ","$0.00 ","$256.58 ","$406.41 ","$410.52 ","$0.00 ","$77.97 ","$0.00 ","$81.69 ","$0.00 "
"275.925","SUP","HCPCS C1713","","275.925  -  NAIL INTRAMEDULLARY 2.5MM 440MM ELAST STAINLESS STEEL","BOTH IP/OP","$567.90 ","$420.25 ","$0.00 ","$551.35 ","$248.11 ","$0.00 ","$118.36 ","$0.00 ","$0.00 ","$96.54 ","$551.35 ","$0.00 ","$275.68 ","$436.67 ","$441.08 ","$0.00 ","$83.77 ","$0.00 ","$87.77 ","$0.00 "
"275.93","SUP","HCPCS C1713","","275.930  -  NAIL INTRAMEDULLARY 3MM 440MM ELAST STAINLESS STEEL","BOTH IP/OP","$582.75 ","$431.24 ","$0.00 ","$582.75 ","$262.24 ","$0.00 ","$121.46 ","$0.00 ","$0.00 ","$102.03 ","$582.75 ","$0.00 ","$291.38 ","$461.54 ","$466.20 ","$0.00 ","$88.54 ","$0.00 ","$92.77 ","$0.00 "
"275.935","SUP","HCPCS C1713","","275.935  -  NAIL INTRAMEDULLARY 3.5MM 440MM ELAST STAINLESS STEEL","BOTH IP/OP","$635.38 ","$470.18 ","$0.00 ","$616.88 ","$277.59 ","$0.00 ","$132.43 ","$0.00 ","$0.00 ","$108.01 ","$616.88 ","$0.00 ","$308.44 ","$488.57 ","$493.50 ","$0.00 ","$93.73 ","$0.00 ","$98.21 ","$0.00 "
"275.94","SUP","HCPCS C1713","","275.940  -  NAIL INTRAMEDULLARY 4MM 440MM ELAST STAINLESS STEEL","BOTH IP/OP","$661.90 ","$489.81 ","$0.00 ","$661.90 ","$297.86 ","$0.00 ","$137.96 ","$0.00 ","$0.00 ","$115.89 ","$661.90 ","$0.00 ","$330.95 ","$524.22 ","$529.52 ","$0.00 ","$100.57 ","$0.00 ","$105.37 ","$0.00 "
"280","SUP","HCPCS C1713","","280.000  -  SCREW BONE 12.7MM 8.2MM 2.7MM 100MM 22MM CANN LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.05","SUP","HCPCS C1713","","280.050  -  SCREW BONE 12.7MM 8.2MM 2.7MM 105MM 22MM CANN LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.1","SUP","HCPCS C1713","","280.100  -  SCREW BONE 12.7MM 8.2MM 2.7MM 110MM 22MM CANN LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.15","SUP","HCPCS C1713","","280.150  -  SCREW BONE 12.7MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.2","SUP","HCPCS C1713","","280.200  -  SCREW BONE 12.7MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.25","SUP","HCPCS C1713","","280.250  -  SCREW BONE 12.7MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.251","SUP","HCPCS C1713","","280.251  -  SCREW BONE 12.7MM 50MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.255","SUP","HCPCS C1713","","280.255  -  SCREW BONE 12.7MM 55MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.26","SUP","HCPCS C1713","","280.260  -  SCREW BONE 12.7MM 60MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.265","SUP","HCPCS C1713","","280.265  -  SCREW BONE 12.7MM 65MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.27","SUP","HCPCS C1713","","280.270  -  SCREW BONE 12.7MM 70MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.275","SUP","HCPCS C1713","","280.275  -  SCREW BONE 12.7MM 75MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.28","SUP","HCPCS C1713","","280.280  -  SCREW BONE 12.7MM 80MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.285","SUP","HCPCS C1713","","280.285  -  SCREW BN 12MM 8MM 2.7MM 85MM NS 22MM DHS DCS LG CNN SS HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.29","SUP","HCPCS C1713","","280.290  -  SCREW BONE 12.7MM 90MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.295","SUP","HCPCS C1713","","280.295  -  SCREW BONE 12.7MM 95MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.3","SUP","HCPCS C1713","","280.300  -  SCREW BONE 12.7MM 130MM 22MM DHS/DCS SS CNDYLR HIP LAG CANN","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.301","SUP","HCPCS C1713","","280.301  -  SCREW BONE 12.7MM 100MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.305","SUP","HCPCS C1713","","280.305  -  SCREW BONE 12.7MM 105MM 22MM LAG CANN DHS/DCS STAINLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.31","SUP","HCPCS C1713","","280.310  -  SCREW BONE 12.7MM 110MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.315","SUP","HCPCS C1713","","280.315  -  SCREW BONE 12.7MM 115MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.32","SUP","HCPCS C1713","","280.320  -  SCREW BONE 12.7MM 120MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.325","SUP","HCPCS C1713","","280.325  -  SCREW BONE 12.7MM 125MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.33","SUP","HCPCS C1713","","280.330  -  SCREW BONE 12.7MM 130MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.335","SUP","HCPCS C1713","","280.335  -  SCREW BONE 13MM 135MM 22MM LAG CANN OCTAGONAL DHS/DCS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.34","SUP","HCPCS C1713","","280.340  -  SCREW BONE 12MM 8MM 2.7MM 140MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.345","SUP","HCPCS C1713","","280.345  -  SCREW BONE 12MM 8MM 2.7MM 145MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.35","SUP","HCPCS C1713","","280.350  -  SCREW BONE 12.7MM 8.2MM 135MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.4","SUP","HCPCS C1713","","280.400  -  SCREW BONE 12.7MM 140MM 22MM 1 STEP LAG THREADED DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.451","SUP","HCPCS C1713","","280.451  -  SCREW BONE 12.7MM 8.2MM 2.7MM 145MM 22MM CANN LAG DHS/DCS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.454","SUP","HCPCS C1713","","280.454  -  SCREW BONE 14MM 2.7MM 50MM 22MM LAG CANN DHS/DCS STAINLESS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.455","SUP","HCPCS C1713","","280.455  -  SCREW BONE 14MM 8.2MM 55MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.46","SUP","HCPCS C1713","","280.460  -  SCREW BONE 14MM 8.2MM 60MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.465","SUP","HCPCS C1713","","280.465  -  SCREW BONE LARGE 14MM 65MM 14MM THREAD DHS/DCS STAINLESS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.47","SUP","HCPCS C1713","","280.470  -  SCREW BONE 14MM 8.2MM 70MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.475","SUP","HCPCS C1713","","280.475  -  SCREW BONE 14MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.48","SUP","HCPCS C1713","","280.480  -  SCREW BONE 14MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.485","SUP","HCPCS C1713","","280.485  -  SCREW BONE 14MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.49","SUP","HCPCS C1713","","280.490  -  SCREW BONE 14MM 8.2MM 90MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.495","SUP","HCPCS C1713","","280.495  -  SCREW BONE 14MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.501","SUP","HCPCS C1713","","280.501  -  SCREW BONE 12.7MM 8.2MM 50MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$702.85 ","$520.11 ","$0.00 ","$682.38 ","$307.07 ","$0.00 ","$146.49 ","$0.00 ","$0.00 ","$119.48 ","$682.38 ","$0.00 ","$341.19 ","$540.44 ","$545.90 ","$0.00 ","$103.68 ","$0.00 ","$108.63 ","$0.00 "
"280.504","SUP","HCPCS C1713","","280.504  -  SCREW BONE 14MM 8MM 2.7MM 100MM 22MM LAG CANN DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.505","SUP","HCPCS C1713","","280.505  -  SCREW BONE 14MM 8.2MM 105MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.51","SUP","HCPCS C1713","","280.510  -  SCREW BONE 14MM 8.2MM 110MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.515","SUP","HCPCS C1713","","280.515  -  SCREW BONE 14MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.52","SUP","HCPCS C1713","","280.520  -  SCREW BONE 14MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.525","SUP","HCPCS C1713","","280.525  -  SCREW BONE 14MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.53","SUP","HCPCS C1713","","280.530  -  SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.535","SUP","HCPCS C1713","","280.535  -  SCREW BONE 14MM 135MM 22MM LAG THREAD DHS/DCS STAINLESS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.54","SUP","HCPCS C1713","","280.540  -  SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.545","SUP","HCPCS C1713","","280.545  -  SCREW BONE 14MM 145MM 22MM LAG THREAD DHS/DCS STAINLESS","BOTH IP/OP","$722.53 ","$534.67 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.55","SUP","HCPCS C1713","","280.550  -  SCREW BONE 8MM 55MM 22MM CANN THREADED LAG DHS/DCS STAINLESS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.6","SUP","HCPCS C1713","","280.600  -  SCREW BONE 12.7MM 8.2MM 2.7MM 60MM 22MM CANN LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.65","SUP","HCPCS C1713","","280.650  -  SCREW BONE 12.7MM 8.2MM 65MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.66","SUP","HCPCS C1713","","280.660  -  SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.67","SUP","HCPCS C1713","","280.670  -  SCREW BONE 14MM 70MM 22MM 1 STEP LAG THREAD DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.68","SUP","HCPCS C1713","","280.680  -  SCREW BONE 14MM 80MM 22MM LAG CANN DHS/DCS STAINLESS STEEL","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.69","SUP","HCPCS C1713","","280.690  -  SCREW BONE 14MM 90MM 22MM LAG CANN DHS/DCS STAINLESS STEEL","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.7","SUP","HCPCS C1713","","280.700  -  SCREW BN 12.7MM 8MM 2.7MM 70MM NS 22MM DHS DCS LG CNN SS HIP","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.71","SUP","HCPCS C1713","","280.710  -  SCREW BONE 14MM 8.2MM 110MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.72","SUP","HCPCS C1713","","280.720  -  SCREW BONE 14MM 8.2MM 120MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.73","SUP","HCPCS C1713","","280.730  -  SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.74","SUP","HCPCS C1713","","280.740  -  SCREW BONE 14MM 8.2MM 140MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$701.48 ","$519.10 ","$0.00 ","$701.48 ","$315.66 ","$0.00 ","$146.20 ","$0.00 ","$0.00 ","$122.82 ","$701.48 ","$0.00 ","$350.74 ","$555.57 ","$561.18 ","$0.00 ","$106.58 ","$0.00 ","$111.67 ","$0.00 "
"280.75","SUP","HCPCS C1713","","280.750  -  SCREW BONE 12.7MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.8","SUP","HCPCS C1713","","280.800  -  SCREW BONE 12.7MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.85","SUP","HCPCS C1713","","280.850  -  SCREW BONE 12.7MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.9","SUP","HCPCS C1713","","280.900  -  SCREW BONE 12.7MM 8MM 2.7MM 90MM 22MM LAG DHS/DCS STAINLESS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.95","SUP","HCPCS C1713","","280.950  -  SCREW BONE 12.7MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS","BOTH IP/OP","$622.33 ","$460.52 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$129.71 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"280.99","SUP","HCPCS C1713","","280.990  -  SCREW BONE 12.7MM 36MM 22MM COMPRESSION DHS/DCS STAINLESS","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"281.01","SUP","HCPCS C1713","","281.010  -  PLATE BONE 130D STANDARD BARREL 174MM 38MM 10 HOLE DHS/DCP","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.012","SUP","HCPCS C1713","","281.012  -  PLATE BN 130D STD BRL 206MM NS 38MM DHS 12 HL SS HIP 4.5MM","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.014","SUP","HCPCS C1713","","281.014  -  PLATE BN 130D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.02","SUP","HCPCS C1713","","281.020  -  PLATE BONE 135D STANDARD BARREL 333X19X5.8MM 38MM 20 HOLE","BOTH IP/OP","$1,771.45 ","$1,310.87 ","$0.00 ","$1,771.45 ","$797.15 ","$0.00 ","$369.21 ","$0.00 ","$0.00 ","$310.17 ","$1,771.45 ","$0.00 ","$885.73 ","$1,402.99 ","$1,417.16 ","$0.00 ","$269.16 ","$0.00 ","$282.01 ","$0.00 "
"281.021","SUP","HCPCS C1713","","281.021  -  PLATE BN 130D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.031","SUP","HCPCS C1713","","281.031  -  PLATE BONE 130D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCS","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.04","SUP","HCPCS C1713","","281.040  -  PLATE BN 130D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.05","SUP","HCPCS C1713","","281.050  -  PLATE BN 130D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.06","SUP","HCPCS C1713","","281.060  -  PLATE BN 130D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.081","SUP","HCPCS C1713","","281.081  -  PLATE BONE 130D STANDARD BARREL 142MM 38MM 8 HOLE","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.1","SUP","HCPCS C1713","","281.100  -  PLATE BN 135D STD BRL 12.6MM 174X19X5.8MM NS 38MM DHS DCP 10","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.102","SUP","HCPCS C1713","","281.102  -  PLATE BN 135D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.11","SUP","HCPCS C1713","","281.110  -  PLATE BN 135D STD BRL 12.6MM 206X19X5.8MM NS 38MM DHS DCP 12","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.13","SUP","HCPCS C1713","","281.130  -  PLATE BN 135D STD BRL 12.6MM 238X19X5.8MM NS 38MM DHS DCP 14","BOTH IP/OP","$1,720.95 ","$1,273.50 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$358.69 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.131","SUP","HCPCS C1713","","281.131  -  PLATE BN 135D STD BRL 12.6MM 62X19X5.8MM NS 38MM DHS DCP 3","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.14","SUP","HCPCS C1713","","281.140  -  PLATE BN 135D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.15","SUP","HCPCS C1713","","281.150  -  PLATE BN 135D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.16","SUP","HCPCS C1713","","281.160  -  PLATE BN 135D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.17","SUP","HCPCS C1713","","281.170  -  PLATE BN 135D STD BRL 12.6MM 270X19X5.8MM NS 38MM DHS DCP 16","BOTH IP/OP","$1,720.95 ","$1,273.50 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$358.69 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.18","SUP","HCPCS C1713","","281.180  -  PLATE BN 135D STD BRL 12.6MM 142X19X5.8MM NS 38MM DHS DCP 8","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.19","SUP","HCPCS C1713","","281.190  -  PLATE BONE 135D STANDARD BARREL 302X19X5.8MM 38MM 18 HOLE","BOTH IP/OP","$1,771.45 ","$1,310.87 ","$0.00 ","$1,771.45 ","$797.15 ","$0.00 ","$369.21 ","$0.00 ","$0.00 ","$310.17 ","$1,771.45 ","$0.00 ","$885.73 ","$1,402.99 ","$1,417.16 ","$0.00 ","$269.16 ","$0.00 ","$282.01 ","$0.00 "
"281.2","SUP","HCPCS C1713","","281.200  -  PLATE BN 140D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.212","SUP","HCPCS C1713","","281.212  -  PLATE BONE STANDARD BARREL 140D 206MM 38MM 12 HOLE DHS","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.214","SUP","HCPCS C1713","","281.214  -  PLATE BN 140D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.216","SUP","HCPCS C1713","","281.216  -  PLATE BONE 140D STANDARD BARREL 12.6MM 270MM 38MM 16 HOLE","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.22","SUP","HCPCS C1713","","281.220  -  PLATE BN 140D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.23","SUP","HCPCS C1713","","281.230  -  PLATE BONE 140D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.24","SUP","HCPCS C1713","","281.240  -  PLATE BN 140D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$181.76 ","$0.00 ","$155.13 ","$0.00 "
"281.25","SUP","HCPCS C1713","","281.250  -  PLATE BN 140D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.26","SUP","HCPCS C1713","","281.260  -  PLATE BN 140D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.28","SUP","HCPCS C1713","","281.280  -  PLATE BN 140D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.308","SUP","HCPCS C1713","","281.308  -  PLATE BN 145D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.31","SUP","HCPCS C1713","","281.310  -  PLATE BN 145D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.312","SUP","HCPCS C1713","","281.312  -  PLATE BONE 145D 206MM 38MM 12 HOLE ANGLED STANDARD BARREL","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.314","SUP","HCPCS C1713","","281.314  -  PLATE BONE 145D STANDARD BARREL 238MM 38MM 14 HOLE DHS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.316","SUP","HCPCS C1713","","281.316  -  PLATE BONE 145D STANDARD BARREL 270MM 38MM 16 HOLE DHS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.32","SUP","HCPCS C1713","","281.320  -  PLATE BN 145D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.33","SUP","HCPCS C1713","","281.330  -  PLATE BONE 145D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.34","SUP","HCPCS C1713","","281.340  -  PLATE BN 145D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.35","SUP","HCPCS C1713","","281.350  -  PLATE BN 145D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.36","SUP","HCPCS C1713","","281.360  -  PLATE BN 145D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.4","SUP","HCPCS C1713","","281.400  -  PLATE BN 150D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.402","SUP","HCPCS C1713","","281.402  -  PLATE BONE 150D STANDARD BARREL 46X19X5.8MM 38MM 2 HOLE","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.41","SUP","HCPCS C1713","","281.410  -  PLATE BONE 150D STANDARD BARREL 12.6MM 206MM 38MM 12 HOLE","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.414","SUP","HCPCS C1713","","281.414  -  PLATE BONE 150D STANDARD BARREL 238MM 38MM 14 HOLE DHS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.416","SUP","HCPCS C1713","","281.416  -  PLATE BONE 150D STANDARD BARREL 270MM 38MM 16 HOLE DHS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"281.418","SUP","HCPCS C1713","","281.418  -  PLATE BONE 150D STANDARD BARRAL 302MM 38MM 18 HOLE DHS/DCP","BOTH IP/OP","$1,824.60 ","$1,350.20 ","$0.00 ","$1,771.45 ","$797.15 ","$0.00 ","$380.29 ","$0.00 ","$0.00 ","$310.17 ","$1,771.45 ","$0.00 ","$885.73 ","$1,402.99 ","$1,417.16 ","$0.00 ","$269.16 ","$0.00 ","$282.01 ","$0.00 "
"281.421","SUP","HCPCS C1713","","281.421  -  PLATE BONE 150D STANDARD BARREL 333MM 38MM 20 HOLE DHS/DCP","BOTH IP/OP","$1,824.60 ","$1,350.20 ","$0.00 ","$1,771.45 ","$797.15 ","$0.00 ","$380.29 ","$0.00 ","$0.00 ","$310.17 ","$1,771.45 ","$0.00 ","$885.73 ","$1,402.99 ","$1,417.16 ","$0.00 ","$269.16 ","$0.00 ","$282.01 ","$0.00 "
"281.43","SUP","HCPCS C1713","","281.430  -  PLATE BONE 150D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.44","SUP","HCPCS C1713","","281.440  -  PLATE BN 150D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$181.76 ","$0.00 ","$155.13 ","$0.00 "
"281.45","SUP","HCPCS C1713","","281.450  -  PLATE BN 150D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.46","SUP","HCPCS C1713","","281.460  -  PLATE BN 150D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.48","SUP","HCPCS C1713","","281.480  -  PLATE BN 150D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"281.502","SUP","HCPCS C1713","","281.502  -  PLATE BONE 130D SHORT BARREL 46MM 25MM 2 HOLE DHS/DCP","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.503","SUP","HCPCS C1713","","281.503  -  PLATE BONE 130D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.504","SUP","HCPCS C1713","","281.504  -  PLATE BONE 130D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.505","SUP","HCPCS C1713","","281.505  -  PLATE BONE 130D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.506","SUP","HCPCS C1713","","281.506  -  PLATE BONE 130D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP","BOTH IP/OP","$1,003.68 ","$742.72 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$209.19 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.52","SUP","HCPCS C1713","","281.520  -  PLATE BN 135D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.53","SUP","HCPCS C1713","","281.530  -  PLATE BONE 135D SHORT BARREL 62MM 25MM 3 HOLE COMPRESSION","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.54","SUP","HCPCS C1713","","281.540  -  PLATE BN 135D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.55","SUP","HCPCS C1713","","281.550  -  PLATE BONE 135D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.56","SUP","HCPCS C1713","","281.560  -  PLATE BONE 135D SHORT BARREL 110MM 6 HOLE DHS STAINLESS","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.62","SUP","HCPCS C1713","","281.620  -  PLATE BN 140D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.63","SUP","HCPCS C1713","","281.630  -  PLATE BONE 140D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.64","SUP","HCPCS C1713","","281.640  -  PLATE BONE 140D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.65","SUP","HCPCS C1713","","281.650  -  PLATE BONE 140D SHORT BARREL 94MM 25MM 5 HOLE DHS STAINLESS","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.66","SUP","HCPCS C1713","","281.660  -  PLATE BONE 140D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.72","SUP","HCPCS C1713","","281.720  -  PLATE BN 145D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.73","SUP","HCPCS C1713","","281.730  -  PLATE BONE 145D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.74","SUP","HCPCS C1713","","281.740  -  PLATE BONE 145D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.75","SUP","HCPCS C1713","","281.750  -  PLATE BONE 145D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.76","SUP","HCPCS C1713","","281.760  -  PLATE BONE 145D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.82","SUP","HCPCS C1713","","281.820  -  PLATE BONE 150D 2 FLAT LP SHORT BARREL 12.6MM 46X19X5.8MM 25","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.83","SUP","HCPCS C1713","","281.830  -  PLATE BONE 150D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.84","SUP","HCPCS C1713","","281.840  -  PLATE BN 150D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.85","SUP","HCPCS C1713","","281.850  -  PLATE BONE 150D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.86","SUP","HCPCS C1713","","281.860  -  PLATE BN 150D SHRT BRL 12.6MM 110X19X5.8MM NS 25MM DHS DCP 6","BOTH IP/OP","$974.43 ","$721.08 ","$0.00 ","$974.43 ","$438.49 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.43 ","$0.00 ","$487.21 ","$771.75 ","$779.54 ","$0.00 ","$148.06 ","$0.00 ","$155.13 ","$0.00 "
"281.869","SUP","HCPCS C1713","","281.869  -  PLATE BN SHRT 138MM NS SS DHS TROCH STAB","BOTH IP/OP","$1,073.95 ","$794.72 ","$0.00 ","$1,042.68 ","$469.20 ","$0.00 ","$223.84 ","$0.00 ","$0.00 ","$182.56 ","$1,042.68 ","$0.00 ","$521.34 ","$825.80 ","$834.14 ","$0.00 ","$158.42 ","$0.00 ","$165.99 ","$0.00 "
"281.87","SUP","HCPCS C1713","","281.870  -  PLATE BN LNG 148MM NS SS DHS TROCH STAB","BOTH IP/OP","$1,042.68 ","$771.58 ","$0.00 ","$1,042.68 ","$469.20 ","$0.00 ","$217.32 ","$0.00 ","$0.00 ","$182.56 ","$1,042.68 ","$0.00 ","$521.34 ","$825.80 ","$834.14 ","$0.00 ","$158.42 ","$0.00 ","$165.99 ","$0.00 "
"281.9","SUP","HCPCS C1713","","281.900  -  PLATE BN 95D SHRT BRL 12.6MM 178X16X5.4MM NS 25MM DCS DCP 10","BOTH IP/OP","$1,685.48 ","$1,247.26 ","$0.00 ","$1,685.48 ","$758.46 ","$0.00 ","$351.30 ","$0.00 ","$0.00 ","$295.11 ","$1,685.48 ","$0.00 ","$842.74 ","$1,334.90 ","$1,348.38 ","$0.00 ","$256.09 ","$0.00 ","$268.33 ","$0.00 "
"281.925","SUP","HCPCS C1713","","281.925  -  PLATE BN 95D SHRT BRL 210MM NS 25MM DCS 12 HL SS CNDRL 4.5MM","BOTH IP/OP","$1,962.35 ","$1,452.14 ","$0.00 ","$1,905.20 ","$857.34 ","$0.00 ","$409.00 ","$0.00 ","$0.00 ","$333.59 ","$1,905.20 ","$0.00 ","$952.60 ","$1,508.92 ","$1,524.16 ","$0.00 ","$289.48 ","$0.00 ","$303.31 ","$0.00 "
"281.93","SUP","HCPCS C1713","","281.930  -  PLATE BN 95D SHRT BRL 12.6MM 242X16X5.4MM NS 25MM DCS DCP 14","BOTH IP/OP","$1,905.20 ","$1,409.85 ","$0.00 ","$1,905.20 ","$857.34 ","$0.00 ","$397.09 ","$0.00 ","$0.00 ","$333.59 ","$1,905.20 ","$0.00 ","$952.60 ","$1,508.92 ","$1,524.16 ","$0.00 ","$289.48 ","$0.00 ","$303.31 ","$0.00 "
"281.94","SUP","HCPCS C1713","","281.940  -  PLATE BN 95D SHRT BRL 12.6MM 274X16X5.4MM NS 25MM DCS DCP 16","BOTH IP/OP","$2,030.75 ","$1,502.76 ","$0.00 ","$2,030.75 ","$913.84 ","$0.00 ","$423.26 ","$0.00 ","$0.00 ","$355.57 ","$2,030.75 ","$0.00 ","$1,015.38 ","$1,608.35 ","$1,624.60 ","$0.00 ","$308.56 ","$0.00 ","$323.30 ","$0.00 "
"281.95","SUP","HCPCS C1713","","281.950  -  PLATE BONE 95D 306MM 25MM 18 HOLE DCS STAINLESS STEEL","BOTH IP/OP","$2,590.30 ","$1,916.82 ","$0.00 ","$2,590.30 ","$1,165.64 ","$0.00 ","$539.88 ","$0.00 ","$0.00 ","$453.54 ","$2,590.30 ","$0.00 ","$1,295.15 ","$2,051.52 ","$2,072.24 ","$0.00 ","$393.57 ","$0.00 ","$412.38 ","$0.00 "
"281.96","SUP","HCPCS C1713","","281.960  -  PLATE BN 95D SHRT BRL 12.6MM 114X16X5.4MM NS 25MM DCS DCP 6","BOTH IP/OP","$1,685.48 ","$1,247.26 ","$0.00 ","$1,685.48 ","$758.46 ","$0.00 ","$351.30 ","$0.00 ","$0.00 ","$295.11 ","$1,685.48 ","$0.00 ","$842.74 ","$1,334.90 ","$1,348.38 ","$0.00 ","$256.09 ","$0.00 ","$268.33 ","$0.00 "
"281.97","SUP","HCPCS C1713","","281.970  -  PLATE BONE 95D 338MM 25MM 20 HOLE DCS DCP STAINLESS STEEL","BOTH IP/OP","$2,676.28 ","$1,980.45 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$557.80 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"281.98","SUP","HCPCS C1713","","281.980  -  PLATE BN 95D SHRT BRL 12.6MM 146X16X5.4MM NS 25MM DCS DCP 8","BOTH IP/OP","$1,685.48 ","$1,247.26 ","$0.00 ","$1,685.48 ","$758.46 ","$0.00 ","$351.30 ","$0.00 ","$0.00 ","$295.11 ","$1,685.48 ","$0.00 ","$842.74 ","$1,334.90 ","$1,348.38 ","$0.00 ","$256.09 ","$0.00 ","$268.33 ","$0.00 "
"281.99","SUP","HCPCS C1713","","281.990  -  PLATE BONE 95D BARREL 370MM 22 HOLE DCS STAINLESS STEEL","BOTH IP/OP","$2,795.00 ","$2,068.30 ","$0.00 ","$2,795.00 ","$1,257.75 ","$0.00 ","$582.55 ","$0.00 ","$0.00 ","$489.38 ","$2,795.00 ","$0.00 ","$1,397.50 ","$2,213.64 ","$2,236.00 ","$0.00 ","$424.68 ","$0.00 ","$444.96 ","$0.00 "
"282.235","SUP","HCPCS C1713","","282.235  -  BLADE IM NAIL 80MM LCP DHHS HIP SS CMPR PLT NONSTRL","BOTH IP/OP","$687.60 ","$508.82 ","$0.00 ","$687.60 ","$309.42 ","$0.00 ","$143.31 ","$0.00 ","$0.00 ","$120.39 ","$687.60 ","$0.00 ","$343.80 ","$544.58 ","$550.08 ","$0.00 ","$107.61 ","$0.00 ","$109.47 ","$0.00 "
"282.236","SUP","HCPCS C1713","","282.236  -  BLADE IM NAIL 85MM LCP DHHS HIP SS CMPR PLT NONSTRL","BOTH IP/OP","$687.60 ","$508.82 ","$0.00 ","$687.60 ","$309.42 ","$0.00 ","$143.31 ","$0.00 ","$0.00 ","$120.39 ","$687.60 ","$0.00 ","$343.80 ","$544.58 ","$550.08 ","$0.00 ","$107.61 ","$0.00 ","$109.47 ","$0.00 "
"282.24","SUP","HCPCS C1713","","282.240  -  BLADE 105MM HLX LCP DHHS SS ORTH SURG NONSTRL","BOTH IP/OP","$741.88 ","$548.99 ","$0.00 ","$741.88 ","$333.84 ","$0.00 ","$154.63 ","$0.00 ","$0.00 ","$129.90 ","$741.88 ","$0.00 ","$370.94 ","$587.57 ","$593.50 ","$0.00 ","$116.10 ","$0.00 ","$118.11 ","$0.00 "
"282.241","SUP","HCPCS C1713","","282.241  -  BLADE FIX 110MM LCP DHHS SS HLCL STRL","BOTH IP/OP","$741.88 ","$548.99 ","$0.00 ","$741.88 ","$333.84 ","$0.00 ","$154.63 ","$0.00 ","$0.00 ","$129.90 ","$741.88 ","$0.00 ","$370.94 ","$587.57 ","$593.50 ","$0.00 ","$116.10 ","$0.00 ","$118.11 ","$0.00 "
"282.242","SUP","HCPCS C1713","","282.242  -  BLADE FIX 115MM LCP DHHS SS HLCL STRL","BOTH IP/OP","$741.88 ","$548.99 ","$0.00 ","$741.88 ","$333.84 ","$0.00 ","$154.63 ","$0.00 ","$0.00 ","$129.90 ","$741.88 ","$0.00 ","$370.94 ","$587.57 ","$593.50 ","$0.00 ","$116.10 ","$0.00 ","$118.11 ","$0.00 "
"282.5","SUP","HCPCS C1713","","282.50  -  PLATE 95D 92 MMX 50MM SS 5 HOLE DCP BONE SM ADLT/YTH 50MM","BOTH IP/OP","$934.85 ","$691.79 ","$0.00 ","$934.85 ","$420.68 ","$0.00 ","$194.85 ","$0.00 ","$0.00 ","$163.68 ","$934.85 ","$0.00 ","$467.43 ","$740.40 ","$747.88 ","$0.00 ","$142.04 ","$0.00 ","$148.83 ","$0.00 "
"282.52","SUP","HCPCS C1713","","282.52  -  PLATE BONE 95D SMALL STATURE 92MM 60MM 5 HOLE DCP STAINLESS","BOTH IP/OP","$962.90 ","$712.55 ","$0.00 ","$934.85 ","$420.68 ","$0.00 ","$200.69 ","$0.00 ","$0.00 ","$163.68 ","$934.85 ","$0.00 ","$467.43 ","$740.40 ","$747.88 ","$0.00 ","$142.04 ","$0.00 ","$148.83 ","$0.00 "
"282.54","SUP","HCPCS C1713","","282.54  -  PLATE BONE 95D SMALL STATURE 92MM 70MM 5 HOLE DCP LC-DCP","BOTH IP/OP","$962.90 ","$712.55 ","$0.00 ","$934.85 ","$420.68 ","$0.00 ","$200.69 ","$0.00 ","$0.00 ","$163.68 ","$934.85 ","$0.00 ","$467.43 ","$740.40 ","$747.88 ","$0.00 ","$142.04 ","$0.00 ","$148.83 ","$0.00 "
"282.58","SUP","HCPCS C1713","","282.58  -  PLATE BONE 95D SMALL STATURE 40MM 92MM 5 HOLE DCP STAINLESS","BOTH IP/OP","$962.90 ","$712.55 ","$0.00 ","$934.85 ","$420.68 ","$0.00 ","$200.69 ","$0.00 ","$0.00 ","$163.68 ","$934.85 ","$0.00 ","$467.43 ","$740.40 ","$747.88 ","$0.00 ","$142.04 ","$0.00 ","$148.83 ","$0.00 "
"282.6","SUP","HCPCS C1713","","282.600  -  SIDEPLATE BONE 130D STANDARD BARREL 54MM 38MM 2 HOLE LCP","BOTH IP/OP","$1,056.33 ","$781.68 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$220.16 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.601","SUP","HCPCS C1713","","282.601  -  SIDEPLATE BONE 130D STANDARD BARREL 72MM 38MM 3 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.602","SUP","HCPCS C1713","","282.602  -  SIDEPLATE BONE 130D STANDARD BARREL 90MM 4 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.603","SUP","HCPCS C1713","","282.603  -  SIDEPLATE BONE 130D STANDARD BARREL 108MM 5 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.604","SUP","HCPCS C1713","","282.604  -  SIDEPLATE BONE 130D STANDARD BARREL 126MM 38MM 6 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.61","SUP","HCPCS C1713","","282.610  -  SIDEPLATE BONE 135D STANDARD BARREL 54MM 38MM 2 HOLE LCP","BOTH IP/OP","$1,056.33 ","$781.68 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$220.16 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.611","SUP","HCPCS C1713","","282.611  -  SIDEPLATE BONE 135D STANDARD BARREL 72MM 38MM 3 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.612","SUP","HCPCS C1713","","282.612  -  SIDEPLATE BONE 135D STANDARD BARREL 90MM 38MM 4 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.613","SUP","HCPCS C1713","","282.613  -  SIDEPLATE BONE 135D STANDARD BARREL 108MM 38MM 5 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.614","SUP","HCPCS C1713","","282.614  -  SIDEPLATE BONE 135D STANDARD BARREL 126MM 38MM 6 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.63","SUP","HCPCS C1713","","282.630  -  SIDEPLATE BONE 140D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP","BOTH IP/OP","$1,056.33 ","$781.68 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$220.16 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.631","SUP","HCPCS C1713","","282.631  -  SIDEPLATE BONE 140D STANDARD BARREL 72MM 38MM 3 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.632","SUP","HCPCS C1713","","282.632  -  SIDEPLATE BONE 140D STANDARD BARREL 90MM 38MM 4 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.633","SUP","HCPCS C1713","","282.633  -  SIDEPLATE BONE 140D STANDARD BARREL 108MM 38MM 5 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.634","SUP","HCPCS C1713","","282.634  -  SIDEPLATE BONE 140D STANDARD BARREL 126MM 38MM 6 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.64","SUP","HCPCS C1713","","282.640  -  SIDEPLATE BONE 145D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP","BOTH IP/OP","$1,056.33 ","$781.68 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$220.16 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.641","SUP","HCPCS C1713","","282.641  -  SIDEPLATE BONE 145D STANDARD BARREL 72MM 38MM 3 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.642","SUP","HCPCS C1713","","282.642  -  SIDEPLATE BONE 145D STANDARD BARREL 90MM 38MM 4 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.643","SUP","HCPCS C1713","","282.643  -  SIDEPLATE BONE 145D STANDARD BARREL 108MM 38MM 5 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.644","SUP","HCPCS C1713","","282.644  -  SIDEPLATE BONE 145D STANDARD BARREL 126MM 38MM 6 HOLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.65","SUP","HCPCS C1713","","282.650  -  SIDEPLATE BONE 150D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP","BOTH IP/OP","$1,056.33 ","$781.68 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$220.16 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.651","SUP","HCPCS C1713","","282.651  -  SIDEPLATE BONE 150D STANDARD BARREL 72MM 38MM 3 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.652","SUP","HCPCS C1713","","282.652  -  SIDEPLATE BONE 150D STANDARD BARREL 90MM 38MM 4 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.653","SUP","HCPCS C1713","","282.653  -  SIDEPLATE BONE 150D STANDARD BARREL 108MM 38MM 5 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.654","SUP","HCPCS C1713","","282.654  -  SIDEPLATE BONE 150D STANDARD BARREL 126MM 38MM 6 HOLE LCP","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.67","SUP","HCPCS C1713","","282.670  -  SIDEPLATE BONE 130D SHORT BARREL LP 54MM 25MM 2 HOLE LCP","BOTH IP/OP","$1,056.33 ","$781.68 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$220.16 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.672","SUP","HCPCS C1713","","282.672  -  SIDEPLATE BONE 130D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.676","SUP","HCPCS C1713","","282.676  -  SIDEPLATE BONE 135D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.678","SUP","HCPCS C1713","","282.678  -  SIDEPLATE BONE 135D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.683","SUP","HCPCS C1713","","282.683  -  SIDEPLATE BONE 140D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.688","SUP","HCPCS C1713","","282.688  -  SIDEPLATE BONE 145D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.691","SUP","HCPCS C1713","","282.691  -  SIDEPLATE BONE 150D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.693","SUP","HCPCS C1713","","282.693  -  SIDEPLATE BONE 150D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,056.33 ","$475.35 ","$0.00 ","$226.77 ","$0.00 ","$0.00 ","$184.95 ","$1,056.33 ","$0.00 ","$528.16 ","$836.61 ","$845.06 ","$0.00 ","$160.50 ","$0.00 ","$168.17 ","$0.00 "
"282.7","SUP","HCPCS C1713","","282.70  -  PLATE BONE 95D SMALL STATURE T PROFILE 124MM 50MM 7 HOLE DCP","BOTH IP/OP","$978.53 ","$724.11 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$203.95 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"282.72","SUP","HCPCS C1713","","282.72  -  PLATE BONE 95D SMALL STATURE 124MM 60MM 7 HOLE ANGLED DCP","BOTH IP/OP","$1,007.88 ","$745.83 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$210.07 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"282.74","SUP","HCPCS C1713","","282.74  -  PLATE BONE 95D SMALL STATURE 124MM 70MM 7 HOLE CNDYLR DCP","BOTH IP/OP","$1,007.88 ","$745.83 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$210.07 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"282.78","SUP","HCPCS C1713","","282.78  -  PLATE BONE 95D SMALL STATURE 124MM 40MM 7 HOLE DCP CAPOS","BOTH IP/OP","$1,007.88 ","$745.83 ","$0.00 ","$978.53 ","$440.34 ","$0.00 ","$210.07 ","$0.00 ","$0.00 ","$171.33 ","$978.53 ","$0.00 ","$489.26 ","$775.00 ","$782.82 ","$0.00 ","$148.68 ","$0.00 ","$155.78 ","$0.00 "
"282.8","SUP","Custom 27803010","","282.80  -  STAPLE BONE 23X20X3MM STAINLESS STEEL NONSTRL","BOTH IP/OP","$251.75 ","$186.30 ","$0.00 ","$251.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.75 ","$0.00 ","$125.88 ","$199.39 ","$201.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.82","SUP","Custom 27803010","","282.82  -  STAPLE BONE 24MM STAINLESS STEEL ORTHOPEDIC NONSTRL","BOTH IP/OP","$251.75 ","$186.30 ","$0.00 ","$251.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.75 ","$0.00 ","$125.88 ","$199.39 ","$201.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.9","SUP","HCPCS C1713","","282.90  -  PLATE BONE 95D SMALL STATURE T PROFILE 156MM 50MM 9 HOLE DCP","BOTH IP/OP","$1,046.78 ","$774.62 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$218.17 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"282.92","SUP","HCPCS C1713","","282.92  -  PLATE BONE 95D SMALL STATURE 156MM 60MM 9 HOLE ANGLED BLADE","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"282.94","SUP","HCPCS C1713","","282.94  -  PLATE BONE 95D SMALL STATURE 156MM 70MM 9 HOLE DCP STAINLESS","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"282.98","SUP","HCPCS C1713","","282.98  -  PLATE BONE 95D SMALL STATURE 156X40MM 40MM 9 HOLE CNDYLR DCP","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"283.4","SUP","HCPCS C1713","","283.40  -  PLATE BONE 130D SMALL STATURE 50MM 60MM 4 HOLE ANGLED BLADE","BOTH IP/OP","$937.58 ","$693.81 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$195.41 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"283.42","SUP","HCPCS C1713","","283.42  -  PLATE BONE 130D SMALL STATURE 60MM 4 HOLE ANGLED BLADE DCP","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"283.44","SUP","HCPCS C1713","","283.44  -  PLATE BONE 130D SMALL STATURE 70MM 60MM ANGLED BLADE DCP","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"283.46","SUP","HCPCS C1713","","283.46  -  PLATE BONE 130D SMALL STATURE 80MM 60MM 4 HOLE ANGLED BLADE","BOTH IP/OP","$965.70 ","$714.62 ","$0.00 ","$937.58 ","$421.91 ","$0.00 ","$201.28 ","$0.00 ","$0.00 ","$164.16 ","$937.58 ","$0.00 ","$468.79 ","$742.56 ","$750.06 ","$0.00 ","$142.46 ","$0.00 ","$149.26 ","$0.00 "
"283.6","SUP","HCPCS C1713","","283.60  -  PLATE BONE 130D 104MM 50MM 6 HOLE ANGLED BLADE DCP STAINLESS","BOTH IP/OP","$993.55 ","$735.23 ","$0.00 ","$993.55 ","$447.10 ","$0.00 ","$207.08 ","$0.00 ","$0.00 ","$173.96 ","$993.55 ","$0.00 ","$496.78 ","$786.89 ","$794.84 ","$0.00 ","$150.96 ","$0.00 ","$158.17 ","$0.00 "
"283.62","SUP","HCPCS C1713","","283.62  -  PLATE BONE 130D 104MM 60MM 6 HOLE ANGLED BLADE DCP STAINLESS","BOTH IP/OP","$1,023.35 ","$757.28 ","$0.00 ","$993.55 ","$447.10 ","$0.00 ","$213.29 ","$0.00 ","$0.00 ","$173.96 ","$993.55 ","$0.00 ","$496.78 ","$786.89 ","$794.84 ","$0.00 ","$150.96 ","$0.00 ","$158.17 ","$0.00 "
"283.64","SUP","HCPCS C1713","","283.64  -  PLATE BLADE 130D 104MM 70MM 6 HOLE ANGLED DCP STAINLESS","BOTH IP/OP","$1,023.35 ","$757.28 ","$0.00 ","$993.55 ","$447.10 ","$0.00 ","$213.29 ","$0.00 ","$0.00 ","$173.96 ","$993.55 ","$0.00 ","$496.78 ","$786.89 ","$794.84 ","$0.00 ","$150.96 ","$0.00 ","$158.17 ","$0.00 "
"283.66","SUP","HCPCS C1713","","283.66  -  SCREW BONE 130D 104MM 80MM 6 HOLE ANGLED BLADE DCP STAINLESS","BOTH IP/OP","$1,023.35 ","$757.28 ","$0.00 ","$993.55 ","$447.10 ","$0.00 ","$213.29 ","$0.00 ","$0.00 ","$173.96 ","$993.55 ","$0.00 ","$496.78 ","$786.89 ","$794.84 ","$0.00 ","$150.96 ","$0.00 ","$158.17 ","$0.00 "
"283.9","SUP","HCPCS C1713","","283.90  -  PLATE BONE 130D SMALL STATURE 152MM 50MM 9 HOLE DCP CAPOS","BOTH IP/OP","$1,072.70 ","$793.80 ","$0.00 ","$1,072.70 ","$482.72 ","$0.00 ","$223.58 ","$0.00 ","$0.00 ","$187.82 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$162.99 ","$0.00 ","$170.77 ","$0.00 "
"283.92","SUP","HCPCS C1713","","283.92  -  PLATE BONE 130D 4.5MM 152MM 60MM 9 HOLE BLADE ANGLED DCP","BOTH IP/OP","$1,104.88 ","$817.61 ","$0.00 ","$1,072.70 ","$482.72 ","$0.00 ","$230.28 ","$0.00 ","$0.00 ","$187.82 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$162.99 ","$0.00 ","$170.77 ","$0.00 "
"283.94","SUP","HCPCS C1713","","283.94  -  PLATE BONE 130D 152MM 70MM 9 HOLE BLADE DCP STAINLESS STEEL","BOTH IP/OP","$1,104.88 ","$817.61 ","$0.00 ","$1,072.70 ","$482.72 ","$0.00 ","$230.28 ","$0.00 ","$0.00 ","$187.82 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$162.99 ","$0.00 ","$170.77 ","$0.00 "
"283.96","SUP","HCPCS C1713","","283.96  -  PLATE BONE 130D 80MM 152MM 80MM 9 HOLE ANGLED BLADE DCP","BOTH IP/OP","$1,104.88 ","$817.61 ","$0.00 ","$1,072.70 ","$482.72 ","$0.00 ","$230.28 ","$0.00 ","$0.00 ","$187.82 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$162.99 ","$0.00 ","$170.77 ","$0.00 "
"288.025","SUP","Custom 27803010","","288.025  -  DISTRACTOR SURG 10MM BODY STAINLESS STEEL NONSTRL","BOTH IP/OP","$11,697.50 ","$8,656.15 ","$0.00 ","$11,697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,697.50 ","$0.00 ","$5,848.75 ","$9,264.42 ","$9,358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.026","SUP","Custom 27803010","","288.026  -  DISTRACTOR SURG 15MM BODY STAINLESS STEEL NONSTRL","BOTH IP/OP","$11,697.50 ","$8,656.15 ","$0.00 ","$11,697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,697.50 ","$0.00 ","$5,848.75 ","$9,264.42 ","$9,358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.027","SUP","Custom 27803010","","288.027  -  DISTRACTOR SURG 20MM BODY STAINLESS STEEL NONSTRL","BOTH IP/OP","$11,697.50 ","$8,656.15 ","$0.00 ","$11,697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,697.50 ","$0.00 ","$5,848.75 ","$9,264.42 ","$9,358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.028","SUP","Custom 27803010","","288.028  -  DISTRACTOR SURG 25MM BODY STAINLESS STEEL NONSTRL","BOTH IP/OP","$11,697.50 ","$8,656.15 ","$0.00 ","$11,697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,697.50 ","$0.00 ","$5,848.75 ","$9,264.42 ","$9,358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.038","SUP","Custom 27803010","","288.038  -  FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL RIGHT ANTERIOR","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.039","SUP","Custom 27803010","","288.039  -  FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL RIGHT ANTERIOR","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.04","SUP","Custom 27803010","","288.040  -  FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL RIGHT ANTERIOR","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.042","SUP","Custom 27803010","","288.042  -  FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL LEFT ANTERIOR MAXL","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.043","SUP","Custom 27803010","","288.043  -  FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL LEFT ANTERIOR","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.044","SUP","Custom 27803010","","288.044  -  FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL LEFT ANTERIOR","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.052","SUP","Custom 27803010","","288.052  -  FOOTPLATE BONE SHORT 7MM OFFST STAINLESS STEEL POSTERIOR","BOTH IP/OP","$2,952.50 ","$2,184.85 ","$0.00 ","$2,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,952.50 ","$0.00 ","$1,476.25 ","$2,338.38 ","$2,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.053","SUP","Custom 27803010","","288.053  -  FOOTPLATE BONE SHORT 12MM OFFST STAINLESS STEEL POSTERIOR","BOTH IP/OP","$2,952.50 ","$2,184.85 ","$0.00 ","$2,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,952.50 ","$0.00 ","$1,476.25 ","$2,338.38 ","$2,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.055","SUP","Custom 27803010","","288.055  -  FOOTPLATE BONE MEDIUM 7MM OFFST STAINLESS STEEL POSTERIOR","BOTH IP/OP","$2,952.50 ","$2,184.85 ","$0.00 ","$2,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,952.50 ","$0.00 ","$1,476.25 ","$2,338.38 ","$2,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.056","SUP","Custom 27803010","","288.056  -  FOOTPLATE BONE MEDIUM 12MM OFFST STAINLESS STEEL POSTERIOR","BOTH IP/OP","$2,952.50 ","$2,184.85 ","$0.00 ","$2,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,952.50 ","$0.00 ","$1,476.25 ","$2,338.38 ","$2,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.058","SUP","Custom 27803010","","288.058  -  FOOTPLATE BONE TALL 7MM OFFST STAINLESS STEEL POSTERIOR MAXL","BOTH IP/OP","$2,952.50 ","$2,184.85 ","$0.00 ","$2,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,952.50 ","$0.00 ","$1,476.25 ","$2,338.38 ","$2,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.059","SUP","Custom 27803010","","288.059  -  FOOTPLATE BONE TALL 12MM OFFST STAINLESS STEEL POSTERIOR","BOTH IP/OP","$2,952.50 ","$2,184.85 ","$0.00 ","$2,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,952.50 ","$0.00 ","$1,476.25 ","$2,338.38 ","$2,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288.065","SUP","HCPCS C1713","","288.065  -  SCREW EXTERNAL DISTRCT 3.5MM STAINLESS STEEL NONSTRL","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"291.01","SUP","Custom 27803010","","291.01  -  WIRE CERCLAGE 1MM 280MM EYE KWIRE STAINLESS STEEL NONSTRL","BOTH IP/OP","$15.18 ","$11.23 ","$0.00 ","$14.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.74 ","$0.00 ","$7.37 ","$11.67 ","$11.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.02","SUP","Custom 27203010","","291.02  -  WIRE CERCLAGE 1.25MM 280MM EYE STAINLESS STEEL NONSTRL","BOTH IP/OP","$15.18 ","$11.23 ","$0.00 ","$14.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.74 ","$0.00 ","$7.37 ","$11.67 ","$11.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.03","SUP","Custom 27803010","","291.03  -  WIRE CERCLAGE 1MM 600MM EYE STAINLESS STEEL NONSTRL","BOTH IP/OP","$22.91 ","$16.95 ","$0.00 ","$22.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.25 ","$0.00 ","$11.12 ","$17.62 ","$17.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.04","SUP","Custom 27203010","","291.04  -  WIRE FIX 1.25MM 600MM CERCLAGE EYE STAINLESS STEEL","BOTH IP/OP","$22.91 ","$16.95 ","$0.00 ","$22.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.25 ","$0.00 ","$11.12 ","$17.62 ","$17.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.05","SUP","Custom 27203010","","291.05  -  WIRE CERCLAGE 1MM 10MR COIL STAINLESS STEEL NONSTRL","BOTH IP/OP","$128.60 ","$95.16 ","$0.00 ","$124.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.85 ","$0.00 ","$62.43 ","$98.88 ","$99.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.06","SUP","Custom 27803010","","291.06  -  WIRE CERCLAGE 1.25MM 1MM COIL STAINLESS STEEL NONSTRL","BOTH IP/OP","$128.60 ","$95.16 ","$0.00 ","$124.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.85 ","$0.00 ","$62.43 ","$98.88 ","$99.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.08","SUP","Custom 27803010","","291.08  -  WIRE CERCLAGE .8MM 280MM EYE STAINLESS STEEL NONSTRL","BOTH IP/OP","$10.61 ","$7.85 ","$0.00 ","$10.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.30 ","$0.00 ","$5.15 ","$8.16 ","$8.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.09","SUP","Custom 27203010","","291.09  -  WIRE CERCLAGE .8MM 10MR COIL STAINLESS STEEL NONSTRL","BOTH IP/OP","$128.60 ","$95.16 ","$0.00 ","$124.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.85 ","$0.00 ","$62.43 ","$98.88 ","$99.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.11","SUP","Custom 27803010","","291.11  -  WIRE CERCLAGE 1.5MM 280MM EYE STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$15.18 ","$11.23 ","$0.00 ","$14.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.74 ","$0.00 ","$7.37 ","$11.67 ","$11.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.12","SUP","Custom 27203010","","291.12  -  WIRE CERCLAGE 1.5MM 600MM EYE STAINLESS STEEL NONSTRL","BOTH IP/OP","$22.91 ","$16.95 ","$0.00 ","$22.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.25 ","$0.00 ","$11.12 ","$17.62 ","$17.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.13","SUP","Custom 27203010","","291.13  -  WIRE CERCLAGE 1.5MM 10MM COIL STAINLESS STEEL NONSTRL","BOTH IP/OP","$128.60 ","$95.16 ","$0.00 ","$124.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.85 ","$0.00 ","$62.43 ","$98.88 ","$99.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.22","SUP","Custom 27203010","","291.22  -  WIRE FX .4MM 150MM NS CRLGE SFT PCUT SS","BOTH IP/OP","$14.34 ","$10.61 ","$0.00 ","$13.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.92 ","$0.00 ","$6.96 ","$11.02 ","$11.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.24","SUP","Custom 27203010","","291.24  -  WIRE CERCLAGE .6MM 175MM SOFT PRECUT STAINLESS STEEL NONSTRL","BOTH IP/OP","$15.18 ","$11.23 ","$0.00 ","$14.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.74 ","$0.00 ","$7.37 ","$11.67 ","$11.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.26","SUP","Custom 27203010","","291.26  -  WIRE CERCLAGE .8MM 200MM SOFT PRECUT STAINLESS STEEL NONSTRL","BOTH IP/OP","$17.29 ","$12.79 ","$0.00 ","$16.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.79 ","$0.00 ","$8.39 ","$13.30 ","$13.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.27","SUP","Custom 27203010","","291.27  -  WIRE CRLGE 1MM 250MM NS PCUT SFT SS","BOTH IP/OP","$18.84 ","$13.94 ","$0.00 ","$18.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.29 ","$0.00 ","$9.14 ","$14.49 ","$14.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.28","SUP","Custom 27203010","","291.28  -  WIRE CRLGE 1.25MM 300MM NS PCUT SFT SS","BOTH IP/OP","$21.51 ","$15.92 ","$0.00 ","$20.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.88 ","$0.00 ","$10.44 ","$16.54 ","$16.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.02","SUP","HCPCS C1713","","292.020  -  GWIRE ORTH 200MM 1.25MM","BOTH IP/OP","$24.68 ","$18.26 ","$0.00 ","$24.68 ","$11.10 ","$0.00 ","$5.14 ","$0.00 ","$0.00 ","$4.32 ","$24.68 ","$0.00 ","$12.34 ","$19.55 ","$19.74 ","$0.00 ","$3.86 ","$0.00 ","$3.93 ","$0.00 "
"292.06","SUP","Custom 27203010","","292.06  -  WIRE FIX .6MM 70MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$14.34 ","$10.61 ","$0.00 ","$13.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.92 ","$0.00 ","$6.96 ","$11.02 ","$11.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.08","SUP","Custom 27203010","","292.08  -  WIRE FIX .8MM 70MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$14.34 ","$10.61 ","$0.00 ","$13.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.92 ","$0.00 ","$6.96 ","$11.02 ","$11.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.1","SUP","Custom 27203010","","292.10  -  WIRE FIX 1MM 150MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$15.64 ","$11.57 ","$0.00 ","$15.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.64 ","$0.00 ","$7.82 ","$12.39 ","$12.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.11","SUP","Custom 27203010","","292.11  -  WIRE FIX 1MM 285MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$20.66 ","$15.29 ","$0.00 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.06 ","$0.00 ","$10.03 ","$15.89 ","$16.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.13","SUP","Custom 27203010","","292.13  -  WIRE FX 1.25MM 285MM NS KRSH TROC PNT SS","BOTH IP/OP","$20.66 ","$15.29 ","$0.00 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.06 ","$0.00 ","$10.03 ","$15.89 ","$16.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.18","SUP","Custom 27203010","","292.18  -  WIRE FIX 1.6MM 285MM 5MM THREADED TROCAR POINT KWIRE","BOTH IP/OP","$20.66 ","$15.29 ","$0.00 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.06 ","$0.00 ","$10.03 ","$15.89 ","$16.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.21","SUP","Custom 27203010","","292.21  -  WIRE FIX 2MM 285MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$23.30 ","$17.24 ","$0.00 ","$23.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.30 ","$0.00 ","$11.65 ","$18.45 ","$18.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.25","SUP","Custom 27203010","","292.25  -  WIRE FIX 2.5MM 150MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$16.59 ","$12.28 ","$0.00 ","$16.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.11 ","$0.00 ","$8.05 ","$12.76 ","$12.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.26","SUP","Custom 27203010","","292.26  -  WIRE FIX 2.5MM 285MM TROCAR KWIRE STAINLESS STEEL NONSTRL","BOTH IP/OP","$20.66 ","$15.29 ","$0.00 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.06 ","$0.00 ","$10.03 ","$15.89 ","$16.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.3","SUP","Custom 27203010","","292.30  -  WIRE FIX TROCAR 3MM 150MM KWIRE STAINLESS STEEL NONSTRL","BOTH IP/OP","$16.11 ","$11.92 ","$0.00 ","$16.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.11 ","$0.00 ","$8.05 ","$12.76 ","$12.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.31","SUP","Custom 27203010","","292.31  -  WIRE FIX 3MM 285MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$20.66 ","$15.29 ","$0.00 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.06 ","$0.00 ","$10.03 ","$15.89 ","$16.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.38","SUP","Custom 27203010","","292.38  -  WIRE FIX 1.8MM 350MM SPADE POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.39","SUP","Custom 27203010","","292.39  -  WIRE FIX 1.8MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.4","SUP","Custom 27203010","","292.40  -  WIRE FIX 2MM 350MM SPADE POINT KWIRE STAINLESS STEEL NONSTRL","BOTH IP/OP","$115.73 ","$85.64 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.41","SUP","Custom 27203010","","292.41  -  WIRE FIX 2MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.46","SUP","Custom 27203010","","292.46  -  WIRE FX .6MM 70MM NS KRSH 2 END TROC PNT SS","BOTH IP/OP","$17.29 ","$12.79 ","$0.00 ","$16.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.79 ","$0.00 ","$8.39 ","$13.30 ","$13.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.48","SUP","Custom 27203010","","292.48  -  WIRE FX .8MM 70MM NS KRSH 2 END TROC PNT SS","BOTH IP/OP","$17.29 ","$12.79 ","$0.00 ","$16.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.79 ","$0.00 ","$8.39 ","$13.30 ","$13.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.5","SUP","Custom 27203010","","292.50  -  WIRE FIX 1MM 150MM 2 END TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$18.97 ","$14.04 ","$0.00 ","$18.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.97 ","$0.00 ","$9.49 ","$15.02 ","$15.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.52","SUP","Custom 27203010","","292.52  -  WIRE FIX TROCAR 1.25MM 150MM KWIRE STAINLESS STEEL NONSTRL","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$18.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.97 ","$0.00 ","$9.49 ","$15.02 ","$15.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.56","SUP","Custom 27203010","","292.56  -  WIRE FIX TROCAR 1.6MM 150MM 2 END KWIRE STAINLESS STEEL","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$18.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.97 ","$0.00 ","$9.49 ","$15.02 ","$15.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.58","SUP","Custom 27203010","","292.58  -  WIRE FX 2MM 150MM NS KRSH 2 END TROC PNT SS","BOTH IP/OP","$19.54 ","$14.46 ","$0.00 ","$18.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.97 ","$0.00 ","$9.49 ","$15.02 ","$15.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.6","SUP","Custom 27203010","","292.600  -  WIRE FX 1.25MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR","BOTH IP/OP","$81.22 ","$60.10 ","$0.00 ","$81.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.22 ","$0.00 ","$40.61 ","$64.33 ","$64.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.619","SUP","HCPCS C1769","","292.619  -  GUIDEWIRE ORTHOPEDIC .8MM 100MM SPADE POINT STAINLESS STEEL","BOTH IP/OP","$28.26 ","$20.91 ","$0.00 ","$41.68 ","$14.90 ","$0.00 ","$5.89 ","$0.00 ","$0.00 ","$4.80 ","$27.43 ","$0.00 ","$13.72 ","$21.72 ","$21.95 ","$0.00 ","$41.68 ","$0.00 ","$4.37 ","$0.00 "
"292.62","SUP","HCPCS C1769","","292.62  -  GWIRE ORTH 150MM 1.25MM SS THRD","BOTH IP/OP","$59.13 ","$43.76 ","$0.00 ","$59.13 ","$32.10 ","$0.00 ","$12.32 ","$0.00 ","$0.00 ","$10.35 ","$59.13 ","$0.00 ","$29.56 ","$46.83 ","$47.30 ","$0.00 ","$9.25 ","$0.00 ","$9.41 ","$0.00 "
"292.621","SUP","HCPCS C1713","","292.621  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREADED SPADE POINT ON 2","BOTH IP/OP","$53.05 ","$39.26 ","$0.00 ","$51.50 ","$23.18 ","$0.00 ","$11.06 ","$0.00 ","$0.00 ","$9.02 ","$51.50 ","$0.00 ","$25.75 ","$40.79 ","$41.20 ","$0.00 ","$7.83 ","$0.00 ","$8.20 ","$0.00 "
"292.622","SUP","HCPCS C1713","","292.622  -  GUIDEWIRE ORTHOPEDIC 1.1MM 150MM THREAD STAINLESS STEEL","BOTH IP/OP","$55.50 ","$41.07 ","$0.00 ","$53.90 ","$24.26 ","$0.00 ","$11.57 ","$0.00 ","$0.00 ","$9.44 ","$53.90 ","$0.00 ","$26.95 ","$42.69 ","$43.12 ","$0.00 ","$8.19 ","$0.00 ","$8.58 ","$0.00 "
"292.623","SUP","HCPCS C1713","","292.623  -  GUIDEWIRE ORTHOPEDIC 1.1MM 150MM NONTHREADED STAINLESS STEEL","BOTH IP/OP","$52.70 ","$39.00 ","$0.00 ","$51.18 ","$23.03 ","$0.00 ","$10.98 ","$0.00 ","$0.00 ","$8.96 ","$51.18 ","$0.00 ","$25.59 ","$40.53 ","$40.94 ","$0.00 ","$7.77 ","$0.00 ","$8.15 ","$0.00 "
"292.626","SUP","HCPCS C1769","","292.626  -  GUIDEWIRE ORTHOPEDIC 150MM 1 END SPADE PONT STAINLESS STEEL","BOTH IP/OP","$62.40 ","$46.18 ","$0.00 ","$62.40 ","$33.88 ","$0.00 ","$13.01 ","$0.00 ","$0.00 ","$10.93 ","$62.40 ","$0.00 ","$31.20 ","$49.42 ","$49.92 ","$0.00 ","$9.77 ","$0.00 ","$9.93 ","$0.00 "
"292.65","SUP","HCPCS C1769","","292.65  -  GUIDEWIRE ORTHOPEDIC SPADE 2MM 230MM THREAD BLACK STAINLESS","BOTH IP/OP","$75.20 ","$55.65 ","$0.00 ","$73.00 ","$39.64 ","$0.00 ","$15.67 ","$0.00 ","$0.00 ","$12.78 ","$73.00 ","$0.00 ","$36.50 ","$57.82 ","$58.40 ","$0.00 ","$11.09 ","$0.00 ","$11.62 ","$0.00 "
"292.651","SUP","HCPCS C1713","","292.651  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"292.652","SUP","HCPCS C1713","","292.652  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT","BOTH IP/OP","$73.78 ","$54.60 ","$0.00 ","$71.63 ","$32.23 ","$0.00 ","$15.38 ","$0.00 ","$0.00 ","$12.54 ","$71.63 ","$0.00 ","$35.81 ","$56.73 ","$57.30 ","$0.00 ","$10.88 ","$0.00 ","$11.40 ","$0.00 "
"292.653","SUP","Custom 27203010","","292.653  -  GUIDEWIRE ORTHOPEDIC 2MM 330MM TROCAR THREAD STAINLESS STEEL","BOTH IP/OP","$111.05 ","$82.18 ","$0.00 ","$107.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.83 ","$0.00 ","$53.91 ","$85.40 ","$86.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.655","SUP","Custom 27203010","","292.655  -  GUIDEWIRE ORTHOPEDIC 1.6MM 410MM","BOTH IP/OP","$101.90 ","$75.41 ","$0.00 ","$98.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.93 ","$0.00 ","$49.46 ","$78.35 ","$79.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.656","SUP","HCPCS C1713","","292.656  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM NONTHREADED STAINLESS STEEL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"292.68","SUP","HCPCS C1713","","292.68  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM TROCAR THREAD STAINLESS","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"292.69","SUP","Custom 27203010","","292.69  -  GUIDEWIRE ORTHOPEDIC 3.2MM 300MM CALIBRATE STAINLESS STEEL","BOTH IP/OP","$231.95 ","$171.64 ","$0.00 ","$225.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.18 ","$0.00 ","$112.59 ","$178.34 ","$180.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.699","SUP","Custom 27203010","","292.699  -  WIRE FX 2MM 280MM NS KRSH THRD SPD PNT TIP SS","BOTH IP/OP","$76.60 ","$56.68 ","$0.00 ","$74.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.38 ","$0.00 ","$37.19 ","$58.91 ","$59.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.708","SUP","Custom 27203010","","292.708  -  WIRE FX 1.6MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR","BOTH IP/OP","$836.60 ","$619.08 ","$0.00 ","$836.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$836.60 ","$0.00 ","$418.30 ","$662.59 ","$669.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.71","SUP","Custom 27203010","","292.71  -  WIRE FIX 1.6MM 15CM 5MM THREADED TROCAR POINT KWIRE","BOTH IP/OP","$294.15 ","$217.67 ","$0.00 ","$294.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$294.15 ","$0.00 ","$147.08 ","$232.97 ","$235.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.72","SUP","HCPCS C1713","","292.72  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREAD STAINLESS STEEL","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$61.43 ","$27.64 ","$0.00 ","$13.18 ","$0.00 ","$0.00 ","$10.76 ","$61.43 ","$0.00 ","$30.71 ","$48.65 ","$49.14 ","$0.00 ","$11.92 ","$0.00 ","$9.78 ","$0.00 "
"292.721","SUP","HCPCS C1713","","292.721  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT","BOTH IP/OP","$73.78 ","$54.60 ","$0.00 ","$71.63 ","$32.23 ","$0.00 ","$15.38 ","$0.00 ","$0.00 ","$12.54 ","$71.63 ","$0.00 ","$35.81 ","$56.73 ","$57.30 ","$0.00 ","$10.88 ","$0.00 ","$11.40 ","$0.00 "
"292.722","SUP","HCPCS C1713","","292.722  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT","BOTH IP/OP","$55.18 ","$40.83 ","$0.00 ","$53.55 ","$24.10 ","$0.00 ","$11.50 ","$0.00 ","$0.00 ","$9.38 ","$53.55 ","$0.00 ","$26.78 ","$42.41 ","$42.84 ","$0.00 ","$8.14 ","$0.00 ","$8.53 ","$0.00 "
"292.727","SUP","HCPCS C1713","","292.727  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM NONTHREADED SPADE POINT","BOTH IP/OP","$53.05 ","$39.26 ","$0.00 ","$51.50 ","$23.18 ","$0.00 ","$11.06 ","$0.00 ","$0.00 ","$9.02 ","$51.50 ","$0.00 ","$25.75 ","$40.79 ","$41.20 ","$0.00 ","$7.83 ","$0.00 ","$8.20 ","$0.00 "
"292.73","SUP","Custom 27203010","","292.73  -  WIRE FX 1.6MM 150MM NS 15MM KRSH TROC PNT THRD SS","BOTH IP/OP","$29.42 ","$21.77 ","$0.00 ","$29.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.42 ","$0.00 ","$14.71 ","$23.30 ","$23.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.75","SUP","Custom 27203010","","292.75  -  WIRE FX 2.5MM 150MM NS 15MM KRSH TROC PNT THRD SS","BOTH IP/OP","$34.30 ","$25.38 ","$0.00 ","$32.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.33 ","$0.00 ","$16.17 ","$25.61 ","$25.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.76","SUP","Custom 27203010","","292.76  -  WIRE FIX 2.5MM 200MM 15MM THREADED TROCAR POINT KWIRE","BOTH IP/OP","$35.57 ","$26.32 ","$0.00 ","$34.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.53 ","$0.00 ","$17.26 ","$27.35 ","$27.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.79","SUP","Custom 27203010","","292.79  -  WIRE FX 2MM 150MM NS 15MM KRSH TROC PNT THRD SS","BOTH IP/OP","$32.19 ","$23.82 ","$0.00 ","$31.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.25 ","$0.00 ","$15.63 ","$24.75 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.801","SUP","Custom 27203010","","292.801  -  WIRE FX 2MM 150MM NS 15MM KRSH CLBRT THRD TROC PNT SS","BOTH IP/OP","$83.25 ","$61.61 ","$0.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292.81","SUP","HCPCS C1713","","292.81  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM 150MM NONTHREADED STAINLESS","BOTH IP/OP","$189.78 ","$140.44 ","$0.00 ","$184.25 ","$82.91 ","$0.00 ","$39.55 ","$0.00 ","$0.00 ","$32.26 ","$184.25 ","$0.00 ","$92.13 ","$145.93 ","$147.40 ","$0.00 ","$27.99 ","$0.00 ","$29.33 ","$0.00 "
"293.35","SUP","Custom 27203010","","293.35  -  PIN FIX 3.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$67.95 ","$50.28 ","$0.00 ","$65.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.98 ","$0.00 ","$32.99 ","$52.26 ","$52.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.36","SUP","Custom 27203010","","293.36  -  PIN FIX 3.5MM 150MM TRACTION STEINMANN STAINLESS STEEL","BOTH IP/OP","$67.95 ","$50.28 ","$0.00 ","$65.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.98 ","$0.00 ","$32.99 ","$52.26 ","$52.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.4","SUP","Custom 27203010","","293.40  -  PIN FIX 4MM 150MM STEINMANN STAINLESS STEEL NONSTRL TRACTION","BOTH IP/OP","$65.98 ","$48.83 ","$0.00 ","$65.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.98 ","$0.00 ","$32.99 ","$52.26 ","$52.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.41","SUP","Custom 27203010","","293.41  -  PIN FIX LARGE 4MM 180MM EXTERNAL IMPLANT TRACTION STEINMANN","BOTH IP/OP","$67.95 ","$50.28 ","$0.00 ","$65.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.98 ","$0.00 ","$32.99 ","$52.26 ","$52.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.42","SUP","Custom 27203010","","293.42  -  PIN FIX 4MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$67.95 ","$50.28 ","$0.00 ","$65.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.98 ","$0.00 ","$32.99 ","$52.26 ","$52.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.44","SUP","Custom 27203010","","293.44  -  PIN FIX 4.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.45","SUP","Custom 27203010","","293.45  -  PIN FIX 4.5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.46","SUP","Custom 27203010","","293.46  -  PIN FIX 4.5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.47","SUP","Custom 27203010","","293.47  -  PIN FIX 4.5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.48","SUP","Custom 27203010","","293.48  -  PIN FIX 4.5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.49","SUP","Custom 27203010","","293.49  -  PIN FIX 4.5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.5","SUP","Custom 27203010","","293.50  -  PIN FIX 5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$122.20 ","$90.43 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.51","SUP","Custom 27203010","","293.51  -  PIN FIX 5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.52","SUP","Custom 27203010","","293.52  -  PIN FIX 5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.53","SUP","Custom 27203010","","293.53  -  PIN FIX 5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.54","SUP","Custom 27203010","","293.54  -  PIN FIX 5MM 300MM STEINMANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.58","SUP","Custom 27203010","","293.58  -  PIN FIX 5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.59","SUP","Custom 27203010","","293.59  -  PIN FIX 5MM 275MM STEINMANN ORTHOPEDIC NONSTRL LARGE EXFIX","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.62","SUP","Custom 27203010","","293.62  -  PIN FIX 4MM 150MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$190.48 ","$140.96 ","$0.00 ","$184.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.93 ","$0.00 ","$92.46 ","$146.46 ","$147.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.63","SUP","Custom 27203010","","293.63  -  PIN FIX 4.5MM 5MM 150MM CENTRL THREAD STEINMANN STAINLESS","BOTH IP/OP","$190.48 ","$140.96 ","$0.00 ","$184.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.93 ","$0.00 ","$92.46 ","$146.46 ","$147.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.67","SUP","Custom 27203010","","293.67  -  PIN FIX 4MM 180MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$190.48 ","$140.96 ","$0.00 ","$184.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.93 ","$0.00 ","$92.46 ","$146.46 ","$147.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.68","SUP","Custom 27203010","","293.68  -  PIN FX CNTR THRD 4.5MM 5MM 180MM NS STNM SS LG XTRNFXTR","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.69","SUP","Custom 27203010","","293.69  -  PIN FIX 5MM 5.5MM 175MM CENTRL THREAD STEINMANN STAINLESS","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.72","SUP","Custom 27203010","","293.72  -  PIN FIX 4MM 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS","BOTH IP/OP","$190.48 ","$140.96 ","$0.00 ","$184.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.93 ","$0.00 ","$92.46 ","$146.46 ","$147.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.73","SUP","Custom 27203010","","293.73  -  PIN FIX 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.74","SUP","Custom 27203010","","293.74  -  PIN FX CNTR THRD 5MM 5.5MM 200MM NS STNM SS LG XTRNFXTR","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.78","SUP","Custom 27203010","","293.78  -  PIN FX CNTR THRD 4.5MM 5MM 225MM NS STNM SS LG XTRNFXTR","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.79","SUP","Custom 27203010","","293.790  -  PIN FIX CENTRL THREAD 5MM 5.5MM 225MM STEINMANN STAINLESS","BOTH IP/OP","$207.65 ","$153.66 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.83","SUP","Custom 27203010","","293.83  -  PIN FIX 4.5MM 250MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.84","SUP","Custom 27203010","","293.840  -  PIN FIX 5MM 5.5MM 250MM 3 FLAT END CENTRL THREAD ROUND","BOTH IP/OP","$207.65 ","$153.66 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.88","SUP","Custom 27203010","","293.88  -  PIN FX CNTR THRD 4.5MM 5MM 275MM NS STNM SS LG XTRNFXTR","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.89","SUP","Custom 27203010","","293.890  -  PIN FIX 5MM 275MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$207.65 ","$153.66 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.93","SUP","Custom 27203010","","293.93  -  PIN FIX 4.5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$213.88 ","$158.27 ","$0.00 ","$207.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.94","SUP","HCPCS C1713","","293.940  -  PIN FIX 5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL","BOTH IP/OP","$207.65 ","$153.66 ","$0.00 ","$207.65 ","$93.44 ","$0.00 ","$43.28 ","$0.00 ","$0.00 ","$36.36 ","$207.65 ","$0.00 ","$103.83 ","$164.46 ","$166.12 ","$0.00 ","$31.55 ","$0.00 ","$33.06 ","$0.00 "
"294.3","SUP","HCPCS C1713","","294.30  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ TROC PNT MR","BOTH IP/OP","$124.38 ","$92.04 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$25.92 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.43","SUP","HCPCS C1713","","294.43  -  SCREW XTRNFX 4MM 60MM NS SCHNZ SPD PNT SS LG XTRNFXTR","BOTH IP/OP","$128.10 ","$94.79 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$26.70 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.44","SUP","HCPCS C1713","","294.44  -  SCREW XTRNFX 4MM 80MM NS SCHNZ SPD PNT MR CONDITIONAL SS LG","BOTH IP/OP","$128.10 ","$94.79 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$26.70 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.45","SUP","HCPCS C1713","","294.45  -  SCREW XTRNFX 4MM 100MM NS 25MM SCHNZ SPD PNT SS PLVC LG","BOTH IP/OP","$128.10 ","$94.79 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$26.70 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.455","SUP","HCPCS C1713","","294.455  -  SCREW BONE 4MM 100MM 38IN SPADE POINT PTHRD SCHANZ","BOTH IP/OP","$128.10 ","$94.79 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$26.70 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.46","SUP","HCPCS C1713","","294.46  -  SCREW XTRNFX 4MM 120MM NS SCHNZ SPD PNT MR CONDITIONAL SS","BOTH IP/OP","$128.10 ","$94.79 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$26.70 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.48","SUP","HCPCS C1713","","294.48  -  SCREW XTRNFX 4MM 150MM NS 25MM SCHNZ SPD PNT SS PLVC LG","BOTH IP/OP","$128.10 ","$94.79 ","$0.00 ","$124.38 ","$55.97 ","$0.00 ","$26.70 ","$0.00 ","$0.00 ","$21.78 ","$124.38 ","$0.00 ","$62.19 ","$98.51 ","$99.50 ","$0.00 ","$18.90 ","$0.00 ","$19.80 ","$0.00 "
"294.52","SUP","HCPCS C1713","","294.52  -  SCREW XTRNFX XLNG 5MM 100MM NS SCHNZ BLNT TROC PNT MR","BOTH IP/OP","$141.48 ","$104.70 ","$0.00 ","$137.35 ","$61.81 ","$0.00 ","$29.49 ","$0.00 ","$0.00 ","$24.05 ","$137.35 ","$0.00 ","$68.68 ","$108.78 ","$109.88 ","$0.00 ","$20.87 ","$0.00 ","$21.87 ","$0.00 "
"294.53","SUP","HCPCS C1713","","294.53  -  SCREW XTRNFX 5MM 125MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL","BOTH IP/OP","$141.48 ","$104.70 ","$0.00 ","$137.35 ","$61.81 ","$0.00 ","$29.49 ","$0.00 ","$0.00 ","$24.05 ","$137.35 ","$0.00 ","$68.68 ","$108.78 ","$109.88 ","$0.00 ","$20.87 ","$0.00 ","$21.87 ","$0.00 "
"294.54","SUP","HCPCS C1713","","294.54  -  SCREW XTRNFX 5MM 150MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL","BOTH IP/OP","$141.48 ","$104.70 ","$0.00 ","$137.35 ","$61.81 ","$0.00 ","$29.49 ","$0.00 ","$0.00 ","$24.05 ","$137.35 ","$0.00 ","$68.68 ","$108.78 ","$109.88 ","$0.00 ","$20.87 ","$0.00 ","$21.87 ","$0.00 "
"294.55","SUP","HCPCS C1713","","294.55  -  SCREW XTRNFX XLNG 5MM 170MM NS 50MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$163.75 ","$121.18 ","$0.00 ","$158.98 ","$71.54 ","$0.00 ","$34.13 ","$0.00 ","$0.00 ","$27.84 ","$158.98 ","$0.00 ","$79.49 ","$125.91 ","$127.18 ","$0.00 ","$34.25 ","$0.00 ","$25.31 ","$0.00 "
"294.56","SUP","HCPCS C1713","","294.56  -  SCREW XTRNFX 5MM 200MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL","BOTH IP/OP","$163.75 ","$121.18 ","$0.00 ","$158.98 ","$71.54 ","$0.00 ","$34.13 ","$0.00 ","$0.00 ","$27.84 ","$158.98 ","$0.00 ","$79.49 ","$125.91 ","$127.18 ","$0.00 ","$24.16 ","$0.00 ","$25.31 ","$0.00 "
"294.57","SUP","HCPCS C1713","","294.57  -  SCREW XTRNFX 5MM 250MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL","BOTH IP/OP","$163.75 ","$121.18 ","$0.00 ","$158.98 ","$71.54 ","$0.00 ","$34.13 ","$0.00 ","$0.00 ","$27.84 ","$158.98 ","$0.00 ","$79.49 ","$125.91 ","$127.18 ","$0.00 ","$24.16 ","$0.00 ","$25.31 ","$0.00 "
"294.65","SUP","HCPCS C1713","","294.65  -  SCREW XTRNFX 6MM 100MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR","BOTH IP/OP","$141.48 ","$104.70 ","$0.00 ","$137.35 ","$61.81 ","$0.00 ","$29.49 ","$0.00 ","$0.00 ","$24.05 ","$137.35 ","$0.00 ","$68.68 ","$108.78 ","$109.88 ","$0.00 ","$20.87 ","$0.00 ","$21.87 ","$0.00 "
"294.66","SUP","HCPCS C1713","","294.66  -  SCREW EXFIX BLUNT SPADE 6MM 130MM 50MM TROCAR SCHANZ","BOTH IP/OP","$141.48 ","$104.70 ","$0.00 ","$137.35 ","$61.81 ","$0.00 ","$29.49 ","$0.00 ","$0.00 ","$24.05 ","$137.35 ","$0.00 ","$68.68 ","$108.78 ","$109.88 ","$0.00 ","$20.87 ","$0.00 ","$21.87 ","$0.00 "
"294.67","SUP","HCPCS C1713","","294.67  -  SCREW XTRNFX 6MM 160MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR","BOTH IP/OP","$147.05 ","$108.82 ","$0.00 ","$142.75 ","$64.24 ","$0.00 ","$30.65 ","$0.00 ","$0.00 ","$24.99 ","$142.75 ","$0.00 ","$71.38 ","$113.06 ","$114.20 ","$0.00 ","$21.69 ","$0.00 ","$22.73 ","$0.00 "
"294.68","SUP","HCPCS C1713","","294.68  -  SCREW XTRNFX 6MM 190MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR","BOTH IP/OP","$147.05 ","$108.82 ","$0.00 ","$142.75 ","$64.24 ","$0.00 ","$30.65 ","$0.00 ","$0.00 ","$24.99 ","$142.75 ","$0.00 ","$71.38 ","$113.06 ","$114.20 ","$0.00 ","$21.69 ","$0.00 ","$22.73 ","$0.00 "
"294.71","SUP","HCPCS C1713","","294.71  -  SCREW EXFIX BLUNT SPADE 4.5MM 80MM 18MM TROCAR SCHANZ","BOTH IP/OP","$124.75 ","$92.32 ","$0.00 ","$121.13 ","$54.51 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$21.21 ","$121.13 ","$0.00 ","$60.56 ","$95.93 ","$96.90 ","$0.00 ","$18.40 ","$0.00 ","$19.28 ","$0.00 "
"294.72","SUP","HCPCS C1713","","294.72  -  SCREW XTRNFX ST 4.5MM 100MM NS 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$124.75 ","$92.32 ","$0.00 ","$121.13 ","$54.51 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$21.21 ","$121.13 ","$0.00 ","$60.56 ","$95.93 ","$96.90 ","$0.00 ","$18.40 ","$0.00 ","$19.28 ","$0.00 "
"294.73","SUP","HCPCS C1713","","294.73  -  SCREW XTRNFX ST 4.5MM 125MM NS 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$124.75 ","$92.32 ","$0.00 ","$121.13 ","$54.51 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$21.21 ","$121.13 ","$0.00 ","$60.56 ","$95.93 ","$96.90 ","$0.00 ","$18.40 ","$0.00 ","$19.28 ","$0.00 "
"294.74","SUP","HCPCS C1713","","294.74  -  SCREW XTRNFX ST 4.5MM 150MM NS 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$124.75 ","$92.32 ","$0.00 ","$121.13 ","$54.51 ","$0.00 ","$26.00 ","$0.00 ","$0.00 ","$21.21 ","$121.13 ","$0.00 ","$60.56 ","$95.93 ","$96.90 ","$0.00 ","$18.40 ","$0.00 ","$19.28 ","$0.00 "
"294.75","SUP","HCPCS C1713","","294.75  -  SCREW XTRNFX ST 4.5MM 175MM NS 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$147.05 ","$108.82 ","$0.00 ","$142.75 ","$64.24 ","$0.00 ","$30.65 ","$0.00 ","$0.00 ","$24.99 ","$142.75 ","$0.00 ","$71.38 ","$113.06 ","$114.20 ","$0.00 ","$21.69 ","$0.00 ","$22.73 ","$0.00 "
"294.76","SUP","HCPCS C1713","","294.76  -  SCREW XTRNFX 4.5MM 200MM NS SCHNZ BLNT TROC PNT MR","BOTH IP/OP","$147.05 ","$108.82 ","$0.00 ","$142.75 ","$64.24 ","$0.00 ","$30.65 ","$0.00 ","$0.00 ","$24.99 ","$142.75 ","$0.00 ","$71.38 ","$113.06 ","$114.20 ","$0.00 ","$21.69 ","$0.00 ","$22.73 ","$0.00 "
"294.767","SUP","HCPCS C1713","","294.767  -  SCREW BONE 4MM 2.5MM 65MM 18MM SLFDRILL TROCAR POINT SCHANZ","BOTH IP/OP","$221.68 ","$164.04 ","$0.00 ","$215.23 ","$96.85 ","$0.00 ","$46.20 ","$0.00 ","$0.00 ","$37.68 ","$215.23 ","$0.00 ","$107.61 ","$170.46 ","$172.18 ","$0.00 ","$32.70 ","$0.00 ","$34.26 ","$0.00 "
"294.768","SUP","HCPCS C1713","","294.768  -  SCREW BONE 4MM 2.5MM 80MM 20MM SLFDRILL TROCAR POINT SCHANZ","BOTH IP/OP","$221.68 ","$164.04 ","$0.00 ","$215.23 ","$96.85 ","$0.00 ","$46.20 ","$0.00 ","$0.00 ","$37.68 ","$215.23 ","$0.00 ","$107.61 ","$170.46 ","$172.18 ","$0.00 ","$32.70 ","$0.00 ","$34.26 ","$0.00 "
"294.769","SUP","HCPCS C1713","","294.769  -  SCREW XTRNFX 4MM 2.5MM 80MM NS 20MM SCHNZ SLF DRL MR","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.771","SUP","HCPCS C1713","","294.771  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.772","SUP","HCPCS C1713","","294.772  -  SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.773","SUP","HCPCS C1713","","294.773  -  SCREW BONE 4MM 3MM 65MM 18MM SELF DRILL SCHANZ STAINLESS","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.774","SUP","HCPCS C1713","","294.774  -  SCREW BONE 4MM 60MM 20MM SELF DRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.775","SUP","HCPCS C1713","","294.775  -  SCREW XTRNFX 4MM 80MM NS 20MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.776","SUP","HCPCS C1713","","294.776  -  SCREW XTRNFX 4MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.777","SUP","HCPCS C1713","","294.777  -  SCREW XTRNFX 4MM 125MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.778","SUP","HCPCS C1713","","294.778  -  SCREW XTRNFX 4MM 150MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.779","SUP","HCPCS C1713","","294.779  -  SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"294.782","SUP","HCPCS C1713","","294.782  -  SCREW XTRNFX 5MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$281.83 ","$208.55 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$58.74 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$41.57 ","$0.00 ","$43.56 ","$0.00 "
"294.783","SUP","HCPCS C1713","","294.783  -  SCREW XTRNFX 5MM 125MM NS 40MM SCHNZ SLF DRL SS HIP CNDYL LG","BOTH IP/OP","$281.83 ","$208.55 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$58.74 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$41.57 ","$0.00 ","$43.56 ","$0.00 "
"294.784","SUP","HCPCS C1713","","294.784  -  SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$281.83 ","$208.55 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$58.74 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$41.57 ","$0.00 ","$43.56 ","$0.00 "
"294.785","SUP","HCPCS C1713","","294.785  -  SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$281.83 ","$208.55 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$58.74 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$41.57 ","$0.00 ","$43.56 ","$0.00 "
"294.786","SUP","HCPCS C1713","","294.786  -  SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$281.83 ","$208.55 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$58.74 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$41.57 ","$0.00 ","$43.56 ","$0.00 "
"294.788","SUP","HCPCS C1713","","294.788  -  SCREW XTRNFX 5MM 250MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$281.83 ","$208.55 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$58.74 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$41.57 ","$0.00 ","$43.56 ","$0.00 "
"294.792","SUP","HCPCS C1713","","294.792  -  SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$292.00 ","$131.40 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$51.13 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$44.37 ","$0.00 ","$46.49 ","$0.00 "
"294.793","SUP","HCPCS C1713","","294.793  -  SCREW BONE 6MM 125MM 40MM SLFDRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$292.00 ","$131.40 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$51.13 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$44.37 ","$0.00 ","$46.49 ","$0.00 "
"294.794","SUP","HCPCS C1713","","294.794  -  SCREW BONE 6MM 150MM 60MM SELF DRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$292.00 ","$131.40 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$51.13 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$44.37 ","$0.00 ","$46.49 ","$0.00 "
"294.795","SUP","HCPCS C1713","","294.795  -  SCREW BONE 6MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$292.00 ","$131.40 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$51.13 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$44.37 ","$0.00 ","$46.49 ","$0.00 "
"294.796","SUP","HCPCS C1713","","294.796  -  SCREW BONE 6MM 200MM 80MM SELF DRILL SCHANZ STAINLESS STEEL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$292.00 ","$131.40 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$51.13 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$44.37 ","$0.00 ","$46.49 ","$0.00 "
"294.798","SUP","HCPCS C1713","","294.798  -  SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$300.78 ","$222.58 ","$0.00 ","$292.00 ","$131.40 ","$0.00 ","$62.69 ","$0.00 ","$0.00 ","$51.13 ","$292.00 ","$0.00 ","$146.00 ","$231.26 ","$233.60 ","$0.00 ","$44.37 ","$0.00 ","$46.49 ","$0.00 "
"294.95","SUP","Custom 27203010","","294.950  -  PIN FIX 6MM 225MM TRANSFIXATION STEINMANN STAINLESS STEEL","BOTH IP/OP","$208.73 ","$154.46 ","$0.00 ","$208.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$208.73 ","$0.00 ","$104.36 ","$165.31 ","$166.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"296.757","SUP","Custom 27803010","","296.757  -  NUT ORTH 6MM SCRL SS RND NONSTRL","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"296.758","SUP","Custom 27803010","","296.758  -  WASHER SPNL 6MM SCRL SS NONSTRL","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"296.759","SUP","Custom 27803010","","296.759  -  NUT ORTH 6MM SCRL SS HEX NONSTRL","BOTH IP/OP","$244.75 ","$181.12 ","$0.00 ","$244.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$244.75 ","$0.00 ","$122.38 ","$193.84 ","$195.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"296.761","SUP","HCPCS C1713","","296.761  -  BAR SPNL 160MM 6MM SCRL SPN SS THRD NONSTRL","BOTH IP/OP","$1,334.50 ","$987.53 ","$0.00 ","$1,334.50 ","$600.53 ","$0.00 ","$278.14 ","$0.00 ","$0.00 ","$233.66 ","$1,334.50 ","$0.00 ","$667.25 ","$1,056.92 ","$1,067.60 ","$0.00 ","$208.85 ","$0.00 ","$212.45 ","$0.00 "
"296.763","SUP","HCPCS C1713","","296.763  -  BAR SPINAL 6MM 200MM THREADED KIT SACRAL NONSTRL","BOTH IP/OP","$1,210.30 ","$895.62 ","$0.00 ","$1,175.05 ","$528.77 ","$0.00 ","$252.26 ","$0.00 ","$0.00 ","$205.74 ","$1,175.05 ","$0.00 ","$587.53 ","$930.64 ","$940.04 ","$0.00 ","$178.54 ","$0.00 ","$187.07 ","$0.00 "
"296.765","SUP","HCPCS C1713","","296.765  -  BAR SPNL 240MM 6MM SCRL SPN SS THRD NONSTRL","BOTH IP/OP","$1,415.75 ","$1,047.66 ","$0.00 ","$1,415.75 ","$637.09 ","$0.00 ","$295.08 ","$0.00 ","$0.00 ","$247.89 ","$1,415.75 ","$0.00 ","$707.88 ","$1,121.27 ","$1,132.60 ","$0.00 ","$221.56 ","$0.00 ","$225.39 ","$0.00 "
"296.766","SUP","HCPCS C1713","","296.766  -  BAR SPINAL 6MM 260MM THREAD STAINLESS STEEL SACRAL SPN","BOTH IP/OP","$1,210.30 ","$895.62 ","$0.00 ","$1,175.05 ","$528.77 ","$0.00 ","$252.26 ","$0.00 ","$0.00 ","$205.74 ","$1,175.05 ","$0.00 ","$587.53 ","$930.64 ","$940.04 ","$0.00 ","$178.54 ","$0.00 ","$187.07 ","$0.00 "
"304","SUP","HCPCS C1778","","304  -  LEAD NEUROSTIMULATOR 3MM 43CM BIPOL PERENNIAFLEX SILICONE","BOTH IP/OP","$17,070.00 ","$12,631.80 ","$0.00 ","$17,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,070.00 ","$0.00 ","$8,535.00 ","$13,519.44 ","$13,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.008","SUP","Custom 27803010","","304.008  -  SPACER SPNL OBLQ 26X10X8MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.009","SUP","Custom 27803010","","304.009  -  SPACER SPNL OBLQ 26X10X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.01","SUP","Custom 27803010","","304.010  -  SPACER SPNL OBLQ 26X10X10MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.011","SUP","Custom 27803010","","304.011  -  SPACER SPNL OBLQ 26X10X11MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.012","SUP","Custom 27803010","","304.012  -  SPACER SPNL OBLQ 26X10X12MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.013","SUP","Custom 27803010","","304.013  -  SPACER SPNL OBLQ 26X10X13MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.014","SUP","Custom 27803010","","304.014  -  SPACER SPNL OBLQ 26X10X14MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.015","SUP","Custom 27803010","","304.015  -  SPACER SPNL OBLQ 26X10X15MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.017","SUP","Custom 27803010","","304.017  -  SPACER SPNL OBLQ 26X10X17MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.065","SUP","Custom 27803010","","304.065  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.066","SUP","Custom 27803010","","304.066  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.067","SUP","Custom 27803010","","304.067  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.068","SUP","Custom 27803010","","304.068  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.069","SUP","Custom 27803010","","304.069  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.07","SUP","Custom 27803010","","304.070  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.071","SUP","Custom 27803010","","304.071  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.072","SUP","Custom 27803010","","304.072  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.078","SUP","Custom 27803010","","304.078  -  SPACER SPNL SM OBLQ 22X8X8MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.079","SUP","Custom 27803010","","304.079  -  SPACER SPNL SM OBLQ 22X8X9MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.08","SUP","Custom 27803010","","304.080  -  SPACER SPNL SM OBLQ 22X8X10MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.081","SUP","Custom 27803010","","304.081  -  SPACER SPNL SM OBLQ 22X8X11MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.082","SUP","Custom 27803010","","304.082  -  SPACER SPNL SM OBLQ 22X8X12MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.083","SUP","Custom 27803010","","304.083  -  SPACER SPNL SM OBLQ 22X8X13MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.085","SUP","Custom 27803010","","304.085  -  SPACER SPNL SM OBLQ 22X8X15MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.087","SUP","Custom 27803010","","304.087  -  SPACER SPNL SM OBLQ 22X8X17MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.088","SUP","Custom 27803010","","304.088  -  SPACER SPNL SM OBLQ 22X10X8MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.089","SUP","Custom 27803010","","304.089  -  SPACER SPNL SM OBLQ 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.09","SUP","Custom 27803010","","304.090  -  SPACER SPNL SM OBLQ 22X10X10MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.091","SUP","Custom 27803010","","304.091  -  SPACER SPNL SM OBLQ 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.092","SUP","Custom 27803010","","304.092  -  SPACER SPNL SM OBLQ 22X10X12MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.093","SUP","Custom 27803010","","304.093  -  SPACER SPNL SM OBLQ 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.095","SUP","Custom 27803010","","304.095  -  SPACER SPNL SM OBLQ 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.097","SUP","Custom 27803010","","304.097  -  SPACER SPNL SM OBLQ 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.104","SUP","Custom 27803010","","304.104  -  MARKER SRG 4MM WHT SCR LGTH SLFDRL SCR","BOTH IP/OP","$106.88 ","$79.09 ","$0.00 ","$106.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.88 ","$0.00 ","$53.44 ","$84.65 ","$85.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.105","SUP","Custom 27803010","","304.105  -  MARKER SRG 5MM WHT SCR LGTH SLF DRL SCR","BOTH IP/OP","$106.88 ","$79.09 ","$0.00 ","$106.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.88 ","$0.00 ","$53.44 ","$84.65 ","$85.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.107","SUP","Custom 27803010","","304.107  -  SPACER SPNL SM 22X10X7MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.109","SUP","Custom 27803010","","304.109  -  SPACER SPNL SM 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.111","SUP","Custom 27803010","","304.111  -  SPACER SPNL SM 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.113","SUP","Custom 27803010","","304.113  -  SPACER SPNL SM 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.115","SUP","Custom 27803010","","304.115  -  SPACER SPNL SM 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.117","SUP","Custom 27803010","","304.117  -  SPACER SPNL SM 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.119","SUP","Custom 27803010","","304.119  -  SPACER SPNL SM 22X10X19MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.121","SUP","Custom 27803010","","304.121  -  SPACER SPNL SM 22X10X21MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.159","SUP","Custom 27803010","","304.159  -  SPACER SPNL SM 18X10X9MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.161","SUP","Custom 27803010","","304.161  -  SPACER SPNL SM 18X10X11MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.163","SUP","Custom 27803010","","304.163  -  SPACER SPNL SM 18X10X13MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.165","SUP","Custom 27803010","","304.165  -  SPACER SPNL SM 18X10X15MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.167","SUP","Custom 27803010","","304.167  -  SPACER SPNL SM 18X10X17MM NS LF SUST O RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.205","SUP","Custom 27803010","","304.205  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.206","SUP","Custom 27803010","","304.206  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.207","SUP","Custom 27803010","","304.207  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST R RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.208","SUP","Custom 27803010","","304.208  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST R RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.209","SUP","Custom 27803010","","304.209  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST R RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.21","SUP","Custom 27803010","","304.210  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST R RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.211","SUP","Custom 27803010","","304.211  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.212","SUP","Custom 27803010","","304.212  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.225","SUP","Custom 27803010","","304.225  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST R RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.226","SUP","Custom 27803010","","304.226  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST R RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.227","SUP","Custom 27803010","","304.227  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST R RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.228","SUP","Custom 27803010","","304.228  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST R RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.229","SUP","Custom 27803010","","304.229  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST R RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.23","SUP","Custom 27803010","","304.230  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST R RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.231","SUP","Custom 27803010","","304.231  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.232","SUP","Custom 27803010","","304.232  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.245","SUP","Custom 27803010","","304.245  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.246","SUP","Custom 27803010","","304.246  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.247","SUP","Custom 27803010","","304.247  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.248","SUP","Custom 27803010","","304.248  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.249","SUP","Custom 27803010","","304.249  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.25","SUP","Custom 27803010","","304.250  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.251","SUP","Custom 27803010","","304.251  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.252","SUP","Custom 27803010","","304.252  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.265","SUP","Custom 27803010","","304.265  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.266","SUP","Custom 27803010","","304.266  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.267","SUP","Custom 27803010","","304.267  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.268","SUP","Custom 27803010","","304.268  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.269","SUP","Custom 27803010","","304.269  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.27","SUP","Custom 27803010","","304.270  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.271","SUP","Custom 27803010","","304.271  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.272","SUP","Custom 27803010","","304.272  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT BEAD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.275","SUP","Custom 27803010","","304.275  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.276","SUP","Custom 27803010","","304.276  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.277","SUP","Custom 27803010","","304.277  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.278","SUP","Custom 27803010","","304.278  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.279","SUP","Custom 27803010","","304.279  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.28","SUP","Custom 27803010","","304.280  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.281","SUP","Custom 27803010","","304.281  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.282","SUP","Custom 27803010","","304.282  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.309","SUP","Custom 27803010","","304.309  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.311","SUP","Custom 27803010","","304.311  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.313","SUP","Custom 27803010","","304.313  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.315","SUP","Custom 27803010","","304.315  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.317","SUP","Custom 27803010","","304.317  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.319","SUP","Custom 27803010","","304.319  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.321","SUP","Custom 27803010","","304.321  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.351","SUP","Custom 27803010","","304.351  -  SPACER SPNL 15D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.352","SUP","Custom 27803010","","304.352  -  SPACER SPNL 15D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.353","SUP","Custom 27803010","","304.353  -  SPACER SPNL 15D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.354","SUP","Custom 27803010","","304.354  -  SPACER SPNL 15D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.355","SUP","Custom 27803010","","304.355  -  SPACER SPNL 15D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.356","SUP","Custom 27803010","","304.356  -  SPACER SPNL 15D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.359","SUP","Custom 27803010","","304.359  -  SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK THORLMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.361","SUP","Custom 27803010","","304.361  -  SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.363","SUP","Custom 27803010","","304.363  -  SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.365","SUP","Custom 27803010","","304.365  -  SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.367","SUP","Custom 27803010","","304.367  -  SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.369","SUP","Custom 27803010","","304.369  -  SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.371","SUP","Custom 27803010","","304.371  -  SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.379","SUP","Custom 27803010","","304.379  -  SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.381","SUP","Custom 27803010","","304.381  -  SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.383","SUP","Custom 27803010","","304.383  -  SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.385","SUP","Custom 27803010","","304.385  -  SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.387","SUP","Custom 27803010","","304.387  -  SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.389","SUP","Custom 27803010","","304.389  -  SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.391","SUP","Custom 27803010","","304.391  -  SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.409","SUP","Custom 27803010","","304.409  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.411","SUP","Custom 27803010","","304.411  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.413","SUP","Custom 27803010","","304.413  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.415","SUP","Custom 27803010","","304.415  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.417","SUP","Custom 27803010","","304.417  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.419","SUP","Custom 27803010","","304.419  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.421","SUP","Custom 27803010","","304.421  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK LAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.45","SUP","Custom 27803010","","304.450  -  SPACER SPNL 4D LRDTC 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.451","SUP","Custom 27803010","","304.451  -  SPACER SPNL 4D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.452","SUP","Custom 27803010","","304.452  -  SPACER SPNL 4D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.453","SUP","Custom 27803010","","304.453  -  SPACER SPNL 4D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.454","SUP","Custom 27803010","","304.454  -  SPACER SPNL 4D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.455","SUP","Custom 27803010","","304.455  -  SPACER SPNL 4D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.456","SUP","Custom 27803010","","304.456  -  SPACER SPNL 4D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.509","SUP","Custom 27803010","","304.509  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.511","SUP","Custom 27803010","","304.511  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.513","SUP","Custom 27803010","","304.513  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.515","SUP","Custom 27803010","","304.515  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.517","SUP","Custom 27803010","","304.517  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.519","SUP","Custom 27803010","","304.519  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.521","SUP","Custom 27803010","","304.521  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK ALAT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.607","SUP","Custom 27803010","","304.607  -  SPACER SPNL SM ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK TLIF","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.609","SUP","Custom 27803010","","304.609  -  SPACER SPNL SM ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK TLIF","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.611","SUP","Custom 27803010","","304.611  -  SPACER SPNL SM ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK TLIF","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.613","SUP","Custom 27803010","","304.613  -  SPACER SPNL SM ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK TLIF","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.615","SUP","Custom 27803010","","304.615  -  SPACER SPNL SM ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK TLIF","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.617","SUP","Custom 27803010","","304.617  -  SPACER SPNL SM ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK TLIF","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.707","SUP","Custom 27803010","","304.707  -  SPACER SPNL SM NAR 22X8X7MM NS LF SUST R RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.709","SUP","Custom 27803010","","304.709  -  SPACER SPNL SM NAR 22X8X9MM NS LF SUST R RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.711","SUP","Custom 27803010","","304.711  -  SPACER SPNL SM NAR 22X8X11MM NS LF SUST R RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.713","SUP","Custom 27803010","","304.713  -  SPACER SPNL SM NAR 22X8X13MM NS LF SUST R RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.715","SUP","Custom 27803010","","304.715  -  SPACER SPNL SM NAR 22X8X15MM NS LF SUST R RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.717","SUP","Custom 27803010","","304.717  -  SPACER SPNL SM NAR 22X8X17MM NS LF SUST R RDLCNT PEEK LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.808","SUP","Custom 27803010","","304.808  -  SPACER SPNL OBLQ 30X10X8MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.809","SUP","Custom 27803010","","304.809  -  SPACER SPNL OBLQ 30X10X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.81","SUP","Custom 27803010","","304.810  -  SPACER SPNL OBLQ 30X10X10MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.811","SUP","Custom 27803010","","304.811  -  SPACER SPNL OBLQ 30X10X11MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.812","SUP","Custom 27803010","","304.812  -  SPACER SPNL OBLQ 30X10X12MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.813","SUP","Custom 27803010","","304.813  -  SPACER SPNL OBLQ 30X10X13MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.814","SUP","Custom 27803010","","304.814  -  SPACER SPNL OBLQ 30X10X14MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.815","SUP","Custom 27803010","","304.815  -  SPACER SPNL OBLQ 30X10X15MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.817","SUP","Custom 27803010","","304.817  -  SPACER SPNL OBLQ 30X10X17MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.868","SUP","Custom 27803010","","304.868  -  SPACER SPNL OBLQ 30X12X8MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.869","SUP","Custom 27803010","","304.869  -  SPACER SPNL OBLQ 30X12X9MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.87","SUP","Custom 27803010","","304.870  -  SPACER SPNL OBLQ 30X12X10MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.871","SUP","Custom 27803010","","304.871  -  SPACER SPNL OBLQ 30X12X11MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.872","SUP","Custom 27803010","","304.872  -  SPACER SPNL OBLQ 30X12X12MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.873","SUP","Custom 27803010","","304.873  -  SPACER SPNL OBLQ 30X12X13MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.874","SUP","Custom 27803010","","304.874  -  SPACER SPNL OBLQ 30X12X14MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.875","SUP","Custom 27803010","","304.875  -  SPACER SPNL OBLQ 30X12X15MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.877","SUP","Custom 27803010","","304.877  -  SPACER SPNL OBLQ 30X12X17MM NS LF SUST RDLCNT PEEK LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.905","SUP","Custom 27803010","","304.905  -  SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.906","SUP","Custom 27803010","","304.906  -  SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.907","SUP","Custom 27803010","","304.907  -  SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.908","SUP","Custom 27803010","","304.908  -  SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.909","SUP","Custom 27803010","","304.909  -  SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.91","SUP","Custom 27803010","","304.910  -  SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.911","SUP","Custom 27803010","","304.911  -  SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.912","SUP","Custom 27803010","","304.912  -  SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.925","SUP","Custom 27803010","","304.925  -  SPACER SPNL 11MM LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.926","SUP","Custom 27803010","","304.926  -  SPACER SPNL 11MM LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.927","SUP","Custom 27803010","","304.927  -  SPACER SPNL 11MM LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.928","SUP","Custom 27803010","","304.928  -  SPACER SPNL 11MM LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.929","SUP","Custom 27803010","","304.929  -  SPACER SPNL 11MM LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.93","SUP","Custom 27803010","","304.930  -  SPACER SPNL 11MM LRDTC MED NAR 12X10MM NS LF SUST RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.931","SUP","Custom 27803010","","304.931  -  SPACER SPNL 11MM LRDTC MED NAR 12X11MM NS LF SUST RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.932","SUP","Custom 27803010","","304.932  -  SPACER SPNL 11MM LRDTC MED NAR 12X12MM NS LF SUST RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.945","SUP","Custom 27803010","","304.945  -  SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.946","SUP","Custom 27803010","","304.946  -  SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.947","SUP","Custom 27803010","","304.947  -  SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.948","SUP","Custom 27803010","","304.948  -  SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.949","SUP","Custom 27803010","","304.949  -  SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.95","SUP","Custom 27803010","","304.950  -  SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.951","SUP","Custom 27803010","","304.951  -  SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.952","SUP","Custom 27803010","","304.952  -  SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.968","SUP","Custom 27803010","","304.968  -  SPACER SPNL OBLQ 26X12X8MM NS LF SUST RDLCNT PEEK INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304.969","SUP","Custom 27803010","","304.969  -  SPACER SPNL OBLQ 26X12X9MM NS LF SUST RDLCNT PEEK INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"310.14","SUP","Custom 27203010","","310.14  -  BIT DRL 1.5MM 70MM NS JCHK MN FRAG SYS","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.141","SUP","Custom 27203010","","310.141  -  BIT DRL 1.5MM 65MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.143","SUP","Custom 27203010","","310.143  -  BIT DRL 1.5MM 75MM NS JLTCH CPLNG CPLNG STRYK","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"310.16","SUP","Custom 27203010","","310.16  -  BIT DRILL 1.5MM 110MM QUICK COUPLING STAINLESS STEEL NONSTRL","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.161","SUP","Custom 27203010","","310.161  -  BIT DRILL 1.5MM 110MM J LATCH DEPTH MARK NONSTRL","BOTH IP/OP","$279.73 ","$207.00 ","$0.00 ","$271.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$271.58 ","$0.00 ","$135.79 ","$215.09 ","$217.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.162","SUP","Custom 27203010","","310.162  -  BIT DRILL 1.8MM 110MM J LATCH DEPTH MARK NONSTRL","BOTH IP/OP","$279.73 ","$207.00 ","$0.00 ","$271.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$271.58 ","$0.00 ","$135.79 ","$215.09 ","$217.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"310.171","SUP","Custom 27203010","","310.171  -  BIT DRILL 125MM 1.5MM 8MM STOP UNV HALL CPLNG NONSTRL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.172","SUP","Custom 27203010","","310.172  -  BIT DRILL 125MM 1.5MM 8MM STOP JLTCH NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.173","SUP","Custom 27203010","","310.173  -  BIT DRILL 125MM 1.5MM 8MM STOP MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.177","SUP","Custom 27203010","","310.177  -  BIT DRILL 1.5MM 4MM STOP JLTCH NONSTRL","BOTH IP/OP","$346.50 ","$256.41 ","$0.00 ","$346.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$346.50 ","$0.00 ","$173.25 ","$274.43 ","$277.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.182","SUP","Custom 27203010","","310.182  -  BIT DRILL 1.5MM 4MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$346.50 ","$256.41 ","$0.00 ","$346.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$346.50 ","$0.00 ","$173.25 ","$274.43 ","$277.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.19","SUP","Custom 27203010","","310.19  -  BIT DRL 2MM 100MM NS QC","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.2","SUP","Custom 27203010","","310.20  -  BIT DRILL STANDARD 2MM 85MM SET BASIC ARTICULATE TENSION","BOTH IP/OP","$131.68 ","$97.44 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.201","SUP","Custom 27203010","","310.201  -  BIT DRL 2MM 65MM NS MNQK CPLNG","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.203","SUP","Custom 27203010","","310.203  -  BIT DRL 2MM 75MM NS JLTCH CPLNG STRYK","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"310.81","SUP","Custom 27203010","","310.81  -  CNTRSNK DRILL QC CENTERING PIN 1.5 MM 2 MM 2.7 MM SCR","BOTH IP/OP","$1,518.75 ","$1,123.88 ","$0.00 ","$1,518.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,518.75 ","$0.00 ","$759.38 ","$1,202.85 ","$1,215.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.811","SUP","Custom 27203010","","310.811  -  COUNTERSINK W/CENTERING PINS FOR 2.0MM SCREWS/HEX COUPLING","BOTH IP/OP","$1,584.00 ","$1,172.16 ","$0.00 ","$1,584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,584.00 ","$0.00 ","$792.00 ","$1,254.53 ","$1,267.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.883","SUP","Custom 27203010","","310.883  -  CNTRSNK DRILL HEX CPLNG 2 MM 2.4 MM SCR","BOTH IP/OP","$1,471.50 ","$1,088.91 ","$0.00 ","$1,471.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,471.50 ","$0.00 ","$735.75 ","$1,165.43 ","$1,177.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311.014","SUP","Custom 27203010","","311.014  -  SCRDRVR SM SURG RCHT NONSTRL","BOTH IP/OP","$3,096.00 ","$2,291.04 ","$0.00 ","$3,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,096.00 ","$0.00 ","$1,548.00 ","$2,452.03 ","$2,476.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311.12","SUP","HCPCS C1713","","311.120  -  TAP MNQK CPLNG SURG 1.3 MM CORTEX SCR","BOTH IP/OP","$326.25 ","$241.43 ","$0.00 ","$326.25 ","$146.81 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$57.12 ","$326.25 ","$0.00 ","$163.13 ","$258.39 ","$261.00 ","$0.00 ","$51.06 ","$0.00 ","$51.94 ","$0.00 "
"311.15","SUP","HCPCS C1713","","311.15  -  TAP SURG 50MM MINI QUICK COUPLING NONSTRL 1.5MM CORTICAL","BOTH IP/OP","$184.15 ","$136.27 ","$0.00 ","$178.78 ","$80.45 ","$0.00 ","$38.38 ","$0.00 ","$0.00 ","$31.30 ","$178.78 ","$0.00 ","$89.39 ","$141.59 ","$143.02 ","$0.00 ","$27.16 ","$0.00 ","$28.46 ","$0.00 "
"311.204","SUP","HCPCS C1713","","311.204  -  TAP 100MM SURG 2MM MANDIB LCK SCR","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"311.209","SUP","HCPCS C1713","","311.209  -  TAP HEX CPLNG SURG 2 MM COARSE PTCH SCR","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$145.80 ","$0.00 ","$67.53 ","$0.00 ","$0.00 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"311.211","SUP","HCPCS C1713","","311.211  -  TAP HEX CPLNG SURG 2 MM CORTEX SCR","BOTH IP/OP","$290.25 ","$214.79 ","$0.00 ","$290.25 ","$130.61 ","$0.00 ","$60.50 ","$0.00 ","$0.00 ","$50.82 ","$290.25 ","$0.00 ","$145.13 ","$229.88 ","$232.20 ","$0.00 ","$45.42 ","$0.00 ","$46.21 ","$0.00 "
"311.23","SUP","HCPCS C1713","","311.23  -  TAP QC SURG 2.4 MM CORTEX SCR","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"311.24","SUP","HCPCS C1713","","311.24  -  TAP LNG QC SURG 2.4MM CORTEX SCR","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"311.241","SUP","HCPCS C1713","","311.241  -  TAP HEX CPLNG SURG 2.4 MM CORTEX SCR","BOTH IP/OP","$423.00 ","$313.02 ","$0.00 ","$423.00 ","$190.35 ","$0.00 ","$88.16 ","$0.00 ","$0.00 ","$74.06 ","$423.00 ","$0.00 ","$211.50 ","$335.02 ","$338.40 ","$0.00 ","$66.20 ","$0.00 ","$67.34 ","$0.00 "
"311.26","SUP","Custom 27203010","","311.26  -  TAP SURG LONG 100MM QUICK COUPLING NONSTRL 2.7MM CORTICAL","BOTH IP/OP","$216.48 ","$160.20 ","$0.00 ","$210.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.18 ","$0.00 ","$105.09 ","$166.46 ","$168.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311.32","SUP","HCPCS C1713","","311.32  -  TAP SURG LONG 110MM QUICK COUPLING GOLD NONSTRL 3.5MM","BOTH IP/OP","$216.48 ","$160.20 ","$0.00 ","$210.18 ","$94.58 ","$0.00 ","$45.12 ","$0.00 ","$0.00 ","$36.80 ","$210.18 ","$0.00 ","$105.09 ","$166.46 ","$168.14 ","$0.00 ","$31.93 ","$0.00 ","$33.46 ","$0.00 "
"311.34","SUP","HCPCS C1713","","311.34  -  TAP SURG 110MM NONSTRL 4MM CANCELLOUS SCREW","BOTH IP/OP","$255.58 ","$189.13 ","$0.00 ","$255.58 ","$115.01 ","$0.00 ","$53.27 ","$0.00 ","$0.00 ","$44.75 ","$255.58 ","$0.00 ","$127.79 ","$166.46 ","$204.46 ","$0.00 ","$31.93 ","$0.00 ","$40.69 ","$0.00 "
"311.349","SUP","HCPCS C1713","","311.349  -  TAP 50MM CLBRT SURG CANC SPNL 3.5 SCR NONSTRL","BOTH IP/OP","$323.75 ","$239.58 ","$0.00 ","$323.75 ","$145.69 ","$0.00 ","$67.48 ","$0.00 ","$0.00 ","$56.69 ","$323.75 ","$0.00 ","$161.88 ","$256.41 ","$259.00 ","$0.00 ","$50.67 ","$0.00 ","$51.54 ","$0.00 "
"311.449","SUP","Custom 27203010","","311.449  -  DEVICE TARGET 4.5MM PUSH PULL REDX LCP NONSTRL 4.5MM LCP","BOTH IP/OP","$484.98 ","$358.89 ","$0.00 ","$470.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.85 ","$0.00 ","$235.43 ","$372.91 ","$376.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311.63","SUP","Custom 27203010","","311.63  -  TAP SURG 147MM CANN NONSTRL 4MM SCREW","BOTH IP/OP","$983.93 ","$728.11 ","$0.00 ","$983.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$983.93 ","$0.00 ","$491.96 ","$656.09 ","$787.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"312.3","SUP","Custom 27203010","","312.30  -  SLEEVE DRILL 3.5MM 2.5MM INSERT LCP NONSTRL","BOTH IP/OP","$204.73 ","$151.50 ","$0.00 ","$204.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$204.73 ","$0.00 ","$102.36 ","$162.15 ","$163.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"312.35","SUP","Custom 27203010","","312.35  -  SLEEVE DRILL 2.7MM 1.25MM 2 END NONSTRL","BOTH IP/OP","$778.75 ","$576.28 ","$0.00 ","$756.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$756.08 ","$0.00 ","$378.04 ","$598.82 ","$604.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"312.648","SUP","HCPCS C1713","","312.648  -  GUIDE DRILL 2.8MM 2.8MM THRD","BOTH IP/OP","$196.80 ","$145.63 ","$0.00 ","$239.78 ","$107.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.98 ","$239.78 ","$0.00 ","$119.89 ","$189.91 ","$191.82 ","$0.00 ","$37.52 ","$0.00 ","$38.17 ","$0.00 "
"313.25","SUP","Custom 27203010","","313.250  -  BIT DRILL 44.5MM MINI 4MM STOP QC NONSTRL","BOTH IP/OP","$281.25 ","$208.13 ","$0.00 ","$281.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.25 ","$0.00 ","$140.63 ","$222.75 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"314.03","SUP","Custom 27203010","","314.03  -  SHAFT SCREWDRIVER 2.5MM SMALL HEXAGON NONSTRL","BOTH IP/OP","$101.90 ","$75.41 ","$0.00 ","$98.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.93 ","$0.00 ","$49.46 ","$78.35 ","$79.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"314.23","SUP","Custom 27203010","","314.23  -  SHAFT SCREWDRIVER 4MM HEXAGONAL CANN QUICK COUPLING","BOTH IP/OP","$601.63 ","$445.21 ","$0.00 ","$584.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$584.13 ","$0.00 ","$292.06 ","$462.63 ","$467.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"314.467","SUP","Custom 27203010","","314.467  -  SHAFT SCREWDRIVER T8 105MM SELF RETAINING QUICK COUPLING","BOTH IP/OP","$556.65 ","$411.92 ","$0.00 ","$540.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.45 ","$0.00 ","$270.23 ","$428.04 ","$432.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"314.57","SUP","Custom 27203010","","314.57  -  SCREWDRIVER SURG LONG SMALL HEXAGONAL 3.5MM CORTEX 4MM","BOTH IP/OP","$423.13 ","$313.12 ","$0.00 ","$410.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.80 ","$0.00 ","$205.40 ","$325.35 ","$328.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"314.743","SUP","Custom 27203010","","314.743  -  REAMER SURG 520MM DRIVE SHAFT NONSTRL RIA","BOTH IP/OP","$8,876.43 ","$6,568.56 ","$0.00 ","$8,617.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,617.88 ","$0.00 ","$4,308.94 ","$6,825.36 ","$6,894.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.05","SUP","Custom 27203010","","315.05  -  BIT DRILL 3.5MM 225MM 3 FLUTED QUICK COUPLING NONSTRL","BOTH IP/OP","$224.90 ","$166.43 ","$0.00 ","$218.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$218.35 ","$0.00 ","$109.18 ","$172.93 ","$174.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.19","SUP","Custom 27203010","","315.19  -  BIT DRILL 2MM 100MM 3 FLUTED QUICK COUPLING NONSTRL","BOTH IP/OP","$192.58 ","$142.51 ","$0.00 ","$186.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.98 ","$0.00 ","$93.49 ","$148.09 ","$149.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.21","SUP","Custom 27203010","","315.21  -  BIT DRILL 2MM 125MM 3 FLUTED QUICK COUPLING NONSTRL","BOTH IP/OP","$192.58 ","$142.51 ","$0.00 ","$186.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.98 ","$0.00 ","$93.49 ","$148.09 ","$149.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.23","SUP","Custom 27203010","","315.23  -  BIT DRILL 2.5MM 180MM 3 FLUTED NONSTRL","BOTH IP/OP","$209.45 ","$154.99 ","$0.00 ","$203.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.25","SUP","Custom 27203010","","315.25  -  BIT DRILL 2.5MM 110MM 3 FLUTED QUICK COUPLING NONSTRL","BOTH IP/OP","$209.45 ","$154.99 ","$0.00 ","$203.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.26","SUP","Custom 27203010","","315.26  -  BIT DRILL 3 FLUTED 2.7MM 110MM QUICK COUPLING NONSTRL","BOTH IP/OP","$216.48 ","$160.20 ","$0.00 ","$210.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.18 ","$0.00 ","$105.09 ","$166.46 ","$168.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.28","SUP","Custom 27203010","","315.28  -  BIT DRL 3 FLUT 2.7MM 125MM NS QC","BOTH IP/OP","$216.48 ","$160.20 ","$0.00 ","$210.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.18 ","$0.00 ","$105.09 ","$166.46 ","$168.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.29","SUP","Custom 27203010","","315.29  -  BIT DRL 3 FLUT 3.2MM 195MM NS QC","BOTH IP/OP","$258.65 ","$191.40 ","$0.00 ","$251.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.31","SUP","Custom 27203010","","315.31  -  BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NONSTRL","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$169.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.23 ","$0.00 ","$84.61 ","$134.03 ","$135.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.33","SUP","Custom 27203010","","315.330  -  BIT DRILL 3.2MM 210MM 68MM 3 FLUTED QUICK COUPLING","BOTH IP/OP","$302.98 ","$224.21 ","$0.00 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.98 ","$0.00 ","$151.49 ","$239.96 ","$242.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.35","SUP","Custom 27203010","","315.35  -  BIT DRILL 3.5MM 110MM 3 FLUTED QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$191.10 ","$141.41 ","$0.00 ","$185.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.53 ","$0.00 ","$92.76 ","$146.94 ","$148.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.37","SUP","Custom 27203010","","315.37  -  BIT DRILL 3.5MM 195MM 3 FLUTE QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$285.93 ","$211.59 ","$0.00 ","$277.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.58 ","$0.00 ","$138.79 ","$219.84 ","$222.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.4","SUP","Custom 27203010","","315.40  -  BIT DRILL 3 FLUTE 4MM 195MM QUICK COUPLING NONSTRL","BOTH IP/OP","$277.58 ","$205.41 ","$0.00 ","$277.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.58 ","$0.00 ","$138.79 ","$219.84 ","$222.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.4","SUP","Custom 27203010","","BIT DRILL 195MM 4MM QC 3 FLT NSTRL","BOTH IP/OP","$277.58 ","$205.41 ","$0.00 ","$277.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.58 ","$0.00 ","$138.79 ","$238.27 ","$222.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.44","SUP","Custom 27203010","","315.44  -  BIT DRILL 4.5MM 145MM QUICK COUPLING 3 FLUTE NONSTRL","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$169.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.23 ","$0.00 ","$84.61 ","$134.03 ","$135.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.48","SUP","Custom 27203010","","315.48  -  BIT DRL 3 FLUT 4.5MM 195MM NS QC","BOTH IP/OP","$258.65 ","$191.40 ","$0.00 ","$251.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.6","SUP","Custom 27203010","","315.60  -  BIT DRILL 6MM 195MM QUICK COUPLING 3 FLUTED NONSTRL","BOTH IP/OP","$324.80 ","$240.35 ","$0.00 ","$324.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$324.80 ","$0.00 ","$162.40 ","$257.24 ","$259.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.92","SUP","Custom 27203010","","315.92  -  BIT DRL 3 FLUT 2.5MM 230MM NS 200MM QC CLBRT","BOTH IP/OP","$350.03 ","$259.02 ","$0.00 ","$339.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$339.83 ","$0.00 ","$169.91 ","$269.15 ","$271.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315.93","SUP","Custom 27203010","","315.93  -  BIT DRILL 200MM 3.2MM 230MM 3 FLUTED QUICK COUPLING","BOTH IP/OP","$432.95 ","$320.38 ","$0.00 ","$420.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.35 ","$0.00 ","$210.18 ","$332.92 ","$336.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.001","SUP","Custom 27203010","","316.001  -  SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.002","SUP","Custom 27203010","","316.002  -  SPACER SPNL 0D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.003","SUP","Custom 27203010","","316.003  -  SPACER SPNL 0D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.004","SUP","Custom 27803010","","316.004  -  SPACER SPNL 0D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.005","SUP","Custom 27803010","","316.005  -  SPACER SPNL 0D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,190.00 ","$16,420.60 ","$0.00 ","$22,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,190.00 ","$0.00 ","$11,095.00 ","$17,574.48 ","$17,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.006","SUP","Custom 27803010","","316.006  -  SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.007","SUP","Custom 27803010","","316.007  -  SPACER SPNL 8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.008","SUP","Custom 27803010","","316.008  -  SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.009","SUP","Custom 27803010","","316.009  -  SPACER SPNL 8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.01","SUP","Custom 27803010","","316.010  -  SPACER SPNL 8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,190.00 ","$16,420.60 ","$0.00 ","$22,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,190.00 ","$0.00 ","$11,095.00 ","$17,574.48 ","$17,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.011","SUP","Custom 27803010","","316.011  -  SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.012","SUP","Custom 27803010","","316.012  -  SPACER SPNL 16D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.013","SUP","Custom 27803010","","316.013  -  SPACER SPNL 16D 25MM LG 30X63MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,190.00 ","$16,420.60 ","$0.00 ","$22,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,190.00 ","$0.00 ","$11,095.00 ","$17,574.48 ","$17,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.014","SUP","Custom 27803010","","316.014  -  SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.015","SUP","Custom 27803010","","316.015  -  SPACER SPNL 16D 25MM LG 30X48MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.016","SUP","Custom 27803010","","316.016  -  SPACER SPNL 16D 25MM LG 30X57MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.017","SUP","Custom 27803010","","316.017  -  SPACER SPNL 16D 25MM LG 30X74MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$23,740.00 ","$17,567.60 ","$0.00 ","$23,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,740.00 ","$0.00 ","$11,870.00 ","$18,802.08 ","$18,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.018","SUP","Custom 27803010","","316.018  -  SPACER SPNL 16D 25MM LG 30X91MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$23,740.00 ","$17,567.60 ","$0.00 ","$23,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,740.00 ","$0.00 ","$11,870.00 ","$18,802.08 ","$18,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.019","SUP","Custom 27803010","","316.019  -  SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.02","SUP","Custom 27803010","","316.020  -  SPACER SPNL -8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.021","SUP","Custom 27803010","","316.021  -  SPACER SPNL -8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.022","SUP","Custom 27803010","","316.022  -  SPACER SPNL -8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.023","SUP","Custom 27803010","","316.023  -  SPACER SPNL -8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,190.00 ","$16,420.60 ","$0.00 ","$22,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,190.00 ","$0.00 ","$11,095.00 ","$17,574.48 ","$17,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.024","SUP","Custom 27803010","","316.024  -  SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.025","SUP","Custom 27803010","","316.025  -  SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.026","SUP","Custom 27803010","","316.026  -  SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.027","SUP","Custom 27803010","","316.027  -  SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$20,400.00 ","$15,096.00 ","$0.00 ","$20,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,400.00 ","$0.00 ","$10,200.00 ","$16,156.80 ","$16,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.03","SUP","Custom 27203010","","316.03  -  BIT DRILL 44.5MM .7MM 3MM STOP UNV HALL CPLNG NONSTRL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.05","SUP","Custom 27203010","","316.05  -  BIT DRILL 44.5MM .76MM 5MM STOP UNV HALL CPLNG NONSTRL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.08","SUP","Custom 27203010","","316.08  -  BIT DRILL 44.5MM .76MM 8MM STOP UNV HALL CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.101","SUP","Custom 27803010","","316.101  -  SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.102","SUP","Custom 27803010","","316.102  -  SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.103","SUP","Custom 27803010","","316.103  -  SPACER SPNL 0D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.104","SUP","Custom 27803010","","316.104  -  SPACER SPNL 0D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.105","SUP","Custom 27803010","","316.105  -  SPACER SPNL 0D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.106","SUP","Custom 27803010","","316.106  -  SPACER SPNL 0D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.107","SUP","Custom 27803010","","316.107  -  SPACER SPNL 0D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.108","SUP","Custom 27803010","","316.108  -  SPACER SPNL 0D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.109","SUP","Custom 27803010","","316.109  -  SPACER SPNL 0D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.11","SUP","Custom 27803010","","316.110  -  SPACER SPNL 0D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.111","SUP","Custom 27803010","","316.111  -  SPACER SPNL 0D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,972.50 ","$14,039.65 ","$0.00 ","$18,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,972.50 ","$0.00 ","$9,486.25 ","$15,026.22 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.112","SUP","Custom 27803010","","316.112  -  SPACER SPNL 0D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,972.50 ","$14,039.65 ","$0.00 ","$18,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,972.50 ","$0.00 ","$9,486.25 ","$15,026.22 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.113","SUP","Custom 27803010","","316.113  -  SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.114","SUP","Custom 27803010","","316.114  -  SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.115","SUP","Custom 27803010","","316.115  -  SPACER SPNL 7D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.116","SUP","Custom 27803010","","316.116  -  SPACER SPNL 7D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.117","SUP","Custom 27803010","","316.117  -  SPACER SPNL 7D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.118","SUP","Custom 27803010","","316.118  -  SPACER SPNL 7D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.119","SUP","Custom 27803010","","316.119  -  SPACER SPNL 7D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.12","SUP","Custom 27803010","","316.120  -  SPACER SPNL 7D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.121","SUP","Custom 27803010","","316.121  -  SPACER SPNL 7D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.122","SUP","Custom 27803010","","316.122  -  SPACER SPNL 7D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.123","SUP","Custom 27803010","","316.123  -  SPACER SPNL 7D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,972.50 ","$14,039.65 ","$0.00 ","$18,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,972.50 ","$0.00 ","$9,486.25 ","$15,026.22 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.124","SUP","Custom 27803010","","316.124  -  SPACER SPNL 7D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,972.50 ","$14,039.65 ","$0.00 ","$18,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,972.50 ","$0.00 ","$9,486.25 ","$15,026.22 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.125","SUP","Custom 27803010","","316.125  -  SPACER SPNL 16D 13MM SM 15X56MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.126","SUP","Custom 27803010","","316.126  -  SPACER SPNL 16D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,540.00 ","$12,979.60 ","$0.00 ","$17,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,540.00 ","$0.00 ","$8,770.00 ","$13,891.68 ","$14,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.127","SUP","Custom 27803010","","316.127  -  SPACER SPNL 16D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,972.50 ","$14,039.65 ","$0.00 ","$18,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,972.50 ","$0.00 ","$9,486.25 ","$15,026.22 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.128","SUP","Custom 27803010","","316.128  -  SPACER SPNL 16D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,972.50 ","$14,039.65 ","$0.00 ","$18,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,972.50 ","$0.00 ","$9,486.25 ","$15,026.22 ","$15,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.129","SUP","Custom 27803010","","316.129  -  SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.13","SUP","Custom 27203010","","316.13  -  BIT DRL 3MM .7MM 44.5MM NS JLTCH CPLNG SLF STP STRYK","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.13","SUP","Custom 27803010","","316.130  -  SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$12,755.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$12,755.16 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.131","SUP","Custom 27803010","","316.131  -  SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.132","SUP","Custom 27803010","","316.132  -  SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$16,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,105.00 ","$0.00 ","$8,052.50 ","$12,755.16 ","$12,884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.15","SUP","Custom 27203010","","316.15  -  BIT DRILL 44.5MM .76MM CPLNG JLTCH STOP 5MM NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.18","SUP","Custom 27203010","","316.18  -  BIT DRILL 44.5MM .76MM JLTCH STOP 8MM NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.201","SUP","Custom 27803010","","316.201  -  SPACER SPNL 6D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.202","SUP","Custom 27803010","","316.202  -  SPACER SPNL 6D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.203","SUP","Custom 27803010","","316.203  -  SPACER SPNL 6D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,447.50 ","$14,391.15 ","$0.00 ","$19,447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,447.50 ","$0.00 ","$9,723.75 ","$15,402.42 ","$15,558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.204","SUP","Custom 27803010","","316.204  -  SPACER SPNL -6D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,807.50 ","$14,657.55 ","$0.00 ","$19,807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,807.50 ","$0.00 ","$9,903.75 ","$15,687.54 ","$15,846.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.205","SUP","Custom 27803010","","316.205  -  SPACER SPNL 6D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.206","SUP","Custom 27803010","","316.206  -  SPACER SPNL -6D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.207","SUP","Custom 27803010","","316.207  -  SPACER SPNL 0D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.208","SUP","Custom 27803010","","316.208  -  SPACER SPNL 0D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.209","SUP","Custom 27803010","","316.209  -  SPACER SPNL 0D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,447.50 ","$14,391.15 ","$0.00 ","$19,447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,447.50 ","$0.00 ","$9,723.75 ","$15,402.42 ","$15,558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.21","SUP","Custom 27803010","","316.210  -  SPACER SPNL 0D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,807.50 ","$14,657.55 ","$0.00 ","$19,807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,807.50 ","$0.00 ","$9,903.75 ","$15,687.54 ","$15,846.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.211","SUP","Custom 27803010","","316.211  -  SPACER SPNL 0D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.212","SUP","Custom 27803010","","316.212  -  SPACER SPNL 0D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.213","SUP","Custom 27803010","","316.213  -  SPACER SPNL 8D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$18,017.50 ","$13,332.95 ","$0.00 ","$18,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,017.50 ","$0.00 ","$9,008.75 ","$14,269.86 ","$14,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.214","SUP","Custom 27803010","","316.214  -  SPACER SPNL 8D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.215","SUP","Custom 27803010","","316.215  -  SPACER SPNL 8D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,447.50 ","$14,391.15 ","$0.00 ","$19,447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,447.50 ","$0.00 ","$9,723.75 ","$15,402.42 ","$15,558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.216","SUP","Custom 27803010","","316.216  -  SPACER SPNL 8D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,807.50 ","$14,657.55 ","$0.00 ","$19,807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,807.50 ","$0.00 ","$9,903.75 ","$15,687.54 ","$15,846.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.217","SUP","Custom 27803010","","316.217  -  SPACER SPNL 8D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.218","SUP","Custom 27803010","","316.218  -  SPACER SPNL 8D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.219","SUP","Custom 27803010","","316.219  -  SPACER SPNL 8D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.22","SUP","Custom 27803010","","316.220  -  SPACER SPNL 8D 21MM MED 23X42MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.221","SUP","Custom 27803010","","316.221  -  SPACER SPNL 0D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.222","SUP","Custom 27803010","","316.222  -  SPACER SPNL 0D 21MM MED 23X82MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$21,832.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,832.50 ","$0.00 ","$10,916.25 ","$17,291.34 ","$17,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.23","SUP","Custom 27203010","","316.23  -  BIT DRILL 60MM .7MM 3MM STOP QC","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.232","SUP","Custom 27203010","","316.232  -  BIT DRILL 60MM 1MM UNV HALL CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.235","SUP","Custom 27203010","","316.235  -  BIT DRL 1MM 60MM NS JLTCH CPLNG WO SLF STP STRYK","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.236","SUP","Custom 27203010","","316.236  -  BIT DRL 1MM 60MM NS JLTCH CPLNG STRYK MDLR HND SYS","BOTH IP/OP","$125.80 ","$93.09 ","$0.00 ","$122.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.13 ","$0.00 ","$61.06 ","$96.73 ","$97.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.238","SUP","Custom 27203010","","316.238  -  BIT DRILL 50MM 1MM MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.25","SUP","Custom 27203010","","316.25  -  BIT DRILL 44.5MM .76MM 5MM STOP MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.28","SUP","Custom 27203010","","316.28  -  BIT DRILL 8MM STOP QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.286","SUP","Custom 27203010","","316.286  -  BIT DRILL MINI .76MM 44.5MM 6MM MINI QUICK COUPLING STOP","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.288","SUP","Custom 27203010","","316.288  -  BIT DRILL MINI .76MM 44.5MM 8MM QUICK COUPLING STOP LCP","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.29","SUP","Custom 27203010","","316.290  -  BIT DRILL MINI .76MM 10MM QUICK COUPLING STAINLESS STEEL","BOTH IP/OP","$270.23 ","$199.97 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.292","SUP","Custom 27203010","","316.292  -  BIT DRILL MINI .76MM 44.5MM 12MM MINI QUICK COUPLING STOP","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.294","SUP","Custom 27203010","","316.294  -  BIT DRILL .76MM 44.5MM 14MM MINI QUICK COULPING STOP NONSTRL","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.301","SUP","Custom 27803010","","316.301  -  SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,062.50 ","$12,626.25 ","$0.00 ","$17,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,062.50 ","$0.00 ","$8,531.25 ","$13,513.50 ","$13,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.302","SUP","Custom 27803010","","316.302  -  SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,062.50 ","$12,626.25 ","$0.00 ","$17,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,062.50 ","$0.00 ","$8,531.25 ","$13,513.50 ","$13,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.303","SUP","Custom 27803010","","316.303  -  SPACER SPNL 0D 21MM S/MED 23X30MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,062.50 ","$12,626.25 ","$0.00 ","$17,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,062.50 ","$0.00 ","$8,531.25 ","$13,513.50 ","$13,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.304","SUP","Custom 27803010","","316.304  -  SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,062.50 ","$12,626.25 ","$0.00 ","$17,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,062.50 ","$0.00 ","$8,531.25 ","$13,513.50 ","$13,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.305","SUP","Custom 27803010","","316.305  -  SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$17,062.50 ","$12,626.25 ","$0.00 ","$17,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,062.50 ","$0.00 ","$8,531.25 ","$13,513.50 ","$13,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.306","SUP","Custom 27203010","","316.306  -  BIT DRL 6MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR MDLR","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.308","SUP","Custom 27203010","","316.308  -  BIT DRILL 8MM STOP .76MM 44.5MM J LATCH NONSTRL","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.31","SUP","Custom 27203010","","316.310  -  BIT DRL 10MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR","BOTH IP/OP","$270.23 ","$199.97 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.312","SUP","Custom 27203010","","316.312  -  BIT DRL 12MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.314","SUP","Custom 27203010","","316.314  -  BIT DRL 14MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR","BOTH IP/OP","$278.33 ","$205.96 ","$0.00 ","$270.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.23 ","$0.00 ","$135.11 ","$214.02 ","$216.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.33","SUP","Custom 27203010","","316.33  -  BIT DRILL 17MM .76MM 3MM STOP MINI QC 90D SCRDRVR NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.332","SUP","Custom 27203010","","316.332  -  BIT DRILL 65MM 1.3MM UNV HALL CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.335","SUP","Custom 27203010","","316.335  -  BIT DRILL 65MM 1.3MM JLTCH NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.338","SUP","Custom 27203010","","316.338  -  BIT DRILL 55MM 1.3MM MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.35","SUP","Custom 27203010","","316.35  -  BIT DRILL 19MM .76MM 5MM STOP MINI QC 90D SCRDRVR NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.38","SUP","Custom 27203010","","316.38  -  BIT DRILL 22MM .76MM 8MM STOP MINI QC 90D SCRDRVR NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.396","SUP","Custom 27203010","","316.396  -  BIT DRILL MINI 1MM 50MM QUICK COUPLING STAINLESS STEEL","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.401","SUP","Custom 27803010","","316.401  -  SPACER SPNL 0D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,922.50 ","$14,742.65 ","$0.00 ","$19,922.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,922.50 ","$0.00 ","$9,961.25 ","$15,778.62 ","$15,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.402","SUP","Custom 27803010","","316.402  -  BIT DRILL MINI 1.3MM 55MM QUICK COUPLING STAINLESS STEEL","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.403","SUP","Custom 27803010","","316.403  -  BIT DRILL 1.3MM 65MM J LATCH NONSTRL","BOTH IP/OP","$139.18 ","$102.99 ","$0.00 ","$135.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.10 ","$0.00 ","$67.55 ","$107.00 ","$108.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.404","SUP","Custom 27803010","","316.404  -  SPACER SPNL 0D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,070.00 ","$16,331.80 ","$0.00 ","$22,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,070.00 ","$0.00 ","$11,035.00 ","$17,479.44 ","$17,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.405","SUP","Custom 27803010","","316.405  -  SPACER SPNL 0D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,785.00 ","$16,860.90 ","$0.00 ","$22,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,785.00 ","$0.00 ","$11,392.50 ","$18,045.72 ","$18,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.406","SUP","Custom 27803010","","316.406  -  SPACER SPNL 0D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,785.00 ","$16,860.90 ","$0.00 ","$22,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,785.00 ","$0.00 ","$11,392.50 ","$18,045.72 ","$18,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.407","SUP","Custom 27803010","","316.407  -  SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,922.50 ","$14,742.65 ","$0.00 ","$19,922.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,922.50 ","$0.00 ","$9,961.25 ","$15,778.62 ","$15,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.408","SUP","Custom 27803010","","316.408  -  SPACER SPNL 3D 25MM MED LG 30X35MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,922.50 ","$14,742.65 ","$0.00 ","$19,922.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,922.50 ","$0.00 ","$9,961.25 ","$15,778.62 ","$15,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.409","SUP","Custom 27803010","","316.409  -  SPACER SPNL 3D 25MM MED LG 30X39MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,070.00 ","$16,331.80 ","$0.00 ","$22,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,070.00 ","$0.00 ","$11,035.00 ","$17,479.44 ","$17,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.41","SUP","Custom 27803010","","316.410  -  SPACER SPNL 3D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,070.00 ","$16,331.80 ","$0.00 ","$22,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,070.00 ","$0.00 ","$11,035.00 ","$17,479.44 ","$17,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.411","SUP","Custom 27803010","","316.411  -  SPACER SPNL 3D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,785.00 ","$16,860.90 ","$0.00 ","$22,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,785.00 ","$0.00 ","$11,392.50 ","$18,045.72 ","$18,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.412","SUP","Custom 27803010","","316.412  -  SPACER SPNL 3D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$22,785.00 ","$16,860.90 ","$0.00 ","$22,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,785.00 ","$0.00 ","$11,392.50 ","$18,045.72 ","$18,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.413","SUP","Custom 27803010","","316.413  -  SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,922.50 ","$14,742.65 ","$0.00 ","$19,922.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,922.50 ","$0.00 ","$9,961.25 ","$15,778.62 ","$15,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.414","SUP","Custom 27803010","","316.414  -  SPACER SPNL 3D 25MM MED LG 30X34MM NS LF XPAND-R RDLCNT SLF","BOTH IP/OP","$19,922.50 ","$14,742.65 ","$0.00 ","$19,922.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,922.50 ","$0.00 ","$9,961.25 ","$15,778.62 ","$15,938.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.441","SUP","Custom 27203010","","316.441  -  BIT DRL 4MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.442","SUP","Custom 27203010","","316.442  -  BIT DRL 6MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.443","SUP","Custom 27203010","","316.443  -  BIT DRL 8MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.446","SUP","Custom 27203010","","316.446  -  BIT DRILL 44.5MM 1MM JLTCH STOP 4MM NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.447","SUP","Custom 27203010","","316.447  -  BIT DRILL 6MM 1MM JLTCH STOP NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.448","SUP","Custom 27203010","","316.448  -  BIT DRILL 8MM 1MM JLTCH STOP NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.451","SUP","Custom 27203010","","316.451  -  BIT DRILL 1MM 4MM STOP MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.452","SUP","Custom 27203010","","316.452  -  BIT DRILL 44.5MM 1MM 6MM STOP MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.453","SUP","Custom 27203010","","316.453  -  BIT DRILL 44.5MM 1MM 8MM STOP MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.605","SUP","Custom 27203010","","316.605  -  BIT DRILL 52MM .76MM 5MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.608","SUP","Custom 27203010","","316.608  -  BIT DRILL 52MM .76MM 8MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.614","SUP","Custom 27203010","","316.614  -  BIT DRILL 52MM 1MM 4MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.616","SUP","Custom 27203010","","316.616  -  BIT DRILL 52MM 1MM 6MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.618","SUP","Custom 27203010","","316.618  -  BIT DRILL 52MM 1MM 8MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.624","SUP","Custom 27203010","","316.624  -  BIT DRILL 1.1MM STOP HEX 4MM 1.5MM CRANFCL SCR NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.626","SUP","Custom 27203010","","316.626  -  BIT DRILL 52MM 1.1MM 6MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.628","SUP","Custom 27203010","","316.628  -  BIT DRILL 52MM 1.1MM 8MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.632","SUP","Custom 27203010","","316.632  -  BIT DRILL 52MM 1.1MM 12MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.644","SUP","Custom 27203010","","316.644  -  BIT DRILL 52MM 1.5MM 4MM STOP HEX CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"317.852","SUP","Custom 27203010","","317.852  -  BIT DRILL 110MM 2MM UNV HALL CPLNG NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.855","SUP","Custom 27203010","","317.855  -  BIT DRL 2MM 110MM NS JLTCH CPLNG WO SLF STP STRYK","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.856","SUP","Custom 27203010","","317.856  -  BIT DRILL 125MM 2MM JLTCH","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.858","SUP","Custom 27203010","","317.858  -  BIT DRILL 110MM 2MM MINI QC NONSTRL","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.861","SUP","Custom 27203010","","317.861  -  BIT DRL 1.8MM 80MM NS MNQK CPLNG D MRK","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.867","SUP","Custom 27203010","","317.867  -  BIT DRL 1.8MM 90MM NS JLTCH CPLNG 2.4MM SCR MDLR HND SYS","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.871","SUP","Custom 27203010","","317.871  -  BIT DRL 2.4MM 80MM NS MNQK CPLNG 2.4MM SCR MDLR HND SYS","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.872","SUP","Custom 27203010","","317.872  -  BIT DRL 2.4MM 90MM NS JLTCH CPLNG STRYK","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.875","SUP","Custom 27203010","","317.875  -  BIT DRL 6MM 1.5MM 100MM NS QC TROC STP","BOTH IP/OP","$380.25 ","$281.39 ","$0.00 ","$380.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.25 ","$0.00 ","$190.13 ","$301.16 ","$304.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.876","SUP","Custom 27203010","","317.876  -  BIT DRL 8-18MM 1.5MM 100MM NS QC TROC CLBRT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.877","SUP","Custom 27203010","","317.877  -  BIT DRL 6MM 1.8MM 100MM NS QC TROC STP","BOTH IP/OP","$380.25 ","$281.39 ","$0.00 ","$380.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.25 ","$0.00 ","$190.13 ","$301.16 ","$304.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.878","SUP","Custom 27203010","","317.878  -  BIT DRL 8-18MM 1.8MM 100MM NS QC TROC CLBRT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"319.006","SUP","Custom 27203010","","319.006  -  GAUGE DEPTH 2 MM 2.4 MM SCREW","BOTH IP/OP","$1,083.80 ","$802.01 ","$0.00 ","$1,052.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,052.23 ","$0.00 ","$526.11 ","$833.37 ","$841.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"319.01","SUP","Custom 27203010","","319.01  -  GAUGE DEPTH MEASURE LCP NONSTRL 2.7/3.5/4 MM SCREW","BOTH IP/OP","$761.88 ","$563.79 ","$0.00 ","$739.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$739.70 ","$0.00 ","$369.85 ","$585.84 ","$591.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323.062","SUP","Custom 27203010","","323.062  -  BIT DRL 2MM 140MM NS QC D MRK","BOTH IP/OP","$279.73 ","$207.00 ","$0.00 ","$271.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$271.58 ","$0.00 ","$135.79 ","$215.09 ","$217.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323.36","SUP","Custom 27203010","","323.36  -  GUIDE DRILL 3.5MM LCP UNV","BOTH IP/OP","$815.30 ","$603.32 ","$0.00 ","$1,013.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,013.33 ","$0.00 ","$506.66 ","$802.56 ","$810.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323.46","SUP","Custom 27203010","","323.46  -  GUIDE DRILL UNIVERSAL 4.5MM LC-DCP","BOTH IP/OP","$774.53 ","$573.15 ","$0.00 ","$751.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$751.98 ","$0.00 ","$375.99 ","$595.57 ","$601.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.101","SUP","Custom 27203010","","324.101  -  HOLDER IMPL VCTR ANT CERV SPN TEMP INS SLFRET HLD SLV ANT","BOTH IP/OP","$264.25 ","$195.55 ","$0.00 ","$264.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.25 ","$0.00 ","$132.13 ","$209.29 ","$211.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.153","SUP","Custom 27203010","","324.153  -  BIT DRL 2.5MM 14MM NS STP","BOTH IP/OP","$516.25 ","$382.03 ","$0.00 ","$516.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$516.25 ","$0.00 ","$258.13 ","$408.87 ","$413.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.155","SUP","Custom 27203010","","324.155  -  BIT DRL 2.5MM 16MM NS STP","BOTH IP/OP","$516.25 ","$382.03 ","$0.00 ","$516.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$516.25 ","$0.00 ","$258.13 ","$408.87 ","$413.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.174","SUP","HCPCS C1769","","324.174  -  GUIDEWIRE ORTHOPEDIC 2.5MM NONSTRL 5MM SCREW","BOTH IP/OP","$275.53 ","$203.89 ","$0.00 ","$267.50 ","$145.25 ","$0.00 ","$57.43 ","$0.00 ","$0.00 ","$46.84 ","$267.50 ","$0.00 ","$133.75 ","$211.86 ","$214.00 ","$0.00 ","$40.64 ","$0.00 ","$42.59 ","$0.00 "
"324.203","SUP","Custom 27203010","","324.203  -  GUIDE DRILL 4.3MM THREAD PERCUTANEOUS","BOTH IP/OP","$718.30 ","$531.54 ","$0.00 ","$697.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.38 ","$0.00 ","$348.69 ","$552.32 ","$557.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.21","SUP","Custom 27203010","","324.210  -  BIT DRL 2.5MM 300MM NS 200MM QC CLBRT","BOTH IP/OP","$341.20 ","$252.49 ","$0.00 ","$341.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.20 ","$0.00 ","$170.60 ","$270.23 ","$272.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.211","SUP","Custom 27203010","","324.211  -  BIT DRL 2.8MM 300MM NS 200MM QC CLBRT","BOTH IP/OP","$351.43 ","$260.06 ","$0.00 ","$341.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.20 ","$0.00 ","$170.60 ","$270.23 ","$272.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.212","SUP","Custom 27203010","","324.212  -  BIT DRL 3.2MM 300MM NS QC CLBRT PERC","BOTH IP/OP","$351.43 ","$260.06 ","$0.00 ","$341.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.20 ","$0.00 ","$170.60 ","$270.23 ","$272.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.213","SUP","Custom 27203010","","324.213  -  BIT DRL 4.3MM 300MM NS QC CLBRT PERC","BOTH IP/OP","$351.43 ","$260.06 ","$0.00 ","$341.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.20 ","$0.00 ","$170.60 ","$270.23 ","$272.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"324.214","SUP","Custom 27203010","","324.214  -  BIT DRL 2.8MM 200MM NS QC CLBRT","BOTH IP/OP","$324.73 ","$240.30 ","$0.00 ","$315.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.25 ","$0.00 ","$157.63 ","$249.68 ","$252.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"325.16","SUP","Custom 27203010","","325.160  -  ROD EXFIX 3MM 270MM THREAD SELF DRILL NONSTRL","BOTH IP/OP","$459.93 ","$340.35 ","$0.00 ","$459.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$459.93 ","$0.00 ","$229.96 ","$364.26 ","$367.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"328.16","SUP","Custom 27203010","","328.160  -  ROD EXFIX 5MM 380MM THREADED SLFDRILL TIP NONSTRL","BOTH IP/OP","$556.83 ","$412.05 ","$0.00 ","$556.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.83 ","$0.00 ","$278.41 ","$441.01 ","$445.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"328.17","SUP","Custom 27203010","","328.170  -  ROD EXFIX BLUNT 5MM 1.6MM 335MM THREAD CANN NONSTRL","BOTH IP/OP","$556.83 ","$412.05 ","$0.00 ","$556.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.83 ","$0.00 ","$278.41 ","$441.01 ","$445.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"329.08","SUP","Custom 27203010","","329.08  -  IRON BENDING NONSTRL 3.5/4.5 MM RECONSTRUCTION PLATE","BOTH IP/OP","$603.05 ","$446.26 ","$0.00 ","$585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$585.48 ","$0.00 ","$292.74 ","$463.70 ","$468.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336.105","SUP","HCPCS C1713","","336.105  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 5MM","BOTH IP/OP","$4,877.50 ","$3,609.35 ","$0.00 ","$4,877.50 ","$2,194.88 ","$0.00 ","$1,016.59 ","$0.00 ","$0.00 ","$854.01 ","$4,877.50 ","$0.00 ","$2,438.75 ","$3,862.98 ","$3,902.00 ","$0.00 ","$763.33 ","$0.00 ","$776.50 ","$0.00 "
"336.107","SUP","HCPCS C1713","","336.107  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 7MM","BOTH IP/OP","$4,877.50 ","$3,609.35 ","$0.00 ","$4,877.50 ","$2,194.88 ","$0.00 ","$1,016.59 ","$0.00 ","$0.00 ","$854.01 ","$4,877.50 ","$0.00 ","$2,438.75 ","$3,862.98 ","$3,902.00 ","$0.00 ","$763.33 ","$0.00 ","$776.50 ","$0.00 "
"336.109","SUP","HCPCS C1713","","336.109  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 9MM","BOTH IP/OP","$4,877.50 ","$3,609.35 ","$0.00 ","$4,877.50 ","$2,194.88 ","$0.00 ","$1,016.59 ","$0.00 ","$0.00 ","$854.01 ","$4,877.50 ","$0.00 ","$2,438.75 ","$3,862.98 ","$3,902.00 ","$0.00 ","$763.33 ","$0.00 ","$776.50 ","$0.00 "
"336.111","SUP","HCPCS C1713","","336.111  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 11MM","BOTH IP/OP","$4,877.50 ","$3,609.35 ","$0.00 ","$4,877.50 ","$2,194.88 ","$0.00 ","$1,016.59 ","$0.00 ","$0.00 ","$854.01 ","$4,877.50 ","$0.00 ","$2,438.75 ","$3,862.98 ","$3,902.00 ","$0.00 ","$763.33 ","$0.00 ","$776.50 ","$0.00 "
"336.113","SUP","HCPCS C1713","","336.113  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 13MM","BOTH IP/OP","$4,877.50 ","$3,609.35 ","$0.00 ","$4,877.50 ","$2,194.88 ","$0.00 ","$1,016.59 ","$0.00 ","$0.00 ","$854.01 ","$4,877.50 ","$0.00 ","$2,438.75 ","$3,862.98 ","$3,902.00 ","$0.00 ","$763.33 ","$0.00 ","$776.50 ","$0.00 "
"337.92","SUP","Custom 27203010","","337.92  -  CANNULA OPHTHALMIC 45D 25GA GRIESHABER DSP STERILE","BOTH IP/OP","$540.75 ","$400.16 ","$0.00 ","$540.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.75 ","$0.00 ","$270.38 ","$428.27 ","$432.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338.002","SUP","Custom 27203010","","338.002  -  GUIDEWIRE ORTHOPEDIC 2.5MM 300MM 12MM DRILL TIP THEADED","BOTH IP/OP","$132.13 ","$97.78 ","$0.00 ","$128.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.28 ","$0.00 ","$64.14 ","$101.60 ","$102.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338.13","SUP","Custom 27203010","","338.13  -  REAMER SURG 3 COMPLETE DHS NONSTRL","BOTH IP/OP","$2,684.88 ","$1,986.81 ","$0.00 ","$2,606.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,606.68 ","$0.00 ","$1,303.34 ","$2,064.49 ","$2,085.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338.17","SUP","Custom 27203010","","338.17  -  TAP SURG 220MM DHS/DCS 12.5MM SCREWS","BOTH IP/OP","$656.45 ","$485.77 ","$0.00 ","$637.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$637.35 ","$0.00 ","$318.68 ","$504.78 ","$509.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338.31","SUP","Custom 27203010","","338.31  -  GUIDE SURG COUPLING SCREW SOLID LATEX FREE DHS/DCS STAINLESS","BOTH IP/OP","$746.43 ","$552.36 ","$0.00 ","$724.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$724.68 ","$0.00 ","$362.34 ","$573.95 ","$579.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338.333","SUP","Custom 27203010","","338.333  -  REAMER SURG HEAD DHS","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338.348","SUP","HCPCS C1713","","338.348  -  IMPACTOR SURG CAP LCP DHHS","BOTH IP/OP","$271.30 ","$200.76 ","$0.00 ","$263.40 ","$118.53 ","$0.00 ","$56.55 ","$0.00 ","$0.00 ","$46.12 ","$263.40 ","$0.00 ","$131.70 ","$208.61 ","$210.72 ","$0.00 ","$40.02 ","$0.00 ","$41.93 ","$0.00 "
"339.21","SUP","Custom 27203010","","339.21  -  PROBE VITRECTOMY 30D 25GA DSP POINTED TIP DIATHERMY","BOTH IP/OP","$695.25 ","$514.49 ","$0.00 ","$695.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$695.25 ","$0.00 ","$347.63 ","$550.64 ","$556.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.715","SUP","Custom 27803010","","342.715  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.717","SUP","Custom 27803010","","342.717  -  SPACER SPNL 0D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.719","SUP","Custom 27803010","","342.719  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.721","SUP","Custom 27803010","","342.721  -  SPACER SPNL 0D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.723","SUP","Custom 27803010","","342.723  -  SPACER SPNL 0D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.725","SUP","Custom 27803010","","342.725  -  SPACER SPNL 0D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.727","SUP","Custom 27803010","","342.727  -  SPACER SPNL 0D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.729","SUP","Custom 27803010","","342.729  -  SPACER SPNL 0D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.731","SUP","Custom 27803010","","342.731  -  SPACER SPNL 0D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.733","SUP","Custom 27803010","","342.733  -  SPACER SPNL 0D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.815","SUP","Custom 27803010","","342.815  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.817","SUP","Custom 27803010","","342.817  -  SPACER SPNL 7D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.819","SUP","Custom 27803010","","342.819  -  SPACER SPNL 7D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.821","SUP","Custom 27803010","","342.821  -  SPACER SPNL 7D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.823","SUP","Custom 27803010","","342.823  -  SPACER SPNL 7D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.825","SUP","Custom 27803010","","342.825  -  SPACER SPNL 7D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.827","SUP","Custom 27803010","","342.827  -  SPACER SPNL 7D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.829","SUP","Custom 27803010","","342.829  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.831","SUP","Custom 27803010","","342.831  -  SPACER SPNL 7D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.833","SUP","Custom 27803010","","342.833  -  SPACER SPNL 7D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.915","SUP","Custom 27803010","","342.915  -  SPACER SPNL 5D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.917","SUP","Custom 27803010","","342.917  -  SPACER SPNL 5D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.919","SUP","Custom 27803010","","342.919  -  SPACER SPNL 5D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.921","SUP","Custom 27803010","","342.921  -  SPACER SPNL 5D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.923","SUP","Custom 27803010","","342.923  -  SPACER SPNL 5D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.925","SUP","Custom 27803010","","342.925  -  SPACER SPNL 5D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.927","SUP","Custom 27803010","","342.927  -  SPACER SPNL 5D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.929","SUP","Custom 27803010","","342.929  -  SPACER SPNL 5D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.931","SUP","Custom 27803010","","342.931  -  SPACER SPNL 5D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342.933","SUP","Custom 27803010","","342.933  -  SPACER SPNL 5D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM","BOTH IP/OP","$7,635.00 ","$5,649.90 ","$0.00 ","$7,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,635.00 ","$0.00 ","$3,817.50 ","$6,046.92 ","$6,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.001","SUP","Custom 27803010","","351.001  -  ENDPLATE SPNL 0D 14MM 14X15MM NS LF FORTIFY-R FTPRNT NO SPK","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.002","SUP","Custom 27803010","","351.002  -  ENDPLATE SPNL 0D 14MM 14X17MM NS LF FORTIFY-R FTPRNT","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.003","SUP","Custom 27803010","","351.003  -  ENDPLATE SPNL 3.5D 14MM 14X17MM NS LF FORTIFY-R FTPRNT NO","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.004","SUP","Custom 27803010","","351.004  -  ENDPLATE SPNL 3.5D 14MM 14X19MM NS LF FORTIFY-R FTPRNT","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.005","SUP","Custom 27803010","","351.005  -  ENDPLATE SPNL 0D 14MM 14X16MM NS LF FORTIFY-R FTPRNT NO SPK","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.006","SUP","Custom 27803010","","351.006  -  ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.007","SUP","Custom 27803010","","351.007  -  ENDPLATE SPNL 3.5D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.008","SUP","Custom 27803010","","351.008  -  ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.009","SUP","Custom 27803010","","351.009  -  ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO SPK","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.01","SUP","Custom 27803010","","351.010  -  ENDPLATE SPNL 0D 14MM 14X20MM NS LF FORTIFY-R FTPRNT","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.011","SUP","Custom 27803010","","351.011  -  ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT NO","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.012","SUP","Custom 27803010","","351.012  -  ENDPLATE SPNL 3.5D 14MM 14X22MM NS LF FORTIFY-R FTPRNT","BOTH IP/OP","$19,050.00 ","$14,097.00 ","$0.00 ","$19,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,050.00 ","$0.00 ","$9,525.00 ","$15,087.60 ","$15,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.05","SUP","Custom 27803010","","351.050  -  ENDPLATE SPNL 14MM 14X24MM NS LF FORTIFY-R","BOTH IP/OP","$18,600.00 ","$13,764.00 ","$0.00 ","$18,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,600.00 ","$0.00 ","$9,300.00 ","$14,731.20 ","$14,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.051","SUP","Custom 27803010","","351.051  -  ENDPLATE SPNL 14MM 14X28MM NS LF FORTIFY-R","BOTH IP/OP","$18,600.00 ","$13,764.00 ","$0.00 ","$18,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,600.00 ","$0.00 ","$9,300.00 ","$14,731.20 ","$14,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.052","SUP","Custom 27803010","","351.052  -  ENDPLATE SPNL 14MM 14X35MM NS LF FORTIFY-R","BOTH IP/OP","$18,600.00 ","$13,764.00 ","$0.00 ","$18,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,600.00 ","$0.00 ","$9,300.00 ","$14,731.20 ","$14,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.053","SUP","Custom 27803010","","351.053  -  ENDPLATE SPNL 14MM 14X49MM NS LF FORTIFY-R","BOTH IP/OP","$18,600.00 ","$13,764.00 ","$0.00 ","$18,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,600.00 ","$0.00 ","$9,300.00 ","$14,731.20 ","$14,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.054","SUP","Custom 27803010","","351.054  -  ENDPLATE SPNL 14MM 14X66MM NS LF FORTIFY-R","BOTH IP/OP","$18,600.00 ","$13,764.00 ","$0.00 ","$18,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,600.00 ","$0.00 ","$9,300.00 ","$14,731.20 ","$14,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.15","SUP","Custom 27803010","","351.150  -  ENDPLATE SPNL 14MM 20X26MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.151","SUP","Custom 27803010","","351.151  -  ENDPLATE SPNL 20MM 20X28MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.152","SUP","Custom 27803010","","351.152  -  ENDPLATE SPNL 20MM 20X33MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.153","SUP","Custom 27803010","","351.153  -  ENDPLATE SPNL 20MM 20X43MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.154","SUP","Custom 27803010","","351.154  -  ENDPLATE SPNL 20MM 20X61MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.155","SUP","Custom 27803010","","351.155  -  ENDPLATE SPNL 20MM 20X80MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.156","SUP","Custom 27803010","","351.156  -  ENDPLATE SPNL 20MM 20X99MM NS LF FORTIFY-R","BOTH IP/OP","$23,600.00 ","$17,464.00 ","$0.00 ","$23,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,600.00 ","$0.00 ","$11,800.00 ","$18,691.20 ","$18,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.27","SUP","Custom 27203010","","351.27  -  BIT DRILL 13MM 300MM CANN NONSTRL","BOTH IP/OP","$1,117.40 ","$826.88 ","$0.00 ","$1,084.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,084.85 ","$0.00 ","$542.43 ","$859.20 ","$867.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.3","SUP","HCPCS C1713","","351.300  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT NO","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.301","SUP","HCPCS C1713","","351.301  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.302","SUP","HCPCS C1713","","351.302  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.303","SUP","HCPCS C1713","","351.303  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.304","SUP","HCPCS C1713","","351.304  -  SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.311","SUP","HCPCS C1713","","351.311  -  SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.313","SUP","HCPCS C1713","","351.313  -  SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.314","SUP","HCPCS C1713","","351.314  -  SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.321","SUP","HCPCS C1713","","351.321  -  SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"351.323","SUP","HCPCS C1713","","351.323  -  SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"351.324","SUP","HCPCS C1713","","351.324  -  SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"351.351","SUP","HCPCS C1713","","351.351  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.353","SUP","HCPCS C1713","","351.353  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.354","SUP","HCPCS C1713","","351.354  -  SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.361","SUP","HCPCS C1713","","351.361  -  SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.363","SUP","HCPCS C1713","","351.363  -  SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.364","SUP","HCPCS C1713","","351.364  -  SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.371","SUP","HCPCS C1713","","351.371  -  SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"351.373","SUP","HCPCS C1713","","351.373  -  SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"351.374","SUP","HCPCS C1713","","351.374  -  SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"351.401","SUP","HCPCS C1713","","351.401  -  SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"351.403","SUP","HCPCS C1713","","351.403  -  SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"351.404","SUP","HCPCS C1713","","351.404  -  SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"351.411","SUP","HCPCS C1713","","351.411  -  SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.413","SUP","HCPCS C1713","","351.413  -  SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.414","SUP","HCPCS C1713","","351.414  -  SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.431","SUP","HCPCS C1713","","351.431  -  SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.433","SUP","HCPCS C1713","","351.433  -  SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.434","SUP","HCPCS C1713","","351.434  -  SPACER SPNL 8D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.451","SUP","HCPCS C1713","","351.451  -  SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"351.453","SUP","HCPCS C1713","","351.453  -  SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"351.454","SUP","HCPCS C1713","","351.454  -  SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,335.00 ","$987.90 ","$0.00 ","$1,335.00 ","$600.75 ","$0.00 ","$278.25 ","$0.00 ","$0.00 ","$233.75 ","$1,335.00 ","$0.00 ","$667.50 ","$1,057.32 ","$1,068.00 ","$0.00 ","$208.93 ","$0.00 ","$212.53 ","$0.00 "
"351.461","SUP","HCPCS C1713","","351.461  -  SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.463","SUP","HCPCS C1713","","351.463  -  SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.464","SUP","HCPCS C1713","","351.464  -  SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.481","SUP","HCPCS C1713","","351.481  -  SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.483","SUP","HCPCS C1713","","351.483  -  SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.485","SUP","HCPCS C1713","","351.485  -  SPACER SPNL 12D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.486","SUP","HCPCS C1713","","351.486  -  SPACER SPNL 16D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"351.92","SUP","Custom 27203010","","351.92  -  REAMER HAND 6MM 450MM NONSTRL","BOTH IP/OP","$548.48 ","$405.88 ","$0.00 ","$532.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$532.50 ","$0.00 ","$266.25 ","$421.74 ","$426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.95","SUP","Custom 27203010","","351.95  -  REAMER HAND 9MM 450MM NONSTRL","BOTH IP/OP","$567.45 ","$419.91 ","$0.00 ","$550.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.93 ","$0.00 ","$275.46 ","$436.34 ","$440.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.04","SUP","Custom 27203010","","352.04  -  MANIPULATOR SURG FLEXIBLE STEM 5MM","BOTH IP/OP","$4,752.58 ","$3,516.91 ","$0.00 ","$5,855.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,855.00 ","$0.00 ","$2,927.50 ","$4,637.16 ","$4,684.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.085","SUP","Custom 27203010","","352.085  -  HEAD RMR 8.5MM MDLRY","BOTH IP/OP","$587.88 ","$435.03 ","$0.00 ","$570.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$570.75 ","$0.00 ","$285.38 ","$452.03 ","$456.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.1","SUP","Custom 27203010","","352.100  -  REAMER SURG 10MM HEAD SDCT MDLRY NSTRL","BOTH IP/OP","$678.55 ","$502.13 ","$0.00 ","$678.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$678.55 ","$0.00 ","$339.28 ","$537.41 ","$542.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.165","SUP","Custom 27203010","","352.165  -  REAMER SURG 16.5MM HEAD SIDE CUT MEDULLARY NONSTRL","BOTH IP/OP","$719.88 ","$532.71 ","$0.00 ","$719.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.88 ","$0.00 ","$359.94 ","$570.14 ","$575.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"355.9","SUP","Custom 27203010","","355.90  -  BIT DRILL 4.5MM 4MM 225MM QUICK COUPLING NONSTRL","BOTH IP/OP","$362.55 ","$268.29 ","$0.00 ","$362.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.55 ","$0.00 ","$181.28 ","$287.14 ","$290.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"356.95","SUP","Custom 27203010","","356.95  -  BIT DRILL 4MM 4.5MM 225MM QUICK COUPLING 3 FLUTED NONSTRL","BOTH IP/OP","$446.28 ","$330.25 ","$0.00 ","$446.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"356.97","SUP","Custom 27203010","","356.97  -  BIT DRILL 3.2MM 215MM 80MM 3 FLUTED CALIBRATED QUICK","BOTH IP/OP","$408.45 ","$302.25 ","$0.00 ","$396.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$396.55 ","$0.00 ","$198.28 ","$314.07 ","$317.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"356.972","SUP","Custom 27203010","","356.972  -  BIT DRILL 82MM CALIBRATION 3.2MM 215MM QUICK COUPLING 3","BOTH IP/OP","$404.08 ","$299.02 ","$0.00 ","$392.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.30 ","$0.00 ","$196.15 ","$310.70 ","$313.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"356.98","SUP","Custom 27203010","","356.98  -  BIT DRILL 4MM 270MM 95MM 3 FLUTED CALIBRATED QUICK COUPLING","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$463.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$463.13 ","$0.00 ","$231.56 ","$366.80 ","$370.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"356.982","SUP","Custom 27203010","","356.982  -  BIT DRILL 4MM 215MM 80MM 3 FLUTED CALIBRATED QUICK COUPLING","BOTH IP/OP","$462.43 ","$342.20 ","$0.00 ","$448.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$448.95 ","$0.00 ","$224.48 ","$355.57 ","$359.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.039","SUP","Custom 27203010","","357.039  -  GUIDEWIRE ORTHOPEDIC 2.8MM 350MM THREADED TROCAR POINT","BOTH IP/OP","$92.78 ","$68.66 ","$0.00 ","$90.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.08 ","$0.00 ","$45.04 ","$71.34 ","$72.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.047","SUP","Custom 27203010","","357.047  -  BIT DRILL 6.5MM 330MM QUICK COUPLING CANN","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.099","SUP","Custom 27203010","","357.099  -  BIT DRILL 5MM 330MM 100MM 3 FLUTED CALIBRATED QUICK COUPLING","BOTH IP/OP","$567.93 ","$420.27 ","$0.00 ","$567.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.93 ","$0.00 ","$283.96 ","$449.80 ","$454.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.394","SUP","Custom 27203010","","357.394  -  BIT DRL 17MM 300MM NS CNN LG QC","BOTH IP/OP","$1,514.18 ","$1,120.49 ","$0.00 ","$1,470.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,470.08 ","$0.00 ","$735.04 ","$1,164.30 ","$1,176.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.399","SUP","Custom 27203010","","357.399  -  GUIDEWIRE ORTHOPEDIC 3.2MM 400MM THREAD TIBIA NONSTRL","BOTH IP/OP","$186.73 ","$138.18 ","$0.00 ","$181.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$181.28 ","$0.00 ","$90.64 ","$143.57 ","$145.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.403","SUP","Custom 27203010","","357.403  -  BIT DRILL 6/10MM 435MM LARGE QUICK COUPLING CANN TAPERED","BOTH IP/OP","$1,088.23 ","$805.29 ","$0.00 ","$1,056.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.53 ","$0.00 ","$528.26 ","$836.77 ","$845.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.404","SUP","Custom 27203010","","357.404  -  BIT DRILL LARGE 11MM 280MM LARGE QUICK COUPLING CANN TAPERED","BOTH IP/OP","$959.85 ","$710.29 ","$0.00 ","$931.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$931.90 ","$0.00 ","$465.95 ","$738.06 ","$745.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"357.407","SUP","Custom 27203010","","357.407  -  BIT DRL 65MM 3 FLUT 4MM 260MM NS QC CLBRT","BOTH IP/OP","$392.40 ","$290.38 ","$0.00 ","$380.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.98 ","$0.00 ","$190.49 ","$301.74 ","$304.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"358.691","SUP","Custom 27203010","","358.691  -  BIT DRILL 102MM STOP 4.5MM 170MM 102MM JACOBS CHUCK CANN","BOTH IP/OP","$693.98 ","$513.55 ","$0.00 ","$693.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$693.98 ","$0.00 ","$346.99 ","$549.63 ","$555.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"359.079","SUP","Custom 27203010","","359.079  -  BIT DRILL LARGE 10.5MM 250MM QUICK COUPLING CANN FLEXIBLE","BOTH IP/OP","$921.20 ","$681.69 ","$0.00 ","$921.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$921.20 ","$0.00 ","$460.60 ","$729.59 ","$736.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"359.081","SUP","Custom 27203010","","359.081  -  BIT DRILL LARGE 8MM 250MM QUICK COUPLING CANN FLEXIBLE","BOTH IP/OP","$921.20 ","$681.69 ","$0.00 ","$921.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$921.20 ","$0.00 ","$460.60 ","$729.59 ","$736.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.01","SUP","Custom 27203010","","360.01  -  BIT DRILL LARGE 6MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,097.85 ","$812.41 ","$0.00 ","$1,065.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,065.88 ","$0.00 ","$532.94 ","$844.18 ","$852.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.02","SUP","Custom 27203010","","360.02  -  BIT DRILL LARGE 7MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,097.85 ","$812.41 ","$0.00 ","$1,065.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,065.88 ","$0.00 ","$532.94 ","$844.18 ","$852.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.03","SUP","Custom 27203010","","360.03  -  BIT DRILL LARGE 8MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,097.85 ","$812.41 ","$0.00 ","$1,065.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,065.88 ","$0.00 ","$532.94 ","$844.18 ","$852.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.04","SUP","Custom 27203010","","360.04  -  BIT DRILL LARGE 9MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,097.85 ","$812.41 ","$0.00 ","$1,065.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,065.88 ","$0.00 ","$532.94 ","$844.18 ","$852.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.05","SUP","Custom 27203010","","360.05  -  BIT DRILL LARGE 10MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,097.85 ","$812.41 ","$0.00 ","$1,065.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,065.88 ","$0.00 ","$532.94 ","$844.18 ","$852.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.06","SUP","Custom 27203010","","360.06  -  BIT DRILL LARGE 11MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,152.68 ","$852.98 ","$0.00 ","$1,119.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,119.10 ","$0.00 ","$559.55 ","$886.33 ","$895.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.07","SUP","Custom 27203010","","360.07  -  BIT DRILL LARGE 12MM 190MM QUICK COUPLING CANN NONSTRL","BOTH IP/OP","$1,152.68 ","$852.98 ","$0.00 ","$1,119.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,119.10 ","$0.00 ","$559.55 ","$886.33 ","$895.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.257","SUP","Custom 27203010","","360.257  -  BIT DRL 13MM 385MM NS LG QC FLXB","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"360.258","SUP","Custom 27203010","","360.258  -  BIT DRL 15.5MM 385MM NS LG QC FLXB","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.009","SUP","Custom 27803010","","364.009  -  SPACER SPNL 0D 20MM XS 25X9MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.011","SUP","Custom 27803010","","364.011  -  SPACER SPNL 0D 20MM XS 25X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.013","SUP","Custom 27803010","","364.013  -  SPACER SPNL 0D 20MM XS 25X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.015","SUP","Custom 27803010","","364.015  -  SPACER SPNL 0D 20MM XS 25X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.017","SUP","Custom 27803010","","364.017  -  SPACER SPNL 0D 20MM XS 25X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.109","SUP","Custom 27803010","","364.109  -  SPACER SPNL 0D 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.111","SUP","Custom 27803010","","364.111  -  SPACER SPNL 0D 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.113","SUP","Custom 27803010","","364.113  -  SPACER SPNL 0D 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.115","SUP","Custom 27803010","","364.115  -  SPACER SPNL 0D 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.117","SUP","Custom 27803010","","364.117  -  SPACER SPNL 0D 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.209","SUP","Custom 27803010","","364.209  -  SPACER SPNL 8D LRDTC 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.211","SUP","Custom 27803010","","364.211  -  SPACER SPNL 8D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.213","SUP","Custom 27803010","","364.213  -  SPACER SPNL 8D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.215","SUP","Custom 27803010","","364.215  -  SPACER SPNL 8D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.217","SUP","Custom 27803010","","364.217  -  SPACER SPNL 8D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.311","SUP","Custom 27803010","","364.311  -  SPACER SPNL 15D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.313","SUP","Custom 27803010","","364.313  -  SPACER SPNL 15D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.315","SUP","Custom 27803010","","364.315  -  SPACER SPNL 15D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.317","SUP","Custom 27803010","","364.317  -  SPACER SPNL 15D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.409","SUP","Custom 27803010","","364.409  -  SPACER SPNL 0D 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.411","SUP","Custom 27803010","","364.411  -  SPACER SPNL 0D 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.413","SUP","Custom 27803010","","364.413  -  SPACER SPNL 0D 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.415","SUP","Custom 27803010","","364.415  -  SPACER SPNL 0D 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.417","SUP","Custom 27803010","","364.417  -  SPACER SPNL 0D 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.419","SUP","Custom 27803010","","364.419  -  SPACER SPNL 0D 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.421","SUP","Custom 27803010","","364.421  -  SPACER SPNL 0D 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.509","SUP","Custom 27803010","","364.509  -  SPACER SPNL 8D LRDTC 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.511","SUP","Custom 27803010","","364.511  -  SPACER SPNL 8D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.513","SUP","Custom 27803010","","364.513  -  SPACER SPNL 8D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.515","SUP","Custom 27803010","","364.515  -  SPACER SPNL 8D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.517","SUP","Custom 27803010","","364.517  -  SPACER SPNL 8D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.519","SUP","Custom 27803010","","364.519  -  SPACER SPNL 8D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.521","SUP","Custom 27803010","","364.521  -  SPACER SPNL 8D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.611","SUP","Custom 27803010","","364.611  -  SPACER SPNL 15D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.613","SUP","Custom 27803010","","364.613  -  SPACER SPNL 15D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.615","SUP","Custom 27803010","","364.615  -  SPACER SPNL 15D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.617","SUP","Custom 27803010","","364.617  -  SPACER SPNL 15D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.619","SUP","Custom 27803010","","364.619  -  SPACER SPNL 15D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.621","SUP","Custom 27803010","","364.621  -  SPACER SPNL 15D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.711","SUP","Custom 27803010","","364.711  -  SPACER SPNL 8D LRDTC 28MM LG 39X11MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.713","SUP","Custom 27803010","","364.713  -  SPACER SPNL 8D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.715","SUP","Custom 27803010","","364.715  -  SPACER SPNL 8D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.717","SUP","Custom 27803010","","364.717  -  SPACER SPNL 8D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.719","SUP","Custom 27803010","","364.719  -  SPACER SPNL 8D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.721","SUP","Custom 27803010","","364.721  -  SPACER SPNL 8D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.759","SUP","Custom 27803010","","364.759  -  CONTINENTAL ALIF SPACER, LARGE 5 DEG, 9MM","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.813","SUP","Custom 27803010","","364.813  -  SPACER SPNL 15D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.815","SUP","Custom 27803010","","364.815  -  SPACER SPNL 15D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.817","SUP","Custom 27803010","","364.817  -  SPACER SPNL 15D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.819","SUP","Custom 27803010","","364.819  -  SPACER SPNL 15D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"364.821","SUP","Custom 27803010","","364.821  -  SPACER SPNL 15D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF","BOTH IP/OP","$13,642.50 ","$10,095.45 ","$0.00 ","$13,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,642.50 ","$0.00 ","$6,821.25 ","$10,804.86 ","$10,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.005","SUP","Custom 27803010","","365.005  -  SPACER SPNL 11MM SM PRLL 12X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.006","SUP","Custom 27803010","","365.006  -  SPACER SPNL 11MM SM PRLL 12X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.007","SUP","Custom 27803010","","365.007  -  SPACER SPNL 11MM SM PRLL 12X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.008","SUP","Custom 27803010","","365.008  -  SPACER SPNL 11MM SM PRLL 12X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.009","SUP","Custom 27803010","","365.009  -  SPACER SPNL 11MM SM PRLL 12X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.01","SUP","Custom 27803010","","365.010  -  SPACER SPNL 11MM SM PRLL 12X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.011","SUP","Custom 27803010","","365.011  -  SPACER SPNL 11MM SM PRLL 12X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.012","SUP","Custom 27803010","","365.012  -  SPACER SPNL 11MM SM PRLL 12X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.045","SUP","Custom 27803010","","365.045  -  SPACER SPNL 15MM 2XL PRLL 18X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.046","SUP","Custom 27803010","","365.046  -  SPACER SPNL 15MM 2XL PRLL 18X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.047","SUP","Custom 27803010","","365.047  -  SPACER SPNL 15MM 2XL PRLL 18X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.048","SUP","Custom 27803010","","365.048  -  SPACER SPNL 15MM 2XL PRLL 18X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.049","SUP","Custom 27803010","","365.049  -  SPACER SPNL 15MM 2XL PRLL 18X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.05","SUP","Custom 27803010","","365.050  -  SPACER SPNL 15MM 2XL PRLL 18X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.051","SUP","Custom 27803010","","365.051  -  SPACER SPNL 15MM 2XL PRLL 18X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.052","SUP","Custom 27803010","","365.052  -  SPACER SPNL 15MM 2XL PRLL 18X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.065","SUP","Custom 27803010","","365.065  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.066","SUP","Custom 27803010","","365.066  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.067","SUP","Custom 27803010","","365.067  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.068","SUP","Custom 27803010","","365.068  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.069","SUP","Custom 27803010","","365.069  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.07","SUP","Custom 27803010","","365.070  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.071","SUP","Custom 27803010","","365.071  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.072","SUP","Custom 27803010","","365.072  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.105","SUP","Custom 27803010","","365.105  -  SPACER SPNL 7D LRDTC 11MM SM 12X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.106","SUP","Custom 27803010","","365.106  -  SPACER SPNL 7D LRDTC 11MM SM 12X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.107","SUP","Custom 27803010","","365.107  -  SPACER SPNL 7D LRDTC 11MM SM 12X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.108","SUP","Custom 27803010","","365.108  -  SPACER SPNL 7D LRDTC 11MM SM 12X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.109","SUP","Custom 27803010","","365.109  -  SPACER SPNL 7D LRDTC 11MM SM 12X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.11","SUP","Custom 27803010","","365.110  -  SPACER SPNL 7D LRDTC 11MM SM 12X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.111","SUP","Custom 27803010","","365.111  -  SPACER SPNL 7D LRDTC 11MM SM 12X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.112","SUP","Custom 27803010","","365.112  -  SPACER SPNL 7D LRDTC 11MM SM 12X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.305","SUP","Custom 27803010","","365.305  -  SPACER SPNL 12MM LG PRLL 14X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.306","SUP","Custom 27803010","","365.306  -  SPACER SPNL 12MM LG PRLL 14X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.307","SUP","Custom 27803010","","365.307  -  SPACER SPNL 12MM LG PRLL 14X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.308","SUP","Custom 27803010","","365.308  -  SPACER SPNL 12MM LG PRLL 14X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.309","SUP","Custom 27803010","","365.309  -  SPACER SPNL 12MM LG PRLL 14X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.31","SUP","Custom 27803010","","365.310  -  SPACER SPNL 12MM LG PRLL 14X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.311","SUP","Custom 27803010","","365.311  -  SPACER SPNL 12MM LG PRLL 14X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.312","SUP","Custom 27803010","","365.312  -  SPACER SPNL 12MM LG PRLL 14X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.405","SUP","Custom 27803010","","365.405  -  SPACER SPNL 7D LRDTC 12MM LG 14X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.406","SUP","Custom 27803010","","365.406  -  SPACER SPNL 7D LRDTC 12MM LG 14X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.407","SUP","Custom 27803010","","365.407  -  SPACER SPNL 7D LRDTC 12MM LG 14X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.408","SUP","Custom 27803010","","365.408  -  SPACER SPNL 7D LRDTC 12MM LG 14X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.409","SUP","Custom 27803010","","365.409  -  SPACER SPNL 7D LRDTC 12MM LG 14X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.41","SUP","Custom 27803010","","365.410  -  SPACER SPNL 7D LRDTC 12MM LG 14X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.411","SUP","Custom 27803010","","365.411  -  SPACER SPNL 7D LRDTC 12MM LG 14X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.412","SUP","Custom 27803010","","365.412  -  SPACER SPNL 7D LRDTC 12MM LG 14X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.705","SUP","Custom 27803010","","365.705  -  SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.706","SUP","Custom 27803010","","365.706  -  SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.707","SUP","Custom 27803010","","365.707  -  SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.708","SUP","Custom 27803010","","365.708  -  SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.709","SUP","Custom 27803010","","365.709  -  SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.71","SUP","Custom 27803010","","365.710  -  SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.711","SUP","Custom 27803010","","365.711  -  SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.712","SUP","Custom 27803010","","365.712  -  SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.805","SUP","Custom 27803010","","365.805  -  SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.806","SUP","Custom 27803010","","365.806  -  SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.807","SUP","Custom 27803010","","365.807  -  SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.808","SUP","Custom 27803010","","365.808  -  SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.809","SUP","Custom 27803010","","365.809  -  SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.81","SUP","Custom 27803010","","365.810  -  SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.811","SUP","Custom 27803010","","365.811  -  SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"365.812","SUP","Custom 27803010","","365.812  -  SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.207","SUP","Custom 27803010","","368.207  -  SPACER SPNL SM 28X10X7MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.208","SUP","Custom 27803010","","368.208  -  SPACER SPNL SM 28X10X8MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.209","SUP","Custom 27803010","","368.209  -  SPACER SPNL SM 28X10X9MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.21","SUP","Custom 27803010","","368.210  -  SPACER SPNL SM 28X10X10MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.211","SUP","Custom 27803010","","368.211  -  SPACER SPNL SM 28X10X11MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.212","SUP","Custom 27803010","","368.212  -  SPACER SPNL SM 28X10X12MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.213","SUP","Custom 27803010","","368.213  -  SPACER SPNL SM 28X10X13MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.215","SUP","Custom 27803010","","368.215  -  SPACER SPNL SM 28X10X15MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.217","SUP","Custom 27803010","","368.217  -  SPACER SPNL SM 28X10X17MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.307","SUP","Custom 27803010","","368.307  -  SPACER SPNL LG 33X11X7MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.308","SUP","Custom 27803010","","368.308  -  SPACER SPNL LG 33X11X8MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.309","SUP","Custom 27803010","","368.309  -  SPACER SPNL LG 33X11X9MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.31","SUP","Custom 27803010","","368.310  -  SPACER SPNL LG 33X11X10MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.311","SUP","Custom 27803010","","368.311  -  SPACER SPNL LG 33X11X11MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.312","SUP","Custom 27803010","","368.312  -  SPACER SPNL LG 33X11X12MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.313","SUP","Custom 27803010","","368.313  -  SPACER SPNL LG 33X11X13MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.315","SUP","Custom 27803010","","368.315  -  SPACER SPNL LG 33X11X15MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"368.317","SUP","Custom 27803010","","368.317  -  SPACER SPNL LG 33X11X17MM NS SGNTR PEEK TLIF","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.008","SUP","Custom 27803010","","375.008  -  TRANSCONTINENTAL LLIF SPACER, SMALL, 0 DEG, 8MM","BOTH IP/OP","$19,642.50 ","$14,535.45 ","$0.00 ","$19,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,642.50 ","$0.00 ","$9,821.25 ","$15,556.86 ","$15,714.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.009","SUP","Custom 27803010","","375.009  -  SPACER SPNL 0D SM 45X18X9MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.011","SUP","Custom 27803010","","375.011  -  SPACER SPNL 0D SM 45X18X11MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.013","SUP","Custom 27803010","","375.013  -  SPACER SPNL 0D SM 45X18X13MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.015","SUP","Custom 27803010","","375.015  -  SPACER SPNL 0D SM 45X18X15MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.017","SUP","Custom 27803010","","375.017  -  SPACER SPNL 0D SM 45X18X17MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.019","SUP","Custom 27803010","","375.019  -  SPACER SPNL 0D SM 45X18X19MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.021","SUP","Custom 27803010","","375.021  -  SPACER SPNL 0D SM 45X18X21MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.109","SUP","Custom 27803010","","375.109  -  SPACER SPNL 6D LRDTC SM 45X18X9MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.111","SUP","Custom 27803010","","375.111  -  SPACER SPNL 6D LRDTC SM 45X18X11MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.113","SUP","Custom 27803010","","375.113  -  SPACER SPNL 6D LRDTC SM 45X18X13MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.115","SUP","Custom 27803010","","375.115  -  SPACER SPNL 6D LRDTC SM 45X18X15MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.117","SUP","Custom 27803010","","375.117  -  SPACER SPNL 6D LRDTC SM 45X18X17MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.119","SUP","Custom 27803010","","375.119  -  SPACER SPNL 6D LRDTC SM 45X18X19MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.121","SUP","Custom 27803010","","375.121  -  SPACER SPNL 6D LRDTC SM 45X18X21MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.209","SUP","Custom 27803010","","375.209  -  SPACER SPNL 0D MED 50X18X9MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.211","SUP","Custom 27803010","","375.211  -  SPACER SPNL 0D MED 50X18X11MM NS LF TRANSCONTINENTAL PEEK","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.213","SUP","Custom 27803010","","375.213  -  SPACER SPNL 0D MED 50X18X13MM NS LF TRANSCONTINENTAL PEEK","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.215","SUP","Custom 27803010","","375.215  -  SPACER SPNL 0D MED 50X18X15MM NS LF TRANSCONTINENTAL PEEK","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.217","SUP","Custom 27803010","","375.217  -  SPACER SPNL 0D MED 50X18X17MM NS LF TRANSCONTINENTAL PEEK","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.219","SUP","Custom 27803010","","375.219  -  SPACER SPNL 0D MED 50X18X19MM NS LF TRANSCONTINENTAL PEEK","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.221","SUP","Custom 27803010","","375.221  -  SPACER SPNL 0D MED 50X18X21MM NS LF TRANSCONTINENTAL PEEK","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.309","SUP","Custom 27803010","","375.309  -  SPACER SPNL 6D LRDTC MED 50X18X9MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.311","SUP","Custom 27803010","","375.311  -  SPACER SPNL 6D LRDTC MED 50X18X11MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.313","SUP","Custom 27803010","","375.313  -  SPACER SPNL 6D LRDTC MED 50X18X13MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.315","SUP","Custom 27803010","","375.315  -  SPACER SPNL 6D LRDTC MED 50X18X15MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.317","SUP","Custom 27803010","","375.317  -  SPACER SPNL 6D LRDTC MED 50X18X17MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.319","SUP","Custom 27803010","","375.319  -  SPACER SPNL 6D LRDTC MED 50X18X19MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.321","SUP","Custom 27803010","","375.321  -  SPACER SPNL 6D LRDTC MED 50X18X21MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.409","SUP","Custom 27803010","","375.409  -  SPACER SPNL 0D LG 55X18X9MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.411","SUP","Custom 27803010","","375.411  -  SPACER SPNL 0D LG 55X18X11MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.413","SUP","Custom 27803010","","375.413  -  SPACER SPNL 0D LG 55X18X13MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.415","SUP","Custom 27803010","","375.415  -  SPACER SPNL 0D LG 55X18X15MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.417","SUP","Custom 27803010","","375.417  -  SPACER SPNL 0D LG 55X18X17MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.419","SUP","Custom 27803010","","375.419  -  SPACER SPNL 0D LG 55X18X19MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.421","SUP","Custom 27803010","","375.421  -  SPACER SPNL 0D LG 55X18X21MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.509","SUP","Custom 27803010","","375.509  -  SPACER SPNL 6D LRDTC LG 55X18X9MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.511","SUP","Custom 27803010","","375.511  -  SPACER SPNL 6D LRDTC LG 55X18X11MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.513","SUP","Custom 27803010","","375.513  -  SPACER SPNL 6D LRDTC LG 55X18X13MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.515","SUP","Custom 27803010","","375.515  -  SPACER SPNL 6D LRDTC LG 55X18X15MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.517","SUP","Custom 27803010","","375.517  -  SPACER SPNL 6D LRDTC LG 55X18X17MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.519","SUP","Custom 27803010","","375.519  -  SPACER SPNL 6D LRDTC LG 55X18X19MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.521","SUP","Custom 27803010","","375.521  -  SPACER SPNL 6D LRDTC LG 55X18X21MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.609","SUP","Custom 27803010","","375.609  -  SPACER SPNL 0D XL 60X18X9MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.611","SUP","Custom 27803010","","375.611  -  SPACER SPNL 0D XL 60X18X11MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.613","SUP","Custom 27803010","","375.613  -  SPACER SPNL 0D XL 60X18X13MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.615","SUP","Custom 27803010","","375.615  -  SPACER SPNL 0D XL 60X18X15MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.617","SUP","Custom 27803010","","375.617  -  SPACER SPNL 0D XL 60X18X17MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.619","SUP","Custom 27803010","","375.619  -  SPACER SPNL 0D XL 60X18X19MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.621","SUP","Custom 27803010","","375.621  -  SPACER SPNL 0D XL 60X18X21MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.709","SUP","Custom 27803010","","375.709  -  SPACER SPNL 6D LRDTC XL 60X18X9MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.711","SUP","Custom 27803010","","375.711  -  SPACER SPNL 6D LRDTC XL 60X18X11MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.713","SUP","Custom 27803010","","375.713  -  SPACER SPNL 6D LRDTC XL 60X18X13MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.715","SUP","Custom 27803010","","375.715  -  SPACER SPNL 6D LRDTC XL 60X18X15MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.717","SUP","Custom 27803010","","375.717  -  SPACER SPNL 6D LRDTC XL 60X18X17MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.719","SUP","Custom 27803010","","375.719  -  SPACER SPNL 6D LRDTC XL 60X18X19MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.721","SUP","Custom 27803010","","375.721  -  SPACER SPNL 6D LRDTC XL 60X18X21MM NS LF TRANSCONTINENTAL","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.809","SUP","Custom 27803010","","375.809  -  SPACER SPNL 0D XS 40X18X9MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.811","SUP","Custom 27803010","","375.811  -  SPACER SPNL 0D XS 40X18X11MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.813","SUP","Custom 27803010","","375.813  -  SPACER SPNL 0D XS 40X18X13MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.815","SUP","Custom 27803010","","375.815  -  SPACER SPNL 0D XS 40X18X15MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375.817","SUP","Custom 27803010","","375.817  -  SPACER SPNL 0D XS 40X18X17MM NS LF TRANSCONTINENTAL PEEK LAT","BOTH IP/OP","$21,065.00 ","$15,588.10 ","$0.00 ","$21,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,065.00 ","$0.00 ","$10,532.50 ","$16,683.48 ","$16,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.111","SUP","Custom 27803010","","376.111  -  INDEPENDENCE SPACER, SMALL, 8&DEG, 11MM","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.113","SUP","Custom 27803010","","376.113  -  SPACER SPNL 8D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.115","SUP","Custom 27803010","","376.115  -  SPACER SPNL 8D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.117","SUP","Custom 27803010","","376.117  -  SPACER SPNL 8D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.211","SUP","Custom 27803010","","376.211  -  SPACER SPNL 15D LRDTC 24MM SM 30X11MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.213","SUP","Custom 27803010","","376.213  -  SPACER SPNL 15D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.215","SUP","Custom 27803010","","376.215  -  SPACER SPNL 15D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.217","SUP","Custom 27803010","","376.217  -  SPACER SPNL 15D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.411","SUP","Custom 27803010","","376.411  -  INDEPENDENCE SPACER, MEDIUM, 8&DEG, 11MM","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.413","SUP","Custom 27803010","","376.413  -  SPACER SPNL 8D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.415","SUP","Custom 27803010","","376.415  -  INDEPENDENCE SPACER, MEDIUM, 8&DEG, 15MM","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.417","SUP","Custom 27803010","","376.417  -  SPACER SPNL 8D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.419","SUP","Custom 27803010","","376.419  -  SPACER SPNL 8D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.421","SUP","Custom 27803010","","376.421  -  SPACER SPNL 8D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.511","SUP","Custom 27803010","","376.511  -  SPACER SPNL 15D LRDTC 26MM MED 24X11MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.513","SUP","Custom 27803010","","376.513  -  SPACER SPNL 15D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.515","SUP","Custom 27803010","","376.515  -  SPACER SPNL 15D LRDTC 26MM MED 34X15MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.517","SUP","Custom 27803010","","376.517  -  SPACER SPNL 15D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.519","SUP","Custom 27803010","","376.519  -  SPACER SPNL 15D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.521","SUP","Custom 27803010","","376.521  -  SPACER SPNL 15D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.711","SUP","Custom 27803010","","376.711  -  SPACER SPNL 8D LRDTC 29MM LG 39X11MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.713","SUP","Custom 27803010","","376.713  -  SPACER SPNL 8D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.715","SUP","Custom 27803010","","376.715  -  SPACER SPNL 8D LRDTC 29MM LG 39X15MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.717","SUP","Custom 27803010","","376.717  -  SPACER SPNL 8D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.719","SUP","Custom 27803010","","376.719  -  SPACER SPNL 8D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.721","SUP","Custom 27803010","","376.721  -  SPACER SPNL 8D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.813","SUP","Custom 27803010","","376.813  -  SPACER SPNL 15D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.815","SUP","Custom 27803010","","376.815  -  INDEPENDENCE SPACER, LARGE, 15&DEG, 15MM","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.817","SUP","Custom 27803010","","376.817  -  SPACER SPNL 15D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.819","SUP","Custom 27803010","","376.819  -  SPACER SPNL 15D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"376.821","SUP","Custom 27803010","","376.821  -  SPACER SPNL 15D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK","BOTH IP/OP","$25,250.00 ","$18,685.00 ","$0.00 ","$25,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,250.00 ","$0.00 ","$12,625.00 ","$19,998.00 ","$20,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.006","SUP","Custom 27803010","","384.006  -  SPACER SPNL 0D 12MM 14X6MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.007","SUP","Custom 27803010","","384.007  -  SPACER SPNL 0D 12MM 14X7MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.008","SUP","Custom 27803010","","384.008  -  SPACER SPNL 0D 12MM 14X8MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.009","SUP","Custom 27803010","","384.009  -  SPACER SPNL 0D 12MM 14X9MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.01","SUP","Custom 27803010","","384.010  -  SPACER SPNL 0D 12MM 14X10MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.011","SUP","Custom 27803010","","384.011  -  SPACER SPNL 0D 12MM 14X11MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.012","SUP","Custom 27803010","","384.012  -  SPACER SPNL 0D 12MM 14X12MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.106","SUP","Custom 27803010","","384.106  -  SPACER SPNL 7D LRDTC 12MM 14X6MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.107","SUP","Custom 27803010","","384.107  -  SPACER SPNL 7D LRDTC 12MM 14X7MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.108","SUP","Custom 27803010","","384.108  -  SPACER SPNL 7D LRDTC 12MM 14X8MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.109","SUP","Custom 27803010","","384.109  -  SPACER SPNL 7D LRDTC 12MM 14X9MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.11","SUP","Custom 27803010","","384.110  -  SPACER SPNL 7D LRDTC 12MM 14X10MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.111","SUP","Custom 27803010","","384.111  -  SPACER SPNL 7D LRDTC 12MM 14X11MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.112","SUP","Custom 27803010","","384.112  -  SPACER SPNL 7D LRDTC 12MM 14X12MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.206","SUP","Custom 27803010","","384.206  -  SPACER SPNL 0D 14MM 16X6MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.207","SUP","Custom 27803010","","384.207  -  SPACER SPNL 0D 14MM 16X7MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.208","SUP","Custom 27803010","","384.208  -  SPACER SPNL 0D 14MM 16X8MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.209","SUP","Custom 27803010","","384.209  -  SPACER SPNL 0D 14MM 16X9MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.21","SUP","Custom 27803010","","384.210  -  SPACER SPNL 0D 14MM 16X10MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.211","SUP","Custom 27803010","","384.211  -  SPACER SPNL 0D 14MM 16X14MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.212","SUP","Custom 27803010","","384.212  -  SPACER SPNL 0D 14MM 16X12MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.306","SUP","Custom 27803010","","384.306  -  SPACER SPNL 7D LRDTC 14MM 16X6MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.307","SUP","Custom 27803010","","384.307  -  SPACER SPNL 7D LRDTC 14MM 16X7MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.308","SUP","Custom 27803010","","384.308  -  SPACER SPNL 7D LRDTC 14MM 16X8MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.309","SUP","Custom 27803010","","384.309  -  SPACER SPNL 7D LRDTC 14MM 16X9MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.31","SUP","Custom 27803010","","384.310  -  SPACER SPNL 7D LRDTC 14MM 16X10MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.311","SUP","Custom 27803010","","384.311  -  SPACER SPNL 7D LRDTC 14MM 16X11MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.312","SUP","Custom 27803010","","384.312  -  SPACER SPNL 7D LRDTC 14MM 16X12MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.406","SUP","Custom 27803010","","384.406  -  SPACER SPNL 0D 15MM 18X6MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.407","SUP","Custom 27803010","","384.407  -  SPACER SPNL 0D 15MM 18X7MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.408","SUP","Custom 27803010","","384.408  -  SPACER SPNL 0D 15MM 18X8MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.409","SUP","Custom 27803010","","384.409  -  SPACER SPNL 0D 15MM 18X9MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.41","SUP","Custom 27803010","","384.410  -  SPACER SPNL 0D 15MM 18X10MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.411","SUP","Custom 27803010","","384.411  -  SPACER SPNL 0D 15MM 18X11MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.412","SUP","Custom 27803010","","384.412  -  SPACER SPNL 0D 15MM 18X12MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.506","SUP","Custom 27803010","","384.506  -  SPACER SPNL 7D LRDTC 15MM 18X6MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.507","SUP","Custom 27803010","","384.507  -  SPACER SPNL 7D LRDTC 15MM 18X7MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.508","SUP","Custom 27803010","","384.508  -  SPACER SPNL 7D LRDTC 15MM 18X8MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.509","SUP","Custom 27803010","","384.509  -  SPACER SPNL 7D LRDTC 15MM 18X9MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.51","SUP","Custom 27803010","","384.510  -  SPACER SPNL 7D LRDTC 15MM 18X10MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.511","SUP","Custom 27803010","","384.511  -  SPACER SPNL 7D LRDTC 15MM 18X11MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"384.512","SUP","Custom 27803010","","384.512  -  SPACER SPNL 7D LRDTC 15MM 18X12MM NS LF COALITION PEEK ACDF","BOTH IP/OP","$12,052.50 ","$8,918.85 ","$0.00 ","$12,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,052.50 ","$0.00 ","$6,026.25 ","$9,545.58 ","$9,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"387.21","SUP","Custom 27203010","","387.21  -  BIT DRILL THORPE","BOTH IP/OP","$375.75 ","$278.06 ","$0.00 ","$375.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.75 ","$0.00 ","$187.88 ","$297.59 ","$300.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"387.604","SUP","Custom 27203010","","387.604  -  BIT DRILL 3MM QC STOP","BOTH IP/OP","$444.50 ","$328.93 ","$0.00 ","$444.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$444.50 ","$0.00 ","$222.25 ","$352.04 ","$355.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"388.174","SUP","Custom 27203010","","388.174  -  BIT DRILL 91MM 1.5MM STOP 4-12MM NONSTRL","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"388.175","SUP","Custom 27203010","","388.175  -  BIT DRILL 91MM STOP ARCH 1.5MM NONSTRL QUICK COUPLING","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"388.177","SUP","Custom 27203010","","388.177  -  BIT DRILL 91MM 10MM STOP 1.5MM NONSTRL","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"388.178","SUP","Custom 27203010","","388.178  -  BIT DRILL 91MM 1.5MM 12MM STOP GUIDE NONSTRL","BOTH IP/OP","$224.00 ","$165.76 ","$0.00 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$224.00 ","$0.00 ","$112.00 ","$177.41 ","$179.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"388.394","SUP","Custom 27203010","","388.394  -  BIT DRL 65MM 2.4MM NS QC STP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"388.868","SUP","HCPCS C1713","","388.868  -  TRIAL SPNL 3.5MM ROD","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$211.50 ","$0.00 ","$97.96 ","$0.00 ","$0.00 ","$82.29 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$73.56 ","$0.00 ","$74.82 ","$0.00 "
"388.906","SUP","HCPCS C1713","","388.906  -  TEMPLATE ROD 150MM NS COAT 5.5MM ROD","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$201.38 ","$0.00 ","$93.27 ","$0.00 ","$0.00 ","$78.35 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$70.03 ","$0.00 ","$71.24 ","$0.00 "
"388.907","SUP","Custom 27203010","","388.907  -  TEMPLATE ROD 500MM NS COAT 5/5.5MM ROD","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.002","SUP","Custom 27203010","","390.002  -  CLAMP EXFIX LARGE 6 POSITION MULTIPIN MR CONDITIONAL NONSTRL","BOTH IP/OP","$1,205.30 ","$891.92 ","$0.00 ","$1,170.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,170.18 ","$0.00 ","$585.09 ","$926.78 ","$936.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.003","SUP","HCPCS C1713","","390.003  -  ROD EXFIX ATTCH NONSTRL LARGE MULTIPIN CLMP","BOTH IP/OP","$675.05 ","$499.54 ","$0.00 ","$655.40 ","$294.93 ","$0.00 ","$140.70 ","$0.00 ","$0.00 ","$114.76 ","$655.40 ","$0.00 ","$327.70 ","$519.08 ","$524.32 ","$0.00 ","$99.58 ","$0.00 ","$104.34 ","$0.00 "
"390.004","SUP","Custom 27203010","","390.004  -  CLAMP EXFIX LARGE 4 POSITION MULTIPIN MR CONDITIONAL NONSTRL","BOTH IP/OP","$1,128.43 ","$835.04 ","$0.00 ","$1,095.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,095.55 ","$0.00 ","$547.78 ","$867.68 ","$876.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.005","SUP","Custom 27203010","","390.005  -  CLAMP EXFIX LARGE COMBO NONSTRL","BOTH IP/OP","$1,053.80 ","$779.81 ","$0.00 ","$1,023.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,023.10 ","$0.00 ","$511.55 ","$810.30 ","$818.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.006","SUP","Custom 27203010","","390.006  -  CLIP XTRNFX NS DYN MR CONDITIONAL LG CMBN CLP","BOTH IP/OP","$167.10 ","$123.65 ","$0.00 ","$162.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.23 ","$0.00 ","$81.11 ","$128.49 ","$129.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.007","SUP","Custom 27203010","","390.007  -  CLAMP EXFIX TUBE TO TUBE MR CONDITIONAL NONSTRL","BOTH IP/OP","$1,088.33 ","$805.36 ","$0.00 ","$1,056.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.63 ","$0.00 ","$528.31 ","$836.85 ","$845.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.008","SUP","Custom 27203010","","390.008  -  CLAMP EXFIX LARGE OPEN ADJUSTABLE NONSTRL","BOTH IP/OP","$873.33 ","$646.26 ","$0.00 ","$847.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$847.90 ","$0.00 ","$423.95 ","$671.54 ","$678.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.009","SUP","Custom 27203010","","390.009  -  CLAMP EXFIX LARGE 4 POSITION PIN NONSTRL LARGE EXFIX","BOTH IP/OP","$729.63 ","$539.93 ","$0.00 ","$708.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$708.38 ","$0.00 ","$354.19 ","$561.04 ","$566.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.01","SUP","Custom 27203010","","390.010  -  CLAMP EXFIX LARGE 6 POSITION PIN NONSTRL","BOTH IP/OP","$727.85 ","$538.61 ","$0.00 ","$727.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$727.85 ","$0.00 ","$363.93 ","$576.46 ","$582.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.011","SUP","Custom 27203010","","390.011  -  POST EXFIX STR 11MM OUTRIGGER NONSTRL","BOTH IP/OP","$197.18 ","$145.91 ","$0.00 ","$191.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.43 ","$0.00 ","$95.71 ","$151.61 ","$153.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.012","SUP","Custom 27203010","","390.012  -  POST EXFIX 30D 11MM OUTRIGGER MR SAFE NONSTRL","BOTH IP/OP","$197.18 ","$145.91 ","$0.00 ","$191.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.43 ","$0.00 ","$95.71 ","$151.61 ","$153.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.013","SUP","Custom 27203010","","390.013  -  POST EXFIX 90D 11MM OUTRIGGER NONSTRL","BOTH IP/OP","$217.23 ","$160.75 ","$0.00 ","$210.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.90 ","$0.00 ","$105.45 ","$167.03 ","$168.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.026","SUP","Custom 27203010","","390.026  -  CLAMP EXFIX MEDIUM 4 POSISTION PIN MR SAFE NONSTRL","BOTH IP/OP","$689.53 ","$510.25 ","$0.00 ","$669.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$669.45 ","$0.00 ","$334.73 ","$530.20 ","$535.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.027","SUP","Custom 27203010","","390.027  -  CLAMP EXFIX MEDIUM 6 POSISTION PIN MR SAFE NONSTRL","BOTH IP/OP","$707.35 ","$523.44 ","$0.00 ","$686.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.75 ","$0.00 ","$343.38 ","$543.91 ","$549.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.028","SUP","Custom 27203010","","390.028  -  POST XTRNFX STRG 8MM NS OTRGR MR CONDITIONAL","BOTH IP/OP","$187.15 ","$138.49 ","$0.00 ","$181.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$181.70 ","$0.00 ","$90.85 ","$143.91 ","$145.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.029","SUP","Custom 27203010","","390.029  -  POST XTRNFX 30D 8MM NS OTRGR MR CONDITIONAL","BOTH IP/OP","$187.15 ","$138.49 ","$0.00 ","$181.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$181.70 ","$0.00 ","$90.85 ","$143.91 ","$145.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.03","SUP","Custom 27203010","","390.030  -  POST XTRNFX 90D 8MM NS OTRGR MR CONDITIONAL","BOTH IP/OP","$199.00 ","$147.26 ","$0.00 ","$199.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.00 ","$0.00 ","$99.50 ","$157.61 ","$159.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.031","SUP","Custom 27203010","","390.031  -  CLAMP EXFIX MEDIUM COMBO SELF HOLDING CLIP ON NONSTRL","BOTH IP/OP","$857.75 ","$634.74 ","$0.00 ","$832.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$832.75 ","$0.00 ","$416.38 ","$659.54 ","$666.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.032","SUP","Custom 27203010","","390.032  -  CLIP XTRNFX NS DYN MR CONDITIONAL MED CMBN CLP","BOTH IP/OP","$186.03 ","$137.66 ","$0.00 ","$180.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.60 ","$0.00 ","$90.30 ","$143.04 ","$144.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.033","SUP","Custom 27203010","","390.033  -  CLAMP EXFIX MEDIUM 4 POSISTION MULTIPIN MR SAFE NONSTRL","BOTH IP/OP","$1,038.20 ","$768.27 ","$0.00 ","$1,007.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,007.95 ","$0.00 ","$503.98 ","$798.30 ","$806.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.034","SUP","Custom 27203010","","390.034  -  CLAMP EXFIX MEDIUM MULTIPIN ROD ATTCH MRI SAFE NONSTRL","BOTH IP/OP","$595.95 ","$441.00 ","$0.00 ","$578.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$578.60 ","$0.00 ","$289.30 ","$458.25 ","$462.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.035","SUP","Custom 27203010","","390.035  -  CLAMP EXFIX MEDIUM OPEN ADJUSTABLE NONSTRL","BOTH IP/OP","$707.35 ","$523.44 ","$0.00 ","$686.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.75 ","$0.00 ","$343.38 ","$543.91 ","$549.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.036","SUP","Custom 27203010","","390.036  -  CLAMP EXFIX MEDIUM 6 POSISTION MULTIPIN MR SAFE NONSTRL","BOTH IP/OP","$1,129.55 ","$835.87 ","$0.00 ","$1,096.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,096.65 ","$0.00 ","$548.33 ","$868.55 ","$877.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.037","SUP","Custom 27203010","","390.037  -  CLAMP EXFIX MEDIUM 8-11MM COMBO MR SAFE NONSTRL","BOTH IP/OP","$986.95 ","$730.34 ","$0.00 ","$958.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$958.20 ","$0.00 ","$479.10 ","$758.89 ","$766.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.041","SUP","Custom 27203010","","390.041  -  CLAMP EXFIX SMALL COMBO NONSTRL","BOTH IP/OP","$553.63 ","$409.69 ","$0.00 ","$537.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.042","SUP","Custom 27203010","","390.042  -  CLAMP EXFIX SM ADJ NONSPANNING MRI SAFE SM EXFIX NONSTRL","BOTH IP/OP","$955.33 ","$706.94 ","$0.00 ","$955.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.33 ","$0.00 ","$477.66 ","$756.62 ","$764.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.101","SUP","Custom 27203010","","BASKET SPEC RTRVL 120CM 2.4FR 12MM STON 4WR SHTH 0TP NTNL","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.12","SUP","HCPCS C1713","","390.120  -  PIN POSITIONING 40MM TITANIUM CRANIAL NONSTRL EXTERNAL","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"390.122","SUP","Custom 27203010","","390.122  -  HOLDER IMPLANT 40MM MOUNT PIN TITANIUM CRANIAL NONSTRL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.124","SUP","Custom 27803010","","390.124  -  PIN FIX 50MM MOUNT MIDFAC NONSTRL EXTERNAL MIDFAC DISTRCT","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.126","SUP","Custom 27203010","","390.126  -  HOLDER IMPLANT 40MM MOUNT PIN TITANIUM MIDFAC","BOTH IP/OP","$677.50 ","$501.35 ","$0.00 ","$677.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.50 ","$0.00 ","$338.75 ","$536.58 ","$542.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390.128","SUP","Custom 27203010","","390.128  -  PIN SKULL 50MM SLFDRILL CRANIUM NONSTRL","BOTH IP/OP","$677.50 ","$501.35 ","$0.00 ","$677.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.50 ","$0.00 ","$338.75 ","$536.58 ","$542.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392.177","SUP","Custom 27203010","","392.177  -  CAP PROTECTIVE CLEAR NONSTRL 1MM 1.25MM K WIRES","BOTH IP/OP","$4.82 ","$3.57 ","$0.00 ","$4.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.68 ","$0.00 ","$2.34 ","$3.71 ","$3.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392.178","SUP","Custom 27203010","","392.178  -  CAP PROTECTIVE NONSTRL 1.6 MM KWIRE WIRE","BOTH IP/OP","$4.82 ","$3.57 ","$0.00 ","$4.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.68 ","$0.00 ","$2.34 ","$3.71 ","$3.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392.179","SUP","Custom 27203010","","392.179  -  CAP PROTECTIVE NONSTRL 2 MM KWIRE WIRE","BOTH IP/OP","$4.54 ","$3.36 ","$0.00 ","$4.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.54 ","$0.00 ","$2.27 ","$3.60 ","$3.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392.18","SUP","Custom 27203010","","392.18  -  CAP PROTECTIVE NONSTRL 1.8-2 MM KWIRE WIRE","BOTH IP/OP","$3.93 ","$2.91 ","$0.00 ","$3.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.81 ","$0.00 ","$1.91 ","$3.02 ","$3.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392.24","SUP","Custom 27203010","","392.24  -  CAP PROTECTIVE NONSTRL 2.5 MM KWIRE WIRE","BOTH IP/OP","$4.82 ","$3.57 ","$0.00 ","$4.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.68 ","$0.00 ","$2.34 ","$3.71 ","$3.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392.961","SUP","HCPCS C1713","","392.961  -  FIXATOR XTRNFX LG ADJ RADL DIST","BOTH IP/OP","$6,189.08 ","$4,579.92 ","$0.00 ","$6,008.83 ","$2,703.97 ","$0.00 ","$1,289.96 ","$0.00 ","$0.00 ","$1,052.10 ","$6,008.83 ","$0.00 ","$3,004.41 ","$4,758.99 ","$4,807.06 ","$0.00 ","$912.99 ","$0.00 ","$956.60 ","$0.00 "
"393.43","SUP","Custom 27203010","","393.43  -  NUT XTRNFX NS RING TO ROD SPRG LD LG XTRNFXTR","BOTH IP/OP","$75.75 ","$56.06 ","$0.00 ","$73.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.436","SUP","Custom 27203010","","393.436  -  CLAMP EXFIX RING TO ROD NONSTRL HYBRID EXFIX","BOTH IP/OP","$1,444.78 ","$1,069.14 ","$0.00 ","$1,402.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,402.70 ","$0.00 ","$701.35 ","$1,110.94 ","$1,122.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.464","SUP","Custom 27203010","","393.464  -  CLAMP EXFIX ADJUSTABLE WIRE PIN NONSTRL HYBRID EXFIX","BOTH IP/OP","$1,289.95 ","$954.56 ","$0.00 ","$1,252.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,252.38 ","$0.00 ","$626.19 ","$991.88 ","$1,001.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.64","SUP","Custom 27203010","","393.64  -  CLAMP EXFIX ADJUSTABLE NONSTRL 4/6 MM SCHANZ SCREW LARGE","BOTH IP/OP","$650.55 ","$481.41 ","$0.00 ","$631.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.60 ","$0.00 ","$315.80 ","$500.23 ","$505.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.66","SUP","Custom 27203010","","393.66  -  CLAMP EXFIX TRNSVRS NONSTRL 4-6 MM SCHANZ SCREW LARGE EXFIX","BOTH IP/OP","$1,088.33 ","$805.36 ","$0.00 ","$1,056.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,056.63 ","$0.00 ","$528.31 ","$836.85 ","$845.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.69","SUP","Custom 27203010","","393.69  -  CLAMP EXFIX OPEN NONSTRL PIN INSERTION CONNECT","BOTH IP/OP","$387.65 ","$286.86 ","$0.00 ","$376.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.35 ","$0.00 ","$188.18 ","$298.07 ","$301.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.721","SUP","Custom 27203010","","393.721  -  RING EXFIX FULL 205MM FULL RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$969.13 ","$717.16 ","$0.00 ","$940.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$940.90 ","$0.00 ","$470.45 ","$745.19 ","$752.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.722","SUP","Custom 27203010","","393.722  -  RING EXFIX .75 205MM .75 RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$868.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$868.45 ","$0.00 ","$434.23 ","$687.81 ","$694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.731","SUP","Custom 27203010","","393.731  -  RING EXFIX FULL 115MM FULL RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$732.98 ","$542.41 ","$0.00 ","$711.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.63 ","$0.00 ","$355.81 ","$563.61 ","$569.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.732","SUP","Custom 27203010","","393.732  -  RING EXFIX .75 115MM .75 RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$658.35 ","$487.18 ","$0.00 ","$639.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$639.18 ","$0.00 ","$319.59 ","$506.23 ","$511.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.734","SUP","Custom 27203010","","393.734  -  RING EXFIX .75 140MM NONSTRL HYBRID FIXATOR","BOTH IP/OP","$719.60 ","$532.50 ","$0.00 ","$698.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$698.65 ","$0.00 ","$349.33 ","$553.33 ","$558.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.735","SUP","Custom 27203010","","393.735  -  RING EXFIX FULL 165MM FULL RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$831.00 ","$614.94 ","$0.00 ","$806.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$806.80 ","$0.00 ","$403.40 ","$638.99 ","$645.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.736","SUP","Custom 27203010","","393.736  -  RING EXFIX .75 165MM .75 RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$755.25 ","$558.89 ","$0.00 ","$733.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$733.25 ","$0.00 ","$366.63 ","$580.73 ","$586.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.737","SUP","Custom 27203010","","393.737  -  RING EXFIX .25 165MM .25 RING NONSTRL HYBRID FIXATOR","BOTH IP/OP","$607.10 ","$449.25 ","$0.00 ","$589.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$589.43 ","$0.00 ","$294.71 ","$466.83 ","$471.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"393.75","SUP","Custom 27203010","","393.75  -  CLAMP EXFIX LARGE UNIVERSAL ADJUSTABLE NONSTRL LARGE EXFIX","BOTH IP/OP","$1,033.93 ","$765.11 ","$0.00 ","$1,033.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,033.93 ","$0.00 ","$516.96 ","$818.87 ","$827.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.05","SUP","Custom 27203010","","394.050  -  FIXATOR XTRNFX NS ADJ RADL DIST","BOTH IP/OP","$2,949.25 ","$2,182.45 ","$0.00 ","$2,949.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,949.25 ","$0.00 ","$1,474.63 ","$2,335.81 ","$2,359.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.055","SUP","Custom 27203010","","394.055  -  FIXATOR XTRNFX HNG ELB UNSTBL FX","BOTH IP/OP","$2,315.90 ","$1,713.77 ","$0.00 ","$2,248.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,248.45 ","$0.00 ","$1,124.23 ","$1,780.77 ","$1,798.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.46","SUP","Custom 27203010","","394.46  -  SLEEVE DISTRCT 105MM HOLD","BOTH IP/OP","$517.98 ","$383.31 ","$0.00 ","$502.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$502.90 ","$0.00 ","$251.45 ","$398.30 ","$402.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.79","SUP","Custom 27203010","","394.79  -  ROD EXFIX 180D CURVE 11MM 850MM CARFBR NONSTRL LARGE EXFIX","BOTH IP/OP","$1,230.90 ","$910.87 ","$0.00 ","$1,195.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.05 ","$0.00 ","$597.53 ","$946.48 ","$956.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.791","SUP","Custom 27203010","","394.791  -  ROD EXFIX 45D 11MM 207MM CVD SPAN ANGLED CARFBR NONSTRL","BOTH IP/OP","$950.20 ","$703.15 ","$0.00 ","$922.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$922.53 ","$0.00 ","$461.26 ","$730.64 ","$738.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.792","SUP","Custom 27203010","","394.792  -  ROD EXFIX 90D 11MM 382MM CVD SPAN ANGLED CARFBR NONSTRL","BOTH IP/OP","$1,044.88 ","$773.21 ","$0.00 ","$1,014.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.45 ","$0.00 ","$507.23 ","$803.44 ","$811.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.793","SUP","Custom 27203010","","394.793  -  ROD EXFIX 135D 11MM 499MM CVD SPAN ANGLED CARFBR NONSTRL","BOTH IP/OP","$1,140.68 ","$844.10 ","$0.00 ","$1,107.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,107.45 ","$0.00 ","$553.73 ","$877.10 ","$885.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.8","SUP","Custom 27203010","","394.80  -  ROD EXFIX 100MM 11MM SM CARFBR LG EXFIX","BOTH IP/OP","$360.93 ","$267.09 ","$0.00 ","$319.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$319.30 ","$0.00 ","$159.65 ","$252.89 ","$255.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.81","SUP","Custom 27203010","","394.81  -  ROD EXFIX 11MM 125MM MR CONDITIONAL CARFBR NONSTRL","BOTH IP/OP","$360.93 ","$267.09 ","$0.00 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.40 ","$0.00 ","$175.20 ","$277.52 ","$280.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.82","SUP","Custom 27203010","","394.82  -  ROD EXFIX 11MM 150MM RADIOLUCENT MR CONDITIONAL CARFBR","BOTH IP/OP","$360.93 ","$267.09 ","$0.00 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.40 ","$0.00 ","$175.20 ","$277.52 ","$280.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.83","SUP","Custom 27203010","","394.83  -  ROD EXFIX 11MM 200MM RADIOLUCENT MR CONDITIONAL CARFBR","BOTH IP/OP","$360.93 ","$267.09 ","$0.00 ","$350.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.40 ","$0.00 ","$175.20 ","$277.52 ","$280.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.84","SUP","Custom 27203010","","394.84  -  ROD EXFIX 11MM 250MM CARFBR NONSTRL","BOTH IP/OP","$387.65 ","$286.86 ","$0.00 ","$376.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.35 ","$0.00 ","$188.18 ","$298.07 ","$301.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.85","SUP","Custom 27203010","","394.85  -  ROD EXFIX 11MM 300MM MR CONDITIONAL CARFBR NONSTRL","BOTH IP/OP","$387.65 ","$286.86 ","$0.00 ","$376.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.35 ","$0.00 ","$188.18 ","$298.07 ","$301.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.86","SUP","Custom 27203010","","394.86  -  ROD EXFIX 11MM 350MM RADIOLUCENT MR CONDITIONAL CARFBR","BOTH IP/OP","$387.65 ","$286.86 ","$0.00 ","$376.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.35 ","$0.00 ","$188.18 ","$298.07 ","$301.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.87","SUP","Custom 27203010","","394.87  -  ROD EXFIX 11MM 400MM MR CONDITIONAL CARFBR NONSTRL","BOTH IP/OP","$425.53 ","$314.89 ","$0.00 ","$413.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$413.13 ","$0.00 ","$206.56 ","$327.20 ","$330.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.88","SUP","Custom 27203010","","394.88  -  ROD EXFIX 11MM 450MM MR CONDITIONAL CARFBR NONSTRL","BOTH IP/OP","$425.53 ","$314.89 ","$0.00 ","$413.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$413.13 ","$0.00 ","$206.56 ","$327.20 ","$330.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.89","SUP","Custom 27203010","","394.89  -  ROD EXFIX 11MM 500MM CARFBR NONSTRL LARGE EXFIX","BOTH IP/OP","$425.53 ","$314.89 ","$0.00 ","$413.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$413.13 ","$0.00 ","$206.56 ","$327.20 ","$330.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.9","SUP","Custom 27203010","","394.90  -  ROD EXFIX 11MM 550MM RADIOLUCENT CARFBR NONSTRL","BOTH IP/OP","$446.65 ","$330.52 ","$0.00 ","$446.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.65 ","$0.00 ","$223.33 ","$353.75 ","$357.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.91","SUP","Custom 27203010","","394.91  -  ROD EXFIX 11MM 600MM CARFBR NONSTRL LARGE EXFIX","BOTH IP/OP","$460.05 ","$340.44 ","$0.00 ","$446.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.65 ","$0.00 ","$223.33 ","$353.75 ","$357.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.92","SUP","Custom 27203010","","394.92  -  ROD EXFIX 11MM 650MM CARFBR NONSTRL LARGE EXFIX","BOTH IP/OP","$460.05 ","$340.44 ","$0.00 ","$446.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.65 ","$0.00 ","$223.33 ","$353.75 ","$357.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.97","SUP","Custom 27203010","","394.97  -  CAP PROTECTIVE NONSTRL 11 MM CARFBR ROD","BOTH IP/OP","$2.39 ","$1.77 ","$0.00 ","$2.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.39 ","$0.00 ","$1.19 ","$1.89 ","$1.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.99","SUP","Custom 27203010","","394.99  -  CAP PROTECTIVE BLACK NONSTRL 4MM CARFBR ROD","BOTH IP/OP","$4.82 ","$3.57 ","$0.00 ","$4.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.68 ","$0.00 ","$2.34 ","$3.71 ","$3.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.991","SUP","Custom 27203010","","394.991  -  CAP PROTECTIVE YELLOW NONSTRL 4MM FIX PIN","BOTH IP/OP","$57.85 ","$42.81 ","$0.00 ","$57.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.85 ","$0.00 ","$28.93 ","$45.82 ","$46.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.992","SUP","Custom 27203010","","394.992  -  CAP PROTECTIVE WHITE NONSTRL 4.5MM FIX PIN","BOTH IP/OP","$5.96 ","$4.41 ","$0.00 ","$5.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.79 ","$0.00 ","$2.89 ","$4.59 ","$4.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"394.994","SUP","Custom 27203010","","394.994  -  CAP PROTECTIVE GREEN NONSTRL 6MM FIX PIN","BOTH IP/OP","$5.96 ","$4.41 ","$0.00 ","$5.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.79 ","$0.00 ","$2.89 ","$4.59 ","$4.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.103","SUP","Custom 27203010","","395.103  -  BAR EXFIX ANGLED 3MM CONNCTNG ROD STAINLESS STEEL NONSTRL","BOTH IP/OP","$83.55 ","$61.83 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.13 ","$0.00 ","$40.56 ","$64.25 ","$64.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.105","SUP","Custom 27203010","","395.105  -  ROD EXFIX 3MM 25MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI","BOTH IP/OP","$65.18 ","$48.23 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.28 ","$0.00 ","$31.64 ","$50.12 ","$50.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.107","SUP","Custom 27203010","","395.107  -  ROD EXFIX 3MM 45MM CARFBR NONSTRL MINI EXFIX","BOTH IP/OP","$65.18 ","$48.23 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.28 ","$0.00 ","$31.64 ","$50.12 ","$50.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.109","SUP","Custom 27203010","","395.109  -  ROD EXFIX 3MM 60MM CARFBR NONSTRL MINI EXFIX","BOTH IP/OP","$65.18 ","$48.23 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.28 ","$0.00 ","$31.64 ","$50.12 ","$50.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.111","SUP","Custom 27203010","","395.111  -  ROD EXFIX 3MM 75MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI","BOTH IP/OP","$65.18 ","$48.23 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.28 ","$0.00 ","$31.64 ","$50.12 ","$50.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.125","SUP","Custom 27203010","","395.125  -  CLAMP EXFIX 1.25MM HOLD NONSTRL MINI EXFIX","BOTH IP/OP","$1,142.90 ","$845.75 ","$0.00 ","$1,109.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,109.63 ","$0.00 ","$554.81 ","$878.83 ","$887.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.126","SUP","Custom 27203010","","395.126  -  CLAMP EXFIX 1.6MM HOLD NONSTRL 1.6MM K WIRE MINI EXFIX","BOTH IP/OP","$1,142.90 ","$845.75 ","$0.00 ","$1,109.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,109.63 ","$0.00 ","$554.81 ","$878.83 ","$887.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.133","SUP","Custom 27203010","","395.133  -  CLAMP EXFIX 3MM CONNCTNG NONSTRL MINI EXFIX","BOTH IP/OP","$1,062.70 ","$786.40 ","$0.00 ","$1,031.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.134","SUP","Custom 27203010","","395.134  -  CLAMP EXFIX 3X4MM CONNCTNG NONSTRL MINI EXFIX SMALL EXFIX","BOTH IP/OP","$1,062.70 ","$786.40 ","$0.00 ","$1,031.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,031.75 ","$0.00 ","$515.88 ","$817.15 ","$825.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.54","SUP","Custom 27803010","","395.54  -  CLAMP XTRNFX 4MM 2.5MM NS OPN SEF","BOTH IP/OP","$521.33 ","$385.78 ","$0.00 ","$506.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$506.15 ","$0.00 ","$253.08 ","$400.87 ","$404.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.55","SUP","Custom 27803010","","395.55  -  CLAMP XTRNFX 4MM NS OPN SEF 4MM SCHNZ SCR","BOTH IP/OP","$521.33 ","$385.78 ","$0.00 ","$506.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$506.15 ","$0.00 ","$253.08 ","$400.87 ","$404.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.56","SUP","Custom 27203010","","395.56  -  CLAMP EXFIX SMALL 2.5MM 4MM NONSTRL SMALL EXFIX","BOTH IP/OP","$486.80 ","$360.23 ","$0.00 ","$472.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$472.63 ","$0.00 ","$236.31 ","$374.32 ","$378.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.57","SUP","Custom 27203010","","395.57  -  CLAMP EXFIX 4MM 4MM NONSTRL 4MM SCHANZ SCREW CONNECT","BOTH IP/OP","$486.80 ","$360.23 ","$0.00 ","$472.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$472.63 ","$0.00 ","$236.31 ","$374.32 ","$378.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.575","SUP","Custom 27203010","","395.575  -  CLAMP EXFIX MULTIVECTOR TITANIUM CARFBR RODS","BOTH IP/OP","$2,157.50 ","$1,596.55 ","$0.00 ","$2,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,157.50 ","$0.00 ","$1,078.75 ","$1,708.74 ","$1,726.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.58","SUP","Custom 27203010","","395.58  -  NUT XTRNFX NS SPRG LD","BOTH IP/OP","$54.85 ","$40.59 ","$0.00 ","$53.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.25 ","$0.00 ","$26.63 ","$42.17 ","$42.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.6","SUP","Custom 27203010","","395.60  -  ROD EXFIX 4MM 60MM CARFBR NONSTRL","BOTH IP/OP","$59.48 ","$44.02 ","$0.00 ","$59.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.48 ","$0.00 ","$29.74 ","$47.11 ","$47.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.61","SUP","Custom 27203010","","395.61  -  ROD EXFIX 4MM 80MM CARFBR NONSTRL SMALL EXFIX","BOTH IP/OP","$61.28 ","$45.35 ","$0.00 ","$59.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.48 ","$0.00 ","$29.74 ","$47.11 ","$47.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.62","SUP","Custom 27203010","","395.62  -  ROD EXFIX 4MM 100MM CARFBR NONSTRL SMALL EXFIX","BOTH IP/OP","$61.28 ","$45.35 ","$0.00 ","$59.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.48 ","$0.00 ","$29.74 ","$47.11 ","$47.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.63","SUP","Custom 27203010","","395.63  -  ROD EXFIX 4MM 120MM CARFBR NONSTRL SMALL EXFIX","BOTH IP/OP","$61.28 ","$45.35 ","$0.00 ","$59.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.48 ","$0.00 ","$29.74 ","$47.11 ","$47.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.64","SUP","Custom 27203010","","395.64  -  ROD EXFIX 4MM 140MM CARFBR NONSTRL SMALL EXFIX","BOTH IP/OP","$84.65 ","$62.64 ","$0.00 ","$82.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.20 ","$0.00 ","$41.10 ","$65.10 ","$65.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.65","SUP","Custom 27203010","","395.65  -  ROD EXFIX 4MM 160MM CARFBR NONSTRL SMALL EXFIX","BOTH IP/OP","$84.65 ","$62.64 ","$0.00 ","$82.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.20 ","$0.00 ","$41.10 ","$65.10 ","$65.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.66","SUP","Custom 27203010","","395.66  -  ROD EXFIX 4MM 180MM CARFBR NONSTRL SMALL EXFIX","BOTH IP/OP","$84.65 ","$62.64 ","$0.00 ","$82.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.20 ","$0.00 ","$41.10 ","$65.10 ","$65.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.67","SUP","Custom 27203010","","395.67  -  ROD EXFIX 4MM 200MM CARFBR NONSTRL","BOTH IP/OP","$84.65 ","$62.64 ","$0.00 ","$82.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.20 ","$0.00 ","$41.10 ","$65.10 ","$65.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.68","SUP","Custom 27203010","","395.680  -  ROD EXFIX 60D CVD 4MM 78MM CARFBR NONSTRL","BOTH IP/OP","$274.70 ","$203.28 ","$0.00 ","$274.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$274.70 ","$0.00 ","$137.35 ","$217.56 ","$219.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.681","SUP","Custom 27203010","","395.681  -  ROD EXFIX 90D 4MM 117MM CVD SPAN ANGLED CARFBR NONSTRL","BOTH IP/OP","$303.00 ","$224.22 ","$0.00 ","$294.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$294.18 ","$0.00 ","$147.09 ","$232.99 ","$235.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.682","SUP","Custom 27203010","","395.682  -  ROD EXFIX 120D 4MM 156MM CVD SPAN ANGLED CARFBR NONSTRL","BOTH IP/OP","$324.15 ","$239.87 ","$0.00 ","$314.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.73 ","$0.00 ","$157.36 ","$249.27 ","$251.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.685","SUP","Custom 27203010","","395.685  -  ROD EXFIX ANGLE 4MM 50X80MM T BAR RECYCLED CARFBR NONSTRL","BOTH IP/OP","$582.60 ","$431.12 ","$0.00 ","$565.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$565.63 ","$0.00 ","$282.81 ","$447.98 ","$452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.686","SUP","Custom 27203010","","395.686  -  ROD EXFIX ANGLE 4MM 120X80MM T BAR CARFBR NONSTRL","BOTH IP/OP","$582.60 ","$431.12 ","$0.00 ","$565.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$565.63 ","$0.00 ","$282.81 ","$447.98 ","$452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.687","SUP","Custom 27203010","","395.687  -  ROD EXFIX ANGLED 4MM 50X110MM T BAR ANGLED CARFBR NONSTRL","BOTH IP/OP","$582.60 ","$431.12 ","$0.00 ","$565.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$565.63 ","$0.00 ","$282.81 ","$447.98 ","$452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.688","SUP","Custom 27203010","","395.688  -  ROD EXFIX ANGLED 4MM 120X110MM T BAR ANGLED CARFBR NONSTRL","BOTH IP/OP","$582.60 ","$431.12 ","$0.00 ","$565.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$565.63 ","$0.00 ","$282.81 ","$447.98 ","$452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.69","SUP","Custom 27203010","","395.690  -  ROD EXFIX 45D 8MM 214MM CVD CARFBR NONSTRL","BOTH IP/OP","$597.00 ","$441.78 ","$0.00 ","$597.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$597.00 ","$0.00 ","$298.50 ","$472.82 ","$477.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.691","SUP","Custom 27203010","","395.691  -  ROD EXFIX 90D 8MM 382MM CVD CARFBR NONSTRL","BOTH IP/OP","$614.90 ","$455.03 ","$0.00 ","$597.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$597.00 ","$0.00 ","$298.50 ","$472.82 ","$477.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.692","SUP","Custom 27203010","","395.692  -  ROD EXFIX 135D 8MM 499MM CVD CARFBR NONSTRL","BOTH IP/OP","$579.60 ","$428.90 ","$0.00 ","$579.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.60 ","$0.00 ","$289.80 ","$459.04 ","$463.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.693","SUP","Custom 27203010","","395.693  -  ROD EXFIX 180D 8MM 540MM CVD SPAN ANGLED CARFBR NONSTRL","BOTH IP/OP","$579.60 ","$428.90 ","$0.00 ","$579.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.60 ","$0.00 ","$289.80 ","$459.04 ","$463.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.7","SUP","Custom 27203010","","395.70  -  BAR XTRNFX 4MM 60MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$47.05 ","$34.82 ","$0.00 ","$47.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.05 ","$0.00 ","$23.53 ","$37.26 ","$37.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.71","SUP","Custom 27203010","","395.71  -  BAR XTRNFX 4MM 80MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$47.05 ","$34.82 ","$0.00 ","$47.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.05 ","$0.00 ","$23.53 ","$37.26 ","$37.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.72","SUP","Custom 27203010","","395.72  -  BAR XTRNFX 4MM 100MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$47.05 ","$34.82 ","$0.00 ","$47.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.05 ","$0.00 ","$23.53 ","$37.26 ","$37.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.73","SUP","Custom 27203010","","395.73  -  BAR XTRNFX 4MM 120MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$47.05 ","$34.82 ","$0.00 ","$47.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.05 ","$0.00 ","$23.53 ","$37.26 ","$37.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.74","SUP","Custom 27203010","","395.74  -  BAR XTRNFX 4MM 140MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$61.65 ","$45.62 ","$0.00 ","$61.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.65 ","$0.00 ","$30.83 ","$48.83 ","$49.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.75","SUP","Custom 27203010","","395.75  -  BAR XTRNFX 4MM 160MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$61.65 ","$45.62 ","$0.00 ","$61.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.65 ","$0.00 ","$30.83 ","$48.83 ","$49.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.76","SUP","Custom 27203010","","395.76  -  BAR XTRNFX 4MM 180MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$61.65 ","$45.62 ","$0.00 ","$61.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.65 ","$0.00 ","$30.83 ","$48.83 ","$49.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.77","SUP","Custom 27203010","","395.77  -  BAR XTRNFX 4MM 200MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$61.65 ","$45.62 ","$0.00 ","$61.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.65 ","$0.00 ","$30.83 ","$48.83 ","$49.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.779","SUP","Custom 27203010","","395.779  -  ROD EXFIX MEDIUM 8MM 160MM CARFBR NONSTRL","BOTH IP/OP","$246.18 ","$182.17 ","$0.00 ","$239.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$239.00 ","$0.00 ","$119.50 ","$189.29 ","$191.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.78","SUP","Custom 27203010","","395.78  -  BAR XTRNFX 4MM 220MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$246.18 ","$182.17 ","$0.00 ","$76.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$60.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.78","SUP","HCPCS C1713","","395.780  -  ROD EXFIX 120MM 8MM MED CARFBR MED EXFIX NONSTRL","BOTH IP/OP","$246.18 ","$182.17 ","$0.00 ","$189.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$189.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.782","SUP","Custom 27203010","","395.782  -  ROD EXFIX 8MM 200MM CARFBR DISTAL RAD NONSTRL","BOTH IP/OP","$243.95 ","$180.52 ","$0.00 ","$236.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.85 ","$0.00 ","$118.43 ","$187.59 ","$189.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.784","SUP","Custom 27203010","","395.784  -  ROD EXFIX 8MM 220MM CARFBR DISTAL RAD NONSTRL","BOTH IP/OP","$243.95 ","$180.52 ","$0.00 ","$236.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.85 ","$0.00 ","$118.43 ","$187.59 ","$189.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.786","SUP","Custom 27203010","","395.786  -  ROD EXFIX 8MM 240MM CARFBR DISTAL RAD NONSTRL","BOTH IP/OP","$243.95 ","$180.52 ","$0.00 ","$236.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.85 ","$0.00 ","$118.43 ","$187.59 ","$189.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.788","SUP","Custom 27203010","","395.788  -  ROD EXFIX 8MM 280MM CARFBR DISTAL RAD NONSTRL","BOTH IP/OP","$246.18 ","$182.17 ","$0.00 ","$239.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$239.00 ","$0.00 ","$119.50 ","$189.29 ","$191.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.79","SUP","Custom 27203010","","395.79  -  BAR XTRNFX 4MM 240MM NS CNCT MRI SAFE SS METACARPUS PHALANX","BOTH IP/OP","$76.13 ","$56.34 ","$0.00 ","$76.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$60.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.792","SUP","Custom 27203010","","395.792  -  ROD EXFIX MEDIUM 8MM 320MM CARFBR NONSTRL","BOTH IP/OP","$246.18 ","$182.17 ","$0.00 ","$239.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$239.00 ","$0.00 ","$119.50 ","$189.29 ","$191.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.796","SUP","Custom 27203010","","395.796  -  ROD EXFIX 8MM 360MM CARFBR NONSTRL","BOTH IP/OP","$265.13 ","$196.20 ","$0.00 ","$257.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.40 ","$0.00 ","$128.70 ","$203.86 ","$205.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.797","SUP","Custom 27203010","","395.797  -  ROD EXFIX MEDIUM 8MM 400MM CARFBR NONSTRL","BOTH IP/OP","$265.13 ","$196.20 ","$0.00 ","$257.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.40 ","$0.00 ","$128.70 ","$203.86 ","$205.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.798","SUP","Custom 27203010","","395.798  -  ROD EXFIX 8MM 460MM CARFBR NONSTRL","BOTH IP/OP","$265.13 ","$196.20 ","$0.00 ","$257.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.40 ","$0.00 ","$128.70 ","$203.86 ","$205.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.8","SUP","Custom 27203010","","395.80  -  BAR XTRNFX 4MM 250MM NS CNCT SS MN XTRNFXTR","BOTH IP/OP","$76.13 ","$56.34 ","$0.00 ","$76.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$60.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.81","SUP","Custom 27203010","","395.81  -  BAR EXFIX 4MM 260MM CONNECT NONSTRL","BOTH IP/OP","$76.13 ","$56.34 ","$0.00 ","$76.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$60.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.82","SUP","Custom 27203010","","395.82  -  BAR EXFIX 4MM 280MM CONNECT NONSTRL","BOTH IP/OP","$76.13 ","$56.34 ","$0.00 ","$76.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$60.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"395.83","SUP","Custom 27203010","","395.83  -  BAR EXFIX 4MM 300MM CONNECT NONSTRL","BOTH IP/OP","$76.13 ","$56.34 ","$0.00 ","$76.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.13 ","$0.00 ","$38.06 ","$60.29 ","$60.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"397.283","SUP","Custom 27203010","","397.283  -  BIT DRILL 1.8MM JLTCH NONSTRL","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"397.284","SUP","Custom 27203010","","397.284  -  BIT DRILL 2.4MM JLTCH NONSTRL","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"397.342","SUP","Custom 27203010","","397.342  -  BIT DRL 140MM 2.5MM 400MM NS JCHK CLBRT","BOTH IP/OP","$969.93 ","$717.75 ","$0.00 ","$941.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"397.343","SUP","Custom 27203010","","397.343  -  BIT DRL 3.5MM 380MM NS JCHK","BOTH IP/OP","$1,017.73 ","$753.12 ","$0.00 ","$988.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$988.08 ","$0.00 ","$494.04 ","$782.56 ","$790.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"398.756","SUP","Custom 27203010","","398.756  -  CLAMP SURG 206MM HOOK ARM BONE","BOTH IP/OP","$5,084.40 ","$3,762.46 ","$0.00 ","$4,936.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,936.30 ","$0.00 ","$2,468.15 ","$3,909.55 ","$3,949.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.006","SUP","HCPCS C1713","","400.006  -  SCREW BONE STANDARD 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.007","SUP","HCPCS C1713","","400.007  -  SCREW BONE STANDARD 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.008","SUP","HCPCS C1713","","400.008  -  SCREW BONE STANDARD 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.009","SUP","HCPCS C1713","","400.009  -  SCREW BONE STANDARD 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.01","SUP","HCPCS C1713","","400.010  -  SCREW BONE STANDARD 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.011","SUP","HCPCS C1713","","400.011  -  SCREW BONE STANDARD 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.012","SUP","HCPCS C1713","","400.012  -  SCREW BONE STANDARD 1.5MM 3MM 12MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.014","SUP","HCPCS C1713","","400.014  -  SCREW BONE STANDARD 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.016","SUP","HCPCS C1713","","400.016  -  SCREW BONE STANDARD 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.018","SUP","HCPCS C1713","","400.018  -  SCREW BONE STANDARD 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.02","SUP","HCPCS C1713","","400.020  -  SCREW BONE STANDARD 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.022","SUP","HCPCS C1713","","400.022  -  SCREW BONE 1.5MM 22MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.024","SUP","HCPCS C1713","","400.024  -  SCREW BONE STANDARD CRCIFRM 1.5MM 3MM 24MM TITANIUM CORTICAL","BOTH IP/OP","$52.88 ","$39.13 ","$0.00 ","$52.88 ","$23.79 ","$0.00 ","$11.02 ","$0.00 ","$0.00 ","$9.26 ","$52.88 ","$0.00 ","$26.44 ","$41.88 ","$42.30 ","$0.00 ","$8.03 ","$0.00 ","$8.42 ","$0.00 "
"400.19","SUP","HCPCS C1713","","400.190  -  PIN FIX 1.8MM 12MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"400.191","SUP","Custom 27203010","","400.191  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.192","SUP","Custom 27203010","","400.192  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.193","SUP","Custom 27203010","","400.193  -  PIN FIX 1.8MM 18MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.194","SUP","HCPCS C1713","","400.194  -  PIN FIX 1.8MM 20MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"400.195","SUP","Custom 27203010","","400.195  -  PIN FIX 1.8MM 22MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.196","SUP","HCPCS C1713","","400.196  -  PIN FIX 1.8MM 24MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"400.197","SUP","Custom 27203010","","400.197  -  PIN FIX 1.8MM 26MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.198","SUP","HCPCS C1713","","400.198  -  PIN FIX 1.8MM 28MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"400.199","SUP","Custom 27203010","","400.199  -  PIN FIX 1.8MM 30MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.406","SUP","HCPCS C1713","","400.406  -  SCREW BONE GOLD 6MM 1MM CORT CRANFCL TI SLFTAP +DR RECESS","BOTH IP/OP","$157.50 ","$116.55 ","$0.00 ","$157.50 ","$70.88 ","$0.00 ","$32.83 ","$0.00 ","$0.00 ","$27.58 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$24.65 ","$0.00 ","$25.07 ","$0.00 "
"400.526","SUP","HCPCS C1713","","400.526  -  SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.527","SUP","HCPCS C1713","","400.527  -  SCREW BONE 1MM 1.6MM 7MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.528","SUP","HCPCS C1713","","400.528  -  SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.529","SUP","HCPCS C1713","","400.529  -  SCREW BONE 1MM 1.6MM 9MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.53","SUP","HCPCS C1713","","400.530  -  SCREW BONE 1MM 1.6MM 10MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$133.05 ","$98.46 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$27.73 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.531","SUP","HCPCS C1713","","400.531  -  SCREW BONE 1MM 1.6MM 11MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.532","SUP","HCPCS C1713","","400.532  -  SCREW BONE 1MM 1.6MM 12MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.533","SUP","HCPCS C1713","","400.533  -  SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.534","SUP","HCPCS C1713","","400.534  -  SCREW BONE 1MM 1.6MM 14MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$133.05 ","$59.87 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$23.30 ","$133.05 ","$0.00 ","$66.53 ","$105.38 ","$106.44 ","$0.00 ","$20.22 ","$0.00 ","$21.18 ","$0.00 "
"400.686","SUP","HCPCS C1713","","400.686  -  SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.687","SUP","HCPCS C1713","","400.687  -  SCREW BONE 1.3MM 2.4MM 7MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.688","SUP","HCPCS C1713","","400.688  -  SCREW BONE 1.3MM 2.4MM 8MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.689","SUP","HCPCS C1713","","400.689  -  SCREW BONE 1.3MM 2.4MM 9MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$27.80 ","$0.00 ","$22.16 ","$0.00 "
"400.69","SUP","HCPCS C1713","","400.690  -  SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$139.20 ","$103.01 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.01 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.691","SUP","HCPCS C1713","","400.691  -  SCREW BONE 1.3MM 2.4MM 11MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.692","SUP","HCPCS C1713","","400.692  -  SCREW BONE 1.3MM 2.4MM 12MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.693","SUP","HCPCS C1713","","400.693  -  SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.694","SUP","HCPCS C1713","","400.694  -  SCREW BONE 1.3MM 2.4MM 14MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.696","SUP","HCPCS C1713","","400.696  -  SCREW BONE 1.3MM 2.4MM 16MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.698","SUP","HCPCS C1713","","400.698  -  SCREW BONE 1.3MM 2.4MM 18MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$62.64 ","$0.00 ","$29.88 ","$0.00 ","$0.00 ","$24.37 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$21.15 ","$0.00 ","$22.16 ","$0.00 "
"400.806","SUP","HCPCS C1713","","400.806  -  SCREW BONE 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.807","SUP","HCPCS C1713","","400.807  -  SCREW BONE 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.808","SUP","HCPCS C1713","","400.808  -  SCREW BONE 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.809","SUP","HCPCS C1713","","400.809  -  SCREW BONE 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.81","SUP","HCPCS C1713","","400.810  -  SCREW BONE 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.22 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.811","SUP","HCPCS C1713","","400.811  -  SCREW BONE 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.812","SUP","HCPCS C1713","","400.812  -  SCREW BONE 1.5MM 3MM 12MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.814","SUP","HCPCS C1713","","400.814  -  SCREW BONE 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.816","SUP","HCPCS C1713","","400.816  -  SCREW BONE 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.818","SUP","HCPCS C1713","","400.818  -  SCREW BONE 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.82","SUP","HCPCS C1713","","400.820  -  SCREW BONE 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$63.45 ","$46.95 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.22 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.822","SUP","HCPCS C1713","","400.822  -  SCREW BONE 1.5MM 3MM 22MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.824","SUP","HCPCS C1713","","400.824  -  SCREW BONE 1.5MM 3MM 24MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.834","SUP","HCPCS C1713","","400.834  -  SCREW BONE 4MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL","BOTH IP/OP","$151.38 ","$112.02 ","$0.00 ","$151.38 ","$68.12 ","$0.00 ","$31.55 ","$0.00 ","$0.00 ","$26.50 ","$151.38 ","$0.00 ","$75.69 ","$119.89 ","$121.10 ","$0.00 ","$23.69 ","$0.00 ","$24.10 ","$0.00 "
"400.835","SUP","HCPCS C1713","","400.835  -  SCREW BONE 5MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL","BOTH IP/OP","$151.38 ","$112.02 ","$0.00 ","$151.38 ","$68.12 ","$0.00 ","$31.55 ","$0.00 ","$0.00 ","$26.50 ","$151.38 ","$0.00 ","$75.69 ","$119.89 ","$121.10 ","$0.00 ","$23.69 ","$0.00 ","$24.10 ","$0.00 "
"400.996","SUP","HCPCS C1713","","400.996  -  SCREW BONE 1.4MM 15MM SLFDRILL WIRE FIX TITANIUM MIDFAC","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$156.38 ","$0.00 ","$72.43 ","$0.00 ","$0.00 ","$60.84 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$54.38 ","$0.00 ","$55.32 ","$0.00 "
"400.997","SUP","HCPCS C1713","","400.997  -  SCREW BONE 1.4MM 21MM SLFDRILL WIRE FIX TITANIUM MIDFAC","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$156.38 ","$0.00 ","$72.43 ","$0.00 ","$0.00 ","$60.84 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$54.38 ","$0.00 ","$55.32 ","$0.00 "
"401.006","SUP","HCPCS C1713","","401.006  -  SCREW BONE STANDARD 2MM 3.5MM 6MM CRCIFRM TITANIUM CORTICAL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.008","SUP","HCPCS C1713","","401.008  -  SCREW BONE STANDARD 2MM 3.5MM 8MM CRCIFRM TITANIUM CORTICAL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.012","SUP","HCPCS C1713","","401.012  -  SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM TITANIUM CORTICAL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.02","SUP","HCPCS C1713","","401.020  -  SCREW BONE STANDARD 2MM 3.5MM 20MM CRCIFRM TITANIUM CORTICAL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.022","SUP","HCPCS C1713","","401.022  -  SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM TITANIUM CORTICAL","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.024","SUP","HCPCS C1713","","401.024  -  SCREW BONE STANDARD 2MM 3.5MM 24MM SLFTAP CRCIFRM RECESS","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.026","SUP","HCPCS C1713","","401.026  -  SCREW BONE 2MM 26MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.028","SUP","HCPCS C1713","","401.028  -  SCREW BONE 2MM 28MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.03","SUP","HCPCS C1713","","401.030  -  SCREW BONE 2MM 30MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.032","SUP","HCPCS C1713","","401.032  -  SCREW BONE 2MM 32MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.034","SUP","HCPCS C1713","","401.034  -  SCREW BONE 2MM 34MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.036","SUP","HCPCS C1713","","401.036  -  SCREW BONE 2MM 36MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.038","SUP","HCPCS C1713","","401.038  -  SCREW BONE 2MM 38MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT","BOTH IP/OP","$52.20 ","$38.63 ","$0.00 ","$52.20 ","$23.49 ","$0.00 ","$10.88 ","$0.00 ","$0.00 ","$9.14 ","$52.20 ","$0.00 ","$26.10 ","$41.34 ","$41.76 ","$0.00 ","$7.93 ","$0.00 ","$8.31 ","$0.00 "
"401.158","SUP","HCPCS C1713","","401.158  -  SCREW BONE 8MM 2MM CORT CRANFCL TI SLFTAP FLUT TIP NONSTRL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"401.292","SUP","HCPCS C1713","","401.292  -  SCREW BONE BLUE 6MM 2MM CRANFCL TI SLFTAP +DR RECESS LCK","BOTH IP/OP","$1,091.25 ","$807.53 ","$0.00 ","$1,091.25 ","$491.06 ","$0.00 ","$227.44 ","$0.00 ","$0.00 ","$191.07 ","$1,091.25 ","$0.00 ","$545.63 ","$864.27 ","$873.00 ","$0.00 ","$170.78 ","$0.00 ","$173.73 ","$0.00 "
"401.295","SUP","HCPCS C1713","","401.295  -  SCREW BONE BLUE 10MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"401.296","SUP","HCPCS C1713","","401.296  -  SCREW BONE BLUE 12MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"401.297","SUP","HCPCS C1713","","401.297  -  SCREW BONE BLUE 14MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"401.298","SUP","HCPCS C1713","","401.298  -  SCREW BONE BLUE 16MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"401.305","SUP","HCPCS C1713","","401.305  -  SCREW BONE 5MM 2.4MM CRNMXF TI ER CRCIFRM RECESS NONSTRL","BOTH IP/OP","$119.25 ","$88.25 ","$0.00 ","$119.25 ","$53.66 ","$0.00 ","$24.85 ","$0.00 ","$0.00 ","$20.88 ","$119.25 ","$0.00 ","$59.63 ","$94.45 ","$95.40 ","$0.00 ","$18.66 ","$0.00 ","$18.98 ","$0.00 "
"401.508","SUP","HCPCS C1713","","401.508  -  SCREW BONE 2.4MM 8MM TI CORT CRNMXF SLFTAP STRL GOLD","BOTH IP/OP","$169.88 ","$125.71 ","$0.00 ","$169.88 ","$76.44 ","$0.00 ","$35.41 ","$0.00 ","$0.00 ","$29.74 ","$169.88 ","$0.00 ","$84.94 ","$134.54 ","$135.90 ","$0.00 ","$26.59 ","$0.00 ","$27.04 ","$0.00 "
"401.51","SUP","HCPCS C1713","","401.510  -  SCREW BONE 2.4MM 10MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL","BOTH IP/OP","$169.88 ","$125.71 ","$0.00 ","$169.88 ","$76.44 ","$0.00 ","$35.41 ","$0.00 ","$0.00 ","$29.74 ","$169.88 ","$0.00 ","$84.94 ","$134.54 ","$135.90 ","$0.00 ","$26.59 ","$0.00 ","$27.04 ","$0.00 "
"401.516","SUP","HCPCS C1713","","401.516  -  SCREW BONE 2.4MM 16MM TI CORT CRNMXF SLFTAP STRL GOLD","BOTH IP/OP","$169.88 ","$125.71 ","$0.00 ","$169.88 ","$76.44 ","$0.00 ","$35.41 ","$0.00 ","$0.00 ","$29.74 ","$169.88 ","$0.00 ","$84.94 ","$134.54 ","$135.90 ","$0.00 ","$26.59 ","$0.00 ","$27.04 ","$0.00 "
"401.518","SUP","HCPCS C1713","","401.518  -  SCREW BONE 2.4MM 18MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL","BOTH IP/OP","$169.88 ","$125.71 ","$0.00 ","$169.88 ","$76.44 ","$0.00 ","$35.41 ","$0.00 ","$0.00 ","$29.74 ","$169.88 ","$0.00 ","$84.94 ","$134.54 ","$135.90 ","$0.00 ","$26.59 ","$0.00 ","$27.04 ","$0.00 "
"401.612","SUP","HCPCS C1713","","401.612  -  SCREW BONE 2.4MM 3.5MM 12MM SELF TAP SMALL CRCIFRM RECESS","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.614","SUP","HCPCS C1713","","401.614  -  SCREW BONE SMALL 2.4MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.616","SUP","HCPCS C1713","","401.616  -  SCREW BONE SMALL 2.4MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.618","SUP","HCPCS C1713","","401.618  -  SCREW BONE SMALL 2.4MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.62","SUP","HCPCS C1713","","401.620  -  SCREW BONE 2.4MM 3.5MM 20MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.622","SUP","HCPCS C1713","","401.622  -  SCREW BONE SMALL 2.4MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.624","SUP","HCPCS C1713","","401.624  -  SCREW BONE SMALL 2.4MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.626","SUP","HCPCS C1713","","401.626  -  SCREW BONE SMALL 2.4MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.628","SUP","HCPCS C1713","","401.628  -  SCREW BONE SMALL 2.4MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.63","SUP","HCPCS C1713","","401.630  -  SCREW BONE SMALL 2.4MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM","BOTH IP/OP","$115.93 ","$85.79 ","$0.00 ","$115.93 ","$52.17 ","$0.00 ","$24.16 ","$0.00 ","$0.00 ","$20.30 ","$115.93 ","$0.00 ","$57.96 ","$91.82 ","$92.74 ","$0.00 ","$18.14 ","$0.00 ","$18.46 ","$0.00 "
"401.756","SUP","HCPCS C1713","","401.756  -  SCREW BONE 2.4MM 6MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.757","SUP","HCPCS C1713","","401.757  -  SCREW BONE 2.4MM 7MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.758","SUP","HCPCS C1713","","401.758  -  SCREW BONE 2.4MM 8MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.759","SUP","HCPCS C1713","","401.759  -  SCREW BONE 2.4MM 9MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.76","SUP","HCPCS C1713","","401.760  -  SCREW BONE 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$101.65 ","$75.22 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.19 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.761","SUP","HCPCS C1713","","401.761  -  SCREW BONE 2.4MM 11MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.762","SUP","HCPCS C1713","","401.762  -  SCREW BONE 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.763","SUP","HCPCS C1713","","401.763  -  SCREW BONE 2.4MM 13MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.764","SUP","HCPCS C1713","","401.764  -  SCREW BONE 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.766","SUP","HCPCS C1713","","401.766  -  SCREW BONE 2.4MM 4MM 16MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.768","SUP","HCPCS C1713","","401.768  -  SCREW BONE 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.77","SUP","HCPCS C1713","","401.770  -  SCREW BONE 2.4MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$101.65 ","$75.22 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.19 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.772","SUP","HCPCS C1713","","401.772  -  SCREW BONE 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.774","SUP","HCPCS C1713","","401.774  -  SCREW BONE 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.776","SUP","HCPCS C1713","","401.776  -  SCREW BONE 2.4MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.778","SUP","HCPCS C1713","","401.778  -  SCREW BONE 2.4MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.78","SUP","HCPCS C1713","","401.780  -  SCREW BONE 2.4MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$101.65 ","$75.22 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.19 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.782","SUP","HCPCS C1713","","401.782  -  SCREW BONE 2.4MM 4MM 32MM T8 STARDRIVE RECESS SELF TAP SELF","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.784","SUP","HCPCS C1713","","401.784  -  SCREW BONE 2.4MM 4MM 34MM T8 STARDRIVE RECESS SELF TAP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.786","SUP","HCPCS C1713","","401.786  -  SCREW BONE 2.4MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.788","SUP","HCPCS C1713","","401.788  -  SCREW BONE 2.4MM 4MM 38MM T8 STARDRIVE RECESS SELF TAP LCP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.79","SUP","HCPCS C1713","","401.790  -  SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP TITANIUM","BOTH IP/OP","$101.65 ","$75.22 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.19 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"401.806","SUP","HCPCS C1713","","401.806  -  SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.808","SUP","HCPCS C1713","","401.808  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.81","SUP","HCPCS C1713","","401.810  -  SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$63.13 ","$46.72 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.812","SUP","HCPCS C1713","","401.812  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.814","SUP","HCPCS C1713","","401.814  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.816","SUP","HCPCS C1713","","401.816  -  SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.818","SUP","HCPCS C1713","","401.818  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.82","SUP","HCPCS C1713","","401.820  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$63.13 ","$46.72 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.822","SUP","HCPCS C1713","","401.822  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.824","SUP","HCPCS C1713","","401.824  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.826","SUP","HCPCS C1713","","401.826  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.828","SUP","HCPCS C1713","","401.828  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.83","SUP","HCPCS C1713","","401.830  -  SCREW BONE 2MM 3.5MM 30MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$63.13 ","$46.72 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.832","SUP","HCPCS C1713","","401.832  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.834","SUP","HCPCS C1713","","401.834  -  SCREW BONE 2MM 3.5MM 34MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.836","SUP","HCPCS C1713","","401.836  -  SCREW BONE 2MM 3.5MM 36MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.838","SUP","HCPCS C1713","","401.838  -  SCREW BONE 2MM 3.5MM 38MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.876","SUP","HCPCS C1713","","401.876  -  SCREW BONE 2MM 6MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.877","SUP","HCPCS C1713","","401.877  -  SCREW BONE 2MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.878","SUP","HCPCS C1713","","401.878  -  SCREW BONE 2MM 8MM SLFTAP LOCKING LCP TITANIUM CORTICAL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.879","SUP","HCPCS C1713","","401.879  -  SCREW BONE 2MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.88","SUP","HCPCS C1713","","401.880  -  SCREW BONE 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM SMALL","BOTH IP/OP","$208.80 ","$154.51 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$43.52 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.881","SUP","HCPCS C1713","","401.881  -  SCREW BONE 2MM 11MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.882","SUP","HCPCS C1713","","401.882  -  SCREW BONE 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM SMALL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.883","SUP","HCPCS C1713","","401.883  -  SCREW BONE 2MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.884","SUP","HCPCS C1713","","401.884  -  SCREW BONE 2MM 14MM SELF TAP STARDRIVE LCP TITANIUM SMALL","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.886","SUP","HCPCS C1713","","401.886  -  SCREW BONE 2MM 16MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.888","SUP","HCPCS C1713","","401.888  -  SCREW BONE 2MM 18MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.89","SUP","HCPCS C1713","","401.890  -  SCREW BONE T6 2MM 20MM SELF TAP LOCK LCP TITANIUM CORTICAL","BOTH IP/OP","$208.80 ","$154.51 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$43.52 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.892","SUP","HCPCS C1713","","401.892  -  SCREW BONE 2MM 22MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.894","SUP","HCPCS C1713","","401.894  -  SCREW BONE 2MM 24MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.896","SUP","HCPCS C1713","","401.896  -  SCREW BONE 2MM 26MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.898","SUP","HCPCS C1713","","401.898  -  SCREW BONE 2MM 28MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.9","SUP","HCPCS C1713","","401.900  -  SCREW BONE 2MM 30MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP","BOTH IP/OP","$208.80 ","$154.51 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$43.52 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"401.962","SUP","Custom 27203010","","401.962  -  PIN FIX 1.8MM 12MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.964","SUP","Custom 27203010","","401.964  -  PIN FIX 1.8MM 14MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.966","SUP","Custom 27203010","","401.966  -  PIN FIX 1.8MM 16MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.968","SUP","Custom 27203010","","401.968  -  PIN FIX 1.8MM 18MM BUTTRESS TITANIUM NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.97","SUP","Custom 27203010","","401.970  -  PIN FIX 1.8MM 20MM BUTTRESS TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$111.23 ","$82.31 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.972","SUP","Custom 27203010","","401.972  -  PIN FIX 1.8MM 22MM BUTTRESS TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.974","SUP","Custom 27203010","","401.974  -  PIN FIX 1.8MM 24MM BUTTRESS TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.976","SUP","Custom 27203010","","401.976  -  PIN FIX 1.8MM 26MM BUTTRESS TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.978","SUP","Custom 27203010","","401.978  -  PIN FIX 1.8MM 28MM BUTTRESS TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.98","SUP","Custom 27203010","","401.980  -  PIN FIX 1.8MM 30MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL","BOTH IP/OP","$111.23 ","$82.31 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"402","SUP","Custom 27204646","","402  -  TUNNELER SURG 2 SLEEVE DISPOSABLE","BOTH IP/OP","$1,080.00 ","$799.20 ","$0.00 ","$1,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,080.00 ","$0.00 ","$540.00 ","$855.36 ","$864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"402.006","SUP","HCPCS C1713","","402.006  -  SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 6MM","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.008","SUP","HCPCS C1713","","402.008  -  SCREW BONE STANDARD 2.7MM 5MM 8MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.01","SUP","HCPCS C1713","","402.010  -  SCREW BONE STANDARD 4MM 2.7MM 10MM T8 STARDRIVE SLFTAP","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.012","SUP","HCPCS C1713","","402.012  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.014","SUP","HCPCS C1713","","402.014  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.016","SUP","HCPCS C1713","","402.016  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 16MM SMALL HEXAGONAL","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.018","SUP","HCPCS C1713","","402.018  -  SCREW BONE 2.7MM 18MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.02","SUP","HCPCS C1713","","402.020  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.022","SUP","HCPCS C1713","","402.022  -  SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 22","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.024","SUP","HCPCS C1713","","402.024  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.026","SUP","HCPCS C1713","","402.026  -  SCREW BONE 2.7MM 26MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.028","SUP","HCPCS C1713","","402.028  -  SCREW BONE STANDARD 2.7MM 5MM 28MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.03","SUP","HCPCS C1713","","402.030  -  SCREW BONE STANDARD 2.7MM 5MM 30MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.032","SUP","HCPCS C1713","","402.032  -  SCREW BONE STANDARD 2.7MM 5MM 32MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.034","SUP","HCPCS C1713","","402.034  -  SCREW BONE 2.7MM 34MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.036","SUP","HCPCS C1713","","402.036  -  SCREW BONE 2.7MM 36MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.038","SUP","HCPCS C1713","","402.038  -  SCREW BONE 2.5MM 38MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.04","SUP","HCPCS C1713","","402.040  -  SCREW BONE 2.7MM 40MM TITANIUM CORTICAL NONSTRL MINI","BOTH IP/OP","$54.93 ","$40.65 ","$0.00 ","$54.93 ","$24.72 ","$0.00 ","$11.45 ","$0.00 ","$0.00 ","$9.62 ","$54.93 ","$0.00 ","$27.46 ","$43.50 ","$43.94 ","$0.00 ","$8.35 ","$0.00 ","$8.74 ","$0.00 "
"402.208","SUP","HCPCS C1713","","402.208  -  SCREW BONE 2.7MM 8MM SLFTAP T8 STARDRIVE RECESS LOCKING LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.21","SUP","HCPCS C1713","","402.210  -  SCREW BONE 2.7MM 10MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.212","SUP","HCPCS C1713","","402.212  -  SCREW BONE 2.7MM 12MM T8 STARDRIVE RECESS SELF TAP LOCK","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.214","SUP","HCPCS C1713","","402.214  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SELF TAP LOCK LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.216","SUP","HCPCS C1713","","402.216  -  SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.218","SUP","HCPCS C1713","","402.218  -  SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.22","SUP","HCPCS C1713","","402.220  -  SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.222","SUP","HCPCS C1713","","402.222  -  SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SELF TAP LOCK LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.224","SUP","HCPCS C1713","","402.224  -  SCREW BONE 2.7MM 24MM CANN SELF TAP LOCK STARDRIVE RECESS","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.226","SUP","HCPCS C1713","","402.226  -  SCREW BONE 2.7MM 26MM CANN SELF TAP LOCK STARDRIVE RECESS","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.228","SUP","HCPCS C1713","","402.228  -  SCREW BONE 2.7MM 28MM CANN SELF TAP LOCK STARDRIVE RECESS","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.23","SUP","HCPCS C1713","","402.230  -  SCREW BONE 2.7MM 30MM SELF TAP LOCK T8 LCP STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.232","SUP","HCPCS C1713","","402.232  -  SCREW BONE 2.7MM 32MM CANN SELF TAP LOCK STARDRIVE RECESS","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.234","SUP","HCPCS C1713","","402.234  -  SCREW BONE 2.7MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.236","SUP","HCPCS C1713","","402.236  -  SCREW BONE 2.7MM 36MM CANN SELF TAP LOCK STARDRIVE RECESS","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.238","SUP","HCPCS C1713","","402.238  -  SCREW BONE 2.7MM 38MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.24","SUP","HCPCS C1713","","402.240  -  SCREW BONE 2.7MM 40MM SELF TAP LOCK T8 LCP STARDRIVE","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.242","SUP","HCPCS C1713","","402.242  -  SCREW BONE 2.7MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.244","SUP","HCPCS C1713","","402.244  -  SCREW BONE 2.7MM 44MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.246","SUP","HCPCS C1713","","402.246  -  SCREW BONE 2.7MM 46MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.248","SUP","HCPCS C1713","","402.248  -  SCREW BONE 2.7MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.25","SUP","HCPCS C1713","","402.250  -  SCREW BONE 2MM 50MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.255","SUP","HCPCS C1713","","402.255  -  SCREW BONE 2.7MM 55MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$222.10 ","$164.35 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$46.29 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.26","SUP","HCPCS C1713","","402.260  -  SCREW BONE 2MM 60MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$215.63 ","$97.03 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$37.75 ","$215.63 ","$0.00 ","$107.81 ","$170.78 ","$172.50 ","$0.00 ","$32.76 ","$0.00 ","$34.33 ","$0.00 "
"402.608","SUP","HCPCS C1713","","402.608  -  SCREW BONE 3MM 4MM 1.2MM 8MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.609","SUP","HCPCS C1713","","402.609  -  SCREW BONE 3MM 4MM 1.2MM 9MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.61","SUP","HCPCS C1713","","402.610  -  SCREW BONE 3MM 4MM 1.2MM 10MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.611","SUP","HCPCS C1713","","402.611  -  SCREW BONE 3MM 4MM 1.2MM 11MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.612","SUP","HCPCS C1713","","402.612  -  SCREW BONE 3MM 4MM 1.2MM 12MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.613","SUP","HCPCS C1713","","402.613  -  SCREW BONE 3MM 4MM 1.2MM 13MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.614","SUP","HCPCS C1713","","402.614  -  SCREW BONE SHORT THREAD 3MM 14MM 4MM CANN SELF DRILL SELF","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.615","SUP","HCPCS C1713","","402.615  -  SCREW BONE 3MM 4MM 1.2MM 15MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.616","SUP","HCPCS C1713","","402.616  -  SCREW BONE 3MM 4MM 1.2MM 16MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.617","SUP","HCPCS C1713","","402.617  -  SCREW BONE 3MM 4MM 1.2MM 17MM 4MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.618","SUP","HCPCS C1713","","402.618  -  SCREW BONE 3MM 4MM 1.2MM 18MM 5MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.619","SUP","HCPCS C1713","","402.619  -  SCREW BONE 3MM 4MM 1.2MM 19MM 5MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.62","SUP","HCPCS C1713","","402.620  -  SCREW BONE 3MM 4MM 1.2MM 20MM 5MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.621","SUP","HCPCS C1713","","402.621  -  SCREW BONE 3MM 4MM 1.2MM 21MM 5MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.622","SUP","HCPCS C1713","","402.622  -  SCREW BONE 3MM 4MM 1.2MM 22MM 5MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.623","SUP","HCPCS C1713","","402.623  -  SCREW BONE 3MM 4MM 1.2MM 23MM 5MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.624","SUP","HCPCS C1713","","402.624  -  SCREW BONE 3MM 4MM 1.2MM 24MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.625","SUP","HCPCS C1713","","402.625  -  SCREW BONE 3MM 4MM 1.2MM 25MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.626","SUP","HCPCS C1713","","402.626  -  SCREW BONE 3MM 4MM 1.2MM 26MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.627","SUP","HCPCS C1713","","402.627  -  SCREW BONE 3MM 4MM 1.2MM 27MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.628","SUP","HCPCS C1713","","402.628  -  SCREW BONE 3MM 4MM 1.2MM 28MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.629","SUP","HCPCS C1713","","402.629  -  SCREW BONE 3MM 4MM 1.2MM 29MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.63","SUP","HCPCS C1713","","402.630  -  SCREW BONE 3MM 4MM 1.2MM 30MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.632","SUP","HCPCS C1713","","402.632  -  SCREW BONE 3MM 4MM 1.2MM 32MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.634","SUP","HCPCS C1713","","402.634  -  SCREW BONE 3MM 4MM 1.2MM 34MM 7MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.636","SUP","HCPCS C1713","","402.636  -  SCREW BONE 3MM 4MM 1.2MM 36MM 7MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.638","SUP","HCPCS C1713","","402.638  -  SCREW BONE 3MM 4MM 1.2MM 38MM 8MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.64","SUP","HCPCS C1713","","402.640  -  SCREW BONE 3MM 4MM 1.2MM 40MM 8MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.714","SUP","HCPCS C1713","","402.714  -  SCREW BONE 3MM 4MM 1.2MM 14MM 6MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.715","SUP","HCPCS C1713","","402.715  -  SCREW BONE LNGTHRD 3MM 15MM CANN LOCK STARDRIVE RECESS","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.716","SUP","HCPCS C1713","","402.716  -  SCREW BONE 3MM 4MM 1.2MM 16MM 7MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.717","SUP","HCPCS C1713","","402.717  -  SCREW BONE 3MM 4MM 1.2MM 17MM 8MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.718","SUP","HCPCS C1713","","402.718  -  SCREW BONE 3MM 4MM 1.2MM 18MM 8MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.719","SUP","HCPCS C1713","","402.719  -  SCREW BONE 3MM 4MM 1.2MM 19MM 9MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.72","SUP","HCPCS C1713","","402.720  -  SCREW BONE 3MM 4MM 1.2MM 20MM 9MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.721","SUP","HCPCS C1713","","402.721  -  SCREW BONE 3MM 4MM 1.2MM 21MM 9MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.722","SUP","HCPCS C1713","","402.722  -  SCREW BONE 3MM 4MM 1.2MM 22MM 10MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.723","SUP","HCPCS C1713","","402.723  -  SCREW BONE 3MM 4MM 1.2MM 23MM 10MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.724","SUP","HCPCS C1713","","402.724  -  SCREW BONE 3MM 4MM 1.2MM 24MM 10MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.725","SUP","HCPCS C1713","","402.725  -  SCREW BONE 3MM 4MM 1.2MM 25MM 10MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.726","SUP","HCPCS C1713","","402.726  -  SCREW BONE 3MM 4MM 1.2MM 26MM 12MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.727","SUP","HCPCS C1713","","402.727  -  SCREW BONE 3MM 4MM 1.2MM 27MM 12MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.728","SUP","HCPCS C1713","","402.728  -  SCREW BONE 3MM 4MM 1.2MM 28MM 12MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.729","SUP","HCPCS C1713","","402.729  -  SCREW BONE 3MM 4MM 1.2MM 29MM 12MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.73","SUP","HCPCS C1713","","402.730  -  SCREW BONE 3MM 4MM 1.2MM 30MM 14MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.732","SUP","HCPCS C1713","","402.732  -  SCREW BONE 3MM 4MM 1.2MM 32MM 14MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.734","SUP","HCPCS C1713","","402.734  -  SCREW BONE 3MM 4MM 1.2MM 34MM 16MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.736","SUP","HCPCS C1713","","402.736  -  SCREW BONE 3MM 4MM 1.2MM 36MM 16MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.738","SUP","HCPCS C1713","","402.738  -  SCREW BONE 3MM 4MM 1.2MM 38MM 18MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.74","SUP","HCPCS C1713","","402.740  -  SCREW BONE 3MM 4MM 1.2MM 40MM 18MM CANN TITANIUM SMALL BONE","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$54.95 ","$0.00 ","$57.57 ","$0.00 "
"402.806","SUP","HCPCS C1713","","402.806  -  SCREW BONE FULTHD 2.7MM 5MM 6MM SELF TAP SPHERICAL HEAD","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.808","SUP","HCPCS C1713","","402.808  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 8MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.81","SUP","HCPCS C1713","","402.810  -  SCREW BONE 2.7MM 5MM 10MM SELF TAP SPHERICAL HEAD SMALL","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.812","SUP","HCPCS C1713","","402.812  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 12MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.814","SUP","HCPCS C1713","","402.814  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 14MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.816","SUP","HCPCS C1713","","402.816  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 16MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.818","SUP","HCPCS C1713","","402.818  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 18MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.82","SUP","HCPCS C1713","","402.820  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 20MM SELF TAP","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.822","SUP","HCPCS C1713","","402.822  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 22MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.824","SUP","HCPCS C1713","","402.824  -  SCREW BONE FULTHD 2.7MM 5MM 24MM SELF TAP SPHERICAL HEAD","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.826","SUP","HCPCS C1713","","402.826  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 26MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.828","SUP","HCPCS C1713","","402.828  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 28MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.83","SUP","HCPCS C1713","","402.830  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 30MM SELF TAP","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.832","SUP","HCPCS C1713","","402.832  -  SCREW BONE FULTHD 2.7MM 5MM 32MM SELF TAP HEXAGONAL SOCKET","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.834","SUP","HCPCS C1713","","402.834  -  SCREW BONE FULTHD 2.7MM 5MM 34MM SELF TAP SPHERICAL HEAD","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.836","SUP","HCPCS C1713","","402.836  -  SCREW BONE FULTHD 2.7MM 5MM 36MM SELF TAP SPHERICAL HEAD","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.838","SUP","HCPCS C1713","","402.838  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 38MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.84","SUP","HCPCS C1713","","402.840  -  SCREW BONE 2.7MM 40MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.845","SUP","HCPCS C1713","","402.845  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 45MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.85","SUP","HCPCS C1713","","402.850  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 50MM SELF TAP","BOTH IP/OP","$59.70 ","$44.18 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.44 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.855","SUP","HCPCS C1713","","402.855  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 55MM SELF TAP","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$59.70 ","$26.87 ","$0.00 ","$12.81 ","$0.00 ","$0.00 ","$10.45 ","$59.70 ","$0.00 ","$29.85 ","$47.28 ","$47.76 ","$0.00 ","$9.07 ","$0.00 ","$9.50 ","$0.00 "
"402.87","SUP","HCPCS C1713","","402.870  -  SCREW BONE T8 2.7MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$68.90 ","$50.99 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.36 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.872","SUP","HCPCS C1713","","402.872  -  SCREW BONE T8 2.7MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.874","SUP","HCPCS C1713","","402.874  -  SCREW BONE T8 2.7MM 14MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.876","SUP","HCPCS C1713","","402.876  -  SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.878","SUP","HCPCS C1713","","402.878  -  SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.88","SUP","HCPCS C1713","","402.880  -  SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$68.90 ","$50.99 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.36 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.882","SUP","HCPCS C1713","","402.882  -  SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.884","SUP","HCPCS C1713","","402.884  -  SCREW BONE 2.7MM 24MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.886","SUP","HCPCS C1713","","402.886  -  SCREW BONE 2.7MM 26MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.888","SUP","HCPCS C1713","","402.888  -  SCREW BONE 2.7MM 28MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.89","SUP","HCPCS C1713","","402.890  -  SCREW BONE 2.7MM 30MM T8 STARDRIVE SELF TAP LCP TITANIUM RAD","BOTH IP/OP","$68.90 ","$50.99 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.36 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.892","SUP","HCPCS C1713","","402.892  -  SCREW BONE 2.7MM 32MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.894","SUP","HCPCS C1713","","402.894  -  SCREW BONE 2.7MM 34MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.896","SUP","HCPCS C1713","","402.896  -  SCREW BONE 2.7MM 36MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.898","SUP","HCPCS C1713","","402.898  -  SCREW BONE 2.7MM 38MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.9","SUP","HCPCS C1713","","402.900  -  SCREW BONE 2.7MM 5MM 40MM SLFTAP T8 STARDRIVE RECESS LCP","BOTH IP/OP","$68.90 ","$50.99 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.36 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.962","SUP","HCPCS C1713","","402.962  -  SCREW BONE 2.7MM 42MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.963","SUP","HCPCS C1713","","402.963  -  SCREW BONE 2.7MM 44MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.965","SUP","HCPCS C1713","","402.965  -  SCREW BONE T8 2.7MM 46MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.966","SUP","HCPCS C1713","","402.966  -  SCREW BONE T8 2.7MM 48MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.967","SUP","HCPCS C1713","","402.967  -  SCREW BONE 2.7MM 50MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.968","SUP","HCPCS C1713","","402.968  -  SCREW BONE 2.7MM 55MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"402.969","SUP","HCPCS C1713","","402.969  -  SCREW BONE 2.7MM 60MM SLFTAP LCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"404.01","SUP","HCPCS C1713","","404.010  -  SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.012","SUP","HCPCS C1713","","404.012  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 12MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.014","SUP","HCPCS C1713","","404.014  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 14MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.016","SUP","HCPCS C1713","","404.016  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 16MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.018","SUP","HCPCS C1713","","404.018  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"404.02","SUP","HCPCS C1713","","404.020  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"404.022","SUP","HCPCS C1713","","404.022  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"404.024","SUP","HCPCS C1713","","404.024  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"404.026","SUP","HCPCS C1713","","404.026  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 26MM SELF TAP SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"404.028","SUP","HCPCS C1713","","404.028  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$12.43 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.20 ","$0.00 ","$4.40 ","$0.00 "
"404.03","SUP","HCPCS C1713","","404.030  -  SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 30MM SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.032","SUP","HCPCS C1713","","404.032  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 32MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.034","SUP","HCPCS C1713","","404.034  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 34MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.036","SUP","HCPCS C1713","","404.036  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 36MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.038","SUP","HCPCS C1713","","404.038  -  SCREW BONE STANDARD 3.5MM 6MM 38MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.04","SUP","HCPCS C1713","","404.040  -  SCREW BONE STANDARD 3.5MM 6MM 40MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.045","SUP","HCPCS C1713","","404.045  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.05","SUP","HCPCS C1713","","404.050  -  SCREW BONE STANDARD 3.5MM 6MM 50MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.055","SUP","HCPCS C1713","","404.055  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 55MM SMALL HEXAGONAL","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.06","SUP","HCPCS C1713","","404.060  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 60MM SMALL HEXAGONAL","BOTH IP/OP","$26.83 ","$19.85 ","$0.00 ","$26.83 ","$12.07 ","$0.00 ","$5.59 ","$0.00 ","$0.00 ","$4.70 ","$26.83 ","$0.00 ","$13.41 ","$21.25 ","$21.46 ","$0.00 ","$4.20 ","$0.00 ","$4.27 ","$0.00 "
"404.216","SUP","HCPCS C1713","","404.216  -  SCREW BONE HEXAGON SPHERE 3.5MM 16MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.218","SUP","HCPCS C1713","","404.218  -  SCREW BONE HEXAGON SPHERE 3.5MM 18MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.22","SUP","HCPCS C1713","","404.220  -  SCREW BONE HEXAGON SPHERE 3.5MM 20MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.222","SUP","HCPCS C1713","","404.222  -  SCREW BONE HEXAGON SPHERE 3.5MM 22MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.224","SUP","HCPCS C1713","","404.224  -  SCREW BONE HEXAGON SPHERE 3.5MM 24MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.226","SUP","HCPCS C1713","","404.226  -  SCREW BONE HEXAGON SPHERE 3.5MM 26MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.228","SUP","HCPCS C1713","","404.228  -  SCREW BONE HEXAGON SPHERE 3.5MM 28MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.23","SUP","HCPCS C1713","","404.230  -  SCREW BONE PTHRD 3.5MM 6MM 30MM 10MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$32.75 ","$24.24 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.232","SUP","HCPCS C1713","","404.232  -  SCREW BONE HEXAGON SPHERE 3.5MM 32MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$33.73 ","$24.96 ","$0.00 ","$32.75 ","$14.74 ","$0.00 ","$7.03 ","$0.00 ","$0.00 ","$5.73 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$4.98 ","$0.00 ","$5.21 ","$0.00 "
"404.234","SUP","HCPCS C1713","","404.234  -  SCREW BONE HEXAGON SPHERE 3.5MM 34MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"404.236","SUP","HCPCS C1713","","404.236  -  SCREW BONE HEXAGON SPHERE 3.5MM 36MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"404.238","SUP","HCPCS C1713","","404.238  -  SCREW BONE HEXAGON SPHERE 3.5MM 38MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"404.24","SUP","HCPCS C1713","","404.240  -  SCREW BONE HEXAGON SPHERE 3.5MM 40MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"404.245","SUP","HCPCS C1713","","404.245  -  SCREW BONE HEXAGON SPHERE 3.5MM 45MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"404.25","SUP","HCPCS C1713","","404.250  -  SCREW BONE HEXAGON SPHERE 3.5MM 50MM SELF TAP SOCKET LC-DCP","BOTH IP/OP","$31.80 ","$23.53 ","$0.00 ","$31.80 ","$14.31 ","$0.00 ","$6.63 ","$0.00 ","$0.00 ","$5.57 ","$31.80 ","$0.00 ","$15.90 ","$25.19 ","$25.44 ","$0.00 ","$4.98 ","$0.00 ","$5.06 ","$0.00 "
"404.81","SUP","HCPCS C1713","","404.810  -  SCREW BONE FULTHD 3.5MM 6MM 10MM SLFTAP HEXAGONAL RECESS LCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.812","SUP","HCPCS C1713","","404.812  -  SCREW BONE FULTHD 3.5MM 6MM 12MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.814","SUP","HCPCS C1713","","404.814  -  SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.816","SUP","HCPCS C1713","","404.816  -  SCREW BONE FULTHD 3.5MM 6MM 16MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$9.70 ","$0.00 ","$6.14 ","$0.00 "
"404.818","SUP","HCPCS C1713","","404.818  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET LCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.82","SUP","HCPCS C1713","","404.820  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET LCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$9.70 ","$0.00 ","$6.14 ","$0.00 "
"404.822","SUP","HCPCS C1713","","404.822  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET LCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.824","SUP","HCPCS C1713","","404.824  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET LCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.826","SUP","HCPCS C1713","","404.826  -  SCREW BONE FULTHD 3.5MM 6MM 26MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.828","SUP","HCPCS C1713","","404.828  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET LCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.83","SUP","HCPCS C1713","","404.830  -  SCREW BONE FULTHD 3.5MM 6MM 30MM SLFTAP HEXAGONAL RECESS LCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.832","SUP","HCPCS C1713","","404.832  -  SCREW BONE FULTHD 3.5MM 6MM 32MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.834","SUP","HCPCS C1713","","404.834  -  SCREW BONE FULTHD 3.5MM 6MM 34MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.836","SUP","HCPCS C1713","","404.836  -  SCREW BONE FULTHD 3.5MM 6MM 36MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.838","SUP","HCPCS C1713","","404.838  -  SCREW BONE FULTHD 3.5MM 6MM 38MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.84","SUP","HCPCS C1713","","404.840  -  SCREW BONE HEXAGON 3.5MM 40MM SLFTAP SMALL RECESS LCP","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.845","SUP","HCPCS C1713","","404.845  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET LCP","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.85","SUP","HCPCS C1713","","404.850  -  SCREW BONE FULTHD 3.5MM 6MM 50MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$38.55 ","$28.53 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.03 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"404.855","SUP","HCPCS C1713","","404.855  -  SCREW BONE FULTHD 3.5MM 6MM 55MM SELF TAP HEXAGONAL RECESS","BOTH IP/OP","$39.70 ","$29.38 ","$0.00 ","$38.55 ","$17.35 ","$0.00 ","$8.27 ","$0.00 ","$0.00 ","$6.75 ","$38.55 ","$0.00 ","$19.28 ","$30.53 ","$30.84 ","$0.00 ","$5.86 ","$0.00 ","$6.14 ","$0.00 "
"406.01","SUP","HCPCS C1713","","406.010  -  SCREW BONE FULTHD 4MM 10MM LCP TITANIUM CANCELLOUS CLAVICLE","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.012","SUP","HCPCS C1713","","406.012  -  SCREW BONE FULTHD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.014","SUP","HCPCS C1713","","406.014  -  SCREW BONE FULTHD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.016","SUP","HCPCS C1713","","406.016  -  SCREW BONE FULTHD HEXAGON 4MM 16MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.018","SUP","HCPCS C1713","","406.018  -  SCREW BONE FULTHD HEXAGON 4MM 18MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.02","SUP","HCPCS C1713","","406.020  -  SCREW BONE FULTHD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.022","SUP","HCPCS C1713","","406.022  -  SCREW BONE FULTHD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.024","SUP","HCPCS C1713","","406.024  -  SCREW BONE FULTHD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.026","SUP","HCPCS C1713","","406.026  -  SCREW BONE FULTHD HEXAGON 4MM 26MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.028","SUP","HCPCS C1713","","406.028  -  SCREW BONE FULTHD HEXAGON 4MM 28MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.03","SUP","HCPCS C1713","","406.030  -  SCREW BONE FULTHD 4MM 6MM 30MM LC-DCP TITANIUM TIBIA","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.032","SUP","HCPCS C1713","","406.032  -  SCREW BONE FULTHD HEXAGON 4MM 32MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.80 ","$22.79 ","$0.00 ","$30.80 ","$13.86 ","$0.00 ","$6.42 ","$0.00 ","$0.00 ","$5.39 ","$30.80 ","$0.00 ","$15.40 ","$24.39 ","$24.64 ","$0.00 ","$4.82 ","$0.00 ","$4.90 ","$0.00 "
"406.035","SUP","HCPCS C1713","","406.035  -  SCREW BONE FULTHD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.04","SUP","HCPCS C1713","","406.040  -  SCREW BONE FULTHD SMALL HEXAGON 4MM 6MM 40MM SOCKET TITANIUM","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.045","SUP","HCPCS C1713","","406.045  -  SCREW BONE FULTHD 4MM 6MM 45MM 15MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.05","SUP","HCPCS C1713","","406.050  -  SCREW BONE FULTHD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$4.82 ","$0.00 ","$5.05 ","$0.00 "
"406.055","SUP","HCPCS C1713","","406.055  -  SCREW BONE FULTHD 4MM 6MM 55MM 15MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$32.68 ","$24.18 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.81 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.06","SUP","HCPCS C1713","","406.060  -  SCREW BONE FULTHD 4MM 6MM 60MM 15MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$14.28 ","$0.00 ","$6.61 ","$0.00 ","$0.00 ","$5.55 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$7.42 ","$0.00 ","$5.05 ","$0.00 "
"406.065","SUP","HCPCS C1713","","406.065  -  SCREW BONE FULTHD 4MM 65MM LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.07","SUP","HCPCS C1713","","406.070  -  SCREW BONE FULTHD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.075","SUP","HCPCS C1713","","406.075  -  SCREW BONE FULTHD 4MM 75MM LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.08","SUP","HCPCS C1713","","406.080  -  SCREW BONE FULTHD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.085","SUP","HCPCS C1713","","406.085  -  SCREW BONE FULTHD 4MM 85MM LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.09","SUP","HCPCS C1713","","406.090  -  SCREW BONE FULTHD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.095","SUP","HCPCS C1713","","406.095  -  SCREW BONE FULTHD 4MM 95MM LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.47 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.1","SUP","HCPCS C1713","","406.100  -  SCREW BONE FULTHD 4MM 100MM LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$34.80 ","$25.75 ","$0.00 ","$34.80 ","$15.66 ","$0.00 ","$7.25 ","$0.00 ","$0.00 ","$6.09 ","$34.80 ","$0.00 ","$17.40 ","$27.56 ","$27.84 ","$0.00 ","$5.29 ","$0.00 ","$5.54 ","$0.00 "
"406.104","SUP","HCPCS C1713","","406.104  -  SCREW BONE LOCK STARDRIVE AXON TITANIUM SPN NONSTRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"407.01","SUP","HCPCS C1713","","407.010  -  SCREW BONE PTHRD HEXAGON 4MM 10MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.012","SUP","HCPCS C1713","","407.012  -  SCREW BONE PTHRD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.014","SUP","HCPCS C1713","","407.014  -  SCREW BONE PTHRD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.016","SUP","HCPCS C1713","","407.016  -  SCREW BONE PTHRD 4MM 6MM 16MM 6MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.018","SUP","HCPCS C1713","","407.018  -  SCREW BONE PTHRD 4MM 6MM 18MM 7MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.02","SUP","HCPCS C1713","","407.020  -  SCREW BONE PTHRD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.022","SUP","HCPCS C1713","","407.022  -  SCREW BONE PTHRD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.024","SUP","HCPCS C1713","","407.024  -  SCREW BONE PTHRD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.026","SUP","HCPCS C1713","","407.026  -  SCREW BONE PTHRD 4MM 6MM 26MM 12MM SMALL HEXAGONAL SOCKET","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.028","SUP","HCPCS C1713","","407.028  -  SCREW BONE PTHRD 4MM 6MM 28MM 14MM HEXAGONAL SOCKET LC-DCP","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.03","SUP","HCPCS C1713","","407.030  -  SCREW BONE PTHRD HEXAGON 4MM 30MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.035","SUP","HCPCS C1713","","407.035  -  SCREW BONE PTHRD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$7.42 ","$0.00 ","$4.78 ","$0.00 "
"407.04","SUP","HCPCS C1713","","407.040  -  SCREW BONE PTHRD HEXAGON 4MM 40MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.045","SUP","HCPCS C1713","","407.045  -  SCREW BONE PTHRD HEXAGON 4MM 45MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.05","SUP","HCPCS C1713","","407.050  -  SCREW BONE PTHRD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.055","SUP","HCPCS C1713","","407.055  -  SCREW BONE PTHRD HEXAGON 4MM 55MM SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.45 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.06","SUP","HCPCS C1713","","407.060  -  SCREW BONE 4MM 60MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$30.03 ","$22.22 ","$0.00 ","$30.03 ","$13.51 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.03 ","$0.00 ","$15.01 ","$23.78 ","$24.02 ","$0.00 ","$4.56 ","$0.00 ","$4.78 ","$0.00 "
"407.065","SUP","HCPCS C1713","","407.065  -  SCREW BONE 4MM 65MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.07","SUP","HCPCS C1713","","407.070  -  SCREW BONE PTHRD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.075","SUP","HCPCS C1713","","407.075  -  SCREW BONE 4MM 75MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.08","SUP","HCPCS C1713","","407.080  -  SCREW BONE PTHRD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.085","SUP","HCPCS C1713","","407.085  -  SCREW BONE 4MM 85MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.09","SUP","HCPCS C1713","","407.090  -  SCREW BONE PTHRD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.095","SUP","HCPCS C1713","","407.095  -  SCREW BONE 4MM 95MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS","BOTH IP/OP","$35.15 ","$26.01 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.33 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.1","SUP","HCPCS C1713","","407.100  -  SCREW BONE PTHRD 4MM 100MM LCP TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$34.13 ","$25.26 ","$0.00 ","$34.13 ","$15.36 ","$0.00 ","$7.11 ","$0.00 ","$0.00 ","$5.98 ","$34.13 ","$0.00 ","$17.06 ","$27.03 ","$27.30 ","$0.00 ","$5.18 ","$0.00 ","$5.43 ","$0.00 "
"407.61","SUP","HCPCS C1713","","407.610  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 10MM SELF DRILL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.612","SUP","HCPCS C1713","","407.612  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 12MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.614","SUP","HCPCS C1713","","407.614  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 14MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.616","SUP","HCPCS C1713","","407.616  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 16MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.618","SUP","HCPCS C1713","","407.618  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 18MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.62","SUP","HCPCS C1713","","407.620  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 20MM SELF DRILL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.622","SUP","HCPCS C1713","","407.622  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 22MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.624","SUP","HCPCS C1713","","407.624  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 24MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.626","SUP","HCPCS C1713","","407.626  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 26MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.628","SUP","HCPCS C1713","","407.628  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 28MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$73.99 ","$0.00 ","$56.93 ","$0.00 "
"407.63","SUP","HCPCS C1713","","407.630  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 30MM SELF DRILL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.632","SUP","HCPCS C1713","","407.632  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 32MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.634","SUP","HCPCS C1713","","407.634  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 34MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.636","SUP","HCPCS C1713","","407.636  -  SCREW BONE SHORT THREAD 4MM 5MM 36MM CANN HEXAGONAL SOCKET","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.638","SUP","HCPCS C1713","","407.638  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 38MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.64","SUP","HCPCS C1713","","407.640  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 40MM SELF DRILL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.642","SUP","HCPCS C1713","","407.642  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 42MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.644","SUP","HCPCS C1713","","407.644  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 44MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.646","SUP","HCPCS C1713","","407.646  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 46MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.648","SUP","HCPCS C1713","","407.648  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 48MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.65","SUP","HCPCS C1713","","407.650  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 50MM SELF DRILL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$73.99 ","$0.00 ","$56.93 ","$0.00 "
"407.652","SUP","HCPCS C1713","","407.652  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 52MM SELF DRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.654","SUP","HCPCS C1713","","407.654  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 54MM SELF DRILL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.656","SUP","HCPCS C1713","","407.656  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 56MM SELF DRILL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.658","SUP","HCPCS C1713","","407.658  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 58MM SELF DRILL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.66","SUP","HCPCS C1713","","407.660  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 60MM SELF DRILL","BOTH IP/OP","$369.85 ","$273.69 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$77.09 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.664","SUP","HCPCS C1713","","407.664  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 64MM SELF DRILL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.668","SUP","HCPCS C1713","","407.668  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 68MM SELF DRILL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.672","SUP","HCPCS C1713","","407.672  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 72MM SELF DRILL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.716","SUP","HCPCS C1713","","407.716  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 16MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.718","SUP","HCPCS C1713","","407.718  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 18MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.72","SUP","HCPCS C1713","","407.720  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 20MM CANN TITANIUM SMALL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.722","SUP","HCPCS C1713","","407.722  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 22MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.724","SUP","HCPCS C1713","","407.724  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 24MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.726","SUP","HCPCS C1713","","407.726  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 26MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.728","SUP","HCPCS C1713","","407.728  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 28MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.73","SUP","HCPCS C1713","","407.730  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 30MM CANN TITANIUM SMALL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.732","SUP","HCPCS C1713","","407.732  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 32MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.734","SUP","HCPCS C1713","","407.734  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 34MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.736","SUP","HCPCS C1713","","407.736  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 36MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.738","SUP","HCPCS C1713","","407.738  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 38MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.74","SUP","HCPCS C1713","","407.740  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 40MM CANN TITANIUM SMALL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.742","SUP","HCPCS C1713","","407.742  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 42MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.744","SUP","HCPCS C1713","","407.744  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 44MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.746","SUP","HCPCS C1713","","407.746  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 46MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.748","SUP","HCPCS C1713","","407.748  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 48MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.75","SUP","HCPCS C1713","","407.750  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 50MM CANN TITANIUM SMALL","BOTH IP/OP","$357.58 ","$264.61 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$74.53 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.752","SUP","HCPCS C1713","","407.752  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 52MM CANN TITANIUM SMALL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"407.754","SUP","HCPCS C1713","","407.754  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 54MM CANN TITANIUM SMALL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.756","SUP","HCPCS C1713","","407.756  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 56MM CANN TITANIUM SMALL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.758","SUP","HCPCS C1713","","407.758  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 58MM CANN TITANIUM SMALL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.76","SUP","HCPCS C1713","","407.760  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 60MM CANN TITANIUM SMALL","BOTH IP/OP","$369.85 ","$273.69 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$77.09 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.764","SUP","HCPCS C1713","","407.764  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 64MM CANN TITANIUM SMALL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.768","SUP","HCPCS C1713","","407.768  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 68MM CANN TITANIUM SMALL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"407.772","SUP","HCPCS C1713","","407.772  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 72MM CANN TITANIUM SMALL","BOTH IP/OP","$380.95 ","$281.90 ","$0.00 ","$369.85 ","$166.43 ","$0.00 ","$79.40 ","$0.00 ","$0.00 ","$64.76 ","$369.85 ","$0.00 ","$184.93 ","$292.92 ","$295.88 ","$0.00 ","$56.20 ","$0.00 ","$58.88 ","$0.00 "
"408.401","SUP","HCPCS C1713","","408.401  -  SCREW BONE 6.5MM 30MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.402","SUP","HCPCS C1713","","408.402  -  SCREW BONE 6.5MM 35MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.403","SUP","HCPCS C1713","","408.403  -  SCREW BONE 6.5MM 40MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.404","SUP","HCPCS C1713","","408.404  -  SCREW BONE 6.5MM 45MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.405","SUP","HCPCS C1713","","408.405  -  SCREW BONE 6.5MM 50MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.406","SUP","HCPCS C1713","","408.406  -  SCREW BONE 6.5MM 55MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.407","SUP","HCPCS C1713","","408.407  -  SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.408","SUP","HCPCS C1713","","408.408  -  SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.409","SUP","HCPCS C1713","","408.409  -  SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.41","SUP","HCPCS C1713","","408.410  -  SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.411","SUP","HCPCS C1713","","408.411  -  SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.412","SUP","HCPCS C1713","","408.412  -  SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.413","SUP","HCPCS C1713","","408.413  -  SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.414","SUP","HCPCS C1713","","408.414  -  SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.415","SUP","HCPCS C1713","","408.415  -  SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.416","SUP","HCPCS C1713","","408.416  -  SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.417","SUP","HCPCS C1713","","408.417  -  SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.418","SUP","HCPCS C1713","","408.418  -  SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.419","SUP","HCPCS C1713","","408.419  -  SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.42","SUP","HCPCS C1713","","408.420  -  SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.421","SUP","HCPCS C1713","","408.421  -  SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.422","SUP","HCPCS C1713","","408.422  -  SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 16MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.423","SUP","HCPCS C1713","","408.423  -  SCREW BONE 6.5MM 140MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.424","SUP","HCPCS C1713","","408.424  -  SCREW BONE 6.5MM 145MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.425","SUP","HCPCS C1713","","408.425  -  SCREW BONE 6.5MM 150MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.426","SUP","HCPCS C1713","","408.426  -  SCREW BONE 6.5MM 160MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.427","SUP","HCPCS C1713","","408.427  -  SCREW BONE 6.5MM 170MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.428","SUP","HCPCS C1713","","408.428  -  SCREW BONE 6.5MM 180MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.431","SUP","HCPCS C1713","","408.431  -  SCREW BONE 6.5MM 45MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.432","SUP","HCPCS C1713","","408.432  -  SCREW BONE 6.5MM 50MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.433","SUP","HCPCS C1713","","408.433  -  SCREW BONE 6.5MM 55MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.434","SUP","HCPCS C1713","","408.434  -  SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.435","SUP","HCPCS C1713","","408.435  -  SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.436","SUP","HCPCS C1713","","408.436  -  SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.437","SUP","HCPCS C1713","","408.437  -  SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.438","SUP","HCPCS C1713","","408.438  -  SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.439","SUP","HCPCS C1713","","408.439  -  SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.44","SUP","HCPCS C1713","","408.440  -  SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.441","SUP","HCPCS C1713","","408.441  -  SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.442","SUP","HCPCS C1713","","408.442  -  SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.443","SUP","HCPCS C1713","","408.443  -  SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.444","SUP","HCPCS C1713","","408.444  -  SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.445","SUP","HCPCS C1713","","408.445  -  SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.446","SUP","HCPCS C1713","","408.446  -  SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.447","SUP","HCPCS C1713","","408.447  -  SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.448","SUP","HCPCS C1713","","408.448  -  SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.449","SUP","HCPCS C1713","","408.449  -  SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 32MM CANN TITANIUM LARGE","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.45","SUP","HCPCS C1713","","408.450  -  SCREW BONE 6.5MM 140MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.451","SUP","HCPCS C1713","","408.451  -  SCREW BONE 6.5MM 145MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.452","SUP","HCPCS C1713","","408.452  -  SCREW BONE 6.5MM 150MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.453","SUP","HCPCS C1713","","408.453  -  SCREW BONE 6.5MM 160MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.454","SUP","HCPCS C1713","","408.454  -  SCREW BONE 6.5MM 170MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.455","SUP","HCPCS C1713","","408.455  -  SCREW BONE 6.5MM 180MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.46","SUP","HCPCS C1713","","408.460  -  SCREW BONE FULTHD 6.5MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.461","SUP","HCPCS C1713","","408.461  -  SCREW BONE FULTHD 6.5MM 25MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.462","SUP","HCPCS C1713","","408.462  -  SCREW BONE FULTHD 6.5MM 30MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.463","SUP","HCPCS C1713","","408.463  -  SCREW BONE FULTHD 6.5MM 35MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.464","SUP","HCPCS C1713","","408.464  -  SCREW BONE FULTHD 6.5MM 40MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.465","SUP","HCPCS C1713","","408.465  -  SCREW BONE 6.5MM 45MM FULTHRD TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.466","SUP","HCPCS C1713","","408.466  -  SCREW BONE FULTHD 6.5MM 50MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.467","SUP","HCPCS C1713","","408.467  -  SCREW BONE FULTHD 6.5MM 55MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.468","SUP","HCPCS C1713","","408.468  -  SCREW BONE FULTHD 6.5MM 60MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.469","SUP","HCPCS C1713","","408.469  -  SCREW BONE FULTHD 6.5MM 65MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.47","SUP","HCPCS C1713","","408.470  -  SCREW BONE FULTHD 6.5MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.471","SUP","HCPCS C1713","","408.471  -  SCREW BONE FULTHD 6.5MM 75MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.472","SUP","HCPCS C1713","","408.472  -  SCREW BONE FULTHD 6.5MM 80MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.473","SUP","HCPCS C1713","","408.473  -  SCREW BONE FULTHD 6.5MM 85MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.474","SUP","HCPCS C1713","","408.474  -  SCREW BONE FULTHD 6.5MM 90MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.475","SUP","HCPCS C1713","","408.475  -  SCREW BONE FULTHD 6.5MM 95MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.476","SUP","HCPCS C1713","","408.476  -  SCREW BONE FULTHD 6.5MM 100MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.477","SUP","HCPCS C1713","","408.477  -  SCREW BONE FULTHD 6.5MM 105MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.478","SUP","HCPCS C1713","","408.478  -  SCREW BONE FULTHD 6.5MM 110MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.479","SUP","HCPCS C1713","","408.479  -  SCREW BONE FULTHD 6.5MM 115MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.48","SUP","HCPCS C1713","","408.480  -  SCREW BONE FULTHD 6.5MM 120MM CANN TITANIUM FEMUR TIBIA","BOTH IP/OP","$472.20 ","$349.43 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$98.42 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.481","SUP","HCPCS C1713","","408.481  -  SCREW BONE FULTHD 6.5MM 125MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.482","SUP","HCPCS C1713","","408.482  -  SCREW BONE FULTHD 6.5MM 130MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"408.483","SUP","HCPCS C1713","","408.483  -  SCREW BONE 6.5MM 140MM CANN FULTHD TITANIUM ORTHOPEDIC","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"408.484","SUP","HCPCS C1713","","408.484  -  SCREW BONE FULTHD 6.5MM 150MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"408.485","SUP","HCPCS C1713","","408.485  -  SCREW BONE FULTHD 6.5MM 160MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"408.486","SUP","HCPCS C1713","","408.486  -  SCREW BONE FULTHD 6.5MM 170MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"408.487","SUP","HCPCS C1713","","408.487  -  SCREW BONE FULTHD 6.5MM 180MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$501.83 ","$371.35 ","$0.00 ","$487.23 ","$219.25 ","$0.00 ","$104.59 ","$0.00 ","$0.00 ","$85.31 ","$487.23 ","$0.00 ","$243.61 ","$385.89 ","$389.78 ","$0.00 ","$74.03 ","$0.00 ","$77.57 ","$0.00 "
"408.83","SUP","HCPCS C1713","","408.830  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 30MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.835","SUP","HCPCS C1713","","408.835  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 35MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.84","SUP","HCPCS C1713","","408.840  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 40MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.845","SUP","HCPCS C1713","","408.845  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.85","SUP","HCPCS C1713","","408.850  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.855","SUP","HCPCS C1713","","408.855  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.86","SUP","HCPCS C1713","","408.860  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.865","SUP","HCPCS C1713","","408.865  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.87","SUP","HCPCS C1713","","408.870  -  SCREW BONE 7.3MM 8.2MM 2.9MM 70MM 16MM CANN SELF TAP SELF","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.875","SUP","HCPCS C1713","","408.875  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.88","SUP","HCPCS C1713","","408.880  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.885","SUP","HCPCS C1713","","408.885  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.89","SUP","HCPCS C1713","","408.890  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.895","SUP","HCPCS C1713","","408.895  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.9","SUP","HCPCS C1713","","408.900  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.905","SUP","HCPCS C1713","","408.905  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.91","SUP","HCPCS C1713","","408.910  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.915","SUP","HCPCS C1713","","408.915  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.92","SUP","HCPCS C1713","","408.920  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.925","SUP","HCPCS C1713","","408.925  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.93","SUP","HCPCS C1713","","408.930  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.935","SUP","HCPCS C1713","","408.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.94","SUP","HCPCS C1713","","408.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.945","SUP","HCPCS C1713","","408.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"408.95","SUP","HCPCS C1713","","408.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.62","SUP","HCPCS C1713","","409.620  -  SCREW BONE FULTHD 7.3MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.625","SUP","HCPCS C1713","","409.625  -  SCREW BONE FULTHD 7.3MM 25MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.63","SUP","HCPCS C1713","","409.630  -  SCREW BONE FULTHD 7.3MM 30MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.635","SUP","HCPCS C1713","","409.635  -  SCREW BONE FULTHD 7.3MM 35MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.64","SUP","HCPCS C1713","","409.640  -  SCREW BONE FULTHD 7.3MM 40MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.645","SUP","HCPCS C1713","","409.645  -  SCREW BONE FULTHD 7.3MM 45MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.65","SUP","HCPCS C1713","","409.650  -  SCREW BONE FULTHD 7.3MM 50MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.655","SUP","HCPCS C1713","","409.655  -  SCREW BONE FULTHD 7.3MM 55MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.66","SUP","HCPCS C1713","","409.660  -  SCREW BONE FULTHD 7.3MM 60MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.665","SUP","HCPCS C1713","","409.665  -  SCREW BONE FULTHD 7.3MM 65MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.67","SUP","HCPCS C1713","","409.670  -  SCREW BONE FULTHD 7.3MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.675","SUP","HCPCS C1713","","409.675  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 75MM CANN SELF DRILL GOLD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.68","SUP","HCPCS C1713","","409.680  -  SCREW BONE FULTHD 7.3MM 8.2MM 80MM CANN SLFDRILL SLFTAP","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.685","SUP","HCPCS C1713","","409.685  -  SCREW BONE FULTHD 7.3MM 85MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.69","SUP","HCPCS C1713","","409.690  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 90MM CANN SELF DRILL GOLD","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.695","SUP","HCPCS C1713","","409.695  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 95MM CANN SELF DRILL GOLD","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.7","SUP","HCPCS C1713","","409.700  -  SCREW BONE FULTHD 7.3MM 100MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.705","SUP","HCPCS C1713","","409.705  -  SCREW BONE FULTHD 7.3MM 105MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.71","SUP","HCPCS C1713","","409.710  -  SCREW BONE FULTHD 7.3MM 110MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.715","SUP","HCPCS C1713","","409.715  -  SCREW BONE FULTHD 7.3MM 115MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.72","SUP","HCPCS C1713","","409.720  -  SCREW BONE FULTHD 7.3MM 120MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.725","SUP","HCPCS C1713","","409.725  -  SCREW BONE FULTHD 7.3MM 125MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.73","SUP","HCPCS C1713","","409.730  -  SCREW BONE FULTHD 7.3MM 130MM CANN TITANIUM ORTHOPEDIC","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.845","SUP","HCPCS C1713","","409.845  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.85","SUP","HCPCS C1713","","409.850  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.855","SUP","HCPCS C1713","","409.855  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.86","SUP","HCPCS C1713","","409.860  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.865","SUP","HCPCS C1713","","409.865  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.87","SUP","HCPCS C1713","","409.870  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 70MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.875","SUP","HCPCS C1713","","409.875  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.88","SUP","HCPCS C1713","","409.880  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.885","SUP","HCPCS C1713","","409.885  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.89","SUP","HCPCS C1713","","409.890  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.895","SUP","HCPCS C1713","","409.895  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.9","SUP","HCPCS C1713","","409.900  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.905","SUP","HCPCS C1713","","409.905  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.91","SUP","HCPCS C1713","","409.910  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.915","SUP","HCPCS C1713","","409.915  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.92","SUP","HCPCS C1713","","409.920  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.925","SUP","HCPCS C1713","","409.925  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.93","SUP","HCPCS C1713","","409.930  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.935","SUP","HCPCS C1713","","409.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.94","SUP","HCPCS C1713","","409.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.945","SUP","HCPCS C1713","","409.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"409.95","SUP","HCPCS C1713","","409.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM","BOTH IP/OP","$469.48 ","$347.42 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$97.85 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"412.101","SUP","HCPCS C1713","","412.101  -  SCREW BONE T15 FULTHD 3.5MM 10MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.102","SUP","HCPCS C1713","","412.102  -  SCREW BONE T15 FULTHD 3.5MM 12MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.103","SUP","HCPCS C1713","","412.103  -  SCREW BONE T15 FULTHD 3.5MM 14MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.104","SUP","HCPCS C1713","","412.104  -  SCREW BONE T15 FULTHD 3.5MM 16MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.105","SUP","HCPCS C1713","","412.105  -  SCREW BONE 3.5MM 5MM 18MM SELF TAP LOCK T15 STARDRIVE RECESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.106","SUP","HCPCS C1713","","412.106  -  SCREW BONE T15 FULTHD 3.5MM 20MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.107","SUP","HCPCS C1713","","412.107  -  SCREW BONE T15 FULTHD 3.5MM 22MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.108","SUP","HCPCS C1713","","412.108  -  SCREW BONE 3.5MM 24MM SELF TAP LOCK STARDRIVE CONICAL HEAD","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.109","SUP","HCPCS C1713","","412.109  -  SCREW BONE T15 FULTHD 3.5MM 26MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.11","SUP","HCPCS C1713","","412.110  -  SCREW BONE T15 FULTHD 3.5MM 28MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.111","SUP","HCPCS C1713","","412.111  -  SCREW BONE T15 FULTHD 3.5MM 30MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.112","SUP","HCPCS C1713","","412.112  -  SCREW BONE T15 FULTHD 3.5MM 32MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.113","SUP","HCPCS C1713","","412.113  -  SCREW BONE T15 FULTHD 3.5MM 34MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.114","SUP","HCPCS C1713","","412.114  -  SCREW BONE T15 FULTHD 3.5MM 35MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.115","SUP","HCPCS C1713","","412.115  -  SCREW BONE T15 FULTHD 3.5MM 36MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$44.32 ","$0.00 ","$36.29 ","$0.00 "
"412.116","SUP","HCPCS C1713","","412.116  -  SCREW BONE T15 FULTHD 3.5MM 38MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.117","SUP","HCPCS C1713","","412.117  -  SCREW BONE T15 FULTHD 3.5MM 40MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.118","SUP","HCPCS C1713","","412.118  -  SCREW BONE T15 FULTHD 3.5MM 42MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.119","SUP","HCPCS C1713","","412.119  -  SCREW BONE T15 FULTHD 3.5MM 45MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.12","SUP","HCPCS C1713","","412.120  -  SCREW BONE T15 FULTHD 3.5MM 48MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.121","SUP","HCPCS C1713","","412.121  -  SCREW BONE T15 FULTHD 3.5MM 50MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.122","SUP","HCPCS C1713","","412.122  -  SCREW BONE T15 FULTHD 3.5MM 52MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.123","SUP","HCPCS C1713","","412.123  -  SCREW BONE T15 FULTHD 3.5MM 55MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.124","SUP","HCPCS C1713","","412.124  -  SCREW BONE T15 FULTHD 3.5MM 60MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.125","SUP","HCPCS C1713","","412.125  -  SCREW BONE 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.126","SUP","HCPCS C1713","","412.126  -  SCREW BONE T15 FULTHD 3.5MM 70MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.127","SUP","HCPCS C1713","","412.127  -  SCREW BONE T15 FULTHD 3.5MM 75MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.128","SUP","HCPCS C1713","","412.128  -  SCREW BONE T15 FULTHD 3.5MM 80MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.129","SUP","HCPCS C1713","","412.129  -  SCREW BONE 3.5MM 85MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.13","SUP","HCPCS C1713","","412.130  -  SCREW BONE 3.5MM 90MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.131","SUP","HCPCS C1713","","412.131  -  SCREW BONE 3.5MM 95MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.134","SUP","HCPCS C1713","","412.134  -  SCREW BONE T15 FULTHD 3.5MM 44MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.136","SUP","HCPCS C1713","","412.136  -  SCREW BONE T15 FULTHD 3.5MM 46MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"412.201","SUP","HCPCS C1713","","412.201  -  SCREW BONE T25 5MM 14MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.202","SUP","HCPCS C1713","","412.202  -  SCREW BONE T25 5MM 16MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.203","SUP","HCPCS C1713","","412.203  -  SCREW BONE T25 5MM 18MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.204","SUP","HCPCS C1713","","412.204  -  SCREW BONE T25 5MM 20MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.205","SUP","HCPCS C1713","","412.205  -  SCREW BONE T25 5MM 22MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.206","SUP","HCPCS C1713","","412.206  -  SCREW BONE T25 5MM 24MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.207","SUP","HCPCS C1713","","412.207  -  SCREW BONE T25 5MM 26MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.208","SUP","HCPCS C1713","","412.208  -  SCREW BONE T25 5MM 28MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.209","SUP","HCPCS C1713","","412.209  -  SCREW BONE T25 5MM 30MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.21","SUP","HCPCS C1713","","412.210  -  SCREW BONE T25 5MM 32MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.211","SUP","HCPCS C1713","","412.211  -  SCREW BONE T25 5MM 34MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.212","SUP","HCPCS C1713","","412.212  -  SCREW BONE T25 5MM 36MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.213","SUP","HCPCS C1713","","412.213  -  SCREW BONE T25 5MM 38MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.214","SUP","HCPCS C1713","","412.214  -  SCREW BONE T25 5MM 40MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.215","SUP","HCPCS C1713","","412.215  -  SCREW BONE 5MM 6.6MM 42MM LOCK T25 STARDRIVE RECESS LCP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.216","SUP","HCPCS C1713","","412.216  -  SCREW BONE 5MM 44MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.217","SUP","HCPCS C1713","","412.217  -  SCREW BONE T25 5MM 46MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.218","SUP","HCPCS C1713","","412.218  -  SCREW BONE 5MM 6.6MM 48MM LOCK SELF TAP T25 STARDRIVE LCP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.219","SUP","HCPCS C1713","","412.219  -  SCREW BONE T25 5MM 50MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.22","SUP","HCPCS C1713","","412.220  -  SCREW BONE T25 5MM 55MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.221","SUP","HCPCS C1713","","412.221  -  SCREW BONE 5MM 60MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.222","SUP","HCPCS C1713","","412.222  -  SCREW BONE T25 5MM 65MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.223","SUP","HCPCS C1713","","412.223  -  SCREW BONE T25 5MM 70MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.224","SUP","HCPCS C1713","","412.224  -  SCREW BONE T25 5MM 75MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.225","SUP","HCPCS C1713","","412.225  -  SCREW BONE T25 5MM 80MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.226","SUP","HCPCS C1713","","412.226  -  SCREW BONE T25 5MM 85MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.227","SUP","HCPCS C1713","","412.227  -  SCREW BONE T25 5MM 90MM SELF TAP STARDRIVE LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"412.251","SUP","HCPCS C1713","","412.251  -  SCREW BONE 5MM 51MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.252","SUP","HCPCS C1713","","412.252  -  SCREW BONE 5MM 52MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.253","SUP","HCPCS C1713","","412.253  -  SCREW BONE 5MM 53MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.254","SUP","HCPCS C1713","","412.254  -  SCREW BONE 5MM 54MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.255","SUP","HCPCS C1713","","412.255  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.256","SUP","HCPCS C1713","","412.256  -  SCREW BONE 5MM 56MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.257","SUP","HCPCS C1713","","412.257  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.258","SUP","HCPCS C1713","","412.258  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.259","SUP","HCPCS C1713","","412.259  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.26","SUP","HCPCS C1713","","412.260  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.261","SUP","HCPCS C1713","","412.261  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.262","SUP","HCPCS C1713","","412.262  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.263","SUP","HCPCS C1713","","412.263  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.264","SUP","HCPCS C1713","","412.264  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.265","SUP","HCPCS C1713","","412.265  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.266","SUP","HCPCS C1713","","412.266  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.267","SUP","HCPCS C1713","","412.267  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS","BOTH IP/OP","$385.58 ","$285.33 ","$0.00 ","$385.58 ","$173.51 ","$0.00 ","$80.36 ","$0.00 ","$0.00 ","$67.51 ","$385.58 ","$0.00 ","$192.79 ","$305.38 ","$308.46 ","$0.00 ","$60.34 ","$0.00 ","$61.38 ","$0.00 "
"412.317","SUP","HCPCS C1713","","412.317  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.319","SUP","HCPCS C1713","","412.319  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.321","SUP","HCPCS C1713","","412.321  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.323","SUP","HCPCS C1713","","412.323  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.324","SUP","HCPCS C1713","","412.324  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.325","SUP","HCPCS C1713","","412.325  -  SCREW BONE FULTHD 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.326","SUP","HCPCS C1713","","412.326  -  SCREW BONE FULTHD 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.327","SUP","HCPCS C1713","","412.327  -  SCREW BONE FULTHD 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.328","SUP","HCPCS C1713","","412.328  -  SCREW BONE FULTHD 3.5MM 80MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.329","SUP","HCPCS C1713","","412.329  -  SCREW BONE FULTHD 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.33","SUP","HCPCS C1713","","412.330  -  SCREW BONE FULTHD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$249.75 ","$184.82 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$52.05 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.331","SUP","HCPCS C1713","","412.331  -  SCREW BONE FULTHD 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.417","SUP","HCPCS C1713","","412.417  -  SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.419","SUP","HCPCS C1713","","412.419  -  SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.421","SUP","HCPCS C1713","","412.421  -  SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.423","SUP","HCPCS C1713","","412.423  -  SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.424","SUP","HCPCS C1713","","412.424  -  SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$264.28 ","$195.57 ","$0.00 ","$256.58 ","$115.46 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$44.92 ","$256.58 ","$0.00 ","$128.29 ","$203.21 ","$205.26 ","$0.00 ","$38.98 ","$0.00 ","$40.85 ","$0.00 "
"412.425","SUP","HCPCS C1713","","412.425  -  SCREW BONE 3.5MM 65MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.426","SUP","HCPCS C1713","","412.426  -  SCREW BONE 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.427","SUP","HCPCS C1713","","412.427  -  SCREW BONE 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.428","SUP","HCPCS C1713","","412.428  -  SCREW BONE 3.5MM 80MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.429","SUP","HCPCS C1713","","412.429  -  SCREW BONE 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.43","SUP","HCPCS C1713","","412.430  -  SCREW BONE PTHRD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS","BOTH IP/OP","$249.75 ","$184.82 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$52.05 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.431","SUP","HCPCS C1713","","412.431  -  SCREW BONE 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS PTHRD","BOTH IP/OP","$257.25 ","$190.37 ","$0.00 ","$249.75 ","$112.39 ","$0.00 ","$53.62 ","$0.00 ","$0.00 ","$43.73 ","$249.75 ","$0.00 ","$124.88 ","$197.80 ","$199.80 ","$0.00 ","$37.95 ","$0.00 ","$39.76 ","$0.00 "
"412.806","SUP","HCPCS C1713","","412.806  -  SCREW BONE 2.4MM 6MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.807","SUP","HCPCS C1713","","412.807  -  SCREW BONE 2.4MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.808","SUP","HCPCS C1713","","412.808  -  SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.809","SUP","HCPCS C1713","","412.809  -  SCREW BONE 2.4MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.81","SUP","HCPCS C1713","","412.810  -  SCREW BONE T8 CONE 2.4MM 10MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.811","SUP","HCPCS C1713","","412.811  -  SCREW BONE T8 CONE 2.4MM 11MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.812","SUP","HCPCS C1713","","412.812  -  SCREW BONE T8 CONE 2.4MM 12MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.813","SUP","HCPCS C1713","","412.813  -  SCREW BONE 2.4MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.814","SUP","HCPCS C1713","","412.814  -  SCREW BONE T8 CONE 2.4MM 14MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.816","SUP","HCPCS C1713","","412.816  -  SCREW BONE T8 CONE 2.4MM 16MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.818","SUP","HCPCS C1713","","412.818  -  SCREW BONE T8 CONE 2.4MM 18MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.82","SUP","HCPCS C1713","","412.820  -  SCREW BONE T8 CONE 2.4MM 20MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.822","SUP","HCPCS C1713","","412.822  -  SCREW BONE T8 CONE 2.4MM 22MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.824","SUP","HCPCS C1713","","412.824  -  SCREW BONE T8 CONE 2.4MM 24MM SELF TAP THREAD STARDRIVE LCP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.826","SUP","HCPCS C1713","","412.826  -  SCREW BONE 2.4MM 1.9MM 26MM T8 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.828","SUP","HCPCS C1713","","412.828  -  SCREW BONE 2.4MM 28MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$219.30 ","$162.28 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$45.71 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"412.83","SUP","HCPCS C1713","","412.830  -  SCREW BONE 2.4MM 30MM T8 STARDRIVE RECESS SLFTAP LOCKING","BOTH IP/OP","$212.90 ","$157.55 ","$0.00 ","$212.90 ","$95.81 ","$0.00 ","$44.37 ","$0.00 ","$0.00 ","$37.28 ","$212.90 ","$0.00 ","$106.45 ","$168.62 ","$170.32 ","$0.00 ","$32.35 ","$0.00 ","$33.89 ","$0.00 "
"413.309","SUP","HCPCS C1776","","413.309  -  SPACER TIBIAL 2MM 5MM 5MM TOMOFIX CHRONOS TITANIUM KNEE","BOTH IP/OP","$182.75 ","$135.24 ","$0.00 ","$177.43 ","$79.84 ","$0.00 ","$38.09 ","$0.00 ","$0.00 ","$31.07 ","$177.43 ","$0.00 ","$88.71 ","$140.52 ","$141.94 ","$0.00 ","$26.96 ","$0.00 ","$28.25 ","$0.00 "
"413.324","SUP","HCPCS C1713","","413.324  -  SCREW BONE 5MM 24MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.326","SUP","HCPCS C1713","","413.326  -  SCREW BONE 5MM 26MM SLFTAP LOCKING HEAD TITANIUM NONSTRL","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.328","SUP","HCPCS C1713","","413.328  -  SCREW BONE 5MM 28MM LOCKING SLFTAP HEX DRIVE TITANIUM FEMUR","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.33","SUP","HCPCS C1713","","413.330  -  SCREW BONE 5MM 30MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.332","SUP","HCPCS C1713","","413.332  -  SCREW BONE 5MM 32MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.334","SUP","HCPCS C1713","","413.334  -  SCREW BONE 5MM 34MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.336","SUP","HCPCS C1713","","413.336  -  SCREW BONE 5MM 36MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.338","SUP","HCPCS C1713","","413.338  -  SCREW BONE 5MM 38MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM SPN","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.34","SUP","HCPCS C1713","","413.340  -  SCREW BONE 5MM 40MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.342","SUP","HCPCS C1713","","413.342  -  SCREW BONE 5MM 42MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.344","SUP","HCPCS C1713","","413.344  -  SCREW BONE 5MM 44MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.346","SUP","HCPCS C1713","","413.346  -  SCREW BONE 5MM 46MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.348","SUP","HCPCS C1713","","413.348  -  SCREW BONE 5MM 48MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.35","SUP","HCPCS C1713","","413.350  -  SCREW BONE 5MM 50MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.355","SUP","HCPCS C1713","","413.355  -  SCREW BONE 5MM 55MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.36","SUP","HCPCS C1713","","413.360  -  SCREW BONE 5MM 60MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.365","SUP","HCPCS C1713","","413.365  -  SCREW BONE 5MM 65MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.37","SUP","HCPCS C1713","","413.370  -  SCREW BONE 5MM 70MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.375","SUP","HCPCS C1713","","413.375  -  SCREW BONE 5MM 75MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.38","SUP","HCPCS C1713","","413.380  -  SCREW BONE 5MM 80MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.385","SUP","HCPCS C1713","","413.385  -  SCREW BONE 5MM 85MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.39","SUP","HCPCS C1713","","413.390  -  SCREW BONE 5MM 90MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.414","SUP","HCPCS C1713","","413.414  -  SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.418","SUP","HCPCS C1713","","413.418  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.422","SUP","HCPCS C1713","","413.422  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.426","SUP","HCPCS C1713","","413.426  -  SCREW BONE 5MM 26MM SELF TAP LOCK HEAD TOMOFIX TITANIUM","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"413.43","SUP","HCPCS C1713","","413.430  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.435","SUP","HCPCS C1713","","413.435  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.44","SUP","HCPCS C1713","","413.440  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.445","SUP","HCPCS C1713","","413.445  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.45","SUP","HCPCS C1713","","413.450  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.455","SUP","HCPCS C1713","","413.455  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.46","SUP","HCPCS C1713","","413.460  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.465","SUP","HCPCS C1713","","413.465  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.47","SUP","HCPCS C1713","","413.470  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING LISS TITANIUM FEMUR","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.475","SUP","HCPCS C1713","","413.475  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.48","SUP","HCPCS C1713","","413.480  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.485","SUP","HCPCS C1713","","413.485  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"413.49","SUP","HCPCS C1713","","413.490  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL","BOTH IP/OP","$378.95 ","$280.42 ","$0.00 ","$378.95 ","$170.53 ","$0.00 ","$78.98 ","$0.00 ","$0.00 ","$66.35 ","$378.95 ","$0.00 ","$189.48 ","$300.13 ","$303.16 ","$0.00 ","$59.31 ","$0.00 ","$60.33 ","$0.00 "
"414.014","SUP","HCPCS C1713","","414.014  -  SCREW BONE 4.5MM 14MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.016","SUP","HCPCS C1713","","414.016  -  SCREW BONE 4.5MM 8MM 16MM HEXAGONAL SOCKET LC-DCP TITANIUM","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.018","SUP","HCPCS C1713","","414.018  -  SCREW BONE 4.5MM 18MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.02","SUP","HCPCS C1713","","414.020  -  SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.022","SUP","HCPCS C1713","","414.022  -  SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET LC-DCP TITANIUM","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.024","SUP","HCPCS C1713","","414.024  -  SCREW BONE 4.5MM 24MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.026","SUP","HCPCS C1713","","414.026  -  SCREW BONE 4.5MM 26MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.028","SUP","HCPCS C1713","","414.028  -  SCREW BONE 4.5MM 28MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.03","SUP","HCPCS C1713","","414.030  -  SCREW BONE 4.5MM 30MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.032","SUP","HCPCS C1713","","414.032  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 32MM LARGE HEXAGONAL","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.034","SUP","HCPCS C1713","","414.034  -  SCREW BONE 4.5MM 34MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.036","SUP","HCPCS C1713","","414.036  -  SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.038","SUP","HCPCS C1713","","414.038  -  SCREW BONE 4.5MM 38MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.04","SUP","HCPCS C1713","","414.040  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 26MM LARGE HEXAGONAL","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.042","SUP","HCPCS C1713","","414.042  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 42MM LARGE HEXAGONAL","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.044","SUP","HCPCS C1713","","414.044  -  SCREW BONE 3MM STANDARD 4.5MM 8MM 44X3.5MM HEXAGONAL SOCKET","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.046","SUP","HCPCS C1713","","414.046  -  SCREW BONE 4.5MM 46MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.048","SUP","HCPCS C1713","","414.048  -  SCREW BONE 4.5MM 48MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.05","SUP","HCPCS C1713","","414.050  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 50MM LARGE HEXAGONAL","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.052","SUP","HCPCS C1713","","414.052  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 52MM LARGE HEXAGONAL","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.054","SUP","HCPCS C1713","","414.054  -  SCREW BONE 4.5MM 54MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.056","SUP","HCPCS C1713","","414.056  -  SCREW BONE 4.5MM 56MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.058","SUP","HCPCS C1713","","414.058  -  SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 14MM SOCKET","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.06","SUP","HCPCS C1713","","414.060  -  SCREW BONE 4.5MM 60MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.062","SUP","HCPCS C1713","","414.062  -  SCREW BONE 4.5MM 62MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.064","SUP","HCPCS C1713","","414.064  -  SCREW BONE 4.5MM 64MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.066","SUP","HCPCS C1713","","414.066  -  SCREW BONE 4.5MM 66MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.068","SUP","HCPCS C1713","","414.068  -  SCREW BONE 4.5MM 68MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$30.55 ","$22.61 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.37 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.07","SUP","HCPCS C1713","","414.070  -  SCREW BONE STANDARD 4.5MM 8MM 70MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$29.68 ","$21.96 ","$0.00 ","$29.68 ","$13.35 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.68 ","$0.00 ","$14.84 ","$23.51 ","$23.74 ","$0.00 ","$4.51 ","$0.00 ","$4.72 ","$0.00 "
"414.072","SUP","HCPCS C1713","","414.072  -  SCREW BONE 4.5MM 72MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$12.96 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"414.076","SUP","HCPCS C1713","","414.076  -  SCREW BONE 4.5MM 76MM SLFTAP LC-DCP TITANIUM CORTICAL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.08","SUP","HCPCS C1713","","414.080  -  SCREW BONE 4.5MM 80MM LC DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.085","SUP","HCPCS C1713","","414.085  -  SCREW BONE 3.5MM 85MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.09","SUP","HCPCS C1713","","414.090  -  SCREW BONE 4.5MM 90MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.095","SUP","HCPCS C1713","","414.095  -  SCREW BONE 4.5MM 95MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.1","SUP","HCPCS C1713","","414.100  -  SCREW BONE 4.5MM 100MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.105","SUP","HCPCS C1713","","414.105  -  SCREW BONE 4.5MM 105MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.11","SUP","HCPCS C1713","","414.110  -  SCREW BONE 4.5MM 110MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.115","SUP","HCPCS C1713","","414.115  -  SCREW BONE 4.5MM 115MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.12","SUP","HCPCS C1713","","414.120  -  SCREW BONE 4.5MM 120MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.125","SUP","HCPCS C1713","","414.125  -  SCREW BONE 4.5MM 125MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.13","SUP","HCPCS C1713","","414.130  -  SCREW BONE 4.5MM 130MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.135","SUP","HCPCS C1713","","414.135  -  SCREW BONE 4.5MM 135MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.14","SUP","HCPCS C1713","","414.140  -  SCREW BONE 4.5MM 140MM LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$46.70 ","$34.56 ","$0.00 ","$46.70 ","$21.02 ","$0.00 ","$9.73 ","$0.00 ","$0.00 ","$8.18 ","$46.70 ","$0.00 ","$23.35 ","$36.99 ","$37.36 ","$0.00 ","$7.31 ","$0.00 ","$7.43 ","$0.00 "
"414.222","SUP","HCPCS C1713","","414.222  -  SCREW BONE 4.5MM 22MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.224","SUP","HCPCS C1713","","414.224  -  SCREW BONE 4.5MM 24CM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.226","SUP","HCPCS C1713","","414.226  -  SCREW BONE 4.5MM 26MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.228","SUP","HCPCS C1713","","414.228  -  SCREW BONE 4.5MM 28MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.23","SUP","HCPCS C1713","","414.230  -  SCREW BONE 4.5MM 30MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.232","SUP","HCPCS C1713","","414.232  -  SCREW BONE 4.5MM 32MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$31.03 ","$22.96 ","$0.00 ","$31.03 ","$13.96 ","$0.00 ","$6.47 ","$0.00 ","$0.00 ","$5.43 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$4.71 ","$0.00 ","$4.94 ","$0.00 "
"414.234","SUP","HCPCS C1713","","414.234  -  SCREW BONE 4.5MM 34MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$31.03 ","$22.96 ","$0.00 ","$31.03 ","$13.96 ","$0.00 ","$6.47 ","$0.00 ","$0.00 ","$5.43 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$4.71 ","$0.00 ","$4.94 ","$0.00 "
"414.236","SUP","HCPCS C1713","","414.236  -  SCREW BONE 4.5MM 36MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$31.03 ","$22.96 ","$0.00 ","$31.03 ","$13.96 ","$0.00 ","$6.47 ","$0.00 ","$0.00 ","$5.43 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$4.71 ","$0.00 ","$4.94 ","$0.00 "
"414.238","SUP","HCPCS C1713","","414.238  -  SCREW BONE 4.5MM 38MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.24","SUP","HCPCS C1713","","414.240  -  SCREW BONE 3.5MM 40MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$13.56 ","$0.00 ","$6.28 ","$0.00 ","$0.00 ","$5.27 ","$30.13 ","$0.00 ","$15.06 ","$23.86 ","$24.10 ","$0.00 ","$4.71 ","$0.00 ","$4.80 ","$0.00 "
"414.242","SUP","HCPCS C1713","","414.242  -  SCREW BONE 4.5MM 42MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.244","SUP","HCPCS C1713","","414.244  -  SCREW BONE 4.5MM 44MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.246","SUP","HCPCS C1713","","414.246  -  SCREW BONE 4.5MM 46MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$34.45 ","$15.50 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$6.03 ","$34.45 ","$0.00 ","$17.23 ","$27.28 ","$27.56 ","$0.00 ","$5.23 ","$0.00 ","$5.48 ","$0.00 "
"414.248","SUP","HCPCS C1713","","414.248  -  SCREW BONE 4.5MM 48MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$34.45 ","$15.50 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$6.03 ","$34.45 ","$0.00 ","$17.23 ","$27.28 ","$27.56 ","$0.00 ","$5.23 ","$0.00 ","$5.48 ","$0.00 "
"414.25","SUP","HCPCS C1713","","414.250  -  SCREW BONE 4.5MM 50MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.252","SUP","HCPCS C1713","","414.252  -  SCREW BONE 4.5MM 52MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$34.45 ","$15.50 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$6.03 ","$34.45 ","$0.00 ","$17.23 ","$27.28 ","$27.56 ","$0.00 ","$5.23 ","$0.00 ","$5.48 ","$0.00 "
"414.254","SUP","HCPCS C1713","","414.254  -  SCREW BONE 4.5MM 54MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.256","SUP","HCPCS C1713","","414.256  -  SCREW BONE 4.5MM 56MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$34.45 ","$15.50 ","$0.00 ","$7.18 ","$0.00 ","$0.00 ","$6.03 ","$34.45 ","$0.00 ","$17.23 ","$27.28 ","$27.56 ","$0.00 ","$5.23 ","$0.00 ","$5.48 ","$0.00 "
"414.258","SUP","HCPCS C1713","","414.258  -  SCREW BONE 4.5MM 58MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.26","SUP","HCPCS C1713","","414.260  -  SCREW BONE 4.5MM 60MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.264","SUP","HCPCS C1713","","414.264  -  SCREW BONE 4.5MM 64MM 20MM PTTHRD SHAFT LC-DCP TITANIUM","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.268","SUP","HCPCS C1713","","414.268  -  SCREW BONE 4.5MM 68MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.272","SUP","HCPCS C1713","","414.272  -  SCREW BONE 4.5MM 72MM SHAFT LCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$33.45 ","$24.75 ","$0.00 ","$33.45 ","$15.05 ","$0.00 ","$6.97 ","$0.00 ","$0.00 ","$5.86 ","$33.45 ","$0.00 ","$16.73 ","$26.49 ","$26.76 ","$0.00 ","$5.23 ","$0.00 ","$5.33 ","$0.00 "
"414.276","SUP","HCPCS C1713","","414.276  -  SCREW BONE 4.5MM 76MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.28","SUP","HCPCS C1713","","414.280  -  SCREW BONE 4.5MM 80MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.285","SUP","HCPCS C1713","","414.285  -  SCREW BONE 4.5MM 85MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.29","SUP","HCPCS C1713","","414.290  -  SCREW BONE 4.5MM 90MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.295","SUP","HCPCS C1713","","414.295  -  SCREW BONE 4.5MM 95MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.3","SUP","HCPCS C1713","","414.300  -  SCREW BONE 4.5MM 100MM SHAFT LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.305","SUP","HCPCS C1713","","414.305  -  SCREW BONE 4.5MM 105MM SHAFT LC-DCP TITANIUM SHAFT NONSTRL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.31","SUP","HCPCS C1713","","414.310  -  SCREW BONE 4.5MM 110MM SHAAFT LC-DCP TITANIUM CORTICAL","BOTH IP/OP","$39.75 ","$29.42 ","$0.00 ","$39.75 ","$17.89 ","$0.00 ","$8.28 ","$0.00 ","$0.00 ","$6.96 ","$39.75 ","$0.00 ","$19.88 ","$31.48 ","$31.80 ","$0.00 ","$6.22 ","$0.00 ","$6.33 ","$0.00 "
"414.52","SUP","HCPCS C1713","","414.520  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.522","SUP","HCPCS C1713","","414.522  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 22MM CANN LARGE HEXAGONAL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.524","SUP","HCPCS C1713","","414.524  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.526","SUP","HCPCS C1713","","414.526  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 26MM CANN LARGE HEXAGONAL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.528","SUP","HCPCS C1713","","414.528  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 28MM CANN LARGE HEXAGONAL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.53","SUP","HCPCS C1713","","414.530  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.532","SUP","HCPCS C1713","","414.532  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.534","SUP","HCPCS C1713","","414.534  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.536","SUP","HCPCS C1713","","414.536  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.538","SUP","HCPCS C1713","","414.538  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.54","SUP","HCPCS C1713","","414.540  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.542","SUP","HCPCS C1713","","414.542  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 42MM CANN LARGE HEXAGONAL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.544","SUP","HCPCS C1713","","414.544  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.546","SUP","HCPCS C1713","","414.546  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.548","SUP","HCPCS C1713","","414.548  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.55","SUP","HCPCS C1713","","414.550  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.552","SUP","HCPCS C1713","","414.552  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 52MM CANN LARGE HEXAGONAL","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.554","SUP","HCPCS C1713","","414.554  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.556","SUP","HCPCS C1713","","414.556  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.56","SUP","HCPCS C1713","","414.560  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 60MM CANN LARGE HEXAGONAL","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.564","SUP","HCPCS C1713","","414.564  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.568","SUP","HCPCS C1713","","414.568  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.572","SUP","HCPCS C1713","","414.572  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM","BOTH IP/OP","$376.73 ","$278.78 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$78.52 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$55.57 ","$0.00 ","$58.23 ","$0.00 "
"414.576","SUP","HCPCS C1713","","414.576  -  SCREW BONE PTHRD 4.5MM 76MM CANN TITANIUM NONSTRL","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.58","SUP","HCPCS C1713","","414.580  -  SCREW BONE PTHRD 4.5MM 80MM CANN TITANIUM NONSTRL","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.72","SUP","HCPCS C1713","","414.720  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 20MM CANN TITANIUM","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.722","SUP","HCPCS C1713","","414.722  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 22MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.724","SUP","HCPCS C1713","","414.724  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 24MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.726","SUP","HCPCS C1713","","414.726  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.728","SUP","HCPCS C1713","","414.728  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 28MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.73","SUP","HCPCS C1713","","414.730  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 30MM CANN TITANIUM","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.732","SUP","HCPCS C1713","","414.732  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.734","SUP","HCPCS C1713","","414.734  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 34MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.736","SUP","HCPCS C1713","","414.736  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 36MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.738","SUP","HCPCS C1713","","414.738  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 38MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.74","SUP","HCPCS C1713","","414.740  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 40MM CANN TITANIUM","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.742","SUP","HCPCS C1713","","414.742  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 42MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.744","SUP","HCPCS C1713","","414.744  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 44MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.746","SUP","HCPCS C1713","","414.746  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 46MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.748","SUP","HCPCS C1713","","414.748  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 48MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.75","SUP","HCPCS C1713","","414.750  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 50MM CANN TITANIUM","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.752","SUP","HCPCS C1713","","414.752  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 52MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.754","SUP","HCPCS C1713","","414.754  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 54MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.756","SUP","HCPCS C1713","","414.756  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 56MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.76","SUP","HCPCS C1713","","414.760  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 60MM CANN TITANIUM","BOTH IP/OP","$376.68 ","$278.74 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$78.51 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.764","SUP","HCPCS C1713","","414.764  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 64MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.768","SUP","HCPCS C1713","","414.768  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 68MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.772","SUP","HCPCS C1713","","414.772  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 72MM CANN TITANIUM","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.776","SUP","HCPCS C1713","","414.776  -  SCREW BONE FULTHD 4.5MM 76MM CANN TITANIUM NONSTRL","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.777","SUP","HCPCS C1713","","414.777  -  SCREW BONE FULTHD 4.5MM 77MM CANN TITANIUM NONSTRL","BOTH IP/OP","$387.98 ","$287.11 ","$0.00 ","$376.68 ","$169.50 ","$0.00 ","$80.86 ","$0.00 ","$0.00 ","$65.95 ","$376.68 ","$0.00 ","$188.34 ","$298.33 ","$301.34 ","$0.00 ","$57.23 ","$0.00 ","$59.97 ","$0.00 "
"414.814","SUP","HCPCS C1713","","414.814  -  SCREW BONE 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET SELF TAP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.816","SUP","HCPCS C1713","","414.816  -  SCREW BONE 4.5MM 8MM 16MM LARGE HEXAGONAL SOCKET SELF TAP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.818","SUP","HCPCS C1713","","414.818  -  SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET SELF TAP TIP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.82","SUP","HCPCS C1713","","414.820  -  SCREW BONE 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET SELF TAP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.822","SUP","HCPCS C1713","","414.822  -  SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET SELF TAP TIP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.824","SUP","HCPCS C1713","","414.824  -  SCREW BONE 4.5MM 8MM 24MM HEXAGONAL SOCKET SELF TAP TIP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.826","SUP","HCPCS C1713","","414.826  -  SCREW BONE 4.5MM 8MM 26MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.828","SUP","HCPCS C1713","","414.828  -  SCREW BONE 4.5MM 8MM 28MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.83","SUP","HCPCS C1713","","414.830  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM SELF TAP SOCKET","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.832","SUP","HCPCS C1713","","414.832  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM SELF TAP SOCKET","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.834","SUP","HCPCS C1713","","414.834  -  SCREW BONE 4.5MM 8MM 34MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.836","SUP","HCPCS C1713","","414.836  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM SELF TAP SOCKET","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.838","SUP","HCPCS C1713","","414.838  -  SCREW BONE 4.5MM 8MM 38MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.84","SUP","HCPCS C1713","","414.840  -  SCREW BONE 4.5MM 8MM 40MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.842","SUP","HCPCS C1713","","414.842  -  SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.844","SUP","HCPCS C1713","","414.844  -  SCREW BONE 4.5MM 8MM 44MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.846","SUP","HCPCS C1713","","414.846  -  SCREW BONE 4.5MM 8MM 46MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.848","SUP","HCPCS C1713","","414.848  -  SCREW BONE 4.5MM 48MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.85","SUP","HCPCS C1713","","414.850  -  SCREW BONE 4.5MM 50MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.852","SUP","HCPCS C1713","","414.852  -  SCREW BONE 4.5MM 52MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.854","SUP","HCPCS C1713","","414.854  -  SCREW BONE 4.5MM 54MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.856","SUP","HCPCS C1713","","414.856  -  SCREW BONE 4.5MM 56MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.858","SUP","HCPCS C1713","","414.858  -  SCREW BONE 4.5MM 58MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.86","SUP","HCPCS C1713","","414.860  -  SCREW BONE 4.5MM 8MM 60MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.862","SUP","HCPCS C1713","","414.862  -  SCREW BONE 4.5MM 62MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.864","SUP","HCPCS C1713","","414.864  -  SCREW BONE 4.5MM 64MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.866","SUP","HCPCS C1713","","414.866  -  SCREW BONE 4.5MM 8MM 66MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.868","SUP","HCPCS C1713","","414.868  -  SCREW BONE 4.5MM 8MM 68MM HEXAGONAL SOCKET SELF TAP LC-DCP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.87","SUP","HCPCS C1713","","414.870  -  SCREW BONE 4.5MM 70MM SELF TAP LCP TITANIUM CORTEX LARGE","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.872","SUP","HCPCS C1713","","414.872  -  SCREW BONE 4.5MM 8MM 72MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$40.05 ","$29.64 ","$0.00 ","$38.88 ","$17.49 ","$0.00 ","$8.35 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$5.91 ","$0.00 ","$6.19 ","$0.00 "
"414.876","SUP","HCPCS C1713","","414.876  -  SCREW BONE 4.5MM 8MM 76MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.88","SUP","HCPCS C1713","","414.880  -  SCREW BONE 4.5MM 8MM 80MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.885","SUP","HCPCS C1713","","414.885  -  SCREW BONE 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.89","SUP","HCPCS C1713","","414.890  -  SCREW BONE 4.5MM 8MM 90MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.895","SUP","HCPCS C1713","","414.895  -  SCREW BONE 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.9","SUP","HCPCS C1713","","414.900  -  SCREW BONE 4.5MM 8MM 100MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.905","SUP","HCPCS C1713","","414.905  -  SCREW BONE 4.5MM 8MM 105MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.91","SUP","HCPCS C1713","","414.910  -  SCREW BONE 4.5MM 8MM 110MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.915","SUP","HCPCS C1713","","414.915  -  SCREW BONE 4.5MM 8MM 115MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.92","SUP","HCPCS C1713","","414.920  -  SCREW BONE 4.5MM 8MM 120MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.925","SUP","HCPCS C1713","","414.925  -  SCREW BONE 4.5MM 8MM 125MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.93","SUP","HCPCS C1713","","414.930  -  SCREW BONE 4.5MM 8MM 130MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.935","SUP","HCPCS C1713","","414.935  -  SCREW BONE 4.5MM 8MM 135MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.94","SUP","HCPCS C1713","","414.940  -  SCREW BONE 4.5MM 8MM 140MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$62.08 ","$45.94 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"414.945","SUP","HCPCS C1713","","414.945  -  SCREW BONE 4.5MM 8MM 145MM LARGE HEXAGONAL SOCKET SLFTAP","BOTH IP/OP","$63.95 ","$47.32 ","$0.00 ","$62.08 ","$27.93 ","$0.00 ","$13.33 ","$0.00 ","$0.00 ","$10.87 ","$62.08 ","$0.00 ","$31.04 ","$49.17 ","$49.66 ","$0.00 ","$9.43 ","$0.00 ","$9.88 ","$0.00 "
"416.03","SUP","HCPCS C1713","","416.030  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.035","SUP","HCPCS C1713","","416.035  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 35MM 16MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.04","SUP","HCPCS C1713","","416.040  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 40MM 16MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.045","SUP","HCPCS C1713","","416.045  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 16MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.05","SUP","HCPCS C1713","","416.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.055","SUP","HCPCS C1713","","416.055  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 16MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.06","SUP","HCPCS C1713","","416.060  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 16MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.065","SUP","HCPCS C1713","","416.065  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 16MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.07","SUP","HCPCS C1713","","416.070  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 16MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.075","SUP","HCPCS C1713","","416.075  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 16MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.08","SUP","HCPCS C1713","","416.080  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 16MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"416.085","SUP","HCPCS C1713","","416.085  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 16MM SOCKET LC-DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"416.09","SUP","HCPCS C1713","","416.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 16MM SOCKET LC-DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"416.095","SUP","HCPCS C1713","","416.095  -  SCREW BONE 6.5MM 8MM 95MM 16MM THREAD LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"416.1","SUP","HCPCS C1713","","416.100  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 16MM SOCKET LC-DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"416.105","SUP","HCPCS C1713","","416.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 16MM SOCKET LC-DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"416.11","SUP","HCPCS C1713","","416.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 16MM SOCKET LC-DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"416.115","SUP","HCPCS C1713","","416.115  -  SCREW BONE 6.5MM 115MM 16MM LC-DCP TITANIUM CANCELLOUS","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"416.12","SUP","HCPCS C1713","","416.120  -  SCREW BONE 6.5MM 120MM 16MM THREAD LC-DCP TITANIUM","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.045","SUP","HCPCS C1713","","417.045  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 32MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.05","SUP","HCPCS C1713","","417.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 32MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.055","SUP","HCPCS C1713","","417.055  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 32MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.06","SUP","HCPCS C1713","","417.060  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 32MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.065","SUP","HCPCS C1713","","417.065  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 32MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.07","SUP","HCPCS C1713","","417.070  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 32MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.075","SUP","HCPCS C1713","","417.075  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 32MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.08","SUP","HCPCS C1713","","417.080  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 32MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"417.085","SUP","HCPCS C1713","","417.085  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 32MM SOCKET LC-DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"417.09","SUP","HCPCS C1713","","417.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LC-DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"417.095","SUP","HCPCS C1713","","417.095  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 95MM 32MM SOCKET LC-DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"417.1","SUP","HCPCS C1713","","417.100  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 32MM SOCKET LC-DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"417.105","SUP","HCPCS C1713","","417.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LC-DCP","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"417.11","SUP","HCPCS C1713","","417.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LC-DCP","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"417.115","SUP","HCPCS C1713","","417.115  -  SCREW BONE PTHRD 6.5MM 8MM 115MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.12","SUP","HCPCS C1713","","417.120  -  SCREW BONE PTHRD 6.5MM 8MM 120MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.125","SUP","HCPCS C1713","","417.125  -  SCREW BONE PTHRD 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.13","SUP","HCPCS C1713","","417.130  -  SCREW BONE PTHRD 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.135","SUP","HCPCS C1713","","417.135  -  SCREW BONE PTHRD 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.14","SUP","HCPCS C1713","","417.140  -  SCREW BONE PTHRD 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.145","SUP","HCPCS C1713","","417.145  -  SCREW BONE PTHRD 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$17.14 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"417.15","SUP","HCPCS C1713","","417.150  -  SCREW BONE PTHRD 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$79.83 ","$59.07 ","$0.00 ","$79.83 ","$35.92 ","$0.00 ","$16.64 ","$0.00 ","$0.00 ","$13.98 ","$79.83 ","$0.00 ","$39.91 ","$63.23 ","$63.86 ","$0.00 ","$12.13 ","$0.00 ","$12.71 ","$0.00 "
"418.009","SUP","HCPCS C1713","","418.009  -  SCREW BONE 6.5MM 60MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.01","SUP","HCPCS C1713","","418.010  -  SCREW BONE FULTHD 6.5MM 4MM 65MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.011","SUP","HCPCS C1713","","418.011  -  SCREW BONE 6.5MM 70MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.012","SUP","HCPCS C1713","","418.012  -  SCREW BONE 6.5MM 75MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.013","SUP","HCPCS C1713","","418.013  -  SCREW BONE 6.5MM 80MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.014","SUP","HCPCS C1713","","418.014  -  SCREW BONE 6.5MM 85MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.015","SUP","HCPCS C1713","","418.015  -  SCREW BONE 6.5MM 90MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.016","SUP","HCPCS C1713","","418.016  -  SCREW BONE 6.5MM 95MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.017","SUP","HCPCS C1713","","418.017  -  SCREW BONE 6.5MM 100MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.018","SUP","HCPCS C1713","","418.018  -  SCREW BONE 6.5MM 105MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.019","SUP","HCPCS C1713","","418.019  -  SCREW BONE 6.5MM 110MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.025","SUP","HCPCS C1713","","418.025  -  SCREW BONE 6.5MM 8MM 25MM HEXAGONAL SOCKET LC-DCP TITANIUM","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.03","SUP","HCPCS C1713","","418.030  -  SCREW BONE 6.5MM 8MM 30MM HEXAGONAL SOCKET LC-DCP TITANIUM","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.035","SUP","HCPCS C1713","","418.035  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 35MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.04","SUP","HCPCS C1713","","418.040  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 40MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.045","SUP","HCPCS C1713","","418.045  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.05","SUP","HCPCS C1713","","418.050  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.055","SUP","HCPCS C1713","","418.055  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LC-DCP","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.06","SUP","HCPCS C1713","","418.060  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LC-DCP","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.065","SUP","HCPCS C1713","","418.065  -  SCREW BONE FULTHD 6.5MM 8MM 65MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.07","SUP","HCPCS C1713","","418.070  -  SCREW BONE FULTHD 6.5MM 8MM 70MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.075","SUP","HCPCS C1713","","418.075  -  SCREW BONE FULTHD 6.5MM 8MM 75MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$61.13 ","$45.24 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.08","SUP","HCPCS C1713","","418.080  -  SCREW BONE FULTHD 6.5MM 8MM 80MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$59.35 ","$43.92 ","$0.00 ","$59.35 ","$26.71 ","$0.00 ","$12.37 ","$0.00 ","$0.00 ","$10.39 ","$59.35 ","$0.00 ","$29.68 ","$47.01 ","$47.48 ","$0.00 ","$9.02 ","$0.00 ","$9.45 ","$0.00 "
"418.085","SUP","HCPCS C1713","","418.085  -  SCREW BONE FULTHD 6.5MM 8MM 85MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"418.09","SUP","HCPCS C1713","","418.090  -  SCREW BONE FULTHD 6.5MM 8MM 90MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"418.095","SUP","HCPCS C1713","","418.095  -  SCREW BONE FULTHD 6.5MM 8MM 95MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"418.1","SUP","HCPCS C1713","","418.100  -  SCREW BONE FULTHD 6.5MM 8MM 100MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"418.105","SUP","HCPCS C1713","","418.105  -  SCREW BONE FULTHD 6.5MM 8MM 105MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$66.08 ","$48.90 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.77 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"418.11","SUP","HCPCS C1713","","418.110  -  SCREW BONE FULTHD 6.5MM 8MM 110MM LARGE HEXAGONAL SOCKET","BOTH IP/OP","$64.15 ","$47.47 ","$0.00 ","$64.15 ","$28.87 ","$0.00 ","$13.37 ","$0.00 ","$0.00 ","$11.23 ","$64.15 ","$0.00 ","$32.08 ","$50.81 ","$51.32 ","$0.00 ","$9.75 ","$0.00 ","$10.21 ","$0.00 "
"418.215","SUP","HCPCS C1713","","418.215  -  SCREW BONE FULTHD 6.5MM 115MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.22","SUP","HCPCS C1713","","418.220  -  SCREW BONE FULTHD 6.5MM 4MM 120MM TITANIUM CANCELLOUS","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.225","SUP","HCPCS C1713","","418.225  -  SCREW BONE FULTHD 6.5MM 125MM TITANIUM CANCELLOUS NONSTRL","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"418.23","SUP","HCPCS C1713","","418.230  -  SCREW BONE FULTHD 6.5MM 4MM 130MM TITANIUM CANCELLOUS","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"419.89","SUP","Custom 27803010","","419.89  -  WASHER ORTHOPEDIC THREAD TITANIUM NONSTRL 3 MM CANN SCREWS","BOTH IP/OP","$258.65 ","$191.40 ","$0.00 ","$251.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.91","SUP","Custom 27803010","","419.91  -  WASHER ORTHOPEDIC 10MM TITANIUM NONSTRL 4.5MM CANN SCREW","BOTH IP/OP","$55.85 ","$41.33 ","$0.00 ","$54.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.23 ","$0.00 ","$27.11 ","$42.95 ","$43.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.96","SUP","Custom 27803010","","419.96  -  NUT ORTHOPEDIC LC-DCP TITANIUM NONSTRL 4.5 MM CORTICAL SCREW","BOTH IP/OP","$55.85 ","$41.33 ","$0.00 ","$54.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.23 ","$0.00 ","$27.11 ","$42.95 ","$43.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.972","SUP","Custom 27803010","","419.972  -  WASHER ORTHOPEDIC 6.5MM CANN TITANIUM NONSTRL 3MM SCREWS","BOTH IP/OP","$54.83 ","$40.57 ","$0.00 ","$53.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.23 ","$0.00 ","$26.61 ","$42.16 ","$42.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.98","SUP","Custom 27803010","","419.98  -  WASHER ORTHOPEDIC 7MM TITANIUM PROXIMAL TIBIA NONSTRL 4MM","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.99","SUP","Custom 27803010","","419.99  -  WASHER ORTHOPEDIC 13MM TITANIUM FEMUR NONSTRL 6.5/7.3MM CANN","BOTH IP/OP","$52.70 ","$39.00 ","$0.00 ","$51.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.18 ","$0.00 ","$25.59 ","$40.53 ","$40.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420","SUP","HCPCS C1713","","420.00  -  PLATE BONE 40X29MM CRANFCL TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$2,607.75 ","$1,929.74 ","$0.00 ","$2,607.75 ","$1,173.49 ","$0.00 ","$543.52 ","$0.00 ","$0.00 ","$456.60 ","$2,607.75 ","$0.00 ","$1,303.88 ","$2,065.34 ","$2,086.20 ","$0.00 ","$408.11 ","$0.00 ","$415.15 ","$0.00 "
"420.01","SUP","HCPCS C1713","","420.01  -  PLATE BONE 30X6MM CRANFCL TI 16 HOLE STRUT 1MM SCR NONSTRL","BOTH IP/OP","$1,131.75 ","$837.50 ","$0.00 ","$1,131.75 ","$509.29 ","$0.00 ","$235.88 ","$0.00 ","$0.00 ","$198.16 ","$1,131.75 ","$0.00 ","$565.88 ","$896.35 ","$905.40 ","$0.00 ","$177.12 ","$0.00 ","$180.17 ","$0.00 "
"420.02","SUP","HCPCS C1713","","420.02  -  PLATE BONE 42X38X.4MM CRANFCL TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$3,145.50 ","$2,327.67 ","$0.00 ","$3,145.50 ","$1,415.48 ","$0.00 ","$655.60 ","$0.00 ","$0.00 ","$550.75 ","$3,145.50 ","$0.00 ","$1,572.75 ","$2,491.24 ","$2,516.40 ","$0.00 ","$492.27 ","$0.00 ","$500.76 ","$0.00 "
"420.031","SUP","HCPCS C1713","","420.031  -  PLATE BONE 50X50MM MIC CRANFCL TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$3,746.25 ","$2,772.23 ","$0.00 ","$3,746.25 ","$1,685.81 ","$0.00 ","$780.81 ","$0.00 ","$0.00 ","$655.94 ","$3,746.25 ","$0.00 ","$1,873.13 ","$2,967.03 ","$2,997.00 ","$0.00 ","$586.29 ","$0.00 ","$596.40 ","$0.00 "
"420.04","SUP","HCPCS C1713","","420.04  -  PLATE BONE 42X6X.4MM CRANFCL TI 22 HOLE STRUT 1MM SCR","BOTH IP/OP","$1,271.25 ","$940.73 ","$0.00 ","$1,271.25 ","$572.06 ","$0.00 ","$264.96 ","$0.00 ","$0.00 ","$222.59 ","$1,271.25 ","$0.00 ","$635.63 ","$1,006.83 ","$1,017.00 ","$0.00 ","$198.95 ","$0.00 ","$202.38 ","$0.00 "
"420.05","SUP","HCPCS C1713","","420.05  -  PLATE BONE 100X50X.4MM CRANFCL TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$3,746.25 ","$2,772.23 ","$0.00 ","$3,746.25 ","$1,685.81 ","$0.00 ","$780.81 ","$0.00 ","$0.00 ","$655.94 ","$3,746.25 ","$0.00 ","$1,873.13 ","$2,967.03 ","$2,997.00 ","$0.00 ","$586.29 ","$0.00 ","$596.40 ","$0.00 "
"420.06","SUP","HCPCS C1713","","420.06  -  PLATE BONE 100X100X.4MM CRANFCL TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$5,346.00 ","$3,956.04 ","$0.00 ","$5,346.00 ","$2,405.70 ","$0.00 ","$1,114.24 ","$0.00 ","$0.00 ","$936.04 ","$5,346.00 ","$0.00 ","$2,673.00 ","$4,234.03 ","$4,276.80 ","$0.00 ","$836.65 ","$0.00 ","$851.08 ","$0.00 "
"420.07","SUP","HCPCS C1713","","420.070  -  PLATE BONE 100X100X.1MM CRANFCL TI MESH SCRN 1MM SCR NONSTRL","BOTH IP/OP","$2,691.00 ","$1,991.34 ","$0.00 ","$2,691.00 ","$1,210.95 ","$0.00 ","$560.87 ","$0.00 ","$0.00 ","$471.17 ","$2,691.00 ","$0.00 ","$1,345.50 ","$2,131.27 ","$2,152.80 ","$0.00 ","$421.14 ","$0.00 ","$428.41 ","$0.00 "
"420.071","SUP","HCPCS C1713","","420.071  -  PLATE BONE 100X100MM CRANFCL TI MESH 1/1.5MM SCR NONSTRL","BOTH IP/OP","$4,603.50 ","$3,406.59 ","$0.00 ","$4,603.50 ","$2,071.58 ","$0.00 ","$959.48 ","$0.00 ","$0.00 ","$806.04 ","$4,603.50 ","$0.00 ","$2,301.75 ","$3,645.97 ","$3,682.80 ","$0.00 ","$720.45 ","$0.00 ","$732.88 ","$0.00 "
"420.1","SUP","HCPCS C1713","","420.10  -  PLATE BONE 100MM CRNMXF TI 34 HOLE ADP 1MM SCR NONSTRL","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$627.75 ","$0.00 ","$290.75 ","$0.00 ","$0.00 ","$244.25 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$218.32 ","$0.00 ","$222.08 ","$0.00 "
"420.21","SUP","HCPCS C1713","","420.21  -  PLATE BONE ORBTL RIM TI 11 HOLE 1 MM SCR NONSTRL","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"420.302","SUP","HCPCS C1713","","420.302  -  PLATE BONE .2MM ORBTL RIM TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$2,889.00 ","$2,137.86 ","$0.00 ","$2,889.00 ","$1,300.05 ","$0.00 ","$602.14 ","$0.00 ","$0.00 ","$505.84 ","$2,889.00 ","$0.00 ","$1,444.50 ","$2,288.09 ","$2,311.20 ","$0.00 ","$452.13 ","$0.00 ","$459.93 ","$0.00 "
"420.303","SUP","HCPCS C1713","","420.303  -  PLATE BONE .3MM ORBTL RIM TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$2,889.00 ","$2,137.86 ","$0.00 ","$2,889.00 ","$1,300.05 ","$0.00 ","$602.14 ","$0.00 ","$0.00 ","$505.84 ","$2,889.00 ","$0.00 ","$1,444.50 ","$2,288.09 ","$2,311.20 ","$0.00 ","$452.13 ","$0.00 ","$459.93 ","$0.00 "
"420.304","SUP","HCPCS C1713","","420.304  -  PLATE BONE .4MM ORBTL RIM TI MESH 1MM SCR NONSTRL","BOTH IP/OP","$2,889.00 ","$2,137.86 ","$0.00 ","$2,889.00 ","$1,300.05 ","$0.00 ","$602.14 ","$0.00 ","$0.00 ","$505.84 ","$2,889.00 ","$0.00 ","$1,444.50 ","$2,288.09 ","$2,311.20 ","$0.00 ","$452.13 ","$0.00 ","$459.93 ","$0.00 "
"420.4","SUP","HCPCS C1713","","420.40  -  PLATE BONE UNV ORBTL FLR TI 1MM SCR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"420.401","SUP","HCPCS C1713","","420.401  -  PLATE SM .3MM TI 1MM SCR ANTM BONE ORBTL FLR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"420.402","SUP","HCPCS C1713","","420.402  -  PLATE BONE LG ORBTL FLR TI ANTM 1MM SCR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"420.403","SUP","HCPCS C1713","","420.403  -  PLATE BONE MED ORBTL FLR TI ANTM 1MM SCR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"420.44","SUP","HCPCS C1713","","420.44  -  PLATE BONE MIC LEFT MDL WL CRANFCL TI 1MM SCR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"420.45","SUP","HCPCS C1713","","420.45  -  PLATE BONE MIC RIGHT MDL WL CRANFCL TI 1MM SCR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"420.54","SUP","HCPCS C1713","","420.54  -  PLATE TI 1 MM SCR L BONE LEFT ORTH NONSTRL","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"420.55","SUP","HCPCS C1713","","420.55  -  SET BONE RIGHT TI 5 HL SHFT 4 BASE 1 MM SCR NONSTRL","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"420.62","SUP","HCPCS C1713","","420.62  -  PLATE BONE CRANFCL TI 9 HOLE Y 1 MM SCR NONSTRL","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"420.63","SUP","HCPCS C1713","","420.63  -  PLATE BONE CRANFCL TI 13 HOLE Y 1 MM SCR NONSTRL","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"420.631","SUP","HCPCS C1713","","420.631  -  PLATE BONE CRANFCL TI 18 HOLE Y 1 MM SCR NONSTRL","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"420.68","SUP","HCPCS C1713","","420.68  -  PLATE BONE CRANFCL TI 1X2 HOLE 2 Y 1 MM SCR NONSTRL","BOTH IP/OP","$591.75 ","$437.90 ","$0.00 ","$591.75 ","$266.29 ","$0.00 ","$123.34 ","$0.00 ","$0.00 ","$103.61 ","$591.75 ","$0.00 ","$295.88 ","$468.67 ","$473.40 ","$0.00 ","$92.61 ","$0.00 ","$94.21 ","$0.00 "
"420.7","SUP","HCPCS C1713","","420.70  -  PLATE TI 1 MM SCR 5X5 HOLE T BONE ORTH NONSTRL","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"420.71","SUP","HCPCS C1713","","420.71  -  PLATE BONE CRANFCL TI 12 HOLE T 1 MM SCR NONSTRL","BOTH IP/OP","$591.75 ","$437.90 ","$0.00 ","$591.75 ","$266.29 ","$0.00 ","$123.34 ","$0.00 ","$0.00 ","$103.61 ","$591.75 ","$0.00 ","$295.88 ","$468.67 ","$473.40 ","$0.00 ","$92.61 ","$0.00 ","$94.21 ","$0.00 "
"420.81","SUP","HCPCS C1713","","420.81  -  SCREW BONE CORT CRANFCL TI 5 HOLE X NONSTRL","BOTH IP/OP","$499.50 ","$369.63 ","$0.00 ","$499.50 ","$224.78 ","$0.00 ","$104.11 ","$0.00 ","$0.00 ","$87.46 ","$499.50 ","$0.00 ","$249.75 ","$395.60 ","$399.60 ","$0.00 ","$78.17 ","$0.00 ","$79.52 ","$0.00 "
"420.84","SUP","HCPCS C1713","","420.84  -  PLATE BONE CRANFCL TI 6 HOLE H 1 MM SCR NONSTRL","BOTH IP/OP","$528.75 ","$391.28 ","$0.00 ","$528.75 ","$237.94 ","$0.00 ","$110.20 ","$0.00 ","$0.00 ","$92.58 ","$528.75 ","$0.00 ","$264.38 ","$418.77 ","$423.00 ","$0.00 ","$82.75 ","$0.00 ","$84.18 ","$0.00 "
"420.85","SUP","HCPCS C1713","","420.85  -  PLATE BONE CRANFCL TI 11 HOLE H 1 MM SCR NONSTRL","BOTH IP/OP","$591.75 ","$437.90 ","$0.00 ","$591.75 ","$266.29 ","$0.00 ","$123.34 ","$0.00 ","$0.00 ","$103.61 ","$591.75 ","$0.00 ","$295.88 ","$468.67 ","$473.40 ","$0.00 ","$92.61 ","$0.00 ","$94.21 ","$0.00 "
"420.9","SUP","Custom 27803010","","420.900  -  BURR SURG 12MM HOLE COVER","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420.91","SUP","Custom 27803010","","420.91  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1MM SCR NONSTRL","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.001","SUP","HCPCS C1713","","421.001  -  PLATE BONE 53X38MM CRANFCL TI MESH MALBLE 1.3MM SCR NONSTRL","BOTH IP/OP","$3,467.25 ","$2,565.77 ","$0.00 ","$3,467.25 ","$1,560.26 ","$0.00 ","$722.66 ","$0.00 ","$0.00 ","$607.09 ","$3,467.25 ","$0.00 ","$1,733.63 ","$2,746.06 ","$2,773.80 ","$0.00 ","$542.62 ","$0.00 ","$551.99 ","$0.00 "
"421.002","SUP","HCPCS C1713","","421.002  -  PLATE BONE TMPR TI MESH MALBLE 1.3 MM SCR NONSTRL","BOTH IP/OP","$1,851.75 ","$1,370.30 ","$0.00 ","$1,851.75 ","$833.29 ","$0.00 ","$385.95 ","$0.00 ","$0.00 ","$324.23 ","$1,851.75 ","$0.00 ","$925.88 ","$1,466.59 ","$1,481.40 ","$0.00 ","$289.80 ","$0.00 ","$294.80 ","$0.00 "
"421.003","SUP","HCPCS C1713","","421.003  -  PLATE BONE CRANIAL TI 8 HOLE CONTUR STRUT 1.3 MM SCR NONSTRL","BOTH IP/OP","$1,365.75 ","$1,010.66 ","$0.00 ","$1,365.75 ","$614.59 ","$0.00 ","$284.66 ","$0.00 ","$0.00 ","$239.13 ","$1,365.75 ","$0.00 ","$682.88 ","$1,081.67 ","$1,092.60 ","$0.00 ","$213.74 ","$0.00 ","$217.43 ","$0.00 "
"421.004","SUP","HCPCS C1713","","421.004  -  PLATE BONE NONSTRL TEAL 45X38MM CRANFCL TI CONTUR MESH","BOTH IP/OP","$3,584.25 ","$2,652.35 ","$0.00 ","$3,584.25 ","$1,612.91 ","$0.00 ","$747.05 ","$0.00 ","$0.00 ","$627.57 ","$3,584.25 ","$0.00 ","$1,792.13 ","$2,838.73 ","$2,867.40 ","$0.00 ","$560.94 ","$0.00 ","$570.61 ","$0.00 "
"421.005","SUP","HCPCS C1713","","421.005  -  PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM","BOTH IP/OP","$3,584.25 ","$2,652.35 ","$0.00 ","$3,584.25 ","$1,612.91 ","$0.00 ","$747.05 ","$0.00 ","$0.00 ","$627.57 ","$3,584.25 ","$0.00 ","$1,792.13 ","$2,838.73 ","$2,867.40 ","$0.00 ","$560.94 ","$0.00 ","$570.61 ","$0.00 "
"421.006","SUP","HCPCS C1713","","421.006  -  PLATE BONE 100X100MM CRANFCL TI 5 HOLE MESH MALBLE 1.3MM SCR","BOTH IP/OP","$5,379.75 ","$3,981.02 ","$0.00 ","$5,379.75 ","$2,420.89 ","$0.00 ","$1,121.27 ","$0.00 ","$0.00 ","$941.95 ","$5,379.75 ","$0.00 ","$2,689.88 ","$4,260.76 ","$4,303.80 ","$0.00 ","$841.93 ","$0.00 ","$856.46 ","$0.00 "
"421.007","SUP","HCPCS C1713","","421.007  -  PLATE BONE NONSTRL TEAL 100X100MM CRANFCL TI CONTUR MESH","BOTH IP/OP","$5,595.75 ","$4,140.86 ","$0.00 ","$5,595.75 ","$2,518.09 ","$0.00 ","$1,166.29 ","$0.00 ","$0.00 ","$979.77 ","$5,595.75 ","$0.00 ","$2,797.88 ","$4,431.83 ","$4,476.60 ","$0.00 ","$875.73 ","$0.00 ","$890.84 ","$0.00 "
"421.008","SUP","HCPCS C1713","","421.008  -  PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM","BOTH IP/OP","$5,595.75 ","$4,140.86 ","$0.00 ","$5,595.75 ","$2,518.09 ","$0.00 ","$1,166.29 ","$0.00 ","$0.00 ","$979.77 ","$5,595.75 ","$0.00 ","$2,797.88 ","$4,431.83 ","$4,476.60 ","$0.00 ","$875.73 ","$0.00 ","$890.84 ","$0.00 "
"421.009","SUP","HCPCS C1713","","421.009  -  PLATE BONE NONSTRL GOLD 200X200MM CRANFCL TI CONTUR MESH RGD","BOTH IP/OP","$22,304.25 ","$16,505.15 ","$0.00 ","$22,304.25 ","$10,036.91 ","$0.00 ","$4,648.76 ","$0.00 ","$0.00 ","$3,905.30 ","$22,304.25 ","$0.00 ","$11,152.13 ","$17,664.97 ","$17,843.40 ","$0.00 ","$3,490.62 ","$0.00 ","$3,550.84 ","$0.00 "
"421.01","SUP","HCPCS C1713","","421.010  -  PLATE BN 95X3.3X.5MM NS 24 HL ADP TI CRNFCL 1.3MM CORT SCR","BOTH IP/OP","$1,446.75 ","$1,070.60 ","$0.00 ","$1,446.75 ","$651.04 ","$0.00 ","$301.54 ","$0.00 ","$0.00 ","$253.31 ","$1,446.75 ","$0.00 ","$723.38 ","$1,145.83 ","$1,157.40 ","$0.00 ","$226.42 ","$0.00 ","$230.32 ","$0.00 "
"421.011","SUP","HCPCS C1713","","421.011  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE SM ARC","BOTH IP/OP","$1,851.75 ","$1,370.30 ","$0.00 ","$1,851.75 ","$833.29 ","$0.00 ","$385.95 ","$0.00 ","$0.00 ","$324.23 ","$1,851.75 ","$0.00 ","$925.88 ","$1,466.59 ","$1,481.40 ","$0.00 ","$289.80 ","$0.00 ","$294.80 ","$0.00 "
"421.012","SUP","HCPCS C1713","","421.012  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE LG ARC","BOTH IP/OP","$2,893.50 ","$2,141.19 ","$0.00 ","$2,893.50 ","$1,302.08 ","$0.00 ","$603.08 ","$0.00 ","$0.00 ","$506.63 ","$2,893.50 ","$0.00 ","$1,446.75 ","$2,291.65 ","$2,314.80 ","$0.00 ","$452.83 ","$0.00 ","$460.65 ","$0.00 "
"421.013","SUP","HCPCS C1713","","421.013  -  PLATE BONE 1.3MM SCR GOLD CRANFCL TI CONTUR MESH RGD SM ARC","BOTH IP/OP","$1,851.75 ","$1,370.30 ","$0.00 ","$1,851.75 ","$833.29 ","$0.00 ","$385.95 ","$0.00 ","$0.00 ","$324.23 ","$1,851.75 ","$0.00 ","$925.88 ","$1,466.59 ","$1,481.40 ","$0.00 ","$289.80 ","$0.00 ","$294.80 ","$0.00 "
"421.014","SUP","HCPCS C1713","","421.014  -  PLATE BONE 1.3MM SCR GOLD CRANFCL TI CONTUR MESH RGD LG ARC","BOTH IP/OP","$2,893.50 ","$2,141.19 ","$0.00 ","$2,893.50 ","$1,302.08 ","$0.00 ","$603.08 ","$0.00 ","$0.00 ","$506.63 ","$2,893.50 ","$0.00 ","$1,446.75 ","$2,291.65 ","$2,314.80 ","$0.00 ","$452.83 ","$0.00 ","$460.65 ","$0.00 "
"421.015","SUP","HCPCS C1713","","421.015  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 30MM","BOTH IP/OP","$1,851.75 ","$1,370.30 ","$0.00 ","$1,851.75 ","$833.29 ","$0.00 ","$385.95 ","$0.00 ","$0.00 ","$324.23 ","$1,851.75 ","$0.00 ","$925.88 ","$1,466.59 ","$1,481.40 ","$0.00 ","$289.80 ","$0.00 ","$294.80 ","$0.00 "
"421.016","SUP","HCPCS C1713","","421.016  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 70MM","BOTH IP/OP","$3,845.25 ","$2,845.49 ","$0.00 ","$3,845.25 ","$1,730.36 ","$0.00 ","$801.45 ","$0.00 ","$0.00 ","$673.27 ","$3,845.25 ","$0.00 ","$1,922.63 ","$3,045.44 ","$3,076.20 ","$0.00 ","$601.78 ","$0.00 ","$612.16 ","$0.00 "
"421.017","SUP","HCPCS C1713","","421.017  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 100MM","BOTH IP/OP","$5,334.75 ","$3,947.72 ","$0.00 ","$5,334.75 ","$2,400.64 ","$0.00 ","$1,111.90 ","$0.00 ","$0.00 ","$934.07 ","$5,334.75 ","$0.00 ","$2,667.38 ","$4,225.12 ","$4,267.80 ","$0.00 ","$834.89 ","$0.00 ","$849.29 ","$0.00 "
"421.018","SUP","HCPCS C1713","","421.018  -  PLATE BONE NONSTRL GOLD 30MM CRANFCL TI CONTUR MESH RGD RND","BOTH IP/OP","$1,851.75 ","$1,370.30 ","$0.00 ","$1,851.75 ","$833.29 ","$0.00 ","$385.95 ","$0.00 ","$0.00 ","$324.23 ","$1,851.75 ","$0.00 ","$925.88 ","$1,466.59 ","$1,481.40 ","$0.00 ","$289.80 ","$0.00 ","$294.80 ","$0.00 "
"421.019","SUP","HCPCS C1713","","421.019  -  PLATE BONE NONSTRL GOLD 70MM CRANFCL TI CONTUR MESH RGD RND","BOTH IP/OP","$3,845.25 ","$2,845.49 ","$0.00 ","$3,845.25 ","$1,730.36 ","$0.00 ","$801.45 ","$0.00 ","$0.00 ","$673.27 ","$3,845.25 ","$0.00 ","$1,922.63 ","$3,045.44 ","$3,076.20 ","$0.00 ","$601.78 ","$0.00 ","$612.16 ","$0.00 "
"421.02","SUP","HCPCS C1713","","421.020  -  PLATE BONE NONSTRL GOLD 100MM CRANFCL TI CONTUR MESH RGD RND","BOTH IP/OP","$5,334.75 ","$3,947.72 ","$0.00 ","$5,334.75 ","$2,400.64 ","$0.00 ","$1,111.90 ","$0.00 ","$0.00 ","$934.07 ","$5,334.75 ","$0.00 ","$2,667.38 ","$4,225.12 ","$4,267.80 ","$0.00 ","$834.89 ","$0.00 ","$849.29 ","$0.00 "
"421.021","SUP","HCPCS C1713","","421.021  -  PLATE BN 35X3.3X.5MM NS 9 HL TI CRNFCL ORBT RIM 1.3MM CORT","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"421.022","SUP","HCPCS C1713","","421.022  -  PLATE BONE 13MM THK.5MM CRANIAL TI 2 HOLE STR 1.3MM SCR","BOTH IP/OP","$101.25 ","$74.93 ","$0.00 ","$101.25 ","$45.56 ","$0.00 ","$21.10 ","$0.00 ","$0.00 ","$17.73 ","$101.25 ","$0.00 ","$50.63 ","$80.19 ","$81.00 ","$0.00 ","$15.85 ","$0.00 ","$16.12 ","$0.00 "
"421.024","SUP","HCPCS C1713","","421.024  -  PLATE BONE 21MM CRANFCL TI 4 HOLE STR 1.3MM SCR NONSTRL","BOTH IP/OP","$139.50 ","$103.23 ","$0.00 ","$139.50 ","$62.78 ","$0.00 ","$29.08 ","$0.00 ","$0.00 ","$24.43 ","$139.50 ","$0.00 ","$69.75 ","$110.48 ","$111.60 ","$0.00 ","$21.83 ","$0.00 ","$22.21 ","$0.00 "
"421.034","SUP","Custom 27803010","","421.034  -  COVER BUR HOLE 17MM CRANIAL TI 5 HOLE SHNT 1.3MM SCR NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.04","SUP","HCPCS C1713","","421.040  -  PLATE BONE UNV ORBTL FLR TI 1.3MM SCR NONSTRL","BOTH IP/OP","$2,531.25 ","$1,873.13 ","$0.00 ","$2,531.25 ","$1,139.06 ","$0.00 ","$527.58 ","$0.00 ","$0.00 ","$443.20 ","$2,531.25 ","$0.00 ","$1,265.63 ","$2,004.75 ","$2,025.00 ","$0.00 ","$396.14 ","$0.00 ","$402.98 ","$0.00 "
"421.043","SUP","HCPCS C1713","","421.043  -  PLATE BONE MED ORBTL FLR TI ANTM 1.3MM SCR NONSTRL","BOTH IP/OP","$2,553.75 ","$1,889.78 ","$0.00 ","$2,553.75 ","$1,149.19 ","$0.00 ","$532.27 ","$0.00 ","$0.00 ","$447.14 ","$2,553.75 ","$0.00 ","$1,276.88 ","$2,022.57 ","$2,043.00 ","$0.00 ","$399.66 ","$0.00 ","$406.56 ","$0.00 "
"421.044","SUP","HCPCS C1713","","421.044  -  PLATE BONE LEFT MDL WL ORBTL FLR TI 1.3 MM SCR NONSTRL","BOTH IP/OP","$2,531.25 ","$1,873.13 ","$0.00 ","$2,531.25 ","$1,139.06 ","$0.00 ","$527.58 ","$0.00 ","$0.00 ","$443.20 ","$2,531.25 ","$0.00 ","$1,265.63 ","$2,004.75 ","$2,025.00 ","$0.00 ","$396.14 ","$0.00 ","$402.98 ","$0.00 "
"421.045","SUP","HCPCS C1713","","421.045  -  PLATE BONE RIGHT MDL WL ORBTL FLR TI 1.3 MM SCR NONSTRL","BOTH IP/OP","$2,531.25 ","$1,873.13 ","$0.00 ","$2,531.25 ","$1,139.06 ","$0.00 ","$527.58 ","$0.00 ","$0.00 ","$443.20 ","$2,531.25 ","$0.00 ","$1,265.63 ","$2,004.75 ","$2,025.00 ","$0.00 ","$396.14 ","$0.00 ","$402.98 ","$0.00 "
"421.048","SUP","HCPCS C1713","","421.048  -  PLATE BN SM .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR","BOTH IP/OP","$2,553.75 ","$1,889.78 ","$0.00 ","$2,553.75 ","$1,149.19 ","$0.00 ","$532.27 ","$0.00 ","$0.00 ","$447.14 ","$2,553.75 ","$0.00 ","$1,276.88 ","$2,022.57 ","$2,043.00 ","$0.00 ","$399.66 ","$0.00 ","$406.56 ","$0.00 "
"421.049","SUP","HCPCS C1713","","421.049  -  PLATE BN LG .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR","BOTH IP/OP","$2,553.75 ","$1,889.78 ","$0.00 ","$2,553.75 ","$1,149.19 ","$0.00 ","$532.27 ","$0.00 ","$0.00 ","$447.14 ","$2,553.75 ","$0.00 ","$1,276.88 ","$2,022.57 ","$2,043.00 ","$0.00 ","$399.66 ","$0.00 ","$406.56 ","$0.00 "
"421.05","SUP","HCPCS C1713","","421.050  -  PLATE BN 100D 9MM SPC L OB L 20X11X.5MM NS 3 HL BS 3 HL SHFT","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"421.051","SUP","HCPCS C1713","","421.051  -  PLATE BN 100D 9MM SPC L OB R 20X11X.5MM NS 3 HL BS 3 HL SHFT","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"421.052","SUP","HCPCS C1713","","421.052  -  PLATE BN 100D 5MM SPC L OB L 20X11X.5MM NS 3 HL BS 4 HL SHFT","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"421.053","SUP","HCPCS C1713","","421.053  -  PLATE BN 100D 5MM SPC L OB R 20X11X.5MM NS 3 HL BS 4 HL SHFT","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"421.061","SUP","HCPCS C1713","","421.061  -  PLATE BN Y 20X10X.5MM NS 5 HL TI CRNFCL 1.3MM CORT SCR","BOTH IP/OP","$522.00 ","$386.28 ","$0.00 ","$522.00 ","$234.90 ","$0.00 ","$108.80 ","$0.00 ","$0.00 ","$91.40 ","$522.00 ","$0.00 ","$261.00 ","$413.42 ","$417.60 ","$0.00 ","$81.69 ","$0.00 ","$83.10 ","$0.00 "
"421.067","SUP","HCPCS C1713","","421.067  -  PLATE BONE 22MM CRANFCL TI 6 HOLE DBL Y 1.3MM SCR NONSTRL","BOTH IP/OP","$571.50 ","$422.91 ","$0.00 ","$571.50 ","$257.18 ","$0.00 ","$119.11 ","$0.00 ","$0.00 ","$100.07 ","$571.50 ","$0.00 ","$285.75 ","$452.63 ","$457.20 ","$0.00 ","$89.44 ","$0.00 ","$90.98 ","$0.00 "
"421.068","SUP","HCPCS C1713","","421.068  -  PLATE BN 6MM SPC 2Y 15X9X.5MM NS 2 HL SHFT 1 HL ARM TI","BOTH IP/OP","$571.50 ","$422.91 ","$0.00 ","$571.50 ","$257.18 ","$0.00 ","$119.11 ","$0.00 ","$0.00 ","$100.07 ","$571.50 ","$0.00 ","$285.75 ","$452.63 ","$457.20 ","$0.00 ","$89.44 ","$0.00 ","$90.98 ","$0.00 "
"421.069","SUP","HCPCS C1713","","421.069  -  PLATE BONE 18MM CRANFCL TI 6 HOLE 2Y 1.3MM SCR NONSTRL","BOTH IP/OP","$571.50 ","$422.91 ","$0.00 ","$571.50 ","$257.18 ","$0.00 ","$119.11 ","$0.00 ","$0.00 ","$100.07 ","$571.50 ","$0.00 ","$285.75 ","$452.63 ","$457.20 ","$0.00 ","$89.44 ","$0.00 ","$90.98 ","$0.00 "
"421.071","SUP","HCPCS C1713","","421.071  -  PLATE BONE CRANFCL TI 7 HOLE T 1.3 MM SCR NONSTRL","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"421.072","SUP","HCPCS C1713","","421.072  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 14MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.073","SUP","HCPCS C1713","","421.073  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 14MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.074","SUP","HCPCS C1713","","421.074  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.075","SUP","HCPCS C1713","","421.075  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.076","SUP","HCPCS C1713","","421.076  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.077","SUP","HCPCS C1713","","421.077  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.078","SUP","HCPCS C1713","","421.078  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 12MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.079","SUP","HCPCS C1713","","421.079  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 12MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.08","SUP","HCPCS C1713","","421.080  -  PLATE BN T 43X8X.5MM NS 2X9 HL STRUT TI CRNFCL 1.3MM CORT","BOTH IP/OP","$1,190.25 ","$880.79 ","$0.00 ","$1,190.25 ","$535.61 ","$0.00 ","$248.08 ","$0.00 ","$0.00 ","$208.40 ","$1,190.25 ","$0.00 ","$595.13 ","$942.68 ","$952.20 ","$0.00 ","$186.27 ","$0.00 ","$189.49 ","$0.00 "
"421.081","SUP","HCPCS C1713","","421.081  -  PLATE BONE CRANFCL TI 4 HOLE X 1.3 MM SCR NONSTRL","BOTH IP/OP","$522.00 ","$386.28 ","$0.00 ","$522.00 ","$234.90 ","$0.00 ","$108.80 ","$0.00 ","$0.00 ","$91.40 ","$522.00 ","$0.00 ","$261.00 ","$413.42 ","$417.60 ","$0.00 ","$81.69 ","$0.00 ","$83.10 ","$0.00 "
"421.082","SUP","HCPCS C1713","","421.082  -  PLATE MAXL T STR 1.3MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.083","SUP","HCPCS C1713","","421.083  -  PLATE MAXL T STR 1.3MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.084","SUP","HCPCS C1713","","421.084  -  PLATE MAXL T STR 1.3MM SCR BONE TI 12MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.085","SUP","HCPCS C1713","","421.085  -  PLATE BONE CRANFCL TI 11 HOLE H 1.3 MM SCR NONSTRL","BOTH IP/OP","$609.75 ","$451.22 ","$0.00 ","$609.75 ","$274.39 ","$0.00 ","$127.09 ","$0.00 ","$0.00 ","$106.76 ","$609.75 ","$0.00 ","$304.88 ","$482.92 ","$487.80 ","$0.00 ","$95.43 ","$0.00 ","$97.07 ","$0.00 "
"421.086","SUP","HCPCS C1713","","421.086  -  PLATE MAXL T STR 1.3MM SCR BONE TI 14MM NONSTRL","BOTH IP/OP","$729.00 ","$539.46 ","$0.00 ","$729.00 ","$328.05 ","$0.00 ","$151.94 ","$0.00 ","$0.00 ","$127.64 ","$729.00 ","$0.00 ","$364.50 ","$577.37 ","$583.20 ","$0.00 ","$114.09 ","$0.00 ","$116.06 ","$0.00 "
"421.09","SUP","Custom 27803010","","421.090  -  COVER BUR HOLE 12MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL","BOTH IP/OP","$632.25 ","$467.87 ","$0.00 ","$632.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.25 ","$0.00 ","$316.13 ","$500.74 ","$505.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.091","SUP","Custom 27803010","","421.091  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL","BOTH IP/OP","$632.25 ","$467.87 ","$0.00 ","$632.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.25 ","$0.00 ","$316.13 ","$500.74 ","$505.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.092","SUP","Custom 27803010","","421.092  -  COVER BUR HOLE 15MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.093","SUP","Custom 27803010","","421.093  -  COVER BUR HOLE 24MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.095","SUP","HCPCS C1713","","421.095  -  PLATE BN BX 13X8MM NS 4 HL TI CRNFCL 1.3MM SCR","BOTH IP/OP","$510.75 ","$377.96 ","$0.00 ","$510.75 ","$229.84 ","$0.00 ","$106.45 ","$0.00 ","$0.00 ","$89.43 ","$510.75 ","$0.00 ","$255.38 ","$404.51 ","$408.60 ","$0.00 ","$79.93 ","$0.00 ","$81.31 ","$0.00 "
"421.096","SUP","HCPCS C1713","","421.096  -  PLATE BONE 13X13MM CRANFCL TI 4 HOLE BOX 1.3MM SCR NONSTRL","BOTH IP/OP","$510.75 ","$377.96 ","$0.00 ","$510.75 ","$229.84 ","$0.00 ","$106.45 ","$0.00 ","$0.00 ","$89.43 ","$510.75 ","$0.00 ","$255.38 ","$404.51 ","$408.60 ","$0.00 ","$79.93 ","$0.00 ","$81.31 ","$0.00 "
"421.099","SUP","HCPCS C1713","","421.099  -  PLATE BONE 100X100MM CRANFCL TI MESH SCRN 1.3MM SCR NONSTRL","BOTH IP/OP","$2,819.25 ","$2,086.25 ","$0.00 ","$2,819.25 ","$1,268.66 ","$0.00 ","$587.60 ","$0.00 ","$0.00 ","$493.63 ","$2,819.25 ","$0.00 ","$1,409.63 ","$2,232.85 ","$2,255.40 ","$0.00 ","$441.21 ","$0.00 ","$448.82 ","$0.00 "
"421.302","SUP","HCPCS C1713","","421.302  -  PLATE BONE .2MM ORBTL FLR TI MESH 1.3MM SCR NONSTRL","BOTH IP/OP","$2,668.50 ","$1,974.69 ","$0.00 ","$2,668.50 ","$1,200.83 ","$0.00 ","$556.18 ","$0.00 ","$0.00 ","$467.23 ","$2,668.50 ","$0.00 ","$1,334.25 ","$2,113.45 ","$2,134.80 ","$0.00 ","$417.62 ","$0.00 ","$424.83 ","$0.00 "
"421.303","SUP","HCPCS C1713","","421.303  -  PLATE BONE .3MM ORBTL FLR TI MESH 1.3MM SCR NONSTRL","BOTH IP/OP","$2,668.50 ","$1,974.69 ","$0.00 ","$2,668.50 ","$1,200.83 ","$0.00 ","$556.18 ","$0.00 ","$0.00 ","$467.23 ","$2,668.50 ","$0.00 ","$1,334.25 ","$2,113.45 ","$2,134.80 ","$0.00 ","$417.62 ","$0.00 ","$424.83 ","$0.00 "
"421.304","SUP","HCPCS C1713","","421.304  -  PLATE BN .4MM AU NS 3 ROW SCR HL MESH MLBL TI ORBT 1.3MM SCR","BOTH IP/OP","$2,668.50 ","$1,974.69 ","$0.00 ","$2,668.50 ","$1,200.83 ","$0.00 ","$556.18 ","$0.00 ","$0.00 ","$467.23 ","$2,668.50 ","$0.00 ","$1,334.25 ","$2,113.45 ","$2,134.80 ","$0.00 ","$417.62 ","$0.00 ","$424.83 ","$0.00 "
"421.306","SUP","HCPCS C1713","","421.306  -  PLATE BN STRG 23MM NS 6 HL LOPRFL PRECONTOUR RECON TI HND","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"421.312","SUP","HCPCS C1713","","421.312  -  PLATE BN STRG 47MM NS 12 HL LOPRFL PRECONTOUR RECON TI HND","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$451.73 ","$203.28 ","$0.00 ","$96.97 ","$0.00 ","$0.00 ","$79.09 ","$451.73 ","$0.00 ","$225.86 ","$357.77 ","$361.38 ","$0.00 ","$68.64 ","$0.00 ","$71.91 ","$0.00 "
"421.32","SUP","HCPCS C1713","","421.320  -  PLATE BONE H 19MMX.5MM 8 HOLE EXTENDED TITANIUM RIGHT HAND","BOTH IP/OP","$431.25 ","$319.13 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$89.88 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"421.321","SUP","HCPCS C1713","","421.321  -  PLATE BONE H 8 HOLE EXTEND PRECONTOUR LP TITANIUM HAND LEFT","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"421.333","SUP","HCPCS C1713","","421.333  -  PLATE BONE T 32MM 3X8 HOLE PRECONTOUR LP TITANIUM HAND","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"421.334","SUP","HCPCS C1713","","421.334  -  PLATE BONE T 32MM 4X8 HOLE PRECONTOUR LP TITANIUM HAND","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"421.335","SUP","HCPCS C1713","","421.335  -  PLATE BONE Y 3X8 HOLE PRECONTOUR LP TITANIUM HAND NONSTRL","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"421.5","SUP","HCPCS C1713","","421.500  -  PLATE BONE MED TMPR TI CONTUR MESH MALBLE LP NONSTRL","BOTH IP/OP","$2,083.50 ","$1,541.79 ","$0.00 ","$2,083.50 ","$937.58 ","$0.00 ","$434.25 ","$0.00 ","$0.00 ","$364.80 ","$2,083.50 ","$0.00 ","$1,041.75 ","$1,650.13 ","$1,666.80 ","$0.00 ","$326.07 ","$0.00 ","$331.69 ","$0.00 "
"421.501","SUP","HCPCS C1713","","421.501  -  PLATE BONE CRANFCL TI 8 HOLE MALBLE CONTUR MESH LP NONSTRL","BOTH IP/OP","$1,572.75 ","$1,163.84 ","$0.00 ","$1,572.75 ","$707.74 ","$0.00 ","$327.80 ","$0.00 ","$0.00 ","$275.38 ","$1,572.75 ","$0.00 ","$786.38 ","$1,245.62 ","$1,258.20 ","$0.00 ","$246.14 ","$0.00 ","$250.38 ","$0.00 "
"421.502","SUP","HCPCS C1713","","421.502  -  PLATE BONE CRANFCL TI 2 HOLE STR LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.503","SUP","HCPCS C1713","","421.503  -  PLATE BONE 9MM CRANFCL TI 2 HOLE STR LP NONSTRL","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$56.19 ","$0.00 ","$26.03 ","$0.00 ","$0.00 ","$21.86 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$19.54 ","$0.00 ","$19.88 ","$0.00 "
"421.504","SUP","HCPCS C1713","","421.504  -  PLATE BONE CRANFCL TI 4 HOLE STR LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.505","SUP","HCPCS C1713","","421.505  -  PLATE BONE ORBTL RIM TI 12 HOLE CVD LP NONSTRL","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"421.506","SUP","HCPCS C1713","","421.506  -  PLATE BONE CRANFCL TI 2X3 HOLE L RIGHT OBLQ LP NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"421.507","SUP","HCPCS C1713","","421.507  -  PLATE BONE CRANFCL TI 2X3 HOLE L LEFT OBLQ LP NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"421.508","SUP","HCPCS C1713","","421.508  -  PLATE BONE CRANFCL TI 3X4 HOLE L RIGHT OBLQ LP NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"421.509","SUP","HCPCS C1713","","421.509  -  PLATE BONE CRANFCL TI 3X4 HOLE L LEFT OBLQ LP NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"421.51","SUP","HCPCS C1713","","421.510  -  PLATE BN X .5MM NS 4 HL LOPRFL TI CRNMXF NEURO SYS","BOTH IP/OP","$636.75 ","$471.20 ","$0.00 ","$636.75 ","$286.54 ","$0.00 ","$132.71 ","$0.00 ","$0.00 ","$111.49 ","$636.75 ","$0.00 ","$318.38 ","$504.31 ","$509.40 ","$0.00 ","$99.65 ","$0.00 ","$101.37 ","$0.00 "
"421.511","SUP","HCPCS C1713","","421.511  -  PLATE BONE 14X14MM CRANFCL TI 4 HOLE BOX LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.512","SUP","HCPCS C1713","","421.512  -  PLATE BONE 16X16MM CRANFCL TI 4 HOLE BOX LP NONSTRL","BOTH IP/OP","$636.75 ","$471.20 ","$0.00 ","$636.75 ","$286.54 ","$0.00 ","$132.71 ","$0.00 ","$0.00 ","$111.49 ","$636.75 ","$0.00 ","$318.38 ","$504.31 ","$509.40 ","$0.00 ","$99.65 ","$0.00 ","$101.37 ","$0.00 "
"421.515","SUP","HCPCS C1713","","421.515  -  PLATE BONE 15MM CRANFCL TI 5 HOLE Y LP NONSTRL","BOTH IP/OP","$636.75 ","$471.20 ","$0.00 ","$636.75 ","$286.54 ","$0.00 ","$132.71 ","$0.00 ","$0.00 ","$111.49 ","$636.75 ","$0.00 ","$318.38 ","$504.31 ","$509.40 ","$0.00 ","$99.65 ","$0.00 ","$101.37 ","$0.00 "
"421.516","SUP","HCPCS C1713","","421.516  -  PLATE BONE 18MM CRANFCL TI 6 HOLE 2Y LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.517","SUP","HCPCS C1713","","421.517  -  PLATE BONE 21MM TI 6 HOLE DBL Y LP","BOTH IP/OP","$636.75 ","$471.20 ","$0.00 ","$636.75 ","$286.54 ","$0.00 ","$132.71 ","$0.00 ","$0.00 ","$111.49 ","$636.75 ","$0.00 ","$318.38 ","$504.31 ","$509.40 ","$0.00 ","$99.65 ","$0.00 ","$101.37 ","$0.00 "
"421.518","SUP","HCPCS C1713","","421.518  -  PLATE BN .5MM NS 5 HL LOPRFL ADP TI CRNMXF NEURO SYS","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.519","SUP","HCPCS C1713","","421.519  -  PLATE BN .5MM NS 7 HL LOPRFL ADP TI CRNMXF NEURO SYS","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.52","SUP","HCPCS C1713","","421.520  -  PLATE BN .5MM NS 20 HL LOPRFL ADP TI CRNMXF NEURO SYS","BOTH IP/OP","$1,413.00 ","$1,045.62 ","$0.00 ","$1,413.00 ","$635.85 ","$0.00 ","$294.50 ","$0.00 ","$0.00 ","$247.40 ","$1,413.00 ","$0.00 ","$706.50 ","$1,119.10 ","$1,130.40 ","$0.00 ","$221.13 ","$0.00 ","$224.95 ","$0.00 "
"421.521","SUP","HCPCS C1713","","421.521  -  PLATE BONE 16X10MM CRANFCL TI 4 HOLE BOX LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.522","SUP","HCPCS C1713","","421.522  -  PLATE BN .5MM NS 6 HL LOPRFL STRUT TI CRNMXF NEURO SYS","BOTH IP/OP","$1,109.25 ","$820.85 ","$0.00 ","$1,109.25 ","$499.16 ","$0.00 ","$231.20 ","$0.00 ","$0.00 ","$194.22 ","$1,109.25 ","$0.00 ","$554.63 ","$878.53 ","$887.40 ","$0.00 ","$173.60 ","$0.00 ","$176.59 ","$0.00 "
"421.523","SUP","HCPCS C1713","","421.523  -  PLATE BN .5MM NS 8 HL LOPRFL STRUT TI CRNMXF NEURO SYS","BOTH IP/OP","$1,572.75 ","$1,163.84 ","$0.00 ","$1,572.75 ","$707.74 ","$0.00 ","$327.80 ","$0.00 ","$0.00 ","$275.38 ","$1,572.75 ","$0.00 ","$786.38 ","$1,245.62 ","$1,258.20 ","$0.00 ","$246.14 ","$0.00 ","$250.38 ","$0.00 "
"421.525","SUP","Custom 27803010","","421.525  -  COVER BUR HOLE 12MM CRANFCL TI LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.526","SUP","Custom 27803010","","421.526  -  COVER BUR HOLE 15MM CRANFCL TI LP NONSTRL","BOTH IP/OP","$661.50 ","$489.51 ","$0.00 ","$661.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.50 ","$0.00 ","$330.75 ","$523.91 ","$529.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.527","SUP","Custom 27803010","","421.527  -  COVER BUR HOLE 17MM CRANFCL TI LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.528","SUP","Custom 27803010","","421.528  -  COVER BUR HOLE 24MM CRANFCL TI LP NONSTRL","BOTH IP/OP","$661.50 ","$489.51 ","$0.00 ","$661.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.50 ","$0.00 ","$330.75 ","$523.91 ","$529.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.531","SUP","HCPCS C1713","","421.531  -  PLATE BONE 45X38MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.532","SUP","HCPCS C1713","","421.532  -  PLATE THK.6MM 45X38MM TI CONTUR MESH RGD BONE NONSTRL SLVR","BOTH IP/OP","$3,620.25 ","$2,678.99 ","$0.00 ","$3,620.25 ","$1,629.11 ","$0.00 ","$754.55 ","$0.00 ","$0.00 ","$633.88 ","$3,620.25 ","$0.00 ","$1,810.13 ","$2,867.24 ","$2,896.20 ","$0.00 ","$566.57 ","$0.00 ","$576.34 ","$0.00 "
"421.533","SUP","HCPCS C1713","","421.533  -  PLATE BONE 100X100MM CRANFCL TI CONTUR MESH MALBLE LP","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.534","SUP","HCPCS C1713","","421.534  -  PLATE BONE 100X100MM CRANFCL TI CONTUR MESH RGD LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.535","SUP","HCPCS C1713","","421.535  -  PLATE BONE 200X200MM CRANFCL TI CONTUR MESH RGD LP NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"421.536","SUP","HCPCS C1713","","421.536  -  PLATE BONE CRANFCL TI CONTUR MESH MALBLE LP SM ARC NONSTRL","BOTH IP/OP","$2,083.50 ","$1,541.79 ","$0.00 ","$2,083.50 ","$937.58 ","$0.00 ","$434.25 ","$0.00 ","$0.00 ","$364.80 ","$2,083.50 ","$0.00 ","$1,041.75 ","$1,650.13 ","$1,666.80 ","$0.00 ","$326.07 ","$0.00 ","$331.69 ","$0.00 "
"421.537","SUP","HCPCS C1713","","421.537  -  PLATE BONE CRANFCL TI CONTUR MESH MALBLE LP LG ARC NONSTRL","BOTH IP/OP","$3,244.50 ","$2,400.93 ","$0.00 ","$3,244.50 ","$1,460.03 ","$0.00 ","$676.23 ","$0.00 ","$0.00 ","$568.09 ","$3,244.50 ","$0.00 ","$1,622.25 ","$2,569.64 ","$2,595.60 ","$0.00 ","$507.76 ","$0.00 ","$516.52 ","$0.00 "
"421.538","SUP","HCPCS C1713","","421.538  -  PLATE BONE CRANFCL TI CONTUR MESH RGD LP SM ARC NONSTRL","BOTH IP/OP","$2,083.50 ","$1,541.79 ","$0.00 ","$2,083.50 ","$937.58 ","$0.00 ","$434.25 ","$0.00 ","$0.00 ","$364.80 ","$2,083.50 ","$0.00 ","$1,041.75 ","$1,650.13 ","$1,666.80 ","$0.00 ","$326.07 ","$0.00 ","$331.69 ","$0.00 "
"421.539","SUP","HCPCS C1713","","421.539  -  PLATE BONE CRANFCL TI CONTUR MESH RGD LP LG ARC NONSTRL","BOTH IP/OP","$3,244.50 ","$2,400.93 ","$0.00 ","$3,244.50 ","$1,460.03 ","$0.00 ","$676.23 ","$0.00 ","$0.00 ","$568.09 ","$3,244.50 ","$0.00 ","$1,622.25 ","$2,569.64 ","$2,595.60 ","$0.00 ","$507.76 ","$0.00 ","$516.52 ","$0.00 "
"421.54","SUP","HCPCS C1713","","421.540  -  PLATE BONE 30MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL","BOTH IP/OP","$2,083.50 ","$1,541.79 ","$0.00 ","$2,083.50 ","$937.58 ","$0.00 ","$434.25 ","$0.00 ","$0.00 ","$364.80 ","$2,083.50 ","$0.00 ","$1,041.75 ","$1,650.13 ","$1,666.80 ","$0.00 ","$326.07 ","$0.00 ","$331.69 ","$0.00 "
"421.541","SUP","HCPCS C1713","","421.541  -  PLATE BONE 70MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL","BOTH IP/OP","$4,311.00 ","$3,190.14 ","$0.00 ","$4,311.00 ","$1,939.95 ","$0.00 ","$898.52 ","$0.00 ","$0.00 ","$754.82 ","$4,311.00 ","$0.00 ","$2,155.50 ","$3,414.31 ","$3,448.80 ","$0.00 ","$674.67 ","$0.00 ","$686.31 ","$0.00 "
"421.542","SUP","HCPCS C1713","","421.542  -  PLATE BONE 100MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL","BOTH IP/OP","$5,373.00 ","$3,976.02 ","$0.00 ","$5,373.00 ","$2,417.85 ","$0.00 ","$1,119.87 ","$0.00 ","$0.00 ","$940.77 ","$5,373.00 ","$0.00 ","$2,686.50 ","$4,255.42 ","$4,298.40 ","$0.00 ","$840.87 ","$0.00 ","$855.38 ","$0.00 "
"421.543","SUP","HCPCS C1713","","421.543  -  PLATE TI LP CONTUR MESH RGD BONE 30MM NEURO NONSTRL","BOTH IP/OP","$2,083.50 ","$1,541.79 ","$0.00 ","$2,083.50 ","$937.58 ","$0.00 ","$434.25 ","$0.00 ","$0.00 ","$364.80 ","$2,083.50 ","$0.00 ","$1,041.75 ","$1,650.13 ","$1,666.80 ","$0.00 ","$326.07 ","$0.00 ","$331.69 ","$0.00 "
"421.544","SUP","HCPCS C1713","","421.544  -  PLATE BONE 70MM CRANFCL TI CONTUR MESH RGD LP NONSTRL","BOTH IP/OP","$4,311.00 ","$3,190.14 ","$0.00 ","$4,311.00 ","$1,939.95 ","$0.00 ","$898.52 ","$0.00 ","$0.00 ","$754.82 ","$4,311.00 ","$0.00 ","$2,155.50 ","$3,414.31 ","$3,448.80 ","$0.00 ","$674.67 ","$0.00 ","$686.31 ","$0.00 "
"421.545","SUP","HCPCS C1713","","421.545  -  PLATE BONE 100MM TI CONTUR MESH MALBLE LP RND","BOTH IP/OP","$5,373.00 ","$3,976.02 ","$0.00 ","$5,373.00 ","$2,417.85 ","$0.00 ","$1,119.87 ","$0.00 ","$0.00 ","$940.77 ","$5,373.00 ","$0.00 ","$2,686.50 ","$4,255.42 ","$4,298.40 ","$0.00 ","$840.87 ","$0.00 ","$855.38 ","$0.00 "
"421.546","SUP","HCPCS C1713","","421.546  -  PLATE BN THK.4MM LG BLU NS CNTR MESH LOPRFL TI CRNL MSTD","BOTH IP/OP","$2,522.25 ","$1,866.47 ","$0.00 ","$2,522.25 ","$1,135.01 ","$0.00 ","$525.70 ","$0.00 ","$0.00 ","$441.63 ","$2,522.25 ","$0.00 ","$1,261.13 ","$1,997.62 ","$2,017.80 ","$0.00 ","$394.73 ","$0.00 ","$401.54 ","$0.00 "
"421.547","SUP","HCPCS C1713","","421.547  -  PLATE MED .4MM MSTD CONTUR MESH MALBLE LP BONE TI","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"421.553","SUP","Custom 27803010","","421.553  -  COVER BUR HOLE 15MM TI SHNT NEURO LP NONSTRL","BOTH IP/OP","$661.50 ","$489.51 ","$0.00 ","$661.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.50 ","$0.00 ","$330.75 ","$523.91 ","$529.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"421.554","SUP","Custom 27803010","","421.554  -  COVER BUR HOLE 17MM CRANFCL TI LP SHNT NONSTRL","BOTH IP/OP","$661.50 ","$489.51 ","$0.00 ","$661.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$661.50 ","$0.00 ","$330.75 ","$523.91 ","$529.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"422.02","SUP","HCPCS C1713","","422.02  -  PLATE BONE 39X12X1MM 2 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$125.55 ","$92.91 ","$0.00 ","$125.55 ","$56.50 ","$0.00 ","$26.17 ","$0.00 ","$0.00 ","$21.98 ","$125.55 ","$0.00 ","$62.78 ","$99.44 ","$100.44 ","$0.00 ","$19.08 ","$0.00 ","$19.99 ","$0.00 "
"422.03","SUP","HCPCS C1713","","422.03  -  PLATE BONE 55X12X1MM 3 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$133.75 ","$98.98 ","$0.00 ","$133.75 ","$60.19 ","$0.00 ","$27.88 ","$0.00 ","$0.00 ","$23.42 ","$133.75 ","$0.00 ","$66.88 ","$105.93 ","$107.00 ","$0.00 ","$20.32 ","$0.00 ","$21.29 ","$0.00 "
"422.04","SUP","HCPCS C1713","","422.04  -  PLATE BONE 71X12X1MM 4 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$144.68 ","$107.06 ","$0.00 ","$144.68 ","$65.10 ","$0.00 ","$30.15 ","$0.00 ","$0.00 ","$25.33 ","$144.68 ","$0.00 ","$72.34 ","$114.59 ","$115.74 ","$0.00 ","$21.98 ","$0.00 ","$23.03 ","$0.00 "
"422.05","SUP","HCPCS C1713","","422.05  -  PLATE BONE 87X12X1MM 5 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$152.85 ","$113.11 ","$0.00 ","$152.85 ","$68.78 ","$0.00 ","$31.86 ","$0.00 ","$0.00 ","$26.76 ","$152.85 ","$0.00 ","$76.43 ","$121.06 ","$122.28 ","$0.00 ","$23.22 ","$0.00 ","$24.33 ","$0.00 "
"422.06","SUP","HCPCS C1713","","422.06  -  PLATE BONE 103X12X1MM 6 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$162.40 ","$120.18 ","$0.00 ","$162.40 ","$73.08 ","$0.00 ","$33.85 ","$0.00 ","$0.00 ","$28.43 ","$162.40 ","$0.00 ","$81.20 ","$128.62 ","$129.92 ","$0.00 ","$24.68 ","$0.00 ","$25.85 ","$0.00 "
"422.07","SUP","HCPCS C1713","","422.07  -  PLATE BONE 119X12X1MM 7 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$169.23 ","$76.15 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$29.63 ","$169.23 ","$0.00 ","$84.61 ","$134.03 ","$135.38 ","$0.00 ","$25.71 ","$0.00 ","$26.94 ","$0.00 "
"422.08","SUP","HCPCS C1713","","422.08  -  PLATE BONE 135X12X1MM 8 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$184.25 ","$136.35 ","$0.00 ","$184.25 ","$82.91 ","$0.00 ","$38.40 ","$0.00 ","$0.00 ","$32.26 ","$184.25 ","$0.00 ","$92.13 ","$145.93 ","$147.40 ","$0.00 ","$27.99 ","$0.00 ","$29.33 ","$0.00 "
"422.09","SUP","HCPCS C1713","","422.09  -  PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$206.08 ","$152.50 ","$0.00 ","$206.08 ","$92.73 ","$0.00 ","$42.95 ","$0.00 ","$0.00 ","$36.08 ","$206.08 ","$0.00 ","$103.04 ","$163.22 ","$164.86 ","$0.00 ","$31.31 ","$0.00 ","$32.81 ","$0.00 "
"422.1","SUP","HCPCS C1713","","422.10  -  PLATE BONE 167X12X1MM 10 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$207.45 ","$153.51 ","$0.00 ","$207.45 ","$93.35 ","$0.00 ","$43.24 ","$0.00 ","$0.00 ","$36.32 ","$207.45 ","$0.00 ","$103.73 ","$164.30 ","$165.96 ","$0.00 ","$31.52 ","$0.00 ","$33.03 ","$0.00 "
"422.11","SUP","HCPCS C1713","","422.11  -  PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$222.45 ","$164.61 ","$0.00 ","$222.45 ","$100.10 ","$0.00 ","$46.36 ","$0.00 ","$0.00 ","$38.95 ","$222.45 ","$0.00 ","$111.23 ","$176.18 ","$177.96 ","$0.00 ","$33.80 ","$0.00 ","$35.41 ","$0.00 "
"422.12","SUP","HCPCS C1713","","422.12  -  PLATE BONE LARGE 183MM 12 HOLE SEMITUBULAR LC-DCP TITANIUM","BOTH IP/OP","$227.93 ","$168.67 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$47.51 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"422.22","SUP","HCPCS C1713","","422.220  -  PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,913.75 ","$2,156.18 ","$0.00 ","$2,913.75 ","$1,311.19 ","$0.00 ","$607.30 ","$0.00 ","$0.00 ","$510.17 ","$2,913.75 ","$0.00 ","$1,456.88 ","$2,307.69 ","$2,331.00 ","$0.00 ","$442.72 ","$0.00 ","$463.87 ","$0.00 "
"422.221","SUP","HCPCS C1713","","422.221  -  PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,001.15 ","$2,220.85 ","$0.00 ","$2,913.75 ","$1,311.19 ","$0.00 ","$625.51 ","$0.00 ","$0.00 ","$510.17 ","$2,913.75 ","$0.00 ","$1,456.88 ","$2,307.69 ","$2,331.00 ","$0.00 ","$442.72 ","$0.00 ","$463.87 ","$0.00 "
"422.222","SUP","HCPCS C1713","","422.222  -  PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$3,061.60 ","$2,265.58 ","$0.00 ","$2,972.43 ","$1,337.59 ","$0.00 ","$638.11 ","$0.00 ","$0.00 ","$520.45 ","$2,972.43 ","$0.00 ","$1,486.21 ","$2,354.16 ","$2,377.94 ","$0.00 ","$451.64 ","$0.00 ","$473.21 ","$0.00 "
"422.223","SUP","HCPCS C1713","","422.223  -  PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,061.60 ","$2,265.58 ","$0.00 ","$2,972.43 ","$1,337.59 ","$0.00 ","$638.11 ","$0.00 ","$0.00 ","$520.45 ","$2,972.43 ","$0.00 ","$1,486.21 ","$2,354.16 ","$2,377.94 ","$0.00 ","$451.64 ","$0.00 ","$473.21 ","$0.00 "
"422.224","SUP","HCPCS C1713","","422.224  -  PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$3,124.85 ","$2,312.39 ","$0.00 ","$3,033.85 ","$1,365.23 ","$0.00 ","$651.30 ","$0.00 ","$0.00 ","$531.20 ","$3,033.85 ","$0.00 ","$1,516.93 ","$2,402.81 ","$2,427.08 ","$0.00 ","$460.97 ","$0.00 ","$482.99 ","$0.00 "
"422.225","SUP","HCPCS C1713","","422.225  -  PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,124.85 ","$2,312.39 ","$0.00 ","$3,033.85 ","$1,365.23 ","$0.00 ","$651.30 ","$0.00 ","$0.00 ","$531.20 ","$3,033.85 ","$0.00 ","$1,516.93 ","$2,402.81 ","$2,427.08 ","$0.00 ","$460.97 ","$0.00 ","$482.99 ","$0.00 "
"422.226","SUP","HCPCS C1713","","422.226  -  PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$3,185.30 ","$2,357.12 ","$0.00 ","$3,092.53 ","$1,391.64 ","$0.00 ","$663.90 ","$0.00 ","$0.00 ","$541.48 ","$3,092.53 ","$0.00 ","$1,546.26 ","$2,449.28 ","$2,474.02 ","$0.00 ","$469.88 ","$0.00 ","$492.33 ","$0.00 "
"422.227","SUP","HCPCS C1713","","422.227  -  PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,185.30 ","$2,357.12 ","$0.00 ","$3,092.53 ","$1,391.64 ","$0.00 ","$663.90 ","$0.00 ","$0.00 ","$541.48 ","$3,092.53 ","$0.00 ","$1,546.26 ","$2,449.28 ","$2,474.02 ","$0.00 ","$469.88 ","$0.00 ","$492.33 ","$0.00 "
"422.228","SUP","HCPCS C1713","","422.228  -  PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$3,248.55 ","$2,403.93 ","$0.00 ","$3,153.93 ","$1,419.27 ","$0.00 ","$677.08 ","$0.00 ","$0.00 ","$552.23 ","$3,153.93 ","$0.00 ","$1,576.96 ","$2,497.91 ","$2,523.14 ","$0.00 ","$479.21 ","$0.00 ","$502.10 ","$0.00 "
"422.229","SUP","HCPCS C1713","","422.229  -  PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,248.55 ","$2,403.93 ","$0.00 ","$3,153.93 ","$1,419.27 ","$0.00 ","$677.08 ","$0.00 ","$0.00 ","$552.23 ","$3,153.93 ","$0.00 ","$1,576.96 ","$2,497.91 ","$2,523.14 ","$0.00 ","$479.21 ","$0.00 ","$502.10 ","$0.00 "
"422.25","SUP","HCPCS C1713","","422.250  -  PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$2,763.63 ","$2,045.09 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$576.01 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"422.251","SUP","HCPCS C1713","","422.251  -  PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$2,846.53 ","$2,106.43 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$593.29 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"422.252","SUP","HCPCS C1713","","422.252  -  PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$2,904.15 ","$2,149.07 ","$0.00 ","$2,819.58 ","$1,268.81 ","$0.00 ","$605.30 ","$0.00 ","$0.00 ","$493.69 ","$2,819.58 ","$0.00 ","$1,409.79 ","$2,233.11 ","$2,255.66 ","$0.00 ","$428.41 ","$0.00 ","$448.88 ","$0.00 "
"422.253","SUP","HCPCS C1713","","422.253  -  PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$2,904.15 ","$2,149.07 ","$0.00 ","$2,819.58 ","$1,268.81 ","$0.00 ","$605.30 ","$0.00 ","$0.00 ","$493.69 ","$2,819.58 ","$0.00 ","$1,409.79 ","$2,233.11 ","$2,255.66 ","$0.00 ","$428.41 ","$0.00 ","$448.88 ","$0.00 "
"422.254","SUP","HCPCS C1713","","422.254  -  PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$2,964.60 ","$2,193.80 ","$0.00 ","$2,878.25 ","$1,295.21 ","$0.00 ","$617.90 ","$0.00 ","$0.00 ","$503.96 ","$2,878.25 ","$0.00 ","$1,439.13 ","$2,279.57 ","$2,302.60 ","$0.00 ","$437.33 ","$0.00 ","$458.22 ","$0.00 "
"422.255","SUP","HCPCS C1713","","422.255  -  PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$2,964.60 ","$2,193.80 ","$0.00 ","$2,878.25 ","$1,295.21 ","$0.00 ","$617.90 ","$0.00 ","$0.00 ","$503.96 ","$2,878.25 ","$0.00 ","$1,439.13 ","$2,279.57 ","$2,302.60 ","$0.00 ","$437.33 ","$0.00 ","$458.22 ","$0.00 "
"422.256","SUP","HCPCS C1713","","422.256  -  PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$2,934.23 ","$1,320.40 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$513.76 ","$2,934.23 ","$0.00 ","$1,467.11 ","$2,323.91 ","$2,347.38 ","$0.00 ","$445.83 ","$0.00 ","$467.13 ","$0.00 "
"422.257","SUP","HCPCS C1713","","422.257  -  PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$2,934.23 ","$1,320.40 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$513.76 ","$2,934.23 ","$0.00 ","$1,467.11 ","$2,323.91 ","$2,347.38 ","$0.00 ","$445.83 ","$0.00 ","$467.13 ","$0.00 "
"422.258","SUP","HCPCS C1713","","422.258  -  PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"422.259","SUP","HCPCS C1713","","422.259  -  PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"422.3","SUP","HCPCS C1713","","422.300  -  PLATE BONE 140MM 5 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA","BOTH IP/OP","$3,003.83 ","$2,222.83 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$626.07 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.301","SUP","HCPCS C1713","","422.301  -  PLATE BONE 140MM 5 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.304","SUP","HCPCS C1713","","422.304  -  PLATE BONE 3.5MM 220MM 9 HOLE LISS TITANIUM RIGHT PROXIMAL","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.305","SUP","HCPCS C1713","","422.305  -  PLATE BONE 220MM 9 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.308","SUP","HCPCS C1713","","422.308  -  PLATE BONE 300MM 13 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.309","SUP","HCPCS C1713","","422.309  -  PLATE BONE 300MM 13 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.34","SUP","HCPCS C1713","","422.340  -  PLATE BONE 156MM 5 HOLE LISS TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$3,003.83 ","$2,222.83 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$626.07 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.341","SUP","HCPCS C1713","","422.341  -  PLATE BN 156MM NS LISS 5 HL TI FEM LT DIST 5MM LCK SCR","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.344","SUP","HCPCS C1713","","422.344  -  PLATE BN 236MM NS LISS 9 HL TI FEM RT DIST 5MM LCK SCR","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.345","SUP","HCPCS C1713","","422.345  -  PLATE BN 236MM NS LISS 9 HL TI FEM LT DIST 5MM LCK SCR","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.348","SUP","HCPCS C1713","","422.348  -  PLATE BN 316MM NS LISS 13 HL TI FEM RT DIST 5MM LCK SCR","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.349","SUP","HCPCS C1713","","422.349  -  PLATE BN 316MM NS LISS 13 HL TI FEM LT DIST 5MM LCK SCR","BOTH IP/OP","$3,093.93 ","$2,289.51 ","$0.00 ","$3,003.83 ","$1,351.72 ","$0.00 ","$644.85 ","$0.00 ","$0.00 ","$525.95 ","$3,003.83 ","$0.00 ","$1,501.91 ","$2,379.03 ","$2,403.06 ","$0.00 ","$456.40 ","$0.00 ","$478.21 ","$0.00 "
"422.39","SUP","Custom 27203010","","422.390  -  INSERT SCR HL 5MM LISS TI FEM","BOTH IP/OP","$176.05 ","$130.28 ","$0.00 ","$176.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.05 ","$0.00 ","$88.03 ","$139.43 ","$140.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"422.391","SUP","HCPCS C1713","","422.391  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$383.50 ","$172.58 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$67.15 ","$383.50 ","$0.00 ","$191.75 ","$303.73 ","$306.80 ","$0.00 ","$58.27 ","$0.00 ","$61.05 ","$0.00 "
"422.392","SUP","HCPCS C1713","","422.392  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 26MM SELF DRILL","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$383.50 ","$172.58 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$67.15 ","$383.50 ","$0.00 ","$191.75 ","$303.73 ","$306.80 ","$0.00 ","$58.27 ","$0.00 ","$61.05 ","$0.00 "
"422.393","SUP","HCPCS C1713","","422.393  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$383.50 ","$172.58 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$67.15 ","$383.50 ","$0.00 ","$191.75 ","$303.73 ","$306.80 ","$0.00 ","$58.27 ","$0.00 ","$61.05 ","$0.00 "
"422.394","SUP","HCPCS C1713","","422.394  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"422.395","SUP","HCPCS C1713","","422.395  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"422.396","SUP","HCPCS C1713","","422.396  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"422.397","SUP","HCPCS C1713","","422.397  -  SCREW BONE 3.5MM 5MM 4.4MM 85MM SLFDRILL LOCKING THREADED","BOTH IP/OP","$402.03 ","$297.50 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"422.402","SUP","HCPCS C1713","","422.402  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 14MM SELF DRILL LCP","BOTH IP/OP","$409.05 ","$302.70 ","$0.00 ","$397.15 ","$178.72 ","$0.00 ","$85.26 ","$0.00 ","$0.00 ","$69.54 ","$397.15 ","$0.00 ","$198.58 ","$314.54 ","$317.72 ","$0.00 ","$60.34 ","$0.00 ","$63.23 ","$0.00 "
"422.404","SUP","HCPCS C1713","","422.404  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL LCP","BOTH IP/OP","$409.05 ","$302.70 ","$0.00 ","$397.15 ","$178.72 ","$0.00 ","$85.26 ","$0.00 ","$0.00 ","$69.54 ","$397.15 ","$0.00 ","$198.58 ","$314.54 ","$317.72 ","$0.00 ","$60.34 ","$0.00 ","$63.23 ","$0.00 "
"422.578","SUP","Custom 27803010","","422.578  -  NUT ORTHOPEDIC 5MM TITANIUM TIBIA PROXIMAL MEDIAL NONSTRL","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$294.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$294.78 ","$0.00 ","$147.39 ","$233.47 ","$235.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"423.406","SUP","HCPCS C1713","","423.406  -  PLATE BONE 86MM 6 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5","BOTH IP/OP","$1,720.58 ","$1,273.23 ","$0.00 ","$1,670.45 ","$751.70 ","$0.00 ","$358.61 ","$0.00 ","$0.00 ","$292.48 ","$1,670.45 ","$0.00 ","$835.23 ","$1,323.00 ","$1,336.36 ","$0.00 ","$253.81 ","$0.00 ","$265.94 ","$0.00 "
"423.407","SUP","HCPCS C1713","","423.407  -  PLATE BONE 99MM 7 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5","BOTH IP/OP","$1,752.90 ","$1,297.15 ","$0.00 ","$1,701.85 ","$765.83 ","$0.00 ","$365.35 ","$0.00 ","$0.00 ","$297.98 ","$1,701.85 ","$0.00 ","$850.93 ","$1,347.87 ","$1,361.48 ","$0.00 ","$258.58 ","$0.00 ","$270.93 ","$0.00 "
"423.408","SUP","HCPCS C1713","","423.408  -  PLATE BONE 112MM 8 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"423.409","SUP","HCPCS C1713","","423.409  -  PLATE BONE 125MM 9 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5","BOTH IP/OP","$1,807.73 ","$1,337.72 ","$0.00 ","$1,755.08 ","$789.78 ","$0.00 ","$376.78 ","$0.00 ","$0.00 ","$307.30 ","$1,755.08 ","$0.00 ","$877.54 ","$1,390.02 ","$1,404.06 ","$0.00 ","$266.67 ","$0.00 ","$279.41 ","$0.00 "
"423.41","SUP","HCPCS C1713","","423.410  -  PLATE BONE 138MM 10 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$1,783.73 ","$1,319.96 ","$0.00 ","$1,783.73 ","$802.68 ","$0.00 ","$371.77 ","$0.00 ","$0.00 ","$312.32 ","$1,783.73 ","$0.00 ","$891.86 ","$1,412.71 ","$1,426.98 ","$0.00 ","$271.02 ","$0.00 ","$283.97 ","$0.00 "
"423.411","SUP","HCPCS C1713","","423.411  -  PLATE BONE 151MM 11 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$1,868.18 ","$1,382.45 ","$0.00 ","$1,813.75 ","$816.19 ","$0.00 ","$389.37 ","$0.00 ","$0.00 ","$317.57 ","$1,813.75 ","$0.00 ","$906.88 ","$1,436.49 ","$1,451.00 ","$0.00 ","$275.58 ","$0.00 ","$288.75 ","$0.00 "
"423.412","SUP","HCPCS C1713","","423.412  -  PLATE BONE 164MM 12 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,410.78 ","$1,783.98 ","$0.00 ","$2,340.55 ","$1,053.25 ","$0.00 ","$502.47 ","$0.00 ","$0.00 ","$409.81 ","$2,340.55 ","$0.00 ","$1,170.28 ","$1,853.72 ","$1,872.44 ","$0.00 ","$355.63 ","$0.00 ","$372.62 ","$0.00 "
"423.414","SUP","HCPCS C1713","","423.414  -  PLATE BONE 190MM 14 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,489.48 ","$1,842.22 ","$0.00 ","$2,416.98 ","$1,087.64 ","$0.00 ","$518.87 ","$0.00 ","$0.00 ","$423.19 ","$2,416.98 ","$0.00 ","$1,208.49 ","$1,914.25 ","$1,933.58 ","$0.00 ","$367.24 ","$0.00 ","$384.78 ","$0.00 "
"423.416","SUP","HCPCS C1713","","423.416  -  PLATE BONE 216MM 16 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,542.90 ","$1,881.75 ","$0.00 ","$2,468.83 ","$1,110.97 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$432.27 ","$2,468.83 ","$0.00 ","$1,234.41 ","$1,955.31 ","$1,975.06 ","$0.00 ","$375.12 ","$0.00 ","$393.04 ","$0.00 "
"423.418","SUP","HCPCS C1713","","423.418  -  PLATE BONE 242MM 18 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,489.48 ","$1,842.22 ","$0.00 ","$2,416.98 ","$1,087.64 ","$0.00 ","$518.87 ","$0.00 ","$0.00 ","$423.19 ","$2,416.98 ","$0.00 ","$1,208.49 ","$1,914.25 ","$1,933.58 ","$0.00 ","$367.24 ","$0.00 ","$384.78 ","$0.00 "
"423.52","SUP","HCPCS C1713","","423.52  -  PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$218.63 ","$161.79 ","$0.00 ","$218.63 ","$98.38 ","$0.00 ","$45.57 ","$0.00 ","$0.00 ","$38.28 ","$218.63 ","$0.00 ","$109.31 ","$173.15 ","$174.90 ","$0.00 ","$34.21 ","$0.00 ","$34.81 ","$0.00 "
"423.521","SUP","HCPCS C1713","","423.521  -  PLATE BONE 33MM 2 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM","BOTH IP/OP","$490.58 ","$363.03 ","$0.00 ","$476.30 ","$214.34 ","$0.00 ","$102.25 ","$0.00 ","$0.00 ","$83.40 ","$476.30 ","$0.00 ","$238.15 ","$377.23 ","$381.04 ","$0.00 ","$72.37 ","$0.00 ","$75.83 ","$0.00 "
"423.53","SUP","HCPCS C1713","","423.53  -  PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$222.60 ","$164.72 ","$0.00 ","$222.60 ","$100.17 ","$0.00 ","$46.40 ","$0.00 ","$0.00 ","$38.98 ","$222.60 ","$0.00 ","$111.30 ","$176.30 ","$178.08 ","$0.00 ","$34.84 ","$0.00 ","$35.44 ","$0.00 "
"423.531","SUP","HCPCS C1713","","423.531  -  PLATE BONE 46MM 3 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM","BOTH IP/OP","$510.28 ","$377.61 ","$0.00 ","$495.40 ","$222.93 ","$0.00 ","$106.35 ","$0.00 ","$0.00 ","$86.74 ","$495.40 ","$0.00 ","$247.70 ","$392.36 ","$396.32 ","$0.00 ","$75.27 ","$0.00 ","$78.87 ","$0.00 "
"423.54","SUP","HCPCS C1713","","423.54  -  PLATE BONE 3.5MM 51X11X3.3MM 4 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$229.23 ","$169.63 ","$0.00 ","$229.23 ","$103.15 ","$0.00 ","$47.78 ","$0.00 ","$0.00 ","$40.14 ","$229.23 ","$0.00 ","$114.61 ","$181.55 ","$183.38 ","$0.00 ","$35.87 ","$0.00 ","$36.49 ","$0.00 "
"423.541","SUP","HCPCS C1713","","423.541  -  PLATE BONE 59MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM","BOTH IP/OP","$532.75 ","$394.24 ","$0.00 ","$517.25 ","$232.76 ","$0.00 ","$111.04 ","$0.00 ","$0.00 ","$90.57 ","$517.25 ","$0.00 ","$258.63 ","$409.66 ","$413.80 ","$0.00 ","$78.59 ","$0.00 ","$82.35 ","$0.00 "
"423.55","SUP","HCPCS C1713","","423.55  -  PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$241.15 ","$178.45 ","$0.00 ","$241.15 ","$108.52 ","$0.00 ","$50.26 ","$0.00 ","$0.00 ","$42.22 ","$241.15 ","$0.00 ","$120.58 ","$190.99 ","$192.92 ","$0.00 ","$37.74 ","$0.00 ","$38.39 ","$0.00 "
"423.551","SUP","HCPCS C1713","","423.551  -  PLATE BONE 72X11X3.4MM 5 HOLE LCP TITANIUM HUMERUS RAD ULNA","BOTH IP/OP","$549.63 ","$406.73 ","$0.00 ","$533.63 ","$240.13 ","$0.00 ","$114.56 ","$0.00 ","$0.00 ","$93.43 ","$533.63 ","$0.00 ","$266.81 ","$422.63 ","$426.90 ","$0.00 ","$81.08 ","$0.00 ","$84.95 ","$0.00 "
"423.56","SUP","HCPCS C1713","","423.56  -  PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$258.38 ","$191.20 ","$0.00 ","$258.38 ","$116.27 ","$0.00 ","$53.85 ","$0.00 ","$0.00 ","$45.24 ","$258.38 ","$0.00 ","$129.19 ","$204.64 ","$206.70 ","$0.00 ","$40.44 ","$0.00 ","$41.13 ","$0.00 "
"423.561","SUP","HCPCS C1713","","423.561  -  PLATE BONE 85X11X3.4MM 6 HOLE LCP TITANIUM HUMERUS RAD ULNA","BOTH IP/OP","$584.78 ","$432.74 ","$0.00 ","$567.73 ","$255.48 ","$0.00 ","$121.88 ","$0.00 ","$0.00 ","$99.40 ","$567.73 ","$0.00 ","$283.86 ","$449.64 ","$454.18 ","$0.00 ","$86.26 ","$0.00 ","$90.38 ","$0.00 "
"423.57","SUP","HCPCS C1713","","423.57  -  PLATE BN 90X11X3.3MM NS LC DCP 7 HL TI 3.5MM SCR SM FRAG SET","BOTH IP/OP","$267.65 ","$198.06 ","$0.00 ","$267.65 ","$120.44 ","$0.00 ","$55.78 ","$0.00 ","$0.00 ","$46.86 ","$267.65 ","$0.00 ","$133.83 ","$211.98 ","$214.12 ","$0.00 ","$41.89 ","$0.00 ","$42.61 ","$0.00 "
"423.571","SUP","HCPCS C1713","","423.571  -  PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END TI","BOTH IP/OP","$608.68 ","$450.42 ","$0.00 ","$590.93 ","$265.92 ","$0.00 ","$126.86 ","$0.00 ","$0.00 ","$103.47 ","$590.93 ","$0.00 ","$295.46 ","$468.02 ","$472.74 ","$0.00 ","$89.79 ","$0.00 ","$94.08 ","$0.00 "
"423.58","SUP","HCPCS C1713","","423.58  -  PLATE BONE SMALL 103X11X3.3MM 8 HOLE LC-DCP TITANIUM","BOTH IP/OP","$282.23 ","$208.85 ","$0.00 ","$282.23 ","$127.00 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$49.42 ","$282.23 ","$0.00 ","$141.11 ","$223.53 ","$225.78 ","$0.00 ","$44.17 ","$0.00 ","$44.93 ","$0.00 "
"423.581","SUP","HCPCS C1713","","423.581  -  PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END TI","BOTH IP/OP","$639.60 ","$473.30 ","$0.00 ","$620.95 ","$279.43 ","$0.00 ","$133.31 ","$0.00 ","$0.00 ","$108.72 ","$620.95 ","$0.00 ","$310.48 ","$491.79 ","$496.76 ","$0.00 ","$94.35 ","$0.00 ","$98.86 ","$0.00 "
"423.59","SUP","HCPCS C1713","","423.59  -  PLATE BN 116X11X3.3MM NS LC DCP 9 HL TI 3.5MM SCR SM FRAG","BOTH IP/OP","$304.75 ","$225.52 ","$0.00 ","$304.75 ","$137.14 ","$0.00 ","$63.52 ","$0.00 ","$0.00 ","$53.36 ","$304.75 ","$0.00 ","$152.38 ","$241.36 ","$243.80 ","$0.00 ","$47.69 ","$0.00 ","$48.52 ","$0.00 "
"423.591","SUP","HCPCS C1713","","423.591  -  PLATE BONE 124X11X3.4MM 9 HOLE LCP TITANIUM HUMERUS RAD ULNA","BOTH IP/OP","$664.90 ","$492.03 ","$0.00 ","$645.53 ","$290.49 ","$0.00 ","$138.58 ","$0.00 ","$0.00 ","$113.03 ","$645.53 ","$0.00 ","$322.76 ","$511.26 ","$516.42 ","$0.00 ","$98.08 ","$0.00 ","$102.77 ","$0.00 "
"423.6","SUP","HCPCS C1713","","423.60  -  PLATE BONE 129X11X3.3MM 10 HOLE LC-DCP TITANIUM DISTAL TIBIA","BOTH IP/OP","$308.73 ","$228.46 ","$0.00 ","$308.73 ","$138.93 ","$0.00 ","$64.35 ","$0.00 ","$0.00 ","$54.06 ","$308.73 ","$0.00 ","$154.36 ","$244.51 ","$246.98 ","$0.00 ","$48.32 ","$0.00 ","$49.15 ","$0.00 "
"423.601","SUP","HCPCS C1713","","423.601  -  PLATE BONE 137X11X3.4MM 10 HOLE LCP TITANIUM HUMERUS RAD","BOTH IP/OP","$685.98 ","$507.63 ","$0.00 ","$666.00 ","$299.70 ","$0.00 ","$142.97 ","$0.00 ","$0.00 ","$116.61 ","$666.00 ","$0.00 ","$333.00 ","$527.47 ","$532.80 ","$0.00 ","$101.19 ","$0.00 ","$106.03 ","$0.00 "
"423.61","SUP","HCPCS C1713","","423.61  -  PLATE BONE 142X11X3.3MM 11 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$324.63 ","$240.23 ","$0.00 ","$324.63 ","$146.08 ","$0.00 ","$67.66 ","$0.00 ","$0.00 ","$56.84 ","$324.63 ","$0.00 ","$162.31 ","$257.11 ","$259.70 ","$0.00 ","$50.80 ","$0.00 ","$51.68 ","$0.00 "
"423.611","SUP","HCPCS C1713","","423.611  -  PLATE BONE 150MM 11 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"423.62","SUP","HCPCS C1713","","423.62  -  PLATE BONE 3.5MM 155X11X3.3MM 12 HOLE LC-DCP TITANIUM","BOTH IP/OP","$347.15 ","$256.89 ","$0.00 ","$347.15 ","$156.22 ","$0.00 ","$72.35 ","$0.00 ","$0.00 ","$60.78 ","$347.15 ","$0.00 ","$173.58 ","$274.94 ","$277.72 ","$0.00 ","$54.33 ","$0.00 ","$55.27 ","$0.00 "
"423.621","SUP","HCPCS C1713","","423.621  -  PLATE BONE 163X11X3.4MM 12 HOLE LCP TITANIUM HUMERUS RAD","BOTH IP/OP","$756.28 ","$559.65 ","$0.00 ","$734.23 ","$330.40 ","$0.00 ","$157.63 ","$0.00 ","$0.00 ","$128.56 ","$734.23 ","$0.00 ","$367.11 ","$581.51 ","$587.38 ","$0.00 ","$111.56 ","$0.00 ","$116.89 ","$0.00 "
"423.631","SUP","HCPCS C1713","","423.631  -  PLATE BONE 176MM 13 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$898.25 ","$664.71 ","$0.00 ","$872.08 ","$392.43 ","$0.00 ","$187.22 ","$0.00 ","$0.00 ","$152.69 ","$872.08 ","$0.00 ","$436.04 ","$690.69 ","$697.66 ","$0.00 ","$132.50 ","$0.00 ","$138.83 ","$0.00 "
"423.64","SUP","HCPCS C1713","","423.64  -  PLATE BONE 181X11X3.3MM 14 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$642.63 ","$475.55 ","$0.00 ","$642.63 ","$289.18 ","$0.00 ","$133.94 ","$0.00 ","$0.00 ","$112.52 ","$642.63 ","$0.00 ","$321.31 ","$508.96 ","$514.10 ","$0.00 ","$100.57 ","$0.00 ","$102.31 ","$0.00 "
"423.641","SUP","HCPCS C1713","","423.641  -  PLATE BONE 189X11X3.4MM 14 HOLE LCP TITANIUM HUMERUS RAD","BOTH IP/OP","$1,134.40 ","$839.46 ","$0.00 ","$1,101.35 ","$495.61 ","$0.00 ","$236.44 ","$0.00 ","$0.00 ","$192.84 ","$1,101.35 ","$0.00 ","$550.68 ","$872.27 ","$881.08 ","$0.00 ","$167.34 ","$0.00 ","$175.33 ","$0.00 "
"423.65","SUP","HCPCS C1713","","423.65  -  PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$673.10 ","$498.09 ","$0.00 ","$673.10 ","$302.90 ","$0.00 ","$140.29 ","$0.00 ","$0.00 ","$117.85 ","$673.10 ","$0.00 ","$336.55 ","$533.10 ","$538.48 ","$0.00 ","$105.34 ","$0.00 ","$107.16 ","$0.00 "
"423.651","SUP","HCPCS C1713","","423.651  -  PLATE BONE 202MM 15 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$1,214.53 ","$898.75 ","$0.00 ","$1,179.15 ","$530.62 ","$0.00 ","$253.14 ","$0.00 ","$0.00 ","$206.46 ","$1,179.15 ","$0.00 ","$589.58 ","$933.89 ","$943.32 ","$0.00 ","$179.16 ","$0.00 ","$187.72 ","$0.00 "
"423.66","SUP","HCPCS C1713","","423.66  -  PLATE BONE 207X11X3.3MM 16 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$738.03 ","$546.14 ","$0.00 ","$738.03 ","$332.11 ","$0.00 ","$153.82 ","$0.00 ","$0.00 ","$129.22 ","$738.03 ","$0.00 ","$369.01 ","$584.52 ","$590.42 ","$0.00 ","$115.50 ","$0.00 ","$117.49 ","$0.00 "
"423.661","SUP","HCPCS C1713","","423.661  -  PLATE BONE 215MM 16 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$1,270.75 ","$940.36 ","$0.00 ","$1,233.73 ","$555.18 ","$0.00 ","$264.86 ","$0.00 ","$0.00 ","$216.02 ","$1,233.73 ","$0.00 ","$616.86 ","$977.11 ","$986.98 ","$0.00 ","$187.46 ","$0.00 ","$196.41 ","$0.00 "
"423.671","SUP","HCPCS C1713","","423.671  -  PLATE BONE 241MM 18 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"423.68","SUP","HCPCS C1713","","423.68  -  PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$825.48 ","$610.86 ","$0.00 ","$825.48 ","$371.46 ","$0.00 ","$172.05 ","$0.00 ","$0.00 ","$144.53 ","$825.48 ","$0.00 ","$412.74 ","$653.78 ","$660.38 ","$0.00 ","$129.19 ","$0.00 ","$131.42 ","$0.00 "
"423.681","SUP","HCPCS C1713","","423.681  -  PLATE BONE 267MM 20 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$1,582.80 ","$1,171.27 ","$0.00 ","$1,536.70 ","$691.52 ","$0.00 ","$329.90 ","$0.00 ","$0.00 ","$269.06 ","$1,536.70 ","$0.00 ","$768.35 ","$1,217.07 ","$1,229.36 ","$0.00 ","$233.49 ","$0.00 ","$244.64 ","$0.00 "
"423.691","SUP","HCPCS C1713","","423.691  -  PLATE BONE 293MM 22 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"423.7","SUP","HCPCS C1713","","423.70  -  PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP TITANIUM CLAVICLE","BOTH IP/OP","$914.25 ","$676.55 ","$0.00 ","$914.25 ","$411.41 ","$0.00 ","$190.55 ","$0.00 ","$0.00 ","$160.08 ","$914.25 ","$0.00 ","$457.13 ","$724.09 ","$731.40 ","$0.00 ","$143.08 ","$0.00 ","$145.55 ","$0.00 "
"424.519","SUP","Custom 27803010","","424.519  -  5.5MM SS STRAIGHT ROD, HEX-END, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"424.52","SUP","HCPCS C1713","","424.52  -  PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$320.73 ","$237.34 ","$0.00 ","$320.73 ","$144.33 ","$0.00 ","$66.85 ","$0.00 ","$0.00 ","$56.16 ","$320.73 ","$0.00 ","$160.36 ","$254.02 ","$256.58 ","$0.00 ","$48.73 ","$0.00 ","$51.06 ","$0.00 "
"424.52","SUP","Custom 27803010","","424.520  -  5.5MM SS STRAIGHT ROD, HEX-END, 400MM","BOTH IP/OP","$320.73 ","$237.34 ","$0.00 ","$396.00 ","$144.33 ","$0.00 ","$66.85 ","$0.00 ","$0.00 ","$56.16 ","$320.73 ","$0.00 ","$160.36 ","$396.00 ","$256.58 ","$0.00 ","$48.73 ","$0.00 ","$51.06 ","$0.00 "
"424.521","SUP","Custom 27803010","","424.521  -  PLATE BONE NARROW 44MM 2 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$588.98 ","$435.85 ","$0.00 ","$571.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$571.83 ","$0.00 ","$285.91 ","$452.89 ","$457.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"424.53","SUP","HCPCS C1713","","424.53  -  PLATE BONE NARROW 52X13.5X4.2MM 3 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$320.73 ","$237.34 ","$0.00 ","$320.73 ","$144.33 ","$0.00 ","$66.85 ","$0.00 ","$0.00 ","$56.16 ","$320.73 ","$0.00 ","$160.36 ","$254.02 ","$256.58 ","$0.00 ","$48.73 ","$0.00 ","$51.06 ","$0.00 "
"424.531","SUP","HCPCS C1713","","424.531  -  PLATE BONE NARROW 62MM 3 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$596.03 ","$441.06 ","$0.00 ","$578.65 ","$260.39 ","$0.00 ","$124.23 ","$0.00 ","$0.00 ","$101.32 ","$578.65 ","$0.00 ","$289.33 ","$458.29 ","$462.92 ","$0.00 ","$87.92 ","$0.00 ","$92.12 ","$0.00 "
"424.54","SUP","HCPCS C1713","","424.54  -  PLATE BONE NARROW 70X13.5X4.2MM 4 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$320.73 ","$237.34 ","$0.00 ","$320.73 ","$144.33 ","$0.00 ","$66.85 ","$0.00 ","$0.00 ","$56.16 ","$320.73 ","$0.00 ","$160.36 ","$254.02 ","$256.58 ","$0.00 ","$48.73 ","$0.00 ","$51.06 ","$0.00 "
"424.541","SUP","HCPCS C1713","","424.541  -  PLATE BONE NARROW 80MM 4 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"424.55","SUP","HCPCS C1713","","424.55  -  PLATE BONE NARROW 88X13.5X4.2MM 5 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$320.73 ","$237.34 ","$0.00 ","$320.73 ","$144.33 ","$0.00 ","$66.85 ","$0.00 ","$0.00 ","$56.16 ","$320.73 ","$0.00 ","$160.36 ","$254.02 ","$256.58 ","$0.00 ","$48.73 ","$0.00 ","$51.06 ","$0.00 "
"424.551","SUP","HCPCS C1713","","424.551  -  PLATE BONE NARROW 98MM 5 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$694.40 ","$513.86 ","$0.00 ","$674.18 ","$303.38 ","$0.00 ","$144.73 ","$0.00 ","$0.00 ","$118.04 ","$674.18 ","$0.00 ","$337.09 ","$533.95 ","$539.34 ","$0.00 ","$102.44 ","$0.00 ","$107.33 ","$0.00 "
"424.56","SUP","HCPCS C1713","","424.56  -  PLATE BONE NARROW 106X13.5X4.2MM 6 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$360.30 ","$266.62 ","$0.00 ","$360.30 ","$162.14 ","$0.00 ","$75.10 ","$0.00 ","$0.00 ","$63.09 ","$360.30 ","$0.00 ","$180.15 ","$285.36 ","$288.24 ","$0.00 ","$54.74 ","$0.00 ","$57.36 ","$0.00 "
"424.561","SUP","HCPCS C1713","","424.561  -  PLATE BONE NARROW 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"424.57","SUP","HCPCS C1713","","424.57  -  PLATE BONE NARROW 124X13.5X4.2MM 7 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$349.80 ","$258.85 ","$0.00 ","$349.80 ","$157.41 ","$0.00 ","$72.91 ","$0.00 ","$0.00 ","$61.25 ","$349.80 ","$0.00 ","$174.90 ","$277.04 ","$279.84 ","$0.00 ","$54.74 ","$0.00 ","$55.69 ","$0.00 "
"424.571","SUP","HCPCS C1713","","424.571  -  PLATE BONE NARROW 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC 4.5MM","BOTH IP/OP","$850.45 ","$629.33 ","$0.00 ","$825.68 ","$371.55 ","$0.00 ","$177.26 ","$0.00 ","$0.00 ","$144.57 ","$825.68 ","$0.00 ","$412.84 ","$653.94 ","$660.54 ","$0.00 ","$125.45 ","$0.00 ","$131.45 ","$0.00 "
"424.58","SUP","HCPCS C1713","","424.58  -  PLATE BONE NARROW 4.5MM 142X13.5X4.2MM 8 HOLE LC-DCP","BOTH IP/OP","$371.10 ","$274.61 ","$0.00 ","$360.30 ","$162.14 ","$0.00 ","$77.35 ","$0.00 ","$0.00 ","$63.09 ","$360.30 ","$0.00 ","$180.15 ","$285.36 ","$288.24 ","$0.00 ","$54.74 ","$0.00 ","$57.36 ","$0.00 "
"424.581","SUP","HCPCS C1713","","424.581  -  PLATE BONE NARROW 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$899.65 ","$665.74 ","$0.00 ","$873.45 ","$393.05 ","$0.00 ","$187.51 ","$0.00 ","$0.00 ","$152.93 ","$873.45 ","$0.00 ","$436.73 ","$691.77 ","$698.76 ","$0.00 ","$132.71 ","$0.00 ","$139.05 ","$0.00 "
"424.59","SUP","HCPCS C1713","","424.59  -  PLATE BONE NARROW 160X13.5X4.2MM 9 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$350.75 ","$259.56 ","$0.00 ","$350.75 ","$157.84 ","$0.00 ","$73.11 ","$0.00 ","$0.00 ","$61.41 ","$350.75 ","$0.00 ","$175.38 ","$277.79 ","$280.60 ","$0.00 ","$53.29 ","$0.00 ","$55.84 ","$0.00 "
"424.591","SUP","HCPCS C1713","","424.591  -  PLATE BONE NARROW 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$941.83 ","$696.95 ","$0.00 ","$914.38 ","$411.47 ","$0.00 ","$196.30 ","$0.00 ","$0.00 ","$160.10 ","$914.38 ","$0.00 ","$457.19 ","$724.19 ","$731.50 ","$0.00 ","$138.93 ","$0.00 ","$145.57 ","$0.00 "
"424.6","SUP","HCPCS C1713","","424.60  -  PLATE BONE NARROW 4.5MM 178X13.5X4.2MM 10 HOLE LC-DCP","BOTH IP/OP","$454.45 ","$336.29 ","$0.00 ","$454.45 ","$204.50 ","$0.00 ","$94.72 ","$0.00 ","$0.00 ","$79.57 ","$454.45 ","$0.00 ","$227.23 ","$359.92 ","$363.56 ","$0.00 ","$69.05 ","$0.00 ","$72.35 ","$0.00 "
"424.601","SUP","HCPCS C1713","","424.601  -  PLATE BONE NARROW 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,023.35 ","$757.28 ","$0.00 ","$993.55 ","$447.10 ","$0.00 ","$213.29 ","$0.00 ","$0.00 ","$173.96 ","$993.55 ","$0.00 ","$496.78 ","$786.89 ","$794.84 ","$0.00 ","$150.96 ","$0.00 ","$158.17 ","$0.00 "
"424.61","SUP","HCPCS C1713","","424.61  -  PLATE BONE NARROW 4.5MM 206MM 11 HOLE LCP TITANIUM NONSTRL","BOTH IP/OP","$468.10 ","$346.39 ","$0.00 ","$468.10 ","$210.65 ","$0.00 ","$97.56 ","$0.00 ","$0.00 ","$81.96 ","$468.10 ","$0.00 ","$234.05 ","$370.74 ","$374.48 ","$0.00 ","$71.13 ","$0.00 ","$74.52 ","$0.00 "
"424.611","SUP","HCPCS C1713","","424.611  -  PLATE BONE NARROW 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,102.08 ","$815.54 ","$0.00 ","$1,069.98 ","$481.49 ","$0.00 ","$229.70 ","$0.00 ","$0.00 ","$187.34 ","$1,069.98 ","$0.00 ","$534.99 ","$847.42 ","$855.98 ","$0.00 ","$162.57 ","$0.00 ","$170.34 ","$0.00 "
"424.62","SUP","HCPCS C1713","","424.62  -  PLATE BONE NARROW 214X13.5X4.2MM 12 HOLE LC-DCP TITANIUM","BOTH IP/OP","$441.23 ","$326.51 ","$0.00 ","$441.23 ","$198.55 ","$0.00 ","$91.96 ","$0.00 ","$0.00 ","$77.25 ","$441.23 ","$0.00 ","$220.61 ","$349.45 ","$352.98 ","$0.00 ","$69.05 ","$0.00 ","$70.24 ","$0.00 "
"424.621","SUP","HCPCS C1713","","424.621  -  PLATE BONE NARROW 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"424.63","SUP","HCPCS C1713","","424.63  -  PLATE BONE NARROW 232X13.5X4.2MM 13 HOLE LC-DCP TITANIUM","BOTH IP/OP","$544.53 ","$402.95 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$113.49 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"424.631","SUP","HCPCS C1713","","424.631  -  PLATE BONE NARROW 242MM 13 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,265.13 ","$936.20 ","$0.00 ","$1,228.28 ","$552.72 ","$0.00 ","$263.68 ","$0.00 ","$0.00 ","$215.06 ","$1,228.28 ","$0.00 ","$614.14 ","$972.80 ","$982.62 ","$0.00 ","$186.63 ","$0.00 ","$195.54 ","$0.00 "
"424.64","SUP","HCPCS C1713","","424.64  -  PLATE BONE NARROW 4.5MM 250X13.5X4.2MM 14 HOLE LC-DCP","BOTH IP/OP","$545.40 ","$403.60 ","$0.00 ","$529.53 ","$238.29 ","$0.00 ","$113.67 ","$0.00 ","$0.00 ","$92.72 ","$529.53 ","$0.00 ","$264.76 ","$419.39 ","$423.62 ","$0.00 ","$80.46 ","$0.00 ","$84.30 ","$0.00 "
"424.641","SUP","HCPCS C1713","","424.641  -  PLATE BONE NARROW 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,328.38 ","$983.00 ","$0.00 ","$1,289.70 ","$580.37 ","$0.00 ","$276.87 ","$0.00 ","$0.00 ","$225.82 ","$1,289.70 ","$0.00 ","$644.85 ","$1,021.44 ","$1,031.76 ","$0.00 ","$195.96 ","$0.00 ","$205.32 ","$0.00 "
"424.65","SUP","HCPCS C1713","","424.65  -  PLATE BONE NARROW 4.5MM 268MM 15 HOLE LC-DCP TITANIUM","BOTH IP/OP","$544.53 ","$402.95 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$113.49 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"424.651","SUP","HCPCS C1713","","424.651  -  PLATE BONE NARROW 278MM 15 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,445.05 ","$1,069.34 ","$0.00 ","$1,402.98 ","$631.34 ","$0.00 ","$301.18 ","$0.00 ","$0.00 ","$245.65 ","$1,402.98 ","$0.00 ","$701.49 ","$1,111.16 ","$1,122.38 ","$0.00 ","$213.17 ","$0.00 ","$223.35 ","$0.00 "
"424.66","SUP","HCPCS C1713","","424.66  -  PLATE BONE NARROW 4.5MM 286MM 16 HOLE LC-DCP TITANIUM","BOTH IP/OP","$544.53 ","$402.95 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$113.49 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"424.661","SUP","HCPCS C1713","","424.661  -  PLATE BONE NARROW 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,553.30 ","$1,149.44 ","$0.00 ","$1,508.05 ","$678.62 ","$0.00 ","$323.75 ","$0.00 ","$0.00 ","$264.05 ","$1,508.05 ","$0.00 ","$754.03 ","$1,194.38 ","$1,206.44 ","$0.00 ","$229.14 ","$0.00 ","$240.08 ","$0.00 "
"424.67","SUP","HCPCS C1713","","424.67  -  PLATE BONE NARROW 4.5MM 305MM 17 HOLE LC-DCP TITANIUM","BOTH IP/OP","$799.75 ","$591.82 ","$0.00 ","$799.75 ","$359.89 ","$0.00 ","$166.69 ","$0.00 ","$0.00 ","$140.03 ","$799.75 ","$0.00 ","$399.88 ","$633.40 ","$639.80 ","$0.00 ","$121.51 ","$0.00 ","$127.32 ","$0.00 "
"424.68","SUP","HCPCS C1713","","424.68  -  PLATE BONE NARROW 4.5MM 323MM 18 HOLE LC-DCP TITANIUM","BOTH IP/OP","$799.75 ","$591.82 ","$0.00 ","$799.75 ","$359.89 ","$0.00 ","$166.69 ","$0.00 ","$0.00 ","$140.03 ","$799.75 ","$0.00 ","$399.88 ","$633.40 ","$639.80 ","$0.00 ","$121.51 ","$0.00 ","$127.32 ","$0.00 "
"424.681","SUP","HCPCS C1713","","424.681  -  PLATE BONE NARROW 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,824.60 ","$1,350.20 ","$0.00 ","$1,771.45 ","$797.15 ","$0.00 ","$380.29 ","$0.00 ","$0.00 ","$310.17 ","$1,771.45 ","$0.00 ","$885.73 ","$1,402.99 ","$1,417.16 ","$0.00 ","$269.16 ","$0.00 ","$282.01 ","$0.00 "
"424.7","SUP","HCPCS C1713","","424.70  -  PLATE BONE NARROW 358X13.5X4.2MM 20 HOLE LC-DCP TITANIUM","BOTH IP/OP","$1,123.20 ","$831.17 ","$0.00 ","$1,123.20 ","$505.44 ","$0.00 ","$234.10 ","$0.00 ","$0.00 ","$196.66 ","$1,123.20 ","$0.00 ","$561.60 ","$889.57 ","$898.56 ","$0.00 ","$170.66 ","$0.00 ","$178.81 ","$0.00 "
"424.701","SUP","HCPCS C1713","","424.701  -  PLATE BONE NARROW 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,319.40 ","$1,716.36 ","$0.00 ","$2,251.85 ","$1,013.33 ","$0.00 ","$483.42 ","$0.00 ","$0.00 ","$394.28 ","$2,251.85 ","$0.00 ","$1,125.93 ","$1,783.47 ","$1,801.48 ","$0.00 ","$342.15 ","$0.00 ","$358.49 ","$0.00 "
"424.72","SUP","HCPCS C1713","","424.72  -  PLATE BONE NARROW 394MM 22 HOLE LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,209.18 ","$894.79 ","$0.00 ","$1,209.18 ","$544.13 ","$0.00 ","$252.02 ","$0.00 ","$0.00 ","$211.72 ","$1,209.18 ","$0.00 ","$604.59 ","$957.67 ","$967.34 ","$0.00 ","$183.72 ","$0.00 ","$192.50 ","$0.00 "
"424.721","SUP","HCPCS C1713","","424.721  -  PLATE BONE NARROW 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,533.05 ","$1,874.46 ","$0.00 ","$2,459.28 ","$1,106.67 ","$0.00 ","$527.95 ","$0.00 ","$0.00 ","$430.60 ","$2,459.28 ","$0.00 ","$1,229.64 ","$1,947.75 ","$1,967.42 ","$0.00 ","$373.67 ","$0.00 ","$391.52 ","$0.00 "
"424.753","SUP","HCPCS C1713","","424.753  -  PLATE BONE 118MM 3/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"424.754","SUP","HCPCS C1713","","424.754  -  PLATE BONE 136MM 4/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$1,807.73 ","$1,337.72 ","$0.00 ","$1,755.08 ","$789.78 ","$0.00 ","$376.78 ","$0.00 ","$0.00 ","$307.30 ","$1,755.08 ","$0.00 ","$877.54 ","$1,390.02 ","$1,404.06 ","$0.00 ","$266.67 ","$0.00 ","$279.41 ","$0.00 "
"424.755","SUP","HCPCS C1713","","424.755  -  PLATE BONE 154MM 5/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$1,837.25 ","$1,359.57 ","$0.00 ","$1,783.73 ","$802.68 ","$0.00 ","$382.93 ","$0.00 ","$0.00 ","$312.32 ","$1,783.73 ","$0.00 ","$891.86 ","$1,412.71 ","$1,426.98 ","$0.00 ","$271.02 ","$0.00 ","$283.97 ","$0.00 "
"424.756","SUP","HCPCS C1713","","424.756  -  PLATE BONE 172MM 6/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$1,868.18 ","$1,382.45 ","$0.00 ","$1,813.75 ","$816.19 ","$0.00 ","$389.37 ","$0.00 ","$0.00 ","$317.57 ","$1,813.75 ","$0.00 ","$906.88 ","$1,436.49 ","$1,451.00 ","$0.00 ","$275.58 ","$0.00 ","$288.75 ","$0.00 "
"424.757","SUP","HCPCS C1713","","424.757  -  PLATE BONE 190MM 7/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,410.78 ","$1,783.98 ","$0.00 ","$2,340.55 ","$1,053.25 ","$0.00 ","$502.47 ","$0.00 ","$0.00 ","$409.81 ","$2,340.55 ","$0.00 ","$1,170.28 ","$1,853.72 ","$1,872.44 ","$0.00 ","$355.63 ","$0.00 ","$372.62 ","$0.00 "
"424.758","SUP","HCPCS C1713","","424.758  -  PLATE BONE 208MM 8/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,436.08 ","$1,802.70 ","$0.00 ","$2,365.10 ","$1,064.30 ","$0.00 ","$507.74 ","$0.00 ","$0.00 ","$414.11 ","$2,365.10 ","$0.00 ","$1,182.55 ","$1,873.16 ","$1,892.08 ","$0.00 ","$359.36 ","$0.00 ","$376.52 ","$0.00 "
"424.759","SUP","HCPCS C1713","","424.759  -  PLATE BONE 226MM 9/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,489.48 ","$1,842.22 ","$0.00 ","$2,416.98 ","$1,087.64 ","$0.00 ","$518.87 ","$0.00 ","$0.00 ","$423.19 ","$2,416.98 ","$0.00 ","$1,208.49 ","$1,914.25 ","$1,933.58 ","$0.00 ","$367.24 ","$0.00 ","$384.78 ","$0.00 "
"424.761","SUP","HCPCS C1713","","424.761  -  PLATE BONE 262MM 11/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,542.90 ","$1,881.75 ","$0.00 ","$2,468.83 ","$1,110.97 ","$0.00 ","$530.00 ","$0.00 ","$0.00 ","$432.27 ","$2,468.83 ","$0.00 ","$1,234.41 ","$1,955.31 ","$1,975.06 ","$0.00 ","$375.12 ","$0.00 ","$393.04 ","$0.00 "
"424.763","SUP","HCPCS C1713","","424.763  -  PLATE BONE 298MM 13/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,590.70 ","$1,917.12 ","$0.00 ","$2,515.23 ","$1,131.85 ","$0.00 ","$539.97 ","$0.00 ","$0.00 ","$440.40 ","$2,515.23 ","$0.00 ","$1,257.61 ","$1,992.06 ","$2,012.18 ","$0.00 ","$382.17 ","$0.00 ","$400.42 ","$0.00 "
"424.765","SUP","HCPCS C1713","","424.765  -  PLATE BONE 334MM 15/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL","BOTH IP/OP","$2,708.78 ","$2,004.50 ","$0.00 ","$2,629.88 ","$1,183.44 ","$0.00 ","$564.58 ","$0.00 ","$0.00 ","$460.47 ","$2,629.88 ","$0.00 ","$1,314.94 ","$2,082.86 ","$2,103.90 ","$0.00 ","$399.59 ","$0.00 ","$418.68 ","$0.00 "
"426.56","SUP","HCPCS C1713","","426.56  -  PLATE BONE BROAD 106X17.5X5.2MM 6 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$488.58 ","$361.55 ","$0.00 ","$488.58 ","$219.86 ","$0.00 ","$101.83 ","$0.00 ","$0.00 ","$85.55 ","$488.58 ","$0.00 ","$244.29 ","$386.96 ","$390.86 ","$0.00 ","$74.24 ","$0.00 ","$77.78 ","$0.00 "
"426.561","SUP","HCPCS C1713","","426.561  -  PLATE BONE BROAD 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$784.38 ","$580.44 ","$0.00 ","$761.53 ","$342.69 ","$0.00 ","$163.48 ","$0.00 ","$0.00 ","$133.34 ","$761.53 ","$0.00 ","$380.76 ","$603.13 ","$609.22 ","$0.00 ","$115.71 ","$0.00 ","$121.23 ","$0.00 "
"426.57","SUP","HCPCS C1713","","426.57  -  PLATE BONE BROAD 124X17.5X5.2MM 7 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$529.53 ","$391.85 ","$0.00 ","$529.53 ","$238.29 ","$0.00 ","$110.37 ","$0.00 ","$0.00 ","$92.72 ","$529.53 ","$0.00 ","$264.76 ","$419.39 ","$423.62 ","$0.00 ","$80.46 ","$0.00 ","$84.30 ","$0.00 "
"426.571","SUP","HCPCS C1713","","426.571  -  PLATE BONE BROAD 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$833.58 ","$616.85 ","$0.00 ","$809.30 ","$364.19 ","$0.00 ","$173.74 ","$0.00 ","$0.00 ","$141.70 ","$809.30 ","$0.00 ","$404.65 ","$640.97 ","$647.44 ","$0.00 ","$122.97 ","$0.00 ","$128.84 ","$0.00 "
"426.58","SUP","HCPCS C1713","","426.58  -  PLATE BONE BROAD 3.5MM 142X17.5X5.2MM 8 HOLE LC-DCP TITANIUM","BOTH IP/OP","$588.20 ","$435.27 ","$0.00 ","$588.20 ","$264.69 ","$0.00 ","$122.60 ","$0.00 ","$0.00 ","$102.99 ","$588.20 ","$0.00 ","$294.10 ","$465.85 ","$470.56 ","$0.00 ","$89.37 ","$0.00 ","$93.64 ","$0.00 "
"426.581","SUP","HCPCS C1713","","426.581  -  PLATE BONE BROAD 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"426.59","SUP","HCPCS C1713","","426.59  -  PLATE BONE BROAD 160X17.5X5.2MM 9 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$605.85 ","$448.33 ","$0.00 ","$588.20 ","$264.69 ","$0.00 ","$126.27 ","$0.00 ","$0.00 ","$102.99 ","$588.20 ","$0.00 ","$294.10 ","$465.85 ","$470.56 ","$0.00 ","$89.37 ","$0.00 ","$93.64 ","$0.00 "
"426.591","SUP","HCPCS C1713","","426.591  -  PLATE BONE BROAD 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,102.08 ","$815.54 ","$0.00 ","$1,069.98 ","$481.49 ","$0.00 ","$229.70 ","$0.00 ","$0.00 ","$187.34 ","$1,069.98 ","$0.00 ","$534.99 ","$847.42 ","$855.98 ","$0.00 ","$162.57 ","$0.00 ","$170.34 ","$0.00 "
"426.6","SUP","HCPCS C1713","","426.60  -  PLATE BONE BROAD 178X17.5X5.2MM 10 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$588.20 ","$435.27 ","$0.00 ","$588.20 ","$264.69 ","$0.00 ","$122.60 ","$0.00 ","$0.00 ","$102.99 ","$588.20 ","$0.00 ","$294.10 ","$465.85 ","$470.56 ","$0.00 ","$89.37 ","$0.00 ","$93.64 ","$0.00 "
"426.601","SUP","HCPCS C1713","","426.601  -  PLATE BONE BROAD 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,150.48 ","$517.71 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$201.44 ","$1,150.48 ","$0.00 ","$575.24 ","$911.18 ","$920.38 ","$0.00 ","$174.81 ","$0.00 ","$183.16 ","$0.00 "
"426.61","SUP","HCPCS C1713","","426.61  -  PLATE BONE BROAD 196X17.5X5.2MM 11 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$615.50 ","$455.47 ","$0.00 ","$615.50 ","$276.98 ","$0.00 ","$128.29 ","$0.00 ","$0.00 ","$107.77 ","$615.50 ","$0.00 ","$307.75 ","$487.48 ","$492.40 ","$0.00 ","$93.52 ","$0.00 ","$97.99 ","$0.00 "
"426.611","SUP","HCPCS C1713","","426.611  -  PLATE BONE BROAD 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,262.30 ","$934.10 ","$0.00 ","$1,225.55 ","$551.50 ","$0.00 ","$263.09 ","$0.00 ","$0.00 ","$214.58 ","$1,225.55 ","$0.00 ","$612.78 ","$970.64 ","$980.44 ","$0.00 ","$186.21 ","$0.00 ","$195.11 ","$0.00 "
"426.62","SUP","HCPCS C1713","","426.62  -  PLATE BONE BROAD 214X17.5X5.2MM 12 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$633.98 ","$469.15 ","$0.00 ","$615.50 ","$276.98 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$107.77 ","$615.50 ","$0.00 ","$307.75 ","$487.48 ","$492.40 ","$0.00 ","$93.52 ","$0.00 ","$97.99 ","$0.00 "
"426.621","SUP","HCPCS C1713","","426.621  -  PLATE BONE BROAD 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,339.63 ","$991.33 ","$0.00 ","$1,300.60 ","$585.27 ","$0.00 ","$279.21 ","$0.00 ","$0.00 ","$227.72 ","$1,300.60 ","$0.00 ","$650.30 ","$1,030.08 ","$1,040.48 ","$0.00 ","$197.62 ","$0.00 ","$207.06 ","$0.00 "
"426.622","SUP","HCPCS C1713","","426.622  -  PLATE BONE BROAD 229MM 12 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,339.63 ","$991.33 ","$0.00 ","$1,300.60 ","$585.27 ","$0.00 ","$279.21 ","$0.00 ","$0.00 ","$227.72 ","$1,300.60 ","$0.00 ","$650.30 ","$1,030.08 ","$1,040.48 ","$0.00 ","$197.62 ","$0.00 ","$207.06 ","$0.00 "
"426.632","SUP","HCPCS C1713","","426.632  -  PLATE BONE BROAD 247MM 13 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,419.75 ","$1,050.62 ","$0.00 ","$1,378.40 ","$620.28 ","$0.00 ","$295.91 ","$0.00 ","$0.00 ","$241.35 ","$1,378.40 ","$0.00 ","$689.20 ","$1,091.69 ","$1,102.72 ","$0.00 ","$209.44 ","$0.00 ","$219.44 ","$0.00 "
"426.64","SUP","HCPCS C1713","","426.64  -  PLATE BONE BROAD 4.5MM 250X17.5X5.2MM 14 HOLE LC-DCP","BOTH IP/OP","$614.80 ","$454.95 ","$0.00 ","$614.80 ","$276.66 ","$0.00 ","$128.14 ","$0.00 ","$0.00 ","$107.65 ","$614.80 ","$0.00 ","$307.40 ","$486.92 ","$491.84 ","$0.00 ","$96.22 ","$0.00 ","$97.88 ","$0.00 "
"426.641","SUP","HCPCS C1713","","426.641  -  PLATE BONE BROAD 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,491.45 ","$1,103.67 ","$0.00 ","$1,448.00 ","$651.60 ","$0.00 ","$310.86 ","$0.00 ","$0.00 ","$253.53 ","$1,448.00 ","$0.00 ","$724.00 ","$1,146.82 ","$1,158.40 ","$0.00 ","$220.01 ","$0.00 ","$230.52 ","$0.00 "
"426.642","SUP","HCPCS C1713","","426.642  -  PLATE BONE BROAD CVD 265MM 14 HOLE LCP TITANIUM ANKLE","BOTH IP/OP","$1,491.45 ","$1,103.67 ","$0.00 ","$1,448.00 ","$651.60 ","$0.00 ","$310.86 ","$0.00 ","$0.00 ","$253.53 ","$1,448.00 ","$0.00 ","$724.00 ","$1,146.82 ","$1,158.40 ","$0.00 ","$220.01 ","$0.00 ","$230.52 ","$0.00 "
"426.652","SUP","HCPCS C1713","","426.652  -  PLATE BONE BROAD 282MM 15 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,655.90 ","$1,225.37 ","$0.00 ","$1,607.68 ","$723.45 ","$0.00 ","$345.13 ","$0.00 ","$0.00 ","$281.49 ","$1,607.68 ","$0.00 ","$803.84 ","$1,273.28 ","$1,286.14 ","$0.00 ","$244.27 ","$0.00 ","$255.94 ","$0.00 "
"426.66","SUP","HCPCS C1713","","426.66  -  PLATE BONE BROAD 286X17.5X5.2MM 16 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$696.03 ","$515.06 ","$0.00 ","$696.03 ","$313.21 ","$0.00 ","$145.07 ","$0.00 ","$0.00 ","$121.87 ","$696.03 ","$0.00 ","$348.01 ","$551.26 ","$556.82 ","$0.00 ","$105.75 ","$0.00 ","$110.81 ","$0.00 "
"426.661","SUP","HCPCS C1713","","426.661  -  PLATE BONE BROAD 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,811.95 ","$1,340.84 ","$0.00 ","$1,759.18 ","$791.63 ","$0.00 ","$377.66 ","$0.00 ","$0.00 ","$308.02 ","$1,759.18 ","$0.00 ","$879.59 ","$1,393.27 ","$1,407.34 ","$0.00 ","$267.29 ","$0.00 ","$280.06 ","$0.00 "
"426.662","SUP","HCPCS C1713","","426.662  -  PLATE BONE BROAD 300MM 16 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,811.95 ","$1,340.84 ","$0.00 ","$1,759.18 ","$791.63 ","$0.00 ","$377.66 ","$0.00 ","$0.00 ","$308.02 ","$1,759.18 ","$0.00 ","$879.59 ","$1,393.27 ","$1,407.34 ","$0.00 ","$267.29 ","$0.00 ","$280.06 ","$0.00 "
"426.672","SUP","HCPCS C1713","","426.672  -  PLATE BONE BROAD 318MM 17 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,897.68 ","$1,404.28 ","$0.00 ","$1,842.43 ","$829.09 ","$0.00 ","$395.52 ","$0.00 ","$0.00 ","$322.59 ","$1,842.43 ","$0.00 ","$921.21 ","$1,459.20 ","$1,473.94 ","$0.00 ","$279.94 ","$0.00 ","$293.31 ","$0.00 "
"426.68","SUP","HCPCS C1713","","426.68  -  PLATE BONE BROAD 4.5MM 322X17.5X5.2MM 18 HOLE LC-DCP","BOTH IP/OP","$788.60 ","$583.56 ","$0.00 ","$765.63 ","$344.53 ","$0.00 ","$164.36 ","$0.00 ","$0.00 ","$134.05 ","$765.63 ","$0.00 ","$382.81 ","$606.38 ","$612.50 ","$0.00 ","$116.33 ","$0.00 ","$121.89 ","$0.00 "
"426.681","SUP","HCPCS C1713","","426.681  -  PLATE BONE BROAD 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,132.43 ","$1,578.00 ","$0.00 ","$2,070.33 ","$931.65 ","$0.00 ","$444.45 ","$0.00 ","$0.00 ","$362.50 ","$2,070.33 ","$0.00 ","$1,035.16 ","$1,639.70 ","$1,656.26 ","$0.00 ","$314.57 ","$0.00 ","$329.60 ","$0.00 "
"426.682","SUP","HCPCS C1713","","426.682  -  PLATE BONE BROAD 336MM 18 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,067.78 ","$1,530.16 ","$0.00 ","$2,007.55 ","$903.40 ","$0.00 ","$430.98 ","$0.00 ","$0.00 ","$351.51 ","$2,007.55 ","$0.00 ","$1,003.78 ","$1,589.98 ","$1,606.04 ","$0.00 ","$305.03 ","$0.00 ","$319.60 ","$0.00 "
"426.7","SUP","HCPCS C1713","","426.70  -  PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$1,123.20 ","$831.17 ","$0.00 ","$1,123.20 ","$505.44 ","$0.00 ","$234.10 ","$0.00 ","$0.00 ","$196.66 ","$1,123.20 ","$0.00 ","$561.60 ","$889.57 ","$898.56 ","$0.00 ","$170.66 ","$0.00 ","$178.81 ","$0.00 "
"426.701","SUP","HCPCS C1713","","426.701  -  PLATE BONE BROAD 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,355.95 ","$1,743.40 ","$0.00 ","$2,287.33 ","$1,029.30 ","$0.00 ","$491.04 ","$0.00 ","$0.00 ","$400.49 ","$2,287.33 ","$0.00 ","$1,143.66 ","$1,811.57 ","$1,829.86 ","$0.00 ","$347.54 ","$0.00 ","$364.14 ","$0.00 "
"426.72","SUP","HCPCS C1713","","426.72  -  PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$1,209.18 ","$894.79 ","$0.00 ","$1,209.18 ","$544.13 ","$0.00 ","$252.02 ","$0.00 ","$0.00 ","$211.72 ","$1,209.18 ","$0.00 ","$604.59 ","$957.67 ","$967.34 ","$0.00 ","$183.72 ","$0.00 ","$192.50 ","$0.00 "
"426.721","SUP","HCPCS C1713","","426.721  -  PLATE BONE BROAD 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,582.25 ","$1,910.87 ","$0.00 ","$2,507.05 ","$1,128.17 ","$0.00 ","$538.21 ","$0.00 ","$0.00 ","$438.96 ","$2,507.05 ","$0.00 ","$1,253.53 ","$1,985.58 ","$2,005.64 ","$0.00 ","$380.92 ","$0.00 ","$399.12 ","$0.00 "
"426.74","SUP","HCPCS C1713","","426.74  -  PLATE BONE BROAD 430X17.5X5.2MM 24 HOLE LC-DCP TITANIUM LONG","BOTH IP/OP","$1,295.15 ","$958.41 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$269.94 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"429.331","SUP","HCPCS C1713","","429.331  -  PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"429.341","SUP","HCPCS C1713","","429.341  -  PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"429.351","SUP","HCPCS C1713","","429.351  -  PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$878.55 ","$650.13 ","$0.00 ","$852.98 ","$383.84 ","$0.00 ","$183.11 ","$0.00 ","$0.00 ","$149.35 ","$852.98 ","$0.00 ","$426.49 ","$675.56 ","$682.38 ","$0.00 ","$129.60 ","$0.00 ","$135.79 ","$0.00 "
"429.361","SUP","HCPCS C1713","","429.361  -  PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$937.60 ","$693.82 ","$0.00 ","$910.30 ","$409.64 ","$0.00 ","$195.42 ","$0.00 ","$0.00 ","$159.39 ","$910.30 ","$0.00 ","$455.15 ","$720.96 ","$728.24 ","$0.00 ","$138.31 ","$0.00 ","$144.92 ","$0.00 "
"429.371","SUP","HCPCS C1713","","429.371  -  PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$981.18 ","$726.07 ","$0.00 ","$952.60 ","$428.67 ","$0.00 ","$204.50 ","$0.00 ","$0.00 ","$166.79 ","$952.60 ","$0.00 ","$476.30 ","$754.46 ","$762.08 ","$0.00 ","$144.74 ","$0.00 ","$151.65 ","$0.00 "
"429.381","SUP","HCPCS C1713","","429.381  -  PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,031.78 ","$763.52 ","$0.00 ","$1,001.73 ","$450.78 ","$0.00 ","$215.05 ","$0.00 ","$0.00 ","$175.39 ","$1,001.73 ","$0.00 ","$500.86 ","$793.37 ","$801.38 ","$0.00 ","$152.20 ","$0.00 ","$159.47 ","$0.00 "
"429.391","SUP","HCPCS C1713","","429.391  -  PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,104.88 ","$817.61 ","$0.00 ","$1,072.70 ","$482.72 ","$0.00 ","$230.28 ","$0.00 ","$0.00 ","$187.82 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$162.99 ","$0.00 ","$170.77 ","$0.00 "
"429.401","SUP","HCPCS C1713","","429.401  -  PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,158.30 ","$857.14 ","$0.00 ","$1,124.55 ","$506.05 ","$0.00 ","$241.42 ","$0.00 ","$0.00 ","$196.90 ","$1,124.55 ","$0.00 ","$562.28 ","$890.64 ","$899.64 ","$0.00 ","$170.87 ","$0.00 ","$179.03 ","$0.00 "
"429.411","SUP","HCPCS C1713","","429.411  -  PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,196.25 ","$885.23 ","$0.00 ","$1,161.40 ","$522.63 ","$0.00 ","$249.33 ","$0.00 ","$0.00 ","$203.35 ","$1,161.40 ","$0.00 ","$580.70 ","$919.83 ","$929.12 ","$0.00 ","$176.47 ","$0.00 ","$184.89 ","$0.00 "
"429.421","SUP","HCPCS C1713","","429.421  -  PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,253.88 ","$927.87 ","$0.00 ","$1,217.35 ","$547.81 ","$0.00 ","$261.34 ","$0.00 ","$0.00 ","$213.15 ","$1,217.35 ","$0.00 ","$608.68 ","$964.14 ","$973.88 ","$0.00 ","$184.97 ","$0.00 ","$193.80 ","$0.00 "
"429.431","SUP","HCPCS C1713","","429.431  -  PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,334.00 ","$987.16 ","$0.00 ","$1,295.15 ","$582.82 ","$0.00 ","$278.04 ","$0.00 ","$0.00 ","$226.77 ","$1,295.15 ","$0.00 ","$647.58 ","$1,025.76 ","$1,036.12 ","$0.00 ","$196.79 ","$0.00 ","$206.19 ","$0.00 "
"429.441","SUP","HCPCS C1713","","429.441  -  PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,370.55 ","$1,014.21 ","$0.00 ","$1,330.63 ","$598.78 ","$0.00 ","$285.66 ","$0.00 ","$0.00 ","$232.98 ","$1,330.63 ","$0.00 ","$665.31 ","$1,053.86 ","$1,064.50 ","$0.00 ","$202.18 ","$0.00 ","$211.84 ","$0.00 "
"429.451","SUP","HCPCS C1713","","429.451  -  PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,428.18 ","$1,056.85 ","$0.00 ","$1,386.58 ","$623.96 ","$0.00 ","$297.67 ","$0.00 ","$0.00 ","$242.78 ","$1,386.58 ","$0.00 ","$693.29 ","$1,098.17 ","$1,109.26 ","$0.00 ","$210.68 ","$0.00 ","$220.74 ","$0.00 "
"429.461","SUP","HCPCS C1713","","429.461  -  PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,466.13 ","$1,084.94 ","$0.00 ","$1,423.43 ","$640.54 ","$0.00 ","$305.58 ","$0.00 ","$0.00 ","$249.23 ","$1,423.43 ","$0.00 ","$711.71 ","$1,127.36 ","$1,138.74 ","$0.00 ","$216.28 ","$0.00 ","$226.61 ","$0.00 "
"432.006","SUP","HCPCS C1713","","432.006  -  PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,929.20 ","$1,427.61 ","$0.00 ","$1,929.20 ","$868.14 ","$0.00 ","$402.09 ","$0.00 ","$0.00 ","$337.79 ","$1,929.20 ","$0.00 ","$964.60 ","$1,527.93 ","$1,543.36 ","$0.00 ","$301.92 ","$0.00 ","$307.13 ","$0.00 "
"432.007","SUP","HCPCS C1713","","432.007  -  PLATE BONE 90D 35MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,929.20 ","$1,427.61 ","$0.00 ","$1,929.20 ","$868.14 ","$0.00 ","$402.09 ","$0.00 ","$0.00 ","$337.79 ","$1,929.20 ","$0.00 ","$964.60 ","$1,527.93 ","$1,543.36 ","$0.00 ","$301.92 ","$0.00 ","$307.13 ","$0.00 "
"432.008","SUP","HCPCS C1713","","432.008  -  PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,929.20 ","$1,427.61 ","$0.00 ","$1,929.20 ","$868.14 ","$0.00 ","$402.09 ","$0.00 ","$0.00 ","$337.79 ","$1,929.20 ","$0.00 ","$964.60 ","$1,527.93 ","$1,543.36 ","$0.00 ","$301.92 ","$0.00 ","$307.13 ","$0.00 "
"432.009","SUP","HCPCS C1713","","432.009  -  PLATE BONE 90D 45MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,929.20 ","$1,427.61 ","$0.00 ","$1,929.20 ","$868.14 ","$0.00 ","$402.09 ","$0.00 ","$0.00 ","$337.79 ","$1,929.20 ","$0.00 ","$964.60 ","$1,527.93 ","$1,543.36 ","$0.00 ","$301.92 ","$0.00 ","$307.13 ","$0.00 "
"432.046","SUP","HCPCS C1713","","432.046  -  PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,538.33 ","$1,138.36 ","$0.00 ","$1,538.33 ","$692.25 ","$0.00 ","$320.63 ","$0.00 ","$0.00 ","$269.35 ","$1,538.33 ","$0.00 ","$769.16 ","$1,218.36 ","$1,230.66 ","$0.00 ","$240.75 ","$0.00 ","$244.90 ","$0.00 "
"432.047","SUP","HCPCS C1713","","432.047  -  PLATE BONE 90D 35MM 4 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,538.33 ","$1,138.36 ","$0.00 ","$1,538.33 ","$692.25 ","$0.00 ","$320.63 ","$0.00 ","$0.00 ","$269.35 ","$1,538.33 ","$0.00 ","$769.16 ","$1,218.36 ","$1,230.66 ","$0.00 ","$240.75 ","$0.00 ","$244.90 ","$0.00 "
"432.048","SUP","HCPCS C1713","","432.048  -  PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,538.33 ","$1,138.36 ","$0.00 ","$1,538.33 ","$692.25 ","$0.00 ","$320.63 ","$0.00 ","$0.00 ","$269.35 ","$1,538.33 ","$0.00 ","$769.16 ","$1,218.36 ","$1,230.66 ","$0.00 ","$240.75 ","$0.00 ","$244.90 ","$0.00 "
"432.049","SUP","HCPCS C1713","","432.049  -  PLATE BONE 90D 45MM 4 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,538.33 ","$1,138.36 ","$0.00 ","$1,538.33 ","$692.25 ","$0.00 ","$320.63 ","$0.00 ","$0.00 ","$269.35 ","$1,538.33 ","$0.00 ","$769.16 ","$1,218.36 ","$1,230.66 ","$0.00 ","$240.75 ","$0.00 ","$244.90 ","$0.00 "
"432.056","SUP","HCPCS C1713","","432.056  -  PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,625.78 ","$1,203.08 ","$0.00 ","$1,625.78 ","$731.60 ","$0.00 ","$338.85 ","$0.00 ","$0.00 ","$284.66 ","$1,625.78 ","$0.00 ","$812.89 ","$1,287.62 ","$1,300.62 ","$0.00 ","$254.43 ","$0.00 ","$258.82 ","$0.00 "
"432.057","SUP","HCPCS C1713","","432.057  -  PLATE BONE 90D 35MM 5 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,625.78 ","$1,203.08 ","$0.00 ","$1,625.78 ","$731.60 ","$0.00 ","$338.85 ","$0.00 ","$0.00 ","$284.66 ","$1,625.78 ","$0.00 ","$812.89 ","$1,287.62 ","$1,300.62 ","$0.00 ","$254.43 ","$0.00 ","$258.82 ","$0.00 "
"432.058","SUP","HCPCS C1713","","432.058  -  PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,625.78 ","$1,203.08 ","$0.00 ","$1,625.78 ","$731.60 ","$0.00 ","$338.85 ","$0.00 ","$0.00 ","$284.66 ","$1,625.78 ","$0.00 ","$812.89 ","$1,287.62 ","$1,300.62 ","$0.00 ","$254.43 ","$0.00 ","$258.82 ","$0.00 "
"432.059","SUP","HCPCS C1713","","432.059  -  PLATE BONE 90D 45MM 5 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,625.78 ","$1,203.08 ","$0.00 ","$1,625.78 ","$731.60 ","$0.00 ","$338.85 ","$0.00 ","$0.00 ","$284.66 ","$1,625.78 ","$0.00 ","$812.89 ","$1,287.62 ","$1,300.62 ","$0.00 ","$254.43 ","$0.00 ","$258.82 ","$0.00 "
"432.066","SUP","HCPCS C1713","","432.066  -  PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,696.00 ","$1,255.04 ","$0.00 ","$1,696.00 ","$763.20 ","$0.00 ","$353.49 ","$0.00 ","$0.00 ","$296.96 ","$1,696.00 ","$0.00 ","$848.00 ","$1,343.23 ","$1,356.80 ","$0.00 ","$265.42 ","$0.00 ","$270.00 ","$0.00 "
"432.067","SUP","HCPCS C1713","","432.067  -  PLATE BONE 90D 35MM 6 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,696.00 ","$1,255.04 ","$0.00 ","$1,696.00 ","$763.20 ","$0.00 ","$353.49 ","$0.00 ","$0.00 ","$296.96 ","$1,696.00 ","$0.00 ","$848.00 ","$1,343.23 ","$1,356.80 ","$0.00 ","$265.42 ","$0.00 ","$270.00 ","$0.00 "
"432.068","SUP","HCPCS C1713","","432.068  -  PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,696.00 ","$1,255.04 ","$0.00 ","$1,696.00 ","$763.20 ","$0.00 ","$353.49 ","$0.00 ","$0.00 ","$296.96 ","$1,696.00 ","$0.00 ","$848.00 ","$1,343.23 ","$1,356.80 ","$0.00 ","$265.42 ","$0.00 ","$270.00 ","$0.00 "
"432.069","SUP","HCPCS C1713","","432.069  -  PLATE BONE 90D 45MM 6 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,696.00 ","$1,255.04 ","$0.00 ","$1,696.00 ","$763.20 ","$0.00 ","$353.49 ","$0.00 ","$0.00 ","$296.96 ","$1,696.00 ","$0.00 ","$848.00 ","$1,343.23 ","$1,356.80 ","$0.00 ","$265.42 ","$0.00 ","$270.00 ","$0.00 "
"432.086","SUP","HCPCS C1713","","432.086  -  PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,819.23 ","$1,346.23 ","$0.00 ","$1,819.23 ","$818.65 ","$0.00 ","$379.17 ","$0.00 ","$0.00 ","$318.53 ","$1,819.23 ","$0.00 ","$909.61 ","$1,440.83 ","$1,455.38 ","$0.00 ","$284.71 ","$0.00 ","$289.62 ","$0.00 "
"432.087","SUP","HCPCS C1713","","432.087  -  PLATE BONE 90D 106MM 35MM 8 HOLE CANN ANGLED TITANIUM","BOTH IP/OP","$1,819.23 ","$1,346.23 ","$0.00 ","$1,819.23 ","$818.65 ","$0.00 ","$379.17 ","$0.00 ","$0.00 ","$318.53 ","$1,819.23 ","$0.00 ","$909.61 ","$1,440.83 ","$1,455.38 ","$0.00 ","$284.71 ","$0.00 ","$289.62 ","$0.00 "
"432.088","SUP","HCPCS C1713","","432.088  -  PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLE BLADE TITANIUM","BOTH IP/OP","$1,819.23 ","$1,346.23 ","$0.00 ","$1,819.23 ","$818.65 ","$0.00 ","$379.17 ","$0.00 ","$0.00 ","$318.53 ","$1,819.23 ","$0.00 ","$909.61 ","$1,440.83 ","$1,455.38 ","$0.00 ","$284.71 ","$0.00 ","$289.62 ","$0.00 "
"432.089","SUP","HCPCS C1713","","432.089  -  PLATE BONE 90D 45MM 8 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,819.23 ","$1,346.23 ","$0.00 ","$1,819.23 ","$818.65 ","$0.00 ","$379.17 ","$0.00 ","$0.00 ","$318.53 ","$1,819.23 ","$0.00 ","$909.61 ","$1,440.83 ","$1,455.38 ","$0.00 ","$284.71 ","$0.00 ","$289.62 ","$0.00 "
"433","SUP","Custom 27203010","","433  -  CUTTER 433 WIRE MODIFIED W/CARBIDE","BOTH IP/OP","$1,126.25 ","$833.43 ","$0.00 ","$1,126.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,126.25 ","$0.00 ","$563.13 ","$891.99 ","$901.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"436.502","SUP","HCPCS C1713","","436.502  -  PLATE BONE 86MM 2 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL","BOTH IP/OP","$1,700.90 ","$1,258.67 ","$0.00 ","$1,651.35 ","$743.11 ","$0.00 ","$354.51 ","$0.00 ","$0.00 ","$289.14 ","$1,651.35 ","$0.00 ","$825.68 ","$1,307.87 ","$1,321.08 ","$0.00 ","$250.91 ","$0.00 ","$262.89 ","$0.00 "
"436.503","SUP","HCPCS C1713","","436.503  -  PLATE BONE 86MM 2 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL","BOTH IP/OP","$1,700.90 ","$1,258.67 ","$0.00 ","$1,651.35 ","$743.11 ","$0.00 ","$354.51 ","$0.00 ","$0.00 ","$289.14 ","$1,651.35 ","$0.00 ","$825.68 ","$1,307.87 ","$1,321.08 ","$0.00 ","$250.91 ","$0.00 ","$262.89 ","$0.00 "
"436.506","SUP","HCPCS C1713","","436.506  -  PLATE BONE 138MM 6 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL","BOTH IP/OP","$1,831.63 ","$1,355.41 ","$0.00 ","$1,778.28 ","$800.22 ","$0.00 ","$381.76 ","$0.00 ","$0.00 ","$311.36 ","$1,778.28 ","$0.00 ","$889.14 ","$1,408.40 ","$1,422.62 ","$0.00 ","$270.19 ","$0.00 ","$283.10 ","$0.00 "
"436.507","SUP","HCPCS C1713","","436.507  -  PLATE BONE 138MM 6 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL","BOTH IP/OP","$1,865.35 ","$1,380.36 ","$0.00 ","$1,811.03 ","$814.96 ","$0.00 ","$388.79 ","$0.00 ","$0.00 ","$317.10 ","$1,811.03 ","$0.00 ","$905.51 ","$1,434.34 ","$1,448.82 ","$0.00 ","$275.17 ","$0.00 ","$288.32 ","$0.00 "
"436.51","SUP","HCPCS C1713","","436.510  -  PLATE BONE 189MM 10 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW","BOTH IP/OP","$1,918.85 ","$1,419.95 ","$0.00 ","$1,918.85 ","$863.48 ","$0.00 ","$399.94 ","$0.00 ","$0.00 ","$335.98 ","$1,918.85 ","$0.00 ","$959.43 ","$1,519.73 ","$1,535.08 ","$0.00 ","$291.55 ","$0.00 ","$305.48 ","$0.00 "
"436.511","SUP","HCPCS C1713","","436.511  -  PLATE BONE 189MM 10 HOLE LCP TITANIUM LEFT OLECRANON ELBOW","BOTH IP/OP","$1,976.40 ","$1,462.54 ","$0.00 ","$1,918.85 ","$863.48 ","$0.00 ","$411.93 ","$0.00 ","$0.00 ","$335.98 ","$1,918.85 ","$0.00 ","$959.43 ","$1,519.73 ","$1,535.08 ","$0.00 ","$291.55 ","$0.00 ","$305.48 ","$0.00 "
"436.512","SUP","HCPCS C1713","","436.512  -  PLATE BONE 215MM 12 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW","BOTH IP/OP","$2,012.95 ","$1,489.58 ","$0.00 ","$1,954.33 ","$879.45 ","$0.00 ","$419.55 ","$0.00 ","$0.00 ","$342.19 ","$1,954.33 ","$0.00 ","$977.16 ","$1,547.83 ","$1,563.46 ","$0.00 ","$296.94 ","$0.00 ","$311.13 ","$0.00 "
"436.513","SUP","HCPCS C1713","","436.513  -  PLATE BONE 215MM 13 HOLE LCP TITANIUM LEFT OLECRANON ELBOW","BOTH IP/OP","$2,012.95 ","$1,489.58 ","$0.00 ","$1,954.33 ","$879.45 ","$0.00 ","$419.55 ","$0.00 ","$0.00 ","$342.19 ","$1,954.33 ","$0.00 ","$977.16 ","$1,547.83 ","$1,563.46 ","$0.00 ","$296.94 ","$0.00 ","$311.13 ","$0.00 "
"437.2","SUP","HCPCS C1713","","437.20  -  PLATE BONE 95D 50MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,268.03 ","$938.34 ","$0.00 ","$1,268.03 ","$570.61 ","$0.00 ","$264.29 ","$0.00 ","$0.00 ","$222.02 ","$1,268.03 ","$0.00 ","$634.01 ","$1,004.28 ","$1,014.42 ","$0.00 ","$198.45 ","$0.00 ","$201.87 ","$0.00 "
"437.22","SUP","HCPCS C1713","","437.22  -  PLATE BONE 95D 204MM 60MM 12 HOLE DCP TITANIUM CONDYLE","BOTH IP/OP","$1,268.03 ","$938.34 ","$0.00 ","$1,268.03 ","$570.61 ","$0.00 ","$264.29 ","$0.00 ","$0.00 ","$222.02 ","$1,268.03 ","$0.00 ","$634.01 ","$1,004.28 ","$1,014.42 ","$0.00 ","$198.45 ","$0.00 ","$201.87 ","$0.00 "
"437.24","SUP","HCPCS C1713","","437.24  -  PLATE BONE 95D 70MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,268.03 ","$938.34 ","$0.00 ","$1,268.03 ","$570.61 ","$0.00 ","$264.29 ","$0.00 ","$0.00 ","$222.02 ","$1,268.03 ","$0.00 ","$634.01 ","$1,004.28 ","$1,014.42 ","$0.00 ","$198.45 ","$0.00 ","$201.87 ","$0.00 "
"437.26","SUP","HCPCS C1713","","437.26  -  PLATE BONE 95D 204MM 80MM 12 HOLE DCP TITANIUM CONDYLE","BOTH IP/OP","$1,268.03 ","$938.34 ","$0.00 ","$1,268.03 ","$570.61 ","$0.00 ","$264.29 ","$0.00 ","$0.00 ","$222.02 ","$1,268.03 ","$0.00 ","$634.01 ","$1,004.28 ","$1,014.42 ","$0.00 ","$198.45 ","$0.00 ","$201.87 ","$0.00 "
"437.5","SUP","HCPCS C1713","","437.50  -  PLATE BONE 95D 50MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,045.43 ","$773.62 ","$0.00 ","$1,045.43 ","$470.44 ","$0.00 ","$217.89 ","$0.00 ","$0.00 ","$183.05 ","$1,045.43 ","$0.00 ","$522.71 ","$827.98 ","$836.34 ","$0.00 ","$163.61 ","$0.00 ","$166.43 ","$0.00 "
"437.52","SUP","HCPCS C1713","","437.52  -  PLATE BONE 95D 60MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,045.43 ","$773.62 ","$0.00 ","$1,045.43 ","$470.44 ","$0.00 ","$217.89 ","$0.00 ","$0.00 ","$183.05 ","$1,045.43 ","$0.00 ","$522.71 ","$827.98 ","$836.34 ","$0.00 ","$163.61 ","$0.00 ","$166.43 ","$0.00 "
"437.54","SUP","HCPCS C1713","","437.54  -  PLATE BONE 95D 70MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,045.43 ","$773.62 ","$0.00 ","$1,045.43 ","$470.44 ","$0.00 ","$217.89 ","$0.00 ","$0.00 ","$183.05 ","$1,045.43 ","$0.00 ","$522.71 ","$827.98 ","$836.34 ","$0.00 ","$163.61 ","$0.00 ","$166.43 ","$0.00 "
"437.56","SUP","HCPCS C1713","","437.56  -  PLATE BONE 95D 80MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,045.43 ","$773.62 ","$0.00 ","$1,045.43 ","$470.44 ","$0.00 ","$217.89 ","$0.00 ","$0.00 ","$183.05 ","$1,045.43 ","$0.00 ","$522.71 ","$827.98 ","$836.34 ","$0.00 ","$163.61 ","$0.00 ","$166.43 ","$0.00 "
"437.7","SUP","HCPCS C1713","","437.70  -  PLATE BONE 95D 50MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,093.13 ","$808.92 ","$0.00 ","$1,093.13 ","$491.91 ","$0.00 ","$227.83 ","$0.00 ","$0.00 ","$191.40 ","$1,093.13 ","$0.00 ","$546.56 ","$865.76 ","$874.50 ","$0.00 ","$171.07 ","$0.00 ","$174.03 ","$0.00 "
"437.72","SUP","HCPCS C1713","","437.72  -  PLATE BONE 95D 60MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,093.13 ","$808.92 ","$0.00 ","$1,093.13 ","$491.91 ","$0.00 ","$227.83 ","$0.00 ","$0.00 ","$191.40 ","$1,093.13 ","$0.00 ","$546.56 ","$865.76 ","$874.50 ","$0.00 ","$171.07 ","$0.00 ","$174.03 ","$0.00 "
"437.74","SUP","HCPCS C1713","","437.74  -  PLATE BONE 95D 70MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,093.13 ","$808.92 ","$0.00 ","$1,093.13 ","$491.91 ","$0.00 ","$227.83 ","$0.00 ","$0.00 ","$191.40 ","$1,093.13 ","$0.00 ","$546.56 ","$865.76 ","$874.50 ","$0.00 ","$171.07 ","$0.00 ","$174.03 ","$0.00 "
"437.76","SUP","HCPCS C1713","","437.76  -  PLATE BONE 95D 80MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,093.13 ","$808.92 ","$0.00 ","$1,093.13 ","$491.91 ","$0.00 ","$227.83 ","$0.00 ","$0.00 ","$191.40 ","$1,093.13 ","$0.00 ","$546.56 ","$865.76 ","$874.50 ","$0.00 ","$171.07 ","$0.00 ","$174.03 ","$0.00 "
"437.9","SUP","HCPCS C1713","","437.90  -  PLATE BONE 95D 50MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,147.45 ","$849.11 ","$0.00 ","$1,147.45 ","$516.35 ","$0.00 ","$239.16 ","$0.00 ","$0.00 ","$200.91 ","$1,147.45 ","$0.00 ","$573.73 ","$908.78 ","$917.96 ","$0.00 ","$179.58 ","$0.00 ","$182.67 ","$0.00 "
"437.92","SUP","HCPCS C1713","","437.92  -  PLATE BONE 95D 60MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,147.45 ","$849.11 ","$0.00 ","$1,147.45 ","$516.35 ","$0.00 ","$239.16 ","$0.00 ","$0.00 ","$200.91 ","$1,147.45 ","$0.00 ","$573.73 ","$908.78 ","$917.96 ","$0.00 ","$179.58 ","$0.00 ","$182.67 ","$0.00 "
"437.94","SUP","HCPCS C1713","","437.94  -  PLATE BONE 95D 70MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,164.68 ","$861.86 ","$0.00 ","$1,164.68 ","$524.10 ","$0.00 ","$242.75 ","$0.00 ","$0.00 ","$203.93 ","$1,164.68 ","$0.00 ","$582.34 ","$922.43 ","$931.74 ","$0.00 ","$182.27 ","$0.00 ","$185.42 ","$0.00 "
"437.96","SUP","HCPCS C1713","","437.96  -  PLATE BONE 95D 80MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL","BOTH IP/OP","$1,164.68 ","$861.86 ","$0.00 ","$1,164.68 ","$524.10 ","$0.00 ","$242.75 ","$0.00 ","$0.00 ","$203.93 ","$1,164.68 ","$0.00 ","$582.34 ","$922.43 ","$931.74 ","$0.00 ","$182.27 ","$0.00 ","$185.42 ","$0.00 "
"438.24","SUP","HCPCS C1713","","438.24  -  PLATE BONE 130D 70MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,276.05 ","$944.28 ","$0.00 ","$1,276.05 ","$574.22 ","$0.00 ","$265.96 ","$0.00 ","$0.00 ","$223.43 ","$1,276.05 ","$0.00 ","$638.03 ","$1,010.63 ","$1,020.84 ","$0.00 ","$193.88 ","$0.00 ","$203.15 ","$0.00 "
"438.26","SUP","HCPCS C1713","","438.26  -  PLATE BONE 130D 80MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,276.05 ","$944.28 ","$0.00 ","$1,276.05 ","$574.22 ","$0.00 ","$265.96 ","$0.00 ","$0.00 ","$223.43 ","$1,276.05 ","$0.00 ","$638.03 ","$1,010.63 ","$1,020.84 ","$0.00 ","$193.88 ","$0.00 ","$203.15 ","$0.00 "
"438.28","SUP","HCPCS C1713","","438.28  -  PLATE BONE 130D 90MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,276.05 ","$944.28 ","$0.00 ","$1,276.05 ","$574.22 ","$0.00 ","$265.96 ","$0.00 ","$0.00 ","$223.43 ","$1,276.05 ","$0.00 ","$638.03 ","$1,010.63 ","$1,020.84 ","$0.00 ","$193.88 ","$0.00 ","$203.15 ","$0.00 "
"438.36","SUP","HCPCS C1713","","438.36  -  PLATE BONE 130D 50MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.38","SUP","HCPCS C1713","","438.38  -  PLATE BONE 130D 60MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.4","SUP","HCPCS C1713","","438.40  -  PLATE BONE 130D 100MM 4 HOLE ANGLE BLADE DCP TITANIUM","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.41","SUP","HCPCS C1713","","438.41  -  PLATE BONE 130D 105MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.42","SUP","HCPCS C1713","","438.42  -  PLATE BONE 130D 110MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.44","SUP","HCPCS C1713","","438.44  -  PLATE BONE 130D 70MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.45","SUP","HCPCS C1713","","438.45  -  PLATE BONE 130D 75MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.46","SUP","HCPCS C1713","","438.46  -  PLATE BONE 130D 80MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.47","SUP","HCPCS C1713","","438.47  -  PLATE BONE 130D 85MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.48","SUP","HCPCS C1713","","438.48  -  PLATE BONE 130D 90MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.49","SUP","HCPCS C1713","","438.49  -  PLATE BONE 130D 95MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$943.05 ","$697.86 ","$0.00 ","$943.05 ","$424.37 ","$0.00 ","$196.56 ","$0.00 ","$0.00 ","$165.12 ","$943.05 ","$0.00 ","$471.53 ","$746.90 ","$754.44 ","$0.00 ","$143.29 ","$0.00 ","$150.13 ","$0.00 "
"438.6","SUP","HCPCS C1713","","438.60  -  PLATE BONE 130D 50MM 6 HOLE ANGLE BLADE DCP TITANIUM NONSTRL","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"438.62","SUP","HCPCS C1713","","438.62  -  PLATE BONE 130D 60MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"438.64","SUP","HCPCS C1713","","438.64  -  PLATE BONE 130D 70MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"438.66","SUP","HCPCS C1713","","438.66  -  PLATE BONE 130D 80MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"438.68","SUP","HCPCS C1713","","438.68  -  PLATE BLADE 130D 90MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,007.18 ","$745.31 ","$0.00 ","$1,007.18 ","$453.23 ","$0.00 ","$209.92 ","$0.00 ","$0.00 ","$176.35 ","$1,007.18 ","$0.00 ","$503.59 ","$797.69 ","$805.74 ","$0.00 ","$153.03 ","$0.00 ","$160.34 ","$0.00 "
"438.7","SUP","HCPCS C1713","","438.700  -  PLATE BONE 116MM 4 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,530.75 ","$1,872.76 ","$0.00 ","$2,530.75 ","$1,138.84 ","$0.00 ","$527.47 ","$0.00 ","$0.00 ","$443.11 ","$2,530.75 ","$0.00 ","$1,265.38 ","$2,004.35 ","$2,024.60 ","$0.00 ","$396.06 ","$0.00 ","$402.90 ","$0.00 "
"438.701","SUP","HCPCS C1713","","438.701  -  PLATE 116MM TI 3.5MM SCR 4 HOLE W/O TAB LCP BONE LEFT DISTAL","BOTH IP/OP","$3,294.20 ","$2,437.71 ","$0.00 ","$3,294.20 ","$1,482.39 ","$0.00 ","$686.59 ","$0.00 ","$0.00 ","$576.79 ","$3,294.20 ","$0.00 ","$1,647.10 ","$2,609.01 ","$2,635.36 ","$0.00 ","$515.54 ","$0.00 ","$524.44 ","$0.00 "
"438.703","SUP","HCPCS C1713","","438.703  -  PLATE 142MM TI 3.5MM SCR 6 HOLE W/O TAB LCP BONE LEFT DISTAL","BOTH IP/OP","$3,234.43 ","$2,393.48 ","$0.00 ","$3,234.43 ","$1,455.49 ","$0.00 ","$674.14 ","$0.00 ","$0.00 ","$566.32 ","$3,234.43 ","$0.00 ","$1,617.21 ","$2,561.67 ","$2,587.54 ","$0.00 ","$506.19 ","$0.00 ","$514.92 ","$0.00 "
"438.705","SUP","HCPCS C1713","","438.705  -  PLATE 168MM TI 3.5MM SCR 8 HOLE W/O TAB LCP BONE LEFT DISTAL","BOTH IP/OP","$3,266.13 ","$2,416.94 ","$0.00 ","$3,266.13 ","$1,469.76 ","$0.00 ","$680.74 ","$0.00 ","$0.00 ","$571.87 ","$3,266.13 ","$0.00 ","$1,633.06 ","$2,586.77 ","$2,612.90 ","$0.00 ","$511.15 ","$0.00 ","$519.97 ","$0.00 "
"438.706","SUP","HCPCS C1713","","438.706  -  PLATE 194MM TI 3.5MM SCR 10 HOLE W/O TAB LCP BONE RIGHT","BOTH IP/OP","$3,399.05 ","$2,515.30 ","$0.00 ","$3,399.05 ","$1,529.57 ","$0.00 ","$708.45 ","$0.00 ","$0.00 ","$595.15 ","$3,399.05 ","$0.00 ","$1,699.53 ","$2,692.05 ","$2,719.24 ","$0.00 ","$531.95 ","$0.00 ","$541.13 ","$0.00 "
"438.708","SUP","HCPCS C1713","","438.708  -  PLATE BONE 220MM 12 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,640.73 ","$1,954.14 ","$0.00 ","$2,640.73 ","$1,188.33 ","$0.00 ","$550.39 ","$0.00 ","$0.00 ","$462.37 ","$2,640.73 ","$0.00 ","$1,320.36 ","$2,091.46 ","$2,112.58 ","$0.00 ","$413.27 ","$0.00 ","$420.40 ","$0.00 "
"438.71","SUP","HCPCS C1713","","438.710  -  PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,675.18 ","$1,979.63 ","$0.00 ","$2,675.18 ","$1,203.83 ","$0.00 ","$557.57 ","$0.00 ","$0.00 ","$468.40 ","$2,675.18 ","$0.00 ","$1,337.59 ","$2,118.74 ","$2,140.14 ","$0.00 ","$418.66 ","$0.00 ","$425.89 ","$0.00 "
"438.711","SUP","HCPCS C1713","","438.711  -  PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,756.00 ","$2,039.44 ","$0.00 ","$2,756.00 ","$1,240.20 ","$0.00 ","$574.42 ","$0.00 ","$0.00 ","$482.55 ","$2,756.00 ","$0.00 ","$1,378.00 ","$2,182.75 ","$2,204.80 ","$0.00 ","$431.31 ","$0.00 ","$438.76 ","$0.00 "
"438.94","SUP","HCPCS C1713","","438.94  -  PLATE BONE 130D 70MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,110.90 ","$822.07 ","$0.00 ","$1,110.90 ","$499.91 ","$0.00 ","$231.54 ","$0.00 ","$0.00 ","$194.51 ","$1,110.90 ","$0.00 ","$555.45 ","$879.83 ","$888.72 ","$0.00 ","$168.79 ","$0.00 ","$176.86 ","$0.00 "
"438.96","SUP","HCPCS C1713","","438.96  -  PLATE BONE 130D 80MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"438.98","SUP","HCPCS C1713","","438.98  -  PLATE BONE 130D 90MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$1,110.90 ","$822.07 ","$0.00 ","$1,110.90 ","$499.91 ","$0.00 ","$231.54 ","$0.00 ","$0.00 ","$194.51 ","$1,110.90 ","$0.00 ","$555.45 ","$879.83 ","$888.72 ","$0.00 ","$168.79 ","$0.00 ","$176.86 ","$0.00 "
"439.2","SUP","HCPCS C1713","","439.20  -  PLATE 90D 10MM DSPL 50MM TI OSTMY DCP BONE ADLT ORTH NONSTRL","BOTH IP/OP","$1,290.98 ","$955.33 ","$0.00 ","$1,290.98 ","$580.94 ","$0.00 ","$269.07 ","$0.00 ","$0.00 ","$226.04 ","$1,290.98 ","$0.00 ","$645.49 ","$1,022.46 ","$1,032.78 ","$0.00 ","$202.04 ","$0.00 ","$205.52 ","$0.00 "
"439.21","SUP","HCPCS C1713","","439.21  -  PLATE BONE 90D 10MM DISPLACEMENT 55MM ANGLED DCP TITANIUM","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.22","SUP","HCPCS C1713","","439.22  -  PLATE BONE 90D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.23","SUP","HCPCS C1713","","439.23  -  PLATE BONE 90D 10MM DISPLACEMENT 65MM ANGLED DCP TITANIUM","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.24","SUP","HCPCS C1713","","439.24  -  PLATE BONE 90D 10MM DISPLACEMENT 70MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.25","SUP","HCPCS C1713","","439.25  -  PLATE BONE 90D 10MM DISPLACEMENT 75MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.28","SUP","HCPCS C1713","","439.28  -  PLATE BONE 90D 10MM DISPLACEMENT 40MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.32","SUP","HCPCS C1713","","439.32  -  PLATE BONE 100D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.43","SUP","HCPCS C1713","","439.43  -  PLATE BONE 110D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.45","SUP","HCPCS C1713","","439.45  -  PLATE BONE 110D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,110.90 ","$822.07 ","$0.00 ","$1,110.90 ","$499.91 ","$0.00 ","$231.54 ","$0.00 ","$0.00 ","$194.51 ","$1,110.90 ","$0.00 ","$555.45 ","$879.83 ","$888.72 ","$0.00 ","$168.79 ","$0.00 ","$176.86 ","$0.00 "
"439.47","SUP","HCPCS C1713","","439.47  -  PLATE BONE 110D 85MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.53","SUP","HCPCS C1713","","439.53  -  PLATE BONE 120D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.55","SUP","HCPCS C1713","","439.55  -  PLATE BONE 120D 75MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.57","SUP","HCPCS C1713","","439.57  -  PLATE BONE 120D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.6","SUP","HCPCS C1713","","439.60  -  PLATE BONE 90D 20MM DISPLACEMENT 50MM 20MM DCP TITANIUM","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.61","SUP","HCPCS C1713","","439.61  -  PLATE BONE 90D 20MM 55MM DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.62","SUP","HCPCS C1713","","439.62  -  PLATE BN 90D 20MM DSPL 60MM NS DCP TI ADLT OSTM","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.63","SUP","HCPCS C1713","","439.63  -  PLATE BONE 90D 20MM DISPLACEMENT 65MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.64","SUP","HCPCS C1713","","439.64  -  PLATE BONE 90D 20MM DISPLACEMENT 70MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.65","SUP","HCPCS C1713","","439.65  -  PLATE BONE 90D 20MM 75MM ANGLED DCP STAINLESS STEEL ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.7","SUP","HCPCS C1713","","439.70  -  PLATE BONE 90D 15MM DISPLACEMENT 50MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.71","SUP","HCPCS C1713","","439.71  -  PLATE BONE 90D 15MM DISPLACEMENT 55MM ANGLED DCP TITANIUM","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.72","SUP","HCPCS C1713","","439.72  -  PLATE BONE 90D 15MM DISPLACEMENT 60MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.73","SUP","HCPCS C1713","","439.73  -  PLATE BONE 90D 15MM DISPLACEMENT 65MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.74","SUP","HCPCS C1713","","439.74  -  PLATE BONE 90D 15MM 70MM DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.76","SUP","HCPCS C1713","","439.76  -  PLATE BONE 90D 15MM DISPLACEMENT 80MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.78","SUP","HCPCS C1713","","439.78  -  PLATE BONE 90D 15MM DISPLACEMENT 40MM DCP TITANIUM ADULT","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.8","SUP","HCPCS C1713","","439.80  -  PLATE BONE 130D 100MM DCP TITANIUM ADULT NONSTRL OSTMY","BOTH IP/OP","$1,110.90 ","$822.07 ","$0.00 ","$1,110.90 ","$499.91 ","$0.00 ","$231.54 ","$0.00 ","$0.00 ","$194.51 ","$1,110.90 ","$0.00 ","$555.45 ","$879.83 ","$888.72 ","$0.00 ","$168.79 ","$0.00 ","$176.86 ","$0.00 "
"439.81","SUP","HCPCS C1713","","439.81  -  PLATE BONE 130D 105MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.82","SUP","HCPCS C1713","","439.82  -  PLATE BONE 130D 110MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.83","SUP","HCPCS C1713","","439.83  -  PLATE BONE 130D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.84","SUP","HCPCS C1713","","439.84  -  PLATE BONE 130D 70MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.85","SUP","HCPCS C1713","","439.85  -  PLATE BONE 130D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.86","SUP","HCPCS C1713","","439.86  -  PLATE BONE 130D 80MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.87","SUP","HCPCS C1713","","439.87  -  PLATE BONE 130D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.88","SUP","HCPCS C1713","","439.88  -  PLATE BONE 130D 90MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.89","SUP","HCPCS C1713","","439.89  -  PLATE BONE 130D 95MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,078.55 ","$798.13 ","$0.00 ","$1,078.55 ","$485.35 ","$0.00 ","$224.80 ","$0.00 ","$0.00 ","$188.85 ","$1,078.55 ","$0.00 ","$539.28 ","$854.21 ","$862.84 ","$0.00 ","$168.79 ","$0.00 ","$171.71 ","$0.00 "
"439.934","SUP","HCPCS C1713","","439.934  -  PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"439.935","SUP","HCPCS C1713","","439.935  -  PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"439.936","SUP","HCPCS C1713","","439.936  -  PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"439.937","SUP","HCPCS C1713","","439.937  -  PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"439.938","SUP","HCPCS C1713","","439.938  -  PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"439.939","SUP","HCPCS C1713","","439.939  -  PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"439.94","SUP","HCPCS C1713","","439.940  -  PLATE BONE 159MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,676.28 ","$1,980.45 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$557.80 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"439.941","SUP","HCPCS C1713","","439.941  -  PLATE BONE 159MM 10 HOLE TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,756.58 ","$2,039.87 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$574.54 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"439.942","SUP","HCPCS C1713","","439.942  -  PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,793.10 ","$2,066.89 ","$0.00 ","$2,711.75 ","$1,220.29 ","$0.00 ","$582.15 ","$0.00 ","$0.00 ","$474.81 ","$2,711.75 ","$0.00 ","$1,355.88 ","$2,147.71 ","$2,169.40 ","$0.00 ","$412.03 ","$0.00 ","$431.71 ","$0.00 "
"439.943","SUP","HCPCS C1713","","439.943  -  PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,793.10 ","$2,066.89 ","$0.00 ","$2,711.75 ","$1,220.29 ","$0.00 ","$582.15 ","$0.00 ","$0.00 ","$474.81 ","$2,711.75 ","$0.00 ","$1,355.88 ","$2,147.71 ","$2,169.40 ","$0.00 ","$412.03 ","$0.00 ","$431.71 ","$0.00 "
"439.944","SUP","HCPCS C1713","","439.944  -  PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,822.63 ","$2,088.75 ","$0.00 ","$2,740.43 ","$1,233.19 ","$0.00 ","$588.31 ","$0.00 ","$0.00 ","$479.83 ","$2,740.43 ","$0.00 ","$1,370.21 ","$2,170.42 ","$2,192.34 ","$0.00 ","$416.38 ","$0.00 ","$436.28 ","$0.00 "
"439.945","SUP","HCPCS C1713","","439.945  -  PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,822.63 ","$2,088.75 ","$0.00 ","$2,740.43 ","$1,233.19 ","$0.00 ","$588.31 ","$0.00 ","$0.00 ","$479.83 ","$2,740.43 ","$0.00 ","$1,370.21 ","$2,170.42 ","$2,192.34 ","$0.00 ","$416.38 ","$0.00 ","$436.28 ","$0.00 "
"439.946","SUP","HCPCS C1713","","439.946  -  PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,922.43 ","$2,162.60 ","$0.00 ","$2,837.33 ","$1,276.80 ","$0.00 ","$609.11 ","$0.00 ","$0.00 ","$496.79 ","$2,837.33 ","$0.00 ","$1,418.66 ","$2,247.17 ","$2,269.86 ","$0.00 ","$431.11 ","$0.00 ","$451.70 ","$0.00 "
"439.947","SUP","HCPCS C1713","","439.947  -  PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,922.43 ","$2,162.60 ","$0.00 ","$2,837.33 ","$1,276.80 ","$0.00 ","$609.11 ","$0.00 ","$0.00 ","$496.79 ","$2,837.33 ","$0.00 ","$1,418.66 ","$2,247.17 ","$2,269.86 ","$0.00 ","$431.11 ","$0.00 ","$451.70 ","$0.00 "
"439.954","SUP","HCPCS C1713","","439.954  -  PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,655.35 ","$1,964.96 ","$0.00 ","$2,578.03 ","$1,160.11 ","$0.00 ","$553.44 ","$0.00 ","$0.00 ","$451.39 ","$2,578.03 ","$0.00 ","$1,289.01 ","$2,041.80 ","$2,062.42 ","$0.00 ","$391.71 ","$0.00 ","$410.42 ","$0.00 "
"439.955","SUP","HCPCS C1713","","439.955  -  PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,655.35 ","$1,964.96 ","$0.00 ","$2,578.03 ","$1,160.11 ","$0.00 ","$553.44 ","$0.00 ","$0.00 ","$451.39 ","$2,578.03 ","$0.00 ","$1,289.01 ","$2,041.80 ","$2,062.42 ","$0.00 ","$391.71 ","$0.00 ","$410.42 ","$0.00 "
"439.956","SUP","HCPCS C1713","","439.956  -  PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,690.50 ","$1,990.97 ","$0.00 ","$2,612.13 ","$1,175.46 ","$0.00 ","$560.77 ","$0.00 ","$0.00 ","$457.36 ","$2,612.13 ","$0.00 ","$1,306.06 ","$2,068.81 ","$2,089.70 ","$0.00 ","$396.89 ","$0.00 ","$415.85 ","$0.00 "
"439.957","SUP","HCPCS C1713","","439.957  -  PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,690.50 ","$1,990.97 ","$0.00 ","$2,612.13 ","$1,175.46 ","$0.00 ","$560.77 ","$0.00 ","$0.00 ","$457.36 ","$2,612.13 ","$0.00 ","$1,306.06 ","$2,068.81 ","$2,089.70 ","$0.00 ","$396.89 ","$0.00 ","$415.85 ","$0.00 "
"439.958","SUP","HCPCS C1713","","439.958  -  PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,722.83 ","$2,014.89 ","$0.00 ","$2,643.53 ","$1,189.59 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$462.86 ","$2,643.53 ","$0.00 ","$1,321.76 ","$2,093.68 ","$2,114.82 ","$0.00 ","$401.66 ","$0.00 ","$420.85 ","$0.00 "
"439.959","SUP","HCPCS C1713","","439.959  -  PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,722.83 ","$2,014.89 ","$0.00 ","$2,643.53 ","$1,189.59 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$462.86 ","$2,643.53 ","$0.00 ","$1,321.76 ","$2,093.68 ","$2,114.82 ","$0.00 ","$401.66 ","$0.00 ","$420.85 ","$0.00 "
"439.96","SUP","HCPCS C1713","","439.960  -  PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,673.55 ","$1,978.43 ","$0.00 ","$2,673.55 ","$1,203.10 ","$0.00 ","$557.23 ","$0.00 ","$0.00 ","$468.12 ","$2,673.55 ","$0.00 ","$1,336.78 ","$2,117.45 ","$2,138.84 ","$0.00 ","$406.22 ","$0.00 ","$425.63 ","$0.00 "
"439.961","SUP","HCPCS C1713","","439.961  -  PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,753.75 ","$2,037.78 ","$0.00 ","$2,673.55 ","$1,203.10 ","$0.00 ","$573.95 ","$0.00 ","$0.00 ","$468.12 ","$2,673.55 ","$0.00 ","$1,336.78 ","$2,117.45 ","$2,138.84 ","$0.00 ","$406.22 ","$0.00 ","$425.63 ","$0.00 "
"439.962","SUP","HCPCS C1713","","439.962  -  PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,783.28 ","$2,059.63 ","$0.00 ","$2,702.20 ","$1,215.99 ","$0.00 ","$580.10 ","$0.00 ","$0.00 ","$473.13 ","$2,702.20 ","$0.00 ","$1,351.10 ","$2,140.14 ","$2,161.76 ","$0.00 ","$410.58 ","$0.00 ","$430.19 ","$0.00 "
"439.963","SUP","HCPCS C1713","","439.963  -  PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,783.28 ","$2,059.63 ","$0.00 ","$2,702.20 ","$1,215.99 ","$0.00 ","$580.10 ","$0.00 ","$0.00 ","$473.13 ","$2,702.20 ","$0.00 ","$1,351.10 ","$2,140.14 ","$2,161.76 ","$0.00 ","$410.58 ","$0.00 ","$430.19 ","$0.00 "
"439.964","SUP","HCPCS C1713","","439.964  -  PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,817.00 ","$2,084.58 ","$0.00 ","$2,734.95 ","$1,230.73 ","$0.00 ","$587.13 ","$0.00 ","$0.00 ","$478.87 ","$2,734.95 ","$0.00 ","$1,367.48 ","$2,166.08 ","$2,187.96 ","$0.00 ","$415.55 ","$0.00 ","$435.40 ","$0.00 "
"439.965","SUP","HCPCS C1713","","439.965  -  PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,817.00 ","$2,084.58 ","$0.00 ","$2,734.95 ","$1,230.73 ","$0.00 ","$587.13 ","$0.00 ","$0.00 ","$478.87 ","$2,734.95 ","$0.00 ","$1,367.48 ","$2,166.08 ","$2,187.96 ","$0.00 ","$415.55 ","$0.00 ","$435.40 ","$0.00 "
"439.966","SUP","HCPCS C1713","","439.966  -  PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,915.40 ","$2,157.40 ","$0.00 ","$2,830.50 ","$1,273.73 ","$0.00 ","$607.64 ","$0.00 ","$0.00 ","$495.60 ","$2,830.50 ","$0.00 ","$1,415.25 ","$2,241.76 ","$2,264.40 ","$0.00 ","$430.07 ","$0.00 ","$450.62 ","$0.00 "
"439.967","SUP","HCPCS C1713","","439.967  -  PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,915.40 ","$2,157.40 ","$0.00 ","$2,830.50 ","$1,273.73 ","$0.00 ","$607.64 ","$0.00 ","$0.00 ","$495.60 ","$2,830.50 ","$0.00 ","$1,415.25 ","$2,241.76 ","$2,264.40 ","$0.00 ","$430.07 ","$0.00 ","$450.62 ","$0.00 "
"439.968","SUP","HCPCS C1713","","439.968  -  PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$3,019.43 ","$2,234.38 ","$0.00 ","$2,931.48 ","$1,319.16 ","$0.00 ","$629.32 ","$0.00 ","$0.00 ","$513.28 ","$2,931.48 ","$0.00 ","$1,465.74 ","$2,321.73 ","$2,345.18 ","$0.00 ","$445.41 ","$0.00 ","$466.69 ","$0.00 "
"439.969","SUP","HCPCS C1713","","439.969  -  PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,110.80 ","$2,301.99 ","$0.00 ","$3,020.20 ","$1,359.09 ","$0.00 ","$648.37 ","$0.00 ","$0.00 ","$528.81 ","$3,020.20 ","$0.00 ","$1,510.10 ","$2,392.00 ","$2,416.16 ","$0.00 ","$458.89 ","$0.00 ","$480.82 ","$0.00 "
"439.97","SUP","HCPCS C1713","","439.970  -  PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$3,028.38 ","$2,241.00 ","$0.00 ","$3,028.38 ","$1,362.77 ","$0.00 ","$631.19 ","$0.00 ","$0.00 ","$530.24 ","$3,028.38 ","$0.00 ","$1,514.19 ","$2,398.48 ","$2,422.70 ","$0.00 ","$460.14 ","$0.00 ","$482.12 ","$0.00 "
"439.971","SUP","HCPCS C1713","","439.971  -  PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$3,119.23 ","$2,308.23 ","$0.00 ","$3,028.38 ","$1,362.77 ","$0.00 ","$650.12 ","$0.00 ","$0.00 ","$530.24 ","$3,028.38 ","$0.00 ","$1,514.19 ","$2,398.48 ","$2,422.70 ","$0.00 ","$460.14 ","$0.00 ","$482.12 ","$0.00 "
"439.984","SUP","HCPCS C1713","","439.984  -  PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,665.20 ","$1,972.25 ","$0.00 ","$2,587.58 ","$1,164.41 ","$0.00 ","$555.49 ","$0.00 ","$0.00 ","$453.06 ","$2,587.58 ","$0.00 ","$1,293.79 ","$2,049.36 ","$2,070.06 ","$0.00 ","$393.16 ","$0.00 ","$411.94 ","$0.00 "
"439.985","SUP","HCPCS C1713","","439.985  -  PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,665.20 ","$1,972.25 ","$0.00 ","$2,587.58 ","$1,164.41 ","$0.00 ","$555.49 ","$0.00 ","$0.00 ","$453.06 ","$2,587.58 ","$0.00 ","$1,293.79 ","$2,049.36 ","$2,070.06 ","$0.00 ","$393.16 ","$0.00 ","$411.94 ","$0.00 "
"439.986","SUP","HCPCS C1713","","439.986  -  PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,697.53 ","$1,996.17 ","$0.00 ","$2,618.95 ","$1,178.53 ","$0.00 ","$562.23 ","$0.00 ","$0.00 ","$458.56 ","$2,618.95 ","$0.00 ","$1,309.48 ","$2,074.21 ","$2,095.16 ","$0.00 ","$397.93 ","$0.00 ","$416.94 ","$0.00 "
"439.987","SUP","HCPCS C1713","","439.987  -  PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,697.53 ","$1,996.17 ","$0.00 ","$2,618.95 ","$1,178.53 ","$0.00 ","$562.23 ","$0.00 ","$0.00 ","$458.56 ","$2,618.95 ","$0.00 ","$1,309.48 ","$2,074.21 ","$2,095.16 ","$0.00 ","$397.93 ","$0.00 ","$416.94 ","$0.00 "
"439.988","SUP","HCPCS C1713","","439.988  -  PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,728.45 ","$2,019.05 ","$0.00 ","$2,648.98 ","$1,192.04 ","$0.00 ","$568.68 ","$0.00 ","$0.00 ","$463.81 ","$2,648.98 ","$0.00 ","$1,324.49 ","$2,097.99 ","$2,119.18 ","$0.00 ","$402.49 ","$0.00 ","$421.72 ","$0.00 "
"439.989","SUP","HCPCS C1713","","439.989  -  PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,728.45 ","$2,019.05 ","$0.00 ","$2,648.98 ","$1,192.04 ","$0.00 ","$568.68 ","$0.00 ","$0.00 ","$463.81 ","$2,648.98 ","$0.00 ","$1,324.49 ","$2,097.99 ","$2,119.18 ","$0.00 ","$402.49 ","$0.00 ","$421.72 ","$0.00 "
"439.99","SUP","HCPCS C1713","","439.990  -  PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,677.65 ","$1,981.46 ","$0.00 ","$2,677.65 ","$1,204.94 ","$0.00 ","$558.09 ","$0.00 ","$0.00 ","$468.84 ","$2,677.65 ","$0.00 ","$1,338.83 ","$2,120.70 ","$2,142.12 ","$0.00 ","$406.85 ","$0.00 ","$426.28 ","$0.00 "
"439.991","SUP","HCPCS C1713","","439.991  -  PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,757.98 ","$2,040.91 ","$0.00 ","$2,677.65 ","$1,204.94 ","$0.00 ","$574.83 ","$0.00 ","$0.00 ","$468.84 ","$2,677.65 ","$0.00 ","$1,338.83 ","$2,120.70 ","$2,142.12 ","$0.00 ","$406.85 ","$0.00 ","$426.28 ","$0.00 "
"439.992","SUP","HCPCS C1713","","439.992  -  PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,793.10 ","$2,066.89 ","$0.00 ","$2,711.75 ","$1,220.29 ","$0.00 ","$582.15 ","$0.00 ","$0.00 ","$474.81 ","$2,711.75 ","$0.00 ","$1,355.88 ","$2,147.71 ","$2,169.40 ","$0.00 ","$412.03 ","$0.00 ","$431.71 ","$0.00 "
"439.993","SUP","HCPCS C1713","","439.993  -  PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,793.10 ","$2,066.89 ","$0.00 ","$2,711.75 ","$1,220.29 ","$0.00 ","$582.15 ","$0.00 ","$0.00 ","$474.81 ","$2,711.75 ","$0.00 ","$1,355.88 ","$2,147.71 ","$2,169.40 ","$0.00 ","$412.03 ","$0.00 ","$431.71 ","$0.00 "
"439.994","SUP","HCPCS C1713","","439.994  -  PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,822.63 ","$2,088.75 ","$0.00 ","$2,740.43 ","$1,233.19 ","$0.00 ","$588.31 ","$0.00 ","$0.00 ","$479.83 ","$2,740.43 ","$0.00 ","$1,370.21 ","$2,170.42 ","$2,192.34 ","$0.00 ","$416.38 ","$0.00 ","$436.28 ","$0.00 "
"439.995","SUP","HCPCS C1713","","439.995  -  PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,822.63 ","$2,088.75 ","$0.00 ","$2,740.43 ","$1,233.19 ","$0.00 ","$588.31 ","$0.00 ","$0.00 ","$479.83 ","$2,740.43 ","$0.00 ","$1,370.21 ","$2,170.42 ","$2,192.34 ","$0.00 ","$416.38 ","$0.00 ","$436.28 ","$0.00 "
"439.996","SUP","HCPCS C1713","","439.996  -  PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL","BOTH IP/OP","$2,850.75 ","$2,109.56 ","$0.00 ","$2,767.73 ","$1,245.48 ","$0.00 ","$594.17 ","$0.00 ","$0.00 ","$484.61 ","$2,767.73 ","$0.00 ","$1,383.86 ","$2,192.04 ","$2,214.18 ","$0.00 ","$420.53 ","$0.00 ","$440.62 ","$0.00 "
"439.997","SUP","HCPCS C1713","","439.997  -  PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,850.75 ","$2,109.56 ","$0.00 ","$2,767.73 ","$1,245.48 ","$0.00 ","$594.17 ","$0.00 ","$0.00 ","$484.61 ","$2,767.73 ","$0.00 ","$1,383.86 ","$2,192.04 ","$2,214.18 ","$0.00 ","$420.53 ","$0.00 ","$440.62 ","$0.00 "
"440.036","SUP","HCPCS C1713","","440.036  -  PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,666.60 ","$1,973.28 ","$0.00 ","$2,588.93 ","$1,165.02 ","$0.00 ","$555.79 ","$0.00 ","$0.00 ","$453.30 ","$2,588.93 ","$0.00 ","$1,294.46 ","$2,050.43 ","$2,071.14 ","$0.00 ","$393.37 ","$0.00 ","$412.16 ","$0.00 "
"440.037","SUP","HCPCS C1713","","440.037  -  PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,666.60 ","$1,973.28 ","$0.00 ","$2,588.93 ","$1,165.02 ","$0.00 ","$555.79 ","$0.00 ","$0.00 ","$453.30 ","$2,588.93 ","$0.00 ","$1,294.46 ","$2,050.43 ","$2,071.14 ","$0.00 ","$393.37 ","$0.00 ","$412.16 ","$0.00 "
"440.038","SUP","HCPCS C1713","","440.038  -  PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,698.93 ","$1,997.21 ","$0.00 ","$2,620.33 ","$1,179.15 ","$0.00 ","$562.52 ","$0.00 ","$0.00 ","$458.80 ","$2,620.33 ","$0.00 ","$1,310.16 ","$2,075.30 ","$2,096.26 ","$0.00 ","$398.14 ","$0.00 ","$417.16 ","$0.00 "
"440.039","SUP","HCPCS C1713","","440.039  -  PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,698.93 ","$1,997.21 ","$0.00 ","$2,620.33 ","$1,179.15 ","$0.00 ","$562.52 ","$0.00 ","$0.00 ","$458.80 ","$2,620.33 ","$0.00 ","$1,310.16 ","$2,075.30 ","$2,096.26 ","$0.00 ","$398.14 ","$0.00 ","$417.16 ","$0.00 "
"440.04","SUP","HCPCS C1713","","440.040  -  PLATE BONE 154MM 8 HOLE LCP TITANIUM RIGHT PROXIMAL TIBIA","BOTH IP/OP","$2,650.35 ","$1,961.26 ","$0.00 ","$2,650.35 ","$1,192.66 ","$0.00 ","$552.40 ","$0.00 ","$0.00 ","$464.06 ","$2,650.35 ","$0.00 ","$1,325.18 ","$2,099.08 ","$2,120.28 ","$0.00 ","$402.70 ","$0.00 ","$421.94 ","$0.00 "
"440.041","SUP","HCPCS C1713","","440.041  -  PLATE BONE 154MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,729.85 ","$2,020.09 ","$0.00 ","$2,650.35 ","$1,192.66 ","$0.00 ","$568.97 ","$0.00 ","$0.00 ","$464.06 ","$2,650.35 ","$0.00 ","$1,325.18 ","$2,099.08 ","$2,120.28 ","$0.00 ","$402.70 ","$0.00 ","$421.94 ","$0.00 "
"440.042","SUP","HCPCS C1713","","440.042  -  PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,759.38 ","$2,041.94 ","$0.00 ","$2,679.00 ","$1,205.55 ","$0.00 ","$575.12 ","$0.00 ","$0.00 ","$469.07 ","$2,679.00 ","$0.00 ","$1,339.50 ","$2,121.77 ","$2,143.20 ","$0.00 ","$407.05 ","$0.00 ","$426.50 ","$0.00 "
"440.043","SUP","HCPCS C1713","","440.043  -  PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,759.38 ","$2,041.94 ","$0.00 ","$2,679.00 ","$1,205.55 ","$0.00 ","$575.12 ","$0.00 ","$0.00 ","$469.07 ","$2,679.00 ","$0.00 ","$1,339.50 ","$2,121.77 ","$2,143.20 ","$0.00 ","$407.05 ","$0.00 ","$426.50 ","$0.00 "
"440.044","SUP","HCPCS C1713","","440.044  -  PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,791.70 ","$2,065.86 ","$0.00 ","$2,710.40 ","$1,219.68 ","$0.00 ","$581.86 ","$0.00 ","$0.00 ","$474.57 ","$2,710.40 ","$0.00 ","$1,355.20 ","$2,146.64 ","$2,168.32 ","$0.00 ","$411.82 ","$0.00 ","$431.50 ","$0.00 "
"440.045","SUP","HCPCS C1713","","440.045  -  PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,791.70 ","$2,065.86 ","$0.00 ","$2,710.40 ","$1,219.68 ","$0.00 ","$581.86 ","$0.00 ","$0.00 ","$474.57 ","$2,710.40 ","$0.00 ","$1,355.20 ","$2,146.64 ","$2,168.32 ","$0.00 ","$411.82 ","$0.00 ","$431.50 ","$0.00 "
"440.046","SUP","HCPCS C1713","","440.046  -  PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL","BOTH IP/OP","$2,821.23 ","$2,087.71 ","$0.00 ","$2,739.05 ","$1,232.57 ","$0.00 ","$588.01 ","$0.00 ","$0.00 ","$479.59 ","$2,739.05 ","$0.00 ","$1,369.53 ","$2,169.33 ","$2,191.24 ","$0.00 ","$416.18 ","$0.00 ","$436.06 ","$0.00 "
"440.047","SUP","HCPCS C1713","","440.047  -  PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL","BOTH IP/OP","$2,821.23 ","$2,087.71 ","$0.00 ","$2,739.05 ","$1,232.57 ","$0.00 ","$588.01 ","$0.00 ","$0.00 ","$479.59 ","$2,739.05 ","$0.00 ","$1,369.53 ","$2,169.33 ","$2,191.24 ","$0.00 ","$416.18 ","$0.00 ","$436.06 ","$0.00 "
"440.05","SUP","HCPCS C1713","","440.05  -  PLATE BONE 5 HOLE SPOON LC-DCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$626.43 ","$463.56 ","$0.00 ","$626.43 ","$281.89 ","$0.00 ","$130.56 ","$0.00 ","$0.00 ","$109.68 ","$626.43 ","$0.00 ","$313.21 ","$496.13 ","$501.14 ","$0.00 ","$95.18 ","$0.00 ","$99.73 ","$0.00 "
"440.06","SUP","HCPCS C1713","","440.06  -  PLATE BONE SPOON 6 HOLE LC DCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$668.73 ","$494.86 ","$0.00 ","$668.73 ","$300.93 ","$0.00 ","$139.38 ","$0.00 ","$0.00 ","$117.09 ","$668.73 ","$0.00 ","$334.36 ","$529.63 ","$534.98 ","$0.00 ","$101.61 ","$0.00 ","$106.46 ","$0.00 "
"440.13","SUP","HCPCS C1713","","440.13  -  PLATE BONE T 68MM 3 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$504.95 ","$373.66 ","$0.00 ","$504.95 ","$227.23 ","$0.00 ","$105.24 ","$0.00 ","$0.00 ","$88.41 ","$504.95 ","$0.00 ","$252.48 ","$399.92 ","$403.96 ","$0.00 ","$76.72 ","$0.00 ","$80.39 ","$0.00 "
"440.14","SUP","HCPCS C1713","","440.14  -  PLATE BONE T 84MM 4 HOLE LC-DCP TITANIUM HUMERUS TIBIAL","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$247.50 ","$0.00 ","$114.63 ","$0.00 ","$0.00 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$83.57 ","$0.00 ","$87.56 ","$0.00 "
"440.141","SUP","HCPCS C1713","","440.141  -  PLATE BONE 83MM 4 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL 4.5","BOTH IP/OP","$1,137.20 ","$841.53 ","$0.00 ","$1,104.08 ","$496.83 ","$0.00 ","$237.02 ","$0.00 ","$0.00 ","$193.31 ","$1,104.08 ","$0.00 ","$552.04 ","$874.43 ","$883.26 ","$0.00 ","$167.76 ","$0.00 ","$175.77 ","$0.00 "
"440.15","SUP","HCPCS C1713","","440.15  -  PLATE BONE T 100MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$577.30 ","$427.20 ","$0.00 ","$577.30 ","$259.79 ","$0.00 ","$120.32 ","$0.00 ","$0.00 ","$101.08 ","$577.30 ","$0.00 ","$288.65 ","$457.22 ","$461.84 ","$0.00 ","$87.71 ","$0.00 ","$91.91 ","$0.00 "
"440.16","SUP","HCPCS C1713","","440.16  -  PLATE BONE T 116MM 6 HOLE LC-DCP TITANIUM HUMERUS TIBIAL","BOTH IP/OP","$656.45 ","$485.77 ","$0.00 ","$656.45 ","$295.40 ","$0.00 ","$136.82 ","$0.00 ","$0.00 ","$114.94 ","$656.45 ","$0.00 ","$328.23 ","$519.91 ","$525.16 ","$0.00 ","$99.74 ","$0.00 ","$104.51 ","$0.00 "
"440.161","SUP","HCPCS C1713","","440.161  -  PLATE BONE 115MM 6 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,304.48 ","$965.32 ","$0.00 ","$1,266.50 ","$569.93 ","$0.00 ","$271.89 ","$0.00 ","$0.00 ","$221.75 ","$1,266.50 ","$0.00 ","$633.25 ","$1,003.07 ","$1,013.20 ","$0.00 ","$192.43 ","$0.00 ","$201.63 ","$0.00 "
"440.18","SUP","HCPCS C1713","","440.18  -  PLATE BONE T 148MM 8 HOLE LC-DCP TITANIUM HUMERUS TIBIAL","BOTH IP/OP","$865.25 ","$640.29 ","$0.00 ","$865.25 ","$389.36 ","$0.00 ","$180.34 ","$0.00 ","$0.00 ","$151.50 ","$865.25 ","$0.00 ","$432.63 ","$685.28 ","$692.20 ","$0.00 ","$131.47 ","$0.00 ","$137.75 ","$0.00 "
"440.181","SUP","HCPCS C1713","","440.181  -  PLATE BONE 147MM 8 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$1,505.50 ","$1,114.07 ","$0.00 ","$1,461.65 ","$657.74 ","$0.00 ","$313.78 ","$0.00 ","$0.00 ","$255.92 ","$1,461.65 ","$0.00 ","$730.83 ","$1,157.63 ","$1,169.32 ","$0.00 ","$222.09 ","$0.00 ","$232.69 ","$0.00 "
"440.34","SUP","HCPCS C1713","","440.34  -  PLATE BONE T BUTTRESS 80MM 4 HOLE LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$839.33 ","$621.10 ","$0.00 ","$839.33 ","$377.70 ","$0.00 ","$174.94 ","$0.00 ","$0.00 ","$146.96 ","$839.33 ","$0.00 ","$419.66 ","$664.75 ","$671.46 ","$0.00 ","$127.53 ","$0.00 ","$133.62 ","$0.00 "
"440.35","SUP","HCPCS C1713","","440.35  -  PLATE BONE T BUTTRESS 96MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$883.00 ","$653.42 ","$0.00 ","$883.00 ","$397.35 ","$0.00 ","$184.04 ","$0.00 ","$0.00 ","$154.61 ","$883.00 ","$0.00 ","$441.50 ","$699.34 ","$706.40 ","$0.00 ","$134.16 ","$0.00 ","$140.57 ","$0.00 "
"440.36","SUP","HCPCS C1713","","440.36  -  PLATE BONE T BUTTRESS 112MM 6 HOLE LC-DCP TITANIUM","BOTH IP/OP","$913.03 ","$675.64 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$190.30 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"440.44","SUP","HCPCS C1713","","440.44  -  PLATE BN ANG LT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI","BOTH IP/OP","$756.28 ","$559.65 ","$0.00 ","$734.23 ","$330.40 ","$0.00 ","$157.63 ","$0.00 ","$0.00 ","$128.56 ","$734.23 ","$0.00 ","$367.11 ","$581.51 ","$587.38 ","$0.00 ","$111.56 ","$0.00 ","$116.89 ","$0.00 "
"440.515","SUP","HCPCS C1713","","440.515  -  PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD","BOTH IP/OP","$1,396.15 ","$1,033.15 ","$0.00 ","$1,396.15 ","$628.27 ","$0.00 ","$290.99 ","$0.00 ","$0.00 ","$244.45 ","$1,396.15 ","$0.00 ","$698.08 ","$1,105.75 ","$1,116.92 ","$0.00 ","$212.13 ","$0.00 ","$222.27 ","$0.00 "
"440.517","SUP","HCPCS C1713","","440.517  -  PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD","BOTH IP/OP","$1,495.78 ","$1,106.88 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$311.76 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"440.519","SUP","HCPCS C1713","","440.519  -  PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD","BOTH IP/OP","$1,604.95 ","$1,187.66 ","$0.00 ","$1,604.95 ","$722.23 ","$0.00 ","$334.51 ","$0.00 ","$0.00 ","$281.01 ","$1,604.95 ","$0.00 ","$802.48 ","$1,271.12 ","$1,283.96 ","$0.00 ","$243.86 ","$0.00 ","$255.51 ","$0.00 "
"440.521","SUP","HCPCS C1713","","440.521  -  PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL","BOTH IP/OP","$1,708.68 ","$1,264.42 ","$0.00 ","$1,708.68 ","$768.90 ","$0.00 ","$356.13 ","$0.00 ","$0.00 ","$299.18 ","$1,708.68 ","$0.00 ","$854.34 ","$1,353.27 ","$1,366.94 ","$0.00 ","$259.62 ","$0.00 ","$272.02 ","$0.00 "
"440.523","SUP","HCPCS C1713","","440.523  -  PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL","BOTH IP/OP","$1,776.90 ","$1,314.91 ","$0.00 ","$1,776.90 ","$799.61 ","$0.00 ","$370.35 ","$0.00 ","$0.00 ","$311.12 ","$1,776.90 ","$0.00 ","$888.45 ","$1,407.30 ","$1,421.52 ","$0.00 ","$269.99 ","$0.00 ","$282.88 ","$0.00 "
"440.525","SUP","HCPCS C1713","","440.525  -  PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD","BOTH IP/OP","$1,396.15 ","$1,033.15 ","$0.00 ","$1,396.15 ","$628.27 ","$0.00 ","$290.99 ","$0.00 ","$0.00 ","$244.45 ","$1,396.15 ","$0.00 ","$698.08 ","$1,105.75 ","$1,116.92 ","$0.00 ","$212.13 ","$0.00 ","$222.27 ","$0.00 "
"440.527","SUP","HCPCS C1713","","440.527  -  PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD","BOTH IP/OP","$1,495.78 ","$1,106.88 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$311.76 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"440.529","SUP","HCPCS C1713","","440.529  -  PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD","BOTH IP/OP","$1,604.95 ","$1,187.66 ","$0.00 ","$1,604.95 ","$722.23 ","$0.00 ","$334.51 ","$0.00 ","$0.00 ","$281.01 ","$1,604.95 ","$0.00 ","$802.48 ","$1,271.12 ","$1,283.96 ","$0.00 ","$243.86 ","$0.00 ","$255.51 ","$0.00 "
"440.531","SUP","HCPCS C1713","","440.531  -  PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL","BOTH IP/OP","$1,708.68 ","$1,264.42 ","$0.00 ","$1,708.68 ","$768.90 ","$0.00 ","$356.13 ","$0.00 ","$0.00 ","$299.18 ","$1,708.68 ","$0.00 ","$854.34 ","$1,353.27 ","$1,366.94 ","$0.00 ","$259.62 ","$0.00 ","$272.02 ","$0.00 "
"440.533","SUP","HCPCS C1713","","440.533  -  PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL","BOTH IP/OP","$1,776.90 ","$1,314.91 ","$0.00 ","$1,776.90 ","$799.61 ","$0.00 ","$370.35 ","$0.00 ","$0.00 ","$311.12 ","$1,776.90 ","$0.00 ","$888.45 ","$1,407.30 ","$1,421.52 ","$0.00 ","$269.99 ","$0.00 ","$282.88 ","$0.00 "
"440.54","SUP","HCPCS C1713","","440.54  -  PLATE BN ANG RT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI","BOTH IP/OP","$754.70 ","$558.48 ","$0.00 ","$754.70 ","$339.62 ","$0.00 ","$157.30 ","$0.00 ","$0.00 ","$132.14 ","$754.70 ","$0.00 ","$377.35 ","$597.72 ","$603.76 ","$0.00 ","$114.67 ","$0.00 ","$120.15 ","$0.00 "
"440.547","SUP","HCPCS C1713","","440.547  -  PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,695.03 ","$1,254.32 ","$0.00 ","$1,695.03 ","$762.76 ","$0.00 ","$353.29 ","$0.00 ","$0.00 ","$296.79 ","$1,695.03 ","$0.00 ","$847.51 ","$1,342.46 ","$1,356.02 ","$0.00 ","$257.54 ","$0.00 ","$269.85 ","$0.00 "
"440.549","SUP","HCPCS C1713","","440.549  -  PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,744.15 ","$1,290.67 ","$0.00 ","$1,744.15 ","$784.87 ","$0.00 ","$363.52 ","$0.00 ","$0.00 ","$305.39 ","$1,744.15 ","$0.00 ","$872.08 ","$1,381.37 ","$1,395.32 ","$0.00 ","$265.01 ","$0.00 ","$277.67 ","$0.00 "
"440.551","SUP","HCPCS C1713","","440.551  -  PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,786.45 ","$1,321.97 ","$0.00 ","$1,786.45 ","$803.90 ","$0.00 ","$372.34 ","$0.00 ","$0.00 ","$312.79 ","$1,786.45 ","$0.00 ","$893.23 ","$1,414.87 ","$1,429.16 ","$0.00 ","$271.44 ","$0.00 ","$284.40 ","$0.00 "
"440.553","SUP","HCPCS C1713","","440.553  -  PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,845.15 ","$1,365.41 ","$0.00 ","$1,845.15 ","$830.32 ","$0.00 ","$384.58 ","$0.00 ","$0.00 ","$323.07 ","$1,845.15 ","$0.00 ","$922.58 ","$1,461.36 ","$1,476.12 ","$0.00 ","$280.35 ","$0.00 ","$293.75 ","$0.00 "
"440.555","SUP","HCPCS C1713","","440.555  -  PLATE BONE 321MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,918.85 ","$1,419.95 ","$0.00 ","$1,918.85 ","$863.48 ","$0.00 ","$399.94 ","$0.00 ","$0.00 ","$335.98 ","$1,918.85 ","$0.00 ","$959.43 ","$1,519.73 ","$1,535.08 ","$0.00 ","$291.55 ","$0.00 ","$305.48 ","$0.00 "
"440.567","SUP","HCPCS C1713","","440.567  -  PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,695.03 ","$1,254.32 ","$0.00 ","$1,695.03 ","$762.76 ","$0.00 ","$353.29 ","$0.00 ","$0.00 ","$296.79 ","$1,695.03 ","$0.00 ","$847.51 ","$1,342.46 ","$1,356.02 ","$0.00 ","$257.54 ","$0.00 ","$269.85 ","$0.00 "
"440.569","SUP","HCPCS C1713","","440.569  -  PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,696.38 ","$1,255.32 ","$0.00 ","$1,696.38 ","$763.37 ","$0.00 ","$353.57 ","$0.00 ","$0.00 ","$297.02 ","$1,696.38 ","$0.00 ","$848.19 ","$1,343.53 ","$1,357.10 ","$0.00 ","$257.75 ","$0.00 ","$270.06 ","$0.00 "
"440.571","SUP","HCPCS C1713","","440.571  -  PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,786.45 ","$1,321.97 ","$0.00 ","$1,786.45 ","$803.90 ","$0.00 ","$372.34 ","$0.00 ","$0.00 ","$312.79 ","$1,786.45 ","$0.00 ","$893.23 ","$1,414.87 ","$1,429.16 ","$0.00 ","$271.44 ","$0.00 ","$284.40 ","$0.00 "
"440.573","SUP","HCPCS C1713","","440.573  -  PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,791.40 ","$1,325.64 ","$0.00 ","$1,791.40 ","$806.13 ","$0.00 ","$373.37 ","$0.00 ","$0.00 ","$313.66 ","$1,791.40 ","$0.00 ","$895.70 ","$1,418.79 ","$1,433.12 ","$0.00 ","$280.35 ","$0.00 ","$285.19 ","$0.00 "
"440.575","SUP","HCPCS C1713","","440.575  -  PLATE BONE 321MM 15 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE","BOTH IP/OP","$1,862.95 ","$1,378.58 ","$0.00 ","$1,862.95 ","$838.33 ","$0.00 ","$388.29 ","$0.00 ","$0.00 ","$326.19 ","$1,862.95 ","$0.00 ","$931.48 ","$1,475.46 ","$1,490.36 ","$0.00 ","$291.55 ","$0.00 ","$296.58 ","$0.00 "
"440.831","SUP","HCPCS C1713","","440.831  -  PLATE BONE SMALL 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL","BOTH IP/OP","$2,445.90 ","$1,809.97 ","$0.00 ","$2,374.68 ","$1,068.60 ","$0.00 ","$509.79 ","$0.00 ","$0.00 ","$415.79 ","$2,374.68 ","$0.00 ","$1,187.34 ","$1,880.75 ","$1,899.74 ","$0.00 ","$360.81 ","$0.00 ","$378.05 ","$0.00 "
"440.834","SUP","HCPCS C1713","","440.834  -  PLATE BONE 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL","BOTH IP/OP","$2,445.90 ","$1,809.97 ","$0.00 ","$2,374.68 ","$1,068.60 ","$0.00 ","$509.79 ","$0.00 ","$0.00 ","$415.79 ","$2,374.68 ","$0.00 ","$1,187.34 ","$1,880.75 ","$1,899.74 ","$0.00 ","$360.81 ","$0.00 ","$378.05 ","$0.00 "
"440.843","SUP","HCPCS C1713","","440.843  -  PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA RIGHT LATERAL","BOTH IP/OP","$2,445.90 ","$1,809.97 ","$0.00 ","$2,374.68 ","$1,068.60 ","$0.00 ","$509.79 ","$0.00 ","$0.00 ","$415.79 ","$2,374.68 ","$0.00 ","$1,187.34 ","$1,880.75 ","$1,899.74 ","$0.00 ","$360.81 ","$0.00 ","$378.05 ","$0.00 "
"440.853","SUP","HCPCS C1713","","440.853  -  PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA LEFT LATERAL","BOTH IP/OP","$2,445.90 ","$1,809.97 ","$0.00 ","$2,374.68 ","$1,068.60 ","$0.00 ","$509.79 ","$0.00 ","$0.00 ","$415.79 ","$2,374.68 ","$0.00 ","$1,187.34 ","$1,880.75 ","$1,899.74 ","$0.00 ","$360.81 ","$0.00 ","$378.05 ","$0.00 "
"440.864","SUP","HCPCS C1713","","440.864  -  PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$2,445.90 ","$1,809.97 ","$0.00 ","$2,374.68 ","$1,068.60 ","$0.00 ","$509.79 ","$0.00 ","$0.00 ","$415.79 ","$2,374.68 ","$0.00 ","$1,187.34 ","$1,880.75 ","$1,899.74 ","$0.00 ","$360.81 ","$0.00 ","$378.05 ","$0.00 "
"440.874","SUP","HCPCS C1713","","440.874  -  PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR LEFT DISTAL LATERAL","BOTH IP/OP","$2,445.90 ","$1,809.97 ","$0.00 ","$2,374.68 ","$1,068.60 ","$0.00 ","$509.79 ","$0.00 ","$0.00 ","$415.79 ","$2,374.68 ","$0.00 ","$1,187.34 ","$1,880.75 ","$1,899.74 ","$0.00 ","$360.81 ","$0.00 ","$378.05 ","$0.00 "
"440.885","SUP","HCPCS C1713","","440.885  -  PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM RIGHT MEDIAL DISTAL","BOTH IP/OP","$2,305.50 ","$1,706.07 ","$0.00 ","$2,305.50 ","$1,037.48 ","$0.00 ","$480.52 ","$0.00 ","$0.00 ","$403.67 ","$2,305.50 ","$0.00 ","$1,152.75 ","$1,825.96 ","$1,844.40 ","$0.00 ","$360.81 ","$0.00 ","$367.04 ","$0.00 "
"440.895","SUP","HCPCS C1713","","440.895  -  PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM LEFT MEDIAL DISTAL","BOTH IP/OP","$2,305.50 ","$1,706.07 ","$0.00 ","$2,305.50 ","$1,037.48 ","$0.00 ","$480.52 ","$0.00 ","$0.00 ","$403.67 ","$2,305.50 ","$0.00 ","$1,152.75 ","$1,825.96 ","$1,844.40 ","$0.00 ","$360.81 ","$0.00 ","$367.04 ","$0.00 "
"441.031","SUP","HCPCS C1713","","441.031  -  PLATE BONE T OBLIQUE RIGHT 52X10X1.5MM 3 HOLE HEAD 3 HOLE","BOTH IP/OP","$684.58 ","$506.59 ","$0.00 ","$664.63 ","$299.08 ","$0.00 ","$142.68 ","$0.00 ","$0.00 ","$116.37 ","$664.63 ","$0.00 ","$332.31 ","$526.39 ","$531.70 ","$0.00 ","$100.99 ","$0.00 ","$105.81 ","$0.00 "
"441.041","SUP","HCPCS C1713","","441.041  -  PLATE BONE T OBLIQUE RIGHT 63X10X1.5MM 3 HOLE HEAD 4 HOLE","BOTH IP/OP","$716.90 ","$530.51 ","$0.00 ","$696.03 ","$313.21 ","$0.00 ","$149.42 ","$0.00 ","$0.00 ","$121.87 ","$696.03 ","$0.00 ","$348.01 ","$551.26 ","$556.82 ","$0.00 ","$105.75 ","$0.00 ","$110.81 ","$0.00 "
"441.051","SUP","HCPCS C1713","","441.051  -  PLATE BONE T OBLIQUE RIGHT 74X10X1.5MM 3 HOLE HEAD 5 HOLE","BOTH IP/OP","$747.83 ","$553.39 ","$0.00 ","$726.05 ","$326.72 ","$0.00 ","$155.87 ","$0.00 ","$0.00 ","$127.13 ","$726.05 ","$0.00 ","$363.03 ","$575.03 ","$580.84 ","$0.00 ","$110.32 ","$0.00 ","$115.59 ","$0.00 "
"441.061","SUP","HCPCS C1713","","441.061  -  PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE RIGHT LCP","BOTH IP/OP","$802.65 ","$593.96 ","$0.00 ","$779.28 ","$350.67 ","$0.00 ","$167.29 ","$0.00 ","$0.00 ","$136.44 ","$779.28 ","$0.00 ","$389.64 ","$617.19 ","$623.42 ","$0.00 ","$118.40 ","$0.00 ","$124.06 ","$0.00 "
"441.062","SUP","HCPCS C1713","","441.062  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,307.78 ","$967.76 ","$0.00 ","$1,307.78 ","$588.50 ","$0.00 ","$272.57 ","$0.00 ","$0.00 ","$228.98 ","$1,307.78 ","$0.00 ","$653.89 ","$1,035.76 ","$1,046.22 ","$0.00 ","$204.67 ","$0.00 ","$208.20 ","$0.00 "
"441.063","SUP","HCPCS C1713","","441.063  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,307.78 ","$967.76 ","$0.00 ","$1,307.78 ","$588.50 ","$0.00 ","$272.57 ","$0.00 ","$0.00 ","$228.98 ","$1,307.78 ","$0.00 ","$653.89 ","$1,035.76 ","$1,046.22 ","$0.00 ","$204.67 ","$0.00 ","$208.20 ","$0.00 "
"441.064","SUP","HCPCS C1713","","441.064  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,307.78 ","$967.76 ","$0.00 ","$1,307.78 ","$588.50 ","$0.00 ","$272.57 ","$0.00 ","$0.00 ","$228.98 ","$1,307.78 ","$0.00 ","$653.89 ","$1,035.76 ","$1,046.22 ","$0.00 ","$204.67 ","$0.00 ","$208.20 ","$0.00 "
"441.065","SUP","HCPCS C1713","","441.065  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,307.78 ","$967.76 ","$0.00 ","$1,307.78 ","$588.50 ","$0.00 ","$272.57 ","$0.00 ","$0.00 ","$228.98 ","$1,307.78 ","$0.00 ","$653.89 ","$1,035.76 ","$1,046.22 ","$0.00 ","$204.67 ","$0.00 ","$208.20 ","$0.00 "
"441.066","SUP","HCPCS C1713","","441.066  -  PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,403.18 ","$1,038.35 ","$0.00 ","$1,403.18 ","$631.43 ","$0.00 ","$292.46 ","$0.00 ","$0.00 ","$245.68 ","$1,403.18 ","$0.00 ","$701.59 ","$1,111.32 ","$1,122.54 ","$0.00 ","$219.60 ","$0.00 ","$223.39 ","$0.00 "
"441.067","SUP","HCPCS C1713","","441.067  -  PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,403.18 ","$1,038.35 ","$0.00 ","$1,403.18 ","$631.43 ","$0.00 ","$292.46 ","$0.00 ","$0.00 ","$245.68 ","$1,403.18 ","$0.00 ","$701.59 ","$1,111.32 ","$1,122.54 ","$0.00 ","$219.60 ","$0.00 ","$223.39 ","$0.00 "
"441.068","SUP","HCPCS C1713","","441.068  -  PLATE BN 18MM 3.5MM 77MM NS 8 HL HK TI CLVCL RT 3.5MM 4MM","BOTH IP/OP","$1,403.18 ","$1,038.35 ","$0.00 ","$1,403.18 ","$631.43 ","$0.00 ","$292.46 ","$0.00 ","$0.00 ","$245.68 ","$1,403.18 ","$0.00 ","$701.59 ","$1,111.32 ","$1,122.54 ","$0.00 ","$219.60 ","$0.00 ","$223.39 ","$0.00 "
"441.069","SUP","HCPCS C1713","","441.069  -  PLATE BONE 18MM 77MM 8 HOLE HOOK TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,403.18 ","$1,038.35 ","$0.00 ","$1,403.18 ","$631.43 ","$0.00 ","$292.46 ","$0.00 ","$0.00 ","$245.68 ","$1,403.18 ","$0.00 ","$701.59 ","$1,111.32 ","$1,122.54 ","$0.00 ","$219.60 ","$0.00 ","$223.39 ","$0.00 "
"441.071","SUP","HCPCS C1713","","441.071  -  PLATE BONE T RIGHT OBLIQUE 96MM 7 HOLE SHAFT 3 HOLE HEAD LCP","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"441.081","SUP","HCPCS C1713","","441.081  -  PLATE BONE 107MM 3X8 HOLE T OBLIQUE RIGHT LCP TITANIUM","BOTH IP/OP","$882.78 ","$653.26 ","$0.00 ","$857.08 ","$385.68 ","$0.00 ","$183.99 ","$0.00 ","$0.00 ","$150.07 ","$857.08 ","$0.00 ","$428.54 ","$678.81 ","$685.66 ","$0.00 ","$130.22 ","$0.00 ","$136.45 ","$0.00 "
"441.13","SUP","HCPCS C1713","","441.13  -  PLATE BONE T RIGHT ANG 50X10X1.2MM 3X3 HOLE LC-DCP TITANIUM","BOTH IP/OP","$232.00 ","$171.68 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$48.35 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"441.131","SUP","HCPCS C1713","","441.131  -  PLATE BONE T RIGHT ANG 50X10X1.5MM 3 HOLE HEAD 3 HOLE SHAFT","BOTH IP/OP","$611.48 ","$452.50 ","$0.00 ","$593.68 ","$267.15 ","$0.00 ","$127.45 ","$0.00 ","$0.00 ","$103.95 ","$593.68 ","$0.00 ","$296.84 ","$470.19 ","$474.94 ","$0.00 ","$90.20 ","$0.00 ","$94.51 ","$0.00 "
"441.132","SUP","HCPCS C1713","","441.132  -  PLATE BONE 50MM 4 HEAD HOLE 3 SHAFT HOLE T RIGHT ANG LCP","BOTH IP/OP","$629.75 ","$466.02 ","$0.00 ","$611.40 ","$275.13 ","$0.00 ","$131.26 ","$0.00 ","$0.00 ","$107.05 ","$611.40 ","$0.00 ","$305.70 ","$484.23 ","$489.12 ","$0.00 ","$92.90 ","$0.00 ","$97.33 ","$0.00 "
"441.14","SUP","HCPCS C1713","","441.14  -  PLATE BONE 3.5MM 56MM T 4 HEAD HOLE 4 SHAFT HOLE RIGHT ANG","BOTH IP/OP","$240.20 ","$177.75 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$50.06 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"441.141","SUP","HCPCS C1713","","441.141  -  PLATE BONE T RIGHT ANG 56X11X1.5MM 4 HOLE HEAD 4 HOLE SHAFT","BOTH IP/OP","$631.15 ","$467.05 ","$0.00 ","$612.78 ","$275.75 ","$0.00 ","$131.55 ","$0.00 ","$0.00 ","$107.29 ","$612.78 ","$0.00 ","$306.39 ","$485.32 ","$490.22 ","$0.00 ","$93.11 ","$0.00 ","$97.55 ","$0.00 "
"441.142","SUP","HCPCS C1713","","441.142  -  PLATE BONE 57MM 3 HOLE HEAD 4 HOLE SHAFT T RIGHT ANG LCP","BOTH IP/OP","$650.83 ","$481.61 ","$0.00 ","$631.88 ","$284.34 ","$0.00 ","$135.65 ","$0.00 ","$0.00 ","$110.64 ","$631.88 ","$0.00 ","$315.94 ","$500.45 ","$505.50 ","$0.00 ","$96.01 ","$0.00 ","$100.59 ","$0.00 "
"441.15","SUP","HCPCS C1713","","441.15  -  PLATE BONE T RIGHT ANG 67X10X1.2MM 3X5 HOLE LC-DCP TITANIUM","BOTH IP/OP","$266.13 ","$196.94 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$55.47 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"441.151","SUP","HCPCS C1713","","441.151  -  PLATE BONE T RIGHT ANG 67X10X1.5MM 3 HOLE HEAD 5 HOLE SHAFT","BOTH IP/OP","$694.40 ","$513.86 ","$0.00 ","$674.18 ","$303.38 ","$0.00 ","$144.73 ","$0.00 ","$0.00 ","$118.04 ","$674.18 ","$0.00 ","$337.09 ","$533.95 ","$539.34 ","$0.00 ","$102.44 ","$0.00 ","$107.33 ","$0.00 "
"441.152","SUP","HCPCS C1713","","441.152  -  PLATE BONE 67MM 4 HEAD HOLE 5 SHAFT HOLE T RIGHT ANG LCP","BOTH IP/OP","$715.50 ","$529.47 ","$0.00 ","$694.65 ","$312.59 ","$0.00 ","$149.13 ","$0.00 ","$0.00 ","$121.63 ","$694.65 ","$0.00 ","$347.33 ","$550.16 ","$555.72 ","$0.00 ","$105.55 ","$0.00 ","$110.59 ","$0.00 "
"441.16","SUP","HCPCS C1713","","441.16  -  PLATE BONE T RIGHT ANG 78X10X1.2MM 4X6 HOLE LC-DCP TITANIUM","BOTH IP/OP","$302.10 ","$223.55 ","$0.00 ","$302.10 ","$135.95 ","$0.00 ","$62.97 ","$0.00 ","$0.00 ","$52.90 ","$302.10 ","$0.00 ","$151.05 ","$239.26 ","$241.68 ","$0.00 ","$47.28 ","$0.00 ","$48.09 ","$0.00 "
"441.161","SUP","HCPCS C1713","","441.161  -  PLATE BONE T RIGHT ANG 78X11X1.5MM 4 HOLE HEAD 6 HOLE SHAFT","BOTH IP/OP","$809.68 ","$599.16 ","$0.00 ","$786.10 ","$353.75 ","$0.00 ","$168.76 ","$0.00 ","$0.00 ","$137.64 ","$786.10 ","$0.00 ","$393.05 ","$622.59 ","$628.88 ","$0.00 ","$119.44 ","$0.00 ","$125.15 ","$0.00 "
"441.162","SUP","HCPCS C1713","","441.162  -  PLATE BONE 77MM 3 HOLE HEAD 6 HOLE SHAFT T RIGHT ANG LCP","BOTH IP/OP","$830.78 ","$614.78 ","$0.00 ","$806.58 ","$362.96 ","$0.00 ","$173.15 ","$0.00 ","$0.00 ","$141.22 ","$806.58 ","$0.00 ","$403.29 ","$638.81 ","$645.26 ","$0.00 ","$122.55 ","$0.00 ","$128.41 ","$0.00 "
"441.171","SUP","HCPCS C1713","","441.171  -  PLATE BONE T RIGHT ANG 87X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT","BOTH IP/OP","$1,014.90 ","$751.03 ","$0.00 ","$985.35 ","$443.41 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$172.53 ","$985.35 ","$0.00 ","$492.68 ","$780.40 ","$788.28 ","$0.00 ","$149.72 ","$0.00 ","$156.87 ","$0.00 "
"441.172","SUP","HCPCS C1713","","441.172  -  PLATE BONE 89MM 4 HOLE HEAD 7 HOLE SHAFT T RIGHT ANG LCP","BOTH IP/OP","$1,041.63 ","$770.81 ","$0.00 ","$1,011.28 ","$455.07 ","$0.00 ","$217.10 ","$0.00 ","$0.00 ","$177.07 ","$1,011.28 ","$0.00 ","$505.64 ","$800.93 ","$809.02 ","$0.00 ","$153.66 ","$0.00 ","$160.99 ","$0.00 "
"441.181","SUP","HCPCS C1713","","441.181  -  PLATE BONE 97MM 3 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP","BOTH IP/OP","$1,214.53 ","$898.75 ","$0.00 ","$1,179.15 ","$530.62 ","$0.00 ","$253.14 ","$0.00 ","$0.00 ","$206.46 ","$1,179.15 ","$0.00 ","$589.58 ","$933.89 ","$943.32 ","$0.00 ","$179.16 ","$0.00 ","$187.72 ","$0.00 "
"441.182","SUP","HCPCS C1713","","441.182  -  PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP","BOTH IP/OP","$1,210.30 ","$895.62 ","$0.00 ","$1,175.05 ","$528.77 ","$0.00 ","$252.26 ","$0.00 ","$0.00 ","$205.74 ","$1,175.05 ","$0.00 ","$587.53 ","$930.64 ","$940.04 ","$0.00 ","$178.54 ","$0.00 ","$187.07 ","$0.00 "
"441.23","SUP","HCPCS C1713","","441.23  -  PLATE BONE T OBLIQUE 53X10X1.2MM 3X3 HOLE LC-DCP TITANIUM","BOTH IP/OP","$398.50 ","$294.89 ","$0.00 ","$398.50 ","$179.33 ","$0.00 ","$83.06 ","$0.00 ","$0.00 ","$69.77 ","$398.50 ","$0.00 ","$199.25 ","$315.61 ","$318.80 ","$0.00 ","$60.55 ","$0.00 ","$63.44 ","$0.00 "
"441.24","SUP","HCPCS C1713","","441.24  -  PLATE BONE T OBLIQUE 63X10X1.2MM 3X4 HOLE LC-DCP TITANIUM","BOTH IP/OP","$423.08 ","$313.08 ","$0.00 ","$423.08 ","$190.38 ","$0.00 ","$88.18 ","$0.00 ","$0.00 ","$74.08 ","$423.08 ","$0.00 ","$211.54 ","$335.08 ","$338.46 ","$0.00 ","$64.28 ","$0.00 ","$67.35 ","$0.00 "
"441.25","SUP","HCPCS C1713","","441.25  -  PLATE BN T OBLQ 75X10X1.5MM LC DCP 3 HLE/HD 5 HL SHFT TI 3.5","BOTH IP/OP","$435.35 ","$322.16 ","$0.00 ","$435.35 ","$195.91 ","$0.00 ","$90.74 ","$0.00 ","$0.00 ","$76.23 ","$435.35 ","$0.00 ","$217.68 ","$344.80 ","$348.28 ","$0.00 ","$66.15 ","$0.00 ","$69.31 ","$0.00 "
"441.262","SUP","HCPCS C1713","","441.262  -  PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT","BOTH IP/OP","$1,790.85 ","$1,325.23 ","$0.00 ","$1,738.70 ","$782.42 ","$0.00 ","$373.26 ","$0.00 ","$0.00 ","$304.43 ","$1,738.70 ","$0.00 ","$869.35 ","$1,377.05 ","$1,390.96 ","$0.00 ","$264.18 ","$0.00 ","$276.80 ","$0.00 "
"441.263","SUP","HCPCS C1713","","441.263  -  PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT","BOTH IP/OP","$1,790.85 ","$1,325.23 ","$0.00 ","$1,738.70 ","$782.42 ","$0.00 ","$373.26 ","$0.00 ","$0.00 ","$304.43 ","$1,738.70 ","$0.00 ","$869.35 ","$1,377.05 ","$1,390.96 ","$0.00 ","$264.18 ","$0.00 ","$276.80 ","$0.00 "
"441.264","SUP","HCPCS C1713","","441.264  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL","BOTH IP/OP","$1,986.25 ","$1,469.83 ","$0.00 ","$1,928.40 ","$867.78 ","$0.00 ","$413.98 ","$0.00 ","$0.00 ","$337.65 ","$1,928.40 ","$0.00 ","$964.20 ","$1,527.29 ","$1,542.72 ","$0.00 ","$293.00 ","$0.00 ","$307.00 ","$0.00 "
"441.265","SUP","HCPCS C1713","","441.265  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL","BOTH IP/OP","$1,986.25 ","$1,469.83 ","$0.00 ","$1,928.40 ","$867.78 ","$0.00 ","$413.98 ","$0.00 ","$0.00 ","$337.65 ","$1,928.40 ","$0.00 ","$964.20 ","$1,527.29 ","$1,542.72 ","$0.00 ","$293.00 ","$0.00 ","$307.00 ","$0.00 "
"441.266","SUP","HCPCS C1713","","441.266  -  PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT","BOTH IP/OP","$2,184.45 ","$1,616.49 ","$0.00 ","$2,120.83 ","$954.37 ","$0.00 ","$455.29 ","$0.00 ","$0.00 ","$371.34 ","$2,120.83 ","$0.00 ","$1,060.41 ","$1,679.70 ","$1,696.66 ","$0.00 ","$322.24 ","$0.00 ","$337.64 ","$0.00 "
"441.267","SUP","HCPCS C1713","","441.267  -  PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT","BOTH IP/OP","$2,184.45 ","$1,616.49 ","$0.00 ","$2,120.83 ","$954.37 ","$0.00 ","$455.29 ","$0.00 ","$0.00 ","$371.34 ","$2,120.83 ","$0.00 ","$1,060.41 ","$1,679.70 ","$1,696.66 ","$0.00 ","$322.24 ","$0.00 ","$337.64 ","$0.00 "
"441.268","SUP","HCPCS C1713","","441.268  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL","BOTH IP/OP","$2,358.75 ","$1,745.48 ","$0.00 ","$2,290.05 ","$1,030.52 ","$0.00 ","$491.62 ","$0.00 ","$0.00 ","$400.97 ","$2,290.05 ","$0.00 ","$1,145.03 ","$1,813.72 ","$1,832.04 ","$0.00 ","$347.95 ","$0.00 ","$364.58 ","$0.00 "
"441.269","SUP","HCPCS C1713","","441.269  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL","BOTH IP/OP","$2,358.75 ","$1,745.48 ","$0.00 ","$2,290.05 ","$1,030.52 ","$0.00 ","$491.62 ","$0.00 ","$0.00 ","$400.97 ","$2,290.05 ","$0.00 ","$1,145.03 ","$1,813.72 ","$1,832.04 ","$0.00 ","$347.95 ","$0.00 ","$364.58 ","$0.00 "
"441.272","SUP","HCPCS C1713","","441.272  -  PLATE BONE 55MM 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS","BOTH IP/OP","$2,053.73 ","$1,519.76 ","$0.00 ","$1,993.90 ","$897.26 ","$0.00 ","$428.05 ","$0.00 ","$0.00 ","$349.12 ","$1,993.90 ","$0.00 ","$996.95 ","$1,579.17 ","$1,595.12 ","$0.00 ","$302.96 ","$0.00 ","$317.43 ","$0.00 "
"441.273","SUP","HCPCS C1713","","441.273  -  PLATE BONE 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT","BOTH IP/OP","$2,053.73 ","$1,519.76 ","$0.00 ","$1,993.90 ","$897.26 ","$0.00 ","$428.05 ","$0.00 ","$0.00 ","$349.12 ","$1,993.90 ","$0.00 ","$996.95 ","$1,579.17 ","$1,595.12 ","$0.00 ","$302.96 ","$0.00 ","$317.43 ","$0.00 "
"441.274","SUP","HCPCS C1713","","441.274  -  PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT","BOTH IP/OP","$2,239.28 ","$1,657.07 ","$0.00 ","$2,174.05 ","$978.32 ","$0.00 ","$466.72 ","$0.00 ","$0.00 ","$380.66 ","$2,174.05 ","$0.00 ","$1,087.03 ","$1,721.85 ","$1,739.24 ","$0.00 ","$330.33 ","$0.00 ","$346.11 ","$0.00 "
"441.275","SUP","HCPCS C1713","","441.275  -  PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT","BOTH IP/OP","$2,239.28 ","$1,657.07 ","$0.00 ","$2,174.05 ","$978.32 ","$0.00 ","$466.72 ","$0.00 ","$0.00 ","$380.66 ","$2,174.05 ","$0.00 ","$1,087.03 ","$1,721.85 ","$1,739.24 ","$0.00 ","$330.33 ","$0.00 ","$346.11 ","$0.00 "
"441.276","SUP","HCPCS C1713","","441.276  -  PLATE BONE 116MM 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS","BOTH IP/OP","$2,426.23 ","$1,795.41 ","$0.00 ","$2,355.55 ","$1,060.00 ","$0.00 ","$505.69 ","$0.00 ","$0.00 ","$412.44 ","$2,355.55 ","$0.00 ","$1,177.78 ","$1,865.60 ","$1,884.44 ","$0.00 ","$357.91 ","$0.00 ","$375.00 ","$0.00 "
"441.277","SUP","HCPCS C1713","","441.277  -  PLATE BONE 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT","BOTH IP/OP","$2,426.23 ","$1,795.41 ","$0.00 ","$2,355.55 ","$1,060.00 ","$0.00 ","$505.69 ","$0.00 ","$0.00 ","$412.44 ","$2,355.55 ","$0.00 ","$1,177.78 ","$1,865.60 ","$1,884.44 ","$0.00 ","$357.91 ","$0.00 ","$375.00 ","$0.00 "
"441.278","SUP","HCPCS C1713","","441.278  -  PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT","BOTH IP/OP","$2,632.85 ","$1,948.31 ","$0.00 ","$2,556.18 ","$1,150.28 ","$0.00 ","$548.75 ","$0.00 ","$0.00 ","$447.57 ","$2,556.18 ","$0.00 ","$1,278.09 ","$2,024.49 ","$2,044.94 ","$0.00 ","$388.39 ","$0.00 ","$406.94 ","$0.00 "
"441.279","SUP","HCPCS C1713","","441.279  -  PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT","BOTH IP/OP","$2,632.85 ","$1,948.31 ","$0.00 ","$2,556.18 ","$1,150.28 ","$0.00 ","$548.75 ","$0.00 ","$0.00 ","$447.57 ","$2,556.18 ","$0.00 ","$1,278.09 ","$2,024.49 ","$2,044.94 ","$0.00 ","$388.39 ","$0.00 ","$406.94 ","$0.00 "
"441.282","SUP","HCPCS C1713","","441.282  -  PLATE BONE 3 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL","BOTH IP/OP","$1,790.85 ","$1,325.23 ","$0.00 ","$1,738.70 ","$782.42 ","$0.00 ","$373.26 ","$0.00 ","$0.00 ","$304.43 ","$1,738.70 ","$0.00 ","$869.35 ","$1,377.05 ","$1,390.96 ","$0.00 ","$264.18 ","$0.00 ","$276.80 ","$0.00 "
"441.283","SUP","HCPCS C1713","","441.283  -  PLATE BONE 58MM 3 HOLE LCP TITANIUM HUMERUS LEFT DISTAL","BOTH IP/OP","$1,790.85 ","$1,325.23 ","$0.00 ","$1,738.70 ","$782.42 ","$0.00 ","$373.26 ","$0.00 ","$0.00 ","$304.43 ","$1,738.70 ","$0.00 ","$869.35 ","$1,377.05 ","$1,390.96 ","$0.00 ","$264.18 ","$0.00 ","$276.80 ","$0.00 "
"441.284","SUP","HCPCS C1713","","441.284  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL MEDIAL","BOTH IP/OP","$1,986.25 ","$1,469.83 ","$0.00 ","$1,928.40 ","$867.78 ","$0.00 ","$413.98 ","$0.00 ","$0.00 ","$337.65 ","$1,928.40 ","$0.00 ","$964.20 ","$1,527.29 ","$1,542.72 ","$0.00 ","$293.00 ","$0.00 ","$307.00 ","$0.00 "
"441.285","SUP","HCPCS C1713","","441.285  -  PLATE BONE 83MM 5 HOLE LCP TITANIUM HUMERUS LEFT DISTAL","BOTH IP/OP","$1,986.25 ","$1,469.83 ","$0.00 ","$1,928.40 ","$867.78 ","$0.00 ","$413.98 ","$0.00 ","$0.00 ","$337.65 ","$1,928.40 ","$0.00 ","$964.20 ","$1,527.29 ","$1,542.72 ","$0.00 ","$293.00 ","$0.00 ","$307.00 ","$0.00 "
"441.286","SUP","HCPCS C1713","","441.286  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL","BOTH IP/OP","$2,184.45 ","$1,616.49 ","$0.00 ","$2,120.83 ","$954.37 ","$0.00 ","$455.29 ","$0.00 ","$0.00 ","$371.34 ","$2,120.83 ","$0.00 ","$1,060.41 ","$1,679.70 ","$1,696.66 ","$0.00 ","$322.24 ","$0.00 ","$337.64 ","$0.00 "
"441.287","SUP","HCPCS C1713","","441.287  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT","BOTH IP/OP","$2,184.45 ","$1,616.49 ","$0.00 ","$2,120.83 ","$954.37 ","$0.00 ","$455.29 ","$0.00 ","$0.00 ","$371.34 ","$2,120.83 ","$0.00 ","$1,060.41 ","$1,679.70 ","$1,696.66 ","$0.00 ","$322.24 ","$0.00 ","$337.64 ","$0.00 "
"441.288","SUP","HCPCS C1713","","441.288  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL","BOTH IP/OP","$2,358.75 ","$1,745.48 ","$0.00 ","$2,290.05 ","$1,030.52 ","$0.00 ","$491.62 ","$0.00 ","$0.00 ","$400.97 ","$2,290.05 ","$0.00 ","$1,145.03 ","$1,813.72 ","$1,832.04 ","$0.00 ","$347.95 ","$0.00 ","$364.58 ","$0.00 "
"441.289","SUP","HCPCS C1713","","441.289  -  PLATE BONE 136MM 9 HOLE LCP TITANIUM HUMERUS LEFT DISTAL","BOTH IP/OP","$2,358.75 ","$1,745.48 ","$0.00 ","$2,290.05 ","$1,030.52 ","$0.00 ","$491.62 ","$0.00 ","$0.00 ","$400.97 ","$2,290.05 ","$0.00 ","$1,145.03 ","$1,813.72 ","$1,832.04 ","$0.00 ","$347.95 ","$0.00 ","$364.58 ","$0.00 "
"441.3","SUP","HCPCS C1713","","441.300  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL","BOTH IP/OP","$2,355.55 ","$1,743.11 ","$0.00 ","$2,355.55 ","$1,060.00 ","$0.00 ","$490.96 ","$0.00 ","$0.00 ","$412.44 ","$2,355.55 ","$0.00 ","$1,177.78 ","$1,865.60 ","$1,884.44 ","$0.00 ","$357.91 ","$0.00 ","$375.00 ","$0.00 "
"441.301","SUP","HCPCS C1713","","441.301  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL","BOTH IP/OP","$2,426.23 ","$1,795.41 ","$0.00 ","$2,355.55 ","$1,060.00 ","$0.00 ","$505.69 ","$0.00 ","$0.00 ","$412.44 ","$2,355.55 ","$0.00 ","$1,177.78 ","$1,865.60 ","$1,884.44 ","$0.00 ","$357.91 ","$0.00 ","$375.00 ","$0.00 "
"441.302","SUP","HCPCS C1713","","441.302  -  PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS","BOTH IP/OP","$2,565.40 ","$1,898.40 ","$0.00 ","$2,490.68 ","$1,120.80 ","$0.00 ","$534.69 ","$0.00 ","$0.00 ","$436.10 ","$2,490.68 ","$0.00 ","$1,245.34 ","$1,972.62 ","$1,992.54 ","$0.00 ","$378.44 ","$0.00 ","$396.52 ","$0.00 "
"441.303","SUP","HCPCS C1713","","441.303  -  PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT","BOTH IP/OP","$2,565.40 ","$1,898.40 ","$0.00 ","$2,490.68 ","$1,120.80 ","$0.00 ","$534.69 ","$0.00 ","$0.00 ","$436.10 ","$2,490.68 ","$0.00 ","$1,245.34 ","$1,972.62 ","$1,992.54 ","$0.00 ","$378.44 ","$0.00 ","$396.52 ","$0.00 "
"441.304","SUP","HCPCS C1713","","441.304  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL","BOTH IP/OP","$2,426.23 ","$1,795.41 ","$0.00 ","$2,355.55 ","$1,060.00 ","$0.00 ","$505.69 ","$0.00 ","$0.00 ","$412.44 ","$2,355.55 ","$0.00 ","$1,177.78 ","$1,865.60 ","$1,884.44 ","$0.00 ","$357.91 ","$0.00 ","$375.00 ","$0.00 "
"441.305","SUP","HCPCS C1713","","441.305  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT DISTAL MEDIAL","BOTH IP/OP","$2,426.23 ","$1,795.41 ","$0.00 ","$2,355.55 ","$1,060.00 ","$0.00 ","$505.69 ","$0.00 ","$0.00 ","$412.44 ","$2,355.55 ","$0.00 ","$1,177.78 ","$1,865.60 ","$1,884.44 ","$0.00 ","$357.91 ","$0.00 ","$375.00 ","$0.00 "
"441.32","SUP","HCPCS C1713","","441.32  -  PLATE BONE 25X9X1MM 2 HOLE 1/3 TUBULAR COLLAR LC-DCP","BOTH IP/OP","$108.25 ","$80.11 ","$0.00 ","$105.08 ","$47.28 ","$0.00 ","$22.56 ","$0.00 ","$0.00 ","$18.40 ","$105.08 ","$0.00 ","$52.54 ","$83.22 ","$84.06 ","$0.00 ","$15.97 ","$0.00 ","$16.73 ","$0.00 "
"441.33","SUP","HCPCS C1713","","441.33  -  PLATE BONE 1/3 TUBULAR 37X9X1MM .5MM 3 HOLE COLLAR LC-DCP","BOTH IP/OP","$111.05 ","$82.18 ","$0.00 ","$107.83 ","$48.52 ","$0.00 ","$23.15 ","$0.00 ","$0.00 ","$18.88 ","$107.83 ","$0.00 ","$53.91 ","$85.40 ","$86.26 ","$0.00 ","$16.38 ","$0.00 ","$17.17 ","$0.00 "
"441.331","SUP","HCPCS C1713","","441.331  -  PLATE BONE 33MM 3 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM","BOTH IP/OP","$274.10 ","$202.83 ","$0.00 ","$266.13 ","$119.76 ","$0.00 ","$57.13 ","$0.00 ","$0.00 ","$46.60 ","$266.13 ","$0.00 ","$133.06 ","$210.77 ","$212.90 ","$0.00 ","$40.44 ","$0.00 ","$42.37 ","$0.00 "
"441.34","SUP","HCPCS C1713","","441.34  -  PLATE BONE 1/3 TUBULAR 49X9X1MM .5MM 4 HOLE COLLAR LC-DCP","BOTH IP/OP","$130.73 ","$96.74 ","$0.00 ","$126.93 ","$57.12 ","$0.00 ","$27.25 ","$0.00 ","$0.00 ","$22.22 ","$126.93 ","$0.00 ","$63.46 ","$100.53 ","$101.54 ","$0.00 ","$19.28 ","$0.00 ","$20.21 ","$0.00 "
"441.341","SUP","HCPCS C1713","","441.341  -  PLATE BONE 45MM 4 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM","BOTH IP/OP","$316.28 ","$234.05 ","$0.00 ","$307.08 ","$138.18 ","$0.00 ","$65.92 ","$0.00 ","$0.00 ","$53.77 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$46.66 ","$0.00 ","$48.89 ","$0.00 "
"441.35","SUP","HCPCS C1713","","441.35  -  PLATE BONE 61X9X1MM 5 HOLE 1/3 TUBULAR COLLAR LC-DCP","BOTH IP/OP","$130.73 ","$96.74 ","$0.00 ","$126.93 ","$57.12 ","$0.00 ","$27.25 ","$0.00 ","$0.00 ","$22.22 ","$126.93 ","$0.00 ","$63.46 ","$100.53 ","$101.54 ","$0.00 ","$19.28 ","$0.00 ","$20.21 ","$0.00 "
"441.351","SUP","HCPCS C1713","","441.351  -  PLATE BONE 1/3 TUBULAR 57X9X1MM 5 HOLE COLLAR LCP TITANIUM","BOTH IP/OP","$316.28 ","$234.05 ","$0.00 ","$307.08 ","$138.18 ","$0.00 ","$65.92 ","$0.00 ","$0.00 ","$53.77 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$61.59 ","$0.00 ","$48.89 ","$0.00 "
"441.36","SUP","HCPCS C1713","","441.36  -  PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR TI 3.5MM","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$59.25 ","$0.00 ","$28.27 ","$0.00 ","$0.00 ","$23.06 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$20.01 ","$0.00 ","$20.96 ","$0.00 "
"441.361","SUP","HCPCS C1713","","441.361  -  PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR TI","BOTH IP/OP","$316.28 ","$234.05 ","$0.00 ","$307.08 ","$138.18 ","$0.00 ","$65.92 ","$0.00 ","$0.00 ","$53.77 ","$307.08 ","$0.00 ","$153.54 ","$243.21 ","$245.66 ","$0.00 ","$46.66 ","$0.00 ","$48.89 ","$0.00 "
"441.37","SUP","HCPCS C1713","","441.37  -  PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR TI 3.5MM","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$59.25 ","$0.00 ","$28.27 ","$0.00 ","$0.00 ","$23.06 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$20.01 ","$0.00 ","$20.96 ","$0.00 "
"441.371","SUP","HCPCS C1713","","441.371  -  PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR TI","BOTH IP/OP","$323.30 ","$239.24 ","$0.00 ","$313.90 ","$141.26 ","$0.00 ","$67.38 ","$0.00 ","$0.00 ","$54.96 ","$313.90 ","$0.00 ","$156.95 ","$248.61 ","$251.12 ","$0.00 ","$47.69 ","$0.00 ","$49.97 ","$0.00 "
"441.38","SUP","HCPCS C1713","","441.38  -  PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR TI 3.5MM","BOTH IP/OP","$140.58 ","$104.03 ","$0.00 ","$136.48 ","$61.41 ","$0.00 ","$29.30 ","$0.00 ","$0.00 ","$23.90 ","$136.48 ","$0.00 ","$68.24 ","$108.09 ","$109.18 ","$0.00 ","$20.74 ","$0.00 ","$21.73 ","$0.00 "
"441.381","SUP","HCPCS C1713","","441.381  -  PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR TI","BOTH IP/OP","$340.18 ","$251.73 ","$0.00 ","$330.28 ","$148.62 ","$0.00 ","$70.90 ","$0.00 ","$0.00 ","$57.83 ","$330.28 ","$0.00 ","$165.14 ","$261.58 ","$264.22 ","$0.00 ","$50.18 ","$0.00 ","$52.58 ","$0.00 "
"441.39","SUP","HCPCS C1713","","441.39  -  PLATE BONE 109X9X1MM 9 HOLE 1/3 TUBULAR COLLAR LC-DCP","BOTH IP/OP","$140.58 ","$104.03 ","$0.00 ","$136.48 ","$61.41 ","$0.00 ","$29.30 ","$0.00 ","$0.00 ","$23.90 ","$136.48 ","$0.00 ","$68.24 ","$108.09 ","$109.18 ","$0.00 ","$20.74 ","$0.00 ","$21.73 ","$0.00 "
"441.391","SUP","HCPCS C1713","","441.391  -  PLATE BONE 105MM 9 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM","BOTH IP/OP","$357.05 ","$264.22 ","$0.00 ","$346.65 ","$155.99 ","$0.00 ","$74.42 ","$0.00 ","$0.00 ","$60.70 ","$346.65 ","$0.00 ","$173.33 ","$274.55 ","$277.32 ","$0.00 ","$52.67 ","$0.00 ","$55.19 ","$0.00 "
"441.4","SUP","HCPCS C1713","","441.40  -  PLATE BONE 121X9X1MM 10 HOLE 1/3 TUBULAR COLLAR LC-DCP","BOTH IP/OP","$136.48 ","$101.00 ","$0.00 ","$136.48 ","$61.41 ","$0.00 ","$28.44 ","$0.00 ","$0.00 ","$23.90 ","$136.48 ","$0.00 ","$68.24 ","$108.09 ","$109.18 ","$0.00 ","$20.74 ","$0.00 ","$21.73 ","$0.00 "
"441.401","SUP","HCPCS C1713","","441.401  -  PLATE BONE 1/3 TUBULAR 12MM 117X9X1MM 10 HOLE COLLAR LCP","BOTH IP/OP","$345.80 ","$255.89 ","$0.00 ","$335.73 ","$151.08 ","$0.00 ","$72.07 ","$0.00 ","$0.00 ","$58.78 ","$335.73 ","$0.00 ","$167.86 ","$265.90 ","$268.58 ","$0.00 ","$51.01 ","$0.00 ","$53.45 ","$0.00 "
"441.42","SUP","HCPCS C1713","","441.42  -  PLATE BONE 145X9X1MM 12 HOLE 1/3 TUBULAR COLLAR TITANIUM RAD","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"441.421","SUP","HCPCS C1713","","441.421  -  PLATE BONE 1/3 TUBULAR 12MM 141X9X1MM 12 HOLE COLLAR LCP","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"441.44","SUP","HCPCS C1713","","441.440  -  PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$2,774.53 ","$2,053.15 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$578.28 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"441.441","SUP","HCPCS C1713","","441.441  -  PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA LEFT DISTAL ANTLAT","BOTH IP/OP","$2,857.78 ","$2,114.76 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$595.63 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"441.442","SUP","HCPCS C1713","","441.442  -  PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$2,890.10 ","$2,138.67 ","$0.00 ","$2,805.93 ","$1,262.67 ","$0.00 ","$602.37 ","$0.00 ","$0.00 ","$491.30 ","$2,805.93 ","$0.00 ","$1,402.96 ","$2,222.30 ","$2,244.74 ","$0.00 ","$426.34 ","$0.00 ","$446.70 ","$0.00 "
"441.443","SUP","HCPCS C1713","","441.443  -  PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$2,890.10 ","$2,138.67 ","$0.00 ","$2,805.93 ","$1,262.67 ","$0.00 ","$602.37 ","$0.00 ","$0.00 ","$491.30 ","$2,805.93 ","$0.00 ","$1,402.96 ","$2,222.30 ","$2,244.74 ","$0.00 ","$426.34 ","$0.00 ","$446.70 ","$0.00 "
"441.444","SUP","HCPCS C1713","","441.444  -  PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$2,919.63 ","$2,160.53 ","$0.00 ","$2,834.58 ","$1,275.56 ","$0.00 ","$608.52 ","$0.00 ","$0.00 ","$496.31 ","$2,834.58 ","$0.00 ","$1,417.29 ","$2,244.99 ","$2,267.66 ","$0.00 ","$430.69 ","$0.00 ","$451.26 ","$0.00 "
"441.445","SUP","HCPCS C1713","","441.445  -  PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$2,919.63 ","$2,160.53 ","$0.00 ","$2,834.58 ","$1,275.56 ","$0.00 ","$608.52 ","$0.00 ","$0.00 ","$496.31 ","$2,834.58 ","$0.00 ","$1,417.29 ","$2,244.99 ","$2,267.66 ","$0.00 ","$430.69 ","$0.00 ","$451.26 ","$0.00 "
"441.446","SUP","HCPCS C1713","","441.446  -  PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$2,947.73 ","$2,181.32 ","$0.00 ","$2,861.88 ","$1,287.84 ","$0.00 ","$614.38 ","$0.00 ","$0.00 ","$501.09 ","$2,861.88 ","$0.00 ","$1,430.94 ","$2,266.61 ","$2,289.50 ","$0.00 ","$434.84 ","$0.00 ","$455.61 ","$0.00 "
"441.447","SUP","HCPCS C1713","","441.447  -  PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$2,947.73 ","$2,181.32 ","$0.00 ","$2,861.88 ","$1,287.84 ","$0.00 ","$614.38 ","$0.00 ","$0.00 ","$501.09 ","$2,861.88 ","$0.00 ","$1,430.94 ","$2,266.61 ","$2,289.50 ","$0.00 ","$434.84 ","$0.00 ","$455.61 ","$0.00 "
"441.448","SUP","HCPCS C1713","","441.448  -  PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$2,980.08 ","$2,205.26 ","$0.00 ","$2,893.28 ","$1,301.97 ","$0.00 ","$621.12 ","$0.00 ","$0.00 ","$506.59 ","$2,893.28 ","$0.00 ","$1,446.64 ","$2,291.48 ","$2,314.62 ","$0.00 ","$439.61 ","$0.00 ","$460.61 ","$0.00 "
"441.449","SUP","HCPCS C1713","","441.449  -  PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$2,980.08 ","$2,205.26 ","$0.00 ","$2,893.28 ","$1,301.97 ","$0.00 ","$621.12 ","$0.00 ","$0.00 ","$506.59 ","$2,893.28 ","$0.00 ","$1,446.64 ","$2,291.48 ","$2,314.62 ","$0.00 ","$439.61 ","$0.00 ","$460.61 ","$0.00 "
"441.45","SUP","HCPCS C1713","","441.450  -  PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$2,931.48 ","$2,169.30 ","$0.00 ","$2,931.48 ","$1,319.16 ","$0.00 ","$610.99 ","$0.00 ","$0.00 ","$513.28 ","$2,931.48 ","$0.00 ","$1,465.74 ","$2,321.73 ","$2,345.18 ","$0.00 ","$445.41 ","$0.00 ","$466.69 ","$0.00 "
"441.451","SUP","HCPCS C1713","","441.451  -  PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$3,019.43 ","$2,234.38 ","$0.00 ","$2,931.48 ","$1,319.16 ","$0.00 ","$629.32 ","$0.00 ","$0.00 ","$513.28 ","$2,931.48 ","$0.00 ","$1,465.74 ","$2,321.73 ","$2,345.18 ","$0.00 ","$445.41 ","$0.00 ","$466.69 ","$0.00 "
"441.452","SUP","HCPCS C1713","","441.452  -  PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$3,047.55 ","$2,255.19 ","$0.00 ","$2,958.78 ","$1,331.45 ","$0.00 ","$635.19 ","$0.00 ","$0.00 ","$518.06 ","$2,958.78 ","$0.00 ","$1,479.39 ","$2,343.35 ","$2,367.02 ","$0.00 ","$449.56 ","$0.00 ","$471.04 ","$0.00 "
"441.453","SUP","HCPCS C1713","","441.453  -  PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$3,047.55 ","$2,255.19 ","$0.00 ","$2,958.78 ","$1,331.45 ","$0.00 ","$635.19 ","$0.00 ","$0.00 ","$518.06 ","$2,958.78 ","$0.00 ","$1,479.39 ","$2,343.35 ","$2,367.02 ","$0.00 ","$449.56 ","$0.00 ","$471.04 ","$0.00 "
"441.454","SUP","HCPCS C1713","","441.454  -  PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$3,071.45 ","$2,272.87 ","$0.00 ","$2,981.98 ","$1,341.89 ","$0.00 ","$640.17 ","$0.00 ","$0.00 ","$522.12 ","$2,981.98 ","$0.00 ","$1,490.99 ","$2,361.73 ","$2,385.58 ","$0.00 ","$453.09 ","$0.00 ","$474.73 ","$0.00 "
"441.455","SUP","HCPCS C1713","","441.455  -  PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$3,071.45 ","$2,272.87 ","$0.00 ","$2,981.98 ","$1,341.89 ","$0.00 ","$640.17 ","$0.00 ","$0.00 ","$522.12 ","$2,981.98 ","$0.00 ","$1,490.99 ","$2,361.73 ","$2,385.58 ","$0.00 ","$453.09 ","$0.00 ","$474.73 ","$0.00 "
"441.456","SUP","HCPCS C1713","","441.456  -  PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA RIGHT DISTAL","BOTH IP/OP","$3,100.95 ","$2,294.70 ","$0.00 ","$3,010.65 ","$1,354.79 ","$0.00 ","$646.32 ","$0.00 ","$0.00 ","$527.14 ","$3,010.65 ","$0.00 ","$1,505.33 ","$2,384.43 ","$2,408.52 ","$0.00 ","$457.44 ","$0.00 ","$479.30 ","$0.00 "
"441.457","SUP","HCPCS C1713","","441.457  -  PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA LEFT DISTAL","BOTH IP/OP","$3,100.95 ","$2,294.70 ","$0.00 ","$3,010.65 ","$1,354.79 ","$0.00 ","$646.32 ","$0.00 ","$0.00 ","$527.14 ","$3,010.65 ","$0.00 ","$1,505.33 ","$2,384.43 ","$2,408.52 ","$0.00 ","$457.44 ","$0.00 ","$479.30 ","$0.00 "
"441.61","SUP","HCPCS C1713","","441.61  -  PLATE BONE 60MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL","BOTH IP/OP","$992.18 ","$734.21 ","$0.00 ","$992.18 ","$446.48 ","$0.00 ","$206.79 ","$0.00 ","$0.00 ","$173.72 ","$992.18 ","$0.00 ","$496.09 ","$785.81 ","$793.74 ","$0.00 ","$150.75 ","$0.00 ","$157.95 ","$0.00 "
"441.62","SUP","HCPCS C1713","","441.62  -  PLATE BONE 70MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL","BOTH IP/OP","$1,015.38 ","$751.38 ","$0.00 ","$1,015.38 ","$456.92 ","$0.00 ","$211.63 ","$0.00 ","$0.00 ","$177.78 ","$1,015.38 ","$0.00 ","$507.69 ","$804.18 ","$812.30 ","$0.00 ","$154.28 ","$0.00 ","$161.65 ","$0.00 "
"441.65","SUP","HCPCS C1713","","441.65  -  PLATE BONE Y 87MMX2MM LC-DCP TITANIUM CALCANEUS NONSTRL","BOTH IP/OP","$1,015.38 ","$751.38 ","$0.00 ","$1,015.38 ","$456.92 ","$0.00 ","$211.63 ","$0.00 ","$0.00 ","$177.78 ","$1,015.38 ","$0.00 ","$507.69 ","$804.18 ","$812.30 ","$0.00 ","$154.28 ","$0.00 ","$161.65 ","$0.00 "
"441.68","SUP","HCPCS C1713","","441.680  -  PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,112.28 ","$823.09 ","$0.00 ","$1,112.28 ","$500.52 ","$0.00 ","$231.83 ","$0.00 ","$0.00 ","$194.75 ","$1,112.28 ","$0.00 ","$556.14 ","$880.93 ","$889.82 ","$0.00 ","$169.00 ","$0.00 ","$177.07 ","$0.00 "
"441.681","SUP","HCPCS C1713","","441.681  -  PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,145.65 ","$847.78 ","$0.00 ","$1,112.28 ","$500.52 ","$0.00 ","$238.78 ","$0.00 ","$0.00 ","$194.75 ","$1,112.28 ","$0.00 ","$556.14 ","$880.93 ","$889.82 ","$0.00 ","$169.00 ","$0.00 ","$177.07 ","$0.00 "
"441.682","SUP","HCPCS C1713","","441.682  -  PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,177.98 ","$871.71 ","$0.00 ","$1,143.65 ","$514.64 ","$0.00 ","$245.52 ","$0.00 ","$0.00 ","$200.24 ","$1,143.65 ","$0.00 ","$571.83 ","$905.77 ","$914.92 ","$0.00 ","$173.77 ","$0.00 ","$182.07 ","$0.00 "
"441.683","SUP","HCPCS C1713","","441.683  -  PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,177.98 ","$871.71 ","$0.00 ","$1,143.65 ","$514.64 ","$0.00 ","$245.52 ","$0.00 ","$0.00 ","$200.24 ","$1,143.65 ","$0.00 ","$571.83 ","$905.77 ","$914.92 ","$0.00 ","$173.77 ","$0.00 ","$182.07 ","$0.00 "
"441.684","SUP","HCPCS C1713","","441.684  -  PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,199.05 ","$887.30 ","$0.00 ","$1,164.13 ","$523.86 ","$0.00 ","$249.91 ","$0.00 ","$0.00 ","$203.83 ","$1,164.13 ","$0.00 ","$582.06 ","$921.99 ","$931.30 ","$0.00 ","$176.88 ","$0.00 ","$185.33 ","$0.00 "
"441.685","SUP","HCPCS C1713","","441.685  -  PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,199.05 ","$887.30 ","$0.00 ","$1,164.13 ","$523.86 ","$0.00 ","$249.91 ","$0.00 ","$0.00 ","$203.83 ","$1,164.13 ","$0.00 ","$582.06 ","$921.99 ","$931.30 ","$0.00 ","$176.88 ","$0.00 ","$185.33 ","$0.00 "
"441.69","SUP","HCPCS C1713","","441.690  -  PLATE BONE 2.4MM 28MM IMPLANT 2 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,112.28 ","$823.09 ","$0.00 ","$1,112.28 ","$500.52 ","$0.00 ","$231.83 ","$0.00 ","$0.00 ","$194.75 ","$1,112.28 ","$0.00 ","$556.14 ","$880.93 ","$889.82 ","$0.00 ","$169.00 ","$0.00 ","$177.07 ","$0.00 "
"441.691","SUP","HCPCS C1713","","441.691  -  PLATE BONE 2.4MM 40MM IMPLANT 3 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,177.98 ","$871.71 ","$0.00 ","$1,143.65 ","$514.64 ","$0.00 ","$245.52 ","$0.00 ","$0.00 ","$200.24 ","$1,143.65 ","$0.00 ","$571.83 ","$905.77 ","$914.92 ","$0.00 ","$173.77 ","$0.00 ","$182.07 ","$0.00 "
"441.692","SUP","HCPCS C1713","","441.692  -  PLATE BONE 2.4MM 50MM IMPLANT 4 HOLE LCP TITANIUM RADIAL","BOTH IP/OP","$1,200.45 ","$888.33 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$250.20 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$177.09 ","$0.00 ","$185.55 ","$0.00 "
"441.83","SUP","HCPCS C1713","","441.83  -  PLATE BONE CLOVERLEAF 88X15X2MM 3 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$570.48 ","$422.16 ","$0.00 ","$570.48 ","$256.71 ","$0.00 ","$118.90 ","$0.00 ","$0.00 ","$99.89 ","$570.48 ","$0.00 ","$285.24 ","$451.82 ","$456.38 ","$0.00 ","$86.68 ","$0.00 ","$90.82 ","$0.00 "
"441.84","SUP","HCPCS C1713","","441.84  -  PLATE BONE CLOVERLEAF 104X15X2MM 4 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$610.05 ","$451.44 ","$0.00 ","$610.05 ","$274.52 ","$0.00 ","$127.15 ","$0.00 ","$0.00 ","$106.81 ","$610.05 ","$0.00 ","$305.03 ","$483.16 ","$488.04 ","$0.00 ","$92.69 ","$0.00 ","$97.12 ","$0.00 "
"441.85","SUP","HCPCS C1713","","441.85  -  PLATE BONE CLOVERLEAF 120X15X2MM 5 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$768.35 ","$568.58 ","$0.00 ","$768.35 ","$345.76 ","$0.00 ","$160.14 ","$0.00 ","$0.00 ","$134.53 ","$768.35 ","$0.00 ","$384.18 ","$608.53 ","$614.68 ","$0.00 ","$116.75 ","$0.00 ","$122.32 ","$0.00 "
"441.86","SUP","HCPCS C1713","","441.86  -  PLATE BONE CLOVERLEAF 136X15X2MM 6 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$833.85 ","$617.05 ","$0.00 ","$833.85 ","$375.23 ","$0.00 ","$173.80 ","$0.00 ","$0.00 ","$146.00 ","$833.85 ","$0.00 ","$416.93 ","$660.41 ","$667.08 ","$0.00 ","$126.70 ","$0.00 ","$132.75 ","$0.00 "
"441.87","SUP","HCPCS C1713","","441.87  -  PLATE BONE CLOVERLEAF 152X15X2MM 7 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$898.00 ","$664.52 ","$0.00 ","$898.00 ","$404.10 ","$0.00 ","$187.17 ","$0.00 ","$0.00 ","$157.23 ","$898.00 ","$0.00 ","$449.00 ","$711.22 ","$718.40 ","$0.00 ","$136.44 ","$0.00 ","$142.96 ","$0.00 "
"441.88","SUP","HCPCS C1713","","441.88  -  PLATE BONE CLOVERLEAF 168X15X2MM 8 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$953.95 ","$705.92 ","$0.00 ","$953.95 ","$429.28 ","$0.00 ","$198.83 ","$0.00 ","$0.00 ","$167.03 ","$953.95 ","$0.00 ","$476.98 ","$755.53 ","$763.16 ","$0.00 ","$144.95 ","$0.00 ","$151.87 ","$0.00 "
"441.89","SUP","HCPCS C1713","","441.89  -  PLATE BONE CLOVERLEAF 200X15X2MM 10 HOLE THIN BLADE LP HEAD","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,030.38 ","$463.67 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$180.41 ","$1,030.38 ","$0.00 ","$515.19 ","$816.06 ","$824.30 ","$0.00 ","$156.56 ","$0.00 ","$164.04 ","$0.00 "
"441.901","SUP","HCPCS C1713","","441.901  -  PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR","BOTH IP/OP","$2,954.78 ","$2,186.54 ","$0.00 ","$2,868.70 ","$1,290.92 ","$0.00 ","$615.85 ","$0.00 ","$0.00 ","$502.29 ","$2,868.70 ","$0.00 ","$1,434.35 ","$2,272.01 ","$2,294.96 ","$0.00 ","$435.88 ","$0.00 ","$456.70 ","$0.00 "
"441.903","SUP","HCPCS C1713","","441.903  -  PLATE BONE STANDARD 114X12X2.5MM 6 HOLE HEAD 5 HOLE SHAFT","BOTH IP/OP","$3,047.55 ","$2,255.19 ","$0.00 ","$2,958.78 ","$1,331.45 ","$0.00 ","$635.19 ","$0.00 ","$0.00 ","$518.06 ","$2,958.78 ","$0.00 ","$1,479.39 ","$2,343.35 ","$2,367.02 ","$0.00 ","$449.56 ","$0.00 ","$471.04 ","$0.00 "
"441.918","SUP","HCPCS C1713","","441.918  -  PLATE BONE LONG 142MM 5 HOLE LOCKING LCP TITANIUM HUMERUS","BOTH IP/OP","$3,077.05 ","$2,277.02 ","$0.00 ","$2,987.45 ","$1,344.35 ","$0.00 ","$641.33 ","$0.00 ","$0.00 ","$523.08 ","$2,987.45 ","$0.00 ","$1,493.73 ","$2,366.06 ","$2,389.96 ","$0.00 ","$453.92 ","$0.00 ","$475.60 ","$0.00 "
"441.919","SUP","HCPCS C1713","","441.919  -  PLATE BONE LONG 160MM 6 HOLE LOCKING LCP TITANIUM HUMERUS","BOTH IP/OP","$3,197.95 ","$2,366.48 ","$0.00 ","$3,104.80 ","$1,397.16 ","$0.00 ","$666.53 ","$0.00 ","$0.00 ","$543.63 ","$3,104.80 ","$0.00 ","$1,552.40 ","$2,459.00 ","$2,483.84 ","$0.00 ","$471.75 ","$0.00 ","$494.28 ","$0.00 "
"441.921","SUP","HCPCS C1713","","441.921  -  PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK","BOTH IP/OP","$3,321.65 ","$2,458.02 ","$0.00 ","$3,224.90 ","$1,451.21 ","$0.00 ","$692.31 ","$0.00 ","$0.00 ","$564.65 ","$3,224.90 ","$0.00 ","$1,612.45 ","$2,554.12 ","$2,579.92 ","$0.00 ","$490.00 ","$0.00 ","$513.40 ","$0.00 "
"441.923","SUP","HCPCS C1713","","441.923  -  PLATE BONE 3.5MM 232MM 10 HOLE LCP TITANIUM HUMERUS PROXIMAL","BOTH IP/OP","$3,445.35 ","$2,549.56 ","$0.00 ","$3,345.00 ","$1,505.25 ","$0.00 ","$718.10 ","$0.00 ","$0.00 ","$585.68 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$508.25 ","$0.00 ","$532.52 ","$0.00 "
"441.925","SUP","HCPCS C1713","","441.925  -  PLATE BONE LONG 268MM 12 HOLE LOCKING LCP TITANIUM HUMERUS","BOTH IP/OP","$3,564.83 ","$2,637.97 ","$0.00 ","$3,461.00 ","$1,557.45 ","$0.00 ","$743.00 ","$0.00 ","$0.00 ","$605.99 ","$3,461.00 ","$0.00 ","$1,730.50 ","$2,741.11 ","$2,768.80 ","$0.00 ","$525.87 ","$0.00 ","$550.99 ","$0.00 "
"441.931","SUP","HCPCS C1713","","441.931  -  PLATE BONE T OBLIQUE LEFT 52X10X1.5MM 3 HOLE HEAD 3 HOLE","BOTH IP/OP","$721.13 ","$533.64 ","$0.00 ","$700.13 ","$315.06 ","$0.00 ","$150.30 ","$0.00 ","$0.00 ","$122.59 ","$700.13 ","$0.00 ","$350.06 ","$554.50 ","$560.10 ","$0.00 ","$106.38 ","$0.00 ","$111.46 ","$0.00 "
"441.941","SUP","HCPCS C1713","","441.941  -  PLATE BONE T OBLIQUE LEFT 63X10X1.5MM 3 HOLE HEAD 4 HOLE","BOTH IP/OP","$756.28 ","$559.65 ","$0.00 ","$734.23 ","$330.40 ","$0.00 ","$157.63 ","$0.00 ","$0.00 ","$128.56 ","$734.23 ","$0.00 ","$367.11 ","$581.51 ","$587.38 ","$0.00 ","$111.56 ","$0.00 ","$116.89 ","$0.00 "
"441.951","SUP","HCPCS C1713","","441.951  -  PLATE BONE T OBLIQUE LEFT 74X10X1.5MM 3 HOLE HEAD 5 HOLE","BOTH IP/OP","$788.60 ","$583.56 ","$0.00 ","$765.63 ","$344.53 ","$0.00 ","$164.36 ","$0.00 ","$0.00 ","$134.05 ","$765.63 ","$0.00 ","$382.81 ","$606.38 ","$612.50 ","$0.00 ","$116.33 ","$0.00 ","$121.89 ","$0.00 "
"441.961","SUP","HCPCS C1713","","441.961  -  PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE LEFT LCP","BOTH IP/OP","$820.93 ","$607.49 ","$0.00 ","$797.03 ","$358.66 ","$0.00 ","$171.10 ","$0.00 ","$0.00 ","$139.55 ","$797.03 ","$0.00 ","$398.51 ","$631.25 ","$637.62 ","$0.00 ","$121.10 ","$0.00 ","$126.89 ","$0.00 "
"441.971","SUP","HCPCS C1713","","441.971  -  PLATE BONE T OBLIQUE 96X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT","BOTH IP/OP","$854.65 ","$632.44 ","$0.00 ","$829.78 ","$373.40 ","$0.00 ","$178.13 ","$0.00 ","$0.00 ","$145.29 ","$829.78 ","$0.00 ","$414.89 ","$657.19 ","$663.82 ","$0.00 ","$126.08 ","$0.00 ","$132.10 ","$0.00 "
"441.981","SUP","HCPCS C1713","","441.981  -  PLATE BONE 107MM 8 SHAFT HOLE 3 HOLE HEAD T OBLIQUE LEFT LCP","BOTH IP/OP","$901.05 ","$666.78 ","$0.00 ","$874.80 ","$393.66 ","$0.00 ","$187.80 ","$0.00 ","$0.00 ","$153.17 ","$874.80 ","$0.00 ","$437.40 ","$692.84 ","$699.84 ","$0.00 ","$132.92 ","$0.00 ","$139.27 ","$0.00 "
"442.03","SUP","HCPCS C1713","","442.03  -  PLATE BONE 23X7X1MM .3MM 3 HOLE .25 TUBULAR COLLAR TITANIUM","BOTH IP/OP","$146.03 ","$108.06 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$30.44 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"442.04","SUP","HCPCS C1713","","442.04  -  PLATE BONE 31X7X1MM .3MM 4 HOLE .25 TUBULAR COLLAR TITANIUM","BOTH IP/OP","$156.03 ","$115.46 ","$0.00 ","$151.48 ","$68.16 ","$0.00 ","$32.52 ","$0.00 ","$0.00 ","$26.52 ","$151.48 ","$0.00 ","$75.74 ","$119.97 ","$121.18 ","$0.00 ","$23.02 ","$0.00 ","$24.11 ","$0.00 "
"442.05","SUP","HCPCS C1713","","442.05  -  PLATE BONE 39X7X1MM .3MM 5 HOLE .25 TUBULAR COLLAR TITANIUM","BOTH IP/OP","$161.05 ","$119.18 ","$0.00 ","$161.05 ","$72.47 ","$0.00 ","$33.57 ","$0.00 ","$0.00 ","$28.20 ","$161.05 ","$0.00 ","$80.53 ","$127.55 ","$128.84 ","$0.00 ","$24.47 ","$0.00 ","$25.64 ","$0.00 "
"442.06","SUP","HCPCS C1713","","442.06  -  PLATE BONE 47X7X1MM .3MM 6 HOLE .25 TUBULAR COLLAR TITANIUM","BOTH IP/OP","$179.93 ","$133.15 ","$0.00 ","$174.70 ","$78.62 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$30.59 ","$174.70 ","$0.00 ","$87.35 ","$138.36 ","$139.76 ","$0.00 ","$26.54 ","$0.00 ","$27.81 ","$0.00 "
"442.07","SUP","HCPCS C1713","","442.07  -  PLATE BONE 55X7X1MM .3MM 7 HOLE .25 TUBULAR COLLAR TITANIUM","BOTH IP/OP","$196.80 ","$145.63 ","$0.00 ","$191.08 ","$85.98 ","$0.00 ","$41.02 ","$0.00 ","$0.00 ","$33.46 ","$191.08 ","$0.00 ","$95.54 ","$151.34 ","$152.86 ","$0.00 ","$29.03 ","$0.00 ","$30.42 ","$0.00 "
"442.08","SUP","HCPCS C1713","","442.08  -  PLATE BONE 63X7X1MM .3MM 8 HOLE .25 TUBULAR COLLAR TITANIUM","BOTH IP/OP","$199.25 ","$147.45 ","$0.00 ","$199.25 ","$89.66 ","$0.00 ","$41.53 ","$0.00 ","$0.00 ","$34.89 ","$199.25 ","$0.00 ","$99.63 ","$157.81 ","$159.40 ","$0.00 ","$30.27 ","$0.00 ","$31.72 ","$0.00 "
"442.33","SUP","HCPCS C1713","","442.33  -  PLATE BONE L LEFT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM","BOTH IP/OP","$113.28 ","$83.83 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"442.34","SUP","HCPCS C1713","","442.34  -  PLATE BONE L RIGHT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM","BOTH IP/OP","$113.28 ","$83.83 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"442.41","SUP","HCPCS C1713","","442.41  -  PLATE BN T 32X7X1.2MM 3 HL TI 2.7MM SCR","BOTH IP/OP","$113.28 ","$83.83 ","$0.00 ","$113.28 ","$50.97 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$19.83 ","$113.28 ","$0.00 ","$56.64 ","$89.72 ","$90.62 ","$0.00 ","$17.21 ","$0.00 ","$18.03 ","$0.00 "
"442.472","SUP","HCPCS C1713","","442.472  -  PLATE BN TI RDS RT DIST DRSL","BOTH IP/OP","$1,854.48 ","$1,372.32 ","$0.00 ","$1,854.48 ","$834.51 ","$0.00 ","$386.52 ","$0.00 ","$0.00 ","$324.70 ","$1,854.48 ","$0.00 ","$927.24 ","$1,468.75 ","$1,483.58 ","$0.00 ","$290.23 ","$0.00 ","$295.23 ","$0.00 "
"442.473","SUP","HCPCS C1713","","442.473  -  PLATE BN TI RDS RT DIST VOLR","BOTH IP/OP","$1,530.63 ","$1,132.67 ","$0.00 ","$1,530.63 ","$688.78 ","$0.00 ","$319.02 ","$0.00 ","$0.00 ","$268.00 ","$1,530.63 ","$0.00 ","$765.31 ","$1,212.26 ","$1,224.50 ","$0.00 ","$239.54 ","$0.00 ","$243.68 ","$0.00 "
"442.477","SUP","HCPCS C1713","","442.477  -  PLATE BONE 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4","BOTH IP/OP","$877.15 ","$649.09 ","$0.00 ","$851.60 ","$383.22 ","$0.00 ","$182.82 ","$0.00 ","$0.00 ","$149.11 ","$851.60 ","$0.00 ","$425.80 ","$674.47 ","$681.28 ","$0.00 ","$129.39 ","$0.00 ","$135.57 ","$0.00 "
"442.478","SUP","HCPCS C1713","","442.478  -  PLATE BONE 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4","BOTH IP/OP","$913.70 ","$676.14 ","$0.00 ","$887.10 ","$399.20 ","$0.00 ","$190.44 ","$0.00 ","$0.00 ","$155.32 ","$887.10 ","$0.00 ","$443.55 ","$702.58 ","$709.68 ","$0.00 ","$134.79 ","$0.00 ","$141.23 ","$0.00 "
"442.479","SUP","HCPCS C1713","","442.479  -  PLATE BONE STR 48MM 5 HOLE LCP TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$832.18 ","$615.81 ","$0.00 ","$807.93 ","$363.57 ","$0.00 ","$173.45 ","$0.00 ","$0.00 ","$141.46 ","$807.93 ","$0.00 ","$403.96 ","$639.88 ","$646.34 ","$0.00 ","$122.76 ","$0.00 ","$128.62 ","$0.00 "
"442.482","SUP","HCPCS C1713","","442.482  -  PLATE BN TI RDS LT DIST DRSL","BOTH IP/OP","$1,854.48 ","$1,372.32 ","$0.00 ","$1,854.48 ","$834.51 ","$0.00 ","$386.52 ","$0.00 ","$0.00 ","$324.70 ","$1,854.48 ","$0.00 ","$927.24 ","$1,468.75 ","$1,483.58 ","$0.00 ","$290.23 ","$0.00 ","$295.23 ","$0.00 "
"442.483","SUP","HCPCS C1713","","442.483  -  PLATE BN TI RDS LT DIST VOLR","BOTH IP/OP","$1,530.63 ","$1,132.67 ","$0.00 ","$1,530.63 ","$688.78 ","$0.00 ","$319.02 ","$0.00 ","$0.00 ","$268.00 ","$1,530.63 ","$0.00 ","$765.31 ","$1,212.26 ","$1,224.50 ","$0.00 ","$239.54 ","$0.00 ","$243.68 ","$0.00 "
"442.49","SUP","HCPCS C1713","","442.490  -  PLATE BONE STR 57MM 6 HOLE LCP TITANIUM DISTAL RAD NONSTRL","BOTH IP/OP","$851.60 ","$630.18 ","$0.00 ","$851.60 ","$383.22 ","$0.00 ","$177.49 ","$0.00 ","$0.00 ","$149.11 ","$851.60 ","$0.00 ","$425.80 ","$674.47 ","$681.28 ","$0.00 ","$129.39 ","$0.00 ","$135.57 ","$0.00 "
"442.491","SUP","HCPCS C1713","","442.491  -  PLATE BN 43MM LCP 5 HLE/HD 3 HL SHFT TI RDS LT DIST VOLR 2.4","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$226.65 ","$0.00 ","$237.47 ","$0.00 "
"442.492","SUP","HCPCS C1713","","442.492  -  PLATE BONE 61MM 5X5 HOLE LCP TITANIUM LEFT DISTAL VOLAR RAD","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"442.493","SUP","HCPCS C1713","","442.493  -  PLATE BONE 43MM 5 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM RAD","BOTH IP/OP","$1,536.43 ","$1,136.96 ","$0.00 ","$1,491.68 ","$671.25 ","$0.00 ","$320.23 ","$0.00 ","$0.00 ","$261.18 ","$1,491.68 ","$0.00 ","$745.84 ","$1,181.41 ","$1,193.34 ","$0.00 ","$226.65 ","$0.00 ","$237.47 ","$0.00 "
"442.494","SUP","HCPCS C1713","","442.494  -  PLATE BONE 61MM 5 HOLE HEAD 5 HOLE SHAFT LCP TITANIUM RAD","BOTH IP/OP","$1,626.38 ","$1,203.52 ","$0.00 ","$1,579.03 ","$710.56 ","$0.00 ","$338.98 ","$0.00 ","$0.00 ","$276.47 ","$1,579.03 ","$0.00 ","$789.51 ","$1,250.59 ","$1,263.22 ","$0.00 ","$239.92 ","$0.00 ","$251.38 ","$0.00 "
"442.5","SUP","HCPCS C1713","","442.500  -  PLATE BONE -90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$822.95 ","$608.98 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$171.52 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"442.501","SUP","HCPCS C1713","","442.501  -  PLATE BONE -90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"442.502","SUP","HCPCS C1713","","442.502  -  PLATE BONE 90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"442.503","SUP","HCPCS C1713","","442.503  -  PLATE BONE 90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"442.504","SUP","HCPCS C1713","","442.504  -  PLATE BONE 90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"442.505","SUP","HCPCS C1713","","442.505  -  PLATE BONE 90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"442.506","SUP","HCPCS C1713","","442.506  -  PLATE BONE -90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"442.507","SUP","HCPCS C1713","","442.507  -  PLATE BONE -90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"442.508","SUP","HCPCS C1713","","442.508  -  PLATE BONE +20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"442.509","SUP","HCPCS C1713","","442.509  -  PLATE BONE +20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"442.51","SUP","HCPCS C1713","","442.51  -  PLATE BN STD BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR","BOTH IP/OP","$1,973.43 ","$1,460.34 ","$0.00 ","$1,973.43 ","$888.04 ","$0.00 ","$411.31 ","$0.00 ","$0.00 ","$345.53 ","$1,973.43 ","$0.00 ","$986.71 ","$1,562.96 ","$1,578.74 ","$0.00 ","$299.85 ","$0.00 ","$314.17 ","$0.00 "
"442.511","SUP","HCPCS C1713","","442.511  -  PLATE BONE -20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$847.63 ","$627.25 ","$0.00 ","$822.95 ","$370.33 ","$0.00 ","$176.67 ","$0.00 ","$0.00 ","$144.09 ","$822.95 ","$0.00 ","$411.48 ","$651.78 ","$658.36 ","$0.00 ","$125.04 ","$0.00 ","$131.01 ","$0.00 "
"442.512","SUP","HCPCS C1713","","442.512  -  PLATE BONE -20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"442.52","SUP","HCPCS C1713","","442.52  -  PLATE BN SHRT BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR","BOTH IP/OP","$1,973.43 ","$1,460.34 ","$0.00 ","$1,973.43 ","$888.04 ","$0.00 ","$411.31 ","$0.00 ","$0.00 ","$345.53 ","$1,973.43 ","$0.00 ","$986.71 ","$1,562.96 ","$1,578.74 ","$0.00 ","$299.85 ","$0.00 ","$314.17 ","$0.00 "
"442.53","SUP","HCPCS C1713","","442.53  -  PLATE BN STRG NS 9 HL FSN TI WRST 2.7/3.5MM CORT SCR","BOTH IP/OP","$1,973.43 ","$1,460.34 ","$0.00 ","$1,973.43 ","$888.04 ","$0.00 ","$411.31 ","$0.00 ","$0.00 ","$345.53 ","$1,973.43 ","$0.00 ","$986.71 ","$1,562.96 ","$1,578.74 ","$0.00 ","$299.85 ","$0.00 ","$314.17 ","$0.00 "
"442.61","SUP","HCPCS C1713","","442.61  -  PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL LT 2.7MM SCR","BOTH IP/OP","$608.68 ","$450.42 ","$0.00 ","$608.68 ","$273.90 ","$0.00 ","$126.86 ","$0.00 ","$0.00 ","$106.57 ","$608.68 ","$0.00 ","$304.34 ","$482.07 ","$486.94 ","$0.00 ","$92.48 ","$0.00 ","$96.90 ","$0.00 "
"442.62","SUP","HCPCS C1713","","442.62  -  PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL RT 2.7MM SCR","BOTH IP/OP","$608.68 ","$450.42 ","$0.00 ","$608.68 ","$273.90 ","$0.00 ","$126.86 ","$0.00 ","$0.00 ","$106.57 ","$608.68 ","$0.00 ","$304.34 ","$482.07 ","$486.94 ","$0.00 ","$92.48 ","$0.00 ","$96.90 ","$0.00 "
"443.054","SUP","HCPCS C1713","","443.054  -  PLATE BONE 22X5X1MM 4 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2","BOTH IP/OP","$408.05 ","$301.96 ","$0.00 ","$408.05 ","$183.62 ","$0.00 ","$85.05 ","$0.00 ","$0.00 ","$71.45 ","$408.05 ","$0.00 ","$204.03 ","$323.18 ","$326.44 ","$0.00 ","$62.00 ","$0.00 ","$64.96 ","$0.00 "
"443.055","SUP","HCPCS C1713","","443.055  -  PLATE BONE 27X5X1MM 5 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2","BOTH IP/OP","$450.38 ","$333.28 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$93.87 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$68.43 ","$0.00 ","$71.70 ","$0.00 "
"443.056","SUP","HCPCS C1713","","443.056  -  PLATE BONE 32X5X1MM 6 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2","BOTH IP/OP","$491.30 ","$363.56 ","$0.00 ","$491.30 ","$221.09 ","$0.00 ","$102.40 ","$0.00 ","$0.00 ","$86.02 ","$491.30 ","$0.00 ","$245.65 ","$389.11 ","$393.04 ","$0.00 ","$74.65 ","$0.00 ","$78.21 ","$0.00 "
"443.057","SUP","HCPCS C1713","","443.057  -  PLATE BONE 37X5X1.5MM 7 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$532.25 ","$393.87 ","$0.00 ","$532.25 ","$239.51 ","$0.00 ","$110.93 ","$0.00 ","$0.00 ","$93.19 ","$532.25 ","$0.00 ","$266.13 ","$421.54 ","$425.80 ","$0.00 ","$80.87 ","$0.00 ","$84.73 ","$0.00 "
"443.058","SUP","HCPCS C1713","","443.058  -  PLATE BONE 42X5X1.5MM 8 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL","BOTH IP/OP","$571.83 ","$423.15 ","$0.00 ","$571.83 ","$257.32 ","$0.00 ","$119.18 ","$0.00 ","$0.00 ","$100.12 ","$571.83 ","$0.00 ","$285.91 ","$452.89 ","$457.46 ","$0.00 ","$86.88 ","$0.00 ","$91.03 ","$0.00 "
"443.178","SUP","HCPCS C1713","","443.178  -  PLATE 31MM TI 2MM SCR 2 BND ARCH BONE SPNL NONSTRL","BOTH IP/OP","$1,342.25 ","$993.27 ","$0.00 ","$1,342.25 ","$604.01 ","$0.00 ","$279.76 ","$0.00 ","$0.00 ","$235.02 ","$1,342.25 ","$0.00 ","$671.13 ","$1,063.06 ","$1,073.80 ","$0.00 ","$210.06 ","$0.00 ","$213.69 ","$0.00 "
"443.18","SUP","HCPCS C1713","","443.180  -  PLATE MINI 10MM SPC 33MM TI 2MM SCR 2 BND ARCH BONE SPNL","BOTH IP/OP","$1,342.25 ","$993.27 ","$0.00 ","$1,342.25 ","$604.01 ","$0.00 ","$279.76 ","$0.00 ","$0.00 ","$235.02 ","$1,342.25 ","$0.00 ","$671.13 ","$1,063.06 ","$1,073.80 ","$0.00 ","$210.06 ","$0.00 ","$213.69 ","$0.00 "
"443.182","SUP","HCPCS C1713","","443.182  -  PLATE MINI 12MM SPC 35MM TI 2MM SCR 2 BND ARCH BONE SPNL","BOTH IP/OP","$1,342.25 ","$993.27 ","$0.00 ","$1,342.25 ","$604.01 ","$0.00 ","$279.76 ","$0.00 ","$0.00 ","$235.02 ","$1,342.25 ","$0.00 ","$671.13 ","$1,063.06 ","$1,073.80 ","$0.00 ","$210.06 ","$0.00 ","$213.69 ","$0.00 "
"443.19","SUP","HCPCS C1713","","443.19  -  PLATE BN STRG 100X5X1MM NS 20 HL TI 2MM SCR","BOTH IP/OP","$458.55 ","$339.33 ","$0.00 ","$458.55 ","$206.35 ","$0.00 ","$95.57 ","$0.00 ","$0.00 ","$80.29 ","$458.55 ","$0.00 ","$229.28 ","$363.17 ","$366.84 ","$0.00 ","$69.67 ","$0.00 ","$73.00 ","$0.00 "
"443.23","SUP","HCPCS C1713","","443.23  -  PLATE BN T 50X5X1.2MM NS 3 HLE/HD 9 HL SHFT TI 2MM SCR","BOTH IP/OP","$390.33 ","$288.84 ","$0.00 ","$390.33 ","$175.65 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$68.34 ","$390.33 ","$0.00 ","$195.16 ","$309.14 ","$312.26 ","$0.00 ","$59.31 ","$0.00 ","$62.14 ","$0.00 "
"443.24","SUP","HCPCS C1713","","443.24  -  PLATE BN T 50X5X1.2MM NS 4 HLE/HD 9 HL SHFT TI 2MM SCR","BOTH IP/OP","$421.70 ","$312.06 ","$0.00 ","$421.70 ","$189.77 ","$0.00 ","$87.89 ","$0.00 ","$0.00 ","$73.84 ","$421.70 ","$0.00 ","$210.85 ","$333.99 ","$337.36 ","$0.00 ","$64.08 ","$0.00 ","$67.13 ","$0.00 "
"443.44","SUP","HCPCS C1713","","443.44  -  PLATE BN 22X5X.9MM NS DCP 4 HL TI ZYG 2MM CORT SCR","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"443.45","SUP","HCPCS C1713","","443.45  -  PLATE BN 27X5X.9MM NS DCP 5 HL TI ZYG 2MM SCR","BOTH IP/OP","$578.25 ","$427.91 ","$0.00 ","$578.25 ","$260.21 ","$0.00 ","$120.52 ","$0.00 ","$0.00 ","$101.25 ","$578.25 ","$0.00 ","$289.13 ","$457.97 ","$462.60 ","$0.00 ","$90.50 ","$0.00 ","$92.06 ","$0.00 "
"443.46","SUP","HCPCS C1713","","443.46  -  PLATE BN 32X5X.9MM NS DCP 6 HL TI ZYG 2MM SCR","BOTH IP/OP","$621.00 ","$459.54 ","$0.00 ","$621.00 ","$279.45 ","$0.00 ","$129.43 ","$0.00 ","$0.00 ","$108.73 ","$621.00 ","$0.00 ","$310.50 ","$491.83 ","$496.80 ","$0.00 ","$97.19 ","$0.00 ","$98.86 ","$0.00 "
"443.48","SUP","HCPCS C1713","","443.48  -  PLATE BONE H 12X11MM 4 HOLE TITANIUM CONDYLE NONSTRL 2MM","BOTH IP/OP","$398.50 ","$294.89 ","$0.00 ","$398.50 ","$179.33 ","$0.00 ","$83.06 ","$0.00 ","$0.00 ","$69.77 ","$398.50 ","$0.00 ","$199.25 ","$315.61 ","$318.80 ","$0.00 ","$60.55 ","$0.00 ","$63.44 ","$0.00 "
"443.54","SUP","HCPCS C1713","","443.54  -  PLATE BONE 22MM DCP MINI CRANFCL TI 4 HOLE 2MM SCR NONSTRL","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"443.55","SUP","HCPCS C1713","","443.55  -  PLATE BONE 27MM DCP MINI CRANFCL TI 5 HOLE 2MM SCR NONSTRL","BOTH IP/OP","$695.25 ","$514.49 ","$0.00 ","$695.25 ","$312.86 ","$0.00 ","$144.91 ","$0.00 ","$0.00 ","$121.73 ","$695.25 ","$0.00 ","$347.63 ","$550.64 ","$556.20 ","$0.00 ","$108.81 ","$0.00 ","$110.68 ","$0.00 "
"443.56","SUP","HCPCS C1713","","443.56  -  PLATE BONE 32MM DCP MINI CRANFCL TI 6 HOLE 2MM SCR NONSTRL","BOTH IP/OP","$760.50 ","$562.77 ","$0.00 ","$760.50 ","$342.23 ","$0.00 ","$158.51 ","$0.00 ","$0.00 ","$133.16 ","$760.50 ","$0.00 ","$380.25 ","$602.32 ","$608.40 ","$0.00 ","$119.02 ","$0.00 ","$121.07 ","$0.00 "
"443.57","SUP","HCPCS C1713","","443.57  -  PLATE BONE 37MM DCP MINI CRANFCL TI 7 HOLE 2MM SCR NONSTRL","BOTH IP/OP","$816.75 ","$604.40 ","$0.00 ","$816.75 ","$367.54 ","$0.00 ","$170.23 ","$0.00 ","$0.00 ","$143.01 ","$816.75 ","$0.00 ","$408.38 ","$646.87 ","$653.40 ","$0.00 ","$127.82 ","$0.00 ","$130.03 ","$0.00 "
"443.58","SUP","HCPCS C1713","","443.58  -  PLATE BONE 42MM DCP MINI CRANFCL TI 8 HOLE 2MM SCR NONSTRL","BOTH IP/OP","$884.25 ","$654.35 ","$0.00 ","$884.25 ","$397.91 ","$0.00 ","$184.30 ","$0.00 ","$0.00 ","$154.83 ","$884.25 ","$0.00 ","$442.13 ","$700.33 ","$707.40 ","$0.00 ","$138.39 ","$0.00 ","$140.77 ","$0.00 "
"443.61","SUP","HCPCS C1713","","443.61  -  PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL LT 2MM SCR","BOTH IP/OP","$551.35 ","$408.00 ","$0.00 ","$551.35 ","$248.11 ","$0.00 ","$114.92 ","$0.00 ","$0.00 ","$96.54 ","$551.35 ","$0.00 ","$275.68 ","$436.67 ","$441.08 ","$0.00 ","$83.77 ","$0.00 ","$87.77 ","$0.00 "
"443.62","SUP","HCPCS C1713","","443.62  -  PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL RT 2MM SCR","BOTH IP/OP","$551.35 ","$408.00 ","$0.00 ","$551.35 ","$248.11 ","$0.00 ","$114.92 ","$0.00 ","$0.00 ","$96.54 ","$551.35 ","$0.00 ","$275.68 ","$436.67 ","$441.08 ","$0.00 ","$83.77 ","$0.00 ","$87.77 ","$0.00 "
"444.002","SUP","HCPCS C1713","","444.002  -  PLATE BONE 2.7MM 20X8X2MM 2 HOLE DCP TITANIUM FT NONSTRL 2.7","BOTH IP/OP","$474.35 ","$351.02 ","$0.00 ","$474.35 ","$213.46 ","$0.00 ","$98.87 ","$0.00 ","$0.00 ","$83.05 ","$474.35 ","$0.00 ","$237.18 ","$375.69 ","$379.48 ","$0.00 ","$74.24 ","$0.00 ","$75.52 ","$0.00 "
"444.004","SUP","HCPCS C1713","","444.004  -  PLATE BONE 36X8X2MM 4 HOLE DCP TITANIUM FT NONSTRL 2.7MM","BOTH IP/OP","$593.60 ","$439.26 ","$0.00 ","$593.60 ","$267.12 ","$0.00 ","$123.72 ","$0.00 ","$0.00 ","$103.93 ","$593.60 ","$0.00 ","$296.80 ","$470.13 ","$474.88 ","$0.00 ","$92.90 ","$0.00 ","$94.50 ","$0.00 "
"444.005","SUP","HCPCS C1713","","444.005  -  PLATE BONE 44X8X2MM 5 HOLE DCP TITANIUM FT NONSTRL 2.7MM","BOTH IP/OP","$669.13 ","$495.16 ","$0.00 ","$669.13 ","$301.11 ","$0.00 ","$139.46 ","$0.00 ","$0.00 ","$117.16 ","$669.13 ","$0.00 ","$334.56 ","$529.95 ","$535.30 ","$0.00 ","$104.72 ","$0.00 ","$106.52 ","$0.00 "
"444.006","SUP","HCPCS C1713","","444.006  -  PLATE BONE 2.7MM 52X8X2MM 6 HOLE DCP TITANIUM FT NONSTRL 2.7","BOTH IP/OP","$716.83 ","$530.45 ","$0.00 ","$716.83 ","$322.57 ","$0.00 ","$149.40 ","$0.00 ","$0.00 ","$125.51 ","$716.83 ","$0.00 ","$358.41 ","$567.73 ","$573.46 ","$0.00 ","$112.18 ","$0.00 ","$114.12 ","$0.00 "
"444.007","SUP","HCPCS C1713","","444.007  -  PLATE BONE 60X8X2.5MM 7 HOLE DCP TITANIUM FT NONSTRL 2.7MM","BOTH IP/OP","$797.65 ","$590.26 ","$0.00 ","$797.65 ","$358.94 ","$0.00 ","$166.25 ","$0.00 ","$0.00 ","$139.66 ","$797.65 ","$0.00 ","$398.83 ","$631.74 ","$638.12 ","$0.00 ","$124.83 ","$0.00 ","$126.99 ","$0.00 "
"444.008","SUP","HCPCS C1713","","444.008  -  PLATE BONE 68X8X2.5MM 8 HOLE DCP TITANIUM FT NONSTRL 2.7MM","BOTH IP/OP","$836.08 ","$618.70 ","$0.00 ","$836.08 ","$376.23 ","$0.00 ","$174.26 ","$0.00 ","$0.00 ","$146.39 ","$836.08 ","$0.00 ","$418.04 ","$662.18 ","$668.86 ","$0.00 ","$130.85 ","$0.00 ","$133.10 ","$0.00 "
"444.009","SUP","HCPCS C1713","","444.009  -  PLATE BONE 2.7MM 76X8X2.5MM 9 HOLE DCP TITANIUM FT NONSTRL","BOTH IP/OP","$910.28 ","$673.61 ","$0.00 ","$910.28 ","$409.62 ","$0.00 ","$189.72 ","$0.00 ","$0.00 ","$159.38 ","$910.28 ","$0.00 ","$455.14 ","$720.94 ","$728.22 ","$0.00 ","$142.46 ","$0.00 ","$144.92 ","$0.00 "
"444.01","SUP","HCPCS C1713","","444.010  -  PLATE BONE 2.7MM 84X8X2.5MM 10 HOLE DCP TITANIUM FT NONSTRL","BOTH IP/OP","$985.80 ","$729.49 ","$0.00 ","$985.80 ","$443.61 ","$0.00 ","$205.47 ","$0.00 ","$0.00 ","$172.61 ","$985.80 ","$0.00 ","$492.90 ","$780.75 ","$788.64 ","$0.00 ","$154.28 ","$0.00 ","$156.94 ","$0.00 "
"444.012","SUP","HCPCS C1713","","444.012  -  PLATE BONE 2.7MM 100X8X2.5MM 12 HOLE DCP TITANIUM FT NONSTRL","BOTH IP/OP","$1,094.45 ","$809.89 ","$0.00 ","$1,094.45 ","$492.50 ","$0.00 ","$228.11 ","$0.00 ","$0.00 ","$191.63 ","$1,094.45 ","$0.00 ","$547.23 ","$866.80 ","$875.56 ","$0.00 ","$171.28 ","$0.00 ","$174.24 ","$0.00 "
"444.022","SUP","HCPCS C1713","","444.022  -  PLATE BONE 1.5MM 26X8X2.5MM 2 HOLE DCP TITANIUM FT NONSTRL","BOTH IP/OP","$494.23 ","$365.73 ","$0.00 ","$494.23 ","$222.40 ","$0.00 ","$103.01 ","$0.00 ","$0.00 ","$86.53 ","$494.23 ","$0.00 ","$247.11 ","$391.43 ","$395.38 ","$0.00 ","$77.35 ","$0.00 ","$78.68 ","$0.00 "
"445","SUP","HCPCS C1713","","445.00  -  PLATE BONE 3.5MM 118MM 10 HOLE RECONSTRUCTION LC-DCP","BOTH IP/OP","$941.68 ","$696.84 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$196.27 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"445.01","SUP","HCPCS C1713","","445.01  -  PLATE BN 130MM NS 11 HL RECON TI 3.5MM SCR","BOTH IP/OP","$962.15 ","$711.99 ","$0.00 ","$962.15 ","$432.97 ","$0.00 ","$200.54 ","$0.00 ","$0.00 ","$168.46 ","$962.15 ","$0.00 ","$481.08 ","$762.02 ","$769.72 ","$0.00 ","$146.19 ","$0.00 ","$153.17 ","$0.00 "
"445.041","SUP","HCPCS C1713","","445.041  -  PLATE BONE 56MM 4 HOLE RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$794.28 ","$357.42 ","$0.00 ","$170.52 ","$0.00 ","$0.00 ","$139.07 ","$794.28 ","$0.00 ","$397.14 ","$629.07 ","$635.42 ","$0.00 ","$120.68 ","$0.00 ","$126.45 ","$0.00 "
"445.051","SUP","HCPCS C1713","","445.051  -  PLATE BN 70X10.1X3.5MM NS LCP CMBN 5 HL RECON TI 3.5MM SCR","BOTH IP/OP","$823.73 ","$609.56 ","$0.00 ","$799.75 ","$359.89 ","$0.00 ","$171.68 ","$0.00 ","$0.00 ","$140.03 ","$799.75 ","$0.00 ","$399.88 ","$633.40 ","$639.80 ","$0.00 ","$121.51 ","$0.00 ","$127.32 ","$0.00 "
"445.061","SUP","HCPCS C1713","","445.061  -  PLATE BN 84X10.1X3.5MM NS LCP CMBN 6 HL RECON TI 3.5MM SCR","BOTH IP/OP","$953.05 ","$705.26 ","$0.00 ","$925.30 ","$416.39 ","$0.00 ","$198.64 ","$0.00 ","$0.00 ","$162.01 ","$925.30 ","$0.00 ","$462.65 ","$732.84 ","$740.24 ","$0.00 ","$140.59 ","$0.00 ","$147.31 ","$0.00 "
"445.071","SUP","HCPCS C1713","","445.071  -  PLATE BONE 98X10.1X3.5MM 7 HOLE LCP TITANIUM CLAVICLE","BOTH IP/OP","$1,002.25 ","$741.67 ","$0.00 ","$973.08 ","$437.88 ","$0.00 ","$208.89 ","$0.00 ","$0.00 ","$170.38 ","$973.08 ","$0.00 ","$486.54 ","$770.68 ","$778.46 ","$0.00 ","$147.85 ","$0.00 ","$154.91 ","$0.00 "
"445.081","SUP","HCPCS C1713","","445.081  -  PLATE BN 112X10.1X3.5MM NS LCP CMBN 8 HL RECON TI 3.5MM SCR","BOTH IP/OP","$1,045.83 ","$773.91 ","$0.00 ","$1,015.38 ","$456.92 ","$0.00 ","$217.98 ","$0.00 ","$0.00 ","$177.78 ","$1,015.38 ","$0.00 ","$507.69 ","$804.18 ","$812.30 ","$0.00 ","$154.28 ","$0.00 ","$161.65 ","$0.00 "
"445.091","SUP","HCPCS C1713","","445.091  -  PLATE BONE 126MM 9 HOLE RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,100.65 ","$814.48 ","$0.00 ","$1,068.60 ","$480.87 ","$0.00 ","$229.40 ","$0.00 ","$0.00 ","$187.10 ","$1,068.60 ","$0.00 ","$534.30 ","$846.33 ","$854.88 ","$0.00 ","$162.36 ","$0.00 ","$170.12 ","$0.00 "
"445.101","SUP","HCPCS C1713","","445.101  -  PLATE BONE 140X10.1X3.5MM 10 HOLE LCP TITANIUM CLAVICLE","BOTH IP/OP","$1,082.38 ","$800.96 ","$0.00 ","$1,050.85 ","$472.88 ","$0.00 ","$225.59 ","$0.00 ","$0.00 ","$184.00 ","$1,050.85 ","$0.00 ","$525.43 ","$832.27 ","$840.68 ","$0.00 ","$159.67 ","$0.00 ","$167.30 ","$0.00 "
"445.111","SUP","HCPCS C1713","","445.111  -  PLATE BONE 154MM 11 HOLE RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,172.35 ","$867.54 ","$0.00 ","$1,138.20 ","$512.19 ","$0.00 ","$244.35 ","$0.00 ","$0.00 ","$199.29 ","$1,138.20 ","$0.00 ","$569.10 ","$901.45 ","$910.56 ","$0.00 ","$172.94 ","$0.00 ","$181.20 ","$0.00 "
"445.121","SUP","HCPCS C1713","","445.121  -  PLATE BONE 168X10.1X3.5MM 12 HOLE LCP TITANIUM CLAVICLE","BOTH IP/OP","$1,176.58 ","$870.67 ","$0.00 ","$1,142.30 ","$514.04 ","$0.00 ","$245.23 ","$0.00 ","$0.00 ","$200.01 ","$1,142.30 ","$0.00 ","$571.15 ","$904.70 ","$913.84 ","$0.00 ","$173.56 ","$0.00 ","$181.85 ","$0.00 "
"445.131","SUP","HCPCS C1713","","445.131  -  PLATE BONE 182MM 13 HOLE RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,273.55 ","$942.43 ","$0.00 ","$1,236.48 ","$556.41 ","$0.00 ","$265.44 ","$0.00 ","$0.00 ","$216.50 ","$1,236.48 ","$0.00 ","$618.24 ","$979.29 ","$989.18 ","$0.00 ","$187.87 ","$0.00 ","$196.85 ","$0.00 "
"445.141","SUP","HCPCS C1713","","445.141  -  PLATE BONE 196MM 14 HOLE RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,322.75 ","$978.84 ","$0.00 ","$1,284.23 ","$577.90 ","$0.00 ","$275.69 ","$0.00 ","$0.00 ","$224.86 ","$1,284.23 ","$0.00 ","$642.11 ","$1,017.11 ","$1,027.38 ","$0.00 ","$195.13 ","$0.00 ","$204.45 ","$0.00 "
"445.15","SUP","HCPCS C1713","","445.15  -  PLATE BONE 58MM 5 HOLE RECONSTRUCTION LC-DCP TITANIUM","BOTH IP/OP","$716.50 ","$530.21 ","$0.00 ","$716.50 ","$322.43 ","$0.00 ","$149.34 ","$0.00 ","$0.00 ","$125.45 ","$716.50 ","$0.00 ","$358.25 ","$567.47 ","$573.20 ","$0.00 ","$108.87 ","$0.00 ","$114.07 ","$0.00 "
"445.16","SUP","HCPCS C1713","","445.16  -  PLATE BONE 70MM 6 HOLE RECONSTRUCTION LC-DCP TITANIUM","BOTH IP/OP","$825.68 ","$611.00 ","$0.00 ","$825.68 ","$371.55 ","$0.00 ","$172.09 ","$0.00 ","$0.00 ","$144.57 ","$825.68 ","$0.00 ","$412.84 ","$653.94 ","$660.54 ","$0.00 ","$125.45 ","$0.00 ","$131.45 ","$0.00 "
"445.161","SUP","HCPCS C1713","","445.161  -  PLATE BONE 224MM 16 HOLE RECONSTRUCTION LCP TITANIUM","BOTH IP/OP","$1,433.80 ","$1,061.01 ","$0.00 ","$1,392.05 ","$626.42 ","$0.00 ","$298.84 ","$0.00 ","$0.00 ","$243.74 ","$1,392.05 ","$0.00 ","$696.03 ","$1,102.50 ","$1,113.64 ","$0.00 ","$211.51 ","$0.00 ","$221.61 ","$0.00 "
"445.17","SUP","HCPCS C1713","","445.17  -  PLATE BONE 82MM 7 HOLE RECONSTRUCTION LC-DCP TITANIUM","BOTH IP/OP","$848.88 ","$628.17 ","$0.00 ","$848.88 ","$381.99 ","$0.00 ","$176.93 ","$0.00 ","$0.00 ","$148.63 ","$848.88 ","$0.00 ","$424.44 ","$672.31 ","$679.10 ","$0.00 ","$128.98 ","$0.00 ","$135.14 ","$0.00 "
"445.18","SUP","HCPCS C1713","","445.18  -  PLATE BONE 94MM 8 HOLE RECONSTRUCTION LC-DCP TITANIUM","BOTH IP/OP","$899.38 ","$665.54 ","$0.00 ","$899.38 ","$404.72 ","$0.00 ","$187.45 ","$0.00 ","$0.00 ","$157.47 ","$899.38 ","$0.00 ","$449.69 ","$712.31 ","$719.50 ","$0.00 ","$136.65 ","$0.00 ","$143.18 ","$0.00 "
"445.181","SUP","HCPCS C1713","","445.181  -  PLATE BN 252X10.1X3.5MM NS LCP CMBN 18 HL RECON TI 3.5MM SCR","BOTH IP/OP","$1,501.28 ","$1,110.95 ","$0.00 ","$1,457.55 ","$655.90 ","$0.00 ","$312.90 ","$0.00 ","$0.00 ","$255.21 ","$1,457.55 ","$0.00 ","$728.78 ","$1,154.38 ","$1,166.04 ","$0.00 ","$221.46 ","$0.00 ","$232.04 ","$0.00 "
"445.19","SUP","HCPCS C1713","","445.19  -  PLATE BONE 106MM 9 HOLE RECONSTRUCTION LC-DCP TITANIUM","BOTH IP/OP","$926.68 ","$685.74 ","$0.00 ","$926.68 ","$417.00 ","$0.00 ","$193.14 ","$0.00 ","$0.00 ","$162.25 ","$926.68 ","$0.00 ","$463.34 ","$733.93 ","$741.34 ","$0.00 ","$140.80 ","$0.00 ","$147.53 ","$0.00 "
"445.201","SUP","HCPCS C1713","","445.201  -  PLATE BN 280X10.1X3.5MM NS LCP CMBN 20 HL RECON TI 3.5MM SCR","BOTH IP/OP","$1,823.18 ","$1,349.15 ","$0.00 ","$1,770.08 ","$796.53 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$309.93 ","$1,770.08 ","$0.00 ","$885.04 ","$1,401.90 ","$1,416.06 ","$0.00 ","$268.95 ","$0.00 ","$281.80 ","$0.00 "
"445.221","SUP","HCPCS C1713","","445.221  -  PLATE BONE 308MM 22 HOLE RECONSTRUCTION LCP TITANIUM NONSTRL","BOTH IP/OP","$1,858.33 ","$1,375.16 ","$0.00 ","$1,804.20 ","$811.89 ","$0.00 ","$387.32 ","$0.00 ","$0.00 ","$315.90 ","$1,804.20 ","$0.00 ","$902.10 ","$1,428.93 ","$1,443.36 ","$0.00 ","$274.13 ","$0.00 ","$287.23 ","$0.00 "
"446.014","SUP","HCPCS C1713","","446.014  -  PLATE BN RECT 45X38X.4MM NS CNTR MESH MLBL TI CRNFCL 1.5MM","BOTH IP/OP","$3,413.25 ","$2,525.81 ","$0.00 ","$3,413.25 ","$1,535.96 ","$0.00 ","$711.41 ","$0.00 ","$0.00 ","$597.63 ","$3,413.25 ","$0.00 ","$1,706.63 ","$2,703.29 ","$2,730.60 ","$0.00 ","$534.17 ","$0.00 ","$543.39 ","$0.00 "
"446.015","SUP","HCPCS C1713","","446.015  -  PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM","BOTH IP/OP","$3,413.25 ","$2,525.81 ","$0.00 ","$3,413.25 ","$1,535.96 ","$0.00 ","$711.41 ","$0.00 ","$0.00 ","$597.63 ","$3,413.25 ","$0.00 ","$1,706.63 ","$2,703.29 ","$2,730.60 ","$0.00 ","$534.17 ","$0.00 ","$543.39 ","$0.00 "
"446.017","SUP","HCPCS C1713","","446.017  -  PLATE BN RECT 100X100X.3MM NS CNTR MESH MLBL TI CRNFCL 1.5MM","BOTH IP/OP","$5,334.75 ","$3,947.72 ","$0.00 ","$5,334.75 ","$2,400.64 ","$0.00 ","$1,111.90 ","$0.00 ","$0.00 ","$934.07 ","$5,334.75 ","$0.00 ","$2,667.38 ","$4,225.12 ","$4,267.80 ","$0.00 ","$834.89 ","$0.00 ","$849.29 ","$0.00 "
"446.018","SUP","HCPCS C1713","","446.018  -  PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM","BOTH IP/OP","$5,334.75 ","$3,947.72 ","$0.00 ","$5,334.75 ","$2,400.64 ","$0.00 ","$1,111.90 ","$0.00 ","$0.00 ","$934.07 ","$5,334.75 ","$0.00 ","$2,667.38 ","$4,225.12 ","$4,267.80 ","$0.00 ","$834.89 ","$0.00 ","$849.29 ","$0.00 "
"446.019","SUP","HCPCS C1713","","446.019  -  PLATE BONE NONSTRL GOLD 200X200MM CRANFCL TI CONTUR MESH RGD","BOTH IP/OP","$19,163.25 ","$14,180.81 ","$0.00 ","$19,163.25 ","$8,623.46 ","$0.00 ","$3,994.10 ","$0.00 ","$0.00 ","$3,355.33 ","$19,163.25 ","$0.00 ","$9,581.63 ","$15,177.29 ","$15,330.60 ","$0.00 ","$2,999.05 ","$0.00 ","$3,050.79 ","$0.00 "
"446.02","SUP","HCPCS C1713","","446.020  -  PLATE BONE CRANIAL TI 2 HOLE STR 1.5 MM SCR NONSTRL","BOTH IP/OP","$105.75 ","$78.26 ","$0.00 ","$105.75 ","$47.59 ","$0.00 ","$22.04 ","$0.00 ","$0.00 ","$18.52 ","$105.75 ","$0.00 ","$52.88 ","$83.75 ","$84.60 ","$0.00 ","$16.55 ","$0.00 ","$16.84 ","$0.00 "
"446.024","SUP","HCPCS C1713","","446.024  -  PLATE BONE 25MM CRANFCL TI 4 HOLE STR LP 1.5MM SCR NONSTRL","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$64.80 ","$0.00 ","$30.01 ","$0.00 ","$0.00 ","$25.21 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$22.54 ","$0.00 ","$22.92 ","$0.00 "
"446.031","SUP","HCPCS C1713","","446.031  -  PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"446.032","SUP","HCPCS C1713","","446.032  -  PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR","BOTH IP/OP","$465.28 ","$344.31 ","$0.00 ","$451.73 ","$203.28 ","$0.00 ","$96.97 ","$0.00 ","$0.00 ","$79.09 ","$451.73 ","$0.00 ","$225.86 ","$357.77 ","$361.38 ","$0.00 ","$68.64 ","$0.00 ","$71.91 ","$0.00 "
"446.033","SUP","HCPCS C1713","","446.033  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE SM ARC","BOTH IP/OP","$1,768.50 ","$1,308.69 ","$0.00 ","$1,768.50 ","$795.83 ","$0.00 ","$368.60 ","$0.00 ","$0.00 ","$309.65 ","$1,768.50 ","$0.00 ","$884.25 ","$1,400.65 ","$1,414.80 ","$0.00 ","$276.77 ","$0.00 ","$281.55 ","$0.00 "
"446.034","SUP","HCPCS C1713","","446.034  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE LG ARC","BOTH IP/OP","$2,754.00 ","$2,037.96 ","$0.00 ","$2,754.00 ","$1,239.30 ","$0.00 ","$574.00 ","$0.00 ","$0.00 ","$482.20 ","$2,754.00 ","$0.00 ","$1,377.00 ","$2,181.17 ","$2,203.20 ","$0.00 ","$431.00 ","$0.00 ","$438.44 ","$0.00 "
"446.035","SUP","HCPCS C1713","","446.035  -  PLATE BONE 1.5MM SCR GOLD CRANFCL TI CONTUR MESH RGD SM ARC","BOTH IP/OP","$1,768.50 ","$1,308.69 ","$0.00 ","$1,768.50 ","$795.83 ","$0.00 ","$368.60 ","$0.00 ","$0.00 ","$309.65 ","$1,768.50 ","$0.00 ","$884.25 ","$1,400.65 ","$1,414.80 ","$0.00 ","$276.77 ","$0.00 ","$281.55 ","$0.00 "
"446.036","SUP","HCPCS C1713","","446.036  -  PLATE BONE 1.5MM SCR GOLD CRANFCL TI CONTUR MESH RGD LG ARC","BOTH IP/OP","$2,754.00 ","$2,037.96 ","$0.00 ","$2,754.00 ","$1,239.30 ","$0.00 ","$574.00 ","$0.00 ","$0.00 ","$482.20 ","$2,754.00 ","$0.00 ","$1,377.00 ","$2,181.17 ","$2,203.20 ","$0.00 ","$431.00 ","$0.00 ","$438.44 ","$0.00 "
"446.04","SUP","HCPCS C1713","","446.040  -  PLATE 0MM RIGHT MAXL PREBNT OFFST ORTHGNAT 1.5MM SCR BONE TI","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.041","SUP","HCPCS C1713","","446.041  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 0MM NONSTRL","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.042","SUP","HCPCS C1713","","446.042  -  PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.043","SUP","HCPCS C1713","","446.043  -  PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.044","SUP","HCPCS C1713","","446.044  -  PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.045","SUP","HCPCS C1713","","446.045  -  PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.046","SUP","HCPCS C1713","","446.046  -  PLATE BN 7MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.047","SUP","HCPCS C1713","","446.047  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 7MM NONSTRL","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.048","SUP","HCPCS C1713","","446.048  -  PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.049","SUP","HCPCS C1713","","446.049  -  PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.05","SUP","HCPCS C1713","","446.050  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 30MM CRANFCL TI","BOTH IP/OP","$1,768.50 ","$1,308.69 ","$0.00 ","$1,768.50 ","$795.83 ","$0.00 ","$368.60 ","$0.00 ","$0.00 ","$309.65 ","$1,768.50 ","$0.00 ","$884.25 ","$1,400.65 ","$1,414.80 ","$0.00 ","$276.77 ","$0.00 ","$281.55 ","$0.00 "
"446.051","SUP","HCPCS C1713","","446.051  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 70MM CRANFCL TI","BOTH IP/OP","$3,665.25 ","$2,712.29 ","$0.00 ","$3,665.25 ","$1,649.36 ","$0.00 ","$763.93 ","$0.00 ","$0.00 ","$641.76 ","$3,665.25 ","$0.00 ","$1,832.63 ","$2,902.88 ","$2,932.20 ","$0.00 ","$573.61 ","$0.00 ","$583.51 ","$0.00 "
"446.052","SUP","HCPCS C1713","","446.052  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 100MM CRANFCL","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"446.053","SUP","HCPCS C1713","","446.053  -  PLATE BONE NONSTRL GOLD 30MM CRANFCL TI CONTUR MESH RGD 1.5","BOTH IP/OP","$1,966.50 ","$1,455.21 ","$0.00 ","$1,966.50 ","$884.93 ","$0.00 ","$409.87 ","$0.00 ","$0.00 ","$344.32 ","$1,966.50 ","$0.00 ","$983.25 ","$1,557.47 ","$1,573.20 ","$0.00 ","$307.76 ","$0.00 ","$313.07 ","$0.00 "
"446.054","SUP","HCPCS C1713","","446.054  -  PLATE BONE NONSTRL GOLD 70MM CRANFCL TI CONTUR MESH RGD 1.5","BOTH IP/OP","$4,070.25 ","$3,011.99 ","$0.00 ","$4,070.25 ","$1,831.61 ","$0.00 ","$848.34 ","$0.00 ","$0.00 ","$712.67 ","$4,070.25 ","$0.00 ","$2,035.13 ","$3,223.64 ","$3,256.20 ","$0.00 ","$636.99 ","$0.00 ","$647.98 ","$0.00 "
"446.055","SUP","HCPCS C1713","","446.055  -  PLATE BONE NONSTRL GOLD 100MM CRANFCL TI CONTUR MESH RGD 1.5","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"446.06","SUP","HCPCS C1713","","446.060  -  PLATE 11MM ADV RIGHT MAXL PREBNT 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.061","SUP","HCPCS C1713","","446.061  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 11MM NONSTRL","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"446.09","SUP","HCPCS C1713","","446.090  -  PLATE MANDIB 4X7 HOLE T 1.5 MM SCR BONE TI NONSTRL","BOTH IP/OP","$625.50 ","$462.87 ","$0.00 ","$625.50 ","$281.48 ","$0.00 ","$130.37 ","$0.00 ","$0.00 ","$109.52 ","$625.50 ","$0.00 ","$312.75 ","$495.40 ","$500.40 ","$0.00 ","$97.89 ","$0.00 ","$99.58 ","$0.00 "
"446.091","SUP","HCPCS C1713","","446.091  -  PLATE MANDIB 4X7 HOLE T MALBLE 1.5 MM SCR BONE TI NONSTRL","BOTH IP/OP","$553.50 ","$409.59 ","$0.00 ","$553.50 ","$249.08 ","$0.00 ","$115.36 ","$0.00 ","$0.00 ","$96.91 ","$553.50 ","$0.00 ","$276.75 ","$438.37 ","$442.80 ","$0.00 ","$86.62 ","$0.00 ","$88.12 ","$0.00 "
"446.096","SUP","HCPCS C1713","","446.096  -  PLATE BONE 14X14MM CRANFCL TI 4 HOLE BOX 1.5MM SCR NONSTRL","BOTH IP/OP","$553.50 ","$409.59 ","$0.00 ","$553.50 ","$249.08 ","$0.00 ","$115.36 ","$0.00 ","$0.00 ","$96.91 ","$553.50 ","$0.00 ","$276.75 ","$438.37 ","$442.80 ","$0.00 ","$86.62 ","$0.00 ","$88.12 ","$0.00 "
"446.097","SUP","HCPCS C1713","","446.097  -  PLATE BONE 16X16MM CRANFCL TI 4 HOLE BOX 1.5MM SCR NONSTRL","BOTH IP/OP","$553.50 ","$409.59 ","$0.00 ","$553.50 ","$249.08 ","$0.00 ","$115.36 ","$0.00 ","$0.00 ","$96.91 ","$553.50 ","$0.00 ","$276.75 ","$438.37 ","$442.80 ","$0.00 ","$86.62 ","$0.00 ","$88.12 ","$0.00 "
"446.1","SUP","HCPCS C1713","","446.10  -  PLATE 4.5MM HOLE SPC 90MM TI 1.5MM SCR 20 HOLE ADP BONE","BOTH IP/OP","$859.50 ","$636.03 ","$0.00 ","$859.50 ","$386.78 ","$0.00 ","$179.14 ","$0.00 ","$0.00 ","$150.49 ","$859.50 ","$0.00 ","$429.75 ","$680.72 ","$687.60 ","$0.00 ","$134.51 ","$0.00 ","$136.83 ","$0.00 "
"446.101","SUP","HCPCS C1713","","446.101  -  PLATE BONE 90MM CRANFCL TI 20 HOLE ADP LP 1.5MM SCR NONSTRL","BOTH IP/OP","$819.00 ","$606.06 ","$0.00 ","$819.00 ","$368.55 ","$0.00 ","$170.70 ","$0.00 ","$0.00 ","$143.40 ","$819.00 ","$0.00 ","$409.50 ","$648.65 ","$655.20 ","$0.00 ","$128.17 ","$0.00 ","$130.38 ","$0.00 "
"446.154","SUP","HCPCS C1713","","446.154  -  1.5MM TI 90� L-PLATE 17MM 2X2 HOLES LOW-PROFILE/LEFT","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$459.00 ","$206.55 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$80.37 ","$459.00 ","$0.00 ","$229.50 ","$363.53 ","$367.20 ","$0.00 ","$71.83 ","$0.00 ","$73.07 ","$0.00 "
"446.155","SUP","HCPCS C1713","","446.155  -  1.5MM TI 90� L-PLATE 17MM 2X2 HOLES LOW-PROFILE/RIGHT","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$459.00 ","$206.55 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$80.37 ","$459.00 ","$0.00 ","$229.50 ","$363.53 ","$367.20 ","$0.00 ","$71.83 ","$0.00 ","$73.07 ","$0.00 "
"446.156","SUP","HCPCS C1713","","446.156  -  1.5MM TI 90� L-PLATE 19MM 2X2 HOLES LOW-PROFILE/LEFT","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$459.00 ","$206.55 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$80.37 ","$459.00 ","$0.00 ","$229.50 ","$363.53 ","$367.20 ","$0.00 ","$71.83 ","$0.00 ","$73.07 ","$0.00 "
"446.157","SUP","HCPCS C1713","","446.157  -  1.5MM TI 90� L-PLATE 19MM 2X2 HOLES LOW-PROFILE/RIGHT","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$459.00 ","$206.55 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$80.37 ","$459.00 ","$0.00 ","$229.50 ","$363.53 ","$367.20 ","$0.00 ","$71.83 ","$0.00 ","$73.07 ","$0.00 "
"446.158","SUP","HCPCS C1713","","446.158  -  1.5MM TI 90� L-PLATE 23MM 2X2 HOLES LOW-PROFILE/LEFT","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$459.00 ","$206.55 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$80.37 ","$459.00 ","$0.00 ","$229.50 ","$363.53 ","$367.20 ","$0.00 ","$71.83 ","$0.00 ","$73.07 ","$0.00 "
"446.159","SUP","HCPCS C1713","","446.159  -  1.5MM TI 90� L-PLATE 23MM 2X2 HOLES LOW-PROFILE/RIGHT","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$459.00 ","$206.55 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$80.37 ","$459.00 ","$0.00 ","$229.50 ","$363.53 ","$367.20 ","$0.00 ","$71.83 ","$0.00 ","$73.07 ","$0.00 "
"446.18","SUP","HCPCS C1713","","446.18  -  PLATE BONE ORBTL RIM TI 8 HOLE RGD 1.5 MM SCR NONSTRL","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$684.00 ","$307.80 ","$0.00 ","$142.56 ","$0.00 ","$0.00 ","$119.76 ","$684.00 ","$0.00 ","$342.00 ","$541.73 ","$547.20 ","$0.00 ","$107.05 ","$0.00 ","$108.89 ","$0.00 "
"446.19","SUP","HCPCS C1713","","446.19  -  PLATE BN STRG 100X3.8X.8MM NS 20 HL TI 1.5MM SCR","BOTH IP/OP","$451.23 ","$333.91 ","$0.00 ","$438.08 ","$197.13 ","$0.00 ","$94.05 ","$0.00 ","$0.00 ","$76.70 ","$438.08 ","$0.00 ","$219.04 ","$346.96 ","$350.46 ","$0.00 ","$66.56 ","$0.00 ","$69.74 ","$0.00 "
"446.2","SUP","HCPCS C1713","","446.20  -  PLATE BN 41MM NS 10 HL TI ORBT RIM 1.5MM SCR","BOTH IP/OP","$722.25 ","$534.47 ","$0.00 ","$722.25 ","$325.01 ","$0.00 ","$150.53 ","$0.00 ","$0.00 ","$126.46 ","$722.25 ","$0.00 ","$361.13 ","$572.02 ","$577.80 ","$0.00 ","$113.03 ","$0.00 ","$114.98 ","$0.00 "
"446.22","SUP","HCPCS C1713","","446.22  -  PLATE BN 49MM NS 12 HL TI ORBT RIM 1.5MM SCR","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"446.23","SUP","HCPCS C1713","","446.23  -  PLATE BONE T 1.5MM 50MM 3X9 HOLE LCP TITANIUM CONDYLE","BOTH IP/OP","$390.78 ","$289.18 ","$0.00 ","$379.40 ","$170.73 ","$0.00 ","$81.45 ","$0.00 ","$0.00 ","$66.43 ","$379.40 ","$0.00 ","$189.70 ","$300.48 ","$303.52 ","$0.00 ","$57.65 ","$0.00 ","$60.40 ","$0.00 "
"446.233","SUP","HCPCS C1713","","446.233  -  PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"446.234","SUP","HCPCS C1713","","446.234  -  PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"446.24","SUP","HCPCS C1713","","446.24  -  PLATE BN T 50X4X1MM NS 4 HLE/HD 9 HL SHFT TI 1.5MM SCR","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"446.4","SUP","HCPCS C1713","","446.40  -  PLATE BONE UNV ORBTL FLR TI 1.5MM SCR NONSTRL","BOTH IP/OP","$2,772.00 ","$2,051.28 ","$0.00 ","$2,772.00 ","$1,247.40 ","$0.00 ","$577.75 ","$0.00 ","$0.00 ","$485.36 ","$2,772.00 ","$0.00 ","$1,386.00 ","$2,195.42 ","$2,217.60 ","$0.00 ","$433.82 ","$0.00 ","$441.30 ","$0.00 "
"446.44","SUP","HCPCS C1713","","446.44  -  PLATE BONE LEFT MDL WL CRANFCL TI 1.5 MM SCR NONSTRL","BOTH IP/OP","$2,457.00 ","$1,818.18 ","$0.00 ","$2,457.00 ","$1,105.65 ","$0.00 ","$512.10 ","$0.00 ","$0.00 ","$430.20 ","$2,457.00 ","$0.00 ","$1,228.50 ","$1,945.94 ","$1,965.60 ","$0.00 ","$384.52 ","$0.00 ","$391.15 ","$0.00 "
"446.45","SUP","HCPCS C1713","","446.45  -  PLATE BONE RIGHT MDL WL CRANFCL TI 1.5 MM SCR NONSTRL","BOTH IP/OP","$2,457.00 ","$1,818.18 ","$0.00 ","$2,457.00 ","$1,105.65 ","$0.00 ","$512.10 ","$0.00 ","$0.00 ","$430.20 ","$2,457.00 ","$0.00 ","$1,228.50 ","$1,945.94 ","$1,965.60 ","$0.00 ","$384.52 ","$0.00 ","$391.15 ","$0.00 "
"446.48","SUP","HCPCS C1713","","446.48  -  PLATE BONE H 1.5MM 6MM 4 HOLE TITANIUM HAND NONSTRL 1.5MM","BOTH IP/OP","$399.23 ","$295.43 ","$0.00 ","$387.60 ","$174.42 ","$0.00 ","$83.21 ","$0.00 ","$0.00 ","$67.87 ","$387.60 ","$0.00 ","$193.80 ","$306.98 ","$310.08 ","$0.00 ","$58.89 ","$0.00 ","$61.71 ","$0.00 "
"446.482","SUP","HCPCS C1713","","446.482  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI RT","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"446.483","SUP","HCPCS C1713","","446.483  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI LT","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"446.5","SUP","HCPCS C1713","","446.50  -  PLATE BN OB L L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.504","SUP","HCPCS C1713","","446.504  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 22MM NONSTRL","BOTH IP/OP","$596.25 ","$441.23 ","$0.00 ","$596.25 ","$268.31 ","$0.00 ","$124.27 ","$0.00 ","$0.00 ","$104.40 ","$596.25 ","$0.00 ","$298.13 ","$472.23 ","$477.00 ","$0.00 ","$93.31 ","$0.00 ","$94.92 ","$0.00 "
"446.505","SUP","HCPCS C1713","","446.505  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 22MM NONSTRL","BOTH IP/OP","$596.25 ","$441.23 ","$0.00 ","$596.25 ","$268.31 ","$0.00 ","$124.27 ","$0.00 ","$0.00 ","$104.40 ","$596.25 ","$0.00 ","$298.13 ","$472.23 ","$477.00 ","$0.00 ","$93.31 ","$0.00 ","$94.92 ","$0.00 "
"446.506","SUP","HCPCS C1713","","446.506  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 24MM NONSTRL","BOTH IP/OP","$596.25 ","$441.23 ","$0.00 ","$596.25 ","$268.31 ","$0.00 ","$124.27 ","$0.00 ","$0.00 ","$104.40 ","$596.25 ","$0.00 ","$298.13 ","$472.23 ","$477.00 ","$0.00 ","$93.31 ","$0.00 ","$94.92 ","$0.00 "
"446.507","SUP","HCPCS C1713","","446.507  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 24MM NONSTRL","BOTH IP/OP","$596.25 ","$441.23 ","$0.00 ","$596.25 ","$268.31 ","$0.00 ","$124.27 ","$0.00 ","$0.00 ","$104.40 ","$596.25 ","$0.00 ","$298.13 ","$472.23 ","$477.00 ","$0.00 ","$93.31 ","$0.00 ","$94.92 ","$0.00 "
"446.508","SUP","HCPCS C1713","","446.508  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 26MM NONSTRL","BOTH IP/OP","$596.25 ","$441.23 ","$0.00 ","$596.25 ","$268.31 ","$0.00 ","$124.27 ","$0.00 ","$0.00 ","$104.40 ","$596.25 ","$0.00 ","$298.13 ","$472.23 ","$477.00 ","$0.00 ","$93.31 ","$0.00 ","$94.92 ","$0.00 "
"446.509","SUP","HCPCS C1713","","446.509  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 26MM NONSTRL","BOTH IP/OP","$596.25 ","$441.23 ","$0.00 ","$596.25 ","$268.31 ","$0.00 ","$124.27 ","$0.00 ","$0.00 ","$104.40 ","$596.25 ","$0.00 ","$298.13 ","$472.23 ","$477.00 ","$0.00 ","$93.31 ","$0.00 ","$94.92 ","$0.00 "
"446.51","SUP","HCPCS C1713","","446.51  -  PLATE BN OB R L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.515","SUP","HCPCS C1713","","446.515  -  PLATE BONE TEAL 22MM 100D CRANFCL TI 5 HOLE L RIGHT OBLQ","BOTH IP/OP","$636.75 ","$471.20 ","$0.00 ","$636.75 ","$286.54 ","$0.00 ","$132.71 ","$0.00 ","$0.00 ","$111.49 ","$636.75 ","$0.00 ","$318.38 ","$504.31 ","$509.40 ","$0.00 ","$99.65 ","$0.00 ","$101.37 ","$0.00 "
"446.516","SUP","HCPCS C1713","","446.516  -  PLATE BONE TEAL 22MM 100D CRANFCL TI 5 HOLE L LEFT OBLQ","BOTH IP/OP","$636.75 ","$471.20 ","$0.00 ","$636.75 ","$286.54 ","$0.00 ","$132.71 ","$0.00 ","$0.00 ","$111.49 ","$636.75 ","$0.00 ","$318.38 ","$504.31 ","$509.40 ","$0.00 ","$99.65 ","$0.00 ","$101.37 ","$0.00 "
"446.52","SUP","HCPCS C1713","","446.52  -  PLATE BN OB L L 3X4 HL TI CRNFCL 1.5MM SCR","BOTH IP/OP","$652.50 ","$482.85 ","$0.00 ","$652.50 ","$293.63 ","$0.00 ","$136.00 ","$0.00 ","$0.00 ","$114.25 ","$652.50 ","$0.00 ","$326.25 ","$516.78 ","$522.00 ","$0.00 ","$102.12 ","$0.00 ","$103.88 ","$0.00 "
"446.527","SUP","HCPCS C1713","","446.527  -  PLATE BONE TEAL 27MM 100D CRANFCL TI 7 HOLE L LEFT OBLQ","BOTH IP/OP","$666.00 ","$492.84 ","$0.00 ","$666.00 ","$299.70 ","$0.00 ","$138.81 ","$0.00 ","$0.00 ","$116.61 ","$666.00 ","$0.00 ","$333.00 ","$527.47 ","$532.80 ","$0.00 ","$104.23 ","$0.00 ","$106.03 ","$0.00 "
"446.53","SUP","HCPCS C1713","","446.53  -  PLATE BN OB R L NS 3X4 HL RGD TI CRNFCL 1.5MM SCR","BOTH IP/OP","$652.50 ","$482.85 ","$0.00 ","$652.50 ","$293.63 ","$0.00 ","$136.00 ","$0.00 ","$0.00 ","$114.25 ","$652.50 ","$0.00 ","$326.25 ","$516.78 ","$522.00 ","$0.00 ","$102.12 ","$0.00 ","$103.88 ","$0.00 "
"446.537","SUP","HCPCS C1713","","446.537  -  PLATE BONE TEAL 27MM 100D CRANFCL TI 7 HOLE L RIGHT OBLQ","BOTH IP/OP","$666.00 ","$492.84 ","$0.00 ","$666.00 ","$299.70 ","$0.00 ","$138.81 ","$0.00 ","$0.00 ","$116.61 ","$666.00 ","$0.00 ","$333.00 ","$527.47 ","$532.80 ","$0.00 ","$104.23 ","$0.00 ","$106.03 ","$0.00 "
"446.538","SUP","HCPCS C1713","","446.538  -  PLATE BONE TEAL ORBTL RIM TI 8 HOLE MALBLE 1.5MM SCR NONSTRL","BOTH IP/OP","$607.50 ","$449.55 ","$0.00 ","$607.50 ","$273.38 ","$0.00 ","$126.62 ","$0.00 ","$0.00 ","$106.37 ","$607.50 ","$0.00 ","$303.75 ","$481.14 ","$486.00 ","$0.00 ","$95.07 ","$0.00 ","$96.71 ","$0.00 "
"446.54","SUP","HCPCS C1713","","446.540  -  PLATE BONE TEAL ORBTL RIM TI 10 HOLE MALBLE 1.5MM SCR","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$288.56 ","$0.00 ","$133.65 ","$0.00 ","$0.00 ","$112.28 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$100.36 ","$0.00 ","$102.09 ","$0.00 "
"446.542","SUP","HCPCS C1713","","446.542  -  PLATE BONE TEAL ORBTL RIM TI 12 HOLE MALBLE 1.5MM SCR","BOTH IP/OP","$690.75 ","$511.16 ","$0.00 ","$690.75 ","$310.84 ","$0.00 ","$143.97 ","$0.00 ","$0.00 ","$120.94 ","$690.75 ","$0.00 ","$345.38 ","$547.07 ","$552.60 ","$0.00 ","$108.10 ","$0.00 ","$109.97 ","$0.00 "
"446.61","SUP","HCPCS C1713","","446.61  -  PLATE BN 36X3.5X.9MM NS 7 HL TI CNDYL LT 1.5MM SCR MDLR HND","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.611","SUP","HCPCS C1713","","446.611  -  PLATE BONE CRANFCL TI 5 HOLE Y LP 1.5 MM SCR NONSTRL","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.612","SUP","HCPCS C1713","","446.612  -  PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$425.93 ","$315.19 ","$0.00 ","$413.53 ","$186.09 ","$0.00 ","$88.77 ","$0.00 ","$0.00 ","$72.40 ","$413.53 ","$0.00 ","$206.76 ","$327.52 ","$330.82 ","$0.00 ","$62.83 ","$0.00 ","$65.83 ","$0.00 "
"446.614","SUP","HCPCS C1713","","446.614  -  PLATE BN 2Y 18MM 6 HL TI CRNFCL 1.5MM SCR","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.615","SUP","HCPCS C1713","","446.615  -  PLATE BN 2Y 21MM 6 HL TI CRNFCL 1.5MM SCR","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.63","SUP","HCPCS C1713","","446.63  -  PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM LEFT","BOTH IP/OP","$539.78 ","$399.44 ","$0.00 ","$524.08 ","$235.83 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$91.76 ","$524.08 ","$0.00 ","$262.04 ","$415.07 ","$419.26 ","$0.00 ","$79.63 ","$0.00 ","$83.43 ","$0.00 "
"446.64","SUP","HCPCS C1713","","446.64  -  PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM RIGHT","BOTH IP/OP","$539.78 ","$399.44 ","$0.00 ","$524.08 ","$235.83 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$91.76 ","$524.08 ","$0.00 ","$262.04 ","$415.07 ","$419.26 ","$0.00 ","$79.63 ","$0.00 ","$83.43 ","$0.00 "
"446.642","SUP","HCPCS C1713","","446.642  -  PLATE 2MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$821.25 ","$607.73 ","$0.00 ","$821.25 ","$369.56 ","$0.00 ","$171.17 ","$0.00 ","$0.00 ","$143.79 ","$821.25 ","$0.00 ","$410.63 ","$650.43 ","$657.00 ","$0.00 ","$128.53 ","$0.00 ","$130.74 ","$0.00 "
"446.644","SUP","HCPCS C1713","","446.644  -  PLATE 4MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$821.25 ","$607.73 ","$0.00 ","$821.25 ","$369.56 ","$0.00 ","$171.17 ","$0.00 ","$0.00 ","$143.79 ","$821.25 ","$0.00 ","$410.63 ","$650.43 ","$657.00 ","$0.00 ","$128.53 ","$0.00 ","$130.74 ","$0.00 "
"446.646","SUP","HCPCS C1713","","446.646  -  PLATE 6MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$821.25 ","$607.73 ","$0.00 ","$821.25 ","$369.56 ","$0.00 ","$171.17 ","$0.00 ","$0.00 ","$143.79 ","$821.25 ","$0.00 ","$410.63 ","$650.43 ","$657.00 ","$0.00 ","$128.53 ","$0.00 ","$130.74 ","$0.00 "
"446.782","SUP","HCPCS C1713","","446.782  -  PLATE SHRT MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 1.5MM SCR","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.783","SUP","HCPCS C1713","","446.783  -  PLATE SHRT MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 1.5MM SCR","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.784","SUP","HCPCS C1713","","446.784  -  PLATE LNG MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 1.5MM SCR","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.785","SUP","HCPCS C1713","","446.785  -  PLATE LNG MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 1.5MM SCR BONE","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.786","SUP","HCPCS C1713","","446.786  -  PLATE SHRT RIGHT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$580.50 ","$429.57 ","$0.00 ","$580.50 ","$261.23 ","$0.00 ","$120.99 ","$0.00 ","$0.00 ","$101.64 ","$580.50 ","$0.00 ","$290.25 ","$459.76 ","$464.40 ","$0.00 ","$90.85 ","$0.00 ","$92.42 ","$0.00 "
"446.787","SUP","HCPCS C1713","","446.787  -  PLATE SHRT LEFT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$580.50 ","$429.57 ","$0.00 ","$580.50 ","$261.23 ","$0.00 ","$120.99 ","$0.00 ","$0.00 ","$101.64 ","$580.50 ","$0.00 ","$290.25 ","$459.76 ","$464.40 ","$0.00 ","$90.85 ","$0.00 ","$92.42 ","$0.00 "
"446.788","SUP","HCPCS C1713","","446.788  -  PLATE LNG RIGHT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$580.50 ","$429.57 ","$0.00 ","$580.50 ","$261.23 ","$0.00 ","$120.99 ","$0.00 ","$0.00 ","$101.64 ","$580.50 ","$0.00 ","$290.25 ","$459.76 ","$464.40 ","$0.00 ","$90.85 ","$0.00 ","$92.42 ","$0.00 "
"446.789","SUP","HCPCS C1713","","446.789  -  PLATE LNG LEFT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL","BOTH IP/OP","$580.50 ","$429.57 ","$0.00 ","$580.50 ","$261.23 ","$0.00 ","$120.99 ","$0.00 ","$0.00 ","$101.64 ","$580.50 ","$0.00 ","$290.25 ","$459.76 ","$464.40 ","$0.00 ","$90.85 ","$0.00 ","$92.42 ","$0.00 "
"446.792","SUP","HCPCS C1713","","446.792  -  PLATE SHRT TI 1.5MM SCR L OBLQ 2X2 HOLE BONE RIGHT NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.793","SUP","HCPCS C1713","","446.793  -  PLATE SHRT 1.5MM TI 1.5MM SCR L OBLQ 2X2 HOLE BONE LEFT","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.794","SUP","HCPCS C1713","","446.794  -  PLATE 1.5MM TI 1.5MM SCR 2X2 HOLE L RIGHT OBLQ BONE NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.795","SUP","HCPCS C1713","","446.795  -  PLATE TI 1.5 MM SCR 2X2 HOLE L LEFT OBLQ BONE NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"446.796","SUP","HCPCS C1713","","446.796  -  PLATE SHRT TI 1.5MM SCR Z BONE RIGHT NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"446.797","SUP","HCPCS C1713","","446.797  -  PLATE SHRT TI 1.5MM SCR Z BONE LEFT NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"446.798","SUP","HCPCS C1713","","446.798  -  PLATE LNG TI 1.5MM SCR Z BONE RIGHT NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"446.799","SUP","HCPCS C1713","","446.799  -  PLATE LNG TI 1.5MM SCR Z BONE LEFT NONSTRL","BOTH IP/OP","$654.75 ","$484.52 ","$0.00 ","$654.75 ","$294.64 ","$0.00 ","$136.47 ","$0.00 ","$0.00 ","$114.64 ","$654.75 ","$0.00 ","$327.38 ","$518.56 ","$523.80 ","$0.00 ","$102.47 ","$0.00 ","$104.24 ","$0.00 "
"446.81","SUP","HCPCS C1713","","446.81  -  PLATE BONE CRNMXF TI 4 HOLE X 1.5 MM SCR NONSTRL","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.811","SUP","HCPCS C1713","","446.811  -  PLATE BONE CRANFCL TI 4 HOLE X LP 1.5 MM SCR NONSTRL","BOTH IP/OP","$616.50 ","$456.21 ","$0.00 ","$616.50 ","$277.43 ","$0.00 ","$128.49 ","$0.00 ","$0.00 ","$107.94 ","$616.50 ","$0.00 ","$308.25 ","$488.27 ","$493.20 ","$0.00 ","$96.48 ","$0.00 ","$98.15 ","$0.00 "
"446.9","SUP","HCPCS C1713","","446.900  -  PLATE BONE 12MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL","BOTH IP/OP","$573.75 ","$424.58 ","$0.00 ","$573.75 ","$258.19 ","$0.00 ","$119.58 ","$0.00 ","$0.00 ","$100.46 ","$573.75 ","$0.00 ","$286.88 ","$454.41 ","$459.00 ","$0.00 ","$89.79 ","$0.00 ","$91.34 ","$0.00 "
"446.901","SUP","Custom 27803010","","446.901  -  COVER BUR HOLE 15MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL","BOTH IP/OP","$573.75 ","$424.58 ","$0.00 ","$573.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$573.75 ","$0.00 ","$286.88 ","$454.41 ","$459.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.902","SUP","Custom 27803010","","446.902  -  COVER BUR HOLE 24MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL","BOTH IP/OP","$573.75 ","$424.58 ","$0.00 ","$573.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$573.75 ","$0.00 ","$286.88 ","$454.41 ","$459.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.91","SUP","Custom 27803010","","446.91  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL","BOTH IP/OP","$573.75 ","$424.58 ","$0.00 ","$573.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$573.75 ","$0.00 ","$286.88 ","$454.41 ","$459.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.911","SUP","Custom 27803010","","446.911  -  CLIP CRNL SPRG TI LT 1.5 MM BUR HL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.912","SUP","Custom 27803010","","446.912  -  CLIP CRNL SPRG TI RT 1.5 MM BUR HL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.913","SUP","Custom 27803010","","446.913  -  CLIP CRNL SPRG TI 1.5 MM BUR HL","BOTH IP/OP","$436.50 ","$323.01 ","$0.00 ","$436.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$436.50 ","$0.00 ","$218.25 ","$345.71 ","$349.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.916","SUP","HCPCS C1713","","446.916  -  PLATE BONE 16X10MM CRANFCL TI 4 HOLE 1.5MM SCR NONSTRL","BOTH IP/OP","$533.25 ","$394.61 ","$0.00 ","$533.25 ","$239.96 ","$0.00 ","$111.14 ","$0.00 ","$0.00 ","$93.37 ","$533.25 ","$0.00 ","$266.63 ","$422.33 ","$426.60 ","$0.00 ","$83.45 ","$0.00 ","$84.89 ","$0.00 "
"446.917","SUP","HCPCS C1713","","446.917  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 4MM NONSTRL","BOTH IP/OP","$794.25 ","$587.75 ","$0.00 ","$794.25 ","$357.41 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$139.07 ","$794.25 ","$0.00 ","$397.13 ","$629.05 ","$635.40 ","$0.00 ","$124.30 ","$0.00 ","$126.44 ","$0.00 "
"446.918","SUP","HCPCS C1713","","446.918  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 6MM NONSTRL","BOTH IP/OP","$794.25 ","$587.75 ","$0.00 ","$794.25 ","$357.41 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$139.07 ","$794.25 ","$0.00 ","$397.13 ","$629.05 ","$635.40 ","$0.00 ","$124.30 ","$0.00 ","$126.44 ","$0.00 "
"446.919","SUP","HCPCS C1713","","446.919  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$794.25 ","$587.75 ","$0.00 ","$794.25 ","$357.41 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$139.07 ","$794.25 ","$0.00 ","$397.13 ","$629.05 ","$635.40 ","$0.00 ","$124.30 ","$0.00 ","$126.44 ","$0.00 "
"446.92","SUP","HCPCS C1713","","446.920  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$794.25 ","$587.75 ","$0.00 ","$794.25 ","$357.41 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$139.07 ","$794.25 ","$0.00 ","$397.13 ","$629.05 ","$635.40 ","$0.00 ","$124.30 ","$0.00 ","$126.44 ","$0.00 "
"446.923","SUP","Custom 27803010","","446.923  -  COVER BUR HOLE 15MM CRANIAL TI 5 HOLE SHNT 1.5MM SCR NONSTRL","BOTH IP/OP","$573.75 ","$424.58 ","$0.00 ","$573.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$573.75 ","$0.00 ","$286.88 ","$454.41 ","$459.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"447.007","SUP","Custom 27803010","","447.007  -  FTPLT BONE ZYG TI 3 HOLE NONSTRL","BOTH IP/OP","$499.50 ","$369.63 ","$0.00 ","$499.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$499.50 ","$0.00 ","$249.75 ","$395.60 ","$399.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"447.008","SUP","HCPCS C1713","","447.008  -  PLATE 6MM MAXFACL 6 HOLE CVD LP BONE NONSTRL","BOTH IP/OP","$726.75 ","$537.80 ","$0.00 ","$726.75 ","$327.04 ","$0.00 ","$151.47 ","$0.00 ","$0.00 ","$127.25 ","$726.75 ","$0.00 ","$363.38 ","$575.59 ","$581.40 ","$0.00 ","$113.74 ","$0.00 ","$115.70 ","$0.00 "
"447.009","SUP","HCPCS C1713","","447.009  -  PLATE 10MM TI 2MM SCR 6 HOLE SGTL SPLT CVD LP BONE NONSTRL","BOTH IP/OP","$726.75 ","$537.80 ","$0.00 ","$726.75 ","$327.04 ","$0.00 ","$151.47 ","$0.00 ","$0.00 ","$127.25 ","$726.75 ","$0.00 ","$363.38 ","$575.59 ","$581.40 ","$0.00 ","$113.74 ","$0.00 ","$115.70 ","$0.00 "
"447.01","SUP","HCPCS C1713","","447.010  -  PLATE MAXFACL 6 HOLE CVD SGTL SPLT 2MM SCR BONE TI 6MM","BOTH IP/OP","$726.75 ","$537.80 ","$0.00 ","$726.75 ","$327.04 ","$0.00 ","$151.47 ","$0.00 ","$0.00 ","$127.25 ","$726.75 ","$0.00 ","$363.38 ","$575.59 ","$581.40 ","$0.00 ","$113.74 ","$0.00 ","$115.70 ","$0.00 "
"447.011","SUP","HCPCS C1713","","447.011  -  PLATE MAXFACL 6 HOLE CVD SGTL SPLT 2MM SCR BONE TI 10MM","BOTH IP/OP","$726.75 ","$537.80 ","$0.00 ","$726.75 ","$327.04 ","$0.00 ","$151.47 ","$0.00 ","$0.00 ","$127.25 ","$726.75 ","$0.00 ","$363.38 ","$575.59 ","$581.40 ","$0.00 ","$113.74 ","$0.00 ","$115.70 ","$0.00 "
"447.013","SUP","HCPCS C1713","","447.013  -  PLATE BONE 65MM CRANFCL TI 13 HOLE ADP 2MM SCR NONSTRL","BOTH IP/OP","$805.50 ","$596.07 ","$0.00 ","$805.50 ","$362.48 ","$0.00 ","$167.89 ","$0.00 ","$0.00 ","$141.04 ","$805.50 ","$0.00 ","$402.75 ","$637.96 ","$644.40 ","$0.00 ","$126.06 ","$0.00 ","$128.24 ","$0.00 "
"447.03","SUP","HCPCS C1713","","447.030  -  PLATE 14MM MAXFACL 6 HOLE CVD 2MM SCR BILAT SGTL SPLT OSTMY","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.031","SUP","HCPCS C1713","","447.031  -  PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR","BOTH IP/OP","$404.85 ","$299.59 ","$0.00 ","$393.05 ","$176.87 ","$0.00 ","$84.38 ","$0.00 ","$0.00 ","$68.82 ","$393.05 ","$0.00 ","$196.53 ","$311.30 ","$314.44 ","$0.00 ","$59.72 ","$0.00 ","$62.57 ","$0.00 "
"447.032","SUP","HCPCS C1713","","447.032  -  PLATE BN STRG 71X5X1.2MM NS PRO-PK 12 HL LOPRFL PRECONTOUR","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"447.033","SUP","HCPCS C1713","","447.033  -  PLATE 2MM 4MM MAXFACL 6 HOLE BAR CVD LP SGTL SPLT 2MM SCR","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.034","SUP","HCPCS C1713","","447.034  -  PLATE 8MM MAXFACL 6 HOLE CVD LP 2MM SCR BILAT SGTL SPLT","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.035","SUP","HCPCS C1713","","447.035  -  PLATE BN CRV 4MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.036","SUP","HCPCS C1713","","447.036  -  PLATE BN CRV 12MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.037","SUP","HCPCS C1713","","447.037  -  PLATE 12MM MAXFACL 6 HOLE CVD LP 2MM SCR BILAT SGTL SPLT","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.038","SUP","HCPCS C1713","","447.038  -  PLATE BN CRV 8MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.039","SUP","HCPCS C1713","","447.039  -  PLATE 16MM MAXFACL 6 HOLE CVD 2MM SCR BILAT SGTL SPLT OSTMY","BOTH IP/OP","$783.00 ","$579.42 ","$0.00 ","$783.00 ","$352.35 ","$0.00 ","$163.20 ","$0.00 ","$0.00 ","$137.10 ","$783.00 ","$0.00 ","$391.50 ","$620.14 ","$626.40 ","$0.00 ","$122.54 ","$0.00 ","$124.65 ","$0.00 "
"447.04","SUP","HCPCS C1713","","447.040  -  PLATE 25MM MAXL RIGHT 3X3 HOLE L 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"447.041","SUP","HCPCS C1713","","447.041  -  PLATE BN L 25X4.8X.9MM NS 15MM 3 HL SHFT 3 HL BS TI MXL LT 2","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"447.042","SUP","HCPCS C1713","","447.042  -  PLATE RIGHT MAXL 3X3 HOLE L 2MM SCR BONE TI 27MM NONSTRL","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"447.043","SUP","HCPCS C1713","","447.043  -  PLATE LEFT MAXL 3X3 HOLE L 2MM SCR BONE TI 27MM NONSTRL","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"447.044","SUP","HCPCS C1713","","447.044  -  PLATE RIGHT MAXL 3X3 HOLE L 2MM SCR BONE TI 29MM NONSTRL","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"447.045","SUP","HCPCS C1713","","447.045  -  PLATE LEFT MAXL 3X3 HOLE L 2MM SCR BONE TI 29MM NONSTRL","BOTH IP/OP","$515.25 ","$381.29 ","$0.00 ","$515.25 ","$231.86 ","$0.00 ","$107.39 ","$0.00 ","$0.00 ","$90.22 ","$515.25 ","$0.00 ","$257.63 ","$408.08 ","$412.20 ","$0.00 ","$80.64 ","$0.00 ","$82.03 ","$0.00 "
"447.046","SUP","HCPCS C1713","","447.046  -  PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR","BOTH IP/OP","$843.75 ","$624.38 ","$0.00 ","$843.75 ","$379.69 ","$0.00 ","$175.86 ","$0.00 ","$0.00 ","$147.73 ","$843.75 ","$0.00 ","$421.88 ","$668.25 ","$675.00 ","$0.00 ","$132.05 ","$0.00 ","$134.33 ","$0.00 "
"447.047","SUP","HCPCS C1713","","447.047  -  PLATE BN MN NAR 4.8X1MM 6 HL LCK MLBL TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.048","SUP","HCPCS C1713","","447.048  -  PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR","BOTH IP/OP","$843.75 ","$624.38 ","$0.00 ","$843.75 ","$379.69 ","$0.00 ","$175.86 ","$0.00 ","$0.00 ","$147.73 ","$843.75 ","$0.00 ","$421.88 ","$668.25 ","$675.00 ","$0.00 ","$132.05 ","$0.00 ","$134.33 ","$0.00 "
"447.049","SUP","HCPCS C1713","","447.049  -  PLATE BN MN NAR 4.8X1MM 6 HL LCK TI MNDB 2MM SCR","BOTH IP/OP","$918.00 ","$679.32 ","$0.00 ","$918.00 ","$413.10 ","$0.00 ","$191.33 ","$0.00 ","$0.00 ","$160.73 ","$918.00 ","$0.00 ","$459.00 ","$727.06 ","$734.40 ","$0.00 ","$143.67 ","$0.00 ","$146.15 ","$0.00 "
"447.05","SUP","HCPCS C1713","","447.050  -  PLATE MINI 1MM MANDIB 12 HOLE LCK ADP 2MM SCR BONE TI","BOTH IP/OP","$1,500.75 ","$1,110.56 ","$0.00 ","$1,500.75 ","$675.34 ","$0.00 ","$312.79 ","$0.00 ","$0.00 ","$262.77 ","$1,500.75 ","$0.00 ","$750.38 ","$1,188.59 ","$1,200.60 ","$0.00 ","$234.87 ","$0.00 ","$238.92 ","$0.00 "
"447.051","SUP","HCPCS C1713","","447.051  -  PLATE BN MN 4.8X1MM 20 HL LCK ADP TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.053","SUP","HCPCS C1713","","447.053  -  PLATE BN MN 4.8X1MM 4 HL LCK TNSNBND TI MNDB 2MM SCR","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$474.86 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"447.055","SUP","HCPCS C1713","","447.055  -  PLATE BN MN BRD 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.057","SUP","HCPCS C1713","","447.057  -  PLATE BN MN BRD CRV 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.07","SUP","HCPCS C1713","","447.070  -  PLATE SM 15MMX.9MM TI 2MM SCR 4 HOLE STR OFFST PURE BONE 3MM","BOTH IP/OP","$571.50 ","$422.91 ","$0.00 ","$571.50 ","$257.18 ","$0.00 ","$119.11 ","$0.00 ","$0.00 ","$100.07 ","$571.50 ","$0.00 ","$285.75 ","$452.63 ","$457.20 ","$0.00 ","$89.44 ","$0.00 ","$90.98 ","$0.00 "
"447.071","SUP","HCPCS C1713","","447.071  -  PLATE CHIN 4 HOLE STR 2MM SCR BONE TI 5MM NONSTRL","BOTH IP/OP","$600.75 ","$444.56 ","$0.00 ","$600.75 ","$270.34 ","$0.00 ","$125.21 ","$0.00 ","$0.00 ","$105.19 ","$600.75 ","$0.00 ","$300.38 ","$475.79 ","$480.60 ","$0.00 ","$94.02 ","$0.00 ","$95.64 ","$0.00 "
"447.072","SUP","HCPCS C1713","","447.072  -  PLATE CHIN 4 HOLE STR 2MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$632.25 ","$467.87 ","$0.00 ","$632.25 ","$284.51 ","$0.00 ","$131.78 ","$0.00 ","$0.00 ","$110.70 ","$632.25 ","$0.00 ","$316.13 ","$500.74 ","$505.80 ","$0.00 ","$98.95 ","$0.00 ","$100.65 ","$0.00 "
"447.073","SUP","HCPCS C1713","","447.073  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 4MM NONSTRL","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"447.074","SUP","HCPCS C1713","","447.074  -  PLATE 6MM CHIN 5 HOLE 2 BND 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"447.075","SUP","HCPCS C1713","","447.075  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"447.076","SUP","HCPCS C1713","","447.076  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"447.077","SUP","HCPCS C1713","","447.077  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 3-5MM NONSTRL","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"447.078","SUP","HCPCS C1713","","447.078  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 6-8MM NONSTRL","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"447.079","SUP","HCPCS C1713","","447.079  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 9-11MM NONSTRL","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"447.082","SUP","HCPCS C1713","","447.082  -  PLATE MAXFACL 8 HOLE STRUT 2 MM SCR BILAT SGTL SPLT OSTMY","BOTH IP/OP","$942.75 ","$697.64 ","$0.00 ","$942.75 ","$424.24 ","$0.00 ","$196.49 ","$0.00 ","$0.00 ","$165.07 ","$942.75 ","$0.00 ","$471.38 ","$746.66 ","$754.20 ","$0.00 ","$147.54 ","$0.00 ","$150.09 ","$0.00 "
"447.083","SUP","HCPCS C1713","","447.083  -  PLATE -90D 38MM MAXFACL 10 HOLE CVD SGTL SPLT CURVE 2MM SCR","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$0.00 ","$0.00 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"447.084","SUP","HCPCS C1713","","447.084  -  PLATE 30MM MAXFACL 4 HOLE STR 2MM SCR BILAT SGTL SPLT OSTMY","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$0.00 ","$0.00 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"447.088","SUP","HCPCS C1713","","447.088  -  PLATE MAXFACL 8 HOLE CVD 2 MM SCR BILAT SGTL SPLT OSTMY BONE","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$0.00 ","$0.00 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"447.1","SUP","HCPCS C1713","","447.10  -  PLATE 100MM MIDFAC 20 HOLE ADOPTION 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1,059.75 ","$784.22 ","$0.00 ","$1,059.75 ","$476.89 ","$0.00 ","$220.88 ","$0.00 ","$0.00 ","$185.55 ","$1,059.75 ","$0.00 ","$529.88 ","$839.32 ","$847.80 ","$0.00 ","$165.85 ","$0.00 ","$168.71 ","$0.00 "
"447.101","SUP","HCPCS C1713","","447.101  -  PLATE MANDIB 6 HOLE INTMD LCK 2 MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.102","SUP","HCPCS C1713","","447.102  -  PLATE MANDIB 12 HOLE INTMD LCK 2 MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.103","SUP","HCPCS C1713","","447.103  -  PLATE LG MANDIB 3X3 HOLE LCK STR 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.104","SUP","HCPCS C1713","","447.104  -  PLATE LG MANDIB 6 HOLE LCK STR 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.105","SUP","HCPCS C1713","","447.105  -  PLATE BN 8MM SPC LG 95X6.5X1.5MM NS 12 HL LCK LOPRFL TI MNDB","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.106","SUP","HCPCS C1713","","447.106  -  PLATE LG MANDIB 20 HOLE LCK STR 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.108","SUP","HCPCS C1713","","447.108  -  PLATE LG MANDIB 6X21 HOLE LCK RIGHT ANG 2MM SCR BONE TI","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.109","SUP","HCPCS C1713","","447.109  -  PLATE LG MANDIB 6X21 HOLE LCK LEFT ANG 2MM SCR BONE TI","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.114","SUP","HCPCS C1713","","447.114  -  PLATE 33MM MAXFACL 4 HOLE ADJ SLDR 2MM SCR BILAT SGTL SPLT","BOTH IP/OP","$1,064.25 ","$787.55 ","$0.00 ","$1,064.25 ","$478.91 ","$0.00 ","$221.82 ","$0.00 ","$0.00 ","$186.34 ","$1,064.25 ","$0.00 ","$532.13 ","$842.89 ","$851.40 ","$0.00 ","$166.56 ","$0.00 ","$169.43 ","$0.00 "
"447.116","SUP","HCPCS C1713","","447.116  -  PLATE 40MM MAXFACL 4 HOLE ADJ SLDR 2MM SCR BILAT SGTL SPLT","BOTH IP/OP","$1,064.25 ","$787.55 ","$0.00 ","$1,064.25 ","$478.91 ","$0.00 ","$221.82 ","$0.00 ","$0.00 ","$186.34 ","$1,064.25 ","$0.00 ","$532.13 ","$842.89 ","$851.40 ","$0.00 ","$166.56 ","$0.00 ","$169.43 ","$0.00 "
"447.117","SUP","HCPCS C1713","","447.117  -  PLATE LG MANDIB 3X3 HOLE LCK CRSNT 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.118","SUP","HCPCS C1713","","447.118  -  PLATE LG MANDIB 3X3 HOLE LCK ANG 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.119","SUP","HCPCS C1713","","447.119  -  PLATE LG MANDIB 4X4 HOLE LCK ANG 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"447.14","SUP","HCPCS C1713","","447.140  -  PLATE BONE 24MM CRANFCL TI 3X3 HOLE T 2MM SCR NONSTRL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$247.05 ","$0.00 ","$114.43 ","$0.00 ","$0.00 ","$96.13 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$85.92 ","$0.00 ","$87.40 ","$0.00 "
"447.141","SUP","HCPCS C1713","","447.141  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 4MM NONSTRL","BOTH IP/OP","$618.75 ","$457.88 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$128.96 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"447.142","SUP","HCPCS C1713","","447.142  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL","BOTH IP/OP","$618.75 ","$457.88 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$128.96 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"447.143","SUP","HCPCS C1713","","447.143  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$618.75 ","$457.88 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$128.96 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"447.144","SUP","HCPCS C1713","","447.144  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$618.75 ","$457.88 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$128.96 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"447.145","SUP","HCPCS C1713","","447.145  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 12MM NONSTRL","BOTH IP/OP","$618.75 ","$457.88 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$128.96 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"447.146","SUP","HCPCS C1713","","447.146  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL","BOTH IP/OP","$677.25 ","$501.17 ","$0.00 ","$677.25 ","$304.76 ","$0.00 ","$141.16 ","$0.00 ","$0.00 ","$118.58 ","$677.25 ","$0.00 ","$338.63 ","$536.38 ","$541.80 ","$0.00 ","$105.99 ","$0.00 ","$107.82 ","$0.00 "
"447.147","SUP","HCPCS C1713","","447.147  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL","BOTH IP/OP","$677.25 ","$501.17 ","$0.00 ","$677.25 ","$304.76 ","$0.00 ","$141.16 ","$0.00 ","$0.00 ","$118.58 ","$677.25 ","$0.00 ","$338.63 ","$536.38 ","$541.80 ","$0.00 ","$105.99 ","$0.00 ","$107.82 ","$0.00 "
"447.148","SUP","HCPCS C1713","","447.148  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$677.25 ","$501.17 ","$0.00 ","$677.25 ","$304.76 ","$0.00 ","$141.16 ","$0.00 ","$0.00 ","$118.58 ","$677.25 ","$0.00 ","$338.63 ","$536.38 ","$541.80 ","$0.00 ","$105.99 ","$0.00 ","$107.82 ","$0.00 "
"447.149","SUP","HCPCS C1713","","447.149  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL","BOTH IP/OP","$677.25 ","$501.17 ","$0.00 ","$677.25 ","$304.76 ","$0.00 ","$141.16 ","$0.00 ","$0.00 ","$118.58 ","$677.25 ","$0.00 ","$338.63 ","$536.38 ","$541.80 ","$0.00 ","$105.99 ","$0.00 ","$107.82 ","$0.00 "
"447.15","SUP","HCPCS C1713","","447.150  -  PLATE RIGHT CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$677.25 ","$501.17 ","$0.00 ","$677.25 ","$304.76 ","$0.00 ","$141.16 ","$0.00 ","$0.00 ","$118.58 ","$677.25 ","$0.00 ","$338.63 ","$536.38 ","$541.80 ","$0.00 ","$105.99 ","$0.00 ","$107.82 ","$0.00 "
"447.151","SUP","HCPCS C1713","","447.151  -  PLATE LEFT CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL","BOTH IP/OP","$677.25 ","$501.17 ","$0.00 ","$677.25 ","$304.76 ","$0.00 ","$141.16 ","$0.00 ","$0.00 ","$118.58 ","$677.25 ","$0.00 ","$338.63 ","$536.38 ","$541.80 ","$0.00 ","$105.99 ","$0.00 ","$107.82 ","$0.00 "
"447.152","SUP","HCPCS C1713","","447.152  -  PLATE BONE 24MM CRANFCL TI 4 HOLE STR 2MM SCR NONSTRL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$275.40 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"447.153","SUP","HCPCS C1713","","447.153  -  PLATE BONE 30MM CRANFCL TI 4 HOLE STR 2MM SCR NONSTRL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$275.40 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"447.154","SUP","HCPCS C1713","","447.154  -  PLATE BONE 17MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.155","SUP","HCPCS C1713","","447.155  -  PLATE BONE 17MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.156","SUP","HCPCS C1713","","447.156  -  PLATE BONE 19MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.157","SUP","HCPCS C1713","","447.157  -  PLATE BONE 19MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.158","SUP","HCPCS C1713","","447.158  -  PLATE BONE 23MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.159","SUP","HCPCS C1713","","447.159  -  PLATE BONE 23MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.18","SUP","HCPCS C1713","","447.18  -  PLATE BONE ORBTL RIM TI 8 HOLE 2 MM SCR NONSTRL","BOTH IP/OP","$528.75 ","$391.28 ","$0.00 ","$528.75 ","$237.94 ","$0.00 ","$110.20 ","$0.00 ","$0.00 ","$92.58 ","$528.75 ","$0.00 ","$264.38 ","$418.77 ","$423.00 ","$0.00 ","$82.75 ","$0.00 ","$84.18 ","$0.00 "
"447.184","SUP","HCPCS C1713","","447.184  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/22MM","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"447.185","SUP","HCPCS C1713","","447.185  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/29MM","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"447.186","SUP","HCPCS C1713","","447.186  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/36MM","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"447.2","SUP","HCPCS C1713","","447.20  -  PLATE BONE ORBTL RIM TI 10 HOLE 2 MM SCR NONSTRL","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"447.204","SUP","HCPCS C1713","","447.204  -  PLATE 1.3MM MANDIB 4 HOLE INTMD LCK CMPR 2MM SCR BONE TI","BOTH IP/OP","$816.75 ","$604.40 ","$0.00 ","$816.75 ","$367.54 ","$0.00 ","$170.23 ","$0.00 ","$0.00 ","$143.01 ","$816.75 ","$0.00 ","$408.38 ","$646.87 ","$653.40 ","$0.00 ","$127.82 ","$0.00 ","$130.03 ","$0.00 "
"447.205","SUP","HCPCS C1713","","447.205  -  PLATE 1.3MM MANDIB 5 HOLE INTMD LCK CMPR 2MM SCR BONE TI","BOTH IP/OP","$888.75 ","$657.68 ","$0.00 ","$888.75 ","$399.94 ","$0.00 ","$185.24 ","$0.00 ","$0.00 ","$155.61 ","$888.75 ","$0.00 ","$444.38 ","$703.89 ","$711.00 ","$0.00 ","$139.09 ","$0.00 ","$141.49 ","$0.00 "
"447.206","SUP","HCPCS C1713","","447.206  -  PLATE 1.3MM MANDIB 6 HOLE INTMD LCK CMPR 2MM SCR BONE TI","BOTH IP/OP","$958.50 ","$709.29 ","$0.00 ","$958.50 ","$431.33 ","$0.00 ","$199.78 ","$0.00 ","$0.00 ","$167.83 ","$958.50 ","$0.00 ","$479.25 ","$759.13 ","$766.80 ","$0.00 ","$150.01 ","$0.00 ","$152.59 ","$0.00 "
"447.208","SUP","HCPCS C1713","","447.208  -  PLATE 1.3MM MANDIB 8 HOLE INTMD LCK CMPR 2MM SCR BONE TI","BOTH IP/OP","$1,084.50 ","$802.53 ","$0.00 ","$1,084.50 ","$488.03 ","$0.00 ","$226.04 ","$0.00 ","$0.00 ","$189.89 ","$1,084.50 ","$0.00 ","$542.25 ","$858.92 ","$867.60 ","$0.00 ","$169.72 ","$0.00 ","$172.65 ","$0.00 "
"447.21","SUP","HCPCS C1713","","447.210  -  PLATE 1.3MM MANDIB 6 HOLE INTMD LCK ANG CMPR 2MM SCR BONE TI","BOTH IP/OP","$1,208.25 ","$894.11 ","$0.00 ","$1,208.25 ","$543.71 ","$0.00 ","$251.83 ","$0.00 ","$0.00 ","$211.55 ","$1,208.25 ","$0.00 ","$604.13 ","$956.93 ","$966.60 ","$0.00 ","$189.09 ","$0.00 ","$192.35 ","$0.00 "
"447.212","SUP","HCPCS C1713","","447.212  -  PLATE 1.3MM MANDIB 8 HOLE INTMD LCK ANG CMPR 2MM SCR BONE TI","BOTH IP/OP","$1,300.50 ","$962.37 ","$0.00 ","$1,300.50 ","$585.23 ","$0.00 ","$271.06 ","$0.00 ","$0.00 ","$227.71 ","$1,300.50 ","$0.00 ","$650.25 ","$1,030.00 ","$1,040.40 ","$0.00 ","$203.53 ","$0.00 ","$207.04 ","$0.00 "
"447.215","SUP","HCPCS C1713","","447.215  -  PLATE 1.3MM MANDIB 5 HOLE INTMD LCK CRSNT 2MM SCR BONE TI","BOTH IP/OP","$1,084.50 ","$802.53 ","$0.00 ","$1,084.50 ","$488.03 ","$0.00 ","$226.04 ","$0.00 ","$0.00 ","$189.89 ","$1,084.50 ","$0.00 ","$542.25 ","$858.92 ","$867.60 ","$0.00 ","$169.72 ","$0.00 ","$172.65 ","$0.00 "
"447.217","SUP","HCPCS C1713","","447.217  -  PLATE 1.3MM MANDIB 7 HOLE INTMD LCK CRSNT 2MM SCR BONE TI","BOTH IP/OP","$1,154.25 ","$854.15 ","$0.00 ","$1,154.25 ","$519.41 ","$0.00 ","$240.57 ","$0.00 ","$0.00 ","$202.10 ","$1,154.25 ","$0.00 ","$577.13 ","$914.17 ","$923.40 ","$0.00 ","$180.64 ","$0.00 ","$183.76 ","$0.00 "
"447.22","SUP","HCPCS C1713","","447.22  -  PLATE BONE ORBTL RIM CRNMXF TI 12 HOLE CVD 2 MM SCR NONSTRL","BOTH IP/OP","$589.50 ","$436.23 ","$0.00 ","$589.50 ","$265.28 ","$0.00 ","$122.87 ","$0.00 ","$0.00 ","$103.22 ","$589.50 ","$0.00 ","$294.75 ","$466.88 ","$471.60 ","$0.00 ","$92.26 ","$0.00 ","$93.85 ","$0.00 "
"447.232","SUP","HCPCS C1713","","447.232  -  PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$83.00 ","$0.00 ","$68.66 ","$0.00 "
"447.233","SUP","HCPCS C1713","","447.233  -  PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"447.244","SUP","HCPCS C1713","","447.244  -  PLATE BONE 25MM CRANFCL TI 3X4 HOLE T 2MM SCR NONSTRL","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"447.304","SUP","HCPCS C1713","","447.304  -  PLATE MINI 1MM RIGHT MANDIB 4 HOLE LCK TNSNBND PREBNT 2MM","BOTH IP/OP","$987.75 ","$730.94 ","$0.00 ","$987.75 ","$444.49 ","$0.00 ","$205.87 ","$0.00 ","$0.00 ","$172.95 ","$987.75 ","$0.00 ","$493.88 ","$782.30 ","$790.20 ","$0.00 ","$154.58 ","$0.00 ","$157.25 ","$0.00 "
"447.305","SUP","HCPCS C1713","","447.305  -  PLATE MINI 1MM LEFT MANDIB 4 HOLE LCK TNSNBND PREBNT 2MM SCR","BOTH IP/OP","$987.75 ","$730.94 ","$0.00 ","$987.75 ","$444.49 ","$0.00 ","$205.87 ","$0.00 ","$0.00 ","$172.95 ","$987.75 ","$0.00 ","$493.88 ","$782.30 ","$790.20 ","$0.00 ","$154.58 ","$0.00 ","$157.25 ","$0.00 "
"447.308","SUP","HCPCS C1713","","447.308  -  PLATE 2 W MINI 1MM MANDIB 12 HOLE LCK MALBLE 2MM SCR BONE TI","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"447.309","SUP","HCPCS C1713","","447.309  -  PLATE 2 W MINI 1MM MANDIB 9 HOLE LCK MALBLE 2MM SCR BONE TI","BOTH IP/OP","$949.50 ","$702.63 ","$0.00 ","$949.50 ","$427.28 ","$0.00 ","$197.90 ","$0.00 ","$0.00 ","$166.25 ","$949.50 ","$0.00 ","$474.75 ","$752.00 ","$759.60 ","$0.00 ","$148.60 ","$0.00 ","$151.16 ","$0.00 "
"447.31","SUP","HCPCS C1713","","447.310  -  PLATE MINI 1MM MANDIB 4 HOLE LCK BOX MALBLE 2MM SCR BONE TI","BOTH IP/OP","$663.75 ","$491.18 ","$0.00 ","$663.75 ","$298.69 ","$0.00 ","$138.34 ","$0.00 ","$0.00 ","$116.22 ","$663.75 ","$0.00 ","$331.88 ","$525.69 ","$531.00 ","$0.00 ","$103.88 ","$0.00 ","$105.67 ","$0.00 "
"447.312","SUP","HCPCS C1713","","447.312  -  PLATE MINI 1MM MANDIB 8 HOLE LCK STRUT MALBLE 2MM SCR BONE","BOTH IP/OP","$1,300.50 ","$962.37 ","$0.00 ","$1,300.50 ","$585.23 ","$0.00 ","$271.06 ","$0.00 ","$0.00 ","$227.71 ","$1,300.50 ","$0.00 ","$650.25 ","$1,030.00 ","$1,040.40 ","$0.00 ","$203.53 ","$0.00 ","$207.04 ","$0.00 "
"447.315","SUP","HCPCS C1713","","447.315  -  PLATE MINI 1MM MANDIB 8 HOLE LCK CVD STRUT MALBLE 2MM SCR","BOTH IP/OP","$1,300.50 ","$962.37 ","$0.00 ","$1,300.50 ","$585.23 ","$0.00 ","$271.06 ","$0.00 ","$0.00 ","$227.71 ","$1,300.50 ","$0.00 ","$650.25 ","$1,030.00 ","$1,040.40 ","$0.00 ","$203.53 ","$0.00 ","$207.04 ","$0.00 "
"447.317","SUP","HCPCS C1713","","447.317  -  PLATE MINI 1MM MANDIB 6 HOLE LCK 2Y MALBLE 2MM SCR BONE TI","BOTH IP/OP","$679.50 ","$502.83 ","$0.00 ","$679.50 ","$305.78 ","$0.00 ","$141.62 ","$0.00 ","$0.00 ","$118.98 ","$679.50 ","$0.00 ","$339.75 ","$538.16 ","$543.60 ","$0.00 ","$106.34 ","$0.00 ","$108.18 ","$0.00 "
"447.318","SUP","HCPCS C1713","","447.318  -  PLATE MINI 1MM RIGHT MANDIB 5 HOLE LCK L MALBLE 2MM SCR BONE","BOTH IP/OP","$627.75 ","$464.54 ","$0.00 ","$627.75 ","$282.49 ","$0.00 ","$130.84 ","$0.00 ","$0.00 ","$109.91 ","$627.75 ","$0.00 ","$313.88 ","$497.18 ","$502.20 ","$0.00 ","$98.24 ","$0.00 ","$99.94 ","$0.00 "
"447.319","SUP","HCPCS C1713","","447.319  -  PLATE MINI 1MM LEFT MANDIB 5 HOLE LCK L MALBLE 2MM SCR BONE","BOTH IP/OP","$627.75 ","$464.54 ","$0.00 ","$627.75 ","$282.49 ","$0.00 ","$130.84 ","$0.00 ","$0.00 ","$109.91 ","$627.75 ","$0.00 ","$313.88 ","$497.18 ","$502.20 ","$0.00 ","$98.24 ","$0.00 ","$99.94 ","$0.00 "
"447.344","SUP","HCPCS C1713","","447.344  -  PLATE BONE 31MM 4 HOLE LP LCP TITANIUM SMALL BONE CORTICAL","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"447.345","SUP","HCPCS C1713","","447.345  -  PLATE BONE 38MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"447.346","SUP","HCPCS C1713","","447.346  -  PLATE BONE 45MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"447.347","SUP","HCPCS C1713","","447.347  -  PLATE BONE 52MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"447.348","SUP","HCPCS C1713","","447.348  -  PLATE BONE 59MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM","BOTH IP/OP","$459.65 ","$340.14 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$95.80 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"447.349","SUP","HCPCS C1713","","447.349  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2 MM SCREWS","BOTH IP/OP","$1,446.45 ","$1,070.37 ","$0.00 ","$1,404.33 ","$631.95 ","$0.00 ","$301.48 ","$0.00 ","$0.00 ","$245.89 ","$1,404.33 ","$0.00 ","$702.16 ","$1,112.23 ","$1,123.46 ","$0.00 ","$213.38 ","$0.00 ","$223.57 ","$0.00 "
"447.35","SUP","HCPCS C1713","","447.350  -  PLATE BONE Y 55MM 3X7 HOLE LCP TITANIUM SMALL BONE NONSTRL 2","BOTH IP/OP","$788.83 ","$583.73 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$164.41 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"447.351","SUP","HCPCS C1713","","447.351  -  PLATE BONE 2 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"447.36","SUP","HCPCS C1713","","447.360  -  PLATE BONE 73MM 10 HOLE LCP TITANIUM SMALL BONE NONSTRL 2MM","BOTH IP/OP","$446.28 ","$330.25 ","$0.00 ","$446.28 ","$200.82 ","$0.00 ","$93.01 ","$0.00 ","$0.00 ","$78.14 ","$446.28 ","$0.00 ","$223.14 ","$353.45 ","$357.02 ","$0.00 ","$67.81 ","$0.00 ","$71.05 ","$0.00 "
"447.362","SUP","HCPCS C1713","","447.362  -  PLATE BONE 81MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$777.35 ","$575.24 ","$0.00 ","$754.70 ","$339.62 ","$0.00 ","$162.02 ","$0.00 ","$0.00 ","$132.14 ","$754.70 ","$0.00 ","$377.35 ","$597.72 ","$603.76 ","$0.00 ","$114.67 ","$0.00 ","$120.15 ","$0.00 "
"447.364","SUP","HCPCS C1713","","447.364  -  PLATE BONE 84MM 10 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"447.366","SUP","HCPCS C1713","","447.366  -  PLATE BONE 88MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$856.08 ","$633.50 ","$0.00 ","$831.13 ","$374.01 ","$0.00 ","$178.43 ","$0.00 ","$0.00 ","$145.52 ","$831.13 ","$0.00 ","$415.56 ","$658.25 ","$664.90 ","$0.00 ","$126.28 ","$0.00 ","$132.32 ","$0.00 "
"447.37","SUP","HCPCS C1713","","447.370  -  PLATE BONE 97MM 12 HOLE ADAPTION LCP TITANIUM SMALL BONE","BOTH IP/OP","$831.13 ","$615.04 ","$0.00 ","$831.13 ","$374.01 ","$0.00 ","$173.23 ","$0.00 ","$0.00 ","$145.52 ","$831.13 ","$0.00 ","$415.56 ","$658.25 ","$664.90 ","$0.00 ","$126.28 ","$0.00 ","$132.32 ","$0.00 "
"447.372","SUP","HCPCS C1713","","447.372  -  PLATE BONE 76MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"447.374","SUP","HCPCS C1713","","447.374  -  PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH TI 2.7","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"447.375","SUP","HCPCS C1713","","447.375  -  PLATE BONE 44MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"447.377","SUP","HCPCS C1713","","447.377  -  PLATE BONE 60MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"447.38","SUP","HCPCS C1713","","447.38  -  PLATE BONE 193MM BRD SPC CRANFCL TI 30 HOLE ADP 2MM SCR","BOTH IP/OP","$1,156.50 ","$855.81 ","$0.00 ","$1,156.50 ","$520.43 ","$0.00 ","$241.04 ","$0.00 ","$0.00 ","$202.49 ","$1,156.50 ","$0.00 ","$578.25 ","$915.95 ","$925.20 ","$0.00 ","$180.99 ","$0.00 ","$184.11 ","$0.00 "
"447.404","SUP","HCPCS C1713","","447.404  -  PLATE LG 1.5MM MANDIB 4X20X4 HOLE LCK 2 ANG 2MM SCR BONE TI","BOTH IP/OP","$4,916.25 ","$3,638.03 ","$0.00 ","$4,916.25 ","$2,212.31 ","$0.00 ","$1,024.67 ","$0.00 ","$0.00 ","$860.80 ","$4,916.25 ","$0.00 ","$2,458.13 ","$3,893.67 ","$3,933.00 ","$0.00 ","$769.39 ","$0.00 ","$782.67 ","$0.00 "
"447.405","SUP","HCPCS C1713","","447.405  -  PLATE LG 1.5MM MANDIB 5X22X5 HOLE LCK 2 ANG 2MM SCR BONE TI","BOTH IP/OP","$5,190.75 ","$3,841.16 ","$0.00 ","$5,190.75 ","$2,335.84 ","$0.00 ","$1,081.88 ","$0.00 ","$0.00 ","$908.86 ","$5,190.75 ","$0.00 ","$2,595.38 ","$4,111.07 ","$4,152.60 ","$0.00 ","$812.35 ","$0.00 ","$826.37 ","$0.00 "
"447.406","SUP","HCPCS C1713","","447.406  -  PLATE LG 1.5MM MANDIB 6X24X6 HOLE LCK 2 ANG 2MM SCR BONE TI","BOTH IP/OP","$5,474.25 ","$4,050.95 ","$0.00 ","$5,474.25 ","$2,463.41 ","$0.00 ","$1,140.97 ","$0.00 ","$0.00 ","$958.50 ","$5,474.25 ","$0.00 ","$2,737.13 ","$4,335.61 ","$4,379.40 ","$0.00 ","$856.72 ","$0.00 ","$871.50 ","$0.00 "
"447.412","SUP","HCPCS C1713","","447.412  -  PLATE 2MM MANDIB 12 HOLE X LCK STR 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1,953.00 ","$1,445.22 ","$0.00 ","$1,953.00 ","$878.85 ","$0.00 ","$407.05 ","$0.00 ","$0.00 ","$341.95 ","$1,953.00 ","$0.00 ","$976.50 ","$1,546.78 ","$1,562.40 ","$0.00 ","$305.64 ","$0.00 ","$310.92 ","$0.00 "
"447.42","SUP","HCPCS C1713","","447.420  -  PLATE 2MM MANDIB 20 HOLE X LCK STR 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$2,697.75 ","$1,996.34 ","$0.00 ","$2,697.75 ","$1,213.99 ","$0.00 ","$562.28 ","$0.00 ","$0.00 ","$472.35 ","$2,697.75 ","$0.00 ","$1,348.88 ","$2,136.62 ","$2,158.20 ","$0.00 ","$422.20 ","$0.00 ","$429.48 ","$0.00 "
"447.422","SUP","HCPCS C1713","","447.422  -  PLATE 2MM MANDIB 6X21 HOLE X LCK RIGHT ANG 2MM SCR BONE TI","BOTH IP/OP","$4,459.50 ","$3,300.03 ","$0.00 ","$4,459.50 ","$2,006.78 ","$0.00 ","$929.47 ","$0.00 ","$0.00 ","$780.82 ","$4,459.50 ","$0.00 ","$2,229.75 ","$3,531.92 ","$3,567.60 ","$0.00 ","$697.91 ","$0.00 ","$709.95 ","$0.00 "
"447.423","SUP","HCPCS C1713","","447.423  -  PLATE MANDIB 6X21 HOLE X LCK LEFT ANG 2 MM SCR BONE TI","BOTH IP/OP","$4,459.50 ","$3,300.03 ","$0.00 ","$4,459.50 ","$2,006.78 ","$0.00 ","$929.47 ","$0.00 ","$0.00 ","$780.82 ","$4,459.50 ","$0.00 ","$2,229.75 ","$3,531.92 ","$3,567.60 ","$0.00 ","$697.91 ","$0.00 ","$709.95 ","$0.00 "
"447.424","SUP","HCPCS C1713","","447.424  -  PLATE 2MM MANDIB 4X20X4 HOLE X LCK 2 ANG 2MM SCR BONE TI","BOTH IP/OP","$5,154.75 ","$3,814.52 ","$0.00 ","$5,154.75 ","$2,319.64 ","$0.00 ","$1,074.38 ","$0.00 ","$0.00 ","$902.56 ","$5,154.75 ","$0.00 ","$2,577.38 ","$4,082.56 ","$4,123.80 ","$0.00 ","$806.72 ","$0.00 ","$820.64 ","$0.00 "
"447.425","SUP","HCPCS C1713","","447.425  -  PLATE 2MM MANDIB 5X22X5 HOLE X LCK 2 ANG 2MM SCR BONE TI","BOTH IP/OP","$5,447.25 ","$4,030.97 ","$0.00 ","$5,447.25 ","$2,451.26 ","$0.00 ","$1,135.34 ","$0.00 ","$0.00 ","$953.77 ","$5,447.25 ","$0.00 ","$2,723.63 ","$4,314.22 ","$4,357.80 ","$0.00 ","$852.49 ","$0.00 ","$867.20 ","$0.00 "
"447.426","SUP","HCPCS C1713","","447.426  -  PLATE 2MM MANDIB 6X24X6 HOLE X LCK 2 ANG 2MM SCR BONE TI","BOTH IP/OP","$5,735.25 ","$4,244.09 ","$0.00 ","$5,735.25 ","$2,580.86 ","$0.00 ","$1,195.37 ","$0.00 ","$0.00 ","$1,004.20 ","$5,735.25 ","$0.00 ","$2,867.63 ","$4,542.32 ","$4,588.20 ","$0.00 ","$897.57 ","$0.00 ","$913.05 ","$0.00 "
"447.5","SUP","HCPCS C1713","","447.50  -  PLATE BN 5MM SPC OB L L 25X10X.9MM NS 4.8MM 2 HL BS 3 HL","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"447.51","SUP","HCPCS C1713","","447.51  -  PLATE 100D TI 2MM SCR 3 HOLE RIGHT OBLQ BONE ORTH NONSTRL","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"447.515","SUP","HCPCS C1713","","447.515  -  PLATE BONE 100D CRANFCL TI 2X3 HOLE L RIGHT OBLQ MALBLE 2MM","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$247.05 ","$0.00 ","$114.43 ","$0.00 ","$0.00 ","$96.13 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$85.92 ","$0.00 ","$87.40 ","$0.00 "
"447.516","SUP","HCPCS C1713","","447.516  -  PLATE BONE 100D CRANFCL TI 2X3 HOLE L LEFT OBLQ MALBLE 2MM","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$247.05 ","$0.00 ","$114.43 ","$0.00 ","$0.00 ","$96.13 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$85.92 ","$0.00 ","$87.40 ","$0.00 "
"447.52","SUP","HCPCS C1713","","447.52  -  PLATE BN 5MM SPC OB L L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL","BOTH IP/OP","$587.25 ","$434.57 ","$0.00 ","$587.25 ","$264.26 ","$0.00 ","$122.40 ","$0.00 ","$0.00 ","$102.82 ","$587.25 ","$0.00 ","$293.63 ","$465.10 ","$469.80 ","$0.00 ","$91.90 ","$0.00 ","$93.49 ","$0.00 "
"447.521","SUP","HCPCS C1713","","447.521  -  PLATE BONE 100D CRANFCL TI 4X3 HOLE L RIGHT OBLQ NO BAR 2MM","BOTH IP/OP","$481.50 ","$356.31 ","$0.00 ","$481.50 ","$216.68 ","$0.00 ","$100.36 ","$0.00 ","$0.00 ","$84.31 ","$481.50 ","$0.00 ","$240.75 ","$381.35 ","$385.20 ","$0.00 ","$75.35 ","$0.00 ","$76.65 ","$0.00 "
"447.522","SUP","HCPCS C1713","","447.522  -  PLATE BONE 100D CRANFCL TI 4X3 HOLE L LEFT OBLQ NO BAR 2MM","BOTH IP/OP","$481.50 ","$356.31 ","$0.00 ","$481.50 ","$216.68 ","$0.00 ","$100.36 ","$0.00 ","$0.00 ","$84.31 ","$481.50 ","$0.00 ","$240.75 ","$381.35 ","$385.20 ","$0.00 ","$75.35 ","$0.00 ","$76.65 ","$0.00 "
"447.524","SUP","HCPCS C1713","","447.524  -  PLATE BONE 20MM 90D RIGHT CRNMXF TI 2X2 HOLE L 2MM SCR","BOTH IP/OP","$488.25 ","$361.31 ","$0.00 ","$488.25 ","$219.71 ","$0.00 ","$101.76 ","$0.00 ","$0.00 ","$85.49 ","$488.25 ","$0.00 ","$244.13 ","$386.69 ","$390.60 ","$0.00 ","$76.41 ","$0.00 ","$77.73 ","$0.00 "
"447.525","SUP","HCPCS C1713","","447.525  -  PLATE BONE 20MM 90D LEFT CRNMXF TI 2X2 HOLE L 2MM SCR","BOTH IP/OP","$488.25 ","$361.31 ","$0.00 ","$488.25 ","$219.71 ","$0.00 ","$101.76 ","$0.00 ","$0.00 ","$85.49 ","$488.25 ","$0.00 ","$244.13 ","$386.69 ","$390.60 ","$0.00 ","$76.41 ","$0.00 ","$77.73 ","$0.00 "
"447.527","SUP","HCPCS C1713","","447.527  -  PLATE BONE 100D CRANFCL TI 3X4 HOLE L LEFT OBLQ MALBLE 2MM","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"447.53","SUP","HCPCS C1713","","447.53  -  PLATE BN 5MM SPC OB R L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL","BOTH IP/OP","$587.25 ","$434.57 ","$0.00 ","$587.25 ","$264.26 ","$0.00 ","$122.40 ","$0.00 ","$0.00 ","$102.82 ","$587.25 ","$0.00 ","$293.63 ","$465.10 ","$469.80 ","$0.00 ","$91.90 ","$0.00 ","$93.49 ","$0.00 "
"447.537","SUP","HCPCS C1713","","447.537  -  PLATE BONE 100D CRANFCL TI 3X4 HOLE L RIGHT OBLQ MALBLE 2MM","BOTH IP/OP","$576.00 ","$426.24 ","$0.00 ","$576.00 ","$259.20 ","$0.00 ","$120.05 ","$0.00 ","$0.00 ","$100.85 ","$576.00 ","$0.00 ","$288.00 ","$456.19 ","$460.80 ","$0.00 ","$90.14 ","$0.00 ","$91.70 ","$0.00 "
"447.54","SUP","HCPCS C1713","","447.54  -  PLATE BN 5MM SPC OB L L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$288.56 ","$0.00 ","$133.65 ","$0.00 ","$0.00 ","$112.28 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$100.36 ","$0.00 ","$102.09 ","$0.00 "
"447.546","SUP","HCPCS C1713","","447.546  -  PLATE SHRT MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 2MM SCR BONE","BOTH IP/OP","$429.75 ","$318.02 ","$0.00 ","$429.75 ","$193.39 ","$0.00 ","$89.57 ","$0.00 ","$0.00 ","$75.25 ","$429.75 ","$0.00 ","$214.88 ","$340.36 ","$343.80 ","$0.00 ","$67.26 ","$0.00 ","$68.42 ","$0.00 "
"447.547","SUP","HCPCS C1713","","447.547  -  PLATE SHRT MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 2MM SCR BONE","BOTH IP/OP","$429.75 ","$318.02 ","$0.00 ","$429.75 ","$193.39 ","$0.00 ","$89.57 ","$0.00 ","$0.00 ","$75.25 ","$429.75 ","$0.00 ","$214.88 ","$340.36 ","$343.80 ","$0.00 ","$67.26 ","$0.00 ","$68.42 ","$0.00 "
"447.548","SUP","HCPCS C1713","","447.548  -  PLATE LNG MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 2MM SCR BONE","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$218.70 ","$0.00 ","$101.29 ","$0.00 ","$0.00 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"447.549","SUP","HCPCS C1713","","447.549  -  PLATE LNG MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 2MM SCR BONE","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$218.70 ","$0.00 ","$101.29 ","$0.00 ","$0.00 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"447.55","SUP","HCPCS C1713","","447.55  -  PLATE BN 5MM SPC OB R L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$288.56 ","$0.00 ","$133.65 ","$0.00 ","$0.00 ","$112.28 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$100.36 ","$0.00 ","$102.09 ","$0.00 "
"447.556","SUP","HCPCS C1713","","447.556  -  PLATE SHRT TI 2MM SCR L 2X2 HOLE BONE LEFT OBLQ NONSTRL","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$218.70 ","$0.00 ","$101.29 ","$0.00 ","$0.00 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"447.557","SUP","HCPCS C1713","","447.557  -  PLATE SHRT TI 2MM SCR L OBLQ 2X2 HOLE BONE LEFT NONSTRL","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$218.70 ","$0.00 ","$101.29 ","$0.00 ","$0.00 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"447.558","SUP","HCPCS C1713","","447.558  -  PLATE LNG TI 2MM SCR L OBLQ 2X2 HOLE BONE RIGHT NONSTRL","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$218.70 ","$0.00 ","$101.29 ","$0.00 ","$0.00 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"447.559","SUP","HCPCS C1713","","447.559  -  PLATE LNG TI 2MM SCR L OBLQ 2X2 HOLE BONE LEFT NONSTRL","BOTH IP/OP","$486.00 ","$359.64 ","$0.00 ","$486.00 ","$218.70 ","$0.00 ","$101.29 ","$0.00 ","$0.00 ","$85.09 ","$486.00 ","$0.00 ","$243.00 ","$384.91 ","$388.80 ","$0.00 ","$76.06 ","$0.00 ","$77.37 ","$0.00 "
"447.562","SUP","HCPCS C1713","","447.562  -  PLATE SHRT TI 2MM SCR Z BONE RIGHT NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.563","SUP","HCPCS C1713","","447.563  -  PLATE SHRT TI 2MM SCR Z BONE LEFT NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.564","SUP","HCPCS C1713","","447.564  -  PLATE LNG TI 2MM SCR Z BONE RIGHT NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.565","SUP","HCPCS C1713","","447.565  -  PLATE LNG TI 2MM SCR Z BONE LEFT NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.572","SUP","HCPCS C1713","","447.572  -  PLATE SHRT RIGHT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.573","SUP","HCPCS C1713","","447.573  -  PLATE SHRT LEFT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.574","SUP","HCPCS C1713","","447.574  -  PLATE LNG RIGHT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.575","SUP","HCPCS C1713","","447.575  -  PLATE LNG LEFT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$551.25 ","$407.93 ","$0.00 ","$551.25 ","$248.06 ","$0.00 ","$114.89 ","$0.00 ","$0.00 ","$96.52 ","$551.25 ","$0.00 ","$275.63 ","$436.59 ","$441.00 ","$0.00 ","$86.27 ","$0.00 ","$87.76 ","$0.00 "
"447.61","SUP","HCPCS C1713","","447.61  -  PLATE BONE CRNMXF TI 5 HOLE Y 2 MM SCR NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"447.612","SUP","HCPCS C1713","","447.612  -  PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$483.55 ","$357.83 ","$0.00 ","$469.48 ","$211.26 ","$0.00 ","$100.78 ","$0.00 ","$0.00 ","$82.20 ","$469.48 ","$0.00 ","$234.74 ","$371.83 ","$375.58 ","$0.00 ","$71.33 ","$0.00 ","$74.74 ","$0.00 "
"447.615","SUP","HCPCS C1713","","447.615  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$788.83 ","$354.97 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$138.12 ","$788.83 ","$0.00 ","$394.41 ","$624.75 ","$631.06 ","$0.00 ","$119.86 ","$0.00 ","$125.58 ","$0.00 "
"447.62","SUP","HCPCS C1713","","447.62  -  PLATE BN Y 32X19X.9MM NS 4.8MM 2 HLE/HD 4 HL SHFT 2 ARM TI","BOTH IP/OP","$580.50 ","$429.57 ","$0.00 ","$580.50 ","$261.23 ","$0.00 ","$120.99 ","$0.00 ","$0.00 ","$101.64 ","$580.50 ","$0.00 ","$290.25 ","$459.76 ","$464.40 ","$0.00 ","$90.85 ","$0.00 ","$92.42 ","$0.00 "
"447.63","SUP","HCPCS C1713","","447.630  -  PLATE BONE CRANFCL TI 7 HOLE Y 2 MM SCR NONSTRL","BOTH IP/OP","$490.50 ","$362.97 ","$0.00 ","$490.50 ","$220.73 ","$0.00 ","$102.23 ","$0.00 ","$0.00 ","$85.88 ","$490.50 ","$0.00 ","$245.25 ","$388.48 ","$392.40 ","$0.00 ","$76.76 ","$0.00 ","$78.09 ","$0.00 "
"447.68","SUP","HCPCS C1713","","447.68  -  PLATE BONE CRANFCL TI 8 HOLE 2 Y 2 MM SCR NONSTRL","BOTH IP/OP","$600.75 ","$444.56 ","$0.00 ","$600.75 ","$270.34 ","$0.00 ","$125.21 ","$0.00 ","$0.00 ","$105.19 ","$600.75 ","$0.00 ","$300.38 ","$475.79 ","$480.60 ","$0.00 ","$94.02 ","$0.00 ","$95.64 ","$0.00 "
"447.681","SUP","HCPCS C1713","","447.681  -  PLATE TI 2 MM SCR 8 HOLE Y BONE NONSTRL","BOTH IP/OP","$600.75 ","$444.56 ","$0.00 ","$600.75 ","$270.34 ","$0.00 ","$125.21 ","$0.00 ","$0.00 ","$105.19 ","$600.75 ","$0.00 ","$300.38 ","$475.79 ","$480.60 ","$0.00 ","$94.02 ","$0.00 ","$95.64 ","$0.00 "
"447.702","SUP","HCPCS C1713","","447.702  -  PLATE BONE SMALL 24X18MM X LOCKING TITANIUM FT NONSTRL","BOTH IP/OP","$1,439.43 ","$1,065.18 ","$0.00 ","$1,397.50 ","$628.88 ","$0.00 ","$300.01 ","$0.00 ","$0.00 ","$244.69 ","$1,397.50 ","$0.00 ","$698.75 ","$1,106.82 ","$1,118.00 ","$0.00 ","$212.34 ","$0.00 ","$222.48 ","$0.00 "
"447.704","SUP","HCPCS C1713","","447.704  -  PLATE BONE MEDIUM 30X20MM X LOCKING TITANIUM FT NONSTRL","BOTH IP/OP","$1,457.70 ","$1,078.70 ","$0.00 ","$1,415.25 ","$636.86 ","$0.00 ","$303.82 ","$0.00 ","$0.00 ","$247.80 ","$1,415.25 ","$0.00 ","$707.63 ","$1,120.88 ","$1,132.20 ","$0.00 ","$215.03 ","$0.00 ","$225.31 ","$0.00 "
"447.706","SUP","HCPCS C1713","","447.706  -  PLATE BONE LARGE 36X20MM X LOCKING TITANIUM FT NONSTRL","BOTH IP/OP","$1,477.38 ","$1,093.26 ","$0.00 ","$1,434.35 ","$645.46 ","$0.00 ","$307.92 ","$0.00 ","$0.00 ","$251.14 ","$1,434.35 ","$0.00 ","$717.18 ","$1,136.01 ","$1,147.48 ","$0.00 ","$217.94 ","$0.00 ","$228.35 ","$0.00 "
"447.71","SUP","HCPCS C1713","","447.710  -  PLATE BN STRG 17X6X1.6MM NS 2 HL LCK RND THRD HL TI HND/MDFT","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$306.45 ","$0.00 ","$141.94 ","$0.00 ","$0.00 ","$119.24 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$103.47 ","$0.00 ","$108.42 ","$0.00 "
"447.711","SUP","HCPCS C1713","","447.711  -  PLATE BONE XS 22X14MM X LOCKING TITANIUM NONSTRL 2.4/2.7MM","BOTH IP/OP","$1,460.53 ","$1,080.79 ","$0.00 ","$1,417.98 ","$638.09 ","$0.00 ","$304.41 ","$0.00 ","$0.00 ","$248.28 ","$1,417.98 ","$0.00 ","$708.99 ","$1,123.04 ","$1,134.38 ","$0.00 ","$215.45 ","$0.00 ","$225.74 ","$0.00 "
"447.81","SUP","HCPCS C1713","","447.81  -  PLATE BN 13MM SPC X 18X18X.9MM NS 4.8MM 4 HL TI CRNFCL 2MM","BOTH IP/OP","$528.75 ","$391.28 ","$0.00 ","$528.75 ","$237.94 ","$0.00 ","$110.20 ","$0.00 ","$0.00 ","$92.58 ","$528.75 ","$0.00 ","$264.38 ","$418.77 ","$423.00 ","$0.00 ","$82.75 ","$0.00 ","$84.18 ","$0.00 "
"447.811","SUP","HCPCS C1713","","447.811  -  PLATE BONE CRANFCL TI 4 HOLE X MALBLE 2 MM SCR NONSTRL","BOTH IP/OP","$432.00 ","$319.68 ","$0.00 ","$432.00 ","$194.40 ","$0.00 ","$90.04 ","$0.00 ","$0.00 ","$75.64 ","$432.00 ","$0.00 ","$216.00 ","$342.14 ","$345.60 ","$0.00 ","$67.61 ","$0.00 ","$68.77 ","$0.00 "
"447.85","SUP","HCPCS C1713","","447.85  -  PLATE BONE CRANFCL TI 9 HOLE H 2 MM SCR NONSTRL","BOTH IP/OP","$594.00 ","$439.56 ","$0.00 ","$594.00 ","$267.30 ","$0.00 ","$123.80 ","$0.00 ","$0.00 ","$104.00 ","$594.00 ","$0.00 ","$297.00 ","$470.45 ","$475.20 ","$0.00 ","$92.96 ","$0.00 ","$94.56 ","$0.00 "
"447.86","SUP","HCPCS C1713","","447.86  -  PLATE BONE CRANFCL TI 8 HOLE H 2 MM SCR NONSTRL","BOTH IP/OP","$594.00 ","$439.56 ","$0.00 ","$594.00 ","$267.30 ","$0.00 ","$123.80 ","$0.00 ","$0.00 ","$104.00 ","$594.00 ","$0.00 ","$297.00 ","$470.45 ","$475.20 ","$0.00 ","$92.96 ","$0.00 ","$94.56 ","$0.00 "
"447.915","SUP","HCPCS C1713","","447.915  -  PLATE BONE 13X13MM CRANFCL TI 4 HOLE BOX 2MM SCR NONSTRL","BOTH IP/OP","$474.75 ","$351.32 ","$0.00 ","$474.75 ","$213.64 ","$0.00 ","$98.95 ","$0.00 ","$0.00 ","$83.12 ","$474.75 ","$0.00 ","$237.38 ","$376.00 ","$379.80 ","$0.00 ","$74.30 ","$0.00 ","$75.58 ","$0.00 "
"449.004","SUP","HCPCS C1713","","449.004  -  PLATE BN NAR STRG 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.006","SUP","HCPCS C1713","","449.006  -  PLATE BN NAR STRG 42X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.008","SUP","HCPCS C1713","","449.008  -  PLATE NAR 55MM MANDIB 8 HOLE STR 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.014","SUP","HCPCS C1713","","449.014  -  PLATE BN CRV NAR 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.016","SUP","HCPCS C1713","","449.016  -  PLATE BN CRV NAR 41X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.017","SUP","HCPCS C1713","","449.017  -  PLATE NAR MANDIB 6 HOLE STRUT 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.018","SUP","HCPCS C1713","","449.018  -  PLATE MANDIB 8 HOLE CVD STRUT 2 MM SCR BONE TI NONSTRL","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"449.02","SUP","HCPCS C1713","","449.020  -  PLATE 119MM MANDIB 20 HOLE ADP 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.021","SUP","HCPCS C1713","","449.021  -  PLATE BONE 100MM CRANFCL TI 2X20 HOLE 2 ADP 2MM SCR BILAT","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"449.024","SUP","HCPCS C1713","","449.024  -  PLATE BN BRD STRG 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.025","SUP","HCPCS C1713","","449.025  -  PLATE BN BRD CRV 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.026","SUP","HCPCS C1713","","449.026  -  PLATE BN BRD STRG 42X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.027","SUP","HCPCS C1713","","449.027  -  PLATE BN BRD CRV 41X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.028","SUP","HCPCS C1713","","449.028  -  PLATE BN BRD STRG 55X4.8X1.25MM NS 8 HL LOPRFL TI MNDB 2MM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.032","SUP","HCPCS C1713","","449.032  -  PLATE 21MM MANDIB 4X4 HOLE ANG 2MM SCR BONE DCP TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.034","SUP","HCPCS C1713","","449.034  -  PLATE BN 30X5X1.25MM NS DCP 4 HL LOPRFL TI MNDB 2MM SCR MDLR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.035","SUP","HCPCS C1713","","449.035  -  PLATE BN 32X5X1.25MM NS DCP 5 HL LOPRFL TI MNDB 2MM SCR MDLR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.036","SUP","HCPCS C1713","","449.036  -  PLATE BN 42X5X1.25MM NS DCP 6 HL LOPRFL TI MNDB 2MM SCR MDLR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.037","SUP","HCPCS C1713","","449.037  -  PLATE 48MM MANDIB 7 HOLE 2MM SCR BONE DCP TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.038","SUP","HCPCS C1713","","449.038  -  PLATE 54MM MANDIB 8 HOLE 2MM SCR BONE DCP TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.04","SUP","HCPCS C1713","","449.04  -  PLATE 22MM MANDIB 4 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$857.25 ","$634.37 ","$0.00 ","$857.25 ","$385.76 ","$0.00 ","$178.67 ","$0.00 ","$0.00 ","$150.10 ","$857.25 ","$0.00 ","$428.63 ","$678.94 ","$685.80 ","$0.00 ","$134.16 ","$0.00 ","$136.47 ","$0.00 "
"449.05","SUP","HCPCS C1713","","449.05  -  PLATE 25MM MANDIB 4 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.06","SUP","HCPCS C1713","","449.06  -  PLATE 35MM MANDIB 6 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL","BOTH IP/OP","$954.00 ","$705.96 ","$0.00 ","$954.00 ","$429.30 ","$0.00 ","$198.84 ","$0.00 ","$0.00 ","$167.04 ","$954.00 ","$0.00 ","$477.00 ","$755.57 ","$763.20 ","$0.00 ","$149.30 ","$0.00 ","$151.88 ","$0.00 "
"449.1","SUP","HCPCS C1713","","449.100  -  PLATE 26MM MANDIB 4 HOLE CMPR TNSNBND 2.4MM SCR BONE LC DCP","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.11","SUP","HCPCS C1713","","449.110  -  PLATE 36MM MANDIB 6 HOLE CMPR TNSNBND 2.4MM SCR BONE LC DCP","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.14","SUP","HCPCS C1713","","449.14  -  PLATE BN 35X6.5X1.65MM NS LC DCP 4 HL TI MNDB 2.4MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.15","SUP","HCPCS C1713","","449.15  -  PLATE BN 39X6.5X1.65MM NS LC DCP 5 HL TI MNDB 2.4MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.16","SUP","HCPCS C1713","","449.16  -  PLATE BN 51X6.5X1.65MM NS LC DCP 6 HL TI MNDB 2.4MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.234","SUP","HCPCS C1713","","449.234  -  PLATE 35MM MANDIB 4 HOLE ECNTRC 2.4MM SCR BONE LC DCP TI","BOTH IP/OP","$1,359.00 ","$1,005.66 ","$0.00 ","$1,359.00 ","$611.55 ","$0.00 ","$283.25 ","$0.00 ","$0.00 ","$237.95 ","$1,359.00 ","$0.00 ","$679.50 ","$1,076.33 ","$1,087.20 ","$0.00 ","$212.68 ","$0.00 ","$216.35 ","$0.00 "
"449.236","SUP","HCPCS C1713","","449.236  -  PLATE 6 HOLE ECNTRC 2.4 MM SCR BONE LC DCP TI NONSTRL","BOTH IP/OP","$1,638.00 ","$1,212.12 ","$0.00 ","$1,638.00 ","$737.10 ","$0.00 ","$341.40 ","$0.00 ","$0.00 ","$286.80 ","$1,638.00 ","$0.00 ","$819.00 ","$1,297.30 ","$1,310.40 ","$0.00 ","$256.35 ","$0.00 ","$260.77 ","$0.00 "
"449.24","SUP","HCPCS C1713","","449.24  -  PLATE 35X6.5X2MM MANDIB 4 HOLE CRSNT 2.4MM SCR BONE LC DCP","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.25","SUP","HCPCS C1713","","449.250  -  PLATE 38MM MANDIB 5 HOLE CRSNT 2.4MM SCR BONE LC DCP TI","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$656.10 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$255.28 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$228.18 ","$0.00 ","$232.11 ","$0.00 "
"449.26","SUP","HCPCS C1713","","449.26  -  PLATE 50MM TI 2.4MM SCR 6 HOLE CRSNT LC DCP BONE MANDIB","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.38","SUP","HCPCS C1713","","449.38  -  PLATE UNV 64MM MANDIB 8 HOLE 2.4MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.4","SUP","HCPCS C1713","","449.40  -  PLATE UNV 80MM MANDIB 10 HOLE STR 2.4MM SCR BONE TI NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.412","SUP","HCPCS C1713","","449.412  -  PLATE MAXFACL 12 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$759.38 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"449.416","SUP","HCPCS C1713","","449.416  -  PLATE MAXFACL 16 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$2,310.75 ","$1,709.96 ","$0.00 ","$2,310.75 ","$1,039.84 ","$0.00 ","$481.62 ","$0.00 ","$0.00 ","$404.59 ","$2,310.75 ","$0.00 ","$1,155.38 ","$1,830.11 ","$1,848.60 ","$0.00 ","$361.63 ","$0.00 ","$367.87 ","$0.00 "
"449.418","SUP","HCPCS C1713","","449.418  -  PLATE MAXFACL 18 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$2,623.50 ","$1,941.39 ","$0.00 ","$2,623.50 ","$1,180.58 ","$0.00 ","$546.80 ","$0.00 ","$0.00 ","$459.35 ","$2,623.50 ","$0.00 ","$1,311.75 ","$2,077.81 ","$2,098.80 ","$0.00 ","$410.58 ","$0.00 ","$417.66 ","$0.00 "
"449.42","SUP","HCPCS C1713","","449.420  -  PLATE MAXFACL 20 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$2,938.50 ","$2,174.49 ","$0.00 ","$2,938.50 ","$1,322.33 ","$0.00 ","$612.46 ","$0.00 ","$0.00 ","$514.51 ","$2,938.50 ","$0.00 ","$1,469.25 ","$2,327.29 ","$2,350.80 ","$0.00 ","$459.88 ","$0.00 ","$467.81 ","$0.00 "
"449.422","SUP","HCPCS C1713","","449.422  -  PLATE MAXFACL 22 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$2,938.50 ","$2,174.49 ","$0.00 ","$2,938.50 ","$1,322.33 ","$0.00 ","$612.46 ","$0.00 ","$0.00 ","$514.51 ","$2,938.50 ","$0.00 ","$1,469.25 ","$2,327.29 ","$2,350.80 ","$0.00 ","$459.88 ","$0.00 ","$467.81 ","$0.00 "
"449.424","SUP","HCPCS C1713","","449.424  -  PLATE MAXFACL 24 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$2,938.50 ","$2,174.49 ","$0.00 ","$2,938.50 ","$1,322.33 ","$0.00 ","$612.46 ","$0.00 ","$0.00 ","$514.51 ","$2,938.50 ","$0.00 ","$1,469.25 ","$2,327.29 ","$2,350.80 ","$0.00 ","$459.88 ","$0.00 ","$467.81 ","$0.00 "
"449.44","SUP","HCPCS C1713","","449.440  -  PLATE MAXFACL 4X8 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$2,938.50 ","$2,174.49 ","$0.00 ","$2,938.50 ","$1,322.33 ","$0.00 ","$612.46 ","$0.00 ","$0.00 ","$514.51 ","$2,938.50 ","$0.00 ","$1,469.25 ","$2,327.29 ","$2,350.80 ","$0.00 ","$459.88 ","$0.00 ","$467.81 ","$0.00 "
"449.441","SUP","HCPCS C1713","","449.441  -  PLATE MAXFACL 4X8 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$2,938.50 ","$2,174.49 ","$0.00 ","$2,938.50 ","$1,322.33 ","$0.00 ","$612.46 ","$0.00 ","$0.00 ","$514.51 ","$2,938.50 ","$0.00 ","$1,469.25 ","$2,327.29 ","$2,350.80 ","$0.00 ","$459.88 ","$0.00 ","$467.81 ","$0.00 "
"449.442","SUP","HCPCS C1713","","449.442  -  PLATE MAXFACL 4X16 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$3,343.50 ","$2,474.19 ","$0.00 ","$3,343.50 ","$1,504.58 ","$0.00 ","$696.87 ","$0.00 ","$0.00 ","$585.42 ","$3,343.50 ","$0.00 ","$1,671.75 ","$2,648.05 ","$2,674.80 ","$0.00 ","$523.26 ","$0.00 ","$532.29 ","$0.00 "
"449.443","SUP","HCPCS C1713","","449.443  -  PLATE MAXFACL 4X16 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$3,343.50 ","$2,474.19 ","$0.00 ","$3,343.50 ","$1,504.58 ","$0.00 ","$696.87 ","$0.00 ","$0.00 ","$585.42 ","$3,343.50 ","$0.00 ","$1,671.75 ","$2,648.05 ","$2,674.80 ","$0.00 ","$523.26 ","$0.00 ","$532.29 ","$0.00 "
"449.444","SUP","HCPCS C1713","","449.444  -  PLATE MAXFACL 5X17 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$3,660.75 ","$2,708.96 ","$0.00 ","$3,660.75 ","$1,647.34 ","$0.00 ","$762.99 ","$0.00 ","$0.00 ","$640.97 ","$3,660.75 ","$0.00 ","$1,830.38 ","$2,899.31 ","$2,928.60 ","$0.00 ","$572.91 ","$0.00 ","$582.79 ","$0.00 "
"449.445","SUP","HCPCS C1713","","449.445  -  PLATE MAXFACL 5X17 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$3,660.75 ","$2,708.96 ","$0.00 ","$3,660.75 ","$1,647.34 ","$0.00 ","$762.99 ","$0.00 ","$0.00 ","$640.97 ","$3,660.75 ","$0.00 ","$1,830.38 ","$2,899.31 ","$2,928.60 ","$0.00 ","$572.91 ","$0.00 ","$582.79 ","$0.00 "
"449.446","SUP","HCPCS C1713","","449.446  -  PLATE MAXFACL 6X18 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$4,027.50 ","$2,980.35 ","$0.00 ","$4,027.50 ","$1,812.38 ","$0.00 ","$839.43 ","$0.00 ","$0.00 ","$705.18 ","$4,027.50 ","$0.00 ","$2,013.75 ","$3,189.78 ","$3,222.00 ","$0.00 ","$630.30 ","$0.00 ","$641.18 ","$0.00 "
"449.447","SUP","HCPCS C1713","","449.447  -  PLATE MAXFACL 6X18 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$4,027.50 ","$2,980.35 ","$0.00 ","$4,027.50 ","$1,812.38 ","$0.00 ","$839.43 ","$0.00 ","$0.00 ","$705.18 ","$4,027.50 ","$0.00 ","$2,013.75 ","$3,189.78 ","$3,222.00 ","$0.00 ","$630.30 ","$0.00 ","$641.18 ","$0.00 "
"449.448","SUP","HCPCS C1713","","449.448  -  PLATE MAXFACL 6X21 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$4,401.00 ","$3,256.74 ","$0.00 ","$4,401.00 ","$1,980.45 ","$0.00 ","$917.28 ","$0.00 ","$0.00 ","$770.58 ","$4,401.00 ","$0.00 ","$2,200.50 ","$3,485.59 ","$3,520.80 ","$0.00 ","$688.76 ","$0.00 ","$700.64 ","$0.00 "
"449.449","SUP","HCPCS C1713","","449.449  -  PLATE MAXFACL 6X21 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$4,401.00 ","$3,256.74 ","$0.00 ","$4,401.00 ","$1,980.45 ","$0.00 ","$917.28 ","$0.00 ","$0.00 ","$770.58 ","$4,401.00 ","$0.00 ","$2,200.50 ","$3,485.59 ","$3,520.80 ","$0.00 ","$688.76 ","$0.00 ","$700.64 ","$0.00 "
"449.45","SUP","HCPCS C1713","","449.450  -  PLATE MAXFACL 4X20X4 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$7,537.50 ","$5,577.75 ","$0.00 ","$7,537.50 ","$3,391.88 ","$0.00 ","$1,571.00 ","$0.00 ","$0.00 ","$1,319.76 ","$7,537.50 ","$0.00 ","$3,768.75 ","$5,969.70 ","$6,030.00 ","$0.00 ","$1,179.62 ","$0.00 ","$1,199.97 ","$0.00 "
"449.451","SUP","HCPCS C1713","","449.451  -  PLATE MAXFACL 5X22X5 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$7,850.25 ","$5,809.19 ","$0.00 ","$7,850.25 ","$3,532.61 ","$0.00 ","$1,636.19 ","$0.00 ","$0.00 ","$1,374.52 ","$7,850.25 ","$0.00 ","$3,925.13 ","$6,217.40 ","$6,280.20 ","$0.00 ","$1,228.56 ","$0.00 ","$1,249.76 ","$0.00 "
"449.452","SUP","HCPCS C1713","","449.452  -  PLATE MAXFACL 6X24X6 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI","BOTH IP/OP","$9,411.75 ","$6,964.70 ","$0.00 ","$9,411.75 ","$4,235.29 ","$0.00 ","$1,961.64 ","$0.00 ","$0.00 ","$1,647.92 ","$9,411.75 ","$0.00 ","$4,705.88 ","$7,454.11 ","$7,529.40 ","$0.00 ","$1,472.94 ","$0.00 ","$1,498.35 ","$0.00 "
"449.612","SUP","HCPCS C1713","","449.612  -  PLATE 96MM MANDIB 12 HOLE LCK STR RECON 2.4/3MM SCR BONE TI","BOTH IP/OP","$2,301.75 ","$1,703.30 ","$0.00 ","$2,301.75 ","$1,035.79 ","$0.00 ","$479.74 ","$0.00 ","$0.00 ","$403.02 ","$2,301.75 ","$0.00 ","$1,150.88 ","$1,822.99 ","$1,841.40 ","$0.00 ","$360.22 ","$0.00 ","$366.44 ","$0.00 "
"449.615","SUP","HCPCS C1713","","449.615  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"449.62","SUP","HCPCS C1713","","449.62  -  PLATE 95MM MANDIB 12 HOLE STR LCK RECON 2.4MM SCR BONE TI","BOTH IP/OP","$2,220.75 ","$1,643.36 ","$0.00 ","$2,220.75 ","$999.34 ","$0.00 ","$462.86 ","$0.00 ","$0.00 ","$388.84 ","$2,220.75 ","$0.00 ","$1,110.38 ","$1,758.83 ","$1,776.60 ","$0.00 ","$347.55 ","$0.00 ","$353.54 ","$0.00 "
"449.621","SUP","HCPCS C1713","","449.621  -  PLATE BN STRG 160X8X2.5MM NS 20 HL LCK RECON TI MNDB 2.4/3MM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.632","SUP","HCPCS C1713","","449.632  -  PLATE 214MM MANDIB 6X23 HOLE LEFT ANG LCK RECON 2.4MM SCR","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.633","SUP","HCPCS C1713","","449.633  -  PLATE BN ANG 214X44X2.4MM NS 44MM 6 HLE/HD 23 HL SHFT LOPRFL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.636","SUP","HCPCS C1713","","449.636  -  PLATE MANDIB 4X20X4 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE","BOTH IP/OP","$5,553.00 ","$4,109.22 ","$0.00 ","$5,553.00 ","$2,498.85 ","$0.00 ","$1,157.38 ","$0.00 ","$0.00 ","$972.29 ","$5,553.00 ","$0.00 ","$2,776.50 ","$4,397.98 ","$4,442.40 ","$0.00 ","$869.04 ","$0.00 ","$884.04 ","$0.00 "
"449.637","SUP","HCPCS C1713","","449.637  -  PLATE MANDIB 5X22X5 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.638","SUP","HCPCS C1713","","449.638  -  PLATE MANDIB 6X24X6 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE","BOTH IP/OP","$6,187.50 ","$4,578.75 ","$0.00 ","$6,187.50 ","$2,784.38 ","$0.00 ","$1,289.63 ","$0.00 ","$0.00 ","$1,083.38 ","$6,187.50 ","$0.00 ","$3,093.75 ","$4,900.50 ","$4,950.00 ","$0.00 ","$968.34 ","$0.00 ","$985.05 ","$0.00 "
"449.644","SUP","HCPCS C1713","","449.644  -  PLATE RIGHT CNDYLR HEAD MANDIB 3X16 HOLE LCK RECON 2.4 MM","BOTH IP/OP","$9,706.50 ","$7,182.81 ","$0.00 ","$9,706.50 ","$4,367.93 ","$0.00 ","$2,023.08 ","$0.00 ","$0.00 ","$1,699.53 ","$9,706.50 ","$0.00 ","$4,853.25 ","$7,687.55 ","$7,765.20 ","$0.00 ","$1,519.07 ","$0.00 ","$1,545.27 ","$0.00 "
"449.645","SUP","HCPCS C1713","","449.645  -  PLATE LEFT CNDYLR HEAD MANDIB 3X16 HOLE LCK RECON 2.4 MM SCR","BOTH IP/OP","$9,706.50 ","$7,182.81 ","$0.00 ","$9,706.50 ","$4,367.93 ","$0.00 ","$2,023.08 ","$0.00 ","$0.00 ","$1,699.53 ","$9,706.50 ","$0.00 ","$4,853.25 ","$7,687.55 ","$7,765.20 ","$0.00 ","$1,519.07 ","$0.00 ","$1,545.27 ","$0.00 "
"449.646","SUP","HCPCS C1713","","449.646  -  PLATE RIGHT CNDYLR HEAD MANDIB 4X18 HOLE LCK RECON 2.4 MM","BOTH IP/OP","$10,248.75 ","$7,584.08 ","$0.00 ","$10,248.75 ","$4,611.94 ","$0.00 ","$2,136.10 ","$0.00 ","$0.00 ","$1,794.47 ","$10,248.75 ","$0.00 ","$5,124.38 ","$8,117.01 ","$8,199.00 ","$0.00 ","$1,603.93 ","$0.00 ","$1,631.60 ","$0.00 "
"449.647","SUP","HCPCS C1713","","449.647  -  PLATE LEFT CNDYLR HEAD MANDIB 4X18 HOLE LCK RECON 2.4 MM SCR","BOTH IP/OP","$10,248.75 ","$7,584.08 ","$0.00 ","$10,248.75 ","$4,611.94 ","$0.00 ","$2,136.10 ","$0.00 ","$0.00 ","$1,794.47 ","$10,248.75 ","$0.00 ","$5,124.38 ","$8,117.01 ","$8,199.00 ","$0.00 ","$1,603.93 ","$0.00 ","$1,631.60 ","$0.00 "
"449.648","SUP","HCPCS C1713","","449.648  -  PLATE TI 2.4 MM SCR 5X20 HOLE LCK RECON LCP BONE RIGHT","BOTH IP/OP","$10,782.00 ","$7,978.68 ","$0.00 ","$10,782.00 ","$4,851.90 ","$0.00 ","$2,247.24 ","$0.00 ","$0.00 ","$1,887.84 ","$10,782.00 ","$0.00 ","$5,391.00 ","$8,539.34 ","$8,625.60 ","$0.00 ","$1,687.38 ","$0.00 ","$1,716.49 ","$0.00 "
"449.649","SUP","HCPCS C1713","","449.649  -  PLATE LEFT CNDYLR HEAD MANDIB 5X20 HOLE LCK RECON 2.4 MM SCR","BOTH IP/OP","$10,782.00 ","$7,978.68 ","$0.00 ","$10,782.00 ","$4,851.90 ","$0.00 ","$2,247.24 ","$0.00 ","$0.00 ","$1,887.84 ","$10,782.00 ","$0.00 ","$5,391.00 ","$8,539.34 ","$8,625.60 ","$0.00 ","$1,687.38 ","$0.00 ","$1,716.49 ","$0.00 "
"449.651","SUP","HCPCS C1713","","449.651  -  PLATE MANDIB 3X3 HOLE LCK CRSNT ANG RECON 2.4/3 MM SCR BONE","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.652","SUP","HCPCS C1713","","449.652  -  PLATE MANDIB 3X3 HOLE LCK ANG RECON 2.4/3 MM SCR BONE TI","BOTH IP/OP","$2,756.25 ","$2,039.63 ","$0.00 ","$2,756.25 ","$1,240.31 ","$0.00 ","$574.47 ","$0.00 ","$0.00 ","$482.60 ","$2,756.25 ","$0.00 ","$1,378.13 ","$2,182.95 ","$2,205.00 ","$0.00 ","$431.35 ","$0.00 ","$438.80 ","$0.00 "
"449.653","SUP","HCPCS C1713","","449.653  -  PLATE MANDIB 4X4 HOLE LCK ANG RECON 2.4/3 MM SCR BONE TI","BOTH IP/OP","$2,972.25 ","$2,199.47 ","$0.00 ","$2,972.25 ","$1,337.51 ","$0.00 ","$619.49 ","$0.00 ","$0.00 ","$520.42 ","$2,972.25 ","$0.00 ","$1,486.13 ","$2,354.02 ","$2,377.80 ","$0.00 ","$465.16 ","$0.00 ","$473.18 ","$0.00 "
"449.654","SUP","HCPCS C1713","","449.654  -  PLATE MANDIB 5X8 HOLE LCK LEFT ANG RECON 2.4/3 MM SCR BONE","BOTH IP/OP","$3,242.25 ","$2,399.27 ","$0.00 ","$3,242.25 ","$1,459.01 ","$0.00 ","$675.77 ","$0.00 ","$0.00 ","$567.69 ","$3,242.25 ","$0.00 ","$1,621.13 ","$2,567.86 ","$2,593.80 ","$0.00 ","$507.41 ","$0.00 ","$516.17 ","$0.00 "
"449.655","SUP","HCPCS C1713","","449.655  -  PLATE MANDIB 5X8 HOLE LCK RIGHT ANG RECON 2.4/3 MM SCR BONE","BOTH IP/OP","$3,242.25 ","$2,399.27 ","$0.00 ","$3,242.25 ","$1,459.01 ","$0.00 ","$675.77 ","$0.00 ","$0.00 ","$567.69 ","$3,242.25 ","$0.00 ","$1,621.13 ","$2,567.86 ","$2,593.80 ","$0.00 ","$507.41 ","$0.00 ","$516.17 ","$0.00 "
"449.669","SUP","HCPCS C1713","","449.669  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT Y LCP TITANIUM","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"449.67","SUP","HCPCS C1713","","449.670  -  PLATE BONE T 58MM 2X7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4","BOTH IP/OP","$1,311.53 ","$970.53 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$273.35 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"449.674","SUP","HCPCS C1713","","449.674  -  PLATE BONE 36MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"449.676","SUP","HCPCS C1713","","449.676  -  PLATE BONE 52MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"449.678","SUP","HCPCS C1713","","449.678  -  PLATE BONE 68MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM","BOTH IP/OP","$735.18 ","$544.03 ","$0.00 ","$713.78 ","$321.20 ","$0.00 ","$153.23 ","$0.00 ","$0.00 ","$124.98 ","$713.78 ","$0.00 ","$356.89 ","$565.31 ","$571.02 ","$0.00 ","$108.45 ","$0.00 ","$113.63 ","$0.00 "
"449.679","SUP","HCPCS C1713","","449.679  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW","BOTH IP/OP","$1,103.48 ","$816.58 ","$0.00 ","$1,071.33 ","$482.10 ","$0.00 ","$229.99 ","$0.00 ","$0.00 ","$187.58 ","$1,071.33 ","$0.00 ","$535.66 ","$848.49 ","$857.06 ","$0.00 ","$162.78 ","$0.00 ","$170.55 ","$0.00 "
"449.68","SUP","HCPCS C1713","","449.680  -  PLATE BONE 40MM 4 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7MM","BOTH IP/OP","$753.35 ","$557.48 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$157.02 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"449.681","SUP","HCPCS C1713","","449.681  -  PLATE BONE 49MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"449.682","SUP","HCPCS C1713","","449.682  -  PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"449.683","SUP","HCPCS C1713","","449.683  -  PLATE BONE 67MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM","BOTH IP/OP","$775.95 ","$574.20 ","$0.00 ","$753.35 ","$339.01 ","$0.00 ","$161.73 ","$0.00 ","$0.00 ","$131.91 ","$753.35 ","$0.00 ","$376.68 ","$596.65 ","$602.68 ","$0.00 ","$114.46 ","$0.00 ","$119.93 ","$0.00 "
"449.684","SUP","HCPCS C1713","","449.684  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7 MM SCREWS","BOTH IP/OP","$1,203.28 ","$890.43 ","$0.00 ","$1,168.23 ","$525.70 ","$0.00 ","$250.79 ","$0.00 ","$0.00 ","$204.55 ","$1,168.23 ","$0.00 ","$584.11 ","$925.24 ","$934.58 ","$0.00 ","$177.50 ","$0.00 ","$185.98 ","$0.00 "
"449.685","SUP","HCPCS C1713","","449.685  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT T LCP TITANIUM","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"449.686","SUP","HCPCS C1713","","449.686  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L RIGHT OBLIQUE LCP","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"449.687","SUP","HCPCS C1713","","449.687  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LEFT OBLIQUE LCP","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"449.688","SUP","HCPCS C1713","","449.688  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LCP TITANIUM RIGHT","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"449.689","SUP","HCPCS C1713","","449.689  -  PLATE BONE 2.7MM 2 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM LEFT","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"449.69","SUP","HCPCS C1713","","449.690  -  PLATE BONE 31MM 5 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL","BOTH IP/OP","$1,454.83 ","$1,076.57 ","$0.00 ","$1,454.83 ","$654.67 ","$0.00 ","$303.22 ","$0.00 ","$0.00 ","$254.73 ","$1,454.83 ","$0.00 ","$727.41 ","$1,152.23 ","$1,163.86 ","$0.00 ","$221.05 ","$0.00 ","$231.61 ","$0.00 "
"449.691","SUP","HCPCS C1713","","449.691  -  PLATE BONE 45MM 8 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL","BOTH IP/OP","$1,529.40 ","$1,131.76 ","$0.00 ","$1,484.85 ","$668.18 ","$0.00 ","$318.77 ","$0.00 ","$0.00 ","$259.99 ","$1,484.85 ","$0.00 ","$742.43 ","$1,176.00 ","$1,187.88 ","$0.00 ","$225.61 ","$0.00 ","$236.39 ","$0.00 "
"449.697","SUP","HCPCS C1713","","449.697  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT T LCP TITANIUM","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"449.698","SUP","HCPCS C1713","","449.698  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"449.699","SUP","HCPCS C1713","","449.699  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LEFT OBLIQUE LCP","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"449.7","SUP","HCPCS C1713","","449.70  -  PLATE MANDIB 20 HOLE STR RECON 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$3,154.50 ","$2,334.33 ","$0.00 ","$3,154.50 ","$1,419.53 ","$0.00 ","$657.48 ","$0.00 ","$0.00 ","$552.33 ","$3,154.50 ","$0.00 ","$1,577.25 ","$2,498.36 ","$2,523.60 ","$0.00 ","$493.68 ","$0.00 ","$502.20 ","$0.00 "
"449.701","SUP","HCPCS C1713","","449.701  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM RIGHT","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"449.702","SUP","HCPCS C1713","","449.702  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM LEFT","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"449.82","SUP","HCPCS C1713","","449.82  -  PLATE UNV 26MM CRNMXF 3X3 HOLE ANG 2.4MM SCR FRAC BONE TI","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.84","SUP","HCPCS C1713","","449.84  -  PLATE UNV 32MM MANDIB 4X4 HOLE ANG FRAC 2.4MM SCR BONE TI","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"449.87","SUP","HCPCS C1713","","449.87  -  PLATE 97X47MM MANDIB 5X13 HOLE ANG RECON 2.4MM SCR BONE TI","BOTH IP/OP","$3,471.75 ","$2,569.10 ","$0.00 ","$3,471.75 ","$1,562.29 ","$0.00 ","$723.60 ","$0.00 ","$0.00 ","$607.88 ","$3,471.75 ","$0.00 ","$1,735.88 ","$2,749.63 ","$2,777.40 ","$0.00 ","$543.33 ","$0.00 ","$552.70 ","$0.00 "
"449.88","SUP","HCPCS C1713","","449.88  -  PLATE MANDIB ANG RECON 2.4 MM SCR BONE TI NONSTRL","BOTH IP/OP","$3,471.75 ","$2,569.10 ","$0.00 ","$3,471.75 ","$1,562.29 ","$0.00 ","$723.60 ","$0.00 ","$0.00 ","$607.88 ","$3,471.75 ","$0.00 ","$1,735.88 ","$2,749.63 ","$2,777.40 ","$0.00 ","$543.33 ","$0.00 ","$552.70 ","$0.00 "
"449.906","SUP","HCPCS C1713","","449.906  -  PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"449.912","SUP","HCPCS C1713","","449.912  -  PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$522.93 ","$386.97 ","$0.00 ","$507.68 ","$228.45 ","$0.00 ","$108.99 ","$0.00 ","$0.00 ","$88.89 ","$507.68 ","$0.00 ","$253.84 ","$402.08 ","$406.14 ","$0.00 ","$77.14 ","$0.00 ","$80.82 ","$0.00 "
"449.913","SUP","HCPCS C1713","","449.913  -  PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$497.63 ","$368.25 ","$0.00 ","$483.13 ","$217.41 ","$0.00 ","$103.72 ","$0.00 ","$0.00 ","$84.59 ","$483.13 ","$0.00 ","$241.56 ","$382.64 ","$386.50 ","$0.00 ","$73.41 ","$0.00 ","$76.91 ","$0.00 "
"449.914","SUP","HCPCS C1713","","449.914  -  PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$531.35 ","$393.20 ","$0.00 ","$515.88 ","$232.14 ","$0.00 ","$110.75 ","$0.00 ","$0.00 ","$90.33 ","$515.88 ","$0.00 ","$257.94 ","$408.58 ","$412.70 ","$0.00 ","$78.38 ","$0.00 ","$82.13 ","$0.00 "
"449.915","SUP","HCPCS C1713","","449.915  -  PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL","BOTH IP/OP","$514.48 ","$380.72 ","$0.00 ","$499.50 ","$224.78 ","$0.00 ","$107.23 ","$0.00 ","$0.00 ","$87.46 ","$499.50 ","$0.00 ","$249.75 ","$395.60 ","$399.60 ","$0.00 ","$75.89 ","$0.00 ","$79.52 ","$0.00 "
"449.916","SUP","HCPCS C1713","","449.916  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH","BOTH IP/OP","$580.55 ","$429.61 ","$0.00 ","$563.65 ","$253.64 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$98.69 ","$563.65 ","$0.00 ","$281.83 ","$446.41 ","$450.92 ","$0.00 ","$85.64 ","$0.00 ","$89.73 ","$0.00 "
"449.917","SUP","HCPCS C1713","","449.917  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH","BOTH IP/OP","$580.55 ","$429.61 ","$0.00 ","$563.65 ","$253.64 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$98.69 ","$563.65 ","$0.00 ","$281.83 ","$446.41 ","$450.92 ","$0.00 ","$85.64 ","$0.00 ","$89.73 ","$0.00 "
"449.924","SUP","HCPCS C1713","","449.924  -  PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$618.50 ","$457.69 ","$0.00 ","$600.50 ","$270.23 ","$0.00 ","$128.91 ","$0.00 ","$0.00 ","$105.14 ","$600.50 ","$0.00 ","$300.25 ","$475.60 ","$480.40 ","$0.00 ","$91.24 ","$0.00 ","$95.60 ","$0.00 "
"449.926","SUP","HCPCS C1713","","449.926  -  PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$695.83 ","$514.91 ","$0.00 ","$675.55 ","$304.00 ","$0.00 ","$145.03 ","$0.00 ","$0.00 ","$118.28 ","$675.55 ","$0.00 ","$337.78 ","$535.04 ","$540.44 ","$0.00 ","$102.64 ","$0.00 ","$107.55 ","$0.00 "
"449.928","SUP","HCPCS C1713","","449.928  -  PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT","BOTH IP/OP","$750.65 ","$555.48 ","$0.00 ","$728.78 ","$327.95 ","$0.00 ","$156.45 ","$0.00 ","$0.00 ","$127.60 ","$728.78 ","$0.00 ","$364.39 ","$577.19 ","$583.02 ","$0.00 ","$141.20 ","$0.00 ","$116.02 ","$0.00 "
"449.931","SUP","HCPCS C1713","","449.931  -  PLATE BN 24X5.5X1.25MM NS LC DCP 4 HL LOPRFL PRECONTOUR TI","BOTH IP/OP","$444.20 ","$328.71 ","$0.00 ","$431.25 ","$194.06 ","$0.00 ","$92.58 ","$0.00 ","$0.00 ","$75.51 ","$431.25 ","$0.00 ","$215.63 ","$341.55 ","$345.00 ","$0.00 ","$65.53 ","$0.00 ","$68.66 ","$0.00 "
"449.936","SUP","HCPCS C1713","","449.936  -  PLATE BN 36X5.5X1.25MM NS LC DCP 6 HL LOPRFL PRECONTOUR TI","BOTH IP/OP","$522.93 ","$386.97 ","$0.00 ","$507.68 ","$228.45 ","$0.00 ","$108.99 ","$0.00 ","$0.00 ","$88.89 ","$507.68 ","$0.00 ","$253.84 ","$402.08 ","$406.14 ","$0.00 ","$77.14 ","$0.00 ","$80.82 ","$0.00 "
"449.938","SUP","HCPCS C1713","","449.938  -  PLATE BN 48X5.5X1.25MM NS LC DCP 8 HL LOPRFL PRECONTOUR TI","BOTH IP/OP","$594.60 ","$440.00 ","$0.00 ","$577.30 ","$259.79 ","$0.00 ","$123.93 ","$0.00 ","$0.00 ","$101.08 ","$577.30 ","$0.00 ","$288.65 ","$457.22 ","$461.84 ","$0.00 ","$87.71 ","$0.00 ","$91.91 ","$0.00 "
"450.101","SUP","HCPCS C1713","","450.101  -  PLATE BONE 90MM CRANFCL TI 20 HOLE ADP MALBLE 1.5MM SCR","BOTH IP/OP","$819.00 ","$606.06 ","$0.00 ","$819.00 ","$368.55 ","$0.00 ","$170.70 ","$0.00 ","$0.00 ","$143.40 ","$819.00 ","$0.00 ","$409.50 ","$648.65 ","$655.20 ","$0.00 ","$128.17 ","$0.00 ","$130.38 ","$0.00 "
"450.611","SUP","HCPCS C1713","","450.611  -  PLATE BONE CRANFCL TI 5 HOLE Y MALBLE 1.5 MM SCR NONSTRL","BOTH IP/OP","$567.00 ","$419.58 ","$0.00 ","$567.00 ","$255.15 ","$0.00 ","$118.18 ","$0.00 ","$0.00 ","$99.28 ","$567.00 ","$0.00 ","$283.50 ","$449.06 ","$453.60 ","$0.00 ","$88.74 ","$0.00 ","$90.27 ","$0.00 "
"450.861","SUP","HCPCS C1713","","450.861  -  SCREW BONE FULTHD 6MM 45MM SELF TAP LOCKING HEXAGONAL RECESS","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.862","SUP","HCPCS C1713","","450.862  -  SCREW BONE 6MM 50MM LOCKING HEXAGONAL RECESS AQUA TITANIUM","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.863","SUP","HCPCS C1713","","450.863  -  SCREW BONE 6MM 55MM LOCKING HEXAGONAL RECESS AQUA TITANIUM","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.864","SUP","HCPCS C1713","","450.864  -  SCREW BONE 6MM 60MM LOCKING HEXAGONAL RECESS AQUA TITANIUM","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.865","SUP","HCPCS C1713","","450.865  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 65MM 2 LEAD","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.866","SUP","HCPCS C1713","","450.866  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 70MM 2 LEAD","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.867","SUP","HCPCS C1713","","450.867  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 75MM 2 LEAD","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.868","SUP","HCPCS C1713","","450.868  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 80MM 2 LEAD","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.869","SUP","HCPCS C1713","","450.869  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 85MM 2 LEAD","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.87","SUP","HCPCS C1713","","450.870  -  SCREW BONE 6MM 90MM LOCKING HEXAGONAL RECESS AQUA TITANIUM","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.871","SUP","HCPCS C1713","","450.871  -  SCREW BONE 6MM 95MM LOCKING HEXAGONAL RECESS AQUA TITANIUM","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.872","SUP","HCPCS C1713","","450.872  -  SCREW BONE 6MM 100MM LOCKING HEXAGONAL RECESS AQUA TITANIUM","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.873","SUP","HCPCS C1713","","450.873  -  SCREW BONE 3.5MM FULTHD 6MM 8MM 30MM 2 LEAD THREAD LOCKING","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.874","SUP","HCPCS C1713","","450.874  -  SCREW BONE FULTHD 6MM 4.8MM 35MM 2 LEAD THREAD LOCKING","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"450.875","SUP","HCPCS C1713","","450.875  -  SCREW BONE FULTHD 6MM 4.8MM 40MM 2 LEAD THREAD LOCKING","BOTH IP/OP","$361.65 ","$267.62 ","$0.00 ","$361.65 ","$162.74 ","$0.00 ","$75.38 ","$0.00 ","$0.00 ","$63.32 ","$361.65 ","$0.00 ","$180.83 ","$286.43 ","$289.32 ","$0.00 ","$57.02 ","$0.00 ","$57.57 ","$0.00 "
"451.101","SUP","HCPCS C1713","","451.101  -  PLATE BONE 100MM CRANFCL TI 20 HOLE ADP MALBLE 1.5MM SCR","BOTH IP/OP","$1,017.00 ","$752.58 ","$0.00 ","$1,017.00 ","$457.65 ","$0.00 ","$211.97 ","$0.00 ","$0.00 ","$178.07 ","$1,017.00 ","$0.00 ","$508.50 ","$805.46 ","$813.60 ","$0.00 ","$159.16 ","$0.00 ","$161.91 ","$0.00 "
"451.611","SUP","HCPCS C1713","","451.611  -  PLATE BONE CRANFCL TI 5 HOLE Y MALBLE 2 MM SCR NONSTRL","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"457.07","SUP","HCPCS C1713","","457.070  -  SCREW BONE 5MM 70MM TI FEM SLFTAP SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.075","SUP","HCPCS C1713","","457.075  -  SCREW BONE 5MM 75MM TI CANC SHFT NONSTRL GOLD IM NAIL","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.08","SUP","HCPCS C1713","","457.080  -  SCREW BONE 5MM 80MM TI FEM SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.085","SUP","HCPCS C1713","","457.085  -  SCREW BONE 5MM 85MM TI FEM SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.09","SUP","HCPCS C1713","","457.090  -  SCREW BONE 5MM 90MM TI FEM SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.095","SUP","HCPCS C1713","","457.095  -  SCREW BONE 5MM 95MM TI FEM SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.1","SUP","HCPCS C1713","","457.100  -  SCREW BONE 5MM 100MM 16MM TI FEM SLFTAP SHFT FRN CUT FLUT","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.105","SUP","HCPCS C1713","","457.105  -  SCREW BONE 5MM 105MM TI FEM SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.11","SUP","HCPCS C1713","","457.110  -  SCREW BONE 5MM 110MM TI FEM SLFTAP SHFT FRN CUT FLUT STRL","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.115","SUP","HCPCS C1713","","457.115  -  SCREW BONE 5MM 115MM TI FEM SHFT NONSTRL GOLD","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.12","SUP","HCPCS C1713","","457.120  -  SCREW BONE GOLD 120MM 5MM FEM TI SLFTAP SHFT FRN CUT FLUT","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"457.125","SUP","HCPCS C1713","","457.125  -  SCREW BONE 5MM 125MM TI FEM SLFTAP SHFT FRN CUT FLUT STRL","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$233.25 ","$0.00 ","$108.03 ","$0.00 ","$0.00 ","$90.75 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$81.12 ","$0.00 ","$82.52 ","$0.00 "
"458.818","SUP","HCPCS C1713","","458.818  -  SCREW BONE 4MM 3.3MM 18MM SELF CUTTING TROCAR TIP LOCKING","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.82","SUP","HCPCS C1713","","458.820  -  SCREW BONE TROCAR 4MM 8MM 20MM 2 LEAD THREAD LOCKING SLFTAP","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.822","SUP","HCPCS C1713","","458.822  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 22MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.824","SUP","HCPCS C1713","","458.824  -  SCREW BONE 4MM 3.3MM 24MM SELF CUTTING TROCAR TIP LOCKING","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.826","SUP","HCPCS C1713","","458.826  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 26MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.828","SUP","HCPCS C1713","","458.828  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 28MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.83","SUP","HCPCS C1713","","458.830  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 30MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.832","SUP","HCPCS C1713","","458.832  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 32MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.834","SUP","HCPCS C1713","","458.834  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 34MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.836","SUP","HCPCS C1713","","458.836  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 36MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.838","SUP","HCPCS C1713","","458.838  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 38MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.84","SUP","HCPCS C1713","","458.840  -  SCREW BONE HEXAGON TROCAR 4MM 3.3MM 40MM SELF CUT LOCK","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.842","SUP","HCPCS C1713","","458.842  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 42MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.844","SUP","HCPCS C1713","","458.844  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 44MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.846","SUP","HCPCS C1713","","458.846  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 46MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.848","SUP","HCPCS C1713","","458.848  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 48MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.85","SUP","HCPCS C1713","","458.850  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 50MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.852","SUP","HCPCS C1713","","458.852  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 52MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.854","SUP","HCPCS C1713","","458.854  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 54MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.856","SUP","HCPCS C1713","","458.856  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 56MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.858","SUP","HCPCS C1713","","458.858  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 58MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.86","SUP","HCPCS C1713","","458.860  -  SCREW BONE TROCAR 4MM 8MM 60MM 2 LEAD THREAD LOCKING SLFTAP","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.862","SUP","HCPCS C1713","","458.862  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 62MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.864","SUP","HCPCS C1713","","458.864  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 64MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.866","SUP","HCPCS C1713","","458.866  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 66MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.868","SUP","HCPCS C1713","","458.868  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 68MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.87","SUP","HCPCS C1713","","458.870  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 70MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.872","SUP","HCPCS C1713","","458.872  -  SCREW BONE TROCAR FULTHD 4MM 8MM 72MM 2 LEAD THREAD LOCKING","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.874","SUP","HCPCS C1713","","458.874  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 74MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.876","SUP","HCPCS C1713","","458.876  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 76MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.878","SUP","HCPCS C1713","","458.878  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 78MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.88","SUP","HCPCS C1713","","458.880  -  SCREW BONE TROCAR 4MM 8MM 80MM 2 LEAD THREAD SLFTAP","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.926","SUP","HCPCS C1713","","458.926  -  SCREW BONE 5MM 26MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.928","SUP","HCPCS C1713","","458.928  -  SCREW BONE NONSTRL IM NAIL 5MM 28MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.93","SUP","HCPCS C1713","","458.930  -  SCREW BONE NONSTRL 5MM 30MM NLEX TI DISTAL FEM/TIB LCK HEX","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.932","SUP","HCPCS C1713","","458.932  -  SCREW BONE NONSTRL IM NAIL 5MM 32MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.934","SUP","HCPCS C1713","","458.934  -  SCREW BONE NONSTRL IM NAIL 5MM 34MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.936","SUP","HCPCS C1713","","458.936  -  SCREW BONE NONSTRL IM NAIL 5MM 36MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.938","SUP","HCPCS C1713","","458.938  -  SCREW BONE 5MM 38MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.94","SUP","HCPCS C1713","","458.940  -  SCREW BONE 5MM 40MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.942","SUP","HCPCS C1713","","458.942  -  SCREW BONE 5MM 42MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.944","SUP","HCPCS C1713","","458.944  -  SCREW BONE 5MM 44MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.946","SUP","HCPCS C1713","","458.946  -  SCREW BONE 5MM 46MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.948","SUP","HCPCS C1713","","458.948  -  SCREW BONE 5MM 48MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.95","SUP","HCPCS C1713","","458.950  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 5MM 8MM 50MM 2 LEAD","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"458.952","SUP","HCPCS C1713","","458.952  -  SCREW BONE 5MM 52MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$395.83 ","$178.12 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$69.31 ","$395.83 ","$0.00 ","$197.91 ","$243.66 ","$316.66 ","$0.00 ","$48.15 ","$0.00 ","$63.02 ","$0.00 "
"458.954","SUP","HCPCS C1713","","458.954  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 54MM NLEX TI DISTAL","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.956","SUP","HCPCS C1713","","458.956  -  SCREW BONE NONSTRL IM NAIL 5MM 56MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.958","SUP","HCPCS C1713","","458.958  -  SCREW BONE NONSTRL IM NAIL 5MM 58MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.96","SUP","HCPCS C1713","","458.960  -  SCREW BONE NONSTRL IM NAIL 5MM 60MM NLEX TI DISTAL FEM/TIB","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.964","SUP","HCPCS C1713","","458.964  -  SCREW BONE 5MM 64MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"458.968","SUP","HCPCS C1713","","458.968  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 68MM NLEX TI DISTAL","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.972","SUP","HCPCS C1713","","458.972  -  SCREW BONE 5MM 72MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.976","SUP","HCPCS C1713","","458.976  -  SCREW BONE 5MM 76MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.98","SUP","HCPCS C1713","","458.980  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 80MM NLEX TI DISTAL","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.985","SUP","HCPCS C1713","","458.985  -  SCREW BONE 5MM 85MM TI ALLOY LCK SLFTAP NONSTRL","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.99","SUP","HCPCS C1713","","458.990  -  SCREW BONE 5MM 90MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.995","SUP","HCPCS C1713","","458.995  -  SCREW BONE 5MM 95MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"458.999","SUP","HCPCS C1713","","458.999  -  SCREW BONE 5MM 100MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"459.68","SUP","HCPCS C1713","","459.68  -  BOLT LOCKING HEXAGON 4.9MM 8MM 68MM SELF TAP SELF CUT TROCAR","BOTH IP/OP","$328.90 ","$243.39 ","$0.00 ","$328.90 ","$148.01 ","$0.00 ","$68.55 ","$0.00 ","$0.00 ","$57.59 ","$328.90 ","$0.00 ","$164.45 ","$260.49 ","$263.12 ","$0.00 ","$51.86 ","$0.00 ","$52.36 ","$0.00 "
"460","SUP","Custom 27203010","","460  -  DRESSING GZE 12X12IN LF QUIKCLOT TRAUMAPAD 3 PLY NWVN FLXB","BOTH IP/OP","$145.58 ","$107.73 ","$0.00 ","$145.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.58 ","$0.00 ","$72.79 ","$115.30 ","$116.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.022","SUP","HCPCS C1713","","460.022  -  PIN FIX EMERGENCY RELEASE TITANIUM STERNUM NONSTRL","BOTH IP/OP","$226.25 ","$167.43 ","$0.00 ","$226.25 ","$101.81 ","$0.00 ","$47.16 ","$0.00 ","$0.00 ","$39.61 ","$226.25 ","$0.00 ","$113.13 ","$179.19 ","$181.00 ","$0.00 ","$35.41 ","$0.00 ","$36.02 ","$0.00 "
"460.023","SUP","HCPCS C1713","","460.023  -  PLATE BONE STR 20 HOLE LOCKING TITANIUM STERNUM NONSTRL 2.4","BOTH IP/OP","$5,407.50 ","$4,001.55 ","$0.00 ","$5,407.50 ","$2,433.38 ","$0.00 ","$1,127.06 ","$0.00 ","$0.00 ","$946.81 ","$5,407.50 ","$0.00 ","$2,703.75 ","$4,282.74 ","$4,326.00 ","$0.00 ","$846.27 ","$0.00 ","$860.87 ","$0.00 "
"460.027","SUP","HCPCS C1713","","460.027  -  PLATE BONE H SMALL 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM","BOTH IP/OP","$2,380.00 ","$1,761.20 ","$0.00 ","$2,380.00 ","$1,071.00 ","$0.00 ","$496.05 ","$0.00 ","$0.00 ","$416.72 ","$2,380.00 ","$0.00 ","$1,190.00 ","$1,884.96 ","$1,904.00 ","$0.00 ","$372.47 ","$0.00 ","$378.90 ","$0.00 "
"460.028","SUP","HCPCS C1713","","460.028  -  PLATE BONE H LARGE 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM","BOTH IP/OP","$2,380.00 ","$1,761.20 ","$0.00 ","$2,380.00 ","$1,071.00 ","$0.00 ","$496.05 ","$0.00 ","$0.00 ","$416.72 ","$2,380.00 ","$0.00 ","$1,190.00 ","$1,884.96 ","$1,904.00 ","$0.00 ","$372.47 ","$0.00 ","$378.90 ","$0.00 "
"460.035","SUP","HCPCS C1713","","460.035  -  PLATE BONE STAR 6 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$1,017.00 ","$0.00 ","$471.04 ","$0.00 ","$0.00 ","$395.71 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$353.69 ","$0.00 ","$359.79 ","$0.00 "
"460.036","SUP","HCPCS C1713","","460.036  -  PLATE BONE STAR 12 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,827.50 ","$2,092.35 ","$0.00 ","$2,827.50 ","$1,272.38 ","$0.00 ","$589.32 ","$0.00 ","$0.00 ","$495.07 ","$2,827.50 ","$0.00 ","$1,413.75 ","$2,239.38 ","$2,262.00 ","$0.00 ","$442.50 ","$0.00 ","$450.14 ","$0.00 "
"460.037","SUP","HCPCS C1713","","460.037  -  PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,492.50 ","$1,844.45 ","$0.00 ","$2,492.50 ","$1,121.63 ","$0.00 ","$519.50 ","$0.00 ","$0.00 ","$436.42 ","$2,492.50 ","$0.00 ","$1,246.25 ","$1,974.06 ","$1,994.00 ","$0.00 ","$390.08 ","$0.00 ","$396.81 ","$0.00 "
"460.038","SUP","HCPCS C1713","","460.038  -  PLATE BONE 2T 14 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,825.00 ","$2,090.50 ","$0.00 ","$2,825.00 ","$1,271.25 ","$0.00 ","$588.80 ","$0.00 ","$0.00 ","$494.63 ","$2,825.00 ","$0.00 ","$1,412.50 ","$2,237.40 ","$2,260.00 ","$0.00 ","$442.11 ","$0.00 ","$449.74 ","$0.00 "
"460.039","SUP","HCPCS C1713","","460.039  -  PLATE BONE ANGLED 12 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$3,817.50 ","$2,824.95 ","$0.00 ","$3,817.50 ","$1,717.88 ","$0.00 ","$795.66 ","$0.00 ","$0.00 ","$668.41 ","$3,817.50 ","$0.00 ","$1,908.75 ","$3,023.46 ","$3,054.00 ","$0.00 ","$597.44 ","$0.00 ","$607.75 ","$0.00 "
"460.04","SUP","HCPCS C1713","","460.040  -  PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,492.50 ","$1,844.45 ","$0.00 ","$2,492.50 ","$1,121.63 ","$0.00 ","$519.50 ","$0.00 ","$0.00 ","$436.42 ","$2,492.50 ","$0.00 ","$1,246.25 ","$1,974.06 ","$1,994.00 ","$0.00 ","$390.08 ","$0.00 ","$396.81 ","$0.00 "
"460.045","SUP","HCPCS C1713","","460.045  -  PLATE BONE STR 8 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$1,224.00 ","$0.00 ","$566.92 ","$0.00 ","$0.00 ","$476.25 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$425.68 ","$0.00 ","$433.02 ","$0.00 "
"460.046","SUP","HCPCS C1713","","460.046  -  PLATE BONE STR 13 HOLE LOCKING TITANIUM STERNUM NONSTRL","BOTH IP/OP","$2,825.00 ","$2,090.50 ","$0.00 ","$2,825.00 ","$1,271.25 ","$0.00 ","$588.80 ","$0.00 ","$0.00 ","$494.63 ","$2,825.00 ","$0.00 ","$1,412.50 ","$2,237.40 ","$2,260.00 ","$0.00 ","$442.11 ","$0.00 ","$449.74 ","$0.00 "
"461","SUP","Custom 27203010","","461  -  DRESSING GAUZE 4YDX3IN ROLL HEMOSTATIC QUIKCLOT","BOTH IP/OP","$99.72 ","$73.79 ","$0.00 ","$101.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.22 ","$0.00 ","$50.61 ","$1.35 ","$80.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.64","SUP","HCPCS C1713","","462.640  -  BLADE IM NAIL GOLD 40MM HUM TI SPRL SLD NONSTRL","BOTH IP/OP","$1,253.08 ","$927.28 ","$0.00 ","$1,253.08 ","$563.88 ","$0.00 ","$261.17 ","$0.00 ","$0.00 ","$219.40 ","$1,253.08 ","$0.00 ","$626.54 ","$992.44 ","$1,002.46 ","$0.00 ","$196.11 ","$0.00 ","$199.49 ","$0.00 "
"462.644","SUP","HCPCS C1713","","462.644  -  BLADE IM FIX GOLD 44CM HUM TI SPRL NONSTRL","BOTH IP/OP","$1,253.08 ","$927.28 ","$0.00 ","$1,253.08 ","$563.88 ","$0.00 ","$261.17 ","$0.00 ","$0.00 ","$219.40 ","$1,253.08 ","$0.00 ","$626.54 ","$992.44 ","$1,002.46 ","$0.00 ","$196.11 ","$0.00 ","$199.49 ","$0.00 "
"476","SUP","Custom 27803010","","00476  -  TUBE NG 45IN 10FR SDPRT WT STY FLXFL PU PED STRL","BOTH IP/OP","$22.88 ","$16.93 ","$0.00 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.88 ","$0.00 ","$11.44 ","$18.12 ","$18.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"482.823","SUP","HCPCS C1713","","482.823  -  PLATE BONE 17X10X.7MM 7 HOLE BUTTON OVAL TITANIUM ORTHOPEDIC","BOTH IP/OP","$721.13 ","$533.64 ","$0.00 ","$700.13 ","$315.06 ","$0.00 ","$150.30 ","$0.00 ","$0.00 ","$122.59 ","$700.13 ","$0.00 ","$350.06 ","$554.50 ","$560.10 ","$0.00 ","$106.38 ","$0.00 ","$111.46 ","$0.00 "
"487.931","SUP","Custom 27803010","","487.931  -  DISTRACTOR SURG MULTI VECTOR BODY TITANIUM MANDIB NONSTRL","BOTH IP/OP","$12,302.50 ","$9,103.85 ","$0.00 ","$12,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,302.50 ","$0.00 ","$6,151.25 ","$9,743.58 ","$9,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.933","SUP","Custom 27803010","","487.933  -  DISTRACTOR SURG 15MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.934","SUP","Custom 27803010","","487.934  -  DISTRACTOR SURG 25MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.935","SUP","Custom 27803010","","487.935  -  DISTRACTOR SURG 35MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.937","SUP","Custom 27803010","","487.937  -  DISTRACTOR SURG NUT LINEAR ACTIVATION TITANIUM MANDIB","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.938","SUP","Custom 27803010","","487.938  -  DISTRACTOR SURG MULTI VECTOR PIN HOLDING CLMP TITANIUM","BOTH IP/OP","$2,622.50 ","$1,940.65 ","$0.00 ","$2,622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,622.50 ","$0.00 ","$1,311.25 ","$2,077.02 ","$2,098.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.939","SUP","Custom 27803010","","487.939  -  DISTRACTOR SURG MULTI VECTOR PIN HOLDING BODY TITANIUM","BOTH IP/OP","$2,622.50 ","$1,940.65 ","$0.00 ","$2,622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,622.50 ","$0.00 ","$1,311.25 ","$2,077.02 ","$2,098.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.94","SUP","Custom 27203010","","487.940  -  CLAMP EXFIX UNIVERSAL PIN HOLDING TITANIUM MULTI VECTOR","BOTH IP/OP","$2,622.50 ","$1,940.65 ","$0.00 ","$2,622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,622.50 ","$0.00 ","$1,311.25 ","$2,077.02 ","$2,098.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.941","SUP","Custom 27203010","","487.941  -  CLAMP EXFIX BODY PIN HOLDING MULTIVECTOR DISTRCT BLUE","BOTH IP/OP","$2,622.50 ","$1,940.65 ","$0.00 ","$2,622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,622.50 ","$0.00 ","$1,311.25 ","$2,077.02 ","$2,098.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.942","SUP","Custom 27203010","","487.942  -  CLAMP EXFIX RAMUS PIN HOLDING MULTIVECTOR DISTRCT GOLD","BOTH IP/OP","$2,622.50 ","$1,940.65 ","$0.00 ","$2,622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,622.50 ","$0.00 ","$1,311.25 ","$2,077.02 ","$2,098.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.96","SUP","HCPCS C1713","","487.960  -  PLATE 1.6MM MAXL ASMBLY BONE TI","BOTH IP/OP","$1,838.25 ","$1,360.31 ","$0.00 ","$1,838.25 ","$827.21 ","$0.00 ","$383.14 ","$0.00 ","$0.00 ","$321.86 ","$1,838.25 ","$0.00 ","$919.13 ","$1,455.89 ","$1,470.60 ","$0.00 ","$287.69 ","$0.00 ","$292.65 ","$0.00 "
"487.962","SUP","Custom 27803010","","487.962  -  FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB","BOTH IP/OP","$16,635.00 ","$12,309.90 ","$0.00 ","$16,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,635.00 ","$0.00 ","$8,317.50 ","$13,174.92 ","$13,308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.963","SUP","Custom 27803010","","487.963  -  FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB","BOTH IP/OP","$16,635.00 ","$12,309.90 ","$0.00 ","$16,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,635.00 ","$0.00 ","$8,317.50 ","$13,174.92 ","$13,308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.964","SUP","Custom 27803010","","487.964  -  FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB","BOTH IP/OP","$16,635.00 ","$12,309.90 ","$0.00 ","$16,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,635.00 ","$0.00 ","$8,317.50 ","$13,174.92 ","$13,308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.965","SUP","Custom 27803010","","487.965  -  FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB","BOTH IP/OP","$16,635.00 ","$12,309.90 ","$0.00 ","$16,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,635.00 ","$0.00 ","$8,317.50 ","$13,174.92 ","$13,308.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.966","SUP","Custom 27803010","","487.966  -  DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM RIGHT MANDIB","BOTH IP/OP","$19,727.50 ","$14,598.35 ","$0.00 ","$19,727.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,727.50 ","$0.00 ","$9,863.75 ","$15,624.18 ","$15,782.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.967","SUP","Custom 27803010","","487.967  -  DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM MANDIB LEFT","BOTH IP/OP","$19,727.50 ","$14,598.35 ","$0.00 ","$19,727.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,727.50 ","$0.00 ","$9,863.75 ","$15,624.18 ","$15,782.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.971","SUP","Custom 27803010","","487.971  -  DISTRACTOR SURG 45MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.973","SUP","Custom 27803010","","487.973  -  DISTRACTOR SURG 55MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.974","SUP","Custom 27803010","","487.974  -  DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB RIGHT NONSTRL","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.975","SUP","Custom 27803010","","487.975  -  DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB LEFT NONSTRL","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.976","SUP","Custom 27803010","","487.976  -  DISTRACTOR SURG 65MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.977","SUP","Custom 27803010","","487.977  -  DISTRACTOR SURG 75MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.978","SUP","Custom 27803010","","487.978  -  DISTRACTOR SURG 85MM MULTI VECTOR ARM TITANIUM MANDIB","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.98","SUP","Custom 27803010","","487.980  -  DISTRACTOR SURG 7MM NUT HEXAGONAL TITANIUM MIDFAC NONSTRL","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.982","SUP","Custom 27803010","","487.982  -  DISTRACTOR SURG 40MM ASMBLY TITANIUM MIDFAC NONSTRL","BOTH IP/OP","$13,747.50 ","$10,173.15 ","$0.00 ","$13,747.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,747.50 ","$0.00 ","$6,873.75 ","$10,888.02 ","$10,998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.984","SUP","Custom 27803010","","487.984  -  FOOTPLATE BONE ELEVATE TITANIUM RIGHT ANTERIOR MIDFAC","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.985","SUP","Custom 27803010","","487.985  -  FOOTPLATE BONE ELEVATE TITANIUM LEFT ANTERIOR MIDFAC NONSTRL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.986","SUP","Custom 27803010","","487.986  -  FOOTPLATE BONE LP SYMMETRICAL TITANIUM ANTERIOR MIDFAC","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.987","SUP","Custom 27803010","","487.987  -  FOOTPLATE BONE ELEVATED SYMMETRICAL TITANIUM ANTERIOR MIDFAC","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.988","SUP","Custom 27803010","","487.988  -  FOOTPLATE BONE MESH TITANIUM ANTERIOR MIDFAC NONSTRL MIDFAC","BOTH IP/OP","$1,542.50 ","$1,141.45 ","$0.00 ","$1,542.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,542.50 ","$0.00 ","$771.25 ","$1,221.66 ","$1,234.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.989","SUP","Custom 27803010","","487.989  -  FOOTPLATE BONE BUTTRESS TITANIUM ANTERIOR MIDFAC NONSTRL","BOTH IP/OP","$1,542.50 ","$1,141.45 ","$0.00 ","$1,542.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,542.50 ","$0.00 ","$771.25 ","$1,221.66 ","$1,234.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.99","SUP","Custom 27803010","","487.990  -  FOOTPLATE BONE 1 VECTOR TITANIUM MIDFAC POSTERIOR NONSTRL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.992","SUP","Custom 27803010","","487.992  -  DISTRACTOR SURG 20MM RIGID EXTN TITANIUM MIDFAC NONSTRL","BOTH IP/OP","$1,252.50 ","$926.85 ","$0.00 ","$1,252.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,252.50 ","$0.00 ","$626.25 ","$991.98 ","$1,002.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.993","SUP","Custom 27803010","","487.993  -  DISTRACTOR SURG 20MM UNIVERSAL JOINT EXTN TITANIUM","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.994","SUP","Custom 27803010","","487.994  -  DISTRACTOR SURG 40MM FLEXIBLE CABLE EXTN TITANIUM MIDFAC","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"487.995","SUP","HCPCS C1713","","487.995  -  SCREW EXTERNAL DISTRCT EXTERNAL MIDFAC DISTRCT SYSTEM","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$164.25 ","$0.00 ","$76.08 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$0.00 ","$182.50 ","$289.08 ","$292.00 ","$0.00 ","$57.12 ","$0.00 ","$58.11 ","$0.00 "
"488.066","SUP","HCPCS C1713","","488.066  -  SCREW BONE 1.6MM MACHINE TITANIUM CRANIAL NONSTRL","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"488.074","SUP","Custom 27803010","","488.074  -  DISTRACTOR SURG 8MM STR PLATE TITANIUM ALVEOLAR NONSTRL","BOTH IP/OP","$2,595.00 ","$1,920.30 ","$0.00 ","$2,595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,595.00 ","$0.00 ","$1,297.50 ","$2,055.24 ","$2,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"488.075","SUP","Custom 27803010","","488.075  -  BODY DISTRCT 12MM STR PLATE TITANIUM ALVEOLAR NONSTRL","BOTH IP/OP","$2,595.00 ","$1,920.30 ","$0.00 ","$2,595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,595.00 ","$0.00 ","$1,297.50 ","$2,055.24 ","$2,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"488.076","SUP","Custom 27803010","","488.076  -  BODY DISTRCT 16MM STR PLATE TITANIUM ALVEOLAR NONSTRL","BOTH IP/OP","$2,595.00 ","$1,920.30 ","$0.00 ","$2,595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,595.00 ","$0.00 ","$1,297.50 ","$2,055.24 ","$2,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"488.75","SUP","HCPCS C1713","","488.750  -  SCREW BONE 4.35MM 25MM TI CANC CERV SPN BTRS LCK XPD HEAD","BOTH IP/OP","$547.75 ","$405.34 ","$0.00 ","$547.75 ","$246.49 ","$0.00 ","$114.16 ","$0.00 ","$0.00 ","$95.91 ","$547.75 ","$0.00 ","$273.88 ","$433.82 ","$438.20 ","$0.00 ","$85.72 ","$0.00 ","$87.20 ","$0.00 "
"488.915","SUP","HCPCS C1713","","488.915  -  PLATE 30MM TI 2 HOLE LCK BTRS BONE SPNL NONSTRL","BOTH IP/OP","$1,232.00 ","$911.68 ","$0.00 ","$1,232.00 ","$554.40 ","$0.00 ","$256.78 ","$0.00 ","$0.00 ","$215.71 ","$1,232.00 ","$0.00 ","$616.00 ","$975.74 ","$985.60 ","$0.00 ","$192.81 ","$0.00 ","$196.13 ","$0.00 "
"492.08","SUP","Custom 27203010","","492.08  -  WIRE FX .8MM 70MM NS KRSH TROC PNT TI","BOTH IP/OP","$19.12 ","$14.15 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.1","SUP","Custom 27203010","","492.10  -  WIRE FX 1MM 150MM NS KRSH TROC PNT TI","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.12","SUP","Custom 27203010","","492.12  -  WIRE FX 1.25MM 150MM NS KRSH TROC PNT TI","BOTH IP/OP","$19.12 ","$14.15 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.16","SUP","Custom 27203010","","492.16  -  WIRE FX 1.6MM 150MM NS KRSH TROC PNT TI","BOTH IP/OP","$19.12 ","$14.15 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.18","SUP","Custom 27203010","","492.18  -  WIRE FX 1.6MM 285MM NS KRSH TROC PNT TI","BOTH IP/OP","$23.05 ","$17.06 ","$0.00 ","$22.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.38 ","$0.00 ","$11.19 ","$17.72 ","$17.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.2","SUP","Custom 27203010","","492.20  -  WIRE FX 2MM 150MM NS KRSH TROC PNT TI","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.21","SUP","Custom 27203010","","492.21  -  WIRE FX 2MM 285MM NS KRSH TROC PNT TI","BOTH IP/OP","$23.05 ","$17.06 ","$0.00 ","$22.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.38 ","$0.00 ","$11.19 ","$17.72 ","$17.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.25","SUP","Custom 27203010","","492.25  -  WIRE FX 2.5MM 150MM NS KRSH TROC PNT TI","BOTH IP/OP","$19.12 ","$14.15 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.26","SUP","Custom 27203010","","492.26  -  WIRE FX 2.5MM 285MM NS KRSH TROC PNT TI","BOTH IP/OP","$23.05 ","$17.06 ","$0.00 ","$22.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.38 ","$0.00 ","$11.19 ","$17.72 ","$17.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.3","SUP","Custom 27203010","","492.30  -  WIRE FX 3MM 150MM NS KRSH TROC PNT TI","BOTH IP/OP","$18.56 ","$13.73 ","$0.00 ","$18.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.56 ","$0.00 ","$9.28 ","$14.70 ","$14.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"492.31","SUP","Custom 27203010","","492.31  -  WIRE FX 3MM 285MM NS KRSH TROC PNT TI","BOTH IP/OP","$23.05 ","$17.06 ","$0.00 ","$22.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.38 ","$0.00 ","$11.19 ","$17.72 ","$17.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"494.769","SUP","HCPCS C1713","","494.769  -  SCREW BONE 4/2.5MM 80MM 20MM SLFDRILL REINFORCED BONE ANCHOR","BOTH IP/OP","$249.53 ","$184.65 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$52.01 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$36.81 ","$0.00 ","$38.57 ","$0.00 "
"494.771","SUP","HCPCS C1713","","494.771  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.772","SUP","HCPCS C1713","","494.772  -  SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ TITANIUM","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.774","SUP","HCPCS C1713","","494.774  -  SCREW BONE 4MM 60MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.775","SUP","HCPCS C1713","","494.775  -  PIN HALF 4MM 80MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.776","SUP","HCPCS C1713","","494.776  -  SCREW FIX 4MM 100MM 30MM SELF DRILL REINFORCE SYMMETRICAL","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.777","SUP","HCPCS C1713","","494.777  -  SCREW BONE 4MM 125MM 40MM SLFDRILL SCHANZ TITANIUM","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.778","SUP","HCPCS C1713","","494.778  -  SCREW BONE 4MM 150MM 40MM SLFDRILL SCHANZ TITANIUM","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.779","SUP","HCPCS C1713","","494.779  -  PIN HALF 4MM 175MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$278.48 ","$206.08 ","$0.00 ","$270.38 ","$121.67 ","$0.00 ","$58.04 ","$0.00 ","$0.00 ","$47.34 ","$270.38 ","$0.00 ","$135.19 ","$214.14 ","$216.30 ","$0.00 ","$41.08 ","$0.00 ","$43.04 ","$0.00 "
"494.782","SUP","HCPCS C1713","","494.782  -  PIN HALF 5MM 100MM 30MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$320.83 ","$237.41 ","$0.00 ","$311.48 ","$140.16 ","$0.00 ","$66.87 ","$0.00 ","$0.00 ","$54.54 ","$311.48 ","$0.00 ","$155.74 ","$246.69 ","$249.18 ","$0.00 ","$47.33 ","$0.00 ","$49.59 ","$0.00 "
"494.783","SUP","HCPCS C1713","","494.783  -  PIN HALF 5MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$320.83 ","$237.41 ","$0.00 ","$311.48 ","$140.16 ","$0.00 ","$66.87 ","$0.00 ","$0.00 ","$54.54 ","$311.48 ","$0.00 ","$155.74 ","$246.69 ","$249.18 ","$0.00 ","$47.33 ","$0.00 ","$49.59 ","$0.00 "
"494.784","SUP","HCPCS C1713","","494.784  -  SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL TI HIP CNDYL LG","BOTH IP/OP","$320.83 ","$237.41 ","$0.00 ","$311.48 ","$140.16 ","$0.00 ","$66.87 ","$0.00 ","$0.00 ","$54.54 ","$311.48 ","$0.00 ","$155.74 ","$246.69 ","$249.18 ","$0.00 ","$47.33 ","$0.00 ","$49.59 ","$0.00 "
"494.785","SUP","HCPCS C1713","","494.785  -  SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL","BOTH IP/OP","$320.83 ","$237.41 ","$0.00 ","$311.48 ","$140.16 ","$0.00 ","$66.87 ","$0.00 ","$0.00 ","$54.54 ","$311.48 ","$0.00 ","$155.74 ","$246.69 ","$249.18 ","$0.00 ","$47.33 ","$0.00 ","$49.59 ","$0.00 "
"494.786","SUP","HCPCS C1713","","494.786  -  SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL TI HIP CNDYL LG","BOTH IP/OP","$320.83 ","$237.41 ","$0.00 ","$311.48 ","$140.16 ","$0.00 ","$66.87 ","$0.00 ","$0.00 ","$54.54 ","$311.48 ","$0.00 ","$155.74 ","$246.69 ","$249.18 ","$0.00 ","$47.33 ","$0.00 ","$49.59 ","$0.00 "
"494.788","SUP","HCPCS C1713","","494.788  -  PIN HALF 5MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$320.83 ","$237.41 ","$0.00 ","$311.48 ","$140.16 ","$0.00 ","$66.87 ","$0.00 ","$0.00 ","$54.54 ","$311.48 ","$0.00 ","$155.74 ","$246.69 ","$249.18 ","$0.00 ","$47.33 ","$0.00 ","$49.59 ","$0.00 "
"494.792","SUP","HCPCS C1713","","494.792  -  SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ TITANIUM","BOTH IP/OP","$341.98 ","$253.07 ","$0.00 ","$332.03 ","$149.41 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$58.13 ","$332.03 ","$0.00 ","$166.01 ","$262.97 ","$265.62 ","$0.00 ","$50.45 ","$0.00 ","$52.86 ","$0.00 "
"494.793","SUP","HCPCS C1713","","494.793  -  PIN HALF 6MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$341.98 ","$253.07 ","$0.00 ","$332.03 ","$149.41 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$58.13 ","$332.03 ","$0.00 ","$166.01 ","$262.97 ","$265.62 ","$0.00 ","$50.45 ","$0.00 ","$52.86 ","$0.00 "
"494.794","SUP","HCPCS C1713","","494.794  -  SCREW BONE 6MM 150MM 60MM SLFDRILL SCHANZ TITANIUM","BOTH IP/OP","$341.98 ","$253.07 ","$0.00 ","$332.03 ","$149.41 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$58.13 ","$332.03 ","$0.00 ","$166.01 ","$262.97 ","$265.62 ","$0.00 ","$50.45 ","$0.00 ","$52.86 ","$0.00 "
"494.795","SUP","HCPCS C1713","","494.795  -  PIN HALF 6MM 175MM 60MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$341.98 ","$253.07 ","$0.00 ","$332.03 ","$149.41 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$58.13 ","$332.03 ","$0.00 ","$166.01 ","$262.97 ","$265.62 ","$0.00 ","$50.45 ","$0.00 ","$52.86 ","$0.00 "
"494.796","SUP","HCPCS C1713","","494.796  -  SCREW BONE 6MM 200MM 80MM SLFDRILL SCHANZ TITANIUM","BOTH IP/OP","$341.98 ","$253.07 ","$0.00 ","$332.03 ","$149.41 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$58.13 ","$332.03 ","$0.00 ","$166.01 ","$262.97 ","$265.62 ","$0.00 ","$50.45 ","$0.00 ","$52.86 ","$0.00 "
"494.798","SUP","HCPCS C1713","","494.798  -  PIN HALF 6MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC","BOTH IP/OP","$341.98 ","$253.07 ","$0.00 ","$332.03 ","$149.41 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$58.13 ","$332.03 ","$0.00 ","$166.01 ","$262.97 ","$265.62 ","$0.00 ","$50.45 ","$0.00 ","$52.86 ","$0.00 "
"495.372","SUP","HCPCS C1713","","495.372  -  CAGE SPNL OBLNG 22X17X12MM NS SNMSH TI VERT BD REPL","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"495.394","SUP","HCPCS C1713","","495.394  -  RING SPNL 5D OBLNG 22MM 17MM 22X17MM NS SNMSH PRFT ALAT","BOTH IP/OP","$830.00 ","$614.20 ","$0.00 ","$830.00 ","$373.50 ","$0.00 ","$172.99 ","$0.00 ","$0.00 ","$145.33 ","$830.00 ","$0.00 ","$415.00 ","$657.36 ","$664.00 ","$0.00 ","$129.90 ","$0.00 ","$132.14 ","$0.00 "
"497.674","SUP","HCPCS C1713","","497.674  -  SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"497.676","SUP","HCPCS C1713","","497.676  -  SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"497.678","SUP","HCPCS C1713","","497.678  -  SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"497.78","SUP","HCPCS C1713","","497.78  -  SCREW BN 1.8MM 5MM LCK TI SPNE","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"497.797","SUP","Custom 27803010","","497.797  -  TRNCON ROD 35-41MM 6MM CLICKX PANGEA USS UNV SPNL TI LP","BOTH IP/OP","$2,432.50 ","$1,800.05 ","$0.00 ","$2,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,432.50 ","$0.00 ","$1,216.25 ","$1,926.54 ","$1,946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.104","SUP","HCPCS C1713","","498.104  -  ROD SPNL 100MM 6MM USS TI HRD NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"498.105","SUP","HCPCS C1713","","498.105  -  ROD SPNL 125MM 6MM USS TI HRD NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"498.106","SUP","HCPCS C1713","","498.106  -  ROD SPNL 150MM 6MM USS TI HRD NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"498.108","SUP","HCPCS C1713","","498.108  -  ROD SPNL 200MM 6MM USS TI HRD NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"498.116","SUP","HCPCS C1713","","498.116  -  ROD SPNL 400MM 6MM USS TI HRD NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"498.12","SUP","HCPCS C1713","","498.120  -  BAR SPNL 80MM 3.5MM USS TI CONCTR TRNSVRS NONSTRL","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"498.125","SUP","HCPCS C1713","","498.125  -  CONNECTOR ROD STR 3.5MM 120MM SET UPPER BAR USS TITANIUM SPN","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"498.136","SUP","HCPCS C1713","","498.136  -  ROD SPNL 40MM 3.5MM AXON TI CVD NONSTRL","BOTH IP/OP","$353.50 ","$261.59 ","$0.00 ","$353.50 ","$159.08 ","$0.00 ","$73.68 ","$0.00 ","$0.00 ","$61.90 ","$353.50 ","$0.00 ","$176.75 ","$279.97 ","$282.80 ","$0.00 ","$55.32 ","$0.00 ","$56.28 ","$0.00 "
"498.137","SUP","HCPCS C1713","","498.137  -  ROD SPINAL CURVE 3.5MM 80MM PREBENT AXON TITANIUM NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"498.141","SUP","HCPCS C1713","","498.141  -  ROD SPNL 65MM 6MM USS TI SFT CVD NONSTRL","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$217.35 ","$0.00 ","$100.67 ","$0.00 ","$0.00 ","$84.57 ","$483.00 ","$0.00 ","$241.50 ","$382.54 ","$386.40 ","$0.00 ","$75.59 ","$0.00 ","$76.89 ","$0.00 "
"500","SUP","Custom 27203010","","LYPHOCHEK ANEMIA CONTROL","BOTH IP/OP","$257.50 ","$190.55 ","$0.00 ","$257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$257.50 ","$0.00 ","$128.75 ","$203.94 ","$206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"510.01","SUP","HCPCS C1713","","510.010  -  4.0MM FIXED SCREW SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.012","SUP","HCPCS C1713","","510.012  -  4.0MM FIXED SCREW SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.014","SUP","HCPCS C1713","","510.014  -  4.0MM FIXED SCREW SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.016","SUP","HCPCS C1713","","510.016  -  4.0MM FIXED SCREW SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.03","SUP","HCPCS C1713","","510.030  -  4.0MM FIXED SCREW SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.032","SUP","HCPCS C1713","","510.032  -  4.0MM FIXED SCREW SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.034","SUP","HCPCS C1713","","510.034  -  4.0MM FIXED SCREW SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.036","SUP","HCPCS C1713","","510.036  -  4.0MM FIXED SCREW SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.038","SUP","HCPCS C1713","","510.038  -  4.0MM FIXED SCREW SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.04","SUP","HCPCS C1713","","510.040  -  4.0MM FIXED SCREW SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.512","SUP","HCPCS C1713","","510.512  -  4.5MM FIXED SCREW SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.514","SUP","HCPCS C1713","","510.514  -  4.5MM FIXED SCREW SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.516","SUP","HCPCS C1713","","510.516  -  4.5MM FIXED SCREW SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.53","SUP","HCPCS C1713","","510.530  -  4.5MM FIXED SCREW SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.532","SUP","HCPCS C1713","","510.532  -  4.5MM FIXED SCREW SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.534","SUP","HCPCS C1713","","510.534  -  4.5MM FIXED SCREW SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.536","SUP","HCPCS C1713","","510.536  -  4.5MM FIXED SCREW SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.538","SUP","HCPCS C1713","","510.538  -  4.5MM FIXED SCREW SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.54","SUP","HCPCS C1713","","510.540  -  4.5MM FIXED SCREW SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.61","SUP","HCPCS C1713","","510.610  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.612","SUP","HCPCS C1713","","510.612  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.614","SUP","HCPCS C1713","","510.614  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.616","SUP","HCPCS C1713","","510.616  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.71","SUP","HCPCS C1713","","510.710  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.712","SUP","HCPCS C1713","","510.712  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.714","SUP","HCPCS C1713","","510.714  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.716","SUP","HCPCS C1713","","510.716  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.81","SUP","HCPCS C1713","","510.810  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.812","SUP","HCPCS C1713","","510.812  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.814","SUP","HCPCS C1713","","510.814  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.816","SUP","HCPCS C1713","","510.816  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.818","SUP","HCPCS C1713","","510.818  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.82","SUP","HCPCS C1713","","510.820  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.91","SUP","HCPCS C1713","","510.910  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.912","SUP","HCPCS C1713","","510.912  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 12MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.914","SUP","HCPCS C1713","","510.914  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 14MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.916","SUP","HCPCS C1713","","510.916  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 16MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.918","SUP","HCPCS C1713","","510.918  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 18MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"510.92","SUP","HCPCS C1713","","510.920  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"511.411","SUP","Custom 27203010","","511.411  -  BIT DRILL 2MM 150MM BRAD POINT 3 FLUTED NONSTRL","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.412","SUP","Custom 27203010","","511.412  -  BIT DRILL 2.5MM 150MM BRAD POINT 3 FLUTED NONSTRL","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.413","SUP","Custom 27203010","","511.413  -  BIT DRILL 2.7MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.414","SUP","Custom 27203010","","511.414  -  BIT DRILL 3 FLUTE 3.2MM 122MM QUICK COUPLING BRAD POINT","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.415","SUP","Custom 27203010","","511.415  -  BIT DRILL 3.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.416","SUP","Custom 27203010","","511.416  -  BIT DRILL 3.6MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.417","SUP","Custom 27203010","","511.417  -  BIT DRILL 4MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.418","SUP","Custom 27203010","","511.418  -  BIT DRILL 4.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.431","SUP","Custom 27203010","","511.431  -  BIT DRILL 3.2MM 105MM BRAD POINT 3 FLUTE NONSTRL","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511.432","SUP","Custom 27203010","","511.432  -  BIT DRILL 4MM 105MM BRAD POINT 3 FLUTED NONSTRL","BOTH IP/OP","$501.80 ","$371.33 ","$0.00 ","$487.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.01","SUP","Custom 27203010","","513.01  -  BIT DRILL MINI 1.1MM 28MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.03","SUP","Custom 27203010","","513.03  -  BIT DRILL MINI 1.1MM 45MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.05","SUP","Custom 27203010","","513.05  -  BIT DRILL MINI 3MM 28MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.08","SUP","Custom 27203010","","513.08  -  BIT DRILL MINI 1.5MM 52MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.1","SUP","Custom 27203010","","513.10  -  BIT DRILL MINI 2MM 28MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.13","SUP","Custom 27203010","","513.13  -  BIT DRILL MINI 2MM 52MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.14","SUP","Custom 27203010","","513.14  -  BIT DRILL MINI 2MM 67MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.17","SUP","Custom 27203010","","513.17  -  BIT DRILL MINI 2.7MM 28MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"513.19","SUP","Custom 27203010","","513.19  -  BIT DRILL MINI 2.7MM 67MM QUICK COUPLING NONSTRL","BOTH IP/OP","$124.55 ","$92.17 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.55 ","$0.00 ","$62.28 ","$98.64 ","$99.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.001","SUP","Custom 27803010","","524.001  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.002","SUP","Custom 27803010","","524.002  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.003","SUP","Custom 27803010","","524.003  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.004","SUP","Custom 27803010","","524.004  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.005","SUP","Custom 27803010","","524.005  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.006","SUP","Custom 27803010","","524.006  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.007","SUP","Custom 27803010","","524.007  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.008","SUP","Custom 27803010","","524.008  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, CP, GRADE 4, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.009","SUP","Custom 27803010","","524.009  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, CP, GRADE 2, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.051","SUP","HCPCS C1713","","524.051  -  5.0MM REVERE REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.052","SUP","HCPCS C1713","","524.052  -  5.0MM REVERE REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.053","SUP","HCPCS C1713","","524.053  -  5.0MM REVERE REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.054","SUP","HCPCS C1713","","524.054  -  5.0MM REVERE REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.055","SUP","HCPCS C1713","","524.055  -  5.0MM REVERE REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.056","SUP","HCPCS C1713","","524.056  -  5.0MM REVERE REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.057","SUP","HCPCS C1713","","524.057  -  5.0MM REVERE REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.071","SUP","HCPCS C1713","","524.071  -  7.5MM REVERE REDUCTION SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.072","SUP","HCPCS C1713","","524.072  -  7.5MM REVERE REDUCTION SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.073","SUP","HCPCS C1713","","524.073  -  7.5MM REVERE REDUCTION SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.074","SUP","HCPCS C1713","","524.074  -  7.5MM REVERE REDUCTION SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.075","SUP","HCPCS C1713","","524.075  -  7.5MM REVERE REDUCTION SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.081","SUP","HCPCS C1713","","524.081  -  8.5MM REVERE REDUCTION SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.082","SUP","HCPCS C1713","","524.082  -  8.5MM REVERE REDUCTION SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.083","SUP","HCPCS C1713","","524.083  -  8.5MM REVERE REDUCTION SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.084","SUP","HCPCS C1713","","524.084  -  8.5MM REVERE REDUCTION SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.085","SUP","HCPCS C1713","","524.085  -  8.5MM REVERE REDUCTION SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.2","SUP","HCPCS C1713","","524.200  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 20MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.201","SUP","HCPCS C1713","","524.201  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.202","SUP","HCPCS C1713","","524.202  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.203","SUP","HCPCS C1713","","524.203  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.204","SUP","HCPCS C1713","","524.204  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.241","SUP","HCPCS C1713","","524.241  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.242","SUP","HCPCS C1713","","524.242  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.243","SUP","HCPCS C1713","","524.243  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.244","SUP","HCPCS C1713","","524.244  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.245","SUP","HCPCS C1713","","524.245  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.252","SUP","HCPCS C1713","","524.252  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.253","SUP","HCPCS C1713","","524.253  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.254","SUP","HCPCS C1713","","524.254  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.255","SUP","HCPCS C1713","","524.255  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.256","SUP","HCPCS C1713","","524.256  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.257","SUP","HCPCS C1713","","524.257  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.258","SUP","HCPCS C1713","","524.258  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.259","SUP","HCPCS C1713","","524.259  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.262","SUP","HCPCS C1713","","524.262  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.263","SUP","HCPCS C1713","","524.263  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.264","SUP","HCPCS C1713","","524.264  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.265","SUP","HCPCS C1713","","524.265  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.266","SUP","HCPCS C1713","","524.266  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.267","SUP","HCPCS C1713","","524.267  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.268","SUP","HCPCS C1713","","524.268  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.269","SUP","HCPCS C1713","","524.269  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.272","SUP","HCPCS C1713","","524.272  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.273","SUP","HCPCS C1713","","524.273  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.274","SUP","HCPCS C1713","","524.274  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.275","SUP","HCPCS C1713","","524.275  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.276","SUP","HCPCS C1713","","524.276  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.277","SUP","HCPCS C1713","","524.277  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.278","SUP","HCPCS C1713","","524.278  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.279","SUP","HCPCS C1713","","524.279  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.282","SUP","HCPCS C1713","","524.282  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.283","SUP","HCPCS C1713","","524.283  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.284","SUP","HCPCS C1713","","524.284  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.285","SUP","HCPCS C1713","","524.285  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.286","SUP","HCPCS C1713","","524.286  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.287","SUP","HCPCS C1713","","524.287  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.288","SUP","HCPCS C1713","","524.288  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.289","SUP","HCPCS C1713","","524.289  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.341","SUP","HCPCS C1713","","524.341  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.342","SUP","HCPCS C1713","","524.342  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.343","SUP","HCPCS C1713","","524.343  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.344","SUP","HCPCS C1713","","524.344  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.345","SUP","HCPCS C1713","","524.345  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.346","SUP","HCPCS C1713","","524.346  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.347","SUP","HCPCS C1713","","524.347  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.351","SUP","HCPCS C1713","","524.351  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.352","SUP","HCPCS C1713","","524.352  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.353","SUP","HCPCS C1713","","524.353  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.354","SUP","HCPCS C1713","","524.354  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.355","SUP","HCPCS C1713","","524.355  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.356","SUP","HCPCS C1713","","524.356  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.357","SUP","HCPCS C1713","","524.357  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.361","SUP","HCPCS C1713","","524.361  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.362","SUP","HCPCS C1713","","524.362  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.363","SUP","HCPCS C1713","","524.363  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.364","SUP","HCPCS C1713","","524.364  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.365","SUP","HCPCS C1713","","524.365  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.366","SUP","HCPCS C1713","","524.366  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.367","SUP","HCPCS C1713","","524.367  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.371","SUP","HCPCS C1713","","524.371  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.372","SUP","HCPCS C1713","","524.372  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.373","SUP","HCPCS C1713","","524.373  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.374","SUP","HCPCS C1713","","524.374  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.375","SUP","HCPCS C1713","","524.375  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.376","SUP","HCPCS C1713","","524.376  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.377","SUP","HCPCS C1713","","524.377  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.441","SUP","HCPCS C1713","","524.441  -  4.5MM REVERE REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.442","SUP","HCPCS C1713","","524.442  -  4.5MM REVERE REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.443","SUP","HCPCS C1713","","524.443  -  4.5MM REVERE REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.444","SUP","HCPCS C1713","","524.444  -  4.5MM REVERE REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.445","SUP","HCPCS C1713","","524.445  -  4.5MM REVERE REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.451","SUP","HCPCS C1713","","524.451  -  5.5MM REVERE REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.452","SUP","HCPCS C1713","","524.452  -  5.5MM REVERE REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.453","SUP","HCPCS C1713","","524.453  -  5.5MM REVERE REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.454","SUP","HCPCS C1713","","524.454  -  5.5MM REVERE REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.455","SUP","HCPCS C1713","","524.455  -  5.5MM REVERE REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.456","SUP","HCPCS C1713","","524.456  -  5.5MM REVERE REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.457","SUP","HCPCS C1713","","524.457  -  5.5MM REVERE REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.461","SUP","HCPCS C1713","","524.461  -  6.5MM REVERE REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.462","SUP","HCPCS C1713","","524.462  -  6.5MM REVERE REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.463","SUP","HCPCS C1713","","524.463  -  6.5MM REVERE REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.464","SUP","HCPCS C1713","","524.464  -  6.5MM REVERE REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.465","SUP","HCPCS C1713","","524.465  -  6.5MM REVERE REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.466","SUP","HCPCS C1713","","524.466  -  6.5MM REVERE REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.467","SUP","HCPCS C1713","","524.467  -  6.5MM REVERE REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.468","SUP","HCPCS C1713","","524.468  -  6.5MM REVERE REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.469","SUP","HCPCS C1713","","524.469  -  6.5MM REVERE REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.471","SUP","HCPCS C1713","","524.471  -  7.5MM REVERE REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.472","SUP","HCPCS C1713","","524.472  -  7.5MM REVERE REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.473","SUP","HCPCS C1713","","524.473  -  7.5MM REVERE REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.474","SUP","HCPCS C1713","","524.474  -  7.5MM REVERE REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.475","SUP","HCPCS C1713","","524.475  -  7.5MM REVERE REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.476","SUP","HCPCS C1713","","524.476  -  7.5MM REVERE REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.477","SUP","HCPCS C1713","","524.477  -  7.5MM REVERE REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.478","SUP","HCPCS C1713","","524.478  -  7.5MM REVERE REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.479","SUP","HCPCS C1713","","524.479  -  7.5MM REVERE REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.481","SUP","HCPCS C1713","","524.481  -  8.5MM REVERE REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.482","SUP","HCPCS C1713","","524.482  -  8.5MM REVERE REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.483","SUP","HCPCS C1713","","524.483  -  8.5MM REVERE REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.484","SUP","HCPCS C1713","","524.484  -  8.5MM REVERE REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.485","SUP","HCPCS C1713","","524.485  -  8.5MM REVERE REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.486","SUP","HCPCS C1713","","524.486  -  8.5MM REVERE REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.487","SUP","HCPCS C1713","","524.487  -  8.5MM REVERE REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.488","SUP","HCPCS C1713","","524.488  -  8.5MM REVERE REDUCTION SCREW, 60MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.489","SUP","HCPCS C1713","","524.489  -  8.5MM REVERE REDUCTION SCREW, 65MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.51","SUP","Custom 27803010","","524.510  -  5.5MM STRAIGHT ROD, HEX-END, 100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.512","SUP","Custom 27803010","","524.512  -  5.5MM STRAIGHT ROD, HEX-END, 125MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.515","SUP","Custom 27803010","","524.515  -  5.5MM STRAIGHT ROD, HEX-END, 150MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.517","SUP","Custom 27803010","","524.517  -  5.5MM STRAIGHT ROD, HEX-END, 200MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.519","SUP","Custom 27803010","","524.519  -  5.5MM STRAIGHT ROD, HEX-END, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.52","SUP","Custom 27803010","","524.520  -  5.5MM STRAIGHT ROD, HEX-END, 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.521","SUP","Custom 27803010","","524.521  -  5.5MM STRAIGHT ROD, HEX-END, 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"524.641","SUP","HCPCS C1713","","524.641  -  REVERE 4.5MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.642","SUP","HCPCS C1713","","524.642  -  REVERE 4.5MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.643","SUP","HCPCS C1713","","524.643  -  REVERE 4.5MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.644","SUP","HCPCS C1713","","524.644  -  REVERE 4.5MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.645","SUP","HCPCS C1713","","524.645  -  REVERE 4.5MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.646","SUP","HCPCS C1713","","524.646  -  REVERE 4.5MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.647","SUP","HCPCS C1713","","524.647  -  REVERE 4.5MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.651","SUP","HCPCS C1713","","524.651  -  REVERE 5.0MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.652","SUP","HCPCS C1713","","524.652  -  REVERE 5.0MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.653","SUP","HCPCS C1713","","524.653  -  REVERE 5.0MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.654","SUP","HCPCS C1713","","524.654  -  REVERE 5.0MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.655","SUP","HCPCS C1713","","524.655  -  REVERE 5.0MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.656","SUP","HCPCS C1713","","524.656  -  REVERE 5.0MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.657","SUP","HCPCS C1713","","524.657  -  REVERE 5.0MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.661","SUP","HCPCS C1713","","524.661  -  REVERE 5.5MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.662","SUP","HCPCS C1713","","524.662  -  REVERE 5.5MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.663","SUP","HCPCS C1713","","524.663  -  REVERE 5.5MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.664","SUP","HCPCS C1713","","524.664  -  REVERE 5.5MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.665","SUP","HCPCS C1713","","524.665  -  REVERE 5.5MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.666","SUP","HCPCS C1713","","524.666  -  REVERE 5.5MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.667","SUP","HCPCS C1713","","524.667  -  REVERE 5.5MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.671","SUP","HCPCS C1713","","524.671  -  REVERE 6.5MM UNIPLANAR SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.672","SUP","HCPCS C1713","","524.672  -  REVERE 6.5MM UNIPLANAR SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.673","SUP","HCPCS C1713","","524.673  -  REVERE 6.5MM UNIPLANAR SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.674","SUP","HCPCS C1713","","524.674  -  REVERE 6.5MM UNIPLANAR SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.675","SUP","HCPCS C1713","","524.675  -  REVERE 6.5MM UNIPLANAR SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.676","SUP","HCPCS C1713","","524.676  -  REVERE 6.5MM UNIPLANAR SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.677","SUP","HCPCS C1713","","524.677  -  REVERE 6.5MM UNIPLANAR SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.851","SUP","HCPCS C1713","","524.851  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 25MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.852","SUP","HCPCS C1713","","524.852  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.853","SUP","HCPCS C1713","","524.853  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.854","SUP","HCPCS C1713","","524.854  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.855","SUP","HCPCS C1713","","524.855  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.856","SUP","HCPCS C1713","","524.856  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.857","SUP","HCPCS C1713","","524.857  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.871","SUP","HCPCS C1713","","524.871  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.872","SUP","HCPCS C1713","","524.872  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.873","SUP","HCPCS C1713","","524.873  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.874","SUP","HCPCS C1713","","524.874  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.875","SUP","HCPCS C1713","","524.875  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.881","SUP","HCPCS C1713","","524.881  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 70MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.882","SUP","HCPCS C1713","","524.882  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 75MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.883","SUP","HCPCS C1713","","524.883  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 80MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.884","SUP","HCPCS C1713","","524.884  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 85MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"524.885","SUP","HCPCS C1713","","524.885  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"553","SUP","Custom 27203010","","CONTROL HGB A2 LYPHCHK LVL 2 1ML EPHRS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"610.514","SUP","Custom 27803010","","610.514  -  BIT DRILL 4MM SM STOP","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"610.712","SUP","Custom 27100030","","610.712  -  BIT DRILL 12MM SPNL","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"610.714","SUP","Custom 27100030","","610.714  -  BIT DRILL 14MM SPNL","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"615.104","SUP","Custom 27100030","","615.104  -  BIT DRILL 2.4MM PRTX CT 3.5MM SCR NONSTRL","BOTH IP/OP","$1,060.00 ","$784.40 ","$0.00 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.00 ","$0.00 ","$530.00 ","$839.52 ","$848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"615.107","SUP","Custom 27100030","","615.107  -  TAP SPNL PRTX CT 3.5-4 MM SCR","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$967.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"615.301","SUP","HCPCS C1713","","615.301  -  TMPLT ROD 240MM","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"618.6","SUP","Custom 27203010","","618.60  -  LENS OPHTHALMIC GRIESHABER MACULA ASPHERIC VITREORETINAL SUR","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"624.214","SUP","Custom 27100030","","624.214  -  TAP 4.5MM SURG SPNL REVERE","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$880.00 ","$0.00 ","$440.00 ","$696.96 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"624.215","SUP","Custom 27100030","","624.215  -  TAP 5.5MM SURG SPNL REVERE","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$880.00 ","$0.00 ","$440.00 ","$696.96 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"624.216","SUP","Custom 27100030","","624.216  -  TAP 6.5MM SURG SPNL REVERE","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$880.00 ","$0.00 ","$440.00 ","$696.96 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.414","SUP","Custom 27803010","","632.414  -  22MM PORT, BEVELED, 40MM","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.415","SUP","Custom 27803010","","632.415  -  22MM PORT, BEVELED, 50MM","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.416","SUP","Custom 27803010","","632.416  -  22MM PORT, BEVELED, 60MM","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.417","SUP","Custom 27803010","","632.417  -  22MM PORT, BEVELED, 70MM","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.418","SUP","Custom 27803010","","632.418  -  22MM PORT, BEVELED, 80MM","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.419","SUP","Custom 27803010","","632.419  -  22MM PORT, BEVELED, 90MM","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.42","SUP","Custom 27803010","","632.420  -  22MM PORT, BEVELED, 100MM","BOTH IP/OP","$1,220.00 ","$902.80 ","$0.00 ","$1,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.00 ","$0.00 ","$610.00 ","$966.24 ","$976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.421","SUP","Custom 27803010","","632.421  -  22MM PORT, BEVELED, 110MM","BOTH IP/OP","$1,220.00 ","$902.80 ","$0.00 ","$1,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.00 ","$0.00 ","$610.00 ","$966.24 ","$976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.422","SUP","Custom 27803010","","632.422  -  22MM PORT, BEVELED, 120MM","BOTH IP/OP","$1,220.00 ","$902.80 ","$0.00 ","$1,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.00 ","$0.00 ","$610.00 ","$966.24 ","$976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.424","SUP","Custom 27803010","","632.424  -  22MM PORT, STRAIGHT, 40MM","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.425","SUP","Custom 27803010","","632.425  -  22MM PORT, STRAIGHT, 50MM","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.426","SUP","Custom 27803010","","632.426  -  22MM PORT, STRAIGHT, 60MM","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.427","SUP","Custom 27803010","","632.427  -  22MM PORT, STRAIGHT, 70MM","BOTH IP/OP","$942.50 ","$697.45 ","$0.00 ","$942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.428","SUP","Custom 27803010","","632.428  -  22MM PORT, STRAIGHT, 80MM","BOTH IP/OP","$942.50 ","$697.45 ","$0.00 ","$942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.429","SUP","Custom 27803010","","632.429  -  22MM PORT, STRAIGHT, 90MM","BOTH IP/OP","$942.50 ","$697.45 ","$0.00 ","$942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.43","SUP","Custom 27803010","","632.430  -  SET SPNL 22MM 100MM STRG PORT","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.431","SUP","Custom 27803010","","632.431  -  22MM PORT, STRAIGHT, 110MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.432","SUP","Custom 27803010","","632.432  -  22MM PORT, STRAIGHT, 120MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.434","SUP","Custom 27803010","","632.434  -  19MM PORT, BEVELED, 40MM","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.435","SUP","Custom 27803010","","632.435  -  19MM PORT, BEVELED, 50MM","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.436","SUP","Custom 27803010","","632.436  -  SPACER SPNL 60MMX19MM BVL PORT PEEK INTRBD FS","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.437","SUP","Custom 27803010","","632.437  -  SPACER SPNL 70MMX19MM BVL PORT PEEK INTRBD FS","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.438","SUP","Custom 27803010","","632.438  -  19MM PORT, BEVELED, 80MM","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.439","SUP","Custom 27803010","","632.439  -  19MM PORT, BEVELED, 90MM","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.44","SUP","Custom 27803010","","632.440  -  19MM PORT, BEVELED, 100MM","BOTH IP/OP","$1,220.00 ","$902.80 ","$0.00 ","$1,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.00 ","$0.00 ","$610.00 ","$966.24 ","$976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.441","SUP","Custom 27803010","","632.441  -  19MM PORT, BEVELED, 110MM","BOTH IP/OP","$1,220.00 ","$902.80 ","$0.00 ","$1,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.00 ","$0.00 ","$610.00 ","$966.24 ","$976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.442","SUP","Custom 27803010","","632.442  -  19MM PORT, BEVELED, 120MM","BOTH IP/OP","$1,220.00 ","$902.80 ","$0.00 ","$1,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.00 ","$0.00 ","$610.00 ","$966.24 ","$976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.444","SUP","Custom 27803010","","632.444  -  SPACER SPNL 19MMX40MM PEEK INTRBD FS","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.445","SUP","Custom 27803010","","632.445  -  SPACER SPNL 50MMX19MM STRG PORT PEEK INTRBD FS","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.446","SUP","Custom 27803010","","632.446  -  19MM PORT, STRAIGHT, 60MM","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.447","SUP","Custom 27803010","","632.447  -  19MM PORT, STRAIGHT, 70MM","BOTH IP/OP","$942.50 ","$697.45 ","$0.00 ","$942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.448","SUP","Custom 27803010","","632.448  -  19MM PORT, STRAIGHT, 80MM","BOTH IP/OP","$942.50 ","$697.45 ","$0.00 ","$942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.449","SUP","Custom 27803010","","632.449  -  19MM PORT, STRAIGHT, 90MM","BOTH IP/OP","$942.50 ","$697.45 ","$0.00 ","$942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.45","SUP","Custom 27803010","","632.450  -  19MM PORT, STRAIGHT, 100MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.451","SUP","Custom 27803010","","632.451  -  19MM PORT, STRAIGHT, 110MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.452","SUP","Custom 27803010","","632.452  -  19MM PORT, STRAIGHT, 120MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.454","SUP","Custom 27803010","","632.454  -  26MM PORT, BEVELED, 40MM","BOTH IP/OP","$1,167.50 ","$863.95 ","$0.00 ","$1,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,167.50 ","$0.00 ","$583.75 ","$924.66 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.455","SUP","Custom 27803010","","632.455  -  26MM PORT, BEVELED, 50MM","BOTH IP/OP","$1,167.50 ","$863.95 ","$0.00 ","$1,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,167.50 ","$0.00 ","$583.75 ","$924.66 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.456","SUP","Custom 27803010","","632.456  -  26MM PORT, BEVELED, 60MM","BOTH IP/OP","$1,167.50 ","$863.95 ","$0.00 ","$1,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,167.50 ","$0.00 ","$583.75 ","$924.66 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.457","SUP","Custom 27803010","","632.457  -  26MM PORT, BEVELED, 70MM","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.458","SUP","Custom 27803010","","632.458  -  26MM PORT, BEVELED, 80MM","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.459","SUP","Custom 27803010","","632.459  -  26MM PORT, BEVELED, 90MM","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.46","SUP","Custom 27803010","","632.460  -  26MM PORT, BEVELED, 100MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.461","SUP","Custom 27803010","","632.461  -  26MM PORT, BEVELED, 110MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.462","SUP","Custom 27803010","","632.462  -  26MM PORT, BEVELED, 120MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.464","SUP","Custom 27803010","","632.464  -  26MM PORT, STRAIGHT, 40MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.465","SUP","Custom 27803010","","632.465  -  26MM PORT, STRAIGHT, 50MM","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.466","SUP","Custom 27803010","","632.466  -  SPACER SPNL TBLR 60MMX26MM PEEK INTRBD FS","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.467","SUP","Custom 27803010","","632.467  -  SPACER SPNL TBLR 70MMX26MM PEEK INTRBD FS","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.468","SUP","Custom 27803010","","632.468  -  SPACER SPNL TBLR 80MMX26MM PEEK INTRBD FS","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.469","SUP","Custom 27803010","","632.469  -  26MM PORT, STRAIGHT, 90MM","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.47","SUP","Custom 27803010","","632.470  -  26MM PORT, STRAIGHT, 100MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.471","SUP","Custom 27803010","","632.471  -  26MM PORT, STRAIGHT, 110MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.472","SUP","Custom 27803010","","632.472  -  26MM PORT, STRAIGHT, 120MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"648.216","SUP","Custom 27203010","","648.216  -  BIT DRILL FIX 2.4MM BONE CORRIDOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"650.012","SUP","HCPCS C1713","","650.012  -  HOLDER IMPLANT TEMPORARY FIX SCREW SPN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"650.112","SUP","Custom 27203010","","650.112  -  BIT DRL 12MM STRL REUSE","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"650.114","SUP","Custom 27100030","","650.114  -  BIT DRL 14MM STRL REUSE","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"650.116","SUP","Custom 27203010","","650.116  -  BIT DRL 16MM STRL REUSE","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"682.104","SUP","Custom 27203010","","682.104  -  BIT DRILL 2.4MM 3.5MM SCR ELLI","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"682.105","SUP","Custom 27203010","","682.105  -  BIT DRILL 4 MM TITANIUM SCREW","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"682.107","SUP","Custom 27203010","","682.107  -  TAP SURG TITANIUM SPN 4 MM SCREW","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"685.005","SUP","HCPCS C1769","","685.005  -  GUIDEWIRE ORTHOPEDIC 500MM BLUNT SPN","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$156.11 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"746","SUP","Custom 27203010","","REAGENT ANALY STA ST FNCT PRTN S CLOT BS ASY 1ML","BOTH IP/OP","$594.95 ","$440.26 ","$0.00 ","$594.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$594.95 ","$0.00 ","$297.48 ","$471.20 ","$475.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"751","SUP","Custom 27203010","","CONTROL CHM 3ML LVL 1 ASY MLANLT LQCHK","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"752","SUP","Custom 27203010","","CONTROL CHM 3ML LVL 2 ASY MLANLT LQCHK","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"804","SUP","HCPCS C1713","","804  -  SCREW 804 2.2MM X-DRV 4MM 6PK","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"805","SUP","HCPCS C1713","","805  -  SCREW 805 2.2MM X-DRV 5MM 6","BOTH IP/OP","$98.10 ","$72.59 ","$0.00 ","$98.10 ","$44.15 ","$0.00 ","$20.45 ","$0.00 ","$0.00 ","$17.18 ","$98.10 ","$0.00 ","$49.05 ","$77.70 ","$78.48 ","$0.00 ","$15.35 ","$0.00 ","$15.62 ","$0.00 "
"807","SUP","HCPCS C1713","","807  -  SCREW 807 2.2MM X-DRV 7MM 6","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"835.105","SUP","Custom 27804086","","835.105  -  MAINTAIN CERVICAL ALLOGRAFT, 5MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.106","SUP","Custom 27804086","","835.106  -  MAINTAIN CERVICAL ALLOGRAFT, 6MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.107","SUP","Custom 27804086","","835.107  -  MAINTAIN CERVICAL ALLOGRAFT, 7MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.108","SUP","Custom 27804086","","835.108  -  MAINTAIN CERVICAL ALLOGRAFT, 8MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.109","SUP","Custom 27804086","","835.109  -  MAINTAIN CERVICAL ALLOGRAFT, 9MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.11","SUP","Custom 27804086","","835.110  -  MAINTAIN CERVICAL ALLOGRAFT, 10MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.111","SUP","Custom 27804086","","835.111  -  MAINTAIN CERVICAL ALLOGRAFT, 11MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.112","SUP","Custom 27804086","","835.112  -  MAINTAIN CERVICAL ALLOGRAFT, 12MM PARALLEL","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.205","SUP","Custom 27804086","","835.205  -  MAINTAIN CERVICAL ALLOGRAFT, 5MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.206","SUP","Custom 27804086","","835.206  -  MAINTAIN CERVICAL ALLOGRAFT, 6MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.207","SUP","Custom 27804086","","835.207  -  MAINTAIN CERVICAL ALLOGRAFT, 7MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.208","SUP","Custom 27804086","","835.208  -  MAINTAIN CERVICAL ALLOGRAFT, 8MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.209","SUP","Custom 27804086","","835.209  -  MAINTAIN CERVICAL ALLOGRAFT, 9MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.21","SUP","Custom 27804086","","835.210  -  MAINTAIN CERVICAL ALLOGRAFT, 10MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.211","SUP","Custom 27804086","","835.211  -  MAINTAIN CERVICAL ALLOGRAFT, 11MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"835.212","SUP","Custom 27804086","","835.212  -  MAINTAIN CERVICAL ALLOGRAFT, 12MM LORDOTIC","BOTH IP/OP","$3,460.00 ","$2,560.40 ","$0.00 ","$3,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,460.00 ","$0.00 ","$1,730.00 ","$2,740.32 ","$2,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"846","SUP","Custom 27011340","","846  -  ELECTRODE PATIENT RETURN THK1/8IN 36X20IN 2 CORD MEGA SOFT","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"876","SUP","Custom 27203010","","BLANKET 64X25IN MXTHR L HPR/HPO NWVN DISP WRM","BOTH IP/OP","$30.93 ","$22.89 ","$0.00 ","$30.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.93 ","$0.00 ","$15.46 ","$24.50 ","$24.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"876.853","SUP","HCPCS C1713","","876.853  -  SCREW BONE 4.5MM 13MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA","BOTH IP/OP","$1,202.95 ","$890.18 ","$0.00 ","$1,202.95 ","$541.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.63 ","$1,202.95 ","$0.00 ","$601.48 ","$952.74 ","$962.36 ","$0.00 ","$188.26 ","$0.00 ","$191.51 ","$0.00 "
"900.601","SUP","Custom 27203010","","900.601  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM DRILL TIP NONSTRL 3.5MM","BOTH IP/OP","$80.83 ","$59.81 ","$0.00 ","$78.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.45 ","$0.00 ","$39.23 ","$62.13 ","$62.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900.721","SUP","HCPCS C1769","","900.721  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM NONTHREADED COBALT NONSTRL","BOTH IP/OP","$52.35 ","$38.74 ","$0.00 ","$50.83 ","$27.60 ","$0.00 ","$10.91 ","$0.00 ","$0.00 ","$8.90 ","$50.83 ","$0.00 ","$25.41 ","$40.26 ","$40.66 ","$0.00 ","$7.72 ","$0.00 ","$8.09 ","$0.00 "
"900.722","SUP","HCPCS C1769","","900.722  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREAD NONSTRL 3.5MM CANN","BOTH IP/OP","$55.50 ","$41.07 ","$0.00 ","$53.90 ","$29.27 ","$0.00 ","$11.57 ","$0.00 ","$0.00 ","$9.44 ","$53.90 ","$0.00 ","$26.95 ","$42.69 ","$43.12 ","$0.00 ","$8.19 ","$0.00 ","$8.58 ","$0.00 "
"900.723","SUP","HCPCS C1769","","900.723  -  GUIDEWIRE ORTHOPEDIC SPADE 2.5MM 230MM THREAD LCP DHHS","BOTH IP/OP","$90.65 ","$67.08 ","$0.00 ","$88.03 ","$47.80 ","$0.00 ","$18.89 ","$0.00 ","$0.00 ","$15.41 ","$88.03 ","$0.00 ","$44.01 ","$69.72 ","$70.42 ","$0.00 ","$13.37 ","$0.00 ","$14.01 ","$0.00 "
"900.726","SUP","HCPCS C1769","","900.726  -  GUIDEWIRE ORTHOPEDIC 2.8MM 450MM 300MM TROCAR POINT THREADED","BOTH IP/OP","$147.60 ","$109.22 ","$0.00 ","$143.30 ","$77.81 ","$0.00 ","$30.76 ","$0.00 ","$0.00 ","$25.09 ","$143.30 ","$0.00 ","$71.65 ","$113.49 ","$114.64 ","$0.00 ","$21.77 ","$0.00 ","$22.81 ","$0.00 "
"910.011","SUP","HCPCS C1713","","910.011  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD SELF-DRILLING SC","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.012","SUP","HCPCS C1713","","910.012  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD SELF-DRILLING SC","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.013","SUP","HCPCS C1713","","910.013  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD SELF-TAPPING SCR","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.014","SUP","HCPCS C1713","","910.014  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD SELF-TAPPING SCR","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.021","SUP","HCPCS C1713","","910.021  -  ASSURE SCREW RACK INSERT FOR 4.0MM RIGID SELF-DRILLING SCREW","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.022","SUP","HCPCS C1713","","910.022  -  ASSURE SCREW RACK INSERT FOR 4.5MM RIGID SELF-DRILLING SCREW","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.023","SUP","HCPCS C1713","","910.023  -  ASSURE SCREW RACK INSERT FOR 4.0MM RIGID SELF-TAPPING SCREWS","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$530.00 ","$238.50 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$92.80 ","$530.00 ","$0.00 ","$265.00 ","$419.76 ","$424.00 ","$0.00 ","$82.95 ","$0.00 ","$84.38 ","$0.00 "
"910.024","SUP","HCPCS C1713","","910.024  -  ASSURE SCREW RACK INSERT FOR 4.5MM RIGID SELF-TAPPING SCREWS","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.03","SUP","HCPCS C1713","","910.030  -  ASSURE SCREW RACK INSERT FOR AUXILLARY SCREWS","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.511","SUP","HCPCS C1713","","910.511  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD FIXED SELF-DRILL","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.512","SUP","HCPCS C1713","","910.512  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD FIXED SELF-DRILL","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.513","SUP","HCPCS C1713","","910.513  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD FIXED SELF-TAPPI","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.514","SUP","HCPCS C1713","","910.514  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD FIXED SELF-TAPPI","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.521","SUP","HCPCS C1713","","910.521  -  ASSURE SCREW RACK INSERT FOR 4.0MM FIXED SELF-DRILLING SCREW","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.522","SUP","HCPCS C1713","","910.522  -  ASSURE SCREW RACK INSERT FOR 4.5MM FIXED SELF-DRILLING SCREW","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.523","SUP","HCPCS C1713","","910.523  -  ASSURE SCREW RACK INSERT FOR 4.0MM FIXED SELF-TAPPING SCREWS","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.524","SUP","HCPCS C1713","","910.524  -  ASSURE SCREW RACK INSERT FOR 4.5MM FIXED SELF-TAPPING SCREWS","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"910.525","SUP","HCPCS C1713","","910.525  -  ASSURE SCREW RACK INSERT FOR AUXILIARY FIXED SCREWS","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"917.002","SUP","HCPCS C1713","","917.002  -  ASSURE TRANSLATIONAL CERVICAL PLATE IMPLANT MODULE FOR 1,2 A","BOTH IP/OP","$2,120.00 ","$1,568.80 ","$0.00 ","$2,120.00 ","$954.00 ","$0.00 ","$441.86 ","$0.00 ","$0.00 ","$371.20 ","$2,120.00 ","$0.00 ","$1,060.00 ","$1,679.04 ","$1,696.00 ","$0.00 ","$331.78 ","$0.00 ","$337.50 ","$0.00 "
"917.004","SUP","HCPCS C1713","","917.004  -  ASSURE TRANSLATIONAL CERVICAL PLATE IMPLANT MODULE FOR 4-LEV","BOTH IP/OP","$1,962.50 ","$1,452.25 ","$0.00 ","$1,962.50 ","$883.13 ","$0.00 ","$409.03 ","$0.00 ","$0.00 ","$343.62 ","$1,962.50 ","$0.00 ","$981.25 ","$1,554.30 ","$1,570.00 ","$0.00 ","$307.13 ","$0.00 ","$312.43 ","$0.00 "
"929.007","SUP","HCPCS C1713","","929.007  -  GATEWAY/CITADEL BONE SCREW MODULE","BOTH IP/OP","$3,180.00 ","$2,353.20 ","$0.00 ","$3,180.00 ","$1,431.00 ","$0.00 ","$662.79 ","$0.00 ","$0.00 ","$556.79 ","$3,180.00 ","$0.00 ","$1,590.00 ","$2,518.56 ","$2,544.00 ","$0.00 ","$497.67 ","$0.00 ","$506.26 ","$0.00 "
"992","SUP","HCPCS C1713","","992  -  KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"1001","SUP","Custom 27203010","","KIT MYCTST M TB AMPLF DIR 50 TST","BOTH IP/OP","$3,090.00 ","$2,286.60 ","$0.00 ","$3,090.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,090.00 ","$0.00 ","$1,545.00 ","$2,447.28 ","$2,472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1006","SUP","Custom 27203010","","1006  -  PROBE VITRTM LGC VRST ATIOP ANT OCCUTOME STRL DISP","BOTH IP/OP","$413.33 ","$305.86 ","$0.00 ","$413.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$413.33 ","$0.00 ","$206.66 ","$327.36 ","$330.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1028","SUP","HCPCS C2628","","1028  -  CATHETER BLNOCC FLOCONTROL","BOTH IP/OP","$6,987.50 ","$5,170.75 ","$0.00 ","$6,987.50 ","$0.00 ","$0.00 ","$1,456.37 ","$0.00 ","$0.00 ","$0.00 ","$6,987.50 ","$0.00 ","$3,493.75 ","$5,534.10 ","$5,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1041","SUP","Custom 27203010","","MASK O2 VNYL ADLT ELNG UNDCHN MED CONCEN TBG 7FT","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1049","SUP","Custom 27203010","","01049  -  MASK O2 VNYL ADLT UNDCHN STY MED CONCEN W/O TBG LATEX FREE","BOTH IP/OP","$1.04 ","$0.77 ","$0.00 ","$1.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.04 ","$0.00 ","$0.52 ","$0.82 ","$0.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1151","SUP","Custom 27203010","","1151  -  MANIPULATOR SURG UT INJECTOR 4.5MM DISP","BOTH IP/OP","$55.70 ","$41.22 ","$0.00 ","$51.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.04 ","$0.00 ","$25.52 ","$40.42 ","$40.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1201","SUP","Custom 27803010","","1201  -  CLIP INTERNAL SMALL CHEVRON TRIANGLE WIDE LIGATE CROSS","BOTH IP/OP","$4.58 ","$3.39 ","$0.00 ","$4.58 ","$2.06 ","$0.00 ","$0.95 ","$0.00 ","$0.00 ","$0.80 ","$4.58 ","$0.00 ","$2.29 ","$0.83 ","$3.66 ","$0.00 ","$0.72 ","$0.00 ","$0.73 ","$0.00 "
"1201","SUP","HCPCS C1760","","001201  -  CLIP SM INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE","BOTH IP/OP","$4.58 ","$3.39 ","$0.00 ","$4.58 ","$2.06 ","$0.00 ","$0.95 ","$0.00 ","$0.00 ","$0.80 ","$4.58 ","$0.00 ","$2.29 ","$3.63 ","$3.66 ","$0.00 ","$0.72 ","$0.00 ","$0.73 ","$0.00 "
"1266","SUP","Custom 27203010","","REAGENT THYGL AB IMMUN","BOTH IP/OP","$621.35 ","$459.80 ","$0.00 ","$621.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$621.35 ","$0.00 ","$310.68 ","$492.11 ","$497.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1273","SUP","Custom 27203010","","KIT IMMUN TST THR MICROSOMAL AB","BOTH IP/OP","$621.35 ","$459.80 ","$0.00 ","$621.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$621.35 ","$0.00 ","$310.68 ","$492.11 ","$497.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1435","SUP","Custom 27203010","","1435  -  BANDAGE COMPRESSION A TUBULAR 10MR MULTPUR ELAST COMFORTABLE","BOTH IP/OP","$39.80 ","$29.45 ","$0.00 ","$42.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.68 ","$0.00 ","$21.34 ","$33.80 ","$34.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1438","SUP","Custom 27203010","","1438  -  BANDAGE COMPRESSION F LARGE KNEE MEDIUM THIGH TUBULAR 10MR","BOTH IP/OP","$89.85 ","$66.49 ","$0.00 ","$86.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.61 ","$0.00 ","$43.30 ","$68.60 ","$69.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1441","SUP","Custom 27203010","","1441  -  BANDAGE COMPRESSION K 10MR TUBULAR MULTPUR COMFORTABLE","BOTH IP/OP","$136.15 ","$100.75 ","$0.00 ","$145.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.98 ","$0.00 ","$72.99 ","$115.62 ","$116.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1443","SUP","Custom 27203010","","1443  -  BANDAGE COMPRESSION C MEDIUM ARM SMALL ANKLE TUBULAR 10MR","BOTH IP/OP","$57.43 ","$42.50 ","$0.00 ","$61.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.56 ","$0.00 ","$30.78 ","$48.76 ","$49.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1534","SUP","Custom 27203010","","1534  -  SYSTEM GSTRC LAV 34FR NS ESLV TUBE RADOPQ STRP EASI-LOK ADPR","BOTH IP/OP","$365.14 ","$270.20 ","$0.00 ","$365.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.14 ","$0.00 ","$182.57 ","$289.19 ","$292.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1537","SUP","Custom 27203010","","1537  -  FORCEPS BIOPSY COLD","BOTH IP/OP","$34.78 ","$25.74 ","$0.00 ","$34.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.78 ","$0.00 ","$17.39 ","$27.55 ","$27.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1651","SUP","Custom 27203010","","SENSOR NEO LNOP FNGR TOE OXM ADH OPTC PRB DISP","BOTH IP/OP","$641.70 ","$474.86 ","$0.00 ","$641.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.70 ","$0.00 ","$320.85 ","$508.23 ","$513.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1791","SUP","Custom 27203010","","REAGENT CT GC AP CMB 2 DTCT KT 1200 TST ANALY","BOTH IP/OP","$64.38 ","$47.64 ","$0.00 ","$64.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.38 ","$0.00 ","$32.19 ","$50.99 ","$51.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1798","SUP","Custom 27203010","","SENSOR NEO LNOP NEO-L OXM ADH DISP","BOTH IP/OP","$31.05 ","$22.98 ","$0.00 ","$31.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.05 ","$0.00 ","$15.53 ","$24.59 ","$24.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1800","SUP","Custom 27203010","","SENSOR INF LNOP GRT TOE THB OXM ADH STRAP INF-L","BOTH IP/OP","$31.05 ","$22.98 ","$0.00 ","$31.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.05 ","$0.00 ","$15.53 ","$24.59 ","$24.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1863","SUP","Custom 27203010","","SENSOR ADLT LNCS DCI OXM ADH CBL NSTRL LF DISP","BOTH IP/OP","$457.20 ","$338.33 ","$0.00 ","$457.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.20 ","$0.00 ","$228.60 ","$362.10 ","$365.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1892","SUP","Custom 27011340","","1892  -  SET PRSS MONITR COMBITRANS","BOTH IP/OP","$113.75 ","$84.18 ","$0.00 ","$113.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.75 ","$0.00 ","$56.88 ","$90.09 ","$91.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1895","SUP","Custom 27203010","","SENSOR REUSABLE TIP CLIP EAR LNOP TC-I","BOTH IP/OP","$457.20 ","$338.33 ","$0.00 ","$457.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.20 ","$0.00 ","$228.60 ","$362.10 ","$365.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1896","SUP","Custom 27203010","","SENSOR REUSABLE FOREHEAD LNOP TF-I","BOTH IP/OP","$572.50 ","$423.65 ","$0.00 ","$572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.50 ","$0.00 ","$286.25 ","$453.42 ","$458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1904","SUP","Custom 27203010","","ENFACARE LIPIL POWDER 12.8OZ","BOTH IP/OP","$190.00 ","$140.60 ","$0.00 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1951","SUP","Custom 27203010","","1951  -  HEMOSTAT ABSORBABLE 14X2IN ORIGINAL FLEXIBLE SHEER WEAVE","BOTH IP/OP","$136.04 ","$100.67 ","$0.00 ","$136.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.04 ","$0.00 ","$68.02 ","$107.74 ","$108.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1974","SUP","Custom 27203010","","1974  -  SPONGE ABSORBABLE THK10MM 100 12.5X8CM HEMOSTAT SURGIFOAM","BOTH IP/OP","$48.96 ","$36.23 ","$0.00 ","$91.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.69 ","$0.00 ","$45.84 ","$72.62 ","$73.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1985","SUP","Custom 27203010","","1985  -  AGENT HMST STRL LF INSTAT ABS MCFIB CLGN 1GM DISP","BOTH IP/OP","$108.73 ","$80.46 ","$0.00 ","$86.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.08 ","$0.00 ","$41.04 ","$86.11 ","$65.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2056","SUP","Custom 27203010","","2056  -  APL BRCHTX 5-6CM VAR TRY MAMST 8MM BRST","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083","SUP","Custom 27203010","","2083  -  HEMOSTAT ABS 4X4IN NWVN BCTRCD SRGCL SNOW CLU FBRC","BOTH IP/OP","$286.01 ","$211.65 ","$0.00 ","$286.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$286.01 ","$0.00 ","$143.01 ","$226.52 ","$228.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2161","SUP","Custom 27203010","","STRIP UA MLSTX 10 SG 9 PRMTR SG REAGENT 100 TST","BOTH IP/OP","$81.00 ","$59.94 ","$0.00 ","$81.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.00 ","$0.00 ","$40.50 ","$64.15 ","$64.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2200","SUP","Custom 27803010","","2200  -  CLIP INTERNAL MEDIUM CHEVRON HEART TRNSVRS GROOVE LIGATE","BOTH IP/OP","$6.90 ","$5.11 ","$0.00 ","$6.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.90 ","$0.00 ","$3.45 ","$5.46 ","$5.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2406","SUP","Custom 27203010","","STAIN DVD MRKNG 2OZ REFL BTL SET AST HISTOLGY","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2456","SUP","Custom 27203010","","2456  -  APL BRCHTX 4-5CM VAR TRY MAMST 8MM BRST","BOTH IP/OP","$1,219.18 ","$902.19 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2550","SUP","Custom 27203010","","2550  -  BAG DRAIN INLINE SELF FILL OASIS 600ML STERILE ATRIUM ATS","BOTH IP/OP","$57.10 ","$42.25 ","$0.00 ","$57.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.10 ","$0.00 ","$28.55 ","$45.22 ","$45.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2649","SUP","Custom 27203010","","CUFF CLASSIC LRG ADLT LNG 2 TB ROSE WHT SCREW CONNECTOR","BOTH IP/OP","$36.25 ","$26.83 ","$0.00 ","$36.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.25 ","$0.00 ","$18.13 ","$28.71 ","$29.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2816","SUP","Custom 27203010","","RESTRAINT XTRMT PSY LMB WRST ANKL FOAM HLDR QRLSE SGL STRAP","BOTH IP/OP","$35.25 ","$26.09 ","$0.00 ","$35.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.25 ","$0.00 ","$17.63 ","$27.92 ","$28.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2845","SUP","Custom 27203010","","KIT MYCTST ACPRB M AVIUM CULT ID 20 TST","BOTH IP/OP","$708.13 ","$524.02 ","$0.00 ","$708.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$708.13 ","$0.00 ","$354.06 ","$560.84 ","$566.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2855","SUP","Custom 27203010","","KIT MYCTST ACPRB MYCB KS 2 CULT ID 20 TST","BOTH IP/OP","$708.33 ","$524.16 ","$0.00 ","$708.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$708.33 ","$0.00 ","$354.16 ","$561.00 ","$566.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2860","SUP","Custom 27203010","","KIT MYCTST ACPRB M TB CULT ID 20 TST","BOTH IP/OP","$708.13 ","$524.02 ","$0.00 ","$708.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$708.13 ","$0.00 ","$354.06 ","$560.84 ","$566.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2910","SUP","Custom 27203010","","KIT MYCTST ACPRB HISTOPLASMA CAPSULATUM CULT ID 20 TST","BOTH IP/OP","$708.33 ","$524.16 ","$0.00 ","$708.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$708.33 ","$0.00 ","$354.16 ","$561.00 ","$566.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2994","SUP","Custom 27203010","","2994  -  AGENT HMST STRL SURGIFLO KT MTRX THRMB","BOTH IP/OP","$650.86 ","$481.64 ","$0.00 ","$650.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$650.86 ","$0.00 ","$325.43 ","$515.48 ","$520.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3037","SUP","HCPCS C1787","","3037  -  PROGRAMMER NRSTM 5L 22X10X4CM INTSTM 240X640 PIXELS PT SLIM","BOTH IP/OP","$2,975.00 ","$2,201.50 ","$0.00 ","$2,975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,975.00 ","$0.00 ","$1,487.50 ","$2,356.20 ","$2,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3048","SUP","HCPCS C1729","","CATHETER IV 14GA 1.25IN RADIOPQ SFSHLD ORNG PCTV TFLN STRL","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3050","SUP","HCPCS C1729","","CATHETER IV 22GA 1IN RADIOPQ SFSHLD BLUE PCTV TFLN STRL LF","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3053","SUP","HCPCS C1729","","CATHETER IV 24GA .75IN RADIOPQ SFSHLD YLW PCTV TFLN STRL LF","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3055","SUP","HCPCS C1729","","CATHETER IV 18GA 1.25IN RADIOPQ SFSHLD GRN PCTV TFLN STRL LF","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.81 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3056","SUP","HCPCS C1729","","CATHETER IV 20GA 1.25IN RADIOPQ SFSHLD PNK PCTV+PLUS TFLN","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3057","SUP","HCPCS C1729","","CATHETER IV 20GA 1IN RADIOPQ SFSHLD PNK PCTV+ TFLN STRL LF","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3110","SUP","Custom 27203010","","03110  -  WRENCH SURG 5MM ALN","BOTH IP/OP","$26.90 ","$19.91 ","$0.00 ","$317.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$317.50 ","$0.00 ","$158.75 ","$251.46 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3125","SUP","Custom 27203010","","03125  -  WRENCH SURG T BONE SCR","BOTH IP/OP","$1,108.70 ","$820.44 ","$0.00 ","$397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3396","SUP","HCPCS C1729","","CATHETER IV 20GA 1.25IN RADIOPQ SFSHLD PNK ACV J TFLN STRL","BOTH IP/OP","$3.93 ","$2.91 ","$0.00 ","$3.93 ","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.69 ","$3.93 ","$0.00 ","$1.96 ","$3.11 ","$3.14 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"3423","SUP","Custom 27203010","","3423  -  DRILL SRG SM SHRT 3.5MM STRL LF EVOS AO QCK CNCT OVR DISP","BOTH IP/OP","$258.36 ","$191.19 ","$0.00 ","$311.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.10 ","$0.00 ","$155.55 ","$204.62 ","$248.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3570","SUP","HCPCS C1729","","CATHETER URTH KNGRD 24FR FOLEY 2W SIL 5ML LTX","BOTH IP/OP","$2.23 ","$1.65 ","$0.00 ","$2.23 ","$1.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.39 ","$2.23 ","$0.00 ","$1.11 ","$1.77 ","$1.78 ","$0.00 ","$0.35 ","$0.00 ","$0.35 ","$0.00 "
"3573","SUP","HCPCS C1729","","CATHETER URTH KNGRD 26FR FOLEY 2W SIL 5ML LTX","BOTH IP/OP","$2.20 ","$1.63 ","$0.00 ","$2.20 ","$1.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.39 ","$2.20 ","$0.00 ","$1.10 ","$1.74 ","$1.76 ","$0.00 ","$0.34 ","$0.00 ","$0.35 ","$0.00 "
"3902","SUP","Custom 27203010","","3902  -  KIT TISS CLSR 2ML EVICEL SLNT FBRN","BOTH IP/OP","$525.98 ","$389.23 ","$0.00 ","$525.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.98 ","$0.00 ","$262.99 ","$416.58 ","$420.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4001","SUP","Custom 27203010","","4001  -  RETAINER INTNL ORG SURGIFISH RADOPQ","BOTH IP/OP","$53.75 ","$39.78 ","$0.00 ","$53.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.75 ","$0.00 ","$26.88 ","$42.57 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4022","SUP","Custom 27203010","","REUSABLE CLIPS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4030","SUP","Custom 27203010","","4030  -  DRESSING HMST 12X12IN STRL LF QUIKCLOT TRAUMAPAD CNTRL+ 3","BOTH IP/OP","$145.58 ","$107.73 ","$0.00 ","$544.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.00 ","$0.00 ","$5.50 ","$544.08 ","$8.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4073","SUP","Custom 27203010","","BLADE LRNSCP 3 MCNTSH","BOTH IP/OP","$41.35 ","$30.60 ","$0.00 ","$41.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.35 ","$0.00 ","$20.68 ","$32.75 ","$33.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4074","SUP","Custom 27203010","","BLADE LRNSCP 4 MCNTSH","BOTH IP/OP","$41.35 ","$30.60 ","$0.00 ","$41.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.35 ","$0.00 ","$20.68 ","$32.75 ","$33.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4080","SUP","Custom 27203010","","BLADE LRNSCP 0 STD MLLR SS","BOTH IP/OP","$41.35 ","$30.60 ","$0.00 ","$41.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.35 ","$0.00 ","$20.68 ","$32.75 ","$33.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4082","SUP","Custom 27203010","","BLADE LRNSCP 2 STN MLLR REUSE","BOTH IP/OP","$37.55 ","$27.79 ","$0.00 ","$37.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.55 ","$0.00 ","$18.78 ","$29.74 ","$30.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4083","SUP","Custom 27203010","","BLADE LRNSCP 3 STD WINCONSIN","BOTH IP/OP","$41.35 ","$30.60 ","$0.00 ","$41.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.35 ","$0.00 ","$20.68 ","$32.75 ","$33.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4200","SUP","Custom 27803010","","004200  -  CLIP INTERNAL LARGE ANGLE RIGHT RING HANDLE LIGATE","BOTH IP/OP","$2.36 ","$1.75 ","$0.00 ","$2.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.36 ","$0.00 ","$1.18 ","$1.87 ","$1.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4259","SUP","Custom 27203010","","04259  -  RESERVOIR ATF XRES B BLD COL DISP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4273","SUP","Custom 27203010","","04273  -  KIT ATSBWL .25IN X ANCOAG ASP LN SCT ASMB TBG PVC DISP","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4275","SUP","Custom 27203010","","04275  -  RESERVOIR ATF 120UM BTM OULET GRS FLTR BLUTSAMMEL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4350","SUP","HCPCS C1765","","4350  -  BRR ADH ABS PLVC INTCD 4X3IN STRL","BOTH IP/OP","$753.34 ","$557.47 ","$0.00 ","$753.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.90 ","$753.34 ","$0.00 ","$376.67 ","$596.65 ","$602.67 ","$0.00 ","$117.90 ","$0.00 ","$0.00 ","$0.00 "
"4353","SUP","Custom 27803010","","4353  -  IMPLANT FACIAL PATIENT SPECIFIC","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4400","SUP","Custom 27803010","","4400  -  RING ANLPLS 28MM MTRL C-E CL TI","BOTH IP/OP","$6,552.50 ","$4,848.85 ","$0.00 ","$6,552.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,552.50 ","$0.00 ","$3,276.25 ","$5,189.58 ","$5,242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450","SUP","Custom 27803010","","4450  -  RING ANLPLS 24-40MM MTRL C-E PH","BOTH IP/OP","$3,295.00 ","$2,438.30 ","$0.00 ","$2,609.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$2,609.64 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4672","SUP","Custom 27803010","","004672  -  DEVICE VENTRICULAR ASSIST 12FR MICROAXIAL PUMP IMPELLA 2.5L","BOTH IP/OP","$62,500.00 ","$46,250.00 ","$0.00 ","$62,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62,500.00 ","$0.00 ","$31,250.00 ","$49,500.00 ","$50,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4823","SUP","HCPCS C1713","","4823.000  -  BLOCKER SPNL XIA 3 TI","BOTH IP/OP","$459.38 ","$339.94 ","$0.00 ","$459.38 ","$206.72 ","$0.00 ","$95.75 ","$0.00 ","$0.00 ","$80.43 ","$459.38 ","$0.00 ","$229.69 ","$363.83 ","$367.50 ","$0.00 ","$71.89 ","$0.00 ","$73.13 ","$0.00 "
"5065","SUP","Custom 27203010","","5065  -  COVER COMPRESSION MEDIUM 12- IN RIGID SOLE VENT HOLE DORSUM","BOTH IP/OP","$172.30 ","$127.50 ","$0.00 ","$172.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.30 ","$0.00 ","$86.15 ","$136.46 ","$137.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5571","SUP","HCPCS C1887","","5571  -  HANDLE LRNSCP MED STD RUSCH DLPHN REUSE","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,182.50 ","$642.10 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$207.05 ","$1,182.50 ","$0.00 ","$591.25 ","$936.54 ","$946.00 ","$0.00 ","$185.06 ","$0.00 ","$188.25 ","$0.00 "
"5897","SUP","Custom 27203010","","5897  -  CUFF CMPR REG KDL SCD EXP BLDR FT","BOTH IP/OP","$80.68 ","$59.70 ","$0.00 ","$73.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.46 ","$0.00 ","$36.73 ","$60.76 ","$58.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5898","SUP","Custom 27203010","","5898  -  SLEEVE CMPR LG SCD EXP ANEMB CUF FT","BOTH IP/OP","$74.55 ","$55.17 ","$0.00 ","$73.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.46 ","$0.00 ","$36.73 ","$60.76 ","$58.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6057","SUP","HCPCS C1765","","6057  -  STYLET LEAD .014IN KT BALL TIP BLUE KNOB","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$0.00 ","$0.00 "
"6081","SUP","Custom 27203010","","6081  -  FILTER LEEP SMOKE EVACUATOR PRE","BOTH IP/OP","$28.90 ","$21.39 ","$0.00 ","$28.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.90 ","$0.00 ","$14.45 ","$22.89 ","$23.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6091","SUP","HCPCS C1765","","6091  -  STYLET LEAD .014IN KT JTP BALL TIP XTD TPR GRY KNOB","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.76 ","$0.00 ","$19.38 ","$79.20 ","$31.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6092","SUP","Custom 27203010","","6092  -  PAPER RCD 110MM EKG THRM CARELINK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$198.00 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6122","SUP","Custom 27203010","","6122  -  MOUTHWASH ORAL 1.5OZ LF RNS ANSEP 0.05% CPC CL","BOTH IP/OP","$86.43 ","$63.96 ","$0.00 ","$86.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.43 ","$0.00 ","$43.21 ","$68.45 ","$69.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6177","SUP","Custom 27203010","","6177  -  SLEEVE PACEMAKER RADIO FREQUENCY HEAD WAND COVER STERILE","BOTH IP/OP","$23.75 ","$17.58 ","$0.00 ","$23.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6196","SUP","HCPCS C1729","","6196  -  CATHETER 7FR 100CM PIGTAIL","BOTH IP/OP","$2.50 ","$1.85 ","$0.00 ","$2.50 ","$1.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.44 ","$2.50 ","$0.00 ","$1.25 ","$1.98 ","$2.00 ","$0.00 ","$0.39 ","$0.00 ","$0.40 ","$0.00 "
"6215","SUP","Custom 27203010","","6215  -  CATHETER GD 6FR ATN GW PU CS VNGR","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6314","SUP","Custom 27803010","","6314  -  GRAFT SYNTH TISSUE 91X56X4MM SMOOTH EXTERIOR SURFACE","BOTH IP/OP","$2,988.60 ","$2,211.56 ","$0.00 ","$4,742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,742.50 ","$0.00 ","$2,371.25 ","$3,756.06 ","$3,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6316","SUP","Custom 27803010","","6316  -  IMPLANT ORBTL 14MM SPHERE BIOCOMPATIBLE POROUS MEDPOR","BOTH IP/OP","$1,265.18 ","$936.23 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6317","SUP","Custom 27803010","","6317  -  IMPLANT ORBTL 20MM SPHERE BIOCOMPATIBLE POROUS MEDPOR","BOTH IP/OP","$1,265.18 ","$936.23 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6322","SUP","Custom 27803010","","6322  -  SPHERE EYE 22MM THK.45MM 42MMX41MMX1MM STRL PE POR MEDPOR","BOTH IP/OP","$1,505.00 ","$1,113.70 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6326","SUP","Custom 27803010","","6326  -  IMPLANT ORBTL 16MM SPHERE BIOCOMPATIBLE POROUS MEDPOR","BOTH IP/OP","$1,265.18 ","$936.23 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6327","SUP","Custom 27803010","","6327  -  IMPLANT ORBTL ROUND 18MM SPHERE BIOCOMPATIBLE POROUS MEDPOR","BOTH IP/OP","$1,265.18 ","$936.23 ","$0.00 ","$1,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,505.00 ","$0.00 ","$752.50 ","$1,191.96 ","$1,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6330","SUP","Custom 27803010","","6330  -  GRAFT SYNTH TISSUE 50X38X1.5MM SHEET POROUS MEDPOR","BOTH IP/OP","$911.05 ","$674.18 ","$0.00 ","$1,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.50 ","$0.00 ","$651.25 ","$1,031.58 ","$1,042.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6331","SUP","Custom 27803010","","6331  -  GRAFT SYNTH TISSUE 76X50X1.5MM SHEET POROUS MEDPOR","BOTH IP/OP","$1,224.65 ","$906.24 ","$0.00 ","$1,386.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.00 ","$0.00 ","$28.50 ","$1,386.00 ","$45.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6332","SUP","Custom 27803010","","6332  -  GRAFT SYNTH TISSUE 38X13X3MM BLOCK POROUS MEDPOR","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6333","SUP","Custom 27803010","","6333  -  GRAFT SYNTH TISSUE 38X13X6MM BLOCK POROUS MEDPOR","BOTH IP/OP","$1,460.25 ","$1,080.59 ","$0.00 ","$1,647.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.50 ","$0.00 ","$823.75 ","$1,304.82 ","$1,318.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6334","SUP","Custom 27803010","","6334  -  GRAFT SYNTH TISSUE 38X13X9.5MM BLOCK POROUS MEDPOR","BOTH IP/OP","$1,940.00 ","$1,435.60 ","$0.00 ","$1,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6335","SUP","Custom 27803010","","6335  -  GRAFT SYNTH TISSUE 50X25X3MM BLOCK POROUS MEDPOR","BOTH IP/OP","$1,730.63 ","$1,280.67 ","$0.00 ","$2,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,425.00 ","$0.00 ","$1,212.50 ","$1,920.60 ","$1,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6336","SUP","Custom 27803010","","6336  -  GRAFT SYNTH TISSUE CNTOUR 25X50X6MM BLOCK MEDPOR","BOTH IP/OP","$1,905.00 ","$1,409.70 ","$0.00 ","$2,667.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,667.50 ","$0.00 ","$1,333.75 ","$2,112.66 ","$2,134.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6337","SUP","Custom 27803010","","6337  -  GRAFT SYNTH TISSUE 50X25X9.5MM BLOCK POROUS MEDPOR","BOTH IP/OP","$3,155.00 ","$2,334.70 ","$0.00 ","$3,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,155.00 ","$0.00 ","$1,577.50 ","$2,498.76 ","$2,524.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6338","SUP","Custom 27803010","","6338  -  GRAFT SYNTH TISSUE 63X38X3MM BLOCK POROUS MEDPOR POLYETHLENE","BOTH IP/OP","$3,155.00 ","$2,334.70 ","$0.00 ","$3,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,155.00 ","$0.00 ","$1,577.50 ","$2,498.76 ","$2,524.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6339","SUP","Custom 27803010","","6339  -  GRAFT SYNTH TISSUE CNTOUR 38X63X6MM BLOCK MEDPOR","BOTH IP/OP","$3,395.00 ","$2,512.30 ","$0.00 ","$3,395.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,395.00 ","$0.00 ","$1,697.50 ","$2,688.84 ","$2,716.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6340","SUP","Custom 27803010","","6340  -  GRAFT SNTH TISS CNTR 38X63X9.5MM STRL MDPR BLCK PE POR","BOTH IP/OP","$3,642.50 ","$2,695.45 ","$0.00 ","$3,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,642.50 ","$0.00 ","$1,821.25 ","$2,884.86 ","$2,914.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6351","SUP","Custom 27803010","","6351  -  GRAFT SYNTH TISSUE MEDPOR 178X127MM SHEET POROUS","BOTH IP/OP","$5,350.00 ","$3,959.00 ","$0.00 ","$5,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,350.00 ","$0.00 ","$2,675.00 ","$4,237.20 ","$4,280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6550","SUP","Custom 27203010","","KIT OC TTHT SWB PRXMNT SOL MOIST LF","BOTH IP/OP","$13.45 ","$9.95 ","$0.00 ","$13.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.45 ","$0.00 ","$6.73 ","$10.65 ","$10.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6640","SUP","HCPCS C1729","","6640  -  SYSTEM DRN 7FR 15ML STRL LF TLS EVACUATE TUBE RADOPQ CATH","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$57.02 ","$0.00 ","$21.88 ","$0.00 ","$0.00 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"6650","SUP","HCPCS C1729","","6650  -  SYSTEM DRAIN 10FR EVACUATE TUBE RADIOPQ RESERVOIR LATEX FREE","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$57.02 ","$0.00 ","$21.88 ","$0.00 ","$0.00 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"7120","SUP","HCPCS C1895","","7120  -  LEAD DFBR 7FR DURATA ECRDL STRD ELUT TRUE BIPOL ACT FIX","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"7122","SUP","HCPCS C1898","","7122  -  LEAD PCNG ECRDL BIPOL ACT FIX XTD-RETRAC HLX TIP DURATA","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"7207","SUP","Custom 27803010","","7207  -  IMPLANT ORBTL CONE FLAT 16MM MULTPUR ANTERIOR SURFACE MEDPOR","BOTH IP/OP","$1,153.66 ","$853.71 ","$0.00 ","$1,153.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,153.66 ","$0.00 ","$576.83 ","$913.70 ","$922.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7208","SUP","Custom 27803010","","7208  -  SAW SURG SAGITTAL SYSTEM 7","BOTH IP/OP","$1,153.66 ","$853.71 ","$0.00 ","$1,153.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,153.66 ","$0.00 ","$576.83 ","$913.70 ","$922.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7209","SUP","Custom 27803010","","7209  -  IMPLANT ORBTL CONE FLAT 20MM MULTPUR ANTERIOR SURFACE MEDPOR","BOTH IP/OP","$1,153.66 ","$853.71 ","$0.00 ","$1,153.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,153.66 ","$0.00 ","$576.83 ","$913.70 ","$922.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7210","SUP","Custom 27803010","","7210  -  GRAFT SYNTH TISSUE ULTRATHIN 50X38X.85MM SHEET POROUS MEDPOR","BOTH IP/OP","$943.40 ","$698.12 ","$0.00 ","$1,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.50 ","$0.00 ","$651.25 ","$1,031.58 ","$1,042.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7212","SUP","Custom 27803010","","7212  -  GRAFT SYNTH TISSUE ULTRATHIN 76X50X.85MM SHEET SMOOTH","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7214","SUP","Custom 27803010","","7214  -  GRAFT SYNTH TISSUE ULTRATHIN 127X76X.85MM SHEET SMOOTH","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$3,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,360.00 ","$0.00 ","$1,680.00 ","$2,661.12 ","$2,688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7216","SUP","Custom 27803010","","7216  -  MEDPOR ULTRA THIN SHEET - 127MM X 178MM X 0.85MM","BOTH IP/OP","$3,710.00 ","$2,745.40 ","$0.00 ","$3,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,710.00 ","$0.00 ","$1,855.00 ","$2,938.32 ","$2,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7222","SUP","Custom 27803010","","7222  -  IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS","BOTH IP/OP","$1,417.05 ","$1,048.62 ","$0.00 ","$1,223.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,053.38 ","$0.00 ","$526.69 ","$1,223.64 ","$842.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7223","SUP","Custom 27803010","","7223  -  IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS","BOTH IP/OP","$1,459.35 ","$1,079.92 ","$0.00 ","$1,592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7341","SUP","Custom 27203010","","STAIN BLUING SOL SGNTR 1GL HPRFR WKG SOL HMTL","BOTH IP/OP","$368.78 ","$272.90 ","$0.00 ","$368.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.78 ","$0.00 ","$184.39 ","$292.07 ","$295.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7511","SUP","Custom 27803010","","7511  -  COVER BURR HOLE 5MM 15X3MM SUPERIOR FLANGE POROUS MEDPOR","BOTH IP/OP","$672.00 ","$497.28 ","$0.00 ","$1,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.00 ","$0.00 ","$535.00 ","$847.44 ","$856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7512","SUP","Custom 27803010","","7512  -  COVER BURR HOLE 29X17X7MM 3PK CRANIOMAXILLOFACIAL","BOTH IP/OP","$672.00 ","$497.28 ","$0.00 ","$1,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.00 ","$0.00 ","$535.00 ","$847.44 ","$856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7514","SUP","Custom 27803010","","7514  -  BURR HOLE DISC - 14MM X 16MM","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7516","SUP","Custom 27803010","","7516  -  GRAFT SYNTH TISSUE SMALL 53X5MM DESIGN A LATEX FREE MEDPOR","BOTH IP/OP","$777.43 ","$575.30 ","$0.00 ","$1,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.50 ","$0.00 ","$538.75 ","$853.38 ","$862.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7517","SUP","Custom 27803010","","7517  -  GRAFT SYNTH TISSUE LARGE 66X8MM IMPLANT DESIGN A POROUS","BOTH IP/OP","$777.43 ","$575.30 ","$0.00 ","$1,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.50 ","$0.00 ","$538.75 ","$853.38 ","$862.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7518","SUP","Custom 27803010","","7518  -  GRAFT SYNTH TISSUE LARGE 67X6.5MM IMPLANT DESIGN B POROUS","BOTH IP/OP","$777.43 ","$575.30 ","$0.00 ","$1,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.50 ","$0.00 ","$538.75 ","$853.38 ","$862.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7520","SUP","Custom 27803010","","7520  -  GRAFT SYNTH TISSUE SMALL 65X37X5MM IMPLANT 1 PIECE DESIGN","BOTH IP/OP","$960.58 ","$710.83 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7521","SUP","Custom 27803010","","7521  -  GRAFT SYNTH TISSUE MEDIUM 65X37X7MM IMPLANT 1 PIECE DESIGN","BOTH IP/OP","$960.58 ","$710.83 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7522","SUP","Custom 27803010","","7522  -  GRAFT SYNTH TISSUE LARGE 65X37X10MM IMPLANT 1 PIECE DESIGN","BOTH IP/OP","$960.58 ","$710.83 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7525","SUP","Custom 27803010","","7525  -  EAR BASE - LEFT - 28MM X 55MM X 13MM","BOTH IP/OP","$2,404.00 ","$1,778.96 ","$0.00 ","$2,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,404.00 ","$0.00 ","$1,202.00 ","$1,903.97 ","$1,923.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7526","SUP","Custom 27803010","","7526  -  GRAFT SYNTH TISSUE LARGE 65X32X16MM BASE RECONSTRUCTION","BOTH IP/OP","$2,454.38 ","$1,816.24 ","$0.00 ","$3,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,367.50 ","$0.00 ","$1,683.75 ","$2,667.06 ","$2,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7527","SUP","Custom 27803010","","7527  -  GRAFT SYNTH TISSUE LARGE 65X32X16MM LATEX FREE EAR LEFT","BOTH IP/OP","$2,454.38 ","$1,816.24 ","$0.00 ","$3,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,367.50 ","$0.00 ","$1,683.75 ","$2,667.06 ","$2,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7535","SUP","Custom 27803010","","7535  -  GRAFT SYNTH TISSUE 47X37X3MM 6.5X3X3MM LATERAL AUGMENTATION","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7536","SUP","Custom 27803010","","7536  -  GRAFT SYNTH TISSUE ANGLE 47X37X3MM AUGMENTATION ONLAY MEDPOR","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,479.06 ","$9.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$1,479.06 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$0.00 ","$0.00 "
"7538","SUP","Custom 27803010","","7538  -  GRAFT SYNTH TISSUE ANGLE 79X32X5MM E-5 INFERIOR RIDGE MEDPOR","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7539","SUP","Custom 27803010","","7539  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7541","SUP","Custom 27803010","","7541  -  GRAFT SYNTH TISSUE ANGLE 79X32X4MM ES-5 INFERIOR RIDGE","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7542","SUP","Custom 27803010","","7542  -  GRAFT SYNTH TISSUE ANGLE 5MM 5MM 79MMX32MM 4MMX5MM RAMUS","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7543","SUP","Custom 27803010","","7543  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7544","SUP","Custom 27803010","","7544  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7594","SUP","Custom 27203010","","REAGENT ANTI-FYB GMA CLN 5ML MNCLN BLOOD BANK","BOTH IP/OP","$1,347.50 ","$997.15 ","$0.00 ","$1,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.50 ","$0.00 ","$673.75 ","$1,067.22 ","$1,078.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7730","SUP","Custom 27203010","","7730  -  ADHESIVE OSTOMY MEDIUM SPRAY CAN REMAIN FLEXIBLE SILICONE","BOTH IP/OP","$607.98 ","$449.91 ","$0.00 ","$39.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.38 ","$0.00 ","$19.69 ","$31.19 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7828","SUP","HCPCS C1768","","007828  -  FABRIC CARDIO 4X4IN SVG THK.61MM FLMN","BOTH IP/OP","$254.37 ","$188.23 ","$0.00 ","$254.37 ","$114.46 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.37 ","$0.00 ","$127.18 ","$201.46 ","$203.49 ","$0.00 ","$39.81 ","$0.00 ","$40.49 ","$0.00 "
"7836","SUP","HCPCS C1768","","7836  -  FELT CARDIO 10X10CM THK1.65MM PTFE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"7836","SUP","HCPCS C1768","","007836  -  FELT CARDIO THK1.65MM 4X4IN PTFE STERILE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$174.60 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"7837","SUP","HCPCS C1768","","007837  -  FELT CARDIO 15X15CM THK1.65MM PTFE PTCH","BOTH IP/OP","$295.55 ","$218.71 ","$0.00 ","$295.55 ","$133.00 ","$0.00 ","$61.60 ","$0.00 ","$0.00 ","$51.75 ","$295.55 ","$0.00 ","$147.78 ","$234.08 ","$236.44 ","$0.00 ","$46.25 ","$0.00 ","$47.05 ","$0.00 "
"8101","SUP","Custom 27203010","","REAGENT METHNL ISOPRPNL FLX 100 1GL ABST DEHYDRANT BTL","BOTH IP/OP","$40.60 ","$30.04 ","$0.00 ","$40.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.60 ","$0.00 ","$20.30 ","$32.16 ","$32.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8185","SUP","HCPCS C1769","","8185  -  GUIDEWIRE VASC STRG 185CM PRIMEWIRE PSTG+ PRSS","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$916.31 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"8305","SUP","Custom 27803010","","8305  -  GRAFT SNTH TISS TRMPT 50X38X1MM STRL MDPR BRR SHT HDPE NPOR","BOTH IP/OP","$1,319.50 ","$976.43 ","$0.00 ","$2,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,020.00 ","$0.00 ","$1,010.00 ","$1,599.84 ","$1,616.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8312","SUP","Custom 27803010","","8312  -  GRAFT SYNTH TISSUE REGULAR 76X50X1MM IMPLANT RECTANGULAR","BOTH IP/OP","$1,288.00 ","$953.12 ","$0.00 ","$1,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,777.50 ","$0.00 ","$888.75 ","$1,407.78 ","$1,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8313","SUP","Custom 27803010","","8313  -  GRAFT SYNTH TISSUE SMALL ROUND 47X45X3MM 2 PIECE DESIGN","BOTH IP/OP","$1,016.40 ","$752.14 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8314","SUP","Custom 27803010","","8314  -  GRAFT SYNTH TISSUE MEDIUM ROUND 47X45X5MM 2 PIECE DESIGN","BOTH IP/OP","$1,016.40 ","$752.14 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8315","SUP","Custom 27803010","","8315  -  IMPLANT CHIN LG RND 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH","BOTH IP/OP","$1,016.40 ","$752.14 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8316","SUP","Custom 27803010","","8316  -  GRAFT SYNTH TISSUE 3MM ROUND EXTEND RZ CHIN","BOTH IP/OP","$1,016.40 ","$752.14 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8317","SUP","Custom 27803010","","8317  -  IMPLANT CHIN MED SQ 47X45X5MM STRL MDPR RZ 2 PC DSGN NTCH","BOTH IP/OP","$1,016.40 ","$752.14 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8318","SUP","Custom 27803010","","8318  -  IMPLANT CHIN LG SQ 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH TAB","BOTH IP/OP","$1,016.40 ","$752.14 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8319","SUP","Custom 27803010","","8319  -  IMPLANT CHIN 45X41X4MM MGG 2 PC","BOTH IP/OP","$1,075.25 ","$795.69 ","$0.00 ","$1,215.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,215.00 ","$0.00 ","$607.50 ","$962.28 ","$972.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8320","SUP","Custom 27803010","","8320  -  GRAFT SNTH TISS SM 56X33X5MM STRL MDPR IMPL 2 PC PRJ TPR WNG","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8321","SUP","Custom 27803010","","8321  -  GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE MEDIUM","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8322","SUP","Custom 27803010","","8322  -  GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE LARGE","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8328","SUP","Custom 27803010","","8328  -  GRAFT SYNTH TISSUE 62X37MM IMPLANT HELICAL RIM POROUS MEDPOR","BOTH IP/OP","$1,225.63 ","$906.97 ","$0.00 ","$1,810.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,810.00 ","$0.00 ","$905.00 ","$1,433.52 ","$1,448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8329","SUP","Custom 27803010","","8329  -  GRAFT SYNTH TISSUE 62X37MM HELICAL RIM POROUS MEDPOR","BOTH IP/OP","$1,225.63 ","$906.97 ","$0.00 ","$1,810.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,810.00 ","$0.00 ","$905.00 ","$1,433.52 ","$1,448.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8330","SUP","Custom 27803010","","8330  -  GRAFT SYNTH TISSUE 60X30MM IMPLANT EXTENDED BASE POROUS","BOTH IP/OP","$2,262.60 ","$1,674.32 ","$0.00 ","$3,317.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,317.50 ","$0.00 ","$1,658.75 ","$2,627.46 ","$2,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8331","SUP","Custom 27803010","","8331  -  GRAFT SYNTH TISSUE 60X30MM BASE EXTENDED POROUS MEDPOR","BOTH IP/OP","$2,262.60 ","$1,674.32 ","$0.00 ","$3,317.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,317.50 ","$0.00 ","$1,658.75 ","$2,627.46 ","$2,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8340","SUP","Custom 27803010","","8340  -  GRAFT SYNTH TISSUE SMALL 60X25X5MM IMPLANT GENIOPLASTY WEDGE","BOTH IP/OP","$984.70 ","$728.68 ","$0.00 ","$1,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8341","SUP","Custom 27803010","","8341  -  GRAFT SYNTH TISSUE MEDIUM 60X25X7.5MM IMPLANT GENIOPLASTY","BOTH IP/OP","$984.70 ","$728.68 ","$0.00 ","$1,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,490.00 ","$0.00 ","$745.00 ","$1,180.08 ","$1,192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8342","SUP","Custom 27803010","","8342  -  GENIOPLASTY WEDGE - LARGE - 60MM X 25MM X 10MM","BOTH IP/OP","$1,096.00 ","$811.04 ","$0.00 ","$1,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,096.00 ","$0.00 ","$548.00 ","$868.03 ","$876.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8438","SUP","Custom 27803010","","8438  -  GRAFT SYNTH TISSUE MICROTHIN 50X30X.4MM SHEET MEDPOR","BOTH IP/OP","$961.35 ","$711.40 ","$0.00 ","$1,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.50 ","$0.00 ","$651.25 ","$1,031.58 ","$1,042.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8536","SUP","Custom 27203010","","8536  -  NEEDLE SUT ULTHN STRL HI-FI 2 ARM SS MNSCL","BOTH IP/OP","$116.80 ","$86.43 ","$0.00 ","$116.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.80 ","$0.00 ","$58.40 ","$92.51 ","$93.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8570","SUP","Custom 27203010","","8570  -  NEEDLE SUT BLU STRL ZN SPC II REPR EYLT NTNL MNSCS","BOTH IP/OP","$64.38 ","$47.64 ","$0.00 ","$64.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.38 ","$0.00 ","$32.19 ","$50.99 ","$51.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8662","SUP","Custom 27803010","","8662  -  GRAFT SYNTH TISSUE MICROTHIN 76X127MM SHEET POROUS MEDPOR","BOTH IP/OP","$2,242.40 ","$1,659.38 ","$0.00 ","$2,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8703","SUP","Custom 27803010","","8703  -  SPHERE - 21MM","BOTH IP/OP","$1,071.20 ","$792.69 ","$0.00 ","$1,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,071.20 ","$0.00 ","$535.60 ","$848.39 ","$856.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8704","SUP","Custom 27803010","","8704  -  SPHERE - 23MM","BOTH IP/OP","$1,071.20 ","$792.69 ","$0.00 ","$1,071.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,071.20 ","$0.00 ","$535.60 ","$848.39 ","$856.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8800","SUP","Custom 27203010","","8800  -  KIT ARTHRO FIX PNACL ACL STRL DISP","BOTH IP/OP","$319.30 ","$236.28 ","$0.00 ","$319.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$319.30 ","$0.00 ","$159.65 ","$252.89 ","$255.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8814","SUP","Custom 27011340","","08814  -  BRACE ORTH 30.5- IN 17-27IN TSCP BRIDGETECH ROM HNG PRMR TRM","BOTH IP/OP","$185.10 ","$136.97 ","$0.00 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.20 ","$0.00 ","$101.60 ","$160.93 ","$162.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9019","SUP","Custom 27803010","","9019  -  VAD 9019 18MM CONVERTIBLE","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9025","SUP","Custom 27803010","","9025  -  CATH 9025 VENT STD XTRA LENGTH MARK IMP","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9031","SUP","Custom 27203010","","9031  -  DEVICE BRCHTX CVTY EVAL TRGT MAMST BRST","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9032","SUP","Custom 27803010","","9032  -  VENT 9032 QUICK RELEASE INTRODUCER","BOTH IP/OP","$270.75 ","$200.36 ","$0.00 ","$270.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.75 ","$0.00 ","$135.38 ","$214.43 ","$216.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9041","SUP","Custom 27203010","","CONNECTOR TBG FMALE LUER LOCK LOCK PLG IV","BOTH IP/OP","$157.50 ","$116.55 ","$0.00 ","$157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9053","SUP","Custom 27203010","","9053  -  VAD 9053 12MM CONVT W/INLET CONN","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9073","SUP","Custom 27203010","","9073  -  STOCKINETTE ORTHOPEDIC 25YDX3IN HIGH ABSORBENT KNIT LATEX","BOTH IP/OP","$28.80 ","$21.31 ","$0.00 ","$28.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9094","SUP","Custom 27203010","","9094  -  STIMULATOR NRV STRL LF CKPNT LCTR DISP","BOTH IP/OP","$1,565.00 ","$1,158.10 ","$0.00 ","$1,565.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,565.00 ","$0.00 ","$782.50 ","$1,239.48 ","$1,252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9207","SUP","HCPCS C1729","","CATHETER XTRN MED XTD WR MALE","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$1.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.53 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.47 ","$0.00 ","$0.48 ","$0.00 "
"9209","SUP","HCPCS C1729","","CATHETER XTRN 36MM LG XTD WR LTX MALE","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$1.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.53 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.47 ","$0.00 ","$0.48 ","$0.00 "
"9305","SUP","Custom 27803010","","9305  -  GRAFT SYNTH TISSUE TRUMPET 50X30X1.6MM SHEET BARRIER MEDPOR","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$2,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,020.00 ","$0.00 ","$1,010.00 ","$1,599.84 ","$1,616.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9312","SUP","Custom 27803010","","9312  -  GRAFT SYNTH TISSUE RECTANGLE 76X50X1.6MM IMPLANT NONPOROUS","BOTH IP/OP","$1,277.70 ","$945.50 ","$0.00 ","$1,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,777.50 ","$0.00 ","$888.75 ","$1,407.78 ","$1,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9429","SUP","Custom 27803010","","9429  -  GRAFT SYNTH TISSUE 43X18MM FLANGE MEDPOR POLYETHYLENE POROUS","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9430","SUP","Custom 27803010","","9430  -  GRAFT SYNTH TISSUE INFERIOR ORBTL RIM RIGHT","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,037.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.57 ","$0.00 ","$3.79 ","$1,037.52 ","$6.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9500","SUP","HCPCS C1769","","9500  -  GUIDEWIRE VASC 3CM COMBOWIRE XT FLXB SHFT DPLR PTFE HDRPHB","BOTH IP/OP","$1.40 ","$1.04 ","$0.00 ","$2,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$2,178.00 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9501","SUP","Custom 27803010","","9501  -  GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,037.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.30 ","$0.00 ","$41.65 ","$1,037.52 ","$66.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9502","SUP","Custom 27803010","","9502  -  GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,037.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.80 ","$0.00 ","$50.40 ","$1,037.52 ","$80.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9503","SUP","Custom 27803010","","9503  -  GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT POROUS MEDPOR","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9504","SUP","Custom 27803010","","9504  -  GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT TAPERED POROUS","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9513","SUP","Custom 27803010","","9513  -  GRAFT SYNTH TISSUE SMALL CNTOUR 45X24X3MM TRIM AUGMENTATION","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,047.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.20 ","$0.00 ","$222.60 ","$1,047.42 ","$356.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9514","SUP","Custom 27803010","","9514  -  GRAFT SYNTH TISSUE SMALL 45X24X3MM EXTEND DESIGN MEDPOR","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,322.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,322.50 ","$0.00 ","$661.25 ","$1,047.42 ","$1,058.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9515","SUP","Custom 27803010","","9515  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 50X26X4MM EXTEND MEDPOR","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,322.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,322.50 ","$0.00 ","$661.25 ","$1,047.42 ","$1,058.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9516","SUP","Custom 27803010","","9516  -  GRAFT SNTH TISS MED 50X26X4MM STRL LF MDPR XTD CNTR PE POR","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,047.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.10 ","$0.00 ","$4.05 ","$1,047.42 ","$6.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9517","SUP","Custom 27803010","","9517  -  GRAFT SNTH TISS LG 55X27X5MM STRL MDPR XTD CNTR POR PE","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,322.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,322.50 ","$0.00 ","$661.25 ","$1,047.42 ","$1,058.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9518","SUP","Custom 27803010","","9518  -  GRAFT SYNTH TISSUE LARGE 55X27X5MM EXTEND SHAPE MEDPOR","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,322.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,322.50 ","$0.00 ","$661.25 ","$1,047.42 ","$1,058.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9519","SUP","Custom 27803010","","9519  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM","BOTH IP/OP","$925.58 ","$684.93 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9520","SUP","Custom 27803010","","9520  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM","BOTH IP/OP","$925.58 ","$684.93 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9521","SUP","Custom 27803010","","9521  -  GRAFT SYNTH TISSUE SMALL 70X70X10MM SMOOTH FLEXIBLE AUGMENT","BOTH IP/OP","$2,869.60 ","$2,123.50 ","$0.00 ","$4,555.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,555.00 ","$0.00 ","$2,277.50 ","$3,607.56 ","$3,644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9522","SUP","Custom 27803010","","9522  -  GRAFT SYNTH TISSUE MEDIUM 88X86X15MM SMOOTH FLEXIBLE AUGMENT","BOTH IP/OP","$2,988.60 ","$2,211.56 ","$0.00 ","$4,742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,742.50 ","$0.00 ","$2,371.25 ","$3,756.06 ","$3,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9523","SUP","Custom 27803010","","9523  -  GRAFT SYNTH TISSUE LARGE 98X95X18MM SMOOTH FLEXIBLE AUGMENT","BOTH IP/OP","$3,102.50 ","$2,295.85 ","$0.00 ","$3,898.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.81 ","$0.00 ","$37.91 ","$3,898.62 ","$60.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9524","SUP","Custom 27803010","","9524  -  GRAFT SYNTH TISSUE THK6MM 107MMX97 GRID CNTOUR MEDPOR","BOTH IP/OP","$7,350.80 ","$5,439.59 ","$0.00 ","$11,927.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9525","SUP","Custom 27803010","","9525  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM","BOTH IP/OP","$925.58 ","$684.93 ","$0.00 ","$1,077.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.62 ","$0.00 ","$44.31 ","$1,077.12 ","$70.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9526","SUP","Custom 27803010","","9526  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM","BOTH IP/OP","$925.58 ","$684.93 ","$0.00 ","$1,077.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$1,077.12 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9527","SUP","Custom 27803010","","9527  -  GRAFT SYNTH TISSUE 38X50X.85MM 1 CHANNEL SHEET MICROPLATE","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9530","SUP","Custom 27203010","","9530  -  SLEEVE COMPRESSION MEDIUM ANTIEMBOLISM ADJUSTABLE CLOSURE","BOTH IP/OP","$45.71 ","$33.83 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.77 ","$0.00 ","$21.89 ","$36.20 ","$35.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9531","SUP","Custom 27803010","","9531  -  GRAFT SYNTH TISSUE 52X40X2.3MM IMPLANT MINIPLATE CHANNEL","BOTH IP/OP","$1,766.23 ","$1,307.01 ","$0.00 ","$2,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9532","SUP","Custom 27803010","","9532  -  GRAFT SNTH TISS 52X40X2.3MM BRR MDPR MCPLT CHNL SHT PE","BOTH IP/OP","$1,766.23 ","$1,307.01 ","$0.00 ","$2,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,920.00 ","$0.00 ","$1,460.00 ","$2,312.64 ","$2,336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9533","SUP","Custom 27803010","","9533  -  GRAFT SYNTH TISSUE 1.1MM SMALL 70X13X2MM ONLAY ARCH SHAPE","BOTH IP/OP","$843.60 ","$624.26 ","$0.00 ","$1,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.50 ","$0.00 ","$588.75 ","$932.58 ","$942.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9534","SUP","Custom 27803010","","9534  -  GRAFT SYNTH TISSUE MEDIUM 70X15X2MM NASAL ARCH POROUS MEDPOR","BOTH IP/OP","$843.60 ","$624.26 ","$0.00 ","$1,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.50 ","$0.00 ","$588.75 ","$932.58 ","$942.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9535","SUP","Custom 27803010","","9535  -  GRAFT SYNTH TISSUE LARGE 70X17X2MM NASAL ARCH ONLAY POROUS","BOTH IP/OP","$843.60 ","$624.26 ","$0.00 ","$1,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.50 ","$0.00 ","$588.75 ","$932.58 ","$942.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9536","SUP","Custom 27803010","","9536  -  GRAFT SYNTH TISSUE 40X9X1.1MM NASAL SHEET POROUS MEDPOR","BOTH IP/OP","$406.00 ","$300.44 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9537","SUP","HCPCS C1763","","9537  -  TISSUE SYNTH PE POR MEDPOR ORBTL RIM","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$427.50 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$166.34 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$148.68 ","$0.00 ","$151.24 ","$0.00 "
"9539","SUP","Custom 27803010","","9539  -  GRAFT SYNTH TISSUE 47X40X6.3MM EXTEND MEDPOR POLYETHYLENE","BOTH IP/OP","$1,371.58 ","$1,014.97 ","$0.00 ","$1,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9540","SUP","Custom 27803010","","9540  -  GRAFT SNTH TISS 47X40X6.3MM STRL MDPR XTD PE POR CRNMXF RT","BOTH IP/OP","$1,371.58 ","$1,014.97 ","$0.00 ","$1,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9541","SUP","Custom 27803010","","9541  -  GRAFT SYNTH TISSUE REGULAR 31X22X7MM ENOPHTHALMOS WEDGE","BOTH IP/OP","$1,215.00 ","$899.10 ","$0.00 ","$1,707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.50 ","$0.00 ","$853.75 ","$1,352.34 ","$1,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9542","SUP","Custom 27803010","","9542  -  GRAFT SYNTH TISSUE REGULAR 31X22X7MM WEDGE ENOPHTHALMOS","BOTH IP/OP","$1,215.00 ","$899.10 ","$0.00 ","$1,707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.50 ","$0.00 ","$853.75 ","$1,352.34 ","$1,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9543","SUP","Custom 27803010","","9543  -  GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE","BOTH IP/OP","$1,215.00 ","$899.10 ","$0.00 ","$1,707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.50 ","$0.00 ","$853.75 ","$1,352.34 ","$1,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9544","SUP","Custom 27803010","","9544  -  GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE","BOTH IP/OP","$1,215.00 ","$899.10 ","$0.00 ","$1,707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.50 ","$0.00 ","$853.75 ","$1,352.34 ","$1,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9545","SUP","Custom 27203010","","9545  -  SLEEVE SMALL SCD EXPRESS THIGH LENGTH","BOTH IP/OP","$99.10 ","$73.33 ","$0.00 ","$99.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.10 ","$0.00 ","$49.55 ","$78.49 ","$79.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9548","SUP","Custom 27803010","","9548  -  CONFORMER OCULAR MEDIUM 24X21X5.3MM NONVENT LATEX FREE ACRYL","BOTH IP/OP","$120.25 ","$88.99 ","$0.00 ","$177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9553","SUP","Custom 27803010","","9553  -  GRAFT SYNTH TISSUE REGULAR SHELL 38X21X17MM 2 INSERT","BOTH IP/OP","$1,130.00 ","$836.20 ","$0.00 ","$1,552.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,552.50 ","$0.00 ","$776.25 ","$1,229.58 ","$1,242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9554","SUP","Custom 27803010","","9554  -  GRAFT SYNTH TISSUE LARGE 40X20X18MM NASAL SHELL 2 INSERTS","BOTH IP/OP","$190.13 ","$140.70 ","$0.00 ","$1,552.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,552.50 ","$0.00 ","$776.25 ","$1,229.58 ","$1,242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9555","SUP","Custom 27203010","","CURETTE 4MM FLXLP ADLT EAR FLXB OVL CUP SURG POLYPRO DISP","BOTH IP/OP","$2.13 ","$1.58 ","$0.00 ","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.13 ","$0.00 ","$1.06 ","$1.69 ","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562","SUP","Custom 27803010","","9562  -  SHEET SNTH 50X38X3MM MDPR NEURO","BOTH IP/OP","$2,214.05 ","$1,638.40 ","$0.00 ","$3,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,360.00 ","$0.00 ","$1,680.00 ","$2,661.12 ","$2,688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9568","SUP","Custom 27803010","","9568  -  GRAFT SNTH TISS 108X75MM STRL MDPR IMPL INFR 2/3 ORBT POR PE","BOTH IP/OP","$7,026.50 ","$5,199.61 ","$0.00 ","$11,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,410.00 ","$0.00 ","$5,705.00 ","$9,036.72 ","$9,128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9570","SUP","Custom 27803010","","9570  -  GRAFT SNTH TISS 93X75MM STRL MDPR IMPL CMPLT POR PE CRNMXF","BOTH IP/OP","$8,342.75 ","$6,173.64 ","$0.00 ","$13,547.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,547.50 ","$0.00 ","$6,773.75 ","$10,729.62 ","$10,838.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9580","SUP","Custom 27203010","","09580  -  DEVICE EXFIX OPTRM ELB TRGT DISC","BOTH IP/OP","$572.50 ","$423.65 ","$0.00 ","$572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.50 ","$0.00 ","$286.25 ","$453.42 ","$458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9595","SUP","HCPCS C1769","","09595  -  WIRE .062IN KWIRE TRGT ORTH NONSTRL","BOTH IP/OP","$257.50 ","$190.55 ","$0.00 ","$257.50 ","$139.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.09 ","$257.50 ","$0.00 ","$128.75 ","$203.94 ","$206.00 ","$0.00 ","$40.30 ","$0.00 ","$40.99 ","$0.00 "
"9600","SUP","Custom 27203010","","09600  -  FXTR EXFIX OPTRM PROX ELB CMPNT","BOTH IP/OP","$11,645.00 ","$8,617.30 ","$0.00 ","$11,645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,645.00 ","$0.00 ","$5,822.50 ","$9,222.84 ","$9,316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9610","SUP","Custom 27803010","","09610  -  CMPNT EXFIX OPTRM RIGHT DISTAL","BOTH IP/OP","$5,727.50 ","$4,238.35 ","$0.00 ","$4,536.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.88 ","$0.00 ","$23.94 ","$4,536.18 ","$38.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9780","SUP","Custom 27203010","","9780  -  DEVICE DRN C400LB 10-24FR STRL LF INVACARE I-FIT ATCH DEV","BOTH IP/OP","$51.01 ","$37.75 ","$0.00 ","$48.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.85 ","$0.00 ","$24.42 ","$40.40 ","$39.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9857","SUP","Custom 27803010","","9857  -  SHEET SNTH SM CNTR 78X61X18MM STRL FLXBLK TF2 MDPR CRNMXF LT","BOTH IP/OP","$3,042.25 ","$2,251.27 ","$0.00 ","$4,542.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,542.50 ","$0.00 ","$2,271.25 ","$3,597.66 ","$3,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9858","SUP","Custom 27803010","","9858  -  GRAFT SYNTH TISSUE SMALL CNTOUR 78X61X18MM FLEXBLOCK TF2","BOTH IP/OP","$3,042.25 ","$2,251.27 ","$0.00 ","$4,542.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,542.50 ","$0.00 ","$2,271.25 ","$3,597.66 ","$3,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9859","SUP","Custom 27803010","","9859  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR","BOTH IP/OP","$3,041.35 ","$2,250.60 ","$0.00 ","$3,763.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$248.26 ","$0.00 ","$124.13 ","$3,763.98 ","$198.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9860","SUP","Custom 27803010","","9860  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR","BOTH IP/OP","$3,041.35 ","$2,250.60 ","$0.00 ","$4,752.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,752.50 ","$0.00 ","$2,376.25 ","$3,763.98 ","$3,802.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9861","SUP","Custom 27803010","","9861  -  GRAFT SYNTH TISSUE LARGE IMPLANT CNTOUR POROUS MEDPOR","BOTH IP/OP","$3,170.50 ","$2,346.17 ","$0.00 ","$4,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,972.50 ","$0.00 ","$2,486.25 ","$3,938.22 ","$3,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9862","SUP","Custom 27803010","","9862  -  GRAFT SYNTH TISSUE LARGE IMPLANT POROUS MEDPOR FLEXBLOCK TF2","BOTH IP/OP","$3,170.50 ","$2,346.17 ","$0.00 ","$4,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,972.50 ","$0.00 ","$2,486.25 ","$3,938.22 ","$3,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9864","SUP","Custom 27803010","","9864  -  GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS","BOTH IP/OP","$2,026.38 ","$1,499.52 ","$0.00 ","$3,515.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,515.00 ","$0.00 ","$1,757.50 ","$2,783.88 ","$2,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9865","SUP","Custom 27803010","","9865  -  GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS LEFT","BOTH IP/OP","$2,026.38 ","$1,499.52 ","$0.00 ","$3,515.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,515.00 ","$0.00 ","$1,757.50 ","$2,783.88 ","$2,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9866","SUP","Custom 27803010","","9866  -  IMPLANT ORBTL 16MM SMALL ROUND MOTILITY 2 CHANNEL 4 ANTERIOR","BOTH IP/OP","$1,273.05 ","$942.06 ","$0.00 ","$1,592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9867","SUP","Custom 27803010","","9867  -  IMPLANT ORBTL 18MM MEDIUM ROUND MOTILITY 2 CHANNEL 4","BOTH IP/OP","$1,592.50 ","$1,178.45 ","$0.00 ","$1,592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9868","SUP","Custom 27803010","","9868  -  IMPLANT ORBTL 20MM LARGE ROUND MOTILITY 2 CHANNEL 4 ANTERIOR","BOTH IP/OP","$1,592.50 ","$1,178.45 ","$0.00 ","$1,592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9952","SUP","Custom 27803010","","9952  -  SET SZR MALAR","BOTH IP/OP","$521.25 ","$385.73 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9955","SUP","Custom 27803010","","9955  -  GRAFT SYNTH TISSUE SMALL 65X35X3MM IMPLANT ANGLED WRAPAROUND","BOTH IP/OP","$1,510.88 ","$1,118.05 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9956","SUP","Custom 27803010","","9956  -  GRAFT SYNTH TISSUE SMALL ANGLE RIGHT 65X35X3MM WRAPAROUND","BOTH IP/OP","$1,420.08 ","$1,050.86 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9957","SUP","Custom 27803010","","9957  -  GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED","BOTH IP/OP","$1,420.08 ","$1,050.86 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9958","SUP","Custom 27803010","","9958  -  GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED","BOTH IP/OP","$1,420.08 ","$1,050.86 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9959","SUP","Custom 27803010","","9959  -  GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED","BOTH IP/OP","$1,420.08 ","$1,050.86 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9960","SUP","Custom 27803010","","9960  -  GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED","BOTH IP/OP","$1,420.08 ","$1,050.86 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10004","SUP","HCPCS C1713","","010004  -  PLATE BONE 4 HOLE UTILITY SPN","BOTH IP/OP","$26.25 ","$19.43 ","$0.00 ","$26.25 ","$11.81 ","$0.00 ","$5.47 ","$0.00 ","$0.00 ","$4.60 ","$26.25 ","$0.00 ","$13.13 ","$20.79 ","$21.00 ","$0.00 ","$4.11 ","$0.00 ","$4.18 ","$0.00 "
"10014","SUP","HCPCS C1713","","010014  -  PLATE BONE 4MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL","BOTH IP/OP","$490.88 ","$363.25 ","$0.00 ","$388.78 ","$0.00 ","$0.00 ","$102.31 ","$0.00 ","$0.00 ","$0.00 ","$173.25 ","$0.00 ","$86.63 ","$388.78 ","$138.60 ","$0.00 ","$0.00 ","$0.00 ","$78.15 ","$0.00 "
"10015","SUP","HCPCS C1713","","10015  -  SPACER ALLOGRAFT 8D NARROW LORDOTIC WEDGE PYRAMIDAL TEETH","BOTH IP/OP","$10,725.00 ","$7,936.50 ","$0.00 ","$10,725.00 ","$4,826.25 ","$0.00 ","$2,235.36 ","$0.00 ","$0.00 ","$1,877.86 ","$10,725.00 ","$0.00 ","$5,362.50 ","$8,494.20 ","$8,580.00 ","$0.00 ","$1,678.46 ","$0.00 ","$1,707.42 ","$0.00 "
"10016","SUP","HCPCS C1713","","010016  -  PLATE BONE 3MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL","BOTH IP/OP","$490.88 ","$363.25 ","$0.00 ","$490.88 ","$220.89 ","$0.00 ","$102.31 ","$0.00 ","$0.00 ","$85.95 ","$490.88 ","$0.00 ","$245.44 ","$388.78 ","$392.70 ","$0.00 ","$76.82 ","$0.00 ","$78.15 ","$0.00 "
"10019","SUP","HCPCS C1713","","10019  -  SPACER ALLOGRAFT 8D NARROW PYRAMID LORDOTIC WEDGE 23-27MMX19","BOTH IP/OP","$10,725.00 ","$7,936.50 ","$0.00 ","$10,725.00 ","$4,826.25 ","$0.00 ","$2,235.36 ","$0.00 ","$0.00 ","$1,877.86 ","$10,725.00 ","$0.00 ","$5,362.50 ","$8,494.20 ","$8,580.00 ","$0.00 ","$1,678.46 ","$0.00 ","$1,707.42 ","$0.00 "
"10040","SUP","HCPCS C1713","","010040  -  SCREW 010040 X-DRV 1.0MM 4MM 6","BOTH IP/OP","$105.19 ","$77.84 ","$0.00 ","$105.19 ","$47.33 ","$0.00 ","$21.92 ","$0.00 ","$0.00 ","$18.42 ","$105.19 ","$0.00 ","$52.59 ","$83.31 ","$84.15 ","$0.00 ","$16.46 ","$0.00 ","$16.75 ","$0.00 "
"10060","SUP","HCPCS C1713","","010060  -  SCREW 010060 X-DRV 1.0MM 6MM 6","BOTH IP/OP","$106.60 ","$78.88 ","$0.00 ","$106.60 ","$47.97 ","$0.00 ","$22.22 ","$0.00 ","$0.00 ","$18.67 ","$106.60 ","$0.00 ","$53.30 ","$84.43 ","$85.28 ","$0.00 ","$16.68 ","$0.00 ","$16.97 ","$0.00 "
"10237","SUP","Custom 27203010","","10237  -  KIT GASTROSTOMY 11 .035IN J LP 18FR 22FR INTROD NEEDLE FEED","BOTH IP/OP","$584.88 ","$432.81 ","$0.00 ","$584.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$584.88 ","$0.00 ","$292.44 ","$438.37 ","$467.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10241","SUP","HCPCS C1713","","010241  -  CATHETER ANGIOGRAPHIC STR PIGTAIL CURVE 6FR 110CM 6 SIDEHOLE","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"10242","SUP","HCPCS C1713","","010242  -  CATHETER ANGIOGRAPHIC 145D VAN TASSEL ANGLED PIGTAIL CURVE 6","BOTH IP/OP","$388.88 ","$287.77 ","$0.00 ","$388.88 ","$174.99 ","$0.00 ","$81.05 ","$0.00 ","$0.00 ","$68.09 ","$388.88 ","$0.00 ","$194.44 ","$307.99 ","$311.10 ","$0.00 ","$60.86 ","$0.00 ","$61.91 ","$0.00 "
"10250","SUP","Custom 27203010","","10250  -  KIT GASTROSTOMY 12FR INTROD LAPSCOP MIC-KEY","BOTH IP/OP","$584.88 ","$432.81 ","$0.00 ","$584.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$584.88 ","$0.00 ","$292.44 ","$463.22 ","$467.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10354","SUP","Custom 27203010","","FUNNEL CNTRF FLTR CRD SL CAP SMPL CHMBR .4ML CYFNL CYTSPN","BOTH IP/OP","$207.05 ","$153.22 ","$0.00 ","$207.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.05 ","$0.00 ","$103.53 ","$163.98 ","$165.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10355","SUP","Custom 27203010","","FUNNEL CNTRF SGL FLTR CRD SL CAP .4ML CYFNL DISP WHT","BOTH IP/OP","$3.00 ","$2.22 ","$0.00 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.00 ","$0.00 ","$1.50 ","$2.38 ","$2.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10400","SUP","Custom 27203010","","REAGENT NEIS HMPHLS API ID CRD ANALY","BOTH IP/OP","$9.80 ","$7.25 ","$0.00 ","$9.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.80 ","$0.00 ","$4.90 ","$7.76 ","$7.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12110","SUP","HCPCS C1887","","12110  -  CATHETER PERFUSION 10IN VENT DLP PVC PEDIATRIC 10FR","BOTH IP/OP","$1.25 ","$0.93 ","$0.00 ","$1,149.45 ","$624.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.26 ","$1,149.45 ","$0.00 ","$574.73 ","$910.36 ","$919.56 ","$0.00 ","$179.89 ","$0.00 ","$182.99 ","$0.00 "
"13030","SUP","HCPCS C1713","","013030  -  SCREW 013030 X-DRV RESCUE 3MM 6PK","BOTH IP/OP","$99.52 ","$73.64 ","$0.00 ","$99.52 ","$44.78 ","$0.00 ","$20.74 ","$0.00 ","$0.00 ","$17.43 ","$99.52 ","$0.00 ","$49.76 ","$78.82 ","$79.62 ","$0.00 ","$15.58 ","$0.00 ","$15.84 ","$0.00 "
"13050","SUP","HCPCS C1713","","013050  -  SCREW 013050 X-DRV RESCUE 5MM 6PK","BOTH IP/OP","$105.19 ","$77.84 ","$0.00 ","$105.19 ","$47.33 ","$0.00 ","$21.92 ","$0.00 ","$0.00 ","$18.42 ","$105.19 ","$0.00 ","$52.59 ","$83.31 ","$84.15 ","$0.00 ","$16.46 ","$0.00 ","$16.75 ","$0.00 "
"13186","SUP","HCPCS C1713","","13186  -  ENDOBUTTON FIXATION BUTTON, 4X 12MM","BOTH IP/OP","$452.40 ","$334.78 ","$0.00 ","$452.40 ","$203.58 ","$0.00 ","$94.29 ","$0.00 ","$0.00 ","$79.21 ","$452.40 ","$0.00 ","$226.20 ","$358.30 ","$361.92 ","$0.00 ","$70.80 ","$0.00 ","$72.02 ","$0.00 "
"14000","SUP","Custom 27203010","","14000  -  SET CRDPLG .25IN 15IN DLP MLT 4 LG ADPR SLIP CNCT","BOTH IP/OP","$49.48 ","$36.62 ","$0.00 ","$49.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.48 ","$0.00 ","$24.74 ","$39.19 ","$39.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14070","SUP","Custom 27203010","","14070  -  SYSTEM 8 1/8-11.75IN OST C2000- ML MAXI DRAIN PORT","BOTH IP/OP","$42.70 ","$31.60 ","$0.00 ","$130.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.02 ","$0.00 ","$65.01 ","$102.98 ","$104.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15030","SUP","HCPCS C1713","","015030  -  SCREW BN 1.5MM 3MM TIMESH XDR TI CRNM","BOTH IP/OP","$92.44 ","$68.41 ","$0.00 ","$92.44 ","$41.60 ","$0.00 ","$19.27 ","$0.00 ","$0.00 ","$16.19 ","$92.44 ","$0.00 ","$46.22 ","$73.21 ","$73.95 ","$0.00 ","$14.47 ","$0.00 ","$14.72 ","$0.00 "
"15031","SUP","HCPCS C1713","","015031  -  SCREW 015031 SELF TAPPING 1.5X3MM 1","BOTH IP/OP","$104.13 ","$77.06 ","$0.00 ","$104.13 ","$46.86 ","$0.00 ","$21.70 ","$0.00 ","$0.00 ","$18.23 ","$104.13 ","$0.00 ","$52.06 ","$82.47 ","$83.30 ","$0.00 ","$16.30 ","$0.00 ","$16.58 ","$0.00 "
"15040","SUP","HCPCS C1713","","015040  -  PLATE BN STRG 4MM TIMESH 1 HLE/HD 1 HL SHFT TI CRNM 1.5MM","BOTH IP/OP","$99.17 ","$73.39 ","$0.00 ","$99.17 ","$44.63 ","$0.00 ","$20.67 ","$0.00 ","$0.00 ","$17.36 ","$99.17 ","$0.00 ","$49.58 ","$78.54 ","$79.33 ","$0.00 ","$15.52 ","$0.00 ","$15.79 ","$0.00 "
"15041","SUP","HCPCS C1713","","015041  -  SCREW 015041 SELF TAPPING 1.5X4MM 1","BOTH IP/OP","$106.25 ","$78.63 ","$0.00 ","$106.25 ","$47.81 ","$0.00 ","$22.15 ","$0.00 ","$0.00 ","$18.60 ","$106.25 ","$0.00 ","$53.13 ","$84.15 ","$85.00 ","$0.00 ","$16.63 ","$0.00 ","$16.92 ","$0.00 "
"15050","SUP","HCPCS C1713","","015050  -  SCREW 015050 X-DRV 1.5MM 5MM 6","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"15051","SUP","HCPCS C1713","","015051  -  SCREW 015051 SELF TAPPING 1.5X5MM 1","BOTH IP/OP","$104.13 ","$77.06 ","$0.00 ","$104.13 ","$46.86 ","$0.00 ","$21.70 ","$0.00 ","$0.00 ","$18.23 ","$104.13 ","$0.00 ","$52.06 ","$82.47 ","$83.30 ","$0.00 ","$16.30 ","$0.00 ","$16.58 ","$0.00 "
"15060","SUP","HCPCS C1713","","015060  -  SCREW 015060 X-DRV 1.5MM 6MM 6","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"15070","SUP","HCPCS C1713","","015070  -  SCREW 015070 X DRV 1.5MM 7MM 6","BOTH IP/OP","$99.52 ","$73.64 ","$0.00 ","$99.52 ","$44.78 ","$0.00 ","$20.74 ","$0.00 ","$0.00 ","$17.43 ","$99.52 ","$0.00 ","$49.76 ","$78.82 ","$79.62 ","$0.00 ","$15.58 ","$0.00 ","$15.84 ","$0.00 "
"15080","SUP","HCPCS C1713","","015080  -  SCREW 015080 X-DRV 1.5MM 8MM 6","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"15090","SUP","HCPCS C1713","","015090  -  SCREW BN 1.5MM 9MM XDR","BOTH IP/OP","$99.52 ","$73.64 ","$0.00 ","$99.52 ","$44.78 ","$0.00 ","$20.74 ","$0.00 ","$0.00 ","$17.43 ","$99.52 ","$0.00 ","$49.76 ","$78.82 ","$79.62 ","$0.00 ","$15.58 ","$0.00 ","$15.84 ","$0.00 "
"15110","SUP","HCPCS C1713","","015110  -  SCREW 015110 X-DRV 1.5MM 11MM 6","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"15170","SUP","Custom 27203010","","015170  -  STAPLER INTNL 57MMX.17MM LACTOMER ABS STPL SQZ","BOTH IP/OP","$1,226.30 ","$907.46 ","$0.00 ","$1,226.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,226.30 ","$0.00 ","$613.15 ","$971.23 ","$981.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15850","SUP","HCPCS C1758","","0015850  -  BAG DRN 9.5IN 19OZ STRL LTX 2 ADJ BELT ADPR NTR RBR BILE","BOTH IP/OP","$253.80 ","$187.81 ","$0.00 ","$253.80 ","$137.81 ","$0.00 ","$52.90 ","$0.00 ","$0.00 ","$44.44 ","$253.80 ","$0.00 ","$126.90 ","$201.01 ","$203.04 ","$0.00 ","$39.72 ","$0.00 ","$40.40 ","$0.00 "
"17061","SUP","Custom 27203010","","PUMP BRST 1 HND FLEXSHIELD","BOTH IP/OP","$55.15 ","$40.81 ","$0.00 ","$55.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.15 ","$0.00 ","$27.58 ","$43.68 ","$44.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17130","SUP","HCPCS C1713","","017130  -  PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR","BOTH IP/OP","$540.00 ","$399.60 ","$0.00 ","$540.00 ","$243.00 ","$0.00 ","$112.55 ","$0.00 ","$0.00 ","$94.55 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$84.51 ","$0.00 ","$85.97 ","$0.00 "
"17152","SUP","Custom 27203010","","KIT BRSTPMP 1 HND DUAL HYGIENIKIT","BOTH IP/OP","$92.10 ","$68.15 ","$0.00 ","$92.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.10 ","$0.00 ","$46.05 ","$72.94 ","$73.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17207","SUP","HCPCS C1762","","017207  -  GRAFT BONE CORT CNC SPCR ANT CERV INTRBD FS 7MM","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$0.00 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$0.00 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$0.00 ","$0.00 "
"17208","SUP","HCPCS C1789","","017208  -  SPACER ALGRF 5D LRDTC OVL 12X14X8MM FRZDR MNLTH LG CNTR LUM","BOTH IP/OP","$2,637.50 ","$1,951.75 ","$0.00 ","$2,637.50 ","$1,186.88 ","$0.00 ","$549.72 ","$0.00 ","$0.00 ","$461.81 ","$2,637.50 ","$0.00 ","$1,318.75 ","$2,088.90 ","$2,110.00 ","$0.00 ","$412.77 ","$0.00 ","$419.89 ","$0.00 "
"17251","SUP","HCPCS C1769","","17251  -  PLATINUM PLUS GUIDEWIRE .014X300CM WIRE","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$190.05 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"17614","SUP","Custom 27203010","","17614  -  STAPLER INTNL 55X4.8MM TI ENDSCP LNR CTR SQZ HNDL STRL LF","BOTH IP/OP","$493.05 ","$364.86 ","$0.00 ","$493.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$493.05 ","$0.00 ","$246.52 ","$390.50 ","$394.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18030","SUP","HCPCS C1713","","018030  -  SCREW 018030 X-DRV RESCUE 3MM 6PK","BOTH IP/OP","$91.73 ","$67.88 ","$0.00 ","$91.73 ","$41.28 ","$0.00 ","$19.12 ","$0.00 ","$0.00 ","$16.06 ","$91.73 ","$0.00 ","$45.86 ","$72.65 ","$73.38 ","$0.00 ","$14.36 ","$0.00 ","$14.60 ","$0.00 "
"18031","SUP","HCPCS C1713","","018031  -  SCREW 018031 CRUCIATE RESCUE 1.8X3MM 1","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$1,376.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,376.26 ","$0.00 ","$688.13 ","$77.42 ","$1,101.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18050","SUP","HCPCS C1713","","018050  -  SCREW 018050 X-DRV RESCUE 5MM 6PK","BOTH IP/OP","$91.73 ","$67.88 ","$0.00 ","$91.73 ","$41.28 ","$0.00 ","$19.12 ","$0.00 ","$0.00 ","$16.06 ","$91.73 ","$0.00 ","$45.86 ","$72.65 ","$73.38 ","$0.00 ","$14.36 ","$0.00 ","$14.60 ","$0.00 "
"18051","SUP","HCPCS C1713","","018051  -  SCREW 018051 CRUCIATE RESCUE 1.8X5MM 1","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"19004","SUP","Custom 27203010","","19004  -  KIT COLOSTOMY/ILEOSTOMY 2.25- IN 2.75IN 12IN 2 PIECE DRAIN","BOTH IP/OP","$34.71 ","$25.69 ","$0.00 ","$34.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.71 ","$0.00 ","$17.36 ","$27.49 ","$27.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19006","SUP","Custom 27203010","","19006  -  KIT OSTOMY 0-3.5IN 4IN 12IN 2 PIECE DRAIN LOCK N ROLL","BOTH IP/OP","$46.72 ","$34.57 ","$0.00 ","$46.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.72 ","$0.00 ","$23.36 ","$37.00 ","$37.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19203","SUP","Custom 27203010","","19203  -  KIT UROSTOMY CUT TO FIT 1.75- IN 2.25IN 9IN 2 PIECE BELT TAB","BOTH IP/OP","$52.03 ","$38.50 ","$0.00 ","$8.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.43 ","$0.00 ","$4.21 ","$6.68 ","$6.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20012","SUP","Custom 27203010","","20012  -  CANNULA PRFSN 12GA 5.5IN DLP ANTGRD STD TIP INTRO VNT LN","BOTH IP/OP","$2.28 ","$1.69 ","$0.00 ","$2.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.28 ","$0.00 ","$1.14 ","$1.81 ","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20028","SUP","Custom 27803010","","20028  -  VAD 20028 BH 12MM W/INT VENT 5.5CM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20033","SUP","HCPCS C1788","","20033  -  PORT 20033 3-WAY CONN W/O SILICONE","BOTH IP/OP","$565.25 ","$418.29 ","$0.00 ","$565.25 ","$254.36 ","$0.00 ","$117.81 ","$0.00 ","$0.00 ","$98.97 ","$565.25 ","$0.00 ","$282.63 ","$447.68 ","$452.20 ","$0.00 ","$88.46 ","$0.00 ","$89.99 ","$0.00 "
"20034","SUP","Custom 27203010","","20034  -  KIT 20034 EDM VENTRICULAR 35CM","BOTH IP/OP","$712.80 ","$527.47 ","$0.00 ","$712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.80 ","$0.00 ","$356.40 ","$564.54 ","$570.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20046","SUP","Custom 27803010","","20046  -  CATH 20046 VENT LARGE 23CM","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20116","SUP","HCPCS C1758","","020116  -  CATH URET 6FR 70CM .038IN OP-EN","BOTH IP/OP","$21.38 ","$15.82 ","$0.00 ","$21.38 ","$11.61 ","$0.00 ","$4.46 ","$0.00 ","$0.00 ","$3.74 ","$21.38 ","$0.00 ","$10.69 ","$16.93 ","$17.10 ","$0.00 ","$3.35 ","$0.00 ","$3.40 ","$0.00 "
"20141","SUP","Custom 27203010","","20141  -  DRESSING BURN 5X4IN ANTIMICROBIAL FAST ACT BARRIER CONTROL","BOTH IP/OP","$39.92 ","$29.54 ","$0.00 ","$39.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.92 ","$0.00 ","$19.96 ","$31.62 ","$31.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20201","SUP","Custom 27203010","","20201  -  DRESSING BURN ANBCTRL FAST ACT VRSTL NCRSTLN SLVR 8X4IN STRL","BOTH IP/OP","$121.69 ","$90.05 ","$0.00 ","$121.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$121.69 ","$0.00 ","$60.85 ","$96.38 ","$97.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20230","SUP","Custom 27203010","","REAGENT .85% SAL API 5ML ANALY","BOTH IP/OP","$160.88 ","$119.05 ","$0.00 ","$160.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.88 ","$0.00 ","$80.44 ","$127.42 ","$128.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20301","SUP","Custom 27203010","","FORMULA  ENFAMIL  AR  RTU","BOTH IP/OP","$176.40 ","$130.54 ","$0.00 ","$176.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.40 ","$0.00 ","$88.20 ","$139.71 ","$141.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20401","SUP","Custom 27203010","","20401  -  DRESSING BRN 16X16IN STRL LF ACTCT ANBCTRL FST ACT BRR CNTRL","BOTH IP/OP","$156.26 ","$115.63 ","$0.00 ","$158.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.60 ","$0.00 ","$79.30 ","$125.61 ","$126.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20421","SUP","Custom 27203010","","MATTRESS PT 16X10IN TRNWRMR PVC PORT NELCTR HEAT SRC INF","BOTH IP/OP","$57.78 ","$42.76 ","$0.00 ","$57.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.78 ","$0.00 ","$28.89 ","$45.76 ","$46.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20934","SUP","Custom 27203010","","020934  -  BAG OST GTCH SNTH UNV 4IN 14-14.5IN 2 PC DRAIN SRFT FLNG TPE","BOTH IP/OP","$81.06 ","$59.98 ","$0.00 ","$81.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.06 ","$0.00 ","$40.53 ","$64.20 ","$64.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21004","SUP","Custom 27803010","","21004  -  CATH 21004 PERT SML OPEN END W/SLITS","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21029","SUP","Custom 27803010","","21029  -  INLET 21029 V A D 12MM W/BOTTOM INLET","BOTH IP/OP","$1,082.60 ","$801.12 ","$0.00 ","$931.00 ","$0.00 ","$0.00 ","$225.64 ","$0.00 ","$0.00 ","$0.00 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21038","SUP","HCPCS C1769","","21038  -  GUIDEWIRE 21038 TEFLON COATED 100CM","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$116.07 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"21066","SUP","Custom 27803010","","21066  -  CONNECTOR 21066 LUMBOPERITONEAL STRT CSF","BOTH IP/OP","$178.13 ","$131.82 ","$0.00 ","$178.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.13 ","$0.00 ","$89.06 ","$141.08 ","$142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22013","SUP","Custom 27803010","","22013  -  CATH 22013 PER SML OPEN 90CM NO SLIT","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22014","SUP","Custom 27803010","","22014  -  CATH 22014 PER STD OPEN 96CM NO SLIT","BOTH IP/OP","$967.50 ","$715.95 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$201.65 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22039","SUP","Custom 27803010","","22039  -  VAD 22039 12MM","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22063","SUP","Custom 27803010","","22063  -  CONNECTOR 22063 STEPDOWN W/TUBING STD","BOTH IP/OP","$1,596.58 ","$1,181.47 ","$0.00 ","$332.77 ","$0.00 ","$0.00 ","$332.77 ","$0.00 ","$0.00 ","$0.00 ","$204.25 ","$0.00 ","$102.13 ","$161.77 ","$163.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22104","SUP","Custom 27803010","","22104  -  VAD 22104 NEONATE RES W/BOTTOM INLET","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22150","SUP","Custom 27203010","","22150  -  DEVICE BLWR/MSTR STRL LF CLRVW TUBE SET N180 N185","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22355","SUP","HCPCS C1713","","22355  -  ROD OST 64MM STRL LF LOOP DISP SFN 70MM FLNG","BOTH IP/OP","$3.65 ","$2.70 ","$0.00 ","$3.70 ","$1.66 ","$0.00 ","$0.76 ","$0.00 ","$0.00 ","$0.65 ","$3.70 ","$0.00 ","$1.85 ","$2.93 ","$2.96 ","$0.00 ","$0.58 ","$0.00 ","$0.59 ","$0.00 "
"22356","SUP","HCPCS C1713","","22356  -  ROD OST 90MM STRL LF SFN CNVTC LOOP DISP 4IN FLNG SKN BRR","BOTH IP/OP","$37.00 ","$27.38 ","$0.00 ","$37.00 ","$16.65 ","$0.00 ","$7.71 ","$0.00 ","$0.00 ","$6.48 ","$37.00 ","$0.00 ","$18.50 ","$29.30 ","$29.60 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"23014","SUP","Custom 27203010","","23014  -  KIT 23014 EDM VENTRICULAR","BOTH IP/OP","$326.40 ","$241.54 ","$0.00 ","$326.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.40 ","$0.00 ","$163.20 ","$258.51 ","$261.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23021","SUP","Custom 27803010","","23021  -  CONNECTOR 23021 LUERLOCK TO FIT 1.5MM ID","BOTH IP/OP","$153.60 ","$113.66 ","$0.00 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$153.60 ","$0.00 ","$76.80 ","$121.65 ","$122.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23045","SUP","Custom 27203010","","23045  -  EDM 23045 PATIENT LINE 91CM W/FEM LR","BOTH IP/OP","$177.60 ","$131.42 ","$0.00 ","$177.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.60 ","$0.00 ","$88.80 ","$140.66 ","$142.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23047","SUP","Custom 27803010","","23047  -  CATH 23047 PERIT STD OE W/SLITS 120","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23067","SUP","HCPCS C2619","","23067  -  ADAPTER 23067 PREIMPLANT TEST SNAP ASSY","BOTH IP/OP","$225.63 ","$166.97 ","$0.00 ","$225.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.63 ","$0.00 ","$112.81 ","$178.70 ","$180.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23069","SUP","Custom 27803010","","23069  -  SHUNT 23069 L-P K-TUBE W/PROX TIP","BOTH IP/OP","$2,272.88 ","$1,681.93 ","$0.00 ","$2,272.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,272.88 ","$0.00 ","$1,136.44 ","$1,800.12 ","$1,818.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23075","SUP","Custom 27803010","","23075  -  CATHETER 23075 VENTRICULAR POLYURETHANE","BOTH IP/OP","$3,479.38 ","$2,574.74 ","$0.00 ","$3,479.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,479.38 ","$0.00 ","$1,739.69 ","$2,755.67 ","$2,783.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23076","SUP","Custom 27803010","","23076  -  CATHETER 23076 PERITITONEAL POLYURETHANE","BOTH IP/OP","$2,470.00 ","$1,827.80 ","$0.00 ","$2,470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,470.00 ","$0.00 ","$1,235.00 ","$1,956.24 ","$1,976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23092","SUP","HCPCS C1750","","23092  -  CATHETER DLYS STD 120CM STRL BA IMPRG OP-EN WL SLT","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$188.10 ","$0.00 ","$87.12 ","$0.00 ","$0.00 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"23093","SUP","Custom 27803010","","23093  -  VALVE 23093 CONT. REG. LOW-LOW","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24010","SUP","Custom 27803010","","24010  -  CATHETER 24010 C/P STD 120CM","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24048","SUP","Custom 27803010","","24048  -  VALVE 24048 DELTA RGL PL 0.5","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24052","SUP","Custom 27203010","","24052  -  KIT 24052 VENTRICULOSTOMY RES 18MM","BOTH IP/OP","$693.50 ","$513.19 ","$0.00 ","$693.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$693.50 ","$0.00 ","$346.75 ","$549.25 ","$554.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24053","SUP","Custom 27803010","","24053  -  CHAMBER 24053 DELTA","BOTH IP/OP","$2,690.88 ","$1,991.25 ","$0.00 ","$5,472.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,690.88 ","$0.00 ","$1,345.44 ","$2,131.18 ","$2,152.70 ","$0.00 ","$5,472.96 ","$0.00 ","$0.00 ","$0.00 "
"24084","SUP","Custom 27803010","","24084  -  RESVR 24084 12MM W INLET AND OUTLET CONN","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24085","SUP","Custom 27803010","","24085  -  DOME 24085 SNAP VENTRIC W/15CM TUBE","BOTH IP/OP","$605.63 ","$448.17 ","$0.00 ","$605.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.63 ","$0.00 ","$302.81 ","$479.66 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24094","SUP","Custom 27803010","","24094  -  CATH 24094 VENT STD INCL SNAP BASE","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24114","SUP","Custom 27803010","","24114  -  CONNECTOR SHNT .7MM CSF LL INTGR PLG","BOTH IP/OP","$187.20 ","$138.53 ","$0.00 ","$187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.20 ","$0.00 ","$93.60 ","$148.26 ","$149.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24146","SUP","Custom 27203010","","24146  -  EDMS 24146 BECKER NO Y-SITE","BOTH IP/OP","$547.20 ","$404.93 ","$0.00 ","$547.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$547.20 ","$0.00 ","$273.60 ","$433.38 ","$437.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24147","SUP","Custom 27803010","","24147  -  VALVE 24147 DELTA SML PL 0.5","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24148","SUP","Custom 27803010","","24148  -  CATH 24148 C/P STD 110CM NO MARKERS","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24154","SUP","Custom 27803010","","24154  -  CATH 24154 VENT STD TRNS W/STRIPE","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24605","SUP","HCPCS C1758","","024605  -  CATH URET 4.8FR 8FR 70CM CONE TIP MCK","BOTH IP/OP","$28.54 ","$21.12 ","$0.00 ","$28.54 ","$15.50 ","$0.00 ","$5.95 ","$0.00 ","$0.00 ","$5.00 ","$28.54 ","$0.00 ","$14.27 ","$22.60 ","$22.83 ","$0.00 ","$4.47 ","$0.00 ","$4.54 ","$0.00 "
"24605","SUP","HCPCS C1758","","24605  -  CATH URET 4.8FR 8FR 70CM CONE TIP MCK","BOTH IP/OP","$28.54 ","$21.12 ","$0.00 ","$28.54 ","$15.50 ","$0.00 ","$5.95 ","$0.00 ","$0.00 ","$5.00 ","$28.54 ","$0.00 ","$14.27 ","$23.44 ","$22.83 ","$0.00 ","$4.47 ","$0.00 ","$4.54 ","$0.00 "
"24712","SUP","Custom 27803010","","24712  -  TUBE VNT T FIRM FLNG 1.14MM 9.5MM 12MM GOODE SFT SIL EAR","BOTH IP/OP","$56.75 ","$42.00 ","$0.00 ","$56.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.75 ","$0.00 ","$28.38 ","$44.95 ","$45.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25020","SUP","Custom 27203010","","OTOSCOPE 3.5V DX SPCLA HAL LGHT WA LEN FBROP SL SYS EXAM","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25024","SUP","Custom 27803010","","25024  -  CATH 25024 PERIT STD TRNS W/STRPE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25027","SUP","Custom 27803010","","25027  -  CONNECTOR 25027 STRT STAINLESS STEEL IMP","BOTH IP/OP","$204.25 ","$151.15 ","$0.00 ","$204.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$204.25 ","$0.00 ","$102.13 ","$161.77 ","$163.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25030","SUP","Custom 27203010","","25030  -  KIT 25030 EDM 46115 46124 46126","BOTH IP/OP","$513.60 ","$380.06 ","$0.00 ","$513.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$513.60 ","$0.00 ","$256.80 ","$406.77 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25068","SUP","Custom 27203010","","25068  -  KIT 25068 EDM 46124 46126","BOTH IP/OP","$290.40 ","$214.90 ","$0.00 ","$290.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.40 ","$0.00 ","$145.20 ","$230.00 ","$232.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25077","SUP","Custom 27803010","","25077  -  TAB FX 1.5MM SIL","BOTH IP/OP","$3,601.78 ","$2,665.32 ","$0.00 ","$750.70 ","$0.00 ","$0.00 ","$750.70 ","$0.00 ","$0.00 ","$0.00 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25104","SUP","Custom 27803010","","25104  -  CATHETER 25104 CP STD TRANS RAD STRP 90","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25115","SUP","Custom 27203010","","REAGENT HBSAG EVOLIS BRCD ANALY","BOTH IP/OP","$496.25 ","$367.23 ","$0.00 ","$496.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$496.25 ","$0.00 ","$248.13 ","$393.03 ","$397.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25120","SUP","Custom 27203010","","25120  -  EDMS II 25120 BECKER W/1-WAY VALVE","BOTH IP/OP","$628.13 ","$464.82 ","$0.00 ","$471.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.11 ","$0.00 ","$14.56 ","$471.40 ","$23.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25123","SUP","HCPCS C1894","","25123  -  TROCAR 25123 WITH PROTECTOR SHEATH","BOTH IP/OP","$237.60 ","$175.82 ","$0.00 ","$237.60 ","$129.02 ","$0.00 ","$49.52 ","$0.00 ","$0.00 ","$41.60 ","$237.60 ","$0.00 ","$118.80 ","$188.18 ","$190.08 ","$0.00 ","$37.18 ","$0.00 ","$37.83 ","$0.00 "
"25173","SUP","Custom 27203010","","KIT IMMUN TST MCPLT EIA RBLA IGG 96 TST","BOTH IP/OP","$356.13 ","$263.54 ","$0.00 ","$356.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.13 ","$0.00 ","$178.06 ","$282.05 ","$284.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25175","SUP","Custom 27203010","","KIT IMMUN TST EIA TOXOPLASMA IGG 96 TST","BOTH IP/OP","$356.13 ","$263.54 ","$0.00 ","$356.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.13 ","$0.00 ","$178.06 ","$282.05 ","$284.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25177","SUP","Custom 27203010","","REAGENT CMV IGG AXSYM EIA 96 TST ANALY","BOTH IP/OP","$356.93 ","$264.13 ","$0.00 ","$356.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.93 ","$0.00 ","$178.46 ","$282.69 ","$285.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25220","SUP","Custom 27203010","","CONTROL ANTI HBS IGM MONOLISA EIA IMMUN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25280","SUP","Custom 27203010","","KIT IMMUN TST MONOLISA BRCD SEQ ANTI HBS","BOTH IP/OP","$552.50 ","$408.85 ","$0.00 ","$552.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$552.50 ","$0.00 ","$276.25 ","$437.58 ","$442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25506","SUP","Custom 27203010","","025506  -  STENT URET 6FR 125CM 2 PGTL CURVE URTSCP SET DRETLER BLUE","BOTH IP/OP","$109.68 ","$81.16 ","$0.00 ","$109.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.68 ","$0.00 ","$54.84 ","$86.87 ","$87.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26040","SUP","Custom 27203010","","26040  -  KIT 26040 BECKER EDMS II","BOTH IP/OP","$31.43 ","$23.26 ","$0.00 ","$825.60 ","$0.00 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$0.00 ","$825.60 ","$0.00 ","$412.80 ","$653.88 ","$660.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26054","SUP","HCPCS C1726","","26054  -  DILAT VASC 4FR 20CM HYDPHI DECREASED FRCTN RADIOPQ STRL DISP","BOTH IP/OP","$26.25 ","$19.43 ","$0.00 ","$26.25 ","$14.25 ","$0.00 ","$5.47 ","$0.00 ","$0.00 ","$4.60 ","$26.25 ","$0.00 ","$13.13 ","$20.79 ","$21.00 ","$0.00 ","$4.11 ","$0.00 ","$4.18 ","$0.00 "
"26057","SUP","Custom 27203010","","26057  -  EDM 26021 CATH VENT STD TRANS 25CM","BOTH IP/OP","$364.80 ","$269.95 ","$0.00 ","$364.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$364.80 ","$0.00 ","$182.40 ","$288.92 ","$291.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26075","SUP","Custom 27803010","","26075  -  RES 26075 VENT BH V-CATH W/7.5MM HLS","BOTH IP/OP","$1,444.00 ","$1,068.56 ","$0.00 ","$1,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,444.00 ","$0.00 ","$722.00 ","$1,143.65 ","$1,155.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26174","SUP","Custom 27203010","","CONTROL ANTI HBC IGM MONOLISA EIA IMMUN","BOTH IP/OP","$1,612.50 ","$1,193.25 ","$0.00 ","$1,612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,612.50 ","$0.00 ","$806.25 ","$1,277.10 ","$1,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26186","SUP","Custom 27203010","","CONTROL ANTI-HBC HBV MONOLISA EIA 192 TST IMMUN","BOTH IP/OP","$1,387.50 ","$1,026.75 ","$0.00 ","$1,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,387.50 ","$0.00 ","$693.75 ","$1,098.90 ","$1,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26189","SUP","Custom 27203010","","KIT IMMUN TST MONOLISA BRCD ANTI HAV","BOTH IP/OP","$496.25 ","$367.23 ","$0.00 ","$496.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$496.25 ","$0.00 ","$248.13 ","$393.03 ","$397.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27010","SUP","Custom 27803010","","27010  -  CATH 27010 CSF-PERIT TRANS XTRA LM","BOTH IP/OP","$600.88 ","$444.65 ","$0.00 ","$600.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.88 ","$0.00 ","$300.44 ","$475.90 ","$480.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27051","SUP","Custom 27803010","","27051  -  VAD 27051 6MM BH UNITIZED CONV.","BOTH IP/OP","$605.63 ","$448.17 ","$0.00 ","$605.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.63 ","$0.00 ","$302.81 ","$479.66 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27081","SUP","Custom 27803010","","27081  -  SHUNT 27081 DELTA ASSY RGL PL 0.5","BOTH IP/OP","$3,462.75 ","$2,562.44 ","$0.00 ","$3,462.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,462.75 ","$0.00 ","$1,731.38 ","$2,742.50 ","$2,770.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27102","SUP","Custom 27803010","","27102  -  VALVE 27102 CONTOURED SML LOW LOW","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27106","SUP","Custom 27803010","","27106  -  BASE 27106 SNAP ASSY W/LARGER ID","BOTH IP/OP","$275.50 ","$203.87 ","$0.00 ","$275.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.50 ","$0.00 ","$137.75 ","$218.20 ","$220.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27156","SUP","Custom 27803010","","27156  -  CATH 27156 VENT 1.3X2.5 FXTN COLLAR","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27165","SUP","Custom 27803010","","27165  -  CATH 27165 VENT INNERVISION 1.5X2.8","BOTH IP/OP","$505.88 ","$374.35 ","$0.00 ","$505.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.88 ","$0.00 ","$252.94 ","$400.66 ","$404.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27211","SUP","Custom 27803010","","27211  -  CATH 27211 VENT SLOTTED 16CM","BOTH IP/OP","$472.63 ","$349.75 ","$0.00 ","$472.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$472.63 ","$0.00 ","$236.31 ","$374.32 ","$378.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27240","SUP","Custom 27803010","","27240  -  CATHETER DRN 15CM STRL LF INNERVISION DISP","BOTH IP/OP","$505.88 ","$374.35 ","$0.00 ","$505.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.88 ","$0.00 ","$252.94 ","$400.66 ","$404.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27251","SUP","Custom 27803010","","27251  -  CATH 27251 VENT SML 8MM OF HOLE","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27274","SUP","Custom 27203010","","27274  -  KIT 27274 VENTRICULOSTOMY RES UNIT","BOTH IP/OP","$821.75 ","$608.10 ","$0.00 ","$821.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$821.75 ","$0.00 ","$410.88 ","$650.83 ","$657.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27297","SUP","Custom 27203010","","27297  -  KIT 27297 EDM DRAINAG VENT CATH","BOTH IP/OP","$806.40 ","$596.74 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$806.40 ","$0.00 ","$403.20 ","$638.67 ","$645.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27298","SUP","HCPCS C1753","","27298  -  V-CATH 27298 INNERVISION W/ SNAP BASE","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$361.10 ","$0.00 ","$138.60 ","$0.00 ","$0.00 ","$116.44 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$104.07 ","$0.00 ","$105.87 ","$0.00 "
"27302","SUP","Custom 27203010","","27302  -  DRAIN 27302 EDM LUMBAR W/120 GRAD CH","BOTH IP/OP","$808.80 ","$598.51 ","$0.00 ","$808.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.80 ","$0.00 ","$404.40 ","$640.57 ","$647.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27303","SUP","Custom 27203010","","27303  -  KIT 27303 EDM LUMBAR DRAINAGE OPEN","BOTH IP/OP","$705.60 ","$522.14 ","$0.00 ","$705.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$705.60 ","$0.00 ","$352.80 ","$558.84 ","$564.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27304","SUP","Custom 27203010","","27304  -  KIT 27304 EDM LUMBAR DRAINAGE CLOSED","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$684.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$684.00 ","$0.00 ","$342.00 ","$541.73 ","$547.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27327","SUP","Custom 27803010","","27327  -  CATH 27327 VENT STD EXTR TRANSLUC 23CM","BOTH IP/OP","$876.38 ","$648.52 ","$0.00 ","$876.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$876.38 ","$0.00 ","$438.19 ","$694.09 ","$701.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27328","SUP","HCPCS C1750","","27328  -  PCATH 27328 EXTRACTED 90 CM","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$598.50 ","$0.00 ","$277.21 ","$0.00 ","$0.00 ","$232.87 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$208.15 ","$0.00 ","$211.74 ","$0.00 "
"27384","SUP","Custom 27803010","","27384  -  CATH 27384 EDM VENT 20CM W/TROCAR","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$396.00 ","$0.00 ","$198.00 ","$313.63 ","$316.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27497","SUP","Custom 27803010","","27497  -  SHUNT 27497 DELTA ASSY SMALL BG 0.5","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27498","SUP","Custom 27803010","","27498  -  SHUNT 27498 DELTA ASSY REG BG 0.5","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27510","SUP","Custom 27203010","","27510  -  EDMS 27510 BECKER W/ Y-SITE EURO","BOTH IP/OP","$520.80 ","$385.39 ","$0.00 ","$520.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$520.80 ","$0.00 ","$260.40 ","$412.47 ","$416.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27536","SUP","Custom 27803010","","27536  -  CATHETER 27536 PERIT W/BIOGLIDE 8 SLITS","BOTH IP/OP","$543.88 ","$402.47 ","$0.00 ","$543.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.88 ","$0.00 ","$271.94 ","$430.75 ","$435.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27548","SUP","Custom 27803010","","27548  -  CATH 27548 PERIT STD OE TRANS BS 120CM","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27579","SUP","Custom 27203010","","27579  -  EDMS 27579 EXACTA W/ PATIENT LINE Y-PORT","BOTH IP/OP","$412.80 ","$305.47 ","$0.00 ","$412.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.80 ","$0.00 ","$206.40 ","$326.94 ","$330.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27581","SUP","Custom 27203010","","27581  -  KIT 27581 EXACTA W/EDM VCATH 35CM","BOTH IP/OP","$777.60 ","$575.42 ","$0.00 ","$777.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$777.60 ","$0.00 ","$388.80 ","$615.86 ","$622.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27600","SUP","Custom 27803010","","27600  -  CATH 27600 VENT INNERVISION SLOTTED 15CM","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27613","SUP","Custom 27203010","","27613  -  LASER 27613 EXACTA W/SCREW ASSY","BOTH IP/OP","$1,024.80 ","$758.35 ","$0.00 ","$1,024.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,024.80 ","$0.00 ","$512.40 ","$811.64 ","$819.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27617","SUP","Custom 27203010","","27617  -  TUBE 27617 TRANS W/STRPE STR CONN","BOTH IP/OP","$539.13 ","$398.96 ","$0.00 ","$539.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$539.13 ","$0.00 ","$269.56 ","$426.99 ","$431.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27623","SUP","Custom 27803010","","27623  -  CATH 27623 INNERV15CM XTRA HOLES 2CM","BOTH IP/OP","$662.63 ","$490.35 ","$0.00 ","$662.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.63 ","$0.00 ","$331.31 ","$524.80 ","$530.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27628","SUP","Custom 27203010","","27628  -  KIT 27628 CSF-VENT RES BH VCATH 15CM","BOTH IP/OP","$836.00 ","$618.64 ","$0.00 ","$836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$836.00 ","$0.00 ","$418.00 ","$662.11 ","$668.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27629","SUP","HCPCS C1729","","27629  -  PCATH 27629 90 TRANS W/STRIPE NO SLT","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$226.97 ","$0.00 ","$87.12 ","$0.00 ","$0.00 ","$73.19 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$65.42 ","$0.00 ","$66.55 ","$0.00 "
"27636","SUP","Custom 27203010","","27636  -  EDM 27636 EXACTA W/BRAIDED CORD LOCK","BOTH IP/OP","$446.40 ","$330.34 ","$0.00 ","$353.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.67 ","$0.00 ","$12.34 ","$353.55 ","$19.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27637","SUP","Custom 27203010","","27637  -  EDM 27637 VCATH TRANS OD 4.9MM W/TROC","BOTH IP/OP","$554.40 ","$410.26 ","$0.00 ","$554.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$554.40 ","$0.00 ","$277.20 ","$439.08 ","$443.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27654","SUP","Custom 27203010","","27654  -  BAG 27654 EXACTA W/DRAINPORT GLUED ON","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27659","SUP","Custom 27203010","","27659  -  EDM 27659 V/CATHETER 20CM LENGTH MARKER","BOTH IP/OP","$436.80 ","$323.23 ","$0.00 ","$345.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$345.95 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27664","SUP","Custom 27803010","","27664  -  RES 27664 CSF-VENT 12MM CONV BTTM INLET","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27666","SUP","Custom 27203010","","27666  -  EDM 27666 EXCTA W GLUE STPCK GR PT LN","BOTH IP/OP","$400.80 ","$296.59 ","$0.00 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.80 ","$0.00 ","$200.40 ","$317.43 ","$320.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27673","SUP","Custom 27203010","","27673  -  KIT 27673 EXACTA W/EDM VCATH BIOGL 35CM","BOTH IP/OP","$859.20 ","$635.81 ","$0.00 ","$859.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.20 ","$0.00 ","$429.60 ","$680.49 ","$687.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27695","SUP","Custom 27803010","","27695  -  CATH 27695 EDM VENT TRANS W/STRIPE 35CM","BOTH IP/OP","$451.20 ","$333.89 ","$0.00 ","$357.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.72 ","$0.00 ","$3.86 ","$357.35 ","$6.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27702","SUP","Custom 27203010","","27702  -  EDMS 27702 EURO BECKER II GR PT LN","BOTH IP/OP","$556.80 ","$412.03 ","$0.00 ","$556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.80 ","$0.00 ","$278.40 ","$440.99 ","$445.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27703","SUP","HCPCS C1729","","27703  -  CATHETER DRN LG 35CM STRL LL CNCT LGTH MRKNG VNTRC","BOTH IP/OP","$424.80 ","$314.35 ","$0.00 ","$424.80 ","$230.67 ","$0.00 ","$88.54 ","$0.00 ","$0.00 ","$74.38 ","$424.80 ","$0.00 ","$212.40 ","$336.44 ","$339.84 ","$0.00 ","$66.48 ","$0.00 ","$67.63 ","$0.00 "
"27705","SUP","Custom 27803010","","27705  -  CATH 27705 EDM NUM LNGTHMARK BIO 35CM","BOTH IP/OP","$460.80 ","$340.99 ","$0.00 ","$460.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.80 ","$0.00 ","$230.40 ","$364.95 ","$368.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27710","SUP","Custom 27803010","","27710  -  CATH 27710 EDM NUM LNGTHMRK BIO 35CM","BOTH IP/OP","$492.00 ","$364.08 ","$0.00 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$492.00 ","$0.00 ","$246.00 ","$389.66 ","$393.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27725","SUP","Custom 27803010","","27725  -  CATH 27725 VENT 8MM HLS NUM LM 23CM","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27726","SUP","Custom 27803010","","27726  -  CATH 27726 VENT 8MM HLS NUM LM 23CM BIO","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$513.00 ","$0.00 ","$256.50 ","$406.30 ","$410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27732","SUP","Custom 27203010","","27732  -  EDM 27732 EXACTA W/NDL-LS INJ. ST W/CAP","BOTH IP/OP","$472.80 ","$349.87 ","$0.00 ","$472.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$472.80 ","$0.00 ","$236.40 ","$374.46 ","$378.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27739","SUP","Custom 27803010","","27739  -  SHUNT 27739 STRATA NSC SNAP SML 120CM","BOTH IP/OP","$10,361.15 ","$7,667.25 ","$0.00 ","$10,361.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,361.15 ","$0.00 ","$5,180.58 ","$8,206.03 ","$8,288.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27740","SUP","Custom 27803010","","27740  -  SHUNT 27740 STRATA NSC SNAP REG 120CM","BOTH IP/OP","$10,361.15 ","$7,667.25 ","$0.00 ","$10,361.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,361.15 ","$0.00 ","$5,180.58 ","$8,206.03 ","$8,288.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27771","SUP","Custom 27803010","","27771  -  CATH 27771 VENTR EDM STD W/L-MARKERS","BOTH IP/OP","$374.40 ","$277.06 ","$0.00 ","$374.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.40 ","$0.00 ","$187.20 ","$296.52 ","$299.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27779","SUP","Custom 27203010","","27779  -  EDMS 27779 BECKER BC NDLESS BOND CONN","BOTH IP/OP","$549.60 ","$406.70 ","$0.00 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.60 ","$0.00 ","$274.80 ","$435.28 ","$439.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27781","SUP","Custom 27803010","","27781  -  CATH 27781 INNERV 3 SETS FLOW HLS 23CM","BOTH IP/OP","$840.75 ","$622.16 ","$0.00 ","$840.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$840.75 ","$0.00 ","$420.38 ","$665.87 ","$672.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27785","SUP","Custom 27203010","","27785  -  EDMS 27785 EXACTA 50ML BC NDLESS INJ","BOTH IP/OP","$475.20 ","$351.65 ","$0.00 ","$475.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.20 ","$0.00 ","$237.60 ","$376.36 ","$380.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27786","SUP","Custom 27803010","","27786  -  SHUNT 27786 STRATA NSC UNI-KIT SML BIOGL","BOTH IP/OP","$10,114.40 ","$7,484.66 ","$0.00 ","$8,010.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,136.00 ","$0.00 ","$1,136.00 ","$8,010.60 ","$908.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27787","SUP","Custom 27803010","","27787  -  SHUNT 27787 STRATA NSC UNI-KIT REG BIOGL","BOTH IP/OP","$10,114.40 ","$7,484.66 ","$0.00 ","$10,114.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,114.40 ","$0.00 ","$5,057.20 ","$8,010.60 ","$8,091.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27788","SUP","Custom 27803010","","27788  -  SHUNT 27788 STRATA NSC SNAP ASSY SM BG","BOTH IP/OP","$11,202.45 ","$8,289.81 ","$0.00 ","$11,202.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,202.45 ","$0.00 ","$5,601.23 ","$8,872.34 ","$8,961.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27789","SUP","Custom 27803010","","27789  -  SHUNT 27789 STRATA NSC SNAP ASSY RG BG","BOTH IP/OP","$11,202.45 ","$8,289.81 ","$0.00 ","$11,202.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,202.45 ","$0.00 ","$5,601.23 ","$8,872.34 ","$8,961.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27794","SUP","Custom 27803010","","27794  -  NSC 27794 N/A STRATA SNAPSHNT NO FLANGE","BOTH IP/OP","$10,361.15 ","$7,667.25 ","$0.00 ","$10,361.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,361.15 ","$0.00 ","$5,180.58 ","$8,206.03 ","$8,288.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27795","SUP","Custom 27203010","","27795  -  EDMS 27795 EXACTA 100ML CATH","BOTH IP/OP","$775.20 ","$573.65 ","$0.00 ","$775.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$775.20 ","$0.00 ","$387.60 ","$613.96 ","$620.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27811","SUP","Custom 27203010","","27811  -  EDMS 27811 BECKER GRN PL VCATH","BOTH IP/OP","$792.00 ","$586.08 ","$0.00 ","$792.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$792.00 ","$0.00 ","$396.00 ","$627.26 ","$633.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27812","SUP","Custom 27803010","","27812  -  VALVE 27812 STRATA II SM EXTRACTED","BOTH IP/OP","$10,144.95 ","$7,507.26 ","$0.00 ","$10,144.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,144.95 ","$0.00 ","$5,072.48 ","$8,034.80 ","$8,115.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27814","SUP","Custom 27803010","","27814  -  SHUNT 27814 STRATA II ASSY SML","BOTH IP/OP","$10,770.05 ","$7,969.84 ","$0.00 ","$10,770.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,770.05 ","$0.00 ","$5,385.03 ","$8,529.88 ","$8,616.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27815","SUP","Custom 27803010","","27815  -  SHUNT 27815 STRATA II ASSY REG","BOTH IP/OP","$10,770.05 ","$7,969.84 ","$0.00 ","$10,770.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,770.05 ","$0.00 ","$5,385.03 ","$8,529.88 ","$8,616.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27816","SUP","Custom 27803010","","27816  -  SHUNT 27816 SNAP STRATA II SMALL","BOTH IP/OP","$11,167.20 ","$8,263.73 ","$0.00 ","$11,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,167.20 ","$0.00 ","$5,583.60 ","$8,844.42 ","$8,933.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27817","SUP","Custom 27803010","","27817  -  SHUNT 27817 SNAP STRATA II REG","BOTH IP/OP","$11,167.20 ","$8,263.73 ","$0.00 ","$11,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,167.20 ","$0.00 ","$5,583.60 ","$8,844.42 ","$8,933.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27818","SUP","Custom 27803010","","27818  -  SHUNT 27818 STRATA II SML BIO","BOTH IP/OP","$11,418.65 ","$8,449.80 ","$0.00 ","$11,418.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,418.65 ","$0.00 ","$5,709.33 ","$9,043.57 ","$9,134.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27819","SUP","Custom 27803010","","27819  -  SHUNT 27819 STRATA II REG BIO","BOTH IP/OP","$11,418.65 ","$8,449.80 ","$0.00 ","$11,418.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,418.65 ","$0.00 ","$5,709.33 ","$9,043.57 ","$9,134.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27820","SUP","Custom 27203010","","27820  -  KIT 27820 UNI STRATA II SM V 11 PCATH90","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27821","SUP","Custom 27203010","","27821  -  KIT 27821 UNI STRATA II REG V13 PCATH90","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27822","SUP","Custom 27803010","","27822  -  SHUNT 27822 STRATA II SNP ASSY SM BIO","BOTH IP/OP","$12,003.80 ","$8,882.81 ","$0.00 ","$12,003.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,003.80 ","$0.00 ","$6,001.90 ","$9,507.01 ","$9,603.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27823","SUP","Custom 27803010","","27823  -  SHUNT 27823 STRATA II ASSY SNP REG BIO","BOTH IP/OP","$12,003.80 ","$8,882.81 ","$0.00 ","$12,003.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,003.80 ","$0.00 ","$6,001.90 ","$9,507.01 ","$9,603.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27824","SUP","Custom 27803010","","27824  -  SHUNT 27824 UNI STRATA II SM BIO","BOTH IP/OP","$11,385.75 ","$8,425.46 ","$0.00 ","$11,385.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,385.75 ","$0.00 ","$5,692.88 ","$9,017.51 ","$9,108.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27825","SUP","Custom 27803010","","27825  -  SHUNT 27825 STRATA II UNI REG BIO","BOTH IP/OP","$11,385.75 ","$8,425.46 ","$0.00 ","$11,385.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,385.75 ","$0.00 ","$5,692.88 ","$9,017.51 ","$9,108.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27827","SUP","Custom 27803010","","27827  -  VALVE 27827 STRATA II REG EXTRACTED","BOTH IP/OP","$10,144.95 ","$7,507.26 ","$0.00 ","$10,144.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,144.95 ","$0.00 ","$5,072.48 ","$8,034.80 ","$8,115.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27828","SUP","Custom 27803010","","27828  -  VALVE 27828 STRATA II SML INLET BUTTON","BOTH IP/OP","$10,953.35 ","$8,105.48 ","$0.00 ","$10,953.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,953.35 ","$0.00 ","$5,476.68 ","$8,675.05 ","$8,762.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27829","SUP","Custom 27803010","","27829  -  VALVE 27829 STRATA II REG INLET BUTTON","BOTH IP/OP","$10,953.35 ","$8,105.48 ","$0.00 ","$10,953.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,953.35 ","$0.00 ","$5,476.68 ","$8,675.05 ","$8,762.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27830","SUP","Custom 27803010","","27830  -  SHUNT 27830 SNAP STRATA II SML BLUNT","BOTH IP/OP","$11,167.20 ","$8,263.73 ","$0.00 ","$11,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,167.20 ","$0.00 ","$5,583.60 ","$8,844.42 ","$8,933.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27831","SUP","Custom 27803010","","27831  -  SHUNT 27831 SNAP STRATA II REG BLUNT P/C","BOTH IP/OP","$11,167.20 ","$8,263.73 ","$0.00 ","$11,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,167.20 ","$0.00 ","$5,583.60 ","$8,844.42 ","$8,933.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27832","SUP","Custom 27803010","","27832  -  VALVE 27832 SNAP STRATA II REG BLUNT","BOTH IP/OP","$10,156.70 ","$7,515.96 ","$0.00 ","$10,156.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,156.70 ","$0.00 ","$5,078.35 ","$8,044.11 ","$8,125.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27842","SUP","Custom 27803010","","27842  -  CATHETER 27842 EDMS VENTRICULAR STD 28CM","BOTH IP/OP","$297.60 ","$220.22 ","$0.00 ","$297.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.60 ","$0.00 ","$148.80 ","$235.70 ","$238.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27843","SUP","Custom 27803010","","27843  -  CATHETER 27843 VENTRICULAR STD 15CM","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27848","SUP","Custom 27203010","","27848  -  KIT 27848 STRATA II SHUNT SML PCATH 90CM","BOTH IP/OP","$10,770.05 ","$7,969.84 ","$0.00 ","$10,770.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,770.05 ","$0.00 ","$5,385.03 ","$8,529.88 ","$8,616.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27852","SUP","Custom 27803010","","27852  -  CATHETER 27852 VENT PLIANT FIX COL 15CM","BOTH IP/OP","$522.50 ","$386.65 ","$0.00 ","$522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$522.50 ","$0.00 ","$261.25 ","$413.82 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27853","SUP","Custom 27803010","","27853  -  CATHETER 27853 OPUS VENT 23CM BIOGLIDE","BOTH IP/OP","$605.63 ","$448.17 ","$0.00 ","$605.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.63 ","$0.00 ","$302.81 ","$479.66 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27855","SUP","Custom 27203010","","27855  -  EDMS 27855 EXACTA VCATH W/NLESS INJ/STES","BOTH IP/OP","$688.80 ","$509.71 ","$0.00 ","$1,369.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,369.61 ","$0.00 ","$684.81 ","$545.53 ","$1,095.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27857","SUP","Custom 27803010","","27857  -  PCATH 27857 STD TRANSL NOSLIT 130CM","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$331.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.83 ","$0.00 ","$7.92 ","$331.06 ","$12.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27861","SUP","Custom 27203010","","27861  -  EDMS 27861 EXACTA 50ML ANTIRFLUX GRNPL","BOTH IP/OP","$470.40 ","$348.10 ","$0.00 ","$470.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.40 ","$0.00 ","$235.20 ","$372.56 ","$376.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27864","SUP","Custom 27803010","","27864  -  SHUNT 27864 STRATA II REGULAR 120CM","BOTH IP/OP","$10,838.20 ","$8,020.27 ","$0.00 ","$10,838.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,838.20 ","$0.00 ","$5,419.10 ","$8,583.85 ","$8,670.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27867","SUP","Custom 27803010","","27867  -  SHUNT 27867 STRATA II SMALL PCATH 130CM","BOTH IP/OP","$10,770.05 ","$7,969.84 ","$0.00 ","$10,770.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,770.05 ","$0.00 ","$5,385.03 ","$8,529.88 ","$8,616.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27868","SUP","Custom 27803010","","27868  -  SHUNT 27868 STRATA NSC SMALL PCATH 130CM","BOTH IP/OP","$9,458.75 ","$6,999.48 ","$0.00 ","$9,458.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,458.75 ","$0.00 ","$4,729.38 ","$7,491.33 ","$7,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27873","SUP","Custom 27203010","","27873  -  EDMS 27873 BECKR W/SC BLW DC W/NLESS INJ","BOTH IP/OP","$496.80 ","$367.63 ","$0.00 ","$496.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$496.80 ","$0.00 ","$248.40 ","$393.47 ","$397.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27875","SUP","Custom 27803010","","27875  -  SHUNT 27875 CSF SNAP VCATH 15CM","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27888","SUP","Custom 27803010","","27888  -  SHNT 27888 STRATA II SNAP ASSY REG PCATH","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27889","SUP","Custom 27803010","","27889  -  RESERVOIR 27889 VENT SNAP EXT FLANGE","BOTH IP/OP","$731.50 ","$541.31 ","$0.00 ","$731.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$731.50 ","$0.00 ","$365.75 ","$579.35 ","$585.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27903","SUP","Custom 27803010","","27903  -  ASSY 27903 STRATA II SM CP CATHETER","BOTH IP/OP","$9,949.90 ","$7,362.93 ","$0.00 ","$9,949.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,949.90 ","$0.00 ","$4,974.95 ","$7,880.32 ","$7,959.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27922","SUP","Custom 27803010","","27922  -  SHUNT 27922 STRATA II REG W/INTEG V/RES","BOTH IP/OP","$11,432.75 ","$8,460.24 ","$0.00 ","$11,432.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,432.75 ","$0.00 ","$5,716.38 ","$9,054.74 ","$9,146.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27923","SUP","Custom 27803010","","27923  -  SHUNT 27923 STRATA II SML W/INTEG V/RES","BOTH IP/OP","$11,432.75 ","$8,460.24 ","$0.00 ","$11,432.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,432.75 ","$0.00 ","$5,716.38 ","$9,054.74 ","$9,146.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27924","SUP","Custom 27803010","","27924  -  SHUNT 27924 STRATA NSC REG W/INTG V/RES","BOTH IP/OP","$10,624.35 ","$7,862.02 ","$0.00 ","$10,624.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,624.35 ","$0.00 ","$5,312.18 ","$8,414.49 ","$8,499.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27925","SUP","Custom 27803010","","27925  -  SHUNT 27925 STRATA NSC SML W/INTEG V/RES","BOTH IP/OP","$10,624.35 ","$7,862.02 ","$0.00 ","$10,624.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,624.35 ","$0.00 ","$5,312.18 ","$8,414.49 ","$8,499.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27926","SUP","Custom 27803010","","27926  -  SHUNT 27926 STRATA II REG W/VRES INNERVN","BOTH IP/OP","$11,900.40 ","$8,806.30 ","$0.00 ","$11,900.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,900.40 ","$0.00 ","$5,950.20 ","$9,425.12 ","$9,520.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27927","SUP","Custom 27803010","","27927  -  SHUNT 27927 STRATA II SML W/VRES INNERVN","BOTH IP/OP","$11,900.40 ","$8,806.30 ","$0.00 ","$11,900.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,900.40 ","$0.00 ","$5,950.20 ","$9,425.12 ","$9,520.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27929","SUP","Custom 27803010","","27929  -  CATHETER 27929 CARDIAC PERIT SML EXTRCTD","BOTH IP/OP","$1,330.00 ","$984.20 ","$0.00 ","$1,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,330.00 ","$0.00 ","$665.00 ","$1,053.36 ","$1,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27930","SUP","Custom 27803010","","27930  -  CATHETER 27930 VENTRICULAR SML EXTRACTD","BOTH IP/OP","$876.38 ","$648.52 ","$0.00 ","$876.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$876.38 ","$0.00 ","$438.19 ","$694.09 ","$701.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27931","SUP","Custom 27203010","","27931  -  EDMS 27931 BECKER GS TUBING SMARTSITES","BOTH IP/OP","$556.80 ","$412.03 ","$0.00 ","$556.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.80 ","$0.00 ","$278.40 ","$440.99 ","$445.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27932","SUP","Custom 27803010","","27932  -  VALVE 27932 STRATA NSC SML EXTRACTED","BOTH IP/OP","$8,781.95 ","$6,498.64 ","$0.00 ","$8,781.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,781.95 ","$0.00 ","$4,390.98 ","$6,955.30 ","$7,025.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27933","SUP","Custom 27803010","","27933  -  VALVE 27933 STRATA NSC REG EXTRACTED","BOTH IP/OP","$8,781.95 ","$6,498.64 ","$0.00 ","$8,781.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,781.95 ","$0.00 ","$4,390.98 ","$6,955.30 ","$7,025.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28707","SUP","Custom 27203010","","SET RTRCTR OCTOBASE HLD INS SUTURE DISP","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29400","SUP","Custom 27203010","","STABILIZER SURG OCT4 DUAL VAC TUBE REINF ARM CARD","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30011","SUP","HCPCS C1776","","30011  -  STEM ULNAR 41X6.2MM PLASMA SPRAY EASE OF INSERTION REDUCE","BOTH IP/OP","$7,947.50 ","$5,881.15 ","$0.00 ","$7,947.50 ","$3,576.38 ","$0.00 ","$1,656.46 ","$0.00 ","$0.00 ","$1,391.54 ","$7,947.50 ","$0.00 ","$3,973.75 ","$6,294.42 ","$6,358.00 ","$0.00 ","$1,243.78 ","$0.00 ","$1,265.24 ","$0.00 "
"30121","SUP","HCPCS C1776","","30121  -  STEM ULNAR LATITUDE MEDIUM STANDARD LEFT ELBOW","BOTH IP/OP","$7,946.75 ","$5,880.60 ","$0.00 ","$7,946.75 ","$3,576.04 ","$0.00 ","$1,656.30 ","$0.00 ","$0.00 ","$1,391.41 ","$7,946.75 ","$0.00 ","$3,973.38 ","$6,293.83 ","$6,357.40 ","$0.00 ","$1,243.67 ","$0.00 ","$1,265.12 ","$0.00 "
"30303","SUP","HCPCS C1776","","30303  -  STEM HUMERAL 90X7.7MM LATITUDE EV 6.5MM 4MM SMALL BOW","BOTH IP/OP","$8,915.00 ","$6,597.10 ","$0.00 ","$8,915.00 ","$4,011.75 ","$0.00 ","$1,858.11 ","$0.00 ","$0.00 ","$1,560.95 ","$8,915.00 ","$0.00 ","$4,457.50 ","$7,060.68 ","$7,132.00 ","$0.00 ","$1,395.20 ","$0.00 ","$1,419.27 ","$0.00 "
"30397","SUP","Custom 27203010","","KIT C. DIFF A B ELISA MCBLTST 50ML 96 TST","BOTH IP/OP","$923.30 ","$683.24 ","$0.00 ","$923.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$923.30 ","$0.00 ","$461.65 ","$731.25 ","$738.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30405","SUP","Custom 27203010","","KIT PARASTST G LMBLA ELISA MCPLT POS NEG CNTRL","BOTH IP/OP","$910.28 ","$673.61 ","$0.00 ","$910.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$910.28 ","$0.00 ","$455.14 ","$720.94 ","$728.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30406","SUP","Custom 27203010","","KIT MYCTST CRPSP ELISA 96 TST","BOTH IP/OP","$883.75 ","$653.98 ","$0.00 ","$883.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$883.75 ","$0.00 ","$441.88 ","$699.93 ","$707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30418","SUP","Custom 27203010","","030418  -  RELOAD STPLR UNV STRG 12MM 30MMX2.5MM WHT STRL LF EGIA 6 ROW","BOTH IP/OP","$223.20 ","$165.17 ","$0.00 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.20 ","$0.00 ","$111.60 ","$176.77 ","$178.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30419","SUP","Custom 27203010","","030419  -  RELOAD STPLR UNV STRG 12MM 30MMX3.5MM BLU STRL LF EGIA 6 ROW","BOTH IP/OP","$223.20 ","$165.17 ","$0.00 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.20 ","$0.00 ","$111.60 ","$176.77 ","$178.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30422","SUP","Custom 27203010","","030422  -  RELOAD STPLR UNV STRG 12MM 45MMX3.5MM BLU STRL LF EGIA 6 ROW","BOTH IP/OP","$230.33 ","$170.44 ","$0.00 ","$230.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.33 ","$0.00 ","$115.16 ","$182.42 ","$184.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30423","SUP","Custom 27203010","","030423  -  RELOAD STPLR UNV 45X4.8MM EGIA 2 TI THKTIS ENDSCP LNR CTR","BOTH IP/OP","$228.04 ","$168.75 ","$0.00 ","$228.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$228.04 ","$0.00 ","$114.02 ","$180.61 ","$182.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30425","SUP","Custom 27203010","","030425  -  RELOAD STPLR UNV 45X2.5MM EGIA 2 TI VASC ENDSCP LNR CTR STRG","BOTH IP/OP","$228.04 ","$168.75 ","$0.00 ","$228.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$228.04 ","$0.00 ","$114.02 ","$180.61 ","$182.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30449","SUP","Custom 27203010","","030449  -  RELOAD STPLR 12X4MM TI UNV LD UN STRL LATEX FREE DISP EGIA","BOTH IP/OP","$253.34 ","$187.47 ","$0.00 ","$253.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.34 ","$0.00 ","$126.67 ","$200.65 ","$202.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30454","SUP","Custom 27203010","","030454  -  RELOAD STPLR UNV 12MM 45MMX2.5MM WHT STRL LF EGIA ROTC 6 ROW","BOTH IP/OP","$386.78 ","$286.22 ","$0.00 ","$396.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$396.79 ","$0.00 ","$198.40 ","$314.26 ","$317.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30455","SUP","Custom 27203010","","030455  -  RELOAD STPLR UNV 12MM 45MMX3.5MM BLU STRL LF EGIA ROTC 6 ROW","BOTH IP/OP","$396.79 ","$293.62 ","$0.00 ","$396.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$396.79 ","$0.00 ","$198.39 ","$314.26 ","$317.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30456","SUP","Custom 27203010","","RELOAD STPLR 45X4.8MM EGIA RT TI THKTIS LNR CTR LAPSCOP STRL","BOTH IP/OP","$425.65 ","$314.98 ","$0.00 ","$416.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.66 ","$0.00 ","$208.33 ","$337.11 ","$333.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30456","SUP","Custom 27203010","","030456  -  RELOAD STPLR UNV 12MM 45MMX4.8MM GRN STRL LF EGIA ROTC 6 ROW","BOTH IP/OP","$416.66 ","$308.33 ","$0.00 ","$416.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.66 ","$0.00 ","$208.33 ","$329.99 ","$333.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30500","SUP","HCPCS C1729","","CATHETER SCT 5FR GRAD STRG CNTRL VLV SF-T-VAC PED STRL LF","BOTH IP/OP","$0.88 ","$0.65 ","$0.00 ","$0.88 ","$0.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.15 ","$0.88 ","$0.00 ","$0.44 ","$0.70 ","$0.70 ","$0.00 ","$0.14 ","$0.00 ","$0.14 ","$0.00 "
"30688","SUP","HCPCS C1729","","CATHETER SCT 6FR GRAD STRG SF-T-VAC PED STRL LF","BOTH IP/OP","$0.88 ","$0.65 ","$0.00 ","$0.88 ","$0.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.15 ","$0.88 ","$0.00 ","$0.44 ","$0.70 ","$0.70 ","$0.00 ","$0.14 ","$0.00 ","$0.14 ","$0.00 "
"30888","SUP","HCPCS C1729","","CATHETER SCT 8FR CNTRL VLV STRG SF-T-VAC STRL LF DISP","BOTH IP/OP","$0.80 ","$0.59 ","$0.00 ","$0.80 ","$0.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.14 ","$0.80 ","$0.00 ","$0.40 ","$0.63 ","$0.64 ","$0.00 ","$0.13 ","$0.00 ","$0.13 ","$0.00 "
"30935","SUP","Custom 25003010","","ANTIBODY CD68/MACRPH MAB MRKR HAM56 LAB","BOTH IP/OP","$353.15 ","$261.33 ","$0.00 ","$353.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$353.15 ","$0.00 ","$176.58 ","$279.69 ","$282.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31000","SUP","HCPCS C1729","","CATHETER SCT 10FR CNTRL VLV STRG SF-T-VAC STRL LF","BOTH IP/OP","$0.63 ","$0.47 ","$0.00 ","$0.63 ","$0.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.11 ","$0.63 ","$0.00 ","$0.31 ","$0.50 ","$0.50 ","$0.00 ","$0.10 ","$0.00 ","$0.10 ","$0.00 "
"31031","SUP","Custom 27203010","","31031  -  BIT DRILL 145MM 3.2MM QC NONSTRL","BOTH IP/OP","$152.70 ","$113.00 ","$0.00 ","$152.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$152.70 ","$0.00 ","$76.35 ","$120.94 ","$122.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31035","SUP","Custom 27203010","","31035  -  BIT DRILL 110MM 3.5MM QC CANN NONSTRL","BOTH IP/OP","$149.30 ","$110.48 ","$0.00 ","$149.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$149.30 ","$0.00 ","$74.65 ","$118.25 ","$119.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31100","SUP","Custom 27203010","","31100  -  SHUNT CV 1MM 14MM STRL CLRVW BLB TPR TIP RADOPQ SIL INTRCOR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31113","SUP","Custom 27203010","","KIT ORTH HCV BRCD SEQ VIR TST 3ML","BOTH IP/OP","$732.50 ","$542.05 ","$0.00 ","$732.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$732.50 ","$0.00 ","$366.25 ","$580.14 ","$586.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31150","SUP","Custom 27203010","","31150  -  SHUNT CV 1.5MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31175","SUP","Custom 27203010","","31175  -  SHUNT CV 1.75MM 14MM STRL CLRVW BLB INTRCOR ARTMY","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31200","SUP","Custom 27203010","","31200  -  SHUNT CV 2MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31250","SUP","Custom 27203010","","31250  -  SHUNT CV 2.5MM 14MM STRL 14MM CLRVW BLB TPR TIP RADOPQ SIL","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31553.91","SUP","Custom 27203010","","HANDLE SCP 3FT CORD HAL LGHT ILUM SYS ANOSCP SGSCP KLNSPC","BOTH IP/OP","$191.73 ","$141.88 ","$0.00 ","$191.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.73 ","$0.00 ","$95.86 ","$151.85 ","$153.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31592","SUP","Custom 27203010","","31592  -  BIT DRILL 230MM 2.5MM 3 FLT QC NONSTRL","BOTH IP/OP","$451.00 ","$333.74 ","$0.00 ","$451.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$451.00 ","$0.00 ","$225.50 ","$357.19 ","$360.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32508","SUP","Custom 27203010","","KIT IMMUN TST WBLOT ANTI-HIV-1 40 TST","BOTH IP/OP","$3,010.00 ","$2,227.40 ","$0.00 ","$3,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,010.00 ","$0.00 ","$1,505.00 ","$2,383.92 ","$2,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32588","SUP","Custom 27203010","","KIT IMMUN TST EIA ANTI-HIV 1 2","BOTH IP/OP","$1,527.50 ","$1,130.35 ","$0.00 ","$1,527.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,527.50 ","$0.00 ","$763.75 ","$1,209.78 ","$1,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32591","SUP","Custom 27203010","","KIT GN HBSAG VIR TST 480 TST","BOTH IP/OP","$1,457.50 ","$1,078.55 ","$0.00 ","$1,457.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,457.50 ","$0.00 ","$728.75 ","$1,154.34 ","$1,166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"32594","SUP","Custom 27203010","","KIT IMMUN TST CNFRM ASY HBSAG 25 TST","BOTH IP/OP","$580.00 ","$429.20 ","$0.00 ","$580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$580.00 ","$0.00 ","$290.00 ","$459.36 ","$464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33000","SUP","Custom 27203010","","REAGENT VIT B2 ACCES 50ML 100 TST ANALY","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33005","SUP","Custom 27203010","","CALIBRATOR CHM 4ML VL VIT B2 ACCES","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33020","SUP","Custom 27203010","","REAGENT FRRTN ACCES 100 TST ANALY","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33025","SUP","Custom 27203010","","CALIBRATOR CHM 4ML VL FRRTN ACCES","BOTH IP/OP","$44.08 ","$32.62 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.08 ","$0.00 ","$22.04 ","$34.91 ","$35.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33138","SUP","Custom 27203010","","FORMULA NUTRITIONAL ENFAMIL IRON FORTIFIED POWDER","BOTH IP/OP","$30.30 ","$22.42 ","$0.00 ","$30.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.30 ","$0.00 ","$15.15 ","$24.00 ","$24.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33200","SUP","Custom 27203010","","REAGENT CEA ACCES 100 TST ANALY","BOTH IP/OP","$595.00 ","$440.30 ","$0.00 ","$595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$595.00 ","$0.00 ","$297.50 ","$471.24 ","$476.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33205","SUP","Custom 27203010","","CALIBRATOR CEA ACCES 50 TST IMMUN","BOTH IP/OP","$161.25 ","$119.33 ","$0.00 ","$161.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.25 ","$0.00 ","$80.63 ","$127.71 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33206","SUP","Custom 27203010","","REAGENT CEA DILU ACCES 4ML ANALY","BOTH IP/OP","$153.75 ","$113.78 ","$0.00 ","$153.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$153.75 ","$0.00 ","$76.88 ","$121.77 ","$123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33211","SUP","Custom 27203010","","REAGENT AFP ACCES 300 TST ANALY","BOTH IP/OP","$1,597.50 ","$1,182.15 ","$0.00 ","$1,597.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,597.50 ","$0.00 ","$798.75 ","$1,265.22 ","$1,278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33410","SUP","Custom 27203010","","REAGENT INSN ACCES SYN ULSNS 50 TST ANALY","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33415","SUP","Custom 27203010","","CALIBRATOR INSN ACCES SYN SET 2ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33500","SUP","Custom 27203010","","REAGENT TL BHCG ACCES 100 TST ANALY","BOTH IP/OP","$141.88 ","$104.99 ","$0.00 ","$141.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.88 ","$0.00 ","$70.94 ","$112.37 ","$113.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33505","SUP","Custom 27203010","","CALIBRATOR TL BHCG ACCES 4ML IMMUN","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33510","SUP","Custom 27203010","","REAGENT LH ACCES 50 TST ANALY","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33515","SUP","Custom 27203010","","CALIBRATOR LH ACCES 4ML IMMUN","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33520","SUP","Custom 27203010","","REAGENT FSH ACCES 50 TST ANALY","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33525","SUP","Custom 27203010","","CALIBRATOR FSH ACCES 4ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33530","SUP","Custom 27203010","","REAGENT PRLCTN ACCES 50 TST ANALY","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33535","SUP","Custom 27203010","","CALIBRATOR PRLCTN ACCES 50 TST IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33540","SUP","Custom 27203010","","REAGENT E2 ACCES 100 TST ANALY","BOTH IP/OP","$501.25 ","$370.93 ","$0.00 ","$501.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.25 ","$0.00 ","$250.63 ","$396.99 ","$401.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33545","SUP","Custom 27203010","","CALIBRATOR E2 ACCES 2.5ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33546","SUP","Custom 27203010","","REAGENT E2 DILU ACCES VL 4ML ANALY","BOTH IP/OP","$91.25 ","$67.53 ","$0.00 ","$91.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.25 ","$0.00 ","$45.63 ","$72.27 ","$73.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33560","SUP","Custom 27203010","","REAGENT T ACCES 50 TST ANALY","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33565","SUP","Custom 27203010","","CALIBRATOR T ACCES 2.5ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33600","SUP","Custom 27203010","","REAGENT CORTSL ACCES 100 TST ANALY","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33605","SUP","Custom 27203010","","CALIBRATOR CORTSL ACCES 50 TST IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33606","SUP","Custom 27203010","","CALIBRATOR CORTSL DILU ACCES 4ML IMMUN","BOTH IP/OP","$74.83 ","$55.37 ","$0.00 ","$74.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.83 ","$0.00 ","$37.41 ","$59.27 ","$59.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33800","SUP","Custom 27203010","","REAGENT TL T4 ACCES 50 TST ANALY","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33805","SUP","Custom 27203010","","CALIBRATOR TL T4 ACCES 4ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33815","SUP","Custom 27203010","","CALIBRATOR T UPTK ACCES 1ML IMMUN","BOTH IP/OP","$45.63 ","$33.77 ","$0.00 ","$45.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.63 ","$0.00 ","$22.81 ","$36.14 ","$36.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33820","SUP","Custom 27203010","","REAGENT TSH ACCES HYPERSENSITIVE 100 TST ANALY","BOTH IP/OP","$1.83 ","$1.35 ","$0.00 ","$1.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.83 ","$0.00 ","$0.91 ","$1.45 ","$1.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33821","SUP","Custom 27203010","","FORMULA NUTRITIONAL NUTRAMIGEN 1LB POWDER CAN","BOTH IP/OP","$56.68 ","$41.94 ","$0.00 ","$56.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.68 ","$0.00 ","$28.34 ","$44.89 ","$45.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33825","SUP","Custom 27203010","","CALIBRATOR TSH ACCES HYPERSENSITIVE VL 4ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33835","SUP","Custom 27203010","","CALIBRATOR TL T3 ACCES 50 TST IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33880","SUP","Custom 27203010","","REAGENT FR T4 ACCES 100 TST ANALY","BOTH IP/OP","$267.50 ","$197.95 ","$0.00 ","$267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.50 ","$0.00 ","$133.75 ","$211.86 ","$214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33885","SUP","Custom 27203010","","CALIBRATOR FR T4 ACCES 2.5ML IMMUN","BOTH IP/OP","$45.63 ","$33.77 ","$0.00 ","$45.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.63 ","$0.00 ","$22.81 ","$36.14 ","$36.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35402","SUP","HCPCS C1729","","CATHETER SCT 14FR CNTRL VLV 2 GLOVE WO SOL MINI TRY SF-T-VAC","BOTH IP/OP","$1.18 ","$0.87 ","$0.00 ","$1.18 ","$0.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.21 ","$1.18 ","$0.00 ","$0.59 ","$0.93 ","$0.94 ","$0.00 ","$0.18 ","$0.00 ","$0.19 ","$0.00 "
"36179","SUP","HCPCS C1769","","36179  -  NEEDLE 5CM 18GA GUIDEWIRE PRC RNL FSCA 10MM","BOTH IP/OP","$82.45 ","$61.01 ","$0.00 ","$82.45 ","$44.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.44 ","$82.45 ","$0.00 ","$41.23 ","$65.30 ","$65.96 ","$0.00 ","$12.90 ","$0.00 ","$13.13 ","$0.00 "
"36721","SUP","Custom 27203010","","FORMULA NUTRITIONAL PREGESTIMIL 1LB POWDER CAN","BOTH IP/OP","$42.50 ","$31.45 ","$0.00 ","$42.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.50 ","$0.00 ","$21.25 ","$33.66 ","$34.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"36826","SUP","HCPCS C1729","","CATHETER SCT 8FR CNTRL VLV COIL GRAD 2 GLOVE PPUP BSIN","BOTH IP/OP","$1.43 ","$1.06 ","$0.00 ","$1.43 ","$0.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.25 ","$1.43 ","$0.00 ","$0.71 ","$1.13 ","$1.14 ","$0.00 ","$0.22 ","$0.00 ","$0.23 ","$0.00 "
"37024","SUP","HCPCS C1729","","CATHETER SCT 10FR CNTRL VLV COIL 2 GLOVE PPUP BSIN KT","BOTH IP/OP","$1.28 ","$0.95 ","$0.00 ","$1.28 ","$0.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.22 ","$1.28 ","$0.00 ","$0.64 ","$1.01 ","$1.02 ","$0.00 ","$0.20 ","$0.00 ","$0.20 ","$0.00 "
"37092","SUP","HCPCS C1787","","37092  -  PROGRAMMER NRSTM STRL ACTIVA PT ANTNA XTRN TELEM DP BRN STM","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37200","SUP","Custom 27203010","","REAGENT PSA ACCES HYBRITECH 100 TST ANALY","BOTH IP/OP","$915.00 ","$677.10 ","$0.00 ","$915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$915.00 ","$0.00 ","$457.50 ","$724.68 ","$732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37205","SUP","Custom 27203010","","CALIBRATOR PSA ACCES HYBRITECH VL 2.5ML IMMUN","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37206","SUP","Custom 27203010","","REAGENT PSA DILU ACCES HYBRITECH 14ML ANALY","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37970","SUP","Custom 27203010","","0037970  -  DEVICE IRR EFL DISP","BOTH IP/OP","$96.75 ","$71.60 ","$0.00 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.50 ","$0.00 ","$63.75 ","$100.98 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38005","SUP","Custom 27803010","","038005  -  FILLER BONE VOID DBX DEMINERALIZED BONE MATRIX .5 CC ALLOGRA","BOTH IP/OP","$243.25 ","$180.01 ","$0.00 ","$243.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.25 ","$0.00 ","$121.63 ","$192.65 ","$194.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38010","SUP","HCPCS C1713","","38010  -  FILLER BONE VOID ALLOGRAFT PUTTY FREEZE DRIED DBX","BOTH IP/OP","$432.25 ","$319.87 ","$0.00 ","$432.25 ","$194.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.68 ","$432.25 ","$0.00 ","$216.13 ","$342.34 ","$345.80 ","$0.00 ","$67.65 ","$0.00 ","$68.81 ","$0.00 "
"38025","SUP","HCPCS C1713","","038025  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 2.5CC","BOTH IP/OP","$935.00 ","$691.90 ","$0.00 ","$935.00 ","$420.75 ","$0.00 ","$194.88 ","$0.00 ","$0.00 ","$163.71 ","$935.00 ","$0.00 ","$467.50 ","$740.52 ","$748.00 ","$0.00 ","$146.33 ","$0.00 ","$148.85 ","$0.00 "
"38050","SUP","HCPCS C1713","","038050  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 5ML","BOTH IP/OP","$1,725.50 ","$1,276.87 ","$0.00 ","$1,725.50 ","$776.48 ","$0.00 ","$359.64 ","$0.00 ","$0.00 ","$302.12 ","$1,725.50 ","$0.00 ","$862.75 ","$1,366.60 ","$1,380.40 ","$0.00 ","$270.04 ","$0.00 ","$274.70 ","$0.00 "
"38100","SUP","Custom 27803010","","038100  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 10ML","BOTH IP/OP","$2,652.00 ","$1,962.48 ","$0.00 ","$2,100.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.28 ","$0.00 ","$53.64 ","$2,100.38 ","$85.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41101","SUP","HCPCS C1729","","41101  -  CATHETER DRN STD 4FR 23CM STRL LF INPT TS CSF IMPREGNATE","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$193.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.38 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$55.75 ","$0.00 ","$56.72 ","$0.00 "
"41103","SUP","Custom 27803010","","41103  -  CATH 41103 CSF-VENT STANDARD PLIANT","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41115","SUP","Custom 27803010","","41115  -  CATH 41115 CSF-VENT STD TRANSLUCENT","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41207","SUP","Custom 27803010","","41207  -  CATH 41207 CSF-VENT SMALL BAR IMP","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41308","SUP","Custom 27803010","","41308  -  CATH 41308 CSF-VENT FLANGED SMALL","BOTH IP/OP","$1,368.00 ","$1,012.32 ","$0.00 ","$1,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,368.00 ","$0.00 ","$684.00 ","$1,083.46 ","$1,094.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41404","SUP","Custom 27803010","","41404  -  CATHETER 41404 CSF-VENT STD W/SNAP 4CM","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41405","SUP","Custom 27803010","","41405  -  CATHETER 41405 CSF-VENT STD W/SNAP 5CM","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41406","SUP","Custom 27803010","","41406  -  CATHETER 41406 CSF-VENT STD W/SNAP 6CM","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41407","SUP","Custom 27803010","","41407  -  CATHETER 41407 CSF-VENT STD W/SNAP 7CM","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41408","SUP","Custom 27803010","","41408  -  CATHETER DRN STD 8CM STRL LF CSF SNP SHNT VNTRC DISP","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41409","SUP","Custom 27803010","","41409  -  CATHETER DRN STD 9CM STRL LF CSF SNP SHNT VNTRC DISP","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41501","SUP","Custom 27803010","","41501  -  CATH 41501 OPUS VENTRICULAR SM 23CM","BOTH IP/OP","$465.50 ","$344.47 ","$0.00 ","$465.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.50 ","$0.00 ","$232.75 ","$368.68 ","$372.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41503","SUP","Custom 27803010","","41503  -  CATH 41503 OPUS VENTRICULAR STD 23CM","BOTH IP/OP","$465.50 ","$344.47 ","$0.00 ","$465.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.50 ","$0.00 ","$232.75 ","$368.68 ","$372.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41701","SUP","Custom 27803010","","41701  -  CATHETER 41701 RIVULET VENTRICULAR","BOTH IP/OP","$619.88 ","$458.71 ","$0.00 ","$619.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$619.88 ","$0.00 ","$309.94 ","$490.94 ","$495.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41704","SUP","Custom 27803010","","41704  -  CATHETER 41704 RIVULET VENT SNAP 4CM","BOTH IP/OP","$790.88 ","$585.25 ","$0.00 ","$790.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.88 ","$0.00 ","$395.44 ","$626.38 ","$632.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41705","SUP","Custom 27803010","","41705  -  CATHETER 41705 RIVULET VENT SNAP 5CM","BOTH IP/OP","$790.88 ","$585.25 ","$0.00 ","$790.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.88 ","$0.00 ","$395.44 ","$626.38 ","$632.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41707","SUP","Custom 27803010","","41707  -  CATHETER 41707 RIVULET VENT SNAP 7CM","BOTH IP/OP","$790.88 ","$585.25 ","$0.00 ","$790.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.88 ","$0.00 ","$395.44 ","$626.38 ","$632.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41709","SUP","Custom 27803010","","41709  -  CATHETER 41709 RIVULET VENT SNAP 9CM","BOTH IP/OP","$790.88 ","$585.25 ","$0.00 ","$790.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.88 ","$0.00 ","$395.44 ","$626.38 ","$632.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42102","SUP","Custom 27803010","","42102  -  VALVE 42102 STANDARD LOW","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42104","SUP","Custom 27803010","","42104  -  VALVE 42104 STANDARD MEDIUM","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42106","SUP","Custom 27803010","","42106  -  VALVE 42106 STANDARD HIGH","BOTH IP/OP","$1,655.38 ","$1,224.98 ","$0.00 ","$1,655.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,655.38 ","$0.00 ","$827.69 ","$1,311.06 ","$1,324.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42312","SUP","Custom 27803010","","42312  -  VALVE 42312 SM CONTOURED LOW PRES IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42314","SUP","Custom 27803010","","42314  -  VALVE 42314 SM CONTOURED MED PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42316","SUP","Custom 27803010","","42316  -  VALVE 42316 SM CONTOURED HIGH PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42322","SUP","Custom 27803010","","42322  -  VALVE SHNT REG STRL DLT CNTR LP CSF","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42324","SUP","Custom 27803010","","42324  -  VALVE SHNT REG CNTR 32X18X7.5MM STRL LF 14MM DLT PS MDCL CSF","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42326","SUP","Custom 27803010","","42326  -  VALVE SHNT REG STRL DLT CNTR HI-PRS IMPRG CSF","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42335","SUP","Custom 27803010","","42335  -  VALVE 42335 STRATA NSC BURR HOLE","BOTH IP/OP","$9,038.10 ","$6,688.19 ","$0.00 ","$9,038.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,038.10 ","$0.00 ","$4,519.05 ","$7,158.18 ","$7,230.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42355","SUP","Custom 27803010","","42355  -  VALVE 42355 FP STRATA NSC SMALL","BOTH IP/OP","$9,038.10 ","$6,688.19 ","$0.00 ","$9,038.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,038.10 ","$0.00 ","$4,519.05 ","$7,158.18 ","$7,230.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42365","SUP","Custom 27803010","","42365  -  VALVE 42365 FP STRATA NSC REGULAR","BOTH IP/OP","$9,038.10 ","$6,688.19 ","$0.00 ","$9,038.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,038.10 ","$0.00 ","$4,519.05 ","$7,158.18 ","$7,230.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42410","SUP","Custom 27803010","","42410  -  VALVE 42410 ULTRA SMALL LOW-LOW","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42412","SUP","Custom 27803010","","42412  -  VALVE 42412 ULTRA SMALL LOW PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42414","SUP","Custom 27803010","","42414  -  VALVE 42414 ULTRA SMALL MEDIUM PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42532","SUP","Custom 27803010","","42532  -  VALVE 42532 BURR HOLE 12MM LOW PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42534","SUP","Custom 27803010","","42534  -  VALVE 42534 BURR HOLE 12MM MED PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42536","SUP","Custom 27803010","","42536  -  VALVE 42536 BURR HOLE 12MM HI PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42542","SUP","Custom 27803010","","42542  -  VALVE 42542 BURR HOLE 16 MM LOW IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42544","SUP","Custom 27803010","","42544  -  VALVE 42544 BURR HOLE 16MM MED PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42546","SUP","Custom 27803010","","42546  -  VALVE 42546 BURR HOLE 16MM HI PRESS IMP","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42812","SUP","Custom 27803010","","42812  -  VALVE 42812 DELTA SMALL LEVEL I","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42813","SUP","Custom 27803010","","42813  -  VALVE 42813 DELTA SMALL LEVEL 1.5","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42814","SUP","Custom 27803010","","42814  -  VALVE 42814 DELTA SMALL LEVEL II","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42822","SUP","Custom 27803010","","42822  -  VALVE SHNT DLT REG CSF PRFRM LVL 1 STRL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42823","SUP","Custom 27803010","","42823  -  VALVE SHNT DLT REG CSF PRFRM LVL 1.5 CHRNC SYSTOLIC STRL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42824","SUP","HCPCS C1877","","42824  -  VALVE SHNT DLT REG CSF PRFRM LVL 2 STRL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$1,627.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$633.33 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$566.08 ","$0.00 ","$575.85 ","$0.00 "
"42830","SUP","Custom 27803010","","42830  -  VALVE 42830 DELTA BURR HOLE 12MM LEV 0.5","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42832","SUP","Custom 27803010","","42832  -  VALVE 42832 DELTA BURR HOLE 12MM LEVEL 1","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42833","SUP","Custom 27803010","","42833  -  VALVE 42833DELTA BURR HOLE 12MM LEV 1.5","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42834","SUP","Custom 27803010","","42834  -  VALVE 42834 DELTA BURR HOLE 12 MM LEVEL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42836","SUP","Custom 27803010","","42836  -  VALVE 42836 STRATA II BURR HOLE","BOTH IP/OP","$9,839.45 ","$7,281.19 ","$0.00 ","$9,839.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,839.45 ","$0.00 ","$4,919.73 ","$7,792.84 ","$7,871.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42840","SUP","Custom 27803010","","42840  -  VALVE 42840 DELTA BURR HOLE 16MM LEV 0.5","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42842","SUP","Custom 27803010","","42842  -  VALVE 42842 DELTA BURR HOLE 16MM LEVEL 1","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42843","SUP","Custom 27803010","","42843  -  VALVE 42843 DELTA BURR HOLE 16 MM LEV 1.","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42844","SUP","Custom 27803010","","42844  -  VALVE 42844 DELTA BURR HOLE 16 MM LEVEL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42856","SUP","Custom 27803010","","42856  -  VALVE 42856 FP-STRATA 2 SMALL","BOTH IP/OP","$9,839.45 ","$7,281.19 ","$0.00 ","$9,839.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,839.45 ","$0.00 ","$4,919.73 ","$7,792.84 ","$7,871.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42866","SUP","Custom 27803010","","42866  -  VALVE 42866 FP-STRATA 2 REGULAR","BOTH IP/OP","$9,839.45 ","$7,281.19 ","$0.00 ","$9,839.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,839.45 ","$0.00 ","$4,919.73 ","$7,792.84 ","$7,871.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43103","SUP","HCPCS C1750","","43103  -  CATHETER PERITONEAL STANDARD 90CM IMPREGNATE BARIUM CARDIAC","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$184.89 ","$0.00 ","$85.64 ","$0.00 ","$0.00 ","$71.94 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$64.30 ","$0.00 ","$65.41 ","$0.00 "
"43105","SUP","HCPCS C1713","","43105  -  SUB BNGFT GRFTN DBM PTTY JAR 5ML","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$1,400.00 ","$630.00 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$245.13 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$219.10 ","$0.00 ","$222.88 ","$0.00 "
"43110","SUP","Custom 27804086","","43110  -  FILLER BN VOID 10ML GRFTN ALGRF PTTY JR DBM","BOTH IP/OP","$2,418.00 ","$1,789.32 ","$0.00 ","$2,418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,418.00 ","$0.00 ","$1,209.00 ","$1,915.06 ","$1,934.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43111","SUP","Custom 27803010","","43111  -  CATH 43111 C/P STANDARD TRANSLUCENT","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43209","SUP","Custom 27803010","","43209  -  CATH 43209 C/P SMALL BAR IMP","BOTH IP/OP","$410.88 ","$304.05 ","$0.00 ","$410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$410.88 ","$0.00 ","$205.44 ","$325.42 ","$328.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43418","SUP","Custom 27803010","","43418  -  CATH 43418 CARDIAC CATH REDUCED TIP 58CM","BOTH IP/OP","$534.38 ","$395.44 ","$0.00 ","$534.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$534.38 ","$0.00 ","$267.19 ","$423.23 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43522","SUP","Custom 27803010","","43522  -  CATH 43522 C/P CATH OPEN END W/SLITS STD","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43551","SUP","Custom 27803010","","43551  -  CATH 43551 C/P STD PLIANT BAR IMP","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43555","SUP","Custom 27803010","","43555  -  CATHETER 43555 PERITONEAL SMALL LUMEN","BOTH IP/OP","$593.75 ","$439.38 ","$0.00 ","$593.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$593.75 ","$0.00 ","$296.88 ","$470.25 ","$475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11-Jan","SUP","HCPCS C1713","","JAN-11  -  PLATE BONE SM RIGHT ORBTL FLR MESH CNTOUR ANTM EZ","BOTH IP/OP","$4,677.50 ","$3,461.35 ","$0.00 ","$4,677.50 ","$2,104.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$818.99 ","$4,677.50 ","$0.00 ","$2,338.75 ","$3,704.58 ","$3,742.00 ","$0.00 ","$732.03 ","$0.00 ","$744.66 ","$0.00 "
"44000","SUP","Custom 27803010","","44000  -  INLET 44000 VENTRICULAR PORT BOTTOM","BOTH IP/OP","$959.50 ","$710.03 ","$0.00 ","$959.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$959.50 ","$0.00 ","$479.75 ","$759.92 ","$767.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44010","SUP","Custom 27803010","","44010  -  INLET 44010 VENTRICULAR PORT SIDE","BOTH IP/OP","$959.50 ","$710.03 ","$0.00 ","$959.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$959.50 ","$0.00 ","$479.75 ","$759.92 ","$767.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44100","SUP","Custom 27803010","","44100  -  RESERVOIR 44100 VENT. 12MM CONVERT 20MM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44101","SUP","Custom 27803010","","44101  -  RESERVOIR DRN SM RT ANG 2.1MM 1.2MM 3CM .1ML STRL LF 12MM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44103","SUP","Custom 27803010","","44103  -  RESERVOIR DRN SM 28MM 2.1MM 1.2MM 23CM 1.1ML CSF SD INLT","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44104","SUP","Custom 27803010","","44104  -  RESERVOIR 44104 VENT. INLET BOTTOM","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44105","SUP","Custom 27803010","","44105  -  SUB BNGFT GRFTN DBM CRNCH JAR 5ML","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44108","SUP","Custom 27803010","","44108  -  RESERVOIR DRN SM 2.1MM 1.2MM 90CM 2.4ML STRL LF 30MM CSF","BOTH IP/OP","$1,503.38 ","$1,112.50 ","$0.00 ","$1,503.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,503.38 ","$0.00 ","$751.69 ","$1,190.68 ","$1,202.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44111","SUP","Custom 27803010","","44111  -  RESERVOIR 44111 VENT. BURR HOLE","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44113","SUP","Custom 27803010","","44113  -  RESERVOIR SHNT 12MM STRL DLT CSF BUR HL","BOTH IP/OP","$931.00 ","$688.94 ","$0.00 ","$931.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$931.00 ","$0.00 ","$465.50 ","$737.35 ","$744.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44150","SUP","HCPCS C1713","","44150  -  SUB BNGFT GRFTN SM DFCT DBM OTHBLND JAR 10ML","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$3,375.00 ","$1,518.75 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$590.94 ","$3,375.00 ","$0.00 ","$1,687.50 ","$2,673.00 ","$2,700.00 ","$0.00 ","$528.19 ","$0.00 ","$537.30 ","$0.00 "
"44200","SUP","Custom 27803010","","44200  -  RES 44200 VENTRICULOSTOMY BH 6MM REG IMP","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44201","SUP","Custom 27803010","","44201  -  KIT VNCLSTM REG 6MM STRL BUR HL CSF","BOTH IP/OP","$714.88 ","$529.01 ","$0.00 ","$714.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$714.88 ","$0.00 ","$357.44 ","$566.18 ","$571.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44210","SUP","Custom 27803010","","44210  -  RESERVOIR VNCLSTM SHLW 6MM CSF BUR HL","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44211","SUP","Custom 27803010","","44211  -  KIT VNCLSTM REG 6MM STRL CSF BUR HL SHLW D","BOTH IP/OP","$714.88 ","$529.01 ","$0.00 ","$714.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$714.88 ","$0.00 ","$357.44 ","$566.18 ","$571.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21-Jun","SUP","Custom 27803010","","6-2021  -  CAGE SPNL 20MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$7,813.35 ","$5,781.88 ","$0.00 ","$7,813.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,813.35 ","$0.00 ","$3,906.68 ","$6,188.17 ","$6,250.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21-Jul","SUP","Custom 27803010","","7-2021  -  DEVICE FSN 20MM 21MM RYTFC","BOTH IP/OP","$6,615.95 ","$4,895.80 ","$0.00 ","$6,615.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,615.95 ","$0.00 ","$3,307.98 ","$5,239.83 ","$5,292.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44405","SUP","Custom 27803010","","44405  -  CATHETER 44405 LUMBAR CLOSED TIP","BOTH IP/OP","$1,472.50 ","$1,089.65 ","$0.00 ","$1,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,472.50 ","$0.00 ","$736.25 ","$1,166.22 ","$1,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44406","SUP","Custom 27803010","","44406  -  CATHETER 44406 LUMBAR OPEN TIP","BOTH IP/OP","$1,472.50 ","$1,089.65 ","$0.00 ","$1,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,472.50 ","$0.00 ","$736.25 ","$1,166.22 ","$1,178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44410","SUP","Custom 27803010","","44410  -  SYSTEM CATH C14-24CM 2O 20GA 14GA 84CM PS MDCL CNCT 3 FX TAB","BOTH IP/OP","$1,686.25 ","$1,247.83 ","$0.00 ","$1,686.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,686.25 ","$0.00 ","$843.13 ","$1,335.51 ","$1,349.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44420","SUP","Custom 27803010","","44420  -  SHUNT 44420 STRATA KIT NSC LP","BOTH IP/OP","$11,247.10 ","$8,322.85 ","$0.00 ","$11,247.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,247.10 ","$0.00 ","$5,623.55 ","$8,907.70 ","$8,997.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44421","SUP","Custom 27203010","","44421  -  KIT 44421 STRATA NSC LP OPEN LUMBAR","BOTH IP/OP","$11,247.10 ","$8,322.85 ","$0.00 ","$11,247.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,247.10 ","$0.00 ","$5,623.55 ","$8,907.70 ","$8,997.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44430","SUP","Custom 27803010","","44430  -  SHUNT 44430 STRATA KIT NSC LP ASSY","BOTH IP/OP","$11,646.60 ","$8,618.48 ","$0.00 ","$11,646.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,646.60 ","$0.00 ","$5,823.30 ","$9,224.11 ","$9,317.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44465","SUP","Custom 27803010","","44465  -  VALVE 44465 STRATA NSC LP","BOTH IP/OP","$9,677.30 ","$7,161.20 ","$0.00 ","$9,677.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,677.30 ","$0.00 ","$4,838.65 ","$7,664.42 ","$7,741.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44513","SUP","Custom 27803010","","44513  -  RES 44513 CSF-LUMBOPERITONEAL 20MM","BOTH IP/OP","$824.13 ","$609.86 ","$0.00 ","$824.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$824.13 ","$0.00 ","$412.06 ","$652.71 ","$659.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44515","SUP","Custom 27803010","","44515  -  RES 44515 CSF-LUMBOPERITONEAL 30MM","BOTH IP/OP","$824.13 ","$609.86 ","$0.00 ","$824.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$824.13 ","$0.00 ","$412.06 ","$652.71 ","$659.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"44520","SUP","Custom 27803010","","44520  -  SHUNT NS 87CM STRL LMBPRTNL CATH T CSF","BOTH IP/OP","$1,835.88 ","$1,358.55 ","$0.00 ","$1,835.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,835.88 ","$0.00 ","$917.94 ","$1,454.02 ","$1,468.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45001","SUP","Custom 27804086","","45001  -  GRAFT BN 1ML GRFTN + PST SYR DBM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45005","SUP","Custom 27804086","","45005  -  CANNULA LAPSCP 10MM DL PK DP50-0116-006","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45010","SUP","Custom 27804086","","45010  -  GRAFT BN 10ML GRFTN + PST SYR DBM","BOTH IP/OP","$2,170.00 ","$1,605.80 ","$0.00 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,170.00 ","$0.00 ","$1,085.00 ","$1,718.64 ","$1,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45103","SUP","Custom 27803010","","45103  -  CONNECTOR SHNT STRG STRL ACFL CSF RADOPQ CATH PLS","BOTH IP/OP","$178.13 ","$131.82 ","$0.00 ","$178.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.13 ","$0.00 ","$89.06 ","$141.08 ","$142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45104","SUP","Custom 27803010","","45104  -  CONNECTOR SHNT RT ANG STRL ACFL CSF CATH PLS","BOTH IP/OP","$178.13 ","$131.82 ","$0.00 ","$178.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.13 ","$0.00 ","$89.06 ","$141.08 ","$142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45105","SUP","Custom 27803010","","45105  -  CONNECTOR SHNT STRL ACFL CSF CATH 3W PLS","BOTH IP/OP","$565.25 ","$418.29 ","$0.00 ","$565.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$565.25 ","$0.00 ","$282.63 ","$447.68 ","$452.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45402","SUP","Custom 27203010","","45402  -  TOOL 45402 SNAP ASSEMBLY","BOTH IP/OP","$729.13 ","$539.56 ","$0.00 ","$729.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$729.13 ","$0.00 ","$364.56 ","$577.47 ","$583.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45792","SUP","HCPCS C1758","","45792  -  CATHETER URET 5FR 70CM .038IN TPR TIP OP-EN RT","BOTH IP/OP","$24.50 ","$18.13 ","$0.00 ","$24.50 ","$13.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.29 ","$24.50 ","$0.00 ","$12.25 ","$19.40 ","$19.60 ","$0.00 ","$3.83 ","$0.00 ","$3.90 ","$0.00 "
"45806","SUP","Custom 27203010","","45806  -  KIT 45806 STRATA VARIOUS","BOTH IP/OP","$8,922.95 ","$6,602.98 ","$0.00 ","$8,922.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,922.95 ","$0.00 ","$4,461.48 ","$7,066.98 ","$7,138.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45807","SUP","Custom 27203010","","45807  -  CARD 45807 SMART STRATA","BOTH IP/OP","$169.20 ","$125.21 ","$0.00 ","$169.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.20 ","$0.00 ","$84.60 ","$134.01 ","$135.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45808","SUP","Custom 27203010","","45808  -  CARD 45808 SMART STRATA NSC","BOTH IP/OP","$232.65 ","$172.16 ","$0.00 ","$232.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.65 ","$0.00 ","$116.33 ","$184.26 ","$186.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45809","SUP","Custom 27203010","","45809  -  TOOL 45809 STRATAVARIUS ADJUSTMENT","BOTH IP/OP","$491.63 ","$363.81 ","$0.00 ","$491.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$491.63 ","$0.00 ","$245.81 ","$389.37 ","$393.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46012","SUP","Custom 27803010","","46012  -  KIT 46012 SHUNT UNITIZED SMALL LOW","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46014","SUP","Custom 27803010","","46014  -  KIT 46014 SHUNT UNITIZED SMALL MED","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46016","SUP","Custom 27803010","","46016  -  KIT 46016 SHUNT UNITIZED SMALL HIGH","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46022","SUP","Custom 27803010","","46022  -  KIT 46022 SHUNT UNITIZED REG LOW","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46024","SUP","Custom 27803010","","46024  -  KIT 46024 SHUNT UNITIZED REG MED","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46026","SUP","Custom 27803010","","46026  -  KIT 46026 SHUNT UNITIZED REG HIGH","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46070","SUP","Custom 27803010","","46070  -  SHNT 46070 FP UNI STRATA NSC SML 8CM","BOTH IP/OP","$10,112.05 ","$7,482.92 ","$0.00 ","$10,112.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,112.05 ","$0.00 ","$5,056.03 ","$8,008.74 ","$8,089.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46075","SUP","Custom 27803010","","46075  -  SHNT 46075 FP UNI STRATA NSC SM 11.5","BOTH IP/OP","$10,112.05 ","$7,482.92 ","$0.00 ","$10,112.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,112.05 ","$0.00 ","$5,056.03 ","$8,008.74 ","$8,089.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46080","SUP","Custom 27803010","","46080  -  SHNT 46080 FP UNI STRATA NSC REG 11","BOTH IP/OP","$10,112.05 ","$7,482.92 ","$0.00 ","$10,112.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,112.05 ","$0.00 ","$5,056.03 ","$8,008.74 ","$8,089.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46085","SUP","Custom 27803010","","46085  -  SHNT 46085 FP UNI STRATA NSC RG 13.5","BOTH IP/OP","$10,112.05 ","$7,482.92 ","$0.00 ","$10,112.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,112.05 ","$0.00 ","$5,056.03 ","$8,008.74 ","$8,089.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46115","SUP","HCPCS C1729","","46115  -  CATHETER DRN 20CM CLR STRL LF BCKR EDMS BA IMPRG SIL VNTRC","BOTH IP/OP","$268.80 ","$198.91 ","$0.00 ","$268.80 ","$145.96 ","$0.00 ","$56.02 ","$0.00 ","$0.00 ","$47.06 ","$268.80 ","$0.00 ","$134.40 ","$212.89 ","$215.04 ","$0.00 ","$42.07 ","$0.00 ","$42.79 ","$0.00 "
"46118","SUP","HCPCS C1729","","46118  -  CATHETER XTRN DRN 2.8MM 1.5MM 35CM 700ML STRL LF 15CM EDM","BOTH IP/OP","$403.20 ","$298.37 ","$0.00 ","$403.20 ","$218.94 ","$0.00 ","$84.04 ","$0.00 ","$0.00 ","$70.60 ","$403.20 ","$0.00 ","$201.60 ","$319.33 ","$322.56 ","$0.00 ","$63.10 ","$0.00 ","$64.19 ","$0.00 "
"46126","SUP","Custom 27203010","","46126  -  EDMS 46126 PATIENT CONN LINE ASSY","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46129","SUP","Custom 27203010","","46129  -  EDMS III 46129 BECKER","BOTH IP/OP","$508.80 ","$376.51 ","$0.00 ","$508.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$508.80 ","$0.00 ","$254.40 ","$402.97 ","$407.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46135","SUP","HCPCS C1713","","46135  -  CLAMP 46135 QUICK ATTACH POLE","BOTH IP/OP","$1,120.80 ","$829.39 ","$0.00 ","$1,120.80 ","$504.36 ","$0.00 ","$233.60 ","$0.00 ","$0.00 ","$196.24 ","$1,120.80 ","$0.00 ","$560.40 ","$887.67 ","$896.64 ","$0.00 ","$175.41 ","$0.00 ","$178.43 ","$0.00 "
"46137","SUP","HCPCS C1713","","46137  -  CLMP 46137 QUICK ATTACH POLE W/LAS","BOTH IP/OP","$1,293.60 ","$957.26 ","$0.00 ","$1,293.60 ","$582.12 ","$0.00 ","$269.62 ","$0.00 ","$0.00 ","$226.50 ","$1,293.60 ","$0.00 ","$646.80 ","$1,024.53 ","$1,034.88 ","$0.00 ","$202.45 ","$0.00 ","$205.94 ","$0.00 "
"46141","SUP","Custom 27203010","","46141  -  KIT 46141 EDM VEN DRAINAGE 5PK","BOTH IP/OP","$751.20 ","$555.89 ","$0.00 ","$751.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$751.20 ","$0.00 ","$375.60 ","$594.95 ","$600.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46154","SUP","Custom 27203010","","46154  -  KIT 46154 VNTRC EURO","BOTH IP/OP","$784.80 ","$580.75 ","$0.00 ","$784.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$784.80 ","$0.00 ","$392.40 ","$621.56 ","$627.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26-Jun","SUP","Custom 27803010","","6-2026  -  CAGE SPNL 20MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$7,813.35 ","$5,781.88 ","$0.00 ","$7,813.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,813.35 ","$0.00 ","$3,906.68 ","$6,188.17 ","$6,250.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46220","SUP","Custom 27803010","","46220  -  KIT 46220 SHUNT ULTRA SMALL 4CM LL","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46222","SUP","Custom 27803010","","46222  -  KIT 46222 SHUNT ULTRA SMALL 4CM LOW","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46224","SUP","Custom 27803010","","46224  -  SHUNT 46224 KIT ULTRA SMALL 4CM MED IMP","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46240","SUP","Custom 27803010","","46240  -  KIT 46240 SHUNT ULTRA SMALL 6CM LL","BOTH IP/OP","$3,080.38 ","$2,279.48 ","$0.00 ","$3,080.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,080.38 ","$0.00 ","$1,540.19 ","$2,439.66 ","$2,464.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46242","SUP","Custom 27803010","","46242  -  KIT 46242 SHUNT ULTRA SMALL 6CM LOW","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46244","SUP","Custom 27803010","","46244  -  KIT 46244 SHUNT ULTRA SMALL 6CM MED","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46418","SUP","Custom 27803010","","46418  -  CATHETER 46418 EDM LUMBAR 24CM OPEN","BOTH IP/OP","$391.20 ","$289.49 ","$0.00 ","$391.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.20 ","$0.00 ","$195.60 ","$309.83 ","$312.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46419","SUP","HCPCS C1729","","46419  -  CATHETER XTRN DRN 80CM STRL EDM CLS TIP BA IMPRG SIL LMBR","BOTH IP/OP","$566.40 ","$419.14 ","$0.00 ","$566.40 ","$307.56 ","$0.00 ","$118.05 ","$0.00 ","$0.00 ","$99.17 ","$566.40 ","$0.00 ","$283.20 ","$448.59 ","$453.12 ","$0.00 ","$88.64 ","$0.00 ","$90.17 ","$0.00 "
"46420","SUP","Custom 27803010","","46420  -  CATH 46420 EDM LUMBAR 80CM/OPEN TIP","BOTH IP/OP","$544.80 ","$403.15 ","$0.00 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$544.80 ","$0.00 ","$272.40 ","$431.48 ","$435.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46430","SUP","Custom 27203010","","46430  -  BAGS 46430 EDM DRAINAGE 10-PACK BOX","BOTH IP/OP","$88.08 ","$65.18 ","$0.00 ","$88.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.08 ","$0.00 ","$44.04 ","$69.76 ","$70.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46440","SUP","Custom 27203010","","46440  -  KIT XTRN DRN 35CM 700ML BE2 MNTR LMBR","BOTH IP/OP","$767.52 ","$567.96 ","$0.00 ","$767.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$767.52 ","$0.00 ","$383.76 ","$607.88 ","$614.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46441","SUP","Custom 27203010","","46441  -  KIT 46441 EDM LUMBAR DRAINAGE 5PK","BOTH IP/OP","$629.76 ","$466.02 ","$0.00 ","$629.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$629.76 ","$0.00 ","$314.88 ","$498.77 ","$503.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46442","SUP","Custom 27203010","","46442  -  KIT 46442 EDM LUMBAR DRN CLS TIP 5PK","BOTH IP/OP","$629.76 ","$466.02 ","$0.00 ","$629.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$629.76 ","$0.00 ","$314.88 ","$498.77 ","$503.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46540","SUP","Custom 27803010","","46540  -  SHUNT 46540 CSF SNAP ASSY BUTTON LOW LOW","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46542","SUP","Custom 27803010","","46542  -  SHUNT NS CSF ASMB SNP BTN LP","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46544","SUP","Custom 27803010","","46544  -  SHUNT NS CSF ASMB SNP BTN MED PRSS","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46560","SUP","Custom 27803010","","46560  -  SHUNT 46560 CSF SNAP ASSY US LOW LOW","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46562","SUP","Custom 27803010","","46562  -  SHUNT 46562 CSF SNAP ASSY US LOW","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46564","SUP","Custom 27803010","","46564  -  SHUNT 46564 CSF SNAP ASSY US MEDIUM","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46622","SUP","Custom 27803010","","46622  -  SHUNT 46622 CSF ASSY SMALL LOW CONT C/P","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46624","SUP","Custom 27803010","","46624  -  SHUNT 46624 CSF ASSY SMALL MED CONT C/P","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46626","SUP","Custom 27803010","","46626  -  SHUNT 46626 CSF ASSY SMALL HIGH CONT C/P","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46635","SUP","Custom 27803010","","46635  -  SHUNT 46635 STRATA NSC BURR HOLE","BOTH IP/OP","$9,458.75 ","$6,999.48 ","$0.00 ","$9,458.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,458.75 ","$0.00 ","$4,729.38 ","$7,491.33 ","$7,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46642","SUP","Custom 27803010","","46642  -  SHUNT 46642 ASSY REG LOW C/P-90CM","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46644","SUP","Custom 27803010","","46644  -  SHUNT 46644 ASSY REG MED C/P-90CM","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46646","SUP","Custom 27803010","","46646  -  SHUNT 46646 ASSY REG HIGH C/P-90CM","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46655","SUP","Custom 27803010","","46655  -  ASSY 46655 FP SHUNT STRATA NSC SMALL","BOTH IP/OP","$9,458.75 ","$6,999.48 ","$0.00 ","$9,458.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,458.75 ","$0.00 ","$4,729.38 ","$7,491.33 ","$7,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46665","SUP","Custom 27803010","","46665  -  ASSY 46665 FP SHUNT STRATA NSC REG","BOTH IP/OP","$9,458.75 ","$6,999.48 ","$0.00 ","$9,458.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,458.75 ","$0.00 ","$4,729.38 ","$7,491.33 ","$7,567.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46700","SUP","Custom 27203010","","46700  -  SYSTEM 46700 EXACTA DISP. DRAINAGE","BOTH IP/OP","$398.40 ","$294.82 ","$0.00 ","$398.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398.40 ","$0.00 ","$199.20 ","$315.53 ","$318.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46705","SUP","Custom 27203010","","46705  -  SYSTEM 46705 EXACTA DRAINAGE 100ML","BOTH IP/OP","$432.00 ","$319.68 ","$0.00 ","$432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$432.00 ","$0.00 ","$216.00 ","$342.14 ","$345.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46710","SUP","Custom 27203010","","46710  -  BAG 46710 EXACTA DRAINAGE","BOTH IP/OP","$110.40 ","$81.70 ","$0.00 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.40 ","$0.00 ","$55.20 ","$87.44 ","$88.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46711","SUP","Custom 27203010","","46711  -  ASSY 46711 EXACTA POLE CLAMP W/LASER","BOTH IP/OP","$1,281.60 ","$948.38 ","$0.00 ","$1,281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,281.60 ","$0.00 ","$640.80 ","$1,015.03 ","$1,025.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46712","SUP","Custom 27203010","","46712  -  BAG 46712 EXACTA DRAINAGE 10 PK","BOTH IP/OP","$88.08 ","$65.18 ","$0.00 ","$88.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.08 ","$0.00 ","$44.04 ","$69.76 ","$70.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46713","SUP","Custom 27203010","","46713  -  ASSY 46713 EXACTA POLE CLAMP NO LASER","BOTH IP/OP","$1,142.40 ","$845.38 ","$0.00 ","$1,142.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,142.40 ","$0.00 ","$571.20 ","$904.78 ","$913.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46715","SUP","HCPCS C1713","","46715  -  CLAMP 46715 EXACTA PL NEG 25CM W/LSR","BOTH IP/OP","$1,399.20 ","$1,035.41 ","$0.00 ","$1,399.20 ","$629.64 ","$0.00 ","$291.63 ","$0.00 ","$0.00 ","$244.99 ","$1,399.20 ","$0.00 ","$699.60 ","$1,108.17 ","$1,119.36 ","$0.00 ","$218.97 ","$0.00 ","$222.75 ","$0.00 "
"46717","SUP","HCPCS C1713","","46717  -  CLAMP 46717 EXACTA POLE -25CM W/O LSR","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"46812","SUP","Custom 27803010","","46812  -  ASSY 46812 DELTA SHUNT SMALL PL 1","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46813","SUP","Custom 27803010","","46813  -  ASSY 46813 DELTA SHUNT SM LEV 1.5","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46814","SUP","Custom 27803010","","46814  -  ASSY 46814 DELTA SHUNT SMALL P/L 2","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46822","SUP","Custom 27803010","","46822  -  ASSY 46822 DELTA SHUNT REG P/L 1","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46823","SUP","Custom 27803010","","46823  -  ASSY 46823 DELTA SHUNT REG LEV 1.5","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46824","SUP","Custom 27803010","","46824  -  ASSY 46824 DELTA SHUNT REG P/L 2","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46832","SUP","Custom 27803010","","46832  -  SHUNT 46832 NEONATAL DELTA SNAP L 1","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46833","SUP","Custom 27803010","","46833  -  SHUNT 46833 NEONATAL DELTA SNAP 1.5","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46834","SUP","Custom 27803010","","46834  -  SHUNT 46834 NEONATAL DELTA SNAP L 2","BOTH IP/OP","$5,191.75 ","$3,841.90 ","$0.00 ","$5,191.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,191.75 ","$0.00 ","$2,595.88 ","$4,111.87 ","$4,153.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46836","SUP","Custom 27803010","","46836  -  SHUNT 46836 STRATA II BURR HOLE","BOTH IP/OP","$10,302.40 ","$7,623.78 ","$0.00 ","$10,302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,302.40 ","$0.00 ","$5,151.20 ","$8,159.50 ","$8,241.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46856","SUP","Custom 27803010","","46856  -  ASSY 46856 FP-STRATA 2 SHUNT SML","BOTH IP/OP","$10,302.40 ","$7,623.78 ","$0.00 ","$10,302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,302.40 ","$0.00 ","$5,151.20 ","$8,159.50 ","$8,241.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46866","SUP","Custom 27803010","","46866  -  ASSY 46866 FP-STRATA 2 SHUNT REG","BOTH IP/OP","$10,302.40 ","$7,623.78 ","$0.00 ","$10,302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,302.40 ","$0.00 ","$5,151.20 ","$8,159.50 ","$8,241.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46871","SUP","Custom 27803010","","46871  -  SHUNT 46871 FP-STRATA UNI SML 8","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46876","SUP","Custom 27803010","","46876  -  UNISHUNT 46876 FP STRATA SM 11.5","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46881","SUP","Custom 27803010","","46881  -  SHUNT 46881 FP-STRATA UNI REG 11","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46886","SUP","Custom 27803010","","46886  -  SHUNT 46886 FP-STRATA UNI REG 13.5","BOTH IP/OP","$10,915.75 ","$8,077.66 ","$0.00 ","$10,915.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,915.75 ","$0.00 ","$5,457.88 ","$8,645.27 ","$8,732.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46911","SUP","Custom 27203010","","46911  -  BAG 46911 DRAINAGE DEHP-FREE 1PK","BOTH IP/OP","$110.40 ","$81.70 ","$0.00 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.40 ","$0.00 ","$55.20 ","$87.44 ","$88.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46912","SUP","Custom 27203010","","46912  -  BAG 46912 DRAINAGE DEHP-FREE 10PK","BOTH IP/OP","$88.08 ","$65.18 ","$0.00 ","$88.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.08 ","$0.00 ","$44.04 ","$69.76 ","$70.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46913","SUP","Custom 27203010","","46913  -  EDMS 46913 DUET INTERLINK SITES","BOTH IP/OP","$566.40 ","$419.14 ","$0.00 ","$566.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$566.40 ","$0.00 ","$283.20 ","$448.59 ","$453.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46914","SUP","Custom 27203010","","46914  -  EDMS 46914 DUET BLUECORE SITES","BOTH IP/OP","$566.40 ","$419.14 ","$0.00 ","$566.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$566.40 ","$0.00 ","$283.20 ","$448.59 ","$453.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46915","SUP","Custom 27203010","","46915  -  EDMS 46915 DUET INTERLINK WITH VCATH","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46916","SUP","Custom 27203010","","46916  -  EDMS 46916 DUET BLUECORE WITH VCATH","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46917","SUP","Custom 27203010","","46917  -  SYSTEM XTRN DRN 60IN DUET LCATH INTLNK CLS SYS XTRN VNTRC","BOTH IP/OP","$1,104.00 ","$816.96 ","$0.00 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,104.00 ","$0.00 ","$552.00 ","$874.37 ","$883.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46918","SUP","Custom 27203010","","46918  -  LEVEL LSR NS LF CLRST REUSE XTRN DRN MNTR SYS","BOTH IP/OP","$211.20 ","$156.29 ","$0.00 ","$211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.20 ","$0.00 ","$105.60 ","$167.27 ","$168.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47032","SUP","Custom 27203010","","47032  -  NEEDLE AMNIO 15CM 20GA ECHTP SDPRT DISP","BOTH IP/OP","$43.13 ","$31.92 ","$0.00 ","$43.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.13 ","$0.00 ","$21.56 ","$34.16 ","$34.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48270","SUP","Custom 27203010","","0048270  -  TUBING SCT 100FT 9/32IN PLST NCDTV ECON INTGR BLSTR CONCTR","BOTH IP/OP","$13.52 ","$10.00 ","$0.00 ","$13.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.52 ","$0.00 ","$6.76 ","$10.71 ","$10.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48403","SUP","Custom 27203010","","48403  -  PASSER 48403 L/P SUBCUT CATH 38CM","BOTH IP/OP","$2,766.88 ","$2,047.49 ","$0.00 ","$2,766.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,766.88 ","$0.00 ","$1,383.44 ","$2,191.37 ","$2,213.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48405","SUP","Custom 27203010","","48405  -  PASSER 48405 CATH V/P SUBCUT 60CM","BOTH IP/OP","$2,914.13 ","$2,156.46 ","$0.00 ","$2,914.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,914.13 ","$0.00 ","$1,457.06 ","$2,307.99 ","$2,331.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48407","SUP","Custom 27203010","","48407  -  PASSER 48407 CATHETER 38CM DISP.","BOTH IP/OP","$344.38 ","$254.84 ","$0.00 ","$344.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$344.38 ","$0.00 ","$172.19 ","$272.75 ","$275.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48409","SUP","Custom 27203010","","48409  -  PASSER 48409 60CM DISP. CATHETER","BOTH IP/OP","$368.13 ","$272.42 ","$0.00 ","$368.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$368.13 ","$0.00 ","$184.06 ","$291.56 ","$294.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50120","SUP","Custom 27803010","","50120  -  CLIP LGT MED LG VESOCCLUDE SMTR 6 CRTDG TI","BOTH IP/OP","$9.38 ","$6.94 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.38 ","$0.00 ","$4.69 ","$7.43 ","$7.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50190","SUP","Custom 27203010","","KIT GSTRM 18FR INTROD BR-MLR TFSTNR DILAT","BOTH IP/OP","$414.50 ","$306.73 ","$0.00 ","$414.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$414.50 ","$0.00 ","$207.25 ","$328.28 ","$331.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50318","SUP","Custom 27803010","","50318  -  CATHETER 50318 EVD ANTIBIOTIC PK 5 NCE","BOTH IP/OP","$3,600.00 ","$2,664.00 ","$0.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,600.00 ","$0.00 ","$1,800.00 ","$2,851.20 ","$2,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50823","SUP","Custom 27203010","","50823  -  INFLATION SYSTEM","BOTH IP/OP","$55.15 ","$40.81 ","$0.00 ","$55.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.15 ","$0.00 ","$27.58 ","$43.68 ","$44.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"52021","SUP","HCPCS Q4108","","52021  -  DRESSING WND 2X2IN MTRX BVN CLGN","BOTH IP/OP","$1,205.92 ","$892.38 ","$0.00 ","$1,370.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,370.36 ","$0.00 ","$685.18 ","$1,085.33 ","$1,096.29 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$0.00 "
"53130","SUP","Custom 27203010","","53130  -  RETAINER SEPRONET 3 25YDX7/8IN ELAST TBLR NT DRSG NYL RBR","BOTH IP/OP","$67.92 ","$50.26 ","$0.00 ","$67.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.92 ","$0.00 ","$33.96 ","$53.79 ","$54.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53660","SUP","HCPCS C1725","","53660  -  CATH BALDILAT .038IN 7FR 80CM 4.5CM ILC FEM POPLT ART TPR","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$20.36 ","$0.00 ","$7.82 ","$0.00 ","$0.00 ","$6.57 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$5.87 ","$0.00 ","$5.97 ","$0.00 "
"54051","SUP","HCPCS Q4108","","54051  -  DRESSING WND 5X4IN STRL BVN CLGN GAG DISP","BOTH IP/OP","$8,046.58 ","$5,954.47 ","$0.00 ","$9,143.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,143.83 ","$0.00 ","$4,571.91 ","$7,241.91 ","$7,315.06 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$0.00 "
"56030","SUP","HCPCS C1729","","056030  -  URETHRAL CATHETERS, BARDEX, ROBINSON MODEL, LATEX 30FR","BOTH IP/OP","$7.03 ","$5.20 ","$0.00 ","$7.03 ","$3.81 ","$0.00 ","$1.46 ","$0.00 ","$0.00 ","$1.23 ","$7.03 ","$0.00 ","$3.51 ","$5.57 ","$5.62 ","$0.00 ","$1.10 ","$0.00 ","$1.12 ","$0.00 "
"57760","SUP","Custom 27203010","","FORMULA NUTRITIONAL SIMILAC 24 CAL IRON FORTIFIED","BOTH IP/OP","$26.03 ","$19.26 ","$0.00 ","$26.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.03 ","$0.00 ","$13.01 ","$20.62 ","$20.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"58025","SUP","Custom 27803010","","58025  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY MIX DBX 2.5CC","BOTH IP/OP","$1,156.00 ","$855.44 ","$0.00 ","$1,156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,156.00 ","$0.00 ","$578.00 ","$915.55 ","$924.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"58050","SUP","HCPCS C1713","","58050  -  FILLER BONE VOID ALLOGRAFT FREEZE DRIED MIX DBX 5ML","BOTH IP/OP","$2,091.00 ","$1,547.34 ","$0.00 ","$2,091.00 ","$940.95 ","$0.00 ","$435.82 ","$0.00 ","$0.00 ","$366.12 ","$2,091.00 ","$0.00 ","$1,045.50 ","$1,656.07 ","$1,672.80 ","$0.00 ","$327.24 ","$0.00 ","$332.89 ","$0.00 "
"58200","SUP","HCPCS C1713","","58200  -  FILLER BONE VOID ALLOGRAFT MIX FREEZE DRIED DBX","BOTH IP/OP","$9,475.00 ","$7,011.50 ","$0.00 ","$9,475.00 ","$4,263.75 ","$0.00 ","$1,974.83 ","$0.00 ","$0.00 ","$1,659.00 ","$9,475.00 ","$0.00 ","$4,737.50 ","$7,504.20 ","$7,580.00 ","$0.00 ","$1,482.84 ","$0.00 ","$1,508.42 ","$0.00 "
"60011","SUP","HCPCS C2625","","60011  -  IMPLANT NASAL 370 MCG MINI 4MM 16MM STEROID RELEASE ZIP TIE","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,312.50 ","$1,040.63 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$404.90 ","$2,312.50 ","$0.00 ","$1,156.25 ","$1,831.50 ","$1,850.00 ","$0.00 ","$361.91 ","$0.00 ","$368.15 ","$0.00 "
"61000","SUP","Custom 27203010","","TUBING PRSS DSPL SET STPCK 45IN REST HRT DISP","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61621","SUP","Custom 27803010","","61621  -  CAGE SPNL 16MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62100","SUP","Custom 27803010","","62100  -  PATCH DURA 2X2IN STRL DUREPAIR RSRB BVN CLGN MTRX CRNL DRPLS","BOTH IP/OP","$996.40 ","$737.34 ","$0.00 ","$996.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$996.40 ","$0.00 ","$498.20 ","$789.15 ","$797.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62105","SUP","Custom 27803010","","62105  -  PATCH DURA 3X3IN DUREPAIR CRANIAL BVN CLGN MTRX RESORB DRPLS","BOTH IP/OP","$1,816.55 ","$1,344.25 ","$0.00 ","$1,816.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,816.55 ","$0.00 ","$908.28 ","$1,438.71 ","$1,453.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62106","SUP","Custom 27803010","","62106  -  DURA 62106 SUBSTITUTE DUREPAIR 1X3IN NCE","BOTH IP/OP","$822.50 ","$608.65 ","$0.00 ","$822.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.50 ","$0.00 ","$411.25 ","$651.42 ","$658.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62110","SUP","Custom 27803010","","62110  -  PATCH DURA 5X4IN DUREPAIR CRANIAL BVN CLGN MTRX RESORB DRPLS","BOTH IP/OP","$3,520.30 ","$2,605.02 ","$0.00 ","$3,520.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,520.30 ","$0.00 ","$1,760.15 ","$2,788.08 ","$2,816.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62111","SUP","Custom 27803010","","62111  -  DURA 62111 SUBSTITUTE DUREPAIR 1X1IN NCE","BOTH IP/OP","$392.45 ","$290.41 ","$0.00 ","$392.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.45 ","$0.00 ","$196.23 ","$310.82 ","$313.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62158","SUP","Custom 27803010","","62158  -  DURA 62158 SUBSTITUTE DUREPAIR 5X8IN NCE","BOTH IP/OP","$8,742.00 ","$6,469.08 ","$0.00 ","$8,742.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,742.00 ","$0.00 ","$4,371.00 ","$6,923.66 ","$6,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"64018","SUP","HCPCS C1729","","064018  -  CATHETER NEPHROSTOMY 18FR 2 EYE DRAIN LATEX PEZZER STERILE","BOTH IP/OP","$43.23 ","$31.99 ","$0.00 ","$43.23 ","$23.47 ","$0.00 ","$9.01 ","$0.00 ","$0.00 ","$7.57 ","$43.23 ","$0.00 ","$21.61 ","$34.24 ","$34.58 ","$0.00 ","$6.76 ","$0.00 ","$6.88 ","$0.00 "
"64024","SUP","HCPCS C1729","","064024  -  CATH NPHSTM 24FR PEZ DRAIN 2 EYE STRL LATEX DISP","BOTH IP/OP","$43.23 ","$31.99 ","$0.00 ","$43.23 ","$23.47 ","$0.00 ","$9.01 ","$0.00 ","$0.00 ","$7.57 ","$43.23 ","$0.00 ","$21.61 ","$34.24 ","$34.58 ","$0.00 ","$6.76 ","$0.00 ","$6.88 ","$0.00 "
"64026","SUP","HCPCS C1729","","064026  -  CATH NPHSTM 26FR PEZ DRAIN 2 EYE STRL LATEX DISP","BOTH IP/OP","$43.23 ","$31.99 ","$0.00 ","$43.23 ","$23.47 ","$0.00 ","$9.01 ","$0.00 ","$0.00 ","$7.57 ","$43.23 ","$0.00 ","$21.61 ","$34.24 ","$34.58 ","$0.00 ","$6.76 ","$0.00 ","$6.88 ","$0.00 "
"64030","SUP","HCPCS C1729","","064030  -  CATHETER NEPHROSTOMY 30FR 2 EYE DRAIN LATEX PEZZER STERILE","BOTH IP/OP","$43.23 ","$31.99 ","$0.00 ","$43.23 ","$23.47 ","$0.00 ","$9.01 ","$0.00 ","$0.00 ","$7.57 ","$43.23 ","$0.00 ","$21.61 ","$34.24 ","$34.58 ","$0.00 ","$6.76 ","$0.00 ","$6.88 ","$0.00 "
"64036","SUP","HCPCS C1729","","064036  -  CATHETER URTH 36FR STRL LTX PEZ 2 EYE DRN PROPORTIONATE HD","BOTH IP/OP","$2.84 ","$2.10 ","$0.00 ","$2.84 ","$1.54 ","$0.00 ","$0.59 ","$0.00 ","$0.00 ","$0.50 ","$2.84 ","$0.00 ","$1.42 ","$2.25 ","$2.27 ","$0.00 ","$0.44 ","$0.00 ","$0.45 ","$0.00 "
"64331","SUP","Custom 27203010","","BRACE ORTH LEFT ANKL FT SWED AFO PE FRDM MALE","BOTH IP/OP","$76.88 ","$56.89 ","$0.00 ","$76.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.88 ","$0.00 ","$38.44 ","$60.89 ","$61.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"67910","SUP","Custom 27203010","","0067910  -  BRUSH FEMORAL CANAL SUCTION IRRIGATION LATEX SIMPULSE PLUS","BOTH IP/OP","$165.48 ","$122.46 ","$0.00 ","$93.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.05 ","$0.00 ","$46.53 ","$73.70 ","$74.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68128","SUP","Custom 27203010","","68128  -  CANNULA PERFUSION 3/8IN CONCTR 28FR 12-15IN 1 STAGE MALBLE","BOTH IP/OP","$786.79 ","$582.22 ","$0.00 ","$897.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.25 ","$0.00 ","$448.63 ","$710.62 ","$717.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68250","SUP","Custom 27803010","","68250  -  GRAFT SFT TIS 1.5X1.5CM TTPLST PRICRD ALGRF PRC STRL","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68333","SUP","Custom 27803010","","68333  -  GRAFT SFT TIS .8X.5CM STRL TTPLST LOPRFL SCLR","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$725.00 ","$0.00 ","$362.50 ","$574.20 ","$580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70011","SUP","HCPCS C2625","","70011  -  STENT NSL 370 MCG PROPEL MOMETASONE FUROATE","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,312.50 ","$1,040.63 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$404.90 ","$2,312.50 ","$0.00 ","$1,156.25 ","$1,831.50 ","$1,850.00 ","$0.00 ","$361.91 ","$0.00 ","$368.15 ","$0.00 "
"71221","SUP","Custom 27803010","","71221  -  CAGE SPNL STD 12MM 21MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71226","SUP","Custom 27803010","","71226  -  CAGE SPNL STD 12MM 26MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71310","SUP","Custom 27203010","","TRAY SPCLA BLK UNV CHRGR","BOTH IP/OP","$69.05 ","$51.10 ","$0.00 ","$69.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.05 ","$0.00 ","$34.53 ","$54.69 ","$55.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71421","SUP","Custom 27803010","","71421  -  CAGE SPNL STD 14MM 21MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71426","SUP","Custom 27803010","","71426  -  CAGE SPNL STD 14MM 26MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71621","SUP","Custom 27803010","","71621  -  CAGE SPNL STD 16MM 21MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71626","SUP","Custom 27803010","","71626  -  CAGE SPNL STD 16MM 26MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71821","SUP","Custom 27803010","","71821  -  CAGE SPNL STD 18MM 21MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71826","SUP","Custom 27803010","","71826  -  CAGE SPNL STD 18MM 26MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$7,087.75 ","$5,244.94 ","$0.00 ","$7,087.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,087.75 ","$0.00 ","$3,543.88 ","$5,613.50 ","$5,670.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72026","SUP","Custom 27803010","","72026  -  CAGE SPNL STD 20MM 26MM RYTFC THRD CNCT TI PLIF","BOTH IP/OP","$6,615.95 ","$4,895.80 ","$0.00 ","$6,615.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,615.95 ","$0.00 ","$3,307.98 ","$5,239.83 ","$5,292.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72228","SUP","Custom 27203010","","72228  -  DRAIN INCISION FULL FLUTE ROUND 15FR 3/16IN CHANNEL RADIOPQ","BOTH IP/OP","$34.44 ","$25.49 ","$0.00 ","$34.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.44 ","$0.00 ","$17.22 ","$27.28 ","$27.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72230","SUP","Custom 27203010","","072230  -  DRAIN 19FR HUBLESS FULL FLUTED","BOTH IP/OP","$43.68 ","$32.32 ","$0.00 ","$43.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.68 ","$0.00 ","$21.84 ","$34.59 ","$34.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72335","SUP","Custom 27203010","","72335  -  SPLINT ORTHOPEDIC LP 35X3IN PRECUT PAD WATER REPELLENT LATEX","BOTH IP/OP","$23.68 ","$17.52 ","$0.00 ","$32.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.04 ","$0.00 ","$12.02 ","$32.08 ","$19.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72430","SUP","Custom 27203010","","72430  -  SPLINT ORTH 30X4IN CNFRM PCUT FELT PD HPOAL H2O RPLNT FBGLS","BOTH IP/OP","$26.74 ","$19.79 ","$0.00 ","$26.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.74 ","$0.00 ","$13.37 ","$21.18 ","$21.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72495","SUP","Custom 27203010","","CONTROL ANTI HAV IGM MONOLISA EIA IMMUN","BOTH IP/OP","$1,612.50 ","$1,193.25 ","$0.00 ","$1,612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,612.50 ","$0.00 ","$806.25 ","$1,277.10 ","$1,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72496","SUP","Custom 27203010","","CONTROL ANTI-HAV IGM IGG HAV MONOLISA EIA 192 TST IMMUN","BOTH IP/OP","$1,387.50 ","$1,026.75 ","$0.00 ","$1,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,387.50 ","$0.00 ","$693.75 ","$1,098.90 ","$1,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72530","SUP","Custom 27203010","","72530  -  SPLINT ORTH 30X5IN PCUT FELT PD FBGLS SCTCHCST CNFRM","BOTH IP/OP","$31.37 ","$23.21 ","$0.00 ","$31.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.37 ","$0.00 ","$15.69 ","$24.85 ","$25.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75000","SUP","HCPCS C1726","","075000  -  SET DILAT 30CM 6-30FR AMPTZ RNL TFE 16CM","BOTH IP/OP","$495.85 ","$366.93 ","$0.00 ","$495.85 ","$269.25 ","$0.00 ","$103.35 ","$0.00 ","$0.00 ","$86.82 ","$495.85 ","$0.00 ","$247.93 ","$392.71 ","$396.68 ","$0.00 ","$77.60 ","$0.00 ","$78.94 ","$0.00 "
"76430","SUP","Custom 27203010","","76430  -  SPLINT ORTHOPEDIC 30X4IN CONFORMABLE MOLDABLE LIGHTWEIGHT 3M","BOTH IP/OP","$72.14 ","$53.38 ","$0.00 ","$37.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.22 ","$0.00 ","$14.11 ","$37.46 ","$22.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"78710","SUP","HCPCS C1713","","SPACER MDI ARCHB+ MED VLV HLD CHMBR HNDHLD CMFSL MASK PED","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"78810","SUP","Custom 27203010","","TRANSILLUMINATOR EXAM TRNSFM ON/OFF SWH LF DISP KLNSPC VAG","BOTH IP/OP","$326.83 ","$241.85 ","$0.00 ","$326.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.83 ","$0.00 ","$163.41 ","$258.85 ","$261.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79910","SUP","Custom 27203010","","TRANSILLUMINATOR EXAM CRDLS CHRG STTN DISP KLNSPC VAG SPCLM","BOTH IP/OP","$461.70 ","$341.66 ","$0.00 ","$461.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$461.70 ","$0.00 ","$230.85 ","$365.67 ","$369.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80010","SUP","Custom 27803010","","80010  -  IMPLANT ORBTL 18MM SPHERE SMOOTH SUTURE TUNNELS POROUS","BOTH IP/OP","$1,630.13 ","$1,206.30 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80018","SUP","Custom 27203010","","80018  -  IMPLANT ORBTL 18MM CONICAL MULTPUR SMOOTH SUTURE TUNNELS","BOTH IP/OP","$1,912.50 ","$1,415.25 ","$0.00 ","$1,912.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,912.50 ","$0.00 ","$956.25 ","$1,514.70 ","$1,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80022","SUP","Custom 27803010","","80022  -  QUAD MOTILITY IMPLANT - EXTRA LARGE (APPROX. 22MM VOLUME)","BOTH IP/OP","$1,188.06 ","$879.16 ","$0.00 ","$1,188.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,188.06 ","$0.00 ","$594.03 ","$940.94 ","$950.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80026","SUP","Custom 27803010","","80026  -  IMPLANT ORBTL CONICAL CONICAL FLAT ANTERIOR SURFACE CHANNELS","BOTH IP/OP","$1,188.06 ","$879.16 ","$0.00 ","$1,188.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,188.06 ","$0.00 ","$594.03 ","$940.94 ","$950.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80036","SUP","Custom 27803010","","80036  -  SPHERE EYE 16MM MDPR+","BOTH IP/OP","$1,277.20 ","$945.13 ","$0.00 ","$1,277.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,277.20 ","$0.00 ","$638.60 ","$1,011.54 ","$1,021.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80038","SUP","Custom 27803010","","80038  -  IMPLANT ORBTL STANDARD SPHERE 18MM MEDPOR PLUS BIOACTIVE","BOTH IP/OP","$1,742.50 ","$1,289.45 ","$0.00 ","$1,742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,742.50 ","$0.00 ","$871.25 ","$1,380.06 ","$1,394.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80040","SUP","Custom 27803010","","80040  -  SPHERE EYE 20MM MDPR+","BOTH IP/OP","$1,277.20 ","$945.13 ","$0.00 ","$1,277.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,277.20 ","$0.00 ","$638.60 ","$1,011.54 ","$1,021.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80042","SUP","Custom 27803010","","80042  -  MEDPOR PLUS - 22MM","BOTH IP/OP","$1,277.20 ","$945.13 ","$0.00 ","$1,277.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,277.20 ","$0.00 ","$638.60 ","$1,011.54 ","$1,021.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80046","SUP","Custom 27803010","","80046  -  MEDPOR PLUS SST - 16MM","BOTH IP/OP","$1,483.20 ","$1,097.57 ","$0.00 ","$1,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,483.20 ","$0.00 ","$741.60 ","$1,174.69 ","$1,186.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80048","SUP","Custom 27803010","","80048  -  MEDPOR PLUS SST - 18MM","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$1,174.69 ","$15.07 ","$4.23 ","$4.23 ","$12.36 ","$12.36 ","$12.52 ","$30.00 ","$8.88 ","$23.66 ","$1,174.69 ","$24.00 ","$12.27 ","$0.00 ","$8.46 ","$9.34 ","$8.46 "
"80050","SUP","Custom 27803010","","80050  -  MEDPOR PLUS SST - 20MM","BOTH IP/OP","$1,483.20 ","$1,097.57 ","$0.00 ","$1,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,483.20 ","$0.00 ","$741.60 ","$1,174.69 ","$1,186.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80052","SUP","Custom 27803010","","80052  -  KIT RETRIEVER 18MM 20X4MM 32MM MICROCATHETER FLEXCELL TREVO","BOTH IP/OP","$13,641.25 ","$10,094.53 ","$0.00 ","$13,641.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,641.25 ","$0.00 ","$6,820.63 ","$10,803.87 ","$10,913.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80056","SUP","Custom 27803010","","80056  -  MEDPOR PLUS SST EZ - 16MM","BOTH IP/OP","$1,483.20 ","$1,097.57 ","$0.00 ","$1,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,483.20 ","$0.00 ","$741.60 ","$1,174.69 ","$1,186.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80058","SUP","Custom 27803010","","80058  -  SPHERE EYE 18MM SST EZ","BOTH IP/OP","$1,483.20 ","$1,097.57 ","$0.00 ","$1,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,483.20 ","$0.00 ","$741.60 ","$1,174.69 ","$1,186.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80060","SUP","Custom 27803010","","80060  -  MEDPOR PLUS SST EZ - 20MM","BOTH IP/OP","$1,483.20 ","$1,097.57 ","$0.00 ","$1,483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,483.20 ","$0.00 ","$741.60 ","$1,174.69 ","$1,186.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80062","SUP","Custom 27803010","","80062  -  IMPLANT ORBTL ROUND 22MM SPHERE SMOOTH SURFACE SUTURE","BOTH IP/OP","$2,052.50 ","$1,518.85 ","$0.00 ","$2,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,052.50 ","$0.00 ","$1,026.25 ","$1,625.58 ","$1,642.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80400","SUP","HCPCS C1751","","0080400  -  DRAIN INCISION 15X5/8IN 3 LUMEN ANTIBACTERIAL FILTER SUMP","BOTH IP/OP","$55.90 ","$41.37 ","$0.00 ","$55.90 ","$30.35 ","$0.00 ","$11.65 ","$0.00 ","$0.00 ","$9.79 ","$55.90 ","$0.00 ","$27.95 ","$44.27 ","$44.72 ","$0.00 ","$8.75 ","$0.00 ","$8.90 ","$0.00 "
"80710","SUP","HCPCS C1713","","SPACER MDI ARCHB+ LG VLV HLD CHMBR HNDHLD CMFSL MASK PED","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$14.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"81001","SUP","Custom 27803010","","81001  -  IMPLANT ORBT 40X40X8.45MM STRL MDPR ONLAY PE POR LT CRNMXF","BOTH IP/OP","$10.00 ","$7.40 ","$1.58 ","$1,536.48 ","$5.65 ","$1.59 ","$1.58 ","$4.63 ","$4.63 ","$4.68 ","$11.00 ","$3.33 ","$8.86 ","$1,536.48 ","$8.80 ","$4.60 ","$4.99 ","$3.17 ","$3.49 ","$3.17 "
"81002","SUP","Custom 27803010","","81002  -  GRAFT SYNTH TISSUE 40X40MM ONLAY MEDPOR POLYETHYLENE POROUS","BOTH IP/OP","$1,371.58 ","$1,014.97 ","$0.00 ","$1,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,940.00 ","$0.00 ","$970.00 ","$1,536.48 ","$1,552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81007","SUP","Custom 27803010","","81007  -  GRAFT SYNTH TISSUE 33X45MM IMPLANT POROUS MEDPOR","BOTH IP/OP","$1,387.50 ","$1,026.75 ","$0.00 ","$1,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,387.50 ","$0.00 ","$693.75 ","$1,098.90 ","$1,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81008","SUP","Custom 27803010","","81008  -  GRAFT SYNTH TISSUE 45X33MM IMPLANT POROUS MEDPOR","BOTH IP/OP","$1,387.50 ","$1,026.75 ","$0.00 ","$1,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,387.50 ","$0.00 ","$693.75 ","$1,098.90 ","$1,110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81013","SUP","Custom 27803010","","81013  -  GRAFT SYNTH TISSUE 30MM 38X33X.8MM IMPLANT ORBITO-ZYGOMATIC","BOTH IP/OP","$1,984.15 ","$1,468.27 ","$0.00 ","$3,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,040.00 ","$0.00 ","$1,520.00 ","$2,407.68 ","$2,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81014","SUP","Custom 27803010","","81014  -  IMPLANT ORBT 38X33X.8MM TRM OFF THE SHLF MDPR RT","BOTH IP/OP","$1,984.15 ","$1,468.27 ","$0.00 ","$3,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,040.00 ","$0.00 ","$1,520.00 ","$2,407.68 ","$2,432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81020","SUP","Custom 27803010","","81020  -  MESH CRANIAL 76X50X.85MM EMBED SHEET MEDPOR TITAN MEDPOR","BOTH IP/OP","$2,677.50 ","$1,981.35 ","$0.00 ","$3,702.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,702.50 ","$0.00 ","$1,851.25 ","$2,932.38 ","$2,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81021","SUP","Custom 27803010","","81021  -  PLATE BONE 38X50X.85MM MESH EMBEDDED POROUS MEDPOR TITAN MTM","BOTH IP/OP","$1,958.10 ","$1,448.99 ","$0.00 ","$2,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81022","SUP","Custom 27803010","","81022  -  PLATE BONE 38X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM","BOTH IP/OP","$1,958.10 ","$1,448.99 ","$0.00 ","$2,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81023","SUP","Custom 27803010","","81023  -  PLATE BONE 76X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM","BOTH IP/OP","$2,447.23 ","$1,810.95 ","$0.00 ","$3,702.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,702.50 ","$0.00 ","$1,851.25 ","$2,932.38 ","$2,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81024","SUP","Custom 27803010","","81024  -  PLATE BONE 38X50X.6MM MESH EMBEDDED NONPOROUS BARRIER","BOTH IP/OP","$2,301.50 ","$1,703.11 ","$0.00 ","$3,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81025","SUP","Custom 27803010","","81025  -  MESH CRANIAL 76X50X.6MM EMBED SHEET MEDPOR TITAN BARRIER","BOTH IP/OP","$26.00 ","$19.24 ","$3.87 ","$3,346.20 ","$11.26 ","$4.31 ","$3.87 ","$9.24 ","$9.24 ","$9.36 ","$30.00 ","$9.04 ","$17.68 ","$3,346.20 ","$24.00 ","$12.48 ","$9.97 ","$8.61 ","$6.98 ","$8.61 "
"81026","SUP","Custom 27803010","","81026  -  MESH CRANIAL 38X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE","BOTH IP/OP","$2,301.50 ","$1,703.11 ","$0.00 ","$3,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81027","SUP","Custom 27803010","","81027  -  MESH CRANIAL 76X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE","BOTH IP/OP","$2,790.63 ","$2,065.07 ","$0.00 ","$4,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,225.00 ","$0.00 ","$2,112.50 ","$3,346.20 ","$3,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81028","SUP","Custom 27803010","","81028  -  PLATE BONE 50X38X1.6MM SHEET SOLID SURFACE MTB POLYETHYLENE","BOTH IP/OP","$2,301.50 ","$1,703.11 ","$0.00 ","$3,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81029","SUP","Custom 27803010","","81029  -  PLATE BONE 76X50X1.6MM MESH EMBEDDED NONPOROUS BARRIER","BOTH IP/OP","$2,790.63 ","$2,065.07 ","$0.00 ","$4,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,225.00 ","$0.00 ","$2,112.50 ","$3,346.20 ","$3,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81030","SUP","Custom 27803010","","81030  -  GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN","BOTH IP/OP","$2,099.93 ","$1,553.95 ","$0.00 ","$2,905.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.00 ","$0.00 ","$1,452.50 ","$2,300.76 ","$2,324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81031","SUP","Custom 27803010","","81031  -  PLATE BN 42X41X1MM STRL MDPR TN MTB MESH EMBED XTN TI PE","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$3,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,417.50 ","$0.00 ","$1,708.75 ","$2,706.66 ","$2,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81032","SUP","Custom 27803010","","81032  -  PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN MTB","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$3,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,417.50 ","$0.00 ","$1,708.75 ","$2,706.66 ","$2,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81033","SUP","Custom 27803010","","81033  -  PLATE BONE 42X41X.6MM MESH EMBED EXTN MEDPOR TITAN DOUBLE","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$3,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,417.50 ","$0.00 ","$1,708.75 ","$2,706.66 ","$2,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81034","SUP","Custom 27803010","","81034  -  GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN MAX","BOTH IP/OP","$2,099.93 ","$1,553.95 ","$0.00 ","$2,905.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,905.00 ","$0.00 ","$1,452.50 ","$2,300.76 ","$2,324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81035","SUP","Custom 27803010","","81035  -  PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN BARRIER","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$3,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,417.50 ","$0.00 ","$1,708.75 ","$2,706.66 ","$2,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81036","SUP","Custom 27803010","","81036  -  PLATE BONE THK1MM 42X41X1MM MESH EMBEDDED EXTENSIONS POROUS","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$3,417.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,417.50 ","$0.00 ","$1,708.75 ","$2,706.66 ","$2,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81037","SUP","Custom 27803010","","81037  -  PLATE BONE THIN PROFILE 130X130X3MM RADIOPQ MEDPOR TITANIUM","BOTH IP/OP","$15,775.50 ","$11,673.87 ","$0.00 ","$25,372.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,372.50 ","$0.00 ","$12,686.25 ","$20,095.02 ","$20,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81038","SUP","Custom 27803010","","81038  -  PLATE BONE 130X130X3MM MESH EMBEDDED POROUS MEDPOR TITAN","BOTH IP/OP","$15,775.50 ","$11,673.87 ","$0.00 ","$25,372.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25,372.50 ","$0.00 ","$12,686.25 ","$20,095.02 ","$20,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81040","SUP","Custom 27803010","","81040  -  PLATE BONE 76X100X1.5MM MESH EMBEDDED SHEET POROUS MEDPOR","BOTH IP/OP","$5,756.90 ","$4,260.11 ","$0.00 ","$8,142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,142.50 ","$0.00 ","$4,071.25 ","$6,448.86 ","$6,514.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81050","SUP","HCPCS C1713","","81050  -  PLATE BONE FAN MTB CRANFCL","BOTH IP/OP","$2,546.25 ","$1,884.23 ","$0.00 ","$3,592.50 ","$1,616.63 ","$0.00 ","$530.70 ","$0.00 ","$0.00 ","$629.02 ","$3,592.50 ","$0.00 ","$1,796.25 ","$2,845.26 ","$2,874.00 ","$0.00 ","$562.23 ","$0.00 ","$571.93 ","$0.00 "
"81060","SUP","Custom 27803010","","81060  -  IMPLANT MANDIB 30X15X.25MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$477.50 ","$353.35 ","$0.00 ","$477.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.50 ","$0.00 ","$238.75 ","$378.18 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81061","SUP","Custom 27803010","","81061  -  IMPLANT MANDIB 30X25X.25MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$720.00 ","$532.80 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$360.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81062","SUP","Custom 27803010","","81062  -  GRAFT SYNTH TISSUE ULTRATHIN 35X45X.25IN SHEET CONTAINMENT","BOTH IP/OP","$957.50 ","$708.55 ","$0.00 ","$957.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$957.50 ","$0.00 ","$478.75 ","$758.34 ","$766.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81063","SUP","Custom 27803010","","81063  -  IMPLANT MANDIB 30X15X.35MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$348.43 ","$257.84 ","$0.00 ","$477.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.50 ","$0.00 ","$238.75 ","$378.18 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81064","SUP","Custom 27803010","","81064  -  IMPLANT MANDIB 30X25X.35MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$527.45 ","$390.31 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$360.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81065","SUP","Custom 27803010","","81065  -  IMPLANT MANDIB 45X35X.35MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$702.63 ","$519.95 ","$0.00 ","$957.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$957.50 ","$0.00 ","$478.75 ","$758.34 ","$766.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81066","SUP","Custom 27803010","","81066  -  IMPLANT MANDIB 30X15X.45MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$477.50 ","$353.35 ","$0.00 ","$477.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$477.50 ","$0.00 ","$238.75 ","$378.18 ","$382.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81067","SUP","Custom 27803010","","81067  -  IMPLANT MANDIB 30X25X.45MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$526.88 ","$389.89 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$360.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81068","SUP","Custom 27803010","","81068  -  IMPLANT MANDIB 35X45X.45MM BIOCOMPATIBLE SPACE MAINTENANCE","BOTH IP/OP","$701.25 ","$518.93 ","$0.00 ","$957.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$957.50 ","$0.00 ","$478.75 ","$758.34 ","$766.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81200","SUP","Custom 27803010","","81200  -  ROD SPNL 5.5MM 50MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81201","SUP","Custom 27803010","","81201  -  ROD SPNL 5.5MM 60MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81202","SUP","Custom 27803010","","81202  -  ROD SPNL 5.5MM 70MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81203","SUP","Custom 27803010","","81203  -  ROD SPNL 5.5MM 80MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81204","SUP","Custom 27803010","","81204  -  ROD SPNL 5.5MM 90MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81205","SUP","Custom 27803010","","81205  -  ROD SPNL 5.5MM 100MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81206","SUP","Custom 27803010","","81206  -  ROD SPNL 5.5MM 110MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81207","SUP","Custom 27803010","","81207  -  ROD SPNL 5.5MM 120MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81208","SUP","Custom 27803010","","81208  -  ROD SPNL 5.5MM 140MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81210","SUP","Custom 27803010","","81210  -  ROD SPNL 5.5MM 160MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81211","SUP","Custom 27803010","","81211  -  ROD SPNL 5.5MM 180MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81212","SUP","Custom 27803010","","81212  -  ROD SPNL 5.5MM 220MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81213","SUP","Custom 27803010","","81213  -  ROD SPNL 5.5MM 240MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81214","SUP","Custom 27803010","","81214  -  ROD SPNL 5.5MM 260MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81215","SUP","Custom 27803010","","81215  -  ROD SPNL 5.5MM 280MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81216","SUP","Custom 27803010","","81216  -  ROD SPNL 5.5MM 300MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81217","SUP","Custom 27803010","","81217  -  ROD SPNL 5.5MM 320MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81218","SUP","Custom 27803010","","81218  -  ROD SPNL 5.5MM 340MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81219","SUP","Custom 27803010","","81219  -  ROD SPNL 5.5MM 360MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81220","SUP","Custom 27803010","","81220  -  ROD SPNL 5.5MM 380MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81906","SUP","Custom 27203010","","REAGENT SBSTR ACCES 130ML ANALY","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$461.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$461.25 ","$0.00 ","$230.63 ","$365.31 ","$369.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81908","SUP","Custom 27203010","","REAGENT SMPL DILU A ANALY","BOTH IP/OP","$74.83 ","$55.37 ","$0.00 ","$74.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.83 ","$0.00 ","$37.41 ","$59.27 ","$59.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81910","SUP","Custom 27203010","","REAGENT SYS CHK SOL ACCES 4ML ANALY","BOTH IP/OP","$95.33 ","$70.54 ","$0.00 ","$95.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.33 ","$0.00 ","$47.66 ","$75.50 ","$76.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82000","SUP","Custom 27803010","","82000  -  GRAFT SYNTH TISSUE THK4MM HEMISPHERE CNTOUR POROUS MEDPOR","BOTH IP/OP","$14,542.50 ","$10,761.45 ","$0.00 ","$14,542.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,542.50 ","$0.00 ","$7,271.25 ","$11,517.66 ","$11,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82001","SUP","Custom 27803010","","82001  -  GRAFT SYNTH TISSUE HEMISPHERE 170X124X4.5MM OFF THE SHELF","BOTH IP/OP","$8,921.60 ","$6,601.98 ","$0.00 ","$14,542.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,542.50 ","$0.00 ","$7,271.25 ","$11,517.66 ","$11,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82006","SUP","Custom 27803010","","82006  -  GRAFT SYNTH TISSUE DOME 180X150X6MM PRESHAPED POROUS MEDPOR","BOTH IP/OP","$15,460.00 ","$11,440.40 ","$0.00 ","$15,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,460.00 ","$0.00 ","$7,730.00 ","$12,244.32 ","$12,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82007","SUP","Custom 27803010","","82007  -  GRAFT SNTH TISS LG 20X2.5X2.5MM STRL MDPR TSI TAB NPOR POST","BOTH IP/OP","$1,108.25 ","$820.11 ","$0.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82008","SUP","Custom 27803010","","82008  -  GRAFT SYNTH TISSUE LARGE 40X40X2.5MM .73MM 3 TABS NONPOROUS","BOTH IP/OP","$1,268.75 ","$938.88 ","$0.00 ","$1,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82011","SUP","Custom 27803010","","82011  -  GRAFT SYNTH TISSUE TRIANGLE 102X3.6X4MM 102X10X6MM IMPLANT","BOTH IP/OP","$672.00 ","$497.28 ","$0.00 ","$1,012.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82013","SUP","Custom 27803010","","82013  -  GRAFT SYNTH TISSUE .6MM V SHAPE 30X10X6MM IMPLANT CRANIOTOMY","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$1,012.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82014","SUP","Custom 27803010","","82014  -  GRAFT SYNTH TISSUE SMALL 36X45X1MM IMPLANT POROUS MEDPOR","BOTH IP/OP","$1,521.50 ","$1,125.91 ","$0.00 ","$2,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,320.00 ","$0.00 ","$1,160.00 ","$1,837.44 ","$1,856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82015","SUP","Custom 27803010","","82015  -  GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR","BOTH IP/OP","$1,974.38 ","$1,461.04 ","$0.00 ","$3,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,207.50 ","$0.00 ","$1,603.75 ","$2,540.34 ","$2,566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82016","SUP","Custom 27803010","","82016  -  GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR","BOTH IP/OP","$1,974.38 ","$1,461.04 ","$0.00 ","$3,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,207.50 ","$0.00 ","$1,603.75 ","$2,540.34 ","$2,566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82019","SUP","Custom 27803010","","82019  -  PLATE BONE CURVE 48X38X.85MM MESH EMBED PRESHAPE MEDPOR","BOTH IP/OP","$2,728.38 ","$2,019.00 ","$0.00 ","$4,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,430.00 ","$0.00 ","$2,215.00 ","$3,508.56 ","$3,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82020","SUP","Custom 27803010","","82020  -  PLATE BONE CURVE 48X38X1MM MESH EMBEDDED PCVD NONPOROUS","BOTH IP/OP","$2,859.75 ","$2,116.22 ","$0.00 ","$5,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,015.00 ","$0.00 ","$2,507.50 ","$3,971.88 ","$4,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82022","SUP","Custom 27803010","","82022  -  FLEXBLOCK IMPLANT - BARRIER 56MM X 91MM X 4MM","BOTH IP/OP","$3,712.00 ","$2,746.88 ","$0.00 ","$3,712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82030","SUP","Custom 27803010","","82030  -  PLATE BONE 96X61X1.5MM IMPLANT POROUS MEDPOR TITAN TITANIUM","BOTH IP/OP","$5,756.83 ","$4,260.05 ","$0.00 ","$8,702.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,702.50 ","$0.00 ","$4,351.25 ","$6,892.38 ","$6,962.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82301","SUP","HCPCS B4088","","082301  -  TUBE JJNSTM 60IN 9-18FR PU COMPAT STPT FEED NSL STRL","BOTH IP/OP","$466.09 ","$344.91 ","$0.00 ","$369.14 ","$9.90 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$3.29 ","$22.00 ","$0.00 ","$11.00 ","$369.14 ","$17.60 ","$13.20 ","$3.29 ","$0.00 ","$3.13 ","$0.00 "
"83003","SUP","Custom 27803010","","83003  -  GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS","BOTH IP/OP","$1,025.43 ","$758.82 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83004","SUP","Custom 27803010","","83004  -  GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS","BOTH IP/OP","$1,025.43 ","$758.82 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83007","SUP","Custom 27803010","","83007  -  GRAFT SNTH TISS 60X40X4MM STRL MDPR IMPL CNTR SHL-TY DSGN","BOTH IP/OP","$1,025.43 ","$758.82 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83008","SUP","Custom 27803010","","83008  -  GRAFT SNTH TISS 60X40MM STRL MDPR IMPL CNTR SHL-TY DSGN POR","BOTH IP/OP","$1,025.43 ","$758.82 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83020","SUP","Custom 27803010","","83020  -  GRAFT SYNTH TISSUE MICROTHIN 38X50X.25MM SHEET POROUS MEDPOR","BOTH IP/OP","$961.35 ","$711.40 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83021","SUP","Custom 27803010","","83021  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.25MM SHEET POROUS MEDPOR","BOTH IP/OP","$1,777.50 ","$1,315.35 ","$0.00 ","$1,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,777.50 ","$0.00 ","$888.75 ","$1,407.78 ","$1,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83022","SUP","Custom 27803010","","83022  -  GRAFT SNTH 38X50X.35MM STRL OFF THE SHLF FTHR EDG SMTH TRNS","BOTH IP/OP","$949.03 ","$702.28 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83023","SUP","Custom 27803010","","83023  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.35MM SHEET POROUS MEDPOR","BOTH IP/OP","$1,777.50 ","$1,315.35 ","$0.00 ","$1,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,777.50 ","$0.00 ","$888.75 ","$1,407.78 ","$1,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83029","SUP","Custom 27803010","","83029  -  GRAFT SYNTH TISSUE MICROTHIN 50X38X.45MM SHEET POROUS MEDPOR","BOTH IP/OP","$949.03 ","$702.28 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83030","SUP","Custom 27803010","","83030  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.45MM SHEET MEDPOR POROUS","BOTH IP/OP","$1,276.28 ","$944.45 ","$0.00 ","$1,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,777.50 ","$0.00 ","$888.75 ","$1,407.78 ","$1,422.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84000","SUP","Custom 27803010","","84000  -  GRAFT SYNTH TISSUE PETITE 45X4X4MM IMPLANT TAPERED PROFILE","BOTH IP/OP","$650.63 ","$481.47 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84001","SUP","Custom 27803010","","84001  -  GRAFT SYNTH TISSUE PETITE 55X4X4MM IMPLANT TAPERED PROFILE","BOTH IP/OP","$650.63 ","$481.47 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84002","SUP","Custom 27803010","","84002  -  GRAFT SYNTH TISSUE PETITE 45X5X5MM IMPLANT TAPERED PROFILE","BOTH IP/OP","$650.63 ","$481.47 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84003","SUP","Custom 27803010","","84003  -  GRAFT SYNTH TISSUE PETITE 55X5X5MM IMPLANT TAPERED PROFILE","BOTH IP/OP","$650.63 ","$481.47 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84004","SUP","Custom 27803010","","84004  -  GRAFT SYNTH TISSUE PETITE 55X9X6MM IMPLANT TAPERED PROFILE","BOTH IP/OP","$650.63 ","$481.47 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84006","SUP","Custom 27803010","","84006  -  IMPLANT FACIAL THIN SHELL NASAL DORSAL","BOTH IP/OP","$1,130.00 ","$836.20 ","$0.00 ","$1,552.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,552.50 ","$0.00 ","$776.25 ","$1,229.58 ","$1,242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84008","SUP","Custom 27803010","","84008  -  NASAL DARTT IMPLANT - 40M X 4MM X 1.4MM","BOTH IP/OP","$884.00 ","$654.16 ","$0.00 ","$884.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$884.00 ","$0.00 ","$442.00 ","$700.13 ","$707.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84010","SUP","Custom 27803010","","84010  -  IMPLANT FACIAL 37X22X.5MM TIP TOP MEDPOR NASAL","BOTH IP/OP","$900.90 ","$666.67 ","$0.00 ","$1,227.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,227.50 ","$0.00 ","$613.75 ","$972.18 ","$982.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84012","SUP","Custom 27803010","","84012  -  GRAFT SYNTH TISSUE 41X9X3MM ONLAY POROUS MEDPOR POLYETHYLENE","BOTH IP/OP","$777.43 ","$575.30 ","$0.00 ","$1,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.50 ","$0.00 ","$538.75 ","$853.38 ","$862.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84129","SUP","Custom 27803010","","84129  -  GRAFT SYNTH TISSUE SMALL 59X34X19.5MM IMPLANT S-SHAPE 1","BOTH IP/OP","$4,354.13 ","$3,222.06 ","$0.00 ","$5,277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,277.50 ","$0.00 ","$2,638.75 ","$4,179.78 ","$4,222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84130","SUP","Custom 27803010","","84130  -  S EAR - SMALL - RIGHT - 59MM X 34MM X 19.5","BOTH IP/OP","$3,886.00 ","$2,875.64 ","$0.00 ","$3,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,886.00 ","$0.00 ","$1,943.00 ","$3,077.71 ","$3,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84131","SUP","Custom 27803010","","84131  -  PROS OSS MED 62X36X20.5MM LEFT EAR S","BOTH IP/OP","$3,886.00 ","$2,875.64 ","$0.00 ","$3,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,886.00 ","$0.00 ","$1,943.00 ","$3,077.71 ","$3,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84132","SUP","Custom 27803010","","84132  -  S EAR - MEDIUM - RIGHT - 62MM X 36MM X 20.5MM","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$3,886.00 ","$0.00 ","$2.38 ","$2.30 ","$0.00 ","$0.00 ","$0.00 ","$3,886.00 ","$0.00 ","$1,943.00 ","$3,077.71 ","$3,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84133","SUP","Custom 27803010","","84133  -  S EAR - LARGE - LEFT - 65MM X 37MM X 21.5MM","BOTH IP/OP","$3,886.00 ","$2,875.64 ","$0.00 ","$3,886.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,886.00 ","$0.00 ","$1,943.00 ","$3,077.71 ","$3,108.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84134","SUP","Custom 27803010","","84134  -  S EAR - LARGE - RIGHT - 65MM X 37MM X 21.5MM","BOTH IP/OP","$4,004.00 ","$2,962.96 ","$0.00 ","$4,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,004.00 ","$0.00 ","$2,002.00 ","$3,171.17 ","$3,203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84505","SUP","Custom 27803010","","84505  -  CONNECTOR 84505 CD CL DOM 7.7MM","BOTH IP/OP","$1,991.25 ","$1,473.53 ","$0.00 ","$1,991.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,991.25 ","$0.00 ","$995.63 ","$1,577.07 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"85040","SUP","Custom 27203010","","85040  -  APPLICATOR FBRTP 6IN FOAM CTTN POLYPRO CSTM OVR 1IN 3/8IN","BOTH IP/OP","$151.63 ","$112.21 ","$0.00 ","$151.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.63 ","$0.00 ","$75.81 ","$120.09 ","$121.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"85201","SUP","HCPCS C1768","","85201  -  GRAFT HEMASHIELD GRAFT? 20X10MM X 40L962.45","BOTH IP/OP","$1,688.05 ","$1,249.16 ","$0.00 ","$1,688.05 ","$759.62 ","$0.00 ","$351.83 ","$0.00 ","$0.00 ","$295.56 ","$1,688.05 ","$0.00 ","$844.03 ","$1,336.94 ","$1,350.44 ","$0.00 ","$264.18 ","$0.00 ","$268.74 ","$0.00 "
"85412","SUP","HCPCS C1876","","85412  -  STENT TRCHBR 6MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$2,756.25 ","$0.00 ","$1,276.60 ","$0.00 ","$0.00 ","$1,072.44 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$958.56 ","$0.00 ","$975.10 ","$0.00 "
"85414","SUP","HCPCS C1876","","85414  -  STENT TRCHBR 7MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO","BOTH IP/OP","$6,115.63 ","$4,525.57 ","$0.00 ","$6,115.63 ","$2,752.03 ","$0.00 ","$1,274.65 ","$0.00 ","$0.00 ","$1,070.80 ","$6,115.63 ","$0.00 ","$3,057.81 ","$4,843.58 ","$4,892.50 ","$0.00 ","$957.10 ","$0.00 ","$973.61 ","$0.00 "
"85415","SUP","HCPCS C1876","","85415  -  STENT TRCHBR 7MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS","BOTH IP/OP","$6,590.63 ","$4,877.07 ","$0.00 ","$6,590.63 ","$2,965.78 ","$0.00 ","$1,373.65 ","$0.00 ","$0.00 ","$1,153.97 ","$6,590.63 ","$0.00 ","$3,295.31 ","$5,219.78 ","$5,272.50 ","$0.00 ","$1,031.43 ","$0.00 ","$1,049.23 ","$0.00 "
"85416","SUP","HCPCS C1876","","85416  -  STENT TRCHBR 8MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO SS","BOTH IP/OP","$6,115.63 ","$4,525.57 ","$0.00 ","$6,115.63 ","$2,752.03 ","$0.00 ","$1,274.65 ","$0.00 ","$0.00 ","$1,070.80 ","$6,115.63 ","$0.00 ","$3,057.81 ","$4,843.58 ","$4,892.50 ","$0.00 ","$957.10 ","$0.00 ","$973.61 ","$0.00 "
"85417","SUP","HCPCS C1876","","85417  -  STENT TRCHBR 8MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS","BOTH IP/OP","$6,590.63 ","$4,877.07 ","$0.00 ","$6,590.63 ","$2,965.78 ","$0.00 ","$1,373.65 ","$0.00 ","$0.00 ","$1,153.97 ","$6,590.63 ","$0.00 ","$3,295.31 ","$5,219.78 ","$5,272.50 ","$0.00 ","$1,031.43 ","$0.00 ","$1,049.23 ","$0.00 "
"85418","SUP","HCPCS C1876","","85418  -  STENT TRCHBR 9MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO","BOTH IP/OP","$6,115.63 ","$4,525.57 ","$0.00 ","$6,115.63 ","$2,752.03 ","$0.00 ","$1,274.65 ","$0.00 ","$0.00 ","$1,070.80 ","$6,115.63 ","$0.00 ","$3,057.81 ","$4,843.58 ","$4,892.50 ","$0.00 ","$957.10 ","$0.00 ","$973.61 ","$0.00 "
"85419","SUP","HCPCS C1876","","85419  -  STENT TRCHBR 9MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS","BOTH IP/OP","$6,590.63 ","$4,877.07 ","$0.00 ","$6,590.63 ","$2,965.78 ","$0.00 ","$1,373.65 ","$0.00 ","$0.00 ","$1,153.97 ","$6,590.63 ","$0.00 ","$3,295.31 ","$5,219.78 ","$5,272.50 ","$0.00 ","$1,031.43 ","$0.00 ","$1,049.23 ","$0.00 "
"85424","SUP","HCPCS C1876","","85424  -  STENT TRCHBR 10MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO","BOTH IP/OP","$6,115.63 ","$4,525.57 ","$0.00 ","$6,115.63 ","$2,752.03 ","$0.00 ","$1,274.65 ","$0.00 ","$0.00 ","$1,070.80 ","$6,115.63 ","$0.00 ","$3,057.81 ","$4,843.58 ","$4,892.50 ","$0.00 ","$957.10 ","$0.00 ","$973.61 ","$0.00 "
"85426","SUP","HCPCS C1768","","85426  -  STENT COVERED  12MMX38MMX120CM","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$2,756.25 ","$0.00 ","$1,276.60 ","$0.00 ","$0.00 ","$1,072.44 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$958.56 ","$0.00 ","$975.10 ","$0.00 "
"85450","SUP","HCPCS C1876","","85450  -  STENT TRCHBR 5MM 6FR 16MM 120CM ICAST CVR ULT LO CX PRFL PWR","BOTH IP/OP","$5,723.75 ","$4,235.58 ","$0.00 ","$5,723.75 ","$2,575.69 ","$0.00 ","$1,192.97 ","$0.00 ","$0.00 ","$1,002.18 ","$5,723.75 ","$0.00 ","$2,861.88 ","$4,533.21 ","$4,579.00 ","$0.00 ","$895.77 ","$0.00 ","$911.22 ","$0.00 "
"85451","SUP","HCPCS C1876","","85451  -  STENT TRCHBR 5MM 6FR 22MM STRL 120CM ICAST CVR CATH INTRO SS","BOTH IP/OP","$6,287.50 ","$4,652.75 ","$0.00 ","$6,287.50 ","$2,829.38 ","$0.00 ","$1,310.47 ","$0.00 ","$0.00 ","$1,100.89 ","$6,287.50 ","$0.00 ","$3,143.75 ","$4,979.70 ","$5,030.00 ","$0.00 ","$983.99 ","$0.00 ","$1,000.97 ","$0.00 "
"85785","SUP","HCPCS C1733","","85785  -  SET TBG 260CM CL PNT 2W CMUNC IRR PMP CATH","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"86000","SUP","Custom 27803010","","86000  -  IMPLANT CHIN CNTR LF 2 PC","BOTH IP/OP","$1,005.00 ","$743.70 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86001","SUP","Custom 27803010","","86001  -  GRAFT SYNTH TISSUE CNTOUR CONCAVE TAPER 74X42X5MM 2 PIECE","BOTH IP/OP","$1,005.00 ","$743.70 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86002","SUP","Custom 27803010","","86002  -  IMPLANT CHIN CNTR TPR 78X50X7MM STRL MDPR 2 PC PE POR","BOTH IP/OP","$1,005.00 ","$743.70 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86003","SUP","Custom 27803010","","86003  -  GRAFT SYNTH TISSUE CNTOUR TAPER 80X55X9MM 2 PIECE GRADUAL","BOTH IP/OP","$1,005.00 ","$743.70 ","$0.00 ","$1,407.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,407.50 ","$0.00 ","$703.75 ","$1,114.74 ","$1,126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86010","SUP","Custom 27803010","","86010  -  GRAFT SNTH TISS SM 3D 40X25X4MM STRL MDPR BTN MXLFCL CHIN","BOTH IP/OP","$848.00 ","$627.52 ","$0.00 ","$1,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.50 ","$0.00 ","$588.75 ","$932.58 ","$942.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86011","SUP","Custom 27803010","","86011  -  GRAFT SNTH TISS MED 3D 47.5X37.5X5.5MM STRL MDPR BTN MXLFCL","BOTH IP/OP","$848.00 ","$627.52 ","$0.00 ","$1,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.50 ","$0.00 ","$588.75 ","$932.58 ","$942.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86012","SUP","HCPCS C2627","","CATHETER SPBC MLCT 12FR 4 WNG DRAIN STRL LTX DISP AMBR","BOTH IP/OP","$165.15 ","$122.21 ","$0.00 ","$38.19 ","$20.73 ","$0.00 ","$34.42 ","$0.00 ","$0.00 ","$6.69 ","$38.19 ","$0.00 ","$19.09 ","$30.25 ","$30.55 ","$0.00 ","$5.98 ","$0.00 ","$6.08 ","$0.00 "
"86014","SUP","HCPCS C1729","","086014  -  CATHETER SUPRAPUBIC 14FR 4 WING DRAIN LATEX MALECOT STERILE","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86016","SUP","HCPCS C1729","","086016  -  CATHETER NPHSTM 16FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86018","SUP","HCPCS C1751","","086018  -  CATHETER NPHSTM 18FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86020","SUP","HCPCS C1729","","086020  -  CATH NPHSTM AMBR 20FR MLCT DRAIN 4 WNG STRL LATEX DISP","BOTH IP/OP","$284.70 ","$210.68 ","$0.00 ","$368.10 ","$199.88 ","$0.00 ","$59.34 ","$0.00 ","$0.00 ","$64.45 ","$368.10 ","$0.00 ","$184.05 ","$291.54 ","$294.48 ","$0.00 ","$57.61 ","$0.00 ","$58.60 ","$0.00 "
"86022","SUP","HCPCS C1729","","086022  -  CATHETER NPHSTM 22FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86024","SUP","HCPCS C1729","","086024  -  CATHETER NPHSTM 24FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86026","SUP","HCPCS C1729","","086026  -  CATHETER NPHSTM 26FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86028","SUP","HCPCS C1729","","086028  -  CATHETER NPHSTM 28FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86030","SUP","HCPCS C1729","","086030  -  CATHETER NPHSTM 30FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86032","SUP","HCPCS C1729","","086032  -  CATHETER NPHSTM 32FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86034","SUP","HCPCS C1729","","086034  -  CATHETER NPHSTM 34FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$24.90 ","$13.52 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$4.36 ","$24.90 ","$0.00 ","$12.45 ","$19.72 ","$19.92 ","$0.00 ","$3.90 ","$0.00 ","$3.96 ","$0.00 "
"86036","SUP","HCPCS C1729","","086036  -  CATHETER NPHSTM 36FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$4.15 ","$3.07 ","$0.00 ","$4.15 ","$2.25 ","$0.00 ","$0.86 ","$0.00 ","$0.00 ","$0.73 ","$4.15 ","$0.00 ","$2.08 ","$3.29 ","$3.32 ","$0.00 ","$0.65 ","$0.00 ","$0.66 ","$0.00 "
"86038","SUP","HCPCS C1751","","086038  -  CATHETER NPHSTM 38FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP","BOTH IP/OP","$24.90 ","$18.43 ","$0.00 ","$61.35 ","$33.31 ","$0.00 ","$5.19 ","$0.00 ","$0.00 ","$10.74 ","$61.35 ","$0.00 ","$30.68 ","$48.59 ","$49.08 ","$0.00 ","$9.60 ","$0.00 ","$9.77 ","$0.00 "
"86202","SUP","Custom 27203010","","86202  -  TUBE ENDOTRAC 6MM CUF MRPH EYE OR R STRL LATEX FREE DISP","BOTH IP/OP","$41.37 ","$30.61 ","$0.00 ","$12.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.26 ","$0.00 ","$6.13 ","$9.71 ","$9.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86203","SUP","Custom 27203010","","86203  -  TUBE ENDOTRAC 6.5MM CUF MRPH EYE PREFRM CURVE OR R STRL","BOTH IP/OP","$12.26 ","$9.07 ","$0.00 ","$12.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.26 ","$0.00 ","$6.13 ","$9.71 ","$9.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86207","SUP","Custom 27203010","","86207  -  TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC","BOTH IP/OP","$14.41 ","$10.66 ","$0.00 ","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.41 ","$0.00 ","$7.21 ","$11.41 ","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86207","SUP","Custom 27203010","","086207  -  TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC","BOTH IP/OP","$14.41 ","$10.66 ","$0.00 ","$14.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.41 ","$0.00 ","$7.21 ","$11.41 ","$11.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86228","SUP","Custom 27203010","","86228  -  TUBE ENDOTRAC 22FR 5.5MM STD NSL/ORL UNCUF MRPH EYE RADIOPQ","BOTH IP/OP","$25.12 ","$18.59 ","$0.00 ","$32.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.66 ","$0.00 ","$16.33 ","$25.87 ","$26.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86266","SUP","Custom 27203010","","86266  -  TUBE ENDOTRAC 4.5MM UNCUF MRPH EYE OR R","BOTH IP/OP","$87.85 ","$65.01 ","$0.00 ","$87.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.85 ","$0.00 ","$43.92 ","$69.58 ","$70.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86287","SUP","Custom 27203010","","86287  -  TUBE NASOTRACHEAL RAE 21FR 5MM UNCUFFED MURPHY EYE","BOTH IP/OP","$6.57 ","$4.86 ","$0.00 ","$8.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.49 ","$0.00 ","$4.24 ","$6.72 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86311","SUP","HCPCS C1757","","86311  -  CATHETER  THROMBECTOMY PROGREAT PRELUMEN","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$0.00 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$0.00 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86395","SUP","Custom 27203010","","86395  -  TUBE ET 7.9MM 5.5MM STRL SHLY LSRFLX 2 CUF MRPH EYE SS","BOTH IP/OP","$114.75 ","$84.92 ","$0.00 ","$114.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.75 ","$0.00 ","$57.38 ","$90.88 ","$91.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86397","SUP","Custom 27203010","","86397  -  TUBE ET MGL CRV 7MM 4.5MM STRL LF LSRFLX MALLINCKRODT 2 CUF","BOTH IP/OP","$114.75 ","$84.92 ","$0.00 ","$114.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.75 ","$0.00 ","$57.38 ","$90.88 ","$91.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86548","SUP","Custom 27203010","","86548  -  TUBE ENDOTRAC 6MM CUFF REINFORCE MURPHY EYE PVC SILICONE","BOTH IP/OP","$45.30 ","$33.52 ","$0.00 ","$45.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.30 ","$0.00 ","$22.65 ","$35.88 ","$36.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86551","SUP","Custom 27203010","","86551  -  TUBE ENDOTRAC 7.5MM NSL/ORL CUF MRPH EYE REINF SIL SS STRL","BOTH IP/OP","$44.63 ","$33.03 ","$0.00 ","$50.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.59 ","$0.00 ","$25.29 ","$40.07 ","$40.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86552","SUP","Custom 27203010","","86552  -  TUBE ENDOTRAC 8MM CUF REINF STRL","BOTH IP/OP","$44.63 ","$33.03 ","$0.00 ","$312.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.93 ","$0.00 ","$156.47 ","$247.84 ","$250.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"86700","SUP","HCPCS C1753","","86700  -  CATH US .018IN 3.4FR 135CM INTVASC NONUNIFORM ROT DSTRTN VSN","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$916.31 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"87003","SUP","Custom 27803010","","87003  -  GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87004","SUP","Custom 27803010","","87004  -  GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI","BOTH IP/OP","$935.63 ","$692.37 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87118","SUP","Custom 27203010","","SLIDE KOVA 2 GLSTC 4 WELL WO GRID UA","BOTH IP/OP","$241.95 ","$179.04 ","$0.00 ","$241.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$241.95 ","$0.00 ","$120.98 ","$191.62 ","$193.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88000","SUP","HCPCS B4088","","88000  -  TUBE JJNSTM 55IN 28FR 12FR SIL CMPCT BLN RADIOPQ STRP ADPR","BOTH IP/OP","$263.90 ","$195.29 ","$0.00 ","$263.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$263.90 ","$0.00 ","$131.95 ","$209.01 ","$211.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88037","SUP","Custom 27803010","","88037  -  GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS","BOTH IP/OP","$1,353.75 ","$1,001.78 ","$0.00 ","$1,897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,897.50 ","$0.00 ","$948.75 ","$1,502.82 ","$1,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88038","SUP","Custom 27803010","","88038  -  GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS","BOTH IP/OP","$1,353.75 ","$1,001.78 ","$0.00 ","$1,897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,897.50 ","$0.00 ","$948.75 ","$1,502.82 ","$1,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88051","SUP","Custom 27803010","","88051  -  GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE","BOTH IP/OP","$1,867.50 ","$1,381.95 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88052","SUP","Custom 27803010","","88052  -  GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE","BOTH IP/OP","$1,867.50 ","$1,381.95 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88053","SUP","Custom 27803010","","88053  -  GRAFT SYNTH TISSUE ANGLE LARGE 57X40X4MM AUGMENTATION","BOTH IP/OP","$1,333.13 ","$986.52 ","$0.00 ","$1,867.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88054","SUP","Custom 27803010","","88054  -  MANDIBLE ANGLE LARGE - RIGHT-57MM X 40MM X 4MM X 10MM X 4MM","BOTH IP/OP","$1,380.00 ","$1,021.20 ","$0.00 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.00 ","$0.00 ","$690.00 ","$1,092.96 ","$1,104.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88710","SUP","HCPCS C1713","","SPACER MDI ARCHB+ SM VLV HLD CHMBR HNDHLD CMFSL MASK PED","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"88900","SUP","HCPCS C1725","","88900  -  CATH US .038IN 8.2FR 90CM INTVASC PULBCK SLED REV","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$1,153.88 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"88901","SUP","HCPCS C1753","","88901  -  CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,357.50 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"89007","SUP","HCPCS C2617","","089007  -  STENT URETERAL 7FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE","BOTH IP/OP","$213.05 ","$157.66 ","$0.00 ","$213.05 ","$95.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.30 ","$213.05 ","$0.00 ","$106.53 ","$168.74 ","$170.44 ","$0.00 ","$33.34 ","$0.00 ","$33.92 ","$0.00 "
"89008","SUP","HCPCS C2617","","089008  -  STENT URETERAL 8FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE","BOTH IP/OP","$213.05 ","$157.66 ","$0.00 ","$213.05 ","$95.87 ","$0.00 ","$44.40 ","$0.00 ","$0.00 ","$37.30 ","$213.05 ","$0.00 ","$106.53 ","$168.74 ","$170.44 ","$0.00 ","$33.34 ","$0.00 ","$33.92 ","$0.00 "
"89020","SUP","HCPCS C1763","","89020  -  TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"89104","SUP","HCPCS C1713","","89104  -  SCREW 89104 CD THR PLUG","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"89223","SUP","Custom 27803010","","89223  -  IMPLANT SOFT TISSUE FLAT 4X1X1CM MOIST TOUGH FLEXIBLE SHEET","BOTH IP/OP","$861.00 ","$637.14 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89224","SUP","Custom 27803010","","89224  -  IMPLANT SOFT TISSUE THK1MM FLAT 5X2CM MOIST TOUGH FLEXIBLE","BOTH IP/OP","$1,742.50 ","$1,289.45 ","$0.00 ","$2,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,267.50 ","$0.00 ","$1,133.75 ","$1,795.86 ","$1,814.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89225","SUP","Custom 27803010","","89225  -  IMPLANT SOFT TISSUE 8X3X1CM MOIST TOUGH FLEXIBLE FLAT SHEET","BOTH IP/OP","$2,109.45 ","$1,560.99 ","$0.00 ","$2,742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,742.50 ","$0.00 ","$1,371.25 ","$2,172.06 ","$2,194.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89612","SUP","Custom 27203010","","TIP PIP 1100UL EPNDF CNDCT","BOTH IP/OP","$3,545.00 ","$2,623.30 ","$0.00 ","$3,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,545.00 ","$0.00 ","$1,772.50 ","$2,807.64 ","$2,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89894","SUP","Custom 27203010","","WASHER PIP KT","BOTH IP/OP","$547.50 ","$405.15 ","$0.00 ","$547.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$547.50 ","$0.00 ","$273.75 ","$433.62 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90001","SUP","Custom 27203010","","090001  -  NEEDLE ENDSCP 35CM 23GA 8MM URTH CSCP INJEC PRC WMS","BOTH IP/OP","$48.50 ","$35.89 ","$0.00 ","$48.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.50 ","$0.00 ","$24.25 ","$38.41 ","$38.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90044","SUP","HCPCS C1887","","90044  -  CATHETER ANGIO 3-2.4FR 150CM MRC 1 LUM RADOPQ","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$644.81 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$207.92 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$185.84 ","$0.00 ","$189.05 ","$0.00 "
"90051","SUP","Custom 27203010","","90051  -  CATHETER URETHRAL 16FR FOLEY TEMPERATURE SENSOR LATEX FREE","BOTH IP/OP","$3.93 ","$2.91 ","$0.00 ","$25.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.75 ","$0.00 ","$12.88 ","$3.11 ","$20.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90071","SUP","Custom 27203010","","090071  -  NEEDLE FASCIAL INCISING 10MM","BOTH IP/OP","$76.95 ","$56.94 ","$0.00 ","$76.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.95 ","$0.00 ","$38.48 ","$60.94 ","$61.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90071","SUP","Custom 27203010","","90071  -  NEEDLE 5CM 18GA GWIRE PRC RNL FSCA 10MM","BOTH IP/OP","$76.95 ","$56.94 ","$0.00 ","$76.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.95 ","$0.00 ","$38.48 ","$65.30 ","$61.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90073","SUP","HCPCS C1887","","CATHETER GUID .038IN 8FR 5.9FR 95CM BLN SIL MRC","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$1,187.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"90074","SUP","HCPCS C1887","","CATHETER BALLOON GUIDE CONCENTRIC 9F 95CM","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$1,187.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"90076","SUP","HCPCS C1887","","CATHETER BALLOON GUIDE CONCENTRIC 8F 80CM","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$1,187.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"90077","SUP","HCPCS C1887","","CATHETER BALLOON GUIDE 9F 80CM","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$1,187.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"90110","SUP","HCPCS C1757","","90110  -  CATHETER THRMB CRKSCR 2MM 180CM 5MM MRC V RTRV V2 FIRM NTNL","BOTH IP/OP","$7,987.50 ","$5,910.75 ","$0.00 ","$7,987.50 ","$0.00 ","$0.00 ","$1,664.79 ","$0.00 ","$0.00 ","$0.00 ","$7,987.50 ","$0.00 ","$3,993.75 ","$6,326.10 ","$6,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90111","SUP","HCPCS C1757","","90111  -  CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIEVER V2.5","BOTH IP/OP","$7,987.50 ","$5,910.75 ","$0.00 ","$7,987.50 ","$0.00 ","$0.00 ","$1,664.79 ","$0.00 ","$0.00 ","$0.00 ","$7,987.50 ","$0.00 ","$3,993.75 ","$6,326.10 ","$6,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90112","SUP","HCPCS C1757","","90112  -  CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIVER V2.5","BOTH IP/OP","$7,987.50 ","$5,910.75 ","$0.00 ","$7,987.50 ","$0.00 ","$0.00 ","$1,664.79 ","$0.00 ","$0.00 ","$0.00 ","$7,987.50 ","$0.00 ","$3,993.75 ","$6,326.10 ","$6,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90113","SUP","HCPCS C1757","","90113  -  CATHETER THRMB CRKSCR 3MM 180CM 7MM MRC V RTRV V3 SFT NTNL","BOTH IP/OP","$7,987.50 ","$5,910.75 ","$0.00 ","$7,987.50 ","$0.00 ","$0.00 ","$1,664.79 ","$0.00 ","$0.00 ","$0.00 ","$7,987.50 ","$0.00 ","$3,993.75 ","$6,326.10 ","$6,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90120","SUP","HCPCS C1757","","90120  -  CATHETER THRMB 3.9FR .038IN 125CM DAC 1 LUM BRAID RADOPQ LL","BOTH IP/OP","$2,700.15 ","$1,998.11 ","$0.00 ","$2,700.15 ","$0.00 ","$0.00 ","$562.78 ","$0.00 ","$0.00 ","$0.00 ","$2,700.15 ","$0.00 ","$1,350.08 ","$2,138.52 ","$2,160.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90121","SUP","HCPCS C1887","","CATHETER THROMBECTOMY DAC 038 - 136CM","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,350.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"90131","SUP","HCPCS C1887","","CATHETER DISTAL ACCESS DAC 057 - 125CM","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,350.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"90160","SUP","HCPCS C1757","","90160  -  CATHETER THRMB 4.3FR .044IN 115CM DAC 1 LUM BRAID RADOPQ LL","BOTH IP/OP","$2,700.15 ","$1,998.11 ","$0.00 ","$2,700.15 ","$0.00 ","$0.00 ","$562.78 ","$0.00 ","$0.00 ","$0.00 ","$2,700.15 ","$0.00 ","$1,350.08 ","$2,138.52 ","$2,160.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90161","SUP","HCPCS C1757","","90161  -  CATHETER THROMBECTOMY DAC� 044 0.044IN / 130CM RADIOPQ SHAFT","BOTH IP/OP","$2,573.25 ","$1,904.21 ","$0.00 ","$2,573.25 ","$0.00 ","$0.00 ","$536.33 ","$0.00 ","$0.00 ","$0.00 ","$2,573.25 ","$0.00 ","$1,286.63 ","$2,038.01 ","$2,058.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90162","SUP","HCPCS C1757","","90162  -  CATHETER THRMB 4.3FR .044IN 136CM DAC 1 LUM BRAID RADOPQ LL","BOTH IP/OP","$2,700.15 ","$1,998.11 ","$0.00 ","$2,700.15 ","$0.00 ","$0.00 ","$562.78 ","$0.00 ","$0.00 ","$0.00 ","$2,700.15 ","$0.00 ","$1,350.08 ","$2,138.52 ","$2,160.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90170","SUP","HCPCS C1757","","90170  -  CATHETER THRMB 6.3FR .07IN 105CM DAC 1 LUM BRD RADOPQ LL HUB","BOTH IP/OP","$2,700.15 ","$1,998.11 ","$0.00 ","$2,700.15 ","$0.00 ","$0.00 ","$562.78 ","$0.00 ","$0.00 ","$0.00 ","$2,700.15 ","$0.00 ","$1,350.08 ","$2,138.52 ","$2,160.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90171","SUP","HCPCS C1757","","90171  -  CATHETER THRMB 6.3FR .07IN 120CM DAC 1 LUM BRD RADOPQ LL HUB","BOTH IP/OP","$2,700.15 ","$1,998.11 ","$0.00 ","$2,700.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,700.15 ","$0.00 ","$1,350.08 ","$2,138.52 ","$2,160.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90182","SUP","Custom 27203010","","90182  -  RETRIEVER ESCP 4MM 20MM TREVO XP PROVUE","BOTH IP/OP","$13,116.25 ","$9,706.03 ","$0.00 ","$13,116.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,116.25 ","$0.00 ","$6,558.13 ","$10,388.07 ","$10,493.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90183","SUP","Custom 27203010","","90183  -  RETRIEVER ESCP 3MM 20MM TREVO XP PROVUE","BOTH IP/OP","$13,116.25 ","$9,706.03 ","$0.00 ","$13,116.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,116.25 ","$0.00 ","$6,558.13 ","$10,388.07 ","$10,493.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90231","SUP","HCPCS C1757","","90231  -  CATHETER INFS MIC 18FR TREVO PRO NRVSC","BOTH IP/OP","$1,703.75 ","$1,260.78 ","$0.00 ","$1,703.75 ","$0.00 ","$0.00 ","$355.10 ","$0.00 ","$0.00 ","$0.00 ","$1,703.75 ","$0.00 ","$851.88 ","$1,349.37 ","$1,363.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90603","SUP","Custom 27203010","","90603  -  DRESSING TRANSPARENT 8X8IN ABSORBENT NONADHESIVE","BOTH IP/OP","$28.88 ","$21.37 ","$0.00 ","$28.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.88 ","$0.00 ","$14.44 ","$22.87 ","$23.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90605","SUP","Custom 27203010","","90605  -  DRESSING FOAM 24X4IN NONADHESIVE HIGH FLUID HANDLE","BOTH IP/OP","$49.61 ","$36.71 ","$0.00 ","$49.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.61 ","$0.00 ","$24.80 ","$39.29 ","$39.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90730","SUP","HCPCS C1757","","90730  -  CATHETER THRMB 5.2FR .057IN 115CM DAC 1 LUM BRAID RADOPQ LL","BOTH IP/OP","$2,700.15 ","$1,998.11 ","$0.00 ","$2,700.15 ","$0.00 ","$0.00 ","$562.78 ","$0.00 ","$0.00 ","$0.00 ","$2,700.15 ","$0.00 ","$1,350.08 ","$2,138.52 ","$2,160.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90760","SUP","HCPCS C1757","","90760  -  CATHETER THRMB 4.3FR .044IN 130CM DAC 1 LUM BRAID RADOPQ LL","BOTH IP/OP","$2,573.25 ","$1,904.21 ","$0.00 ","$2,573.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,573.25 ","$0.00 ","$1,286.63 ","$2,038.01 ","$2,058.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90805","SUP","Custom 27203010","","90805  -  DRESSING TRANSPARENT LARGE SQUARE 8INX7 7/8IN 6INX5 7/8IN","BOTH IP/OP","$24.44 ","$18.09 ","$0.00 ","$24.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.44 ","$0.00 ","$12.22 ","$19.36 ","$19.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91101","SUP","Custom 27203010","","91101  -  CATHETER NEUROSURGICAL ANTIBIOTIC IMPREGNATED ARES VENTRICLE","BOTH IP/OP","$770.00 ","$569.80 ","$0.00 ","$770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$770.00 ","$0.00 ","$385.00 ","$609.84 ","$616.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91265","SUP","Custom 27203010","","91265  -  FLAT VENOUS 2 STAGE CANNULA MC2","BOTH IP/OP","$78.68 ","$58.22 ","$0.00 ","$86.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.09 ","$0.00 ","$43.04 ","$68.18 ","$68.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91503","SUP","Custom 27803010","","91503  -  CATH 91503 BIOGLIDE VENT 23CM CLOSED IMP","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$513.00 ","$0.00 ","$256.50 ","$406.30 ","$410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92001","SUP","Custom 27203010","","092001  -  CLIP INTNL ANG RT 15MM STRL LF LDS LNR CTR PWR SF LKOUT","BOTH IP/OP","$387.15 ","$286.49 ","$0.00 ","$387.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.15 ","$0.00 ","$193.58 ","$306.62 ","$309.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100","SUP","Custom 27203010","","0092100  -  TUBE ESPH 20FR 8IN NS LTX 1.5IN BLKMR BLN SPCL NTR RBR ADLT","BOTH IP/OP","$758.28 ","$561.13 ","$0.00 ","$365.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.88 ","$0.00 ","$182.94 ","$289.78 ","$292.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92100","SUP","Custom 27203010","","TUBE NG 8IN 20FR 3 LUM BLN RADIOPQ STRP BLKMR ADLT NSTRL LTX","BOTH IP/OP","$758.28 ","$561.13 ","$0.00 ","$704.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.88 ","$0.00 ","$182.94 ","$704.23 ","$292.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92312","SUP","Custom 27803010","","92312  -  VALVE 92312 CSF CONTRD SML LOW BIO","BOTH IP/OP","$2,681.38 ","$1,984.22 ","$0.00 ","$2,681.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,681.38 ","$0.00 ","$1,340.69 ","$2,123.65 ","$2,145.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92314","SUP","Custom 27803010","","92314  -  VALVE 92314 CSF CONT SML MED BIO","BOTH IP/OP","$2,681.38 ","$1,984.22 ","$0.00 ","$2,681.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,681.38 ","$0.00 ","$1,340.69 ","$2,123.65 ","$2,145.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92316","SUP","Custom 27803010","","92316  -  VALVE 92316 CSF CONT SML HIGH BIO","BOTH IP/OP","$3,018.63 ","$2,233.79 ","$0.00 ","$3,018.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,018.63 ","$0.00 ","$1,509.31 ","$2,390.75 ","$2,414.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92322","SUP","Custom 27803010","","92322  -  VALVE 92322 CSF CONT REG LOW BIO","BOTH IP/OP","$2,681.38 ","$1,984.22 ","$0.00 ","$2,681.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,681.38 ","$0.00 ","$1,340.69 ","$2,123.65 ","$2,145.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92324","SUP","Custom 27803010","","92324  -  VALVE 92324 CSF CONT REG MED BIO","BOTH IP/OP","$2,681.38 ","$1,984.22 ","$0.00 ","$2,681.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,681.38 ","$0.00 ","$1,340.69 ","$2,123.65 ","$2,145.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92326","SUP","Custom 27803010","","92326  -  VALVE 92326 CSF CONT REG HIGH BIO","BOTH IP/OP","$2,681.38 ","$1,984.22 ","$0.00 ","$2,681.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,681.38 ","$0.00 ","$1,340.69 ","$2,123.65 ","$2,145.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92355","SUP","Custom 27803010","","92355  -  VALVE 92355 STRATA NSC SML BIOGLIDE","BOTH IP/OP","$9,501.05 ","$7,030.78 ","$0.00 ","$9,501.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,501.05 ","$0.00 ","$4,750.53 ","$7,524.83 ","$7,600.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92365","SUP","Custom 27803010","","92365  -  VALVE 92365 STRATA NSC REG BIOGLIDE","BOTH IP/OP","$9,501.05 ","$7,030.78 ","$0.00 ","$9,501.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,501.05 ","$0.00 ","$4,750.53 ","$7,524.83 ","$7,600.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92812","SUP","Custom 27803010","","92812  -  VALVE 92812 BIOGLIDE DELTA SM 1.0","BOTH IP/OP","$4,358.13 ","$3,225.02 ","$0.00 ","$4,358.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,358.13 ","$0.00 ","$2,179.06 ","$3,451.64 ","$3,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92813","SUP","Custom 27803010","","92813  -  VALVE 92813 BIOGLIDE DELTA SM 1.5","BOTH IP/OP","$4,358.13 ","$3,225.02 ","$0.00 ","$4,358.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,358.13 ","$0.00 ","$2,179.06 ","$3,451.64 ","$3,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92814","SUP","Custom 27803010","","92814  -  VALVE 92814 BIOGLIDE DELTA SM 2.0","BOTH IP/OP","$4,358.13 ","$3,225.02 ","$0.00 ","$4,358.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,358.13 ","$0.00 ","$2,179.06 ","$3,451.64 ","$3,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92822","SUP","Custom 27803010","","92822  -  VALVE 92822 BIOGLIDE DELTA REG. 1.0","BOTH IP/OP","$4,358.13 ","$3,225.02 ","$0.00 ","$4,358.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,358.13 ","$0.00 ","$2,179.06 ","$3,451.64 ","$3,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92823","SUP","Custom 27803010","","92823  -  VALVE 92823 BIOGLIDE DELTA REG. 1.5","BOTH IP/OP","$4,358.13 ","$3,225.02 ","$0.00 ","$4,358.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,358.13 ","$0.00 ","$2,179.06 ","$3,451.64 ","$3,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92824","SUP","Custom 27803010","","92824  -  VALVE 92824 BIOGLIDE DELTA REG. 2.0","BOTH IP/OP","$4,358.13 ","$3,225.02 ","$0.00 ","$4,358.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,358.13 ","$0.00 ","$2,179.06 ","$3,451.64 ","$3,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92830","SUP","Custom 27803010","","92830  -  VALVE 92830 DELTA BH 12MM PL 0.5 BIOGLID","BOTH IP/OP","$4,612.25 ","$3,413.07 ","$0.00 ","$4,612.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,612.25 ","$0.00 ","$2,306.13 ","$3,652.90 ","$3,689.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92833","SUP","Custom 27803010","","92833  -  VALVE 92833 BIOGLIDE DELTA BH 12 1.5","BOTH IP/OP","$3,904.50 ","$2,889.33 ","$0.00 ","$3,904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,904.50 ","$0.00 ","$1,952.25 ","$3,092.36 ","$3,123.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92834","SUP","Custom 27803010","","92834  -  VALVE 92834 BIOGLIDE DELTA BH 12 2.0","BOTH IP/OP","$4,612.25 ","$3,413.07 ","$0.00 ","$4,612.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,612.25 ","$0.00 ","$2,306.13 ","$3,652.90 ","$3,689.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92840","SUP","Custom 27803010","","92840  -  VALVE 92840 DELTA BH 16MM PL 0.5 BIOGLID","BOTH IP/OP","$3,904.50 ","$2,889.33 ","$0.00 ","$3,904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,904.50 ","$0.00 ","$1,952.25 ","$3,092.36 ","$3,123.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92842","SUP","Custom 27803010","","92842  -  VALVE 92842 BIOGLIDE DELTA BH 16 1.0","BOTH IP/OP","$3,904.50 ","$2,889.33 ","$0.00 ","$3,904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,904.50 ","$0.00 ","$1,952.25 ","$3,092.36 ","$3,123.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92843","SUP","Custom 27803010","","92843  -  VALVE 92843 BIOGLIDE DELTA BH 16 1.5","BOTH IP/OP","$3,904.50 ","$2,889.33 ","$0.00 ","$3,904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,904.50 ","$0.00 ","$1,952.25 ","$3,092.36 ","$3,123.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92844","SUP","Custom 27803010","","92844  -  VALVE 92844 BIOGLIDE DELTA BH 16 2.0","BOTH IP/OP","$3,904.50 ","$2,889.33 ","$0.00 ","$3,904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,904.50 ","$0.00 ","$1,952.25 ","$3,092.36 ","$3,123.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92856","SUP","Custom 27803010","","92856  -  VALVE 92856 FP STRATA 2 SML BG","BOTH IP/OP","$10,337.65 ","$7,649.86 ","$0.00 ","$10,337.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,337.65 ","$0.00 ","$5,168.83 ","$8,187.42 ","$8,270.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92866","SUP","Custom 27803010","","92866  -  VALVE 92866 FP STRATA 2 REG BG","BOTH IP/OP","$10,337.65 ","$7,649.86 ","$0.00 ","$10,337.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,337.65 ","$0.00 ","$5,168.83 ","$8,187.42 ","$8,270.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93092","SUP","Custom 27203010","","93092  -  CATHETER NEUROSURGICAL 120CM ANTIBIOTIC IMPREGNATED ARES","BOTH IP/OP","$770.00 ","$569.80 ","$0.00 ","$770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$770.00 ","$0.00 ","$385.00 ","$609.84 ","$616.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"93320","SUP","HCPCS C1769","","93320  -  WIRE 35-180 COONS","BOTH IP/OP","$60.75 ","$44.96 ","$0.00 ","$60.75 ","$32.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.64 ","$60.75 ","$0.00 ","$30.38 ","$48.11 ","$48.60 ","$0.00 ","$9.51 ","$0.00 ","$9.67 ","$0.00 "
"93522","SUP","Custom 27803010","","93522  -  CATHETER 93522 BIOGLIDE PERITONEAL","BOTH IP/OP","$543.88 ","$402.47 ","$0.00 ","$543.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.88 ","$0.00 ","$271.94 ","$430.75 ","$435.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"94965","SUP","Custom 27203010","","94965  -  DLP RETROGRADE CORONARY PERFUSION CANNULA 15 FR","BOTH IP/OP","$199.49 ","$147.62 ","$0.00 ","$218.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95001","SUP","Custom 27203010","","95001  -  KIT CATH STRL LF ARES ANBTC","BOTH IP/OP","$336.88 ","$249.29 ","$0.00 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95201","SUP","Custom 27203010","","PUMP CNTRF BPMP BPX80 STRL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96115","SUP","Custom 27803010","","96115  -  CATH 96115 BIOGLIDE EDM VENT 20 CM","BOTH IP/OP","$458.40 ","$339.22 ","$0.00 ","$458.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.40 ","$0.00 ","$229.20 ","$363.05 ","$366.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96118","SUP","Custom 27803010","","96118  -  CATH 96118 BIOGLIDE EDM VENT 35 CM","BOTH IP/OP","$549.60 ","$406.70 ","$0.00 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.60 ","$0.00 ","$274.80 ","$435.28 ","$439.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96655","SUP","Custom 27803010","","96655  -  SHUNT 96655 STRATA NSC ASSY SML BIOGLIDE","BOTH IP/OP","$9,921.70 ","$7,342.06 ","$0.00 ","$9,921.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,921.70 ","$0.00 ","$4,960.85 ","$7,857.99 ","$7,937.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96665","SUP","Custom 27803010","","96665  -  SHUNT 96665 STRATA NSC ASSY REG BIOGLIDE","BOTH IP/OP","$9,921.70 ","$7,342.06 ","$0.00 ","$9,921.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,921.70 ","$0.00 ","$4,960.85 ","$7,857.99 ","$7,937.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96812","SUP","Custom 27803010","","96812  -  SHUNT 96812 DELTA ASSY SMALL P/L 1.0 BIO","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96813","SUP","Custom 27803010","","96813  -  SHUNT 96813 DELTA ASSY SMALL P/L 1.5 BIO","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96814","SUP","Custom 27803010","","96814  -  SHUNT 96814 DELTA ASSY SMALL P/L 2.0 BIO","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96822","SUP","Custom 27803010","","96822  -  SHUNT 96822 DELTA ASSY REG P/L 1.0 BIO","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96823","SUP","Custom 27803010","","96823  -  SHUNT 96823 DELTA ASSY REG P/L 1.5 BIO","BOTH IP/OP","$4,949.50 ","$3,662.63 ","$0.00 ","$4,949.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,949.50 ","$0.00 ","$2,474.75 ","$3,920.00 ","$3,959.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96824","SUP","Custom 27803010","","96824  -  SHUNT 96824 DELTA ASSY REG P/L 2.0 BIO","BOTH IP/OP","$5,569.38 ","$4,121.34 ","$0.00 ","$5,569.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,569.38 ","$0.00 ","$2,784.69 ","$4,410.95 ","$4,455.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"97021","SUP","Custom 27203010","","KIT OC KIMVENT SLF CLEAN Y CONNCTR SCT HNDL","BOTH IP/OP","$38.04 ","$28.15 ","$0.00 ","$38.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.04 ","$0.00 ","$19.02 ","$30.13 ","$30.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98200","SUP","Custom 27203010","","TRIAGE BIOSITE BNP REAGENT 2/PK","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98201","SUP","Custom 27203010","","CONTROL BNP TRG BKMN SYS IMMUN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98202","SUP","Custom 27203010","","CALIBRATOR CHM BKMN SYS VRFR BNP TRG 98202","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"98433","SUP","HCPCS C1894","","98433  -  KIT GASTROSTOMY 22FR 18GA DILAT INTROD NEEDLE HEMOSTAT LATEX","BOTH IP/OP","$531.70 ","$393.46 ","$0.00 ","$531.70 ","$288.71 ","$0.00 ","$110.82 ","$0.00 ","$0.00 ","$93.10 ","$531.70 ","$0.00 ","$265.85 ","$421.11 ","$425.36 ","$0.00 ","$83.21 ","$0.00 ","$84.65 ","$0.00 "
"99102","SUP","Custom 27803010","","99102  -  CATH 99102 INNERVISION BIOGLIDE","BOTH IP/OP","$729.13 ","$539.56 ","$0.00 ","$729.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$729.13 ","$0.00 ","$364.56 ","$577.47 ","$583.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99800","SUP","Custom 27203010","","0099800  -  DRAIN INCS 10FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY","BOTH IP/OP","$34.88 ","$25.81 ","$0.00 ","$34.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.88 ","$0.00 ","$17.44 ","$27.62 ","$27.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99810","SUP","HCPCS C1729","","0099810  -  DRAIN INCS 12FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY","BOTH IP/OP","$28.78 ","$21.30 ","$0.00 ","$28.78 ","$15.62 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.78 ","$0.00 ","$14.39 ","$22.79 ","$23.02 ","$0.00 ","$4.50 ","$0.00 ","$4.58 ","$0.00 "
"99820","SUP","Custom 27203010","","99820  -  TUBES T 14FR","BOTH IP/OP","$31.68 ","$23.44 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.68 ","$0.00 ","$15.84 ","$25.09 ","$25.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99830","SUP","Custom 27203010","","99830  -  DRAIN INCS 16FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY","BOTH IP/OP","$173.25 ","$128.21 ","$0.00 ","$173.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99840","SUP","HCPCS C1729","","0099840  -  DRAIN INCS 18FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY","BOTH IP/OP","$28.78 ","$21.30 ","$0.00 ","$28.78 ","$15.62 ","$0.00 ","$6.00 ","$0.00 ","$0.00 ","$5.04 ","$28.78 ","$0.00 ","$14.39 ","$22.79 ","$23.02 ","$0.00 ","$4.50 ","$0.00 ","$4.58 ","$0.00 "
"100100","SUP","Custom 27011340","","100100  -  ROD XTRNFX LG 100MM ILZ TLSCP BSC SET SS AL PED FEM","BOTH IP/OP","$1,686.40 ","$1,247.94 ","$0.00 ","$1,686.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,686.40 ","$0.00 ","$843.20 ","$1,335.63 ","$1,349.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100101","SUP","Custom 27011340","","100101  -  ROD XTRNFX LG 150MM ILZ TLSCP SYS","BOTH IP/OP","$1,686.40 ","$1,247.94 ","$0.00 ","$1,686.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,686.40 ","$0.00 ","$843.20 ","$1,335.63 ","$1,349.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100102","SUP","Custom 27011340","","100102  -  ROD XTRNFX LG 200MM ILZ TLSCP","BOTH IP/OP","$2,048.50 ","$1,515.89 ","$0.00 ","$2,048.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100103","SUP","Custom 27011340","","100103  -  ROD XTRNFX LG 250MM ILZ CIRC TLSCP SS AL","BOTH IP/OP","$2,048.50 ","$1,515.89 ","$0.00 ","$2,048.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100104","SUP","Custom 27011340","","100104  -  ROD XTRNFX 60MM ILZ GRAD TLSCP SYS SS AL","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$3,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,145.00 ","$0.00 ","$1,572.50 ","$2,490.84 ","$2,516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100105","SUP","Custom 27011340","","100105  -  ROD XTRNFX LG 100MM ILZ TLSCP GRAD DLX SET ADLT TIB","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$3,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,145.00 ","$0.00 ","$1,572.50 ","$2,490.84 ","$2,516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100106","SUP","Custom 27011340","","100106  -  ROD XTRNFX 150MM ILZ GRAD TLSCP SYS SS AL","BOTH IP/OP","$4,615.50 ","$3,415.47 ","$0.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,615.50 ","$0.00 ","$2,307.75 ","$3,655.48 ","$3,692.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100107","SUP","Custom 27011340","","100107  -  ROD XTRNFX 200MM ILZ GRAD TLSCP SYS SS AL","BOTH IP/OP","$4,615.50 ","$3,415.47 ","$0.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,615.50 ","$0.00 ","$2,307.75 ","$3,655.48 ","$3,692.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100108","SUP","Custom 27011340","","100108  -  ROD XTRNFX 250MM ILZ GRAD TLSCP AL SS","BOTH IP/OP","$4,615.50 ","$3,415.47 ","$0.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,615.50 ","$0.00 ","$2,307.75 ","$3,655.48 ","$3,692.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100200","SUP","Custom 27011340","","100200  -  WIRE XTRNFX ILZ BSC SET BCKL DTCH ADLT FEM SS RING","BOTH IP/OP","$826.20 ","$611.39 ","$0.00 ","$826.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$826.20 ","$0.00 ","$413.10 ","$654.35 ","$660.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100241","SUP","Custom 27011340","","100241  -  DEVICE XTRNFX ILZ WRE FX BCKL CIRC SM BN FXTR","BOTH IP/OP","$1,768.00 ","$1,308.32 ","$0.00 ","$1,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,768.00 ","$0.00 ","$884.00 ","$1,400.26 ","$1,414.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100250","SUP","Custom 27203010","","100250  -  DEVICE XTRNFX ILZ WRE FX BCKL CIRC COMP RING","BOTH IP/OP","$911.20 ","$674.29 ","$0.00 ","$911.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$911.20 ","$0.00 ","$455.60 ","$721.67 ","$728.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100301","SUP","Custom 27011340","","100301  -  CLAMP XTRNFX ILZ 1 HL PIN","BOTH IP/OP","$892.50 ","$660.45 ","$0.00 ","$892.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.50 ","$0.00 ","$446.25 ","$706.86 ","$714.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100302","SUP","Custom 27011340","","100302  -  CLAMP XTRNFX ILZ 2 HL PIN","BOTH IP/OP","$892.50 ","$660.45 ","$0.00 ","$892.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.50 ","$0.00 ","$446.25 ","$706.86 ","$714.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100303","SUP","Custom 27011340","","100303  -  CLAMP XTRNFX ILZ 3 HL PIN","BOTH IP/OP","$892.50 ","$660.45 ","$0.00 ","$892.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.50 ","$0.00 ","$446.25 ","$706.86 ","$714.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100304","SUP","Custom 27011340","","100304  -  CLAMP XTRNFX ILZ 4 HL PIN","BOTH IP/OP","$1,251.20 ","$925.89 ","$0.00 ","$1,251.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,251.20 ","$0.00 ","$625.60 ","$990.95 ","$1,000.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100305","SUP","Custom 27011340","","100305  -  CLAMP XTRNFX ILZ 5 HL PIN","BOTH IP/OP","$1,251.20 ","$925.89 ","$0.00 ","$1,251.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,251.20 ","$0.00 ","$625.60 ","$990.95 ","$1,000.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100400","SUP","Custom 27011340","","100400  -  PLATE XTRNFX LNG 155MM 8 HL CNCT","BOTH IP/OP","$974.10 ","$720.83 ","$0.00 ","$974.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$974.10 ","$0.00 ","$487.05 ","$771.49 ","$779.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100401","SUP","Custom 27011340","","100401  -  PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT","BOTH IP/OP","$974.10 ","$720.83 ","$0.00 ","$974.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$974.10 ","$0.00 ","$487.05 ","$771.49 ","$779.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100402","SUP","Custom 27011340","","100402  -  PLATE XTRNFX LNG 355MM ILZ 17 HL CNCT SYS","BOTH IP/OP","$1,184.90 ","$876.83 ","$0.00 ","$1,184.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,184.90 ","$0.00 ","$592.45 ","$938.44 ","$947.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100409","SUP","Custom 27011340","","100409  -  PLATE XTRNFX LNG 72MM ILZ 5 HL SM BN FXTR SET","BOTH IP/OP","$873.80 ","$646.61 ","$0.00 ","$873.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$873.80 ","$0.00 ","$436.90 ","$692.05 ","$699.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100412","SUP","Custom 27011340","","100412  -  PLATE XTRNFX LNG 102MM ILZ 7 HL SM BN FXTR SET","BOTH IP/OP","$958.80 ","$709.51 ","$0.00 ","$958.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$958.80 ","$0.00 ","$479.40 ","$759.37 ","$767.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100415","SUP","Custom 27011340","","100415  -  PLATE XTRNFX LNG 72MM ILZ 9 HL SM BN FXTR SET","BOTH IP/OP","$1,014.90 ","$751.03 ","$0.00 ","$1,014.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,014.90 ","$0.00 ","$507.45 ","$803.80 ","$811.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100418","SUP","Custom 27011340","","100418  -  PLATE XTRNFX LNG 162MM ILZ 11 HL SM BN FXTR SET","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100420","SUP","Custom 27011340","","100420  -  PLATE XTRNFX LNG 155MM ILZ 8 HL CNCT CIRC COMP CFBR EPOXY","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100421","SUP","Custom 27011340","","100421  -  PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT CIRC COMP CFBR EPOXY","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100422","SUP","Custom 27011340","","100422  -  PLATE XTRNFX LNG 335MM ILZ 17 HL CNCT CIRC COMP CFBR EPOXY","BOTH IP/OP","$1,354.00 ","$1,001.96 ","$0.00 ","$1,354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,354.00 ","$0.00 ","$677.00 ","$1,072.37 ","$1,083.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100500","SUP","Custom 27011340","","100500  -  PLATE XTRNFX 135MM ILZ 5 HL CNCT THRD END","BOTH IP/OP","$1,079.50 ","$798.83 ","$0.00 ","$1,079.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,079.50 ","$0.00 ","$539.75 ","$854.96 ","$863.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100501","SUP","Custom 27011340","","100501  -  PLATE XTRNFX 175MM ILZ 7 HL CNCT SYS THRD END","BOTH IP/OP","$1,079.50 ","$798.83 ","$0.00 ","$1,079.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,079.50 ","$0.00 ","$539.75 ","$854.96 ","$863.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100502","SUP","Custom 27011340","","100502  -  PLATE XTRNFX 215MM ILZ 9 HL CNCT CIRC THRD END","BOTH IP/OP","$1,380.40 ","$1,021.50 ","$0.00 ","$1,380.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,380.40 ","$0.00 ","$690.20 ","$1,093.28 ","$1,104.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100503","SUP","Custom 27011340","","100503  -  PLATE XTRNFX 255MM ILZ 11 HL CNCT THRD END SS ADLT TIB","BOTH IP/OP","$1,416.00 ","$1,047.84 ","$0.00 ","$1,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,416.00 ","$0.00 ","$708.00 ","$1,121.47 ","$1,132.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100550","SUP","HCPCS C1713","","100550  -  BOLT XTRNFX 8MM ILZ CNCT SS ADLT","BOTH IP/OP","$16.15 ","$11.95 ","$0.00 ","$16.15 ","$7.27 ","$0.00 ","$3.37 ","$0.00 ","$0.00 ","$2.83 ","$16.15 ","$0.00 ","$8.08 ","$12.79 ","$12.92 ","$0.00 ","$2.53 ","$0.00 ","$2.57 ","$0.00 "
"100600","SUP","Custom 27203010","","100600  -  BOLT XTRNFX ILZ CNN WRE FEM","BOTH IP/OP","$143.83 ","$106.43 ","$0.00 ","$143.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.83 ","$0.00 ","$71.91 ","$113.91 ","$115.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100601","SUP","Custom 27011340","","100601  -  BOLT XTRNFX ILZ CNN WRE CIRC THRD HD","BOTH IP/OP","$223.20 ","$165.17 ","$0.00 ","$223.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.20 ","$0.00 ","$111.60 ","$176.77 ","$178.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100613","SUP","Custom 27011340","","100613  -  BOLT XTRNFX 3MM ILZ .5 PIN CIRC","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100614","SUP","Custom 27011340","","100614  -  BOLT XTRNFX 4MM ILZ .5 PIN CIRC","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100615","SUP","Custom 27011340","","100615  -  BOLT XTRNFX CRC 5MM ILZ HLF PIN","BOTH IP/OP","$672.00 ","$497.28 ","$0.00 ","$672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.00 ","$0.00 ","$336.00 ","$532.22 ","$537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100616","SUP","Custom 27011340","","100616  -  BOLT XTRNFX CRC 6MM ILZ HLF PIN","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"100700","SUP","HCPCS C1713","","100700  -  BOLT XTRNFX ILZ SLOT WRE BSC SET FEM","BOTH IP/OP","$161.85 ","$119.77 ","$0.00 ","$161.85 ","$72.83 ","$0.00 ","$33.73 ","$0.00 ","$0.00 ","$28.34 ","$161.85 ","$0.00 ","$80.93 ","$128.19 ","$129.48 ","$0.00 ","$25.33 ","$0.00 ","$25.77 ","$0.00 "
"100819","SUP","HCPCS C1713","","100819  -  PLATE XTRNFX SHRT 27MM 2 HL CNCT CIRC SM BN","BOTH IP/OP","$484.50 ","$358.53 ","$0.00 ","$484.50 ","$218.03 ","$0.00 ","$100.98 ","$0.00 ","$0.00 ","$84.83 ","$484.50 ","$0.00 ","$242.25 ","$383.72 ","$387.60 ","$0.00 ","$75.82 ","$0.00 ","$77.13 ","$0.00 "
"100822","SUP","HCPCS C1713","","100822  -  PLATE XTRNFX SHRT 37MM 3 HL CNCT CIRC SM BN","BOTH IP/OP","$564.40 ","$417.66 ","$0.00 ","$564.40 ","$253.98 ","$0.00 ","$117.64 ","$0.00 ","$0.00 ","$98.82 ","$564.40 ","$0.00 ","$282.20 ","$447.00 ","$451.52 ","$0.00 ","$88.33 ","$0.00 ","$89.85 ","$0.00 "
"100825","SUP","HCPCS C1713","","100825  -  PLATE XTRNFX SHRT 47MM 4 HL CNCT CIRC SM BN","BOTH IP/OP","$600.10 ","$444.07 ","$0.00 ","$600.10 ","$270.05 ","$0.00 ","$125.08 ","$0.00 ","$0.00 ","$105.07 ","$600.10 ","$0.00 ","$300.05 ","$475.28 ","$480.08 ","$0.00 ","$93.92 ","$0.00 ","$95.54 ","$0.00 "
"100882","SUP","HCPCS C1713","","100882  -  SPACER XTRNFX 20MM SM BN FXTR","BOTH IP/OP","$511.70 ","$378.66 ","$0.00 ","$511.70 ","$230.27 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$89.59 ","$511.70 ","$0.00 ","$255.85 ","$405.27 ","$409.36 ","$0.00 ","$80.08 ","$0.00 ","$81.46 ","$0.00 "
"100883","SUP","HCPCS C1713","","100883  -  SPACER XTRNFX 30MM SM BN FXTR","BOTH IP/OP","$511.70 ","$378.66 ","$0.00 ","$511.70 ","$230.27 ","$0.00 ","$106.65 ","$0.00 ","$0.00 ","$89.59 ","$511.70 ","$0.00 ","$255.85 ","$405.27 ","$409.36 ","$0.00 ","$80.08 ","$0.00 ","$81.46 ","$0.00 "
"101010","SUP","HCPCS Q4116","","101010  -  GRAFT SKIN 14X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR","BOTH IP/OP","$1.39 ","$1.03 ","$0.00 ","$1.39 ","$0.63 ","$0.00 ","$0.29 ","$0.00 ","$0.00 ","$0.24 ","$1.39 ","$0.00 ","$0.70 ","$1.10 ","$1.11 ","$0.00 ","$0.22 ","$0.00 ","$0.22 ","$0.00 "
"101020","SUP","HCPCS Q4116","","101020  -  GRAFT SKIN 12X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR","BOTH IP/OP","$1.63 ","$1.21 ","$0.00 ","$1.63 ","$0.73 ","$0.00 ","$0.34 ","$0.00 ","$0.00 ","$0.28 ","$1.63 ","$0.00 ","$0.81 ","$1.29 ","$1.30 ","$0.00 ","$0.25 ","$0.00 ","$0.26 ","$0.00 "
"101400","SUP","Custom 27011340","","101400  -  POST EXFIX ILZ SS 2 HOLE MALE","BOTH IP/OP","$409.70 ","$303.18 ","$0.00 ","$409.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$409.70 ","$0.00 ","$204.85 ","$324.48 ","$327.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101401","SUP","Custom 27011340","","101401  -  POST EXFIX ILZ TIB 3 HOLE MALE PED","BOTH IP/OP","$428.40 ","$317.02 ","$0.00 ","$428.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$428.40 ","$0.00 ","$214.20 ","$339.29 ","$342.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101510","SUP","HCPCS Q4116","","101510  -  GRAFT SKIN 36X5MM ALLOGRAFT MESHED ALLODERM ACELLULAR DERMIS","BOTH IP/OP","$0.54 ","$0.40 ","$0.00 ","$0.54 ","$0.24 ","$0.00 ","$0.11 ","$0.00 ","$0.00 ","$0.09 ","$0.54 ","$0.00 ","$0.27 ","$0.43 ","$0.43 ","$0.00 ","$0.08 ","$0.00 ","$0.09 ","$0.00 "
"101520","SUP","HCPCS Q4116","","101520  -  GRAFT SKIN 14.5X4CM ALLOGRAFT MESHED ALLODERM ACELLULAR","BOTH IP/OP","$1.68 ","$1.24 ","$0.00 ","$1.68 ","$0.76 ","$0.00 ","$0.35 ","$0.00 ","$0.00 ","$0.29 ","$1.68 ","$0.00 ","$0.84 ","$1.33 ","$1.34 ","$0.00 ","$0.26 ","$0.00 ","$0.27 ","$0.00 "
"101602","SUP","Custom 27011340","","101602  -  HINGE XTRNFX ILZ M CNCT LOPRFL SS TIB","BOTH IP/OP","$367.20 ","$271.73 ","$0.00 ","$367.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$367.20 ","$0.00 ","$183.60 ","$290.82 ","$293.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"101804","SUP","HCPCS C1713","","101804  -  PLATE XTRNFX SHRT 85MM ILZ 7 HL CNCT TIB","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"101805","SUP","HCPCS C1713","","101805  -  PLATE XTRNFX SHRT 95MM ILZ 8 HL CNCT TIB","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"101806","SUP","HCPCS C1713","","101806  -  PLATE XTRNFX SHRT 105MM ILZ 9 HL CNCT  TIB","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"101807","SUP","HCPCS C1713","","101807  -  PLATE XTRNFX SHRT 115MM ILZ 10 HL CNCT CIRC","BOTH IP/OP","$642.60 ","$475.52 ","$0.00 ","$642.60 ","$289.17 ","$0.00 ","$133.93 ","$0.00 ","$0.00 ","$112.51 ","$642.60 ","$0.00 ","$321.30 ","$508.94 ","$514.08 ","$0.00 ","$100.57 ","$0.00 ","$102.30 ","$0.00 "
"101900","SUP","HCPCS C1713","","101900  -  PLATE BN 45MM 2 HL TWST ORTH","BOTH IP/OP","$364.00 ","$269.36 ","$0.00 ","$364.00 ","$163.80 ","$0.00 ","$75.87 ","$0.00 ","$0.00 ","$63.73 ","$364.00 ","$0.00 ","$182.00 ","$288.29 ","$291.20 ","$0.00 ","$56.97 ","$0.00 ","$57.95 ","$0.00 "
"101901","SUP","HCPCS C1713","","101901  -  PLATE XTRNFX 65MM ILZ 3 HL TWST DLX SET ADLT TIB","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"101902","SUP","HCPCS C1713","","101902  -  PLATE XTRNFX 85MM ILZ 3 HL TWST DLX SET ADLT","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"102000","SUP","HCPCS C1713","","102000  -  PLATE XTRNFX ILZ 3 HL CRV CIRC","BOTH IP/OP","$623.90 ","$461.69 ","$0.00 ","$623.90 ","$280.76 ","$0.00 ","$130.04 ","$0.00 ","$0.00 ","$109.24 ","$623.90 ","$0.00 ","$311.95 ","$494.13 ","$499.12 ","$0.00 ","$97.64 ","$0.00 ","$99.32 ","$0.00 "
"102003","SUP","HCPCS Q4116","","102003  -  MATRIX TISSUE THICK 2X1CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$273.75 ","$123.19 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$47.93 ","$273.75 ","$0.00 ","$136.88 ","$216.81 ","$219.00 ","$0.00 ","$42.84 ","$0.00 ","$43.58 ","$0.00 "
"102007","SUP","HCPCS Q4116","","102007  -  MATRIX TISSUE THIN 4X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED","BOTH IP/OP","$148.13 ","$109.62 ","$0.00 ","$230.00 ","$103.50 ","$0.00 ","$30.87 ","$0.00 ","$0.00 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"102009","SUP","HCPCS Q4116","","102009  -  GRAFT SKIN 4X2CM ALLOGRAFT ALLODERM ACELLULAR DERMIS","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$100.94 ","$45.42 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$17.67 ","$100.94 ","$0.00 ","$50.47 ","$79.94 ","$80.75 ","$0.00 ","$15.80 ","$0.00 ","$16.07 ","$0.00 "
"102010","SUP","HCPCS Q4116","","102010  -  MATRIX TISSUE THIN 4X2CM ALLOGRAFT REGENERATIVE FREEZE DRIED","BOTH IP/OP","$1,030.00 ","$762.20 ","$0.00 ","$1,600.00 ","$720.00 ","$0.00 ","$214.68 ","$0.00 ","$0.00 ","$280.15 ","$1,600.00 ","$0.00 ","$800.00 ","$1,267.20 ","$1,280.00 ","$0.00 ","$250.40 ","$0.00 ","$254.72 ","$0.00 "
"102012","SUP","HCPCS Q4116","","102012  -  MATRIX TISSUE THICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$128.75 ","$95.28 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$26.83 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"102016","SUP","HCPCS Q4116","","102016  -  ALLODERM IMPLANTABLE","BOTH IP/OP","$12,497.50 ","$9,248.15 ","$0.00 ","$12,497.50 ","$5,623.88 ","$0.00 ","$2,604.79 ","$0.00 ","$0.00 ","$2,188.21 ","$12,497.50 ","$0.00 ","$6,248.75 ","$9,898.02 ","$9,998.00 ","$0.00 ","$1,955.86 ","$0.00 ","$1,989.60 ","$0.00 "
"102020","SUP","HCPCS Q4116","","102020  -  MATRIX TISSUE MEDIUM 7X3CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$83.45 ","$61.75 ","$0.00 ","$129.40 ","$58.23 ","$0.00 ","$17.39 ","$0.00 ","$0.00 ","$22.66 ","$129.40 ","$0.00 ","$64.70 ","$102.48 ","$103.52 ","$0.00 ","$20.25 ","$0.00 ","$20.60 ","$0.00 "
"102021","SUP","HCPCS Q4116","","102021  -  MATRIX TISSUE THICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$83.45 ","$61.75 ","$0.00 ","$129.40 ","$58.23 ","$0.00 ","$17.39 ","$0.00 ","$0.00 ","$22.66 ","$129.40 ","$0.00 ","$64.70 ","$102.48 ","$103.52 ","$0.00 ","$20.25 ","$0.00 ","$20.60 ","$0.00 "
"102031","SUP","HCPCS Q4116","","102031  -  MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED","BOTH IP/OP","$32.59 ","$24.12 ","$0.00 ","$50.63 ","$22.78 ","$0.00 ","$6.79 ","$0.00 ","$0.00 ","$8.86 ","$50.63 ","$0.00 ","$25.31 ","$40.10 ","$40.50 ","$0.00 ","$7.92 ","$0.00 ","$8.06 ","$0.00 "
"102033","SUP","HCPCS Q4116","","102033  -  MATRIX TISSUE MEDIUM 7X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$64.73 ","$47.90 ","$0.00 ","$100.54 ","$45.24 ","$0.00 ","$13.49 ","$0.00 ","$0.00 ","$17.60 ","$100.54 ","$0.00 ","$50.27 ","$79.63 ","$80.43 ","$0.00 ","$15.73 ","$0.00 ","$16.01 ","$0.00 "
"102034","SUP","HCPCS Q4116","","102034  -  MATRIX TISSUE THICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$64.73 ","$47.90 ","$0.00 ","$100.54 ","$45.24 ","$0.00 ","$13.49 ","$0.00 ","$0.00 ","$17.60 ","$100.54 ","$0.00 ","$50.27 ","$79.63 ","$80.43 ","$0.00 ","$15.73 ","$0.00 ","$16.01 ","$0.00 "
"102049","SUP","HCPCS Q4116","","102049  -  MATRIX TISSUE MEDIUM 12X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$104.11 ","$77.04 ","$0.00 ","$104.11 ","$46.85 ","$0.00 ","$21.70 ","$0.00 ","$0.00 ","$18.23 ","$104.11 ","$0.00 ","$52.06 ","$82.46 ","$83.29 ","$0.00 ","$16.29 ","$0.00 ","$16.58 ","$0.00 "
"102050","SUP","HCPCS Q4116","","102050  -  MATRIX TISSUE THICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"102061","SUP","HCPCS Q4116","","102061  -  MATRIX TISSUE MEDIUM 10X5CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$64.55 ","$47.77 ","$0.00 ","$100.20 ","$45.09 ","$0.00 ","$13.45 ","$0.00 ","$0.00 ","$17.54 ","$100.20 ","$0.00 ","$50.10 ","$79.36 ","$80.16 ","$0.00 ","$15.68 ","$0.00 ","$15.95 ","$0.00 "
"102062","SUP","HCPCS Q4116","","102062  -  MATRIX TISSUE THICK 10X5CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$3,227.50 ","$2,388.35 ","$0.00 ","$5,010.00 ","$2,254.50 ","$0.00 ","$672.69 ","$0.00 ","$0.00 ","$877.21 ","$5,010.00 ","$0.00 ","$2,505.00 ","$3,967.92 ","$4,008.00 ","$0.00 ","$784.07 ","$0.00 ","$797.59 ","$0.00 "
"102071","SUP","HCPCS Q4116","","102071  -  MATRIX TISSUE MEDIUM 12X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$70.80 ","$52.39 ","$0.00 ","$70.80 ","$31.86 ","$0.00 ","$14.76 ","$0.00 ","$0.00 ","$12.40 ","$70.80 ","$0.00 ","$35.40 ","$56.07 ","$56.64 ","$0.00 ","$11.08 ","$0.00 ","$11.27 ","$0.00 "
"102072","SUP","HCPCS Q4116","","102072  -  MATRIX TISSUE THICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$188.80 ","$139.71 ","$0.00 ","$70.80 ","$31.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.40 ","$70.80 ","$0.00 ","$35.40 ","$56.07 ","$56.64 ","$0.00 ","$11.08 ","$0.00 ","$11.27 ","$0.00 "
"102081","SUP","HCPCS Q4116","","102081  -  MATRIX TISSUE MEDIUM 16X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.09 ","$57.79 ","$0.00 ","$78.09 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.09 ","$0.00 ","$39.04 ","$61.85 ","$62.47 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"102082","SUP","HCPCS Q4116","","102082  -  MATRIX TISSUE THICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$867.50 ","$641.95 ","$0.00 ","$78.09 ","$35.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.67 ","$78.09 ","$0.00 ","$39.04 ","$61.85 ","$62.47 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"102096","SUP","HCPCS Q4116","","102096  -  MATRIX TISSUE THICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$78.10 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.10 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"102102","SUP","Custom 27203010","","102102 - WIRE XTRNFX 1.8MM 370MM NS ILZ BYNT PNT DLX SET SS TIB","BOTH IP/OP","$208.50 ","$154.29 ","$0.00 ","$208.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$208.50 ","$0.00 ","$104.25 ","$165.13 ","$166.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"102128","SUP","HCPCS Q4116","","102128  -  MATRIX TISSUE THICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.11 ","$57.80 ","$0.00 ","$78.11 ","$35.15 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.68 ","$78.11 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"102132","SUP","HCPCS C1760","","CLIP HLF PIN CIRC DISC ILZ EXFIXA 4","BOTH IP/OP","$4.65 ","$3.44 ","$0.00 ","$4.65 ","$2.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.81 ","$4.65 ","$0.00 ","$2.33 ","$3.68 ","$3.72 ","$0.00 ","$0.73 ","$0.00 ","$0.74 ","$0.00 "
"102144","SUP","HCPCS Q4116","","102144  -  MATRIX TISSUE THICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$68.23 ","$50.49 ","$0.00 ","$105.87 ","$47.64 ","$0.00 ","$14.22 ","$0.00 ","$0.00 ","$18.54 ","$105.87 ","$0.00 ","$52.93 ","$83.85 ","$84.69 ","$0.00 ","$16.57 ","$0.00 ","$16.85 ","$0.00 "
"102196","SUP","HCPCS Q4116","","102196  -  MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$78.10 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.10 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"102302","SUP","HCPCS C1713","","102302  -  SET XTRNFX 100MM ILZ THRD ROD ADLT TIB","BOTH IP/OP","$109.60 ","$81.10 ","$0.00 ","$109.60 ","$49.32 ","$0.00 ","$22.84 ","$0.00 ","$0.00 ","$19.19 ","$109.60 ","$0.00 ","$54.80 ","$86.80 ","$87.68 ","$0.00 ","$17.15 ","$0.00 ","$17.45 ","$0.00 "
"102303","SUP","HCPCS C1713","","102303  -  ROD EXFIX 120MM ILZ TIB THRD DLX SET ADLT","BOTH IP/OP","$109.60 ","$81.10 ","$0.00 ","$109.60 ","$49.32 ","$0.00 ","$22.84 ","$0.00 ","$0.00 ","$19.19 ","$109.60 ","$0.00 ","$54.80 ","$86.80 ","$87.68 ","$0.00 ","$17.15 ","$0.00 ","$17.45 ","$0.00 "
"102304","SUP","HCPCS C1713","","102304  -  ROD XTRNFX 150MM ILZ THRD DLX SET SS ADLT TIB","BOTH IP/OP","$109.60 ","$81.10 ","$0.00 ","$109.60 ","$49.32 ","$0.00 ","$22.84 ","$0.00 ","$0.00 ","$19.19 ","$109.60 ","$0.00 ","$54.80 ","$86.80 ","$87.68 ","$0.00 ","$17.15 ","$0.00 ","$17.45 ","$0.00 "
"102320","SUP","HCPCS Q4116","","102320  -  MATRIX TISSUE THICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.12 ","$57.81 ","$0.00 ","$78.12 ","$35.15 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.68 ","$78.12 ","$0.00 ","$39.06 ","$61.87 ","$62.49 ","$0.00 ","$12.23 ","$0.00 ","$12.44 ","$0.00 "
"102600","SUP","HCPCS C1713","","102600  -  WASHER XTRNFX THK3MM 14MM ILZ SLT BSC SET ADLT FEM","BOTH IP/OP","$65.40 ","$48.40 ","$0.00 ","$65.40 ","$29.43 ","$0.00 ","$13.63 ","$0.00 ","$0.00 ","$11.45 ","$65.40 ","$0.00 ","$32.70 ","$51.80 ","$52.32 ","$0.00 ","$10.24 ","$0.00 ","$10.41 ","$0.00 "
"102701","SUP","HCPCS C1713","","102701  -  WASHER XTRNFX 2MM 14MM ILZ BSC SET ADLT TIB","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$13.50 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"102706","SUP","HCPCS C1713","","102706  -  WASHER XTRNFX THK2MM ILZ BOLT","BOTH IP/OP","$65.40 ","$48.40 ","$0.00 ","$65.40 ","$29.43 ","$0.00 ","$13.63 ","$0.00 ","$0.00 ","$11.45 ","$65.40 ","$0.00 ","$32.70 ","$51.80 ","$52.32 ","$0.00 ","$10.24 ","$0.00 ","$10.41 ","$0.00 "
"102707","SUP","HCPCS C1713","","102707  -  WASHER XTRNFX THK4MM ILZ BOLT","BOTH IP/OP","$65.40 ","$48.40 ","$0.00 ","$65.40 ","$29.43 ","$0.00 ","$13.63 ","$0.00 ","$0.00 ","$11.45 ","$65.40 ","$0.00 ","$32.70 ","$51.80 ","$52.32 ","$0.00 ","$10.24 ","$0.00 ","$10.41 ","$0.00 "
"102715","SUP","HCPCS C1713","","102715  -  WASHER XTRNFX THK1MM 1MM CIRC SM BN FXTR","BOTH IP/OP","$45.90 ","$33.97 ","$0.00 ","$45.90 ","$20.66 ","$0.00 ","$9.57 ","$0.00 ","$0.00 ","$8.04 ","$45.90 ","$0.00 ","$22.95 ","$36.35 ","$36.72 ","$0.00 ","$7.18 ","$0.00 ","$7.31 ","$0.00 "
"102718","SUP","HCPCS C1713","","102718  -  WASHER XTRNFX THK1.5MM 1.5MM CIRC SM BN FXTR","BOTH IP/OP","$45.90 ","$33.97 ","$0.00 ","$45.90 ","$20.66 ","$0.00 ","$9.57 ","$0.00 ","$0.00 ","$8.04 ","$45.90 ","$0.00 ","$22.95 ","$36.35 ","$36.72 ","$0.00 ","$7.18 ","$0.00 ","$7.31 ","$0.00 "
"102721","SUP","HCPCS C1713","","102721  -  WASHER XTRNFX THK3MM SLT SM BN FXTR","BOTH IP/OP","$86.30 ","$63.86 ","$0.00 ","$86.30 ","$38.84 ","$0.00 ","$17.99 ","$0.00 ","$0.00 ","$15.11 ","$86.30 ","$0.00 ","$43.15 ","$68.35 ","$69.04 ","$0.00 ","$13.51 ","$0.00 ","$13.74 ","$0.00 "
"103044","SUP","Custom 27203010","","103044  -  BIT DRL 2.7MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS","BOTH IP/OP","$1,023.40 ","$757.32 ","$0.00 ","$1,023.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,023.40 ","$0.00 ","$511.70 ","$810.53 ","$818.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103045","SUP","Custom 27203010","","103045  -  BIT DRL 3.8MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS","BOTH IP/OP","$1,023.40 ","$757.32 ","$0.00 ","$1,023.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,023.40 ","$0.00 ","$511.70 ","$810.53 ","$818.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103201","SUP","HCPCS C1713","","103201  -  BOLT XTRNFX UNV 16MM ILZ CMPS BSC SET CIRC CNCT HNG SS ADLT","BOTH IP/OP","$0.81 ","$0.60 ","$0.00 ","$16.15 ","$7.27 ","$0.00 ","$0.17 ","$0.00 ","$0.00 ","$2.83 ","$16.15 ","$0.00 ","$8.08 ","$12.79 ","$12.92 ","$0.00 ","$2.53 ","$0.00 ","$2.57 ","$0.00 "
"103301","SUP","HCPCS C1713","","103301  -  NUT XTRNFX THK5MM 10MM 6MM ILZ THRD INS HEX SS NYL","BOTH IP/OP","$77.20 ","$57.13 ","$0.00 ","$77.20 ","$34.74 ","$0.00 ","$16.09 ","$0.00 ","$0.00 ","$13.52 ","$77.20 ","$0.00 ","$38.60 ","$61.14 ","$61.76 ","$0.00 ","$12.08 ","$0.00 ","$12.29 ","$0.00 "
"103313","SUP","HCPCS C1713","","103313  -  NUT XTRNFX 3ANG SM BN FXTR","BOTH IP/OP","$409.70 ","$303.18 ","$0.00 ","$409.70 ","$184.37 ","$0.00 ","$85.39 ","$0.00 ","$0.00 ","$71.74 ","$409.70 ","$0.00 ","$204.85 ","$324.48 ","$327.76 ","$0.00 ","$64.12 ","$0.00 ","$65.22 ","$0.00 "
"103406","SUP","HCPCS C1776","","103406  -  SLEEVE XTRNFX 6MM ILZ CENTERING","BOTH IP/OP","$406.30 ","$300.66 ","$0.00 ","$406.30 ","$182.84 ","$0.00 ","$84.68 ","$0.00 ","$0.00 ","$71.14 ","$406.30 ","$0.00 ","$203.15 ","$321.79 ","$325.04 ","$0.00 ","$63.59 ","$0.00 ","$64.68 ","$0.00 "
"103452","SUP","HCPCS C1713","","103452  -  CUBE XTRNFX ILZ 2 HL SS RNCH SYS","BOTH IP/OP","$578.00 ","$427.72 ","$0.00 ","$578.00 ","$260.10 ","$0.00 ","$120.47 ","$0.00 ","$0.00 ","$101.20 ","$578.00 ","$0.00 ","$289.00 ","$457.78 ","$462.40 ","$0.00 ","$90.46 ","$0.00 ","$92.02 ","$0.00 "
"103453","SUP","HCPCS C1713","","103453  -  CUBE EXFIX UNIVERSAL 3 HOLE COMPONENT SET HINGE COMPASS","BOTH IP/OP","$668.00 ","$494.32 ","$0.00 ","$668.00 ","$300.60 ","$0.00 ","$139.23 ","$0.00 ","$0.00 ","$116.96 ","$668.00 ","$0.00 ","$334.00 ","$529.06 ","$534.40 ","$0.00 ","$104.54 ","$0.00 ","$106.35 ","$0.00 "
"103454","SUP","Custom 27203010","","103454  -  CUBE XTRNFX ILZ 4 HL SS RNCH SYS","BOTH IP/OP","$686.80 ","$508.23 ","$0.00 ","$686.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.80 ","$0.00 ","$343.40 ","$543.95 ","$549.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103455","SUP","HCPCS C1713","","CUBE 5 HOLE CIRC EXFIXA RNCH SYS","BOTH IP/OP","$758.20 ","$561.07 ","$0.00 ","$482.43 ","$217.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.47 ","$482.43 ","$0.00 ","$241.21 ","$382.08 ","$385.94 ","$0.00 ","$75.50 ","$0.00 ","$76.80 ","$0.00 "
"106132","SUP","HCPCS C1713","","106132  -  BLADE SW DMD 800X.64X.54MM","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"106133","SUP","HCPCS C1713","","106133  -  SAW 0106133 DIAMOND 0.81 0.91MM X 800MM","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"108280","SUP","Custom 27203010","","108280  -  DOPPLER VASC 8MHZ STRL PRB DISP","BOTH IP/OP","$374.38 ","$277.04 ","$0.00 ","$374.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.38 ","$0.00 ","$187.19 ","$296.51 ","$299.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-00","SUP","Custom 27803010","","01-2200  -  HEAD FEMORAL MORSE TAPER LFIT HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-2200  -  HEAD FEM +0MM OFST CTPR 22MM STRL LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110021","SUP","Custom 27203010","","110021  -  BIT DRL 6.3MM AMBI PRFR","BOTH IP/OP","$200.55 ","$148.41 ","$0.00 ","$200.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.55 ","$0.00 ","$100.28 ","$158.84 ","$160.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110107","SUP","HCPCS C1713","","110107  -  SCREW SET CLLS FRM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"110242","SUP","Custom 27203010","","110242  -  BIT DRL 2.7MM STRL COLE TWST RDLCNT","BOTH IP/OP","$635.63 ","$470.37 ","$0.00 ","$635.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$635.63 ","$0.00 ","$317.81 ","$503.42 ","$508.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110244","SUP","Custom 27203010","","110244  -  BIT DRL 3.5MM STRL COLE TWST RDLCNT","BOTH IP/OP","$635.63 ","$470.37 ","$0.00 ","$635.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$635.63 ","$0.00 ","$317.81 ","$503.42 ","$508.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110245","SUP","Custom 27203010","","110245  -  BIT DRL 4MM COLE RDLCNT","BOTH IP/OP","$635.63 ","$470.37 ","$0.00 ","$635.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$635.63 ","$0.00 ","$317.81 ","$503.42 ","$508.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110246","SUP","Custom 27203010","","110246  -  BIT DRL 4.8MM COLE RDLCNT","BOTH IP/OP","$635.63 ","$470.37 ","$0.00 ","$635.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$635.63 ","$0.00 ","$317.81 ","$503.42 ","$508.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110300","SUP","HCPCS C1713","","110300  -  SCREW 110300  BABY CD SELF BRKNG","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"110675","SUP","Custom 27203010","","110675  -  PASSER SUT 6.1IN BLK STRL LF 3.6CM SWNSN WIRELOOP ATCL SS","BOTH IP/OP","$199.70 ","$147.78 ","$0.00 ","$199.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.70 ","$0.00 ","$99.85 ","$158.16 ","$159.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111250","SUP","HCPCS C1762","","111250  -  GRAFT SOFT TISSUE 1-2MM 50MM ALLOGRAFT AXONAL REGENERATION","BOTH IP/OP","$11,165.00 ","$8,262.10 ","$0.00 ","$10,125.00 ","$0.00 ","$0.00 ","$2,327.07 ","$0.00 ","$0.00 ","$0.00 ","$10,125.00 ","$0.00 ","$5,062.50 ","$8,019.00 ","$8,100.00 ","$0.00 ","$1,584.56 ","$0.00 ","$0.00 ","$0.00 "
"5-Jan","SUP","Custom 27803010","","01-2205  -  HEAD FEMORAL +5MM 22MM MORSE TAPERED LFIT COCR HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jun","SUP","Custom 27803010","","06-2205  -  HEAD FEM +5MM OFST CTPR 22MM STRL LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"111630","SUP","HCPCS C1713","","111630  -  PIN FX SM DUNN-DAUTREY STRPR UNCMP","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"111640","SUP","HCPCS C1713","","111640  -  PIN FX 4MM 170MM STRL KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"111650","SUP","HCPCS C1776","","111650  -  KIT THR STRL FEM/TIB CKPNT KT KN","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$174.38 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"111651","SUP","HCPCS C1776","","111651  -  COMPONENT FEM STRL TIB CKPNT KN","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$54.00 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"111652","SUP","HCPCS C1776","","111652  -  COMPONENT FEM STRL FEM CKPNT KN","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$92.25 ","$0.00 ","$42.73 ","$0.00 ","$0.00 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"111655","SUP","HCPCS C1713","","111655  -  SCREW BN STRL VA CORT","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$298.13 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"111670","SUP","HCPCS C1713","","111670  -  PIN ORTH 3.2MM 80MM STRL KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"111680","SUP","HCPCS C1713","","111680  -  PIN FX 4MM 80MM STRL KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"6-Jan","SUP","HCPCS C1713","","1-2206  -  SPACER SPNL 6MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$7,632.00 ","$5,647.68 ","$0.00 ","$7,632.00 ","$3,434.40 ","$0.00 ","$1,590.70 ","$0.00 ","$0.00 ","$1,336.30 ","$7,632.00 ","$0.00 ","$3,816.00 ","$6,044.54 ","$6,105.60 ","$0.00 ","$1,194.41 ","$0.00 ","$1,215.01 ","$0.00 "
"8-Jan","SUP","HCPCS C1713","","1-2208  -  SPACER SPNL 8MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$7,632.00 ","$5,647.68 ","$0.00 ","$7,632.00 ","$3,434.40 ","$0.00 ","$1,590.70 ","$0.00 ","$0.00 ","$1,336.30 ","$7,632.00 ","$0.00 ","$3,816.00 ","$6,044.54 ","$6,105.60 ","$0.00 ","$1,194.41 ","$0.00 ","$1,215.01 ","$0.00 "
"112640","SUP","HCPCS C1781","","0112640  -  MESH SURG 4X1IN PATCH FLAT SHEET KNIT MARLEX GROIN HERN","BOTH IP/OP","$118.25 ","$87.51 ","$0.00 ","$118.25 ","$53.21 ","$0.00 ","$24.65 ","$0.00 ","$0.00 ","$20.70 ","$118.25 ","$0.00 ","$59.13 ","$93.65 ","$94.60 ","$0.00 ","$18.51 ","$0.00 ","$18.83 ","$0.00 "
"112660","SUP","HCPCS C1781","","112660  -  MESH HERN GROIN POLYPRO 14X10IN FLAT PTCH KNTD MRLX STRL","BOTH IP/OP","$1,350.00 ","$999.00 ","$0.00 ","$1,350.00 ","$607.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.37 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$211.28 ","$0.00 ","$214.92 ","$0.00 "
"112727","SUP","Custom 27203010","","112727  -  SCREW XTRNFX SPTL FRM HXFX SET SS","BOTH IP/OP","$33.83 ","$25.03 ","$0.00 ","$33.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.83 ","$0.00 ","$16.91 ","$26.79 ","$27.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"112960","SUP","HCPCS C1781","","0112960  -  PLUG SURG MEDIUM TAPER 1.55X1.3IN MONOFILAMENT NONABSORBABLE","BOTH IP/OP","$725.75 ","$537.06 ","$0.00 ","$736.64 ","$331.49 ","$0.00 ","$151.26 ","$0.00 ","$0.00 ","$128.98 ","$736.64 ","$0.00 ","$368.32 ","$583.42 ","$589.31 ","$0.00 ","$115.28 ","$0.00 ","$117.27 ","$0.00 "
"112970","SUP","HCPCS C1781","","0112970  -  MESH SRG LG 1.9IN 1.6IN STRL BARD PRFX PLG MFL PLT EDG PP","BOTH IP/OP","$732.25 ","$541.87 ","$0.00 ","$743.23 ","$334.46 ","$0.00 ","$152.62 ","$0.00 ","$0.00 ","$130.13 ","$743.23 ","$0.00 ","$371.62 ","$588.64 ","$594.59 ","$0.00 ","$116.32 ","$0.00 ","$118.32 ","$0.00 "
"112970","SUP","HCPCS C1781","","112970  -  MESH SURG LARGE 1.9IN 1.6IN PLUG MONOFILAMENT PERFIX POLYPRO","BOTH IP/OP","$732.25 ","$541.87 ","$0.00 ","$2,706.86 ","$334.46 ","$0.00 ","$152.62 ","$0.00 ","$0.00 ","$130.13 ","$743.23 ","$0.00 ","$371.62 ","$2,706.86 ","$594.59 ","$0.00 ","$116.32 ","$0.00 ","$118.32 ","$0.00 "
"112980","SUP","HCPCS C1781","","0112980  -  MESH SURG XL 2X1.6IN NONABSORBABLE PLUG TAPERED MARLEX","BOTH IP/OP","$849.25 ","$628.45 ","$0.00 ","$849.25 ","$382.16 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$148.70 ","$849.25 ","$0.00 ","$424.63 ","$672.61 ","$679.40 ","$0.00 ","$132.91 ","$0.00 ","$135.20 ","$0.00 "
"10-Jan","SUP","HCPCS C1713","","1-2210  -  SPACER SPNL 10MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$7,632.00 ","$5,647.68 ","$0.00 ","$7,632.00 ","$3,434.40 ","$0.00 ","$1,590.70 ","$0.00 ","$0.00 ","$1,336.30 ","$7,632.00 ","$0.00 ","$3,816.00 ","$6,044.54 ","$6,105.60 ","$0.00 ","$1,194.41 ","$0.00 ","$1,215.01 ","$0.00 "
"10-Jun","SUP","Custom 27803010","","06-2210  -  HEAD FEM +10MM OFST CTPR 22MM STRL LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12-Jan","SUP","HCPCS C1713","","1-2212  -  SPACER SPNL 12MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$7,632.00 ","$5,647.68 ","$0.00 ","$7,632.00 ","$3,434.40 ","$0.00 ","$1,590.70 ","$0.00 ","$0.00 ","$1,336.30 ","$7,632.00 ","$0.00 ","$3,816.00 ","$6,044.54 ","$6,105.60 ","$0.00 ","$1,194.41 ","$0.00 ","$1,215.01 ","$0.00 "
"114153","SUP","HCPCS C1880","","114153  -  CATHETER SCT KT 2 LUM COIL XTD LGTH","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"114156","SUP","HCPCS C1788","","114156  -  SET HMDIAL 33ML LF AQDX BLD CRCT UF-500","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"14-Jan","SUP","HCPCS C1713","","1-2214  -  SPACER SPNL 14MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$7,632.00 ","$5,647.68 ","$0.00 ","$7,632.00 ","$3,434.40 ","$0.00 ","$1,590.70 ","$0.00 ","$0.00 ","$1,336.30 ","$7,632.00 ","$0.00 ","$3,816.00 ","$6,044.54 ","$6,105.60 ","$0.00 ","$1,194.41 ","$0.00 ","$1,215.01 ","$0.00 "
"116240","SUP","HCPCS C1713","","116240  -  SCREW BN STRL CORT","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$298.13 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"120019","SUP","HCPCS C1713","","120019  -  BUTTON SUT 19MM STRL LF HWSN 4 HL HD PE LGMNT DISP","BOTH IP/OP","$310.40 ","$229.70 ","$0.00 ","$310.40 ","$139.68 ","$0.00 ","$64.70 ","$0.00 ","$0.00 ","$54.35 ","$310.40 ","$0.00 ","$155.20 ","$245.84 ","$248.32 ","$0.00 ","$48.58 ","$0.00 ","$49.42 ","$0.00 "
"121100","SUP","HCPCS C1713","","121100  -  SCREW BN STD 12.7MM 9MM 55MM STRL 21MM AMBI CLS LG CMPR SS","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121101","SUP","HCPCS C1713","","121101  -  SCREW BN STD 9MM .5MM 60MM CLS AMBI IMHS LG THRD HIP","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121102","SUP","HCPCS C1713","","121102  -  SCREW BN STD 12.7MM 9MM 65MM STRL 21MM AMBI CLS LG CMPR SS","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121103","SUP","HCPCS C1713","","121103  -  SCREW BN STD 9MM .5MM 70MM CLS AMBI IMHS LG THRD HIP","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121104","SUP","HCPCS C1713","","121104  -  SCREW BN STD 12.7MM 9MM 75MM STRL 21MM AMBI IMHS CLS LG CMPR","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121105","SUP","HCPCS C1713","","121105  -  SCREW BN STD 12.7MM 9MM 80MM STRL 21MM AMBI IMHS CLS LG CMPR","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121106","SUP","HCPCS C1713","","121106  -  SCREW BN P/T 12.7MM 9MM 85MM 21MM AMBI CHS IMHS STD LG HIP","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121107","SUP","HCPCS C1713","","121107  -  SCREW BN P/T 12.7MM 9MM 90MM 21MM AMBI CHS IMHS STD LG HIP","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121108","SUP","HCPCS C1713","","121108  -  SCREW BN 12.7MM 9MM 95MM 21MM AMBI CHS STD LG SS HIP","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121109","SUP","HCPCS C1713","","121109  -  SCREW BN STD 12.7MM 9MM 100MM STRL 21MM AMBI IMHS CLS LG","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121110","SUP","HCPCS C1713","","121110  -  SCREW BN 12.7MM 9MM 105MM 21MM AMBI CHS STD LG SS HIP","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121111","SUP","HCPCS C1713","","121111  -  SCREW BN STD .5IN 9MM 110MM 21MM IMHS LG HIP SP CNDL PLT","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121112","SUP","HCPCS C1713","","121112  -  SCREW BN STD .5IN 9MM 115MM 21MM AMBI CLS IMHS LG","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121116","SUP","HCPCS C1713","","121116  -  SCREW BN HEX 3.5MM 19MM AMBI IMHS CLS CMPR SS HIP SP CNDL IM","BOTH IP/OP","$199.40 ","$147.56 ","$0.00 ","$199.40 ","$89.73 ","$0.00 ","$41.56 ","$0.00 ","$0.00 ","$34.91 ","$199.40 ","$0.00 ","$99.70 ","$157.92 ","$159.52 ","$0.00 ","$31.21 ","$0.00 ","$31.74 ","$0.00 "
"121117","SUP","HCPCS C1713","","121117  -  SCREW BN HEX 3.5MM 28.5MM AMBI IMHS CLS CMPR SS HIP SP CNDL","BOTH IP/OP","$199.40 ","$147.56 ","$0.00 ","$199.40 ","$89.73 ","$0.00 ","$41.56 ","$0.00 ","$0.00 ","$34.91 ","$199.40 ","$0.00 ","$99.70 ","$157.92 ","$159.52 ","$0.00 ","$31.21 ","$0.00 ","$31.74 ","$0.00 "
"121120","SUP","HCPCS C1713","","121120  -  PLATE BN 130D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP","BOTH IP/OP","$1,081.50 ","$800.31 ","$0.00 ","$1,081.50 ","$486.68 ","$0.00 ","$225.41 ","$0.00 ","$0.00 ","$189.36 ","$1,081.50 ","$0.00 ","$540.75 ","$856.55 ","$865.20 ","$0.00 ","$169.25 ","$0.00 ","$172.17 ","$0.00 "
"121121","SUP","HCPCS C1713","","121121  -  PLATE BN 135D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP","BOTH IP/OP","$1,081.50 ","$800.31 ","$0.00 ","$1,081.50 ","$486.68 ","$0.00 ","$225.41 ","$0.00 ","$0.00 ","$189.36 ","$1,081.50 ","$0.00 ","$540.75 ","$856.55 ","$865.20 ","$0.00 ","$169.25 ","$0.00 ","$172.17 ","$0.00 "
"121122","SUP","HCPCS C1713","","121122  -  PLATE BN 140D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP","BOTH IP/OP","$1,081.50 ","$800.31 ","$0.00 ","$1,081.50 ","$486.68 ","$0.00 ","$225.41 ","$0.00 ","$0.00 ","$189.36 ","$1,081.50 ","$0.00 ","$540.75 ","$856.55 ","$865.20 ","$0.00 ","$169.25 ","$0.00 ","$172.17 ","$0.00 "
"121123","SUP","HCPCS C1713","","121123  -  PLATE BN 145D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP","BOTH IP/OP","$1,081.50 ","$800.31 ","$0.00 ","$1,081.50 ","$486.68 ","$0.00 ","$225.41 ","$0.00 ","$0.00 ","$189.36 ","$1,081.50 ","$0.00 ","$540.75 ","$856.55 ","$865.20 ","$0.00 ","$169.25 ","$0.00 ","$172.17 ","$0.00 "
"121124","SUP","HCPCS C1713","","121124  -  PLATE BN 150D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP","BOTH IP/OP","$1,081.50 ","$800.31 ","$0.00 ","$1,081.50 ","$486.68 ","$0.00 ","$225.41 ","$0.00 ","$0.00 ","$189.36 ","$1,081.50 ","$0.00 ","$540.75 ","$856.55 ","$865.20 ","$0.00 ","$169.25 ","$0.00 ","$172.17 ","$0.00 "
"121125","SUP","HCPCS C1713","","121125  -  PLATE BN 130D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"121126","SUP","HCPCS C1713","","121126  -  PLATE BN 135D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"121127","SUP","HCPCS C1713","","121127  -  PLATE BN 140D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"121128","SUP","HCPCS C1713","","121128  -  PLATE BN 145D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"121130","SUP","HCPCS C1713","","121130  -  PLATE BN 130D STD BRL 100MM 38.1MM AMBI 4 HL CMPR SS HIP","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"121131","SUP","HCPCS C1713","","121131  -  PLATE BN 135D STD BRL 135MM 38.1MM AMBI 4 HL CMPR SS HIP","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"121135","SUP","HCPCS C1713","","121135  -  PLATE BN 130D STD BRL 120MM 38.1MM AMBI CHS 5 HL SS HIP","BOTH IP/OP","$1,191.75 ","$881.90 ","$0.00 ","$1,191.75 ","$536.29 ","$0.00 ","$248.39 ","$0.00 ","$0.00 ","$208.67 ","$1,191.75 ","$0.00 ","$595.88 ","$943.87 ","$953.40 ","$0.00 ","$186.51 ","$0.00 ","$189.73 ","$0.00 "
"121137","SUP","HCPCS C1713","","121137  -  PLATE BN 140D STD BRL 120MM 38.1MM AMBI 5 HL HIP","BOTH IP/OP","$1,191.75 ","$881.90 ","$0.00 ","$1,191.75 ","$536.29 ","$0.00 ","$248.39 ","$0.00 ","$0.00 ","$208.67 ","$1,191.75 ","$0.00 ","$595.88 ","$943.87 ","$953.40 ","$0.00 ","$186.51 ","$0.00 ","$189.73 ","$0.00 "
"121138","SUP","HCPCS C1713","","121138  -  PLATE BN 145D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP","BOTH IP/OP","$1,191.75 ","$881.90 ","$0.00 ","$1,191.75 ","$536.29 ","$0.00 ","$248.39 ","$0.00 ","$0.00 ","$208.67 ","$1,191.75 ","$0.00 ","$595.88 ","$943.87 ","$953.40 ","$0.00 ","$186.51 ","$0.00 ","$189.73 ","$0.00 "
"121139","SUP","HCPCS C1713","","121139  -  PLATE BN 150D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP","BOTH IP/OP","$1,191.75 ","$881.90 ","$0.00 ","$1,191.75 ","$536.29 ","$0.00 ","$248.39 ","$0.00 ","$0.00 ","$208.67 ","$1,191.75 ","$0.00 ","$595.88 ","$943.87 ","$953.40 ","$0.00 ","$186.51 ","$0.00 ","$189.73 ","$0.00 "
"121141","SUP","HCPCS C1713","","121141  -  PLATE BN 135D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP","BOTH IP/OP","$1,239.00 ","$916.86 ","$0.00 ","$1,239.00 ","$557.55 ","$0.00 ","$258.24 ","$0.00 ","$0.00 ","$216.94 ","$1,239.00 ","$0.00 ","$619.50 ","$981.29 ","$991.20 ","$0.00 ","$193.90 ","$0.00 ","$197.25 ","$0.00 "
"121143","SUP","HCPCS C1713","","121143  -  PLATE BN 145D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP","BOTH IP/OP","$1,239.00 ","$916.86 ","$0.00 ","$1,239.00 ","$557.55 ","$0.00 ","$258.24 ","$0.00 ","$0.00 ","$216.94 ","$1,239.00 ","$0.00 ","$619.50 ","$981.29 ","$991.20 ","$0.00 ","$193.90 ","$0.00 ","$197.25 ","$0.00 "
"121144","SUP","HCPCS C1713","","121144  -  PLATE BN 150D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP","BOTH IP/OP","$1,239.00 ","$916.86 ","$0.00 ","$1,239.00 ","$557.55 ","$0.00 ","$258.24 ","$0.00 ","$0.00 ","$216.94 ","$1,239.00 ","$0.00 ","$619.50 ","$981.29 ","$991.20 ","$0.00 ","$193.90 ","$0.00 ","$197.25 ","$0.00 "
"121145","SUP","HCPCS C1713","","121145  -  PLATE BN 130D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP","BOTH IP/OP","$1,501.50 ","$1,111.11 ","$0.00 ","$1,501.50 ","$675.68 ","$0.00 ","$312.95 ","$0.00 ","$0.00 ","$262.90 ","$1,501.50 ","$0.00 ","$750.75 ","$1,189.19 ","$1,201.20 ","$0.00 ","$234.98 ","$0.00 ","$239.04 ","$0.00 "
"121147","SUP","HCPCS C1713","","121147  -  PLATE BN 140D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP","BOTH IP/OP","$1,501.50 ","$1,111.11 ","$0.00 ","$1,501.50 ","$675.68 ","$0.00 ","$312.95 ","$0.00 ","$0.00 ","$262.90 ","$1,501.50 ","$0.00 ","$750.75 ","$1,189.19 ","$1,201.20 ","$0.00 ","$234.98 ","$0.00 ","$239.04 ","$0.00 "
"121148","SUP","HCPCS C1713","","121148  -  PLATE BN 145D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP","BOTH IP/OP","$1,501.50 ","$1,111.11 ","$0.00 ","$1,501.50 ","$675.68 ","$0.00 ","$312.95 ","$0.00 ","$0.00 ","$262.90 ","$1,501.50 ","$0.00 ","$750.75 ","$1,189.19 ","$1,201.20 ","$0.00 ","$234.98 ","$0.00 ","$239.04 ","$0.00 "
"121149","SUP","HCPCS C1713","","121149  -  PLATE BN 150D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP","BOTH IP/OP","$1,501.50 ","$1,111.11 ","$0.00 ","$1,501.50 ","$675.68 ","$0.00 ","$312.95 ","$0.00 ","$0.00 ","$262.90 ","$1,501.50 ","$0.00 ","$750.75 ","$1,189.19 ","$1,201.20 ","$0.00 ","$234.98 ","$0.00 ","$239.04 ","$0.00 "
"121150","SUP","HCPCS C1713","","121150  -  PLATE BN 130D STD BRL 220MM 38.1MM AMBI 10 HL SS HIP","BOTH IP/OP","$1,758.75 ","$1,301.48 ","$0.00 ","$1,758.75 ","$791.44 ","$0.00 ","$366.57 ","$0.00 ","$0.00 ","$307.94 ","$1,758.75 ","$0.00 ","$879.38 ","$1,392.93 ","$1,407.00 ","$0.00 ","$275.24 ","$0.00 ","$279.99 ","$0.00 "
"121152","SUP","HCPCS C1713","","121152  -  PLATE BN 140D STD BRL 220MM 1.5IN AMBI 10 HL SS HIP","BOTH IP/OP","$1,758.75 ","$1,301.48 ","$0.00 ","$1,758.75 ","$791.44 ","$0.00 ","$366.57 ","$0.00 ","$0.00 ","$307.94 ","$1,758.75 ","$0.00 ","$879.38 ","$1,392.93 ","$1,407.00 ","$0.00 ","$275.24 ","$0.00 ","$279.99 ","$0.00 "
"121153","SUP","HCPCS C1713","","121153  -  PLATE BN 145D STD BRL 180MM 38.1MM AMBI 10 HL CMPR SS HIP","BOTH IP/OP","$1,758.75 ","$1,301.48 ","$0.00 ","$1,758.75 ","$791.44 ","$0.00 ","$366.57 ","$0.00 ","$0.00 ","$307.94 ","$1,758.75 ","$0.00 ","$879.38 ","$1,392.93 ","$1,407.00 ","$0.00 ","$275.24 ","$0.00 ","$279.99 ","$0.00 "
"121154","SUP","HCPCS C1713","","121154  -  PLATE BN 150D STD BRL 220MM 38.1MM AMBI 10 HL CMPR SS HIP","BOTH IP/OP","$1,758.75 ","$1,301.48 ","$0.00 ","$1,758.75 ","$791.44 ","$0.00 ","$366.57 ","$0.00 ","$0.00 ","$307.94 ","$1,758.75 ","$0.00 ","$879.38 ","$1,392.93 ","$1,407.00 ","$0.00 ","$275.24 ","$0.00 ","$279.99 ","$0.00 "
"121156","SUP","HCPCS C1713","","121156  -  PLATE BN 135D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP","BOTH IP/OP","$1,879.50 ","$1,390.83 ","$0.00 ","$1,879.50 ","$845.78 ","$0.00 ","$391.73 ","$0.00 ","$0.00 ","$329.09 ","$1,879.50 ","$0.00 ","$939.75 ","$1,488.56 ","$1,503.60 ","$0.00 ","$294.14 ","$0.00 ","$299.22 ","$0.00 "
"121158","SUP","HCPCS C1713","","121158  -  PLATE BN 145D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP","BOTH IP/OP","$1,879.50 ","$1,390.83 ","$0.00 ","$1,879.50 ","$845.78 ","$0.00 ","$391.73 ","$0.00 ","$0.00 ","$329.09 ","$1,879.50 ","$0.00 ","$939.75 ","$1,488.56 ","$1,503.60 ","$0.00 ","$294.14 ","$0.00 ","$299.22 ","$0.00 "
"121159","SUP","HCPCS C1713","","121159  -  PLATE BN 150D STD BRL 260MM 38.1MM AMBI 12 HL CMPR HIP","BOTH IP/OP","$889.35 ","$658.12 ","$0.00 ","$889.35 ","$400.21 ","$0.00 ","$185.36 ","$0.00 ","$0.00 ","$155.72 ","$889.35 ","$0.00 ","$444.68 ","$704.37 ","$711.48 ","$0.00 ","$139.18 ","$0.00 ","$141.58 ","$0.00 "
"121161","SUP","HCPCS C1713","","121161  -  PLATE BN 135D STD BRL 300MM 38.1MM AMBI 14 SLOT SS HIP","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"121165","SUP","HCPCS C1713","","121165  -  PLATE BN 130D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP","BOTH IP/OP","$1,212.75 ","$897.44 ","$0.00 ","$1,212.75 ","$545.74 ","$0.00 ","$252.77 ","$0.00 ","$0.00 ","$212.34 ","$1,212.75 ","$0.00 ","$606.38 ","$960.50 ","$970.20 ","$0.00 ","$189.80 ","$0.00 ","$193.07 ","$0.00 "
"121166","SUP","HCPCS C1713","","121166  -  PLATE BN 135D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP","BOTH IP/OP","$1,212.75 ","$897.44 ","$0.00 ","$1,212.75 ","$545.74 ","$0.00 ","$252.77 ","$0.00 ","$0.00 ","$212.34 ","$1,212.75 ","$0.00 ","$606.38 ","$960.50 ","$970.20 ","$0.00 ","$189.80 ","$0.00 ","$193.07 ","$0.00 "
"121167","SUP","HCPCS C1713","","121167  -  PLATE BN 140D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP","BOTH IP/OP","$1,212.75 ","$897.44 ","$0.00 ","$1,212.75 ","$545.74 ","$0.00 ","$252.77 ","$0.00 ","$0.00 ","$212.34 ","$1,212.75 ","$0.00 ","$606.38 ","$960.50 ","$970.20 ","$0.00 ","$189.80 ","$0.00 ","$193.07 ","$0.00 "
"121168","SUP","HCPCS C1713","","121168  -  PLATE BN 145D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP","BOTH IP/OP","$1,212.75 ","$897.44 ","$0.00 ","$1,212.75 ","$545.74 ","$0.00 ","$252.77 ","$0.00 ","$0.00 ","$212.34 ","$1,212.75 ","$0.00 ","$606.38 ","$960.50 ","$970.20 ","$0.00 ","$189.80 ","$0.00 ","$193.07 ","$0.00 "
"121169","SUP","HCPCS C1713","","121169  -  PLATE BN 150D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP","BOTH IP/OP","$1,212.75 ","$897.44 ","$0.00 ","$1,212.75 ","$545.74 ","$0.00 ","$252.77 ","$0.00 ","$0.00 ","$212.34 ","$1,212.75 ","$0.00 ","$606.38 ","$960.50 ","$970.20 ","$0.00 ","$189.80 ","$0.00 ","$193.07 ","$0.00 "
"121176","SUP","HCPCS C1713","","121176  -  SCREW BN STD .5IN 9MM 130MM 21MM AMBI CLS IMHS LG","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121177","SUP","HCPCS C1713","","121177  -  SCREW BN 12.7MM 9MM 135MM 21MM IMHS CP STD LG SS HIP IM NL","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121178","SUP","HCPCS C1713","","121178  -  SCREW BN 12.7MM 9MM 140MM 21MM IMHS CP STD LG SS HIP IM NL","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$726.60 ","$326.97 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$127.22 ","$726.60 ","$0.00 ","$363.30 ","$575.47 ","$581.28 ","$0.00 ","$113.71 ","$0.00 ","$115.67 ","$0.00 "
"121181","SUP","HCPCS C1713","","121181  -  SCREW BN 14.3MM 9MM 60MM 21MM SPLG HIP","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121191","SUP","HCPCS C1713","","121191  -  SCREW BN 9/16IN 9MM 110MM 21MM AMBI CLS SPLG","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121192","SUP","HCPCS C1713","","121192  -  SCREW BN 14.3MM 9MM 115MM STRL 21MM AMBI CLS SPLG CMPR SS","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121193","SUP","HCPCS C1713","","121193  -  SCREW BN 14.3MM 9MM 120MM STRL 21MM AMBI CLS SPLG CMPR SS","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121194","SUP","HCPCS C1713","","121194  -  SCREW BN 14.3MM 9MM 125MM STRL 21MM AMBI CLS SPLG CMPR SS","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121195","SUP","HCPCS C1713","","121195  -  SCREW BN 14.3MM 9MM 130MM 21MM CHS SPLG SS HIP","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121196","SUP","HCPCS C1713","","121196  -  SCREW BN 14.3MM 9MM 135MM 21MM CHS SPLG SS HIP","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121197","SUP","HCPCS C1713","","121197  -  SCREW BN 14.3MM 9MM 140MM 21MM CHS SPLG SS HIP","BOTH IP/OP","$774.90 ","$573.43 ","$0.00 ","$774.90 ","$348.71 ","$0.00 ","$161.51 ","$0.00 ","$0.00 ","$135.68 ","$774.90 ","$0.00 ","$387.45 ","$613.72 ","$619.92 ","$0.00 ","$121.27 ","$0.00 ","$123.36 ","$0.00 "
"121198","SUP","HCPCS C1713","","121198  -  PLATE BN 130D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP","BOTH IP/OP","$1,165.50 ","$862.47 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$242.92 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$182.40 ","$0.00 ","$185.55 ","$0.00 "
"121199","SUP","HCPCS C1713","","121199  -  PLATE BN 135D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP","BOTH IP/OP","$1,165.50 ","$862.47 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$242.92 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$182.40 ","$0.00 ","$185.55 ","$0.00 "
"121200","SUP","HCPCS C1713","","121200  -  PLATE BN 140D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP","BOTH IP/OP","$1,165.50 ","$862.47 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$242.92 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$182.40 ","$0.00 ","$185.55 ","$0.00 "
"121201","SUP","HCPCS C1713","","121201  -  PLATE BN 145D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP","BOTH IP/OP","$1,165.50 ","$862.47 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$242.92 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$182.40 ","$0.00 ","$185.55 ","$0.00 "
"121202","SUP","HCPCS C1713","","121202  -  PLATE BN 150D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP","BOTH IP/OP","$1,165.50 ","$862.47 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$242.92 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$182.40 ","$0.00 ","$185.55 ","$0.00 "
"121410","SUP","Custom 27203010","","121410  -  DEVICE BIOP 10CM 14GA MNPTY 22MM INSTR AUTO STRL DISP","BOTH IP/OP","$176.32 ","$130.48 ","$0.00 ","$176.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.32 ","$0.00 ","$88.16 ","$139.65 ","$141.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121625","SUP","HCPCS C1713","","121625  -  SCREW BN 6.5MM 25MM STRL 16MM IMSC CNN SS SP CNDL","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121626","SUP","HCPCS C1713","","121626  -  SCREW BN UNV 6.5MM 30MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121627","SUP","HCPCS C1713","","121627  -  SCREW BN UNV 6.5MM 35MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121628","SUP","HCPCS C1713","","121628  -  SCREW BN UNV 6.5MM 40MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121629","SUP","HCPCS C1713","","121629  -  SCREW BN UNV 6.5MM 45MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121630","SUP","HCPCS C1713","","121630  -  SCREW BN UNV 6.5MM 50MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121631","SUP","HCPCS C1713","","121631  -  SCREW BN UNV 6.5MM 55MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121632","SUP","HCPCS C1713","","121632  -  SCREW BN UNV 6.5MM 60MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121633","SUP","HCPCS C1713","","121633  -  SCREW BN UNV 6.5MM 65MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121634","SUP","HCPCS C1713","","121634  -  SCREW BN UNV 6.5MM 70MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121635","SUP","HCPCS C1713","","121635  -  SCREW BN UNV 6.5MM 75MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121636","SUP","HCPCS C1713","","121636  -  SCREW BN P/T 6.5MM 4.5MM 80MM STRL 20MM CNN SS HIP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121637","SUP","HCPCS C1713","","121637  -  SCREW BN UNV 6.5MM 85MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121638","SUP","HCPCS C1713","","121638  -  SCREW BN 6.5MM 90MM CNN MTPHSL","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121639","SUP","HCPCS C1713","","121639  -  SCREW BN UNV 6.5MM 95MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121640","SUP","HCPCS C1713","","121640  -  SCREW BN 6.5MM 100MM CNN SP CNDL","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121641","SUP","HCPCS C1713","","121641  -  SCREW BN UNV 6.5MM 105MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121642","SUP","HCPCS C1713","","121642  -  SCREW BN UNV 6.5MM 110MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121643","SUP","HCPCS C1713","","121643  -  SCREW BN UNV 6.5MM 115MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121644","SUP","HCPCS C1713","","121644  -  SCREW BN UNV 6.5MM 120MM STRL 20MM IMSC CNN CMPR SS HIP SP","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"121654","SUP","HCPCS C1713","","121654  -  PIN FX 30MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121655","SUP","HCPCS C1713","","121655  -  PIN FX 35MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121656","SUP","HCPCS C1713","","121656  -  PIN FX 40MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121657","SUP","HCPCS C1713","","121657  -  PIN FX 45MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121658","SUP","HCPCS C1713","","121658  -  PIN FX 50MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121659","SUP","HCPCS C1713","","121659  -  PIN FX 55MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121660","SUP","HCPCS C1713","","121660  -  PIN FX 60MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121661","SUP","HCPCS C1713","","121661  -  PIN FX 65MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121662","SUP","HCPCS C1713","","121662  -  PIN FX 6.35MM 70MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121663","SUP","HCPCS C1713","","121663  -  PIN FX 75MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121664","SUP","HCPCS C1713","","121664  -  PIN FX 6.35MM 80MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121665","SUP","HCPCS C1713","","121665  -  PIN FX 6.35MM 85MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121666","SUP","HCPCS C1713","","121666  -  PIN FX 6.35MM 90MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121667","SUP","HCPCS C1713","","121667  -  PIN FX 6.35MM 95MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121668","SUP","HCPCS C1713","","121668  -  PIN FX 6.35MM 100MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121669","SUP","HCPCS C1713","","121669  -  PIN FX 105MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121670","SUP","HCPCS C1713","","121670  -  PIN FX 6.35MM 110MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121671","SUP","HCPCS C1713","","121671  -  PIN FX 6.35MM 115MM 16MM CNN HIP","BOTH IP/OP","$700.35 ","$518.26 ","$0.00 ","$700.35 ","$315.16 ","$0.00 ","$145.97 ","$0.00 ","$0.00 ","$122.63 ","$700.35 ","$0.00 ","$350.18 ","$554.68 ","$560.28 ","$0.00 ","$109.60 ","$0.00 ","$111.50 ","$0.00 "
"121672","SUP","HCPCS C1713","","121672  -  PIN FX 6.86MM 115MM STRL 16MM CNN HEX HD SS HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121673","SUP","HCPCS C1713","","121673  -  PIN FX 125MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121674","SUP","HCPCS C1713","","121674  -  PIN FX 130MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121675","SUP","HCPCS C1713","","121675  -  PIN FX 135MM CNN HIP","BOTH IP/OP","$761.25 ","$563.33 ","$0.00 ","$761.25 ","$342.56 ","$0.00 ","$158.66 ","$0.00 ","$0.00 ","$133.29 ","$761.25 ","$0.00 ","$380.63 ","$602.91 ","$609.00 ","$0.00 ","$119.14 ","$0.00 ","$121.19 ","$0.00 "
"121680","SUP","HCPCS C1713","","121680  -  WASHER ORTH UNV 12.7MM 6.5MM 1MM STRL SET SS 6.5MM CNN SCR","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$71.10 ","$0.00 ","$32.93 ","$0.00 ","$0.00 ","$27.66 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$24.73 ","$0.00 ","$25.15 ","$0.00 "
"121810","SUP","HCPCS C1713","","121810  -  SCREW BN 2.5MM FLUT 4MM 6MM 10MM STRL 5MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121812","SUP","HCPCS C1713","","121812  -  SCREW BN 2.5MM FLUT 4MM 6MM 12MM STRL 5MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121814","SUP","HCPCS C1713","","121814  -  SCREW BN 2.5MM FLUT 4MM 6MM 14MM STRL 5MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121816","SUP","HCPCS C1713","","121816  -  SCREW BN 2.5MM FLUT 4MM 6MM 16MM STRL 6MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121818","SUP","HCPCS C1713","","121818  -  SCREW BN 2.5MM FLUT 4MM 6MM 18MM STRL 7MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121820","SUP","HCPCS C1713","","121820  -  SCREW BN 2.5MM FLUT 4MM 6MM 20MM STRL 8MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121822","SUP","HCPCS C1713","","121822  -  SCREW BN 2.5MM FLUT 4MM 6MM 22MM STRL 9MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121824","SUP","HCPCS C1713","","121824  -  SCREW BN 2.5MM FLUT 4MM 6MM 24MM STRL 10MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121826","SUP","HCPCS C1713","","121826  -  SCREW BN 2.5MM FLUT 4MM 6MM 26MM STRL 12MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121828","SUP","HCPCS C1713","","121828  -  SCREW BN 2.5MM FLUT 4MM 6MM 28MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121830","SUP","HCPCS C1713","","121830  -  SCREW BN 2.5MM FLUT 4MM 6MM 30MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121832","SUP","HCPCS C1713","","121832  -  SCREW BN 2.5MM FLUT 4MM 6MM 32MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121834","SUP","HCPCS C1713","","121834  -  SCREW BN 2.5MM FLUT 4MM 6MM 34MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121836","SUP","HCPCS C1713","","121836  -  SCREW BN 2.5MM FLUT 4MM 6MM 36MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121838","SUP","HCPCS C1713","","121838  -  SCREW BN 2.5MM FLUT 4MM 6MM 38MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121840","SUP","HCPCS C1713","","121840  -  SCREW BN 2.5MM FLUT 4MM 6MM 40MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121842","SUP","HCPCS C1713","","121842  -  SCREW BN 2.5MM FLUT 4MM 6MM 42MM STRL 14MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121844","SUP","HCPCS C1713","","121844  -  SCREW BN P/T 4MM 6MM 1.3MM 44MM STRL 2.9MM CNN ST SLF DRL","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121846","SUP","HCPCS C1713","","121846  -  SCREW BN 2.5MM FLUT 4MM 6MM 46MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121848","SUP","HCPCS C1713","","121848  -  SCREW BN 2.5MM FLUT P/T 4MM 6MM 48MM STRL 15MM PRLC ST CNN","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121850","SUP","HCPCS C1713","","121850  -  SCREW BN 2.5MM FLUT 4MM 6MM 50MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121852","SUP","HCPCS C1713","","121852  -  SCREW BN 2.5MM FLUT 4MM 6MM 52MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121854","SUP","HCPCS C1713","","121854  -  SCREW BN 2.5MM FLUT 4MM 6MM 54MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$316.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.71 ","$0.00 ","$80.86 ","$316.01 ","$129.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"121856","SUP","HCPCS C1713","","121856  -  SCREW BN 2.5MM FLUT 4MM 6MM 56MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121858","SUP","HCPCS C1713","","121858  -  SCREW BN 2.5MM FLUT 4MM 6MM 58MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121860","SUP","HCPCS C1713","","121860  -  SCREW BN 2.5MM FLUT 4MM 6MM 60MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121865","SUP","HCPCS C1713","","121865  -  SCREW BN 2.5MM FLUT 4MM 6MM 65MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121870","SUP","HCPCS C1713","","121870  -  SCREW BN 2.5MM FLUT 4MM 6MM 70MM STRL 15MM PRLC ST CNN TROC","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"121905","SUP","HCPCS C1713","","121905  -  NAIL IM 8MM 32CM RUS-TYLR DLT SS FEM","BOTH IP/OP","$1,704.38 ","$1,261.24 ","$0.00 ","$1,704.38 ","$766.97 ","$0.00 ","$355.23 ","$0.00 ","$0.00 ","$298.42 ","$1,704.38 ","$0.00 ","$852.19 ","$1,349.87 ","$1,363.50 ","$0.00 ","$266.73 ","$0.00 ","$271.34 ","$0.00 "
"121906","SUP","HCPCS C1713","","121906  -  NAIL IM 8MM 34CM RUS-TYLR DLT II FEM","BOTH IP/OP","$1,704.38 ","$1,261.24 ","$0.00 ","$1,704.38 ","$766.97 ","$0.00 ","$355.23 ","$0.00 ","$0.00 ","$298.42 ","$1,704.38 ","$0.00 ","$852.19 ","$1,349.87 ","$1,363.50 ","$0.00 ","$266.73 ","$0.00 ","$271.34 ","$0.00 "
"121907","SUP","HCPCS C1713","","121907  -  NAIL IM 8MM 36CM RUS-TYLR DLT II FEM","BOTH IP/OP","$1,704.38 ","$1,261.24 ","$0.00 ","$1,704.38 ","$766.97 ","$0.00 ","$355.23 ","$0.00 ","$0.00 ","$298.42 ","$1,704.38 ","$0.00 ","$852.19 ","$1,349.87 ","$1,363.50 ","$0.00 ","$266.73 ","$0.00 ","$271.34 ","$0.00 "
"122034","SUP","HCPCS C1713","","122034  -  NAIL IM 11MM 44CM RUS-TYLR DLT SS FEM","BOTH IP/OP","$1,563.75 ","$1,157.18 ","$0.00 ","$1,563.75 ","$703.69 ","$0.00 ","$325.92 ","$0.00 ","$0.00 ","$273.80 ","$1,563.75 ","$0.00 ","$781.88 ","$1,238.49 ","$1,251.00 ","$0.00 ","$244.73 ","$0.00 ","$248.95 ","$0.00 "
"122153","SUP","HCPCS C1713","","122153  -  NAIL IM 15MM 42CM RUS-TYLR INTLK SS FEM","BOTH IP/OP","$2,711.25 ","$2,006.33 ","$0.00 ","$2,711.25 ","$1,220.06 ","$0.00 ","$565.09 ","$0.00 ","$0.00 ","$474.72 ","$2,711.25 ","$0.00 ","$1,355.63 ","$2,147.31 ","$2,169.00 ","$0.00 ","$424.31 ","$0.00 ","$431.63 ","$0.00 "
"122159","SUP","HCPCS C1713","","122159  -  NAIL IM 16MM 40CM RUS-TYLR INTLK SS FEM","BOTH IP/OP","$2,711.25 ","$2,006.33 ","$0.00 ","$2,711.25 ","$1,220.06 ","$0.00 ","$565.09 ","$0.00 ","$0.00 ","$474.72 ","$2,711.25 ","$0.00 ","$1,355.63 ","$2,147.31 ","$2,169.00 ","$0.00 ","$424.31 ","$0.00 ","$431.63 ","$0.00 "
"122202","SUP","HCPCS C1713","","122202  -  NAIL IM 13MM 36CM RUS-TYLR INTLK SS TIB","BOTH IP/OP","$3,150.00 ","$2,331.00 ","$0.00 ","$3,150.00 ","$1,417.50 ","$0.00 ","$656.54 ","$0.00 ","$0.00 ","$551.54 ","$3,150.00 ","$0.00 ","$1,575.00 ","$2,494.80 ","$2,520.00 ","$0.00 ","$492.98 ","$0.00 ","$501.48 ","$0.00 "
"122341","SUP","HCPCS C1713","","122341  -  NAIL IM 10MM 38CM RUS-TYLR DLT INTLK RECON SS FEM RT","BOTH IP/OP","$8,375.63 ","$6,197.97 ","$0.00 ","$8,375.63 ","$3,769.03 ","$0.00 ","$1,745.69 ","$0.00 ","$0.00 ","$1,466.50 ","$8,375.63 ","$0.00 ","$4,187.81 ","$6,633.50 ","$6,700.50 ","$0.00 ","$1,310.79 ","$0.00 ","$1,333.40 ","$0.00 "
"122466","SUP","HCPCS C1713","","122466  -  NAIL IM 8MM 30CM RUS-TYLR INTLK SS HUM","BOTH IP/OP","$6,519.38 ","$4,824.34 ","$0.00 ","$6,519.38 ","$2,933.72 ","$0.00 ","$1,358.80 ","$0.00 ","$0.00 ","$1,141.49 ","$6,519.38 ","$0.00 ","$3,259.69 ","$5,163.35 ","$5,215.50 ","$0.00 ","$1,020.28 ","$0.00 ","$1,037.88 ","$0.00 "
"122670","SUP","HCPCS C1713","","122670  -  CAP END RECON FEM","BOTH IP/OP","$70.10 ","$51.87 ","$0.00 ","$70.10 ","$31.55 ","$0.00 ","$14.61 ","$0.00 ","$0.00 ","$12.27 ","$70.10 ","$0.00 ","$35.05 ","$55.52 ","$56.08 ","$0.00 ","$10.97 ","$0.00 ","$11.16 ","$0.00 "
"122671","SUP","HCPCS C1713","","122671  -  CAP END RUS-TYLR RUS-TYLR RECON NL","BOTH IP/OP","$66.83 ","$49.45 ","$0.00 ","$66.83 ","$30.07 ","$0.00 ","$13.93 ","$0.00 ","$0.00 ","$11.70 ","$66.83 ","$0.00 ","$33.41 ","$52.93 ","$53.46 ","$0.00 ","$10.46 ","$0.00 ","$10.64 ","$0.00 "
"122700","SUP","HCPCS C1713","","122700  -  PIN HLF UNV 4MM 20MM 20MM HXFX RN HNG KT CMPS TI ORTH XTRNFX","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122701","SUP","HCPCS C1713","","122701  -  PIN HLF 4MM 25MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122703","SUP","HCPCS C1713","","122703  -  PIN HLF 4MM 35MM HXFX TI ORTH","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122704","SUP","HCPCS C1713","","122704  -  PIN HLF 4MM 40MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122705","SUP","HCPCS C1713","","122705  -  PIN HLF 4MM 45MM HXFX TI ORTH","BOTH IP/OP","$469.20 ","$347.21 ","$0.00 ","$469.20 ","$211.14 ","$0.00 ","$97.79 ","$0.00 ","$0.00 ","$82.15 ","$469.20 ","$0.00 ","$234.60 ","$371.61 ","$375.36 ","$0.00 ","$73.43 ","$0.00 ","$74.70 ","$0.00 "
"122706","SUP","HCPCS C1713","","122706  -  PIN HLF 4MM 50MM HXFX TI","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$252.45 ","$0.00 ","$116.93 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$87.80 ","$0.00 ","$89.31 ","$0.00 "
"122707","SUP","HCPCS C1713","","122707  -  PIN HLF P/T 5MM 20MM HXFX SET TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122708","SUP","HCPCS C1713","","122708  -  PIN HLF P/T 5MM 25MM 25MM HXFX TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122709","SUP","HCPCS C1713","","122709  -  PIN HLF P/T 5MM 30MM HXFX TI","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122710","SUP","HCPCS C1713","","122710  -  PIN HLF P/T 5MM 35MM HXFX TI XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122711","SUP","HCPCS C1713","","122711  -  PIN HLF P/T 5MM 40MM HXFX TI XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122712","SUP","HCPCS C1713","","122712  -  PIN HLF 5MM 45MM HXFX RN TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122714","SUP","HCPCS C1713","","122714  -  PIN HLF 5MM 55MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122715","SUP","HCPCS C1713","","122715  -  PIN HLF 5MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122716","SUP","HCPCS C1713","","122716  -  PIN HLF 5MM 65MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$533.80 ","$395.01 ","$0.00 ","$533.80 ","$240.21 ","$0.00 ","$111.26 ","$0.00 ","$0.00 ","$93.46 ","$533.80 ","$0.00 ","$266.90 ","$422.77 ","$427.04 ","$0.00 ","$83.54 ","$0.00 ","$84.98 ","$0.00 "
"122717","SUP","HCPCS C1713","","122717  -  PIN HLF 5MM 70MM HXFX TI ORTH","BOTH IP/OP","$394.40 ","$291.86 ","$0.00 ","$394.40 ","$177.48 ","$0.00 ","$82.20 ","$0.00 ","$0.00 ","$69.06 ","$394.40 ","$0.00 ","$197.20 ","$312.36 ","$315.52 ","$0.00 ","$61.72 ","$0.00 ","$62.79 ","$0.00 "
"122718","SUP","HCPCS C1713","","122718  -  PIN HLF 5MM 75MM HXFX TI ORTH","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$252.45 ","$0.00 ","$116.93 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$87.80 ","$0.00 ","$89.31 ","$0.00 "
"122719","SUP","HCPCS C1713","","122719  -  PIN HLF 5MM 80MM HXFX TI","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$252.45 ","$0.00 ","$116.93 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$87.80 ","$0.00 ","$89.31 ","$0.00 "
"122720","SUP","HCPCS C1713","","122720  -  PIN HLF 5MM 85MM HXFX TI ORTH","BOTH IP/OP","$472.60 ","$349.72 ","$0.00 ","$472.60 ","$212.67 ","$0.00 ","$98.50 ","$0.00 ","$0.00 ","$82.75 ","$472.60 ","$0.00 ","$236.30 ","$374.30 ","$378.08 ","$0.00 ","$73.96 ","$0.00 ","$75.24 ","$0.00 "
"122721","SUP","HCPCS C1713","","122721  -  PIN HLF 5MM 90MM HXFX TI ORTH","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$252.45 ","$0.00 ","$116.93 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$87.80 ","$0.00 ","$89.31 ","$0.00 "
"122725","SUP","HCPCS C1713","","122725  -  PIN HLF 6MM 40MM 40MM HXFX RN UNLAT THRD TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122727","SUP","HCPCS C1713","","122727  -  PIN HLF 6MM 50MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122729","SUP","HCPCS C1713","","122729  -  PIN HLF 6MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS","BOTH IP/OP","$780.30 ","$577.42 ","$0.00 ","$780.30 ","$351.14 ","$0.00 ","$162.63 ","$0.00 ","$0.00 ","$136.62 ","$780.30 ","$0.00 ","$390.15 ","$618.00 ","$624.24 ","$0.00 ","$122.12 ","$0.00 ","$124.22 ","$0.00 "
"122733","SUP","HCPCS C1713","","122733  -  PIN HLF 6MM 80MM HXFX TI","BOTH IP/OP","$472.60 ","$349.72 ","$0.00 ","$472.60 ","$212.67 ","$0.00 ","$98.50 ","$0.00 ","$0.00 ","$82.75 ","$472.60 ","$0.00 ","$236.30 ","$374.30 ","$378.08 ","$0.00 ","$73.96 ","$0.00 ","$75.24 ","$0.00 "
"122735","SUP","HCPCS C1713","","122735  -  PIN FX HLF 6MM 90MM","BOTH IP/OP","$561.00 ","$415.14 ","$0.00 ","$561.00 ","$252.45 ","$0.00 ","$116.93 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$87.80 ","$0.00 ","$89.31 ","$0.00 "
"122741","SUP","HCPCS C1713","","122741  -  PIN HLF 4MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"122742","SUP","HCPCS C1713","","122742  -  PIN HLF 4MM 30MM HXFX SS ORTH","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$282.20 ","$126.99 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$49.41 ","$282.20 ","$0.00 ","$141.10 ","$223.50 ","$225.76 ","$0.00 ","$44.16 ","$0.00 ","$44.93 ","$0.00 "
"122743","SUP","HCPCS C1713","","122743  -  PIN HLF 4MM 35MM HXFX SS ORTH","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$282.20 ","$126.99 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$49.41 ","$282.20 ","$0.00 ","$141.10 ","$223.50 ","$225.76 ","$0.00 ","$44.16 ","$0.00 ","$44.93 ","$0.00 "
"122744","SUP","HCPCS C1713","","122744  -  PIN HLF 4MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"122745","SUP","HCPCS C1713","","122745  -  PIN HLF 4MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"122746","SUP","HCPCS C1713","","122746  -  PIN HLF 4MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"122747","SUP","HCPCS C1713","","122747  -  PIN HLF 5MM 20MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122748","SUP","HCPCS C1713","","122748  -  PIN HLF 5MM 25MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122749","SUP","HCPCS C1713","","122749  -  PIN HLF 5MM 30MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122750","SUP","HCPCS C1713","","122750  -  PIN HLF 5MM 35MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122751","SUP","HCPCS C1713","","122751  -  PIN HLF 5MM 40MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122752","SUP","HCPCS C1713","","122752  -  PIN HLF 5MM 45MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122753","SUP","HCPCS C1713","","122753  -  PIN HLF 5MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122754","SUP","HCPCS C1713","","122754  -  PIN HLF 5MM 55MM HXFX SS ORTH","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$153.00 ","$0.00 ","$70.86 ","$0.00 ","$0.00 ","$59.53 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$53.21 ","$0.00 ","$54.13 ","$0.00 "
"122755","SUP","HCPCS C1713","","122755  -  PIN HLF 5MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$209.10 ","$154.73 ","$0.00 ","$209.10 ","$94.10 ","$0.00 ","$43.58 ","$0.00 ","$0.00 ","$36.61 ","$209.10 ","$0.00 ","$104.55 ","$165.61 ","$167.28 ","$0.00 ","$32.72 ","$0.00 ","$33.29 ","$0.00 "
"122756","SUP","HCPCS C1713","","122756  -  PIN HLF 5MM 65MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"122757","SUP","HCPCS C1713","","122757  -  PIN HLF 5MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$209.10 ","$154.73 ","$0.00 ","$209.10 ","$94.10 ","$0.00 ","$43.58 ","$0.00 ","$0.00 ","$36.61 ","$209.10 ","$0.00 ","$104.55 ","$165.61 ","$167.28 ","$0.00 ","$32.72 ","$0.00 ","$33.29 ","$0.00 "
"122758","SUP","HCPCS C1713","","122758  -  PIN HLF 5MM 75MM HXFX SS ORTH","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$153.00 ","$0.00 ","$70.86 ","$0.00 ","$0.00 ","$59.53 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$53.21 ","$0.00 ","$54.13 ","$0.00 "
"122759","SUP","HCPCS C1713","","122759  -  PIN HLF 5MM 80MM HXFX SS ORTH","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$153.00 ","$0.00 ","$70.86 ","$0.00 ","$0.00 ","$59.53 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$53.21 ","$0.00 ","$54.13 ","$0.00 "
"122760","SUP","HCPCS C1713","","122760  -  PIN HLF 5MM 85MM HXFX SS ORTH","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$153.00 ","$0.00 ","$70.86 ","$0.00 ","$0.00 ","$59.53 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$53.21 ","$0.00 ","$54.13 ","$0.00 "
"122761","SUP","HCPCS C1713","","122761  -  PIN HLF 5MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$209.10 ","$154.73 ","$0.00 ","$209.10 ","$94.10 ","$0.00 ","$43.58 ","$0.00 ","$0.00 ","$36.61 ","$209.10 ","$0.00 ","$104.55 ","$165.61 ","$167.28 ","$0.00 ","$32.72 ","$0.00 ","$33.29 ","$0.00 "
"122765","SUP","HCPCS C1713","","122765  -  PIN HLF 6MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122767","SUP","HCPCS C1713","","122767  -  PIN HLF 6MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122769","SUP","HCPCS C1713","","122769  -  PIN HLF 6MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$567.80 ","$420.17 ","$0.00 ","$567.80 ","$255.51 ","$0.00 ","$118.34 ","$0.00 ","$0.00 ","$99.42 ","$567.80 ","$0.00 ","$283.90 ","$449.70 ","$454.24 ","$0.00 ","$88.86 ","$0.00 ","$90.39 ","$0.00 "
"122771","SUP","HCPCS C1713","","122771  -  PIN HLF 6MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"122773","SUP","HCPCS C1713","","122773  -  PIN HLF 6MM 80MM HXFX SS ORTH","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$282.20 ","$126.99 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$49.41 ","$282.20 ","$0.00 ","$141.10 ","$223.50 ","$225.76 ","$0.00 ","$44.16 ","$0.00 ","$44.93 ","$0.00 "
"122775","SUP","HCPCS C1713","","122775  -  PIN HLF 6MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS","BOTH IP/OP","$499.80 ","$369.85 ","$0.00 ","$499.80 ","$224.91 ","$0.00 ","$104.17 ","$0.00 ","$0.00 ","$87.51 ","$499.80 ","$0.00 ","$249.90 ","$395.84 ","$399.84 ","$0.00 ","$78.22 ","$0.00 ","$79.57 ","$0.00 "
"124120","SUP","HCPCS C1713","","124120  -  PLATE BN 130D STD BRL 60MM 38.1MM CLS CHS 2 HL SS HIP","BOTH IP/OP","$1,107.75 ","$819.74 ","$0.00 ","$1,107.75 ","$498.49 ","$0.00 ","$230.88 ","$0.00 ","$0.00 ","$193.96 ","$1,107.75 ","$0.00 ","$553.88 ","$877.34 ","$886.20 ","$0.00 ","$173.36 ","$0.00 ","$176.35 ","$0.00 "
"124121","SUP","HCPCS C1713","","124121  -  PLATE BN 135D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP","BOTH IP/OP","$1,107.75 ","$819.74 ","$0.00 ","$1,107.75 ","$498.49 ","$0.00 ","$230.88 ","$0.00 ","$0.00 ","$193.96 ","$1,107.75 ","$0.00 ","$553.88 ","$877.34 ","$886.20 ","$0.00 ","$173.36 ","$0.00 ","$176.35 ","$0.00 "
"124122","SUP","HCPCS C1713","","124122  -  PLATE BN 140D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP","BOTH IP/OP","$1,107.75 ","$819.74 ","$0.00 ","$1,107.75 ","$498.49 ","$0.00 ","$230.88 ","$0.00 ","$0.00 ","$193.96 ","$1,107.75 ","$0.00 ","$553.88 ","$877.34 ","$886.20 ","$0.00 ","$173.36 ","$0.00 ","$176.35 ","$0.00 "
"124123","SUP","HCPCS C1713","","124123  -  PLATE BN 145D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP","BOTH IP/OP","$1,107.75 ","$819.74 ","$0.00 ","$1,107.75 ","$498.49 ","$0.00 ","$230.88 ","$0.00 ","$0.00 ","$193.96 ","$1,107.75 ","$0.00 ","$553.88 ","$877.34 ","$886.20 ","$0.00 ","$173.36 ","$0.00 ","$176.35 ","$0.00 "
"124124","SUP","HCPCS C1713","","124124  -  PLATE BN 150D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP","BOTH IP/OP","$1,107.75 ","$819.74 ","$0.00 ","$1,107.75 ","$498.49 ","$0.00 ","$230.88 ","$0.00 ","$0.00 ","$193.96 ","$1,107.75 ","$0.00 ","$553.88 ","$877.34 ","$886.20 ","$0.00 ","$173.36 ","$0.00 ","$176.35 ","$0.00 "
"124125","SUP","HCPCS C1713","","124125  -  PLATE BN 130D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124126","SUP","HCPCS C1713","","124126  -  PLATE BN 135D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124127","SUP","HCPCS C1713","","124127  -  PLATE BN 140D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124128","SUP","HCPCS C1713","","124128  -  PLATE BN 145D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124129","SUP","HCPCS C1713","","124129  -  PLATE BN 150D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124130","SUP","HCPCS C1713","","124130  -  PLATE BN 130D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124131","SUP","HCPCS C1713","","124131  -  PLATE BN 135D STD BRL 100MM 1.5MM CLS 4 HL HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124132","SUP","HCPCS C1713","","124132  -  PLATE BN 140D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124133","SUP","HCPCS C1713","","124133  -  PLATE BN 145D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124134","SUP","HCPCS C1713","","124134  -  PLATE BN 150D STD BRL 100MM 38.1MM CLS CHS 4 HL SS HIP","BOTH IP/OP","$1,144.50 ","$846.93 ","$0.00 ","$1,144.50 ","$515.03 ","$0.00 ","$238.54 ","$0.00 ","$0.00 ","$200.39 ","$1,144.50 ","$0.00 ","$572.25 ","$906.44 ","$915.60 ","$0.00 ","$179.11 ","$0.00 ","$182.20 ","$0.00 "
"124135","SUP","HCPCS C1713","","124135  -  PLATE BN 130D STD BRL 120MM 38.1MM CLS CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,223.25 ","$905.21 ","$0.00 ","$1,223.25 ","$550.46 ","$0.00 ","$254.96 ","$0.00 ","$0.00 ","$214.18 ","$1,223.25 ","$0.00 ","$611.63 ","$968.81 ","$978.60 ","$0.00 ","$191.44 ","$0.00 ","$194.74 ","$0.00 "
"124136","SUP","HCPCS C1713","","124136  -  PLATE BN 135D STD BRL 120MM 1.5MM CLS 5 HL HIP","BOTH IP/OP","$1,223.25 ","$905.21 ","$0.00 ","$1,223.25 ","$550.46 ","$0.00 ","$254.96 ","$0.00 ","$0.00 ","$214.18 ","$1,223.25 ","$0.00 ","$611.63 ","$968.81 ","$978.60 ","$0.00 ","$191.44 ","$0.00 ","$194.74 ","$0.00 "
"124137","SUP","HCPCS C1713","","124137  -  PLATE BN 140D STD BRL 120MM 38.1MM CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,223.25 ","$905.21 ","$0.00 ","$1,223.25 ","$550.46 ","$0.00 ","$254.96 ","$0.00 ","$0.00 ","$214.18 ","$1,223.25 ","$0.00 ","$611.63 ","$968.81 ","$978.60 ","$0.00 ","$191.44 ","$0.00 ","$194.74 ","$0.00 "
"124138","SUP","HCPCS C1713","","124138  -  PLATE BN 145D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP","BOTH IP/OP","$1,223.25 ","$905.21 ","$0.00 ","$1,223.25 ","$550.46 ","$0.00 ","$254.96 ","$0.00 ","$0.00 ","$214.18 ","$1,223.25 ","$0.00 ","$611.63 ","$968.81 ","$978.60 ","$0.00 ","$191.44 ","$0.00 ","$194.74 ","$0.00 "
"124139","SUP","HCPCS C1713","","124139  -  PLATE BN 150D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP","BOTH IP/OP","$1,223.25 ","$905.21 ","$0.00 ","$1,223.25 ","$550.46 ","$0.00 ","$254.96 ","$0.00 ","$0.00 ","$214.18 ","$1,223.25 ","$0.00 ","$611.63 ","$968.81 ","$978.60 ","$0.00 ","$191.44 ","$0.00 ","$194.74 ","$0.00 "
"124140","SUP","HCPCS C1713","","124140  -  PLATE BN 130D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"124141","SUP","HCPCS C1713","","124141  -  PLATE BN 135D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"124142","SUP","HCPCS C1713","","124142  -  PLATE BN 140D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"124143","SUP","HCPCS C1713","","124143  -  PLATE BN 145D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"124144","SUP","HCPCS C1713","","124144  -  PLATE BN 150D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"124145","SUP","HCPCS C1713","","124145  -  PLATE BN 130D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP","BOTH IP/OP","$1,554.00 ","$1,149.96 ","$0.00 ","$1,554.00 ","$699.30 ","$0.00 ","$323.89 ","$0.00 ","$0.00 ","$272.09 ","$1,554.00 ","$0.00 ","$777.00 ","$1,230.77 ","$1,243.20 ","$0.00 ","$243.20 ","$0.00 ","$247.40 ","$0.00 "
"124146","SUP","HCPCS C1713","","124146  -  PLATE BN 135D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP","BOTH IP/OP","$1,554.00 ","$1,149.96 ","$0.00 ","$1,554.00 ","$699.30 ","$0.00 ","$323.89 ","$0.00 ","$0.00 ","$272.09 ","$1,554.00 ","$0.00 ","$777.00 ","$1,230.77 ","$1,243.20 ","$0.00 ","$243.20 ","$0.00 ","$247.40 ","$0.00 "
"124147","SUP","HCPCS C1713","","124147  -  PLATE BN 140D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP","BOTH IP/OP","$1,554.00 ","$1,149.96 ","$0.00 ","$1,554.00 ","$699.30 ","$0.00 ","$323.89 ","$0.00 ","$0.00 ","$272.09 ","$1,554.00 ","$0.00 ","$777.00 ","$1,230.77 ","$1,243.20 ","$0.00 ","$243.20 ","$0.00 ","$247.40 ","$0.00 "
"124148","SUP","HCPCS C1713","","124148  -  PLATE BN 145D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP","BOTH IP/OP","$1,554.00 ","$1,149.96 ","$0.00 ","$1,554.00 ","$699.30 ","$0.00 ","$323.89 ","$0.00 ","$0.00 ","$272.09 ","$1,554.00 ","$0.00 ","$777.00 ","$1,230.77 ","$1,243.20 ","$0.00 ","$243.20 ","$0.00 ","$247.40 ","$0.00 "
"124149","SUP","HCPCS C1713","","124149  -  PLATE BN 150D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP","BOTH IP/OP","$1,554.00 ","$1,149.96 ","$0.00 ","$1,554.00 ","$699.30 ","$0.00 ","$323.89 ","$0.00 ","$0.00 ","$272.09 ","$1,554.00 ","$0.00 ","$777.00 ","$1,230.77 ","$1,243.20 ","$0.00 ","$243.20 ","$0.00 ","$247.40 ","$0.00 "
"124150","SUP","HCPCS C1713","","124150  -  PLATE BN 130D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP","BOTH IP/OP","$1,811.25 ","$1,340.33 ","$0.00 ","$1,811.25 ","$815.06 ","$0.00 ","$377.51 ","$0.00 ","$0.00 ","$317.14 ","$1,811.25 ","$0.00 ","$905.63 ","$1,434.51 ","$1,449.00 ","$0.00 ","$283.46 ","$0.00 ","$288.35 ","$0.00 "
"124151","SUP","HCPCS C1713","","124151  -  PLATE BN 135D STD BRL 220MM 38.1MM CHS 10 HL SS HIP","BOTH IP/OP","$1,811.25 ","$1,340.33 ","$0.00 ","$1,811.25 ","$815.06 ","$0.00 ","$377.51 ","$0.00 ","$0.00 ","$317.14 ","$1,811.25 ","$0.00 ","$905.63 ","$1,434.51 ","$1,449.00 ","$0.00 ","$283.46 ","$0.00 ","$288.35 ","$0.00 "
"124152","SUP","HCPCS C1713","","124152  -  PLATE BN 140D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP","BOTH IP/OP","$1,811.25 ","$1,340.33 ","$0.00 ","$1,811.25 ","$815.06 ","$0.00 ","$377.51 ","$0.00 ","$0.00 ","$317.14 ","$1,811.25 ","$0.00 ","$905.63 ","$1,434.51 ","$1,449.00 ","$0.00 ","$283.46 ","$0.00 ","$288.35 ","$0.00 "
"124153","SUP","HCPCS C1713","","124153  -  PLATE BN 145D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP","BOTH IP/OP","$1,811.25 ","$1,340.33 ","$0.00 ","$1,811.25 ","$815.06 ","$0.00 ","$377.51 ","$0.00 ","$0.00 ","$317.14 ","$1,811.25 ","$0.00 ","$905.63 ","$1,434.51 ","$1,449.00 ","$0.00 ","$283.46 ","$0.00 ","$288.35 ","$0.00 "
"124154","SUP","HCPCS C1713","","124154  -  PLATE BN 150D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP","BOTH IP/OP","$1,811.25 ","$1,340.33 ","$0.00 ","$1,811.25 ","$815.06 ","$0.00 ","$377.51 ","$0.00 ","$0.00 ","$317.14 ","$1,811.25 ","$0.00 ","$905.63 ","$1,434.51 ","$1,449.00 ","$0.00 ","$283.46 ","$0.00 ","$288.35 ","$0.00 "
"124156","SUP","HCPCS C1713","","124156  -  PLATE BN 135D STD BRL 260MM 38.1MM CLS CHS 12 HL CMPR HIP","BOTH IP/OP","$1,937.25 ","$1,433.57 ","$0.00 ","$1,937.25 ","$871.76 ","$0.00 ","$403.77 ","$0.00 ","$0.00 ","$339.20 ","$1,937.25 ","$0.00 ","$968.63 ","$1,534.30 ","$1,549.80 ","$0.00 ","$303.18 ","$0.00 ","$308.41 ","$0.00 "
"124158","SUP","HCPCS C1713","","124158  -  PLATE BN 145D STD BRL 260MM 38.1MM CLS CHS 12 HL SS HIP","BOTH IP/OP","$1,937.25 ","$1,433.57 ","$0.00 ","$1,937.25 ","$871.76 ","$0.00 ","$403.77 ","$0.00 ","$0.00 ","$339.20 ","$1,937.25 ","$0.00 ","$968.63 ","$1,534.30 ","$1,549.80 ","$0.00 ","$303.18 ","$0.00 ","$308.41 ","$0.00 "
"124161","SUP","HCPCS C1713","","124161  -  PLATE BN 135D STD BRL 300MM 38.1MM CLS CHS 14 HL CMPR HIP","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$1,032.41 ","$0.00 ","$478.18 ","$0.00 ","$0.00 ","$401.70 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$359.05 ","$0.00 ","$365.24 ","$0.00 "
"124162","SUP","HCPCS C1713","","124162  -  PLATE BN 140D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP","BOTH IP/OP","$2,160.00 ","$1,598.40 ","$0.00 ","$2,160.00 ","$972.00 ","$0.00 ","$450.20 ","$0.00 ","$0.00 ","$378.20 ","$2,160.00 ","$0.00 ","$1,080.00 ","$1,710.72 ","$1,728.00 ","$0.00 ","$338.04 ","$0.00 ","$343.87 ","$0.00 "
"124163","SUP","HCPCS C1713","","124163  -  PLATE BN 145D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$1,032.41 ","$0.00 ","$478.18 ","$0.00 ","$0.00 ","$401.70 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$359.05 ","$0.00 ","$365.24 ","$0.00 "
"124164","SUP","HCPCS C1713","","124164  -  PLATE BN 150D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP","BOTH IP/OP","$1,386.00 ","$1,025.64 ","$0.00 ","$1,386.00 ","$623.70 ","$0.00 ","$288.88 ","$0.00 ","$0.00 ","$242.68 ","$1,386.00 ","$0.00 ","$693.00 ","$1,097.71 ","$1,108.80 ","$0.00 ","$216.91 ","$0.00 ","$220.65 ","$0.00 "
"124165","SUP","HCPCS C1713","","124165  -  PLATE BN 130D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"124166","SUP","HCPCS C1713","","124166  -  PLATE BN 135D SHRT BRL 120MM 25.9MM CLS CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"124167","SUP","HCPCS C1713","","124167  -  PLATE BN 140D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"124168","SUP","HCPCS C1713","","124168  -  PLATE BN 145D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"124169","SUP","HCPCS C1713","","124169  -  PLATE BN 150D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"124176","SUP","HCPCS C1713","","124176  -  PLATE BN 130D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$538.65 ","$0.00 ","$249.48 ","$0.00 ","$0.00 ","$209.59 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$187.33 ","$0.00 ","$190.56 ","$0.00 "
"124177","SUP","HCPCS C1713","","124177  -  PLATE BN 135D SHRT BRL 100MM 1MM CLS 4 HL HIP","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$538.65 ","$0.00 ","$249.48 ","$0.00 ","$0.00 ","$209.59 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$187.33 ","$0.00 ","$190.56 ","$0.00 "
"124178","SUP","HCPCS C1713","","124178  -  PLATE BN 140D SHRT BRL 100MM CLS 4 SLOT CMPR","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$538.65 ","$0.00 ","$249.48 ","$0.00 ","$0.00 ","$209.59 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$187.33 ","$0.00 ","$190.56 ","$0.00 "
"124179","SUP","HCPCS C1713","","124179  -  PLATE BN 145D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$538.65 ","$0.00 ","$249.48 ","$0.00 ","$0.00 ","$209.59 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$187.33 ","$0.00 ","$190.56 ","$0.00 "
"124180","SUP","HCPCS C1713","","124180  -  PLATE BN 150D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$538.65 ","$0.00 ","$249.48 ","$0.00 ","$0.00 ","$209.59 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$187.33 ","$0.00 ","$190.56 ","$0.00 "
"124810","SUP","HCPCS C1713","","124810  -  PIN TRC 4MM 250MM 50MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$708.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.00 ","$0.00 ","$3.00 ","$708.44 ","$4.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"124811","SUP","HCPCS C1713","","124811  -  PIN TRC 4MM 150MM 60MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124820","SUP","HCPCS C1713","","124820  -  PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124823","SUP","HCPCS C1713","","124823  -  PIN TRC 4MM 300MM 40MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124824","SUP","HCPCS C1713","","124824  -  PIN TRC 4MM 300MM 50MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124825","SUP","HCPCS C1713","","124825  -  PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124826","SUP","HCPCS C1713","","124826  -  PIN TRC 5MM 250MM 50MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124827","SUP","HCPCS C1713","","124827  -  PIN TRC 5MM 250MM 60MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124828","SUP","HCPCS C1713","","124828  -  PIN TRC 3MM 60MM 16MM HLF COVE PNT ORTH","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"124829","SUP","HCPCS C1713","","124829  -  PIN TRC 3MM 60MM 22MM HLF COVE PNT","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"124830","SUP","HCPCS C1713","","124830  -  PIN TRC 3MM 75MM 28MM HLF COVE PNT ORTH","BOTH IP/OP","$558.00 ","$412.92 ","$0.00 ","$558.00 ","$251.10 ","$0.00 ","$116.30 ","$0.00 ","$0.00 ","$97.70 ","$558.00 ","$0.00 ","$279.00 ","$441.94 ","$446.40 ","$0.00 ","$87.33 ","$0.00 ","$88.83 ","$0.00 "
"124831","SUP","HCPCS C1713","","124831  -  PIN TRC 4MM 150MM 50MM HLF COVE PNT ORTH","BOTH IP/OP","$770.00 ","$569.80 ","$0.00 ","$770.00 ","$346.50 ","$0.00 ","$160.49 ","$0.00 ","$0.00 ","$134.82 ","$770.00 ","$0.00 ","$385.00 ","$609.84 ","$616.00 ","$0.00 ","$120.51 ","$0.00 ","$122.58 ","$0.00 "
"124833","SUP","HCPCS C1713","","124833  -  PIN TRC 5MM 150MM 50MM HLF COVE PNT ORTH","BOTH IP/OP","$770.00 ","$569.80 ","$0.00 ","$770.00 ","$346.50 ","$0.00 ","$160.49 ","$0.00 ","$0.00 ","$134.82 ","$770.00 ","$0.00 ","$385.00 ","$609.84 ","$616.00 ","$0.00 ","$120.51 ","$0.00 ","$122.58 ","$0.00 "
"124834","SUP","HCPCS C1713","","124834  -  PIN TRC 5MM 200MM 35MM HLF COVE PNT ORTH","BOTH IP/OP","$614.00 ","$454.36 ","$0.00 ","$614.00 ","$276.30 ","$0.00 ","$127.97 ","$0.00 ","$0.00 ","$107.51 ","$614.00 ","$0.00 ","$307.00 ","$486.29 ","$491.20 ","$0.00 ","$96.09 ","$0.00 ","$97.75 ","$0.00 "
"124835","SUP","HCPCS C1713","","124835  -  PIN TRC 3MM 250MM 50MM HLF COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"124839","SUP","HCPCS C1713","","124839  -  PIN HLF 5MM 150MM 40MM PDRLL ORTH","BOTH IP/OP","$614.00 ","$454.36 ","$0.00 ","$614.00 ","$276.30 ","$0.00 ","$127.97 ","$0.00 ","$0.00 ","$107.51 ","$614.00 ","$0.00 ","$307.00 ","$486.29 ","$491.20 ","$0.00 ","$96.09 ","$0.00 ","$97.75 ","$0.00 "
"124840","SUP","HCPCS C1713","","124840  -  PIN HLF 5MM 150MM 45MM PDRLL ORTH","BOTH IP/OP","$493.00 ","$364.82 ","$0.00 ","$493.00 ","$221.85 ","$0.00 ","$102.75 ","$0.00 ","$0.00 ","$86.32 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$0.00 ","$77.15 ","$0.00 ","$78.49 ","$0.00 "
"124841","SUP","HCPCS C1713","","124841  -  PIN HLF 5MM 150MM 50MM PDRLL ORTH","BOTH IP/OP","$493.00 ","$364.82 ","$0.00 ","$493.00 ","$221.85 ","$0.00 ","$102.75 ","$0.00 ","$0.00 ","$86.32 ","$493.00 ","$0.00 ","$246.50 ","$390.46 ","$394.40 ","$0.00 ","$77.15 ","$0.00 ","$78.49 ","$0.00 "
"125037","SUP","Custom 27203010","","125037  -  TUBE ENDBR 37FR 5.1MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$126.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.83 ","$0.00 ","$63.41 ","$100.45 ","$101.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125039","SUP","Custom 27203010","","125039  -  TUBE ENDBR 39FR 5.3MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT","BOTH IP/OP","$298.25 ","$220.71 ","$0.00 ","$126.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.83 ","$0.00 ","$63.41 ","$100.45 ","$101.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"125195","SUP","HCPCS C1713","","125195  -  SCREW BN SLT HD CMPR PED","BOTH IP/OP","$183.75 ","$135.98 ","$0.00 ","$183.75 ","$82.69 ","$0.00 ","$38.30 ","$0.00 ","$0.00 ","$32.17 ","$183.75 ","$0.00 ","$91.88 ","$145.53 ","$147.00 ","$0.00 ","$28.76 ","$0.00 ","$29.25 ","$0.00 "
"125292","SUP","HCPCS C1713","","125292  -  PLATE BN 100D 3 HL BRL INTMD SS HIP","BOTH IP/OP","$601.65 ","$445.22 ","$0.00 ","$601.65 ","$270.74 ","$0.00 ","$125.40 ","$0.00 ","$0.00 ","$105.34 ","$601.65 ","$0.00 ","$300.83 ","$476.51 ","$481.32 ","$0.00 ","$94.16 ","$0.00 ","$95.78 ","$0.00 "
"125294","SUP","HCPCS C1713","","125294  -  PLATE BN 130D 76.2MM 3 HL BRL INTMD SS HIP KY-LOK","BOTH IP/OP","$558.60 ","$413.36 ","$0.00 ","$558.60 ","$251.37 ","$0.00 ","$116.43 ","$0.00 ","$0.00 ","$97.81 ","$558.60 ","$0.00 ","$279.30 ","$442.41 ","$446.88 ","$0.00 ","$87.42 ","$0.00 ","$88.93 ","$0.00 "
"125800","SUP","HCPCS C1713","","125800  -  PIN HLF 4MM 150MM 35MM SKL TRX COVE PNT","BOTH IP/OP","$383.50 ","$283.79 ","$0.00 ","$383.50 ","$172.58 ","$0.00 ","$79.93 ","$0.00 ","$0.00 ","$67.15 ","$383.50 ","$0.00 ","$191.75 ","$303.73 ","$306.80 ","$0.00 ","$60.02 ","$0.00 ","$61.05 ","$0.00 "
"125900","SUP","HCPCS C1713","","125900  -  PIN TRC 4MM 300MM 60MM FULL COVE PNT ORTH","BOTH IP/OP","$894.50 ","$661.93 ","$0.00 ","$894.50 ","$402.53 ","$0.00 ","$186.44 ","$0.00 ","$0.00 ","$156.62 ","$894.50 ","$0.00 ","$447.25 ","$708.44 ","$715.60 ","$0.00 ","$139.99 ","$0.00 ","$142.40 ","$0.00 "
"127016","SUP","HCPCS C1713","","127016  -  SCREW BN 4.5MM 16MM IMHS ST HIP","BOTH IP/OP","$36.50 ","$27.01 ","$0.00 ","$36.50 ","$16.43 ","$0.00 ","$7.61 ","$0.00 ","$0.00 ","$6.39 ","$36.50 ","$0.00 ","$18.25 ","$28.91 ","$29.20 ","$0.00 ","$5.71 ","$0.00 ","$5.81 ","$0.00 "
"127018","SUP","HCPCS C1713","","127018  -  SCREW BN 4.5MM 18MM IMHS ST HIP","BOTH IP/OP","$36.50 ","$27.01 ","$0.00 ","$36.50 ","$16.43 ","$0.00 ","$7.61 ","$0.00 ","$0.00 ","$6.39 ","$36.50 ","$0.00 ","$18.25 ","$28.91 ","$29.20 ","$0.00 ","$5.71 ","$0.00 ","$5.81 ","$0.00 "
"127020","SUP","HCPCS C1713","","127020  -  SCREW BN 4.5MM 20MM IMHS ST HIP","BOTH IP/OP","$36.50 ","$27.01 ","$0.00 ","$36.50 ","$16.43 ","$0.00 ","$7.61 ","$0.00 ","$0.00 ","$6.39 ","$36.50 ","$0.00 ","$18.25 ","$28.91 ","$29.20 ","$0.00 ","$5.71 ","$0.00 ","$5.81 ","$0.00 "
"127026","SUP","HCPCS C1713","","127026  -  SCREW BN 4.5MM 26MM IMHS ST HIP","BOTH IP/OP","$36.50 ","$27.01 ","$0.00 ","$36.50 ","$16.43 ","$0.00 ","$7.61 ","$0.00 ","$0.00 ","$6.39 ","$36.50 ","$0.00 ","$18.25 ","$28.91 ","$29.20 ","$0.00 ","$5.71 ","$0.00 ","$5.81 ","$0.00 "
"127032","SUP","HCPCS C1713","","127032  -  SCREW BN 4.5MM 32MM IMHS ST HIP","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$17.55 ","$0.00 ","$8.13 ","$0.00 ","$0.00 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"127042","SUP","HCPCS C1713","","127042  -  SCREW BN 4.5MM 8MM 42MM IMHS ST THRD HD CORT","BOTH IP/OP","$32.10 ","$23.75 ","$0.00 ","$32.10 ","$14.45 ","$0.00 ","$6.69 ","$0.00 ","$0.00 ","$5.62 ","$32.10 ","$0.00 ","$16.05 ","$25.42 ","$25.68 ","$0.00 ","$5.02 ","$0.00 ","$5.11 ","$0.00 "
"127056","SUP","HCPCS C1713","","127056  -  SCREW BN 4.5MM 56MM IMHS ST HIP","BOTH IP/OP","$39.00 ","$28.86 ","$0.00 ","$39.00 ","$17.55 ","$0.00 ","$8.13 ","$0.00 ","$0.00 ","$6.83 ","$39.00 ","$0.00 ","$19.50 ","$30.89 ","$31.20 ","$0.00 ","$6.10 ","$0.00 ","$6.21 ","$0.00 "
"127060","SUP","HCPCS C1713","","127060  -  SCREW BN 4.5MM 60MM IMHS ST SS HIP","BOTH IP/OP","$36.50 ","$27.01 ","$0.00 ","$36.50 ","$16.43 ","$0.00 ","$7.61 ","$0.00 ","$0.00 ","$6.39 ","$36.50 ","$0.00 ","$18.25 ","$28.91 ","$29.20 ","$0.00 ","$5.71 ","$0.00 ","$5.81 ","$0.00 "
"127062","SUP","HCPCS C1713","","127062  -  SCREW BN 4.5MM 62MM ST CORT","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"127820","SUP","HCPCS C1769","","127820  -  WIRE FX .85MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH","BOTH IP/OP","$164.70 ","$121.88 ","$0.00 ","$164.70 ","$89.43 ","$0.00 ","$34.33 ","$0.00 ","$0.00 ","$28.84 ","$164.70 ","$0.00 ","$82.35 ","$130.44 ","$131.76 ","$0.00 ","$25.78 ","$0.00 ","$26.22 ","$0.00 "
"127821","SUP","HCPCS C1769","","127821  -  WIRE FX .035MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS","BOTH IP/OP","$164.70 ","$121.88 ","$0.00 ","$164.70 ","$89.43 ","$0.00 ","$34.33 ","$0.00 ","$0.00 ","$28.84 ","$164.70 ","$0.00 ","$82.35 ","$130.44 ","$131.76 ","$0.00 ","$25.78 ","$0.00 ","$26.22 ","$0.00 "
"127840","SUP","HCPCS C1769","","127840  -  WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH","BOTH IP/OP","$164.70 ","$121.88 ","$0.00 ","$164.70 ","$89.43 ","$0.00 ","$34.33 ","$0.00 ","$0.00 ","$28.84 ","$164.70 ","$0.00 ","$82.35 ","$130.44 ","$131.76 ","$0.00 ","$25.78 ","$0.00 ","$26.22 ","$0.00 "
"127841","SUP","HCPCS C1769","","127841  -  WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS","BOTH IP/OP","$164.70 ","$121.88 ","$0.00 ","$164.70 ","$89.43 ","$0.00 ","$34.33 ","$0.00 ","$0.00 ","$28.84 ","$164.70 ","$0.00 ","$82.35 ","$130.44 ","$131.76 ","$0.00 ","$25.78 ","$0.00 ","$26.22 ","$0.00 "
"127860","SUP","HCPCS C1769","","127860  -  WIRE FX 1.5MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH","BOTH IP/OP","$164.70 ","$121.88 ","$0.00 ","$164.70 ","$89.43 ","$0.00 ","$34.33 ","$0.00 ","$0.00 ","$28.84 ","$164.70 ","$0.00 ","$82.35 ","$130.44 ","$131.76 ","$0.00 ","$25.78 ","$0.00 ","$26.22 ","$0.00 "
"127861","SUP","HCPCS C1769","","127861  -  WIRE FX 1.5IN 9IN NS KRSH THRD F TY PNT SS ORTH","BOTH IP/OP","$164.70 ","$121.88 ","$0.00 ","$164.70 ","$89.43 ","$0.00 ","$34.33 ","$0.00 ","$0.00 ","$28.84 ","$164.70 ","$0.00 ","$82.35 ","$130.44 ","$131.76 ","$0.00 ","$25.78 ","$0.00 ","$26.22 ","$0.00 "
"127874","SUP","HCPCS C1713","","127874  -  PIN FX 1.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127877","SUP","HCPCS C1713","","127877  -  PIN FX 1.9IN 9IN NS STNM SMTH TY D THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127880","SUP","HCPCS C1713","","127880  -  PIN FX 5/64IN 9IN NS STNM THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127881","SUP","HCPCS C1713","","127881  -  PIN FX 1.9IN 9IN NS STNM F PLN THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127894","SUP","HCPCS C1713","","127894  -  PIN FX 2.3MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127900","SUP","HCPCS C1713","","127900  -  PIN FX 2.3IN 9IN NS STNM THRD TY E SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127901","SUP","HCPCS C1713","","127901  -  PIN FX 2.3MM 9IN NS STNM 2 END DMD PT TY F SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127914","SUP","HCPCS C1713","","127914  -  PIN FX 2.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127917","SUP","HCPCS C1713","","127917  -  PIN FX 2.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127920","SUP","HCPCS C1713","","127920  -  PIN FX 7/64IN 9IN NS STNM THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127921","SUP","HCPCS C1713","","127921  -  PIN FX 2.7IN 9IN NS STNM F PLN THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127934","SUP","HCPCS C1713","","127934  -  PIN FX 3.1MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127937","SUP","HCPCS C1713","","127937  -  PIN FX 3.1MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127940","SUP","HCPCS C1713","","127940  -  PIN FX 1/8IN 9IN NS STNM THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127941","SUP","HCPCS C1713","","127941  -  PIN FX 3.1IN 9IN NS STNM F PLN THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127954","SUP","HCPCS C1713","","127954  -  PIN FX 3.5MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127957","SUP","HCPCS C1713","","127957  -  PIN FX 3.5MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127960","SUP","HCPCS C1713","","127960  -  PIN FX 9/64IN 9IN NS STNM THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127961","SUP","HCPCS C1713","","127961  -  PIN FX 3.5MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127974","SUP","HCPCS C1713","","127974  -  PIN FX 3.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127977","SUP","HCPCS C1713","","127977  -  PIN FX 3.9MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127980","SUP","HCPCS C1713","","127980  -  PIN FX 5/32IN 9IN NS STNM THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127981","SUP","HCPCS C1713","","127981  -  PIN FX 3.9IN 9IN NS STNM THRD TY F SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127994","SUP","HCPCS C1713","","127994  -  PIN FX 4.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"127997","SUP","HCPCS C1713","","127997  -  PIN FX 4.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"128000","SUP","HCPCS C1713","","128000  -  PIN FX 3/16IN 9IN NS STNM THRD SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"128001","SUP","HCPCS C1713","","128001  -  PIN FX 4.7MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH","BOTH IP/OP","$170.40 ","$126.10 ","$0.00 ","$170.40 ","$76.68 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.40 ","$0.00 ","$85.20 ","$134.96 ","$136.32 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"128005","SUP","HCPCS C1769","","128005  -  WIRE FX .028MM 4MM NS KRSH SMTH TROC PNT BOTH END TY A SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128007","SUP","HCPCS C1769","","128007  -  WIRE FX .76IN 4IN NS KRSH PLN PNT TY A SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128010","SUP","HCPCS C1769","","128010  -  WIRE FX .035IN 4IN STRL KRSH PLN 2 PNT TY A TROC SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128011","SUP","HCPCS C1769","","128011  -  WIRE FX .85MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128012","SUP","HCPCS C1769","","128012  -  WIRE FX .035IN 9IN NS KRSH 1 DMD PT SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128017","SUP","HCPCS C1769","","128017  -  WIRE FX .85IN 4IN NS KRSH PLN PNT TY A SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128020","SUP","HCPCS C1769","","128020  -  WIRE FX .85MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128021","SUP","HCPCS C1769","","128021  -  WIRE FX .035IN 7IN NS KRSH PLN PNT TY F SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128022","SUP","HCPCS C1769","","128022  -  WIRE FX .85IN 9IN NS KRSH PLN PNT TY F SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128030","SUP","HCPCS C1769","","128030  -  WIRE FX .045MM 4MM STRL KRSH TROC PNT BOTH END TY A SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128031","SUP","HCPCS C1769","","128031  -  WIRE FX 1.1MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128032","SUP","HCPCS C1769","","128032  -  WIRE FX .045IN 9IN NS KRSH PLN PNT TY E SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128034","SUP","HCPCS C1769","","128034  -  WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128037","SUP","HCPCS C1769","","128037  -  WIRE FX .045IN 4IN NS KRSH SMTH TY A SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128040","SUP","HCPCS C1769","","128040  -  WIRE FX 1.1MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128041","SUP","HCPCS C1769","","128041  -  WIRE FX .045IN 7IN NS KRSH PLN PNT TY F SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128042","SUP","HCPCS C1769","","128042  -  WIRE FX .045IN 9IN NS KRSH DMD PT 2 END SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128044","SUP","HCPCS C1769","","128044  -  WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS","BOTH IP/OP","$49.40 ","$36.56 ","$0.00 ","$49.40 ","$26.82 ","$0.00 ","$10.30 ","$0.00 ","$0.00 ","$8.65 ","$49.40 ","$0.00 ","$24.70 ","$39.12 ","$39.52 ","$0.00 ","$7.73 ","$0.00 ","$7.86 ","$0.00 "
"128050","SUP","HCPCS C1769","","128050  -  WIRE FX .062IN 4IN NS KRSH PLN 2 PNT TY A TROC SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128051","SUP","HCPCS C1769","","128051  -  WIRE FX 1.5MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128052","SUP","HCPCS C1769","","128052  -  WIRE FX .062IN 9IN NS KRSH PLN PNT TY E SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128054","SUP","HCPCS C1769","","128054  -  WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128057","SUP","HCPCS C1769","","128057  -  WIRE FX 1.5IN 4IN NS KRSH PLN PNT TY A SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128060","SUP","HCPCS C1769","","128060  -  WIRE FX 1.5MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128061","SUP","HCPCS C1769","","128061  -  WIRE FX .062IN 7IN NS KRSH PLN PNT TY F SS ORTH","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128062","SUP","HCPCS C1769","","128062  -  WIRE FX 1.5IN 9IN NS KRSH PLN TY F SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128064","SUP","HCPCS C1769","","128064  -  WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS","BOTH IP/OP","$78.70 ","$58.24 ","$0.00 ","$78.70 ","$42.73 ","$0.00 ","$16.40 ","$0.00 ","$0.00 ","$13.78 ","$78.70 ","$0.00 ","$39.35 ","$62.33 ","$62.96 ","$0.00 ","$12.32 ","$0.00 ","$12.53 ","$0.00 "
"128076","SUP","HCPCS C1713","","128076  -  PIN FX 1.9IN 9IN NS STNM 2 END DMD PT PLN TY A SS ORTH","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$87.40 ","$39.33 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$15.30 ","$87.40 ","$0.00 ","$43.70 ","$69.22 ","$69.92 ","$0.00 ","$13.68 ","$0.00 ","$13.91 ","$0.00 "
"128077","SUP","HCPCS C1713","","128077  -  PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$87.40 ","$39.33 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$15.30 ","$87.40 ","$0.00 ","$43.70 ","$69.22 ","$69.92 ","$0.00 ","$13.68 ","$0.00 ","$13.91 ","$0.00 "
"128078","SUP","HCPCS C1713","","128078  -  PIN FX 1.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$87.40 ","$39.33 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$15.30 ","$87.40 ","$0.00 ","$43.70 ","$69.22 ","$69.92 ","$0.00 ","$13.68 ","$0.00 ","$13.91 ","$0.00 "
"128079","SUP","HCPCS C1713","","128079  -  PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$87.40 ","$39.33 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$15.30 ","$87.40 ","$0.00 ","$43.70 ","$69.22 ","$69.92 ","$0.00 ","$13.68 ","$0.00 ","$13.91 ","$0.00 "
"128080","SUP","HCPCS C1713","","128080  -  PIN FX 1.9IN 9IN NS STNM SMTH TY E SS ORTH","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$87.40 ","$39.33 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$15.30 ","$87.40 ","$0.00 ","$43.70 ","$69.22 ","$69.92 ","$0.00 ","$13.68 ","$0.00 ","$13.91 ","$0.00 "
"128081","SUP","HCPCS C1713","","128081  -  PIN FX 1.9IN 9IN NS STNM 2 END DMD PT TY F SS","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$87.40 ","$39.33 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$15.30 ","$87.40 ","$0.00 ","$43.70 ","$69.22 ","$69.92 ","$0.00 ","$13.68 ","$0.00 ","$13.91 ","$0.00 "
"128086","SUP","HCPCS C1713","","128086  -  PIN FX 2.3IN 9IN NS STNM A PLN SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128087","SUP","HCPCS C1713","","128087  -  PIN FX 2.3MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128088","SUP","HCPCS C1713","","128088  -  PIN FX 2.3MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128089","SUP","HCPCS C1713","","128089  -  PIN FX 3/32IN 9IN NS STNM TY D SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128090","SUP","HCPCS C1713","","128090  -  PIN FX 2.3IN 9IN NS STNM SMTH TY E SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128091","SUP","HCPCS C1713","","128091  -  PIN FX 2.3MM 9IN NS STNM 2 END DMD PT SMTH TY F SS","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128097","SUP","HCPCS C1713","","128097  -  PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128098","SUP","HCPCS C1713","","128098  -  PIN FX 2.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128099","SUP","HCPCS C1713","","128099  -  PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128100","SUP","HCPCS C1713","","128100  -  PIN FX 2.7IN 9IN NS STNM SMTH DMD PT RND END TY E SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128101","SUP","HCPCS C1713","","128101  -  PIN FX 7/64IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY F SS","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128106","SUP","HCPCS C1713","","128106  -  PIN FX 3.1IN 9IN NS STNM A PLN SS ORTH","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$42.75 ","$0.00 ","$19.80 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"128107","SUP","HCPCS C1713","","128107  -  PIN FX 3.1MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS","BOTH IP/OP","$102.70 ","$76.00 ","$0.00 ","$102.70 ","$46.22 ","$0.00 ","$21.41 ","$0.00 ","$0.00 ","$17.98 ","$102.70 ","$0.00 ","$51.35 ","$81.34 ","$82.16 ","$0.00 ","$16.07 ","$0.00 ","$16.35 ","$0.00 "
"128108","SUP","HCPCS C1713","","128108  -  PIN FX 3.1MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$102.70 ","$76.00 ","$0.00 ","$102.70 ","$46.22 ","$0.00 ","$21.41 ","$0.00 ","$0.00 ","$17.98 ","$102.70 ","$0.00 ","$51.35 ","$81.34 ","$82.16 ","$0.00 ","$16.07 ","$0.00 ","$16.35 ","$0.00 "
"128109","SUP","HCPCS C1713","","128109  -  PIN FX 3.1IN 9IN NS STNM PLN PNT TY D TROC RND END SS","BOTH IP/OP","$102.70 ","$76.00 ","$0.00 ","$102.70 ","$46.22 ","$0.00 ","$21.41 ","$0.00 ","$0.00 ","$17.98 ","$102.70 ","$0.00 ","$51.35 ","$81.34 ","$82.16 ","$0.00 ","$16.07 ","$0.00 ","$16.35 ","$0.00 "
"128110","SUP","HCPCS C1713","","128110  -  PIN FX 3.1IN 9IN NS STNM SMTH TY E SS ORTH","BOTH IP/OP","$102.70 ","$76.00 ","$0.00 ","$102.70 ","$46.22 ","$0.00 ","$21.41 ","$0.00 ","$0.00 ","$17.98 ","$102.70 ","$0.00 ","$51.35 ","$81.34 ","$82.16 ","$0.00 ","$16.07 ","$0.00 ","$16.35 ","$0.00 "
"128111","SUP","HCPCS C1713","","128111  -  PIN FX 3.1IN 9IN NS STNM F PLN SS","BOTH IP/OP","$102.70 ","$76.00 ","$0.00 ","$102.70 ","$46.22 ","$0.00 ","$21.41 ","$0.00 ","$0.00 ","$17.98 ","$102.70 ","$0.00 ","$51.35 ","$81.34 ","$82.16 ","$0.00 ","$16.07 ","$0.00 ","$16.35 ","$0.00 "
"128116","SUP","HCPCS C1713","","128116  -  PIN FX 3.5IN 9IN NS STNM A PLN SS ORTH","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"128117","SUP","HCPCS C1713","","128117  -  PIN FX 3.5IN 9IN NS STNM PLN PNT TY A SS","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"128118","SUP","HCPCS C1713","","128118  -  PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"128119","SUP","HCPCS C1713","","128119  -  PIN FX 3.5IN 9IN NS STNM PLN PNT TY D TROC RND END SS","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"128120","SUP","HCPCS C1713","","128120  -  PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"128121","SUP","HCPCS C1713","","128121  -  PIN FX 3.5IN 9IN NS STNM F PLN SS","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$49.95 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"128126","SUP","HCPCS C1713","","128126  -  PIN FX 3.9IN 9IN NS STNM A PLN SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128127","SUP","HCPCS C1713","","128127  -  PIN FX 3.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128128","SUP","HCPCS C1713","","128128  -  PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128129","SUP","HCPCS C1713","","128129  -  PIN FX 5/32IN 9IN NS STNM TY D SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128130","SUP","HCPCS C1713","","128130  -  PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128131","SUP","HCPCS C1713","","128131  -  PIN FX 3.9IN 9IN NS STNM F PLN SS","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128136","SUP","HCPCS C1713","","128136  -  PIN FX 4.7IN 9IN NS STNM PLN TY A SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128137","SUP","HCPCS C1713","","128137  -  PIN FX 4.7IN 9IN NS STNM SMTH TROC PNT 1 END TY B SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128138","SUP","HCPCS C1713","","128138  -  PIN FX 4.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128139","SUP","HCPCS C1713","","128139  -  PIN FX 4.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128140","SUP","HCPCS C1713","","128140  -  PIN FX 4.7IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY E SS ORTH","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128141","SUP","HCPCS C1713","","128141  -  PIN FX 4.7IN 9IN NS STNM F PLN SS","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128146","SUP","HCPCS C1713","","128146  -  PIN FX 1.14MM 5IN SWNSN SS FNGR XTRNFX SYS","BOTH IP/OP","$76.00 ","$56.24 ","$0.00 ","$76.00 ","$34.20 ","$0.00 ","$15.84 ","$0.00 ","$0.00 ","$13.31 ","$76.00 ","$0.00 ","$38.00 ","$60.19 ","$60.80 ","$0.00 ","$11.89 ","$0.00 ","$12.10 ","$0.00 "
"128162","SUP","HCPCS C1713","","128162  -  PIN FX 5/32IN 11.5IN THRD ORTH K-DONK","BOTH IP/OP","$452.20 ","$334.63 ","$0.00 ","$452.20 ","$203.49 ","$0.00 ","$94.25 ","$0.00 ","$0.00 ","$79.18 ","$452.20 ","$0.00 ","$226.10 ","$358.14 ","$361.76 ","$0.00 ","$70.77 ","$0.00 ","$71.99 ","$0.00 "
"128175","SUP","HCPCS C1713","","128175  -  PIN FX TROC PNT 1 END ORTH K-DONK","BOTH IP/OP","$452.20 ","$334.63 ","$0.00 ","$452.20 ","$203.49 ","$0.00 ","$94.25 ","$0.00 ","$0.00 ","$79.18 ","$452.20 ","$0.00 ","$226.10 ","$358.14 ","$361.76 ","$0.00 ","$70.77 ","$0.00 ","$71.99 ","$0.00 "
"128177","SUP","HCPCS C1713","","128177  -  PIN FX 7/64IN 9IN TROC PNT 1 END ORTH K-DONK","BOTH IP/OP","$598.40 ","$442.82 ","$0.00 ","$598.40 ","$269.28 ","$0.00 ","$124.72 ","$0.00 ","$0.00 ","$104.78 ","$598.40 ","$0.00 ","$299.20 ","$473.93 ","$478.72 ","$0.00 ","$93.65 ","$0.00 ","$95.27 ","$0.00 "
"128307","SUP","HCPCS C1713","","128307  -  PIN FX .15IN 2.25IN KNWL SS ORTH","BOTH IP/OP","$418.95 ","$310.02 ","$0.00 ","$418.95 ","$188.53 ","$0.00 ","$87.32 ","$0.00 ","$0.00 ","$73.35 ","$418.95 ","$0.00 ","$209.48 ","$331.81 ","$335.16 ","$0.00 ","$65.57 ","$0.00 ","$66.70 ","$0.00 "
"128310","SUP","HCPCS C1713","","128310  -  PIN FX 5/32IN 3IN KNWL SS","BOTH IP/OP","$418.95 ","$310.02 ","$0.00 ","$418.95 ","$188.53 ","$0.00 ","$87.32 ","$0.00 ","$0.00 ","$73.35 ","$418.95 ","$0.00 ","$209.48 ","$331.81 ","$335.16 ","$0.00 ","$65.57 ","$0.00 ","$66.70 ","$0.00 "
"128314","SUP","HCPCS C1713","","128314  -  PIN FX 5/32IN 4IN KNWL SS","BOTH IP/OP","$418.95 ","$310.02 ","$0.00 ","$418.95 ","$188.53 ","$0.00 ","$87.32 ","$0.00 ","$0.00 ","$73.35 ","$418.95 ","$0.00 ","$209.48 ","$331.81 ","$335.16 ","$0.00 ","$65.57 ","$0.00 ","$66.70 ","$0.00 "
"128408","SUP","HCPCS C1713","","128408  -  PIN FX 5/32IN 6IN 1.5IN HAGIE ORTH","BOTH IP/OP","$319.20 ","$236.21 ","$0.00 ","$319.20 ","$143.64 ","$0.00 ","$66.53 ","$0.00 ","$0.00 ","$55.89 ","$319.20 ","$0.00 ","$159.60 ","$252.81 ","$255.36 ","$0.00 ","$49.95 ","$0.00 ","$50.82 ","$0.00 "
"128416","SUP","HCPCS C1713","","128416  -  PIN FX 3/16IN 6IN 1.25IN HAGIE ORTH","BOTH IP/OP","$319.20 ","$236.21 ","$0.00 ","$319.20 ","$143.64 ","$0.00 ","$66.53 ","$0.00 ","$0.00 ","$55.89 ","$319.20 ","$0.00 ","$159.60 ","$252.81 ","$255.36 ","$0.00 ","$49.95 ","$0.00 ","$50.82 ","$0.00 "
"128418","SUP","HCPCS C1713","","128418  -  PIN FX 3/16IN 6IN 1.5IN HAGIE ORTH","BOTH IP/OP","$319.20 ","$236.21 ","$0.00 ","$319.20 ","$143.64 ","$0.00 ","$66.53 ","$0.00 ","$0.00 ","$55.89 ","$319.20 ","$0.00 ","$159.60 ","$252.81 ","$255.36 ","$0.00 ","$49.95 ","$0.00 ","$50.82 ","$0.00 "
"128436","SUP","HCPCS C1713","","128436  -  PIN FX .25IN 6IN 1.25IN HAGIE ORTH","BOTH IP/OP","$319.20 ","$236.21 ","$0.00 ","$319.20 ","$143.64 ","$0.00 ","$66.53 ","$0.00 ","$0.00 ","$55.89 ","$319.20 ","$0.00 ","$159.60 ","$252.81 ","$255.36 ","$0.00 ","$49.95 ","$0.00 ","$50.82 ","$0.00 "
"128518","SUP","HCPCS C1713","","128518  -  PIN FX .89MM 2IN STRL INSTR ORTH XTRNFX SYS","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128520","SUP","HCPCS C1713","","128520  -  PIN FX 1.1MM 2IN STRL INSTR ORTH XTRNFX SYS","BOTH IP/OP","$102.70 ","$76.00 ","$0.00 ","$102.70 ","$46.22 ","$0.00 ","$21.41 ","$0.00 ","$0.00 ","$17.98 ","$102.70 ","$0.00 ","$51.35 ","$81.34 ","$82.16 ","$0.00 ","$16.07 ","$0.00 ","$16.35 ","$0.00 "
"128522","SUP","HCPCS C1713","","128522  -  PIN FX 1.5MM 2IN STRL INSTR ORTH XTRNFX SYS","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$124.00 ","$55.80 ","$0.00 ","$25.84 ","$0.00 ","$0.00 ","$21.71 ","$124.00 ","$0.00 ","$62.00 ","$98.21 ","$99.20 ","$0.00 ","$19.41 ","$0.00 ","$19.74 ","$0.00 "
"128551","SUP","HCPCS C1713","","128551  -  PIN FX .062IN 5.8IN SML SS ORTH","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$67.05 ","$0.00 ","$31.06 ","$0.00 ","$0.00 ","$26.09 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$23.32 ","$0.00 ","$23.72 ","$0.00 "
"128552","SUP","HCPCS C1713","","128552  -  PIN FX .062IN 7.8IN SML SS ORTH","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$53.55 ","$0.00 ","$24.80 ","$0.00 ","$0.00 ","$20.84 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$18.62 ","$0.00 ","$18.94 ","$0.00 "
"128553","SUP","HCPCS C1713","","128553  -  PIN FX .062IN 1IN SML SS ORTH","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$53.55 ","$0.00 ","$24.80 ","$0.00 ","$0.00 ","$20.84 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$18.62 ","$0.00 ","$18.94 ","$0.00 "
"128555","SUP","HCPCS C1713","","128555  -  PIN FX .062IN 1.25IN SML SS ORTH","BOTH IP/OP","$119.00 ","$88.06 ","$0.00 ","$119.00 ","$53.55 ","$0.00 ","$24.80 ","$0.00 ","$0.00 ","$20.84 ","$119.00 ","$0.00 ","$59.50 ","$94.25 ","$95.20 ","$0.00 ","$18.62 ","$0.00 ","$18.94 ","$0.00 "
"128607","SUP","HCPCS C1713","","128607  -  STAPLE BN 12MM 12MM KRCKW HTO OFST COCR TIB LAT BLDE","BOTH IP/OP","$852.60 ","$630.92 ","$0.00 ","$852.60 ","$383.67 ","$0.00 ","$177.70 ","$0.00 ","$0.00 ","$149.28 ","$852.60 ","$0.00 ","$426.30 ","$675.26 ","$682.08 ","$0.00 ","$133.43 ","$0.00 ","$135.73 ","$0.00 "
"128608","SUP","HCPCS C1713","","128608  -  STAPLE BN 14MM 14MM KRCKW HTO OFST COCR TIB LAT BLDE","BOTH IP/OP","$852.60 ","$630.92 ","$0.00 ","$852.60 ","$383.67 ","$0.00 ","$177.70 ","$0.00 ","$0.00 ","$149.28 ","$852.60 ","$0.00 ","$426.30 ","$675.26 ","$682.08 ","$0.00 ","$133.43 ","$0.00 ","$135.73 ","$0.00 "
"128609","SUP","HCPCS C1713","","128609  -  STAPLE BN 16MM 16MM KRCKW HTO OFST COCR TIB LAT BLDE","BOTH IP/OP","$852.60 ","$630.92 ","$0.00 ","$852.60 ","$383.67 ","$0.00 ","$177.70 ","$0.00 ","$0.00 ","$149.28 ","$852.60 ","$0.00 ","$426.30 ","$675.26 ","$682.08 ","$0.00 ","$133.43 ","$0.00 ","$135.73 ","$0.00 "
"128610","SUP","HCPCS C1713","","128610  -  STAPLE BN 25X25MM BLK KRCKW HTO COCR TIB MDL MEDAL","BOTH IP/OP","$852.60 ","$630.92 ","$0.00 ","$852.60 ","$383.67 ","$0.00 ","$177.70 ","$0.00 ","$0.00 ","$149.28 ","$852.60 ","$0.00 ","$426.30 ","$675.26 ","$682.08 ","$0.00 ","$133.43 ","$0.00 ","$135.73 ","$0.00 "
"128673","SUP","HCPCS C1713","","128673  -  STAPLE BN 5MM OFST 26.5X23MM FX COCR OSTM","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"128674","SUP","HCPCS C1713","","128674  -  STAPLE BN 10MM 21.5X23MM FX OFST COCR ORTH OSTM","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"128675","SUP","HCPCS C1713","","128675  -  STAPLE BN 14MM 17.5X23MM FX COCR ORTH OSTM","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"128690","SUP","HCPCS C1713","","128690  -  STAPLE BN XS 23.22X6.35MM SPK FX COCR","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128691","SUP","HCPCS C1713","","128691  -  STAPLE BN XS 23.22X6.35MM WO SPK COCR ORTH","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128692","SUP","HCPCS C1713","","128692  -  STAPLE BN SM SPK 23X12MM FX COCR","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128693","SUP","HCPCS C1713","","128693  -  STAPLE BN SM REG 23.22X7.94MM FX COCR OSTM","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128695","SUP","HCPCS C1713","","128695  -  STAPLE BN MED 23.22X11.11MM SPK COCR ORTH","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128696","SUP","HCPCS C1713","","128696  -  STAPLE BN LG REG 23.22X14.29MM SPK COCR ORTH OSTM","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128697","SUP","HCPCS C1713","","128697  -  STAPLE BN LG 23.22X14.29MM FX COCR OSTM","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128698","SUP","HCPCS C1713","","128698  -  STAPLE BN SM 16X13MM TBL FX COCR","BOTH IP/OP","$655.20 ","$484.85 ","$0.00 ","$655.20 ","$294.84 ","$0.00 ","$136.56 ","$0.00 ","$0.00 ","$114.72 ","$655.20 ","$0.00 ","$327.60 ","$518.92 ","$524.16 ","$0.00 ","$102.54 ","$0.00 ","$104.31 ","$0.00 "
"128699","SUP","HCPCS C1713","","128699  -  STAPLE BN 16 MED 22X16MM TBL FX RTRCT COCR ORTH","BOTH IP/OP","$655.20 ","$484.85 ","$0.00 ","$655.20 ","$294.84 ","$0.00 ","$136.56 ","$0.00 ","$0.00 ","$114.72 ","$655.20 ","$0.00 ","$327.60 ","$518.92 ","$524.16 ","$0.00 ","$102.54 ","$0.00 ","$104.31 ","$0.00 "
"128720","SUP","HCPCS C1713","","128720  -  STAPLE BN XS 15X6.35MM FX SPK SHRT LG COCR","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128721","SUP","HCPCS C1713","","128721  -  STAPLE BN XS 15X6.35MM WO SPK SHRT LG COCR ORTH","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128722","SUP","HCPCS C1713","","128722  -  STAPLE BN SM 15X7.94MM SPK SHRT LG FX COCR","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128723","SUP","HCPCS C1713","","128723  -  STAPLE BN SM 15X7.94MM WO SPK SHRT LG COCR ORTH","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128724","SUP","HCPCS C1713","","128724  -  STAPLE BN MED 15X11.11MM SPK SHRT LG FX COCR","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128725","SUP","HCPCS C1713","","128725  -  STAPLE BN MED 15X11.11MM WO SPK SHRT LG COCR ORTH","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128726","SUP","HCPCS C1713","","128726  -  STAPLE BN LG 15X14.29MM SPK SHRT LG FX COCR","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"128727","SUP","HCPCS C1713","","128727  -  STAPLE BN LG 15X14.29MM WO SPK SHRT LG COCR ORTH","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"131710","SUP","HCPCS Q4130","","131710  -  DRESSING BIO 48X3IN EZ DERM MSH PRFR PRCN XENOGRAFT","BOTH IP/OP","$890.29 ","$658.81 ","$0.00 ","$973.95 ","$0.00 ","$0.00 ","$185.56 ","$0.00 ","$0.00 ","$0.00 ","$973.95 ","$0.00 ","$486.97 ","$771.37 ","$779.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"140100","SUP","Custom 27203010","","KIT IMMUN TST AGLT SYS CRPTCOC NFRMNS AG LTX","BOTH IP/OP","$950.70 ","$703.52 ","$0.00 ","$950.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.70 ","$0.00 ","$475.35 ","$752.95 ","$760.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"143080","SUP","HCPCS C1713","","143080  -  PIN FX 3.2MM 80MM STRL","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"143090","SUP","HCPCS C1713","","143090  -  PIN FX 3.2MM 90MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"143100","SUP","HCPCS C1713","","143100  -  PIN FX 3.2MM 100MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"143110","SUP","HCPCS C1713","","143110  -  PIN FX 3.2MM 110MM STRL","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"143120","SUP","HCPCS C1713","","143120  -  PIN FX 3.2MM 120MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$1,352.93 ","$0.00 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$0.00 ","$1,352.93 ","$0.00 ","$676.47 ","$239.58 ","$1,082.34 ","$0.00 ","$0.00 ","$0.00 ","$48.16 ","$0.00 "
"143130","SUP","HCPCS C1713","","143130  -  PIN FX 3.2MM 130MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"143140","SUP","HCPCS C1713","","143140  -  PIN FX 3.2MM 140MM STRL","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$239.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.00 ","$0.00 ","$11.00 ","$239.58 ","$17.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"144080","SUP","HCPCS C1713","","144080  -  PIN FX 4MM 80MM NS KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144090","SUP","HCPCS C1713","","144090  -  PIN FX 4MM 90MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144100","SUP","HCPCS C1713","","144100  -  PIN FX 4MM 100MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144110","SUP","HCPCS C1713","","144110  -  PIN FX 4MM 110MM STRL","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144120","SUP","HCPCS C1713","","144120  -  PIN FX 4MM 1200MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144130","SUP","HCPCS C1713","","144130  -  PIN FX 4MM 130MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144140","SUP","HCPCS C1713","","144140  -  PIN FX 4MM 140MM STRL KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144150","SUP","HCPCS C1713","","144150  -  PIN FX 4MM 150MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144160","SUP","HCPCS C1713","","144160  -  PIN FX 4MM 160MM STRL PRM KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"144170","SUP","HCPCS C1713","","144170  -  PIN FX 4MM 170MM STRL KN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"151435","SUP","Custom 27203010","","RETAINER TBGRP A 33FTX1.5IN NTR ELAST TBLR DRSG LTX","BOTH IP/OP","$40.13 ","$29.70 ","$0.00 ","$40.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.13 ","$0.00 ","$20.06 ","$31.78 ","$32.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151436","SUP","Custom 27203010","","151436  -  RETAINER TBGRP B 33FTX2.5IN NTR ELAST TBLR DRSG LF","BOTH IP/OP","$52.92 ","$39.16 ","$0.00 ","$52.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.92 ","$0.00 ","$26.46 ","$41.91 ","$42.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151437","SUP","Custom 27203010","","151437  -  RETAINER DRSG D 33FTX3IN NTR LF TBGRP ELC TBLR","BOTH IP/OP","$73.13 ","$54.12 ","$0.00 ","$73.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.13 ","$0.00 ","$36.57 ","$57.92 ","$58.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151440","SUP","Custom 27203010","","151440  -  RETAINER TBGRP J 33FTX6.75IN NTR ELAST TBLR DRSG LTX","BOTH IP/OP","$55.61 ","$41.15 ","$0.00 ","$55.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.61 ","$0.00 ","$27.80 ","$44.04 ","$44.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151442","SUP","Custom 27203010","","151442  -  RTNR TBGRP LG 10MR NTR ELAST TBLR DRSG LATEX","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"160821","SUP","Custom 27203010","","160821  -  BURR SURG MICRO 14 FLUTE BARREL .24IN 2.13IN .41IN STAINLESS","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"163663","SUP","HCPCS C1776","","163663  -  HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"165808","SUP","Custom 27203010","","165808  -  CATHETER URETHRAL 8FR 2 WAY FOLEY LATEX FREE BARD SILICONE 3","BOTH IP/OP","$8.13 ","$6.02 ","$0.00 ","$8.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.13 ","$0.00 ","$4.06 ","$6.44 ","$6.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"165810","SUP","Custom 27203010","","165810  -  CATHETER URETHRAL 10FR 2 WAY FOLEY LATEX FREE BARD SILICONE","BOTH IP/OP","$8.13 ","$6.02 ","$0.00 ","$8.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.13 ","$0.00 ","$4.06 ","$6.44 ","$6.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"165814","SUP","Custom 27203010","","165814  -  CATHETER URTH 14FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL","BOTH IP/OP","$7.83 ","$5.79 ","$0.00 ","$7.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.83 ","$0.00 ","$3.91 ","$6.20 ","$6.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"165816","SUP","Custom 27203010","","165816  -  CATHETER URTH 16FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL","BOTH IP/OP","$7.83 ","$5.79 ","$0.00 ","$7.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.83 ","$0.00 ","$3.91 ","$6.20 ","$6.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"165818","SUP","Custom 27203010","","165818  -  CATHETER URTH 18FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL","BOTH IP/OP","$7.83 ","$5.79 ","$0.00 ","$7.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.83 ","$0.00 ","$3.91 ","$6.20 ","$6.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"165822","SUP","Custom 27203010","","165822  -  CATHETER URETHRAL 22FR 2 WAY FOLEY LATEX FREE BARD SILICONE","BOTH IP/OP","$7.83 ","$5.79 ","$0.00 ","$7.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.83 ","$0.00 ","$3.91 ","$6.20 ","$6.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"170057","SUP","Custom 27803010","","170057  -  RELOAD SUT AS 2-0 ES-9 48IN UD E STCH PLSRB 1 STCH LACTOMER","BOTH IP/OP","$620.10 ","$458.87 ","$0.00 ","$620.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$620.10 ","$0.00 ","$310.05 ","$491.12 ","$496.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"173016","SUP","Custom 27203010","","173016  -  DEVICE SUTURING 10MM 15IN PUSH BUTTON GRIP HANDLE LATEX FREE","BOTH IP/OP","$284.40 ","$210.46 ","$0.00 ","$288.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.67 ","$0.00 ","$144.33 ","$228.63 ","$230.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"173019","SUP","Custom 27203010","","173019  -  RETRACTOR LAPSCOP STANDARD LENGTH 5MM 45CM TROCAR ADAPTER","BOTH IP/OP","$50.43 ","$37.32 ","$0.00 ","$51.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.18 ","$0.00 ","$25.59 ","$40.53 ","$40.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"174001","SUP","Custom 27203010","","174001  -  CLAMP LAPSCP STD 10MM 31CM GRN STRL E-BBCK ON OFF SWH RCHT","BOTH IP/OP","$176.91 ","$130.91 ","$0.00 ","$176.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.91 ","$0.00 ","$88.46 ","$140.11 ","$141.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"174006","SUP","Custom 27203010","","174006  -  STAPLER INTERNAL 35.5X5MM 30 HELICAL FASTENER LATEX FREE","BOTH IP/OP","$584.95 ","$432.86 ","$0.00 ","$593.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$593.72 ","$0.00 ","$296.86 ","$470.23 ","$474.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"175424","SUP","HCPCS C1768","","175424  -  GRAFT CV 24MM 30CM HMSH PL WVN STRG","BOTH IP/OP","$1,236.58 ","$915.07 ","$0.00 ","$1,236.58 ","$556.46 ","$0.00 ","$257.73 ","$0.00 ","$0.00 ","$216.51 ","$1,236.58 ","$0.00 ","$618.29 ","$979.37 ","$989.26 ","$0.00 ","$193.52 ","$0.00 ","$196.86 ","$0.00 "
"175428","SUP","HCPCS C1768","","175428  -  GRAFT VASC 30CM 28MM HMSH GMCVL WVN STR","BOTH IP/OP","$1,317.40 ","$974.88 ","$0.00 ","$1,317.40 ","$592.83 ","$0.00 ","$274.58 ","$0.00 ","$0.00 ","$230.67 ","$1,317.40 ","$0.00 ","$658.70 ","$1,043.38 ","$1,053.92 ","$0.00 ","$206.17 ","$0.00 ","$209.73 ","$0.00 "
"175432","SUP","HCPCS C1768","","175432  -  GRAFT CV 32MM 30CM HMSH GMCVL WVN STRG","BOTH IP/OP","$1,317.40 ","$974.88 ","$0.00 ","$1,317.40 ","$592.83 ","$0.00 ","$274.58 ","$0.00 ","$0.00 ","$230.67 ","$1,317.40 ","$0.00 ","$658.70 ","$1,043.38 ","$1,053.92 ","$0.00 ","$206.17 ","$0.00 ","$209.73 ","$0.00 "
"176605","SUP","Custom 27203010","","176605  -  SCISSORS LAPSCP 5MM 31CM E SCZ MNPLR CAUT ADPR HK CRV JAW","BOTH IP/OP","$187.02 ","$138.39 ","$0.00 ","$187.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.02 ","$0.00 ","$93.51 ","$148.12 ","$149.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"176620","SUP","Custom 27203010","","176620  -  APPLIER INTERNAL CLIP LARGE 5MM 11IN TROCAR SLEEVE ENDO CLIP","BOTH IP/OP","$373.88 ","$276.67 ","$0.00 ","$373.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$373.88 ","$0.00 ","$186.94 ","$296.11 ","$299.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"176643","SUP","Custom 27203010","","176643  -  SHEARS MONOPOLAR STANDARD CURVE 5MM 31CM MONOPOLAR CAUTERY","BOTH IP/OP","$151.10 ","$111.81 ","$0.00 ","$153.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$153.37 ","$0.00 ","$76.68 ","$121.47 ","$122.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"176657","SUP","Custom 27203010","","176657  -  APPLIER INTERNAL CLIP MEDIUM LARGE 10MM 10MM PISTOL GRIP","BOTH IP/OP","$206.08 ","$152.50 ","$0.00 ","$209.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.17 ","$0.00 ","$104.58 ","$165.66 ","$167.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"176816","SUP","Custom 27203010","","176816  -  CATHETER URTH 16FR 30ML STRL LF BARD LBRSL 2W FL BLN SIL","BOTH IP/OP","$18.70 ","$13.84 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.70 ","$0.00 ","$9.35 ","$14.81 ","$14.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"177017","SUP","Custom 27203010","","REAGENT ANALY QUICKCOMP FLUOROCHROME MNCLN LQ 50 TST","BOTH IP/OP","$1,849.53 ","$1,368.65 ","$0.00 ","$1,849.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,849.53 ","$0.00 ","$924.76 ","$1,464.83 ","$1,479.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179301","SUP","Custom 27203010","","179301  -  TROCAR ENDSCP 10.5MM NONCONDUCTIVE SLEEVE THORACOPORT TEAL","BOTH IP/OP","$38.25 ","$28.31 ","$0.00 ","$38.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.82 ","$0.00 ","$19.41 ","$30.75 ","$31.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179309","SUP","Custom 27203010","","179309  -  TROCAR ENDSCP 12MM SOFT CONDUCTIVE SLEEVE OBTURATOR","BOTH IP/OP","$38.25 ","$28.31 ","$0.00 ","$38.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.82 ","$0.00 ","$19.41 ","$30.75 ","$31.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"180402","SUP","HCPCS C1776","","180402  -  COMPONENT FEM 2 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180403","SUP","HCPCS C1776","","180403  -  COMPONENT FEM 3 KN PTLFEM LT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180404","SUP","HCPCS C1776","","180404  -  COMPONENT FEM 4 KN PTLFEM LT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180405","SUP","HCPCS C1776","","180405  -  COMPONENT FEM 5 KN PTLFEM LT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180406","SUP","HCPCS C1776","","180406  -  COMPONENT FEM 6 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180407","SUP","HCPCS C1776","","180407  -  COMPONENT FEM 7 KN PTLFEM LT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180412","SUP","HCPCS C1776","","180412  -  COMPONENT FEM 2 KN PTLFEM RT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180413","SUP","HCPCS C1776","","180413  -  COMPONENT FEM 3 KN RT PTLFEM MULTICOMPARTMENTAL KN SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180414","SUP","HCPCS C1776","","180414  -  COMPONENT FEM 4 KN PTLFEM RT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180415","SUP","HCPCS C1776","","180415  -  COMPONENT FEM 5 KN PTLFEM RT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180416","SUP","HCPCS C1776","","180416  -  COMPONENT FEM 6 KN PTLFEM RT MCK SYS","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180417","SUP","HCPCS C1776","","180417  -  COMPONENT FEM 7 STD KN PTLFEM RT","BOTH IP/OP","$9,780.00 ","$7,237.20 ","$0.00 ","$9,780.00 ","$4,401.00 ","$0.00 ","$2,038.40 ","$0.00 ","$0.00 ","$1,712.40 ","$9,780.00 ","$0.00 ","$4,890.00 ","$7,745.76 ","$7,824.00 ","$0.00 ","$1,530.57 ","$0.00 ","$1,556.98 ","$0.00 "
"180502","SUP","HCPCS C1776","","180502  -  COMPONENT FEM 2 KN LT MDL RL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180503","SUP","HCPCS C1776","","180503  -  COMPONENT FEM 3 KN LT MDL RL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180504","SUP","HCPCS C1776","","180504  -  COMPONENT FEM 4 KN LT MDL RL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180505","SUP","HCPCS C1776","","180505  -  COMPONENT FEM 5 KN LT MDL RL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180506","SUP","HCPCS C1776","","180506  -  COMPONENT FEM 6 KN LT MDL RL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180507","SUP","HCPCS C1776","","180507  -  COMPONENT FEM 7 KN LT MDL RL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180512","SUP","HCPCS C1776","","180512  -  COMPONENT FEM 2 KN RMLL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180513","SUP","HCPCS C1776","","180513  -  COMPONENT FEM 3 KN RMLL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180514","SUP","HCPCS C1776","","180514  -  COMPONENT FEM 4 KN RMLL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180515","SUP","HCPCS C1776","","180515  -  COMPONENT FEM 5 KN RMLL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180516","SUP","HCPCS C1776","","180516  -  COMPONENT FEM 6 KN RMLL MCK SYS","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180517","SUP","HCPCS C1776","","180517  -  COMPONENT FEM 7 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180518","SUP","HCPCS C1776","","180518  -  COMPONENT FEM 8 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"180601","SUP","HCPCS C1776","","180601  -  BASEPLATE TIB 1 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180602","SUP","HCPCS C1776","","180602  -  BASEPLATE TIB 2 KN LT MDL RL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180603","SUP","HCPCS C1776","","180603  -  BASEPLATE TIB 3 KN LT MDL RL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180604","SUP","HCPCS C1776","","180604  -  BASEPLATE TIB 4 KN LT MDL RL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180605","SUP","HCPCS C1776","","180605  -  BASEPLATE TIB 5 KN LT MDL RL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180606","SUP","HCPCS C1776","","180606  -  BASEPLATE TIB 6 KN LT MDL RL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180607","SUP","HCPCS C1776","","180607  -  BASEPLATE TIB 7 KN LT MDL RL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180608","SUP","HCPCS C1776","","180608  -  BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180612","SUP","HCPCS C1776","","180612  -  BASEPLATE TIB 2 KN RMLL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180613","SUP","HCPCS C1776","","180613  -  BASEPLATE TIB 3 KN RMLL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180614","SUP","HCPCS C1776","","180614  -  BASEPLATE TIB 4 STRL RESTORIS KN RMLL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180615","SUP","HCPCS C1776","","180615  -  BASEPLATE TIB 5 STRL RESTORIS KN RMLL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180616","SUP","HCPCS C1776","","180616  -  BASEPLATE TIB 6 KN RMLL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180617","SUP","HCPCS C1776","","180617  -  BASEPLATE TIB 7 KN RMLL MCK SYS","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"180618","SUP","HCPCS C1776","","180618  -  BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"186140","SUP","HCPCS C1776","","186140  -  LINER ACTB NTRL RESTORIS XLVE HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186240","SUP","HCPCS C1776","","186240  -  LINER ACTB RESTORIS HW XLVE HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"200641","SUP","Custom 27805411","","200641  -  GRAFT BONE CORNERSTONE CORTICAL L14 MM X W11 MM X H6 MM BLOC","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200741","SUP","HCPCS C1713","","200741  -  GRAFT BONE CRSTN SR CORT BLCK 14X11X7MM CERV SPNE","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"200744","SUP","Custom 27804086","","200744  -  GRAFT BONE 14X14X7MM BLOCK CORNERSTONE SR CORTICAL CERV SPN","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"200841","SUP","HCPCS C1713","","200841  -  GRAFT BONE CRSTN PSR CORT BLOCK 14X11X8MM CERV SPN","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"200941","SUP","Custom 27804086","","200941  -  GRAFT BONE 14X11X9MM BLOCK FREEZE DRIED CORNERSTONE CORTICAL","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201400","SUP","HCPCS C1713","","201400  -  PIN HLF 4MM 120MM 30MM ILZ THRD ORTH","BOTH IP/OP","$422.00 ","$312.28 ","$0.00 ","$422.00 ","$189.90 ","$0.00 ","$87.96 ","$0.00 ","$0.00 ","$73.89 ","$422.00 ","$0.00 ","$211.00 ","$334.22 ","$337.60 ","$0.00 ","$66.04 ","$0.00 ","$67.18 ","$0.00 "
"201401","SUP","HCPCS C1713","","201401  -  PIN HLF 4MM 150MM 35MM ILZ THRD ORTH","BOTH IP/OP","$428.00 ","$316.72 ","$0.00 ","$428.00 ","$192.60 ","$0.00 ","$89.21 ","$0.00 ","$0.00 ","$74.94 ","$428.00 ","$0.00 ","$214.00 ","$338.98 ","$342.40 ","$0.00 ","$66.98 ","$0.00 ","$68.14 ","$0.00 "
"201402","SUP","HCPCS C1713","","201402  -  PIN HLF 4MM 180MM 40MM ILZ THRD ORTH","BOTH IP/OP","$448.00 ","$331.52 ","$0.00 ","$448.00 ","$201.60 ","$0.00 ","$93.37 ","$0.00 ","$0.00 ","$78.44 ","$448.00 ","$0.00 ","$224.00 ","$354.82 ","$358.40 ","$0.00 ","$70.11 ","$0.00 ","$71.32 ","$0.00 "
"201502","SUP","HCPCS C1713","","201502  -  PIN HLF 5MM 180MM 50MM ILZ THRD CNCL ORTH","BOTH IP/OP","$480.00 ","$355.20 ","$0.00 ","$480.00 ","$216.00 ","$0.00 ","$100.04 ","$0.00 ","$0.00 ","$84.04 ","$480.00 ","$0.00 ","$240.00 ","$380.16 ","$384.00 ","$0.00 ","$75.12 ","$0.00 ","$76.42 ","$0.00 "
"201700","SUP","HCPCS C1713","","201700  -  WASHER ORTH ILZ CNCL CPL","BOTH IP/OP","$128.80 ","$95.31 ","$0.00 ","$128.80 ","$57.96 ","$0.00 ","$26.85 ","$0.00 ","$0.00 ","$22.55 ","$128.80 ","$0.00 ","$64.40 ","$102.01 ","$103.04 ","$0.00 ","$20.16 ","$0.00 ","$20.50 ","$0.00 "
"202050","SUP","Custom 27203010","","202050  -  SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE","BOTH IP/OP","$2,732.63 ","$2,022.15 ","$0.00 ","$2,760.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,760.94 ","$0.00 ","$1,380.47 ","$2,186.66 ","$2,208.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"204002","SUP","HCPCS Q4116","","204002  -  GRAFT SKN STRATTICE 20 X 40","BOTH IP/OP","$50,720.00 ","$37,532.80 ","$0.00 ","$50,720.00 ","$22,824.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$50,720.00 ","$0.00 ","$25,360.00 ","$40,170.24 ","$40,576.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,074.62 ","$0.00 "
"205108","SUP","Custom 27203010","","205108  -  DEVICE TISSUE CLOSURE 8CM EXTEND TIP APPLICATOR","BOTH IP/OP","$2,830.10 ","$2,094.27 ","$0.00 ","$2,830.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,830.10 ","$0.00 ","$1,415.05 ","$2,241.44 ","$2,264.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"206010","SUP","Custom 27203010","","206010  -  STONE BREAKER","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"206020","SUP","Custom 27203010","","206020  -  STONE BRAKER PROBE 20 MM","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"206520","SUP","Custom 27203010","","206520  -  SEALANT TISS CLSR 5ML STRL LF DURASEAL EXACT SPNE DISP","BOTH IP/OP","$14,296.10 ","$10,579.11 ","$0.00 ","$14,296.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,296.10 ","$0.00 ","$7,148.05 ","$11,322.51 ","$11,436.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"208058","SUP","Custom 27203010","","FORMULA 1QT MCT OIL SUPPL GLS BTL ADLT 7.7 CAL","BOTH IP/OP","$375.20 ","$277.65 ","$0.00 ","$375.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.20 ","$0.00 ","$187.60 ","$297.16 ","$300.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210439","SUP","Custom 27203010","","210439  -  BIT DRL LNG 2MM 127MM STRL TWST SS","BOTH IP/OP","$175.40 ","$129.80 ","$0.00 ","$175.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.40 ","$0.00 ","$87.70 ","$138.92 ","$140.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210440","SUP","Custom 27203010","","210440  -  BIT DRL LNG 2.4MM 127MM STRL CUT SS","BOTH IP/OP","$175.40 ","$129.80 ","$0.00 ","$175.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.40 ","$0.00 ","$87.70 ","$138.92 ","$140.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210441","SUP","Custom 27203010","","210441  -  BIT DRL LNG 2.7MM 127MM STRL TWST SS","BOTH IP/OP","$175.40 ","$129.80 ","$0.00 ","$175.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.40 ","$0.00 ","$87.70 ","$138.92 ","$140.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210442","SUP","Custom 27203010","","210442  -  BIT DRL 3.2MM 127MM STRL TWST SS","BOTH IP/OP","$175.40 ","$129.80 ","$0.00 ","$175.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.40 ","$0.00 ","$87.70 ","$138.92 ","$140.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210444","SUP","Custom 27203010","","210444  -  BIT DRL LNG 4MM 127MM STRL TWST SS","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$132.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.30 ","$0.00 ","$66.15 ","$104.78 ","$105.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210445","SUP","Custom 27203010","","210445  -  BIT DRL LNG 4.3MM 127MM STRL CUT SS","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$132.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.30 ","$0.00 ","$66.15 ","$104.78 ","$105.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210446","SUP","Custom 27203010","","210446  -  BIT DRL LNG 4.7MM 127MM TWST SS","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$132.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.30 ","$0.00 ","$66.15 ","$104.78 ","$105.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210447","SUP","Custom 27203010","","210447  -  BIT DRL 5.5MM 127MM STRL TWST SS","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$140.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.70 ","$0.00 ","$70.35 ","$111.43 ","$112.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210448","SUP","Custom 27203010","","210448  -  BIT DRL LNG 6.4MM 127MM STRL CUT SS","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$132.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.30 ","$0.00 ","$66.15 ","$104.78 ","$105.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210450","SUP","Custom 27203010","","210450  -  BIT DRL 2.7MM 152.4MM STRL TWST SS","BOTH IP/OP","$157.50 ","$116.55 ","$0.00 ","$157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210451","SUP","Custom 27203010","","210451  -  BIT DRL LNG 3.5MM 152.4MM STRL TWST SS","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210454","SUP","Custom 27203010","","210454  -  BIT DRL 5/16MM STRL TWST SS","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210455","SUP","Custom 27203010","","210455  -  BIT DRL LG 9.5MM 127MM STRL TWST SS","BOTH IP/OP","$632.10 ","$467.75 ","$0.00 ","$632.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.10 ","$0.00 ","$316.05 ","$500.62 ","$505.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210458","SUP","Custom 27203010","","210458  -  BIT DRL LG 11.1MM 127MM STRL TWST SS","BOTH IP/OP","$679.35 ","$502.72 ","$0.00 ","$679.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.35 ","$0.00 ","$339.68 ","$538.05 ","$543.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210461","SUP","Custom 27203010","","210461  -  BIT DRL LG 12.7MM 127MM TWST","BOTH IP/OP","$679.35 ","$502.72 ","$0.00 ","$679.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$679.35 ","$0.00 ","$339.68 ","$538.05 ","$543.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210465","SUP","Custom 27203010","","210465  -  BIT DRL 3.6MM 152.4MM STRL TWST SS","BOTH IP/OP","$217.35 ","$160.84 ","$0.00 ","$217.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$217.35 ","$0.00 ","$108.68 ","$172.14 ","$173.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210521","SUP","Custom 27203010","","210521  -  FORCEP SPEC RTRVL 65CM 5.2FR 1 JAW ALGTR TOOTH FLXB SHFT","BOTH IP/OP","$707.35 ","$523.44 ","$0.00 ","$707.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.35 ","$0.00 ","$353.68 ","$560.22 ","$565.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210550","SUP","Custom 27203010","","210550  -  BIT DRL 2.4MM 127MM STRL TWST SUT HL SS","BOTH IP/OP","$166.95 ","$123.54 ","$0.00 ","$166.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.95 ","$0.00 ","$83.48 ","$132.22 ","$133.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210551","SUP","Custom 27203010","","210551  -  BIT DRL 2.7MM 127MM STRL TWST SUT HL SS","BOTH IP/OP","$166.95 ","$123.54 ","$0.00 ","$166.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.95 ","$0.00 ","$83.48 ","$132.22 ","$133.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210552","SUP","Custom 27203010","","210552  -  BIT DRL 3.1MM 127MM STRL TWST SUT HL SS","BOTH IP/OP","$164.85 ","$121.99 ","$0.00 ","$164.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.85 ","$0.00 ","$82.43 ","$130.56 ","$131.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"210554","SUP","Custom 27203010","","210554  -  BIT DRL 3.9MM 127MM STRL TWST SUT HL","BOTH IP/OP","$164.85 ","$121.99 ","$0.00 ","$164.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.85 ","$0.00 ","$82.43 ","$130.56 ","$131.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"211250","SUP","HCPCS C1763","","211250  -  GRAFT SOFT TISSUE 2-3MM 50MM ALLOGRAFT MULTIPLE CLEAN AVANCE","BOTH IP/OP","$11,165.00 ","$8,262.10 ","$0.00 ","$10,125.00 ","$4,556.25 ","$0.00 ","$2,327.07 ","$0.00 ","$0.00 ","$1,772.81 ","$10,125.00 ","$0.00 ","$5,062.50 ","$8,019.00 ","$8,100.00 ","$0.00 ","$1,584.56 ","$0.00 ","$1,611.90 ","$0.00 "
"212038","SUP","HCPCS C1713","","212038  -  ANCHOR SUTURE OTHCRD","BOTH IP/OP","$1,027.50 ","$760.35 ","$0.00 ","$1,027.50 ","$462.38 ","$0.00 ","$214.16 ","$0.00 ","$0.00 ","$179.91 ","$1,027.50 ","$0.00 ","$513.75 ","$813.78 ","$822.00 ","$0.00 ","$160.80 ","$0.00 ","$163.58 ","$0.00 "
"212133","SUP","HCPCS C1713","","212133  -  ANCHOR SUTURE 0 OS-2 MINI QANCHR+ SFT TIS SHLDR ARTHRO TI","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"212525","SUP","Custom 27203010","","STAIN MCBL GM CRYS VIOL WKG SOL BBL 250ML","BOTH IP/OP","$17.55 ","$12.99 ","$0.00 ","$17.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.55 ","$0.00 ","$8.78 ","$13.90 ","$14.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"212843","SUP","HCPCS C1713","","212843  -  ANCHOR SUT 3-0 V-4 MIC 1.3MM STRL LF QANCHR+ OTHCRD BABSR","BOTH IP/OP","$1,480.00 ","$1,095.20 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$308.47 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"212865","SUP","HCPCS C1713","","212865  -  ANCHOR SUT 3-0 V-4 MIC QAN+ ETH BIT","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$333.00 ","$0.00 ","$154.23 ","$0.00 ","$0.00 ","$129.57 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$115.81 ","$0.00 ","$117.81 ","$0.00 "
"213352","SUP","Custom 27203010","","REAGENT FLW CYMTR CTCHX FIXAT TRNSPT STOR 1ML","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"213524","SUP","HCPCS C1713","","213524  -  PIN FX 3.2MM 110MM STRL LF BN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"213527","SUP","HCPCS C1713","","213527  -  PIN FX 3.2MM 140MM STRL LF BN","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"219791","SUP","Custom 27203010","","219791  -  MONTEFIORE 7FR X 100CM","BOTH IP/OP","$39.38 ","$29.14 ","$0.00 ","$39.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.38 ","$0.00 ","$19.69 ","$31.19 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"221716","SUP","Custom 27203010","","MEDIA CULT TSB TUBE MCFLS 5ML","BOTH IP/OP","$75.88 ","$56.15 ","$0.00 ","$75.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.88 ","$0.00 ","$37.94 ","$60.10 ","$60.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"222000","SUP","Custom 27203010","","222000  -  IMMOBILIZER ORTH UNV 18-24IN KNEE 2 CUF SLD TO  ADJ EXOFORM","BOTH IP/OP","$47.13 ","$34.88 ","$0.00 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.59 ","$0.00 ","$21.29 ","$33.73 ","$34.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"222228","SUP","Custom 27203010","","MEDIA CULT C DFC SLCT AGAR PLT BBL","BOTH IP/OP","$26.43 ","$19.56 ","$0.00 ","$26.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.43 ","$0.00 ","$13.21 ","$20.93 ","$21.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"222820","SUP","HCPCS C1713","","222820  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 20MM STRL EXCEL ST FLUT CNN","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222822","SUP","HCPCS C1713","","222822  -  SCREW BN FT FLUT 4MM 22MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222824","SUP","HCPCS C1713","","222824  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 24MM STRL EXCEL ST FLUT CNN","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222826","SUP","HCPCS C1713","","222826  -  SCREW BN FT FLUT 4MM 26MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222828","SUP","HCPCS C1713","","222828  -  SCREW BN FT FLUT 4MM 28MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222830","SUP","HCPCS C1713","","222830  -  SCREW BN FT FLUT 4MM 30MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222835","SUP","HCPCS C1713","","222835  -  SCREW BN FT FLUT 4MM 35MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222840","SUP","HCPCS C1713","","222840  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 40MM STRL EXCEL ST FLUT CNN","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222845","SUP","HCPCS C1713","","222845  -  SCREW BN FT FLUT 4MM 45MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222850","SUP","HCPCS C1713","","222850  -  SCREW BN FT FLUT 4MM 50MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222855","SUP","HCPCS C1713","","222855  -  SCREW BN FT FLUT 4MM 55MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222860","SUP","HCPCS C1713","","222860  -  SCREW BN FT FLUT 4MM 60MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222865","SUP","HCPCS C1713","","222865  -  SCREW BN FT FLUT 4MM 65MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222870","SUP","HCPCS C1713","","222870  -  SCREW BN FT FLUT 4MM 70MM STRL EXCEL ST CNN TROC SS HIP","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"222983","SUP","HCPCS C1713","","222983  -  ANCHOR SUT 2 CP-2 2.4MM 8.8MM STRL G2QKAN + OTHCRD NDL NTNL","BOTH IP/OP","$1,030.00 ","$762.20 ","$0.00 ","$1,030.00 ","$463.50 ","$0.00 ","$214.68 ","$0.00 ","$0.00 ","$180.34 ","$1,030.00 ","$0.00 ","$515.00 ","$815.76 ","$824.00 ","$0.00 ","$161.20 ","$0.00 ","$163.98 ","$0.00 "
"222984","SUP","HCPCS C1713","","222984  -  ANCHOR SUT 2 CP-2 2.8MM 11.4MM STRL QANCHR+ OTHCRD NDL NTNL","BOTH IP/OP","$1,712.50 ","$1,267.25 ","$0.00 ","$1,045.00 ","$470.25 ","$0.00 ","$356.93 ","$0.00 ","$0.00 ","$182.97 ","$1,045.00 ","$0.00 ","$522.50 ","$827.64 ","$836.00 ","$0.00 ","$163.54 ","$0.00 ","$166.36 ","$0.00 "
"223522","SUP","HCPCS C1713","","223522  -  NAIL IM 3.5MM 22CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223524","SUP","HCPCS C1713","","223524  -  NAIL IM 3.5MM 24CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223525","SUP","HCPCS C1713","","223525  -  NAIL IM 3.5MM 25CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223526","SUP","HCPCS C1713","","223526  -  NAIL IM 3.5MM 26CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223527","SUP","HCPCS C1713","","223527  -  NAIL IM 3.5MM 27CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223528","SUP","HCPCS C1713","","223528  -  NAIL IM 3.5MM 28CM ENDR ORTH","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223529","SUP","HCPCS C1713","","223529  -  NAIL IM 3.5MM 29CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223530","SUP","HCPCS C1713","","223530  -  NAIL IM 3.5MM 30CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223531","SUP","HCPCS C1713","","223531  -  NAIL IM 3.5MM 31CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223532","SUP","HCPCS C1713","","223532  -  NAIL IM 3.5MM 32CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223533","SUP","HCPCS C1713","","223533  -  NAIL IM 3.5MM 33CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223534","SUP","HCPCS C1713","","223534  -  NAIL IM 3.5MM 34CM ENDR ADLT ORTH","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223535","SUP","HCPCS C1713","","223535  -  NAIL IM 3.5MM 35CM ENDR ORTH","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223536","SUP","HCPCS C1713","","223536  -  NAIL IM 3.5MM 36CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223537","SUP","HCPCS C1713","","223537  -  NAIL IM 3.5MM 37CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"223538","SUP","HCPCS C1713","","223538  -  NAIL IM 3.5MM 38CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224022","SUP","HCPCS C1713","","224022  -  NAIL IM 4MM 22CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224023","SUP","HCPCS C1713","","224023  -  NAIL IM 4MM 23CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224024","SUP","HCPCS C1713","","224024  -  NAIL IM 4MM 24CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224025","SUP","HCPCS C1713","","224025  -  NAIL IM 4MM 25CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224026","SUP","HCPCS C1713","","224026  -  NAIL IM 4MM 26CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224027","SUP","HCPCS C1713","","224027  -  NAIL IM 4MM 27CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224028","SUP","HCPCS C1713","","224028  -  NAIL IM 4MM 28CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224029","SUP","HCPCS C1713","","224029  -  NAIL IM 4MM 29CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224030","SUP","HCPCS C1713","","224030  -  NAIL IM 4MM 30CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224031","SUP","HCPCS C1713","","224031  -  NAIL IM 4MM 31CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224032","SUP","HCPCS C1713","","224032  -  NAIL IM 4MM 32CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224033","SUP","HCPCS C1713","","224033  -  NAIL IM 4MM 33CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224034","SUP","HCPCS C1713","","224034  -  NAIL IM 4MM 34CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224035","SUP","HCPCS C1713","","224035  -  NAIL IM 4MM 35CM ENDR SS HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224037","SUP","HCPCS C1713","","224037  -  NAIL IM 4MM 37CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224527","SUP","HCPCS C1713","","224527  -  NAIL IM 4.5MM 27CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224532","SUP","HCPCS C1713","","224532  -  NAIL IM 4.5MM 32CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224533","SUP","HCPCS C1713","","224533  -  NAIL IM 4.5MM 33CM ENDR","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224534","SUP","HCPCS C1713","","224534  -  NAIL IM 4.5MM 34CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224535","SUP","HCPCS C1713","","224535  -  NAIL IM 4.5MM 35CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224536","SUP","HCPCS C1713","","224536  -  NAIL IM 4.5MM 36CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224537","SUP","HCPCS C1713","","224537  -  NAIL IM 4.5MM 37CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224538","SUP","HCPCS C1713","","224538  -  NAIL IM 4.5MM 38CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224539","SUP","HCPCS C1713","","224539  -  NAIL IM 4.5MM 39CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224540","SUP","HCPCS C1713","","224540  -  NAIL IM 4.5MM 40CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224541","SUP","HCPCS C1713","","224541  -  NAIL IM 4.5MM 41CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224542","SUP","HCPCS C1713","","224542  -  NAIL IM 4.5MM 42CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224543","SUP","HCPCS C1713","","224543  -  NAIL IM 4.5MM 43CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224544","SUP","HCPCS C1713","","224544  -  NAIL IM 4.5MM 44CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224545","SUP","HCPCS C1713","","224545  -  NAIL IM 4.5MM 45CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224546","SUP","HCPCS C1713","","224546  -  NAIL IM 4.5MM 46CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224547","SUP","HCPCS C1713","","224547  -  NAIL IM 4.5MM 47CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224548","SUP","HCPCS C1713","","224548  -  NAIL IM 4.5MM 48CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"224549","SUP","HCPCS C1713","","224549  -  NAIL IM 4.5MM 49CM ENDR HUM TIB","BOTH IP/OP","$1,092.38 ","$808.36 ","$0.00 ","$1,092.38 ","$491.57 ","$0.00 ","$227.68 ","$0.00 ","$0.00 ","$191.27 ","$1,092.38 ","$0.00 ","$546.19 ","$865.16 ","$873.90 ","$0.00 ","$170.96 ","$0.00 ","$173.91 ","$0.00 "
"231554","SUP","Custom 25003010","","DISK OPTOCHIN PNMC DIFF BD TXO SNS","BOTH IP/OP","$91.08 ","$67.40 ","$0.00 ","$91.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.08 ","$0.00 ","$45.54 ","$72.14 ","$72.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"232447","SUP","HCPCS C1713","","232447  -  SYSTEM FX STD RIGIDLOOP ADJ CORT","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"240765","SUP","Custom 27203010","","REAGENT VDRL CRDLPN AG BUFF SAL DFC .5ML 60ML NTRPN VL SERO","BOTH IP/OP","$127.95 ","$94.68 ","$0.00 ","$127.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.95 ","$0.00 ","$63.98 ","$101.34 ","$102.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-00","SUP","Custom 27803010","","01-2600  -  HEAD FEMORAL MORSE TAPERED LFIT HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-2600  -  HEAD FEMORAL 0 26MM C TAPER LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jan","SUP","Custom 27803010","","01-2605  -  HEAD FEMORAL +5MM 26MM MORSE TAPERED LFIT COCR HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jun","SUP","Custom 27803010","","06-2605  -  HEAD FEMORAL +5MM 26MM C TAPER OFFST LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"258962","SUP","HCPCS C1769","","258962  -  INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT","BOTH IP/OP","$843.75 ","$624.38 ","$0.00 ","$843.75 ","$458.16 ","$0.00 ","$175.86 ","$0.00 ","$0.00 ","$147.73 ","$843.75 ","$0.00 ","$421.88 ","$668.25 ","$675.00 ","$0.00 ","$132.05 ","$0.00 ","$134.33 ","$0.00 "
"10-Jan","SUP","Custom 27803010","","01-2610  -  HEAD FEMORAL +10MM 26MM MORSE TAPERED LFIT COCR","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Jun","SUP","Custom 27803010","","06-2610  -  HEAD FEMORAL +10MM 26MM C TAPER LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"261187","SUP","Custom 27203010","","REAGENT MCBL DMACA INDL DRPR BBL .5ML","BOTH IP/OP","$1.33 ","$0.98 ","$0.00 ","$1.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.33 ","$0.00 ","$0.66 ","$1.05 ","$1.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"261221","SUP","Custom 27203010","","261221  -  PERFORATOR SURG 14MM 11MM 14X11MM CRANIUM ADULT STERILE","BOTH IP/OP","$735.05 ","$543.94 ","$0.00 ","$735.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.05 ","$0.00 ","$367.53 ","$582.16 ","$588.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"263567","SUP","HCPCS C1769","","263567  -  SET INTROD 24-26-28FR CGL BRHN 6 PERC EZ-PASS HYDPHI COAT","BOTH IP/OP","$905.05 ","$669.74 ","$0.00 ","$905.05 ","$491.44 ","$0.00 ","$188.64 ","$0.00 ","$0.00 ","$158.47 ","$905.05 ","$0.00 ","$452.53 ","$716.80 ","$724.04 ","$0.00 ","$141.64 ","$0.00 ","$144.08 ","$0.00 "
"265724","SUP","Custom 27203010","","265724  -  CATHETER FOLEY 5CC 24FR","BOTH IP/OP","$4.60 ","$3.40 ","$0.00 ","$4.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.89 ","$0.00 ","$2.45 ","$3.87 ","$3.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"266720","SUP","Custom 27203010","","266720  -  CATHETER URTH 20FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE","BOTH IP/OP","$5.73 ","$4.24 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.73 ","$0.00 ","$2.86 ","$4.54 ","$4.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"266722","SUP","Custom 27203010","","266722  -  CATHETER URTH 22FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE","BOTH IP/OP","$5.73 ","$4.24 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.73 ","$0.00 ","$2.86 ","$4.54 ","$4.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"266728","SUP","Custom 27203010","","266728  -  CATH URTH 28FR 2W 2 OPPS EYE FOLEY RND TIP SIL-EL 30ML STRL","BOTH IP/OP","$0.48 ","$0.36 ","$0.00 ","$6.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.18 ","$0.00 ","$3.09 ","$4.89 ","$4.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"268877","SUP","Custom 27203010","","TUBE ACD SOL B 3ML YLW VCTNR CNV CLSR COLLECT","BOTH IP/OP","$0.65 ","$0.48 ","$0.00 ","$0.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.65 ","$0.00 ","$0.33 ","$0.51 ","$0.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"272905","SUP","Custom 27203010","","DEVICE MACV DISPENSTIRS RPR VDRL KT SERTST .05ML","BOTH IP/OP","$183.63 ","$135.89 ","$0.00 ","$183.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$183.63 ","$0.00 ","$91.81 ","$145.43 ","$146.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276081","SUP","Custom 27803010","","276081  -  SHUNT 276081 UNI DSM VCATH23CM PCTH120CM","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276082","SUP","Custom 27803010","","276082  -  SHUNT 276082 UNI DSM VCATH23CM PCTH120CM","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276084","SUP","Custom 27803010","","276084  -  SHUNT 276084 UNI DSM VCATH23CM PCTH120CM","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276085","SUP","Custom 27803010","","276085  -  SHUNT 276085 UNI DSM VCATH23CM PCTH120CM","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276124","SUP","Custom 27803010","","276124  -  SHUNT 276124 UNIDLTA VCATH11 PCATH90 38+","BOTH IP/OP","$4,251.25 ","$3,145.93 ","$0.00 ","$4,251.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,251.25 ","$0.00 ","$2,125.63 ","$3,366.99 ","$3,401.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276125","SUP","Custom 27803010","","276125  -  SHUNT 276125 UNIDLTA VCATH11 PCATH90 38+","BOTH IP/OP","$4,251.25 ","$3,145.93 ","$0.00 ","$4,251.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,251.25 ","$0.00 ","$2,125.63 ","$3,366.99 ","$3,401.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276201","SUP","Custom 27203010","","276201  -  KIT 276201 SHNT SM BIO PCATH 90 VCATH 15","BOTH IP/OP","$5,804.50 ","$4,295.33 ","$0.00 ","$5,804.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,804.50 ","$0.00 ","$2,902.25 ","$4,597.16 ","$4,643.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276391","SUP","Custom 27203010","","276391  -  KIT 276391 DREG VRES PCATH120 VCATH15","BOTH IP/OP","$4,970.88 ","$3,678.45 ","$0.00 ","$4,970.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,970.88 ","$0.00 ","$2,485.44 ","$3,936.94 ","$3,976.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276412","SUP","Custom 27803010","","276412  -  SHUNT 276412 DSM PCATH130 STRP NOSLT","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276421","SUP","Custom 27803010","","276421  -  SHUNT 276421 DREG PCATH130 STRP P/L 1.0","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"276709","SUP","Custom 27203010","","CONTROL RPR BBL MACV CRD 1.5ML IMMUN","BOTH IP/OP","$105.93 ","$78.39 ","$0.00 ","$105.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.93 ","$0.00 ","$52.96 ","$83.90 ","$84.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"278801","SUP","Custom 27803010","","278801  -  SHUNT 278801 DELTA SNP ASY BG SML PL 1.0","BOTH IP/OP","$2,983.00 ","$2,207.42 ","$0.00 ","$2,983.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,983.00 ","$0.00 ","$1,491.50 ","$2,362.54 ","$2,386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"278802","SUP","Custom 27803010","","278802  -  SHUNT 278802 DELTA SNP ASY BG SML PL 2.0","BOTH IP/OP","$2,983.00 ","$2,207.42 ","$0.00 ","$2,983.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,983.00 ","$0.00 ","$1,491.50 ","$2,362.54 ","$2,386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"278805","SUP","Custom 27803010","","278805  -  SHUNT 278805 DELTA SNP ASY BG SML PL 1.5","BOTH IP/OP","$2,983.00 ","$2,207.42 ","$0.00 ","$2,983.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,983.00 ","$0.00 ","$1,491.50 ","$2,362.54 ","$2,386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"281000","SUP","Custom 27203010","","281000  -  DRESSING FOAM THIN 2X1.6IN SELF ADHERENT MOISTURE PROOF","BOTH IP/OP","$221.83 ","$164.15 ","$0.00 ","$266.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.72 ","$0.00 ","$133.36 ","$211.24 ","$213.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282400","SUP","Custom 27203010","","282400  -  DRESSING FM 9.2X9.2IN MPLX BR ADH SAFETAC SIL SCRM","BOTH IP/OP","$26.69 ","$19.75 ","$0.00 ","$26.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.69 ","$0.00 ","$13.34 ","$21.14 ","$21.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"287300","SUP","Custom 27203010","","287300  -  DRESSING FOAM 6X6IN ABSORBENT SELF ADHERENT WATERPROOF","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$42.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.48 ","$0.00 ","$21.24 ","$33.64 ","$33.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"287500","SUP","Custom 27203010","","287500  -  DRESSING FOAM 20X8IN GENTLE ADHERENCE POLYURETHANE FOAM PAD","BOTH IP/OP","$154.14 ","$114.06 ","$0.00 ","$167.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$167.05 ","$0.00 ","$83.52 ","$132.30 ","$133.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-91","SUP","HCPCS C1713","","01-2691  -  PLATE BONE RECONSTRUCTION ADD ON LEFT CNDYLR HEAD MANDIB 2.4","BOTH IP/OP","$7,577.50 ","$5,607.35 ","$0.00 ","$7,577.50 ","$3,409.88 ","$0.00 ","$1,579.34 ","$0.00 ","$0.00 ","$1,326.76 ","$7,577.50 ","$0.00 ","$3,788.75 ","$6,001.38 ","$6,062.00 ","$0.00 ","$1,185.88 ","$0.00 ","$1,206.34 ","$0.00 "
"Jan-92","SUP","HCPCS C1713","","01-2692  -  PLATE BONE RECONSTRUCTION ADD ON RIGHT CNDYLR HEAD MANDIB","BOTH IP/OP","$7,577.50 ","$5,607.35 ","$0.00 ","$7,577.50 ","$3,409.88 ","$0.00 ","$1,579.34 ","$0.00 ","$0.00 ","$1,326.76 ","$7,577.50 ","$0.00 ","$3,788.75 ","$6,001.38 ","$6,062.00 ","$0.00 ","$1,185.88 ","$0.00 ","$1,206.34 ","$0.00 "
"290058","SUP","HCPCS C1713","","290058  -  CAP PCTV 4MM RD STRL","BOTH IP/OP","$84.30 ","$62.38 ","$0.00 ","$84.30 ","$37.94 ","$0.00 ","$17.57 ","$0.00 ","$0.00 ","$14.76 ","$84.30 ","$0.00 ","$42.15 ","$66.77 ","$67.44 ","$0.00 ","$13.19 ","$0.00 ","$13.42 ","$0.00 "
"290060","SUP","HCPCS C1713","","290060  -  CAP PCTV 3MM GRN STRL","BOTH IP/OP","$83.70 ","$61.94 ","$0.00 ","$83.70 ","$37.67 ","$0.00 ","$17.45 ","$0.00 ","$0.00 ","$14.66 ","$83.70 ","$0.00 ","$41.85 ","$66.29 ","$66.96 ","$0.00 ","$13.10 ","$0.00 ","$13.33 ","$0.00 "
"290061","SUP","HCPCS C1713","","290061  -  CAP PROTECTIVE 5MM BLACK STERILE","BOTH IP/OP","$78.20 ","$57.87 ","$0.00 ","$78.20 ","$35.19 ","$0.00 ","$16.30 ","$0.00 ","$0.00 ","$13.69 ","$78.20 ","$0.00 ","$39.10 ","$61.93 ","$62.56 ","$0.00 ","$12.24 ","$0.00 ","$12.45 ","$0.00 "
"293400","SUP","Custom 27203010","","293400  -  DRESSING MPFRM THN 7X4IN ADH FLXB WTPRF SAFETAC TCH WND SIL","BOTH IP/OP","$17.62 ","$13.04 ","$0.00 ","$17.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.62 ","$0.00 ","$8.81 ","$13.96 ","$14.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"295900","SUP","Custom 27203010","","295900  -  DRESSING FOAM 12X4IN ABSORBENT NONADHERENT WATERPROOF","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.07 ","$297.89 ","$300.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"296348","SUP","Custom 27203010","","MEDIA MYCL SAB-DEX EMNS AGAR GNTA BBL PLT DP FILL","BOTH IP/OP","$57.80 ","$42.77 ","$0.00 ","$57.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.80 ","$0.00 ","$28.90 ","$45.78 ","$46.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"304206","SUP","HCPCS C1729","","CATHETER IV 16GA 1.25IN RADIOPQ SFSHLD GRY PCTV TFLN STRL LF","BOTH IP/OP","$3.88 ","$2.87 ","$0.00 ","$3.88 ","$2.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$3.88 ","$0.00 ","$1.94 ","$3.07 ","$3.10 ","$0.00 ","$0.61 ","$0.00 ","$0.62 ","$0.00 "
"310431","SUP","Custom 27203010","","310431  -  BIT DRILL 180MM 4.3MM QC 5MM LCK SCR NONSTRL","BOTH IP/OP","$260.10 ","$192.47 ","$0.00 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$260.10 ","$0.00 ","$130.05 ","$206.00 ","$208.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311270","SUP","HCPCS C1768","","311270  -  GRAFT, AVANCE NERVE, 3-4MM X 70MM","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$14,750.00 ","$6,637.50 ","$0.00 ","$3,356.68 ","$0.00 ","$0.00 ","$2,582.61 ","$14,750.00 ","$0.00 ","$7,375.00 ","$11,682.00 ","$11,800.00 ","$0.00 ","$2,308.38 ","$0.00 ","$2,348.20 ","$0.00 "
"315804","SUP","Custom 27203010","","315804  -  CANNU PRFSN 11.4IN 4MM CORON ART STR SLF INFL BLN LATEX FREE","BOTH IP/OP","$163.75 ","$121.18 ","$0.00 ","$163.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.75 ","$0.00 ","$81.88 ","$129.69 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315805","SUP","Custom 27203010","","315805  -  CANNULA PERFUSION 2.1MM STR 5MM 11.4IN SELF INFLATING","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315806","SUP","Custom 27203010","","315806  -  CANNU PRFSN 11.4IN 6MM CORON ART 3MM STR SLF INFL BLN FMALE","BOTH IP/OP","$196.50 ","$145.41 ","$0.00 ","$196.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.50 ","$0.00 ","$98.25 ","$155.63 ","$157.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315807","SUP","Custom 27203010","","315807  -  CANNU PRFSN 11.4IN 7MM CORON ART 3MM STR SLF INFL BLN FMALE","BOTH IP/OP","$163.75 ","$121.18 ","$0.00 ","$163.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.75 ","$0.00 ","$81.88 ","$129.69 ","$131.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323020","SUP","Custom 27803010","","323020  -  STENT LARYNGEAL SMALL 2 SUTURE BUTTON FLEXIBLE NONADHERENT","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323025","SUP","Custom 27803010","","323025  -  STENT LARYNGEAL MEDIUM FLEXIBLE NONADHERENT INTEGRAL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323030","SUP","Custom 27803010","","323030  -  STENT LARYNGEAL LARGE FLEXIBLE NONADHERENT INTEGRAL","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"325014","SUP","HCPCS C1713","","325014  -  SCREW BN 4MM 14MM NS ASNS III P/T CNN SS","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325016","SUP","HCPCS C1713","","325016  -  SCREW BONE 4MM 16MM ASNS 3 SS PTHRD FRARM CANN NONSTRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$192.50 ","$86.63 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"325018","SUP","HCPCS C1713","","325018  -  SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325020","SUP","HCPCS C1713","","325020  -  SCREW BONE 4MM 20MM ASNS 3 SS CANN NONSTRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325022","SUP","HCPCS C1713","","325022  -  SCREW BONE 4MM 22MM ASNS 3 SS CANN NONSTRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325024","SUP","HCPCS C1713","","325024  -  SCREW BONE 4MM 24MM ASNS 3 SS PTHRD FRARM CANN NONSTRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$192.50 ","$86.63 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"325026","SUP","HCPCS C1713","","325026  -  SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325028","SUP","HCPCS C1713","","325028  -  SCREW BN 4MM 28MM STRL 9.5MM ASNS III CNN SS","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325030","SUP","HCPCS C1713","","325030  -  SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325032","SUP","HCPCS C1713","","325032  -  SCREW BONE 4MM 32MM SS PTTHRD IMPL STRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325034","SUP","HCPCS C1713","","325034  -  SCREW BONE 4MM 34MM SS PTTHRD IMPL STRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325036","SUP","HCPCS C1713","","325036  -  SCREW BONE 4MM 36MM ASNS 3 SS PTHRD FEM HIP STRL","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325038","SUP","HCPCS C1713","","325038  -  SCREW BN P/T 4MM 38MM NS ASNS III ST SLF DRL LOPRFL HD CNN","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325040","SUP","HCPCS C1713","","325040  -  SCREW BONE 4MM 40MM ASNS 3 SS PTHRD HIP CANN SYS SLFTAP CUT","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325042","SUP","HCPCS C1713","","325042  -  SCREW BONE 4MM 42MM ASNS 3 SS ORTH CANN","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325044","SUP","HCPCS C1713","","325044  -  SCREW BONE 4MM 44MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"325046","SUP","HCPCS C1713","","325046  -  SCREW BONE 4MM 46MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325048","SUP","HCPCS C1713","","325048  -  SCREW BN P/T 4MM 48MM NS ASNS III ST SLF DRL LOPRFL HD CNN","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325050","SUP","HCPCS C1713","","325050  -  SCREW BONE 4MM 50MM ASNS 3 SS PTHRD HIP CANN SLFTAP SLFDRILL","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325055","SUP","HCPCS C1713","","325055  -  SCREW BONE 4MM 55MM ASNS 3 SS PTHRD HIP CANN SLFTAP CUT STRL","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325060","SUP","HCPCS C1713","","325060  -  SCREW BONE 4MM 60MM ASNS 3 SS CANN NONSTRL","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"325065","SUP","HCPCS C1713","","325065  -  SCREW BONE 4MM 65MM ASNS 3 SS HIP CANN NONSTRL","BOTH IP/OP","$274.55 ","$203.17 ","$0.00 ","$286.00 ","$128.70 ","$0.00 ","$57.22 ","$0.00 ","$0.00 ","$50.08 ","$286.00 ","$0.00 ","$143.00 ","$226.51 ","$228.80 ","$0.00 ","$44.76 ","$0.00 ","$45.53 ","$0.00 "
"325070","SUP","HCPCS C1713","","325070  -  SCREW BONE 4MM 70MM ASNS 3 SS PTHRD HIP CANN STRL","BOTH IP/OP","$274.55 ","$203.17 ","$0.00 ","$286.00 ","$128.70 ","$0.00 ","$57.22 ","$0.00 ","$0.00 ","$50.08 ","$286.00 ","$0.00 ","$143.00 ","$226.51 ","$228.80 ","$0.00 ","$44.76 ","$0.00 ","$45.53 ","$0.00 "
"325420","SUP","HCPCS C1713","","325420  -  SCREW BONE 5MM 20MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$166.38 ","$74.87 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$29.13 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$26.04 ","$0.00 ","$26.49 ","$0.00 "
"326260","SUP","HCPCS C1713","","326260  -  SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"Jan-00","SUP","Custom 27803010","","01-2800  -  HEAD FEM +0MM OFST MRS TPR 28MM STRL HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-2800  -  HEAD FEM +0MM OFST CTPR 28MM LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"330046","SUP","Custom 27203010","","ADAPTER TBG Y 2 FMALE SCR TO 1 MALE BYNT","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jan","SUP","HCPCS C1776","","01-2805  -  HEAD FEM +5MM 28MM LFIT MRS TPR COCR HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$807.75 ","$0.00 ","$374.12 ","$0.00 ","$0.00 ","$314.29 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$280.92 ","$0.00 ","$285.76 ","$0.00 "
"5-Jun","SUP","Custom 27803010","","06-2805  -  HEAD FEM +5MM OFST CTPR 28MM LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"331822","SUP","HCPCS C1729","","CATHETER CONTAMINATING GUARD AG-2000","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"332079","SUP","Custom 27203010","","TRAY EPDRL 17GA 3.5IN NDL MTL TIP SYR FLTR PRFX TH SCHF","BOTH IP/OP","$720.00 ","$532.80 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$360.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Jan","SUP","Custom 27803010","","01-2810  -  HEAD FEM LFIT MRS TPR","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Jun","SUP","Custom 27803010","","06-2810  -  HEAD FEM +10MM OFST CTPR 28MM LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"333676","SUP","Custom 27203010","","NEEDLE NS STPLX D BVL INSL EXTN SET 15D 4.75IN 22GA","BOTH IP/OP","$127.50 ","$94.35 ","$0.00 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.50 ","$0.00 ","$63.75 ","$100.98 ","$102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"333690","SUP","Custom 27203010","","NEEDLE NS STPLX A INSL EXTN SET BVL 30D DIG/HNS11 STM 2IN 22","BOTH IP/OP","$23.45 ","$17.35 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.45 ","$0.00 ","$11.73 ","$18.57 ","$18.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"334050","SUP","HCPCS C1900","","334050  -  PHILOS DR SYSTEM","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$1,771.61 ","$0.00 ","$0.00 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$0.00 ","$0.00 "
"335903","SUP","HCPCS C1729","","CATHETER IV 20GA 1.75IN RADIOPQ SFSHLD PNK ACV+ OCRILON STRL","BOTH IP/OP","$3.98 ","$2.95 ","$0.00 ","$3.98 ","$2.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.70 ","$3.98 ","$0.00 ","$1.99 ","$3.15 ","$3.18 ","$0.00 ","$0.62 ","$0.00 ","$0.63 ","$0.00 "
"338001","SUP","HCPCS C1729","","CATHETER IV 22GA 1IN RADIOPQ SFSHLD BLUE ACV J TFLN STRL LF","BOTH IP/OP","$3.80 ","$2.81 ","$0.00 ","$3.80 ","$2.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.67 ","$3.80 ","$0.00 ","$1.90 ","$3.01 ","$3.04 ","$0.00 ","$0.59 ","$0.00 ","$0.60 ","$0.00 "
"338610","SUP","HCPCS C1713","","338610  -  SCREW BONE 3.5MM 10MM AXSOS SS FULTHD CORT SLFTAP","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338612","SUP","HCPCS C1713","","338612  -  SCREW BONE 3.5MM 12MM SS CORT SLFTAP","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338614","SUP","HCPCS C1713","","338614  -  SCREW BONE 3.5MM 14MM AXSOS SS FULTHD CORT HUM HEX DRV","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338616","SUP","HCPCS C1713","","338616  -  SCREW BONE 3.5MM 16MM SS CORT SLFTAP","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338618","SUP","HCPCS C1713","","338618  -  SCREW BONE 3.5MM 2.5MM 18MM AXSOS SS CORT PROX HUM HEX DRV","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338620","SUP","HCPCS C1713","","338620  -  SCREW BN 2.5MM 3.5MM 20MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338622","SUP","HCPCS C1713","","338622  -  SCREW BN 2.5MM 3.5MM 22MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338624","SUP","HCPCS C1713","","338624  -  SCREW BN 2.5MM 3.5MM 24MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338626","SUP","HCPCS C1713","","338626  -  SCREW BN 2.5MM 3.5MM 26MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338628","SUP","HCPCS C1713","","338628  -  SCREW BN 2.5MM 3.5MM 28MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338630","SUP","HCPCS C1713","","338630  -  SCREW BN 2.5MM 3.5MM 30MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338632","SUP","HCPCS C1713","","338632  -  SCREW BONE 3.5MM 32MM AXSOS SS 2.5MM PROX CORT HUM SLFTAP","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338634","SUP","HCPCS C1713","","338634  -  SCREW BN 2.5MM 3.5MM 34MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338636","SUP","HCPCS C1713","","338636  -  SCREW BONE 3.5MM 36MM AXSOS SS FULTHD CORT HUM HEX DRV","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338638","SUP","HCPCS C1713","","338638  -  SCREW BN 2.5MM 3.5MM 38MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338640","SUP","HCPCS C1713","","338640  -  SCREW BN 2.5MM 3.5MM 40MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338642","SUP","HCPCS C1713","","338642  -  SCREW BONE 3.5MM 40MM AXSOS SS FULTHD CORT SLFTAP","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338644","SUP","HCPCS C1713","","338644  -  SCREW BONE 3.5MM 44MM AXSOS SS FULTHD CORT HUM HEX DRV","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338645","SUP","HCPCS C1713","","338645  -  SCREW BN 2.5MM 3.5MM 45MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338646","SUP","HCPCS C1713","","338646  -  SCREW BONE 3.5MM 46MM SS CORT SLFTAP","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338648","SUP","HCPCS C1713","","338648  -  SCREW BONE 3.5MM 48MM AXSOS SS FULTHD CORT HUM HEX DRV","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338650","SUP","HCPCS C1713","","338650  -  SCREW BN 2.5MM 3.5MM 50MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338655","SUP","HCPCS C1713","","338655  -  SCREW BN 2.5MM 3.5MM 55MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338660","SUP","HCPCS C1713","","338660  -  SCREW BN 2.5MM 3.5MM 60MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338665","SUP","HCPCS C1713","","338665  -  SCREW BN 2.5MM 3.5MM 65MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338670","SUP","HCPCS C1713","","338670  -  SCREW BN 2.5MM 3.5MM 70MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338675","SUP","HCPCS C1713","","338675  -  SCREW BN 2.5MM 3.5MM 75MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338680","SUP","HCPCS C1713","","338680  -  SCREW BN 2.5MM 3.5MM 80MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338685","SUP","HCPCS C1713","","338685  -  SCREW BN 2.5MM 3.5MM 85MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338690","SUP","HCPCS C1713","","338690  -  SCREW BN 2.5MM 3.5MM 90MM NS ST HEX SS CORT AXSOS SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338695","SUP","HCPCS C1713","","338695  -  SCREW BONE 3.5MM 95MM CORT SLFTAP","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"338700","SUP","HCPCS C1713","","338700  -  SCREW BN FT 3.5MM 100MM ST HEX SS CORT AXSOS SM FRAG SET","BOTH IP/OP","$43.20 ","$31.97 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"338705","SUP","HCPCS C1713","","338705  -  SCREW BONE 3.5MM 105MM CORT SLFTAP","BOTH IP/OP","$43.20 ","$31.97 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"338710","SUP","HCPCS C1713","","338710  -  SCREW BONE 3.5MM 110MM CORT SLFTAP","BOTH IP/OP","$43.20 ","$31.97 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"338715","SUP","HCPCS C1713","","338715  -  SCREW BONE 3.5MM 115MM SS CORT SLFTAP","BOTH IP/OP","$43.20 ","$31.97 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"338720","SUP","HCPCS C1713","","338720  -  SCREW BONE 3.5MM 120MM SS CORT SLFTAP","BOTH IP/OP","$43.20 ","$31.97 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"340612","SUP","HCPCS C1713","","340612  -  SCREW BONE 4.5MM 12MM CORT SLFTAP","BOTH IP/OP","$28.88 ","$21.37 ","$0.00 ","$28.88 ","$12.99 ","$0.00 ","$6.02 ","$0.00 ","$0.00 ","$5.06 ","$28.88 ","$0.00 ","$14.44 ","$22.87 ","$23.10 ","$0.00 ","$4.52 ","$0.00 ","$4.60 ","$0.00 "
"340614","SUP","HCPCS C1713","","340614  -  SCREW BONE 4.5MM 14MM CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340616","SUP","HCPCS C1713","","340616  -  SCREW BONE 4.5MM 16MM ISO SS FULTHD CORT SLFTAP NONSTRL","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340618","SUP","HCPCS C1713","","340618  -  SCREW BONE 4.5MM 18MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340620","SUP","HCPCS C1713","","340620  -  SCREW BONE 4.5MM 20MM SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340622","SUP","HCPCS C1713","","340622  -  SCREW BONE 4.5MM 22MM SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340624","SUP","HCPCS C1713","","340624  -  SCREW BONE 4.5MM 24MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340626","SUP","HCPCS C1713","","340626  -  SCREW BONE 4.5MM 26MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340628","SUP","HCPCS C1713","","340628  -  SCREW BONE 4.5MM 28MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340630","SUP","HCPCS C1713","","340630  -  SCREW BONE 4.5MM 30MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340632","SUP","HCPCS C1713","","340632  -  SCREW BONE 4.5MM 32MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340634","SUP","HCPCS C1713","","340634  -  SCREW BONE 4.5MM 34MM SPS SS CORT SLFTAP BASIC FRAG SET","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340636","SUP","HCPCS C1713","","340636  -  SCREW BONE 4.5MM 36MM AXSOS SS 3.5MM LAT DISTAL CORT FEM","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340638","SUP","HCPCS C1713","","340638  -  SCREW BONE 4.5MM 38MM AXSOS SS 3.5MM LAT DISTAL CORT FEM","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340640","SUP","HCPCS C1713","","340640  -  SCREW BONE 4.5MM 40MM AXSOS SS 3.5MM LAT DISTAL CORT FEM","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340642","SUP","HCPCS C1713","","340642  -  SCREW BONE 4.5MM 42MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340644","SUP","HCPCS C1713","","340644  -  SCREW BONE 4.5MM 44MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340646","SUP","HCPCS C1713","","340646  -  SCREW BONE 4.5MM 46MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340648","SUP","HCPCS C1713","","340648  -  SCREW BONE 4.5MM 48MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340650","SUP","HCPCS C1713","","340650  -  SCREW BONE 4.5MM 50MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340652","SUP","HCPCS C1713","","340652  -  SCREW BONE 4.5MM 52MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340654","SUP","HCPCS C1713","","340654  -  SCREW BONE 4.5MM 54MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340656","SUP","HCPCS C1713","","340656  -  SCREW BONE 4.5MM 56MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340658","SUP","HCPCS C1713","","340658  -  SCREW BONE 4.5MM 58MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340660","SUP","HCPCS C1713","","340660  -  SCREW BONE 4.5MM 60MM AXSOS SS CORT SLFTAP LCK HEX DRV","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340665","SUP","HCPCS C1713","","340665  -  SCREW BONE 4.5MM 3.5MM 65MM AXSOS SS CORT HEX DRV SLFTAP LCK","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340670","SUP","HCPCS C1713","","340670  -  SCREW BONE 4.5MM 70MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340675","SUP","HCPCS C1713","","340675  -  SCREW BONE 4.5MM 75MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340680","SUP","HCPCS C1713","","340680  -  SCREW BONE 4.5MM 80MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340685","SUP","HCPCS C1713","","340685  -  SCREW BONE 4.5MM 85MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340690","SUP","HCPCS C1713","","340690  -  SCREW BONE 4.5MM 90MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340695","SUP","HCPCS C1713","","340695  -  SCREW BONE 4.5MM 95MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$33.00 ","$14.85 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$5.78 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$5.16 ","$0.00 ","$5.25 ","$0.00 "
"340700","SUP","HCPCS C1713","","340700  -  SCREW BONE 4.5MM 100MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340705","SUP","HCPCS C1713","","340705  -  SCREW BONE 4.5MM 105MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340710","SUP","HCPCS C1713","","340710  -  SCREW BONE 4.5MM 100MM AXSOS SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340715","SUP","HCPCS C1713","","340715  -  SCREW BONE 4.5MM 115MM SS CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340720","SUP","HCPCS C1713","","340720  -  SCREW BONE 4.5MM 120MM CORT","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340725","SUP","HCPCS C1713","","340725  -  SCREW BONE 4.5MM 125MM ISO SS FULTHD CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340730","SUP","HCPCS C1713","","340730  -  SCREW BONE 4.5MM 130MM ISO SS FULTHD CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340735","SUP","HCPCS C1713","","340735  -  SCREW BONE 4.5MM 135MM ISO SS FULTHD CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340740","SUP","HCPCS C1713","","340740  -  SCREW BONE 4.5MM 140MM ISO SS FULTHD CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340745","SUP","HCPCS C1713","","340745  -  SCREW BONE 4.5MM 145MM ISO SS FULTHD CORT SLFTAP","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"340750","SUP","HCPCS C1713","","340750  -  SCREW BONE 4.5MM 150MM ISO SS CORT SLFTAP FULTHD","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.16 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"341025","SUP","HCPCS C1713","","341025  -  SCREW BN 6.5MM 25MM 16MM P/T CANC","BOTH IP/OP","$52.25 ","$38.67 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$10.89 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341030","SUP","HCPCS C1713","","341030  -  SCREW BONE 6.5MM 30MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341035","SUP","HCPCS C1713","","341035  -  SCREW BONE 6.5MM 35MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341040","SUP","HCPCS C1713","","341040  -  SCREW BONE 6.5MM 40MM 16MM CANC PTHRD","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341045","SUP","HCPCS C1713","","341045  -  SCREW BONE 6.5MM 45MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341050","SUP","HCPCS C1713","","341050  -  SCREW BONE 6.5MM 50MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341055","SUP","HCPCS C1713","","341055  -  SCREW BONE 6.5MM 55MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341060","SUP","HCPCS C1713","","341060  -  SCREW BONE 6.5MM 60MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341065","SUP","HCPCS C1713","","341065  -  SCREW BONE 6.5MM 65MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341070","SUP","HCPCS C1713","","341070  -  SCREW BONE 6.5MM 70MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341075","SUP","HCPCS C1713","","341075  -  SCREW BONE 6.5MM 75MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341080","SUP","HCPCS C1713","","341080  -  SCREW BONE 6.5MM 80MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341085","SUP","HCPCS C1713","","341085  -  SCREW BONE 6.5MM 85MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341090","SUP","HCPCS C1713","","341090  -  SCREW BONE 6.5MM 90MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341095","SUP","HCPCS C1713","","341095  -  SCREW BONE 6.5MM 95MM 16MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"341100","SUP","HCPCS C1713","","341100  -  SCREW BONE 6.5MM 100MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341105","SUP","HCPCS C1713","","341105  -  SCREW BONE 6.5MM 105MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341110","SUP","HCPCS C1713","","341110  -  SCREW BONE 6.5MM 110MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341115","SUP","HCPCS C1713","","341115  -  SCREW BONE 6.5MM 115MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341120","SUP","HCPCS C1713","","341120  -  SCREW BONE 6.5MM 120MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341125","SUP","HCPCS C1713","","341125  -  SCREW BONE 6.5MM 125MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341130","SUP","HCPCS C1713","","341130  -  SCREW BONE 6.5MM 130MM 16MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341140","SUP","HCPCS C1713","","341140  -  SCREW BONE 6.5MM 140MM 16MM SS CANC SLFTAP FULTHD ISO","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"341824","SUP","HCPCS C1786","","341824  -  PACEMAKER CRD THK6MM 53X39MM 11ML PH2 SR IMPL 1 CHMBR RR","BOTH IP/OP","$8,000.00 ","$5,920.00 ","$0.00 ","$8,000.00 ","$0.00 ","$0.00 ","$1,667.40 ","$0.00 ","$0.00 ","$0.00 ","$8,000.00 ","$0.00 ","$4,000.00 ","$6,336.00 ","$6,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"342040","SUP","HCPCS C1713","","342040  -  SCREW BONE 6.5MM 40MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342045","SUP","HCPCS C1713","","342045  -  SCREW BONE 6.5MM 45MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342050","SUP","HCPCS C1713","","342050  -  SCREW BONE 6.5MM 50MM SS CANC PTTHRD","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342055","SUP","HCPCS C1713","","342055  -  SCREW BONE 6.5MM 55MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342060","SUP","HCPCS C1713","","342060  -  SCREW BONE 6.5MM 60MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342065","SUP","HCPCS C1713","","342065  -  SCREW BONE 6.5MM 65MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342070","SUP","HCPCS C1713","","342070  -  SCREW BONE 6.5MM 70MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342075","SUP","HCPCS C1713","","342075  -  SCREW BONE 6.5MM 75MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342080","SUP","HCPCS C1713","","342080  -  SCREW BONE 6.5MM 80MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342085","SUP","HCPCS C1713","","342085  -  SCREW BONE 6.5MM 85MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342090","SUP","HCPCS C1713","","342090  -  SCREW BONE 6.5MM 90MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342095","SUP","HCPCS C1713","","342095  -  SCREW BONE 6.5MM 95MM 32MM SS CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"342100","SUP","HCPCS C1713","","342100  -  SCREW BONE 6.5MM 100MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342105","SUP","HCPCS C1713","","342105  -  SCREW BONE 6.5MM 105MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342110","SUP","HCPCS C1713","","342110  -  SCREW BONE 6.5MM 110MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342115","SUP","HCPCS C1713","","342115  -  SCREW BONE 6.5MM 115MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342120","SUP","HCPCS C1713","","342120  -  SCREW BONE 6.5MM 120MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342125","SUP","HCPCS C1713","","342125  -  SCREW BONE 6.5MM 125MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342130","SUP","HCPCS C1713","","342130  -  SCREW BONE 6.5MM 130MM 32MM SS CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"342140","SUP","HCPCS C1713","","342140  -  SCREW BONE 6.5MM 140MM 32MM SS CANC","BOTH IP/OP","$61.88 ","$45.79 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.90 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343020","SUP","HCPCS C1713","","343020  -  SCREW BONE 6.5MM 20MM SS FULTHD CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343025","SUP","HCPCS C1713","","343025  -  SCREW BONE 6.5MM 25MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343030","SUP","HCPCS C1713","","343030  -  SCREW BONE 6.5MM 30MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343035","SUP","HCPCS C1713","","343035  -  SCREW BONE 6.5MM 35MM SS FULTHD CANC LCK HEX DRV","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343040","SUP","HCPCS C1713","","343040  -  SCREW BONE 6.5MM 40MM ISO TI FULTHD CANC NONSTRL","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343045","SUP","HCPCS C1713","","343045  -  SCREW BONE 6.5MM 45MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343050","SUP","HCPCS C1713","","343050  -  SCREW BONE 6.5MM 50MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343055","SUP","HCPCS C1713","","343055  -  SCREW BONE 6.5MM 55MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343060","SUP","HCPCS C1713","","343060  -  SCREW BONE 6.5MM 60MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343065","SUP","HCPCS C1713","","343065  -  SCREW BONE 6.5MM 65MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343070","SUP","HCPCS C1713","","343070  -  SCREW BONE 6.5MM 70MM SS FULTHD CANC LCK HEX DRV","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343075","SUP","HCPCS C1713","","343075  -  SCREW BONE 6.5MM 75MM SS FULTHD CANC LCK HEX DRV","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343080","SUP","HCPCS C1713","","343080  -  SCREW BONE 6.5MM 80MM SS FULTHD CANC LCK HEX DRV","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343085","SUP","HCPCS C1713","","343085  -  SCREW BONE 6.5MM 85MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343090","SUP","HCPCS C1713","","343090  -  SCREW BONE 6.5MM 90MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343095","SUP","HCPCS C1713","","343095  -  SCREW BONE 6.5MM 95MM SS FULTHD CANC","BOTH IP/OP","$57.00 ","$42.18 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$11.88 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"343100","SUP","HCPCS C1713","","343100  -  SCREW BONE 6.5MM 100MM SS FULTHD CANC","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343105","SUP","HCPCS C1713","","343105  -  SCREW BONE 6.5MM 105MM SS CANC FULTHRD","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343110","SUP","HCPCS C1713","","343110  -  SCREW BONE 6.5MM 110MM SS CANC FULTHRD","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343115","SUP","HCPCS C1713","","343115  -  SCREW BONE 6.5MM 115MM SS CANC FULTHRD","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343120","SUP","HCPCS C1713","","343120  -  SCREW BONE 6.5MM 120MM ISO SS CANC FULTHRD","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343125","SUP","HCPCS C1713","","343125  -  SCREW BONE 6.5MM 125MM ISO SS FULTHD CANC HIP NONSTRL","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"343130","SUP","HCPCS C1713","","343130  -  SCREW BONE 6.5MM 130MM ISO SS FULTHD CANC HIP NONSTRL","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$61.88 ","$27.84 ","$0.00 ","$12.67 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"345410","SUP","HCPCS C1713","","345410  -  SCREW BONE 4MM 10MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345412","SUP","HCPCS C1713","","345412  -  SCREW BONE 4MM 12MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345414","SUP","HCPCS C1713","","345414  -  SCREW BONE 4MM 14MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345416","SUP","HCPCS C1713","","345416  -  SCREW BONE 4MM 16MM SS FULTHD CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345418","SUP","HCPCS C1713","","345418  -  SCREW BONE 4MM 18MM SS FULTHD CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345420","SUP","HCPCS C1713","","345420  -  SCREW BONE 4MM 20MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345422","SUP","HCPCS C1713","","345422  -  SCREW BONE 4MM 22MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345424","SUP","HCPCS C1713","","345424  -  SCREW BONE 4MM 24MM UNIFLEX SS FULTHD CANC IM NAIL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345426","SUP","HCPCS C1713","","345426  -  SCREW BONE 4MM 26MM UNIFLEX SS FULTHD CANC IM NAIL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345428","SUP","HCPCS C1713","","345428  -  SCREW BONE 4MM 28MM ISO SS FULTHD CANC NONSTRL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345430","SUP","HCPCS C1713","","345430  -  SCREW BONE 4MM 30MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345432","SUP","HCPCS C1713","","345432  -  SCREW BONE 4MM 32MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345434","SUP","HCPCS C1713","","345434  -  SCREW BONE 4MM 34MM UNIFLEX SS FULTHD CANC IM NAIL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345436","SUP","HCPCS C1713","","345436  -  SCREW BONE 4MM 36MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345438","SUP","HCPCS C1713","","345438  -  SCREW BONE 4MM 38MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345440","SUP","HCPCS C1713","","345440  -  SCREW BONE 4MM 40MM SS FULTHD CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345445","SUP","HCPCS C1713","","345445  -  SCREW BONE 4MM 45MM AXSOS SS 2.5MM FULTHD PROX CANC HUM LCK","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345450","SUP","HCPCS C1713","","345450  -  SCREW BONE 4MM 50MM SS FULTHD CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345455","SUP","HCPCS C1713","","345455  -  SCREW BONE 4MM 55MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345460","SUP","HCPCS C1713","","345460  -  SCREW BONE 4MM 60MM UNIFLEX SS FULTHD CANC IM NAIL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345465","SUP","HCPCS C1713","","345465  -  SCREW BONE 4MM 65MM AXSOS SS FULTHD CANC HEX DRV LCK","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345470","SUP","HCPCS C1713","","345470  -  SCREW BONE 4MM 70MM ISO SS FULTHD CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345475","SUP","HCPCS C1713","","345475  -  SCREW BONE 4MM 75MM SS FULTHD CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345480","SUP","HCPCS C1713","","345480  -  SCREW BONE 4MM 80MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345485","SUP","HCPCS C1713","","345485  -  SCREW BONE 4MM 85MM SS FULTHD CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345490","SUP","HCPCS C1713","","345490  -  SCREW BONE 4MM 90MM SS FULTHD CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345495","SUP","HCPCS C1713","","345495  -  SCREW BONE 4MM 95MM ISO SS FULTHD CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345500","SUP","HCPCS C1713","","345500  -  SCREW BONE 4MM 100MM ISO SS FULTHD CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345510","SUP","HCPCS C1713","","345510  -  SCREW BONE 4MM 10MM 5MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345512","SUP","HCPCS C1713","","345512  -  SCREW BONE 4MM 12MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345514","SUP","HCPCS C1713","","345514  -  SCREW BONE 4MM 14MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345516","SUP","HCPCS C1713","","345516  -  SCREW BONE 4MM 16MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345518","SUP","HCPCS C1758","","345518  -  SCREW BONE 4MM 18MM UNIFLEX SS CANC PTTHRD IM NAIL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345520","SUP","HCPCS C1713","","345520  -  SCREW BONE 4MM 20MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345522","SUP","HCPCS C1713","","345522  -  SCREW BONE 4MM 22MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345524","SUP","HCPCS C1713","","345524  -  SCREW BONE 4MM 24MM ISO SS PTHRD CANC PARTIL THRD SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345526","SUP","HCPCS C1713","","345526  -  SCREW BONE 4MM 26MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345528","SUP","HCPCS C1713","","345528  -  SCREW BONE 4MM 28MM UNIFLEX SS CANC PTHRD IM NAIL","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345530","SUP","HCPCS C1713","","345530  -  SCREW BONE 4MM 30MM AXSOS SS PTHRD CANC PTHRD SM FRAG SET","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345532","SUP","HCPCS C1713","","345532  -  SCREW BONE 4MM 32MM 14MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345534","SUP","HCPCS C1713","","345534  -  SCREW BONE 4MM 34MM 14MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345536","SUP","HCPCS C1713","","345536  -  SCREW BONE 4MM 36MM 14MM SS CANC PTHRD","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345538","SUP","HCPCS C1713","","345538  -  SCREW BONE 4MM 38MM 14MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345540","SUP","HCPCS C1713","","345540  -  SCREW BONE 4MM 40MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345545","SUP","HCPCS C1713","","345545  -  SCREW BN 2.5MM P/T 4MM 45MM NS HEX SS CANC AXSOS SM FRAG SET","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345550","SUP","HCPCS C1713","","345550  -  SCREW BONE 4MM 50MM AXSOS SS PTHRD CANC PTHRD SM FRAG SET","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345555","SUP","HCPCS C1713","","345555  -  SCREW BONE 4MM 55MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345560","SUP","HCPCS C1713","","345560  -  SCREW BONE 4MM 60MM 16MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345565","SUP","HCPCS C1713","","345565  -  SCREW BONE 4MM 65MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345570","SUP","HCPCS C1713","","345570  -  SCREW BONE 4MM 70MM 14MM SS CANC","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$8.44 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345575","SUP","HCPCS C1713","","345575  -  SCREW BONE 4MM 75MM SS CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345580","SUP","HCPCS C1713","","345580  -  SCREW BONE 4MM 80MM SS CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345585","SUP","HCPCS C1713","","345585  -  SCREW BONE 4MM 85MM 16MM ISO SS CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345590","SUP","HCPCS C1713","","345590  -  SCREW BONE 4MM 90MM 16MM ISO SS CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345595","SUP","HCPCS C1713","","345595  -  SCREW BONE 4MM 95MM AXSOS SS CANC LCK PTHRD","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"345600","SUP","HCPCS C1713","","345600  -  SCREW BONE 4MM 100MM 16MM ISO SS CANC","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$31.63 ","$14.23 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"348446","SUP","HCPCS C1900","","348446  -  PHILOS II DR SYSTEM","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$0.00 ","$0.00 "
"350974","SUP","HCPCS C1895","","350974  -  SETROX S 53 LEAD","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"353440","SUP","Custom 27203010","","PUNCH 7IN 4MM STD TIP STRL LF DISP AOR","BOTH IP/OP","$335.90 ","$248.57 ","$0.00 ","$465.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.00 ","$0.00 ","$232.50 ","$368.28 ","$372.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"355149","SUP","HCPCS C1900","","355149  -  COROX OTW 85 BP-S LEAD","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"356053","SUP","HCPCS C1900","","356053  -  CYLOS VR SYSTEM WITH CLS AUTONOMIC RESPONSE","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,500.00 ","$0.00 ","$0.00 ","$1,980.04 ","$0.00 ","$0.00 ","$0.00 ","$9,500.00 ","$0.00 ","$4,750.00 ","$7,524.00 ","$7,600.00 ","$0.00 ","$1,486.75 ","$0.00 ","$0.00 ","$0.00 "
"359654","SUP","HCPCS C1721","","359654  -  LUMAX 340 DR-T HIGH ENERGY WITH HM MOBILE GSM","BOTH IP/OP","$46,450.00 ","$34,373.00 ","$0.00 ","$46,450.00 ","$20,902.50 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,133.02 ","$46,450.00 ","$0.00 ","$23,225.00 ","$36,788.40 ","$37,160.00 ","$0.00 ","$7,269.43 ","$0.00 ","$7,394.84 ","$0.00 "
"359655","SUP","HCPCS C1721","","359655  -  LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM","BOTH IP/OP","$56,450.00 ","$41,773.00 ","$0.00 ","$56,450.00 ","$25,402.50 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$56,450.00 ","$0.00 ","$28,225.00 ","$44,708.40 ","$45,160.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"359656","SUP","HCPCS C1721","","359656  -  LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM LANDLINE","BOTH IP/OP","$51,450.00 ","$38,073.00 ","$0.00 ","$51,450.00 ","$23,152.50 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$51,450.00 ","$0.00 ","$25,725.00 ","$40,748.40 ","$41,160.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"359659","SUP","HCPCS C1882","","359659  -  LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM","BOTH IP/OP","$72,600.00 ","$53,724.00 ","$0.00 ","$72,600.00 ","$32,670.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$72,600.00 ","$0.00 ","$36,300.00 ","$57,499.20 ","$58,080.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"359662","SUP","HCPCS C1882","","359662  -  LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM LANDLINE","BOTH IP/OP","$67,600.00 ","$50,024.00 ","$0.00 ","$67,600.00 ","$30,420.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$67,600.00 ","$0.00 ","$33,800.00 ","$53,539.20 ","$54,080.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"359664","SUP","HCPCS C1786","","359664  -  LUMAX 340 VR-T HIGH ENERGY WITH HM MOBILE GSM","BOTH IP/OP","$42,700.00 ","$31,598.00 ","$0.00 ","$42,700.00 ","$0.00 ","$0.00 ","$8,899.75 ","$0.00 ","$0.00 ","$0.00 ","$42,700.00 ","$0.00 ","$21,350.00 ","$33,818.40 ","$34,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"359665","SUP","HCPCS C1786","","359665  -  LUMAX 340 VR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM","BOTH IP/OP","$52,700.00 ","$38,998.00 ","$0.00 ","$52,700.00 ","$0.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$0.00 ","$52,700.00 ","$0.00 ","$26,350.00 ","$41,738.40 ","$42,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"359666","SUP","HCPCS C1874","","359666  -  DFBR CRD LUMAX 340 VR-T AV 1 CHMBR RSYN THRP IMPLTABLE","BOTH IP/OP","$47,700.00 ","$35,298.00 ","$0.00 ","$47,700.00 ","$21,465.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$47,700.00 ","$0.00 ","$23,850.00 ","$37,778.40 ","$38,160.00 ","$0.00 ","$7,465.05 ","$0.00 ","$7,593.84 ","$0.00 "
"360101","SUP","Custom 27203010","","360101  -  DEVICE SPEC RTRVL .018IN 10MM 10CM INTLK DTCH COIL","BOTH IP/OP","$455.50 ","$337.07 ","$0.00 ","$455.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$455.50 ","$0.00 ","$227.75 ","$360.76 ","$364.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-98","SUP","Custom 27803010","","06-2898  -  HEAD FEM -3MM OFST CTPR 28MM LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"370001","SUP","Custom 27803010","","370001  -  INSERT ACETAB 3MM HIP LCK","BOTH IP/OP","$71.20 ","$52.69 ","$0.00 ","$74.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.25 ","$0.00 ","$37.13 ","$58.81 ","$59.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"370002","SUP","Custom 27803010","","370002  -  INSERT ACETAB 4MM SM BONE SS AXSOS PLT SYS","BOTH IP/OP","$78.40 ","$58.02 ","$0.00 ","$74.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.25 ","$0.00 ","$37.13 ","$58.81 ","$59.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"370003","SUP","Custom 27803010","","370003  -  INSERT TIB LAT DISTAL FEM SS LCK AXSOS 5MM NONSTRL BASIC","BOTH IP/OP","$96.25 ","$71.23 ","$0.00 ","$96.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"370004","SUP","HCPCS C1713","","370004  -  PLUG CABLE 4MM AXSOS SS SM FRAG","BOTH IP/OP","$78.40 ","$58.02 ","$0.00 ","$74.25 ","$33.41 ","$0.00 ","$16.34 ","$0.00 ","$0.00 ","$13.00 ","$74.25 ","$0.00 ","$37.13 ","$58.81 ","$59.40 ","$0.00 ","$11.62 ","$0.00 ","$11.82 ","$0.00 "
"370005","SUP","HCPCS C1713","","370005  -  PLUG CABLE 5MM AXSOS LAT DISTAL FEM SS NONSTRL","BOTH IP/OP","$102.40 ","$75.78 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.34 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"370008","SUP","HCPCS C1713","","370008  -  SCREW BONE 3MM 8MM ORTH LCK","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370010","SUP","HCPCS C1713","","370010  -  SCREW BONE 3MM 10MM ORTH LCK","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370012","SUP","HCPCS C1713","","370012  -  SCREW BONE 3MM 12MM AXSOS SS CORT T8 DRV LCK SLFTAP","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370014","SUP","HCPCS C1713","","370014  -  SCREW BONE 3MM 14MM AXSOS SS CORT T8 DRV LCK SLFTAP","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370016","SUP","HCPCS C1713","","370016  -  SCREW BONE 3MM 16MM AXSOS SS CORT T8 DRV LCK SLFTAP","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370018","SUP","HCPCS C1713","","370018  -  SCREW BONE 3MM 18MM AXSOS SS HUM FEM/TIB T8 DRV LCK SLFTAP","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370020","SUP","HCPCS C1713","","370020  -  SCREW BONE 3MM 20MM ORTH LCK","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370022","SUP","HCPCS C1713","","370022  -  SCREW BONE 3MM 22MM ORTH LCK","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370024","SUP","HCPCS C1713","","370024  -  SCREW BONE 3MM 24MM AXSOS SS CORT T8 DRV LCK SLFTAP","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370026","SUP","HCPCS C1713","","370026  -  SCREW BONE 3MM 26MM ORTH LCK","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370028","SUP","HCPCS C1713","","370028  -  SCREW BONE 3MM 28MM ORTH LCK","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370030","SUP","HCPCS C1713","","370030  -  SCREW BONE 3MM 30MM AXSOS SS CORT T8 DRV LCK SLFTAP","BOTH IP/OP","$132.00 ","$97.68 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$27.51 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"370110","SUP","HCPCS C1713","","370110  -  SCREW BONE 5MM 10MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$260.80 ","$192.99 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.36 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"370112","SUP","HCPCS C1713","","370112  -  SCREW BONE 5MM 12MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$260.80 ","$192.99 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.36 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"370114","SUP","HCPCS C1713","","370114  -  SCREW BONE 5MM 14MM AXSOS DISTAL LAT FEM SLFTAP LCK T20 DRV","BOTH IP/OP","$260.80 ","$192.99 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.36 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"370116","SUP","HCPCS C1713","","370116  -  SCREW BONE 5MM 16MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV","BOTH IP/OP","$260.80 ","$192.99 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.36 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"370118","SUP","HCPCS C1713","","370118  -  SCREW BONE 5MM 18MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$260.80 ","$192.99 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.36 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"370120","SUP","HCPCS C1713","","370120  -  SCREW BONE 5MM 20MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$260.80 ","$192.99 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.36 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"370314","SUP","HCPCS C1713","","370314  -  SCREW BONE 5MM 14MM ORTH LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370316","SUP","HCPCS C1713","","370316  -  SCREW BONE 5MM 16MM ORTH LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370318","SUP","HCPCS C1713","","370318  -  SCREW BONE 5MM 18MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370320","SUP","HCPCS C1713","","370320  -  SCREW BONE 5MM 20MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370322","SUP","HCPCS C1713","","370322  -  SCREW BONE 5MM 22MM ORTH LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370324","SUP","HCPCS C1713","","370324  -  SCREW BONE 5MM 24MM ORTH LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370326","SUP","HCPCS C1713","","370326  -  SCREW BONE 5MM 26MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370328","SUP","HCPCS C1713","","370328  -  SCREW BONE 5MM 28MM AXSOS SS LCK SLFTAP T20 DRV PLT SYS","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370330","SUP","HCPCS C1713","","370330  -  SCREW BONE 5MM 30MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370332","SUP","HCPCS C1713","","370332  -  SCREW BONE 5MM 32MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370334","SUP","HCPCS C1713","","370334  -  SCREW BONE 5MM 34MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370336","SUP","HCPCS C1713","","370336  -  SCREW BONE 5MM 36MM AXSOS SS HUM FEM/TIB T20 DRV SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370338","SUP","HCPCS C1713","","370338  -  SCREW BONE 5MM 38MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370340","SUP","HCPCS C1713","","370340  -  SCREW BONE 5MM 40MM AXSOS SS DISTAL LAT FEM LCK SLFTAP T20","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370342","SUP","HCPCS C1713","","370342  -  SCREW BONE 5MM 42MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370344","SUP","HCPCS C1713","","370344  -  SCREW BONE 5MM 44MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370346","SUP","HCPCS C1713","","370346  -  SCREW BONE 5MM 46MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370348","SUP","HCPCS C1713","","370348  -  SCREW BONE 5MM 48MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370350","SUP","HCPCS C1713","","370350  -  SCREW BONE 5MM 50MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370355","SUP","HCPCS C1713","","370355  -  SCREW BONE 5MM 55MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370360","SUP","HCPCS C1713","","370360  -  SCREW BONE 5MM 60MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370365","SUP","HCPCS C1713","","370365  -  SCREW BONE 5MM 65MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370370","SUP","HCPCS C1713","","370370  -  SCREW BONE 5MM 70MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370375","SUP","HCPCS C1713","","370375  -  SCREW BONE 5MM 75MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370380","SUP","HCPCS C1713","","370380  -  SCREW BONE 5MM 80MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370385","SUP","HCPCS C1713","","370385  -  SCREW BONE 5MM 85MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370390","SUP","HCPCS C1713","","370390  -  SCREW BONE 5MM 90MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370395","SUP","HCPCS C1713","","370395  -  SCREW BONE 5MM 95MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"370400","SUP","HCPCS C1713","","370400  -  SCREW BONE 5MM 100MM ORTH LCK","BOTH IP/OP","$196.63 ","$145.51 ","$0.00 ","$196.63 ","$88.48 ","$0.00 ","$40.98 ","$0.00 ","$0.00 ","$34.43 ","$196.63 ","$0.00 ","$98.31 ","$155.73 ","$157.30 ","$0.00 ","$30.77 ","$0.00 ","$31.30 ","$0.00 "
"370405","SUP","HCPCS C1713","","370405  -  SCREW BONE 5MM 105MM ORTH LCK","BOTH IP/OP","$196.63 ","$145.51 ","$0.00 ","$196.63 ","$88.48 ","$0.00 ","$40.98 ","$0.00 ","$0.00 ","$34.43 ","$196.63 ","$0.00 ","$98.31 ","$155.73 ","$157.30 ","$0.00 ","$30.77 ","$0.00 ","$31.30 ","$0.00 "
"370410","SUP","HCPCS C1713","","370410  -  SCREW BONE 5MM 110MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$196.63 ","$145.51 ","$0.00 ","$196.63 ","$88.48 ","$0.00 ","$40.98 ","$0.00 ","$0.00 ","$34.43 ","$196.63 ","$0.00 ","$98.31 ","$155.73 ","$157.30 ","$0.00 ","$30.77 ","$0.00 ","$31.30 ","$0.00 "
"370415","SUP","HCPCS C1713","","370415  -  SCREW BONE 5MM 115MM ORTH LCK","BOTH IP/OP","$196.63 ","$145.51 ","$0.00 ","$196.63 ","$88.48 ","$0.00 ","$40.98 ","$0.00 ","$0.00 ","$34.43 ","$196.63 ","$0.00 ","$98.31 ","$155.73 ","$157.30 ","$0.00 ","$30.77 ","$0.00 ","$31.30 ","$0.00 "
"370420","SUP","HCPCS C1713","","370420  -  SCREW BONE 5MM 120MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$196.63 ","$145.51 ","$0.00 ","$196.63 ","$88.48 ","$0.00 ","$40.98 ","$0.00 ","$0.00 ","$34.43 ","$196.63 ","$0.00 ","$98.31 ","$155.73 ","$157.30 ","$0.00 ","$30.77 ","$0.00 ","$31.30 ","$0.00 "
"370514","SUP","HCPCS C1713","","370514  -  SCREW BONE 4MM 14MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370516","SUP","HCPCS C1713","","370516  -  SCREW BONE 4MM 16MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370518","SUP","HCPCS C1713","","370518  -  SCREW BONE 4MM 18MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370520","SUP","HCPCS C1713","","370520  -  SCREW BONE 4MM 20MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370522","SUP","HCPCS C1713","","370522  -  SCREW BONE 4MM 22MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370524","SUP","HCPCS C1713","","370524  -  SCREW BONE 4MM 24MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370526","SUP","HCPCS C1713","","370526  -  SCREW BONE 4MM 26MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370528","SUP","HCPCS C1713","","370528  -  SCREW BONE 4MM 28MM AXSOS SS LCK SLFTAP T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370530","SUP","HCPCS C1713","","370530  -  SCREW BONE 4MM 30MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370532","SUP","HCPCS C1713","","370532  -  SCREW BONE 4MM 32MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370534","SUP","HCPCS C1713","","370534  -  SCREW BONE 4MM 34MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370536","SUP","HCPCS C1713","","370536  -  SCREW BONE 4MM 36MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370538","SUP","HCPCS C1713","","370538  -  SCREW BONE 4MM 38MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370540","SUP","HCPCS C1713","","370540  -  SCREW BONE 4MM 40MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370542","SUP","HCPCS C1713","","370542  -  SCREW BONE 4MM 42MM AXSOS SS LCK SLFTAP T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370544","SUP","HCPCS C1713","","370544  -  SCREW BONE 4MM 44MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370546","SUP","HCPCS C1713","","370546  -  SCREW BONE 4MM 46MM AXSOS SS LCK SLFTAP T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370548","SUP","HCPCS C1713","","370548  -  SCREW BONE 4MM 48MM AXSOS SS HUM FEM/TIB LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370550","SUP","HCPCS C1713","","370550  -  SCREW BONE 4MM 50MM AXSOS SS LCK SLFTAP T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370555","SUP","HCPCS C1713","","370555  -  SCREW BONE 4MM 55MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370560","SUP","HCPCS C1713","","370560  -  SCREW BONE 4MM 60MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370565","SUP","HCPCS C1713","","370565  -  SCREW BONE 4MM 65MM AXSOS SS HUM FEM/TIB SLFTAP LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370570","SUP","HCPCS C1713","","370570  -  SCREW BONE 4MM 70MM AXSOS SS SLFTAP LCK T15 DRV NONSTRL","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370575","SUP","HCPCS C1713","","370575  -  SCREW BONE 4MM 75MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370580","SUP","HCPCS C1713","","370580  -  SCREW BONE 4MM 80MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370585","SUP","HCPCS C1713","","370585  -  SCREW BONE 4MM 85MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370590","SUP","HCPCS C1713","","370590  -  SCREW BONE 4MM 90MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370595","SUP","HCPCS C1713","","370595  -  SCREW BONE 3.5MM 95MM AXSOS SS HUM FEM/TIB ST LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370600","SUP","HCPCS C1713","","370600  -  SCREW BONE 4MM 100MM ORTH LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370605","SUP","HCPCS C1713","","370605  -  SCREW BONE 4MM 105MM ORTH LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370610","SUP","HCPCS C1713","","370610  -  SCREW BONE 4MM 110MM ORTH LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370615","SUP","HCPCS C1713","","370615  -  SCREW BONE 4MM 115MM ORTH LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"370620","SUP","HCPCS C1713","","370620  -  SCREW BONE 4MM 120MM ORTH LCK","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"371008","SUP","HCPCS C1713","","371008  -  SCREW BONE 3MM 8MM AXSOS T8 DRV LCK SLFTAP","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371010","SUP","HCPCS C1713","","371010  -  SCREW BONE 3MM 10MM AXSOS SS LCK SLFTAP T8 DRV","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371012","SUP","HCPCS C1713","","371012  -  SCREW BONE 3MM 12MM AXSOS LCK","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371014","SUP","HCPCS C1713","","371014  -  SCREW BONE 3MM 14MM AXSOS SS PERIART LCK SLFTAP T8 DRV","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371016","SUP","HCPCS C1713","","371016  -  SCREW BONE 3MM 16MM AXSOS SS PERIART LCK SLFTAP T8 DRV","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371018","SUP","HCPCS C1713","","371018  -  SCREW BONE 3MM 18MM AXSOS SS PERIART LCK SLFTAP T8 DRV","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371020","SUP","HCPCS C1713","","371020  -  SCREW BONE 3MM 20MM AXSOS SS PERIART T8 DRV LCK SLFTAP","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371022","SUP","HCPCS C1713","","371022  -  SCREW BONE 3MM 22MM AXSOS SS LCK SLFTAP T8 DRV","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371024","SUP","HCPCS C1713","","371024  -  SCREW BONE 3MM 24MM AXSOS T8 DRV LCK SLFTAP","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371026","SUP","HCPCS C1713","","371026  -  SCREW BONE 3MM 26MM AXSOS T8 DRV LCK SLFTAP","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371028","SUP","HCPCS C1713","","371028  -  SCREW BONE 3MM 28MM AXSOS T8 DRV LCK SLFTAP","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371030","SUP","HCPCS C1713","","371030  -  SCREW BONE 3MM 30MM AXSOS SS PERIART LCK SLFTAP T8 DRV","BOTH IP/OP","$123.20 ","$91.17 ","$0.00 ","$132.00 ","$59.40 ","$0.00 ","$25.68 ","$0.00 ","$0.00 ","$23.11 ","$132.00 ","$0.00 ","$66.00 ","$104.54 ","$105.60 ","$0.00 ","$20.66 ","$0.00 ","$21.01 ","$0.00 "
"371314","SUP","HCPCS C1713","","371314  -  LOCKING SCREW AXSOS 5.0MM / L14MM","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371316","SUP","HCPCS C1713","","371316  -  LOCKING SCREW AXSOS 5.0MM / L16MM","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371318","SUP","HCPCS C1713","","371318  -  SCREW BONE 5MM 18MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371320","SUP","HCPCS C1713","","371320  -  SCREW BONE 5MM 20MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371322","SUP","HCPCS C1713","","371322  -  LOCKING SCREW AXSOS 5.0MM / L22MM","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371324","SUP","HCPCS C1713","","371324  -  SCREW BONE 5MM 24MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371326","SUP","HCPCS C1713","","371326  -  SCREW BONE 5MM 26MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371328","SUP","HCPCS C1713","","371328  -  SCREW BONE 5MM 28MM AXOS SS T20 DRV LCK SLFTAP NONSTRL","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371330","SUP","HCPCS C1713","","371330  -  SCREW BONE 5MM 30MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371332","SUP","HCPCS C1713","","371332  -  SCREW BONE 5MM 32MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371334","SUP","HCPCS C1713","","371334  -  SCREW BONE 5MM 34MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371336","SUP","HCPCS C1713","","371336  -  LOCKING SCREW AXSOS 5.0MM / L36MM","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371338","SUP","HCPCS C1713","","371338  -  SCREW BONE 5MM 38MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371340","SUP","HCPCS C1713","","371340  -  SCREW BONE 5MM 40MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371342","SUP","HCPCS C1713","","371342  -  SCREW BONE 5MM 42MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371344","SUP","HCPCS C1713","","371344  -  SCREW BONE 5MM 44MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371346","SUP","HCPCS C1713","","371346  -  SCREW BONE 5MM 46MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371348","SUP","HCPCS C1713","","371348  -  SCREW BONE 5MM 48MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371350","SUP","HCPCS C1713","","371350  -  SCREW BONE 5MM 50MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371355","SUP","HCPCS C1713","","371355  -  SCREW BONE 5MM 55MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371360","SUP","HCPCS C1713","","371360  -  SCREW BONE 5MM 60MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371365","SUP","HCPCS C1713","","371365  -  SCREW BONE 5MM 65MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371370","SUP","HCPCS C1713","","371370  -  SCREW BONE 5MM 70MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371375","SUP","HCPCS C1713","","371375  -  SCREW BONE 5MM 75MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371380","SUP","HCPCS C1713","","371380  -  SCREW BONE 5MM 80MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371385","SUP","HCPCS C1713","","371385  -  SCREW BONE 5MM 85MM AXSOS SS LCK","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371390","SUP","HCPCS C1713","","371390  -  SCREW BONE 5MM 90MM AXSOS SS LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371395","SUP","HCPCS C1713","","371395  -  SCREW BONE 5MM 95MM AXSOS SS PERIART LCK SLFTAP T20 DRV","BOTH IP/OP","$228.00 ","$168.72 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$47.52 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"371514","SUP","HCPCS C1713","","371514  -  SCREW BONE 4MM 14MM SS T15 SLFTAP LCK DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371516","SUP","HCPCS C1713","","371516  -  SCREW BONE 4MM 16MM SS LCK SLFTAP T15 DRV NONSTRL","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371518","SUP","HCPCS C1713","","371518  -  SCREW BONE 4MM 18MM AXSOS SS LCK SLFTAP T15 DRV NONSTRL","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371520","SUP","HCPCS C1713","","371520  -  SCREW BN T15 4MM 20MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371522","SUP","HCPCS C1713","","371522  -  SCREW BN T15 4MM 22MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371524","SUP","HCPCS C1713","","371524  -  SCREW BN T15 4MM 24MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371526","SUP","HCPCS C1713","","371526  -  SCREW BN T15 4MM 26MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371528","SUP","HCPCS C1713","","371528  -  SCREW BN T15 4MM 28MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371530","SUP","HCPCS C1713","","371530  -  SCREW BN T15 4MM 30MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371532","SUP","HCPCS C1713","","371532  -  SCREW BN T15 4MM 32MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371534","SUP","HCPCS C1713","","371534  -  SCREW BN T15 4MM 34MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371536","SUP","HCPCS C1713","","371536  -  SCREW BN T15 4MM 36MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371538","SUP","HCPCS C1713","","371538  -  SCREW BN T15 4MM 38MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371540","SUP","HCPCS C1713","","371540  -  SCREW BONE 4MM 40MM AXSOS SS PERIART LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371542","SUP","HCPCS C1713","","371542  -  SCREW BONE 4MM 42MM AXSOS SS PERIART LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371544","SUP","HCPCS C1713","","371544  -  SCREW BONE 4MM 44MM AXSOS SS PERIART LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371546","SUP","HCPCS C1713","","371546  -  SCREW BONE 4MM 46MM AXSOS SS PERIART LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371548","SUP","HCPCS C1713","","371548  -  SCREW BN T15 4MM 48MM NS ST LCK SS AXSOS SM FRAG SET XTRMT","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371550","SUP","HCPCS C1713","","371550  -  SCREW BONE 4MM 50MM AXSOS SS HUM FEM/TIB LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371555","SUP","HCPCS C1713","","371555  -  SCREW BONE 4MM 55MM AXSOS SS PERIART LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371560","SUP","HCPCS C1713","","371560  -  SCREW BONE 4MM 60MM AXSOS SS PERIART LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371565","SUP","HCPCS C1713","","371565  -  SCREW BONE 4MM 65MM AXSOS SS LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371570","SUP","HCPCS C1713","","371570  -  SCREW BONE T15 4MM 70MM SELF TAP LOCK AXSOS STAINLESS STEEL","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371575","SUP","HCPCS C1713","","371575  -  SCREW BONE 4MM 75MM AXSOS SS LCK SLFTAP T15 DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371580","SUP","HCPCS C1713","","371580  -  SCREW BONE 4MM 80MM AXSOS LCK","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371585","SUP","HCPCS C1713","","371585  -  SCREW BONE 4MM 85MM AXSOS SS T15 SLFTAP LCK DRV","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371590","SUP","HCPCS C1713","","371590  -  SCREW BONE 4MM 90MM AXSOS SS T15 DRV SLFTAP LCK","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"371595","SUP","HCPCS C1713","","371595  -  LOCKING SCREW AXSOS 4.0MM / L95MM","BOTH IP/OP","$204.80 ","$151.55 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$42.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"372615","SUP","HCPCS C1713","","372615  -  SCALPEL SURG 15 1 HAND ACTIVATION LOCK RETRACTABLE SHIELD","BOTH IP/OP","$36.48 ","$27.00 ","$0.00 ","$37.02 ","$16.66 ","$0.00 ","$7.60 ","$0.00 ","$0.00 ","$6.48 ","$37.02 ","$0.00 ","$18.51 ","$29.32 ","$29.62 ","$0.00 ","$5.79 ","$0.00 ","$5.89 ","$0.00 "
"373741","SUP","Custom 27203010","","373741  -  KNIFE OPHTHALMIC 45D ANGLED 4.1MM BEVEL UP PHACO SLIT MATTE","BOTH IP/OP","$30.07 ","$22.25 ","$0.00 ","$30.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.07 ","$0.00 ","$15.03 ","$23.82 ","$24.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"373808","SUP","Custom 27203010","","373808  -  SCALPEL SURG 2.5MM 2.5MM STR ROUND TIP CRESCENT OPHTHALMIC","BOTH IP/OP","$34.30 ","$25.38 ","$0.00 ","$69.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.80 ","$0.00 ","$16.90 ","$69.44 ","$27.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"378227","SUP","Custom 27203010","","378227  -  KNIFE OPHTHALMIC 45D BEVEL 2.75MM BLADE MATTE FINISH SLIT BD","BOTH IP/OP","$35.63 ","$26.37 ","$0.00 ","$35.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.63 ","$0.00 ","$17.81 ","$28.22 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"378230","SUP","Custom 27203010","","378230  -  KNIFE OPHTHALMIC 45D BEVEL 3MM PHACO SLIT SAFETY MATTE","BOTH IP/OP","$35.63 ","$26.37 ","$0.00 ","$35.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.63 ","$0.00 ","$17.81 ","$28.22 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"378231","SUP","Custom 27203010","","378231  -  KNIFE OPHTHALMIC 20D .9MM 3MM SAFETY SIDEPORT RETRACTABLE","BOTH IP/OP","$48.69 ","$36.03 ","$0.00 ","$128.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.88 ","$0.00 ","$64.44 ","$102.07 ","$103.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"381112","SUP","HCPCS C1729","","CATHETER IV 24GA .75IN RADIOPQ YLW ANGCTH TFLN STRL LF","BOTH IP/OP","$4.45 ","$3.29 ","$0.00 ","$4.45 ","$2.42 ","$0.00 ","$0.93 ","$0.00 ","$0.00 ","$0.78 ","$4.45 ","$0.00 ","$2.23 ","$3.52 ","$3.56 ","$0.00 ","$0.70 ","$0.00 ","$0.71 ","$0.00 "
"381137","SUP","HCPCS C1729","","CATHETER IV 20GA 1.88IN RADIOPQ PNK ANGCTH TFLN STRL LF","BOTH IP/OP","$9.18 ","$6.79 ","$0.00 ","$9.18 ","$4.98 ","$0.00 ","$1.91 ","$0.00 ","$0.00 ","$1.61 ","$9.18 ","$0.00 ","$4.59 ","$7.27 ","$7.34 ","$0.00 ","$1.44 ","$0.00 ","$1.46 ","$0.00 "
"381144","SUP","HCPCS C1729","","CATHETER IV 18GA 1.16IN RADIOPQ GRN ANGCTH TFLN STRL LF","BOTH IP/OP","$9.93 ","$7.35 ","$0.00 ","$9.93 ","$5.39 ","$0.00 ","$2.07 ","$0.00 ","$0.00 ","$1.74 ","$9.93 ","$0.00 ","$4.96 ","$7.86 ","$7.94 ","$0.00 ","$1.55 ","$0.00 ","$1.58 ","$0.00 "
"381511","SUP","HCPCS C1729","","CATHETER IV 24GA .56IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD","BOTH IP/OP","$6.65 ","$4.92 ","$0.00 ","$6.65 ","$3.61 ","$0.00 ","$1.39 ","$0.00 ","$0.00 ","$1.16 ","$6.65 ","$0.00 ","$3.33 ","$5.27 ","$5.32 ","$0.00 ","$1.04 ","$0.00 ","$1.06 ","$0.00 "
"381512","SUP","HCPCS C1729","","CATHETER IV 24GA .75IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD","BOTH IP/OP","$4.93 ","$3.65 ","$0.00 ","$4.93 ","$2.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.86 ","$4.93 ","$0.00 ","$2.46 ","$3.90 ","$3.94 ","$0.00 ","$0.77 ","$0.00 ","$0.78 ","$0.00 "
"381523","SUP","HCPCS C1729","","CATHETER IV 22GA 1IN RADIOPQ SFSHLD WNG BLUE INST-N ATGRD","BOTH IP/OP","$4.78 ","$3.54 ","$0.00 ","$4.78 ","$2.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.84 ","$4.78 ","$0.00 ","$2.39 ","$3.79 ","$3.82 ","$0.00 ","$0.75 ","$0.00 ","$0.76 ","$0.00 "
"381533","SUP","HCPCS C1729","","CATHETER IV 20GA 1IN RADIOPQ SFSHLD WNG PNK INST AGRD VLN","BOTH IP/OP","$4.53 ","$3.35 ","$0.00 ","$4.53 ","$2.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.79 ","$4.53 ","$0.00 ","$2.26 ","$3.59 ","$3.62 ","$0.00 ","$0.71 ","$0.00 ","$0.72 ","$0.00 "
"382259","SUP","HCPCS C1729","","CATHETER IV 16GA 5.25IN RADIOPQ YLW ANGCTH TFLN STRL LF","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$28.48 ","$15.46 ","$0.00 ","$6.88 ","$0.00 ","$0.00 ","$4.99 ","$28.48 ","$0.00 ","$14.24 ","$22.56 ","$22.78 ","$0.00 ","$4.46 ","$0.00 ","$4.53 ","$0.00 "
"382269","SUP","HCPCS C1729","","CATHETER IV 14GA 5.25IN RADIOPQ SFSHLD ORNG ANGCTH TFLN STRL","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$28.48 ","$15.46 ","$0.00 ","$6.88 ","$0.00 ","$0.00 ","$4.99 ","$28.48 ","$0.00 ","$14.24 ","$22.56 ","$22.78 ","$0.00 ","$4.46 ","$0.00 ","$4.53 ","$0.00 "
"382861","SUP","HCPCS C1898","","382861  -  PASSIVE FIXATION PACING LEAD, J-SHAPE, SILICONE INSULATION,","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382866","SUP","HCPCS C1898","","382866  -  PASSIVE FIXATION PACING LEAD, J-SHAPE, SILICONE INSULATION,","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382872","SUP","HCPCS C1898","","382872  -  PASSIVE FIXATION PACING LEAD, STRAIGHT, SILICONE INSULATION,","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382878","SUP","HCPCS C1898","","382878  -  PASSIVE FIXATION PACING LEAD, STRAIGHT, SILICONE INSULATION,","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382884","SUP","HCPCS C1898","","382884  -  LEAD PCNG HLX 45CM SIL ATR TILDA","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382889","SUP","HCPCS C1895","","382889  -  LEAD PCNG HLX 53CM SIL ATR TILDA","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382895","SUP","HCPCS C1895","","382895  -  LEAD PCNG HLX 60CM SIL VNTRC TILDA","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"382903","SUP","HCPCS C1777","","382903  -  LEAD PCNG 65CM VIGILA","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"382918","SUP","HCPCS C1721","","382918  -  PASSIVE FIXATION, DUAL COIL, SILICONE INSULATION, 65 CM, 18","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"382924","SUP","HCPCS C1721","","382924  -  ACTIVE FIXATION, DUAL COIL, SILICONE INSULATION, 60 CM, 16 C","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"382936","SUP","HCPCS C1721","","382936  -  ACTIVE FIXATION, DUAL COIL, SILICONE INSULATION, 65 CM, 18 C","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"382961","SUP","HCPCS C1900","","382961  -  LEFT VENTRICULAR LEAD WITH 3D PRE-SHAPED HELIX AT DISTAL END","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"382972","SUP","HCPCS C1900","","382972  -  LEFT VENTRICULAR LEAD WITH PRE-SHAPED BEND AND THREAD FIXATI","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"383395","SUP","HCPCS C1900","","383395  -  LEFT VENTRICULAR LEAD WITH 2D PRE-SHAPED BEND AT DISTAL END,","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"384021","SUP","HCPCS C1887","","INTRODUCER CATH 26GA 1.9FR INTRST-N NEO","BOTH IP/OP","$96.18 ","$71.17 ","$0.00 ","$96.18 ","$52.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.84 ","$96.18 ","$0.00 ","$48.09 ","$76.17 ","$76.94 ","$0.00 ","$15.05 ","$0.00 ","$15.31 ","$0.00 "
"384232","SUP","HCPCS C1729","","CATHETER CEN VEN 1.9FR 50CM 1 LUM PICC 1ST PICC SIL","BOTH IP/OP","$143.63 ","$106.29 ","$0.00 ","$143.63 ","$77.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.15 ","$143.63 ","$0.00 ","$71.81 ","$113.75 ","$114.90 ","$0.00 ","$22.48 ","$0.00 ","$22.87 ","$0.00 "
"384825","SUP","Custom 27203010","","TRAY PRC DRSG SCSR TRNQT NEO","BOTH IP/OP","$110.10 ","$81.47 ","$0.00 ","$110.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.10 ","$0.00 ","$55.05 ","$87.20 ","$88.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"386358","SUP","Custom 27203010","","CALIBRATOR CA 125 ACCES OV MONITR VL 2.5ML IMMUN","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"386371","SUP","Custom 27203010","","REAGENT CKMB ACCES 100 TST ANALY","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"386372","SUP","Custom 27203010","","CALIBRATOR CHM SET CK-MB ACCES 6X2ML","BOTH IP/OP","$264.45 ","$195.69 ","$0.00 ","$264.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.45 ","$0.00 ","$132.23 ","$209.44 ","$211.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"390016","SUP","HCPCS C1713","","390016  -  WASHER 6.6MM CANN ASNS 3 ORTH SS 8IN 6.5/8MM SCR","BOTH IP/OP","$59.13 ","$43.76 ","$0.00 ","$59.13 ","$26.61 ","$0.00 ","$12.32 ","$0.00 ","$0.00 ","$10.35 ","$59.13 ","$0.00 ","$29.56 ","$46.83 ","$47.30 ","$0.00 ","$9.25 ","$0.00 ","$9.41 ","$0.00 "
"390017","SUP","HCPCS C1713","","390017  -  WASHER 5MM ASNS 3 ORTH SS 7MM CANN SCR","BOTH IP/OP","$46.75 ","$34.60 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$9.74 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"390018","SUP","HCPCS C1713","","390018  -  WASHER 8MM ASNS 3 ORTH SS 7MM CANN SCR","BOTH IP/OP","$46.75 ","$34.60 ","$0.00 ","$49.50 ","$22.28 ","$0.00 ","$9.74 ","$0.00 ","$0.00 ","$8.67 ","$49.50 ","$0.00 ","$24.75 ","$39.20 ","$39.60 ","$0.00 ","$7.75 ","$0.00 ","$7.88 ","$0.00 "
"390019","SUP","HCPCS C1713","","390019  -  WASHER 9MM ASNS 3 ORTH SS 8IN 3.5MM CANN SCR","BOTH IP/OP","$50.88 ","$37.65 ","$0.00 ","$50.88 ","$22.89 ","$0.00 ","$10.60 ","$0.00 ","$0.00 ","$8.91 ","$50.88 ","$0.00 ","$25.44 ","$40.30 ","$40.70 ","$0.00 ","$7.96 ","$0.00 ","$8.10 ","$0.00 "
"390083","SUP","HCPCS C1713","","390083  -  PIN HLD 5MM ORTH REDX 150MM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"390084","SUP","HCPCS C1713","","390084  -  PIN HLD 5MM ORTH REDX SS 180MM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"390086","SUP","HCPCS C1713","","390086  -  PIN HALF 150MM 6MM PLVC SS SLF CUT REDX","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"390087","SUP","HCPCS C1713","","390087  -  PIN HLD 6MM ORTH REDX 180MM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"390181","SUP","HCPCS C1713","","390181  -  WIRE FX 2.5MM 285MM NS KRSH TROC PNT SS","BOTH IP/OP","$136.00 ","$100.64 ","$0.00 ","$140.25 ","$63.11 ","$0.00 ","$28.35 ","$0.00 ","$0.00 ","$24.56 ","$140.25 ","$0.00 ","$70.13 ","$111.08 ","$112.20 ","$0.00 ","$21.95 ","$0.00 ","$22.33 ","$0.00 "
"390195","SUP","HCPCS C1713","","390195  -  WIRE FX 3MM 285MM NS KRSH TROC PNT SS","BOTH IP/OP","$129.25 ","$95.65 ","$0.00 ","$129.25 ","$58.16 ","$0.00 ","$26.94 ","$0.00 ","$0.00 ","$22.63 ","$129.25 ","$0.00 ","$64.63 ","$102.37 ","$103.40 ","$0.00 ","$20.23 ","$0.00 ","$20.58 ","$0.00 "
"397003","SUP","HCPCS C1713","","397003  -  CEMENT BONE SLF SET INJ OSTCNDC HYDROSET BONE SUB VOID FILR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,522.63 ","$1,135.18 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$441.69 ","$2,522.63 ","$0.00 ","$1,261.31 ","$1,997.92 ","$2,018.10 ","$0.00 ","$394.79 ","$0.00 ","$401.60 ","$0.00 "
"397005","SUP","HCPCS C1713","","397005  -  CEMENT BONE HYDROSET CALCIUM PHOS 5ML INJ SLF SET VOID FILR","BOTH IP/OP","$3,285.00 ","$2,430.90 ","$0.00 ","$4,045.50 ","$1,820.48 ","$0.00 ","$684.68 ","$0.00 ","$0.00 ","$708.33 ","$4,045.50 ","$0.00 ","$2,022.75 ","$3,204.04 ","$3,236.40 ","$0.00 ","$633.12 ","$0.00 ","$644.04 ","$0.00 "
"397010","SUP","HCPCS C1713","","397010  -  CEMENT BONE SLF SET INJ OSTCNDC HYDROSET BONE SUB VOID FILR","BOTH IP/OP","$6,252.50 ","$4,626.85 ","$0.00 ","$7,777.13 ","$3,499.71 ","$0.00 ","$1,303.18 ","$0.00 ","$0.00 ","$1,361.71 ","$7,777.13 ","$0.00 ","$3,888.56 ","$6,159.49 ","$6,221.70 ","$0.00 ","$1,217.12 ","$0.00 ","$1,238.12 ","$0.00 "
"397015","SUP","HCPCS C1713","","397015  -  CEMENT BONE HYDROSET BONE SUB VOID FILR CALCIUM PHOS 15ML","BOTH IP/OP","$8,970.94 ","$6,638.50 ","$0.00 ","$11,160.00 ","$5,022.00 ","$0.00 ","$1,869.77 ","$0.00 ","$0.00 ","$1,954.03 ","$11,160.00 ","$0.00 ","$5,580.00 ","$8,838.72 ","$8,928.00 ","$0.00 ","$1,746.54 ","$0.00 ","$1,776.67 ","$0.00 "
"400077","SUP","Custom 27203010","","400077  -  SEAL CNN 8MM DVNC EWRST DISP","BOTH IP/OP","$3.75 ","$2.78 ","$0.00 ","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.75 ","$0.00 ","$1.88 ","$2.97 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400180","SUP","Custom 27203010","","400180  -  COVER ESCP TIP 8MM STD HOT SHR DVNC EWRST CAUT MNPLR DISP","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400427","SUP","Custom 27203010","","400427  -  PACKING NSL 2.5X.9X2CM MRCL BRN SIN-PK STNG SLIM PRFL","BOTH IP/OP","$18.98 ","$14.05 ","$0.00 ","$18.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.98 ","$0.00 ","$9.49 ","$15.03 ","$15.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401531","SUP","Custom 27203010","","401531  -  BAG OST SFN MINI 1.75IN 5IN 2 SIDE COROVIN LATEX FREE DISP","BOTH IP/OP","$1.50 ","$1.11 ","$0.00 ","$1.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.50 ","$0.00 ","$0.75 ","$1.19 ","$1.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401552","SUP","Custom 27203010","","KIT 1.5IN UROS STD SRFT","BOTH IP/OP","$4.00 ","$2.96 ","$0.00 ","$4.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.00 ","$0.00 ","$2.00 ","$3.17 ","$3.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"402025","SUP","HCPCS Q4116","","402025  -  MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED","BOTH IP/OP","$64.73 ","$47.90 ","$0.00 ","$100.54 ","$45.24 ","$0.00 ","$13.49 ","$0.00 ","$0.00 ","$17.60 ","$100.54 ","$0.00 ","$50.27 ","$79.63 ","$80.43 ","$0.00 ","$15.73 ","$0.00 ","$16.01 ","$0.00 "
"402045","SUP","HCPCS Q4116","","402045  -  MATRIX TISSUE THIN 12X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$64.58 ","$47.79 ","$0.00 ","$100.16 ","$45.07 ","$0.00 ","$13.46 ","$0.00 ","$0.00 ","$17.54 ","$100.16 ","$0.00 ","$50.08 ","$79.33 ","$80.13 ","$0.00 ","$15.67 ","$0.00 ","$15.94 ","$0.00 "
"402432","SUP","Custom 27803010","","402432  -  CEMENT BONE CO HV LG 40GM HVISC STRL","BOTH IP/OP","$292.50 ","$216.45 ","$0.00 ","$292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$292.50 ","$0.00 ","$146.25 ","$231.66 ","$234.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"402433","SUP","Custom 27803010","","402433  -  CEMENT BONE CBLT G-HV 40GM HVISC GNTA STRL","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"403326","SUP","Custom 27203010","","DRESSING DUODERM 4X4 SIGNAL","BOTH IP/OP","$6.60 ","$4.88 ","$0.00 ","$6.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.60 ","$0.00 ","$3.30 ","$5.23 ","$5.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"403711","SUP","Custom 27203010","","403711  -  DRESSING WOUND RECTANGLE 10X8IN STRONGER GREATER ABSORBENCY","BOTH IP/OP","$82.33 ","$60.92 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.33 ","$0.00 ","$41.16 ","$65.21 ","$65.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"403771","SUP","Custom 27203010","","403771  -  DRESSING HYDROCOLLOID RIBBON 18X.75IN STITCHBOND LATEX FREE","BOTH IP/OP","$29.96 ","$22.17 ","$0.00 ","$29.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.96 ","$0.00 ","$14.98 ","$23.73 ","$23.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"405416","SUP","HCPCS C1892","","405416  -  INTROD SHTH 9FR 14CM HMSTS GWIRE PLWY .038IN TRNSPT","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$1,980.04 ","$4.34 ","$0.00 ","$1,980.04 ","$0.00 ","$0.00 ","$1.40 ","$8.00 ","$0.00 ","$4.00 ","$6.34 ","$6.40 ","$0.00 ","$1.25 ","$0.00 ","$1.27 ","$0.00 "
"406136","SUP","HCPCS C1894","","406136  -  INTROD CATH 12CM 14FR .038IN TRNSPT FSTCTH HMSTS","BOTH IP/OP","$42.75 ","$31.64 ","$0.00 ","$42.75 ","$23.21 ","$0.00 ","$8.91 ","$0.00 ","$0.00 ","$7.49 ","$42.75 ","$0.00 ","$21.38 ","$33.86 ","$34.20 ","$0.00 ","$6.69 ","$0.00 ","$6.81 ","$0.00 "
"406701","SUP","HCPCS C1894","","406701  -  INTRODUCER SHEATH .038IN STANDARD 6FR 12CM 50CM 2 DISTAL","BOTH IP/OP","$2.75 ","$2.04 ","$0.00 ","$2.75 ","$1.49 ","$0.00 ","$0.57 ","$0.00 ","$0.00 ","$0.48 ","$2.75 ","$0.00 ","$1.38 ","$2.18 ","$2.20 ","$0.00 ","$0.43 ","$0.00 ","$0.44 ","$0.00 "
"407145","SUP","HCPCS C1785","","407145  -  PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$6,862.50 ","$0.00 ","$3,178.48 ","$0.00 ","$0.00 ","$2,670.15 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$2,386.63 ","$0.00 ","$2,427.80 ","$0.00 "
"407157","SUP","HCPCS C1786","","407157  -  PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT","BOTH IP/OP","$13,375.00 ","$9,897.50 ","$0.00 ","$13,375.00 ","$0.00 ","$0.00 ","$2,787.68 ","$0.00 ","$0.00 ","$0.00 ","$13,375.00 ","$0.00 ","$6,687.50 ","$10,593.00 ","$10,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"410298","SUP","Custom 27803010","","410298  -  STAPLER INTNL 14MM 45MM NS LF DVNC SI EWRST RPSB 50 FRNG","BOTH IP/OP","$17,500.00 ","$12,950.00 ","$0.00 ","$17,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,500.00 ","$0.00 ","$8,750.00 ","$13,860.00 ","$14,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"410322","SUP","Custom 27203010","","410322  -  TIP CAUT 8MM 1 DVNC SI EWRST VSL SLR DISP","BOTH IP/OP","$8,925.00 ","$6,604.50 ","$0.00 ","$8,925.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,925.00 ","$0.00 ","$4,462.50 ","$7,068.60 ","$7,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"410370","SUP","Custom 27203010","","410370  -  SHEATH LAPSCP 45MM STPLR","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"410500","SUP","Custom 27203010","","410500  -  DRESSING HYDROCOLLOID TAPER 7.8X7.5IN ABSORBENT FLEXIBLE","BOTH IP/OP","$29.32 ","$21.70 ","$0.00 ","$29.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.75 ","$0.00 ","$14.88 ","$23.56 ","$23.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"410501","SUP","Custom 27203010","","SACRAL DUODERM SIGNAL 7.8X8.77","BOTH IP/OP","$28.28 ","$20.93 ","$0.00 ","$28.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.28 ","$0.00 ","$14.14 ","$22.40 ","$22.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"410614","SUP","Custom 27203010","","410614  -  DRESSING FOAM 8X8IN GELLING LATEX FREE VERSIVA XC","BOTH IP/OP","$33.99 ","$25.15 ","$0.00 ","$33.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.99 ","$0.00 ","$16.99 ","$26.92 ","$27.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"411250","SUP","HCPCS C1762","","411250  -  GRAFT SOFT TISSUE 4-5MM 50MM ALLOGRAFT NATURAL CONNECT","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$0.00 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$0.00 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$0.00 ","$0.00 "
"411270","SUP","HCPCS C1768","","411270  -  GRAFT, AVANCE NERVE, 4-5MM X 70MM","BOTH IP/OP","$16,105.00 ","$11,917.70 ","$0.00 ","$14,750.00 ","$6,637.50 ","$0.00 ","$3,356.68 ","$0.00 ","$0.00 ","$2,582.61 ","$14,750.00 ","$0.00 ","$7,375.00 ","$11,682.00 ","$11,800.00 ","$0.00 ","$2,308.38 ","$0.00 ","$2,348.20 ","$0.00 "
"415807","SUP","Custom 27203010","","415807  -  CANNULA PERFUSION 7MM 3MM 11.4IN BALLOON RIGHT ANGLED LATEX","BOTH IP/OP","$982.50 ","$727.05 ","$0.00 ","$982.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$982.50 ","$0.00 ","$491.25 ","$778.14 ","$786.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"417300","SUP","Custom 27803010","","417300  -  SYSTEM BONE CMNT TRPL MX KIT 120GM OPTVC","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419588","SUP","HCPCS C1898","","419588  -  LEAD PACING 5FR 88CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,562.50 ","$1,603.13 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$623.77 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$567.15 ","$0.00 "
"419678","SUP","HCPCS C1898","","419678  -  LEAD PACING 2 CURVE 4FR 78CM BIPOL IS-1 ATTAIN ABILITY","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,562.50 ","$1,603.13 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$623.77 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$567.15 ","$0.00 "
"419688","SUP","HCPCS C1898","","419688  -  LEAD PACING 4FR 88CM OTW TRACKABILITY STEERABLE BIPOL","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,562.50 ","$1,603.13 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$623.77 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$567.15 ","$0.00 "
"420006","SUP","Custom 27203010","","420006  -  DRIVER NDL 0-30D LG 8MM 54.4CM 1CM S/SI EWRST","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420024","SUP","Custom 27203010","","420024  -  OBTURATOR LAPSCP LNG 8MM STRL DVNC S/SI EWRST DISP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420206","SUP","Custom 27203010","","420206  -  SEAL ENDSCP INSTR 8.5-13MM S/SI EWRST CANNU HD SD","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420290","SUP","Custom 27203010","","420290  -  KIT ACC 8MM DVNC SI 3 ARM CAM CNN SL INST DRP DISP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420291","SUP","Custom 27203010","","420291  -  KIT 8MM 4 ARM CAM CANNU SL INSTR DRP ACC DVNC SI","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"425304","SUP","HCPCS C1713","","425304  -  PLATE  PELVIS  108MM RADIUS","BOTH IP/OP","$284.63 ","$210.63 ","$0.00 ","$284.63 ","$128.08 ","$0.00 ","$59.32 ","$0.00 ","$0.00 ","$49.84 ","$284.63 ","$0.00 ","$142.31 ","$225.43 ","$227.70 ","$0.00 ","$44.54 ","$0.00 ","$45.31 ","$0.00 "
"425306","SUP","HCPCS C1713","","425306  -  PLATE  PELVIS  108MM RADIUS","BOTH IP/OP","$361.63 ","$267.61 ","$0.00 ","$361.63 ","$162.73 ","$0.00 ","$75.37 ","$0.00 ","$0.00 ","$63.32 ","$361.63 ","$0.00 ","$180.81 ","$286.41 ","$289.30 ","$0.00 ","$56.59 ","$0.00 ","$57.57 ","$0.00 "
"425308","SUP","HCPCS C1713","","425308  -  PLATE  PELVIS  108MM RADIUS","BOTH IP/OP","$354.75 ","$262.52 ","$0.00 ","$354.75 ","$159.64 ","$0.00 ","$73.94 ","$0.00 ","$0.00 ","$62.11 ","$354.75 ","$0.00 ","$177.38 ","$280.96 ","$283.80 ","$0.00 ","$55.52 ","$0.00 ","$56.48 ","$0.00 "
"425310","SUP","HCPCS C1713","","425310  -  PLATE  PELVIS  108MM RADIUS","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"425312","SUP","HCPCS C1713","","425312  -  PLATE  PELVIS  108MM RADIUS","BOTH IP/OP","$419.38 ","$310.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$87.41 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"425406","SUP","HCPCS C1713","","425406  -  PLATE  PELVIS  88MM RADIUS","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"425408","SUP","HCPCS C1713","","425408  -  PLATE  PELVIS  88MM RADIUS","BOTH IP/OP","$349.25 ","$258.45 ","$0.00 ","$349.25 ","$157.16 ","$0.00 ","$72.79 ","$0.00 ","$0.00 ","$61.15 ","$349.25 ","$0.00 ","$174.63 ","$276.61 ","$279.40 ","$0.00 ","$54.66 ","$0.00 ","$55.60 ","$0.00 "
"425410","SUP","HCPCS C1713","","425410  -  PLATE  PELVIS  88MM RADIUS","BOTH IP/OP","$389.13 ","$287.96 ","$0.00 ","$389.13 ","$175.11 ","$0.00 ","$81.10 ","$0.00 ","$0.00 ","$68.13 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$60.90 ","$0.00 ","$61.95 ","$0.00 "
"425412","SUP","HCPCS C1713","","425412  -  PLATE  PELVIS  88MM RADIUS","BOTH IP/OP","$419.38 ","$310.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$87.41 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"425504","SUP","HCPCS C1713","","425504  -  PELVIC PLATE STRAIGHT 4H/64MM","BOTH IP/OP","$233.75 ","$172.98 ","$0.00 ","$233.75 ","$105.19 ","$0.00 ","$48.72 ","$0.00 ","$0.00 ","$40.93 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$36.58 ","$0.00 ","$37.21 ","$0.00 "
"425506","SUP","HCPCS C1713","","425506  -  PLATE  PELVIS  STRAIGHT","BOTH IP/OP","$268.13 ","$198.42 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$55.88 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"425509","SUP","HCPCS C1713","","425509  -  PELVIC PLATE STRAIGHT 9H/154MM","BOTH IP/OP","$338.25 ","$250.31 ","$0.00 ","$338.25 ","$152.21 ","$0.00 ","$70.50 ","$0.00 ","$0.00 ","$59.22 ","$338.25 ","$0.00 ","$169.13 ","$267.89 ","$270.60 ","$0.00 ","$52.94 ","$0.00 ","$53.85 ","$0.00 "
"425512","SUP","HCPCS C1713","","425512  -  PLATE. PELVIS. STRAIGHT","BOTH IP/OP","$398.75 ","$295.08 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$83.11 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"425602","SUP","HCPCS C1713","","425602  -  PLATE 108MM RAD 26.5MM 2 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$383.63 ","$283.89 ","$0.00 ","$383.63 ","$172.63 ","$0.00 ","$79.96 ","$0.00 ","$0.00 ","$67.17 ","$383.63 ","$0.00 ","$191.81 ","$303.83 ","$306.90 ","$0.00 ","$60.04 ","$0.00 ","$61.07 ","$0.00 "
"425603","SUP","HCPCS C1713","","425603  -  PLATE 108MM RAD 42.5MM 3 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$426.25 ","$315.43 ","$0.00 ","$426.25 ","$191.81 ","$0.00 ","$88.84 ","$0.00 ","$0.00 ","$74.63 ","$426.25 ","$0.00 ","$213.13 ","$337.59 ","$341.00 ","$0.00 ","$66.71 ","$0.00 ","$67.86 ","$0.00 "
"425604","SUP","HCPCS C1713","","425604  -  PLATE 108MM RAD 58.5MM SS R108 4 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$468.88 ","$210.99 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$82.10 ","$468.88 ","$0.00 ","$234.44 ","$371.35 ","$375.10 ","$0.00 ","$73.38 ","$0.00 ","$74.64 ","$0.00 "
"425605","SUP","HCPCS C1713","","425605  -  PLATE 108MM 74.5MM 5 HOLE CVD BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$512.88 ","$230.79 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$89.80 ","$512.88 ","$0.00 ","$256.44 ","$406.20 ","$410.30 ","$0.00 ","$80.26 ","$0.00 ","$81.65 ","$0.00 "
"425606","SUP","HCPCS C1713","","425606  -  PLATE 108MM RAD 90.5MM SS 6 HOLE CVD MPS BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$554.13 ","$249.36 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$97.02 ","$554.13 ","$0.00 ","$277.06 ","$438.87 ","$443.30 ","$0.00 ","$86.72 ","$0.00 ","$88.22 ","$0.00 "
"425607","SUP","HCPCS C1713","","425607  -  PLATE 108MM 106.5MM 5 HOLE CVD BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"425608","SUP","HCPCS C1713","","425608  -  PLATE 108MM RAD 122.5MM SS 8 HOLE CVD MPS BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$607.75 ","$273.49 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$106.41 ","$607.75 ","$0.00 ","$303.88 ","$481.34 ","$486.20 ","$0.00 ","$95.11 ","$0.00 ","$96.75 ","$0.00 "
"425609","SUP","HCPCS C1713","","425609  -  PLATE 108MM RAD 138.5X10.5X2.5MM 9 HL SHFT CVD MATTA BONE","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"425610","SUP","HCPCS C1713","","425610  -  PLATE BN CRV 154.5MM MPS 10 HL SS R108","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$640.75 ","$288.34 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$112.19 ","$640.75 ","$0.00 ","$320.38 ","$507.47 ","$512.60 ","$0.00 ","$100.28 ","$0.00 ","$102.01 ","$0.00 "
"425611","SUP","HCPCS C1713","","425611  -  PLATE 108MM RAD 170.5X10.5X2.5MM 11 HL SHFT CVD MATTA BONE","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$649.00 ","$292.05 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$113.63 ","$649.00 ","$0.00 ","$324.50 ","$514.01 ","$519.20 ","$0.00 ","$101.57 ","$0.00 ","$103.32 ","$0.00 "
"425612","SUP","HCPCS C1713","","425612  -  PLATE 186.5MM SS 12 HOLE CVD MPS BONE 108MM PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$671.00 ","$301.95 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$117.49 ","$671.00 ","$0.00 ","$335.50 ","$531.43 ","$536.80 ","$0.00 ","$105.01 ","$0.00 ","$106.82 ","$0.00 "
"425613","SUP","HCPCS C1713","","425613  -  PLATE 108MM RAD 202.5X10.5X2.5MM 13 HL SHFT CVD MATTA BONE","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$694.38 ","$312.47 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$121.58 ","$694.38 ","$0.00 ","$347.19 ","$549.95 ","$555.50 ","$0.00 ","$108.67 ","$0.00 ","$110.54 ","$0.00 "
"425614","SUP","HCPCS C1713","","425614  -  PLATE 218.5MM SS 14 HOLE CVD MPS BONE 108MM PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$746.63 ","$335.98 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$130.73 ","$746.63 ","$0.00 ","$373.31 ","$591.33 ","$597.30 ","$0.00 ","$116.85 ","$0.00 ","$118.86 ","$0.00 "
"425615","SUP","HCPCS C1713","","425615  -  PLATE 108MM RAD 234.5X10.5X2.5MM 15 HL SHFT CVD MATTA BONE","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$778.25 ","$350.21 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$136.27 ","$778.25 ","$0.00 ","$389.13 ","$616.37 ","$622.60 ","$0.00 ","$121.80 ","$0.00 ","$123.90 ","$0.00 "
"425616","SUP","HCPCS C1713","","425616  -  PLATE 108MM RAD 250.5MM 16 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$966.70 ","$715.36 ","$0.00 ","$800.25 ","$360.11 ","$0.00 ","$201.48 ","$0.00 ","$0.00 ","$140.12 ","$800.25 ","$0.00 ","$400.13 ","$633.80 ","$640.20 ","$0.00 ","$125.24 ","$0.00 ","$127.40 ","$0.00 "
"425618","SUP","HCPCS C1713","","425618  -  PLATE 108MM RAD 282.5X10.5X2.5MM 18 HL SHFT CVD MATTA BONE","BOTH IP/OP","$966.70 ","$715.36 ","$0.00 ","$864.88 ","$389.19 ","$0.00 ","$201.48 ","$0.00 ","$0.00 ","$151.43 ","$864.88 ","$0.00 ","$432.44 ","$684.98 ","$691.90 ","$0.00 ","$135.35 ","$0.00 ","$137.69 ","$0.00 "
"425620","SUP","HCPCS C1713","","425620  -  PLATE 108MM RAD 314.5X10.5X2.5MM 20 HL SHFT CVD MATTA BONE","BOTH IP/OP","$1,012.00 ","$748.88 ","$0.00 ","$1,012.00 ","$455.40 ","$0.00 ","$210.93 ","$0.00 ","$0.00 ","$177.19 ","$1,012.00 ","$0.00 ","$506.00 ","$801.50 ","$809.60 ","$0.00 ","$158.38 ","$0.00 ","$161.11 ","$0.00 "
"425653","SUP","HCPCS C1713","","425653  -  PLATE 88MM RAD 42.5MM 3 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$426.25 ","$191.81 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$74.63 ","$426.25 ","$0.00 ","$213.13 ","$337.59 ","$341.00 ","$0.00 ","$66.71 ","$0.00 ","$67.86 ","$0.00 "
"425654","SUP","HCPCS C1713","","425654  -  PLATE 88MM RAD 58.8MM SS 4 HOLE CVD MPS BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$468.88 ","$210.99 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$82.10 ","$468.88 ","$0.00 ","$234.44 ","$371.35 ","$375.10 ","$0.00 ","$73.38 ","$0.00 ","$74.64 ","$0.00 "
"425655","SUP","HCPCS C1713","","425655  -  PLATE BN 88MM RDS CRV 74.5MM NS MATTA 5 HL SS PLV","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$512.88 ","$230.79 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$89.80 ","$512.88 ","$0.00 ","$256.44 ","$406.20 ","$410.30 ","$0.00 ","$80.26 ","$0.00 ","$81.65 ","$0.00 "
"425656","SUP","HCPCS C1713","","425656  -  PLATE 88MM RAD 90.5MM SS 6 HOLE CVD MPS BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$554.13 ","$249.36 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$97.02 ","$554.13 ","$0.00 ","$277.06 ","$438.87 ","$443.30 ","$0.00 ","$86.72 ","$0.00 ","$88.22 ","$0.00 "
"425657","SUP","HCPCS C1713","","425657  -  PLATE 88MM 106.5MM 7 HOLE CVD BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"425658","SUP","HCPCS C1713","","425658  -  PLATE 122.5MM SS 8 HOLE CVD BONE 88MM PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$607.75 ","$273.49 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$106.41 ","$607.75 ","$0.00 ","$303.88 ","$481.34 ","$486.20 ","$0.00 ","$95.11 ","$0.00 ","$96.75 ","$0.00 "
"425659","SUP","HCPCS C1713","","425659  -  PLATE 88MM RAD 138.5MM 9 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"425660","SUP","HCPCS C1713","","425660  -  PLATE 154.5MM SS 10 HOLE CVD MPS BONE 88MM PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$640.75 ","$288.34 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$112.19 ","$640.75 ","$0.00 ","$320.38 ","$507.47 ","$512.60 ","$0.00 ","$100.28 ","$0.00 ","$102.01 ","$0.00 "
"425661","SUP","HCPCS C1713","","425661  -  PLATE 88MM RAD 170.5MM 11 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$649.00 ","$292.05 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$113.63 ","$649.00 ","$0.00 ","$324.50 ","$514.01 ","$519.20 ","$0.00 ","$101.57 ","$0.00 ","$103.32 ","$0.00 "
"425662","SUP","HCPCS C1713","","425662  -  PLATE 186.5MM SS 12 HOLE CVD MPS BONE 88MM PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$671.00 ","$301.95 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$117.49 ","$671.00 ","$0.00 ","$335.50 ","$531.43 ","$536.80 ","$0.00 ","$105.01 ","$0.00 ","$106.82 ","$0.00 "
"425663","SUP","HCPCS C1713","","425663  -  PLATE 88MM RAD 202.5MM 13 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$694.38 ","$312.47 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$121.58 ","$694.38 ","$0.00 ","$347.19 ","$549.95 ","$555.50 ","$0.00 ","$108.67 ","$0.00 ","$110.54 ","$0.00 "
"425664","SUP","HCPCS C1713","","425664  -  PLATE 218.5MM SS 14 HOLE CVD MPS BONE 88MM PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$746.63 ","$335.98 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$130.73 ","$746.63 ","$0.00 ","$373.31 ","$591.33 ","$597.30 ","$0.00 ","$116.85 ","$0.00 ","$118.86 ","$0.00 "
"425665","SUP","HCPCS C1713","","425665  -  PLATE 88MM RAD 234.5MM 15 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$778.25 ","$350.21 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$136.27 ","$778.25 ","$0.00 ","$389.13 ","$616.37 ","$622.60 ","$0.00 ","$121.80 ","$0.00 ","$123.90 ","$0.00 "
"425666","SUP","HCPCS C1713","","425666  -  PLATE 88MM RAD 250.5MM 16 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$800.25 ","$360.11 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$140.12 ","$800.25 ","$0.00 ","$400.13 ","$633.80 ","$640.20 ","$0.00 ","$125.24 ","$0.00 ","$127.40 ","$0.00 "
"425667","SUP","HCPCS C1713","","425667  -  PLATE 88MM RAD 266.5MM 17 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$833.25 ","$616.61 ","$0.00 ","$833.25 ","$374.96 ","$0.00 ","$173.67 ","$0.00 ","$0.00 ","$145.90 ","$833.25 ","$0.00 ","$416.63 ","$659.93 ","$666.60 ","$0.00 ","$130.40 ","$0.00 ","$132.65 ","$0.00 "
"425668","SUP","HCPCS C1713","","425668  -  PLATE 88MM RAD 282.5MM 18 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$880.60 ","$651.64 ","$0.00 ","$864.88 ","$389.19 ","$0.00 ","$183.54 ","$0.00 ","$0.00 ","$151.43 ","$864.88 ","$0.00 ","$432.44 ","$684.98 ","$691.90 ","$0.00 ","$135.35 ","$0.00 ","$137.69 ","$0.00 "
"425670","SUP","HCPCS C1713","","425670  -  PLATE 88MM RAD 314.5MM 20 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$974.95 ","$721.46 ","$0.00 ","$1,012.00 ","$455.40 ","$0.00 ","$203.20 ","$0.00 ","$0.00 ","$177.19 ","$1,012.00 ","$0.00 ","$506.00 ","$801.50 ","$809.60 ","$0.00 ","$158.38 ","$0.00 ","$161.11 ","$0.00 "
"425672","SUP","HCPCS C1713","","425672  -  PLATE 88MM RAD 346.5MM 22 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$1,012.00 ","$748.88 ","$0.00 ","$1,012.00 ","$455.40 ","$0.00 ","$210.93 ","$0.00 ","$0.00 ","$177.19 ","$1,012.00 ","$0.00 ","$506.00 ","$801.50 ","$809.60 ","$0.00 ","$158.38 ","$0.00 ","$161.11 ","$0.00 "
"425674","SUP","HCPCS C1713","","425674  -  PLATE 88MM RAD 378.5MM 24 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$1,012.00 ","$748.88 ","$0.00 ","$1,012.00 ","$455.40 ","$0.00 ","$210.93 ","$0.00 ","$0.00 ","$177.19 ","$1,012.00 ","$0.00 ","$506.00 ","$801.50 ","$809.60 ","$0.00 ","$158.38 ","$0.00 ","$161.11 ","$0.00 "
"425676","SUP","HCPCS C1713","","425676  -  PLATE 88MM RAD 410.5MM 26 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$1,067.00 ","$789.58 ","$0.00 ","$1,067.00 ","$480.15 ","$0.00 ","$222.39 ","$0.00 ","$0.00 ","$186.82 ","$1,067.00 ","$0.00 ","$533.50 ","$845.06 ","$853.60 ","$0.00 ","$166.99 ","$0.00 ","$169.87 ","$0.00 "
"425678","SUP","HCPCS C1713","","425678  -  PLATE 442.5MM 28 HOLE CVD BONE 88MM PLVC","BOTH IP/OP","$1,067.00 ","$789.58 ","$0.00 ","$1,067.00 ","$480.15 ","$0.00 ","$222.39 ","$0.00 ","$0.00 ","$186.82 ","$1,067.00 ","$0.00 ","$533.50 ","$845.06 ","$853.60 ","$0.00 ","$166.99 ","$0.00 ","$169.87 ","$0.00 "
"425680","SUP","HCPCS C1713","","425680  -  PLATE 88MM RAD 474.5MM 30 HOLE CVD MATTA BONE PLVC","BOTH IP/OP","$1,067.00 ","$789.58 ","$0.00 ","$1,067.00 ","$480.15 ","$0.00 ","$222.39 ","$0.00 ","$0.00 ","$186.82 ","$1,067.00 ","$0.00 ","$533.50 ","$845.06 ","$853.60 ","$0.00 ","$166.99 ","$0.00 ","$169.87 ","$0.00 "
"425702","SUP","HCPCS C1713","","425702  -  PLATE 26.5MMX10.5MMX2.5M SS 2 HOLE STR MATTA BONE PLVC","BOTH IP/OP","$659.40 ","$487.96 ","$0.00 ","$349.25 ","$157.16 ","$0.00 ","$137.44 ","$0.00 ","$0.00 ","$61.15 ","$349.25 ","$0.00 ","$174.63 ","$276.61 ","$279.40 ","$0.00 ","$54.66 ","$0.00 ","$55.60 ","$0.00 "
"425703","SUP","HCPCS C1713","","425703  -  PLATE 42.5MM SS 3 HOLE STR BONE PLVC","BOTH IP/OP","$659.40 ","$487.96 ","$0.00 ","$401.50 ","$180.68 ","$0.00 ","$137.44 ","$0.00 ","$0.00 ","$70.30 ","$401.50 ","$0.00 ","$200.75 ","$317.99 ","$321.20 ","$0.00 ","$62.83 ","$0.00 ","$63.92 ","$0.00 "
"425704","SUP","HCPCS C1713","","425704  -  PLATE 58.5MM SS 4 HOLE STR MPS BONE PLVC","BOTH IP/OP","$659.40 ","$487.96 ","$0.00 ","$422.13 ","$189.96 ","$0.00 ","$137.44 ","$0.00 ","$0.00 ","$73.91 ","$422.13 ","$0.00 ","$211.06 ","$334.33 ","$337.70 ","$0.00 ","$66.06 ","$0.00 ","$67.20 ","$0.00 "
"425705","SUP","HCPCS C1713","","425705  -  PLATE 74.5MM 5 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$659.40 ","$487.96 ","$0.00 ","$441.38 ","$198.62 ","$0.00 ","$137.44 ","$0.00 ","$0.00 ","$77.28 ","$441.38 ","$0.00 ","$220.69 ","$349.57 ","$353.10 ","$0.00 ","$69.08 ","$0.00 ","$70.27 ","$0.00 "
"425706","SUP","HCPCS C1713","","425706  -  PLATE 90.5MM SS 6 HOLE STR MPS BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$479.88 ","$215.94 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$84.02 ","$479.88 ","$0.00 ","$239.94 ","$380.06 ","$383.90 ","$0.00 ","$75.10 ","$0.00 ","$76.40 ","$0.00 "
"425707","SUP","HCPCS C1713","","425707  -  PLATE 106.5MM 7 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$510.13 ","$229.56 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$89.32 ","$510.13 ","$0.00 ","$255.06 ","$404.02 ","$408.10 ","$0.00 ","$79.83 ","$0.00 ","$81.21 ","$0.00 "
"425708","SUP","HCPCS C1713","","425708  -  PLATE 122.5MM SS 8 HOLE STR MPS BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$541.75 ","$243.79 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$94.86 ","$541.75 ","$0.00 ","$270.88 ","$429.07 ","$433.40 ","$0.00 ","$84.78 ","$0.00 ","$86.25 ","$0.00 "
"425709","SUP","HCPCS C1713","","425709  -  PLATE 138.5MM 9 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$561.00 ","$252.45 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$98.23 ","$561.00 ","$0.00 ","$280.50 ","$444.31 ","$448.80 ","$0.00 ","$87.80 ","$0.00 ","$89.31 ","$0.00 "
"425710","SUP","HCPCS C1713","","425710  -  PLATE 154.5MM SS 10 HOLE STR MPS BONE PLVC","BOTH IP/OP","$726.60 ","$537.68 ","$0.00 ","$580.25 ","$261.11 ","$0.00 ","$151.44 ","$0.00 ","$0.00 ","$101.60 ","$580.25 ","$0.00 ","$290.13 ","$459.56 ","$464.20 ","$0.00 ","$90.81 ","$0.00 ","$92.38 ","$0.00 "
"425711","SUP","HCPCS C1713","","425711  -  PLATE 170.5MM 11 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$600.88 ","$270.39 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$105.21 ","$600.88 ","$0.00 ","$300.44 ","$475.90 ","$480.70 ","$0.00 ","$94.04 ","$0.00 ","$95.66 ","$0.00 "
"425712","SUP","HCPCS C1713","","425712  -  PLATE 186.5MM SS 12 HOLE STR MATTA MPS BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$621.50 ","$279.68 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$108.82 ","$621.50 ","$0.00 ","$310.75 ","$492.23 ","$497.20 ","$0.00 ","$97.26 ","$0.00 ","$98.94 ","$0.00 "
"425713","SUP","HCPCS C1713","","425713  -  PLATE 202.5MM 13 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$642.13 ","$288.96 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$112.43 ","$642.13 ","$0.00 ","$321.06 ","$508.57 ","$513.70 ","$0.00 ","$100.49 ","$0.00 ","$102.23 ","$0.00 "
"425714","SUP","HCPCS C1713","","425714  -  PLATE 218.5MM SS 14 HOLE STR MATTA BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$661.38 ","$297.62 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$115.80 ","$661.38 ","$0.00 ","$330.69 ","$523.81 ","$529.10 ","$0.00 ","$103.51 ","$0.00 ","$105.29 ","$0.00 "
"425715","SUP","HCPCS C1713","","425715  -  PLATE 234.5MM 15 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$799.40 ","$591.56 ","$0.00 ","$680.63 ","$306.28 ","$0.00 ","$166.61 ","$0.00 ","$0.00 ","$119.17 ","$680.63 ","$0.00 ","$340.31 ","$539.06 ","$544.50 ","$0.00 ","$106.52 ","$0.00 ","$108.36 ","$0.00 "
"425716","SUP","HCPCS C1713","","425716  -  PLATE 250.5MMX10.5MMX2.5M SS 16 HOLE STR MATTA BONE PLVC","BOTH IP/OP","$877.80 ","$649.57 ","$0.00 ","$720.50 ","$324.23 ","$0.00 ","$182.96 ","$0.00 ","$0.00 ","$126.15 ","$720.50 ","$0.00 ","$360.25 ","$570.64 ","$576.40 ","$0.00 ","$112.76 ","$0.00 ","$114.70 ","$0.00 "
"425718","SUP","HCPCS C1713","","425718  -  PLATE 282.5MM 18 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$877.80 ","$649.57 ","$0.00 ","$801.63 ","$360.73 ","$0.00 ","$182.96 ","$0.00 ","$0.00 ","$140.36 ","$801.63 ","$0.00 ","$400.81 ","$634.89 ","$641.30 ","$0.00 ","$125.45 ","$0.00 ","$127.62 ","$0.00 "
"425720","SUP","HCPCS C1713","","425720  -  PLATE 314.5MM 20 HL SHFT STR MATTA BONE PLVC","BOTH IP/OP","$902.00 ","$667.48 ","$0.00 ","$902.00 ","$405.90 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$157.93 ","$902.00 ","$0.00 ","$451.00 ","$714.38 ","$721.60 ","$0.00 ","$141.16 ","$0.00 ","$143.60 ","$0.00 "
"425752","SUP","HCPCS C1713","","425752  -  PLATE 22.5MM 2 HOLE STR BONE ACETAB","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$374.00 ","$168.30 ","$0.00 ","$77.95 ","$0.00 ","$0.00 ","$65.48 ","$374.00 ","$0.00 ","$187.00 ","$296.21 ","$299.20 ","$0.00 ","$58.53 ","$0.00 ","$59.54 ","$0.00 "
"425753","SUP","HCPCS C1713","","425753  -  PLATE 34.5MM 3 HOLE STR BONE ACETAB","BOTH IP/OP","$762.30 ","$564.10 ","$0.00 ","$426.25 ","$191.81 ","$0.00 ","$158.88 ","$0.00 ","$0.00 ","$74.63 ","$426.25 ","$0.00 ","$213.13 ","$337.59 ","$341.00 ","$0.00 ","$66.71 ","$0.00 ","$67.86 ","$0.00 "
"425754","SUP","HCPCS C1713","","425754  -  PLATE 46.5MM SS 4 HOLE STR MPS BONE ACETAB","BOTH IP/OP","$762.30 ","$564.10 ","$0.00 ","$448.25 ","$201.71 ","$0.00 ","$158.88 ","$0.00 ","$0.00 ","$78.48 ","$448.25 ","$0.00 ","$224.13 ","$355.01 ","$358.60 ","$0.00 ","$70.15 ","$0.00 ","$71.36 ","$0.00 "
"425755","SUP","HCPCS C1713","","425755  -  PLATE 58.5MM 5 HOLE STR BONE ACETAB","BOTH IP/OP","$762.30 ","$564.10 ","$0.00 ","$468.88 ","$210.99 ","$0.00 ","$158.88 ","$0.00 ","$0.00 ","$82.10 ","$468.88 ","$0.00 ","$234.44 ","$371.35 ","$375.10 ","$0.00 ","$73.38 ","$0.00 ","$74.64 ","$0.00 "
"425756","SUP","HCPCS C1713","","425756  -  PLATE 70.5MM SS 6 HOLE STR MPS BONE ACETAB","BOTH IP/OP","$837.90 ","$620.05 ","$0.00 ","$512.88 ","$230.79 ","$0.00 ","$174.64 ","$0.00 ","$0.00 ","$89.80 ","$512.88 ","$0.00 ","$256.44 ","$406.20 ","$410.30 ","$0.00 ","$80.26 ","$0.00 ","$81.65 ","$0.00 "
"425757","SUP","HCPCS C1713","","425757  -  PLATE 82.5MM 7 HOLE STR BONE ACETAB","BOTH IP/OP","$837.90 ","$620.05 ","$0.00 ","$543.13 ","$244.41 ","$0.00 ","$174.64 ","$0.00 ","$0.00 ","$95.10 ","$543.13 ","$0.00 ","$271.56 ","$430.16 ","$434.50 ","$0.00 ","$85.00 ","$0.00 ","$86.47 ","$0.00 "
"425758","SUP","HCPCS C1713","","425758  -  PLATE 94.5MM SS 8 HOLE STR MPS BONE ACETAB","BOTH IP/OP","$837.90 ","$620.05 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$174.64 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"425759","SUP","HCPCS C1713","","425759  -  PLATE 106.5MM 9 HOLE STR BONE ACETAB","BOTH IP/OP","$837.90 ","$620.05 ","$0.00 ","$598.13 ","$269.16 ","$0.00 ","$174.64 ","$0.00 ","$0.00 ","$104.73 ","$598.13 ","$0.00 ","$299.06 ","$473.72 ","$478.50 ","$0.00 ","$93.61 ","$0.00 ","$95.22 ","$0.00 "
"425760","SUP","HCPCS C1713","","425760  -  PLATE 118.5MM SS 10 HOLE STR MPS BONE ACETAB","BOTH IP/OP","$837.90 ","$620.05 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$174.64 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"425761","SUP","HCPCS C1713","","425761  -  PLATE 130.5MM 11 HOLE STR BONE ACETAB","BOTH IP/OP","$924.70 ","$684.28 ","$0.00 ","$640.75 ","$288.34 ","$0.00 ","$192.73 ","$0.00 ","$0.00 ","$112.19 ","$640.75 ","$0.00 ","$320.38 ","$507.47 ","$512.60 ","$0.00 ","$100.28 ","$0.00 ","$102.01 ","$0.00 "
"425762","SUP","HCPCS C1713","","425762  -  PLATE 142.5MM SS 12 HOLE STR MATTA MPS BONE ACETAB","BOTH IP/OP","$924.70 ","$684.28 ","$0.00 ","$662.75 ","$298.24 ","$0.00 ","$192.73 ","$0.00 ","$0.00 ","$116.04 ","$662.75 ","$0.00 ","$331.38 ","$524.90 ","$530.20 ","$0.00 ","$103.72 ","$0.00 ","$105.51 ","$0.00 "
"425763","SUP","HCPCS C1713","","425763  -  PLATE 154.5MM 13 HOLE STR BONE ACETAB","BOTH IP/OP","$924.70 ","$684.28 ","$0.00 ","$682.00 ","$306.90 ","$0.00 ","$192.73 ","$0.00 ","$0.00 ","$119.41 ","$682.00 ","$0.00 ","$341.00 ","$540.14 ","$545.60 ","$0.00 ","$106.73 ","$0.00 ","$108.57 ","$0.00 "
"425764","SUP","HCPCS C1713","","425764  -  PLATE 166.5MM SS 14 HOLE STR MATTA MPS BONE ACETAB","BOTH IP/OP","$924.70 ","$684.28 ","$0.00 ","$704.00 ","$316.80 ","$0.00 ","$192.73 ","$0.00 ","$0.00 ","$123.26 ","$704.00 ","$0.00 ","$352.00 ","$557.57 ","$563.20 ","$0.00 ","$110.18 ","$0.00 ","$112.08 ","$0.00 "
"425765","SUP","HCPCS C1713","","425765  -  PLATE 178.5MM 15 HOLE STR BONE ACETAB","BOTH IP/OP","$924.70 ","$684.28 ","$0.00 ","$726.00 ","$326.70 ","$0.00 ","$192.73 ","$0.00 ","$0.00 ","$127.12 ","$726.00 ","$0.00 ","$363.00 ","$574.99 ","$580.80 ","$0.00 ","$113.62 ","$0.00 ","$115.58 ","$0.00 "
"425766","SUP","HCPCS C1713","","425766  -  PLATE 190.5MM SS 16 HOLE STR BONE ACETAB","BOTH IP/OP","$1,014.30 ","$750.58 ","$0.00 ","$767.25 ","$345.26 ","$0.00 ","$211.41 ","$0.00 ","$0.00 ","$134.34 ","$767.25 ","$0.00 ","$383.63 ","$607.66 ","$613.80 ","$0.00 ","$120.07 ","$0.00 ","$122.15 ","$0.00 "
"425767","SUP","HCPCS C1713","","425767  -  PLATE 202.5MM 17 HOLE STR BONE ACETAB","BOTH IP/OP","$1,014.30 ","$750.58 ","$0.00 ","$809.88 ","$364.44 ","$0.00 ","$211.41 ","$0.00 ","$0.00 ","$141.80 ","$809.88 ","$0.00 ","$404.94 ","$641.42 ","$647.90 ","$0.00 ","$126.75 ","$0.00 ","$128.93 ","$0.00 "
"425768","SUP","HCPCS C1713","","425768  -  PLATE 214.5MM 18 HOLE STR BONE ACETAB","BOTH IP/OP","$1,014.30 ","$750.58 ","$0.00 ","$851.13 ","$383.01 ","$0.00 ","$211.41 ","$0.00 ","$0.00 ","$149.03 ","$851.13 ","$0.00 ","$425.56 ","$674.09 ","$680.90 ","$0.00 ","$133.20 ","$0.00 ","$135.50 ","$0.00 "
"425769","SUP","HCPCS C1713","","425769  -  PLATE 226.5MM 19 HOLE STR BONE ACETAB","BOTH IP/OP","$961.13 ","$711.24 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$200.32 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425770","SUP","HCPCS C1713","","425770  -  PLATE 238.5MM 20 HOLE STR BONE ACETAB","BOTH IP/OP","$1,014.30 ","$750.58 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$211.41 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425772","SUP","HCPCS C1713","","425772  -  PLATE 262.5MM 22 HOLE STR BONE ACETAB","BOTH IP/OP","$1,014.30 ","$750.58 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$211.41 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425774","SUP","HCPCS C1713","","425774  -  PLATE 286.5MM 24 HOLE STR BONE ACETAB","BOTH IP/OP","$961.13 ","$711.24 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$200.32 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425776","SUP","HCPCS C1713","","425776  -  PLATE 310.5MM 26 HOLE STR BONE ACETAB","BOTH IP/OP","$961.13 ","$711.24 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$200.32 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425778","SUP","HCPCS C1713","","425778  -  PLATE 334.5MM 28 HOLE STR BONE ACETAB","BOTH IP/OP","$961.13 ","$711.24 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$200.32 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425780","SUP","HCPCS C1713","","425780  -  PLATE 358.5MM 30 HOLE STR BONE ACETAB","BOTH IP/OP","$1,014.30 ","$750.58 ","$0.00 ","$961.13 ","$432.51 ","$0.00 ","$211.41 ","$0.00 ","$0.00 ","$168.29 ","$961.13 ","$0.00 ","$480.56 ","$761.21 ","$768.90 ","$0.00 ","$150.42 ","$0.00 ","$153.01 ","$0.00 "
"425794","SUP","HCPCS C1713","","425794  -  PLATE BN 60.5MM MPS 4 HL SS R75","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,018.88 ","$458.49 ","$0.00 ","$233.44 ","$0.00 ","$0.00 ","$178.40 ","$1,018.88 ","$0.00 ","$509.44 ","$806.95 ","$815.10 ","$0.00 ","$159.45 ","$0.00 ","$162.20 ","$0.00 "
"425796","SUP","HCPCS C1713","","425796  -  PLATE BN 92.5MM MPS 6 HL SS R75","BOTH IP/OP","$1,187.20 ","$878.53 ","$0.00 ","$1,071.13 ","$482.01 ","$0.00 ","$247.44 ","$0.00 ","$0.00 ","$187.55 ","$1,071.13 ","$0.00 ","$535.56 ","$848.33 ","$856.90 ","$0.00 ","$167.63 ","$0.00 ","$170.52 ","$0.00 "
"425798","SUP","HCPCS C1713","","425798  -  PLATE 75MM RAD 124.5MM 8 HOLE BONE PUBIS SYMPHYSIS","BOTH IP/OP","$1,122.00 ","$830.28 ","$0.00 ","$1,122.00 ","$504.90 ","$0.00 ","$233.85 ","$0.00 ","$0.00 ","$196.45 ","$1,122.00 ","$0.00 ","$561.00 ","$888.62 ","$897.60 ","$0.00 ","$175.59 ","$0.00 ","$178.62 ","$0.00 "
"427002","SUP","HCPCS C1713","","427002  -  PLATE 32MM SS 4MM SCR SM FRAG 2 HOLE WST CMPR LCK AXSOS BONE","BOTH IP/OP","$182.40 ","$134.98 ","$0.00 ","$178.75 ","$80.44 ","$0.00 ","$38.02 ","$0.00 ","$0.00 ","$31.30 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$27.97 ","$0.00 ","$28.46 ","$0.00 "
"427003","SUP","HCPCS C1713","","427003  -  PLATE 45MM SS 3 HOLE WST CMPR SM FRAG IMPL AXSOS BONE 4MM","BOTH IP/OP","$182.40 ","$134.98 ","$0.00 ","$178.75 ","$80.44 ","$0.00 ","$38.02 ","$0.00 ","$0.00 ","$31.30 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$27.97 ","$0.00 ","$28.46 ","$0.00 "
"427004","SUP","HCPCS C1713","","427004  -  PLATE 58MM SS 4MM SCR SM FRAG 4 HOLE WST CMPR LCK AXSOS BONE","BOTH IP/OP","$182.40 ","$134.98 ","$0.00 ","$192.50 ","$86.63 ","$0.00 ","$38.02 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"427005","SUP","HCPCS C1713","","427005  -  PLATE BN 71MM NS AXSOS 5 HL LCK CMPR SS WST 4MM SCR SM FRAG","BOTH IP/OP","$233.60 ","$172.86 ","$0.00 ","$226.88 ","$102.09 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$39.72 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$35.51 ","$0.00 ","$36.12 ","$0.00 "
"427006","SUP","HCPCS C1713","","427006  -  PLATE BN 84MM NS AXSOS 6 HL LCK CMPR SS WST 4MM SCR SM FRAG","BOTH IP/OP","$233.60 ","$172.86 ","$0.00 ","$226.88 ","$102.09 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$39.72 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$35.51 ","$0.00 ","$36.12 ","$0.00 "
"427007","SUP","HCPCS C1713","","427007  -  PLATE BN 97MM NS AXSOS 7 HL LCK CMPR SS WST 4MM SCR SM FRAG","BOTH IP/OP","$233.60 ","$172.86 ","$0.00 ","$226.88 ","$102.09 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$39.72 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$35.51 ","$0.00 ","$36.12 ","$0.00 "
"427008","SUP","HCPCS C1713","","427008  -  PLATE 110MM SS 4MM SCR 8 HOLE WST CMPR SM FRAG IMPL AXSOS","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"427009","SUP","HCPCS C1713","","427009  -  PLATE 123MM SS 4MM SCR SM FRAG 29 HOLE WST CMPR LCK AXSOS","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"427010","SUP","HCPCS C1713","","427010  -  PLATE 4MM SCR NONSTRL 136MM SS 10 HOLE LCK CMPR WST SM FRAG","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"427011","SUP","HCPCS C1713","","427011  -  PLATE 149MM SS 4MM SCR SM FRAG 11 HOLE WST CMPR LCK AXSOS","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"427012","SUP","HCPCS C1713","","427012  -  PLATE BN 162MM NS AXSOS 12 HL LCK CMPR SS WST 4MM SCR SM","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"427014","SUP","HCPCS C1713","","427014  -  PLATE 188MM 14 HOLE CMPR WST LCK AXSOS BONE 4MM","BOTH IP/OP","$311.20 ","$230.29 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$64.86 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"427016","SUP","HCPCS C1713","","427016  -  PLATE 241MM SS 16 HOLE WST CMPR BONE 4MM STRL","BOTH IP/OP","$311.20 ","$230.29 ","$0.00 ","$336.88 ","$151.59 ","$0.00 ","$64.86 ","$0.00 ","$0.00 ","$58.98 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$52.72 ","$0.00 ","$53.63 ","$0.00 "
"427018","SUP","HCPCS C1713","","427018  -  PLATE 240MM SS 4MM SCR SM FRAG 18 HOLE WST CMPR LCK AXSOS","BOTH IP/OP","$363.20 ","$268.77 ","$0.00 ","$378.13 ","$170.16 ","$0.00 ","$75.70 ","$0.00 ","$0.00 ","$66.21 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$59.18 ","$0.00 ","$60.20 ","$0.00 "
"427020","SUP","HCPCS C1713","","427020  -  PLATE 266MM SS 4MM SCR SM FRAG 20 HOLE WST CMPR LCK AXSOS","BOTH IP/OP","$363.20 ","$268.77 ","$0.00 ","$378.13 ","$170.16 ","$0.00 ","$75.70 ","$0.00 ","$0.00 ","$66.21 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$59.18 ","$0.00 ","$60.20 ","$0.00 "
"427062","SUP","HCPCS C1713","","427062  -  PLATE 24MM SS 3MM SCR SM FRAG 2 HOLE 1/3 TBLR LCK SYS AXSOS","BOTH IP/OP","$179.20 ","$132.61 ","$0.00 ","$180.13 ","$81.06 ","$0.00 ","$37.35 ","$0.00 ","$0.00 ","$31.54 ","$180.13 ","$0.00 ","$90.06 ","$142.66 ","$144.10 ","$0.00 ","$28.19 ","$0.00 ","$28.68 ","$0.00 "
"427063","SUP","HCPCS C1713","","427063  -  PLATE 37MM SS 3 HOLE 1/3 TBLR BONE 3MM","BOTH IP/OP","$190.40 ","$140.90 ","$0.00 ","$189.75 ","$85.39 ","$0.00 ","$39.68 ","$0.00 ","$0.00 ","$33.22 ","$189.75 ","$0.00 ","$94.88 ","$150.28 ","$151.80 ","$0.00 ","$29.70 ","$0.00 ","$30.21 ","$0.00 "
"427064","SUP","HCPCS C1713","","427064  -  PLATE 50MM SS 3MM SCR SM FRAG SET 4 HOLE 1/3 TBLR LCK AXSOS","BOTH IP/OP","$218.40 ","$161.62 ","$0.00 ","$218.63 ","$98.38 ","$0.00 ","$45.52 ","$0.00 ","$0.00 ","$38.28 ","$218.63 ","$0.00 ","$109.31 ","$173.15 ","$174.90 ","$0.00 ","$34.21 ","$0.00 ","$34.81 ","$0.00 "
"427065","SUP","HCPCS C1713","","427065  -  PLATE 3MM 63MM SS 5 HOLE 1/3 TBLR SM FRAG AXSOS BONE","BOTH IP/OP","$218.40 ","$161.62 ","$0.00 ","$218.63 ","$98.38 ","$0.00 ","$45.52 ","$0.00 ","$0.00 ","$38.28 ","$218.63 ","$0.00 ","$109.31 ","$173.15 ","$174.90 ","$0.00 ","$34.21 ","$0.00 ","$34.81 ","$0.00 "
"427066","SUP","HCPCS C1713","","427066  -  PLATE BN 1/3 TBLR 76MM NS AXSOS 6 HL LCK SS 3MM SCR SM FRAG","BOTH IP/OP","$218.40 ","$161.62 ","$0.00 ","$88.00 ","$39.60 ","$0.00 ","$45.52 ","$0.00 ","$0.00 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"427067","SUP","HCPCS C1713","","427067  -  PLATE 89MM SS 3MM SCR SM FRAG 7 HOLE 1/3 TBLR LCK AXSOS BONE","BOTH IP/OP","$223.20 ","$165.17 ","$0.00 ","$224.13 ","$100.86 ","$0.00 ","$46.52 ","$0.00 ","$0.00 ","$39.24 ","$224.13 ","$0.00 ","$112.06 ","$177.51 ","$179.30 ","$0.00 ","$35.08 ","$0.00 ","$35.68 ","$0.00 "
"427068","SUP","HCPCS C1713","","427068  -  PLATE BN 1/3 TBLR 102MM NS AXSOS 8 HL LCK SS 3MM SCR SM FRAG","BOTH IP/OP","$236.80 ","$175.23 ","$0.00 ","$236.50 ","$106.43 ","$0.00 ","$49.36 ","$0.00 ","$0.00 ","$41.41 ","$236.50 ","$0.00 ","$118.25 ","$187.31 ","$189.20 ","$0.00 ","$37.01 ","$0.00 ","$37.65 ","$0.00 "
"427070","SUP","HCPCS C1713","","427070  -  PLATE 3MM 128MM SS 10 HOLE 1/3 TBLR SM FRAG IMPL AXSOS BONE","BOTH IP/OP","$236.80 ","$175.23 ","$0.00 ","$236.50 ","$106.43 ","$0.00 ","$49.36 ","$0.00 ","$0.00 ","$41.41 ","$236.50 ","$0.00 ","$118.25 ","$187.31 ","$189.20 ","$0.00 ","$37.01 ","$0.00 ","$37.65 ","$0.00 "
"427072","SUP","HCPCS C1713","","427072  -  PLATE 154MM SS 3MM SCR SM FRAG 12 HOLE 1/3 TBLR LCK AXSOS","BOTH IP/OP","$243.20 ","$179.97 ","$0.00 ","$243.38 ","$109.52 ","$0.00 ","$50.69 ","$0.00 ","$0.00 ","$42.61 ","$243.38 ","$0.00 ","$121.69 ","$192.76 ","$194.70 ","$0.00 ","$38.09 ","$0.00 ","$38.75 ","$0.00 "
"427074","SUP","HCPCS C1713","","427074  -  PLATE 180MM SS 3MM SCR SM FRAG 14 HOLE 1/3 TBLR LCK AXSOS","BOTH IP/OP","$247.20 ","$182.93 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.52 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"427102","SUP","HCPCS C1713","","427102  -  PLATE NAR 43MM SS 5MM SCR BASIC FRAG 2 HOLE WST CMPR LCK","BOTH IP/OP","$245.60 ","$181.74 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"427103","SUP","HCPCS C1713","","427103  -  PLATE NAR 61MM SS 5MM SCR BASIC FRAG 3 HOLE WST CMPR LCK","BOTH IP/OP","$245.60 ","$181.74 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"427104","SUP","HCPCS C1713","","427104  -  PLATE NAR 79MM SS 5MM SCR BASIC FRAG 4 HOLE WST CMPR LCK","BOTH IP/OP","$245.60 ","$181.74 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"427105","SUP","HCPCS C1713","","427105  -  PLATE NAR 97MM SS 5MM SCR BASIC FRAG 5 HOLE WST CMPR LCK","BOTH IP/OP","$245.60 ","$181.74 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"427106","SUP","HCPCS C1713","","427106  -  PLATE NAR 115MM SS WST CMPR 6 HOLE BONE 5MM","BOTH IP/OP","$245.60 ","$181.74 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"427107","SUP","HCPCS C1713","","427107  -  PLATE NAR 133MM SS 7 HL SHFT CMPR WST BONE 5MM","BOTH IP/OP","$293.60 ","$217.26 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$61.19 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"427108","SUP","HCPCS C1713","","427108  -  PLATE BN NAR 151MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC","BOTH IP/OP","$293.60 ","$217.26 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$61.19 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"427109","SUP","HCPCS C1713","","427109  -  PLATE NAR 169MM SS BASIC FRAG SET 9 HOLE LCK CMPR AXSOS BONE","BOTH IP/OP","$293.60 ","$217.26 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$61.19 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"427110","SUP","HCPCS C1713","","427110  -  PLATE NAR 187MM SS 5MM SCR BASIC FRAG 10 HOLE WST CMPR LCK","BOTH IP/OP","$293.60 ","$217.26 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$61.19 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"427112","SUP","HCPCS C1713","","427112  -  PLATE NAR 223MM SS 5MM SCR BASIC FRAG 12 HOLE WST CMPR LCK","BOTH IP/OP","$351.20 ","$259.89 ","$0.00 ","$316.25 ","$142.31 ","$0.00 ","$73.20 ","$0.00 ","$0.00 ","$55.37 ","$316.25 ","$0.00 ","$158.13 ","$250.47 ","$253.00 ","$0.00 ","$49.49 ","$0.00 ","$50.35 ","$0.00 "
"427114","SUP","HCPCS C1713","","427114  -  PLATE BN NAR 259MM NS AXSOS 14 HL LCK CMPR SS WST 5MM SCR","BOTH IP/OP","$351.20 ","$259.89 ","$0.00 ","$316.25 ","$142.31 ","$0.00 ","$73.20 ","$0.00 ","$0.00 ","$55.37 ","$316.25 ","$0.00 ","$158.13 ","$250.47 ","$253.00 ","$0.00 ","$49.49 ","$0.00 ","$50.35 ","$0.00 "
"427116","SUP","HCPCS C1713","","427116  -  PLATE NAR NONSTRL 295MM SS 5MM SCR BASIC FRAG 16 HOLE WST","BOTH IP/OP","$378.40 ","$280.02 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$78.87 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"427118","SUP","HCPCS C1713","","427118  -  PLATE NAR NONSTRL 331MM SS 5MM SCR BASIC FRAG 18 HOLE WST","BOTH IP/OP","$418.40 ","$309.62 ","$0.00 ","$446.88 ","$201.09 ","$0.00 ","$87.21 ","$0.00 ","$0.00 ","$78.24 ","$446.88 ","$0.00 ","$223.44 ","$353.93 ","$357.50 ","$0.00 ","$69.94 ","$0.00 ","$71.14 ","$0.00 "
"427120","SUP","HCPCS C1713","","427120  -  PLATE NAR 367MM SS 5MM SCR BASIC FRAG 20 HOLE WST CMPR LCK","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$132.56 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"427122","SUP","HCPCS C1713","","427122  -  PLATE NAR NONSTRL 403MM SS 5MM SCR BASIC FRAG 22 HOLE WST","BOTH IP/OP","$636.00 ","$470.64 ","$0.00 ","$563.75 ","$253.69 ","$0.00 ","$132.56 ","$0.00 ","$0.00 ","$98.71 ","$563.75 ","$0.00 ","$281.88 ","$446.49 ","$451.00 ","$0.00 ","$88.23 ","$0.00 ","$89.75 ","$0.00 "
"427136","SUP","HCPCS C1713","","427136  -  PLATE BRD 119MM SS 5MM SCR BASIC FRAG SET 6 HOLE LCK CMPR","BOTH IP/OP","$340.80 ","$252.19 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$71.03 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"427137","SUP","HCPCS C1713","","427137  -  PLATE BRD 137MM SS 7 HL SHFT CMPR WST BONE 5MM","BOTH IP/OP","$358.40 ","$265.22 ","$0.00 ","$332.75 ","$149.74 ","$0.00 ","$74.70 ","$0.00 ","$0.00 ","$58.26 ","$332.75 ","$0.00 ","$166.38 ","$263.54 ","$266.20 ","$0.00 ","$52.08 ","$0.00 ","$52.97 ","$0.00 "
"427138","SUP","HCPCS C1713","","427138  -  PLATE BN BRD 155MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$332.75 ","$149.74 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$58.26 ","$332.75 ","$0.00 ","$166.38 ","$263.54 ","$266.20 ","$0.00 ","$52.08 ","$0.00 ","$52.97 ","$0.00 "
"427139","SUP","HCPCS C1713","","427139  -  PLATE BRD 173MM SS 5MM SCR BASIC FRAG 9 HOLE WST CMPR LCK","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$332.75 ","$149.74 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$58.26 ","$332.75 ","$0.00 ","$166.38 ","$263.54 ","$266.20 ","$0.00 ","$52.08 ","$0.00 ","$52.97 ","$0.00 "
"427140","SUP","HCPCS C1713","","427140  -  PLATE BN BRD 191MM NS AXSOS 10 HL LCK CMPR SS WST 5MM SCR","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$332.75 ","$149.74 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$58.26 ","$332.75 ","$0.00 ","$166.38 ","$263.54 ","$266.20 ","$0.00 ","$52.08 ","$0.00 ","$52.97 ","$0.00 "
"427141","SUP","HCPCS C1713","","427141  -  PLATE BRD 209MM SS 5MM SCR BASIC FRAG 11 HOLE WST CMPR LCK","BOTH IP/OP","$416.80 ","$308.43 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$86.87 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"427142","SUP","HCPCS C1713","","427142  -  PLATE BRD 227MM SS BASIC FRAG SET 12 HOLE LCK CMPR AXSOS","BOTH IP/OP","$416.80 ","$308.43 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$86.87 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"427143","SUP","HCPCS C1713","","427143  -  PLATE BRD 245MM SS 5MM SCR BASIC FRAG 13 HOLE WST CMPR LCK","BOTH IP/OP","$416.80 ","$308.43 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$86.87 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"427144","SUP","HCPCS C1713","","427144  -  PLATE BRD 263MM SS 5MM SCR BASIC FRAG 14 HOLE WST CMPR LCK","BOTH IP/OP","$416.80 ","$308.43 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$86.87 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"427146","SUP","HCPCS C1713","","427146  -  PLATE BRD 299MM SS 5MM SCR BASIC FRAG 16 HOLE WST CMPR LCK","BOTH IP/OP","$446.40 ","$330.34 ","$0.00 ","$407.00 ","$183.15 ","$0.00 ","$93.04 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"427148","SUP","HCPCS C1713","","427148  -  PLATE BRD 335MM SS 5MM SCR BASIC FRAG 18 HOLE WST CMPR LCK","BOTH IP/OP","$446.40 ","$330.34 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$93.04 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"427150","SUP","HCPCS C1713","","427150  -  PLATE BRD 371MM SS 5MM SCR BASIC FRAG 20 HOLE WST CMPR LCK","BOTH IP/OP","$597.60 ","$442.22 ","$0.00 ","$559.63 ","$251.83 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$97.99 ","$559.63 ","$0.00 ","$279.81 ","$443.23 ","$447.70 ","$0.00 ","$87.58 ","$0.00 ","$89.09 ","$0.00 "
"427152","SUP","HCPCS C1713","","427152  -  PLATE BRD 407MM SS 5MM SCR BASIC FRAG 22 HOLE WST CMPR LCK","BOTH IP/OP","$597.60 ","$442.22 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$124.55 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"429688","SUP","HCPCS C1900","","429688  -  LEAD PACING 2 CURVE 5.3FR 88CM BIPOL 2 ELECTRODE 2 FIX IS-1","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$0.00 ","$0.00 "
"430009","SUP","HCPCS C1713","","430009  -  PLATE 117MM SS SM FRAG SET 9 HOLE WST CMPR SPS BONE ORTH","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$225.50 ","$101.48 ","$0.00 ","$42.52 ","$0.00 ","$0.00 ","$39.48 ","$225.50 ","$0.00 ","$112.75 ","$178.60 ","$180.40 ","$0.00 ","$35.29 ","$0.00 ","$35.90 ","$0.00 "
"430012","SUP","HCPCS C1713","","430012  -  PLATE 156X10.3X3.2MM SS 12 HOLE CMPR WST BONE ORTH","BOTH IP/OP","$287.25 ","$212.57 ","$0.00 ","$243.38 ","$109.52 ","$0.00 ","$59.87 ","$0.00 ","$0.00 ","$42.61 ","$243.38 ","$0.00 ","$121.69 ","$192.76 ","$194.70 ","$0.00 ","$38.09 ","$0.00 ","$38.75 ","$0.00 "
"430014","SUP","HCPCS C1713","","430014  -  PLATE 182MM SS SM FRAG SET 14 HOLE WST CMPR SPS BONE ORTH","BOTH IP/OP","$306.40 ","$226.74 ","$0.00 ","$389.13 ","$175.11 ","$0.00 ","$63.86 ","$0.00 ","$0.00 ","$68.13 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$60.90 ","$0.00 ","$61.95 ","$0.00 "
"430016","SUP","HCPCS C1713","","430016  -  PLATE 208MM SS SM FRAG SET 16 HOLE WST CMPR SPS BONE ORTH","BOTH IP/OP","$509.60 ","$377.10 ","$0.00 ","$606.38 ","$272.87 ","$0.00 ","$106.21 ","$0.00 ","$0.00 ","$106.17 ","$606.38 ","$0.00 ","$303.19 ","$480.25 ","$485.10 ","$0.00 ","$94.90 ","$0.00 ","$96.53 ","$0.00 "
"430018","SUP","HCPCS C1713","","430018  -  PLATE 234X10.3X3.2MM SS 18 HOLE CMPR WST BONE ORTH","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$691.63 ","$311.23 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$121.10 ","$691.63 ","$0.00 ","$345.81 ","$547.77 ","$553.30 ","$0.00 ","$108.24 ","$0.00 ","$110.11 ","$0.00 "
"430055","SUP","HCPCS C1713","","430055  -  PLATE STD 65MM SS 5 HOLE CMPR SPS BONE DISTAL ULN NONSTRL","BOTH IP/OP","$191.13 ","$141.44 ","$0.00 ","$191.13 ","$86.01 ","$0.00 ","$39.84 ","$0.00 ","$0.00 ","$33.46 ","$191.13 ","$0.00 ","$95.56 ","$151.37 ","$152.90 ","$0.00 ","$29.91 ","$0.00 ","$30.43 ","$0.00 "
"430056","SUP","HCPCS C1713","","430056  -  PLATE STD 78MM SS 6 HOLE CMPR BONE","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$159.50 ","$71.78 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$27.93 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$24.96 ","$0.00 ","$25.39 ","$0.00 "
"430060","SUP","HCPCS C1713","","430060  -  PLATE STD 130MM SS 10 HOLE CMPR SPS BONE DISTAL ULN NONSTRL","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"431748","SUP","HCPCS C1785","","431748  -  PACEMAKER CRD EDORA PROMRI CLS HOME MNTR DR-T","BOTH IP/OP","$17,750.00 ","$13,135.00 ","$0.00 ","$17,750.00 ","$7,987.50 ","$0.00 ","$3,699.54 ","$0.00 ","$0.00 ","$3,107.88 ","$17,750.00 ","$0.00 ","$8,875.00 ","$14,058.00 ","$14,200.00 ","$0.00 ","$2,777.88 ","$0.00 ","$2,825.80 ","$0.00 "
"431749","SUP","HCPCS C1786","","431749  -  PACEMAKER CRD EDORA PROMRI CLS HOME MNTR SR-T","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$0.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$0.00 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"432203","SUP","HCPCS C1713","","432203  -  PLATE 46MM SS 4.5MM SCR 3 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$312.80 ","$231.47 ","$0.00 ","$324.50 ","$146.03 ","$0.00 ","$65.20 ","$0.00 ","$0.00 ","$56.82 ","$324.50 ","$0.00 ","$162.25 ","$257.00 ","$259.60 ","$0.00 ","$50.78 ","$0.00 ","$51.66 ","$0.00 "
"432204","SUP","HCPCS C1713","","432204  -  PLATE 62MM SS 4.5MM SCR 4 HL SHFT RECON BONE","BOTH IP/OP","$358.40 ","$265.22 ","$0.00 ","$374.00 ","$168.30 ","$0.00 ","$74.70 ","$0.00 ","$0.00 ","$65.48 ","$374.00 ","$0.00 ","$187.00 ","$296.21 ","$299.20 ","$0.00 ","$58.53 ","$0.00 ","$59.54 ","$0.00 "
"432205","SUP","HCPCS C1713","","432205  -  PLATE 78MM SS 4.5MM SCR 5 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$392.80 ","$290.67 ","$0.00 ","$409.75 ","$184.39 ","$0.00 ","$81.87 ","$0.00 ","$0.00 ","$71.74 ","$409.75 ","$0.00 ","$204.88 ","$324.52 ","$327.80 ","$0.00 ","$64.13 ","$0.00 ","$65.23 ","$0.00 "
"432206","SUP","HCPCS C1713","","432206  -  PLATE 94MM SS 4.5MM SCR 6 HL SHFT RECON BONE","BOTH IP/OP","$419.20 ","$310.21 ","$0.00 ","$437.25 ","$196.76 ","$0.00 ","$87.37 ","$0.00 ","$0.00 ","$76.56 ","$437.25 ","$0.00 ","$218.63 ","$346.30 ","$349.80 ","$0.00 ","$68.43 ","$0.00 ","$69.61 ","$0.00 "
"432207","SUP","HCPCS C1713","","432207  -  PLATE 110MM SS 4.5MM SCR 7 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$436.00 ","$322.64 ","$0.00 ","$455.13 ","$204.81 ","$0.00 ","$90.87 ","$0.00 ","$0.00 ","$79.69 ","$455.13 ","$0.00 ","$227.56 ","$360.46 ","$364.10 ","$0.00 ","$71.23 ","$0.00 ","$72.46 ","$0.00 "
"432208","SUP","HCPCS C1713","","432208  -  PLATE 126MM SS 4.5MM SCR 8 HL SHFT RECON BONE","BOTH IP/OP","$454.40 ","$336.26 ","$0.00 ","$481.25 ","$216.56 ","$0.00 ","$94.71 ","$0.00 ","$0.00 ","$84.26 ","$481.25 ","$0.00 ","$240.63 ","$381.15 ","$385.00 ","$0.00 ","$75.32 ","$0.00 ","$76.62 ","$0.00 "
"432209","SUP","HCPCS C1713","","432209  -  PLATE 142MM SS 4.5MM SCR 9 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$485.60 ","$359.34 ","$0.00 ","$517.00 ","$232.65 ","$0.00 ","$101.21 ","$0.00 ","$0.00 ","$90.52 ","$517.00 ","$0.00 ","$258.50 ","$409.46 ","$413.60 ","$0.00 ","$80.91 ","$0.00 ","$82.31 ","$0.00 "
"432210","SUP","HCPCS C1713","","432210  -  PLATE 158MM SS 4.5MM SCR 10 HOLE RECON BONE","BOTH IP/OP","$503.20 ","$372.37 ","$0.00 ","$534.88 ","$240.69 ","$0.00 ","$104.88 ","$0.00 ","$0.00 ","$93.65 ","$534.88 ","$0.00 ","$267.44 ","$423.62 ","$427.90 ","$0.00 ","$83.71 ","$0.00 ","$85.15 ","$0.00 "
"432211","SUP","HCPCS C1713","","432211  -  PLATE 174MM SS 4.5MM SCR 11 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$529.50 ","$391.83 ","$0.00 ","$511.50 ","$230.18 ","$0.00 ","$110.36 ","$0.00 ","$0.00 ","$89.56 ","$511.50 ","$0.00 ","$255.75 ","$405.11 ","$409.20 ","$0.00 ","$80.05 ","$0.00 ","$81.43 ","$0.00 "
"432212","SUP","HCPCS C1713","","432212  -  PLATE 190MM SS 4.5MM SCR 12 HOLE RECON BONE","BOTH IP/OP","$566.40 ","$419.14 ","$0.00 ","$587.13 ","$264.21 ","$0.00 ","$118.05 ","$0.00 ","$0.00 ","$102.80 ","$587.13 ","$0.00 ","$293.56 ","$465.01 ","$469.70 ","$0.00 ","$91.89 ","$0.00 ","$93.47 ","$0.00 "
"432213","SUP","HCPCS C1713","","432213  -  PLATE 206MM SS 4.5MM SCR 13 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$587.20 ","$434.53 ","$0.00 ","$624.25 ","$280.91 ","$0.00 ","$122.39 ","$0.00 ","$0.00 ","$109.30 ","$624.25 ","$0.00 ","$312.13 ","$494.41 ","$499.40 ","$0.00 ","$97.70 ","$0.00 ","$99.38 ","$0.00 "
"432214","SUP","HCPCS C1713","","432214  -  PLATE 222MM SS 4.5MM SCR 14 HL SHFT RECON BONE","BOTH IP/OP","$591.20 ","$437.49 ","$0.00 ","$642.13 ","$288.96 ","$0.00 ","$123.22 ","$0.00 ","$0.00 ","$112.43 ","$642.13 ","$0.00 ","$321.06 ","$508.57 ","$513.70 ","$0.00 ","$100.49 ","$0.00 ","$102.23 ","$0.00 "
"432215","SUP","HCPCS C1713","","432215  -  PLATE 238MM SS 4.5MM SCR 15 HOLE RECON SPS BONE DISTAL TIB","BOTH IP/OP","$592.00 ","$438.08 ","$0.00 ","$607.75 ","$273.49 ","$0.00 ","$123.39 ","$0.00 ","$0.00 ","$106.41 ","$607.75 ","$0.00 ","$303.88 ","$481.34 ","$486.20 ","$0.00 ","$95.11 ","$0.00 ","$96.75 ","$0.00 "
"432216","SUP","HCPCS C1713","","432216  -  PLATE 254MM SS 4.5MM SCR 16 HL SHFT RECON BONE","BOTH IP/OP","$625.60 ","$462.94 ","$0.00 ","$686.13 ","$308.76 ","$0.00 ","$130.39 ","$0.00 ","$0.00 ","$120.13 ","$686.13 ","$0.00 ","$343.06 ","$543.41 ","$548.90 ","$0.00 ","$107.38 ","$0.00 ","$109.23 ","$0.00 "
"433165","SUP","Custom 27803010","","433165  -  CEMENT BONE SIL 65MM 40GM TIB KNEE SPCR MLD STRL DISP","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"436003","SUP","HCPCS C1713","","436003  -  PLATE 3 HOLE BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,174.40 ","$869.06 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$244.77 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436004","SUP","HCPCS C1713","","436004  -  PLATE 4 HOLE BONE LEFT DISTAL VOLR RAD","BOTH IP/OP","$1,174.40 ","$869.06 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$244.77 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436006","SUP","HCPCS C1713","","436006  -  PLATE 6 HOLE BONE LEFT DISTAL VOLR RAD","BOTH IP/OP","$1,031.25 ","$763.13 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$214.94 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436008","SUP","HCPCS C1713","","436008  -  DISTAL VOLAR RADIUS  8 HOLE LT","BOTH IP/OP","$1,031.25 ","$763.13 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$214.94 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436010","SUP","HCPCS C1713","","436010  -  PLATE 10 HOLE BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,031.25 ","$763.13 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$214.94 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436023","SUP","HCPCS C1713","","436023  -  PLATE 3 HOLE BONE RIGHT DISTAL VOLR RAD","BOTH IP/OP","$1,174.40 ","$869.06 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$244.77 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436024","SUP","HCPCS C1713","","436024  -  PLATE 4 HOLE BONE RIGHT DISTAL VOLR RAD","BOTH IP/OP","$1,174.40 ","$869.06 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$244.77 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436026","SUP","HCPCS C1713","","436026  -  PLATE 6 HOLE BONE RIGHT DISTAL VOLR RAD","BOTH IP/OP","$1,031.25 ","$763.13 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$214.94 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436028","SUP","HCPCS C1713","","436028  -  PLATE 8 HOLE BONE RIGHT DISTAL VOLR RADL","BOTH IP/OP","$1,031.25 ","$763.13 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$214.94 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436030","SUP","HCPCS C1713","","436030  -  PLATE 10 HOLE BONE RIGHT DISTAL VOLR RADL","BOTH IP/OP","$1,031.25 ","$763.13 ","$0.00 ","$1,031.25 ","$464.06 ","$0.00 ","$214.94 ","$0.00 ","$0.00 ","$180.56 ","$1,031.25 ","$0.00 ","$515.63 ","$816.75 ","$825.00 ","$0.00 ","$161.39 ","$0.00 ","$164.18 ","$0.00 "
"436103","SUP","HCPCS C1713","","436103  -  PLATE 86MM SS 5 HOLE BONE LEFT PROX LAT HUM","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"436105","SUP","HCPCS C1713","","436105  -  PLATE 5 HOLE BONE LEFT PROX LAT HUM","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"436108","SUP","HCPCS C1713","","436108  -  PLATE 150MM SS 8 HOLE BONE LEFT PROX LAT HUM","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"436123","SUP","HCPCS C1713","","436123  -  PLATE 86MM SS 5 HOLE BONE RIGHT PROX LAT HUM","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"436125","SUP","HCPCS C1713","","436125  -  PLATE 112MM SS 5 HOLE BONE RIGHT PROX LAT HUM","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"436128","SUP","HCPCS C1713","","436128  -  PLATE 112MM 8 HOLE LCK BONE 4MM RIGHT PROX HUM PERIART TIB","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"436204","SUP","HCPCS C1713","","436204  -  PLATE 94MM SS 4MM 3.5MM STD LCK SCR 4 SHFT HOLE AXSOS BONE","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436206","SUP","HCPCS C1713","","436206  -  PLATE 6 HOLE BONE LEFT DISTAL MDL TIB","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436208","SUP","HCPCS C1713","","436208  -  PLATE 8 HOLE BONE LEFT DISTAL MDL TIB","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436210","SUP","HCPCS C1713","","436210  -  PLATE 172MM SS 10 HOLE BONE LEFT DISTAL MDL TIB","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436212","SUP","HCPCS C1713","","436212  -  PLATE 198MM SS 12 HOLE BONE LEFT DISTAL MDL TIB","BOTH IP/OP","$2,143.63 ","$1,586.29 ","$0.00 ","$2,143.63 ","$964.63 ","$0.00 ","$446.79 ","$0.00 ","$0.00 ","$375.33 ","$2,143.63 ","$0.00 ","$1,071.81 ","$1,697.75 ","$1,714.90 ","$0.00 ","$335.48 ","$0.00 ","$341.27 ","$0.00 "
"436214","SUP","HCPCS C1713","","436214  -  PLATE 224MM SS 14 SHFT HOLE LCK BONE 4MM 3.5MM DISTAL MDL","BOTH IP/OP","$2,143.63 ","$1,586.29 ","$0.00 ","$2,143.63 ","$964.63 ","$0.00 ","$446.79 ","$0.00 ","$0.00 ","$375.33 ","$2,143.63 ","$0.00 ","$1,071.81 ","$1,697.75 ","$1,714.90 ","$0.00 ","$335.48 ","$0.00 ","$341.27 ","$0.00 "
"436216","SUP","HCPCS C1713","","436216  -  PLATE 250MM SS 16 HOLE BONE LEFT DISTAL MDL TIB","BOTH IP/OP","$2,143.63 ","$1,586.29 ","$0.00 ","$2,143.63 ","$964.63 ","$0.00 ","$446.79 ","$0.00 ","$0.00 ","$375.33 ","$2,143.63 ","$0.00 ","$1,071.81 ","$1,697.75 ","$1,714.90 ","$0.00 ","$335.48 ","$0.00 ","$341.27 ","$0.00 "
"436224","SUP","HCPCS C1713","","436224  -  PLATE 4 HOLE BONE RIGHT DISTAL MDL TIB","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436226","SUP","HCPCS C1713","","436226  -  PLATE 120MM SS 4MM 3.5MM STD LCK SCR 6 SHFT HOLE AXSOS BONE","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436228","SUP","HCPCS C1713","","436228  -  PLATE 8 HOLE BONE RIGHT DISTAL MDL TIB","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436230","SUP","HCPCS C1713","","436230  -  PLATE 172MM SS 10 HOLE BONE RIGHT DISTAL MDL TIB","BOTH IP/OP","$1,813.63 ","$1,342.09 ","$0.00 ","$1,813.63 ","$816.13 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$317.55 ","$1,813.63 ","$0.00 ","$906.81 ","$1,436.39 ","$1,450.90 ","$0.00 ","$283.83 ","$0.00 ","$288.73 ","$0.00 "
"436232","SUP","HCPCS C1713","","436232  -  PLATE 198MM SS 12 SHFT HOLE LCK BONE 4MM 3.5MM DISTAL MDL","BOTH IP/OP","$2,143.63 ","$1,586.29 ","$0.00 ","$2,143.63 ","$964.63 ","$0.00 ","$446.79 ","$0.00 ","$0.00 ","$375.33 ","$2,143.63 ","$0.00 ","$1,071.81 ","$1,697.75 ","$1,714.90 ","$0.00 ","$335.48 ","$0.00 ","$341.27 ","$0.00 "
"436234","SUP","HCPCS C1713","","436234  -  PLATE 224MM SS 14 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL","BOTH IP/OP","$2,143.63 ","$1,586.29 ","$0.00 ","$2,143.63 ","$964.63 ","$0.00 ","$446.79 ","$0.00 ","$0.00 ","$375.33 ","$2,143.63 ","$0.00 ","$1,071.81 ","$1,697.75 ","$1,714.90 ","$0.00 ","$335.48 ","$0.00 ","$341.27 ","$0.00 "
"436236","SUP","HCPCS C1713","","436236  -  PLATE 250MM SS 16 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL","BOTH IP/OP","$2,143.63 ","$1,586.29 ","$0.00 ","$2,143.63 ","$964.63 ","$0.00 ","$446.79 ","$0.00 ","$0.00 ","$375.33 ","$2,143.63 ","$0.00 ","$1,071.81 ","$1,697.75 ","$1,714.90 ","$0.00 ","$335.48 ","$0.00 ","$341.27 ","$0.00 "
"436302","SUP","HCPCS C1713","","436302  -  PLATE 2 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436304","SUP","HCPCS C1713","","436304  -  PLATE 4 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436306","SUP","HCPCS C1713","","436306  -  PLATE 6 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436308","SUP","HCPCS C1713","","436308  -  PLATE 8 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436310","SUP","HCPCS C1713","","436310  -  PLATE 10 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436312","SUP","HCPCS C1713","","436312  -  PLATE 12 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,874.13 ","$1,386.86 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$390.61 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"436314","SUP","HCPCS C1713","","436314  -  PLATE 14 HOLE BONE LEFT PROX LAT TIB","BOTH IP/OP","$2,061.13 ","$1,525.24 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$429.59 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"436322","SUP","HCPCS C1713","","436322  -  PLATE 2 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436324","SUP","HCPCS C1713","","436324  -  PLATE 4 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436326","SUP","HCPCS C1713","","436326  -  PLATE 6 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436328","SUP","HCPCS C1713","","436328  -  PLATE 8 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436330","SUP","HCPCS C1713","","436330  -  PLATE 10 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436332","SUP","HCPCS C1713","","436332  -  PLATE 12 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$2,061.13 ","$1,525.24 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$429.59 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"436334","SUP","HCPCS C1713","","436334  -  PLATE 14 HOLE BONE RIGHT PROX LAT TIB","BOTH IP/OP","$1,874.13 ","$1,386.86 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$390.61 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"436342","SUP","HCPCS C1713","","436342  -  PLATE 95MM SS 3.5MM 4MM STD SCR 2 SHFT HOLE 5 LCK HOLE BONE","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436344","SUP","HCPCS C1713","","436344  -  PLATE 121MM 4MM SCR 4 HOLE LCK AXSOS BONE LEFT PROX LAT","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436346","SUP","HCPCS C1713","","436346  -  PLATE 147MM 6 HL SHFT LCK BONE LEFT PROX LAT TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436348","SUP","HCPCS C1713","","436348  -  PLATE 173MM SS 3.5MM 4MM STD SCR 8 SHFT HOLE 5 LCK HOLE BONE","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436350","SUP","HCPCS C1713","","436350  -  PLATE 199MM 4MM SCR 10X5 HOLE LCK AXSOS BONE LEFT PROX LAT","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436352","SUP","HCPCS C1713","","436352  -  PLATE 225MM 4MM SCR 12X5 HOLE LCK AXSOS BONE LEFT PROX LAT","BOTH IP/OP","$2,061.13 ","$1,525.24 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$429.59 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"436354","SUP","HCPCS C1713","","436354  -  PLATE 251MM 15 HOLE LCK BONE 4MM RIGHT PROX LAT PERIART TIB","BOTH IP/OP","$1,874.13 ","$1,386.86 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$390.61 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"436362","SUP","HCPCS C1713","","436362  -  PLATE 2 HOLE BONE RIGHT PROX TIB","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436364","SUP","HCPCS C1713","","436364  -  PLATE 121MM 4MM SCR 4X5 HOLE LCK AXSOS BONE RIGHT PROX LAT","BOTH IP/OP","$1,574.38 ","$1,165.04 ","$0.00 ","$1,574.38 ","$708.47 ","$0.00 ","$328.14 ","$0.00 ","$0.00 ","$275.66 ","$1,574.38 ","$0.00 ","$787.19 ","$1,246.91 ","$1,259.50 ","$0.00 ","$246.39 ","$0.00 ","$250.64 ","$0.00 "
"436366","SUP","HCPCS C1713","","436366  -  PLATE 147MM 4MM SCR 6X5 HOLE LCK AXSOS BONE RIGHT PROX LAT","BOTH IP/OP","$1,731.13 ","$1,281.04 ","$0.00 ","$1,731.13 ","$779.01 ","$0.00 ","$360.81 ","$0.00 ","$0.00 ","$303.11 ","$1,731.13 ","$0.00 ","$865.56 ","$1,371.05 ","$1,384.90 ","$0.00 ","$270.92 ","$0.00 ","$275.60 ","$0.00 "
"436368","SUP","HCPCS C1713","","436368  -  PLATE 173MM 4MM SCR 8X5 HOLE LCK AXSOS BONE RIGHT PROX LAT","BOTH IP/OP","$1,574.38 ","$1,165.04 ","$0.00 ","$1,574.38 ","$708.47 ","$0.00 ","$328.14 ","$0.00 ","$0.00 ","$275.66 ","$1,574.38 ","$0.00 ","$787.19 ","$1,246.91 ","$1,259.50 ","$0.00 ","$246.39 ","$0.00 ","$250.64 ","$0.00 "
"436370","SUP","HCPCS C1713","","436370  -  PLATE 199MM 4MM SCR 10X5 HOLE LCK AXSOS BONE RIGHT PROX LAT","BOTH IP/OP","$1,574.38 ","$1,165.04 ","$0.00 ","$1,574.38 ","$708.47 ","$0.00 ","$328.14 ","$0.00 ","$0.00 ","$275.66 ","$1,574.38 ","$0.00 ","$787.19 ","$1,246.91 ","$1,259.50 ","$0.00 ","$246.39 ","$0.00 ","$250.64 ","$0.00 "
"436372","SUP","HCPCS C1713","","436372  -  PLATE 225MM 4MM SCR 12X5 HOLE LCK AXSOS BONE RIGHT PROX LAT","BOTH IP/OP","$1,874.13 ","$1,386.86 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$390.61 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"436374","SUP","HCPCS C1713","","436374  -  PLATE 251MM 14 HL SHFT LCK BONE RIGHT PROX LAT MTPHSL TIB","BOTH IP/OP","$1,874.13 ","$1,386.86 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$390.61 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"436404","SUP","HCPCS C1713","","436404  -  PLATE 4 HOLE BONE LEFT DISTAL ANT LAT TIB","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436406","SUP","HCPCS C1713","","436406  -  PLATE 123MM SS 6 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436408","SUP","HCPCS C1713","","436408  -  PLATE 149MM SS 8 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436410","SUP","HCPCS C1713","","436410  -  PLATE 10 HOLE BONE LEFT DISTAL ANTLAT TIB","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436412","SUP","HCPCS C1713","","436412  -  PLATE 12 HOLE BONE LEFT DISTAL ANTLAT TIB","BOTH IP/OP","$2,638.63 ","$1,952.59 ","$0.00 ","$2,638.63 ","$1,187.38 ","$0.00 ","$549.96 ","$0.00 ","$0.00 ","$462.00 ","$2,638.63 ","$0.00 ","$1,319.31 ","$2,089.79 ","$2,110.90 ","$0.00 ","$412.94 ","$0.00 ","$420.07 ","$0.00 "
"436414","SUP","HCPCS C1713","","436414  -  PLATE 14 HOLE BONE LEFT DISTAL ANT LAT TIB","BOTH IP/OP","$2,638.63 ","$1,952.59 ","$0.00 ","$2,638.63 ","$1,187.38 ","$0.00 ","$549.96 ","$0.00 ","$0.00 ","$462.00 ","$2,638.63 ","$0.00 ","$1,319.31 ","$2,089.79 ","$2,110.90 ","$0.00 ","$412.94 ","$0.00 ","$420.07 ","$0.00 "
"436416","SUP","HCPCS C1713","","436416  -  PLATE 16 HOLE BONE LEFT DISTAL ANTLAT TIB","BOTH IP/OP","$2,638.63 ","$1,952.59 ","$0.00 ","$2,638.63 ","$1,187.38 ","$0.00 ","$549.96 ","$0.00 ","$0.00 ","$462.00 ","$2,638.63 ","$0.00 ","$1,319.31 ","$2,089.79 ","$2,110.90 ","$0.00 ","$412.94 ","$0.00 ","$420.07 ","$0.00 "
"436424","SUP","HCPCS C1713","","436424  -  PLATE 4 HOLE BONE RIGHT DISTAL ANT LAT TIB","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436426","SUP","HCPCS C1713","","436426  -  PLATE 123MM SS 6 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436428","SUP","HCPCS C1713","","436428  -  PLATE 149MM SS 8 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436430","SUP","HCPCS C1713","","436430  -  PLATE 4 HOLE BONE RIGHT DISTAL ANT LAT TIB","BOTH IP/OP","$2,308.63 ","$1,708.39 ","$0.00 ","$2,308.63 ","$1,038.88 ","$0.00 ","$481.18 ","$0.00 ","$0.00 ","$404.22 ","$2,308.63 ","$0.00 ","$1,154.31 ","$1,828.43 ","$1,846.90 ","$0.00 ","$361.30 ","$0.00 ","$367.53 ","$0.00 "
"436432","SUP","HCPCS C1713","","436432  -  PLATE 12 HOLE BONE RIGHT DISTAL ANT LAT TIB","BOTH IP/OP","$2,638.63 ","$1,952.59 ","$0.00 ","$2,638.63 ","$1,187.38 ","$0.00 ","$549.96 ","$0.00 ","$0.00 ","$462.00 ","$2,638.63 ","$0.00 ","$1,319.31 ","$2,089.79 ","$2,110.90 ","$0.00 ","$412.94 ","$0.00 ","$420.07 ","$0.00 "
"436434","SUP","HCPCS C1713","","436434  -  PLATE 14 HOLE BONE RIGHT DISTAL ANT LAT TIB","BOTH IP/OP","$2,638.63 ","$1,952.59 ","$0.00 ","$2,638.63 ","$1,187.38 ","$0.00 ","$549.96 ","$0.00 ","$0.00 ","$462.00 ","$2,638.63 ","$0.00 ","$1,319.31 ","$2,089.79 ","$2,110.90 ","$0.00 ","$412.94 ","$0.00 ","$420.07 ","$0.00 "
"436436","SUP","HCPCS C1713","","436436  -  PLATE 16 HOLE BONE RIGHT DISTAL ANT LAT TIB","BOTH IP/OP","$2,638.63 ","$1,952.59 ","$0.00 ","$2,638.63 ","$1,187.38 ","$0.00 ","$549.96 ","$0.00 ","$0.00 ","$462.00 ","$2,638.63 ","$0.00 ","$1,319.31 ","$2,089.79 ","$2,110.90 ","$0.00 ","$412.94 ","$0.00 ","$420.07 ","$0.00 "
"436504","SUP","HCPCS C1713","","436504  -  PLATE 130MM SS 5MM SCR 4 HOLE LCK AXSOS BONE LEFT DISTAL LAT","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436506","SUP","HCPCS C1713","","436506  -  PLATE 6 HOLE BONE LEFT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436508","SUP","HCPCS C1713","","436508  -  PLATE 202MM SS 8 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL LAT","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436510","SUP","HCPCS C1713","","436510  -  PLATE 238MM SS 5MM SCR 10 HOLE LCK AXSOS BONE LEFT DISTAL","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436512","SUP","HCPCS C1713","","436512  -  PLATE 274MM SS 12 HL SHFT LCK AXSOS BONE LEFT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436514","SUP","HCPCS C1713","","436514  -  PLATE 310MM SS 14 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436516","SUP","HCPCS C1713","","436516  -  PLATE 343MM SS 16 HL SHFT LCK AXSOS BONE LEFT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436524","SUP","HCPCS C1713","","436524  -  PLATE 130MM SS 5MM/4.5MM/6.5MM SCR 4X5 HOLE LCK AXSOS BONE","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436526","SUP","HCPCS C1713","","436526  -  PLATE 166MM SS 5MM/4.5MM/6.5MM SCR 6X5 HOLE LCK AXSOS BONE","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436528","SUP","HCPCS C1713","","436528  -  PLATE 8 HOLE BONE RIGHT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436530","SUP","HCPCS C1713","","436530  -  PLATE SS 10 SHFT HOLE 5 LCK HOLE BONE","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436532","SUP","HCPCS C1713","","436532  -  PLATE 274MM SS 12X5 HOLE LCK AXSOS BONE RIGHT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436534","SUP","HCPCS C1713","","436534  -  PLATE 14 HOLE BONE RIGHT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"436536","SUP","HCPCS C1713","","436536  -  PLATE 343MM SS 16X5 HOLE LCK AXSOS BONE RIGHT DISTAL LAT FEM","BOTH IP/OP","$1,930.50 ","$1,428.57 ","$0.00 ","$1,930.50 ","$868.73 ","$0.00 ","$402.36 ","$0.00 ","$0.00 ","$338.02 ","$1,930.50 ","$0.00 ","$965.25 ","$1,528.96 ","$1,544.40 ","$0.00 ","$302.12 ","$0.00 ","$307.34 ","$0.00 "
"437103","SUP","HCPCS C1713","","437103  -  PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM LT PROX 3.5/4MM","BOTH IP/OP","$2,319.20 ","$1,716.21 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$483.38 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"437105","SUP","HCPCS C1713","","437105  -  PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM LT PROX 3.5/4MM","BOTH IP/OP","$2,319.20 ","$1,716.21 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$483.38 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"437108","SUP","HCPCS C1713","","437108  -  PLATE 150MM 4MM SCR 8 SHFT HOLE LCK THRD BONE LEFT PROX","BOTH IP/OP","$2,319.20 ","$1,716.21 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$483.38 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"437123","SUP","HCPCS C1713","","437123  -  PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM RT PROX 3.5/4MM","BOTH IP/OP","$2,319.20 ","$1,716.21 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$483.38 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"437125","SUP","HCPCS C1713","","437125  -  PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM RT PROX 3.5/4MM","BOTH IP/OP","$2,319.20 ","$1,716.21 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$483.38 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"437128","SUP","HCPCS C1713","","437128  -  PLATE BN 150MM NS AXSOS 8X7X 4 HL LCK SS HUM RT PROX 3.5/4MM","BOTH IP/OP","$2,319.20 ","$1,716.21 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$483.38 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"437204","SUP","HCPCS C1713","","437204  -  PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB LT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437206","SUP","HCPCS C1713","","437206  -  PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB LT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437208","SUP","HCPCS C1713","","437208  -  PLATE BN 146MM NS AXSOS 8X4X 4 HL LCK SS TIB LT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437210","SUP","HCPCS C1713","","437210  -  PLATE 172MM 10X4X 5 HOLE LCK THRD SHFT HOLE SYS AXSOS BONE","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437212","SUP","HCPCS C1713","","437212  -  PLATE 198MM 4MM SCR 12 SHFT HOLE LCK THRD BONE LEFT DISTAL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437214","SUP","HCPCS C1713","","437214  -  PLATE BN 224MM NS AXSOS 14X4X 7 HL LCK SS TIB LT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437216","SUP","HCPCS C1713","","437216  -  PLATE 16 HL SHFT BONE DISTAL MDL TIB","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437224","SUP","HCPCS C1713","","437224  -  PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB RT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437226","SUP","HCPCS C1713","","437226  -  PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB RT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437228","SUP","HCPCS C1713","","437228  -  PLATE BN 146MM NS AXSOS 8X4X 4 HL SS TIB RT DIST MDL 4/3.5MM","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437230","SUP","HCPCS C1713","","437230  -  PLATE BN 172MM NS AXSOS 10X4X 5 HL LCK SS TIB RT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437232","SUP","HCPCS C1713","","437232  -  PLATE BN 198MM NS AXSOS 12X4X 6 HL LCK SS TIB RT DIST MDL","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437234","SUP","HCPCS C1713","","437234  -  PLATE SS 14 HOLE TOT STAB AXSOS BONE DISTAL MDL TIB","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437236","SUP","HCPCS C1713","","437236  -  PLATE 250MM BONE RIGHT DISTAL MDL TIB","BOTH IP/OP","$2,049.60 ","$1,516.70 ","$0.00 ","$2,063.88 ","$928.74 ","$0.00 ","$427.19 ","$0.00 ","$0.00 ","$361.37 ","$2,063.88 ","$0.00 ","$1,031.94 ","$1,634.59 ","$1,651.10 ","$0.00 ","$323.00 ","$0.00 ","$328.57 ","$0.00 "
"437302","SUP","HCPCS C1713","","437302  -  PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB LT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437304","SUP","HCPCS C1713","","437304  -  PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB LT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437306","SUP","HCPCS C1713","","437306  -  PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB LT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437308","SUP","HCPCS C1713","","437308  -  PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB LT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437310","SUP","HCPCS C1713","","437310  -  PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB LT PROX LAT 3.5/4","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437312","SUP","HCPCS C1713","","437312  -  PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB LT PROX LAT 3.5/4","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437314","SUP","HCPCS C1713","","437314  -  PLATE 251MM 4MM SCR 14 SHFT HOLE LCK THRD BONE LEFT PROX LAT","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437322","SUP","HCPCS C1713","","437322  -  PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB RT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437324","SUP","HCPCS C1713","","437324  -  PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB RT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437326","SUP","HCPCS C1713","","437326  -  PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB RT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437328","SUP","HCPCS C1713","","437328  -  PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB RT PROX LAT 3.5/4MM","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437330","SUP","HCPCS C1713","","437330  -  PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB RT PROX LAT 3.5/4","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437332","SUP","HCPCS C1713","","437332  -  PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB RT PROX LAT 3.5/4","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437334","SUP","HCPCS C1713","","437334  -  PLATE 251MM 4MM SCR 14 SHFT HOLE LCK THRD BONE RIGHT PROX","BOTH IP/OP","$2,025.60 ","$1,498.94 ","$0.00 ","$1,874.13 ","$843.36 ","$0.00 ","$422.19 ","$0.00 ","$0.00 ","$328.14 ","$1,874.13 ","$0.00 ","$937.06 ","$1,484.31 ","$1,499.30 ","$0.00 ","$293.30 ","$0.00 ","$298.36 ","$0.00 "
"437404","SUP","HCPCS C1713","","437404  -  PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB LT DIST ALAT 3.5/4MM","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437406","SUP","HCPCS C1713","","437406  -  PLATE BN 123MM NS AXSOS 6X3X 3 HL SS TIB LT DIST ALAT 3.5/4","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437408","SUP","HCPCS C1713","","437408  -  PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB LT DIST ALAT 3.5/4","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437410","SUP","HCPCS C1713","","437410  -  PLATE BN 175MM NS AXSOS 10X3X 5 HL SS TIB LT DIST ALAT 3.5/4","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437412","SUP","HCPCS C1713","","437412  -  PLATE 12 HL SHFT BONE DISTAL ANTLAT TIB","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$465.20 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437414","SUP","HCPCS C1713","","437414  -  PLATE 14 HL SHFT BONE DISTAL ANTLAT TIB","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$465.20 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437416","SUP","HCPCS C1713","","437416  -  PLATE 16 HL SHFT BONE DISTAL ANTLAT TIB","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$465.20 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437424","SUP","HCPCS C1713","","437424  -  PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB RT DIST ALAT 3.5/4MM","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437426","SUP","HCPCS C1713","","437426  -  PLATE 123MM SS RFLX BONE RIGHT ANTLAT TIB","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437428","SUP","HCPCS C1713","","437428  -  PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB RT DIST ALAT 4/3.5","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437430","SUP","HCPCS C1713","","437430  -  PLATE 10 HL SHFT BONE DISTAL ANTLAT TIB","BOTH IP/OP","$2,126.40 ","$1,573.54 ","$0.00 ","$2,061.13 ","$927.51 ","$0.00 ","$443.19 ","$0.00 ","$0.00 ","$360.89 ","$2,061.13 ","$0.00 ","$1,030.56 ","$1,632.41 ","$1,648.90 ","$0.00 ","$322.57 ","$0.00 ","$328.13 ","$0.00 "
"437432","SUP","HCPCS C1713","","437432  -  PLATE 12 HL SHFT BONE DISTAL ANTLAT TIB","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$465.20 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437434","SUP","HCPCS C1713","","437434  -  PLATE BN 14 HL SHFT TIB RT ALAT DIST","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$465.20 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437436","SUP","HCPCS C1713","","437436  -  PLATE 16 HL SHFT BONE DISTAL ANTLAT TIB","BOTH IP/OP","$2,232.00 ","$1,651.68 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$465.20 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437504","SUP","HCPCS C1713","","437504  -  PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM LT DIST LAT","BOTH IP/OP","$2,439.20 ","$1,805.01 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$508.39 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437506","SUP","HCPCS C1713","","437506  -  PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM LT DIST LAT","BOTH IP/OP","$2,439.20 ","$1,805.01 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$508.39 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437508","SUP","HCPCS C1713","","437508  -  PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM LT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437510","SUP","HCPCS C1713","","437510  -  PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM LT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437512","SUP","HCPCS C1713","","437512  -  PLATE 12 HL SHFT BONE DISTAL LAT FEM","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437514","SUP","HCPCS C1713","","437514  -  PLATE BN 310MM NS AXSOS 10X5X 7 HL SS FEM LT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437516","SUP","HCPCS C1713","","437516  -  PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM LT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437524","SUP","HCPCS C1713","","437524  -  PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM RT DIST LAT","BOTH IP/OP","$2,439.20 ","$1,805.01 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$508.39 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437526","SUP","HCPCS C1713","","437526  -  PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM RT DIST LAT","BOTH IP/OP","$2,439.20 ","$1,805.01 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$508.39 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437528","SUP","HCPCS C1713","","437528  -  PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM RT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437530","SUP","HCPCS C1713","","437530  -  PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM RT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437532","SUP","HCPCS C1713","","437532  -  PLATE BN 274MM NS AXSOS 12X5X 6 HL SS FEM RT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437534","SUP","HCPCS C1713","","437534  -  PLATE 310MM 14 HL SHFT BONE RIGHT DISTAL LAT PERIART FEM","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"437536","SUP","HCPCS C1713","","437536  -  PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM RT DIST LAT","BOTH IP/OP","$2,449.60 ","$1,812.70 ","$0.00 ","$2,356.75 ","$1,060.54 ","$0.00 ","$510.56 ","$0.00 ","$0.00 ","$412.65 ","$2,356.75 ","$0.00 ","$1,178.38 ","$1,866.55 ","$1,885.40 ","$0.00 ","$368.83 ","$0.00 ","$375.19 ","$0.00 "
"439678","SUP","HCPCS C1900","","439678  -  LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN","BOTH IP/OP","$3,562.50 ","$2,636.25 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$0.00 ","$0.00 "
"439688","SUP","HCPCS C1900","","439688  -  LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN","BOTH IP/OP","$3,562.50 ","$2,636.25 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$0.00 ","$0.00 "
"440400","SUP","Custom 27203010","","440400  -  DRESSING NSL THK1.5CM STD 4.5CM WHT STRL LF MRCL TMPN SPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446400","SUP","Custom 27203010","","REAGENT IGG IMMAGE 300 TST ANALY","BOTH IP/OP","$1,608.75 ","$1,190.48 ","$0.00 ","$1,608.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,608.75 ","$0.00 ","$804.38 ","$1,274.13 ","$1,287.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"447060","SUP","Custom 27203010","","REAGENT WSH SOL IMMAGE 10L ANALY","BOTH IP/OP","$318.75 ","$235.88 ","$0.00 ","$318.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$318.75 ","$0.00 ","$159.38 ","$252.45 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"447600","SUP","Custom 27203010","","REAGENT ALBM IMMAGE 150 TST ANALY","BOTH IP/OP","$811.25 ","$600.33 ","$0.00 ","$811.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$811.25 ","$0.00 ","$405.63 ","$642.51 ","$649.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"447640","SUP","Custom 27203010","","REAGENT DILU 1 IMMAGE 120ML ANALY","BOTH IP/OP","$328.13 ","$242.82 ","$0.00 ","$328.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$328.13 ","$0.00 ","$164.06 ","$259.88 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"447650","SUP","Custom 27203010","","REAGENT BUFF 1 IMMAGE 120ML ANALY","BOTH IP/OP","$328.13 ","$242.82 ","$0.00 ","$328.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$328.13 ","$0.00 ","$164.06 ","$259.88 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"449560","SUP","Custom 27203010","","CALIBRATOR ARY CHM SYS IMMUN","BOTH IP/OP","$806.25 ","$596.63 ","$0.00 ","$806.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$806.25 ","$0.00 ","$403.13 ","$638.55 ","$645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"449730","SUP","Custom 27203010","","CALIBRATOR TRNFRN IMMAGE ARY LVL 3 3ML 360 SER IMMUN","BOTH IP/OP","$534.38 ","$395.44 ","$0.00 ","$534.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$534.38 ","$0.00 ","$267.19 ","$423.23 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"453547","SUP","HCPCS C1751","","453547  -  CATHETER IV 26GA .75IN STRL LF ABCTH-T ISO CLR CD TFLN","BOTH IP/OP","$8.68 ","$6.42 ","$0.00 ","$8.68 ","$3.90 ","$0.00 ","$1.81 ","$0.00 ","$0.00 ","$1.52 ","$8.68 ","$0.00 ","$4.34 ","$6.87 ","$6.94 ","$0.00 ","$1.36 ","$0.00 ","$1.38 ","$0.00 "
"465990","SUP","Custom 27203010","","CONTROL NH3 ALC SYN LVL 1 4ML CX7/LX SER TOX","BOTH IP/OP","$107.50 ","$79.55 ","$0.00 ","$107.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.50 ","$0.00 ","$53.75 ","$85.14 ","$86.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"465993","SUP","Custom 27203010","","CONTROL NH3 ALC SYN LVL 2 4ML CX7/LX SER TOX","BOTH IP/OP","$107.50 ","$79.55 ","$0.00 ","$107.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.50 ","$0.00 ","$53.75 ","$85.14 ","$86.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"465996","SUP","Custom 27203010","","CONTROL NH3 ALC SYN LVL 3 4ML CX7/LX SER TOX","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"472620","SUP","CPT� Q4128","","472620  -  GRAFT SKIN THK1.8+ MM ULTRATHICK 20X16CM ALLOGRAFT HYDRATE","BOTH IP/OP","$21,021.00 ","$15,555.54 ","$0.00 ","$21,021.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,021.00 ","$0.00 ","$10,510.50 ","$16,648.63 ","$16,816.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-00","SUP","Custom 27803010","","01-3200  -  HEAD FEMORAL +0MM 32MM MORSE TAPER LFIT COCR HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-3200  -  HEAD FEMORAL 0 32MM C TAPER LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"474976","SUP","Custom 27203010","","CONTROL MUL-DRUG SYN LOW 10ML CX/LX SER TOX","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jan","SUP","Custom 27803010","","01-3205  -  HEAD FEMORAL +5MM MORSE TAPER 32MM LFIT COCR HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6-Jan","SUP","HCPCS C1713","","1-3206  -  SPACER SPNL 6MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"8-Jan","SUP","HCPCS C1713","","1-3208  -  SPACER SPNL 8MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"10-Jan","SUP","Custom 27803010","","01-3210  -  HEAD FEMORAL 10MM MORSE TAPER 32MM MORSE TAPER LFIT HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Jan","SUP","HCPCS C1713","","1-3210  -  SPACER SPNL 10MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$6,658.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$6,658.74 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Jun","SUP","Custom 27803010","","06-3210  -  HEAD FEM +10MM OFST CTPR 32MM STRL LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12-Jan","SUP","HCPCS C1713","","1-3212  -  SPACER SPNL 12MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"14-Jan","SUP","HCPCS C1713","","1-3214  -  SPACER SPNL 14MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"16-Jan","SUP","HCPCS C1713","","1-3216  -  SPACER SPNL 16MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"482047","SUP","HCPCS C1763","","482047  -  IMPL URO PLVCL BCMPT VERSATILITY DRBLTY STRTH ACLR CLGN MTRX","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"502452","SUP","HCPCS C1769","","502452  -  GUIDEWIRE VASC 3MM RDS J .025IN 260CM STRL LF 7CM CRDS EMRLD","BOTH IP/OP","$25.08 ","$18.56 ","$0.00 ","$22.58 ","$12.26 ","$0.00 ","$5.23 ","$0.00 ","$0.00 ","$3.95 ","$22.58 ","$0.00 ","$11.29 ","$17.88 ","$18.06 ","$0.00 ","$3.53 ","$0.00 ","$3.59 ","$0.00 "
"502455","SUP","HCPCS C1769","","502455  -  GUIDEWIRE VASC 3MM RDS J .035IN 260CM STRL LF 7CM CRDS EMRLD","BOTH IP/OP","$25.08 ","$18.56 ","$0.00 ","$22.58 ","$12.26 ","$0.00 ","$5.23 ","$0.00 ","$0.00 ","$3.95 ","$22.58 ","$0.00 ","$11.29 ","$17.88 ","$18.06 ","$0.00 ","$3.53 ","$0.00 ","$3.59 ","$0.00 "
"502521","SUP","HCPCS C1769","","502521  -  GUIDEWIRE VASC 3MM RDS J .035IN 150CM STRL LF 7CM CRDS EMRLD","BOTH IP/OP","$16.25 ","$12.03 ","$0.00 ","$14.45 ","$7.85 ","$0.00 ","$3.39 ","$0.00 ","$0.00 ","$2.53 ","$14.45 ","$0.00 ","$7.23 ","$11.44 ","$11.56 ","$0.00 ","$2.26 ","$0.00 ","$2.30 ","$0.00 "
"502542","SUP","HCPCS C1769","","502542  -  GUIDEWIRE VASC STRG .035IN 150CM STRL LF 7CM CRDS EMRLD FLXB","BOTH IP/OP","$16.25 ","$12.03 ","$0.00 ","$14.45 ","$7.85 ","$0.00 ","$3.39 ","$0.00 ","$0.00 ","$2.53 ","$14.45 ","$0.00 ","$7.23 ","$11.44 ","$11.56 ","$0.00 ","$2.26 ","$0.00 ","$2.30 ","$0.00 "
"509748","SUP","Custom 27203010","","DRUG ANBTC VITEK2 ETST DXYCL DC 256 B100","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"510422","SUP","HCPCS A4351","","510422  -  CATHETER URETHRAL 22FR 16IN 2 STAGGERED EYE RADIOPQ LATEX","BOTH IP/OP","$10.58 ","$7.83 ","$0.00 ","$10.58 ","$0.00 ","$0.00 ","$2.20 ","$0.00 ","$0.00 ","$0.00 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"510426","SUP","HCPCS C1729","","510426  -  CATHETER URTH RBNSN 26FR RBR STRL LTX RD","BOTH IP/OP","$105.75 ","$78.26 ","$0.00 ","$203.45 ","$110.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.62 ","$203.45 ","$0.00 ","$101.73 ","$161.13 ","$162.76 ","$0.00 ","$31.84 ","$0.00 ","$32.39 ","$0.00 "
"510428","SUP","HCPCS C1758","","510428  -  CATHETER URTH 28FR 16IN RD STRL LTX 2 STGR EYE RADOPQ RBR","BOTH IP/OP","$10.58 ","$7.83 ","$0.00 ","$10.58 ","$5.74 ","$0.00 ","$2.20 ","$0.00 ","$0.00 ","$1.85 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$1.65 ","$0.00 ","$1.68 ","$0.00 "
"Jan-99","SUP","Custom 27803010","","01-3299  -  HEAD FEMORAL -5MM 32MM MORSE TAPER LFIT COCR HIP","BOTH IP/OP","$1,795.00 ","$1,328.30 ","$0.00 ","$1,795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,795.00 ","$0.00 ","$897.50 ","$1,421.64 ","$1,436.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-99","SUP","Custom 27203010","","06-3299  -  HEAD FEM -5MM OFST CTPR 32MM STRL LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"511212","SUP","HCPCS C1898","","511212  -  IS-1, SILICONE, 54CM, V PLACEMENT","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"513658","SUP","Custom 27203010","","STRIP IMPNM .002-32 MCG SNS","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"516001","SUP","HCPCS Q4130","","0516001  -  MATRIX TISSUE 16X5CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$24,997.50 ","$18,498.15 ","$0.00 ","$24,997.50 ","$0.00 ","$0.00 ","$5,210.10 ","$0.00 ","$0.00 ","$0.00 ","$24,997.50 ","$0.00 ","$12,498.75 ","$19,798.02 ","$19,998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"520368","SUP","HCPCS C1713","","520368  -  SCREW BN 2MM CMPR HEX SCKT","BOTH IP/OP","$38.40 ","$28.42 ","$0.00 ","$38.40 ","$17.28 ","$0.00 ","$8.00 ","$0.00 ","$0.00 ","$6.72 ","$38.40 ","$0.00 ","$19.20 ","$30.41 ","$30.72 ","$0.00 ","$6.01 ","$0.00 ","$6.11 ","$0.00 "
"522022","SUP","HCPCS C1776","","522022  -  HEAD FEM +0MM 11/13 TPR 22MM STRL SR COCR HIP MDLR SYS","BOTH IP/OP","$3,187.50 ","$2,358.75 ","$0.00 ","$3,187.50 ","$1,434.38 ","$0.00 ","$664.35 ","$0.00 ","$0.00 ","$558.11 ","$3,187.50 ","$0.00 ","$1,593.75 ","$2,524.50 ","$2,550.00 ","$0.00 ","$498.84 ","$0.00 ","$507.45 ","$0.00 "
"525558","SUP","Custom 27203010","","STRIP VNCMCN ETST SNS","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"528341","SUP","Custom 27203010","","528341  -  PILLING SURGILUX H/L VAR. 10-75 MM","BOTH IP/OP","$2,400.00 ","$1,776.00 ","$0.00 ","$2,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,400.00 ","$0.00 ","$1,200.00 ","$1,900.80 ","$1,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"531658","SUP","Custom 27203010","","DISK ERTAPENEM SNS","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"532644","SUP","HCPCS C1725","","532644  -  CATHETER ANGIO MP A2 CRV 6FR 125CM ST BRD ATRM SLCT 2 SH PU","BOTH IP/OP","$21.13 ","$15.64 ","$0.00 ","$21.13 ","$11.47 ","$0.00 ","$4.40 ","$0.00 ","$0.00 ","$3.70 ","$21.13 ","$0.00 ","$10.56 ","$16.73 ","$16.90 ","$0.00 ","$3.31 ","$0.00 ","$3.36 ","$0.00 "
"533448","SUP","Custom 27203010","","STRIP PLMXN ETST SNS","BOTH IP/OP","$785.00 ","$580.90 ","$0.00 ","$785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$785.00 ","$0.00 ","$392.50 ","$621.72 ","$628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"533558","SUP","Custom 27203010","","STRIP TIGECYCLINE 256 MCG ETST VK2 SNS F100","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"535058","SUP","Custom 27203010","","STRIP DAPTOMYCIN .016-256 MCG ETST SNS","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"535070","SUP","Custom 27203010","","535070  -  KIT TRACHEOSTOMY 9.6MM 7MM 82MM 2 DECK TRAY DILAT OBTURATOR","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$627.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$627.63 ","$0.00 ","$313.81 ","$497.08 ","$502.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"535080","SUP","Custom 27203010","","535080  -  KIT TRCH 10.9MM 8MM 86MM STRL LTX PRFT PRTX 2 DECK TRY DIL","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$627.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$627.63 ","$0.00 ","$313.81 ","$497.08 ","$502.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"535090","SUP","Custom 27203010","","535090  -  KIT TRACHEOSTOMY 12.3MM 9MM COMPLETE SET INNER CANNU","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$627.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$627.63 ","$0.00 ","$313.81 ","$497.08 ","$502.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540015","SUP","Custom 27203010","","540015  -  DRILL SURG MICRO CORE","BOTH IP/OP","$13,025.75 ","$9,639.06 ","$0.00 ","$13,025.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,025.75 ","$0.00 ","$6,512.88 ","$10,316.39 ","$10,420.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"544230","SUP","Custom 27803010","","544230  -  CLIP INTNL MED LG CHEVRON HRT GRN STRL LF WECK HEM-O-LOK LGT","BOTH IP/OP","$86.61 ","$64.09 ","$0.00 ","$86.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.61 ","$0.00 ","$43.30 ","$68.60 ","$69.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"544240","SUP","Custom 27803010","","544240  -  CLIP INTERNAL LARGE LIGATE CARTRIDGE LATEX FREE WECK","BOTH IP/OP","$86.61 ","$64.09 ","$0.00 ","$86.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.61 ","$0.00 ","$43.30 ","$68.60 ","$69.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"544250","SUP","Custom 27803010","","544250  -  CLIP XL INTNL HEM-O-LOK PLMR LAPSCOP STRL DISP LATEX FREE","BOTH IP/OP","$81.75 ","$60.50 ","$0.00 ","$81.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.75 ","$0.00 ","$40.88 ","$64.75 ","$65.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"570624","SUP","HCPCS C1729","","570624  -  CATH URTH SMPLS 24FR 16IN FOLEY 3W CVLR TIP 30ML STRL LATEX","BOTH IP/OP","$84.50 ","$62.53 ","$0.00 ","$84.50 ","$45.88 ","$0.00 ","$17.61 ","$0.00 ","$0.00 ","$14.80 ","$84.50 ","$0.00 ","$42.25 ","$66.92 ","$67.60 ","$0.00 ","$13.22 ","$0.00 ","$13.45 ","$0.00 "
"573030","SUP","HCPCS C1725","","573030  -  CATH BALDILAT .014IN 3MM 145CM 10MM OTW NC DRLN NC RPTR","BOTH IP/OP","$597.55 ","$442.19 ","$0.00 ","$597.55 ","$324.47 ","$0.00 ","$124.54 ","$0.00 ","$0.00 ","$104.63 ","$597.55 ","$0.00 ","$298.78 ","$473.26 ","$478.04 ","$0.00 ","$93.52 ","$0.00 ","$95.13 ","$0.00 "
"585040","SUP","Custom 27203010","","585040  -  CANNULA OPHTHALMIC 40D 1.1MM 25MM 8MM SMOOTH TIP AIR INJEC","BOTH IP/OP","$198.83 ","$147.13 ","$0.00 ","$193.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$193.03 ","$0.00 ","$96.51 ","$152.88 ","$154.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"585047","SUP","Custom 27203010","","585047  -  CANNULA IRR 23GA .8IN .4IN .3MM STRL LF SMC ASP PORT THNWL","BOTH IP/OP","$172.77 ","$127.85 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"585119","SUP","Custom 27203010","","585119  -  CANNULA OPHTHALMIC 45D ULTRATHIN WALL BEVEL 20GA 4MM INFUS","BOTH IP/OP","$256.00 ","$189.44 ","$0.00 ","$256.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$256.00 ","$0.00 ","$128.00 ","$202.75 ","$204.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"585233","SUP","Custom 27203010","","585233  -  UNIT IRRIGATION 14MM SQUEEGEE LASIK FLAP ROLLER SLEEVE BD","BOTH IP/OP","$59.80 ","$44.25 ","$0.00 ","$59.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.80 ","$0.00 ","$29.90 ","$47.36 ","$47.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600040","SUP","HCPCS C1751","","0600040  -  CATHETER CV 2 BRCH 2.7FR .9MM .5MM 71CM STRL LTX BRVC 1 LUM","BOTH IP/OP","$195.50 ","$144.67 ","$0.00 ","$169.81 ","$0.00 ","$0.00 ","$38.71 ","$0.00 ","$0.00 ","$0.00 ","$169.81 ","$0.00 ","$84.91 ","$154.84 ","$135.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600125","SUP","Custom 27203010","","0600125  -  APPLICATOR ENDSCP FLSL BXTR NRFL COMP CANNU COMP","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$166.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.33 ","$0.00 ","$83.17 ","$131.73 ","$133.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600160","SUP","HCPCS C1751","","0600160  -  CATHETER 9FR SINGLE LUMEN HICKMAN","BOTH IP/OP","$61.35 ","$45.40 ","$0.00 ","$61.35 ","$33.31 ","$0.00 ","$12.79 ","$0.00 ","$0.00 ","$10.74 ","$61.35 ","$0.00 ","$30.68 ","$48.59 ","$49.08 ","$0.00 ","$9.60 ","$0.00 ","$9.77 ","$0.00 "
"600544","SUP","HCPCS C1751","","0600544  -  KIT CATH 6.6FR 57CM STRL LF BRVC 1 LUM LOPRFL ADPR SIL PED","BOTH IP/OP","$371.13 ","$274.64 ","$0.00 ","$293.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.62 ","$0.00 ","$9.31 ","$293.93 ","$14.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"600560","SUP","HCPCS C1751","","0600560  -  CATHETER CEN VEN 9.6FR 3.2MM 1.6MM 90CM 1 LUMEN TISSUE","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$312.84 ","$23.40 ","$0.00 ","$1.05 ","$0.00 ","$0.00 ","$3.91 ","$52.00 ","$0.00 ","$26.00 ","$312.84 ","$41.60 ","$0.00 ","$3.91 ","$0.00 ","$3.73 ","$0.00 "
"600600","SUP","HCPCS C1751","","0600600  -  KIT CATH 9FR 54CM STRL LF HKMN PEEL-APART 2 LUM LOPRFL ADPR","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$192.77 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"601600","SUP","HCPCS C1751","","0601600  -  KIT CATH REPR 2.7FR .9MM .5MM 71CM .15ML WHT STRL LTX BRVC 1","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"601610","SUP","HCPCS C1751","","0601610  -  KIT CATH REPR 4.2FR 1.4MM .7MM 71CM .3ML WHT STRL LF BRVC 1","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"601648","SUP","HCPCS C1713","","601648  -  SCREW BONE PTHRD 5MM 48MM CANN LP HEAD REVERSE CUTTING FLUTE","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$510.23 ","$229.60 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$89.34 ","$510.23 ","$0.00 ","$255.11 ","$404.10 ","$408.18 ","$0.00 ","$79.85 ","$0.00 ","$81.23 ","$0.00 "
"602230","SUP","HCPCS C1788","","0602230  -  PORT IMPLTABLE INFUS SBQ TI 9.6FR 1 LUM ATCH CATH PLAPRT","BOTH IP/OP","$2,108.70 ","$1,560.44 ","$0.00 ","$2,108.70 ","$948.92 ","$0.00 ","$439.51 ","$0.00 ","$0.00 ","$369.22 ","$2,108.70 ","$0.00 ","$1,054.35 ","$1,670.09 ","$1,686.96 ","$0.00 ","$330.01 ","$0.00 ","$335.71 ","$0.00 "
"602645","SUP","HCPCS C1713","","602645  -  SCREW BN 6.5MM 45MM STRL 20MM ASNS III ST SLFDRL CNN TI ORTH","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"602650","SUP","HCPCS C1713","","602650  -  SCREW BN 6.5MM 50MM STRL 20MM ASNS III ST SLF DRL CNN TI HIP","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"602660","SUP","HCPCS C1713","","602660  -  SCREW BN 6.5MM 60MM STRL 20MM ASNS III SLF DRL ST CNN TI LNG","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"602885","SUP","HCPCS C1713","","602885  -  SCREW BN LOPRFL REVCT FLUT 6.5MM 85MM NS 40MM ASNS III CNN","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"603020","SUP","HCPCS Q4116","","603020  -  MATRIX TISSUE INJECTABLE CYMETRA MAT ACELLULAR DERMIS 2ML","BOTH IP/OP","$373.75 ","$276.58 ","$0.00 ","$373.75 ","$168.19 ","$0.00 ","$77.90 ","$0.00 ","$0.00 ","$65.44 ","$373.75 ","$0.00 ","$186.88 ","$296.01 ","$299.00 ","$0.00 ","$58.49 ","$0.00 ","$59.50 ","$0.00 "
"606008","SUP","HCPCS Q4130","","0606008  -  MESH SURG 6X6MM STMA TISS HERN PTCH","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$0.00 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$0.00 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"606096","SUP","Custom 27203010","","KIT IMMUN TST PRMR POS NEG CNTRL H PYLR IGG 96 TST","BOTH IP/OP","$1,619.25 ","$1,198.25 ","$0.00 ","$1,619.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,619.25 ","$0.00 ","$809.63 ","$1,282.45 ","$1,295.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"606560","SUP","HCPCS C1751","","0606560  -  KIT CATH 10FR 59CM STRL LF HKMN 3 LUM LOPRFL ADPR PLAPRT","BOTH IP/OP","$455.05 ","$336.74 ","$0.00 ","$455.05 ","$247.09 ","$0.00 ","$94.84 ","$0.00 ","$0.00 ","$79.68 ","$455.05 ","$0.00 ","$227.53 ","$360.40 ","$364.04 ","$0.00 ","$71.22 ","$0.00 ","$72.44 ","$0.00 "
"608001","SUP","HCPCS Q4130","","0608001  -  MATRIX TISS 8X6CM STRL STRATTICE RECON PRCN DERM","BOTH IP/OP","$2,825.00 ","$2,090.50 ","$0.00 ","$4,270.00 ","$0.00 ","$0.00 ","$588.80 ","$0.00 ","$0.00 ","$0.00 ","$4,270.00 ","$0.00 ","$2,135.00 ","$3,381.84 ","$3,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"609002","SUP","Custom 27803010","","609002  -  TISSUE 609002 2MM FACET SHIM","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"609003","SUP","Custom 27803010","","609003  -  TISSUE 609003 3MM FACET SHIM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"609004","SUP","HCPCS C1763","","609004  -  GRAFT SFT SHIM 4 MM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"609404","SUP","HCPCS C1763","","609404  -  GRAFT SFT TIS 10X8X4MM FACET","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"609604","SUP","HCPCS C1763","","609604  -  GRAFT SFT TIS WDG 8X8X4MM LF","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"610008","SUP","HCPCS Q4130","","0610008  -  MATRIX TISSUE 10X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$3,785.00 ","$2,800.90 ","$0.00 ","$5,720.00 ","$0.00 ","$0.00 ","$788.89 ","$0.00 ","$0.00 ","$0.00 ","$5,720.00 ","$0.00 ","$2,860.00 ","$4,530.24 ","$4,576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"610102","SUP","HCPCS C1894","","INTRODUCER SHTH 6FR 16CM TRAW ADPR DILAT SET INDN SPNLK .038","BOTH IP/OP","$67.10 ","$49.65 ","$0.00 ","$67.10 ","$36.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.75 ","$67.10 ","$0.00 ","$33.55 ","$53.14 ","$53.68 ","$0.00 ","$10.50 ","$0.00 ","$10.68 ","$0.00 "
"610104","SUP","HCPCS C1894","","INTRODUCER 8 FR TEAR AWAY","BOTH IP/OP","$70.40 ","$52.10 ","$0.00 ","$70.40 ","$38.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.33 ","$70.40 ","$0.00 ","$35.20 ","$55.76 ","$56.32 ","$0.00 ","$11.02 ","$0.00 ","$11.21 ","$0.00 "
"610106","SUP","HCPCS C1892","","INTRODUCER SHTH 10FR 16CM TRAW DILAT SET ADPR INTRDN .038IN","BOTH IP/OP","$69.35 ","$51.32 ","$0.00 ","$69.35 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.14 ","$69.35 ","$0.00 ","$34.68 ","$54.93 ","$55.48 ","$0.00 ","$10.85 ","$0.00 ","$11.04 ","$0.00 "
"610130","SUP","HCPCS C1760","","610130  -  DEVICE CLSR 6FR .035IN 70CM STRL LF ANGSL VIP BONDEK-+ HMST","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"610131","SUP","HCPCS C1760","","610131  -  DEVICE CLSR 8FR ANGSL VIP VASC HMST STRL LATEX FREE DISP","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"610400","SUP","Custom 27203010","","CONNECTOR CATH 9.5FR Y SWVL LUER LOCK SDPRT SGL","BOTH IP/OP","$65.65 ","$48.58 ","$0.00 ","$65.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.65 ","$0.00 ","$32.83 ","$51.99 ","$52.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"611125","SUP","HCPCS C1713","","611125  -  SCREW BONE 8MM 125MM 25MM ASNS 3 TI ORTH SLFTAP SLFDRILL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"611130","SUP","HCPCS C1713","","611130  -  SCREW BONE 8MM 130MM 25MM ASNS 3 TI ORTH SLFTAP SLFDRILL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"611335","SUP","HCPCS C1713","","611335  -  SCREW BONE 8MM 135MM ASNS 3 TI FULTHRD CANN NONSTRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"611340","SUP","HCPCS C1713","","611340  -  SCREW BONE 8MM 140MM ASNS 3 TI FULTHRD CANN NONSTRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"611345","SUP","HCPCS C1713","","611345  -  SCREW BONE 8MM 145MM ASNS 3 TI FULTHRD CANN NONSTRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"611350","SUP","HCPCS C1713","","611350  -  SCREW BONE 8MM 150MM ASNS 3 TI FULTHRD CANN NONSTRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"612601","SUP","HCPCS C1892","","612601 - INTRODUCER SHTH 5FR 19CM 16CM TRAW ADPR DILAT SET INDN SPNLK","BOTH IP/OP","$60.88 ","$45.05 ","$0.00 ","$60.88 ","$33.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.66 ","$60.88 ","$0.00 ","$30.44 ","$48.22 ","$48.70 ","$0.00 ","$9.53 ","$0.00 ","$9.69 ","$0.00 "
"614508","SUP","HCPCS C1713","","614508  -  SCREW BONE 2.7MM 8MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614510","SUP","HCPCS C1713","","614510  -  SCREW BONE 2.7MM 10MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614512","SUP","HCPCS C1713","","614512  -  SCREW BONE 2.7MM 12MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614514","SUP","HCPCS C1713","","614514  -  SCREW BONE 2.7MM 14MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614516","SUP","HCPCS C1713","","614516  -  SCREW BONE 2.7MM 16MM LCK STRL","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614518","SUP","HCPCS C1713","","614518  -  SCREW BONE 2.7MM 18MM LCK STRL","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614520","SUP","HCPCS C1713","","614520  -  SCREW BONE 2.7MM 20MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614522","SUP","HCPCS C1713","","614522  -  SCREW BONE 2.7MM 22MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614524","SUP","HCPCS C1713","","614524  -  SCREW BONE 2.7MM 24MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614526","SUP","HCPCS C1713","","614526  -  SCREW BONE 2.7MM 26MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614528","SUP","HCPCS C1713","","614528  -  SCREW BONE 2.7MM 28MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614530","SUP","HCPCS C1713","","614530  -  SCREW BONE 2.7MM 30MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614532","SUP","HCPCS C1713","","614532  -  SCREW BONE 2.7MM 32MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614534","SUP","HCPCS C1713","","614534  -  SCREW BONE 2.7MM 34MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614536","SUP","HCPCS C1713","","614536  -  SCREW BONE 2.7MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614538","SUP","HCPCS C1713","","614538  -  SCREW BONE 2.7MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614540","SUP","HCPCS C1713","","614540  -  SCREW BONE 2.7MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614542","SUP","HCPCS C1713","","614542  -  SCREW BONE 2.7MM 42MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$964.83 ","$713.97 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$201.09 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614544","SUP","HCPCS C1713","","614544  -  SCREW BONE 2.7MM 44MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614546","SUP","HCPCS C1713","","614546  -  SCREW BONE 2.7MM 46MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614548","SUP","HCPCS C1713","","614548  -  SCREW BONE 2.7MM 48MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614550","SUP","HCPCS C1713","","614550  -  SCREW BONE 2.7MM 50MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614555","SUP","HCPCS C1713","","614555  -  SCREW BONE 2.7MM 55MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614560","SUP","HCPCS C1713","","614560  -  SCREW BONE 2.7MM 60MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614565","SUP","HCPCS C1713","","614565  -  SCREW BONE 2.7MM 65MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614570","SUP","HCPCS C1713","","614570  -  SCREW BONE 2.7MM 70MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"614608","SUP","HCPCS C1713","","614608  -  SCREW BONE 3.5MM 8MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614610","SUP","HCPCS C1713","","614610  -  SCREW BONE 3.5MM 10MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614612","SUP","HCPCS C1713","","614612  -  SCREW BONE 3.5MM 12MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614614","SUP","HCPCS C1713","","614614  -  SCREW BONE 3.5MM 14MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614616","SUP","HCPCS C1713","","614616  -  SCREW BONE 3.5MM 16MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614618","SUP","HCPCS C1713","","614618  -  SCREW BONE 3.5MM 18MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614620","SUP","HCPCS C1713","","614620  -  SCREW BONE 3.5MM 20MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614622","SUP","HCPCS C1713","","614622  -  SCREW BONE 3.5MM 22MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614624","SUP","HCPCS C1713","","614624  -  SCREW BONE 3.5MM 24MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614626","SUP","HCPCS C1713","","614626  -  SCREW BONE 3.5MM 26MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614628","SUP","HCPCS C1713","","614628  -  SCREW BONE 3.5MM 28MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614630","SUP","HCPCS C1713","","614630  -  SCREW BONE 3.5MM 30MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614632","SUP","HCPCS C1713","","614632  -  SCREW BONE 3.5MM 32MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614634","SUP","HCPCS C1713","","614634  -  SCREW BONE 3.5MM 42MM VARIAX TI ELB SLFTAP LCK NONSTRL","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614636","SUP","HCPCS C1713","","614636  -  SCREW BONE 3.5MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614638","SUP","HCPCS C1713","","614638  -  SCREW BONE 3.5MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614640","SUP","HCPCS C1713","","614640  -  SCREW BONE 3.5MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614642","SUP","HCPCS C1713","","614642  -  SCREW BONE 3.5MM 42MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614644","SUP","HCPCS C1713","","614644  -  SCREW BONE 3.5MM 44MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614646","SUP","HCPCS C1713","","614646  -  SCREW BONE 3.5MM 46MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614648","SUP","HCPCS C1713","","614648  -  SCREW BONE 3.5MM 48MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614650","SUP","HCPCS C1713","","614650  -  SCREW BONE 3.5MM 50MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614655","SUP","HCPCS C1713","","614655  -  SCREW BONE 3.5MM 55MM VARIAX LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614660","SUP","HCPCS C1713","","614660  -  SCREW BONE 3.5MM 60MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614665","SUP","HCPCS C1713","","614665  -  SCREW BONE 3.5MM 65MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614670","SUP","HCPCS C1713","","614670  -  SCREW BONE 3.5MM 70MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"614708","SUP","HCPCS C1713","","614708  -  SCREW BONE 2.7MM 8MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614710","SUP","HCPCS C1713","","614710  -  SCREW BONE 2.7MM 10MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614712","SUP","HCPCS C1713","","614712  -  SCREW BONE 2.7MM 12MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614714","SUP","HCPCS C1713","","614714  -  SCREW BONE 2.7MM 14MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614716","SUP","HCPCS C1713","","614716  -  SCREW BONE 2.7MM 16MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614718","SUP","HCPCS C1713","","614718  -  SCREW BONE 2.7MM 18MM VARIAX SLFTAP","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614720","SUP","HCPCS C1713","","614720  -  SCREW BONE 2.7MM 20MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614722","SUP","HCPCS C1713","","614722  -  SCREW BONE 2.7MM 22MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614724","SUP","HCPCS C1713","","614724  -  SCREW BONE 2.7MM 24MM VARIAX SLFTAP","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614726","SUP","HCPCS C1713","","614726  -  SCREW BONE 2.7MM 26MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614728","SUP","HCPCS C1713","","614728  -  SCREW BONE 2.7MM 28MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614730","SUP","HCPCS C1713","","614730  -  SCREW BONE 2.7MM 30MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614732","SUP","HCPCS C1713","","614732  -  SCREW BONE 2.7MM 32MM VARIAX TI ELB SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614734","SUP","HCPCS C1713","","614734  -  SCREW BONE 2.7MM 34MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614736","SUP","HCPCS C1713","","614736  -  SCREW BONE 2.7MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614738","SUP","HCPCS C1713","","614738  -  SCREW BONE 2.7MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614740","SUP","HCPCS C1713","","614740  -  SCREW BONE 2.7MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614742","SUP","HCPCS C1713","","614742  -  SCREW BONE 2.7MM 42MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614744","SUP","HCPCS C1713","","614744  -  SCREW BONE 2.7MM 44MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614746","SUP","HCPCS C1713","","614746  -  SCREW BONE 2.7MM 46MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614748","SUP","HCPCS C1713","","614748  -  SCREW BONE 2.7MM 48MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614750","SUP","HCPCS C1713","","614750  -  SCREW BONE 2.7MM 50MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614755","SUP","HCPCS C1713","","614755  -  SCREW BONE 2.7MM 55MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614760","SUP","HCPCS C1713","","614760  -  SCREW BONE 2.7MM 60MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614765","SUP","HCPCS C1713","","614765  -  SCREW BONE 2.7MM 65MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614770","SUP","HCPCS C1713","","614770  -  SCREW BONE 2.7MM 70MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$111.30 ","$82.36 ","$0.00 ","$107.25 ","$48.26 ","$0.00 ","$23.20 ","$0.00 ","$0.00 ","$18.78 ","$107.25 ","$0.00 ","$53.63 ","$84.94 ","$85.80 ","$0.00 ","$16.78 ","$0.00 ","$17.07 ","$0.00 "
"614808","SUP","HCPCS C1713","","614808  -  SCREW BONE 3.5MM 8MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614810","SUP","HCPCS C1713","","614810  -  SCREW BONE 3.5MM 10MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614812","SUP","HCPCS C1713","","614812  -  SCREW BONE 3.5MM 12MM VARIAX TI ELB LCK SLFTAP PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614814","SUP","HCPCS C1713","","614814  -  SCREW BONE 3.5MM 14MM VARIAX SS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614816","SUP","HCPCS C1713","","614816  -  SCREW BONE 3.5MM 16MM VARIAX SS NLCKG","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614818","SUP","HCPCS C1713","","614818  -  SCREW BONE 3.5MM 18MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614820","SUP","HCPCS C1713","","614820  -  SCREW BONE 3.5MM 20MM VARIAX SS ELB SLFTAP LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614822","SUP","HCPCS C1713","","614822  -  SCREW BONE 3.5MM 22MM VARIAX TI ELB SLFTAP LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614824","SUP","HCPCS C1713","","614824  -  SCREW BONE 3.5MM 24MM VARIAX TI ELB SLFTAP LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614826","SUP","HCPCS C1713","","614826  -  SCREW BONE 3.5MM 26MM VARIAX TI","BOTH IP/OP","$1,941.50 ","$1,436.71 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"614828","SUP","HCPCS C1713","","614828  -  SCREW BONE 3.5MM 28MM VARIAX TI","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614830","SUP","HCPCS C1713","","614830  -  SCREW BONE 3.5MM 30MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614832","SUP","HCPCS C1713","","614832  -  SCREW BONE 3.5MM 32MM VARIAX TI ELB SLFTAP LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614834","SUP","HCPCS C1713","","614834  -  SCREW BONE 3.5MM 34MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614836","SUP","HCPCS C1713","","614836  -  SCREW BONE 3.5MM 36MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614838","SUP","HCPCS C1713","","614838  -  SCREW BONE 3.5MM 38MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614840","SUP","HCPCS C1713","","614840  -  SCREW BONE 3.5MM 40MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614842","SUP","HCPCS C1713","","614842  -  SCREW BONE 3.5MM 42MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614844","SUP","HCPCS C1713","","614844  -  SCREW BONE 3.5MM 44MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614846","SUP","HCPCS C1713","","614846  -  SCREW BONE 3.5MM 46MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614848","SUP","HCPCS C1713","","614848  -  SCREW BONE 3.5MM 48MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614850","SUP","HCPCS C1713","","614850  -  SCREW BONE 3.5MM 50MM VARIAX NLCKG","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614855","SUP","HCPCS C1713","","614855  -  SCREW BONE 3.5MM 55MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614860","SUP","HCPCS C1713","","614860  -  SCREW BONE 3.5MM 60MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614865","SUP","HCPCS C1713","","614865  -  SCREW BONE 3.5MM 65MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"614870","SUP","HCPCS C1713","","614870  -  SCREW BONE 3.5MM 70MM VARIAX TI ELB SLFTAP LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"616002","SUP","HCPCS Q4130","","0616002  -  MATRIX TISSUE 16X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$58.88 ","$43.57 ","$0.00 ","$88.98 ","$0.00 ","$0.00 ","$12.27 ","$0.00 ","$0.00 ","$0.00 ","$88.98 ","$0.00 ","$44.49 ","$70.47 ","$71.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-3600  -  HEAD FEM +0MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621552","SUP","HCPCS C1713","","621552  -  PLATE LNG 50MM TI BONE CALCANEUS","BOTH IP/OP","$705.38 ","$521.98 ","$0.00 ","$705.38 ","$317.42 ","$0.00 ","$147.02 ","$0.00 ","$0.00 ","$123.51 ","$705.38 ","$0.00 ","$352.69 ","$558.66 ","$564.30 ","$0.00 ","$110.39 ","$0.00 ","$112.30 ","$0.00 "
"621553","SUP","HCPCS C1713","","621553  -  PLATE LNG 60MM TI BONE CALCANEUS","BOTH IP/OP","$705.38 ","$521.98 ","$0.00 ","$705.38 ","$317.42 ","$0.00 ","$147.02 ","$0.00 ","$0.00 ","$123.51 ","$705.38 ","$0.00 ","$352.69 ","$558.66 ","$564.30 ","$0.00 ","$110.39 ","$0.00 ","$112.30 ","$0.00 "
"621554","SUP","HCPCS C1713","","621554  -  PLATE LNG 70MM TI BONE CALCANEUS","BOTH IP/OP","$705.38 ","$521.98 ","$0.00 ","$705.38 ","$317.42 ","$0.00 ","$147.02 ","$0.00 ","$0.00 ","$123.51 ","$705.38 ","$0.00 ","$352.69 ","$558.66 ","$564.30 ","$0.00 ","$110.39 ","$0.00 ","$112.30 ","$0.00 "
"621555","SUP","HCPCS C1713","","621555  -  PLATE LNG 80MM TI BONE CALCANEUS","BOTH IP/OP","$541.75 ","$400.90 ","$0.00 ","$541.75 ","$243.79 ","$0.00 ","$112.91 ","$0.00 ","$0.00 ","$94.86 ","$541.75 ","$0.00 ","$270.88 ","$429.07 ","$433.40 ","$0.00 ","$84.78 ","$0.00 ","$86.25 ","$0.00 "
"624519","SUP","Custom 27203010","","CALIBRATOR CL S-CL KT 4.2ML HMTL","BOTH IP/OP","$78.85 ","$58.35 ","$0.00 ","$78.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.85 ","$0.00 ","$39.43 ","$62.45 ","$63.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"626001","SUP","HCPCS C1713","","626001  -  PLATE LNG 1 LVL RPS BONE SPNL","BOTH IP/OP","$2,830.60 ","$2,094.64 ","$0.00 ","$2,830.60 ","$1,273.77 ","$0.00 ","$589.97 ","$0.00 ","$0.00 ","$495.62 ","$2,830.60 ","$0.00 ","$1,415.30 ","$2,241.84 ","$2,264.48 ","$0.00 ","$442.99 ","$0.00 ","$450.63 ","$0.00 "
"626002","SUP","HCPCS C1713","","626002  -  PLATE LNG TI 2 LVL BONE ORTH","BOTH IP/OP","$3,124.90 ","$2,312.43 ","$0.00 ","$3,124.90 ","$1,406.21 ","$0.00 ","$651.31 ","$0.00 ","$0.00 ","$547.14 ","$3,124.90 ","$0.00 ","$1,562.45 ","$2,474.92 ","$2,499.92 ","$0.00 ","$489.05 ","$0.00 ","$497.48 ","$0.00 "
"626011","SUP","HCPCS C1713","","626011  -  PLATE SHRT 1 LVL RPS BONE SPNL","BOTH IP/OP","$2,830.60 ","$2,094.64 ","$0.00 ","$2,830.60 ","$1,273.77 ","$0.00 ","$589.97 ","$0.00 ","$0.00 ","$495.62 ","$2,830.60 ","$0.00 ","$1,415.30 ","$2,241.84 ","$2,264.48 ","$0.00 ","$442.99 ","$0.00 ","$450.63 ","$0.00 "
"626300","SUP","Custom 27803010","","626300  -  CONCTR ROD RPS FIX SPNL","BOTH IP/OP","$2,122.93 ","$1,570.97 ","$0.00 ","$2,122.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,122.93 ","$0.00 ","$1,061.46 ","$1,681.36 ","$1,698.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"629004","SUP","HCPCS C1713","","629004  -  PLATE BN 4 HL HUM DIST LAT","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629006","SUP","HCPCS C1713","","629006  -  PLATE BN 6 HL HUM LT DIST LAT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629008","SUP","HCPCS C1713","","629008  -  PLATE BN 8 HL HUM LT DIST LAT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629024","SUP","HCPCS C1713","","629024  -  PLATE BN 4 HL HUM RT DIST LAT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629026","SUP","HCPCS C1713","","629026  -  PLATE BN 6 HL HUM RT DIST LAT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629028","SUP","HCPCS C1713","","629028  -  PLATE BN 8 HL HUM RT DIST LAT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629044","SUP","HCPCS C1713","","629044  -  PLATE BN 4 HL HUM DP LAT","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629046","SUP","HCPCS C1713","","629046  -  PLATE BN 6 HL HUM L/L POST DIST","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629048","SUP","HCPCS C1713","","629048  -  PLATE BN 8 HL HUM L/L POST DIST","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629064","SUP","HCPCS C1713","","629064  -  PLATE BN 4 HL HUM RL POST DIST","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629066","SUP","HCPCS C1713","","629066  -  PLATE BN 6 HL HUM RL POST DIST","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629068","SUP","HCPCS C1713","","629068  -  PLATE BN 8 HL HUM DP LAT","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629084","SUP","HCPCS C1713","","629084  -  PLATE BN XTD HUM DIST MDL","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629086","SUP","HCPCS C1713","","629086  -  PLATE BN 6 HL XTD HUM DIST MDL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629088","SUP","HCPCS C1713","","629088  -  PLATE BN XTD HUM DIST MDL","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629104","SUP","HCPCS C1713","","629104  -  PLATE BN 4 HL HUM MDL POST DIST","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629106","SUP","HCPCS C1713","","629106  -  DIST. POST. MED. HUM. PL. 6 HOLE / LEFT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629108","SUP","HCPCS C1713","","629108  -  PLATE BN 8 HL HUM MDL POST DIST","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629124","SUP","HCPCS C1713","","629124  -  PLATE BN 4 HL HUM MDL POST DIST","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629126","SUP","HCPCS C1713","","629126  -  PLATE BN 6 HL HUM MDL POST DIST","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629128","SUP","HCPCS C1713","","629128  -  PLATE BN 8 HL HUM MDL POST DIST","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629144","SUP","HCPCS C1713","","629144  -  PLATE BN 4 HL LT OLCRN","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629146","SUP","HCPCS C1713","","629146  -  PLATE BN 6 HL LT OLCRN","BOTH IP/OP","$1,567.50 ","$1,159.95 ","$0.00 ","$1,567.50 ","$705.38 ","$0.00 ","$326.71 ","$0.00 ","$0.00 ","$274.46 ","$1,567.50 ","$0.00 ","$783.75 ","$1,241.46 ","$1,254.00 ","$0.00 ","$245.31 ","$0.00 ","$249.55 ","$0.00 "
"629148","SUP","HCPCS C1713","","629148  -  PLATE BN 8 HL LT OLCRN","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629164","SUP","HCPCS C1713","","629164  -  OLECRANON PLATE 4 HOLE / RIGHT","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629166","SUP","HCPCS C1713","","629166  -  PLATE SS 6 HOLE LCK BONE OLCRN","BOTH IP/OP","$1,567.50 ","$1,159.95 ","$0.00 ","$1,567.50 ","$705.38 ","$0.00 ","$326.71 ","$0.00 ","$0.00 ","$274.46 ","$1,567.50 ","$0.00 ","$783.75 ","$1,241.46 ","$1,254.00 ","$0.00 ","$245.31 ","$0.00 ","$249.55 ","$0.00 "
"629168","SUP","HCPCS C1713","","629168  -  PLATE BN 8 HL RT OLCRN","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629184","SUP","HCPCS C1713","","629184  -  PLATE BN 4 HL HUM DIST MDL","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"629186","SUP","HCPCS C1713","","629186  -  DIST. MED. HUM. PLATE 6 HOLE","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"629188","SUP","HCPCS C1713","","629188  -  PLATE BN 8 HL HUM DIST MDL","BOTH IP/OP","$1,815.00 ","$1,343.10 ","$0.00 ","$1,815.00 ","$816.75 ","$0.00 ","$378.29 ","$0.00 ","$0.00 ","$317.79 ","$1,815.00 ","$0.00 ","$907.50 ","$1,437.48 ","$1,452.00 ","$0.00 ","$284.05 ","$0.00 ","$288.95 ","$0.00 "
"629204","SUP","HCPCS C1713","","629204  -  PLATE BN 109MM NS VARIAX 4 HL TI HUM LT DIST LAT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629206","SUP","HCPCS C1713","","629206  -  PLATE BN 132MM NS VARIAX 6 HL TI HUM LT DIST LAT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629208","SUP","HCPCS C1713","","629208  -  PLATE BN 156MM NS VARIAX 8 HL TI HUM LT DIST LAT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629224","SUP","HCPCS C1713","","629224  -  PLATE BN 109MM NS VARIAX 4 HL TI HUM RT DIST LAT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629226","SUP","HCPCS C1713","","629226  -  PLATE BN 132MM NS VARIAX 6 HL TI HUM RT DIST LAT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629228","SUP","HCPCS C1713","","629228  -  PLATE BN 156MM NS VARIAX 8 HL TI HUM RT DIST LAT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629244","SUP","HCPCS C1713","","629244  -  PLATE BN 105MM NS VARIAX 4 HL TI HUM LT P/L","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629246","SUP","HCPCS C1713","","629246  -  PLATE BN 128MM NS VARIAX 6 HL TI HUM LT P/L","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629248","SUP","HCPCS C1713","","629248  -  PLATE BN 150MM NS VARIAX 8 HL TI HUM LT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629264","SUP","HCPCS C1713","","629264  -  PLATE BN 105MM NS VARIAX 4 HL TI HUM RT P/L","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629266","SUP","HCPCS C1713","","629266  -  PLATE BN 128MM NS VARIAX 6 HL TI HUM RT P/L","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629268","SUP","HCPCS C1713","","629268  -  PLATE BN 150MM NS VARIAX 8 HL TI HUM RT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629284","SUP","HCPCS C1713","","629284  -  PLATE BN 96MM NS VARIAX 4 HL XTD TI HUM DIST MDL","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629286","SUP","HCPCS C1713","","629286  -  PLATE BN 120MM NS VARIAX 6 HL XTD TI HUM DIST MDL","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629288","SUP","HCPCS C1713","","629288  -  PLATE BN 143MM NS VARIAX 8 HL XTD TI HUM DIST MDL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629304","SUP","HCPCS C1713","","629304  -  PLATE 104MM TI 4 SHFT HOLE VARIAX BONE LEFT POST MDL ELB","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629306","SUP","HCPCS C1713","","629306  -  PLATE 128MM TI 6 SHFT HOLE VARIAX BONE LEFT POST MDL ELB","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629308","SUP","HCPCS C1713","","629308  -  PLATE 151MM TI 8 SHFT HOLE VARIAX BONE LEFT POST MDL ELB","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629324","SUP","HCPCS C1713","","629324  -  PLATE 104MM TI 4 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629326","SUP","HCPCS C1713","","629326  -  PLATE 128MM TI 6 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629328","SUP","HCPCS C1713","","629328  -  PLATE 151MM TI 8 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"629344","SUP","HCPCS C1713","","629344  -  PLATE BN 89MM NS VARIAX 4 HL TI OLCRN LT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629346","SUP","HCPCS C1713","","629346  -  PLATE BN 113MM NS VARIAX 6 HL TI OLCRN LT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,677.50 ","$754.88 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$293.72 ","$1,677.50 ","$0.00 ","$838.75 ","$1,328.58 ","$1,342.00 ","$0.00 ","$262.53 ","$0.00 ","$267.06 ","$0.00 "
"629348","SUP","HCPCS C1713","","629348  -  PLATE BN 137MM NS VARIAX 8 HL TI OLCRN LT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629364","SUP","HCPCS C1713","","629364  -  PLATE BN 89MM NS VARIAX 4 HL TI OLCRN RT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629366","SUP","HCPCS C1713","","629366  -  PLATE BN 113MM NS VARIAX 6 HL TI OLCRN RT","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,677.50 ","$754.88 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$293.72 ","$1,677.50 ","$0.00 ","$838.75 ","$1,328.58 ","$1,342.00 ","$0.00 ","$262.53 ","$0.00 ","$267.06 ","$0.00 "
"629368","SUP","HCPCS C1713","","629368  -  PLATE BN 137MM NS VARIAX 8 HL TI OLCRN RT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629384","SUP","HCPCS C1713","","629384  -  PLATE BN 92MM NS VARIAX 4 HL TI HUM DIST MDL","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,589.50 ","$715.28 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$278.31 ","$1,589.50 ","$0.00 ","$794.75 ","$1,258.88 ","$1,271.60 ","$0.00 ","$248.76 ","$0.00 ","$253.05 ","$0.00 "
"629385","SUP","Custom 27203010","","629385  -  STYLET LEAD STR BALL TAPER .016IN 85CM KIT EXTEND KNOB","BOTH IP/OP","$16.00 ","$11.84 ","$0.00 ","$16.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.00 ","$0.00 ","$8.00 ","$12.67 ","$12.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"629386","SUP","HCPCS C1713","","629386  -  PLATE BN 116MM NS VARIAX 6 HL TI HUM DIST MDL","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,765.50 ","$794.48 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$309.12 ","$1,765.50 ","$0.00 ","$882.75 ","$1,398.28 ","$1,412.40 ","$0.00 ","$276.30 ","$0.00 ","$281.07 ","$0.00 "
"629388","SUP","HCPCS C1713","","629388  -  PLATE BN 139MM NS VARIAX 8 HL TI HUM DIST MDL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,941.50 ","$873.68 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$339.94 ","$1,941.50 ","$0.00 ","$970.75 ","$1,537.67 ","$1,553.20 ","$0.00 ","$303.84 ","$0.00 ","$309.09 ","$0.00 "
"25-Jun","SUP","Custom 27803010","","06-3625  -  HEAD FEM +2.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"631400","SUP","Custom 27203010","","631400  -  PARTICLES EMBL TRFL KT LQ SYS NBCA 2GM","BOTH IP/OP","$10,375.00 ","$7,677.50 ","$0.00 ","$10,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,375.00 ","$0.00 ","$5,187.50 ","$8,217.00 ","$8,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"631500","SUP","Custom 27203010","","631500  -  PARTICLES EMBL TRFL KT LQ SYS NBCA 1GM","BOTH IP/OP","$8,099.68 ","$5,993.76 ","$0.00 ","$8,099.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,099.68 ","$0.00 ","$4,049.84 ","$6,414.95 ","$6,479.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"633000","SUP","HCPCS C1884","","COIL EMBL 2MM .014IN TRFL STRG PSH 2CM PLTN NRVSC","BOTH IP/OP","$172.50 ","$127.65 ","$0.00 ","$172.50 ","$77.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.20 ","$172.50 ","$0.00 ","$86.25 ","$136.62 ","$138.00 ","$0.00 ","$27.00 ","$0.00 ","$27.46 ","$0.00 "
"633340","SUP","HCPCS C1884","","COIL EMBL 5MM TRFL PSH CMPLX SHP","BOTH IP/OP","$389.50 ","$288.23 ","$0.00 ","$389.50 ","$175.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.20 ","$389.50 ","$0.00 ","$194.75 ","$308.48 ","$311.60 ","$0.00 ","$60.96 ","$0.00 ","$62.01 ","$0.00 "
"633360","SUP","HCPCS C1884","","COIL EMBL 60MM 7MM TRFL OCL PSH CMPLX SHP NYL","BOTH IP/OP","$389.50 ","$288.23 ","$0.00 ","$389.50 ","$175.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.20 ","$389.50 ","$0.00 ","$194.75 ","$308.48 ","$311.60 ","$0.00 ","$60.96 ","$0.00 ","$62.01 ","$0.00 "
"635002","SUP","Custom 27803010","","635002  -  SYRINGE INFLAT/DEFLATION INDEFLATOR TRUFILL DCS II PLATINUM","BOTH IP/OP","$674.40 ","$499.06 ","$0.00 ","$674.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$674.40 ","$0.00 ","$337.20 ","$534.12 ","$539.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"636032","SUP","HCPCS C1713","","636032  -  SPACER 636032 PERIMETER XS 10X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636053","SUP","HCPCS C1713","","636053  -  SPACER 636053 PERIMETER XS 10X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636132","SUP","HCPCS C1713","","636132  -  SPACER 636132 PERIMETER XS 11X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636153","SUP","HCPCS C1713","","636153  -  SPACER 636153 PERIMETER XS 11X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636232","SUP","HCPCS C1713","","636232  -  SPACER 636232 PERIMETER XS 12X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636253","SUP","HCPCS C1713","","636253  -  SPACER 636253 PERIMETER XS 12X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636532","SUP","HCPCS C1713","","636532  -  SPACER 636532 PERIMETER XS 5X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636553","SUP","HCPCS C1713","","636553  -  SPACER 636553 PERIMETER XS 5X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636632","SUP","HCPCS C1713","","636632  -  SPACER 636632 PERIMETER XS 6X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636653","SUP","HCPCS C1713","","636653  -  SPACER 636653 PERIMETER XS 6X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636732","SUP","HCPCS C1713","","636732  -  SPACER 636732 PERIMETER XS 7X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636753","SUP","HCPCS C1713","","636753  -  SPACER 636753 PERIMETER XS 7X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636832","SUP","HCPCS C1713","","636832  -  SPACER 636832 PERIMETER XS 8X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636853","SUP","HCPCS C1713","","636853  -  SPACER 636853 PERIMETER XS 8X15X13MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636932","SUP","HCPCS C1713","","636932  -  SPACER 636932 PERIMETER XS 9X13X12MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"636953","SUP","HCPCS C1713","","636953  -  SPACER SPNL XS 15X13X9MM PRIMTR PEEK-OPTM LMBR INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"Jun-75","SUP","Custom 27803010","","06-3675  -  HEAD FEM +7.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"650038","SUP","Custom 27203010","","CONTROL CHM LX SER LVL 1 2 HBA1C SYN VIGIL","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"653050","SUP","HCPCS C1762","","653050  -  GRAFT BONE SHORT 5X2.5CM DEMINERALIZED BONE MATRIX","BOTH IP/OP","$6,800.00 ","$5,032.00 ","$0.00 ","$6,800.00 ","$0.00 ","$0.00 ","$1,417.29 ","$0.00 ","$0.00 ","$0.00 ","$6,800.00 ","$0.00 ","$3,400.00 ","$5,385.60 ","$5,440.00 ","$0.00 ","$1,064.20 ","$0.00 ","$0.00 ","$0.00 "
"653100","SUP","HCPCS C1762","","653100  -  GRAFT BONE BIO BOAT ALLOGRAFT DEMINERALIZED BONE MATRIX 20ML","BOTH IP/OP","$10,975.00 ","$8,121.50 ","$0.00 ","$10,975.00 ","$0.00 ","$0.00 ","$2,287.46 ","$0.00 ","$0.00 ","$0.00 ","$10,975.00 ","$0.00 ","$5,487.50 ","$8,692.20 ","$8,780.00 ","$0.00 ","$1,717.59 ","$0.00 ","$0.00 ","$0.00 "
"Jun-97","SUP","Custom 27803010","","06-3697  -  HEAD FEMORAL C TAPER LOW FRICTION HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-99","SUP","Custom 27803010","","06-3699  -  HEAD FEMORAL -5 36MM C TAPER ANATOMIC LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663940","SUP","Custom 27203010","","CALIBRATOR MLANLT IMMAGE ARY 1ML IMMUN","BOTH IP/OP","$543.75 ","$402.38 ","$0.00 ","$543.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.75 ","$0.00 ","$271.88 ","$430.65 ","$435.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665040","SUP","Custom 27803010","","665040  -  ROD SPINAL 6MM 40MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665050","SUP","Custom 27803010","","665050  -  ROD SPINAL 6MM 50MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665060","SUP","Custom 27803010","","665060  -  ROD SPINAL 6MM 60MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665070","SUP","Custom 27803010","","665070  -  ROD SPINAL 6MM 70MM UNION TRIO THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665080","SUP","Custom 27803010","","665080  -  ROD SPINAL 6MM 80MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665090","SUP","Custom 27803010","","665090  -  ROD SPINAL 6MM 90MM UNION TRIO THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665100","SUP","Custom 27803010","","665100  -  ROD SPINAL 6MM 100MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665110","SUP","Custom 27803010","","665110  -  ROD SPINAL 6MM 110MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665120","SUP","Custom 27803010","","665120  -  ROD SPINAL 6MM 120MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665130","SUP","Custom 27803010","","665130  -  ROD SPINAL 6MM 130MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665140","SUP","Custom 27803010","","665140  -  ROD SPINAL 6MM 140MM UNION TOP LOADING TRIO THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665150","SUP","Custom 27803010","","665150  -  ROD SPINAL 6MM 150MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665160","SUP","Custom 27803010","","665160  -  ROD SPINAL 6MM 160MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665170","SUP","Custom 27803010","","665170  -  ROD SPINAL 6MM 170MM UNION DIAPASON TITANIUM THORACOLUMBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665180","SUP","Custom 27803010","","665180  -  ROD SPINAL 6MM 180MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665190","SUP","Custom 27803010","","665190  -  ROD SPINAL 190MM UNION DIAPASON TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665200","SUP","Custom 27803010","","665200  -  ROD SPINAL 6MM 200MM UNION DIAPASON TITANIUM PEDICLE","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665210","SUP","Custom 27803010","","665210  -  ROD SPINAL 210MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665250","SUP","Custom 27803010","","665250  -  ROD SPINAL 250MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665270","SUP","Custom 27803010","","665270  -  ROD SPINAL 270MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665300","SUP","Custom 27803010","","665300  -  ROD SPINAL 300MM UNION DIAPASON OSS TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665350","SUP","Custom 27803010","","665350  -  ROD SPINAL 6MM 350MM UNION TRIO THORACOLUMBAR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665400","SUP","Custom 27803010","","665400  -  ROD SPINAL 6MM 400MM UNION DIAPASON TITANIUM PEDICLE","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"665480","SUP","Custom 27803010","","665480  -  ROD SPINAL 6MM 480MM UNION DIAPASON TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"670001","SUP","HCPCS C1713","","670001  -  SCREW BONE 6.7MM 35MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670002","SUP","HCPCS C1713","","670002  -  SCREW BONE 6.7MM 40MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670003","SUP","HCPCS C1713","","670003  -  SCREW BONE 6.7MM 45MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670004","SUP","HCPCS C1713","","670004  -  SCREW BONE 6.5MM 50MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670005","SUP","HCPCS C1713","","670005  -  SCREW BONE 7.5MM 35MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670006","SUP","HCPCS C1713","","670006  -  SCREW BONE 7.5MM 40MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670007","SUP","HCPCS C1713","","670007  -  SCREW BONE 7.5MM 45MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670008","SUP","HCPCS C1713","","670008  -  SCREW BONE 7.5MM 50MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670009","SUP","HCPCS C1713","","670009  -  SCREW BONE 7.5MM 55MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670015","SUP","HCPCS C1713","","670015  -  SCREW BONE 6.5MM 55MM OPUS SPNL CYLND","BOTH IP/OP","$1,505.15 ","$1,113.81 ","$0.00 ","$1,505.15 ","$677.32 ","$0.00 ","$313.71 ","$0.00 ","$0.00 ","$263.54 ","$1,505.15 ","$0.00 ","$752.58 ","$1,192.08 ","$1,204.12 ","$0.00 ","$235.56 ","$0.00 ","$239.62 ","$0.00 "
"670062","SUP","HCPCS C1713","","670062  -  SCREW BONE 5.5MM 35MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670063","SUP","HCPCS C1713","","670063  -  SCREW BONE 5.5MM 40MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670071","SUP","HCPCS C1713","","670071  -  SCREW BONE 6.5MM 35MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670072","SUP","HCPCS C1713","","670072  -  SCREW BONE 6.5MM 40MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670073","SUP","HCPCS C1713","","670073  -  SCREW BONE 6.5MM 45MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,644.45 ","$1,216.89 ","$0.00 ","$1,644.45 ","$740.00 ","$0.00 ","$342.74 ","$0.00 ","$0.00 ","$287.93 ","$1,644.45 ","$0.00 ","$822.23 ","$1,302.40 ","$1,315.56 ","$0.00 ","$257.36 ","$0.00 ","$261.80 ","$0.00 "
"670074","SUP","HCPCS C1713","","670074  -  SCREW BONE 6.5MM 50MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670075","SUP","HCPCS C1713","","670075  -  SCREW BONE 6.5MM 55MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670081","SUP","HCPCS C1713","","670081  -  SCREW BONE 7.5MM 35MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670082","SUP","HCPCS C1713","","670082  -  SCREW BONE 7.5MM 40MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670083","SUP","HCPCS C1713","","670083  -  SCREW BONE 7.5MM 45MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670084","SUP","HCPCS C1713","","670084  -  SCREW BONE 7.5MM 50MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670086","SUP","HCPCS C1713","","670086  -  SCREW BONE 7.5MM 55MM OPUS LNG SPNL HEX CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670102","SUP","HCPCS C1713","","670102  -  SCREW BONE 8MM 40MM OPUS SPNL CONICAL","BOTH IP/OP","$1,026.65 ","$759.72 ","$0.00 ","$1,026.65 ","$461.99 ","$0.00 ","$213.98 ","$0.00 ","$0.00 ","$179.76 ","$1,026.65 ","$0.00 ","$513.33 ","$813.11 ","$821.32 ","$0.00 ","$160.67 ","$0.00 ","$163.44 ","$0.00 "
"670103","SUP","HCPCS C1713","","670103  -  SCREW BONE 8MM 45MM OPUS SPNL CONICAL","BOTH IP/OP","$1,026.65 ","$759.72 ","$0.00 ","$1,026.65 ","$461.99 ","$0.00 ","$213.98 ","$0.00 ","$0.00 ","$179.76 ","$1,026.65 ","$0.00 ","$513.33 ","$813.11 ","$821.32 ","$0.00 ","$160.67 ","$0.00 ","$163.44 ","$0.00 "
"670111","SUP","HCPCS C1713","","670111  -  SCREW BONE 9MM 35MM OPUS SPNL CONICAL","BOTH IP/OP","$1,062.58 ","$786.31 ","$0.00 ","$1,062.58 ","$478.16 ","$0.00 ","$221.47 ","$0.00 ","$0.00 ","$186.05 ","$1,062.58 ","$0.00 ","$531.29 ","$841.56 ","$850.06 ","$0.00 ","$166.29 ","$0.00 ","$169.16 ","$0.00 "
"670112","SUP","HCPCS C1713","","670112  -  SCREW BONE 9MM 40MM OPUS SPNL CONICAL","BOTH IP/OP","$1,062.58 ","$786.31 ","$0.00 ","$1,062.58 ","$478.16 ","$0.00 ","$221.47 ","$0.00 ","$0.00 ","$186.05 ","$1,062.58 ","$0.00 ","$531.29 ","$841.56 ","$850.06 ","$0.00 ","$166.29 ","$0.00 ","$169.16 ","$0.00 "
"670113","SUP","HCPCS C1713","","670113  -  SCREW BONE 9MM 45MM OPUS SPNL CONICAL","BOTH IP/OP","$1,062.58 ","$786.31 ","$0.00 ","$1,062.58 ","$478.16 ","$0.00 ","$221.47 ","$0.00 ","$0.00 ","$186.05 ","$1,062.58 ","$0.00 ","$531.29 ","$841.56 ","$850.06 ","$0.00 ","$166.29 ","$0.00 ","$169.16 ","$0.00 "
"670114","SUP","HCPCS C1713","","670114  -  SCREW BONE 9MM 50MM OPUS SPNL CONICAL","BOTH IP/OP","$1,062.58 ","$786.31 ","$0.00 ","$1,062.58 ","$478.16 ","$0.00 ","$221.47 ","$0.00 ","$0.00 ","$186.05 ","$1,062.58 ","$0.00 ","$531.29 ","$841.56 ","$850.06 ","$0.00 ","$166.29 ","$0.00 ","$169.16 ","$0.00 "
"670115","SUP","HCPCS C1713","","670115  -  SCREW BONE 9MM 55MM OPUS SPNL CONICAL","BOTH IP/OP","$1,062.58 ","$786.31 ","$0.00 ","$1,062.58 ","$478.16 ","$0.00 ","$221.47 ","$0.00 ","$0.00 ","$186.05 ","$1,062.58 ","$0.00 ","$531.29 ","$841.56 ","$850.06 ","$0.00 ","$166.29 ","$0.00 ","$169.16 ","$0.00 "
"670213","SUP","HCPCS C1713","","670213  -  SCREW BONE 5.5MM 35MM OPUS SPNL SGTL DUAL CUT","BOTH IP/OP","$1,505.15 ","$1,113.81 ","$0.00 ","$1,505.15 ","$677.32 ","$0.00 ","$313.71 ","$0.00 ","$0.00 ","$263.54 ","$1,505.15 ","$0.00 ","$752.58 ","$1,192.08 ","$1,204.12 ","$0.00 ","$235.56 ","$0.00 ","$239.62 ","$0.00 "
"670214","SUP","HCPCS C1713","","670214  -  SCREW BONE 5.5MM 40MM OPUS SPNL CONICAL","BOTH IP/OP","$1,675.90 ","$1,240.17 ","$0.00 ","$1,675.90 ","$754.16 ","$0.00 ","$349.30 ","$0.00 ","$0.00 ","$293.44 ","$1,675.90 ","$0.00 ","$837.95 ","$1,327.31 ","$1,340.72 ","$0.00 ","$262.28 ","$0.00 ","$266.80 ","$0.00 "
"670221","SUP","HCPCS C1713","","670221  -  PLATE LNG 35MM 2 HOLE OPUS BONE SPNL","BOTH IP/OP","$2,619.45 ","$1,938.39 ","$0.00 ","$2,619.45 ","$1,178.75 ","$0.00 ","$545.96 ","$0.00 ","$0.00 ","$458.64 ","$2,619.45 ","$0.00 ","$1,309.73 ","$2,074.60 ","$2,095.56 ","$0.00 ","$409.94 ","$0.00 ","$417.02 ","$0.00 "
"670222","SUP","HCPCS C1713","","670222  -  PLATE SHRT 2 HOLE OPUS BONE SPNL","BOTH IP/OP","$2,619.45 ","$1,938.39 ","$0.00 ","$2,619.45 ","$1,178.75 ","$0.00 ","$545.96 ","$0.00 ","$0.00 ","$458.64 ","$2,619.45 ","$0.00 ","$1,309.73 ","$2,074.60 ","$2,095.56 ","$0.00 ","$409.94 ","$0.00 ","$417.02 ","$0.00 "
"670223","SUP","HCPCS C1713","","670223  -  PLATE LNG 3 HOLE OPUS BONE SPNL","BOTH IP/OP","$2,772.18 ","$2,051.41 ","$0.00 ","$2,772.18 ","$1,247.48 ","$0.00 ","$577.79 ","$0.00 ","$0.00 ","$485.39 ","$2,772.18 ","$0.00 ","$1,386.09 ","$2,195.57 ","$2,217.74 ","$0.00 ","$433.85 ","$0.00 ","$441.33 ","$0.00 "
"670224","SUP","HCPCS C1713","","670224  -  PLATE 90MM OPUS BONE SPNL","BOTH IP/OP","$2,621.70 ","$1,940.06 ","$0.00 ","$2,621.70 ","$1,179.77 ","$0.00 ","$546.43 ","$0.00 ","$0.00 ","$459.04 ","$2,621.70 ","$0.00 ","$1,310.85 ","$2,076.39 ","$2,097.36 ","$0.00 ","$410.30 ","$0.00 ","$417.37 ","$0.00 "
"670225","SUP","HCPCS C1713","","670225  -  PLATE 105MM OPUS BONE SPNL","BOTH IP/OP","$2,495.88 ","$1,846.95 ","$0.00 ","$2,495.88 ","$1,123.14 ","$0.00 ","$520.20 ","$0.00 ","$0.00 ","$437.01 ","$2,495.88 ","$0.00 ","$1,247.94 ","$1,976.74 ","$1,996.70 ","$0.00 ","$390.60 ","$0.00 ","$397.34 ","$0.00 "
"670226","SUP","HCPCS C1713","","670226  -  PLATE 120MM OPUS BONE SPNL","BOTH IP/OP","$2,495.88 ","$1,846.95 ","$0.00 ","$2,495.88 ","$1,123.14 ","$0.00 ","$520.20 ","$0.00 ","$0.00 ","$437.01 ","$2,495.88 ","$0.00 ","$1,247.94 ","$1,976.74 ","$1,996.70 ","$0.00 ","$390.60 ","$0.00 ","$397.34 ","$0.00 "
"670282","SUP","Custom 27803010","","670282  -  CONCTR ROD 35MM 5.5MM OPUS LONGTOP SPNL","BOTH IP/OP","$1,121.03 ","$829.56 ","$0.00 ","$1,121.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,121.03 ","$0.00 ","$560.51 ","$887.86 ","$896.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"670283","SUP","Custom 27803010","","670283  -  CONCTR ROD 40MM 5.5MM OPUS LONGTOP SPNL","BOTH IP/OP","$1,121.03 ","$829.56 ","$0.00 ","$1,121.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,121.03 ","$0.00 ","$560.51 ","$887.86 ","$896.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"670301","SUP","HCPCS C1713","","670301  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670302","SUP","HCPCS C1713","","670302  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670303","SUP","HCPCS C1713","","670303  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,644.45 ","$1,216.89 ","$0.00 ","$1,644.45 ","$740.00 ","$0.00 ","$342.74 ","$0.00 ","$0.00 ","$287.93 ","$1,644.45 ","$0.00 ","$822.23 ","$1,302.40 ","$1,315.56 ","$0.00 ","$257.36 ","$0.00 ","$261.80 ","$0.00 "
"670304","SUP","HCPCS C1713","","670304  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670305","SUP","HCPCS C1713","","670305  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670311","SUP","HCPCS C1713","","670311  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670312","SUP","HCPCS C1713","","670312  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670313","SUP","HCPCS C1713","","670313  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670314","SUP","HCPCS C1713","","670314  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670315","SUP","HCPCS C1713","","670315  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP CONICAL","BOTH IP/OP","$1,565.80 ","$1,158.69 ","$0.00 ","$1,565.80 ","$704.61 ","$0.00 ","$326.35 ","$0.00 ","$0.00 ","$274.16 ","$1,565.80 ","$0.00 ","$782.90 ","$1,240.11 ","$1,252.64 ","$0.00 ","$245.05 ","$0.00 ","$249.28 ","$0.00 "
"670371","SUP","HCPCS C1713","","670371  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670372","SUP","HCPCS C1713","","670372  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670373","SUP","HCPCS C1713","","670373  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670374","SUP","HCPCS C1713","","670374  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670381","SUP","HCPCS C1713","","670381  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670382","SUP","HCPCS C1713","","670382  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670383","SUP","HCPCS C1713","","670383  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670384","SUP","HCPCS C1713","","670384  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP LNG HEX CONICAL","BOTH IP/OP","$1,073.85 ","$794.65 ","$0.00 ","$1,073.85 ","$483.23 ","$0.00 ","$223.82 ","$0.00 ","$0.00 ","$188.02 ","$1,073.85 ","$0.00 ","$536.93 ","$850.49 ","$859.08 ","$0.00 ","$168.06 ","$0.00 ","$170.96 ","$0.00 "
"670501","SUP","HCPCS C1713","","670501  -  OPUS WASHER","BOTH IP/OP","$141.55 ","$104.75 ","$0.00 ","$141.55 ","$63.70 ","$0.00 ","$29.50 ","$0.00 ","$0.00 ","$24.78 ","$141.55 ","$0.00 ","$70.78 ","$112.11 ","$113.24 ","$0.00 ","$22.15 ","$0.00 ","$22.53 ","$0.00 "
"670504","SUP","HCPCS C1713","","670504  -  OPUS PLATE NUT","BOTH IP/OP","$141.55 ","$104.75 ","$0.00 ","$141.55 ","$63.70 ","$0.00 ","$29.50 ","$0.00 ","$0.00 ","$24.78 ","$141.55 ","$0.00 ","$70.78 ","$112.11 ","$113.24 ","$0.00 ","$22.15 ","$0.00 ","$22.53 ","$0.00 "
"670600","SUP","Custom 27803010","","670600  -  CONCTR ROD OPUS SPNL","BOTH IP/OP","$1,062.58 ","$786.31 ","$0.00 ","$1,062.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,062.58 ","$0.00 ","$531.29 ","$841.56 ","$850.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"670604","SUP","HCPCS C1713","","670604  -  OPUS ROD NUT","BOTH IP/OP","$199.95 ","$147.96 ","$0.00 ","$199.95 ","$89.98 ","$0.00 ","$41.67 ","$0.00 ","$0.00 ","$35.01 ","$199.95 ","$0.00 ","$99.98 ","$158.36 ","$159.96 ","$0.00 ","$31.29 ","$0.00 ","$31.83 ","$0.00 "
"670610","SUP","Custom 27803010","","670610  -  CONCTR ROD OPUS OFFST SPNL","BOTH IP/OP","$1,251.28 ","$925.95 ","$0.00 ","$1,251.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,251.28 ","$0.00 ","$625.64 ","$991.01 ","$1,001.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671040","SUP","Custom 27803010","","671040  -  ROD SPNL 40MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671050","SUP","Custom 27803010","","671050  -  ROD SPNL 50MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671060","SUP","Custom 27803010","","671060  -  ROD SPNL 60MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671070","SUP","Custom 27803010","","671070  -  ROD SPNL 70MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671080","SUP","Custom 27803010","","671080  -  ROD SPNL 80MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671090","SUP","Custom 27803010","","671090  -  ROD SPNL 90MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671100","SUP","Custom 27803010","","671100  -  ROD SPNL 100MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671110","SUP","Custom 27803010","","671110  -  ROD SPNL 110MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671120","SUP","Custom 27803010","","671120  -  ROD SPNL 120MM OPUS","BOTH IP/OP","$707.65 ","$523.66 ","$0.00 ","$707.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.65 ","$0.00 ","$353.83 ","$560.46 ","$566.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"671140","SUP","Custom 27803010","","671140  -  ROD SPNL 140MM OPUS","BOTH IP/OP","$458.30 ","$339.14 ","$0.00 ","$458.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.30 ","$0.00 ","$229.15 ","$362.97 ","$366.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"703178","SUP","Custom 27203010","","703178  -  BIT DRILL 4.2MM TROCAR PNT AO STRL","BOTH IP/OP","$243.38 ","$180.10 ","$0.00 ","$243.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.38 ","$0.00 ","$121.69 ","$192.76 ","$194.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703541","SUP","Custom 27203010","","703541  -  BIT DRILL 310MM 4.3MM CLBRT AO FIT","BOTH IP/OP","$331.38 ","$245.22 ","$0.00 ","$331.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.38 ","$0.00 ","$165.69 ","$262.45 ","$265.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703542","SUP","Custom 27203010","","703542  -  BIT DRILL 310MM 3.2MM CLBRT AO FIT","BOTH IP/OP","$320.38 ","$237.08 ","$0.00 ","$320.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.38 ","$0.00 ","$160.19 ","$253.74 ","$256.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703543","SUP","Custom 27203010","","703543  -  SET ORTH 4.5MM AO","BOTH IP/OP","$336.88 ","$249.29 ","$0.00 ","$336.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703551","SUP","Custom 27803010","","703551  -  TAP 4.5MM 295MM AO FIT SURG CORT AXSOS","BOTH IP/OP","$475.75 ","$352.06 ","$0.00 ","$475.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.75 ","$0.00 ","$237.88 ","$376.79 ","$380.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703553","SUP","Custom 27803010","","703553  -  TAP 6.5MM 295MM AO FIT SURG CANC AXSOS","BOTH IP/OP","$490.45 ","$362.93 ","$0.00 ","$490.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.88 ","$0.00 ","$245.44 ","$388.78 ","$392.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703554","SUP","Custom 27803010","","703554  -  TAP 5MM 295MM LCK SURG","BOTH IP/OP","$489.50 ","$362.23 ","$0.00 ","$489.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$489.50 ","$0.00 ","$244.75 ","$387.68 ","$391.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703561","SUP","HCPCS C1713","","703561  -  WIRE FX 2MM 315MM KRSH DRL TIP","BOTH IP/OP","$108.63 ","$80.39 ","$0.00 ","$108.63 ","$48.88 ","$0.00 ","$22.64 ","$0.00 ","$0.00 ","$19.02 ","$108.63 ","$0.00 ","$54.31 ","$86.03 ","$86.90 ","$0.00 ","$17.00 ","$0.00 ","$17.29 ","$0.00 "
"703574","SUP","HCPCS C1713","","703574  -  TAP BN LCK SPHRCL TIP 4 MM SCR","BOTH IP/OP","$606.38 ","$448.72 ","$0.00 ","$606.38 ","$272.87 ","$0.00 ","$126.38 ","$0.00 ","$0.00 ","$106.17 ","$606.38 ","$0.00 ","$303.19 ","$480.25 ","$485.10 ","$0.00 ","$94.90 ","$0.00 ","$96.53 ","$0.00 "
"703583","SUP","HCPCS C1713","","703583  -  WIRE FX 2MM 285MM KRSH DRL TIP","BOTH IP/OP","$167.45 ","$123.91 ","$0.00 ","$173.25 ","$77.96 ","$0.00 ","$34.90 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"703585","SUP","Custom 27203010","","703585  -  BIT DRILL 3.1MM","BOTH IP/OP","$323.13 ","$239.12 ","$0.00 ","$323.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.13 ","$0.00 ","$161.56 ","$255.92 ","$258.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703586","SUP","Custom 27203010","","703586  -  BIT DRL 2.5MM CLBRT AO","BOTH IP/OP","$323.13 ","$239.12 ","$0.00 ","$323.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.13 ","$0.00 ","$161.56 ","$255.92 ","$258.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703588","SUP","Custom 27803010","","703588  -  TAP 3.5MM SURG CORT AXSOS","BOTH IP/OP","$575.45 ","$425.83 ","$0.00 ","$576.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$576.13 ","$0.00 ","$288.06 ","$456.29 ","$460.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703589","SUP","Custom 27803010","","703589  -  TAP SURG AXSOS 4 MM CANC SCR","BOTH IP/OP","$575.45 ","$425.83 ","$0.00 ","$576.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$576.13 ","$0.00 ","$288.06 ","$456.29 ","$460.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703590","SUP","Custom 27203010","","703590  -  DRILL SURG SM AO 3.5MM","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703615","SUP","Custom 27203010","","703615  -  BIT DRL 4.3MM 264MM CLBRT","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$251.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703616","SUP","Custom 27203010","","703616  -  BIT DRL 3.1MM 205MM CLBRT","BOTH IP/OP","$259.50 ","$192.03 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703617","SUP","Custom 27203010","","703617  -  CALIBRATED DRILL BIT 03.1 X 285MM","BOTH IP/OP","$279.75 ","$207.02 ","$0.00 ","$207.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.63 ","$0.00 ","$103.81 ","$164.44 ","$166.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703618","SUP","Custom 27203010","","703618  -  CALIBRATED DRILL BIT 04.3 X 315MM","BOTH IP/OP","$363.80 ","$269.21 ","$0.00 ","$389.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703701","SUP","Custom 27203010","","703701  -  DRILL SURG AO CONNECT 2MM 2.7MM SCR","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703702","SUP","Custom 27203010","","703702  -  DRILL SURG AO CONNECT 2.6MM 3.5MM SCR","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703703","SUP","Custom 27203010","","703703  -  DRILL SURG OVR AO CONNECT 2.7 MM SCR","BOTH IP/OP","$232.90 ","$172.35 ","$0.00 ","$233.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703704","SUP","Custom 27203010","","703704  -  BIT DRL 3.5MM STRL DISP","BOTH IP/OP","$232.90 ","$172.35 ","$0.00 ","$233.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703705","SUP","Custom 27803010","","703705  -  TAP AO CONNECT SURG VARIAX 2.7 MM SCR NONSTRL","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703706","SUP","Custom 27803010","","703706  -  TAP AO CONNECT SURG 3.5 MM SCR","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"704501","SUP","Custom 27203010","","704501  -  DRILL SURG SHRT 246MM CANN JCB FIT HANSSON ADLT 6.7MM","BOTH IP/OP","$680.63 ","$503.67 ","$0.00 ","$680.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$680.63 ","$0.00 ","$340.31 ","$539.06 ","$544.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"704502","SUP","Custom 27203010","","704502  -  DRILL SURG LNG 276MM CANN JCB FIT HANSSON ADLT 6.7MM","BOTH IP/OP","$680.63 ","$503.67 ","$0.00 ","$680.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$680.63 ","$0.00 ","$340.31 ","$539.06 ","$544.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"711050","SUP","Custom 27203010","","00711050  -  DEVICE SPECIMEN RETRIEVAL STANDARD 2.5MM 230CM 6X3CM STRONG","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"712001","SUP","Custom 27203010","","712001  -  CLIP PMP IRR MDNXT","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"714080","SUP","Custom 27203010","","REAGENT ANTI-LTTL C RH 4 BCLN 5ML MNCLN TUBE MCPLT BLOOD","BOTH IP/OP","$470.23 ","$347.97 ","$0.00 ","$470.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.23 ","$0.00 ","$235.11 ","$372.42 ","$376.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"719101","SUP","Custom 27203010","","REAGENT .8% RBC SRGSCRN 10ML AB SCRN BLOOD BANK","BOTH IP/OP","$80.35 ","$59.46 ","$0.00 ","$80.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.35 ","$0.00 ","$40.18 ","$63.64 ","$64.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"721543","SUP","Custom 27203010","","REAGENT ANALY CLTR CLEAN SOL 10L LH SER","BOTH IP/OP","$106.15 ","$78.55 ","$0.00 ","$106.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.15 ","$0.00 ","$53.08 ","$84.07 ","$84.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"725230","SUP","Custom 27203010","","REAGENT ANTI-FY LTTL B BLOOD BANK","BOTH IP/OP","$1,350.63 ","$999.47 ","$0.00 ","$1,350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,350.63 ","$0.00 ","$675.31 ","$1,069.70 ","$1,080.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"732420","SUP","HCPCS C1713","","732420  -  SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"733008","SUP","HCPCS C1768","","733008  -  GRAFT CARDIO STR 8MM 30CM SUTURE RETENTION UNIQUE","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"733010","SUP","HCPCS C1768","","733010  -  GRAFT CV STRG 10MM 30CM GLWV SUT RTNT UNQ HYDROLYZABLE GELTN","BOTH IP/OP","$1,202.25 ","$889.67 ","$0.00 ","$1,202.25 ","$541.01 ","$0.00 ","$250.58 ","$0.00 ","$0.00 ","$210.50 ","$1,202.25 ","$0.00 ","$601.13 ","$952.18 ","$961.80 ","$0.00 ","$188.15 ","$0.00 ","$191.40 ","$0.00 "
"733026","SUP","HCPCS C1768","","733026  -  GRAFT CARDIO STR 26MM 30CM WOVEN VASCUTEK GELWEAVE THORAX","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"733028","SUP","HCPCS C1768","","733028  -  GRAFT CARDIO STR 28MM 30CM SUTURE RETENTION UNIQUE","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"733030","SUP","HCPCS C1768","","733030  -  GRAFT CARDIO STR 30MM 30CM SUTURE RETENTION UNIQUE","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"733032","SUP","HCPCS C1768","","733032  -  GRAFT CARDIO STR 32MM 30CM SUTURE RETENTION UNIQUE","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"740026","SUP","Custom 27203010","","740026  -  DEVICE PSTN STRL THE SEC AST 2 ADJ CLP BT FTBRD PLS KN DISP","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-4000  -  HEAD FEM +0MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jun","SUP","Custom 27803010","","06-4005  -  HEAD FEM +5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3/11/4010","SUP","HCPCS C1713","","03-11-4010  -  SCREW BONE 4MM 10MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4010","SUP","HCPCS C1713","","03-12-4010  -  SCREW BONE 4MM 10MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"10-Jun","SUP","Custom 27803010","","06-4010  -  HEAD FEMORAL +10 40MM C TAPER ANATOMIC OFFST LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3/11/4011","SUP","HCPCS C1713","","03-11-4011  -  SCREW BONE 4MM 11MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4011","SUP","HCPCS C1713","","03-12-4011  -  SCREW BONE 4MM 11MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4012","SUP","HCPCS C1713","","03-11-4012  -  SCREW BONE 4MM 12MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4012","SUP","HCPCS C1713","","03-12-4012  -  SCREW BONE 4MM 12MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4013","SUP","HCPCS C1713","","03-11-4013  -  SCREW BONE 4MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4013","SUP","HCPCS C1713","","03-12-4013  -  SCREW BONE 4MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4014","SUP","HCPCS C1713","","03-11-4014  -  SCREW BONE 4MM 14MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4014","SUP","HCPCS C1713","","03-12-4014  -  SCREW BONE 4MM 14MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4015","SUP","HCPCS C1713","","03-11-4015  -  SCREW BONE 4MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4015","SUP","HCPCS C1713","","03-12-4015  -  SCREW BONE 4MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4016","SUP","HCPCS C1713","","03-11-4016  -  SCREW BONE 4MM 16MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4016","SUP","HCPCS C1713","","03-12-4016  -  SCREW BONE 4MM 16MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4017","SUP","HCPCS C1713","","03-11-4017  -  SCREW BONE 4MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4017","SUP","HCPCS C1713","","03-12-4017  -  SCREW BONE 4MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4018","SUP","HCPCS C1713","","03-11-4018  -  SCREW BONE 4MM 18MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4018","SUP","HCPCS C1713","","03-12-4018  -  SCREW BONE 4MM 18MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"773997","SUP","Custom 27203010","","CIRCUIT BRTHG HEAT WIRE 38IN","BOTH IP/OP","$299.35 ","$221.52 ","$0.00 ","$299.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.35 ","$0.00 ","$149.68 ","$237.09 ","$239.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3/11/4019","SUP","HCPCS C1713","","03-11-4019  -  SCREW BONE 4MM 19MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4019","SUP","HCPCS C1713","","03-12-4019  -  SCREW BONE 4MM 19MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4020","SUP","HCPCS C1713","","03-11-4020  -  SCREW BONE 4MM 20MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4020","SUP","HCPCS C1713","","03-12-4020  -  SCREW BONE 4MM 20MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"775856","SUP","Custom 27203010","","CIRCUIT BRTHG 3100B F AND P 850 VIASYS","BOTH IP/OP","$329.58 ","$243.89 ","$0.00 ","$329.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.58 ","$0.00 ","$164.79 ","$261.03 ","$263.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-Jun","SUP","Custom 27803010","","06-4025  -  HEAD FEM +2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-75","SUP","Custom 27803010","","06-4075  -  HEAD FEM +7.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"800070","SUP","Custom 27203010","","800070  -  SLIDE INSTRUCTIONAL HMRHD THD SYS","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"800257","SUP","Custom 27203010","","TIP ANALY PIP ALQ","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-97","SUP","Custom 27803010","","06-4097  -  HEAD FEM -2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-99","SUP","Custom 27803010","","06-4099  -  HEAD FEM -5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"807603","SUP","Custom 27203010","","807603  -  FORCEPS BIPOL .5MM SMALL 8IN IRRIGATION DISPOSABLE","BOTH IP/OP","$1,088.00 ","$805.12 ","$0.00 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,088.00 ","$0.00 ","$544.00 ","$861.70 ","$870.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"808006","SUP","HCPCS Q4130","","0808006  -  MATRIX TISSUE 8X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$4,617.50 ","$0.00 ","$0.00 ","$636.74 ","$0.00 ","$0.00 ","$0.00 ","$4,617.50 ","$0.00 ","$2,308.75 ","$3,657.06 ","$3,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"810051","SUP","HCPCS C1771","","810051  -  SLING GYN GNCR TVT OBT INTROD SYS DEV FMALE STRS URN INCNT","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$613.13 ","$0.00 ","$283.98 ","$0.00 ","$0.00 ","$238.56 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$213.23 ","$0.00 ","$216.91 ","$0.00 "
"810061","SUP","HCPCS C1769","","810061  -  GUIDE CATHETER 7FR 100CM RIGID TAPE TVT FMALE VAGINA","BOTH IP/OP","$347.63 ","$257.25 ","$0.00 ","$347.63 ","$188.76 ","$0.00 ","$72.45 ","$0.00 ","$0.00 ","$60.87 ","$347.63 ","$0.00 ","$173.81 ","$275.32 ","$278.10 ","$0.00 ","$54.40 ","$0.00 ","$55.34 ","$0.00 "
"811558","SUP","Custom 27803010","","811558  -  X-10 CROSSLINK","BOTH IP/OP","$4,640.30 ","$3,433.82 ","$0.00 ","$4,640.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,640.30 ","$0.00 ","$2,320.15 ","$3,675.12 ","$3,712.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"815009","SUP","HCPCS Q4130","","815009  -  MATRIX TISSUE 15X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$7,235.00 ","$5,353.90 ","$0.00 ","$7,235.00 ","$0.00 ","$0.00 ","$1,507.95 ","$0.00 ","$0.00 ","$0.00 ","$7,235.00 ","$0.00 ","$3,617.50 ","$5,730.12 ","$5,788.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"816001","SUP","HCPCS Q4130","","0816001  -  MATRIX TISSUE 16X8CM RECONSTRUCTIVE PLIABLE STRATTICE PIG","BOTH IP/OP","$8,120.00 ","$6,008.80 ","$0.00 ","$8,120.00 ","$0.00 ","$0.00 ","$1,692.41 ","$0.00 ","$0.00 ","$0.00 ","$8,120.00 ","$0.00 ","$4,060.00 ","$6,431.04 ","$6,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"816458","SUP","HCPCS C1713","","816458  -  CROSSLINK X-10/58MM","BOTH IP/OP","$4,640.30 ","$3,433.82 ","$0.00 ","$4,640.30 ","$2,088.14 ","$0.00 ","$967.15 ","$0.00 ","$0.00 ","$812.48 ","$4,640.30 ","$0.00 ","$2,320.15 ","$3,675.12 ","$3,712.24 ","$0.00 ","$726.21 ","$0.00 ","$738.74 ","$0.00 "
"821707","SUP","Custom 27203010","","821707  -  KIT XTRN DRN CDMN CATH LMBR","BOTH IP/OP","$527.05 ","$390.02 ","$0.00 ","$527.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$527.05 ","$0.00 ","$263.53 ","$417.42 ","$421.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"821739","SUP","Custom 27803010","","821739  -  SET VENTRICULAR DRAINAGE TRAUMACATH L35 CM OD10 FR ODSEC3.3","BOTH IP/OP","$271.95 ","$201.24 ","$0.00 ","$271.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$271.95 ","$0.00 ","$135.98 ","$215.38 ","$217.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"821750","SUP","HCPCS C1729","","821750  -  CATHETER EXTERNAL DRAIN LARGE 1.9MM LATEX FREE BACTISEAL EVD","BOTH IP/OP","$1,241.73 ","$918.88 ","$0.00 ","$1,228.85 ","$667.27 ","$0.00 ","$258.81 ","$0.00 ","$0.00 ","$215.16 ","$1,228.85 ","$0.00 ","$614.43 ","$973.25 ","$983.08 ","$0.00 ","$192.32 ","$0.00 ","$195.63 ","$0.00 "
"858445","SUP","HCPCS C1713","","858445  -  SCREW BONE 4.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858450","SUP","HCPCS C1713","","858450  -  SCREW BONE 4.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"862309","SUP","Custom 27203010","","862309  -  ELECTRODE MONOPOLAR 24.5FR 26FR HOOK BIPOL","BOTH IP/OP","$721.13 ","$533.64 ","$0.00 ","$724.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$724.75 ","$0.00 ","$362.38 ","$574.00 ","$579.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"873011","SUP","Custom 27203010","","873011  -  SPRDR SURG DURA MATER","BOTH IP/OP","$398.08 ","$294.58 ","$0.00 ","$398.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398.08 ","$0.00 ","$199.04 ","$315.28 ","$318.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"874002","SUP","Custom 27803010","","874002  -  PIN DISTRACTION 10MM RELIANCE STERILE C","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"898716","SUP","Custom 27203010","","898716  -  TRAY CATH 16FR 350ML FOLEY URMTR LATEX","BOTH IP/OP","$40.06 ","$29.64 ","$0.00 ","$40.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.06 ","$0.00 ","$20.03 ","$31.73 ","$32.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900284","SUP","Custom 27203010","","900284  -  SUTURE NABSB 2 KHC-5 BLU MXBRD BRAID","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900334","SUP","Custom 27203010","","900334  -  SUTURE NABSB 2 C-2 BLU MXBRD BRAID","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900339","SUP","Custom 27203010","","900339  -  DEVICE FX MAXFIRE REPR ZIPLOOP TCH MNSCS","BOTH IP/OP","$1,085.00 ","$802.90 ","$0.00 ","$1,085.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,085.00 ","$0.00 ","$542.50 ","$859.32 ","$868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"901124","SUP","HCPCS C1894","","901124  -  INTRO SHTH PRTNL","BOTH IP/OP","$777.50 ","$575.35 ","$0.00 ","$777.50 ","$422.18 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$136.13 ","$777.50 ","$0.00 ","$388.75 ","$615.78 ","$622.00 ","$0.00 ","$121.68 ","$0.00 ","$123.78 ","$0.00 "
"902916","SUP","Custom 27203010","","902916  -  TRAY CATHETERIZATION 16FR URINE METER FOLEY STATLOCK LATEX","BOTH IP/OP","$38.29 ","$28.33 ","$0.00 ","$38.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.29 ","$0.00 ","$19.15 ","$30.33 ","$30.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"904754","SUP","Custom 27803010","","904754  -  DEVICE FX 7 50IN TOGGLELOC ZIPLOOP LNG LOOP XTD PE FEM","BOTH IP/OP","$1,452.50 ","$1,074.85 ","$0.00 ","$1,452.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,452.50 ","$0.00 ","$726.25 ","$1,150.38 ","$1,162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905256","SUP","HCPCS C1713","","905256  -  SCREW INTFR 9MM 25MM COMPOSITCP RND HD","BOTH IP/OP","$1,122.50 ","$830.65 ","$0.00 ","$1,122.50 ","$505.13 ","$0.00 ","$233.96 ","$0.00 ","$0.00 ","$196.54 ","$1,122.50 ","$0.00 ","$561.25 ","$889.02 ","$898.00 ","$0.00 ","$175.67 ","$0.00 ","$178.70 ","$0.00 "
"905257","SUP","HCPCS C1713","","905257  -  SCREW BABSR 9MM 30MM COMPOSITCP RND HD","BOTH IP/OP","$1,122.50 ","$830.65 ","$0.00 ","$1,122.50 ","$505.13 ","$0.00 ","$233.96 ","$0.00 ","$0.00 ","$196.54 ","$1,122.50 ","$0.00 ","$561.25 ","$889.02 ","$898.00 ","$0.00 ","$175.67 ","$0.00 ","$178.70 ","$0.00 "
"905261","SUP","HCPCS C1713","","905261  -  SCREW INTFR FT 10MM 30MM COMPOSITCP","BOTH IP/OP","$1,122.50 ","$830.65 ","$0.00 ","$1,122.50 ","$505.13 ","$0.00 ","$233.96 ","$0.00 ","$0.00 ","$196.54 ","$1,122.50 ","$0.00 ","$561.25 ","$889.02 ","$898.00 ","$0.00 ","$175.67 ","$0.00 ","$178.70 ","$0.00 "
"905263","SUP","HCPCS C1713","","905263  -  SCREW INTFR FT 11MM 30MM COMPOSITCP","BOTH IP/OP","$1,122.50 ","$830.65 ","$0.00 ","$1,122.50 ","$505.13 ","$0.00 ","$233.96 ","$0.00 ","$0.00 ","$196.54 ","$1,122.50 ","$0.00 ","$561.25 ","$889.02 ","$898.00 ","$0.00 ","$175.67 ","$0.00 ","$178.70 ","$0.00 "
"905732","SUP","Custom 27203010","","905732  -  CUTTER SRG 203MM MAXFIRE DISP","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"906520","SUP","Custom 27203010","","BAG PPR THK1/6IN C50LB LG KRAFT BRL","BOTH IP/OP","$0.35 ","$0.26 ","$0.00 ","$0.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.35 ","$0.00 ","$0.18 ","$0.28 ","$0.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"908469","SUP","HCPCS C1713","","908469  -  WASHER ORTH SPK 16MM WSHRLC XTD TIP TI TIB","BOTH IP/OP","$1,450.00 ","$1,073.00 ","$0.00 ","$1,450.00 ","$652.50 ","$0.00 ","$302.22 ","$0.00 ","$0.00 ","$253.88 ","$1,450.00 ","$0.00 ","$725.00 ","$1,148.40 ","$1,160.00 ","$0.00 ","$226.93 ","$0.00 ","$230.84 ","$0.00 "
"908846","SUP","HCPCS C1713","","908846  -  SCREW BN 6MM 46MM STRL WSHRLC TI ACL/PCL CANC ASCP","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$226.13 ","$0.00 ","$104.73 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"908850","SUP","HCPCS C1713","","908850  -  SCREW BN 6MM 50MM STRL WSHRLC TI ACL/PCL CANC ASCP","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$226.13 ","$0.00 ","$104.73 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"908860","SUP","HCPCS C1713","","908860  -  SCREW BN 6MM 60MM STRL WSHRLC TI ACL/PCL CANC ASCP","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$226.13 ","$0.00 ","$104.73 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"909848","SUP","Custom 27203010","","909848  -  KIT ASCP FX TOGGLELOC ZIPLOOP","BOTH IP/OP","$3,657.50 ","$2,706.55 ","$0.00 ","$3,657.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,657.50 ","$0.00 ","$1,828.75 ","$2,896.74 ","$2,926.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"912076","SUP","HCPCS C1713","","912076  -  ANCHOR SUT JUGGERKNOT SFT TIS","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"Jun-00","SUP","Custom 27803010","","06-4400  -  HEAD FEM +0MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5-Jun","SUP","Custom 27803010","","06-4405  -  HEAD FEM +5MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Jun","SUP","Custom 27803010","","06-4410  -  HEAD FEMORAL +10MM 44MM C TAPER LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"921031","SUP","HCPCS C9250","","921031  -  SET SPRY 2 SPRY TIP CONCTR HOSE STRL FLTR TSMT DISP","BOTH IP/OP","$111.69 ","$82.65 ","$0.00 ","$173.09 ","$59.25 ","$111.69 ","$23.28 ","$0.00 ","$0.00 ","$23.05 ","$131.66 ","$173.09 ","$65.83 ","$104.27 ","$105.33 ","$131.66 ","$20.60 ","$0.00 ","$20.96 ","$164.85 "
"25-Jun","SUP","Custom 27803010","","06-4425  -  HEAD FEMORAL +2.5MM 44MM C TAPER LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"928950","SUP","HCPCS C1894","","0928950  -  MICROMICROINTRUDUCER 7CM 5.0FR FLECURA GUIDEWIRE","BOTH IP/OP","$78.50 ","$58.09 ","$0.00 ","$78.50 ","$42.63 ","$0.00 ","$16.36 ","$0.00 ","$0.00 ","$13.74 ","$78.50 ","$0.00 ","$39.25 ","$62.17 ","$62.80 ","$0.00 ","$12.29 ","$0.00 ","$12.50 ","$0.00 "
"930740","SUP","Custom 27203010","","KIT IMMUN TST ELISA ANTI-HCV 480 TST","BOTH IP/OP","$7,582.50 ","$5,611.05 ","$0.00 ","$7,582.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,582.50 ","$0.00 ","$3,791.25 ","$6,005.34 ","$6,066.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"933040","SUP","Custom 27203010","","REAGENT ANTI-HCV ELISA STOP SOL 500ML ANALY","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-75","SUP","Custom 27803010","","06-4475  -  HEAD FEMORAL +7.5MM 44MM C TAPER LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-97","SUP","Custom 27803010","","06-4497  -  HEAD FEMORAL -2.5MM 44MM C TAPER LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jun-99","SUP","Custom 27803010","","06-4499  -  HEAD FEMORAL -5MM 44MM C TAPER ANATOMIC LFIT V40 COCR","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3/11/4513","SUP","HCPCS C1713","","03-11-4513  -  SCREW BONE 4.5MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4513","SUP","HCPCS C1713","","03-12-4513  -  SCREW BONE 4.5MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4515","SUP","HCPCS C1713","","03-11-4515  -  SCREW BONE 4.5MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4515","SUP","HCPCS C1713","","03-12-4515  -  SCREW BONE 4.5MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/11/4517","SUP","HCPCS C1713","","03-11-4517  -  SCREW BONE 4.5MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3/12/4517","SUP","HCPCS C1713","","03-12-4517  -  SCREW BONE 4.5MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"982001","SUP","HCPCS Q4116","","982001  -  GRAFT SKN XTHICK 1X1CM ALDRM","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$29.18 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"982003","SUP","HCPCS Q4116","","982003  -  GRAFT SKN 2X1CM ALDRM RGNRT ACLR DRML MTRX","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$547.50 ","$246.38 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$95.86 ","$547.50 ","$0.00 ","$273.75 ","$433.62 ","$438.00 ","$0.00 ","$85.68 ","$0.00 ","$87.16 ","$0.00 "
"982007","SUP","HCPCS Q4116","","982007  -  MATRIX TISSUE XTHICK 4X1CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$148.13 ","$109.62 ","$0.00 ","$230.00 ","$103.50 ","$0.00 ","$30.87 ","$0.00 ","$0.00 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"982011","SUP","HCPCS Q4116","","982011  -  MATRIX TISSUE XTHICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$1,030.00 ","$762.20 ","$0.00 ","$1,600.00 ","$720.00 ","$0.00 ","$214.68 ","$0.00 ","$0.00 ","$280.15 ","$1,600.00 ","$0.00 ","$800.00 ","$1,267.20 ","$1,280.00 ","$0.00 ","$250.40 ","$0.00 ","$254.72 ","$0.00 "
"982021","SUP","HCPCS Q4116","","982021  -  MATRIX TISSUE XTHICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$83.45 ","$61.75 ","$0.00 ","$129.40 ","$58.23 ","$0.00 ","$17.39 ","$0.00 ","$0.00 ","$22.66 ","$129.40 ","$0.00 ","$64.70 ","$102.48 ","$103.52 ","$0.00 ","$20.25 ","$0.00 ","$20.60 ","$0.00 "
"982024","SUP","HCPCS Q4116","","982024  -  GRAFT SKN XTHICK 12X2CM ALDRM","BOTH IP/OP","$1,507.50 ","$1,115.55 ","$0.00 ","$2,337.50 ","$1,051.88 ","$0.00 ","$314.20 ","$0.00 ","$0.00 ","$409.28 ","$2,337.50 ","$0.00 ","$1,168.75 ","$1,851.30 ","$1,870.00 ","$0.00 ","$365.82 ","$0.00 ","$372.13 ","$0.00 "
"982028","SUP","HCPCS Q4116","","982028  -  MATRIX TISSUE XTHICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$64.73 ","$47.90 ","$0.00 ","$100.54 ","$45.24 ","$0.00 ","$13.49 ","$0.00 ","$0.00 ","$17.60 ","$100.54 ","$0.00 ","$50.27 ","$79.63 ","$80.43 ","$0.00 ","$15.73 ","$0.00 ","$16.01 ","$0.00 "
"982048","SUP","HCPCS Q4116","","982048  -  MATRIX TISSUE XTHICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"982060","SUP","HCPCS Q4116","","982060  -  MATRIX TISSUE XTHICK 10CMX5CMX2.3-3.3MM ALLOGRAFT","BOTH IP/OP","$64.55 ","$47.77 ","$0.00 ","$100.20 ","$45.09 ","$0.00 ","$13.45 ","$0.00 ","$0.00 ","$17.54 ","$100.20 ","$0.00 ","$50.10 ","$79.36 ","$80.16 ","$0.00 ","$15.68 ","$0.00 ","$15.95 ","$0.00 "
"982070","SUP","HCPCS Q4116","","982070  -  MATRIX TISSUE XTHICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$70.80 ","$52.39 ","$0.00 ","$70.80 ","$31.86 ","$0.00 ","$14.76 ","$0.00 ","$0.00 ","$12.40 ","$70.80 ","$0.00 ","$35.40 ","$56.07 ","$56.64 ","$0.00 ","$11.08 ","$0.00 ","$11.27 ","$0.00 "
"982080","SUP","HCPCS Q4116","","982080  -  MATRIX TISSUE XTHICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.09 ","$57.79 ","$0.00 ","$78.09 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.09 ","$0.00 ","$39.04 ","$61.85 ","$62.47 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"982096","SUP","HCPCS Q4116","","982096  -  MATRIX TISSUE XTHICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$78.10 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.10 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"982108","SUP","HCPCS Q4116","","982108  -  MATRIX TISSUE XTHICK 18X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$92.57 ","$68.50 ","$0.00 ","$92.57 ","$41.66 ","$0.00 ","$19.29 ","$0.00 ","$0.00 ","$16.21 ","$92.57 ","$0.00 ","$46.28 ","$73.32 ","$74.06 ","$0.00 ","$14.49 ","$0.00 ","$14.74 ","$0.00 "
"982128","SUP","HCPCS Q4116","","982128  -  MATRIX TISSUE XTHICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.11 ","$57.80 ","$0.00 ","$78.11 ","$35.15 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.68 ","$78.11 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"982144","SUP","HCPCS Q4116","","982144  -  MATRIX TISSUE XTHICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$68.23 ","$50.49 ","$0.00 ","$105.87 ","$47.64 ","$0.00 ","$14.22 ","$0.00 ","$0.00 ","$18.54 ","$105.87 ","$0.00 ","$52.93 ","$83.85 ","$84.69 ","$0.00 ","$16.57 ","$0.00 ","$16.85 ","$0.00 "
"982196","SUP","HCPCS Q4116","","982196  -  MATRIX TISSUE XTHICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$78.10 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.10 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"982320","SUP","HCPCS Q4116","","982320  -  MATRIX TISSUE XTHICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.12 ","$57.81 ","$0.00 ","$78.12 ","$35.15 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.68 ","$78.12 ","$0.00 ","$39.06 ","$61.87 ","$62.49 ","$0.00 ","$12.23 ","$0.00 ","$12.44 ","$0.00 "
"983102","SUP","Custom 27203010","","983102  -  COLLAR CERV CHLD SHRT CHIN REST TRCH OPN ADJ STRAP CNTCT","BOTH IP/OP","$67.45 ","$49.91 ","$0.00 ","$67.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.45 ","$0.00 ","$33.73 ","$53.42 ","$53.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983104","SUP","Custom 27203010","","983104  -  COLLAR CERV CHLD REG ASPN CHIN REST TRCH OPN ADJ STRAP CNTCT","BOTH IP/OP","$70.54 ","$52.20 ","$0.00 ","$75.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.97 ","$0.00 ","$37.98 ","$60.17 ","$60.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983106","SUP","Custom 27203010","","983106  -  COLLAR CERV CHLD TOT CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR","BOTH IP/OP","$81.85 ","$60.57 ","$0.00 ","$72.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.63 ","$0.00 ","$36.31 ","$57.52 ","$58.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983112","SUP","Custom 27203010","","983112  -  COLLAR CERV ADLT TLL CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR","BOTH IP/OP","$65.80 ","$48.69 ","$0.00 ","$65.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.80 ","$0.00 ","$32.90 ","$52.11 ","$52.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983114","SUP","Custom 27203010","","983114  -  COLLAR CERV ADLT XTALL CHIN REST TRCH OPN ADJ STRAP CNTCT","BOTH IP/OP","$69.50 ","$51.43 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$0.00 ","$65.80 ","$0.00 ","$32.90 ","$52.11 ","$52.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983119","SUP","Custom 27203010","","983119  -  COLLAR CERV ADLT LG BACK PNL PLST","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$0.00 ","$36.85 ","$0.00 ","$18.42 ","$29.19 ","$29.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983190","SUP","Custom 27203010","","983190  -  COLLAR IMMOB CERVICAL INFANT FOAM PAD TRACH OPEN FLEXIBLE TA","BOTH IP/OP","$65.80 ","$48.69 ","$0.00 ","$65.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.80 ","$0.00 ","$32.90 ","$52.11 ","$52.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"983195","SUP","Custom 27203010","","983195  -  COLLAR CERV INF REG CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR","BOTH IP/OP","$81.85 ","$60.57 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$0.00 ","$72.28 ","$0.00 ","$36.14 ","$57.25 ","$57.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"992003","SUP","HCPCS Q4116","","992003  -  MATRIX TISSUE THIN 2X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"992128","SUP","HCPCS Q4116","","992128  -  MATRIX TISSUE MEDIUM 16X8CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.11 ","$57.80 ","$0.00 ","$78.11 ","$35.15 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.68 ","$78.11 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"992196","SUP","HCPCS Q4116","","992196  -  MATRIX TISSUE THIN 16X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$78.10 ","$35.14 ","$0.00 ","$16.28 ","$0.00 ","$0.00 ","$13.67 ","$78.10 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$12.22 ","$0.00 ","$12.43 ","$0.00 "
"1001740","SUP","HCPCS C1769","","1001740  -  GUIDEWIRE VASCULAR STR .014IN 190CM 3CM RADIOPQ HI-TORQUE","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$96.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$31.08 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$27.78 ","$0.00 ","$28.26 ","$0.00 "
"1001741","SUP","HCPCS C1769","","1001741  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE ALL STAR","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$96.38 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$31.08 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$27.78 ","$0.00 ","$28.26 ","$0.00 "
"1002005","SUP","Custom 27203010","","1002005  -  NON STERILE DISPOSABLE DRILL BIT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004722","SUP","Custom 27804086","","1004722  -  GRAFT BN 11X11X5MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004723","SUP","Custom 27804086","","1004723  -  GRAFT BN 11X11X6MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004724","SUP","Custom 27804086","","1004724  -  GRAFT BN 11X11X7MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004725","SUP","Custom 27804086","","1004725  -  GRAFT BN 11X11X8MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004726","SUP","Custom 27804086","","1004726  -  GRAFT BN 11X11X9MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004727","SUP","Custom 27804086","","1004727  -  GRAFT BN 11X11X10MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004728","SUP","Custom 27804086","","1004728  -  GRAFT BN 11X11X11IN ALGRF SPNE","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004732","SUP","Custom 27804086","","1004732  -  GRAFT BN 14X11X5MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004733","SUP","Custom 27804086","","1004733  -  GRAFT BN 14X11X6MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004734","SUP","Custom 27804086","","1004734  -  GRAFT BN 7X11X14MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004735","SUP","Custom 27804086","","1004735  -  GRAFT BN 14X11X8MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004736","SUP","Custom 27804086","","1004736  -  GRAFT BN 14X11X9MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004737","SUP","Custom 27804086","","1004737  -  GRAFT BN 14X11X10MM TRD CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004772","SUP","Custom 27804086","","1004772  -  GRAFT BN 20X9X8MM TRD PLIF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004773","SUP","Custom 27804086","","1004773  -  GRAFT BN 20X9X10MM TRD PLIF ALGRF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004774","SUP","Custom 27804086","","1004774  -  GRAFT BN 20X9X12MM TRD PLIF ALGRF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004775","SUP","Custom 27804086","","1004775  -  GRAFT BN 20X9X14MM TRD PLIF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004782","SUP","Custom 27804086","","1004782  -  GRAFT BN 20X11X8MM TRD TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004783","SUP","Custom 27804086","","1004783  -  GRAFT BN 20X11X10MM TRD TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004784","SUP","Custom 27804086","","1004784  -  GRAFT BN 20X11X12MM TRD TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004785","SUP","Custom 27804086","","1004785  -  GRAFT BN 20X11X14MM TRD TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004792","SUP","Custom 27804086","","1004792  -  GRAFT BN 25X9X8MM TRD PLIF ALGRF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004793","SUP","Custom 27804086","","1004793  -  GRAFT BN 25X9X10MM TRD PLIF ALGRF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004794","SUP","Custom 27804086","","1004794  -  GRAFT BN 25X9X12MM TRD PLIF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004795","SUP","Custom 27804086","","1004795  -  GRAFT BN 25X9X14MM TRD PLIF","BOTH IP/OP","$5,257.50 ","$3,890.55 ","$0.00 ","$5,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,257.50 ","$0.00 ","$2,628.75 ","$4,163.94 ","$4,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004802","SUP","Custom 27804086","","1004802  -  GRAFT BN 25X11X8MM TRD TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004803","SUP","Custom 27804086","","1004803  -  GRAFT BN 25X11X10MM TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004804","SUP","Custom 27804086","","1004804  -  GRAFT BN 25X11X12MM TRD TLIF ALGRF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1004805","SUP","Custom 27804086","","1004805  -  GRAFT BN 25X11X14MM TLIF","BOTH IP/OP","$7,017.50 ","$5,192.95 ","$0.00 ","$7,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,017.50 ","$0.00 ","$3,508.75 ","$5,557.86 ","$5,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1005203","SUP","HCPCS C1769","","1005203  -  GUIDEWIRE VASCULAR STR .014IN 300CM 5CM STEERABLE CORE TO","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$112.67 ","$0.00 ","$43.25 ","$0.00 ","$0.00 ","$36.33 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$32.47 ","$0.00 ","$33.03 ","$0.00 "
"1005987","SUP","Custom 27203010","","MASK F/F DISP W/HEADSTRP PED","BOTH IP/OP","$58.40 ","$43.22 ","$0.00 ","$58.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.40 ","$0.00 ","$29.20 ","$46.25 ","$46.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1007633","SUP","HCPCS C1713","","1007633  -  MESH SRG 10X6MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007634","SUP","HCPCS C1713","","1007634  -  MESH SRG 10X7MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007635","SUP","HCPCS C1713","","1007635  -  MESH SRG 10X8MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007636","SUP","HCPCS C1713","","1007636  -  MESH SRG 10X9MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007637","SUP","HCPCS C1713","","1007637  -  MESH SRG 10X10MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007639","SUP","HCPCS C1713","","1007639  -  MESH SRG 12X10MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007640","SUP","HCPCS C1713","","1007640  -  MESH SRG 10X14MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007643","SUP","HCPCS C1713","","1007643  -  MESH SRG 50X10MM SPNE","BOTH IP/OP","$6,322.50 ","$4,678.65 ","$0.00 ","$6,322.50 ","$2,845.13 ","$0.00 ","$1,317.77 ","$0.00 ","$0.00 ","$1,107.02 ","$6,322.50 ","$0.00 ","$3,161.25 ","$5,007.42 ","$5,058.00 ","$0.00 ","$989.47 ","$0.00 ","$1,006.54 ","$0.00 "
"1007653","SUP","HCPCS C1713","","1007653  -  MESH SRG 12X6MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007654","SUP","HCPCS C1713","","1007654  -  MESH SRG 12X7MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007655","SUP","HCPCS C1713","","1007655  -  MESH SRG 12X8MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007656","SUP","HCPCS C1713","","1007656  -  MESH SRG 12X9MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007657","SUP","HCPCS C1713","","1007657  -  MESH SRG 10X12MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007659","SUP","HCPCS C1713","","1007659  -  MESH SRG 12X12MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007660","SUP","HCPCS C1713","","1007660  -  MESH SRG 12X14MM SPNE","BOTH IP/OP","$2,617.50 ","$1,936.95 ","$0.00 ","$2,617.50 ","$1,177.88 ","$0.00 ","$545.55 ","$0.00 ","$0.00 ","$458.30 ","$2,617.50 ","$0.00 ","$1,308.75 ","$2,073.06 ","$2,094.00 ","$0.00 ","$409.64 ","$0.00 ","$416.71 ","$0.00 "
"1007663","SUP","HCPCS C1713","","1007663  -  MESH SRG 50X12MM SPNE","BOTH IP/OP","$7,227.50 ","$5,348.35 ","$0.00 ","$7,227.50 ","$3,252.38 ","$0.00 ","$1,506.39 ","$0.00 ","$0.00 ","$1,265.48 ","$7,227.50 ","$0.00 ","$3,613.75 ","$5,724.18 ","$5,782.00 ","$0.00 ","$1,131.10 ","$0.00 ","$1,150.62 ","$0.00 "
"1007673","SUP","HCPCS C1713","","1007673  -  MESH SRG 14X6MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007674","SUP","HCPCS C1713","","1007674  -  MESH SRG 14X7MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007675","SUP","HCPCS C1713","","1007675  -  MESH SRG 14X8MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007676","SUP","HCPCS C1713","","1007676  -  MESH SRG 14X9MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007677","SUP","HCPCS C1713","","1007677  -  MESH SRG 14X10MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007679","SUP","HCPCS C1713","","1007679  -  MESH SRG 14X12MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007680","SUP","HCPCS C1713","","1007680  -  MESH SRG 14X14MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007683","SUP","HCPCS C1713","","1007683  -  MESH SRG 50X14MM TI SPNE","BOTH IP/OP","$8,132.50 ","$6,018.05 ","$0.00 ","$8,132.50 ","$3,659.63 ","$0.00 ","$1,695.02 ","$0.00 ","$0.00 ","$1,423.94 ","$8,132.50 ","$0.00 ","$4,066.25 ","$6,440.94 ","$6,506.00 ","$0.00 ","$1,272.74 ","$0.00 ","$1,294.69 ","$0.00 "
"1007693","SUP","HCPCS C1713","","1007693  -  MESH SRG 16X6MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007694","SUP","HCPCS C1713","","1007694  -  MESH SRG 16X7MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007695","SUP","HCPCS C1713","","1007695  -  MESH SRG 16X8MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007696","SUP","HCPCS C1713","","1007696  -  MESH SRG 16X9MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007697","SUP","HCPCS C1713","","1007697  -  MESH SRG 16X10MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007699","SUP","HCPCS C1713","","1007699  -  MESH SRG 16X12MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007700","SUP","HCPCS C1713","","1007700  -  MESH SRG 16X14MM SPNE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"1007703","SUP","HCPCS C1713","","1007703  -  CAGE SPNL 16MM 50MM MESH","BOTH IP/OP","$8,132.50 ","$6,018.05 ","$0.00 ","$8,132.50 ","$3,659.63 ","$0.00 ","$1,695.02 ","$0.00 ","$0.00 ","$1,423.94 ","$8,132.50 ","$0.00 ","$4,066.25 ","$6,440.94 ","$6,506.00 ","$0.00 ","$1,272.74 ","$0.00 ","$1,294.69 ","$0.00 "
"1007704","SUP","HCPCS C1713","","1007704  -  MESH SRG 90X16MM SPNE","BOTH IP/OP","$10,122.50 ","$7,490.65 ","$0.00 ","$10,122.50 ","$4,555.13 ","$0.00 ","$2,109.78 ","$0.00 ","$0.00 ","$1,772.37 ","$10,122.50 ","$0.00 ","$5,061.25 ","$8,017.02 ","$8,098.00 ","$0.00 ","$1,584.17 ","$0.00 ","$1,611.50 ","$0.00 "
"1010008","SUP","HCPCS Q4130","","1010008  -  SUBSTITUTE TISS 10X10CM STRATTICE MESH RECON TISS MTRX PRCN","BOTH IP/OP","$6,825.00 ","$5,050.50 ","$0.00 ","$6,825.00 ","$0.00 ","$0.00 ","$1,422.50 ","$0.00 ","$0.00 ","$0.00 ","$6,825.00 ","$0.00 ","$3,412.50 ","$5,405.40 ","$5,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1010020","SUP","Custom 27203010","","1010020  -  AGENT HMST AVTN CLGN MCFIB FLUR 1GM STRL LATEX FREE DISP","BOTH IP/OP","$256.15 ","$189.55 ","$0.00 ","$256.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$256.15 ","$0.00 ","$128.08 ","$202.87 ","$204.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1010150","SUP","Custom 27203010","","1010150  -  AGENT HEMOSTATIC 10MM 42CM 50X15X1MM PRELOAD APPLICATOR","BOTH IP/OP","$245.25 ","$181.49 ","$0.00 ","$245.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.25 ","$0.00 ","$122.63 ","$194.24 ","$196.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1011132","SUP","HCPCS C1713","","1011132  -  MESH SRG 30X20MM SPNE","BOTH IP/OP","$6,012.50 ","$4,449.25 ","$0.00 ","$6,012.50 ","$2,705.63 ","$0.00 ","$1,253.16 ","$0.00 ","$0.00 ","$1,052.74 ","$6,012.50 ","$0.00 ","$3,006.25 ","$4,761.90 ","$4,810.00 ","$0.00 ","$940.96 ","$0.00 ","$957.19 ","$0.00 "
"1011134","SUP","HCPCS C1713","","1011134  -  MESH SRG 60X20MM SPNE","BOTH IP/OP","$8,495.00 ","$6,286.30 ","$0.00 ","$8,495.00 ","$3,822.75 ","$0.00 ","$1,770.57 ","$0.00 ","$0.00 ","$1,487.41 ","$8,495.00 ","$0.00 ","$4,247.50 ","$6,728.04 ","$6,796.00 ","$0.00 ","$1,329.47 ","$0.00 ","$1,352.40 ","$0.00 "
"1011135","SUP","HCPCS C1713","","1011135  -  MESH SRG 90X20MM SPNE","BOTH IP/OP","$10,662.50 ","$7,890.25 ","$0.00 ","$10,662.50 ","$4,798.13 ","$0.00 ","$2,222.33 ","$0.00 ","$0.00 ","$1,866.92 ","$10,662.50 ","$0.00 ","$5,331.25 ","$8,444.70 ","$8,530.00 ","$0.00 ","$1,668.68 ","$0.00 ","$1,697.47 ","$0.00 "
"1011152","SUP","HCPCS C1713","","1011152  -  MESH SRG 30X24MM SPNE","BOTH IP/OP","$6,012.50 ","$4,449.25 ","$0.00 ","$6,012.50 ","$2,705.63 ","$0.00 ","$1,253.16 ","$0.00 ","$0.00 ","$1,052.74 ","$6,012.50 ","$0.00 ","$3,006.25 ","$4,761.90 ","$4,810.00 ","$0.00 ","$940.96 ","$0.00 ","$957.19 ","$0.00 "
"1011154","SUP","HCPCS C1713","","1011154  -  MESH SRG 60X24MM SPNE","BOTH IP/OP","$9,035.00 ","$6,685.90 ","$0.00 ","$9,035.00 ","$4,065.75 ","$0.00 ","$1,883.12 ","$0.00 ","$0.00 ","$1,581.96 ","$9,035.00 ","$0.00 ","$4,517.50 ","$7,155.72 ","$7,228.00 ","$0.00 ","$1,413.98 ","$0.00 ","$1,438.37 ","$0.00 "
"1011155","SUP","HCPCS C1713","","1011155  -  MESH SRG 90X24MM SPNE","BOTH IP/OP","$11,207.50 ","$8,293.55 ","$0.00 ","$11,207.50 ","$5,043.38 ","$0.00 ","$2,335.92 ","$0.00 ","$0.00 ","$1,962.34 ","$11,207.50 ","$0.00 ","$5,603.75 ","$8,876.34 ","$8,966.00 ","$0.00 ","$1,753.97 ","$0.00 ","$1,784.23 ","$0.00 "
"1012572","SUP","Custom 27203010","","MASK CPAP LG ADLT HDGR FULL ADJ STRAP FRHD CLIP PRFMTRK LF","BOTH IP/OP","$65.20 ","$48.25 ","$0.00 ","$65.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.20 ","$0.00 ","$32.60 ","$51.64 ","$52.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1012624","SUP","Custom 27203010","","MASK CPAP MED ADLT HDGR FULL ADJ STRAP FRHD CLIP PRFMTRK LF","BOTH IP/OP","$65.20 ","$48.25 ","$0.00 ","$65.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.20 ","$0.00 ","$32.60 ","$51.64 ","$52.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1016002","SUP","HCPCS Q4130","","1016002  -  MATRIX TISSUE 16X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$58.88 ","$43.57 ","$0.00 ","$88.98 ","$0.00 ","$0.00 ","$12.27 ","$0.00 ","$0.00 ","$0.00 ","$88.98 ","$0.00 ","$44.49 ","$70.47 ","$71.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1016692","SUP","Custom 27203010","","MASK CPAP MED LG 2 FLP CSHN HDSTRP SIL CNTOUR DLX LF DISP","BOTH IP/OP","$37.53 ","$27.77 ","$0.00 ","$37.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.53 ","$0.00 ","$18.76 ","$29.72 ","$30.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1025002","SUP","HCPCS Q4130","","1025002  -  MATRIX TISSUE 25X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$14,720.00 ","$10,892.80 ","$0.00 ","$22,245.00 ","$0.00 ","$0.00 ","$3,068.02 ","$0.00 ","$0.00 ","$0.00 ","$22,245.00 ","$0.00 ","$11,122.50 ","$17,618.04 ","$17,796.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1040014","SUP","Custom 27803010","","1040014  -  TUBE VNT 1.14MM 3.6MM 1.3MM GRN POPE GRMT BVL FLRPLAS EAR","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$44.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.25 ","$0.00 ","$22.13 ","$35.05 ","$35.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1046742","SUP","Custom 27203010","","PACIFIER NBN WTHMB PRMTR PUR","BOTH IP/OP","$7.40 ","$5.48 ","$0.00 ","$7.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.40 ","$0.00 ","$3.70 ","$5.86 ","$5.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1050044","SUP","Custom 27203010","","1050044  -  HYSTOCRYL BLUE FOIL POUCH 10X0.5ML","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$48.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.75 ","$0.00 ","$24.38 ","$38.61 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1112095","SUP","HCPCS C1713","","1112095  -  PROSTHESIS OSS 90D RND 4MM 1.1MM 5MM FULL CNN SHFT OFF CNTR","BOTH IP/OP","$442.50 ","$327.45 ","$0.00 ","$442.50 ","$199.13 ","$0.00 ","$92.23 ","$0.00 ","$0.00 ","$77.48 ","$442.50 ","$0.00 ","$221.25 ","$350.46 ","$354.00 ","$0.00 ","$69.25 ","$0.00 ","$70.45 ","$0.00 "
"1135510","SUP","HCPCS C1713","","1135510  -  RELINE MAS ROD, 100MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1151015","SUP","HCPCS C1781","","1151015  -  GRAFT PRCN RECT 5.9X3.9IN STRL XENMATRIX AB NONCROSSLINK","BOTH IP/OP","$11,445.00 ","$8,469.30 ","$0.00 ","$11,445.00 ","$5,150.25 ","$0.00 ","$2,385.42 ","$0.00 ","$0.00 ","$2,003.93 ","$11,445.00 ","$0.00 ","$5,722.50 ","$9,064.44 ","$9,156.00 ","$0.00 ","$1,791.14 ","$0.00 ","$1,822.04 ","$0.00 "
"1151928","SUP","HCPCS C1781","","1151928  -  GRAFT PRCN RECT 11X7.5IN STRL XENMATRIX AB RGNRT","BOTH IP/OP","$22,877.00 ","$16,928.98 ","$0.00 ","$22,877.00 ","$10,294.65 ","$0.00 ","$4,768.14 ","$0.00 ","$0.00 ","$4,005.58 ","$22,877.00 ","$0.00 ","$11,438.50 ","$18,118.58 ","$18,301.60 ","$0.00 ","$3,580.25 ","$0.00 ","$3,642.02 ","$0.00 "
"1161015","SUP","HCPCS C1781","","1161015  -  GRAFT PIG THK1.8-2.5MM 5.9X3.9IN REGENERATIVE XENMATRIX","BOTH IP/OP","$10,374.00 ","$7,676.76 ","$0.00 ","$10,374.00 ","$4,668.30 ","$0.00 ","$2,162.20 ","$0.00 ","$0.00 ","$1,816.40 ","$10,374.00 ","$0.00 ","$5,187.00 ","$8,216.21 ","$8,299.20 ","$0.00 ","$1,623.53 ","$0.00 ","$1,651.54 ","$0.00 "
"1161520","SUP","HCPCS C1781","","1161520  -  GRAFT PIG THK1.8-2.5MM 7.9X5.9IN REGENERATIVE XENMATRIX","BOTH IP/OP","$20,748.00 ","$15,353.52 ","$0.00 ","$20,748.00 ","$9,336.60 ","$0.00 ","$4,324.40 ","$0.00 ","$0.00 ","$3,632.81 ","$20,748.00 ","$0.00 ","$10,374.00 ","$16,432.42 ","$16,598.40 ","$0.00 ","$3,247.06 ","$0.00 ","$3,303.08 ","$0.00 "
"1161928","SUP","HCPCS C1781","","1161928  -  GRAFT SURG 11X7.5IN REGENERATIVE XENMATRIX COLLAGEN MATRIX","BOTH IP/OP","$35,479.60 ","$26,254.90 ","$0.00 ","$35,479.60 ","$15,965.82 ","$0.00 ","$7,394.84 ","$0.00 ","$0.00 ","$6,212.19 ","$35,479.60 ","$0.00 ","$17,739.80 ","$28,099.84 ","$28,383.68 ","$0.00 ","$5,552.56 ","$0.00 ","$5,648.35 ","$0.00 "
"1190602","SUP","HCPCS C1781","","1190602  -  PLUG SURG LARGE 1.9X1.5IN MONOFILAMENT MESH PLEATED EDGE","BOTH IP/OP","$1,572.25 ","$1,163.47 ","$0.00 ","$1,572.25 ","$707.51 ","$0.00 ","$327.70 ","$0.00 ","$0.00 ","$275.29 ","$1,572.25 ","$0.00 ","$786.13 ","$1,245.22 ","$1,257.80 ","$0.00 ","$246.06 ","$0.00 ","$250.30 ","$0.00 "
"1190603","SUP","HCPCS C1781","","1190603  -  PLUG SURG XL 1.6X1.3IN MESH MULTILAYER PHASIX","BOTH IP/OP","$1,585.75 ","$1,173.46 ","$0.00 ","$1,585.75 ","$713.59 ","$0.00 ","$330.51 ","$0.00 ","$0.00 ","$277.65 ","$1,585.75 ","$0.00 ","$792.88 ","$1,255.91 ","$1,268.60 ","$0.00 ","$248.17 ","$0.00 ","$252.45 ","$0.00 "
"1203105","SUP","Custom 27203010","","1203105  -  TUBE ENDBR 9FR STRL UNIBLOCKER ADLT","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1303346","SUP","Custom 27203010","","1303346  -  SPONGE ABS HMST AGNT PWDR GELTN GLFM 50 STRL","BOTH IP/OP","$421.96 ","$312.25 ","$0.00 ","$288.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.43 ","$0.00 ","$144.21 ","$228.44 ","$230.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10-Oct","SUP","Custom 27203010","","10-5510  -  DRESSING GZE 36X36IN STRL LF 1-+ 17 PLY W MESH 1 LYR","BOTH IP/OP","$37.32 ","$27.62 ","$0.00 ","$33.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.69 ","$0.00 ","$16.85 ","$26.68 ","$26.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6/11/5537","SUP","HCPCS C1776","","5537-6/11  -  STEM HUMERAL 6 135MM PRESS FIT ANATOMIC TITANIUM NONSTRL","BOTH IP/OP","$6,566.70 ","$4,859.36 ","$0.00 ","$6,566.70 ","$2,955.02 ","$0.00 ","$1,368.66 ","$0.00 ","$0.00 ","$1,149.78 ","$6,566.70 ","$0.00 ","$3,283.35 ","$5,200.83 ","$5,253.36 ","$0.00 ","$1,027.69 ","$0.00 ","$1,045.42 ","$0.00 "
"8/12/5537","SUP","HCPCS C1776","","5537-8/12  -  STEM HUMERAL 8 120MM PRESS FIT ANATOMIC SELF CENTERING EPOCA","BOTH IP/OP","$6,566.70 ","$4,859.36 ","$0.00 ","$6,566.70 ","$2,955.02 ","$0.00 ","$1,368.66 ","$0.00 ","$0.00 ","$1,149.78 ","$6,566.70 ","$0.00 ","$3,283.35 ","$5,200.83 ","$5,253.36 ","$0.00 ","$1,027.69 ","$0.00 ","$1,045.42 ","$0.00 "
"10/12/5537","SUP","HCPCS C1776","","5537-10/12  -  STEM HUMERAL 10 125MM PRESS FIT ANATOMIC SELF CENTERING","BOTH IP/OP","$6,566.70 ","$4,859.36 ","$0.00 ","$6,566.70 ","$2,955.02 ","$0.00 ","$1,368.66 ","$0.00 ","$0.00 ","$1,149.78 ","$6,566.70 ","$0.00 ","$3,283.35 ","$5,200.83 ","$5,253.36 ","$0.00 ","$1,027.69 ","$0.00 ","$1,045.42 ","$0.00 "
"12/13/5537","SUP","HCPCS C1776","","5537-12/13  -  STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM NONSTRL","BOTH IP/OP","$6,566.70 ","$4,859.36 ","$0.00 ","$6,566.70 ","$2,955.02 ","$0.00 ","$1,368.66 ","$0.00 ","$0.00 ","$1,149.78 ","$6,566.70 ","$0.00 ","$3,283.35 ","$5,200.83 ","$5,253.36 ","$0.00 ","$1,027.69 ","$0.00 ","$1,045.42 ","$0.00 "
"6/11/5540","SUP","HCPCS C1776","","5540-6/11  -  STEM HUMERAL 6MM 115MM PRESS FIT TITANIUM HA STERILE","BOTH IP/OP","$6,943.00 ","$5,137.82 ","$0.00 ","$6,943.00 ","$3,124.35 ","$0.00 ","$1,447.09 ","$0.00 ","$0.00 ","$1,215.66 ","$6,943.00 ","$0.00 ","$3,471.50 ","$5,498.86 ","$5,554.40 ","$0.00 ","$1,086.58 ","$0.00 ","$1,105.33 ","$0.00 "
"8/12/5540","SUP","HCPCS C1776","","5540-8/12  -  STEM HUMERAL 8MM 120MM PRESS FIT EPOCA TITANIUM HA SHOULDER","BOTH IP/OP","$6,943.00 ","$5,137.82 ","$0.00 ","$6,943.00 ","$3,124.35 ","$0.00 ","$1,447.09 ","$0.00 ","$0.00 ","$1,215.66 ","$6,943.00 ","$0.00 ","$3,471.50 ","$5,498.86 ","$5,554.40 ","$0.00 ","$1,086.58 ","$0.00 ","$1,105.33 ","$0.00 "
"10/12/5540","SUP","HCPCS C1776","","5540-10/12  -  STEM HUMERAL 10 125MM PRESS FIT IMPLANT TITANIUM HA SHOULDER","BOTH IP/OP","$6,943.00 ","$5,137.82 ","$0.00 ","$6,943.00 ","$3,124.35 ","$0.00 ","$1,447.09 ","$0.00 ","$0.00 ","$1,215.66 ","$6,943.00 ","$0.00 ","$3,471.50 ","$5,498.86 ","$5,554.40 ","$0.00 ","$1,086.58 ","$0.00 ","$1,105.33 ","$0.00 "
"12/13/5540","SUP","HCPCS C1776","","5540-12/13  -  STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM HA STERILE","BOTH IP/OP","$6,943.00 ","$5,137.82 ","$0.00 ","$6,943.00 ","$3,124.35 ","$0.00 ","$1,447.09 ","$0.00 ","$0.00 ","$1,215.66 ","$6,943.00 ","$0.00 ","$3,471.50 ","$5,498.86 ","$5,554.40 ","$0.00 ","$1,086.58 ","$0.00 ","$1,105.33 ","$0.00 "
"6/11/5624","SUP","HCPCS C1776","","5624-6/11  -  STEM HUMERAL 8MM 115MM CEMENT EPOCA COCR SHOULDER STERILE","BOTH IP/OP","$5,769.05 ","$4,269.10 ","$0.00 ","$5,769.05 ","$2,596.07 ","$0.00 ","$1,202.41 ","$0.00 ","$0.00 ","$1,010.11 ","$5,769.05 ","$0.00 ","$2,884.53 ","$4,569.09 ","$4,615.24 ","$0.00 ","$902.86 ","$0.00 ","$918.43 ","$0.00 "
"8/12/5624","SUP","HCPCS C1776","","5624-8/12  -  STEM HUMERAL 8MM 120MM CEMENTED ANATOMIC SELF CENTERING","BOTH IP/OP","$5,769.05 ","$4,269.10 ","$0.00 ","$5,769.05 ","$2,596.07 ","$0.00 ","$1,202.41 ","$0.00 ","$0.00 ","$1,010.11 ","$5,769.05 ","$0.00 ","$2,884.53 ","$4,569.09 ","$4,615.24 ","$0.00 ","$902.86 ","$0.00 ","$918.43 ","$0.00 "
"10/12/5624","SUP","HCPCS C1776","","5624-10/12  -  STEM HUMERAL 10 125MM CEMENTED ANATOMIC COCR STERILE","BOTH IP/OP","$5,769.05 ","$4,269.10 ","$0.00 ","$5,769.05 ","$2,596.07 ","$0.00 ","$1,202.41 ","$0.00 ","$0.00 ","$1,010.11 ","$5,769.05 ","$0.00 ","$2,884.53 ","$4,569.09 ","$4,615.24 ","$0.00 ","$902.86 ","$0.00 ","$918.43 ","$0.00 "
"12/13/5624","SUP","HCPCS C1776","","5624-12/13  -  STEM HUMERAL 12 130MM CEMENTED ANATOMIC COCR STERILE","BOTH IP/OP","$5,769.05 ","$4,269.10 ","$0.00 ","$5,769.05 ","$2,596.07 ","$0.00 ","$1,202.41 ","$0.00 ","$0.00 ","$1,010.11 ","$5,769.05 ","$0.00 ","$2,884.53 ","$4,569.09 ","$4,615.24 ","$0.00 ","$902.86 ","$0.00 ","$918.43 ","$0.00 "
"1371120","SUP","Custom 27203010","","PIPETTE TRNSF PE 6IN 5.8ML GRAD STRL","BOTH IP/OP","$0.30 ","$0.22 ","$0.00 ","$0.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.30 ","$0.00 ","$0.15 ","$0.24 ","$0.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1372301","SUP","Custom 27203010","","1372301  -  SET ADM 110IN 0.2 MH NVNT ADON","BOTH IP/OP","$38.38 ","$28.40 ","$0.00 ","$38.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.38 ","$0.00 ","$19.19 ","$30.40 ","$30.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1424571","SUP","HCPCS C1713","","PLATE MCWL 96 WELL UBTM RGD PS DISP","BOTH IP/OP","$4.48 ","$3.32 ","$0.00 ","$4.48 ","$2.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.78 ","$4.48 ","$0.00 ","$2.24 ","$3.55 ","$3.58 ","$0.00 ","$0.70 ","$0.00 ","$0.71 ","$0.00 "
"1437374","SUP","Custom 27203010","","BLADE HISTOLGY 130MM ACED SHRT SS TRM DISP","BOTH IP/OP","$539.75 ","$399.42 ","$0.00 ","$539.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$539.75 ","$0.00 ","$269.88 ","$427.48 ","$431.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1500181","SUP","Custom 27203010","","1500181  -  APL ENDSCP FLSL STRL DISP","BOTH IP/OP","$147.78 ","$109.36 ","$0.00 ","$147.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.78 ","$0.00 ","$73.89 ","$117.04 ","$118.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1501262","SUP","HCPCS C9250","","1501262  -  KIT TISSUE CLOSURE 1 PREFILL SYRINGE PLUNGER 2 PULL STRAP","BOTH IP/OP","$385.60 ","$285.34 ","$0.00 ","$601.60 ","$270.72 ","$156.84 ","$80.37 ","$0.00 ","$0.00 ","$105.33 ","$601.60 ","$173.09 ","$300.80 ","$476.47 ","$481.28 ","$239.03 ","$94.15 ","$0.00 ","$95.77 ","$164.85 "
"1501263","SUP","HCPCS C9250","","1501263  -  KIT TISS CLSR 10ML 2 PCH FRZN SLNT SYRPLNG Y PC CONCTR TSSL","BOTH IP/OP","$946.28 ","$700.25 ","$0.00 ","$1,391.58 ","$626.21 ","$156.84 ","$197.23 ","$0.00 ","$0.00 ","$243.65 ","$1,391.58 ","$173.09 ","$695.79 ","$1,102.13 ","$1,113.26 ","$239.03 ","$217.78 ","$0.00 ","$221.54 ","$164.85 "
"1518128","SUP","HCPCS Q4116","","1518128  -  MATRIX TISS THK.4-1.6MM 128SQ CM MED RECT 16X8CM ALDRM SLCT","BOTH IP/OP","$8,732.50 ","$6,462.05 ","$0.00 ","$13,550.00 ","$6,097.50 ","$0.00 ","$1,820.07 ","$0.00 ","$0.00 ","$2,372.50 ","$13,550.00 ","$0.00 ","$6,775.00 ","$10,731.60 ","$10,840.00 ","$0.00 ","$2,120.58 ","$0.00 ","$2,157.16 ","$0.00 "
"1518320","SUP","HCPCS Q4116","","1518320  -  MATRIX TISS THK.4-1.6MM 320SQ CM MED RECT 20X16CM ALDRM SLCT","BOTH IP/OP","$21,832.50 ","$16,156.05 ","$0.00 ","$33,875.00 ","$15,243.75 ","$0.00 ","$4,550.44 ","$0.00 ","$0.00 ","$5,931.24 ","$33,875.00 ","$0.00 ","$16,937.50 ","$26,829.00 ","$27,100.00 ","$0.00 ","$5,301.44 ","$0.00 ","$5,392.90 ","$0.00 "
"1518616","SUP","HCPCS Q4116","","1518616  -  MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE","BOTH IP/OP","$7,497.50 ","$5,548.15 ","$0.00 ","$7,497.50 ","$3,373.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,312.75 ","$7,497.50 ","$0.00 ","$3,748.75 ","$5,938.02 ","$5,998.00 ","$0.00 ","$1,173.36 ","$0.00 ","$1,193.60 ","$0.00 "
"1520616","SUP","HCPCS Q4116","","1520616  -  MATRIX TISS THK.4-1.6MM MED 16X6CM ALDRM SLCT ALGRF RGNRT","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$10,162.50 ","$4,573.13 ","$0.00 ","$1,365.18 ","$0.00 ","$0.00 ","$1,779.37 ","$10,162.50 ","$0.00 ","$5,081.25 ","$8,048.70 ","$8,130.00 ","$0.00 ","$1,590.43 ","$0.00 ","$1,617.87 ","$0.00 "
"1523901","SUP","Custom 27203010","","1523901  -  SET IRRIGATION .28IN 85IN 4 LEAD 3Y CONCTR SIGHT CHAMBER","BOTH IP/OP","$385.75 ","$285.46 ","$0.00 ","$385.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$385.75 ","$0.00 ","$192.88 ","$305.51 ","$308.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1524055","SUP","Custom 27203010","","1524055  -  SPLINT NSL WHT STRL LF DYLE II CMPR ANT TIP INTGR ARWY SIL","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1525002","SUP","HCPCS Q4130","","1525002  -  MATRIX TISSUE 25X15CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$22,080.00 ","$16,339.20 ","$0.00 ","$33,367.50 ","$0.00 ","$0.00 ","$4,602.02 ","$0.00 ","$0.00 ","$0.00 ","$33,367.50 ","$0.00 ","$16,683.75 ","$26,427.06 ","$26,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1527005","SUP","Custom 27803010","","1527005  -  SPLINT NSL THK.5MM STD REUT PREPUNCH HL FLRPLAS SPT","BOTH IP/OP","$74.50 ","$55.13 ","$0.00 ","$74.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.50 ","$0.00 ","$37.25 ","$59.00 ","$59.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1527010","SUP","HCPCS C1713","","1527010  -  SPLINT 1527010 10PK PAIR REUTER LRG THIN","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$74.50 ","$33.53 ","$0.00 ","$20.84 ","$0.00 ","$0.00 ","$13.04 ","$74.50 ","$0.00 ","$37.25 ","$59.00 ","$59.60 ","$0.00 ","$11.66 ","$0.00 ","$11.86 ","$0.00 "
"1527020","SUP","Custom 27803010","","1527020  -  SPLINT 1527020 10PK PAIR REUTER LRG THK","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$74.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.50 ","$0.00 ","$37.25 ","$59.00 ","$59.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1528120","SUP","Custom 27203010","","1528120  -  SPLINT NASAL MEDIUM REGULAR 2.38X1.53IN EXTERNAL RUBBER FOAM","BOTH IP/OP","$2,912.50 ","$2,155.25 ","$0.00 ","$2,912.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,912.50 ","$0.00 ","$1,456.25 ","$2,306.70 ","$2,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1528126","SUP","Custom 27203010","","1528126  -  SPLINT NSL MED 2.38X1.53IN WHT STRL LF XTRN KT FM RBR SPT","BOTH IP/OP","$93.50 ","$69.19 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1528136","SUP","Custom 27203010","","1528136  -  SPLINT NSL LG KT XTRN LTWT STRNG WTR RS ADH FM AL SPT","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1528137","SUP","Custom 27203010","","1528137  -  SPLINT NASAL LARGE 2.63INX1.73IN ADHERENT EXTERNAL STRONG","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1529010","SUP","Custom 27803010","","1529010  -  SPLINT NSL MED 2.38X1.53IN WHT STRL LF THRMSPLNT KT XTRN","BOTH IP/OP","$7.80 ","$5.77 ","$0.00 ","$577.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1529020","SUP","Custom 27203010","","1529020  -  SPLINT NSL LG 2.63INX1.73IN WHT STRL LF THRMSPLNT KT XTRN","BOTH IP/OP","$56.75 ","$42.00 ","$0.00 ","$56.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.75 ","$0.00 ","$28.38 ","$44.95 ","$45.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1608695","SUP","Custom 27203010","","1608695  -  BURR SURG ROUND .157MM 2.13IN DIAMOND MEDIUM GRIT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1620002","SUP","HCPCS Q4130","","1620002  -  MATRIX TISSUE 20X16CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$58.88 ","$43.57 ","$0.00 ","$88.98 ","$0.00 ","$0.00 ","$12.27 ","$0.00 ","$0.00 ","$0.00 ","$88.98 ","$0.00 ","$44.49 ","$70.47 ","$71.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1664017","SUP","HCPCS C1713","","1664017  -  SET SCREW 1664017 4.75 SOL PERC MULTI S","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"1677545","SUP","HCPCS C1713","","1677545  -  SCREW BN 7.5MM 45MM NS PRCPT PA CR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"1677550","SUP","HCPCS C1713","","1677550  -  SCREW BN 7.5MM 50MM NS PRCPT PA CR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"1801303","SUP","HCPCS C1713","","1801303  -  ENDPLATE SPNL 3D MED NS INFIX TI THORLMBR ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"1801306","SUP","HCPCS C1713","","1801306  -  ENDPLATE SPNL 6D MED NS INFIX TI THORLMBR ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"1803205","SUP","HCPCS C1776","","1803205  -  DOME PTLR RND 38MM RSRFC KN MCK SYS","BOTH IP/OP","$2,192.50 ","$1,622.45 ","$0.00 ","$2,192.50 ","$986.63 ","$0.00 ","$456.97 ","$0.00 ","$0.00 ","$383.89 ","$2,192.50 ","$0.00 ","$1,096.25 ","$1,736.46 ","$1,754.00 ","$0.00 ","$343.13 ","$0.00 ","$349.05 ","$0.00 "
"1804308","SUP","HCPCS C1713","","1804308  -  STRUT SPNL MED 8MM BLU NS INFIX TI THORLMBR ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"1807052","SUP","HCPCS C1776","","1807052  -  INSERT TIB 5 9MM ONLAY KN MCK SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"1807081","SUP","HCPCS C1776","","1807081  -  INSERT TIB 8 8MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"1850300","SUP","HCPCS C1894","","1850300  -  SHEATH ENDSCP CLEAN 170MM 4MM ESCRB 25D SIN LEN SYS STRL","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$272.86 ","$0.00 ","$104.73 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"Jan-33","SUP","HCPCS C1713","","01-7033  -  PLATE 100D MED RIGHT MIDFAC 3X3 HOLE L 1.5MM SCR BONE TI","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"Jan-38","SUP","HCPCS C1713","","01-7038  -  PLATE BONE 1.5MM REGULAR L SILVER LEFT MIDFAC","BOTH IP/OP","$910.00 ","$673.40 ","$0.00 ","$910.00 ","$409.50 ","$0.00 ","$189.67 ","$0.00 ","$0.00 ","$159.33 ","$910.00 ","$0.00 ","$455.00 ","$720.72 ","$728.00 ","$0.00 ","$142.42 ","$0.00 ","$144.87 ","$0.00 "
"Jan-40","SUP","HCPCS C1713","","01-7040  -  PLATE BONE REGULAR STR 16MMX.6MM 4 HOLE TRAUMAONE LORENZ","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"Jan-45","SUP","HCPCS C1713","","01-7045  -  PLATE BONE MEDIUM STR 17MMX.6MM 4 HOLE SILVER TITANIUM","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"Jan-47","SUP","HCPCS C1713","","01-7047  -  PLATE BONE LONG STR 4 HOLE GRADE II TRAUMAONE LORENZ SILVER","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"Jan-50","SUP","HCPCS C1713","","01-7050  -  PLATE BONE REGULAR STR 6 HOLE TRAUMAONE LORENZ SILVER","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$201.38 ","$0.00 ","$93.27 ","$0.00 ","$0.00 ","$78.35 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$70.03 ","$0.00 ","$71.24 ","$0.00 "
"Jan-65","SUP","HCPCS C1713","","01-7065  -  PLATE BONE MESH SIDE PROFILE PRECONTOUR 163X115X.3MM ULTRA","BOTH IP/OP","$10,742.50 ","$7,949.45 ","$0.00 ","$10,742.50 ","$4,834.13 ","$0.00 ","$2,239.01 ","$0.00 ","$0.00 ","$1,880.93 ","$10,742.50 ","$0.00 ","$5,371.25 ","$8,508.06 ","$8,594.00 ","$0.00 ","$1,681.20 ","$0.00 ","$1,710.21 ","$0.00 "
"Jan-66","SUP","HCPCS C1713","","01-7066  -  PLATE BONE 16 HOLE STR LORENZ TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"Jan-92","SUP","HCPCS C1713","","01-7092  -  PLATE BONE MED 2T CRNMXF TI 1.5MM SCR","BOTH IP/OP","$710.00 ","$525.40 ","$0.00 ","$710.00 ","$319.50 ","$0.00 ","$147.98 ","$0.00 ","$0.00 ","$124.32 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$111.12 ","$0.00 ","$113.03 ","$0.00 "
"2-Jan","SUP","HCPCS C1713","","01-7102  -  PLATE BONE LONG REGULAR Y 5 HOLE TRAUMAONE LORENZ SILVER","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$840.00 ","$378.00 ","$0.00 ","$175.08 ","$0.00 ","$0.00 ","$147.08 ","$840.00 ","$0.00 ","$420.00 ","$665.28 ","$672.00 ","$0.00 ","$131.46 ","$0.00 ","$133.73 ","$0.00 "
"1900233","SUP","Custom 27203010","","REAGENT XYLN SHDN 120ML SUB MOUNTANT HISTOLGY","BOTH IP/OP","$54.45 ","$40.29 ","$0.00 ","$54.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.45 ","$0.00 ","$27.23 ","$43.12 ","$43.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4-Jan","SUP","HCPCS C1713","","01-7104  -  PLATE BONE XL Y 19MMX.6MM 5 HOLE LORENZ SILVER TITANIUM","BOTH IP/OP","$710.00 ","$525.40 ","$0.00 ","$710.00 ","$319.50 ","$0.00 ","$147.98 ","$0.00 ","$0.00 ","$124.32 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$111.12 ","$0.00 ","$113.03 ","$0.00 "
"6-Jan","SUP","HCPCS C1713","","01-7106  -  PLATE BONE SMALL PREFORM TITANIUM ORBTL FLOOR","BOTH IP/OP","$3,112.50 ","$2,303.25 ","$0.00 ","$3,112.50 ","$1,400.63 ","$0.00 ","$648.72 ","$0.00 ","$0.00 ","$544.97 ","$3,112.50 ","$0.00 ","$1,556.25 ","$2,465.10 ","$2,490.00 ","$0.00 ","$487.11 ","$0.00 ","$495.51 ","$0.00 "
"7-Jan","SUP","HCPCS C1713","","01-7107  -  PLATE BONE MEDIUM .3MM PREFORM TRAUMAONE LORENZ GOLD","BOTH IP/OP","$3,112.50 ","$2,303.25 ","$0.00 ","$3,112.50 ","$1,400.63 ","$0.00 ","$648.72 ","$0.00 ","$0.00 ","$544.97 ","$3,112.50 ","$0.00 ","$1,556.25 ","$2,465.10 ","$2,490.00 ","$0.00 ","$487.11 ","$0.00 ","$495.51 ","$0.00 "
"1901819","SUP","HCPCS C1713","","1901819  -  PLATE BONE MED ORBTL FLR TI MESH","BOTH IP/OP","$3,112.50 ","$2,303.25 ","$0.00 ","$1,980,000.00 ","$1,400.63 ","$0.00 ","$648.72 ","$0.00 ","$0.00 ","$544.97 ","$3,112.50 ","$0.00 ","$1,556.25 ","$1,980,000.00 ","$2,490.00 ","$0.00 ","$487.11 ","$0.00 ","$495.51 ","$0.00 "
"8-Jan","SUP","HCPCS C1713","","01-7108  -  PLATE BONE LARGE .3MM PREFORM TITANIUM ORBTL FLOOR STERILE","BOTH IP/OP","$3,242.50 ","$2,399.45 ","$0.00 ","$3,242.50 ","$1,459.13 ","$0.00 ","$675.82 ","$0.00 ","$0.00 ","$567.74 ","$3,242.50 ","$0.00 ","$1,621.25 ","$2,568.06 ","$2,594.00 ","$0.00 ","$507.45 ","$0.00 ","$516.21 ","$0.00 "
"9-Jan","SUP","HCPCS C1713","","01-7109  -  PLATE BONE .3MM GRADE IV PREFORME TRAUMAONE LORENZ GOLD","BOTH IP/OP","$2,835.00 ","$2,097.90 ","$0.00 ","$2,835.00 ","$1,275.75 ","$0.00 ","$590.88 ","$0.00 ","$0.00 ","$496.39 ","$2,835.00 ","$0.00 ","$1,417.50 ","$2,245.32 ","$2,268.00 ","$0.00 ","$443.68 ","$0.00 ","$451.33 ","$0.00 "
"10-Jan","SUP","HCPCS C1713","","01-7110  -  PLATE BN REG 2Y 6 HL TI MDFC 1.5MM SCR","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$760.00 ","$342.00 ","$0.00 ","$158.40 ","$0.00 ","$0.00 ","$133.07 ","$760.00 ","$0.00 ","$380.00 ","$601.92 ","$608.00 ","$0.00 ","$118.94 ","$0.00 ","$120.99 ","$0.00 "
"12-Jan","SUP","HCPCS C1713","","01-7112  -  PLATE BONE LONG 6 HOLE 2Y TITANIUM MIDFAC 1.5MM SCREWS","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$382.50 ","$0.00 ","$177.16 ","$0.00 ","$0.00 ","$148.83 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$133.03 ","$0.00 ","$135.32 ","$0.00 "
"14-Jan","SUP","HCPCS C1713","","01-7114  -  PLATE BONE XLONG 2Y TITANIUM CRANIOMAXILLOFACIAL 1.5MM SCREW","BOTH IP/OP","$745.00 ","$551.30 ","$0.00 ","$745.00 ","$335.25 ","$0.00 ","$155.28 ","$0.00 ","$0.00 ","$130.44 ","$745.00 ","$0.00 ","$372.50 ","$590.04 ","$596.00 ","$0.00 ","$116.59 ","$0.00 ","$118.60 ","$0.00 "
"20-Jan","SUP","HCPCS C1713","","01-7120  -  PLATE BONE REGULAR X TITANIUM CRANIOMAXILLOFACIAL STERILE","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$840.00 ","$378.00 ","$0.00 ","$175.08 ","$0.00 ","$0.00 ","$147.08 ","$840.00 ","$0.00 ","$420.00 ","$665.28 ","$672.00 ","$0.00 ","$131.46 ","$0.00 ","$133.73 ","$0.00 "
"21-Jan","SUP","HCPCS C1713","","01-7121  -  PLATE BONE 6 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"22-Jan","SUP","HCPCS C1713","","01-7122  -  PLATE BONE 18 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC","BOTH IP/OP","$1,570.00 ","$1,161.80 ","$0.00 ","$1,570.00 ","$706.50 ","$0.00 ","$327.23 ","$0.00 ","$0.00 ","$274.89 ","$1,570.00 ","$0.00 ","$785.00 ","$1,243.44 ","$1,256.00 ","$0.00 ","$245.71 ","$0.00 ","$249.94 ","$0.00 "
"23-Jan","SUP","HCPCS C1713","","01-7123  -  PLATE BONE 4 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC","BOTH IP/OP","$932.50 ","$690.05 ","$0.00 ","$932.50 ","$419.63 ","$0.00 ","$194.36 ","$0.00 ","$0.00 ","$163.27 ","$932.50 ","$0.00 ","$466.25 ","$738.54 ","$746.00 ","$0.00 ","$145.94 ","$0.00 ","$148.45 ","$0.00 "
"26-Jan","SUP","HCPCS C1713","","01-7126  -  PLATE BONE REGULAR CURVE 6 HOLE GRADE II TRAUMAONE LORENZ","BOTH IP/OP","$857.50 ","$634.55 ","$0.00 ","$857.50 ","$385.88 ","$0.00 ","$178.72 ","$0.00 ","$0.00 ","$150.14 ","$857.50 ","$0.00 ","$428.75 ","$679.14 ","$686.00 ","$0.00 ","$134.20 ","$0.00 ","$136.51 ","$0.00 "
"28-Jan","SUP","HCPCS C1713","","01-7128  -  PLATE BONE REGULAR CURVE .6MM 8 HOLE TRAUMAONE LORENZ SILVER","BOTH IP/OP","$540.00 ","$399.60 ","$0.00 ","$540.00 ","$243.00 ","$0.00 ","$112.55 ","$0.00 ","$0.00 ","$94.55 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$84.51 ","$0.00 ","$85.97 ","$0.00 "
"30-Jan","SUP","HCPCS C1713","","01-7130  -  PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR","BOTH IP/OP","$540.00 ","$399.60 ","$0.00 ","$540.00 ","$243.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.55 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$84.51 ","$0.00 ","$85.97 ","$0.00 "
"31-Jan","SUP","HCPCS C1713","","01-7131  -  PLATE BN SQ 12MM LORENZ 4 HL NEURO 1.5MM SCR","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$760.00 ","$342.00 ","$0.00 ","$158.40 ","$0.00 ","$0.00 ","$133.07 ","$760.00 ","$0.00 ","$380.00 ","$601.92 ","$608.00 ","$0.00 ","$118.94 ","$0.00 ","$120.99 ","$0.00 "
"1912000","SUP","HCPCS C1894","","1912000  -  SHEATH ENDSCP CLEAN 0D 4MM LENS SOFTWARE CONTROL ENDO-SCRUB","BOTH IP/OP","$32.80 ","$24.27 ","$0.00 ","$32.80 ","$17.81 ","$0.00 ","$6.84 ","$0.00 ","$0.00 ","$5.74 ","$32.80 ","$0.00 ","$16.40 ","$25.98 ","$26.24 ","$0.00 ","$5.13 ","$0.00 ","$5.22 ","$0.00 "
"1912010","SUP","HCPCS C1892","","1912010  -  SHEATH ENDSCP CLEAN 4MM ESCRB2 30D SIN LEN STRL LATEX FREE","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$14.93 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"Jan-36","SUP","HCPCS C1713","","01-7136  -  PLATE BONE RECTANGLE 2X3 HOLE TRAUMAONE MATRIX SILVER","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$427.50 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$166.34 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$148.68 ","$0.00 ","$151.24 ","$0.00 "
"Jan-37","SUP","HCPCS C1713","","01-7137  -  PLATE BONE 2X4 HOLE RECTANGULAR LORENZ TITANIUM","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$427.50 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$166.34 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$148.68 ","$0.00 ","$151.24 ","$0.00 "
"Jan-42","SUP","Custom 27203010","","01-7142  -  DRILL TWIST 5MM STOP 1MM 50MM LORENZ MANDIB","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-44","SUP","Custom 27203010","","01-7144  -  DRILL TWIST 1.1MM 50MM 7MM STOP LORENZ 1.5MM SCREW MIDAS REX","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-46","SUP","Custom 27203010","","01-7146  -  DRILL TWIST 1.1MM 50MM 9MM STOP","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-48","SUP","Custom 27203010","","01-7148  -  DRILL TWIST 1.1MM 50MM 15MM STOP","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924542","SUP","Custom 27803010","","1924542  -  ROD SPNL 5.5MM 200MM SPRL R90D HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924543","SUP","Custom 27803010","","1924543  -  ROD SPNL 5.5MM 400MM SPRL R90D HEX END","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924547","SUP","HCPCS C1713","","1924547  -  SCREW BN 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,345.68 ","$995.80 ","$0.00 ","$1,345.68 ","$605.55 ","$0.00 ","$280.47 ","$0.00 ","$0.00 ","$235.62 ","$1,345.68 ","$0.00 ","$672.84 ","$1,065.78 ","$1,076.54 ","$0.00 ","$210.60 ","$0.00 ","$214.23 ","$0.00 "
"1924548","SUP","HCPCS C1713","","1924548  -  SCREW BN 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,345.68 ","$995.80 ","$0.00 ","$1,345.68 ","$605.55 ","$0.00 ","$280.47 ","$0.00 ","$0.00 ","$235.62 ","$1,345.68 ","$0.00 ","$672.84 ","$1,065.78 ","$1,076.54 ","$0.00 ","$210.60 ","$0.00 ","$214.23 ","$0.00 "
"1924549","SUP","HCPCS C1713","","1924549  -  SCREW BN 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,345.68 ","$995.80 ","$0.00 ","$1,345.68 ","$605.55 ","$0.00 ","$280.47 ","$0.00 ","$0.00 ","$235.62 ","$1,345.68 ","$0.00 ","$672.84 ","$1,065.78 ","$1,076.54 ","$0.00 ","$210.60 ","$0.00 ","$214.23 ","$0.00 "
"1924550","SUP","HCPCS C1713","","1924550  -  SCREW BN 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,345.68 ","$995.80 ","$0.00 ","$1,345.68 ","$605.55 ","$0.00 ","$280.47 ","$0.00 ","$0.00 ","$235.62 ","$1,345.68 ","$0.00 ","$672.84 ","$1,065.78 ","$1,076.54 ","$0.00 ","$210.60 ","$0.00 ","$214.23 ","$0.00 "
"1924551","SUP","HCPCS C1713","","1924551  -  SCREW BN 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,345.68 ","$995.80 ","$0.00 ","$1,345.68 ","$605.55 ","$0.00 ","$280.47 ","$0.00 ","$0.00 ","$235.62 ","$1,345.68 ","$0.00 ","$672.84 ","$1,065.78 ","$1,076.54 ","$0.00 ","$210.60 ","$0.00 ","$214.23 ","$0.00 "
"1924552","SUP","Custom 27803010","","1924552  -  ROD SPNL 5.5MM 200MM SPRL R90D SCRL EYE TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924553","SUP","Custom 27803010","","1924553  -  ROD SPNL 5.5MM 400MM SPRL R90D SCRL EYE TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924900","SUP","Custom 27803010","","1924900  -  ROD SPNL 5.5MM 40MM SPRL R90D NONHEXAGONAL TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924901","SUP","Custom 27803010","","1924901  -  ROD SPNL 5.5MM 50MM SPRL R90D NONHEXAGONAL TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924902","SUP","Custom 27803010","","1924902  -  ROD SPNL 5.5MM 60MM SPRL R90D TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924903","SUP","Custom 27803010","","1924903  -  ROD SPNL 5.5MM 70MM SPRL R90D NONHEXAGONAL TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924904","SUP","Custom 27803010","","1924904  -  ROD SPNL 5.5MM 80MM SPRL R90D NONHEXAGONAL TI SPNE","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924905","SUP","Custom 27803010","","1924905  -  ROD SPNL 5.5MM 90MM SPRL R90D NONHEXAGONAL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924906","SUP","Custom 27803010","","1924906  -  ROD SPNL 5.5MM 100MM SPRL R90D NONHEXAGONAL TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924907","SUP","Custom 27803010","","1924907  -  ROD SPNL 5.5MM 110MM SPRL R90D NONHEXAGONAL TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924908","SUP","Custom 27803010","","1924908  -  ROD SPNL 5.5MM 120MM SPRL R90D NONHEXAGONAL TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924909","SUP","Custom 27803010","","1924909  -  ROD SPNL 5.5MM 600MM SPRL R90D HEX TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-80","SUP","HCPCS C1713","","01-7180  -  PLATE BN REG 80X53X.6MM SLVR LORENZ GRID MESH PNL TI CRNMXF","BOTH IP/OP","$4,182.50 ","$3,095.05 ","$0.00 ","$4,182.50 ","$1,882.13 ","$0.00 ","$871.74 ","$0.00 ","$0.00 ","$732.32 ","$4,182.50 ","$0.00 ","$2,091.25 ","$3,312.54 ","$3,346.00 ","$0.00 ","$654.56 ","$0.00 ","$665.85 ","$0.00 "
"Jan-82","SUP","HCPCS C1713","","01-7182  -  PLATE BONE SMALL 85X53X.6MM GRID MESH PANEL LORENZ SILVER","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"Jan-85","SUP","HCPCS C1713","","01-7185  -  PLATE BONE SMALL 85X53X.3MM GRID MESH PANEL LORENZ SILVER","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"Jan-49","SUP","HCPCS C1713","","01-7249  -  PLATE BONE 100X100X.6MM CONTUR MESH LORENZ STERILE 1.5MM","BOTH IP/OP","$6,692.50 ","$4,952.45 ","$0.00 ","$6,692.50 ","$3,011.63 ","$0.00 ","$1,394.88 ","$0.00 ","$0.00 ","$1,171.80 ","$6,692.50 ","$0.00 ","$3,346.25 ","$5,300.46 ","$5,354.00 ","$0.00 ","$1,047.38 ","$0.00 ","$1,065.45 ","$0.00 "
"5-Jan","SUP","HCPCS C1713","","01-7305  -  PLATE BONE LORENZ TITANIUM H.5 MM OD18.5 MM CRANIOMAXILLOFAC","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"6-Jan","SUP","HCPCS C1713","","01-7306  -  PLATE BONE 18.5MM .5MM BURR HOLE LORENZ TITANIUM","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"8-Jan","SUP","HCPCS C1713","","01-7308  -  PLATE BONE 18.5MM BURR HOLE TITANIUM MIDFAC 1.5MM SCREWS","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"9-Jan","SUP","HCPCS C1713","","01-7309  -  PLATE BONE 22MM .5MM BURR HOLE LORENZ TITANIUM","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"Jan-40","SUP","HCPCS C1713","","01-7340  -  PLATE BONE 1/1.5MM 85X50X.2MM HEXAGONAL PANEL LORENZ","BOTH IP/OP","$4,022.50 ","$2,976.65 ","$0.00 ","$4,022.50 ","$1,810.13 ","$0.00 ","$838.39 ","$0.00 ","$0.00 ","$704.31 ","$4,022.50 ","$0.00 ","$2,011.25 ","$3,185.82 ","$3,218.00 ","$0.00 ","$629.52 ","$0.00 ","$640.38 ","$0.00 "
"Jan-45","SUP","HCPCS C1713","","01-7345  -  PLATE BONE MEDIUM 2 HOLE STR TITANIUM MIDFAC 1.5MM SCREWS","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"Jan-47","SUP","HCPCS C1713","","01-7347  -  PLATE BONE LONG STR .6MM 2 HOLE TRAUMAONE LORENZ SILVER","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"Jan-51","SUP","HCPCS C1713","","01-7351  -  PLATE BN 25MM LORENZ 6 HL GAP NEURO 1.5MM SCR","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"Jan-53","SUP","HCPCS C1713","","01-7353  -  PLATE BONE MEDIUM 35MMX.5MM 6 HOLE GAP LORENZ TITANIUM","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"Jan-55","SUP","HCPCS C1713","","01-7355  -  PLATE BN 45MMX.5MM LORENZ 6 HL GAP TI CRNM 1.5MM SCR","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"2010027","SUP","Custom 27203010","","2010027  -  ELECTRODE EMG DMD STRL LF I-PAS III SPRINGLESS DISP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2010028","SUP","Custom 27203010","","2010028  -  SET SPINAL INSULATED PEDICLE ACCES SYSTEM DIAMOND TIP I-PAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2010029","SUP","Custom 27203010","","2010029  -  SET SPINAL INSULATED PEDICLE ACCES SYSTEM BEVELED TIP I-PAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2010036","SUP","Custom 27011340","","2010036  -  STIMULATOR NRV STRL LF NVJJB DYNMC DISP","BOTH IP/OP","$182.50 ","$135.05 ","$0.00 ","$182.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$182.50 ","$0.00 ","$91.25 ","$144.54 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2010037","SUP","Custom 27203010","","2010037  -  ELECTRODE EMG BVL STRL LF I-PAS III SPRINGLESS DISP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2011202","SUP","Custom 27203010","","2011202  -  RETRACTOR SRG SHTH NRV ROOT","BOTH IP/OP","$1,205.00 ","$891.70 ","$0.00 ","$1,205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,205.00 ","$0.00 ","$602.50 ","$954.36 ","$964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2012021","SUP","Custom 27011340","","2012021  -  PROBE EMG STM HNDPC NV M5","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8-Oct","SUP","Custom 27203010","","10-7408  -  BANDAGE COMPRESSION 7 TUBULAR 42-52IN 10YD ELAST DRESSING","BOTH IP/OP","$107.89 ","$79.84 ","$0.00 ","$29.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.31 ","$0.00 ","$14.65 ","$23.21 ","$23.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9-Oct","SUP","Custom 27203010","","10-7409  -  RETAINER DRESSING 8 TUBULAR 52-58IN 10YD ELAST LATEX SAFE","BOTH IP/OP","$157.99 ","$116.91 ","$0.00 ","$39.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.97 ","$0.00 ","$19.98 ","$31.66 ","$31.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13-Oct","SUP","Custom 27203010","","10-7413  -  RETAINER DRESSING 12 10YD ELAST LATEX SAFE STRETCHED TUBULAR","BOTH IP/OP","$65.24 ","$48.28 ","$0.00 ","$65.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.24 ","$0.00 ","$32.62 ","$51.67 ","$52.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2020000","SUP","HCPCS Q4130","","2020000  -  SUB TISS 20X20CM STRATTICE PIG DRML MTRX FIRM PTCH RECON","BOTH IP/OP","$65.23 ","$48.27 ","$0.00 ","$65.23 ","$0.00 ","$0.00 ","$13.59 ","$0.00 ","$0.00 ","$0.00 ","$65.23 ","$0.00 ","$32.61 ","$51.66 ","$52.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2020002","SUP","HCPCS Q4130","","2020002  -  MATRIX TISSUE 20X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$23,552.50 ","$17,428.85 ","$0.00 ","$35,592.50 ","$0.00 ","$0.00 ","$4,908.93 ","$0.00 ","$0.00 ","$0.00 ","$35,592.50 ","$0.00 ","$17,796.25 ","$28,189.26 ","$28,474.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2025002","SUP","HCPCS Q4130","","2025002  -  MATRIX TISSUE 25X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS","BOTH IP/OP","$29,440.00 ","$21,785.60 ","$0.00 ","$44,490.00 ","$0.00 ","$0.00 ","$6,136.03 ","$0.00 ","$0.00 ","$0.00 ","$44,490.00 ","$0.00 ","$22,245.00 ","$35,236.08 ","$35,592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2029950","SUP","Custom 27803010","","2029950  -  KIT SPINAL DILAT XLIF NEUROVISION DISPOSABLE M5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2030365","SUP","Custom 27203010","","STRIP ACCK CMFCRV GLUC CHMTEST","BOTH IP/OP","$60.20 ","$44.55 ","$0.00 ","$60.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.20 ","$0.00 ","$30.10 ","$47.68 ","$48.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2040001","SUP","HCPCS C1713","","2040001  -  DIGITIZER INST BENDINI ROD BNDRG ARY","BOTH IP/OP","$5,660.00 ","$4,188.40 ","$0.00 ","$5,660.00 ","$2,547.00 ","$0.00 ","$1,179.69 ","$0.00 ","$0.00 ","$991.02 ","$5,660.00 ","$0.00 ","$2,830.00 ","$4,482.72 ","$4,528.00 ","$0.00 ","$885.79 ","$0.00 ","$901.07 ","$0.00 "
"2078175","SUP","HCPCS C1769","","2078175  -  GUIDEWIRE VASCULAR .014IN 300CM 3CM SHAPEABLE TIP STEERABLE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"2110140","SUP","HCPCS C1713","","2110140  -  SPACER SPNL 0D 40X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110145","SUP","HCPCS C1713","","2110145  -  SPACER SPNL 0D 45X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110150","SUP","HCPCS C1713","","2110150  -  SPACER SPNL 0D 50X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110155","SUP","HCPCS C1713","","2110155  -  SPACER SPNL 0D 55X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110160","SUP","HCPCS C1713","","2110160  -  SPACER SPNL 0D 60X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110240","SUP","HCPCS C1713","","2110240  -  SPACER SPNL 0D 40X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110245","SUP","HCPCS C1713","","2110245  -  SPACER SPNL 0D 45X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110250","SUP","HCPCS C1713","","2110250  -  SPACER SPNL 0D 50X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110255","SUP","HCPCS C1713","","2110255  -  SPACER SPNL 0D 55X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110260","SUP","HCPCS C1713","","2110260  -  SPACER SPNL 0D 60X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110340","SUP","HCPCS C1713","","2110340  -  SPACER SPNL 0D 40X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110345","SUP","HCPCS C1713","","2110345  -  SPACER SPNL 0D 45X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110350","SUP","HCPCS C1713","","2110350  -  SPACER SPNL 0D 50X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110355","SUP","HCPCS C1713","","2110355  -  SPACER SPNL 0D 55X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110360","SUP","HCPCS C1713","","2110360  -  SPACER SPNL 0D 60X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110440","SUP","HCPCS C1713","","2110440  -  SPACER SPNL 0D 40X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110445","SUP","HCPCS C1713","","2110445  -  SPACER SPNL 0D 45X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110450","SUP","HCPCS C1713","","2110450  -  SPACER SPNL 0D 50X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110455","SUP","HCPCS C1713","","2110455  -  SPACER SPNL 0D 55X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110460","SUP","HCPCS C1713","","2110460  -  SPACER SPNL 0D 60X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110540","SUP","HCPCS C1713","","2110540  -  SPACER SPNL 0D 40X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110545","SUP","HCPCS C1713","","2110545  -  SPACER SPNL 0D 45X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110550","SUP","HCPCS C1713","","2110550  -  SPACER SPNL 0D 50X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110555","SUP","HCPCS C1713","","2110555  -  SPACER SPNL 0D 55X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2110560","SUP","HCPCS C1713","","2110560  -  SPACER SPNL 0D 60X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111140","SUP","HCPCS C1713","","2111140  -  SPACER SPNL 6D 40X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111145","SUP","HCPCS C1713","","2111145  -  SPACER SPNL 6D 45X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111150","SUP","HCPCS C1713","","2111150  -  SPACER SPNL 6D 50X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111155","SUP","HCPCS C1713","","2111155  -  SPACER SPNL 6D 55X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111160","SUP","HCPCS C1713","","2111160  -  SPACER SPNL 6D 60X20X8MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111240","SUP","HCPCS C1713","","2111240  -  SPACER SPNL 6D 40X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111245","SUP","HCPCS C1713","","2111245  -  SPACER SPNL 6D 45X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111250","SUP","HCPCS C1713","","2111250  -  SPACER SPNL 6D 50X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111255","SUP","HCPCS C1713","","2111255  -  SPACER SPNL 6D 55X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111260","SUP","HCPCS C1713","","2111260  -  SPACER SPNL 6D 60X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111340","SUP","HCPCS C1713","","2111340  -  SPACER SPNL 6D 40X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111345","SUP","HCPCS C1713","","2111345  -  SPACER SPNL 6D 45X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111350","SUP","HCPCS C1713","","2111350  -  SPACER SPNL 6D 50X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111355","SUP","HCPCS C1713","","2111355  -  SPACER SPNL 6D 55X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111360","SUP","HCPCS C1713","","2111360  -  SPACER SPNL 6D 60X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111440","SUP","HCPCS C1713","","2111440  -  SPACER SPNL 6D 40X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111445","SUP","HCPCS C1713","","2111445  -  SPACER SPNL 6D 45X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111450","SUP","HCPCS C1713","","2111450  -  SPACER SPNL 6D 50X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111455","SUP","HCPCS C1713","","2111455  -  SPACER SPNL 6D 55X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111460","SUP","HCPCS C1713","","2111460  -  SPACER SPNL 6D 60X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111540","SUP","HCPCS C1713","","2111540  -  SPACER SPNL 6D 40X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111545","SUP","HCPCS C1713","","2111545  -  SPACER SPNL 6D 45X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111550","SUP","HCPCS C1713","","2111550  -  SPACER SPNL 6D 50X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111555","SUP","HCPCS C1713","","2111555  -  SPACER SPNL 6D 55X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2111560","SUP","HCPCS C1713","","2111560  -  SPACER SPNL 6D 60X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112240","SUP","HCPCS C1713","","2112240  -  SPACER SPNL 12D 40X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112245","SUP","HCPCS C1713","","2112245  -  SPACER SPNL 12D 45X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112250","SUP","HCPCS C1713","","2112250  -  SPACER SPNL 12D 50X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112255","SUP","HCPCS C1713","","2112255  -  SPACER SPNL 12D 55X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112260","SUP","HCPCS C1713","","2112260  -  SPACER SPNL 12D 60X20X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112340","SUP","HCPCS C1713","","2112340  -  SPACER SPNL 12D 40X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112345","SUP","HCPCS C1713","","2112345  -  SPACER SPNL 12D 45X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112350","SUP","HCPCS C1713","","2112350  -  SPACER SPNL 12D 50X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112355","SUP","HCPCS C1713","","2112355  -  SPACER SPNL 12D 55X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112360","SUP","HCPCS C1713","","2112360  -  SPACER SPNL 12D 60X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112440","SUP","HCPCS C1713","","2112440  -  SPACER SPNL 12D 40X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112445","SUP","HCPCS C1713","","2112445  -  SPACER SPNL 12D 45X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112450","SUP","HCPCS C1713","","2112450  -  SPACER SPNL 12D 50X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112455","SUP","HCPCS C1713","","2112455  -  SPACER SPNL 12D 55X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112460","SUP","HCPCS C1713","","2112460  -  SPACER SPNL 12D 60X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112540","SUP","HCPCS C1713","","2112540  -  SPACER SPNL 12D 40X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112545","SUP","HCPCS C1713","","2112545  -  SPACER SPNL 12D 45X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112550","SUP","HCPCS C1713","","2112550  -  SPACER SPNL 12D 50X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112555","SUP","HCPCS C1713","","2112555  -  SPACER SPNL 12D 55X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112560","SUP","HCPCS C1713","","2112560  -  SPACER SPNL 12D 60X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112640","SUP","HCPCS C1713","","2112640  -  SPACER SPNL 12D 40X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112645","SUP","HCPCS C1713","","2112645  -  SPACER SPNL 12D 45X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112650","SUP","HCPCS C1713","","2112650  -  SPACER SPNL 12D 50X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112655","SUP","HCPCS C1713","","2112655  -  SPACER SPNL 12D 55X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2112660","SUP","HCPCS C1713","","2112660  -  SPACER SPNL 12D 60X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113340","SUP","HCPCS C1713","","2113340  -  SPACER SPNL 18D 40X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113345","SUP","HCPCS C1713","","2113345  -  SPACER SPNL 18D 45X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113350","SUP","HCPCS C1713","","2113350  -  SPACER SPNL 18D 50X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113355","SUP","HCPCS C1713","","2113355  -  SPACER SPNL 18D 55X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113360","SUP","HCPCS C1713","","2113360  -  SPACER SPNL 18D 60X20X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113440","SUP","HCPCS C1713","","2113440  -  SPACER SPNL 18D 40X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113445","SUP","HCPCS C1713","","2113445  -  SPACER SPNL 18D 45X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113450","SUP","HCPCS C1713","","2113450  -  SPACER SPNL 18D 50X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113455","SUP","HCPCS C1713","","2113455  -  SPACER SPNL 18D 55X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113460","SUP","HCPCS C1713","","2113460  -  SPACER SPNL 18D 60X20X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113540","SUP","HCPCS C1713","","2113540  -  SPACER SPNL 18D 40X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113545","SUP","HCPCS C1713","","2113545  -  SPACER SPNL 18D 45X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113550","SUP","HCPCS C1713","","2113550  -  SPACER SPNL 18D 50X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113555","SUP","HCPCS C1713","","2113555  -  SPACER SPNL 18D 55X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113560","SUP","HCPCS C1713","","2113560  -  SPACER SPNL 18D 60X20X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113640","SUP","HCPCS C1713","","2113640  -  SPACER SPNL 18D 40X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113645","SUP","HCPCS C1713","","2113645  -  SPACER SPNL 18D 45X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113650","SUP","HCPCS C1713","","2113650  -  SPACER SPNL 18D 50X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113655","SUP","HCPCS C1713","","2113655  -  SPACER SPNL 18D 55X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2113660","SUP","HCPCS C1713","","2113660  -  SPACER SPNL 18D 60X20X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131240","SUP","HCPCS C1713","","2131240  -  SPACER SPNL 6D 40X27X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131245","SUP","HCPCS C1713","","2131245  -  SPACER SPNL 6D 45X27X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131250","SUP","HCPCS C1713","","2131250  -  SPACER SPNL 6D 50X27X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131255","SUP","HCPCS C1713","","2131255  -  SPACER SPNL 6D 55X27X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131260","SUP","HCPCS C1713","","2131260  -  SPACER SPNL 6D 60X27X10MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131340","SUP","HCPCS C1713","","2131340  -  SPACER SPNL 6D 40X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131345","SUP","HCPCS C1713","","2131345  -  SPACER SPNL 6D 45X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131350","SUP","HCPCS C1713","","2131350  -  SPACER SPNL 6D 50X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131355","SUP","HCPCS C1713","","2131355  -  SPACER SPNL 6D 55X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131360","SUP","HCPCS C1713","","2131360  -  SPACER SPNL 6D 60X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131440","SUP","HCPCS C1713","","2131440  -  SPACER SPNL 6D 40X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131445","SUP","HCPCS C1713","","2131445  -  SPACER SPNL 6D 45X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131450","SUP","HCPCS C1713","","2131450  -  SPACER SPNL 6D 50X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131455","SUP","HCPCS C1713","","2131455  -  SPACER SPNL 6D 55X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131460","SUP","HCPCS C1713","","2131460  -  SPACER SPNL 6D 60X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131540","SUP","HCPCS C1713","","2131540  -  SPACER SPNL 6D 40X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131545","SUP","HCPCS C1713","","2131545  -  SPACER SPNL 6D 45X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131550","SUP","HCPCS C1713","","2131550  -  SPACER SPNL 6D 50X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131555","SUP","HCPCS C1713","","2131555  -  SPACER SPNL 6D 55X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2131560","SUP","HCPCS C1713","","2131560  -  SPACER SPNL 6D 60X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132340","SUP","HCPCS C1713","","2132340  -  SPACER SPNL 12D 40X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132345","SUP","HCPCS C1713","","2132345  -  SPACER SPNL 12D 45X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132350","SUP","HCPCS C1713","","2132350  -  SPACER SPNL 12D 50X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132355","SUP","HCPCS C1713","","2132355  -  SPACER SPNL 12D 55X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132360","SUP","HCPCS C1713","","2132360  -  SPACER SPNL 12D 60X27X12MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132440","SUP","HCPCS C1713","","2132440  -  SPACER SPNL 12D 40X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132445","SUP","HCPCS C1713","","2132445  -  SPACER SPNL 12D 45X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132450","SUP","HCPCS C1713","","2132450  -  SPACER SPNL 12D 50X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132455","SUP","HCPCS C1713","","2132455  -  SPACER SPNL 12D 55X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132460","SUP","HCPCS C1713","","2132460  -  SPACER SPNL 12D 60X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132540","SUP","HCPCS C1713","","2132540  -  SPACER SPNL 12D 40X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132545","SUP","HCPCS C1713","","2132545  -  SPACER SPNL 12D 45X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132550","SUP","HCPCS C1713","","2132550  -  SPACER SPNL 12D 50X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132555","SUP","HCPCS C1713","","2132555  -  SPACER SPNL 12D 55X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132560","SUP","HCPCS C1713","","2132560  -  SPACER SPNL 12D 60X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132640","SUP","HCPCS C1713","","2132640  -  SPACER SPNL 12D 40X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132645","SUP","HCPCS C1713","","2132645  -  SPACER SPNL 12D 45X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132650","SUP","HCPCS C1713","","2132650  -  SPACER SPNL 12D 50X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132655","SUP","HCPCS C1713","","2132655  -  SPACER SPNL 12D 55X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2132660","SUP","HCPCS C1713","","2132660  -  SPACER SPNL 12D 60X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133440","SUP","HCPCS C1713","","2133440  -  SPACER SPNL 18D 40X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133445","SUP","HCPCS C1713","","2133445  -  SPACER SPNL 18D 45X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133450","SUP","HCPCS C1713","","2133450  -  SPACER SPNL 18D 50X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133455","SUP","HCPCS C1713","","2133455  -  SPACER SPNL 18D 55X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133460","SUP","HCPCS C1713","","2133460  -  SPACER SPNL 18D 60X27X14MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133540","SUP","HCPCS C1713","","2133540  -  SPACER SPNL 18D 40X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133545","SUP","HCPCS C1713","","2133545  -  SPACER SPNL 18D 45X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133550","SUP","HCPCS C1713","","2133550  -  SPACER SPNL 18D 50X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133555","SUP","HCPCS C1713","","2133555  -  SPACER SPNL 18D 55X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133560","SUP","HCPCS C1713","","2133560  -  SPACER SPNL 18D 60X27X16MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133640","SUP","HCPCS C1713","","2133640  -  SPACER SPNL 18D 40X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133645","SUP","HCPCS C1713","","2133645  -  SPACER SPNL 18D 45X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133650","SUP","HCPCS C1713","","2133650  -  SPACER SPNL 18D 50X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133655","SUP","HCPCS C1713","","2133655  -  SPACER SPNL 18D 55X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2133660","SUP","HCPCS C1713","","2133660  -  SPACER SPNL 18D 60X27X18MM PIVOX LAT OLIF25","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2140001","SUP","HCPCS C1713","","2140001  -  PLATE SPNL SM 2 HOLE OLIF25 STRL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2140002","SUP","HCPCS C1713","","2140002  -  PLATE SPNL LG 2 HOLE OLIF25 STRL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2140120","SUP","HCPCS C1713","","2140120  -  SCREW BONE 5.5MM 20MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2140125","SUP","HCPCS C1713","","2140125  -  SCREW BONE 5.5MM 25MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2140130","SUP","HCPCS C1713","","2140130  -  SCREW BONE 5.5MM 30MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2140135","SUP","HCPCS C1713","","2140135  -  SCREW BONE 5.5MM 35MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2140140","SUP","HCPCS C1713","","2140140  -  SCREW BONE 5.5MM 40MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2140145","SUP","HCPCS C1713","","2140145  -  SCREW BONE 5.5MM 45MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2140150","SUP","HCPCS C1713","","2140150  -  SCREW BONE 5.5MM 50MM LMBR SPN STRL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2150010","SUP","HCPCS C1713","","2150010  -  PLATE SPNL 10MM DIVERGENCE-L OLIF51","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2150012","SUP","HCPCS C1713","","2150012  -  PLATE SPNL 12MM DIVERGENCE-L OLIF51","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2150014","SUP","HCPCS C1713","","2150014  -  PLATE SPNL 14MM DIVERGENCE-L OLIF51","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2150016","SUP","HCPCS C1713","","2150016  -  PLATE SPNL 16MM DIVERGENCE-L OLIF51","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2150018","SUP","HCPCS C1713","","2150018  -  PLATE SPNL 18MM DIVERGENCE-L OLIF51","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2150020","SUP","HCPCS C1713","","2150020  -  PLATE SPNL 20MM DIVERGENCE-L OLIF51","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2150120","SUP","HCPCS C1713","","2150120  -  SCREW BONE 20MM DIVERGENCE-L SPN","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2150125","SUP","HCPCS C1713","","2150125  -  SCREW BONE 25MM DIVERGENCE-L SPN","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2150130","SUP","HCPCS C1713","","2150130  -  SCREW BONE 6.5MM 30MM DIVERGENCE-L SPN","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2150135","SUP","HCPCS C1713","","2150135  -  SCREW BONE 6.5MM 35MM DIVERGENCE-L SPN","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2150140","SUP","HCPCS C1713","","2150140  -  SCREW BONE 6.5MM 40MM DIVERGENCE-L SPN","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"2151110","SUP","HCPCS C1713","","2151110  -  CAGE SPNL 6D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151112","SUP","HCPCS C1713","","2151112  -  CAGE SPNL 32X25X12MM DIVERGENCE-L 6D SM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151114","SUP","HCPCS C1713","","2151114  -  CAGE SPNL 6D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151116","SUP","HCPCS C1713","","2151116  -  CAGE SPNL 6D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151118","SUP","HCPCS C1713","","2151118  -  CAGE SPNL 6D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151120","SUP","HCPCS C1713","","2151120  -  CAGE SPNL 6D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151210","SUP","HCPCS C1713","","2151210  -  CAGE SPNL 6D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151212","SUP","HCPCS C1713","","2151212  -  CAGE SPNL 6D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151214","SUP","HCPCS C1713","","2151214  -  CAGE SPNL 6D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151216","SUP","HCPCS C1713","","2151216  -  CAGE SPNL 6D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151218","SUP","HCPCS C1713","","2151218  -  CAGE SPNL 6D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151220","SUP","HCPCS C1713","","2151220  -  CAGE SPNL 6D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151310","SUP","HCPCS C1713","","2151310  -  CAGE SPNL 6D LG 42X32X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151312","SUP","HCPCS C1713","","2151312  -  CAGE SPNL 6D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151314","SUP","HCPCS C1713","","2151314  -  CAGE SPNL 6D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151316","SUP","HCPCS C1713","","2151316  -  CAGE SPNL 6D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151318","SUP","HCPCS C1713","","2151318  -  CAGE SPNL 6D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2151320","SUP","HCPCS C1713","","2151320  -  CAGE SPNL 6D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152110","SUP","HCPCS C1713","","2152110  -  CAGE SPNL 12D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152112","SUP","HCPCS C1713","","2152112  -  CAGE SPNL 12D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152114","SUP","HCPCS C1713","","2152114  -  CAGE SPNL 12D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152116","SUP","HCPCS C1713","","2152116  -  CAGE SPNL 12D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152118","SUP","HCPCS C1713","","2152118  -  CAGE SPNL 12D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152120","SUP","HCPCS C1713","","2152120  -  CAGE SPNL 12D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152210","SUP","HCPCS C1713","","2152210  -  CAGE SPNL 12D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152212","SUP","HCPCS C1713","","2152212  -  CAGE SPNL 12D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152214","SUP","HCPCS C1713","","2152214  -  CAGE SPNL 12D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152216","SUP","HCPCS C1713","","2152216  -  CAGE SPNL 12D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152218","SUP","HCPCS C1713","","2152218  -  CAGE SPNL 12D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152220","SUP","HCPCS C1713","","2152220  -  CAGE SPNL 12D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152312","SUP","HCPCS C1713","","2152312  -  CAGE SPNL 12D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152314","SUP","HCPCS C1713","","2152314  -  CAGE SPNL 12D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152316","SUP","HCPCS C1713","","2152316  -  CAGE SPNL 12D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152318","SUP","HCPCS C1713","","2152318  -  CAGE SPNL 12D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2152320","SUP","HCPCS C1713","","2152320  -  CAGE SPNL 12D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153112","SUP","HCPCS C1713","","2153112  -  CAGE SPNL 18D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153114","SUP","HCPCS C1713","","2153114  -  CAGE SPNL 18D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153116","SUP","HCPCS C1713","","2153116  -  CAGE SPNL 18D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153118","SUP","HCPCS C1713","","2153118  -  CAGE SPNL 18D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153120","SUP","HCPCS C1713","","2153120  -  CAGE SPNL 18D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153214","SUP","HCPCS C1713","","2153214  -  CAGE SPNL 18D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153216","SUP","HCPCS C1713","","2153216  -  CAGE SPNL 18D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153218","SUP","HCPCS C1713","","2153218  -  CAGE SPNL 18D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153220","SUP","HCPCS C1713","","2153220  -  CAGE SPNL 18D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153316","SUP","HCPCS C1713","","2153316  -  CAGE SPNL 18D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153318","SUP","HCPCS C1713","","2153318  -  CAGE SPNL 18D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2153320","SUP","HCPCS C1713","","2153320  -  CAGE SPNL 18D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154116","SUP","HCPCS C1713","","2154116  -  CAGE SPNL 24D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154118","SUP","HCPCS C1713","","2154118  -  CAGE SPNL 24D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154120","SUP","HCPCS C1713","","2154120  -  CAGE SPNL 24D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154216","SUP","HCPCS C1713","","2154216  -  CAGE SPNL 24D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154218","SUP","HCPCS C1713","","2154218  -  CAGE SPNL 24D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154220","SUP","HCPCS C1713","","2154220  -  CAGE SPNL 24D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154318","SUP","HCPCS C1713","","2154318  -  CAGE SPNL 24D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2154320","SUP","HCPCS C1713","","2154320  -  CAGE SPNL 24D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2160010","SUP","HCPCS C1713","","2160010  -  PLATE SPNL 10MM DIVERGENCE-L ALIF","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"2160012","SUP","HCPCS C1713","","2160012  -  PLATE SPNL 12MM DIVERGENCE-L ALIF","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"11-Jan","SUP","HCPCS C1713","","01-8611  -  PLATE BN SM MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG RT","BOTH IP/OP","$4,677.50 ","$3,461.35 ","$0.00 ","$4,677.50 ","$2,104.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$818.99 ","$4,677.50 ","$0.00 ","$2,338.75 ","$3,704.58 ","$3,742.00 ","$0.00 ","$732.03 ","$0.00 ","$744.66 ","$0.00 "
"12-Jan","SUP","HCPCS C1713","","01-8612  -  PLATE BN LG MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG LT","BOTH IP/OP","$4,837.50 ","$3,579.75 ","$0.00 ","$4,837.50 ","$2,176.88 ","$0.00 ","$1,008.26 ","$0.00 ","$0.00 ","$847.01 ","$4,837.50 ","$0.00 ","$2,418.75 ","$3,831.30 ","$3,870.00 ","$0.00 ","$757.07 ","$0.00 ","$770.13 ","$0.00 "
"Jan-36","SUP","HCPCS C1713","","01-8636  -  PLATE BONE LONG 3X3 HOLE L RIGID DELTA GOLD LEFT","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"Jan-62","SUP","HCPCS C1713","","01-8662  -  PLATE BONE 8 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC","BOTH IP/OP","$872.50 ","$645.65 ","$0.00 ","$872.50 ","$392.63 ","$0.00 ","$181.85 ","$0.00 ","$0.00 ","$152.77 ","$872.50 ","$0.00 ","$436.25 ","$691.02 ","$698.00 ","$0.00 ","$136.55 ","$0.00 ","$138.90 ","$0.00 "
"Jan-64","SUP","HCPCS C1713","","01-8664  -  PLATE BONE 4 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC","BOTH IP/OP","$872.50 ","$645.65 ","$0.00 ","$872.50 ","$392.63 ","$0.00 ","$181.85 ","$0.00 ","$0.00 ","$152.77 ","$872.50 ","$0.00 ","$436.25 ","$691.02 ","$698.00 ","$0.00 ","$136.55 ","$0.00 ","$138.90 ","$0.00 "
"Jan-70","SUP","HCPCS C1713","","01-8670  -  PLATE BONE LONG STR 20 HOLE RIGID SYSTEM LORENZ TRAUMAONE","BOTH IP/OP","$1,510.00 ","$1,117.40 ","$0.00 ","$1,510.00 ","$679.50 ","$0.00 ","$314.72 ","$0.00 ","$0.00 ","$264.39 ","$1,510.00 ","$0.00 ","$755.00 ","$1,195.92 ","$1,208.00 ","$0.00 ","$236.32 ","$0.00 ","$240.39 ","$0.00 "
"Jan-78","SUP","HCPCS C1713","","01-8678  -  PLATE LEFT MIDFAC 2X2 HOLE L RGD 1.5MM SCR BONE LORENZ","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"Jan-79","SUP","HCPCS C1713","","01-8679  -  PLATE RIGHT MIDFAC 2X2 HOLE L RGD 1.5MM SCR BONE LORENZ","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"Jan-80","SUP","HCPCS C1713","","01-8680  -  PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM","BOTH IP/OP","$1,015.00 ","$751.10 ","$0.00 ","$1,015.00 ","$456.75 ","$0.00 ","$211.55 ","$0.00 ","$0.00 ","$177.72 ","$1,015.00 ","$0.00 ","$507.50 ","$803.88 ","$812.00 ","$0.00 ","$158.85 ","$0.00 ","$161.59 ","$0.00 "
"Jan-81","SUP","HCPCS C1713","","01-8681  -  PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM","BOTH IP/OP","$1,015.00 ","$751.10 ","$0.00 ","$1,015.00 ","$456.75 ","$0.00 ","$211.55 ","$0.00 ","$0.00 ","$177.72 ","$1,015.00 ","$0.00 ","$507.50 ","$803.88 ","$812.00 ","$0.00 ","$158.85 ","$0.00 ","$161.59 ","$0.00 "
"Jan-89","SUP","HCPCS C1713","","01-8689  -  PLATE BONE LONG 14 HOLE CVD RIGID TRAUMAONE GOLD TITANIUM","BOTH IP/OP","$1,102.50 ","$815.85 ","$0.00 ","$1,102.50 ","$496.13 ","$0.00 ","$229.79 ","$0.00 ","$0.00 ","$193.04 ","$1,102.50 ","$0.00 ","$551.25 ","$873.18 ","$882.00 ","$0.00 ","$172.54 ","$0.00 ","$175.52 ","$0.00 "
"Jan-92","SUP","Custom 27203010","","01-9192  -  TW DRILL 1.5X50MM 5MM STP W/NT","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Jan-93","SUP","Custom 27203010","","01-9193  -  DRILL TWIST 1.5MM 50MM 7MM STOP TRAUMAONE","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20-Jan","SUP","HCPCS C1781","","01-9520  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC","BOTH IP/OP","$16,200.00 ","$11,988.00 ","$0.00 ","$16,200.00 ","$7,290.00 ","$0.00 ","$3,376.49 ","$0.00 ","$0.00 ","$2,836.49 ","$16,200.00 ","$0.00 ","$8,100.00 ","$12,830.40 ","$12,960.00 ","$0.00 ","$2,535.30 ","$0.00 ","$2,579.04 ","$0.00 "
"21-Jan","SUP","HCPCS C1781","","01-9521  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC","BOTH IP/OP","$18,900.00 ","$13,986.00 ","$0.00 ","$18,900.00 ","$8,505.00 ","$0.00 ","$3,939.23 ","$0.00 ","$0.00 ","$3,309.24 ","$18,900.00 ","$0.00 ","$9,450.00 ","$14,968.80 ","$15,120.00 ","$0.00 ","$2,957.85 ","$0.00 ","$3,008.88 ","$0.00 "
"22-Jan","SUP","HCPCS C1781","","01-9522  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC","BOTH IP/OP","$18,900.00 ","$13,986.00 ","$0.00 ","$18,900.00 ","$8,505.00 ","$0.00 ","$3,939.23 ","$0.00 ","$0.00 ","$3,309.24 ","$18,900.00 ","$0.00 ","$9,450.00 ","$14,968.80 ","$15,120.00 ","$0.00 ","$2,957.85 ","$0.00 ","$3,008.88 ","$0.00 "
"23-Jan","SUP","HCPCS C1781","","01-9523  -  MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC","BOTH IP/OP","$21,060.00 ","$15,584.40 ","$0.00 ","$21,060.00 ","$9,477.00 ","$0.00 ","$4,389.43 ","$0.00 ","$0.00 ","$3,687.44 ","$21,060.00 ","$0.00 ","$10,530.00 ","$16,679.52 ","$16,848.00 ","$0.00 ","$3,295.89 ","$0.00 ","$3,352.75 ","$0.00 "
"24-Jan","SUP","HCPCS C1781","","01-9524  -  MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC","BOTH IP/OP","$21,060.00 ","$15,584.40 ","$0.00 ","$21,060.00 ","$9,477.00 ","$0.00 ","$4,389.43 ","$0.00 ","$0.00 ","$3,687.44 ","$21,060.00 ","$0.00 ","$10,530.00 ","$16,679.52 ","$16,848.00 ","$0.00 ","$3,295.89 ","$0.00 ","$3,352.75 ","$0.00 "
"2800724","SUP","HCPCS C1713","","2800724  -  CAGE SPNL 0D 24MMX7MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2800824","SUP","HCPCS C1713","","2800824  -  CAGE SPNL 0D 24MMX8MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2840924","SUP","HCPCS C1713","","2840924  -  CAGE SPNL 4D 24MMX9MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2841024","SUP","HCPCS C1713","","2841024  -  CAGE SPNL 4D 24MMX10MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2841124","SUP","HCPCS C1713","","2841124  -  CAGE SPNL 4D 24MMX11MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2841224","SUP","HCPCS C1713","","2841224  -  CAGE SPNL 4D 24MMX12MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2841324","SUP","HCPCS C1713","","2841324  -  CAGE SPNL 4D 24MMX13MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2841424","SUP","HCPCS C1713","","2841424  -  CAGE SPNL 4D 24MMX14MM STRL FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2880924","SUP","HCPCS C1713","","2880924  -  CAGE SPNL 8D 24MMX9MM FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2881024","SUP","HCPCS C1713","","2881024  -  CAGE SPNL 8D 24MMX10MM FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2881124","SUP","HCPCS C1713","","2881124  -  CAGE SPNL 8D 24MMX11MM FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2881224","SUP","HCPCS C1713","","2881224  -  CAGE SPNL 8D 24MMX12MM FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2881324","SUP","HCPCS C1713","","2881324  -  CAGE SPNL 8D 24MMX13MM FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2881424","SUP","HCPCS C1713","","2881424  -  CAGE SPNL 8D 24MMX14MM FUSE TI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"2920040","SUP","Custom 27803010","","2920040  -  CAGE SPNL 0D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920045","SUP","Custom 27803010","","2920045  -  CAGE SPNL 0D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920050","SUP","Custom 27803010","","2920050  -  CAGE SPNL 0D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920055","SUP","Custom 27803010","","2920055  -  CAGE SPNL 0D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920060","SUP","Custom 27803010","","2920060  -  CAGE SPNL 0D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920240","SUP","Custom 27803010","","2920240  -  CAGE SPNL 0D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920245","SUP","Custom 27803010","","2920245  -  CAGE SPNL 0D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920250","SUP","Custom 27803010","","2920250  -  CAGE SPNL 0D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920255","SUP","Custom 27803010","","2920255  -  CAGE SPNL 0D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920260","SUP","Custom 27803010","","2920260  -  CAGE SPNL 0D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920440","SUP","Custom 27803010","","2920440  -  CAGE SPNL 0D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920445","SUP","Custom 27803010","","2920445  -  CAGE SPNL 0D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920450","SUP","Custom 27803010","","2920450  -  CAGE SPNL 0D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920455","SUP","Custom 27803010","","2920455  -  CAGE SPNL 0D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920460","SUP","Custom 27803010","","2920460  -  CAGE SPNL 0D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920640","SUP","Custom 27803010","","2920640  -  CAGE SPNL 0D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920645","SUP","Custom 27803010","","2920645  -  CAGE SPNL 0D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920650","SUP","Custom 27803010","","2920650  -  CAGE SPNL 0D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920655","SUP","Custom 27803010","","2920655  -  CAGE SPNL 0D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920660","SUP","Custom 27803010","","2920660  -  CAGE SPNL 0D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920840","SUP","Custom 27803010","","2920840  -  CAGE SPNL 0D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920845","SUP","Custom 27803010","","2920845  -  CAGE SPNL 0D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920850","SUP","Custom 27803010","","2920850  -  CAGE SPNL 0D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920855","SUP","Custom 27803010","","2920855  -  CAGE SPNL 0D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2920860","SUP","Custom 27803010","","2920860  -  CAGE SPNL 0D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922040","SUP","Custom 27803010","","2922040  -  CAGE SPNL 12D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922045","SUP","Custom 27803010","","2922045  -  CAGE SPNL 12D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922050","SUP","Custom 27803010","","2922050  -  CAGE SPNL 12D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922055","SUP","Custom 27803010","","2922055  -  CAGE SPNL 12D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922060","SUP","Custom 27803010","","2922060  -  CAGE SPNL 12D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922240","SUP","Custom 27803010","","2922240  -  CAGE SPNL 12D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922245","SUP","Custom 27803010","","2922245  -  CAGE SPNL 12D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922250","SUP","Custom 27803010","","2922250  -  CAGE SPNL 12D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922255","SUP","Custom 27803010","","2922255  -  CAGE SPNL 12D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922260","SUP","Custom 27803010","","2922260  -  CAGE SPNL 12D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922440","SUP","Custom 27803010","","2922440  -  CAGE SPNL 12D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922445","SUP","Custom 27803010","","2922445  -  CAGE SPNL 12D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922450","SUP","Custom 27803010","","2922450  -  CAGE SPNL 12D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922455","SUP","Custom 27803010","","2922455  -  CAGE SPNL 12D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922460","SUP","Custom 27803010","","2922460  -  CAGE SPNL 12D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922640","SUP","Custom 27803010","","2922640  -  CAGE SPNL 12D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922645","SUP","Custom 27803010","","2922645  -  CAGE SPNL 12D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922650","SUP","Custom 27803010","","2922650  -  CAGE SPNL 12D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922655","SUP","Custom 27803010","","2922655  -  CAGE SPNL 12D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2922660","SUP","Custom 27803010","","2922660  -  CAGE SPNL 12D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926040","SUP","Custom 27803010","","2926040  -  CAGE SPNL 6D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926045","SUP","Custom 27803010","","2926045  -  CAGE SPNL 6D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926050","SUP","Custom 27803010","","2926050  -  CAGE SPNL 6D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926055","SUP","Custom 27803010","","2926055  -  CAGE SPNL 6D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926060","SUP","Custom 27803010","","2926060  -  CAGE SPNL 6D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926240","SUP","Custom 27803010","","2926240  -  CAGE SPNL 6D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926245","SUP","Custom 27803010","","2926245  -  CAGE SPNL 6D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926250","SUP","Custom 27803010","","2926250  -  CAGE SPNL 6D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926255","SUP","Custom 27803010","","2926255  -  CAGE SPNL 6D 22X12X55MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926260","SUP","Custom 27803010","","2926260  -  CAGE SPNL 6D 60X12X22MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926440","SUP","Custom 27803010","","2926440  -  CAGE SPNL 6D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926445","SUP","Custom 27803010","","2926445  -  CAGE SPNL 6D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926450","SUP","Custom 27803010","","2926450  -  CAGE SPNL 6D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926455","SUP","Custom 27803010","","2926455  -  CAGE SPNL 6D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926460","SUP","Custom 27803010","","2926460  -  CAGE SPNL 6D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926640","SUP","Custom 27803010","","2926640  -  CAGE SPNL 6D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926645","SUP","Custom 27803010","","2926645  -  CAGE SPNL 6D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926650","SUP","Custom 27803010","","2926650  -  CAGE SPNL 6D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926655","SUP","Custom 27803010","","2926655  -  CAGE SPNL 6D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926660","SUP","Custom 27803010","","2926660  -  CAGE SPNL 6D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926840","SUP","Custom 27803010","","2926840  -  CAGE SPNL 6D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926845","SUP","Custom 27803010","","2926845  -  CAGE SPNL 6D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926850","SUP","Custom 27803010","","2926850  -  CAGE SPNL 6D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926855","SUP","Custom 27803010","","2926855  -  CAGE SPNL 6D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2926860","SUP","Custom 27803010","","2926860  -  CAGE SPNL 6D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2960822","SUP","Custom 27803010","","2960822  -  SPACER SPNL 22MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2960826","SUP","HCPCS C1713","","2960826  -  SPACER SPNL 26MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2960832","SUP","Custom 27803010","","2960832  -  SPACER SPNL 32MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2960836","SUP","Custom 27803010","","2960836  -  SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961022","SUP","Custom 27803010","","2961022  -  SPACER SPNL 22MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961026","SUP","HCPCS C1713","","2961026  -  SPACER SPNL 26MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2961032","SUP","Custom 27803010","","2961032  -  SPACER SPNL 32MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961036","SUP","Custom 27803010","","2961036  -  SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961222","SUP","Custom 27803010","","2961222  -  SPACER SPNL 22MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961226","SUP","Custom 27803010","","2961226  -  SPACER SPNL 26MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961232","SUP","Custom 27803010","","2961232  -  SPACER SPNL 32MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961236","SUP","Custom 27803010","","2961236  -  SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961422","SUP","Custom 27803010","","2961422  -  SPACER SPNL 22MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961426","SUP","Custom 27803010","","2961426  -  SPACER SPNL 26X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961432","SUP","Custom 27803010","","2961432  -  SPACER SPNL 32MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2961436","SUP","Custom 27803010","","2961436  -  SPACER SPNL 36X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2962036","SUP","HCPCS C1713","","2962036  -  SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962040","SUP","HCPCS C1713","","2962040  -  SPACER SPNL 40MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962044","SUP","HCPCS C1713","","2962044  -  SPACER SPNL 44MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962236","SUP","HCPCS C1713","","2962236  -  SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962240","SUP","HCPCS C1713","","2962240  -  SPACER SPNL 40MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962244","SUP","HCPCS C1713","","2962244  -  SPACER SPNL 44MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962436","SUP","HCPCS C1713","","2962436  -  SPACER SPNL 36MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962440","SUP","HCPCS C1713","","2962440  -  SPACER SPNL 40MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962444","SUP","HCPCS C1713","","2962444  -  SPACER SPNL 44MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962836","SUP","HCPCS C1713","","2962836  -  SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962840","SUP","HCPCS C1713","","2962840  -  SPACER SPNL 40MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2962844","SUP","HCPCS C1713","","2962844  -  SPACER SPNL 44MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"2968040","SUP","Custom 27803010","","2968040  -  CAGE SPNL 6D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968045","SUP","Custom 27803010","","2968045  -  CAGE SPNL 6D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968050","SUP","Custom 27803010","","2968050  -  CAGE SPNL 6D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968055","SUP","Custom 27803010","","2968055  -  CAGE SPNL 6D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968060","SUP","Custom 27803010","","2968060  -  CAGE SPNL 6D 60MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968240","SUP","Custom 27803010","","2968240  -  CAGE SPNL 6D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968245","SUP","Custom 27803010","","2968245  -  CAGE SPNL 6D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968250","SUP","Custom 27803010","","2968250  -  CAGE SPNL 6D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968255","SUP","Custom 27803010","","2968255  -  CAGE SPNL 6D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968260","SUP","Custom 27803010","","2968260  -  CAGE SPNL 6D 60MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968440","SUP","Custom 27803010","","2968440  -  CAGE SPNL 6D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968445","SUP","Custom 27803010","","2968445  -  CAGE SPNL 6D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968450","SUP","Custom 27803010","","2968450  -  CAGE SPNL 6D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968455","SUP","Custom 27803010","","2968455  -  CAGE SPNL 6D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968460","SUP","Custom 27803010","","2968460  -  CAGE SPNL 6D 60MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968640","SUP","Custom 27803010","","2968640  -  CAGE SPNL 6D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968645","SUP","Custom 27803010","","2968645  -  CAGE SPNL 6D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968650","SUP","Custom 27803010","","2968650  -  CAGE SPNL 6D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968655","SUP","Custom 27803010","","2968655  -  CAGE SPNL 6D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968660","SUP","Custom 27803010","","2968660  -  CAGE SPNL 6D 60MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968840","SUP","Custom 27803010","","2968840  -  CAGE SPNL 6D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968845","SUP","Custom 27803010","","2968845  -  CAGE SPNL 6D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968850","SUP","Custom 27803010","","2968850  -  CAGE SPNL 6D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968855","SUP","Custom 27803010","","2968855  -  CAGE SPNL 6D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2968860","SUP","Custom 27803010","","2968860  -  CAGE SPNL 6D 60MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969040","SUP","Custom 27803010","","2969040  -  CAGE SPNL 0D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969045","SUP","Custom 27803010","","2969045  -  CAGE SPNL 0D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969050","SUP","Custom 27803010","","2969050  -  CAGE SPNL 0D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969055","SUP","Custom 27803010","","2969055  -  CAGE SPNL 0D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969240","SUP","Custom 27803010","","2969240  -  CAGE SPNL 0D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969245","SUP","Custom 27803010","","2969245  -  CAGE SPNL 0D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969250","SUP","Custom 27803010","","2969250  -  CAGE SPNL 0D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969255","SUP","Custom 27803010","","2969255  -  CAGE SPNL 0D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969440","SUP","Custom 27803010","","2969440  -  CAGE SPNL 0D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969445","SUP","Custom 27803010","","2969445  -  CAGE SPNL 0D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969450","SUP","Custom 27803010","","2969450  -  CAGE SPNL 0D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969455","SUP","Custom 27803010","","2969455  -  CAGE SPNL 0D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969640","SUP","Custom 27803010","","2969640  -  CAGE SPNL 0D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969645","SUP","Custom 27803010","","2969645  -  CAGE SPNL 0D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969650","SUP","Custom 27803010","","2969650  -  CAGE SPNL 0D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969655","SUP","Custom 27803010","","2969655  -  CAGE SPNL 0D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969840","SUP","Custom 27803010","","2969840  -  CAGE SPNL 0D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969845","SUP","Custom 27803010","","2969845  -  CAGE SPNL 0D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969850","SUP","Custom 27803010","","2969850  -  CAGE SPNL 0D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2969855","SUP","Custom 27803010","","2969855  -  CAGE SPNL 0D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2990622","SUP","HCPCS C1713","","2990622  -  SPACER SPNL 22MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2990626","SUP","HCPCS C1713","","2990626  -  SPACER SPNL 26MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2990722","SUP","HCPCS C1713","","2990722  -  SPACER SPNL 22MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2990726","SUP","HCPCS C1713","","2990726  -  SPACER SPNL 26MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2990732","SUP","HCPCS C1713","","2990732  -  SPACER SPNL 32MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2990736","SUP","HCPCS C1713","","2990736  -  SPACER SPNL 36MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2990822","SUP","Custom 27803010","","2990822  -  SPACER SPNL 22MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2990826","SUP","Custom 27803010","","2990826  -  SPACER SPNL 26MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2990832","SUP","Custom 27803010","","2990832  -  SPACER SPNL 32MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2990836","SUP","Custom 27803010","","2990836  -  SPACER SPNL 36MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2990922","SUP","HCPCS C1713","","2990922  -  SPACER SPNL 22MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2990926","SUP","HCPCS C1713","","2990926  -  SPACER SPNL 26MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2990932","SUP","HCPCS C1713","","2990932  -  SPACER SPNL 32MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2990936","SUP","HCPCS C1713","","2990936  -  SPACER SPNL 36MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991022","SUP","Custom 27803010","","2991022  -  SPACER SPNL 22MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991026","SUP","Custom 27803010","","2991026  -  SPACER SPNL 26MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991032","SUP","Custom 27803010","","2991032  -  SPACER SPNL 32MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991036","SUP","Custom 27803010","","2991036  -  SPACER SPNL 36MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991122","SUP","HCPCS C1713","","2991122  -  SPACER SPNL 22MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2991126","SUP","HCPCS C1713","","2991126  -  SPACER SPNL 26MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991132","SUP","HCPCS C1713","","2991132  -  SPACER SPNL 32MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991136","SUP","HCPCS C1713","","2991136  -  SPACER SPNL 36MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991222","SUP","Custom 27803010","","2991222  -  SPACER SPNL 22MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991226","SUP","Custom 27803010","","2991226  -  SPACER SPNL 26MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991232","SUP","Custom 27803010","","2991232  -  SPACER SPNL 32MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991236","SUP","Custom 27803010","","2991236  -  SPACER SPNL 36MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991322","SUP","HCPCS C1713","","2991322  -  SPACER SPNL 22MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2991326","SUP","HCPCS C1713","","2991326  -  SPACER SPNL 26MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991332","SUP","HCPCS C1713","","2991332  -  SPACER SPNL 32MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991336","SUP","HCPCS C1713","","2991336  -  SPACER SPNL 36MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991422","SUP","Custom 27803010","","2991422  -  SPACER SPNL 22MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991426","SUP","Custom 27803010","","2991426  -  SPACER SPNL 26MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991432","SUP","Custom 27803010","","2991432  -  SPACER SPNL 32MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991436","SUP","Custom 27803010","","2991436  -  SPACER SPNL 36MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991522","SUP","HCPCS C1713","","2991522  -  SPACER SPNL 22MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2991526","SUP","HCPCS C1713","","2991526  -  SPACER SPNL 26MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991532","SUP","HCPCS C1713","","2991532  -  SPACER SPNL 32MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991536","SUP","HCPCS C1713","","2991536  -  SPACER SPNL 36MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"2991622","SUP","Custom 27803010","","2991622  -  SPACER SPNL 22MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991626","SUP","Custom 27803010","","2991626  -  SPACER SPNL 26MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991632","SUP","Custom 27803010","","2991632  -  SPACER SPNL 32MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2991636","SUP","Custom 27803010","","2991636  -  SPACER SPNL 36MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3001015","SUP","HCPCS C1713","","3001015  -  PLATE BN 15MM ZEVO 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001017","SUP","HCPCS C1713","","3001017  -  PLATE BN 17MM ZEVO 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001019","SUP","HCPCS C1713","","3001019  -  PLATE BN 19MM ZEVO 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001021","SUP","HCPCS C1713","","3001021  -  PLATE BN 21MM ZEVO 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001023","SUP","HCPCS C1713","","3001023  -  PLATE BN 23MM ZEVO 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001027","SUP","HCPCS C1713","","3001027  -  PLATE 27MM TI LVL 1 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001029","SUP","HCPCS C1713","","3001029  -  PLATE 29MM TI LVL 1 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3001031","SUP","HCPCS C1713","","3001031  -  PLATE 31MM TI LVL 1 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3002035","SUP","HCPCS C1713","","3002035  -  PLATE BN 35MM ZEVO 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3002039","SUP","HCPCS C1713","","3002039  -  PLATE BN 39MM ZEVO 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3002043","SUP","HCPCS C1713","","3002043  -  PLATE 43MM TI LVL 2 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3002045","SUP","HCPCS C1713","","3002045  -  PLATE BN 45MM ZEVO 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3002047","SUP","HCPCS C1713","","3002047  -  PLATE 47MM TI LVL 2 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3002048","SUP","HCPCS C1713","","3002048  -  PLATE BN 48MM ZEVO 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3002049","SUP","HCPCS C1713","","3002049  -  PLATE 49MM TI LVL 2 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3002051","SUP","HCPCS C1713","","3002051  -  PLATE BN 51MM ZEVO 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3002053","SUP","HCPCS C1713","","3002053  -  PLATE 53MM TI LVL 2 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"3003047","SUP","HCPCS C1713","","3003047  -  PLATE BN 47MM ZEVO 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003049","SUP","HCPCS C1713","","3003049  -  PLATE 49MM TI LVL 3 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003055","SUP","HCPCS C1713","","3003055  -  PLATE BN 55MM ZEVO LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003063","SUP","HCPCS C1713","","3003063  -  PLATE BN 63MM ZEVO LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003065","SUP","HCPCS C1713","","3003065  -  PLATE 65MM TI LVL 3 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003067","SUP","HCPCS C1713","","3003067  -  PLATE 67MM TI LVL 3 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003068","SUP","HCPCS C1713","","3003068  -  PLATE 68MM TI LVL 3 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003069","SUP","HCPCS C1713","","3003069  -  PLATE 69MM TI LVL 3 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003071","SUP","HCPCS C1713","","3003071  -  PLATE 71MM TI LVL 3 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"3003248","SUP","Custom 27203010","","REAGENT PCR HOT SRT REAC MX LTCYCLR 96 TST","BOTH IP/OP","$597.50 ","$442.15 ","$0.00 ","$597.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$597.50 ","$0.00 ","$298.75 ","$473.22 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3004071","SUP","HCPCS C1713","","3004071  -  PLATE 71MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004073","SUP","HCPCS C1713","","3004073  -  PLATE BN 73MM ZEVO 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004075","SUP","HCPCS C1713","","3004075  -  PLATE BN 75MM ZEVO 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004077","SUP","HCPCS C1713","","3004077  -  PLATE 77MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004078","SUP","HCPCS C1713","","3004078  -  PLATE BN 78MM ZEVO 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004079","SUP","HCPCS C1713","","3004079  -  PLATE 79MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004081","SUP","HCPCS C1713","","3004081  -  PLATE 81MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004083","SUP","HCPCS C1713","","3004083  -  PLATE 83MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004085","SUP","HCPCS C1713","","3004085  -  PLATE 85MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004086","SUP","HCPCS C1713","","3004086  -  PLATE 86MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004087","SUP","HCPCS C1713","","3004087  -  PLATE 87MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3004089","SUP","HCPCS C1713","","3004089  -  PLATE 89MM TI LVL 4 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"3005075","SUP","HCPCS C1713","","3005075  -  PLATE 75MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005077","SUP","HCPCS C1713","","3005077  -  PLATE 77MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005079","SUP","HCPCS C1713","","3005079  -  PLATE 79MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005081","SUP","HCPCS C1713","","3005081  -  PLATE 81MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005085","SUP","HCPCS C1713","","3005085  -  PLATE 85MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005090","SUP","HCPCS C1713","","3005090  -  PLATE 90MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005095","SUP","HCPCS C1713","","3005095  -  PLATE 95MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005100","SUP","HCPCS C1713","","3005100  -  PLATE 100MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005105","SUP","HCPCS C1713","","3005105  -  PLATE 105MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3005108","SUP","HCPCS C1713","","3005108  -  PLATE 108MM TI LVL 5 ZEVO BONE SPN CERV ANT","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"3034001","SUP","Custom 27203010","","3034001  -  DRILL BIT 3034001 ADJUSTABLE STERILE","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3101001","SUP","Custom 27203010","","EARPLUG FOAM EAR NSE RDC BRL SHP PCTV EAR","BOTH IP/OP","$0.18 ","$0.13 ","$0.00 ","$0.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.18 ","$0.00 ","$0.09 ","$0.14 ","$0.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3120211","SUP","HCPCS C1713","","3120211  -  SCREW BN 4MM 11MM NS ATLNTS ST FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120212","SUP","HCPCS C1713","","3120212  -  SCREW 3120212 4.0 X 12 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120213","SUP","HCPCS C1713","","3120213  -  SCREW 3120213 4.0 X 13 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120214","SUP","HCPCS C1713","","3120214  -  SCREW BONE 4MM 14MM ATLNTS TI ANT CERV SPN SLFTAP FIXANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120215","SUP","HCPCS C1713","","3120215  -  SCREW BN 4MM 15MM NS ATLNTS ST FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120216","SUP","HCPCS C1713","","3120216  -  SCREW 3120216 4.0 X 16 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120217","SUP","HCPCS C1713","","3120217  -  SCREW BN 4MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120218","SUP","HCPCS C1713","","3120218  -  SCREW 3120218 4.0 X 18 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120219","SUP","HCPCS C1713","","3120219  -  SCREW 3120219 4.0 X 19 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120220","SUP","HCPCS C1713","","3120220  -  SCREW 3120220 4.0 X 20 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120311","SUP","HCPCS C1713","","3120311  -  SCREW BN 4MM 11MM NS ATLNTS ST VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120312","SUP","HCPCS C1713","","3120312  -  SCREW 3120312 4.0 X 12 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120313","SUP","HCPCS C1713","","3120313  -  SCREW 3120313 4.0 X 13 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120314","SUP","HCPCS C1713","","3120314  -  SCREW BN 4MM 14MM NS ATLNTS ST VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120315","SUP","HCPCS C1713","","3120315  -  SCREW BN 4MM 15MM NS ATLNTS ST VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120316","SUP","HCPCS C1713","","3120316  -  SCREW BN 4MM 16MM NS ATLNTS ST VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120317","SUP","HCPCS C1713","","3120317  -  SCREW BN 4MM 17MM NS ATLNTS ST VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120318","SUP","HCPCS C1713","","3120318  -  SCREW 3120318 4.0 X 18 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120319","SUP","HCPCS C1713","","3120319  -  SCREW 3120319 4.0 X 19 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120320","SUP","HCPCS C1713","","3120320  -  SCREW 3120320 4.0 X 20 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120411","SUP","HCPCS C1713","","3120411  -  SCREW 3120411 4.0 X 11 SELF DRILL FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120412","SUP","HCPCS C1713","","3120412  -  SCREW BN 4MM 12MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120413","SUP","HCPCS C1713","","3120413  -  SCREW BN 4MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120414","SUP","HCPCS C1713","","3120414  -  SCREW BN 4MM 14MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120415","SUP","HCPCS C1713","","3120415  -  SCREW BN 4MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120416","SUP","HCPCS C1713","","3120416  -  SCREW BN 4MM 16MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120417","SUP","HCPCS C1713","","3120417  -  SCREW 3120417 4.0 X 17 SELF DRILL FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120419","SUP","HCPCS C1713","","3120419  -  SCREW 3120419 4.0 X 19 SELF DRILL FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120420","SUP","HCPCS C1713","","3120420  -  SCREW 3120420 4.0 X 20 SELF DRILL FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120511","SUP","HCPCS C1713","","3120511  -  SCREW BN 4MM 11MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120512","SUP","HCPCS C1713","","3120512  -  SCREW BN 4MM 12MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120513","SUP","HCPCS C1713","","3120513  -  SCREW BN 4MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120514","SUP","HCPCS C1713","","3120514  -  SCREW BN 4MM 14MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120515","SUP","HCPCS C1713","","3120515  -  SCREW BN 4MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120516","SUP","HCPCS C1713","","3120516  -  SCREW BN 4MM 16MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120517","SUP","HCPCS C1713","","3120517  -  SCREW BN 4MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120518","SUP","HCPCS C1713","","3120518  -  SCREW 3120518 4.0 X 18 SELF DRILL VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120519","SUP","HCPCS C1713","","3120519  -  SCREW 3120519 4.0 X 19 SELF DRILL VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3120520","SUP","HCPCS C1713","","3120520  -  SCREW 3120520 4.0 X 20 SELF DRILL VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125211","SUP","HCPCS C1713","","3125211  -  SCREW 3125211 4.5 X 11 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125213","SUP","HCPCS C1713","","3125213  -  SCREW 3125213 4.5 X 13 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125215","SUP","HCPCS C1713","","3125215  -  SCREW 3125215 4.5 X 15 SELF TAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125217","SUP","HCPCS C1713","","3125217  -  SCREW BN 4.5MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125311","SUP","HCPCS C1713","","3125311  -  SCREW 3125311 4.5 X 11 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125313","SUP","HCPCS C1713","","3125313  -  SCREW 3125313 4.5 X 13 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125315","SUP","HCPCS C1713","","3125315  -  SCREW 3125315 4.5 X 15 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125317","SUP","HCPCS C1713","","3125317  -  SCREW 3125317 4.5 X 17 SELF TAP VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125411","SUP","HCPCS C1713","","3125411  -  SCREW 3125411 4.5 X 11 SELF DRILL FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125413","SUP","HCPCS C1713","","3125413  -  SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125415","SUP","HCPCS C1713","","3125415  -  SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125417","SUP","HCPCS C1713","","3125417  -  SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125511","SUP","HCPCS C1713","","3125511  -  SCREW 3125511 4.5 X 11 SELF DRILL VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125513","SUP","HCPCS C1713","","3125513  -  SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125515","SUP","HCPCS C1713","","3125515  -  SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125517","SUP","HCPCS C1713","","3125517  -  SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3125520","SUP","HCPCS C1713","","3125520  -  SCREW 3125520 4.5 X 20 SELF DRILL VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"3155648","SUP","Custom 27203010","","3155648  -  BURR SURG .8MM LOW FRICTION SLEEVE BEARING OTO-FLEX SKEETER","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3200028","SUP","Custom 27203010","","3200028  -  KIT SPNL MAXCESS SHIM FX","BOTH IP/OP","$920.00 ","$680.80 ","$0.00 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3200060","SUP","Custom 27203010","","3200060  -  KIT SPNL MAXCESS MOD STRL DISP","BOTH IP/OP","$3,765.00 ","$2,786.10 ","$0.00 ","$3,765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,765.00 ","$0.00 ","$1,882.50 ","$2,981.88 ","$3,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3230101","SUP","HCPCS C1713","","3230101  -  WIRE FIX 13.5IN KWIRE SPN","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"3240060","SUP","Custom 27803010","","3240060  -  RETRACTOR SURG MAXCESS 4 DISPOSABLE","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3240061","SUP","Custom 27203010","","3240061  -  KIT SPNL MAXCESS4 SHIM DISP","BOTH IP/OP","$2,957.50 ","$2,188.55 ","$0.00 ","$2,957.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,957.50 ","$0.00 ","$1,478.75 ","$2,342.34 ","$2,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3391208","SUP","HCPCS C1713","","3391208  -  SPACER SPNL 4D SM 8MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3391210","SUP","HCPCS C1713","","3391210  -  SPACER SPNL 4D SM 10MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3391212","SUP","HCPCS C1713","","3391212  -  SPACER SPNL 4D SM 12MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3391214","SUP","HCPCS C1713","","3391214  -  SPACER SPNL 4D SM 14MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3392308","SUP","Custom 27803010","","3392308  -  SPACER SPNL 8D MED 8MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3392310","SUP","Custom 27803010","","3392310  -  SPACER SPNL 8D MED 10MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3392312","SUP","Custom 27803010","","3392312  -  SPACER SPNL 8D MED 12MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3392314","SUP","Custom 27803010","","3392314  -  SPACER SPNL 8D MED 14MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3392316","SUP","Custom 27803010","","3392316  -  SPACER SPNL 8D MED 16MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3392318","SUP","HCPCS C1713","","3392318  -  SPACER SPNL 8D MED 18MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3392320","SUP","HCPCS C1713","","3392320  -  SPACER SPNL 8D MED 20MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3393308","SUP","Custom 27803010","","3393308  -  SPACER SPNL 8D LG 8MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393310","SUP","Custom 27803010","","3393310  -  SPACER SPNL 8D LG 10MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393312","SUP","Custom 27803010","","3393312  -  SPACER SPNL 8D LG 12MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393314","SUP","Custom 27803010","","3393314  -  SPACER SPNL 8D LG 14MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393316","SUP","Custom 27803010","","3393316  -  SPACER SPNL 8D LG 16MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393318","SUP","HCPCS C1713","","3393318  -  SPACER SPNL 8D LG 18MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3393320","SUP","HCPCS C1713","","3393320  -  SPACER SPNL 8D LG 20MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3393412","SUP","Custom 27803010","","3393412  -  SPACER SPNL 12D LG 12MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393414","SUP","Custom 27803010","","3393414  -  SPACER SPNL 12D LG 14MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393416","SUP","Custom 27803010","","3393416  -  SPACER SPNL 12D LG 16MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3393418","SUP","HCPCS C1713","","3393418  -  SPACER SPNL 12D LG 18MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3393420","SUP","HCPCS C1713","","3393420  -  SPACER SPNL 12D LG 20MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3394310","SUP","HCPCS C1713","","3394310  -  SPACER SPNL 8D XL 8MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3394312","SUP","HCPCS C1713","","3394312  -  SPACER SPNL 8D XL 12MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3394314","SUP","HCPCS C1713","","3394314  -  SPACER SPNL 8D XL 14MM PRIMTR ADON PEEK-OPTM ALIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3400014","SUP","HCPCS C1713","","3400014  -  SPACER SPNL TLIF HOOD SHIM","BOTH IP/OP","$920.00 ","$680.80 ","$0.00 ","$920.00 ","$414.00 ","$0.00 ","$191.75 ","$0.00 ","$0.00 ","$161.08 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$143.98 ","$0.00 ","$146.46 ","$0.00 "
"3400033","SUP","Custom 27203010","","3400033  -  KIT SPNL MAS LGHT CBL SLFRET TLIF","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3491208","SUP","HCPCS C1713","","3491208  -  SPACER SPNL 4D LRDTC SM 8MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3491210","SUP","HCPCS C1713","","3491210  -  SPACER SPNL 4D LRDTC SM 10MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3491212","SUP","HCPCS C1713","","3491212  -  SPACER SPNL 4D LRDTC SM 12MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3491214","SUP","HCPCS C1713","","3491214  -  SPACER SPNL 4D LRDTC SM 14MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3491216","SUP","HCPCS C1713","","3491216  -  SPACER SPNL 4D LRDTC SM 16MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3491218","SUP","HCPCS C1713","","3491218  -  SPACER SPNL 4D LRDTC SM 18MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3491220","SUP","HCPCS C1713","","3491220  -  SPACER SPNL 4D LRDTC SM 20MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492308","SUP","HCPCS C1713","","3492308  -  SPACER SPNL 8D LRDTC MED 8MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492310","SUP","HCPCS C1713","","3492310  -  SPACER SPNL 8D LRDTC MED 10MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492312","SUP","HCPCS C1713","","3492312  -  SPACER SPNL 8D LRDTC MED 12MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492314","SUP","HCPCS C1713","","3492314  -  SPACER SPNL 8D LRDTC MED 14MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492316","SUP","HCPCS C1713","","3492316  -  SPACER SPNL 8D LRDTC MED 16MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492318","SUP","HCPCS C1713","","3492318  -  SPACER SPNL 8D LRDTC MED 18MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3492320","SUP","HCPCS C1713","","3492320  -  SPACER SPNL 8D LRDTC MED 20MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493308","SUP","HCPCS C1713","","3493308  -  SPACER SPNL 8D LRDTC LG 8MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493310","SUP","HCPCS C1713","","3493310  -  SPACER SPNL 8D LRDTC LG 10MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493312","SUP","HCPCS C1713","","3493312  -  SPACER SPNL 8D LRDTC LG 12MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493314","SUP","HCPCS C1713","","3493314  -  SPACER SPNL 8D LRDTC LG 14MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493316","SUP","HCPCS C1713","","3493316  -  SPACER SPNL 8D LRDTC LG 16MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493318","SUP","HCPCS C1713","","3493318  -  SPACER SPNL 8D LRDTC LG 18MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493320","SUP","HCPCS C1713","","3493320  -  SPACER SPNL 8D LRDTC LG 20MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493412","SUP","HCPCS C1713","","3493412  -  SPACER SPNL 12D LRDTC LG 12MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493414","SUP","HCPCS C1713","","3493414  -  SPACER SPNL 12D LRDTC LG 14MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493416","SUP","HCPCS C1713","","3493416  -  SPACER SPNL 12D LRDTC LG 16MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493418","SUP","HCPCS C1713","","3493418  -  SPACER SPNL 12D LRDTC LG 18MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493420","SUP","HCPCS C1713","","3493420  -  SPACER SPNL 12D LRDTC LG 20MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493512","SUP","HCPCS C1713","","3493512  -  SPACER SPNL 15D LRDTC LG 12MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493514","SUP","HCPCS C1713","","3493514  -  SPACER SPNL 15D LRDTC LG 14MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493516","SUP","HCPCS C1713","","3493516  -  SPACER SPNL 15D LRDTC LG 16MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493518","SUP","HCPCS C1713","","3493518  -  SPACER SPNL 15D LRDTC LG 18MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3493520","SUP","HCPCS C1713","","3493520  -  SPACER SPNL 15D LRDTC LG 20MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3494310","SUP","HCPCS C1713","","3494310  -  SPACER SPNL 8D LRDTC XL 10MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3494312","SUP","HCPCS C1713","","3494312  -  SPACER SPNL 8D LRDTC XL 12MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3494314","SUP","HCPCS C1713","","3494314  -  SPACER SPNL 8D LRDTC XL 14MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3494316","SUP","HCPCS C1713","","3494316  -  SPACER SPNL 8D LRDTC XL 16MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3494318","SUP","HCPCS C1713","","3494318  -  SPACER SPNL 8D LRDTC XL 18MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3494320","SUP","HCPCS C1713","","3494320  -  SPACER SPNL 8D LRDTC XL 20MM PRIMTR VERT BD REPL","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3547213","SUP","HCPCS C1789","","3547213  -  EXPANDER TISS 450ML TAB MED HT STY 7200 CPX3 SLTX CNTOUR","BOTH IP/OP","$3,312.50 ","$2,451.25 ","$0.00 ","$3,312.50 ","$1,490.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.99 ","$3,312.50 ","$0.00 ","$1,656.25 ","$2,623.50 ","$2,650.00 ","$0.00 ","$518.41 ","$0.00 ","$527.35 ","$0.00 "
"3549213","SUP","HCPCS C1789","","3549213  -  EXPANDER TISS P7CM CNTR PRFL MED HT 12.7X10.8CM 450ML CPX4","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"3549214","SUP","HCPCS C1789","","3549214  -  EXPANDER TISS P7.4CM CNTR PRFL MED HT 13.5X11.7CM 550ML CPX4","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"3549215","SUP","HCPCS C1789","","3549215  -  EXPANDER TISS P7.6CM CNTR PRFL MED HT 14.6X12.6CM 650ML CPX4","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"3549216","SUP","HCPCS C1789","","3549216  -  EXPANDER TISS P8CM CNTR PRFL MED HT 15.6X13.3CM 800ML CPX4","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"3712039","SUP","Custom 27203010","","PUNCH SURG 3.5MM UP BITE ANG CIRC CUT 160MM 45D","BOTH IP/OP","$2,515.00 ","$1,861.10 ","$0.00 ","$2,515.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,515.00 ","$0.00 ","$1,257.50 ","$1,991.88 ","$2,012.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3714231","SUP","Custom 27203010","","PROBE SURG 208MM FRNTL OSTM SKR RT ANG 2 END BALL TIP","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3714284","SUP","Custom 27203010","","CURETTE 5MM 2MM 75D CURVE CUP SURG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3756230","SUP","HCPCS C1713","","03756230  -  SCREW SET BUTTRESS BLOCKER XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"3800750","SUP","HCPCS C1713","","03800750  -  SCREW BONE 7.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801530","SUP","HCPCS C1713","","03801530  -  SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801535","SUP","HCPCS C1713","","03801535  -  SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801540","SUP","HCPCS C1713","","03801540  -  SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801545","SUP","HCPCS C1713","","03801545  -  SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801550","SUP","HCPCS C1713","","03801550  -  SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801555","SUP","HCPCS C1713","","03801555  -  SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801630","SUP","HCPCS C1713","","03801630  -  SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801635","SUP","HCPCS C1713","","03801635  -  SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801640","SUP","HCPCS C1713","","03801640  -  SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801645","SUP","HCPCS C1713","","03801645  -  SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801650","SUP","HCPCS C1713","","03801650  -  SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801655","SUP","HCPCS C1713","","03801655  -  SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801660","SUP","HCPCS C1713","","03801660  -  SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801730","SUP","HCPCS C1713","","03801730  -  SCREW BONE 7.5MM 30MM POLYAX XIA SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801735","SUP","HCPCS C1713","","03801735  -  SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801740","SUP","HCPCS C1713","","03801740  -  SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801745","SUP","HCPCS C1713","","03801745  -  SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801750","SUP","HCPCS C1713","","03801750  -  SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801755","SUP","HCPCS C1713","","03801755  -  SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801760","SUP","HCPCS C1713","","03801760  -  SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3801800","SUP","HCPCS C1713","","03801800  -  SCREW BONE 8.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801830","SUP","HCPCS C1713","","03801830  -  SCREW BONE 8.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801835","SUP","HCPCS C1713","","03801835  -  SCREW BONE 8.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801840","SUP","HCPCS C1713","","03801840  -  SCREW BONE 8.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801845","SUP","HCPCS C1713","","03801845  -  SCREW BONE 8.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801850","SUP","HCPCS C1713","","03801850  -  SCREW BONE 8.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801855","SUP","HCPCS C1713","","03801855  -  SCREW BONE 8.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801860","SUP","HCPCS C1713","","03801860  -  SCREW BONE 8.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801870","SUP","HCPCS C1713","","03801870  -  SCREW BONE 8.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801880","SUP","HCPCS C1713","","03801880  -  SCREW BONE 8.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801890","SUP","HCPCS C1713","","03801890  -  SCREW BONE 8.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3801900","SUP","HCPCS C1713","","03801900  -  SCREW BONE 9.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,162.50 ","$860.25 ","$0.00 ","$1,162.50 ","$523.13 ","$0.00 ","$242.29 ","$0.00 ","$0.00 ","$203.54 ","$1,162.50 ","$0.00 ","$581.25 ","$920.70 ","$930.00 ","$0.00 ","$181.93 ","$0.00 ","$185.07 ","$0.00 "
"3801960","SUP","HCPCS C1713","","03801960  -  SCREW BONE 9.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,162.50 ","$860.25 ","$0.00 ","$1,162.50 ","$523.13 ","$0.00 ","$242.29 ","$0.00 ","$0.00 ","$203.54 ","$1,162.50 ","$0.00 ","$581.25 ","$920.70 ","$930.00 ","$0.00 ","$181.93 ","$0.00 ","$185.07 ","$0.00 "
"3801970","SUP","HCPCS C1713","","03801970  -  SCREW BONE 9.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"3801980","SUP","HCPCS C1713","","03801980  -  SCREW BONE 9.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$4,437.50 ","$3,283.75 ","$0.00 ","$4,437.50 ","$1,996.88 ","$0.00 ","$924.89 ","$0.00 ","$0.00 ","$776.97 ","$4,437.50 ","$0.00 ","$2,218.75 ","$3,514.50 ","$3,550.00 ","$0.00 ","$694.47 ","$0.00 ","$706.45 ","$0.00 "
"3801990","SUP","HCPCS C1713","","03801990  -  SCREW BONE 9.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3802070","SUP","Custom 27803010","","03802070  -  ROD SPNL 70MM 6MM XIA TI CENTRL POST","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3802110","SUP","Custom 27803010","","03802110  -  ROD SPNL 110MM 6MM XIA TI CENTRL POST","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3802480","SUP","Custom 27803010","","03802480  -  ROD SPNL 480MM 6MM XIA TI CENTRL POST","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3804025","SUP","Custom 27803010","","03804025  -  CONNECTOR ROD XIA SPN I","BOTH IP/OP","$991.68 ","$733.84 ","$0.00 ","$991.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$991.68 ","$0.00 ","$495.84 ","$785.41 ","$793.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3804120","SUP","Custom 27803010","","03804120  -  CONNECTOR ROD ADAPTER XIA SPN","BOTH IP/OP","$991.68 ","$733.84 ","$0.00 ","$991.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$991.68 ","$0.00 ","$495.84 ","$785.41 ","$793.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3805000","SUP","Custom 27803010","","03805000  -  BLOCK SPINAL XIA TITANIUM SACRAL","BOTH IP/OP","$4,082.50 ","$3,021.05 ","$0.00 ","$4,082.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,082.50 ","$0.00 ","$2,041.25 ","$3,233.34 ","$3,266.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3805001","SUP","Custom 27803010","","03805001  -  CLAMP SPINAL ROD TO ROD PARALLEL XIA TITANIUM","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3805002","SUP","Custom 27803010","","03805002  -  CLAMP SPINAL AXIAL XIA TITANIUM","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3805025","SUP","HCPCS C1713","","03805025  -  SCREW BONE 6.5MM 25MM XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,400.00 ","$1,776.00 ","$0.00 ","$2,400.00 ","$1,080.00 ","$0.00 ","$500.22 ","$0.00 ","$0.00 ","$420.22 ","$2,400.00 ","$0.00 ","$1,200.00 ","$1,900.80 ","$1,920.00 ","$0.00 ","$375.60 ","$0.00 ","$382.08 ","$0.00 "
"3805030","SUP","HCPCS C1713","","03805030  -  SCREW BONE 6.5MM 30MM XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,400.00 ","$1,776.00 ","$0.00 ","$2,400.00 ","$1,080.00 ","$0.00 ","$500.22 ","$0.00 ","$0.00 ","$420.22 ","$2,400.00 ","$0.00 ","$1,200.00 ","$1,900.80 ","$1,920.00 ","$0.00 ","$375.60 ","$0.00 ","$382.08 ","$0.00 "
"3805035","SUP","HCPCS C1713","","03805035  -  SCREW BONE 6.5MM 35MM XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3806001","SUP","Custom 27803010","","03806001  -  HOOK SPINAL LARGE XIA TITANIUM LAMINA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3806002","SUP","Custom 27803010","","03806002  -  HOOK SPINAL MEDIUM XIA TITANIUM LAMINA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3806003","SUP","Custom 27803010","","03806003  -  HOOK SPINAL SMALL XIA TITANIUM LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3806006","SUP","Custom 27803010","","03806006  -  HOOK SPINAL LEFT EXTEND BODY XIA TITANIUM LAMINA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3806007","SUP","Custom 27803010","","03806007  -  HOOK SPINAL RIGHT EXTEND BODY XIA TITANIUM LAMINA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3806009","SUP","Custom 27803010","","03806009  -  HOOK SPINAL LARGE ANGLE LEFT XIA TITANIUM LAMINA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3806012","SUP","Custom 27803010","","03806012  -  HOOK SPINAL SMALL XIA GOLD TITANIUM PEDICLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820100","SUP","HCPCS C1713","","03820100  -  WASHER SPINAL LP XIA II TITANIUM","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"3820101","SUP","Custom 27803010","","03820101  -  CONCTR ROD XIA OFFST SCR TI THORLMBR SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820104","SUP","HCPCS C1713","","03820104  -  STAPLE BONE 1 HOLE XIA TITANIUM SPN ANTERIOR","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"3820110","SUP","HCPCS C1713","","03820110  -  STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3820111","SUP","HCPCS C1713","","03820111  -  STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3820112","SUP","HCPCS C1713","","03820112  -  STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3820113","SUP","HCPCS C1713","","03820113  -  STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3820114","SUP","HCPCS C1713","","03820114  -  STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3820115","SUP","HCPCS C1713","","03820115  -  STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3820120","SUP","HCPCS C1713","","03820120  -  WASHER SPINAL 4.5MM LP XIA TITANIUM","BOTH IP/OP","$223.38 ","$165.30 ","$0.00 ","$223.38 ","$100.52 ","$0.00 ","$46.56 ","$0.00 ","$0.00 ","$39.11 ","$223.38 ","$0.00 ","$111.69 ","$176.92 ","$178.70 ","$0.00 ","$34.96 ","$0.00 ","$35.56 ","$0.00 "
"3820124","SUP","HCPCS C1713","","03820124  -  WASHER SPINAL 8.5MM LP XIA TITANIUM","BOTH IP/OP","$223.38 ","$165.30 ","$0.00 ","$223.38 ","$100.52 ","$0.00 ","$46.56 ","$0.00 ","$0.00 ","$39.11 ","$223.38 ","$0.00 ","$111.69 ","$176.92 ","$178.70 ","$0.00 ","$34.96 ","$0.00 ","$35.56 ","$0.00 "
"3820130","SUP","Custom 27803010","","03820130  -  CONNECTOR ROD 75D XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820131","SUP","Custom 27803010","","03820131  -  CONNECTOR ROD 0D PLATE XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820132","SUP","Custom 27803010","","03820132  -  CONNECTOR ROD 105D OFFST PLATE XIA TITANIUM SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820133","SUP","Custom 27803010","","03820133  -  CONNECTOR ROD NEUTRAL 80MM OFFST XIA 3 TITANIUM STAINLESS","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820134","SUP","Custom 27803010","","03820134  -  CONNECTOR ROD 0D SMALL XIA TITANIUM SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820135","SUP","Custom 27803010","","03820135  -  CONNECTOR ROD 30D SMALL XIA TITANIUM SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820136","SUP","Custom 27803010","","03820136  -  CONNECTOR ROD 0D LARGE XIA TITANIUM SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820137","SUP","Custom 27803010","","03820137  -  CONNECTOR ROD 30D LARGE XIA TITANIUM SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820200","SUP","Custom 27803010","","03820200  -  HOOK SPINAL SMALL STANDARD BLADE XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820201","SUP","Custom 27803010","","03820201  -  HOOK SPINAL SMALL NARROW XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820202","SUP","Custom 27803010","","03820202  -  HOOK SPINAL LARGE STANDARD BLADE XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820203","SUP","Custom 27803010","","03820203  -  HOOK SPINAL LARGE LEGENDARY BLADE XIA II TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820204","SUP","Custom 27803010","","03820204  -  HOOK SPINAL EXTEND XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820206","SUP","Custom 27803010","","03820206  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820207","SUP","Custom 27803010","","03820207  -  HOOK SPINAL LEFT OFFST XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820208","SUP","Custom 27803010","","03820208  -  HOOK SPINAL ANGLE BLADE XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820210","SUP","Custom 27803010","","03820210  -  HOOK SPINAL STANDARD BLADE XIA TITANIUM LMNR THORACIC","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820211","SUP","Custom 27803010","","03820211  -  HOOK SPINAL SMALL NARROW BLADE XIA TITANIUM THORAX LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820212","SUP","Custom 27803010","","03820212  -  HOOK SPINAL SMALL RIGHT OFFST XIA TITANIUM THORACOLUMBAR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820213","SUP","Custom 27803010","","03820213  -  HOOK SPINAL SMALL LEFT OFFST XIA TITANIUM THORACOLUMBAR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820214","SUP","Custom 27803010","","03820214  -  HOOK SPINAL LARGE RIGHT OFFST XIA TITANIUM THORAX LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820215","SUP","Custom 27803010","","03820215  -  HOOK SPINAL LARGE LEFT OFFST XIA TITANIUM THORAX LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820220","SUP","Custom 27803010","","03820220  -  HOOK SPINAL SMALL LOCK XIA TITANIUM PEDICLE","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820221","SUP","Custom 27803010","","03820221  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820230","SUP","Custom 27803010","","03820230  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM TRNSVRS PROCESS","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820231","SUP","Custom 27803010","","03820231  -  HOOK SPINAL LEFT OFFST XIA II TITANIUM TRNSVRS PROCESS","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820240","SUP","Custom 27803010","","03820240  -  HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820241","SUP","Custom 27803010","","03820241  -  HOOK SPINAL WIDE ANGLE REDUCE BLADE XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820242","SUP","Custom 27803010","","03820242  -  HOOK SPINAL ANGLE REDUCE XIA TITANIUM LAMINA","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820243","SUP","Custom 27803010","","03820243  -  HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM THORAX","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820244","SUP","Custom 27803010","","03820244  -  HOOK SPINAL LP RED BLADE XIA TITANIUM PEDIATRIC PEDICLE","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3820425","SUP","HCPCS C1713","","03820425  -  SCREW BONE 4.5MM 25MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820430","SUP","HCPCS C1713","","03820430  -  SCREW BONE 4.5MM 30MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820435","SUP","HCPCS C1713","","03820435  -  SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820440","SUP","HCPCS C1713","","03820440  -  SCREW BONE 4.5MM 40MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820445","SUP","HCPCS C1713","","03820445  -  SCREW BONE 4.5MM 45MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820525","SUP","HCPCS C1713","","03820525  -  SCREW BONE 5.5MM 25MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820530","SUP","HCPCS C1713","","03820530  -  SCREW BONE 5.5MM 30MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820535","SUP","HCPCS C1713","","03820535  -  SCREW BONE 5.5MM 35MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820540","SUP","HCPCS C1713","","03820540  -  SCREW BONE 5.5MM 40MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820545","SUP","HCPCS C1713","","03820545  -  SCREW BONE 5.5MM 45MM XIA SPNL MNOAX","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820550","SUP","HCPCS C1713","","03820550  -  SCREW BONE 5.5MM 50MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820555","SUP","HCPCS C1713","","03820555  -  SCREW BONE 5.5MM 55MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820600","SUP","HCPCS C1713","","03820600  -  SCREW BONE 6.5MM 100MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820630","SUP","HCPCS C1713","","03820630  -  SCREW BONE 6.5MM 30MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820635","SUP","HCPCS C1713","","03820635  -  SCREW BONE 6.5MM 35MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820640","SUP","HCPCS C1713","","03820640  -  SCREW BONE 6.5MM 40MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820645","SUP","HCPCS C1713","","03820645  -  SCREW BONE 6.5MM 45MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820650","SUP","HCPCS C1713","","03820650  -  SCREW BONE 6.5MM 50MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820655","SUP","HCPCS C1713","","03820655  -  SCREW BONE 6.5MM 55MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820660","SUP","HCPCS C1713","","03820660  -  SCREW BONE 6.5MM 60MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820670","SUP","HCPCS C1713","","03820670  -  SCREW BONE 6.5MM 70MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820680","SUP","HCPCS C1713","","03820680  -  SCREW BONE 6.5MM 80MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820690","SUP","HCPCS C1713","","03820690  -  SCREW BONE 6.5MM 90MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820700","SUP","HCPCS C1713","","03820700  -  SCREW BONE 7.5MM 100MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820730","SUP","HCPCS C1713","","03820730  -  SCREW BONE 7.5MM 30MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820735","SUP","HCPCS C1713","","03820735  -  SCREW BONE 7.5MM 35MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820740","SUP","HCPCS C1713","","03820740  -  SCREW BONE 7.5MM 40MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820745","SUP","HCPCS C1713","","03820745  -  SCREW BONE 7.5MM 45MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820750","SUP","HCPCS C1713","","03820750  -  SCREW BONE 7.5MM 50MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820755","SUP","HCPCS C1713","","03820755  -  SCREW BONE 7.5MM 55MM XIA TI SPNL MNOAX","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820760","SUP","HCPCS C1713","","03820760  -  SCREW BONE 7.5MM 60MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820770","SUP","HCPCS C1713","","03820770  -  SCREW BONE 7.5MM 70MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820780","SUP","HCPCS C1713","","03820780  -  SCREW BONE 7.5MM 80MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820790","SUP","HCPCS C1713","","03820790  -  SCREW BONE 7.5MM 90MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820800","SUP","HCPCS C1713","","03820800  -  SCREW BONE 8.5MM 100MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820830","SUP","HCPCS C1713","","03820830  -  SCREW BONE 8.5MM 30MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820835","SUP","HCPCS C1713","","03820835  -  SCREW BONE 8.5MM 35MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820840","SUP","HCPCS C1713","","03820840  -  SCREW BONE 8.5MM 40MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820845","SUP","HCPCS C1713","","03820845  -  SCREW BONE 8.5MM 45MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820850","SUP","HCPCS C1713","","03820850  -  SCREW BONE 8.5MM 50MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820855","SUP","HCPCS C1713","","03820855  -  SCREW BONE 8.5MM 55MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820860","SUP","HCPCS C1713","","03820860  -  SCREW BONE 8.5MM 60MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820870","SUP","HCPCS C1713","","03820870  -  SCREW BONE 8.5MM 70MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3820880","SUP","HCPCS C1713","","03820880  -  SCREW BONE 8.5MM 80MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"3820890","SUP","HCPCS C1713","","03820890  -  SCREW BONE 8.5MM 90MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820900","SUP","HCPCS C1713","","03820900  -  SCREW BONE 9.5MM 100MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820960","SUP","HCPCS C1713","","03820960  -  SCREW BONE 9.5MM 60MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820970","SUP","HCPCS C1713","","03820970  -  SCREW BONE 9.5MM 70MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820980","SUP","HCPCS C1713","","03820980  -  SCREW BONE 9.5MM 80MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3820990","SUP","HCPCS C1713","","03820990  -  SCREW BONE 9.5MM 90MM MNOAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3821015","SUP","Custom 27803010","","03821015  -  CONNECTOR ROD 15MM CROSSLINK XIA MAC TITANIUM THORACOLUMBAR","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3821016","SUP","Custom 27803010","","03821016  -  CONNECTOR ROD 16MM MULTIAX CROSSLINK XIA MAC TITANIUM","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3821017","SUP","Custom 27803010","","03821017  -  CONNECTOR ROD 17MM MULTIAX CROSSLINK XIA MAC TITANIUM","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3821018","SUP","Custom 27803010","","03821018  -  CONNECTOR ROD 18MM MULTIAX CROSSLINK XIA MAC TITANIUM","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3821019","SUP","Custom 27803010","","03821019  -  CONNECTOR ROD 19MM MULTIAX CROSSLINK XIA MAC TITANIUM","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3821020","SUP","Custom 27803010","","03821020  -  CONNECTOR ROD 20MM MULTIAX CROSSLINK XIA MAC TITANIUM","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3821425","SUP","HCPCS C1713","","03821425  -  SCREW BONE 4.5MM 25MM XIA TI THORLMBR SPN POLYAX","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"3821430","SUP","HCPCS C1713","","03821430  -  SCREW BONE 4.5MM 30MM XIA TI THORLMBR SPN POLYAX","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"3821435","SUP","HCPCS C1713","","03821435  -  SCREW BONE 4.5MM 35MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821440","SUP","HCPCS C1713","","03821440  -  SCREW BONE 4.5MM 40MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821445","SUP","HCPCS C1713","","03821445  -  SCREW BONE 4.5MM 45MM FIX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821525","SUP","HCPCS C1713","","03821525  -  SCREW BONE 5.5MM 25MM XIA TI SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"3821530","SUP","HCPCS C1713","","03821530  -  SCREW BONE 5.5MM 30MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821535","SUP","HCPCS C1713","","03821535  -  SCREW BONE 5.5MM 30MM XIA TI SPNL POLYAX LP","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"3821540","SUP","HCPCS C1713","","03821540  -  SCREW BONE 5.5MM 40MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821545","SUP","HCPCS C1713","","03821545  -  SCREW BONE 5.5MM 45MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821550","SUP","HCPCS C1713","","03821550  -  SCREW BONE 5.5MM 50MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821555","SUP","HCPCS C1713","","03821555  -  SCREW BONE 5.5MM 55MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821600","SUP","HCPCS C1713","","03821600  -  SCREW BONE 6.5MM 100MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821630","SUP","HCPCS C1713","","03821630  -  SCREW BONE 6.5MM 30MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821635","SUP","HCPCS C1713","","03821635  -  SCREW BONE 6.5MM 35MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821640","SUP","HCPCS C1713","","03821640  -  SCREW BONE 6.5MM 40MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821645","SUP","HCPCS C1713","","03821645  -  SCREW BONE 6.5MM 45MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821650","SUP","HCPCS C1713","","03821650  -  SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"3821650","SUP","HCPCS C1713","","03821650  -  SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"3821655","SUP","HCPCS C1713","","03821655  -  SCREW BONE 6.5MM 55MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821660","SUP","HCPCS C1713","","03821660  -  SCREW BONE 6.5MM 60MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821670","SUP","HCPCS C1713","","03821670  -  SCREW BONE 6.5MM 70MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3821680","SUP","HCPCS C1713","","03821680  -  SCREW BONE 6.5MM 80MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821690","SUP","HCPCS C1713","","03821690  -  SCREW BONE 6.5MM 90MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821700","SUP","HCPCS C1713","","03821700  -  SCREW BONE 7.5MM 100MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821730","SUP","HCPCS C1713","","03821730  -  SCREW BONE 7.5MM 30MM POLYAX XIA SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821735","SUP","HCPCS C1713","","03821735  -  SCREW BONE 7.5MM 35MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821740","SUP","HCPCS C1713","","03821740  -  SCREW BONE 7.5MM 40MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821745","SUP","HCPCS C1713","","03821745  -  SCREW BONE 7.5MM 45MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821750","SUP","HCPCS C1713","","03821750  -  SCREW BONE 7.5MM 50MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821755","SUP","HCPCS C1713","","03821755  -  SCREW BONE 7.5MM 55MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821760","SUP","HCPCS C1713","","03821760  -  SCREW BONE 7.5MM 60MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821770","SUP","HCPCS C1713","","03821770  -  SCREW BONE 7.5MM 70MM POLYAX XIA II SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821780","SUP","HCPCS C1713","","03821780  -  SCREW BONE 7.5MM 80MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3821790","SUP","HCPCS C1713","","03821790  -  SCREW BONE 7.5MM 90MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3822601","SUP","Custom 27803010","","03822601  -  ROD SPINAL 6MM 600MM XIA VITALLIUM","BOTH IP/OP","$2,356.58 ","$1,743.87 ","$0.00 ","$2,356.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,356.58 ","$0.00 ","$1,178.29 ","$1,866.41 ","$1,885.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3827201","SUP","Custom 27803010","","03827201  -  HOOK SPINAL SMALL NARROW BLADE LMNR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3827202","SUP","Custom 27803010","","03827202  -  HOOK SPINAL LARGE STANDARD BLADE LMNR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3827203","SUP","Custom 27803010","","03827203  -  HOOK SPINAL LARGE NARROW BLADE LMNR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3827211","SUP","Custom 27803010","","03827211  -  HOOK SPINAL STANDARD BLADE LMNR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3827220","SUP","Custom 27803010","","03827220  -  HOOK SPINAL SMALL LONG ARM PEDICLE","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3828425","SUP","HCPCS C1713","","03828425  -  SCREW BONE LONG ARM 4.5MM 25MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828430","SUP","HCPCS C1713","","03828430  -  SCREW BONE LONG ARM 4.5MM 30MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828435","SUP","HCPCS C1713","","03828435  -  SCREW BONE LONG ARM 4.5MM 35MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828440","SUP","HCPCS C1713","","03828440  -  SCREW BONE LONG ARM 4.5MM 40MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828445","SUP","HCPCS C1713","","03828445  -  SCREW BONE LONG ARM 4.5MM 45MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828530","SUP","HCPCS C1713","","03828530  -  SCREW BONE 5.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828535","SUP","HCPCS C1713","","03828535  -  SCREW BONE 5.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828540","SUP","HCPCS C1713","","03828540  -  SCREW BONE 5.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828545","SUP","HCPCS C1713","","03828545  -  SCREW BONE 5.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828550","SUP","HCPCS C1713","","03828550  -  SCREW BONE LONG ARM 5.5MM 50MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828555","SUP","HCPCS C1713","","03828555  -  SCREW BONE LONG ARM 5.5MM 55MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828630","SUP","HCPCS C1713","","03828630  -  SCREW BONE 6.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828635","SUP","HCPCS C1713","","03828635  -  SCREW BONE 6.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828640","SUP","HCPCS C1713","","03828640  -  SCREW BONE 6.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828645","SUP","HCPCS C1713","","03828645  -  SCREW BONE 6.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828650","SUP","HCPCS C1713","","03828650  -  SCREW BONE 6.5MM 50MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828655","SUP","HCPCS C1713","","03828655  -  SCREW BONE 6.5MM 55MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828660","SUP","HCPCS C1713","","03828660  -  SCREW BONE LONG ARM 6.5MM 60MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828730","SUP","HCPCS C1713","","03828730  -  SCREW BONE 7.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828735","SUP","HCPCS C1713","","03828735  -  SCREW BONE 7.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828740","SUP","HCPCS C1713","","03828740  -  SCREW BONE 7.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828745","SUP","HCPCS C1713","","03828745  -  SCREW BONE 7.5MM 45MM MNOAX REDX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828750","SUP","HCPCS C1713","","03828750  -  SCREW BONE 7.5MM 50MM MULTIAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828755","SUP","HCPCS C1713","","03828755  -  SCREW BONE LONG ARM 7.5MM 55MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3828760","SUP","HCPCS C1713","","03828760  -  SCREW BONE LONG ARM 7.5MM 60MM MNOAX XIA TITANIUM SPN","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"3829425","SUP","HCPCS C1713","","03829425  -  SCREW BONE LONG ARM 4.5MM 25MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3829430","SUP","HCPCS C1713","","03829430  -  SCREW BONE LONG ARM 4.5MM 30MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3829435","SUP","HCPCS C1713","","03829435  -  SCREW BONE LONG ARM 4.5MM 35MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3829440","SUP","HCPCS C1713","","03829440  -  SCREW BONE LONG ARM 4.5MM 40MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"3829445","SUP","HCPCS C1713","","03829445  -  SCREW BONE LONG ARM 4.5MM 45MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"3829530","SUP","HCPCS C1713","","03829530  -  SCREW BONE 5.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"3829535","SUP","HCPCS C1713","","03829535  -  SCREW BONE 5.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$371.25 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"3829540","SUP","HCPCS C1713","","03829540  -  SCREW BONE 5.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829550","SUP","HCPCS C1713","","03829550  -  SCREW BONE 5.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829555","SUP","HCPCS C1713","","03829555  -  SCREW BONE LONG ARM 5.5MM 55MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829630","SUP","HCPCS C1713","","03829630  -  SCREW BONE 6.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829635","SUP","HCPCS C1713","","03829635  -  SCREW BONE 6.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829640","SUP","HCPCS C1713","","03829640  -  SCREW BONE 6.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829645","SUP","HCPCS C1713","","03829645  -  SCREW BONE 6.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829650","SUP","HCPCS C1713","","03829650  -  SCREW BONE 6.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829655","SUP","HCPCS C1713","","03829655  -  SCREW BONE 6.5MM 55MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829660","SUP","HCPCS C1713","","03829660  -  SCREW BONE LONG ARM 6.5MM 60MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829730","SUP","HCPCS C1713","","03829730  -  SCREW BONE 7.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829735","SUP","HCPCS C1713","","03829735  -  SCREW BONE 7.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829740","SUP","HCPCS C1713","","03829740  -  SCREW BONE 7.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829745","SUP","HCPCS C1713","","03829745  -  SCREW BONE 7.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829750","SUP","HCPCS C1713","","03829750  -  SCREW BONE 7.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829755","SUP","HCPCS C1713","","03829755  -  SCREW BONE LONG ARM 7.5MM 55MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3829760","SUP","HCPCS C1713","","03829760  -  SCREW BONE LONG ARM 7.5MM 60MM POLYAX XIA TITANIUM SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"3992206","SUP","HCPCS C1713","","3992206  -  SPACER SPNL 0D 27MMX6MM STRL LF CPSTN CNTRL PEEK INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992207","SUP","HCPCS C1713","","3992207  -  SPACER SPNL 22MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992208","SUP","HCPCS C1713","","3992208  -  SPACER SPNL 22MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992209","SUP","HCPCS C1713","","3992209  -  SPACER SPNL 22MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992210","SUP","HCPCS C1713","","3992210  -  SPACER SPNL 22MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992211","SUP","HCPCS C1713","","3992211  -  SPACER SPNL 22MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992212","SUP","HCPCS C1713","","3992212  -  SPACER SPNL 22MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992213","SUP","HCPCS C1713","","3992213  -  SPACER SPNL 22MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992214","SUP","HCPCS C1713","","3992214  -  SPACER SPNL 22MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992215","SUP","HCPCS C1713","","3992215  -  SPACER SPNL 22MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992216","SUP","HCPCS C1713","","3992216  -  SPACER SPNL 22MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"3992606","SUP","HCPCS C1713","","3992606  -  SPACER SPNL 26MMX6MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992607","SUP","HCPCS C1713","","3992607  -  SPACER SPNL 26MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992608","SUP","HCPCS C1713","","3992608  -  SPACER SPNL 26MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992609","SUP","HCPCS C1713","","3992609  -  SPACER SPNL 26MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992610","SUP","HCPCS C1713","","3992610  -  SPACER SPNL 26MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992611","SUP","HCPCS C1713","","3992611  -  SPACER SPNL 26MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992612","SUP","HCPCS C1713","","3992612  -  SPACER SPNL 26MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992613","SUP","HCPCS C1713","","3992613  -  SPACER SPNL 26MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992614","SUP","HCPCS C1713","","3992614  -  SPACER SPNL 26X14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992615","SUP","HCPCS C1713","","3992615  -  SPACER SPNL 26MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3992616","SUP","HCPCS C1713","","3992616  -  SPACER SPNL 26MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993207","SUP","HCPCS C1713","","3993207  -  SPACER SPNL 32MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993208","SUP","HCPCS C1713","","3993208  -  SPACER SPNL 32MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993209","SUP","HCPCS C1713","","3993209  -  SPACER SPNL 32MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993210","SUP","HCPCS C1713","","3993210  -  SPACER SPNL 32MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993211","SUP","HCPCS C1713","","3993211  -  SPACER SPNL 32MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993212","SUP","HCPCS C1713","","3993212  -  SPACER SPNL 32MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993213","SUP","HCPCS C1713","","3993213  -  SPACER SPNL 32MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993214","SUP","HCPCS C1713","","3993214  -  SPACER SPNL 32MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993215","SUP","HCPCS C1713","","3993215  -  SPACER SPNL 32MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993216","SUP","HCPCS C1713","","3993216  -  SPACER SPNL 32MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"3993616","SUP","HCPCS C1713","","3993616  -  SPACER SPNL 36MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"4001122","SUP","HCPCS C1713","","4001122  -  SPACER SPNL 6D 22MMX11MM STRL LF CPSTN CNTRL PEEK INTRBD FS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4001227","SUP","HCPCS C1713","","4001227  -  SPACER SPNL 6D 27MMX12MM STRL LF CPSTN CNTRL PEEK INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"4001322","SUP","HCPCS C1713","","4001322  -  SPACER SPNL 6D 22MMX13MM STRL LF CPSTN CNTRL PEEK INTRBD FS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4011022","SUP","HCPCS C1713","","4011022  -  SPACER SPNL 12D 22MMX10MM STRL LF CPSTN CNTRL PEEK INTRBD FS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4011222","SUP","HCPCS C1713","","4011222  -  SPACER SPNL 12D 22MMX12MM CPSTN CNTRL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4025900","SUP","Custom 27203010","","VIAL ANALY CODA POLYPRO 5 REAGENT 23ML","BOTH IP/OP","$25.75 ","$19.06 ","$0.00 ","$25.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.75 ","$0.00 ","$12.88 ","$20.39 ","$20.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4098545","SUP","HCPCS C1713","","4098545  -  SCREW BONE CYLINDER 8.5MM 45MM OSS SPN","BOTH IP/OP","$1,213.13 ","$897.72 ","$0.00 ","$1,213.13 ","$545.91 ","$0.00 ","$252.85 ","$0.00 ","$0.00 ","$212.41 ","$1,213.13 ","$0.00 ","$606.56 ","$960.80 ","$970.50 ","$0.00 ","$189.85 ","$0.00 ","$193.13 ","$0.00 "
"4098550","SUP","HCPCS C1713","","4098550  -  SCREW BONE CYLINDER 8.5MM 50MM OSS SPN","BOTH IP/OP","$1,213.13 ","$897.72 ","$0.00 ","$1,213.13 ","$545.91 ","$0.00 ","$252.85 ","$0.00 ","$0.00 ","$212.41 ","$1,213.13 ","$0.00 ","$606.56 ","$960.80 ","$970.50 ","$0.00 ","$189.85 ","$0.00 ","$193.13 ","$0.00 "
"4105535","SUP","HCPCS C1713","","4105535  -  SCREW BONE 5.5MM 35MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4105540","SUP","HCPCS C1713","","4105540  -  SCREW BONE 5.5MM 40MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4105545","SUP","HCPCS C1713","","4105545  -  SCREW BONE 5.5MM 45MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4106535","SUP","HCPCS C1713","","4106535  -  SCREW BONE 6.5MM 35MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4106540","SUP","HCPCS C1713","","4106540  -  SCREW BONE 6.5MM 40MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4106550","SUP","HCPCS C1713","","4106550  -  SCREW BONE 6.5MM 50MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4106555","SUP","HCPCS C1713","","4106555  -  SCREW BONE 6.5MM 55MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4106560","SUP","HCPCS C1713","","4106560  -  SCREW BONE 6.5MM 60MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4107017","SUP","Custom 27803010","","4107017  -  CONNECTOR ROD 17MM MULTIAX CROSS XIA CROSSLINK TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107020","SUP","Custom 27803010","","4107020  -  CONNECTOR ROD 20MM MULTIAX CROSS XIA CROSSLINK TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107023","SUP","Custom 27803010","","4107023  -  CONNECTOR ROD 23MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107026","SUP","Custom 27803010","","4107026  -  CONNECTOR ROD 26MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107029","SUP","Custom 27803010","","4107029  -  CONNECTOR ROD 29-31MM MULTIAX CROSS XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107031","SUP","Custom 27803010","","4107031  -  CONNECTOR ROD 31-34MM MULTIAX MAC CROSSLINK TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107035","SUP","Custom 27803010","","4107035  -  CONNECTOR ROD 35MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107038","SUP","Custom 27803010","","4107038  -  CONNECTOR ROD 38-43MM MULTIAX CROSSLINK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107042","SUP","Custom 27803010","","4107042  -  CONNECTOR ROD 42-51MM MULTIAX CROSSLINK MAC SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107050","SUP","Custom 27803010","","4107050  -  CONNECTOR ROD 50-67MM MULTIAX CROSSLINK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107066","SUP","Custom 27803010","","4107066  -  CONNECTOR ROD 66-99MM MULTIAX CROSS XIA MAC TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4107535","SUP","HCPCS C1713","","4107535  -  SCREW BONE 7.5MM 35MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4107545","SUP","HCPCS C1713","","4107545  -  SCREW BONE 7.5MM 45MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4107555","SUP","HCPCS C1713","","4107555  -  SCREW BONE 7.5MM 55MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4107560","SUP","HCPCS C1713","","4107560  -  SCREW BONE 7.5MM 60MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4108535","SUP","HCPCS C1713","","4108535  -  SCREW BONE 8.5MM 35MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4108540","SUP","HCPCS C1713","","4108540  -  SCREW BONE 8.5MM 40MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4108560","SUP","HCPCS C1713","","4108560  -  SCREW BONE 8.5MM 60MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4109040","SUP","HCPCS C1713","","4109040  -  SCREW BONE 9MM 40MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4109045","SUP","HCPCS C1713","","4109045  -  SCREW BONE 9MM 45MM OSS SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"4110101","SUP","Custom 27803010","","4110101  -  HOOK SPINAL OSS LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110102","SUP","Custom 27803010","","4110102  -  HOOK SPINAL LONG OSS LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110113","SUP","Custom 27803010","","4110113  -  HOOK SPINAL SMALL OSS LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110118","SUP","Custom 27803010","","4110118  -  HOOK SPINAL LARGE OSS LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110201","SUP","Custom 27803010","","4110201  -  HOOK SPINAL CENTERED OSS TITANIUM LMNR LUMBAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110202","SUP","Custom 27803010","","4110202  -  HOOK SPINAL LARGE OSS LMNR LUMBAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110203","SUP","Custom 27803010","","4110203  -  HOOK SPINAL OSS RIGHT LMNR LUMBAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110204","SUP","Custom 27803010","","4110204  -  HOOK SPINAL CENTERING OSS LEFT LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110223","SUP","Custom 27803010","","4110223  -  HOOK SPINAL OSS RIGHT INFERIOR LMNR LUMBAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110224","SUP","Custom 27803010","","4110224  -  HOOK SPINAL OSS LEFT INFERIOR LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110231","SUP","Custom 27803010","","4110231  -  HOOK SPINAL SMALL LOWER RIGHT OFFST OSS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110232","SUP","Custom 27803010","","4110232  -  HOOK SPINAL SMALL LOWER LEFT OFFST OSS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4110302","SUP","Custom 27803010","","4110302  -  HOOK SPINAL LONG BLADE OSS TITANIUM PEDICLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4123010","SUP","Custom 27803010","","4123010  -  RING SPNL OSS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4123021","SUP","HCPCS C1713","","4123021  -  CAP SCR SPNL OSS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"4125303","SUP","Custom 27803010","","4125303  -  RING SPNL OSS XL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4195103","SUP","HCPCS C1898","","4195103  -  LEAD PACING 5FR 103CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1","BOTH IP/OP","$3,562.50 ","$2,636.25 ","$0.00 ","$3,562.50 ","$1,603.13 ","$0.00 ","$742.51 ","$0.00 ","$0.00 ","$623.77 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$567.15 ","$0.00 "
"4200015","SUP","HCPCS C1762","","4200015  -  GRAFT SOFT TISSUE DELIVERY UNCRIMPED","BOTH IP/OP","$1,415.30 ","$1,047.32 ","$0.00 ","$1,415.30 ","$0.00 ","$0.00 ","$294.98 ","$0.00 ","$0.00 ","$0.00 ","$1,415.30 ","$0.00 ","$707.65 ","$1,120.92 ","$1,132.24 ","$0.00 ","$221.49 ","$0.00 ","$0.00 ","$0.00 "
"4210564","SUP","Custom 27803010","","4210564  -  SPACER SPNL 14MM 16X5MM STRL PRVL STNDALN PEEK-OPTM CRV","BOTH IP/OP","$5,775.00 ","$4,273.50 ","$0.00 ","$5,775.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,775.00 ","$0.00 ","$2,887.50 ","$4,573.80 ","$4,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4210664","SUP","Custom 27803010","","4210664  -  SPACER SPNL 14MM 16X6MM STRL PRVL STNDALN PEEK-OPTM CRV","BOTH IP/OP","$5,775.00 ","$4,273.50 ","$0.00 ","$5,775.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,775.00 ","$0.00 ","$2,887.50 ","$4,573.80 ","$4,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4210764","SUP","Custom 27803010","","4210764  -  SPACER SPNL 14MM 16X7MM STRL PRVL STNDALN PEEK-OPTM CRV","BOTH IP/OP","$5,775.00 ","$4,273.50 ","$0.00 ","$5,775.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,775.00 ","$0.00 ","$2,887.50 ","$4,573.80 ","$4,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4210864","SUP","Custom 27803010","","4210864  -  SPACER SPNL 14MM 16X8MM STRL PRVL STNDALN PEEK-OPTM CRV","BOTH IP/OP","$5,775.00 ","$4,273.50 ","$0.00 ","$5,775.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,775.00 ","$0.00 ","$2,887.50 ","$4,573.80 ","$4,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4210964","SUP","Custom 27803010","","4210964  -  SPACER SPNL 14MM 16X9MM STRL PRVL STNDALN PEEK-OPTM CRV","BOTH IP/OP","$5,775.00 ","$4,273.50 ","$0.00 ","$5,775.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,775.00 ","$0.00 ","$2,887.50 ","$4,573.80 ","$4,620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240041","SUP","Custom 27803010","","4240041  -  CAGE SPNL 11MM 14X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240064","SUP","Custom 27803010","","4240064  -  CAGE SPNL 14MM 16X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240086","SUP","Custom 27803010","","4240086  -  CAGE SPNL 16MM 18X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240141","SUP","Custom 27803010","","4240141  -  CAGE SPNL 11MM 14X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240164","SUP","Custom 27803010","","4240164  -  CAGE SPNL 14MM 16X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240186","SUP","Custom 27803010","","4240186  -  CAGE SPNL 16MM 18X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240241","SUP","Custom 27803010","","4240241  -  CAGE SPNL 11MM 14X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240264","SUP","Custom 27803010","","4240264  -  CAGE SPNL 14MM 16X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240286","SUP","Custom 27803010","","4240286  -  CAGE SPNL 16MM 18X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240341","SUP","Custom 27803010","","4240341  -  CAGE SPNL 11MM 14X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240364","SUP","Custom 27803010","","4240364  -  CAGE SPNL 14MM 16X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240386","SUP","Custom 27803010","","4240386  -  CAGE SPNL 16MM 18X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240441","SUP","Custom 27803010","","4240441  -  CAGE SPNL 11MM 14X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240464","SUP","Custom 27803010","","4240464  -  CAGE SPNL 14MM 16X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240486","SUP","Custom 27803010","","4240486  -  CAGE SPNL 16MM 18X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240541","SUP","Custom 27803010","","4240541  -  CAGE SPNL 11MM 14X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240564","SUP","Custom 27803010","","4240564  -  CAGE SPNL 14MM 16X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240586","SUP","Custom 27803010","","4240586  -  CAGE SPNL 16MM 18X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240641","SUP","Custom 27803010","","4240641  -  CAGE SPNL 11MM 14X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240664","SUP","Custom 27803010","","4240664  -  CAGE SPNL 14MM 16X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240686","SUP","Custom 27803010","","4240686  -  CAGE SPNL 16MM 18X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240741","SUP","Custom 27803010","","4240741  -  CAGE SPNL 11MM 14X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240764","SUP","Custom 27803010","","4240764  -  CAGE SPNL 14MM 16X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240786","SUP","Custom 27803010","","4240786  -  CAGE SPNL 16MM 18X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240841","SUP","Custom 27803010","","4240841  -  CAGE SPNL 11MM 14X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240864","SUP","Custom 27803010","","4240864  -  CAGE SPNL 14MM 16X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240886","SUP","Custom 27803010","","4240886  -  CAGE SPNL 16MM 18X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240941","SUP","Custom 27803010","","4240941  -  CAGE SPNL 11MM 14X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240964","SUP","Custom 27803010","","4240964  -  CAGE SPNL 14MM 16X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4240986","SUP","Custom 27803010","","4240986  -  CAGE SPNL 16MM 18X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4264606","SUP","Custom 27203010","","4264606  -  KIT PRSS MONITR 84IN SFST 2 INLN BLD SMPL PORT TRNDCR KIT AN","BOTH IP/OP","$41.40 ","$30.64 ","$0.00 ","$41.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.40 ","$0.00 ","$20.70 ","$32.79 ","$33.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4302208","SUP","HCPCS C1713","","4302208  -  SPACER 4302208 TELAMON P VBS 0 22X8MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302210","SUP","HCPCS C1713","","4302210  -  SPACER 4302210 TELAMON P VBS 0 22X10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302212","SUP","HCPCS C1713","","4302212  -  SPACER 4302212 TELAMON P VBS 0 22X12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302214","SUP","HCPCS C1713","","4302214  -  SPACER 4302214 TELAMON P VBS 0 22X14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302608","SUP","HCPCS C1713","","4302608  -  SPACER 4302608 TELAMON P VBS 0 26X8MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302610","SUP","HCPCS C1713","","4302610  -  SPACER 4302610 TELAMON P VBS 0 26X10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302612","SUP","HCPCS C1713","","4302612  -  SPACER 4302612 TELAMON P VBS 0 26X12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4302614","SUP","Custom 27803010","","4302614  -  TELAMON-P 4302614 VBS 0 26 X 14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312513","SUP","Custom 27203010","","STAIN MYCL DFC TB KMNO4 PK 250ML","BOTH IP/OP","$79.45 ","$58.79 ","$0.00 ","$79.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.45 ","$0.00 ","$39.73 ","$62.92 ","$63.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312514","SUP","Custom 27203010","","STAIN MYCL DFC TB ARMN M BTL 250ML","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312518","SUP","Custom 27203010","","STAIN MYCL BBL TB CRBL FCHSN WKG SOL 250ML","BOTH IP/OP","$224.40 ","$166.06 ","$0.00 ","$224.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$224.40 ","$0.00 ","$112.20 ","$177.72 ","$179.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312526","SUP","Custom 27203010","","STAIN MCBL GM CRYS VIOL WKG SOL BBL 1GL","BOTH IP/OP","$132.05 ","$97.72 ","$0.00 ","$132.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.05 ","$0.00 ","$66.03 ","$104.58 ","$105.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312531","SUP","Custom 27203010","","STAIN MCBL GM SFRN WKG SOL DFC 250ML","BOTH IP/OP","$53.95 ","$39.92 ","$0.00 ","$53.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.95 ","$0.00 ","$26.98 ","$42.73 ","$43.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312532","SUP","Custom 27203010","","STAIN MCBL GM SFRN REPL REAGENT BBL 1GL","BOTH IP/OP","$122.30 ","$90.50 ","$0.00 ","$122.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.30 ","$0.00 ","$61.15 ","$96.86 ","$97.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4312542","SUP","Custom 27203010","","STAIN MCBL GM IOD STAB DFC 250ML","BOTH IP/OP","$60.45 ","$44.73 ","$0.00 ","$60.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.45 ","$0.00 ","$30.23 ","$47.88 ","$48.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321039","SUP","Custom 27203010","","MEDIA CULT TSI SLANT MCFLS","BOTH IP/OP","$121.63 ","$90.01 ","$0.00 ","$121.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$121.63 ","$0.00 ","$60.81 ","$96.33 ","$97.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321087","SUP","Custom 27203010","","MEDIA CULT TSA SLANT BBL","BOTH IP/OP","$115.03 ","$85.12 ","$0.00 ","$115.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.03 ","$0.00 ","$57.51 ","$91.10 ","$92.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321283","SUP","Custom 27203010","","MEDIA CULT TSA PLT BBL","BOTH IP/OP","$104.93 ","$77.65 ","$0.00 ","$104.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$104.93 ","$0.00 ","$52.46 ","$83.10 ","$83.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321326","SUP","Custom 27203010","","MEDIA CULT OF BSL MED TUBE BBL 5ML","BOTH IP/OP","$39.93 ","$29.55 ","$0.00 ","$39.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.93 ","$0.00 ","$19.96 ","$31.62 ","$31.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321328","SUP","Custom 27203010","","MEDIA CULT OF MED DEX TUBE BBL 5ML","BOTH IP/OP","$39.93 ","$29.55 ","$0.00 ","$39.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.93 ","$0.00 ","$19.96 ","$31.62 ","$31.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321388","SUP","Custom 27203010","","MEDIA MYCL L-J MED BBL SLANT","BOTH IP/OP","$156.83 ","$116.05 ","$0.00 ","$156.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.83 ","$0.00 ","$78.41 ","$124.21 ","$125.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321739","SUP","Custom 27203010","","MEDIA CULT CDC ANAER AGAR PEA 5% SB PLT BBL","BOTH IP/OP","$25.93 ","$19.19 ","$0.00 ","$25.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.93 ","$0.00 ","$12.96 ","$20.54 ","$20.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4321826","SUP","Custom 27203010","","MEDIA MYCL SAB EMNS DEX AGAR BBL SLANT","BOTH IP/OP","$1.78 ","$1.32 ","$0.00 ","$1.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.78 ","$0.00 ","$0.89 ","$1.41 ","$1.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4328351","SUP","Custom 27203010","","REAGENT MCBL ANSR SHIG FLEXNERI GRP B TYPE 1-6 LYPH 3ML","BOTH IP/OP","$272.00 ","$201.28 ","$0.00 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.00 ","$0.00 ","$136.00 ","$215.42 ","$217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331107","SUP","Custom 27203010","","STRIP X FCTR HMPHLS DIFF TAXO ID","BOTH IP/OP","$314.40 ","$232.66 ","$0.00 ","$314.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.40 ","$0.00 ","$157.20 ","$249.00 ","$251.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331109","SUP","Custom 27203010","","STRIP FCTR 5 DIFF TAXO ID","BOTH IP/OP","$278.90 ","$206.39 ","$0.00 ","$278.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$278.90 ","$0.00 ","$139.45 ","$220.89 ","$223.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331264","SUP","Custom 25003010","","DISK AMPCLN 10 MCG BD SNS DS SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331275","SUP","Custom 25003010","","DISK CLNDMCN 2 MCG BD SNS DS SNS","BOTH IP/OP","$66.78 ","$49.42 ","$0.00 ","$66.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.78 ","$0.00 ","$33.39 ","$52.89 ","$53.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331286","SUP","Custom 25003010","","DISK DXYCL 30 MCG BD SNS DS SNS","BOTH IP/OP","$1.58 ","$1.17 ","$0.00 ","$1.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.58 ","$0.00 ","$0.79 ","$1.25 ","$1.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331290","SUP","Custom 25003010","","DISK EMYCIN 15 MCG SNSDC SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331299","SUP","Custom 25003010","","DISK GNTA 10 MCG BD SNS DS SNS","BOTH IP/OP","$0.68 ","$0.50 ","$0.00 ","$0.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$0.00 ","$0.34 ","$0.54 ","$0.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331321","SUP","Custom 25003010","","DISK PEN 10 UN SNSDC SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331344","SUP","Custom 25003010","","DISK TTRCLN 30 MCG SNSDC SNS","BOTH IP/OP","$64.70 ","$47.88 ","$0.00 ","$64.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.70 ","$0.00 ","$32.35 ","$51.24 ","$51.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331539","SUP","Custom 25003010","","DISK SXT 23.75 MCG 1.25 MCG SNSDC SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331569","SUP","Custom 25003010","","DISK TBR 10 MCG BD SNS DS SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331593","SUP","Custom 25003010","","DISK CFZLN 30 MCG SNSDC SNS","BOTH IP/OP","$67.93 ","$50.27 ","$0.00 ","$67.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.93 ","$0.00 ","$33.96 ","$53.80 ","$54.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331597","SUP","Custom 27203010","","DISK AMK 30 MCG BD SNS DS SNS","BOTH IP/OP","$67.93 ","$50.27 ","$0.00 ","$67.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.93 ","$0.00 ","$33.96 ","$53.80 ","$54.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331609","SUP","Custom 25003010","","DISK PIPRCLN 100 MCG SNSDC SNS","BOTH IP/OP","$60.13 ","$44.50 ","$0.00 ","$60.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.13 ","$0.00 ","$30.06 ","$47.62 ","$48.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331621","SUP","Custom 25003010","","DISK CEFRXM 30 MCG BD SNS DS SNS","BOTH IP/OP","$60.13 ","$44.50 ","$0.00 ","$60.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.13 ","$0.00 ","$30.06 ","$47.62 ","$48.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331633","SUP","Custom 25003010","","DISK CFTZDM 30 MCG BD SNS DS SNS","BOTH IP/OP","$6.55 ","$4.85 ","$0.00 ","$6.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.55 ","$0.00 ","$3.28 ","$5.19 ","$5.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331635","SUP","Custom 25003010","","DISK CEFTRXN 30 MCG SNSDC SNS","BOTH IP/OP","$60.13 ","$44.50 ","$0.00 ","$60.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.13 ","$0.00 ","$30.06 ","$47.62 ","$48.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331649","SUP","Custom 25003010","","DISK TCR CLVLN 75 10 MCG SNSDC SNS","BOTH IP/OP","$66.78 ","$49.42 ","$0.00 ","$66.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.78 ","$0.00 ","$33.39 ","$52.89 ","$53.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331658","SUP","Custom 25003010","","DISK CIPRO 5 MCG BD SNS DS SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331696","SUP","Custom 25003010","","DISK CEFEPIME 30 MCG BD SNS DS SNS","BOTH IP/OP","$6.80 ","$5.03 ","$0.00 ","$6.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.80 ","$0.00 ","$3.40 ","$5.39 ","$5.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331704","SUP","Custom 25003010","","DISK MRPNM 10 MCG BD SNS DS SNS","BOTH IP/OP","$0.68 ","$0.50 ","$0.00 ","$0.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.68 ","$0.00 ","$0.34 ","$0.54 ","$0.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331752","SUP","Custom 25003010","","DISK CFTXM CLVLN 30 10 MCG BD SNS DS SNS","BOTH IP/OP","$216.88 ","$160.49 ","$0.00 ","$216.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.88 ","$0.00 ","$108.44 ","$171.77 ","$173.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4331754","SUP","Custom 25003010","","DISK CFTZDM CLVLN 30 10 MCG BD SNS DS SNS","BOTH IP/OP","$56.13 ","$41.54 ","$0.00 ","$56.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.13 ","$0.00 ","$28.06 ","$44.45 ","$44.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4332208","SUP","HCPCS C1713","","4332208  -  SPACER SPNL 3D 22MMX8MM TLMN-PPEEK-OPTM END PC VERT BD REPL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332210","SUP","HCPCS C1713","","4332210  -  SPACER SPNL 3D 22MMX10MM TLMN-PPEEK-OPTM END PC VERT BD REPL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332212","SUP","HCPCS C1713","","4332212  -  SPACER 4332212 TELAMON P VBS 3 22X12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332214","SUP","HCPCS C1713","","4332214  -  SPACER 4332214 TELAMON P VBS 3 22X14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332608","SUP","HCPCS C1713","","4332608  -  SPACER 4332608 TELAMON P VBS 3 26X8MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332610","SUP","HCPCS C1713","","4332610  -  SPACER 4332610 TELAMON P VBS 3 26X10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332612","SUP","HCPCS C1713","","4332612  -  SPACER SPNL 3D 26MMX12MM TLMN-PPEEK-OPTM END PC VERT BD REPL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4332614","SUP","HCPCS C1713","","4332614  -  SPACER 4332614 TELAMON P VBS 3 26X14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"4340765","SUP","Custom 27203010","","REAGENT VDRL AG BUFF SAL BBL .5ML 60ML SERO","BOTH IP/OP","$183.70 ","$135.94 ","$0.00 ","$183.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$183.70 ","$0.00 ","$91.85 ","$145.49 ","$146.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340826","SUP","Custom 27203010","","REAGENT MCBL COAG PLSM EDTA LYPH RBT BBL 15ML","BOTH IP/OP","$301.25 ","$222.93 ","$0.00 ","$301.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$301.25 ","$0.00 ","$150.63 ","$238.59 ","$241.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340983","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O GRP A GLYCERINATED DFC 3ML","BOTH IP/OP","$291.48 ","$215.70 ","$0.00 ","$291.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$291.48 ","$0.00 ","$145.74 ","$230.85 ","$233.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340984","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O GRP B GLYCERINATED DFC 3ML","BOTH IP/OP","$194.85 ","$144.19 ","$0.00 ","$194.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$194.85 ","$0.00 ","$97.43 ","$154.32 ","$155.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340985","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O GRP C1 GLYCERINATED DFC 3ML","BOTH IP/OP","$363.13 ","$268.72 ","$0.00 ","$363.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$363.13 ","$0.00 ","$181.56 ","$287.60 ","$290.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340986","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O GRP C2 GLYCERINATED DFC 3ML","BOTH IP/OP","$306.63 ","$226.91 ","$0.00 ","$306.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.63 ","$0.00 ","$153.31 ","$242.85 ","$245.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340987","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O GRP D GLYCERINATED DFC 3ML","BOTH IP/OP","$133.28 ","$98.63 ","$0.00 ","$133.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.28 ","$0.00 ","$66.64 ","$105.56 ","$106.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340988","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O GRP E GLYCERINATED DFC 3ML","BOTH IP/OP","$240.65 ","$178.08 ","$0.00 ","$240.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.65 ","$0.00 ","$120.33 ","$190.59 ","$192.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340993","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA O PLVLNT A-1 6 GLYCERINATED DFC 3ML","BOTH IP/OP","$234.25 ","$173.35 ","$0.00 ","$234.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$234.25 ","$0.00 ","$117.13 ","$185.53 ","$187.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4340994","SUP","Custom 27203010","","REAGENT MCBL ANSR SLMNLA 6 GLYCERINATED DFC 3ML","BOTH IP/OP","$228.23 ","$168.89 ","$0.00 ","$228.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$228.23 ","$0.00 ","$114.11 ","$180.76 ","$182.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4360130","SUP","HCPCS C1713","","4360130  -  ENDCAP 4360130 13MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360135","SUP","HCPCS C1713","","4360135  -  ENDCAP 4360135 13MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360138","SUP","HCPCS C1713","","4360138  -  ENDCAP 4360138 13MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360160","SUP","HCPCS C1713","","4360160  -  ENDCAP 4360160 16MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360165","SUP","HCPCS C1713","","4360165  -  ENDCAP 4360165 16MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360168","SUP","HCPCS C1713","","4360168  -  ENDCAP 4360168 16MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360200","SUP","HCPCS C1713","","4360200  -  ENDCAP 4360200 20MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360205","SUP","HCPCS C1713","","4360205  -  ENDCAP 4360205 20MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360208","SUP","HCPCS C1713","","4360208  -  ENDCAP 4360208 20MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360220","SUP","HCPCS C1713","","4360220  -  ENDCAP 4360220 22MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360225","SUP","HCPCS C1713","","4360225  -  ENDCAP 4360225 22MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360228","SUP","HCPCS C1713","","4360228  -  ENDCAP 4360228 22MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360250","SUP","HCPCS C1713","","4360250  -  ENDCAP 4360250 25MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360255","SUP","HCPCS C1713","","4360255  -  ENDCAP 4360255 25MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360258","SUP","HCPCS C1713","","4360258  -  ENDCAP 4360258 25MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360300","SUP","HCPCS C1713","","4360300  -  ENDCAP 4360300 30MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360305","SUP","HCPCS C1713","","4360305  -  ENDCAP 4360305 30MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360308","SUP","HCPCS C1713","","4360308  -  ENDCAP 4360308 30MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4360678","SUP","Custom 27203010","","4360678  -  SYSTEM CULT SCHT GSPK EZ","BOTH IP/OP","$82.23 ","$60.85 ","$0.00 ","$82.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.23 ","$0.00 ","$41.12 ","$65.13 ","$65.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4361130","SUP","HCPCS C1713","","4361130  -  ENDCAP 4361130 13MM 0 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361135","SUP","HCPCS C1713","","4361135  -  ENDCAP 4361135 13MM 15 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361138","SUP","HCPCS C1713","","4361138  -  ENDCAP 4361138 13MM 8 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361160","SUP","HCPCS C1713","","4361160  -  ENDCAP 4361160 16MM 0 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361165","SUP","HCPCS C1713","","4361165  -  ENDCAP 4361165 16MM 15 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361168","SUP","HCPCS C1713","","4361168  -  ENDCAP 4361168 16MM 8 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361200","SUP","HCPCS C1713","","4361200  -  ENDCAP 4361200 20MM 0 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361205","SUP","HCPCS C1713","","4361205  -  ENDCAP 4361205 20MM 15 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361208","SUP","HCPCS C1713","","4361208  -  ENDCAP 4361208 20MM 8 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361220","SUP","HCPCS C1713","","4361220  -  ENDCAP 4361220 22MM 0 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361225","SUP","HCPCS C1713","","4361225  -  ENDCAP 4361225 22MM 15 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361228","SUP","HCPCS C1713","","4361228  -  ENDCAP 4361228 22MM 8 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361250","SUP","HCPCS C1713","","4361250  -  ENDCAP 4361250 25MM 0 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361255","SUP","HCPCS C1713","","4361255  -  ENDCAP 4361255 25MM 15 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361258","SUP","HCPCS C1713","","4361258  -  ENDCAP 4361258 25MM 8 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361300","SUP","HCPCS C1713","","4361300  -  ENDCAP 4361300 30MM 0 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361305","SUP","HCPCS C1713","","4361305  -  ENDCAP 4361305 30MM 15 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4361308","SUP","HCPCS C1713","","4361308  -  ENDCAP 4361308 30MM 8 DEGREE STERILE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"4395872","SUP","Custom 27203010","","MEDIA CULT CHOC AGAR SLANT MCFLS","BOTH IP/OP","$49.63 ","$36.73 ","$0.00 ","$49.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.63 ","$0.00 ","$24.81 ","$39.31 ","$39.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4396266","SUP","Custom 27203010","","MEDIA CULT T-H BROTH TUBE MYCFLS 5ML","BOTH IP/OP","$176.30 ","$130.46 ","$0.00 ","$176.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.30 ","$0.00 ","$88.15 ","$139.63 ","$141.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4396348","SUP","Custom 27203010","","MEDIA MYCL SAB-DEX EMNS AGAR GNTA BBL PLT DP FILL","BOTH IP/OP","$62.88 ","$46.53 ","$0.00 ","$62.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.88 ","$0.00 ","$31.44 ","$49.80 ","$50.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397222","SUP","Custom 27203010","","MEDIA CULT TRSN AGAR PR TUBE BBL 20ML","BOTH IP/OP","$55.08 ","$40.76 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.08 ","$0.00 ","$27.54 ","$43.62 ","$44.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397224","SUP","Custom 27203010","","MEDIA CULT XANTHINE AGAR PR TUBE BBL 20ML","BOTH IP/OP","$55.08 ","$40.76 ","$0.00 ","$55.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.08 ","$0.00 ","$27.54 ","$43.62 ","$44.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397231","SUP","Custom 27203010","","MEDIA CULT LYSOZYME BROTH TUBE MCFLS 5ML","BOTH IP/OP","$62.83 ","$46.49 ","$0.00 ","$62.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.83 ","$0.00 ","$31.41 ","$49.76 ","$50.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397232","SUP","Custom 27203010","","MEDIA CULT LYSOZYME CNTRL BROTH TUBE MCFLS 5ML","BOTH IP/OP","$56.98 ","$42.17 ","$0.00 ","$56.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.98 ","$0.00 ","$28.49 ","$45.13 ","$45.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397448","SUP","Custom 27203010","","MEDIA MYCL MDBRK COHN 7H10 AGAR MCFLS SLANT","BOTH IP/OP","$53.98 ","$39.95 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.98 ","$0.00 ","$26.99 ","$42.75 ","$43.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397770","SUP","Custom 27203010","","MEDIA MYCL SAB EMNS DEX AGAR GNTA SLANT","BOTH IP/OP","$759.05 ","$561.70 ","$0.00 ","$759.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$759.05 ","$0.00 ","$379.53 ","$601.17 ","$607.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397793","SUP","Custom 27203010","","MEDIA CULT SKIRROWS MED PLT BBL","BOTH IP/OP","$60.70 ","$44.92 ","$0.00 ","$60.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.70 ","$0.00 ","$30.35 ","$48.07 ","$48.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397875","SUP","Custom 27203010","","MEDIA MYCL BIRD SEED AGAR BBL PLT","BOTH IP/OP","$45.85 ","$33.93 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.85 ","$0.00 ","$22.93 ","$36.31 ","$36.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397880","SUP","Custom 27203010","","MEDIA CULT BCYE SLCT AGAR PAV PLT BBL","BOTH IP/OP","$37.03 ","$27.40 ","$0.00 ","$37.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.03 ","$0.00 ","$18.51 ","$29.33 ","$29.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4397886","SUP","Custom 27203010","","MEDIA MYCL YST XTRT PHOS AGAR BBL PLT DP FILL","BOTH IP/OP","$26.43 ","$19.56 ","$0.00 ","$26.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.43 ","$0.00 ","$13.21 ","$20.93 ","$21.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4484525","SUP","HCPCS C1713","","4484525  -  SCREW BN 4.5MM 25MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484530","SUP","HCPCS C1713","","4484530  -  SCREW BN 4.5MM 30MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484535","SUP","HCPCS C1713","","4484535  -  SCREW BN 4.5MM 35MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484540","SUP","HCPCS C1713","","4484540  -  SCREW BN 4.5MM 40MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484545","SUP","HCPCS C1713","","4484545  -  SCREW BN 4.5MM 45MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484550","SUP","HCPCS C1713","","4484550  -  SCREW BN 4.5MM 50MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484555","SUP","HCPCS C1713","","4484555  -  SCREW BN 4.5MM 55MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484560","SUP","HCPCS C1713","","4484560  -  SCREW BN 4.5MM 60MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484565","SUP","HCPCS C1713","","4484565  -  SCREW BN 4.5MM 65MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484570","SUP","HCPCS C1713","","4484570  -  SCREW BN 4.5MM 70MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484575","SUP","HCPCS C1713","","4484575  -  SCREW BN 4.5MM 75MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4484580","SUP","HCPCS C1713","","4484580  -  SCREW BN 4.5MM 80MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485525","SUP","HCPCS C1713","","4485525  -  SCREW BN 5.5MM 25MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485530","SUP","HCPCS C1713","","4485530  -  SCREW BN 5.5MM 30MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485535","SUP","HCPCS C1713","","4485535  -  SCREW BN 5.5MM 35MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485540","SUP","HCPCS C1713","","4485540  -  SCREW BN 5.5MM 40MM NS DBR III SPHERX CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485545","SUP","HCPCS C1713","","4485545  -  SCREW BN 5.5MM 45MM NS DBR III SPHERX CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485550","SUP","HCPCS C1713","","4485550  -  SCREW BN 5.5MM 50MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485555","SUP","HCPCS C1713","","4485555  -  SCREW BN 5.5MM 55MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485560","SUP","HCPCS C1713","","4485560  -  SCREW BN 5.5MM 60MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485565","SUP","HCPCS C1713","","4485565  -  SCREW BN 5.5MM 65MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485570","SUP","HCPCS C1713","","4485570  -  SCREW BN 5.5MM 70MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485575","SUP","HCPCS C1713","","4485575  -  SCREW BN 5.5MM 75MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4485580","SUP","HCPCS C1713","","4485580  -  SCREW BN 5.5MM 80MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486510","SUP","HCPCS C1713","","4486510  -  SCREW BN 6.5MM 100MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486511","SUP","HCPCS C1713","","4486511  -  SCREW BN 6.5MM 105MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486512","SUP","HCPCS C1713","","4486512  -  SCREW BN 6.5MM 110MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486513","SUP","HCPCS C1713","","4486513  -  SCREW BN 6.5MM 115MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486514","SUP","HCPCS C1713","","4486514  -  SCREW BN 6.5MM 120MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486525","SUP","HCPCS C1713","","4486525  -  SCREW BN 6.5MM 25MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486530","SUP","HCPCS C1713","","4486530  -  SCREW BN 6.5MM 30MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486535","SUP","HCPCS C1713","","4486535  -  SCREW BN 6.5MM 35MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486540","SUP","HCPCS C1713","","4486540  -  SCREW BN 6.5MM 40MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486545","SUP","HCPCS C1713","","4486545  -  SCREW BN 6.5MM 45MM NS DBR III SPHERX CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486550","SUP","HCPCS C1713","","4486550  -  SCREW BN 6.5MM 50MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486555","SUP","HCPCS C1713","","4486555  -  SCREW BN 6.5MM 55MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486560","SUP","HCPCS C1713","","4486560  -  SCREW BN 6.5MM 60MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486565","SUP","HCPCS C1713","","4486565  -  SCREW BN 6.5MM 65MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486570","SUP","HCPCS C1713","","4486570  -  SCREW BN 6.5MM 70MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486575","SUP","HCPCS C1713","","4486575  -  SCREW BN 6.5MM 75MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486580","SUP","HCPCS C1713","","4486580  -  SCREW BN 6.5MM 80MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486585","SUP","HCPCS C1713","","4486585  -  SCREW BN 6.5MM 85MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486590","SUP","HCPCS C1713","","4486590  -  SCREW BN 6.5MM 90MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4486595","SUP","HCPCS C1713","","4486595  -  SCREW BN 6.5MM 95MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487510","SUP","HCPCS C1713","","4487510  -  SCREW BN 7.5MM 100MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487511","SUP","HCPCS C1713","","4487511  -  SCREW BN 7.5MM 105MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487512","SUP","HCPCS C1713","","4487512  -  SCREW BN 7.5MM 110MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487513","SUP","HCPCS C1713","","4487513  -  SCREW BN 7.5MM 115MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487514","SUP","HCPCS C1713","","4487514  -  SCREW BN 7.5MM 120MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487525","SUP","HCPCS C1713","","4487525  -  SCREW BN 7.5MM 25MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487530","SUP","HCPCS C1713","","4487530  -  SCREW BN 7.5MM 30MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487535","SUP","HCPCS C1713","","4487535  -  SCREW BN 7.5MM 35MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487540","SUP","HCPCS C1713","","4487540  -  SCREW BN 7.5MM 40MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487545","SUP","HCPCS C1713","","4487545  -  SCREW BN 7.5MM 45MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487550","SUP","HCPCS C1713","","4487550  -  SCREW BN 7.5MM 50MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487555","SUP","HCPCS C1713","","4487555  -  SCREW BN 7.5MM 55MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487560","SUP","HCPCS C1713","","4487560  -  SCREW BN 7.5MM 60MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487565","SUP","HCPCS C1713","","4487565  -  SCREW BN 7.5MM 65MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487570","SUP","HCPCS C1713","","4487570  -  SCREW BN 7.5MM 70MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487575","SUP","HCPCS C1713","","4487575  -  SCREW BN 7.5MM 75MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487580","SUP","HCPCS C1713","","4487580  -  SCREW BN 7.5MM 80MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487585","SUP","HCPCS C1713","","4487585  -  SCREW BN 7.5MM 85MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487590","SUP","HCPCS C1713","","4487590  -  SCREW BN 7.5MM 90MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4487595","SUP","HCPCS C1713","","4487595  -  SCREW BN 7.5MM 95MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488510","SUP","HCPCS C1713","","4488510  -  SCREW BN 8.5MM 100MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488511","SUP","HCPCS C1713","","4488511  -  SCREW BN 8.5MM 105MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488512","SUP","HCPCS C1713","","4488512  -  SCREW BN 8.5MM 110MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488513","SUP","HCPCS C1713","","4488513  -  SCREW BN 8.5MM 115MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488514","SUP","HCPCS C1713","","4488514  -  SCREW BN 8.5MM 120MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488525","SUP","HCPCS C1713","","4488525  -  SCREW BN 8.5MM 25MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488530","SUP","HCPCS C1713","","4488530  -  SCREW BN 8.5MM 30MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488535","SUP","HCPCS C1713","","4488535  -  SCREW BN 8.5MM 35MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488540","SUP","HCPCS C1713","","4488540  -  SCREW BN 8.5MM 40MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488545","SUP","HCPCS C1713","","4488545  -  SCREW BN 8.5MM 45MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488550","SUP","HCPCS C1713","","4488550  -  SCREW BN 8.5MM 50MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488555","SUP","HCPCS C1713","","4488555  -  SCREW BN 8.5MM 55MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488560","SUP","HCPCS C1713","","4488560  -  SCREW BN 8.5MM 60MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488565","SUP","HCPCS C1713","","4488565  -  SCREW BN 8.5MM 65MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488570","SUP","HCPCS C1713","","4488570  -  SCREW BN 8.5MM 70MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488575","SUP","HCPCS C1713","","4488575  -  SCREW BN 8.5MM 75MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488580","SUP","HCPCS C1713","","4488580  -  SCREW BN 8.5MM 80MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488585","SUP","HCPCS C1713","","4488585  -  SCREW BN 8.5MM 85MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488590","SUP","HCPCS C1713","","4488590  -  SCREW BN 8.5MM 90MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4488595","SUP","HCPCS C1713","","4488595  -  SCREW BN 8.5MM 95MM DBR III CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"4527020","SUP","Custom 27203010","","4527020  -  BIT DRILL 2MM 102MM AO SHAFT","BOTH IP/OP","$306.30 ","$226.66 ","$0.00 ","$306.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.30 ","$0.00 ","$153.15 ","$242.59 ","$245.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4535020","SUP","Custom 27203010","","4535020  -  BIT DRL 3.6MM RD YLW AO FIT 3.5MM VARIAX LCK PLT SYSTE","BOTH IP/OP","$306.30 ","$226.66 ","$0.00 ","$306.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.30 ","$0.00 ","$153.15 ","$242.59 ","$245.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4622801","SUP","Custom 27203010","","MATTRESS HEAD SECTION /FA","BOTH IP/OP","$1,264.83 ","$935.97 ","$0.00 ","$1,264.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,264.83 ","$0.00 ","$632.41 ","$1,001.75 ","$1,011.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4623002","SUP","Custom 27203010","","MATTRESS FOOT SECTION /FA","BOTH IP/OP","$1,015.35 ","$751.36 ","$0.00 ","$1,015.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,015.35 ","$0.00 ","$507.68 ","$804.16 ","$812.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920040","SUP","HCPCS C1713","","4920040  -  CAGE SPNL 0D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920045","SUP","HCPCS C1713","","4920045  -  CAGE SPNL 0D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920050","SUP","HCPCS C1713","","4920050  -  CAGE SPNL 0D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920055","SUP","HCPCS C1713","","4920055  -  CAGE SPNL 0D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920060","SUP","HCPCS C1713","","4920060  -  CAGE SPNL 0D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920240","SUP","HCPCS C1713","","4920240  -  CAGE SPNL 0D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920245","SUP","HCPCS C1713","","4920245  -  CAGE SPNL 0D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920250","SUP","HCPCS C1713","","4920250  -  CAGE SPNL 0D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920255","SUP","HCPCS C1713","","4920255  -  CAGE SPNL 0D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920260","SUP","HCPCS C1713","","4920260  -  CAGE SPNL 0D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920440","SUP","HCPCS C1713","","4920440  -  CAGE SPNL 0D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920445","SUP","HCPCS C1713","","4920445  -  CAGE SPNL 0D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920450","SUP","HCPCS C1713","","4920450  -  CAGE SPNL 0D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920455","SUP","HCPCS C1713","","4920455  -  CAGE SPNL 0D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920460","SUP","HCPCS C1713","","4920460  -  CAGE SPNL 0D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920640","SUP","HCPCS C1713","","4920640  -  CAGE SPNL 0D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920645","SUP","HCPCS C1713","","4920645  -  CAGE SPNL 0D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920650","SUP","HCPCS C1713","","4920650  -  CAGE SPNL 0D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920655","SUP","HCPCS C1713","","4920655  -  CAGE SPNL 0D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920660","SUP","HCPCS C1713","","4920660  -  CAGE SPNL 0D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920840","SUP","HCPCS C1713","","4920840  -  CAGE SPNL 0D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920845","SUP","HCPCS C1713","","4920845  -  CAGE SPNL 0D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920850","SUP","HCPCS C1713","","4920850  -  CAGE SPNL 0D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920855","SUP","HCPCS C1713","","4920855  -  CAGE SPNL 0D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4920860","SUP","HCPCS C1713","","4920860  -  CAGE SPNL 0D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922040","SUP","HCPCS C1713","","4922040  -  CAGE SPNL 12D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922045","SUP","HCPCS C1713","","4922045  -  CAGE SPNL 12D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922050","SUP","HCPCS C1713","","4922050  -  CAGE SPNL 12D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922055","SUP","HCPCS C1713","","4922055  -  CAGE SPNL 12D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922060","SUP","HCPCS C1713","","4922060  -  CAGE SPNL 12D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922240","SUP","HCPCS C1713","","4922240  -  CAGE SPNL 12D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922245","SUP","HCPCS C1713","","4922245  -  CAGE SPNL 12D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922250","SUP","HCPCS C1713","","4922250  -  CAGE SPNL 12D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922255","SUP","HCPCS C1713","","4922255  -  CAGE SPNL 12D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922260","SUP","HCPCS C1713","","4922260  -  CAGE SPNL 12D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922440","SUP","HCPCS C1713","","4922440  -  CAGE SPNL 12D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922445","SUP","HCPCS C1713","","4922445  -  CAGE SPNL 12D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922450","SUP","HCPCS C1713","","4922450  -  CAGE SPNL 12D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922455","SUP","HCPCS C1713","","4922455  -  CAGE SPNL 12D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922460","SUP","HCPCS C1713","","4922460  -  CAGE SPNL 12D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922640","SUP","HCPCS C1713","","4922640  -  CAGE SPNL 12D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922645","SUP","HCPCS C1713","","4922645  -  CAGE SPNL 12D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922650","SUP","HCPCS C1713","","4922650  -  CAGE SPNL 12D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922655","SUP","HCPCS C1713","","4922655  -  CAGE SPNL 12D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4922660","SUP","HCPCS C1713","","4922660  -  CAGE SPNL 12D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926040","SUP","HCPCS C1713","","4926040  -  CAGE SPNL 6D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926045","SUP","HCPCS C1713","","4926045  -  CAGE SPNL 6D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926050","SUP","HCPCS C1713","","4926050  -  CAGE SPNL 6D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926055","SUP","HCPCS C1713","","4926055  -  CAGE SPNL 6D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926060","SUP","HCPCS C1713","","4926060  -  CAGE SPNL 6D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926240","SUP","HCPCS C1713","","4926240  -  CAGE SPNL 6D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926245","SUP","HCPCS C1713","","4926245  -  CAGE SPNL 6D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926250","SUP","HCPCS C1713","","4926250  -  CAGE SPNL 6D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926255","SUP","HCPCS C1713","","4926255  -  CAGE SPNL 6D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926260","SUP","HCPCS C1713","","4926260  -  CAGE SPNL 6D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926440","SUP","HCPCS C1713","","4926440  -  CAGE SPNL 6D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926445","SUP","HCPCS C1713","","4926445  -  CAGE SPNL 6D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926450","SUP","HCPCS C1713","","4926450  -  CAGE SPNL 6D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926455","SUP","HCPCS C1713","","4926455  -  CAGE SPNL 6D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926460","SUP","HCPCS C1713","","4926460  -  CAGE SPNL 6D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926640","SUP","HCPCS C1713","","4926640  -  CAGE SPNL 6D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926645","SUP","HCPCS C1713","","4926645  -  CAGE SPNL 6D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926650","SUP","HCPCS C1713","","4926650  -  CAGE SPNL 6D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926655","SUP","HCPCS C1713","","4926655  -  CAGE SPNL 6D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926660","SUP","HCPCS C1713","","4926660  -  CAGE SPNL 6D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926840","SUP","HCPCS C1713","","4926840  -  CAGE SPNL 6D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926845","SUP","HCPCS C1713","","4926845  -  CAGE SPNL 6D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926850","SUP","HCPCS C1713","","4926850  -  CAGE SPNL 6D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926855","SUP","HCPCS C1713","","4926855  -  CAGE SPNL 6D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4926860","SUP","HCPCS C1713","","4926860  -  CAGE SPNL 6D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980040","SUP","HCPCS C1713","","4980040  -  CAGE SPNL 0D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980045","SUP","HCPCS C1713","","4980045  -  CAGE SPNL 0D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980050","SUP","HCPCS C1713","","4980050  -  CAGE SPNL 0D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980055","SUP","HCPCS C1713","","4980055  -  CAGE SPNL 0D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980240","SUP","HCPCS C1713","","4980240  -  CAGE SPNL 0D 40X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980245","SUP","HCPCS C1713","","4980245  -  CAGE SPNL 0D 45X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980250","SUP","HCPCS C1713","","4980250  -  CAGE SPNL 0D 50X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980255","SUP","HCPCS C1713","","4980255  -  CAGE SPNL 0D 55X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980440","SUP","HCPCS C1713","","4980440  -  CAGE SPNL 0D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980445","SUP","HCPCS C1713","","4980445  -  CAGE SPNL 0D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980450","SUP","HCPCS C1713","","4980450  -  CAGE SPNL 0D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980455","SUP","HCPCS C1713","","4980455  -  CAGE SPNL 0D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980640","SUP","HCPCS C1713","","4980640  -  CAGE SPNL 0D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980645","SUP","HCPCS C1713","","4980645  -  CAGE SPNL 0D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980650","SUP","HCPCS C1713","","4980650  -  CAGE SPNL 0D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980655","SUP","HCPCS C1713","","4980655  -  CAGE SPNL 0D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980840","SUP","HCPCS C1713","","4980840  -  CAGE SPNL 0D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980845","SUP","HCPCS C1713","","4980845  -  CAGE SPNL 0D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980850","SUP","HCPCS C1713","","4980850  -  CAGE SPNL 0D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4980855","SUP","HCPCS C1713","","4980855  -  CAGE SPNL 0D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986040","SUP","HCPCS C1713","","4986040  -  CAGE SPNL 6D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986045","SUP","HCPCS C1713","","4986045  -  CAGE SPNL 6D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986050","SUP","HCPCS C1713","","4986050  -  CAGE SPNL 6D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986055","SUP","HCPCS C1713","","4986055  -  CAGE SPNL 6D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986060","SUP","HCPCS C1713","","4986060  -  CAGE SPNL 6D 60X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986240","SUP","HCPCS C1713","","4986240  -  CAGE SPNL 6D 40X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986245","SUP","HCPCS C1713","","4986245  -  CAGE SPNL 6D 45X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986250","SUP","HCPCS C1713","","4986250  -  CAGE SPNL 6D 50X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986255","SUP","HCPCS C1713","","4986255  -  CAGE SPNL 6D 55X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986260","SUP","HCPCS C1713","","4986260  -  CAGE SPNL 6D 60X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986440","SUP","HCPCS C1713","","4986440  -  CAGE SPNL 6D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986445","SUP","HCPCS C1713","","4986445  -  CAGE SPNL 6D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986450","SUP","HCPCS C1713","","4986450  -  CAGE SPNL 6D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986455","SUP","HCPCS C1713","","4986455  -  CAGE SPNL 6D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986460","SUP","HCPCS C1713","","4986460  -  CAGE SPNL 6D 60X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986640","SUP","HCPCS C1713","","4986640  -  CAGE SPNL 6D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986645","SUP","HCPCS C1713","","4986645  -  CAGE SPNL 6D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986650","SUP","HCPCS C1713","","4986650  -  CAGE SPNL 6D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986655","SUP","HCPCS C1713","","4986655  -  CAGE SPNL 6D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986660","SUP","HCPCS C1713","","4986660  -  CAGE SPNL 6D 60X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986840","SUP","HCPCS C1713","","4986840  -  CAGE SPNL 6D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986845","SUP","HCPCS C1713","","4986845  -  CAGE SPNL 6D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986850","SUP","HCPCS C1713","","4986850  -  CAGE SPNL 6D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986855","SUP","HCPCS C1713","","4986855  -  CAGE SPNL 6D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"4986860","SUP","HCPCS C1713","","4986860  -  CAGE SPNL 6D 60X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"5010001","SUP","HCPCS C1788","","5010001  -  DEVICE BX 6 PORT ASP BN MRW","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$156.38 ","$0.00 ","$72.43 ","$0.00 ","$0.00 ","$60.84 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$54.38 ","$0.00 ","$55.32 ","$0.00 "
"5010005","SUP","Custom 27804086","","5010005  -  SUBSTITUTE BNGF 5ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5010008","SUP","Custom 27203010","","5010008  -  NEEDLE SPNL 8IN ASP PORT","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5010010","SUP","Custom 27804086","","5010010  -  SUBSTITUTE BNGF 10ML STRL FORMAGRAFT GRNL BVN CLGN MTRX","BOTH IP/OP","$3,505.00 ","$2,593.70 ","$0.00 ","$3,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,505.00 ","$0.00 ","$1,752.50 ","$2,775.96 ","$2,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5010020","SUP","Custom 27804086","","5010020  -  SUBSTITUTE BNGF 20ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP","BOTH IP/OP","$3,505.00 ","$2,593.70 ","$0.00 ","$3,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,505.00 ","$0.00 ","$1,752.50 ","$2,775.96 ","$2,804.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5010024","SUP","HCPCS C1884","","5010024  -  FILTER CV .035IN LOPRFL CONE 9FR 70CM VNTC LP PROVEN DSGN","BOTH IP/OP","$2,925.60 ","$2,164.94 ","$0.00 ","$2,925.60 ","$1,316.52 ","$0.00 ","$609.77 ","$0.00 ","$0.00 ","$512.25 ","$2,925.60 ","$0.00 ","$1,462.80 ","$2,317.08 ","$2,340.48 ","$0.00 ","$457.86 ","$0.00 ","$465.76 ","$0.00 "
"5010085","SUP","Custom 27804086","","5010085  -  SUBSTITUTE BNGF SM STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP","BOTH IP/OP","$4,130.00 ","$3,056.20 ","$0.00 ","$4,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,130.00 ","$0.00 ","$2,065.00 ","$3,270.96 ","$3,304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5010125","SUP","HCPCS C1713","","5010125  -  SUBSTITUTE BNGF LG STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$2,008.13 ","$0.00 ","$930.10 ","$0.00 ","$0.00 ","$781.35 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$698.38 ","$0.00 ","$710.43 ","$0.00 "
"5010205","SUP","Custom 27804086","","5010205  -  SUBSTITUTE BNGF 5ML STRL FORMAGRAFT STRP BVN CLGN MTRX TCP","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5013001","SUP","HCPCS C1762","","5013001  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 1ML","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$0.00 ","$0.00 "
"5013005","SUP","HCPCS C1762","","5013005  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 5ML","BOTH IP/OP","$5,632.50 ","$4,168.05 ","$0.00 ","$5,632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,632.50 ","$0.00 ","$2,816.25 ","$4,460.94 ","$4,506.00 ","$0.00 ","$881.49 ","$0.00 ","$0.00 ","$0.00 "
"5013010","SUP","Custom 27804086","","5013010  -  GRAFT BN 10ML OSTEOCEL + CLLR BN MTRX","BOTH IP/OP","$9,625.00 ","$7,122.50 ","$0.00 ","$9,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,625.00 ","$0.00 ","$4,812.50 ","$7,623.00 ","$7,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5013015","SUP","HCPCS C1762","","5013015  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 15ML","BOTH IP/OP","$11,475.00 ","$8,491.50 ","$0.00 ","$11,475.00 ","$0.00 ","$0.00 ","$2,391.68 ","$0.00 ","$0.00 ","$0.00 ","$11,475.00 ","$0.00 ","$5,737.50 ","$9,088.20 ","$9,180.00 ","$0.00 ","$1,795.84 ","$0.00 ","$0.00 ","$0.00 "
"5016001","SUP","HCPCS C1762","","5016001  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 1ML","BOTH IP/OP","$1,345.00 ","$995.30 ","$0.00 ","$1,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,345.00 ","$0.00 ","$672.50 ","$1,065.24 ","$1,076.00 ","$0.00 ","$210.49 ","$0.00 ","$0.00 ","$0.00 "
"5016005","SUP","HCPCS C1762","","5016005  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 5ML","BOTH IP/OP","$6,195.00 ","$4,584.30 ","$0.00 ","$6,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,195.00 ","$0.00 ","$3,097.50 ","$4,906.44 ","$4,956.00 ","$0.00 ","$969.52 ","$0.00 ","$0.00 ","$0.00 "
"5016010","SUP","HCPCS C1762","","5016010  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 10ML","BOTH IP/OP","$10,652.50 ","$7,882.85 ","$0.00 ","$10,652.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,652.50 ","$0.00 ","$5,326.25 ","$8,436.78 ","$8,522.00 ","$0.00 ","$1,667.12 ","$0.00 ","$0.00 ","$0.00 "
"5017905","SUP","HCPCS C1713","","5017905  -  SCREW BN 1.7MM 5MM NS LEIBINGER UNV 2 SLF DRL XPN TI MDFC","BOTH IP/OP","$103.40 ","$76.52 ","$0.00 ","$147.90 ","$66.56 ","$0.00 ","$21.55 ","$0.00 ","$0.00 ","$25.90 ","$147.90 ","$0.00 ","$73.95 ","$117.14 ","$118.32 ","$0.00 ","$23.15 ","$0.00 ","$23.55 ","$0.00 "
"5020001","SUP","HCPCS C1713","","5020001  -  GRAFT BN SM STRL LF PROPEL ALGRF PTTY","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"5020005","SUP","HCPCS C1713","","5020005  -  GRAFT BN MED STRL LF PROPEL ALGRF PTTY","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5020010","SUP","HCPCS C1713","","5020010  -  GRAFT BN LG STRL LF PROPEL ALGRF PTTY","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5020404","SUP","HCPCS C1713","","5020404  -  SCREW BN 2MM 4MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL","BOTH IP/OP","$87.40 ","$64.68 ","$0.00 ","$125.93 ","$56.67 ","$0.00 ","$18.22 ","$0.00 ","$0.00 ","$22.05 ","$125.93 ","$0.00 ","$62.96 ","$99.74 ","$100.74 ","$0.00 ","$19.71 ","$0.00 ","$20.05 ","$0.00 "
"5022105","SUP","HCPCS C1713","","5022105  -  GRAFT BN MED PROPEL ALGRF DBM FBR","BOTH IP/OP","$1,450.00 ","$1,073.00 ","$0.00 ","$1,450.00 ","$652.50 ","$0.00 ","$302.22 ","$0.00 ","$0.00 ","$253.88 ","$1,450.00 ","$0.00 ","$725.00 ","$1,148.40 ","$1,160.00 ","$0.00 ","$226.93 ","$0.00 ","$230.84 ","$0.00 "
"5022112","SUP","HCPCS C1713","","5022112  -  GRAFT BN SM BOAT PROPEL ALGRF DBM FBR","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"5022113","SUP","HCPCS C1713","","5022113  -  GRAFT BN LG BOAT PROPEL ALGRF DBM FBR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"5030641","SUP","HCPCS C1713","","5030641  -  CAGE SPNL 11MM 14MMX6MM STRL ANTM RADOPQ PTC CRV INTRBD FS","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$5,940.00 ","$2,673.00 ","$0.00 ","$1,238.04 ","$0.00 ","$0.00 ","$1,040.05 ","$5,940.00 ","$0.00 ","$2,970.00 ","$4,704.48 ","$4,752.00 ","$0.00 ","$929.61 ","$0.00 ","$945.65 ","$0.00 "
"5101302","SUP","HCPCS C1713","","5101302  -  CAGE SPNL 12D 30X11X10MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5101308","SUP","HCPCS C1713","","5101308  -  CAGE SPNL 8D 30X11X10MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5104308","SUP","HCPCS C1713","","5104308  -  CAGE SPNL 8D 30MMX14MMX10 NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5109308","SUP","HCPCS C1713","","5109308  -  CAGE SPNL 8D 30X10X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5111308","SUP","HCPCS C1713","","5111308  -  CAGE SPNL 8D 30X11X11MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5119308","SUP","HCPCS C1713","","5119308  -  CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5121308","SUP","HCPCS C1713","","5121308  -  CAGE SPNL 8D 30X12X11MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5129308","SUP","HCPCS C1713","","5129308  -  CAGE SPNL 8D 30X12X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5149308","SUP","HCPCS C1713","","5149308  -  CAGE SPNL 8D 30X14X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5161600","SUP","Custom 27803010","","5161600  -  ENDCAP 16MM RND 0 DEG OD16 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5161604","SUP","Custom 27803010","","5161604  -  ENDCAP 16MM RND 4 DEG OD16 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5161608","SUP","Custom 27803010","","5161608  -  ENDCAP 16MM RND 8 DEG OD16 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5161612","SUP","Custom 27803010","","5161612  -  ENDCAP 16MM RND 12 DEG XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5163000","SUP","Custom 27803010","","5163000  -  ENDCAP OD16X16X30MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5163004","SUP","Custom 27803010","","5163004  -  ENDCAP� OD16X16X30MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5163014","SUP","Custom 27803010","","5163014  -  ENDCAP OD16X16X30MM -4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5164000","SUP","Custom 27803010","","5164000  -  ENDCAP OD16X16X40MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5164004","SUP","Custom 27803010","","5164004  -  ENDCAP OD16X16X40MM 4 DEG TI XCORE TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5164014","SUP","Custom 27803010","","5164014  -  ENDCAP OD16X16X40MM -4 DEG TI OD16 TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5181308","SUP","HCPCS C1713","","5181308  -  CAGE SPNL 8D 30X11X8MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5181800","SUP","Custom 27803010","","5181800  -  ENDCAP 18MM RND 0 DEG OD16 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5181804","SUP","Custom 27803010","","5181804  -  ENDCAP 18MM RND 4 DEG OD16 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5181808","SUP","Custom 27803010","","5181808  -  ENDCAP 18MM RND 8 DEG OD16 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5181812","SUP","Custom 27803010","","5181812  -  ENDCAP 18MM RND 12 DEG OD18 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5189300","SUP","HCPCS C1713","","5189300  -  CAGE SPNL 0D 30X9X8MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5189302","SUP","HCPCS C1713","","5189302  -  CAGE SPNL 12D 30X9X8MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5191302","SUP","HCPCS C1713","","5191302  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5191308","SUP","HCPCS C1713","","5191308  -  CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5199300","SUP","HCPCS C1713","","5199300  -  CAGE SPNL 0D 30X9X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5199302","SUP","HCPCS C1713","","5199302  -  CAGE SPNL 12D 30X9X9MM NS LF CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5289308","SUP","HCPCS C1713","","5289308  -  CAGE SPNL 8D 30X9X8MM NS LF TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5300252","SUP","HCPCS C1713","","5300252  -  CAGE SPNL 12D OBLQ 25X10X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5300254","SUP","HCPCS C1713","","5300254  -  CAGE SPNL 4D OBLQ 25X10X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5300302","SUP","HCPCS C1713","","5300302  -  CAGE SPNL 12D OBLQ 30X10X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5300304","SUP","HCPCS C1713","","5300304  -  CAGE SPNL 4D OBLQ 30X10X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5300354","SUP","HCPCS C1713","","5300354  -  CAGE SPNL 4D OBLQ 35X10X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5304252","SUP","HCPCS C1713","","5304252  -  CAGE SPNL 12D OBLQ 25X10X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5304254","SUP","HCPCS C1713","","5304254  -  CAGE SPNL 4D OBLQ 25X10X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5304302","SUP","HCPCS C1713","","5304302  -  CAGE SPNL 12D OBLQ 30X10X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5304304","SUP","HCPCS C1713","","5304304  -  CAGE SPNL 4D OBLQ 30X10X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5320252","SUP","HCPCS C1713","","5320252  -  CAGE SPNL 12D OBLQ 25X12X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5320254","SUP","HCPCS C1713","","5320254  -  CAGE SPNL 4D OBLQ 25X12X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5320302","SUP","HCPCS C1713","","5320302  -  CAGE SPNL 12D OBLQ 30X12X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5320304","SUP","HCPCS C1713","","5320304  -  CAGE SPNL 4D OBLQ 30X12X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5320354","SUP","HCPCS C1713","","5320354  -  CAGE SPNL 4D OBLQ 35X12X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5324252","SUP","HCPCS C1713","","5324252  -  CAGE SPNL 12D OBLQ 25X12X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5324254","SUP","HCPCS C1713","","5324254  -  CAGE SPNL 4D OBLQ 25X12X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5324302","SUP","HCPCS C1713","","5324302  -  CAGE SPNL 12D OBLQ 30X12X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5324304","SUP","HCPCS C1713","","5324304  -  CAGE SPNL 4D OBLQ 30X12X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5340252","SUP","HCPCS C1713","","5340252  -  CAGE SPNL 12D OBLQ 25X14X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5340254","SUP","HCPCS C1713","","5340254  -  CAGE SPNL 4D OBLQ 25X14X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5340302","SUP","HCPCS C1713","","5340302  -  CAGE SPNL 12D OBLQ 30X14X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5340304","SUP","HCPCS C1713","","5340304  -  CAGE SPNL 4D OBLQ 30X14X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5340354","SUP","HCPCS C1713","","5340354  -  CAGE SPNL 4D OBLQ 35X14X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5380252","SUP","HCPCS C1713","","5380252  -  CAGE SPNL 12D OBLQ 25X8X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5380254","SUP","HCPCS C1713","","5380254  -  CAGE SPNL 4D OBLQ 25X8X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5380302","SUP","HCPCS C1713","","5380302  -  CAGE SPNL 12D OBLQ 30X8X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5380304","SUP","HCPCS C1713","","5380304  -  CAGE SPNL 4D OBLQ 30X8X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5380354","SUP","HCPCS C1713","","5380354  -  CAGE SPNL 4D OBLQ 35X8X10MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5384252","SUP","HCPCS C1713","","5384252  -  CAGE SPNL 12D OBLQ 25X8X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5384254","SUP","HCPCS C1713","","5384254  -  CAGE SPNL 4D OBLQ 25X8X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5384302","SUP","HCPCS C1713","","5384302  -  CAGE SPNL 12D OBLQ 30X8X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5384304","SUP","HCPCS C1713","","5384304  -  CAGE SPNL 4D OBLQ 30X8X14MM TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400250","SUP","HCPCS C1713","","5400250  -  CAGE SPNL 0D OBLQ 25X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400252","SUP","HCPCS C1713","","5400252  -  CAGE SPNL 12D OBLQ 25X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400254","SUP","HCPCS C1713","","5400254  -  CAGE SPNL 4D OBLQ 25X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400255","SUP","HCPCS C1713","","5400255  -  CAGE SPNL 15D OBLQ 25X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400258","SUP","HCPCS C1713","","5400258  -  CAGE SPNL 8D OBLQ 25X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400300","SUP","HCPCS C1713","","5400300  -  CAGE SPNL 0D OBLQ 30X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400302","SUP","HCPCS C1713","","5400302  -  CAGE SPNL 12D OBLQ 30X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400304","SUP","HCPCS C1713","","5400304  -  CAGE SPNL 4D OBLQ 30X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400305","SUP","HCPCS C1713","","5400305  -  CAGE SPNL 15D OBLQ 30X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400308","SUP","HCPCS C1713","","5400308  -  CAGE SPNL 8D OBLQ 30X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400350","SUP","HCPCS C1713","","5400350  -  CAGE SPNL 0D OBLQ 35X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400352","SUP","HCPCS C1713","","5400352  -  CAGE SPNL 12D OBLQ 35X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400354","SUP","HCPCS C1713","","5400354  -  CAGE SPNL 4D OBLQ 35X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5400355","SUP","HCPCS C1713","","5400355  -  CAGE SPNL 15D OBLQ 35X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400358","SUP","HCPCS C1713","","5400358  -  CAGE SPNL 8D OBLQ 35X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400400","SUP","HCPCS C1713","","5400400  -  CAGE SPNL 0D OBLQ 40X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400402","SUP","HCPCS C1713","","5400402  -  CAGE SPNL 12D OBLQ 40X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400404","SUP","HCPCS C1713","","5400404  -  CAGE SPNL 4D OBLQ 40X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400405","SUP","HCPCS C1713","","5400405  -  CAGE SPNL 15D OBLQ 40X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5400408","SUP","HCPCS C1713","","5400408  -  CAGE SPNL 8D OBLQ 40X10X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404250","SUP","HCPCS C1713","","5404250  -  CAGE SPNL 0D OBLQ 25X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404252","SUP","HCPCS C1713","","5404252  -  CAGE SPNL 12D OBLQ 25X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5404254","SUP","HCPCS C1713","","5404254  -  CAGE SPNL 4D OBLQ 25X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5404255","SUP","HCPCS C1713","","5404255  -  CAGE SPNL 15D OBLQ 25X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404258","SUP","HCPCS C1713","","5404258  -  CAGE SPNL 8D OBLQ 25X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404300","SUP","HCPCS C1713","","5404300  -  CAGE SPNL 0D OBLQ 30X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404302","SUP","HCPCS C1713","","5404302  -  CAGE SPNL 12D OBLQ 30X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404304","SUP","HCPCS C1713","","5404304  -  CAGE SPNL 4D OBLQ 30X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5404305","SUP","HCPCS C1713","","5404305  -  CAGE SPNL 15D OBLQ 30X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404308","SUP","HCPCS C1713","","5404308  -  CAGE SPNL 8D OBLQ 30X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404350","SUP","HCPCS C1713","","5404350  -  CAGE SPNL 0D OBLQ 35X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404352","SUP","HCPCS C1713","","5404352  -  CAGE SPNL 12D OBLQ 35X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404354","SUP","HCPCS C1713","","5404354  -  CAGE SPNL 4D OBLQ 35X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404355","SUP","HCPCS C1713","","5404355  -  CAGE SPNL 15D OBLQ 35X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404358","SUP","HCPCS C1713","","5404358  -  CAGE SPNL 8D OBLQ 35X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404400","SUP","HCPCS C1713","","5404400  -  CAGE SPNL 0D OBLQ 40X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404402","SUP","HCPCS C1713","","5404402  -  CAGE SPNL 12D OBLQ 40X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404404","SUP","HCPCS C1713","","5404404  -  CAGE SPNL 4D OBLQ 40X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404405","SUP","HCPCS C1713","","5404405  -  CAGE SPNL 15D OBLQ 40X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5404408","SUP","HCPCS C1713","","5404408  -  CAGE SPNL 8D OBLQ 40X14X10MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410250","SUP","HCPCS C1713","","5410250  -  CAGE SPNL 0D OBLQ 25X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410252","SUP","HCPCS C1713","","5410252  -  CAGE SPNL 12D OBLQ 25X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410254","SUP","HCPCS C1713","","5410254  -  CAGE SPNL 4D OBLQ 25X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410255","SUP","HCPCS C1713","","5410255  -  CAGE SPNL 15D OBLQ 25X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410258","SUP","HCPCS C1713","","5410258  -  CAGE SPNL 8D OBLQ 25X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410300","SUP","HCPCS C1713","","5410300  -  CAGE SPNL 0D OBLQ 30X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410302","SUP","HCPCS C1713","","5410302  -  CAGE SPNL 12D OBLQ 30X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410304","SUP","HCPCS C1713","","5410304  -  CAGE SPNL 4D OBLQ 30X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410305","SUP","HCPCS C1713","","5410305  -  CAGE SPNL 15D OBLQ 30X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410308","SUP","HCPCS C1713","","5410308  -  CAGE SPNL 8D OBLQ 30X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410350","SUP","HCPCS C1713","","5410350  -  CAGE SPNL 0D OBLQ 35X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410352","SUP","HCPCS C1713","","5410352  -  CAGE SPNL 12D OBLQ 35X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410354","SUP","HCPCS C1713","","5410354  -  CAGE SPNL 4D OBLQ 35X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410355","SUP","HCPCS C1713","","5410355  -  CAGE SPNL 15D OBLQ 35X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410358","SUP","HCPCS C1713","","5410358  -  CAGE SPNL 8D OBLQ 35X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410400","SUP","HCPCS C1713","","5410400  -  CAGE SPNL 0D OBLQ 40X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410402","SUP","HCPCS C1713","","5410402  -  CAGE SPNL 12D OBLQ 40X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410404","SUP","HCPCS C1713","","5410404  -  CAGE SPNL 4D OBLQ 40X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410405","SUP","HCPCS C1713","","5410405  -  CAGE SPNL 15D OBLQ 40X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5410408","SUP","HCPCS C1713","","5410408  -  CAGE SPNL 8D OBLQ 40X10X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414250","SUP","HCPCS C1713","","5414250  -  CAGE SPNL 0D OBLQ 25X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414252","SUP","HCPCS C1713","","5414252  -  CAGE SPNL 12D OBLQ 25X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414254","SUP","HCPCS C1713","","5414254  -  CAGE SPNL 4D OBLQ 25X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414255","SUP","HCPCS C1713","","5414255  -  CAGE SPNL 15D OBLQ 25X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414258","SUP","HCPCS C1713","","5414258  -  CAGE SPNL 8D OBLQ 25X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414300","SUP","HCPCS C1713","","5414300  -  CAGE SPNL 0D OBLQ 30X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414302","SUP","HCPCS C1713","","5414302  -  CAGE SPNL 12D OBLQ 30X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414304","SUP","HCPCS C1713","","5414304  -  CAGE SPNL 4D OBLQ 30X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414305","SUP","HCPCS C1713","","5414305  -  CAGE SPNL 15D OBLQ 30X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414308","SUP","HCPCS C1713","","5414308  -  CAGE SPNL 8D OBLQ 30X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414350","SUP","HCPCS C1713","","5414350  -  CAGE SPNL 0D OBLQ 35X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414352","SUP","HCPCS C1713","","5414352  -  CAGE SPNL 12D OBLQ 35X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414355","SUP","HCPCS C1713","","5414355  -  CAGE SPNL 15D OBLQ 35X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414358","SUP","HCPCS C1713","","5414358  -  CAGE SPNL 8D OBLQ 35X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414400","SUP","HCPCS C1713","","5414400  -  CAGE SPNL 0D OBLQ 40X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414402","SUP","HCPCS C1713","","5414402  -  CAGE SPNL 12D OBLQ 40X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414404","SUP","HCPCS C1713","","5414404  -  CAGE SPNL 4D OBLQ 40X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414405","SUP","HCPCS C1713","","5414405  -  CAGE SPNL 15D OBLQ 40X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5414408","SUP","HCPCS C1713","","5414408  -  CAGE SPNL 8D OBLQ 40X14X11MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420250","SUP","HCPCS C1713","","5420250  -  CAGE SPNL 0D OBLQ 25X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420252","SUP","HCPCS C1713","","5420252  -  CAGE SPNL 12D OBLQ 25X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5420254","SUP","HCPCS C1713","","5420254  -  CAGE SPNL 4D OBLQ 25X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5420255","SUP","HCPCS C1713","","5420255  -  CAGE SPNL 15D OBLQ 25X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420258","SUP","HCPCS C1713","","5420258  -  CAGE SPNL 8D OBLQ 25X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420300","SUP","HCPCS C1713","","5420300  -  CAGE SPNL 0D OBLQ 30X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420302","SUP","HCPCS C1713","","5420302  -  CAGE SPNL 12D OBLQ 30X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5420304","SUP","HCPCS C1713","","5420304  -  CAGE SPNL 4D OBLQ 30X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5420305","SUP","HCPCS C1713","","5420305  -  CAGE SPNL 15D OBLQ 30X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420308","SUP","HCPCS C1713","","5420308  -  CAGE SPNL 8D OBLQ 30X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420350","SUP","HCPCS C1713","","5420350  -  CAGE SPNL 0D OBLQ 35X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420352","SUP","HCPCS C1713","","5420352  -  CAGE SPNL 12D OBLQ 35X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420354","SUP","HCPCS C1713","","5420354  -  CAGE SPNL 4D OBLQ 35X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5420355","SUP","HCPCS C1713","","5420355  -  CAGE SPNL 15D OBLQ 35X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420358","SUP","HCPCS C1713","","5420358  -  CAGE SPNL 8D OBLQ 35X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420400","SUP","HCPCS C1713","","5420400  -  CAGE SPNL 0D OBLQ 40X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420402","SUP","HCPCS C1713","","5420402  -  CAGE SPNL 12D OBLQ 40X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420404","SUP","HCPCS C1713","","5420404  -  CAGE SPNL 4D OBLQ 40X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420405","SUP","HCPCS C1713","","5420405  -  CAGE SPNL 15D OBLQ 40X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5420408","SUP","HCPCS C1713","","5420408  -  CAGE SPNL 8D OBLQ 40X10X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424250","SUP","HCPCS C1713","","5424250  -  CAGE SPNL 0D OBLQ 25X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424252","SUP","HCPCS C1713","","5424252  -  CAGE SPNL 12D OBLQ 25X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5424254","SUP","HCPCS C1713","","5424254  -  CAGE SPNL 4D OBLQ 25X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5424255","SUP","HCPCS C1713","","5424255  -  CAGE SPNL 15D OBLQ 25X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424258","SUP","HCPCS C1713","","5424258  -  CAGE SPNL 8D OBLQ 25X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424300","SUP","HCPCS C1713","","5424300  -  CAGE SPNL 0D OBLQ 30X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424302","SUP","HCPCS C1713","","5424302  -  CAGE SPNL 12D OBLQ 30X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424304","SUP","HCPCS C1713","","5424304  -  CAGE SPNL 4D OBLQ 30X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5424305","SUP","HCPCS C1713","","5424305  -  CAGE SPNL 15D OBLQ 30X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424308","SUP","HCPCS C1713","","5424308  -  CAGE SPNL 8D OBLQ 30X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424350","SUP","HCPCS C1713","","5424350  -  CAGE SPNL 0D OBLQ 35X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424352","SUP","HCPCS C1713","","5424352  -  CAGE SPNL 12D OBLQ 35X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424354","SUP","HCPCS C1713","","5424354  -  CAGE SPNL 4D OBLQ 35X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424355","SUP","HCPCS C1713","","5424355  -  CAGE SPNL 15D OBLQ 35X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424358","SUP","HCPCS C1713","","5424358  -  CAGE SPNL 8D OBLQ 35X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424400","SUP","HCPCS C1713","","5424400  -  CAGE SPNL 0D OBLQ 40X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424402","SUP","HCPCS C1713","","5424402  -  CAGE SPNL 12D OBLQ 40X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424404","SUP","HCPCS C1713","","5424404  -  CAGE SPNL 4D OBLQ 40X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424405","SUP","HCPCS C1713","","5424405  -  CAGE SPNL 15D OBLQ 40X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5424408","SUP","HCPCS C1713","","5424408  -  CAGE SPNL 8D OBLQ 40X14X12MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430250","SUP","HCPCS C1713","","5430250  -  CAGE SPNL 0D OBLQ 25X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430252","SUP","HCPCS C1713","","5430252  -  CAGE SPNL 12D OBLQ 25X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430254","SUP","HCPCS C1713","","5430254  -  CAGE SPNL 4D OBLQ 25X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430255","SUP","HCPCS C1713","","5430255  -  CAGE SPNL 15D OBLQ 25X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430258","SUP","HCPCS C1713","","5430258  -  CAGE SPNL 8D OBLQ 25X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430300","SUP","HCPCS C1713","","5430300  -  CAGE SPNL 0D OBLQ 30X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430302","SUP","HCPCS C1713","","5430302  -  CAGE SPNL 12D OBLQ 30X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430304","SUP","HCPCS C1713","","5430304  -  CAGE SPNL 4D OBLQ 30X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430305","SUP","HCPCS C1713","","5430305  -  CAGE SPNL 15D OBLQ 30X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430308","SUP","HCPCS C1713","","5430308  -  CAGE SPNL 8D OBLQ 30X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430350","SUP","HCPCS C1713","","5430350  -  CAGE SPNL 0D OBLQ 35X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430352","SUP","HCPCS C1713","","5430352  -  CAGE SPNL 12D OBLQ 35X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430354","SUP","HCPCS C1713","","5430354  -  CAGE SPNL 4D OBLQ 35X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430355","SUP","HCPCS C1713","","5430355  -  CAGE SPNL 15D OBLQ 35X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430358","SUP","HCPCS C1713","","5430358  -  CAGE SPNL 8D OBLQ 35X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430400","SUP","HCPCS C1713","","5430400  -  CAGE SPNL 0D OBLQ 40X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430402","SUP","HCPCS C1713","","5430402  -  CAGE SPNL 12D OBLQ 40X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430404","SUP","HCPCS C1713","","5430404  -  CAGE SPNL 4D OBLQ 40X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430405","SUP","HCPCS C1713","","5430405  -  CAGE SPNL 15D OBLQ 40X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5430408","SUP","HCPCS C1713","","5430408  -  CAGE SPNL 8D OBLQ 40X10X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434250","SUP","HCPCS C1713","","5434250  -  CAGE SPNL 0D OBLQ 25X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434252","SUP","HCPCS C1713","","5434252  -  CAGE SPNL 12D OBLQ 25X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434254","SUP","HCPCS C1713","","5434254  -  CAGE SPNL 4D OBLQ 25X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434255","SUP","HCPCS C1713","","5434255  -  CAGE SPNL 15D OBLQ 25X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434258","SUP","HCPCS C1713","","5434258  -  CAGE SPNL 8D OBLQ 25X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434300","SUP","HCPCS C1713","","5434300  -  CAGE SPNL 0D OBLQ 30X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434302","SUP","HCPCS C1713","","5434302  -  CAGE SPNL 12D OBLQ 30X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434304","SUP","HCPCS C1713","","5434304  -  CAGE SPNL 4D OBLQ 30X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434305","SUP","HCPCS C1713","","5434305  -  CAGE SPNL 15D OBLQ 30X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434308","SUP","HCPCS C1713","","5434308  -  CAGE SPNL 8D OBLQ 30X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434350","SUP","HCPCS C1713","","5434350  -  CAGE SPNL 0D OBLQ 35X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434352","SUP","HCPCS C1713","","5434352  -  CAGE SPNL 12D OBLQ 35X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434354","SUP","HCPCS C1713","","5434354  -  CAGE SPNL 4D OBLQ 35X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434355","SUP","HCPCS C1713","","5434355  -  CAGE SPNL 15D OBLQ 35X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434358","SUP","HCPCS C1713","","5434358  -  CAGE SPNL 8D OBLQ 35X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434400","SUP","HCPCS C1713","","5434400  -  CAGE SPNL 0D OBLQ 40X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434402","SUP","HCPCS C1713","","5434402  -  CAGE SPNL 12D OBLQ 40X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434404","SUP","HCPCS C1713","","5434404  -  CAGE SPNL 4D OBLQ 40X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434405","SUP","HCPCS C1713","","5434405  -  CAGE SPNL 15D OBLQ 40X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5434408","SUP","HCPCS C1713","","5434408  -  CAGE SPNL 8D OBLQ 40X14X13MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440030","SUP","HCPCS C1713","","5440030  -  SET SCREW 5440030 4.75 TI NS BRK OFF","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5440130","SUP","HCPCS C1713","","5440130  -  SET SCREW 5440130 4.75 TI NS NON BRK OFF","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5440230","SUP","HCPCS C1713","","5440230  -  SET SCREW 5440230 4.75 TI NS RED BRK OFF","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5440250","SUP","HCPCS C1713","","5440250  -  CAGE SPNL 0D OBLQ 25X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440252","SUP","HCPCS C1713","","5440252  -  CAGE SPNL 12D OBLQ 25X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5440254","SUP","HCPCS C1713","","5440254  -  CAGE SPNL 4D OBLQ 25X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5440255","SUP","HCPCS C1713","","5440255  -  CAGE SPNL 15D OBLQ 25X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440258","SUP","HCPCS C1713","","5440258  -  CAGE SPNL 8D OBLQ 25X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440300","SUP","HCPCS C1713","","5440300  -  CAGE SPNL 0D OBLQ 30X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440302","SUP","HCPCS C1713","","5440302  -  CAGE SPNL 12D OBLQ 30X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5440304","SUP","HCPCS C1713","","5440304  -  CAGE SPNL 4D OBLQ 30X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5440305","SUP","HCPCS C1713","","5440305  -  CAGE SPNL 15D OBLQ 30X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440308","SUP","HCPCS C1713","","5440308  -  CAGE SPNL 8D OBLQ 30X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440350","SUP","HCPCS C1713","","5440350  -  CAGE SPNL 0D OBLQ 35X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440352","SUP","HCPCS C1713","","5440352  -  CAGE SPNL 12D OBLQ 35X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440355","SUP","HCPCS C1713","","5440355  -  CAGE SPNL 15D OBLQ 35X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440358","SUP","HCPCS C1713","","5440358  -  CAGE SPNL 8D OBLQ 35X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440400","SUP","HCPCS C1713","","5440400  -  CAGE SPNL 0D OBLQ 40X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440402","SUP","HCPCS C1713","","5440402  -  CAGE SPNL 12D OBLQ 40X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440404","SUP","HCPCS C1713","","5440404  -  CAGE SPNL 4D OBLQ 40X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440405","SUP","HCPCS C1713","","5440405  -  CAGE SPNL 15D OBLQ 40X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440408","SUP","HCPCS C1713","","5440408  -  CAGE SPNL 8D OBLQ 40X10X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5440430","SUP","HCPCS C1713","","5440430  -  SCREW SET BREAKOFF SOLERA SEXTANT CD HORIZON TITANIUM SPN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5441101","SUP","HCPCS C1713","","5441101  -  HOOK 5441101 4.75 TI NS PEDICLE  XSML","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441102","SUP","HCPCS C1713","","5441102  -  HOOK 5441102 PEDICLE 4.75 SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441103","SUP","HCPCS C1713","","5441103  -  HOOK 5441103 PEDICLE 4.75 MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441104","SUP","HCPCS C1713","","5441104  -  HOOK 5441104 PEDICLE 4.75 LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441112","SUP","HCPCS C1713","","5441112  -  HOOK 5441112 WIDE BLADE 4.75 SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441113","SUP","HCPCS C1713","","5441113  -  HOOK 5441113 WIDE BLADE 4.75 MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441114","SUP","HCPCS C1713","","5441114  -  HOOK 5441114 WIDE BLADE 4.75 LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441122","SUP","HCPCS C1713","","5441122  -  HOOK 5441122 NARROW BLADE 4.75 SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441123","SUP","HCPCS C1713","","5441123  -  HOOK 5441123 NARROW BLADE 4.75 MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441124","SUP","HCPCS C1713","","5441124  -  HOOK 5441124 NARROW BLADE 4.75 LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441133","SUP","HCPCS C1713","","5441133  -  HOOK 5441133 RAMP WIDE BLADE 4.75 MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441142","SUP","HCPCS C1713","","5441142  -  HOOK 5441142 RMP NRW BLADE 4.75 SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441143","SUP","HCPCS C1713","","5441143  -  HOOK 5441143 RMP NRW BLADE 4.75 MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441172","SUP","HCPCS C1713","","5441172  -  HOOK 5441172 EXTENDED BODY 4.75 SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441173","SUP","HCPCS C1713","","5441173  -  HOOK 5441173 EXTENDED BODY 4.75 MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441174","SUP","HCPCS C1713","","5441174  -  HOOK 5441174 EXTENDED BODY 4.75 LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441196","SUP","HCPCS C1713","","5441196  -  HOOK 5441196 4.75 TI NS OFFSET SML RT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441197","SUP","HCPCS C1713","","5441197  -  HOOK 5441197 4.75 TI NS OFFSET SML LEFT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441198","SUP","HCPCS C1713","","5441198  -  HOOK 5441198 OFFSET 4.75 RIGHT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441199","SUP","HCPCS C1713","","5441199  -  HOOK 5441199 OFFSET 4.75 LEFT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441302","SUP","HCPCS C1713","","5441302  -  HOOK 5441302 4.75 TI NS TAH PEDICLE SML","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441303","SUP","HCPCS C1713","","5441303  -  HOOK 5441303 4.75 TI NS TAH PEDICLE MED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441342","SUP","HCPCS C1713","","5441342  -  HOOK 5441342 4.75 TI NS TAH TRAN PRO SML","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5441343","SUP","HCPCS C1713","","5441343  -  HOOK 5441343 4.75 TI NS TAH TRAN PRO MED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"5442016","SUP","HCPCS C1713","","5442016  -  CROSSLINK 5442016 4.75 TI NS FIXED 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442019","SUP","HCPCS C1713","","5442019  -  CROSSLINK 5442019 4.75 TI NS FIXED 19MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442022","SUP","HCPCS C1713","","5442022  -  CROSSLINK 5442022 4.75 TI NS FIXED 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442025","SUP","HCPCS C1713","","5442025  -  CROSSLINK 5442025 4.75 TI NS FIXED 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442028","SUP","HCPCS C1713","","5442028  -  CROSSLINK 5442028 4.75 TI NS FIXED 28MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442031","SUP","HCPCS C1713","","5442031  -  CROSSLINK 5442031 4.75 TI NS FIXED 31MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442034","SUP","HCPCS C1713","","5442034  -  CROSSLINK 5442034 4.75 TI NS FIXED 34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442037","SUP","HCPCS C1713","","5442037  -  CROSSLINK 5442037 4.75 TI NS FIXED 37MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442130","SUP","HCPCS C1713","","5442130  -  PLATE BN 30-32MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442132","SUP","HCPCS C1713","","5442132  -  PLATE BN 32-37MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442136","SUP","HCPCS C1713","","5442136  -  PLATE BN 36-38MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442138","SUP","HCPCS C1713","","5442138  -  PLATE BN 38-42MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442141","SUP","HCPCS C1713","","5442141  -  PLATE BN 41-48MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442144","SUP","HCPCS C1713","","5442144  -  CROSSLINK 5442144 4.75X10 MLTSPN 44-54MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442147","SUP","HCPCS C1713","","5442147  -  PLATE BN 47-60MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442152","SUP","HCPCS C1713","","5442152  -  CROSSLINK 5442152 4.75X10 MLTSPN 52-70MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5442160","SUP","HCPCS C1713","","5442160  -  CROSSLINK 5442160 4.75X10 MLTSPN 60-86MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"5443110","SUP","Custom 27803010","","5443110  -  CONNECTOR 5443110 475/635 TI CL ILC 10MM","BOTH IP/OP","$1,929.00 ","$1,427.46 ","$0.00 ","$1,929.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,929.00 ","$0.00 ","$964.50 ","$1,527.77 ","$1,543.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5443120","SUP","Custom 27803010","","5443120  -  CONNECTOR 5443120 475/635 TI CL ILC 20MM","BOTH IP/OP","$1,929.00 ","$1,427.46 ","$0.00 ","$1,929.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,929.00 ","$0.00 ","$964.50 ","$1,527.77 ","$1,543.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5443130","SUP","Custom 27803010","","5443130  -  CONNECTOR 5443130 475/635 TI CL ILC 30MM","BOTH IP/OP","$1,929.00 ","$1,427.46 ","$0.00 ","$1,929.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,929.00 ","$0.00 ","$964.50 ","$1,527.77 ","$1,543.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5443160","SUP","Custom 27803010","","5443160  -  CONNECTOR 5443160 475/635 TI CL ILC 60MM","BOTH IP/OP","$1,929.00 ","$1,427.46 ","$0.00 ","$1,929.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,929.00 ","$0.00 ","$964.50 ","$1,527.77 ","$1,543.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5444250","SUP","HCPCS C1713","","5444250  -  CAGE SPNL 0D OBLQ 25X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444252","SUP","HCPCS C1713","","5444252  -  CAGE SPNL 12D OBLQ 25X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444254","SUP","HCPCS C1713","","5444254  -  CAGE SPNL 4D OBLQ 25X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444255","SUP","HCPCS C1713","","5444255  -  CAGE SPNL 15D OBLQ 25X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444258","SUP","HCPCS C1713","","5444258  -  CAGE SPNL 8D OBLQ 25X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444300","SUP","HCPCS C1713","","5444300  -  CAGE SPNL 0D OBLQ 30X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444302","SUP","HCPCS C1713","","5444302  -  CAGE SPNL 12D OBLQ 30X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444304","SUP","HCPCS C1713","","5444304  -  CAGE SPNL 4D OBLQ 30X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444305","SUP","HCPCS C1713","","5444305  -  CAGE SPNL 15D OBLQ 30X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444308","SUP","HCPCS C1713","","5444308  -  CAGE SPNL 8D OBLQ 30X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444350","SUP","HCPCS C1713","","5444350  -  CAGE SPNL 0D OBLQ 35X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444352","SUP","HCPCS C1713","","5444352  -  CAGE SPNL 12D OBLQ 35X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444354","SUP","HCPCS C1713","","5444354  -  CAGE SPNL 4D OBLQ 35X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444355","SUP","HCPCS C1713","","5444355  -  CAGE SPNL 15D OBLQ 35X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444358","SUP","HCPCS C1713","","5444358  -  CAGE SPNL 8D OBLQ 35X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444400","SUP","HCPCS C1713","","5444400  -  CAGE SPNL 0D OBLQ 40X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444402","SUP","HCPCS C1713","","5444402  -  CAGE SPNL 12D OBLQ 40X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444404","SUP","HCPCS C1713","","5444404  -  CAGE SPNL 4D OBLQ 40X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444405","SUP","HCPCS C1713","","5444405  -  CAGE SPNL 15D OBLQ 40X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5444408","SUP","HCPCS C1713","","5444408  -  CAGE SPNL 8D OBLQ 40X14X14MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460250","SUP","HCPCS C1713","","5460250  -  CAGE SPNL 0D OBLQ 25X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5460252","SUP","HCPCS C1713","","5460252  -  CAGE SPNL 12D OBLQ 25X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460254","SUP","HCPCS C1713","","5460254  -  CAGE SPNL 4D OBLQ 25X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5460255","SUP","HCPCS C1713","","5460255  -  CAGE SPNL 15D OBLQ 25X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460258","SUP","HCPCS C1713","","5460258  -  CAGE SPNL 8D OBLQ 25X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460300","SUP","HCPCS C1713","","5460300  -  CAGE SPNL 0D OBLQ 30X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5460302","SUP","HCPCS C1713","","5460302  -  CAGE SPNL 12D OBLQ 30X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460304","SUP","HCPCS C1713","","5460304  -  CAGE SPNL 4D OBLQ 30X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5460305","SUP","HCPCS C1713","","5460305  -  CAGE SPNL 15D OBLQ 30X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460308","SUP","HCPCS C1713","","5460308  -  CAGE SPNL 8D OBLQ 30X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460350","SUP","HCPCS C1713","","5460350  -  CAGE SPNL 0D OBLQ 35X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460352","SUP","HCPCS C1713","","5460352  -  CAGE SPNL 12D OBLQ 35X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460354","SUP","HCPCS C1713","","5460354  -  CAGE SPNL 4D OBLQ 35X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460355","SUP","HCPCS C1713","","5460355  -  CAGE SPNL 15D OBLQ 35X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460358","SUP","HCPCS C1713","","5460358  -  CAGE SPNL 8D OBLQ 35X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460400","SUP","HCPCS C1713","","5460400  -  CAGE SPNL 0D OBLQ 40X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460402","SUP","HCPCS C1713","","5460402  -  CAGE SPNL 12D OBLQ 40X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460404","SUP","HCPCS C1713","","5460404  -  CAGE SPNL 4D OBLQ 40X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460405","SUP","HCPCS C1713","","5460405  -  CAGE SPNL 15D OBLQ 40X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5460408","SUP","HCPCS C1713","","5460408  -  CAGE SPNL 8D OBLQ 40X10X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464250","SUP","HCPCS C1713","","5464250  -  CAGE SPNL 0D OBLQ 25X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464252","SUP","HCPCS C1713","","5464252  -  CAGE SPNL 12D OBLQ 25X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464254","SUP","HCPCS C1713","","5464254  -  CAGE SPNL 4D OBLQ 25X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464255","SUP","HCPCS C1713","","5464255  -  CAGE SPNL 15D OBLQ 25X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464258","SUP","HCPCS C1713","","5464258  -  CAGE SPNL 8D OBLQ 25X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464300","SUP","HCPCS C1713","","5464300  -  CAGE SPNL 0D OBLQ 30X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464302","SUP","HCPCS C1713","","5464302  -  CAGE SPNL 12D OBLQ 30X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464304","SUP","HCPCS C1713","","5464304  -  CAGE SPNL 4D OBLQ 30X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464305","SUP","HCPCS C1713","","5464305  -  CAGE SPNL 15D OBLQ 30X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464308","SUP","HCPCS C1713","","5464308  -  CAGE SPNL 8D OBLQ 30X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464350","SUP","HCPCS C1713","","5464350  -  CAGE SPNL 0D OBLQ 35X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464352","SUP","HCPCS C1713","","5464352  -  CAGE SPNL 12D OBLQ 35X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464354","SUP","HCPCS C1713","","5464354  -  CAGE SPNL 4D OBLQ 35X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464355","SUP","HCPCS C1713","","5464355  -  CAGE SPNL 15D OBLQ 35X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464358","SUP","HCPCS C1713","","5464358  -  CAGE SPNL 8D OBLQ 35X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464400","SUP","HCPCS C1713","","5464400  -  CAGE SPNL 0D OBLQ 40X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464402","SUP","HCPCS C1713","","5464402  -  CAGE SPNL 12D OBLQ 40X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464404","SUP","HCPCS C1713","","5464404  -  CAGE SPNL 4D OBLQ 40X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464405","SUP","HCPCS C1713","","5464405  -  CAGE SPNL 15D OBLQ 40X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5464408","SUP","HCPCS C1713","","5464408  -  CAGE SPNL 8D OBLQ 40X14X6MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470250","SUP","HCPCS C1713","","5470250  -  CAGE SPNL 0D OBLQ 25X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5470252","SUP","HCPCS C1713","","5470252  -  CAGE SPNL 12D OBLQ 25X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470254","SUP","HCPCS C1713","","5470254  -  CAGE SPNL 4D OBLQ 25X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470255","SUP","HCPCS C1713","","5470255  -  CAGE SPNL 15D OBLQ 25X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470258","SUP","HCPCS C1713","","5470258  -  CAGE SPNL 8D OBLQ 25X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470300","SUP","HCPCS C1713","","5470300  -  CAGE SPNL 0D OBLQ 30X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5470302","SUP","HCPCS C1713","","5470302  -  CAGE SPNL 12D OBLQ 30X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470304","SUP","HCPCS C1713","","5470304  -  CAGE SPNL 4D OBLQ 30X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470305","SUP","HCPCS C1713","","5470305  -  CAGE SPNL 15D OBLQ 30X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470308","SUP","HCPCS C1713","","5470308  -  CAGE SPNL 8D OBLQ 30X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470350","SUP","HCPCS C1713","","5470350  -  CAGE SPNL 0D OBLQ 35X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470352","SUP","HCPCS C1713","","5470352  -  CAGE SPNL 12D OBLQ 35X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470354","SUP","HCPCS C1713","","5470354  -  CAGE SPNL 4D OBLQ 35X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470355","SUP","HCPCS C1713","","5470355  -  CAGE SPNL 15D OBLQ 35X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470358","SUP","HCPCS C1713","","5470358  -  CAGE SPNL 8D OBLQ 35X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470400","SUP","HCPCS C1713","","5470400  -  CAGE SPNL 0D OBLQ 40X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470402","SUP","HCPCS C1713","","5470402  -  CAGE SPNL 12D OBLQ 40X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470404","SUP","HCPCS C1713","","5470404  -  CAGE SPNL 4D OBLQ 40X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470405","SUP","HCPCS C1713","","5470405  -  CAGE SPNL 15D OBLQ 40X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5470408","SUP","HCPCS C1713","","5470408  -  CAGE SPNL 8D OBLQ 40X10X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474250","SUP","HCPCS C1713","","5474250  -  CAGE SPNL 0D OBLQ 25X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474252","SUP","HCPCS C1713","","5474252  -  CAGE SPNL 12D OBLQ 25X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474254","SUP","HCPCS C1713","","5474254  -  CAGE SPNL 4D OBLQ 25X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474255","SUP","HCPCS C1713","","5474255  -  CAGE SPNL 15D OBLQ 25X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474258","SUP","HCPCS C1713","","5474258  -  CAGE SPNL 8D OBLQ 25X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474300","SUP","HCPCS C1713","","5474300  -  CAGE SPNL 0D OBLQ 30X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474302","SUP","HCPCS C1713","","5474302  -  CAGE SPNL 12D OBLQ 30X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474304","SUP","HCPCS C1713","","5474304  -  CAGE SPNL 4D OBLQ 30X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474305","SUP","HCPCS C1713","","5474305  -  CAGE SPNL 15D OBLQ 30X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474308","SUP","HCPCS C1713","","5474308  -  CAGE SPNL 8D OBLQ 30X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474350","SUP","HCPCS C1713","","5474350  -  CAGE SPNL 0D OBLQ 35X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474352","SUP","HCPCS C1713","","5474352  -  CAGE SPNL 12D OBLQ 35X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474355","SUP","HCPCS C1713","","5474355  -  CAGE SPNL 15D OBLQ 35X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474358","SUP","HCPCS C1713","","5474358  -  CAGE SPNL 8D OBLQ 35X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474400","SUP","HCPCS C1713","","5474400  -  CAGE SPNL 0D OBLQ 40X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474402","SUP","HCPCS C1713","","5474402  -  CAGE SPNL 12D OBLQ 40X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474404","SUP","HCPCS C1713","","5474404  -  CAGE SPNL 4D OBLQ 40X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474405","SUP","HCPCS C1713","","5474405  -  CAGE SPNL 15D OBLQ 40X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5474408","SUP","HCPCS C1713","","5474408  -  CAGE SPNL 8D OBLQ 40X14X7MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5475525","SUP","HCPCS C1713","","5475525  -  SCREW BN 5.5MM 25MM NS CRNT FX ANG SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475540","SUP","HCPCS C1713","","5475540  -  SCREW BN 5.5MM 40MM NS CRNT FX ANG SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475545","SUP","HCPCS C1713","","5475545  -  SCREW BN 5.5MM 45MM NS CRNT FX ANG SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475550","SUP","HCPCS C1713","","5475550  -  SCREW BN 5.5MM 50MM NS CRNT FX ANG SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475555","SUP","HCPCS C1713","","5475555  -  SCREW BN 5.5MM 55MM NS CRNT FX ANG SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475560","SUP","HCPCS C1713","","5475560  -  SCREW BN 5.5MM 60MM NS CRNT FX ANG SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475565","SUP","HCPCS C1713","","5475565  -  SCREW BN 5.5MM 65MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5475570","SUP","HCPCS C1713","","5475570  -  SCREW BN 5.5MM 70MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476525","SUP","HCPCS C1713","","5476525  -  SCREW BN 6.5MM 25MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476540","SUP","HCPCS C1713","","5476540  -  SCREW BN 6.5MM 40MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476545","SUP","HCPCS C1713","","5476545  -  SCREW BN 6.5MM 45MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476550","SUP","HCPCS C1713","","5476550  -  SCREW BN 6.5MM 50MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476555","SUP","HCPCS C1713","","5476555  -  SCREW BN 6.5MM 55MM FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476560","SUP","HCPCS C1713","","5476560  -  SCREW BN 6.5MM 60MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476565","SUP","HCPCS C1713","","5476565  -  SCREW BN 6.5MM 65MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5476570","SUP","HCPCS C1713","","5476570  -  SCREW BN 6.5MM 70MM CRNT XLIF FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5480250","SUP","HCPCS C1713","","5480250  -  CAGE SPNL 0D OBLQ 25X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480252","SUP","HCPCS C1713","","5480252  -  CAGE SPNL 12D OBLQ 25X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480254","SUP","HCPCS C1713","","5480254  -  CAGE SPNL 4D OBLQ 25X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480255","SUP","HCPCS C1713","","5480255  -  CAGE SPNL 15D OBLQ 25X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480258","SUP","HCPCS C1713","","5480258  -  CAGE SPNL 8D OBLQ 25X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480300","SUP","HCPCS C1713","","5480300  -  CAGE SPNL 0D OBLQ 30X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480302","SUP","HCPCS C1713","","5480302  -  CAGE SPNL 12D OBLQ 30X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480304","SUP","HCPCS C1713","","5480304  -  CAGE SPNL 4D OBLQ 30X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480305","SUP","HCPCS C1713","","5480305  -  CAGE SPNL 15D OBLQ 30X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480308","SUP","HCPCS C1713","","5480308  -  CAGE SPNL 8D OBLQ 30X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480350","SUP","HCPCS C1713","","5480350  -  CAGE SPNL 0D OBLQ 35X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480352","SUP","HCPCS C1713","","5480352  -  CAGE SPNL 12D OBLQ 35X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480354","SUP","HCPCS C1713","","5480354  -  CAGE SPNL 4D OBLQ 35X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5480355","SUP","HCPCS C1713","","5480355  -  CAGE SPNL 15D OBLQ 35X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480358","SUP","HCPCS C1713","","5480358  -  CAGE SPNL 8D OBLQ 35X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480400","SUP","HCPCS C1713","","5480400  -  CAGE SPNL 0D OBLQ 40X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480402","SUP","HCPCS C1713","","5480402  -  CAGE SPNL 12D OBLQ 40X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480404","SUP","HCPCS C1713","","5480404  -  CAGE SPNL 4D OBLQ 40X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480405","SUP","HCPCS C1713","","5480405  -  CAGE SPNL 15D OBLQ 40X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5480408","SUP","HCPCS C1713","","5480408  -  CAGE SPNL 8D OBLQ 40X10X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484250","SUP","HCPCS C1713","","5484250  -  CAGE SPNL 0D OBLQ 25X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484252","SUP","HCPCS C1713","","5484252  -  CAGE SPNL 12D OBLQ 25X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5484254","SUP","HCPCS C1713","","5484254  -  CAGE SPNL 4D OBLQ 25X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5484258","SUP","HCPCS C1713","","5484258  -  CAGE SPNL 8D OBLQ 25X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484300","SUP","HCPCS C1713","","5484300  -  CAGE SPNL 0D OBLQ 30X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484350","SUP","HCPCS C1713","","5484350  -  CAGE SPNL 0D OBLQ 35X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484352","SUP","HCPCS C1713","","5484352  -  CAGE SPNL 12D OBLQ 35X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484354","SUP","HCPCS C1713","","5484354  -  CAGE SPNL 4D OBLQ 35X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484355","SUP","HCPCS C1713","","5484355  -  CAGE SPNL 15D OBLQ 35X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484358","SUP","HCPCS C1713","","5484358  -  CAGE SPNL 8D OBLQ 35X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484400","SUP","HCPCS C1713","","5484400  -  CAGE SPNL 0D OBLQ 40X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484402","SUP","HCPCS C1713","","5484402  -  CAGE SPNL 12D OBLQ 40X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484404","SUP","HCPCS C1713","","5484404  -  CAGE SPNL 4D OBLQ 40X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484405","SUP","HCPCS C1713","","5484405  -  CAGE SPNL 15D OBLQ 40X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5484408","SUP","HCPCS C1713","","5484408  -  CAGE SPNL 8D OBLQ 40X14X8MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5485525","SUP","HCPCS C1713","","5485525  -  SCREW BONE 5.5MM 25MM VARIABLE COROENT XLF SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485540","SUP","HCPCS C1713","","5485540  -  SCREW BN 5.5MM 40MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485545","SUP","HCPCS C1713","","5485545  -  SCREW BN 5.5MM 45MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485550","SUP","HCPCS C1713","","5485550  -  SCREW BN 5.5MM 50MM CRNT XLF VA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485555","SUP","HCPCS C1713","","5485555  -  SCREW BN 5.5MM 55MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485560","SUP","HCPCS C1713","","5485560  -  SCREW BN 5.5MM 60MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485565","SUP","HCPCS C1713","","5485565  -  SCREW BN 5.5MM 65MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5485570","SUP","HCPCS C1713","","5485570  -  SCREW BN 5.5MM 70MM CRNT XLF VAR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486525","SUP","HCPCS C1713","","5486525  -  SCREW BN 6.5MM 25MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486540","SUP","HCPCS C1713","","5486540  -  SCREW BN 6.5MM 40MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486545","SUP","HCPCS C1713","","5486545  -  SCREW BN 6.5MM 45MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486550","SUP","HCPCS C1713","","5486550  -  SCREW BN 6.5MM 50MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486555","SUP","HCPCS C1713","","5486555  -  SCREW BN 6.5MM 55MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486560","SUP","HCPCS C1713","","5486560  -  SCREW BN 6.5MM 60MM NS CRNT VA SPNE XLF SYS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486565","SUP","HCPCS C1713","","5486565  -  SCREW BN 6.5MM 65MM CRNT XLF VAR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5486570","SUP","HCPCS C1713","","5486570  -  SCREW BN 6.5MM 70MM CRNT XLF VAR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5490250","SUP","HCPCS C1713","","5490250  -  CAGE SPNL 0D OBLQ 25X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5490252","SUP","HCPCS C1713","","5490252  -  CAGE SPNL 12D OBLQ 25X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490254","SUP","HCPCS C1713","","5490254  -  CAGE SPNL 4D OBLQ 25X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490255","SUP","HCPCS C1713","","5490255  -  CAGE SPNL 15D OBLQ 25X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490258","SUP","HCPCS C1713","","5490258  -  CAGE SPNL 8D OBLQ 25X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490300","SUP","HCPCS C1713","","5490300  -  CAGE SPNL 0D OBLQ 30X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5490302","SUP","HCPCS C1713","","5490302  -  CAGE SPNL 12D OBLQ 30X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490304","SUP","HCPCS C1713","","5490304  -  CAGE SPNL 4D OBLQ 30X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490305","SUP","HCPCS C1713","","5490305  -  CAGE SPNL 15D OBLQ 30X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490308","SUP","HCPCS C1713","","5490308  -  CAGE SPNL 8D OBLQ 30X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490350","SUP","HCPCS C1713","","5490350  -  CAGE SPNL 0D OBLQ 35X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490352","SUP","HCPCS C1713","","5490352  -  CAGE SPNL 12D OBLQ 35X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490354","SUP","HCPCS C1713","","5490354  -  CAGE SPNL 4D OBLQ 35X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490355","SUP","HCPCS C1713","","5490355  -  CAGE SPNL 15D OBLQ 35X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490358","SUP","HCPCS C1713","","5490358  -  CAGE SPNL 8D OBLQ 35X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490400","SUP","HCPCS C1713","","5490400  -  CAGE SPNL 0D OBLQ 40X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490402","SUP","HCPCS C1713","","5490402  -  CAGE SPNL 12D OBLQ 40X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490404","SUP","HCPCS C1713","","5490404  -  CAGE SPNL 4D OBLQ 40X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490405","SUP","HCPCS C1713","","5490405  -  CAGE SPNL 15D OBLQ 40X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5490408","SUP","HCPCS C1713","","5490408  -  CAGE SPNL 8D OBLQ 40X10X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494250","SUP","HCPCS C1713","","5494250  -  CAGE SPNL 0D OBLQ 25X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494252","SUP","HCPCS C1713","","5494252  -  CAGE SPNL 12D OBLQ 25X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494254","SUP","HCPCS C1713","","5494254  -  CAGE SPNL 4D OBLQ 25X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494255","SUP","HCPCS C1713","","5494255  -  CAGE SPNL 15D OBLQ 25X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494258","SUP","HCPCS C1713","","5494258  -  CAGE SPNL 8D OBLQ 25X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494300","SUP","HCPCS C1713","","5494300  -  CAGE SPNL 0D OBLQ 30X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494302","SUP","HCPCS C1713","","5494302  -  CAGE SPNL 12D OBLQ 30X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494304","SUP","HCPCS C1713","","5494304  -  CAGE SPNL 4D OBLQ 30X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494305","SUP","HCPCS C1713","","5494305  -  CAGE SPNL 15D OBLQ 30X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494308","SUP","HCPCS C1713","","5494308  -  CAGE SPNL 8D OBLQ 30X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494350","SUP","HCPCS C1713","","5494350  -  CAGE SPNL 0D OBLQ 35X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494352","SUP","HCPCS C1713","","5494352  -  CAGE SPNL 12D OBLQ 35X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494354","SUP","HCPCS C1713","","5494354  -  CAGE SPNL 4D OBLQ 35X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494355","SUP","HCPCS C1713","","5494355  -  CAGE SPNL 15D OBLQ 35X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494358","SUP","HCPCS C1713","","5494358  -  CAGE SPNL 8D OBLQ 35X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494400","SUP","HCPCS C1713","","5494400  -  CAGE SPNL 0D OBLQ 40X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494402","SUP","HCPCS C1713","","5494402  -  CAGE SPNL 12D OBLQ 40X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494404","SUP","HCPCS C1713","","5494404  -  CAGE SPNL 4D OBLQ 40X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494405","SUP","HCPCS C1713","","5494405  -  CAGE SPNL 15D OBLQ 40X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5494408","SUP","HCPCS C1713","","5494408  -  CAGE SPNL 8D OBLQ 40X14X9MM NS LF CRNT TI TLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"5500302","SUP","HCPCS C1769","","GUIDEWIRE VASC .035IN 150CM 3MM JTP FIX CORE PTFE","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"5500801","SUP","HCPCS C1769","","GUIDEWIRE VASC .035IN 150CM BNTSN STRG FIX CORE PTFE","BOTH IP/OP","$22.50 ","$16.65 ","$0.00 ","$22.50 ","$12.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.94 ","$22.50 ","$0.00 ","$11.25 ","$17.82 ","$18.00 ","$0.00 ","$3.52 ","$0.00 ","$3.58 ","$0.00 "
"5500803","SUP","Custom 27203010","","GUIDEWIRE BENTSON .038 150CM","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5501701","SUP","HCPCS C1769","","GUIDEWIRE VASC .035IN 150CM 1.5MM RSN CURVE JTP FIX CORE","BOTH IP/OP","$22.50 ","$16.65 ","$0.00 ","$22.50 ","$12.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.94 ","$22.50 ","$0.00 ","$11.25 ","$17.82 ","$18.00 ","$0.00 ","$3.52 ","$0.00 ","$3.58 ","$0.00 "
"5513150","SUP","HCPCS C1894","","5513150  -  INTRODUCER CATH 15FR 13CM ARGD VLV HMDIAL","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$133.04 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"5534010","SUP","HCPCS C1713","","5534010  -  SPACER ALGRF 30X10X2MM EXTENSURE SPNE","BOTH IP/OP","$5,577.50 ","$4,127.35 ","$0.00 ","$5,577.50 ","$2,509.88 ","$0.00 ","$1,162.49 ","$0.00 ","$0.00 ","$976.58 ","$5,577.50 ","$0.00 ","$2,788.75 ","$4,417.38 ","$4,462.00 ","$0.00 ","$872.88 ","$0.00 ","$887.94 ","$0.00 "
"5534012","SUP","HCPCS C1713","","5534012  -  SPACER ALGRF 30X12X2MM EXTENSURE SPNE","BOTH IP/OP","$5,577.50 ","$4,127.35 ","$0.00 ","$5,577.50 ","$2,509.88 ","$0.00 ","$1,162.49 ","$0.00 ","$0.00 ","$976.58 ","$5,577.50 ","$0.00 ","$2,788.75 ","$4,417.38 ","$4,462.00 ","$0.00 ","$872.88 ","$0.00 ","$887.94 ","$0.00 "
"5534014","SUP","HCPCS C1713","","5534014  -  SPACER ALGRF 30X14X2MM EXTENSURE SPNE","BOTH IP/OP","$5,577.50 ","$4,127.35 ","$0.00 ","$5,577.50 ","$2,509.88 ","$0.00 ","$1,162.49 ","$0.00 ","$0.00 ","$976.58 ","$5,577.50 ","$0.00 ","$2,788.75 ","$4,417.38 ","$4,462.00 ","$0.00 ","$872.88 ","$0.00 ","$887.94 ","$0.00 "
"5534018","SUP","HCPCS C1713","","5534018  -  SPACER SPNL 30X18X2MM EXTENSURE ALGRF","BOTH IP/OP","$5,577.50 ","$4,127.35 ","$0.00 ","$5,577.50 ","$2,509.88 ","$0.00 ","$1,162.49 ","$0.00 ","$0.00 ","$976.58 ","$5,577.50 ","$0.00 ","$2,788.75 ","$4,417.38 ","$4,462.00 ","$0.00 ","$872.88 ","$0.00 ","$887.94 ","$0.00 "
"5540030","SUP","HCPCS C1713","","5540030  -  SCREW SET BREAK OFF CD HORIZON TITANIUM SPINAL NONSTRL 5.5","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5540130","SUP","HCPCS C1713","","5540130  -  SET SCREW 5540130  5.5/6.0 TI NS NON BO","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5540230","SUP","HCPCS C1713","","5540230  -  SET SCREW 5540230 5.5/6.0 TI NS RED BO","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5540430","SUP","HCPCS C1713","","5540430  -  SCREW SET SOLERA SEXTANT CD HORIZON TITANIUM 5.5-6MM NONSTRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5560001","SUP","Custom 27804086","","5560001  -  GRAFT BN 13MMX5MM FACET DWL SPNE","BOTH IP/OP","$3,177.50 ","$2,351.35 ","$0.00 ","$3,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,177.50 ","$0.00 ","$1,588.75 ","$2,516.58 ","$2,542.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5587000","SUP","HCPCS C1750","","5587000  -  KIT CATH REPR REPL CNCT PU HMDIAL","BOTH IP/OP","$325.28 ","$240.71 ","$0.00 ","$325.28 ","$146.37 ","$0.00 ","$67.80 ","$0.00 ","$0.00 ","$56.95 ","$325.28 ","$0.00 ","$162.64 ","$257.62 ","$260.22 ","$0.00 ","$50.91 ","$0.00 ","$51.78 ","$0.00 "
"5688000","SUP","Custom 27203010","","5688000  -  TUNNELER SRG 30MM 8IN HMSPLT HMSPLT XK MLBL TPR","BOTH IP/OP","$61.25 ","$45.33 ","$0.00 ","$61.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.25 ","$0.00 ","$30.63 ","$48.51 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5740105","SUP","Custom 27804086","","5740105  -  GRAFT BN LRDTC 14X11X5MM SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5740106","SUP","Custom 27804086","","5740106  -  GRAFT BONE 14X11X6MM ALLOGRAFT TRIAD CANCELLOUS CORTICAL SPN","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5740107","SUP","Custom 27804086","","5740107  -  GRAFT BONE LORDOSIS 14X7X11MM ALLOGRAFT TRAID CANCELLOUS","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5740109","SUP","Custom 27804086","","5740109  -  GRAFT BN LRDTC 14X11X9MM TRD ALGRF CORT CNC","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5740110","SUP","Custom 27804086","","5740110  -  GRAFT BN LRDTC 14X11X10MM ALGRF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750005","SUP","Custom 27804086","","5750005  -  GRAFT BN 14X11X5MM TRD ALGRF SPNE CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5750007","SUP","HCPCS C1713","","5750007  -  TRIAD CR ALLOGRAFT, 7X 11X 14MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"5750010","SUP","Custom 27804086","","5750010  -  GRAFT BN 14X11X10MM TRD ALGRF SPNE CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5950007","SUP","HCPCS C1781","","5950007  -  PATCH SURG SMALL CIR 1.7IN STRAP VENTRALEX ST SEPRA","BOTH IP/OP","$1,769.50 ","$1,309.43 ","$0.00 ","$1,769.50 ","$796.28 ","$0.00 ","$368.81 ","$0.00 ","$0.00 ","$309.83 ","$1,769.50 ","$0.00 ","$884.75 ","$1,401.44 ","$1,415.60 ","$0.00 ","$276.93 ","$0.00 ","$281.70 ","$0.00 "
"5950008","SUP","HCPCS C1781","","5950008  -  PATCH SURG MEDIUM CIR 2.5IN STRAP VENTRALEX ST SEPRA","BOTH IP/OP","$2,117.00 ","$1,566.58 ","$0.00 ","$2,117.00 ","$952.65 ","$0.00 ","$441.24 ","$0.00 ","$0.00 ","$370.67 ","$2,117.00 ","$0.00 ","$1,058.50 ","$1,676.66 ","$1,693.60 ","$0.00 ","$331.31 ","$0.00 ","$337.03 ","$0.00 "
"5950009","SUP","HCPCS C1781","","5950009  -  PATCH SRG LG CRC 3.2IN STRL VNTRLX ST SEPRA SORBAFLEX SPRG","BOTH IP/OP","$2,405.50 ","$1,780.07 ","$0.00 ","$2,405.50 ","$1,082.48 ","$0.00 ","$501.37 ","$0.00 ","$0.00 ","$421.18 ","$2,405.50 ","$0.00 ","$1,202.75 ","$1,905.16 ","$1,924.40 ","$0.00 ","$376.46 ","$0.00 ","$382.96 ","$0.00 "
"5950020","SUP","HCPCS C1781","","5950020  -  PATCH SURG LARGE CIR 4.5IN SELF EXPAND VENTRIO ST SORBAFLEX","BOTH IP/OP","$2,760.75 ","$2,042.96 ","$0.00 ","$2,760.75 ","$1,242.34 ","$0.00 ","$575.41 ","$0.00 ","$0.00 ","$483.39 ","$2,760.75 ","$0.00 ","$1,380.38 ","$2,186.51 ","$2,208.60 ","$0.00 ","$432.06 ","$0.00 ","$439.51 ","$0.00 "
"5950030","SUP","HCPCS C1781","","5950030  -  PATCH SURG SMALL OVAL 4.7X3.1IN SELF EXPAND VENTRIO ST","BOTH IP/OP","$1,213.38 ","$897.90 ","$0.00 ","$1,213.38 ","$546.02 ","$0.00 ","$252.90 ","$0.00 ","$0.00 ","$212.45 ","$1,213.38 ","$0.00 ","$606.69 ","$961.00 ","$970.70 ","$0.00 ","$189.89 ","$0.00 ","$193.17 ","$0.00 "
"5950040","SUP","HCPCS C1781","","5950040  -  PATCH SURG MEDIUM OVAL 5.5X4.3IN SELF EXPAND VENTRIO ST","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"5950050","SUP","HCPCS C1781","","5950050  -  PATCH SURG LARGE OVAL 7X5.4IN SELF EXPAND VENTRIO ST","BOTH IP/OP","$4,550.25 ","$3,367.19 ","$0.00 ","$4,550.25 ","$2,047.61 ","$0.00 ","$948.39 ","$0.00 ","$0.00 ","$796.71 ","$4,550.25 ","$0.00 ","$2,275.13 ","$3,603.80 ","$3,640.20 ","$0.00 ","$712.11 ","$0.00 ","$724.40 ","$0.00 "
"5950070","SUP","HCPCS C1781","","5950070  -  PATCH SURG XL CIR 9.7X7.7IN SELF EXPAND VENTRIO ST SORBAFLEX","BOTH IP/OP","$6,143.00 ","$4,545.82 ","$0.00 ","$6,143.00 ","$2,764.35 ","$0.00 ","$1,280.35 ","$0.00 ","$0.00 ","$1,075.59 ","$6,143.00 ","$0.00 ","$3,071.50 ","$4,865.26 ","$4,914.40 ","$0.00 ","$961.38 ","$0.00 ","$977.97 ","$0.00 "
"5950080","SUP","HCPCS C1781","","5950080  -  PATCH SURG XL CIR 10.7X8.7IN SELF EXPAND VENTRIO ST","BOTH IP/OP","$7,356.25 ","$5,443.63 ","$0.00 ","$7,356.25 ","$3,310.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,288.02 ","$7,356.25 ","$0.00 ","$3,678.13 ","$5,826.15 ","$5,885.00 ","$0.00 ","$1,151.25 ","$0.00 ","$1,171.12 ","$0.00 "
"5960011","SUP","HCPCS C1713","","5960011  -  SCREW SET UNIVERSAL END CAP SPN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5960033","SUP","HCPCS C1713","","5960033  -  SCREW BN 12MM X-COR MN VBR LCK TI SPNE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5960034","SUP","HCPCS C1713","","5960034  -  SCREW BONE 14MM X-CORE MINI VBR TI SPN LOCK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"5960200","SUP","HCPCS C1713","","5960200  -  END CAP SPNL PRLL 12MM 14MM NS X-COR MN","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5960400","SUP","HCPCS C1713","","5960400  -  END CAP SPNL 16MM PRLL 14MM CORE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5962152","SUP","HCPCS C1713","","5962152  -  CAGE SPNL 12MM 15-20MM NS LF X-COR MN XPD VERT BD REPL","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5962172","SUP","Custom 27803010","","5962172  -  CAGE SPNL 12MM 17-24MM NS LF X-COR MN XPD VERT BD REPL","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5962223","SUP","HCPCS C1713","","5962223  -  CAGE SPNL 12MM 22-34MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5962253","SUP","HCPCS C1713","","5962253  -  CAGE SPNL 12MM 25-40MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5962294","SUP","HCPCS C1713","","5962294  -  CAGE SPNL 12MM 29-48MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5962366","SUP","HCPCS C1713","","5962366  -  CAGE SPNL 12MM 36-62MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5962427","SUP","HCPCS C1713","","5962427  -  CAGE SPNL 12MM 42-74MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5962520","SUP","Custom 27803010","","5962520  -  ENDCAP SPINAL 12MM 15MM PARALLEL TITANIUM 12MM CORE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5962521","SUP","Custom 27803010","","5962521  -  ENDCAP SPINAL CONVEX 12MM 15X12MM TOP X-CORE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5962526","SUP","Custom 27803010","","5962526  -  ENDCAP SPINAL 7D 12MM 15MM BOTTOM TITANIUM 12MM CORE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5962527","SUP","Custom 27803010","","5962527  -  ENDCAP SPINAL 7D 12MM 15MM TOP TITANIUM 12MM CORE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5962740","SUP","HCPCS C1713","","5962740  -  END CAP SPNL PRLL 12MM 17MM NS 14MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5962741","SUP","HCPCS C1713","","5962741  -  END CAP SPNL 12MM 17MM NS 14MM X-COR MN CNTR TOP TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5962746","SUP","HCPCS C1713","","5962746  -  END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC BTM TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5962747","SUP","HCPCS C1713","","5962747  -  END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC TOP TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963740","SUP","HCPCS C1713","","5963740  -  END CAP SPNL ANG 14MM 17MM PRLL TOP TI 14MM COR","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963745","SUP","HCPCS C1713","","5963745  -  END CAP SPNL ANG 14MM 17MM PRLL BTM TI 14MM COR","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963746","SUP","HCPCS C1713","","5963746  -  END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR BTM","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963747","SUP","HCPCS C1713","","5963747  -  END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR TOP","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963960","SUP","HCPCS C1713","","5963960  -  END CAP SPNL ANG 16MM 19MM PRLL TOP TI 14MM COR","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963965","SUP","HCPCS C1713","","5963965  -  END CAP SPNL ANG 16MM 19MM PRLL BTM TI 14MM COR","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963966","SUP","HCPCS C1713","","5963966  -  END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR BTM","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5963967","SUP","HCPCS C1713","","5963967  -  END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR TOP","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964152","SUP","HCPCS C1713","","5964152  -  CAGE SPNL 14MM 15-20MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5964172","SUP","Custom 27803010","","5964172  -  CAGE SPNL 14MM 17-24MM NS LF X-COR MN XPD VERT BD REPL","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5964223","SUP","HCPCS C1713","","5964223  -  CAGE SPNL 14MM 22-34MM NS LF X-COR MN XPD VERT BD REPL","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5964253","SUP","HCPCS C1713","","5964253  -  CAGE SPNL 14MM 25-40MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5964294","SUP","HCPCS C1713","","5964294  -  CAGE SPNL 14MM 29-48MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5964366","SUP","HCPCS C1713","","5964366  -  CAGE SPNL 14MM 36-62MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5964427","SUP","HCPCS C1713","","5964427  -  CAGE SPNL 14MM 42-74MM NS LF X-COR MN","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"5964740","SUP","HCPCS C1713","","5964740  -  END CAP SPNL PRLL 14MM 17MM NS 14MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964741","SUP","HCPCS C1713","","5964741  -  END CAP SPNL 14MM 17MM NS 14MM X-COR MN CNTR TOP TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964746","SUP","HCPCS C1713","","5964746  -  END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964747","SUP","HCPCS C1713","","5964747  -  END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964960","SUP","HCPCS C1713","","5964960  -  END CAP SPNL PRLL 14MM 19MM NS 14MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964966","SUP","HCPCS C1713","","5964966  -  END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5964967","SUP","HCPCS C1713","","5964967  -  END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"5975730","SUP","HCPCS C1713","","5975730  -  VUE POINT 435 X 30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6014908","SUP","Custom 27203010","","6014908  -  DRILL TWST 1.4MM 18MM 8MM WL","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$760.00 ","$0.00 ","$380.00 ","$601.92 ","$608.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6019135","SUP","Custom 27203010","","6019135  -  DRILL TWST 1.9MM 115MM LF","BOTH IP/OP","$617.05 ","$456.62 ","$0.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6046385","SUP","HCPCS C1713","","6046385  -  4.0 CANNULATED, 38MM","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"6101045","SUP","HCPCS C1713","","6101045  -  SPACER SPNL XL STD 45X18X10CM C-THRU PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101050","SUP","HCPCS C1713","","6101050  -  CAGE SPNL XL 50X18X10MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101055","SUP","HCPCS C1713","","6101055  -  CAGE SPNL XL STD 55X18X10MM CRNT CT4","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101060","SUP","HCPCS C1713","","6101060  -  CAGE SPNL XL STD 60X18X10MM CRNT CT4","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101245","SUP","HCPCS C1713","","6101245  -  SPACER SPNL 45X18X12MM CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101250","SUP","HCPCS C1713","","6101250  -  CAGE SPNL XL CRNL TPR 50X18X12MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101255","SUP","HCPCS C1713","","6101255  -  CAGE SPNL XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101260","SUP","HCPCS C1713","","6101260  -  CAGE SPNL XL CRNL TPR 60X18X12MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101445","SUP","HCPCS C1713","","6101445  -  CAGE SPNL XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101450","SUP","HCPCS C1713","","6101450  -  CAGE SPNL XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101455","SUP","HCPCS C1713","","6101455  -  CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101460","SUP","HCPCS C1713","","6101460  -  CAGE SPNL XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101645","SUP","HCPCS C1713","","6101645  -  CAGE SPNL XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101650","SUP","HCPCS C1713","","6101650  -  CAGE SPNL XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101655","SUP","HCPCS C1713","","6101655  -  CAGE SPNL XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6101660","SUP","HCPCS C1713","","6101660  -  CAGE SPNL XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111045","SUP","HCPCS C1713","","6111045  -  CAGE SPNL 10D LRDTC 45X18X10MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111050","SUP","HCPCS C1713","","6111050  -  CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111055","SUP","HCPCS C1713","","6111055  -  CAGE SPNL 10D LRDTC 55X18X10MM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111060","SUP","HCPCS C1713","","6111060  -  CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111245","SUP","HCPCS C1713","","6111245  -  CAGE SPNL 10D LRDTC 45X18X12MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111250","SUP","HCPCS C1713","","6111250  -  CAGE SPNL XL 10D 50X18X12MM CRNT COALITION PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111255","SUP","HCPCS C1713","","6111255  -  CAGE SPNL 10D XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111260","SUP","HCPCS C1713","","6111260  -  SPACER SPNL 10D XL 60X18X12MM PEEK BCK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111445","SUP","HCPCS C1713","","6111445  -  CAGE SPNL 10D XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111450","SUP","HCPCS C1713","","6111450  -  CAGE SPNL 10D XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111455","SUP","HCPCS C1713","","6111455  -  CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111460","SUP","HCPCS C1713","","6111460  -  CAGE SPNL 10D XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111645","SUP","HCPCS C1713","","6111645  -  CAGE SPNL 10D XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111650","SUP","HCPCS C1713","","6111650  -  CAGE SPNL 10D XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111655","SUP","HCPCS C1713","","6111655  -  CAGE SPNL 10D XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6111660","SUP","HCPCS C1713","","6111660  -  CAGE SPNL 10D XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM IM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6160850","SUP","HCPCS C1713","","6160850  -  CAGE SPNL XL W 50X22X8MM CRNT FX","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6160855","SUP","HCPCS C1713","","6160855  -  CAGE SPNL XL W 55X22X8MM CRNT FX","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6160860","SUP","HCPCS C1713","","6160860  -  CAGE SPNL XL W 60X22X8MM CRNT FX","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161045","SUP","HCPCS C1713","","6161045  -  CAGE SPNL XL 45X22X10MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161050","SUP","HCPCS C1713","","6161050  -  CAGE SPNL XL W 50X22X10MM CRNT FX","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161055","SUP","HCPCS C1713","","6161055  -  CAGE SPNL XL W 55X22X10MM CRNT FX","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161060","SUP","HCPCS C1713","","6161060  -  CAGE SPNL XL W 60X22X10MM CRNT FX","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161255","SUP","HCPCS C1713","","6161255  -  CAGE SPNL XL W 55X22X12MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161260","SUP","HCPCS C1713","","6161260  -  CAGE SPNL XL W 60X22X12MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161450","SUP","HCPCS C1713","","6161450  -  CAGE SPNL XL W 50X22X14MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161455","SUP","HCPCS C1713","","6161455  -  CAGE SPNL XL W 55X22X14MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6161460","SUP","HCPCS C1713","","6161460  -  CAGE SPNL XL W 60X22X14MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6170850","SUP","HCPCS C1713","","6170850  -  CAGE SPNL XL W LRDTC 50X22X8MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6170855","SUP","HCPCS C1713","","6170855  -  CAGE SPNL XL LRDTC 55X22X8MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6170860","SUP","HCPCS C1713","","6170860  -  CAGE SPNL XL LRDTC 60X22X8MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171050","SUP","HCPCS C1713","","6171050  -  SPACER SPNL XL W LRDTC 50X22X10MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171055","SUP","HCPCS C1713","","6171055  -  CAGE SPNL XL LRDTC 55X22X10MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171060","SUP","HCPCS C1713","","6171060  -  CAGE SPNL XL LRDTC 60X22X10MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171250","SUP","HCPCS C1713","","6171250  -  CAGE SPNL XL W LRDTC 50X22X12MM CRNT FSN","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171255","SUP","HCPCS C1713","","6171255  -  CAGE SPNL XL LRDTC 55X22X12MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171260","SUP","HCPCS C1713","","6171260  -  CAGE SPNL XL LRDTC 60X22X12MM NS LF CRNT W FTPRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171450","SUP","HCPCS C1713","","6171450  -  CAGE SPNL XL W LRDTC 50X22X14MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171455","SUP","HCPCS C1713","","6171455  -  CAGE SPNL XL W LRDTC 55X22X14MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6171460","SUP","HCPCS C1713","","6171460  -  CAGE SPNL XL W LRDTC 60X22X14MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6181800","SUP","Custom 27803010","","6181800  -  ENDCAP 18MM RND 0 DEG OD18 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6181804","SUP","Custom 27803010","","6181804  -  ENDCAP 18MM RND 4 DEG OD18 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6181808","SUP","Custom 27803010","","6181808  -  ENDCAP 18MM RND 8 DEG XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183000","SUP","Custom 27803010","","6183000  -  ENDCAP OD18X18X30MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183004","SUP","Custom 27803010","","6183004  -  ENDCAP OD18X18X30MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183008","SUP","Custom 27803010","","6183008  -  ENDCAP OD18X18X30MM 8 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183014","SUP","Custom 27803010","","6183014  -  ENDCAP OD18X18X30MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6184000","SUP","Custom 27803010","","6184000  -  ENDCAP OD18X18X40MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6184004","SUP","Custom 27803010","","6184004  -  ENDCAP OD18X18X40MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6184008","SUP","Custom 27803010","","6184008  -  ENDCAP OD18X18X40MM 8 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6184014","SUP","Custom 27803010","","6184014  -  ENDCAP OD18X18X40MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6185000","SUP","Custom 27803010","","6185000  -  ENDCAP OD18X18X50MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6185004","SUP","Custom 27803010","","6185004  -  ENDCAP OD18X18X50MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6185008","SUP","Custom 27803010","","6185008  -  ENDCAP OD18X18X50MM 8 DEG TI XCORE TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6185014","SUP","Custom 27803010","","6185014  -  ENDCAP OD18X18X50MM 4 DEG TI OD18 TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6200240","SUP","HCPCS C1713","","6200240  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200245","SUP","HCPCS C1713","","6200245  -  CAGE SPNL 20D XL 45X22X2MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200250","SUP","HCPCS C1713","","6200250  -  CAGE SPNL 20D XL 50X22X2MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200255","SUP","HCPCS C1713","","6200255  -  CAGE SPNL 20D XL 55X22X2MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200260","SUP","HCPCS C1713","","6200260  -  CAGE SPNL 20D XL 60X22X2MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200265","SUP","HCPCS C1713","","6200265  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200440","SUP","HCPCS C1713","","6200440  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200445","SUP","HCPCS C1713","","6200445  -  CAGE SPNL 20D XL 45X22X4MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200450","SUP","HCPCS C1713","","6200450  -  CAGE SPNL 20D XL 50X22X4MM PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200455","SUP","HCPCS C1713","","6200455  -  CAGE SPNL 20D XL 55X22X4MM PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200460","SUP","HCPCS C1713","","6200460  -  CAGE SPNL 20D XL 60X22X4MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200465","SUP","HCPCS C1713","","6200465  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200640","SUP","HCPCS C1713","","6200640  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200645","SUP","HCPCS C1713","","6200645  -  CAGE SPNL 20D XL 45X22X6MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200650","SUP","HCPCS C1713","","6200650  -  CAGE SPNL 20D XL 50X22X6MM CRNT PEEK","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200655","SUP","HCPCS C1713","","6200655  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200660","SUP","HCPCS C1713","","6200660  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200665","SUP","HCPCS C1713","","6200665  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200840","SUP","HCPCS C1713","","6200840  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200845","SUP","HCPCS C1713","","6200845  -  CAGE SPNL 20D XL HYPERLORDOTIC 45X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200850","SUP","HCPCS C1713","","6200850  -  CAGE SPNL 20D XL HYPERLORDOTIC 50X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200855","SUP","HCPCS C1713","","6200855  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200860","SUP","HCPCS C1713","","6200860  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6200865","SUP","HCPCS C1713","","6200865  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6201040","SUP","HCPCS C1713","","6201040  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6201045","SUP","HCPCS C1713","","6201045  -  CAGE SPNL 20D XL HYPERLORDOTIC 45X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6201050","SUP","HCPCS C1713","","6201050  -  CAGE SPNL 20D XL HYPERLORDOTIC 50X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6201055","SUP","HCPCS C1713","","6201055  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6201060","SUP","HCPCS C1713","","6201060  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6201065","SUP","HCPCS C1713","","6201065  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6208045","SUP","HCPCS C1713","","6208045  -  CAGE SPNL XL XW 45X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208050","SUP","HCPCS C1713","","6208050  -  CAGE SPNL XL XW 50X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208055","SUP","HCPCS C1713","","6208055  -  CAGE SPNL XL XW 55X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208060","SUP","HCPCS C1713","","6208060  -  CAGE SPNL XL XW 60X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208145","SUP","HCPCS C1713","","6208145  -  CAGE SPNL 10D XL XW 45X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208150","SUP","HCPCS C1713","","6208150  -  CAGE SPNL 10D XL XW 50X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208155","SUP","HCPCS C1713","","6208155  -  CAGE SPNL 10D XL XW 55X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6208160","SUP","HCPCS C1713","","6208160  -  CAGE SPNL 10D XL XW 60X26X8MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210045","SUP","HCPCS C1713","","6210045  -  CAGE SPNL XL XW 45X26X10MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210050","SUP","HCPCS C1713","","6210050  -  CAGE SPNL XL XW 50X26X10MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210055","SUP","HCPCS C1713","","6210055  -  CAGE SPNL XL XW 55X26X10MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210060","SUP","HCPCS C1713","","6210060  -  CAGE SPNL XL XW 60X26X10MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210145","SUP","HCPCS C1713","","6210145  -  CAGE SPNL 10D XL XW 45X26X10MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210150","SUP","HCPCS C1713","","6210150  -  CAGE SPNL 10D XL XW 50X26X10MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6210155","SUP","HCPCS C1713","","6210155  -  CAGE SPNL 10D XL XW 55X26X10MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212045","SUP","HCPCS C1713","","6212045  -  CAGE SPNL XL XW 45X26X12MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212050","SUP","HCPCS C1713","","6212050  -  CAGE SPNL XL XW 50X26X12MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212055","SUP","HCPCS C1713","","6212055  -  CAGE SPNL XL XW 55X26X12MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212060","SUP","HCPCS C1713","","6212060  -  CAGE SPNL XL XW 60X26X12MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212145","SUP","HCPCS C1713","","6212145  -  CAGE SPNL 10D XL XW 45X26X12MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212150","SUP","HCPCS C1713","","6212150  -  CAGE SPNL 10D XL XW LRDTC 50X26X12MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212155","SUP","HCPCS C1713","","6212155  -  CAGE SPNL 10D XL XW LRDTC 55X26X12MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6212160","SUP","HCPCS C1713","","6212160  -  CAGE SPNL 10D XL XW 60X26X12MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214045","SUP","HCPCS C1713","","6214045  -  CAGE SPNL XL XW 45X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214050","SUP","HCPCS C1713","","6214050  -  CAGE SPNL XL XW 50X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214055","SUP","HCPCS C1713","","6214055  -  CAGE SPNL XL XW 55X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214060","SUP","HCPCS C1713","","6214060  -  CAGE SPNL XL XW 60X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214145","SUP","HCPCS C1713","","6214145  -  CAGE SPNL 10D XL XW 45X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214150","SUP","HCPCS C1713","","6214150  -  CAGE SPNL 10D XL XW 50X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214155","SUP","HCPCS C1713","","6214155  -  CAGE SPNL 10D XL XW 55X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6214160","SUP","HCPCS C1713","","6214160  -  CAGE SPNL 10D XL XW 60X26X14MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216045","SUP","HCPCS C1713","","6216045  -  CAGE SPNL XL XW 45X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216050","SUP","HCPCS C1713","","6216050  -  CAGE SPNL XL XW 50X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216055","SUP","HCPCS C1713","","6216055  -  CAGE SPNL XL XW 55X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216060","SUP","HCPCS C1713","","6216060  -  CAGE SPNL XL XW 60X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216145","SUP","HCPCS C1713","","6216145  -  CAGE SPNL 10D XL XW 45X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216150","SUP","HCPCS C1713","","6216150  -  CAGE SPNL 10D XL XW 50X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216155","SUP","HCPCS C1713","","6216155  -  CAGE SPNL 10D XL XW 55X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6216160","SUP","HCPCS C1713","","6216160  -  CAGE SPNL 10D XL XW 60X26X16MM CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6222200","SUP","Custom 27803010","","6222200  -  ENDCAP 22MM RND 0 DEG OD18 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6222204","SUP","Custom 27803010","","6222204  -  ENDCAP 22MM RND 4 DEG OD18 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6222208","SUP","Custom 27803010","","6222208  -  ENDCAP 22MM RND 8 DEG XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6223000","SUP","Custom 27803010","","6223000  -  ENDCAP OD18X22X30MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6223004","SUP","HCPCS C1713","","6223004  -  END CAP SPNL 4D 18MM 30MM NS 22MM X-COR 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$1,420.88 ","$0.00 ","$658.10 ","$0.00 ","$0.00 ","$552.85 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$494.15 ","$0.00 ","$502.67 ","$0.00 "
"6223008","SUP","Custom 27803010","","6223008  -  ENDCAP OD18X22X30MM 8 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6223012","SUP","Custom 27803010","","6223012  -  ENDCAP OD18X22X30MM 12 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6224000","SUP","Custom 27803010","","6224000  -  ENDCAP OD18X22X40MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6224004","SUP","Custom 27803010","","6224004  -  ENDCAP OD18X22X40MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6224008","SUP","Custom 27803010","","6224008  -  ENDCAP OD18X22X40MM 8 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6224012","SUP","Custom 27803010","","6224012  -  ENDCAP OD18X22X40MM 12 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6225000","SUP","Custom 27803010","","6225000  -  ENDCAP OD18X22X50MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6225004","SUP","Custom 27803010","","6225004  -  ENDCAP OD18X22X50MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6225008","SUP","Custom 27803010","","6225008  -  ENDCAP OD18X22X50MM 8 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6225012","SUP","Custom 27803010","","6225012  -  ENDCAP OD18X22X50MM 12 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6226000","SUP","Custom 27803010","","6226000  -  ENDCAP OD18X22X60MM 0 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6226004","SUP","Custom 27803010","","6226004  -  ENDCAP OD18X22X60MM 4 DEG TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6226008","SUP","Custom 27803010","","6226008  -  ENDCAP OD18X22X60MM 8 DEG TI XCORE TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6226012","SUP","Custom 27803010","","6226012  -  ENDCAP OD18X22X60MM 12 DEG TI OD18 TI XCORE 2","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240041","SUP","Custom 27803010","","6240041  -  SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240064","SUP","Custom 27803010","","6240064  -  SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240086","SUP","Custom 27803010","","6240086  -  SPACER SPNL 16MM 18X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240141","SUP","Custom 27803010","","6240141  -  SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240164","SUP","Custom 27803010","","6240164  -  SPACER SPNL 14MM 16X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240186","SUP","Custom 27803010","","6240186  -  SPACER SPNL 16MM 18X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240241","SUP","Custom 27803010","","6240241  -  SPACER SPNL 12MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240264","SUP","Custom 27803010","","6240264  -  SPACER SPNL 14MM 16X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240286","SUP","Custom 27803010","","6240286  -  SPACER SPNL 16MM 18X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240341","SUP","Custom 27803010","","6240341  -  SPACER SPNL 13MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240364","SUP","Custom 27803010","","6240364  -  SPACER SPNL 14MM 16X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240386","SUP","Custom 27803010","","6240386  -  SPACER SPNL 16MM 18X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240441","SUP","Custom 27803010","","6240441  -  SPACER SPNL 14MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240464","SUP","Custom 27803010","","6240464  -  SPACER SPNL 14MM 16X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240486","SUP","Custom 27803010","","6240486  -  SPACER SPNL 16MM 18X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240541","SUP","Custom 27803010","","6240541  -  SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240564","SUP","Custom 27803010","","6240564  -  SPACER SPNL 5MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240586","SUP","Custom 27803010","","6240586  -  SPACER SPNL 16MM 18X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240641","SUP","Custom 27803010","","6240641  -  SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240664","SUP","Custom 27803010","","6240664  -  SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240686","SUP","Custom 27803010","","6240686  -  SPACER SPNL 16MM 18X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240741","SUP","Custom 27803010","","6240741  -  SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240764","SUP","Custom 27803010","","6240764  -  SPACER SPNL 7MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240786","SUP","Custom 27803010","","6240786  -  SPACER SPNL 16MM 18X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240841","SUP","HCPCS C1713","","6240841  -  SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6240864","SUP","Custom 27803010","","6240864  -  SPACER SPNL 8MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240886","SUP","Custom 27803010","","6240886  -  SPACER SPNL 16MM 18X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240941","SUP","Custom 27803010","","6240941  -  SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240964","SUP","Custom 27803010","","6240964  -  SPACER SPNL 9MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6240986","SUP","Custom 27803010","","6240986  -  SPACER SPNL 16MM 18X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6241041","SUP","HCPCS C1713","","6241041  -  STRUT SPNL 11MM 14X5MM VRTSTCK HDRSRB PEEK-OPTM CRV","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"6241064","SUP","HCPCS C1713","","6241064  -  STRUT SPNL 14MM 16X5MM VRTSTCK HDRSRB PEEK-OPTM CRV","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"6241086","SUP","HCPCS C1713","","6241086  -  STRUT SPNL 16MM 18X5MM VRTSTCK HDRSRB PEEK-OPTM CRV","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"6242041","SUP","HCPCS C1713","","6242041  -  STRUT SPNL 11MM 14X24MM VRTSTCK HDRSRB PEEK-OPTM CRV","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"6242064","SUP","HCPCS C1713","","6242064  -  STRUT SPNL 14MM 16X24MM VRTSTCK HDRSRB PEEK-OPTM CRV","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"6242086","SUP","HCPCS C1713","","6242086  -  STRUT SPNL 16MM 18X24MM VRTSTCK HDRSRB PEEK-OPTM CRV","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"6260535","SUP","HCPCS C1713","","6260535  -  SCREW BONE 5MM 35MM RPS SPNL FIX","BOTH IP/OP","$2,122.93 ","$1,570.97 ","$0.00 ","$2,122.93 ","$955.32 ","$0.00 ","$442.47 ","$0.00 ","$0.00 ","$371.71 ","$2,122.93 ","$0.00 ","$1,061.46 ","$1,681.36 ","$1,698.34 ","$0.00 ","$332.24 ","$0.00 ","$337.97 ","$0.00 "
"6260540","SUP","HCPCS C1713","","6260540  -  SCREW BONE 5MM 40MM RPS SPNL FIX","BOTH IP/OP","$2,122.93 ","$1,570.97 ","$0.00 ","$2,122.93 ","$955.32 ","$0.00 ","$442.47 ","$0.00 ","$0.00 ","$371.71 ","$2,122.93 ","$0.00 ","$1,061.46 ","$1,681.36 ","$1,698.34 ","$0.00 ","$332.24 ","$0.00 ","$337.97 ","$0.00 "
"6260555","SUP","HCPCS C1713","","6260555  -  SCREW BONE 5MM 55MM RPS SPNL FIX","BOTH IP/OP","$2,122.93 ","$1,570.97 ","$0.00 ","$2,122.93 ","$955.32 ","$0.00 ","$442.47 ","$0.00 ","$0.00 ","$371.71 ","$2,122.93 ","$0.00 ","$1,061.46 ","$1,681.36 ","$1,698.34 ","$0.00 ","$332.24 ","$0.00 ","$337.97 ","$0.00 "
"6260560","SUP","HCPCS C1713","","6260560  -  SCREW BONE 5MM 60MM RPS SPNL FIX","BOTH IP/OP","$2,122.93 ","$1,570.97 ","$0.00 ","$2,122.93 ","$955.32 ","$0.00 ","$442.47 ","$0.00 ","$0.00 ","$371.71 ","$2,122.93 ","$0.00 ","$1,061.46 ","$1,681.36 ","$1,698.34 ","$0.00 ","$332.24 ","$0.00 ","$337.97 ","$0.00 "
"6260625","SUP","HCPCS C1713","","6260625  -  SCREW BONE 6MM 25MM TECHTONIX TI SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260630","SUP","HCPCS C1713","","6260630  -  SCREW BONE 6MM 30MM TECHTONIX SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260635","SUP","HCPCS C1713","","6260635  -  SCREW BONE 6MM 35MM TECHTONIX TI SPNL LP","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260640","SUP","HCPCS C1713","","6260640  -  SCREW BONE 6MM 40MM TECHTONIX TI SPNL LP","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260645","SUP","HCPCS C1713","","6260645  -  SCREW BONE 6MM 44MM TECHTONIX TI SPNL LP","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260650","SUP","HCPCS C1713","","6260650  -  SCREW BONE 6MM 50MM TECHTONIX TI SPNL LP","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260655","SUP","HCPCS C1713","","6260655  -  SCREW BONE 6MM 55MM TECHTONIX","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6260660","SUP","HCPCS C1713","","6260660  -  SCREW BONE 6MM 60MM TECHTONIX","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262525","SUP","HCPCS C1713","","6262525  -  SCREW BONE 5MM 25MM TECHTONIX TI SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262530","SUP","HCPCS C1713","","6262530  -  SCREW BONE 5MM 30MM TECHTONIX","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262535","SUP","HCPCS C1713","","6262535  -  SCREW BONE 5MM 35MM TECHTONIX TI SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262540","SUP","HCPCS C1713","","6262540  -  SCREW BONE 5MM 40MM TECHTONIX SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262545","SUP","HCPCS C1713","","6262545  -  SCREW BONE 5MM 45MM TECHTONIX SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262550","SUP","HCPCS C1713","","6262550  -  SCREW BONE 5MM 50MM TECHTONIX SPNL","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262555","SUP","HCPCS C1713","","6262555  -  SCREW BONE 5MM 55MM TECHTONIX","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262560","SUP","HCPCS C1713","","6262560  -  SCREW BONE 5MM 60MM TECHTONIX","BOTH IP/OP","$3,232.75 ","$2,392.24 ","$0.00 ","$3,232.75 ","$1,454.74 ","$0.00 ","$673.79 ","$0.00 ","$0.00 ","$566.03 ","$3,232.75 ","$0.00 ","$1,616.38 ","$2,560.34 ","$2,586.20 ","$0.00 ","$505.93 ","$0.00 ","$514.65 ","$0.00 "
"6262600","SUP","Custom 27803010","","6262600  -  ENDCAP 26MM RND 0 DEG OD18 TI XCORE 2","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6262604","SUP","Custom 27803010","","6262604  -  ENDCAP 26MM RND 4 DEG OD18","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6262608","SUP","Custom 27803010","","6262608  -  ENDCAP 26MM RND 8 DEG","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6271044","SUP","HCPCS C1713","","6271044  -  SPACER SPNL 11MM 11X44MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$2,246.40 ","$0.00 ","$1,040.46 ","$0.00 ","$0.00 ","$874.06 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$781.25 ","$0.00 ","$794.73 ","$0.00 "
"6272044","SUP","Custom 27803010","","6272044  -  SPACER SPNL 11MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6273044","SUP","Custom 27803010","","6273044  -  SPACER SPNL 14MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6276011","SUP","HCPCS C1713","","6276011  -  SPACER SPNL 11MM 11X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276025","SUP","HCPCS C1713","","6276025  -  SPACER SPNL 11MM 11X25MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$2,246.40 ","$0.00 ","$1,040.46 ","$0.00 ","$0.00 ","$874.06 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$781.25 ","$0.00 ","$794.73 ","$0.00 "
"6276111","SUP","HCPCS C1713","","6276111  -  SPACER SPNL 11MM 11X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276211","SUP","HCPCS C1713","","6276211  -  SPACER SPNL 12MM 11X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276311","SUP","HCPCS C1713","","6276311  -  SPACER SPNL 11MM 11X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276411","SUP","HCPCS C1713","","6276411  -  SPACER SPNL 11MM 11X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276511","SUP","HCPCS C1713","","6276511  -  SPACER SPNL 11MM 11X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276611","SUP","HCPCS C1713","","6276611  -  SPACER SPNL 11MM 11X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276711","SUP","HCPCS C1713","","6276711  -  SPACER SPNL 11MM 11X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276811","SUP","HCPCS C1713","","6276811  -  SPACER SPNL 11MM 11X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6276911","SUP","HCPCS C1713","","6276911  -  SPACER SPNL 11MM 11X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277006","SUP","HCPCS C1713","","6277006  -  SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$2,246.40 ","$0.00 ","$1,040.46 ","$0.00 ","$0.00 ","$874.06 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$781.25 ","$0.00 ","$794.73 ","$0.00 "
"6277025","SUP","Custom 27803010","","6277025  -  SPACER SPNL 11MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6277041","SUP","HCPCS C1713","","6277041  -  SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277141","SUP","HCPCS C1713","","6277141  -  SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277241","SUP","Custom 27803010","","6277241  -  SPACER SPNL 11MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6277341","SUP","Custom 27803010","","6277341  -  SPACER SPNL 11MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6277441","SUP","Custom 27803010","","6277441  -  SPACER SPNL 11MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6277541","SUP","HCPCS C1713","","6277541  -  SPACER SPNL 11MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277641","SUP","HCPCS C1713","","6277641  -  SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277741","SUP","HCPCS C1713","","6277741  -  SPACER SPNL 11MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277841","SUP","HCPCS C1713","","6277841  -  SPACER SPNL 11MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6277941","SUP","HCPCS C1713","","6277941  -  SPACER SPNL 11MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6278006","SUP","Custom 27803010","","6278006  -  SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278025","SUP","Custom 27803010","","6278025  -  SPACER SPNL 14MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT","BOTH IP/OP","$4,992.00 ","$3,694.08 ","$0.00 ","$4,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,992.00 ","$0.00 ","$2,496.00 ","$3,953.66 ","$3,993.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278044","SUP","Custom 27803010","","6278044  -  SPACER SPNL 14MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278144","SUP","Custom 27803010","","6278144  -  SPACER SPNL 14MM 14X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278244","SUP","Custom 27803010","","6278244  -  SPACER SPNL 14MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278344","SUP","Custom 27803010","","6278344  -  SPACER SPNL 14MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278444","SUP","Custom 27803010","","6278444  -  SPACER SPNL 14MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278544","SUP","Custom 27803010","","6278544  -  SPACER SPNL 14MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278644","SUP","Custom 27803010","","6278644  -  SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278744","SUP","Custom 27803010","","6278744  -  SPACER SPNL 14MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278844","SUP","Custom 27803010","","6278844  -  SPACER SPNL 14MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6278944","SUP","Custom 27803010","","6278944  -  SPACER SPNL 14MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6284011","SUP","HCPCS C1713","","6284011  -  SPACER SPNL 11MM 11X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284041","SUP","HCPCS C1713","","6284041  -  SPACER SPNL 11MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284044","SUP","HCPCS C1713","","6284044  -  SPACER SPNL 14MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284111","SUP","HCPCS C1713","","6284111  -  SPACER SPNL 11MM 11X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284141","SUP","HCPCS C1713","","6284141  -  SPACER SPNL 11MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284144","SUP","HCPCS C1713","","6284144  -  SPACER SPNL 14MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284211","SUP","HCPCS C1713","","6284211  -  SPACER SPNL 11MM 11X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284241","SUP","HCPCS C1713","","6284241  -  SPACER SPNL 11MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284244","SUP","HCPCS C1713","","6284244  -  SPACER SPNL 14MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284311","SUP","HCPCS C1713","","6284311  -  SPACER SPNL 11MM 11X13MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284511","SUP","HCPCS C1713","","6284511  -  SPACER SPNL 11MM 11X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284541","SUP","HCPCS C1713","","6284541  -  SPACER SPNL 11MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284544","SUP","HCPCS C1713","","6284544  -  SPACER SPNL 14MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284611","SUP","HCPCS C1713","","6284611  -  SPACER SPNL 11MM 11X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284641","SUP","HCPCS C1713","","6284641  -  SPACER SPNL 11MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284644","SUP","HCPCS C1713","","6284644  -  SPACER SPNL 14MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284711","SUP","HCPCS C1713","","6284711  -  SPACER SPNL 11MM 11X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284741","SUP","HCPCS C1713","","6284741  -  SPACER SPNL 11MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284744","SUP","HCPCS C1713","","6284744  -  SPACER SPNL 14MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284811","SUP","HCPCS C1713","","6284811  -  SPACER SPNL 11MM 11X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284841","SUP","HCPCS C1713","","6284841  -  SPACER SPNL 11MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284844","SUP","HCPCS C1713","","6284844  -  SPACER SPNL 14MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284911","SUP","HCPCS C1713","","6284911  -  SPACER SPNL 11MM 11X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284941","SUP","HCPCS C1713","","6284941  -  SPACER SPNL 11MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6284944","SUP","HCPCS C1713","","6284944  -  SPACER SPNL 14MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286011","SUP","HCPCS C1713","","6286011  -  SPACER SPNL 11MM 11X10MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286111","SUP","HCPCS C1713","","6286111  -  SPACER SPNL 11MM 11X11MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286211","SUP","HCPCS C1713","","6286211  -  SPACER SPNL 11MM 11X12MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286311","SUP","HCPCS C1713","","6286311  -  SPACER SPNL 11MM 11X13MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286511","SUP","HCPCS C1713","","6286511  -  SPACER SPNL 11MM 11X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286611","SUP","HCPCS C1713","","6286611  -  SPACER SPNL 11MM 11X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286711","SUP","HCPCS C1713","","6286711  -  SPACER SPNL 11MM 11X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286811","SUP","HCPCS C1713","","6286811  -  SPACER SPNL 11MM 11X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6286911","SUP","HCPCS C1713","","6286911  -  SPACER SPNL 11MM 11X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287041","SUP","HCPCS C1713","","6287041  -  SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287141","SUP","HCPCS C1713","","6287141  -  SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287241","SUP","HCPCS C1713","","6287241  -  SPACER SPNL 11MM 14X12MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287341","SUP","HCPCS C1713","","6287341  -  SPACER SPNL 11MM 14X13MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287541","SUP","HCPCS C1713","","6287541  -  SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287641","SUP","HCPCS C1713","","6287641  -  SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287741","SUP","HCPCS C1713","","6287741  -  SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287841","SUP","HCPCS C1713","","6287841  -  SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6287941","SUP","HCPCS C1713","","6287941  -  SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288044","SUP","HCPCS C1713","","6288044  -  SPACER SPNL 14MM 14X10MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288144","SUP","HCPCS C1713","","6288144  -  SPACER SPNL 14MM 14X11MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288244","SUP","HCPCS C1713","","6288244  -  SPACER SPNL 14MM 14X12MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288344","SUP","HCPCS C1713","","6288344  -  SPACER SPNL 14MM 14X13MM VRTSTCK CRSTN PSR LAT PORT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288544","SUP","HCPCS C1713","","6288544  -  SPACER SPNL 14MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288644","SUP","HCPCS C1713","","6288644  -  SPACER SPNL 14MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288744","SUP","HCPCS C1713","","6288744  -  SPACER SPNL 14MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288844","SUP","HCPCS C1713","","6288844  -  SPACER SPNL 14MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6288944","SUP","HCPCS C1713","","6288944  -  SPACER SPNL 14MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6300240","SUP","HCPCS C1713","","6300240  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300245","SUP","HCPCS C1713","","6300245  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300250","SUP","HCPCS C1713","","6300250  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300255","SUP","HCPCS C1713","","6300255  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300260","SUP","HCPCS C1713","","6300260  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300265","SUP","HCPCS C1713","","6300265  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X2MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300440","SUP","HCPCS C1713","","6300440  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300445","SUP","HCPCS C1713","","6300445  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300450","SUP","HCPCS C1713","","6300450  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300455","SUP","HCPCS C1713","","6300455  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300460","SUP","HCPCS C1713","","6300460  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300465","SUP","HCPCS C1713","","6300465  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X4MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300640","SUP","HCPCS C1713","","6300640  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300645","SUP","HCPCS C1713","","6300645  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300650","SUP","HCPCS C1713","","6300650  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300655","SUP","HCPCS C1713","","6300655  -  CAGE SPNL 30D LRDTC HI","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300660","SUP","HCPCS C1713","","6300660  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300665","SUP","HCPCS C1713","","6300665  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X6MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300840","SUP","HCPCS C1713","","6300840  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300845","SUP","HCPCS C1713","","6300845  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300850","SUP","HCPCS C1713","","6300850  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300855","SUP","HCPCS C1713","","6300855  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300860","SUP","HCPCS C1713","","6300860  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6300865","SUP","HCPCS C1713","","6300865  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X8MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6301040","SUP","HCPCS C1713","","6301040  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6301045","SUP","HCPCS C1713","","6301045  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6301050","SUP","HCPCS C1713","","6301050  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6301055","SUP","HCPCS C1713","","6301055  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6301060","SUP","HCPCS C1713","","6301060  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6301065","SUP","HCPCS C1713","","6301065  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X10MM CRNT","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"6360032","SUP","HCPCS C1713","","6360032  -  SPACER SPNL XS 13X12X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360053","SUP","HCPCS C1713","","6360053  -  SPACER SPNL XS 15X13X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360132","SUP","HCPCS C1713","","6360132  -  SPACER SPNL XS 13X12X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360153","SUP","HCPCS C1713","","6360153  -  SPACER SPNL XS 15X13X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360232","SUP","HCPCS C1713","","6360232  -  SPACER SPNL XS 13X12X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360253","SUP","HCPCS C1713","","6360253  -  SPACER SPNL XS 15X13X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360532","SUP","HCPCS C1713","","6360532  -  SPACER SPNL XS 13X12X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360553","SUP","HCPCS C1713","","6360553  -  SPACER SPNL XS 15X13X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360632","SUP","HCPCS C1713","","6360632  -  SPACER SPNL XS 13X12X6MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360653","SUP","HCPCS C1713","","6360653  -  SPACER SPNL XS 15X6X3MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360732","SUP","HCPCS C1713","","6360732  -  SPACER SPNL XS 13X12X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360753","SUP","HCPCS C1713","","6360753  -  SPACER SPNL XS 15X13X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360832","SUP","HCPCS C1713","","6360832  -  SPACER SPNL XS 13X12X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360853","SUP","HCPCS C1713","","6360853  -  SPACER SPNL XS 15X13X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360932","SUP","HCPCS C1713","","6360932  -  SPACER SPNL XS 13X12X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6360953","SUP","HCPCS C1713","","6360953  -  SPACER SPNL XS 15X13X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6390206","SUP","Custom 27803010","","6390206  -  CAGE SPNL CYL LRDTC TPR 6MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390207","SUP","Custom 27803010","","6390207  -  CAGE SPNL CYL LRDTC TPR 7MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390208","SUP","Custom 27803010","","6390208  -  CAGE SPNL CYL LRDTC TPR 8MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390209","SUP","Custom 27803010","","6390209  -  CAGE SPNL CYL LRDTC TPR 9MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390210","SUP","Custom 27803010","","6390210  -  CAGE SPNL CYL LRDTC TPR 10MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390211","SUP","Custom 27803010","","6390211  -  CAGE SPNL CYL LRDTC TPR 11MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390212","SUP","Custom 27803010","","6390212  -  CAGE SPNL CYL LRDTC TPR 12MM 12MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390406","SUP","Custom 27803010","","6390406  -  CAGE SPNL CYL LRDTC TPR 6MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390407","SUP","Custom 27803010","","6390407  -  CAGE SPNL CYL LRDTC TPR 7MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390408","SUP","Custom 27803010","","6390408  -  CAGE SPNL CYL LRDTC TPR 8MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390409","SUP","Custom 27803010","","6390409  -  CAGE SPNL CYL LRDTC TPR 9MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390410","SUP","Custom 27803010","","6390410  -  CAGE SPNL CYL LRDTC TPR 10MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390411","SUP","Custom 27803010","","6390411  -  CAGE SPNL CYL LRDTC TPR 11MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6390412","SUP","Custom 27803010","","6390412  -  CAGE SPNL CYL LRDTC TPR 12MM 14MM AFF CLS CHMFR EDG MLT THR","BOTH IP/OP","$6,988.50 ","$5,171.49 ","$0.00 ","$6,988.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,988.50 ","$0.00 ","$3,494.25 ","$5,534.89 ","$5,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6430530","SUP","HCPCS C1713","","6430530  -  SCREW SET TI 4.75MM SPN PERC SOLERA CD HZN STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"6440530","SUP","HCPCS C1713","","6440530  -  SET SCREW 6440530 4.75 SOLERA PERC TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"6470314","SUP","Custom 27203010","","6470314  -  BRYAN CERVICAL DISC, 14MM","BOTH IP/OP","$8,850.00 ","$6,549.00 ","$0.00 ","$8,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,850.00 ","$0.00 ","$4,425.00 ","$7,009.20 ","$7,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6470315","SUP","Custom 27803010","","6470315  -  DISK SPINAL MOTION BRYAN 15MM CERV","BOTH IP/OP","$8,850.00 ","$6,549.00 ","$0.00 ","$8,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,850.00 ","$0.00 ","$4,425.00 ","$7,009.20 ","$7,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6474024","SUP","HCPCS C1713","","6474024  -  PIN DISTRACTION 14MM 3.5MM REUSABLE","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"6474176","SUP","Custom 27203010","","6474176  -  BIT DRILL SPN","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6474524","SUP","Custom 27203010","","6474524  -  BRYAN DISC CUTTER 14MM","BOTH IP/OP","$1,350.00 ","$999.00 ","$0.00 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6533131","SUP","HCPCS C1713","","6533131  -  END CAP SPNL 0D 30X18MM VBR EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533141","SUP","HCPCS C1713","","6533141  -  END CAP SPNL 0D 40X18MM VBR EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533151","SUP","HCPCS C1713","","6533151  -  CAGE SPNL 0D 50X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533231","SUP","HCPCS C1713","","6533231  -  END CAP SPNL 4D 30X18MM VBR EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533241","SUP","HCPCS C1713","","6533241  -  CAGE SPNL 4D 40X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533251","SUP","HCPCS C1713","","6533251  -  END CAP SPNL 4D 50X18MM VBR EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533331","SUP","HCPCS C1713","","6533331  -  CAGE SPNL 8D 30X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533341","SUP","HCPCS C1713","","6533341  -  CAGE SPNL 8D 40X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533351","SUP","HCPCS C1713","","6533351  -  CAGE SPNL 8D 50X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533431","SUP","HCPCS C1713","","6533431  -  END CAP SPNL -4D 30X18MM VBR EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533441","SUP","HCPCS C1713","","6533441  -  CAGE SPNL -4D 40X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6533451","SUP","HCPCS C1713","","6533451  -  CAGE SPNL -4D 50X18MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535241","SUP","HCPCS C1713","","6535241  -  CAGE SPNL 0D 40X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535251","SUP","HCPCS C1713","","6535251  -  CAGE SPNL 0D 50X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535261","SUP","HCPCS C1713","","6535261  -  CAGE SPNL 0D 60X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535341","SUP","HCPCS C1713","","6535341  -  CAGE SPNL 4D 40X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535351","SUP","HCPCS C1713","","6535351  -  CAGE SPNL 4D 50X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535361","SUP","HCPCS C1713","","6535361  -  CAGE SPNL 4D 60X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535441","SUP","HCPCS C1713","","6535441  -  CAGE SPNL 8D 40X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535451","SUP","HCPCS C1713","","6535451  -  CAGE SPNL 8D 50X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535461","SUP","HCPCS C1713","","6535461  -  CAGE SPNL 8D 60X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535541","SUP","HCPCS C1713","","6535541  -  CAGE SPNL 12D 40X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535551","SUP","HCPCS C1713","","6535551  -  CAGE SPNL 12D 50X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6535561","SUP","HCPCS C1713","","6535561  -  CAGE SPNL 12D 60X22MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$3,740.00 ","$2,767.60 ","$0.00 ","$3,740.00 ","$1,683.00 ","$0.00 ","$779.51 ","$0.00 ","$0.00 ","$654.84 ","$3,740.00 ","$0.00 ","$1,870.00 ","$2,962.08 ","$2,992.00 ","$0.00 ","$585.31 ","$0.00 ","$595.41 ","$0.00 "
"6537124","SUP","HCPCS C1713","","6537124  -  END CAP SPNL 0D RND 18MM 22MM VBR EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537125","SUP","HCPCS C1713","","6537125  -  CAGE SPNL 0D RND 18MM 26MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537134","SUP","HCPCS C1713","","6537134  -  END CAP SPNL 8D RND 18MM 22MM VBR EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537135","SUP","HCPCS C1713","","6537135  -  CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537225","SUP","HCPCS C1713","","6537225  -  CAGE SPNL 0D RND 22MM 26MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537226","SUP","HCPCS C1713","","6537226  -  CAGE SPNL 0D RND 22MM 30MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537235","SUP","HCPCS C1713","","6537235  -  CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6537236","SUP","HCPCS C1713","","6537236  -  CAGE SPNL 8D RND 22MM 30MM VBR ENDCP EXPANDABLE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$490.32 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"6539001","SUP","HCPCS C1713","","6539001  -  SCREW BN SM VBR EXPANDABLE LCK SPNE","BOTH IP/OP","$620.00 ","$458.80 ","$0.00 ","$620.00 ","$279.00 ","$0.00 ","$129.22 ","$0.00 ","$0.00 ","$108.56 ","$620.00 ","$0.00 ","$310.00 ","$491.04 ","$496.00 ","$0.00 ","$97.03 ","$0.00 ","$98.70 ","$0.00 "
"6539002","SUP","HCPCS C1713","","6539002  -  SCREW BN LG VBR LCK EXPANDABLE SPNE","BOTH IP/OP","$620.00 ","$458.80 ","$0.00 ","$620.00 ","$279.00 ","$0.00 ","$129.22 ","$0.00 ","$0.00 ","$108.56 ","$620.00 ","$0.00 ","$310.00 ","$491.04 ","$496.00 ","$0.00 ","$97.03 ","$0.00 ","$98.70 ","$0.00 "
"6540530","SUP","HCPCS C1713","","6540530  -  SCREW SET 5.5/6MM NS LF CD HZN SOLERAL VYGR","BOTH IP/OP","$912.50 ","$675.25 ","$0.00 ","$912.50 ","$410.63 ","$0.00 ","$190.19 ","$0.00 ","$0.00 ","$159.77 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$142.81 ","$0.00 ","$145.27 ","$0.00 "
"6541019","SUP","HCPCS C1713","","6541019  -  STAPLE 6541019 19MM ROSTRAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541021","SUP","HCPCS C1713","","6541021  -  STAPLE 6541021 21MM ROSTRAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541023","SUP","HCPCS C1713","","6541023  -  STAPLE 6541023 23MM ROSTRAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541025","SUP","HCPCS C1713","","6541025  -  STAPLE 6541025 25MM ROSTRAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541119","SUP","HCPCS C1713","","6541119  -  STAPLE 6541119 19MM CAUDAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541121","SUP","HCPCS C1713","","6541121  -  STAPLE 6541121 21MM CAUDAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541123","SUP","HCPCS C1713","","6541123  -  STAPLE 6541123 23MM CAUDAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541125","SUP","HCPCS C1713","","6541125  -  STAPLE 6541125 25MM CAUDAL","BOTH IP/OP","$2,932.13 ","$2,169.78 ","$0.00 ","$2,932.13 ","$1,319.46 ","$0.00 ","$611.13 ","$0.00 ","$0.00 ","$513.39 ","$2,932.13 ","$0.00 ","$1,466.06 ","$2,322.25 ","$2,345.70 ","$0.00 ","$458.88 ","$0.00 ","$466.79 ","$0.00 "
"6541213","SUP","HCPCS C1713","","6541213  -  STAPLE 6541213 SINGLE 13MM","BOTH IP/OP","$1,465.50 ","$1,084.47 ","$0.00 ","$1,465.50 ","$659.48 ","$0.00 ","$305.45 ","$0.00 ","$0.00 ","$256.60 ","$1,465.50 ","$0.00 ","$732.75 ","$1,160.68 ","$1,172.40 ","$0.00 ","$229.35 ","$0.00 ","$233.31 ","$0.00 "
"6541215","SUP","HCPCS C1713","","6541215  -  STAPLE 6541215 SINGLE 15MM","BOTH IP/OP","$1,465.50 ","$1,084.47 ","$0.00 ","$1,465.50 ","$659.48 ","$0.00 ","$305.45 ","$0.00 ","$0.00 ","$256.60 ","$1,465.50 ","$0.00 ","$732.75 ","$1,160.68 ","$1,172.40 ","$0.00 ","$229.35 ","$0.00 ","$233.31 ","$0.00 "
"6541217","SUP","HCPCS C1713","","6541217  -  STAPLE 6541217 SINGLE 17MM","BOTH IP/OP","$1,465.50 ","$1,084.47 ","$0.00 ","$1,465.50 ","$659.48 ","$0.00 ","$305.45 ","$0.00 ","$0.00 ","$256.60 ","$1,465.50 ","$0.00 ","$732.75 ","$1,160.68 ","$1,172.40 ","$0.00 ","$229.35 ","$0.00 ","$233.31 ","$0.00 "
"6543420","SUP","HCPCS C1713","","6543420  -  SCREW 6543420 4.5MM FAS FOR 5.5 20MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543425","SUP","HCPCS C1713","","6543425  -  SCREW 6543425 4.5MM FAS FOR 5.5 25MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543430","SUP","HCPCS C1713","","6543430  -  SCREW 6543430 4.5MM FAS FOR 5.5 30MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543435","SUP","HCPCS C1713","","6543435  -  SCREW 6543435 4.5MM FAS FOR 5.5 35MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543440","SUP","HCPCS C1713","","6543440  -  SCREW 6543440 4.5MM FAS FOR 5.5 40MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543445","SUP","HCPCS C1713","","6543445  -  SCREW 6543445 4.5MM FAS FOR 5.5 45MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543450","SUP","HCPCS C1713","","6543450  -  SCREW 6543450 4.5MM FAS FOR 5.5 50MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543520","SUP","HCPCS C1713","","6543520  -  SCREW 6543520 5.5MM FAS FOR 5.5 20MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543525","SUP","HCPCS C1713","","6543525  -  SCREW 6543525 5.5MM FAS FOR 5.5 25MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543530","SUP","HCPCS C1713","","6543530  -  SCREW 6543530 5.5MM FAS FOR 5.5 30MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543535","SUP","HCPCS C1713","","6543535  -  SCREW 6543535 5.5MM FAS FOR 5.5 35MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543540","SUP","HCPCS C1713","","6543540  -  SCREW 6543540 5.5MM FAS FOR 5.5 40MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543545","SUP","HCPCS C1713","","6543545  -  SCREW 6543545 5.5MM FAS FOR 5.5 45MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543550","SUP","HCPCS C1713","","6543550  -  SCREW 6543550 5.5MM FAS FOR 5.5 50MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543620","SUP","HCPCS C1713","","6543620  -  SCREW 6543620 6.5MM FAS FOR 5.5 20MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543625","SUP","HCPCS C1713","","6543625  -  SCREW 6543625 6.5MM FAS FOR 5.5 25MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543630","SUP","HCPCS C1713","","6543630  -  SCREW 6543630 6.5MM FAS FOR 5.5 30MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543635","SUP","HCPCS C1713","","6543635  -  SCREW 6543635 6.5MM FAS FOR 5.5 35MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543640","SUP","HCPCS C1713","","6543640  -  SCREW 6543640 6.5MM FAS FOR 5.5 40MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543645","SUP","HCPCS C1713","","6543645  -  SCREW 6543645 6.5MM FAS FOR 5.5 45MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543650","SUP","HCPCS C1713","","6543650  -  SCREW 6543650 6.5MM FAS FOR 5.5 50MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543655","SUP","HCPCS C1713","","6543655  -  SCREW 6543655 6.5MM FAS FOR 5.5 55MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543660","SUP","HCPCS C1713","","6543660  -  SCREW 6543660 6.5MM FAS FOR 5.5 60MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543720","SUP","HCPCS C1713","","6543720  -  SCREW 6543720 7.5MM FAS FOR 5.5 20MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543725","SUP","HCPCS C1713","","6543725  -  SCREW 6543725 7.5MM FAS FOR 5.5 25MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543730","SUP","HCPCS C1713","","6543730  -  SCREW 6543730 7.5MM FAS FOR 5.5 30MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543735","SUP","HCPCS C1713","","6543735  -  SCREW 6543735 7.5MM FAS FOR 5.5 35MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543740","SUP","HCPCS C1713","","6543740  -  SCREW 6543740 7.5MM FAS FOR 5.5 40MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543745","SUP","HCPCS C1713","","6543745  -  SCREW 6543745 7.5MM FAS FOR 5.5 45MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543750","SUP","HCPCS C1713","","6543750  -  SCREW 6543750 7.5MM FAS FOR 5.5 50MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543755","SUP","HCPCS C1713","","6543755  -  SCREW 6543755 7.5MM FAS FOR 5.5 55MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543760","SUP","HCPCS C1713","","6543760  -  SCREW 6543760 7.5MM FAS FOR 5.5 60MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543820","SUP","HCPCS C1713","","6543820  -  SCREW 6543820 8.5MM FAS FOR 5.5 20MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543825","SUP","HCPCS C1713","","6543825  -  SCREW 6543825 8.5MM FAS FOR 5.5 25MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543830","SUP","HCPCS C1713","","6543830  -  SCREW 6543830 8.5MM FAS FOR 5.5 30MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543835","SUP","HCPCS C1713","","6543835  -  SCREW 6543835 8.5MM FAS FOR 5.5 35MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543840","SUP","HCPCS C1713","","6543840  -  SCREW 6543840 8.5MM FAS FOR 5.5 40MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543845","SUP","HCPCS C1713","","6543845  -  SCREW 6543845 8.5MM FAS FOR 5.5 45MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543850","SUP","HCPCS C1713","","6543850  -  SCREW 6543850 8.5MM FAS FOR 5.5 50MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543855","SUP","HCPCS C1713","","6543855  -  SCREW 6543855 8.5MM FAS FOR 5.5 55MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6543860","SUP","HCPCS C1713","","6543860  -  SCREW 6543860 8.5MM FAS FOR 5.5 60MM LG","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"6591011","SUP","HCPCS C1713","","6591011  -  CAGE SPNL 18MM 20-22MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591012","SUP","HCPCS C1713","","6591012  -  CAGE SPNL 18MM 21-25MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591013","SUP","HCPCS C1713","","6591013  -  CAGE SPNL 18MM 24-31MM VBR COR XPD","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591014","SUP","HCPCS C1713","","6591014  -  CAGE SPNL 18MM 28-40MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591015","SUP","HCPCS C1713","","6591015  -  CAGE SPNL 18MM 35-52MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591016","SUP","HCPCS C1713","","6591016  -  CAGE SPNL 18MM 41-65MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591017","SUP","HCPCS C1713","","6591017  -  CAGE SPNL 18MM 47-75MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591021","SUP","HCPCS C1713","","6591021  -  CAGE SPNL 22MM 20-22MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591022","SUP","HCPCS C1713","","6591022  -  CAGE SPNL 22MM 21-25MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591023","SUP","HCPCS C1713","","6591023  -  CAGE SPNL 22MM 24-31MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591024","SUP","HCPCS C1713","","6591024  -  CAGE SPNL 22MM 28-40MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591025","SUP","HCPCS C1713","","6591025  -  CAGE SPNL 22MM 35-52MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591026","SUP","HCPCS C1713","","6591026  -  CAGE SPNL 22MM 41-65MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6591027","SUP","HCPCS C1713","","6591027  -  CAGE SPNL 22MM 47-75MM VBR EXPANDABLE","BOTH IP/OP","$11,245.00 ","$8,321.30 ","$0.00 ","$11,245.00 ","$5,060.25 ","$0.00 ","$2,343.74 ","$0.00 ","$0.00 ","$1,968.91 ","$11,245.00 ","$0.00 ","$5,622.50 ","$8,906.04 ","$8,996.00 ","$0.00 ","$1,759.84 ","$0.00 ","$1,790.20 ","$0.00 "
"6605359","SUP","Custom 27203010","","CALIBRATOR FLW CYMTR FLW-CHK FLUOROSPHERES 10ML","BOTH IP/OP","$458.68 ","$339.42 ","$0.00 ","$458.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.68 ","$0.00 ","$229.34 ","$363.27 ","$366.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6607007","SUP","Custom 27203010","","CALIBRATOR FLW CYMTR FLW-SET FLUOROSPHERES 10ML","BOTH IP/OP","$458.68 ","$339.42 ","$0.00 ","$458.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.68 ","$0.00 ","$229.34 ","$363.27 ","$366.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6607013","SUP","Custom 27203010","","ANTIBODY CD45 CD4 CD8 CD3 CLONE B3821F4A SFCI12T4D11 SFCI21","BOTH IP/OP","$722.10 ","$534.35 ","$0.00 ","$722.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$722.10 ","$0.00 ","$361.05 ","$571.90 ","$577.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6607023","SUP","Custom 27203010","","CALIBRATOR FLW CYMTR CYTO-COMP HMN LYMPH LYPH 250 TST","BOTH IP/OP","$285.35 ","$211.16 ","$0.00 ","$285.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.35 ","$0.00 ","$142.68 ","$226.00 ","$228.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6607077","SUP","Custom 27203010","","CONTROL FLW CYMTR IMTRL POS 3ML 60 TST","BOTH IP/OP","$403.73 ","$298.76 ","$0.00 ","$403.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$403.73 ","$0.00 ","$201.86 ","$319.75 ","$322.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6607098","SUP","Custom 27203010","","CONTROL FLW CYMTR IMTRL LOW 3ML 60 TST","BOTH IP/OP","$403.73 ","$298.76 ","$0.00 ","$403.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$403.73 ","$0.00 ","$201.86 ","$319.75 ","$322.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6608125","SUP","HCPCS C1713","","6608125  -  CAGE SPNL 8D LG CNTR 25X11X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6608925","SUP","HCPCS C1713","","6608925  -  CAGE SPNL 8D LG CNTR 25X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6609125","SUP","HCPCS C1713","","6609125  -  CAGE SPNL LG 25X11X9MM CNTR PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6609925","SUP","HCPCS C1713","","6609925  -  CAGE SPNL 8 25X9X9MM PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6610125","SUP","HCPCS C1713","","6610125  -  CAGE SPNL 8D LG CNTR 25X11X10MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6610925","SUP","HCPCS C1713","","6610925  -  CAGE SPNL 8D LG CNTR 25X10X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6611125","SUP","HCPCS C1713","","6611125  -  SPACER SPNL LG 25X11X11MM CNTR PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6611925","SUP","Custom 27803010","","6611925  -  CAGE SPNL 8D LG CNTR 25X9X11MM NS LF CRNT PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6612125","SUP","HCPCS C1713","","6612125  -  CAGE SPNL 8D LG CNTR 25X12X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6612925","SUP","HCPCS C1713","","6612925  -  CAGE SPNL 8D LG CNTR 25X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6613125","SUP","HCPCS C1713","","6613125  -  SPACER SPNL 25X11X13MM PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6613925","SUP","HCPCS C1713","","6613925  -  CAGE SPNL 8D LG CNTR 25X9X13MM NS LF CRNT PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6614125","SUP","HCPCS C1713","","6614125  -  CAGE SPNL 8D LG CNTR 25X14X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6614925","SUP","HCPCS C1713","","6614925  -  CAGE SPNL 8D LG CNTR 25X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6615125","SUP","HCPCS C1713","","6615125  -  SPACER SPNL LG 25X11X15MM CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6615925","SUP","HCPCS C1713","","6615925  -  CAGE SPNL 8D LG 25X9X15MM PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6616125","SUP","HCPCS C1713","","6616125  -  CAGE SPNL LG 25X11X16MM PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6616925","SUP","HCPCS C1713","","6616925  -  CAGE SPNL 8D LG 25X9X16MM PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6660725","SUP","HCPCS C1713","","6660725  -  SPACER SPNL 6D 25X10X7MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660730","SUP","HCPCS C1713","","6660730  -  SPACER SPNL 6D 30X10X7MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660736","SUP","HCPCS C1713","","6660736  -  SPACER SPNL 6D 36X10X7MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660825","SUP","HCPCS C1713","","6660825  -  SPACER SPNL 6D 25X10X8MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660830","SUP","HCPCS C1713","","6660830  -  SPACER SPNL 6D 30X10X8MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660836","SUP","HCPCS C1713","","6660836  -  SPACER SPNL 6D 36X10X8MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660925","SUP","HCPCS C1713","","6660925  -  SPACER SPNL 6D 25X10X9MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660930","SUP","HCPCS C1713","","6660930  -  SPACER SPNL 6D 30X10X9MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6660936","SUP","HCPCS C1713","","6660936  -  SPACER SPNL 6D 36X10X9MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661025","SUP","HCPCS C1713","","6661025  -  SPACER SPNL 6D 25X10X10MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661030","SUP","HCPCS C1713","","6661030  -  SPACER SPNL 6D 30X10X10MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661036","SUP","HCPCS C1713","","6661036  -  SPACER SPNL 6D 36X10X10MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661125","SUP","HCPCS C1713","","6661125  -  SPACER SPNL 6D 25X10X11MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661130","SUP","HCPCS C1713","","6661130  -  SPACER SPNL 6D 30X10X11MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661136","SUP","HCPCS C1713","","6661136  -  SPACER SPNL 6D 36X10X11MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661225","SUP","HCPCS C1713","","6661225  -  SPACER SPNL 6D 25X10X12MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661230","SUP","HCPCS C1713","","6661230  -  SPACER SPNL 6D 30X10X12MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661236","SUP","HCPCS C1713","","6661236  -  SPACER SPNL 6D 36X10X12MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661325","SUP","HCPCS C1713","","6661325  -  SPACER SPNL 6D 25X10X13MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661330","SUP","HCPCS C1713","","6661330  -  SPACER SPNL 6D 30X10X13MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661336","SUP","HCPCS C1713","","6661336  -  SPACER SPNL 6D 36X10X13MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661425","SUP","HCPCS C1713","","6661425  -  SPACER SPNL 6D 25X10X14MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661430","SUP","HCPCS C1713","","6661430  -  SPACER SPNL 6D 30X10X14MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661436","SUP","HCPCS C1713","","6661436  -  SPACER SPNL 6D 36X10X14MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661525","SUP","HCPCS C1713","","6661525  -  SPACER SPNL 6D 25X10X15MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661530","SUP","HCPCS C1713","","6661530  -  SPACER SPNL 6D 30X10X15MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661536","SUP","HCPCS C1713","","6661536  -  SPACER SPNL 6D 36X10X15MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661625","SUP","HCPCS C1713","","6661625  -  SPACER SPNL 6D 25X10X16MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661630","SUP","HCPCS C1713","","6661630  -  SPACER SPNL 6D 30X10X16MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6661636","SUP","HCPCS C1713","","6661636  -  SPACER SPNL 6D 36X10X16MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670725","SUP","HCPCS C1713","","6670725  -  SPACER SPNL W 25X10X7MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670730","SUP","HCPCS C1713","","6670730  -  SPACER SPNL W 30X10X7MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670736","SUP","HCPCS C1713","","6670736  -  SPACER SPNL W 36X10X7MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670825","SUP","HCPCS C1713","","6670825  -  SPACER SPNL W 25X10X8MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670830","SUP","HCPCS C1713","","6670830  -  SPACER SPNL W 30X10X8MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670836","SUP","HCPCS C1713","","6670836  -  SPACER SPNL W 36X10X8MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670925","SUP","HCPCS C1713","","6670925  -  SPACER SPNL W 25X10X9MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670930","SUP","HCPCS C1713","","6670930  -  SPACER SPNL W 30X10X9MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6670936","SUP","HCPCS C1713","","6670936  -  SPACER SPNL W 36X10X9MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671025","SUP","HCPCS C1713","","6671025  -  SPACER SPNL W 25X10X10MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671030","SUP","HCPCS C1713","","6671030  -  SPACER SPNL W 30X10X10MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671036","SUP","HCPCS C1713","","6671036  -  SPACER SPNL W 36X10X10MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671125","SUP","HCPCS C1713","","6671125  -  SPACER SPNL W 25X10X11MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671130","SUP","HCPCS C1713","","6671130  -  SPACER SPNL W 30X10X11MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671136","SUP","HCPCS C1713","","6671136  -  SPACER SPNL W 36X10X11MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671225","SUP","HCPCS C1713","","6671225  -  SPACER SPNL W 25X10X12MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671230","SUP","HCPCS C1713","","6671230  -  SPACER SPNL W 30X10X12MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671236","SUP","HCPCS C1713","","6671236  -  SPACER SPNL W 36X10X12MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671325","SUP","HCPCS C1713","","6671325  -  SPACER SPNL W 25X10X13MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671330","SUP","HCPCS C1713","","6671330  -  SPACER SPNL W 30X10X13MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671336","SUP","HCPCS C1713","","6671336  -  SPACER SPNL W 36X10X13MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671425","SUP","HCPCS C1713","","6671425  -  SPACER SPNL W 25X10X14MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671430","SUP","HCPCS C1713","","6671430  -  SPACER SPNL W 30X10X14MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671436","SUP","HCPCS C1713","","6671436  -  SPACER SPNL W 36X10X14MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671525","SUP","HCPCS C1713","","6671525  -  SPACER SPNL W 25X10X15MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671530","SUP","HCPCS C1713","","6671530  -  SPACER SPNL W 30X10X15MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671536","SUP","HCPCS C1713","","6671536  -  SPACER SPNL W 36X10X15MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671625","SUP","HCPCS C1713","","6671625  -  SPACER SPNL W 25X10X16MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671630","SUP","HCPCS C1713","","6671630  -  SPACER SPNL W 30X10X16MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6671636","SUP","HCPCS C1713","","6671636  -  SPACER SPNL W 36X10X16MM STRL CRSNT TI","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"6708120","SUP","HCPCS C1713","","6708120  -  CAGE SPNL 4D LG IMPCT 20X11X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708126","SUP","Custom 27803010","","6708126  -  CAGE SPNL 4D LG IMPCT 26X11X8MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6708132","SUP","HCPCS C1713","","6708132  -  CAGE SPNL 4D LG IMPCT 32X11X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708520","SUP","HCPCS C1713","","6708520  -  SPACER SPNL 20X9X8MM CRNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708820","SUP","HCPCS C1713","","6708820  -  SPACER SPNL 8D LG 20X9X8MM CRNT THORLMBR INTRBD FS TPR PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708926","SUP","Custom 27803010","","6708926  -  CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6708932","SUP","HCPCS C1713","","6708932  -  CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709120","SUP","HCPCS C1713","","6709120  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709126","SUP","HCPCS C1713","","6709126  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709132","SUP","HCPCS C1713","","6709132  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709920","SUP","HCPCS C1713","","6709920  -  CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709926","SUP","Custom 27803010","","6709926  -  CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6709932","SUP","Custom 27803010","","6709932  -  CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6710120","SUP","HCPCS C1713","","6710120  -  CAGE SPNL 4D LG IMPCT 20X11X10MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710126","SUP","HCPCS C1713","","6710126  -  CAGE SPNL 4D LG IMPCT 26X11X10MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710132","SUP","HCPCS C1713","","6710132  -  CAGE SPNL 4D LG IMPCT 32X11X10MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710520","SUP","HCPCS C1713","","6710520  -  SPACER SPNL 20X10X9MM PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710820","SUP","HCPCS C1713","","6710820  -  SPACER SPNL 20X10X8MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710920","SUP","HCPCS C1713","","6710920  -  CAGE SPNL 20X10X9MM CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710926","SUP","Custom 27803010","","6710926  -  CAGE SPNL 4D LG IMPCT 26X9X10MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6710932","SUP","HCPCS C1713","","6710932  -  CAGE SPNL 4D LG IMPCT 32X9X10MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711120","SUP","HCPCS C1713","","6711120  -  CAGE SPNL 4D LG IMPCT 20X11X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711126","SUP","HCPCS C1713","","6711126  -  CAGE SPNL 4D LG IMPCT 26X11X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711132","SUP","HCPCS C1713","","6711132  -  CAGE SPNL 4D LG IMPCT 32X11X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711920","SUP","HCPCS C1713","","6711920  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711926","SUP","HCPCS C1713","","6711926  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711932","SUP","HCPCS C1713","","6711932  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712120","SUP","HCPCS C1713","","6712120  -  CAGE SPNL 4D LG IMPCT 20X12X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712126","SUP","HCPCS C1713","","6712126  -  CAGE SPNL 4D LG IMPCT 26X12X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712132","SUP","HCPCS C1713","","6712132  -  CAGE SPNL 4D LG IMPCT 32X12X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712520","SUP","HCPCS C1713","","6712520  -  SPACER SPNL 12MM 15MM INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712820","SUP","HCPCS C1713","","6712820  -  CAGE SPNL 8D LG 20X9X12MM CRNT TPR PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712920","SUP","HCPCS C1713","","6712920  -  CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712926","SUP","HCPCS C1713","","6712926  -  CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712932","SUP","HCPCS C1713","","6712932  -  CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713120","SUP","HCPCS C1713","","6713120  -  CAGE SPNL 4D LG IMPCT 20X13X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713126","SUP","HCPCS C1713","","6713126  -  CAGE SPNL 4D LG IMPCT 26X13X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713132","SUP","HCPCS C1713","","6713132  -  CAGE SPNL 4D LG IMPCT 32X13X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713920","SUP","HCPCS C1713","","6713920  -  CAGE SPNL 4D LG IMPCT 20X13X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713926","SUP","HCPCS C1713","","6713926  -  CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713932","SUP","HCPCS C1713","","6713932  -  CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714120","SUP","HCPCS C1713","","6714120  -  CAGE SPNL 4D LG IMPCT 20X14X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714126","SUP","HCPCS C1713","","6714126  -  CAGE SPNL 4D LG IMPCT 26X14X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714132","SUP","HCPCS C1713","","6714132  -  CAGE SPNL 4D LG IMPCT 32X14X11MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714820","SUP","HCPCS C1713","","6714820  -  SPACER SPNL 20X14X9MM INTRBD FS TPR PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714920","SUP","HCPCS C1713","","6714920  -  CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714926","SUP","HCPCS C1713","","6714926  -  CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714932","SUP","HCPCS C1713","","6714932  -  CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6733206","SUP","HCPCS C1713","","6733206  -  CAGE SPNL 10D SM 16X19X6MM NS LF CRNT ACR RADOPQ","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"6733209","SUP","HCPCS C1713","","6733209  -  CAGE SPNL 10D SM 16X19X9MM NS LF CRNT ACR RADOPQ","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"6736207","SUP","HCPCS C1713","","6736207  -  CAGE SPNL 10D 7X17X14MM NS CRNT ACR TA SM INTLK RADOPQ","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"6790151","SUP","Custom 27203010","","6790151  -  BIT DRL SM 12-16MM INTLK DISP B","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6790152","SUP","Custom 27203010","","6790152  -  TAP SRG 12MM TEMP SPNE DISP","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6790225","SUP","HCPCS C1713","","6790225  -  CAGE SPNL 5MM CRNT INTLK CRV","BOTH IP/OP","$4,832.50 ","$3,576.05 ","$0.00 ","$4,832.50 ","$2,174.63 ","$0.00 ","$1,007.21 ","$0.00 ","$0.00 ","$846.13 ","$4,832.50 ","$0.00 ","$2,416.25 ","$3,827.34 ","$3,866.00 ","$0.00 ","$756.29 ","$0.00 ","$769.33 ","$0.00 "
"6790228","SUP","HCPCS C1713","","6790228  -  CAGE SPNL 7D SM 17X14X8MM NS LF CRNT INTLK CRV","BOTH IP/OP","$4,832.50 ","$3,576.05 ","$0.00 ","$4,832.50 ","$2,174.63 ","$0.00 ","$1,007.21 ","$0.00 ","$0.00 ","$846.13 ","$4,832.50 ","$0.00 ","$2,416.25 ","$3,827.34 ","$3,866.00 ","$0.00 ","$756.29 ","$0.00 ","$769.33 ","$0.00 "
"6790229","SUP","HCPCS C1713","","6790229  -  CAGE SPNL 9MM CRNT INTLK CRV","BOTH IP/OP","$4,832.50 ","$3,576.05 ","$0.00 ","$4,832.50 ","$2,174.63 ","$0.00 ","$1,007.21 ","$0.00 ","$0.00 ","$846.13 ","$4,832.50 ","$0.00 ","$2,416.25 ","$3,827.34 ","$3,866.00 ","$0.00 ","$756.29 ","$0.00 ","$769.33 ","$0.00 "
"6790230","SUP","HCPCS C1713","","6790230  -  CAGE SPNL 10MM CRNT INTLK CRV","BOTH IP/OP","$4,832.50 ","$3,576.05 ","$0.00 ","$4,832.50 ","$2,174.63 ","$0.00 ","$1,007.21 ","$0.00 ","$0.00 ","$846.13 ","$4,832.50 ","$0.00 ","$2,416.25 ","$3,827.34 ","$3,866.00 ","$0.00 ","$756.29 ","$0.00 ","$769.33 ","$0.00 "
"6790231","SUP","HCPCS C1713","","6790231  -  CAGE SPNL 11MM CRNT INTLK CRV","BOTH IP/OP","$4,832.50 ","$3,576.05 ","$0.00 ","$4,832.50 ","$2,174.63 ","$0.00 ","$1,007.21 ","$0.00 ","$0.00 ","$846.13 ","$4,832.50 ","$0.00 ","$2,416.25 ","$3,827.34 ","$3,866.00 ","$0.00 ","$756.29 ","$0.00 ","$769.33 ","$0.00 "
"6790232","SUP","HCPCS C1713","","6790232  -  CAGE SPNL 12MM CRNT INTLK CRV","BOTH IP/OP","$4,832.50 ","$3,576.05 ","$0.00 ","$4,832.50 ","$2,174.63 ","$0.00 ","$1,007.21 ","$0.00 ","$0.00 ","$846.13 ","$4,832.50 ","$0.00 ","$2,416.25 ","$3,827.34 ","$3,866.00 ","$0.00 ","$756.29 ","$0.00 ","$769.33 ","$0.00 "
"6791512","SUP","HCPCS C1713","","6791512  -  SCREW BN 4MM 12MM CRNT SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791513","SUP","HCPCS C1713","","6791513  -  SCREW BN 4MM 13MM CRNT SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791514","SUP","HCPCS C1713","","6791514  -  SCREW BN 4MM 14MM CRNT SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791515","SUP","HCPCS C1713","","6791515  -  SCREW BN 4MM 15MM CRNT SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791516","SUP","HCPCS C1713","","6791516  -  SCREW BN 4MM 16MM CRNT SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791612","SUP","HCPCS C1713","","6791612  -  SCREW BN 4.5MM 12MM CRNT SM INTLK SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791613","SUP","HCPCS C1713","","6791613  -  SCREW BN 4.5MM 13MM CRNT SM INTLK SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791614","SUP","HCPCS C1713","","6791614  -  SCREW BN 4.5MM 14MM CRNT SM INTLK SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791615","SUP","HCPCS C1713","","6791615  -  SCREW BN 4.5MM 15MM CRNT SM INTLK SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791616","SUP","HCPCS C1713","","6791616  -  SCREW BN 4.5MM 16MM CRNT SM INTLK SLF DRL SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791712","SUP","HCPCS C1713","","6791712  -  SCREW BN 4MM 12MM SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791713","SUP","HCPCS C1713","","6791713  -  SCREW BN 4MM 13MM RSC SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791714","SUP","HCPCS C1713","","6791714  -  SCREW BN 4MM 14MM RSC SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791715","SUP","HCPCS C1713","","6791715  -  SCREW BN 4MM 15MM SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791716","SUP","HCPCS C1713","","6791716  -  SCREW BN 4MM 16MM SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791812","SUP","HCPCS C1713","","6791812  -  SCREW BN 4.5MM 12MM RSC SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791813","SUP","HCPCS C1713","","6791813  -  SCREW BN 4.5MM 13MM RSC SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791814","SUP","HCPCS C1713","","6791814  -  SCREW BN 4.5MM 14MM RSC SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6791816","SUP","HCPCS C1713","","6791816  -  SCREW BN 4.5MM 16MM RSC SPNE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"6805115","SUP","HCPCS C1713","","6805115  -  CAGE SPNL SM 14X11X5MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6805714","SUP","HCPCS C1713","","6805714  -  CAGE SPNL 5D SM LRDTC 14X11X5MM NS LF CRNT RDLCNT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6805815","SUP","HCPCS C1713","","6805815  -  CAGE SPNL SM LRDTC + 15X13X5MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6806115","SUP","HCPCS C1713","","6806115  -  CAGE SPNL SM 14X11X6MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6806714","SUP","HCPCS C1713","","6806714  -  CAGE SPNL 5D SM LRDTC 14X11X6MM NS LF CRNT RDLCNT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6806815","SUP","Custom 27803010","","6806815  -  CAGE SPNL SM LRDTC + 15X13X6MM NS LF CRNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6807115","SUP","HCPCS C1713","","6807115  -  CAGE SPNL SM 14X11X7MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6807714","SUP","HCPCS C1713","","6807714  -  CAGE SPNL 5D SM LRDTC 14X11X7MM NS LF CRNT RDLCNT PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6807815","SUP","HCPCS C1713","","6807815  -  CAGE SPNL 5D SM LRDTC + 15X13X7MM NS LF CRNT RDLCNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6808115","SUP","HCPCS C1713","","6808115  -  CAGE SPNL SM 14X11X8MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6808125","SUP","HCPCS C1713","","6808125  -  SPACER SPNL 25X11X8MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6808130","SUP","HCPCS C1713","","6808130  -  RESTRICTOR CMNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6808240","SUP","HCPCS C1713","","6808240  -  SPACER SPNL XL W 40X22X8MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6808340","SUP","HCPCS C1713","","6808340  -  SPACER SPNL XL 10 40X22X8MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6808815","SUP","Custom 27803010","","6808815  -  CAGE SPNL SM LRDTC + 15X13X8MM NS LF CRNT PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6808925","SUP","HCPCS C1713","","6808925  -  SPACER SPNL 25X9X8MM INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6808930","SUP","HCPCS C1713","","6808930  -  SPACER SPNL 30X9X8MM INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6809115","SUP","HCPCS C1713","","6809115  -  CAGE SPNL SM 14X11X9MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6809714","SUP","HCPCS C1713","","6809714  -  CAGE SPNL 5D SM LRDTC 14X11X9MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6809925","SUP","HCPCS C1713","","6809925  -  SPACER SPNL 25X9X9MM STRL CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6810115","SUP","HCPCS C1713","","6810115  -  CAGE SPNL SM 14X11X10MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6810125","SUP","HCPCS C1713","","6810125  -  SPACER SPNL 25X11X10MM STRL CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6810130","SUP","HCPCS C1713","","6810130  -  SPACER SPNL 30INX11INX10MM STRL CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6810240","SUP","HCPCS C1713","","6810240  -  SPACER SPNL XL W 40X22X10MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6810340","SUP","HCPCS C1713","","6810340  -  SPACER SPNL 10D XL W LRDTC 40X22X10MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6810714","SUP","HCPCS C1713","","6810714  -  CAGE SPNL 5D SM LRDTC 14X11X10MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6810815","SUP","HCPCS C1713","","6810815  -  CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6810925","SUP","HCPCS C1713","","6810925  -  SPACER SPNL NAR 25X10X9MM INTRBD FS PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6810930","SUP","HCPCS C1713","","6810930  -  SPACER SPNL NAR 30X10X9MM INTRBD FS PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6811115","SUP","HCPCS C1713","","6811115  -  CAGE SPNL SM 14X11X11MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6811714","SUP","HCPCS C1713","","6811714  -  CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6811815","SUP","HCPCS C1713","","6811815  -  CAGE SPNL SM LRDTC + 15X13X11MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6811925","SUP","HCPCS C1713","","6811925  -  SPACER SPNL 25X11X9MM STRL CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6812115","SUP","HCPCS C1713","","6812115  -  CAGE SPNL SM 14X11X11MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6812125","SUP","HCPCS C1713","","6812125  -  SPACER SPNL LG 25X12X11MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6812130","SUP","HCPCS C1713","","6812130  -  CAGE SPNL LG 30X12X10MM CRNT THORLMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6812240","SUP","HCPCS C1713","","6812240  -  SPACER SPNL XL W 40X22X12MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6812340","SUP","HCPCS C1713","","6812340  -  SPACER SPNL 10 XL W LRDTC 40X22X12MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6812714","SUP","HCPCS C1713","","6812714  -  CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6812815","SUP","HCPCS C1713","","6812815  -  CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6812925","SUP","HCPCS C1713","","6812925  -  SPACER SPNL 25X12X9MM CRNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6812930","SUP","HCPCS C1713","","6812930  -  SPACER SPNL 30X12X9MM STRL CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6813815","SUP","HCPCS C1713","","6813815  -  SPACER SPNL SM 15X13X13MM LOPRFL PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6813925","SUP","HCPCS C1713","","6813925  -  SPACER SPNL LG NAR 25X13X9MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6814125","SUP","HCPCS C1713","","6814125  -  SPACER SPNL LG 25X14X11MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6814130","SUP","HCPCS C1713","","6814130  -  SPACER SPNL LG W 14X11X30MM CRNT LMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6814240","SUP","HCPCS C1713","","6814240  -  SPACER SPNL XL W 40X22X14MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6814340","SUP","HCPCS C1713","","6814340  -  SPACER SPNL 10D XL W LRDTC 40X22X14MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6814815","SUP","HCPCS C1713","","6814815  -  SPACER SPNL SM 15X14X13MM LOPRFL PEEK-OPTM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6814925","SUP","HCPCS C1713","","6814925  -  SPACER SPNL 25X14X9MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6814930","SUP","HCPCS C1713","","6814930  -  CAGE SPNL LG NAR 30X9X14MM CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6816240","SUP","HCPCS C1713","","6816240  -  SPACER SPNL XL W 40X22X16MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6816340","SUP","HCPCS C1713","","6816340  -  SPACER SPNL 10D XL W LRDTC 40X22X16MM PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6850810","SUP","HCPCS C1713","","6850810  -  SPACER SPNL GRN CRNT LMBR OBLQ","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6850811","SUP","HCPCS C1713","","6850811  -  CAGE SPNL 5D LG 30X10X8MM CRNT OBLQ PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6850813","SUP","HCPCS C1713","","6850813  -  CAGE SPNL LG 40X10X8MM GRN OBLQ PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851012","SUP","HCPCS C1713","","6851012  -  CAGE SPNL 5D LG 35X10X10MM CRNT OBLQ PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851013","SUP","HCPCS C1713","","6851013  -  CAGE SPNL 5D LG 40X10X10MM CRNT OBLQ PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851211","SUP","HCPCS C1713","","6851211  -  CAGE SPNL 30X12X10MM CRNT PEEK LRDTC 5","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851212","SUP","HCPCS C1713","","6851212  -  SPACER SPNL 5D LG 35X12X10MM CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851213","SUP","HCPCS C1713","","6851213  -  CAGE SPNL 5D LG 40X10X12MM CRNT OBLQ PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851411","SUP","HCPCS C1713","","6851411  -  SPACER SPNL 5D LG 30X14X10MM CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851412","SUP","HCPCS C1713","","6851412  -  CAGE SPNL 5D LG OBLQ 35X14X10MM CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6851413","SUP","Custom 27804086","","6851413  -  GRAFT BN LG CRNT PEEK SPNE 5DE","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6860010","SUP","HCPCS C1713","","6860010  -  SCREW BN 4MM 10MM PRMR ST TI CANC ANT CSPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860011","SUP","HCPCS C1713","","6860011  -  SCREW BN 4MM 11MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860012","SUP","HCPCS C1713","","6860012  -  SCREW BN 4MM 12MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860013","SUP","HCPCS C1713","","6860013  -  SCREW BN 4MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860014","SUP","HCPCS C1713","","6860014  -  SCREW BN 4MM 14MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860015","SUP","HCPCS C1713","","6860015  -  SCREW BN 4MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860016","SUP","HCPCS C1713","","6860016  -  SCREW BN 4MM 16MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860017","SUP","HCPCS C1713","","6860017  -  SCREW BN 4MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860018","SUP","HCPCS C1713","","6860018  -  SCREW BN 4MM 18MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860019","SUP","HCPCS C1713","","6860019  -  SCREW BN 4MM 19MM STRL PRMR ST TI CANC ANT CSPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860020","SUP","HCPCS C1713","","6860020  -  SCREW BN 4MM 20MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860053","SUP","HCPCS C1713","","6860053  -  SCREW BN 4.5MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860055","SUP","HCPCS C1713","","6860055  -  SCREW BN 4.5MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860057","SUP","HCPCS C1713","","6860057  -  SCREW BN 4.5MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"6860123","SUP","HCPCS C1713","","6860123  -  PLATE 6860123 23  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6860125","SUP","HCPCS C1713","","6860125  -  PLATE 6860125 25  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6860127","SUP","HCPCS C1713","","6860127  -  PLATE 6860127 27.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6860130","SUP","HCPCS C1713","","6860130  -  PLATE 6860130 30 MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6860132","SUP","HCPCS C1713","","6860132  -  PLATE 6860132 32.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6860135","SUP","HCPCS C1713","","6860135  -  PLATE 6860135 35  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860137","SUP","HCPCS C1713","","6860137  -  PLATE 6860137 37.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860140","SUP","HCPCS C1713","","6860140  -  PLATE 6860140 40  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860142","SUP","HCPCS C1713","","6860142  -  PLATE 6860142 42.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860145","SUP","HCPCS C1713","","6860145  -  PLATE 6860145 45  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860147","SUP","HCPCS C1713","","6860147  -  PLATE 6860147 47.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860150","SUP","HCPCS C1713","","6860150  -  PLATE 6860150 50  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6860152","SUP","HCPCS C1713","","6860152  -  PLATE 6860152 52.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860155","SUP","HCPCS C1713","","6860155  -  PLATE 6860155 55  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860157","SUP","HCPCS C1713","","6860157  -  PLATE 6860157 57.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860160","SUP","HCPCS C1713","","6860160  -  PLATE 6860160 60  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860162","SUP","HCPCS C1713","","6860162  -  PLATE 6860162 62.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860165","SUP","HCPCS C1713","","6860165  -  PLATE 6860165 65  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860167","SUP","HCPCS C1713","","6860167  -  PLATE 6860167 67.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6860170","SUP","HCPCS C1713","","6860170  -  PLATE 6860170 70  MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860172","SUP","HCPCS C1713","","6860172  -  PLATE 6860172 72.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860175","SUP","HCPCS C1713","","6860175  -  PLATE 6860175 75 MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860177","SUP","HCPCS C1713","","6860177  -  PLATE 6860177 77 5MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860180","SUP","HCPCS C1713","","6860180  -  PLATE 6860180 80 MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860182","SUP","HCPCS C1713","","6860182  -  PLATE 6860182 82 5MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860185","SUP","HCPCS C1713","","6860185  -  PLATE 6860185 85 MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6860187","SUP","HCPCS C1713","","6860187  -  PLATE 6860187 87 5MM ANT CERV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6860190","SUP","HCPCS C1713","","6860190  -  PLATE 6860190 90 MM ANT CERV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6860195","SUP","HCPCS C1713","","6860195  -  PLATE 6860195 95 MM ANT CERV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6860200","SUP","HCPCS C1713","","6860200  -  PLATE 6860200 100 MM ANT CERV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6860205","SUP","HCPCS C1713","","6860205  -  PLATE 6860205 105 MM ANT CERV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6860210","SUP","HCPCS C1713","","6860210  -  PLATE 6860210 110 MM ANT CERV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6860405","SUP","Custom 27803010","","6860405  -  PIN 6860405 PREMIER MIDLINE FIXATION","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$177.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.00 ","$0.00 ","$88.50 ","$140.18 ","$141.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6861130","SUP","HCPCS C1713","","6861130  -  PLATE 6861130 30MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6861137","SUP","HCPCS C1713","","6861137  -  PLATE 6861137 37.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861150","SUP","HCPCS C1713","","6861150  -  PLATE 6861150 50 MM ANT CERV PLATE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861157","SUP","HCPCS C1713","","6861157  -  PLATE 6861157 57.5 MM ANT CERV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861165","SUP","HCPCS C1713","","6861165  -  PLATE 6861165 65 MM ANT CERV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861167","SUP","HCPCS C1713","","6861167  -  PLATE 6861167 67.5 MM ANT CERV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861175","SUP","HCPCS C1713","","6861175  -  PLATE 6861175 75 MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861177","SUP","HCPCS C1713","","6861177  -  PLATE 6861177 77.5 MM ANT CERV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861182","SUP","HCPCS C1713","","6861182  -  PLATE 6861182 82.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861185","SUP","HCPCS C1713","","6861185  -  PLATE 6861185 85MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861200","SUP","HCPCS C1713","","6861200  -  PLATE 6861200 100MM ANTERIOR CERVICAL","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6861223","SUP","HCPCS C1713","","6861223  -  PLATE 6861223 23MM FSP ANTERIOR CRV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6861225","SUP","HCPCS C1713","","6861225  -  PLATE 6861225 25MM FSP ANTERIOR CRV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6861227","SUP","HCPCS C1713","","6861227  -  PLATE 6861227 27.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6861230","SUP","HCPCS C1713","","6861230  -  PLATE 6861230 30MM FSP ANTERIOR CRV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6861232","SUP","HCPCS C1713","","6861232  -  PLATE 6861232 32.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6861235","SUP","HCPCS C1713","","6861235  -  PLATE 6861235 35MM FSP ANTERIOR CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861237","SUP","HCPCS C1713","","6861237  -  PLATE 6861237 37.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861240","SUP","HCPCS C1713","","6861240  -  PLATE 6861240 40 MM FSP ANTERIOR CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861242","SUP","HCPCS C1713","","6861242  -  PLATE 6861242 42.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861245","SUP","HCPCS C1713","","6861245  -  PLATE 6861245 45MM FSP ANTERIOR CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861247","SUP","HCPCS C1713","","6861247  -  PLATE 6861247 47.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6861250","SUP","HCPCS C1713","","6861250  -  PLATE 6861250 50MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861252","SUP","HCPCS C1713","","6861252  -  PLATE 6861252 52.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861255","SUP","HCPCS C1713","","6861255  -  PLATE 6861255 55MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861257","SUP","HCPCS C1713","","6861257  -  PLATE 6861257 57.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861260","SUP","HCPCS C1713","","6861260  -  PLATE 6861260 60MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861262","SUP","HCPCS C1713","","6861262  -  PLATE 6861262 62.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861265","SUP","HCPCS C1713","","6861265  -  PLATE 6861265 65MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861267","SUP","HCPCS C1713","","6861267  -  PLATE 6861267 67.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"6861270","SUP","HCPCS C1713","","6861270  -  PLATE 6861270 70MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861272","SUP","HCPCS C1713","","6861272  -  PLATE 6861272 72.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861275","SUP","HCPCS C1713","","6861275  -  PLATE 6861275 75MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861277","SUP","HCPCS C1713","","6861277  -  PLATE 6861277 77.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861280","SUP","HCPCS C1713","","6861280  -  PLATE 6861280 80MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861282","SUP","HCPCS C1713","","6861282  -  PLATE 6861282 82.5MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861285","SUP","HCPCS C1713","","6861285  -  PLATE 6861285 85MM FSP ANTERIOR CRV","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"6861287","SUP","HCPCS C1713","","6861287  -  PLATE 6861287 87.5MM FSP ANTERIOR CRV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6861290","SUP","HCPCS C1713","","6861290  -  PLATE 6861290 90MM FSP ANTERIOR CRV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6861295","SUP","HCPCS C1713","","6861295  -  PLATE 6861295 95MM FSP ANTERIOR CRV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6861300","SUP","HCPCS C1713","","6861300  -  PLATE 6861300 100MM FSP ANTERIOR CRV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6861305","SUP","HCPCS C1713","","6861305  -  PLATE 6861305 105MM FSP ANTERIOR CRV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6861310","SUP","HCPCS C1713","","6861310  -  PLATE 6861310 110MM FSP ANTERIOR CRV","BOTH IP/OP","$4,266.00 ","$3,156.84 ","$0.00 ","$4,266.00 ","$1,919.70 ","$0.00 ","$889.14 ","$0.00 ","$0.00 ","$746.94 ","$4,266.00 ","$0.00 ","$2,133.00 ","$3,378.67 ","$3,412.80 ","$0.00 ","$667.63 ","$0.00 ","$679.15 ","$0.00 "
"6900120","SUP","HCPCS C1713","","6900120  -  ROD SPNL SHRT 3.2MM 120MM VRTX MX CNCT PNT TI RECON SYS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"6900240","SUP","HCPCS C1713","","6900240  -  ROD SPNL 240MM 3.2MM VRTX STD TI PCVD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"6900241","SUP","Custom 27203010","","6900241  -  INSTRUMENT 6900241 3.2MMX240MM ROD TMPLT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6900270","SUP","HCPCS C1713","","6900270  -  ROD SPNL 100MM 3.2MM VRTX STD OCCPTL TI PCVD OCCPTL PLT","BOTH IP/OP","$4,216.50 ","$3,120.21 ","$0.00 ","$4,216.50 ","$1,897.43 ","$0.00 ","$878.82 ","$0.00 ","$0.00 ","$738.28 ","$4,216.50 ","$0.00 ","$2,108.25 ","$3,339.47 ","$3,373.20 ","$0.00 ","$659.88 ","$0.00 ","$671.27 ","$0.00 "
"6900280","SUP","HCPCS C1713","","6900280  -  ROD SPNL 200MM 3.2MM VRTX STD OCCPTL TI PCVD OCCPTL PLT","BOTH IP/OP","$4,216.50 ","$3,120.21 ","$0.00 ","$4,216.50 ","$1,897.43 ","$0.00 ","$878.82 ","$0.00 ","$0.00 ","$738.28 ","$4,216.50 ","$0.00 ","$2,108.25 ","$3,339.47 ","$3,373.20 ","$0.00 ","$659.88 ","$0.00 ","$671.27 ","$0.00 "
"6900506","SUP","HCPCS C1713","","6900506  -  SCREW BN 3.5MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900508","SUP","HCPCS C1713","","6900508  -  SCREW BN 3.5MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900510","SUP","HCPCS C1713","","6900510  -  SCREW BN 3.5MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900512","SUP","HCPCS C1713","","6900512  -  SCREW 6900512 VAS CANCELLOUS 3.5X12MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900514","SUP","HCPCS C1713","","6900514  -  SCREW 6900514 VAS CANCELLOUS 3.5X14MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900516","SUP","HCPCS C1713","","6900516  -  SCREW 6900516 VAS CANCELLOUS 3.5X16MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900518","SUP","HCPCS C1713","","6900518  -  SCREW 6900518 VAS CANCELLOUS 3.5X18MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900520","SUP","HCPCS C1713","","6900520  -  SCREW 6900520 VAS CANCELLOUS 3.5X20MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900522","SUP","HCPCS C1713","","6900522  -  SCREW BONE 3.5MM 22MM VRTX TI CANC THOR SPN MULTIAX STRL","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900524","SUP","HCPCS C1713","","6900524  -  SCREW 6900524 CANCELLOUS 3.5MMX24MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900606","SUP","HCPCS C1713","","6900606  -  SCREW BN 4MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900608","SUP","HCPCS C1713","","6900608  -  SCREW BN 4MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900610","SUP","HCPCS C1713","","6900610  -  SCREW BN 4MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900612","SUP","HCPCS C1713","","6900612  -  SCREW 6900612 VAS CANCELLOUS 4.0X12MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900614","SUP","HCPCS C1713","","6900614  -  SCREW 6900614 VAS CANCELLOUS 4.0X14MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900616","SUP","HCPCS C1713","","6900616  -  SCREW 6900616 VAS CANCELLOUS 4.0X16MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900618","SUP","HCPCS C1713","","6900618  -  SCREW 6900618 VAS CANCELLOUS 4.0X18MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900620","SUP","HCPCS C1713","","6900620  -  SCREW 6900620 VAS CANCELLOUS 4.0X20MM TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900622","SUP","HCPCS C1713","","6900622  -  BONE SCREW 6900622 4.0MMX22MM CANC TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900624","SUP","HCPCS C1713","","6900624  -  BONE SCREW 6900624 4.0MMX24MM CANC TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900626","SUP","HCPCS C1713","","6900626  -  BONE SCREW 6900626 4.0MMX26MM CORT TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6900628","SUP","HCPCS C1713","","6900628  -  BONE SCREW 6900628 4.0MMX28MM CORT TI","BOTH IP/OP","$696.00 ","$515.04 ","$0.00 ","$696.00 ","$313.20 ","$0.00 ","$145.06 ","$0.00 ","$0.00 ","$121.86 ","$696.00 ","$0.00 ","$348.00 ","$551.23 ","$556.80 ","$0.00 ","$108.92 ","$0.00 ","$110.80 ","$0.00 "
"6901000","SUP","Custom 27803010","","6901000  -  CONNECTOR 6901000 SCREW","BOTH IP/OP","$963.38 ","$712.90 ","$0.00 ","$963.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$963.38 ","$0.00 ","$481.69 ","$763.00 ","$770.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6902130","SUP","Custom 27803010","","6902130  -  CONNECTOR 6902130 LATERAL CLOSED 10MM","BOTH IP/OP","$963.38 ","$712.90 ","$0.00 ","$963.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$963.38 ","$0.00 ","$481.69 ","$763.00 ","$770.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6902131","SUP","Custom 27803010","","6902131  -  CONNECTOR 6902131 13MM LATRL CONCTR CLSE","BOTH IP/OP","$963.38 ","$712.90 ","$0.00 ","$963.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$963.38 ","$0.00 ","$481.69 ","$763.00 ","$770.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6902135","SUP","Custom 27803010","","6902135  -  CONNECTOR 6902135 LATERAL OPEN 10MM","BOTH IP/OP","$963.38 ","$712.90 ","$0.00 ","$963.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$963.38 ","$0.00 ","$481.69 ","$763.00 ","$770.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6902200","SUP","Custom 27803010","","6902200  -  CONNECTOR 6902200 ROD 3.2-5.5 TI","BOTH IP/OP","$1,389.00 ","$1,027.86 ","$0.00 ","$1,389.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,389.00 ","$0.00 ","$694.50 ","$1,100.09 ","$1,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6902220","SUP","Custom 27803010","","6902220  -  CONNECTOR 6902220 ROD 3.2-4.5 TI","BOTH IP/OP","$1,389.00 ","$1,027.86 ","$0.00 ","$1,389.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,389.00 ","$0.00 ","$694.50 ","$1,100.09 ","$1,111.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6902525","SUP","HCPCS C1713","","6902525  -  CROSSLINK 6902525 CRSSLNK CONNECTOR CLIP","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6902530","SUP","HCPCS C1713","","6902530  -  CROSSLINK 6902530 CRSSLNK CONNECTOR BAR","BOTH IP/OP","$276.00 ","$204.24 ","$0.00 ","$276.00 ","$124.20 ","$0.00 ","$57.53 ","$0.00 ","$0.00 ","$48.33 ","$276.00 ","$0.00 ","$138.00 ","$218.59 ","$220.80 ","$0.00 ","$43.19 ","$0.00 ","$43.94 ","$0.00 "
"6904045","SUP","HCPCS C1713","","6904045  -  HOOK 6904045 LAMINAR 4.5MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6904060","SUP","HCPCS C1713","","6904060  -  HOOK 6904060 LAMINAR 6.0MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6904075","SUP","HCPCS C1713","","6904075  -  HOOK 6904075 LAMINAR 7.5MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6904090","SUP","HCPCS C1713","","6904090  -  HOOK 6904090 LAMINAR 9.0MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6908245","SUP","HCPCS C1713","","6908245  -  CAGE SPNL XL W 45X22X8MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6908250","SUP","HCPCS C1713","","6908250  -  CAGE SPNL XL W 50X22X8MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6908255","SUP","HCPCS C1713","","6908255  -  CAGE SPNL XL W 55X22X8MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6908260","SUP","HCPCS C1713","","6908260  -  CAGE SPNL XL W 60X22X8MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6908840","SUP","HCPCS C1713","","6908840  -  SPACER SPNL XL 40X18X8MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6908845","SUP","HCPCS C1713","","6908845  -  CAGE SPNL XL 45X18X8MM NS LF CRNT PEEK LMBR INTRBD FS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6908850","SUP","HCPCS C1713","","6908850  -  CAGE SPNL XL 50X18X8MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6908855","SUP","HCPCS C1713","","6908855  -  CAGE SPNL XL 55X18X8MM NS LF CRNT PEEK LMBR INTRBD FS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6908860","SUP","HCPCS C1713","","6908860  -  CAGE SPNL XL 60X18X8MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6910245","SUP","HCPCS C1713","","6910245  -  CAGE SPNL XL W 45X22X10MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6910250","SUP","HCPCS C1713","","6910250  -  CAGE SPNL XL W 50X22X10MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6910255","SUP","Custom 27803010","","6910255  -  CAGE SPNL XL W 55X22X10MM NS LF CRNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6910260","SUP","HCPCS C1713","","6910260  -  CAGE SPNL XL W 60X22X10MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6910840","SUP","HCPCS C1713","","6910840  -  SPACER SPNL XL 40X18X10MM CRNT THORLMBR INTRBD FS RDLCNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6910845","SUP","HCPCS C1713","","6910845  -  CAGE SPNL XL 45X18X10MM NS LF CRNT RADOPQ PEEK TLIF","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6910850","SUP","HCPCS C1713","","6910850  -  CAGE SPNL XL 50X18X10MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6910855","SUP","HCPCS C1713","","6910855  -  CAGE SPNL XL 55X18X10MM NS LF CRNT RADOPQ PEEK TLIF","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6910860","SUP","HCPCS C1713","","6910860  -  CAGE SPNL XL 60X18X10MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6912245","SUP","HCPCS C1713","","6912245  -  CAGE SPNL XL W 45X22X12MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6912250","SUP","HCPCS C1713","","6912250  -  CAGE SPNL XL W 50X22X12MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6912255","SUP","HCPCS C1713","","6912255  -  CAGE SPNL XL W 55X22X12MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6912260","SUP","HCPCS C1713","","6912260  -  CAGE SPNL XL W 60X22X12MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6912840","SUP","HCPCS C1713","","6912840  -  SPACER SPNL XL 40X18X12MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6912845","SUP","HCPCS C1713","","6912845  -  CAGE SPNL XL 45X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6912850","SUP","HCPCS C1713","","6912850  -  CAGE SPNL XL 50X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6912855","SUP","Custom 27803010","","6912855  -  CAGE SPNL XL 55X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6912860","SUP","HCPCS C1713","","6912860  -  CAGE SPNL XL 60X18X12MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6914245","SUP","HCPCS C1713","","6914245  -  SPACER SPNL XL W 45X22X14MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6914250","SUP","HCPCS C1713","","6914250  -  CAGE SPNL XL W 50X22X14MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6914255","SUP","HCPCS C1713","","6914255  -  SPACER SPNL XL W 55X22X14MM CRNT LMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6914260","SUP","HCPCS C1713","","6914260  -  CAGE SPNL XL 60X22X14MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6914840","SUP","HCPCS C1713","","6914840  -  SPACER SPNL 40X18X14MM INTRBD FS GFT RSTRC","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6914845","SUP","HCPCS C1713","","6914845  -  SPACER SPNL XL 45X18X14MM STRL CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6914850","SUP","HCPCS C1713","","6914850  -  CAGE SPNL XL 50X18X14MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6914855","SUP","HCPCS C1713","","6914855  -  CAGE SPNL XL 55X18X14MM NS LF CRNT PEEK LMBR INTRBD FS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6914860","SUP","HCPCS C1713","","6914860  -  CAGE SPNL 10D XL 60X18X14MM XLIF CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6916245","SUP","HCPCS C1713","","6916245  -  SPACER SPNL XL W 45X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6916250","SUP","HCPCS C1713","","6916250  -  CAGE SPNL XL W 50X22X16MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6916255","SUP","HCPCS C1713","","6916255  -  SPACER SPNL XL W 55X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6916260","SUP","HCPCS C1713","","6916260  -  SPACER SPNL XL W 60X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6916840","SUP","HCPCS C1713","","6916840  -  SPACER SPNL XL 40X18X16MM CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6916845","SUP","HCPCS C1713","","6916845  -  SPACER SPNL XL 45X18X16MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6916850","SUP","HCPCS C1713","","6916850  -  CAGE SPNL XL 50X18X16MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6916855","SUP","HCPCS C1713","","6916855  -  SPACER SPNL XL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6916860","SUP","HCPCS C1713","","6916860  -  SPACER SPNL 10D XL 60X18X16MM XLIF CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6920845","SUP","HCPCS C1713","","6920845  -  CAGE SPNL XL W LRDTC 45X22X8MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6920855","SUP","HCPCS C1713","","6920855  -  CAGE SPNL XL W LRDTC 55X22X8MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6920860","SUP","HCPCS C1713","","6920860  -  CAGE SPNL XL W LRDTC 60X22X8MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921044","SUP","HCPCS C1713","","6921044  -  CAGE SPNL 8D XL 24X34X10MM CRNT RND PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921045","SUP","HCPCS C1713","","6921045  -  CAGE SPNL XL W LRDTC 45X22X10MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921050","SUP","HCPCS C1713","","6921050  -  CAGE SPNL XL W LRDTC 50X22X10MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921055","SUP","HCPCS C1713","","6921055  -  CAGE SPNL XL W LRDTC 55X22X10MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921088","SUP","HCPCS C1713","","6921088  -  SPACER SPNL 8D XL 38X28X10MM CRNT PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921244","SUP","HCPCS C1713","","6921244  -  SPACER SPNL XL 12X34X24MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921245","SUP","HCPCS C1713","","6921245  -  CAGE SPNL XL W LRDTC 45X22X12MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921255","SUP","HCPCS C1713","","6921255  -  CAGE SPNL XL W LRDTC 55X22X12MM NS LF CRNT PEEK LMBR INTRBD","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921260","SUP","HCPCS C1713","","6921260  -  CAGE SPNL XL W LRDTC 60X22X12MM NS LF CRNT","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921288","SUP","HCPCS C1713","","6921288  -  CAGE SPNL 8D XL 28X38X12MM CRNT RND PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921444","SUP","HCPCS C1713","","6921444  -  CAGE SPNL 8D XL 24X34X14MM CRNT RND PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921445","SUP","HCPCS C1713","","6921445  -  SPACER SPNL 10D LRDTC XL W 45X22X14MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921450","SUP","HCPCS C1713","","6921450  -  SPACER SPNL 10D LRDTC XL W 50X22X14MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921455","SUP","HCPCS C1713","","6921455  -  SPACER SPNL 10D LRDTC XL W 55X22X14MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921460","SUP","HCPCS C1713","","6921460  -  SPACER SPNL 10D LRDTC XL W 60X22X14MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921488","SUP","HCPCS C1713","","6921488  -  SPACER SPNL 8D XL 38X28X114MM LMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921644","SUP","HCPCS C1713","","6921644  -  SPACER SPNL 8D XL 34X24X16MM CRNT PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921645","SUP","HCPCS C1713","","6921645  -  SPACER SPNL 10D LRDTC XL W 45X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921650","SUP","HCPCS C1713","","6921650  -  SPACER SPNL 10D LRDTC XL W 50X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921655","SUP","HCPCS C1713","","6921655  -  SPACER SPNL 10D LRDTC XL W 55X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921660","SUP","HCPCS C1713","","6921660  -  SPACER SPNL 10D LRDTC XL W 60X22X16MM PEEK","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6921688","SUP","HCPCS C1713","","6921688  -  SPACER SPNL 8D XL 38X28X16MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921844","SUP","HCPCS C1713","","6921844  -  SPACER SPNL 8D XL 34X24X18MM LMBR INTRBD FS RDLCNT PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6921888","SUP","HCPCS C1713","","6921888  -  SPACER SPNL 8D XL 38X28X18MM LMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6922044","SUP","HCPCS C1713","","6922044  -  SPACER SPNL 8D XL 34X24X20MM LMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6922088","SUP","HCPCS C1713","","6922088  -  SPACER SPNL 8D XL 38X28X20MM LMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6931288","SUP","HCPCS C1713","","6931288  -  CAGE SPNL 15D XL 28X38X12MM CRNT RND PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6931488","SUP","HCPCS C1713","","6931488  -  CAGE SPNL 15D XL 28X38X14MM CRNT RND PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6931688","SUP","HCPCS C1713","","6931688  -  SPACER SPNL XL 38X28X16MM CRNT INTRBD FS PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6931888","SUP","HCPCS C1713","","6931888  -  SPACER SPNL 15D XL 38X28X18MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6932088","SUP","HCPCS C1713","","6932088  -  SPACER SPNL 15D XL 38X28X20MM TLIF RDLCNT PEEK-OPTM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$6,750.00 ","$0.00 ","$3,126.38 ","$0.00 ","$0.00 ","$2,626.38 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$2,347.50 ","$0.00 ","$2,388.00 ","$0.00 "
"6940664","SUP","HCPCS C1713","","6940664  -  GRAFT BN 16X14X6MM SPCR ANTM SPNE CRV","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"6940764","SUP","HCPCS C1713","","6940764  -  SPACER ALGRF 16X14X7MM SPNE CRV","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"6940864","SUP","HCPCS C1713","","6940864  -  SPACER ALGRF 16X14X8MM SPNE CRV","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"6940964","SUP","HCPCS C1713","","6940964  -  SPACER ALGRF 16X14X9MM SPNE CRV","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"6941034","SUP","HCPCS C1713","","6941034  -  CAGE SPNL 8D 34X24X10MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941038","SUP","HCPCS C1713","","6941038  -  CAGE SPNL 8D 38X28X10MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941042","SUP","HCPCS C1713","","6941042  -  CAGE SPNL 8D 42X30X10MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941234","SUP","HCPCS C1713","","6941234  -  CAGE SPNL 8D 34X24X12MM NS LF BRIGADE TI","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941238","SUP","HCPCS C1713","","6941238  -  CAGE SPNL 8D 38X28X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941242","SUP","HCPCS C1713","","6941242  -  CAGE SPNL 8D 42X30X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941434","SUP","HCPCS C1713","","6941434  -  CAGE SPNL 8D 34X24X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941438","SUP","HCPCS C1713","","6941438  -  CAGE SPNL 8D 38X28X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941442","SUP","HCPCS C1713","","6941442  -  CAGE SPNL 8D 42X30X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941634","SUP","HCPCS C1713","","6941634  -  CAGE SPNL 8D 34X24X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941638","SUP","HCPCS C1713","","6941638  -  CAGE SPNL 8D 38X28X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941642","SUP","HCPCS C1713","","6941642  -  CAGE SPNL 8D 42X30X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941834","SUP","HCPCS C1713","","6941834  -  CAGE SPNL 8D 34X24X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941838","SUP","HCPCS C1713","","6941838  -  CAGE SPNL 8D 38X28X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6941842","SUP","HCPCS C1713","","6941842  -  CAGE SPNL 8D 42X30X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6942034","SUP","HCPCS C1713","","6942034  -  CAGE SPNL 8D 34X24X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6942038","SUP","HCPCS C1713","","6942038  -  CAGE SPNL 8D 38X28X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6942042","SUP","HCPCS C1713","","6942042  -  CAGE SPNL 8D 42X30X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6950305","SUP","HCPCS C1713","","6950305  -  SCREW BN 3.5MM 5MM LGHT BLU NS VRTX MX 3 RLF NTCH ST TOP LD","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"6950315","SUP","HCPCS C1713","","6950315  -  SCREW SET TI 15MM 3.5MM POST SPN M6 VRTX","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"6951034","SUP","HCPCS C1713","","6951034  -  CAGE SPNL 12D 34X24X10MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951234","SUP","HCPCS C1713","","6951234  -  CAGE SPNL 12D 34X24X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951238","SUP","HCPCS C1713","","6951238  -  CAGE SPNL 12D 38X28X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951242","SUP","HCPCS C1713","","6951242  -  CAGE SPNL 12D 42X30X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951434","SUP","HCPCS C1713","","6951434  -  CAGE SPNL 12D 34X24X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951438","SUP","HCPCS C1713","","6951438  -  CAGE SPNL 12D 38X28X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951442","SUP","HCPCS C1713","","6951442  -  CAGE SPNL 12D 42X30X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951634","SUP","HCPCS C1713","","6951634  -  CAGE SPNL 12D 34X24X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951638","SUP","HCPCS C1713","","6951638  -  CAGE SPNL 12D 38X28X16MM NS LF BRIGADE TI","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951642","SUP","HCPCS C1713","","6951642  -  CAGE SPNL 12D 42X30X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951834","SUP","HCPCS C1713","","6951834  -  CAGE SPNL 12D 34X24X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951838","SUP","HCPCS C1713","","6951838  -  CAGE SPNL 12D 38X28X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6951842","SUP","HCPCS C1713","","6951842  -  CAGE SPNL 12D 42X30X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6952034","SUP","HCPCS C1713","","6952034  -  CAGE SPNL 12D 34X24X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6952038","SUP","HCPCS C1713","","6952038  -  CAGE SPNL 12D 38X28X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6952042","SUP","HCPCS C1713","","6952042  -  CAGE SPNL 12D 42X30X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6955240","SUP","Custom 27803010","","6955240  -  CONCTR ROD 240MM 3.2MM VRTX MX THRD TI SPNL RECON SYS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6955245","SUP","HCPCS C1713","","6955245  -  ROD SPNL 4.5MM 360MM VRTX MX THRD TI RECON SYS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"6955255","SUP","HCPCS C1713","","6955255  -  ROD SPNL 5.5MM 360MM VRTX MX THRD TI OCPTL RECON SYS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"6955260","SUP","HCPCS C1713","","6955260  -  ROD 6955260 3.2 X 100 PRECURVED OC TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"6955270","SUP","HCPCS C1713","","6955270  -  ROD 6955270 3.2 X 200 PRECURVED OC TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"6955273","SUP","HCPCS C1713","","6955273  -  PLATE 6955273 OCCIPITAL KEEL SMALL","BOTH IP/OP","$6,735.00 ","$4,983.90 ","$0.00 ","$6,735.00 ","$3,030.75 ","$0.00 ","$1,403.74 ","$0.00 ","$0.00 ","$1,179.24 ","$6,735.00 ","$0.00 ","$3,367.50 ","$5,334.12 ","$5,388.00 ","$0.00 ","$1,054.03 ","$0.00 ","$1,072.21 ","$0.00 "
"6955274","SUP","HCPCS C1713","","6955274  -  PLATE 6955274 OCCIPITAL KEEL MEDIUM","BOTH IP/OP","$6,735.00 ","$4,983.90 ","$0.00 ","$6,735.00 ","$3,030.75 ","$0.00 ","$1,403.74 ","$0.00 ","$0.00 ","$1,179.24 ","$6,735.00 ","$0.00 ","$3,367.50 ","$5,334.12 ","$5,388.00 ","$0.00 ","$1,054.03 ","$0.00 ","$1,072.21 ","$0.00 "
"6955275","SUP","HCPCS C1713","","6955275  -  PLATE 6955275 OCCIPITAL KEEL LARGE","BOTH IP/OP","$6,735.00 ","$4,983.90 ","$0.00 ","$6,735.00 ","$3,030.75 ","$0.00 ","$1,403.74 ","$0.00 ","$0.00 ","$1,179.24 ","$6,735.00 ","$0.00 ","$3,367.50 ","$5,334.12 ","$5,388.00 ","$0.00 ","$1,054.03 ","$0.00 ","$1,072.21 ","$0.00 "
"6955406","SUP","HCPCS C1713","","6955406  -  BONE SCREW 6955406 4.0 X 6MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955408","SUP","HCPCS C1713","","6955408  -  BONE SCREW 6955408 4.0 X 8MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955410","SUP","HCPCS C1713","","6955410  -  BONE SCREW 6955410 4.0 X 10MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955412","SUP","HCPCS C1713","","6955412  -  BONE SCREW 6955412 4.0 X 12MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955414","SUP","HCPCS C1713","","6955414  -  BONE SCREW 6955414 4.0 X 14MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955416","SUP","HCPCS C1713","","6955416  -  BONE SCREW 6955416 4.0 X 16MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955418","SUP","HCPCS C1713","","6955418  -  BONE SCREW 6955418 4.0 X 18MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955506","SUP","HCPCS C1713","","6955506  -  BONE SCREW 6955506 4.5 X 6MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955508","SUP","HCPCS C1713","","6955508  -  BONE SCREW 6955508 4.5 X 8MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955510","SUP","HCPCS C1713","","6955510  -  BONE SCREW 6955510 4.5 X 10MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955512","SUP","HCPCS C1713","","6955512  -  BONE SCREW 6955512 4.5 X 12MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955514","SUP","HCPCS C1713","","6955514  -  BONE SCREW 6955514 4.5 X 14MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955516","SUP","HCPCS C1713","","6955516  -  BONE SCREW 6955516 4.5 X 16MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955518","SUP","HCPCS C1713","","6955518  -  BONE SCREW 6955518 4.5 X 18MM CORTICAL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955520","SUP","HCPCS C1713","","6955520  -  SCREW BONE 4.5MM 20MM TI CORT SPNL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955524","SUP","HCPCS C1713","","6955524  -  SCREW BONE 4.5MM 24MM CORT SPNL","BOTH IP/OP","$694.88 ","$514.21 ","$0.00 ","$694.88 ","$312.69 ","$0.00 ","$144.83 ","$0.00 ","$0.00 ","$121.67 ","$694.88 ","$0.00 ","$347.44 ","$550.34 ","$555.90 ","$0.00 ","$108.75 ","$0.00 ","$110.62 ","$0.00 "
"6955710","SUP","HCPCS C1713","","6955710  -  SCREW BN 3.5MM 10MM GRN VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955712","SUP","HCPCS C1713","","6955712  -  SCREW BN 3.5MM 12MM STRL VRTX MA TI THOR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955714","SUP","HCPCS C1713","","6955714  -  SCREW BN 3.5MM 14MM GRN VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955718","SUP","HCPCS C1713","","6955718  -  SCREW BN 3.5MM 18MM GRN VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955826","SUP","HCPCS C1713","","6955826  -  SCREW BN 4MM 26MM BLU VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955830","SUP","HCPCS C1713","","6955830  -  SCREW BN 4MM 30MM AU VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955926","SUP","HCPCS C1713","","6955926  -  SCREW BN 4.5MM 26MM MAG VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6955960","SUP","Custom 27803010","","6955960  -  CONNECTOR 6955960 10MM LAT OFFSET OPEN","BOTH IP/OP","$970.50 ","$718.17 ","$0.00 ","$970.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.50 ","$0.00 ","$485.25 ","$768.64 ","$776.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6955965","SUP","Custom 27803010","","6955965  -  CONNECTOR 6955965 13MM LAT OFFSET OPEN","BOTH IP/OP","$970.50 ","$718.17 ","$0.00 ","$970.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.50 ","$0.00 ","$485.25 ","$768.64 ","$776.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6955973","SUP","HCPCS C1713","","6955973  -  HOOK SPNL 4.5MM NS VRTX MX TI LMN RECON SYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6955974","SUP","HCPCS C1713","","6955974  -  HOOK SPNL 6MM VRTX MX LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6956010","SUP","Custom 27203010","","6956010  -  BIT DRL 2.4MM STRL VRTX DISP","BOTH IP/OP","$649.50 ","$480.63 ","$0.00 ","$649.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$649.50 ","$0.00 ","$324.75 ","$514.40 ","$519.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6956011","SUP","Custom 27203010","","6956011  -  BIT DRILL 26-52MM 2.9MM VRTX MX STRL DISP","BOTH IP/OP","$649.50 ","$480.63 ","$0.00 ","$649.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$649.50 ","$0.00 ","$324.75 ","$514.40 ","$519.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6956035","SUP","HCPCS C1713","","6956035  -  TAP 3.5MM 10-24MM SURG VRTX MX","BOTH IP/OP","$385.50 ","$285.27 ","$0.00 ","$385.50 ","$173.48 ","$0.00 ","$80.35 ","$0.00 ","$0.00 ","$67.50 ","$385.50 ","$0.00 ","$192.75 ","$305.32 ","$308.40 ","$0.00 ","$60.33 ","$0.00 ","$61.37 ","$0.00 "
"6957314","SUP","HCPCS C1769","","6957314  -  GWIRE ORTH 720MM SPN THRD","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$141.72 ","$0.00 ","$54.40 ","$0.00 ","$0.00 ","$45.70 ","$261.00 ","$0.00 ","$130.50 ","$206.71 ","$208.80 ","$0.00 ","$40.85 ","$0.00 ","$41.55 ","$0.00 "
"6957315","SUP","HCPCS C1769","","6957315  -  GWIRE ORTH 3MM CANN","BOTH IP/OP","$261.00 ","$193.14 ","$0.00 ","$261.00 ","$141.72 ","$0.00 ","$54.40 ","$0.00 ","$0.00 ","$45.70 ","$261.00 ","$0.00 ","$130.50 ","$206.71 ","$208.80 ","$0.00 ","$40.85 ","$0.00 ","$41.55 ","$0.00 "
"6958710","SUP","HCPCS C1713","","6958710  -  SCREW BN 3.5MM 10MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958712","SUP","HCPCS C1713","","6958712  -  SCREW BN 3.5MM 12MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958714","SUP","HCPCS C1713","","6958714  -  SCREW BN 3.5MM 14MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958716","SUP","HCPCS C1713","","6958716  -  SCREW BN 3.5MM 16MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958718","SUP","HCPCS C1713","","6958718  -  SCREW BN 3.5MM 18MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958720","SUP","HCPCS C1713","","6958720  -  SCREW BN 3.5MM 20MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958722","SUP","HCPCS C1713","","6958722  -  SCREW BN 3.5MM 22MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958724","SUP","HCPCS C1713","","6958724  -  SCREW BN 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958726","SUP","HCPCS C1713","","6958726  -  SCREW BN 3.5MM 26MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958728","SUP","HCPCS C1713","","6958728  -  SCREW BN 3.5MM 28MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958730","SUP","HCPCS C1713","","6958730  -  SCREW BN 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958732","SUP","HCPCS C1713","","6958732  -  SCREW BN 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958734","SUP","HCPCS C1713","","6958734  -  SCREW BN 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958736","SUP","HCPCS C1713","","6958736  -  SCREW BN 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958738","SUP","HCPCS C1713","","6958738  -  SCREW BN 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958740","SUP","HCPCS C1713","","6958740  -  SCREW BN 3.5MM 40MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958742","SUP","HCPCS C1713","","6958742  -  SCREW BN 3.5MM 42MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958744","SUP","HCPCS C1713","","6958744  -  SCREW BN 3.5MM 44MM GRN VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958746","SUP","HCPCS C1713","","6958746  -  SCREW BN 3.5MM 46MM GRN VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958748","SUP","HCPCS C1713","","6958748  -  SCREW BN 3.5MM 48MM GRN VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958750","SUP","HCPCS C1713","","6958750  -  SCREW BN 3.5MM 50MM GRN VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958752","SUP","HCPCS C1713","","6958752  -  SCREW BN 3.5MM 52MM GRN VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958810","SUP","HCPCS C1713","","6958810  -  SCREW BN 4MM 10MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958812","SUP","HCPCS C1713","","6958812  -  SCREW 6958812 4.0 X 12MM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958814","SUP","HCPCS C1713","","6958814  -  SCREW BN 4MM 14MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958816","SUP","HCPCS C1713","","6958816  -  SCREW BN 4MM 16MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958818","SUP","HCPCS C1713","","6958818  -  SCREW BN 4MM 18MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958820","SUP","HCPCS C1713","","6958820  -  SCREW BN 4MM 20MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958822","SUP","HCPCS C1713","","6958822  -  SCREW BN 4MM 22MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958824","SUP","HCPCS C1713","","6958824  -  SCREW BN 4MM 24MM BLU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958826","SUP","HCPCS C1713","","6958826  -  SCREW BN 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958828","SUP","HCPCS C1713","","6958828  -  SCREW BN 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958830","SUP","HCPCS C1713","","6958830  -  SCREW BN 4MM 30MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958832","SUP","HCPCS C1713","","6958832  -  SCREW BN 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958834","SUP","HCPCS C1713","","6958834  -  SCREW BN 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958836","SUP","HCPCS C1713","","6958836  -  SCREW BN 4MM 36MM AU VRTX MX MA ST ROT SDL TI THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958838","SUP","HCPCS C1713","","6958838  -  SCREW BN 4MM 38MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958840","SUP","HCPCS C1713","","6958840  -  SCREW BN 4MM 40MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958842","SUP","HCPCS C1713","","6958842  -  SCREW BN 4MM 42MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958844","SUP","HCPCS C1713","","6958844  -  SCREW BN 4MM 44MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958846","SUP","HCPCS C1713","","6958846  -  SCREW BN 4MM 46MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958848","SUP","HCPCS C1713","","6958848  -  SCREW BN 4MM 48MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958850","SUP","HCPCS C1713","","6958850  -  SCREW BN 4MM 50MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958852","SUP","HCPCS C1713","","6958852  -  SCREW BN 4MM 52MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958910","SUP","HCPCS C1713","","6958910  -  SCREW BN 4.5MM 10MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958912","SUP","HCPCS C1713","","6958912  -  SCREW BN 4.5MM 12MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958914","SUP","HCPCS C1713","","6958914  -  SCREW BN 4.5MM 14MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958916","SUP","HCPCS C1713","","6958916  -  SCREW BN 4.5MM 16MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958918","SUP","HCPCS C1713","","6958918  -  SCREW BN 4.5MM 18MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958920","SUP","HCPCS C1713","","6958920  -  SCREW BN 4.5MM 20MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958922","SUP","HCPCS C1713","","6958922  -  SCREW BN 4.5MM 22MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958924","SUP","HCPCS C1713","","6958924  -  SCREW BN 4.5MM 24MM MAG NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958926","SUP","HCPCS C1713","","6958926  -  SCREW BN 4.5MM 26MM MAG NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958928","SUP","HCPCS C1713","","6958928  -  SCREW BN 4.5MM 28MM MAG NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958930","SUP","HCPCS C1713","","6958930  -  SCREW BN 4.5MM 30MM MAG NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958932","SUP","HCPCS C1713","","6958932  -  SCREW BN 4.5MM 32MM MAG NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958934","SUP","HCPCS C1713","","6958934  -  SCREW BN 4.5MM 34MM MAG NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958936","SUP","HCPCS C1713","","6958936  -  SCREW BN 4.5MM 36MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958938","SUP","HCPCS C1713","","6958938  -  SCREW BN 4.5MM 38MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958940","SUP","HCPCS C1713","","6958940  -  SCREW BN 4.5MM 40MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958942","SUP","HCPCS C1713","","6958942  -  SCREW BN 4.5MM 42MM MAG NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958944","SUP","HCPCS C1713","","6958944  -  SCREW 6958944 4.5 X 44MM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958946","SUP","HCPCS C1713","","6958946  -  SCREW 6958946 4.5 X 46MM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958948","SUP","HCPCS C1713","","6958948  -  SCREW 6958948 4.5 X 48MM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958950","SUP","HCPCS C1713","","6958950  -  SCREW 6958950 4.5 X 50MM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958952","SUP","HCPCS C1713","","6958952  -  SCREW 6958952 4.5 X 52MM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6959418","SUP","HCPCS C1713","","6959418  -  SCREW BN 4MM 18MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959420","SUP","HCPCS C1713","","6959420  -  SCREW BN 4MM 20MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959422","SUP","HCPCS C1713","","6959422  -  SCREW BN 4MM 22MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959424","SUP","HCPCS C1713","","6959424  -  SCREW BN 4MM 24MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959426","SUP","HCPCS C1713","","6959426  -  SCREW BN 4MM 26MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959430","SUP","HCPCS C1713","","6959430  -  SCREW BN 4MM 30MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959432","SUP","HCPCS C1713","","6959432  -  SCREW BN 4MM 32MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959434","SUP","HCPCS C1713","","6959434  -  SCREW BN 4MM 34MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959436","SUP","HCPCS C1713","","6959436  -  SCREW BN 4MM 36MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959438","SUP","HCPCS C1713","","6959438  -  SCREW BN 4MM 38MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959440","SUP","HCPCS C1713","","6959440  -  SCREW BN 4MM 40MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959442","SUP","HCPCS C1713","","6959442  -  SCREW BN 4MM 42MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959444","SUP","HCPCS C1713","","6959444  -  SCREW BN 4MM 44MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959446","SUP","HCPCS C1713","","6959446  -  SCREW BN 4MM 46MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959448","SUP","HCPCS C1713","","6959448  -  SCREW BN 4MM 48MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959450","SUP","HCPCS C1713","","6959450  -  SCREW BN 4MM 50MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959452","SUP","HCPCS C1713","","6959452  -  SCREW BN 4MM 52MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959510","SUP","HCPCS C1713","","6959510  -  SCREW BN 4.5MM 10MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959512","SUP","HCPCS C1713","","6959512  -  SCREW BN 4.5MM 12MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959514","SUP","HCPCS C1713","","6959514  -  SCREW BN 4.5MM 14MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959516","SUP","HCPCS C1713","","6959516  -  SCREW BN 4.5MM 16MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959518","SUP","HCPCS C1713","","6959518  -  SCREW BN 4.5MM 18MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959520","SUP","HCPCS C1713","","6959520  -  SCREW BN 4.5MM 20MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959522","SUP","HCPCS C1713","","6959522  -  SCREW BN 4.5MM 22MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959524","SUP","HCPCS C1713","","6959524  -  SCREW BN 4.5MM 24MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959526","SUP","HCPCS C1713","","6959526  -  SCREW BN 4.5MM 26MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959528","SUP","HCPCS C1713","","6959528  -  SCREW BN 4.5MM 28MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959530","SUP","HCPCS C1713","","6959530  -  SCREW BN 4.5MM 30MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959532","SUP","HCPCS C1713","","6959532  -  SCREW BN 4.5MM 32MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959534","SUP","HCPCS C1713","","6959534  -  SCREW BN 4.5MM 34MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959536","SUP","HCPCS C1713","","6959536  -  SCREW BN 4.5MM 36MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959538","SUP","HCPCS C1713","","6959538  -  SCREW BN 4.5MM 38MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959540","SUP","HCPCS C1713","","6959540  -  SCREW BN 4.5MM 40MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959542","SUP","HCPCS C1713","","6959542  -  SCREW BN 4.5MM 42MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959544","SUP","HCPCS C1713","","6959544  -  SCREW BN 4.5MM 44MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959546","SUP","HCPCS C1713","","6959546  -  SCREW BN 4.5MM 46MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959548","SUP","HCPCS C1713","","6959548  -  SCREW BN 4.5MM 48MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959550","SUP","HCPCS C1713","","6959550  -  SCREW BN 4.5MM 50MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959552","SUP","HCPCS C1713","","6959552  -  SCREW BN 4.5MM 52MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959970","SUP","HCPCS C1713","","6959970  -  PLATE 6959970 LP OC KEEL SMALL","BOTH IP/OP","$7,095.00 ","$5,250.30 ","$0.00 ","$7,095.00 ","$3,192.75 ","$0.00 ","$1,478.78 ","$0.00 ","$0.00 ","$1,242.28 ","$7,095.00 ","$0.00 ","$3,547.50 ","$5,619.24 ","$5,676.00 ","$0.00 ","$1,110.37 ","$0.00 ","$1,129.52 ","$0.00 "
"6959971","SUP","HCPCS C1713","","6959971  -  PLATE 6959971 LP OC KEEL MEDIUM","BOTH IP/OP","$7,095.00 ","$5,250.30 ","$0.00 ","$7,095.00 ","$3,192.75 ","$0.00 ","$1,478.78 ","$0.00 ","$0.00 ","$1,242.28 ","$7,095.00 ","$0.00 ","$3,547.50 ","$5,619.24 ","$5,676.00 ","$0.00 ","$1,110.37 ","$0.00 ","$1,129.52 ","$0.00 "
"6959972","SUP","HCPCS C1713","","6959972  -  PLATE 6959972 LP OC KEEL LARGE","BOTH IP/OP","$7,095.00 ","$5,250.30 ","$0.00 ","$7,095.00 ","$3,192.75 ","$0.00 ","$1,478.78 ","$0.00 ","$0.00 ","$1,242.28 ","$7,095.00 ","$0.00 ","$3,547.50 ","$5,619.24 ","$5,676.00 ","$0.00 ","$1,110.37 ","$0.00 ","$1,129.52 ","$0.00 "
"6960013","SUP","HCPCS C1713","","6960013  -  SCREW 6960013 PRSTG BON FAST 4.0X13MM","BOTH IP/OP","$633.00 ","$468.42 ","$0.00 ","$633.00 ","$284.85 ","$0.00 ","$131.93 ","$0.00 ","$0.00 ","$110.83 ","$633.00 ","$0.00 ","$316.50 ","$501.34 ","$506.40 ","$0.00 ","$99.06 ","$0.00 ","$100.77 ","$0.00 "
"6960015","SUP","HCPCS C1713","","6960015  -  SCREW 6960015 PRSTG BONE FAST 4.0X15MM","BOTH IP/OP","$633.00 ","$468.42 ","$0.00 ","$633.00 ","$284.85 ","$0.00 ","$131.93 ","$0.00 ","$0.00 ","$110.83 ","$633.00 ","$0.00 ","$316.50 ","$501.34 ","$506.40 ","$0.00 ","$99.06 ","$0.00 ","$100.77 ","$0.00 "
"6960113","SUP","HCPCS C1713","","6960113  -  SCREW 6960113 PRSTG BONE FAST 4.5X13MM","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"6960120","SUP","HCPCS C1713","","6960120  -  SCREW 6960120  LOCK","BOTH IP/OP","$268.50 ","$198.69 ","$0.00 ","$268.50 ","$120.83 ","$0.00 ","$55.96 ","$0.00 ","$0.00 ","$47.01 ","$268.50 ","$0.00 ","$134.25 ","$212.65 ","$214.80 ","$0.00 ","$42.02 ","$0.00 ","$42.75 ","$0.00 "
"6961038","SUP","HCPCS C1713","","6961038  -  CAGE SPNL 8D 38X32X10MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6961238","SUP","HCPCS C1713","","6961238  -  CAGE SPNL 8D 38X32X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6961260","SUP","Custom 27803010","","6961260  -  PRESTIGE ARTIFICIAL DISC 6X12MM","BOTH IP/OP","$7,342.50 ","$5,433.45 ","$0.00 ","$7,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,342.50 ","$0.00 ","$3,671.25 ","$5,815.26 ","$5,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6961438","SUP","HCPCS C1713","","6961438  -  CAGE SPNL 8D 38X32X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6961460","SUP","Custom 27203010","","6961460  -  DISC 6961460 CERVICAL DISC 6MM X 14MM","BOTH IP/OP","$7,342.50 ","$5,433.45 ","$0.00 ","$7,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,342.50 ","$0.00 ","$3,671.25 ","$5,815.26 ","$5,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6961470","SUP","Custom 27203010","","6961470  -  DISC 6961470 PRESTIGE ARTIFICIAL 7X14MM","BOTH IP/OP","$7,342.50 ","$5,433.45 ","$0.00 ","$7,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,342.50 ","$0.00 ","$3,671.25 ","$5,815.26 ","$5,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6961638","SUP","HCPCS C1713","","6961638  -  CAGE SPNL 8D 38X32X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6961660","SUP","Custom 27203010","","6961660  -  DISC 6961660 CERVICAL DISC 6MM X 16MM","BOTH IP/OP","$7,342.50 ","$5,433.45 ","$0.00 ","$7,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,342.50 ","$0.00 ","$3,671.25 ","$5,815.26 ","$5,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6961670","SUP","Custom 27203010","","6961670  -  DISC 6961670 CERVICAL DISC 7MM X 16MM","BOTH IP/OP","$7,342.50 ","$5,433.45 ","$0.00 ","$7,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,342.50 ","$0.00 ","$3,671.25 ","$5,815.26 ","$5,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6961838","SUP","HCPCS C1713","","6961838  -  CAGE SPNL 8D 38X32X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6961870","SUP","Custom 27203010","","6961870  -  DISC 6961870 CERVICAL DISC 7MM X 18MM","BOTH IP/OP","$7,342.50 ","$5,433.45 ","$0.00 ","$7,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,342.50 ","$0.00 ","$3,671.25 ","$5,815.26 ","$5,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6962038","SUP","HCPCS C1713","","6962038  -  CAGE SPNL 8D 38X32X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6971238","SUP","HCPCS C1713","","6971238  -  CAGE SPNL 12D 38X32X12MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6971250","SUP","HCPCS C1713","","6971250  -  DISC ARTF 12MM 5MM CERV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971260","SUP","HCPCS C1713","","6971260  -  DISC ARTF 12MM 6MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971270","SUP","HCPCS C1713","","6971270  -  DISC ARTF 12MM 7MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971438","SUP","HCPCS C1713","","6971438  -  CAGE SPNL 12D 38X32X14MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6971450","SUP","HCPCS C1713","","6971450  -  DISC ARTF 14MM 5MM CERV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971460","SUP","HCPCS C1713","","6971460  -  DISC ARTF 14MM 6MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971470","SUP","HCPCS C1713","","6971470  -  DISC ARTF 14MM 7MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971480","SUP","HCPCS C1713","","6971480  -  DISC ARTF 14MM 8MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971638","SUP","HCPCS C1713","","6971638  -  CAGE SPNL 12D 38X32X16MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6971650","SUP","HCPCS C1713","","6971650  -  DISC 6971650 CERVICAL 5MM X 16MM","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971660","SUP","HCPCS C1713","","6971660  -  DISC ARTF 16MM 6MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971670","SUP","HCPCS C1713","","6971670  -  DISC ARTF 16MM 7MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971680","SUP","HCPCS C1713","","6971680  -  DISC ARTF 16MM 8MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971838","SUP","HCPCS C1713","","6971838  -  CAGE SPNL 12D 38X32X18MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6971870","SUP","HCPCS C1713","","6971870  -  DISC ARTF 18MM 7MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971880","SUP","HCPCS C1713","","6971880  -  DISC ARTF 18MM 8MM CERV MTN","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972038","SUP","HCPCS C1713","","6972038  -  CAGE SPNL 12D 38X32X20MM NS LF BRIGADE","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"6972118","SUP","Custom 27203010","","6972118  -  BIT DRL DMD 1.5MM STRL RAIL CTR DISP","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6972250","SUP","HCPCS C1713","","6972250  -  DISC 6972250 PRESTIGE","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972260","SUP","HCPCS C1713","","6972260  -  DISC INTVRTB 12MM 6MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972270","SUP","HCPCS C1713","","6972270  -  DISC INTVRTB 12MM 7MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972450","SUP","HCPCS C1713","","6972450  -  DISC INTVRTB 14MM 4MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972460","SUP","HCPCS C1713","","6972460  -  DISC INTVRTB 14MM 6MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972470","SUP","HCPCS C1713","","6972470  -  DISC INTVRTB 14MM 7MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972480","SUP","HCPCS C1713","","6972480  -  DISC INTVRTB 14MM 8MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972650","SUP","HCPCS C1713","","6972650  -  DISC INTVRTB 16MM 5MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972660","SUP","HCPCS C1713","","6972660  -  DISC INTVRTB 16MM 6MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972670","SUP","HCPCS C1713","","6972670  -  DISC INTVRTB 16MM 7MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972680","SUP","HCPCS C1713","","6972680  -  DISC INTVRTB 16MM 8MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972860","SUP","HCPCS C1713","","6972860  -  DISC INTVRTB 18MM 6MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972870","SUP","HCPCS C1713","","6972870  -  DISC INTVRTB 18MM 7MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6972880","SUP","HCPCS C1713","","6972880  -  DISC INTVRTB 18MM 8MM PSTG LP CERV SPN TI","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6980840","SUP","HCPCS C1713","","6980840  -  SPACER SPNL 40X18X8MM LMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6980850","SUP","HCPCS C1713","","6980850  -  CAGE SPNL 10D XL 50X18X8MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6980855","SUP","HCPCS C1713","","6980855  -  CAGE SPNL 10D XL 55X18X8MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6980860","SUP","HCPCS C1713","","6980860  -  CAGE SPNL 10D XL 60X18X8MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981040","SUP","HCPCS C1713","","6981040  -  CAGE SPNL 40X18X10MM PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981045","SUP","Custom 27803010","","6981045  -  CAGE SPNL 10D XL 45X18X10MM NS LF CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6981050","SUP","HCPCS C1713","","6981050  -  CAGE SPNL 10D XL 50X18X10MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981055","SUP","HCPCS C1713","","6981055  -  CAGE SPNL 10D XL 55X18X10MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981060","SUP","HCPCS C1713","","6981060  -  CAGE SPNL 10D XL 60X18X10MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981240","SUP","HCPCS C1713","","6981240  -  SPACER SPNL LRDTC XL 40X18X12MM CRNT PEEK LMBR INTRBD FS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981245","SUP","Custom 27803010","","6981245  -  CAGE SPNL 10D XL 45X18X12MM NS LF CRNT PEEK LMBR INTRBD FS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6981250","SUP","HCPCS C1713","","6981250  -  CAGE SPNL 10D XL 50X18X12MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981255","SUP","Custom 27803010","","6981255  -  CAGE SPNL 10D XL 55X18X12MM NS LF CRNT PEEK LMBR INTRBD FS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6981260","SUP","HCPCS C1713","","6981260  -  CAGE SPNL 10D XL 60X18X12MM NS LF CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981440","SUP","HCPCS C1713","","6981440  -  SPACER SPNL XL 40X18X14MM CRNT LMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981445","SUP","HCPCS C1713","","6981445  -  CAGE SPNL 10D XL 45X18X14MM CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981455","SUP","HCPCS C1713","","6981455  -  CAGE SPNL 55X18X14MM CRNT THORLMBR INTRBD FS RDLCNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981460","SUP","HCPCS C1713","","6981460  -  CAGE SPNL 10D XL 60X18X14MM CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981640","SUP","HCPCS C1713","","6981640  -  SPACER SPNL XL 40X18X16MM INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981645","SUP","HCPCS C1713","","6981645  -  CAGE SPNL 10D XL 45X18X16MM CRNT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981650","SUP","HCPCS C1713","","6981650  -  CAGE SPNL 10D XL 50X18X16MM CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981655","SUP","HCPCS C1713","","6981655  -  CAGE SPNL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6981660","SUP","HCPCS C1713","","6981660  -  CAGE SPNL XL LRDTC 60X18X14MM CRNT PEEK","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"6990625","SUP","HCPCS C1713","","6990625  -  CAGE SPNL XL 25X16X6MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990630","SUP","HCPCS C1713","","6990630  -  CAGE SPNL XL 30X16X6MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990635","SUP","HCPCS C1713","","6990635  -  CAGE SPNL XL 35X16X6MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990640","SUP","HCPCS C1713","","6990640  -  CAGE SPNL XL 40X16X6MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990825","SUP","HCPCS C1713","","6990825  -  CAGE SPNL XL 25X16X8MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990830","SUP","HCPCS C1713","","6990830  -  CAGE SPNL XL 30X16X8MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990835","SUP","HCPCS C1713","","6990835  -  CAGE SPNL XL 35X16X8MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6990840","SUP","HCPCS C1713","","6990840  -  CAGE SPNL XL 40X16X8MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991025","SUP","HCPCS C1713","","6991025  -  CAGE SPNL XL 25X16X10MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991030","SUP","HCPCS C1713","","6991030  -  CAGE SPNL XL 30X16X10MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991035","SUP","HCPCS C1713","","6991035  -  CAGE SPNL XL 35X16X10MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991040","SUP","HCPCS C1713","","6991040  -  CAGE SPNL XL 40X16X10MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991225","SUP","HCPCS C1713","","6991225  -  CAGE SPNL XL 25X16X12MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991230","SUP","HCPCS C1713","","6991230  -  CAGE SPNL XL 30X16X12MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991235","SUP","HCPCS C1713","","6991235  -  CAGE SPNL XL 35X16X12MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"6991240","SUP","HCPCS C1713","","6991240  -  CAGE SPNL XL 40X16X12MM NS LF CRNT THOR","BOTH IP/OP","$13,000.00 ","$9,620.00 ","$0.00 ","$13,000.00 ","$5,850.00 ","$0.00 ","$2,709.53 ","$0.00 ","$0.00 ","$2,276.20 ","$13,000.00 ","$0.00 ","$6,500.00 ","$10,296.00 ","$10,400.00 ","$0.00 ","$2,034.50 ","$0.00 ","$2,069.60 ","$0.00 "
"7002500","SUP","HCPCS C1713","","7002500  -  CROSSLINK SET SCREW","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7002525","SUP","HCPCS C1713","","7002525  -  LINK SPNL XLNK VRTX SM TI PLT RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7002526","SUP","HCPCS C1713","","7002526  -  PLATE BONE XLNK MED SPNL TI PLT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7002527","SUP","Custom 27803010","","7002527  -  CONCTR ROD LG VRTX MX XLNK PLT TI SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7020500","SUP","HCPCS C1713","","7020500  -  BONE SCREW 7020500 ILIAC 5.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020535","SUP","HCPCS C1713","","7020535  -  BONE SCREW 7020535 ILIAC 5.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020540","SUP","HCPCS C1713","","7020540  -  BONE SCREW 7020540 ILIAC 5.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020545","SUP","HCPCS C1713","","7020545  -  BONE SCREW 7020545 ILIAC 5.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020550","SUP","HCPCS C1713","","7020550  -  BONE SCREW 7020550 ILIAC 5.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020555","SUP","HCPCS C1713","","7020555  -  BONE SCREW 7020555 ILIAC 5.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020560","SUP","HCPCS C1713","","7020560  -  BONE SCREW 7020560 ILIAC 5.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020570","SUP","HCPCS C1713","","7020570  -  BONE SCREW 7020570 ILIAC 5.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020580","SUP","HCPCS C1713","","7020580  -  BONE SCREW 7020580 ILIAC 5.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020590","SUP","HCPCS C1713","","7020590  -  BONE SCREW 7020590 ILIAC 5.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020600","SUP","HCPCS C1713","","7020600  -  BONE SCREW 7020600 ILIAC 6.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020635","SUP","HCPCS C1713","","7020635  -  BONE SCREW 7020635 ILIAC 6.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020640","SUP","HCPCS C1713","","7020640  -  BONE SCREW 7020640 ILIAC 6.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020645","SUP","HCPCS C1713","","7020645  -  BONE SCREW 7020645 ILIAC 6.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020650","SUP","HCPCS C1713","","7020650  -  BONE SCREW 7020650 ILIAC 6.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020655","SUP","HCPCS C1713","","7020655  -  BONE SCREW 7020655 ILIAC 6.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020660","SUP","HCPCS C1713","","7020660  -  BONE SCREW 7020660 ILIAC 6.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020670","SUP","HCPCS C1713","","7020670  -  BONE SCREW 7020670 ILIAC 6.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020680","SUP","HCPCS C1713","","7020680  -  BONE SCREW 7020680 ILIAC 6.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020690","SUP","HCPCS C1713","","7020690  -  BONE SCREW 7020690 ILIAC 6.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020700","SUP","HCPCS C1713","","7020700  -  BONE SCREW 7020700 ILIAC 7.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020735","SUP","HCPCS C1713","","7020735  -  BONE SCREW 7020735 ILIAC 7.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020740","SUP","HCPCS C1713","","7020740  -  BONE SCREW 7020740 ILIAC 7.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020745","SUP","HCPCS C1713","","7020745  -  BONE SCREW 7020745 ILIAC 7.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020750","SUP","HCPCS C1713","","7020750  -  BONE SCREW 7020750 ILIAC 7.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020755","SUP","HCPCS C1713","","7020755  -  BONE SCREW 7020755 ILIAC 7.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020760","SUP","HCPCS C1713","","7020760  -  BONE SCREW 7020760 ILIAC 7.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020770","SUP","HCPCS C1713","","7020770  -  BONE SCREW 7020770 ILIAC 7.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020780","SUP","HCPCS C1713","","7020780  -  BONE SCREW 7020780 ILIAC 7.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020790","SUP","HCPCS C1713","","7020790  -  BONE SCREW 7020790 ILIAC 7.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020800","SUP","HCPCS C1713","","7020800  -  BONE SCREW 7020800 ILIAC 8.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020835","SUP","HCPCS C1713","","7020835  -  BONE SCREW 7020835 ILIAC 8.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020840","SUP","HCPCS C1713","","7020840  -  BONE SCREW 7020840 ILIAC 8.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020845","SUP","HCPCS C1713","","7020845  -  BONE SCREW 7020845 ILIAC 8.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020850","SUP","HCPCS C1713","","7020850  -  BONE SCREW 7020850 ILIAC 8.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020860","SUP","HCPCS C1713","","7020860  -  BONE SCREW 7020860 ILIAC 8.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020870","SUP","HCPCS C1713","","7020870  -  BONE SCREW 7020870 ILIAC 8.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020880","SUP","HCPCS C1713","","7020880  -  BONE SCREW 7020880 ILIAC 8.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7020890","SUP","HCPCS C1713","","7020890  -  BONE SCREW 7020890 ILIAC 8.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021210","SUP","Custom 27803010","","7021210  -  CONCTR ROD 10MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021220","SUP","Custom 27803010","","7021220  -  CONCTR ROD 20MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021230","SUP","Custom 27803010","","7021230  -  CONCTR ROD 30MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021310","SUP","Custom 27803010","","7021310  -  CONNECTOR 7021310 5.5 6.35 CLS LAT 10 SS","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021320","SUP","Custom 27803010","","7021320  -  CONNECTOR 7021320 5.5 6.35 CLS LAT 20 SS","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021330","SUP","Custom 27803010","","7021330  -  CONNECTOR 7021330 5.5 6.35 CLS LAT 30 SS","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021360","SUP","Custom 27803010","","7021360  -  CONCTR ROD 60MM 5.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021410","SUP","Custom 27803010","","7021410  -  CONNECTOR 7021410 6.35 6.35 CLS LT 10 SS","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021420","SUP","Custom 27803010","","7021420  -  CONNECTOR 7021420 6.35 6.35 CLS LT 20 SS","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021430","SUP","Custom 27803010","","7021430  -  CONNECTOR 7021430 6.35 6.35 CLS LT 30 SS","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021460","SUP","Custom 27803010","","7021460  -  CONCTR ROD 60MM 6.35MM CD HZN LGC CLOSE OFFST SS SPNL LAT","BOTH IP/OP","$1,730.18 ","$1,280.33 ","$0.00 ","$1,730.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,730.18 ","$0.00 ","$865.09 ","$1,370.30 ","$1,384.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7021600","SUP","HCPCS C1713","","7021600  -  BONE SCREW 7021600 10 DEG ILC 6.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021635","SUP","HCPCS C1713","","7021635  -  BONE SCREW 7021635 10 DEG ILC 6.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021640","SUP","HCPCS C1713","","7021640  -  BONE SCREW 7021640 10 DEG ILC 6.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021645","SUP","HCPCS C1713","","7021645  -  BONE SCREW 7021645 10 DEG ILC 6.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021650","SUP","HCPCS C1713","","7021650  -  BONE SCREW 7021650 10 DEG ILC 6.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021655","SUP","HCPCS C1713","","7021655  -  BONE SCREW 7021655 10 DEG ILC 6.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021660","SUP","HCPCS C1713","","7021660  -  BONE SCREW 7021660 10 DEG ILC 6.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021670","SUP","HCPCS C1713","","7021670  -  BONE SCREW 7021670 10 DEG ILC 6.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021680","SUP","HCPCS C1713","","7021680  -  BONE SCREW 7021680 10 DEG ILC 6.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021690","SUP","HCPCS C1713","","7021690  -  BONE SCREW 7021690 10 DEG ILC 6.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021700","SUP","HCPCS C1713","","7021700  -  BONE SCREW 7021700 10 DEG ILC 7.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021735","SUP","HCPCS C1713","","7021735  -  BONE SCREW 7021735 10 DEG ILC 7.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021740","SUP","HCPCS C1713","","7021740  -  BONE SCREW 7021740 10 DEG ILC 7.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021745","SUP","HCPCS C1713","","7021745  -  BONE SCREW 7021745 10 DEG ILC 7.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021750","SUP","HCPCS C1713","","7021750  -  BONE SCREW 7021750 10 DEG ILC 7.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021755","SUP","HCPCS C1713","","7021755  -  BONE SCREW 7021755 10 DEG ILC 7.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021760","SUP","HCPCS C1713","","7021760  -  BONE SCREW 7021760 10 DEG ILC 7.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021770","SUP","HCPCS C1713","","7021770  -  BONE SCREW 7021770 10 DEG ILC 7.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021780","SUP","HCPCS C1713","","7021780  -  BONE SCREW 7021780 10 DEG ILC 7.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021790","SUP","HCPCS C1713","","7021790  -  BONE SCREW 7021790 10 DEG ILC 7.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021800","SUP","HCPCS C1713","","7021800  -  BONE SCREW 7021800 10 DEG ILC 8.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021835","SUP","HCPCS C1713","","7021835  -  BONE SCREW 7021835 10 DEG ILC 8.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021840","SUP","HCPCS C1713","","7021840  -  BONE SCREW 7021840 10 DEG ILC 8.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021845","SUP","HCPCS C1713","","7021845  -  BONE SCREW 7021845 10 DEG ILC 8.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021850","SUP","HCPCS C1713","","7021850  -  BONE SCREW 7021850 10 DEG ILC 8.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021855","SUP","HCPCS C1713","","7021855  -  BONE SCREW 7021855 10 DEG ILC 8.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021860","SUP","HCPCS C1713","","7021860  -  BONE SCREW 7021860 10 DEG ILC 8.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021870","SUP","HCPCS C1713","","7021870  -  BONE SCREW 7021870 10 DEG ILC 8.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021880","SUP","HCPCS C1713","","7021880  -  BONE SCREW 7021880 10 DEG ILC 8.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7021890","SUP","HCPCS C1713","","7021890  -  BONE SCREW 7021890 10 DEG ILC 8.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022210","SUP","Custom 27803010","","7022210  -  CONNECTOR 7022210 LAT CONN SS 4.5 12MM","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7022230","SUP","Custom 27803010","","7022230  -  CONNECTOR 7022230 LAT CONN SS 4.5 32MM","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7022310","SUP","Custom 27803010","","7022310  -  CONNECTOR 7022310 LAT CONN SS 5.5 12MM","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7022330","SUP","Custom 27803010","","7022330  -  CONNECTOR 7022330 LAT CONN SS 5.5 32MM","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7022410","SUP","Custom 27803010","","7022410  -  CONNECTOR 7022410 LAT CONN SS 6.35 12MM","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7022430","SUP","Custom 27803010","","7022430  -  CONNECTOR 7022430 LAT CONN SS 6.35 32MM","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7022600","SUP","HCPCS C1713","","7022600  -  BONE SCREW 7022600 20 DEG ILC 6.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022635","SUP","HCPCS C1713","","7022635  -  BONE SCREW 7022635 20 DEG ILC 6.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022640","SUP","HCPCS C1713","","7022640  -  BONE SCREW 7022640 20 DEG ILC 6.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022645","SUP","HCPCS C1713","","7022645  -  BONE SCREW 7022645 20 DEG ILC 6.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022650","SUP","HCPCS C1713","","7022650  -  BONE SCREW 7022650 20 DEG ILC 6.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022655","SUP","HCPCS C1713","","7022655  -  BONE SCREW 7022655 20 DEG ILC 6.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022660","SUP","HCPCS C1713","","7022660  -  BONE SCREW 7022660 20 DEG ILC 6.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022670","SUP","HCPCS C1713","","7022670  -  BONE SCREW 7022670 20 DEG ILC 6.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022680","SUP","HCPCS C1713","","7022680  -  BONE SCREW 7022680 20 DEG ILC 6.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022690","SUP","HCPCS C1713","","7022690  -  BONE SCREW 7022690 20 DEG ILC 6.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022700","SUP","HCPCS C1713","","7022700  -  BONE SCREW 7022700 20 DEG ILC 7.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022735","SUP","HCPCS C1713","","7022735  -  BONE SCREW 7022735 20 DEG ILC 7.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022740","SUP","HCPCS C1713","","7022740  -  BONE SCREW 7022740 20 DEG ILC 7.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022750","SUP","HCPCS C1713","","7022750  -  BONE SCREW 7022750 20 DEG ILC 7.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022755","SUP","HCPCS C1713","","7022755  -  BONE SCREW 7022755 20 DEG ILC 7.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022760","SUP","HCPCS C1713","","7022760  -  BONE SCREW 7022760 20 DEG ILC 7.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022770","SUP","HCPCS C1713","","7022770  -  BONE SCREW 7022770 20 DEG ILC 7.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022780","SUP","HCPCS C1713","","7022780  -  BONE SCREW 7022780 20 DEG ILC 7.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022790","SUP","HCPCS C1713","","7022790  -  BONE SCREW 7022790 20 DEG ILC 7.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022800","SUP","HCPCS C1713","","7022800  -  BONE SCREW 7022800 20 DEG ILC 8.5X100 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022835","SUP","HCPCS C1713","","7022835  -  BONE SCREW 7022835 20 DEG ILC 8.5X35 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022840","SUP","HCPCS C1713","","7022840  -  BONE SCREW 7022840 20 DEG ILC 8.5X40 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022845","SUP","HCPCS C1713","","7022845  -  BONE SCREW 7022845 20 DEG ILC 8.5X45 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022850","SUP","HCPCS C1713","","7022850  -  BONE SCREW 7022850 20 DEG ILC 8.5X50 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022855","SUP","HCPCS C1713","","7022855  -  BONE SCREW 7022855 20 DEG ILC 8.5X55 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022860","SUP","HCPCS C1713","","7022860  -  BONE SCREW 7022860 20 DEG ILC 8.5X60 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022870","SUP","HCPCS C1713","","7022870  -  BONE SCREW 7022870 20 DEG ILC 8.5X70 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022880","SUP","HCPCS C1713","","7022880  -  BONE SCREW 7022880 20 DEG ILC 8.5X80 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7022890","SUP","HCPCS C1713","","7022890  -  BONE SCREW 7022890 20 DEG ILC 8.5X90 SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7023130","SUP","Custom 27203010","","7023130  -  CASE STERILIZATION ILIAC SCREW SET","BOTH IP/OP","$409.50 ","$303.03 ","$0.00 ","$409.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$409.50 ","$0.00 ","$204.75 ","$324.32 ","$327.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7024855","SUP","HCPCS C1713","","7024855  -  SCREW SET SS .25IN 32 THRD SPN PDCL BRKOF CD HZN LGC 6.35MM","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7025855","SUP","HCPCS C1713","","7025855  -  SET SCREW 7025855 1 4 32 BREAK OFF SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7030500","SUP","HCPCS C1713","","7030500  -  PROXIMAL SCREW 5.5 X 100, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030550","SUP","HCPCS C1713","","7030550  -  PROXIMAL SCREW 5.5 X 50, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030555","SUP","HCPCS C1713","","7030555  -  PROXIMAL SCREW 5.5 X 55, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030560","SUP","HCPCS C1713","","7030560  -  PROXIMAL SCREW 5.5 X 60, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030570","SUP","HCPCS C1713","","7030570  -  PROXIMAL SCREW 5.5 X 70, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030580","SUP","HCPCS C1713","","7030580  -  PROXIMAL SCREW 5.5 X 80, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030590","SUP","HCPCS C1713","","7030590  -  PROXIMAL SCREW 5.5 X 90, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030600","SUP","HCPCS C1713","","7030600  -  PROXIMAL SCREW 6.5 X 100, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030655","SUP","HCPCS C1713","","7030655  -  PROXIMAL SCREW 6.5 X 55, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030680","SUP","HCPCS C1713","","7030680  -  PROXIMAL SCREW 6.5 X 80, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030690","SUP","HCPCS C1713","","7030690  -  PROXIMAL SCREW 6.5 X 90, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030750","SUP","HCPCS C1713","","7030750  -  PROXIMAL SCREW 7.5 X 50, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030755","SUP","HCPCS C1713","","7030755  -  PROXIMAL SCREW 7.5 X 55, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030850","SUP","HCPCS C1713","","7030850  -  PROXIMAL SCREW 8.5 X 50, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030855","SUP","HCPCS C1713","","7030855  -  PROXIMAL SCREW 8.5 X 55, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7030860","SUP","HCPCS C1713","","7030860  -  PROXIMAL SCREW 8.5 X 60, SS","BOTH IP/OP","$2,134.10 ","$1,579.23 ","$0.00 ","$2,134.10 ","$960.35 ","$0.00 ","$444.80 ","$0.00 ","$0.00 ","$373.66 ","$2,134.10 ","$0.00 ","$1,067.05 ","$1,690.21 ","$1,707.28 ","$0.00 ","$333.99 ","$0.00 ","$339.75 ","$0.00 "
"7040500","SUP","HCPCS C1713","","7040500  -  BONE SCREW 7040500 ILIAC 5.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040535","SUP","HCPCS C1713","","7040535  -  BONE SCREW 7040535 ILIAC 5.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040540","SUP","HCPCS C1713","","7040540  -  BONE SCREW 7040540 ILIAC 5.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040545","SUP","HCPCS C1713","","7040545  -  BONE SCREW 7040545 ILIAC 5.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040550","SUP","HCPCS C1713","","7040550  -  BONE SCREW 7040550 ILIAC 5.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040555","SUP","HCPCS C1713","","7040555  -  BONE SCREW 7040555 ILIAC 5.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040570","SUP","HCPCS C1713","","7040570  -  BONE SCREW 7040570 ILIAC 5.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040580","SUP","HCPCS C1713","","7040580  -  BONE SCREW 7040580 ILIAC 5.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040590","SUP","HCPCS C1713","","7040590  -  BONE SCREW 7040590 ILIAC 5.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040600","SUP","HCPCS C1713","","7040600  -  BONE SCREW 7040600 ILIAC 6.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040635","SUP","HCPCS C1713","","7040635  -  BONE SCREW 7040635 ILIAC 6.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040640","SUP","HCPCS C1713","","7040640  -  BONE SCREW 7040640 ILIAC 6.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040645","SUP","HCPCS C1713","","7040645  -  BONE SCREW 7040645 ILIAC 6.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040650","SUP","HCPCS C1713","","7040650  -  BONE SCREW 7040650 ILIAC 6.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040655","SUP","HCPCS C1713","","7040655  -  BONE SCREW 7040655 ILIAC 6.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040660","SUP","HCPCS C1713","","7040660  -  BONE SCREW 7040660 ILIAC 6.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040670","SUP","HCPCS C1713","","7040670  -  BONE SCREW 7040670 ILIAC 6.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040680","SUP","HCPCS C1713","","7040680  -  BONE SCREW 7040680 ILIAC 6.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040690","SUP","HCPCS C1713","","7040690  -  BONE SCREW 7040690 ILIAC 6.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040700","SUP","HCPCS C1713","","7040700  -  BONE SCREW 7040700 ILIAC 7.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040740","SUP","HCPCS C1713","","7040740  -  BONE SCREW 7040740 ILIAC 7.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040745","SUP","HCPCS C1713","","7040745  -  BONE SCREW 7040745 ILIAC 7.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040750","SUP","HCPCS C1713","","7040750  -  BONE SCREW 7040750 ILIAC 7.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040755","SUP","HCPCS C1713","","7040755  -  BONE SCREW 7040755 ILIAC 7.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040760","SUP","HCPCS C1713","","7040760  -  BONE SCREW 7040760 ILIAC 7.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040770","SUP","HCPCS C1713","","7040770  -  BONE SCREW 7040770 ILIAC 7.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040780","SUP","HCPCS C1713","","7040780  -  BONE SCREW 7040780 ILIAC 7.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040790","SUP","HCPCS C1713","","7040790  -  BONE SCREW 7040790 ILIAC 7.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040800","SUP","HCPCS C1713","","7040800  -  BONE SCREW 7040800 ILIAC 8.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040835","SUP","HCPCS C1713","","7040835  -  BONE SCREW 7040835 ILIAC 8.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040840","SUP","HCPCS C1713","","7040840  -  BONE SCREW 7040840 ILIAC 8.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040845","SUP","HCPCS C1713","","7040845  -  BONE SCREW 7040845 ILIAC 8.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040850","SUP","HCPCS C1713","","7040850  -  BONE SCREW 7040850 ILIAC 8.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040860","SUP","HCPCS C1713","","7040860  -  BONE SCREW 7040860 ILIAC 8.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040870","SUP","HCPCS C1713","","7040870  -  BONE SCREW 7040870 ILIAC 8.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040880","SUP","HCPCS C1713","","7040880  -  BONE SCREW 7040880 ILIAC 8.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7040890","SUP","HCPCS C1713","","7040890  -  BONE SCREW 7040890 ILIAC 8.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041210","SUP","Custom 27803010","","7041210  -  CONCTR ROD 10MM CD HZN LGC CLOSE OFFST TI LAT SPNL 4.5/6.35","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041220","SUP","Custom 27803010","","7041220  -  CONECTOR 7041220 CLSLAT 20MM TI 4.5/6.35","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041230","SUP","Custom 27803010","","7041230  -  CONECTOR 7041230 CLSLAT 30MM TI 4.5/6.35","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041310","SUP","Custom 27803010","","7041310  -  CONNECTOR 7041310 5.5 6.35 CLS LAT 10 TI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041320","SUP","Custom 27803010","","7041320  -  CONCTR ROD 20MM CD HZN LGC CLOSE OFFST TI LAT SPNL 5.5/6.35","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041330","SUP","Custom 27803010","","7041330  -  CONNECTOR 7041330 5.5 6.35 CLS LAT 30 TI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041360","SUP","Custom 27803010","","7041360  -  CONECTR 7041360 5.5/6.35 CLS LAT 60MM TI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041410","SUP","Custom 27803010","","7041410  -  CONNECTOR 7041410 6.35 6.35 CLS LT 10 TI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041420","SUP","Custom 27803010","","7041420  -  CONNECTOR 7041420 6.35 6.35 CLS LT 20 TI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041430","SUP","Custom 27803010","","7041430  -  CONNECTOR 7041430 6.35 6.35 CLS LT 30 TI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041460","SUP","Custom 27803010","","7041460  -  CONECTR 7041460 6.35/6.35 CLS LAT 60MMTI","BOTH IP/OP","$1,843.63 ","$1,364.29 ","$0.00 ","$1,843.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.63 ","$0.00 ","$921.81 ","$1,460.15 ","$1,474.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7041600","SUP","HCPCS C1713","","7041600  -  BONE SCREW 7041600 10 DEG ILC 6.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041635","SUP","HCPCS C1713","","7041635  -  BONE SCREW 7041635 10 DEG ILC 6.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041640","SUP","HCPCS C1713","","7041640  -  BONE SCREW 7041640 10 DEG ILC 6.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041645","SUP","HCPCS C1713","","7041645  -  BONE SCREW 7041645 10 DEG ILC 6.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041650","SUP","HCPCS C1713","","7041650  -  BONE SCREW 7041650 10 DEG ILC 6.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041655","SUP","HCPCS C1713","","7041655  -  BONE SCREW 7041655 10 DEG ILC 6.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041660","SUP","HCPCS C1713","","7041660  -  BONE SCREW 7041660 10 DEG ILC 6.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041670","SUP","HCPCS C1713","","7041670  -  BONE SCREW 7041670 10 DEG ILC 6.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041680","SUP","HCPCS C1713","","7041680  -  BONE SCREW 7041680 10 DEG ILC 6.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041690","SUP","HCPCS C1713","","7041690  -  BONE SCREW 7041690 10 DEG ILC 6.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041700","SUP","HCPCS C1713","","7041700  -  BONE SCREW 7041700 10 DEG ILC 7.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041735","SUP","HCPCS C1713","","7041735  -  BONE SCREW 7041735 10 DEG ILC 7.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041740","SUP","HCPCS C1713","","7041740  -  BONE SCREW 7041740 10 DEG ILC 7.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041745","SUP","HCPCS C1713","","7041745  -  BONE SCREW 7041745 10 DEG ILC 7.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041750","SUP","HCPCS C1713","","7041750  -  BONE SCREW 7041750 10 DEG ILC 7.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041755","SUP","HCPCS C1713","","7041755  -  BONE SCREW 7041755 10 DEG ILC 7.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041760","SUP","HCPCS C1713","","7041760  -  BONE SCREW 7041760 10 DEG ILC 7.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041770","SUP","HCPCS C1713","","7041770  -  BONE SCREW 7041770 10 DEG ILC 7.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041780","SUP","HCPCS C1713","","7041780  -  BONE SCREW 7041780 10 DEG ILC 7.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041790","SUP","HCPCS C1713","","7041790  -  BONE SCREW 7041790 10 DEG ILC 7.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041800","SUP","HCPCS C1713","","7041800  -  BONE SCREW 7041800 10 DEG ILC 8.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041835","SUP","HCPCS C1713","","7041835  -  BONE SCREW 7041835 10 DEG ILC 8.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041840","SUP","HCPCS C1713","","7041840  -  BONE SCREW 7041840 10 DEG ILC 8.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041845","SUP","HCPCS C1713","","7041845  -  BONE SCREW 7041845 10 DEG ILC 8.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041850","SUP","HCPCS C1713","","7041850  -  BONE SCREW 7041850 10 DEG ILC 8.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041855","SUP","HCPCS C1713","","7041855  -  BONE SCREW 7041855 10 DEG ILC 8.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041860","SUP","HCPCS C1713","","7041860  -  BONE SCREW 7041860 10 DEG ILC 8.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041870","SUP","HCPCS C1713","","7041870  -  BONE SCREW 7041870 10 DEG ILC 8.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041880","SUP","HCPCS C1713","","7041880  -  BONE SCREW 7041880 10 DEG ILC 8.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7041890","SUP","HCPCS C1713","","7041890  -  BONE SCREW 7041890 10 DEG ILC 8.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042210","SUP","Custom 27803010","","7042210  -  CONNECTOR 7042210 LAT CONN TI 4.5 12MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042230","SUP","Custom 27803010","","7042230  -  CONNECTOR 7042230 LAT CONN TI 4.5 32MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042310","SUP","Custom 27803010","","7042310  -  CONNECTOR 7042310 LAT CONN TI 5.5 12MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042320","SUP","Custom 27803010","","7042320  -  CONNECTOR 7042320 LAT CONN TI 5.5 22MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042330","SUP","Custom 27803010","","7042330  -  CONNECTOR 7042330 LAT CONN TI 5.5 32MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042410","SUP","Custom 27803010","","7042410  -  CONNECTOR 7042410 LAT CONN TI 6.35 12MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042430","SUP","Custom 27803010","","7042430  -  CONNECTOR 7042430 LAT CONN TI 6.35 32MM","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7042600","SUP","HCPCS C1713","","7042600  -  BONE SCREW 7042600 20 DEG ILC 6.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042635","SUP","HCPCS C1713","","7042635  -  BONE SCREW 7042635 20 DEG ILC 6.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042640","SUP","HCPCS C1713","","7042640  -  BONE SCREW 7042640 20 DEG ILC 6.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042645","SUP","HCPCS C1713","","7042645  -  BONE SCREW 7042645 20 DEG ILC 6.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042650","SUP","HCPCS C1713","","7042650  -  BONE SCREW 7042650 20 DEG ILC 6.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042655","SUP","HCPCS C1713","","7042655  -  BONE SCREW 7042655 20 DEG ILC 6.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042660","SUP","HCPCS C1713","","7042660  -  BONE SCREW 7042660 20 DEG ILC 6.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042670","SUP","HCPCS C1713","","7042670  -  BONE SCREW 7042670 20 DEG ILC 6.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042680","SUP","HCPCS C1713","","7042680  -  BONE SCREW 7042680 20 DEG ILC 6.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042690","SUP","HCPCS C1713","","7042690  -  BONE SCREW 7042690 20 DEG ILC 6.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042700","SUP","HCPCS C1713","","7042700  -  BONE SCREW 7042700 20 DEG ILC 7.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042735","SUP","HCPCS C1713","","7042735  -  BONE SCREW 7042735 20 DEG ILC 7.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042740","SUP","HCPCS C1713","","7042740  -  BONE SCREW 7042740 20 DEG ILC 7.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042745","SUP","HCPCS C1713","","7042745  -  BONE SCREW 7042745 20 DEG ILC 7.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042750","SUP","HCPCS C1713","","7042750  -  BONE SCREW 7042750 20 DEG ILC 7.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042755","SUP","HCPCS C1713","","7042755  -  BONE SCREW 7042755 20 DEG ILC 7.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042760","SUP","HCPCS C1713","","7042760  -  BONE SCREW 7042760 20 DEG ILC 7.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042770","SUP","HCPCS C1713","","7042770  -  BONE SCREW 7042770 20 DEG ILC 7.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042780","SUP","HCPCS C1713","","7042780  -  BONE SCREW 7042780 20 DEG ILC 7.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042790","SUP","HCPCS C1713","","7042790  -  BONE SCREW 7042790 20 DEG ILC 7.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042800","SUP","HCPCS C1713","","7042800  -  BONE SCREW 7042800 20 DEG ILC 8.5X100 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042835","SUP","HCPCS C1713","","7042835  -  BONE SCREW 7042835 20 DEG ILC 8.5X35 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042840","SUP","HCPCS C1713","","7042840  -  BONE SCREW 7042840 20 DEG ILC 8.5X40 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042845","SUP","HCPCS C1713","","7042845  -  BONE SCREW 7042845 20 DEG ILC 8.5X45 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042850","SUP","HCPCS C1713","","7042850  -  BONE SCREW 7042850 20 DEG ILC 8.5X50 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042855","SUP","HCPCS C1713","","7042855  -  BONE SCREW 7042855 20 DEG ILC 8.5X55 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042860","SUP","HCPCS C1713","","7042860  -  BONE SCREW 7042860 20 DEG ILC 8.5X60 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042870","SUP","HCPCS C1713","","7042870  -  BONE SCREW 7042870 20 DEG ILC 8.5X70 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042880","SUP","HCPCS C1713","","7042880  -  BONE SCREW 7042880 20 DEG ILC 8.5X80 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7042890","SUP","HCPCS C1713","","7042890  -  BONE SCREW 7042890 20 DEG ILC 8.5X90 TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7045855","SUP","HCPCS C1713","","7045855  -  SET SCREW 7045855 1 4 32 BREAK OFF TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7049855","SUP","HCPCS C1713","","7049855  -  SCREW 7049855 HEX BREAK OFF TI .25 32","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7050500","SUP","HCPCS C1713","","7050500  -  PROXIMAL SCREW 5.5 X 100, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050550","SUP","HCPCS C1713","","7050550  -  PROXIMAL SCREW 5.5 X 50, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050555","SUP","HCPCS C1713","","7050555  -  PROXIMAL SCREW 5.5 X 55, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050560","SUP","HCPCS C1713","","7050560  -  PROXIMAL SCREW 5.5 X 60, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050570","SUP","HCPCS C1713","","7050570  -  PROXIMAL SCREW 5.5 X 70, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050580","SUP","HCPCS C1713","","7050580  -  PROXIMAL SCREW 5.5 X 80, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050590","SUP","HCPCS C1713","","7050590  -  PROXIMAL SCREW 5.5 X 90, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050600","SUP","HCPCS C1713","","7050600  -  PROXIMAL SCREW 6.5 X 100, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050655","SUP","HCPCS C1713","","7050655  -  PROXIMAL SCREW 6.5 X 55, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050680","SUP","HCPCS C1713","","7050680  -  PROXIMAL SCREW 6.5 X 80, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050690","SUP","HCPCS C1713","","7050690  -  PROXIMAL SCREW 6.5 X 90, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050750","SUP","HCPCS C1713","","7050750  -  PROXIMAL SCREW 7.5 X 50, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050755","SUP","HCPCS C1713","","7050755  -  PROXIMAL SCREW 7.5 X 55, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050850","SUP","HCPCS C1713","","7050850  -  PROXIMAL SCREW 8.5 X 50, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050855","SUP","HCPCS C1713","","7050855  -  PROXIMAL SCREW 8.5 X 55, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7050860","SUP","HCPCS C1713","","7050860  -  PROXIMAL SCREW 8.5 X 60, TI","BOTH IP/OP","$2,273.50 ","$1,682.39 ","$0.00 ","$2,273.50 ","$1,023.08 ","$0.00 ","$473.85 ","$0.00 ","$0.00 ","$398.07 ","$2,273.50 ","$0.00 ","$1,136.75 ","$1,800.61 ","$1,818.80 ","$0.00 ","$355.80 ","$0.00 ","$361.94 ","$0.00 "
"7060300","SUP","Custom 27803010","","7060300  -  TUBE ET 9MM 6MM STRL LSRSHLD II CUF WRP REFLC SIL AL FLRPLAS","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7060400","SUP","Custom 27803010","","7060400  -  TUBE ET 10.5MM 7MM STRL LSRSHLD II CUF WRP REFLC SIL AL","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7060500","SUP","Custom 27803010","","7060500  -  TUBE ET 11.5MM 8MM STRL LF LSRSHLD II DISP","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7070501","SUP","Custom 27203010","","7070501  -  DRILL SRG 4.5MM NS LF DISP MAS PLIF","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7070502","SUP","Custom 27203010","","7070502  -  DRILL SRG 5MM DISP MAS PLIF","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7070503","SUP","Custom 27203010","","7070503  -  DRILL SRG 5.5MM DISP MAS PLIF","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7080510","SUP","Custom 27203010","","7080510  -  BIT DRL 11MM STRL DISP","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7080513","SUP","Custom 27203010","","7080513  -  BIT DRL 13MM STRL DISP","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7096530","SUP","HCPCS C1713","","7096530  -  SCREW BN 6.5MM 30MM MAS PLIF","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7110001","SUP","HCPCS C1713","","7110001  -  SCREW LOCK DIA 16 CORE VBR 2","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"7110003","SUP","HCPCS C1713","","7110003  -  SCREW LOCK  CORE DIA 18 DIA 22 XCORE 2 TI","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"7124540","SUP","HCPCS C1713","","7124540  -  SCREW BN 4.5MM 40MM SPNE MAS PLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7125025","SUP","HCPCS C1713","","7125025  -  SCREW BN 5MM 25MM NS MAS PA SPNE 3Z PLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7125035","SUP","HCPCS C1713","","7125035  -  SCREW BN 5MM 35MM SPNE MAS PLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7125525","SUP","HCPCS C1713","","7125525  -  SCREW BN 5.5MM 25MM SPNE MAS PLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7125535","SUP","HCPCS C1713","","7125535  -  SCREW BN 5.5MM 35MM SPNE MAS PLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7135100","SUP","Custom 27203010","","7135100  -  KIT AUTOTRANSFUSION BOWL SMALL ASMBLY LOW VOLUME CENTRIFUGE","BOTH IP/OP","$1,378.93 ","$1,020.41 ","$0.00 ","$1,378.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,378.93 ","$0.00 ","$689.46 ","$1,092.11 ","$1,103.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7140208","SUP","HCPCS C1713","","7140208  -  PLATE BN 8 NS DECADE 2 HL SPNE XLIF","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$0.00 ","$0.00 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"7140210","SUP","HCPCS C1713","","7140210  -  PLATE BN 10 NS DECADE 2 HL SPNE XLIF","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$0.00 ","$0.00 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"7140212","SUP","HCPCS C1713","","7140212  -  PLATE BN 12 NS DECADE 2 HL SPNE XLIF","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$0.00 ","$0.00 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"7140214","SUP","HCPCS C1713","","7140214  -  PLATE BN 14 NS DECADE 2 HL SPNE XLIF","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$0.00 ","$0.00 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"7140216","SUP","HCPCS C1713","","7140216  -  PLATE BN 16 NS DECADE 2 HL SPNE XLIF","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$0.00 ","$0.00 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"7140218","SUP","HCPCS C1713","","7140218  -  PLATE BN 18 NS DECADE 2 HL SPNE XLIF","BOTH IP/OP","$9,005.00 ","$6,663.70 ","$0.00 ","$9,005.00 ","$4,052.25 ","$0.00 ","$1,876.87 ","$0.00 ","$0.00 ","$1,576.70 ","$9,005.00 ","$0.00 ","$4,502.50 ","$7,131.96 ","$7,204.00 ","$0.00 ","$1,409.28 ","$0.00 ","$1,433.60 ","$0.00 "
"7140408","SUP","HCPCS C1713","","7140408  -  PLATE BN 8 NS DECADE 4 HL SPNE XLIF","BOTH IP/OP","$9,642.50 ","$7,135.45 ","$0.00 ","$9,642.50 ","$4,339.13 ","$0.00 ","$2,009.74 ","$0.00 ","$0.00 ","$1,688.32 ","$9,642.50 ","$0.00 ","$4,821.25 ","$7,636.86 ","$7,714.00 ","$0.00 ","$1,509.05 ","$0.00 ","$1,535.09 ","$0.00 "
"7140410","SUP","HCPCS C1713","","7140410  -  PLATE BN 10 NS DECADE 4 HL SPNE XLIF","BOTH IP/OP","$9,642.50 ","$7,135.45 ","$0.00 ","$9,642.50 ","$4,339.13 ","$0.00 ","$2,009.74 ","$0.00 ","$0.00 ","$1,688.32 ","$9,642.50 ","$0.00 ","$4,821.25 ","$7,636.86 ","$7,714.00 ","$0.00 ","$1,509.05 ","$0.00 ","$1,535.09 ","$0.00 "
"7140412","SUP","HCPCS C1713","","7140412  -  PLATE BN 12 NS DECADE 4 HL SPNE XLIF","BOTH IP/OP","$9,642.50 ","$7,135.45 ","$0.00 ","$9,642.50 ","$4,339.13 ","$0.00 ","$2,009.74 ","$0.00 ","$0.00 ","$1,688.32 ","$9,642.50 ","$0.00 ","$4,821.25 ","$7,636.86 ","$7,714.00 ","$0.00 ","$1,509.05 ","$0.00 ","$1,535.09 ","$0.00 "
"7140414","SUP","HCPCS C1713","","7140414  -  PLATE BN 14 NS DECADE 4 HL SPNE XLIF","BOTH IP/OP","$9,642.50 ","$7,135.45 ","$0.00 ","$9,642.50 ","$4,339.13 ","$0.00 ","$2,009.74 ","$0.00 ","$0.00 ","$1,688.32 ","$9,642.50 ","$0.00 ","$4,821.25 ","$7,636.86 ","$7,714.00 ","$0.00 ","$1,509.05 ","$0.00 ","$1,535.09 ","$0.00 "
"7140416","SUP","HCPCS C1713","","7140416  -  PLATE BN 16 NS DECADE 4 HL SPNE XLIF","BOTH IP/OP","$9,642.50 ","$7,135.45 ","$0.00 ","$9,642.50 ","$4,339.13 ","$0.00 ","$2,009.74 ","$0.00 ","$0.00 ","$1,688.32 ","$9,642.50 ","$0.00 ","$4,821.25 ","$7,636.86 ","$7,714.00 ","$0.00 ","$1,509.05 ","$0.00 ","$1,535.09 ","$0.00 "
"7140418","SUP","HCPCS C1713","","7140418  -  PLATE BN 18 NS DECADE 4 HL SPNE XLIF","BOTH IP/OP","$9,642.50 ","$7,135.45 ","$0.00 ","$9,642.50 ","$4,339.13 ","$0.00 ","$2,009.74 ","$0.00 ","$0.00 ","$1,688.32 ","$9,642.50 ","$0.00 ","$4,821.25 ","$7,636.86 ","$7,714.00 ","$0.00 ","$1,509.05 ","$0.00 ","$1,535.09 ","$0.00 "
"7141112","SUP","Custom 27203010","","7141112  -  GUIDE PIN ORTH 100MM DECADE SPNE XLIF","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7141113","SUP","HCPCS C1713","","7141113  -  PIN FX DECADE SCR XLIF","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"7141230","SUP","HCPCS C1713","","7141230  -  BOLT SPNL SM 5MM 30MM DECADE IMPACTABLE XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7141240","SUP","HCPCS C1713","","7141240  -  BOLT SPNL SM 5MM 40MM DECADE IMPACTABLE XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7141250","SUP","HCPCS C1713","","7141250  -  BOLT SPNL SM 5MM 50MM DECADE IMPACTABLE XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145030","SUP","HCPCS C1713","","7145030  -  BOLT SPNL SM 5MM 30MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145035","SUP","HCPCS C1713","","7145035  -  BOLT SPNL SM 5MM 35MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145040","SUP","HCPCS C1713","","7145040  -  BOLT SPNL SM 5MM 40MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145045","SUP","HCPCS C1713","","7145045  -  BOLT SPNL SM 5MM 45MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145050","SUP","HCPCS C1713","","7145050  -  BOLT SPNL SM 5MM 50MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145055","SUP","HCPCS C1713","","7145055  -  BOLT SPNL SM 5MM 55MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145060","SUP","HCPCS C1713","","7145060  -  BOLT SPNL SM 5MM 60MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145130","SUP","HCPCS C1713","","7145130  -  BOLT SPNL SM 5.5MM 30MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145140","SUP","HCPCS C1713","","7145140  -  BOLT SPNL SM 5.5MM 40MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145150","SUP","HCPCS C1713","","7145150  -  BOLT SPNL SM 5.5MM 50MM NS DECADE THRD PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145525","SUP","HCPCS C1713","","7145525  -  BOLT SPNL LG 5.5MM 25MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145530","SUP","HCPCS C1713","","7145530  -  BOLT SPNL LG 5.5MM 30MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145535","SUP","HCPCS C1713","","7145535  -  BOLT SPNL LG 5.5MM 35MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145540","SUP","HCPCS C1713","","7145540  -  BOLT SPNL LG 5.5MM 40MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145545","SUP","HCPCS C1713","","7145545  -  BOLT SPNL LG 5.5MM 45MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145550","SUP","HCPCS C1713","","7145550  -  BOLT SPNL LG 5.5MM 50MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145555","SUP","HCPCS C1713","","7145555  -  BOLT SPNL LG 5.5MM 55MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7145560","SUP","HCPCS C1713","","7145560  -  BOLT SPNL LG 5.5MM 60MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146525","SUP","HCPCS C1713","","7146525  -  BOLT SPNL LG 6.5MM 25MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146530","SUP","HCPCS C1713","","7146530  -  BOLT SPNL LG 6.5MM 30MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146535","SUP","HCPCS C1713","","7146535  -  BOLT SPNL LG 6.5MM 35MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146540","SUP","HCPCS C1713","","7146540  -  BOLT SPNL LG 6.5MM 40MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146545","SUP","HCPCS C1713","","7146545  -  BOLT SPNL LG 6.5MM 45MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146550","SUP","HCPCS C1713","","7146550  -  BOLT SPNL LG 6.5MM 50MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146555","SUP","HCPCS C1713","","7146555  -  BOLT SPNL LG 6.5MM 55MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7146560","SUP","HCPCS C1713","","7146560  -  BOLT SPNL LG 6.5MM 60MM NS DECADE PLT XLIF","BOTH IP/OP","$2,407.50 ","$1,781.55 ","$0.00 ","$2,407.50 ","$1,083.38 ","$0.00 ","$501.78 ","$0.00 ","$0.00 ","$421.53 ","$2,407.50 ","$0.00 ","$1,203.75 ","$1,906.74 ","$1,926.00 ","$0.00 ","$376.77 ","$0.00 ","$383.27 ","$0.00 "
"7160012","SUP","Custom 27803010","","7160012  -  CAGE SPNL 16MM 12MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160014","SUP","Custom 27803010","","7160014  -  CAGE SPNL 16MM 14MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160022","SUP","Custom 27803010","","7160022  -  CAGE SPNL 16MM 16-22MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160025","SUP","Custom 27803010","","7160025  -  CAGE SPNL 16MM 18-25MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160035","SUP","Custom 27803010","","7160035  -  CAGE SPNL 16MM 23-35MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160041","SUP","Custom 27803010","","7160041  -  CAGE SPNL 16MM 26-41MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160049","SUP","Custom 27803010","","7160049  -  CAGE SPNL 16MM 30-49MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160063","SUP","Custom 27803010","","7160063  -  CAGE SPNL 16MM 37-63MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160075","SUP","Custom 27803010","","7160075  -  CAGE SPNL 16MM 43-75MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7162000","SUP","HCPCS C1713","","7162000  -  SCREW LOCK ENDCAP XCORE 2 TI","BOTH IP/OP","$620.00 ","$458.80 ","$0.00 ","$620.00 ","$279.00 ","$0.00 ","$129.22 ","$0.00 ","$0.00 ","$108.56 ","$620.00 ","$0.00 ","$310.00 ","$491.04 ","$496.00 ","$0.00 ","$97.03 ","$0.00 ","$98.70 ","$0.00 "
"7164565","SUP","HCPCS C1713","","7164565  -  5.0X 65MM SCREW","BOTH IP/OP","$648.00 ","$479.52 ","$0.00 ","$648.00 ","$291.60 ","$0.00 ","$135.06 ","$0.00 ","$0.00 ","$113.46 ","$648.00 ","$0.00 ","$324.00 ","$513.22 ","$518.40 ","$0.00 ","$101.41 ","$0.00 ","$103.16 ","$0.00 "
"7180016","SUP","Custom 27803010","","7180016  -  CAGE SPNL 18MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180018","SUP","Custom 27803010","","7180018  -  CAGE SPNL 18MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180025","SUP","Custom 27803010","","7180025  -  CAGE SPNL 18MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180027","SUP","Custom 27803010","","7180027  -  CAGE SPNL 18MM 21-27MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180033","SUP","Custom 27803010","","7180033  -  CAGE SPNL 18MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180041","SUP","Custom 27803010","","7180041  -  CAGE SPNL 18MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180055","SUP","Custom 27803010","","7180055  -  CAGE SPINAL 18X35-55MM X-CORE 2 TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180067","SUP","Custom 27803010","","7180067  -  CAGE SPNL 18MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180079","SUP","Custom 27803010","","7180079  -  CAGE SPNL 18MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180121","SUP","Custom 27803010","","7180121  -  CAGE SPNL 18MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7191525","SUP","HCPCS C1713","","7191525  -  CDH 7191525 HA COATED  5.5X25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191530","SUP","HCPCS C1713","","7191530  -  CDH 7191530 HA COATED  5.5X30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191535","SUP","HCPCS C1713","","7191535  -  SCREW BN 5.5MM 35MM STRL CD HZN LGC MA HA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191540","SUP","HCPCS C1713","","7191540  -  SCREW BN 5.5MM 40MM STRL CD HZN LGC MA HA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191545","SUP","HCPCS C1713","","7191545  -  CDH 7191545 HA COATED  5.5X45","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191550","SUP","HCPCS C1713","","7191550  -  CDH HA COATED MAS 5.5X50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191555","SUP","HCPCS C1713","","7191555  -  CDH HA COATED MAS 5.5X55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191560","SUP","HCPCS C1713","","7191560  -  CDH HA COATED MAS 5.5X60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191625","SUP","HCPCS C1713","","7191625  -  CDH HA COATED MAS 6.5X25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191630","SUP","HCPCS C1713","","7191630  -  CDH HA COATED MAS 6.5X30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191635","SUP","HCPCS C1713","","7191635  -  SCREW BN 6.5MM 35MM STRL CD HZN LGC MA HA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191640","SUP","HCPCS C1713","","7191640  -  SCREW BN 6.5MM 40MM STRL CD HZN LGC MA HA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191645","SUP","HCPCS C1713","","7191645  -  SCREW BN 6.5MM 45MM STRL CD HZN LGC MA HA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191650","SUP","HCPCS C1713","","7191650  -  CDH HA COATED MAS 6.5X50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191655","SUP","HCPCS C1713","","7191655  -  CDH HA COATED MAS 6.5X55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191660","SUP","HCPCS C1713","","7191660  -  CDH HA COATED MAS 6.5X60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191665","SUP","HCPCS C1713","","7191665  -  CDH HA COATED MAS 6.5X65","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191725","SUP","HCPCS C1713","","7191725  -  CDH HA COATED MAS 7.5X25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191730","SUP","HCPCS C1713","","7191730  -  CDH HA COATED MAS 7.5X30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191735","SUP","HCPCS C1713","","7191735  -  CDH 7191735 HA COATED  7.5X35","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191740","SUP","HCPCS C1713","","7191740  -  SCREW BN 7.5MM 40MM STRL CD HZN LGC MA HA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191745","SUP","HCPCS C1713","","7191745  -  SCREW 7191745 MULTI-AXIAL HA COATED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191750","SUP","HCPCS C1713","","7191750  -  CDH HA COATED MAS 7.5X50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191755","SUP","HCPCS C1713","","7191755  -  CDH HA COATED MAS 7.5X55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191760","SUP","HCPCS C1713","","7191760  -  CDH HA COATED MAS 7.5X60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191765","SUP","HCPCS C1713","","7191765  -  SCREW 7191765 CDH HA COATED MA 7.5X65","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191770","SUP","HCPCS C1713","","7191770  -  CDH HA COATED MAS 7.5X70","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191825","SUP","HCPCS C1713","","7191825  -  CDH HA COATED MAS 8.5X25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191830","SUP","HCPCS C1713","","7191830  -  CDH HA COATED MAS 8.5X30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191835","SUP","HCPCS C1713","","7191835  -  CDH 7191835 HA COATED  8.5X35","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191840","SUP","HCPCS C1713","","7191840  -  SCREW 7191840 MULTI-AXIAL HA COATED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191845","SUP","HCPCS C1713","","7191845  -  SCREW 7191845 MULTI-AXIAL HA COATED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191850","SUP","HCPCS C1713","","7191850  -  CDH HA COATED MAS 8.5X50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191855","SUP","HCPCS C1713","","7191855  -  CDH 7191855 HA COATED  8.5X55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191860","SUP","HCPCS C1713","","7191860  -  CDH HA COATED MAS 8.5X60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7191865","SUP","HCPCS C1713","","7191865  -  CDH HA COATED MAS 8.5X65","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7195535","SUP","HCPCS C1713","","7195535  -  SCREW BN 5.5MM 35MM SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7195540","SUP","HCPCS C1713","","7195540  -  SCREW BN 5.5MM 40MM 2 LD CNN SPNE PDCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7195545","SUP","HCPCS C1713","","7195545  -  SCREW BN 5.5MM 45MM SPHERX II 2 LCK SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7195550","SUP","HCPCS C1713","","7195550  -  SCREW BN 5.5MM 50MM 2 LD CNN SPNE PDCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7195555","SUP","HCPCS C1713","","7195555  -  SCREW BN 5.5MM 55MM 2 LD CNN SPNE PDCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7196535","SUP","HCPCS C1713","","7196535  -  SCREW BN 6.5MM 35MM SPHERX II SPNE DLS","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7196540","SUP","HCPCS C1713","","7196540  -  SCREW BN 6.5MM 40MM SPHERX II 2 LCK SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7196545","SUP","HCPCS C1713","","7196545  -  SCREW BN 6.5MM 45MM SPHERX II 2 SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7196550","SUP","HCPCS C1713","","7196550  -  SCREW BN 6.5MM 50MM SPHERX II 2 LCK SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7196555","SUP","HCPCS C1713","","7196555  -  SCREW BN 6.5MM 55MM SPHERX II 2 LCK SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7197535","SUP","HCPCS C1713","","7197535  -  SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7197540","SUP","HCPCS C1713","","7197540  -  SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7197545","SUP","HCPCS C1713","","7197545  -  SCREW BN 7.5MM 45MM 2 LD SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7197550","SUP","HCPCS C1713","","7197550  -  SCREW BN 7.5MM 50MM 2 LD SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7197555","SUP","HCPCS C1713","","7197555  -  SCREW BN 7.5MM 55MM SPHERX II PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7200019","SUP","HCPCS C1713","","7200019  -  PLATE BN 19MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200021","SUP","HCPCS C1713","","7200021  -  PLATE BN 21MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200023","SUP","HCPCS C1713","","7200023  -  PLATE BN 23MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200025","SUP","HCPCS C1713","","7200025  -  PLATE BN 25MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200027","SUP","HCPCS C1713","","7200027  -  PLATE BN 27.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200030","SUP","HCPCS C1713","","7200030  -  PLATE BN 30MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200032","SUP","HCPCS C1713","","7200032  -  PLATE 7200032 ATL VISION ELITE 32.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200035","SUP","HCPCS C1713","","7200035  -  PLATE BN 35MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200037","SUP","HCPCS C1713","","7200037  -  PLATE BN 37.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200040","SUP","HCPCS C1713","","7200040  -  PLATE BN 40MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200042","SUP","HCPCS C1713","","7200042  -  PLATE BN 42.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200045","SUP","HCPCS C1713","","7200045  -  PLATE BN 45MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200047","SUP","HCPCS C1713","","7200047  -  PLATE BN 47.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200050","SUP","HCPCS C1713","","7200050  -  PLATE 7200050 ATL VISION ELITE 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200052","SUP","HCPCS C1713","","7200052  -  PLATE BN 52.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200055","SUP","HCPCS C1713","","7200055  -  PLATE BN 55MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200057","SUP","HCPCS C1713","","7200057  -  PLATE BN 57.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200060","SUP","HCPCS C1713","","7200060  -  PLATE BN 60MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200062","SUP","HCPCS C1713","","7200062  -  PLATE BN 62.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200065","SUP","HCPCS C1713","","7200065  -  PLATE BN 65MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200067","SUP","HCPCS C1713","","7200067  -  PLATE BN 67.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200070","SUP","HCPCS C1713","","7200070  -  PLATE 7200070 ATL VISION ELITE 70MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200072","SUP","HCPCS C1713","","7200072  -  PLATE 7200072 ATL VISION ELITE 72.5MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200075","SUP","HCPCS C1713","","7200075  -  PLATE 7200075 ATL VISION ELITE 75MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200077","SUP","HCPCS C1713","","7200077  -  PLATE 7200077 ATL VISION ELITE 77.5MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200080","SUP","HCPCS C1713","","7200080  -  PLATE BN 80MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200082","SUP","HCPCS C1713","","7200082  -  PLATE BN 82.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200085","SUP","HCPCS C1713","","7200085  -  PLATE 7200085 ATL VISION ELITE 85MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200087","SUP","HCPCS C1713","","7200087  -  PLATE 7200087 ATL VISION ELITE 87.5MM","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200090","SUP","HCPCS C1713","","7200090  -  PLATE 7200090 ATL VISION ELITE 90MM","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200095","SUP","HCPCS C1713","","7200095  -  PLATE BN 95MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200100","SUP","HCPCS C1713","","7200100  -  PLATE 7200100 ATL VISION ELITE 100MM","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200105","SUP","HCPCS C1713","","7200105  -  PLATE 7200105 ATL VISION ELITE 105MM","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200110","SUP","HCPCS C1713","","7200110  -  PLATE 7200110 ATL VISION ELITE 110MM","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200127","SUP","Custom 27203010","","RESERVOIR REAGENT NTR CSTR PS MT CHNL PIPETTER 50ML STRL","BOTH IP/OP","$1.48 ","$1.10 ","$0.00 ","$1.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.48 ","$0.00 ","$0.74 ","$1.17 ","$1.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7200130","SUP","HCPCS C1713","","7200130  -  PLATE 7200130 ATL VISION ELITE 30MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200132","SUP","HCPCS C1713","","7200132  -  PLATE BN 32.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7200145","SUP","HCPCS C1713","","7200145  -  PLATE BN 45MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200147","SUP","HCPCS C1713","","7200147  -  PLATE 7200147 ATL VISION ELITE 47.5MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200150","SUP","HCPCS C1713","","7200150  -  PLATE BN 50MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7200152","SUP","HCPCS C1713","","7200152  -  PLATE BN 52.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200155","SUP","HCPCS C1713","","7200155  -  PLATE BN 55MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7200167","SUP","HCPCS C1713","","7200167  -  PLATE 7200167 ATL VISION ELITE 67.5MM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200170","SUP","HCPCS C1713","","7200170  -  PLATE BN 70MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200172","SUP","HCPCS C1713","","7200172  -  PLATE BN 72.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7200180","SUP","HCPCS C1713","","7200180  -  PLATE BN 80MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200182","SUP","HCPCS C1713","","7200182  -  PLATE 7200182 ATL VISION ELITE 82.5MM","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200185","SUP","HCPCS C1713","","7200185  -  PLATE BN 85MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT","BOTH IP/OP","$4,492.00 ","$3,324.08 ","$0.00 ","$4,492.00 ","$2,021.40 ","$0.00 ","$936.25 ","$0.00 ","$0.00 ","$786.51 ","$4,492.00 ","$0.00 ","$2,246.00 ","$3,557.66 ","$3,593.60 ","$0.00 ","$703.00 ","$0.00 ","$715.13 ","$0.00 "
"7200300","SUP","Custom 27203010","","TIP PIP 1-200UL POLYPRO GRAD BVL RK NTR NSTRL","BOTH IP/OP","$0.13 ","$0.10 ","$0.00 ","$0.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.13 ","$0.00 ","$0.06 ","$0.10 ","$0.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7200502","SUP","HCPCS C1713","","7200502  -  WIRE FX LNG KRSH SS ORTH","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"7205345","SUP","Custom 27203010","","7205345  -  DYONICS 4.5MM INCISOR PLUS BLSDE BX/6","BOTH IP/OP","$56.10 ","$41.51 ","$0.00 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.10 ","$0.00 ","$28.05 ","$44.43 ","$44.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7209984","SUP","Custom 27203010","","7209984  -  CANNU ARTHRO 72MM OBT THRD CL-TRC STRL DISP 8.5MM LATEX FREE","BOTH IP/OP","$61.26 ","$45.33 ","$0.00 ","$61.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.26 ","$0.00 ","$30.63 ","$48.52 ","$49.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7209985","SUP","Custom 27203010","","7209985  -  CANNU ENDSCP GRY 72MM OBT THRD CL-TRC CMPLT STRL DISP 7MM","BOTH IP/OP","$61.26 ","$45.33 ","$0.00 ","$61.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.26 ","$0.00 ","$30.63 ","$48.52 ","$49.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7217020","SUP","HCPCS C1713","","7217020  -  ROD SPNL PREBNT 20MM","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217025","SUP","HCPCS C1713","","7217025  -  ROD SPNL PREBNT 6MM 25MM SPHERX TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217030","SUP","HCPCS C1713","","7217030  -  ROD SPNL PREBNT 6MM 30MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217035","SUP","HCPCS C1713","","7217035  -  ROD SPNL PREBNT 6MM 35MM TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217040","SUP","HCPCS C1713","","7217040  -  ROD SPNL PREBNT 40MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217045","SUP","HCPCS C1713","","7217045  -  ROD SPNL PREBNT 45MM","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217050","SUP","HCPCS C1713","","7217050  -  ROD SPNL PREBNT 6MM 50MM TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217055","SUP","HCPCS C1713","","7217055  -  ROD SPNL PREBNT 55MM NS SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217060","SUP","HCPCS C1713","","7217060  -  ROD SPNL PREBNT 60MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217065","SUP","HCPCS C1713","","7217065  -  ROD SPNL PREBNT 65MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217070","SUP","HCPCS C1713","","7217070  -  ROD SPNL PREBNT 70MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217075","SUP","HCPCS C1713","","7217075  -  ROD SPNL PREBNT 75MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217080","SUP","HCPCS C1713","","7217080  -  ROD SPNL PREBNT 80MM SPHERX DBR II TI","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"7217085","SUP","HCPCS C1713","","7217085  -  ROD SPNL PREBNT 85MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217090","SUP","HCPCS C1713","","7217090  -  ROD SPNL PREBNT 90MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217095","SUP","HCPCS C1713","","7217095  -  ROD SPNL PREBNT 95MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217100","SUP","HCPCS C1713","","7217100  -  ROD SPNL PREBNT 100MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217105","SUP","HCPCS C1713","","7217105  -  ROD SPNL PREBNT 105MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217110","SUP","HCPCS C1713","","7217110  -  ROD SPNL PREBNT 110MM SPHERX DBR II TI","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217120","SUP","HCPCS C1713","","7217120  -  ROD SPNL PREBNT 120MM SPHERX DBR II TI","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217130","SUP","HCPCS C1713","","7217130  -  ROD SPNL PREBNT 130MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217140","SUP","HCPCS C1713","","7217140  -  ROD SPNL PREBNT 140MM SPHERX II DBR","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7217150","SUP","HCPCS C1713","","7217150  -  ROD SPNL PREBNT 150MM SPHERX DBR II","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$641.25 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$249.51 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$223.01 ","$0.00 ","$226.86 ","$0.00 "
"7220016","SUP","Custom 27803010","","7220016  -  CAGE SPNL 22MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220018","SUP","Custom 27803010","","7220018  -  CAGE SPNL 22MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220025","SUP","Custom 27803010","","7220025  -  CAGE SPNL 22MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220027","SUP","Custom 27803010","","7220027  -  CAGE SPINAL 22X21-27MM X-CORE 2 TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220033","SUP","Custom 27803010","","7220033  -  CAGE SPNL 22MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220041","SUP","Custom 27803010","","7220041  -  CAGE SPNL 22MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220055","SUP","Custom 27803010","","7220055  -  CAGE SPNL 22MM 35-55MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220067","SUP","Custom 27803010","","7220067  -  CAGE SPNL 22MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220079","SUP","Custom 27803010","","7220079  -  CAGE SPNL 22MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220121","SUP","Custom 27803010","","7220121  -  CAGE SPNL 22MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220850","SUP","HCPCS C1713","","7220850  -  SCREW SET 50MM 8.5MM SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7222200","SUP","Custom 27803010","","7222200  -  ENDCAP SPNL 22MM RND 0 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7222204","SUP","Custom 27803010","","7222204  -  ENDCAP SPNL 22MM RND 4 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7222208","SUP","Custom 27803010","","7222208  -  ENDCAP SPNL 22MM RND 8 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7222212","SUP","Custom 27803010","","7222212  -  ENDCAP SPNL 22MM RND 12 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224000","SUP","Custom 27803010","","7224000  -  ENDCAP SPNL OD 22X22X40MM 0 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224004","SUP","Custom 27803010","","7224004  -  ENDCAP SPNL OD 22X22X40MM 4 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224008","SUP","Custom 27803010","","7224008  -  ENDCAP SPNL OD 22X22X40MM 8 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7224012","SUP","Custom 27803010","","7224012  -  ENDCAP SPNL OD 22X22X40MM 12 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7225000","SUP","Custom 27803010","","7225000  -  ENDCAP SPNL OD 22X22X50MM 0 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7225004","SUP","Custom 27803010","","7225004  -  ENDCAP SPNL OD 22X22X50MM 4 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7225008","SUP","Custom 27803010","","7225008  -  ENDCAP SPNL OD 22X22X50MM 8 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7225012","SUP","Custom 27803010","","7225012  -  ENDCAP SPNL OD 22X22X50MM 12 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7226000","SUP","Custom 27803010","","7226000  -  ENDCAP SPNL OD 22X22X60MM 0 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7226004","SUP","Custom 27803010","","7226004  -  ENDCAP SPNL OD 22X22X60MM 4 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7226008","SUP","Custom 27803010","","7226008  -  ENDCAP SPNL OD 22X22X60MM 8 DEG XCORE 2 TI","BOTH IP/OP","$3,157.50 ","$2,336.55 ","$0.00 ","$3,157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,157.50 ","$0.00 ","$1,578.75 ","$2,500.74 ","$2,526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7240033","SUP","HCPCS C1713","","7240033  -  TMPLT ROD 250MM","BOTH IP/OP","$1,012.50 ","$749.25 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$211.03 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"7240034","SUP","HCPCS C1713","","7240034  -  TMPLT ROD 500MM SPHERX 2 TI","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$534.38 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$207.92 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$185.84 ","$0.00 ","$189.05 ","$0.00 "
"7241045","SUP","HCPCS C1713","","7241045  -  CONNECTOR ROD 45-60MM SPHERX II TRNSV TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241055","SUP","HCPCS C1713","","7241055  -  CONNECTOR ROD 55-81MM SPHERX II TRNSV TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241075","SUP","HCPCS C1713","","7241075  -  CONNECTOR ROD 74-85MM SPHERX II TRNSV TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241100","SUP","HCPCS C1713","","7241100  -  SCREW BN SM 1.5MM 10MM SPHERX DBR II LCK TI SPNE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7241102","SUP","HCPCS C1713","","7241102  -  HOOK SPNL SM SPHERX II TI PDCL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241103","SUP","HCPCS C1713","","7241103  -  HOOK SPNL MED SPHERX II TI PDCL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241104","SUP","HCPCS C1713","","7241104  -  HOOK SPNL 6MM SPHERX II NAR BLDE TI LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241105","SUP","HCPCS C1713","","7241105  -  HOOK SPNL 8MM SPHERX II NAR BLDE TI LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241106","SUP","HCPCS C1713","","7241106  -  HOOK SPNL 10MM SPHERX II NAR BLDE TI LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241107","SUP","HCPCS C1713","","7241107  -  HOOK SPNL 6MM SPHERX II W BLDE ANG LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241108","SUP","HCPCS C1713","","7241108  -  HOOK SPNL 8MM SPHERX II W BLDE ANG LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241109","SUP","HCPCS C1713","","7241109  -  HOOK SPNL 10MM SPHERX II W BLDE ANG LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241110","SUP","HCPCS C1713","","7241110  -  HOOK SPNL 6MM SPHERX II NAR BLDE ANG RDC TIP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241111","SUP","HCPCS C1713","","7241111  -  HOOK SPNL 8MM SPHERX II NAR BLDE ANG RDC TIP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241112","SUP","HCPCS C1713","","7241112  -  HOOK SPNL 10MM SPHERX II NAR BLDE ANG RDC TIP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241113","SUP","HCPCS C1713","","7241113  -  HOOK SPNL 6MM SPHERX II WA RDC TIP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241114","SUP","HCPCS C1713","","7241114  -  HOOK SPNL 8MM SPHERX II W BLDE ANG RDC TIP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241115","SUP","HCPCS C1713","","7241115  -  HOOK SPNL 10MM SPHERX II W BLDE ANG RDC TIP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241116","SUP","HCPCS C1713","","7241116  -  HOOK SPNL 6MM SPHERX II NAR BLDE DN ANG LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241117","SUP","HCPCS C1713","","7241117  -  HOOK SPNL 8MM SPHERX II NAR BLDE DN ANG LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241118","SUP","HCPCS C1713","","7241118  -  HOOK SPNL 10MM SPHERX II NAR BLDE DN ANG LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241119","SUP","HCPCS C1713","","7241119  -  HOOK SPNL 6MM SPHERX II NAR BLDE ANG XTD LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241120","SUP","HCPCS C1713","","7241120  -  HOOK SPNL 8MM SPHERX II NAR BLDE ANG XTD LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241121","SUP","HCPCS C1713","","7241121  -  HOOK SPNL 45D SPHERX II NAR BLDE ANG","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241122","SUP","HCPCS C1713","","7241122  -  HOOK SPNL SPHERX II NAR BLDE ANG RT OFST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241123","SUP","HCPCS C1713","","7241123  -  HOOK SPNL SPHERX II NAR BLDE ANG LT OFST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241124","SUP","HCPCS C1713","","7241124  -  HOOK SPNL SPHERX II NAR BLDE ANG RT OFST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241125","SUP","HCPCS C1713","","7241125  -  HOOK SPNL SPHERX II NAR BLDE ANG LT OFST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241131","SUP","HCPCS C1713","","7241131  -  HOOK SPNL 6MM SPHERX II ANG UP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241132","SUP","HCPCS C1713","","7241132  -  HOOK SPNL 8MM SPHERX II ANG UP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241133","SUP","HCPCS C1713","","7241133  -  HOOK SPNL 10MM SPHERX II ANG UP LMR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"7241200","SUP","HCPCS C1713","","7241200  -  CONNECTOR ROD 20MM SPHERX II TRNSV FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241225","SUP","HCPCS C1713","","7241225  -  CONNECTOR ROD 22MM SPHERX II TRNSV FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241250","SUP","HCPCS C1713","","7241250  -  CONNECTOR ROD 25MM SPHERX II TRNSV FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241275","SUP","HCPCS C1713","","7241275  -  CONNECTOR ROD 27MM SPHERX II TRNSV FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241300","SUP","HCPCS C1713","","7241300  -  CONNECTOR ROD 30MM TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241325","SUP","HCPCS C1713","","7241325  -  CONNECTOR ROD 32.5MM TRNSV FX SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241350","SUP","HCPCS C1713","","7241350  -  CONNECTOR ROD 35MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241375","SUP","HCPCS C1713","","7241375  -  CONNECTOR ROD 37.5MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241400","SUP","HCPCS C1713","","7241400  -  CONNECTOR ROD 40MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241450","SUP","HCPCS C1713","","7241450  -  CONNECTOR ROD 45MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241500","SUP","HCPCS C1713","","7241500  -  CONNECTOR ROD 50MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241550","SUP","HCPCS C1713","","7241550  -  CONNECTOR ROD 55MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7241600","SUP","HCPCS C1713","","7241600  -  CONNECTOR ROD 60MM SPHERX II TRNSV FA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7242020","SUP","HCPCS C1713","","7242020  -  ROD SPNL PREBNT 20MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242030","SUP","HCPCS C1713","","7242030  -  ROD SPNL PREBNT 30MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242035","SUP","HCPCS C1713","","7242035  -  ROD SPNL PREBNT 35MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242040","SUP","HCPCS C1713","","7242040  -  ROD SPINAL 40MM PREBENT CONVENTIONAL SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242050","SUP","HCPCS C1713","","7242050  -  ROD SPNL PREBNT 50MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242055","SUP","HCPCS C1713","","7242055  -  ROD SPNL PREBNT 55MM NS SPHERX II MAS PLIF","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242060","SUP","HCPCS C1713","","7242060  -  ROD SPNL PREBNT 60MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242065","SUP","HCPCS C1713","","7242065  -  ROD SPNL PREBNT 65MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242070","SUP","HCPCS C1713","","7242070  -  ROD SPNL PREBNT 70MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242075","SUP","HCPCS C1713","","7242075  -  ROD SPINAL 75MM PREBENT CONVENTIONAL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242080","SUP","HCPCS C1713","","7242080  -  ROD SPNL PREBNT 80MM NS SPHERX II MAS PLIF","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242085","SUP","HCPCS C1713","","7242085  -  ROD SPNL PREBNT 85MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242095","SUP","HCPCS C1713","","7242095  -  ROD SPNL PREBNT 95MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7242110","SUP","HCPCS C1713","","7242110  -  ROD SPNL PREBNT 110MM SPHERX II","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7243045","SUP","HCPCS C1713","","7243045  -  TRANSCONNECTOR ROD PREBNT 45-50MM ADJ ARCH SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7243050","SUP","HCPCS C1713","","7243050  -  CONNECTOR ROD 50-60MM TRNSV SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7243060","SUP","HCPCS C1713","","7243060  -  TRANSCONNECTOR ROD 60-70MM ADJ ARCH VAR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7243070","SUP","HCPCS C1713","","7243070  -  CONNECTOR ROD 70-85MM VAR ADJ TRANSVRS","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245525","SUP","HCPCS C1713","","7245525  -  SCREW BN 5.5MM 25MM SPHERX DBR II PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245530","SUP","HCPCS C1713","","7245530  -  SCREW BN 5.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245535","SUP","HCPCS C1713","","7245535  -  SCREW BN 5.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245540","SUP","HCPCS C1713","","7245540  -  SCREW BN 5.5MM 40MM PA SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245545","SUP","HCPCS C1713","","7245545  -  SCREW BN 5.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245550","SUP","HCPCS C1713","","7245550  -  SCREW BN 5.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245555","SUP","HCPCS C1713","","7245555  -  SCREW BN 5.5MM 55MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7245560","SUP","HCPCS C1713","","7245560  -  SCREW BN 5.5MM 60MM SPHERX II PA SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246510","SUP","HCPCS C1713","","7246510  -  SCREW BN 6.5MM 100MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246525","SUP","HCPCS C1713","","7246525  -  SCREW BN 6.5MM 25MM SPHERX II PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246530","SUP","HCPCS C1713","","7246530  -  SCREW BN 6.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246535","SUP","HCPCS C1713","","7246535  -  SCREW BN 6.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246540","SUP","HCPCS C1713","","7246540  -  SCREW BN 6.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246545","SUP","HCPCS C1713","","7246545  -  SCREW BN 6.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246550","SUP","HCPCS C1713","","7246550  -  SCREW BN 6.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246555","SUP","HCPCS C1713","","7246555  -  SCREW BN 6.5MM 55MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246560","SUP","HCPCS C1713","","7246560  -  SCREW BN 6.5MM 60MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246565","SUP","HCPCS C1713","","7246565  -  SCREW BN 6.5MM 65MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246570","SUP","HCPCS C1713","","7246570  -  SCREW BN 6.5MM 70MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246575","SUP","HCPCS C1713","","7246575  -  SCREW BN 6.5MM 75MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246580","SUP","HCPCS C1713","","7246580  -  SCREW BN 6.5MM 80MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246585","SUP","HCPCS C1713","","7246585  -  SCREW BN 6.5MM 85MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246590","SUP","HCPCS C1713","","7246590  -  SCREW BN 6.5MM 90MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7246595","SUP","HCPCS C1713","","7246595  -  SCREW BN 6.5MM 95MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247510","SUP","HCPCS C1713","","7247510  -  SCREW BN 7.5MM 100MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247525","SUP","HCPCS C1713","","7247525  -  SCREW BN 7.5MM 25MM SPHERX II PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247530","SUP","HCPCS C1713","","7247530  -  SCREW BN 7.5MM 30MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247535","SUP","HCPCS C1713","","7247535  -  SCREW BN 7.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247540","SUP","HCPCS C1713","","7247540  -  SCREW BN 7.5MM 40MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247545","SUP","HCPCS C1713","","7247545  -  SCREW BN 7.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247550","SUP","HCPCS C1713","","7247550  -  SCREW BN 7.5MM 50MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247555","SUP","HCPCS C1713","","7247555  -  SCREW BN 7.5MM 55MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247560","SUP","HCPCS C1713","","7247560  -  SCREW BN 7.5MM 60MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247565","SUP","HCPCS C1713","","7247565  -  SCREW BN 7.5MM 65MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247570","SUP","HCPCS C1713","","7247570  -  SCREW BN 7.5MM 70MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247575","SUP","HCPCS C1713","","7247575  -  SCREW BN 7.5MM 75MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247580","SUP","HCPCS C1713","","7247580  -  SCREW BN 7.5MM 80MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247585","SUP","HCPCS C1713","","7247585  -  SCREW BN 7.5MM 85MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247590","SUP","HCPCS C1713","","7247590  -  SCREW BN 7.5MM 90MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7247595","SUP","HCPCS C1713","","7247595  -  SCREW BN 7.5MM 95MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248025","SUP","HCPCS C1713","","7248025  -  ROD SPNL 25MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248030","SUP","HCPCS C1713","","7248030  -  ROD SPNL 30MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248035","SUP","HCPCS C1713","","7248035  -  ROD SPNL 35MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248040","SUP","HCPCS C1713","","7248040  -  ROD SPNL 40MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248045","SUP","HCPCS C1713","","7248045  -  ROD SPNL 45MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248050","SUP","HCPCS C1713","","7248050  -  ROD SPNL 50MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248055","SUP","HCPCS C1713","","7248055  -  ROD SPNL 55MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248060","SUP","HCPCS C1713","","7248060  -  ROD SPNL 60MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248065","SUP","HCPCS C1713","","7248065  -  ROD SPNL 65MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248070","SUP","HCPCS C1713","","7248070  -  ROD SPNL 70MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248075","SUP","HCPCS C1713","","7248075  -  ROD SPNL 75MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248080","SUP","HCPCS C1713","","7248080  -  ROD SPNL 80MM SPHERX DBR II THOR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248085","SUP","HCPCS C1713","","7248085  -  ROD SPNL 85MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248090","SUP","HCPCS C1713","","7248090  -  ROD SPNL 90MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248095","SUP","HCPCS C1713","","7248095  -  ROD SPNL 95MM SPHERX II CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7248100","SUP","HCPCS C1713","","7248100  -  ROD SPNL 100MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248105","SUP","HCPCS C1713","","7248105  -  ROD SPNL 105MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248110","SUP","HCPCS C1713","","7248110  -  ROD SPNL 110MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248115","SUP","HCPCS C1713","","7248115  -  ROD SPNL 115MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248120","SUP","HCPCS C1713","","7248120  -  ROD SPNL 120MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248125","SUP","HCPCS C1713","","7248125  -  ROD SPNL 125MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248130","SUP","HCPCS C1713","","7248130  -  ROD SPNL 130MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248135","SUP","HCPCS C1713","","7248135  -  ROD SPNL 135MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248140","SUP","HCPCS C1713","","7248140  -  ROD SPNL 140MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248145","SUP","HCPCS C1713","","7248145  -  ROD SPNL 145MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248150","SUP","HCPCS C1713","","7248150  -  ROD SPNL 150MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248300","SUP","HCPCS C1713","","7248300  -  ROD SPNL 300MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248500","SUP","HCPCS C1713","","7248500  -  ROD SPNL 500MM SPHERX II CNV","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7248510","SUP","HCPCS C1713","","7248510  -  SCREW BN 8.5MM 100MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248525","SUP","HCPCS C1713","","7248525  -  SCREW BN 8.5MM 25MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248530","SUP","HCPCS C1713","","7248530  -  SCREW BN 8.5MM 30MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248535","SUP","HCPCS C1713","","7248535  -  SCREW BN 8.5MM 35MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248540","SUP","HCPCS C1713","","7248540  -  SCREW BN 8.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248545","SUP","HCPCS C1713","","7248545  -  SCREW BN 8.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248550","SUP","HCPCS C1713","","7248550  -  SCREW BN 8.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248555","SUP","HCPCS C1713","","7248555  -  SCREW BN 8.5MM 55MM PA SPNE PDCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248560","SUP","HCPCS C1713","","7248560  -  SCREW BN 8.5MM 60MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248565","SUP","HCPCS C1713","","7248565  -  SCREW BN 8.5MM 65MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248570","SUP","HCPCS C1713","","7248570  -  SCREW BN 8.5MM 70MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248575","SUP","HCPCS C1713","","7248575  -  SCREW BN 8.5MM 75MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248580","SUP","HCPCS C1713","","7248580  -  SCREW BN 8.5MM 80MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248585","SUP","HCPCS C1713","","7248585  -  SCREW BN 8.5MM 85MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248590","SUP","HCPCS C1713","","7248590  -  SCREW BN 8.5MM 90MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7248595","SUP","HCPCS C1713","","7248595  -  SCREW BN 8.5MM 95MM PA ILIUM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7249310","SUP","HCPCS C1713","","7249310  -  CONNECTOR ROD OFST 100MM SPNE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"7249335","SUP","HCPCS C1713","","7249335  -  CONNECTOR ROD OFST 35MM SPHERX II SPNE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"7249350","SUP","HCPCS C1713","","7249350  -  CONNECTOR ROD OFST 50MM SPNE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"7251526","SUP","HCPCS C1713","","7251526  -  STAPLE BN SM INFR ANT THOR SPNL","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$973.13 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$378.64 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$338.43 ","$0.00 ","$344.27 ","$0.00 "
"7251528","SUP","HCPCS C1713","","7251528  -  STAPLE BN MED INFR ANT THOR SPNL","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$973.13 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$378.64 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$338.43 ","$0.00 ","$344.27 ","$0.00 "
"7251530","SUP","HCPCS C1713","","7251530  -  STAPLE BN LG INFR ANT THOR SPNL","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$973.13 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$378.64 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$338.43 ","$0.00 ","$344.27 ","$0.00 "
"7251626","SUP","HCPCS C1713","","7251626  -  STAPLE BN SM SUP ANT THOR SPNL","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$973.13 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$378.64 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$338.43 ","$0.00 ","$344.27 ","$0.00 "
"7251628","SUP","HCPCS C1713","","7251628  -  STAPLE BN MED SUP ANT THOR SPNL","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$973.13 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$378.64 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$338.43 ","$0.00 ","$344.27 ","$0.00 "
"7251630","SUP","HCPCS C1713","","7251630  -  STAPLE BN LG SUP ANT THOR SPNL","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$973.13 ","$0.00 ","$450.72 ","$0.00 ","$0.00 ","$378.64 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$338.43 ","$0.00 ","$344.27 ","$0.00 "
"7253012","SUP","HCPCS C1713","","7253012  -  STAPLE BN SM 1 HL","BOTH IP/OP","$947.50 ","$701.15 ","$0.00 ","$947.50 ","$426.38 ","$0.00 ","$197.48 ","$0.00 ","$0.00 ","$165.90 ","$947.50 ","$0.00 ","$473.75 ","$750.42 ","$758.00 ","$0.00 ","$148.28 ","$0.00 ","$150.84 ","$0.00 "
"7253014","SUP","HCPCS C1713","","7253014  -  STAPLE BN MED 1 HL","BOTH IP/OP","$947.50 ","$701.15 ","$0.00 ","$947.50 ","$426.38 ","$0.00 ","$197.48 ","$0.00 ","$0.00 ","$165.90 ","$947.50 ","$0.00 ","$473.75 ","$750.42 ","$758.00 ","$0.00 ","$148.28 ","$0.00 ","$150.84 ","$0.00 "
"7253016","SUP","HCPCS C1713","","7253016  -  STAPLE BN LG 1 HL","BOTH IP/OP","$947.50 ","$701.15 ","$0.00 ","$947.50 ","$426.38 ","$0.00 ","$197.48 ","$0.00 ","$0.00 ","$165.90 ","$947.50 ","$0.00 ","$473.75 ","$750.42 ","$758.00 ","$0.00 ","$148.28 ","$0.00 ","$150.84 ","$0.00 "
"7253112","SUP","HCPCS C1713","","7253112  -  WASHER SPNL SM","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$174.38 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"7253114","SUP","HCPCS C1713","","7253114  -  WASHER SPNL MED","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$174.38 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"7253116","SUP","HCPCS C1713","","7253116  -  WASHER SPNL LG","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$174.38 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"7254022","SUP","HCPCS C1713","","7254022  -  CONNECTOR ROD 22MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7254525","SUP","HCPCS C1713","","7254525  -  SCREW BN 4.5MM 25MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7254530","SUP","HCPCS C1713","","7254530  -  SCREW BN 4.5MM 30MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7254535","SUP","HCPCS C1713","","7254535  -  SCREW BN 4.5MM 35MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7254540","SUP","HCPCS C1713","","7254540  -  SCREW BN 4.5MM 40MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7254545","SUP","HCPCS C1713","","7254545  -  SCREW BN 4.5MM 45MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7254550","SUP","HCPCS C1713","","7254550  -  SCREW BN 4.5MM 50MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255525","SUP","HCPCS C1713","","7255525  -  SCREW BN 5.5MM 25MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255530","SUP","HCPCS C1713","","7255530  -  SCREW BN 5.5MM 30MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255535","SUP","HCPCS C1713","","7255535  -  SCREW BN 5.5MM 35MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255540","SUP","HCPCS C1713","","7255540  -  SCREW BN 5.5MM 40MM SPHERX DBR II FX ANG TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255545","SUP","HCPCS C1713","","7255545  -  SCREW BN 5.5MM 45MM SPHERX DBR II FX ANG TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255550","SUP","HCPCS C1713","","7255550  -  SCREW BN 5.5MM 50MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255555","SUP","HCPCS C1713","","7255555  -  SCREW BN 5.5MM 55MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7255560","SUP","HCPCS C1713","","7255560  -  SCREW BN 5.5MM 60MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256012","SUP","HCPCS C1713","","7256012  -  CONNECTOR ROD 12MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256013","SUP","HCPCS C1713","","7256013  -  CONNECTOR ROD 13MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256014","SUP","HCPCS C1713","","7256014  -  CONNECTOR ROD 14MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256015","SUP","HCPCS C1713","","7256015  -  CONNECTOR ROD 15MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256016","SUP","HCPCS C1713","","7256016  -  CONNECTOR ROD 16MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256017","SUP","HCPCS C1713","","7256017  -  CONNECTOR ROD 17MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256018","SUP","HCPCS C1713","","7256018  -  CONNECTOR ROD 18MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256019","SUP","HCPCS C1713","","7256019  -  CONNECTOR ROD 19MM TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256020","SUP","HCPCS C1713","","7256020  -  CONNECTOR ROD 20MM TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256021","SUP","HCPCS C1713","","7256021  -  CONNECTOR ROD 21MM SPHERX II FX SPNE ANT","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256530","SUP","HCPCS C1713","","7256530  -  SCREW BN 6.5MM 30MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256535","SUP","HCPCS C1713","","7256535  -  SCREW BN 6.5MM 35MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256540","SUP","HCPCS C1713","","7256540  -  SCREW BN 6.5MM 40MM SPHERX DBR II FX ANG TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256545","SUP","HCPCS C1713","","7256545  -  SCREW BN 6.5MM 45MM SPHERX II FX","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256550","SUP","HCPCS C1713","","7256550  -  SCREW BN 6.5MM 50MM SPHERX DBR II FX ANG TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256555","SUP","HCPCS C1713","","7256555  -  SCREW BN 6.5MM 55MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7256560","SUP","HCPCS C1713","","7256560  -  SCREW BN 6.5MM 60MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257530","SUP","HCPCS C1713","","7257530  -  SCREW BN 7.5MM 30MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257535","SUP","HCPCS C1713","","7257535  -  SCREW BN 7.5MM 35MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257540","SUP","HCPCS C1713","","7257540  -  SCREW BN 7.5IN 40MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257545","SUP","HCPCS C1713","","7257545  -  SCREW BN 7.5MM 45MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257550","SUP","HCPCS C1713","","7257550  -  SCREW BN 7.5MM 50MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257555","SUP","HCPCS C1713","","7257555  -  SCREW BN 7.5MM 55MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7257560","SUP","HCPCS C1713","","7257560  -  SCREW BN 7.5MM 60MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258530","SUP","HCPCS C1713","","7258530  -  SCREW BN 8.5MM 30MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258535","SUP","HCPCS C1713","","7258535  -  SCREW BN 8.5MM 35MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258540","SUP","HCPCS C1713","","7258540  -  SCREW BN 8.5MM 40MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258545","SUP","HCPCS C1713","","7258545  -  SCREW BN 8.5MM 45MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258550","SUP","HCPCS C1713","","7258550  -  SCREW BN 8.5MM 50MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258555","SUP","HCPCS C1713","","7258555  -  SCREW BN 8.5MM 55MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7258560","SUP","HCPCS C1713","","7258560  -  SCREW BN 8.5MM 60MM SPHERX II FA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7262600","SUP","Custom 27803010","","7262600  -  ENDCAP SPNL 26MM RND 0 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7262604","SUP","Custom 27803010","","7262604  -  ENDCAP SPNL 26MM RND 4 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7262608","SUP","Custom 27803010","","7262608  -  ENDCAP SPNL 26MM RND 8 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7262612","SUP","Custom 27803010","","7262612  -  ENDCAP SPNL 26MM RND 12 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7265535","SUP","HCPCS C1713","","7265535  -  SCREW BN 5.5MM 35MM RDC PA SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7265540","SUP","HCPCS C1713","","7265540  -  SCREW BN 5.5MM 40MM PA RDC SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7265545","SUP","HCPCS C1713","","7265545  -  SCREW BN 5.5MM 45MM PA RDC SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7265550","SUP","HCPCS C1713","","7265550  -  SCREW BN 5.5MM 50MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7265555","SUP","HCPCS C1713","","7265555  -  SCREW BN 5.5MM 55MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7266535","SUP","HCPCS C1713","","7266535  -  SCREW BN 6.5MM 35MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7266540","SUP","HCPCS C1713","","7266540  -  SCREW BN 6.5MM 40MM SPHERX RDC SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7266545","SUP","HCPCS C1713","","7266545  -  SCREW BN 6.5MM 45MM SPHERX II RDC PA SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7266550","SUP","HCPCS C1713","","7266550  -  SCREW BN 6.5MM 50MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7266555","SUP","HCPCS C1713","","7266555  -  SCREW BN 6.5MM 55MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7267535","SUP","HCPCS C1713","","7267535  -  SCREW BN 7.5MM 35MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7267540","SUP","HCPCS C1713","","7267540  -  SCREW BN 7.5MM 40MM RDC PA SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7267545","SUP","HCPCS C1713","","7267545  -  SCREW BN 7.5MM 45MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7267550","SUP","HCPCS C1713","","7267550  -  SCREW BN 7.5MM 50MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7267555","SUP","HCPCS C1713","","7267555  -  SCREW BN 7.5MM 55MM SPHERX PA SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7270100","SUP","HCPCS C1713","","7270100  -  WIRE FX KRSH BVL TIP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"7270200","SUP","HCPCS C1713","","7270200  -  WIRE FX KRSH THRD","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"7270300","SUP","HCPCS C1713","","7270300  -  WIRE FX XLNG KRSH THRD TIP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"7270411","SUP","HCPCS C1713","","7270411  -  SPACER SPNL 11MM 11X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270441","SUP","HCPCS C1713","","7270441  -  SPACER SPNL 11MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270444","SUP","HCPCS C1713","","7270444  -  SPACER SPNL 14MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270511","SUP","HCPCS C1713","","7270511  -  SPACER SPNL 11MM 11X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270541","SUP","HCPCS C1713","","7270541  -  SPACER SPNL 11MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270544","SUP","HCPCS C1713","","7270544  -  SPACER SPNL 14MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270611","SUP","HCPCS C1713","","7270611  -  SPACER SPNL 11MM 11X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270641","SUP","HCPCS C1713","","7270641  -  SPACER SPNL 11MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270644","SUP","HCPCS C1713","","7270644  -  SPACER SPNL 14MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270711","SUP","HCPCS C1713","","7270711  -  SPACER SPNL 11MM 11X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270741","SUP","HCPCS C1713","","7270741  -  SPACER SPNL 11MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270744","SUP","HCPCS C1713","","7270744  -  SPACER SPNL 14MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270811","SUP","HCPCS C1713","","7270811  -  SPACER SPNL 11MM 11X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270841","SUP","HCPCS C1713","","7270841  -  SPACER SPNL 11MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270844","SUP","HCPCS C1713","","7270844  -  SPACER SPNL 14MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270911","SUP","HCPCS C1713","","7270911  -  SPACER SPNL 11MM 11X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270941","SUP","HCPCS C1713","","7270941  -  SPACER SPNL 11MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7270944","SUP","HCPCS C1713","","7270944  -  SPACER SPNL 14MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271011","SUP","HCPCS C1713","","7271011  -  SPACER SPNL 11MM 11X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271041","SUP","HCPCS C1713","","7271041  -  SPACER SPNL 11MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271044","SUP","HCPCS C1713","","7271044  -  SPACER SPNL 14MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271111","SUP","HCPCS C1713","","7271111  -  SPACER SPNL 11MM 11X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271141","SUP","HCPCS C1713","","7271141  -  SPACER SPNL 11MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271144","SUP","HCPCS C1713","","7271144  -  SPACER SPNL 14MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271211","SUP","HCPCS C1713","","7271211  -  SPACER SPNL 11MM 11X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271241","SUP","HCPCS C1713","","7271241  -  SPACER SPNL 11MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271244","SUP","HCPCS C1713","","7271244  -  SPACER SPNL 14MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271311","SUP","HCPCS C1713","","7271311  -  SPACER SPNL 11MM 11X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271341","SUP","HCPCS C1713","","7271341  -  SPACER SPNL 11MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7271344","SUP","HCPCS C1713","","7271344  -  SPACER SPNL 14MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7284525","SUP","HCPCS C1713","","7284525  -  SCREW BN 4.5MM 25MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7284530","SUP","HCPCS C1713","","7284530  -  SCREW BN 4.5MM 30MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7284535","SUP","HCPCS C1713","","7284535  -  SCREW BN 4.5MM 35MM PA SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7284540","SUP","HCPCS C1713","","7284540  -  SCREW BN 4.5MM 40MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7284545","SUP","HCPCS C1713","","7284545  -  SCREW BN 4.5MM 45MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7284550","SUP","HCPCS C1713","","7284550  -  SCREW BN 4.5MM 50MM SPHERX II PA TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7291025","SUP","HCPCS C1713","","7291025  -  ROD SPNL 5.5MM 25MM SPHERX II TI","BOTH IP/OP","$782.50 ","$579.05 ","$0.00 ","$782.50 ","$352.13 ","$0.00 ","$163.09 ","$0.00 ","$0.00 ","$137.01 ","$782.50 ","$0.00 ","$391.25 ","$619.74 ","$626.00 ","$0.00 ","$122.46 ","$0.00 ","$124.57 ","$0.00 "
"7291030","SUP","HCPCS C1713","","7291030  -  ROD SPNL 5.5MM 30MM SPHERX II TI","BOTH IP/OP","$782.50 ","$579.05 ","$0.00 ","$782.50 ","$352.13 ","$0.00 ","$163.09 ","$0.00 ","$0.00 ","$137.01 ","$782.50 ","$0.00 ","$391.25 ","$619.74 ","$626.00 ","$0.00 ","$122.46 ","$0.00 ","$124.57 ","$0.00 "
"7291035","SUP","HCPCS C1713","","7291035  -  ROD SPNL 5.5MM 35MM 1 BALL","BOTH IP/OP","$782.50 ","$579.05 ","$0.00 ","$782.50 ","$352.13 ","$0.00 ","$163.09 ","$0.00 ","$0.00 ","$137.01 ","$782.50 ","$0.00 ","$391.25 ","$619.74 ","$626.00 ","$0.00 ","$122.46 ","$0.00 ","$124.57 ","$0.00 "
"7291040","SUP","HCPCS C1713","","7291040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX II 1 BALL","BOTH IP/OP","$782.50 ","$579.05 ","$0.00 ","$782.50 ","$352.13 ","$0.00 ","$163.09 ","$0.00 ","$0.00 ","$137.01 ","$782.50 ","$0.00 ","$391.25 ","$619.74 ","$626.00 ","$0.00 ","$122.46 ","$0.00 ","$124.57 ","$0.00 "
"7291045","SUP","HCPCS C1713","","7291045  -  ROD SPNL 5.5MM 45MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291050","SUP","HCPCS C1713","","7291050  -  ROD SPNL 5.5MM 50MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291055","SUP","HCPCS C1713","","7291055  -  ROD SPNL 5.5MM 55MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291060","SUP","HCPCS C1713","","7291060  -  ROD SPNL 5.5MM 60MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291065","SUP","HCPCS C1713","","7291065  -  ROD SPNL 5.5MM 65MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291070","SUP","HCPCS C1713","","7291070  -  ROD SPNL 5.5MM 70MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291075","SUP","HCPCS C1713","","7291075  -  ROD SPNL 5.5MM 75MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291080","SUP","HCPCS C1713","","7291080  -  ROD SPNL 5.5MM 80MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291085","SUP","HCPCS C1713","","7291085  -  ROD SPNL 5.5MM 85MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291090","SUP","HCPCS C1713","","7291090  -  ROD SPNL 5.5MM 90MM SPHERX II TI","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$387.00 ","$0.00 ","$179.25 ","$0.00 ","$0.00 ","$150.58 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$134.59 ","$0.00 ","$136.91 ","$0.00 "
"7291095","SUP","HCPCS C1713","","7291095  -  ROD SPNL 5.5MM 95MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291100","SUP","HCPCS C1713","","7291100  -  ROD SPNL 5.5MM 100MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291110","SUP","HCPCS C1713","","7291110  -  ROD SPNL 5.5MM 110MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291120","SUP","HCPCS C1713","","7291120  -  ROD SPNL PREBNT 5.5MM 120MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291130","SUP","HCPCS C1713","","7291130  -  ROD SPNL 5.5MM 400MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291140","SUP","HCPCS C1713","","7291140  -  ROD SPNL PREBNT 5.5MM 140MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291150","SUP","HCPCS C1713","","7291150  -  ROD SPNL 150MM MAS PLIF","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291160","SUP","HCPCS C1713","","7291160  -  ROD SPNL PREBNT 5.5MM 160MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291180","SUP","HCPCS C1713","","7291180  -  ROD SPNL PREBNT 5.5MM 180MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291200","SUP","HCPCS C1713","","7291200  -  ROD SPNL PREBNT 5.5MM 200MM SPHERX II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291300","SUP","HCPCS C1713","","7291300  -  ROD SPNL PREBNT 5.5MM 300MM SPHERX DBR II TI","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$191.23 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"7291500","SUP","HCPCS C1713","","7291500  -  ROD SPNL PREBNT 5.5MM 500MM SPHERX II TI","BOTH IP/OP","$1,052.50 ","$778.85 ","$0.00 ","$1,052.50 ","$473.63 ","$0.00 ","$219.37 ","$0.00 ","$0.00 ","$184.28 ","$1,052.50 ","$0.00 ","$526.25 ","$833.58 ","$842.00 ","$0.00 ","$164.72 ","$0.00 ","$167.56 ","$0.00 "
"7292025","SUP","HCPCS C1713","","7292025  -  ROD SPNL PREBNT 5.5MM 25MM SPHERX II TI","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292030","SUP","HCPCS C1713","","7292030  -  ROD SPNL PREBNT 5.5MM 30MM SPHERX II","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292040","SUP","HCPCS C1713","","7292040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX II TI","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292050","SUP","HCPCS C1713","","7292050  -  ROD SPNL PREBNT 5.5MM 50MM SPHERX II TI","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292060","SUP","HCPCS C1713","","7292060  -  ROD SPNL PREBNT 5.5MM 60MM SPHERX II TI","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292065","SUP","HCPCS C1713","","7292065  -  ROD SPNL PREBNT 5.5MM 65MM SPHERX II TI","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292070","SUP","HCPCS C1713","","7292070  -  ROD SPNL PREBNT 5.5MM 70MM SPHERX II","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292080","SUP","HCPCS C1713","","7292080  -  ROD SPNL PREBNT 5.5MM 80MM","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292085","SUP","HCPCS C1713","","7292085  -  ROD SPNL PREBNT 5.5MM 85MM","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292090","SUP","HCPCS C1713","","7292090  -  ROD SPNL PREBNT 5.5MM 90MM","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292095","SUP","HCPCS C1713","","7292095  -  ROD SPNL PREBNT 5.5MM 95MM","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292100","SUP","HCPCS C1713","","7292100  -  ROD SPNL PREBNT 5.5MM 100MM SPHERX II TI","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7292120","SUP","HCPCS C1713","","7292120  -  ROD SPNL PREBNT 120MM SPHERX","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"7303000","SUP","Custom 27803010","","7303000  -  ENDCAP SPNL 30MM RND 0 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7303004","SUP","Custom 27803010","","7303004  -  ENDCAP SPNL 30MM RND 4 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7303008","SUP","Custom 27803010","","7303008  -  ENDCAP SPNL 30MM RND 8 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7303012","SUP","Custom 27803010","","7303012  -  ENDCAP SPNL 30MM RND 12 DEG OD 22 XCORE 2 TI","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7340000","SUP","HCPCS C1713","","7340000  -  SET SCREW 7340000 BREAKOFF M6XI BUTTRESS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7340300","SUP","HCPCS C1713","","7340300  -  ROD 7340300 3.5MM TI  300MM LENGTH","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7340500","SUP","HCPCS C1713","","7340500  -  ROD 7340500 3.5MM TI  500MM LENGTH","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7341101","SUP","HCPCS C1713","","7341101  -  HOOK 7341101 PEDICLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7341111","SUP","HCPCS C1713","","7341111  -  HOOK 7341111 SMALL LAMINIAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7341112","SUP","HCPCS C1713","","7341112  -  HOOK 7341112 MEDIUM LAMINIAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7341113","SUP","HCPCS C1713","","7341113  -  HOOK 7341113 LARGE LAMINIAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7341142","SUP","HCPCS C1713","","7341142  -  HOOK 7341142 RAMPED NARROW BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7341171","SUP","HCPCS C1713","","7341171  -  HOOK 7341171 EXTENDED BODY","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7342410","SUP","HCPCS C1713","","7342410  -  SCREW 7342410 FAS 4.0 X 10MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7342415","SUP","HCPCS C1713","","7342415  -  SCREW 7342415 FAS 4.0 X 15MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7342420","SUP","HCPCS C1713","","7342420  -  SCREW 7342420 FAS 4.0 X 20MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7342425","SUP","HCPCS C1713","","7342425  -  SCREW 7342425 FAS 4.0 X 25MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7342430","SUP","HCPCS C1713","","7342430  -  SCREW 7342430 FAS 4.0 X 30MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7342435","SUP","HCPCS C1713","","7342435  -  FAS 4.0 X 35MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7342440","SUP","HCPCS C1713","","7342440  -  FAS 4.0 X 40MM FOR 3.5 ROD","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343310","SUP","HCPCS C1713","","7343310  -  SCREW 7343310 3.5 X 10","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343315","SUP","HCPCS C1713","","7343315  -  SCREW 7343315 3.5 X 15","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343320","SUP","HCPCS C1713","","7343320  -  SCREW 7343320 3.5 X 20","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343325","SUP","HCPCS C1713","","7343325  -  SCREW 7343325 3.5 X 25","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343330","SUP","HCPCS C1713","","7343330  -  SCREW 7343330 3.5 X 30","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343415","SUP","HCPCS C1713","","7343415  -  SCREW 7343415 4.5 X 15","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343420","SUP","HCPCS C1713","","7343420  -  SCREW 7343420 4.5 X 20","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343425","SUP","HCPCS C1713","","7343425  -  SCREW 7343425 4.5 X 25","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343430","SUP","HCPCS C1713","","7343430  -  SCREW 7343430 4.5 X 30","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343435","SUP","HCPCS C1713","","7343435  -  SCREW 7343435 4.5 X 35","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343440","SUP","HCPCS C1713","","7343440  -  SCREW 7343440 4.5 X 40","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343520","SUP","HCPCS C1713","","7343520  -  SCREW 7343520 5.5 X 20","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343525","SUP","HCPCS C1713","","7343525  -  SCREW 7343525 5.5 X 25","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343530","SUP","HCPCS C1713","","7343530  -  SCREW 7343530 5.5 X 30","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343535","SUP","HCPCS C1713","","7343535  -  SCREW 7343535 5.5 X 35","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343540","SUP","HCPCS C1713","","7343540  -  SCREW 7343540 5.5 X 40","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7343545","SUP","HCPCS C1713","","7343545  -  SCREW 7343545 5.5 X 45","BOTH IP/OP","$1,959.00 ","$1,449.66 ","$0.00 ","$1,959.00 ","$881.55 ","$0.00 ","$408.30 ","$0.00 ","$0.00 ","$343.01 ","$1,959.00 ","$0.00 ","$979.50 ","$1,551.53 ","$1,567.20 ","$0.00 ","$306.58 ","$0.00 ","$311.87 ","$0.00 "
"7360000","SUP","HCPCS C1713","","7360000  -  SET SCREW 7360000 BRK OFF M6 BUTR PLG SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7360300","SUP","HCPCS C1713","","7360300  -  ROD 7360300 ROD 3.5MM DIA SS L 300","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7360500","SUP","HCPCS C1713","","7360500  -  ROD 7360500 ROD 3.5MM DIA SS L 500","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7361101","SUP","HCPCS C1713","","7361101  -  HOOK 7361101 PEDICLE HOOK 3.5MM DIA SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7361111","SUP","HCPCS C1713","","7361111  -  HOOK 7361111 S LAMINAR HOOK 3.5MM DIA SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7361112","SUP","HCPCS C1713","","7361112  -  HOOK 7361112 M LAMINAR HOOK 3.5MM DIA SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7361113","SUP","HCPCS C1713","","7361113  -  HOOK 7361113 L LAMINAR HOOK 3.5MM DIA SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7361142","SUP","HCPCS C1713","","7361142  -  HOOK 7361142 RMP NAR BLD HK 3.5MM DIA SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7361171","SUP","HCPCS C1713","","7361171  -  HOOK 7361171 EXTD BODY HOOK 3.5MM DIA SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7362410","SUP","HCPCS C1713","","7362410  -  FAS 4.0 X 10MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7362415","SUP","HCPCS C1713","","7362415  -  FAS 4.0 X 15MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7362420","SUP","HCPCS C1713","","7362420  -  FAS 4.0 X 20MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7362425","SUP","HCPCS C1713","","7362425  -  FAS 4.0 X 25MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7362430","SUP","HCPCS C1713","","7362430  -  FAS 4.0 X 30MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7362435","SUP","HCPCS C1713","","7362435  -  FAS 4.0 X 35MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7362440","SUP","HCPCS C1713","","7362440  -  FAS 4.0 X 40MM FOR 3.5 ROD, SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363310","SUP","HCPCS C1713","","7363310  -  BONE SCREW 7363310 FAS 3.5 X 10 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363315","SUP","HCPCS C1713","","7363315  -  BONE SCREW 7363315 FAS 3.5 X 15 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363320","SUP","HCPCS C1713","","7363320  -  BONE SCREW 7363320 FAS 3.5 X 20 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363325","SUP","HCPCS C1713","","7363325  -  BONE SCREW 7363325 FAS 3.5 X 25 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363330","SUP","HCPCS C1713","","7363330  -  BONE SCREW 7363330 FAS 3.5 X 30 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363415","SUP","HCPCS C1713","","7363415  -  BONE SCREW 7363415 FAS 4.5 X 15 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363420","SUP","HCPCS C1713","","7363420  -  BONE SCREW 7363420 FAS 4.5 X 20 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363425","SUP","HCPCS C1713","","7363425  -  BONE SCREW 7363425 FAS 4.5 X 25 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363430","SUP","HCPCS C1713","","7363430  -  BONE SCREW 7363430 FAS 4.5 X 30 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363435","SUP","HCPCS C1713","","7363435  -  BONE SCREW 7363435 FAS 4.5 X 35 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363440","SUP","HCPCS C1713","","7363440  -  BONE SCREW 7363440 FAS 4.5 X 40 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363520","SUP","HCPCS C1713","","7363520  -  BONE SCREW 7363520 FAS 5.5 X 20 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363525","SUP","HCPCS C1713","","7363525  -  BONE SCREW 7363525 FAS 5.5 X 25 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363530","SUP","HCPCS C1713","","7363530  -  BONE SCREW 7363530 FAS 5.5 X 30 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363535","SUP","HCPCS C1713","","7363535  -  BONE SCREW 7363535 FAS 5.5 X 35 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363540","SUP","HCPCS C1713","","7363540  -  BONE SCREW 7363540 FAS 5.5 X 40 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7363545","SUP","HCPCS C1713","","7363545  -  BONE SCREW 7363545 FAS 5.5 X 45 SS","BOTH IP/OP","$1,825.50 ","$1,350.87 ","$0.00 ","$1,825.50 ","$821.48 ","$0.00 ","$380.48 ","$0.00 ","$0.00 ","$319.63 ","$1,825.50 ","$0.00 ","$912.75 ","$1,445.80 ","$1,460.40 ","$0.00 ","$285.69 ","$0.00 ","$290.62 ","$0.00 "
"7370100","SUP","HCPCS C1713","","7370100  -  SCREW BONE .5MM 10MM SPHERX DBR 2 TI SPNL LCK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7375530","SUP","HCPCS C1713","","7375530  -  SCREW BN 5.5MM 30MM SPHERX II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7375535","SUP","HCPCS C1713","","7375535  -  SCREW BN 5.5MM 35MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7375540","SUP","HCPCS C1713","","7375540  -  SCREW BN 5.5MM 40MM PA CNN CANC SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7375545","SUP","HCPCS C1713","","7375545  -  SCREW BN 5.5MM 45MM PA CNN CANC SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7375550","SUP","HCPCS C1713","","7375550  -  SCREW BN 5.5MM 50MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7375555","SUP","HCPCS C1713","","7375555  -  SCREW BN 5.5MM 55MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7376530","SUP","HCPCS C1713","","7376530  -  SCREW BN 6.5MM 30MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7376535","SUP","HCPCS C1713","","7376535  -  SCREW BN 6.5MM 35MM PA CANC SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7376540","SUP","HCPCS C1713","","7376540  -  SCREW BN 6.5MM 40MM SPHERX DBR II PA CNN TI SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7376550","SUP","HCPCS C1713","","7376550  -  SCREW BN 6.5MM 50MM SPHERX DBR II PA CNN TI SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7376555","SUP","HCPCS C1713","","7376555  -  SCREW BN 6.5MM 55MM SPHERX DBR II PA CNN TI SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7377530","SUP","HCPCS C1713","","7377530  -  SCREW BN 7.5MM 30MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7377535","SUP","HCPCS C1713","","7377535  -  SCREW BN 7.5MM 35MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7377540","SUP","HCPCS C1713","","7377540  -  SCREW BN 7.5MM 40MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7377545","SUP","HCPCS C1713","","7377545  -  SCREW BN 7.5MM 45MM SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7377550","SUP","HCPCS C1713","","7377550  -  SCREW BN 7.5MM 50MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7377555","SUP","HCPCS C1713","","7377555  -  SCREW BN 7.5MM 55MM SPHERX DBR II PA CNN SPNE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"7401151","SUP","Custom 27203010","","KIT CYTOBLOCK REPL REAGENT TISS FRAG CELL PREP CYTO","BOTH IP/OP","$65.18 ","$48.23 ","$0.00 ","$65.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.18 ","$0.00 ","$32.59 ","$51.62 ","$52.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7440020","SUP","HCPCS C1713","","7440020  -  SET SCREW 7440020 BREAKOFF TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7440030","SUP","HCPCS C1713","","7440030  -  SET SCREW 7440030 L 4.5 G4 TI BRK OFF","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7440100","SUP","HCPCS C1713","","7440100  -  SET SCREW, NON BREAK-OFF, TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7440120","SUP","HCPCS C1713","","7440120  -  SET SCREW, NON BREAK-OFF, TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7440122","SUP","HCPCS C1713","","7440122  -  PLATE BN 22MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440124","SUP","HCPCS C1713","","7440124  -  PLATE BN 24MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440126","SUP","HCPCS C1713","","7440126  -  PLATE BN 26MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440128","SUP","HCPCS C1713","","7440128  -  PLATE BN 28MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440130","SUP","HCPCS C1713","","7440130  -  PLATE BN 30MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440132","SUP","HCPCS C1713","","7440132  -  PLATE BN 32MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440134","SUP","HCPCS C1713","","7440134  -  PLATE BN 34MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440136","SUP","HCPCS C1713","","7440136  -  PLATE BN 36MM NS GRDNT + 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440236","SUP","HCPCS C1713","","7440236  -  PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440238","SUP","HCPCS C1713","","7440238  -  PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440240","SUP","HCPCS C1713","","7440240  -  PLATE BN 40MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440242","SUP","HCPCS C1713","","7440242  -  PLATE BN 42MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440244","SUP","HCPCS C1713","","7440244  -  PLATE BN 44MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440246","SUP","HCPCS C1713","","7440246  -  PLATE BN 46MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440248","SUP","HCPCS C1713","","7440248  -  PLATE BN 48MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440250","SUP","HCPCS C1713","","7440250  -  PLATE BN 50MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440252","SUP","HCPCS C1713","","7440252  -  PLATE BN 52MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440254","SUP","HCPCS C1713","","7440254  -  PLATE BN 54MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440354","SUP","HCPCS C1713","","7440354  -  PLATE BN 54MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440356","SUP","HCPCS C1713","","7440356  -  PLATE BN 56MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440358","SUP","HCPCS C1713","","7440358  -  PLATE BN 58MM NS GRDNT + 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440360","SUP","HCPCS C1713","","7440360  -  PLATE BN 60MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440362","SUP","HCPCS C1713","","7440362  -  PLATE BN 62MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440364","SUP","HCPCS C1713","","7440364  -  PLATE BN 64MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440366","SUP","HCPCS C1713","","7440366  -  PLATE BN 66MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440368","SUP","HCPCS C1713","","7440368  -  PLATE BN 68MM NS GRDNT + 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440468","SUP","HCPCS C1713","","7440468  -  PLATE BN 68MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440470","SUP","HCPCS C1713","","7440470  -  PLATE BN 70MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440474","SUP","HCPCS C1713","","7440474  -  PLATE BN 74MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440478","SUP","HCPCS C1713","","7440478  -  PLATE BN 78MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440482","SUP","HCPCS C1713","","7440482  -  PLATE BN 82MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440486","SUP","HCPCS C1713","","7440486  -  PLATE BN 86MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440490","SUP","HCPCS C1713","","7440490  -  PLATE BN 90MM NS GRDNT + 4 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7440500","SUP","HCPCS C1713","","7440500  -  PLATE BN RND HL CVR TI SPNE CRV ANT","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$169.88 ","$0.00 ","$78.68 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"7440918","SUP","Custom 27203010","","7440918  -  BIT DRL MN 10MM HLX ACP SPNE","BOTH IP/OP","$570.00 ","$421.80 ","$0.00 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$570.00 ","$0.00 ","$285.00 ","$451.44 ","$456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7441102","SUP","HCPCS C1713","","7441102  -  HOOK 7441102 PEDICLE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441112","SUP","HCPCS C1713","","7441112  -  HOOK 7441112 WIDE BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441113","SUP","HCPCS C1713","","7441113  -  HOOK 7441113 WIDE BLADE MED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441114","SUP","HCPCS C1713","","7441114  -  HOOK 7441114 WIDE BLADE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441122","SUP","HCPCS C1713","","7441122  -  HOOK 7441122 NARROW BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441142","SUP","HCPCS C1713","","7441142  -  HOOK 7441142 RAMPED THORACIC TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441162","SUP","HCPCS C1713","","7441162  -  HOOK 7441162 LUMBAR ANGLED BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441172","SUP","HCPCS C1713","","7441172  -  HOOK 7441172 EXTENDED BODY TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441198","SUP","HCPCS C1713","","7441198  -  HOOK 7441198 OFFSET RT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7441199","SUP","HCPCS C1713","","7441199  -  HOOK 7441199 OFFSET LT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7442420","SUP","HCPCS C1713","","7442420  -  BONE SCREW 7442420 FXD ANGLE 4.0X20 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442425","SUP","HCPCS C1713","","7442425  -  BONE SCREW 7442425 FXD ANGLE 4.0X25 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442430","SUP","HCPCS C1713","","7442430  -  BONE SCREW 7442430 FXD ANGLE 4.0X30 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442435","SUP","HCPCS C1713","","7442435  -  BONE SCREW 7442435 FXD ANGLE 4.0X35 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442440","SUP","HCPCS C1713","","7442440  -  BONE SCREW 7442440 FXD ANGLE 4.0X40 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442525","SUP","HCPCS C1713","","7442525  -  BONE SCREW 7442525 FXD ANGLE 5.0X25 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442528","SUP","HCPCS C1713","","7442528  -  SCREW, FIXED ANGLE,5.0X27.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442530","SUP","HCPCS C1713","","7442530  -  BONE SCREW 7442530 FXD ANGLE 5.0X30 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442533","SUP","HCPCS C1713","","7442533  -  SCREW, FIXED ANGLE,5.0X32.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442535","SUP","HCPCS C1713","","7442535  -  BONE SCREW 7442535 FXD ANGLE 5.0X35 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442538","SUP","HCPCS C1713","","7442538  -  SCREW, FIXED ANGLE,5.0X37.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442540","SUP","HCPCS C1713","","7442540  -  BONE SCREW 7442540 FXD ANGLE 5.0X40 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442545","SUP","HCPCS C1713","","7442545  -  BONE SCREW 7442545 FXD ANGLE 5.0X45 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442550","SUP","HCPCS C1713","","7442550  -  BONE SCREW 7442550 FXD ANGLE 5.0X50 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442625","SUP","HCPCS C1713","","7442625  -  BONE SCREW 7442625 FXD ANGLE6.0X25TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442628","SUP","HCPCS C1713","","7442628  -  SCREW, FIXED ANGLE,6.0X27.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442630","SUP","HCPCS C1713","","7442630  -  BONE SCREW 7442630 FXD ANGLE6.0X30TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442633","SUP","HCPCS C1713","","7442633  -  SCREW, FIXED ANGLE,6.0X32.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442635","SUP","HCPCS C1713","","7442635  -  BONE SCREW 7442635 FXD ANGLE6.0X35TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442638","SUP","HCPCS C1713","","7442638  -  SCREW, FIXED ANGLE,6.0X37.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442640","SUP","HCPCS C1713","","7442640  -  BONE SCREW 7442640 FXD ANGLE6.0X40TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442645","SUP","HCPCS C1713","","7442645  -  BONE SCREW 7442645 FXD ANGLE6.0X45TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7442650","SUP","HCPCS C1713","","7442650  -  BONE SCREW 7442650 FXD ANGLE6.0X50TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443425","SUP","HCPCS C1713","","7443425  -  BONE SCREW 7443425 FXD ANGLE 4.5X25 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443428","SUP","HCPCS C1713","","7443428  -  SCREW, FIXED ANGLE,4.5X27.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443430","SUP","HCPCS C1713","","7443430  -  BONE SCREW 7443430 FXD ANGLE 4.5X30 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443433","SUP","HCPCS C1713","","7443433  -  SCREW, FIXED ANGLE,4.5X32.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443435","SUP","HCPCS C1713","","7443435  -  BONE SCREW 7443435 FXD ANGLE 4.5X35 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443438","SUP","HCPCS C1713","","7443438  -  SCREW, FIXED ANGLE,4.5X37.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443440","SUP","HCPCS C1713","","7443440  -  BONE SCREW 7443440 FXD ANGLE 4.5X40 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443445","SUP","HCPCS C1713","","7443445  -  SCREW, FIXED ANGLE, 4.5X45, TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443450","SUP","HCPCS C1713","","7443450  -  SCREW, FIXED ANGLE, 4.5X50, TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443525","SUP","HCPCS C1713","","7443525  -  BONE SCREW 7443525 FXD ANGLE 5.5X25 TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443528","SUP","HCPCS C1713","","7443528  -  SCREW, FIXED ANGLE,5.5X27.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443530","SUP","HCPCS C1713","","7443530  -  BONE SCREW 7443530 FXD ANGLE5.5X30TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443533","SUP","HCPCS C1713","","7443533  -  SCREW, FIXED ANGLE,5.5X32.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443535","SUP","HCPCS C1713","","7443535  -  BONE SCREW 7443535 FXD ANGLE5.5X35TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443538","SUP","HCPCS C1713","","7443538  -  SCREW, FIXED ANGLE,5.5X37.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443540","SUP","HCPCS C1713","","7443540  -  BONE SCREW 7443540 FXD ANGLE5.5X40TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443545","SUP","HCPCS C1713","","7443545  -  BONE SCREW 7443545 FXD ANGLE5.5X45TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443550","SUP","HCPCS C1713","","7443550  -  BONE SCREW 7443550 FXD ANGLE5.5X50TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443625","SUP","HCPCS C1713","","7443625  -  BONE SCREW 7443625 FXD ANGLE6.5X25TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443628","SUP","HCPCS C1713","","7443628  -  SCREW, FIXED ANGLE,6.5X27.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443630","SUP","HCPCS C1713","","7443630  -  BONE SCREW 7443630 FXD ANGLE6.5X30TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443633","SUP","HCPCS C1713","","7443633  -  SCREW, FIXED ANGLE,6.5X32.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443635","SUP","HCPCS C1713","","7443635  -  BONE SCREW 7443635 FXD ANGLE6.5X35TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443638","SUP","HCPCS C1713","","7443638  -  SCREW, FIXED ANGLE,6.5X37.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443640","SUP","HCPCS C1713","","7443640  -  BONE SCREW 7443640 FXD ANGLE6.5X40TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443645","SUP","HCPCS C1713","","7443645  -  BONE SCREW 7443645 FXD ANGLE6.5X45TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443650","SUP","HCPCS C1713","","7443650  -  BONE SCREW 7443650 FXD ANGLE6.5X50TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443655","SUP","HCPCS C1713","","7443655  -  BONE SCREW 7443655 FXD ANGLE6.5X55TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443725","SUP","HCPCS C1713","","7443725  -  SCREW, FIXED ANGLE,7.5X25,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443728","SUP","HCPCS C1713","","7443728  -  SCREW, FIXED ANGLE,7.5X27.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443730","SUP","HCPCS C1713","","7443730  -  SCREW, FIXED ANGLE,7.5X30,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443733","SUP","HCPCS C1713","","7443733  -  SCREW, FIXED ANGLE,7.5X32.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443735","SUP","HCPCS C1713","","7443735  -  SCREW, FIXED ANGLE,7.5X35,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443738","SUP","HCPCS C1713","","7443738  -  SCREW, FIXED ANGLE,7.5X37.5,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443740","SUP","HCPCS C1713","","7443740  -  SCREW, FIXED ANGLE,7.5X40,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443745","SUP","HCPCS C1713","","7443745  -  SCREW, FIXED ANGLE,7.5X45,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443750","SUP","HCPCS C1713","","7443750  -  SCREW, FIXED ANGLE,7.5X50,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7443755","SUP","HCPCS C1713","","7443755  -  SCREW, FIXED ANGLE,7.5X55,TI","BOTH IP/OP","$1,864.50 ","$1,379.73 ","$0.00 ","$1,864.50 ","$839.03 ","$0.00 ","$388.61 ","$0.00 ","$0.00 ","$326.46 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$291.79 ","$0.00 ","$296.83 ","$0.00 "
"7450122","SUP","HCPCS C1713","","7450122  -  PLATE BN 22MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450124","SUP","HCPCS C1713","","7450124  -  PLATE BN 24MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450126","SUP","HCPCS C1713","","7450126  -  PLATE BN 26MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450128","SUP","HCPCS C1713","","7450128  -  PLATE BN 28MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450130","SUP","HCPCS C1713","","7450130  -  PLATE BN 30MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450132","SUP","HCPCS C1713","","7450132  -  PLATE BN 32MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450134","SUP","HCPCS C1713","","7450134  -  PLATE BN 34MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450136","SUP","HCPCS C1713","","7450136  -  PLATE BN 36MM GRDNT + 1 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450236","SUP","HCPCS C1713","","7450236  -  PLATE BN 36MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450238","SUP","HCPCS C1713","","7450238  -  PLATE BN 38MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450240","SUP","HCPCS C1713","","7450240  -  PLATE BN 40MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450242","SUP","HCPCS C1713","","7450242  -  PLATE BN 42MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450244","SUP","HCPCS C1713","","7450244  -  PLATE BN 44MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450246","SUP","HCPCS C1713","","7450246  -  PLATE BN 46MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450248","SUP","HCPCS C1713","","7450248  -  PLATE BN 48MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450250","SUP","HCPCS C1713","","7450250  -  PLATE BN 50MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450252","SUP","HCPCS C1713","","7450252  -  PLATE BN 52MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450254","SUP","HCPCS C1713","","7450254  -  PLATE BN 54MM GRDNT + 2 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7450354","SUP","HCPCS C1713","","7450354  -  PLATE BN 54MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450356","SUP","HCPCS C1713","","7450356  -  PLATE BN 56MM GRDNT + LVL 3 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450358","SUP","HCPCS C1713","","7450358  -  PLATE BN 58MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450360","SUP","HCPCS C1713","","7450360  -  PLATE BN 60MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450362","SUP","HCPCS C1713","","7450362  -  PLATE BN 62MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450364","SUP","HCPCS C1713","","7450364  -  PLATE BN 64MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450366","SUP","HCPCS C1713","","7450366  -  PLATE BN 66MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450368","SUP","HCPCS C1713","","7450368  -  PLATE BN 68MM GRDNT + 3 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450468","SUP","HCPCS C1713","","7450468  -  PLATE BN 68MM GRDNT + 4 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450470","SUP","HCPCS C1713","","7450470  -  PLATE BN 70MM GRDNT + 4 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450474","SUP","HCPCS C1713","","7450474  -  PLATE BN 74MM GRDNT + 4 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450478","SUP","HCPCS C1713","","7450478  -  PLATE BN 78MM GRDNT + 4 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450482","SUP","HCPCS C1713","","7450482  -  PLATE BN 82MM GRDNT + 4 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450486","SUP","HCPCS C1713","","7450486  -  PLATE BN 86MM GRDNT + 4 LVL FX SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450490","SUP","HCPCS C1713","","7450490  -  PLATE BN 90MM GRDNT + LVL 4 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450500","SUP","HCPCS C1713","","7450500  -  PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450505","SUP","HCPCS C1713","","7450505  -  PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450510","SUP","HCPCS C1713","","7450510  -  PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450595","SUP","HCPCS C1713","","7450595  -  PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7450610","SUP","HCPCS C1713","","7450610  -  SCREW BN 4MM 10MM NS GRDNT + FX ANG SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450612","SUP","HCPCS C1713","","7450612  -  SCREW BN 4MM 12MM NS GRDNT + FX ANG SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450614","SUP","HCPCS C1713","","7450614  -  SCREW BN 4MM 14MM NS GRDNT + FX ANG SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450616","SUP","HCPCS C1713","","7450616  -  SCREW BN 4MM FA ANT CSPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450710","SUP","HCPCS C1713","","7450710  -  SCREW BN 4.5MM 10MM NS GRDNT + FX ANG SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450712","SUP","HCPCS C1713","","7450712  -  SCREW BN 4.5MM 12MM NS GRDNT + FX ANG SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450714","SUP","HCPCS C1713","","7450714  -  SCREW BN 4.5MM 14MM NS GRDNT + FX ANG SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450716","SUP","HCPCS C1713","","7450716  -  SCREW BN 4.5MM 16MM GRDNT + FA ANT CSPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7450800","SUP","Custom 27803010","","7450800  -  HOLDER IMPL VLCK TEMP FX TACK","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7451500","SUP","HCPCS C1713","","7451500  -  PLATE BN NS GRDNT + SLOT HL CVR TI SPNE","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$169.88 ","$0.00 ","$78.68 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"7451501","SUP","HCPCS C1713","","7451501  -  PLATE BN NS GRDNT + RND HL CVR TI SPNE","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$169.88 ","$0.00 ","$78.68 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"7460020","SUP","HCPCS C1713","","7460020  -  SET SCREW 7460020 BREAK OFF SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7460120","SUP","HCPCS C1713","","7460120  -  SET SCREW, NON BREAK-OFF, SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7460500","SUP","HCPCS C1713","","7460500  -  PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7460505","SUP","HCPCS C1713","","7460505  -  PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7460510","SUP","HCPCS C1713","","7460510  -  PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7460595","SUP","HCPCS C1713","","7460595  -  PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7460610","SUP","HCPCS C1713","","7460610  -  SCREW BN 4MM 10MM NS GRDNT + SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460612","SUP","HCPCS C1713","","7460612  -  SCREW BN 4MM 12MM NS GRDNT + SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460614","SUP","HCPCS C1713","","7460614  -  SCREW BN 4MM 14MM NS GRDNT + SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460616","SUP","HCPCS C1713","","7460616  -  SCREW BN 4MM 16MM GRDNT + VA TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460710","SUP","HCPCS C1713","","7460710  -  SCREW BN 4.5MM 10MM NS GRDNT + SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460712","SUP","HCPCS C1713","","7460712  -  SCREW BN 4.5MM 12MM NS GRDNT + SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460714","SUP","HCPCS C1713","","7460714  -  SCREW BN 4.5MM 14MM NS GRDNT + SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7460716","SUP","HCPCS C1713","","7460716  -  SCREW BN 4.5MM 16MM GRDNT + VA ANT CSPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7461102","SUP","HCPCS C1713","","7461102  -  HOOK 7461102 PEDICLE SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461112","SUP","HCPCS C1713","","7461112  -  HOOK 7461112 WIDE BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461113","SUP","HCPCS C1713","","7461113  -  HOOK 7461113 WIDE BLADE MED SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461114","SUP","HCPCS C1713","","7461114  -  HOOK 7461114 WIDE BLADE LGE SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461122","SUP","HCPCS C1713","","7461122  -  HOOK 7461122 NARROW BLADE SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461142","SUP","HCPCS C1713","","7461142  -  HOOK 7461142 RAMPED THORACIC SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461162","SUP","HCPCS C1713","","7461162  -  HOOK 7461162 LUMBAR ANGLED BLADE SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461172","SUP","HCPCS C1713","","7461172  -  HOOK 7461172 EXTENDED BODY SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461198","SUP","HCPCS C1713","","7461198  -  HOOK 7461198 OFFSET RIGHT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461199","SUP","HCPCS C1713","","7461199  -  HOOK 7461199 OFFSET LEFT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7461500","SUP","HCPCS C1713","","7461500  -  PLATE BN NS GRDNT + SLOT HL CVR TI SPNE","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$169.88 ","$0.00 ","$78.68 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"7461501","SUP","HCPCS C1713","","7461501  -  PLATE BN NS GRDNT + RND HL CVR TI SPNE","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$169.88 ","$0.00 ","$78.68 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"7462420","SUP","HCPCS C1713","","7462420  -  SCREW 7462420 FIXED ANGLE 4.0X20 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462425","SUP","HCPCS C1713","","7462425  -  SCREW 7462425 FIXED ANGLE 4.0X25 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462430","SUP","HCPCS C1713","","7462430  -  SCREW 7462430 FIXED ANGLE 4.0X30 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462435","SUP","HCPCS C1713","","7462435  -  SCREW 7462435 FIXED ANGLE 4.0X35 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462440","SUP","HCPCS C1713","","7462440  -  SCREW 7462440 FIXED ANGLE 4.0X40 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462525","SUP","HCPCS C1713","","7462525  -  SCREW 7462525 FIXED ANGLE 5.0X25 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462528","SUP","HCPCS C1713","","7462528  -  SCREW, FIXED ANGLE,5.0X27.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462530","SUP","HCPCS C1713","","7462530  -  SCREW 7462530 FIXED ANGLE 5.0X30 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462533","SUP","HCPCS C1713","","7462533  -  SCREW, FIXED ANGLE,5.0X32.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462535","SUP","HCPCS C1713","","7462535  -  SCREW 7462535 FIXED ANGLE 5.0X35 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462538","SUP","HCPCS C1713","","7462538  -  SCREW, FIXED ANGLE,5.0X37.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462540","SUP","HCPCS C1713","","7462540  -  SCREW 7462540 FIXED ANGLE 5.0X40 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462545","SUP","HCPCS C1713","","7462545  -  SCREW 7462545 FIXED ANGLE 5.0X45 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462550","SUP","HCPCS C1713","","7462550  -  SCREW 7462550 FIXED ANGLE 5.0X50 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462625","SUP","HCPCS C1713","","7462625  -  SCREW 7462625 FIXED ANGLE 6.0X25 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462628","SUP","HCPCS C1713","","7462628  -  SCREW, FIXED ANGLE,6.0X27.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462630","SUP","HCPCS C1713","","7462630  -  SCREW 7462630 FIXED ANGLE 6.0X30 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462633","SUP","HCPCS C1713","","7462633  -  SCREW, FIXED ANGLE,6.0X32.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462635","SUP","HCPCS C1713","","7462635  -  SCREW 7462635 FIXED ANGLE 6.0X35 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462638","SUP","HCPCS C1713","","7462638  -  SCREW, FIXED ANGLE,6.0X37.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462640","SUP","HCPCS C1713","","7462640  -  SCREW 7462640 FIXED ANGLE 6.0X40 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462645","SUP","HCPCS C1713","","7462645  -  SCREW 7462645 FIXED ANGLE 6.0X45 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7462650","SUP","HCPCS C1713","","7462650  -  SCREW 7462650 FIXED ANGLE 6.0X50 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463425","SUP","HCPCS C1713","","7463425  -  SCREW 7463425 FIXED ANGLE 4.5X25 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463428","SUP","HCPCS C1713","","7463428  -  SCREW, FIXED ANGLE,4.5X27.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463430","SUP","HCPCS C1713","","7463430  -  SCREW 7463430 FIXED ANGLE 4.5X30 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463433","SUP","HCPCS C1713","","7463433  -  SCREW, FIXED ANGLE,4.5X32.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463435","SUP","HCPCS C1713","","7463435  -  SCREW 7463435 FIXED ANGLE 4.5X35 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463438","SUP","HCPCS C1713","","7463438  -  SCREW, FIXED ANGLE,4.5X37.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463440","SUP","HCPCS C1713","","7463440  -  SCREW 7463440 FIXED ANGLE 4.5X40 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463445","SUP","HCPCS C1713","","7463445  -  SCREW, FIXED ANGLE, 4.5X45, SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463450","SUP","HCPCS C1713","","7463450  -  SCREW, FIXED ANGLE, 4.5X50, SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463525","SUP","HCPCS C1713","","7463525  -  SCREW 7463525 FIXED ANGLE 5.5X25 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463528","SUP","HCPCS C1713","","7463528  -  SCREW, FIXED ANGLE,5.5X27.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463530","SUP","HCPCS C1713","","7463530  -  SCREW 7463530 FIXED ANGLE 5.5X30 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463533","SUP","HCPCS C1713","","7463533  -  SCREW, FIXED ANGLE,5.5X32.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463535","SUP","HCPCS C1713","","7463535  -  SCREW 7463535 FIXED ANGLE 5.5X35 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463538","SUP","HCPCS C1713","","7463538  -  SCREW, FIXED ANGLE,5.5X37.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463540","SUP","HCPCS C1713","","7463540  -  SCREW 7463540 FIXED ANGLE 5.5X40 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463545","SUP","HCPCS C1713","","7463545  -  SCREW 7463545 FIXED ANGLE 5.5X45 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463550","SUP","HCPCS C1713","","7463550  -  SCREW 7463550 FIXED ANGLE 5.5X50 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463625","SUP","HCPCS C1713","","7463625  -  SCREW 7463625 FIXED ANGLE 6.5X25 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463628","SUP","HCPCS C1713","","7463628  -  SCREW, FIXED ANGLE,6.5X27.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463630","SUP","HCPCS C1713","","7463630  -  SCREW 7463630 FIXED ANGLE 6.5X30 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463633","SUP","HCPCS C1713","","7463633  -  SCREW, FIXED ANGLE,6.5X32.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463635","SUP","HCPCS C1713","","7463635  -  SCREW 7463635 FIXED ANGLE 6.5X35 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463638","SUP","HCPCS C1713","","7463638  -  SCREW, FIXED ANGLE,6.5X37.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463640","SUP","HCPCS C1713","","7463640  -  SCREW 7463640 FIXED ANGLE 6.5X40 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463645","SUP","HCPCS C1713","","7463645  -  SCREW 7463645 FIXED ANGLE 6.5X45 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463650","SUP","HCPCS C1713","","7463650  -  SCREW 7463650 FIXED ANGLE 6.5X50 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463655","SUP","HCPCS C1713","","7463655  -  SCREW 7463655 FIXED ANGLE 6.5X55 SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463725","SUP","HCPCS C1713","","7463725  -  SCREW, FIXED ANGLE,7.5X25,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463728","SUP","HCPCS C1713","","7463728  -  SCREW, FIXED ANGLE,7.5X27.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463730","SUP","HCPCS C1713","","7463730  -  SCREW, FIXED ANGLE,7.5X30,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463733","SUP","HCPCS C1713","","7463733  -  SCREW, FIXED ANGLE,7.5X32.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463735","SUP","HCPCS C1713","","7463735  -  SCREW, FIXED ANGLE,7.5X35,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463738","SUP","HCPCS C1713","","7463738  -  SCREW, FIXED ANGLE,7.5X37.5,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463740","SUP","HCPCS C1713","","7463740  -  SCREW, FIXED ANGLE,7.5X40,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463745","SUP","HCPCS C1713","","7463745  -  SCREW, FIXED ANGLE,7.5X45,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463750","SUP","HCPCS C1713","","7463750  -  SCREW, FIXED ANGLE,7.5X50,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7463755","SUP","HCPCS C1713","","7463755  -  SCREW, FIXED ANGLE,7.5X55,SS","BOTH IP/OP","$1,666.50 ","$1,233.21 ","$0.00 ","$1,666.50 ","$749.93 ","$0.00 ","$347.34 ","$0.00 ","$0.00 ","$291.79 ","$1,666.50 ","$0.00 ","$833.25 ","$1,319.87 ","$1,333.20 ","$0.00 ","$260.81 ","$0.00 ","$265.31 ","$0.00 "
"7490122","SUP","HCPCS C1713","","7490122  -  PLATE BN 22MM GRDNT + 1 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490124","SUP","HCPCS C1713","","7490124  -  PLATE BN 24MM GRDNT + 1 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490126","SUP","HCPCS C1713","","7490126  -  PLATE BN 26MM GRDNT + 1 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490128","SUP","HCPCS C1713","","7490128  -  PLATE BN 28MM GRDNT + 1 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490236","SUP","HCPCS C1713","","7490236  -  PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490238","SUP","HCPCS C1713","","7490238  -  PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490240","SUP","HCPCS C1713","","7490240  -  PLATE BN 40MM GRDNT + 2 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490242","SUP","HCPCS C1713","","7490242  -  PLATE BN 42MM GRDNT + 2 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490244","SUP","HCPCS C1713","","7490244  -  PLATE BN 44MM GRDNT + 2 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490246","SUP","HCPCS C1713","","7490246  -  PLATE BN 46MM GRDNT + 2 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490248","SUP","HCPCS C1713","","7490248  -  PLATE BN 48MM GRDNT + 2 LVL FX SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7490354","SUP","HCPCS C1713","","7490354  -  PLATE BN 54MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490356","SUP","HCPCS C1713","","7490356  -  PLATE BN 56MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490358","SUP","HCPCS C1713","","7490358  -  PLATE BN 58MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490360","SUP","HCPCS C1713","","7490360  -  PLATE BN 60MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490362","SUP","HCPCS C1713","","7490362  -  PLATE BN 62MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490364","SUP","HCPCS C1713","","7490364  -  PLATE BN 64MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490366","SUP","HCPCS C1713","","7490366  -  PLATE BN 66MM GRDNT + 3 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490468","SUP","HCPCS C1713","","7490468  -  PLATE BN 68MM GRDNT + 4 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490470","SUP","HCPCS C1713","","7490470  -  PLATE BN 70MM GRDNT + 4 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490474","SUP","HCPCS C1713","","7490474  -  PLATE BN 74MM GRDNT + 4 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490478","SUP","HCPCS C1713","","7490478  -  PLATE BN 78MM GRDNT + 4 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490482","SUP","HCPCS C1713","","7490482  -  PLATE BN 82MM GRDNT + 4 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7490486","SUP","HCPCS C1713","","7490486  -  PLATE BN 86MM GRDNT + 4 LVL FX SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7502073","SUP","HCPCS C1713","","7502073  -  CAGE SPNL 20D HYPERLORDOTIC 34X6X24MM CRNT BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502077","SUP","HCPCS C1713","","7502077  -  CAGE SPNL 20D HYPERLORDOTIC 34X10X24MM NS BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502100","SUP","HCPCS C1713","","7502100  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X6MM NS LF BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502102","SUP","HCPCS C1713","","7502102  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502104","SUP","HCPCS C1713","","7502104  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502219","SUP","HCPCS C1713","","7502219  -  CAGE SPNL 20D HYPERLORDOTIC 34X8X24MM CRNT BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502221","SUP","HCPCS C1713","","7502221  -  CAGE SPNL 30D HYPERLORDOTIC 34X10X24MM CRNT BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502244","SUP","HCPCS C1713","","7502244  -  CAGE SPNL 30D HYPERLORDOTIC 38X6X28MM CRNT BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502246","SUP","HCPCS C1713","","7502246  -  CAGE SPNL 30D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7502248","SUP","HCPCS C1713","","7502248  -  CAGE SPNL 30D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE","BOTH IP/OP","$18,375.00 ","$13,597.50 ","$0.00 ","$18,375.00 ","$8,268.75 ","$0.00 ","$3,829.81 ","$0.00 ","$0.00 ","$3,217.32 ","$18,375.00 ","$0.00 ","$9,187.50 ","$14,553.00 ","$14,700.00 ","$0.00 ","$2,875.69 ","$0.00 ","$2,925.30 ","$0.00 "
"7509145","SUP","Custom 27804086","","7509145  -  GRAFT BN 5X1.75CM MAGNIFUSE DBM","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7509211","SUP","Custom 27804086","","7509211  -  GRAFT BN 10X1CM MAGNIFUSE DBM","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7509215","SUP","Custom 27804086","","7509215  -  GRAFT BN 5X1CM MAGNIFUSE DBM SPNE CRV POST","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7510001","SUP","HCPCS C1713","","7510001  -  NUT LCK 5.5MM LAT PLT SPNE","BOTH IP/OP","$317.50 ","$234.95 ","$0.00 ","$317.50 ","$142.88 ","$0.00 ","$66.17 ","$0.00 ","$0.00 ","$55.59 ","$317.50 ","$0.00 ","$158.75 ","$251.46 ","$254.00 ","$0.00 ","$49.69 ","$0.00 ","$50.55 ","$0.00 "
"7510050","SUP","HCPCS C1713","","7510050  -  GRAFT BONE 2XS 12MM 20MM ABSORBABLE SPONGE STERILE WATER","BOTH IP/OP","$2,387.50 ","$1,766.75 ","$0.00 ","$2,387.50 ","$1,074.38 ","$0.00 ","$497.61 ","$0.00 ","$0.00 ","$418.03 ","$2,387.50 ","$0.00 ","$1,193.75 ","$1,890.90 ","$1,910.00 ","$0.00 ","$373.64 ","$0.00 ","$380.09 ","$0.00 "
"7510100","SUP","HCPCS C1713","","7510100  -  GRAFT BONE XS KIT INFUSE BOVINE COLLAGEN RHBMP-2 LUMBAR","BOTH IP/OP","$4,762.50 ","$3,524.25 ","$0.00 ","$4,762.50 ","$2,143.13 ","$0.00 ","$992.62 ","$0.00 ","$0.00 ","$833.88 ","$4,762.50 ","$0.00 ","$2,381.25 ","$3,771.90 ","$3,810.00 ","$0.00 ","$745.33 ","$0.00 ","$758.19 ","$0.00 "
"7510200","SUP","HCPCS C1713","","7510200  -  GRAFT BONE SMALL 14MM 23MM ABSORBABLE SPONGE STERILE WATER","BOTH IP/OP","$9,512.50 ","$7,039.25 ","$0.00 ","$9,512.50 ","$4,280.63 ","$0.00 ","$1,982.64 ","$0.00 ","$0.00 ","$1,665.56 ","$9,512.50 ","$0.00 ","$4,756.25 ","$7,533.90 ","$7,610.00 ","$0.00 ","$1,488.71 ","$0.00 ","$1,514.39 ","$0.00 "
"7510400","SUP","HCPCS C1713","","7510400  -  GRAFT BONE MEDIUM 20GA 2X1IN VIAL ABSORBABLE COLLAGEN SPONGE","BOTH IP/OP","$13,250.00 ","$9,805.00 ","$0.00 ","$13,250.00 ","$5,962.50 ","$0.00 ","$2,761.63 ","$0.00 ","$0.00 ","$2,319.97 ","$13,250.00 ","$0.00 ","$6,625.00 ","$10,494.00 ","$10,600.00 ","$0.00 ","$2,073.63 ","$0.00 ","$2,109.40 ","$0.00 "
"7510800","SUP","HCPCS C1713","","7510800  -  GRAFT BONE LARGE II 18MM 26MM ABSORBABLE SPONGE STERILE","BOTH IP/OP","$14,775.00 ","$10,933.50 ","$0.00 ","$14,775.00 ","$6,648.75 ","$0.00 ","$3,079.48 ","$0.00 ","$0.00 ","$2,586.98 ","$14,775.00 ","$0.00 ","$7,387.50 ","$11,701.80 ","$11,820.00 ","$0.00 ","$2,312.29 ","$0.00 ","$2,352.18 ","$0.00 "
"7521006","SUP","HCPCS C1713","","7521006  -  PLATE BN 6MM XLP 2 HL TI SPNE LAT","BOTH IP/OP","$7,022.50 ","$5,196.65 ","$0.00 ","$7,022.50 ","$3,160.13 ","$0.00 ","$1,463.66 ","$0.00 ","$0.00 ","$1,229.58 ","$7,022.50 ","$0.00 ","$3,511.25 ","$5,561.82 ","$5,618.00 ","$0.00 ","$1,099.02 ","$0.00 ","$1,117.98 ","$0.00 "
"7521008","SUP","HCPCS C1713","","7521008  -  PLATE BN 8MM XLP 2 HL TI SPNE LAT","BOTH IP/OP","$7,022.50 ","$5,196.65 ","$0.00 ","$7,022.50 ","$3,160.13 ","$0.00 ","$1,463.66 ","$0.00 ","$0.00 ","$1,229.58 ","$7,022.50 ","$0.00 ","$3,511.25 ","$5,561.82 ","$5,618.00 ","$0.00 ","$1,099.02 ","$0.00 ","$1,117.98 ","$0.00 "
"7521012","SUP","HCPCS C1713","","7521012  -  PLATE BN 12MM XLP 2 HL TI SPNE LAT","BOTH IP/OP","$7,022.50 ","$5,196.65 ","$0.00 ","$7,022.50 ","$3,160.13 ","$0.00 ","$1,463.66 ","$0.00 ","$0.00 ","$1,229.58 ","$7,022.50 ","$0.00 ","$3,511.25 ","$5,561.82 ","$5,618.00 ","$0.00 ","$1,099.02 ","$0.00 ","$1,117.98 ","$0.00 "
"7521014","SUP","HCPCS C1713","","7521014  -  PLATE BN 14MM XLP 2 HL TI SPNE LAT","BOTH IP/OP","$7,022.50 ","$5,196.65 ","$0.00 ","$7,022.50 ","$3,160.13 ","$0.00 ","$1,463.66 ","$0.00 ","$0.00 ","$1,229.58 ","$7,022.50 ","$0.00 ","$3,511.25 ","$5,561.82 ","$5,618.00 ","$0.00 ","$1,099.02 ","$0.00 ","$1,117.98 ","$0.00 "
"7521016","SUP","HCPCS C1713","","7521016  -  PLATE BN 16MM XLP 2 HL TI SPNE LAT","BOTH IP/OP","$7,022.50 ","$5,196.65 ","$0.00 ","$7,022.50 ","$3,160.13 ","$0.00 ","$1,463.66 ","$0.00 ","$0.00 ","$1,229.58 ","$7,022.50 ","$0.00 ","$3,511.25 ","$5,561.82 ","$5,618.00 ","$0.00 ","$1,099.02 ","$0.00 ","$1,117.98 ","$0.00 "
"7533006","SUP","HCPCS C1713","","7533006  -  PLATE BN 6MM XLP + 4 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7533008","SUP","HCPCS C1713","","7533008  -  PLATE BN 8MM XLP + 4 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7533010","SUP","HCPCS C1713","","7533010  -  PLATE BN 10MM XLP + 4 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7533012","SUP","HCPCS C1713","","7533012  -  PLATE BN 12MM XLP + 4 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7533014","SUP","HCPCS C1713","","7533014  -  PLATE BN 14MM XLP + 4 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7533016","SUP","HCPCS C1713","","7533016  -  PLATE BN 16MM XLP + 4 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7534006","SUP","HCPCS C1713","","7534006  -  PLATE BN 6MM XLP + 2X2 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7534008","SUP","HCPCS C1713","","7534008  -  PLATE BN 8MM XLP + 2X2 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7534010","SUP","HCPCS C1713","","7534010  -  PLATE BN 10MM XLP + 2X2 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7534012","SUP","HCPCS C1713","","7534012  -  PLATE BN 12MM XLP + 2X2 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7534014","SUP","HCPCS C1713","","7534014  -  PLATE BN 14MM XLP + 2X2 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7534016","SUP","HCPCS C1713","","7534016  -  PLATE BN 16MM XLP + 2X2 HL SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7539006","SUP","HCPCS C1713","","7539006  -  PLATE BN ANG FAVORED 6MM XLP + SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7539008","SUP","HCPCS C1713","","7539008  -  PLATE BN ANG FAVORED 8MM XLP + SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7539010","SUP","HCPCS C1713","","7539010  -  PLATE BN ANG FAVORED 10MM XLP + SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7539012","SUP","HCPCS C1713","","7539012  -  PLATE BN ANG FAVORED 12MM XLP + SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7539014","SUP","HCPCS C1713","","7539014  -  PLATE BN ANG FAVORED 14MM XLP + SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7539016","SUP","HCPCS C1713","","7539016  -  PLATE BN ANG FAVORED 16MM XLP + SPNE","BOTH IP/OP","$7,887.50 ","$5,836.75 ","$0.00 ","$7,887.50 ","$3,549.38 ","$0.00 ","$1,643.95 ","$0.00 ","$0.00 ","$1,381.04 ","$7,887.50 ","$0.00 ","$3,943.75 ","$6,246.90 ","$6,310.00 ","$0.00 ","$1,234.39 ","$0.00 ","$1,255.69 ","$0.00 "
"7540020","SUP","HCPCS C1713","","7540020  -  SCREW BONE 20MM SPNL TI BRKOF","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7540120","SUP","HCPCS C1713","","7540120  -  SET SCREW 7540120 NON BREAK OFF TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7540220","SUP","HCPCS C1713","","7540220  -  SET SCREW 7540220 LEGACY 5.5 RED PLUG TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7541102","SUP","HCPCS C1713","","7541102  -  HOOK 7541102 PEDICLE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541103","SUP","HCPCS C1713","","7541103  -  HOOK 7541103 PEDICLE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541104","SUP","HCPCS C1713","","7541104  -  HOOK 7541104 PEDICLE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541112","SUP","HCPCS C1713","","7541112  -  HOOK 7541112 WIDE BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541113","SUP","HCPCS C1713","","7541113  -  HOOK 7541113 WIDE BLADE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541114","SUP","HCPCS C1713","","7541114  -  HOOK 7541114 WIDE BLADE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541122","SUP","HCPCS C1713","","7541122  -  HOOK 7541122 NARROW BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541123","SUP","HCPCS C1713","","7541123  -  HOOK 7541123 NARROW BLADE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541124","SUP","HCPCS C1713","","7541124  -  HOOK 7541124 NARROW BLADE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541133","SUP","HCPCS C1713","","7541133  -  HOOK 7541133 RAMP WIDE BLADE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541142","SUP","HCPCS C1713","","7541142  -  HOOK 7541142 RAMP NARROW BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541143","SUP","HCPCS C1713","","7541143  -  HOOK 7541143 RAMP NARROW BLADE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541153","SUP","HCPCS C1713","","7541153  -  HOOK 7541153 SUPRA LAM LUMBAR MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541162","SUP","HCPCS C1713","","7541162  -  HOOK 7541162 LUMBAR ANG BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541163","SUP","HCPCS C1713","","7541163  -  HOOK 7541163 LUMBAR ANG BLADE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541172","SUP","HCPCS C1713","","7541172  -  HOOK 7541172 EXTENDED BODY SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541173","SUP","HCPCS C1713","","7541173  -  HOOK 7541173 EXTENDED BODY MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541174","SUP","HCPCS C1713","","7541174  -  HOOK 7541174 EXTENDED BODY LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541188","SUP","HCPCS C1713","","7541188  -  HOOK 7541188 THORACIC ANG BLADE RT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541189","SUP","HCPCS C1713","","7541189  -  HOOK 7541189 THORACIC ANG BLADE LT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541198","SUP","HCPCS C1713","","7541198  -  HOOK 7541198 OFFSET RT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541199","SUP","HCPCS C1713","","7541199  -  HOOK 7541199 OFFSET LT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541203","SUP","HCPCS C1713","","7541203  -  HOOK 7541203 PEDICLE WITH LIP MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541213","SUP","HCPCS C1713","","7541213  -  HOOK 7541213 WIDE BLADEW LIP MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541223","SUP","HCPCS C1713","","7541223  -  HOOK 7541223 NARROW BLADEW LIP MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541302","SUP","HCPCS C1713","","7541302  -  TAH PEDICLE HOOK - SMALL, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541303","SUP","HCPCS C1713","","7541303  -  TAH PEDICLE HOOK - MEDIUM, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541304","SUP","HCPCS C1713","","7541304  -  TAH PEDICLE HOOK - LARGE,TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541312","SUP","HCPCS C1713","","7541312  -  TAH SUPRA-LAMINAR HOOK -SM, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541313","SUP","HCPCS C1713","","7541313  -  TAH SUPRA-LAMINAR HOOK -MD, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541314","SUP","HCPCS C1713","","7541314  -  TAH SUPRA-LAMINAR HOOK-LG, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541322","SUP","HCPCS C1713","","7541322  -  TAH INFRA-LAMINAR HOOK-SM, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541323","SUP","HCPCS C1713","","7541323  -  TAH INFRA-LAMINAR HOOK-MD, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541324","SUP","HCPCS C1713","","7541324  -  TAH INFRA-LAMINAR HOOK-LG, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541342","SUP","HCPCS C1713","","7541342  -  TAH TRANSVERSE PROCESS HOOK-SM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541343","SUP","HCPCS C1713","","7541343  -  TAH TRANSVERSE PROCESS HOOK-MD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7541344","SUP","HCPCS C1713","","7541344  -  TAH TRANSVERSE PROCESS HOOK-TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7542420","SUP","HCPCS C1713","","7542420  -  SCREW, FIXED ANGLE, 4.0X20, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542425","SUP","HCPCS C1713","","7542425  -  SCREW 7542425 FIXED ANGLE 4.0X25 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542430","SUP","HCPCS C1713","","7542430  -  SCREW, FIXED ANGLE, 4.0X30, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542435","SUP","HCPCS C1713","","7542435  -  SCREW, FIXED ANGLE, 4.0X35, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542440","SUP","HCPCS C1713","","7542440  -  SCREW, FIXED ANGLE, 4.0X40, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542445","SUP","HCPCS C1713","","7542445  -  SCREW, FIXED ANGLE, 4.0X45, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542450","SUP","HCPCS C1713","","7542450  -  SCREW, FIXED ANGLE, 4.0X50, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542455","SUP","HCPCS C1713","","7542455  -  SCREW, FIXED ANGLE, 4.0X55, TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542520","SUP","HCPCS C1713","","7542520  -  SCREW 7542520 FIXED ANGLE 5.0X20 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542525","SUP","HCPCS C1713","","7542525  -  SCREW BN 5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542530","SUP","HCPCS C1713","","7542530  -  SCREW BN 5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542535","SUP","HCPCS C1713","","7542535  -  SCREW BN 5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542540","SUP","HCPCS C1713","","7542540  -  SCREW BN 5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542545","SUP","HCPCS C1713","","7542545  -  SCREW BN 5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542550","SUP","HCPCS C1713","","7542550  -  SCREW 7542550 FIXED ANGLE 5.0X50 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542555","SUP","HCPCS C1713","","7542555  -  SCREW 7542555 FIXED ANGLE 5.0X55 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542625","SUP","HCPCS C1713","","7542625  -  SCREW 7542625 FIXED ANGLE 6.0X25 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542630","SUP","HCPCS C1713","","7542630  -  SCREW 7542630 FIXED ANGLE 6.0X30 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542635","SUP","HCPCS C1713","","7542635  -  SCREW 7542635 FIXED ANGLE 6.0X35 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542640","SUP","HCPCS C1713","","7542640  -  SCREW 7542640 FIXED ANGLE 6.0X40 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542645","SUP","HCPCS C1713","","7542645  -  BONE SCREW 7542645 FIXED ANGLE 6.0X45 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542650","SUP","HCPCS C1713","","7542650  -  SCREW 7542650 FIXED ANGLE 6.0X50 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542655","SUP","HCPCS C1713","","7542655  -  SCREW 7542655 FIXED ANGLE 6.0X55 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7542660","SUP","HCPCS C1713","","7542660  -  SCREW 7542660 FIXED ANGLE 6.0X60 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543420","SUP","HCPCS C1713","","7543420  -  SCREW 7543420 FIXED ANGLE 4.5X20 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543425","SUP","HCPCS C1713","","7543425  -  SCREW BN 4.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543430","SUP","HCPCS C1713","","7543430  -  SCREW BN 4.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543435","SUP","HCPCS C1713","","7543435  -  SCREW BN 4.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543440","SUP","HCPCS C1713","","7543440  -  SCREW BN 4.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543445","SUP","HCPCS C1713","","7543445  -  SCREW BN 4.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543450","SUP","HCPCS C1713","","7543450  -  SCREW 7543450 FIXED ANGLE 4.5X50 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543455","SUP","HCPCS C1713","","7543455  -  SCREW 7543455 FIXED ANGLE 4.5X55 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543525","SUP","HCPCS C1713","","7543525  -  SCREW BN 5.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543530","SUP","HCPCS C1713","","7543530  -  SCREW BN 5.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543535","SUP","HCPCS C1713","","7543535  -  SCREW BN 5.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543540","SUP","HCPCS C1713","","7543540  -  SCREW BN 5.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543545","SUP","HCPCS C1713","","7543545  -  SCREW BN 5.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543550","SUP","HCPCS C1713","","7543550  -  SCREW BN 5.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543555","SUP","HCPCS C1713","","7543555  -  SCREW 7543555 FIXED ANGLE 5.5X55 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543560","SUP","HCPCS C1713","","7543560  -  SCREW 7543560 FIXED ANGLE 5.5X60 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543625","SUP","HCPCS C1713","","7543625  -  SCREW 7543625 FIXED ANGLE 6.5X25 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543630","SUP","HCPCS C1713","","7543630  -  SCREW BN 6.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543635","SUP","HCPCS C1713","","7543635  -  SCREW BN 6.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543640","SUP","HCPCS C1713","","7543640  -  SCREW BN 6.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543645","SUP","HCPCS C1713","","7543645  -  SCREW BN 6.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543650","SUP","HCPCS C1713","","7543650  -  SCREW BN 6.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543655","SUP","HCPCS C1713","","7543655  -  SCREW BN 6.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543660","SUP","HCPCS C1713","","7543660  -  SCREW 7543660 FIXED ANGLE 6.5X60 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543725","SUP","HCPCS C1713","","7543725  -  SCREW 7543725 FIXED ANGLE 7.5X25 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543730","SUP","HCPCS C1713","","7543730  -  SCREW BN 7.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543735","SUP","HCPCS C1713","","7543735  -  SCREW BN 7.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543740","SUP","HCPCS C1713","","7543740  -  SCREW BN 7.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543745","SUP","HCPCS C1713","","7543745  -  SCREW BN 7.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543750","SUP","HCPCS C1713","","7543750  -  SCREW BN 7.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543755","SUP","HCPCS C1713","","7543755  -  SCREW BN 7.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543760","SUP","HCPCS C1713","","7543760  -  SCREW 7543760 FIXED ANGLE 7.5X60 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7543765","SUP","HCPCS C1713","","7543765  -  SCREW 7543765 FIXED ANGLE 7.5X65 TI","BOTH IP/OP","$1,896.00 ","$1,403.04 ","$0.00 ","$1,896.00 ","$853.20 ","$0.00 ","$395.17 ","$0.00 ","$0.00 ","$331.97 ","$1,896.00 ","$0.00 ","$948.00 ","$1,501.63 ","$1,516.80 ","$0.00 ","$296.72 ","$0.00 ","$301.84 ","$0.00 "
"7544035","SUP","HCPCS C1713","","7544035  -  SCREW BN 4MM 35MM CD HZN LGC MA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7546999","SUP","Custom 27203010","","REAGENT SOL A B C IMPRP KT 300 TST ANALY","BOTH IP/OP","$559.15 ","$413.77 ","$0.00 ","$559.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$559.15 ","$0.00 ","$279.58 ","$442.85 ","$447.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7547053","SUP","Custom 27203010","","CONTROL FLW CYMTR FLWCNT FLUOROSPHERES 20ML","BOTH IP/OP","$686.15 ","$507.75 ","$0.00 ","$686.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.15 ","$0.00 ","$343.08 ","$543.43 ","$548.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7547116","SUP","Custom 27203010","","CONTROL CLTR 5C 3PK DISK 3.3ML HMTL","BOTH IP/OP","$40.83 ","$30.21 ","$0.00 ","$40.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.83 ","$0.00 ","$20.41 ","$32.34 ","$32.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7547125","SUP","Custom 27203010","","CONTROL RETCYT CLTR RTC C GNS 3PK 3.3ML LH SER HMTL","BOTH IP/OP","$38.73 ","$28.66 ","$0.00 ","$38.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.73 ","$0.00 ","$19.36 ","$30.67 ","$30.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7547178","SUP","Custom 27203010","","STAIN WRTS GMS TRUCOLOR 2L SLD LH SER HMTL","BOTH IP/OP","$517.38 ","$382.86 ","$0.00 ","$517.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$517.38 ","$0.00 ","$258.69 ","$409.76 ","$413.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7547181","SUP","Custom 27203010","","STAIN WRTS GMS TRUCOLOR 2L SLD BUFF LH SER HMTL","BOTH IP/OP","$316.25 ","$234.03 ","$0.00 ","$316.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.25 ","$0.00 ","$158.13 ","$250.47 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7555025","SUP","HCPCS C1713","","7555025  -  BOLT SPNL 5.5MM 25MM PLT","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555030","SUP","HCPCS C1713","","7555030  -  BOLT SPNL 5.5MM 30MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555035","SUP","HCPCS C1713","","7555035  -  BOLT SPNL 5MM 35MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555040","SUP","HCPCS C1713","","7555040  -  BOLT SPNL 5.5MM 40MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555050","SUP","HCPCS C1713","","7555050  -  BOLT SPNL 5.5MM 50MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555055","SUP","HCPCS C1713","","7555055  -  BOLT SPNL 5.5MM 55MM XLP","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555060","SUP","HCPCS C1713","","7555060  -  BOLT SPNL 5.5MM 60MM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7555065","SUP","HCPCS C1713","","7555065  -  BOLT SPNL 5.5MM 65MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7560020","SUP","HCPCS C1713","","7560020  -  SET SCREW 7560020 BREAK OFF SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7560120","SUP","HCPCS C1713","","7560120  -  SET SCREW 7560120 NON BREAK OFF SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7560220","SUP","HCPCS C1713","","7560220  -  SET SCREW 7560220 LEGACY 5.5 RED PLUG SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7561102","SUP","HCPCS C1713","","7561102  -  HOOK 7561102 PEDICLE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561103","SUP","HCPCS C1713","","7561103  -  HOOK 7561103 PEDICLE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561104","SUP","HCPCS C1713","","7561104  -  HOOK 7561104 PEDICLE LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561112","SUP","HCPCS C1713","","7561112  -  HOOK 7561112 WIDE BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561113","SUP","HCPCS C1713","","7561113  -  HOOK 7561113 WIDE BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561114","SUP","HCPCS C1713","","7561114  -  HOOK 7561114 WIDE BLADE LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561122","SUP","HCPCS C1713","","7561122  -  HOOK 7561122 NARROW BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561123","SUP","HCPCS C1713","","7561123  -  HOOK 7561123 NARROW BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561124","SUP","HCPCS C1713","","7561124  -  HOOK 7561124 NARROW BLADE LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561133","SUP","HCPCS C1713","","7561133  -  HOOK SPNL MED CD HZN LGC RAMP W BLDE SS THOR 5.5MM ROD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561142","SUP","HCPCS C1713","","7561142  -  HOOK 7561142 RAMP NARROW BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561143","SUP","HCPCS C1713","","7561143  -  HOOK 7561143 RAMP NARROW BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561153","SUP","HCPCS C1713","","7561153  -  HOOK 7561153 SUPRA LAM LUMBAR MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561162","SUP","HCPCS C1713","","7561162  -  HOOK 7561162 LUMBAR ANG BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561163","SUP","HCPCS C1713","","7561163  -  HOOK 7561163 LUMBAR ANG BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561172","SUP","HCPCS C1713","","7561172  -  HOOK 7561172 EXTENDED BODY SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561173","SUP","HCPCS C1713","","7561173  -  HOOK 7561173 EXTENDED BODY MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561174","SUP","HCPCS C1713","","7561174  -  HOOK 7561174 EXTENDED BODY LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561188","SUP","HCPCS C1713","","7561188  -  HOOK 7561188 THORACIC ANG BLADE RT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561189","SUP","HCPCS C1713","","7561189  -  HOOK 7561189 THORACIC ANG BLADE LT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561198","SUP","HCPCS C1713","","7561198  -  HOOK 7561198 OFFSET RT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561199","SUP","HCPCS C1713","","7561199  -  HOOK 7561199 OFFSET LT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561203","SUP","HCPCS C1713","","7561203  -  HOOK 7561203 PEDICLE WITH LIP MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561213","SUP","HCPCS C1713","","7561213  -  HOOK 7561213 WIDE BLADE W LIP MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7561223","SUP","HCPCS C1713","","7561223  -  HOOK 7561223 NARROW BLADE W LIP MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7562420","SUP","HCPCS C1713","","7562420  -  SCREW, FIXED ANGLE, 4.0X20, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562425","SUP","HCPCS C1713","","7562425  -  SCREW, FIXED ANGLE, 4.0X25, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562430","SUP","HCPCS C1713","","7562430  -  SCREW, FIXED ANGLE, 4.0X30, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562435","SUP","HCPCS C1713","","7562435  -  SCREW, FIXED ANGLE, 4.0X35, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562440","SUP","HCPCS C1713","","7562440  -  SCREW, FIXED ANGLE, 4.0X40, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562445","SUP","HCPCS C1713","","7562445  -  SCREW, FIXED ANGLE, 4.0X45, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562450","SUP","HCPCS C1713","","7562450  -  SCREW, FIXED ANGLE, 4.0X50, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562455","SUP","HCPCS C1713","","7562455  -  SCREW, FIXED ANGLE, 4.0X55, SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562520","SUP","HCPCS C1713","","7562520  -  SCREW 7562520 FIXED ANGLE 5.0X20 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562525","SUP","HCPCS C1713","","7562525  -  SCREW 7562525 FIXED ANGLE 5.0X25 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562530","SUP","HCPCS C1713","","7562530  -  BONE SCREW 7562530 FIXED ANGLE 5X30 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562535","SUP","HCPCS C1713","","7562535  -  SCREW 7562535 FIXED ANGLE 5.0X35 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562540","SUP","HCPCS C1713","","7562540  -  SCREW 7562540 FIXED ANGLE 5.0X40 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562545","SUP","HCPCS C1713","","7562545  -  SCREW 7562545 FIXED ANGLE 5.0X45 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562550","SUP","HCPCS C1713","","7562550  -  SCREW 7562550 FIXED ANGLE 5.0X50 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562555","SUP","HCPCS C1713","","7562555  -  SCREW 7562555 FIXED ANGLE 5.0X55 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562625","SUP","HCPCS C1713","","7562625  -  SCREW 7562625 FIXED ANGLE 6.0X25 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562630","SUP","HCPCS C1713","","7562630  -  SCREW 7562630 FIXED ANGLE 6.0X30 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562635","SUP","HCPCS C1713","","7562635  -  SCREW 7562635 FIXED ANGLE 6.0X35 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562640","SUP","HCPCS C1713","","7562640  -  SCREW 7562640 FIXED ANGLE 6.0X40 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562645","SUP","HCPCS C1713","","7562645  -  SCREW 7562645 FIXED ANGLE 6.0X45 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562650","SUP","HCPCS C1713","","7562650  -  SCREW 7562650 FIXED ANGLE 6.0X50 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562655","SUP","HCPCS C1713","","7562655  -  SCREW 7562655 FIXED ANGLE 6.0X55 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7562660","SUP","HCPCS C1713","","7562660  -  SCREW 7562660 FIXED ANGLE 6.0X60 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563420","SUP","HCPCS C1713","","7563420  -  SCREW 7563420 FIXED ANGLE 4.5X20 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563425","SUP","HCPCS C1713","","7563425  -  SCREW 7563425 FIXED ANGLE 4.5X25 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563430","SUP","HCPCS C1713","","7563430  -  SCREW 7563430 FIXED ANGLE 4.5X30 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563435","SUP","HCPCS C1713","","7563435  -  SCREW 7563435 FIXED ANGLE 4.5X35 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563440","SUP","HCPCS C1713","","7563440  -  SCREW 7563440 FIXED ANGLE 4.5X40 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563445","SUP","HCPCS C1713","","7563445  -  SCREW 7563445 FIXED ANGLE 4.5X45 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563450","SUP","HCPCS C1713","","7563450  -  SCREW 7563450 FIXED ANGLE 4.5X50 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563455","SUP","HCPCS C1713","","7563455  -  SCREW 7563455 FIXED ANGLE 4.5X55 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563525","SUP","HCPCS C1713","","7563525  -  SCREW 7563525 FIXED ANGLE 5.5X25 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563530","SUP","HCPCS C1713","","7563530  -  SCREW 7563530 FIXED ANGLE 5.5X30 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563535","SUP","HCPCS C1713","","7563535  -  SCREW 7563535 FIXED ANGLE 5.5X35 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563540","SUP","HCPCS C1713","","7563540  -  SCREW 7563540 FIXED ANGLE 5.5X40 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563545","SUP","HCPCS C1713","","7563545  -  SCREW 7563545 FIXED ANGLE 5.5X45 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563550","SUP","HCPCS C1713","","7563550  -  SCREW 7563550 FIXED ANGLE 5.5X50 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563555","SUP","HCPCS C1713","","7563555  -  SCREW 7563555 FIXED ANGLE 5.5X55 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563560","SUP","HCPCS C1713","","7563560  -  SCREW 7563560 FIXED ANGLE 5.5X60 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563625","SUP","HCPCS C1713","","7563625  -  SCREW 7563625 FIXED ANGLE 6.5X25 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563630","SUP","HCPCS C1713","","7563630  -  SCREW 7563630 FIXED ANGLE 6.5X30 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563635","SUP","HCPCS C1713","","7563635  -  SCREW 7563635 FIXED ANGLE 6.5X35 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563640","SUP","HCPCS C1713","","7563640  -  SCREW 7563640 FIXED ANGLE 6.5X40 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563645","SUP","HCPCS C1713","","7563645  -  SCREW 7563645 FIXED ANGLE 6.5X45 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563650","SUP","HCPCS C1713","","7563650  -  SCREW 7563650 FIXED ANGLE 6.5X50 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563655","SUP","HCPCS C1713","","7563655  -  SCREW 7563655 FIXED ANGLE 6.5X55 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563660","SUP","HCPCS C1713","","7563660  -  SCREW 7563660 FIXED ANGLE 6.5X60 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563725","SUP","HCPCS C1713","","7563725  -  SCREW 7563725 FIXED ANGLE 7.5X25 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563730","SUP","HCPCS C1713","","7563730  -  SCREW 7563730 FIXED ANGLE 7.5X30 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563735","SUP","HCPCS C1713","","7563735  -  SCREW 7563735 FIXED ANGLE 7.5X35 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563740","SUP","HCPCS C1713","","7563740  -  SCREW 7563740 FIXED ANGLE 7.5X40 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563745","SUP","HCPCS C1713","","7563745  -  SCREW 7563745 FIXED ANGLE 7.5X45 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563750","SUP","HCPCS C1713","","7563750  -  SCREW 7563750 FIXED ANGLE 7.5X50 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563755","SUP","HCPCS C1713","","7563755  -  SCREW 7563755 FIXED ANGLE 7.5X55 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563760","SUP","HCPCS C1713","","7563760  -  SCREW 7563760 FIXED ANGLE 7.5X60 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7563765","SUP","HCPCS C1713","","7563765  -  SCREW 7563765 FIXED ANGLE 7.5X65 SS","BOTH IP/OP","$2,036.15 ","$1,506.75 ","$0.00 ","$2,036.15 ","$916.27 ","$0.00 ","$424.38 ","$0.00 ","$0.00 ","$356.51 ","$2,036.15 ","$0.00 ","$1,018.08 ","$1,612.63 ","$1,628.92 ","$0.00 ","$318.66 ","$0.00 ","$324.16 ","$0.00 "
"7565025","SUP","HCPCS C1713","","7565025  -  BOLT SPNL 6.5MM 25MM PLT","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565030","SUP","HCPCS C1713","","7565030  -  BOLT SPNL 6.5MM 30MM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565035","SUP","HCPCS C1713","","7565035  -  BOLT SPNL 6.5MM 35MM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565040","SUP","HCPCS C1713","","7565040  -  BOLT SPNL 6.5MM 40MM XLP","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565045","SUP","HCPCS C1713","","7565045  -  BOLT SPNL 6.5MM 45MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565050","SUP","HCPCS C1713","","7565050  -  BOLT SPNL 6.5MM 50MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565055","SUP","HCPCS C1713","","7565055  -  BOLT SPNL 6.5MM 55MM TI","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565060","SUP","HCPCS C1713","","7565060  -  BOLT SPNL 6.5MM 60MM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7565065","SUP","HCPCS C1713","","7565065  -  BOLT SPNL 6.5MM 65MM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7570955","SUP","HCPCS C1713","","7570955  -  SCREW SET CD HZN SXTNT II BRKOF SS SPNE PDCL ROD INS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7571030","SUP","HCPCS C1713","","7571030  -  ROD 7571030 5.5MM STRAIGHT 30MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571035","SUP","HCPCS C1713","","7571035  -  PLATE BN 35MM AFFIX II SPNE SPINOUS PRC","BOTH IP/OP","$8,730.00 ","$6,460.20 ","$0.00 ","$8,730.00 ","$3,928.50 ","$0.00 ","$1,819.55 ","$0.00 ","$0.00 ","$1,528.55 ","$8,730.00 ","$0.00 ","$4,365.00 ","$6,914.16 ","$6,984.00 ","$0.00 ","$1,366.25 ","$0.00 ","$1,389.82 ","$0.00 "
"7571040","SUP","HCPCS C1713","","7571040  -  ROD 7571040 5.5MM STRAIGHT 40MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571045","SUP","HCPCS C1713","","7571045  -  PLATE BN 45MM XLIF AFFIX XTRM SPNE","BOTH IP/OP","$8,730.00 ","$6,460.20 ","$0.00 ","$8,730.00 ","$3,928.50 ","$0.00 ","$1,819.55 ","$0.00 ","$0.00 ","$1,528.55 ","$8,730.00 ","$0.00 ","$4,365.00 ","$6,914.16 ","$6,984.00 ","$0.00 ","$1,366.25 ","$0.00 ","$1,389.82 ","$0.00 "
"7571050","SUP","HCPCS C1713","","7571050  -  ROD 7571050 5.5MM STRAIGHT 50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571055","SUP","HCPCS C1713","","7571055  -  PLATE BN 55MM AFFIX II SPNE SPINOUS PRC","BOTH IP/OP","$8,730.00 ","$6,460.20 ","$0.00 ","$8,730.00 ","$3,928.50 ","$0.00 ","$1,819.55 ","$0.00 ","$0.00 ","$1,528.55 ","$8,730.00 ","$0.00 ","$4,365.00 ","$6,914.16 ","$6,984.00 ","$0.00 ","$1,366.25 ","$0.00 ","$1,389.82 ","$0.00 "
"7571060","SUP","HCPCS C1713","","7571060  -  ROD 7571060 5.5MM STRAIGHT 60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571070","SUP","HCPCS C1713","","7571070  -  ROD 7571070 5.5MM STRAIGHT 70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571080","SUP","HCPCS C1713","","7571080  -  ROD 7571080 5.5MM STRAIGHT 80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571090","SUP","HCPCS C1713","","7571090  -  ROD 7571090 5.5MM STRAIGHT 90MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571100","SUP","HCPCS C1713","","7571100  -  ROD 7571100 5.5MM STRAIGHT 100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571110","SUP","HCPCS C1713","","7571110  -  ROD 7571110 5.5MM STRAIGHT 110MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571120","SUP","HCPCS C1713","","7571120  -  ROD 7571120 5.5MM STRAIGHT 120MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571130","SUP","HCPCS C1713","","7571130  -  ROD 7571130 5.5MM STRAIGHT 130MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571140","SUP","HCPCS C1713","","7571140  -  ROD 7571140 5.5MM STRAIGHT 140MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571150","SUP","HCPCS C1713","","7571150  -  ROD 7571150 5.5MM STRAIGHT 150MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571160","SUP","HCPCS C1713","","7571160  -  ROD 7571160 5.5MM STRAIGHT 160MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571170","SUP","HCPCS C1713","","7571170  -  ROD 7571170 5.5MM STRAIGHT 170MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571180","SUP","HCPCS C1713","","7571180  -  ROD 7571180 5.5MM STRAIGHT 180MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571190","SUP","HCPCS C1713","","7571190  -  ROD 7571190 5.5MM STRAIGHT 190MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571200","SUP","HCPCS C1713","","7571200  -  ROD 7571200 5.5MM STRAIGHT 200MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571210","SUP","HCPCS C1713","","7571210  -  ROD 7571210 5.5MM STRAIGHT 210MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571220","SUP","HCPCS C1713","","7571220  -  ROD 7571220 5.5MM STRAIGHT 220MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571230","SUP","HCPCS C1713","","7571230  -  ROD 7571230 5.5MM STRAIGHT 230MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571240","SUP","HCPCS C1713","","7571240  -  ROD 7571240 5.5MM STRAIGHT 240MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571250","SUP","HCPCS C1713","","7571250  -  ROD 7571250 5.5MM STRAIGHT 250MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571260","SUP","HCPCS C1713","","7571260  -  ROD 7571260 5.5MM STRAIGHT 260MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571270","SUP","HCPCS C1713","","7571270  -  ROD 7571270 5.5MM STRAIGHT 270MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571280","SUP","HCPCS C1713","","7571280  -  ROD 7571280 5.5MM STRAIGHT 280MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571290","SUP","HCPCS C1713","","7571290  -  ROD 7571290 5.5MM STRAIGHT 290MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571300","SUP","HCPCS C1713","","7571300  -  ROD 7571300 5.5MM STRAIGHT 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571310","SUP","HCPCS C1713","","7571310  -  ROD 7571310 5.5MM STRAIGHT 310MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571320","SUP","HCPCS C1713","","7571320  -  ROD 7571320 5.5MM STRAIGHT 320MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571330","SUP","HCPCS C1713","","7571330  -  ROD 7571330 5.5MM STRAIGHT 330MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571340","SUP","HCPCS C1713","","7571340  -  ROD 7571340 5.5MM STRAIGHT 340MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571350","SUP","HCPCS C1713","","7571350  -  ROD 7571350 5.5MM STRAIGHT 350MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571360","SUP","HCPCS C1713","","7571360  -  ROD 7571360 5.5MM STRAIGHT 360MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571370","SUP","HCPCS C1713","","7571370  -  ROD 7571370 5.5MM STRAIGHT 370MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571380","SUP","HCPCS C1713","","7571380  -  ROD 7571380 5.5MM STRAIGHT 380MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571390","SUP","HCPCS C1713","","7571390  -  ROD 7571390 5.5MM STRAIGHT 390MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571400","SUP","HCPCS C1713","","7571400  -  ROD 7571400 5.5MM STRAIGHT 400MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571410","SUP","HCPCS C1713","","7571410  -  ROD 7571410 5.5MM STRAIGHT 410MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571420","SUP","HCPCS C1713","","7571420  -  ROD 7571420 5.5MM STRAIGHT 420MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571430","SUP","HCPCS C1713","","7571430  -  ROD 7571430 5.5MM STRAIGHT 430MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571440","SUP","HCPCS C1713","","7571440  -  ROD 7571440 5.5MM STRAIGHT 440MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571450","SUP","HCPCS C1713","","7571450  -  ROD 7571450 5.5MM STRAIGHT 450MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571460","SUP","HCPCS C1713","","7571460  -  ROD 7571460 5.5MM STRAIGHT 460MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571470","SUP","HCPCS C1713","","7571470  -  ROD 7571470 5.5MM STRAIGHT 470MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571480","SUP","HCPCS C1713","","7571480  -  ROD 7571480 5.5MM STRAIGHT 480MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571490","SUP","HCPCS C1713","","7571490  -  ROD 7571490 5.5MM STRAIGHT 490MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7571500","SUP","HCPCS C1713","","7571500  -  ROD 7571500 5.5MM STRAIGHT 500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7575535","SUP","HCPCS C1713","","7575535  -  SCREW BN 5.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7575540","SUP","HCPCS C1713","","7575540  -  SCREW BN 5.5MM 40MM CD HZN LGC MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7575545","SUP","HCPCS C1713","","7575545  -  SCREW BN 5.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7575550","SUP","HCPCS C1713","","7575550  -  SCREW BN 5.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7576309","SUP","Custom 27203010","","7576309  -  INSTRUMENT 7576309 TALL REDUX NUT DR","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$726.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$726.00 ","$0.00 ","$363.00 ","$574.99 ","$580.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7576535","SUP","HCPCS C1713","","7576535  -  SCREW BN 6.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7576540","SUP","HCPCS C1713","","7576540  -  SCREW BN 6.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7576545","SUP","HCPCS C1713","","7576545  -  SCREW BN 6.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7576550","SUP","HCPCS C1713","","7576550  -  SCREW BN 6.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7576555","SUP","HCPCS C1713","","7576555  -  SCREW BN 6.5MM 55MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7577025","SUP","HCPCS C1713","","7577025  -  PLATE BN MN 25MM NS AFFIX II SPNE LMBR","BOTH IP/OP","$9,162.50 ","$6,780.25 ","$0.00 ","$9,162.50 ","$4,123.13 ","$0.00 ","$1,909.69 ","$0.00 ","$0.00 ","$1,604.28 ","$9,162.50 ","$0.00 ","$4,581.25 ","$7,256.70 ","$7,330.00 ","$0.00 ","$1,433.93 ","$0.00 ","$1,458.67 ","$0.00 "
"7577035","SUP","HCPCS C1713","","7577035  -  PLATE BN 35MM NS AFFIX II SPNE LMBR","BOTH IP/OP","$9,162.50 ","$6,780.25 ","$0.00 ","$9,162.50 ","$4,123.13 ","$0.00 ","$1,909.69 ","$0.00 ","$0.00 ","$1,604.28 ","$9,162.50 ","$0.00 ","$4,581.25 ","$7,256.70 ","$7,330.00 ","$0.00 ","$1,433.93 ","$0.00 ","$1,458.67 ","$0.00 "
"7577045","SUP","HCPCS C1713","","7577045  -  PLATE BN 45MM NS AFFIX II SPNE LMBR","BOTH IP/OP","$9,162.50 ","$6,780.25 ","$0.00 ","$9,162.50 ","$4,123.13 ","$0.00 ","$1,909.69 ","$0.00 ","$0.00 ","$1,604.28 ","$9,162.50 ","$0.00 ","$4,581.25 ","$7,256.70 ","$7,330.00 ","$0.00 ","$1,433.93 ","$0.00 ","$1,458.67 ","$0.00 "
"7577055","SUP","HCPCS C1713","","7577055  -  PLATE BN 55MM NS AFFIX II SPNE LMBR","BOTH IP/OP","$9,162.50 ","$6,780.25 ","$0.00 ","$9,162.50 ","$4,123.13 ","$0.00 ","$1,909.69 ","$0.00 ","$0.00 ","$1,604.28 ","$9,162.50 ","$0.00 ","$4,581.25 ","$7,256.70 ","$7,330.00 ","$0.00 ","$1,433.93 ","$0.00 ","$1,458.67 ","$0.00 "
"7577530","SUP","HCPCS C1713","","7577530  -  SCREW BN 7.5MM 30MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7577535","SUP","HCPCS C1713","","7577535  -  SCREW BN 7.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7577540","SUP","HCPCS C1713","","7577540  -  SCREW BN 7.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7577545","SUP","HCPCS C1713","","7577545  -  SCREW BN 7.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$6,185.00 ","$4,576.90 ","$0.00 ","$6,185.00 ","$2,783.25 ","$0.00 ","$1,289.11 ","$0.00 ","$0.00 ","$1,082.94 ","$6,185.00 ","$0.00 ","$3,092.50 ","$4,898.52 ","$4,948.00 ","$0.00 ","$967.95 ","$0.00 ","$984.65 ","$0.00 "
"7600320","SUP","HCPCS C1713","","7600320  -  SUB BNGFT CALCIUM PHOS CLGN 20ML MS GRFT VOID FILR MTRX","BOTH IP/OP","$3,575.00 ","$2,645.50 ","$0.00 ","$3,575.00 ","$1,608.75 ","$0.00 ","$745.12 ","$0.00 ","$0.00 ","$625.95 ","$3,575.00 ","$0.00 ","$1,787.50 ","$2,831.40 ","$2,860.00 ","$0.00 ","$559.49 ","$0.00 ","$569.14 ","$0.00 "
"7640120","SUP","HCPCS C1713","","7640120  -  SET SCREW 7640120 NON BREAK OFF  TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7640220","SUP","HCPCS C1713","","7640220  -  SET SCREW 7640220 REDUCTION PLUG  TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7641102","SUP","HCPCS C1713","","7641102  -  HOOK 7641102 L6.35 PEDICLE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641103","SUP","HCPCS C1713","","7641103  -  HOOK 7641103 L6.35 PEDICLE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641104","SUP","HCPCS C1713","","7641104  -  HOOK 7641104 L6.35 PEDICLE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641112","SUP","HCPCS C1713","","7641112  -  HOOK 7641112 L6.35 WIDE BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641113","SUP","HCPCS C1713","","7641113  -  HOOK 7641113 L6.35 WIDE BLADE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641114","SUP","HCPCS C1713","","7641114  -  HOOK 7641114 L6.35 WIDE BLADE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641122","SUP","HCPCS C1713","","7641122  -  HOOK 7641122 L6.35 NARRW BLDE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641123","SUP","HCPCS C1713","","7641123  -  HOOK 7641123 L6.35 NARRW BLDE MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641124","SUP","HCPCS C1713","","7641124  -  HOOK 7641124 L6.35 NARRW BLDE LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641133","SUP","HCPCS C1713","","7641133  -  HOOK 7641133 RAMP WIDE BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641142","SUP","HCPCS C1713","","7641142  -  HOOK 7641142 RAMP NARROW BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641143","SUP","HCPCS C1713","","7641143  -  HOOK 7641143 RAMP NARROW BLADE MED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641162","SUP","HCPCS C1713","","7641162  -  HOOK 7641162 LUMBAR ANG BLADE SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641163","SUP","HCPCS C1713","","7641163  -  HOOK 7641163 LUMBAR ANG BLADE MED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641173","SUP","HCPCS C1713","","7641173  -  HOOK 7641173 EXTENDED BODY MED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641174","SUP","HCPCS C1713","","7641174  -  HOOK 7641174 EXTENDED BODY LARGE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641188","SUP","HCPCS C1713","","7641188  -  HOOK 7641188 THORACIC ANG BLADE RT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641189","SUP","HCPCS C1713","","7641189  -  HOOK 7641189 THORACIC ANG BLADE LT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641198","SUP","HCPCS C1713","","7641198  -  HOOK 7641198 OFFSET RIGHT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641199","SUP","HCPCS C1713","","7641199  -  HOOK 7641199 OFFSET LEFT TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641202","SUP","HCPCS C1713","","7641202  -  HOOK 7641202 PEDICLE WITH LIP SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641203","SUP","HCPCS C1713","","7641203  -  HOOK 7641203 PEDICLE WITH LIP MED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641204","SUP","HCPCS C1713","","7641204  -  HOOK 7641204 PEDICLE WITH LIP LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641212","SUP","HCPCS C1713","","7641212  -  HOOK 7641212 WIDE BLADE W SHELF SM T","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641213","SUP","HCPCS C1713","","7641213  -  HOOK 7641213 WIDE BLADE W SHELF MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641214","SUP","HCPCS C1713","","7641214  -  HOOK 7641214 WIDE BLADE W SHELF LG TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641222","SUP","HCPCS C1713","","7641222  -  HOOK 7641222 NARROW BLADE W SHELF SM TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641223","SUP","HCPCS C1713","","7641223  -  HOOK 7641223 NARROW BLADE W SHELF MD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7641224","SUP","HCPCS C1713","","7641224  -  HOOK 7641224 NARROW BLADE W SHELF LG T","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7642420","SUP","HCPCS C1713","","7642420  -  SCREW, FIXED ANGLE, 4.0X20, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642425","SUP","HCPCS C1713","","7642425  -  SCREW, FIXED ANGLE, 4.0X25, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642430","SUP","HCPCS C1713","","7642430  -  SCREW, FIXED ANGLE, 4.0X30, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642435","SUP","HCPCS C1713","","7642435  -  SCREW, FIXED ANGLE, 4.0X35, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642440","SUP","HCPCS C1713","","7642440  -  SCREW, FIXED ANGLE, 4.0X40, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642445","SUP","HCPCS C1713","","7642445  -  SCREW, FIXED ANGLE, 4.0X45, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642450","SUP","HCPCS C1713","","7642450  -  SCREW, FIXED ANGLE, 4.0X50, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642455","SUP","HCPCS C1713","","7642455  -  SCREW, FIXED ANGLE, 4.0X55, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642520","SUP","HCPCS C1713","","7642520  -  SCREW, FIXED ANGLE, 5.0X20, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642525","SUP","HCPCS C1713","","7642525  -  SCREW, FIXED ANGLE, 5.0X25, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642530","SUP","HCPCS C1713","","7642530  -  SCREW, FIXED ANGLE, 5.0X30, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642535","SUP","HCPCS C1713","","7642535  -  SCREW, FIXED ANGLE, 5.0X35, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642540","SUP","HCPCS C1713","","7642540  -  SCREW, FIXED ANGLE, 5.0X40, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642545","SUP","HCPCS C1713","","7642545  -  SCREW, FIXED ANGLE, 5.0X45, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642550","SUP","HCPCS C1713","","7642550  -  SCREW, FIXED ANGLE, 5.0X50, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642555","SUP","HCPCS C1713","","7642555  -  FIXED ANGLE 5.0X55 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642625","SUP","HCPCS C1713","","7642625  -  SCREW, FIXED ANGLE, 6.0X25, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642630","SUP","HCPCS C1713","","7642630  -  SCREW, FIXED ANGLE, 6.0X30, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642635","SUP","HCPCS C1713","","7642635  -  SCREW, FIXED ANGLE, 6.0X35, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642640","SUP","HCPCS C1713","","7642640  -  SCREW, FIXED ANGLE, 6.0X40, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642645","SUP","HCPCS C1713","","7642645  -  SCREW, FIXED ANGLE, 6.0X45, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642650","SUP","HCPCS C1713","","7642650  -  SCREW, FIXED ANGLE, 6.0X50, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642655","SUP","HCPCS C1713","","7642655  -  SCREW, FIXED ANGLE, 6.0X55, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7642660","SUP","HCPCS C1713","","7642660  -  SCREW, FIXED ANGLE, 6.0X60, TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643420","SUP","HCPCS C1713","","7643420  -  BONE SCREW 7643420 FXD ANGLE 4.5X20 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643425","SUP","HCPCS C1713","","7643425  -  BONE SCREW 7643425 FXD ANGLE 4.5X25 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643430","SUP","HCPCS C1713","","7643430  -  BONE SCREW 7643430 FXD ANGLE 4.5X30 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643435","SUP","HCPCS C1713","","7643435  -  BONE SCREW 7643435 FXD ANGLE 4.5X35 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643440","SUP","HCPCS C1713","","7643440  -  BONE SCREW 7643440 FXD ANGLE 4.5X40 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643445","SUP","HCPCS C1713","","7643445  -  BONE SCREW 7643445 FXD ANGLE 4.5X45 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643450","SUP","HCPCS C1713","","7643450  -  BONE SCREW 7643450 FXD ANGLE 4.5X50 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643455","SUP","HCPCS C1713","","7643455  -  BONE SCREW 7643455 FXD ANGLE 4.5X55 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643525","SUP","HCPCS C1713","","7643525  -  BONE SCREW 7643525 FXD ANGLE 5.5X25 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643530","SUP","HCPCS C1713","","7643530  -  BONE SCREW 7643530 FXD ANGLE 5.5X30 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643535","SUP","HCPCS C1713","","7643535  -  BONE SCREW 7643535 FXD ANGLE 5.5X35 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643540","SUP","HCPCS C1713","","7643540  -  BONE SCREW 7643540 FXD ANGLE 5.5X40 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643545","SUP","HCPCS C1713","","7643545  -  BONE SCREW 7643545 FXD ANGLE 5.5X45 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643550","SUP","HCPCS C1713","","7643550  -  BONE SCREW 7643550 FXD ANGLE 5.5X50 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643555","SUP","HCPCS C1713","","7643555  -  BONE SCREW 7643555 FXD ANGLE 5.5X55 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643560","SUP","HCPCS C1713","","7643560  -  BONE SCREW 7643560 FXD ANGLE 5.5X60 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643625","SUP","HCPCS C1713","","7643625  -  SCREW 7643625 FIXED ANGLE 6.5X25 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643630","SUP","HCPCS C1713","","7643630  -  SCREW 7643630 FIXED ANGLE 6.5X30 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643635","SUP","HCPCS C1713","","7643635  -  BONE SCREW 7643635 FXD ANGLE 6.5X35 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643640","SUP","HCPCS C1713","","7643640  -  BONE SCREW 7643640 FXD ANGLE 6.5X40 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643645","SUP","HCPCS C1713","","7643645  -  BONE SCREW 7643645 FXD ANGLE 6.5X45 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643650","SUP","HCPCS C1713","","7643650  -  BONE SCREW 7643650 FXD ANGLE 6.5X50 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643655","SUP","HCPCS C1713","","7643655  -  BONE SCREW 7643655 FXD ANGLE 6.5X55 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643660","SUP","HCPCS C1713","","7643660  -  BONE SCREW 7643660 FXD ANGLE 6.5X60 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643665","SUP","HCPCS C1713","","7643665  -  BONE SCREW 7643665 FXD ANGLE 6.5X65 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643670","SUP","HCPCS C1713","","7643670  -  BONE SCREW 7643670 FXD ANGLE 6.5X70 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643725","SUP","HCPCS C1713","","7643725  -  BONE SCREW 7643725 FXD ANGLE 7.5X25 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643730","SUP","HCPCS C1713","","7643730  -  BONE SCREW 7643730 FXD ANGLE 7.5X30 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643735","SUP","HCPCS C1713","","7643735  -  BONE SCREW 7643735 FXD ANGLE 7.5X35 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643740","SUP","HCPCS C1713","","7643740  -  BONE SCREW 7643740 FXD ANGLE 7.5X40 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643745","SUP","HCPCS C1713","","7643745  -  BONE SCREW 7643745 FXD ANGLE 7.5X45 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643750","SUP","HCPCS C1713","","7643750  -  BONE SCREW 7643750 FXD ANGLE 7.5X50 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643755","SUP","HCPCS C1713","","7643755  -  BONE SCREW 7643755 FXD ANGLE 7.5X55 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643760","SUP","HCPCS C1713","","7643760  -  BONE SCREW 7643760 FXD ANGLE 7.5X60 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7643765","SUP","HCPCS C1713","","7643765  -  BONE SCREW 7643765 FXD ANGLE 7.5X65 TI","BOTH IP/OP","$1,933.50 ","$1,430.79 ","$0.00 ","$1,933.50 ","$870.08 ","$0.00 ","$402.99 ","$0.00 ","$0.00 ","$338.54 ","$1,933.50 ","$0.00 ","$966.75 ","$1,531.33 ","$1,546.80 ","$0.00 ","$302.59 ","$0.00 ","$307.81 ","$0.00 "
"7650008","SUP","HCPCS C1713","","7650008  -  PLATE BONE SMALL 8MM TRADITIONAL SPN CERV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650009","SUP","HCPCS C1713","","7650009  -  PLATE BONE MEDIUM 9.5MM TRADITIONAL SPN CERV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650011","SUP","HCPCS C1713","","7650011  -  PLATE BONE LARGE 11MM TRADITIONAL SPN CERV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650012","SUP","HCPCS C1713","","7650012  -  PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650108","SUP","HCPCS C1713","","7650108  -  PLATE BN SM 8MM NS LVRG TRD SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650109","SUP","HCPCS C1713","","7650109  -  PLATE MED 9.5MM TRD BONE SPN CERV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650111","SUP","HCPCS C1713","","7650111  -  PLATE BN LG 11MM NS LVRG TRD SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650112","SUP","HCPCS C1713","","7650112  -  PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650208","SUP","HCPCS C1713","","7650208  -  PLATE BONE SMALL 8MM GRAFT SPN CERV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650209","SUP","HCPCS C1713","","7650209  -  PLATE BONE MEDIUM 9.5MM GRAFT SPN CERV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650211","SUP","HCPCS C1713","","7650211  -  PLATE BN LG 11MM NS LVRG GFT SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650212","SUP","HCPCS C1713","","7650212  -  PLATE BN XL 12.5MM GFT SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650308","SUP","HCPCS C1713","","7650308  -  PLATE BN SM 8MM NS LVRG GFT SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650309","SUP","HCPCS C1713","","7650309  -  PLATE BN MED 9.5MM NS LVRG GFT SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650311","SUP","HCPCS C1713","","7650311  -  PLATE BN LG 11MM NS LVRG GFT SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650312","SUP","HCPCS C1713","","7650312  -  PLATE BN XL 12.5MM NS LVRG GFT SPNE CRV","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650408","SUP","HCPCS C1713","","7650408  -  PLATE BN SM 8MM NS LVRG SPNE CRV LMN","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650409","SUP","HCPCS C1713","","7650409  -  PLATE BN MED 9.5MM NS LVRG SPNE CRV LMN","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650411","SUP","HCPCS C1713","","7650411  -  PLATE BN LG 11MM NS LVRG SPNE CRV LMN","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650412","SUP","HCPCS C1713","","7650412  -  PLATE BN XL 12.5MM NS LVRG SPNE CRV LMN","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"7650505","SUP","HCPCS C1713","","7650505  -  SCREW BONE 2.6MM 5MM LATERAL MASS CERV","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650506","SUP","HCPCS C1713","","7650506  -  SCREW BONE 2.6MM 6MM LATERAL MASS SPN CERV","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650507","SUP","HCPCS C1713","","7650507  -  SCREW BONE 2.6MM 7MM LATERAL MASS SPN CERV","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650508","SUP","HCPCS C1713","","7650508  -  LATERAL MASS SCREW, 2.6X8MM","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650605","SUP","HCPCS C1713","","7650605  -  SCREW BONE 3MM 5MM LATERAL MASS CERV","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650607","SUP","HCPCS C1713","","7650607  -  SCREW BONE 3MM 7MM LATERAL MASS SPN CERV","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650608","SUP","HCPCS C1713","","7650608  -  SCREW BN 3MM 8MM NS LVRG LAT MASS SPNE CRV","BOTH IP/OP","$410.00 ","$303.40 ","$0.00 ","$410.00 ","$184.50 ","$0.00 ","$85.45 ","$0.00 ","$0.00 ","$71.79 ","$410.00 ","$0.00 ","$205.00 ","$324.72 ","$328.00 ","$0.00 ","$64.17 ","$0.00 ","$65.27 ","$0.00 "
"7650705","SUP","HCPCS C1713","","7650705  -  SCREW BONE 2.6MM 5MM SPN CERV LAMINA","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"7650753","SUP","Custom 27203010","","7650753  -  BIT DRILL 3MM SHAFT SPN DISPOSABLE","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7650755","SUP","Custom 27203010","","7650755  -  BIT DRILL 5MM SHAFT SPN DISPOSABLE","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7650756","SUP","Custom 27203010","","7650756  -  BIT DRILL 6MM SHAFT SPN DISPOSABLE","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7650757","SUP","Custom 27203010","","7650757  -  BIT DRILL 7MM SHAFT DISPOSABLE LVG LFS","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7650758","SUP","Custom 27203010","","7650758  -  LAMINOPLASTY DRILL BIT, 8MM","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7650805","SUP","HCPCS C1713","","7650805  -  SCREW BONE 3MM 5MM LAMINA CERV SPN","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"7650811","SUP","HCPCS C1713","","7650811  -  CAGE SPNL 11MM ALGRF XLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7650812","SUP","HCPCS C1713","","7650812  -  CAGE SPNL 12.5MM ALGRF XLIF","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7660020","SUP","HCPCS C1713","","7660020  -  SET SCREW 7660020 BREAK OFF  SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7660120","SUP","HCPCS C1713","","7660120  -  SET SCREW 7660120 NON BREAK OFF  SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7660220","SUP","HCPCS C1713","","7660220  -  SET SCREW 7660220 REDUCTION PLUG  SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7661102","SUP","HCPCS C1713","","7661102  -  HOOK 7661102 PEDICLE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661103","SUP","HCPCS C1713","","7661103  -  HOOK 7661103 PEDICLE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661104","SUP","HCPCS C1713","","7661104  -  HOOK 7661104 PEDICLE LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661112","SUP","HCPCS C1713","","7661112  -  HOOK 7661112 WIDE BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661113","SUP","HCPCS C1713","","7661113  -  HOOK 7661113 WIDE BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661114","SUP","HCPCS C1713","","7661114  -  HOOK 7661114 WIDE BLADE LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661122","SUP","HCPCS C1713","","7661122  -  HOOK 7661122 NARROW BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661123","SUP","HCPCS C1713","","7661123  -  HOOK 7661123 NARROW BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661124","SUP","HCPCS C1713","","7661124  -  HOOK 7661124 NARROW BLADE LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661133","SUP","HCPCS C1713","","7661133  -  HOOK 7661133 RAMP WIDE BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661142","SUP","HCPCS C1713","","7661142  -  HOOK 7661142 RAMP NARROW BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661143","SUP","HCPCS C1713","","7661143  -  HOOK 7661143 RAMP NARROW BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661162","SUP","HCPCS C1713","","7661162  -  HOOK 7661162 LUMBAR ANG BLADE SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661163","SUP","HCPCS C1713","","7661163  -  HOOK 7661163 LUMBAR ANG BLADE MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661173","SUP","HCPCS C1713","","7661173  -  HOOK 7661173 EXTENDED BODY MD SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661174","SUP","HCPCS C1713","","7661174  -  HOOK 7661174 EXTENDED BODY LG SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661188","SUP","HCPCS C1713","","7661188  -  HOOK 7661188 THORACIC ANG BLADE RT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661189","SUP","HCPCS C1713","","7661189  -  HOOK 7661189 THORACIC ANG BLADE LT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661198","SUP","HCPCS C1713","","7661198  -  HOOK 7661198 OFFSET RT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661199","SUP","HCPCS C1713","","7661199  -  HOOK 7661199 OFFSET LT SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661202","SUP","HCPCS C1713","","7661202  -  HOOK 7661202 PEDICLE WITH LIP SM SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661203","SUP","HCPCS C1713","","7661203  -  HOOK, PEDICLE WITH LIP, MD,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661204","SUP","HCPCS C1713","","7661204  -  HOOK, PEDICLE WITH LIP, LG,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661212","SUP","HCPCS C1713","","7661212  -  HOOK, WIDE BLADE W/LIP,SM,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661213","SUP","HCPCS C1713","","7661213  -  HOOK, WIDE BLADE W/LIP,MD,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661214","SUP","HCPCS C1713","","7661214  -  HOOK, WIDE BLADE W/LIP,LG,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661222","SUP","HCPCS C1713","","7661222  -  HOOK, NARROW BLADE W/LIP,SM,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661223","SUP","HCPCS C1713","","7661223  -  HOOK, NARROW BLADE W/LIP,MD,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7661224","SUP","HCPCS C1713","","7661224  -  HOOK, NARROW BLADE W/LIP,LG,SS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7662420","SUP","HCPCS C1713","","7662420  -  SCREW, FIXED ANGLE, 4.0X20, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662425","SUP","HCPCS C1713","","7662425  -  SCREW, FIXED ANGLE, 4.0X25, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662430","SUP","HCPCS C1713","","7662430  -  SCREW, FIXED ANGLE, 4.0X30, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662435","SUP","HCPCS C1713","","7662435  -  SCREW, FIXED ANGLE, 4.0X35, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662440","SUP","HCPCS C1713","","7662440  -  SCREW, FIXED ANGLE, 4.0X40, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662445","SUP","HCPCS C1713","","7662445  -  SCREW, FIXED ANGLE, 4.0X45, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662450","SUP","HCPCS C1713","","7662450  -  SCREW, FIXED ANGLE, 4.0X50, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662455","SUP","HCPCS C1713","","7662455  -  SCREW, FIXED ANGLE, 4.0X55, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662520","SUP","HCPCS C1713","","7662520  -  SCREW, FIXED ANGLE, 5.0X20, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662525","SUP","HCPCS C1713","","7662525  -  SCREW, FIXED ANGLE, 5.0X25, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662530","SUP","HCPCS C1713","","7662530  -  SCREW, FIXED ANGLE, 5.0X30, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662535","SUP","HCPCS C1713","","7662535  -  SCREW, FIXED ANGLE, 5.0X35, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662540","SUP","HCPCS C1713","","7662540  -  SCREW, FIXED ANGLE, 5.0X40, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662545","SUP","HCPCS C1713","","7662545  -  SCREW, FIXED ANGLE, 5.0X45, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662550","SUP","HCPCS C1713","","7662550  -  SCREW, FIXED ANGLE, 5.0X50, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662555","SUP","HCPCS C1713","","7662555  -  SCREW, FIXED ANGLE, 5.0X55, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662625","SUP","HCPCS C1713","","7662625  -  SCREW, FIXED ANGLE, 6.0X25, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662630","SUP","HCPCS C1713","","7662630  -  SCREW, FIXED ANGLE, 6.0X30, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662635","SUP","HCPCS C1713","","7662635  -  SCREW, FIXED ANGLE, 6.0X35, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662640","SUP","HCPCS C1713","","7662640  -  SCREW, FIXED ANGLE, 6.0X40, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662645","SUP","HCPCS C1713","","7662645  -  SCREW, FIXED ANGLE, 6.0X45, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662650","SUP","HCPCS C1713","","7662650  -  SCREW, FIXED ANGLE, 6.0X50, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662655","SUP","HCPCS C1713","","7662655  -  SCREW, FIXED ANGLE, 6.0X55, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7662660","SUP","HCPCS C1713","","7662660  -  SCREW, FIXED ANGLE, 6.0X60, SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663420","SUP","HCPCS C1713","","7663420  -  SCREW 7663420 FIXED ANGLE 4.5X20 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663425","SUP","HCPCS C1713","","7663425  -  SCREW 7663425 FIXED ANGLE 4.5X25 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663430","SUP","HCPCS C1713","","7663430  -  SCREW 7663430 FIXED ANGLE 4.5X30 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663435","SUP","HCPCS C1713","","7663435  -  SCREW 7663435 FIXED ANGLE 4.5X35 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663440","SUP","HCPCS C1713","","7663440  -  SCREW 7663440 FIXED ANGLE 4.5X40 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663445","SUP","HCPCS C1713","","7663445  -  SCREW 7663445 FIXED ANGLE 4.5X45 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663450","SUP","HCPCS C1713","","7663450  -  SCREW 7663450 FIXED ANGLE 4.5X50 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663455","SUP","HCPCS C1713","","7663455  -  SCREW 7663455 FIXED ANGLE 4.5X55 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663525","SUP","HCPCS C1713","","7663525  -  SCREW 7663525 FIXED ANGLE 5.5X25 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663530","SUP","HCPCS C1713","","7663530  -  SCREW 7663530 FIXED ANGLE 5.5X30 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663535","SUP","HCPCS C1713","","7663535  -  SCREW 7663535 FIXED ANGLE 5.5X35 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663540","SUP","HCPCS C1713","","7663540  -  SCREW 7663540 FIXED ANGLE 5.5X40 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663545","SUP","HCPCS C1713","","7663545  -  SCREW 7663545 FIXED ANGLE 5.5X45 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663550","SUP","HCPCS C1713","","7663550  -  SCREW 7663550 FIXED ANGLE 5.5X50 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663555","SUP","HCPCS C1713","","7663555  -  SCREW 7663555 FIXED ANGLE 5.5X55 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663560","SUP","HCPCS C1713","","7663560  -  SCREW 7663560 FIXED ANGLE 5.5X60 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663625","SUP","HCPCS C1713","","7663625  -  SCREW 7663625 FIXED ANGLE 6.5X25 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663630","SUP","HCPCS C1713","","7663630  -  SCREW 7663630 FIXED ANGLE 6.5X30 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663635","SUP","HCPCS C1713","","7663635  -  SCREW 7663635 FIXED ANGLE 6.5X35 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663640","SUP","HCPCS C1713","","7663640  -  SCREW 7663640 FIXED ANGLE 6.5X40 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663645","SUP","HCPCS C1713","","7663645  -  SCREW 7663645 FIXED ANGLE 6.5X45 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663650","SUP","HCPCS C1713","","7663650  -  SCREW 7663650 FIXED ANGLE 6.5X50 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663655","SUP","HCPCS C1713","","7663655  -  BONE SCREW 7663655 FIXED ANGLE 6.5X55 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663660","SUP","HCPCS C1713","","7663660  -  SCREW 7663660 FIXED ANGLE 6.5X60 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663665","SUP","HCPCS C1713","","7663665  -  SCREW 7663665 FIXED ANGLE 6.5X65 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663670","SUP","HCPCS C1713","","7663670  -  SCREW 7663670 FIXED ANGLE 6.5X70 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663725","SUP","HCPCS C1713","","7663725  -  SCREW 7663725 FIXED ANGLE 7.5X25 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663730","SUP","HCPCS C1713","","7663730  -  SCREW 7663730 FIXED ANGLE 7.5X30 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663735","SUP","HCPCS C1713","","7663735  -  SCREW 7663735 FIXED ANGLE 7.5X35 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663740","SUP","HCPCS C1713","","7663740  -  SCREW 7663740 FIXED ANGLE 7.5X40 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663745","SUP","HCPCS C1713","","7663745  -  SCREW 7663745 FIXED ANGLE 7.5X45 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663750","SUP","HCPCS C1713","","7663750  -  SCREW 7663750 FIXED ANGLE 7.5X50 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663755","SUP","HCPCS C1713","","7663755  -  SCREW 7663755 FIXED ANGLE 7.5X55 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663760","SUP","HCPCS C1713","","7663760  -  SCREW 7663760 FIXED ANGLE 7.5X60 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7663765","SUP","HCPCS C1713","","7663765  -  SCREW 7663765 FIXED ANGLE 7.5X65 SS","BOTH IP/OP","$1,762.50 ","$1,304.25 ","$0.00 ","$1,762.50 ","$793.13 ","$0.00 ","$367.35 ","$0.00 ","$0.00 ","$308.60 ","$1,762.50 ","$0.00 ","$881.25 ","$1,395.90 ","$1,410.00 ","$0.00 ","$275.83 ","$0.00 ","$280.59 ","$0.00 "
"7670212","SUP","HCPCS C1713","","7670212  -  12MM CASPAR PINS","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"7670214","SUP","HCPCS C1713","","7670214  -  SCREW DSTRCT 14MM PCM SPNE","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"7680265","SUP","Custom 27803010","","7680265  -  DISK SPNL SM 6.5MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680272","SUP","Custom 27803010","","7680272  -  DISC INTVRTB 14MM SM 17X7.2MM STRL LF PCM ARTF SPNE CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680280","SUP","Custom 27803010","","7680280  -  DISK SPNL SM 8MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680372","SUP","Custom 27803010","","7680372  -  DISK SPNL MED 7.2MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680380","SUP","Custom 27803010","","7680380  -  DISK SPNL MED 8MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680465","SUP","Custom 27803010","","7680465  -  DISK SPNL LG 6.5MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680472","SUP","Custom 27803010","","7680472  -  DISK SPNL LG 7.2MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7680480","SUP","Custom 27803010","","7680480  -  DISK SPNL LG 8MM PCM CRV","BOTH IP/OP","$13,077.50 ","$9,677.35 ","$0.00 ","$13,077.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,077.50 ","$0.00 ","$6,538.75 ","$10,357.38 ","$10,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7710635","SUP","HCPCS C1713","","7710635  -  CAGE SPNL 6MM CRNT LO CX PRFL PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7710835","SUP","HCPCS C1713","","7710835  -  CAGE SPNL 8MM CRNT LO CX PRFL PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7711055","SUP","HCPCS C1713","","7711055  -  CAGE SPNL 10MM CRNT LO CX PRFL PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7711275","SUP","HCPCS C1713","","7711275  -  CAGE SPNL 12MM CRNT LX","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7711495","SUP","HCPCS C1713","","7711495  -  SPACER SPNL 14MM CRNT LX EXTENSURE","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7711615","SUP","HCPCS C1713","","7711615  -  SPACER SPNL 16MM CRNT LX EXTENSURE","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7711835","SUP","HCPCS C1713","","7711835  -  SPACER SPNL 18MM CRNT LX EXTENSURE","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7712055","SUP","HCPCS C1713","","7712055  -  SPACER SPNL 20MM CRNT LX EXTENSURE LMBR INTRBD FS PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"7713510","SUP","HCPCS C1713","","7713510  -  SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713511","SUP","HCPCS C1713","","7713511  -  SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713512","SUP","HCPCS C1713","","7713512  -  SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713514","SUP","HCPCS C1713","","7713514  -  SCREW BONE 3.5MM 14MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713515","SUP","HCPCS C1713","","7713515  -  SCREW BONE 3.5MM 15MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713516","SUP","HCPCS C1713","","7713516  -  SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713517","SUP","HCPCS C1713","","7713517  -  SCREW BONE 3.5MM 17MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713518","SUP","HCPCS C1713","","7713518  -  SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713519","SUP","HCPCS C1713","","7713519  -  SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713520","SUP","HCPCS C1713","","7713520  -  SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713521","SUP","HCPCS C1713","","7713521  -  SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713522","SUP","HCPCS C1713","","7713522  -  SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713523","SUP","HCPCS C1713","","7713523  -  SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7713524","SUP","HCPCS C1713","","7713524  -  SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714010","SUP","HCPCS C1713","","7714010  -  SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714011","SUP","HCPCS C1713","","7714011  -  SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714012","SUP","HCPCS C1713","","7714012  -  SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714014","SUP","HCPCS C1713","","7714014  -  SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714016","SUP","HCPCS C1713","","7714016  -  SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714018","SUP","HCPCS C1713","","7714018  -  SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714019","SUP","HCPCS C1713","","7714019  -  SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714020","SUP","HCPCS C1713","","7714020  -  SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714021","SUP","HCPCS C1713","","7714021  -  SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714022","SUP","HCPCS C1713","","7714022  -  SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714023","SUP","HCPCS C1713","","7714023  -  SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7714024","SUP","HCPCS C1713","","7714024  -  SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR SLF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723510","SUP","HCPCS C1713","","7723510  -  SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723511","SUP","HCPCS C1713","","7723511  -  SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723512","SUP","HCPCS C1713","","7723512  -  SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723514","SUP","HCPCS C1713","","7723514  -  SCREW BN 3.5MM 14MM ZEVO VAR ST TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723515","SUP","HCPCS C1713","","7723515  -  SCREW BN 3.5MM 15MM ZEVO VAR ST TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723516","SUP","HCPCS C1713","","7723516  -  SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723517","SUP","HCPCS C1713","","7723517  -  SCREW BONE 3.5MM 17MM VARIABLE SELF TAP ZEVO TITANIUM SPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723518","SUP","HCPCS C1713","","7723518  -  SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723519","SUP","HCPCS C1713","","7723519  -  SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723520","SUP","HCPCS C1713","","7723520  -  SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723521","SUP","HCPCS C1713","","7723521  -  SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723522","SUP","HCPCS C1713","","7723522  -  SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723523","SUP","HCPCS C1713","","7723523  -  SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7723524","SUP","HCPCS C1713","","7723524  -  SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724010","SUP","HCPCS C1713","","7724010  -  SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724011","SUP","HCPCS C1713","","7724011  -  SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724012","SUP","HCPCS C1713","","7724012  -  SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724014","SUP","HCPCS C1713","","7724014  -  SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724016","SUP","HCPCS C1713","","7724016  -  SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724017","SUP","HCPCS C1713","","7724017  -  SCREW BN 4MM 17MM ZEVO VAR ST TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724018","SUP","HCPCS C1713","","7724018  -  SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724019","SUP","HCPCS C1713","","7724019  -  SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724020","SUP","HCPCS C1713","","7724020  -  SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724021","SUP","HCPCS C1713","","7724021  -  SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724022","SUP","HCPCS C1713","","7724022  -  SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724023","SUP","HCPCS C1713","","7724023  -  SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7724024","SUP","HCPCS C1713","","7724024  -  SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7730016","SUP","Custom 27203010","","7730016  -  BIT DRL 13MM STRL HLX ACP SPNE","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7732111","SUP","HCPCS C1713","","7732111  -  SCREW BN 4MM 11MM NS HLX ACP SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7732113","SUP","HCPCS C1713","","7732113  -  SCREW BN 4MM 13MM NS HLX-T SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7732115","SUP","HCPCS C1713","","7732115  -  SCREW BN 4MM 15MM NS HLX-T SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7733111","SUP","HCPCS C1713","","7733111  -  SCREW BN 4MM 11MM NS HLX ACP ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7733119","SUP","HCPCS C1713","","7733119  -  SCREW BN 4MM 19MM NS HLX ACP ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7734111","SUP","HCPCS C1713","","7734111  -  SCREW BN 4MM 11MM NS HLX-T ACP ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7734113","SUP","HCPCS C1713","","7734113  -  SCREW BN 4MM 13MM NS HLX-T ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7734115","SUP","HCPCS C1713","","7734115  -  SCREW BN 4MM 15MM NS HLX-T ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7734117","SUP","HCPCS C1713","","7734117  -  SCREW BN 4MM 17MM NS HLX-T ACP ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7734119","SUP","HCPCS C1713","","7734119  -  SCREW BN 4MM 19MM NS HLX-T ACP ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7735111","SUP","HCPCS C1713","","7735111  -  SCREW BN 4.5MM 11MM HLX ACP VA ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7735113","SUP","HCPCS C1713","","7735113  -  SCREW BN 4.5MM 13MM NS HLX-T ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7735115","SUP","HCPCS C1713","","7735115  -  SCREW BN 4.5MM 15MM NS HLX-T ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7735117","SUP","HCPCS C1713","","7735117  -  SCREW BN 4.5MM 17MM NS HLX ACP ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7735119","SUP","HCPCS C1713","","7735119  -  SCREW BN 4.5MM 19MM NS HLX ACP ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7736113","SUP","HCPCS C1713","","7736113  -  SCREW BN 4.5MM 13MM NS HLX-T ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7736115","SUP","HCPCS C1713","","7736115  -  SCREW BN 4.5MM 15MM NS HLX-T ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7736117","SUP","HCPCS C1713","","7736117  -  SCREW BN 4.5MM 17MM NS HLX ACP ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7737110","SUP","Custom 27203010","","7737110  -  HOLDER IMPL NS HLX ACP TEMP TACK SPNE","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7738120","SUP","HCPCS C1713","","7738120  -  PLATE BN 20MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738122","SUP","HCPCS C1713","","7738122  -  PLATE BN 22MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738124","SUP","HCPCS C1713","","7738124  -  PLATE BN 24MM HLX ACP 1 LVL TI ANT CSPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738126","SUP","HCPCS C1713","","7738126  -  PLATE BN 26MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738128","SUP","HCPCS C1713","","7738128  -  PLATE BN 28MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738130","SUP","HCPCS C1713","","7738130  -  PLATE BN 30MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738132","SUP","HCPCS C1713","","7738132  -  PLATE BN 32MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738134","SUP","HCPCS C1713","","7738134  -  PLATE BN 34MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738236","SUP","HCPCS C1713","","7738236  -  PLATE BN 36MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738238","SUP","HCPCS C1713","","7738238  -  PLATE BN 38MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738240","SUP","HCPCS C1713","","7738240  -  PLATE BN 40MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738242","SUP","HCPCS C1713","","7738242  -  PLATE BN 42MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738244","SUP","HCPCS C1713","","7738244  -  PLATE BN 44MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738246","SUP","HCPCS C1713","","7738246  -  PLATE BN 46MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738248","SUP","HCPCS C1713","","7738248  -  PLATE BN 48MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738250","SUP","HCPCS C1713","","7738250  -  PLATE BN 50MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738252","SUP","HCPCS C1713","","7738252  -  PLATE BN 52MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738254","SUP","HCPCS C1713","","7738254  -  PLATE BN 54MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7738356","SUP","HCPCS C1713","","7738356  -  PLATE BN 56MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738358","SUP","HCPCS C1713","","7738358  -  PLATE BN 58MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738360","SUP","HCPCS C1713","","7738360  -  PLATE BN 60MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738362","SUP","HCPCS C1713","","7738362  -  PLATE BN 62MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738364","SUP","HCPCS C1713","","7738364  -  PLATE BN 64MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738366","SUP","HCPCS C1713","","7738366  -  PLATE BN 66MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738368","SUP","HCPCS C1713","","7738368  -  PLATE BN 68MM HLX LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738470","SUP","HCPCS C1713","","7738470  -  PLATE BN 70MM HLX LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738474","SUP","HCPCS C1713","","7738474  -  PLATE BN 74MM HLX LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738478","SUP","HCPCS C1713","","7738478  -  PLATE BN 78MM HLX LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738482","SUP","HCPCS C1713","","7738482  -  PLATE BN 82MM HLX LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738486","SUP","HCPCS C1713","","7738486  -  PLATE BN 86MM HLX LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738490","SUP","HCPCS C1713","","7738490  -  PLATE BN 90MM HLX LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738500","SUP","HCPCS C1713","","7738500  -  PLATE BN 100MM HLX LVL 5 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738505","SUP","HCPCS C1713","","7738505  -  PLATE BN 105MM HLX LVL 5 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738510","SUP","HCPCS C1713","","7738510  -  PLATE BN 110MM HLX LVL 5 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7738595","SUP","HCPCS C1713","","7738595  -  PLATE BN 95MM HLX LVL 5 TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7739111","SUP","HCPCS C1713","","7739111  -  SCREW BN 4MM 11MM NS HLX ACP SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7739113","SUP","HCPCS C1713","","7739113  -  SCREW BN 4MM 13MM NS HLX-T SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7739115","SUP","HCPCS C1713","","7739115  -  SCREW BN 4MM 15MM NS HLX-T SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7739213","SUP","HCPCS C1713","","7739213  -  SCREW BN 4MM 13MM NS HLX-T ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7739215","SUP","HCPCS C1713","","7739215  -  SCREW BN 4MM 15MM NS HLX-T ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7739217","SUP","HCPCS C1713","","7739217  -  SCREW BN 4MM 17MM NS HLX ACP ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7740120","SUP","HCPCS C1713","","7740120  -  PLATE BN MN 20MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740122","SUP","HCPCS C1713","","7740122  -  PLATE BN MN 22MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740124","SUP","HCPCS C1713","","7740124  -  PLATE BN MN 24MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740126","SUP","HCPCS C1713","","7740126  -  PLATE BN MN 26MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740128","SUP","HCPCS C1713","","7740128  -  PLATE BN MN 28MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740130","SUP","HCPCS C1713","","7740130  -  PLATE BN MN 30MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740132","SUP","HCPCS C1713","","7740132  -  PLATE BN MN 32MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740134","SUP","HCPCS C1713","","7740134  -  PLATE BN MN 34MM HLX LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7740236","SUP","HCPCS C1713","","7740236  -  PLATE BN MN 36MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740238","SUP","HCPCS C1713","","7740238  -  PLATE BN MN 38MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740240","SUP","HCPCS C1713","","7740240  -  PLATE BONE 40MM LEVEL 2 HELIX MINI TITANIUM SPN CERV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740242","SUP","HCPCS C1713","","7740242  -  PLATE BN MN 42MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740244","SUP","HCPCS C1713","","7740244  -  PLATE BN MN 44MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740246","SUP","HCPCS C1713","","7740246  -  PLATE BN MN 46MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740248","SUP","HCPCS C1713","","7740248  -  PLATE BN MN 48MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7740250","SUP","HCPCS C1713","","7740250  -  PLATE BN MN 50MM HLX LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7741111","SUP","HCPCS C1713","","7741111  -  SCREW BN HEX 4MM 11MM VA SLF DRL SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7741113","SUP","HCPCS C1713","","7741113  -  SCREW BN HEX 4MM 13MM VA SLF DRL SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7741115","SUP","HCPCS C1713","","7741115  -  SCREW BN HEX 4MM 15MM VA SLF DRL SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7742111","SUP","HCPCS C1713","","7742111  -  SCREW BN 4MM 11MM FX ANG SLF DRL SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7742113","SUP","HCPCS C1713","","7742113  -  SCREW BN 4MM 13MM FX ANG SLF DRL SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7742115","SUP","HCPCS C1713","","7742115  -  SCREW BN 4MM 15MM FX ANG SLF DRL SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7746111","SUP","HCPCS C1713","","7746111  -  SCREW BN 4.5MM 11MM FX ANG ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7746113","SUP","HCPCS C1713","","7746113  -  SCREW BN 4.5MM 13MM FX ANG ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7746115","SUP","HCPCS C1713","","7746115  -  SCREW BN 4.5MM 15MM FX ANG ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7747111","SUP","HCPCS C1713","","7747111  -  SCREW BN 4MM 11MM FX ANG ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7747113","SUP","HCPCS C1713","","7747113  -  SCREW BONE 13MM FIX ANGLE SELF TAP 4MM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7747115","SUP","HCPCS C1713","","7747115  -  SCREW BN 4MM 15MM FX ANG ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7748111","SUP","HCPCS C1713","","7748111  -  SCREW BN 4MM 11MM VA ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7748113","SUP","HCPCS C1713","","7748113  -  SCREW BONE 13MM VAR ANG SELF TAP 4MM SPN CERV ANTERIOR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7748115","SUP","HCPCS C1713","","7748115  -  SCREW BN 4MM 15MM VA ST SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7750010","SUP","HCPCS C1713","","7750010  -  ROD 7750010 3.5MM ROD 120MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7750015","SUP","HCPCS C1713","","7750015  -  ROD 7750015 3.5MM ROD 240MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7750020","SUP","HCPCS C1713","","7750020  -  ROD 7750020 3.5MM ROD 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7750086","SUP","HCPCS C1713","","7750086  -  ROD 7750086 3.5MM CHROMALOY PLUS 120MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7750087","SUP","HCPCS C1713","","7750087  -  ROD 7750087 3.5MM CHROMALOY PLUS 240MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7750088","SUP","HCPCS C1713","","7750088  -  ROD 7750088 3.5MM CHROMALOY PLUS 300MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7750346","SUP","Custom 27803010","","7750346  -  CONNECTOR 7750346 DMNO3.5 4.0 TO 3.5 4.0","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7750347","SUP","Custom 27803010","","7750347  -  CONNECTOR 7750347 AX DOMNO3.5 4.0 TO 4.5","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7750348","SUP","Custom 27803010","","7750348  -  CONNECTOR 7750348 AX DOMNO3.5 4.0 TO 5.5","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7750443","SUP","HCPCS C1713","","7750443  -  DOMINO 7750443 OFFSET 3.2,3.5 TO 3.2,3.5","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$656.10 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$255.28 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$228.18 ","$0.00 ","$232.11 ","$0.00 "
"7750444","SUP","HCPCS C1713","","7750444  -  DOMINO 7750444 OFSET 3.2-3.5 TO 4.5-4.75","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$656.10 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$255.28 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$228.18 ","$0.00 ","$232.11 ","$0.00 "
"7750445","SUP","HCPCS C1713","","7750445  -  DOMINO 7750445 OFFSET 3.2, 3.5 TO 5.5","BOTH IP/OP","$1,458.00 ","$1,078.92 ","$0.00 ","$1,458.00 ","$656.10 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$255.28 ","$1,458.00 ","$0.00 ","$729.00 ","$1,154.74 ","$1,166.40 ","$0.00 ","$228.18 ","$0.00 ","$232.11 ","$0.00 "
"7750506","SUP","HCPCS C1713","","7750506  -  SCREW BN 4.5MM 6MM VRTX SLCT TI SPNE OCPTL","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750508","SUP","HCPCS C1713","","7750508  -  SCREW BN 4.5MM 8MM VRTX SLCT TI SPNE OCPTL","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750510","SUP","HCPCS C1713","","7750510  -  SCREW BN 4.5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750512","SUP","HCPCS C1713","","7750512  -  SCREW BN 4.5MM 12MM VRTX SLCT TI SPNE OCPTL","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750514","SUP","HCPCS C1713","","7750514  -  SCREW BN 4.5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750516","SUP","HCPCS C1713","","7750516  -  SCREW BN 4.5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750518","SUP","HCPCS C1713","","7750518  -  SCREW BN 4.5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750606","SUP","HCPCS C1713","","7750606  -  SCREW BN 5MM 6MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750608","SUP","HCPCS C1713","","7750608  -  SCREW BONE 4MM 8MM CORT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750610","SUP","HCPCS C1713","","7750610  -  SCREW BN 5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750612","SUP","HCPCS C1713","","7750612  -  SCREW BN 5MM 12MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750614","SUP","HCPCS C1713","","7750614  -  SCREW BN 5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750616","SUP","HCPCS C1713","","7750616  -  SCREW BN 5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7750618","SUP","HCPCS C1713","","7750618  -  SCREW BN 5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$323.55 ","$0.00 ","$149.86 ","$0.00 ","$0.00 ","$125.89 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$112.52 ","$0.00 ","$114.46 ","$0.00 "
"7751101","SUP","HCPCS C1713","","7751101  -  POSTED SCREW CONNECTOR 7751101 SMALL","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$807.30 ","$0.00 ","$373.91 ","$0.00 ","$0.00 ","$314.12 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$280.76 ","$0.00 ","$285.60 ","$0.00 "
"7751103","SUP","HCPCS C1713","","7751103  -  POSTED SCREW CONNECTOR 7751103 MEDIUM","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$807.30 ","$0.00 ","$373.91 ","$0.00 ","$0.00 ","$314.12 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$280.76 ","$0.00 ","$285.60 ","$0.00 "
"7751105","SUP","HCPCS C1713","","7751105  -  POSTED SCREW CONNECTOR 7751105 LARGE","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$807.30 ","$0.00 ","$373.91 ","$0.00 ","$0.00 ","$314.12 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$280.76 ","$0.00 ","$285.60 ","$0.00 "
"7751110","SUP","Custom 27803010","","7751110  -  CONNECTOR 7751110 OPEN CABLE CONN","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7751710","SUP","HCPCS C1713","","7751710  -  SCREW 7751710 3.5 X 10MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751712","SUP","HCPCS C1713","","7751712  -  SCREW 7751712 3.5 X 12MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751714","SUP","HCPCS C1713","","7751714  -  SCREW 7751714 3.5 X 14MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751716","SUP","HCPCS C1713","","7751716  -  SCREW 7751716 3.5 X 16MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751718","SUP","HCPCS C1713","","7751718  -  SCREW 7751718 3.5 X 18MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751720","SUP","HCPCS C1713","","7751720  -  SCREW 7751720 3.5 X 20MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751722","SUP","HCPCS C1713","","7751722  -  SCREW 7751722 3.5 X 22MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751724","SUP","HCPCS C1713","","7751724  -  SCREW 7751724 3.5 X 24MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751726","SUP","HCPCS C1713","","7751726  -  SCREW 7751726 3.5 X 26MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751728","SUP","HCPCS C1713","","7751728  -  SCREW 7751728 3.5 X 28MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751730","SUP","HCPCS C1713","","7751730  -  SCREW 7751730 3.5 X 30MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751732","SUP","HCPCS C1713","","7751732  -  SCREW 7751732 3.5 X 32MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751734","SUP","HCPCS C1713","","7751734  -  SCREW 7751734 3.5 X 34MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751810","SUP","HCPCS C1713","","7751810  -  SCREW 7751810 4.0 X 10MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751812","SUP","HCPCS C1713","","7751812  -  SCREW 7751812 4.0 X 12MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751814","SUP","HCPCS C1713","","7751814  -  SCREW 7751814 4.0 X 14MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751816","SUP","HCPCS C1713","","7751816  -  SCREW 7751816 4.0 X 16MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751818","SUP","HCPCS C1713","","7751818  -  SCREW 7751818 4.0 X 18MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751820","SUP","HCPCS C1713","","7751820  -  SCREW 7751820 4.0 X 20MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751822","SUP","HCPCS C1713","","7751822  -  SCREW 7751822 4.0 X 22MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751824","SUP","HCPCS C1713","","7751824  -  SCREW 7751824 4.0 X 24MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751826","SUP","HCPCS C1713","","7751826  -  SCREW 7751826 4.0 X 26MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751828","SUP","HCPCS C1713","","7751828  -  SCREW 7751828 4.0 X 28MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751830","SUP","HCPCS C1713","","7751830  -  SCREW 7751830 4.0 X 30MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751832","SUP","HCPCS C1713","","7751832  -  SCREW 7751832 4.0 X 32MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751834","SUP","HCPCS C1713","","7751834  -  SCREW 7751834 4.0 X 34MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751924","SUP","HCPCS C1713","","7751924  -  SCREW 7751924 4.5 X 24MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751926","SUP","HCPCS C1713","","7751926  -  SCREW 7751926 4.5 X 26MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751928","SUP","HCPCS C1713","","7751928  -  SCREW 7751928 4.5 X 28MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751930","SUP","HCPCS C1713","","7751930  -  SCREW 7751930 4.5 X 30MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751932","SUP","HCPCS C1713","","7751932  -  SCREW 7751932 4.5 X 32MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751934","SUP","HCPCS C1713","","7751934  -  SCREW 7751934 4.5 X 34MM POSTED","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7752510","SUP","HCPCS C1713","","7752510  -  SET SCREW 7752510 CROSSLINK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7752515","SUP","HCPCS C1713","","7752515  -  SCREW 7752515 FLAT CONNECTOR SETSCREW","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7752525","SUP","HCPCS C1713","","7752525  -  CROSSLINK 7752525 SMALL MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7752526","SUP","HCPCS C1713","","7752526  -  CROSSLINK 7752526 MEDIUM MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7752527","SUP","HCPCS C1713","","7752527  -  CROSSLINK 7752527 LARGE MAS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7752528","SUP","Custom 27803010","","7752528  -  CONNECTOR 7752528 MAS CROSSLINK ROD","BOTH IP/OP","$719.00 ","$532.06 ","$0.00 ","$719.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.00 ","$0.00 ","$359.50 ","$569.45 ","$575.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7752529","SUP","HCPCS C1713","","7752529  -  SCREW 7752529 MAS CROSSLINK LOCKING","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7752535","SUP","HCPCS C1713","","7752535  -  CROSSLINK 7752535 SMALL ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7752536","SUP","HCPCS C1713","","7752536  -  CROSSLINK 7752536 MEDIUM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7752537","SUP","HCPCS C1713","","7752537  -  CROSSLINK 7752537 LARGE ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7753500","SUP","HCPCS C1713","","7753500  -  SET SCREW 7753500 MAS CONNECTOR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7753520","SUP","HCPCS C1713","","7753520  -  SET SCREW 7753520 MAS EXT.,  LAT. CONN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7753730","SUP","HCPCS C1713","","7753730  -  ROD SPINAL 30MM PRECUT VERTEX 3.5MM NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7753740","SUP","HCPCS C1713","","7753740  -  ROD SPNL 40MM 3.5MM VRTX PCUT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7753750","SUP","HCPCS C1713","","7753750  -  ROD SPINAL 3.5MM 50MM PRECUT VERTEX NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7753760","SUP","HCPCS C1713","","7753760  -  ROD SPINAL 3.5MM 60MM PRECUT VERTEX SELECT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7753770","SUP","HCPCS C1713","","7753770  -  ROD SPINAL 70MM PRECUT CCM PLUS 3.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7753780","SUP","HCPCS C1713","","7753780  -  ROD SPINAL 80MM PRECUT TITANIUM 3.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7753806","SUP","HCPCS C1713","","7753806  -  ROD SPINAL 420MM CCM PLUS STAINLESS STEEL 4.75MM 3.5MM","BOTH IP/OP","$2,362.50 ","$1,748.25 ","$0.00 ","$2,362.50 ","$1,063.13 ","$0.00 ","$492.40 ","$0.00 ","$0.00 ","$413.65 ","$2,362.50 ","$0.00 ","$1,181.25 ","$1,871.10 ","$1,890.00 ","$0.00 ","$369.73 ","$0.00 ","$376.11 ","$0.00 "
"7753880","SUP","HCPCS C1713","","7753880  -  ROD SPINAL 80MM PRECUT CCM PLUS 3.5MM","BOTH IP/OP","$1,252.50 ","$926.85 ","$0.00 ","$1,252.50 ","$563.63 ","$0.00 ","$261.05 ","$0.00 ","$0.00 ","$219.30 ","$1,252.50 ","$0.00 ","$626.25 ","$991.98 ","$1,002.00 ","$0.00 ","$196.02 ","$0.00 ","$199.40 ","$0.00 "
"7753890","SUP","HCPCS C1713","","7753890  -  ROD SPINAL 90MM PRECUT CCM PLUS 3.5MM","BOTH IP/OP","$1,252.50 ","$926.85 ","$0.00 ","$1,252.50 ","$563.63 ","$0.00 ","$261.05 ","$0.00 ","$0.00 ","$219.30 ","$1,252.50 ","$0.00 ","$626.25 ","$991.98 ","$1,002.00 ","$0.00 ","$196.02 ","$0.00 ","$199.40 ","$0.00 "
"7753900","SUP","HCPCS C1713","","7753900  -  ROD SPINAL 100MM PRECUT CCM PLUS 3.5MM","BOTH IP/OP","$1,252.50 ","$926.85 ","$0.00 ","$1,252.50 ","$563.63 ","$0.00 ","$261.05 ","$0.00 ","$0.00 ","$219.30 ","$1,252.50 ","$0.00 ","$626.25 ","$991.98 ","$1,002.00 ","$0.00 ","$196.02 ","$0.00 ","$199.40 ","$0.00 "
"7754525","SUP","HCPCS C1713","","7754525  -  SCREW BN 4.5MM 25MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7754530","SUP","HCPCS C1713","","7754530  -  SCREW BN 4.5MM 35MM SHNK PPS SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7754535","SUP","HCPCS C1713","","7754535  -  SCREW BN 4.5MM 35MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7754540","SUP","HCPCS C1713","","7754540  -  SCREW BN 4.5MM 40MM HLX-REV ACP SHNK PLYP-PHENYLENE SLF SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7754545","SUP","HCPCS C1713","","7754545  -  SCREW BN 4.5MM 45MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7754550","SUP","HCPCS C1713","","7754550  -  SCREW BN 4.5MM 50MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7755120","SUP","HCPCS C1713","","7755120  -  ROD SPNL 3.5MM HNG","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755122","SUP","HCPCS C1713","","7755122  -  ROD SPNL 3.2/3.5MM 120MM HNG ADJ OCPTL","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"7755123","SUP","HCPCS C1713","","7755123  -  ROD SPNL 3.5MM 3.2MM 220MM ADJ OCPTL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755124","SUP","HCPCS C1713","","7755124  -  ROD SPNL 3.5MM 220MM STRL VRTX ADJ TI OCPTL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755217","SUP","HCPCS C1713","","7755217  -  VERTEX SELECT PRE-CURVED OC ROD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755231","SUP","HCPCS C1713","","7755231  -  ROD SPNL 3.5MM 100MM OCPTL PLT","BOTH IP/OP","$4,426.50 ","$3,275.61 ","$0.00 ","$4,426.50 ","$1,991.93 ","$0.00 ","$922.59 ","$0.00 ","$0.00 ","$775.04 ","$4,426.50 ","$0.00 ","$2,213.25 ","$3,505.79 ","$3,541.20 ","$0.00 ","$692.75 ","$0.00 ","$704.70 ","$0.00 "
"7755232","SUP","HCPCS C1713","","7755232  -  ROD SPNL 3.5MM 200MM PCRV PLT OCPTL","BOTH IP/OP","$4,426.50 ","$3,275.61 ","$0.00 ","$4,426.50 ","$1,991.93 ","$0.00 ","$922.59 ","$0.00 ","$0.00 ","$775.04 ","$4,426.50 ","$0.00 ","$2,213.25 ","$3,505.79 ","$3,541.20 ","$0.00 ","$692.75 ","$0.00 ","$704.70 ","$0.00 "
"7755240","SUP","HCPCS C1713","","7755240  -  ROD SPNL 3.5MM 240MM VRTX THRD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755245","SUP","HCPCS C1713","","7755245  -  ROD THRD 4.5MM 360MM SPNE","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755247","SUP","HCPCS C1713","","7755247  -  ROD SPNL 5.5MM 360MM VRTX THRD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755266","SUP","HCPCS C1713","","7755266  -  ROD SPNL P/T 4.75MM 360MM CIRC","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755270","SUP","HCPCS C1713","","7755270  -  ROD SPNL 3.5MM 100MM PCRV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755271","SUP","HCPCS C1713","","7755271  -  ROD SPNL 3.5MM 200MM VRTX PCRV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755274","SUP","HCPCS C1713","","7755274  -  ROD 7755274 3.5 PRECURV CHROMALOY PL 100","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755275","SUP","HCPCS C1713","","7755275  -  ROD SPNL CRV 3.5MM 200MM NS CHROMALOY +","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7755278","SUP","HCPCS C1713","","7755278  -  PLATE BN 50MM NS VRTX SLCT ADJ SPNE OCPTL RECON SYS","BOTH IP/OP","$8,085.00 ","$5,982.90 ","$0.00 ","$8,085.00 ","$3,638.25 ","$0.00 ","$1,685.12 ","$0.00 ","$0.00 ","$1,415.62 ","$8,085.00 ","$0.00 ","$4,042.50 ","$6,403.32 ","$6,468.00 ","$0.00 ","$1,265.30 ","$0.00 ","$1,287.13 ","$0.00 "
"7755325","SUP","HCPCS C1713","","7755325  -  CONNECTOR ROD SM LOPRFL SCR OCPTL SPNE","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$807.30 ","$0.00 ","$373.91 ","$0.00 ","$0.00 ","$314.12 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$280.76 ","$0.00 ","$285.60 ","$0.00 "
"7755327","SUP","HCPCS C1713","","7755327  -  SCREW BN OFST 27MM CNCT SPNE OCPTL","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$807.30 ","$0.00 ","$373.91 ","$0.00 ","$0.00 ","$314.12 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$280.76 ","$0.00 ","$285.60 ","$0.00 "
"7755530","SUP","HCPCS C1713","","7755530  -  SCREW BN 5.5MM 30MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7755535","SUP","HCPCS C1713","","7755535  -  SCREW BN 5.5MM 35MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7755540","SUP","HCPCS C1713","","7755540  -  SCREW BN 5.5MM 40MM CNN TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7755545","SUP","HCPCS C1713","","7755545  -  SCREW BN 5.5MM 45MM CNN TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7755550","SUP","HCPCS C1713","","7755550  -  SCREW BN 5.5MM 50MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7755555","SUP","HCPCS C1713","","7755555  -  SCREW BN 5.5MM 55MM HLX-REV ACP SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7756007","SUP","Custom 27203010","","7756007  -  BIT DRILL 2.4MM","BOTH IP/OP","$660.00 ","$488.40 ","$0.00 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$660.00 ","$0.00 ","$330.00 ","$522.72 ","$528.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756010","SUP","Custom 27203010","","7756010  -  BIT DRL 2.4MM STRL VRTX SLCT DISP","BOTH IP/OP","$660.00 ","$488.40 ","$0.00 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$660.00 ","$0.00 ","$330.00 ","$522.72 ","$528.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756035","SUP","Custom 27203010","","7756035  -  TAP SURG INSTR 3.5MM","BOTH IP/OP","$1,038.00 ","$768.12 ","$0.00 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,038.00 ","$0.00 ","$519.00 ","$822.10 ","$830.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756064","SUP","Custom 27803010","","7756064  -  LATERAL CONNECTOR 7756064 OPEN, 10MM","BOTH IP/OP","$1,077.00 ","$796.98 ","$0.00 ","$1,077.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.00 ","$0.00 ","$538.50 ","$852.98 ","$861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756066","SUP","Custom 27803010","","7756066  -  LATERAL CONNECTOR 7756066 OPEN, 13MM","BOTH IP/OP","$1,077.00 ","$796.98 ","$0.00 ","$1,077.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.00 ","$0.00 ","$538.50 ","$852.98 ","$861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756067","SUP","Custom 27803010","","7756067  -  LATERAL CONNECTOR 7756067 CLOSED, 10MM","BOTH IP/OP","$1,018.50 ","$753.69 ","$0.00 ","$1,018.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,018.50 ","$0.00 ","$509.25 ","$806.65 ","$814.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756068","SUP","Custom 27803010","","7756068  -  LATERAL CONNECTOR 7756068 CLOSED, 13MM","BOTH IP/OP","$1,018.50 ","$753.69 ","$0.00 ","$1,018.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,018.50 ","$0.00 ","$509.25 ","$806.65 ","$814.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756069","SUP","Custom 27803010","","7756069  -  MAS EXTENSION CONN. 7756069 3.2, 3.5MM","BOTH IP/OP","$1,077.00 ","$796.98 ","$0.00 ","$1,077.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.00 ","$0.00 ","$538.50 ","$852.98 ","$861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756071","SUP","Custom 27803010","","7756071  -  CONNECTOR MAS EXT 7756071 4.5-4.75MM","BOTH IP/OP","$1,077.00 ","$796.98 ","$0.00 ","$1,077.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.00 ","$0.00 ","$538.50 ","$852.98 ","$861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756072","SUP","Custom 27803010","","7756072  -  MAS EXTENSION CONN. 7756072 5.5MM","BOTH IP/OP","$1,077.00 ","$796.98 ","$0.00 ","$1,077.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,077.00 ","$0.00 ","$538.50 ","$852.98 ","$861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756073","SUP","HCPCS C1713","","7756073  -  HOOK 7756073 LAMINAR, 4.5MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7756074","SUP","HCPCS C1713","","7756074  -  HOOK 7756074 LAMINAR, 6.0MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7756131","SUP","Custom 27203010","","7756131  -  DRILL BIT 7756131 3.2MM DRILL BIT","BOTH IP/OP","$676.50 ","$500.61 ","$0.00 ","$676.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$676.50 ","$0.00 ","$338.25 ","$535.79 ","$541.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756133","SUP","Custom 27203010","","7756133  -  DRILL BIT 7756133 3.2MM DRILL BIT","BOTH IP/OP","$676.50 ","$500.61 ","$0.00 ","$676.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$676.50 ","$0.00 ","$338.25 ","$535.79 ","$541.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756300","SUP","Custom 27203010","","7756300  -  TAP SPINAL VERTEX SELECT 3MM","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7756530","SUP","HCPCS C1713","","7756530  -  SCREW BN 6.5MM 30MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7756535","SUP","HCPCS C1713","","7756535  -  SCREW BN 6.5MM 35MM CNN TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7756540","SUP","HCPCS C1713","","7756540  -  SCREW BN 6.5MM 40MM CNN TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7756545","SUP","HCPCS C1713","","7756545  -  SCREW BN 6.5MM 45MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7756550","SUP","HCPCS C1713","","7756550  -  SCREW BN 6.5MM 50MM CNN TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7756555","SUP","HCPCS C1713","","7756555  -  SCREW BN 6.5MM 55MM NEURO SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7757530","SUP","HCPCS C1713","","7757530  -  SCREW BN 7.5MM 30MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7757535","SUP","HCPCS C1713","","7757535  -  SCREW BN 7.5MM 35MM SHNK CNN SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7757540","SUP","HCPCS C1713","","7757540  -  SCREW BN 7.5MM 40MM CNN TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7757545","SUP","HCPCS C1713","","7757545  -  SCREW BN 7.5MM 45MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7757550","SUP","HCPCS C1713","","7757550  -  SCREW BN 7.5MM 50MM SPHERX PPS CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7757555","SUP","HCPCS C1713","","7757555  -  SCREW BN 7.5MM 55MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7758535","SUP","HCPCS C1713","","7758535  -  SCREW BN 8.5MM 35MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7758540","SUP","HCPCS C1713","","7758540  -  SCREW BN 8.5MM 40MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7758545","SUP","HCPCS C1713","","7758545  -  SCREW BN 8.5MM 45MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7758550","SUP","HCPCS C1713","","7758550  -  SCREW BN 8.5MM 50MM CNN SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7759970","SUP","HCPCS C1713","","7759970  -  PLATE BN SM LOPRFL VRTX SLCT LCK SLCT SPNE OC","BOTH IP/OP","$7,095.00 ","$5,250.30 ","$0.00 ","$7,095.00 ","$3,192.75 ","$0.00 ","$1,478.78 ","$0.00 ","$0.00 ","$1,242.28 ","$7,095.00 ","$0.00 ","$3,547.50 ","$5,619.24 ","$5,676.00 ","$0.00 ","$1,110.37 ","$0.00 ","$1,129.52 ","$0.00 "
"7759971","SUP","HCPCS C1713","","7759971  -  PLATE BN MED LOPRFL VRTX SLCT LCK SLCT SPNE OC","BOTH IP/OP","$7,095.00 ","$5,250.30 ","$0.00 ","$7,095.00 ","$3,192.75 ","$0.00 ","$1,478.78 ","$0.00 ","$0.00 ","$1,242.28 ","$7,095.00 ","$0.00 ","$3,547.50 ","$5,619.24 ","$5,676.00 ","$0.00 ","$1,110.37 ","$0.00 ","$1,129.52 ","$0.00 "
"7759972","SUP","HCPCS C1713","","7759972  -  PLATE BN LG LOPRFL VRTX SLCT LCK SLCT SPNE OC","BOTH IP/OP","$7,095.00 ","$5,250.30 ","$0.00 ","$7,095.00 ","$3,192.75 ","$0.00 ","$1,478.78 ","$0.00 ","$0.00 ","$1,242.28 ","$7,095.00 ","$0.00 ","$3,547.50 ","$5,619.24 ","$5,676.00 ","$0.00 ","$1,110.37 ","$0.00 ","$1,129.52 ","$0.00 "
"7764525","SUP","HCPCS C1713","","7764525  -  SCREW BN 4.5MM 25MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7764530","SUP","HCPCS C1713","","7764530  -  SCREW BN 4.5MM 30MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7764535","SUP","HCPCS C1713","","7764535  -  SCREW BN 4.5MM 35MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7764540","SUP","HCPCS C1713","","7764540  -  SCREW BN 4.5MM 40MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7764545","SUP","HCPCS C1713","","7764545  -  SCREW BN 4.5MM 45MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765530","SUP","HCPCS C1713","","7765530  -  SCREW BN 5.5MM 30MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765535","SUP","HCPCS C1713","","7765535  -  SCREW BN 5.5MM 35MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765540","SUP","HCPCS C1713","","7765540  -  SCREW BN 5.5MM 40MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765545","SUP","HCPCS C1713","","7765545  -  SCREW BN 5.5MM 45MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765550","SUP","HCPCS C1713","","7765550  -  SCREW BN 5.5MM 50MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765555","SUP","HCPCS C1713","","7765555  -  SCREW BN 5.5MM 55MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7765560","SUP","HCPCS C1713","","7765560  -  SCREW BN 5.5MM 60MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766530","SUP","HCPCS C1713","","7766530  -  SCREW BN 6.5MM 30MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766535","SUP","HCPCS C1713","","7766535  -  SCREW BN 6.5MM 35MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766540","SUP","HCPCS C1713","","7766540  -  SCREW BN 6.5MM 40MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766545","SUP","HCPCS C1713","","7766545  -  SCREW BN 6.5MM 45MM TI SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766550","SUP","HCPCS C1713","","7766550  -  SCREW BN 6.5MM 50MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766555","SUP","HCPCS C1713","","7766555  -  SCREW BN 6.5MM 55MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7766560","SUP","HCPCS C1713","","7766560  -  SCREW BN 6.5MM 60MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767530","SUP","HCPCS C1713","","7767530  -  SCREW BN 7.5MM 30MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767535","SUP","HCPCS C1713","","7767535  -  SCREW BN 7.5MM 35MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767540","SUP","HCPCS C1713","","7767540  -  SCREW BN 7.5MM 40MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767545","SUP","HCPCS C1713","","7767545  -  SCREW BN 7.5MM 45MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767550","SUP","HCPCS C1713","","7767550  -  SCREW BN 7.5MM 50MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767555","SUP","HCPCS C1713","","7767555  -  SCREW BN 7.5MM 55MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7767560","SUP","HCPCS C1713","","7767560  -  SCREW BN 7.5MM 60MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7768535","SUP","HCPCS C1713","","7768535  -  SCREW BN 8.5MM 35MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7768540","SUP","HCPCS C1713","","7768540  -  SCREW BN 8.5MM 40MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7768545","SUP","HCPCS C1713","","7768545  -  SCREW BN 8.5MM 45MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7768550","SUP","HCPCS C1713","","7768550  -  SCREW BN 8.5MM 50MM NCLNLT SHNK SPNE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"7770723","SUP","HCPCS C1713","","7770723  -  SPACER SPNL XLORDOTIC 23MMX7MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770728","SUP","HCPCS C1713","","7770728  -  SPACER SPNL XLORDOTIC 28MMX7MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770732","SUP","HCPCS C1713","","7770732  -  SPACER SPNL XLORDOTIC 32MMX7MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770823","SUP","HCPCS C1713","","7770823  -  SPACER SPNL STD 23MMX8MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770828","SUP","HCPCS C1713","","7770828  -  SPACER SPNL STD 28MMX8MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770832","SUP","HCPCS C1713","","7770832  -  SPACER SPNL STD 32MMX8MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770923","SUP","HCPCS C1713","","7770923  -  SPACER SPNL STD 23MMX9MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770928","SUP","HCPCS C1713","","7770928  -  SPACER SPNL STD 28MMX9MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7770932","SUP","HCPCS C1713","","7770932  -  SPACER SPNL STD 32MMX9MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771023","SUP","HCPCS C1713","","7771023  -  SPACER SPNL STD 23MMX10MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771028","SUP","HCPCS C1713","","7771028  -  SPACER SPNL STD 28MMX10MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771032","SUP","HCPCS C1713","","7771032  -  SPACER SPNL STD 32MMX10MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771123","SUP","HCPCS C1713","","7771123  -  SPACER SPNL STD 23MMX11MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771128","SUP","HCPCS C1713","","7771128  -  SPACER SPNL STD 28MMX11MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771132","SUP","HCPCS C1713","","7771132  -  SPACER SPNL STD 32MMX11MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"7771174","SUP","Custom 27203010","","7771174  -  SLEEVE SPNL SPHERX PRODUCTIVE PPS","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7772001","SUP","HCPCS C1713","","7772001  -  SCREW BN TULIP LCK SPNE 6.25 MM ROD","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7781120","SUP","HCPCS C1713","","7781120  -  PLATE BN 20MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781122","SUP","HCPCS C1713","","7781122  -  PLATE BN 22MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781124","SUP","HCPCS C1713","","7781124  -  PLATE BN 24MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781126","SUP","HCPCS C1713","","7781126  -  PLATE BN 26MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781128","SUP","HCPCS C1713","","7781128  -  PLATE BN 28MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781130","SUP","HCPCS C1713","","7781130  -  PLATE BN 30MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781132","SUP","HCPCS C1713","","7781132  -  PLATE BN 32MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781134","SUP","HCPCS C1713","","7781134  -  PLATE BN 34MM NS HLX-T 1 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781234","SUP","HCPCS C1713","","7781234  -  PLATE BN 34MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781236","SUP","HCPCS C1713","","7781236  -  PLATE BN 36MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781238","SUP","HCPCS C1713","","7781238  -  PLATE BN 38MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781240","SUP","HCPCS C1713","","7781240  -  PLATE BN 40MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781242","SUP","HCPCS C1713","","7781242  -  PLATE BN 42MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781244","SUP","HCPCS C1713","","7781244  -  PLATE BN 44MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781246","SUP","HCPCS C1713","","7781246  -  PLATE BN 46MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781248","SUP","HCPCS C1713","","7781248  -  PLATE BN 48MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781250","SUP","HCPCS C1713","","7781250  -  PLATE BN 50MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781252","SUP","HCPCS C1713","","7781252  -  PLATE BN 52MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781254","SUP","HCPCS C1713","","7781254  -  PLATE BN 54MM NS HLX-T 2 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781354","SUP","HCPCS C1713","","7781354  -  PLATE BN 54MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781356","SUP","HCPCS C1713","","7781356  -  PLATE BN 56MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781358","SUP","HCPCS C1713","","7781358  -  PLATE BN 58MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781360","SUP","HCPCS C1713","","7781360  -  PLATE BN 60MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781362","SUP","HCPCS C1713","","7781362  -  PLATE BN 62MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781364","SUP","HCPCS C1713","","7781364  -  PLATE BN 64MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781366","SUP","HCPCS C1713","","7781366  -  PLATE BN 66MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781368","SUP","HCPCS C1713","","7781368  -  PLATE BN 68MM NS HLX-T 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781470","SUP","HCPCS C1713","","7781470  -  PLATE BN 70MM NS HLX-T 4 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781474","SUP","HCPCS C1713","","7781474  -  PLATE BN 74MM NS HLX-T 4 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781478","SUP","HCPCS C1713","","7781478  -  PLATE BN 78MM NS HLX-T 4 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781482","SUP","HCPCS C1713","","7781482  -  PLATE BN 82MM NS HLX-T 4 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781486","SUP","HCPCS C1713","","7781486  -  PLATE BN 86MM NS HLX-T 4 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781490","SUP","HCPCS C1713","","7781490  -  PLATE BN 90MM NS HLX-T 4 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781501","SUP","HCPCS C1713","","7781501  -  PLATE BN T 100MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781505","SUP","HCPCS C1713","","7781505  -  PLATE BN T 105MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781510","SUP","HCPCS C1713","","7781510  -  PLATE BN T 110MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7781595","SUP","HCPCS C1713","","7781595  -  PLATE BN T 95MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7782001","SUP","HCPCS C1713","","7782001  -  SCREW LCK 5.5MM SPHERX PPS SPNE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7782300","SUP","HCPCS C1713","","7782300  -  ROD SPNL 5.5MM 300MM STRL SPHERX XTN","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$693.00 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"7782500","SUP","HCPCS C1713","","7782500  -  ROD SPNL 5.5MM 500MM SPHERX XTN","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$693.00 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"7783025","SUP","HCPCS C1713","","7783025  -  ROD SPNL PREBNT 5.5MM 25MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783030","SUP","HCPCS C1713","","7783030  -  ROD SPNL PREBNT 5.5MM 30MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783035","SUP","HCPCS C1713","","7783035  -  ROD SPNL PREBNT 5.5MM 35MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783040","SUP","HCPCS C1713","","7783040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783045","SUP","HCPCS C1713","","7783045  -  ROD SPNL PREBNT 5.5MM 45MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783050","SUP","HCPCS C1713","","7783050  -  ROD SPNL PREBNT 5.5MM 50MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783055","SUP","HCPCS C1713","","7783055  -  ROD SPNL PREBNT 5.5MM 55MM SPHERX XTN","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"7783060","SUP","HCPCS C1713","","7783060  -  ROD SPNL PREBNT 5.5MM 60MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783065","SUP","HCPCS C1713","","7783065  -  ROD SPNL PREBNT 5.5MM 65MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783070","SUP","HCPCS C1713","","7783070  -  ROD SPNL PREBNT 5.5MM 70MM SPHERX PPS XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783075","SUP","HCPCS C1713","","7783075  -  ROD SPNL PREBNT 5.5MM 75MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783080","SUP","HCPCS C1713","","7783080  -  ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783085","SUP","HCPCS C1713","","7783085  -  ROD SPNL PREBNT 5.5MM 85MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783090","SUP","HCPCS C1713","","7783090  -  ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783095","SUP","HCPCS C1713","","7783095  -  ROD SPNL PREBNT 5.5MM 95MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783100","SUP","HCPCS C1713","","7783100  -  ROD SPNL PREBNT 5.5MM 100MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783110","SUP","HCPCS C1713","","7783110  -  ROD SPNL PREBNT 5.5MM 110MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783120","SUP","HCPCS C1713","","7783120  -  ROD SPNL PREBNT 5.5MM 120MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783150","SUP","HCPCS C1713","","7783150  -  ROD SPNL PREBNT 5.5MM 150MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783300","SUP","HCPCS C1713","","7783300  -  ROD SPNL PREBNT 5.5MM 300MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7783500","SUP","HCPCS C1713","","7783500  -  ROD SPNL PREBNT 5.5MM 500MM SPHERX XTN","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"7800015","SUP","HCPCS C1713","","7800015  -  PIN FX HLX TEMP SLFCNTR TACK SPNE","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$240.75 ","$0.00 ","$111.51 ","$0.00 ","$0.00 ","$93.67 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$83.73 ","$0.00 ","$85.17 ","$0.00 "
"7800120","SUP","HCPCS C1713","","7800120  -  PLATE BONE 20MM LEVEL 1 HELIX T STAINLESS STEEL SPN CERV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800122","SUP","HCPCS C1713","","7800122  -  PLATE BONE 22MM LEVEL 1 HELIX T STAINLESS STEEL SPN CERV","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800124","SUP","HCPCS C1713","","7800124  -  PLATE BN 24MM NS HLX R 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800126","SUP","HCPCS C1713","","7800126  -  PLATE BN 26MM NS HLX R 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800128","SUP","HCPCS C1713","","7800128  -  PLATE BN 28MM NS HLX R 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800130","SUP","HCPCS C1713","","7800130  -  PLATE BN 30MM NS HLX R 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800132","SUP","HCPCS C1713","","7800132  -  PLATE BN 32MM NS HLX R 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800134","SUP","HCPCS C1713","","7800134  -  PLATE BN 34MM NS HLX R 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7800232","SUP","HCPCS C1713","","7800232  -  PLATE BN 32MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800234","SUP","HCPCS C1713","","7800234  -  PLATE BN 34MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800236","SUP","HCPCS C1713","","7800236  -  PLATE BN 36MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800238","SUP","HCPCS C1713","","7800238  -  PLATE BONE 38MM LEVEL 2 HELIX-REVOLUTION SPN CERV ANTERIOR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800240","SUP","HCPCS C1713","","7800240  -  PLATE BONE 40MM LEVEL 1 HELIX-REVOLUTION SPN CERV ANTERIOR","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800242","SUP","HCPCS C1713","","7800242  -  PLATE BN 42MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800244","SUP","HCPCS C1713","","7800244  -  PLATE BN 44MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800246","SUP","HCPCS C1713","","7800246  -  PLATE BN 46MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800248","SUP","HCPCS C1713","","7800248  -  PLATE BN 48MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800250","SUP","HCPCS C1713","","7800250  -  PLATE BN 50MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800252","SUP","HCPCS C1713","","7800252  -  PLATE BN 52MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800254","SUP","HCPCS C1713","","7800254  -  PLATE BN 54MM NS HLX R 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"7800350","SUP","HCPCS C1713","","7800350  -  PLATE BN 50MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800352","SUP","HCPCS C1713","","7800352  -  PLATE BN 52MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800354","SUP","HCPCS C1713","","7800354  -  PLATE BN 54MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800356","SUP","HCPCS C1713","","7800356  -  PLATE BN 56MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800358","SUP","HCPCS C1713","","7800358  -  PLATE BN 58MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800360","SUP","HCPCS C1713","","7800360  -  PLATE BN 60MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800362","SUP","HCPCS C1713","","7800362  -  PLATE BN 62MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800364","SUP","HCPCS C1713","","7800364  -  PLATE BN 64MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800366","SUP","HCPCS C1713","","7800366  -  PLATE BN 66MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800368","SUP","HCPCS C1713","","7800368  -  PLATE BN 68MM NS HLX R 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"7800466","SUP","HCPCS C1713","","7800466  -  PLATE BN 66MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800468","SUP","HCPCS C1713","","7800468  -  PLATE BN 68MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800470","SUP","HCPCS C1713","","7800470  -  PLATE BN 70MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800474","SUP","HCPCS C1713","","7800474  -  PLATE BN 74MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800478","SUP","HCPCS C1713","","7800478  -  PLATE BN 78MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800482","SUP","HCPCS C1713","","7800482  -  PLATE BN 82MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800486","SUP","HCPCS C1713","","7800486  -  PLATE BN 86MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800490","SUP","HCPCS C1713","","7800490  -  PLATE BN 90MM NS HLX R 4 LVL SPNE","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800500","SUP","HCPCS C1713","","7800500  -  PLATE BN 100MM HLX-REV LVL 5 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800505","SUP","HCPCS C1713","","7800505  -  PLATE BN 105MM HLX-REV LVL 5 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800510","SUP","HCPCS C1713","","7800510  -  PLATE BN 110MM HLX-REV LVL 5 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800590","SUP","HCPCS C1713","","7800590  -  PLATE BN 90MM HLX-REV LVL 5 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7800595","SUP","HCPCS C1713","","7800595  -  PLATE BN 95MM HLX-REV LVL 5 SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"7801111","SUP","HCPCS C1713","","7801111  -  SCREW BN 4MM 11MM NS HLX R SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7801113","SUP","HCPCS C1713","","7801113  -  SCREW BONE 13MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP 4MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7801115","SUP","HCPCS C1713","","7801115  -  SCREW BONE 15MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP 4MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7801117","SUP","HCPCS C1713","","7801117  -  SCREW BN 4MM 17MM HLX REV ACP SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7802211","SUP","HCPCS C1713","","7802211  -  SCREW BN 4MM 11MM NS HLX R SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7802213","SUP","HCPCS C1713","","7802213  -  SCREW BONE 13MM FIX ANGLE SELF DRILL HELIX-REVOLUTION ACP 4","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7802215","SUP","HCPCS C1713","","7802215  -  SCREW BONE 15MM FIX ANGLE SELF DRILL HELIX-REVOLUTION ACP 4","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7803111","SUP","HCPCS C1713","","7803111  -  SCREW BN 4MM 11MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7803113","SUP","HCPCS C1713","","7803113  -  SCREW BONE 13MM VAR ANG SELF TAP HELIX-REVOLUTION ACP 4MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7803115","SUP","HCPCS C1713","","7803115  -  SCREW BONE 15MM VAR ANG SELF TAP HELIX-REVOLUTION ACP 4MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7803117","SUP","HCPCS C1713","","7803117  -  SCREW BN 4MM 17MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7803119","SUP","HCPCS C1713","","7803119  -  SCREW BN 4MM 19MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7804211","SUP","HCPCS C1713","","7804211  -  SCREW BN 4MM 11MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7804213","SUP","HCPCS C1713","","7804213  -  SCREW BONE 13MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP 4MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7804215","SUP","HCPCS C1713","","7804215  -  SCREW BN 4MM 15MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7804217","SUP","HCPCS C1713","","7804217  -  SCREW BN 4MM 17MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7804219","SUP","HCPCS C1713","","7804219  -  SCREW BN 4MM 19MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7805111","SUP","HCPCS C1713","","7805111  -  SCREW BN 4.5MM 11MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7805113","SUP","HCPCS C1713","","7805113  -  SCREW BN 4.5MM 13MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7805114","SUP","HCPCS C1713","","7805114  -  SCREW BN 4.5MM 14MM VAR ST SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7805115","SUP","HCPCS C1713","","7805115  -  SCREW BN 4.5MM 15MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7805117","SUP","HCPCS C1713","","7805117  -  SCREW BN 4.5MM 17MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7805119","SUP","HCPCS C1713","","7805119  -  SCREW BN 4.5MM 19MM NS HLX R ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7806211","SUP","HCPCS C1713","","7806211  -  SCREW BN 4.5MM 11MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7806213","SUP","HCPCS C1713","","7806213  -  SCREW BN 4.5MM 13MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7806215","SUP","HCPCS C1713","","7806215  -  SCREW BONE 15MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP 4.5","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7806217","SUP","HCPCS C1713","","7806217  -  SCREW BN 4.5MM 17MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7806219","SUP","HCPCS C1713","","7806219  -  SCREW BN 4.5MM 19MM NS HLX R ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"7807110","SUP","Custom 27203010","","7807110  -  PIN FIX TEMPORARY HELIX","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7812025","SUP","Custom 27203010","","7812025  -  BIT DRILL 10MM","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7820015","SUP","HCPCS C1713","","7820015  -  PLATE BONE 15MM FIX TRAVERSE SPN","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820020","SUP","HCPCS C1713","","7820020  -  PLATE BN 20MM FX TRAVERSE SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820025","SUP","HCPCS C1713","","7820025  -  PLATE BN 25MM FX TRAVERSE SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820030","SUP","HCPCS C1713","","7820030  -  PLATE BONE 30MM FIX TRAVERSE SPN","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820040","SUP","HCPCS C1713","","7820040  -  PLATE BONE 40MM FIX TRAVERSE SPN","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820045","SUP","HCPCS C1713","","7820045  -  PLATE BN 45MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820050","SUP","HCPCS C1713","","7820050  -  PLATE BN 50MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820055","SUP","HCPCS C1713","","7820055  -  PLATE BN 55MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820060","SUP","HCPCS C1713","","7820060  -  PLATE BN 60MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820065","SUP","HCPCS C1713","","7820065  -  PLATE BN 65MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820070","SUP","HCPCS C1713","","7820070  -  PLATE BN 70MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820080","SUP","HCPCS C1713","","7820080  -  PLATE BN 80MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7820090","SUP","HCPCS C1713","","7820090  -  PLATE BN 90MM NS TRAVERSE FX SPNE","BOTH IP/OP","$10,232.50 ","$7,572.05 ","$0.00 ","$10,232.50 ","$4,604.63 ","$0.00 ","$2,132.71 ","$0.00 ","$0.00 ","$1,791.63 ","$10,232.50 ","$0.00 ","$5,116.25 ","$8,104.14 ","$8,186.00 ","$0.00 ","$1,601.39 ","$0.00 ","$1,629.01 ","$0.00 "
"7821045","SUP","HCPCS C1713","","7821045  -  PLATE BN 45MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821050","SUP","HCPCS C1713","","7821050  -  PLATE BN 50MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821055","SUP","HCPCS C1713","","7821055  -  PLATE BN 55MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821060","SUP","HCPCS C1713","","7821060  -  PLATE BN 60MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821065","SUP","HCPCS C1713","","7821065  -  PLATE BN 65MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821070","SUP","HCPCS C1713","","7821070  -  PLATE BN 70MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821075","SUP","HCPCS C1713","","7821075  -  PLATE BN 75MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821080","SUP","HCPCS C1713","","7821080  -  PLATE BN 80MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821085","SUP","HCPCS C1713","","7821085  -  PLATE BN 85MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821095","SUP","HCPCS C1713","","7821095  -  PLATE BN 95MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7821105","SUP","HCPCS C1713","","7821105  -  PLATE BN 105MM NS TRAVERSE CMPR SPNE","BOTH IP/OP","$11,560.00 ","$8,554.40 ","$0.00 ","$11,560.00 ","$5,202.00 ","$0.00 ","$2,409.39 ","$0.00 ","$0.00 ","$2,024.06 ","$11,560.00 ","$0.00 ","$5,780.00 ","$9,155.52 ","$9,248.00 ","$0.00 ","$1,809.14 ","$0.00 ","$1,840.35 ","$0.00 "
"7822035","SUP","HCPCS C1713","","7822035  -  PLATE BN 35MM NS TRAVERSE 2 BOLT SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822040","SUP","HCPCS C1713","","7822040  -  PLATE BN 40MM NS TRAVERSE 2 BOLT SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822045","SUP","HCPCS C1713","","7822045  -  PLATE BN 45MM NS TRAVERSE 2 BOLT SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822050","SUP","HCPCS C1713","","7822050  -  PLATE BN 50MM NS TRAVERSE 2 BOLT SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822055","SUP","HCPCS C1713","","7822055  -  PLATE BN 55MM NS TRAVERSE 2 BOLT SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822060","SUP","HCPCS C1713","","7822060  -  PLATE BONE 60MM 2 BOLT TRAVERSE SPN","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822065","SUP","HCPCS C1713","","7822065  -  PLATE BONE 65MM 2 BOLT TRAVERSE SPN","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822070","SUP","HCPCS C1713","","7822070  -  PLATE BN 70MM 2 BOLT TRAVERSE SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822075","SUP","HCPCS C1713","","7822075  -  PLATE BN 75MM 2 BOLT TRAVERSE SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822080","SUP","HCPCS C1713","","7822080  -  PLATE BN 80MM 2 BOLT TRAVERSE SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822085","SUP","HCPCS C1713","","7822085  -  PLATE BN 85MM 2 BOLT TRAVERSE SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822095","SUP","HCPCS C1713","","7822095  -  PLATE BN 95MM 2 BOLT TRAVERSE SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7822105","SUP","HCPCS C1713","","7822105  -  PLATE BN 105MM 2 BOLT TRAVERSE SPNE","BOTH IP/OP","$9,747.50 ","$7,213.15 ","$0.00 ","$9,747.50 ","$4,386.38 ","$0.00 ","$2,031.62 ","$0.00 ","$0.00 ","$1,706.71 ","$9,747.50 ","$0.00 ","$4,873.75 ","$7,720.02 ","$7,798.00 ","$0.00 ","$1,525.48 ","$0.00 ","$1,551.80 ","$0.00 "
"7830002","SUP","HCPCS C1713","","7830002  -  SCREW BONE NUT LOCKING TITANIUM SPN","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"7835525","SUP","HCPCS C1713","","7835525  -  SCREW BONE 5.5MM 25MM ASMBLY TRAVERSE SPN","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835530","SUP","HCPCS C1713","","7835530  -  SCREW BONE 5.5MM 30MM TRAVERSE SPN","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835535","SUP","HCPCS C1713","","7835535  -  SCREW BONE 35MM TRAVERSE 5.5MM SPN","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835540","SUP","HCPCS C1713","","7835540  -  SCREW BN 5.5MM 40MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835545","SUP","HCPCS C1713","","7835545  -  SCREW BN 5.5MM 45MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835550","SUP","HCPCS C1713","","7835550  -  SCREW BONE 5.5MM 50MM TRAVERSE SPN","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835555","SUP","HCPCS C1713","","7835555  -  SCREW BN 5.5MM 55MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835560","SUP","HCPCS C1713","","7835560  -  SCREW BN 5.5MM 60MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7835565","SUP","HCPCS C1713","","7835565  -  SCREW BN 5.5MM 65MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846525","SUP","HCPCS C1713","","7846525  -  SCREW BN 6.5MM 25MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846530","SUP","HCPCS C1713","","7846530  -  SCREW BONE 6.5MM 30MM TRAVERSE SPN","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846535","SUP","HCPCS C1713","","7846535  -  SCREW BN 6.5MM 35MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846540","SUP","HCPCS C1713","","7846540  -  SCREW BN 6.5MM 40MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846545","SUP","HCPCS C1713","","7846545  -  TRAVERSE 6.5X 45MM VARIABLE SCREW","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846550","SUP","HCPCS C1713","","7846550  -  TRAVERSE 6.5X 50MM VARIABLE SCREW","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846555","SUP","HCPCS C1713","","7846555  -  SCREW BN 6.5MM 55MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846560","SUP","HCPCS C1713","","7846560  -  SCREW BN 6.5MM 60MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7846565","SUP","HCPCS C1713","","7846565  -  SCREW BN 6.5MM 65MM NS TRAVERSE SPNE","BOTH IP/OP","$1,007.50 ","$745.55 ","$0.00 ","$1,007.50 ","$453.38 ","$0.00 ","$209.99 ","$0.00 ","$0.00 ","$176.41 ","$1,007.50 ","$0.00 ","$503.75 ","$797.94 ","$806.00 ","$0.00 ","$157.67 ","$0.00 ","$160.39 ","$0.00 "
"7856525","SUP","HCPCS C1713","","7856525  -  BOLT SPNL 6.5MM 25MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856530","SUP","HCPCS C1713","","7856530  -  BOLT SPINAL 6.5MM 30MM","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856535","SUP","HCPCS C1713","","7856535  -  BOLT SPINAL 6.5MM 35MM","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856540","SUP","HCPCS C1713","","7856540  -  BOLT SPNL 6.5MM 40MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856545","SUP","HCPCS C1713","","7856545  -  BOLT SPINAL 6.5MM 45MM TITANIUM","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856550","SUP","HCPCS C1713","","7856550  -  BOLT SPINAL 6.5MM 50MM","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856555","SUP","HCPCS C1713","","7856555  -  BOLT SPNL 6.5MM 55MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856560","SUP","HCPCS C1713","","7856560  -  BOLT SPNL 6.5MM 60MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7856565","SUP","HCPCS C1713","","7856565  -  BOLT SPNL 6.5MM 65MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7860845","SUP","HCPCS C1713","","7860845  -  CAGE SPNL 45X18X8MM CRNT XLIF","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7860850","SUP","HCPCS C1713","","7860850  -  CAGE SPNL XL 50X18X8MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7860855","SUP","HCPCS C1713","","7860855  -  CAGE SPNL XL 55X18X8MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7860860","SUP","HCPCS C1713","","7860860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861045","SUP","HCPCS C1713","","7861045  -  SPACER SPNL 45X18X10MM CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861050","SUP","HCPCS C1713","","7861050  -  CAGE SPNL XL 50X18X10MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861055","SUP","HCPCS C1713","","7861055  -  CAGE SPNL XL 55X18X10MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861060","SUP","HCPCS C1713","","7861060  -  CAGE SPNL STD XL 60X10MM PLT FSN PEEK","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861245","SUP","HCPCS C1713","","7861245  -  SPACER SPNL XL 45X18X12MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861250","SUP","HCPCS C1713","","7861250  -  CAGE SPNL XL 50X12X12MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861255","SUP","HCPCS C1713","","7861255  -  CAGE SPNL XL 55X12X12MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861260","SUP","HCPCS C1713","","7861260  -  SPACER SPNL XL 60X18X12MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861445","SUP","HCPCS C1713","","7861445  -  SPACER SPNL XL 45X18X14MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861450","SUP","HCPCS C1713","","7861450  -  SPACER SPNL XL 50X18X14MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861455","SUP","HCPCS C1713","","7861455  -  IMPLANT SPNL 55X18X14MM XLIF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861460","SUP","HCPCS C1713","","7861460  -  SPACER SPNL XL 60X18X14MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861645","SUP","HCPCS C1713","","7861645  -  SPACER SPNL XL 45X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861650","SUP","HCPCS C1713","","7861650  -  SPACER SPNL XL 50X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861655","SUP","HCPCS C1713","","7861655  -  SPACER SPNL XL 55X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861660","SUP","HCPCS C1713","","7861660  -  SPACER SPNL XL 60X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861845","SUP","HCPCS C1713","","7861845  -  CAGE SPNL XL 45X18X18MM NS LF CRNT PEEK-OPTM 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861850","SUP","HCPCS C1713","","7861850  -  CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861855","SUP","HCPCS C1713","","7861855  -  SPACER SPNL XL 55X18X18MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7861860","SUP","HCPCS C1713","","7861860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7867525","SUP","HCPCS C1713","","7867525  -  BOLT SPNL 7.5MM 25MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867530","SUP","HCPCS C1713","","7867530  -  BOLT SPNL 7.5MM 30MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867535","SUP","HCPCS C1713","","7867535  -  BOLT SPNL 7.5MM 35MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867540","SUP","HCPCS C1713","","7867540  -  BOLT SPNL 7.5MM 40MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867545","SUP","HCPCS C1713","","7867545  -  BOLT SPNL 7.5MM 45MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867550","SUP","HCPCS C1713","","7867550  -  BOLT SPNL 7.5MM 50MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867555","SUP","HCPCS C1713","","7867555  -  BOLT SPNL 7.5MM 55MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867560","SUP","HCPCS C1713","","7867560  -  BOLT SPNL 7.5MM 60MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7867565","SUP","HCPCS C1713","","7867565  -  BOLT SPNL 7.5MM 65MM NS TRAVERSE PLT","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"7870845","SUP","HCPCS C1713","","7870845  -  SPACER SPNL 10D XL 45X18X8MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7870850","SUP","HCPCS C1713","","7870850  -  CAGE SPNL 10D XL 50X18X8MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7870855","SUP","HCPCS C1713","","7870855  -  CAGE SPNL 10D XL 55X18X8MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7870860","SUP","HCPCS C1713","","7870860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871055","SUP","HCPCS C1713","","7871055  -  CAGE SPNL 10D XL 55X18X10MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871060","SUP","HCPCS C1713","","7871060  -  CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871245","SUP","HCPCS C1713","","7871245  -  SPACER SPNL XL 45X18X12MM CRNT FSN","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871250","SUP","HCPCS C1713","","7871250  -  CAGE SPNL 10D XL 50X18X10MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871255","SUP","HCPCS C1713","","7871255  -  CAGE SPNL 10D XL 55X18X12MM NS LF CRNT","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871260","SUP","HCPCS C1713","","7871260  -  CAGE SPNL 10D LRDTC 60X18X12MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871445","SUP","HCPCS C1713","","7871445  -  SPACER SPNL 10D XL 45X18X14MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871450","SUP","HCPCS C1713","","7871450  -  SPACER SPNL 10D XL 50X18X14MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871455","SUP","HCPCS C1713","","7871455  -  CAGE SPNL 10D LRDTC 55X18X14MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871460","SUP","HCPCS C1713","","7871460  -  CAGE SPNL 10D LRDTC 60X18X14MM CRNT XLIF PEEK-OPTM","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871645","SUP","HCPCS C1713","","7871645  -  SPACER SPNL 10D XL 45X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871650","SUP","HCPCS C1713","","7871650  -  SPACER SPNL 10D XL 50X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871655","SUP","HCPCS C1713","","7871655  -  SPACER SPNL 10D XL 55X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871660","SUP","HCPCS C1713","","7871660  -  SPACER SPNL 10D XL 60X18X16MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871845","SUP","HCPCS C1713","","7871845  -  SPACER SPNL 10D XL 45X18X18MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871850","SUP","HCPCS C1713","","7871850  -  SPACER SPNL 10D XL 50X18X18MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871855","SUP","HCPCS C1713","","7871855  -  SPACER SPNL 10D XL 55X18X18MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7871860","SUP","HCPCS C1713","","7871860  -  SPACER SPNL 10D XL 60X18X18MM CRNT 1ST LAT APRCH","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"7875520","SUP","HCPCS C1713","","7875520  -  SCREW BN 5.5MM 20MM HALO SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875522","SUP","HCPCS C1713","","7875522  -  SCREW BN 5.5MM 22MM HALO SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875524","SUP","HCPCS C1713","","7875524  -  SCREW BN 5.5MM 24MM HALO SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875526","SUP","HCPCS C1713","","7875526  -  SCREW BN 5.5MM 26MM HALO SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875528","SUP","HCPCS C1713","","7875528  -  SCREW BN 5.5MM 28MM HALO SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875530","SUP","HCPCS C1713","","7875530  -  SCREW BN 5.5MM 30MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875532","SUP","HCPCS C1713","","7875532  -  SCREW BN 5.5MM 32MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7875534","SUP","HCPCS C1713","","7875534  -  SCREW BN 5.5MM 34MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876520","SUP","HCPCS C1713","","7876520  -  SCREW BN 6.5MM 20MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876522","SUP","HCPCS C1713","","7876522  -  SCREW BN 6.5MM 22MM HALO SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876526","SUP","HCPCS C1713","","7876526  -  SCREW BN 6.5MM 26MM HALO ANT LMBR SPNE PLT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876528","SUP","HCPCS C1713","","7876528  -  SCREW BN 6.5MM 28MM HALO PLT ANT LMBR SPNE","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876530","SUP","HCPCS C1713","","7876530  -  SCREW BN 6.5MM 30MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876532","SUP","HCPCS C1713","","7876532  -  SCREW BN 6.5MM 32MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7876534","SUP","HCPCS C1713","","7876534  -  SCREW BN 6.5MM 34MM HALO SPNE LMBR ANT","BOTH IP/OP","$1,057.50 ","$782.55 ","$0.00 ","$1,057.50 ","$475.88 ","$0.00 ","$220.41 ","$0.00 ","$0.00 ","$185.16 ","$1,057.50 ","$0.00 ","$528.75 ","$837.54 ","$846.00 ","$0.00 ","$165.50 ","$0.00 ","$168.35 ","$0.00 "
"7890030","SUP","HCPCS C1713","","7890030  -  PIN SKL HALO SLV ANT LMBR SPNE","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"7891032","SUP","HCPCS C1713","","7891032  -  PLATE BN 32MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891034","SUP","HCPCS C1713","","7891034  -  PLATE BN 34MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891036","SUP","HCPCS C1713","","7891036  -  PLATE BN 36MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891038","SUP","HCPCS C1713","","7891038  -  PLATE BN 38MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891040","SUP","HCPCS C1713","","7891040  -  PLATE BN 40MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891042","SUP","HCPCS C1713","","7891042  -  PLATE BN 42MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891044","SUP","HCPCS C1713","","7891044  -  PLATE BN 44MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7891046","SUP","HCPCS C1713","","7891046  -  PLATE BN 46MM HALO TI SPNE LMBR ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892032","SUP","HCPCS C1713","","7892032  -  PLATE BN 32MM HALO TI SPNE SCRM ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892034","SUP","HCPCS C1713","","7892034  -  PLATE BN 34MM HALO TI SPNE SCRM ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892038","SUP","HCPCS C1713","","7892038  -  PLATE BN 38MM HALO TI SPNE SCRM ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892042","SUP","HCPCS C1713","","7892042  -  PLATE BN 42MM HALO TI SPNE SCRM ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892044","SUP","HCPCS C1713","","7892044  -  PLATE BN 44MM HALO TI SPNE SCRM ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892046","SUP","HCPCS C1713","","7892046  -  PLATE BN 46MM HALO TI SPNE SCRM ANT","BOTH IP/OP","$8,407.50 ","$6,221.55 ","$0.00 ","$8,407.50 ","$3,783.38 ","$0.00 ","$1,752.33 ","$0.00 ","$0.00 ","$1,472.09 ","$8,407.50 ","$0.00 ","$4,203.75 ","$6,658.74 ","$6,726.00 ","$0.00 ","$1,315.77 ","$0.00 ","$1,338.47 ","$0.00 "
"7892525","SUP","HCPCS C1713","","7892525  -  SCREW 7892525 HA COATED NONCAN 5.5 X 25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892530","SUP","HCPCS C1713","","7892530  -  SCREW 7892530 HA COATED NONCAN 5.5 X 30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892535","SUP","HCPCS C1713","","7892535  -  SCREW 7892535 HA COATED NONCAN 5.5 X 35","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892540","SUP","HCPCS C1713","","7892540  -  SCREW 7892540 HA COATED NONCAN 5.5 X 40","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892545","SUP","HCPCS C1713","","7892545  -  SCREW 7892545 HA COATED NONCAN 5.5 X 45","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892550","SUP","HCPCS C1713","","7892550  -  SCREW 7892550 HA COATED NONCAN 5.5 X 50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892555","SUP","HCPCS C1713","","7892555  -  SCREW 7892555 HA COATED NONCAN 5.5 X 55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892560","SUP","HCPCS C1713","","7892560  -  SCREW 7892560 HA COATED NONCANN 5.5X60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892625","SUP","HCPCS C1713","","7892625  -  SCREW 7892625 HA COATED NONCAN 6.5 X 25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892630","SUP","HCPCS C1713","","7892630  -  SCREW 7892630 HA COATED NONCAN 6.5 X 30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892635","SUP","HCPCS C1713","","7892635  -  SCREW 7892635 HA COATED NONCAN 6.5 X 35","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892640","SUP","HCPCS C1713","","7892640  -  SCREW 7892640 HA COATED NONCAN 6.5 X 40","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892645","SUP","HCPCS C1713","","7892645  -  SCREW 7892645 HA COATED NONCAN 6.5 X 45","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892650","SUP","HCPCS C1713","","7892650  -  SCREW 7892650 HA COATED NONCAN 6.5 X 50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892655","SUP","HCPCS C1713","","7892655  -  SCREW 7892655 HA COATED NONCAN 6.5 X 55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892660","SUP","HCPCS C1713","","7892660  -  SCREW 7892660 HA COATED NONCAN 6.5 X 60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892665","SUP","HCPCS C1713","","7892665  -  SCREW 7892665 HA COATED NONCAN 6.5 X 65","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892725","SUP","HCPCS C1713","","7892725  -  SCREW 7892725 HA COATED NONCAN 7.5 X 25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892730","SUP","HCPCS C1713","","7892730  -  SCREW 7892730 HA COATED NONCAN 7.5 X 30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892735","SUP","HCPCS C1713","","7892735  -  SCREW 7892735 HA COATED NONCAN 7.5 X 35","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892740","SUP","HCPCS C1713","","7892740  -  SCREW BN 7.5MM 40MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892745","SUP","HCPCS C1713","","7892745  -  SCREW BN 7.5MM 45MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892750","SUP","HCPCS C1713","","7892750  -  SCREW 7892750 HA COATED NONCAN 7.5 X 50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892755","SUP","HCPCS C1713","","7892755  -  SCREW 7892755 HA COATED NONCAN 7.5 X 55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892760","SUP","HCPCS C1713","","7892760  -  SCREW 7892760 HA COATED NONCAN 7.5 X 60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892765","SUP","HCPCS C1713","","7892765  -  SCREW 7892765 HA COATED NONCAN 7.5 X 65","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892770","SUP","HCPCS C1713","","7892770  -  SCREW 7892770 HA COATED NONCAN 7.5 X 70","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892825","SUP","HCPCS C1713","","7892825  -  SCREW 7892825 HA COATED NONCAN 8.5 X 25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892830","SUP","HCPCS C1713","","7892830  -  SCREW 7892830 HA COATED NONCAN 8.5 X 30","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892835","SUP","HCPCS C1713","","7892835  -  SCREW 7892835 HA COATED NONCAN 8.5 X 35","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892840","SUP","HCPCS C1713","","7892840  -  SCREW 7892840 HA COATED NONCAN 8.5 X 40","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892845","SUP","HCPCS C1713","","7892845  -  SCREW 7892845 HA COATED NONCAN 8.5 X 45","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892850","SUP","HCPCS C1713","","7892850  -  SCREW 7892850 HA COATED NONCAN 8.5 X 50","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892855","SUP","HCPCS C1713","","7892855  -  SCREW 7892855 HA COATED NONCAN 8.5 X 55","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892860","SUP","HCPCS C1713","","7892860  -  SCREW 7892860 HA COATED NONCAN 8.5 X 60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7892865","SUP","HCPCS C1713","","7892865  -  SCREW 7892865 HA COATED NONCAN 8.5 X 65","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7893025","SUP","HCPCS C1713","","7893025  -  ROD 7893025 6.35MM X 25MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893030","SUP","HCPCS C1713","","7893030  -  ROD 7893030 6.35MM X 30MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893035","SUP","HCPCS C1713","","7893035  -  ROD 7893035 6.35MM X 35MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893040","SUP","HCPCS C1713","","7893040  -  ROD 7893040 6.35MM X 40MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893045","SUP","HCPCS C1713","","7893045  -  ROD 7893045 6.35MM X 45MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893050","SUP","HCPCS C1713","","7893050  -  ROD 7893050 6.35MM X 50MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893055","SUP","HCPCS C1713","","7893055  -  ROD 7893055 6.35MM X 55MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893060","SUP","HCPCS C1713","","7893060  -  ROD SPNL 60MM 6.35MM PEEK","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893065","SUP","HCPCS C1713","","7893065  -  ROD 7893065 6.35MM X 65MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893070","SUP","HCPCS C1713","","7893070  -  ROD 7893070 6.35MM X 70MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893075","SUP","HCPCS C1713","","7893075  -  ROD 7893075 6.35MM X 75MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893076","SUP","HCPCS C1713","","7893076  -  PLATE BN 76MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893080","SUP","HCPCS C1713","","7893080  -  PLATE BN 80MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893084","SUP","HCPCS C1713","","7893084  -  PLATE BN 84MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893085","SUP","HCPCS C1713","","7893085  -  ROD 7893085 6.35MM X 85MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893088","SUP","HCPCS C1713","","7893088  -  PLATE BN 88MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893090","SUP","HCPCS C1713","","7893090  -  ROD 7893090 6.35MM X 90MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893092","SUP","HCPCS C1713","","7893092  -  PLATE BN 92MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893095","SUP","HCPCS C1713","","7893095  -  ROD 7893095 6.35MM X 95MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893096","SUP","HCPCS C1713","","7893096  -  PLATE BN 96MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893100","SUP","HCPCS C1713","","7893100  -  PLATE BN 100MM HALO LVL 2 TI SPNE LMBR ANT","BOTH IP/OP","$11,927.50 ","$8,826.35 ","$0.00 ","$11,927.50 ","$5,367.38 ","$0.00 ","$2,485.99 ","$0.00 ","$0.00 ","$2,088.41 ","$11,927.50 ","$0.00 ","$5,963.75 ","$9,446.58 ","$9,542.00 ","$0.00 ","$1,866.65 ","$0.00 ","$1,898.86 ","$0.00 "
"7893105","SUP","HCPCS C1713","","7893105  -  ROD 7893105 6.35MM X 105MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893110","SUP","HCPCS C1713","","7893110  -  ROD 7893110 6.35MM X 110MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893115","SUP","HCPCS C1713","","7893115  -  ROD 7893115 6.35MM X 115MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893120","SUP","HCPCS C1713","","7893120  -  ROD 7893120 6.35MM X 120MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893125","SUP","HCPCS C1713","","7893125  -  ROD 7893125 6.35MM X 125MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7893130","SUP","HCPCS C1713","","7893130  -  ROD 7893130 6.35MM X 130MM PEEK ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"7894525","SUP","HCPCS C1713","","7894525  -  SCREW 7894525 CDH PEEK 4.5X25 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7894530","SUP","HCPCS C1713","","7894530  -  SCREW 7894530 CDH PEEK 4.5X30 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7894535","SUP","HCPCS C1713","","7894535  -  SCREW 7894535 CDH PEEK 4.5X35 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7894540","SUP","HCPCS C1713","","7894540  -  SCREW 7894540 CDH PEEK 4.5X40 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7894545","SUP","HCPCS C1713","","7894545  -  SCREW 7894545 CDH PEEK 4.5X45 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7894550","SUP","HCPCS C1713","","7894550  -  SCREW 7894550 CDH PEEK 4.5X50 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895525","SUP","HCPCS C1713","","7895525  -  SCREW 7895525 CDH PEEK 5.5X25 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895530","SUP","HCPCS C1713","","7895530  -  SCREW 7895530 CDH PEEK 5.5X30 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895535","SUP","HCPCS C1713","","7895535  -  SCREW 7895535 CDH PEEK 5.5X35 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895540","SUP","HCPCS C1713","","7895540  -  SCREW 7895540 CDH PEEK 5.5X40 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895545","SUP","HCPCS C1713","","7895545  -  SCREW BN 5.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895550","SUP","HCPCS C1713","","7895550  -  SCREW 7895550 CDH PEEK 5.5X50 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895555","SUP","HCPCS C1713","","7895555  -  SCREW 7895555 CDH PEEK 5.5X55 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7895560","SUP","HCPCS C1713","","7895560  -  SCREW 7895560 CDH PEEK 5.5X60 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896525","SUP","HCPCS C1713","","7896525  -  SCREW 7896525 CDH PEEK 6.5X25 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896530","SUP","HCPCS C1713","","7896530  -  SCREW 7896530 CDH PEEK 6.5X30 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896535","SUP","HCPCS C1713","","7896535  -  SCREW BN 6.5MM 35MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896540","SUP","HCPCS C1713","","7896540  -  SCREW BN 6.5MM 40MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896545","SUP","HCPCS C1713","","7896545  -  SCREW BN 6.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896550","SUP","HCPCS C1713","","7896550  -  SCREW BN 6.5MM 50MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896555","SUP","HCPCS C1713","","7896555  -  SCREW 7896555 CDH PEEK 6.5X55 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896560","SUP","HCPCS C1713","","7896560  -  SCREW 7896560 CDH PEEK 6.5X60 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7896565","SUP","HCPCS C1713","","7896565  -  SCREW 7896565 CDH PEEK 6.5X65 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897530","SUP","HCPCS C1713","","7897530  -  SCREW 7897530 CDH PEEK 7.5X30 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897535","SUP","HCPCS C1713","","7897535  -  SCREW 7897535 CDH PEEK 7.5X35 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897540","SUP","HCPCS C1713","","7897540  -  SCREW BONE 7.5MM 40MM CD HZN LGC PEEK SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897545","SUP","HCPCS C1713","","7897545  -  SCREW 7897545 CDH PEEK 7.5X45 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897550","SUP","HCPCS C1713","","7897550  -  SCREW 7897550 CDH PEEK 7.5X50 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897555","SUP","HCPCS C1713","","7897555  -  SCREW 7897555 CDH PEEK 7.5X55 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897560","SUP","HCPCS C1713","","7897560  -  SCREW 7897560 CDH PEEK 7.5X60 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897565","SUP","HCPCS C1713","","7897565  -  SCREW 7897565 CDH PEEK 7.5X65 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7897570","SUP","HCPCS C1713","","7897570  -  SCREW 7897570 CDH PEEK 7.5X70 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898530","SUP","HCPCS C1713","","7898530  -  SCREW 7898530 CDH PEEK 8.5X30 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898535","SUP","HCPCS C1713","","7898535  -  SCREW 7898535 CDH PEEK 8.5X35 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898540","SUP","HCPCS C1713","","7898540  -  SCREW 7898540 CDH PEEK 8.5X40 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898545","SUP","HCPCS C1713","","7898545  -  SCREW 7898545 CDH PEEK 8.5X45 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898550","SUP","HCPCS C1713","","7898550  -  SCREW 7898550 CDH PEEK 8.5X50 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898555","SUP","HCPCS C1713","","7898555  -  SCREW 7898555 CDH PEEK 8.5X55 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898560","SUP","HCPCS C1713","","7898560  -  SCREW 7898560 CDH PEEK 8.5X60 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7898565","SUP","HCPCS C1713","","7898565  -  SCREW 7898565 CDH PEEK 8.5X65 NON CANN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905310","SUP","HCPCS C1713","","7905310  -  SCREW BONE 3.5MM 10MM TI SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905312","SUP","HCPCS C1713","","7905312  -  SCREW BONE 3.5MM 12MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905314","SUP","HCPCS C1713","","7905314  -  SCREW BONE 3.5MM 14MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905316","SUP","HCPCS C1713","","7905316  -  SCREW BONE 3.5MM 16MM VUEPOINT POST CERV SPN MULTIAX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905318","SUP","HCPCS C1713","","7905318  -  SCREW BONE 3.5MM 18MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905320","SUP","HCPCS C1713","","7905320  -  SCREW BONE 3.5MM 20MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905322","SUP","HCPCS C1713","","7905322  -  SCREW BONE 3.5MM 22MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905324","SUP","HCPCS C1713","","7905324  -  SCREW BONE 3.5MM 24MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905326","SUP","HCPCS C1713","","7905326  -  SCREW BONE 3.5MM 26MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905328","SUP","HCPCS C1713","","7905328  -  SCREW BONE 3.5MM 28MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905330","SUP","HCPCS C1713","","7905330  -  SCREW BONE 3.5MM 30MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905332","SUP","HCPCS C1713","","7905332  -  SCREW BONE 3.5MM 32MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905334","SUP","HCPCS C1713","","7905334  -  SCREW BONE 34MM 3.5MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905410","SUP","HCPCS C1713","","7905410  -  SCREW BONE 4MM 10MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905412","SUP","HCPCS C1713","","7905412  -  SCREW BONE 4MM 12MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905414","SUP","HCPCS C1713","","7905414  -  SCREW BONE 4MM 14MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905416","SUP","HCPCS C1713","","7905416  -  SCREW BONE 16MM 40MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905418","SUP","HCPCS C1713","","7905418  -  SCREW BONE 4MM 18MM VUEPOINT TI POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905420","SUP","HCPCS C1713","","7905420  -  SCREW BONE 24MM 40MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905422","SUP","HCPCS C1713","","7905422  -  SCREW BONE 4MM 22MM POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905424","SUP","HCPCS C1713","","7905424  -  SCREW BONE 4MM 24MM VUEPOINT POST CERV SPN MULTIAX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905426","SUP","HCPCS C1713","","7905426  -  SCREW BONE 4MM 26MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905428","SUP","HCPCS C1713","","7905428  -  SCREW BONE 4MM 28MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905430","SUP","HCPCS C1713","","7905430  -  SCREW BONE 4MM 30MM VUEPOINT POST CERV SPN MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905432","SUP","HCPCS C1713","","7905432  -  SCREW BONE 4MM 32MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905434","SUP","HCPCS C1713","","7905434  -  SCREW BONE 4MM 34MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905436","SUP","HCPCS C1713","","7905436  -  SCREW BONE 4MM 36MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905438","SUP","HCPCS C1713","","7905438  -  SCREW BONE 4MM 38MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905440","SUP","HCPCS C1713","","7905440  -  SCREW BONE 4MM 40MM VUEPOINT POST CERV SPN MULTIAX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905510","SUP","HCPCS C1713","","7905510  -  SCREW BONE 3.5MM 10MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905512","SUP","HCPCS C1713","","7905512  -  SCREW BONE 3.5MM 12MM TI SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905514","SUP","HCPCS C1713","","7905514  -  SCREW BONE 3.5MM 14MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905516","SUP","HCPCS C1713","","7905516  -  SCREW BONE 3.5MM 16MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905518","SUP","HCPCS C1713","","7905518  -  SCREW BONE 3.5MM 18MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905520","SUP","HCPCS C1713","","7905520  -  SCREW BONE 3.5MM 20MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905522","SUP","HCPCS C1713","","7905522  -  SCREW BONE 22MM 35MM SPNL FAVORED ANG FULTHRD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905524","SUP","HCPCS C1713","","7905524  -  SCREW BONE 3.5MM 24MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905526","SUP","HCPCS C1713","","7905526  -  SCREW BONE 3.5MM 26MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905528","SUP","HCPCS C1713","","7905528  -  SCREW BONE 3.5MM 28MM SPNL MULTIAX FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905530","SUP","HCPCS C1713","","7905530  -  SCREW BONE 3.5MM 30MM SPNL MULTIAX FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905532","SUP","HCPCS C1713","","7905532  -  SCREW BONE 3.5MM 32MM SPNL MULTIAX FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905534","SUP","HCPCS C1713","","7905534  -  SCREW BONE 3.5MM 34MM VUEPOINT POST CERV SPN MULTIAX FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905610","SUP","HCPCS C1713","","7905610  -  SCREW BONE 4MM 10MM TULIP SPNL ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905612","SUP","HCPCS C1713","","7905612  -  SCREW BONE 4MM 12MM TI SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905614","SUP","HCPCS C1713","","7905614  -  SCREW BONE 4MM 14MM TULIP SPNL ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905616","SUP","HCPCS C1713","","7905616  -  SCREW BONE 4MM 20MM TULIP SPNL ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905618","SUP","HCPCS C1713","","7905618  -  SCREW BONE 4MM 18MM TULIP SPNL ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905620","SUP","HCPCS C1713","","7905620  -  SCREW BONE 4MM 20MM TULIP SPNL ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905622","SUP","HCPCS C1713","","7905622  -  SCREW BONE 4MM 22MM TULIP SPNL ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905624","SUP","HCPCS C1713","","7905624  -  SCREW BONE 4MM 24MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905626","SUP","HCPCS C1713","","7905626  -  SCREW BONE 4MM 26MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905628","SUP","HCPCS C1713","","7905628  -  SCREW BONE 4MM 28MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905630","SUP","HCPCS C1713","","7905630  -  SCREW BONE 4MM 30MM VUEPOINT TULIP POST CERV SPN FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905632","SUP","HCPCS C1713","","7905632  -  SCREW BONE 4MM 32MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905634","SUP","HCPCS C1713","","7905634  -  SCREW BONE 4MM 34MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905636","SUP","HCPCS C1713","","7905636  -  SCREW BONE 4MM 36MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905638","SUP","HCPCS C1713","","7905638  -  SCREW BONE 4MM 38MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905640","SUP","HCPCS C1713","","7905640  -  SCREW BONE 4MM 40MM TULIP SPNL FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905710","SUP","HCPCS C1713","","7905710  -  SCREW BONE 4.5MM 10MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905712","SUP","HCPCS C1713","","7905712  -  SCREW BONE 4.5MM 12MM VUEPOINT SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905714","SUP","HCPCS C1713","","7905714  -  SCREW BONE 4.5MM 14MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905716","SUP","HCPCS C1713","","7905716  -  SCREW BONE 4.5MM 16MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905718","SUP","HCPCS C1713","","7905718  -  SCREW BONE 4.5MM 18MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905720","SUP","HCPCS C1713","","7905720  -  SCREW BONE 4.5MM 20MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905722","SUP","HCPCS C1713","","7905722  -  SCREW BONE 4.5MM 22MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905724","SUP","HCPCS C1713","","7905724  -  SCREW BONE 4.5MM 24MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905726","SUP","HCPCS C1713","","7905726  -  SCREW BONE 4.5MM 26MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905728","SUP","HCPCS C1713","","7905728  -  SCREW BONE 4.5MM 28MM VUEPOINT POST CERV SPN SYS MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905730","SUP","HCPCS C1713","","7905730  -  SCREW BONE 4.5MM 30MM VUEPOINT POST CERV SPN SYS MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905732","SUP","HCPCS C1713","","7905732  -  SCREW BONE 4.5MM 32MM VUEPOINT POST CERV SPN SYS MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905734","SUP","HCPCS C1713","","7905734  -  SCREW BONE 4.5MM 34MM VUEPOINT POST CERV SPN SYS MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905736","SUP","HCPCS C1713","","7905736  -  SCREW BONE 4.5MM 36MM VUEPOINT POST CERV SPN SYS MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905738","SUP","HCPCS C1713","","7905738  -  SCREW BONE 4.5MM 38MM VUEPOINT POST CERV SPN SYS MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905740","SUP","HCPCS C1713","","7905740  -  SCREW BONE 4.5MM 40MM SPNL MULTIAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905824","SUP","HCPCS C1713","","7905824  -  SCREW BONE 3.5MM 24MM SPNL FAVORED ANG PTTHRD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905826","SUP","HCPCS C1713","","7905826  -  SCREW BONE 3.5MM 26MM SPNL PTTHRD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905828","SUP","HCPCS C1713","","7905828  -  SCREW BONE 3.5MM 28MM VUEPOINT POST CERV SPN SYS FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905830","SUP","HCPCS C1713","","7905830  -  SCREW BONE 3.5MM 30MM VUEPOINT TI POST CERV SPN FAVORED ANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905832","SUP","HCPCS C1713","","7905832  -  SCREW BONE 3.5MM 32MM SPNL FAVORED ANG PTTHRD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905834","SUP","HCPCS C1713","","7905834  -  SCREW BONE 3.5MM 14MM VUEPOINT POST CERV SPN FAVORED ANG SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7905836","SUP","HCPCS C1713","","7905836  -  SCREW BONE 3.5MM 36MM VUEPOINT PTHRD POST CERV SPN FAVORED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906000","SUP","HCPCS C1713","","7906000  -  SCREW SET 3.5MM POST CERV SPN LMNR HOOK TULIP SYS VUEPOINT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"7906005","SUP","Custom 27803010","","7906005  -  HOOK SPNL 5MM LMNR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906007","SUP","Custom 27803010","","7906007  -  HOOK SPNL 7MM LMNR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906008","SUP","HCPCS C1713","","7906008  -  SCREW BONE 11MM VUEPOINT POST CERV SPN SYS OFFST CONCTR OPN","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"7906022","SUP","HCPCS C1713","","7906022  -  SCREW BONE 25MM VUEPOINT LG POST CERV SPN SYS OFFST CONCTR","BOTH IP/OP","$1,240.00 ","$917.60 ","$0.00 ","$1,240.00 ","$558.00 ","$0.00 ","$258.45 ","$0.00 ","$0.00 ","$217.11 ","$1,240.00 ","$0.00 ","$620.00 ","$982.08 ","$992.00 ","$0.00 ","$194.06 ","$0.00 ","$197.41 ","$0.00 "
"7906025","SUP","HCPCS C1713","","7906025  -  CONCTR ROD ACUTE ANG OFFST","BOTH IP/OP","$1,240.00 ","$917.60 ","$0.00 ","$1,240.00 ","$558.00 ","$0.00 ","$258.45 ","$0.00 ","$0.00 ","$217.11 ","$1,240.00 ","$0.00 ","$620.00 ","$982.08 ","$992.00 ","$0.00 ","$194.06 ","$0.00 ","$197.41 ","$0.00 "
"7906035","SUP","HCPCS C1713","","7906035  -  CONCTR ROD 3.5MM INLN","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906045","SUP","HCPCS C1713","","7906045  -  CONCTR ROD 3.5-4.5MM INLN","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906055","SUP","HCPCS C1713","","7906055  -  CONCTR ROD 5.5MM 3.5MM INLN","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906065","SUP","HCPCS C1713","","7906065  -  CONCTR ROD 6.5MM 3.5MM INLN","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906120","SUP","HCPCS C1713","","7906120  -  CONCTR ROD 120MM 3.5MM VUEPOINT SYS POST CERV SPN","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7906126","SUP","HCPCS C1713","","7906126  -  CONCTR ROD 26MM FIX CX SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906128","SUP","HCPCS C1713","","7906128  -  CONCTR ROD 28MM CX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906130","SUP","HCPCS C1713","","7906130  -  CONCTR ROD 30MM FIX CX SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906132","SUP","HCPCS C1713","","7906132  -  CONCTR ROD 32MM FIX CX TI SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906134","SUP","HCPCS C1713","","7906134  -  CONCTR ROD 34MM CX FIX SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906136","SUP","HCPCS C1713","","7906136  -  CONCTR ROD 36MM CX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906138","SUP","HCPCS C1713","","7906138  -  CONCTR ROD 38MM VUEPOINT FIX CX SYS POST CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906140","SUP","HCPCS C1713","","7906140  -  CONCTR ROD 40MM CX FIX SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906142","SUP","HCPCS C1713","","7906142  -  CONCTR ROD 42MM XLNK SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906144","SUP","HCPCS C1713","","7906144  -  CONCTR ROD 44MM VUEPOINT FIX CX SYS POST CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906146","SUP","HCPCS C1713","","7906146  -  CONCTR ROD 46MM VUEPOINT FIX CX SYS POST CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906148","SUP","HCPCS C1713","","7906148  -  CONCTR ROD 48MM VUEPOINT FIX CX SYS POST CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906150","SUP","HCPCS C1713","","7906150  -  CONCTR ROD 50MM VUEPOINT FIX CX SYS POST CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"7906160","SUP","HCPCS C1713","","7906160  -  CONCTR ROD 60MM 3.5MM VUEPOINT SYS POST CERV SPN","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7906240","SUP","HCPCS C1713","","7906240  -  ROD SPNL 240MM 3.5MM","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"7906300","SUP","HCPCS C1713","","7906300  -  ROD SPNL 45D PCVD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"7906302","SUP","Custom 27203010","","7906302  -  CONCTR CORD EYLT OCCPTL","BOTH IP/OP","$1,277.50 ","$945.35 ","$0.00 ","$1,277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,277.50 ","$0.00 ","$638.75 ","$1,011.78 ","$1,022.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7906306","SUP","HCPCS C1713","","7906306  -  SCREW BONE 4.5MM 6MM VUEPOINT POST CERV SPN OCCPTL CORT SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906308","SUP","HCPCS C1713","","7906308  -  SCREW BONE 4.5MM 8MM VUEPOINT POST CERV SPN OCCPTL CORT SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906310","SUP","HCPCS C1713","","7906310  -  SCREW BONE 4.5MM 10MM VUEPOINT POST CERV SPN CORT OCCPTL SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906312","SUP","HCPCS C1713","","7906312  -  SCREW BONE 4.5MM 12MM VUEPOINT POST CERV SPN CORT OCCPTL SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906314","SUP","HCPCS C1713","","7906314  -  SCREW BONE 4.5MM 14MM VUEPOINT POST CERV SPN CORT OCCPTL SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906335","SUP","HCPCS C1713","","7906335  -  PLATE 35MM KLD POST CERV SYS VUEPOINT BONE","BOTH IP/OP","$6,355.00 ","$4,702.70 ","$0.00 ","$6,355.00 ","$2,859.75 ","$0.00 ","$1,324.54 ","$0.00 ","$0.00 ","$1,112.71 ","$6,355.00 ","$0.00 ","$3,177.50 ","$5,033.16 ","$5,084.00 ","$0.00 ","$994.56 ","$0.00 ","$1,011.72 ","$0.00 "
"7906340","SUP","HCPCS C1713","","7906340  -  PLATE 40MM KLD SYS VUEPOINT BONE POST CERV SPN","BOTH IP/OP","$6,355.00 ","$4,702.70 ","$0.00 ","$6,355.00 ","$2,859.75 ","$0.00 ","$1,324.54 ","$0.00 ","$0.00 ","$1,112.71 ","$6,355.00 ","$0.00 ","$3,177.50 ","$5,033.16 ","$5,084.00 ","$0.00 ","$994.56 ","$0.00 ","$1,011.72 ","$0.00 "
"7906345","SUP","HCPCS C1713","","7906345  -  PLATE 45MM KLD BONE","BOTH IP/OP","$6,355.00 ","$4,702.70 ","$0.00 ","$6,355.00 ","$2,859.75 ","$0.00 ","$1,324.54 ","$0.00 ","$0.00 ","$1,112.71 ","$6,355.00 ","$0.00 ","$3,177.50 ","$5,033.16 ","$5,084.00 ","$0.00 ","$994.56 ","$0.00 ","$1,011.72 ","$0.00 "
"7906355","SUP","HCPCS C1713","","7906355  -  ROD SPNL 3.5-5.5MM VUEPOINT TRNS","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906356","SUP","HCPCS C1713","","7906356  -  SCREW BONE 5MM 6MM VUEPOINT POST CERV SPN OCCPTL CORT SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906358","SUP","HCPCS C1713","","7906358  -  SCREW BONE 5MM 8MM VUEPOINT POST CERV SPN OCCPTL CORT SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906360","SUP","HCPCS C1713","","7906360  -  SCREW BONE 5MM 10MM LEFT OCCPTL CORT","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906362","SUP","HCPCS C1713","","7906362  -  SCREW BONE 5MM 12MM VUEPOINT POST CERV SPN CORT OCCPTL SYS","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906364","SUP","HCPCS C1713","","7906364  -  SCREW BONE 5MM 14MM CORT OCCPTL","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"7906435","SUP","HCPCS C1713","","7906435  -  CONCTR ROD 35MM OFFST","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906445","SUP","HCPCS C1713","","7906445  -  CONCTR ROD 4.5MM 3.5MM OFFST","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906455","SUP","HCPCS C1713","","7906455  -  CONCTR ROD 5.5MM 3.5MM OFFST","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7906465","SUP","HCPCS C1713","","7906465  -  CONCTR ROD 6.25MM 3.5MM OFFST","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"7907010","SUP","Custom 27203010","","7907010  -  BIT DRILL 2.05MM SYSTEM VUEPOINT POSTERIOR CERV SPN","BOTH IP/OP","$647.50 ","$479.15 ","$0.00 ","$647.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$647.50 ","$0.00 ","$323.75 ","$512.82 ","$518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7907012","SUP","Custom 27203010","","7907012  -  BIT DRILL 2.5MM","BOTH IP/OP","$647.50 ","$479.15 ","$0.00 ","$647.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$647.50 ","$0.00 ","$323.75 ","$512.82 ","$518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7907220","SUP","HCPCS C1713","","7907220  -  TEMPLATE SZ 120MM ROD","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$61.88 ","$0.00 ","$28.66 ","$0.00 ","$0.00 ","$24.08 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$21.52 ","$0.00 ","$21.89 ","$0.00 "
"7907240","SUP","HCPCS C1713","","7907240  -  TMPLT ROD 240MM VUEPOINT POST CERV SPN","BOTH IP/OP","$157.50 ","$116.55 ","$0.00 ","$157.50 ","$70.88 ","$0.00 ","$32.83 ","$0.00 ","$0.00 ","$27.58 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$24.65 ","$0.00 ","$25.07 ","$0.00 "
"7908300","SUP","HCPCS C1713","","7908300  -  ROD SPNL VUEPOINT 45D COCR BNT","BOTH IP/OP","$1,680.00 ","$1,243.20 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$350.15 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$262.92 ","$0.00 ","$267.46 ","$0.00 "
"7908355","SUP","HCPCS C1713","","7908355  -  ROD TRANSITION COCR 5.5 MM","BOTH IP/OP","$3,150.00 ","$2,331.00 ","$0.00 ","$3,150.00 ","$1,417.50 ","$0.00 ","$656.54 ","$0.00 ","$0.00 ","$551.54 ","$3,150.00 ","$0.00 ","$1,575.00 ","$2,494.80 ","$2,520.00 ","$0.00 ","$492.98 ","$0.00 ","$501.48 ","$0.00 "
"7965520","SUP","HCPCS C1713","","7965520  -  SCREW 7965520 5.5MM X 20MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7965525","SUP","HCPCS C1713","","7965525  -  SCREW 7965525 5.5MM X 25MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7965530","SUP","HCPCS C1713","","7965530  -  SCREW 7965530 5.5MM X 30MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7965535","SUP","HCPCS C1713","","7965535  -  SCREW 7965535 5.5MM X 35MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7966020","SUP","HCPCS C1713","","7966020  -  SCREW 7966020 6.0MM X 20MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7966025","SUP","HCPCS C1713","","7966025  -  SCREW 7966025 6.0MM X 25MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7966030","SUP","HCPCS C1713","","7966030  -  SCREW 7966030 6.0MM X 30MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7966035","SUP","HCPCS C1713","","7966035  -  SCREW 7966035 6.0MM X 35MM SELF TAP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7967210","SUP","HCPCS C1713","","7967210  -  SPACER SPNL 12D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967212","SUP","HCPCS C1713","","7967212  -  SPACER SPNL 12D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967214","SUP","HCPCS C1713","","7967214  -  SPACER SPNL 12D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967216","SUP","HCPCS C1713","","7967216  -  SPACER SPNL 12D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967218","SUP","HCPCS C1713","","7967218  -  SPACER SPNL 12D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967220","SUP","HCPCS C1713","","7967220  -  SPACER SPNL 12D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967810","SUP","HCPCS C1713","","7967810  -  SPACER SPNL 8D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967812","SUP","HCPCS C1713","","7967812  -  SPACER SPNL 8D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967814","SUP","HCPCS C1713","","7967814  -  SPACER SPNL 8D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967816","SUP","HCPCS C1713","","7967816  -  SPACER SPNL 8D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967818","SUP","HCPCS C1713","","7967818  -  SPACER SPNL 8D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7967820","SUP","HCPCS C1713","","7967820  -  SPACER SPNL 8D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968210","SUP","HCPCS C1713","","7968210  -  SPACER SPNL 12D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968212","SUP","HCPCS C1713","","7968212  -  SPACER SPNL 12D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968214","SUP","HCPCS C1713","","7968214  -  SPACER SPNL 12D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968216","SUP","HCPCS C1713","","7968216  -  SPACER SPNL 12D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968218","SUP","HCPCS C1713","","7968218  -  SPACER SPNL 12D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968220","SUP","HCPCS C1713","","7968220  -  SPACER SPNL 12D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968810","SUP","HCPCS C1713","","7968810  -  SPACER SPNL 8D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968812","SUP","HCPCS C1713","","7968812  -  SPACER SPNL 8D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968814","SUP","HCPCS C1713","","7968814  -  SPACER SPNL 8D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968816","SUP","HCPCS C1713","","7968816  -  SPACER SPNL 8D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968818","SUP","HCPCS C1713","","7968818  -  SPACER SPNL 8D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7968820","SUP","HCPCS C1713","","7968820  -  SPACER SPNL 8D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969210","SUP","HCPCS C1713","","7969210  -  SPACER SPNL 12D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969212","SUP","HCPCS C1713","","7969212  -  SPACER SPNL 12D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969214","SUP","HCPCS C1713","","7969214  -  SPACER SPNL 12D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969216","SUP","HCPCS C1713","","7969216  -  SPACER SPNL 12D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969218","SUP","HCPCS C1713","","7969218  -  SPACER SPNL 12D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969220","SUP","HCPCS C1713","","7969220  -  SPACER SPNL 12D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969810","SUP","HCPCS C1713","","7969810  -  SPACER SPNL 8D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969812","SUP","HCPCS C1713","","7969812  -  SPACER SPNL 8D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969814","SUP","HCPCS C1713","","7969814  -  SPACER SPNL 8D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969816","SUP","HCPCS C1713","","7969816  -  SPACER SPNL 8D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969818","SUP","HCPCS C1713","","7969818  -  SPACER SPNL 8D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7969820","SUP","HCPCS C1713","","7969820  -  SPACER SPNL 8D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK","BOTH IP/OP","$14,190.00 ","$10,500.60 ","$0.00 ","$14,190.00 ","$6,385.50 ","$0.00 ","$2,957.55 ","$0.00 ","$0.00 ","$2,484.56 ","$14,190.00 ","$0.00 ","$7,095.00 ","$11,238.48 ","$11,352.00 ","$0.00 ","$2,220.74 ","$0.00 ","$2,259.05 ","$0.00 "
"7975520","SUP","HCPCS C1713","","7975520  -  SCREW 7975520 SOVEREIGN FA  5.5 X 20MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7975525","SUP","HCPCS C1713","","7975525  -  SCREW 7975525 SOVEREIGN FA 5.5 X 25MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7975530","SUP","HCPCS C1713","","7975530  -  SCREW 7975530 SOVEREIGN FA 5.5 X 30MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7975535","SUP","HCPCS C1713","","7975535  -  SCREW 7975535 SOVEREIGN FA 5.5 X 35MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7976020","SUP","HCPCS C1713","","7976020  -  SCREW 7976020 SOVEREIGN FA 6.0 X 20MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7976025","SUP","HCPCS C1713","","7976025  -  SCREW 7976025 SOVEREIGN FA 6.0 X 25MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7976030","SUP","HCPCS C1713","","7976030  -  SCREW 7976030 SOVEREIGN FA 6.0 X 30MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"7976035","SUP","HCPCS C1713","","7976035  -  SCREW 7976035 SOVEREIGN FA 6.0 X 35MM","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"8001501","SUP","Custom 27203010","","8001501  -  TRAY 8001501 CRANI FIX 1.5 MM ST","BOTH IP/OP","$4,636.75 ","$3,431.20 ","$0.00 ","$4,636.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,636.75 ","$0.00 ","$2,318.38 ","$3,672.31 ","$3,709.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8001505","SUP","HCPCS C1713","","8001505  -  CADDY 8001505 SCREW CRANI FIX 1.5MM ST","BOTH IP/OP","$1,177.25 ","$871.17 ","$0.00 ","$1,177.25 ","$529.76 ","$0.00 ","$245.37 ","$0.00 ","$0.00 ","$206.13 ","$1,177.25 ","$0.00 ","$588.63 ","$932.38 ","$941.80 ","$0.00 ","$184.24 ","$0.00 ","$187.42 ","$0.00 "
"8001601","SUP","HCPCS C1713","","8001601  -  CADDY 8001601 SCREW 1.6 SDS","BOTH IP/OP","$930.75 ","$688.76 ","$0.00 ","$930.75 ","$418.84 ","$0.00 ","$193.99 ","$0.00 ","$0.00 ","$162.97 ","$930.75 ","$0.00 ","$465.38 ","$737.15 ","$744.60 ","$0.00 ","$145.66 ","$0.00 ","$148.18 ","$0.00 "
"8001602","SUP","Custom 27203010","","8001602  -  TRAY 8001602 CRANI FIX 1.6MM SD","BOTH IP/OP","$4,636.75 ","$3,431.20 ","$0.00 ","$4,636.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,636.75 ","$0.00 ","$2,318.38 ","$3,672.31 ","$3,709.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8001605","SUP","HCPCS C1713","","8001605  -  CADDY 8001605 CRANI FIX SCRW 1.6MM SD","BOTH IP/OP","$1,247.38 ","$923.06 ","$0.00 ","$1,247.38 ","$561.32 ","$0.00 ","$259.98 ","$0.00 ","$0.00 ","$218.41 ","$1,247.38 ","$0.00 ","$623.69 ","$987.92 ","$997.90 ","$0.00 ","$195.21 ","$0.00 ","$198.58 ","$0.00 "
"8001830","SUP","HCPCS C1713","","8001830  -  SCREW BONE 1.8MM 3MM RSC TI SPNL","BOTH IP/OP","$119.35 ","$88.32 ","$0.00 ","$119.35 ","$53.71 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.35 ","$0.00 ","$59.68 ","$94.53 ","$95.48 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"8002635","SUP","HCPCS C1713","","8002635  -  SCREW BONE 1.6MM 3.5MM TIMESH TI CRANIAL SLFDRILL STRL","BOTH IP/OP","$126.08 ","$93.30 ","$0.00 ","$126.08 ","$56.74 ","$0.00 ","$26.28 ","$0.00 ","$0.00 ","$22.08 ","$126.08 ","$0.00 ","$63.04 ","$99.86 ","$100.87 ","$0.00 ","$19.73 ","$0.00 ","$20.07 ","$0.00 "
"8004200","SUP","Custom 27203010","","8004200  -  BPD TRAY","BOTH IP/OP","$896.75 ","$663.60 ","$0.00 ","$896.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$896.75 ","$0.00 ","$448.38 ","$710.23 ","$717.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8009000","SUP","Custom 27803010","","8009000  -  BASE 8009000 TRAY CRANI FIX 1.5/1.6MM","BOTH IP/OP","$1,544.88 ","$1,143.21 ","$0.00 ","$1,544.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.88 ","$0.00 ","$772.44 ","$1,223.54 ","$1,235.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8009002","SUP","HCPCS C1713","","8009002  -  CADDY 8009002 PLATE CRANI FIX 1.5/1.6MM","BOTH IP/OP","$773.50 ","$572.39 ","$0.00 ","$773.50 ","$348.08 ","$0.00 ","$161.22 ","$0.00 ","$0.00 ","$135.43 ","$773.50 ","$0.00 ","$386.75 ","$612.61 ","$618.80 ","$0.00 ","$121.05 ","$0.00 ","$123.14 ","$0.00 "
"8009220","SUP","Custom 27803010","","8009220  -  BASE 8009220 TRAY COMBO CRANI FIX SYS","BOTH IP/OP","$809.63 ","$599.13 ","$0.00 ","$809.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$809.63 ","$0.00 ","$404.81 ","$641.23 ","$647.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8010050","SUP","Custom 27203010","","8010050  -  ELECTRODE EEG 2 NDL MNTR PK SPNE","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8011830","SUP","HCPCS C1713","","8011830  -  SCREW 8011830 RESCUE SDS 1.8X3MM 1","BOTH IP/OP","$140.25 ","$103.79 ","$0.00 ","$140.25 ","$63.11 ","$0.00 ","$29.23 ","$0.00 ","$0.00 ","$24.56 ","$140.25 ","$0.00 ","$70.13 ","$111.08 ","$112.20 ","$0.00 ","$21.95 ","$0.00 ","$22.33 ","$0.00 "
"8011850","SUP","HCPCS C1713","","8011850  -  SCREW 8011850 RESCUE SDS 1.8X5MM 1","BOTH IP/OP","$140.25 ","$103.79 ","$0.00 ","$140.25 ","$63.11 ","$0.00 ","$29.23 ","$0.00 ","$0.00 ","$24.56 ","$140.25 ","$0.00 ","$70.13 ","$111.08 ","$112.20 ","$0.00 ","$21.95 ","$0.00 ","$22.33 ","$0.00 "
"8012635","SUP","HCPCS C1713","","8012635  -  SCREW 8012635 CRUCIATE SDS 1.6X3.5MM 1","BOTH IP/OP","$142.38 ","$105.36 ","$0.00 ","$142.38 ","$64.07 ","$0.00 ","$29.67 ","$0.00 ","$0.00 ","$24.93 ","$142.38 ","$0.00 ","$71.19 ","$112.76 ","$113.90 ","$0.00 ","$22.28 ","$0.00 ","$22.67 ","$0.00 "
"8012640","SUP","HCPCS C1713","","8012640  -  SCREW 8012640 CRUCIATE SDS 1.6X4MM 1","BOTH IP/OP","$142.38 ","$105.36 ","$0.00 ","$142.38 ","$64.07 ","$0.00 ","$29.67 ","$0.00 ","$0.00 ","$24.93 ","$142.38 ","$0.00 ","$71.19 ","$112.76 ","$113.90 ","$0.00 ","$22.28 ","$0.00 ","$22.67 ","$0.00 "
"8020016","SUP","Custom 27011340","","8020016  -  PROBE EMG M5 MOD","BOTH IP/OP","$3,377.50 ","$2,499.35 ","$0.00 ","$3,377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,377.50 ","$0.00 ","$1,688.75 ","$2,674.98 ","$2,702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8020018","SUP","Custom 27203010","","8020018  -  ELECTRODE EMG SRFC MOD CLIP NVM5","BOTH IP/OP","$3,377.50 ","$2,499.35 ","$0.00 ","$3,377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,377.50 ","$0.00 ","$1,688.75 ","$2,674.98 ","$2,702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8020020","SUP","Custom 27203010","","8020020  -  ELECTRODE EMG NRVSN MOD CLIP PRB","BOTH IP/OP","$4,140.00 ","$3,063.60 ","$0.00 ","$4,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,140.00 ","$0.00 ","$2,070.00 ","$3,278.88 ","$3,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8020021","SUP","Custom 27203010","","8020021  -  ELECTRODE EMG MOD CLIP SHTH NVM5","BOTH IP/OP","$3,367.50 ","$2,491.95 ","$0.00 ","$3,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,367.50 ","$0.00 ","$1,683.75 ","$2,667.06 ","$2,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8020029","SUP","Custom 27203010","","8020029  -  KIT EMG XLIF NVM5","BOTH IP/OP","$4,442.50 ","$3,287.45 ","$0.00 ","$4,442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,442.50 ","$0.00 ","$2,221.25 ","$3,518.46 ","$3,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8020215","SUP","Custom 27203010","","8020215  -  ELTRD EMG NRVSN MOD M5","BOTH IP/OP","$3,572.50 ","$2,643.65 ","$0.00 ","$3,572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,572.50 ","$0.00 ","$1,786.25 ","$2,829.42 ","$2,858.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050015","SUP","Custom 27203010","","8050015  -  ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5","BOTH IP/OP","$2,687.50 ","$1,988.75 ","$0.00 ","$2,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,687.50 ","$0.00 ","$1,343.75 ","$2,128.50 ","$2,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050016","SUP","Custom 27203010","","8050016  -  MODULE EMG NDL PRB M5","BOTH IP/OP","$3,377.50 ","$2,499.35 ","$0.00 ","$3,377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,377.50 ","$0.00 ","$1,688.75 ","$2,674.98 ","$2,702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050018","SUP","Custom 27203010","","8050018  -  MODULE SPNL M5 NDL EMG CLIP","BOTH IP/OP","$3,377.50 ","$2,499.35 ","$0.00 ","$3,377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,377.50 ","$0.00 ","$1,688.75 ","$2,674.98 ","$2,702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050020","SUP","Custom 27203010","","8050020  -  ELECTRODE EMG 20MM NRVSN M5 NDL MOD PRB","BOTH IP/OP","$4,140.00 ","$3,063.60 ","$0.00 ","$4,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,140.00 ","$0.00 ","$2,070.00 ","$3,278.88 ","$3,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050021","SUP","Custom 27203010","","8050021  -  MODULE SPNL M5 NDL EMG CLIP SHTH","BOTH IP/OP","$3,367.50 ","$2,491.95 ","$0.00 ","$3,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,367.50 ","$0.00 ","$1,683.75 ","$2,667.06 ","$2,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050029","SUP","Custom 27203010","","8050029  -  MODULE SPNL M5 NDL EMG XLIF KT","BOTH IP/OP","$4,442.50 ","$3,287.45 ","$0.00 ","$4,442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,442.50 ","$0.00 ","$2,221.25 ","$3,518.46 ","$3,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8050215","SUP","Custom 27011340","","8050215  -  ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5","BOTH IP/OP","$3,572.50 ","$2,643.65 ","$0.00 ","$3,572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,572.50 ","$0.00 ","$1,786.25 ","$2,829.42 ","$2,858.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8051100","SUP","HCPCS C1713","","8051100  -  SCREW BONE 100MM TULIP TI LOCK CLOSE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8052025","SUP","HCPCS C1713","","8052025  -  ROD SPNL 25MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052030","SUP","HCPCS C1713","","8052030  -  ROD SPNL 30MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052035","SUP","HCPCS C1713","","8052035  -  ROD SPNL 35MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052040","SUP","HCPCS C1713","","8052040  -  ROD SPNL 40MM 5.5MM ARMADA TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052045","SUP","HCPCS C1713","","8052045  -  ROD SPNL 45MM 5.5MM ARMADA TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052050","SUP","HCPCS C1713","","8052050  -  ROD SPNL 50MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052055","SUP","HCPCS C1713","","8052055  -  ROD SPNL 55MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052060","SUP","HCPCS C1713","","8052060  -  ROD SPNL 60MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052065","SUP","HCPCS C1713","","8052065  -  ROD SPNL 65MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052070","SUP","HCPCS C1713","","8052070  -  ROD SPNL 70MM 5.5MM PREBNT ARM15 CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052075","SUP","HCPCS C1713","","8052075  -  ROD SPNL 75MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052080","SUP","HCPCS C1713","","8052080  -  ROD SPNL 80MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052085","SUP","HCPCS C1713","","8052085  -  ROD SPNL 85MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052090","SUP","HCPCS C1713","","8052090  -  ROD SPNL 90MM 5.5MM PREBNT ARM15 CNV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052095","SUP","HCPCS C1713","","8052095  -  ROD SPNL 95MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052100","SUP","HCPCS C1713","","8052100  -  ROD SPNL 100MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052110","SUP","HCPCS C1713","","8052110  -  ROD SPNL 110MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052120","SUP","HCPCS C1713","","8052120  -  ROD SPNL 120MM 5.5MM TI PREBNT ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8052200","SUP","HCPCS C1713","","8052200  -  ROD SPNL PREBNT 5.5MM 200MM ARMADA TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8060040","SUP","Custom 27011340","","8060040  -  PLANER SRG NUVAMAP","BOTH IP/OP","$2,990.00 ","$2,212.60 ","$0.00 ","$2,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,990.00 ","$0.00 ","$1,495.00 ","$2,368.08 ","$2,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8100845","SUP","HCPCS C1713","","8100845  -  SCREW 8100845 BREAKOFF SET SCRW 10-32","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8100855","SUP","HCPCS C1713","","8100855  -  SCREW 8100855  BREAKOFF SET 12 32","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8103500","SUP","HCPCS C1713","","8103500  -  SETSCREW, SS, FOR 3.5MM X10","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8103513","SUP","HCPCS C1713","","8103513  -  CROSSLINK 8103513 X10 FOR 3.5ROD L 13","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103517","SUP","HCPCS C1713","","8103517  -  CROSSLINK 8103517 X10 FOR 3.5ROD L 17","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103521","SUP","HCPCS C1713","","8103521  -  CROSSLINK 8103521 X10 FOR 3.5ROD L 21","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103525","SUP","HCPCS C1713","","8103525  -  CROSSLINK 8103525 X10 FOR 3.5ROD L 25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103529","SUP","HCPCS C1713","","8103529  -  CROSSLINK 8103529 X10 FOR 3.5ROD L 29","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103533","SUP","HCPCS C1713","","8103533  -  CROSSLINK 8103533 X10 FOR 3.5ROD L 33","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103537","SUP","HCPCS C1713","","8103537  -  CROSSLINK 8103537 X10 FOR 3.5ROD L 37","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104516","SUP","HCPCS C1713","","8104516  -  CROSSLINK 8104516 16MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104519","SUP","HCPCS C1713","","8104519  -  CROSSLINK 8104519 19MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104522","SUP","HCPCS C1713","","8104522  -  CROSSLINK 8104522 22MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104525","SUP","HCPCS C1713","","8104525  -  CROSSLINK 8104525 25MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104528","SUP","HCPCS C1713","","8104528  -  CROSSLINK 8104528 28MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104531","SUP","HCPCS C1713","","8104531  -  CROSSLINK 8104531 31MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104534","SUP","HCPCS C1713","","8104534  -  CROSSLINK 8104534 34MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104537","SUP","HCPCS C1713","","8104537  -  CROSSLINK 8104537 37MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104540","SUP","HCPCS C1713","","8104540  -  CROSSLINK 8104540 40MM X10 PLATE 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105516","SUP","HCPCS C1713","","8105516  -  CROSSLINK 8105516 16MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105519","SUP","HCPCS C1713","","8105519  -  CROSSLINK 8105519 19MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105522","SUP","HCPCS C1713","","8105522  -  CROSSLINK 8105522 22MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105525","SUP","HCPCS C1713","","8105525  -  CROSSLINK 8105525 25MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105527","SUP","HCPCS C1713","","8105527  -  CROSSLINK 8105527 28MM FXD LP 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105528","SUP","HCPCS C1713","","8105528  -  CROSSLINK 8105528 28TO30MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105530","SUP","HCPCS C1713","","8105530  -  CROSSLINK 8105530 30TO34MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105531","SUP","HCPCS C1713","","8105531  -  CROSSLINK 8105531 31MM FXD LP 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105534","SUP","HCPCS C1713","","8105534  -  CROSSLINK 8105534 34TO36MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105536","SUP","HCPCS C1713","","8105536  -  CROSSLINK 8105536 36TO39MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105539","SUP","HCPCS C1713","","8105539  -  CROSSLINK 8105539 39TO45MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105545","SUP","HCPCS C1713","","8105545  -  CROSSLINK 8105545 45TO58MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8105558","SUP","HCPCS C1713","","8105558  -  CROSSLINK 8105558 58TO80MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106416","SUP","HCPCS C1713","","8106416  -  CROSSLINK 8106416 16MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106419","SUP","HCPCS C1713","","8106419  -  CROSSLINK 8106419 19MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106422","SUP","HCPCS C1713","","8106422  -  CROSSLINK 8106422 22MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106425","SUP","HCPCS C1713","","8106425  -  CROSSLINK 8106425 25MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106427","SUP","HCPCS C1713","","8106427  -  CROSSLINK 8106427 28MM FXD LP 6.35 SS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106428","SUP","HCPCS C1713","","8106428  -  CROSSLINK 8106428 28TO30MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106430","SUP","HCPCS C1713","","8106430  -  CROSSLINK 8106430 30TO34MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106431","SUP","HCPCS C1713","","8106431  -  CROSSLINK 8106431 31MM FXD LP 6.35 SS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106434","SUP","HCPCS C1713","","8106434  -  CROSSLINK 8106434 34TO36MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106436","SUP","HCPCS C1713","","8106436  -  CROSSLINK 8106436 36TO39MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106439","SUP","HCPCS C1713","","8106439  -  CROSSLINK 8106439 39TO45MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106445","SUP","HCPCS C1713","","8106445  -  CROSSLINK 8106445 45TO58MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8106458","SUP","HCPCS C1713","","8106458  -  CROSSLINK 8106458 58TO80MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110450","SUP","HCPCS C1713","","8110450  -  SCREW 8110450 NA LP CROSSLINK SET  TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8110614","SUP","HCPCS C1713","","8110614  -  PLATE 14MM TI FIX CD HZN ANTARES XLNK BONE SPNL","BOTH IP/OP","$4,155.00 ","$3,074.70 ","$0.00 ","$4,155.00 ","$1,869.75 ","$0.00 ","$866.01 ","$0.00 ","$0.00 ","$727.51 ","$4,155.00 ","$0.00 ","$2,077.50 ","$3,290.76 ","$3,324.00 ","$0.00 ","$650.26 ","$0.00 ","$661.48 ","$0.00 "
"8110713","SUP","HCPCS C1713","","8110713  -  CROSSLINK 8110713 ANTERIOR 13MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110714","SUP","HCPCS C1713","","8110714  -  CROSSLINK 8110714 ANTERIOR 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110715","SUP","HCPCS C1713","","8110715  -  CROSSLINK 8110715 ANTERIOR 15MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110716","SUP","HCPCS C1713","","8110716  -  CROSSLINK 8110716 ANTERIOR 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110717","SUP","HCPCS C1713","","8110717  -  CROSSLINK 8110717 ANTERIOR 17MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110718","SUP","HCPCS C1713","","8110718  -  CROSSLINK 8110718 ANTERIOR 18MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110719","SUP","HCPCS C1713","","8110719  -  CROSSLINK 8110719 ANTERIOR 19MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8110845","SUP","HCPCS C1713","","8110845  -  SCREW 8110845 BREAKOFF SET SCREW 10-32TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8110855","SUP","HCPCS C1713","","8110855  -  SCREW SET TI 12-32MM 5.5MM SPNL BRKOF X10 XLNK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8113500","SUP","HCPCS C1713","","8113500  -  SETSCREW, TI, FOR 3.5MM X10","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8113513","SUP","HCPCS C1713","","8113513  -  CROSSLINK 8113513 X10 FOR 3.5ROD L 13","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8113517","SUP","HCPCS C1713","","8113517  -  CROSSLINK 8113517 X10 FOR 3.5ROD L 17","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8113521","SUP","HCPCS C1713","","8113521  -  CROSSLINK 8113521 X10 FOR 3.5ROD L 21","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8113525","SUP","HCPCS C1713","","8113525  -  CROSSLINK 8113525 X10 FOR 3.5ROD L 25","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8113529","SUP","HCPCS C1713","","8113529  -  CROSSLINK 8113529 X10 FOR 3.5ROD L 29","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8113533","SUP","HCPCS C1713","","8113533  -  CROSSLINK 8113533 X10 FOR 3.5ROD L 33","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8113537","SUP","HCPCS C1713","","8113537  -  CROSSLINK 8113537 X10 FOR 3.5ROD L 37","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114516","SUP","HCPCS C1713","","8114516  -  CROSSLINK 8114516 16MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114519","SUP","HCPCS C1713","","8114519  -  CROSSLINK 8114519 19MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114522","SUP","HCPCS C1713","","8114522  -  CROSSLINK 8114522 22MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114525","SUP","HCPCS C1713","","8114525  -  CROSSLINK 8114525 25MM X10 PLT 4.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114528","SUP","HCPCS C1713","","8114528  -  CROSSLINK 8114528 28MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114531","SUP","HCPCS C1713","","8114531  -  CROSSLINK 8114531 31MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114534","SUP","HCPCS C1713","","8114534  -  CROSSLINK 8114534 34MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114537","SUP","HCPCS C1713","","8114537  -  CROSSLINK 8114537 37MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114540","SUP","HCPCS C1713","","8114540  -  CROSSLINK 8114540 40MM X10 PLATE 4.5 TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115516","SUP","HCPCS C1713","","8115516  -  PLATE BN 16MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115519","SUP","HCPCS C1713","","8115519  -  PLATE BN 19MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115522","SUP","HCPCS C1713","","8115522  -  CROSSLINK 8115522 22MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115525","SUP","HCPCS C1713","","8115525  -  PLATE BN 25MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115527","SUP","HCPCS C1713","","8115527  -  CROSSLINK 8115527 28MM FXD LP TI 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115528","SUP","HCPCS C1713","","8115528  -  PLATE BN 28-30MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115530","SUP","HCPCS C1713","","8115530  -  PLATE BN 30-34MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115531","SUP","HCPCS C1713","","8115531  -  CROSSLINK 8115531 31MM FXD LP TI 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115534","SUP","HCPCS C1713","","8115534  -  PLATE BN 34-36MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115536","SUP","HCPCS C1713","","8115536  -  PLATE BN 36-39MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115539","SUP","HCPCS C1713","","8115539  -  PLATE BN 39-45MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115545","SUP","HCPCS C1713","","8115545  -  PLATE BN 45-58MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8115558","SUP","HCPCS C1713","","8115558  -  PLATE BN 58-81MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116416","SUP","HCPCS C1713","","8116416  -  CROSSLINK 8116416 16MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116419","SUP","HCPCS C1713","","8116419  -  CROSSLINK 8116419 19MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116422","SUP","HCPCS C1713","","8116422  -  CROSSLINK 8116422 22MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116425","SUP","HCPCS C1713","","8116425  -  CROSSLINK 8116425 25MM X10 FIXED","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116427","SUP","HCPCS C1713","","8116427  -  CROSSLINK 8116427 28MM FXD L P 6 35TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116428","SUP","HCPCS C1713","","8116428  -  CROSSLINK 8116428 28 30MM X10  MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116430","SUP","HCPCS C1713","","8116430  -  CROSSLINK 8116430 30 34MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116431","SUP","HCPCS C1713","","8116431  -  CROSSLINK 8116431 31MM FXD LP TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116434","SUP","HCPCS C1713","","8116434  -  PLATE 34-36MM TI 6.35MM ROD MLSPN X10 XLNK BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116436","SUP","HCPCS C1713","","8116436  -  CROSSLINK 8116436 36 39MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116439","SUP","HCPCS C1713","","8116439  -  CROSSLINK 8116439 39 45MM X10 MULTI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116445","SUP","HCPCS C1713","","8116445  -  PLATE 45-57MM TI 6.35MM ROD MLSPN X10 XLNK BONE SPNL STRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8116458","SUP","HCPCS C1713","","8116458  -  PLATE 58-80MM TI 6.35MM SCR MULTIAX X10 XLNK BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8151100","SUP","HCPCS C1713","","8151100  -  SCREW BONE SS SPNL LCK CLOSE HEAD","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"8162102","SUP","HCPCS C1713","","8162102  -  STAPLE 8162102  2MM X 9MM TWO PRONG SMA","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"8162103","SUP","HCPCS C1713","","8162103  -  STAPLE 8162103  3MM X 9MM TWO PRONG SMA","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"8162104","SUP","HCPCS C1713","","8162104  -  STAPLE 8162104  4MM X 10MM 2PRONG SMA","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"8162106","SUP","HCPCS C1713","","8162106  -  STAPLE 8162106  6MM X 11MM 2PRONG SMA","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"8162108","SUP","HCPCS C1713","","8162108  -  STAPLE 8162108  8MM X 12MM 2PRONG SMA","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"8162110","SUP","HCPCS C1713","","8162110  -  STAPLE 8162110  10MM X 13MM 2PRONG SMA","BOTH IP/OP","$1,972.50 ","$1,459.65 ","$0.00 ","$1,972.50 ","$887.63 ","$0.00 ","$411.12 ","$0.00 ","$0.00 ","$345.37 ","$1,972.50 ","$0.00 ","$986.25 ","$1,562.22 ","$1,578.00 ","$0.00 ","$308.70 ","$0.00 ","$314.02 ","$0.00 "
"8164604","SUP","HCPCS C1713","","8164604  -  STAPLE 8164604  4MM X 10MM 4 PRONG SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8164605","SUP","HCPCS C1713","","8164605  -  STAPLE BONE 4 PR 10X5MM SPNL SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8164606","SUP","HCPCS C1713","","8164606  -  STAPLE 8164606  6MM X 11MM 4 PRONG SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8164608","SUP","HCPCS C1713","","8164608  -  STAPLE 8164608  8MM X 12MM 4 PRONG SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8164610","SUP","HCPCS C1713","","8164610  -  STAPLE 8164610  10MM X 13MM 4 PRONG SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8164612","SUP","HCPCS C1713","","8164612  -  STAPLE 8164612 12MMX14MM 4PRNG SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8164614","SUP","HCPCS C1713","","8164614  -  STAPLE 8164614 14MMX15MM 4PRNG SMA","BOTH IP/OP","$6,300.65 ","$4,662.48 ","$0.00 ","$6,300.65 ","$2,835.29 ","$0.00 ","$1,313.21 ","$0.00 ","$0.00 ","$1,103.19 ","$6,300.65 ","$0.00 ","$3,150.33 ","$4,990.11 ","$5,040.52 ","$0.00 ","$986.05 ","$0.00 ","$1,003.06 ","$0.00 "
"8200001","SUP","HCPCS C1713","","8200001  -  CLIP SPNL LG NUVASIVE INC","BOTH IP/OP","$2,282.50 ","$1,689.05 ","$0.00 ","$2,282.50 ","$1,027.13 ","$0.00 ","$475.73 ","$0.00 ","$0.00 ","$399.65 ","$2,282.50 ","$0.00 ","$1,141.25 ","$1,807.74 ","$1,826.00 ","$0.00 ","$357.21 ","$0.00 ","$363.37 ","$0.00 "
"8200003","SUP","HCPCS C1769","","8200003  -  WIRE FX KRSH MAXCESS MOD","BOTH IP/OP","$1,857.50 ","$1,374.55 ","$0.00 ","$1,857.50 ","$1,008.62 ","$0.00 ","$387.15 ","$0.00 ","$0.00 ","$325.23 ","$1,857.50 ","$0.00 ","$928.75 ","$1,471.14 ","$1,486.00 ","$0.00 ","$290.70 ","$0.00 ","$295.71 ","$0.00 "
"8200010","SUP","Custom 27203010","","8200010  -  KIT SPNL STRL MAXCESS SHIM DISP","BOTH IP/OP","$3,572.50 ","$2,643.65 ","$0.00 ","$3,572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,572.50 ","$0.00 ","$1,786.25 ","$2,829.42 ","$2,858.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8200011","SUP","Custom 27203010","","8200011  -  KIT SPNL STRL MAXCESS MOD DISP","BOTH IP/OP","$5,115.00 ","$3,785.10 ","$0.00 ","$5,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,115.00 ","$0.00 ","$2,557.50 ","$4,051.08 ","$4,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8200200","SUP","HCPCS C1713","","8200200  -  SCREW BN MA MOD TLIF SPNE DISP","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"8200201","SUP","HCPCS C1713","","8200201  -  SCREW BN MA HP SHIM LGHT CBL SPNE TLIF","BOTH IP/OP","$4,662.50 ","$3,450.25 ","$0.00 ","$4,662.50 ","$2,098.13 ","$0.00 ","$971.78 ","$0.00 ","$0.00 ","$816.37 ","$4,662.50 ","$0.00 ","$2,331.25 ","$3,692.70 ","$3,730.00 ","$0.00 ","$729.68 ","$0.00 ","$742.27 ","$0.00 "
"8200202","SUP","HCPCS C1713","","8200202  -  SCREW BN MA MOD TLIF HP SHIM SPNE","BOTH IP/OP","$3,575.00 ","$2,645.50 ","$0.00 ","$3,575.00 ","$1,608.75 ","$0.00 ","$745.12 ","$0.00 ","$0.00 ","$625.95 ","$3,575.00 ","$0.00 ","$1,787.50 ","$2,831.40 ","$2,860.00 ","$0.00 ","$559.49 ","$0.00 ","$569.14 ","$0.00 "
"8203030","SUP","Custom 27203010","","8203030  -  AIRWAY PHARYNGEAL 3 SMALL 15MM CONCTR NONINFLATABLE CUFF","BOTH IP/OP","$23.05 ","$17.06 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.08 ","$0.00 ","$17.54 ","$27.78 ","$28.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8227103","SUP","HCPCS C1898","","8227103  -  ELECTRODE EMG 4MM 12MM 2MM 2 CHANNEL NEEDLE LANCET TIP","BOTH IP/OP","$227.50 ","$168.35 ","$0.00 ","$227.50 ","$102.38 ","$0.00 ","$47.42 ","$0.00 ","$0.00 ","$39.83 ","$227.50 ","$0.00 ","$113.75 ","$180.18 ","$182.00 ","$0.00 ","$35.60 ","$0.00 ","$36.22 ","$0.00 "
"8229507","SUP","Custom 27203010","","8229507  -  TUBE ENDOTRACHEAL NIM STAINLESS STEEL PVC OD10.5 MM ID7.0 MM","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8229706","SUP","Custom 27803010","","8229706  -  TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED","BOTH IP/OP","$1,014.13 ","$750.46 ","$0.00 ","$923.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$923.88 ","$0.00 ","$461.94 ","$731.71 ","$739.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8229707","SUP","Custom 27803010","","8229707  -  TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED","BOTH IP/OP","$1,014.13 ","$750.46 ","$0.00 ","$923.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$923.88 ","$0.00 ","$461.94 ","$731.71 ","$739.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8229708","SUP","Custom 27803010","","8229708  -  TUBE ENDOTRAC STANDARD LP 10.7MM 8MM DEPH FREE NONREINFORCED","BOTH IP/OP","$852.63 ","$630.95 ","$0.00 ","$852.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$852.63 ","$0.00 ","$426.31 ","$675.28 ","$682.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8240001","SUP","Custom 27203010","","8240001  -  KIT SPINAL 4 MAXCESS","BOTH IP/OP","$2,385.00 ","$1,764.90 ","$0.00 ","$2,385.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,385.00 ","$0.00 ","$1,192.50 ","$1,888.92 ","$1,908.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8240060","SUP","Custom 27203010","","8240060  -  MODULE SPNL 4 MAXCESS","BOTH IP/OP","$5,850.25 ","$4,329.19 ","$0.00 ","$5,850.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,850.25 ","$0.00 ","$2,925.13 ","$4,633.40 ","$4,680.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8240061","SUP","Custom 27203010","","8240061  -  MODULE SPNL 4 MAXCESS SHIM","BOTH IP/OP","$4,695.25 ","$3,474.49 ","$0.00 ","$4,695.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,695.25 ","$0.00 ","$2,347.63 ","$3,718.64 ","$3,756.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8275525","SUP","HCPCS C1713","","8275525  -  SCREW BN 5.5MM 25MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8275530","SUP","HCPCS C1713","","8275530  -  SCREW BN 5.5MM 30MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8275535","SUP","HCPCS C1713","","8275535  -  SCREW BN 5.5MM 35MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8275540","SUP","HCPCS C1713","","8275540  -  SCREW BONE 5.5MM 40MM REDX TITANIUM SPN 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8275545","SUP","HCPCS C1713","","8275545  -  SCREW BN 5.5MM 45MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8275550","SUP","HCPCS C1713","","8275550  -  SCREW BN 5.5MM 50MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8275555","SUP","HCPCS C1713","","8275555  -  SCREW BN 5.5MM 55MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8276530","SUP","HCPCS C1713","","8276530  -  SCREW BN 6.5MM 30MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8276535","SUP","HCPCS C1713","","8276535  -  SCREW BN 6.5MM 35MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8276545","SUP","HCPCS C1713","","8276545  -  SCREW BN 6.5MM 45MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8276555","SUP","HCPCS C1713","","8276555  -  SCREW BN 6.5MM 55MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8277530","SUP","HCPCS C1713","","8277530  -  SCREW BN 7.5MM 30MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8277535","SUP","HCPCS C1713","","8277535  -  SCREW BN 7.5MM 35MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8277540","SUP","HCPCS C1713","","8277540  -  SCREW BN 7.5MM 40MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8277550","SUP","HCPCS C1713","","8277550  -  SCREW BN 7.5MM 50MM RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$3,257.50 ","$2,410.55 ","$0.00 ","$3,257.50 ","$1,465.88 ","$0.00 ","$678.94 ","$0.00 ","$0.00 ","$570.36 ","$3,257.50 ","$0.00 ","$1,628.75 ","$2,579.94 ","$2,606.00 ","$0.00 ","$509.80 ","$0.00 ","$518.59 ","$0.00 "
"8281190","SUP","HCPCS C1713","","8281190  -  SCREW 8281190 TSRH .25 32 LOCK NON BREAK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8281246","SUP","HCPCS C1713","","8281246  -  SCREW 8281246 SET 3BDL HEX TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8281248","SUP","HCPCS C1713","","8281248  -  SET SCREW 8281248 0.25 32 FLSH BRK LK TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8350424","SUP","Custom 27203010","","8350424  -  TAP SURG OSTEOGRIP 5.5MM","BOTH IP/OP","$790.50 ","$584.97 ","$0.00 ","$790.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.50 ","$0.00 ","$395.25 ","$626.08 ","$632.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8350426","SUP","Custom 27203010","","8350426  -  TAP SURG OSTEOGRIP 6.5MM","BOTH IP/OP","$790.50 ","$584.97 ","$0.00 ","$790.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.50 ","$0.00 ","$395.25 ","$626.08 ","$632.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8351500","SUP","HCPCS C1713","","8351500  -  SET SCREW 8351500 TSRH 3DX FLUSH BREAK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8351502","SUP","HCPCS C1713","","8351502  -  SET SCREW 8351502 TSRH 3DX NON-BREAK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8351520","SUP","Custom 27803010","","8351520  -  CONNECTOR 8351520 TSRH 3DX SMALL","BOTH IP/OP","$2,316.75 ","$1,714.40 ","$0.00 ","$2,316.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,316.75 ","$0.00 ","$1,158.38 ","$1,834.87 ","$1,853.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8351521","SUP","Custom 27803010","","8351521  -  CONNECTOR 8351521 TSRH 3DX MEDIUM","BOTH IP/OP","$2,316.75 ","$1,714.40 ","$0.00 ","$2,316.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,316.75 ","$0.00 ","$1,158.38 ","$1,834.87 ","$1,853.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8351522","SUP","Custom 27803010","","8351522  -  CONNECTOR 8351522 TSRH 3DX LARGE","BOTH IP/OP","$2,316.75 ","$1,714.40 ","$0.00 ","$2,316.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,316.75 ","$0.00 ","$1,158.38 ","$1,834.87 ","$1,853.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8351523","SUP","Custom 27803010","","8351523  -  CONNECTOR 8351523 TSRH 3DX 90 DEG OFFSET","BOTH IP/OP","$2,316.75 ","$1,714.40 ","$0.00 ","$2,316.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,316.75 ","$0.00 ","$1,158.38 ","$1,834.87 ","$1,853.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8352200","SUP","HCPCS C1713","","8352200  -  ROD 5.5MM USS 200MM","BOTH IP/OP","$2,017.50 ","$1,492.95 ","$0.00 ","$2,017.50 ","$907.88 ","$0.00 ","$420.50 ","$0.00 ","$0.00 ","$353.25 ","$2,017.50 ","$0.00 ","$1,008.75 ","$1,597.86 ","$1,614.00 ","$0.00 ","$315.74 ","$0.00 ","$321.19 ","$0.00 "
"8352300","SUP","HCPCS C1713","","8352300  -  ROD 5.5MM USS 300MM","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$0.00 ","$2,275.00 ","$1,023.75 ","$0.00 ","$474.17 ","$0.00 ","$0.00 ","$398.33 ","$2,275.00 ","$0.00 ","$1,137.50 ","$1,801.80 ","$1,820.00 ","$0.00 ","$356.04 ","$0.00 ","$362.18 ","$0.00 "
"8352500","SUP","HCPCS C1713","","8352500  -  ROD 5.5MM USS 500MM","BOTH IP/OP","$2,502.50 ","$1,851.85 ","$0.00 ","$2,502.50 ","$1,126.13 ","$0.00 ","$521.58 ","$0.00 ","$0.00 ","$438.17 ","$2,502.50 ","$0.00 ","$1,251.25 ","$1,981.98 ","$2,002.00 ","$0.00 ","$391.64 ","$0.00 ","$398.40 ","$0.00 "
"8352510","SUP","Custom 27803010","","8352510  -  CONNECTOR 8352510 5.5 SLOTTED TI","BOTH IP/OP","$2,031.00 ","$1,502.94 ","$0.00 ","$2,031.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,031.00 ","$0.00 ","$1,015.50 ","$1,608.55 ","$1,624.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8354525","SUP","HCPCS C1713","","8354525  -  SCREW BONE 4.5MM 25MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8354530","SUP","HCPCS C1713","","8354530  -  SCREW BONE 4.5MM 30MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8354535","SUP","HCPCS C1713","","8354535  -  SCREW BONE 4.5MM 35MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8354540","SUP","HCPCS C1713","","8354540  -  SCREW BONE 4.5MM 40MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8355530","SUP","HCPCS C1713","","8355530  -  SCREW BONE 5.5MM 30MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8355535","SUP","HCPCS C1713","","8355535  -  SCREW BONE 5.5MM 35MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8355540","SUP","HCPCS C1713","","8355540  -  SCREW BONE 5.5MM 40MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8355545","SUP","HCPCS C1713","","8355545  -  SCREW BONE 5.5MM 45MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8356535","SUP","HCPCS C1713","","8356535  -  SCREW BONE 6.5MM 35MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8356540","SUP","HCPCS C1713","","8356540  -  SCREW BONE 6.5MM 40MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8356545","SUP","HCPCS C1713","","8356545  -  SCREW BONE 6.5MM 45MM SS SPNL LCK 5.5MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8364525","SUP","HCPCS C1713","","8364525  -  SCREW BONE 4.5MM 25MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8364530","SUP","HCPCS C1713","","8364530  -  SCREW BONE 4.5MM 30MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8364535","SUP","HCPCS C1713","","8364535  -  SCREW BONE 4.5MM 35MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8364540","SUP","HCPCS C1713","","8364540  -  SCREW BONE 4.5MM 40MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8364545","SUP","HCPCS C1713","","8364545  -  SCREW BONE 4.5MM 45MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8365530","SUP","HCPCS C1713","","8365530  -  SCREW BONE 5.5MM 30MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8365535","SUP","HCPCS C1713","","8365535  -  SCREW BONE 5.5MM 35MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8365540","SUP","HCPCS C1713","","8365540  -  SCREW BONE 5.5MM 40MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8365545","SUP","HCPCS C1713","","8365545  -  SCREW BONE 5.5MM 45MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8366535","SUP","HCPCS C1713","","8366535  -  SCREW BONE 6.5MM 35MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8366540","SUP","HCPCS C1713","","8366540  -  SCREW BONE 6.5MM 40MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8366545","SUP","HCPCS C1713","","8366545  -  SCREW BONE 6.5MM 45MM SPNL LCK 6.35MM ROD","BOTH IP/OP","$5,507.50 ","$4,075.55 ","$0.00 ","$5,507.50 ","$2,478.38 ","$0.00 ","$1,147.90 ","$0.00 ","$0.00 ","$964.32 ","$5,507.50 ","$0.00 ","$2,753.75 ","$4,361.94 ","$4,406.00 ","$0.00 ","$861.92 ","$0.00 ","$876.79 ","$0.00 "
"8367645","SUP","HCPCS C1713","","8367645  -  BONE SCREW 8367645 EXTRACTOR 4.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367650","SUP","HCPCS C1713","","8367650  -  BONE SCREW 8367650 EXTRACTPR 5.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367655","SUP","HCPCS C1713","","8367655  -  BONE SCREW 8367655 EXTRACTOR 5.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367660","SUP","HCPCS C1713","","8367660  -  BONE SCREW 8367660 EXTRACTOR 6.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367665","SUP","HCPCS C1713","","8367665  -  BONE SCREW 8367665 EXTRACTOR 6.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367670","SUP","HCPCS C1713","","8367670  -  BONE SCREW 8367670 EXTRACTOR 7.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367675","SUP","HCPCS C1713","","8367675  -  BONE SCREW 8367675 EXTRACTOR 7.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367680","SUP","HCPCS C1713","","8367680  -  BONE SCREW 8367680 EXTRACTOR 8.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367745","SUP","HCPCS C1713","","8367745  -  BONE SCREW 8367745 TREPHINE 4.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367750","SUP","HCPCS C1713","","8367750  -  BONE SCREW 8367750 TREPHINE 5.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367755","SUP","HCPCS C1713","","8367755  -  BONE SCREW 8367755 TREPHINE 5.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367760","SUP","HCPCS C1713","","8367760  -  BONE SCREW 8367760 TREPHINE 6.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367765","SUP","HCPCS C1713","","8367765  -  BONE SCREW 8367765 TREPHINE 6.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367770","SUP","HCPCS C1713","","8367770  -  BONE SCREW 8367770 TREPHINE 7.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367775","SUP","HCPCS C1713","","8367775  -  BONE SCREW 8367775 TREPHINE 7.5MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8367780","SUP","HCPCS C1713","","8367780  -  BONE SCREW 8367780 TREPHINE 8.0MM","BOTH IP/OP","$1,138.50 ","$842.49 ","$0.00 ","$1,138.50 ","$512.33 ","$0.00 ","$237.29 ","$0.00 ","$0.00 ","$199.34 ","$1,138.50 ","$0.00 ","$569.25 ","$901.69 ","$910.80 ","$0.00 ","$178.18 ","$0.00 ","$181.25 ","$0.00 "
"8370030","SUP","HCPCS C1713","","8370030  -  ROD 8370030 TSR2D PCUT BENT 3.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370035","SUP","HCPCS C1713","","8370035  -  ROD 8370035 TSR2D PCUT BENT 3.5CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370040","SUP","HCPCS C1713","","8370040  -  ROD 8370040 TSR2D PCUT BENT 4.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370045","SUP","HCPCS C1713","","8370045  -  ROD SPNL 450MM 5.5MM TSRH3D TI PREBNT PCUT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370050","SUP","HCPCS C1713","","8370050  -  ROD 8370050 TSR2D PCUT BENT 5.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370055","SUP","HCPCS C1713","","8370055  -  ROD SPNL 550MM 5.5MM TSRH3D TI PREBNT PCUT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370060","SUP","HCPCS C1713","","8370060  -  ROD 8370060 TSR2D PCUT BENT 6.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370065","SUP","HCPCS C1713","","8370065  -  ROD 8370065 6.5CM X 5.5MM PRE-CUT/BENT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370070","SUP","HCPCS C1713","","8370070  -  ROD 8370070 TSR2D PCUT BENT 7.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370080","SUP","HCPCS C1713","","8370080  -  ROD 8370080 TSR2D PCUT BENT8.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370090","SUP","HCPCS C1713","","8370090  -  ROD 8370090 TSR2D PCUT BENT 9.0CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370095","SUP","HCPCS C1713","","8370095  -  ROD SPNL 950MM 5.5MM TSRH3D TI PREBNT PCUT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370100","SUP","HCPCS C1713","","8370100  -  ROD 8370100 TSR2D PCUT BENT 10CMX5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8370420","SUP","HCPCS C1713","","8370420  -  SCREW 8370420 TSRH SHORT POST4.5X20 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370425","SUP","HCPCS C1713","","8370425  -  SCREW 8370425 TSRH SHORT POST4.5X25 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370430","SUP","HCPCS C1713","","8370430  -  SCREW 8370430 TSRH SHORT POST4.5X30 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370435","SUP","HCPCS C1713","","8370435  -  SCREW 8370435 TSRH SHORT POST4.5X35 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370440","SUP","HCPCS C1713","","8370440  -  SCREW 8370440 TSRH SHORT POST4.5X40 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370445","SUP","HCPCS C1713","","8370445  -  SCREW 8370445 TSRH SHORT POST4.5X45 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370450","SUP","HCPCS C1713","","8370450  -  SCREW 8370450 TSRH SHORT POST4.5X50 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8370455","SUP","HCPCS C1713","","8370455  -  SCREW 8370455 TSRH SHORT POST4.5X55 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8371030","SUP","HCPCS C1713","","8371030  -  ROD 8371030 TSR2D PCUT BENT 3.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371035","SUP","HCPCS C1713","","8371035  -  ROD 8371035 3.5CMX6.35 PRE CUT BENT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371040","SUP","HCPCS C1713","","8371040  -  ROD 8371040 TSR2D PCUT BENT 4.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371050","SUP","HCPCS C1713","","8371050  -  ROD 8371050 TSR2D PCUT BENT 5.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371060","SUP","HCPCS C1713","","8371060  -  ROD 8371060 TSR2D PCUT BENT 6.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371070","SUP","HCPCS C1713","","8371070  -  ROD 8371070 TSR2D PCUT BENT 7.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371080","SUP","HCPCS C1713","","8371080  -  ROD 8371080 TSR2D PCUT BENT 8.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371090","SUP","HCPCS C1713","","8371090  -  ROD 8371090 TSR2D PCUT BENT 9.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371100","SUP","HCPCS C1713","","8371100  -  ROD 8371100 TSR2D PCUT BENT 10.0CMX6.35","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8371530","SUP","HCPCS C1713","","8371530  -  SCREW 8371530 TSR3D THRD 5.5X30MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371535","SUP","HCPCS C1713","","8371535  -  SCREW 8371535 TSR3D THRD 5.5X35MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371540","SUP","HCPCS C1713","","8371540  -  SCREW 8371540 TSR3D THRD 5.5X40MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371545","SUP","HCPCS C1713","","8371545  -  SCREW 8371545 TSR3D THRD 5.5X45MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371550","SUP","HCPCS C1713","","8371550  -  SCREW 8371550 TSR3D THRD 5.5X50MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371630","SUP","HCPCS C1713","","8371630  -  SCREW 8371630 TSR3D THRD 6.5X30MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371635","SUP","HCPCS C1713","","8371635  -  SCREW 8371635 TSR3D THRD 6.5X35MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371640","SUP","HCPCS C1713","","8371640  -  SCREW 8371640 TSR3D THRD 6.5X40MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371645","SUP","HCPCS C1713","","8371645  -  SCREW 8371645 TSR3D THRD 6.5X45MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371650","SUP","HCPCS C1713","","8371650  -  SCREW 8371650 TSR3D THRD 6.5X50MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371655","SUP","HCPCS C1713","","8371655  -  SCREW 8371655 TSR3D THRD 6.5X55MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371660","SUP","HCPCS C1713","","8371660  -  SCREW 8371660 TSR3D THRD 6.5X60MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371730","SUP","HCPCS C1713","","8371730  -  SCREW 8371730 TSR3D THRD 7.5X30MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371735","SUP","HCPCS C1713","","8371735  -  SCREW 8371735 TSR3D THRD 7.5X35MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371740","SUP","HCPCS C1713","","8371740  -  SCREW 8371740 TSR3D THRD 7.5X40MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371745","SUP","HCPCS C1713","","8371745  -  SCREW 8371745 TSR3D THRD 7.5X45MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371750","SUP","HCPCS C1713","","8371750  -  SCREW 8371750 TSR3D THRD 7.5X50MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371755","SUP","HCPCS C1713","","8371755  -  SCREW 8371755 TSR3D THRD 7.5X55MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371760","SUP","HCPCS C1713","","8371760  -  SCREW 8371760 TSR3D THRD 7.5X60MM TI","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371830","SUP","HCPCS C1713","","8371830  -  SCREW 8371830 TSRH 3D 8 5MMX30MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371835","SUP","HCPCS C1713","","8371835  -  SCREW 8371835 TSRH 3D 8 5MMX35MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371840","SUP","HCPCS C1713","","8371840  -  SCREW 8371840 TSRH 3D 8 5MMX40MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371845","SUP","HCPCS C1713","","8371845  -  SCREW 8371845 TSRH 3D 8 5MMX45MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371850","SUP","HCPCS C1713","","8371850  -  SCREW 8371850 TSRH 3D 8 5MMX50MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371855","SUP","HCPCS C1713","","8371855  -  SCREW 8371855 TSRH 3D 8 5MMX55MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8371860","SUP","HCPCS C1713","","8371860  -  SCREW 8371860 TSRH 3D 8 5MMX60MM THR PST","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$535.95 ","$0.00 ","$248.23 ","$0.00 ","$0.00 ","$208.53 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$186.39 ","$0.00 ","$189.61 ","$0.00 "
"8372520","SUP","HCPCS C1713","","8372520  -  SCREW 8372520 TSR3D SHORT POST 5.5X20 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372525","SUP","HCPCS C1713","","8372525  -  SCREW 8372525 TSR3D SHORT POST 5.5X25 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372530","SUP","HCPCS C1713","","8372530  -  SCREW 8372530 TSR3D SHORT POST 5.5X30 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372535","SUP","HCPCS C1713","","8372535  -  SCREW 8372535 TSR3D SHORT POST 5.5X35 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372540","SUP","HCPCS C1713","","8372540  -  SCREW 8372540 TSR3D SHORT POST 5.5X40 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372545","SUP","HCPCS C1713","","8372545  -  SCREW 8372545 TSR3D SHORT POST 5.5X45 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372550","SUP","HCPCS C1713","","8372550  -  SCREW 8372550 TSR3D SHORT POST 5.5X50 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372555","SUP","HCPCS C1713","","8372555  -  SCREW 8372555 TSR3D SHORT POST 5.5X55 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372620","SUP","HCPCS C1713","","8372620  -  SCREW 8372620 TSR3D SHORT POST 6.5X20 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372625","SUP","HCPCS C1713","","8372625  -  SCREW 8372625 TSR3D SHORT POST 6.5X25 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372630","SUP","HCPCS C1713","","8372630  -  SCREW 8372630 TSR3D SHORT POST 6.5X30 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372635","SUP","HCPCS C1713","","8372635  -  SCREW 8372635 TSR3D SHORT POST 6.5X35 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372640","SUP","HCPCS C1713","","8372640  -  SCREW 8372640 TSR3D SHORT POST 6.5X40 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372645","SUP","HCPCS C1713","","8372645  -  SCREW 8372645 TSR3D SHORT POST 6.5X45 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372650","SUP","HCPCS C1713","","8372650  -  SCREW 8372650 TSR3D SHORT POST 6.5X50 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372655","SUP","HCPCS C1713","","8372655  -  SCREW 8372655 TSR3D SHORT POST 6.5X55 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372660","SUP","HCPCS C1713","","8372660  -  SCREW 8372660 TSR3D SHORT POST 6.5X60 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372720","SUP","HCPCS C1713","","8372720  -  SCREW 8372720 TSR3D SHORT POST 7.5X20 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372725","SUP","HCPCS C1713","","8372725  -  SCREW 8372725 TSR3D SHORT POST 7.5X25 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372730","SUP","HCPCS C1713","","8372730  -  SCREW 8372730 TSR3D SHORT POST 7.5X30 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372735","SUP","HCPCS C1713","","8372735  -  SCREW 8372735 TSR3D SHORT POST 7.5X35 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372740","SUP","HCPCS C1713","","8372740  -  SCREW 8372740 TSR3D SHORT POST 7.5X40 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372745","SUP","HCPCS C1713","","8372745  -  SCREW 8372745 TSR3D SHORT POST 7.5X45 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372750","SUP","HCPCS C1713","","8372750  -  SCREW 8372750 TSR3D SHORT POST 7.5X50 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372755","SUP","HCPCS C1713","","8372755  -  SCREW 8372755 TSR3D SHORT POST 7.5X55 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372760","SUP","HCPCS C1713","","8372760  -  SCREW 8372760 TSR3D SHORT POST 7.5X60 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372820","SUP","HCPCS C1713","","8372820  -  SCREW 8372820 TSR3D SHORT POST 8.5X20 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372825","SUP","HCPCS C1713","","8372825  -  SCREW 8372825 TSR3D SHORT POST 8.5X25 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372830","SUP","HCPCS C1713","","8372830  -  SCREW 8372830 TSR3D SHORT POST 8.5X30 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372835","SUP","HCPCS C1713","","8372835  -  SCREW 8372835 TSR3D SHORT POST 8.5X35 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372840","SUP","HCPCS C1713","","8372840  -  SCREW 8372840 TSR3D SHORT POST 8.5X40 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372845","SUP","HCPCS C1713","","8372845  -  SCREW 8372845 TSR3D SHORT POST 8.5X45 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372850","SUP","HCPCS C1713","","8372850  -  SCREW 8372850 TSR3D SHORT POST 8.5X50 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372855","SUP","HCPCS C1713","","8372855  -  SCREW 8372855 TSR3D SHORT POST 8.5X55 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8372860","SUP","HCPCS C1713","","8372860  -  SCREW 8372860 TSR3D SHORT POST 8.5X60 TI","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8373745","SUP","HCPCS C1713","","8373745  -  SCREW BONE 7.5MM 45MM SCRL","BOTH IP/OP","$1,122.00 ","$830.28 ","$0.00 ","$1,122.00 ","$504.90 ","$0.00 ","$233.85 ","$0.00 ","$0.00 ","$196.45 ","$1,122.00 ","$0.00 ","$561.00 ","$888.62 ","$897.60 ","$0.00 ","$175.59 ","$0.00 ","$178.62 ","$0.00 "
"8374535","SUP","HCPCS C1713","","8374535  -  SCREW BONE 4.5MM 35MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8374540","SUP","HCPCS C1713","","8374540  -  SCREW BONE 4.5MM 40MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8374545","SUP","HCPCS C1713","","8374545  -  SCREW BONE 4.5MM 45MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8375530","SUP","HCPCS C1713","","8375530  -  SCREW BONE 5.5MM 30MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8375535","SUP","HCPCS C1713","","8375535  -  SCREW BONE 5.5MM 35MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8375540","SUP","HCPCS C1713","","8375540  -  SCREW BONE 5.5MM 40MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8375545","SUP","HCPCS C1713","","8375545  -  SCREW BONE 5.5MM 45MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8375550","SUP","HCPCS C1713","","8375550  -  SCREW BONE 5.5MM 50MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8376520","SUP","HCPCS C1713","","8376520  -  MPA SHRT SCREW, 5.5MMX20MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376525","SUP","HCPCS C1713","","8376525  -  MPA SHRT SCREW, 5.5MMX25MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376530","SUP","HCPCS C1713","","8376530  -  MPA SHRT SCREW, 5.5MMX30MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376535","SUP","HCPCS C1713","","8376535  -  SCREW 8376535 MPA SHRT 5 5MMX35MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376540","SUP","HCPCS C1713","","8376540  -  SCREW BONE 6.5MM 40MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8376545","SUP","HCPCS C1713","","8376545  -  SCREW BONE 6.5MM 45MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8376550","SUP","HCPCS C1713","","8376550  -  SCREW BONE 6.5MM 50MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8376555","SUP","HCPCS C1713","","8376555  -  SCREW BONE 6.5MM 55MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8376620","SUP","HCPCS C1713","","8376620  -  MPA SHRT SCREW, 6.5MMX20MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376625","SUP","HCPCS C1713","","8376625  -  MPA SHRT SCREW, 6.5MMX25MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376630","SUP","HCPCS C1713","","8376630  -  MPA SHRT SCREW, 6.5MMX30MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376635","SUP","HCPCS C1713","","8376635  -  BONE SCREW 8376635 MPA SHRT 6.5MMX35MM","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376640","SUP","HCPCS C1713","","8376640  -  SCREW 8376640 MPA SHRT 6 5MMX40MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376645","SUP","HCPCS C1713","","8376645  -  SCREW 8376645 MPA SHRT 6 5MMX45MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376650","SUP","HCPCS C1713","","8376650  -  SCREW 8376650 MPA SHRT 6 5MMX50MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376655","SUP","HCPCS C1713","","8376655  -  MPA SHRT SCREW, 6.5MMX55MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376660","SUP","HCPCS C1713","","8376660  -  MPA SHRT SCREW, 6.5MMX60MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376720","SUP","HCPCS C1713","","8376720  -  MPA SHRT SCREW, 7.5MMX20MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376725","SUP","HCPCS C1713","","8376725  -  MPA SHRT SCREW, 7.5MMX25MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376730","SUP","HCPCS C1713","","8376730  -  MPA SHRT SCREW, 7.5MMX30MM, TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376735","SUP","HCPCS C1713","","8376735  -  SCREW 8376735 MPA SHRT 7 5MMX35MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376740","SUP","HCPCS C1713","","8376740  -  SCREW 8376740 MPA SHRT 7 5MMX40MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376745","SUP","HCPCS C1713","","8376745  -  SCREW 8376745 MPA SHRT 7 5MMX45MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376750","SUP","HCPCS C1713","","8376750  -  SCREW 8376750 MPA SHRT 7 5MMX50MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376755","SUP","HCPCS C1713","","8376755  -  SCREW 8376755 MPA SHRT 7 5MMX55MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8376760","SUP","HCPCS C1713","","8376760  -  SCREW 8376760 MPA SHRT 7 5MMX60MM TI","BOTH IP/OP","$1,279.50 ","$946.83 ","$0.00 ","$1,279.50 ","$575.78 ","$0.00 ","$266.68 ","$0.00 ","$0.00 ","$224.03 ","$1,279.50 ","$0.00 ","$639.75 ","$1,013.36 ","$1,023.60 ","$0.00 ","$200.24 ","$0.00 ","$203.70 ","$0.00 "
"8377530","SUP","HCPCS C1713","","8377530  -  BONE SCREW 8377530 MPA THRD 5.5X30 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377535","SUP","HCPCS C1713","","8377535  -  BONE SCREW 8377535 MPA THRD 5.5X35 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377540","SUP","HCPCS C1713","","8377540  -  SCREW BONE 7.5MM 40MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8377545","SUP","HCPCS C1713","","8377545  -  SCREW BONE 7.5MM 45MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8377550","SUP","HCPCS C1713","","8377550  -  SCREW BONE 7.5MM 50MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8377555","SUP","HCPCS C1713","","8377555  -  SCREW BONE 7.5MM 55MM SPNL REDX 5.5MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8377630","SUP","HCPCS C1713","","8377630  -  BONE SCREW 8377630 MPA THRD 6.5X30 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377635","SUP","HCPCS C1713","","8377635  -  BONE SCREW 8377635 MPA THRD 6.5X35 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377640","SUP","HCPCS C1713","","8377640  -  BONE SCREW 8377640 MPA THRD 6.5X40 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377645","SUP","HCPCS C1713","","8377645  -  BONE SCREW 8377645 MPA THRD 6.5X45 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377650","SUP","HCPCS C1713","","8377650  -  BONE SCREW 8377650 MPA THRD 6.5X50 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377655","SUP","HCPCS C1713","","8377655  -  BONE SCREW 8377655 MPA THRD 6.5X55 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377660","SUP","HCPCS C1713","","8377660  -  BONE SCREW 8377660 MPA THRD 6.5X60 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377730","SUP","HCPCS C1713","","8377730  -  BONE SCREW 8377730 MPA THRD 7.5X30 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377735","SUP","HCPCS C1713","","8377735  -  BONE SCREW 8377735 MPA THRD 7.5X35 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377740","SUP","HCPCS C1713","","8377740  -  BONE SCREW 8377740 MPA THRD 7.5X40 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377745","SUP","HCPCS C1713","","8377745  -  BONE SCREW 8377745 MPA THRD 7.5X45 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377750","SUP","HCPCS C1713","","8377750  -  BONE SCREW 8377750 MPA THRD 7.5X50 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377755","SUP","HCPCS C1713","","8377755  -  BONE SCREW 8377755 MPA THRD 7.5X55 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8377760","SUP","HCPCS C1713","","8377760  -  BONE SCREW 8377760 MPA THRD 7.5X60 TI","BOTH IP/OP","$1,549.50 ","$1,146.63 ","$0.00 ","$1,549.50 ","$697.28 ","$0.00 ","$322.95 ","$0.00 ","$0.00 ","$271.31 ","$1,549.50 ","$0.00 ","$774.75 ","$1,227.20 ","$1,239.60 ","$0.00 ","$242.50 ","$0.00 ","$246.68 ","$0.00 "
"8379120","SUP","Custom 27803010","","8379120  -  CONNECTOR 8379120 5.5 TSRH 3D SML TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379121","SUP","Custom 27803010","","8379121  -  CONNECTOR 8379121 5.5 TSRH 3D MED TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379122","SUP","Custom 27803010","","8379122  -  CONNECTOR 8379122 5.5 TSRH 3D LRG TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379124","SUP","Custom 27803010","","8379124  -  CONNECTOR 8379124 90 DEG OFFSET 5.5 TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379130","SUP","Custom 27803010","","8379130  -  CONNECTOR ROD 8379130 6.35 TSRH 3D SM","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379131","SUP","Custom 27803010","","8379131  -  CONNECTOR 8379131 6.35 TSRH 3D MED TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379132","SUP","Custom 27803010","","8379132  -  CONNECTOR 8379132 6.35 TSRH 3D LRG TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379134","SUP","Custom 27803010","","8379134  -  CONNECTOR 8379134 90 DEG OSET 6.35 TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379140","SUP","Custom 27803010","","8379140  -  CONNECTOR 8379140 SM TRSH-3D 6.35MM TI","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379141","SUP","Custom 27803010","","8379141  -  CONNECTOR 8379141 6.35 TSRH-3D MED","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379142","SUP","Custom 27803010","","8379142  -  CONCTR ROD LG 6.35MM TSRH3D CLOSE OFFST TI POST PDCL","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8384535","SUP","HCPCS C1713","","8384535  -  SCREW BONE 4.5MM 35MM SPNL REDX 6.35MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8384540","SUP","HCPCS C1713","","8384540  -  SCREW BONE 4.5MM 40MM SPNL REDX 6.35MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
"8384545","SUP","HCPCS C1713","","8384545  -  SCREW BONE 4.5MM 45MM SPNL REDX 6.35MM ROD","BOTH IP/OP","$5,220.00 ","$3,862.80 ","$0.00 ","$5,220.00 ","$2,349.00 ","$0.00 ","$1,087.98 ","$0.00 ","$0.00 ","$913.98 ","$5,220.00 ","$0.00 ","$2,610.00 ","$4,134.24 ","$4,176.00 ","$0.00 ","$816.93 ","$0.00 ","$831.02 ","$0.00 "
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"8448590","SUP","HCPCS C1713","","8448590  -  SCREW BONE 8.5MM 90MM ILC SLT 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8449510","SUP","HCPCS C1713","","8449510  -  SCREW BONE 9.5MM 100MM ILC SLT 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8449560","SUP","HCPCS C1713","","8449560  -  SCREW BONE 9.5MM 60MM ILC SLT 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8449570","SUP","HCPCS C1713","","8449570  -  SCREW BONE 9.5MM 70MM ILC SLT 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8449580","SUP","HCPCS C1713","","8449580  -  SCREW BONE 9.5MM 80MM ILC SLT 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8449590","SUP","HCPCS C1713","","8449590  -  SCREW BONE 9.5MM 90MM ILC SLT 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8450120","SUP","HCPCS C1713","","8450120  -  CONCTR ROD 20MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450122","SUP","HCPCS C1713","","8450122  -  CONCTR ROD 22MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450125","SUP","HCPCS C1713","","8450125  -  CONCTR ROD 25MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450127","SUP","HCPCS C1713","","8450127  -  CONCTR ROD 27.5MM BCN CX BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450130","SUP","HCPCS C1713","","8450130  -  CONCTR ROD 30MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450132","SUP","HCPCS C1713","","8450132  -  CONCTR ROD 32.5MM 5.5MM ARMADA CX SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450135","SUP","HCPCS C1713","","8450135  -  CONCTR ROD 35MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450137","SUP","HCPCS C1713","","8450137  -  CONCTR ROD 37MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450140","SUP","HCPCS C1713","","8450140  -  CONCTR ROD 40MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450145","SUP","HCPCS C1713","","8450145  -  CONCTR ROD 45MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450150","SUP","HCPCS C1713","","8450150  -  CONCTR ROD 50MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450155","SUP","HCPCS C1713","","8450155  -  CONCTR ROD 55MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450160","SUP","HCPCS C1713","","8450160  -  CONCTR ROD 60MM 5.5MM FIX CX TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450245","SUP","HCPCS C1713","","8450245  -  TRNCON ROD 45-50MM ADJ ARCH","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450250","SUP","HCPCS C1713","","8450250  -  CONCTR ROD 50-60MM ADJ TRNSVRS SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8450260","SUP","HCPCS C1713","","8450260  -  TRNCON ROD 60-70MM ADJ ARCH","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451188","SUP","HCPCS C1713","","8451188  -  POSITIONING CLIP 8451188 5.5MM ROD","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$16.88 ","$0.00 ","$7.82 ","$0.00 ","$0.00 ","$6.57 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$5.87 ","$0.00 ","$5.97 ","$0.00 "
"8451302","SUP","HCPCS C1713","","8451302  -  CONNECTOR ROD 5.5MM INLN TI","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8451402","SUP","HCPCS C1713","","8451402  -  CONCTR ROD 5.5MM T PRLL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8451530","SUP","HCPCS C1713","","8451530  -  SCREW BONE 10.5MM 30MM POLYAX� 5.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451535","SUP","HCPCS C1713","","8451535  -  SCREW BONE 10.5MM 35MM POLYAX� 5.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451540","SUP","HCPCS C1713","","8451540  -  SCREW BONE 10.5MM 40MM POLYAX� 5.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451545","SUP","HCPCS C1713","","8451545  -  SCREW BONE 10.5MM 45MM POLYAX� 5.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451550","SUP","HCPCS C1713","","8451550  -  SCREW BONE 10.5MM 50MM POLYAX� 5.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451555","SUP","HCPCS C1713","","8451555  -  SCREW BONE 10.5MM 55MM POLYAX� 5.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8451602","SUP","HCPCS C1713","","8451602  -  CONCTR ROD 5.5MM 4 HOLE TI ARM15","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8452004","SUP","HCPCS C1713","","8452004  -  ROD LATERAL OFFSET","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$1,057.50 ","$0.00 ","$489.80 ","$0.00 ","$0.00 ","$411.47 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$367.78 ","$0.00 ","$374.12 ","$0.00 "
"8452025","SUP","HCPCS C1713","","8452025  -  ROD SPNL 25MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452030","SUP","HCPCS C1713","","8452030  -  ROD SPNL 30MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452035","SUP","HCPCS C1713","","8452035  -  ROD SPNL 35MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452040","SUP","HCPCS C1713","","8452040  -  ROD SPNL 40MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452045","SUP","HCPCS C1713","","8452045  -  ROD SPNL 45MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452050","SUP","HCPCS C1713","","8452050  -  ROD SPNL 50MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452055","SUP","HCPCS C1713","","8452055  -  ROD SPNL 55MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452060","SUP","HCPCS C1713","","8452060  -  ROD SPNL 60MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452065","SUP","HCPCS C1713","","8452065  -  ROD SPNL 65MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452070","SUP","HCPCS C1713","","8452070  -  ROD SPNL 70MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452075","SUP","HCPCS C1713","","8452075  -  ROD SPNL 5.5MM 75MM TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452080","SUP","HCPCS C1713","","8452080  -  ROD SPNL 80MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452090","SUP","HCPCS C1713","","8452090  -  ROD SPNL 90MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452100","SUP","HCPCS C1713","","8452100  -  ROD SPNL 100MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452120","SUP","HCPCS C1713","","8452120  -  ROD SPNL 120MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452140","SUP","HCPCS C1713","","8452140  -  ROD SPNL 140MM 5.5MM TI ARM15","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452152","SUP","HCPCS C1713","","8452152  -  ROD-ROD 5.5MM O -5.5MM O","BOTH IP/OP","$3,530.00 ","$2,612.20 ","$0.00 ","$3,530.00 ","$1,588.50 ","$0.00 ","$735.74 ","$0.00 ","$0.00 ","$618.07 ","$3,530.00 ","$0.00 ","$1,765.00 ","$2,795.76 ","$2,824.00 ","$0.00 ","$552.45 ","$0.00 ","$561.98 ","$0.00 "
"8452156","SUP","HCPCS C1713","","8452156  -  ROD-ROD 5.5MM O-6.35MM O","BOTH IP/OP","$3,530.00 ","$2,612.20 ","$0.00 ","$3,530.00 ","$1,588.50 ","$0.00 ","$735.74 ","$0.00 ","$0.00 ","$618.07 ","$3,530.00 ","$0.00 ","$1,765.00 ","$2,795.76 ","$2,824.00 ","$0.00 ","$552.45 ","$0.00 ","$561.98 ","$0.00 "
"8452160","SUP","HCPCS C1713","","8452160  -  ROD SPNL 160MM 5.5MM TI ARM15T","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452166","SUP","HCPCS C1713","","8452166  -  ROD-ROD 6.35MM O-6.35MM O","BOTH IP/OP","$3,530.00 ","$2,612.20 ","$0.00 ","$3,530.00 ","$1,588.50 ","$0.00 ","$735.74 ","$0.00 ","$0.00 ","$618.07 ","$3,530.00 ","$0.00 ","$1,765.00 ","$2,795.76 ","$2,824.00 ","$0.00 ","$552.45 ","$0.00 ","$561.98 ","$0.00 "
"8452200","SUP","HCPCS C1713","","8452200  -  ROD SPNL 200MM 5.5MM ARMADA TI ARM15T","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452255","SUP","HCPCS C1713","","8452255  -  ROD-ROD 5.5MM O-5.5MM OW","BOTH IP/OP","$3,530.00 ","$2,612.20 ","$0.00 ","$3,530.00 ","$1,588.50 ","$0.00 ","$735.74 ","$0.00 ","$0.00 ","$618.07 ","$3,530.00 ","$0.00 ","$1,765.00 ","$2,795.76 ","$2,824.00 ","$0.00 ","$552.45 ","$0.00 ","$561.98 ","$0.00 "
"8452256","SUP","HCPCS C1713","","8452256  -  ROD-ROD 5.5MM O-6.35MM OW","BOTH IP/OP","$3,530.00 ","$2,612.20 ","$0.00 ","$3,530.00 ","$1,588.50 ","$0.00 ","$735.74 ","$0.00 ","$0.00 ","$618.07 ","$3,530.00 ","$0.00 ","$1,765.00 ","$2,795.76 ","$2,824.00 ","$0.00 ","$552.45 ","$0.00 ","$561.98 ","$0.00 "
"8452266","SUP","HCPCS C1713","","8452266  -  ROD-ROD 6.35MM O-6.35MM OW","BOTH IP/OP","$3,530.00 ","$2,612.20 ","$0.00 ","$3,530.00 ","$1,588.50 ","$0.00 ","$735.74 ","$0.00 ","$0.00 ","$618.07 ","$3,530.00 ","$0.00 ","$1,765.00 ","$2,795.76 ","$2,824.00 ","$0.00 ","$552.45 ","$0.00 ","$561.98 ","$0.00 "
"8452300","SUP","HCPCS C1713","","8452300  -  ROD SPNL 300MM NS ARMADA ARM15T","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8452355","SUP","HCPCS C1713","","8452355  -  ROD-ROD 90 DEG 5.5MM O-5.5MM C","BOTH IP/OP","$3,845.00 ","$2,845.30 ","$0.00 ","$3,845.00 ","$1,730.25 ","$0.00 ","$801.39 ","$0.00 ","$0.00 ","$673.23 ","$3,845.00 ","$0.00 ","$1,922.50 ","$3,045.24 ","$3,076.00 ","$0.00 ","$601.74 ","$0.00 ","$612.12 ","$0.00 "
"8452356","SUP","HCPCS C1713","","8452356  -  ROD-ROD 90 DEG 5.5MM O 6.35MM C","BOTH IP/OP","$3,845.00 ","$2,845.30 ","$0.00 ","$3,845.00 ","$1,730.25 ","$0.00 ","$801.39 ","$0.00 ","$0.00 ","$673.23 ","$3,845.00 ","$0.00 ","$1,922.50 ","$3,045.24 ","$3,076.00 ","$0.00 ","$601.74 ","$0.00 ","$612.12 ","$0.00 "
"8452365","SUP","HCPCS C1713","","8452365  -  ROD-ROD 90 DEG 6.35MM O 5.5MM C","BOTH IP/OP","$3,845.00 ","$2,845.30 ","$0.00 ","$3,845.00 ","$1,730.25 ","$0.00 ","$801.39 ","$0.00 ","$0.00 ","$673.23 ","$3,845.00 ","$0.00 ","$1,922.50 ","$3,045.24 ","$3,076.00 ","$0.00 ","$601.74 ","$0.00 ","$612.12 ","$0.00 "
"8452366","SUP","HCPCS C1713","","8452366  -  ROD-ROD 90 DEG 6.35MM O 6.35MM C","BOTH IP/OP","$3,845.00 ","$2,845.30 ","$0.00 ","$3,845.00 ","$1,730.25 ","$0.00 ","$801.39 ","$0.00 ","$0.00 ","$673.23 ","$3,845.00 ","$0.00 ","$1,922.50 ","$3,045.24 ","$3,076.00 ","$0.00 ","$601.74 ","$0.00 ","$612.12 ","$0.00 "
"8452412","SUP","HCPCS C1713","","8452412  -  ROD CONNECTOR LH 5.5MM 15 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452422","SUP","HCPCS C1713","","8452422  -  ROD CONNECTOR LH 5.5MM 25 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452432","SUP","HCPCS C1713","","8452432  -  ROD CONNECTOR LH 5.5MM 35 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452442","SUP","HCPCS C1713","","8452442  -  ROD CONNECTOR LH 5.5MM 40 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452500","SUP","HCPCS C1713","","8452500  -  ROD SPNL 500MM 5.5MM TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"8452512","SUP","HCPCS C1713","","8452512  -  ROD CONNECTOR RH 5.5MM 15 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452522","SUP","HCPCS C1713","","8452522  -  ROD CONNECTOR RH 5.5MM 25 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452532","SUP","HCPCS C1713","","8452532  -  ROD CONNECTOR RH 5.5MM 35 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8452542","SUP","HCPCS C1713","","8452542  -  ROD CONNECTOR RH 5.5MM 40 X 200MM","BOTH IP/OP","$5,105.00 ","$3,777.70 ","$0.00 ","$5,105.00 ","$2,297.25 ","$0.00 ","$1,064.01 ","$0.00 ","$0.00 ","$893.84 ","$5,105.00 ","$0.00 ","$2,552.50 ","$4,043.16 ","$4,084.00 ","$0.00 ","$798.93 ","$0.00 ","$812.72 ","$0.00 "
"8453101","SUP","Custom 27803010","","8453101  -  HOOK SPNL 5.5MM SM PDCL TI","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453102","SUP","Custom 27803010","","8453102  -  HOOK SPNL 5.5MM MED PDCL TI","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453112","SUP","Custom 27803010","","8453112  -  HOOK SPNL 6MM 5.5MM LMNR TI RED","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453113","SUP","Custom 27803010","","8453113  -  HOOK SPNL 8MM 5.5MM LMNR TI RED","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453114","SUP","Custom 27803010","","8453114  -  HOOK SPNL 10MM 5.5MM LMNR RED","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453121","SUP","Custom 27803010","","8453121  -  HOOK SPNL 5.5MM RIGHT TI ANG","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453122","SUP","Custom 27803010","","8453122  -  HOOK SPNL 5.5MM LEFT TI ANG","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453123","SUP","Custom 27803010","","8453123  -  HOOK SPNL 5.5MM TI RIGHT OFFST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8453124","SUP","Custom 27803010","","8453124  -  HOOK SPNL 5.5MM TI LEFT OFFST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8454025","SUP","HCPCS C1713","","8454025  -  SCREW BONE 4MM 25MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454030","SUP","HCPCS C1713","","8454030  -  SCREW BONE 4MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454035","SUP","HCPCS C1713","","8454035  -  SCREW BONE 4MM 35MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454040","SUP","HCPCS C1713","","8454040  -  SCREW BONE 4MM 40MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454045","SUP","HCPCS C1713","","8454045  -  SCREW BONE 4MM 45MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454402","SUP","HCPCS C1713","","8454402  -  CONNECTOR ROD PARALLEL 5.5MM CLOSE TITANIUM SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8454404","SUP","HCPCS C1713","","8454404  -  CONNECTOR ROD 5.5MM NS ARMADA PRLL SPNE ASF25T","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8454525","SUP","HCPCS C1713","","8454525  -  SCREW BONE 4.5MM 25MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454530","SUP","HCPCS C1713","","8454530  -  SCREW BONE 4.5MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454535","SUP","HCPCS C1713","","8454535  -  SCREW BONE 4.5MM 35MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454540","SUP","HCPCS C1713","","8454540  -  SCREW BONE 40MM 4.5MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454545","SUP","HCPCS C1713","","8454545  -  SCREW BONE 45MM 4.5MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8454602","SUP","HCPCS C1713","","8454602  -  CONNECTOR ROD 5.5MM 4 HOLE TITANIUM SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8454604","SUP","HCPCS C1713","","8454604  -  CONNECTOR ROD 5.5MM NS ARMADA 4 HL PRLL SPNE ASF25T","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8455025","SUP","HCPCS C1713","","8455025  -  SCREW BONE 5MM 25MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455030","SUP","HCPCS C1713","","8455030  -  SCREW BONE 5MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455035","SUP","HCPCS C1713","","8455035  -  SCREW BONE 5MM 35MM SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455040","SUP","HCPCS C1713","","8455040  -  SCREW BONE 5MM 40MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455045","SUP","HCPCS C1713","","8455045  -  SCREW BONE 5MM 45MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455050","SUP","HCPCS C1713","","8455050  -  SCREW BONE 5MM 50MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455525","SUP","HCPCS C1713","","8455525  -  SCREW BONE 5.5MM 25MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455530","SUP","HCPCS C1713","","8455530  -  SCREW BONE 5.5MM 30MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455535","SUP","HCPCS C1713","","8455535  -  SCREW BONE 5.5MM 35MM SPNL POLYAX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455540","SUP","HCPCS C1713","","8455540  -  SCREW BONE 5.5MM 40MM SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455545","SUP","HCPCS C1713","","8455545  -  SCREW BONE 5.5MM 45MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455550","SUP","HCPCS C1713","","8455550  -  SCREW BONE 5.5MM 50MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8455555","SUP","HCPCS C1713","","8455555  -  SCREW BONE 5.5MM 55MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456530","SUP","HCPCS C1713","","8456530  -  SCREW BONE 6.5MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456535","SUP","HCPCS C1713","","8456535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456540","SUP","HCPCS C1713","","8456540  -  SCREW BN 6.5MM 40MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456545","SUP","HCPCS C1713","","8456545  -  SCREW BN 6.5MM 45MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456550","SUP","HCPCS C1713","","8456550  -  SCREW BN 6.5MM 50MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456555","SUP","HCPCS C1713","","8456555  -  SCREW BN 6.5MM 55MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8456560","SUP","HCPCS C1713","","8456560  -  SCREW BONE 6.5MM 60MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457530","SUP","HCPCS C1713","","8457530  -  SCREW BONE 7.5MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457535","SUP","HCPCS C1713","","8457535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457540","SUP","HCPCS C1713","","8457540  -  SCREW BN 7.5MM 40MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457545","SUP","HCPCS C1713","","8457545  -  SCREW BN 7.5MM 45MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457550","SUP","HCPCS C1713","","8457550  -  SCREW BN 7.5MM 50MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457555","SUP","HCPCS C1713","","8457555  -  SCREW BN 7.5MM 55MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8457560","SUP","HCPCS C1713","","8457560  -  SCREW BN 7.5MM 60MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8458530","SUP","HCPCS C1713","","8458530  -  SCREW BONE 8.5MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8458535","SUP","HCPCS C1713","","8458535  -  SCREW BONE 8.5MM 35MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8458540","SUP","HCPCS C1713","","8458540  -  SCREW BONE 8.5MM 40MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8458545","SUP","HCPCS C1713","","8458545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8458550","SUP","HCPCS C1713","","8458550  -  SCREW BN 8.5MM 50MM NS ARMADA PA TI SPNE ARM15T","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8459530","SUP","HCPCS C1713","","8459530  -  SCREW BONE 9.5MM 30MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8459535","SUP","HCPCS C1713","","8459535  -  SCREW BONE 9.5MM 35MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8459540","SUP","HCPCS C1713","","8459540  -  SCREW BONE 9.5MM 40MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8459545","SUP","HCPCS C1713","","8459545  -  SCREW BONE 9.5MM 45MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8459550","SUP","HCPCS C1713","","8459550  -  SCREW BONE 9.5MM 50MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8459555","SUP","HCPCS C1713","","8459555  -  SCREW BONE 9.5MM 55MM POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8461100","SUP","HCPCS C1713","","8461100  -  SCREW BN 5.5MM 100MM NS ARMADA LCK OPN TULIP TI SPNE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8461302","SUP","HCPCS C1713","","8461302  -  CONNECTOR ROD 5.5MM 6.25MM INLN TI","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8461402","SUP","HCPCS C1713","","8461402  -  CONCTR ROD 6.5/5.5MM PRLL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8461602","SUP","HCPCS C1713","","8461602  -  CONCTR ROD 6.25/5.5MM 4 HOLE TI","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8464402","SUP","HCPCS C1713","","8464402  -  CONNECTOR ROD PARALLEL 5.5MM 6.35MM CLOSE TITANIUM SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8464404","SUP","HCPCS C1713","","8464404  -  CONNECTOR ROD 5.5-6.35MM NS ARMADA PRLL SPNE ASF26T","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8464602","SUP","HCPCS C1713","","8464602  -  CONNECTOR ROD PARALLEL 5.5MM 6.35MM 4 HOLE TITANIUM SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8464604","SUP","HCPCS C1713","","8464604  -  CONNECTOR ROD 5.5-6.35MM NS ARMADA 4 HL PRLL SPNE ASF26T","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8480511","SUP","HCPCS C1713","","8480511  -  STAPLE 8480511   3 PRONG 12MM TI","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$260.55 ","$0.00 ","$120.68 ","$0.00 ","$0.00 ","$101.38 ","$579.00 ","$0.00 ","$289.50 ","$458.57 ","$463.20 ","$0.00 ","$90.61 ","$0.00 ","$92.18 ","$0.00 "
"8480512","SUP","HCPCS C1713","","8480512  -  STAPLE 8480512 12MM TI","BOTH IP/OP","$579.00 ","$428.46 ","$0.00 ","$579.00 ","$260.55 ","$0.00 ","$120.68 ","$0.00 ","$0.00 ","$101.38 ","$579.00 ","$0.00 ","$289.50 ","$458.57 ","$463.20 ","$0.00 ","$90.61 ","$0.00 ","$92.18 ","$0.00 "
"8481623","SUP","HCPCS C1713","","8481623  -  SCREW 8481623 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481625","SUP","HCPCS C1713","","8481625  -  SCREW 8481625 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481628","SUP","HCPCS C1713","","8481628  -  SCREW 8481628 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481630","SUP","HCPCS C1713","","8481630  -  SCREW 8481630 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481633","SUP","HCPCS C1713","","8481633  -  SCREW 8481633 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481635","SUP","HCPCS C1713","","8481635  -  SCREW 8481635 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481638","SUP","HCPCS C1713","","8481638  -  SCREW 8481638 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481640","SUP","HCPCS C1713","","8481640  -  SCREW 8481640 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481643","SUP","HCPCS C1713","","8481643  -  SCREW 8481643 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481645","SUP","HCPCS C1713","","8481645  -  SCREW 8481645 CANNULATED BONE 6.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481648","SUP","HCPCS C1713","","8481648  -  BONE SCREW 8481648 6.5MM TI CANNULATED","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481650","SUP","HCPCS C1713","","8481650  -  SCREW BONE 6.5MM 50MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481653","SUP","HCPCS C1713","","8481653  -  SCREW BONE 6.5MM 53MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481655","SUP","HCPCS C1713","","8481655  -  SCREW BONE 6.5MM 55MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481723","SUP","HCPCS C1713","","8481723  -  SCREW BONE 7.5MM 48MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481725","SUP","HCPCS C1713","","8481725  -  SCREW BONE 7.5MM 50MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481728","SUP","HCPCS C1713","","8481728  -  SCREW BONE 7.5MM 53MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481730","SUP","HCPCS C1713","","8481730  -  SCREW BONE 7.5MM 55MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481733","SUP","HCPCS C1713","","8481733  -  SCREW 8481733 CANNULATED BONE 7.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481735","SUP","HCPCS C1713","","8481735  -  SCREW 8481735 CANNULATED BONE 7.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481738","SUP","HCPCS C1713","","8481738  -  SCREW 8481738 CANNULATED BONE 7.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481743","SUP","HCPCS C1713","","8481743  -  SCREW 8481743 CANNULATED BONE 7.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481745","SUP","HCPCS C1713","","8481745  -  SCREW 8481745 CANNULATED BONE 7.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481748","SUP","HCPCS C1713","","8481748  -  SCREW BONE 7.5MM 48MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481750","SUP","HCPCS C1713","","8481750  -  SCREW BONE 7.5MM 50MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481753","SUP","HCPCS C1713","","8481753  -  SCREW BONE 7.5MM 53MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481755","SUP","HCPCS C1713","","8481755  -  SCREW BONE 7.5MM 55MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481823","SUP","HCPCS C1713","","8481823  -  SCREW BONE 8.5MM 23MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481825","SUP","HCPCS C1713","","8481825  -  SCREW 8481825 CANNULATED BONE 8.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481828","SUP","HCPCS C1713","","8481828  -  SCREW BONE 8.5MM 28MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481830","SUP","HCPCS C1713","","8481830  -  SCREW 8481830 CANNULATED BONE 8.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481833","SUP","HCPCS C1713","","8481833  -  SCREW BONE 8.5MM 33MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481835","SUP","HCPCS C1713","","8481835  -  SCREW 8481835 CANNULATED BONE 8.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481838","SUP","HCPCS C1713","","8481838  -  SCREW BONE 8.5MM 38MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481840","SUP","HCPCS C1713","","8481840  -  SCREW 8481840 CANNULATED BONE 8.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481843","SUP","HCPCS C1713","","8481843  -  SCREW BONE 8.5MM 43MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481845","SUP","HCPCS C1713","","8481845  -  SCREW 8481845 CANNULATED BONE 8.5MM TI","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481848","SUP","HCPCS C1713","","8481848  -  SCREW BONE 8.5MM 48MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481850","SUP","HCPCS C1713","","8481850  -  SCREW BONE 8.5MM 50MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481853","SUP","HCPCS C1713","","8481853  -  SCREW BONE 8.5MM 53MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481855","SUP","HCPCS C1713","","8481855  -  SCREW BONE 8.5MM 55MM TI SPNL CANN","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"8481910","SUP","Custom 27203010","","8481910  -  INSTRUMENT 8481910 6.5MM RM CAN TAP","BOTH IP/OP","$945.00 ","$699.30 ","$0.00 ","$945.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$945.00 ","$0.00 ","$472.50 ","$748.44 ","$756.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8481912","SUP","Custom 27203010","","8481912  -  INSTRUMENT 8481912 7.5MM RM TP HNDL GRN","BOTH IP/OP","$945.00 ","$699.30 ","$0.00 ","$945.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$945.00 ","$0.00 ","$472.50 ","$748.44 ","$756.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8482623","SUP","HCPCS C1713","","8482623  -  SCREW 8482623 CDH ECLIPSE 6.5X22.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482625","SUP","HCPCS C1713","","8482625  -  SCREW 8482625 CDH ECLIPSE 6.5X25MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482628","SUP","HCPCS C1713","","8482628  -  SCREW 8482628 CDH ECLIPSE 6.5X27.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482630","SUP","HCPCS C1713","","8482630  -  SCREW 8482630 CDH ECLIPSE 6.5X30MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482633","SUP","HCPCS C1713","","8482633  -  SCREW 8482633 CDH ECLIPSE 6.5X32.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482635","SUP","HCPCS C1713","","8482635  -  SCREW 8482635 CDH ECLIPSE 6.5X35MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482638","SUP","HCPCS C1713","","8482638  -  SCREW 8482638 CDH ECLIPSE 6.5X37.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482640","SUP","HCPCS C1713","","8482640  -  SCREW 8482640 CDH ECLIPSE 6.5X40MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482643","SUP","HCPCS C1713","","8482643  -  SCREW 8482643 CDH ECLIPSE 6.5X42.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482645","SUP","HCPCS C1713","","8482645  -  SCREW 8482645 CDH ECLIPSE 6.5X45MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482648","SUP","HCPCS C1713","","8482648  -  SCREW BONE 6.5MM 47.5MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482650","SUP","HCPCS C1713","","8482650  -  SCREW BONE 6.5MM 50MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482653","SUP","HCPCS C1713","","8482653  -  SCREW BONE 6.5MM 52.5MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482655","SUP","HCPCS C1713","","8482655  -  SCREW BONE 6.5MM 55MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482723","SUP","HCPCS C1713","","8482723  -  SCREW 8482723 CDH ECLIPSE 7.5X22.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482725","SUP","HCPCS C1713","","8482725  -  SCREW 8482725 CDH ECLIPSE 7.5X25MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482728","SUP","HCPCS C1713","","8482728  -  SCREW 8482728 CDH ECLIPSE 7.5X27.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482730","SUP","HCPCS C1713","","8482730  -  SCREW 8482730 CDH ECLIPSE 7.5X30MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482733","SUP","HCPCS C1713","","8482733  -  SCREW 8482733 CDH ECLIPSE 7.5X32.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482735","SUP","HCPCS C1713","","8482735  -  SCREW 8482735 CDH ECLIPSE 7.5X35MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482738","SUP","HCPCS C1713","","8482738  -  SCREW 8482738 CDH ECLIPSE 7.5X37.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482740","SUP","HCPCS C1713","","8482740  -  SCREW 8482740 CDH ECLIPSE 7.5X40MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482743","SUP","HCPCS C1713","","8482743  -  SCREW 8482743 CDH ECLIPSE 7.5X42.5MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482745","SUP","HCPCS C1713","","8482745  -  SCREW 8482745 CDH ECLIPSE 7.5X45MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482748","SUP","HCPCS C1713","","8482748  -  SCREW BONE 7.5MM 47.5MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482750","SUP","HCPCS C1713","","8482750  -  SCREW BONE 7.5MM 50MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482753","SUP","HCPCS C1713","","8482753  -  SCREW BONE 7.5MM 52.5MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482755","SUP","HCPCS C1713","","8482755  -  SCREW BONE 7.5MM 55MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482823","SUP","HCPCS C1713","","8482823  -  SCREW BONE 8.5MM 22.5MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482825","SUP","HCPCS C1713","","8482825  -  SCREW 8482825 CDH ECLIPSE 8.5X25MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482828","SUP","HCPCS C1713","","8482828  -  SCREW BONE 8.5MM 27.5MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482830","SUP","HCPCS C1713","","8482830  -  SCREW 8482830 CDH ECLIPSE 8.5X30MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482833","SUP","HCPCS C1713","","8482833  -  SCREW BONE 8.5MM 32.5MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482835","SUP","HCPCS C1713","","8482835  -  SCREW 8482835 CDH ECLIPSE 8.5X35MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482838","SUP","HCPCS C1713","","8482838  -  SCREW BONE 8.5MM 37.5MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482840","SUP","HCPCS C1713","","8482840  -  SCREW 8482840 CDH ECLIPSE 8.5X40MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482843","SUP","HCPCS C1713","","8482843  -  SCREW BONE 8.5MM 42.5MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482845","SUP","HCPCS C1713","","8482845  -  SCREW 8482845 CDH ECLIPSE 8.5X45MM","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482848","SUP","HCPCS C1713","","8482848  -  SCREW BONE 8.5MM 47.5MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482850","SUP","HCPCS C1713","","8482850  -  SCREW BONE 8.5MM 50MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482853","SUP","HCPCS C1713","","8482853  -  SCREW BONE 8.5MM 52.5MM ECLPS SPNL","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8482855","SUP","HCPCS C1713","","8482855  -  SCREW BONE 8.5MM 55MM ECLPS DBL HEX","BOTH IP/OP","$2,890.50 ","$2,138.97 ","$0.00 ","$2,890.50 ","$1,300.73 ","$0.00 ","$602.45 ","$0.00 ","$0.00 ","$506.10 ","$2,890.50 ","$0.00 ","$1,445.25 ","$2,289.28 ","$2,312.40 ","$0.00 ","$452.36 ","$0.00 ","$460.17 ","$0.00 "
"8530000","SUP","HCPCS C1713","","8530000  -  PLATE 8530000 TROUGH PLATE","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"8530008","SUP","HCPCS C1713","","8530008  -  PLATE 8MM BONE SPN","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"8530408","SUP","HCPCS C1713","","8530408  -  PLATE BN 8MM NS CENTERPIECE GFT SPNE","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"8530605","SUP","Custom 27203010","","8530605  -  BIT DRL 1.9MM STRL 3 FLT DISP","BOTH IP/OP","$349.50 ","$258.63 ","$0.00 ","$349.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$349.50 ","$0.00 ","$174.75 ","$276.80 ","$279.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8536510","SUP","HCPCS C1713","","8536510  -  SCREW ILIAC 6.5MM 100MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8536560","SUP","HCPCS C1713","","8536560  -  SCREW ILIAC 6.5MM 60MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8536570","SUP","HCPCS C1713","","8536570  -  SCREW ILIAC 6.5MM 70MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8536580","SUP","HCPCS C1713","","8536580  -  SCREW ILIAC 6.5MM 80MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8536590","SUP","HCPCS C1713","","8536590  -  SCREW ILIAC 6.5MM 90MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8537510","SUP","HCPCS C1713","","8537510  -  SCREW ILIAC 7.5MM 100MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8537570","SUP","HCPCS C1713","","8537570  -  SCREW ILIAC 7.5MM 70MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8537580","SUP","HCPCS C1713","","8537580  -  SCREW ILIAC 7.5MM 80MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8537590","SUP","HCPCS C1713","","8537590  -  SCREW ILIAC 7.5MM 90MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8538510","SUP","HCPCS C1713","","8538510  -  SCREW ILIAC 8.5MM 100MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8538570","SUP","HCPCS C1713","","8538570  -  SCREW ILIAC 8.5MM 70MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8538580","SUP","HCPCS C1713","","8538580  -  SCREW ILIAC 8.5MM 80MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8538590","SUP","HCPCS C1713","","8538590  -  SCREW ILIAC 8.5MM 90MM SC 5.5MM SS","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8540611","SUP","HCPCS C1713","","8540611  -  CROSSLINK 8540611 11 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8540612","SUP","HCPCS C1713","","8540612  -  CROSSLINK 8540612 12 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8540613","SUP","HCPCS C1713","","8540613  -  CROSSLINK 8540613 13 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8540614","SUP","HCPCS C1713","","8540614  -  CROSSLINK 8540614 14 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8540615","SUP","HCPCS C1713","","8540615  -  CROSSLINK 8540615 15 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8540616","SUP","HCPCS C1713","","8540616  -  CROSSLINK 8540616 16 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8540617","SUP","HCPCS C1713","","8540617  -  CROSSLINK 8540617 17 MM ANTERIOR LPC TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8546796","SUP","Custom 27203010","","REAGENT LYS SOL CLTR LYS S 5L MAXM/HMX/LH SER ANALY","BOTH IP/OP","$815.20 ","$603.25 ","$0.00 ","$815.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$815.20 ","$0.00 ","$407.60 ","$645.64 ","$652.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8547008","SUP","Custom 27203010","","REAGENT SHTH FLUID ISFLW 1.8L ANALY","BOTH IP/OP","$38.05 ","$28.16 ","$0.00 ","$38.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.05 ","$0.00 ","$19.03 ","$30.14 ","$30.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8547194","SUP","Custom 27203010","","REAGENT DILU CLTR ISOT CARBOY 20L LH700 SER ANALY","BOTH IP/OP","$64.33 ","$47.60 ","$0.00 ","$64.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.33 ","$0.00 ","$32.16 ","$50.95 ","$51.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8547195","SUP","Custom 27203010","","REAGENT DILU CLTR SCTR PK 20L LH700 SER ANALY","BOTH IP/OP","$354.18 ","$262.09 ","$0.00 ","$354.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.18 ","$0.00 ","$177.09 ","$280.51 ","$283.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8547196","SUP","Custom 27203010","","REAGENT RETCYT CLTR 20L LH700 SER ANALY","BOTH IP/OP","$419.10 ","$310.13 ","$0.00 ","$419.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$419.10 ","$0.00 ","$209.55 ","$331.93 ","$335.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8548498","SUP","HCPCS C1713","","8548498  -  STAPLE 8548498  19MM CAUDAL TI","BOTH IP/OP","$2,518.50 ","$1,863.69 ","$0.00 ","$2,518.50 ","$1,133.33 ","$0.00 ","$524.92 ","$0.00 ","$0.00 ","$440.97 ","$2,518.50 ","$0.00 ","$1,259.25 ","$1,994.65 ","$2,014.80 ","$0.00 ","$394.15 ","$0.00 ","$400.95 ","$0.00 "
"8548499","SUP","HCPCS C1713","","8548499  -  STAPLE 8548499  19MM ROSTRAL TI","BOTH IP/OP","$2,518.50 ","$1,863.69 ","$0.00 ","$2,518.50 ","$1,133.33 ","$0.00 ","$524.92 ","$0.00 ","$0.00 ","$440.97 ","$2,518.50 ","$0.00 ","$1,259.25 ","$1,994.65 ","$2,014.80 ","$0.00 ","$394.15 ","$0.00 ","$400.95 ","$0.00 "
"8548500","SUP","HCPCS C1713","","8548500  -  STAPLE 8548500  21 MM CAUDAL TI","BOTH IP/OP","$2,518.50 ","$1,863.69 ","$0.00 ","$2,518.50 ","$1,133.33 ","$0.00 ","$524.92 ","$0.00 ","$0.00 ","$440.97 ","$2,518.50 ","$0.00 ","$1,259.25 ","$1,994.65 ","$2,014.80 ","$0.00 ","$394.15 ","$0.00 ","$400.95 ","$0.00 "
"8548501","SUP","HCPCS C1713","","8548501  -  STAPLE 8548501  21 MM ROSTRAL TI","BOTH IP/OP","$2,518.50 ","$1,863.69 ","$0.00 ","$2,518.50 ","$1,133.33 ","$0.00 ","$524.92 ","$0.00 ","$0.00 ","$440.97 ","$2,518.50 ","$0.00 ","$1,259.25 ","$1,994.65 ","$2,014.80 ","$0.00 ","$394.15 ","$0.00 ","$400.95 ","$0.00 "
"8549008","SUP","HCPCS C1713","","8549008  -  CROSSLINK 8549008 16TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549009","SUP","HCPCS C1713","","8549009  -  CROSSLINK 8549009 19TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549010","SUP","HCPCS C1713","","8549010  -  CROSSLINK 8549010 22TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549011","SUP","HCPCS C1713","","8549011  -  CROSSLINK 8549011 25TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549012","SUP","HCPCS C1713","","8549012  -  CROSSLINK 8549012 29TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549013","SUP","HCPCS C1713","","8549013  -  CROSSLINK 8549013 32TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549014","SUP","HCPCS C1713","","8549014  -  CROSSLINK 8549014 35TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549015","SUP","HCPCS C1713","","8549015  -  CROSSLINK 8549015 38TI LPC FOR 4.5ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549016","SUP","HCPCS C1713","","8549016  -  CROSSLINK 8549016 4.5MM MLTSPAN LPC SM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549017","SUP","HCPCS C1713","","8549017  -  CROSSLINK 8549017 4.5MM MLTSPAN LPC MD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549018","SUP","HCPCS C1713","","8549018  -  CROSSLINK 8549018 4.5MM MLTSPAN LPC LG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8549300","SUP","Custom 27803010","","8549300  -  CONNECTOR 8549300 4.5 4.5 OPEN DOMINO TI","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8549301","SUP","Custom 27803010","","8549301  -  CONNECTOR 8549301 4.5 5.5 OPEN DOMINO TI","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8549305","SUP","Custom 27803010","","8549305  -  CONNECTOR 8549305 4.5 MM DOMINO","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8549306","SUP","Custom 27803010","","8549306  -  CONNECTOR 8549306 4.5 MM 5.5MM DOMINO","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8550120","SUP","HCPCS C1713","","8550120  -  CONCTR ROD 20MM 5.5MM CX FIX SS","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550122","SUP","HCPCS C1713","","8550122  -  CONCTR ROD 22.5MM 5.5MM CX FIX SS","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550125","SUP","HCPCS C1713","","8550125  -  CONCTR ROD 25MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550127","SUP","HCPCS C1713","","8550127  -  CONCTR ROD 27.5MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550130","SUP","HCPCS C1713","","8550130  -  CONCTR ROD 30MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550132","SUP","HCPCS C1713","","8550132  -  CONCTR ROD 32.5MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550135","SUP","HCPCS C1713","","8550135  -  CONCTR ROD 35MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550137","SUP","HCPCS C1713","","8550137  -  CONCTR ROD 37.5MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550140","SUP","HCPCS C1713","","8550140  -  CONCTR ROD 40MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550145","SUP","HCPCS C1713","","8550145  -  CONCTR ROD 45MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550150","SUP","HCPCS C1713","","8550150  -  CONCTR ROD 50MM 5.5MM SS CX FIX","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"8550245","SUP","HCPCS C1713","","8550245  -  CONCTR ROD 45-50MM 5.5MM SS CX","BOTH IP/OP","$4,905.00 ","$3,629.70 ","$0.00 ","$4,905.00 ","$2,207.25 ","$0.00 ","$1,022.32 ","$0.00 ","$0.00 ","$858.83 ","$4,905.00 ","$0.00 ","$2,452.50 ","$3,884.76 ","$3,924.00 ","$0.00 ","$767.63 ","$0.00 ","$780.88 ","$0.00 "
"8550250","SUP","HCPCS C1713","","8550250  -  CONCTR ROD 50-60MM 5.5MM SS CX","BOTH IP/OP","$4,905.00 ","$3,629.70 ","$0.00 ","$4,905.00 ","$2,207.25 ","$0.00 ","$1,022.32 ","$0.00 ","$0.00 ","$858.83 ","$4,905.00 ","$0.00 ","$2,452.50 ","$3,884.76 ","$3,924.00 ","$0.00 ","$767.63 ","$0.00 ","$780.88 ","$0.00 "
"8550260","SUP","HCPCS C1713","","8550260  -  CONCTR ROD 60-70MM 5.5MM SS CX","BOTH IP/OP","$4,905.00 ","$3,629.70 ","$0.00 ","$4,905.00 ","$2,207.25 ","$0.00 ","$1,022.32 ","$0.00 ","$0.00 ","$858.83 ","$4,905.00 ","$0.00 ","$2,452.50 ","$3,884.76 ","$3,924.00 ","$0.00 ","$767.63 ","$0.00 ","$780.88 ","$0.00 "
"8550270","SUP","HCPCS C1713","","8550270  -  CONCTR ROD 70-85MM 5.5MM SS CX","BOTH IP/OP","$4,905.00 ","$3,629.70 ","$0.00 ","$4,905.00 ","$2,207.25 ","$0.00 ","$1,022.32 ","$0.00 ","$0.00 ","$858.83 ","$4,905.00 ","$0.00 ","$2,452.50 ","$3,884.76 ","$3,924.00 ","$0.00 ","$767.63 ","$0.00 ","$780.88 ","$0.00 "
"8550302","SUP","HCPCS C1713","","8550302  -  CONCTR ROD 5.5MM SS INLN","BOTH IP/OP","$2,880.00 ","$2,131.20 ","$0.00 ","$2,880.00 ","$1,296.00 ","$0.00 ","$600.26 ","$0.00 ","$0.00 ","$504.26 ","$2,880.00 ","$0.00 ","$1,440.00 ","$2,280.96 ","$2,304.00 ","$0.00 ","$450.72 ","$0.00 ","$458.50 ","$0.00 "
"8550402","SUP","HCPCS C1713","","8550402  -  CONCTR ROD 5.5MM SS PRLL","BOTH IP/OP","$2,880.00 ","$2,131.20 ","$0.00 ","$2,880.00 ","$1,296.00 ","$0.00 ","$600.26 ","$0.00 ","$0.00 ","$504.26 ","$2,880.00 ","$0.00 ","$1,440.00 ","$2,280.96 ","$2,304.00 ","$0.00 ","$450.72 ","$0.00 ","$458.50 ","$0.00 "
"8550602","SUP","HCPCS C1713","","8550602  -  CONCTR ROD 5.5MM SS 4 HOLE","BOTH IP/OP","$3,617.50 ","$2,676.95 ","$0.00 ","$3,617.50 ","$1,627.88 ","$0.00 ","$753.98 ","$0.00 ","$0.00 ","$633.40 ","$3,617.50 ","$0.00 ","$1,808.75 ","$2,865.06 ","$2,894.00 ","$0.00 ","$566.14 ","$0.00 ","$575.91 ","$0.00 "
"8552200","SUP","HCPCS C1713","","8552200  -  ROD 5.5MM 200MM SS","BOTH IP/OP","$1,295.00 ","$958.30 ","$0.00 ","$1,295.00 ","$582.75 ","$0.00 ","$269.91 ","$0.00 ","$0.00 ","$226.74 ","$1,295.00 ","$0.00 ","$647.50 ","$1,025.64 ","$1,036.00 ","$0.00 ","$202.67 ","$0.00 ","$206.16 ","$0.00 "
"8552300","SUP","HCPCS C1713","","8552300  -  ROD 5.5MM 300MM SS","BOTH IP/OP","$1,860.00 ","$1,376.40 ","$0.00 ","$1,860.00 ","$837.00 ","$0.00 ","$387.67 ","$0.00 ","$0.00 ","$325.67 ","$1,860.00 ","$0.00 ","$930.00 ","$1,473.12 ","$1,488.00 ","$0.00 ","$291.09 ","$0.00 ","$296.11 ","$0.00 "
"8552500","SUP","HCPCS C1713","","8552500  -  ROD SPNL 500MM 5.5MM SS","BOTH IP/OP","$1,922.50 ","$1,422.65 ","$0.00 ","$1,922.50 ","$865.13 ","$0.00 ","$400.70 ","$0.00 ","$0.00 ","$336.61 ","$1,922.50 ","$0.00 ","$961.25 ","$1,522.62 ","$1,538.00 ","$0.00 ","$300.87 ","$0.00 ","$306.06 ","$0.00 "
"8553101","SUP","Custom 27803010","","8553101  -  HOOK SPNL 5.5MM SM PDCL SS","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$1,557.50 ","$2,467.08 ","$2,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553102","SUP","Custom 27803010","","8553102  -  HOOK SPNL 5.5MM MED PDCL SS","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$1,557.50 ","$2,467.08 ","$2,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553112","SUP","Custom 27803010","","8553112  -  HOOK SPNL 6MM LMNR SS RED 5.5MM ROD","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$1,557.50 ","$2,467.08 ","$2,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553113","SUP","Custom 27803010","","8553113  -  HOOK SPNL 8MM LMNR SS RED 5.5MM ROD","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$1,557.50 ","$2,467.08 ","$2,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553114","SUP","Custom 27803010","","8553114  -  HOOK SPNL 10MM LMNR SS RED 5.5MM ROD","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$1,557.50 ","$2,467.08 ","$2,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553121","SUP","Custom 27803010","","8553121  -  HOOK SPNL SS RIGHT ANG 5.5 MM ROD","BOTH IP/OP","$3,950.00 ","$2,923.00 ","$0.00 ","$3,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,950.00 ","$0.00 ","$1,975.00 ","$3,128.40 ","$3,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553122","SUP","Custom 27803010","","8553122  -  HOOK SPNL SS LEFT ANG 5.5 MM ROD","BOTH IP/OP","$3,950.00 ","$2,923.00 ","$0.00 ","$3,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,950.00 ","$0.00 ","$1,975.00 ","$3,128.40 ","$3,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553123","SUP","Custom 27803010","","8553123  -  HOOK SPNL SS RIGHT OFFST 5.5 MM ROD","BOTH IP/OP","$3,950.00 ","$2,923.00 ","$0.00 ","$3,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,950.00 ","$0.00 ","$1,975.00 ","$3,128.40 ","$3,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8553124","SUP","Custom 27803010","","8553124  -  HOOK SPNL SS LEFT OFFST 5.5 MM ROD","BOTH IP/OP","$3,950.00 ","$2,923.00 ","$0.00 ","$3,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,950.00 ","$0.00 ","$1,975.00 ","$3,128.40 ","$3,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8554025","SUP","HCPCS C1713","","8554025  -  SCREW BONE 4MM 25MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554030","SUP","HCPCS C1713","","8554030  -  SCREW BONE 4MM 30MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554035","SUP","HCPCS C1713","","8554035  -  SCREW BONE 4MM 35MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554040","SUP","HCPCS C1713","","8554040  -  SCREW BONE 4MM 40MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554525","SUP","HCPCS C1713","","8554525  -  SCREW BONE 4.5MM 25MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554530","SUP","HCPCS C1713","","8554530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554535","SUP","HCPCS C1713","","8554535  -  SCREW BONE 4.5MM 35MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554540","SUP","HCPCS C1713","","8554540  -  SCREW BONE 4.5MM 40MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8554545","SUP","HCPCS C1713","","8554545  -  SCREW BONE 4.5MM 45MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555025","SUP","HCPCS C1713","","8555025  -  SCREW BONE 5MM 25MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555030","SUP","HCPCS C1713","","8555030  -  SCREW BONE 5MM 30MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555035","SUP","HCPCS C1713","","8555035  -  SCREW BONE 5MM 35MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555040","SUP","HCPCS C1713","","8555040  -  SCREW BONE 5MM 40MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555045","SUP","HCPCS C1713","","8555045  -  SCREW BONE 5MM 45MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555530","SUP","HCPCS C1713","","8555530  -  SCREW BONE 5.5MM 30MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555535","SUP","HCPCS C1713","","8555535  -  SCREW BONE 5.5MM 35MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555540","SUP","HCPCS C1713","","8555540  -  SCREW BONE 5.5MM 40MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555545","SUP","HCPCS C1713","","8555545  -  SCREW BONE 5.5MM 45MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555550","SUP","HCPCS C1713","","8555550  -  SCREW BONE 5.5MM 50MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8555555","SUP","HCPCS C1713","","8555555  -  SCREW BONE 5.5MM 55MM SS SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8556535","SUP","HCPCS C1713","","8556535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8556540","SUP","HCPCS C1713","","8556540  -  SCREW BONE 6.5MM 40MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8556545","SUP","HCPCS C1713","","8556545  -  SCREW BONE 6.5MM 45MM SS SPNL","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8556550","SUP","HCPCS C1713","","8556550  -  SCREW BONE 6.5MM 50MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8556555","SUP","HCPCS C1713","","8556555  -  SCREW BONE 6.5MM 55MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8557535","SUP","HCPCS C1713","","8557535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8557540","SUP","HCPCS C1713","","8557540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8557545","SUP","HCPCS C1713","","8557545  -  SCREW BONE 7.5MM 45MM SS SPNL","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8557550","SUP","HCPCS C1713","","8557550  -  SCREW BONE 7.5MM 50MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8557555","SUP","HCPCS C1713","","8557555  -  SCREW BONE 7.5MM 55MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8558540","SUP","HCPCS C1713","","8558540  -  SCREW BONE 8.5MM 40MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8558545","SUP","HCPCS C1713","","8558545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8558550","SUP","HCPCS C1713","","8558550  -  SCREW BONE 8.5MM 50MM SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8560302","SUP","HCPCS C1713","","8560302  -  CONCTR ROD 6.35/5.5MM SS INLN","BOTH IP/OP","$2,880.00 ","$2,131.20 ","$0.00 ","$2,880.00 ","$1,296.00 ","$0.00 ","$600.26 ","$0.00 ","$0.00 ","$504.26 ","$2,880.00 ","$0.00 ","$1,440.00 ","$2,280.96 ","$2,304.00 ","$0.00 ","$450.72 ","$0.00 ","$458.50 ","$0.00 "
"8560402","SUP","HCPCS C1713","","8560402  -  CONCTR ROD 6.35/5.5MM SS PRLL","BOTH IP/OP","$2,880.00 ","$2,131.20 ","$0.00 ","$2,880.00 ","$1,296.00 ","$0.00 ","$600.26 ","$0.00 ","$0.00 ","$504.26 ","$2,880.00 ","$0.00 ","$1,440.00 ","$2,280.96 ","$2,304.00 ","$0.00 ","$450.72 ","$0.00 ","$458.50 ","$0.00 "
"8560602","SUP","HCPCS C1713","","8560602  -  CONCTR ROD 6.35/5.5MM SS 4 HOLE","BOTH IP/OP","$3,617.50 ","$2,676.95 ","$0.00 ","$3,617.50 ","$1,627.88 ","$0.00 ","$753.98 ","$0.00 ","$0.00 ","$633.40 ","$3,617.50 ","$0.00 ","$1,808.75 ","$2,865.06 ","$2,894.00 ","$0.00 ","$566.14 ","$0.00 ","$575.91 ","$0.00 "
"8561100","SUP","HCPCS C1713","","8561100  -  SCREW BONE ARMADA SPNL LCK","BOTH IP/OP","$910.00 ","$673.40 ","$0.00 ","$910.00 ","$409.50 ","$0.00 ","$189.67 ","$0.00 ","$0.00 ","$159.33 ","$910.00 ","$0.00 ","$455.00 ","$720.72 ","$728.00 ","$0.00 ","$142.42 ","$0.00 ","$144.87 ","$0.00 "
"8561300","SUP","HCPCS C1713","","8561300  -  CONCTR ROD ROD TO ROD LCK SCR SIDE SPNL","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"8562010","SUP","Custom 27203010","","8562010  -  STIMULATOR NRV STD VRSTIM3 HNDHLD LCTR SUBDERMIS","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8562250","SUP","HCPCS C1713","","8562250  -  ROD SPNL 250MM 6.35MM SS","BOTH IP/OP","$1,860.00 ","$1,376.40 ","$0.00 ","$1,860.00 ","$837.00 ","$0.00 ","$387.67 ","$0.00 ","$0.00 ","$325.67 ","$1,860.00 ","$0.00 ","$930.00 ","$1,473.12 ","$1,488.00 ","$0.00 ","$291.09 ","$0.00 ","$296.11 ","$0.00 "
"8562500","SUP","HCPCS C1713","","8562500  -  ROD SPNL 500MM 6.35MM SS","BOTH IP/OP","$2,017.50 ","$1,492.95 ","$0.00 ","$2,017.50 ","$907.88 ","$0.00 ","$420.50 ","$0.00 ","$0.00 ","$353.25 ","$2,017.50 ","$0.00 ","$1,008.75 ","$1,597.86 ","$1,614.00 ","$0.00 ","$315.74 ","$0.00 ","$321.19 ","$0.00 "
"8564525","SUP","HCPCS C1713","","8564525  -  SCREW BONE 4.5MM 25MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8564530","SUP","HCPCS C1713","","8564530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8564535","SUP","HCPCS C1713","","8564535  -  SCREW BONE 4.5MM 35MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8564540","SUP","HCPCS C1713","","8564540  -  SCREW BONE 4.5MM 40MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8564545","SUP","HCPCS C1713","","8564545  -  SCREW BONE 4.5MM 45MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8565530","SUP","HCPCS C1713","","8565530  -  SCREW BONE 5.5MM 30MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8565535","SUP","HCPCS C1713","","8565535  -  SCREW BONE 5.5MM 35MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8565540","SUP","HCPCS C1713","","8565540  -  SCREW BONE 5.5MM 40MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8565545","SUP","HCPCS C1713","","8565545  -  SCREW BONE 5.5MM 45MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8565550","SUP","HCPCS C1713","","8565550  -  SCREW BONE 5.5MM 50MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8565555","SUP","HCPCS C1713","","8565555  -  SCREW BONE 5.5MM 55MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8566530","SUP","HCPCS C1713","","8566530  -  SCREW BONE 6.5MM 30MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8566535","SUP","HCPCS C1713","","8566535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8566540","SUP","HCPCS C1713","","8566540  -  SCREW BONE 6.5MM 40MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8566545","SUP","HCPCS C1713","","8566545  -  SCREW BONE 6.5MM 45MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8566550","SUP","HCPCS C1713","","8566550  -  SCREW BONE 6.5MM 50MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8566555","SUP","HCPCS C1713","","8566555  -  SCREW BONE 6.5MM 55MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8567535","SUP","HCPCS C1713","","8567535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8567540","SUP","HCPCS C1713","","8567540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8567545","SUP","HCPCS C1713","","8567545  -  SCREW BONE 7.5MM 45MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8567550","SUP","HCPCS C1713","","8567550  -  SCREW BONE 7.5MM 50MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8567555","SUP","HCPCS C1713","","8567555  -  SCREW BONE 7.5MM 55MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8568535","SUP","HCPCS C1713","","8568535  -  SCREW BONE 8.5MM 35MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8568540","SUP","HCPCS C1713","","8568540  -  SCREW BONE 8.5MM 40MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8568545","SUP","HCPCS C1713","","8568545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8568550","SUP","HCPCS C1713","","8568550  -  SCREW BONE 8.5MM 50MM SPNL POLYAX 6.35MM ROD","BOTH IP/OP","$4,607.50 ","$3,409.55 ","$0.00 ","$4,607.50 ","$2,073.38 ","$0.00 ","$960.32 ","$0.00 ","$0.00 ","$806.74 ","$4,607.50 ","$0.00 ","$2,303.75 ","$3,649.14 ","$3,686.00 ","$0.00 ","$721.07 ","$0.00 ","$733.51 ","$0.00 "
"8570611","SUP","HCPCS C1713","","8570611  -  CROSSLINK 8570611 4.5MM DUAL ROD 11MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8570612","SUP","HCPCS C1713","","8570612  -  CROSSLINK 8570612 4.5MM DUAL ROD 12MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8570613","SUP","HCPCS C1713","","8570613  -  CROSSLINK 8570613 4.5MM DUAL ROD 13MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8570614","SUP","HCPCS C1713","","8570614  -  CROSSLINK 8570614 4.5MM DUAL ROD 14MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8570615","SUP","HCPCS C1713","","8570615  -  CROSSLINK 8570615 4.5MM DUAL ROD 15MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8570616","SUP","HCPCS C1713","","8570616  -  CROSSLINK 8570616 4.5MM DUAL ROD 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8570617","SUP","HCPCS C1713","","8570617  -  CROSSLINK 8570617 4.5MM DUAL ROD 17MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8576510","SUP","HCPCS C1713","","8576510  -  SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8576570","SUP","HCPCS C1713","","8576570  -  SCREW BONE 6.5MM 70MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8576580","SUP","HCPCS C1713","","8576580  -  SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8576590","SUP","HCPCS C1713","","8576590  -  SCREW BONE 6.5MM 90MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8577510","SUP","HCPCS C1713","","8577510  -  SCREW BONE 7.5MM 100MM ILC SPNL 6.3MM","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8577570","SUP","HCPCS C1713","","8577570  -  SCREW BONE 7.5MM 70MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8577580","SUP","HCPCS C1713","","8577580  -  SCREW BONE 7.5MM 80MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8577590","SUP","HCPCS C1713","","8577590  -  SCREW BONE 7.5MM 90MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8578510","SUP","HCPCS C1713","","8578510  -  SCREW BONE 8.5MM 100MM ILC SPNL 6.3MM","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8578570","SUP","HCPCS C1713","","8578570  -  SCREW BONE 8.5MM 70MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8578580","SUP","HCPCS C1713","","8578580  -  SCREW BONE 8.5MM 80MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8578590","SUP","HCPCS C1713","","8578590  -  SCREW BONE 8.5MM 90MM ILC SPNL 6.35MM ROD","BOTH IP/OP","$5,602.50 ","$4,145.85 ","$0.00 ","$5,602.50 ","$2,521.13 ","$0.00 ","$1,167.70 ","$0.00 ","$0.00 ","$980.95 ","$5,602.50 ","$0.00 ","$2,801.25 ","$4,437.18 ","$4,482.00 ","$0.00 ","$876.79 ","$0.00 ","$891.92 ","$0.00 "
"8579008","SUP","HCPCS C1713","","8579008  -  CROSSLINK 8579008 4.5 LP .625 16MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579009","SUP","HCPCS C1713","","8579009  -  CROSSLINK 8579009 4.5 LP .750 19MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579010","SUP","HCPCS C1713","","8579010  -  CROSSLINK 8579010 4.5 LP .875 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579011","SUP","HCPCS C1713","","8579011  -  CROSSLINK 8579011 4.5 LP 1.00 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579012","SUP","HCPCS C1713","","8579012  -  CROSSLINK 8579012 4.5 LP 1.12529MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579013","SUP","HCPCS C1713","","8579013  -  CROSSLINK 8579013 4.5 LP 1.25032MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579014","SUP","HCPCS C1713","","8579014  -  CROSSLINK 8579014 4.5 LP 1.37535MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579015","SUP","HCPCS C1713","","8579015  -  CROSSLINK 8579015 4.5 LP 1.50038MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579016","SUP","HCPCS C1713","","8579016  -  CROSSLINK 8579016 4.5 LP 1.55 1.75","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579017","SUP","HCPCS C1713","","8579017  -  CROSSLINK 8579017 4.5 LP 1.75 2.15","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579018","SUP","HCPCS C1713","","8579018  -  CROSSLINK 8579018 4.5 LP 2.15 2.95","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8579300","SUP","Custom 27803010","","8579300  -  CONNECTOR 8579300 4.5 TO 4.5MM DOMINO","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8579301","SUP","Custom 27803010","","8579301  -  CONNECTOR 8579301 4.5 TO 5.5MM DOMINO","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8580858","SUP","HCPCS C1713","","8580858  -  SET SCREW, BREAK-OFF, M8, SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8590855","SUP","HCPCS C1713","","8590855  -  SCREW SET TI 55MM SPNL BRKOF CLOSE HZNM8 5.5MM ROD","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8590858","SUP","HCPCS C1713","","8590858  -  SET SCREW, BREAK-OFF, M8, TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8594520","SUP","HCPCS C1713","","8594520  -  SCREW BN 4.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8594522","SUP","HCPCS C1713","","8594522  -  SCREW BN 4.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8594525","SUP","HCPCS C1713","","8594525  -  SCREW BONE 4.5MM 25MM POLYAX BRIGADE SPN","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8594527","SUP","HCPCS C1713","","8594527  -  SCREW BN 4.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8594530","SUP","HCPCS C1713","","8594530  -  SCREW BN 4.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8594535","SUP","HCPCS C1713","","8594535  -  SCREW BN 4.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8595520","SUP","HCPCS C1713","","8595520  -  SCREW BN 5.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8595522","SUP","HCPCS C1713","","8595522  -  SCREW BN 5.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8595525","SUP","HCPCS C1713","","8595525  -  SCREW BN 5.5MM 25MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8595527","SUP","HCPCS C1713","","8595527  -  SCREW BN 5.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8595530","SUP","HCPCS C1713","","8595530  -  SCREW BN 5.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8595535","SUP","HCPCS C1713","","8595535  -  SCREW BN 5.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"8610425","SUP","HCPCS C1713","","8610425  -  SCREW 8610425 CLRD 4.5MMX25MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610430","SUP","HCPCS C1713","","8610430  -  SCREW 8610430 CLRD 4.5MMX30MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610435","SUP","HCPCS C1713","","8610435  -  SCREW 8610435 CLRD 4.5MMX35MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610440","SUP","HCPCS C1713","","8610440  -  SCREW 8610440 CLRD 4.5MMX40MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610445","SUP","HCPCS C1713","","8610445  -  SCREW 8610445 CLRD  4.5MMX45MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610525","SUP","HCPCS C1713","","8610525  -  SCREW 8610525 CLRD 5.5MMX25MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610530","SUP","HCPCS C1713","","8610530  -  SCREW 8610530 CLRD 5.5MMX30MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610535","SUP","HCPCS C1713","","8610535  -  SCREW 8610535 CLRD 5.5MMX35MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610540","SUP","HCPCS C1713","","8610540  -  SCREW 8610540 CLRD 5.5MMX40MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610545","SUP","HCPCS C1713","","8610545  -  SCREW 8610545 CLRD 5.5MMX45MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610550","SUP","HCPCS C1713","","8610550  -  SCREW 8610550 CLRD 5.5MMX50MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610555","SUP","HCPCS C1713","","8610555  -  SCREW 8610555 CLRD 5.5MMX55MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610630","SUP","HCPCS C1713","","8610630  -  SCREW 8610630 CLRD 6.5MMX30MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610635","SUP","HCPCS C1713","","8610635  -  SCREW 8610635 CLRD 6.5MMX35MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610640","SUP","HCPCS C1713","","8610640  -  SCREW 8610640 CLRD 6.5MMX40MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610645","SUP","HCPCS C1713","","8610645  -  SCREW 8610645 CLRD 6.5MMX45MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610650","SUP","HCPCS C1713","","8610650  -  SCREW 8610650 CLRD 6.5MMX50MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610655","SUP","HCPCS C1713","","8610655  -  SCREW 8610655 CLRD 6.5MMX55MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610735","SUP","HCPCS C1713","","8610735  -  SCREW 8610735 CLRD 7.5MMX35MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610740","SUP","HCPCS C1713","","8610740  -  SCREW 8610740 CLRD 7.5MMX40MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610745","SUP","HCPCS C1713","","8610745  -  SCREW 8610745 CLRD 7.5MMX45MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8610750","SUP","HCPCS C1713","","8610750  -  SCREW 8610750 CLRD 7.5MMX50MM","BOTH IP/OP","$2,517.00 ","$1,862.58 ","$0.00 ","$2,517.00 ","$1,132.65 ","$0.00 ","$524.61 ","$0.00 ","$0.00 ","$440.71 ","$2,517.00 ","$0.00 ","$1,258.50 ","$1,993.46 ","$2,013.60 ","$0.00 ","$393.91 ","$0.00 ","$400.71 ","$0.00 "
"8611102","SUP","HCPCS C1713","","8611102  -  HOOK 8611102 PEDICULAR SM GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8611104","SUP","HCPCS C1713","","8611104  -  HOOK 8611104 PEDICULAR LG GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8611202","SUP","HCPCS C1713","","8611202  -  HOOK 8611202 LAMINAR SM GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8611203","SUP","HCPCS C1713","","8611203  -  HOOK 8611203 LAM MEDIUM GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8611204","SUP","HCPCS C1713","","8611204  -  HOOK 8611204 LAMINAR LG GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8611300","SUP","HCPCS C1713","","8611300  -  STAPLE 8611300 PEDICULAR HK","BOTH IP/OP","$873.00 ","$646.02 ","$0.00 ","$873.00 ","$392.85 ","$0.00 ","$181.96 ","$0.00 ","$0.00 ","$152.86 ","$873.00 ","$0.00 ","$436.50 ","$691.42 ","$698.40 ","$0.00 ","$136.62 ","$0.00 ","$138.98 ","$0.00 "
"8611402","SUP","HCPCS C1713","","8611402  -  HOOK 8611402 CLOSED LAM THOR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8612055","SUP","HCPCS C1713","","8612055  -  SCREW 8612055 CLRD ILIO SCARAL 7.0X55MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612060","SUP","HCPCS C1713","","8612060  -  SCREW 8612060 CLRD ILIO SCARAL 7.0X60MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612065","SUP","HCPCS C1713","","8612065  -  SCREW 8612065 CLRD ILIO SCARAL 7.0X65MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612070","SUP","HCPCS C1713","","8612070  -  SCREW 8612070 CLRD ILIO SCARAL 7.0X70MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612075","SUP","HCPCS C1713","","8612075  -  SCREW 8612075 CLRD ILIO SCARAL 7.0X75MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612080","SUP","HCPCS C1713","","8612080  -  SCREW 8612080 CLRD ILIO SCARAL 7.0X80MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612230","SUP","HCPCS C1713","","8612230  -  SCREW 8612230 CLRD SACRAL 6.5X30MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612235","SUP","HCPCS C1713","","8612235  -  SCREW 8612235 CLRD SACRAL 6.5X35MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612240","SUP","HCPCS C1713","","8612240  -  SCREW 8612240 CLRD SACRAL 6.5X40MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612245","SUP","HCPCS C1713","","8612245  -  SCREW 8612245 CLRD SACRAL 6.5X45MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612250","SUP","HCPCS C1713","","8612250  -  SCREW 8612250 CLRD SACRAL 6.5X50MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612255","SUP","HCPCS C1713","","8612255  -  SCREW 8612255 CLRD SACRAL 6.5X55MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612260","SUP","HCPCS C1713","","8612260  -  SCREW 8612260 CLRD SACRAL 6.5X60MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612265","SUP","HCPCS C1713","","8612265  -  SCREW 8612265 CLRD SACRAL 6.5X65MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8612270","SUP","HCPCS C1713","","8612270  -  SCREW 8612270 CLRD SACRAL 6.5X70MM","BOTH IP/OP","$1,594.50 ","$1,179.93 ","$0.00 ","$1,594.50 ","$717.53 ","$0.00 ","$332.33 ","$0.00 ","$0.00 ","$279.18 ","$1,594.50 ","$0.00 ","$797.25 ","$1,262.84 ","$1,275.60 ","$0.00 ","$249.54 ","$0.00 ","$253.84 ","$0.00 "
"8613505","SUP","HCPCS C1713","","8613505  -  ROD 8613505 CLRD 5.0X50MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613506","SUP","HCPCS C1713","","8613506  -  ROD 8613506 CLRD 5.0X60MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613507","SUP","HCPCS C1713","","8613507  -  ROD 8613507 CLRD 5.0X70MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613508","SUP","HCPCS C1713","","8613508  -  ROD 8613508 CLRD 5.0X80MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613509","SUP","HCPCS C1713","","8613509  -  ROD 8613509 CLRD 5.0X90MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613510","SUP","HCPCS C1713","","8613510  -  ROD 8613510 CLRD 5.0X100MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613511","SUP","HCPCS C1713","","8613511  -  ROD 8613511 CLRD 5.0X110MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613512","SUP","HCPCS C1713","","8613512  -  ROD 8613512 CLRD 5.0X120MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613514","SUP","HCPCS C1713","","8613514  -  ROD 8613514 CLRD 5.0X140MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613516","SUP","HCPCS C1713","","8613516  -  ROD 8613516 CLRD 5.0X160MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613518","SUP","HCPCS C1713","","8613518  -  ROD 8613518 CLRD 5.0X180MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613520","SUP","HCPCS C1713","","8613520  -  ROD 8613520 CLRD 5.0X200MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613522","SUP","HCPCS C1713","","8613522  -  ROD 8613522 CLRD 5.0X220MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613524","SUP","HCPCS C1713","","8613524  -  ROD 8613524 CLRD 5.0X240MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613526","SUP","HCPCS C1713","","8613526  -  ROD 8613526 CLRD 5.0X260MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613528","SUP","HCPCS C1713","","8613528  -  ROD 8613528 CLRD 5.0X280MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613530","SUP","HCPCS C1713","","8613530  -  ROD 8613530 CLRD 5.0X300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613532","SUP","HCPCS C1713","","8613532  -  ROD 8613532 CLRD 5.0X320MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613534","SUP","HCPCS C1713","","8613534  -  ROD 8613534 CLRD 5.0X340MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613536","SUP","HCPCS C1713","","8613536  -  ROD 8613536 CLRD 5.0X360MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613538","SUP","HCPCS C1713","","8613538  -  ROD 8613538 CLRD 5.0X380MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613544","SUP","HCPCS C1713","","8613544  -  ROD 8613544 CLRD 5.0X440MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8613560","SUP","HCPCS C1713","","8613560  -  ROD 8613560 CLRD 5MM X 600MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8614100","SUP","Custom 27803010","","8614100  -  CONNECTOR 8614100 CLAMP FOR 5MM ROD","BOTH IP/OP","$1,255.50 ","$929.07 ","$0.00 ","$1,255.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,255.50 ","$0.00 ","$627.75 ","$994.36 ","$1,004.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8614110","SUP","Custom 27803010","","8614110  -  CONNECTOR 8614110 SACRAL ILIO PLATE","BOTH IP/OP","$1,710.00 ","$1,265.40 ","$0.00 ","$1,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,710.00 ","$0.00 ","$855.00 ","$1,354.32 ","$1,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8614111","SUP","HCPCS C1713","","8614111  -  SCREW 8614111  BREAK OFF NUT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8614120","SUP","HCPCS C1713","","8614120  -  SCREW 8614120  BREAK OFF SET  XLINK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8614200","SUP","Custom 27803010","","8614200  -  CONNECTOR 8614200 OFFSET","BOTH IP/OP","$1,870.50 ","$1,384.17 ","$0.00 ","$1,870.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,870.50 ","$0.00 ","$935.25 ","$1,481.44 ","$1,496.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8615400","SUP","Custom 27803010","","8615400  -  CONNECTOR 8615400 5MM X 5MM AXIAL","BOTH IP/OP","$2,631.50 ","$1,947.31 ","$0.00 ","$2,631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,631.50 ","$0.00 ","$1,315.75 ","$2,084.15 ","$2,105.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8615405","SUP","HCPCS C1713","","8615405  -  SCREW 8615405  BK OFF  AXIALLAT CLSD HK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8615410","SUP","Custom 27803010","","8615410  -  CONNECTOR 8615410 5MM X 5MM LATERAL","BOTH IP/OP","$2,631.50 ","$1,947.31 ","$0.00 ","$2,631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,631.50 ","$0.00 ","$1,315.75 ","$2,084.15 ","$2,105.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8615420","SUP","Custom 27803010","","8615420  -  CONNECTOR 8615420 5MM X 5.5MM AXIAL","BOTH IP/OP","$2,833.50 ","$2,096.79 ","$0.00 ","$2,833.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,833.50 ","$0.00 ","$1,416.75 ","$2,244.13 ","$2,266.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8615440","SUP","Custom 27803010","","8615440  -  CONNECTOR 8615440 5MM X 7MM AXIAL","BOTH IP/OP","$2,631.50 ","$1,947.31 ","$0.00 ","$2,631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,631.50 ","$0.00 ","$1,315.75 ","$2,084.15 ","$2,105.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8616100","SUP","Custom 27203010","","BLADE LRNSCP 1 MLLR IMRSB REUSE","BOTH IP/OP","$60.80 ","$44.99 ","$0.00 ","$60.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.80 ","$0.00 ","$30.40 ","$48.15 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8619110","SUP","HCPCS C1713","","8619110  -  PLATE 8619110 RIGHT SACRAL","BOTH IP/OP","$3,873.00 ","$2,866.02 ","$0.00 ","$3,873.00 ","$1,742.85 ","$0.00 ","$807.23 ","$0.00 ","$0.00 ","$678.13 ","$3,873.00 ","$0.00 ","$1,936.50 ","$3,067.42 ","$3,098.40 ","$0.00 ","$606.12 ","$0.00 ","$616.58 ","$0.00 "
"8619120","SUP","HCPCS C1713","","8619120  -  PLATE 8619120 LEFT SACRAL","BOTH IP/OP","$3,873.00 ","$2,866.02 ","$0.00 ","$3,873.00 ","$1,742.85 ","$0.00 ","$807.23 ","$0.00 ","$0.00 ","$678.13 ","$3,873.00 ","$0.00 ","$1,936.50 ","$3,067.42 ","$3,098.40 ","$0.00 ","$606.12 ","$0.00 ","$616.58 ","$0.00 "
"8619210","SUP","HCPCS C1713","","8619210  -  PLATE 8619210 RIGHT ILLIO SACRAL","BOTH IP/OP","$4,800.00 ","$3,552.00 ","$0.00 ","$4,800.00 ","$2,160.00 ","$0.00 ","$1,000.44 ","$0.00 ","$0.00 ","$840.44 ","$4,800.00 ","$0.00 ","$2,400.00 ","$3,801.60 ","$3,840.00 ","$0.00 ","$751.20 ","$0.00 ","$764.16 ","$0.00 "
"8619220","SUP","HCPCS C1713","","8619220  -  PLATE 8619220 LEFT ILLIO SACRAL","BOTH IP/OP","$4,800.00 ","$3,552.00 ","$0.00 ","$4,800.00 ","$2,160.00 ","$0.00 ","$1,000.44 ","$0.00 ","$0.00 ","$840.44 ","$4,800.00 ","$0.00 ","$2,400.00 ","$3,801.60 ","$3,840.00 ","$0.00 ","$751.20 ","$0.00 ","$764.16 ","$0.00 "
"8619300","SUP","HCPCS C1713","","8619300  -  SCREW 8619300  SET  SAC LLIO SAC PLATE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8619400","SUP","HCPCS C1713","","8619400  -  STAPLE 8619400 ANTERIOR","BOTH IP/OP","$873.00 ","$646.02 ","$0.00 ","$873.00 ","$392.85 ","$0.00 ","$181.96 ","$0.00 ","$0.00 ","$152.86 ","$873.00 ","$0.00 ","$436.50 ","$691.42 ","$698.40 ","$0.00 ","$136.62 ","$0.00 ","$138.98 ","$0.00 "
"8619654","SUP","HCPCS C1713","","8619654  -  PLATE 8619654 INTERPEDICULAR 54MM","BOTH IP/OP","$2,187.00 ","$1,618.38 ","$0.00 ","$2,187.00 ","$984.15 ","$0.00 ","$455.83 ","$0.00 ","$0.00 ","$382.93 ","$2,187.00 ","$0.00 ","$1,093.50 ","$1,732.10 ","$1,749.60 ","$0.00 ","$342.27 ","$0.00 ","$348.17 ","$0.00 "
"8624110","SUP","Custom 27803010","","8624110  -  CONNECTOR 8624110 5.5MM ILIO SAC PLT","BOTH IP/OP","$1,710.00 ","$1,265.40 ","$0.00 ","$1,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,710.00 ","$0.00 ","$855.00 ","$1,354.32 ","$1,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8630540","SUP","HCPCS C1713","","8630540  -  SCREW 8630540 CLRD 5.5MMX40MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8630550","SUP","HCPCS C1713","","8630550  -  SCREW 8630550 CLRD 5.5MMX50MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8630645","SUP","HCPCS C1713","","8630645  -  SCREW 8630645 CLRD 6.5MMX45MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8630650","SUP","HCPCS C1713","","8630650  -  SCREW 8630650 CLRD 6.5MMX50MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8631203","SUP","HCPCS C1713","","8631203  -  HOOK 8631203 MEDIUM LAMINAR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8631300","SUP","HCPCS C1713","","8631300  -  STAPLE 8631300","BOTH IP/OP","$988.50 ","$731.49 ","$0.00 ","$988.50 ","$444.83 ","$0.00 ","$206.03 ","$0.00 ","$0.00 ","$173.08 ","$988.50 ","$0.00 ","$494.25 ","$782.89 ","$790.80 ","$0.00 ","$154.70 ","$0.00 ","$157.37 ","$0.00 "
"8631402","SUP","HCPCS C1713","","8631402  -  HOOK 8631402 CLOSED LAMINAR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8632050","SUP","HCPCS C1713","","8632050  -  SCREW 8632050 CLRD ILIO SACRAL 7.0X50MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632055","SUP","HCPCS C1713","","8632055  -  SCREW 8632055 CLRD ILIO SACRAL 7.0X55MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632060","SUP","HCPCS C1713","","8632060  -  SCREW 8632060 CLRD ILIO SACRAL 7.0X60MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632065","SUP","HCPCS C1713","","8632065  -  SCREW 8632065 CLRD ILIO SACRAL 7.0X65MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632070","SUP","HCPCS C1713","","8632070  -  SCREW 8632070 CLRD ILIO SACRAL 7.0X70MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632075","SUP","HCPCS C1713","","8632075  -  SCREW 8632075 CLRD ILIO SACRAL 7.0X75MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632080","SUP","HCPCS C1713","","8632080  -  SCREW 8632080 CLRD ILIO SACRAL 7.0X80MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632230","SUP","HCPCS C1713","","8632230  -  SCREW 8632230 CLRD SACRAL 6.5X30MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632235","SUP","HCPCS C1713","","8632235  -  SCREW 8632235 CLRD SACRAL 6.5X35MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632240","SUP","HCPCS C1713","","8632240  -  SCREW 8632240 CLRD SACRAL 6.5X40MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632245","SUP","HCPCS C1713","","8632245  -  SCREW 8632245 CLRD SACRAL 6.5X45MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632250","SUP","HCPCS C1713","","8632250  -  SCREW 8632250 CLRD SACRAL 6.5X50MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632255","SUP","HCPCS C1713","","8632255  -  SCREW 8632255 CLRD SACRAL 6.5X55MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632260","SUP","HCPCS C1713","","8632260  -  SCREW 8632260 CLRD SACRAL 6.5X60MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632265","SUP","HCPCS C1713","","8632265  -  SCREW 8632265 CLRD SACRAL 6.5X65MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632270","SUP","HCPCS C1713","","8632270  -  SCREW 8632270 CLRD SACRAL 6.5X70MM","BOTH IP/OP","$1,821.23 ","$1,347.71 ","$0.00 ","$1,821.23 ","$819.55 ","$0.00 ","$379.59 ","$0.00 ","$0.00 ","$318.88 ","$1,821.23 ","$0.00 ","$910.61 ","$1,442.41 ","$1,456.98 ","$0.00 ","$285.02 ","$0.00 ","$289.94 ","$0.00 "
"8632330","SUP","HCPCS C1713","","8632330  -  SCREW 8632330 CLRD SACRAL 7.0X30MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632335","SUP","HCPCS C1713","","8632335  -  SCREW 8632335 CLRD SACRAL 7.0X35MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632340","SUP","HCPCS C1713","","8632340  -  SCREW 8632340 CLRD SACRAL 7.0X40MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632345","SUP","HCPCS C1713","","8632345  -  SCREW 8632345 CLRD SACRAL 7.0X45MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632350","SUP","HCPCS C1713","","8632350  -  SCREW 8632350 CLRD SACRAL 7.0X50MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632355","SUP","HCPCS C1713","","8632355  -  SCREW 8632355 CLRD SACRAL 7.0X55MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632360","SUP","HCPCS C1713","","8632360  -  SCREW 8632360 CLRD SACRAL 7.0X60MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632365","SUP","HCPCS C1713","","8632365  -  SCREW 8632365 CLRD SACRAL 7.0X65MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8632370","SUP","HCPCS C1713","","8632370  -  SCREW 8632370 CLRD SACRAL 7.0X70MM","BOTH IP/OP","$1,811.63 ","$1,340.61 ","$0.00 ","$1,811.63 ","$815.23 ","$0.00 ","$377.59 ","$0.00 ","$0.00 ","$317.20 ","$1,811.63 ","$0.00 ","$905.81 ","$1,434.81 ","$1,449.30 ","$0.00 ","$283.52 ","$0.00 ","$288.41 ","$0.00 "
"8634100","SUP","Custom 27803010","","8634100  -  CONNECTOR 8634100 CLAMP FOR 5MM ROD","BOTH IP/OP","$1,453.50 ","$1,075.59 ","$0.00 ","$1,453.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,453.50 ","$0.00 ","$726.75 ","$1,151.17 ","$1,162.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8634110","SUP","Custom 27803010","","8634110  -  CONNECTOR 8634110 SACRAL ILIO PLATE","BOTH IP/OP","$1,935.50 ","$1,432.27 ","$0.00 ","$1,935.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,935.50 ","$0.00 ","$967.75 ","$1,532.92 ","$1,548.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8634111","SUP","HCPCS C1713","","8634111  -  SCREW 8634111  BREAK OFF NUT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8634200","SUP","Custom 27803010","","8634200  -  CONNECTOR 8634200 OFFSET CLAMP","BOTH IP/OP","$1,935.50 ","$1,432.27 ","$0.00 ","$1,935.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,935.50 ","$0.00 ","$967.75 ","$1,532.92 ","$1,548.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8635400","SUP","Custom 27803010","","8635400  -  CONNECTOR 8635400 5.5X5.5 LAT CLOSE CLMP","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8635405","SUP","HCPCS C1713","","8635405  -  SCREW 8635405  BREAK OFF LOCKING","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8635430","SUP","Custom 27803010","","8635430  -  CONNECTOR 8635430 LATERAL CLOSED","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8638102","SUP","HCPCS C1713","","8638102  -  HOOK 8638102 PED SMALL GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8638104","SUP","HCPCS C1713","","8638104  -  HOOK 8638104 PED LARGE GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8638110","SUP","HCPCS C1713","","8638110  -  PLATE 8638110 RIGHT SACRAL","BOTH IP/OP","$3,873.00 ","$2,866.02 ","$0.00 ","$3,873.00 ","$1,742.85 ","$0.00 ","$807.23 ","$0.00 ","$0.00 ","$678.13 ","$3,873.00 ","$0.00 ","$1,936.50 ","$3,067.42 ","$3,098.40 ","$0.00 ","$606.12 ","$0.00 ","$616.58 ","$0.00 "
"8638120","SUP","HCPCS C1713","","8638120  -  PLATE 8638120 LEFT SACRAL","BOTH IP/OP","$3,873.00 ","$2,866.02 ","$0.00 ","$3,873.00 ","$1,742.85 ","$0.00 ","$807.23 ","$0.00 ","$0.00 ","$678.13 ","$3,873.00 ","$0.00 ","$1,936.50 ","$3,067.42 ","$3,098.40 ","$0.00 ","$606.12 ","$0.00 ","$616.58 ","$0.00 "
"8638203","SUP","HCPCS C1713","","8638203  -  HOOK 8638203 LAM MEDIUM GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8638210","SUP","HCPCS C1713","","8638210  -  PLATE 8638210 RIGHT LLIO SACRAL","BOTH IP/OP","$4,938.00 ","$3,654.12 ","$0.00 ","$4,938.00 ","$2,222.10 ","$0.00 ","$1,029.20 ","$0.00 ","$0.00 ","$864.60 ","$4,938.00 ","$0.00 ","$2,469.00 ","$3,910.90 ","$3,950.40 ","$0.00 ","$772.80 ","$0.00 ","$786.13 ","$0.00 "
"8638220","SUP","HCPCS C1713","","8638220  -  PLATE 8638220 LEFT ILIO SACRAL","BOTH IP/OP","$4,938.00 ","$3,654.12 ","$0.00 ","$4,938.00 ","$2,222.10 ","$0.00 ","$1,029.20 ","$0.00 ","$0.00 ","$864.60 ","$4,938.00 ","$0.00 ","$2,469.00 ","$3,910.90 ","$3,950.40 ","$0.00 ","$772.80 ","$0.00 ","$786.13 ","$0.00 "
"8638425","SUP","HCPCS C1713","","8638425  -  SCREW 8638425 PED D4.5MM L25MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638430","SUP","HCPCS C1713","","8638430  -  SCREW 8638430 CLRD PED 4.5X30MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638435","SUP","HCPCS C1713","","8638435  -  SCREW 8638435 CLRD PED 4.5X35MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638440","SUP","HCPCS C1713","","8638440  -  BONE SCREW 8638440 PED D4.5MM L40MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638445","SUP","HCPCS C1713","","8638445  -  SCREW 8638445 CLRD PED 4.5X45MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638525","SUP","HCPCS C1713","","8638525  -  SCREW 8638525 CLRD PED 5.5X25MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638530","SUP","HCPCS C1713","","8638530  -  SCREW 8638530 CLRD PED 5.5X30MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638535","SUP","HCPCS C1713","","8638535  -  SCREW 8638535 CLRD PED 5.5X35MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638540","SUP","HCPCS C1713","","8638540  -  SCREW 8638540 CLRD PED 5.5X40MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638545","SUP","HCPCS C1713","","8638545  -  SCREW 8638545 CLRD PED 5.5X45MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638550","SUP","HCPCS C1713","","8638550  -  SCREW 8638550 CLRD PED 5.5X50MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638555","SUP","HCPCS C1713","","8638555  -  SCREW 8638555 CLRD PED 5.5X55MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638625","SUP","HCPCS C1713","","8638625  -  SCREW 8638625 PED D6.5MM L25MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638630","SUP","HCPCS C1713","","8638630  -  SCREW 8638630 CLRD PED 6.5X30MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638635","SUP","HCPCS C1713","","8638635  -  SCREW BN 6.5MM 35MM CO2 SPNE PDCL","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638640","SUP","HCPCS C1713","","8638640  -  SCREW BN 6.5MM 35MM CO2 SPNE PDCL","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638645","SUP","HCPCS C1713","","8638645  -  SCREW 8638645 CLRD PED 6.5X45MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638650","SUP","HCPCS C1713","","8638650  -  SCREW 8638650 CLRD PED 6.5X50MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638655","SUP","HCPCS C1713","","8638655  -  SCREW 8638655 CLRD PED 6.5X55MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638660","SUP","HCPCS C1713","","8638660  -  SCREW 8638660 PED D6.5MM L60MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638665","SUP","HCPCS C1713","","8638665  -  SCREW 8638665 PED D6.5MM L65MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638725","SUP","HCPCS C1713","","8638725  -  SCREW 8638725 PED D7.5MM L25MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638730","SUP","HCPCS C1713","","8638730  -  BONE SCREW 8638730 PED D7.5MM L30MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638735","SUP","HCPCS C1713","","8638735  -  SCREW 8638735 CLRD PED 7.5X35MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638740","SUP","HCPCS C1713","","8638740  -  SCREW 8638740 CLRD PED 7.5X40MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638745","SUP","HCPCS C1713","","8638745  -  SCREW 8638745 CLRD PED 7.5X45MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638750","SUP","HCPCS C1713","","8638750  -  SCREW 8638750 CLRD PED 7.5X50MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638755","SUP","HCPCS C1713","","8638755  -  BONE SCREW 8638755 PED SCRW D7.5MM L55MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638760","SUP","HCPCS C1713","","8638760  -  SCREW 8638760 PED D7.5MM L60MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8638765","SUP","HCPCS C1713","","8638765  -  SCREW 8638765 PED D7.5MM L65MM","BOTH IP/OP","$2,818.50 ","$2,085.69 ","$0.00 ","$2,818.50 ","$1,268.33 ","$0.00 ","$587.45 ","$0.00 ","$0.00 ","$493.50 ","$2,818.50 ","$0.00 ","$1,409.25 ","$2,232.25 ","$2,254.80 ","$0.00 ","$441.10 ","$0.00 ","$448.71 ","$0.00 "
"8639300","SUP","HCPCS C1713","","8639300  -  SCREW 8639300  L AND ILIO L  SET","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8639400","SUP","HCPCS C1713","","8639400  -  STAPLE 8639400  ANTERIOR","BOTH IP/OP","$988.50 ","$731.49 ","$0.00 ","$988.50 ","$444.83 ","$0.00 ","$206.03 ","$0.00 ","$0.00 ","$173.08 ","$988.50 ","$0.00 ","$494.25 ","$782.89 ","$790.80 ","$0.00 ","$154.70 ","$0.00 ","$157.37 ","$0.00 "
"8644525","SUP","HCPCS C1713","","8644525  -  SCREW BN 4.5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8644530","SUP","HCPCS C1713","","8644530  -  SCREW BN 4.5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8644535","SUP","HCPCS C1713","","8644535  -  SCREW BN 4.5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8644540","SUP","HCPCS C1713","","8644540  -  SCREW BN 4.5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8644545","SUP","HCPCS C1713","","8644545  -  SCREW BN 4.5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8645025","SUP","HCPCS C1713","","8645025  -  SCREW BN 5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8645030","SUP","HCPCS C1713","","8645030  -  SCREW BN 5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8645035","SUP","HCPCS C1713","","8645035  -  SCREW BN 5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8645040","SUP","HCPCS C1713","","8645040  -  SCREW BN 5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8645045","SUP","HCPCS C1713","","8645045  -  SCREW BN 5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8645050","SUP","HCPCS C1713","","8645050  -  SCREW BN 6MM 55MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8646030","SUP","HCPCS C1713","","8646030  -  SCREW BN 5MM 50MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8646035","SUP","HCPCS C1713","","8646035  -  SCREW BN 6MM 30MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8646040","SUP","HCPCS C1713","","8646040  -  SCREW BN 6MM 35MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8646045","SUP","HCPCS C1713","","8646045  -  SCREW BN 6MM 40MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8646050","SUP","HCPCS C1713","","8646050  -  SCREW BN 6MM 45MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8646055","SUP","HCPCS C1713","","8646055  -  SCREW BN 6MM 50MM UNIPLANAR TI SPNE 5.5MM ROD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"8650520","SUP","HCPCS C1713","","8650520  -  CONCTR ROD 20MM 5.5MM OFFST TI SPNL","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,655.00 ","$744.75 ","$0.00 ","$344.94 ","$0.00 ","$0.00 ","$289.78 ","$1,655.00 ","$0.00 ","$827.50 ","$1,310.76 ","$1,324.00 ","$0.00 ","$259.01 ","$0.00 ","$263.48 ","$0.00 "
"8650530","SUP","HCPCS C1713","","8650530  -  CONCTR ROD 30MM 4.5MM OFFST TI","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,655.00 ","$744.75 ","$0.00 ","$344.94 ","$0.00 ","$0.00 ","$289.78 ","$1,655.00 ","$0.00 ","$827.50 ","$1,310.76 ","$1,324.00 ","$0.00 ","$259.01 ","$0.00 ","$263.48 ","$0.00 "
"8650560","SUP","HCPCS C1713","","8650560  -  CONCTR ROD 60MM 4.5MM OFFST TI","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,655.00 ","$744.75 ","$0.00 ","$344.94 ","$0.00 ","$0.00 ","$289.78 ","$1,655.00 ","$0.00 ","$827.50 ","$1,310.76 ","$1,324.00 ","$0.00 ","$259.01 ","$0.00 ","$263.48 ","$0.00 "
"8651520","SUP","HCPCS C1713","","8651520  -  CONCTR ROD 5.5MM OFFST CLOSE TI","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,655.00 ","$744.75 ","$0.00 ","$344.94 ","$0.00 ","$0.00 ","$289.78 ","$1,655.00 ","$0.00 ","$827.50 ","$1,310.76 ","$1,324.00 ","$0.00 ","$259.01 ","$0.00 ","$263.48 ","$0.00 "
"8651530","SUP","HCPCS C1713","","8651530  -  CONCTR ROD 5.5MM OFFST CLOSE TI","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,655.00 ","$744.75 ","$0.00 ","$344.94 ","$0.00 ","$0.00 ","$289.78 ","$1,655.00 ","$0.00 ","$827.50 ","$1,310.76 ","$1,324.00 ","$0.00 ","$259.01 ","$0.00 ","$263.48 ","$0.00 "
"8651560","SUP","HCPCS C1713","","8651560  -  CONCTR ROD 5.5MM OFFST CLOSE TI","BOTH IP/OP","$1,655.00 ","$1,224.70 ","$0.00 ","$1,655.00 ","$744.75 ","$0.00 ","$344.94 ","$0.00 ","$0.00 ","$289.78 ","$1,655.00 ","$0.00 ","$827.50 ","$1,310.76 ","$1,324.00 ","$0.00 ","$259.01 ","$0.00 ","$263.48 ","$0.00 "
"8664110","SUP","Custom 27803010","","8664110  -  CONNECTOR 8664110 6.35MM SACRAL SS","BOTH IP/OP","$1,710.00 ","$1,265.40 ","$0.00 ","$1,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,710.00 ","$0.00 ","$855.00 ","$1,354.32 ","$1,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8664111","SUP","HCPCS C1713","","8664111  -  SET SCREW 8664111 FOR 6.35MM CONN SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8670001","SUP","HCPCS C1769","","8670001  -  GUIDEWIRE ORTHOPEDIC BLUNT INSTR SEXTANT TITANIUM SPN","BOTH IP/OP","$151.50 ","$112.11 ","$0.00 ","$151.50 ","$82.26 ","$0.00 ","$31.58 ","$0.00 ","$0.00 ","$26.53 ","$151.50 ","$0.00 ","$75.75 ","$119.99 ","$121.20 ","$0.00 ","$23.71 ","$0.00 ","$24.12 ","$0.00 "
"8670002","SUP","HCPCS C1769","","8670002  -  GUIDEWIRE ORTHOPEDIC SHARP CD HORIZON TITANIUM SPN","BOTH IP/OP","$151.50 ","$112.11 ","$0.00 ","$151.50 ","$82.26 ","$0.00 ","$31.58 ","$0.00 ","$0.00 ","$26.53 ","$151.50 ","$0.00 ","$75.75 ","$119.99 ","$121.20 ","$0.00 ","$23.71 ","$0.00 ","$24.12 ","$0.00 "
"8672030","SUP","HCPCS C1713","","8672030  -  ROD SPNL STD PREBNT CNTR 5.5MM 30MM SXTNT CD HZN TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672035","SUP","HCPCS C1713","","8672035  -  ROD SPNL PREBNT 5.5MM 35MM SXTNT CD HZN TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672040","SUP","HCPCS C1713","","8672040  -  ROD SPNL STD CNTR PREBNT 5.5MM 40MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672045","SUP","HCPCS C1713","","8672045  -  ROD SPNL STD CNTR PREBNT 5.5MM 45MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672050","SUP","HCPCS C1713","","8672050  -  ROD SPNL STD CNTR PREBNT 5.5MM 50MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672055","SUP","HCPCS C1713","","8672055  -  ROD SPNL STD PREBNT PCUT CNTR 5.5MM 55MM SXTNT CD HZN TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672060","SUP","HCPCS C1713","","8672060  -  ROD SPNL STD CNTR PREBNT 5.5MM 60MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672065","SUP","HCPCS C1713","","8672065  -  ROD SPNL STD CNTR PREBNT 5.5MM 65MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672070","SUP","HCPCS C1713","","8672070  -  ROD SPNL STD CNTR PREBNT 5.5MM 70MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672075","SUP","HCPCS C1713","","8672075  -  ROD SPNL STD CNTR PREBNT 5.5MM 75MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672080","SUP","HCPCS C1713","","8672080  -  ROD SPNL STD CNTR PREBNT 5.5MM 80MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672085","SUP","HCPCS C1713","","8672085  -  ROD SPNL STD PREBNT PCUT CNTR 5.5MM 85MM SXTNT CD HZN TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672090","SUP","HCPCS C1713","","8672090  -  ROD SPNL STD PREBNT CNTR 5.5MM 90MM SXTNT CD HZN TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672095","SUP","HCPCS C1713","","8672095  -  ROD SPNL STD CNTR PREBNT 5.5MM 95MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8672100","SUP","HCPCS C1713","","8672100  -  ROD SPNL STD CNTR PREBNT 5.5MM 100MM CD HZN SXTNT PCUT TI","BOTH IP/OP","$2,072.50 ","$1,533.65 ","$0.00 ","$2,072.50 ","$932.63 ","$0.00 ","$431.96 ","$0.00 ","$0.00 ","$362.88 ","$2,072.50 ","$0.00 ","$1,036.25 ","$1,641.42 ","$1,658.00 ","$0.00 ","$324.35 ","$0.00 ","$329.94 ","$0.00 "
"8674110","SUP","Custom 27803010","","8674110  -  CONNECTOR 8674110 6.35MM SACRAL TI","BOTH IP/OP","$1,935.50 ","$1,432.27 ","$0.00 ","$1,935.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,935.50 ","$0.00 ","$967.75 ","$1,532.92 ","$1,548.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8674111","SUP","HCPCS C1713","","8674111  -  SCREW 8674111  SET  FOR 6.35MM CONN TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8680853","SUP","HCPCS C1713","","8680853  -  M8 REDUCTION SCREW PLUG, SS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8688498","SUP","HCPCS C1713","","8688498  -  STAPLE 8688498 19MM CAUDAL SS","BOTH IP/OP","$2,173.50 ","$1,608.39 ","$0.00 ","$2,173.50 ","$978.08 ","$0.00 ","$453.01 ","$0.00 ","$0.00 ","$380.56 ","$2,173.50 ","$0.00 ","$1,086.75 ","$1,721.41 ","$1,738.80 ","$0.00 ","$340.15 ","$0.00 ","$346.02 ","$0.00 "
"8688499","SUP","HCPCS C1713","","8688499  -  STAPLE 8688499 19MM ROSTRAL SS","BOTH IP/OP","$2,173.50 ","$1,608.39 ","$0.00 ","$2,173.50 ","$978.08 ","$0.00 ","$453.01 ","$0.00 ","$0.00 ","$380.56 ","$2,173.50 ","$0.00 ","$1,086.75 ","$1,721.41 ","$1,738.80 ","$0.00 ","$340.15 ","$0.00 ","$346.02 ","$0.00 "
"8688500","SUP","HCPCS C1713","","8688500  -  STAPLE 8688500 21MM CAUDAL SS","BOTH IP/OP","$2,173.50 ","$1,608.39 ","$0.00 ","$2,173.50 ","$978.08 ","$0.00 ","$453.01 ","$0.00 ","$0.00 ","$380.56 ","$2,173.50 ","$0.00 ","$1,086.75 ","$1,721.41 ","$1,738.80 ","$0.00 ","$340.15 ","$0.00 ","$346.02 ","$0.00 "
"8688501","SUP","HCPCS C1713","","8688501  -  STAPLE 8688501 21MM ROSTRAL SS","BOTH IP/OP","$2,173.50 ","$1,608.39 ","$0.00 ","$2,173.50 ","$978.08 ","$0.00 ","$453.01 ","$0.00 ","$0.00 ","$380.56 ","$2,173.50 ","$0.00 ","$1,086.75 ","$1,721.41 ","$1,738.80 ","$0.00 ","$340.15 ","$0.00 ","$346.02 ","$0.00 "
"8690024","SUP","HCPCS C1713","","8690024  -  ROD 8690024 5.5MM CCM ROD L 500MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8690030","SUP","HCPCS C1713","","8690030  -  ROD SPNL PREBNT 5.5MM 30MM CD HZN TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690035","SUP","HCPCS C1713","","8690035  -  PRE-BENT ROD, 5.5X35, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690040","SUP","HCPCS C1713","","8690040  -  ROD SPNL PREBNT 5.5MM 40MM LGC CD HZN TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690045","SUP","HCPCS C1713","","8690045  -  PRE-BENT ROD, 5.5X45, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690050","SUP","HCPCS C1713","","8690050  -  ROD SPNL PCUT PREBNT 5.5MM 50MM LGC CD HZN TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690055","SUP","HCPCS C1713","","8690055  -  ROD 8690055 PRE-BENT 5.5X55 TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690060","SUP","HCPCS C1713","","8690060  -  ROD SPNL PREBNT 5.5MM 60MM CD HZN LGC CNTR POST TI THRX","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690065","SUP","HCPCS C1713","","8690065  -  PRE-BENT ROD, 5.5X65, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690070","SUP","HCPCS C1713","","8690070  -  ROD SPNL PREBNT 5.5MM 70MM CD HZN LGC CNTR POST TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690075","SUP","HCPCS C1713","","8690075  -  PRE-BENT ROD, 5.5X75, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690080","SUP","HCPCS C1713","","8690080  -  ROD SPNL 80MM 5.5MM CD HZN LGC TI PREBNT CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690085","SUP","HCPCS C1713","","8690085  -  PRE-BENT ROD, 5.5X85, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690090","SUP","HCPCS C1713","","8690090  -  ROD SPNL PREBNT 5.5MM 90MM CD HZN LGC CNTR POST TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690095","SUP","HCPCS C1713","","8690095  -  ROD 8690095, PRE-BENT 5.5X95, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690100","SUP","HCPCS C1713","","8690100  -  ROD SPNL PREBNT 5.5MM 100MM LGC CD HZN TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690105","SUP","HCPCS C1713","","8690105  -  PRE-BENT ROD, 5.5X105, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690110","SUP","HCPCS C1713","","8690110  -  ROD 8690110 CDH PBNT 5.5X110 TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690115","SUP","HCPCS C1713","","8690115  -  PRE-BENT ROD, 5.5X115, TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690120","SUP","HCPCS C1713","","8690120  -  ROD 8690120 CDH PBNT 5.5X120 TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8690853","SUP","HCPCS C1713","","8690853  -  SCREW 8690853  M8 REDUCTION PLUG TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8690878","SUP","HCPCS C1713","","8690878  -  SET SCREW, REDUCTION, M8, TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8691530","SUP","HCPCS C1713","","8691530  -  CDH M8 5.5 X 30 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691535","SUP","HCPCS C1713","","8691535  -  CDH M8 5.5 X 35 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691540","SUP","HCPCS C1713","","8691540  -  CDH M8 5.5 X 40 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691545","SUP","HCPCS C1713","","8691545  -  CDH M8 5.5 X 45 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691550","SUP","HCPCS C1713","","8691550  -  CDH M8 5.5 X 50 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691630","SUP","HCPCS C1713","","8691630  -  CDH M8 6.5 X 30 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691635","SUP","HCPCS C1713","","8691635  -  CDH M8 6.5 X 35 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691640","SUP","HCPCS C1713","","8691640  -  CDH M8 6.5 X 40 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691645","SUP","HCPCS C1713","","8691645  -  CDH M8 6.5 X 45 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691650","SUP","HCPCS C1713","","8691650  -  CDH M8 6.5 X 50 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691655","SUP","HCPCS C1713","","8691655  -  CDH M8 6.5 X 55 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691730","SUP","HCPCS C1713","","8691730  -  CDH M8 7.5 X 30 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691735","SUP","HCPCS C1713","","8691735  -  CDH M8 7.5 X 35 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691745","SUP","HCPCS C1713","","8691745  -  CDH M8 7.5 X 45 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8691750","SUP","HCPCS C1713","","8691750  -  CDH M8 7.5 X 50 RED FAS 5.5 TI","BOTH IP/OP","$2,362.40 ","$1,748.18 ","$0.00 ","$2,362.40 ","$1,063.08 ","$0.00 ","$492.38 ","$0.00 ","$0.00 ","$413.64 ","$2,362.40 ","$0.00 ","$1,181.20 ","$1,871.02 ","$1,889.92 ","$0.00 ","$369.72 ","$0.00 ","$376.09 ","$0.00 "
"8692150","SUP","HCPCS C1713","","8692150  -  M8 RED. STD. RAMPED HOOK, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8692152","SUP","HCPCS C1713","","8692152  -  M8 RED. NARROW RAMP HOOK, TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8698501","SUP","HCPCS C1713","","8698501  -  STAPLE BONE SM 2 ROD 21MM TI RSTRL SPN CD HZN ANTARES STRL","BOTH IP/OP","$4,240.00 ","$3,137.60 ","$0.00 ","$4,240.00 ","$1,908.00 ","$0.00 ","$883.72 ","$0.00 ","$0.00 ","$742.39 ","$4,240.00 ","$0.00 ","$2,120.00 ","$3,358.08 ","$3,392.00 ","$0.00 ","$663.56 ","$0.00 ","$675.01 ","$0.00 "
"8698502","SUP","HCPCS C1713","","8698502  -  STAPLE BONE MED 2 ROD TI CDL SPN CD HZN ANTARES","BOTH IP/OP","$4,240.00 ","$3,137.60 ","$0.00 ","$4,240.00 ","$1,908.00 ","$0.00 ","$883.72 ","$0.00 ","$0.00 ","$742.39 ","$4,240.00 ","$0.00 ","$2,120.00 ","$3,358.08 ","$3,392.00 ","$0.00 ","$663.56 ","$0.00 ","$675.01 ","$0.00 "
"8699050","SUP","HCPCS C1713","","8699050  -  CDH 5.5X50 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699055","SUP","HCPCS C1713","","8699055  -  CDH 5.5X55 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699060","SUP","HCPCS C1713","","8699060  -  CDH 5.5X60 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699065","SUP","HCPCS C1713","","8699065  -  CDH 5.5X65 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699070","SUP","HCPCS C1713","","8699070  -  CDH 5.5X70 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699075","SUP","HCPCS C1713","","8699075  -  CDH 5.5X75 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699080","SUP","HCPCS C1713","","8699080  -  CDH 5.5X80 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699085","SUP","HCPCS C1713","","8699085  -  CDH 5.5X85 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699090","SUP","HCPCS C1713","","8699090  -  CDH 5.5X90 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699095","SUP","HCPCS C1713","","8699095  -  CDH 5.5X95 STRAIGHT ROD, TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8699100","SUP","HCPCS C1713","","8699100  -  CDH 5.5X100 STRAIGHT ROD,TI CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8730006","SUP","Custom 27203010","","8730006  -  UCSS CANNULATED DRILL BIT, STERILE","BOTH IP/OP","$1,099.50 ","$813.63 ","$0.00 ","$1,099.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,099.50 ","$0.00 ","$549.75 ","$870.80 ","$879.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8750520","SUP","HCPCS C1713","","8750520  -  CONCTR ROD 20MM 5.5MM SS OFFST","BOTH IP/OP","$2,482.50 ","$1,837.05 ","$0.00 ","$2,482.50 ","$1,117.13 ","$0.00 ","$517.42 ","$0.00 ","$0.00 ","$434.67 ","$2,482.50 ","$0.00 ","$1,241.25 ","$1,966.14 ","$1,986.00 ","$0.00 ","$388.51 ","$0.00 ","$395.21 ","$0.00 "
"8750530","SUP","HCPCS C1713","","8750530  -  CONCTR ROD 30MM 5.5MM SS OFFST","BOTH IP/OP","$2,482.50 ","$1,837.05 ","$0.00 ","$2,482.50 ","$1,117.13 ","$0.00 ","$517.42 ","$0.00 ","$0.00 ","$434.67 ","$2,482.50 ","$0.00 ","$1,241.25 ","$1,966.14 ","$1,986.00 ","$0.00 ","$388.51 ","$0.00 ","$395.21 ","$0.00 "
"8750560","SUP","HCPCS C1713","","8750560  -  CONCTR ROD 60MM 5.5MM SS OFFST","BOTH IP/OP","$2,482.50 ","$1,837.05 ","$0.00 ","$2,482.50 ","$1,117.13 ","$0.00 ","$517.42 ","$0.00 ","$0.00 ","$434.67 ","$2,482.50 ","$0.00 ","$1,241.25 ","$1,966.14 ","$1,986.00 ","$0.00 ","$388.51 ","$0.00 ","$395.21 ","$0.00 "
"8754025","SUP","HCPCS C1713","","8754025  -  SCREW UNIPLANER 4.0MM 25MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754030","SUP","HCPCS C1713","","8754030  -  SCREW UNIPLANER 4.0MM 30MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754035","SUP","HCPCS C1713","","8754035  -  SCREW UNIPLANER 4.0MM 35MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754040","SUP","HCPCS C1713","","8754040  -  SCREW UNIPLANER 4.0MM 40MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754045","SUP","HCPCS C1713","","8754045  -  SCREW UNIPLANER 4.0MM 45MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754525","SUP","HCPCS C1713","","8754525  -  SCREW UNIPLANER 4.5MM 25MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754530","SUP","HCPCS C1713","","8754530  -  SCREW UNIPLANER 4.5MM 30MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754535","SUP","HCPCS C1713","","8754535  -  SCREW UNIPLANER 4.5MM 35MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754540","SUP","HCPCS C1713","","8754540  -  SCREW UNIPLANER 4.5MM 40MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754545","SUP","HCPCS C1713","","8754545  -  SCREW UNIPLANER 4.5MM 45MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8754550","SUP","HCPCS C1713","","8754550  -  SCREW UNIPLANER 4.5MM 50MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755025","SUP","HCPCS C1713","","8755025  -  SCREW UNIPLANER 5.0MM 25MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755030","SUP","HCPCS C1713","","8755030  -  SCREW UNIPLANER 5.0MM 30MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755035","SUP","HCPCS C1713","","8755035  -  SCREW UNIPLANER 5.0MM 35MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755040","SUP","HCPCS C1713","","8755040  -  SCREW UNIPLANER 5.0MM 40MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755045","SUP","HCPCS C1713","","8755045  -  SCREW UNIPLANER 5.0MM 45MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755050","SUP","HCPCS C1713","","8755050  -  SCREW UNIPLANER 5.0MM 50MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755525","SUP","HCPCS C1713","","8755525  -  SCREW UNIPLANER 5.5MM 25MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755530","SUP","HCPCS C1713","","8755530  -  SCREW UNIPLANER 5.5MM 30MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755535","SUP","HCPCS C1713","","8755535  -  SCREW UNIPLANER 5.5MM 35MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755540","SUP","HCPCS C1713","","8755540  -  SCREW UNIPLANER 5.5MM 40MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755545","SUP","HCPCS C1713","","8755545  -  SCREW UNIPLANER 5.5MM 45MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755550","SUP","HCPCS C1713","","8755550  -  SCREW UNIPLANER 5.5MM 50MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755555","SUP","HCPCS C1713","","8755555  -  SCREW UNIPLANER 5.5MM 55MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755560","SUP","HCPCS C1713","","8755560  -  SCREW UNIPLANER 5.5MM 60MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8755565","SUP","HCPCS C1713","","8755565  -  SCREW UNIPLANER 5.5MM 65MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756025","SUP","HCPCS C1713","","8756025  -  SCREW UNIPLANER 6.0MM 25MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756030","SUP","HCPCS C1713","","8756030  -  SCREW UNIPLANER 6.0MM 30MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756035","SUP","HCPCS C1713","","8756035  -  SCREW UNIPLANER 6.0MM 35MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756040","SUP","HCPCS C1713","","8756040  -  SCREW UNIPLANER 6.0MM 40MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756045","SUP","HCPCS C1713","","8756045  -  SCREW UNIPLANER 6.0MM 45MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756050","SUP","HCPCS C1713","","8756050  -  SCREW UNIPLANER 6.0MM 50MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756055","SUP","HCPCS C1713","","8756055  -  SCREW UNIPLANER 6.0MM 55MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756060","SUP","HCPCS C1713","","8756060  -  SCREW UNIPLANER 6.0MM 60MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8756065","SUP","HCPCS C1713","","8756065  -  SCREW UNIPLANER 6.0MM 65MM 5.5MM SS","BOTH IP/OP","$5,192.50 ","$3,842.45 ","$0.00 ","$5,192.50 ","$2,336.63 ","$0.00 ","$1,082.25 ","$0.00 ","$0.00 ","$909.17 ","$5,192.50 ","$0.00 ","$2,596.25 ","$4,112.46 ","$4,154.00 ","$0.00 ","$812.63 ","$0.00 ","$826.65 ","$0.00 "
"8780111","SUP","HCPCS C1713","","8780111  -  SCREW BN 4MM 11MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780113","SUP","HCPCS C1713","","8780113  -  SCREW BN 4MM 13MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780115","SUP","HCPCS C1713","","8780115  -  SCREW BN 4MM 15MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780211","SUP","HCPCS C1713","","8780211  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780213","SUP","HCPCS C1713","","8780213  -  SCREW BN 4MM 13MM ARCHON SLF DRL VA SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780215","SUP","HCPCS C1713","","8780215  -  SCREW BN 4MM 15MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780216","SUP","HCPCS C1713","","8780216  -  SCREW BN 4MM 16MM SLF DRL VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780311","SUP","HCPCS C1713","","8780311  -  SCREW BN 4MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780313","SUP","HCPCS C1713","","8780313  -  SCREW BN 4MM 13MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780319","SUP","HCPCS C1713","","8780319  -  SCREW BN 4MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780411","SUP","HCPCS C1713","","8780411  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780511","SUP","HCPCS C1713","","8780511  -  SCREW BN 4.5MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780515","SUP","HCPCS C1713","","8780515  -  SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780517","SUP","HCPCS C1713","","8780517  -  SCREW BN 4.5MM 17MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780519","SUP","HCPCS C1713","","8780519  -  SCREW BN 4.5MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780613","SUP","HCPCS C1713","","8780613  -  SCREW BN 4.5MM 13MM NS ARCHON ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780617","SUP","HCPCS C1713","","8780617  -  SCREW BN 4.5MM 17MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780619","SUP","HCPCS C1713","","8780619  -  SCREW BN 4.5MM 19MM NS ARCHON ST VA SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780711","SUP","HCPCS C1713","","8780711  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780715","SUP","HCPCS C1713","","8780715  -  SCREW BN 4MM 15MM NS ARCHON SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780811","SUP","HCPCS C1713","","8780811  -  SCREW BN 4MM 11MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780813","SUP","HCPCS C1713","","8780813  -  SCREW BN 4MM 13MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780815","SUP","HCPCS C1713","","8780815  -  SCREW BN 4MM 15MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780817","SUP","HCPCS C1713","","8780817  -  SCREW BN 4MM 17MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780819","SUP","HCPCS C1713","","8780819  -  SCREW BN 4MM 19MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780911","SUP","HCPCS C1713","","8780911  -  SCREW BN 4.5MM 11MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780913","SUP","HCPCS C1713","","8780913  -  SCREW BN 4.5MM 13MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780915","SUP","HCPCS C1713","","8780915  -  SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780917","SUP","HCPCS C1713","","8780917  -  SCREW BN 4.5MM 17MM NS ARCHON SLF DRL FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8780919","SUP","HCPCS C1713","","8780919  -  SCREW BN 4.5MM 19MM NS ARCHON ST FX ANG SPNE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8787118","SUP","HCPCS C1713","","8787118  -  ARCHON 18MM PLATE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8787120","SUP","HCPCS C1713","","8787120  -  PLATE BN 20MM ARCHON 1 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8787128","SUP","HCPCS C1713","","8787128  -  PLATE BN 28MM NS ARCHON 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8787130","SUP","HCPCS C1713","","8787130  -  PLATE BN 30MM NS ARCHON 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8787132","SUP","HCPCS C1713","","8787132  -  PLATE BN 32MM NS ARCHON 1 LVL SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8787234","SUP","HCPCS C1713","","8787234  -  PLATE BN 34MM NS ARCHON 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787236","SUP","HCPCS C1713","","8787236  -  PLATE BN 36MM NS ARCHON 2 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787238","SUP","HCPCS C1713","","8787238  -  ARCHON 2 LEVEL PLATE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787240","SUP","HCPCS C1713","","8787240  -  ARCHON LEVEL2, CERVICAL PLATE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787242","SUP","HCPCS C1713","","8787242  -  PLATE BN 42MM ARCHON 2 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787244","SUP","HCPCS C1713","","8787244  -  ARCHON PLATE, 2 LEVEL, 44MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787246","SUP","HCPCS C1713","","8787246  -  PLATE BN 46MM NS ARCHON 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787248","SUP","HCPCS C1713","","8787248  -  PLATE BN 48MM NS ARCHON 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787250","SUP","HCPCS C1713","","8787250  -  PLATE BN 50MM NS ARCHON 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787252","SUP","HCPCS C1713","","8787252  -  PLATE BN 52MM NS ARCHON 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787254","SUP","HCPCS C1713","","8787254  -  PLATE BN 54MM NS ARCHON 2 LVL SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8787350","SUP","HCPCS C1713","","8787350  -  PLATE BN 50MM NS ARCHON 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8787352","SUP","HCPCS C1713","","8787352  -  PLATE BN 52MM NS ARCHON 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8787356","SUP","HCPCS C1713","","8787356  -  PLATE BN 56MM NS ARCHON 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8787364","SUP","HCPCS C1713","","8787364  -  PLATE BN 64MM NS ARCHON 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8787366","SUP","HCPCS C1713","","8787366  -  PLATE BN 66MM NS ARCHON 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8787368","SUP","HCPCS C1713","","8787368  -  PLATE BN 68MM NS ARCHON 3 LVL SPNE","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8787468","SUP","HCPCS C1713","","8787468  -  PLATE BN 68MM ARCHON 4 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"8787474","SUP","HCPCS C1713","","8787474  -  PLATE BN 74MM ARCHON 4 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"8787486","SUP","HCPCS C1713","","8787486  -  PLATE BN 86MM ARCHON 4 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"8787500","SUP","HCPCS C1713","","8787500  -  PLATE BN 100MM ARCHON 5 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"8787510","SUP","HCPCS C1713","","8787510  -  PLATE BN 110MM ARCHON 5 LVL SPNE DEGENERATIVE DISC","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"8792111","SUP","HCPCS C1713","","8792111  -  SCREW 8792111 VAST CNCLLS 3.5X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792113","SUP","HCPCS C1713","","8792113  -  SCREW 8792113 ZEPHIR VAST 3.5X13","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792115","SUP","HCPCS C1713","","8792115  -  SCREW 8792115 ZEPHIR VAST 3.5X15","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792117","SUP","HCPCS C1713","","8792117  -  SCREW 8792117 ZEPHIR VAST 3.5X17","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792711","SUP","HCPCS C1713","","8792711  -  SCREW 8792711 VAST CNCLLS 4.0X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792713","SUP","HCPCS C1713","","8792713  -  SCREW 8792713 VAST CNCLLS 4.0X13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792715","SUP","HCPCS C1713","","8792715  -  SCREW 8792715 VAST CNCLLS 4.0X15MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792717","SUP","HCPCS C1713","","8792717  -  SCREW 8792717 VASD CNCLLS 4.0X17MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792811","SUP","HCPCS C1713","","8792811  -  SCREW 8792811 VA SELF DRILLING 3.5X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792813","SUP","HCPCS C1713","","8792813  -  SCREW 8792813 VA SELF DRILLING 3.5X13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792815","SUP","HCPCS C1713","","8792815  -  SCREW BN 3.5MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792817","SUP","HCPCS C1713","","8792817  -  SCREW 8792817 VA SELF DRILLING 3.5X17MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792911","SUP","HCPCS C1713","","8792911  -  SCREW 8792911 VA SELF DRILLING 4.0X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792913","SUP","HCPCS C1713","","8792913  -  SCREW 8792913 VA SELF DRILLING 4.0X13MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792915","SUP","HCPCS C1713","","8792915  -  SCREW BN 4MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8792917","SUP","HCPCS C1713","","8792917  -  SCREW 8792917 VA SELF DRILLING 4.0X17MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"8799022","SUP","HCPCS C1713","","8799022  -  PLATE 8799022 ANT CERV  22.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799025","SUP","HCPCS C1713","","8799025  -  PLATE 8799025 ANT CERV 25MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799027","SUP","HCPCS C1713","","8799027  -  PLATE 8799027 ANT CERV 27.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799130","SUP","HCPCS C1713","","8799130  -  PLATE 8799130 ZEPHIR 30MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799132","SUP","HCPCS C1713","","8799132  -  PLATE 8799132 ZEPHIR 32.5MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799135","SUP","HCPCS C1713","","8799135  -  PLATE 8799135 ZEPHIR 35MM TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799137","SUP","HCPCS C1713","","8799137  -  PLATE 8799137 ZEPHIR 37.5MM TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799140","SUP","HCPCS C1713","","8799140  -  PLATE 8799140 ZEPHIR  40MM TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799142","SUP","HCPCS C1713","","8799142  -  PLATE 8799142 ZEPHIR 42.5MM TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799145","SUP","HCPCS C1713","","8799145  -  PLATE 8799145 ZEPHIR 45MM TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799147","SUP","HCPCS C1713","","8799147  -  PLATE 8799147ZEPHIR 47.5MM TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799150","SUP","HCPCS C1713","","8799150  -  PLATE 8799150 ZEPHIR 50MM TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799152","SUP","HCPCS C1713","","8799152  -  PLATE 8799152 ZEPHIR 52.5MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799155","SUP","HCPCS C1713","","8799155  -  PLATE 8799155 ZEPHIR 55MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799157","SUP","HCPCS C1713","","8799157  -  PLATE 8799157 ZEPHIR 57.5MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799160","SUP","HCPCS C1713","","8799160  -  PLATE 8799160 ZEPHIR 60MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799162","SUP","HCPCS C1713","","8799162  -  PLATE 8799162 ZEPHIR 62.5MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799165","SUP","HCPCS C1713","","8799165  -  PLATE 8799165 ZEPHIR 65MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799167","SUP","HCPCS C1713","","8799167  -  PLATE 8799167 ZEPHIR 67.5MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799170","SUP","HCPCS C1713","","8799170  -  PLATE 8799170 ZEPHIR 70MM TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799180","SUP","HCPCS C1713","","8799180  -  PLATE 8799180 ZEPHIR KIT 22MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799190","SUP","HCPCS C1713","","8799190  -  PLATE 8799190 ZEPHIR KIT 25MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799200","SUP","HCPCS C1713","","8799200  -  PLATE 8799200 ZEPHIR KIT 27MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799230","SUP","HCPCS C1713","","8799230  -  ZEPHIR DUAL SLOT PLATE, 30MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799232","SUP","HCPCS C1713","","8799232  -  ZEPHIR DUAL SLOT PLATE, 32.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799235","SUP","HCPCS C1713","","8799235  -  ZEPHIR DUAL SLOT PLATE, 35MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8799237","SUP","HCPCS C1713","","8799237  -  ZEPHIR DUAL SLOT PLATE, 37.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799245","SUP","HCPCS C1713","","8799245  -  ZEPHIR DUAL SLOT PLATE, 45MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799247","SUP","HCPCS C1713","","8799247  -  ZEPHIR DUAL SLOT PLATE, 47.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799250","SUP","HCPCS C1713","","8799250  -  ZEPHIR DUAL SLOT PLATE, 50MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8799252","SUP","HCPCS C1713","","8799252  -  ZEPHIR DUAL SLOT PLATE, 52.5MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799255","SUP","HCPCS C1713","","8799255  -  ZEPHIR DUAL SLOT PLATE, 55MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799257","SUP","HCPCS C1713","","8799257  -  ZEPHIR DUAL SLOT PLATE, 57.5MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799260","SUP","HCPCS C1713","","8799260  -  ZEPHIR DUAL SLOT PLATE, 60MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799262","SUP","HCPCS C1713","","8799262  -  ZEPHIR DUAL SLOT PLATE, 62.5MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799265","SUP","HCPCS C1713","","8799265  -  ZEPHIR DUAL SLOT PLATE, 65MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799267","SUP","HCPCS C1713","","8799267  -  ZEPHIR DUAL SLOT PLATE, 67.5MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8799270","SUP","HCPCS C1713","","8799270  -  ZEPHIR DUAL SLOT PLATE, 70MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"8800000","SUP","HCPCS C1713","","8800000  -  SCREW BONE SPNL MULTIAX LCK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8801054","SUP","Custom 27203010","","8801054  -  MARKER SRG STRL NDI 4 SPHR IN TRY STD MNT POST DISP","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8801068","SUP","HCPCS C1769","","8801068  -  WIRE KWIRE SPNL THRD","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"8801269","SUP","HCPCS C1713","","8801269  -  WIRE FX LNG PRCPT GSB MAS KRSH BVL TIP NTNL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"8804525","SUP","HCPCS C1713","","8804525  -  SCREW BONE 4.5MM 25MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804530","SUP","HCPCS C1713","","8804530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"8804535","SUP","HCPCS C1713","","8804535  -  SCREW BONE 4.5MM 35MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804540","SUP","HCPCS C1713","","8804540  -  SCREW BONE 4.5MM 40MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804545","SUP","HCPCS C1713","","8804545  -  SCREW BONE 4.5MM 45MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805530","SUP","HCPCS C1713","","8805530  -  SCREW BONE 5.5MM 30MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805535","SUP","HCPCS C1713","","8805535  -  SCREW BONE 5.5MM 35MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805540","SUP","HCPCS C1713","","8805540  -  SCREW BONE 5.5MM 40MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805545","SUP","HCPCS C1713","","8805545  -  SCREW BONE 5.5MM 45MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805550","SUP","HCPCS C1713","","8805550  -  SCREW BONE 5.5MM 50MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805555","SUP","HCPCS C1713","","8805555  -  SCREW BONE 5.5MM 55MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806530","SUP","HCPCS C1713","","8806530  -  SCREW BONE 6.5MM 30MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806535","SUP","HCPCS C1713","","8806535  -  SCREW BONE 6.5MM 35MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806540","SUP","HCPCS C1713","","8806540  -  SCREW BONE 6.5MM 40MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806545","SUP","HCPCS C1713","","8806545  -  SCREW BONE 6.5MM 45MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806550","SUP","HCPCS C1713","","8806550  -  SCREW BONE 6.5MM 50MM MULTIAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806555","SUP","HCPCS C1713","","8806555  -  SCREW BONE 6.5MM 55MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807500","SUP","HCPCS C1713","","8807500  -  SCREW BONE 7.5MM 50MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807530","SUP","HCPCS C1713","","8807530  -  SCREW BONE 7.5MM 30MM SPNL POLYAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807535","SUP","HCPCS C1713","","8807535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807540","SUP","HCPCS C1713","","8807540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807545","SUP","HCPCS C1713","","8807545  -  SCREW BONE 7.5MM 45MM SPNL POLYAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807550","SUP","HCPCS C1713","","8807550  -  SCREW BONE 7.5MM 50MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807555","SUP","HCPCS C1713","","8807555  -  SCREW BONE 7.5MM 55MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807560","SUP","HCPCS C1713","","8807560  -  SCREW BONE 7.5MM 60MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807570","SUP","HCPCS C1713","","8807570  -  SCREW BONE 7.5MM 70MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807580","SUP","HCPCS C1713","","8807580  -  SCREW BONE 7.5MM 80MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807590","SUP","HCPCS C1713","","8807590  -  SCREW BONE 7.5MM 90MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808500","SUP","HCPCS C1713","","8808500  -  SCREW BONE 8.5MM 100MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808535","SUP","HCPCS C1713","","8808535  -  SCREW BONE 8.5MM 35MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808540","SUP","HCPCS C1713","","8808540  -  SCREW BONE 8.5MM 40MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808545","SUP","HCPCS C1713","","8808545  -  SCREW BONE 8.5MM 45MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808550","SUP","HCPCS C1713","","8808550  -  SCREW BONE 8.5MM 50MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808555","SUP","HCPCS C1713","","8808555  -  SCREW BONE 8.5MM 55MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808560","SUP","HCPCS C1713","","8808560  -  SCREW BONE 8.5MM 60MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808570","SUP","HCPCS C1713","","8808570  -  SCREW BONE 8.5MM 70MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808580","SUP","HCPCS C1713","","8808580  -  SCREW BONE 8.5MM 80MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808590","SUP","HCPCS C1713","","8808590  -  SCREW BONE 8.5MM 90MM SPNL MULTIAX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8824525","SUP","HCPCS C1713","","8824525  -  SCREW BN 4.5MM 25MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8824530","SUP","HCPCS C1713","","8824530  -  SCREW BN 4.5MM 30MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8824535","SUP","HCPCS C1713","","8824535  -  SCREW BN 4.5MM 35MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8824540","SUP","HCPCS C1713","","8824540  -  SCREW BN 4.5MM 40MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8824545","SUP","HCPCS C1713","","8824545  -  SCREW BN 4.5MM 45MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8825530","SUP","HCPCS C1713","","8825530  -  SCREW BN 7.5MM 35MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8825545","SUP","HCPCS C1713","","8825545  -  SCREW BN 7.5MM 50MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8825550","SUP","HCPCS C1713","","8825550  -  SCREW BN 7.5MM 55MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8825555","SUP","HCPCS C1713","","8825555  -  SCREW BN 6.5MM 40MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8826530","SUP","HCPCS C1713","","8826530  -  SCREW BN 6.5MM 45MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8826540","SUP","HCPCS C1713","","8826540  -  SCREW BN 6.5MM 40MM NS PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8826550","SUP","HCPCS C1713","","8826550  -  SCREW BN 5.5MM 30MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8826555","SUP","HCPCS C1713","","8826555  -  SCREW BN 5.5MM 35MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827500","SUP","HCPCS C1713","","8827500  -  SCREW BN 7.5MM 100MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827530","SUP","HCPCS C1713","","8827530  -  SCREW BN 5.5MM 40MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827535","SUP","HCPCS C1713","","8827535  -  SCREW BN 5.5MM 45MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827550","SUP","HCPCS C1713","","8827550  -  SCREW BN 6.5MM 30MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827555","SUP","HCPCS C1713","","8827555  -  SCREW BN 6.5MM 35MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827560","SUP","HCPCS C1713","","8827560  -  SCREW BN 7.5MM 60MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827570","SUP","HCPCS C1713","","8827570  -  SCREW BN 7.5MM 70MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827580","SUP","HCPCS C1713","","8827580  -  SCREW BN 7.5MM 80MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8827590","SUP","HCPCS C1713","","8827590  -  SCREW BN 7.5MM 90MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828500","SUP","HCPCS C1713","","8828500  -  SCREW BN 8.5MM 100MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828535","SUP","HCPCS C1713","","8828535  -  SCREW BN 8.5MM 35MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828540","SUP","HCPCS C1713","","8828540  -  SCREW BN 8.5MM 40MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828545","SUP","HCPCS C1713","","8828545  -  SCREW BN 8.5MM 45MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828550","SUP","HCPCS C1713","","8828550  -  SCREW BN 8.5MM 50MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828555","SUP","HCPCS C1713","","8828555  -  SCREW BN 8.5MM 55MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828560","SUP","HCPCS C1713","","8828560  -  SCREW BN 8.5MM 60MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828570","SUP","HCPCS C1713","","8828570  -  SCREW BN 8.5MM 70MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828580","SUP","HCPCS C1713","","8828580  -  SCREW BN 8.5MM 80MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8828590","SUP","HCPCS C1713","","8828590  -  SCREW BN 8.5MM 90MM PRCPT RDC SPNE","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"8847020","SUP","HCPCS C1713","","8847020  -  ROD SPNL 20MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847025","SUP","HCPCS C1713","","8847025  -  ROD SPNL 25MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847030","SUP","HCPCS C1713","","8847030  -  ROD SPNL 30MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847035","SUP","HCPCS C1713","","8847035  -  ROD SPNL 35MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847040","SUP","HCPCS C1713","","8847040  -  ROD SPNL 540MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847045","SUP","HCPCS C1713","","8847045  -  ROD SPNL 45MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847050","SUP","HCPCS C1713","","8847050  -  ROD SPNL 50MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847055","SUP","HCPCS C1713","","8847055  -  ROD SPNL 55MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847060","SUP","HCPCS C1713","","8847060  -  ROD SPNL 60MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847065","SUP","HCPCS C1713","","8847065  -  ROD SPNL 65MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847070","SUP","HCPCS C1713","","8847070  -  ROD SPNL 70MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847075","SUP","HCPCS C1713","","8847075  -  ROD SPNL 75MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847080","SUP","HCPCS C1713","","8847080  -  ROD SPNL 80MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847085","SUP","HCPCS C1713","","8847085  -  ROD SPNL 85MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847090","SUP","HCPCS C1713","","8847090  -  ROD SPNL 90MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847095","SUP","HCPCS C1713","","8847095  -  ROD SPNL 95MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847100","SUP","HCPCS C1713","","8847100  -  ROD SPNL 100MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847110","SUP","HCPCS C1713","","8847110  -  ROD SPNL 110MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847120","SUP","HCPCS C1713","","8847120  -  ROD SPNL 120MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847130","SUP","HCPCS C1713","","8847130  -  ROD SPNL 130MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847140","SUP","HCPCS C1713","","8847140  -  ROD SPNL 140MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847150","SUP","HCPCS C1713","","8847150  -  ROD SPNL 150MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8847160","SUP","HCPCS C1713","","8847160  -  ROD SPNL 160MM PRCPT PREBNT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848160","SUP","HCPCS C1713","","8848160  -  ROD SPNL 160MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848170","SUP","HCPCS C1713","","8848170  -  ROD SPNL 170MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848180","SUP","HCPCS C1713","","8848180  -  ROD SPNL 180MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848190","SUP","HCPCS C1713","","8848190  -  ROD SPNL 190MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848200","SUP","HCPCS C1713","","8848200  -  ROD SPNL 200MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848210","SUP","HCPCS C1713","","8848210  -  ROD SPNL 210MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848220","SUP","HCPCS C1713","","8848220  -  ROD SPNL 220MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848230","SUP","HCPCS C1713","","8848230  -  ROD SPNL 230MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848240","SUP","HCPCS C1713","","8848240  -  ROD SPNL 240MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848250","SUP","HCPCS C1713","","8848250  -  ROD SPNL 250MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848300","SUP","HCPCS C1713","","8848300  -  ROD SPNL 300MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848500","SUP","HCPCS C1713","","8848500  -  ROD SPNL 500MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8848600","SUP","HCPCS C1713","","8848600  -  ROD SPNL 600MM PRCPT STRAIGHT TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8880823","SUP","HCPCS C1713","","8880823  -  SPACER SPNL XLORDOTIC 23MMX8MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8880828","SUP","HCPCS C1713","","8880828  -  SPACER SPNL XLORDOTIC 28MMX8MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8880832","SUP","HCPCS C1713","","8880832  -  SPACER SPNL XLORDOTIC 32MMX8MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8880923","SUP","HCPCS C1713","","8880923  -  SPACER SPNL XLORDOTIC 23MMX9MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8880928","SUP","HCPCS C1713","","8880928  -  SPACER SPNL 28MMX9MM ELEV XLORDOTIC PEEK TI STRL","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8880932","SUP","HCPCS C1713","","8880932  -  SPACER SPNL XLORDOTIC 32MMX9MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8881023","SUP","HCPCS C1713","","8881023  -  SPACER SPNL XLORDOTIC 23MMX10MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8881028","SUP","HCPCS C1713","","8881028  -  SPACER SPNL XLORDOTIC 28MMX10MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8881032","SUP","HCPCS C1713","","8881032  -  SPACER SPNL XLORDOTIC 32MMX10MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8881123","SUP","HCPCS C1713","","8881123  -  SPACER SPNL XLORDOTIC 23MMX11MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8881128","SUP","HCPCS C1713","","8881128  -  SPACER SPNL XLORDOTIC 28MMX11MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8881132","SUP","HCPCS C1713","","8881132  -  SPACER SPNL XLORDOTIC 32MMX11MM STRL ELEV PEEK TI","BOTH IP/OP","$11,698.50 ","$8,656.89 ","$0.00 ","$11,698.50 ","$5,264.33 ","$0.00 ","$2,438.26 ","$0.00 ","$0.00 ","$2,048.31 ","$11,698.50 ","$0.00 ","$5,849.25 ","$9,265.21 ","$9,358.80 ","$0.00 ","$1,830.82 ","$0.00 ","$1,862.40 ","$0.00 "
"8896555","SUP","HCPCS C1713","","8896555  -  SCREW BONE 6.5MM 55MM GSB PRCPT SPN MDLR CANN SHNK","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"8914000","SUP","HCPCS C1713","","8914000  -  M4 BREAK-OFF SCREW","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8915008","SUP","HCPCS C1713","","8915008  -  SPACER SPNL SM FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915010","SUP","HCPCS C1713","","8915010  -  SPACER SPNL SM FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915012","SUP","HCPCS C1713","","8915012  -  SPACER SPNL SM FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915014","SUP","HCPCS C1713","","8915014  -  SPACER SPNL SM FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915016","SUP","HCPCS C1713","","8915016  -  SPACER SPNL SM FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915018","SUP","HCPCS C1713","","8915018  -  SPACER SPNL SM FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915020","SUP","HCPCS C1713","","8915020  -  SPACER SPNL SM FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915408","SUP","HCPCS C1713","","8915408  -  SPACER SPNL SM LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915410","SUP","HCPCS C1713","","8915410  -  SPACER SPNL SM LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915412","SUP","HCPCS C1713","","8915412  -  SPACER SPNL SM LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915414","SUP","HCPCS C1713","","8915414  -  SPACER SPNL SM LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915416","SUP","HCPCS C1713","","8915416  -  SPACER SPNL SM LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915418","SUP","HCPCS C1713","","8915418  -  SPACER SPNL SM LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915420","SUP","HCPCS C1713","","8915420  -  SPACER SPNL SM LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915805","SUP","HCPCS C1713","","8915805  -  SPACER SPNL SM 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915810","SUP","HCPCS C1713","","8915810  -  SPACER SPNL SM 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915820","SUP","HCPCS C1713","","8915820  -  SPACER SPNL SM 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915830","SUP","HCPCS C1713","","8915830  -  SPACER SPNL SM 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8915840","SUP","HCPCS C1713","","8915840  -  SPACER SPNL SM 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916008","SUP","HCPCS C1713","","8916008  -  SPACER SPNL LG FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916010","SUP","HCPCS C1713","","8916010  -  SPACER SPNL LG FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916012","SUP","HCPCS C1713","","8916012  -  SPACER SPNL LG FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916014","SUP","HCPCS C1713","","8916014  -  SPACER SPNL LG FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916016","SUP","HCPCS C1713","","8916016  -  SPACER SPNL LG FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916018","SUP","HCPCS C1713","","8916018  -  SPACER SPNL LG FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916020","SUP","HCPCS C1713","","8916020  -  SPACER SPNL LG FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916408","SUP","HCPCS C1713","","8916408  -  SPACER SPNL LG LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916410","SUP","HCPCS C1713","","8916410  -  SPACER SPNL LG LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916412","SUP","HCPCS C1713","","8916412  -  SPACER SPNL LG LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916414","SUP","HCPCS C1713","","8916414  -  SPACER SPNL LG LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916416","SUP","HCPCS C1713","","8916416  -  SPACER SPNL LG LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916418","SUP","HCPCS C1713","","8916418  -  SPACER SPNL LG LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916420","SUP","HCPCS C1713","","8916420  -  SPACER SPNL LG LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916805","SUP","HCPCS C1713","","8916805  -  SPACER SPNL LG 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916810","SUP","HCPCS C1713","","8916810  -  SPACER SPNL LG 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916820","SUP","HCPCS C1713","","8916820  -  SPACER SPNL LG 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916830","SUP","HCPCS C1713","","8916830  -  SPACER SPNL LG 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8916840","SUP","HCPCS C1713","","8916840  -  SPACER SPNL LG 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"8941420","SUP","Custom 27803010","","8941420  -  CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941423","SUP","Custom 27803010","","8941423  -  CAGE SPNL 14MM 23X17.5MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941620","SUP","Custom 27803010","","8941620  -  CAGE SPNL 16MM 20X19MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941623","SUP","Custom 27803010","","8941623  -  CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941626","SUP","Custom 27803010","","8941626  -  CAGE SPNL 16MM 26X20MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941823","SUP","Custom 27803010","","8941823  -  CAGE SPNL 18MM 23X21.5MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941826","SUP","Custom 27803010","","8941826  -  CAGE SPNL 18MM 26X22MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,226.25 ","$5,347.43 ","$0.00 ","$7,226.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,226.25 ","$0.00 ","$3,613.13 ","$5,723.19 ","$5,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8954025","SUP","HCPCS C1713","","8954025  -  SCREW BONE 25MM 4MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954030","SUP","HCPCS C1713","","8954030  -  SCREW BONE 30MM 4MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954035","SUP","HCPCS C1713","","8954035  -  SCREW BONE 35MM 4MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954525","SUP","HCPCS C1713","","8954525  -  SCREW BONE 25MM 4.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954530","SUP","HCPCS C1713","","8954530  -  SCREW BONE 30MM 4.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954535","SUP","HCPCS C1713","","8954535  -  SCREW BONE 35MM 4.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954540","SUP","HCPCS C1713","","8954540  -  SCREW BONE 40MM 4.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8954545","SUP","HCPCS C1713","","8954545  -  SCREW BONE 45MM 4.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8955530","SUP","HCPCS C1713","","8955530  -  SCREW BONE 30MM 5.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8955535","SUP","HCPCS C1713","","8955535  -  SCREW BONE 35MM 5.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8955540","SUP","HCPCS C1713","","8955540  -  SCREW BONE 40MM 5.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8955545","SUP","HCPCS C1713","","8955545  -  SCREW BONE 45MM 5.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8956535","SUP","HCPCS C1713","","8956535  -  SCREW BONE 35MM 6.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8956540","SUP","HCPCS C1713","","8956540  -  SCREW BONE 40MM 6.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8956545","SUP","HCPCS C1713","","8956545  -  SCREW BONE 45MM 6.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8956550","SUP","HCPCS C1713","","8956550  -  SCREW BONE 50MM 6.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8957535","SUP","HCPCS C1713","","8957535  -  SCREW BONE 35MM 7.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8957540","SUP","HCPCS C1713","","8957540  -  SCREW BONE 40MM 7.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8957545","SUP","HCPCS C1713","","8957545  -  SCREW BONE 45MM 7.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8957550","SUP","HCPCS C1713","","8957550  -  SCREW BONE 50MM 7.5MM SS FIX 5.5MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8964525","SUP","HCPCS C1713","","8964525  -  SCREW BONE 4.5MM 25MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8964530","SUP","HCPCS C1713","","8964530  -  SCREW BONE 4.5MM 30MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8964535","SUP","HCPCS C1713","","8964535  -  SCREW BONE 4.5MM 35MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8964540","SUP","HCPCS C1713","","8964540  -  SCREW BONE 4.5MM 40MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8964545","SUP","HCPCS C1713","","8964545  -  SCREW BONE 4.5MM 45MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8965530","SUP","HCPCS C1713","","8965530  -  SCREW BONE 5.5MM 30MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8965535","SUP","HCPCS C1713","","8965535  -  SCREW BONE 5.5MM 35MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8965540","SUP","HCPCS C1713","","8965540  -  SCREW BONE 5.5MM 40MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8965545","SUP","HCPCS C1713","","8965545  -  SCREW BONE 5.5MM 45MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8966535","SUP","HCPCS C1713","","8966535  -  SCREW BONE 6.5MM 35MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8966540","SUP","HCPCS C1713","","8966540  -  SCREW BONE 6.5MM 40MM SS SPNL FIX 6.35MM ROD","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8966545","SUP","HCPCS C1713","","8966545  -  SCREW BONE 6.5MM 6.35MM 45MM SS SPNL FIX","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8966550","SUP","HCPCS C1713","","8966550  -  SCREW BONE 6.5MM 6.35MM 50MM SS SPNL FIX","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8967535","SUP","HCPCS C1713","","8967535  -  SCREW BONE 7.5MM 6.35MM 35MM SS SPNL FIX","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8967540","SUP","HCPCS C1713","","8967540  -  SCREW BONE 7.5MM 6.35MM 40MM SS SPNL FIX","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8967545","SUP","HCPCS C1713","","8967545  -  SCREW BONE 7.5MM 6.35MM 45MM SS SPNL FIX","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8967550","SUP","HCPCS C1713","","8967550  -  SCREW BONE 7.5MM 6.35MM 50MM SS SPNL FIX","BOTH IP/OP","$2,802.50 ","$2,073.85 ","$0.00 ","$2,802.50 ","$1,261.13 ","$0.00 ","$584.11 ","$0.00 ","$0.00 ","$490.70 ","$2,802.50 ","$0.00 ","$1,401.25 ","$2,219.58 ","$2,242.00 ","$0.00 ","$438.59 ","$0.00 ","$446.16 ","$0.00 "
"8968625","SUP","HCPCS C1713","","8968625  -  SCREW 8968625 PYRMD BONE FAS 6.5X25MM","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"8968630","SUP","HCPCS C1713","","8968630  -  SCREW 8968630 PYRMD BONE FAS 6.5X30MM","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"8968635","SUP","HCPCS C1713","","8968635  -  SCREW 8968635 PYRMD BONE FAS 6.5X35MM","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"8969117","SUP","HCPCS C1713","","8969117  -  PLATE 8969117 PLATE 17MM","BOTH IP/OP","$8,377.50 ","$6,199.35 ","$0.00 ","$8,377.50 ","$3,769.88 ","$0.00 ","$1,746.08 ","$0.00 ","$0.00 ","$1,466.83 ","$8,377.50 ","$0.00 ","$4,188.75 ","$6,634.98 ","$6,702.00 ","$0.00 ","$1,311.08 ","$0.00 ","$1,333.70 ","$0.00 "
"8969119","SUP","HCPCS C1713","","8969119  -  PLATE 8969119 PLATE 19MM","BOTH IP/OP","$8,377.50 ","$6,199.35 ","$0.00 ","$8,377.50 ","$3,769.88 ","$0.00 ","$1,746.08 ","$0.00 ","$0.00 ","$1,466.83 ","$8,377.50 ","$0.00 ","$4,188.75 ","$6,634.98 ","$6,702.00 ","$0.00 ","$1,311.08 ","$0.00 ","$1,333.70 ","$0.00 "
"8969121","SUP","HCPCS C1713","","8969121  -  PLATE 8969121 PLATE 21MM","BOTH IP/OP","$8,377.50 ","$6,199.35 ","$0.00 ","$8,377.50 ","$3,769.88 ","$0.00 ","$1,746.08 ","$0.00 ","$0.00 ","$1,466.83 ","$8,377.50 ","$0.00 ","$4,188.75 ","$6,634.98 ","$6,702.00 ","$0.00 ","$1,311.08 ","$0.00 ","$1,333.70 ","$0.00 "
"8969123","SUP","HCPCS C1713","","8969123  -  PLATE 8969123 PLATE 23MM","BOTH IP/OP","$8,377.50 ","$6,199.35 ","$0.00 ","$8,377.50 ","$3,769.88 ","$0.00 ","$1,746.08 ","$0.00 ","$0.00 ","$1,466.83 ","$8,377.50 ","$0.00 ","$4,188.75 ","$6,634.98 ","$6,702.00 ","$0.00 ","$1,311.08 ","$0.00 ","$1,333.70 ","$0.00 "
"8969125","SUP","HCPCS C1713","","8969125  -  PLATE 8969125 PLATE 25MM","BOTH IP/OP","$8,377.50 ","$6,199.35 ","$0.00 ","$8,377.50 ","$3,769.88 ","$0.00 ","$1,746.08 ","$0.00 ","$0.00 ","$1,466.83 ","$8,377.50 ","$0.00 ","$4,188.75 ","$6,634.98 ","$6,702.00 ","$0.00 ","$1,311.08 ","$0.00 ","$1,333.70 ","$0.00 "
"8969127","SUP","HCPCS C1713","","8969127  -  PLATE 8969127 PLATE 27MM","BOTH IP/OP","$8,377.50 ","$6,199.35 ","$0.00 ","$8,377.50 ","$3,769.88 ","$0.00 ","$1,746.08 ","$0.00 ","$0.00 ","$1,466.83 ","$8,377.50 ","$0.00 ","$4,188.75 ","$6,634.98 ","$6,702.00 ","$0.00 ","$1,311.08 ","$0.00 ","$1,333.70 ","$0.00 "
"8969201","SUP","HCPCS C1713","","8969201  -  SET SCREW 8969201 LOCKING PLATE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8969217","SUP","HCPCS C1713","","8969217  -  PLATE 8969217 COVER PLATE 17MM","BOTH IP/OP","$1,105.50 ","$818.07 ","$0.00 ","$1,105.50 ","$497.48 ","$0.00 ","$230.41 ","$0.00 ","$0.00 ","$193.56 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$173.01 ","$0.00 ","$176.00 ","$0.00 "
"8969219","SUP","HCPCS C1713","","8969219  -  PLATE 8969219 COVER PLATE 19MM","BOTH IP/OP","$1,105.50 ","$818.07 ","$0.00 ","$1,105.50 ","$497.48 ","$0.00 ","$230.41 ","$0.00 ","$0.00 ","$193.56 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$173.01 ","$0.00 ","$176.00 ","$0.00 "
"8969221","SUP","HCPCS C1713","","8969221  -  PLATE 8969221 COVER PLATE 21MM","BOTH IP/OP","$1,105.50 ","$818.07 ","$0.00 ","$1,105.50 ","$497.48 ","$0.00 ","$230.41 ","$0.00 ","$0.00 ","$193.56 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$173.01 ","$0.00 ","$176.00 ","$0.00 "
"8969223","SUP","HCPCS C1713","","8969223  -  PLATE 8969223 COVER PLATE 23MM","BOTH IP/OP","$1,105.50 ","$818.07 ","$0.00 ","$1,105.50 ","$497.48 ","$0.00 ","$230.41 ","$0.00 ","$0.00 ","$193.56 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$173.01 ","$0.00 ","$176.00 ","$0.00 "
"8969225","SUP","HCPCS C1713","","8969225  -  PLATE 8969225 COVER PLATE 25MM","BOTH IP/OP","$1,105.50 ","$818.07 ","$0.00 ","$1,105.50 ","$497.48 ","$0.00 ","$230.41 ","$0.00 ","$0.00 ","$193.56 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$173.01 ","$0.00 ","$176.00 ","$0.00 "
"8969227","SUP","HCPCS C1713","","8969227  -  PLATE 8969227 COVER PLATE 27MM","BOTH IP/OP","$1,105.50 ","$818.07 ","$0.00 ","$1,105.50 ","$497.48 ","$0.00 ","$230.41 ","$0.00 ","$0.00 ","$193.56 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$173.01 ","$0.00 ","$176.00 ","$0.00 "
"8970000","SUP","HCPCS C1713","","8970000  -  SCREW LOCK 2 VUE POINT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8970240","SUP","HCPCS C1713","","8970240  -  VUE POINT II, ROD TEMPLATE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"8975310","SUP","HCPCS C1713","","8975310  -  SCREW BN 3.5MM 10MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975312","SUP","HCPCS C1713","","8975312  -  SCREW BN 3.5MM 12MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975314","SUP","HCPCS C1713","","8975314  -  SCREW BN 3.5MM 14MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975318","SUP","HCPCS C1713","","8975318  -  SCREW BN 3.5MM 18MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975320","SUP","HCPCS C1713","","8975320  -  SCREW BN 3.5MM 20MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975322","SUP","HCPCS C1713","","8975322  -  SCREW BN 3.5MM 22MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975324","SUP","HCPCS C1713","","8975324  -  SCREW BN 3.5MM 24MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975326","SUP","HCPCS C1713","","8975326  -  SCREW BN 3.5MM 26MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975328","SUP","HCPCS C1713","","8975328  -  SCREW BN 3.5MM 28MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975330","SUP","HCPCS C1713","","8975330  -  SCREW BN 3.5MM 30MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975332","SUP","HCPCS C1713","","8975332  -  SCREW BN 3.5MM 32MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975334","SUP","HCPCS C1713","","8975334  -  SCREW BN 3.5MM 34MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975410","SUP","HCPCS C1713","","8975410  -  SCREW BN 4MM 10MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975412","SUP","HCPCS C1713","","8975412  -  SCREW BN 4MM 12MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975414","SUP","HCPCS C1713","","8975414  -  SCREW BN 4MM 14MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975416","SUP","HCPCS C1713","","8975416  -  SCREW BN 4MM 16MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975418","SUP","HCPCS C1713","","8975418  -  SCREW BN 4MM 18MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975420","SUP","HCPCS C1713","","8975420  -  SCREW BN 4MM 20MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975422","SUP","HCPCS C1713","","8975422  -  SCREW BN 4MM 22MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975424","SUP","HCPCS C1713","","8975424  -  SCREW BN 4MM 24MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975426","SUP","HCPCS C1713","","8975426  -  SCREW BN 4MM 26MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975428","SUP","HCPCS C1713","","8975428  -  SCREW BN 4MM 28MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975430","SUP","HCPCS C1713","","8975430  -  SCREW BN 4MM 30MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975432","SUP","HCPCS C1713","","8975432  -  SCREW BN 4MM 32MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975434","SUP","HCPCS C1713","","8975434  -  SCREW BN 4MM 34MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975436","SUP","HCPCS C1713","","8975436  -  SCREW BN 4MM 36MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975438","SUP","HCPCS C1713","","8975438  -  SCREW BN 4MM 38MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975440","SUP","HCPCS C1713","","8975440  -  SCREW BN 4MM 40MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975510","SUP","HCPCS C1713","","8975510  -  SCREW BONE 3.5MM 10MM FAVORED ANGLE SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975512","SUP","HCPCS C1713","","8975512  -  SCREW BONE 2MM 12MM VUEPOINT POSTERIOR CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975514","SUP","HCPCS C1713","","8975514  -  SCREW BONE 3.5MM 14MM VUEPOINT SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975516","SUP","HCPCS C1713","","8975516  -  SCREW BN 3.5MM 16MM VUEPOINT II FAVOR ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975518","SUP","HCPCS C1713","","8975518  -  SCREW BN 3.5MM 18MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975526","SUP","HCPCS C1713","","8975526  -  SCREW BN 3.5MM 26MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975528","SUP","HCPCS C1713","","8975528  -  SCREW BN 3.5MM 28MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975530","SUP","HCPCS C1713","","8975530  -  SCREW BN 3.5MM 30MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975532","SUP","HCPCS C1713","","8975532  -  SCREW BN 3.5MM 32MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975534","SUP","HCPCS C1713","","8975534  -  SCREW BN 3.5MM 34MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975618","SUP","HCPCS C1713","","8975618  -  SCREW BN 4MM 18MM VUEPOINT II FAVOR ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975622","SUP","HCPCS C1713","","8975622  -  VUE POINT 2, 4.0X 22MM, FAVORED ANGLE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975624","SUP","HCPCS C1713","","8975624  -  VUE POINT 2 4.0X 24MM SCREW","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975636","SUP","HCPCS C1713","","8975636  -  SCREW BN 4MM 36MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975638","SUP","HCPCS C1713","","8975638  -  SCREW BN 4MM 38MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975640","SUP","HCPCS C1713","","8975640  -  SCREW BN 4MM 40MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975710","SUP","HCPCS C1713","","8975710  -  SCREW BN 4.5MM 10MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975712","SUP","HCPCS C1713","","8975712  -  SCREW BN 4.5MM 12MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975716","SUP","HCPCS C1713","","8975716  -  SCREW BN 4.5MM 16MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975718","SUP","HCPCS C1713","","8975718  -  SCREW BN 4.5MM 18MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975720","SUP","HCPCS C1713","","8975720  -  VUE POINT 435 X 20","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975722","SUP","HCPCS C1713","","8975722  -  SCREW BN 4.5MM 22MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975724","SUP","HCPCS C1713","","8975724  -  SCREW BONE MULTIAX TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975726","SUP","HCPCS C1713","","8975726  -  SCREW BN 4.5MM 26MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975728","SUP","HCPCS C1713","","8975728  -  VUEPOINT 2 MULTI-AXIAL SCREW 4.5 X28","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975732","SUP","HCPCS C1713","","8975732  -  VUE POINT II, SCREW 4.5X32MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975734","SUP","HCPCS C1713","","8975734  -  VUE POINT II, SCREW 4.5X34MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975736","SUP","HCPCS C1713","","8975736  -  VUE POINT II, SCREW 4.5X36MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975738","SUP","HCPCS C1713","","8975738  -  VUE POINT II, SCREW 4.5X38MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975740","SUP","HCPCS C1713","","8975740  -  SCREW BN 4.5MM 40MM NS VUEPOINT II MA SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975824","SUP","HCPCS C1713","","8975824  -  SCREW BN P/T 3.5MM 24MM NS VUEPOINT II FAVORED ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975834","SUP","HCPCS C1713","","8975834  -  SCREW BN P/T 3.5MM 34MM VUEPOINT II FAVOR ANG SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8975838","SUP","HCPCS C1713","","8975838  -  VUE POINT II, FA/PT SCREW 3.5X38","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976006","SUP","HCPCS C1713","","8976006  -  HOOK SPNL 6MM NS VUEPOINT II LMN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976008","SUP","HCPCS C1713","","8976008  -  HOOK SPNL 8MM NS VUEPOINT II LMN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976011","SUP","HCPCS C1713","","8976011  -  CONNECTOR ROD 11MM OFST VUEPOINT II OPN SPNE","BOTH IP/OP","$1,095.00 ","$810.30 ","$0.00 ","$1,095.00 ","$492.75 ","$0.00 ","$228.23 ","$0.00 ","$0.00 ","$191.73 ","$1,095.00 ","$0.00 ","$547.50 ","$867.24 ","$876.00 ","$0.00 ","$171.37 ","$0.00 ","$174.32 ","$0.00 "
"8976025","SUP","HCPCS C1713","","8976025  -  CONNECTOR ROD 25MM LNG OFST NS VUEPOINT II OPN SPNE","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"8976030","SUP","HCPCS C1713","","8976030  -  CONNECTOR ROD 45D OFST NS VUEPOINT II SPNE","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"8976035","SUP","HCPCS C1713","","8976035  -  CONNECTOR ROD 3.5MM NS VUEPOINT II INLN SPNE","BOTH IP/OP","$1,867.50 ","$1,381.95 ","$0.00 ","$1,867.50 ","$840.38 ","$0.00 ","$389.23 ","$0.00 ","$0.00 ","$326.98 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$292.26 ","$0.00 ","$297.31 ","$0.00 "
"8976055","SUP","HCPCS C1713","","8976055  -  CONNECTOR ROD 3.5-5.5MM NS VUEPOINT II INLN SPNE","BOTH IP/OP","$1,867.50 ","$1,381.95 ","$0.00 ","$1,867.50 ","$840.38 ","$0.00 ","$389.23 ","$0.00 ","$0.00 ","$326.98 ","$1,867.50 ","$0.00 ","$933.75 ","$1,479.06 ","$1,494.00 ","$0.00 ","$292.26 ","$0.00 ","$297.31 ","$0.00 "
"8976112","SUP","HCPCS C1713","","8976112  -  ROD SPNL 3.5MM 120MM VUEPOINT II","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8976124","SUP","HCPCS C1713","","8976124  -  ROD 240MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8976128","SUP","HCPCS C1713","","8976128  -  CONNECTOR ROD 28MM NS VUEPOINT II FX CX SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976130","SUP","HCPCS C1713","","8976130  -  CONNECTOR ROD 30MM NS VUEPOINT II FX CX SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976132","SUP","HCPCS C1713","","8976132  -  VUE POINT 2 32MM FIXED CROSS CONN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976136","SUP","HCPCS C1713","","8976136  -  CONNECTOR ROD 36MM NS VUEPOINT II FX CX SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976138","SUP","HCPCS C1713","","8976138  -  CONNECTOR ROD 38MM VUEPOINT II CX STC SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976160","SUP","HCPCS C1713","","8976160  -  VUE POINT II ROD 60MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8976165","SUP","HCPCS C1713","","8976165  -  CONNECTOR ROD NS VUEPOINT II X SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976180","SUP","HCPCS C1713","","8976180  -  ROD SPNL 80MM NS VUEPOINT II PRECONTOUR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8976240","SUP","HCPCS C1713","","8976240  -  ROD SPNL 45D 240MM NS VUEPOINT II PRECURVE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8976355","SUP","HCPCS C1713","","8976355  -  TRANSITION ROD, 3.5X 5.5MM","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"8976406","SUP","HCPCS C1713","","8976406  -  SCREW BN 4.5MM 6MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976412","SUP","HCPCS C1713","","8976412  -  SCREW BN 4.5MM 12MM NS VUEPOINT II SPNE OCPTL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976414","SUP","HCPCS C1713","","8976414  -  SCREW BN 4.5MM 14MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976435","SUP","HCPCS C1713","","8976435  -  CONNECTOR ROD OFST 3.5MM NS VUEPOINT II SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976455","SUP","HCPCS C1713","","8976455  -  CONNECTOR ROD OFST 3.5-5.5MM NS VUEPOINT II SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8976506","SUP","HCPCS C1713","","8976506  -  SCREW BN 5MM 6MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976508","SUP","HCPCS C1713","","8976508  -  SCREW BN 5MM 8MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976510","SUP","HCPCS C1713","","8976510  -  SCREW BN 5MM 10MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976512","SUP","HCPCS C1713","","8976512  -  SCREW BN 5MM 12MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8976514","SUP","HCPCS C1713","","8976514  -  SCREW BN 5MM 14MM VUEPOINT II SPNE OCPTL CORT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"8977010","SUP","Custom 27203010","","8977010  -  DRILL BIT VUE POINT 2 2.4MM","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8977035","SUP","HCPCS C1713","","8977035  -  SCREW TAP VUE POINT 3.5MM","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"8977040","SUP","HCPCS C1713","","8977040  -  SCREW TAP VUE POINT 4.0MM","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"9000027","SUP","Custom 27203010","","9000027  -  SPIDER FLEX SERRATED GRASPER","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9000028","SUP","Custom 27203010","","9000028  -  SPIDER FLEX MARYLAND DISSECTOR","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9000031","SUP","Custom 27203010","","9000031  -  SPIDER FLEX MONOPOLAR HOOK","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9000240","SUP","HCPCS C1713","","9000240  -  SCREW BONE 40MM CANN TITANIUM 12MM SACROILIAC","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,000.00 ","$4,950.00 ","$0.00 ","$2,292.68 ","$0.00 ","$0.00 ","$1,926.01 ","$11,000.00 ","$0.00 ","$5,500.00 ","$8,712.00 ","$8,800.00 ","$0.00 ","$1,721.50 ","$0.00 ","$1,751.20 ","$0.00 "
"9000250","SUP","HCPCS C1713","","9000250  -  SCREW BONE 12MM 50MM TI SACROILIAC CANN","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,000.00 ","$4,950.00 ","$0.00 ","$2,292.68 ","$0.00 ","$0.00 ","$1,926.01 ","$11,000.00 ","$0.00 ","$5,500.00 ","$8,712.00 ","$8,800.00 ","$0.00 ","$1,721.50 ","$0.00 ","$1,751.20 ","$0.00 "
"9001635","SUP","HCPCS C1713","","9001635  -  SCREW BONE 1.6MM 35MM TIMESH TI SPNL","BOTH IP/OP","$146.20 ","$108.19 ","$0.00 ","$146.20 ","$65.79 ","$0.00 ","$30.47 ","$0.00 ","$0.00 ","$25.60 ","$146.20 ","$0.00 ","$73.10 ","$115.79 ","$116.96 ","$0.00 ","$22.88 ","$0.00 ","$23.28 ","$0.00 "
"9001640","SUP","HCPCS C1713","","9001640  -  SCREW BONE 1.6MM 4MM TI SPNL SLFDRILL STRL","BOTH IP/OP","$731.00 ","$540.94 ","$0.00 ","$731.00 ","$328.95 ","$0.00 ","$152.36 ","$0.00 ","$0.00 ","$127.99 ","$731.00 ","$0.00 ","$365.50 ","$578.95 ","$584.80 ","$0.00 ","$114.40 ","$0.00 ","$116.38 ","$0.00 "
"9002196","SUP","Custom 27203010","","9002196  -  KIT NDL GD 21GA 96IN STRT US","BOTH IP/OP","$68.43 ","$50.64 ","$0.00 ","$53.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011221","SUP","Custom 27803010","","9011221  -  CAGE SPNL 12MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011225","SUP","Custom 27803010","","9011225  -  CAGE SPNL 12MM 25MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011420","SUP","Custom 27803010","","9011420  -  CAGE SPNL 14MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011423","SUP","Custom 27803010","","9011423  -  CAGE SPNL 14MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011426","SUP","Custom 27803010","","9011426  -  CAGE SPNL 14MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011429","SUP","Custom 27803010","","9011429  -  CAGE SPNL 14MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011620","SUP","Custom 27803010","","9011620  -  CAGE SPNL 16MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011623","SUP","Custom 27803010","","9011623  -  CAGE SPNL 16MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011626","SUP","Custom 27803010","","9011626  -  CAGE SPNL 16MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011629","SUP","Custom 27803010","","9011629  -  CAGE SPNL 16MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011635","SUP","HCPCS C1713","","9011635  -  SCREW 9011635 TIMESH 1.6X3.5MM SDS OPT 1","BOTH IP/OP","$127.50 ","$94.35 ","$0.00 ","$127.50 ","$57.38 ","$0.00 ","$26.57 ","$0.00 ","$0.00 ","$22.32 ","$127.50 ","$0.00 ","$63.75 ","$100.98 ","$102.00 ","$0.00 ","$19.95 ","$0.00 ","$20.30 ","$0.00 "
"9011640","SUP","HCPCS C1713","","9011640  -  SCREW 9011640 TIMESH 1.6X4.0MM SDS OPT 1","BOTH IP/OP","$129.63 ","$95.93 ","$0.00 ","$129.63 ","$58.33 ","$0.00 ","$27.02 ","$0.00 ","$0.00 ","$22.70 ","$129.63 ","$0.00 ","$64.81 ","$102.67 ","$103.70 ","$0.00 ","$20.29 ","$0.00 ","$20.64 ","$0.00 "
"9011820","SUP","Custom 27803010","","9011820  -  CAGE SPNL 18MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011823","SUP","Custom 27803010","","9011823  -  CAGE SPNL 18MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011826","SUP","Custom 27803010","","9011826  -  CAGE SPNL 18MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9011829","SUP","Custom 27803010","","9011829  -  CAGE SPNL 18MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012020","SUP","Custom 27803010","","9012020  -  CAGE SPNL 20MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012023","SUP","Custom 27803010","","9012023  -  CAGE SPNL 20MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012026","SUP","Custom 27803010","","9012026  -  CAGE SPNL 20MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012029","SUP","Custom 27803010","","9012029  -  CAGE SPNL 20MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012220","SUP","Custom 27803010","","9012220  -  CAGE SPNL 22MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012223","SUP","Custom 27803010","","9012223  -  CAGE SPNL 22MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012226","SUP","Custom 27803010","","9012226  -  CAGE SPNL 22MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012229","SUP","Custom 27803010","","9012229  -  CAGE SPNL 22MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012420","SUP","Custom 27803010","","9012420  -  CAGE SPNL 24MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012423","SUP","Custom 27803010","","9012423  -  CAGE SPNL 24MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012426","SUP","Custom 27803010","","9012426  -  CAGE SPNL 24MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9012429","SUP","Custom 27803010","","9012429  -  CAGE SPNL 24MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9050012","SUP","HCPCS C1781","","9050012  -  CAGE SPNL 12MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050014","SUP","HCPCS C1781","","9050014  -  CAGE SPNL 14MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050016","SUP","HCPCS C1781","","9050016  -  CAGE SPNL 16MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050018","SUP","HCPCS C1781","","9050018  -  CAGE SPNL 18MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050020","SUP","HCPCS C1781","","9050020  -  CAGE SPNL 20MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050413","SUP","HCPCS C1781","","9050413  -  CAGE SPNL OVOID 14X13X10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050414","SUP","HCPCS C1781","","9050414  -  CAGE SPNL OVOID 14X14X10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050450","SUP","HCPCS C1781","","9050450  -  MESH 9050450 PYRAMESH IMP 10MMX14MMX50MM","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9050513","SUP","HCPCS C1781","","9050513  -  CAGE SPNL OVOID 17X13X13MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050514","SUP","HCPCS C1781","","9050514  -  CAGE SPNL OVOID 17X13X14MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9050700","SUP","Custom 27203010","","9050700  -  INSTRUMENT 9050700 PYMSH END CAP INSERT","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9050713","SUP","HCPCS C1781","","9050713  -  MESH 9050713  PYMSH IMPL 13MM END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"9050716","SUP","HCPCS C1781","","9050716  -  MESH 9050716  PYMSH IMPL 16MM END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"9050719","SUP","HCPCS C1781","","9050719  -  MESH 9050719  PYMSH IMPL 19MM END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"9050722","SUP","HCPCS C1781","","9050722  -  MESH 9050722 PYMSH IMPL 22MM END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"9050725","SUP","HCPCS C1781","","9050725  -  MESH 9050725 PYMSH IMPL 25MM END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"9050823","SUP","HCPCS C1781","","9050823  -  CAGE SPNL OVOID 24X10X8MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051009","SUP","HCPCS C1781","","9051009  -  CAGE SPNL RND 10MM 9MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"9051011","SUP","HCPCS C1781","","9051011  -  CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"9051013","SUP","HCPCS C1781","","9051013  -  CAGE SPNL 13MMX10MM PRMSH LMBR INTRBD FS RND TI","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"9051014","SUP","HCPCS C1781","","9051014  -  CAGE SPNL RND 10MM 14MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"9051023","SUP","HCPCS C1781","","9051023  -  CAGE SPNL RND 10MM 23MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051050","SUP","HCPCS C1781","","9051050  -  CAGE SPNL RND 10MM 50MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9051223","SUP","HCPCS C1781","","9051223  -  CAGE SPNL RND 12MM 23MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051314","SUP","HCPCS C1781","","9051314  -  CAGE SPNL RND 13MM 14MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"9051315","SUP","HCPCS C1781","","9051315  -  CAGE SPNL RND 13MM 15MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"9051350","SUP","HCPCS C1781","","9051350  -  MESH 9051350 PYRAMESH IMP 13MMX50MM RND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9051423","SUP","HCPCS C1781","","9051423  -  CAGE SPNL RND 14MM 23MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051690","SUP","HCPCS C1781","","9051690  -  CAGE SPNL RND 16MM 90MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9051710","SUP","HCPCS C1781","","9051710  -  CAGE SPNL OVOID 22X17X10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051715","SUP","HCPCS C1781","","9051715  -  CAGE SPNL OVOID 22X17X15MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051730","SUP","HCPCS C1781","","9051730  -  CAGE SPNL RND 22MM 30MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051750","SUP","HCPCS C1781","","9051750  -  CAGE SPNL OVOID 22X17X50MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9051770","SUP","HCPCS C1781","","9051770  -  CAGE SPNL OVOID 22X17X70MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9051790","SUP","HCPCS C1781","","9051790  -  CAGE SPNL OVOID 22X17X90MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9051915","SUP","HCPCS C1781","","9051915  -  CAGE SPNL RND 15MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9051918","SUP","HCPCS C1781","","9051918  -  CAGE SPNL RND 18MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052205","SUP","HCPCS C1781","","9052205  -  CAGE SPNL RND 22MM 15MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052208","SUP","HCPCS C1781","","9052208  -  MESH 9052208 PYRMSH IMPL 22MM AGL 13X18","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052215","SUP","HCPCS C1781","","9052215  -  MESH 9052215 PYRAMESH IMPLT 22MMX15MM RD","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052230","SUP","HCPCS C1781","","9052230  -  MESH 9052230 PYRAMESH IMPLT 22MMX30MM RD","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052250","SUP","HCPCS C1781","","9052250  -  CAGE SPNL RND 22MM 50MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9052270","SUP","HCPCS C1781","","9052270  -  MESH 9052270  PYRM IMPLANT 22MMX70MM RND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9052290","SUP","HCPCS C1781","","9052290  -  MESH 9052290 PYRAMESH IMP 22MMX90MM RND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9052315","SUP","HCPCS C1781","","9052315  -  MESH 9052315 PYMSH IMPL 23X27 AGL 10X15","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052318","SUP","HCPCS C1781","","9052318  -  MESH 9052318 PYMSH IMPL 25X27 AGL 13X18","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052518","SUP","HCPCS C1781","","9052518  -  MESH 9052518 PYRMSH IMPL 25MM AGL 13X18","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052815","SUP","HCPCS C1781","","9052815  -  MESH 9052815 PYRAMESH IMP 22MMX28MMX15MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"9052830","SUP","HCPCS C1781","","9052830  -  MESH 9052830 PYRAMESH IMP 22MMX28MMX30MM","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9052850","SUP","HCPCS C1781","","9052850  -  MESH SRG OVOID 50X28X22MM NS PRMSH CG TI","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9052870","SUP","HCPCS C1781","","9052870  -  PYRAMESH IMPL 22MMX28MMX70MM","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"9052890","SUP","HCPCS C1781","","9052890  -  CAGE SPNL OVOID 28X22X90MM PRMSH HLW CNTR OP-EN TI LMBR","BOTH IP/OP","$16,827.60 ","$12,452.42 ","$0.00 ","$16,827.60 ","$7,572.42 ","$0.00 ","$3,507.29 ","$0.00 ","$0.00 ","$2,946.38 ","$16,827.60 ","$0.00 ","$8,413.80 ","$13,327.46 ","$13,462.08 ","$0.00 ","$2,633.52 ","$0.00 ","$2,678.95 ","$0.00 "
"9059104","SUP","Custom 27203010","","9059104  -  DISPOSABLE 9059104 MESH CUTTER BLADE","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9098526","SUP","HCPCS C1713","","9098526  -  SCREW BONE 4MM 26MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098530","SUP","HCPCS C1713","","9098530  -  SCREW BONE 4MM 30MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098534","SUP","HCPCS C1713","","9098534  -  SCREW BONE 4MM 34MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098538","SUP","HCPCS C1713","","9098538  -  SCREW BONE 4MM 38MM CORTEX SPN","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098540","SUP","HCPCS C1713","","9098540  -  SCREW BONE 4MM 40MM CORTEX SPN","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098542","SUP","HCPCS C1713","","9098542  -  SCREW BONE 4MM 42MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098544","SUP","HCPCS C1713","","9098544  -  SCREW BONE 4MM 44MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098546","SUP","HCPCS C1713","","9098546  -  SCREW BONE 4MM 46MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098548","SUP","HCPCS C1713","","9098548  -  SCREW BONE 4MM 48MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098550","SUP","HCPCS C1713","","9098550  -  SCREW BONE 4MM 50MM CORTEX SPN","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098552","SUP","HCPCS C1713","","9098552  -  SCREW BONE 4MM 52MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098554","SUP","HCPCS C1713","","9098554  -  SCREW BONE 4MM 54MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098556","SUP","HCPCS C1713","","9098556  -  SCREW BONE 4MM 56MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098558","SUP","HCPCS C1713","","9098558  -  SCREW BONE 4MM 58MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9098560","SUP","HCPCS C1713","","9098560  -  SCREW BONE 4MM 60MM CORT SPNL","BOTH IP/OP","$1,384.50 ","$1,024.53 ","$0.00 ","$1,384.50 ","$623.03 ","$0.00 ","$288.56 ","$0.00 ","$0.00 ","$242.41 ","$1,384.50 ","$0.00 ","$692.25 ","$1,096.52 ","$1,107.60 ","$0.00 ","$216.67 ","$0.00 ","$220.41 ","$0.00 "
"9164400","SUP","Custom 27803010","","9164400  -  CONNECTOR 9164400 CDH 4.5 DOMINO","BOTH IP/OP","$1,506.00 ","$1,114.44 ","$0.00 ","$1,506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,506.00 ","$0.00 ","$753.00 ","$1,192.75 ","$1,204.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9192507","SUP","HCPCS C1713","","9192507  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X7MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192508","SUP","HCPCS C1713","","9192508  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X8MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192509","SUP","HCPCS C1713","","9192509  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X9MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192510","SUP","HCPCS C1713","","9192510  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X10MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192511","SUP","HCPCS C1713","","9192511  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X11MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192512","SUP","HCPCS C1713","","9192512  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X12MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192513","SUP","HCPCS C1713","","9192513  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X13MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192514","SUP","HCPCS C1713","","9192514  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X14MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9192515","SUP","HCPCS C1713","","9192515  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X15MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193007","SUP","HCPCS C1713","","9193007  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X7MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193008","SUP","HCPCS C1713","","9193008  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X8MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193009","SUP","HCPCS C1713","","9193009  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X9MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193010","SUP","HCPCS C1713","","9193010  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X10MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193011","SUP","HCPCS C1713","","9193011  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X11MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193012","SUP","HCPCS C1713","","9193012  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X12MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193013","SUP","HCPCS C1713","","9193013  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X13MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193014","SUP","HCPCS C1713","","9193014  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X14MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193015","SUP","HCPCS C1713","","9193015  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X15MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193607","SUP","HCPCS C1713","","9193607  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X7MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193608","SUP","HCPCS C1713","","9193608  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X8MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193609","SUP","HCPCS C1713","","9193609  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X9MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193610","SUP","HCPCS C1713","","9193610  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X10MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193611","SUP","HCPCS C1713","","9193611  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X11MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193612","SUP","HCPCS C1713","","9193612  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X12MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193613","SUP","HCPCS C1713","","9193613  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X13MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193614","SUP","HCPCS C1713","","9193614  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X14MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9193615","SUP","HCPCS C1713","","9193615  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X15MM VRTSTCK CRSNT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9206768","SUP","HCPCS C1713","","9206768  -  PLATE BN 90D STD L 4MM 9 HL BAR CRNMXF LT","BOTH IP/OP","$1,315.00 ","$973.10 ","$0.00 ","$1,315.00 ","$591.75 ","$0.00 ","$274.08 ","$0.00 ","$0.00 ","$230.25 ","$1,315.00 ","$0.00 ","$657.50 ","$1,041.48 ","$1,052.00 ","$0.00 ","$205.80 ","$0.00 ","$209.35 ","$0.00 "
"9240100","SUP","HCPCS C1713","","9240100  -  PLATE 9240100 SPINOUS PROCESS","BOTH IP/OP","$8,608.50 ","$6,370.29 ","$0.00 ","$8,608.50 ","$3,873.83 ","$0.00 ","$1,794.23 ","$0.00 ","$0.00 ","$1,507.28 ","$8,608.50 ","$0.00 ","$4,304.25 ","$6,817.93 ","$6,886.80 ","$0.00 ","$1,347.23 ","$0.00 ","$1,370.47 ","$0.00 "
"9240150","SUP","HCPCS C1713","","9240150  -  SCREW 9240150 M4 BREAKOFFS","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9240200","SUP","HCPCS C1713","","9240200  -  PLATE  9240200 35MM SPIRE","BOTH IP/OP","$8,608.50 ","$6,370.29 ","$0.00 ","$8,608.50 ","$3,873.83 ","$0.00 ","$1,794.23 ","$0.00 ","$0.00 ","$1,507.28 ","$8,608.50 ","$0.00 ","$4,304.25 ","$6,817.93 ","$6,886.80 ","$0.00 ","$1,347.23 ","$0.00 ","$1,370.47 ","$0.00 "
"9255562","SUP","HCPCS C1713","","9255562  -  PLATE BN 3D CRV 1.5MM 6X2 HL CRNMXF","BOTH IP/OP","$1,965.00 ","$1,454.10 ","$0.00 ","$1,965.00 ","$884.25 ","$0.00 ","$409.56 ","$0.00 ","$0.00 ","$344.06 ","$1,965.00 ","$0.00 ","$982.50 ","$1,556.28 ","$1,572.00 ","$0.00 ","$307.52 ","$0.00 ","$312.83 ","$0.00 "
"9330000","SUP","HCPCS C1713","","9330000  -  NUT LOCK VNTG SPNL TI LCK SCR SET STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9330001","SUP","HCPCS C1713","","9330001  -  STAPLE BONE 2 HOLE TI RSTRL VNTG STRL","BOTH IP/OP","$2,805.00 ","$2,075.70 ","$0.00 ","$2,805.00 ","$1,262.25 ","$0.00 ","$584.63 ","$0.00 ","$0.00 ","$491.13 ","$2,805.00 ","$0.00 ","$1,402.50 ","$2,221.56 ","$2,244.00 ","$0.00 ","$438.98 ","$0.00 ","$446.56 ","$0.00 "
"9330002","SUP","HCPCS C1713","","9330002  -  STAPLE BONE 2 HOLE TI CDL VNTG STRL","BOTH IP/OP","$2,805.00 ","$2,075.70 ","$0.00 ","$2,805.00 ","$1,262.25 ","$0.00 ","$584.63 ","$0.00 ","$0.00 ","$491.13 ","$2,805.00 ","$0.00 ","$1,402.50 ","$2,221.56 ","$2,244.00 ","$0.00 ","$438.98 ","$0.00 ","$446.56 ","$0.00 "
"9330003","SUP","HCPCS C1713","","9330003  -  STAPLE BONE 2 HOLE TI RSTRL VNTG STRL","BOTH IP/OP","$2,805.00 ","$2,075.70 ","$0.00 ","$2,805.00 ","$1,262.25 ","$0.00 ","$584.63 ","$0.00 ","$0.00 ","$491.13 ","$2,805.00 ","$0.00 ","$1,402.50 ","$2,221.56 ","$2,244.00 ","$0.00 ","$438.98 ","$0.00 ","$446.56 ","$0.00 "
"9330004","SUP","HCPCS C1713","","9330004  -  STAPLE BONE 2 HOLE TI CDL VNTG STRL","BOTH IP/OP","$2,805.00 ","$2,075.70 ","$0.00 ","$2,805.00 ","$1,262.25 ","$0.00 ","$584.63 ","$0.00 ","$0.00 ","$491.13 ","$2,805.00 ","$0.00 ","$1,402.50 ","$2,221.56 ","$2,244.00 ","$0.00 ","$438.98 ","$0.00 ","$446.56 ","$0.00 "
"9330040","SUP","HCPCS C1713","","9330040  -  PLATE 9330040 4CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330045","SUP","HCPCS C1713","","9330045  -  PLATE 9330045 4 5CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330050","SUP","HCPCS C1713","","9330050  -  PLATE 9330050 5CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330055","SUP","HCPCS C1713","","9330055  -  PLATE 9330055 5 5CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330060","SUP","HCPCS C1713","","9330060  -  PLATE BN 6CM VNTG SMTH TI SPNE THORLMBR ANT","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330065","SUP","HCPCS C1713","","9330065  -  PLATE 65MM TI LCK ATLNTS BONE ANT CERV SPN","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330070","SUP","HCPCS C1713","","9330070  -  PLATE 7CM TI LCK VNTG BONE LAT LMBR","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330075","SUP","HCPCS C1713","","9330075  -  PLATE 9330075 7 5CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330080","SUP","HCPCS C1713","","9330080  -  PLATE 9330080 8CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330085","SUP","HCPCS C1713","","9330085  -  PLATE 9330085 8 5CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330090","SUP","HCPCS C1713","","9330090  -  PLATE 9330090 9CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330095","SUP","HCPCS C1713","","9330095  -  PLATE 9330095 9 5CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9330100","SUP","HCPCS C1713","","9330100  -  PLATE 9330100 10CM ATL TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331025","SUP","Custom 27803010","","9331025  -  PLATE 25MM TI VNTG BONE ANT THORLMBR SPN STRL","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9331030","SUP","HCPCS C1713","","9331030  -  PLATE 9331030 3CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331035","SUP","HCPCS C1713","","9331035  -  PLATE 9331035 3 5CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331040","SUP","HCPCS C1713","","9331040  -  PLATE 9331040 4CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331045","SUP","HCPCS C1713","","9331045  -  PLATE 9331045 4 5CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331050","SUP","HCPCS C1713","","9331050  -  PLATE 9331050 5CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331055","SUP","HCPCS C1713","","9331055  -  PLATE BN 5.5CM VNTG SMTH TI SPNE THOR ANT","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331060","SUP","HCPCS C1713","","9331060  -  PLATE BN 6CM VNTG SMTH TI SPNE THOR ANT","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331065","SUP","HCPCS C1713","","9331065  -  PLATE 9331065 6 5CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331070","SUP","HCPCS C1713","","9331070  -  PLATE 9331070 7CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331075","SUP","HCPCS C1713","","9331075  -  PLATE 9331075 7CM THORACIC TI 5","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9331080","SUP","HCPCS C1713","","9331080  -  PLATE 9331080 8CM THORACIC TI","BOTH IP/OP","$6,778.50 ","$5,016.09 ","$0.00 ","$6,778.50 ","$3,050.33 ","$0.00 ","$1,412.81 ","$0.00 ","$0.00 ","$1,186.86 ","$6,778.50 ","$0.00 ","$3,389.25 ","$5,368.57 ","$5,422.80 ","$0.00 ","$1,060.84 ","$0.00 ","$1,079.14 ","$0.00 "
"9335515","SUP","HCPCS C1713","","9335515  -  SCREW 9335515 THORACIC 5.5X15MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335520","SUP","HCPCS C1713","","9335520  -  SCREW 9335520 THORACIC 5.5X20MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335525","SUP","HCPCS C1713","","9335525  -  SCREW 9335525 THORACIC 5.5X25MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335530","SUP","HCPCS C1713","","9335530  -  SCREW 9335530 THORACIC 5.5X30MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335535","SUP","HCPCS C1713","","9335535  -  SCREW BN 5.5MM 35MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335540","SUP","HCPCS C1713","","9335540  -  SCREW BN 5.5MM 40MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335545","SUP","HCPCS C1713","","9335545  -  SCREW 9335545 THORACIC 5.5X45MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9335550","SUP","HCPCS C1713","","9335550  -  SCREW 9335550 THORACIC 5.5X50MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336525","SUP","HCPCS C1713","","9336525  -  SCREW BONE 6.5MM 25MM ATLNTS TI ANT CERV SPN","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336530","SUP","HCPCS C1713","","9336530  -  SCREW 9336530 FAST ATL 6.5X30MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336535","SUP","HCPCS C1713","","9336535  -  SCREW BONE 6.5MM 35MM ATLNTS TI ANT CERV SPN","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336540","SUP","HCPCS C1713","","9336540  -  SCREW BN 6.5MM 40MM NS ATLNTS VNTG FST CLSR TI SPNE CRV ANT","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336545","SUP","HCPCS C1713","","9336545  -  SCREW 9336545 FAST ATL 6.5X45MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336550","SUP","HCPCS C1713","","9336550  -  SCREW 9336550 FAST ATL 6.5X50MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336555","SUP","HCPCS C1713","","9336555  -  SCREW 9336555 FAST ATL 6.5X55MM TI","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9336560","SUP","HCPCS C1713","","9336560  -  SCREW BONE 6.5MM 60MM ATLNTS TI ANT CERV SPN","BOTH IP/OP","$1,305.00 ","$965.70 ","$0.00 ","$1,305.00 ","$587.25 ","$0.00 ","$271.99 ","$0.00 ","$0.00 ","$228.50 ","$1,305.00 ","$0.00 ","$652.50 ","$1,033.56 ","$1,044.00 ","$0.00 ","$204.23 ","$0.00 ","$207.76 ","$0.00 "
"9338020","SUP","HCPCS C1713","","9338020  -  BOLT SPNL 20MM 8MM ANT","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338025","SUP","HCPCS C1713","","9338025  -  BOLT SPNL 25MM 8MM VNTG TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338030","SUP","HCPCS C1713","","9338030  -  BOLT SPNL 30MM 8MM ANT TI SGL","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338035","SUP","HCPCS C1713","","9338035  -  SCREW BONE 8MM 35MM TI ANT SPN","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338040","SUP","HCPCS C1713","","9338040  -  BOLT SPNL 40MM 8MM VNTG TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338045","SUP","HCPCS C1713","","9338045  -  SCREW BONE 8MM 45MM TI ANT SPN","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338050","SUP","HCPCS C1713","","9338050  -  BOLT SPNL 50MM 8MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338055","SUP","HCPCS C1713","","9338055  -  BOLT SPNL 55MM 8MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338920","SUP","HCPCS C1713","","9338920  -  BOLT SPNL 20MM 9MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338925","SUP","HCPCS C1713","","9338925  -  BOLT SPNL 25MM 9MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338930","SUP","HCPCS C1713","","9338930  -  BOLT SPNL 30MM 9MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338935","SUP","HCPCS C1713","","9338935  -  BOLT SPNL 35MM 6MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338940","SUP","HCPCS C1713","","9338940  -  BOLT SPNL 40MM 9MM SGL","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338945","SUP","HCPCS C1713","","9338945  -  BOLT SPNL 45MM 9MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338950","SUP","HCPCS C1713","","9338950  -  BOLT SPNL 50MM 9MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9338955","SUP","HCPCS C1713","","9338955  -  BOLT SPNL 55MM 9MM TI","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9391316","SUP","HCPCS C1713","","9391316  -  CAGE SPNL 13MM 16MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391319","SUP","HCPCS C1713","","9391319  -  CAGE SPNL 13MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391322","SUP","HCPCS C1713","","9391322  -  CAGE SPNL 13MM 22MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391326","SUP","HCPCS C1713","","9391326  -  CAGE SPNL 13MM 26MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391332","SUP","HCPCS C1713","","9391332  -  CAGE SPNL 13MM 32MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391341","SUP","HCPCS C1713","","9391341  -  CAGE SPNL 13MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391617","SUP","HCPCS C1713","","9391617  -  CAGE SPNL 16MM 17MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391620","SUP","HCPCS C1713","","9391620  -  CENTERPIECE 9391620 16 X 20MM 16B","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391623","SUP","HCPCS C1713","","9391623  -  CAGE SPNL 16MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391628","SUP","HCPCS C1713","","9391628  -  CAGE SPNL 16MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$9,968.75 ","$7,376.88 ","$0.00 ","$9,968.75 ","$4,485.94 ","$0.00 ","$2,077.74 ","$0.00 ","$0.00 ","$1,745.45 ","$9,968.75 ","$0.00 ","$4,984.38 ","$7,895.25 ","$7,975.00 ","$0.00 ","$1,560.11 ","$0.00 ","$1,587.03 ","$0.00 "
"9391633","SUP","HCPCS C1713","","9391633  -  CAGE SPNL 16MM 33MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391641","SUP","HCPCS C1713","","9391641  -  CAGE SPNL 16MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391919","SUP","HCPCS C1713","","9391919  -  CAGE SPNL 19MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391923","SUP","HCPCS C1713","","9391923  -  CAGE SPNL 19MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391928","SUP","HCPCS C1713","","9391928  -  CAGE SPNL 19MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391936","SUP","HCPCS C1713","","9391936  -  CAGE SPNL 19MM 36MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9391947","SUP","HCPCS C1713","","9391947  -  CAGE SPNL 19MM 47MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$13,406.25 ","$9,920.63 ","$0.00 ","$13,406.25 ","$6,032.81 ","$0.00 ","$2,794.20 ","$0.00 ","$0.00 ","$2,347.33 ","$13,406.25 ","$0.00 ","$6,703.13 ","$10,617.75 ","$10,725.00 ","$0.00 ","$2,098.08 ","$0.00 ","$2,134.28 ","$0.00 "
"9391969","SUP","HCPCS C1713","","9391969  -  CAGE SPNL 19MM 69MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$13,406.25 ","$9,920.63 ","$0.00 ","$13,406.25 ","$6,032.81 ","$0.00 ","$2,794.20 ","$0.00 ","$0.00 ","$2,347.33 ","$13,406.25 ","$0.00 ","$6,703.13 ","$10,617.75 ","$10,725.00 ","$0.00 ","$2,098.08 ","$0.00 ","$2,134.28 ","$0.00 "
"9392221","SUP","HCPCS C1713","","9392221  -  CAGE SPNL 22MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392225","SUP","HCPCS C1713","","9392225  -  CAGE SPNL 22MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392231","SUP","HCPCS C1713","","9392231  -  CAGE SPNL 22MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392237","SUP","HCPCS C1713","","9392237  -  CAGE SPNL 22MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392248","SUP","HCPCS C1713","","9392248  -  CAGE SPNL 22MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$13,406.25 ","$9,920.63 ","$0.00 ","$13,406.25 ","$6,032.81 ","$0.00 ","$2,794.20 ","$0.00 ","$0.00 ","$2,347.33 ","$13,406.25 ","$0.00 ","$6,703.13 ","$10,617.75 ","$10,725.00 ","$0.00 ","$2,098.08 ","$0.00 ","$2,134.28 ","$0.00 "
"9392268","SUP","HCPCS C1713","","9392268  -  CAGE SPNL 22MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$13,406.25 ","$9,920.63 ","$0.00 ","$13,406.25 ","$6,032.81 ","$0.00 ","$2,794.20 ","$0.00 ","$0.00 ","$2,347.33 ","$13,406.25 ","$0.00 ","$6,703.13 ","$10,617.75 ","$10,725.00 ","$0.00 ","$2,098.08 ","$0.00 ","$2,134.28 ","$0.00 "
"9392507","SUP","HCPCS C1713","","9392507  -  SPACER SPNL 25MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392508","SUP","HCPCS C1713","","9392508  -  SPACER SPNL 25MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392509","SUP","HCPCS C1713","","9392509  -  SPACER SPNL 25MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392510","SUP","HCPCS C1713","","9392510  -  SPACER SPNL 25MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392511","SUP","HCPCS C1713","","9392511  -  SPACER SPNL 25MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392512","SUP","HCPCS C1713","","9392512  -  SPACER SPNL 25MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392513","SUP","HCPCS C1713","","9392513  -  SPACER SPNL 25MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392514","SUP","HCPCS C1713","","9392514  -  SPACER SPNL 25MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392515","SUP","HCPCS C1713","","9392515  -  SPACER SPNL 25MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9392521","SUP","HCPCS C1713","","9392521  -  CAGE SPNL 25MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392525","SUP","HCPCS C1713","","9392525  -  CAGE SPNL 25MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392531","SUP","HCPCS C1713","","9392531  -  CAGE SPNL 25MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392537","SUP","HCPCS C1713","","9392537  -  CAGE SPNL 25MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$11,687.50 ","$8,648.75 ","$0.00 ","$11,687.50 ","$5,259.38 ","$0.00 ","$2,435.97 ","$0.00 ","$0.00 ","$2,046.39 ","$11,687.50 ","$0.00 ","$5,843.75 ","$9,256.50 ","$9,350.00 ","$0.00 ","$1,829.09 ","$0.00 ","$1,860.65 ","$0.00 "
"9392548","SUP","HCPCS C1713","","9392548  -  CAGE SPNL 25MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$13,406.25 ","$9,920.63 ","$0.00 ","$13,406.25 ","$6,032.81 ","$0.00 ","$2,794.20 ","$0.00 ","$0.00 ","$2,347.33 ","$13,406.25 ","$0.00 ","$6,703.13 ","$10,617.75 ","$10,725.00 ","$0.00 ","$2,098.08 ","$0.00 ","$2,134.28 ","$0.00 "
"9392568","SUP","HCPCS C1713","","9392568  -  CAGE SPNL 25MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR","BOTH IP/OP","$13,406.25 ","$9,920.63 ","$0.00 ","$13,406.25 ","$6,032.81 ","$0.00 ","$2,794.20 ","$0.00 ","$0.00 ","$2,347.33 ","$13,406.25 ","$0.00 ","$6,703.13 ","$10,617.75 ","$10,725.00 ","$0.00 ","$2,098.08 ","$0.00 ","$2,134.28 ","$0.00 "
"9393007","SUP","HCPCS C1713","","9393007  -  SPACER SPNL 30MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393008","SUP","HCPCS C1713","","9393008  -  SPACER SPNL 30MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393009","SUP","HCPCS C1713","","9393009  -  SPACER SPNL 30MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393010","SUP","HCPCS C1713","","9393010  -  SPACER SPNL 30MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393011","SUP","HCPCS C1713","","9393011  -  SPACER SPNL 30MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393012","SUP","HCPCS C1713","","9393012  -  SPACER SPNL 30MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393013","SUP","HCPCS C1713","","9393013  -  SPACER SPNL 30MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393014","SUP","HCPCS C1713","","9393014  -  SPACER SPNL 30MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393015","SUP","HCPCS C1713","","9393015  -  SPACER SPNL 30MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393607","SUP","HCPCS C1713","","9393607  -  SPACER SPNL 36MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393608","SUP","HCPCS C1713","","9393608  -  SPACER SPNL 36MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393609","SUP","HCPCS C1713","","9393609  -  SPACER SPNL 36MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393610","SUP","HCPCS C1713","","9393610  -  SPACER SPNL 36MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393611","SUP","HCPCS C1713","","9393611  -  SPACER SPNL 36MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393612","SUP","HCPCS C1713","","9393612  -  SPACER SPNL 36MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393613","SUP","HCPCS C1713","","9393613  -  SPACER SPNL 36MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393614","SUP","HCPCS C1713","","9393614  -  SPACER SPNL 36MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9393615","SUP","HCPCS C1713","","9393615  -  SPACER SPNL 36MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"9401300","SUP","HCPCS C1713","","9401300  -  END CAP 9401300 13MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401304","SUP","HCPCS C1713","","9401304  -  END CAP 9401304 13MM 4 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401308","SUP","HCPCS C1713","","9401308  -  END CAP 9401308 13MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401315","SUP","HCPCS C1713","","9401315  -  END CAP 9401315 13MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401600","SUP","HCPCS C1713","","9401600  -  END CAP 9401600 16MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401604","SUP","HCPCS C1713","","9401604  -  END CAP 9401604 16MM 4 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401608","SUP","HCPCS C1713","","9401608  -  END CAP 9401608 16MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401615","SUP","HCPCS C1713","","9401615  -  END CAP 9401615 16MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401900","SUP","HCPCS C1713","","9401900  -  END CAP 9401900 19MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401904","SUP","HCPCS C1713","","9401904  -  END CAP 9401904 19MM 4 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401908","SUP","HCPCS C1713","","9401908  -  END CAP 9401908 19MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9401915","SUP","HCPCS C1713","","9401915  -  END CAP 9401915 19MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402200","SUP","HCPCS C1713","","9402200  -  END CAP 9402200 22MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402204","SUP","HCPCS C1713","","9402204  -  CAGE SPNL 4D 22MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402208","SUP","HCPCS C1713","","9402208  -  END CAP 9402208 22MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402215","SUP","HCPCS C1713","","9402215  -  END CAP 9402215 22MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402500","SUP","HCPCS C1713","","9402500  -  END CAP 9402500 25MM 0 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402504","SUP","HCPCS C1713","","9402504  -  CAGE SPNL 4D 25MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402508","SUP","HCPCS C1713","","9402508  -  END CAP 9402508 25MM 8 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9402515","SUP","HCPCS C1713","","9402515  -  END CAP 9402515 25MM 15 DEGREE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"9450002","SUP","Custom 27203010","","9450002  -  DISPOSABLE 9450002 ELECTRO LOW IMPED22MM","BOTH IP/OP","$669.00 ","$495.06 ","$0.00 ","$669.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$669.00 ","$0.00 ","$334.50 ","$529.85 ","$535.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9450003","SUP","Custom 27203010","","9450003  -  DISPOSABLE 9450003 ELECTRO TWST PAIR 8CH","BOTH IP/OP","$936.00 ","$692.64 ","$0.00 ","$936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$936.00 ","$0.00 ","$468.00 ","$741.31 ","$748.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9450019","SUP","Custom 27203010","","9450019  -  DISPOSABLE 9450019 NIM PED PROBE THORAC","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9450020","SUP","Custom 27203010","","9450020  -  NEEDLE SPNL STRL LF NIM-SPNE ACC PDCL DISP","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9450047","SUP","Custom 27203010","","9450047  -  DISPOSABLE 9450047 NEW PED PROBE LMBR","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9450051","SUP","Custom 27203010","","9450051  -  DISPOSABLE 9450051 NIM 2.3MM BLL TIP PRB","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560551","SUP","Custom 27203010","","9560551  -  INSTRUMENT 9560551 METRX SHTHD KNF BLDE","BOTH IP/OP","$645.00 ","$477.30 ","$0.00 ","$645.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$645.00 ","$0.00 ","$322.50 ","$510.84 ","$516.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560658","SUP","Custom 27203010","","9560658  -  INSTRUMENT 9560658 QUADRANT ILLUMIN SYS","BOTH IP/OP","$1,207.50 ","$893.55 ","$0.00 ","$1,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,207.50 ","$0.00 ","$603.75 ","$956.34 ","$966.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560659","SUP","Custom 27203010","","9560659  -  KNIFE SRG BYNT STRL MTRX SPNE CRV ANT DISP DSCTMY","BOTH IP/OP","$781.50 ","$578.31 ","$0.00 ","$781.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$781.50 ","$0.00 ","$390.75 ","$618.95 ","$625.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560702","SUP","Custom 27203010","","9560702  -  INSTRUMENT 9560702 RADIANCE ILLUMIN SYS","BOTH IP/OP","$1,062.00 ","$785.88 ","$0.00 ","$1,062.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,062.00 ","$0.00 ","$531.00 ","$841.10 ","$849.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560703","SUP","Custom 27203010","","9560703  -  INSTRUMENT 9560703 DISP 22MMX3CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560704","SUP","Custom 27203010","","9560704  -  INSTRUMENT 9560704 DISP 22MMX4CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560705","SUP","Custom 27203010","","9560705  -  INSTRUMENT 9560705 DISP 22MMX5CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560706","SUP","Custom 27203010","","9560706  -  INSTRUMENT 9560706 DISP 22MMX6CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560707","SUP","Custom 27203010","","9560707  -  INSTRUMENT 9560707 DISP 22MMX7CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560708","SUP","Custom 27203010","","9560708  -  INSTRUMENT 9560708 DISP 22MMX8CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560709","SUP","Custom 27203010","","9560709  -  INSTRUMENT 9560709 DISP 22MMX9CM RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560757","SUP","Custom 27203010","","9560757  -  INSTRUMENT 9560757 RDINCEXILLUMIN SYS","BOTH IP/OP","$1,290.00 ","$954.60 ","$0.00 ","$1,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,290.00 ","$0.00 ","$645.00 ","$1,021.68 ","$1,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9560802","SUP","Custom 27803010","","9560802  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$958.50 ","$709.29 ","$0.00 ","$958.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$958.50 ","$0.00 ","$479.25 ","$759.13 ","$766.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561424","SUP","Custom 27203010","","9561424  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$921.00 ","$681.54 ","$0.00 ","$921.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$921.00 ","$0.00 ","$460.50 ","$729.43 ","$736.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561426","SUP","Custom 27203010","","9561426  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561427","SUP","Custom 27203010","","9561427  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561428","SUP","Custom 27203010","","9561428  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561523","SUP","Custom 27203010","","9561523  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$5,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,940.00 ","$0.00 ","$2,970.00 ","$4,704.48 ","$4,752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561524","SUP","Custom 27203010","","9561524  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$8,920.50 ","$6,601.17 ","$0.00 ","$8,920.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,920.50 ","$0.00 ","$4,460.25 ","$7,065.04 ","$7,136.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561525","SUP","Custom 27203010","","9561525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,314.50 ","$1,712.73 ","$0.00 ","$2,314.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,314.50 ","$0.00 ","$1,157.25 ","$1,833.08 ","$1,851.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561526","SUP","Custom 27203010","","9561526  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561813","SUP","Custom 27203010","","9561813  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561814","SUP","Custom 27203010","","9561814  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561815","SUP","Custom 27203010","","9561815  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561816","SUP","Custom 27203010","","9561816  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561817","SUP","Custom 27203010","","9561817  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561818","SUP","Custom 27203010","","9561818  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9561819","SUP","Custom 27203010","","9561819  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562613","SUP","Custom 27203010","","9562613  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562614","SUP","Custom 27203010","","9562614  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$631.50 ","$467.31 ","$0.00 ","$631.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.50 ","$0.00 ","$315.75 ","$500.15 ","$505.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562615","SUP","Custom 27203010","","9562615  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562616","SUP","Custom 27203010","","9562616  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562617","SUP","Custom 27203010","","9562617  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562618","SUP","Custom 27203010","","9562618  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9562619","SUP","Custom 27203010","","9562619  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569575","SUP","Custom 27203010","","9569575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569813","SUP","Custom 27203010","","9569813  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569814","SUP","Custom 27203010","","9569814  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569815","SUP","Custom 27203010","","9569815  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569816","SUP","Custom 27203010","","9569816  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569817","SUP","Custom 27203010","","9569817  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569818","SUP","Custom 27203010","","9569818  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9569819","SUP","Custom 27203010","","9569819  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$681.00 ","$503.94 ","$0.00 ","$681.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$681.00 ","$0.00 ","$340.50 ","$539.35 ","$544.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9680050","SUP","Custom 27203010","","9680050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,451.00 ","$1,813.74 ","$0.00 ","$2,451.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,451.00 ","$0.00 ","$1,225.50 ","$1,941.19 ","$1,960.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9680853","SUP","HCPCS C1713","","9680853  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"9680854","SUP","HCPCS C1713","","9680854  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9680855","SUP","HCPCS C1713","","9680855  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9690030","SUP","HCPCS C1713","","9690030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690040","SUP","HCPCS C1713","","9690040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690050","SUP","HCPCS C1713","","9690050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690060","SUP","HCPCS C1713","","9690060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690070","SUP","HCPCS C1713","","9690070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690080","SUP","HCPCS C1713","","9690080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690090","SUP","HCPCS C1713","","9690090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690100","SUP","HCPCS C1713","","9690100  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690110","SUP","HCPCS C1713","","9690110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"9690853","SUP","HCPCS C1713","","9690853  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9690854","SUP","HCPCS C1713","","9690854  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9690855","SUP","HCPCS C1713","","9690855  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"9733065","SUP","Custom 27203010","","9733065  -  SYSTEM GUIDANCE EXTERNAL TRAJECTORY KIT NAVIGUS","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9733068","SUP","Custom 27203010","","9733068  -  KIT BIOP NEEDLE PASSIVE NAVIGUS","BOTH IP/OP","$1,562.50 ","$1,156.25 ","$0.00 ","$1,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,562.50 ","$0.00 ","$781.25 ","$1,237.50 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9733497","SUP","Custom 27203010","","9733497  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,642.50 ","$1,215.45 ","$0.00 ","$1,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,642.50 ","$0.00 ","$821.25 ","$1,300.86 ","$1,314.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9733498","SUP","Custom 27203010","","9733498  -  KIT STRTC STRL LF NAVIGATE ACC SPNE PDCL DISP","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9734887","SUP","Custom 27203010","","9734887  -  TRACKER NVG STRL LF NINVS DISP","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9735428","SUP","Custom 27203010","","9735428  -  STYLET NVG STRL LF 2 COIL DISP","BOTH IP/OP","$1,420.00 ","$1,050.80 ","$0.00 ","$1,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9790019","SUP","HCPCS C1713","","9790019  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"9790021","SUP","HCPCS C1713","","9790021  -  PLATE 21MM TI LCK VNTR BONE ANT CERV SPN STRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"9790023","SUP","HCPCS C1713","","9790023  -  PLATE BN 23MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"9790025","SUP","HCPCS C1713","","9790025  -  PLATE BN 25MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"9790027","SUP","HCPCS C1713","","9790027  -  PLATE BN 27.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"9790030","SUP","HCPCS C1713","","9790030  -  PLATE BN 30MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"9790032","SUP","HCPCS C1713","","9790032  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790035","SUP","HCPCS C1713","","9790035  -  PLATE 35MM TI LCK VNTR BONE ANT CERV SPN STRL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790037","SUP","HCPCS C1713","","9790037  -  PLATE 37.5MM TI LCK VNTR BONE ANT CERV SPN STRL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790040","SUP","HCPCS C1713","","9790040  -  PLATE BN 40MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790042","SUP","HCPCS C1713","","9790042  -  PLATE 42.5MM TI LCK VNTR BONE ANT CERV SPN STRL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790045","SUP","HCPCS C1713","","9790045  -  PLATE BN 45MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790047","SUP","HCPCS C1713","","9790047  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790050","SUP","HCPCS C1713","","9790050  -  PLATE BN 50MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"9790052","SUP","HCPCS C1713","","9790052  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790055","SUP","HCPCS C1713","","9790055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790057","SUP","HCPCS C1713","","9790057  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790060","SUP","HCPCS C1713","","9790060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790062","SUP","HCPCS C1713","","9790062  -  PLATE BN 62.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790065","SUP","HCPCS C1713","","9790065  -  PLATE BN 65MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790067","SUP","HCPCS C1713","","9790067  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790070","SUP","HCPCS C1713","","9790070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790072","SUP","HCPCS C1713","","9790072  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"9790075","SUP","HCPCS C1713","","9790075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"9790077","SUP","HCPCS C1713","","9790077  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"9790080","SUP","HCPCS C1713","","9790080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"9790082","SUP","HCPCS C1713","","9790082  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"9790085","SUP","HCPCS C1713","","9790085  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"9790087","SUP","HCPCS C1713","","9790087  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9790090","SUP","HCPCS C1713","","9790090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9790095","SUP","HCPCS C1713","","9790095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9790100","SUP","HCPCS C1713","","9790100  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9790105","SUP","HCPCS C1713","","9790105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
"9790110","SUP","HCPCS C1713","","9790110  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,525.50 ","$3,348.87 ","$0.00 ","$4,525.50 ","$2,036.48 ","$0.00 ","$943.23 ","$0.00 ","$0.00 ","$792.38 ","$4,525.50 ","$0.00 ","$2,262.75 ","$3,584.20 ","$3,620.40 ","$0.00 ","$708.24 ","$0.00 ","$720.46 ","$0.00 "
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"9795327","SUP","HCPCS C1713","","9795327  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"9795329","SUP","HCPCS C1713","","9795329  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"9873033","SUP","HCPCS C1713","","9873033  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873035","SUP","HCPCS C1713","","9873035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873037","SUP","HCPCS C1713","","9873037  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873039","SUP","HCPCS C1713","","9873039  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873041","SUP","HCPCS C1713","","9873041  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873133","SUP","HCPCS C1713","","9873133  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873135","SUP","HCPCS C1713","","9873135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873137","SUP","HCPCS C1713","","9873137  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873139","SUP","HCPCS C1713","","9873139  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9873141","SUP","HCPCS C1713","","9873141  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9874035","SUP","HCPCS C1713","","9874035  -  PLATE BN 35MM PRMD 4 HL SPNE LMBR ANT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9874037","SUP","HCPCS C1713","","9874037  -  PLATE BN 37MM PRMD 4 HL SPNE LMBR ANT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9874039","SUP","HCPCS C1713","","9874039  -  PLATE BN 39MM PRMD 4 HL SPNE LMBR ANT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9874041","SUP","HCPCS C1713","","9874041  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9874043","SUP","HCPCS C1713","","9874043  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9874045","SUP","HCPCS C1713","","9874045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$9,487.50 ","$7,020.75 ","$0.00 ","$9,487.50 ","$4,269.38 ","$0.00 ","$1,977.43 ","$0.00 ","$0.00 ","$1,661.19 ","$9,487.50 ","$0.00 ","$4,743.75 ","$7,514.10 ","$7,590.00 ","$0.00 ","$1,484.79 ","$0.00 ","$1,510.41 ","$0.00 "
"9990700","SUP","Custom 27203010","","KWIQ DIP","BOTH IP/OP","$223.78 ","$165.60 ","$0.00 ","$223.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.78 ","$0.00 ","$111.89 ","$177.23 ","$179.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10000607","SUP","HCPCS C1713","","10000607  -  WIRE FX RELINE MAS BLNT THRD NTNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"10004354","SUP","Custom 27203010","","MAX-FAST FOREHEAD SENSOR WITH HEADBAND","BOTH IP/OP","$117.73 ","$87.12 ","$0.00 ","$117.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.73 ","$0.00 ","$58.87 ","$93.24 ","$94.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10055332","SUP","HCPCS C1713","","10055332  -  RELINE FIXED CROSS CONN. 37.5MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"10055425","SUP","HCPCS C1713","","10055425  -  CONNECTOR ROD 5.5MM 25-30MM RELINE CX ADJ LOPRFL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"10056425","SUP","HCPCS C1713","","10056425  -  CONNECTOR ROD 5.5-6MM 25-30MM RELINE CX ADJ LOPRFL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"10612513","SUP","Custom 27203010","","TIP PIP 1000UL DISP BLK","BOTH IP/OP","$1,844.75 ","$1,365.12 ","$0.00 ","$1,844.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,844.75 ","$0.00 ","$922.38 ","$1,461.04 ","$1,475.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10719701","SUP","HCPCS C1725","","CATHETER ANGIO .035IN 5FR 65CM C1 CURVE NBRD SFT RADIOPQ TIP","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$4.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.58 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$1.41 ","$0.00 ","$1.43 ","$0.00 "
"10719702","SUP","HCPCS C1725","","CATHETER ANGIO .035IN C2 CURVE 5FR 65CM 2 SH NBRD SFT","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$4.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.58 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$1.41 ","$0.00 ","$1.43 ","$0.00 "
"10720401","SUP","HCPCS C1725","","CATHETER ANGIO .038IN SOS OMNI1 CURVE 5FR 80CM NBRD SFT","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$23.50 ","$12.76 ","$0.00 ","$7.29 ","$0.00 ","$0.00 ","$4.11 ","$23.50 ","$0.00 ","$11.75 ","$18.61 ","$18.80 ","$0.00 ","$3.68 ","$0.00 ","$3.74 ","$0.00 "
"10720405","SUP","HCPCS C1725","","CATHETER ANGIO .038IN SOS OMNI2 CURVE 5FR 80CM NBRD SFT","BOTH IP/OP","$23.75 ","$17.58 ","$0.00 ","$23.75 ","$12.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.16 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$3.72 ","$0.00 ","$3.78 ","$0.00 "
"10722102","SUP","HCPCS C1725","","CATHETER ANGIO .038IN BERN CURVE 5FR 100CM NBRD SFT RADIOPQ","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"10732101","SUP","HCPCS C1725","","CATHETER ANGIO .038IN MIK CURVE 5FR 80CM NBRD SFT RADIOPQ","BOTH IP/OP","$23.75 ","$17.58 ","$0.00 ","$23.75 ","$12.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.16 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$3.72 ","$0.00 ","$3.78 ","$0.00 "
"10800702","SUP","HCPCS C1769","","SET CATH 20CM .035IN SCHN XL GUIDEWIRE INTROD NDL HMDIAL","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$133.04 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"10802701","SUP","HCPCS C1769","","SET CATH 15CM .035IN SIL SCHN XL GUIDEWIRE INTROD NDL FULL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"10802702","SUP","HCPCS C1769","","SET CATH 20CM .035IN SIL SCHN XL GUIDEWIRE INTROD NDL FULL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"10802703","SUP","HCPCS C1752","","10802703  -  SET CATH 24CM SCHN XL FULL HMDIAL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$818.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$818.34 ","$0.00 ","$409.17 ","$648.13 ","$654.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11221000","SUP","Custom 27203010","","11221000  -  COLLAR XTRIC MN PRFT AC SM CERV PLST ADJ PED","BOTH IP/OP","$74.37 ","$55.03 ","$0.00 ","$74.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.37 ","$0.00 ","$37.18 ","$58.90 ","$59.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11355025","SUP","HCPCS C1713","","11355025  -  ROD SPNL LRDTC 5.5MM 25MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355030","SUP","HCPCS C1713","","11355030  -  ROD SPNL LRDTC 5.5MM 30MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355035","SUP","HCPCS C1713","","11355035  -  ROD SPNL LRDTC 5.5MM 35MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355045","SUP","HCPCS C1713","","11355045  -  ROD SPNL LRDTC 5.5MM 45MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355050","SUP","HCPCS C1713","","11355050  -  ROD SPNL LRDTC 5.5MM 50MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355055","SUP","HCPCS C1713","","11355055  -  ROD SPNL LRDTC 5.5MM 55MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355060","SUP","HCPCS C1713","","11355060  -  ROD SPNL LRDTC 5.5MM 60MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355070","SUP","HCPCS C1713","","11355070  -  ROD SPNL LRDTC 5.5MM 70MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355085","SUP","HCPCS C1713","","11355085  -  RELINE ROD 85MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355090","SUP","HCPCS C1713","","11355090  -  RELINE ROD, 90MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355095","SUP","HCPCS C1713","","11355095  -  ROD SPNL LRDTC 5.5MM 95MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355110","SUP","HCPCS C1713","","11355110  -  ROD SPNL LRDTC 5.5MM 110MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355150","SUP","HCPCS C1713","","11355150  -  ROD SPNL LRDTC 5.5MM 150MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11355160","SUP","HCPCS C1713","","11355160  -  ROD SPNL LRDTC 5.5MM 160MM NS RELINE TI MAS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"11403002","SUP","Custom 27203010","","11403002  -  KIT PROCEDURE .035IN 21GA 65CM LONG ACCES GWIRE NEEDLE GOLD","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12401812","SUP","HCPCS C1757","","12401812  -  CATHETER THROMBECTOMY 5FR 135CM 10CM OCCLUDING BALL WIRE","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12401813","SUP","HCPCS C1729","","CATHETER INFUS 5FR 25MM 20CM SLT DSGN FLW THRU HUB OCL WIRE","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"12401816","SUP","HCPCS C1729","","CATHETER INFUS 5FR 25MM 50CM CORON SLT DSGN FLW THRU HUB OCL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"13010545","SUP","HCPCS C1713","","13010545  -  SCREW BN 2S 10.5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13014030","SUP","HCPCS C1713","","13014030  -  SCREW BN 2S 4MM 30MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13014040","SUP","HCPCS C1713","","13014040  -  SCREW BN 2S 4MM 40MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13014530","SUP","HCPCS C1713","","13014530  -  SCREW BN 2S 4.5MM 30MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13014540","SUP","HCPCS C1713","","13014540  -  SCREW BN 2S 4.5MM 40MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015035","SUP","HCPCS C1713","","13015035  -  SCREW BN 2S 5MM 35MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015045","SUP","HCPCS C1713","","13015045  -  SCREW BN 2S 5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015050","SUP","HCPCS C1713","","13015050  -  SCREW BN 2S 5MM 50MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015055","SUP","HCPCS C1713","","13015055  -  SCREW BN 2S 5MM 55MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015525","SUP","HCPCS C1713","","13015525  -  SCREW BN 2S 5.5MM 25MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015530","SUP","HCPCS C1713","","13015530  -  SCREW BN 2S 5.5MM 30MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015535","SUP","HCPCS C1713","","13015535  -  SCREW BN 2S 5.5MM 35MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015540","SUP","HCPCS C1713","","13015540  -  SCREW BN 2S 5.5MM 40MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015545","SUP","HCPCS C1713","","13015545  -  SCREW BN 2S 5.5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015550","SUP","HCPCS C1713","","13015550  -  SCREW BN 2S 5.5MM 50MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13015555","SUP","HCPCS C1713","","13015555  -  SCREW BN 2S 5.5MM 55MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016535","SUP","HCPCS C1713","","13016535  -  SCREW BN 2S 6.5MM 35MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016540","SUP","HCPCS C1713","","13016540  -  SCREW BN 2S 6.5MM 40MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016545","SUP","HCPCS C1713","","13016545  -  SCREW BN 2S 6.5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016550","SUP","HCPCS C1713","","13016550  -  SCREW BN 2S 6.5MM 50MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016555","SUP","HCPCS C1713","","13016555  -  SCREW BN 2S 6.5MM 55MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13017535","SUP","HCPCS C1713","","13017535  -  SCREW BN 2S 7.5MM 35MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13017540","SUP","HCPCS C1713","","13017540  -  SCREW BN 2S 7.5MM 40MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13017545","SUP","HCPCS C1713","","13017545  -  SCREW BN 2S 7.5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13017550","SUP","HCPCS C1713","","13017550  -  SCREW BN 2S 7.5MM 50MM NS LF RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13017555","SUP","HCPCS C1713","","13017555  -  SCREW BN 2S 7.5MM 55MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13018535","SUP","HCPCS C1713","","13018535  -  SCREW BN 2S 8.5MM 35MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13018540","SUP","HCPCS C1713","","13018540  -  SCREW BN 2S 8.5MM 40MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13018545","SUP","HCPCS C1713","","13018545  -  SCREW BN 2S 8.5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13018550","SUP","HCPCS C1713","","13018550  -  SCREW BN 2S 8.5MM 50MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13018555","SUP","HCPCS C1713","","13018555  -  SCREW BN 2S 8.5MM 55MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13018560","SUP","HCPCS C1713","","13018560  -  SCREW BN 2S 8.5MM 60MM NS LF RELINE-O PA SPNE LLIAC","BOTH IP/OP","$3,450.00 ","$2,553.00 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$719.07 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$549.24 ","$0.00 "
"13018580","SUP","HCPCS C1713","","13018580  -  SCREW BN 2S 8.5MM 80MM NS RELINE-O PA SPNE LLIAC","BOTH IP/OP","$3,450.00 ","$2,553.00 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$719.07 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$549.24 ","$0.00 "
"13019545","SUP","HCPCS C1713","","13019545  -  SCREW BN 2S 9.5MM 45MM NS RELINE-O PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13025545","SUP","HCPCS C1713","","13025545  -  SCREW BN 2S 5.5MM 45MM NS RELINE RELINEO RDC SPNE","BOTH IP/OP","$3,580.00 ","$2,649.20 ","$0.00 ","$3,580.00 ","$1,611.00 ","$0.00 ","$746.16 ","$0.00 ","$0.00 ","$626.83 ","$3,580.00 ","$0.00 ","$1,790.00 ","$2,835.36 ","$2,864.00 ","$0.00 ","$560.27 ","$0.00 ","$569.94 ","$0.00 "
"13025555","SUP","HCPCS C1713","","13025555  -  SCREW BN 2S 5.5MM 55MM NS RELINE RELINEO RDC SPNE","BOTH IP/OP","$3,580.00 ","$2,649.20 ","$0.00 ","$3,580.00 ","$1,611.00 ","$0.00 ","$746.16 ","$0.00 ","$0.00 ","$626.83 ","$3,580.00 ","$0.00 ","$1,790.00 ","$2,835.36 ","$2,864.00 ","$0.00 ","$560.27 ","$0.00 ","$569.94 ","$0.00 "
"13026545","SUP","HCPCS C1713","","13026545  -  SCREW BN 2S 6.5MM 45MM NS RELINE-O RDC SPNE","BOTH IP/OP","$3,580.00 ","$2,649.20 ","$0.00 ","$3,580.00 ","$1,611.00 ","$0.00 ","$746.16 ","$0.00 ","$0.00 ","$626.83 ","$3,580.00 ","$0.00 ","$1,790.00 ","$2,835.36 ","$2,864.00 ","$0.00 ","$560.27 ","$0.00 ","$569.94 ","$0.00 "
"13037590","SUP","HCPCS C1713","","13037590  -  SCREW BN 2S 7.5MM 90MM NS RELINE-O CLS PA SPNE ILC","BOTH IP/OP","$3,450.00 ","$2,553.00 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$719.07 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$549.24 ","$0.00 "
"13038560","SUP","HCPCS C1713","","13038560  -  SCREW BN 2S 8.5MM 60MM NS RELINE-O CLS SPNE ILC","BOTH IP/OP","$3,450.00 ","$2,553.00 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$719.07 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$549.24 ","$0.00 "
"13038580","SUP","HCPCS C1713","","13038580  -  SCREW BN 2S 8.5MM 80MM NS RELINE-O CLS SPNE ILC","BOTH IP/OP","$3,450.00 ","$2,553.00 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$719.07 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$549.24 ","$0.00 "
"13039510","SUP","HCPCS C1713","","13039510  -  SCREW BN 2S 9.5MM 100MM NS RELINE-O CLS SPNE ILC","BOTH IP/OP","$3,450.00 ","$2,553.00 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$719.07 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$549.24 ","$0.00 "
"13114540","SUP","HCPCS C1713","","13114540  -  SCREW BN 4.5MM 40MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13115540","SUP","HCPCS C1713","","13115540  -  SCREW BN 5.5MM 40MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13115545","SUP","HCPCS C1713","","13115545  -  SCREW BN 5.5MM 45MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13115550","SUP","HCPCS C1713","","13115550  -  SCREW BN 5.5MM 50MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13115555","SUP","HCPCS C1713","","13115555  -  SCREW BN 5.5MM 55MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13116545","SUP","HCPCS C1713","","13116545  -  SCREW BN 6.5MM 45MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13116550","SUP","HCPCS C1713","","13116550  -  SCREW BN 6.5MM 50MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13117550","SUP","HCPCS C1713","","13117550  -  SCREW BN 7.5MM 50MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13117555","SUP","HCPCS C1713","","13117555  -  SCREW BN 7.5MM 55MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13118555","SUP","HCPCS C1713","","13118555  -  SCREW BN 8.5MM 55MM NS RELINE-O PA TRC SPNE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"13210510","SUP","HCPCS C1713","","13210510  -  SCREW BN 10.5MM 100MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210511","SUP","HCPCS C1713","","13210511  -  SCREW BN 10.5MM 110MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210512","SUP","HCPCS C1713","","13210512  -  SCREW BN 10.5MM 120MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210525","SUP","HCPCS C1713","","13210525  -  SCREW BN 10.5MM 25MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210530","SUP","HCPCS C1713","","13210530  -  SCREW BN 10.5MM 30MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210535","SUP","HCPCS C1713","","13210535  -  SCREW BN 10.5MM 35MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210540","SUP","HCPCS C1713","","13210540  -  SCREW BN 10.5MM 40MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210545","SUP","HCPCS C1713","","13210545  -  SCREW BN 10.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210550","SUP","HCPCS C1713","","13210550  -  SCREW BN 10.5MM 50MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210555","SUP","HCPCS C1713","","13210555  -  SCREW BN 10.5MM 55MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210560","SUP","HCPCS C1713","","13210560  -  SCREW BN 10.5MM 60MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210565","SUP","HCPCS C1713","","13210565  -  SCREW BN 10.5MM 65MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210570","SUP","HCPCS C1713","","13210570  -  SCREW BN 10.5MM 70MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210575","SUP","HCPCS C1713","","13210575  -  SCREW BN 10.5MM 75MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210580","SUP","HCPCS C1713","","13210580  -  SCREW BN 10.5MM 80MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210585","SUP","HCPCS C1713","","13210585  -  SCREW BN 10.5MM 85MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210590","SUP","HCPCS C1713","","13210590  -  SCREW BN 10.5MM 90MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13210595","SUP","HCPCS C1713","","13210595  -  SCREW BN 10.5MM 95MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13211010","SUP","HCPCS C1713","","13211010  -  SCREW BN 10MM 100MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13219545","SUP","HCPCS C1713","","13219545  -  SCREW BN 9.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13550000","SUP","HCPCS C1713","","13550000  -  RELINE LOCK SCREW","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"13600000","SUP","HCPCS C1713","","13600000  -  SCREW BN 6MM NS RELINE LCK OPN TULIP SPNE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"14355030","SUP","HCPCS C1713","","14355030  -  ROD SPNL LRDTC 5.5MM 30MM NS RELINE-O TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"14355035","SUP","HCPCS C1713","","14355035  -  ROD SPNL LRDTC 5.5MM 35MM NS RELINE-O TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"14355045","SUP","HCPCS C1713","","14355045  -  RELINE ROD, 45MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"14355050","SUP","HCPCS C1713","","14355050  -  ROD SPNL LRDTC 5.5MM 50MM NS RELINE-O TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"14355055","SUP","HCPCS C1713","","14355055  -  ROD SPNL LRDTC 5.5MM 55MM NS RELINE-O TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"14355060","SUP","HCPCS C1713","","14355060  -  ROD SPNL LRDTC 5.5MM 60MM NS RELINE-O TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"14910164","SUP","Custom 27203010","","KIT IMMUN TST PRMR POS NEG CNTRL H PYLR IGG 96 TST","BOTH IP/OP","$1,619.25 ","$1,198.25 ","$0.00 ","$1,619.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,619.25 ","$0.00 ","$809.63 ","$1,282.45 ","$1,295.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15355300","SUP","HCPCS C1713","","15355300  -  RELINE ROD, 300MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"16014520","SUP","HCPCS C1713","","16014520  -  SCREW BN 4.5MM 20MM NS RELINE MAS PA SPNL 2C","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16015520","SUP","HCPCS C1713","","16015520  -  SCREW BN 5.5MM 20MM NS RELINE MAS PA SPNL 2C","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16015540","SUP","HCPCS C1713","","16015540  -  SCREW BN 2C 5.5MM 40MM NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16016520","SUP","HCPCS C1713","","16016520  -  SCREW BN 6.5MM 20MM NS RELINE MAS PA SPNL 2C","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16016535","SUP","HCPCS C1713","","16016535  -  SCREW BN 2C 6.5MM 35MM NS LF RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16016550","SUP","HCPCS C1713","","16016550  -  SCREW BN 6.5MM 50MM RELINE POLYAX MA SPNE 2C","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16017540","SUP","HCPCS C1713","","16017540  -  SCREW BN 2C 7.5MM 40MM NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16017545","SUP","HCPCS C1713","","16017545  -  SCREW BN 2C 7.5MM 45MM NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16018510","SUP","HCPCS C1713","","16018510  -  SCREW BN 2C 8.5MM 100MM NS RELINE PA SPNE ILC MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16018580","SUP","HCPCS C1713","","16018580  -  SCREW BN 2C 8.5MM 80MM NS LF RELINE PA SPNE LLIAC MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16018590","SUP","HCPCS C1713","","16018590  -  RELINE MAS SCREW 8.5X 90","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16024530","SUP","HCPCS C1713","","16024530  -  SCREW BN 2C 4.5MM 30MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16024535","SUP","HCPCS C1713","","16024535  -  SCREW BN 2C 4.5MM 35MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16024540","SUP","HCPCS C1713","","16024540  -  SCREW BN 2C 4.5MM 40MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16024545","SUP","HCPCS C1713","","16024545  -  SCREW BN 2C 4.5MM 45MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16025535","SUP","HCPCS C1713","","16025535  -  SCREW BN 2C 5.5MM 35MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16026540","SUP","HCPCS C1713","","16026540  -  SCREW BN 2C 6.5MM 40MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16026545","SUP","HCPCS C1713","","16026545  -  RELINE REDUCTIONSCREW, 6.5 X 45","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16026550","SUP","HCPCS C1713","","16026550  -  RELINE MAS REDUCTION SCREW, 6.5X 50","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16026555","SUP","HCPCS C1713","","16026555  -  RELINE MAS REDUCTION SCREW, 6.5X 55","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16027535","SUP","HCPCS C1713","","16027535  -  SCREW BN 2C 7.5MM 35MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16027555","SUP","HCPCS C1713","","16027555  -  RELINE REDUCTION SCREW, 7.5X 55","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16028535","SUP","HCPCS C1713","","16028535  -  SCREW BN 2C 8.5MM 35MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16028540","SUP","HCPCS C1713","","16028540  -  SCREW BN 2C 8.5MM 40MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16028545","SUP","HCPCS C1713","","16028545  -  SCREW BN 2C 8.5MM 45MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16028550","SUP","HCPCS C1713","","16028550  -  SCREW BN 2C 8.5MM 50MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16028555","SUP","HCPCS C1713","","16028555  -  SCREW BN 2C 8.5MM 55MM RD NS RELINE PA SPNE MAS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16084520","SUP","HCPCS C1713","","16084520  -  SCREW BN T 4.5MM 20MM NS RELINE MAS MA SPNL 2C","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16085520","SUP","HCPCS C1713","","16085520  -  SCREW BN T 5.5MM 20MM NS RELINE MAS MA SPNL 2C","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16086520","SUP","HCPCS C1713","","16086520  -  SCREW BN T 5.5MM 20MM RELINE MAS MA SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"16500311","SUP","HCPCS C1876","","BALLOON WORKHOUSE  7-2/5/75","BOTH IP/OP","$2.50 ","$1.85 ","$0.00 ","$2.50 ","$1.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.44 ","$2.50 ","$0.00 ","$1.25 ","$1.98 ","$2.00 ","$0.00 ","$0.39 ","$0.00 ","$0.40 ","$0.00 "
"16500317","SUP","HCPCS C1725","","CATHETER BALDILAT 5MM 100CM 2CM NC LOW PROFILE HI-PRS","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"16500412","SUP","HCPCS C1725","","CATHETER BALDILAT 6FR 8MM 75CM 2CM NC LOW PROFILE HI-PRS","BOTH IP/OP","$320.00 ","$236.80 ","$0.00 ","$320.00 ","$173.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.03 ","$320.00 ","$0.00 ","$160.00 ","$253.44 ","$256.00 ","$0.00 ","$50.08 ","$0.00 ","$50.94 ","$0.00 "
"16500414","SUP","HCPCS C1725","","CATHETER BALDILAT 6FR 6MM 75CM 4CM NC LOW PROFILE HI-PRS","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$169.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"16500416","SUP","HCPCS C1725","","CATHETER BALDILAT 6FR 8MM 75CM 4CM NC LOW PROFILE HI-PRS","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$169.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"16500446","SUP","HCPCS C1725","","CATHETER BALDILAT 7FR 10MM 75CM 4CM NC LOW PROFILE HI-PRS","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"16500448","SUP","HCPCS C1725","","CATHETER BALDILAT 7FR 10MM 100CM 4CM NC LOW PROFILE HI-PRS","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"16701001","SUP","HCPCS C1876","","STENT BILIARY OMNIFLEX 6FR X 75CM X 5MM X 15MM BALLOON EXPAN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"18600545","SUP","HCPCS C1713","","18600545  -  SCREW ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"18600550","SUP","HCPCS C1713","","18600550  -  SCREW ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"18600555","SUP","HCPCS C1713","","18600555  -  SCREW ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"18600560","SUP","HCPCS C1713","","18600560  -  SCREW ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"20585507","SUP","Custom 27203010","","HEMOCONCENTRATOR PK RINSELESS TBG CONNCTR WST BAG PRFSN 1400","BOTH IP/OP","$655.10 ","$484.77 ","$0.00 ","$655.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$655.10 ","$0.00 ","$327.55 ","$518.84 ","$524.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21074025","SUP","Custom 27203010","","21074025  -  BIT DRILL 4MM 25MM STERILE","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21381338","SUP","Custom 27203010","","TIP PIP 2.5ML EPNDF CMBTP PLUS 25UL INCR GRAD PLNG CYL STRL","BOTH IP/OP","$3.15 ","$2.33 ","$0.00 ","$3.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.15 ","$0.00 ","$1.58 ","$2.49 ","$2.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22046341","SUP","Custom 27203010","","REAGENT CLRT 3 1GL CLR AGNT HISTOLGY","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$68.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.75 ","$0.00 ","$34.38 ","$54.45 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22046344","SUP","Custom 27203010","","REAGENT METHNL ISOPRPNL FLX 100 1GL ABST DEHYDRANT BTL","BOTH IP/OP","$40.60 ","$30.04 ","$0.00 ","$40.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.60 ","$0.00 ","$20.30 ","$32.16 ","$32.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22046346","SUP","Custom 27203010","","REAGENT METHNL ISOPRPNL FLX 95 1GL DEHYDRANT BTL HISTOLGY","BOTH IP/OP","$158.90 ","$117.59 ","$0.00 ","$158.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.90 ","$0.00 ","$79.45 ","$125.85 ","$127.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22046348","SUP","Custom 27203010","","REAGENT METHNL ISOPRPNL FLX 80 1GL DEHYDRANT BTL HISTOLGY","BOTH IP/OP","$169.55 ","$125.47 ","$0.00 ","$169.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.55 ","$0.00 ","$84.78 ","$134.28 ","$135.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22046619","SUP","Custom 27203010","","CONTROL OSMTR ACCUREF 2ML 290 SER","BOTH IP/OP","$116.03 ","$85.86 ","$0.00 ","$116.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.03 ","$0.00 ","$58.01 ","$91.90 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22266306","SUP","Custom 27203010","","TIP PIP 5ML CMBTP PLUS EPPPENDORF INCRM NSTRL","BOTH IP/OP","$273.28 ","$202.23 ","$0.00 ","$273.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$273.28 ","$0.00 ","$136.64 ","$216.44 ","$218.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22610135","SUP","Custom 27203010","","CAP TUBE 12MM FLNG","BOTH IP/OP","$0.08 ","$0.06 ","$0.00 ","$0.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.08 ","$0.00 ","$0.04 ","$0.06 ","$0.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23022523","SUP","Custom 27203010","","AIR CMPR AERS DSTR EXTN TUBE O3 SAFE TRPL FLTR 11OZ 5IN SUP","BOTH IP/OP","$43.33 ","$32.06 ","$0.00 ","$43.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.33 ","$0.00 ","$21.66 ","$34.32 ","$34.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23022524","SUP","Custom 27203010","","FREEZER CRYGN SUP FRND FRZ-IT AERS TISS SPRY PE SNORKEL 11OZ","BOTH IP/OP","$35.83 ","$26.51 ","$0.00 ","$35.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.83 ","$0.00 ","$17.91 ","$28.38 ","$28.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23030817","SUP","HCPCS C1783","","23030817  -  DRAIN GLAUCOMA IMNPLANT BAERVELDT SILICONE ANTER CHAM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"23038384","SUP","Custom 27203010","","CONTROL MLANLT MAS NRM VL 60ML UA","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23046581","SUP","Custom 27203010","","CONTROL ESR ESRCHX LVL 1 2 9ML HMTL","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23046595","SUP","Custom 27203010","","KIT IMMUN TST CLRVW COMBO 2 CLIA COMPLEXITY WVD SER URN HCG","BOTH IP/OP","$108.25 ","$80.11 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.25 ","$0.00 ","$54.13 ","$85.73 ","$86.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23255961","SUP","Custom 27203010","","STAIN MCBL GM IOD PRTCL 500ML","BOTH IP/OP","$66.35 ","$49.10 ","$0.00 ","$66.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.35 ","$0.00 ","$33.18 ","$52.55 ","$53.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23270181","SUP","Custom 27203010","","STAIN MCBL GM IOD UNSTBL PRTCL 1GL","BOTH IP/OP","$324.78 ","$240.34 ","$0.00 ","$324.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$324.78 ","$0.00 ","$162.39 ","$257.23 ","$259.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23285625","SUP","Custom 27203010","","REAGENT SCKL SCRN SCKCHX BUFF PWDR HMTL","BOTH IP/OP","$8.53 ","$6.31 ","$0.00 ","$8.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.53 ","$0.00 ","$4.26 ","$6.76 ","$6.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100101","SUP","Custom 27203010","","30100101  -  BIT DRILL 16-24MM BIOTRAK STD CANN BIOTRACK","BOTH IP/OP","$650.00 ","$481.00 ","$8.15 ","$657.00 ","$29.07 ","$8.15 ","$8.15 ","$23.81 ","$23.81 ","$24.09 ","$657.00 ","$17.12 ","$45.56 ","$429.66 ","$525.60 ","$23.64 ","$25.67 ","$16.30 ","$17.97 ","$16.30 "
"30100102","SUP","Custom 27203010","","30100102  -  BIT DRILL BIOTRAK STD TAP","BOTH IP/OP","$791.00 ","$585.34 ","$6.62 ","$782.00 ","$32.19 ","$12.05 ","$10.84 ","$8.77 ","$8.77 ","$8.87 ","$782.00 ","$25.29 ","$16.78 ","$429.66 ","$625.60 ","$34.93 ","$9.45 ","$24.09 ","$6.62 ","$24.09 "
"30100151","SUP","Custom 27203010","","30100151  -  BIT DRL MN BIOTRAK","BOTH IP/OP","$510.00 ","$377.40 ","$11.73 ","$464.00 ","$34.50 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$429.66 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100152","SUP","Custom 27203010","","30100152  -  BIT DRL BIOTRAK TAP","BOTH IP/OP","$462.00 ","$341.88 ","$11.73 ","$464.00 ","$34.50 ","$13.04 ","$11.73 ","$28.25 ","$28.25 ","$28.59 ","$464.00 ","$27.37 ","$54.08 ","$429.66 ","$371.20 ","$37.80 ","$30.46 ","$26.07 ","$21.33 ","$26.07 "
"30100153","SUP","Custom 27203010","","30100153  -  DRIVER MINI BIOTRAK SURG","BOTH IP/OP","$176.00 ","$130.24 ","$9.49 ","$429.66 ","$27.63 ","$10.55 ","$9.49 ","$22.62 ","$22.62 ","$22.90 ","$176.00 ","$22.14 ","$43.30 ","$429.66 ","$140.80 ","$30.58 ","$24.40 ","$21.09 ","$17.08 ","$21.09 "
"30100154","SUP","Custom 27203010","","30100154  -  EJTR MINI BLADE BIOTRAK INDIV SET NONSTRL","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30100351","SUP","Custom 27203010","","30100351  -  DRILL SRG BIOTRAK","BOTH IP/OP","$276.00 ","$204.24 ","$10.62 ","$429.66 ","$37.85 ","$10.62 ","$10.62 ","$31.01 ","$31.01 ","$31.36 ","$276.00 ","$22.29 ","$59.34 ","$429.66 ","$220.80 ","$30.78 ","$33.42 ","$21.23 ","$23.39 ","$21.23 "
"31002701","SUP","Custom 27803010","","31002701  -  VALVE MTRL 27MM 35MM 24MM 19MM 14MM MSC CNCH FLXB STNT","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"37129000","SUP","Custom 27203010","","FORMULA 237ML PTMN SUPPL CHOC","BOTH IP/OP","$7.28 ","$5.39 ","$0.00 ","$7.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.28 ","$0.00 ","$3.64 ","$5.77 ","$5.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38204020","SUP","HCPCS C1713","","038204020  -  SCREW BONE 4MM 20MM MULTIAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38204025","SUP","HCPCS C1713","","038204025  -  SCREW BONE 4MM 25MM MULTIAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38204030","SUP","HCPCS C1713","","038204030  -  SCREW BONE 4MM 30MM MULTIAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38204035","SUP","HCPCS C1713","","038204035  -  SCREW BONE 4MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38204040","SUP","HCPCS C1713","","038204040  -  SCREW BONE 4MM 40MM MULTIAX XIA II TITANIUM SPN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38205025","SUP","HCPCS C1713","","038205025  -  SCREW BONE 5MM 25MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38205030","SUP","HCPCS C1713","","038205030  -  SCREW BONE 5MM 30MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38205035","SUP","HCPCS C1713","","038205035  -  SCREW BONE 5MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38205040","SUP","HCPCS C1713","","038205040  -  SCREW BONE 5MM 40MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"38205045","SUP","HCPCS C1713","","038205045  -  SCREW BONE 5MM 45MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"38214020","SUP","HCPCS C1713","","038214020  -  SCREW BONE 4MM 20MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"38214025","SUP","HCPCS C1713","","038214025  -  SCREW BONE 4MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"38214030","SUP","HCPCS C1713","","038214030  -  SCREW BONE 4MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"38214035","SUP","HCPCS C1713","","038214035  -  SCREW BONE 4MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"38214040","SUP","HCPCS C1713","","038214040  -  SCREW BONE 4MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"38215025","SUP","HCPCS C1713","","038215025  -  SCREW BONE 5MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"38215030","SUP","HCPCS C1713","","038215030  -  SCREW BONE 5MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"38215035","SUP","HCPCS C1713","","038215035  -  SCREW BONE 5MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"38215040","SUP","HCPCS C1713","","038215040  -  SCREW BONE 5MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"38215045","SUP","HCPCS C1713","","038215045  -  SCREW BONE 5MM 45MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"40036170","SUP","Custom 27803010","","61421  -  SPACER SPNL 21MMX14MM RYTFC UNT","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48030022","SUP","HCPCS C1713","","48030022  -  PLATE BONE 22MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030025","SUP","HCPCS C1713","","48030025  -  PLATE BONE 25MM NONCOMPRESSION 1 LEVEL THORACIC","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030028","SUP","HCPCS C1713","","48030028  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030031","SUP","HCPCS C1713","","48030031  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030034","SUP","HCPCS C1713","","48030034  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030037","SUP","HCPCS C1713","","48030037  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030040","SUP","HCPCS C1713","","48030040  -  PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$8,793.48 ","$6,507.18 ","$0.00 ","$8,793.48 ","$3,957.06 ","$0.00 ","$1,832.78 ","$0.00 ","$0.00 ","$1,539.67 ","$8,793.48 ","$0.00 ","$4,396.74 ","$6,964.44 ","$7,034.78 ","$0.00 ","$1,376.18 ","$0.00 ","$1,399.92 ","$0.00 "
"48030225","SUP","HCPCS C1713","","48030225  -  SCREW BONE 6.5MM 22MM COMPRESSION SPN THORACIC","BOTH IP/OP","$1,008.65 ","$746.40 ","$0.00 ","$1,008.65 ","$453.89 ","$0.00 ","$210.23 ","$0.00 ","$0.00 ","$176.61 ","$1,008.65 ","$0.00 ","$504.33 ","$798.85 ","$806.92 ","$0.00 ","$157.85 ","$0.00 ","$160.58 ","$0.00 "
"48030265","SUP","HCPCS C1713","","48030265  -  PLATE BONE 65MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48030271","SUP","HCPCS C1713","","48030271  -  PLATE BONE 71MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48030277","SUP","HCPCS C1713","","48030277  -  PLATE BONE 77MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48030283","SUP","HCPCS C1713","","48030283  -  PLATE BONE 83MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48030289","SUP","HCPCS C1713","","48030289  -  PLATE BONE 89MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48030350","SUP","HCPCS C1713","","48030350  -  SCREW BONE 6MM 35MM COMPRESSION SPN THORACIC","BOTH IP/OP","$1,008.65 ","$746.40 ","$0.00 ","$1,008.65 ","$453.89 ","$0.00 ","$210.23 ","$0.00 ","$0.00 ","$176.61 ","$1,008.65 ","$0.00 ","$504.33 ","$798.85 ","$806.92 ","$0.00 ","$157.85 ","$0.00 ","$160.58 ","$0.00 "
"48032040","SUP","HCPCS C1713","","48032040  -  PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032044","SUP","HCPCS C1713","","48032044  -  PLATE BONE 44MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032048","SUP","HCPCS C1713","","48032048  -  PLATE BONE 48MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032052","SUP","HCPCS C1713","","48032052  -  PLATE BONE 52MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032056","SUP","HCPCS C1713","","48032056  -  PLATE BONE 56MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032060","SUP","HCPCS C1713","","48032060  -  PLATE BONE 60MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032064","SUP","HCPCS C1713","","48032064  -  PLATE BONE 64MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032068","SUP","HCPCS C1713","","48032068  -  PLATE BONE 68MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032072","SUP","HCPCS C1713","","48032072  -  PLATE BONE 72MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032076","SUP","HCPCS C1713","","48032076  -  PLATE BONE 76MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$12,217.15 ","$9,040.69 ","$0.00 ","$12,217.15 ","$5,497.72 ","$0.00 ","$2,546.36 ","$0.00 ","$0.00 ","$2,139.13 ","$12,217.15 ","$0.00 ","$6,108.58 ","$9,675.98 ","$9,773.72 ","$0.00 ","$1,911.98 ","$0.00 ","$1,944.97 ","$0.00 "
"48032080","SUP","HCPCS C1713","","48032080  -  PLATE BONE 80MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$13,963.70 ","$10,333.14 ","$0.00 ","$13,963.70 ","$6,283.67 ","$0.00 ","$2,910.38 ","$0.00 ","$0.00 ","$2,444.93 ","$13,963.70 ","$0.00 ","$6,981.85 ","$11,059.25 ","$11,170.96 ","$0.00 ","$2,185.32 ","$0.00 ","$2,223.02 ","$0.00 "
"48032084","SUP","HCPCS C1713","","48032084  -  PLATE BONE 84MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$13,963.70 ","$10,333.14 ","$0.00 ","$13,963.70 ","$6,283.67 ","$0.00 ","$2,910.38 ","$0.00 ","$0.00 ","$2,444.93 ","$13,963.70 ","$0.00 ","$6,981.85 ","$11,059.25 ","$11,170.96 ","$0.00 ","$2,185.32 ","$0.00 ","$2,223.02 ","$0.00 "
"48032088","SUP","HCPCS C1713","","48032088  -  PLATE BONE 88MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$13,963.70 ","$10,333.14 ","$0.00 ","$13,963.70 ","$6,283.67 ","$0.00 ","$2,910.38 ","$0.00 ","$0.00 ","$2,444.93 ","$13,963.70 ","$0.00 ","$6,981.85 ","$11,059.25 ","$11,170.96 ","$0.00 ","$2,185.32 ","$0.00 ","$2,223.02 ","$0.00 "
"48032092","SUP","HCPCS C1713","","48032092  -  PLATE BONE 92MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$13,963.70 ","$10,333.14 ","$0.00 ","$13,963.70 ","$6,283.67 ","$0.00 ","$2,910.38 ","$0.00 ","$0.00 ","$2,444.93 ","$13,963.70 ","$0.00 ","$6,981.85 ","$11,059.25 ","$11,170.96 ","$0.00 ","$2,185.32 ","$0.00 ","$2,223.02 ","$0.00 "
"48032096","SUP","HCPCS C1713","","48032096  -  PLATE BONE 96MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$13,963.70 ","$10,333.14 ","$0.00 ","$13,963.70 ","$6,283.67 ","$0.00 ","$2,910.38 ","$0.00 ","$0.00 ","$2,444.93 ","$13,963.70 ","$0.00 ","$6,981.85 ","$11,059.25 ","$11,170.96 ","$0.00 ","$2,185.32 ","$0.00 ","$2,223.02 ","$0.00 "
"48032100","SUP","HCPCS C1713","","48032100  -  PLATE BONE 100MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$13,963.70 ","$10,333.14 ","$0.00 ","$13,963.70 ","$6,283.67 ","$0.00 ","$2,910.38 ","$0.00 ","$0.00 ","$2,444.93 ","$13,963.70 ","$0.00 ","$6,981.85 ","$11,059.25 ","$11,170.96 ","$0.00 ","$2,185.32 ","$0.00 ","$2,223.02 ","$0.00 "
"48034525","SUP","HCPCS C1713","","48034525  -  PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48034528","SUP","HCPCS C1713","","48034528  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48034531","SUP","HCPCS C1713","","48034531  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48034534","SUP","HCPCS C1713","","48034534  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48034537","SUP","HCPCS C1713","","48034537  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48035125","SUP","HCPCS C1713","","48035125  -  PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48035128","SUP","HCPCS C1713","","48035128  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48035131","SUP","HCPCS C1713","","48035131  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48035134","SUP","HCPCS C1713","","48035134  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48035137","SUP","HCPCS C1713","","48035137  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM","BOTH IP/OP","$9,160.23 ","$6,778.57 ","$0.00 ","$9,160.23 ","$4,122.10 ","$0.00 ","$1,909.22 ","$0.00 ","$0.00 ","$1,603.88 ","$9,160.23 ","$0.00 ","$4,580.11 ","$7,254.90 ","$7,328.18 ","$0.00 ","$1,433.58 ","$0.00 ","$1,458.31 ","$0.00 "
"48035225","SUP","HCPCS C1713","","48035225  -  SCREW BONE 6.5MM 22MM COMPRESSION THORACIC SPN","BOTH IP/OP","$1,008.65 ","$746.40 ","$0.00 ","$1,008.65 ","$453.89 ","$0.00 ","$210.23 ","$0.00 ","$0.00 ","$176.61 ","$1,008.65 ","$0.00 ","$504.33 ","$798.85 ","$806.92 ","$0.00 ","$157.85 ","$0.00 ","$160.58 ","$0.00 "
"48035350","SUP","HCPCS C1713","","48035350  -  SCREW BONE 6.5MM 35MM COMPRESSION THORACIC SPN","BOTH IP/OP","$1,008.65 ","$746.40 ","$0.00 ","$1,008.65 ","$453.89 ","$0.00 ","$210.23 ","$0.00 ","$0.00 ","$176.61 ","$1,008.65 ","$0.00 ","$504.33 ","$798.85 ","$806.92 ","$0.00 ","$157.85 ","$0.00 ","$160.58 ","$0.00 "
"48130000","SUP","Custom 27803010","","48130000  -  SCREW SET BLOCKER XIA TITANIUM SPN 4.5 MM ROD","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130110","SUP","HCPCS C1713","","48130110  -  STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN CAUDAL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48130111","SUP","HCPCS C1713","","48130111  -  STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN ROSTRAL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48130112","SUP","HCPCS C1713","","48130112  -  STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN CAUDAL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48130113","SUP","HCPCS C1713","","48130113  -  STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN ROSTRAL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48130201","SUP","Custom 27803010","","48130201  -  HOOK SPINAL SMALL XIA TITANIUM LMNR 4.5MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130202","SUP","Custom 27803010","","48130202  -  HOOK SPINAL MEDIUM XIA TITANIUM LMNR 4.5MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130203","SUP","Custom 27803010","","48130203  -  HOOK SPINAL LARGE XIA TITANIUM LMNR 4.5MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130204","SUP","Custom 27803010","","48130204  -  HOOK SPINAL EXTEND XIA TITANIUM LMNR 4.5 MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130208","SUP","Custom 27803010","","48130208  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR 4.5 MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130210","SUP","Custom 27803010","","48130210  -  HOOK SPINAL XIA TITANIUM LMNR THORACIC 4.5 MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130212","SUP","Custom 27803010","","48130212  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130213","SUP","Custom 27803010","","48130213  -  HOOK SPINAL LEFT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130214","SUP","Custom 27803010","","48130214  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130215","SUP","Custom 27803010","","48130215  -  HOOK SPINAL LEFT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130220","SUP","Custom 27803010","","48130220  -  HOOK SPINAL SMALL XIA TITANIUM PEDICLE 4.5MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130221","SUP","Custom 27803010","","48130221  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE 4.5MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130230","SUP","Custom 27803010","","48130230  -  HOOK SPINAL RIGHT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48130231","SUP","Custom 27803010","","48130231  -  HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48132040","SUP","HCPCS C1713","","48132040  -  ROD SPNL STRG 4.5MM 40MM XIA HEX VIT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"48132090","SUP","HCPCS C1713","","48132090  -  ROD SPNL STRG 4.5MM 90MM XIA HEX VIT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"48132100","SUP","HCPCS C1713","","48132100  -  ROD SPNL STRG 4.5MM 100MM XIA HEX VIT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"48132601","SUP","HCPCS C1713","","48132601  -  ROD SPINAL 4.5MM 600MM XIA VITALLIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"48133012","SUP","HCPCS C1713","","48133012  -  SCREW BONE 4.5MM 12MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133013","SUP","HCPCS C1713","","48133013  -  SCREW BONE 4.5MM 13MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133014","SUP","HCPCS C1713","","48133014  -  SCREW BONE 4.5MM 14MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133015","SUP","Custom 27803010","","48133015  -  CROSSLINK SPINAL 15MM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48133016","SUP","HCPCS C1713","","48133016  -  SCREW BONE 4.5MM 16MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133017","SUP","HCPCS C1713","","48133017  -  SCREW BONE 4.5MM 17MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133018","SUP","HCPCS C1713","","48133018  -  SCREW BONE 4.5MM 18MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133019","SUP","HCPCS C1713","","48133019  -  CONNECTOR ROD 4.5MM 19MM MONOBLOCK CROSSLINK XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133021","SUP","HCPCS C1713","","48133021  -  SCREW BONE 4.5MM 21MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133023","SUP","HCPCS C1713","","48133023  -  SCREW BONE 4.5MM 23MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133024","SUP","HCPCS C1713","","48133024  -  SCREW BONE 4.5MM 24MM CONCTR MONOBLOCK XIA TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48133200","SUP","Custom 27803010","","48133200  -  ROD SPINAL 5.5MM 40MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48133224","SUP","Custom 27803010","","48133224  -  CONNECTOR ROD SMALL 24-30MM POLYAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48133230","SUP","Custom 27803010","","48133230  -  CONNECTOR ROD MEDIUM 30-36MM POLYAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48133236","SUP","Custom 27803010","","48133236  -  CONNECTOR ROD LARGE 36-45MM CROSSLINK XIA TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48133245","SUP","Custom 27803010","","48133245  -  CONNECTOR ROD LARGE 45-60MM POLYAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48133480","SUP","Custom 27803010","","48133480  -  ROD SPINAL 4.5MM 480MM XIA TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48134020","SUP","HCPCS C1713","","48134020  -  SCREW BONE 4MM 20MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134025","SUP","HCPCS C1713","","48134025  -  SCREW BONE 4MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134030","SUP","HCPCS C1713","","48134030  -  SCREW BONE 4MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134035","SUP","HCPCS C1713","","48134035  -  SCREW BONE 4MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134040","SUP","HCPCS C1713","","48134040  -  SCREW BONE 4MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134520","SUP","HCPCS C1713","","48134520  -  SCREW BONE 4.5MM 20MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134525","SUP","HCPCS C1713","","48134525  -  SCREW BONE 4.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134530","SUP","HCPCS C1713","","48134530  -  SCREW BONE 4.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134535","SUP","HCPCS C1713","","48134535  -  SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134540","SUP","HCPCS C1713","","48134540  -  SCREW BONE 4.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48134545","SUP","HCPCS C1713","","48134545  -  SCREW BONE 4.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135000","SUP","Custom 27803010","","48135000  -  CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN","BOTH IP/OP","$1,819.65 ","$1,346.54 ","$0.00 ","$1,819.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,819.65 ","$0.00 ","$909.83 ","$1,441.16 ","$1,455.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135000","SUP","Custom 27803010","","0048135000  -  CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN","BOTH IP/OP","$1,819.65 ","$1,346.54 ","$0.00 ","$1,819.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,819.65 ","$0.00 ","$909.83 ","$1,441.16 ","$1,455.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135001","SUP","Custom 27803010","","48135001  -  CONNECTOR ROD 4.5MM 60MM XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135003","SUP","Custom 27803010","","48135003  -  CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135004","SUP","Custom 27803010","","48135004  -  CONNECTOR ROD 4.5-6MM ROD TO ROD XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135005","SUP","Custom 27803010","","48135005  -  CONNECTOR ROD SMALL 4.5MM ROD TO ROD PARALLEL XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135006","SUP","Custom 27803010","","48135006  -  CONNECTOR ROD LARGE 4.5MM ROD TO ROD PARALLEL XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135008","SUP","Custom 27803010","","48135008  -  CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135020","SUP","HCPCS C1713","","48135020  -  SCREW BONE 5MM 20MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135025","SUP","HCPCS C1713","","48135025  -  SCREW BONE 5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135030","SUP","HCPCS C1713","","48135030  -  SCREW BONE 5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135035","SUP","HCPCS C1713","","48135035  -  SCREW BONE 5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135040","SUP","HCPCS C1713","","48135040  -  SCREW BONE 5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135045","SUP","HCPCS C1713","","48135045  -  SCREW BONE 5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135050","SUP","HCPCS C1713","","48135050  -  SCREW BONE 5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135055","SUP","HCPCS C1713","","48135055  -  SCREW BONE 5MM 55MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135060","SUP","HCPCS C1713","","48135060  -  SCREW BONE 5MM 60MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135070","SUP","HCPCS C1713","","48135070  -  SCREW BONE 5MM 70MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135080","SUP","HCPCS C1713","","48135080  -  SCREW BONE 5MM 80MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135101","SUP","Custom 27803010","","48135101  -  CONNECTOR ROD 4.5MM 30MM OFFST XIA TITANIUM SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135102","SUP","Custom 27803010","","48135102  -  CONNECTOR ROD 4.5MM 70MM OFFST XIA SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135103","SUP","Custom 27803010","","48135103  -  CONNECTOR ROD SMALL EXTEND XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$3,032.78 ","$2,244.26 ","$0.00 ","$3,032.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,032.78 ","$0.00 ","$1,516.39 ","$2,401.96 ","$2,426.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135104","SUP","Custom 27803010","","48135104  -  CONNECTOR ROD LONG 4.5MM EXTEND XIA SPN","BOTH IP/OP","$3,032.78 ","$2,244.26 ","$0.00 ","$3,032.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,032.78 ","$0.00 ","$1,516.39 ","$2,401.96 ","$2,426.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135105","SUP","Custom 27803010","","48135105  -  CONNECTOR ROD STR XIA TITANIUM ILIAC SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135106","SUP","Custom 27803010","","48135106  -  CONNECTOR ROD 15D 4.5MM STR XIA SPN ILIAC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135107","SUP","Custom 27803010","","48135107  -  CONNECTOR ROD 25D 4.5MM STR XIA SPN ILIAC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135108","SUP","Custom 27803010","","48135108  -  CONNECTOR ROD 35D 4.5MM STR XIA SPN ILIAC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135109","SUP","Custom 27803010","","48135109  -  CONNECTOR ROD 45D 4.5MM STR XIA SPN ILIAC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48135520","SUP","HCPCS C1713","","48135520  -  SCREW BONE 5.5MM 20MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135525","SUP","HCPCS C1713","","48135525  -  SCREW BONE 5.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135530","SUP","HCPCS C1713","","48135530  -  SCREW BONE 5.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135535","SUP","HCPCS C1713","","48135535  -  SCREW BONE 5.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135540","SUP","HCPCS C1713","","48135540  -  SCREW BONE 5.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135545","SUP","HCPCS C1713","","48135545  -  SCREW BONE 5.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135550","SUP","HCPCS C1713","","48135550  -  SCREW BONE 5.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135555","SUP","HCPCS C1713","","48135555  -  SCREW BONE 5.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135560","SUP","HCPCS C1713","","48135560  -  SCREW BONE 5.5MM 60MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135570","SUP","HCPCS C1713","","48135570  -  SCREW BONE 5.5MM 70MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48135580","SUP","HCPCS C1713","","48135580  -  SCREW BONE 5.5MM 80MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136025","SUP","HCPCS C1713","","48136025  -  SCREW BONE 6MM 25MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136030","SUP","HCPCS C1713","","48136030  -  SCREW BONE 6MM 30MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136035","SUP","HCPCS C1713","","48136035  -  SCREW BONE 6MM 35MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136040","SUP","HCPCS C1713","","48136040  -  SCREW BONE 6MM 40MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136045","SUP","HCPCS C1713","","48136045  -  SCREW BONE 6MM 45MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136050","SUP","HCPCS C1713","","48136050  -  SCREW BONE 6MM 50MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136055","SUP","HCPCS C1713","","48136055  -  SCREW BONE 6MM 55MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136060","SUP","HCPCS C1713","","48136060  -  SCREW BONE 6MM 60MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136070","SUP","HCPCS C1713","","48136070  -  SCREW BONE 6MM 70MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136080","SUP","HCPCS C1713","","48136080  -  SCREW BONE 6MM 80MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136530","SUP","HCPCS C1713","","48136530  -  SCREW BONE 6.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136535","SUP","HCPCS C1713","","48136535  -  SCREW BONE 6.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136540","SUP","HCPCS C1713","","48136540  -  SCREW BONE 6.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136545","SUP","HCPCS C1713","","48136545  -  SCREW BONE 6.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136550","SUP","HCPCS C1713","","48136550  -  SCREW BONE 6.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136555","SUP","HCPCS C1713","","48136555  -  SCREW BONE 6.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136560","SUP","HCPCS C1713","","48136560  -  SCREW BONE 6.5MM 60MM MNOAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136570","SUP","HCPCS C1713","","48136570  -  SCREW BONE 6.5MM 70MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48136580","SUP","HCPCS C1713","","48136580  -  SCREW BONE 6.5MM 80MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137030","SUP","HCPCS C1713","","48137030  -  SCREW BONE 7MM 30MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137035","SUP","HCPCS C1713","","48137035  -  SCREW BONE 7MM 35MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137040","SUP","HCPCS C1713","","48137040  -  SCREW BONE 7MM 40MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137045","SUP","HCPCS C1713","","48137045  -  SCREW BONE 7MM 45MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137050","SUP","HCPCS C1713","","48137050  -  SCREW BONE 7MM 50MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137060","SUP","HCPCS C1713","","48137060  -  SCREW BONE 7MM 60MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137070","SUP","HCPCS C1713","","48137070  -  SCREW BONE 7MM 70MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137080","SUP","HCPCS C1713","","48137080  -  SCREW BONE 7MM 80MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137530","SUP","HCPCS C1713","","48137530  -  SCREW BONE 7.5MM 30MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137535","SUP","HCPCS C1713","","48137535  -  SCREW BONE 7.5MM 35MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137540","SUP","HCPCS C1713","","48137540  -  SCREW BONE 7.5MM 40MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137545","SUP","HCPCS C1713","","48137545  -  SCREW BONE 7.5MM 45MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137550","SUP","HCPCS C1713","","48137550  -  SCREW BONE 7.5MM 50MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137555","SUP","HCPCS C1713","","48137555  -  SCREW BONE 7.5MM 55MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137560","SUP","HCPCS C1713","","48137560  -  SCREW BONE 7.5MM 60MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137570","SUP","HCPCS C1713","","48137570  -  SCREW BONE 7.5MM 70MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48137580","SUP","HCPCS C1713","","48137580  -  SCREW BONE 7.5MM 80MM MNOAX XIA SPN 4.5MM ROD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"48144020","SUP","HCPCS C1713","","48144020  -  SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144025","SUP","HCPCS C1713","","48144025  -  SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144030","SUP","HCPCS C1713","","48144030  -  SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144035","SUP","HCPCS C1713","","48144035  -  SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144040","SUP","HCPCS C1713","","48144040  -  SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144520","SUP","HCPCS C1713","","48144520  -  SCREW BONE 4.5MM 20MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144525","SUP","HCPCS C1713","","48144525  -  SCREW BONE 4.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144530","SUP","HCPCS C1713","","48144530  -  SCREW BONE 4.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144535","SUP","HCPCS C1713","","48144535  -  SCREW BONE 4.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144540","SUP","HCPCS C1713","","48144540  -  SCREW BONE 4.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144545","SUP","HCPCS C1713","","48144545  -  SCREW BONE 4.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144560","SUP","HCPCS C1713","","48144560  -  SCREW BONE 4.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48144570","SUP","HCPCS C1713","","48144570  -  SCREW BONE 4.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145020","SUP","HCPCS C1713","","48145020  -  SCREW BONE 5MM 20MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145025","SUP","HCPCS C1713","","48145025  -  SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145030","SUP","HCPCS C1713","","48145030  -  SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145035","SUP","HCPCS C1713","","48145035  -  SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145040","SUP","HCPCS C1713","","48145040  -  SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145045","SUP","HCPCS C1713","","48145045  -  SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145050","SUP","HCPCS C1713","","48145050  -  SCREW BONE 5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145055","SUP","HCPCS C1713","","48145055  -  SCREW BONE 5MM 55MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145060","SUP","HCPCS C1713","","48145060  -  SCREW BONE 5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145070","SUP","HCPCS C1713","","48145070  -  SCREW BONE 5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145080","SUP","HCPCS C1713","","48145080  -  SCREW BONE 5MM 80MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145520","SUP","HCPCS C1713","","48145520  -  SCREW BONE 5.5MM 20MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145525","SUP","HCPCS C1713","","48145525  -  SCREW BONE 5.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145530","SUP","HCPCS C1713","","48145530  -  SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145535","SUP","HCPCS C1713","","48145535  -  SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145540","SUP","HCPCS C1713","","48145540  -  SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145545","SUP","HCPCS C1713","","48145545  -  SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145550","SUP","HCPCS C1713","","48145550  -  SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145555","SUP","HCPCS C1713","","48145555  -  SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145560","SUP","HCPCS C1713","","48145560  -  SCREW BONE 5.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145570","SUP","HCPCS C1713","","48145570  -  SCREW BONE 5.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48145580","SUP","HCPCS C1713","","48145580  -  SCREW BONE 5.5MM 80MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146025","SUP","HCPCS C1713","","48146025  -  SCREW BONE 6MM 25MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146030","SUP","HCPCS C1713","","48146030  -  SCREW BONE 6MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146035","SUP","HCPCS C1713","","48146035  -  SCREW BONE 6MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146040","SUP","HCPCS C1713","","48146040  -  SCREW BONE 6MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146045","SUP","HCPCS C1713","","48146045  -  SCREW BONE 6MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146050","SUP","HCPCS C1713","","48146050  -  SCREW BONE 6MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146055","SUP","HCPCS C1713","","48146055  -  SCREW BONE 6MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146060","SUP","HCPCS C1713","","48146060  -  SCREW BONE 6MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146070","SUP","HCPCS C1713","","48146070  -  SCREW BONE 6MM 70MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146080","SUP","HCPCS C1713","","48146080  -  SCREW BONE 6MM 80MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146530","SUP","HCPCS C1713","","48146530  -  SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146535","SUP","HCPCS C1713","","48146535  -  SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146540","SUP","HCPCS C1713","","48146540  -  SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146545","SUP","HCPCS C1713","","48146545  -  SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146550","SUP","HCPCS C1713","","48146550  -  SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146555","SUP","HCPCS C1713","","48146555  -  SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146560","SUP","HCPCS C1713","","48146560  -  SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146570","SUP","HCPCS C1713","","48146570  -  SCREW BONE 6.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48146580","SUP","HCPCS C1713","","48146580  -  SCREW BONE 6.5MM 80MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147030","SUP","HCPCS C1713","","48147030  -  SCREW BONE 7MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147035","SUP","HCPCS C1713","","48147035  -  SCREW BONE 7MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147040","SUP","HCPCS C1713","","48147040  -  SCREW BONE 7MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147045","SUP","HCPCS C1713","","48147045  -  SCREW BONE 7MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147050","SUP","HCPCS C1713","","48147050  -  SCREW BONE 7MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147055","SUP","HCPCS C1713","","48147055  -  SCREW BONE 7MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147060","SUP","HCPCS C1713","","48147060  -  SCREW BONE 7MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147070","SUP","HCPCS C1713","","48147070  -  SCREW BONE 7MM 70MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147080","SUP","HCPCS C1713","","48147080  -  SCREW BONE 7MM 80MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147530","SUP","HCPCS C1713","","48147530  -  SCREW BONE 7.5MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147535","SUP","HCPCS C1713","","48147535  -  SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147540","SUP","HCPCS C1713","","48147540  -  SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147545","SUP","HCPCS C1713","","48147545  -  SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147550","SUP","HCPCS C1713","","48147550  -  SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147555","SUP","HCPCS C1713","","48147555  -  SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147560","SUP","HCPCS C1713","","48147560  -  SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147570","SUP","HCPCS C1713","","48147570  -  SCREW BONE 7.5MM 70MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48147580","SUP","HCPCS C1713","","48147580  -  SCREW BONE 7.5MM 80MM POLYAX XIA SPN 4.5MM ROD","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48200000","SUP","HCPCS C1713","","48200000  -  BLOCKER SPINAL BLOCKER TECHTONIX LUMBAR SACRAL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"48200005","SUP","Custom 27803010","","48200005  -  BLOCKER SPINAL 4.5MM BLOCKER TECHTONIX LUMBAR SACRAL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48200022","SUP","HCPCS C1713","","48200022  -  PLATE BONE 22MM LEVEL 2 TECHTONIX TITANIUM SPN","BOTH IP/OP","$3,306.20 ","$2,446.59 ","$0.00 ","$3,306.20 ","$1,487.79 ","$0.00 ","$689.09 ","$0.00 ","$0.00 ","$578.89 ","$3,306.20 ","$0.00 ","$1,653.10 ","$2,618.51 ","$2,644.96 ","$0.00 ","$517.42 ","$0.00 ","$526.35 ","$0.00 "
"48202234","SUP","HCPCS C1713","","48202234  -  PLATE BONE 22-34MM LEVEL 2 TECHTONIX TITANIUM SPN","BOTH IP/OP","$3,306.20 ","$2,446.59 ","$0.00 ","$3,306.20 ","$1,487.79 ","$0.00 ","$689.09 ","$0.00 ","$0.00 ","$578.89 ","$3,306.20 ","$0.00 ","$1,653.10 ","$2,618.51 ","$2,644.96 ","$0.00 ","$517.42 ","$0.00 ","$526.35 ","$0.00 "
"48202840","SUP","HCPCS C1713","","48202840  -  PLATE BONE 28-40MM LEVEL 2 TECHTONIX TITANIUM SPN","BOTH IP/OP","$3,306.20 ","$2,446.59 ","$0.00 ","$3,306.20 ","$1,487.79 ","$0.00 ","$689.09 ","$0.00 ","$0.00 ","$578.89 ","$3,306.20 ","$0.00 ","$1,653.10 ","$2,618.51 ","$2,644.96 ","$0.00 ","$517.42 ","$0.00 ","$526.35 ","$0.00 "
"48204658","SUP","HCPCS C1713","","48204658  -  PLATE BONE 46-58MM LEVEL 2 TECHTONIX TITANIUM SPN","BOTH IP/OP","$3,729.85 ","$2,760.09 ","$0.00 ","$3,729.85 ","$1,678.43 ","$0.00 ","$777.39 ","$0.00 ","$0.00 ","$653.07 ","$3,729.85 ","$0.00 ","$1,864.93 ","$2,954.04 ","$2,983.88 ","$0.00 ","$583.72 ","$0.00 ","$593.79 ","$0.00 "
"48213017","SUP","Custom 27803010","","48213017  -  CONNECTOR ROD 17MM MONOBLOCK MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213020","SUP","Custom 27803010","","48213020  -  CONNECTOR ROD 20MM MONOBLOCK MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213023","SUP","Custom 27803010","","48213023  -  CONNECTOR ROD 23MM MULTIAX CROSS XIA MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213026","SUP","Custom 27803010","","48213026  -  CONNECTOR ROD 26MM MULTIAX CROSS XIA MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213029","SUP","Custom 27803010","","48213029  -  CONNECTOR ROD 29-31MM CROSS MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213031","SUP","Custom 27803010","","48213031  -  CONNECTOR ROD SMALL 31-35MM MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213035","SUP","Custom 27803010","","48213035  -  CONNECTOR ROD SMALL 35-40MM MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213038","SUP","Custom 27803010","","48213038  -  CONNECTOR ROD STANDARD 39-43MM MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213042","SUP","Custom 27803010","","48213042  -  CONNECTOR ROD 42MM MULTIAX CROSSLINK MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213050","SUP","Custom 27803010","","48213050  -  CONNECTOR ROD 50MM MULTIAX CROSSLINK MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48213066","SUP","Custom 27803010","","48213066  -  CONNECTOR ROD 67-99MM MULTIAX CROSS XIA MAC TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218030","SUP","Custom 27803010","","48218030  -  ROD SPINAL 3.5IN RAD PREBENT 30MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218035","SUP","Custom 27803010","","48218035  -  ROD SPINAL 6MM 35MM RAD XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218040","SUP","Custom 27803010","","48218040  -  ROD SPINAL 3.5IN 40MM XIA RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218045","SUP","Custom 27803010","","48218045  -  ROD SPINAL 4.25IN RAD 6MM 45MM RAD XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218050","SUP","Custom 27803010","","48218050  -  ROD SPINAL 4.25IN RAD 6MM 50MM CVD XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218060","SUP","Custom 27803010","","48218060  -  ROD SPINAL 4.25IN RAD 6MM 60MM CVD XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218070","SUP","Custom 27803010","","48218070  -  ROD SPINAL 6MM 70MM RAD XIA RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218080","SUP","Custom 27803010","","48218080  -  ROD SPINAL 5IN RAD 5IN 80MM XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48218090","SUP","Custom 27803010","","48218090  -  ROD SPINAL 5IN RAD PREBENT 90MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48219050","SUP","Custom 27803010","","48219050  -  ROD SPNL 50MM 6MM XIA TI RAD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48219060","SUP","Custom 27803010","","48219060  -  ROD SPNL 60MM XIA TI 2 RAD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48219070","SUP","Custom 27803010","","48219070  -  ROD SPNL 70MM XIA MXTI 2 RAD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48219080","SUP","Custom 27803010","","48219080  -  ROD SPNL 80MM XIA TI 2 RAD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220000","SUP","Custom 27803010","","48220000  -  SCREW SET BUTTRESS THREAD BLOCKER XIA STAINLESS STEEL","BOTH IP/OP","$2,400.00 ","$1,776.00 ","$0.00 ","$2,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,400.00 ","$0.00 ","$1,200.00 ","$1,900.80 ","$1,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220100","SUP","HCPCS C1713","","48220100  -  WASHER SPINAL XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS","BOTH IP/OP","$202.18 ","$149.61 ","$0.00 ","$202.18 ","$90.98 ","$0.00 ","$42.14 ","$0.00 ","$0.00 ","$35.40 ","$202.18 ","$0.00 ","$101.09 ","$160.13 ","$161.74 ","$0.00 ","$31.64 ","$0.00 ","$32.19 ","$0.00 "
"48220101","SUP","Custom 27803010","","48220101  -  CONNECTOR ROD OFFST XIA STAINLESS STEEL SCOLIOS","BOTH IP/OP","$556.50 ","$411.81 ","$0.00 ","$556.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$556.50 ","$0.00 ","$278.25 ","$440.75 ","$445.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220102","SUP","Custom 27803010","","48220102  -  CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR","BOTH IP/OP","$1,001.30 ","$740.96 ","$0.00 ","$1,001.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,001.30 ","$0.00 ","$500.65 ","$793.03 ","$801.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220103","SUP","Custom 27803010","","48220103  -  CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR","BOTH IP/OP","$1,001.30 ","$740.96 ","$0.00 ","$1,001.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,001.30 ","$0.00 ","$500.65 ","$793.03 ","$801.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220104","SUP","HCPCS C1713","","48220104  -  STAPLE BONE XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS","BOTH IP/OP","$223.38 ","$165.30 ","$0.00 ","$223.38 ","$100.52 ","$0.00 ","$46.56 ","$0.00 ","$0.00 ","$39.11 ","$223.38 ","$0.00 ","$111.69 ","$176.92 ","$178.70 ","$0.00 ","$34.96 ","$0.00 ","$35.56 ","$0.00 "
"48220110","SUP","HCPCS C1713","","48220110  -  STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL","BOTH IP/OP","$2,133.55 ","$1,578.83 ","$0.00 ","$2,133.55 ","$960.10 ","$0.00 ","$444.69 ","$0.00 ","$0.00 ","$373.57 ","$2,133.55 ","$0.00 ","$1,066.78 ","$1,689.77 ","$1,706.84 ","$0.00 ","$333.90 ","$0.00 ","$339.66 ","$0.00 "
"48220111","SUP","HCPCS C1713","","48220111  -  STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR","BOTH IP/OP","$2,133.55 ","$1,578.83 ","$0.00 ","$2,133.55 ","$960.10 ","$0.00 ","$444.69 ","$0.00 ","$0.00 ","$373.57 ","$2,133.55 ","$0.00 ","$1,066.78 ","$1,689.77 ","$1,706.84 ","$0.00 ","$333.90 ","$0.00 ","$339.66 ","$0.00 "
"48220112","SUP","HCPCS C1713","","48220112  -  STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR","BOTH IP/OP","$2,133.55 ","$1,578.83 ","$0.00 ","$2,133.55 ","$960.10 ","$0.00 ","$444.69 ","$0.00 ","$0.00 ","$373.57 ","$2,133.55 ","$0.00 ","$1,066.78 ","$1,689.77 ","$1,706.84 ","$0.00 ","$333.90 ","$0.00 ","$339.66 ","$0.00 "
"48220113","SUP","HCPCS C1713","","48220113  -  STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR","BOTH IP/OP","$2,133.55 ","$1,578.83 ","$0.00 ","$2,133.55 ","$960.10 ","$0.00 ","$444.69 ","$0.00 ","$0.00 ","$373.57 ","$2,133.55 ","$0.00 ","$1,066.78 ","$1,689.77 ","$1,706.84 ","$0.00 ","$333.90 ","$0.00 ","$339.66 ","$0.00 "
"48220114","SUP","HCPCS C1713","","48220114  -  STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL","BOTH IP/OP","$2,133.55 ","$1,578.83 ","$0.00 ","$2,133.55 ","$960.10 ","$0.00 ","$444.69 ","$0.00 ","$0.00 ","$373.57 ","$2,133.55 ","$0.00 ","$1,066.78 ","$1,689.77 ","$1,706.84 ","$0.00 ","$333.90 ","$0.00 ","$339.66 ","$0.00 "
"48220115","SUP","HCPCS C1713","","48220115  -  STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR","BOTH IP/OP","$2,133.55 ","$1,578.83 ","$0.00 ","$2,133.55 ","$960.10 ","$0.00 ","$444.69 ","$0.00 ","$0.00 ","$373.57 ","$2,133.55 ","$0.00 ","$1,066.78 ","$1,689.77 ","$1,706.84 ","$0.00 ","$333.90 ","$0.00 ","$339.66 ","$0.00 "
"48220130","SUP","Custom 27803010","","48220130  -  CONNECTOR ROD 75D OFFST XIA STAINLESS STEEL SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220131","SUP","Custom 27803010","","48220131  -  CONNECTOR ROD OFFST STAINLESS STEEL SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220132","SUP","Custom 27803010","","48220132  -  CONNECTOR ROD 105D OFFST XIA STAINLESS STEEL SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220133","SUP","Custom 27803010","","48220133  -  CONNECTOR ROD NEUTRAL LONG OFFST XIA STAINLESS STEEL SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220134","SUP","Custom 27803010","","48220134  -  CONNECTOR ROD 0D SMALL PARALLEL XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220135","SUP","Custom 27803010","","48220135  -  CONNECTOR ROD 30D SMALL ROD TO ROD XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220136","SUP","Custom 27803010","","48220136  -  CONNECTOR ROD 0D LARGE ROD TO ROD XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220137","SUP","Custom 27803010","","48220137  -  CONNECTOR ROD 30D LARGE ROD TO ROD XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220200","SUP","Custom 27803010","","48220200  -  HOOK SPINAL SMALL STANDARD LAMINATE XIA STAINLESS STEEL LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220201","SUP","Custom 27803010","","48220201  -  HOOK SPINAL SMALL NARROW XIA STAINLESS STEEL LMNR SCOLIOS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220202","SUP","Custom 27803010","","48220202  -  HOOK SPINAL LARGE STANDARD BLADE XIA STAINLESS STEEL LAMINA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220203","SUP","Custom 27203010","","48220203  -  HOOK SURG LARGE NARROW BLADE XIA STAINLESS STEEL SPINAL LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220204","SUP","Custom 27803010","","48220204  -  HOOK SPINAL EXTENDED BODY XIA STAINLESS STEEL LMNR SCOLIOS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220205","SUP","Custom 27803010","","48220205  -  HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220206","SUP","Custom 27803010","","48220206  -  HOOK SPINAL OFFST XIA STAINLESS STEEL RIGHT LMNR SCOLIOS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220207","SUP","Custom 27803010","","48220207  -  HOOK SPINAL OFFST XIA LEFT LMNR SCOLIOS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220208","SUP","Custom 27803010","","48220208  -  HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220210","SUP","Custom 27803010","","48220210  -  HOOK SPINAL STANDARD BLADE XIA STAINLESS STEEL LMNR SCOLIOS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220211","SUP","Custom 27803010","","48220211  -  HOOK SPINAL NARROW BLADE XIA STAINLESS STEEL LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220212","SUP","Custom 27803010","","48220212  -  HOOK SPINAL SMALL RIGHT OFFST XIA STAINLESS STEEL LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220213","SUP","Custom 27803010","","48220213  -  HOOK SPINAL SMALL LEFT OFFST XIA STAINLESS STEEL LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220214","SUP","Custom 27803010","","48220214  -  HOOK SPINAL LARGE STANDARD RIGHT OFFST XIA STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220215","SUP","Custom 27803010","","48220215  -  HOOK SPINAL LARGE LEFT OFFST XIA STAINLESS STEEL LMNR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220220","SUP","Custom 27803010","","48220220  -  HOOK SPINAL SMALL XIA PEDICLE SCOLIOS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220221","SUP","Custom 27803010","","48220221  -  HOOK SPINAL LARGE XIA PEDICLE SCOLIOS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220230","SUP","Custom 27803010","","48220230  -  HOOK SPINAL STANDARD TRNSVRS PROCESS XIA STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220231","SUP","Custom 27803010","","48220231  -  HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA STAINLESS STEEL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220240","SUP","Custom 27203010","","48220240  -  HOOK RETRACTION WIDE LAMINA RBH","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220241","SUP","Custom 27803010","","48220241  -  HOOK SPINAL WIDE BLADE RED XIA STAINLESS STEEL LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220242","SUP","Custom 27203010","","48220242  -  HOOK RETRACTION ANGLED LP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220243","SUP","Custom 27803010","","48220243  -  HOOK SPINAL RED NARROW BLADE XIA TITANIUM LMNR THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220244","SUP","Custom 27803010","","48220244  -  HOOK SPINAL RED BLADE XIA STAINLESS STEEL PEDICLE SCOLIOS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220317","SUP","Custom 27803010","","48220317  -  CONNECTOR ROD 17MM CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220319","SUP","Custom 27803010","","48220319  -  CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220321","SUP","Custom 27803010","","48220321  -  CONNECTOR ROD 21MM MOMO TYPE XIA MAC STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220323","SUP","Custom 27803010","","48220323  -  CONNECTOR ROD 23MM MULTIAX CROSS XIA STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220326","SUP","Custom 27803010","","48220326  -  CONNECTOR ROD 26MM MOMO TYPE XIA MAC STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220329","SUP","Custom 27803010","","48220329  -  CONNECTOR ROD 29MM MULTIAX MONO XIA STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220331","SUP","Custom 27803010","","48220331  -  CROSSLINK SPINAL 31-34MM MULTIAX XIA STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220335","SUP","Custom 27803010","","48220335  -  CONNECTOR ROD SMALL 35-37MM MULTIAX CROSS XIA STAINLESS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220338","SUP","Custom 27803010","","48220338  -  CROSSLINK SPINAL 38-43MM MULTIAX XIA STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220342","SUP","Custom 27803010","","48220342  -  CONNECTOR ROD 42-51MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220350","SUP","Custom 27803010","","48220350  -  CONNECTOR ROD 50-67MM CROSSLINK XIA SPN SCOLIOS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48220425","SUP","HCPCS C1713","","48220425  -  SCREW BONE 4.5MM 25MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220430","SUP","HCPCS C1713","","48220430  -  SCREW BONE 4.5MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220435","SUP","HCPCS C1713","","48220435  -  SCREW BONE 4.5MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220440","SUP","HCPCS C1713","","48220440  -  SCREW BONE 4.5MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220445","SUP","HCPCS C1713","","48220445  -  SCREW BONE 4.5MM 45MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220525","SUP","HCPCS C1713","","48220525  -  SCREW BONE 5.5MM 25MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220530","SUP","HCPCS C1713","","48220530  -  SCREW BONE 5.5MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220535","SUP","HCPCS C1713","","48220535  -  SCREW BONE 5.5MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220540","SUP","HCPCS C1713","","48220540  -  SCREW BONE 5.5MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220545","SUP","HCPCS C1713","","48220545  -  SCREW BONE 5.5MM 45MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220550","SUP","HCPCS C1713","","48220550  -  SCREW BONE 5.5MM 50MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220555","SUP","HCPCS C1713","","48220555  -  SCREW BONE 5.5MM 55MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220600","SUP","HCPCS C1713","","48220600  -  SCREW BONE 6.5MM 100MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220630","SUP","HCPCS C1713","","48220630  -  SCREW BONE 6.5MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220635","SUP","HCPCS C1713","","48220635  -  SCREW BONE 6.5MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220640","SUP","HCPCS C1713","","48220640  -  SCREW BONE 6.5MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220645","SUP","HCPCS C1713","","48220645  -  SCREW BONE 6.5MM 45MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220650","SUP","HCPCS C1713","","48220650  -  SCREW BONE 6.5MM 50MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220655","SUP","HCPCS C1713","","48220655  -  SCREW BONE 6.5MM 55MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220660","SUP","HCPCS C1713","","48220660  -  SCREW BONE 6.5MM 60MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220670","SUP","HCPCS C1713","","48220670  -  SCREW BONE 6.5MM 70MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220680","SUP","HCPCS C1713","","48220680  -  SCREW BONE 6.5MM 80MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220690","SUP","HCPCS C1713","","48220690  -  SCREW BONE 6.5MM 90MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220700","SUP","HCPCS C1713","","48220700  -  SCREW BONE 7.5MM 100MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220730","SUP","HCPCS C1713","","48220730  -  SCREW BONE 7.5MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220735","SUP","HCPCS C1713","","48220735  -  SCREW BONE 7.5MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220740","SUP","HCPCS C1713","","48220740  -  SCREW BONE 7.5MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220745","SUP","HCPCS C1713","","48220745  -  SCREW BONE 7.5MM 45MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48220750","SUP","HCPCS C1713","","48220750  -  SCREW BONE 7.5MM 50MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220755","SUP","HCPCS C1713","","48220755  -  SCREW BONE 7.5MM 55MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220760","SUP","HCPCS C1713","","48220760  -  SCREW BONE 7.5MM 60MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220770","SUP","HCPCS C1713","","48220770  -  SCREW BONE 7.5MM 70MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220780","SUP","HCPCS C1713","","48220780  -  SCREW BONE 7.5MM 80MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220790","SUP","HCPCS C1713","","48220790  -  SCREW BONE 7.5MM 90MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220800","SUP","HCPCS C1713","","48220800  -  SCREW BONE 8.5MM 100MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220830","SUP","HCPCS C1713","","48220830  -  SCREW BONE 8.5MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220835","SUP","HCPCS C1713","","48220835  -  SCREW BONE 8.5MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220840","SUP","HCPCS C1713","","48220840  -  SCREW BONE 8.5MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220845","SUP","HCPCS C1713","","48220845  -  SCREW BONE 8.5MM 45MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220850","SUP","HCPCS C1713","","48220850  -  SCREW BONE 8.5MM 50MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220855","SUP","HCPCS C1713","","48220855  -  SCREW BONE 8.5MM 55MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220860","SUP","HCPCS C1713","","48220860  -  SCREW BONE 8.5MM 60MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220870","SUP","HCPCS C1713","","48220870  -  SCREW BONE 8.5MM 70MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220880","SUP","HCPCS C1713","","48220880  -  SCREW BONE 8.5MM 80MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220890","SUP","HCPCS C1713","","48220890  -  SCREW BONE 8.5MM 90MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220900","SUP","HCPCS C1713","","48220900  -  SCREW BONE 9.5MM 100MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220960","SUP","HCPCS C1713","","48220960  -  SCREW BONE 9.5MM 60MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220970","SUP","HCPCS C1713","","48220970  -  SCREW BONE 9.5MM 70MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220980","SUP","HCPCS C1713","","48220980  -  SCREW BONE 9.5MM 80MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48220990","SUP","HCPCS C1713","","48220990  -  SCREW BONE 9.5MM 90MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"48221015","SUP","Custom 27803010","","48221015  -  CONNECTOR ROD 15MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48221016","SUP","Custom 27803010","","48221016  -  CONNECTOR ROD 16MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48221017","SUP","Custom 27803010","","48221017  -  CONNECTOR ROD 17MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48221018","SUP","Custom 27803010","","48221018  -  CONNECTOR ROD 18MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48221019","SUP","Custom 27803010","","48221019  -  CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48221020","SUP","Custom 27803010","","48221020  -  CONNECTOR ROD 20MM MULTIAX CROSS XIA MAC STAINLESS STEEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48221425","SUP","HCPCS C1713","","48221425  -  SCREW BONE 4.5MM 25MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"48221430","SUP","HCPCS C1713","","48221430  -  SCREW BONE 4.5MM 30MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"48221435","SUP","HCPCS C1713","","48221435  -  SCREW BONE 4.5MM 35MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"48221440","SUP","HCPCS C1713","","48221440  -  SCREW BONE 4.5MM 40MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"48221445","SUP","HCPCS C1713","","48221445  -  SCREW BONE 4.5MM 45MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"48221525","SUP","HCPCS C1713","","48221525  -  SCREW BONE 5.5MM 25MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"48221530","SUP","HCPCS C1713","","48221530  -  SCREW BONE 5.5MM 30MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"48221535","SUP","HCPCS C1713","","48221535  -  SCREW BONE 5.5MM 35MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"48221540","SUP","HCPCS C1713","","48221540  -  SCREW BONE 5.5MM 40MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"48221545","SUP","HCPCS C1713","","48221545  -  SCREW BONE 5.5MM 45MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221550","SUP","HCPCS C1713","","48221550  -  SCREW BONE 5.5MM 50MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221555","SUP","HCPCS C1713","","48221555  -  SCREW BONE 5.5MM 55MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221600","SUP","HCPCS C1713","","48221600  -  SCREW BONE 6.5MM 100MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221630","SUP","HCPCS C1713","","48221630  -  SCREW BONE 6.5MM 30MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221635","SUP","HCPCS C1713","","48221635  -  SCREW BONE 6.5MM 35MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221640","SUP","HCPCS C1713","","48221640  -  SCREW BONE 6.5MM 40MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221645","SUP","HCPCS C1713","","48221645  -  SCREW BONE 6.5MM 45MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221650","SUP","HCPCS C1713","","48221650  -  SCREW BONE 6.5MM 50MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221655","SUP","HCPCS C1713","","48221655  -  SCREW BONE 6.5MM 55MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221660","SUP","HCPCS C1713","","48221660  -  SCREW BONE 6.5MM 60MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221670","SUP","HCPCS C1713","","48221670  -  SCREW BONE 6.5MM 70MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221680","SUP","HCPCS C1713","","48221680  -  SCREW BONE 6.5MM 80MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221690","SUP","HCPCS C1713","","48221690  -  SCREW BONE 6.5MM 90MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221700","SUP","HCPCS C1713","","48221700  -  SCREW BONE 7.5MM 100MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221730","SUP","HCPCS C1713","","48221730  -  SCREW BONE 7.5MM 30MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221735","SUP","HCPCS C1713","","48221735  -  SCREW BONE 7.5MM 35MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221740","SUP","HCPCS C1713","","48221740  -  SCREW BONE 7.5MM 40MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221745","SUP","HCPCS C1713","","48221745  -  SCREW BONE 7.5MM 45MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221750","SUP","HCPCS C1713","","48221750  -  SCREW BONE 7.5MM 50MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221755","SUP","HCPCS C1713","","48221755  -  SCREW BONE 7.5MM 55MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221760","SUP","HCPCS C1713","","48221760  -  SCREW BONE 7.5MM 60MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221770","SUP","HCPCS C1713","","48221770  -  SCREW BONE 7.5MM 70MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221780","SUP","HCPCS C1713","","48221780  -  SCREW BONE 7.5MM 80MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48221790","SUP","HCPCS C1713","","48221790  -  SCREW BONE 7.5MM 90MM POLYAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"48222000","SUP","Custom 27803010","","48222000  -  ROD SPINAL STANDARD 5.5MM 480MM XIA STAINLESS STEEL SCOLIOS","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48222001","SUP","Custom 27803010","","48222001  -  ROD SPINAL STANDARD 5.5MM 480MM STIFF XIA STAINLESS STEEL","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48222003","SUP","Custom 27803010","","48222003  -  ROD SPNL 5.5MM 480MM NS XIA STF HEX SS","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48222600","SUP","Custom 27803010","","48222600  -  ROD SPINAL STANDARD 600MM XIA STAINLESS STEEL SCOLIOS","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48222601","SUP","Custom 27803010","","48222601  -  ROD SPINAL 600MM STIFF XIA STAINLESS STEEL SCOLIOS","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48222603","SUP","Custom 27803010","","48222603  -  ROD SPNL 5.5MM 600MM NS XIA STF HEX SS","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48223425","SUP","HCPCS C1713","","48223425  -  SCREW BONE 4.5MM 25MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$6,800.00 ","$5,032.00 ","$0.00 ","$6,800.00 ","$3,060.00 ","$0.00 ","$1,417.29 ","$0.00 ","$0.00 ","$1,190.63 ","$6,800.00 ","$0.00 ","$3,400.00 ","$5,385.60 ","$5,440.00 ","$0.00 ","$1,064.20 ","$0.00 ","$1,082.56 ","$0.00 "
"48223430","SUP","HCPCS C1713","","48223430  -  SCREW BONE 4.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$10,975.00 ","$8,121.50 ","$0.00 ","$10,975.00 ","$4,938.75 ","$0.00 ","$2,287.46 ","$0.00 ","$0.00 ","$1,921.63 ","$10,975.00 ","$0.00 ","$5,487.50 ","$8,692.20 ","$8,780.00 ","$0.00 ","$1,717.59 ","$0.00 ","$1,747.22 ","$0.00 "
"48223435","SUP","HCPCS C1713","","48223435  -  SCREW BONE 4.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223440","SUP","HCPCS C1713","","48223440  -  SCREW BONE 4.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223445","SUP","HCPCS C1713","","48223445  -  SCREW BONE 4.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223530","SUP","HCPCS C1713","","48223530  -  SCREW BONE 5.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223535","SUP","HCPCS C1713","","48223535  -  SCREW BONE 5.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223540","SUP","HCPCS C1713","","48223540  -  SCREW BONE 5.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223545","SUP","HCPCS C1713","","48223545  -  SCREW BONE 5.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223550","SUP","HCPCS C1713","","48223550  -  SCREW BONE 5.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223630","SUP","HCPCS C1713","","48223630  -  SCREW BONE 6.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223635","SUP","HCPCS C1713","","48223635  -  SCREW BONE 6.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223640","SUP","HCPCS C1713","","48223640  -  SCREW BONE 6.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223645","SUP","HCPCS C1713","","48223645  -  SCREW BONE 6.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48223650","SUP","HCPCS C1713","","48223650  -  SCREW BONE 6.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48227201","SUP","Custom 27803010","","48227201  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48227202","SUP","Custom 27803010","","48227202  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48227203","SUP","Custom 27803010","","48227203  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48227211","SUP","Custom 27803010","","48227211  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48227220","SUP","Custom 27803010","","48227220  -  HOOK SPINAL REDX LONG ARM STAINLESS STEEL PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48228425","SUP","HCPCS C1713","","48228425  -  SCREW BONE 4.5MM 25MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228430","SUP","HCPCS C1713","","48228430  -  SCREW BONE 4.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228435","SUP","HCPCS C1713","","48228435  -  SCREW BONE 4.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228440","SUP","HCPCS C1713","","48228440  -  SCREW BONE 4.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228445","SUP","HCPCS C1713","","48228445  -  SCREW BONE 4.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228530","SUP","HCPCS C1713","","48228530  -  SCREW BONE 5.5MM 30MM REDX MNOAX LONG ARM STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228535","SUP","HCPCS C1713","","48228535  -  SCREW BONE 5.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228540","SUP","HCPCS C1713","","48228540  -  SCREW BONE 5.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228545","SUP","HCPCS C1713","","48228545  -  SCREW BONE 5.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228550","SUP","HCPCS C1713","","48228550  -  SCREW BONE 5.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228555","SUP","HCPCS C1713","","48228555  -  SCREW BONE 5.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228630","SUP","HCPCS C1713","","48228630  -  SCREW BONE 6.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228635","SUP","HCPCS C1713","","48228635  -  SCREW BONE 6.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228640","SUP","HCPCS C1713","","48228640  -  SCREW BONE 6.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228645","SUP","HCPCS C1713","","48228645  -  SCREW BONE 6.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228650","SUP","HCPCS C1713","","48228650  -  SCREW BONE 6.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$1,313.08 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"48228655","SUP","HCPCS C1713","","48228655  -  SCREW BONE 6.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228660","SUP","HCPCS C1713","","48228660  -  SCREW BONE 6.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228730","SUP","HCPCS C1713","","48228730  -  SCREW BONE 7.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228735","SUP","HCPCS C1713","","48228735  -  SCREW BONE 7.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228740","SUP","HCPCS C1713","","48228740  -  SCREW BONE 7.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228745","SUP","HCPCS C1713","","48228745  -  SCREW BONE 7.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228750","SUP","HCPCS C1713","","48228750  -  SCREW BONE 7.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228755","SUP","HCPCS C1713","","48228755  -  SCREW BONE 7.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48228760","SUP","HCPCS C1713","","48228760  -  SCREW BONE 7.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"48229425","SUP","HCPCS C1713","","48229425  -  SCREW BONE LONG ARM 4.5MM 25MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48229430","SUP","HCPCS C1713","","48229430  -  SCREW BONE 4.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229435","SUP","HCPCS C1713","","48229435  -  SCREW BONE 4.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229440","SUP","HCPCS C1713","","48229440  -  SCREW BONE 4.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229445","SUP","HCPCS C1713","","48229445  -  SCREW BONE LONG ARM 4.5MM 45MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229530","SUP","HCPCS C1713","","48229530  -  SCREW BONE 5.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229535","SUP","HCPCS C1713","","48229535  -  SCREW BONE 5.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229540","SUP","HCPCS C1713","","48229540  -  SCREW BONE 5.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229545","SUP","HCPCS C1713","","48229545  -  SCREW BONE LONG ARM 5.5MM 45MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229550","SUP","HCPCS C1713","","48229550  -  SCREW BONE LONG ARM 5.5MM 50MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229555","SUP","HCPCS C1713","","48229555  -  SCREW BONE LONG ARM 5.5MM 55MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229630","SUP","HCPCS C1713","","48229630  -  SCREW BONE 6.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229635","SUP","HCPCS C1713","","48229635  -  SCREW BONE 6.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229640","SUP","HCPCS C1713","","48229640  -  SCREW BONE 6.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229645","SUP","HCPCS C1713","","48229645  -  SCREW BONE 6.5MM 45MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229650","SUP","HCPCS C1713","","48229650  -  SCREW BONE 6.5MM 50MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229655","SUP","HCPCS C1713","","48229655  -  SCREW BONE 6.5MM 55MM REDX LONG ARM POLYAX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229660","SUP","HCPCS C1713","","48229660  -  SCREW BONE LONG ARM 6.5MM 60MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229730","SUP","HCPCS C1713","","48229730  -  SCREW BONE LONG ARM 7.5MM 30MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229735","SUP","HCPCS C1713","","48229735  -  SCREW BONE LONG ARM 7.5MM 35MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229740","SUP","HCPCS C1713","","48229740  -  SCREW BONE LONG ARM 7.5MM 40MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229745","SUP","HCPCS C1713","","48229745  -  SCREW BONE LONG ARM 7.5MM 45MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229750","SUP","HCPCS C1713","","48229750  -  SCREW BONE LONG ARM 7.5MM 50MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229755","SUP","HCPCS C1713","","48229755  -  SCREW BONE LONG ARM 7.5MM 55MM POLYAX REDX XIA STAINLESS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48229760","SUP","HCPCS C1713","","48229760  -  BLOCKER SPNL XIA 3 TI SPNE","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"48230000","SUP","Custom 27803010","","48230000  -  SCREW SET BLOCKER XIA 3 TITANIUM SPN","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230133","SUP","Custom 27803010","","48230133  -  CONNECTOR ROD LARGE OFFST ILIAC PELVIC","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230138","SUP","Custom 27803010","","48230138  -  CONNECTOR ROD SMALL REVISION OFFST ILIOSACRAL SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230139","SUP","Custom 27803010","","48230139  -  CONNECTOR ROD LONG REVISION OFFST XIA 3 ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230141","SUP","Custom 27803010","","48230141  -  CONNECTOR ROD SMALL 7MM REVISION ROD TO ROD PARALLEL XIA 3","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230143","SUP","Custom 27803010","","48230143  -  CONNECTOR ROD REVISION J HOOK OFFST ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230144","SUP","Custom 27803010","","48230144  -  CONNECTOR ROD REVISION OFFST ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230201","SUP","Custom 27803010","","48230201  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230202","SUP","Custom 27803010","","48230202  -  HOOK SPINAL LARGE XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230203","SUP","Custom 27803010","","48230203  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230204","SUP","Custom 27803010","","48230204  -  HOOK SPINAL EXTENDED BODY XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230205","SUP","Custom 27803010","","48230205  -  HOOK SPINAL EXTENDED BODY XIA 3 TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230206","SUP","Custom 27803010","","48230206  -  HOOK SPINAL RIGHT OFFST XIA LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230207","SUP","Custom 27803010","","48230207  -  HOOK SPINAL LEFT OFFST XIA LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230208","SUP","Custom 27803010","","48230208  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230209","SUP","Custom 27803010","","48230209  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230210","SUP","Custom 27803010","","48230210  -  HOOK SPINAL OPEN XIA THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230211","SUP","Custom 27803010","","48230211  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230212","SUP","Custom 27803010","","48230212  -  HOOK SPINAL XIA RIGHT LMNR THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230213","SUP","Custom 27803010","","48230213  -  HOOK SPINAL XIA LEFT LMNR THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230214","SUP","Custom 27803010","","48230214  -  HOOK SPINAL LARGE OFFST XIA 3 TITANIUM RIGHT LMNR THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230215","SUP","Custom 27803010","","48230215  -  HOOK SPINAL LARGE OFFST XIA 3 TITANIUM LEFT LMNR THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230216","SUP","Custom 27803010","","48230216  -  HOOK SPINAL SMALL XIA TITANIUM LMNR THORACIC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230217","SUP","Custom 27803010","","48230217  -  HOOK SPNL XIA LG TI RIGHT OFFST","BOTH IP/OP","$2,687.35 ","$1,988.64 ","$0.00 ","$2,687.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,687.35 ","$0.00 ","$1,343.68 ","$2,128.38 ","$2,149.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230218","SUP","Custom 27803010","","48230218  -  HOOK SPNL XIA LG TI LEFT OFFST","BOTH IP/OP","$2,687.35 ","$1,988.64 ","$0.00 ","$2,687.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,687.35 ","$0.00 ","$1,343.68 ","$2,128.38 ","$2,149.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230220","SUP","Custom 27803010","","48230220  -  HOOK SPINAL SMALL XIA TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230221","SUP","Custom 27803010","","48230221  -  HOOK SPINAL MEDIUM XIA TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230222","SUP","Custom 27803010","","48230222  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230230","SUP","HCPCS C1713","","48230230  -  WIRE FIX SHARP CANN KWIRE SPN","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48230231","SUP","HCPCS C1713","","48230231  -  WIRE FIX BLUNT KWIRE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48230232","SUP","Custom 27803010","","48230232  -  HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM RIGHT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230233","SUP","Custom 27803010","","48230233  -  HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM LEFT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230240","SUP","Custom 27803010","","48230240  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230241","SUP","Custom 27803010","","48230241  -  HOOK SPINAL XIA TITANIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230250","SUP","Custom 27803010","","48230250  -  HOOK SPINAL MEDIUM LMNR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230260","SUP","Custom 27803010","","48230260  -  HOOK SPINAL REVISION ILIOSACRAL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48231535","SUP","HCPCS C1713","","48231535  -  SCREW BONE 5.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231540","SUP","HCPCS C1713","","48231540  -  SCREW BONE 5.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231545","SUP","HCPCS C1713","","48231545  -  SCREW BONE 5.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231550","SUP","HCPCS C1713","","48231550  -  SCREW BONE 5.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231630","SUP","HCPCS C1713","","48231630  -  SCREW BONE 6.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231635","SUP","HCPCS C1713","","48231635  -  SCREW BONE 6.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231640","SUP","HCPCS C1713","","48231640  -  SCREW BONE 6.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231645","SUP","HCPCS C1713","","48231645  -  SCREW BONE 6.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231650","SUP","HCPCS C1713","","48231650  -  SCREW BONE 6.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231655","SUP","HCPCS C1713","","48231655  -  SCREW BN 6.5MM 50MM XIA 3 PA TI SPNE THORLMBR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231730","SUP","HCPCS C1713","","48231730  -  SCREW BONE 7.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231735","SUP","HCPCS C1713","","48231735  -  SCREW BONE 7.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231740","SUP","HCPCS C1713","","48231740  -  SCREW BONE 7.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231745","SUP","HCPCS C1713","","48231745  -  SCREW BN 7.5MM 45MM XIA 3 PA TI SPNE THORLMBR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231750","SUP","HCPCS C1713","","48231750  -  SCREW BONE 7.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48231755","SUP","HCPCS C1713","","48231755  -  SCREW BN 7.5MM 50MM XIA CNN TI SPNE THORLMBR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"48232030","SUP","Custom 27803010","","48232030  -  ROD SPINAL 6MM 30MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232040","SUP","Custom 27803010","","48232040  -  ROD SPINAL 40MM XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232050","SUP","Custom 27803010","","48232050  -  ROD SPINAL 6MM 50MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232060","SUP","Custom 27803010","","48232060  -  ROD SPINAL 6MM 60MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232070","SUP","Custom 27803010","","48232070  -  ROD SPINAL 6MM 70MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232080","SUP","Custom 27803010","","48232080  -  ROD SPINAL 6MM 80MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232090","SUP","Custom 27803010","","48232090  -  ROD SPINAL 6MM 90MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232100","SUP","Custom 27803010","","48232100  -  ROD SPINAL 6MM 100MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232110","SUP","Custom 27803010","","48232110  -  ROD SPINAL 6MM 110MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232120","SUP","Custom 27803010","","48232120  -  ROD SPINAL 6MM 120MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232130","SUP","Custom 27803010","","48232130  -  ROD SPINAL 6MM 130MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232140","SUP","Custom 27803010","","48232140  -  ROD SPINAL 6MM 140MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232150","SUP","Custom 27803010","","48232150  -  ROD SPINAL 6MM 30MM XIA 3 TITANIUM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232480","SUP","Custom 27803010","","48232480  -  ROD SPINAL 6MM 480MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48232600","SUP","Custom 27803010","","48232600  -  ROD SPINAL 6MM 600MM COMPRESSION XIA TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233030","SUP","Custom 27803010","","48233030  -  ROD SPINAL 6MM 30MM XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233040","SUP","Custom 27803010","","48233040  -  ROD SPINAL 6MM 40MM XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233050","SUP","Custom 27803010","","48233050  -  ROD SPINAL 6MM 50MM XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233060","SUP","Custom 27803010","","48233060  -  ROD SPINAL 6MM 60MM XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233070","SUP","Custom 27803010","","48233070  -  ROD SPINAL 6MM 70MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233080","SUP","Custom 27803010","","48233080  -  ROD SPINAL 6MM 80MM XIA TITANIUM ALLOY","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233090","SUP","Custom 27803010","","48233090  -  ROD SPINAL 6MM 90MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233100","SUP","Custom 27803010","","48233100  -  ROD SPINAL 100MM STR DIAPASON XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233110","SUP","Custom 27803010","","48233110  -  ROD SPINAL 110MM STR DIAPASON XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233120","SUP","Custom 27803010","","48233120  -  ROD SPINAL 6MM 120MM XIA TITANIUM ALLOY","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233130","SUP","Custom 27803010","","48233130  -  ROD SPINAL 6MM 13MM XIA TITANIUM ALLOY","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233140","SUP","Custom 27803010","","48233140  -  ROD SPINAL 6MM 14MM XIA TITANIUM ALLOY","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233150","SUP","Custom 27803010","","48233150  -  ROD SPINAL 6MM 15MM XIA TITANIUM ALLOY","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233420","SUP","HCPCS C1713","","48233420  -  SCREW BONE 4.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233425","SUP","HCPCS C1713","","48233425  -  SCREW BONE 4.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233430","SUP","HCPCS C1713","","48233430  -  SCREW BONE 4.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233435","SUP","HCPCS C1713","","48233435  -  SCREW BONE 4.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233440","SUP","HCPCS C1713","","48233440  -  SCREW BONE 4.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233445","SUP","HCPCS C1713","","48233445  -  SCREW BONE 4.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233480","SUP","HCPCS C1713","","48233480  -  ROD SPINAL 6MM 480MM XIA 3","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"48233500","SUP","HCPCS C1713","","48233500  -  SCREW SET M6 NS XIA 3 SPNE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48233520","SUP","HCPCS C1713","","48233520  -  SCREW BONE 5.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233525","SUP","HCPCS C1713","","48233525  -  SCREW BONE 5.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233530","SUP","HCPCS C1713","","48233530  -  SCREW BONE 5.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233535","SUP","HCPCS C1713","","48233535  -  SCREW BONE 5.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233540","SUP","HCPCS C1713","","48233540  -  SCREW BONE 5.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233545","SUP","HCPCS C1713","","48233545  -  SCREW BONE 5.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233550","SUP","HCPCS C1713","","48233550  -  SCREW BONE 5.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233555","SUP","HCPCS C1713","","48233555  -  SCREW BONE 5.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233600","SUP","Custom 27803010","","48233600  -  ROD SPINAL 6MM 60MM XIA TITANIUM ALLOY","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48233625","SUP","HCPCS C1713","","48233625  -  SCREW BONE 6.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233630","SUP","HCPCS C1713","","48233630  -  SCREW BONE 6.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233635","SUP","HCPCS C1713","","48233635  -  SCREW BONE 6.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233640","SUP","HCPCS C1713","","48233640  -  SCREW BONE 6.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233645","SUP","HCPCS C1713","","48233645  -  SCREW BONE 6.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233650","SUP","HCPCS C1713","","48233650  -  SCREW BONE 6.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233655","SUP","HCPCS C1713","","48233655  -  SCREW BONE 6.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233660","SUP","HCPCS C1713","","48233660  -  SCREW BONE 6.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233730","SUP","HCPCS C1713","","48233730  -  SCREW BONE 7.5MM 30MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233735","SUP","HCPCS C1713","","48233735  -  SCREW BONE 7.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233740","SUP","HCPCS C1713","","48233740  -  SCREW BONE 7.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233745","SUP","HCPCS C1713","","48233745  -  SCREW BONE 7.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233750","SUP","HCPCS C1713","","48233750  -  SCREW BONE 7.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233755","SUP","HCPCS C1713","","48233755  -  SCREW BONE 7.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48233760","SUP","HCPCS C1713","","48233760  -  SCREW BONE 7.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48235007","SUP","HCPCS C1713","","48235007  -  SCREW BONE REVISION SPN ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"48235008","SUP","Custom 27803010","","48235008  -  CONNECTOR ROD REVISION ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48235009","SUP","Custom 27803010","","48235009  -  CONNECTOR ROD LARGE PARALLEL 11MM XIA 3 TITANIUM SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48235010","SUP","HCPCS C1713","","48235010  -  SCREW BONE REVISION PARALLEL ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"48235011","SUP","Custom 27803010","","48235011  -  CONNECTOR ROD REVISION ROD TO ROD PARALLEL ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48235012","SUP","Custom 27803010","","48235012  -  CONNECTOR ROD REVISION ROD TO ROD ILIOSACRAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236014","SUP","Custom 27803010","","48236014  -  CROSSLINK SPINAL 14MM MONOBLOCK XIA TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236015","SUP","Custom 27803010","","48236015  -  CROSSLINK SPINAL 15MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236016","SUP","Custom 27803010","","48236016  -  CROSSLINK SPINAL 16MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236017","SUP","Custom 27803010","","48236017  -  CROSSLINK SPINAL 17MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236018","SUP","Custom 27803010","","48236018  -  CROSSLINK SPINAL 18MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236019","SUP","Custom 27803010","","48236019  -  CROSSLINK SPINAL 19MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236020","SUP","Custom 27803010","","48236020  -  CROSSLINK SPINAL 20MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236022","SUP","Custom 27803010","","48236022  -  CROSSLINK SPINAL 22MM MONOBLOCK XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236024","SUP","Custom 27803010","","48236024  -  CROSSLINK SPINAL 24MM MONOBLOCK XIA TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236026","SUP","HCPCS C1713","","48236026  -  SCREW BONE 26MM MONOBLOCK SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48236028","SUP","Custom 27803010","","48236028  -  CONNECTOR ROD 28-31MM MULTIAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236030","SUP","Custom 27803010","","48236030  -  CONNECTOR ROD 35-44MM XIA 3 MA CX TI THORLMBR SPNE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236035","SUP","Custom 27803010","","48236035  -  CONNECTOR ROD 35-44MM MULTIAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236043","SUP","Custom 27803010","","48236043  -  CONNECTOR ROD 70-99MM XIA 3 MA CX TI THORLMBR SPNE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236053","SUP","Custom 27803010","","48236053  -  CONNECTOR ROD 53-73MM MULTIAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48236070","SUP","HCPCS C1713","","48236070  -  CONNECTOR ROD 70-99MM MULTIAX CROSS XIA 3 TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48236540","SUP","HCPCS C1713","","48236540  -  SCREW BONE 6.5MM 40MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48236550","SUP","HCPCS C1713","","48236550  -  SCREW BONE 6.5MM 50MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48236560","SUP","HCPCS C1713","","48236560  -  SCREW BONE 6.5MM 60MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48237105","SUP","Custom 27203010","","48237105  -  NEEDLE BIOP 10GA 5IN JAMSHIDI","BOTH IP/OP","$73.55 ","$54.43 ","$0.00 ","$73.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48237110","SUP","Custom 27203010","","48237110  -  BLADE SURG 10GA 9IN JAMSHIDI","BOTH IP/OP","$73.55 ","$54.43 ","$0.00 ","$73.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48237115","SUP","HCPCS C1713","","48237115  -  WIRE FIX JAMSHIDI SPN","BOTH IP/OP","$73.55 ","$54.43 ","$0.00 ","$73.55 ","$33.10 ","$0.00 ","$15.33 ","$0.00 ","$0.00 ","$12.88 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$11.51 ","$0.00 ","$11.71 ","$0.00 "
"48237135","SUP","Custom 27203010","","48237135  -  NEEDLE BIOP 13GA 5IN","BOTH IP/OP","$73.55 ","$54.43 ","$0.00 ","$73.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.55 ","$0.00 ","$36.78 ","$58.25 ","$58.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48237540","SUP","HCPCS C1713","","48237540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48237550","SUP","HCPCS C1713","","48237550  -  SCREW BONE 7.5MM 50MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48237560","SUP","HCPCS C1713","","48237560  -  SCREW BONE 7.5MM 60MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48238030","SUP","Custom 27803010","","48238030  -  ROD SPINAL 6MM 30MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238035","SUP","Custom 27803010","","48238035  -  ROD SPINAL 6MM 35MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238040","SUP","Custom 27803010","","48238040  -  ROD SPINAL 6MM 40MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238045","SUP","Custom 27803010","","48238045  -  ROD SPINAL 6MM 45MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238050","SUP","Custom 27803010","","48238050  -  ROD SPINAL 6MM 50MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238060","SUP","Custom 27803010","","48238060  -  ROD SPINAL 6MM 60MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238070","SUP","Custom 27803010","","48238070  -  ROD SPINAL 6MM 70MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238080","SUP","Custom 27803010","","48238080  -  ROD SPINAL 6MM 80MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238090","SUP","Custom 27803010","","48238090  -  ROD SPINAL 6MM 90MM RADIOLUCENT XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238100","SUP","Custom 27803010","","48238100  -  ROD SPINAL 6MM 100MM XIA 3 TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238110","SUP","Custom 27803010","","48238110  -  ROD SPINAL 6MM 110MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238120","SUP","Custom 27803010","","48238120  -  ROD SPINAL 6MM 120MM XIA TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48238540","SUP","HCPCS C1713","","48238540  -  SCREW BONE 8.5MM 40MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48238550","SUP","HCPCS C1713","","48238550  -  SCREW BONE 8.5MM 50MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48238560","SUP","HCPCS C1713","","48238560  -  SCREW BONE 8.5MM 60MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48239050","SUP","Custom 27803010","","48239050  -  ROD SPNL 50MM XIA 2 BND","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239060","SUP","Custom 27803010","","48239060  -  ROD SPINAL 60MM MAX XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239070","SUP","Custom 27803010","","48239070  -  ROD SPINAL 70MM XIA MAX","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239080","SUP","Custom 27803010","","48239080  -  ROD SPINAL 80MM XIA MAXL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239090","SUP","Custom 27803010","","48239090  -  ROD SPINAL 90MM RAD MAX","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239100","SUP","Custom 27803010","","48239100  -  ROD SPINAL 100MM RAD XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239110","SUP","Custom 27803010","","48239110  -  ROD SPINAL 110MM RAD XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239120","SUP","Custom 27803010","","48239120  -  ROD SPINAL 120MM RAD XIA","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48239540","SUP","HCPCS C1713","","48239540  -  SCREW BONE 9.5MM 40MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48239550","SUP","HCPCS C1713","","48239550  -  SCREW BONE 9.5MM 50MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48239560","SUP","HCPCS C1713","","48239560  -  SCREW BONE 9.5MM 60MM REVISION ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48250210","SUP","Custom 27203010","","48250210  -  RETRACTOR FIBER OPTIC LUXOR","BOTH IP/OP","$597.13 ","$441.88 ","$0.00 ","$597.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$597.13 ","$0.00 ","$298.56 ","$472.93 ","$477.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251040","SUP","Custom 27803010","","48251040  -  SLEEVE RB 40MM LUXOR SIL","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251050","SUP","Custom 27803010","","48251050  -  SLEEVE RB 50MM LUXOR SIL","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251060","SUP","Custom 27803010","","48251060  -  SPREADER SURG OVAL 60MM SLEEVE LUXOR SILICONE THORACOLUMBAR","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251070","SUP","Custom 27803010","","48251070  -  SPREADER SURG OVAL 70MM SLEEVE LUXOR SILICONE SPN","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251080","SUP","Custom 27803010","","48251080  -  SPREADER SURG OVAL 80MM SLEEVE LUXOR SILICONE SPN","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251090","SUP","Custom 27803010","","48251090  -  SLEEVE RB 90MM LUXOR SIL","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251105","SUP","Custom 27803010","","48251105  -  SLEEVE RB 105MM LUXOR SIL","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48251120","SUP","Custom 27803010","","48251120  -  SLEEVE RB 120MM LUXOR SIL","BOTH IP/OP","$906.95 ","$671.14 ","$0.00 ","$906.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$906.95 ","$0.00 ","$453.48 ","$718.30 ","$725.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48285425","SUP","HCPCS C1713","","48285425  -  SCREW BONE 4.5MM 25MM CANN MANTIS SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285430","SUP","HCPCS C1713","","48285430  -  SCREW BONE 4.5MM 30MM CANN MANTIS SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285435","SUP","HCPCS C1713","","48285435  -  SCREW BONE 4.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285440","SUP","HCPCS C1713","","48285440  -  SCREW BONE 4.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285445","SUP","HCPCS C1713","","48285445  -  SCREW BONE 4.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285530","SUP","HCPCS C1713","","48285530  -  SCREW BONE 5.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285535","SUP","HCPCS C1713","","48285535  -  SCREW BONE 5.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285540","SUP","HCPCS C1713","","48285540  -  SCREW BONE 5.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285545","SUP","HCPCS C1713","","48285545  -  SCREW BONE 5.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285550","SUP","HCPCS C1713","","48285550  -  SCREW BONE 5.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285555","SUP","HCPCS C1713","","48285555  -  SCREW BONE 5.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285630","SUP","HCPCS C1713","","48285630  -  SCREW BONE 6.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285635","SUP","HCPCS C1713","","48285635  -  SCREW BONE 6.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285640","SUP","HCPCS C1713","","48285640  -  SCREW BONE 6.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285645","SUP","HCPCS C1713","","48285645  -  SCREW BONE 6.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285650","SUP","HCPCS C1713","","48285650  -  SCREW BONE 6.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285655","SUP","HCPCS C1713","","48285655  -  SCREW BONE 6.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285660","SUP","HCPCS C1713","","48285660  -  SCREW BONE 6.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285730","SUP","HCPCS C1713","","48285730  -  SCREW BONE 7.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285735","SUP","HCPCS C1713","","48285735  -  SCREW BONE 7.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285740","SUP","HCPCS C1713","","48285740  -  SCREW BONE 7.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285745","SUP","HCPCS C1713","","48285745  -  SCREW BONE 7.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285750","SUP","HCPCS C1713","","48285750  -  SCREW BONE 7.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285755","SUP","HCPCS C1713","","48285755  -  SCREW BONE 7.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48285760","SUP","HCPCS C1713","","48285760  -  SCREW BONE 7.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"48286030","SUP","Custom 27803010","","48286030  -  ROD SPINAL 6MM 30MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286035","SUP","Custom 27803010","","48286035  -  ROD SPINAL 6MM 35MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286040","SUP","Custom 27803010","","48286040  -  ROD SPINAL 6MM 40MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286045","SUP","Custom 27803010","","48286045  -  ROD SPINAL 6MM 45MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286050","SUP","Custom 27803010","","48286050  -  ROD SPINAL 6MM 50MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286060","SUP","Custom 27803010","","48286060  -  ROD SPINAL 6MM 60MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286070","SUP","Custom 27803010","","48286070  -  ROD SPINAL 6MM 70MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286080","SUP","Custom 27803010","","48286080  -  ROD SPINAL 6MM 80MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286090","SUP","Custom 27803010","","48286090  -  ROD SPINAL 6MM 90MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286100","SUP","Custom 27803010","","48286100  -  ROD SPINAL 6MM 100MM RAD MANTIS TITANIUM PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286110","SUP","Custom 27803010","","48286110  -  ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286120","SUP","Custom 27803010","","48286120  -  ROD SPINAL 120MM CVD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48286130","SUP","Custom 27803010","","48286130  -  ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287050","SUP","Custom 27803010","","48287050  -  ROD SPINAL 6MM 50MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287060","SUP","Custom 27803010","","48287060  -  ROD SPINAL 6MM 60MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287070","SUP","Custom 27803010","","48287070  -  ROD SPINAL 6MM 70MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287080","SUP","Custom 27803010","","48287080  -  ROD SPINAL 6MM 80MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287090","SUP","Custom 27803010","","48287090  -  ROD SPINAL 6MM 90MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287100","SUP","Custom 27803010","","48287100  -  ROD SPINAL 6MM 100MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287110","SUP","Custom 27803010","","48287110  -  ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287120","SUP","Custom 27803010","","48287120  -  ROD SPINAL 6MM 120MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287130","SUP","Custom 27803010","","48287130  -  ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48287200","SUP","Custom 27803010","","48287200  -  ROD SPINAL 6MM 200MM STR MANTIS PEDICLE","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288030","SUP","Custom 27803010","","48288030  -  ROD SPINAL STR 6MM 30MM MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288040","SUP","Custom 27803010","","48288040  -  ROD SPINAL STR 6MM 40MM MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288050","SUP","Custom 27803010","","48288050  -  ROD SPINAL 6MM 50MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288060","SUP","Custom 27803010","","48288060  -  ROD SPINAL 6MM 60MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288070","SUP","Custom 27803010","","48288070  -  ROD SPINAL STR 6MM 70MM MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288080","SUP","Custom 27803010","","48288080  -  ROD SPINAL STR 6MM 80MM MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288090","SUP","Custom 27803010","","48288090  -  ROD SPINAL 6MM 90MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288100","SUP","Custom 27803010","","48288100  -  ROD SPINAL 6MM 100MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288110","SUP","Custom 27803010","","48288110  -  ROD SPINAL STR 6MM 110MM MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288120","SUP","Custom 27803010","","48288120  -  ROD SPINAL 6MM 120MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288130","SUP","Custom 27803010","","48288130  -  ROD SPINAL 6MM 130MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48288480","SUP","Custom 27803010","","48288480  -  ROD SPINAL 6MM 480MM STR MANTIS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48290220","SUP","Custom 27803010","","48290220  -  END CAP SPNL 20D 22MM 18MM NS VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48290225","SUP","Custom 27803010","","48290225  -  ENDCAP SPINAL 25D 22MM CLOSE","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48290230","SUP","Custom 27803010","","48290230  -  ENDCAP SPINAL 30D 22MM CLOSE","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291180","SUP","Custom 27803010","","48291180  -  ENDCAP SPINAL 0D 18MM MODULAR OPEN SNAP EXTERIOR METAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291183","SUP","Custom 27803010","","48291183  -  ENDCAP SPINAL 3D 18MM MODULAR OPEN SNAP EXTERIOR METAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291188","SUP","Custom 27803010","","48291188  -  ENDCAP SPINAL 8D 18MM 118MM VLIFT","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291220","SUP","Custom 27803010","","48291220  -  ENDCAP SPINAL 0D 22MM MODULAR OPEN SNAP EXTERIOR METAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291223","SUP","Custom 27803010","","48291223  -  ENDCAP SPINAL 3D 22MM MODULAR OPEN SNAP EXTERIOR METAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291228","SUP","Custom 27803010","","48291228  -  ENDCAP SPINAL 8D 22MM MODULAR OPEN SNAP EXTERIOR METAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291800","SUP","HCPCS C1781","","48291800  -  EXTENSION STEM 18MM VLIFT","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"48291820","SUP","Custom 27803010","","48291820  -  CAGE SPNL 18MM 20MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291825","SUP","Custom 27803010","","48291825  -  CAGE SPNL 18MM 25MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48291832","SUP","Custom 27803010","","48291832  -  CAGE SPNL 18MM 32MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48292200","SUP","Custom 27803010","","48292200  -  EXTENSION SPNL 22MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48292215","SUP","Custom 27803010","","48292215  -  ENDCAP SPINAL 15D 22MM MODULAR OPEN SNAP EXTERIOR METAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48292225","SUP","Custom 27803010","","48292225  -  CAGE SPNL 22MM 25MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48292232","SUP","Custom 27803010","","48292232  -  CAGE SPNL 22MM 32MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48292237","SUP","Custom 27803010","","48292237  -  CAGE SPNL 22MM 37MM NS LF VLIFT TI LMBR INTRBD FS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321060","SUP","Custom 27803010","","48321060  -  CAGE SPNL 0D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321064","SUP","Custom 27803010","","48321064  -  CAGE SPNL 4D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321068","SUP","Custom 27803010","","48321068  -  CAGE SPNL 8D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321070","SUP","Custom 27803010","","48321070  -  CAGE SPNL 0D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321074","SUP","Custom 27803010","","48321074  -  CAGE SPNL 4D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321078","SUP","Custom 27803010","","48321078  -  CAGE SPNL 8D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321080","SUP","Custom 27803010","","48321080  -  CAGE SPNL 0D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321084","SUP","Custom 27803010","","48321084  -  CAGE SPNL 4D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321088","SUP","Custom 27803010","","48321088  -  CAGE SPNL 8D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321090","SUP","Custom 27803010","","48321090  -  CAGE SPNL 0D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321094","SUP","Custom 27803010","","48321094  -  CAGE SPNL 4D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321098","SUP","Custom 27803010","","48321098  -  CAGE SPNL 8D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321100","SUP","Custom 27803010","","48321100  -  CAGE SPNL 0D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321104","SUP","Custom 27803010","","48321104  -  CAGE SPNL 4D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321108","SUP","Custom 27803010","","48321108  -  CAGE SPNL 8D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321110","SUP","Custom 27803010","","48321110  -  CAGE SPNL 0D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321114","SUP","Custom 27803010","","48321114  -  CAGE SPNL 4D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321118","SUP","Custom 27803010","","48321118  -  CAGE SPNL 8D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321120","SUP","Custom 27803010","","48321120  -  CAGE SPNL 0D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321124","SUP","Custom 27803010","","48321124  -  CAGE SPNL 4D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48321128","SUP","Custom 27803010","","48321128  -  CAGE SPNL 8D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322040","SUP","Custom 27803010","","48322040  -  SPACER SPNL 0D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322044","SUP","Custom 27803010","","48322044  -  SPACER SPNL 4D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322050","SUP","Custom 27803010","","48322050  -  SPACER SPNL 0D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322054","SUP","Custom 27803010","","48322054  -  SPACER SPNL 4D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322060","SUP","Custom 27803010","","48322060  -  SPACER SPNL 0D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322064","SUP","Custom 27803010","","48322064  -  SPACER SPNL 4D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322070","SUP","Custom 27803010","","48322070  -  SPACER SPNL 0D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322074","SUP","Custom 27803010","","48322074  -  SPACER SPNL 4D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322080","SUP","Custom 27803010","","48322080  -  SPACER SPNL 0D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322084","SUP","Custom 27803010","","48322084  -  SPACER SPNL 4D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322090","SUP","Custom 27803010","","48322090  -  SPACER SPNL 0D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322094","SUP","Custom 27803010","","48322094  -  SPACER SPNL 4D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322100","SUP","Custom 27803010","","48322100  -  SPACER SPNL 0D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322104","SUP","Custom 27803010","","48322104  -  SPACER SPNL 4D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322110","SUP","Custom 27803010","","48322110  -  SPACER SPNL 0D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322114","SUP","Custom 27803010","","48322114  -  SPACER SPNL 4D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322120","SUP","Custom 27803010","","48322120  -  SPACER SPNL 0D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322124","SUP","Custom 27803010","","48322124  -  SPACER SPNL 4D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48322204","SUP","Custom 27803010","","48322204  -  SPACER SPNL 4D 12MM 14X20MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323060","SUP","Custom 27803010","","48323060  -  CAGE SPNL 0D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323064","SUP","Custom 27803010","","48323064  -  CAGE SPNL 4D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323068","SUP","Custom 27803010","","48323068  -  CAGE SPNL 8D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323070","SUP","Custom 27803010","","48323070  -  CAGE SPNL 0D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323074","SUP","Custom 27803010","","48323074  -  CAGE SPNL 4D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323078","SUP","Custom 27803010","","48323078  -  CAGE SPNL 8D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323080","SUP","Custom 27803010","","48323080  -  CAGE SPNL 0D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323084","SUP","Custom 27803010","","48323084  -  CAGE SPNL 4D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323088","SUP","Custom 27803010","","48323088  -  CAGE SPNL 8D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323090","SUP","Custom 27803010","","48323090  -  CAGE SPNL 0D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323094","SUP","Custom 27803010","","48323094  -  CAGE SPNL 4D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323098","SUP","Custom 27803010","","48323098  -  CAGE SPNL 8D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323100","SUP","Custom 27803010","","48323100  -  CAGE SPNL 0D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323104","SUP","Custom 27803010","","48323104  -  CAGE SPNL 4D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323108","SUP","Custom 27803010","","48323108  -  CAGE SPNL 8D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323110","SUP","Custom 27803010","","48323110  -  CAGE SPNL 0D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323114","SUP","Custom 27803010","","48323114  -  CAGE SPNL 4D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323118","SUP","Custom 27803010","","48323118  -  CAGE SPNL 8D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323120","SUP","Custom 27803010","","48323120  -  CAGE SPNL 0D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323124","SUP","Custom 27803010","","48323124  -  CAGE SPNL 4D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48323128","SUP","Custom 27803010","","48323128  -  CAGE SPNL 8D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW","BOTH IP/OP","$3,875.00 ","$2,867.50 ","$0.00 ","$3,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,875.00 ","$0.00 ","$1,937.50 ","$3,069.00 ","$3,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324040","SUP","Custom 27803010","","48324040  -  SPACER SPNL 0D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324044","SUP","Custom 27803010","","48324044  -  SPACER SPNL 4D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324050","SUP","Custom 27803010","","48324050  -  SPACER SPNL 0D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324054","SUP","Custom 27803010","","48324054  -  SPACER SPNL 4D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324060","SUP","Custom 27803010","","48324060  -  SPACER SPNL 0D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324064","SUP","Custom 27803010","","48324064  -  SPACER SPNL 4D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324070","SUP","Custom 27803010","","48324070  -  SPACER SPNL 0D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324074","SUP","Custom 27803010","","48324074  -  SPACER SPNL 4D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324080","SUP","Custom 27803010","","48324080  -  SPACER SPNL 0D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324084","SUP","Custom 27803010","","48324084  -  SPACER SPNL 4D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324090","SUP","Custom 27803010","","48324090  -  SPACER SPNL 0D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324094","SUP","Custom 27803010","","48324094  -  SPACER SPNL 4D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324100","SUP","Custom 27803010","","48324100  -  SPACER SPNL 0D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324104","SUP","Custom 27803010","","48324104  -  SPACER SPNL 4D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324110","SUP","Custom 27803010","","48324110  -  SPACER SPNL 0D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324114","SUP","Custom 27803010","","48324114  -  SPACER SPNL 4D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324120","SUP","Custom 27803010","","48324120  -  SPACER SPNL 0D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48324124","SUP","Custom 27803010","","48324124  -  SPACER SPNL 4D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48325308","SUP","HCPCS C1713","","48325308  -  SCREW BONE 3.5MM 8MM SPNL SLFTAP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325310","SUP","HCPCS C1713","","48325310  -  SCREW BONE 3.5MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325312","SUP","HCPCS C1713","","48325312  -  SCREW BONE 3.5MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325314","SUP","HCPCS C1713","","48325314  -  SCREW BONE 3.5MM 14MM SPNL SLFTAP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325408","SUP","HCPCS C1713","","48325408  -  SCREW BONE 4MM 8MM SPNL SLFTAP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325410","SUP","HCPCS C1713","","48325410  -  SCREW BONE 4MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325412","SUP","HCPCS C1713","","48325412  -  SCREW BONE 4MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48325414","SUP","HCPCS C1713","","48325414  -  ANCHOR-C  4.0 X 14MM SELF TAPPING SCREW","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48326084","SUP","Custom 27803010","","48326084  -  SPACER SPNL 4D 28X22X8MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326088","SUP","Custom 27803010","","48326088  -  SPACER SPNL 8D 28X22X8MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326104","SUP","Custom 27803010","","48326104  -  SPACER SPNL 4D 28X22X10MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326108","SUP","Custom 27803010","","48326108  -  SPACER SPNL 8D 28X22X10MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326122","SUP","Custom 27803010","","48326122  -  SPACER SPNL 12D 28X22X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326124","SUP","Custom 27803010","","48326124  -  SPACER SPNL 4D 28X22X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326126","SUP","Custom 27803010","","48326126  -  SPACER SPNL 16D 28X22X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326128","SUP","Custom 27803010","","48326128  -  SPACER SPNL 8D 28X22X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326142","SUP","Custom 27803010","","48326142  -  SPACER SPNL 12D 28X22X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326144","SUP","Custom 27803010","","48326144  -  SPACER SPNL 4D 28X22X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326146","SUP","Custom 27803010","","48326146  -  SPACER SPNL 16D 28X22X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326148","SUP","Custom 27803010","","48326148  -  SPACER SPNL 8D 28X22X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326162","SUP","Custom 27803010","","48326162  -  SPACER SPNL 12D 28X22X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326164","SUP","Custom 27803010","","48326164  -  SPACER SPNL 4D 28X22X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326166","SUP","Custom 27803010","","48326166  -  SPACER SPNL 16D 28X22X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326168","SUP","Custom 27803010","","48326168  -  SPACER SPNL 8D 28X22X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326182","SUP","Custom 27803010","","48326182  -  SPACER SPNL 12D 28X22X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326184","SUP","Custom 27803010","","48326184  -  SPACER SPNL 4D 28X22X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326186","SUP","Custom 27803010","","48326186  -  SPACER SPNL 16D 28X22X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326188","SUP","Custom 27803010","","48326188  -  SPACER SPNL 8D 28X22X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326202","SUP","Custom 27803010","","48326202  -  SPACER SPNL 12D 28X22X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326204","SUP","Custom 27803010","","48326204  -  SPACER SPNL 4D 28X22X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326206","SUP","Custom 27803010","","48326206  -  SPACER SPNL 16D 22X28X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48326208","SUP","Custom 27803010","","48326208  -  SPACER SPNL 8D 28X22X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328084","SUP","Custom 27803010","","48328084  -  SPACER SPNL 4D 28X33X8MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328088","SUP","Custom 27803010","","48328088  -  SPACER SPNL 8D 28X33X8MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328104","SUP","Custom 27803010","","48328104  -  SPACER SPNL 4D 28X33X10MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328108","SUP","Custom 27803010","","48328108  -  SPACER SPNL 8D 28X33X10MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328122","SUP","Custom 27803010","","48328122  -  SPACER SPNL 12D 28X33X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328124","SUP","Custom 27803010","","48328124  -  SPACER SPNL 4D 28X33X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328126","SUP","Custom 27803010","","48328126  -  SPACER SPNL 16D 28X33X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328128","SUP","Custom 27803010","","48328128  -  SPACER SPNL 8D 28X33X12MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328142","SUP","Custom 27803010","","48328142  -  SPACER SPNL 12D 28X33X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328144","SUP","Custom 27803010","","48328144  -  SPACER SPNL 4D 28X33X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328146","SUP","Custom 27803010","","48328146  -  SPACER SPNL 16D 28X33X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328148","SUP","Custom 27803010","","48328148  -  SPACER SPNL 8D 28X33X14MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328162","SUP","Custom 27803010","","48328162  -  SPACER SPNL 12D 28X33X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328164","SUP","Custom 27803010","","48328164  -  SPACER SPNL 4D 28X33X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328166","SUP","Custom 27803010","","48328166  -  SPACER SPNL 16D 28X33X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328168","SUP","Custom 27803010","","48328168  -  SPACER SPNL 8D 28X33X16MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328182","SUP","Custom 27803010","","48328182  -  SPACER SPNL 12D 28X33X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328184","SUP","Custom 27803010","","48328184  -  SPACER SPNL 4D 28X33X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328186","SUP","Custom 27803010","","48328186  -  SPACER SPNL 16D 28X33X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328188","SUP","Custom 27803010","","48328188  -  SPACER SPNL 8D 28X33X18MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328202","SUP","Custom 27803010","","48328202  -  SPACER SPNL 12D 28X33X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328204","SUP","Custom 27803010","","48328204  -  SPACER SPNL 4D 28X33X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328206","SUP","Custom 27803010","","48328206  -  SPACER SPNL 16D 33X28X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328208","SUP","Custom 27803010","","48328208  -  SPACER SPNL 8D 28X33X20MM AVS AL PEEK ALIF","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328908","SUP","Custom 27203010","","48328908  -  BIT DRILL 2.3MM 8MM AVS ANCHOR-C","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328910","SUP","Custom 27203010","","48328910  -  BIT DRILL 2.3MM 10MM AVS ANCHOR-C","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48328912","SUP","Custom 27203010","","48328912  -  BIT DRILL 2.3MM 12MM AVS ANCHOR-C","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48335308","SUP","HCPCS C1713","","48335308  -  ANCHOR-C  3.5 X 8MM SELF DRILLING SCREW","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335310","SUP","HCPCS C1713","","48335310  -  ANCHOR-C  3.5 X 10MM SELF DRILLING SCREW","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335312","SUP","HCPCS C1713","","48335312  -  SCREW BONE 3.5MM 12MM SPNL SLFDRILL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335314","SUP","HCPCS C1713","","48335314  -  SCREW BONE 3.5MM 14MM SPNL SLFDRILL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335408","SUP","HCPCS C1713","","48335408  -  SCREW BONE 4MM 8MM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335410","SUP","HCPCS C1713","","48335410  -  ANCHOR-C  4.0 X 10MM SELF DRILLING SCREW","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335412","SUP","HCPCS C1713","","48335412  -  SCREW BONE 4MM 12MM SPNL SLFDRILL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48335414","SUP","HCPCS C1713","","48335414  -  SCREW BONE 4MM 14MM SPNL SLFDRILL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48340074","SUP","Custom 27803010","","48340074  -  SPACER SPNL 4D WDG 20X9X7MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340084","SUP","Custom 27803010","","48340084  -  SPACER SPNL 4D WDG 20X9X8MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340090","SUP","Custom 27803010","","48340090  -  SPACER SPNL 0D RECT 20X9X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340094","SUP","Custom 27803010","","48340094  -  SPACER SPNL 4D WDG 20X9X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340098","SUP","Custom 27803010","","48340098  -  SPACER SPNL 8D WDG 20X9X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340100","SUP","Custom 27803010","","48340100  -  SPACER SPNL 0D RECT 20X9X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340104","SUP","Custom 27803010","","48340104  -  SPACER SPNL 4D WDG 20X9X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340108","SUP","Custom 27803010","","48340108  -  SPACER SPNL 8D WDG 20X9X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340110","SUP","Custom 27803010","","48340110  -  SPACER SPNL 0D RECT 20X9X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340114","SUP","Custom 27803010","","48340114  -  SPACER SPNL 4D WDG 20X9X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340118","SUP","Custom 27803010","","48340118  -  SPACER SPNL 8D WDG 20X9X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340120","SUP","Custom 27803010","","48340120  -  SPACER SPNL 0D RECT 20X9X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340124","SUP","Custom 27803010","","48340124  -  SPACER SPNL 4D WDG 20X9X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340128","SUP","Custom 27803010","","48340128  -  SPACER SPNL 8D WDG 20X9X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340130","SUP","Custom 27803010","","48340130  -  SPACER SPNL 0D RECT 20X9X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340134","SUP","Custom 27803010","","48340134  -  SPACER SPNL 4D WDG 20X9X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340138","SUP","Custom 27803010","","48340138  -  SPACER SPNL 8D WDG 20X9X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340140","SUP","Custom 27803010","","48340140  -  SPACER SPNL 0D RECT 20X9X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340144","SUP","Custom 27803010","","48340144  -  SPACER SPNL 4D WDG 20X9X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340148","SUP","Custom 27803010","","48340148  -  SPACER SPNL 8D WDG 20X9X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340150","SUP","Custom 27803010","","48340150  -  SPACER SPNL 0D RECT 20X9X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340154","SUP","Custom 27803010","","48340154  -  SPACER SPNL 4D WDG 20X9X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340158","SUP","Custom 27803010","","48340158  -  SPACER SPNL 8D WDG 20X9X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340160","SUP","Custom 27803010","","48340160  -  SPACER SPNL 0D RECT 20X9X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340164","SUP","Custom 27803010","","48340164  -  SPACER SPNL 4D WDG 20X9X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48340168","SUP","Custom 27803010","","48340168  -  SPACER SPNL 8D WDG 20X9X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345074","SUP","Custom 27803010","","48345074  -  SPACER SPNL 4D WDG 25X8X7MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345084","SUP","Custom 27803010","","48345084  -  SPACER SPNL 4D WDG 25X8X8MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345090","SUP","Custom 27803010","","48345090  -  SPACER SPNL 0D RECT 25X8X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345094","SUP","Custom 27803010","","48345094  -  SPACER SPNL 4D WDG 25X8X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345098","SUP","Custom 27803010","","48345098  -  SPACER SPNL 8D WDG 25X8X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345100","SUP","Custom 27803010","","48345100  -  SPACER SPNL 0D RECT 25X8X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345104","SUP","Custom 27803010","","48345104  -  SPACER SPNL 4D WDG 25X8X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345108","SUP","Custom 27803010","","48345108  -  SPACER SPNL 8D WDG 25X8X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345110","SUP","Custom 27803010","","48345110  -  SPACER SPNL 0D RECT 25X8X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345114","SUP","Custom 27803010","","48345114  -  SPACER SPNL 4D WDG 25X8X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345118","SUP","Custom 27803010","","48345118  -  SPACER SPNL 8D WDG 25X8X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345120","SUP","Custom 27803010","","48345120  -  SPACER SPNL 0D RECT 25X8X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345124","SUP","Custom 27803010","","48345124  -  SPACER SPNL 4D WDG 25X8X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345128","SUP","Custom 27803010","","48345128  -  SPACER SPNL 8D WDG 25X8X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345130","SUP","Custom 27803010","","48345130  -  SPACER SPNL 0D RECT 25X8X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345134","SUP","Custom 27803010","","48345134  -  SPACER SPNL 4D WDG 25X8X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345138","SUP","Custom 27803010","","48345138  -  SPACER SPNL 8D WDG 25X8X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345140","SUP","Custom 27803010","","48345140  -  SPACER SPNL 0D RECT 25X8X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345144","SUP","Custom 27803010","","48345144  -  SPACER SPNL 4D WDG 25X8X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345148","SUP","Custom 27803010","","48345148  -  SPACER SPNL 8D WDG 25X8X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345150","SUP","Custom 27803010","","48345150  -  SPACER SPNL 0D RECT 25X8X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345154","SUP","Custom 27803010","","48345154  -  SPACER SPNL 4D WDG 25X8X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345158","SUP","Custom 27803010","","48345158  -  SPACER SPNL 8D WDG 25X8X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345160","SUP","Custom 27803010","","48345160  -  SPACER SPNL 0D RECT 25X8X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345164","SUP","Custom 27803010","","48345164  -  SPACER SPNL 4D WDG 25X8X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48345168","SUP","Custom 27803010","","48345168  -  SPACER SPNL 8D WDG 25X8X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350060","SUP","Custom 27803010","","48350060  -  SPACER SPNL 0D WDG NOSE 20X11X6MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350064","SUP","Custom 27803010","","48350064  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X6MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350070","SUP","Custom 27803010","","48350070  -  SPACER SPNL 0D WDG NOSE 20X11X7MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350074","SUP","Custom 27803010","","48350074  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X7MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350080","SUP","Custom 27803010","","48350080  -  SPACER SPNL 0D WDG NOSE 20X11X8MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350084","SUP","Custom 27803010","","48350084  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X8MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350090","SUP","Custom 27803010","","48350090  -  SPACER SPNL 0D RECT 20X11X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350094","SUP","Custom 27803010","","48350094  -  SPACER SPNL 4D WDG 20X11X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350100","SUP","Custom 27803010","","48350100  -  SPACER SPNL 0D RECT 20X11X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350104","SUP","Custom 27803010","","48350104  -  SPACER SPNL 4D WDG 20X11X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350110","SUP","Custom 27803010","","48350110  -  SPACER SPNL 0D RECT 20X11X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350114","SUP","Custom 27803010","","48350114  -  SPACER SPNL 4D WDG 20X11X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350120","SUP","Custom 27803010","","48350120  -  SPACER SPNL 0D RECT 20X11X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350124","SUP","Custom 27803010","","48350124  -  SPACER SPNL 4D WDG 20X11X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350130","SUP","Custom 27803010","","48350130  -  SPACER SPNL 0D RECT 20X11X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350134","SUP","Custom 27803010","","48350134  -  SPACER SPNL 4D WDG 20X11X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350160","SUP","Custom 27803010","","48350160  -  SPACER SPNL 0D RECT 20X11X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350164","SUP","Custom 27803010","","48350164  -  SPACER SPNL 4D WDG 20X11X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350180","SUP","Custom 27803010","","48350180  -  SPACER SPNL 0D RECT 20X11X18MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48350184","SUP","Custom 27803010","","48350184  -  SPACER SPNL 4D WDG 20X11X18MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351060","SUP","Custom 27803010","","48351060  -  SPACER SPNL 0D WDG NOSE 30X11X6MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351064","SUP","Custom 27803010","","48351064  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X6MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351070","SUP","Custom 27803010","","48351070  -  SPACER SPNL 0D WDG NOSE 30X11X7MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351074","SUP","Custom 27803010","","48351074  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X7MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351080","SUP","Custom 27803010","","48351080  -  SPACER SPNL 0D WDG NOSE 30X11X8MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351084","SUP","Custom 27803010","","48351084  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X8MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351090","SUP","Custom 27803010","","48351090  -  SPACER SPNL 0D WDG NOSE 30X11X9MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351094","SUP","Custom 27803010","","48351094  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X9MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351100","SUP","Custom 27803010","","48351100  -  SPACER SPNL 0D WDG NOSE 30X11X10MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351104","SUP","Custom 27803010","","48351104  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X10MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351110","SUP","Custom 27803010","","48351110  -  SPACER SPNL 0D WDG NOSE 30X11X11MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351114","SUP","Custom 27803010","","48351114  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X11MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351120","SUP","Custom 27803010","","48351120  -  SPACER SPNL 0D WDG NOSE 30X11X12MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351124","SUP","Custom 27803010","","48351124  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X12MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351130","SUP","Custom 27803010","","48351130  -  SPACER SPNL 0D WDG NOSE 30X11X13MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351134","SUP","Custom 27803010","","48351134  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X13MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351140","SUP","Custom 27803010","","48351140  -  SPACER SPNL 0D WDG NOSE 30X11X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48351144","SUP","Custom 27803010","","48351144  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X14MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353060","SUP","HCPCS C1713","","48353060  -  SPACER SPNL 0D WDG NOSE 33X11X6MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$2,475.00 ","$0.00 ","$1,146.34 ","$0.00 ","$0.00 ","$963.01 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$860.75 ","$0.00 ","$875.60 ","$0.00 "
"48353064","SUP","Custom 27803010","","48353064  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X6MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353070","SUP","Custom 27803010","","48353070  -  SPACER SPNL 0D WDG NOSE 33X11X7MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353074","SUP","Custom 27803010","","48353074  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X7MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353080","SUP","Custom 27803010","","48353080  -  SPACER SPNL 0D WDG NOSE 33X11X8MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353084","SUP","Custom 27803010","","48353084  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X8MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353090","SUP","Custom 27803010","","48353090  -  SPACER SPNL 0D WDG NOSE 33X11X9MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353094","SUP","Custom 27803010","","48353094  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X9MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353100","SUP","Custom 27803010","","48353100  -  SPACER SPNL 0D WDG NOSE 33X11X10MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353104","SUP","Custom 27803010","","48353104  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X10MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353110","SUP","Custom 27803010","","48353110  -  SPACER SPNL 0D WDG NOSE 33X11X11MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353114","SUP","Custom 27803010","","48353114  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X11MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353120","SUP","Custom 27803010","","48353120  -  SPACER SPNL 0D WDG NOSE 33X11X12MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353124","SUP","Custom 27803010","","48353124  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X12MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353130","SUP","Custom 27803010","","48353130  -  SPACER SPNL 0D WDG NOSE 33X11X13MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353134","SUP","Custom 27803010","","48353134  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X13MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353140","SUP","Custom 27803010","","48353140  -  SPACER SPNL 0D WDG NOSE 33X11X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48353144","SUP","Custom 27803010","","48353144  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X14MM AVS UNILIF HLW","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355060","SUP","Custom 27803010","","48355060  -  SPACER SPNL 0D WDG NOSE 25X11X6MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355064","SUP","Custom 27803010","","48355064  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X6MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355070","SUP","Custom 27803010","","48355070  -  SPACER SPNL 0D WDG NOSE 25X11X7MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355074","SUP","Custom 27803010","","48355074  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X7MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355080","SUP","Custom 27803010","","48355080  -  SPACER SPNL 0D WDG NOSE 25X11X8MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355084","SUP","Custom 27803010","","48355084  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X8MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355090","SUP","Custom 27803010","","48355090  -  SPACER SPNL 0D RECT 25X11X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355094","SUP","Custom 27803010","","48355094  -  SPACER SPNL 4D WDG 25X11X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355100","SUP","Custom 27803010","","48355100  -  SPACER SPNL 0D RECT 25X11X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355104","SUP","Custom 27803010","","48355104  -  SPACER SPNL 4D WDG 25X11X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355110","SUP","Custom 27803010","","48355110  -  SPACER SPNL 0D RECT 25X11X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355114","SUP","Custom 27803010","","48355114  -  SPACER SPNL 4D WDG 25X11X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355120","SUP","Custom 27803010","","48355120  -  SPACER SPNL 0D RECT 25X11X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355124","SUP","Custom 27803010","","48355124  -  SPACER SPNL 4D WDG 25X11X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355130","SUP","Custom 27803010","","48355130  -  SPACER SPNL 0D RECT 25X11X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355134","SUP","Custom 27803010","","48355134  -  SPACER SPNL 4D WDG 25X11X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355164","SUP","Custom 27803010","","48355164  -  SPACER SPNL 4D WDG 25X11X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355180","SUP","Custom 27803010","","48355180  -  SPACER SPNL 0D RECT 25X11X18MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48355184","SUP","Custom 27803010","","48355184  -  SPACER SPNL 4D WDG 25X11X18MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370090","SUP","Custom 27803010","","48370090  -  SPACER SPNL 0D PRLL 30X9MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370094","SUP","Custom 27803010","","48370094  -  SPACER SPNL 4D WDG 30X9MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370100","SUP","Custom 27803010","","48370100  -  SPACER SPNL 0D PRLL 30X10MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370104","SUP","Custom 27803010","","48370104  -  SPACER SPNL 4D WDG 30X10MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370110","SUP","Custom 27803010","","48370110  -  SPACER SPNL 0D PRLL 30X11MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370114","SUP","Custom 27803010","","48370114  -  SPACER SPNL 4D WDG 30X11MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370120","SUP","Custom 27803010","","48370120  -  SPACER SPNL 0D PRLL 30X12MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370124","SUP","Custom 27803010","","48370124  -  SPACER SPNL 4D WDG 30X12MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370130","SUP","Custom 27803010","","48370130  -  SPACER SPNL 0D PRLL 30X13MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370134","SUP","Custom 27803010","","48370134  -  SPACER SPNL 4D WDG 30X13MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370140","SUP","Custom 27803010","","48370140  -  SPACER SPNL 0D PRLL 30X14MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370144","SUP","Custom 27803010","","48370144  -  SPACER SPNL 4D WDG 30X14MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370150","SUP","Custom 27803010","","48370150  -  SPACER SPNL 0D PRLL 30X15MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370154","SUP","Custom 27803010","","48370154  -  SPACER SPNL 4D WDG 30X15MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370160","SUP","Custom 27803010","","48370160  -  SPACER SPNL 0D PRLL 30X16MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370164","SUP","Custom 27803010","","48370164  -  SPACER SPNL 4D WDG 30X16MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370170","SUP","Custom 27803010","","48370170  -  SPACER SPNL 0D PRLL 30X17MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370174","SUP","Custom 27803010","","48370174  -  SPACER SPNL 4D WDG 30X17MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370180","SUP","Custom 27803010","","48370180  -  SPACER SPNL 0D PRLL 30X18MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48370184","SUP","Custom 27803010","","48370184  -  SPACER SPNL 4D WDG 30X18MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375070","SUP","Custom 27803010","","48375070  -  SPACER SPNL 0D PRLL 25X7MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375074","SUP","Custom 27803010","","48375074  -  SPACER SPNL 4D WDG 25X7MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375080","SUP","Custom 27803010","","48375080  -  SPACER SPNL 0D PRLL 25X8MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375084","SUP","Custom 27803010","","48375084  -  SPACER SPNL 4D WDG 25X8MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375090","SUP","Custom 27803010","","48375090  -  SPACER SPNL 0D PRLL 25X9MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375094","SUP","Custom 27803010","","48375094  -  SPACER SPNL 4D WDG 25X9MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375100","SUP","Custom 27803010","","48375100  -  SPACER SPNL 0D PRLL 25X10MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375104","SUP","Custom 27803010","","48375104  -  SPACER SPNL 4D WDG 25X10MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375110","SUP","Custom 27803010","","48375110  -  SPACER SPNL 0D PRLL 25X11MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375114","SUP","Custom 27803010","","48375114  -  SPACER SPNL 4D WDG 25X11MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375120","SUP","Custom 27803010","","48375120  -  SPACER SPNL 0D PRLL 25X12MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375124","SUP","Custom 27803010","","48375124  -  SPACER SPNL 4D WDG 25X12MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375130","SUP","Custom 27803010","","48375130  -  SPACER SPNL 0D PRLL 25X13MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375134","SUP","Custom 27803010","","48375134  -  SPACER SPNL 4D WDG 25X13MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375140","SUP","Custom 27803010","","48375140  -  SPACER SPNL 0D PRLL 25X14MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48375144","SUP","Custom 27803010","","48375144  -  SPACER SPNL 4D WDG 25X14MM AVS TL HLW PEEK TLIF","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390090","SUP","Custom 27803010","","48390090  -  SPACER SPNL 0D WDG NOSE 20X11X9MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390094","SUP","Custom 27803010","","48390094  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390101","SUP","Custom 27803010","","48390101  -  SPACER SPNL 0D WDG NOSE 20X11X10MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390104","SUP","Custom 27803010","","48390104  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390111","SUP","Custom 27803010","","48390111  -  SPACER SPNL 0D WDG NOSE 20X11X11MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390114","SUP","Custom 27803010","","48390114  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390120","SUP","Custom 27803010","","48390120  -  SPACER SPNL 0D WDG NOSE 20X11X12MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390124","SUP","Custom 27803010","","48390124  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390130","SUP","Custom 27803010","","48390130  -  SPACER SPNL 0D WDG NOSE 20X11X13MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390134","SUP","Custom 27803010","","48390134  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390140","SUP","Custom 27803010","","48390140  -  SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390144","SUP","Custom 27803010","","48390144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390150","SUP","Custom 27803010","","48390150  -  SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390154","SUP","Custom 27803010","","48390154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390160","SUP","Custom 27803010","","48390160  -  SPACER SPNL 0D WDG NOSE 20X11X16MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390164","SUP","Custom 27803010","","48390164  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48390180","SUP","Custom 27803010","","48390180  -  SPACER SPNL 0D WDG NOSE 20X11X18MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395090","SUP","Custom 27803010","","48395090  -  SPACER SPNL 0D WDG NOSE 25X11X9MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395094","SUP","Custom 27803010","","48395094  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X9MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395100","SUP","Custom 27803010","","48395100  -  SPACER SPNL 0D WDG NOSE 25X11X10MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395104","SUP","Custom 27803010","","48395104  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X10MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395110","SUP","Custom 27803010","","48395110  -  SPACER SPNL 0D WDG NOSE 25X11X11MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395114","SUP","Custom 27803010","","48395114  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X11MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395120","SUP","Custom 27803010","","48395120  -  SPACER SPNL 0D WDG NOSE 25X11X12MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395124","SUP","Custom 27803010","","48395124  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X12MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395130","SUP","Custom 27803010","","48395130  -  SPACER SPNL 0D WDG NOSE 25X11X13MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395134","SUP","Custom 27803010","","48395134  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X13MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395140","SUP","Custom 27803010","","48395140  -  SPACER SPNL 0D WDG NOSE 25X11X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395144","SUP","Custom 27803010","","48395144  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X14MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395150","SUP","Custom 27803010","","48395150  -  SPACER SPNL 0D WDG NOSE 25X11X15MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395154","SUP","Custom 27803010","","48395154  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X15MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395160","SUP","Custom 27803010","","48395160  -  SPACER SPNL 0D WDG NOSE 25X11X16MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395164","SUP","Custom 27803010","","48395164  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X16MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395180","SUP","Custom 27803010","","48395180  -  SPACER SPNL 0D WDG NOSE 25X11X18MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48395184","SUP","Custom 27803010","","48395184  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X18MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480074","SUP","Custom 27803010","","48480074  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X7MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480084","SUP","Custom 27803010","","48480084  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X8MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480090","SUP","Custom 27803010","","48480090  -  SPACER SPNL 0D WDG NOSE 20X9X9MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480094","SUP","Custom 27803010","","48480094  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X9MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480100","SUP","Custom 27803010","","48480100  -  SPACER SPNL 0D WDG NOSE 20X9X10MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480104","SUP","Custom 27803010","","48480104  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X10MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480110","SUP","Custom 27803010","","48480110  -  SPACER SPNL 0D WDG NOSE 20X9X11MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480114","SUP","Custom 27803010","","48480114  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X11MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480120","SUP","Custom 27803010","","48480120  -  SPACER SPNL 0D WDG NOSE 20X9X12MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480124","SUP","Custom 27803010","","48480124  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X12MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480130","SUP","Custom 27803010","","48480130  -  SPACER SPNL 0D WDG NOSE 20X9X13MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480134","SUP","Custom 27803010","","48480134  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X13MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480140","SUP","Custom 27803010","","48480140  -  SPACER SPNL 0D WDG NOSE 20X9X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480144","SUP","Custom 27803010","","48480144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X14MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480150","SUP","Custom 27803010","","48480150  -  SPACER SPNL 0D WDG NOSE 20X9X15MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480154","SUP","Custom 27803010","","48480154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X15MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480160","SUP","Custom 27803010","","48480160  -  SPACER SPNL 0D WDG NOSE 20X9X16MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48480164","SUP","Custom 27803010","","48480164  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X16MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48482001","SUP","HCPCS C1713","","48482001  -  SCREW BONE DIAPASON OSS LMBR SPN COMBO","BOTH IP/OP","$271.83 ","$201.15 ","$0.00 ","$271.83 ","$122.32 ","$0.00 ","$56.66 ","$0.00 ","$0.00 ","$47.59 ","$271.83 ","$0.00 ","$135.91 ","$215.29 ","$217.46 ","$0.00 ","$42.54 ","$0.00 ","$43.27 ","$0.00 "
"48482010","SUP","HCPCS C1713","","48482010  -  CAP IMPL DIAPASON OSS BLOCKER SPNE","BOTH IP/OP","$271.83 ","$201.15 ","$0.00 ","$271.83 ","$122.32 ","$0.00 ","$56.66 ","$0.00 ","$0.00 ","$47.59 ","$271.83 ","$0.00 ","$135.91 ","$215.29 ","$217.46 ","$0.00 ","$42.54 ","$0.00 ","$43.27 ","$0.00 "
"48482020","SUP","HCPCS C1713","","48482020  -  RING IMPL DIAPASON OSS BLOCKER SPNE","BOTH IP/OP","$271.83 ","$201.15 ","$0.00 ","$271.83 ","$122.32 ","$0.00 ","$56.66 ","$0.00 ","$0.00 ","$47.59 ","$271.83 ","$0.00 ","$135.91 ","$215.29 ","$217.46 ","$0.00 ","$42.54 ","$0.00 ","$43.27 ","$0.00 "
"48485074","SUP","Custom 27803010","","48485074  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X7MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485084","SUP","Custom 27803010","","48485084  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X8MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485090","SUP","Custom 27803010","","48485090  -  SPACER SPNL 0D WDG NOSE 25X8X9MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485094","SUP","Custom 27803010","","48485094  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X9MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485100","SUP","Custom 27803010","","48485100  -  SPACER SPNL 0D WDG NOSE 25X8X10MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485104","SUP","Custom 27803010","","48485104  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X10MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485110","SUP","Custom 27803010","","48485110  -  SPACER SPNL 0D WDG NOSE 25X8X11MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485114","SUP","Custom 27803010","","48485114  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X11MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485120","SUP","Custom 27803010","","48485120  -  SPACER SPNL 0D WDG NOSE 25X8X12MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485124","SUP","Custom 27803010","","48485124  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X12MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485130","SUP","Custom 27803010","","48485130  -  SPACER SPNL 0D WDG NOSE 25X8X13MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485134","SUP","Custom 27803010","","48485134  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X13MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485140","SUP","Custom 27803010","","48485140  -  SPACER SPNL 0D WDG NOSE 25X8X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485144","SUP","Custom 27803010","","48485144  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X14MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485150","SUP","Custom 27803010","","48485150  -  SPACER SPNL 0D WDG NOSE 25X8X15MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485154","SUP","Custom 27803010","","48485154  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X15MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485160","SUP","Custom 27803010","","48485160  -  SPACER SPNL 0D WDG NOSE 25X8X16MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485164","SUP","Custom 27803010","","48485164  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X16MM AVS UNILIF HLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48485530","SUP","HCPCS C1713","","48485530  -  SCREW BONE 5.5MM 30MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48485535","SUP","HCPCS C1713","","48485535  -  SCREW BONE 5.5MM 35MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48485540","SUP","HCPCS C1713","","48485540  -  SCREW BONE 5.5MM 40MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48485545","SUP","HCPCS C1713","","48485545  -  SCREW BONE 5.5MM 45MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48485550","SUP","HCPCS C1713","","48485550  -  SCREW BONE 5.5MM 50MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48485555","SUP","HCPCS C1713","","48485555  -  SCREW BONE 5.5MM 55MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486730","SUP","HCPCS C1713","","48486730  -  SCREW BONE 6.7MM 30MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486735","SUP","HCPCS C1713","","48486735  -  SCREW BONE 6.7MM 35MM DIAPASON OSS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486740","SUP","HCPCS C1713","","48486740  -  SCREW BONE 6.7MM 40MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486745","SUP","HCPCS C1713","","48486745  -  SCREW BONE 6.7MM 45MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486750","SUP","HCPCS C1713","","48486750  -  SCREW BONE 6.7MM 50MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486755","SUP","HCPCS C1713","","48486755  -  SCREW BONE 6.7MM 55MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486760","SUP","HCPCS C1713","","48486760  -  SCREW BONE 6.7MM 60MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487730","SUP","HCPCS C1713","","48487730  -  SCREW BONE 7.7MM 30MM DIAPASON OSS TI LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487735","SUP","HCPCS C1713","","48487735  -  SCREW BONE 7.7MM 35MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487740","SUP","HCPCS C1713","","48487740  -  SCREW BONE 7.7MM 40MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487745","SUP","HCPCS C1713","","48487745  -  SCREW BONE 7.7MM 45MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487750","SUP","HCPCS C1713","","48487750  -  SCREW BONE 7.7MM 50MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487755","SUP","HCPCS C1713","","48487755  -  SCREW BONE 7.7MM 55MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487760","SUP","HCPCS C1713","","48487760  -  SCREW BONE 7.7MM 60MM DIAPASON OSS LMBR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488035","SUP","HCPCS C1713","","48488035  -  SCREW BONE 8MM 35MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488040","SUP","HCPCS C1713","","48488040  -  SCREW BONE 8MM 40MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488045","SUP","HCPCS C1713","","48488045  -  SCREW BONE 8MM 45MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488050","SUP","HCPCS C1713","","48488050  -  SCREW BONE 8MM 50MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488055","SUP","HCPCS C1713","","48488055  -  SCREW BONE 8MM 55MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48489040","SUP","HCPCS C1713","","48489040  -  SCREW BONE 9MM 40MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48489045","SUP","HCPCS C1713","","48489045  -  SCREW BONE 9MM 45MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48489050","SUP","HCPCS C1713","","48489050  -  SCREW BONE 9MM 50MM DIAPASON OSS SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48489055","SUP","HCPCS C1713","","48489055  -  SCREW BONE 9MM 55MM DIAPASON OSS TI SCRL SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48510410","SUP","Custom 27203010","","48510410  -  PIN FIX STANDARD TEMPORARY NAIL REFLEX SPN","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48510420","SUP","Custom 27203010","","48510420  -  PIN FIX LONG REFLEX HYBRID","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48510610","SUP","HCPCS C1729","","48510610  -  BIT DRILL 10MM REFLEX HYBRID STERILE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48510612","SUP","Custom 27203010","","48510612  -  BIT DRILL 12MM REFLEX HYBRID SPN CERV ANTERIOR STERILE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48510614","SUP","Custom 27203010","","48510614  -  BIT DRILL 14MM REFLEX HYBRID SPN CERV ANTERIOR STERILE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48510616","SUP","Custom 27203010","","48510616  -  BIT DRILL 16MM REFLEX HYBRID SPN CERV ANTERIOR STERILE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48510618","SUP","HCPCS C1729","","48510618  -  BIT DRILL 18MM REFLEX HYBRID SPN CERV ANTERIOR STERILE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48510620","SUP","HCPCS C1729","","48510620  -  BIT DRILL 20MM","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$142.54 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"48550260","SUP","HCPCS C1713","","48550260  -  ROD SPNL 60MM 3.5MM OASYS TI","BOTH IP/OP","$480.48 ","$355.56 ","$0.00 ","$480.48 ","$216.21 ","$0.00 ","$100.14 ","$0.00 ","$0.00 ","$84.13 ","$480.48 ","$0.00 ","$240.24 ","$380.54 ","$384.38 ","$0.00 ","$75.19 ","$0.00 ","$76.49 ","$0.00 "
"48551000","SUP","Custom 27803010","","48551000  -  SCREW SET BUTTRESS THREAD BLOCKER OASYS TITANIUM","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551006","SUP","HCPCS C1713","","48551006  -  SCREW SET OASYS SPN CONCTR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48551040","SUP","HCPCS C1713","","48551040  -  PLATE BONE 130D STR OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551042","SUP","HCPCS C1713","","48551042  -  PLATE BONE 100D STR OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551044","SUP","HCPCS C1713","","48551044  -  PLATE BONE SMALL OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551045","SUP","HCPCS C1713","","48551045  -  PLATE BONE MEDIUM OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551046","SUP","HCPCS C1713","","48551046  -  PLATE BONE LARGE OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551047","SUP","HCPCS C1713","","48551047  -  PLATE BONE LARGE LONG OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551048","SUP","HCPCS C1713","","48551048  -  PLATE BONE MINI OASYS TITANIUM SPN THORACIC OCCIPITOCERVICAL","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551049","SUP","Custom 27803010","","48551049  -  HOOK SPINAL 3.5MM OASYS TITANIUM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551050","SUP","Custom 27803010","","48551050  -  HOOK SPINAL SHORT 5MM OASYS TITANIUM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551053","SUP","Custom 27803010","","48551053  -  HOOK SPINAL 6.5MM OASYS TITANIUM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551055","SUP","Custom 27803010","","48551055  -  HOOK SPINAL STANDARD 8MM TALL OASYS TITANIUM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551060","SUP","Custom 27803010","","48551060  -  HOOK SPINAL RIGHT OFFST OASYS TITANIUM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551065","SUP","Custom 27803010","","48551065  -  HOOK SPINAL LEFT OFFST OASYS TITANIUM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551070","SUP","Custom 27803010","","48551070  -  CONNECTOR ROD TRNSVRS POLYAX OASYS CROSSLINK SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551071","SUP","Custom 27803010","","48551071  -  CONNECTOR ROD 60MM TRNSVRS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551072","SUP","Custom 27803010","","48551072  -  CONNECTOR ROD 40MM TRNSVRS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551073","SUP","HCPCS C1713","","48551073  -  PLATE BONE SMALL CROSS CONCTR OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48551074","SUP","Custom 27203010","","48551074  -  CONNECTOR ROD MEDIUM 32MM CROSS PLATE OASYS SPN NONSTRL 91","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551075","SUP","HCPCS C1713","","48551075  -  PLATE BONE CROSS CONCTR OASYS TITANIUM SPN THORACIC","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48551080","SUP","Custom 27803010","","48551080  -  CONNECTOR ROD OFFST OASYS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551081","SUP","Custom 27803010","","48551081  -  CONNECTOR ROD 12MM CROSS PLATE OASYS CERV SPN NONSTRL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551084","SUP","Custom 27803010","","48551084  -  CONNECTOR ROD 3.5-4.5MM AXIAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551085","SUP","Custom 27803010","","48551085  -  CONNECTOR ROD 3.5/3.5MM AXIAL OASYS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551086","SUP","Custom 27803010","","48551086  -  CONNECTOR ROD 3.5/5.5MM AXIAL OASYS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551087","SUP","Custom 27803010","","48551087  -  CONNECTOR ROD 3.5/6MM AXIAL OASYS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551088","SUP","Custom 27803010","","48551088  -  CONNECTOR ROD 3.5/3.5MM ROD TO ROD OASYS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551089","SUP","Custom 27803010","","48551089  -  CONNECTOR ROD 3.5/5.5MM ROD TO ROD OASYS SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551090","SUP","Custom 27803010","","48551090  -  CONNECTOR ROD 3.5MM 90MM POLYAX ROD TO ROD OASYS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551091","SUP","Custom 27803010","","48551091  -  CONNECTOR ROD 3.5/4.5MM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551094","SUP","Custom 27803010","","48551094  -  CONNECTOR ROD SADDLE SCREW OASYS SPN 3.5 MM ROD","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551240","SUP","Custom 27803010","","48551240  -  ROD SPINAL 3.5MM 240MM OASYS","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48551350","SUP","Custom 27803010","","48551350  -  ROD SPINAL 3.5MM 350MM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552025","SUP","Custom 27803010","","48552025  -  ROD SPINAL 3.5MM 25MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552030","SUP","Custom 27803010","","48552030  -  ROD SPINAL 3.5MM 30MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552040","SUP","Custom 27803010","","48552040  -  ROD SPINAL 3.5MM 40MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552050","SUP","Custom 27803010","","48552050  -  ROD SPINAL 3.5MM 50MM OASYS TITANIUM OCCIPITO CERVICO","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552060","SUP","Custom 27803010","","48552060  -  ROD SPINAL 3.5MM 60MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552070","SUP","Custom 27803010","","48552070  -  ROD SPINAL 3.5MM 70MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552080","SUP","Custom 27803010","","48552080  -  ROD SPINAL 3.5MM 80MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552120","SUP","Custom 27803010","","48552120  -  ROD SPINAL 3.5MM 120MM OASYS TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552240","SUP","Custom 27803010","","48552240  -  ROD SPINAL 3.5MM 240MM OASYS TITANIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48552310","SUP","HCPCS C1713","","48552310  -  SCREW BONE 3.5MM 10MM BIAS ANGLE POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552312","SUP","HCPCS C1713","","48552312  -  SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552314","SUP","HCPCS C1713","","48552314  -  SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552316","SUP","HCPCS C1713","","48552316  -  SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552318","SUP","HCPCS C1713","","48552318  -  SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552320","SUP","HCPCS C1713","","48552320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552322","SUP","HCPCS C1713","","48552322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552324","SUP","HCPCS C1713","","48552324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552326","SUP","HCPCS C1713","","48552326  -  SCREW BONE LP 3.5MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552328","SUP","HCPCS C1713","","48552328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552330","SUP","HCPCS C1713","","48552330  -  SCREW BONE LP 3.5MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552332","SUP","HCPCS C1713","","48552332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552334","SUP","HCPCS C1713","","48552334  -  SCREW BONE LP 3.5MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552336","SUP","HCPCS C1713","","48552336  -  SCREW BONE 3.5MM 36MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552338","SUP","HCPCS C1713","","48552338  -  SCREW BONE 3.5MM 38MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552340","SUP","HCPCS C1713","","48552340  -  SCREW BONE 3.5MM 40MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552342","SUP","HCPCS C1713","","48552342  -  SCREW BONE 3.5MM 42MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552344","SUP","HCPCS C1713","","48552344  -  SCREW BONE 3.5MM 44MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552346","SUP","HCPCS C1713","","48552346  -  SCREW BONE 3.5MM 46MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552348","SUP","HCPCS C1713","","48552348  -  SCREW BONE 3.5MM 48MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552350","SUP","HCPCS C1713","","48552350  -  SCREW BONE 3.5MM 50MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552352","SUP","HCPCS C1713","","48552352  -  SCREW BONE 3.5MM 52MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552354","SUP","HCPCS C1713","","48552354  -  SCREW BONE 3.5MM 54MM POLYAX OASYS SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552410","SUP","HCPCS C1713","","48552410  -  SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552412","SUP","HCPCS C1713","","48552412  -  SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552414","SUP","HCPCS C1713","","48552414  -  SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552416","SUP","HCPCS C1713","","48552416  -  SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552418","SUP","HCPCS C1713","","48552418  -  SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552420","SUP","HCPCS C1713","","48552420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552422","SUP","HCPCS C1713","","48552422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552424","SUP","HCPCS C1713","","48552424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552426","SUP","HCPCS C1713","","48552426  -  SCREW BONE LP 4MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552428","SUP","HCPCS C1713","","48552428  -  SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552430","SUP","HCPCS C1713","","48552430  -  SCREW BONE LP 4MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552432","SUP","HCPCS C1713","","48552432  -  SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552434","SUP","HCPCS C1713","","48552434  -  SCREW BONE LP 4MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552436","SUP","HCPCS C1713","","48552436  -  SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552438","SUP","HCPCS C1713","","48552438  -  SCREW BONE LP 4MM 38MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552440","SUP","HCPCS C1713","","48552440  -  SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552442","SUP","HCPCS C1713","","48552442  -  SCREW BONE LP 4MM 42MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552446","SUP","HCPCS C1713","","48552446  -  SCREW BONE LP 4MM 46MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48552450","SUP","HCPCS C1713","","48552450  -  SCREW BONE LP 4MM 50MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48553600","SUP","Custom 27803010","","48553600  -  ROD SPINAL 3.5-4.5MM 600MM TRANSITION OASYS TITANIUM","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48553602","SUP","Custom 27803010","","48553602  -  ROD SPNL 3.5-4.5MM 600MM NS LF OASYS TRNS VIT","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48553604","SUP","Custom 27803010","","48553604  -  ROD SPNL 3.5-5.5MM 600MM NS OASYS TRNS TI","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48553606","SUP","Custom 27803010","","48553606  -  ROD SPINAL 3.5-5.5MM TRANSITION OASYS VITALLIUM","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48553608","SUP","Custom 27803010","","48553608  -  ROD SPNL 3.5-6MM 600MM NS OASYS TRNS TI","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48553610","SUP","Custom 27803010","","48553610  -  ROD SPINAL 3.5-6MM TRANSITION OASYS VITALLIUM","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48554306","SUP","HCPCS C1713","","48554306  -  SCREW BONE LP 3.5MM 6MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554308","SUP","HCPCS C1713","","48554308  -  SCREW BONE LP 3.5MM 8MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554310","SUP","HCPCS C1713","","48554310  -  SCREW BONE LP 3.5MM 10MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554312","SUP","HCPCS C1713","","48554312  -  SCREW BONE LP 3.5MM 12MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554314","SUP","HCPCS C1713","","48554314  -  SCREW BONE LP 3.5MM 14MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554316","SUP","HCPCS C1713","","48554316  -  SCREW BONE LP 3.5MM 16MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554406","SUP","HCPCS C1713","","48554406  -  SCREW BONE LP 4MM 6MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554408","SUP","HCPCS C1713","","48554408  -  SCREW BONE LP 4MM 8MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554410","SUP","HCPCS C1713","","48554410  -  SCREW BONE LP 4MM 10MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554412","SUP","HCPCS C1713","","48554412  -  SCREW BONE LP 4MM 12MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554414","SUP","HCPCS C1713","","48554414  -  SCREW BONE LP 4MM 14MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554416","SUP","HCPCS C1713","","48554416  -  SCREW BONE LP 4MM 16MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554506","SUP","HCPCS C1713","","48554506  -  SCREW BONE LP 4.5MM 6MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554508","SUP","HCPCS C1713","","48554508  -  SCREW BONE LP 4.5MM 8MM OASYS TITANIUM SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554510","SUP","HCPCS C1713","","48554510  -  SCREW BONE 4.5MM 10MM OASYS SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554512","SUP","HCPCS C1713","","48554512  -  SCREW BONE 4.5MM 12MM OASYS SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554514","SUP","HCPCS C1713","","48554514  -  SCREW BONE 4.5MM 14MM OASYS SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48554516","SUP","HCPCS C1713","","48554516  -  SCREW BONE 4.5MM 16MM OASYS SPN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"48555320","SUP","HCPCS C1713","","48555320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555322","SUP","HCPCS C1713","","48555322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555324","SUP","HCPCS C1713","","48555324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555328","SUP","HCPCS C1713","","48555328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555332","SUP","HCPCS C1713","","48555332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555336","SUP","HCPCS C1713","","48555336  -  SCREW BONE LP 3.5MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555340","SUP","HCPCS C1713","","48555340  -  SCREW BONE LP 3.5MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555420","SUP","HCPCS C1713","","48555420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555422","SUP","HCPCS C1713","","48555422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555424","SUP","HCPCS C1713","","48555424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555428","SUP","HCPCS C1713","","48555428  -  SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555432","SUP","HCPCS C1713","","48555432  -  SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555436","SUP","HCPCS C1713","","48555436  -  SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555440","SUP","HCPCS C1713","","48555440  -  SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555444","SUP","HCPCS C1713","","48555444  -  SCREW BONE LP 4MM 44MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555448","SUP","HCPCS C1713","","48555448  -  SCREW BONE LP 4MM 48MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48555452","SUP","HCPCS C1713","","48555452  -  SCREW BONE LP 4MM 52MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556322","SUP","HCPCS C1713","","48556322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556324","SUP","HCPCS C1713","","48556324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556326","SUP","HCPCS C1713","","48556326  -  SCREW BONE LP 3.5MM 26MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556328","SUP","HCPCS C1713","","48556328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556330","SUP","HCPCS C1713","","48556330  -  SCREW BONE LP 3.5MM 30MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556332","SUP","HCPCS C1713","","48556332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556334","SUP","HCPCS C1713","","48556334  -  SCREW BONE LP 3.5MM 34MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556336","SUP","HCPCS C1713","","48556336  -  SCREW BONE LP 3.5MM 36MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556338","SUP","HCPCS C1713","","48556338  -  SCREW BONE LP 3.5MM 38MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48556340","SUP","HCPCS C1713","","48556340  -  SCREW BONE LP 3.5MM 40MM BIAS ANGLE SMOOTH SHANK OASYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557310","SUP","HCPCS C1713","","48557310  -  SCREW BONE LP 3.5MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557312","SUP","HCPCS C1713","","48557312  -  SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557314","SUP","HCPCS C1713","","48557314  -  SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557316","SUP","HCPCS C1713","","48557316  -  SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557318","SUP","HCPCS C1713","","48557318  -  SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557320","SUP","HCPCS C1713","","48557320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557322","SUP","HCPCS C1713","","48557322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557324","SUP","HCPCS C1713","","48557324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557410","SUP","HCPCS C1713","","48557410  -  SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557412","SUP","HCPCS C1713","","48557412  -  SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557414","SUP","HCPCS C1713","","48557414  -  SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557416","SUP","HCPCS C1713","","48557416  -  SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557418","SUP","HCPCS C1713","","48557418  -  SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557420","SUP","HCPCS C1713","","48557420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557422","SUP","HCPCS C1713","","48557422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48557424","SUP","HCPCS C1713","","48557424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558310","SUP","HCPCS C1713","","48558310  -  SCREW BONE LP 3.5MM 10MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558312","SUP","HCPCS C1713","","48558312  -  SCREW BN 3.5MM 12MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558314","SUP","HCPCS C1713","","48558314  -  SCREW BN 3.5MM 14MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558316","SUP","HCPCS C1713","","48558316  -  SCREW BONE LP 3.5MM 16MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558318","SUP","HCPCS C1713","","48558318  -  SCREW BONE LP 3.5MM 18MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558320","SUP","HCPCS C1713","","48558320  -  SCREW BONE LP 3.5MM 20MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558410","SUP","HCPCS C1713","","48558410  -  SCREW BONE LP 4MM 10MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558412","SUP","HCPCS C1713","","48558412  -  SCREW BONE LP 4MM 12MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558414","SUP","HCPCS C1713","","48558414  -  SCREW BONE LP 4MM 14MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558416","SUP","HCPCS C1713","","48558416  -  SCREW BONE LP 4MM 16MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558418","SUP","HCPCS C1713","","48558418  -  SCREW BONE LP 4MM 18MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558420","SUP","HCPCS C1713","","48558420  -  SCREW BONE LP 4MM 20MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558520","SUP","HCPCS C1713","","48558520  -  SCREW BONE LP 4.5MM 20MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558524","SUP","HCPCS C1713","","48558524  -  SCREW BN 4.5MM 24MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558528","SUP","HCPCS C1713","","48558528  -  SCREW BONE LP 4.5MM 28MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558532","SUP","HCPCS C1713","","48558532  -  SCREW BONE LP 4.5MM 32MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558536","SUP","HCPCS C1713","","48558536  -  SCREW BONE LP 4.5MM 36MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558540","SUP","HCPCS C1713","","48558540  -  SCREW BONE LP 4.5MM 40MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558544","SUP","HCPCS C1713","","48558544  -  SCREW BONE LP 4.5MM 44MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558548","SUP","HCPCS C1713","","48558548  -  SCREW BONE LP 4.5MM 48MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48558552","SUP","HCPCS C1713","","48558552  -  SCREW BONE LP 4.5MM 52MM POLYAX OASYS TITANIUM SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"48560314","SUP","Custom 27803010","","48560314  -  TAP SPINAL 3.5MM DRILL BIT OASYS","BOTH IP/OP","$490.83 ","$363.21 ","$0.00 ","$490.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.83 ","$0.00 ","$245.41 ","$388.74 ","$392.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48560323","SUP","Custom 27203010","","48560323  -  BIT DRL 2.5MM 3.5MM PA SCR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48560414","SUP","HCPCS C1713","","48560414  -  TAP SURG 4MM OASYS SPN 4MM SCREW","BOTH IP/OP","$490.83 ","$363.21 ","$0.00 ","$490.83 ","$220.87 ","$0.00 ","$102.30 ","$0.00 ","$0.00 ","$85.94 ","$490.83 ","$0.00 ","$245.41 ","$388.74 ","$392.66 ","$0.00 ","$76.81 ","$0.00 ","$78.14 ","$0.00 "
"48560423","SUP","Custom 27203010","","48560423  -  DRILL SURG 3MM OASYS SPN STERILE 4MM SCREW","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48560514","SUP","HCPCS C1713","","48560514  -  TAP SPINAL 3.5MM OASYS SPN","BOTH IP/OP","$425.30 ","$314.72 ","$0.00 ","$425.30 ","$191.39 ","$0.00 ","$88.64 ","$0.00 ","$0.00 ","$74.47 ","$425.30 ","$0.00 ","$212.65 ","$336.84 ","$340.24 ","$0.00 ","$66.56 ","$0.00 ","$67.71 ","$0.00 "
"48570114","SUP","Custom 27203010","","48570114  -  BIT DRL 4MM ESCALATE LAMINOPLASTY","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48570116","SUP","Custom 27203010","","48570116  -  DRILL SURG 6MM ESCALATE NONSTRL LAMINOPLASTY","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48570118","SUP","Custom 27203010","","48570118  -  DRILL SURG 8MM ESCALATE NONSTRL LAMINOPLASTY","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48570204","SUP","HCPCS C1713","","48570204  -  SCREW BONE 2MM 4MM SELF DRILL ESCALATE MAGENTA SPN CERV","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570206","SUP","HCPCS C1713","","48570206  -  SCREW BONE 2MM 6MM SELF DRILL ESCALATE MAGENTA SPN CERV","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570208","SUP","HCPCS C1713","","48570208  -  SCREW BONE 2MM 8MM SELF DRILL ESCALATE MAGENTA SPN CERV","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570210","SUP","HCPCS C1713","","48570210  -  ESCALATE 2.0 X 10MM SELF DRILLING SCREW","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570240","SUP","HCPCS C1713","","48570240  -  ESCALATE 2.4 X 10MM SELF TAPPING SCREW","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570244","SUP","HCPCS C1713","","48570244  -  ESCALATE 2.4 X 4MM SELF TAPPING SCREW","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570246","SUP","HCPCS C1713","","48570246  -  ESCALATE 2.4 X 6MM SELF TAPPING SCREW","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570248","SUP","HCPCS C1713","","48570248  -  ESCALATE 2.4 X 8MM SELF TAPPING SCREW","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48570300","SUP","HCPCS C1713","","48570300  -  PLATE BONE 5MM EXPANDABLE ESCALATE TITANIUM SPN CERV NONSTRL","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"48570301","SUP","HCPCS C1713","","48570301  -  PLATE BONE 5MM 2 HOLE BASE ESCALATE TITANIUM SPN CERV","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"48610112","SUP","HCPCS C1713","","48610112  -  PLATE 12MM TI 1 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610114","SUP","HCPCS C1713","","48610114  -  PLATE 14MM TI 1 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610116","SUP","HCPCS C1713","","48610116  -  PLATE 16MM TI 1 LVL RFLX HB BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610118","SUP","HCPCS C1713","","48610118  -  PLATE 18MM TI 1 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610120","SUP","HCPCS C1713","","48610120  -  PLATE 20MM TI 1 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610122","SUP","HCPCS C1713","","48610122  -  PLATE 22MM TI 1 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610224","SUP","HCPCS C1713","","48610224  -  PLATE 24MM TI 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610226","SUP","HCPCS C1713","","48610226  -  PLATE 26MM TI 2 LVL RFLX HB BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610228","SUP","HCPCS C1713","","48610228  -  PLATE 28MM TI 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610230","SUP","HCPCS C1713","","48610230  -  PLATE 30MM TI 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610232","SUP","HCPCS C1713","","48610232  -  PLATE 32MM TI 2 LVL RFLX BONE ANT CERV","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610234","SUP","HCPCS C1713","","48610234  -  PLATE 34MM TI 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610237","SUP","HCPCS C1713","","48610237  -  PLATE 37MM TI 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610240","SUP","HCPCS C1713","","48610240  -  PLATE 40MM TI 2 LVL RFLX HB BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610243","SUP","HCPCS C1713","","48610243  -  PLATE 43MM TI 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610246","SUP","HCPCS C1713","","48610246  -  PLATE 46MM 2 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48610339","SUP","HCPCS C1713","","48610339  -  PLATE 39MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610342","SUP","HCPCS C1713","","48610342  -  PLATE 42MM TI 3 LVL RFLX BONE ANT CERV","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610345","SUP","HCPCS C1713","","48610345  -  PLATE 45MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610348","SUP","HCPCS C1713","","48610348  -  PLATE 48MM 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610351","SUP","HCPCS C1713","","48610351  -  PLATE 51MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610354","SUP","HCPCS C1713","","48610354  -  PLATE 54MM TI 3 LVL RFLX HB BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610357","SUP","HCPCS C1713","","48610357  -  PLATE 57MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610360","SUP","HCPCS C1713","","48610360  -  PLATE 60MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610363","SUP","HCPCS C1713","","48610363  -  PLATE 63MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610366","SUP","HCPCS C1713","","48610366  -  PLATE 66MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610369","SUP","HCPCS C1713","","48610369  -  PLATE 69MM TI 3 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610460","SUP","HCPCS C1713","","48610460  -  PLATE 60MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610464","SUP","HCPCS C1713","","48610464  -  PLATE 64MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610468","SUP","HCPCS C1713","","48610468  -  PLATE 68MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610472","SUP","HCPCS C1713","","48610472  -  PLATE 72MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610476","SUP","HCPCS C1713","","48610476  -  PLATE 76MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610480","SUP","HCPCS C1713","","48610480  -  PLATE 80MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48610484","SUP","HCPCS C1713","","48610484  -  PLATE 84MM TI 4 LVL RFLX BONE ANT CERV SPN","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"48624010","SUP","HCPCS C1713","","48624010  -  SCREW BONE 4MM 10MM RFLX HB TI ANT CERV SPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624012","SUP","HCPCS C1713","","48624012  -  SCREW BONE 4MM 12MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624014","SUP","HCPCS C1713","","48624014  -  SCREW BONE 4MM 14MM RFLX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624016","SUP","HCPCS C1713","","48624016  -  SCREW BONE 4MM 16MM RFLX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624018","SUP","HCPCS C1713","","48624018  -  SCREW BONE 4MM 18MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624020","SUP","HCPCS C1713","","48624020  -  SCREW BONE 4MM 20MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624022","SUP","HCPCS C1713","","48624022  -  SCREW BONE 4MM 22MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624512","SUP","HCPCS C1713","","48624512  -  SCREW BONE 4.5MM 12MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624514","SUP","HCPCS C1713","","48624514  -  SCREW BONE 4.5MM 14MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624516","SUP","HCPCS C1713","","48624516  -  SCREW BONE 4.5MM 16MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624518","SUP","HCPCS C1713","","48624518  -  SCREW BONE 4.5MM 18MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624520","SUP","HCPCS C1713","","48624520  -  SCREW BONE 4.5MM 20MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48624522","SUP","HCPCS C1713","","48624522  -  SCREW BONE 4.5MM 22MM RFLX TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48644010","SUP","HCPCS C1713","","48644010  -  SCREW BONE 4MM 10MM RFLX HB TI SPNL SLFDRILL VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"48644012","SUP","HCPCS C1713","","48644012  -  SCREW BONE 4MM 12MM VAR ANG SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48644014","SUP","HCPCS C1713","","48644014  -  SCREW BONE 4MM 14MM VAR ANG SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48644016","SUP","HCPCS C1713","","48644016  -  SCREW BONE 4MM 16MM VAR ANG SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48644018","SUP","HCPCS C1713","","48644018  -  SCREW BONE 4MM 18MM VAR ANG SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48650228","SUP","HCPCS C1713","","48650228  -  PLATE BN 28MM RFLX HB LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"48651112","SUP","HCPCS C1713","","48651112  -  PLATE BONE 12MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651114","SUP","HCPCS C1713","","48651114  -  PLATE BN 14MM NS RFLX HB LVL 1 TI SPNE CRV ANT","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651116","SUP","HCPCS C1713","","48651116  -  PLATE BONE 16MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651118","SUP","HCPCS C1713","","48651118  -  PLATE BONE 18MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651120","SUP","HCPCS C1713","","48651120  -  PLATE BONE 20MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651122","SUP","HCPCS C1713","","48651122  -  PLATE BONE 22MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651224","SUP","HCPCS C1713","","48651224  -  PLATE BONE 24MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651226","SUP","HCPCS C1713","","48651226  -  PLATE BONE 26MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651228","SUP","HCPCS C1713","","48651228  -  PLATE BN 28MM NS RFLX HB LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651230","SUP","HCPCS C1713","","48651230  -  PLATE BONE 30MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651232","SUP","HCPCS C1713","","48651232  -  PLATE BN 32MM NS RFLX HB LVL 2 TI SPNE CRV ANT","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651234","SUP","HCPCS C1713","","48651234  -  PLATE BONE 34MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651237","SUP","HCPCS C1713","","48651237  -  PLATE BONE 37MM 6 HOLE LEVEL 2 REFLEX HYBRID TITANIUM SPN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651240","SUP","HCPCS C1713","","48651240  -  PLATE BONE 40MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651243","SUP","HCPCS C1713","","48651243  -  PLATE BONE 43MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651246","SUP","HCPCS C1713","","48651246  -  PLATE BONE 46MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48651339","SUP","HCPCS C1713","","48651339  -  PLATE BONE 39MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651342","SUP","HCPCS C1713","","48651342  -  PLATE BONE 42MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651345","SUP","HCPCS C1713","","48651345  -  PLATE BONE 45MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651348","SUP","HCPCS C1713","","48651348  -  PLATE BN 48MM NS RFLX HB LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651351","SUP","HCPCS C1713","","48651351  -  PLATE BONE 51MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651354","SUP","HCPCS C1713","","48651354  -  PLATE BONE 54MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651357","SUP","HCPCS C1713","","48651357  -  PLATE BONE 57MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651360","SUP","HCPCS C1713","","48651360  -  PLATE BN 60MM NS RFLX HB LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651363","SUP","HCPCS C1713","","48651363  -  PLATE BN 63MM RFLX HB LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651366","SUP","HCPCS C1713","","48651366  -  PLATE BN 66MM RFLX HB LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651369","SUP","HCPCS C1713","","48651369  -  PLATE BN 69MM RFLX HB LVL 3 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651460","SUP","HCPCS C1713","","48651460  -  PLATE BN 60MM NS RFLX HB LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651464","SUP","HCPCS C1713","","48651464  -  PLATE BONE 64MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651468","SUP","HCPCS C1713","","48651468  -  PLATE BONE 68MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651472","SUP","HCPCS C1713","","48651472  -  PLATE BONE 72MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651476","SUP","HCPCS C1713","","48651476  -  PLATE BN 76MM RFLX HB LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651480","SUP","HCPCS C1713","","48651480  -  PLATE BN 80MM RFLX HB LVL 4 TI SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651484","SUP","HCPCS C1713","","48651484  -  PLATE BONE 84MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651488","SUP","HCPCS C1713","","48651488  -  PLATE BONE 88MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651492","SUP","HCPCS C1713","","48651492  -  PLATE BN 92MM LVL 4 SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48651496","SUP","HCPCS C1713","","48651496  -  PLATE BN 96MM LVL 4 SPNE CRV ANT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48654010","SUP","HCPCS C1713","","48654010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48654012","SUP","HCPCS C1713","","48654012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48654014","SUP","HCPCS C1713","","48654014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48654016","SUP","HCPCS C1713","","48654016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48654018","SUP","HCPCS C1713","","48654018  -  SCREW BONE 4MM 18MM FIX ANGLE SELF DRILL DYNATRAN REFLEX","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48660112","SUP","HCPCS C1713","","48660112  -  PLATE 12MM 1 LVL ZERO PRFL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660114","SUP","HCPCS C1713","","48660114  -  PLATE 14MM 1 LVL BONE","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660116","SUP","HCPCS C1713","","48660116  -  PLATE 16MM ZERO PRFL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660118","SUP","HCPCS C1713","","48660118  -  PLATE 18MM 1 LVL BONE ANT CERV SPN","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660120","SUP","HCPCS C1713","","48660120  -  PLATE 20MM 1 LVL ZERO PRFL ACP BONE","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660122","SUP","HCPCS C1713","","48660122  -  PLATE 22MM 1 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660124","SUP","HCPCS C1713","","48660124  -  PLATE 24MM 1 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,263.88 ","$3,155.27 ","$0.00 ","$4,263.88 ","$1,918.74 ","$0.00 ","$888.70 ","$0.00 ","$0.00 ","$746.57 ","$4,263.88 ","$0.00 ","$2,131.94 ","$3,376.99 ","$3,411.10 ","$0.00 ","$667.30 ","$0.00 ","$678.81 ","$0.00 "
"48660224","SUP","HCPCS C1713","","48660224  -  PLATE 24MM 2 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660226","SUP","HCPCS C1713","","48660226  -  PLATE 26MM 2 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660228","SUP","HCPCS C1713","","48660228  -  PLATE 28MM 2 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660230","SUP","HCPCS C1713","","48660230  -  PLATE 30MM 2 LVL BONE SPNL","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660232","SUP","HCPCS C1713","","48660232  -  PLATE 32MM 2 LVL ACP BONE","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660234","SUP","HCPCS C1713","","48660234  -  PLATE 34MM 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660236","SUP","HCPCS C1713","","48660236  -  PLATE 36MM 2 LVL ACP BONE","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660238","SUP","HCPCS C1713","","48660238  -  PLATE 38MM 2 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660240","SUP","HCPCS C1713","","48660240  -  PLATE 40MM 2 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48660242","SUP","HCPCS C1713","","48660242  -  PLATE 42MM 2 LVL ACP BONE ANT CERV SPN","BOTH IP/OP","$4,477.28 ","$3,313.19 ","$0.00 ","$4,477.28 ","$2,014.77 ","$0.00 ","$933.18 ","$0.00 ","$0.00 ","$783.94 ","$4,477.28 ","$0.00 ","$2,238.64 ","$3,546.01 ","$3,581.82 ","$0.00 ","$700.69 ","$0.00 ","$712.78 ","$0.00 "
"48665030","SUP","HCPCS C1713","","48665030  -  SCREW BN 5MM 30MM AVS ANCH-L ST SLF DRL 2 THRD LD CUT FLUT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"48667000","SUP","HCPCS C1713","","48667000  -  ANCHOR-L LOCKING PLATE","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"48668142","SUP","HCPCS C1713","","48668142  -  SPACER SPNL 12D RECT 28X40X14MM NS LF AVS ANCH-L RADOPQ HLW","BOTH IP/OP","$9,375.00 ","$6,937.50 ","$0.00 ","$9,375.00 ","$4,218.75 ","$0.00 ","$1,953.98 ","$0.00 ","$0.00 ","$1,641.49 ","$9,375.00 ","$0.00 ","$4,687.50 ","$7,425.00 ","$7,500.00 ","$0.00 ","$1,467.19 ","$0.00 ","$1,492.50 ","$0.00 "
"48674010","SUP","HCPCS C1713","","48674010  -  SCREW BONE FLUTE 4MM 10MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674012","SUP","HCPCS C1713","","48674012  -  SCREW BONE FLUTE 4MM 12MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674014","SUP","HCPCS C1713","","48674014  -  SCREW BONE FLUTE 4MM 14MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674016","SUP","HCPCS C1713","","48674016  -  SCREW BONE FLUTE 4MM 16MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674018","SUP","HCPCS C1713","","48674018  -  SCREW BONE FLUTE 4MM 18MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674020","SUP","HCPCS C1713","","48674020  -  SCREW BONE FLUTE 4MM 20MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674512","SUP","HCPCS C1713","","48674512  -  SCREW BONE FLUTE 4.5MM 12MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674514","SUP","HCPCS C1713","","48674514  -  SCREW BONE FLUTE 4.5MM 14MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674516","SUP","HCPCS C1713","","48674516  -  SCREW BONE FLUTE 4.5MM 16MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674518","SUP","HCPCS C1713","","48674518  -  SCREW BONE FLUTE 4.5MM 18MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48674520","SUP","HCPCS C1713","","48674520  -  SCREW BONE FLUTE 4.5MM 20MM FIX ANGLE SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694010","SUP","HCPCS C1713","","48694010  -  SCREW BONE FLUTE 4MM 10MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694012","SUP","HCPCS C1713","","48694012  -  SCREW BONE FLUTE 4MM 12MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694014","SUP","HCPCS C1713","","48694014  -  SCREW BONE FLUTE 4MM 14MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694016","SUP","HCPCS C1713","","48694016  -  SCREW BONE FLUTE 4MM 16MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694018","SUP","HCPCS C1713","","48694018  -  SCREW BONE FLUTE 4MM 18MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694020","SUP","HCPCS C1713","","48694020  -  SCREW BONE FLUTE 4MM 20MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694512","SUP","HCPCS C1713","","48694512  -  SCREW BONE FLUTE 4.5MM 12MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694514","SUP","HCPCS C1713","","48694514  -  SCREW BONE FLUTE 4.5MM 14MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694516","SUP","HCPCS C1713","","48694516  -  SCREW BONE FLUTE 4.5MM 16MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694518","SUP","HCPCS C1713","","48694518  -  SCREW BONE FLUTE 4.5MM 18MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48694520","SUP","HCPCS C1713","","48694520  -  SCREW BONE FLUTE 4.5MM 20MM VAR ANG SELF TAP COLOR CODED","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48770410","SUP","Custom 27203010","","48770410  -  PIN FIX TEMPORARY AVIATOR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48770610","SUP","Custom 27203010","","48770610  -  BIT DRILL 10MM AVTR","BOTH IP/OP","$656.90 ","$486.11 ","$0.00 ","$656.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.90 ","$0.00 ","$328.45 ","$520.26 ","$525.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48770612","SUP","Custom 27203010","","48770612  -  BIT DRILL 12MM AVTR","BOTH IP/OP","$656.90 ","$486.11 ","$0.00 ","$656.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.90 ","$0.00 ","$328.45 ","$520.26 ","$525.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48770614","SUP","Custom 27203010","","48770614  -  BIT DRILL 14MM AVTR","BOTH IP/OP","$656.90 ","$486.11 ","$0.00 ","$656.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.90 ","$0.00 ","$328.45 ","$520.26 ","$525.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48770616","SUP","Custom 27203010","","48770616  -  BIT DRILL 16MM AVTR","BOTH IP/OP","$656.90 ","$486.11 ","$0.00 ","$656.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.90 ","$0.00 ","$328.45 ","$520.26 ","$525.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48771610","SUP","Custom 27203010","","48771610  -  BIT DRILL 2.5MM 10MM AVIATOR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48771612","SUP","Custom 27203010","","48771612  -  BIT DRILL 2.5MM 12MM AVIATOR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48771614","SUP","Custom 27203010","","48771614  -  BIT DRILL 2.5MM 14MM AVIATOR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48771616","SUP","Custom 27203010","","48771616  -  BIT DRILL 2.5MM 16MM AVIATOR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48811112","SUP","HCPCS C1713","","48811112  -  PLATE BONE 12X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811114","SUP","HCPCS C1713","","48811114  -  PLATE BONE 14X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811116","SUP","HCPCS C1713","","48811116  -  PLATE BONE 16X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811118","SUP","HCPCS C1713","","48811118  -  PLATE BONE 18X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811120","SUP","HCPCS C1713","","48811120  -  PLATE BONE 20X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811122","SUP","HCPCS C1713","","48811122  -  PLATE BONE 22X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811224","SUP","HCPCS C1713","","48811224  -  PLATE BONE 24X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811226","SUP","HCPCS C1713","","48811226  -  PLATE BONE 26X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811228","SUP","HCPCS C1713","","48811228  -  PLATE BONE 28X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811230","SUP","HCPCS C1713","","48811230  -  PLATE BONE 30X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811232","SUP","HCPCS C1713","","48811232  -  PLATE BONE 32X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811234","SUP","HCPCS C1713","","48811234  -  PLATE BONE 34X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811237","SUP","HCPCS C1713","","48811237  -  PLATE BONE 37X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811240","SUP","HCPCS C1713","","48811240  -  PLATE BONE 40X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811243","SUP","HCPCS C1713","","48811243  -  PLATE BONE 43X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811246","SUP","HCPCS C1713","","48811246  -  PLATE BONE 46X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"48811339","SUP","HCPCS C1713","","48811339  -  PLATE BONE 39X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811342","SUP","HCPCS C1713","","48811342  -  PLATE BONE 42X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811345","SUP","HCPCS C1713","","48811345  -  PLATE BONE 45X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811348","SUP","HCPCS C1713","","48811348  -  PLATE BONE 48X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811351","SUP","HCPCS C1713","","48811351  -  PLATE BONE 51X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811354","SUP","HCPCS C1713","","48811354  -  PLATE BONE 54X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811357","SUP","HCPCS C1713","","48811357  -  PLATE BONE 57X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811360","SUP","HCPCS C1713","","48811360  -  PLATE BONE 60X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811363","SUP","HCPCS C1713","","48811363  -  PLATE BONE 63X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811366","SUP","HCPCS C1713","","48811366  -  PLATE BONE 66MM LEVEL 3 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811369","SUP","HCPCS C1713","","48811369  -  PLATE BONE 69MM LEVEL 3 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811456","SUP","HCPCS C1713","","48811456  -  PLATE BONE 56MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811460","SUP","HCPCS C1713","","48811460  -  PLATE BONE 60MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811464","SUP","HCPCS C1713","","48811464  -  PLATE BONE 64MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811468","SUP","HCPCS C1713","","48811468  -  PLATE BONE 68MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811472","SUP","HCPCS C1713","","48811472  -  PLATE BONE 72MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811476","SUP","HCPCS C1713","","48811476  -  PLATE BONE 76MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811480","SUP","HCPCS C1713","","48811480  -  PLATE BONE 80MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811484","SUP","HCPCS C1713","","48811484  -  PLATE BONE 84MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811488","SUP","HCPCS C1713","","48811488  -  PLATE BONE 88MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811492","SUP","HCPCS C1713","","48811492  -  PLATE BONE 92MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48811496","SUP","HCPCS C1713","","48811496  -  PLATE BONE 96MM LEVEL 4 AVIATOR SPN CERV ANTERIOR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"48814010","SUP","HCPCS C1713","","48814010  -  SCREW BONE 4MM 10MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814012","SUP","HCPCS C1713","","48814012  -  SCREW BONE 4MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814014","SUP","HCPCS C1713","","48814014  -  SCREW BONE 4MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814016","SUP","HCPCS C1713","","48814016  -  SCREW BONE 4MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814018","SUP","HCPCS C1713","","48814018  -  SCREW BONE 4MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814512","SUP","HCPCS C1713","","48814512  -  SCREW BONE 4.35MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814514","SUP","HCPCS C1713","","48814514  -  SCREW BONE 4.35MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814516","SUP","HCPCS C1713","","48814516  -  SCREW BONE 4.35MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814518","SUP","HCPCS C1713","","48814518  -  SCREW BONE 4.35MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48814520","SUP","HCPCS C1713","","48814520  -  SCREW BONE 4.35MM 20MM VAR ANG SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48815540","SUP","HCPCS C1713","","48815540  -  SCREW POLYAXIAL 5.5X40MM XIA CT","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"48824010","SUP","HCPCS C1713","","48824010  -  SCREW BONE 4MM 10MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48824012","SUP","HCPCS C1713","","48824012  -  SCREW BONE 4MM 12MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48824014","SUP","HCPCS C1713","","48824014  -  SCREW BONE 4MM 14MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48824016","SUP","HCPCS C1713","","48824016  -  SCREW BONE 4MM 16MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48824018","SUP","HCPCS C1713","","48824018  -  SCREW BONE 4MM 18MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834010","SUP","HCPCS C1713","","48834010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834012","SUP","HCPCS C1713","","48834012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834014","SUP","HCPCS C1713","","48834014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF TAP AVIATOR SPN CERV","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834016","SUP","HCPCS C1713","","48834016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834018","SUP","HCPCS C1713","","48834018  -  SCREW BONE 4MM 18MM SPNL FIX SLFDRILL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834512","SUP","HCPCS C1713","","48834512  -  SCREW BONE 4.35MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834514","SUP","HCPCS C1713","","48834514  -  SCREW BN 4.35MM 14MM AVTR ST FA SPNE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834516","SUP","HCPCS C1713","","48834516  -  SCREW BONE 4.35MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834518","SUP","HCPCS C1713","","48834518  -  SCREW BONE 4.35MM 18MM SELF TAP FIX ANGLE AVIATOR SPN CERV","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48834520","SUP","HCPCS C1713","","48834520  -  SCREW BONE 4.35MM 20MM SELF TAP FIX ANGLE AVIATOR SPN CERV","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48844010","SUP","HCPCS C1713","","48844010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL AVIATOR TITANIUM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48844012","SUP","HCPCS C1713","","48844012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL AVIATOR TITANIUM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48844014","SUP","HCPCS C1713","","48844014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL AVIATOR TITANIUM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48844016","SUP","HCPCS C1713","","48844016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL AVIATOR TITANIUM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48844018","SUP","HCPCS C1713","","48844018  -  SCREW BONE 4MM 18MM SELF DRILL FIX ANGLE AVIATOR SPN CERV","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"48850000","SUP","HCPCS C1713","","48850000  -  BLOCKER SPNL CORT XIA","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"48857535","SUP","Custom 27203010","","48857535  -  XIA CT 05.0mmX35mm TAP MARKER","BOTH IP/OP","$406.58 ","$300.87 ","$0.00 ","$406.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$406.58 ","$0.00 ","$203.29 ","$322.01 ","$325.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48858435","SUP","Custom 27203010","","48858435  -  XIA CT 04.5mmX35mm TAP MARKER","BOTH IP/OP","$406.58 ","$300.87 ","$0.00 ","$406.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$406.58 ","$0.00 ","$203.29 ","$322.01 ","$325.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48858535","SUP","Custom 27203010","","48858535  -  XIA CT 05.5mmX35mm TAP MARKER","BOTH IP/OP","$406.58 ","$300.87 ","$0.00 ","$406.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$406.58 ","$0.00 ","$203.29 ","$322.01 ","$325.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48900425","SUP","HCPCS C1713","","48900425  -  SCREW BONE STANDARD POST 4.5MM 25MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900430","SUP","HCPCS C1713","","48900430  -  SCREW BONE STANDARD POST 4.5MM 30MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900435","SUP","HCPCS C1713","","48900435  -  SCREW BONE STANDARD POST 4.5MM 35MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900440","SUP","HCPCS C1713","","48900440  -  SCREW BONE STANDARD POST 4.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900445","SUP","HCPCS C1713","","48900445  -  SCREW BONE 4.5MM 45MM STANDARD POST TRIO SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48900450","SUP","HCPCS C1713","","48900450  -  SCREW BONE 4.5MM 50MM STANDARD POST TRIO SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48900455","SUP","HCPCS C1713","","48900455  -  SCREW BONE 4.5MM 55MM STANDARD POST TRIO SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48900525","SUP","HCPCS C1713","","48900525  -  SCREW BONE STANDARD POST 5.5MM 25MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900530","SUP","HCPCS C1713","","48900530  -  SCREW BONE STANDARD POST 5.5MM 30MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900535","SUP","HCPCS C1713","","48900535  -  SCREW BONE STANDARD POST 5.5MM 35MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900540","SUP","HCPCS C1713","","48900540  -  SCREW BONE STANDARD POST 5.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900545","SUP","HCPCS C1713","","48900545  -  SCREW BONE STANDARD POST 5.5MM 45MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900550","SUP","HCPCS C1713","","48900550  -  SCREW BONE STANDARD POST 5.5MM 50MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900555","SUP","HCPCS C1713","","48900555  -  SCREW BONE 5.5MM 55MM STANDARD POST TRIO SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48900560","SUP","HCPCS C1713","","48900560  -  SCREW BONE 5.5MM 60MM STANDARD POST TRIO SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"48900630","SUP","HCPCS C1713","","48900630  -  SCREW BONE STANDARD POST 6.5MM 30MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900635","SUP","HCPCS C1713","","48900635  -  SCREW BONE STANDARD POST 6.5MM 35MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900640","SUP","HCPCS C1713","","48900640  -  SCREW BONE STANDARD POST 6.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900645","SUP","HCPCS C1713","","48900645  -  SCREW BONE STANDARD POST 6.5MM 45MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900650","SUP","HCPCS C1713","","48900650  -  SCREW BONE STANDARD POST 6.5MM 50MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900655","SUP","HCPCS C1713","","48900655  -  SCREW BONE STANDARD POST 6.5MM 55MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900660","SUP","HCPCS C1713","","48900660  -  SCREW BONE STANDARD POST 6.5MM 60MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900730","SUP","HCPCS C1713","","48900730  -  SCREW BONE STANDARD POST 7.5MM 30MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900735","SUP","HCPCS C1713","","48900735  -  SCREW BONE STANDARD POST 7.5MM 35MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900740","SUP","HCPCS C1713","","48900740  -  SCREW BONE STANDARD POST 7.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900745","SUP","HCPCS C1713","","48900745  -  SCREW BONE STANDARD POST 7.5MM 45MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900750","SUP","HCPCS C1713","","48900750  -  SCREW BONE STANDARD POST 7.5MM 50MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900755","SUP","HCPCS C1713","","48900755  -  SCREW BONE STANDARD POST 7.5MM 55MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900760","SUP","HCPCS C1713","","48900760  -  SCREW BONE STANDARD POST 7.5MM 60MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900830","SUP","HCPCS C1713","","48900830  -  SCREW BONE STANDARD POST 8.5MM 30MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900835","SUP","HCPCS C1713","","48900835  -  SCREW BONE STANDARD POST 8.5MM 35MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900840","SUP","HCPCS C1713","","48900840  -  SCREW BONE STANDARD POST 8.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900845","SUP","HCPCS C1713","","48900845  -  SCREW BONE STANDARD POST 8.5MM 45MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900850","SUP","HCPCS C1713","","48900850  -  SCREW BONE STANDARD POST 8.5MM 50MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900855","SUP","HCPCS C1713","","48900855  -  SCREW BONE STANDARD POST 8.5MM 55MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48900860","SUP","HCPCS C1713","","48900860  -  SCREW BONE STANDARD POST 8.5MM 60MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48901640","SUP","HCPCS C1713","","48901640  -  SCREW BONE LONG POST 6.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48901645","SUP","HCPCS C1713","","48901645  -  SCREW BONE LONG POST 6.5MM 45MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48901650","SUP","HCPCS C1713","","48901650  -  SCREW BONE LONG POST 6.5MM 50MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48901740","SUP","HCPCS C1713","","48901740  -  SCREW BONE LONG POST 7.5MM 40MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48901745","SUP","HCPCS C1713","","48901745  -  SCREW BONE LONG POST 7.5MM 45MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48901750","SUP","HCPCS C1713","","48901750  -  SCREW BONE LONG POST 7.5MM 50MM TITANIUM SPN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"48902015","SUP","Custom 27803010","","48902015  -  CONNECTOR ROD SMALL OFFST UPGRADE TRIO SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48902025","SUP","Custom 27803010","","48902025  -  CONNECTOR ROD MEDIUM LP SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48902035","SUP","Custom 27803010","","48902035  -  CONNECTOR ROD LARGE LP OFFST SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48902040","SUP","Custom 27803010","","48902040  -  CONNECTOR ROD 2 STEP LOCKING TITANIUM SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48902060","SUP","Custom 27803010","","48902060  -  CONNECTOR ROD RIGHT OFFST BIASED SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48902070","SUP","Custom 27803010","","48902070  -  CONNECTOR ROD LEFT BIASED OFFST TITANIUM SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48910530","SUP","HCPCS C1713","","48910530  -  SCREW BONE 5.5MM 30MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910535","SUP","HCPCS C1713","","48910535  -  SCREW BONE 5.5MM 35MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910540","SUP","HCPCS C1713","","48910540  -  SCREW BONE 5.5MM 40MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910545","SUP","HCPCS C1713","","48910545  -  SCREW BONE 5.5MM 45MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910550","SUP","HCPCS C1713","","48910550  -  SCREW BONE 5.5MM 50MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910635","SUP","HCPCS C1713","","48910635  -  SCREW BONE 6.5MM 35MM TI STD POST SPNL PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910640","SUP","HCPCS C1713","","48910640  -  SCREW BONE 6.5MM 40MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910645","SUP","HCPCS C1713","","48910645  -  SCREW BONE 6.5MM 45MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910655","SUP","HCPCS C1713","","48910655  -  SCREW BONE 6.5MM 55MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910660","SUP","HCPCS C1713","","48910660  -  SCREW BONE 6.5MM 60MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910730","SUP","HCPCS C1713","","48910730  -  SCREW BONE 7.5MM 30MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910735","SUP","HCPCS C1713","","48910735  -  SCREW BONE 7.5MM 35MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910740","SUP","HCPCS C1713","","48910740  -  SCREW BONE 7.5MM 40MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910745","SUP","HCPCS C1713","","48910745  -  SCREW BONE 7.5MM 45MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910755","SUP","HCPCS C1713","","48910755  -  SCREW BONE 7.5MM 55MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910760","SUP","HCPCS C1713","","48910760  -  SCREW BONE 7.5MM 60MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910830","SUP","HCPCS C1713","","48910830  -  SCREW BONE 8.5MM 30MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910835","SUP","HCPCS C1713","","48910835  -  SCREW BONE 8.5MM 35MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910840","SUP","HCPCS C1713","","48910840  -  SCREW BONE 8.5MM 40MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910855","SUP","HCPCS C1713","","48910855  -  SCREW BONE 8.5MM 55MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48910860","SUP","HCPCS C1713","","48910860  -  SCREW BONE 8.5MM 60MM STD POST PS","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"48911640","SUP","HCPCS C1713","","48911640  -  SCREW BONE 6.5MM 40MM LNG POST PS","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"48911645","SUP","HCPCS C1713","","48911645  -  SCREW BONE 6.5MM 45MM LNG POST PS","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"48911650","SUP","HCPCS C1713","","48911650  -  SCREW BONE 6.5MM 50MM LNG POST PS","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"48911740","SUP","HCPCS C1713","","48911740  -  SCREW BONE 7.5MM 40MM LNG POST PS","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"48911745","SUP","HCPCS C1713","","48911745  -  SCREW BONE 7.5MM 45MM LNG POST PS","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"48911750","SUP","HCPCS C1713","","48911750  -  SCREW BONE 7.5MM 50MM LNG POST PS","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"48912035","SUP","HCPCS C1713","","48912035  -  PLATE 35MM LRDTC STAB BONE POST","BOTH IP/OP","$2,866.53 ","$2,121.23 ","$0.00 ","$2,866.53 ","$1,289.94 ","$0.00 ","$597.46 ","$0.00 ","$0.00 ","$501.91 ","$2,866.53 ","$0.00 ","$1,433.26 ","$2,270.29 ","$2,293.22 ","$0.00 ","$448.61 ","$0.00 ","$456.35 ","$0.00 "
"48912040","SUP","HCPCS C1713","","48912040  -  PLATE 40MM LRDTC STAB BONE POST","BOTH IP/OP","$2,866.53 ","$2,121.23 ","$0.00 ","$2,866.53 ","$1,289.94 ","$0.00 ","$597.46 ","$0.00 ","$0.00 ","$501.91 ","$2,866.53 ","$0.00 ","$1,433.26 ","$2,270.29 ","$2,293.22 ","$0.00 ","$448.61 ","$0.00 ","$456.35 ","$0.00 "
"48912060","SUP","HCPCS C1713","","48912060  -  PLATE 60MM LRDTC STAB BONE POST","BOTH IP/OP","$3,102.43 ","$2,295.80 ","$0.00 ","$3,102.43 ","$1,396.09 ","$0.00 ","$646.62 ","$0.00 ","$0.00 ","$543.21 ","$3,102.43 ","$0.00 ","$1,551.21 ","$2,457.12 ","$2,481.94 ","$0.00 ","$485.53 ","$0.00 ","$493.91 ","$0.00 "
"48912070","SUP","HCPCS C1713","","48912070  -  PLATE 70MM POST STAB LRDTC BONE SPNL","BOTH IP/OP","$3,102.43 ","$2,295.80 ","$0.00 ","$3,102.43 ","$1,396.09 ","$0.00 ","$646.62 ","$0.00 ","$0.00 ","$543.21 ","$3,102.43 ","$0.00 ","$1,551.21 ","$2,457.12 ","$2,481.94 ","$0.00 ","$485.53 ","$0.00 ","$493.91 ","$0.00 "
"48912080","SUP","HCPCS C1713","","48912080  -  PLATE 80MM POST STAB LRDTC BONE SPNL","BOTH IP/OP","$3,102.43 ","$2,295.80 ","$0.00 ","$3,102.43 ","$1,396.09 ","$0.00 ","$646.62 ","$0.00 ","$0.00 ","$543.21 ","$3,102.43 ","$0.00 ","$1,551.21 ","$2,457.12 ","$2,481.94 ","$0.00 ","$485.53 ","$0.00 ","$493.91 ","$0.00 "
"48912090","SUP","HCPCS C1713","","48912090  -  PLATE 90MM POST STAB LRDTC BONE SPNL","BOTH IP/OP","$3,102.43 ","$2,295.80 ","$0.00 ","$3,102.43 ","$1,396.09 ","$0.00 ","$646.62 ","$0.00 ","$0.00 ","$543.21 ","$3,102.43 ","$0.00 ","$1,551.21 ","$2,457.12 ","$2,481.94 ","$0.00 ","$485.53 ","$0.00 ","$493.91 ","$0.00 "
"48912105","SUP","HCPCS C1713","","48912105  -  PLATE 105MM POST STAB LRDTC BONE SPNL","BOTH IP/OP","$3,338.33 ","$2,470.36 ","$0.00 ","$3,338.33 ","$1,502.25 ","$0.00 ","$695.79 ","$0.00 ","$0.00 ","$584.51 ","$3,338.33 ","$0.00 ","$1,669.16 ","$2,643.96 ","$2,670.66 ","$0.00 ","$522.45 ","$0.00 ","$531.46 ","$0.00 "
"48912120","SUP","HCPCS C1713","","48912120  -  PLATE 120MM POST STAB LRDTC BONE SPNL","BOTH IP/OP","$3,338.33 ","$2,470.36 ","$0.00 ","$3,338.33 ","$1,502.25 ","$0.00 ","$695.79 ","$0.00 ","$0.00 ","$584.51 ","$3,338.33 ","$0.00 ","$1,669.16 ","$2,643.96 ","$2,670.66 ","$0.00 ","$522.45 ","$0.00 ","$531.46 ","$0.00 "
"48912510","SUP","Custom 27803010","","48912510  -  NUT LOCK 9MM POST TI HEX STAB POST STAB","BOTH IP/OP","$294.28 ","$217.77 ","$0.00 ","$294.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$294.28 ","$0.00 ","$147.14 ","$233.07 ","$235.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48912520","SUP","HCPCS C1713","","48912520  -  PLATE 20MM POST STAB POLYAX DOME BONE SPNL","BOTH IP/OP","$224.65 ","$166.24 ","$0.00 ","$224.65 ","$101.09 ","$0.00 ","$46.82 ","$0.00 ","$0.00 ","$39.33 ","$224.65 ","$0.00 ","$112.33 ","$177.92 ","$179.72 ","$0.00 ","$35.16 ","$0.00 ","$35.76 ","$0.00 "
"48953112","SUP","Custom 27803010","","48953112  -  CAGE SPNL 12D LRDTC 28X11X11MM STRL LF TRITANIUM PLIF","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48955106","SUP","Custom 27203010","","48955106  -  CAGE SPNL 6D LRDTC 28X11X10MM STRL LF TRITANIUM PLIF","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48955126","SUP","HCPCS C1713","","48955126  -  POSTERIOR LUMBAR CAGE 12MM X 28MM X 6 - 11MM","BOTH IP/OP","$5,500.00 ","$4,070.00 ","$0.00 ","$5,500.00 ","$2,475.00 ","$0.00 ","$1,146.34 ","$0.00 ","$0.00 ","$963.01 ","$5,500.00 ","$0.00 ","$2,750.00 ","$4,356.00 ","$4,400.00 ","$0.00 ","$860.75 ","$0.00 ","$875.60 ","$0.00 "
"50506000","SUP","Custom 27011340","","050506000  -  CONCTR PRFSN STR EQL 3/8INX3/8IN 3/8INX3/8IN STRL","BOTH IP/OP","$248.78 ","$184.10 ","$0.00 ","$248.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$248.78 ","$0.00 ","$124.39 ","$197.03 ","$199.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50516000","SUP","Custom 27011340","","050516000  -  CONNECTOR PRFSN .25IN 3/8IN STRL RDCR","BOTH IP/OP","$281.50 ","$208.31 ","$0.00 ","$281.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.50 ","$0.00 ","$140.75 ","$222.95 ","$225.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50524000","SUP","Custom 27011340","","050524000  -  CONNECTOR PRFSN .25IN X .25IN X .25IN STRL Y EQL","BOTH IP/OP","$11.28 ","$8.35 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.28 ","$0.00 ","$5.64 ","$8.93 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50524000","SUP","Custom 27011340","","50524000  -  CONNECTOR PERFUSION EQUAL Y STER 1/4 X 1/4IN","BOTH IP/OP","$11.28 ","$8.35 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.28 ","$0.00 ","$5.64 ","$10.10 ","$9.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50526000","SUP","Custom 27203010","","CONNECTOR PRFSN Y EQL 3/8INX3/8INX3/8IN","BOTH IP/OP","$10.95 ","$8.10 ","$0.00 ","$10.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.95 ","$0.00 ","$5.48 ","$8.67 ","$8.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50529000","SUP","Custom 27011340","","050529000  -  CONCTR PRFSN RDC WYE .5X3/8IN STRL","BOTH IP/OP","$13.33 ","$9.86 ","$0.00 ","$22.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.39 ","$0.00 ","$11.19 ","$17.73 ","$17.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60060083","SUP","Custom 27203010","","60060083  -  KIT PRSS MNTR CSTM TRNDCR RT HRT","BOTH IP/OP","$35.57 ","$26.32 ","$0.00 ","$35.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.57 ","$0.00 ","$17.78 ","$28.17 ","$28.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65305001","SUP","HCPCS C1762","","65305001  -  GRAFT BONE DBM 10ML SPNL","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$0.00 ","$0.00 "
"66020016","SUP","Custom 27203010","","66020016  -  BANDAGE COMPRESSION 7.25+ IN 4IN MULTILAYER HIGH WOUND","BOTH IP/OP","$21.65 ","$16.02 ","$0.00 ","$21.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.97 ","$0.00 ","$10.99 ","$17.40 ","$17.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"66800433","SUP","Custom 27203010","","66800433  -  DRESSING BRN 16X16IN STRL LF ACTCT FLX 3 ANMC BRR FLXB SFT","BOTH IP/OP","$150.59 ","$111.44 ","$0.00 ","$152.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$152.85 ","$0.00 ","$76.42 ","$121.06 ","$122.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"66800434","SUP","Custom 27203010","","66800434 -  DRESSING BURN 16X16IN ANTIBACTERIAL FAST ACT BARRIER CONTROL","BOTH IP/OP","$179.20 ","$132.61 ","$0.00 ","$175.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.61 ","$0.00 ","$87.81 ","$139.08 ","$140.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"67005200","SUP","HCPCS C1887","","CATHETER GUID XB3 CURVE 6FR .070IN 100CM PTFE VSBR BLUE YLW","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"67005300","SUP","HCPCS C1887","","CATHETER GUID XB3 CURVE 6FR .070IN 100CM SH PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"67005500","SUP","HCPCS C1887","","CATHETER GUID XB3.5 CURVE 6FR .070IN 100CM SH PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"67011200","SUP","HCPCS C1887","","CATHETER GUID AR2 CURVE 6FR .070IN 100CM PTFE VSBR BLUE YLW","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"68304060","SUP","Custom 27803010","","68304060  -  ROD SPNL 60MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304070","SUP","Custom 27803010","","68304070  -  ROD SPNL 70MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304080","SUP","Custom 27803010","","68304080  -  ROD SPNL 80MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304090","SUP","Custom 27803010","","68304090  -  ROD SPNL 90MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304100","SUP","Custom 27803010","","68304100  -  ROD SPNL 100MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304110","SUP","Custom 27803010","","68304110  -  ROD SPNL 110MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304120","SUP","Custom 27803010","","68304120  -  ROD SPNL 120MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304130","SUP","Custom 27803010","","68304130  -  ROD SPNL 130MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304140","SUP","Custom 27803010","","68304140  -  ROD SPNL 140MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304150","SUP","Custom 27803010","","68304150  -  ROD SPNL 150MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68304160","SUP","Custom 27803010","","68304160  -  ROD SPNL 160MM 4MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306060","SUP","Custom 27803010","","68306060  -  ROD SPNL 60MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306070","SUP","Custom 27803010","","68306070  -  ROD SPNL 70MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306080","SUP","Custom 27803010","","68306080  -  ROD SPNL 80MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306090","SUP","Custom 27803010","","68306090  -  ROD SPNL 90MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306100","SUP","Custom 27803010","","68306100  -  ROD SPNL 100MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306110","SUP","Custom 27803010","","68306110  -  ROD SPNL 110MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306120","SUP","Custom 27803010","","68306120  -  ROD SPNL 120MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306130","SUP","Custom 27803010","","68306130  -  ROD SPNL 130MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306140","SUP","Custom 27803010","","68306140  -  ROD SPNL 140MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306150","SUP","Custom 27803010","","68306150  -  ROD SPNL 150MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68306160","SUP","Custom 27803010","","68306160  -  ROD SPNL 160MM 6MM CENTAUR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68415525","SUP","HCPCS C1713","","68415525  -  SCREW BONE 5.5MM 25MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68415530","SUP","HCPCS C1713","","68415530  -  SCREW BONE 5.5MM 30MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68415535","SUP","HCPCS C1713","","68415535  -  SCREW BONE 5.5MM 35MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68415540","SUP","HCPCS C1713","","68415540  -  SCREW BONE 5.5MM 40MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68415545","SUP","HCPCS C1713","","68415545  -  SCREW BONE 5.5MM 45MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68415550","SUP","HCPCS C1713","","68415550  -  SCREW BONE 5.5MM 50MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68415555","SUP","HCPCS C1713","","68415555  -  SCREW BONE 5.5MM 55MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417025","SUP","HCPCS C1713","","68417025  -  SCREW BONE 7MM 25MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417030","SUP","HCPCS C1713","","68417030  -  SCREW BONE 30MM 7MM CENTAUR PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417035","SUP","HCPCS C1713","","68417035  -  SCREW BONE 7MM 35MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417040","SUP","HCPCS C1713","","68417040  -  SCREW BONE 7MM 40MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417045","SUP","HCPCS C1713","","68417045  -  SCREW BONE 7MM 45MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417050","SUP","HCPCS C1713","","68417050  -  SCREW BONE 7MM 50MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68417055","SUP","HCPCS C1713","","68417055  -  SCREW BONE 7MM 55MM CENTAUR SPNL PLT","BOTH IP/OP","$1,204.15 ","$891.07 ","$0.00 ","$1,204.15 ","$541.87 ","$0.00 ","$250.97 ","$0.00 ","$0.00 ","$210.84 ","$1,204.15 ","$0.00 ","$602.08 ","$953.69 ","$963.32 ","$0.00 ","$188.45 ","$0.00 ","$191.70 ","$0.00 "
"68420000","SUP","HCPCS C1713","","68420000  -  PLATE SPRT CENTAUR BONE SPNL","BOTH IP/OP","$354.95 ","$262.66 ","$0.00 ","$354.95 ","$159.73 ","$0.00 ","$73.98 ","$0.00 ","$0.00 ","$62.15 ","$354.95 ","$0.00 ","$177.48 ","$281.12 ","$283.96 ","$0.00 ","$55.55 ","$0.00 ","$56.51 ","$0.00 "
"68425525","SUP","HCPCS C1713","","68425525  -  BOLT SPNL 25MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68425530","SUP","HCPCS C1713","","68425530  -  BOLT SPNL 30MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68425535","SUP","HCPCS C1713","","68425535  -  BOLT SPNL 35MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68425540","SUP","HCPCS C1713","","68425540  -  BOLT SPNL 40MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68425545","SUP","HCPCS C1713","","68425545  -  BOLT SPNL 45MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68425550","SUP","HCPCS C1713","","68425550  -  BOLT SPNL 50MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68425555","SUP","HCPCS C1713","","68425555  -  BOLT SPNL 55MM 5.5MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427025","SUP","HCPCS C1713","","68427025  -  BOLT SPNL 25MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427030","SUP","HCPCS C1713","","68427030  -  BOLT SPNL 30MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427035","SUP","HCPCS C1713","","68427035  -  BOLT SPNL 35MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427040","SUP","HCPCS C1713","","68427040  -  BOLT SPNL 40MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427045","SUP","HCPCS C1713","","68427045  -  BOLT SPNL 45MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427050","SUP","HCPCS C1713","","68427050  -  BOLT SPNL 50MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68427055","SUP","HCPCS C1713","","68427055  -  BOLT SPNL 55MM 7MM CENTAUR","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$626.78 ","$0.00 ","$290.30 ","$0.00 ","$0.00 ","$243.88 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$217.98 ","$0.00 ","$221.74 ","$0.00 "
"68430000","SUP","Custom 27803010","","68430000  -  CONCTR ROD CENTAUR SET SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435525","SUP","Custom 27803010","","68435525  -  BOLT SPNL 25MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435530","SUP","Custom 27803010","","68435530  -  BOLT SPNL 30MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435535","SUP","Custom 27803010","","68435535  -  BOLT SPNL 35MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435540","SUP","Custom 27803010","","68435540  -  BOLT SPNL 40MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435545","SUP","Custom 27803010","","68435545  -  BOLT SPNL 45MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435550","SUP","Custom 27803010","","68435550  -  BOLT SPNL 50MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68435555","SUP","Custom 27803010","","68435555  -  BOLT SPNL 55MM 5.5MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437025","SUP","Custom 27803010","","68437025  -  BOLT SPNL 25MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437030","SUP","Custom 27803010","","68437030  -  BOLT SPNL 30MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437035","SUP","Custom 27803010","","68437035  -  BOLT SPNL 35MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437040","SUP","Custom 27803010","","68437040  -  BOLT SPNL 40MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437045","SUP","Custom 27803010","","68437045  -  BOLT SPNL 45MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437050","SUP","Custom 27803010","","68437050  -  BOLT SPNL 50MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68437055","SUP","Custom 27803010","","68437055  -  BOLT SPNL 55MM 7MM CENTAUR ROD","BOTH IP/OP","$1,392.85 ","$1,030.71 ","$0.00 ","$1,392.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.85 ","$0.00 ","$696.43 ","$1,103.14 ","$1,114.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68470030","SUP","HCPCS C1713","","68470030  -  PLATE 30MM STR CENTAUR BONE SPNL","BOTH IP/OP","$6,274.48 ","$4,643.12 ","$0.00 ","$6,274.48 ","$2,823.51 ","$0.00 ","$1,307.76 ","$0.00 ","$0.00 ","$1,098.61 ","$6,274.48 ","$0.00 ","$3,137.24 ","$4,969.39 ","$5,019.58 ","$0.00 ","$981.96 ","$0.00 ","$998.90 ","$0.00 "
"68470040","SUP","HCPCS C1713","","68470040  -  PLATE 40MM STR CENTAUR BONE SPNL","BOTH IP/OP","$6,274.48 ","$4,643.12 ","$0.00 ","$6,274.48 ","$2,823.51 ","$0.00 ","$1,307.76 ","$0.00 ","$0.00 ","$1,098.61 ","$6,274.48 ","$0.00 ","$3,137.24 ","$4,969.39 ","$5,019.58 ","$0.00 ","$981.96 ","$0.00 ","$998.90 ","$0.00 "
"68470050","SUP","HCPCS C1713","","68470050  -  PLATE 50MM STR CENTAUR BONE SPNL","BOTH IP/OP","$6,723.78 ","$4,975.60 ","$0.00 ","$6,723.78 ","$3,025.70 ","$0.00 ","$1,401.40 ","$0.00 ","$0.00 ","$1,177.28 ","$6,723.78 ","$0.00 ","$3,361.89 ","$5,325.23 ","$5,379.02 ","$0.00 ","$1,052.27 ","$0.00 ","$1,070.42 ","$0.00 "
"68470060","SUP","HCPCS C1713","","68470060  -  PLATE 60MM STR CENTAUR BONE SPNL","BOTH IP/OP","$6,723.78 ","$4,975.60 ","$0.00 ","$6,723.78 ","$3,025.70 ","$0.00 ","$1,401.40 ","$0.00 ","$0.00 ","$1,177.28 ","$6,723.78 ","$0.00 ","$3,361.89 ","$5,325.23 ","$5,379.02 ","$0.00 ","$1,052.27 ","$0.00 ","$1,070.42 ","$0.00 "
"68470070","SUP","HCPCS C1713","","68470070  -  PLATE 70MM STR CENTAUR BONE SPNL","BOTH IP/OP","$7,006.85 ","$5,185.07 ","$0.00 ","$7,006.85 ","$3,153.08 ","$0.00 ","$1,460.40 ","$0.00 ","$0.00 ","$1,226.84 ","$7,006.85 ","$0.00 ","$3,503.43 ","$5,549.43 ","$5,605.48 ","$0.00 ","$1,096.57 ","$0.00 ","$1,115.49 ","$0.00 "
"68470080","SUP","HCPCS C1713","","68470080  -  PLATE 80MM STR CENTAUR BONE SPNL","BOTH IP/OP","$7,006.85 ","$5,185.07 ","$0.00 ","$7,006.85 ","$3,153.08 ","$0.00 ","$1,460.40 ","$0.00 ","$0.00 ","$1,226.84 ","$7,006.85 ","$0.00 ","$3,503.43 ","$5,549.43 ","$5,605.48 ","$0.00 ","$1,096.57 ","$0.00 ","$1,115.49 ","$0.00 "
"68470090","SUP","HCPCS C1713","","68470090  -  PLATE 90MM STR CENTAUR BONE SPNL","BOTH IP/OP","$7,465.13 ","$5,524.20 ","$0.00 ","$7,465.13 ","$3,359.31 ","$0.00 ","$1,555.92 ","$0.00 ","$0.00 ","$1,307.08 ","$7,465.13 ","$0.00 ","$3,732.56 ","$5,912.38 ","$5,972.10 ","$0.00 ","$1,168.29 ","$0.00 ","$1,188.45 ","$0.00 "
"68480060","SUP","HCPCS C1713","","68480060  -  PLATE 60MM LRDTC CENTAUR BONE SPNL","BOTH IP/OP","$4,953.53 ","$3,665.61 ","$0.00 ","$4,953.53 ","$2,229.09 ","$0.00 ","$1,032.44 ","$0.00 ","$0.00 ","$867.32 ","$4,953.53 ","$0.00 ","$2,476.76 ","$3,923.20 ","$3,962.82 ","$0.00 ","$775.23 ","$0.00 ","$788.60 ","$0.00 "
"68480070","SUP","HCPCS C1713","","68480070  -  PLATE 70MM LRDTC CENTAUR BONE SPNL","BOTH IP/OP","$5,166.98 ","$3,823.57 ","$0.00 ","$5,166.98 ","$2,325.14 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,166.98 ","$0.00 ","$2,583.49 ","$4,092.25 ","$4,133.58 ","$0.00 ","$808.63 ","$0.00 ","$822.58 ","$0.00 "
"68480080","SUP","HCPCS C1713","","68480080  -  PLATE 80MM LRDTC CENTAUR BONE SPNL","BOTH IP/OP","$5,366.88 ","$3,971.49 ","$0.00 ","$5,366.88 ","$2,415.09 ","$0.00 ","$1,118.59 ","$0.00 ","$0.00 ","$939.70 ","$5,366.88 ","$0.00 ","$2,683.44 ","$4,250.57 ","$4,293.50 ","$0.00 ","$839.92 ","$0.00 ","$854.41 ","$0.00 "
"68480090","SUP","HCPCS C1713","","68480090  -  PLATE 90MM LRDTC CENTAUR BONE SPNL","BOTH IP/OP","$5,366.88 ","$3,971.49 ","$0.00 ","$5,366.88 ","$2,415.09 ","$0.00 ","$1,118.59 ","$0.00 ","$0.00 ","$939.70 ","$5,366.88 ","$0.00 ","$2,683.44 ","$4,250.57 ","$4,293.50 ","$0.00 ","$839.92 ","$0.00 ","$854.41 ","$0.00 "
"68490050","SUP","HCPCS C1713","","68490050  -  PLATE 50MM KYPHOTIC CENTAUR BONE SPNL","BOTH IP/OP","$6,818.15 ","$5,045.43 ","$0.00 ","$6,818.15 ","$3,068.17 ","$0.00 ","$1,421.07 ","$0.00 ","$0.00 ","$1,193.80 ","$6,818.15 ","$0.00 ","$3,409.08 ","$5,399.97 ","$5,454.52 ","$0.00 ","$1,067.04 ","$0.00 ","$1,085.45 ","$0.00 "
"68490060","SUP","HCPCS C1713","","68490060  -  PLATE 60MM KYPHOTIC CENTAUR BONE SPNL","BOTH IP/OP","$7,112.45 ","$5,263.21 ","$0.00 ","$7,112.45 ","$3,200.60 ","$0.00 ","$1,482.41 ","$0.00 ","$0.00 ","$1,245.33 ","$7,112.45 ","$0.00 ","$3,556.23 ","$5,633.06 ","$5,689.96 ","$0.00 ","$1,113.10 ","$0.00 ","$1,132.30 ","$0.00 "
"68490070","SUP","HCPCS C1713","","68490070  -  PLATE 70MM KYPHOTIC CENTAUR BONE SPNL","BOTH IP/OP","$7,395.48 ","$5,472.66 ","$0.00 ","$7,395.48 ","$3,327.96 ","$0.00 ","$1,541.40 ","$0.00 ","$0.00 ","$1,294.89 ","$7,395.48 ","$0.00 ","$3,697.74 ","$5,857.22 ","$5,916.38 ","$0.00 ","$1,157.39 ","$0.00 ","$1,177.36 ","$0.00 "
"68490080","SUP","HCPCS C1713","","68490080  -  PLATE 80MM KYPHOTIC CENTAUR BONE SPNL","BOTH IP/OP","$7,831.35 ","$5,795.20 ","$0.00 ","$7,831.35 ","$3,524.11 ","$0.00 ","$1,632.25 ","$0.00 ","$0.00 ","$1,371.21 ","$7,831.35 ","$0.00 ","$3,915.68 ","$6,202.43 ","$6,265.08 ","$0.00 ","$1,225.61 ","$0.00 ","$1,246.75 ","$0.00 "
"68490090","SUP","HCPCS C1713","","68490090  -  PLATE 90MM KYPHOTIC CENTAUR BONE SPNL","BOTH IP/OP","$8,386.20 ","$6,205.79 ","$0.00 ","$8,386.20 ","$3,773.79 ","$0.00 ","$1,747.89 ","$0.00 ","$0.00 ","$1,468.36 ","$8,386.20 ","$0.00 ","$4,193.10 ","$6,641.87 ","$6,708.96 ","$0.00 ","$1,312.44 ","$0.00 ","$1,335.08 ","$0.00 "
"70000267","SUP","HCPCS C1894","","612606 - INTRODUCER SHTH 9FR 16CM TRAW ADPR DILAT SET INDN SPNLK .035","BOTH IP/OP","$67.10 ","$49.65 ","$0.00 ","$67.10 ","$36.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.75 ","$67.10 ","$0.00 ","$33.55 ","$53.14 ","$53.68 ","$0.00 ","$10.50 ","$0.00 ","$10.68 ","$0.00 "
"70035009","SUP","Custom 27203010","","70035009  -  STOPCOCK ANGIO 400 PSI NAMIC 3W ROT ADPR RT PORT","BOTH IP/OP","$2.80 ","$2.07 ","$0.00 ","$2.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.80 ","$0.00 ","$1.40 ","$2.22 ","$2.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70055017","SUP","Custom 27203010","","70055017  -  STOPCOCK ANGIO 1050 PSI NAMIC 1 WY FX M LL","BOTH IP/OP","$161.28 ","$119.35 ","$0.00 ","$161.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.28 ","$0.00 ","$80.64 ","$127.73 ","$129.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70245550","SUP","HCPCS C1713","","70245550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70245560","SUP","HCPCS C1713","","70245560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70260500","SUP","HCPCS C1713","","70260500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70260511","SUP","HCPCS C1713","","70260511  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70260580","SUP","HCPCS C1713","","70260580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70260590","SUP","HCPCS C1713","","70260590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265530","SUP","HCPCS C1713","","70265530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265535","SUP","HCPCS C1713","","70265535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265540","SUP","HCPCS C1713","","70265540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265545","SUP","HCPCS C1713","","70265545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265550","SUP","HCPCS C1713","","70265550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265555","SUP","HCPCS C1713","","70265555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70265560","SUP","HCPCS C1713","","70265560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266535","SUP","HCPCS C1713","","70266535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266540","SUP","HCPCS C1713","","70266540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266545","SUP","HCPCS C1713","","70266545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266550","SUP","HCPCS C1713","","70266550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266555","SUP","HCPCS C1713","","70266555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266560","SUP","HCPCS C1713","","70266560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70266570","SUP","HCPCS C1713","","70266570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267500","SUP","HCPCS C1713","","70267500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267540","SUP","HCPCS C1713","","70267540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267545","SUP","HCPCS C1713","","70267545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267550","SUP","HCPCS C1713","","70267550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267555","SUP","HCPCS C1713","","70267555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267560","SUP","HCPCS C1713","","70267560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267570","SUP","HCPCS C1713","","70267570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267580","SUP","HCPCS C1713","","70267580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70267590","SUP","HCPCS C1713","","70267590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268500","SUP","HCPCS C1713","","70268500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268540","SUP","HCPCS C1713","","70268540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268545","SUP","HCPCS C1713","","70268545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268550","SUP","HCPCS C1713","","70268550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268555","SUP","HCPCS C1713","","70268555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268560","SUP","HCPCS C1713","","70268560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268570","SUP","HCPCS C1713","","70268570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268580","SUP","HCPCS C1713","","70268580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70268590","SUP","HCPCS C1713","","70268590  -  SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70269500","SUP","HCPCS C1713","","70269500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70269511","SUP","HCPCS C1713","","70269511  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70269580","SUP","HCPCS C1713","","70269580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70269590","SUP","HCPCS C1713","","70269590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"70460500","SUP","HCPCS C1713","","70460500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70460511","SUP","HCPCS C1713","","70460511  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70460580","SUP","HCPCS C1713","","70460580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70460590","SUP","HCPCS C1713","","70460590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465530","SUP","HCPCS C1713","","70465530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465535","SUP","HCPCS C1713","","70465535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465540","SUP","HCPCS C1713","","70465540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465545","SUP","HCPCS C1713","","70465545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465550","SUP","HCPCS C1713","","70465550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465555","SUP","HCPCS C1713","","70465555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70465560","SUP","HCPCS C1713","","70465560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466535","SUP","HCPCS C1713","","70466535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466540","SUP","HCPCS C1713","","70466540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466545","SUP","HCPCS C1713","","70466545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466550","SUP","HCPCS C1713","","70466550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466555","SUP","HCPCS C1713","","70466555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466560","SUP","HCPCS C1713","","70466560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70466570","SUP","HCPCS C1713","","70466570  -  SCREW BN 6.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467500","SUP","HCPCS C1713","","70467500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467540","SUP","HCPCS C1713","","70467540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467545","SUP","HCPCS C1713","","70467545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467550","SUP","HCPCS C1713","","70467550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467555","SUP","HCPCS C1713","","70467555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467560","SUP","HCPCS C1713","","70467560  -  SCREW BN 7.5MM 60MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467570","SUP","HCPCS C1713","","70467570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467580","SUP","HCPCS C1713","","70467580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70467590","SUP","HCPCS C1713","","70467590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468500","SUP","HCPCS C1713","","70468500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468540","SUP","HCPCS C1713","","70468540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468545","SUP","HCPCS C1713","","70468545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468550","SUP","HCPCS C1713","","70468550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468555","SUP","HCPCS C1713","","70468555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468560","SUP","HCPCS C1713","","70468560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468570","SUP","HCPCS C1713","","70468570  -  SCREW BN 8.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468580","SUP","HCPCS C1713","","70468580  -  SCREW BN 8.5MM 80MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70468590","SUP","HCPCS C1713","","70468590  -  SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70469500","SUP","HCPCS C1713","","70469500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70469511","SUP","HCPCS C1713","","70469511  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70469580","SUP","HCPCS C1713","","70469580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"70469590","SUP","HCPCS C1713","","70469590  -  SCREW BN 9.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE","BOTH IP/OP","$3,091.50 ","$2,287.71 ","$0.00 ","$3,091.50 ","$1,391.18 ","$0.00 ","$644.35 ","$0.00 ","$0.00 ","$541.30 ","$3,091.50 ","$0.00 ","$1,545.75 ","$2,448.47 ","$2,473.20 ","$0.00 ","$483.82 ","$0.00 ","$492.17 ","$0.00 "
"71010705","SUP","HCPCS C1713","","71010705  -  BOLT EXFIX ILZ RSN WIRE","BOTH IP/OP","$147.60 ","$109.22 ","$0.00 ","$147.60 ","$66.42 ","$0.00 ","$30.76 ","$0.00 ","$0.00 ","$25.84 ","$147.60 ","$0.00 ","$73.80 ","$116.90 ","$118.08 ","$0.00 ","$23.10 ","$0.00 ","$23.50 ","$0.00 "
"71011002","SUP","HCPCS C1713","","71011002  -  NUT XTRNFX ILZ QCK CNCT CIRC","BOTH IP/OP","$175.10 ","$129.57 ","$0.00 ","$175.10 ","$78.80 ","$0.00 ","$36.50 ","$0.00 ","$0.00 ","$30.66 ","$175.10 ","$0.00 ","$87.55 ","$138.68 ","$140.08 ","$0.00 ","$27.40 ","$0.00 ","$27.88 ","$0.00 "
"71011550","SUP","HCPCS C1713","","71011550  -  WASHER ORTH 7MM TI","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"71012000","SUP","HCPCS C1713","","71012000  -  WASHER XTRNFX CNCL CPL SM BN FXTR","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$86.40 ","$0.00 ","$40.02 ","$0.00 ","$0.00 ","$33.62 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$30.05 ","$0.00 ","$30.57 ","$0.00 "
"71012005","SUP","HCPCS C1713","","71012005  -  NUT XTRNFX CIRC NYL SM BN FXTR","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$13.37 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$4.65 ","$0.00 ","$4.73 ","$0.00 "
"71012502","SUP","HCPCS C1713","","71012502  -  PIN HLF 5MM 180MM ILZ SS ANKL/FT XTRNFXTR","BOTH IP/OP","$627.30 ","$464.20 ","$0.00 ","$627.30 ","$282.29 ","$0.00 ","$130.75 ","$0.00 ","$0.00 ","$109.84 ","$627.30 ","$0.00 ","$313.65 ","$496.82 ","$501.84 ","$0.00 ","$98.17 ","$0.00 ","$99.87 ","$0.00 "
"71013000","SUP","Custom 27203010","","71013000  -  BOLT XTRNFX LNG ILZ SLOT WRE","BOTH IP/OP","$178.50 ","$132.09 ","$0.00 ","$178.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.50 ","$0.00 ","$89.25 ","$141.37 ","$142.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71013204","SUP","HCPCS C1713","","71013204  -  BOLT EXFIX ILIZAROV","BOTH IP/OP","$148.33 ","$109.76 ","$0.00 ","$148.33 ","$66.75 ","$0.00 ","$30.91 ","$0.00 ","$0.00 ","$25.97 ","$148.33 ","$0.00 ","$74.16 ","$117.48 ","$118.66 ","$0.00 ","$23.21 ","$0.00 ","$23.61 ","$0.00 "
"71021027","SUP","HCPCS C1713","","71021027  -  PIN HLF 6MM 45MM HXFX TI","BOTH IP/OP","$472.60 ","$349.72 ","$0.00 ","$472.60 ","$212.67 ","$0.00 ","$98.50 ","$0.00 ","$0.00 ","$82.75 ","$472.60 ","$0.00 ","$236.30 ","$374.30 ","$378.08 ","$0.00 ","$73.96 ","$0.00 ","$75.24 ","$0.00 "
"71021029","SUP","HCPCS C1713","","71021029  -  PIN HLF 6MM 55MM HXFX TI","BOTH IP/OP","$472.60 ","$349.72 ","$0.00 ","$472.60 ","$212.67 ","$0.00 ","$98.50 ","$0.00 ","$0.00 ","$82.75 ","$472.60 ","$0.00 ","$236.30 ","$374.30 ","$378.08 ","$0.00 ","$73.96 ","$0.00 ","$75.24 ","$0.00 "
"71021031","SUP","HCPCS C1713","","71021031  -  PIN HLF 6MM 65MM HXFX TI ORTH XTRNFX SYS","BOTH IP/OP","$719.10 ","$532.13 ","$0.00 ","$719.10 ","$323.60 ","$0.00 ","$149.88 ","$0.00 ","$0.00 ","$125.91 ","$719.10 ","$0.00 ","$359.55 ","$569.53 ","$575.28 ","$0.00 ","$112.54 ","$0.00 ","$114.48 ","$0.00 "
"71021033","SUP","HCPCS C1713","","71021033  -  PIN HLF 6MM 75MM HXFX TI ORTH XTRNFX SYS","BOTH IP/OP","$719.10 ","$532.13 ","$0.00 ","$719.10 ","$323.60 ","$0.00 ","$149.88 ","$0.00 ","$0.00 ","$125.91 ","$719.10 ","$0.00 ","$359.55 ","$569.53 ","$575.28 ","$0.00 ","$112.54 ","$0.00 ","$114.48 ","$0.00 "
"71021035","SUP","HCPCS C1713","","71021035  -  PIN HLF 6MM 85MM HXFX TI ORTH XTRNFX SYS","BOTH IP/OP","$719.10 ","$532.13 ","$0.00 ","$719.10 ","$323.60 ","$0.00 ","$149.88 ","$0.00 ","$0.00 ","$125.91 ","$719.10 ","$0.00 ","$359.55 ","$569.53 ","$575.28 ","$0.00 ","$112.54 ","$0.00 ","$114.48 ","$0.00 "
"71021072","SUP","HCPCS C1713","","71021072  -  PIN HLF 6MM 20MM HXFX SS ORTH XTRNFX SYS","BOTH IP/OP","$719.10 ","$532.13 ","$0.00 ","$719.10 ","$323.60 ","$0.00 ","$149.88 ","$0.00 ","$0.00 ","$125.91 ","$719.10 ","$0.00 ","$359.55 ","$569.53 ","$575.28 ","$0.00 ","$112.54 ","$0.00 ","$114.48 ","$0.00 "
"71021073","SUP","HCPCS C1713","","71021073  -  PIN HLF 6MM 25MM HXFX SS","BOTH IP/OP","$248.20 ","$183.67 ","$0.00 ","$248.20 ","$111.69 ","$0.00 ","$51.73 ","$0.00 ","$0.00 ","$43.46 ","$248.20 ","$0.00 ","$124.10 ","$196.57 ","$198.56 ","$0.00 ","$38.84 ","$0.00 ","$39.51 ","$0.00 "
"71021074","SUP","HCPCS C1713","","71021074  -  PIN HLF 6MM 30MM HXFX SS","BOTH IP/OP","$496.40 ","$367.34 ","$0.00 ","$496.40 ","$223.38 ","$0.00 ","$103.46 ","$0.00 ","$0.00 ","$86.92 ","$496.40 ","$0.00 ","$248.20 ","$393.15 ","$397.12 ","$0.00 ","$77.69 ","$0.00 ","$79.03 ","$0.00 "
"71021075","SUP","HCPCS C1713","","71021075  -  PIN HLF 6MM 35MM HXFX SS","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$282.20 ","$126.99 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$49.41 ","$282.20 ","$0.00 ","$141.10 ","$223.50 ","$225.76 ","$0.00 ","$44.16 ","$0.00 ","$44.93 ","$0.00 "
"71021077","SUP","HCPCS C1713","","71021077  -  PIN HLF 6MM 45MM HXFX SS ORTH XTRNFX SYS","BOTH IP/OP","$719.10 ","$532.13 ","$0.00 ","$719.10 ","$323.60 ","$0.00 ","$149.88 ","$0.00 ","$0.00 ","$125.91 ","$719.10 ","$0.00 ","$359.55 ","$569.53 ","$575.28 ","$0.00 ","$112.54 ","$0.00 ","$114.48 ","$0.00 "
"71021079","SUP","HCPCS C1713","","71021079  -  PIN HLF 6MM 55MM HXFX SS","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$282.20 ","$126.99 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$49.41 ","$282.20 ","$0.00 ","$141.10 ","$223.50 ","$225.76 ","$0.00 ","$44.16 ","$0.00 ","$44.93 ","$0.00 "
"71021081","SUP","HCPCS C1713","","71021081  -  PIN HLF 6MM 65MM HXFX SS ORTH XTRNFX SYS","BOTH IP/OP","$409.70 ","$303.18 ","$0.00 ","$409.70 ","$184.37 ","$0.00 ","$85.39 ","$0.00 ","$0.00 ","$71.74 ","$409.70 ","$0.00 ","$204.85 ","$324.48 ","$327.76 ","$0.00 ","$64.12 ","$0.00 ","$65.22 ","$0.00 "
"71021083","SUP","HCPCS C1713","","71021083  -  PIN HLF 6MM 75MM HXFX SS ORTH XTRNFX SYS","BOTH IP/OP","$409.70 ","$303.18 ","$0.00 ","$409.70 ","$184.37 ","$0.00 ","$85.39 ","$0.00 ","$0.00 ","$71.74 ","$409.70 ","$0.00 ","$204.85 ","$324.48 ","$327.76 ","$0.00 ","$64.12 ","$0.00 ","$65.22 ","$0.00 "
"71021085","SUP","HCPCS C1713","","71021085  -  PIN HLF 6MM 85MM HXFX SS ORTH XTRNFX SYS","BOTH IP/OP","$409.70 ","$303.18 ","$0.00 ","$409.70 ","$184.37 ","$0.00 ","$85.39 ","$0.00 ","$0.00 ","$71.74 ","$409.70 ","$0.00 ","$204.85 ","$324.48 ","$327.76 ","$0.00 ","$64.12 ","$0.00 ","$65.22 ","$0.00 "
"71022001","SUP","HCPCS C1713","","71022001  -  PIN FX 3MM 120MM 16MM COVE PNT ORTH","BOTH IP/OP","$533.80 ","$395.01 ","$0.00 ","$533.80 ","$240.21 ","$0.00 ","$111.26 ","$0.00 ","$0.00 ","$93.46 ","$533.80 ","$0.00 ","$266.90 ","$422.77 ","$427.04 ","$0.00 ","$83.54 ","$0.00 ","$84.98 ","$0.00 "
"71022002","SUP","HCPCS C1713","","71022002  -  PIN FX 3MM 120MM 22MM COVE PNT ORTH","BOTH IP/OP","$533.80 ","$395.01 ","$0.00 ","$533.80 ","$240.21 ","$0.00 ","$111.26 ","$0.00 ","$0.00 ","$93.46 ","$533.80 ","$0.00 ","$266.90 ","$422.77 ","$427.04 ","$0.00 ","$83.54 ","$0.00 ","$84.98 ","$0.00 "
"71022003","SUP","HCPCS C1713","","71022003  -  PIN HLF 3MM 28MM 28MM COVE PNT DIST RADL","BOTH IP/OP","$533.80 ","$395.01 ","$0.00 ","$533.80 ","$240.21 ","$0.00 ","$111.26 ","$0.00 ","$0.00 ","$93.46 ","$533.80 ","$0.00 ","$266.90 ","$422.77 ","$427.04 ","$0.00 ","$83.54 ","$0.00 ","$84.98 ","$0.00 "
"71031033","SUP","HCPCS C1713","","71031033  -  POSITIONER SRG 5MM HXFX CENTERING SLV PIN","BOTH IP/OP","$691.90 ","$512.01 ","$0.00 ","$691.90 ","$311.36 ","$0.00 ","$144.21 ","$0.00 ","$0.00 ","$121.15 ","$691.90 ","$0.00 ","$345.95 ","$547.98 ","$553.52 ","$0.00 ","$108.28 ","$0.00 ","$110.15 ","$0.00 "
"71031034","SUP","HCPCS C1713","","71031034  -  POSITIONER SRG 6MM HXFX CENTERING SLV PIN","BOTH IP/OP","$691.90 ","$512.01 ","$0.00 ","$691.90 ","$311.36 ","$0.00 ","$144.21 ","$0.00 ","$0.00 ","$121.15 ","$691.90 ","$0.00 ","$345.95 ","$547.98 ","$553.52 ","$0.00 ","$108.28 ","$0.00 ","$110.15 ","$0.00 "
"71031040","SUP","Custom 27203010","","71031040  -  GUIDE HXFX TROCAR SURG","BOTH IP/OP","$5,262.50 ","$3,894.25 ","$0.00 ","$5,262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,262.50 ","$0.00 ","$2,631.25 ","$4,167.90 ","$4,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71033019","SUP","Custom 27203010","","71033019  -  BIT DRL 2MM DIST RDS SYS","BOTH IP/OP","$914.60 ","$676.80 ","$0.00 ","$914.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$914.60 ","$0.00 ","$457.30 ","$724.36 ","$731.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71053002","SUP","Custom 27203010","","71053002  -  BIT DRL 2.8MM","BOTH IP/OP","$1,106.70 ","$818.96 ","$0.00 ","$1,106.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,106.70 ","$0.00 ","$553.35 ","$876.51 ","$885.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71053004","SUP","Custom 27203010","","71053004  -  BIT DRL 4.8MM","BOTH IP/OP","$1,106.70 ","$818.96 ","$0.00 ","$1,106.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,106.70 ","$0.00 ","$553.35 ","$876.51 ","$885.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71053033","SUP","HCPCS C1713","","71053033  -  WASHER XTRNFX 8MM CNTR BD LCK BOLT","BOTH IP/OP","$265.20 ","$196.25 ","$0.00 ","$265.20 ","$119.34 ","$0.00 ","$55.27 ","$0.00 ","$0.00 ","$46.43 ","$265.20 ","$0.00 ","$132.60 ","$210.04 ","$212.16 ","$0.00 ","$41.50 ","$0.00 ","$42.22 ","$0.00 "
"71053101","SUP","HCPCS C1713","","71053101  -  PIN HLF 3MM 10MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$218.75 ","$161.88 ","$0.00 ","$218.75 ","$98.44 ","$0.00 ","$45.59 ","$0.00 ","$0.00 ","$38.30 ","$218.75 ","$0.00 ","$109.38 ","$173.25 ","$175.00 ","$0.00 ","$34.23 ","$0.00 ","$34.83 ","$0.00 "
"71053151","SUP","HCPCS C1713","","71053151  -  PIN HLF 3MM 15MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$218.75 ","$161.88 ","$0.00 ","$218.75 ","$98.44 ","$0.00 ","$45.59 ","$0.00 ","$0.00 ","$38.30 ","$218.75 ","$0.00 ","$109.38 ","$173.25 ","$175.00 ","$0.00 ","$34.23 ","$0.00 ","$34.83 ","$0.00 "
"71053201","SUP","HCPCS C1713","","71053201  -  PIN HLF 3MM 20MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$218.75 ","$161.88 ","$0.00 ","$218.75 ","$98.44 ","$0.00 ","$45.59 ","$0.00 ","$0.00 ","$38.30 ","$218.75 ","$0.00 ","$109.38 ","$173.25 ","$175.00 ","$0.00 ","$34.23 ","$0.00 ","$34.83 ","$0.00 "
"71053251","SUP","HCPCS C1713","","71053251  -  PIN HLF 3MM 25MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$218.75 ","$161.88 ","$0.00 ","$218.75 ","$98.44 ","$0.00 ","$45.59 ","$0.00 ","$0.00 ","$38.30 ","$218.75 ","$0.00 ","$109.38 ","$173.25 ","$175.00 ","$0.00 ","$34.23 ","$0.00 ","$34.83 ","$0.00 "
"71054151","SUP","HCPCS C1713","","71054151  -  PIN HLF 4MM 15MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$231.88 ","$171.59 ","$0.00 ","$231.88 ","$104.34 ","$0.00 ","$48.33 ","$0.00 ","$0.00 ","$40.60 ","$231.88 ","$0.00 ","$115.94 ","$183.65 ","$185.50 ","$0.00 ","$36.29 ","$0.00 ","$36.91 ","$0.00 "
"71054201","SUP","HCPCS C1713","","71054201  -  PIN HLF 4MM 20MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$231.88 ","$171.59 ","$0.00 ","$231.88 ","$104.34 ","$0.00 ","$48.33 ","$0.00 ","$0.00 ","$40.60 ","$231.88 ","$0.00 ","$115.94 ","$183.65 ","$185.50 ","$0.00 ","$36.29 ","$0.00 ","$36.91 ","$0.00 "
"71054251","SUP","HCPCS C1713","","71054251  -  PIN HLF 4MM 25MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$231.88 ","$171.59 ","$0.00 ","$231.88 ","$104.34 ","$0.00 ","$48.33 ","$0.00 ","$0.00 ","$40.60 ","$231.88 ","$0.00 ","$115.94 ","$183.65 ","$185.50 ","$0.00 ","$36.29 ","$0.00 ","$36.91 ","$0.00 "
"71054301","SUP","HCPCS C1713","","71054301  -  PIN HLF 4MM 30MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$231.88 ","$171.59 ","$0.00 ","$231.88 ","$104.34 ","$0.00 ","$48.33 ","$0.00 ","$0.00 ","$40.60 ","$231.88 ","$0.00 ","$115.94 ","$183.65 ","$185.50 ","$0.00 ","$36.29 ","$0.00 ","$36.91 ","$0.00 "
"71054351","SUP","HCPCS C1713","","71054351  -  PIN HLF 4MM 35MM JTX TI ORTH XTRNFX SYS","BOTH IP/OP","$231.88 ","$171.59 ","$0.00 ","$231.88 ","$104.34 ","$0.00 ","$48.33 ","$0.00 ","$0.00 ","$40.60 ","$231.88 ","$0.00 ","$115.94 ","$183.65 ","$185.50 ","$0.00 ","$36.29 ","$0.00 ","$36.91 ","$0.00 "
"71055020","SUP","HCPCS C1713","","71055020  -  PIN HLF 5MM 20MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$121.13 ","$89.64 ","$0.00 ","$121.13 ","$54.51 ","$0.00 ","$25.25 ","$0.00 ","$0.00 ","$21.21 ","$121.13 ","$0.00 ","$60.56 ","$95.93 ","$96.90 ","$0.00 ","$18.96 ","$0.00 ","$19.28 ","$0.00 "
"71055201","SUP","HCPCS C1713","","71055201  -  PIN HLF SHRT 5MM 20MM JTX TI NTRD","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055251","SUP","HCPCS C1713","","71055251  -  PIN HLF SHRT 5MM 25MM JTX TI NTRD","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055301","SUP","HCPCS C1713","","71055301  -  PIN HLF SHRT 5MM 30MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055351","SUP","HCPCS C1713","","71055351  -  PIN HLF SHRT 5MM 35MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055401","SUP","HCPCS C1713","","71055401  -  PIN HLF SHRT 5MM 40MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055451","SUP","HCPCS C1713","","71055451  -  PIN HLF SHRT 5MM 45MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055501","SUP","HCPCS C1713","","71055501  -  PIN HLF SHRT 5MM 50MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055502","SUP","HCPCS C1713","","71055502  -  PIN HLF LNG 5MM 50MM TI","BOTH IP/OP","$234.50 ","$173.53 ","$0.00 ","$234.50 ","$105.53 ","$0.00 ","$48.88 ","$0.00 ","$0.00 ","$41.06 ","$234.50 ","$0.00 ","$117.25 ","$185.72 ","$187.60 ","$0.00 ","$36.70 ","$0.00 ","$37.33 ","$0.00 "
"71055503","SUP","HCPCS C1713","","71055503  -  PIN HLF 5MM 50MM STRL TI","BOTH IP/OP","$718.38 ","$531.60 ","$0.00 ","$718.38 ","$323.27 ","$0.00 ","$149.73 ","$0.00 ","$0.00 ","$125.78 ","$718.38 ","$0.00 ","$359.19 ","$568.96 ","$574.70 ","$0.00 ","$112.43 ","$0.00 ","$114.37 ","$0.00 "
"71055551","SUP","HCPCS C1713","","71055551  -  PIN HLF SHRT 5MM 55MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055552","SUP","HCPCS C1713","","71055552  -  PIN HLF LNG 5MM 55MM TI","BOTH IP/OP","$234.50 ","$173.53 ","$0.00 ","$234.50 ","$105.53 ","$0.00 ","$48.88 ","$0.00 ","$0.00 ","$41.06 ","$234.50 ","$0.00 ","$117.25 ","$185.72 ","$187.60 ","$0.00 ","$36.70 ","$0.00 ","$37.33 ","$0.00 "
"71055601","SUP","HCPCS C1713","","71055601  -  PIN HLF SHRT 5MM 60MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055602","SUP","HCPCS C1713","","71055602  -  PIN HLF LNG 5MM 60MM TI","BOTH IP/OP","$234.50 ","$173.53 ","$0.00 ","$234.50 ","$105.53 ","$0.00 ","$48.88 ","$0.00 ","$0.00 ","$41.06 ","$234.50 ","$0.00 ","$117.25 ","$185.72 ","$187.60 ","$0.00 ","$36.70 ","$0.00 ","$37.33 ","$0.00 "
"71055651","SUP","HCPCS C1713","","71055651  -  PIN HLF SHRT 5MM 65MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055701","SUP","HCPCS C1713","","71055701  -  PIN HLF SHRT 5MM 70MM TI","BOTH IP/OP","$253.75 ","$187.78 ","$0.00 ","$253.75 ","$114.19 ","$0.00 ","$52.89 ","$0.00 ","$0.00 ","$44.43 ","$253.75 ","$0.00 ","$126.88 ","$200.97 ","$203.00 ","$0.00 ","$39.71 ","$0.00 ","$40.40 ","$0.00 "
"71055702","SUP","HCPCS C1713","","71055702  -  PIN HLF LNG 5MM 70MM TI","BOTH IP/OP","$234.50 ","$173.53 ","$0.00 ","$234.50 ","$105.53 ","$0.00 ","$48.88 ","$0.00 ","$0.00 ","$41.06 ","$234.50 ","$0.00 ","$117.25 ","$185.72 ","$187.60 ","$0.00 ","$36.70 ","$0.00 ","$37.33 ","$0.00 "
"71056208","SUP","HCPCS C1713","","71056208  -  PIN HLF SHRT 6MM 20MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056209","SUP","HCPCS C1713","","71056209  -  PIN HLF LNG 20MM JTX TI ORTH","BOTH IP/OP","$248.50 ","$183.89 ","$0.00 ","$248.50 ","$111.83 ","$0.00 ","$51.79 ","$0.00 ","$0.00 ","$43.51 ","$248.50 ","$0.00 ","$124.25 ","$196.81 ","$198.80 ","$0.00 ","$38.89 ","$0.00 ","$39.56 ","$0.00 "
"71056258","SUP","HCPCS C1713","","71056258  -  PIN HLF SHRT 6MM 25MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056308","SUP","HCPCS C1713","","71056308  -  PIN HLF SHRT 6MM 30MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056309","SUP","HCPCS C1713","","71056309  -  PIN HLF LNG 30MM JTX TI ORTH","BOTH IP/OP","$248.50 ","$183.89 ","$0.00 ","$248.50 ","$111.83 ","$0.00 ","$51.79 ","$0.00 ","$0.00 ","$43.51 ","$248.50 ","$0.00 ","$124.25 ","$196.81 ","$198.80 ","$0.00 ","$38.89 ","$0.00 ","$39.56 ","$0.00 "
"71056358","SUP","HCPCS C1713","","71056358  -  PIN HLF SHRT 6MM 35MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056408","SUP","HCPCS C1713","","71056408  -  PIN HLF SHRT 6MM 40MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056409","SUP","HCPCS C1713","","71056409  -  PIN HLF LNG 40MM JTX TI ORTH","BOTH IP/OP","$248.50 ","$183.89 ","$0.00 ","$248.50 ","$111.83 ","$0.00 ","$51.79 ","$0.00 ","$0.00 ","$43.51 ","$248.50 ","$0.00 ","$124.25 ","$196.81 ","$198.80 ","$0.00 ","$38.89 ","$0.00 ","$39.56 ","$0.00 "
"71056458","SUP","HCPCS C1713","","71056458  -  PIN HLF SHRT 6MM 45MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056459","SUP","HCPCS C1713","","71056459  -  PIN HLF LNG 45MM JTX TI ORTH","BOTH IP/OP","$248.50 ","$183.89 ","$0.00 ","$248.50 ","$111.83 ","$0.00 ","$51.79 ","$0.00 ","$0.00 ","$43.51 ","$248.50 ","$0.00 ","$124.25 ","$196.81 ","$198.80 ","$0.00 ","$38.89 ","$0.00 ","$39.56 ","$0.00 "
"71056508","SUP","HCPCS C1713","","71056508  -  PIN HLF SHRT 6MM 50MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056509","SUP","HCPCS C1713","","71056509  -  PIN HLF LNG 50MM JTX TI ORTH","BOTH IP/OP","$260.75 ","$192.96 ","$0.00 ","$260.75 ","$117.34 ","$0.00 ","$54.35 ","$0.00 ","$0.00 ","$45.66 ","$260.75 ","$0.00 ","$130.38 ","$206.51 ","$208.60 ","$0.00 ","$40.81 ","$0.00 ","$41.51 ","$0.00 "
"71056558","SUP","HCPCS C1713","","71056558  -  PIN HLF SHRT 6MM 55MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056608","SUP","HCPCS C1713","","71056608  -  PIN HLF SHRT 6MM 60MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056609","SUP","HCPCS C1713","","71056609  -  PIN HLF 60MM JTX TI ORTH","BOTH IP/OP","$260.75 ","$192.96 ","$0.00 ","$260.75 ","$117.34 ","$0.00 ","$54.35 ","$0.00 ","$0.00 ","$45.66 ","$260.75 ","$0.00 ","$130.38 ","$206.51 ","$208.60 ","$0.00 ","$40.81 ","$0.00 ","$41.51 ","$0.00 "
"71056658","SUP","HCPCS C1713","","71056658  -  PIN HLF SHRT 6MM 65MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056708","SUP","HCPCS C1713","","71056708  -  PIN HLF SHRT 6MM 70MM JTX TI NTRD","BOTH IP/OP","$259.00 ","$191.66 ","$0.00 ","$259.00 ","$116.55 ","$0.00 ","$53.98 ","$0.00 ","$0.00 ","$45.35 ","$259.00 ","$0.00 ","$129.50 ","$205.13 ","$207.20 ","$0.00 ","$40.53 ","$0.00 ","$41.23 ","$0.00 "
"71056709","SUP","HCPCS C1713","","71056709  -  PIN HLF LNG 60MM JTX TI ORTH","BOTH IP/OP","$260.75 ","$192.96 ","$0.00 ","$260.75 ","$117.34 ","$0.00 ","$54.35 ","$0.00 ","$0.00 ","$45.66 ","$260.75 ","$0.00 ","$130.38 ","$206.51 ","$208.60 ","$0.00 ","$40.81 ","$0.00 ","$41.51 ","$0.00 "
"71061001","SUP","HCPCS C1713","","71061001  -  PIN FX 3.2MM 86MM TROC PNT 1 END ORTH","BOTH IP/OP","$494.00 ","$365.56 ","$0.00 ","$494.00 ","$222.30 ","$0.00 ","$102.96 ","$0.00 ","$0.00 ","$86.50 ","$494.00 ","$0.00 ","$247.00 ","$391.25 ","$395.20 ","$0.00 ","$77.31 ","$0.00 ","$78.64 ","$0.00 "
"71062007","SUP","HCPCS C1713","","71062007  -  CAP PCTV 5MM","BOTH IP/OP","$60.30 ","$44.62 ","$0.00 ","$60.30 ","$27.14 ","$0.00 ","$12.57 ","$0.00 ","$0.00 ","$10.56 ","$60.30 ","$0.00 ","$30.15 ","$47.76 ","$48.24 ","$0.00 ","$9.44 ","$0.00 ","$9.60 ","$0.00 "
"71062008","SUP","HCPCS C1713","","71062008  -  BAR XTRNFX JTX CAP","BOTH IP/OP","$69.10 ","$51.13 ","$0.00 ","$69.10 ","$31.10 ","$0.00 ","$14.40 ","$0.00 ","$0.00 ","$12.10 ","$69.10 ","$0.00 ","$34.55 ","$54.73 ","$55.28 ","$0.00 ","$10.81 ","$0.00 ","$11.00 ","$0.00 "
"71062017","SUP","HCPCS C1713","","71062017  -  CAP END 4MM JTX PIN ORTH XTRNFX SYS","BOTH IP/OP","$115.50 ","$85.47 ","$0.00 ","$115.50 ","$51.98 ","$0.00 ","$24.07 ","$0.00 ","$0.00 ","$20.22 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$18.08 ","$0.00 ","$18.39 ","$0.00 "
"71062200","SUP","HCPCS C1713","","71062200  -  BAR XTRNFX 200MM NS JTX CFBR DISP","BOTH IP/OP","$400.75 ","$296.56 ","$0.00 ","$400.75 ","$180.34 ","$0.00 ","$83.53 ","$0.00 ","$0.00 ","$70.17 ","$400.75 ","$0.00 ","$200.38 ","$317.39 ","$320.60 ","$0.00 ","$62.72 ","$0.00 ","$63.80 ","$0.00 "
"71062250","SUP","Custom 27203010","","71062250  -  BAR XTRNFX 250MM NS JTX CFBR DISP","BOTH IP/OP","$430.50 ","$318.57 ","$0.00 ","$430.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$430.50 ","$0.00 ","$215.25 ","$340.96 ","$344.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71062300","SUP","HCPCS C1713","","71062300  -  BAR XTRNFX 300MM NS JTX CFBR DISP","BOTH IP/OP","$430.50 ","$318.57 ","$0.00 ","$430.50 ","$193.73 ","$0.00 ","$89.73 ","$0.00 ","$0.00 ","$75.38 ","$430.50 ","$0.00 ","$215.25 ","$340.96 ","$344.40 ","$0.00 ","$67.37 ","$0.00 ","$68.54 ","$0.00 "
"71062350","SUP","HCPCS C1713","","71062350  -  BAR XTRNFX 350MM NS JTX CFBR DISP","BOTH IP/OP","$430.50 ","$318.57 ","$0.00 ","$430.50 ","$193.73 ","$0.00 ","$89.73 ","$0.00 ","$0.00 ","$75.38 ","$430.50 ","$0.00 ","$215.25 ","$340.96 ","$344.40 ","$0.00 ","$67.37 ","$0.00 ","$68.54 ","$0.00 "
"71062400","SUP","HCPCS C1713","","71062400  -  BAR XTRNFX 400MM NS JTX CFBR DISP","BOTH IP/OP","$474.25 ","$350.95 ","$0.00 ","$474.25 ","$213.41 ","$0.00 ","$98.85 ","$0.00 ","$0.00 ","$83.04 ","$474.25 ","$0.00 ","$237.13 ","$375.61 ","$379.40 ","$0.00 ","$74.22 ","$0.00 ","$75.50 ","$0.00 "
"71063006","SUP","Custom 27203010","","71063006  -  BIT DRL 3.5MM STRL JTX AO CNCT","BOTH IP/OP","$470.75 ","$348.36 ","$0.00 ","$470.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.75 ","$0.00 ","$235.38 ","$372.83 ","$376.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71063011","SUP","HCPCS C1769","","71063011  -  GUIDEWIRE ESCP 1.6MM","BOTH IP/OP","$1,876.88 ","$1,388.89 ","$0.00 ","$1,876.88 ","$1,019.14 ","$0.00 ","$391.19 ","$0.00 ","$0.00 ","$328.63 ","$1,876.88 ","$0.00 ","$938.44 ","$1,486.49 ","$1,501.50 ","$0.00 ","$293.73 ","$0.00 ","$298.80 ","$0.00 "
"71063028","SUP","Custom 27203010","","71063028  -  BIT DRL 3.5MM STRL JTX GRAD STP SHRT HLF PIN","BOTH IP/OP","$413.88 ","$306.27 ","$0.00 ","$413.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$413.88 ","$0.00 ","$206.94 ","$327.79 ","$331.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71063152","SUP","HCPCS C1713","","71063152  -  PIN XTRNFX SHRT 3MM 15MM JTX TI NTRD DIST RDS XTRNFX SYS","BOTH IP/OP","$317.63 ","$235.05 ","$0.00 ","$317.63 ","$142.93 ","$0.00 ","$66.20 ","$0.00 ","$0.00 ","$55.61 ","$317.63 ","$0.00 ","$158.81 ","$251.56 ","$254.10 ","$0.00 ","$49.71 ","$0.00 ","$50.57 ","$0.00 "
"71063202","SUP","HCPCS C1713","","71063202  -  PIN XTRNFX SHRT 3MM 20MM JTX TI NTRD DIST RDS XTRNFX SYS","BOTH IP/OP","$317.63 ","$235.05 ","$0.00 ","$317.63 ","$142.93 ","$0.00 ","$66.20 ","$0.00 ","$0.00 ","$55.61 ","$317.63 ","$0.00 ","$158.81 ","$251.56 ","$254.10 ","$0.00 ","$49.71 ","$0.00 ","$50.57 ","$0.00 "
"71063203","SUP","Custom 27203010","","71063203  -  BIT DRL SHRT 3MM STRL GRAD HLF PIN","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71064151","SUP","HCPCS C1713","","71064151  -  PIN HLF 4MM 95MM 15MM JTX SS DIST RDS FT XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064158","SUP","HCPCS C1713","","71064158  -  PIN HLF SHRT 4MM 15MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064201","SUP","HCPCS C1713","","71064201  -  PIN HLF 4MM 20MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064208","SUP","HCPCS C1713","","71064208  -  PIN HLF SHRT 4MM 20MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064251","SUP","HCPCS C1713","","71064251  -  PIN HLF 4MM 25MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064258","SUP","HCPCS C1713","","71064258  -  PIN HLF SHRT 4MM 25MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064301","SUP","HCPCS C1713","","71064301  -  PIN HLF SHRT 4MM 30MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064308","SUP","HCPCS C1713","","71064308  -  PIN HALF SHORT 4MM 30MM JET-X TITANIUM NITRIDE ORTHOPEDIC","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064351","SUP","HCPCS C1713","","71064351  -  PIN HLF 4MM 35MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71064358","SUP","HCPCS C1713","","71064358  -  PIN HLF SHRT 4MM 35MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$219.63 ","$162.53 ","$0.00 ","$219.63 ","$98.83 ","$0.00 ","$45.78 ","$0.00 ","$0.00 ","$38.45 ","$219.63 ","$0.00 ","$109.81 ","$173.95 ","$175.70 ","$0.00 ","$34.37 ","$0.00 ","$34.96 ","$0.00 "
"71065301","SUP","HCPCS C1713","","71065301  -  PIN HLF 5MM 17.5CM 30MM JTX SS XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065302","SUP","HCPCS C1713","","71065302  -  PIN HLF LNG 5MM 255MM 30MM JTX SS XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065304","SUP","HCPCS C1713","","71065304  -  PIN HLF XSH 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065309","SUP","HCPCS C1713","","71065309  -  PIN HLF LNG 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065351","SUP","HCPCS C1713","","71065351  -  PIN HLF 5MM 17.5CM 35MM JTX SS XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065352","SUP","HCPCS C1713","","71065352  -  PIN HLF LNG 5MM 255MM 35MM JTX SS XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065354","SUP","HCPCS C1713","","71065354  -  PIN HLF XSH 5MM 35MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065358","SUP","HCPCS C1713","","71065358  -  PIN HLF SHRT 5MM 35MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065359","SUP","HCPCS C1713","","71065359  -  PIN HLF LNG 5MM 35MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065400","SUP","HCPCS C1713","","71065400  -  PIN HLF 5MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$176.40 ","$0.00 ","$81.70 ","$0.00 ","$0.00 ","$68.64 ","$392.00 ","$0.00 ","$196.00 ","$310.46 ","$313.60 ","$0.00 ","$61.35 ","$0.00 ","$62.41 ","$0.00 "
"71065401","SUP","HCPCS C1713","","71065401  -  PIN HLF 5MM 17.5CM 40MM JTX SS XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065402","SUP","HCPCS C1713","","71065402  -  PIN HLF LNG 5MM 225MM 40MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065404","SUP","HCPCS C1713","","71065404  -  PIN HLF XSH 5MM 40MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065407","SUP","HCPCS C1713","","71065407  -  PIN HLF XSH 1.6MM 40MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$176.40 ","$0.00 ","$81.70 ","$0.00 ","$0.00 ","$68.64 ","$392.00 ","$0.00 ","$196.00 ","$310.46 ","$313.60 ","$0.00 ","$61.35 ","$0.00 ","$62.41 ","$0.00 "
"71065408","SUP","HCPCS C1713","","71065408  -  PIN HLF SHRT 5MM 40MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065409","SUP","HCPCS C1713","","71065409  -  PIN HLF LNG 5MM 40MM JTX TI NTRD XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065451","SUP","HCPCS C1713","","71065451  -  PIN HLF 5MM 17.5CM 45MM JTX SS XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065452","SUP","HCPCS C1713","","71065452  -  PIN HLF LNG 5MM 255MM 45MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065454","SUP","HCPCS C1713","","71065454  -  PIN HLF XSH 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065458","SUP","HCPCS C1713","","71065458  -  PIN HLF SHRT 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065459","SUP","HCPCS C1713","","71065459  -  PIN HLF LNG 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71065501","SUP","HCPCS C1713","","71065501  -  PIN HLF SHRT 5MM 175MM 50MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065502","SUP","HCPCS C1713","","71065502  -  PIN HLF LNG 5MM 255MM 50MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065508","SUP","HCPCS C1713","","71065508  -  PIN HLF SHRT 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065509","SUP","HCPCS C1713","","71065509  -  PIN HLF LNG 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065551","SUP","HCPCS C1713","","71065551  -  PIN HLF SHRT 5MM 175MM 55MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065552","SUP","HCPCS C1713","","71065552  -  PIN HLF LNG 5MM 255MM 55MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065558","SUP","HCPCS C1713","","71065558  -  PIN HLF SHRT 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065559","SUP","HCPCS C1713","","71065559  -  PIN HLF LNG 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065601","SUP","HCPCS C1713","","71065601  -  PIN HLF SHRT 5MM 60MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065602","SUP","HCPCS C1713","","71065602  -  PIN HLF LNG 5MM 60MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065608","SUP","HCPCS C1713","","71065608  -  PIN HLF SHRT 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065609","SUP","HCPCS C1713","","71065609  -  PIN HLF LNG 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065651","SUP","HCPCS C1713","","71065651  -  PIN HLF SHRT 5MM 65MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065652","SUP","HCPCS C1713","","71065652  -  PIN HLF LNG 5MM 65MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065658","SUP","HCPCS C1713","","71065658  -  PIN HLF SHRT 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065659","SUP","HCPCS C1713","","71065659  -  PIN HLF LNG 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$230.13 ","$170.30 ","$0.00 ","$230.13 ","$103.56 ","$0.00 ","$47.96 ","$0.00 ","$0.00 ","$40.29 ","$230.13 ","$0.00 ","$115.06 ","$182.26 ","$184.10 ","$0.00 ","$36.01 ","$0.00 ","$36.64 ","$0.00 "
"71065701","SUP","HCPCS C1713","","71065701  -  PIN HLF SHRT 5MM 70MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065702","SUP","HCPCS C1713","","71065702  -  PIN HLF LNG 5MM 70MM JTX SS ORTH XTRNFX SYS","BOTH IP/OP","$278.25 ","$205.91 ","$0.00 ","$278.25 ","$125.21 ","$0.00 ","$57.99 ","$0.00 ","$0.00 ","$48.72 ","$278.25 ","$0.00 ","$139.13 ","$220.37 ","$222.60 ","$0.00 ","$43.55 ","$0.00 ","$44.30 ","$0.00 "
"71065708","SUP","HCPCS C1713","","71065708  -  PIN HLF SHRT 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71065709","SUP","HCPCS C1713","","71065709  -  PIN HLF LNG 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71066409","SUP","HCPCS C1713","","71066409  -  PIN FX LNG 6MM 40MM NS 160MM JTX SLF DRL ST TI NTRD","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71066459","SUP","HCPCS C1713","","71066459  -  PIN HLF LNG 6MM 45MM JTX TI NTRD","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71066509","SUP","HCPCS C1713","","71066509  -  PIN HALF 50MM 6MM JTX LNG TI NTRD","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"71066559","SUP","HCPCS C1713","","71066559  -  PIN HLF LNG 6MM 55MM JTX TI NTRD","BOTH IP/OP","$233.63 ","$172.89 ","$0.00 ","$233.63 ","$105.13 ","$0.00 ","$48.69 ","$0.00 ","$0.00 ","$40.91 ","$233.63 ","$0.00 ","$116.81 ","$185.03 ","$186.90 ","$0.00 ","$36.56 ","$0.00 ","$37.19 ","$0.00 "
"71067315","SUP","Custom 27203010","","71067315  -  BIT DRL 2MM 3MM HLF PIN","BOTH IP/OP","$569.63 ","$421.53 ","$0.00 ","$569.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.63 ","$0.00 ","$284.81 ","$451.15 ","$455.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71067319","SUP","Custom 27203010","","71067319  -  BIT DRILL LNG 5MM HALF PIN","BOTH IP/OP","$569.63 ","$421.53 ","$0.00 ","$569.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.63 ","$0.00 ","$284.81 ","$451.15 ","$455.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71067321","SUP","Custom 27203010","","71067321  -  BIT DRILL 6 MM HALF PIN","BOTH IP/OP","$569.63 ","$421.53 ","$0.00 ","$569.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.63 ","$0.00 ","$284.81 ","$451.15 ","$455.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71067374","SUP","HCPCS C1713","","71067374  -  CLAMP EXFIX 10.5MM 10.5MM QUICK CONNECT BAR TO BAR JET-X","BOTH IP/OP","$1,015.00 ","$751.10 ","$0.00 ","$1,015.00 ","$456.75 ","$0.00 ","$211.55 ","$0.00 ","$0.00 ","$177.72 ","$1,015.00 ","$0.00 ","$507.50 ","$803.88 ","$812.00 ","$0.00 ","$158.85 ","$0.00 ","$161.59 ","$0.00 "
"71070113","SUP","HCPCS C1713","","71070113  -  RING EXFIX CIR FULL 130MM TAYLOR SPATIAL FRAME","BOTH IP/OP","$3,230.00 ","$2,390.20 ","$0.00 ","$3,230.00 ","$1,453.50 ","$0.00 ","$673.21 ","$0.00 ","$0.00 ","$565.55 ","$3,230.00 ","$0.00 ","$1,615.00 ","$2,558.16 ","$2,584.00 ","$0.00 ","$505.50 ","$0.00 ","$514.22 ","$0.00 "
"71070116","SUP","HCPCS C1713","","71070116  -  RING EXFIX FULL 205MM ALUMINUM TAYLOR SPATIAL FRAME","BOTH IP/OP","$3,230.00 ","$2,390.20 ","$0.00 ","$3,230.00 ","$1,453.50 ","$0.00 ","$673.21 ","$0.00 ","$0.00 ","$565.55 ","$3,230.00 ","$0.00 ","$1,615.00 ","$2,558.16 ","$2,584.00 ","$0.00 ","$505.50 ","$0.00 ","$514.22 ","$0.00 "
"71070117","SUP","Custom 27203010","","71070117  -  RING EXFIX 230MM FULL RING CIRCULAR TAYLOR SPATIAL FRAME","BOTH IP/OP","$3,230.00 ","$2,390.20 ","$0.00 ","$3,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,230.00 ","$0.00 ","$1,615.00 ","$2,558.16 ","$2,584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070124","SUP","Custom 27011340","","71070124  -  RING EXFIX 155MM CIR HALF TLT SP","BOTH IP/OP","$3,459.50 ","$2,560.03 ","$0.00 ","$3,459.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,459.50 ","$0.00 ","$1,729.75 ","$2,739.92 ","$2,767.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070144","SUP","Custom 27011340","","71070144  -  RING EXFIX 155MM LNG CIR FT TLT SP","BOTH IP/OP","$4,080.00 ","$3,019.20 ","$0.00 ","$4,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,080.00 ","$0.00 ","$2,040.00 ","$3,231.36 ","$3,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070272","SUP","HCPCS C1776","","71070272  -  SLEEVE CENTERING 6MM","BOTH IP/OP","$406.30 ","$300.66 ","$0.00 ","$406.30 ","$182.84 ","$0.00 ","$84.68 ","$0.00 ","$0.00 ","$71.14 ","$406.30 ","$0.00 ","$203.15 ","$321.79 ","$325.04 ","$0.00 ","$63.59 ","$0.00 ","$64.68 ","$0.00 "
"71070273","SUP","Custom 27011340","","71070273  -  CUBE XTRNFX ILZ 1 HL POST RNCH SYS","BOTH IP/OP","$527.00 ","$389.98 ","$0.00 ","$527.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$527.00 ","$0.00 ","$263.50 ","$417.38 ","$421.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070282","SUP","Custom 27011340","","71070282  -  CONNECTOR EXFIX 30MM SHRT XTD","BOTH IP/OP","$406.30 ","$300.66 ","$0.00 ","$406.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$406.30 ","$0.00 ","$203.15 ","$321.79 ","$325.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070283","SUP","Custom 27011340","","71070283  -  CONNECTOR ROD 50MM LNG XTD","BOTH IP/OP","$406.30 ","$300.66 ","$0.00 ","$406.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$406.30 ","$0.00 ","$203.15 ","$321.79 ","$325.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070284","SUP","HCPCS C1713","","71070284  -  BOLT XTRNFX ILZ CMBN WRE","BOTH IP/OP","$191.20 ","$141.49 ","$0.00 ","$191.20 ","$86.04 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$33.48 ","$191.20 ","$0.00 ","$95.60 ","$151.43 ","$152.96 ","$0.00 ","$29.92 ","$0.00 ","$30.44 ","$0.00 "
"71070285","SUP","HCPCS C1713","","71070285  -  NUT ORTH LNG RSN","BOTH IP/OP","$32.80 ","$24.27 ","$0.00 ","$32.80 ","$14.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.74 ","$32.80 ","$0.00 ","$16.40 ","$25.98 ","$26.24 ","$0.00 ","$5.13 ","$0.00 ","$5.22 ","$0.00 "
"71070286","SUP","HCPCS C1713","","71070286  -  NUT ORTH 10MM","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$49.05 ","$0.00 ","$22.72 ","$0.00 ","$0.00 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"71070290","SUP","HCPCS C1713","","71070290  -  CAP PIN 6MM HALF HALF ORANGE","BOTH IP/OP","$80.33 ","$59.44 ","$0.00 ","$80.33 ","$36.15 ","$0.00 ","$16.74 ","$0.00 ","$0.00 ","$14.06 ","$80.33 ","$0.00 ","$40.16 ","$63.62 ","$64.26 ","$0.00 ","$12.57 ","$0.00 ","$12.79 ","$0.00 "
"71070340","SUP","HCPCS C1713","","71070340  -  KIT XTRNFX FST FX ID BAND STD STRUT","BOTH IP/OP","$1,057.40 ","$782.48 ","$0.00 ","$1,057.40 ","$475.83 ","$0.00 ","$220.39 ","$0.00 ","$0.00 ","$185.14 ","$1,057.40 ","$0.00 ","$528.70 ","$837.46 ","$845.92 ","$0.00 ","$165.48 ","$0.00 ","$168.34 ","$0.00 "
"71070345","SUP","Custom 27203010","","71070345  -  DRILL SURG SHORT 3.8MM STEP","BOTH IP/OP","$1,072.70 ","$793.80 ","$0.00 ","$1,072.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070348","SUP","Custom 27203010","","71070348  -  DRILL SURG LONG 3.8MM STEP","BOTH IP/OP","$1,072.70 ","$793.80 ","$0.00 ","$1,072.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.70 ","$0.00 ","$536.35 ","$849.58 ","$858.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070365","SUP","Custom 27011340","","71070365  -  RING EXFIX 180MM 155MM RCKR","BOTH IP/OP","$2,592.50 ","$1,918.45 ","$0.00 ","$2,592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,592.50 ","$0.00 ","$1,296.25 ","$2,053.26 ","$2,074.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070515","SUP","HCPCS C1713","","71070515  -  BOLT CNCT 12MM TLT SP","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$11.25 ","$0.00 ","$5.21 ","$0.00 ","$0.00 ","$4.38 ","$25.00 ","$0.00 ","$12.50 ","$19.80 ","$20.00 ","$0.00 ","$3.91 ","$0.00 ","$3.98 ","$0.00 "
"71070720","SUP","HCPCS C1713","","71070720  -  STRUT EXFIX MEDIUM CIR 143-205MM FAST-FIX TAYLOR SPATIAL","BOTH IP/OP","$3,332.00 ","$2,465.68 ","$0.00 ","$3,332.00 ","$1,499.40 ","$0.00 ","$694.47 ","$0.00 ","$0.00 ","$583.41 ","$3,332.00 ","$0.00 ","$1,666.00 ","$2,638.94 ","$2,665.60 ","$0.00 ","$521.46 ","$0.00 ","$530.45 ","$0.00 "
"71070730","SUP","HCPCS C1713","","71070730  -  STRUT XTRNFX LNG 195-311MM FST FX TLT SP","BOTH IP/OP","$3,332.00 ","$2,465.68 ","$0.00 ","$3,332.00 ","$1,499.40 ","$0.00 ","$694.47 ","$0.00 ","$0.00 ","$583.41 ","$3,332.00 ","$0.00 ","$1,666.00 ","$2,638.94 ","$2,665.60 ","$0.00 ","$521.46 ","$0.00 ","$530.45 ","$0.00 "
"71070800","SUP","HCPCS C1713","","71070800  -  PIN HLF 6MM 150MM 20MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070801","SUP","HCPCS C1713","","71070801  -  PIN HLF 6MM 200MM 20MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070802","SUP","HCPCS C1713","","71070802  -  PIN HALF 6MM 150MM 25MM HA EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070803","SUP","HCPCS C1713","","71070803  -  PIN HALF 6MM 200MM 25MM HA ORTHOPEDIC EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070804","SUP","HCPCS C1713","","71070804  -  PIN HALF 6MM 150MM 30MM HA EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070805","SUP","HCPCS C1713","","71070805  -  PIN HLF 6MM 200MM 30MM HA ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070806","SUP","HCPCS C1713","","71070806  -  PIN HALF 6MM 150MM 35MM HA EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070808","SUP","HCPCS C1713","","71070808  -  PIN HALF 6MM 150MM 40MM HA EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070809","SUP","HCPCS C1713","","71070809  -  PIN HALF 200MM 6MM HA 40MM EXFIX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070812","SUP","HCPCS C1713","","71070812  -  PIN HLF 6MM 150MM 55MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070814","SUP","HCPCS C1713","","71070814  -  PIN HLF 6MM 150MM 60MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070815","SUP","HCPCS C1713","","71070815  -  PIN HLF 6MM 200MM 60MM HAP XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070816","SUP","HCPCS C1713","","71070816  -  PIN HLF 6MM 150MM 65MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070817","SUP","HCPCS C1713","","71070817  -  PIN HLF 6MM 200MM 65MM HAP XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070818","SUP","HCPCS C1713","","71070818  -  PIN HLF 6MM 150MM 70MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070819","SUP","HCPCS C1713","","71070819  -  PIN HLF 6MM 200MM 70MM HAP ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070820","SUP","HCPCS C1713","","71070820  -  PIN HLF 6MM 200MM 80MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070821","SUP","HCPCS C1713","","71070821  -  PIN HLF 6MM 200MM 90MM HAP ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070822","SUP","HCPCS C1713","","71070822  -  PIN HLF 6MM 150MM 20MM HAP ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070823","SUP","HCPCS C1713","","71070823  -  PIN HLF 4.5MM 150MM 10MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070824","SUP","HCPCS C1713","","71070824  -  PIN HLF 4.5MM 150MM 20MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070825","SUP","HCPCS C1713","","71070825  -  PIN HALF 4.5MM 150MM 30MM THREAD HA ORTHOPEDIC EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070826","SUP","HCPCS C1713","","71070826  -  PIN HALF 4.5MM 150MM 40MM THREAD HA ORTHOPEDIC EXFIX SYSTEM","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070827","SUP","HCPCS C1713","","71070827  -  PIN HLF 4.5MM 150MM 50MM THRD HA ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070828","SUP","HCPCS C1713","","71070828  -  PIN HLF 6MM 150MM 15MM HA ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070829","SUP","HCPCS C1713","","71070829  -  PIN HLF 6MM 200MM 15MM HAP ORTH XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070835","SUP","HCPCS C1713","","71070835  -  PIN HLF 6MM 150MM 45MM HA XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070836","SUP","HCPCS C1713","","71070836  -  PIN HLF 6MM 200MM 45MM HAP XTRNFX SYS","BOTH IP/OP","$586.50 ","$434.01 ","$0.00 ","$586.50 ","$263.93 ","$0.00 ","$122.24 ","$0.00 ","$0.00 ","$102.69 ","$586.50 ","$0.00 ","$293.25 ","$464.51 ","$469.20 ","$0.00 ","$91.79 ","$0.00 ","$93.37 ","$0.00 "
"71070844","SUP","Custom 27203010","","71070844  -  BIT DRL LNG 4.8MM HA PIN","BOTH IP/OP","$1,237.60 ","$915.82 ","$0.00 ","$1,237.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.60 ","$0.00 ","$618.80 ","$980.18 ","$990.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070845","SUP","Custom 27203010","","71070845  -  BIT DRL 1.8MM 4.8MM CNN HA PIN","BOTH IP/OP","$1,603.10 ","$1,186.29 ","$0.00 ","$1,603.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,603.10 ","$0.00 ","$801.55 ","$1,269.66 ","$1,282.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71070846","SUP","Custom 27203010","","71070846  -  BIT DRL 1.5MM 3.8MM CNN HA PIN","BOTH IP/OP","$1,603.10 ","$1,186.29 ","$0.00 ","$1,603.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,603.10 ","$0.00 ","$801.55 ","$1,269.66 ","$1,282.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71100045","SUP","HCPCS C1713","","71100045  -  SCREW BN 6.5MM 45MM STRL 32MM CNN ORTH","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100050","SUP","HCPCS C1713","","71100050  -  SCREW BN 6.5MM 8MM 3.5MM 50MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100055","SUP","HCPCS C1713","","71100055  -  SCREW BN 6.5MM 8MM 3.5MM 55MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100060","SUP","HCPCS C1713","","71100060  -  SCREW BN 6.5MM 8MM 3.5MM 60MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100065","SUP","HCPCS C1713","","71100065  -  SCREW BN 6.5MM 8MM 3.5MM 65MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100070","SUP","HCPCS C1713","","71100070  -  SCREW BN 6.5MM 8MM 3.5MM 70MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100075","SUP","HCPCS C1713","","71100075  -  SCREW BN 6.5MM 8MM 3.5MM 75MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100080","SUP","HCPCS C1713","","71100080  -  SCREW BN 6.5MM 8MM 3.5MM 80MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100085","SUP","HCPCS C1713","","71100085  -  SCREW BN 6.5MM 8MM 3.5MM 85MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100090","SUP","HCPCS C1713","","71100090  -  SCREW BN 6.5MM 8MM 3.5MM 90MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100095","SUP","HCPCS C1713","","71100095  -  SCREW BN 6.5MM 8MM 3.5MM 95MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100100","SUP","HCPCS C1713","","71100100  -  SCREW BN 6.5MM 8MM 3.5MM 100MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100105","SUP","HCPCS C1713","","71100105  -  SCREW BN 6.5MM 105MM STRL 32MM CNN ORTH","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100110","SUP","HCPCS C1713","","71100110  -  SCREW BN 6.5MM 8MM 3.5MM 110MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100115","SUP","HCPCS C1713","","71100115  -  SCREW BN 6.5MM 115MM STRL 32MM CNN ORTH","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100120","SUP","HCPCS C1713","","71100120  -  SCREW BN 6.5MM 8MM 3.5MM 120MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100125","SUP","HCPCS C1713","","71100125  -  SCREW BN 6.5MM 125MM STRL 32MM CNN ORTH","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71100130","SUP","HCPCS C1713","","71100130  -  SCREW BN 6.5MM 8MM 3.5MM 130MM STRL 32MM CNN SS HIP ACPT 2.4","BOTH IP/OP","$531.30 ","$393.16 ","$0.00 ","$531.30 ","$239.09 ","$0.00 ","$110.74 ","$0.00 ","$0.00 ","$93.03 ","$531.30 ","$0.00 ","$265.65 ","$420.79 ","$425.04 ","$0.00 ","$83.15 ","$0.00 ","$84.58 ","$0.00 "
"71101000","SUP","HCPCS C1713","","71101000  -  WASHER ORTH 8MM 4MM STRL TI","BOTH IP/OP","$187.70 ","$138.90 ","$0.00 ","$187.70 ","$84.47 ","$0.00 ","$39.12 ","$0.00 ","$0.00 ","$32.86 ","$187.70 ","$0.00 ","$93.85 ","$148.66 ","$150.16 ","$0.00 ","$29.38 ","$0.00 ","$29.88 ","$0.00 "
"71101020","SUP","HCPCS C1713","","71101020  -  SCREW BN 4MM 20MM STRL 8MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101022","SUP","HCPCS C1713","","71101022  -  SCREW BN 4MM 22MM STRL 10MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101024","SUP","HCPCS C1713","","71101024  -  SCREW BN 4MM 24MM STRL 12MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101026","SUP","HCPCS C1713","","71101026  -  SCREW BN 4MM 26MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101028","SUP","HCPCS C1713","","71101028  -  SCREW BN 4MM 28MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101030","SUP","HCPCS C1713","","71101030  -  SCREW BN 4MM 30MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101032","SUP","HCPCS C1713","","71101032  -  SCREW BN 4MM 32MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101034","SUP","HCPCS C1713","","71101034  -  SCREW BN 4MM 34MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101036","SUP","HCPCS C1713","","71101036  -  SCREW BN 4MM 36MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101038","SUP","HCPCS C1713","","71101038  -  SCREW BN 4MM 38MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101040","SUP","HCPCS C1713","","71101040  -  SCREW BN 4MM 40MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101042","SUP","HCPCS C1713","","71101042  -  SCREW BN 4MM 42MM STRL 14MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101044","SUP","HCPCS C1713","","71101044  -  SCREW BN 4MM 44MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101046","SUP","HCPCS C1713","","71101046  -  SCREW BN 4MM 46MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101048","SUP","HCPCS C1713","","71101048  -  SCREW BN 4MM 48MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101050","SUP","HCPCS C1713","","71101050  -  SCREW BN 4MM 50MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101052","SUP","HCPCS C1713","","71101052  -  SCREW BN 4MM 52MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101054","SUP","HCPCS C1713","","71101054  -  SCREW BN 4MM 54MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101056","SUP","HCPCS C1713","","71101056  -  SCREW BN 4MM 56MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101058","SUP","HCPCS C1713","","71101058  -  SCREW BN 4MM 58MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101060","SUP","HCPCS C1713","","71101060  -  SCREW BN 4MM 60MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101065","SUP","HCPCS C1713","","71101065  -  SCREW BN 4MM 65MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101070","SUP","HCPCS C1713","","71101070  -  SCREW BN 4MM 70MM STRL 15MM CNN TI ORTH","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71101401","SUP","HCPCS C1713","","71101401  -  CAP PCTV 1.1 MM WRE","BOTH IP/OP","$30.70 ","$22.72 ","$0.00 ","$30.70 ","$13.82 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$5.38 ","$30.70 ","$0.00 ","$15.35 ","$24.31 ","$24.56 ","$0.00 ","$4.80 ","$0.00 ","$4.89 ","$0.00 "
"71101402","SUP","HCPCS C1713","","71101402  -  CAP PCTV 1.25 MM WRE","BOTH IP/OP","$30.70 ","$22.72 ","$0.00 ","$30.70 ","$13.82 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$5.38 ","$30.70 ","$0.00 ","$15.35 ","$24.31 ","$24.56 ","$0.00 ","$4.80 ","$0.00 ","$4.89 ","$0.00 "
"71101403","SUP","HCPCS C1713","","71101403  -  CAP PCTV 1.6 MM WRE","BOTH IP/OP","$30.70 ","$22.72 ","$0.00 ","$30.70 ","$13.82 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$5.38 ","$30.70 ","$0.00 ","$15.35 ","$24.31 ","$24.56 ","$0.00 ","$4.80 ","$0.00 ","$4.89 ","$0.00 "
"71101404","SUP","HCPCS C1713","","71101404  -  CAP PCTV 2 MM WRE","BOTH IP/OP","$30.70 ","$22.72 ","$0.00 ","$30.70 ","$13.82 ","$0.00 ","$6.40 ","$0.00 ","$0.00 ","$5.38 ","$30.70 ","$0.00 ","$15.35 ","$24.31 ","$24.56 ","$0.00 ","$4.80 ","$0.00 ","$4.89 ","$0.00 "
"71101501","SUP","Custom 27203010","","71101501  -  WIRE FX 2MM 150MM DRL TIP","BOTH IP/OP","$145.50 ","$107.67 ","$0.00 ","$145.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.50 ","$0.00 ","$72.75 ","$115.24 ","$116.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71101502","SUP","Custom 27203010","","71101502  -  WIRE FX FLUT 1.6MM 150MM VLP DRL TIP COCR","BOTH IP/OP","$105.63 ","$78.17 ","$0.00 ","$105.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.63 ","$0.00 ","$52.81 ","$83.66 ","$84.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71101691","SUP","HCPCS C1713","","71101691  -  WASHER ORTH 21.7MM 12.7MM OBLNG SS","BOTH IP/OP","$109.20 ","$80.81 ","$0.00 ","$109.20 ","$49.14 ","$0.00 ","$22.76 ","$0.00 ","$0.00 ","$19.12 ","$109.20 ","$0.00 ","$54.60 ","$86.49 ","$87.36 ","$0.00 ","$17.09 ","$0.00 ","$17.38 ","$0.00 "
"71101693","SUP","HCPCS C1713","","71101693  -  WASHER ORTH 21.7MM BTRFLY SS","BOTH IP/OP","$103.33 ","$76.46 ","$0.00 ","$103.33 ","$46.50 ","$0.00 ","$21.54 ","$0.00 ","$0.00 ","$18.09 ","$103.33 ","$0.00 ","$51.66 ","$81.84 ","$82.66 ","$0.00 ","$16.17 ","$0.00 ","$16.45 ","$0.00 "
"71102000","SUP","HCPCS C1713","","71102000  -  WASHER ORTH 12.7MM 6.5MM 1MM TI","BOTH IP/OP","$242.40 ","$179.38 ","$0.00 ","$242.40 ","$109.08 ","$0.00 ","$50.52 ","$0.00 ","$0.00 ","$42.44 ","$242.40 ","$0.00 ","$121.20 ","$191.98 ","$193.92 ","$0.00 ","$37.94 ","$0.00 ","$38.59 ","$0.00 "
"71102030","SUP","HCPCS C1713","","71102030  -  PIN FX 30MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102035","SUP","HCPCS C1713","","71102035  -  PIN FX 35MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102040","SUP","HCPCS C1713","","71102040  -  PIN FX 40MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102045","SUP","HCPCS C1713","","71102045  -  PIN FX 45MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102050","SUP","HCPCS C1713","","71102050  -  PIN FX 50MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102055","SUP","HCPCS C1713","","71102055  -  PIN FX 55MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102060","SUP","HCPCS C1713","","71102060  -  PIN FX 60MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102065","SUP","HCPCS C1713","","71102065  -  PIN FX 65MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102070","SUP","HCPCS C1713","","71102070  -  PIN FX 70MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102075","SUP","HCPCS C1713","","71102075  -  PIN FX 75MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102080","SUP","HCPCS C1713","","71102080  -  PIN FX 80MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102085","SUP","HCPCS C1713","","71102085  -  PIN FX 85MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102090","SUP","HCPCS C1713","","71102090  -  PIN FX 90MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102095","SUP","HCPCS C1713","","71102095  -  PIN FX 95MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102100","SUP","HCPCS C1713","","71102100  -  PIN FX 100MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102105","SUP","HCPCS C1713","","71102105  -  PIN FX 105MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102110","SUP","HCPCS C1713","","71102110  -  PIN FX 110MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102115","SUP","HCPCS C1713","","71102115  -  PIN FX 115MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102120","SUP","HCPCS C1713","","71102120  -  PIN FX 120MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102125","SUP","HCPCS C1713","","71102125  -  PIN FX 125MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102130","SUP","HCPCS C1713","","71102130  -  PIN FX 130MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71102135","SUP","HCPCS C1713","","71102135  -  PIN FX 135MM 16MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71103045","SUP","HCPCS C1713","","71103045  -  PIN FX 45MM 32MM CNN TI HIP","BOTH IP/OP","$741.30 ","$548.56 ","$0.00 ","$741.30 ","$333.59 ","$0.00 ","$154.51 ","$0.00 ","$0.00 ","$129.80 ","$741.30 ","$0.00 ","$370.65 ","$587.11 ","$593.04 ","$0.00 ","$116.01 ","$0.00 ","$118.01 ","$0.00 "
"71107030","SUP","HCPCS C1713","","71107030  -  SCREW BN 7MM 30MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107035","SUP","HCPCS C1713","","71107035  -  SCREW BN 7MM 35MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107040","SUP","HCPCS C1713","","71107040  -  SCREW BN 7MM 40MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107045","SUP","HCPCS C1713","","71107045  -  SCREW BN 7MM 45MM 16MM CNN P/T TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107050","SUP","HCPCS C1713","","71107050  -  SCREW BN 7MM 50MM 16MM CNN P/T TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107055","SUP","HCPCS C1713","","71107055  -  SCREW BN 7MM 55MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107060","SUP","HCPCS C1713","","71107060  -  SCREW BN 7MM 60MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107065","SUP","HCPCS C1713","","71107065  -  SCREW BN P/T 7MM 65MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107070","SUP","HCPCS C1713","","71107070  -  SCREW BN P/T 7MM 70MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107075","SUP","HCPCS C1713","","71107075  -  SCREW BN P/T 7MM 75MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107080","SUP","HCPCS C1713","","71107080  -  SCREW BN P/T 7MM 80MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107085","SUP","HCPCS C1713","","71107085  -  SCREW BN P/T 7MM 85MM STRL 16MM CNN TI SM BN LNG BN","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107090","SUP","HCPCS C1713","","71107090  -  SCREW BN P/T 7MM 90MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107095","SUP","HCPCS C1713","","71107095  -  SCREW BN P/T 7MM 95MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107100","SUP","HCPCS C1713","","71107100  -  SCREW BN P/T 7MM 100MM STRL 16MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107105","SUP","HCPCS C1713","","71107105  -  SCREW BN P/T 7MM 105MM STRL 16MM CNN TI SM BN LNG BN","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107110","SUP","HCPCS C1713","","71107110  -  SCREW BN 7MM 110MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107115","SUP","HCPCS C1713","","71107115  -  SCREW BN 7MM 115MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107120","SUP","HCPCS C1713","","71107120  -  SCREW BN 7MM 120MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107125","SUP","HCPCS C1713","","71107125  -  SCREW BN 7MM 125MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107130","SUP","HCPCS C1713","","71107130  -  SCREW BN 7MM 130MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107135","SUP","HCPCS C1713","","71107135  -  SCREW BN 7MM 135MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107140","SUP","HCPCS C1713","","71107140  -  SCREW BN 7MM 140MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107145","SUP","HCPCS C1713","","71107145  -  SCREW BN 7MM 145MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71107150","SUP","HCPCS C1713","","71107150  -  SCREW BN 7MM 150MM STRL 16MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108045","SUP","HCPCS C1713","","71108045  -  SCREW BN 7MM 45MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108050","SUP","HCPCS C1713","","71108050  -  SCREW BN 7MM 50MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108055","SUP","HCPCS C1713","","71108055  -  SCREW BN 7MM 55MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108060","SUP","HCPCS C1713","","71108060  -  SCREW BN 7MM 60MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108065","SUP","HCPCS C1713","","71108065  -  SCREW BN 7MM 65MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108070","SUP","HCPCS C1713","","71108070  -  SCREW BN 7MM 70MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108075","SUP","HCPCS C1713","","71108075  -  SCREW BN P/T 7MM 75MM STRL 32MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108080","SUP","HCPCS C1713","","71108080  -  SCREW BN P/T 7MM 80MM STRL 32MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108085","SUP","HCPCS C1713","","71108085  -  SCREW BN 7MM 85MM 32MM CNN P/T TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108090","SUP","HCPCS C1713","","71108090  -  SCREW BN P/T 7MM 90MM STRL 32MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108095","SUP","HCPCS C1713","","71108095  -  SCREW BN P/T 7MM 95MM STRL 32MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108100","SUP","HCPCS C1713","","71108100  -  SCREW BN P/T 7MM 100MM STRL 32MM CNN TI","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108105","SUP","HCPCS C1713","","71108105  -  SCREW BN 7MM 105MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108110","SUP","HCPCS C1713","","71108110  -  SCREW BN 7MM 110MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108115","SUP","HCPCS C1713","","71108115  -  SCREW BN 7MM 115MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108120","SUP","HCPCS C1713","","71108120  -  SCREW BN 7MM 120MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108125","SUP","HCPCS C1713","","71108125  -  SCREW BN 7MM 125MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108130","SUP","HCPCS C1713","","71108130  -  SCREW BN 7MM 130MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108135","SUP","HCPCS C1713","","71108135  -  SCREW BN 7MM 135MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108140","SUP","HCPCS C1713","","71108140  -  SCREW BN 7MM 140MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108145","SUP","HCPCS C1713","","71108145  -  SCREW BN 7MM 145MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108150","SUP","HCPCS C1713","","71108150  -  SCREW BN 7MM 150MM STRL 32MM CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71108670","SUP","HCPCS C1713","","71108670  -  SCREW BN P/T 8MM 170MM 24MM CNN SS CANC","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"71109030","SUP","HCPCS C1713","","71109030  -  SCREW BN FT 7MM 30MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109035","SUP","HCPCS C1713","","71109035  -  SCREW BN FT 7MM 35MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109040","SUP","HCPCS C1713","","71109040  -  SCREW BN FT 7MM 40MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109045","SUP","HCPCS C1713","","71109045  -  SCREW BN FT 7MM 45MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109050","SUP","HCPCS C1713","","71109050  -  SCREW BN FT 7MM 50MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109055","SUP","HCPCS C1713","","71109055  -  SCREW BN FT 7MM 55MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109060","SUP","HCPCS C1713","","71109060  -  SCREW BN FT 7MM 60MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109065","SUP","HCPCS C1713","","71109065  -  SCREW BN FT 7MM 65MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109070","SUP","HCPCS C1713","","71109070  -  SCREW BN FT 7MM 70MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109075","SUP","HCPCS C1713","","71109075  -  SCREW BN FT 7MM 75MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109080","SUP","HCPCS C1713","","71109080  -  SCREW BN FT 7MM 80MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109085","SUP","HCPCS C1713","","71109085  -  SCREW BN FT 7MM 85MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109090","SUP","HCPCS C1713","","71109090  -  SCREW BN FT 7MM 90MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109095","SUP","HCPCS C1713","","71109095  -  SCREW BN FT 7MM 95MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109100","SUP","HCPCS C1713","","71109100  -  SCREW BN FT 7MM 100MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109105","SUP","HCPCS C1713","","71109105  -  SCREW BN FT 7MM 105MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109110","SUP","HCPCS C1713","","71109110  -  SCREW BN FT 7MM 110MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109115","SUP","HCPCS C1713","","71109115  -  SCREW BN 7MM 115MM STRL CNN FT TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109120","SUP","HCPCS C1713","","71109120  -  SCREW BN 7MM 120MM STRL CNN FT TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109125","SUP","HCPCS C1713","","71109125  -  SCREW BN FT 7MM 125MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71109130","SUP","HCPCS C1713","","71109130  -  SCREW BN FT 7MM 130MM STRL CNN TI ORTH","BOTH IP/OP","$519.75 ","$384.62 ","$0.00 ","$519.75 ","$233.89 ","$0.00 ","$108.33 ","$0.00 ","$0.00 ","$91.00 ","$519.75 ","$0.00 ","$259.88 ","$411.64 ","$415.80 ","$0.00 ","$81.34 ","$0.00 ","$82.74 ","$0.00 "
"71110027","SUP","Custom 27203010","","71110027  -  BIT DRL 4.5MM TWST","BOTH IP/OP","$143.85 ","$106.45 ","$0.00 ","$143.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.85 ","$0.00 ","$71.93 ","$113.93 ","$115.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71110045","SUP","Custom 27203010","","71110045  -  BIT DRL 3.5MM TWST","BOTH IP/OP","$114.45 ","$84.69 ","$0.00 ","$114.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.45 ","$0.00 ","$57.23 ","$90.64 ","$91.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71116060","SUP","HCPCS C1713","","71116060  -  PIN FX 3IN ORTH","BOTH IP/OP","$1,459.50 ","$1,080.03 ","$0.00 ","$1,459.50 ","$656.78 ","$0.00 ","$304.20 ","$0.00 ","$0.00 ","$255.55 ","$1,459.50 ","$0.00 ","$729.75 ","$1,155.92 ","$1,167.60 ","$0.00 ","$228.41 ","$0.00 ","$232.35 ","$0.00 "
"71119005","SUP","HCPCS C1713","","71119005  -  WASHER XTRNFX 12.7MM SLV 7MM CNN SCR","BOTH IP/OP","$308.70 ","$228.44 ","$0.00 ","$308.70 ","$138.92 ","$0.00 ","$64.34 ","$0.00 ","$0.00 ","$54.05 ","$308.70 ","$0.00 ","$154.35 ","$244.49 ","$246.96 ","$0.00 ","$48.31 ","$0.00 ","$49.15 ","$0.00 "
"71119007","SUP","Custom 27203010","","71119007  -  BIT DRL 4MM STRL CNN","BOTH IP/OP","$807.45 ","$597.51 ","$0.00 ","$807.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$807.45 ","$0.00 ","$403.73 ","$639.50 ","$645.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71119106","SUP","Custom 27203010","","71119106  -  BIT DRL 5.2MM STRL CNN 7MM SCR","BOTH IP/OP","$940.80 ","$696.19 ","$0.00 ","$940.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$940.80 ","$0.00 ","$470.40 ","$745.11 ","$752.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71120006","SUP","HCPCS C1713","","71120006  -  WASHER ORTH THK1MM 8MM 4MM STRL CNN SS 4MM CNN SCR","BOTH IP/OP","$121.90 ","$90.21 ","$0.00 ","$121.90 ","$54.86 ","$0.00 ","$25.41 ","$0.00 ","$0.00 ","$21.34 ","$121.90 ","$0.00 ","$60.95 ","$96.54 ","$97.52 ","$0.00 ","$19.08 ","$0.00 ","$19.41 ","$0.00 "
"71123122","SUP","HCPCS C1713","","71123122  -  PLATE BN 90D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123124","SUP","HCPCS C1713","","71123124  -  PLATE BN 100D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123126","SUP","HCPCS C1713","","71123126  -  PLATE BN 110D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123128","SUP","HCPCS C1713","","71123128  -  PLATE BN 120D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123130","SUP","HCPCS C1713","","71123130  -  PLATE BN 130D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123132","SUP","HCPCS C1713","","71123132  -  PLATE BN 135D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123134","SUP","HCPCS C1713","","71123134  -  PLATE BN 140D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123136","SUP","HCPCS C1713","","71123136  -  PLATE BN 145D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123138","SUP","HCPCS C1713","","71123138  -  PLATE BN 150D 55MM CHS 3 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123140","SUP","HCPCS C1713","","71123140  -  PLATE BN 90D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123142","SUP","HCPCS C1713","","71123142  -  PLATE BN 100D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123144","SUP","HCPCS C1713","","71123144  -  PLATE BN 110D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123146","SUP","HCPCS C1713","","71123146  -  PLATE BN 120D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123148","SUP","HCPCS C1713","","71123148  -  PLATE BN 130D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123150","SUP","HCPCS C1713","","71123150  -  PLATE BN 135D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123152","SUP","HCPCS C1713","","71123152  -  PLATE BN 140D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123154","SUP","HCPCS C1713","","71123154  -  PLATE BN 145D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123156","SUP","HCPCS C1713","","71123156  -  PLATE BN 150D 76MM CHS 4 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123158","SUP","HCPCS C1713","","71123158  -  PLATE BN 90D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123160","SUP","HCPCS C1713","","71123160  -  PLATE BN 100D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123162","SUP","HCPCS C1713","","71123162  -  PLATE BN 110D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123164","SUP","HCPCS C1713","","71123164  -  PLATE BN 120D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123166","SUP","HCPCS C1713","","71123166  -  PLATE BN 130D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123168","SUP","HCPCS C1713","","71123168  -  PLATE BN 135D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123170","SUP","HCPCS C1713","","71123170  -  PLATE BN 140D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123172","SUP","HCPCS C1713","","71123172  -  PLATE BN 145D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123174","SUP","HCPCS C1713","","71123174  -  PLATE BN 150D 102MM CHS 6 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123176","SUP","HCPCS C1713","","71123176  -  PLATE BN 130D 127MM CHS 8 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123178","SUP","HCPCS C1713","","71123178  -  PLATE BN 135D 127MM CHS 8 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123180","SUP","HCPCS C1713","","71123180  -  PLATE BN 140D 127MM CHS 8 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123182","SUP","HCPCS C1713","","71123182  -  PLATE BN 145D 127MM CHS 8 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123184","SUP","HCPCS C1713","","71123184  -  PLATE BN 150D 127MM CHS 8 HL INTMD SS PED HIP","BOTH IP/OP","$1,832.25 ","$1,355.87 ","$0.00 ","$1,832.25 ","$824.51 ","$0.00 ","$381.89 ","$0.00 ","$0.00 ","$320.81 ","$1,832.25 ","$0.00 ","$916.13 ","$1,451.14 ","$1,465.80 ","$0.00 ","$286.75 ","$0.00 ","$291.69 ","$0.00 "
"71123186","SUP","HCPCS C1713","","71123186  -  SCREW BN 35MM CHS INTMD LG SS PED HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123187","SUP","HCPCS C1713","","71123187  -  SCREW BN 40MM CHS INTMD LG SS PED HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123188","SUP","HCPCS C1713","","71123188  -  SCREW BN 45MM CHS INTMD LG SS PED HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123189","SUP","HCPCS C1713","","71123189  -  SCREW BN 50MM CHS INTMD LG SS PED HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123190","SUP","HCPCS C1713","","71123190  -  SCREW BN 55MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123191","SUP","HCPCS C1713","","71123191  -  SCREW BN 60MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123192","SUP","HCPCS C1713","","71123192  -  SCREW BN 65MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123193","SUP","HCPCS C1713","","71123193  -  SCREW BN 70MM CHS INTMD LG SS PED HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123194","SUP","HCPCS C1713","","71123194  -  SCREW BN 75MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123195","SUP","HCPCS C1713","","71123195  -  SCREW BN 80MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123196","SUP","HCPCS C1713","","71123196  -  SCREW BN 85MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123197","SUP","HCPCS C1713","","71123197  -  SCREW BN 90MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123198","SUP","HCPCS C1713","","71123198  -  SCREW BN 95MM CHS INTMD LG SS HIP","BOTH IP/OP","$1,307.25 ","$967.37 ","$0.00 ","$1,307.25 ","$588.26 ","$0.00 ","$272.46 ","$0.00 ","$0.00 ","$228.89 ","$1,307.25 ","$0.00 ","$653.63 ","$1,035.34 ","$1,045.80 ","$0.00 ","$204.58 ","$0.00 ","$208.11 ","$0.00 "
"71123199","SUP","HCPCS C1713","","71123199  -  SCREW BN 2.5MM CHS INTMD CMPR HEX HD SS PED HIP","BOTH IP/OP","$216.30 ","$160.06 ","$0.00 ","$216.30 ","$97.34 ","$0.00 ","$45.08 ","$0.00 ","$0.00 ","$37.87 ","$216.30 ","$0.00 ","$108.15 ","$171.31 ","$173.04 ","$0.00 ","$33.85 ","$0.00 ","$34.43 ","$0.00 "
"71123228","SUP","HCPCS C1713","","71123228  -  SCREW BN FT 2.7MM 28MM ST PED HIP","BOTH IP/OP","$40.70 ","$30.12 ","$0.00 ","$40.70 ","$18.32 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$7.13 ","$40.70 ","$0.00 ","$20.35 ","$32.23 ","$32.56 ","$0.00 ","$6.37 ","$0.00 ","$6.48 ","$0.00 "
"71123232","SUP","HCPCS C1713","","71123232  -  SCREW BN 2.7MM 32MM ST HEX HD","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"71123234","SUP","HCPCS C1713","","71123234  -  SCREW BN 2.7MM 34MM ST HEX HD","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"71123236","SUP","HCPCS C1713","","71123236  -  SCREW BN 2.7MM 36MM ST HEX HD","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"71123238","SUP","HCPCS C1713","","71123238  -  SCREW BN 2.7MM 38MM ST HEX HD","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$18.81 ","$0.00 ","$8.71 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"71123242","SUP","HCPCS C1713","","71123242  -  PLATE BN 90D 50MM CHS 4 PROX HL SS PED HIP","BOTH IP/OP","$2,394.00 ","$1,771.56 ","$0.00 ","$2,394.00 ","$1,077.30 ","$0.00 ","$498.97 ","$0.00 ","$0.00 ","$419.17 ","$2,394.00 ","$0.00 ","$1,197.00 ","$1,896.05 ","$1,915.20 ","$0.00 ","$374.66 ","$0.00 ","$381.12 ","$0.00 "
"71123244","SUP","HCPCS C1713","","71123244  -  PLATE BN 100D .385IN CHS 4 PROX HL SS PED HIP","BOTH IP/OP","$2,394.00 ","$1,771.56 ","$0.00 ","$2,394.00 ","$1,077.30 ","$0.00 ","$498.97 ","$0.00 ","$0.00 ","$419.17 ","$2,394.00 ","$0.00 ","$1,197.00 ","$1,896.05 ","$1,915.20 ","$0.00 ","$374.66 ","$0.00 ","$381.12 ","$0.00 "
"71123246","SUP","HCPCS C1713","","71123246  -  PLATE BN 110D 50MM CHS 4 PROX HL SS PED HIP","BOTH IP/OP","$2,394.00 ","$1,771.56 ","$0.00 ","$2,394.00 ","$1,077.30 ","$0.00 ","$498.97 ","$0.00 ","$0.00 ","$419.17 ","$2,394.00 ","$0.00 ","$1,197.00 ","$1,896.05 ","$1,915.20 ","$0.00 ","$374.66 ","$0.00 ","$381.12 ","$0.00 "
"71123248","SUP","HCPCS C1713","","71123248  -  PLATE BN 120D 50MM CHS 4 PROX HL SS PED HIP","BOTH IP/OP","$2,394.00 ","$1,771.56 ","$0.00 ","$2,394.00 ","$1,077.30 ","$0.00 ","$498.97 ","$0.00 ","$0.00 ","$419.17 ","$2,394.00 ","$0.00 ","$1,197.00 ","$1,896.05 ","$1,915.20 ","$0.00 ","$374.66 ","$0.00 ","$381.12 ","$0.00 "
"71123250","SUP","HCPCS C1713","","71123250  -  PLATE BN 130D 50MM CHS 4 PROX HL SS PED HIP","BOTH IP/OP","$2,394.00 ","$1,771.56 ","$0.00 ","$2,394.00 ","$1,077.30 ","$0.00 ","$498.97 ","$0.00 ","$0.00 ","$419.17 ","$2,394.00 ","$0.00 ","$1,197.00 ","$1,896.05 ","$1,915.20 ","$0.00 ","$374.66 ","$0.00 ","$381.12 ","$0.00 "
"71123252","SUP","HCPCS C1713","","71123252  -  PLATE BN 140D 50MM CHS 4 PROX HL SS PED HIP","BOTH IP/OP","$2,394.00 ","$1,771.56 ","$0.00 ","$2,394.00 ","$1,077.30 ","$0.00 ","$498.97 ","$0.00 ","$0.00 ","$419.17 ","$2,394.00 ","$0.00 ","$1,197.00 ","$1,896.05 ","$1,915.20 ","$0.00 ","$374.66 ","$0.00 ","$381.12 ","$0.00 "
"71123254","SUP","HCPCS C1713","","71123254  -  SCREW BN 22MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71123256","SUP","HCPCS C1713","","71123256  -  SCREW BN 25MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71123258","SUP","HCPCS C1713","","71123258  -  SCREW BN 28MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71123260","SUP","HCPCS C1713","","71123260  -  SCREW BN 31MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71123262","SUP","HCPCS C1713","","71123262  -  SCREW BN 34MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71123264","SUP","HCPCS C1713","","71123264  -  SCREW BN 37MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71123266","SUP","HCPCS C1713","","71123266  -  SCREW BN 40MM CHS LG SS PED HIP","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71124002","SUP","HCPCS C1713","","71124002  -  NAIL IM 4MM 22CM FRSGHT SET FRARM","BOTH IP/OP","$6,380.00 ","$4,721.20 ","$0.00 ","$6,380.00 ","$2,871.00 ","$0.00 ","$1,329.75 ","$0.00 ","$0.00 ","$1,117.09 ","$6,380.00 ","$0.00 ","$3,190.00 ","$5,052.96 ","$5,104.00 ","$0.00 ","$998.47 ","$0.00 ","$1,015.70 ","$0.00 "
"71124010","SUP","HCPCS C1713","","71124010  -  SCREW BN 2.7MM 10MM UNICORTICAL","BOTH IP/OP","$373.40 ","$276.32 ","$0.00 ","$373.40 ","$168.03 ","$0.00 ","$77.83 ","$0.00 ","$0.00 ","$65.38 ","$373.40 ","$0.00 ","$186.70 ","$295.73 ","$298.72 ","$0.00 ","$58.44 ","$0.00 ","$59.45 ","$0.00 "
"71126130","SUP","HCPCS C1713","","71126130  -  PLATE BN 130D CLS 4 HL CMPR LOPRFL HIP","BOTH IP/OP","$715.05 ","$529.14 ","$0.00 ","$715.05 ","$321.77 ","$0.00 ","$149.03 ","$0.00 ","$0.00 ","$125.20 ","$715.05 ","$0.00 ","$357.53 ","$566.32 ","$572.04 ","$0.00 ","$111.91 ","$0.00 ","$113.84 ","$0.00 "
"71126131","SUP","HCPCS C1713","","71126131  -  PLATE BN 135D CLS LP 4 HL","BOTH IP/OP","$532.35 ","$393.94 ","$0.00 ","$532.35 ","$239.56 ","$0.00 ","$110.96 ","$0.00 ","$0.00 ","$93.21 ","$532.35 ","$0.00 ","$266.18 ","$421.62 ","$425.88 ","$0.00 ","$83.31 ","$0.00 ","$84.75 ","$0.00 "
"71127030","SUP","HCPCS C1713","","71127030  -  SCREW BN 7MM 30MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127035","SUP","HCPCS C1713","","71127035  -  SCREW BN 7MM 35MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127040","SUP","HCPCS C1713","","71127040  -  SCREW BN 7MM 40MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127045","SUP","HCPCS C1713","","71127045  -  SCREW BN 7MM 45MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127050","SUP","HCPCS C1713","","71127050  -  SCREW BN 7MM 50MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127055","SUP","HCPCS C1713","","71127055  -  SCREW BN 7MM 55MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127060","SUP","HCPCS C1713","","71127060  -  SCREW BN 7MM 60MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127065","SUP","HCPCS C1713","","71127065  -  SCREW BN 7MM 65MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127070","SUP","HCPCS C1713","","71127070  -  SCREW BN P/T TROC SPHR 7MM 5.2MM 70MM 16MM CNN SLFDRL ST HD","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127075","SUP","HCPCS C1713","","71127075  -  SCREW BN 7MM 75MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127080","SUP","HCPCS C1713","","71127080  -  SCREW BN 7MM 80MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127085","SUP","HCPCS C1713","","71127085  -  SCREW BN 7MM 85MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127090","SUP","HCPCS C1713","","71127090  -  SCREW BN 7MM 90MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127095","SUP","HCPCS C1713","","71127095  -  SCREW BN 7MM 95MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127100","SUP","HCPCS C1713","","71127100  -  SCREW BN 7MM 100MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127105","SUP","HCPCS C1713","","71127105  -  SCREW BN 7MM 105MM STRL 16MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127110","SUP","HCPCS C1713","","71127110  -  SCREW BN 7MM 110MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127115","SUP","HCPCS C1713","","71127115  -  SCREW BN 7MM 115MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127120","SUP","HCPCS C1713","","71127120  -  SCREW BN 7MM 120MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127125","SUP","HCPCS C1713","","71127125  -  SCREW BN 7MM 125MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127130","SUP","HCPCS C1713","","71127130  -  SCREW BN 7MM 130MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127135","SUP","HCPCS C1713","","71127135  -  SCREW BN 7MM 135MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127140","SUP","HCPCS C1713","","71127140  -  SCREW BN 7MM 140MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127145","SUP","HCPCS C1713","","71127145  -  SCREW BN 7MM 145MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71127150","SUP","HCPCS C1713","","71127150  -  SCREW BN 7MM 150MM STRL 16MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128045","SUP","HCPCS C1713","","71128045  -  SCREW BN 7MM 45MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128050","SUP","HCPCS C1713","","71128050  -  SCREW BN 7MM 50MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128055","SUP","HCPCS C1713","","71128055  -  SCREW BN 7MM 55MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128060","SUP","HCPCS C1713","","71128060  -  SCREW BN 7MM 60MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128065","SUP","HCPCS C1713","","71128065  -  SCREW BN 7MM 65MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128070","SUP","HCPCS C1713","","71128070  -  SCREW BN 7MM 70MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128075","SUP","HCPCS C1713","","71128075  -  SCREW BN 7MM 75MM STRL 32MM CNN SET SS ORTH IMPL","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128080","SUP","HCPCS C1713","","71128080  -  SCREW BN 7MM 80MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128085","SUP","HCPCS C1713","","71128085  -  SCREW BN 7MM 85MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128090","SUP","HCPCS C1713","","71128090  -  SCREW BN 7MM 90MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128095","SUP","HCPCS C1713","","71128095  -  SCREW BN 7MM 95MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128100","SUP","HCPCS C1713","","71128100  -  SCREW BN 7MM 100MM STRL 32MM CNN SS CORT","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
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"71128115","SUP","HCPCS C1713","","71128115  -  SCREW BN 7MM 115MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
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"71128125","SUP","HCPCS C1713","","71128125  -  SCREW BN 7MM 125MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128130","SUP","HCPCS C1713","","71128130  -  SCREW BN 7MM 130MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128135","SUP","HCPCS C1713","","71128135  -  SCREW BN 7MM 135MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$467.25 ","$345.77 ","$0.00 ","$467.25 ","$210.26 ","$0.00 ","$97.39 ","$0.00 ","$0.00 ","$81.81 ","$467.25 ","$0.00 ","$233.63 ","$370.06 ","$373.80 ","$0.00 ","$73.12 ","$0.00 ","$74.39 ","$0.00 "
"71128140","SUP","HCPCS C1713","","71128140  -  SCREW BN 7MM 140MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128145","SUP","HCPCS C1713","","71128145  -  SCREW BN 7MM 145MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$467.25 ","$345.77 ","$0.00 ","$467.25 ","$210.26 ","$0.00 ","$97.39 ","$0.00 ","$0.00 ","$81.81 ","$467.25 ","$0.00 ","$233.63 ","$370.06 ","$373.80 ","$0.00 ","$73.12 ","$0.00 ","$74.39 ","$0.00 "
"71128150","SUP","HCPCS C1713","","71128150  -  SCREW BN 7MM 150MM STRL 32MM CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71128690","SUP","HCPCS C1713","","71128690  -  STAPLE BN SM 23X10.8MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128691","SUP","HCPCS C1713","","71128691  -  STAPLE BN SM 23X10.8MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128692","SUP","HCPCS C1713","","71128692  -  STAPLE BN SM 23X12MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128693","SUP","HCPCS C1713","","71128693  -  STAPLE BN SM 23X12MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128694","SUP","HCPCS C1713","","71128694  -  STAPLE BN MED 23X15MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128695","SUP","HCPCS C1713","","71128695  -  STAPLE BN MED 23X15MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128696","SUP","HCPCS C1713","","71128696  -  STAPLE BN LG 23X18MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128697","SUP","HCPCS C1713","","71128697  -  STAPLE BN LG 23X18MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128698","SUP","HCPCS C1713","","71128698  -  STAPLE BN SM 16X13MM TBL FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128699","SUP","HCPCS C1713","","71128699  -  STAPLE BN MED 22X16MM TBL FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128720","SUP","HCPCS C1713","","71128720  -  STAPLE BN SM 15X11MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128721","SUP","HCPCS C1713","","71128721  -  STAPLE BN SM 15X11MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128722","SUP","HCPCS C1713","","71128722  -  STAPLE BN SM 15X12.5MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128723","SUP","HCPCS C1713","","71128723  -  STAPLE BN SM 23X12.5MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128724","SUP","HCPCS C1713","","71128724  -  STAPLE BN SM 16X15MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128725","SUP","HCPCS C1713","","71128725  -  STAPLE BN SM 16X15MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128726","SUP","HCPCS C1713","","71128726  -  STAPLE BN LG 19X15MM SPK FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71128727","SUP","HCPCS C1713","","71128727  -  STAPLE BN LG 19X15MM FX","BOTH IP/OP","$507.15 ","$375.29 ","$0.00 ","$507.15 ","$228.22 ","$0.00 ","$105.70 ","$0.00 ","$0.00 ","$88.80 ","$507.15 ","$0.00 ","$253.58 ","$401.66 ","$405.72 ","$0.00 ","$79.37 ","$0.00 ","$80.74 ","$0.00 "
"71129030","SUP","HCPCS C1713","","71129030  -  SCREW BN FT 7MM 30MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129035","SUP","HCPCS C1713","","71129035  -  SCREW BN FT 7MM 35MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129040","SUP","HCPCS C1713","","71129040  -  SCREW BN FT 7MM 40MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129045","SUP","HCPCS C1713","","71129045  -  SCREW BN FT 7MM 45MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129050","SUP","HCPCS C1713","","71129050  -  SCREW BN FT 7MM 50MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129055","SUP","HCPCS C1713","","71129055  -  SCREW BN FT 7MM 55MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129060","SUP","HCPCS C1713","","71129060  -  SCREW BN FT 7MM 60MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129065","SUP","HCPCS C1713","","71129065  -  SCREW BN FT 7MM 65MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129070","SUP","HCPCS C1713","","71129070  -  SCREW BN FT 7MM 70MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129075","SUP","HCPCS C1713","","71129075  -  SCREW BN FT 7MM 75MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129080","SUP","HCPCS C1713","","71129080  -  SCREW BN FT 7MM 80MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129085","SUP","HCPCS C1713","","71129085  -  SCREW BN FT 7MM 85MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129090","SUP","HCPCS C1713","","71129090  -  SCREW BN FT 7MM 90MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129095","SUP","HCPCS C1713","","71129095  -  SCREW BN FT 7MM 95MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129100","SUP","HCPCS C1713","","71129100  -  SCREW BN FT 7MM 100MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129105","SUP","HCPCS C1713","","71129105  -  SCREW BN FT 7MM 105MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129110","SUP","HCPCS C1713","","71129110  -  SCREW BN FT 7MM 110MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129115","SUP","HCPCS C1713","","71129115  -  SCREW BN FT 7MM 115MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129120","SUP","HCPCS C1713","","71129120  -  SCREW BN FT 7MM 120MM STRL CNN SS ORTH","BOTH IP/OP","$467.25 ","$345.77 ","$0.00 ","$467.25 ","$210.26 ","$0.00 ","$97.39 ","$0.00 ","$0.00 ","$81.81 ","$467.25 ","$0.00 ","$233.63 ","$370.06 ","$373.80 ","$0.00 ","$73.12 ","$0.00 ","$74.39 ","$0.00 "
"71129125","SUP","HCPCS C1713","","71129125  -  SCREW BN FT 7MM 125MM STRL CNN SS ORTH","BOTH IP/OP","$467.25 ","$345.77 ","$0.00 ","$467.25 ","$210.26 ","$0.00 ","$97.39 ","$0.00 ","$0.00 ","$81.81 ","$467.25 ","$0.00 ","$233.63 ","$370.06 ","$373.80 ","$0.00 ","$73.12 ","$0.00 ","$74.39 ","$0.00 "
"71129130","SUP","HCPCS C1713","","71129130  -  SCREW BN FT 7MM 130MM STRL CNN SS ORTH","BOTH IP/OP","$487.20 ","$360.53 ","$0.00 ","$487.20 ","$219.24 ","$0.00 ","$101.54 ","$0.00 ","$0.00 ","$85.30 ","$487.20 ","$0.00 ","$243.60 ","$385.86 ","$389.76 ","$0.00 ","$76.25 ","$0.00 ","$77.56 ","$0.00 "
"71129212","SUP","HCPCS C1713","","71129212  -  SCREW BN 4.5MM 12MM AMBI CLS ST CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129214","SUP","HCPCS C1713","","71129214  -  SCREW BN 4.5MM 3.2MM 14MM AMBI CLS ST SS CORT HIP PLT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129216","SUP","HCPCS C1713","","71129216  -  SCREW BN 4.5MM 8MM 16MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129218","SUP","HCPCS C1713","","71129218  -  SCREW BN 4.5MM 8MM 18MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129220","SUP","HCPCS C1713","","71129220  -  SCREW BN 4.5MM 8MM 20MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129222","SUP","HCPCS C1713","","71129222  -  SCREW BN 4.5MM 8MM 22MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129224","SUP","HCPCS C1713","","71129224  -  SCREW BN 4.5MM 24MM CHS ST SS CORT HIP PLT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129226","SUP","HCPCS C1713","","71129226  -  SCREW BN 4.5MM 26MM AMBI CLS ST SS CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129228","SUP","HCPCS C1713","","71129228  -  SCREW BN 4.5MM 8MM 28MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129230","SUP","HCPCS C1713","","71129230  -  SCREW BN 4.5MM 3.2MM 30MM ST SS CORT SP CNDL PLT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129232","SUP","HCPCS C1713","","71129232  -  SCREW BN 4.5MM 8MM 32MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129234","SUP","HCPCS C1713","","71129234  -  SCREW BN 4.5MM 34MM IMHS ST SS CORT IM NL","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129236","SUP","HCPCS C1713","","71129236  -  SCREW BN 4.5MM 8MM 36MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129238","SUP","HCPCS C1713","","71129238  -  SCREW BN 4.5MM 8MM 38MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129240","SUP","HCPCS C1713","","71129240  -  SCREW BN 4.5MM 8MM 40MM ST HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129242","SUP","HCPCS C1713","","71129242  -  SCREW BN 4.5MM 8MM 42MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129244","SUP","HCPCS C1713","","71129244  -  SCREW BN 4.5MM 8MM 44MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129246","SUP","HCPCS C1713","","71129246  -  SCREW BN 4.5MM 8MM 46MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129248","SUP","HCPCS C1713","","71129248  -  SCREW BN 4.5MM 8MM 48MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129250","SUP","HCPCS C1713","","71129250  -  SCREW BN 4.5MM 8MM 50MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129252","SUP","HCPCS C1713","","71129252  -  SCREW BN 4.5MM 8MM 52MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129254","SUP","HCPCS C1713","","71129254  -  SCREW BN 4.5MM 8MM 54MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129256","SUP","HCPCS C1713","","71129256  -  SCREW BN 4.5MM 8MM 56MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129258","SUP","HCPCS C1713","","71129258  -  SCREW BN 4.5MM 3.2MM 58MM AMBI CLS ST SS CORT HIP PLT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129260","SUP","HCPCS C1713","","71129260  -  SCREW BN 4.5MM 8MM 60MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129262","SUP","HCPCS C1713","","71129262  -  SCREW BN 4.5MM 3.2MM 62MM AMBI CLS ST SS CORT HIP PLT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71129264","SUP","HCPCS C1713","","71129264  -  SCREW BN 4.5MM 8MM 64MM AMBI CLS ST SS HIP CORT","BOTH IP/OP","$54.13 ","$40.06 ","$0.00 ","$54.13 ","$24.36 ","$0.00 ","$11.28 ","$0.00 ","$0.00 ","$9.48 ","$54.13 ","$0.00 ","$27.06 ","$42.87 ","$43.30 ","$0.00 ","$8.47 ","$0.00 ","$8.62 ","$0.00 "
"71130205","SUP","HCPCS C1713","","71130205  -  PLATE BN 3.5MM 5 HL CMPR PRV FX 3.5MM SCR SM FRAG SET","BOTH IP/OP","$359.10 ","$265.73 ","$0.00 ","$359.10 ","$161.60 ","$0.00 ","$74.85 ","$0.00 ","$0.00 ","$62.88 ","$359.10 ","$0.00 ","$179.55 ","$284.41 ","$287.28 ","$0.00 ","$56.20 ","$0.00 ","$57.17 ","$0.00 "
"71130206","SUP","HCPCS C1713","","71130206  -  PLATE BN 3.5MM 6 HL CMPR PRV FX 3.5MM SCR SM FRAG SET","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$170.10 ","$0.00 ","$78.78 ","$0.00 ","$0.00 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$59.16 ","$0.00 ","$60.18 ","$0.00 "
"71130207","SUP","HCPCS C1713","","71130207  -  PLATE BN 3.5MM 7 HL CMPR PRV FX 3.5MM SCR SM FRAG SET","BOTH IP/OP","$389.55 ","$288.27 ","$0.00 ","$389.55 ","$175.30 ","$0.00 ","$81.19 ","$0.00 ","$0.00 ","$68.21 ","$389.55 ","$0.00 ","$194.78 ","$308.52 ","$311.64 ","$0.00 ","$60.96 ","$0.00 ","$62.02 ","$0.00 "
"71130208","SUP","HCPCS C1713","","71130208  -  PLATE BN 3.5MM 8 HL CMPR PRV FX 3.5MM SCR SM FRAG SET","BOTH IP/OP","$411.60 ","$304.58 ","$0.00 ","$411.60 ","$185.22 ","$0.00 ","$85.79 ","$0.00 ","$0.00 ","$72.07 ","$411.60 ","$0.00 ","$205.80 ","$325.99 ","$329.28 ","$0.00 ","$64.42 ","$0.00 ","$65.53 ","$0.00 "
"71130209","SUP","HCPCS C1713","","71130209  -  PLATE BN 3.5MM 9 HL CMPR PRV FX 3.5MM SCR SM FRAG SET","BOTH IP/OP","$434.70 ","$321.68 ","$0.00 ","$434.70 ","$195.62 ","$0.00 ","$90.60 ","$0.00 ","$0.00 ","$76.11 ","$434.70 ","$0.00 ","$217.35 ","$344.28 ","$347.76 ","$0.00 ","$68.03 ","$0.00 ","$69.20 ","$0.00 "
"71130210","SUP","HCPCS C1713","","71130210  -  PLATE BN 3.5MM 10 HL CMPR PRV FX 3.5MM SCR SM FRAG SET","BOTH IP/OP","$442.05 ","$327.12 ","$0.00 ","$442.05 ","$198.92 ","$0.00 ","$92.13 ","$0.00 ","$0.00 ","$77.40 ","$442.05 ","$0.00 ","$221.03 ","$350.10 ","$353.64 ","$0.00 ","$69.18 ","$0.00 ","$70.37 ","$0.00 "
"71130303","SUP","HCPCS C1713","","71130303  -  PLATE BN 1/3 TBLR 3 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$190.05 ","$140.64 ","$0.00 ","$190.05 ","$85.52 ","$0.00 ","$39.61 ","$0.00 ","$0.00 ","$33.28 ","$190.05 ","$0.00 ","$95.03 ","$150.52 ","$152.04 ","$0.00 ","$29.74 ","$0.00 ","$30.26 ","$0.00 "
"71130304","SUP","HCPCS C1713","","71130304  -  PLATE BN 1/3 TBLR 4 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$204.75 ","$92.14 ","$0.00 ","$42.68 ","$0.00 ","$0.00 ","$35.85 ","$204.75 ","$0.00 ","$102.38 ","$162.16 ","$163.80 ","$0.00 ","$32.04 ","$0.00 ","$32.60 ","$0.00 "
"71130305","SUP","HCPCS C1713","","71130305  -  PLATE BN 1/3 TBLR 5 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$218.40 ","$161.62 ","$0.00 ","$218.40 ","$98.28 ","$0.00 ","$45.52 ","$0.00 ","$0.00 ","$38.24 ","$218.40 ","$0.00 ","$109.20 ","$172.97 ","$174.72 ","$0.00 ","$34.18 ","$0.00 ","$34.77 ","$0.00 "
"71130306","SUP","HCPCS C1713","","71130306  -  PLATE BN 1/3 TBLR 6 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$211.05 ","$156.18 ","$0.00 ","$211.05 ","$94.97 ","$0.00 ","$43.99 ","$0.00 ","$0.00 ","$36.95 ","$211.05 ","$0.00 ","$105.53 ","$167.15 ","$168.84 ","$0.00 ","$33.03 ","$0.00 ","$33.60 ","$0.00 "
"71130307","SUP","HCPCS C1713","","71130307  -  PLATE BN 1/3 TBLR 7 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$227.85 ","$168.61 ","$0.00 ","$227.85 ","$102.53 ","$0.00 ","$47.49 ","$0.00 ","$0.00 ","$39.89 ","$227.85 ","$0.00 ","$113.93 ","$180.46 ","$182.28 ","$0.00 ","$35.66 ","$0.00 ","$36.27 ","$0.00 "
"71130308","SUP","HCPCS C1713","","71130308  -  PLATE BN 1/3 TBLR 8 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$235.20 ","$174.05 ","$0.00 ","$235.20 ","$105.84 ","$0.00 ","$49.02 ","$0.00 ","$0.00 ","$41.18 ","$235.20 ","$0.00 ","$117.60 ","$186.28 ","$188.16 ","$0.00 ","$36.81 ","$0.00 ","$37.44 ","$0.00 "
"71130310","SUP","HCPCS C1713","","71130310  -  PLATE BN 1/3 TBLR 10 HL COLR PRV FX SM FRAG SET","BOTH IP/OP","$246.75 ","$182.60 ","$0.00 ","$246.75 ","$111.04 ","$0.00 ","$51.43 ","$0.00 ","$0.00 ","$43.20 ","$246.75 ","$0.00 ","$123.38 ","$195.43 ","$197.40 ","$0.00 ","$38.62 ","$0.00 ","$39.28 ","$0.00 "
"71130403","SUP","HCPCS C1713","","71130403  -  PLATE BN T SM 3 HL PRV FX SM FRAG SET","BOTH IP/OP","$352.80 ","$261.07 ","$0.00 ","$352.80 ","$158.76 ","$0.00 ","$73.53 ","$0.00 ","$0.00 ","$61.77 ","$352.80 ","$0.00 ","$176.40 ","$279.42 ","$282.24 ","$0.00 ","$55.21 ","$0.00 ","$56.17 ","$0.00 "
"71130404","SUP","HCPCS C1713","","71130404  -  PLATE BN T SM 4 HL PRV FX SM FRAG SET","BOTH IP/OP","$360.15 ","$266.51 ","$0.00 ","$360.15 ","$162.07 ","$0.00 ","$75.06 ","$0.00 ","$0.00 ","$63.06 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$56.36 ","$0.00 ","$57.34 ","$0.00 "
"71130405","SUP","HCPCS C1713","","71130405  -  PLATE BN T SM 5 HL PRV FX SM FRAG SET","BOTH IP/OP","$456.75 ","$338.00 ","$0.00 ","$456.75 ","$205.54 ","$0.00 ","$95.20 ","$0.00 ","$0.00 ","$79.97 ","$456.75 ","$0.00 ","$228.38 ","$361.75 ","$365.40 ","$0.00 ","$71.48 ","$0.00 ","$72.71 ","$0.00 "
"71130503","SUP","HCPCS C1713","","71130503  -  PLATE BN T OBLQ 3 HL PRV FX SM FRAG SET","BOTH IP/OP","$581.70 ","$430.46 ","$0.00 ","$581.70 ","$261.77 ","$0.00 ","$121.24 ","$0.00 ","$0.00 ","$101.85 ","$581.70 ","$0.00 ","$290.85 ","$460.71 ","$465.36 ","$0.00 ","$91.04 ","$0.00 ","$92.61 ","$0.00 "
"71130504","SUP","HCPCS C1713","","71130504  -  PLATE BN T OBLQ 4 HL PRV FX SM FRAG SET","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"71130505","SUP","HCPCS C1713","","71130505  -  PLATE BN T OBLQ 5 HL PRV FX SM FRAG SET","BOTH IP/OP","$640.50 ","$473.97 ","$0.00 ","$640.50 ","$288.23 ","$0.00 ","$133.50 ","$0.00 ","$0.00 ","$112.15 ","$640.50 ","$0.00 ","$320.25 ","$507.28 ","$512.40 ","$0.00 ","$100.24 ","$0.00 ","$101.97 ","$0.00 "
"71130603","SUP","HCPCS C1713","","71130603  -  PLATE BN CLVRLF 3 HL PRV FX SM FRAG SET","BOTH IP/OP","$819.00 ","$606.06 ","$0.00 ","$819.00 ","$368.55 ","$0.00 ","$170.70 ","$0.00 ","$0.00 ","$143.40 ","$819.00 ","$0.00 ","$409.50 ","$648.65 ","$655.20 ","$0.00 ","$128.17 ","$0.00 ","$130.38 ","$0.00 "
"71130804","SUP","HCPCS C1713","","71130804  -  PLATE BN L BTRS 4 HL PRV FX LT LG FRAG SET","BOTH IP/OP","$922.95 ","$682.98 ","$0.00 ","$922.95 ","$415.33 ","$0.00 ","$192.37 ","$0.00 ","$0.00 ","$161.60 ","$922.95 ","$0.00 ","$461.48 ","$730.98 ","$738.36 ","$0.00 ","$144.44 ","$0.00 ","$146.93 ","$0.00 "
"71130904","SUP","HCPCS C1713","","71130904  -  PLATE BN L BTRS 4 HL PRV FX RT LG FRAG SET","BOTH IP/OP","$922.95 ","$682.98 ","$0.00 ","$922.95 ","$415.33 ","$0.00 ","$192.37 ","$0.00 ","$0.00 ","$161.60 ","$922.95 ","$0.00 ","$461.48 ","$730.98 ","$738.36 ","$0.00 ","$144.44 ","$0.00 ","$146.93 ","$0.00 "
"71131007","SUP","HCPCS C1713","","71131007  -  PLATE BN BTRS 7 HL PRV FX TIBHD RL LG FRAG SET","BOTH IP/OP","$1,974.00 ","$1,460.76 ","$0.00 ","$1,974.00 ","$888.30 ","$0.00 ","$411.43 ","$0.00 ","$0.00 ","$345.63 ","$1,974.00 ","$0.00 ","$987.00 ","$1,563.41 ","$1,579.20 ","$0.00 ","$308.93 ","$0.00 ","$314.26 ","$0.00 "
"71131009","SUP","HCPCS C1713","","71131009  -  PLATE BN BTRS 9 HL PRV FX TIBHD RL LG FRAG SET","BOTH IP/OP","$2,110.50 ","$1,561.77 ","$0.00 ","$2,110.50 ","$949.73 ","$0.00 ","$439.88 ","$0.00 ","$0.00 ","$369.53 ","$2,110.50 ","$0.00 ","$1,055.25 ","$1,671.52 ","$1,688.40 ","$0.00 ","$330.29 ","$0.00 ","$335.99 ","$0.00 "
"71131107","SUP","HCPCS C1713","","71131107  -  PLATE BN BTRS 7 HL PRV FX TIBHD L/L LG FRAG SET","BOTH IP/OP","$1,974.00 ","$1,460.76 ","$0.00 ","$1,974.00 ","$888.30 ","$0.00 ","$411.43 ","$0.00 ","$0.00 ","$345.63 ","$1,974.00 ","$0.00 ","$987.00 ","$1,563.41 ","$1,579.20 ","$0.00 ","$308.93 ","$0.00 ","$314.26 ","$0.00 "
"71131109","SUP","HCPCS C1713","","71131109  -  PLATE BN BTRS 9 HL PRV FX TIBHD L/L LG FRAG SET","BOTH IP/OP","$2,110.50 ","$1,561.77 ","$0.00 ","$2,110.50 ","$949.73 ","$0.00 ","$439.88 ","$0.00 ","$0.00 ","$369.53 ","$2,110.50 ","$0.00 ","$1,055.25 ","$1,671.52 ","$1,688.40 ","$0.00 ","$330.29 ","$0.00 ","$335.99 ","$0.00 "
"71131206","SUP","HCPCS C1713","","71131206  -  PLATE BN 4.5MM BRD 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$703.50 ","$520.59 ","$0.00 ","$703.50 ","$316.58 ","$0.00 ","$146.63 ","$0.00 ","$0.00 ","$123.18 ","$703.50 ","$0.00 ","$351.75 ","$557.17 ","$562.80 ","$0.00 ","$110.10 ","$0.00 ","$112.00 ","$0.00 "
"71131207","SUP","HCPCS C1713","","71131207  -  PLATE BN 4.5MM BRD 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$703.50 ","$520.59 ","$0.00 ","$703.50 ","$316.58 ","$0.00 ","$146.63 ","$0.00 ","$0.00 ","$123.18 ","$703.50 ","$0.00 ","$351.75 ","$557.17 ","$562.80 ","$0.00 ","$110.10 ","$0.00 ","$112.00 ","$0.00 "
"71131208","SUP","HCPCS C1713","","71131208  -  PLATE BN 4.5MM BRD 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$875.70 ","$648.02 ","$0.00 ","$875.70 ","$394.07 ","$0.00 ","$182.52 ","$0.00 ","$0.00 ","$153.33 ","$875.70 ","$0.00 ","$437.85 ","$693.55 ","$700.56 ","$0.00 ","$137.05 ","$0.00 ","$139.41 ","$0.00 "
"71131209","SUP","HCPCS C1713","","71131209  -  PLATE BN 4.5MM BRD 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$875.70 ","$648.02 ","$0.00 ","$875.70 ","$394.07 ","$0.00 ","$182.52 ","$0.00 ","$0.00 ","$153.33 ","$875.70 ","$0.00 ","$437.85 ","$693.55 ","$700.56 ","$0.00 ","$137.05 ","$0.00 ","$139.41 ","$0.00 "
"71131210","SUP","HCPCS C1713","","71131210  -  PLATE BN 4.5MM BRD 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$875.70 ","$648.02 ","$0.00 ","$875.70 ","$394.07 ","$0.00 ","$182.52 ","$0.00 ","$0.00 ","$153.33 ","$875.70 ","$0.00 ","$437.85 ","$693.55 ","$700.56 ","$0.00 ","$137.05 ","$0.00 ","$139.41 ","$0.00 "
"71131212","SUP","HCPCS C1713","","71131212  -  PLATE BN 4.5MM BRD 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$939.75 ","$695.42 ","$0.00 ","$939.75 ","$422.89 ","$0.00 ","$195.87 ","$0.00 ","$0.00 ","$164.54 ","$939.75 ","$0.00 ","$469.88 ","$744.28 ","$751.80 ","$0.00 ","$147.07 ","$0.00 ","$149.61 ","$0.00 "
"71131214","SUP","HCPCS C1713","","71131214  -  PLATE BN 4.5MM BRD 14 HL PRV FX PERIART MTPHSL 4.5MM SCR LG","BOTH IP/OP","$939.75 ","$695.42 ","$0.00 ","$939.75 ","$422.89 ","$0.00 ","$195.87 ","$0.00 ","$0.00 ","$164.54 ","$939.75 ","$0.00 ","$469.88 ","$744.28 ","$751.80 ","$0.00 ","$147.07 ","$0.00 ","$149.61 ","$0.00 "
"71131304","SUP","HCPCS C1713","","71131304  -  PLATE BN SMTB 4 HL PRV FX LG FRAG SET","BOTH IP/OP","$190.05 ","$140.64 ","$0.00 ","$190.05 ","$85.52 ","$0.00 ","$39.61 ","$0.00 ","$0.00 ","$33.28 ","$190.05 ","$0.00 ","$95.03 ","$150.52 ","$152.04 ","$0.00 ","$29.74 ","$0.00 ","$30.26 ","$0.00 "
"71131305","SUP","HCPCS C1713","","71131305  -  PLATE BN SMTB 5 HL PRV FX LG FRAG SET","BOTH IP/OP","$192.15 ","$142.19 ","$0.00 ","$192.15 ","$86.47 ","$0.00 ","$40.05 ","$0.00 ","$0.00 ","$33.64 ","$192.15 ","$0.00 ","$96.08 ","$152.18 ","$153.72 ","$0.00 ","$30.07 ","$0.00 ","$30.59 ","$0.00 "
"71131306","SUP","HCPCS C1713","","71131306  -  PLATE BN SMTB 6 HL PRV FX LG FRAG SET","BOTH IP/OP","$211.05 ","$156.18 ","$0.00 ","$211.05 ","$94.97 ","$0.00 ","$43.99 ","$0.00 ","$0.00 ","$36.95 ","$211.05 ","$0.00 ","$105.53 ","$167.15 ","$168.84 ","$0.00 ","$33.03 ","$0.00 ","$33.60 ","$0.00 "
"71131307","SUP","HCPCS C1713","","71131307  -  PLATE BN SMTB 7 HL PRV FX LG FRAG SET","BOTH IP/OP","$223.65 ","$165.50 ","$0.00 ","$223.65 ","$100.64 ","$0.00 ","$46.61 ","$0.00 ","$0.00 ","$39.16 ","$223.65 ","$0.00 ","$111.83 ","$177.13 ","$178.92 ","$0.00 ","$35.00 ","$0.00 ","$35.61 ","$0.00 "
"71131403","SUP","HCPCS C1713","","71131403  -  PLATE BN NAR 3 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$473.55 ","$350.43 ","$0.00 ","$473.55 ","$213.10 ","$0.00 ","$98.70 ","$0.00 ","$0.00 ","$82.91 ","$473.55 ","$0.00 ","$236.78 ","$375.05 ","$378.84 ","$0.00 ","$74.11 ","$0.00 ","$75.39 ","$0.00 "
"71131404","SUP","HCPCS C1713","","71131404  -  PLATE BN NAR 4 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$473.55 ","$350.43 ","$0.00 ","$473.55 ","$213.10 ","$0.00 ","$98.70 ","$0.00 ","$0.00 ","$82.91 ","$473.55 ","$0.00 ","$236.78 ","$375.05 ","$378.84 ","$0.00 ","$74.11 ","$0.00 ","$75.39 ","$0.00 "
"71131405","SUP","HCPCS C1713","","71131405  -  PLATE BN NAR 5 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$473.55 ","$350.43 ","$0.00 ","$473.55 ","$213.10 ","$0.00 ","$98.70 ","$0.00 ","$0.00 ","$82.91 ","$473.55 ","$0.00 ","$236.78 ","$375.05 ","$378.84 ","$0.00 ","$74.11 ","$0.00 ","$75.39 ","$0.00 "
"71131406","SUP","HCPCS C1713","","71131406  -  PLATE BN NAR 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71131407","SUP","HCPCS C1713","","71131407  -  PLATE BN NAR 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$526.05 ","$389.28 ","$0.00 ","$526.05 ","$236.72 ","$0.00 ","$109.64 ","$0.00 ","$0.00 ","$92.11 ","$526.05 ","$0.00 ","$263.03 ","$416.63 ","$420.84 ","$0.00 ","$82.33 ","$0.00 ","$83.75 ","$0.00 "
"71131408","SUP","HCPCS C1713","","71131408  -  PLATE BN NAR 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71131409","SUP","HCPCS C1713","","71131409  -  PLATE BN NAR 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71131410","SUP","HCPCS C1713","","71131410  -  PLATE BN NAR 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$570.15 ","$421.91 ","$0.00 ","$570.15 ","$256.57 ","$0.00 ","$118.83 ","$0.00 ","$0.00 ","$99.83 ","$570.15 ","$0.00 ","$285.08 ","$451.56 ","$456.12 ","$0.00 ","$89.23 ","$0.00 ","$90.77 ","$0.00 "
"71131411","SUP","HCPCS C1713","","71131411  -  PLATE BN NAR 11 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$696.15 ","$515.15 ","$0.00 ","$696.15 ","$313.27 ","$0.00 ","$145.10 ","$0.00 ","$0.00 ","$121.89 ","$696.15 ","$0.00 ","$348.08 ","$551.35 ","$556.92 ","$0.00 ","$108.95 ","$0.00 ","$110.83 ","$0.00 "
"71131412","SUP","HCPCS C1713","","71131412  -  PLATE BN NAR 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG","BOTH IP/OP","$696.15 ","$515.15 ","$0.00 ","$696.15 ","$313.27 ","$0.00 ","$145.10 ","$0.00 ","$0.00 ","$121.89 ","$696.15 ","$0.00 ","$348.08 ","$551.35 ","$556.92 ","$0.00 ","$108.95 ","$0.00 ","$110.83 ","$0.00 "
"71131510","SUP","HCPCS C1713","","71131510  -  PIN FX LG ST 2MM 61MM 10MM TRL SS","BOTH IP/OP","$221.55 ","$163.95 ","$0.00 ","$221.55 ","$99.70 ","$0.00 ","$46.18 ","$0.00 ","$0.00 ","$38.79 ","$221.55 ","$0.00 ","$110.78 ","$175.47 ","$177.24 ","$0.00 ","$34.67 ","$0.00 ","$35.27 ","$0.00 "
"71131511","SUP","HCPCS C1713","","71131511  -  PIN FX LG MED THRD 2MM 38MM 13MM TRL SS","BOTH IP/OP","$221.55 ","$163.95 ","$0.00 ","$221.55 ","$99.70 ","$0.00 ","$46.18 ","$0.00 ","$0.00 ","$38.79 ","$221.55 ","$0.00 ","$110.78 ","$175.47 ","$177.24 ","$0.00 ","$34.67 ","$0.00 ","$35.27 ","$0.00 "
"71131512","SUP","HCPCS C1713","","71131512  -  PIN FX LG L/T 2MM 61MM 23MM TRL SS","BOTH IP/OP","$235.20 ","$174.05 ","$0.00 ","$235.20 ","$105.84 ","$0.00 ","$49.02 ","$0.00 ","$0.00 ","$41.18 ","$235.20 ","$0.00 ","$117.60 ","$186.28 ","$188.16 ","$0.00 ","$36.81 ","$0.00 ","$37.44 ","$0.00 "
"71131604","SUP","HCPCS C1713","","71131604  -  PLATE BN T 4 HL PRV FX LG FRAG SET","BOTH IP/OP","$340.20 ","$251.75 ","$0.00 ","$340.20 ","$153.09 ","$0.00 ","$70.91 ","$0.00 ","$0.00 ","$59.57 ","$340.20 ","$0.00 ","$170.10 ","$269.44 ","$272.16 ","$0.00 ","$53.24 ","$0.00 ","$54.16 ","$0.00 "
"71131606","SUP","HCPCS C1713","","71131606  -  PLATE BN T 6 HL PRV FX LG FRAG SET","BOTH IP/OP","$376.95 ","$278.94 ","$0.00 ","$376.95 ","$169.63 ","$0.00 ","$78.57 ","$0.00 ","$0.00 ","$66.00 ","$376.95 ","$0.00 ","$188.48 ","$298.54 ","$301.56 ","$0.00 ","$58.99 ","$0.00 ","$60.01 ","$0.00 "
"71131608","SUP","HCPCS C1713","","71131608  -  PLATE BN T 8 HL PRV FX LG FRAG SET","BOTH IP/OP","$1,118.25 ","$827.51 ","$0.00 ","$1,118.25 ","$503.21 ","$0.00 ","$233.07 ","$0.00 ","$0.00 ","$195.80 ","$1,118.25 ","$0.00 ","$559.13 ","$885.65 ","$894.60 ","$0.00 ","$175.01 ","$0.00 ","$178.03 ","$0.00 "
"71134016","SUP","Custom 27203010","","71134016  -  BIT DRL 2MM TWST PED","BOTH IP/OP","$91.40 ","$67.64 ","$0.00 ","$91.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.40 ","$0.00 ","$45.70 ","$72.39 ","$73.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71134064","SUP","Custom 27203010","","71134064  -  BIT DRL 2.7MM TWST PED","BOTH IP/OP","$95.70 ","$70.82 ","$0.00 ","$95.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.70 ","$0.00 ","$47.85 ","$75.79 ","$76.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71140003","SUP","HCPCS C1713","","71140003  -  PLATE BN 45MM TC100 3 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$798.00 ","$590.52 ","$0.00 ","$798.00 ","$359.10 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$139.72 ","$798.00 ","$0.00 ","$399.00 ","$632.02 ","$638.40 ","$0.00 ","$124.89 ","$0.00 ","$127.04 ","$0.00 "
"71140004","SUP","HCPCS C1713","","71140004  -  PLATE BN 61MM TC100 4 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$846.30 ","$626.26 ","$0.00 ","$846.30 ","$380.84 ","$0.00 ","$176.39 ","$0.00 ","$0.00 ","$148.18 ","$846.30 ","$0.00 ","$423.15 ","$670.27 ","$677.04 ","$0.00 ","$132.45 ","$0.00 ","$134.73 ","$0.00 "
"71140005","SUP","HCPCS C1713","","71140005  -  PLATE BN 77MM TC100 5 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$910.35 ","$673.66 ","$0.00 ","$910.35 ","$409.66 ","$0.00 ","$189.74 ","$0.00 ","$0.00 ","$159.40 ","$910.35 ","$0.00 ","$455.18 ","$721.00 ","$728.28 ","$0.00 ","$142.47 ","$0.00 ","$144.93 ","$0.00 "
"71140006","SUP","HCPCS C1713","","71140006  -  PLATE BN 93MM TC100 6 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$972.30 ","$719.50 ","$0.00 ","$972.30 ","$437.54 ","$0.00 ","$202.65 ","$0.00 ","$0.00 ","$170.24 ","$972.30 ","$0.00 ","$486.15 ","$770.06 ","$777.84 ","$0.00 ","$152.16 ","$0.00 ","$154.79 ","$0.00 "
"71140007","SUP","HCPCS C1713","","71140007  -  PLATE BN 109MM TC100 7 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,025.85 ","$759.13 ","$0.00 ","$1,025.85 ","$461.63 ","$0.00 ","$213.81 ","$0.00 ","$0.00 ","$179.62 ","$1,025.85 ","$0.00 ","$512.93 ","$812.47 ","$820.68 ","$0.00 ","$160.55 ","$0.00 ","$163.32 ","$0.00 "
"71140008","SUP","HCPCS C1713","","71140008  -  PLATE BN 125MM TC100 8 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71140009","SUP","HCPCS C1713","","71140009  -  PLATE BN 141MM TC100 9 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,391.25 ","$1,029.53 ","$0.00 ","$1,391.25 ","$626.06 ","$0.00 ","$289.97 ","$0.00 ","$0.00 ","$243.60 ","$1,391.25 ","$0.00 ","$695.63 ","$1,101.87 ","$1,113.00 ","$0.00 ","$217.73 ","$0.00 ","$221.49 ","$0.00 "
"71140010","SUP","HCPCS C1713","","71140010  -  PLATE BN 157MM TC100 10 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,464.75 ","$1,083.92 ","$0.00 ","$1,464.75 ","$659.14 ","$0.00 ","$305.29 ","$0.00 ","$0.00 ","$256.47 ","$1,464.75 ","$0.00 ","$732.38 ","$1,160.08 ","$1,171.80 ","$0.00 ","$229.23 ","$0.00 ","$233.19 ","$0.00 "
"71140011","SUP","HCPCS C1713","","71140011  -  PLATE BN 173MM TC100 11 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,506.75 ","$1,115.00 ","$0.00 ","$1,506.75 ","$678.04 ","$0.00 ","$314.04 ","$0.00 ","$0.00 ","$263.82 ","$1,506.75 ","$0.00 ","$753.38 ","$1,193.35 ","$1,205.40 ","$0.00 ","$235.81 ","$0.00 ","$239.87 ","$0.00 "
"71140012","SUP","HCPCS C1713","","71140012  -  PLATE BN 189MM TC100 12 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71140013","SUP","HCPCS C1713","","71140013  -  PLATE BN 205MM TC100 13 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$0.00 ","$0.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"71140014","SUP","HCPCS C1713","","71140014  -  PLATE BN 221MM TC100 14 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71140015","SUP","HCPCS C1713","","71140015  -  PLATE BN 237MM TC100 15 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,806.00 ","$1,336.44 ","$0.00 ","$1,806.00 ","$812.70 ","$0.00 ","$376.42 ","$0.00 ","$0.00 ","$316.22 ","$1,806.00 ","$0.00 ","$903.00 ","$1,430.35 ","$1,444.80 ","$0.00 ","$282.64 ","$0.00 ","$287.52 ","$0.00 "
"71140016","SUP","HCPCS C1713","","71140016  -  PLATE BN 253MM TC100 16 HL RECON SS PLVC 4.5MM SCR","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,869.00 ","$841.05 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$327.25 ","$1,869.00 ","$0.00 ","$934.50 ","$1,480.25 ","$1,495.20 ","$0.00 ","$292.50 ","$0.00 ","$297.54 ","$0.00 "
"71140104","SUP","HCPCS C1713","","71140104  -  PLATE BN 46MM TC100 4 HL RECON SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$875.70 ","$648.02 ","$0.00 ","$875.70 ","$394.07 ","$0.00 ","$182.52 ","$0.00 ","$0.00 ","$153.33 ","$875.70 ","$0.00 ","$437.85 ","$693.55 ","$700.56 ","$0.00 ","$137.05 ","$0.00 ","$139.41 ","$0.00 "
"71140105","SUP","HCPCS C1713","","71140105  -  PLATE BN 58MM TC100 5 HL RECON SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$812.70 ","$601.40 ","$0.00 ","$812.70 ","$365.72 ","$0.00 ","$169.39 ","$0.00 ","$0.00 ","$142.30 ","$812.70 ","$0.00 ","$406.35 ","$643.66 ","$650.16 ","$0.00 ","$127.19 ","$0.00 ","$129.38 ","$0.00 "
"71140106","SUP","HCPCS C1713","","71140106  -  PLATE BN 70MM TC100 6 HL RECON SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,022.70 ","$756.80 ","$0.00 ","$1,022.70 ","$460.22 ","$0.00 ","$213.16 ","$0.00 ","$0.00 ","$179.07 ","$1,022.70 ","$0.00 ","$511.35 ","$809.98 ","$818.16 ","$0.00 ","$160.05 ","$0.00 ","$162.81 ","$0.00 "
"71140107","SUP","HCPCS C1713","","71140107  -  PLATE BN 82MM TC100 7 HL RECON SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$974.40 ","$721.06 ","$0.00 ","$974.40 ","$438.48 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.40 ","$0.00 ","$487.20 ","$771.72 ","$779.52 ","$0.00 ","$152.49 ","$0.00 ","$155.12 ","$0.00 "
"71140108","SUP","HCPCS C1713","","71140108  -  PLATE BN 94MM TC100 8 HL RECON SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,118.25 ","$827.51 ","$0.00 ","$1,118.25 ","$503.21 ","$0.00 ","$233.07 ","$0.00 ","$0.00 ","$195.80 ","$1,118.25 ","$0.00 ","$559.13 ","$885.65 ","$894.60 ","$0.00 ","$175.01 ","$0.00 ","$178.03 ","$0.00 "
"71140109","SUP","HCPCS C1713","","71140109  -  PLATE BN 106MM TC100 9 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$472.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$183.85 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$164.33 ","$0.00 ","$167.16 ","$0.00 "
"71140110","SUP","HCPCS C1713","","71140110  -  PLATE BN 118MM TC100 10 HL RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71140111","SUP","HCPCS C1713","","71140111  -  PLATE BN 130MM TC100 11 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,118.25 ","$827.51 ","$0.00 ","$1,118.25 ","$503.21 ","$0.00 ","$233.07 ","$0.00 ","$0.00 ","$195.80 ","$1,118.25 ","$0.00 ","$559.13 ","$885.65 ","$894.60 ","$0.00 ","$175.01 ","$0.00 ","$178.03 ","$0.00 "
"71140112","SUP","HCPCS C1713","","71140112  -  PLATE BN 142MM TC100 12 HL RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71140113","SUP","HCPCS C1713","","71140113  -  PLATE BN 154MM TC100 13 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"71140114","SUP","HCPCS C1713","","71140114  -  PLATE BN 166MM TC100 14 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,380.75 ","$1,021.76 ","$0.00 ","$1,380.75 ","$621.34 ","$0.00 ","$287.78 ","$0.00 ","$0.00 ","$241.76 ","$1,380.75 ","$0.00 ","$690.38 ","$1,093.55 ","$1,104.60 ","$0.00 ","$216.09 ","$0.00 ","$219.82 ","$0.00 "
"71140115","SUP","HCPCS C1713","","71140115  -  PLATE BN 178MM TC100 15 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,648.50 ","$1,219.89 ","$0.00 ","$1,648.50 ","$741.83 ","$0.00 ","$343.59 ","$0.00 ","$0.00 ","$288.64 ","$1,648.50 ","$0.00 ","$824.25 ","$1,305.61 ","$1,318.80 ","$0.00 ","$257.99 ","$0.00 ","$262.44 ","$0.00 "
"71140116","SUP","HCPCS C1713","","71140116  -  PLATE BN 190MM TC100 16 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$633.15 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$246.35 ","$1,407.00 ","$0.00 ","$703.50 ","$1,114.34 ","$1,125.60 ","$0.00 ","$220.20 ","$0.00 ","$223.99 ","$0.00 "
"71140118","SUP","HCPCS C1713","","71140118  -  PLATE BN 214MM TC100 18 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,480.50 ","$1,095.57 ","$0.00 ","$1,480.50 ","$666.23 ","$0.00 ","$308.57 ","$0.00 ","$0.00 ","$259.22 ","$1,480.50 ","$0.00 ","$740.25 ","$1,172.56 ","$1,184.40 ","$0.00 ","$231.70 ","$0.00 ","$235.70 ","$0.00 "
"71140120","SUP","HCPCS C1713","","71140120  -  PLATE BN 238MM TC100 20 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,800.75 ","$1,332.56 ","$0.00 ","$1,800.75 ","$810.34 ","$0.00 ","$375.32 ","$0.00 ","$0.00 ","$315.30 ","$1,800.75 ","$0.00 ","$900.38 ","$1,426.19 ","$1,440.60 ","$0.00 ","$281.82 ","$0.00 ","$286.68 ","$0.00 "
"71140122","SUP","HCPCS C1713","","71140122  -  PLATE BN 263MM TC100 22 HL RECON SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,283.75 ","$1,027.69 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$399.87 ","$2,283.75 ","$0.00 ","$1,141.88 ","$1,808.73 ","$1,827.00 ","$0.00 ","$357.41 ","$0.00 ","$363.57 ","$0.00 "
"71140202","SUP","HCPCS C1713","","71140202  -  PLATE BN 25MM TC100 2 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$296.10 ","$219.11 ","$0.00 ","$296.10 ","$133.25 ","$0.00 ","$61.71 ","$0.00 ","$0.00 ","$51.84 ","$296.10 ","$0.00 ","$148.05 ","$234.51 ","$236.88 ","$0.00 ","$46.34 ","$0.00 ","$47.14 ","$0.00 "
"71140203","SUP","HCPCS C1713","","71140203  -  PLATE BN 37MM TC100 3 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$309.75 ","$229.22 ","$0.00 ","$309.75 ","$139.39 ","$0.00 ","$64.56 ","$0.00 ","$0.00 ","$54.23 ","$309.75 ","$0.00 ","$154.88 ","$245.32 ","$247.80 ","$0.00 ","$48.48 ","$0.00 ","$49.31 ","$0.00 "
"71140204","SUP","HCPCS C1713","","71140204  -  PLATE BN 49MM TC100 4 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$316.05 ","$233.88 ","$0.00 ","$316.05 ","$142.22 ","$0.00 ","$65.87 ","$0.00 ","$0.00 ","$55.34 ","$316.05 ","$0.00 ","$158.03 ","$250.31 ","$252.84 ","$0.00 ","$49.46 ","$0.00 ","$50.32 ","$0.00 "
"71140205","SUP","HCPCS C1713","","71140205  -  PLATE BN 61MM TC100 5 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$345.45 ","$255.63 ","$0.00 ","$345.45 ","$155.45 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$60.49 ","$345.45 ","$0.00 ","$172.73 ","$273.60 ","$276.36 ","$0.00 ","$54.06 ","$0.00 ","$55.00 ","$0.00 "
"71140206","SUP","HCPCS C1713","","71140206  -  PLATE BN 73MM TC100 6 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$361.20 ","$267.29 ","$0.00 ","$361.20 ","$162.54 ","$0.00 ","$75.28 ","$0.00 ","$0.00 ","$63.24 ","$361.20 ","$0.00 ","$180.60 ","$286.07 ","$288.96 ","$0.00 ","$56.53 ","$0.00 ","$57.50 ","$0.00 "
"71140207","SUP","HCPCS C1713","","71140207  -  PLATE BN 85MM TC100 7 HL CMPR SS PLVC 3.5MM SCR","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$170.10 ","$0.00 ","$78.78 ","$0.00 ","$0.00 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$59.16 ","$0.00 ","$60.18 ","$0.00 "
"71140208","SUP","HCPCS C1713","","71140208  -  PLATE BN 97MM 8 HL HIP 3.5MM SCR SM FRAG SET","BOTH IP/OP","$405.30 ","$299.92 ","$0.00 ","$405.30 ","$182.39 ","$0.00 ","$84.47 ","$0.00 ","$0.00 ","$70.96 ","$405.30 ","$0.00 ","$202.65 ","$321.00 ","$324.24 ","$0.00 ","$63.43 ","$0.00 ","$64.52 ","$0.00 "
"71140209","SUP","HCPCS C1713","","71140209  -  PLATE BN 109MM TC100 9 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$414.75 ","$306.92 ","$0.00 ","$414.75 ","$186.64 ","$0.00 ","$86.44 ","$0.00 ","$0.00 ","$72.62 ","$414.75 ","$0.00 ","$207.38 ","$328.48 ","$331.80 ","$0.00 ","$64.91 ","$0.00 ","$66.03 ","$0.00 "
"71140210","SUP","HCPCS C1713","","71140210  -  PLATE BN 121MM TC100 10 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$426.30 ","$315.46 ","$0.00 ","$426.30 ","$191.84 ","$0.00 ","$88.85 ","$0.00 ","$0.00 ","$74.64 ","$426.30 ","$0.00 ","$213.15 ","$337.63 ","$341.04 ","$0.00 ","$66.72 ","$0.00 ","$67.87 ","$0.00 "
"71140212","SUP","HCPCS C1713","","71140212  -  PLATE BN 145MM TC100 12 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$473.55 ","$350.43 ","$0.00 ","$473.55 ","$213.10 ","$0.00 ","$98.70 ","$0.00 ","$0.00 ","$82.91 ","$473.55 ","$0.00 ","$236.78 ","$375.05 ","$378.84 ","$0.00 ","$74.11 ","$0.00 ","$75.39 ","$0.00 "
"71140214","SUP","HCPCS C1713","","71140214  -  PLATE BN 169MM TC100 14 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$889.35 ","$658.12 ","$0.00 ","$889.35 ","$400.21 ","$0.00 ","$185.36 ","$0.00 ","$0.00 ","$155.72 ","$889.35 ","$0.00 ","$444.68 ","$704.37 ","$711.48 ","$0.00 ","$139.18 ","$0.00 ","$141.58 ","$0.00 "
"71140216","SUP","HCPCS C1713","","71140216  -  PLATE BN 194MM TC100 16 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,025.85 ","$759.13 ","$0.00 ","$1,025.85 ","$461.63 ","$0.00 ","$213.81 ","$0.00 ","$0.00 ","$179.62 ","$1,025.85 ","$0.00 ","$512.93 ","$812.47 ","$820.68 ","$0.00 ","$160.55 ","$0.00 ","$163.32 ","$0.00 "
"71140218","SUP","HCPCS C1713","","71140218  -  PLATE BN 217MM TC100 18 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,380.75 ","$1,021.76 ","$0.00 ","$1,380.75 ","$621.34 ","$0.00 ","$287.78 ","$0.00 ","$0.00 ","$241.76 ","$1,380.75 ","$0.00 ","$690.38 ","$1,093.55 ","$1,104.60 ","$0.00 ","$216.09 ","$0.00 ","$219.82 ","$0.00 "
"71140220","SUP","HCPCS C1713","","71140220  -  PLATE BN 242MM TC100 20 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,270.50 ","$940.17 ","$0.00 ","$1,270.50 ","$571.73 ","$0.00 ","$264.80 ","$0.00 ","$0.00 ","$222.45 ","$1,270.50 ","$0.00 ","$635.25 ","$1,006.24 ","$1,016.40 ","$0.00 ","$198.83 ","$0.00 ","$202.26 ","$0.00 "
"71140222","SUP","HCPCS C1713","","71140222  -  PLATE BN 265MM TC100 22 HL CMPR SS PLVC 3.5MM SCR SM FRAG","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$0.00 ","$0.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"71140302","SUP","HCPCS C1713","","71140302  -  PLATE BN 25MM TC100 2 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$169.05 ","$125.10 ","$0.00 ","$169.05 ","$76.07 ","$0.00 ","$35.23 ","$0.00 ","$0.00 ","$29.60 ","$169.05 ","$0.00 ","$84.53 ","$133.89 ","$135.24 ","$0.00 ","$26.46 ","$0.00 ","$26.91 ","$0.00 "
"71140303","SUP","HCPCS C1713","","71140303  -  PLATE BN 37MM TC100 3 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$143.85 ","$106.45 ","$0.00 ","$143.85 ","$64.73 ","$0.00 ","$29.98 ","$0.00 ","$0.00 ","$25.19 ","$143.85 ","$0.00 ","$71.93 ","$113.93 ","$115.08 ","$0.00 ","$22.51 ","$0.00 ","$22.90 ","$0.00 "
"71140304","SUP","HCPCS C1713","","71140304  -  PLATE BN 49MM TC100 4 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$169.05 ","$125.10 ","$0.00 ","$169.05 ","$76.07 ","$0.00 ","$35.23 ","$0.00 ","$0.00 ","$29.60 ","$169.05 ","$0.00 ","$84.53 ","$133.89 ","$135.24 ","$0.00 ","$26.46 ","$0.00 ","$26.91 ","$0.00 "
"71140305","SUP","HCPCS C1713","","71140305  -  PLATE BN 61MM TC100 5 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$211.05 ","$156.18 ","$0.00 ","$211.05 ","$94.97 ","$0.00 ","$43.99 ","$0.00 ","$0.00 ","$36.95 ","$211.05 ","$0.00 ","$105.53 ","$167.15 ","$168.84 ","$0.00 ","$33.03 ","$0.00 ","$33.60 ","$0.00 "
"71140306","SUP","HCPCS C1713","","71140306  -  PLATE BN 73MM TC100 6 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$175.35 ","$129.76 ","$0.00 ","$175.35 ","$78.91 ","$0.00 ","$36.55 ","$0.00 ","$0.00 ","$30.70 ","$175.35 ","$0.00 ","$87.68 ","$138.88 ","$140.28 ","$0.00 ","$27.44 ","$0.00 ","$27.92 ","$0.00 "
"71140307","SUP","HCPCS C1713","","71140307  -  PLATE BN 1/3 TBLR 85MM NS TC100 7 HL COLR SS PLVC 3.5MM SCR","BOTH IP/OP","$175.35 ","$129.76 ","$0.00 ","$175.35 ","$78.91 ","$0.00 ","$36.55 ","$0.00 ","$0.00 ","$30.70 ","$175.35 ","$0.00 ","$87.68 ","$138.88 ","$140.28 ","$0.00 ","$27.44 ","$0.00 ","$27.92 ","$0.00 "
"71140308","SUP","HCPCS C1713","","71140308  -  PLATE BN 97MM TC100 8 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"71140309","SUP","HCPCS C1713","","71140309  -  PLATE BN 109MM TC100 9 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"71140310","SUP","HCPCS C1713","","71140310  -  PLATE BN 121MM TC100 10 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"71140312","SUP","HCPCS C1713","","71140312  -  PLATE BN 145MM TC100 12 HL 1/3 TBLR COLR SS ORTH SM FRAG SET","BOTH IP/OP","$181.65 ","$134.42 ","$0.00 ","$181.65 ","$81.74 ","$0.00 ","$37.86 ","$0.00 ","$0.00 ","$31.81 ","$181.65 ","$0.00 ","$90.83 ","$143.87 ","$145.32 ","$0.00 ","$28.43 ","$0.00 ","$28.92 ","$0.00 "
"71140403","SUP","HCPCS C1713","","71140403  -  PLATE BN SM T RT ANG 50MM TC100 3X3 HL SS PLVC SM FRAG SET","BOTH IP/OP","$313.95 ","$232.32 ","$0.00 ","$313.95 ","$141.28 ","$0.00 ","$65.44 ","$0.00 ","$0.00 ","$54.97 ","$313.95 ","$0.00 ","$156.98 ","$248.65 ","$251.16 ","$0.00 ","$49.13 ","$0.00 ","$49.98 ","$0.00 "
"71140404","SUP","HCPCS C1713","","71140404  -  PLATE BN SM T RT ANG 50MM TC100 4X4 HL SS PLVC SM FRAG SET","BOTH IP/OP","$320.25 ","$236.99 ","$0.00 ","$320.25 ","$144.11 ","$0.00 ","$66.75 ","$0.00 ","$0.00 ","$56.07 ","$320.25 ","$0.00 ","$160.13 ","$253.64 ","$256.20 ","$0.00 ","$50.12 ","$0.00 ","$50.98 ","$0.00 "
"71140405","SUP","HCPCS C1713","","71140405  -  PLATE BN SM T RT ANG 50MM TC100 3X5 HL SS PLVC SM FRAG SET","BOTH IP/OP","$360.15 ","$266.51 ","$0.00 ","$360.15 ","$162.07 ","$0.00 ","$75.06 ","$0.00 ","$0.00 ","$63.06 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$56.36 ","$0.00 ","$57.34 ","$0.00 "
"71140406","SUP","HCPCS C1713","","71140406  -  PLATE BN 78MM TC100 4 HLE/HD 6 HL SHFT T RT ANG SS ORTH SM","BOTH IP/OP","$414.75 ","$306.92 ","$0.00 ","$414.75 ","$186.64 ","$0.00 ","$86.44 ","$0.00 ","$0.00 ","$72.62 ","$414.75 ","$0.00 ","$207.38 ","$328.48 ","$331.80 ","$0.00 ","$64.91 ","$0.00 ","$66.03 ","$0.00 "
"71140503","SUP","HCPCS C1713","","71140503  -  PLATE BN SM T OBLQ 53MM TC100 3X3 HL SS PLVC SM FRAG SET","BOTH IP/OP","$563.85 ","$417.25 ","$0.00 ","$563.85 ","$253.73 ","$0.00 ","$117.52 ","$0.00 ","$0.00 ","$98.73 ","$563.85 ","$0.00 ","$281.93 ","$446.57 ","$451.08 ","$0.00 ","$88.24 ","$0.00 ","$89.76 ","$0.00 "
"71140504","SUP","HCPCS C1713","","71140504  -  PLATE BN SM T OBLQ 53MM TC100 3X4 HL SS PLVC SM FRAG SET","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$264.60 ","$0.00 ","$122.55 ","$0.00 ","$0.00 ","$102.95 ","$588.00 ","$0.00 ","$294.00 ","$465.70 ","$470.40 ","$0.00 ","$92.02 ","$0.00 ","$93.61 ","$0.00 "
"71140505","SUP","HCPCS C1713","","71140505  -  PLATE BN SM T OBLQ 53MM TC100 3X5 HL SS PLVC SM FRAG SET","BOTH IP/OP","$609.00 ","$450.66 ","$0.00 ","$609.00 ","$274.05 ","$0.00 ","$126.93 ","$0.00 ","$0.00 ","$106.63 ","$609.00 ","$0.00 ","$304.50 ","$482.33 ","$487.20 ","$0.00 ","$95.31 ","$0.00 ","$96.95 ","$0.00 "
"71140603","SUP","HCPCS C1713","","71140603  -  PLATE BN 88MM TC100 3 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$744.45 ","$550.89 ","$0.00 ","$744.45 ","$335.00 ","$0.00 ","$155.16 ","$0.00 ","$0.00 ","$130.35 ","$744.45 ","$0.00 ","$372.23 ","$589.60 ","$595.56 ","$0.00 ","$116.51 ","$0.00 ","$118.52 ","$0.00 "
"71140604","SUP","HCPCS C1713","","71140604  -  PLATE BN 104MM TC100 4 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$798.00 ","$590.52 ","$0.00 ","$798.00 ","$359.10 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$139.72 ","$798.00 ","$0.00 ","$399.00 ","$632.02 ","$638.40 ","$0.00 ","$124.89 ","$0.00 ","$127.04 ","$0.00 "
"71140606","SUP","HCPCS C1713","","71140606  -  PLATE BN 70MM TC100 6 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,039.50 ","$769.23 ","$0.00 ","$1,039.50 ","$467.78 ","$0.00 ","$216.66 ","$0.00 ","$0.00 ","$182.01 ","$1,039.50 ","$0.00 ","$519.75 ","$823.28 ","$831.60 ","$0.00 ","$162.68 ","$0.00 ","$165.49 ","$0.00 "
"71140608","SUP","HCPCS C1713","","71140608  -  PLATE BN 94MM TC100 8 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,134.00 ","$839.16 ","$0.00 ","$1,134.00 ","$510.30 ","$0.00 ","$236.35 ","$0.00 ","$0.00 ","$198.55 ","$1,134.00 ","$0.00 ","$567.00 ","$898.13 ","$907.20 ","$0.00 ","$177.47 ","$0.00 ","$180.53 ","$0.00 "
"71140610","SUP","HCPCS C1713","","71140610  -  PLATE BN 118MM TC100 10 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,186.50 ","$878.01 ","$0.00 ","$1,186.50 ","$533.93 ","$0.00 ","$247.30 ","$0.00 ","$0.00 ","$207.75 ","$1,186.50 ","$0.00 ","$593.25 ","$939.71 ","$949.20 ","$0.00 ","$185.69 ","$0.00 ","$188.89 ","$0.00 "
"71140612","SUP","HCPCS C1713","","71140612  -  PLATE BN 142MM TC100 12 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,244.25 ","$920.75 ","$0.00 ","$1,244.25 ","$559.91 ","$0.00 ","$259.33 ","$0.00 ","$0.00 ","$217.86 ","$1,244.25 ","$0.00 ","$622.13 ","$985.45 ","$995.40 ","$0.00 ","$194.73 ","$0.00 ","$198.08 ","$0.00 "
"71140614","SUP","HCPCS C1713","","71140614  -  PLATE BN 166MM TC100 14 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,401.75 ","$1,037.30 ","$0.00 ","$1,401.75 ","$630.79 ","$0.00 ","$292.16 ","$0.00 ","$0.00 ","$245.44 ","$1,401.75 ","$0.00 ","$700.88 ","$1,110.19 ","$1,121.40 ","$0.00 ","$219.37 ","$0.00 ","$223.16 ","$0.00 "
"71140616","SUP","HCPCS C1713","","71140616  -  PLATE BN 190MM TC100 16 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,485.75 ","$1,099.46 ","$0.00 ","$1,485.75 ","$668.59 ","$0.00 ","$309.67 ","$0.00 ","$0.00 ","$260.14 ","$1,485.75 ","$0.00 ","$742.88 ","$1,176.71 ","$1,188.60 ","$0.00 ","$232.52 ","$0.00 ","$236.53 ","$0.00 "
"71140618","SUP","HCPCS C1713","","71140618  -  PLATE BN 214MM TC100 18 HL CRV RECON SS PLVC 3.5MM SCR","BOTH IP/OP","$1,601.25 ","$1,184.93 ","$0.00 ","$1,601.25 ","$720.56 ","$0.00 ","$333.74 ","$0.00 ","$0.00 ","$280.37 ","$1,601.25 ","$0.00 ","$800.63 ","$1,268.19 ","$1,281.00 ","$0.00 ","$250.60 ","$0.00 ","$254.92 ","$0.00 "
"71140625","SUP","HCPCS C1713","","71140625  -  PLATE BN 120MM TC100 5 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$1,013.25 ","$749.81 ","$0.00 ","$1,013.25 ","$455.96 ","$0.00 ","$211.19 ","$0.00 ","$0.00 ","$177.41 ","$1,013.25 ","$0.00 ","$506.63 ","$802.49 ","$810.60 ","$0.00 ","$158.57 ","$0.00 ","$161.31 ","$0.00 "
"71140626","SUP","HCPCS C1713","","71140626  -  PLATE BN 136MM TC100 6 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$1,113.00 ","$823.62 ","$0.00 ","$1,113.00 ","$500.85 ","$0.00 ","$231.98 ","$0.00 ","$0.00 ","$194.88 ","$1,113.00 ","$0.00 ","$556.50 ","$881.50 ","$890.40 ","$0.00 ","$174.18 ","$0.00 ","$177.19 ","$0.00 "
"71140627","SUP","HCPCS C1713","","71140627  -  PLATE BN 152MM TC100 7 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$1,186.50 ","$878.01 ","$0.00 ","$1,186.50 ","$533.93 ","$0.00 ","$247.30 ","$0.00 ","$0.00 ","$207.75 ","$1,186.50 ","$0.00 ","$593.25 ","$939.71 ","$949.20 ","$0.00 ","$185.69 ","$0.00 ","$188.89 ","$0.00 "
"71140628","SUP","HCPCS C1713","","71140628  -  PLATE BN 168MM TC100 8 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71140629","SUP","HCPCS C1713","","71140629  -  PLATE BN 184MM TC100 9 HL CLVRLF SS ORTH SM FRAG SET","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$614.25 ","$0.00 ","$284.50 ","$0.00 ","$0.00 ","$239.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$213.62 ","$0.00 ","$217.31 ","$0.00 "
"71140704","SUP","HCPCS C1713","","71140704  -  PLATE BN 80MM TC100 4 HL T BTRS SS ORTH LG FRAG SET","BOTH IP/OP","$926.10 ","$685.31 ","$0.00 ","$926.10 ","$416.75 ","$0.00 ","$193.02 ","$0.00 ","$0.00 ","$162.15 ","$926.10 ","$0.00 ","$463.05 ","$733.47 ","$740.88 ","$0.00 ","$144.93 ","$0.00 ","$147.44 ","$0.00 "
"71140705","SUP","HCPCS C1713","","71140705  -  PLATE BN 96MM TC100 5 HL T BTRS SS ORTH LG FRAG SET","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71140706","SUP","HCPCS C1713","","71140706  -  PLATE BN 112MM TC100 6 HL T BTRS SS ORTH LG FRAG SET","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"71140804","SUP","HCPCS C1713","","71140804  -  PLATE BN 86MM TC100 4 HL L BTRS RT ANG SS TIB LT LG FRAG SET","BOTH IP/OP","$828.45 ","$613.05 ","$0.00 ","$828.45 ","$372.80 ","$0.00 ","$172.67 ","$0.00 ","$0.00 ","$145.05 ","$828.45 ","$0.00 ","$414.23 ","$656.13 ","$662.76 ","$0.00 ","$129.65 ","$0.00 ","$131.89 ","$0.00 "
"71140904","SUP","HCPCS C1713","","71140904  -  PLATE BN 86MM TC100 4 HL L BTRS LT ANG SS TIB RT LG FRAG SET","BOTH IP/OP","$828.45 ","$613.05 ","$0.00 ","$828.45 ","$372.80 ","$0.00 ","$172.67 ","$0.00 ","$0.00 ","$145.05 ","$828.45 ","$0.00 ","$414.23 ","$656.13 ","$662.76 ","$0.00 ","$129.65 ","$0.00 ","$131.89 ","$0.00 "
"71141003","SUP","HCPCS C1713","","71141003  -  PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD RL LG FRAG SET","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71141005","SUP","HCPCS C1713","","71141005  -  PLATE BN 188MM TC100 5 HL BTRS SS TIBHD RL LG FRAG SET","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71141007","SUP","HCPCS C1713","","71141007  -  PLATE BN 149MM TC100 7 HL BTRS SS TIBHD RL LG FRAG SET","BOTH IP/OP","$1,785.00 ","$1,320.90 ","$0.00 ","$1,785.00 ","$803.25 ","$0.00 ","$372.04 ","$0.00 ","$0.00 ","$312.54 ","$1,785.00 ","$0.00 ","$892.50 ","$1,413.72 ","$1,428.00 ","$0.00 ","$279.35 ","$0.00 ","$284.17 ","$0.00 "
"71141009","SUP","HCPCS C1713","","71141009  -  PLATE BN 181MM TC100 9 HL BTRS SS TIBHD RL LG FRAG SET","BOTH IP/OP","$1,905.75 ","$1,410.26 ","$0.00 ","$1,905.75 ","$857.59 ","$0.00 ","$397.21 ","$0.00 ","$0.00 ","$333.68 ","$1,905.75 ","$0.00 ","$952.88 ","$1,509.35 ","$1,524.60 ","$0.00 ","$298.25 ","$0.00 ","$303.40 ","$0.00 "
"71141011","SUP","HCPCS C1713","","71141011  -  PLATE BN 214MM TC100 11 HL BTRS SS TIBHD RL LG FRAG SET","BOTH IP/OP","$2,499.00 ","$1,849.26 ","$0.00 ","$2,499.00 ","$1,124.55 ","$0.00 ","$520.85 ","$0.00 ","$0.00 ","$437.55 ","$2,499.00 ","$0.00 ","$1,249.50 ","$1,979.21 ","$1,999.20 ","$0.00 ","$391.09 ","$0.00 ","$397.84 ","$0.00 "
"71141013","SUP","HCPCS C1713","","71141013  -  PLATE BN 246MM TC100 13 HL BTRS SS TIBHD RL LG FRAG SET","BOTH IP/OP","$2,593.50 ","$1,919.19 ","$0.00 ","$2,593.50 ","$1,167.08 ","$0.00 ","$540.55 ","$0.00 ","$0.00 ","$454.10 ","$2,593.50 ","$0.00 ","$1,296.75 ","$2,054.05 ","$2,074.80 ","$0.00 ","$405.88 ","$0.00 ","$412.89 ","$0.00 "
"71141103","SUP","HCPCS C1713","","71141103  -  PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD L/L LG FRAG SET","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71141105","SUP","HCPCS C1713","","71141105  -  PLATE BN 188MM TC100 5 HL BTRS SS TIBHD L/L LG FRAG SET","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71141107","SUP","HCPCS C1713","","71141107  -  PLATE BN 149MM TC100 7 HL BTRS SS TIBHD L/L LG FRAG SET","BOTH IP/OP","$1,785.00 ","$1,320.90 ","$0.00 ","$1,785.00 ","$803.25 ","$0.00 ","$372.04 ","$0.00 ","$0.00 ","$312.54 ","$1,785.00 ","$0.00 ","$892.50 ","$1,413.72 ","$1,428.00 ","$0.00 ","$279.35 ","$0.00 ","$284.17 ","$0.00 "
"71141109","SUP","HCPCS C1713","","71141109  -  PLATE BN 181MM TC100 9 HL BTRS SS TIBHD L/L LG FRAG SET","BOTH IP/OP","$1,905.75 ","$1,410.26 ","$0.00 ","$1,905.75 ","$857.59 ","$0.00 ","$397.21 ","$0.00 ","$0.00 ","$333.68 ","$1,905.75 ","$0.00 ","$952.88 ","$1,509.35 ","$1,524.60 ","$0.00 ","$298.25 ","$0.00 ","$303.40 ","$0.00 "
"71141111","SUP","HCPCS C1713","","71141111  -  PLATE BN 214MM TC100 11 HL BTRS SS TIBHD L/L LG FRAG SET","BOTH IP/OP","$2,499.00 ","$1,849.26 ","$0.00 ","$2,499.00 ","$1,124.55 ","$0.00 ","$520.85 ","$0.00 ","$0.00 ","$437.55 ","$2,499.00 ","$0.00 ","$1,249.50 ","$1,979.21 ","$1,999.20 ","$0.00 ","$391.09 ","$0.00 ","$397.84 ","$0.00 "
"71141113","SUP","HCPCS C1713","","71141113  -  PLATE BN 246MM TC100 13 HL BTRS SS TIBHD L/L LG FRAG SET","BOTH IP/OP","$2,593.50 ","$1,919.19 ","$0.00 ","$2,593.50 ","$1,167.08 ","$0.00 ","$540.55 ","$0.00 ","$0.00 ","$454.10 ","$2,593.50 ","$0.00 ","$1,296.75 ","$2,054.05 ","$2,074.80 ","$0.00 ","$405.88 ","$0.00 ","$412.89 ","$0.00 "
"71141206","SUP","HCPCS C1713","","71141206  -  PLATE BN BRD 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$245.70 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"71141207","SUP","HCPCS C1713","","71141207  -  PLATE BN BRD 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$245.70 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"71141208","SUP","HCPCS C1713","","71141208  -  PLATE BN BRD 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"71141209","SUP","HCPCS C1713","","71141209  -  PLATE BN BRD 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"71141210","SUP","HCPCS C1713","","71141210  -  PLATE BN BRD 167MM TC100 10 HL CMPR SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"71141212","SUP","HCPCS C1713","","71141212  -  PLATE BN BRD 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$731.85 ","$541.57 ","$0.00 ","$731.85 ","$329.33 ","$0.00 ","$152.54 ","$0.00 ","$0.00 ","$128.14 ","$731.85 ","$0.00 ","$365.93 ","$579.63 ","$585.48 ","$0.00 ","$114.53 ","$0.00 ","$116.51 ","$0.00 "
"71141214","SUP","HCPCS C1713","","71141214  -  PLATE BN BRD 231MM TC100 14 HL CMPR SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$731.85 ","$541.57 ","$0.00 ","$731.85 ","$329.33 ","$0.00 ","$152.54 ","$0.00 ","$0.00 ","$128.14 ","$731.85 ","$0.00 ","$365.93 ","$579.63 ","$585.48 ","$0.00 ","$114.53 ","$0.00 ","$116.51 ","$0.00 "
"71141216","SUP","HCPCS C1713","","71141216  -  PLATE BN BRD 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$926.10 ","$685.31 ","$0.00 ","$926.10 ","$416.75 ","$0.00 ","$193.02 ","$0.00 ","$0.00 ","$162.15 ","$926.10 ","$0.00 ","$463.05 ","$733.47 ","$740.88 ","$0.00 ","$144.93 ","$0.00 ","$147.44 ","$0.00 "
"71141218","SUP","HCPCS C1713","","71141218  -  PLATE BN BRD 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,022.70 ","$756.80 ","$0.00 ","$1,022.70 ","$460.22 ","$0.00 ","$213.16 ","$0.00 ","$0.00 ","$179.07 ","$1,022.70 ","$0.00 ","$511.35 ","$809.98 ","$818.16 ","$0.00 ","$160.05 ","$0.00 ","$162.81 ","$0.00 "
"71141220","SUP","HCPCS C1713","","71141220  -  PLATE BN BRD 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,459.50 ","$1,080.03 ","$0.00 ","$1,459.50 ","$656.78 ","$0.00 ","$304.20 ","$0.00 ","$0.00 ","$255.55 ","$1,459.50 ","$0.00 ","$729.75 ","$1,155.92 ","$1,167.60 ","$0.00 ","$228.41 ","$0.00 ","$232.35 ","$0.00 "
"71141222","SUP","HCPCS C1713","","71141222  -  PLATE BN BRD 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,543.50 ","$1,142.19 ","$0.00 ","$1,543.50 ","$694.58 ","$0.00 ","$321.70 ","$0.00 ","$0.00 ","$270.25 ","$1,543.50 ","$0.00 ","$771.75 ","$1,222.45 ","$1,234.80 ","$0.00 ","$241.56 ","$0.00 ","$245.73 ","$0.00 "
"71141224","SUP","HCPCS C1713","","71141224  -  PLATE BN BRD 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"71141226","SUP","HCPCS C1713","","71141226  -  PLATE BN BRD 423MM TC100 26 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,811.25 ","$1,340.33 ","$0.00 ","$1,811.25 ","$815.06 ","$0.00 ","$377.51 ","$0.00 ","$0.00 ","$317.14 ","$1,811.25 ","$0.00 ","$905.63 ","$1,434.51 ","$1,449.00 ","$0.00 ","$283.46 ","$0.00 ","$288.35 ","$0.00 "
"71141302","SUP","HCPCS C1713","","71141302  -  PLATE BN 39MM TC100 2 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71141303","SUP","HCPCS C1713","","71141303  -  PLATE BN 55MM TC100 3 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$147.00 ","$108.78 ","$0.00 ","$147.00 ","$66.15 ","$0.00 ","$30.64 ","$0.00 ","$0.00 ","$25.74 ","$147.00 ","$0.00 ","$73.50 ","$116.42 ","$117.60 ","$0.00 ","$23.01 ","$0.00 ","$23.40 ","$0.00 "
"71141304","SUP","HCPCS C1713","","71141304  -  PLATE BN 71MM TC100 4 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$159.60 ","$118.10 ","$0.00 ","$159.60 ","$71.82 ","$0.00 ","$33.26 ","$0.00 ","$0.00 ","$27.94 ","$159.60 ","$0.00 ","$79.80 ","$126.40 ","$127.68 ","$0.00 ","$24.98 ","$0.00 ","$25.41 ","$0.00 "
"71141305","SUP","HCPCS C1713","","71141305  -  PLATE BN 87MM TC100 5 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$166.95 ","$123.54 ","$0.00 ","$166.95 ","$75.13 ","$0.00 ","$34.80 ","$0.00 ","$0.00 ","$29.23 ","$166.95 ","$0.00 ","$83.48 ","$132.22 ","$133.56 ","$0.00 ","$26.13 ","$0.00 ","$26.58 ","$0.00 "
"71141306","SUP","HCPCS C1713","","71141306  -  PLATE BN 103MM TC100 6 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"71141307","SUP","HCPCS C1713","","71141307  -  PLATE BN 119MM TC100 7 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$192.15 ","$142.19 ","$0.00 ","$192.15 ","$86.47 ","$0.00 ","$40.05 ","$0.00 ","$0.00 ","$33.64 ","$192.15 ","$0.00 ","$96.08 ","$152.18 ","$153.72 ","$0.00 ","$30.07 ","$0.00 ","$30.59 ","$0.00 "
"71141308","SUP","HCPCS C1713","","71141308  -  PLATE BN 135MM TC100 8 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$246.75 ","$182.60 ","$0.00 ","$246.75 ","$111.04 ","$0.00 ","$51.43 ","$0.00 ","$0.00 ","$43.20 ","$246.75 ","$0.00 ","$123.38 ","$195.43 ","$197.40 ","$0.00 ","$38.62 ","$0.00 ","$39.28 ","$0.00 "
"71141309","SUP","HCPCS C1713","","71141309  -  PLATE BN 151MM TC100 9 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$218.40 ","$161.62 ","$0.00 ","$218.40 ","$98.28 ","$0.00 ","$45.52 ","$0.00 ","$0.00 ","$38.24 ","$218.40 ","$0.00 ","$109.20 ","$172.97 ","$174.72 ","$0.00 ","$34.18 ","$0.00 ","$34.77 ","$0.00 "
"71141310","SUP","HCPCS C1713","","71141310  -  PLATE BN 167MM TC100 10 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$270.90 ","$200.47 ","$0.00 ","$270.90 ","$121.91 ","$0.00 ","$56.46 ","$0.00 ","$0.00 ","$47.43 ","$270.90 ","$0.00 ","$135.45 ","$214.55 ","$216.72 ","$0.00 ","$42.40 ","$0.00 ","$43.13 ","$0.00 "
"71141311","SUP","HCPCS C1713","","71141311  -  PLATE BN 183MM TC100 11 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$282.45 ","$209.01 ","$0.00 ","$282.45 ","$127.10 ","$0.00 ","$58.87 ","$0.00 ","$0.00 ","$49.45 ","$282.45 ","$0.00 ","$141.23 ","$223.70 ","$225.96 ","$0.00 ","$44.20 ","$0.00 ","$44.97 ","$0.00 "
"71141312","SUP","HCPCS C1713","","71141312  -  PLATE BN 199MM TC100 12 HL SMTB SS ORTH LG FRAG SET","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"71141402","SUP","HCPCS C1713","","71141402  -  PLATE BN NAR 39MM TC100 2 HL CMPR SS ORTH 4.5MM SCR","BOTH IP/OP","$352.80 ","$261.07 ","$0.00 ","$352.80 ","$158.76 ","$0.00 ","$73.53 ","$0.00 ","$0.00 ","$61.77 ","$352.80 ","$0.00 ","$176.40 ","$279.42 ","$282.24 ","$0.00 ","$55.21 ","$0.00 ","$56.17 ","$0.00 "
"71141403","SUP","HCPCS C1713","","71141403  -  PLATE BN NAR 55MM TC100 3 HL CMPR SS 4.5MM SCR LG FRAG SET","BOTH IP/OP","$368.55 ","$272.73 ","$0.00 ","$368.55 ","$165.85 ","$0.00 ","$76.82 ","$0.00 ","$0.00 ","$64.53 ","$368.55 ","$0.00 ","$184.28 ","$291.89 ","$294.84 ","$0.00 ","$57.68 ","$0.00 ","$58.67 ","$0.00 "
"71141404","SUP","HCPCS C1713","","71141404  -  PLATE BN NAR 71MM TC100 4 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$368.55 ","$272.73 ","$0.00 ","$368.55 ","$165.85 ","$0.00 ","$76.82 ","$0.00 ","$0.00 ","$64.53 ","$368.55 ","$0.00 ","$184.28 ","$291.89 ","$294.84 ","$0.00 ","$57.68 ","$0.00 ","$58.67 ","$0.00 "
"71141405","SUP","HCPCS C1713","","71141405  -  PLATE BN NAR 87MM TC100 5 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$368.55 ","$272.73 ","$0.00 ","$368.55 ","$165.85 ","$0.00 ","$76.82 ","$0.00 ","$0.00 ","$64.53 ","$368.55 ","$0.00 ","$184.28 ","$291.89 ","$294.84 ","$0.00 ","$57.68 ","$0.00 ","$58.67 ","$0.00 "
"71141406","SUP","HCPCS C1713","","71141406  -  PLATE BN NAR 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"71141407","SUP","HCPCS C1713","","71141407  -  PLATE BN NAR 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"71141408","SUP","HCPCS C1713","","71141408  -  PLATE BN NAR 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"71141409","SUP","HCPCS C1713","","71141409  -  PLATE BN NAR 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"71141410","SUP","HCPCS C1713","","71141410  -  PLATE BN NAR 167MM TC100 10 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71141411","SUP","HCPCS C1713","","71141411  -  PLATE BN NAR 183MM TC100 11 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71141412","SUP","HCPCS C1713","","71141412  -  PLATE BN NAR 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71141413","SUP","HCPCS C1713","","71141413  -  PLATE BN NAR 215MM TC100 13 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"71141414","SUP","HCPCS C1713","","71141414  -  PLATE BN NAR 231MM TC100 14 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$763.35 ","$564.88 ","$0.00 ","$763.35 ","$343.51 ","$0.00 ","$159.10 ","$0.00 ","$0.00 ","$133.66 ","$763.35 ","$0.00 ","$381.68 ","$604.57 ","$610.68 ","$0.00 ","$119.46 ","$0.00 ","$121.53 ","$0.00 "
"71141415","SUP","HCPCS C1713","","71141415  -  PLATE BN NAR 247MM TC100 15 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$805.35 ","$595.96 ","$0.00 ","$805.35 ","$362.41 ","$0.00 ","$167.86 ","$0.00 ","$0.00 ","$141.01 ","$805.35 ","$0.00 ","$402.68 ","$637.84 ","$644.28 ","$0.00 ","$126.04 ","$0.00 ","$128.21 ","$0.00 "
"71141416","SUP","HCPCS C1713","","71141416  -  PLATE BN NAR 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$805.35 ","$595.96 ","$0.00 ","$805.35 ","$362.41 ","$0.00 ","$167.86 ","$0.00 ","$0.00 ","$141.01 ","$805.35 ","$0.00 ","$402.68 ","$637.84 ","$644.28 ","$0.00 ","$126.04 ","$0.00 ","$128.21 ","$0.00 "
"71141418","SUP","HCPCS C1713","","71141418  -  PLATE BN NAR 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71141420","SUP","HCPCS C1713","","71141420  -  PLATE BN NAR 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,038.45 ","$768.45 ","$0.00 ","$1,038.45 ","$467.30 ","$0.00 ","$216.44 ","$0.00 ","$0.00 ","$181.82 ","$1,038.45 ","$0.00 ","$519.23 ","$822.45 ","$830.76 ","$0.00 ","$162.52 ","$0.00 ","$165.32 ","$0.00 "
"71141422","SUP","HCPCS C1713","","71141422  -  PLATE BN NAR 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,401.75 ","$1,037.30 ","$0.00 ","$1,401.75 ","$630.79 ","$0.00 ","$292.16 ","$0.00 ","$0.00 ","$245.44 ","$1,401.75 ","$0.00 ","$700.88 ","$1,110.19 ","$1,121.40 ","$0.00 ","$219.37 ","$0.00 ","$223.16 ","$0.00 "
"71141424","SUP","HCPCS C1713","","71141424  -  PLATE BN NAR 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG","BOTH IP/OP","$1,517.25 ","$1,122.77 ","$0.00 ","$1,517.25 ","$682.76 ","$0.00 ","$316.23 ","$0.00 ","$0.00 ","$265.66 ","$1,517.25 ","$0.00 ","$758.63 ","$1,201.66 ","$1,213.80 ","$0.00 ","$237.45 ","$0.00 ","$241.55 ","$0.00 "
"71141505","SUP","HCPCS C1713","","71141505  -  PLATE BN 100MM TC100 5 HL SPN SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$866.25 ","$641.03 ","$0.00 ","$866.25 ","$389.81 ","$0.00 ","$180.55 ","$0.00 ","$0.00 ","$151.67 ","$866.25 ","$0.00 ","$433.13 ","$686.07 ","$693.00 ","$0.00 ","$135.57 ","$0.00 ","$137.91 ","$0.00 "
"71141506","SUP","HCPCS C1713","","71141506  -  PLATE BN 120MM TC100 6 HL SPN SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$753.90 ","$557.89 ","$0.00 ","$753.90 ","$339.26 ","$0.00 ","$157.13 ","$0.00 ","$0.00 ","$132.00 ","$753.90 ","$0.00 ","$376.95 ","$597.09 ","$603.12 ","$0.00 ","$117.99 ","$0.00 ","$120.02 ","$0.00 "
"71141603","SUP","HCPCS C1713","","71141603  -  PLATE BN 68MM TC100 3 HL T SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"71141604","SUP","HCPCS C1713","","71141604  -  PLATE BN 84MM TC100 4 HL T SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$631.05 ","$466.98 ","$0.00 ","$631.05 ","$283.97 ","$0.00 ","$131.53 ","$0.00 ","$0.00 ","$110.49 ","$631.05 ","$0.00 ","$315.53 ","$499.79 ","$504.84 ","$0.00 ","$98.76 ","$0.00 ","$100.46 ","$0.00 "
"71141605","SUP","HCPCS C1713","","71141605  -  PLATE BN 100MM TC100 5 HL T SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$670.95 ","$496.50 ","$0.00 ","$670.95 ","$301.93 ","$0.00 ","$139.84 ","$0.00 ","$0.00 ","$117.48 ","$670.95 ","$0.00 ","$335.48 ","$531.39 ","$536.76 ","$0.00 ","$105.00 ","$0.00 ","$106.82 ","$0.00 "
"71141606","SUP","HCPCS C1713","","71141606  -  PLATE BN 116MM TC100 6 HL T SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$742.35 ","$549.34 ","$0.00 ","$742.35 ","$334.06 ","$0.00 ","$154.72 ","$0.00 ","$0.00 ","$129.98 ","$742.35 ","$0.00 ","$371.18 ","$587.94 ","$593.88 ","$0.00 ","$116.18 ","$0.00 ","$118.18 ","$0.00 "
"71141608","SUP","HCPCS C1713","","71141608  -  PLATE BN 148MM TC100 8 HL T SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$1,025.85 ","$759.13 ","$0.00 ","$1,025.85 ","$461.63 ","$0.00 ","$213.81 ","$0.00 ","$0.00 ","$179.62 ","$1,025.85 ","$0.00 ","$512.93 ","$812.47 ","$820.68 ","$0.00 ","$160.55 ","$0.00 ","$163.32 ","$0.00 "
"71141704","SUP","HCPCS C1713","","71141704  -  PLATE BN 123MM TC100 4 HL HK SS ORTH 4.5MM SCR LG FRAG SET","BOTH IP/OP","$2,084.25 ","$1,542.35 ","$0.00 ","$2,084.25 ","$937.91 ","$0.00 ","$434.41 ","$0.00 ","$0.00 ","$364.94 ","$2,084.25 ","$0.00 ","$1,042.13 ","$1,650.73 ","$1,667.40 ","$0.00 ","$326.19 ","$0.00 ","$331.81 ","$0.00 "
"71141809","SUP","HCPCS C1713","","71141809  -  PLATE BN 188MM TC100 9 HL CBR HD SS ORTH 4.5MM SCR LG FRAG","BOTH IP/OP","$945.00 ","$699.30 ","$0.00 ","$945.00 ","$425.25 ","$0.00 ","$196.96 ","$0.00 ","$0.00 ","$165.46 ","$945.00 ","$0.00 ","$472.50 ","$748.44 ","$756.00 ","$0.00 ","$147.89 ","$0.00 ","$150.44 ","$0.00 "
"71141900","SUP","HCPCS C1713","","71141900  -  PLATE BN 20MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$345.45 ","$255.63 ","$0.00 ","$345.45 ","$155.45 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$60.49 ","$345.45 ","$0.00 ","$172.73 ","$273.60 ","$276.36 ","$0.00 ","$54.06 ","$0.00 ","$55.00 ","$0.00 "
"71141902","SUP","HCPCS C1713","","71141902  -  PLATE BN 26MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"71141904","SUP","HCPCS C1713","","71141904  -  PLATE BN 36MM TC100 4 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$316.05 ","$233.88 ","$0.00 ","$316.05 ","$142.22 ","$0.00 ","$65.87 ","$0.00 ","$0.00 ","$55.34 ","$316.05 ","$0.00 ","$158.03 ","$250.31 ","$252.84 ","$0.00 ","$49.46 ","$0.00 ","$50.32 ","$0.00 "
"71141905","SUP","HCPCS C1713","","71141905  -  PLATE BN 44MM TC100 5 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$375.90 ","$278.17 ","$0.00 ","$375.90 ","$169.16 ","$0.00 ","$78.35 ","$0.00 ","$0.00 ","$65.82 ","$375.90 ","$0.00 ","$187.95 ","$297.71 ","$300.72 ","$0.00 ","$58.83 ","$0.00 ","$59.84 ","$0.00 "
"71141906","SUP","HCPCS C1713","","71141906  -  PLATE BN 52MM 6 HL 2.7MM SCR","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71141907","SUP","HCPCS C1713","","71141907  -  PLATE BN 60MM TC100 7 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$452.55 ","$334.89 ","$0.00 ","$452.55 ","$203.65 ","$0.00 ","$94.32 ","$0.00 ","$0.00 ","$79.24 ","$452.55 ","$0.00 ","$226.28 ","$358.42 ","$362.04 ","$0.00 ","$70.82 ","$0.00 ","$72.05 ","$0.00 "
"71141908","SUP","HCPCS C1713","","71141908  -  PLATE BN 68MM TC100 8 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$495.60 ","$366.74 ","$0.00 ","$495.60 ","$223.02 ","$0.00 ","$103.30 ","$0.00 ","$0.00 ","$86.78 ","$495.60 ","$0.00 ","$247.80 ","$392.52 ","$396.48 ","$0.00 ","$77.56 ","$0.00 ","$78.90 ","$0.00 "
"71141909","SUP","HCPCS C1713","","71141909  -  PLATE BN 76MM TC100 9 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$639.45 ","$473.19 ","$0.00 ","$639.45 ","$287.75 ","$0.00 ","$133.28 ","$0.00 ","$0.00 ","$111.96 ","$639.45 ","$0.00 ","$319.73 ","$506.44 ","$511.56 ","$0.00 ","$100.07 ","$0.00 ","$101.80 ","$0.00 "
"71141910","SUP","HCPCS C1713","","71141910  -  PLATE BN 84MM TC100 10 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET","BOTH IP/OP","$701.40 ","$519.04 ","$0.00 ","$701.40 ","$315.63 ","$0.00 ","$146.19 ","$0.00 ","$0.00 ","$122.81 ","$701.40 ","$0.00 ","$350.70 ","$555.51 ","$561.12 ","$0.00 ","$109.77 ","$0.00 ","$111.66 ","$0.00 "
"71141912","SUP","HCPCS C1713","","71141912  -  PLATE BN 100MM TC100 12 HL CMPR SS ORTH 2.7MM SCR SM FRAG","BOTH IP/OP","$777.00 ","$574.98 ","$0.00 ","$777.00 ","$349.65 ","$0.00 ","$161.95 ","$0.00 ","$0.00 ","$136.05 ","$777.00 ","$0.00 ","$388.50 ","$615.38 ","$621.60 ","$0.00 ","$121.60 ","$0.00 ","$123.70 ","$0.00 "
"71142007","SUP","HCPCS C1713","","71142007  -  PLATE BN 158MM TC100 7 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG","BOTH IP/OP","$1,953.00 ","$1,445.22 ","$0.00 ","$1,953.00 ","$878.85 ","$0.00 ","$407.05 ","$0.00 ","$0.00 ","$341.95 ","$1,953.00 ","$0.00 ","$976.50 ","$1,546.78 ","$1,562.40 ","$0.00 ","$305.64 ","$0.00 ","$310.92 ","$0.00 "
"71142009","SUP","HCPCS C1713","","71142009  -  PLATE BN 190MM TC100 9 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG","BOTH IP/OP","$2,026.50 ","$1,499.61 ","$0.00 ","$2,026.50 ","$911.93 ","$0.00 ","$422.37 ","$0.00 ","$0.00 ","$354.82 ","$2,026.50 ","$0.00 ","$1,013.25 ","$1,604.99 ","$1,621.20 ","$0.00 ","$317.15 ","$0.00 ","$322.62 ","$0.00 "
"71142011","SUP","HCPCS C1713","","71142011  -  PLATE BN 221MM TC100 11 HL BTRS SS CNDYL LT 4.5MM SCR LG","BOTH IP/OP","$2,541.00 ","$1,880.34 ","$0.00 ","$2,541.00 ","$1,143.45 ","$0.00 ","$529.61 ","$0.00 ","$0.00 ","$444.91 ","$2,541.00 ","$0.00 ","$1,270.50 ","$2,012.47 ","$2,032.80 ","$0.00 ","$397.67 ","$0.00 ","$404.53 ","$0.00 "
"71142013","SUP","HCPCS C1713","","71142013  -  PLATE BN 253MM TC100 13 HL BTRS SS CNDYL LT 4.5MM SCR LG","BOTH IP/OP","$2,136.75 ","$1,581.20 ","$0.00 ","$2,136.75 ","$961.54 ","$0.00 ","$445.35 ","$0.00 ","$0.00 ","$374.13 ","$2,136.75 ","$0.00 ","$1,068.38 ","$1,692.31 ","$1,709.40 ","$0.00 ","$334.40 ","$0.00 ","$340.17 ","$0.00 "
"71142015","SUP","HCPCS C1713","","71142015  -  PLATE BN 285MM TC100 15 HL BTRS SS CNDYL LT 4.5MM SCR LG","BOTH IP/OP","$2,682.75 ","$1,985.24 ","$0.00 ","$2,682.75 ","$1,207.24 ","$0.00 ","$559.15 ","$0.00 ","$0.00 ","$469.73 ","$2,682.75 ","$0.00 ","$1,341.38 ","$2,124.74 ","$2,146.20 ","$0.00 ","$419.85 ","$0.00 ","$427.09 ","$0.00 "
"71142107","SUP","HCPCS C1713","","71142107  -  PLATE BN 158MM TC100 7 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG","BOTH IP/OP","$2,367.75 ","$1,752.14 ","$0.00 ","$2,367.75 ","$1,065.49 ","$0.00 ","$493.50 ","$0.00 ","$0.00 ","$414.57 ","$2,367.75 ","$0.00 ","$1,183.88 ","$1,875.26 ","$1,894.20 ","$0.00 ","$370.55 ","$0.00 ","$376.95 ","$0.00 "
"71142109","SUP","HCPCS C1713","","71142109  -  PLATE BN 190MM TC100 9 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG","BOTH IP/OP","$2,026.50 ","$1,499.61 ","$0.00 ","$2,026.50 ","$911.93 ","$0.00 ","$422.37 ","$0.00 ","$0.00 ","$354.82 ","$2,026.50 ","$0.00 ","$1,013.25 ","$1,604.99 ","$1,621.20 ","$0.00 ","$317.15 ","$0.00 ","$322.62 ","$0.00 "
"71142111","SUP","HCPCS C1713","","71142111  -  PLATE BN 221MM TC100 11 HL BTRS SS CNDYL RT 4.5MM SCR LG","BOTH IP/OP","$2,541.00 ","$1,880.34 ","$0.00 ","$2,541.00 ","$1,143.45 ","$0.00 ","$529.61 ","$0.00 ","$0.00 ","$444.91 ","$2,541.00 ","$0.00 ","$1,270.50 ","$2,012.47 ","$2,032.80 ","$0.00 ","$397.67 ","$0.00 ","$404.53 ","$0.00 "
"71142113","SUP","HCPCS C1713","","71142113  -  PLATE BN 253MM TC100 13 HL BTRS SS CNDYL RT 4.5MM SCR LG","BOTH IP/OP","$2,604.00 ","$1,926.96 ","$0.00 ","$2,604.00 ","$1,171.80 ","$0.00 ","$542.74 ","$0.00 ","$0.00 ","$455.94 ","$2,604.00 ","$0.00 ","$1,302.00 ","$2,062.37 ","$2,083.20 ","$0.00 ","$407.53 ","$0.00 ","$414.56 ","$0.00 "
"71142115","SUP","HCPCS C1713","","71142115  -  PLATE BN 285MM TC100 15 HL BTRS SS CNDYL RT 4.5MM SCR LG","BOTH IP/OP","$2,682.75 ","$1,985.24 ","$0.00 ","$2,682.75 ","$1,207.24 ","$0.00 ","$559.15 ","$0.00 ","$0.00 ","$469.73 ","$2,682.75 ","$0.00 ","$1,341.38 ","$2,124.74 ","$2,146.20 ","$0.00 ","$419.85 ","$0.00 ","$427.09 ","$0.00 "
"71143004","SUP","HCPCS C1713","","71143004  -  WASHER ORTH 4.5MM 2.2MM STRL TC100 SS","BOTH IP/OP","$94.40 ","$69.86 ","$0.00 ","$94.40 ","$42.48 ","$0.00 ","$19.68 ","$0.00 ","$0.00 ","$16.53 ","$94.40 ","$0.00 ","$47.20 ","$74.76 ","$75.52 ","$0.00 ","$14.77 ","$0.00 ","$15.03 ","$0.00 "
"71143007","SUP","HCPCS C1713","","71143007  -  WASHER ORTH 7MM 3.7MM STRL TC100 SS","BOTH IP/OP","$94.40 ","$69.86 ","$0.00 ","$94.40 ","$42.48 ","$0.00 ","$19.68 ","$0.00 ","$0.00 ","$16.53 ","$94.40 ","$0.00 ","$47.20 ","$74.76 ","$75.52 ","$0.00 ","$14.77 ","$0.00 ","$15.03 ","$0.00 "
"71143010","SUP","HCPCS C1713","","71143010  -  WASHER ORTH THK2MM 10MM ILZ SPC CIRC","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$49.05 ","$0.00 ","$22.72 ","$0.00 ","$0.00 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"71143013","SUP","HCPCS C1713","","71143013  -  WASHER ORTH 13MM 6.6MM STRL TC100 SS","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$54.00 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"71143045","SUP","HCPCS C1713","","71143045  -  NUT ORTH STRL TC100 SS 4.5 MM CORT SCR","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71143104","SUP","HCPCS C1713","","71143104  -  WASHER ORTH 4.5MM 2.2MM NS TC100 SS","BOTH IP/OP","$94.40 ","$69.86 ","$0.00 ","$94.40 ","$42.48 ","$0.00 ","$19.68 ","$0.00 ","$0.00 ","$16.53 ","$94.40 ","$0.00 ","$47.20 ","$74.76 ","$75.52 ","$0.00 ","$14.77 ","$0.00 ","$15.03 ","$0.00 "
"71143107","SUP","HCPCS C1713","","71143107  -  WASHER ORTH HEX 7MM NS TC100","BOTH IP/OP","$94.40 ","$69.86 ","$0.00 ","$94.40 ","$42.48 ","$0.00 ","$19.68 ","$0.00 ","$0.00 ","$16.53 ","$94.40 ","$0.00 ","$47.20 ","$74.76 ","$75.52 ","$0.00 ","$14.77 ","$0.00 ","$15.03 ","$0.00 "
"71143110","SUP","HCPCS C1713","","71143110  -  WASHER ORTH 10MM NS TC100","BOTH IP/OP","$109.00 ","$80.66 ","$0.00 ","$109.00 ","$49.05 ","$0.00 ","$22.72 ","$0.00 ","$0.00 ","$19.09 ","$109.00 ","$0.00 ","$54.50 ","$86.33 ","$87.20 ","$0.00 ","$17.06 ","$0.00 ","$17.35 ","$0.00 "
"71143113","SUP","HCPCS C1713","","71143113  -  WASHER ORTH 13MM NS TC100 SS","BOTH IP/OP","$94.40 ","$69.86 ","$0.00 ","$94.40 ","$42.48 ","$0.00 ","$19.68 ","$0.00 ","$0.00 ","$16.53 ","$94.40 ","$0.00 ","$47.20 ","$74.76 ","$75.52 ","$0.00 ","$14.77 ","$0.00 ","$15.03 ","$0.00 "
"71144010","SUP","HCPCS C1713","","71144010  -  PLATE BN 60MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4","BOTH IP/OP","$1,338.75 ","$990.68 ","$0.00 ","$1,338.75 ","$602.44 ","$0.00 ","$279.03 ","$0.00 ","$0.00 ","$234.40 ","$1,338.75 ","$0.00 ","$669.38 ","$1,060.29 ","$1,071.00 ","$0.00 ","$209.51 ","$0.00 ","$213.13 ","$0.00 "
"71144011","SUP","HCPCS C1713","","71144011  -  PLATE BN 70MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4","BOTH IP/OP","$1,354.50 ","$1,002.33 ","$0.00 ","$1,354.50 ","$609.53 ","$0.00 ","$282.31 ","$0.00 ","$0.00 ","$237.16 ","$1,354.50 ","$0.00 ","$677.25 ","$1,072.76 ","$1,083.60 ","$0.00 ","$211.98 ","$0.00 ","$215.64 ","$0.00 "
"71144012","SUP","HCPCS C1713","","71144012  -  PLATE BN STRL TC100 9 HL BNDRG TMPLT SS CALCANEUS 3.5 MM SCR","BOTH IP/OP","$1,559.25 ","$1,153.85 ","$0.00 ","$1,559.25 ","$701.66 ","$0.00 ","$324.99 ","$0.00 ","$0.00 ","$273.01 ","$1,559.25 ","$0.00 ","$779.63 ","$1,234.93 ","$1,247.40 ","$0.00 ","$244.02 ","$0.00 ","$248.23 ","$0.00 "
"71145020","SUP","HCPCS C1713","","71145020  -  PLATE BN 100MM TC100 20 HL STRG SS ORTH 1.5MM SCR MN FRAG","BOTH IP/OP","$570.15 ","$421.91 ","$0.00 ","$570.15 ","$256.57 ","$0.00 ","$118.83 ","$0.00 ","$0.00 ","$99.83 ","$570.15 ","$0.00 ","$285.08 ","$451.56 ","$456.12 ","$0.00 ","$89.23 ","$0.00 ","$90.77 ","$0.00 "
"71145022","SUP","HCPCS C1713","","71145022  -  PLATE BN TC100 3 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$226.80 ","$0.00 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$78.88 ","$0.00 ","$80.24 ","$0.00 "
"71145024","SUP","HCPCS C1713","","71145024  -  PLATE BN TC100 4 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN","BOTH IP/OP","$534.45 ","$395.49 ","$0.00 ","$534.45 ","$240.50 ","$0.00 ","$111.39 ","$0.00 ","$0.00 ","$93.58 ","$534.45 ","$0.00 ","$267.23 ","$423.28 ","$427.56 ","$0.00 ","$83.64 ","$0.00 ","$85.08 ","$0.00 "
"71145026","SUP","HCPCS C1713","","71145026  -  PLATE BN TC100 7 HL SS CNDYL LT 1.5 MM SCR MN FRAG SET","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"71145028","SUP","HCPCS C1713","","71145028  -  PLATE BN TC100 7 HL SS CNDYL RT 1.5 MM SCR MN FRAG SET","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"71145030","SUP","HCPCS C1713","","71145030  -  PLATE BN TC100 4 HL H SS ORTH 1.5 MM SCR MN FRAG SET","BOTH IP/OP","$406.35 ","$300.70 ","$0.00 ","$406.35 ","$182.86 ","$0.00 ","$84.69 ","$0.00 ","$0.00 ","$71.15 ","$406.35 ","$0.00 ","$203.18 ","$321.83 ","$325.08 ","$0.00 ","$63.59 ","$0.00 ","$64.69 ","$0.00 "
"71146020","SUP","HCPCS C1713","","71146020  -  PLATE BN 20MM TC100 3 HL STRG SS CNDYL 2MM SCR MN FRAG SET","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"71146022","SUP","HCPCS C1713","","71146022  -  PLATE BN 22MM TC100 4 HL STRG SS CNDYL 2MM SCR MN FRAG SET","BOTH IP/OP","$148.05 ","$109.56 ","$0.00 ","$148.05 ","$66.62 ","$0.00 ","$30.86 ","$0.00 ","$0.00 ","$25.92 ","$148.05 ","$0.00 ","$74.03 ","$117.26 ","$118.44 ","$0.00 ","$23.17 ","$0.00 ","$23.57 ","$0.00 "
"71146024","SUP","HCPCS C1713","","71146024  -  PLATE BN 24MM TC100 5 HL STRG SS CNDYL 2MM SCR MN FRAG SET","BOTH IP/OP","$159.60 ","$118.10 ","$0.00 ","$159.60 ","$71.82 ","$0.00 ","$33.26 ","$0.00 ","$0.00 ","$27.94 ","$159.60 ","$0.00 ","$79.80 ","$126.40 ","$127.68 ","$0.00 ","$24.98 ","$0.00 ","$25.41 ","$0.00 "
"71146026","SUP","HCPCS C1713","","71146026  -  PLATE BN 35MM TC100 6 HL STRG SS ORTH 2MM SCR MN FRAG SET","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"71146028","SUP","HCPCS C1713","","71146028  -  PLATE BN 28MM TC100 20 HL STRG SS CNDYL 2MM SCR MN FRAG SET","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"71146030","SUP","HCPCS C1713","","71146030  -  PLATE BN 5X1.2MM TC100 3 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$226.80 ","$0.00 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$78.88 ","$0.00 ","$80.24 ","$0.00 "
"71146032","SUP","HCPCS C1713","","71146032  -  PLATE BN 5X1.2MM TC100 4 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR","BOTH IP/OP","$534.45 ","$395.49 ","$0.00 ","$534.45 ","$240.50 ","$0.00 ","$111.39 ","$0.00 ","$0.00 ","$93.58 ","$534.45 ","$0.00 ","$267.23 ","$423.28 ","$427.56 ","$0.00 ","$83.64 ","$0.00 ","$85.08 ","$0.00 "
"71146034","SUP","HCPCS C1713","","71146034  -  PLATE BN 5X.9MM TC100 2 HLE/HD 2 HL SHFT T SS CNDYL 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"71146036","SUP","HCPCS C1713","","71146036  -  PLATE BN 5X.9MM TC100 2 HL SHFT L RT OBLQ SS CNDYL 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"71146038","SUP","HCPCS C1713","","71146038  -  PLATE BN 5X.9MM TC100 2 HL SHFT L LT OBLQ SS CNDYL 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"71146040","SUP","HCPCS C1713","","71146040  -  PLATE BN TC100 7 HL SS CNDYL LT 2 MM SCR MN FRAG SET","BOTH IP/OP","$678.30 ","$501.94 ","$0.00 ","$678.30 ","$305.24 ","$0.00 ","$141.37 ","$0.00 ","$0.00 ","$118.76 ","$678.30 ","$0.00 ","$339.15 ","$537.21 ","$542.64 ","$0.00 ","$106.15 ","$0.00 ","$107.99 ","$0.00 "
"71146042","SUP","HCPCS C1713","","71146042  -  PLATE BN 39X5X12MM TC100 7 HL SS CNDYL RT 2MM SCR MN FRAG","BOTH IP/OP","$678.30 ","$501.94 ","$0.00 ","$678.30 ","$305.24 ","$0.00 ","$141.37 ","$0.00 ","$0.00 ","$118.76 ","$678.30 ","$0.00 ","$339.15 ","$537.21 ","$542.64 ","$0.00 ","$106.15 ","$0.00 ","$107.99 ","$0.00 "
"71146044","SUP","HCPCS C1713","","71146044  -  PLATE BN TC100 L SS RT ORTH 2 MM SCR MN FRAG SET","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"71146046","SUP","HCPCS C1713","","71146046  -  PLATE BN TC100 L SS LT ORTH 2 MM SCR MN FRAG SET","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"71146048","SUP","HCPCS C1713","","71146048  -  PLATE BN TC100 4 HL H SS ORTH 2 MM SCR MN FRAG SET","BOTH IP/OP","$406.35 ","$300.70 ","$0.00 ","$406.35 ","$182.86 ","$0.00 ","$84.69 ","$0.00 ","$0.00 ","$71.15 ","$406.35 ","$0.00 ","$203.18 ","$321.83 ","$325.08 ","$0.00 ","$63.59 ","$0.00 ","$64.69 ","$0.00 "
"71147001","SUP","HCPCS C1713","","71147001  -  PLATE BN TC100 L SS RT ORTH 2.7 MM SCR MN FRAG SET","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71147002","SUP","HCPCS C1713","","71147002  -  PLATE BN 35X7X1.2MM TC100 L LT OBLQ SS CNDYL 2.7MM SCR MN","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71147003","SUP","HCPCS C1713","","71147003  -  PLATE BN TC100 L SS LT ORTH 2.7 MM SCR MN FRAG SET","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71147004","SUP","HCPCS C1713","","71147004  -  PLATE BN 35X7X1.2MM TC100 L RT OBLQ SS CNDYL 2.7MM SCR MN","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71147006","SUP","HCPCS C1713","","71147006  -  PLATE BN 32X7X1.2MM TC100 3 HL T SS CNDYL 2.7MM SCR MN FRAG","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71147008","SUP","HCPCS C1713","","71147008  -  PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL LT 2.7MM SCR MN FRAG","BOTH IP/OP","$720.30 ","$533.02 ","$0.00 ","$720.30 ","$324.14 ","$0.00 ","$150.13 ","$0.00 ","$0.00 ","$126.12 ","$720.30 ","$0.00 ","$360.15 ","$570.48 ","$576.24 ","$0.00 ","$112.73 ","$0.00 ","$114.67 ","$0.00 "
"71147010","SUP","HCPCS C1713","","71147010  -  PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL RT 2.7MM SCR MN FRAG","BOTH IP/OP","$720.30 ","$533.02 ","$0.00 ","$720.30 ","$324.14 ","$0.00 ","$150.13 ","$0.00 ","$0.00 ","$126.12 ","$720.30 ","$0.00 ","$360.15 ","$570.48 ","$576.24 ","$0.00 ","$112.73 ","$0.00 ","$114.67 ","$0.00 "
"71147012","SUP","HCPCS C1713","","71147012  -  PLATE BN TC100 7 HL MULTIFRAGMENT SS ORTH 2.7 MM SCR MN FRAG","BOTH IP/OP","$169.05 ","$125.10 ","$0.00 ","$169.05 ","$76.07 ","$0.00 ","$35.23 ","$0.00 ","$0.00 ","$29.60 ","$169.05 ","$0.00 ","$84.53 ","$133.89 ","$135.24 ","$0.00 ","$26.46 ","$0.00 ","$26.91 ","$0.00 "
"71148003","SUP","HCPCS C1713","","71148003  -  PLATE BN 23MM TC100 3 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG","BOTH IP/OP","$159.60 ","$118.10 ","$0.00 ","$159.60 ","$71.82 ","$0.00 ","$33.26 ","$0.00 ","$0.00 ","$27.94 ","$159.60 ","$0.00 ","$79.80 ","$126.40 ","$127.68 ","$0.00 ","$24.98 ","$0.00 ","$25.41 ","$0.00 "
"71148004","SUP","HCPCS C1713","","71148004  -  PLATE BN 31MM TC100 4 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG","BOTH IP/OP","$175.35 ","$129.76 ","$0.00 ","$175.35 ","$78.91 ","$0.00 ","$36.55 ","$0.00 ","$0.00 ","$30.70 ","$175.35 ","$0.00 ","$87.68 ","$138.88 ","$140.28 ","$0.00 ","$27.44 ","$0.00 ","$27.92 ","$0.00 "
"71148005","SUP","HCPCS C1713","","71148005  -  PLATE BN 39MM TC100 5 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG","BOTH IP/OP","$185.85 ","$137.53 ","$0.00 ","$185.85 ","$83.63 ","$0.00 ","$38.74 ","$0.00 ","$0.00 ","$32.54 ","$185.85 ","$0.00 ","$92.93 ","$147.19 ","$148.68 ","$0.00 ","$29.09 ","$0.00 ","$29.59 ","$0.00 "
"71148006","SUP","HCPCS C1713","","71148006  -  PLATE BN 47MM TC100 6 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG","BOTH IP/OP","$205.80 ","$152.29 ","$0.00 ","$205.80 ","$92.61 ","$0.00 ","$42.89 ","$0.00 ","$0.00 ","$36.03 ","$205.80 ","$0.00 ","$102.90 ","$162.99 ","$164.64 ","$0.00 ","$32.21 ","$0.00 ","$32.76 ","$0.00 "
"71148007","SUP","HCPCS C1713","","71148007  -  PLATE BN 55MM TC100 7 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG","BOTH IP/OP","$214.20 ","$158.51 ","$0.00 ","$214.20 ","$96.39 ","$0.00 ","$44.64 ","$0.00 ","$0.00 ","$37.50 ","$214.20 ","$0.00 ","$107.10 ","$169.65 ","$171.36 ","$0.00 ","$33.52 ","$0.00 ","$34.10 ","$0.00 "
"71148008","SUP","HCPCS C1713","","71148008  -  PLATE BN 63MM TC100 QT TBLR SS ORTH 2.7MM SCR MN FRAG SET","BOTH IP/OP","$227.85 ","$168.61 ","$0.00 ","$227.85 ","$102.53 ","$0.00 ","$47.49 ","$0.00 ","$0.00 ","$39.89 ","$227.85 ","$0.00 ","$113.93 ","$180.46 ","$182.28 ","$0.00 ","$35.66 ","$0.00 ","$36.27 ","$0.00 "
"71149006","SUP","HCPCS C1713","","71149006  -  SCREW BN 1.5MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149007","SUP","HCPCS C1713","","71149007  -  SCREW BN 1.5MM 7MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149008","SUP","HCPCS C1713","","71149008  -  SCREW BN 1.5MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149009","SUP","HCPCS C1713","","71149009  -  SCREW BN 1.5MM 9MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149010","SUP","HCPCS C1713","","71149010  -  SCREW BN 1.5MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149011","SUP","HCPCS C1713","","71149011  -  SCREW BN 1.5MM 11MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149012","SUP","HCPCS C1713","","71149012  -  SCREW BN 1.5MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149014","SUP","HCPCS C1713","","71149014  -  SCREW BN 1.5MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149016","SUP","HCPCS C1713","","71149016  -  SCREW BN 1.5MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149018","SUP","HCPCS C1713","","71149018  -  SCREW BN 1.5MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149020","SUP","HCPCS C1713","","71149020  -  SCREW BN 1.5MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149022","SUP","HCPCS C1713","","71149022  -  SCREW BN 1.5MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149024","SUP","HCPCS C1713","","71149024  -  SCREW BN 1.5MM 24MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149106","SUP","HCPCS C1713","","71149106  -  SCREW BN 1.5MM 6MM TC100 ST HEX SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149107","SUP","HCPCS C1713","","71149107  -  SCREW BN 1.5MM 7MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149108","SUP","HCPCS C1713","","71149108  -  SCREW BN 1.5MM 8MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149109","SUP","HCPCS C1713","","71149109  -  SCREW BN 1.5MM 9MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149110","SUP","HCPCS C1713","","71149110  -  SCREW BN 1.5MM 10MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149111","SUP","HCPCS C1713","","71149111  -  SCREW BN 1.5MM 11MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149112","SUP","HCPCS C1713","","71149112  -  SCREW BN 1.5MM 12MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149114","SUP","HCPCS C1713","","71149114  -  SCREW BN 1.5MM 14MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149116","SUP","HCPCS C1713","","71149116  -  SCREW BN 1.5MM 16MM TC100 ST HEX SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149118","SUP","HCPCS C1713","","71149118  -  SCREW BN 1.5MM 3MM 18MM TC100 HEX HD ST SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149120","SUP","HCPCS C1713","","71149120  -  SCREW BN 1.5MM 3MM 20MM TC100 HEX HD ST SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149122","SUP","HCPCS C1713","","71149122  -  SCREW BN 1.5MM 3MM 22MM TC100 HEX HD ST SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149124","SUP","HCPCS C1713","","71149124  -  SCREW BN 1.5MM 3MM 24MM TC100 HEX HD ST SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149206","SUP","HCPCS C1713","","71149206  -  SCREW BN 2MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149208","SUP","HCPCS C1713","","71149208  -  SCREW BN 2MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149210","SUP","HCPCS C1713","","71149210  -  SCREW BN 2MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149212","SUP","HCPCS C1713","","71149212  -  SCREW BN 2MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149214","SUP","HCPCS C1713","","71149214  -  SCREW BN 2MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149216","SUP","HCPCS C1713","","71149216  -  SCREW BN 2MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149218","SUP","HCPCS C1713","","71149218  -  SCREW BN 2MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149220","SUP","HCPCS C1713","","71149220  -  SCREW BN 2MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149222","SUP","HCPCS C1713","","71149222  -  SCREW BN 2MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149224","SUP","HCPCS C1713","","71149224  -  SCREW BN 2MM 24MM TC100 ST LTWT MDLR CRCTE HD SS CORT MN","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149226","SUP","HCPCS C1713","","71149226  -  SCREW BN 2MM 26MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149228","SUP","HCPCS C1713","","71149228  -  SCREW BN 2MM 28MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149230","SUP","HCPCS C1713","","71149230  -  SCREW BN 2MM 30MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149232","SUP","HCPCS C1713","","71149232  -  SCREW BN 2MM 32MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149234","SUP","HCPCS C1713","","71149234  -  SCREW BN 2MM 34MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149236","SUP","HCPCS C1713","","71149236  -  SCREW BN 2MM 36MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149238","SUP","HCPCS C1713","","71149238  -  SCREW BN 2MM 38MM TC100 ST CRCTE HD SS CORT MN FRAG SET","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"71149306","SUP","HCPCS C1713","","71149306  -  SCREW BN MN 2MM 4MM 6MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149308","SUP","HCPCS C1713","","71149308  -  SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149310","SUP","HCPCS C1713","","71149310  -  SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149312","SUP","HCPCS C1713","","71149312  -  SCREW BN 2MM 4MM 12MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149314","SUP","HCPCS C1713","","71149314  -  SCREW BN 2MM 4MM 14MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149316","SUP","HCPCS C1713","","71149316  -  SCREW BN 2MM 4MM 16MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149318","SUP","HCPCS C1713","","71149318  -  SCREW BN 2MM 4MM 18MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149320","SUP","HCPCS C1713","","71149320  -  SCREW BN 2MM 4MM 20MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149322","SUP","HCPCS C1713","","71149322  -  SCREW BN 2MM 4MM 22MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149324","SUP","HCPCS C1713","","71149324  -  SCREW BN 2MM 4MM 24MM TC100 ST HEX HD SS CORT MN FRAG SYS","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149326","SUP","HCPCS C1713","","71149326  -  SCREW BN 2MM 26MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149328","SUP","HCPCS C1713","","71149328  -  SCREW BN 2MM 28MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149330","SUP","HCPCS C1713","","71149330  -  SCREW BN 2MM 30MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149332","SUP","HCPCS C1713","","71149332  -  SCREW BN 2MM 32MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149334","SUP","HCPCS C1713","","71149334  -  SCREW BN 2MM 34MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149336","SUP","HCPCS C1713","","71149336  -  SCREW BN 2MM 36MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149338","SUP","HCPCS C1713","","71149338  -  SCREW BN 2MM 38MM TC100 ST CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"71149406","SUP","HCPCS C1713","","71149406  -  SCREW BN 2.7MM 5MM 6MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149408","SUP","HCPCS C1713","","71149408  -  SCREW BN 2.7MM 5MM 8MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149410","SUP","HCPCS C1713","","71149410  -  SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149412","SUP","HCPCS C1713","","71149412  -  SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149414","SUP","HCPCS C1713","","71149414  -  SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149416","SUP","HCPCS C1713","","71149416  -  SCREW BN 2.7MM 5MM 16MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149418","SUP","HCPCS C1713","","71149418  -  SCREW BN 2.7MM 18MM TC100 ST CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149420","SUP","HCPCS C1713","","71149420  -  SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149422","SUP","HCPCS C1713","","71149422  -  SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149424","SUP","HCPCS C1713","","71149424  -  SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149426","SUP","HCPCS C1713","","71149426  -  SCREW BN 2.7MM 5MM 26MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149428","SUP","HCPCS C1713","","71149428  -  SCREW BN 2.7MM 5MM 28MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149430","SUP","HCPCS C1713","","71149430  -  SCREW BN 2.7MM 5MM 30MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149432","SUP","HCPCS C1713","","71149432  -  SCREW BN 2.7MM 5MM 32MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149434","SUP","HCPCS C1713","","71149434  -  SCREW BN 2.7MM 5MM 34MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149436","SUP","HCPCS C1713","","71149436  -  SCREW BN 2.7MM 5MM 36MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149438","SUP","HCPCS C1713","","71149438  -  SCREW BN 2.7MM 5MM 38MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149440","SUP","HCPCS C1713","","71149440  -  SCREW BN 2.7MM 5MM 40MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149445","SUP","HCPCS C1713","","71149445  -  SCREW BN 2.7MM 5MM 45MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149450","SUP","HCPCS C1713","","71149450  -  SCREW BN 2.7MM 5MM 50MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149455","SUP","HCPCS C1713","","71149455  -  SCREW BN 2.7MM 5MM 55MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149460","SUP","HCPCS C1713","","71149460  -  SCREW BN 2.7MM 5MM 60MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149465","SUP","HCPCS C1713","","71149465  -  SCREW BN 2.7MM 5MM 65MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149470","SUP","HCPCS C1713","","71149470  -  SCREW BN 2.7MM 5MM 70MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71149510","SUP","HCPCS C1713","","71149510  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149512","SUP","HCPCS C1713","","71149512  -  SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149514","SUP","HCPCS C1713","","71149514  -  SCREW BN 3.5MM 14MM ST DIST CORT VOLR RDS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149516","SUP","HCPCS C1713","","71149516  -  SCREW BN HEX 3.5MM 16MM ST DIST CORT VOLR RDS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149518","SUP","HCPCS C1713","","71149518  -  SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149520","SUP","HCPCS C1713","","71149520  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149522","SUP","HCPCS C1713","","71149522  -  SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149524","SUP","HCPCS C1713","","71149524  -  SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149526","SUP","HCPCS C1713","","71149526  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149528","SUP","HCPCS C1713","","71149528  -  SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149530","SUP","HCPCS C1713","","71149530  -  SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149532","SUP","HCPCS C1713","","71149532  -  SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149534","SUP","HCPCS C1713","","71149534  -  SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149536","SUP","HCPCS C1713","","71149536  -  SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149538","SUP","HCPCS C1713","","71149538  -  SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149540","SUP","HCPCS C1713","","71149540  -  SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149545","SUP","HCPCS C1713","","71149545  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149550","SUP","HCPCS C1713","","71149550  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149555","SUP","HCPCS C1713","","71149555  -  SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149560","SUP","HCPCS C1713","","71149560  -  SCREW BN 3.5MM 6MM 60MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149565","SUP","HCPCS C1713","","71149565  -  SCREW BN 3.5MM 6MM 65MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149570","SUP","HCPCS C1713","","71149570  -  SCREW BN 3.5MM 6MM 70MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149575","SUP","HCPCS C1713","","71149575  -  SCREW BN 3.5MM 6MM 75MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149580","SUP","HCPCS C1713","","71149580  -  SCREW BN 3.5MM 6MM 80MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149585","SUP","HCPCS C1713","","71149585  -  SCREW BN 3.5MM 6MM 85MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149590","SUP","HCPCS C1713","","71149590  -  SCREW BN 3.5MM 6MM 90MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149595","SUP","HCPCS C1713","","71149595  -  SCREW BN 3.5MM 6MM 95MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149600","SUP","HCPCS C1713","","71149600  -  SCREW BN 3.5MM 100MM TC100 ST DP HEX HD SS CORT SM FRAG SET","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149605","SUP","HCPCS C1713","","71149605  -  SCREW BN 3.5MM 105MM TC100 ST DP HEX HD SS CORT SM FRAG SET","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149610","SUP","HCPCS C1713","","71149610  -  SCREW BN 3.5MM 110MM TC100 ST DP HEX HD SS CORT SM FRAG SET","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"71149615","SUP","HCPCS C1713","","71149615  -  SCREW BN 3.5MM 115MM STRL TC100 ST DP HEX HD SS CORT SM FRAG","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"71149620","SUP","HCPCS C1713","","71149620  -  SCREW BN 3.5MM 120MM STRL TC100 ST DP HEX HD SS CORT SM FRAG","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"71149625","SUP","HCPCS C1713","","71149625  -  SCREW BN 3.5MM 125MM STRL TC100 ST DP HEX HD SS CORT SM FRAG","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"71149630","SUP","HCPCS C1713","","71149630  -  SCREW BN 3.5MM 130MM STRL TC100 ST DP HEX HD SS CORT SM FRAG","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"71149714","SUP","HCPCS C1713","","71149714  -  SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG SCR SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149716","SUP","HCPCS C1713","","71149716  -  SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149718","SUP","HCPCS C1713","","71149718  -  SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG SCR SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149720","SUP","HCPCS C1713","","71149720  -  SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG SCR SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149722","SUP","HCPCS C1713","","71149722  -  SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149724","SUP","HCPCS C1713","","71149724  -  SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149726","SUP","HCPCS C1713","","71149726  -  SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149728","SUP","HCPCS C1713","","71149728  -  SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149730","SUP","HCPCS C1713","","71149730  -  SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149732","SUP","HCPCS C1713","","71149732  -  SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149734","SUP","HCPCS C1713","","71149734  -  SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149736","SUP","HCPCS C1713","","71149736  -  SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149738","SUP","HCPCS C1713","","71149738  -  SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149740","SUP","HCPCS C1713","","71149740  -  SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149742","SUP","HCPCS C1713","","71149742  -  SCREW BN HEX 4.5MM 42MM TC100 ST SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149744","SUP","HCPCS C1713","","71149744  -  SCREW BN HEX 4.5MM 44MM TC100 ST SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149746","SUP","HCPCS C1713","","71149746  -  SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149748","SUP","HCPCS C1713","","71149748  -  SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149750","SUP","HCPCS C1713","","71149750  -  SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149752","SUP","HCPCS C1713","","71149752  -  SCREW BN 4.5MM 52MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149754","SUP","HCPCS C1713","","71149754  -  SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149756","SUP","HCPCS C1713","","71149756  -  SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149758","SUP","HCPCS C1713","","71149758  -  SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149760","SUP","HCPCS C1713","","71149760  -  SCREW BN 4.5MM 60MM TC100 ST HEX SCKT SS CORT LG SCR SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149762","SUP","HCPCS C1713","","71149762  -  SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149764","SUP","HCPCS C1713","","71149764  -  SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149766","SUP","HCPCS C1713","","71149766  -  SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149768","SUP","HCPCS C1713","","71149768  -  SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149770","SUP","HCPCS C1713","","71149770  -  SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SET","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71149772","SUP","HCPCS C1713","","71149772  -  SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149776","SUP","HCPCS C1713","","71149776  -  SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149785","SUP","HCPCS C1713","","71149785  -  SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149795","SUP","HCPCS C1713","","71149795  -  SCREW BN 4.5MM 95MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149800","SUP","HCPCS C1713","","71149800  -  SCREW BN 4.5MM 100MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149805","SUP","HCPCS C1713","","71149805  -  SCREW BN 4.5MM 105MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149810","SUP","HCPCS C1713","","71149810  -  SCREW BN 4.5MM 110MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149815","SUP","HCPCS C1713","","71149815  -  SCREW BN 4.5MM 115MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149820","SUP","HCPCS C1713","","71149820  -  SCREW BN 4.5MM 120MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149825","SUP","HCPCS C1713","","71149825  -  SCREW BN 4.5MM 125MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149830","SUP","HCPCS C1713","","71149830  -  SCREW BN 4.5MM 130MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149835","SUP","HCPCS C1713","","71149835  -  SCREW BN 4.5MM 135MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149840","SUP","HCPCS C1713","","71149840  -  SCREW BN 4.5MM 140MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71149845","SUP","HCPCS C1713","","71149845  -  SCREW BN 4.5MM 145MM TC100 ST HEX HD SS CORT LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71160095","SUP","HCPCS C1713","","71160095  -  SCREW BN 95MM LG TI ORTH","BOTH IP/OP","$689.85 ","$510.49 ","$0.00 ","$689.85 ","$310.43 ","$0.00 ","$143.78 ","$0.00 ","$0.00 ","$120.79 ","$689.85 ","$0.00 ","$344.93 ","$546.36 ","$551.88 ","$0.00 ","$107.96 ","$0.00 ","$109.82 ","$0.00 "
"71161008","SUP","HCPCS C1769","","71161008  -  WIRE FX .8MM 70MM STRL KRSH TROC PNT 1 END SS ORTH","BOTH IP/OP","$47.70 ","$35.30 ","$0.00 ","$47.70 ","$25.90 ","$0.00 ","$9.94 ","$0.00 ","$0.00 ","$8.35 ","$47.70 ","$0.00 ","$23.85 ","$37.78 ","$38.16 ","$0.00 ","$7.47 ","$0.00 ","$7.59 ","$0.00 "
"71161010","SUP","HCPCS C1769","","71161010  -  WIRE FX 1MM 150MM STRL KRSH TROC PNT 1 END SS ORTH","BOTH IP/OP","$47.70 ","$35.30 ","$0.00 ","$47.70 ","$25.90 ","$0.00 ","$9.94 ","$0.00 ","$0.00 ","$8.35 ","$47.70 ","$0.00 ","$23.85 ","$37.78 ","$38.16 ","$0.00 ","$7.47 ","$0.00 ","$7.59 ","$0.00 "
"71161020","SUP","Custom 27203010","","71161020  -  WIRE FX 2MM 150MM STRL KRSH TROC PNT SS ORTH DISP","BOTH IP/OP","$67.20 ","$49.73 ","$0.00 ","$67.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.20 ","$0.00 ","$33.60 ","$53.22 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71161040","SUP","HCPCS C1713","","71161040  -  SCREW BN P/T 6.5MM 40MM NS 20MM CNN TI","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161045","SUP","HCPCS C1713","","71161045  -  SCREW BN P/T 6.5MM 45MM NS 20MM CNN TI","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161050","SUP","HCPCS C1713","","71161050  -  SCREW BN P/T 6.5MM 50MM NS 20MM CNN TI","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161055","SUP","HCPCS C1713","","71161055  -  SCREW BN P/T 6.5MM 55MM NS 20MM CNN TI","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161060","SUP","HCPCS C1713","","71161060  -  SCREW BN P/T 6.5MM 60MM NS 20MM CNN TI","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161065","SUP","HCPCS C1713","","71161065  -  SCREW BN P/T 6.5MM 65MM NS 20MM CNN TI","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161066","SUP","HCPCS C1769","","71161066  -  WIRE FX .6MM STRL KRSH","BOTH IP/OP","$47.70 ","$35.30 ","$0.00 ","$47.70 ","$25.90 ","$0.00 ","$9.94 ","$0.00 ","$0.00 ","$8.35 ","$47.70 ","$0.00 ","$23.85 ","$37.78 ","$38.16 ","$0.00 ","$7.47 ","$0.00 ","$7.59 ","$0.00 "
"71161070","SUP","HCPCS C1713","","71161070  -  SCREW BN 6.5MM 70MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161075","SUP","HCPCS C1713","","71161075  -  SCREW BN 6.5MM 75MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161080","SUP","HCPCS C1713","","71161080  -  SCREW BN LG 6.5MM 80MM STRL 20MM CNN THRD TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161085","SUP","HCPCS C1713","","71161085  -  SCREW BN 6.5MM 85MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161090","SUP","HCPCS C1713","","71161090  -  SCREW BN 6.5MM 90MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161095","SUP","HCPCS C1713","","71161095  -  SCREW BN 6.5MM 95MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161100","SUP","HCPCS C1713","","71161100  -  SCREW BN 6.5MM 100MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161105","SUP","HCPCS C1713","","71161105  -  SCREW BN 6.5MM 105MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161110","SUP","HCPCS C1713","","71161110  -  SCREW BN 6.5MM 110MM NS 20MM CNN P/T TI ORTH","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"71161303","SUP","HCPCS C1713","","71161303  -  PLATE BN 130D CLS 3 HL CMPR TI HIP","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71161352","SUP","HCPCS C1713","","71161352  -  PLATE BN 135D CLS 2 HL CMPR TI HIP","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71161354","SUP","HCPCS C1713","","71161354  -  PLATE BN 135D CLS 4 HL CMPR TI HIP","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71161355","SUP","HCPCS C1713","","71161355  -  PLATE BN 135D CLS 5 HL CMPR TI HIP","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71161404","SUP","HCPCS C1713","","71161404  -  PLATE BN 140D CLS 4 HL CMPR TI HIP","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71161405","SUP","HCPCS C1713","","71161405  -  PLATE BN 140D CLS 5 HL CMPR TI HIP","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"71161506","SUP","HCPCS C1713","","71161506  -  SCREW BN 1.5MM 6MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161507","SUP","HCPCS C1713","","71161507  -  SCREW BN 1.5MM 7MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161508","SUP","HCPCS C1713","","71161508  -  SCREW BN 1.5MM 8MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161509","SUP","HCPCS C1713","","71161509  -  SCREW BN 1.5MM 9MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161510","SUP","HCPCS C1713","","71161510  -  SCREW BN 1.5MM 10MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161511","SUP","HCPCS C1713","","71161511  -  SCREW BN 1.5MM 11MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161512","SUP","HCPCS C1713","","71161512  -  SCREW BN 1.5MM 12MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161514","SUP","HCPCS C1713","","71161514  -  SCREW BN 1.5MM 14MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
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"71161518","SUP","HCPCS C1713","","71161518  -  SCREW BN 1.5MM 18MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161520","SUP","HCPCS C1713","","71161520  -  SCREW BN 1.5MM 20MM TC100 HEX SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161606","SUP","HCPCS C1713","","71161606  -  SCREW BN MN 1.5MM 6MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161607","SUP","HCPCS C1713","","71161607  -  SCREW BN MN 1.5MM 7MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161608","SUP","HCPCS C1713","","71161608  -  SCREW BN MN 1.5MM 8MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161609","SUP","HCPCS C1713","","71161609  -  SCREW BN MN 1.5MM 9MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161610","SUP","HCPCS C1713","","71161610  -  SCREW BN 1.5MM 10MM TC100 CRCTE SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161611","SUP","HCPCS C1713","","71161611  -  SCREW BN MN 1.5MM 11MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161612","SUP","HCPCS C1713","","71161612  -  SCREW BN 1.5MM 12MM TC100 CRCTE SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161614","SUP","HCPCS C1713","","71161614  -  SCREW BN 1.5MM 14MM TC100 CRCTE SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161616","SUP","HCPCS C1713","","71161616  -  SCREW BN 1.5MM 16MM TC100 CRCTE SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161618","SUP","HCPCS C1713","","71161618  -  SCREW BN 1.5MM 18MM TC100 CRCTE SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71161620","SUP","HCPCS C1713","","71161620  -  SCREW BN 1.5MM 20MM TC100 CRCTE SCKT SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162008","SUP","HCPCS C1713","","71162008  -  SCREW BN 2MM 8MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162010","SUP","HCPCS C1713","","71162010  -  SCREW BN 2MM 10MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162012","SUP","HCPCS C1713","","71162012  -  SCREW BN 2MM 12MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162014","SUP","HCPCS C1713","","71162014  -  SCREW BN 2MM 14MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162016","SUP","HCPCS C1713","","71162016  -  SCREW BN 2MM 16MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162018","SUP","HCPCS C1713","","71162018  -  SCREW BN 2MM 18MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162020","SUP","HCPCS C1713","","71162020  -  SCREW BN 2MM 20MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162022","SUP","HCPCS C1713","","71162022  -  SCREW BN 2MM 22MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162024","SUP","HCPCS C1713","","71162024  -  SCREW BN 2MM 24MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162026","SUP","HCPCS C1713","","71162026  -  SCREW BN 2MM 26MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162028","SUP","HCPCS C1713","","71162028  -  SCREW BN 2MM 28MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162030","SUP","HCPCS C1713","","71162030  -  SCREW BN 2MM 30MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162032","SUP","HCPCS C1713","","71162032  -  SCREW BN 2MM 32MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162036","SUP","HCPCS C1713","","71162036  -  SCREW BN 2MM 36MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162038","SUP","HCPCS C1713","","71162038  -  SCREW BN 2MM 38MM TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162106","SUP","HCPCS C1713","","71162106  -  SCREW BN 2MM 6MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162108","SUP","HCPCS C1713","","71162108  -  SCREW BN 2MM 8MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162110","SUP","HCPCS C1713","","71162110  -  SCREW BN 2MM 10MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162112","SUP","HCPCS C1713","","71162112  -  SCREW BN 2MM 12MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162114","SUP","HCPCS C1713","","71162114  -  SCREW BN 2MM 14MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162116","SUP","HCPCS C1713","","71162116  -  SCREW BN 2MM 16MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162118","SUP","HCPCS C1713","","71162118  -  SCREW BN 2MM 18MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162120","SUP","HCPCS C1713","","71162120  -  SCREW BN 2MM 20MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162122","SUP","HCPCS C1713","","71162122  -  SCREW BN 2MM 22MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162124","SUP","HCPCS C1713","","71162124  -  SCREW BN 2MM 24MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162126","SUP","HCPCS C1713","","71162126  -  SCREW BN 2MM 26MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162128","SUP","HCPCS C1713","","71162128  -  SCREW BN 2MM 28MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162130","SUP","HCPCS C1713","","71162130  -  SCREW BN 2MM 30MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162132","SUP","HCPCS C1713","","71162132  -  SCREW BN 2MM 32MM TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162134","SUP","HCPCS C1713","","71162134  -  SCREW BN 2MM 34MM STRL TC100 CRCTE HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71162206","SUP","HCPCS C1713","","71162206  -  SCREW BN 2MM 6MM STRL TC100 HEX HD SS CORT","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71163006","SUP","HCPCS C1769","","71163006  -  WIRE FX .6MM 175MM STRL KRSH CRLGE SS ORTH","BOTH IP/OP","$50.40 ","$37.30 ","$0.00 ","$50.40 ","$27.37 ","$0.00 ","$10.50 ","$0.00 ","$0.00 ","$8.82 ","$50.40 ","$0.00 ","$25.20 ","$39.92 ","$40.32 ","$0.00 ","$7.89 ","$0.00 ","$8.02 ","$0.00 "
"71163008","SUP","HCPCS C1769","","71163008  -  WIRE FX .8MM 200MM STRL KRSH CRLGE SS ORTH","BOTH IP/OP","$50.40 ","$37.30 ","$0.00 ","$50.40 ","$27.37 ","$0.00 ","$10.50 ","$0.00 ","$0.00 ","$8.82 ","$50.40 ","$0.00 ","$25.20 ","$39.92 ","$40.32 ","$0.00 ","$7.89 ","$0.00 ","$8.02 ","$0.00 "
"71164026","SUP","HCPCS C1713","","71164026  -  SCREW BN 4.5MM 26MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164028","SUP","HCPCS C1713","","71164028  -  SCREW BN 4.5MM 28MM ST CMPR TI CORT","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164030","SUP","HCPCS C1713","","71164030  -  SCREW BN 4.5MM 30MM ST TI ORTH","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164032","SUP","HCPCS C1713","","71164032  -  SCREW BN 4.5MM 32MM ST CMPR TI CORT","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164034","SUP","HCPCS C1713","","71164034  -  SCREW BN 4.5MM 34MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164036","SUP","HCPCS C1713","","71164036  -  SCREW BN 4.5MM 36MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164038","SUP","HCPCS C1713","","71164038  -  SCREW BN 4.5MM 38MM ST CMPR TI CORT","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164040","SUP","HCPCS C1713","","71164040  -  SCREW BN 4.5MM 40MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164042","SUP","HCPCS C1713","","71164042  -  SCREW BN 4.5MM 42MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164044","SUP","HCPCS C1713","","71164044  -  SCREW BN 4.5MM 44MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164046","SUP","HCPCS C1713","","71164046  -  SCREW BN 4.5MM 46MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164048","SUP","HCPCS C1713","","71164048  -  SCREW BN 4.5MM 48MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164050","SUP","HCPCS C1713","","71164050  -  SCREW BN 4.5MM 50MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71164052","SUP","HCPCS C1713","","71164052  -  SCREW BN 4.5MM 52MM ST CMPR TI CORT HIP","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$27.17 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"71170001","SUP","Custom 27203010","","71170001  -  BIT DRL 1.1MM QC","BOTH IP/OP","$163.80 ","$121.21 ","$0.00 ","$163.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71170003","SUP","Custom 27203010","","71170003  -  BIT DRL 1.5MM 85MM STRL 60MM TC100 QC","BOTH IP/OP","$163.80 ","$121.21 ","$0.00 ","$163.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71170005","SUP","Custom 27203010","","71170005  -  BIT DRL 2MM STRL GLD HL","BOTH IP/OP","$163.80 ","$121.21 ","$0.00 ","$163.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71170007","SUP","Custom 27203010","","71170007  -  BIT DRL 2.7MM QC","BOTH IP/OP","$163.80 ","$121.21 ","$0.00 ","$163.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.80 ","$0.00 ","$81.90 ","$129.73 ","$131.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71170071","SUP","Custom 27203010","","71170071  -  BIT DRL 2.5MM 110MM AU STRL QC","BOTH IP/OP","$270.90 ","$200.47 ","$0.00 ","$270.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.90 ","$0.00 ","$135.45 ","$214.55 ","$216.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"71176547","SUP","Custom 27203010","","71176547  -  BIT DRL 4.5MM 180MM NQCK CPLNG","BOTH IP/OP","$303.45 ","$224.55 ","$0.00 ","$303.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.45 ","$0.00 ","$151.73 ","$240.33 ","$242.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71177134","SUP","Custom 27203010","","71177134  -  BIT DRL 5MM CNN","BOTH IP/OP","$918.75 ","$679.88 ","$0.00 ","$918.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$918.75 ","$0.00 ","$459.38 ","$727.65 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71177135","SUP","Custom 27203010","","71177135  -  BIT DRL 5.5MM CNN 8MM SCR","BOTH IP/OP","$918.75 ","$679.88 ","$0.00 ","$918.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$918.75 ","$0.00 ","$459.38 ","$727.65 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71177197","SUP","Custom 27203010","","71177197  -  BIT DRL SHRT 2MM VLP MN-MOD AO QC OVR","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.00 ","$0.00 ","$121.00 ","$191.66 ","$193.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71177201","SUP","HCPCS C1713","","71177201  -  PIN GD 3.2MM 300MM THRD","BOTH IP/OP","$170.80 ","$126.39 ","$0.00 ","$170.80 ","$76.86 ","$0.00 ","$35.60 ","$0.00 ","$0.00 ","$29.91 ","$170.80 ","$0.00 ","$85.40 ","$135.27 ","$136.64 ","$0.00 ","$26.73 ","$0.00 ","$27.19 ","$0.00 "
"71177202","SUP","Custom 27203010","","71177202  -  BIT DRL 3.2MM 300MM QC","BOTH IP/OP","$361.20 ","$267.29 ","$0.00 ","$361.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.20 ","$0.00 ","$180.60 ","$286.07 ","$288.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71190808","SUP","HCPCS C1713","","71190808  -  PIN HLF 6MM HAP ORTH","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$38.25 ","$0.00 ","$17.72 ","$0.00 ","$0.00 ","$14.88 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$13.30 ","$0.00 ","$13.53 ","$0.00 "
"71191010","SUP","HCPCS C1713","","71191010  -  TRIAL SRG 3.5MM SMPL LCK PLT HUM LT PROX","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"71191019","SUP","HCPCS C1713","","71191019  -  TRIAL SRG SMPL LCK PLT RT OLCRN","BOTH IP/OP","$500.85 ","$370.63 ","$0.00 ","$500.85 ","$225.38 ","$0.00 ","$104.39 ","$0.00 ","$0.00 ","$87.69 ","$500.85 ","$0.00 ","$250.43 ","$396.67 ","$400.68 ","$0.00 ","$78.38 ","$0.00 ","$79.74 ","$0.00 "
"71191025","SUP","HCPCS C1713","","71191025  -  TRIAL SRG 10 HL SMPL LCK PLT INFR MDL CLVCL","BOTH IP/OP","$465.15 ","$344.21 ","$0.00 ","$465.15 ","$209.32 ","$0.00 ","$96.95 ","$0.00 ","$0.00 ","$81.44 ","$465.15 ","$0.00 ","$232.58 ","$368.40 ","$372.12 ","$0.00 ","$72.80 ","$0.00 ","$74.05 ","$0.00 "
"71192010","SUP","HCPCS C1713","","71192010  -  TRIAL SRG 2.7MM 55MM SMPL LCK SCR CORT","BOTH IP/OP","$18.23 ","$13.49 ","$0.00 ","$18.23 ","$8.20 ","$0.00 ","$3.80 ","$0.00 ","$0.00 ","$3.19 ","$18.23 ","$0.00 ","$9.11 ","$14.44 ","$14.58 ","$0.00 ","$2.85 ","$0.00 ","$2.90 ","$0.00 "
"71192011","SUP","HCPCS C1713","","71192011  -  TRIAL SRG 2.7MM 20MM SMPL SCR CORT","BOTH IP/OP","$17.65 ","$13.06 ","$0.00 ","$17.65 ","$7.94 ","$0.00 ","$3.68 ","$0.00 ","$0.00 ","$3.09 ","$17.65 ","$0.00 ","$8.83 ","$13.98 ","$14.12 ","$0.00 ","$2.76 ","$0.00 ","$2.81 ","$0.00 "
"71192012","SUP","HCPCS C1713","","71192012  -  TRIAL SRG 2.7MM 55MM SMPL SCR CORT","BOTH IP/OP","$19.53 ","$14.45 ","$0.00 ","$19.53 ","$8.79 ","$0.00 ","$4.07 ","$0.00 ","$0.00 ","$3.42 ","$19.53 ","$0.00 ","$9.76 ","$15.47 ","$15.62 ","$0.00 ","$3.06 ","$0.00 ","$3.11 ","$0.00 "
"71192016","SUP","HCPCS C1713","","71192016  -  TRIAL SRG 2.5MM 20MM SMPL SCR CORT","BOTH IP/OP","$17.65 ","$13.06 ","$0.00 ","$17.65 ","$7.94 ","$0.00 ","$3.68 ","$0.00 ","$0.00 ","$3.09 ","$17.65 ","$0.00 ","$8.83 ","$13.98 ","$14.12 ","$0.00 ","$2.76 ","$0.00 ","$2.81 ","$0.00 "
"71192535","SUP","HCPCS C1713","","71192535  -  TRIAL SRG 5MM 35MM HEX SCR ORTH SMPL","BOTH IP/OP","$26.78 ","$19.82 ","$0.00 ","$26.78 ","$12.05 ","$0.00 ","$5.58 ","$0.00 ","$0.00 ","$4.69 ","$26.78 ","$0.00 ","$13.39 ","$21.21 ","$21.42 ","$0.00 ","$4.19 ","$0.00 ","$4.26 ","$0.00 "
"71192570","SUP","HCPCS C1713","","71192570  -  TRIAL SRG 5MM 70MM HEX SCR ORTH SMPL","BOTH IP/OP","$39.33 ","$29.10 ","$0.00 ","$39.33 ","$17.70 ","$0.00 ","$8.20 ","$0.00 ","$0.00 ","$6.89 ","$39.33 ","$0.00 ","$19.66 ","$31.15 ","$31.46 ","$0.00 ","$6.15 ","$0.00 ","$6.26 ","$0.00 "
"71193006","SUP","HCPCS C1713","","71193006  -  SCREW SET ASIAN SMPL HIP IM NL","BOTH IP/OP","$65.30 ","$48.32 ","$0.00 ","$65.30 ","$29.39 ","$0.00 ","$13.61 ","$0.00 ","$0.00 ","$11.43 ","$65.30 ","$0.00 ","$32.65 ","$51.72 ","$52.24 ","$0.00 ","$10.22 ","$0.00 ","$10.40 ","$0.00 "
"71193039","SUP","HCPCS C1713","","71193039  -  NAIL IM 11.5MM 40CM TRGN RTRGD TI FEM","BOTH IP/OP","$178.88 ","$132.37 ","$0.00 ","$178.88 ","$80.49 ","$0.00 ","$37.28 ","$0.00 ","$0.00 ","$31.32 ","$178.88 ","$0.00 ","$89.44 ","$141.67 ","$143.10 ","$0.00 ","$27.99 ","$0.00 ","$28.48 ","$0.00 "
"71193111","SUP","HCPCS C1713","","71193111  -  TRIAL SRG MT-NL SMPL CAP NL","BOTH IP/OP","$29.35 ","$21.72 ","$0.00 ","$29.35 ","$13.21 ","$0.00 ","$6.12 ","$0.00 ","$0.00 ","$5.14 ","$29.35 ","$0.00 ","$14.68 ","$23.25 ","$23.48 ","$0.00 ","$4.59 ","$0.00 ","$4.67 ","$0.00 "
"71193125","SUP","HCPCS C1713","","71193125  -  NAIL IM 11.5MM 25CM TRGN TI FEM","BOTH IP/OP","$176.40 ","$130.54 ","$0.00 ","$176.40 ","$79.38 ","$0.00 ","$36.77 ","$0.00 ","$0.00 ","$30.89 ","$176.40 ","$0.00 ","$88.20 ","$139.71 ","$141.12 ","$0.00 ","$27.61 ","$0.00 ","$28.08 ","$0.00 "
"71193632","SUP","HCPCS C1713","","71193632  -  NAIL IM 10MM 32CM TRGN TI TIB DIST","BOTH IP/OP","$239.63 ","$177.33 ","$0.00 ","$239.63 ","$107.83 ","$0.00 ","$49.94 ","$0.00 ","$0.00 ","$41.96 ","$239.63 ","$0.00 ","$119.81 ","$189.79 ","$191.70 ","$0.00 ","$37.50 ","$0.00 ","$38.15 ","$0.00 "
"71194828","SUP","HCPCS C1713","","71194828  -  NAIL IM 10/8.5MM 28CM TRGN BNT TI HUM","BOTH IP/OP","$339.75 ","$251.42 ","$0.00 ","$339.75 ","$152.89 ","$0.00 ","$70.81 ","$0.00 ","$0.00 ","$59.49 ","$339.75 ","$0.00 ","$169.88 ","$269.08 ","$271.80 ","$0.00 ","$53.17 ","$0.00 ","$54.09 ","$0.00 "
"71220006","SUP","HCPCS C1713","","71220006  -  SCREW BN 2.7MM 6MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220008","SUP","HCPCS C1713","","71220008  -  SCREW BN 2.7MM 8MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220010","SUP","HCPCS C1713","","71220010  -  SCREW BN MN 2.7MM 10MM TC100 SS CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220012","SUP","HCPCS C1713","","71220012  -  SCREW BN MN 2.7MM 12MM TC100 SS CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220014","SUP","HCPCS C1713","","71220014  -  SCREW BN MN 2.7MM 14MM TC100 SS CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220016","SUP","HCPCS C1713","","71220016  -  SCREW BN MN 2.7MM 16MM TC100 SS CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220018","SUP","HCPCS C1713","","71220018  -  SCREW BN 2.7MM 18MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220020","SUP","HCPCS C1713","","71220020  -  SCREW BN 2.7MM 20MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220022","SUP","HCPCS C1713","","71220022  -  SCREW BN 2.7MM 22MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220024","SUP","HCPCS C1713","","71220024  -  SCREW BN 2.7MM 24MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220026","SUP","HCPCS C1713","","71220026  -  SCREW BN 2.7MM 26MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220028","SUP","HCPCS C1713","","71220028  -  SCREW BN 2.7MM 28MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220030","SUP","HCPCS C1713","","71220030  -  SCREW BN 2.7MM 30MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220032","SUP","HCPCS C1713","","71220032  -  SCREW BN 2.7MM 32MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220034","SUP","HCPCS C1713","","71220034  -  SCREW BN MN 2.7MM 34MM TC100 SS CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220036","SUP","HCPCS C1713","","71220036  -  SCREW BN 2.7MM 36MM TC100 ST HEX HD SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220038","SUP","HCPCS C1713","","71220038  -  SCREW BN 2.7MM 38MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220040","SUP","HCPCS C1713","","71220040  -  SCREW BN 2.7MM 40MM TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220045","SUP","HCPCS C1713","","71220045  -  SCREW BN MN 2.7MM 45MM TC100 SS CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71220050","SUP","HCPCS C1713","","71220050  -  SCREW BN 2.7MM 50MM STRL TC100 SS CORT MN FRAG SET","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222010","SUP","HCPCS C1713","","71222010  -  SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222012","SUP","HCPCS C1713","","71222012  -  SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222014","SUP","HCPCS C1713","","71222014  -  SCREW BN 3.5MM 6MM 14MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222016","SUP","HCPCS C1713","","71222016  -  SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222018","SUP","HCPCS C1713","","71222018  -  SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222020","SUP","HCPCS C1713","","71222020  -  SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222022","SUP","HCPCS C1713","","71222022  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222024","SUP","HCPCS C1713","","71222024  -  SCREW BN 3.5MM 6MM 24MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222026","SUP","HCPCS C1713","","71222026  -  SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222028","SUP","HCPCS C1713","","71222028  -  SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222030","SUP","HCPCS C1713","","71222030  -  SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222032","SUP","HCPCS C1713","","71222032  -  SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222034","SUP","HCPCS C1713","","71222034  -  SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222036","SUP","HCPCS C1713","","71222036  -  SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222038","SUP","HCPCS C1713","","71222038  -  SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222040","SUP","HCPCS C1713","","71222040  -  SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222045","SUP","HCPCS C1713","","71222045  -  SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222050","SUP","HCPCS C1713","","71222050  -  SCREW BN 3.5MM 6MM 50MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222055","SUP","HCPCS C1713","","71222055  -  SCREW BN 3.5MM 6MM 55MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71222060","SUP","HCPCS C1713","","71222060  -  SCREW BN 3.5MM 6MM 60MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222065","SUP","HCPCS C1713","","71222065  -  SCREW BN 3.5MM 6MM 65MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222070","SUP","HCPCS C1713","","71222070  -  SCREW BN 3.5MM 6MM 70MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222075","SUP","HCPCS C1713","","71222075  -  SCREW BN 3.5MM 6MM 75MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222080","SUP","HCPCS C1713","","71222080  -  SCREW BN 3.5MM 6MM 80MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222085","SUP","HCPCS C1713","","71222085  -  SCREW BN 3.5MM 6MM 85MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222090","SUP","HCPCS C1713","","71222090  -  SCREW BN 3.5MM 6MM 90MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222095","SUP","HCPCS C1713","","71222095  -  SCREW BN 3.5MM 6MM 95MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222100","SUP","HCPCS C1713","","71222100  -  SCREW BN 3.5MM 100MM TC100 SS CORT SM FRAG SET","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222105","SUP","HCPCS C1713","","71222105  -  SCREW BN 3.5MM 105MM TC100 SS CORT SM FRAG SET","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222110","SUP","HCPCS C1713","","71222110  -  SCREW BN SM 3.5MM 110MM TC100 SS CORT","BOTH IP/OP","$89.40 ","$66.16 ","$0.00 ","$89.40 ","$40.23 ","$0.00 ","$18.63 ","$0.00 ","$0.00 ","$15.65 ","$89.40 ","$0.00 ","$44.70 ","$70.80 ","$71.52 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"71222115","SUP","HCPCS C1713","","71222115  -  SCREW BN 3.5MM 115MM TC100 SS CORT SM FRAG SET","BOTH IP/OP","$101.48 ","$75.10 ","$0.00 ","$101.48 ","$45.66 ","$0.00 ","$21.15 ","$0.00 ","$0.00 ","$17.77 ","$101.48 ","$0.00 ","$50.74 ","$80.37 ","$81.18 ","$0.00 ","$15.88 ","$0.00 ","$16.15 ","$0.00 "
"71222120","SUP","HCPCS C1713","","71222120  -  SCREW BN 3.5MM 120MM TC100 SS CORT SM FRAG SET","BOTH IP/OP","$101.48 ","$75.10 ","$0.00 ","$101.48 ","$45.66 ","$0.00 ","$21.15 ","$0.00 ","$0.00 ","$17.77 ","$101.48 ","$0.00 ","$50.74 ","$80.37 ","$81.18 ","$0.00 ","$15.88 ","$0.00 ","$16.15 ","$0.00 "
"71222130","SUP","HCPCS C1713","","71222130  -  SCREW BN 3.5MM 130MM TC100 SS CORT SM FRAG SET","BOTH IP/OP","$101.48 ","$75.10 ","$0.00 ","$101.48 ","$45.66 ","$0.00 ","$21.15 ","$0.00 ","$0.00 ","$17.77 ","$101.48 ","$0.00 ","$50.74 ","$80.37 ","$81.18 ","$0.00 ","$15.88 ","$0.00 ","$16.15 ","$0.00 "
"71223010","SUP","HCPCS C1713","","71223010  -  SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223012","SUP","HCPCS C1713","","71223012  -  SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223014","SUP","HCPCS C1713","","71223014  -  SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223016","SUP","HCPCS C1713","","71223016  -  SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223018","SUP","HCPCS C1713","","71223018  -  SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223020","SUP","HCPCS C1713","","71223020  -  SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223022","SUP","HCPCS C1713","","71223022  -  SCREW BN FT 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223024","SUP","HCPCS C1713","","71223024  -  SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223026","SUP","HCPCS C1713","","71223026  -  SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223028","SUP","HCPCS C1713","","71223028  -  SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223030","SUP","HCPCS C1713","","71223030  -  SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223032","SUP","HCPCS C1713","","71223032  -  SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223035","SUP","HCPCS C1713","","71223035  -  SCREW BN FT 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223036","SUP","HCPCS C1713","","71223036  -  SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223040","SUP","HCPCS C1713","","71223040  -  SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223045","SUP","HCPCS C1713","","71223045  -  SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223050","SUP","HCPCS C1713","","71223050  -  SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223055","SUP","HCPCS C1713","","71223055  -  SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223060","SUP","HCPCS C1713","","71223060  -  SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$61.70 ","$45.66 ","$0.00 ","$61.70 ","$27.77 ","$0.00 ","$12.86 ","$0.00 ","$0.00 ","$10.80 ","$61.70 ","$0.00 ","$30.85 ","$48.87 ","$49.36 ","$0.00 ","$9.66 ","$0.00 ","$9.82 ","$0.00 "
"71223065","SUP","HCPCS C1713","","71223065  -  SCREW BN FT 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223070","SUP","HCPCS C1713","","71223070  -  SCREW BN FT 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223075","SUP","HCPCS C1713","","71223075  -  SCREW BN FT 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223080","SUP","HCPCS C1713","","71223080  -  SCREW BN FT 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223085","SUP","HCPCS C1713","","71223085  -  SCREW BN FT 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$81.53 ","$36.69 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$14.27 ","$81.53 ","$0.00 ","$40.76 ","$64.57 ","$65.22 ","$0.00 ","$12.76 ","$0.00 ","$12.98 ","$0.00 "
"71223090","SUP","HCPCS C1713","","71223090  -  SCREW BN FT 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$81.53 ","$36.69 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$14.27 ","$81.53 ","$0.00 ","$40.76 ","$64.57 ","$65.22 ","$0.00 ","$12.76 ","$0.00 ","$12.98 ","$0.00 "
"71223095","SUP","HCPCS C1713","","71223095  -  SCREW BN FT 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$81.53 ","$36.69 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$14.27 ","$81.53 ","$0.00 ","$40.76 ","$64.57 ","$65.22 ","$0.00 ","$12.76 ","$0.00 ","$12.98 ","$0.00 "
"71223100","SUP","HCPCS C1713","","71223100  -  SCREW BN FT 4MM 100MM TC100 SS CANC SM FRAG SET","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$81.53 ","$36.69 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$14.27 ","$81.53 ","$0.00 ","$40.76 ","$64.57 ","$65.22 ","$0.00 ","$12.76 ","$0.00 ","$12.98 ","$0.00 "
"71223210","SUP","HCPCS C1713","","71223210  -  SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223212","SUP","HCPCS C1713","","71223212  -  SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223214","SUP","HCPCS C1713","","71223214  -  SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223216","SUP","HCPCS C1713","","71223216  -  SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223218","SUP","HCPCS C1713","","71223218  -  SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223220","SUP","HCPCS C1713","","71223220  -  SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223222","SUP","HCPCS C1713","","71223222  -  SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223224","SUP","HCPCS C1713","","71223224  -  SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223226","SUP","HCPCS C1713","","71223226  -  SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223228","SUP","HCPCS C1713","","71223228  -  SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223230","SUP","HCPCS C1713","","71223230  -  SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223235","SUP","HCPCS C1713","","71223235  -  SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223240","SUP","HCPCS C1713","","71223240  -  SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223245","SUP","HCPCS C1713","","71223245  -  SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223250","SUP","HCPCS C1713","","71223250  -  SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223255","SUP","HCPCS C1713","","71223255  -  SCREW BN P/T 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223260","SUP","HCPCS C1713","","71223260  -  SCREW BN P/T 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$59.53 ","$44.05 ","$0.00 ","$59.53 ","$26.79 ","$0.00 ","$12.41 ","$0.00 ","$0.00 ","$10.42 ","$59.53 ","$0.00 ","$29.76 ","$47.15 ","$47.62 ","$0.00 ","$9.32 ","$0.00 ","$9.48 ","$0.00 "
"71223265","SUP","HCPCS C1713","","71223265  -  SCREW BN P/T 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223270","SUP","HCPCS C1713","","71223270  -  SCREW BN P/T 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223275","SUP","HCPCS C1713","","71223275  -  SCREW BN P/T 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223280","SUP","HCPCS C1713","","71223280  -  SCREW BN P/T 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71223285","SUP","HCPCS C1713","","71223285  -  SCREW BN P/T 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71223290","SUP","HCPCS C1713","","71223290  -  SCREW BN P/T 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71223295","SUP","HCPCS C1713","","71223295  -  SCREW BN P/T 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71223300","SUP","HCPCS C1713","","71223300  -  SCREW BN 4MM 100MM TC100 P/T SS CANC","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225014","SUP","HCPCS C1713","","71225014  -  SCREW BN 4.5MM 14MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225016","SUP","HCPCS C1713","","71225016  -  SCREW BN 4.5MM 16MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225018","SUP","HCPCS C1713","","71225018  -  SCREW BN 4.5MM 18MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225020","SUP","HCPCS C1713","","71225020  -  SCREW BN 4.5MM 20MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225022","SUP","HCPCS C1713","","71225022  -  SCREW BN 4.5MM 22MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225024","SUP","HCPCS C1713","","71225024  -  SCREW BN 4.5MM 24MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225026","SUP","HCPCS C1713","","71225026  -  SCREW BN 4.5MM 26MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225028","SUP","HCPCS C1713","","71225028  -  SCREW BN 4.5MM 28MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225030","SUP","HCPCS C1713","","71225030  -  SCREW BN 4.5MM 30MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225032","SUP","HCPCS C1713","","71225032  -  SCREW BN 4.5MM 32MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225034","SUP","HCPCS C1713","","71225034  -  SCREW BN 4.5MM 34MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225036","SUP","HCPCS C1713","","71225036  -  SCREW BN 4.5MM 36MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225038","SUP","HCPCS C1713","","71225038  -  SCREW BN 4.5MM 38MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225040","SUP","HCPCS C1713","","71225040  -  SCREW BN 4.5MM 40MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225042","SUP","HCPCS C1713","","71225042  -  SCREW BN 4.5MM 42MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225044","SUP","HCPCS C1713","","71225044  -  SCREW BN 4.5MM 44MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225046","SUP","HCPCS C1713","","71225046  -  SCREW BN 4.5MM 46MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225048","SUP","HCPCS C1713","","71225048  -  SCREW BN 4.5MM 48MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225050","SUP","HCPCS C1713","","71225050  -  SCREW BN 4.5MM 50MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225052","SUP","HCPCS C1713","","71225052  -  SCREW BN 4.5MM 52MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225054","SUP","HCPCS C1713","","71225054  -  SCREW BN 4.5MM 54MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225056","SUP","HCPCS C1713","","71225056  -  SCREW BN 4.5MM 56MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225058","SUP","HCPCS C1713","","71225058  -  SCREW BN 4.5MM 58MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225060","SUP","HCPCS C1713","","71225060  -  SCREW BN 4.5MM 8MM 60MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225062","SUP","HCPCS C1713","","71225062  -  SCREW BN 4.5MM 62MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225064","SUP","HCPCS C1713","","71225064  -  SCREW BN 4.5MM 64MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225066","SUP","HCPCS C1713","","71225066  -  SCREW BN 4.5MM 66MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225068","SUP","HCPCS C1713","","71225068  -  SCREW BN 4.5MM 68MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225070","SUP","HCPCS C1713","","71225070  -  SCREW BN 4.5MM 70MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225072","SUP","HCPCS C1713","","71225072  -  SCREW BN 4.5MM 72MM TC100 CORT","BOTH IP/OP","$57.60 ","$42.62 ","$0.00 ","$57.60 ","$25.92 ","$0.00 ","$12.01 ","$0.00 ","$0.00 ","$10.09 ","$57.60 ","$0.00 ","$28.80 ","$45.62 ","$46.08 ","$0.00 ","$9.01 ","$0.00 ","$9.17 ","$0.00 "
"71225076","SUP","HCPCS C1713","","71225076  -  SCREW BN 4.5MM 8MM 76MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225080","SUP","HCPCS C1713","","71225080  -  SCREW BN 4.5MM 8MM 80MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225085","SUP","HCPCS C1713","","71225085  -  SCREW BN 4.5MM 8MM 85MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225090","SUP","HCPCS C1713","","71225090  -  SCREW BN 4.5MM 8MM 90MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225095","SUP","HCPCS C1713","","71225095  -  SCREW BN 4.5MM 8MM 95MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225100","SUP","HCPCS C1713","","71225100  -  SCREW BN 4.5MM 100MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225105","SUP","HCPCS C1713","","71225105  -  SCREW BN 4.5MM 105MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$99.33 ","$73.50 ","$0.00 ","$99.33 ","$44.70 ","$0.00 ","$20.70 ","$0.00 ","$0.00 ","$17.39 ","$99.33 ","$0.00 ","$49.66 ","$78.67 ","$79.46 ","$0.00 ","$15.54 ","$0.00 ","$15.81 ","$0.00 "
"71225110","SUP","HCPCS C1713","","71225110  -  SCREW BN LG 4.5MM 110MM TC100 SS CORT","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225115","SUP","HCPCS C1713","","71225115  -  SCREW BN 4.5MM 115MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225120","SUP","HCPCS C1713","","71225120  -  SCREW BN 4.5MM 120MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225125","SUP","HCPCS C1713","","71225125  -  SCREW BN 4.5MM 125MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225130","SUP","HCPCS C1713","","71225130  -  SCREW BN 4.5MM 130MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225135","SUP","HCPCS C1713","","71225135  -  SCREW BN 4.5MM 135MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225140","SUP","HCPCS C1713","","71225140  -  SCREW BN 4.5MM 140MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225145","SUP","HCPCS C1713","","71225145  -  SCREW BN 4.5MM 145MM TC100 SS CORT LG FRAG SET","BOTH IP/OP","$108.15 ","$80.03 ","$0.00 ","$108.15 ","$48.67 ","$0.00 ","$22.54 ","$0.00 ","$0.00 ","$18.94 ","$108.15 ","$0.00 ","$54.08 ","$85.65 ","$86.52 ","$0.00 ","$16.93 ","$0.00 ","$17.22 ","$0.00 "
"71225225","SUP","HCPCS C1713","","71225225  -  SCREW BN 4.5MM 25MM STRL 12MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225230","SUP","HCPCS C1713","","71225230  -  SCREW BN 4.5MM 30MM STRL 15MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225235","SUP","HCPCS C1713","","71225235  -  SCREW BN 4.5MM 35MM STRL 18MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225240","SUP","HCPCS C1713","","71225240  -  SCREW BN 4.5MM 40MM STRL 20MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225245","SUP","HCPCS C1713","","71225245  -  SCREW BN 4.5MM 45MM STRL 22MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225250","SUP","HCPCS C1713","","71225250  -  SCREW BN 4.5MM 50MM STRL 24MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225255","SUP","HCPCS C1713","","71225255  -  SCREW BN 4.5MM 55MM STRL 26MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225260","SUP","HCPCS C1713","","71225260  -  SCREW BN 4.5MM 60MM STRL 28MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225265","SUP","HCPCS C1713","","71225265  -  SCREW BN 4.5MM 65MM STRL 30MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225270","SUP","HCPCS C1713","","71225270  -  SCREW BN 4.5MM 70MM STRL 32MM TC100 SS MLR LG FRAG SET","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"71225320","SUP","HCPCS C1713","","71225320  -  PLATE BN 90D 10MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225321","SUP","HCPCS C1713","","71225321  -  PLATE BN 90D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT PROX FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225322","SUP","HCPCS C1713","","71225322  -  PLATE BN 90D 10MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225323","SUP","HCPCS C1713","","71225323  -  PLATE BN 90D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT PROX FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225324","SUP","HCPCS C1713","","71225324  -  PLATE BN 90D 10MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225325","SUP","HCPCS C1713","","71225325  -  PLATE BN 90D 10MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225326","SUP","HCPCS C1713","","71225326  -  PLATE BN 90D 10MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225327","SUP","HCPCS C1713","","71225327  -  PLATE BN 90D 15MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225328","SUP","HCPCS C1713","","71225328  -  PLATE BN 90D 15MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225329","SUP","HCPCS C1713","","71225329  -  PLATE BN 90D 15MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225330","SUP","HCPCS C1713","","71225330  -  PLATE BN 90D 15MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225331","SUP","HCPCS C1713","","71225331  -  PLATE BN 90D 15MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225332","SUP","HCPCS C1713","","71225332  -  PLATE BN 90D 15MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225333","SUP","HCPCS C1713","","71225333  -  PLATE BN 90D 15MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225334","SUP","HCPCS C1713","","71225334  -  PLATE BN 90D 15MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225335","SUP","HCPCS C1713","","71225335  -  PLATE BN 90D 20MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225336","SUP","HCPCS C1713","","71225336  -  PLATE BN 90D 20MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225337","SUP","HCPCS C1713","","71225337  -  PLATE BN 90D 20MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225338","SUP","HCPCS C1713","","71225338  -  PLATE BN 90D 20MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225339","SUP","HCPCS C1713","","71225339  -  PLATE BN 100D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225340","SUP","HCPCS C1713","","71225340  -  PLATE BN 100D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225341","SUP","HCPCS C1713","","71225341  -  PLATE BN 110D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225342","SUP","HCPCS C1713","","71225342  -  PLATE BN 110D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225343","SUP","HCPCS C1713","","71225343  -  PLATE BN 110D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225344","SUP","HCPCS C1713","","71225344  -  PLATE BN 120D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225345","SUP","HCPCS C1713","","71225345  -  PLATE BN 120D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225346","SUP","HCPCS C1713","","71225346  -  PLATE BN 120D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225347","SUP","HCPCS C1713","","71225347  -  PLATE BN 130D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225348","SUP","HCPCS C1713","","71225348  -  PLATE BN 130D 70MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225349","SUP","HCPCS C1713","","71225349  -  PLATE BN 130D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225350","SUP","HCPCS C1713","","71225350  -  PLATE BN 130D 80MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225351","SUP","HCPCS C1713","","71225351  -  PLATE BN 130D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225352","SUP","HCPCS C1713","","71225352  -  PLATE BN 130D 90MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225353","SUP","HCPCS C1713","","71225353  -  PLATE BN 130D 95MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225354","SUP","HCPCS C1713","","71225354  -  PLATE BN 130D 100MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225355","SUP","HCPCS C1713","","71225355  -  PLATE BN 130D 105MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225356","SUP","HCPCS C1713","","71225356  -  PLATE BN 130D 110MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225400","SUP","HCPCS C1713","","71225400  -  PLATE BN 95D 92MM 50MM TC100 5 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225401","SUP","HCPCS C1713","","71225401  -  PLATE BN 95D 92MM 60MM TC100 5 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225402","SUP","HCPCS C1713","","71225402  -  PLATE BN 95D 92MM 70MM TC100 5 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225403","SUP","HCPCS C1713","","71225403  -  PLATE BN 95D 92MM 80MM TC100 5 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225404","SUP","HCPCS C1713","","71225404  -  PLATE BN 95D 124MM 50MM TC100 7 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225405","SUP","HCPCS C1713","","71225405  -  PLATE BN 95D 124MM 60MM TC100 7 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225406","SUP","HCPCS C1713","","71225406  -  PLATE BN 95D 124MM 70MM TC100 7 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225407","SUP","HCPCS C1713","","71225407  -  PLATE BN 95D 124MM 80MM TC100 7 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225408","SUP","HCPCS C1713","","71225408  -  PLATE BN 95D 156MM 50MM TC100 9 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225409","SUP","HCPCS C1713","","71225409  -  PLATE BN 95D 156MM 60MM TC100 9 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225410","SUP","HCPCS C1713","","71225410  -  PLATE BN 95D 156MM 70MM TC100 9 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225411","SUP","HCPCS C1713","","71225411  -  PLATE BN 95D 156MM 80MM TC100 9 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225412","SUP","HCPCS C1713","","71225412  -  PLATE BN 95D 204MM 50MM TC100 12 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225413","SUP","HCPCS C1713","","71225413  -  PLATE BN 95D 204MM 60MM TC100 12 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225414","SUP","HCPCS C1713","","71225414  -  PLATE BN 95D 204MM 70MM TC100 12 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225415","SUP","HCPCS C1713","","71225415  -  PLATE BN 95D 204MM 80MM TC100 12 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225416","SUP","HCPCS C1713","","71225416  -  PLATE BN 95D 235MM 50MM TC100 14 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225417","SUP","HCPCS C1713","","71225417  -  PLATE BN 95D 235MM 60MM TC100 14 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225418","SUP","HCPCS C1713","","71225418  -  PLATE BN 95D 235MM 70MM TC100 14 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225419","SUP","HCPCS C1713","","71225419  -  PLATE BN 95D 235MM 80MM TC100 14 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225420","SUP","HCPCS C1713","","71225420  -  PLATE BN 95D 267MM 60MM TC100 16 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225421","SUP","HCPCS C1713","","71225421  -  PLATE BN 95D 267MM 70MM TC100 16 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225422","SUP","HCPCS C1713","","71225422  -  PLATE BN 95D 267MM 80MM TC100 16 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225423","SUP","HCPCS C1713","","71225423  -  PLATE BN 95D 299MM 60MM TC100 18 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225424","SUP","HCPCS C1713","","71225424  -  PLATE BN 95D 299MM 70MM TC100 18 HL OSTM SS ADLT CNDYL FEM","BOTH IP/OP","$2,955.75 ","$2,187.26 ","$0.00 ","$2,955.75 ","$1,330.09 ","$0.00 ","$616.05 ","$0.00 ","$0.00 ","$517.53 ","$2,955.75 ","$0.00 ","$1,477.88 ","$2,340.95 ","$2,364.60 ","$0.00 ","$462.57 ","$0.00 ","$470.56 ","$0.00 "
"71225430","SUP","HCPCS C1713","","71225430  -  PLATE BN 95D SM STAT 92MM 40MM TC100 5 HL OSTM SS CNDYL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71225431","SUP","HCPCS C1713","","71225431  -  PLATE BN 95D SM STAT 92MM 50MM TC100 5 HL OSTM SS CNDYL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71225432","SUP","HCPCS C1713","","71225432  -  PLATE BN 95D SM STAT 92MM 60MM TC100 5 HL OSTM SS CNDYL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71225433","SUP","HCPCS C1713","","71225433  -  PLATE BN 95D SM STAT 92MM 70MM TC100 5 HL OSTM SS CNDYL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71225434","SUP","HCPCS C1713","","71225434  -  PLATE BN 95D SM STAT 124MM 40MM TC100 7 HL OSTM SS CNDYL","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225435","SUP","HCPCS C1713","","71225435  -  PLATE BN 95D SM STAT 124MM 50MM TC100 7 HL OSTM SS CNDYL","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225436","SUP","HCPCS C1713","","71225436  -  PLATE BN 95D SM STAT 124MM 60MM TC100 7 HL OSTM SS CNDYL","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225437","SUP","HCPCS C1713","","71225437  -  PLATE BN 95D SM STAT 124MM 70MM TC100 7 HL OSTM SS CNDYL","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225438","SUP","HCPCS C1713","","71225438  -  PLATE BN 95D SM STAT 156MM 40MM TC100 9 HL OSTM SS CNDYL","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"71225439","SUP","HCPCS C1713","","71225439  -  PLATE BN 95D SM STAT 156MM 50MM TC100 9 HL OSTM SS CNDYL","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"71225440","SUP","HCPCS C1713","","71225440  -  PLATE BN 95D SM STAT 156MM 60MM TC100 9 HL OSTM SS CNDYL","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"71225441","SUP","HCPCS C1713","","71225441  -  PLATE BN 95D SM STAT 156MM 70MM TC100 9 HL OSTM SS CNDYL","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"71225500","SUP","HCPCS C1713","","71225500  -  PLATE BN 130D 50MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225501","SUP","HCPCS C1713","","71225501  -  PLATE BN 130D 60MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225502","SUP","HCPCS C1713","","71225502  -  PLATE BN 130D 70MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225503","SUP","HCPCS C1713","","71225503  -  PLATE BN 130D 75MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225504","SUP","HCPCS C1713","","71225504  -  PLATE BN 130D 80MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225505","SUP","HCPCS C1713","","71225505  -  PLATE BN 130D 85MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225506","SUP","HCPCS C1713","","71225506  -  PLATE BN 130D 90MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225507","SUP","HCPCS C1713","","71225507  -  PLATE BN 130D 95MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225508","SUP","HCPCS C1713","","71225508  -  PLATE BN 130D 100MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225509","SUP","HCPCS C1713","","71225509  -  PLATE BN 130D 105MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225510","SUP","HCPCS C1713","","71225510  -  PLATE BN 130D 110MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,412.25 ","$1,045.07 ","$0.00 ","$1,412.25 ","$635.51 ","$0.00 ","$294.35 ","$0.00 ","$0.00 ","$247.27 ","$1,412.25 ","$0.00 ","$706.13 ","$1,118.50 ","$1,129.80 ","$0.00 ","$221.02 ","$0.00 ","$224.83 ","$0.00 "
"71225511","SUP","HCPCS C1713","","71225511  -  PLATE BN 130D 50MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"71225512","SUP","HCPCS C1713","","71225512  -  PLATE BN 130D 60MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"71225513","SUP","HCPCS C1713","","71225513  -  PLATE BN 130D 70MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"71225514","SUP","HCPCS C1713","","71225514  -  PLATE BN 130D 80MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"71225515","SUP","HCPCS C1713","","71225515  -  PLATE BN 130D 90MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"71225516","SUP","HCPCS C1713","","71225516  -  PLATE BN 130D 70MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225517","SUP","HCPCS C1713","","71225517  -  PLATE BN 130D 80MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225518","SUP","HCPCS C1713","","71225518  -  PLATE BN 130D 90MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"71225519","SUP","HCPCS C1713","","71225519  -  PLATE BN 130D 70MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,911.00 ","$859.95 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$334.60 ","$1,911.00 ","$0.00 ","$955.50 ","$1,513.51 ","$1,528.80 ","$0.00 ","$299.07 ","$0.00 ","$304.23 ","$0.00 "
"71225520","SUP","HCPCS C1713","","71225520  -  PLATE BN 130D 80MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,911.00 ","$859.95 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$334.60 ","$1,911.00 ","$0.00 ","$955.50 ","$1,513.51 ","$1,528.80 ","$0.00 ","$299.07 ","$0.00 ","$304.23 ","$0.00 "
"71225521","SUP","HCPCS C1713","","71225521  -  PLATE BN 130D 90MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,911.00 ","$859.95 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$334.60 ","$1,911.00 ","$0.00 ","$955.50 ","$1,513.51 ","$1,528.80 ","$0.00 ","$299.07 ","$0.00 ","$304.23 ","$0.00 "
"71225530","SUP","HCPCS C1713","","71225530  -  PLATE BN 130D SM STAT 50MM 60MM TC100 4 HL OSTM SS FEM PROX","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225531","SUP","HCPCS C1713","","71225531  -  PLATE BN 130D SM STAT 60MM 60MM TC100 4 HL OSTM SS FEM PROX","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225532","SUP","HCPCS C1713","","71225532  -  PLATE BN 130D SM STAT 70MM 60MM TC100 4 HL OSTM SS FEM PROX","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225533","SUP","HCPCS C1713","","71225533  -  PLATE BN 130D SM STAT 80MM 60MM TC100 4 HL OSTM SS FEM PROX","BOTH IP/OP","$1,580.25 ","$1,169.39 ","$0.00 ","$1,580.25 ","$711.11 ","$0.00 ","$329.36 ","$0.00 ","$0.00 ","$276.69 ","$1,580.25 ","$0.00 ","$790.13 ","$1,251.56 ","$1,264.20 ","$0.00 ","$247.31 ","$0.00 ","$251.58 ","$0.00 "
"71225534","SUP","HCPCS C1713","","71225534  -  PLATE BN 130D SM STAT 50MM 104MM TC100 6 HL OSTM SS FEM PROX","BOTH IP/OP","$1,680.00 ","$1,243.20 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$350.15 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$262.92 ","$0.00 ","$267.46 ","$0.00 "
"71225535","SUP","HCPCS C1713","","71225535  -  PLATE BN 130D SM STAT 104MM 70MM TC100 6 HL ANG SS FEM PROX","BOTH IP/OP","$1,680.00 ","$1,243.20 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$350.15 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$262.92 ","$0.00 ","$267.46 ","$0.00 "
"71225536","SUP","HCPCS C1713","","71225536  -  PLATE BN 130D SM STAT 104MM 60MM TC100 6 HL ANG SS FEM PROX","BOTH IP/OP","$1,680.00 ","$1,243.20 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$350.15 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$262.92 ","$0.00 ","$267.46 ","$0.00 "
"71225537","SUP","HCPCS C1713","","71225537  -  PLATE BN 130D SM STAT 104MM 80MM TC100 6 HL ANG SS FEM PROX","BOTH IP/OP","$1,680.00 ","$1,243.20 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$350.15 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$262.92 ","$0.00 ","$267.46 ","$0.00 "
"71225539","SUP","HCPCS C1713","","71225539  -  PLATE BN 130D SM STAT 152MM 60MM TC100 9 HL ANG SS FEM PROX","BOTH IP/OP","$1,853.25 ","$1,371.41 ","$0.00 ","$1,853.25 ","$833.96 ","$0.00 ","$386.26 ","$0.00 ","$0.00 ","$324.49 ","$1,853.25 ","$0.00 ","$926.63 ","$1,467.77 ","$1,482.60 ","$0.00 ","$290.03 ","$0.00 ","$295.04 ","$0.00 "
"71225540","SUP","HCPCS C1713","","71225540  -  PLATE BN 130D SM STAT 152MM 72MM TC100 9 HL ANG SS FEM PROX","BOTH IP/OP","$1,853.25 ","$1,371.41 ","$0.00 ","$1,853.25 ","$833.96 ","$0.00 ","$386.26 ","$0.00 ","$0.00 ","$324.49 ","$1,853.25 ","$0.00 ","$926.63 ","$1,467.77 ","$1,482.60 ","$0.00 ","$290.03 ","$0.00 ","$295.04 ","$0.00 "
"71225541","SUP","HCPCS C1713","","71225541  -  PLATE BN 130D SM STAT 152MM 80MM TC100 9 HL ANG SS FEM PROX","BOTH IP/OP","$1,853.25 ","$1,371.41 ","$0.00 ","$1,853.25 ","$833.96 ","$0.00 ","$386.26 ","$0.00 ","$0.00 ","$324.49 ","$1,853.25 ","$0.00 ","$926.63 ","$1,467.77 ","$1,482.60 ","$0.00 ","$290.03 ","$0.00 ","$295.04 ","$0.00 "
"71225600","SUP","HCPCS C1713","","71225600  -  PLATE BN 90D 7MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225601","SUP","HCPCS C1713","","71225601  -  PLATE BN 90D 12MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225602","SUP","HCPCS C1713","","71225602  -  PLATE BN 90D 7MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225603","SUP","HCPCS C1713","","71225603  -  PLATE BN 90D 12MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225610","SUP","HCPCS C1713","","71225610  -  PLATE BN 115D 5MM 30MM TC100 BFUR ANG SS PED FEM PROX 3.5MM","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"71225611","SUP","HCPCS C1713","","71225611  -  PLATE BN 115D 5MM 35MM TC100 BFUR ANG SS PED FEM PROX 3.5MM","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"71225620","SUP","HCPCS C1713","","71225620  -  PLATE BN 80D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225621","SUP","HCPCS C1713","","71225621  -  PLATE BN 80D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225622","SUP","HCPCS C1713","","71225622  -  PLATE BN 90D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$951.30 ","$703.96 ","$0.00 ","$951.30 ","$428.09 ","$0.00 ","$198.27 ","$0.00 ","$0.00 ","$166.57 ","$951.30 ","$0.00 ","$475.65 ","$753.43 ","$761.04 ","$0.00 ","$148.88 ","$0.00 ","$151.45 ","$0.00 "
"71225623","SUP","HCPCS C1713","","71225623  -  PLATE BN 90D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225624","SUP","HCPCS C1713","","71225624  -  PLATE BN 100D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225625","SUP","HCPCS C1713","","71225625  -  PLATE BN 100D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"71225640","SUP","HCPCS C1713","","71225640  -  PLATE BN 90D 10MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71225641","SUP","HCPCS C1713","","71225641  -  PLATE BN 90D 15MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71225642","SUP","HCPCS C1713","","71225642  -  PLATE BN 90D 10MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71225643","SUP","HCPCS C1713","","71225643  -  PLATE BN 90D 15MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71225644","SUP","HCPCS C1713","","71225644  -  PLATE BN 90D 15MM 60MM TC100 3 HL ANG SS PED FEM PROX 4.5MM","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"71225716","SUP","HCPCS C1713","","71225716  -  SCREW BN 3.5MM 16MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225718","SUP","HCPCS C1713","","71225718  -  SCREW BN 3.5MM 18MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225720","SUP","HCPCS C1713","","71225720  -  SCREW BN 3.5MM 20MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225722","SUP","HCPCS C1713","","71225722  -  SCREW BN 3.5MM 22MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225724","SUP","HCPCS C1713","","71225724  -  SCREW BN 3.5MM 24MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225726","SUP","HCPCS C1713","","71225726  -  SCREW BN 3.5MM 26MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225728","SUP","HCPCS C1713","","71225728  -  SCREW BN 3.5MM 28MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225730","SUP","HCPCS C1713","","71225730  -  SCREW BN 3.5MM 30MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225732","SUP","HCPCS C1713","","71225732  -  SCREW BN 3.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225734","SUP","HCPCS C1713","","71225734  -  SCREW BN 3.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225736","SUP","HCPCS C1713","","71225736  -  SCREW BN 3.5MM 36MM STRL 12MM TC100 ST SS ORTH","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225738","SUP","HCPCS C1713","","71225738  -  SCREW BN 3.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225740","SUP","HCPCS C1713","","71225740  -  SCREW BN 3.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225745","SUP","HCPCS C1713","","71225745  -  SCREW BN 3.5MM 45MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225750","SUP","HCPCS C1713","","71225750  -  SCREW BN 3.5MM 50MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG","BOTH IP/OP","$65.53 ","$48.49 ","$0.00 ","$65.53 ","$29.49 ","$0.00 ","$13.66 ","$0.00 ","$0.00 ","$11.47 ","$65.53 ","$0.00 ","$32.76 ","$51.90 ","$52.42 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"71225822","SUP","HCPCS C1713","","71225822  -  SCREW BN 4.5MM 22MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225824","SUP","HCPCS C1713","","71225824  -  SCREW BN 4.5MM 24MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225826","SUP","HCPCS C1713","","71225826  -  SCREW BN 4.5MM 26MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225828","SUP","HCPCS C1713","","71225828  -  SCREW BN 4.5MM 28MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225830","SUP","HCPCS C1713","","71225830  -  SCREW BN 4.5MM 30MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225832","SUP","HCPCS C1713","","71225832  -  SCREW BN 4.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225834","SUP","HCPCS C1713","","71225834  -  SCREW BN 4.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225836","SUP","HCPCS C1713","","71225836  -  SCREW BN 4.5MM 36MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225838","SUP","HCPCS C1713","","71225838  -  SCREW BN 4.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225840","SUP","HCPCS C1713","","71225840  -  SCREW BN 4.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$67.53 ","$49.97 ","$0.00 ","$67.53 ","$30.39 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.53 ","$0.00 ","$33.76 ","$53.48 ","$54.02 ","$0.00 ","$10.57 ","$0.00 ","$10.75 ","$0.00 "
"71225842","SUP","HCPCS C1713","","71225842  -  SCREW BN 4.5MM 42MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225844","SUP","HCPCS C1713","","71225844  -  SCREW BN 4.5MM 44MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225846","SUP","HCPCS C1713","","71225846  -  SCREW BN 4.5MM 46MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225848","SUP","HCPCS C1713","","71225848  -  SCREW BN 4.5MM 48MM STRL 12MM TC100 ST SS ORTH","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225850","SUP","HCPCS C1713","","71225850  -  SCREW BN 4.5MM 50MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225852","SUP","HCPCS C1713","","71225852  -  SCREW BN 4.5MM 52MM STRL 15MM TC100 ST SS ORTH","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225854","SUP","HCPCS C1713","","71225854  -  SCREW BN 4.5MM 54MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225856","SUP","HCPCS C1713","","71225856  -  SCREW BN 4.5MM 56MM STRL 15MM TC100 ST SS ORTH","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225858","SUP","HCPCS C1713","","71225858  -  SCREW BN 4.5MM 58MM STRL 15MM TC100 ST SS ORTH","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225860","SUP","HCPCS C1713","","71225860  -  SCREW BN 4.5MM 60MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225864","SUP","HCPCS C1713","","71225864  -  SCREW BN 4.5MM 64MM STRL 18MM TC100 ST SS ORTH","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225868","SUP","HCPCS C1713","","71225868  -  SCREW BN 4.5MM 68MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225872","SUP","HCPCS C1713","","71225872  -  SCREW BN 4.5MM 72MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"71225876","SUP","HCPCS C1713","","71225876  -  SCREW BN 4.5MM 76MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71225880","SUP","HCPCS C1713","","71225880  -  SCREW BN 4.5MM 80MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71225885","SUP","HCPCS C1713","","71225885  -  SCREW BN 4.5MM 85MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71225890","SUP","HCPCS C1713","","71225890  -  SCREW BN 4.5MM 90MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71225895","SUP","HCPCS C1713","","71225895  -  SCREW BN 4.5MM 95MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71225900","SUP","HCPCS C1713","","71225900  -  SCREW BN 4.5MM 100MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"71226030","SUP","HCPCS C1713","","71226030  -  SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226035","SUP","HCPCS C1713","","71226035  -  SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226040","SUP","HCPCS C1713","","71226040  -  SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226045","SUP","HCPCS C1713","","71226045  -  SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226050","SUP","HCPCS C1713","","71226050  -  SCREW BN P/T 6.5MM 8MM 50MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226055","SUP","HCPCS C1713","","71226055  -  SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226060","SUP","HCPCS C1713","","71226060  -  SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226065","SUP","HCPCS C1713","","71226065  -  SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226070","SUP","HCPCS C1713","","71226070  -  SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226075","SUP","HCPCS C1713","","71226075  -  SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226080","SUP","HCPCS C1713","","71226080  -  SCREW BN P/T 6.5MM 8MM 80MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71226085","SUP","HCPCS C1713","","71226085  -  SCREW BN P/T 6.5MM 8MM 85MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71226090","SUP","HCPCS C1713","","71226090  -  SCREW BN P/T 6.5MM 8MM 90MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71226095","SUP","HCPCS C1713","","71226095  -  SCREW BN P/T 6.5MM 8MM 95MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71226100","SUP","HCPCS C1713","","71226100  -  SCREW BN 6.5MM 100MM 16MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71226105","SUP","HCPCS C1713","","71226105  -  SCREW BN 6.5MM 105MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71226110","SUP","HCPCS C1713","","71226110  -  SCREW BN 6.5MM 110MM 16MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71226115","SUP","HCPCS C1713","","71226115  -  SCREW BN 6.5MM 115MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226120","SUP","HCPCS C1713","","71226120  -  SCREW BN 6.5MM 120MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226125","SUP","HCPCS C1713","","71226125  -  SCREW BN 6.5MM 125MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226130","SUP","HCPCS C1713","","71226130  -  SCREW BN 6.5MM 130MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226135","SUP","HCPCS C1713","","71226135  -  SCREW BN 6.5MM 135MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226140","SUP","HCPCS C1713","","71226140  -  SCREW BN 6.5MM 140MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226145","SUP","HCPCS C1713","","71226145  -  SCREW BN 6.5MM 145MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71226150","SUP","HCPCS C1713","","71226150  -  SCREW BN 6.5MM 150MM 16MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228045","SUP","HCPCS C1713","","71228045  -  SCREW BN 6.5MM 45MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228050","SUP","HCPCS C1713","","71228050  -  SCREW BN 6.5MM 50MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228055","SUP","HCPCS C1713","","71228055  -  SCREW BN 6.5MM 55MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228060","SUP","HCPCS C1713","","71228060  -  SCREW BN 6.5MM 60MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228065","SUP","HCPCS C1713","","71228065  -  SCREW BN 6.5MM 65MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228070","SUP","HCPCS C1713","","71228070  -  SCREW BN 6.5MM 70MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228075","SUP","HCPCS C1713","","71228075  -  SCREW BN 6.5MM 75MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228080","SUP","HCPCS C1713","","71228080  -  SCREW BN 6.5MM 80MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71228085","SUP","HCPCS C1713","","71228085  -  SCREW BN 6.5MM 85MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$143.85 ","$106.45 ","$0.00 ","$143.85 ","$64.73 ","$0.00 ","$29.98 ","$0.00 ","$0.00 ","$25.19 ","$143.85 ","$0.00 ","$71.93 ","$113.93 ","$115.08 ","$0.00 ","$22.51 ","$0.00 ","$22.90 ","$0.00 "
"71228090","SUP","HCPCS C1713","","71228090  -  SCREW BN 6.5MM 90MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71228095","SUP","HCPCS C1713","","71228095  -  SCREW BN 6.5MM 95MM 32MM TC100 THRD SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71228100","SUP","HCPCS C1713","","71228100  -  SCREW BN 6.5MM 100MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71228105","SUP","HCPCS C1713","","71228105  -  SCREW BN 6.5MM 105MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71228110","SUP","HCPCS C1713","","71228110  -  SCREW BN 6.5MM 110MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71228115","SUP","HCPCS C1713","","71228115  -  SCREW BN 6.5MM 115MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228120","SUP","HCPCS C1713","","71228120  -  SCREW BN 6.5MM 120MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228125","SUP","HCPCS C1713","","71228125  -  SCREW BN 6.5MM 125MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228130","SUP","HCPCS C1713","","71228130  -  SCREW BN 6.5MM 130MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228135","SUP","HCPCS C1713","","71228135  -  SCREW BN 6.5MM 135MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228140","SUP","HCPCS C1713","","71228140  -  SCREW BN 6.5MM 140MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228145","SUP","HCPCS C1713","","71228145  -  SCREW BN 6.5MM 145MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71228150","SUP","HCPCS C1713","","71228150  -  SCREW BN 6.5MM 150MM 32MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229025","SUP","HCPCS C1713","","71229025  -  SCREW BN FT 6.5MM 8MM 25MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229030","SUP","HCPCS C1713","","71229030  -  SCREW BN FT 6.5MM 8MM 30MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229035","SUP","HCPCS C1713","","71229035  -  SCREW BN FT 6.5MM 8MM 35MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229040","SUP","HCPCS C1713","","71229040  -  SCREW BN FT 6.5MM 8MM 40MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229045","SUP","HCPCS C1713","","71229045  -  SCREW BN FT 6.5MM 8MM 45MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229050","SUP","HCPCS C1713","","71229050  -  SCREW BN FT 6.5MM 8MM 50MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229055","SUP","HCPCS C1713","","71229055  -  SCREW BN FT 6.5MM 8MM 55MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229060","SUP","HCPCS C1713","","71229060  -  SCREW BN FT 6.5MM 8MM 60MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229065","SUP","HCPCS C1713","","71229065  -  SCREW BN FT 6.5MM 8MM 65MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229070","SUP","HCPCS C1713","","71229070  -  SCREW BN FT 6.5MM 8MM 70MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229075","SUP","HCPCS C1713","","71229075  -  SCREW BN FT 6.5MM 75MM TC100 CANC","BOTH IP/OP","$123.90 ","$91.69 ","$0.00 ","$123.90 ","$55.76 ","$0.00 ","$25.82 ","$0.00 ","$0.00 ","$21.69 ","$123.90 ","$0.00 ","$61.95 ","$98.13 ","$99.12 ","$0.00 ","$19.39 ","$0.00 ","$19.72 ","$0.00 "
"71229080","SUP","HCPCS C1713","","71229080  -  SCREW BN FT 6.5MM 80MM TC100 CANC","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229085","SUP","HCPCS C1713","","71229085  -  SCREW BN FT 6.5MM 85MM TC100 CANC","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229090","SUP","HCPCS C1713","","71229090  -  SCREW BN FT 6.5MM 90MM TC100 CANC","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229095","SUP","HCPCS C1713","","71229095  -  SCREW BN FT 6.5MM 8MM 95MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229100","SUP","HCPCS C1713","","71229100  -  SCREW BN FT 6.5MM 100MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229105","SUP","HCPCS C1713","","71229105  -  SCREW BN FT 6.5MM 105MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229110","SUP","HCPCS C1713","","71229110  -  SCREW BN FT 6.5MM 110MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$135.45 ","$100.23 ","$0.00 ","$135.45 ","$60.95 ","$0.00 ","$28.23 ","$0.00 ","$0.00 ","$23.72 ","$135.45 ","$0.00 ","$67.73 ","$107.28 ","$108.36 ","$0.00 ","$21.20 ","$0.00 ","$21.56 ","$0.00 "
"71229115","SUP","HCPCS C1713","","71229115  -  SCREW BN FT 6.5MM 115MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229120","SUP","HCPCS C1713","","71229120  -  SCREW BN FT 6.5MM 120MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229125","SUP","HCPCS C1713","","71229125  -  SCREW BN FT 6.5MM 125MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229130","SUP","HCPCS C1713","","71229130  -  SCREW BN FT 6.5MM 130MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229135","SUP","HCPCS C1713","","71229135  -  SCREW BN FT 6.5MM 135MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229140","SUP","HCPCS C1713","","71229140  -  SCREW BN FT 6.5MM 140MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229145","SUP","HCPCS C1713","","71229145  -  SCREW BN FT 6.5MM 145MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71229150","SUP","HCPCS C1713","","71229150  -  SCREW BN FT 6.5MM 150MM TC100 SS CANC LG FRAG SET","BOTH IP/OP","$174.30 ","$128.98 ","$0.00 ","$174.30 ","$78.44 ","$0.00 ","$36.33 ","$0.00 ","$0.00 ","$30.52 ","$174.30 ","$0.00 ","$87.15 ","$138.05 ","$139.44 ","$0.00 ","$27.28 ","$0.00 ","$27.75 ","$0.00 "
"71453122","SUP","HCPCS C1776","","71453122  -  INSERT TIB 5-6 11MM LEGION CR HI FLXN XLPE KN","BOTH IP/OP","$10,175.00 ","$7,529.50 ","$0.00 ","$10,175.00 ","$4,578.75 ","$0.00 ","$2,120.72 ","$0.00 ","$0.00 ","$1,781.56 ","$10,175.00 ","$0.00 ","$5,087.50 ","$8,058.60 ","$8,140.00 ","$0.00 ","$1,592.39 ","$0.00 ","$1,619.86 ","$0.00 "
"71525986","SUP","HCPCS C1713","","71525986  -  SCREW BN 5MM 55MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525989","SUP","HCPCS C1713","","71525989  -  SCREW BN 5MM 70MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525990","SUP","HCPCS C1713","","71525990  -  SCREW BN 5MM 75MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525991","SUP","HCPCS C1713","","71525991  -  SCREW BN 5MM 80MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525993","SUP","HCPCS C1713","","71525993  -  SCREW BN 5MM 90MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525994","SUP","HCPCS C1713","","71525994  -  SCREW BN 5MM 95MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525995","SUP","HCPCS C1713","","71525995  -  SCREW BN 5MM 100MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525996","SUP","HCPCS C1713","","71525996  -  SCREW BN 5MM 105MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71525997","SUP","HCPCS C1713","","71525997  -  SCREW BN 5MM 110MM ORTH","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$137.70 ","$0.00 ","$63.78 ","$0.00 ","$0.00 ","$53.58 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$47.89 ","$0.00 ","$48.72 ","$0.00 "
"71631035","SUP","Custom 27203010","","71631035  -  DRILL SURG 6.4MM STERILE","BOTH IP/OP","$587.25 ","$434.57 ","$0.00 ","$587.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$587.25 ","$0.00 ","$293.63 ","$465.10 ","$469.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71631110","SUP","Custom 27203010","","71631110  -  BIT DRILL LONG 4MM PILOT TRIGEN GOLD STERILE DISPOSABLE","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71631112","SUP","Custom 27203010","","71631112  -  BIT DRL SHRT 3.2MM STRL TRGN PILT","BOTH IP/OP","$148.50 ","$109.89 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.50 ","$0.00 ","$74.25 ","$117.61 ","$118.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71631117","SUP","Custom 27203010","","71631117  -  BIT DRILL 4MM TRGN SHRT PILT STRL DISP","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71631626","SUP","HCPCS C1769","","71631626  -  GUIDE ROD ORTH BALL 3MM 1000MM STRL TRGN BALL TIP SS DISP","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$235.19 ","$0.00 ","$90.27 ","$0.00 ","$0.00 ","$75.84 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$67.78 ","$0.00 ","$68.95 ","$0.00 "
"71631690","SUP","Custom 27203010","","71631690  -  GUIDEWIRE ORTHOPEDIC THREAD 3.2MM TRIGEN DISTAL FEMUR","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$209.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.25 ","$0.00 ","$104.63 ","$165.73 ","$167.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71632001","SUP","HCPCS C1713","","71632001  -  NUT ORTH 5MM STRL TRGN STBLK LCK STAB 5MM SCR","BOTH IP/OP","$585.00 ","$432.90 ","$0.00 ","$585.00 ","$263.25 ","$0.00 ","$121.93 ","$0.00 ","$0.00 ","$102.43 ","$585.00 ","$0.00 ","$292.50 ","$463.32 ","$468.00 ","$0.00 ","$91.55 ","$0.00 ","$93.13 ","$0.00 "
"71632002","SUP","HCPCS C1713","","71632002  -  NUT ORTH 4.5MM STBLK WSHR","BOTH IP/OP","$303.75 ","$224.78 ","$0.00 ","$303.75 ","$136.69 ","$0.00 ","$63.31 ","$0.00 ","$0.00 ","$53.18 ","$303.75 ","$0.00 ","$151.88 ","$240.57 ","$243.00 ","$0.00 ","$47.54 ","$0.00 ","$48.36 ","$0.00 "
"71632125","SUP","HCPCS C1713","","71632125  -  SCREW BN 4.5MM 25MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632130","SUP","HCPCS C1713","","71632130  -  SCREW BN 4.5MM 30MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632135","SUP","HCPCS C1713","","71632135  -  SCREW BN 4.5MM 35MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632140","SUP","HCPCS C1713","","71632140  -  SCREW BN 4.5MM 40MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632150","SUP","HCPCS C1713","","71632150  -  SCREW BN 4.5MM 50MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632200","SUP","HCPCS C1713","","71632200  -  SCREW BN 5MM 100MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632205","SUP","HCPCS C1713","","71632205  -  SCREW BN 5MM 105MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632210","SUP","HCPCS C1713","","71632210  -  SCREW BN 5MM 110MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632220","SUP","HCPCS C1713","","71632220  -  SCREW BN 5MM 20MM AU TRGN ST SLFDRL CPTR FLUT TIP THRD TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632230","SUP","HCPCS C1713","","71632230  -  SCREW BN 5MM 30MM AU TRGN FLUT TIP ST DRL CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632260","SUP","HCPCS C1713","","71632260  -  SCREW BN 5MM 60MM AU TRGN CPTR SLF DRL ST TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632275","SUP","HCPCS C1713","","71632275  -  SCREW BN 5MM 75MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632280","SUP","HCPCS C1713","","71632280  -  SCREW BN 5MM 80MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN","BOTH IP/OP","$407.25 ","$301.37 ","$0.00 ","$407.25 ","$183.26 ","$0.00 ","$84.88 ","$0.00 ","$0.00 ","$71.31 ","$407.25 ","$0.00 ","$203.63 ","$322.54 ","$325.80 ","$0.00 ","$63.73 ","$0.00 ","$64.83 ","$0.00 "
"71632300","SUP","HCPCS C1713","","71632300  -  SCREW BN 6.4MM 100MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632305","SUP","HCPCS C1713","","71632305  -  SCREW BN 6.4MM 105MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632316","SUP","HCPCS C1713","","71632316  -  SCREW BN 6.4MM 115MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632325","SUP","HCPCS C1713","","71632325  -  SCREW BN 6.4MM 125MM BLU TRGN CPTR RECON TI KN IM NL","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632375","SUP","HCPCS C1713","","71632375  -  SCREW BN 6.4MM 75MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632380","SUP","HCPCS C1713","","71632380  -  SCREW BN 6.4MM 80MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632385","SUP","HCPCS C1713","","71632385  -  SCREW BN 6.4MM 85MM BLU TRGN CPTR RECON TI KN IM NL","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632390","SUP","HCPCS C1713","","71632390  -  SCREW BN 6.4MM 90MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71632395","SUP","HCPCS C1713","","71632395  -  SCREW BN 6.4MM 95MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM","BOTH IP/OP","$685.13 ","$507.00 ","$0.00 ","$685.13 ","$308.31 ","$0.00 ","$142.80 ","$0.00 ","$0.00 ","$119.96 ","$685.13 ","$0.00 ","$342.56 ","$542.62 ","$548.10 ","$0.00 ","$107.22 ","$0.00 ","$109.07 ","$0.00 "
"71633005","SUP","HCPCS C1713","","71633005  -  CAP END 5MM 5MM TRGN XTD TI FEM IM NL","BOTH IP/OP","$418.50 ","$309.69 ","$0.00 ","$418.50 ","$188.33 ","$0.00 ","$87.23 ","$0.00 ","$0.00 ","$73.28 ","$418.50 ","$0.00 ","$209.25 ","$331.45 ","$334.80 ","$0.00 ","$65.50 ","$0.00 ","$66.63 ","$0.00 "
"71633010","SUP","HCPCS C1713","","71633010  -  CAP END 10MM 10MM TRGN XTD TI FEM IM NL","BOTH IP/OP","$418.50 ","$309.69 ","$0.00 ","$418.50 ","$188.33 ","$0.00 ","$87.23 ","$0.00 ","$0.00 ","$73.28 ","$418.50 ","$0.00 ","$209.25 ","$331.45 ","$334.80 ","$0.00 ","$65.50 ","$0.00 ","$66.63 ","$0.00 "
"71633015","SUP","HCPCS C1713","","71633015  -  CAP END 15MM TRGN TI ORTH IM NL","BOTH IP/OP","$418.50 ","$309.69 ","$0.00 ","$418.50 ","$188.33 ","$0.00 ","$87.23 ","$0.00 ","$0.00 ","$73.28 ","$418.50 ","$0.00 ","$209.25 ","$331.45 ","$334.80 ","$0.00 ","$65.50 ","$0.00 ","$66.63 ","$0.00 "
"71633020","SUP","HCPCS C1713","","71633020  -  CAP END 20MM TRGN TI ORTH IM NL","BOTH IP/OP","$418.50 ","$309.69 ","$0.00 ","$418.50 ","$188.33 ","$0.00 ","$87.23 ","$0.00 ","$0.00 ","$73.28 ","$418.50 ","$0.00 ","$209.25 ","$331.45 ","$334.80 ","$0.00 ","$65.50 ","$0.00 ","$66.63 ","$0.00 "
"71633315","SUP","HCPCS C1713","","71633315  -  NAIL IM 11.5MM 15CM AU TRGN SET TI KN SP CNDL","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"71633320","SUP","HCPCS C1713","","71633320  -  NAIL IM 11.5MM 20CM AU TRGN TI KN TIB","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"71633325","SUP","HCPCS C1713","","71633325  -  NAIL IM 11.5MM 25CM AU TRGN SET TI KN SP CNDL","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"71633415","SUP","HCPCS C1713","","71633415  -  NAIL IM 13MM 15CM AU TRGN SET TI KN SP CNDL","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"71633420","SUP","HCPCS C1713","","71633420  -  NAIL IM 13MM 20CM AU TRGN SET TI KN SP CNDL","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"71633425","SUP","HCPCS C1713","","71633425  -  NAIL IM 13MM 25CM AU TRGN SET TI KN SP CNDL","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"71633448","SUP","HCPCS C1713","","71633448  -  NAIL IM 13MM 48CM AU TRGN RTRGD ANTGRD TI FEM TIB","BOTH IP/OP","$6,490.00 ","$4,802.60 ","$0.00 ","$6,490.00 ","$2,920.50 ","$0.00 ","$1,352.68 ","$0.00 ","$0.00 ","$1,136.35 ","$6,490.00 ","$0.00 ","$3,245.00 ","$5,140.08 ","$5,192.00 ","$0.00 ","$1,015.69 ","$0.00 ","$1,033.21 ","$0.00 "
"71634000","SUP","HCPCS C1713","","71634000  -  CAP END 0MM TRGN SET TI DISP INTNL HEX IM NL","BOTH IP/OP","$420.75 ","$311.36 ","$0.00 ","$420.75 ","$189.34 ","$0.00 ","$87.69 ","$0.00 ","$0.00 ","$73.67 ","$420.75 ","$0.00 ","$210.38 ","$333.23 ","$336.60 ","$0.00 ","$65.85 ","$0.00 ","$66.98 ","$0.00 "
"71634005","SUP","HCPCS C1713","","71634005  -  CAP END 5MM TRGN SET TI DISP INTNL HEX IM NL","BOTH IP/OP","$420.75 ","$311.36 ","$0.00 ","$420.75 ","$189.34 ","$0.00 ","$87.69 ","$0.00 ","$0.00 ","$73.67 ","$420.75 ","$0.00 ","$210.38 ","$333.23 ","$336.60 ","$0.00 ","$65.85 ","$0.00 ","$66.98 ","$0.00 "
"71634010","SUP","HCPCS C1713","","71634010  -  CAP END 10MM 10MM TRGN TI ORTH IM NL","BOTH IP/OP","$420.75 ","$311.36 ","$0.00 ","$420.75 ","$189.34 ","$0.00 ","$87.69 ","$0.00 ","$0.00 ","$73.67 ","$420.75 ","$0.00 ","$210.38 ","$333.23 ","$336.60 ","$0.00 ","$65.85 ","$0.00 ","$66.98 ","$0.00 "
"71634015","SUP","HCPCS C1713","","71634015  -  CAP END 15MM 15MM TRGN ORTH IM NL","BOTH IP/OP","$420.75 ","$311.36 ","$0.00 ","$420.75 ","$189.34 ","$0.00 ","$87.69 ","$0.00 ","$0.00 ","$73.67 ","$420.75 ","$0.00 ","$210.38 ","$333.23 ","$336.60 ","$0.00 ","$65.85 ","$0.00 ","$66.98 ","$0.00 "
"71634020","SUP","HCPCS C1713","","71634020  -  CAP END 20MM TRGN TI INTNL HEX IM NL","BOTH IP/OP","$420.75 ","$311.36 ","$0.00 ","$420.75 ","$189.34 ","$0.00 ","$87.69 ","$0.00 ","$0.00 ","$73.67 ","$420.75 ","$0.00 ","$210.38 ","$333.23 ","$336.60 ","$0.00 ","$65.85 ","$0.00 ","$66.98 ","$0.00 "
"71634230","SUP","HCPCS C1713","","71634230  -  NAIL IM STD 10MM 30CM LIME TRGN ANTGRD FAN TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634232","SUP","HCPCS C1713","","71634232  -  NAIL IM STD 10MM 32CM LIME TRGN ANTGRD FAN TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634234","SUP","HCPCS C1713","","71634234  -  NAIL IM STD 10MM 34CM LIME TRGN ANTGRD FAN TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634236","SUP","HCPCS C1713","","71634236  -  NAIL IM STD 10MM 36CM LIME TRGN ANTGRD FAN TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634238","SUP","HCPCS C1713","","71634238  -  NAIL IM STD 10MM 38CM LIME TRGN ANTGRD FAN TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634240","SUP","HCPCS C1713","","71634240  -  NAIL IM STD 10MM 40CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634242","SUP","HCPCS C1713","","71634242  -  NAIL IM STD 10MM 42CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634244","SUP","HCPCS C1713","","71634244  -  NAIL IM STD 10MM 44CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634246","SUP","HCPCS C1713","","71634246  -  NAIL IM STD 10MM 46CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634248","SUP","HCPCS C1713","","71634248  -  NAIL IM STD 10MM 48CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634250","SUP","HCPCS C1713","","71634250  -  NAIL IM 10MM 50CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634330","SUP","HCPCS C1713","","71634330  -  NAIL IM 11.5MM 30CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634332","SUP","HCPCS C1713","","71634332  -  NAIL IM STD 11.5MM 32CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634334","SUP","HCPCS C1713","","71634334  -  NAIL IM STD 11.5MM 34CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634336","SUP","HCPCS C1713","","71634336  -  NAIL IM STD 11.5MM 36CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634338","SUP","HCPCS C1713","","71634338  -  NAIL IM STD 11.5MM 38CM FAN LIME TRGN ANTGRD RECON TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634340","SUP","HCPCS C1713","","71634340  -  NAIL IM STD 11.5MM 40CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634342","SUP","HCPCS C1713","","71634342  -  NAIL IM STD 11.5MM 42CM FAN LIME TRGN ANTGRD TI LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634344","SUP","HCPCS C1713","","71634344  -  NAIL IM STD 11.5MM 44CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634346","SUP","HCPCS C1713","","71634346  -  NAIL IM STD 11.5MM 46CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634348","SUP","HCPCS C1713","","71634348  -  NAIL IM STD 11.5MM 48CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634350","SUP","HCPCS C1713","","71634350  -  NAIL IM 11.5MM 50CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634430","SUP","HCPCS C1713","","71634430  -  NAIL IM 13MM 30CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634432","SUP","HCPCS C1713","","71634432  -  NAIL IM STD 13MM 32CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634434","SUP","HCPCS C1713","","71634434  -  NAIL IM STD 13MM 34CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634436","SUP","HCPCS C1713","","71634436  -  NAIL IM STD 13MM 36CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634438","SUP","HCPCS C1713","","71634438  -  NAIL IM STD 13MM 38CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634440","SUP","HCPCS C1713","","71634440  -  NAIL IM STD 13MM 40CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634442","SUP","HCPCS C1713","","71634442  -  NAIL IM STD 13MM 42CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71634444","SUP","HCPCS C1713","","71634444  -  NAIL IM STD 13MM 44CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634446","SUP","HCPCS C1713","","71634446  -  NAIL IM STD 13MM 46CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634448","SUP","HCPCS C1713","","71634448  -  NAIL IM STD 13MM 48CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634450","SUP","HCPCS C1713","","71634450  -  NAIL IM 13MM 50CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71634830","SUP","HCPCS C1713","","71634830  -  NAIL IM 130D 8.5MM 30CM ROSE TN RT","BOTH IP/OP","$3,971.25 ","$2,938.73 ","$0.00 ","$3,971.25 ","$1,787.06 ","$0.00 ","$827.71 ","$0.00 ","$0.00 ","$695.33 ","$3,971.25 ","$0.00 ","$1,985.63 ","$3,145.23 ","$3,177.00 ","$0.00 ","$621.50 ","$0.00 ","$632.22 ","$0.00 "
"71635230","SUP","HCPCS C1713","","71635230  -  NAIL IM 10MM 30CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635232","SUP","HCPCS C1713","","71635232  -  NAIL IM STD 10MM 32CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635234","SUP","HCPCS C1713","","71635234  -  NAIL IM STD 10MM 34CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635236","SUP","HCPCS C1713","","71635236  -  NAIL IM 130D STD 10MM 36CM ROSE TRGN ANTGRD RND XSECT CNN TI","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635238","SUP","HCPCS C1713","","71635238  -  NAIL IM STD 10MM 38CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635240","SUP","HCPCS C1713","","71635240  -  NAIL IM STD 10MM 40CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635242","SUP","HCPCS C1713","","71635242  -  NAIL IM STD 10MM 42CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635244","SUP","HCPCS C1713","","71635244  -  NAIL IM STD 10MM 44CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635246","SUP","HCPCS C1713","","71635246  -  NAIL IM STD 10MM 46CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635248","SUP","HCPCS C1713","","71635248  -  NAIL IM STD 10MM 48CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635250","SUP","HCPCS C1713","","71635250  -  NAIL IM 10MM 50CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635330","SUP","HCPCS C1713","","71635330  -  NAIL IM 11.5MM 30CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635332","SUP","HCPCS C1713","","71635332  -  NAIL IM STD 11.5MM 32CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635334","SUP","HCPCS C1713","","71635334  -  NAIL IM STD 11.5MM 34CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635336","SUP","HCPCS C1713","","71635336  -  NAIL IM STD 11.5MM 36CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635338","SUP","HCPCS C1713","","71635338  -  NAIL IM STD 11.5MM 38CM FAN ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635340","SUP","HCPCS C1713","","71635340  -  NAIL IM STD 11.5MM 40CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635342","SUP","HCPCS C1713","","71635342  -  NAIL IM STD 11.5MM 42CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635344","SUP","HCPCS C1713","","71635344  -  NAIL IM STD 11.5MM 44CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635346","SUP","HCPCS C1713","","71635346  -  NAIL IM STD 11.5MM 46CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635348","SUP","HCPCS C1713","","71635348  -  NAIL IM STD 11.5MM 48CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635350","SUP","HCPCS C1713","","71635350  -  NAIL IM 11.5MM 50CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635430","SUP","HCPCS C1713","","71635430  -  NAIL IM 13MM 30CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635432","SUP","HCPCS C1713","","71635432  -  NAIL IM STD 13MM 32CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635434","SUP","HCPCS C1713","","71635434  -  NAIL IM STD 13MM 34CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635436","SUP","HCPCS C1713","","71635436  -  NAIL IM STD 13MM 36CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635438","SUP","HCPCS C1713","","71635438  -  NAIL IM STD 13MM 38CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635440","SUP","HCPCS C1713","","71635440  -  NAIL IM STD 13MM 40CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635442","SUP","HCPCS C1713","","71635442  -  NAIL IM STD 13MM 42CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71635444","SUP","HCPCS C1713","","71635444  -  NAIL IM STD 13MM 44CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635446","SUP","HCPCS C1713","","71635446  -  NAIL IM STD 13MM 46CM ROSE TRGN ANTGRD TI FEM LT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635448","SUP","HCPCS C1713","","71635448  -  NAIL IM STD 13MM 48CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71635450","SUP","HCPCS C1713","","71635450  -  NAIL IM 13MM 50CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71636126","SUP","HCPCS C1713","","71636126  -  NAIL IM 8.5IN 26IN GRY TRGN ANTGRD TI FEM","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71636128","SUP","HCPCS C1713","","71636128  -  NAIL IM 8.5MM 28CM GRY TRGN ANTGRD TI FEM","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71636130","SUP","HCPCS C1713","","71636130  -  NAIL IM 10MM 30CM GRY TRGN ANTGRD TI FEM","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71636132","SUP","HCPCS C1713","","71636132  -  NAIL IM 8.5MM 32CM GRY TRGN ANTGRD TI KN FEM","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71636134","SUP","HCPCS C1713","","71636134  -  NAIL IM 8.5MM 34CM GRY TRGN CNN ANTGRD TI FEM","BOTH IP/OP","$4,044.38 ","$2,992.84 ","$0.00 ","$4,044.38 ","$1,819.97 ","$0.00 ","$842.95 ","$0.00 ","$0.00 ","$708.14 ","$4,044.38 ","$0.00 ","$2,022.19 ","$3,203.15 ","$3,235.50 ","$0.00 ","$632.94 ","$0.00 ","$643.86 ","$0.00 "
"71636136","SUP","HCPCS C1713","","71636136  -  NAIL IM 8.5MM 36CM GRY TRGN ANTGRD TI FEM","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71636138","SUP","HCPCS C1713","","71636138  -  NAIL IM 8.5MM 38CM GRY TRGN ANTGRD TI FEM","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71636140","SUP","HCPCS C1713","","71636140  -  NAIL IM 8.5MM 40CM GRY TRGN ANTGRD TI FEM","BOTH IP/OP","$3,870.00 ","$2,863.80 ","$0.00 ","$3,870.00 ","$1,741.50 ","$0.00 ","$806.60 ","$0.00 ","$0.00 ","$677.61 ","$3,870.00 ","$0.00 ","$1,935.00 ","$3,065.04 ","$3,096.00 ","$0.00 ","$605.66 ","$0.00 ","$616.10 ","$0.00 "
"71637124","SUP","HCPCS C1713","","71637124  -  NAIL IM 135D 8.5MM 24CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637130","SUP","HCPCS C1713","","71637130  -  NAIL IM 135D 8.5MM 30CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637132","SUP","HCPCS C1713","","71637132  -  NAIL IM 135D 8.5MM 32CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637134","SUP","HCPCS C1713","","71637134  -  NAIL IM 135D 8.5MM 34CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637136","SUP","HCPCS C1713","","71637136  -  NAIL IM 135D 8.5MM 36CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637138","SUP","HCPCS C1713","","71637138  -  NAIL IM 135D 8.5MM 38CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637140","SUP","HCPCS C1713","","71637140  -  NAIL IM 135D 8.5MM 40CM LIME LT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71637230","SUP","HCPCS C1713","","71637230  -  NAIL IM 135D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637232","SUP","HCPCS C1713","","71637232  -  NAIL IM 135D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637234","SUP","HCPCS C1713","","71637234  -  NAIL IM 135D 10MM 34MM LGHT LIME TRGN ANTGRD TI LT","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637236","SUP","HCPCS C1713","","71637236  -  NAIL IM 135D 10MM 36MM LGHT LIME TRGN ANTGRD TI LT","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637238","SUP","HCPCS C1713","","71637238  -  NAIL IM 135D 10MM 38MM LGHT LIME TRGN ANTGRD TI LT","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637240","SUP","HCPCS C1713","","71637240  -  NAIL IM 135D 10MM 40CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637242","SUP","HCPCS C1713","","71637242  -  NAIL IM 135D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637244","SUP","HCPCS C1713","","71637244  -  NAIL IM 135D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637246","SUP","HCPCS C1713","","71637246  -  NAIL IM 135D 10MM 46CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637248","SUP","HCPCS C1713","","71637248  -  NAIL IM 135D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637250","SUP","HCPCS C1713","","71637250  -  NAIL IM 135D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637330","SUP","HCPCS C1713","","71637330  -  NAIL IM 135D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637332","SUP","HCPCS C1713","","71637332  -  NAIL IM 135D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637334","SUP","HCPCS C1713","","71637334  -  NAIL IM 135D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637336","SUP","HCPCS C1713","","71637336  -  NAIL IM 135D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637338","SUP","HCPCS C1713","","71637338  -  NAIL IM 135D 11.5MM 38CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637340","SUP","HCPCS C1713","","71637340  -  NAIL IM 135D 11.5MM 40CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637342","SUP","HCPCS C1713","","71637342  -  NAIL IM 135D 11.5MM 42CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637344","SUP","HCPCS C1713","","71637344  -  NAIL IM 135D 11.5MM 44CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637346","SUP","HCPCS C1713","","71637346  -  NAIL IM 135D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637348","SUP","HCPCS C1713","","71637348  -  NAIL IM 135D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637350","SUP","HCPCS C1713","","71637350  -  NAIL IM 135D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637430","SUP","HCPCS C1713","","71637430  -  NAIL IM 135D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637432","SUP","HCPCS C1713","","71637432  -  NAIL IM 135D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637434","SUP","HCPCS C1713","","71637434  -  NAIL IM 135D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637436","SUP","HCPCS C1713","","71637436  -  NAIL IM 135D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637438","SUP","HCPCS C1713","","71637438  -  NAIL IM 135D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637440","SUP","HCPCS C1713","","71637440  -  NAIL IM 135D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637442","SUP","HCPCS C1713","","71637442  -  NAIL IM 135D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71637444","SUP","HCPCS C1713","","71637444  -  NAIL IM 135D 13MM 44CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637446","SUP","HCPCS C1713","","71637446  -  NAIL IM 135D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637448","SUP","HCPCS C1713","","71637448  -  NAIL IM 135D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71637450","SUP","HCPCS C1713","","71637450  -  NAIL IM 135D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638124","SUP","HCPCS C1713","","71638124  -  NAIL IM 135D 8.5MM 24CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638128","SUP","HCPCS C1713","","71638128  -  NAIL IM 135D 8.5MM 28CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638130","SUP","HCPCS C1713","","71638130  -  NAIL IM 135D 8.5MM 30CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638132","SUP","HCPCS C1713","","71638132  -  NAIL IM 135D 8.5MM 32CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638134","SUP","HCPCS C1713","","71638134  -  NAIL IM 135D 8.5MM 34CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638136","SUP","HCPCS C1713","","71638136  -  NAIL IM 135D 8.5MM 36CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638138","SUP","HCPCS C1713","","71638138  -  NAIL IM 135D 8.5MM 38CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638140","SUP","HCPCS C1713","","71638140  -  NAIL IM 135D 8.5MM 40CM ROSE RT TROCH","BOTH IP/OP","$2,840.63 ","$2,102.07 ","$0.00 ","$2,840.63 ","$1,278.28 ","$0.00 ","$592.06 ","$0.00 ","$0.00 ","$497.37 ","$2,840.63 ","$0.00 ","$1,420.31 ","$2,249.78 ","$2,272.50 ","$0.00 ","$444.56 ","$0.00 ","$452.23 ","$0.00 "
"71638230","SUP","HCPCS C1713","","71638230  -  NAIL IM 135D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638232","SUP","HCPCS C1713","","71638232  -  NAIL IM 135D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638234","SUP","HCPCS C1713","","71638234  -  NAIL IM 135D 10MM 34CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638236","SUP","HCPCS C1713","","71638236  -  NAIL IM 135D 10MM 36CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638238","SUP","HCPCS C1713","","71638238  -  NAIL IM 135D 10MM 38CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638240","SUP","HCPCS C1713","","71638240  -  NAIL IM 135D 10MM 40CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638242","SUP","HCPCS C1713","","71638242  -  NAIL IM 135D 10MM 42CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638244","SUP","HCPCS C1713","","71638244  -  NAIL IM 135D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638246","SUP","HCPCS C1713","","71638246  -  NAIL IM 135D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638248","SUP","HCPCS C1713","","71638248  -  NAIL IM 135D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638250","SUP","HCPCS C1713","","71638250  -  NAIL IM 135D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638330","SUP","HCPCS C1713","","71638330  -  NAIL IM 135D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638332","SUP","HCPCS C1713","","71638332  -  NAIL IM 135D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638334","SUP","HCPCS C1713","","71638334  -  NAIL IM 135D 11.5MM 34CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638336","SUP","HCPCS C1713","","71638336  -  NAIL IM 135D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638338","SUP","HCPCS C1713","","71638338  -  NAIL IM 135D 11.5MM 38CM ROSE TN TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638340","SUP","HCPCS C1713","","71638340  -  NAIL IM 135D 11.5MM 40CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638342","SUP","HCPCS C1713","","71638342  -  NAIL IM 135D 11.5MM 42CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638344","SUP","HCPCS C1713","","71638344  -  NAIL IM 135D 11.5MM 44CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638346","SUP","HCPCS C1713","","71638346  -  NAIL IM 135D 11.5MM 46CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638348","SUP","HCPCS C1713","","71638348  -  NAIL IM 135D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638350","SUP","HCPCS C1713","","71638350  -  NAIL IM 135D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638430","SUP","HCPCS C1713","","71638430  -  NAIL IM 135D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638432","SUP","HCPCS C1713","","71638432  -  NAIL IM 135D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638434","SUP","HCPCS C1713","","71638434  -  NAIL IM 135D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638436","SUP","HCPCS C1713","","71638436  -  NAIL IM 135D 13MM 36CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638438","SUP","HCPCS C1713","","71638438  -  NAIL IM 135D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638440","SUP","HCPCS C1713","","71638440  -  NAIL IM 135D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638442","SUP","HCPCS C1713","","71638442  -  NAIL IM 135D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,696.88 ","$3,475.69 ","$0.00 ","$4,696.88 ","$2,113.59 ","$0.00 ","$978.95 ","$0.00 ","$0.00 ","$822.39 ","$4,696.88 ","$0.00 ","$2,348.44 ","$3,719.93 ","$3,757.50 ","$0.00 ","$735.06 ","$0.00 ","$747.74 ","$0.00 "
"71638444","SUP","HCPCS C1713","","71638444  -  NAIL IM 135D 13MM 44CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638446","SUP","HCPCS C1713","","71638446  -  NAIL IM 135D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638448","SUP","HCPCS C1713","","71638448  -  NAIL IM 135D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71638450","SUP","HCPCS C1713","","71638450  -  NAIL IM 135D 13MM 50CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"71639215","SUP","HCPCS C1713","","71639215  -  NAIL IM SHRT BND 10MM 15CM BLU TRGN ANTGRD TI FEM TROCH","BOTH IP/OP","$2,857.50 ","$2,114.55 ","$0.00 ","$2,857.50 ","$1,285.88 ","$0.00 ","$595.57 ","$0.00 ","$0.00 ","$500.33 ","$2,857.50 ","$0.00 ","$1,428.75 ","$2,263.14 ","$2,286.00 ","$0.00 ","$447.20 ","$0.00 ","$454.91 ","$0.00 "
"71639315","SUP","HCPCS C1713","","71639315  -  NAIL IM SHRT 11.5MM 15CM BLU TRGN ANTGRD BND TI FEM TROCH","BOTH IP/OP","$4,033.13 ","$2,984.52 ","$0.00 ","$4,033.13 ","$1,814.91 ","$0.00 ","$840.60 ","$0.00 ","$0.00 ","$706.17 ","$4,033.13 ","$0.00 ","$2,016.56 ","$3,194.24 ","$3,226.50 ","$0.00 ","$631.18 ","$0.00 ","$642.07 ","$0.00 "
"71640530","SUP","HCPCS C1713","","71640530  -  NAIL IM 9MM 30CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640532","SUP","HCPCS C1713","","71640532  -  NAIL IM 9MM 32CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640534","SUP","HCPCS C1713","","71640534  -  NAIL IM 9MM 34CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640536","SUP","HCPCS C1713","","71640536  -  NAIL IM 9MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640538","SUP","HCPCS C1713","","71640538  -  NAIL IM 9MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640540","SUP","HCPCS C1713","","71640540  -  NAIL IM 9MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640542","SUP","HCPCS C1713","","71640542  -  NAIL IM 9MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640544","SUP","HCPCS C1713","","71640544  -  NAIL IM 9MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640546","SUP","HCPCS C1713","","71640546  -  NAIL IM 9MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640548","SUP","HCPCS C1713","","71640548  -  NAIL IM 9MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640550","SUP","HCPCS C1713","","71640550  -  NAIL IM 9MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640630","SUP","HCPCS C1713","","71640630  -  NAIL IM 10MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640632","SUP","HCPCS C1713","","71640632  -  NAIL IM 10MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640634","SUP","HCPCS C1713","","71640634  -  NAIL IM 10MM 34CM ROSE TRGN MT-TN RT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640636","SUP","HCPCS C1713","","71640636  -  NAIL IM 10MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640638","SUP","HCPCS C1713","","71640638  -  NAIL IM 10MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640640","SUP","HCPCS C1713","","71640640  -  NAIL IM 10MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640642","SUP","HCPCS C1713","","71640642  -  NAIL IM 10MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640644","SUP","HCPCS C1713","","71640644  -  NAIL IM 10MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640646","SUP","HCPCS C1713","","71640646  -  NAIL IM 10MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640648","SUP","HCPCS C1713","","71640648  -  NAIL IM 10MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640650","SUP","HCPCS C1713","","71640650  -  NAIL IM 10MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640730","SUP","HCPCS C1713","","71640730  -  NAIL IM 11.5MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640732","SUP","HCPCS C1713","","71640732  -  NAIL IM 11.5MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640734","SUP","HCPCS C1713","","71640734  -  NAIL IM 11.5MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640736","SUP","HCPCS C1713","","71640736  -  NAIL IM 11.5MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640738","SUP","HCPCS C1713","","71640738  -  NAIL IM 11.5MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640740","SUP","HCPCS C1713","","71640740  -  NAIL IM 11.5MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640742","SUP","HCPCS C1713","","71640742  -  NAIL IM 11.5MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640744","SUP","HCPCS C1713","","71640744  -  NAIL IM 11.5MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640746","SUP","HCPCS C1713","","71640746  -  NAIL IM 11.5MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640748","SUP","HCPCS C1713","","71640748  -  NAIL IM 11.5MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640750","SUP","HCPCS C1713","","71640750  -  NAIL IM 11.5MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640830","SUP","HCPCS C1713","","71640830  -  NAIL IM 13MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640832","SUP","HCPCS C1713","","71640832  -  NAIL IM 13MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640834","SUP","HCPCS C1713","","71640834  -  NAIL IM 13MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640836","SUP","HCPCS C1713","","71640836  -  NAIL IM 13MM 36CM MT-NL TN RT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640838","SUP","HCPCS C1713","","71640838  -  NAIL IM 13MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640840","SUP","HCPCS C1713","","71640840  -  NAIL IM 13MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640842","SUP","HCPCS C1713","","71640842  -  NAIL IM 13MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640844","SUP","HCPCS C1713","","71640844  -  NAIL IM 13MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640846","SUP","HCPCS C1713","","71640846  -  NAIL IM 13MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640848","SUP","HCPCS C1713","","71640848  -  NAIL IM 13MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71640850","SUP","HCPCS C1713","","71640850  -  NAIL IM 13MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71641123","SUP","Custom 27203010","","71641123  -  BIT DRL SHRT 4MM STRL TRGN AO STP SET DPHSL DISP","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71642120","SUP","HCPCS C1713","","71642120  -  SCREW BN 4.5MM 20MM TRGN CPTR TI ORTH","BOTH IP/OP","$283.50 ","$209.79 ","$0.00 ","$283.50 ","$127.58 ","$0.00 ","$59.09 ","$0.00 ","$0.00 ","$49.64 ","$283.50 ","$0.00 ","$141.75 ","$224.53 ","$226.80 ","$0.00 ","$44.37 ","$0.00 ","$45.13 ","$0.00 "
"71642125","SUP","HCPCS C1713","","71642125  -  SCREW BN 4.5MM 25MM GRY TRGN INTNL CPTR HEX TI FEM IM NL","BOTH IP/OP","$438.75 ","$324.68 ","$0.00 ","$438.75 ","$197.44 ","$0.00 ","$91.45 ","$0.00 ","$0.00 ","$76.82 ","$438.75 ","$0.00 ","$219.38 ","$347.49 ","$351.00 ","$0.00 ","$68.66 ","$0.00 ","$69.85 ","$0.00 "
"71642130","SUP","HCPCS C1713","","71642130  -  SCREW BN 4.5MM 30MM GRY TRGN INTNL CPTR TI FEM IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642135","SUP","HCPCS C1713","","71642135  -  SCREW BN HEX 4.5MM 35MM GRY TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642140","SUP","HCPCS C1713","","71642140  -  SCREW BN HEX 4.5MM 40MM GRY TRGN INTNL CPTR TI KN TIB IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642145","SUP","HCPCS C1713","","71642145  -  SCREW BN 4.5MM 45MM GRY TRGN INTNL CPTR TI ORTH IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642150","SUP","HCPCS C1713","","71642150  -  SCREW BN HEX 4.5MM 50MM GRY TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642155","SUP","HCPCS C1713","","71642155  -  SCREW BN FT 4.5MM 55MM GRY TRGN INTNL CPTR HEX HD TI FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642160","SUP","HCPCS C1713","","71642160  -  SCREW BN 4.5MM 60MM GRY TRGN INTNL CPTR HEX HD TI FEM IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642165","SUP","HCPCS C1713","","71642165  -  SCREW BN 4.5MM 65MM GRY TRGN INTNL CPTR TI ORTH IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642200","SUP","HCPCS C1713","","71642200  -  SCREW BN HEX 5MM 100MM AU TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642205","SUP","HCPCS C1713","","71642205  -  SCREW BN FT 5MM 105MM AU TRGN NTERNAL CPTR HEX HD TI FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642210","SUP","HCPCS C1713","","71642210  -  SCREW BN FT 5MM 110MM AU TRGN INTNL CPTR HEX HD TI FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642220","SUP","HCPCS C1713","","71642220  -  SCREW BN 5MM 20MM TRGN INTNL CPTR HEX HD TI FEM IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642225","SUP","HCPCS C1713","","71642225  -  SCREW BN 5MM 25MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642230","SUP","HCPCS C1713","","71642230  -  SCREW BN 5MM 30MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642235","SUP","HCPCS C1713","","71642235  -  SCREW BN HEX 5MM 35MM AU TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642240","SUP","HCPCS C1713","","71642240  -  SCREW BONE HEXAGON 5MM 40MM INTERNAL CAPTURE TRIGEN GOLD","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642245","SUP","HCPCS C1713","","71642245  -  SCREW BONE HEXAGON 5MM 45MM INTERNAL CAPTURE TRIGEN GOLD","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642250","SUP","HCPCS C1713","","71642250  -  SCREW BONE HEXAGON 5MM 50MM INTERNAL CAPTURE TRIGEN GOLD","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642255","SUP","HCPCS C1713","","71642255  -  SCREW BN HEX 5MM 55MM AU TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642260","SUP","HCPCS C1713","","71642260  -  SCREW BONE HEXAGON 5MM 60MM INTERNAL CAPTURE TRIGEN GOLD","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642265","SUP","HCPCS C1713","","71642265  -  SCREW BN HEX 5MM 65MM AU TRGN INTNL CPTR TI FEM IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642270","SUP","HCPCS C1713","","71642270  -  SCREW BONE HEXAGON 5MM 70MM INTERNAL CAPTURE TRIGEN GOLD","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642275","SUP","HCPCS C1713","","71642275  -  SCREW BN HEX 5MM 75MM AU TRGN INTNL CPTR TI FEM IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642280","SUP","HCPCS C1713","","71642280  -  SCREW BN HEX 5MM 80MM AU TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642285","SUP","HCPCS C1713","","71642285  -  SCREW BN HEX 5MM 85MM AU TRGN INTNL CPTR TI FEM IM NL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642290","SUP","HCPCS C1713","","71642290  -  SCREW BN HEX 5MM 90MM AU TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642295","SUP","HCPCS C1713","","71642295  -  SCREW BN HEX 5MM 95MM AU TRGN INTNL CPTR TI FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71642300","SUP","HCPCS C1713","","71642300  -  SCREW BONE HEXAGON 6.4MM 100MM INTERNAL CAPTURE","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642305","SUP","HCPCS C1713","","71642305  -  SCREW BONE HEXAGON 6.4MM 105MM INTERNAL CAPTURE","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642320","SUP","HCPCS C1713","","71642320  -  SCREW BN HEX 6.4MM 120MM BLU TRGN INTNL CPTR RECON TI FEM IM","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642325","SUP","HCPCS C1713","","71642325  -  SCREW BN HEX 6.4MM 125MM BLU TRGN INTNL CPTR RECON TI FEM IM","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642365","SUP","HCPCS C1713","","71642365  -  SCREW BN HEX 6.4MM 65MM BLU TRGN INTNL CPTR RECON TI FEM IM","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642370","SUP","HCPCS C1713","","71642370  -  SCREW BONE HEXAGON 6.4MM 70MM INTERNAL CAPTURE","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642375","SUP","HCPCS C1713","","71642375  -  SCREW BONE HEXAGON 6.4MM 75MM INTERNAL CAPTURE","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642380","SUP","HCPCS C1713","","71642380  -  SCREW BONE HEXAGON 6.4MM 80MM INTERNAL CAPTURE","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642385","SUP","HCPCS C1713","","71642385  -  SCREW BONE HEXAGON 6.4MM 85MM INTERNAL CAPTURE","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642390","SUP","HCPCS C1713","","71642390  -  SCREW BN 6.4MM 90MM BLU INTNL CPTR RECON HEX TI TROCH TRGN","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642395","SUP","HCPCS C1713","","71642395  -  SCREW BN 6.4MM 95MM BLU INTNL CPTR RECON HEX TI TROCH TRGN","BOTH IP/OP","$727.88 ","$538.63 ","$0.00 ","$727.88 ","$327.54 ","$0.00 ","$151.71 ","$0.00 ","$0.00 ","$127.45 ","$727.88 ","$0.00 ","$363.94 ","$576.48 ","$582.30 ","$0.00 ","$113.91 ","$0.00 ","$115.88 ","$0.00 "
"71642520","SUP","HCPCS C1713","","71642520  -  SCREW BN 5MM 20MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642527","SUP","HCPCS C1713","","71642527  -  SCREW BN 5MM 27.5MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642530","SUP","HCPCS C1713","","71642530  -  SCREW BN 5MM 30MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642532","SUP","HCPCS C1713","","71642532  -  SCREW BN 5MM 32.5MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642535","SUP","HCPCS C1713","","71642535  -  SCREW BN 5MM 35MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642537","SUP","HCPCS C1713","","71642537  -  SCREW BN 5MM 37.5MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642540","SUP","HCPCS C1713","","71642540  -  SCREW BN 5MM 40MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642542","SUP","HCPCS C1713","","71642542  -  SCREW BN 5MM 42.5MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642545","SUP","HCPCS C1713","","71642545  -  SCREW BN 5MM 45MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642550","SUP","HCPCS C1713","","71642550  -  SCREW BN 5MM 50MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642552","SUP","HCPCS C1713","","71642552  -  SCREW BN 5MM 52.5MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642555","SUP","HCPCS C1713","","71642555  -  SCREW BN 5MM 55MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642557","SUP","HCPCS C1713","","71642557  -  SCREW BN 5MM 57.5MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642565","SUP","HCPCS C1713","","71642565  -  SCREW BN 5MM 65MM SURESHOT","BOTH IP/OP","$356.63 ","$263.91 ","$0.00 ","$356.63 ","$160.48 ","$0.00 ","$74.33 ","$0.00 ","$0.00 ","$62.44 ","$356.63 ","$0.00 ","$178.31 ","$282.45 ","$285.30 ","$0.00 ","$55.81 ","$0.00 ","$56.77 ","$0.00 "
"71642575","SUP","HCPCS C1713","","71642575  -  SCREW BN 5MM 75MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642630","SUP","HCPCS C1713","","71642630  -  SCREW BN 2.5MM 30MM TN SURESHOT LG CMPR TROCH","BOTH IP/OP","$706.00 ","$522.44 ","$0.00 ","$706.00 ","$317.70 ","$0.00 ","$147.15 ","$0.00 ","$0.00 ","$123.61 ","$706.00 ","$0.00 ","$353.00 ","$559.15 ","$564.80 ","$0.00 ","$110.49 ","$0.00 ","$112.40 ","$0.00 "
"71642735","SUP","HCPCS C1713","","71642735  -  SCREW SET 0MM TN SURESHOT","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"71642736","SUP","HCPCS C1713","","71642736  -  SCREW SET 5MM TN SURESHOT","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"71642737","SUP","HCPCS C1713","","71642737  -  SCREW SET 10MM TN SURESHOT","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"71642840","SUP","HCPCS C1713","","71642840  -  SCREW BN 4.5MM 40MM SURESHOT LNG BN","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642845","SUP","HCPCS C1713","","71642845  -  SCREW BN 4.5MM 45MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642850","SUP","HCPCS C1713","","71642850  -  SCREW BN 4.5MM 50MM SURESHOT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"71642935","SUP","HCPCS C1713","","71642935  -  SCREW BN 35MM MT-TN CMPR FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"71642936","SUP","HCPCS C1713","","71642936  -  SET SCR MT-TN INTGR CNN","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$192.38 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"71642937","SUP","HCPCS C1713","","71642937  -  SET SCR 5MM TRGN MT-TN","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$192.38 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"71642938","SUP","HCPCS C1713","","71642938  -  SCREW SET 10MM MT-TN MT-TN","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$192.38 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"71644536","SUP","HCPCS C1713","","71644536  -  NAIL IM 14.5MM 36CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644538","SUP","HCPCS C1713","","71644538  -  NAIL IM 14.5MM 38CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644540","SUP","HCPCS C1713","","71644540  -  NAIL IM 14.5MM 40CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644542","SUP","HCPCS C1713","","71644542  -  NAIL IM 14.5MM 42CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644544","SUP","HCPCS C1713","","71644544  -  NAIL IM 14.5MM 44CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644636","SUP","HCPCS C1713","","71644636  -  NAIL IM 16MM 36CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644638","SUP","HCPCS C1713","","71644638  -  NAIL IM 16MM 38CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644640","SUP","HCPCS C1713","","71644640  -  NAIL IM 16MM 40CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644642","SUP","HCPCS C1713","","71644642  -  NAIL IM 16MM 42CM LIME ANTGRD FEM","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71644644","SUP","HCPCS C1713","","71644644  -  NAIL IM 16MM 44CM LIME TRGN ANTGRD TI FEM LT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645020","SUP","HCPCS C1713","","71645020  -  SCREW BN 5MM 20MM TRGN LOPRFL FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645022","SUP","HCPCS C1713","","71645022  -  SCREW BONE 5MM 22.5MM TRGN FEM LP HEXDRIVER","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645025","SUP","HCPCS C1713","","71645025  -  SCREW BN 5MM 25MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645027","SUP","HCPCS C1713","","71645027  -  SCREW BN 5MM 27MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645030","SUP","HCPCS C1713","","71645030  -  SCREW BN 5MM 30MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645032","SUP","HCPCS C1713","","71645032  -  SCREW BN 5MM 32.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645035","SUP","HCPCS C1713","","71645035  -  SCREW BN 5MM 35MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645037","SUP","HCPCS C1713","","71645037  -  SCREW BN 5MM 37.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645040","SUP","HCPCS C1713","","71645040  -  SCREW BN 5MM 40MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645042","SUP","HCPCS C1713","","71645042  -  SCREW BN 5MM 42.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645045","SUP","HCPCS C1713","","71645045  -  SCREW BN 5MM 45MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645047","SUP","HCPCS C1713","","71645047  -  SCREW BN 5MM 47.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645050","SUP","HCPCS C1713","","71645050  -  SCREW BN 5MM 50MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645052","SUP","HCPCS C1713","","71645052  -  SCREW BN 5MM 52.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645055","SUP","HCPCS C1713","","71645055  -  SCREW BN 5MM 55MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645057","SUP","HCPCS C1713","","71645057  -  SCREW BN 5MM 57MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645060","SUP","HCPCS C1713","","71645060  -  SCREW BN 5MM 60MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645062","SUP","HCPCS C1713","","71645062  -  SCREW BONE 5MM 62.5MM LP TRIGEN FEMUR","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645065","SUP","HCPCS C1713","","71645065  -  SCREW BN LOPRFL 5MM 65MM TRGN FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645067","SUP","HCPCS C1713","","71645067  -  SCREW BN 5MM 67MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645070","SUP","HCPCS C1713","","71645070  -  SCREW BN 5MM 70MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645072","SUP","HCPCS C1713","","71645072  -  SCREW BN 5MM 72MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645075","SUP","HCPCS C1713","","71645075  -  SCREW BN 5MM 75MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645077","SUP","HCPCS C1713","","71645077  -  SCREW BONE 5MM 77.5MM LP TRIGEN FEMUR","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645080","SUP","HCPCS C1713","","71645080  -  SCREW BN 5MM 80MM LOPRFL INTNL HEX FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645085","SUP","HCPCS C1713","","71645085  -  SCREW BN LOPRFL 5MM 85MM TRGN FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645090","SUP","HCPCS C1713","","71645090  -  SCREW BN LOPRFL 5MM 90MM TRGN FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645095","SUP","HCPCS C1713","","71645095  -  SCREW BN 5MM 95MM TRGN LOPRFL HEXDRIVER FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645100","SUP","HCPCS C1713","","71645100  -  SCREW BONE 5MM 100MM TRGN FEM LP","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645105","SUP","HCPCS C1713","","71645105  -  SCREW BN 5MM 105MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645110","SUP","HCPCS C1713","","71645110  -  SCREW BN 5MM 110MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645124","SUP","HCPCS C1713","","71645124  -  NAIL IM 130D 8.5MM 24CM LIME TRGN ANTGRD TI ADLT FEM LT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645126","SUP","HCPCS C1713","","71645126  -  NAIL IM 130D 8.5MM 26CM LIME TRGN ANTGRD TI PED LT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645128","SUP","HCPCS C1713","","71645128  -  NAIL IM 130D 8.5MM 28CM TRGN ANTGRD TI PED LT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645130","SUP","HCPCS C1713","","71645130  -  NAIL IM 130D 8.5MM 30CM LIME TRGN ANTGRD TI PED LT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645132","SUP","HCPCS C1713","","71645132  -  NAIL IM 130D 8.5MM 32CM LIME TRGN ANTGRD PED LT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645134","SUP","HCPCS C1713","","71645134  -  NAIL IM 130D 8.5MM 34CM LIME TRGN ANTGRD TI ADLT FEM LT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645136","SUP","HCPCS C1713","","71645136  -  NAIL IM 130D 8.5MM 36CM LIME TRGN ANTGRD SET TI PED LT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645138","SUP","HCPCS C1713","","71645138  -  NAIL IM 130D 8.5MM 38CM LIME TRGN ANTGRD TI ADLT FEM LT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645140","SUP","HCPCS C1713","","71645140  -  NAIL IM 130D 8.5MM 40CM LIME TRGN ANTGRD SET TI PED LT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71645420","SUP","HCPCS C1713","","71645420  -  SCREW BN 4.5MM 20MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645422","SUP","HCPCS C1713","","71645422  -  SCREW BN 4.5MM 22.5MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645425","SUP","HCPCS C1713","","71645425  -  SCREW BN LOPRFL 4.5MM 25MM TRGN FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645427","SUP","HCPCS C1713","","71645427  -  SCREW BONE 4.5MM 27.5MM TRGN LP IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645430","SUP","HCPCS C1713","","71645430  -  SCREW BN LOPRFL 4.5MM 30MM TRGN FEM IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645432","SUP","HCPCS C1713","","71645432  -  SCREW BN 4.5MM 32.5MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645435","SUP","HCPCS C1713","","71645435  -  SCREW BONE LP 4.5MM 35MM TRIGEN FEMUR INTRAMEDULLARY NAIL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645437","SUP","HCPCS C1713","","71645437  -  SCREW BN 4.5MM 37.5MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645440","SUP","HCPCS C1713","","71645440  -  SCREW BN 4.5MM 40MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645442","SUP","HCPCS C1713","","71645442  -  SCREW BN 4.5MM 42.5MM TRGN LOPRFL FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645445","SUP","HCPCS C1713","","71645445  -  SCREW BN 4.5MM 45MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645447","SUP","HCPCS C1713","","71645447  -  SCREW BN 4.5MM 47.5MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645450","SUP","HCPCS C1713","","71645450  -  SCREW BN 4.5MM 50MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645452","SUP","HCPCS C1713","","71645452  -  SCREW BN 4.5MM 52.5MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645455","SUP","HCPCS C1713","","71645455  -  SCREW BN 4.5MM 55MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645457","SUP","HCPCS C1713","","71645457  -  SCREW BN 4.5MM 57.5MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645460","SUP","HCPCS C1713","","71645460  -  SCREW BN 4.5MM 60MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645462","SUP","HCPCS C1713","","71645462  -  SCREW BN 4.5MM 62.5MM TRGN LOPRFL IM NL SYS","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645465","SUP","HCPCS C1713","","71645465  -  SCREW BN 4.5MM 6.5MM TRGN LOPRFL FEM","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"71645536","SUP","HCPCS C1713","","71645536  -  NAIL IM 14.5MM 36CM ROSE ANTGRD FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645538","SUP","HCPCS C1713","","71645538  -  NAIL IM 14.5MM 38CM ROSE ANTGRD FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645540","SUP","HCPCS C1713","","71645540  -  NAIL IM 14.5MM 40CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645542","SUP","HCPCS C1713","","71645542  -  NAIL IM 14.5MM 42CM ROSE ANTGRD FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645544","SUP","HCPCS C1713","","71645544  -  NAIL IM 14.5MM 44CM ROSE ANTGRD FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645636","SUP","HCPCS C1713","","71645636  -  NAIL IM 16MM 36CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645638","SUP","HCPCS C1713","","71645638  -  NAIL IM 16MM 38CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645640","SUP","HCPCS C1713","","71645640  -  NAIL IM 16MM 40CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645642","SUP","HCPCS C1713","","71645642  -  NAIL IM 16MM 42CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71645644","SUP","HCPCS C1713","","71645644  -  NAIL IM 16MM 44CM ROSE TRGN ANTGRD TI FEM RT","BOTH IP/OP","$7,008.75 ","$5,186.48 ","$0.00 ","$7,008.75 ","$3,153.94 ","$0.00 ","$1,460.80 ","$0.00 ","$0.00 ","$1,227.18 ","$7,008.75 ","$0.00 ","$3,504.38 ","$5,550.93 ","$5,607.00 ","$0.00 ","$1,096.87 ","$0.00 ","$1,115.79 ","$0.00 "
"71646124","SUP","HCPCS C1713","","71646124  -  NAIL IM 130D 8.5MM 24CM ROSE TRGN ANTGRD TI ADLT FEM RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646126","SUP","HCPCS C1713","","71646126  -  NAIL IM 130D 8.5MM 26CM ROSE TRGN ANTGRD TI ADLT FEM RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646128","SUP","HCPCS C1713","","71646128  -  NAIL IM 130D 8.5MM 28CM ROSE TRGN ANTGRD TI ADLT FEM RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646130","SUP","HCPCS C1713","","71646130  -  NAIL IM 8.5MM 30CM TN RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646132","SUP","HCPCS C1713","","71646132  -  NAIL IM 130D 8.5MM 32CM ROSE TRGN ANTGRD TI ADLT FEM RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646134","SUP","HCPCS C1713","","71646134  -  NAIL IM 130D 8.5MM 34CM ROSE TRGN ANTGRD TI ADLT FEM RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646136","SUP","HCPCS C1713","","71646136  -  NAIL IM 130D 8.5MM 36CM ROSE TRGN ANTGRD TI ADLT FEM RT","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646138","SUP","HCPCS C1713","","71646138  -  NAIL INTRAMEDULLARY 130D 8.5MM 38CM ANTEGRADE TRIGEN ROSE","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71646140","SUP","HCPCS C1713","","71646140  -  NAIL IM 130D 8.5MM 40CM ROSE TRGN ANTGRD TI PED RT TROCH","BOTH IP/OP","$3,751.88 ","$2,776.39 ","$0.00 ","$3,751.88 ","$1,688.34 ","$0.00 ","$781.98 ","$0.00 ","$0.00 ","$656.92 ","$3,751.88 ","$0.00 ","$1,875.94 ","$2,971.49 ","$3,001.50 ","$0.00 ","$587.17 ","$0.00 ","$597.30 ","$0.00 "
"71647230","SUP","HCPCS C1713","","71647230  -  NAIL IM 130D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647232","SUP","HCPCS C1713","","71647232  -  NAIL IM 130D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647234","SUP","HCPCS C1713","","71647234  -  NAIL IM 130D 10MM 34CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647236","SUP","HCPCS C1713","","71647236  -  NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN LIME","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647238","SUP","HCPCS C1713","","71647238  -  NAIL IM 130D 10MM 38CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647240","SUP","HCPCS C1713","","71647240  -  NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN LIME","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647242","SUP","HCPCS C1713","","71647242  -  NAIL IM 130D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647244","SUP","HCPCS C1713","","71647244  -  NAIL IM 130D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647246","SUP","HCPCS C1713","","71647246  -  NAIL INTRAMEDULLARY 130D 10MM 46CM ANTEGRADE TRIGEN LIME","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647248","SUP","HCPCS C1713","","71647248  -  NAIL IM 130D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647250","SUP","HCPCS C1713","","71647250  -  NAIL IM 130D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647330","SUP","HCPCS C1713","","71647330  -  NAIL IM 130D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647332","SUP","HCPCS C1713","","71647332  -  NAIL IM 130D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647334","SUP","HCPCS C1713","","71647334  -  NAIL IM 130D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647336","SUP","HCPCS C1713","","71647336  -  NAIL IM 130D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647338","SUP","HCPCS C1713","","71647338  -  NAIL INTRAMEDULLARY 130D 11.5MM 38CM 5 HOLE STATIC DYNAMIC","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647340","SUP","HCPCS C1713","","71647340  -  NAIL INTRAMEDULLARY 130D 11.5MM 40CM 5 HOLE STATIC DYNAMIC","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647342","SUP","HCPCS C1713","","71647342  -  NAIL INTRAMEDULLARY 130D 11.5MM 42CM ANTEGRADE TRIGEN LIME","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647346","SUP","HCPCS C1713","","71647346  -  NAIL IM 130D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647348","SUP","HCPCS C1713","","71647348  -  NAIL IM 130D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647350","SUP","HCPCS C1713","","71647350  -  NAIL IM 130D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647430","SUP","HCPCS C1713","","71647430  -  NAIL IM 130D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647432","SUP","HCPCS C1713","","71647432  -  NAIL IM 130D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647434","SUP","HCPCS C1713","","71647434  -  NAIL IM 130D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647436","SUP","HCPCS C1713","","71647436  -  NAIL IM 130D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647438","SUP","HCPCS C1713","","71647438  -  NAIL IM 130D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH IM NL","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647440","SUP","HCPCS C1713","","71647440  -  NAIL IM 130D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647442","SUP","HCPCS C1713","","71647442  -  NAIL IM 130D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647444","SUP","HCPCS C1713","","71647444  -  NAIL IM 130D 13MM 44CM LIME TRGN TN 5 HL STC DYNMC PROX DIST","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647446","SUP","HCPCS C1713","","71647446  -  NAIL IM 130D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647448","SUP","HCPCS C1713","","71647448  -  NAIL IM 130D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71647450","SUP","HCPCS C1713","","71647450  -  NAIL IM 130D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648230","SUP","HCPCS C1713","","71648230  -  NAIL IM 130D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648232","SUP","HCPCS C1713","","71648232  -  NAIL IM 130D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648234","SUP","HCPCS C1713","","71648234  -  NAIL IM 130D 10MM 34CM ROSE TRGN TN 5 HL STC DYNMC RND XSECT","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648236","SUP","HCPCS C1713","","71648236  -  NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN ROSE","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648238","SUP","HCPCS C1713","","71648238  -  NAIL INTRAMEDULLARY 130D 10MM 38CM SET ANTEGRADE TRIGEN ROSE","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648240","SUP","HCPCS C1713","","71648240  -  NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN ROSE","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648242","SUP","HCPCS C1713","","71648242  -  NAIL INTRAMEDULLARY 130D 10MM 42CM ANTEGRADE TRIGEN ROSE","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648244","SUP","HCPCS C1713","","71648244  -  NAIL IM 130D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648246","SUP","HCPCS C1713","","71648246  -  NAIL IM 130D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648248","SUP","HCPCS C1713","","71648248  -  NAIL IM 130D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648250","SUP","HCPCS C1713","","71648250  -  NAIL IM 130D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648330","SUP","HCPCS C1713","","71648330  -  NAIL IM 130D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648332","SUP","HCPCS C1713","","71648332  -  NAIL IM 130D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648334","SUP","HCPCS C1713","","71648334  -  NAIL INTRAMEDULLARY 130D 11.5MM 34CM ANTEGRADE TRIGEN ROSE","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648336","SUP","HCPCS C1713","","71648336  -  NAIL IM 130D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648338","SUP","HCPCS C1713","","71648338  -  NAIL INTRAMEDULLARY 130D 11.5MM 38CM SET ANTEGRADE TRIGEN","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648340","SUP","HCPCS C1713","","71648340  -  NAIL INTRAMEDULLARY 130D 11.5MM 40CM ANTEGRADE SET TRIGEN","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648342","SUP","HCPCS C1713","","71648342  -  NAIL IM 130D 11.5MM 42CM ROSE STRL TRGN TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648344","SUP","HCPCS C1713","","71648344  -  NAIL INTRAMEDULLARY TRIGEN TITANIUM  L44 CM OD11.5 MM TAN","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648348","SUP","HCPCS C1713","","71648348  -  NAIL IM 130D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648350","SUP","HCPCS C1713","","71648350  -  NAIL IM 130D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648430","SUP","HCPCS C1713","","71648430  -  NAIL IM 130D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648432","SUP","HCPCS C1713","","71648432  -  NAIL IM 130D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648434","SUP","HCPCS C1713","","71648434  -  NAIL IM 130D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648436","SUP","HCPCS C1713","","71648436  -  NAIL IM 130D 13MM 36CM ROSE TRGN ANTGRD TN SET TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648438","SUP","HCPCS C1713","","71648438  -  NAIL IM 130D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648440","SUP","HCPCS C1713","","71648440  -  NAIL IM 130D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648442","SUP","HCPCS C1713","","71648442  -  NAIL IM 130D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648446","SUP","HCPCS C1713","","71648446  -  NAIL IM 130D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648448","SUP","HCPCS C1713","","71648448  -  NAIL IM 130D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71648450","SUP","HCPCS C1713","","71648450  -  NAIL IM 130D RT ANG 13MM 50CM ROSE TN SET TROCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"71649530","SUP","HCPCS C1713","","71649530  -  NAIL IM 9MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649532","SUP","HCPCS C1713","","71649532  -  NAIL IM 9MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649534","SUP","HCPCS C1713","","71649534  -  NAIL IM 9MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649536","SUP","HCPCS C1713","","71649536  -  NAIL IM 9MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649538","SUP","HCPCS C1713","","71649538  -  NAIL IM 9MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649540","SUP","HCPCS C1713","","71649540  -  NAIL IM 9MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649542","SUP","HCPCS C1713","","71649542  -  NAIL IM 9MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649544","SUP","HCPCS C1713","","71649544  -  NAIL IM 9MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649546","SUP","HCPCS C1713","","71649546  -  NAIL IM 9MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649548","SUP","HCPCS C1713","","71649548  -  NAIL IM 9MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649550","SUP","HCPCS C1713","","71649550  -  NAIL IM 9MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649630","SUP","HCPCS C1713","","71649630  -  NAIL IM 10MM 30MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649632","SUP","HCPCS C1713","","71649632  -  NAIL IM 10MM 32MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649634","SUP","HCPCS C1713","","71649634  -  NAIL IM 10MM 34CM LIME TRGN MT-TN LT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649636","SUP","HCPCS C1713","","71649636  -  NAIL IM 10MM 36MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649638","SUP","HCPCS C1713","","71649638  -  NAIL IM 10MM 38MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649640","SUP","HCPCS C1713","","71649640  -  NAIL IM 10MM 40MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649642","SUP","HCPCS C1713","","71649642  -  NAIL IM 10MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649644","SUP","HCPCS C1713","","71649644  -  NAIL IM 10MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649646","SUP","HCPCS C1713","","71649646  -  NAIL IM 10MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649648","SUP","HCPCS C1713","","71649648  -  NAIL IM 10MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649650","SUP","HCPCS C1713","","71649650  -  NAIL IM 10MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649730","SUP","HCPCS C1713","","71649730  -  NAIL IM 11.5MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649732","SUP","HCPCS C1713","","71649732  -  NAIL IM 11.5MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649734","SUP","HCPCS C1713","","71649734  -  NAIL IM 11.5MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649736","SUP","HCPCS C1713","","71649736  -  NAIL IM 11.5MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649738","SUP","HCPCS C1713","","71649738  -  NAIL IM 11.5MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649740","SUP","HCPCS C1713","","71649740  -  NAIL IM 11.5MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649742","SUP","HCPCS C1713","","71649742  -  NAIL IM 11.5MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649744","SUP","HCPCS C1713","","71649744  -  NAIL IM 11.5MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649746","SUP","HCPCS C1713","","71649746  -  NAIL IM 11.5MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649748","SUP","HCPCS C1713","","71649748  -  NAIL IM 11.5MM 48CM MT-TN LT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649750","SUP","HCPCS C1713","","71649750  -  NAIL IM 11.5MM 50CM MT-TN LT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649830","SUP","HCPCS C1713","","71649830  -  NAIL IM 13MM 30CM LIME TRGN MT-TN LT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649832","SUP","HCPCS C1713","","71649832  -  NAIL IM 13MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649834","SUP","HCPCS C1713","","71649834  -  NAIL IM 13MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649836","SUP","HCPCS C1713","","71649836  -  NAIL IM 13MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649838","SUP","HCPCS C1713","","71649838  -  NAIL IM 13MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649840","SUP","HCPCS C1713","","71649840  -  NAIL IM 13MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649842","SUP","HCPCS C1713","","71649842  -  NAIL IM 13MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649844","SUP","HCPCS C1713","","71649844  -  NAIL IM 13MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649846","SUP","HCPCS C1713","","71649846  -  NAIL IM 13MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649848","SUP","HCPCS C1713","","71649848  -  NAIL IM 13MM 48CM MT-TN LT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71649850","SUP","HCPCS C1713","","71649850  -  NAIL IM 13MM 50CM MT-TN LT","BOTH IP/OP","$3,526.88 ","$2,609.89 ","$0.00 ","$3,526.88 ","$1,587.09 ","$0.00 ","$735.09 ","$0.00 ","$0.00 ","$617.53 ","$3,526.88 ","$0.00 ","$1,763.44 ","$2,793.29 ","$2,821.50 ","$0.00 ","$551.96 ","$0.00 ","$561.48 ","$0.00 "
"71653018","SUP","HCPCS C1713","","71653018  -  NAIL IM 10MM 18CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653020","SUP","HCPCS C1713","","71653020  -  NAIL IM 10MM 20CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653022","SUP","HCPCS C1713","","71653022  -  NAIL IM 10MM 22CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653024","SUP","HCPCS C1713","","71653024  -  NAIL IM 10MM 24CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653026","SUP","HCPCS C1713","","71653026  -  NAIL IM 10MM 26CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653028","SUP","HCPCS C1713","","71653028  -  NAIL IM 10MM 28CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653030","SUP","HCPCS C1713","","71653030  -  NAIL IM 10MM 30CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653032","SUP","HCPCS C1713","","71653032  -  NAIL IM 10MM 32CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653034","SUP","HCPCS C1713","","71653034  -  NAIL IM 10MM 34CM AU TRGN MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653036","SUP","HCPCS C1713","","71653036  -  NAIL IM 10MM 36CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653038","SUP","HCPCS C1713","","71653038  -  NAIL IM 10MM 38CM AU TRGN MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653040","SUP","HCPCS C1713","","71653040  -  NAIL IM STD 10MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653042","SUP","HCPCS C1713","","71653042  -  NAIL IM STD 10MM 42CM AU STRL TRGN MT-NL RTRGD HMR SLT TI","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653044","SUP","HCPCS C1713","","71653044  -  NAIL IM 10MM 44CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653046","SUP","HCPCS C1713","","71653046  -  NAIL IM 10MM 46CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653048","SUP","HCPCS C1713","","71653048  -  NAIL IM 10MM 48CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653050","SUP","HCPCS C1713","","71653050  -  NAIL IM 10MM 50CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653120","SUP","HCPCS C1713","","71653120  -  NAIL IM 11.5MM 20CM TRGN TI SP CNDL","BOTH IP/OP","$3,510.00 ","$2,597.40 ","$0.00 ","$3,510.00 ","$1,579.50 ","$0.00 ","$731.57 ","$0.00 ","$0.00 ","$614.57 ","$3,510.00 ","$0.00 ","$1,755.00 ","$2,779.92 ","$2,808.00 ","$0.00 ","$549.32 ","$0.00 ","$558.79 ","$0.00 "
"71653125","SUP","HCPCS C1713","","71653125  -  NAIL IM 11.5MM 25CM TRGN TI SP CNDL","BOTH IP/OP","$3,510.00 ","$2,597.40 ","$0.00 ","$3,510.00 ","$1,579.50 ","$0.00 ","$731.57 ","$0.00 ","$0.00 ","$614.57 ","$3,510.00 ","$0.00 ","$1,755.00 ","$2,779.92 ","$2,808.00 ","$0.00 ","$549.32 ","$0.00 ","$558.79 ","$0.00 "
"71653218","SUP","HCPCS C1713","","71653218  -  NAIL IM 11.5MM 18CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653220","SUP","HCPCS C1713","","71653220  -  NAIL IM 11.5MM 20CM MT-NL RTRGD TI6AL4V FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653222","SUP","HCPCS C1713","","71653222  -  NAIL IM 11.5MM 22CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653224","SUP","HCPCS C1713","","71653224  -  NAIL IM 11.5MM 24CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653226","SUP","HCPCS C1713","","71653226  -  NAIL IM 11.5MM 26CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653228","SUP","HCPCS C1713","","71653228  -  NAIL IM 11.5MM 28CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653230","SUP","HCPCS C1713","","71653230  -  NAIL IM 11.5MM 30CM TRGN MT-NL IMPL SET RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653232","SUP","HCPCS C1713","","71653232  -  NAIL IM 11.5MM 32CM AU TRGN MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653234","SUP","HCPCS C1713","","71653234  -  NAIL IM 11.5MM 34CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653236","SUP","HCPCS C1713","","71653236  -  NAIL IM 11.5MM 36CM TRGN MT-NL IMPL SET RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653238","SUP","HCPCS C1713","","71653238  -  NAIL IM 10MM 38CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653240","SUP","HCPCS C1713","","71653240  -  RETROGRADE FEMUR NAIL, 11.5MMX40CM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653242","SUP","HCPCS C1713","","71653242  -  NAIL IM 11.5MM 42CM TRGN MT-NL RTRGD FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653244","SUP","HCPCS C1713","","71653244  -  NAIL IM 11.5MM 44CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653246","SUP","HCPCS C1713","","71653246  -  NAIL IM 11.5MM 46CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653248","SUP","HCPCS C1713","","71653248  -  NAIL IM 11.5MM 48CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653250","SUP","HCPCS C1713","","71653250  -  NAIL IM 11.5MM 50CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653320","SUP","HCPCS C1713","","71653320  -  NAIL IM 13MM 20CM TRGN TI TIB","BOTH IP/OP","$3,510.00 ","$2,597.40 ","$0.00 ","$3,510.00 ","$1,579.50 ","$0.00 ","$731.57 ","$0.00 ","$0.00 ","$614.57 ","$3,510.00 ","$0.00 ","$1,755.00 ","$2,779.92 ","$2,808.00 ","$0.00 ","$549.32 ","$0.00 ","$558.79 ","$0.00 "
"71653325","SUP","HCPCS C1713","","71653325  -  NAIL IM 13MM 25CM TRGN TI TIB","BOTH IP/OP","$3,510.00 ","$2,597.40 ","$0.00 ","$3,510.00 ","$1,579.50 ","$0.00 ","$731.57 ","$0.00 ","$0.00 ","$614.57 ","$3,510.00 ","$0.00 ","$1,755.00 ","$2,779.92 ","$2,808.00 ","$0.00 ","$549.32 ","$0.00 ","$558.79 ","$0.00 "
"71653418","SUP","HCPCS C1713","","71653418  -  NAIL IM 13MM 18CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653420","SUP","HCPCS C1713","","71653420  -  NAIL IM 13MM 20CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653422","SUP","HCPCS C1713","","71653422  -  NAIL IM 13MM 22CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653424","SUP","HCPCS C1713","","71653424  -  NAIL IM 13MM 24CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653426","SUP","HCPCS C1713","","71653426  -  NAIL IM 13MM 26CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653428","SUP","HCPCS C1713","","71653428  -  NAIL IM 13MM 28CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653430","SUP","HCPCS C1713","","71653430  -  NAIL IM 13MM 30CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653432","SUP","HCPCS C1713","","71653432  -  NAIL IM 13MM 32CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653434","SUP","HCPCS C1713","","71653434  -  NAIL IM 13MM 34CM TRGN MT-NL IMPL SET RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653436","SUP","HCPCS C1713","","71653436  -  NAIL IM 13MM 36CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653438","SUP","HCPCS C1713","","71653438  -  NAIL IM 13MM 38CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653440","SUP","HCPCS C1713","","71653440  -  NAIL IM STD 13MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653442","SUP","HCPCS C1713","","71653442  -  NAIL IM 13MM 42CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653444","SUP","HCPCS C1713","","71653444  -  NAIL IM 13MM 44CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653446","SUP","HCPCS C1713","","71653446  -  NAIL IM 13MM 46CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653448","SUP","HCPCS C1713","","71653448  -  NAIL IM 13MM 48CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71653450","SUP","HCPCS C1713","","71653450  -  NAIL IM 13MM 50CM MT-NL RTRGD TI FEM","BOTH IP/OP","$3,622.50 ","$2,680.65 ","$0.00 ","$3,622.50 ","$1,630.13 ","$0.00 ","$755.02 ","$0.00 ","$0.00 ","$634.27 ","$3,622.50 ","$0.00 ","$1,811.25 ","$2,869.02 ","$2,898.00 ","$0.00 ","$566.92 ","$0.00 ","$576.70 ","$0.00 "
"71655016","SUP","HCPCS C1713","","71655016  -  NAIL IM 8.5MM 16CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655018","SUP","HCPCS C1713","","71655018  -  NAIL IM 8.5MM 18CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655020","SUP","HCPCS C1713","","71655020  -  NAIL IM 8.5MM 20CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655022","SUP","HCPCS C1713","","71655022  -  NAIL IM 8.5MM 22CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655024","SUP","HCPCS C1713","","71655024  -  NAIL IM 8.5MM 24CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655026","SUP","HCPCS C1713","","71655026  -  NAIL IM 8.5MM 26CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655028","SUP","HCPCS C1713","","71655028  -  NAIL IM 8.5MM 28CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655029","SUP","HCPCS C1713","","71655029  -  NAIL IM 8.5MM 29CM TRGN MT-NL TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655030","SUP","HCPCS C1713","","71655030  -  NAIL 8.5MM 30CM TIB MT-NAIL IM TI","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655031","SUP","HCPCS C1713","","71655031  -  NAIL IM 8.5MM 31CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655032","SUP","HCPCS C1713","","71655032  -  NAIL IM 8.5MM 32CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655034","SUP","HCPCS C1713","","71655034  -  NAIL IM 8.5MM 34CM TRGN MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655035","SUP","HCPCS C1713","","71655035  -  NAIL IM 8.5MM 35CM MT-NL TI TIB METAPHYSIS","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655036","SUP","HCPCS C1713","","71655036  -  NAIL IM 8.5MM 36CM TRGN MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655037","SUP","HCPCS C1713","","71655037  -  NAIL IM 8.5MM 37CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655038","SUP","HCPCS C1713","","71655038  -  NAIL IM 8.5MM 38CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655039","SUP","HCPCS C1713","","71655039  -  NAIL IM 8.5MM 39CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655040","SUP","HCPCS C1713","","71655040  -  NAIL IM 8.5MM 40CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655041","SUP","HCPCS C1713","","71655041  -  NAIL IM 8.5MM 41CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655042","SUP","HCPCS C1713","","71655042  -  NAIL IM 8.5MM 42CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655043","SUP","HCPCS C1713","","71655043  -  NAIL IM 8.5MM 43CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655044","SUP","HCPCS C1713","","71655044  -  NAIL IM 8.5MM 44CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655046","SUP","HCPCS C1713","","71655046  -  NAIL IM 8.5MM 46CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655048","SUP","HCPCS C1713","","71655048  -  NAIL IM 8.5MM 48CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655050","SUP","HCPCS C1713","","71655050  -  NAIL IM 8.5MM 50CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655116","SUP","HCPCS C1713","","71655116  -  NAIL IM 10MM 16CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655118","SUP","HCPCS C1713","","71655118  -  NAIL IM 10MM 18CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655120","SUP","HCPCS C1713","","71655120  -  NAIL IM 10MM 20CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655122","SUP","HCPCS C1713","","71655122  -  NAIL IM 10MM 22CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655124","SUP","HCPCS C1713","","71655124  -  NAIL IM 10MM 24CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655126","SUP","HCPCS C1713","","71655126  -  NAIL IM 10MM 26CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655128","SUP","HCPCS C1713","","71655128  -  NAIL IM 10MM 28CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655129","SUP","HCPCS C1713","","71655129  -  NAIL IM 10MM 29CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655130","SUP","HCPCS C1713","","71655130  -  NAIL IM 10MM 30CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655131","SUP","HCPCS C1713","","71655131  -  NAIL IM 10MM 31CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655132","SUP","HCPCS C1713","","71655132  -  NAIL INTRAMEDULLARY 10MM 32CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655133","SUP","HCPCS C1713","","71655133  -  NAIL IM 10MM 33CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655134","SUP","HCPCS C1713","","71655134  -  NAIL INTRAMEDULLARY 10MM 34CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655135","SUP","HCPCS C1713","","71655135  -  NAIL INTRAMEDULLARY 10MM 35CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655136","SUP","HCPCS C1713","","71655136  -  NAIL INTRAMEDULLARY 10MM 36CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655137","SUP","HCPCS C1713","","71655137  -  NAIL INTRAMEDULLARY 10MM 37CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655138","SUP","HCPCS C1713","","71655138  -  NAIL INTRAMEDULLARY 10MM 38CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655139","SUP","HCPCS C1713","","71655139  -  NAIL INTRAMEDULLARY 10MM 39CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655142","SUP","HCPCS C1713","","71655142  -  NAIL IM 10MM 42CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655143","SUP","HCPCS C1713","","71655143  -  NAIL IM 10MM 43CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655144","SUP","HCPCS C1713","","71655144  -  NAIL IM 10MM 44CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655146","SUP","HCPCS C1713","","71655146  -  NAIL IM 10MM 46CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655148","SUP","HCPCS C1713","","71655148  -  NAIL IM 10MM 48CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655150","SUP","HCPCS C1713","","71655150  -  NAIL IM 10MM 50CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655216","SUP","HCPCS C1713","","71655216  -  NAIL IM 11.5MM 16CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655218","SUP","HCPCS C1713","","71655218  -  NAIL IM 11.5MM 18CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655220","SUP","HCPCS C1713","","71655220  -  NAIL IM 11.5MM 20CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655222","SUP","HCPCS C1713","","71655222  -  NAIL IM 11.5MM 22CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655224","SUP","HCPCS C1713","","71655224  -  NAIL IM 11.5MM 24CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655226","SUP","HCPCS C1713","","71655226  -  NAIL IM 11.5MM 26CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655228","SUP","HCPCS C1713","","71655228  -  NAIL IM 11.5MM 28CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655229","SUP","HCPCS C1713","","71655229  -  NAIL IM 11.5MM 29CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655230","SUP","HCPCS C1713","","71655230  -  NAIL IM 11.5MM 30CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655231","SUP","HCPCS C1713","","71655231  -  NAIL IM 11.5MM 31CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655232","SUP","HCPCS C1713","","71655232  -  NAIL IM 11.5MM 32CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655233","SUP","HCPCS C1713","","71655233  -  NAIL IM 11.5MM 33CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655234","SUP","HCPCS C1713","","71655234  -  NAIL IM 11.5MM 34CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655235","SUP","HCPCS C1713","","71655235  -  NAIL IM 11.5MM 35CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655236","SUP","HCPCS C1713","","71655236  -  NAIL 11.5MM 36CM TIB TRGN MT-NAIL IM HMR SLT TI","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655237","SUP","HCPCS C1713","","71655237  -  NAIL IM 11.5MM 37CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655238","SUP","HCPCS C1713","","71655238  -  NAIL IM 11.5MM 38CM AU STRL TRGN MT-NL HMR SLT TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655239","SUP","HCPCS C1713","","71655239  -  NAIL IM 11.5MM 39CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655240","SUP","HCPCS C1713","","71655240  -  NAIL INTRAMEDULLARY 11.5MM 40CM META-NAIL TITANIUM TIBIA","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655241","SUP","HCPCS C1713","","71655241  -  NAIL IM 11.5MM 41CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655242","SUP","HCPCS C1713","","71655242  -  NAIL IM 11.5MM 42CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655243","SUP","HCPCS C1713","","71655243  -  NAIL IM 11.5MM 43CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655244","SUP","HCPCS C1713","","71655244  -  NAIL IM 11.5MM 44CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655246","SUP","HCPCS C1713","","71655246  -  NAIL IM 11.5MM 46CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655248","SUP","HCPCS C1713","","71655248  -  NAIL IM 11.5MM 48CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655250","SUP","HCPCS C1713","","71655250  -  NAIL IM 11.5MM 50CM MT-NL TI TIB","BOTH IP/OP","$3,538.13 ","$2,618.22 ","$0.00 ","$3,538.13 ","$1,592.16 ","$0.00 ","$737.43 ","$0.00 ","$0.00 ","$619.50 ","$3,538.13 ","$0.00 ","$1,769.06 ","$2,802.20 ","$2,830.50 ","$0.00 ","$553.72 ","$0.00 ","$563.27 ","$0.00 "
"71655316","SUP","HCPCS C1713","","71655316  -  NAIL IM 13MM 16CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655318","SUP","HCPCS C1713","","71655318  -  NAIL IM 13MM 18CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655320","SUP","HCPCS C1713","","71655320  -  NAIL IM 13MM 20CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655322","SUP","HCPCS C1713","","71655322  -  NAIL IM 13MM 22CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655324","SUP","HCPCS C1713","","71655324  -  NAIL IM 13MM 24CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655326","SUP","HCPCS C1713","","71655326  -  NAIL IM 13MM 26CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655328","SUP","HCPCS C1713","","71655328  -  NAIL IM 13MM 28CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655329","SUP","HCPCS C1713","","71655329  -  NAIL IM 13MM 29CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655330","SUP","HCPCS C1713","","71655330  -  NAIL IM 13MM 30CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655331","SUP","HCPCS C1713","","71655331  -  NAIL IM 13MM 31CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655332","SUP","HCPCS C1713","","71655332  -  NAIL IM 13MM 32CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655333","SUP","HCPCS C1713","","71655333  -  NAIL IM 13MM 33CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655334","SUP","HCPCS C1713","","71655334  -  NAIL IM RND 13MM 34CM AU MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655335","SUP","HCPCS C1713","","71655335  -  NAIL IM 13MM 35CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655336","SUP","HCPCS C1713","","71655336  -  NAIL IM 13MM 36CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655337","SUP","HCPCS C1713","","71655337  -  NAIL IM 13MM 37CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655338","SUP","HCPCS C1713","","71655338  -  NAIL IM 13MM 38CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655339","SUP","HCPCS C1713","","71655339  -  NAIL IM 13MM 39CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655340","SUP","HCPCS C1713","","71655340  -  NAIL IM RND 13MM 40CM AU MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655341","SUP","HCPCS C1713","","71655341  -  NAIL IM 13MM 41CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655342","SUP","HCPCS C1713","","71655342  -  NAIL IM 13MM 42CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655343","SUP","HCPCS C1713","","71655343  -  NAIL IM 13MM 43CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655344","SUP","HCPCS C1713","","71655344  -  NAIL IM 13MM 44CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655346","SUP","HCPCS C1713","","71655346  -  NAIL IM 13MM 46CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655348","SUP","HCPCS C1713","","71655348  -  NAIL IM 13MM 48CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71655350","SUP","HCPCS C1713","","71655350  -  NAIL IM 13MM 50CM MT-NL TI TIB","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"71656000","SUP","HCPCS C1713","","71656000  -  CAP END 0MM MT-NL NL SCR SET TI TIB","BOTH IP/OP","$354.38 ","$262.24 ","$0.00 ","$354.38 ","$159.47 ","$0.00 ","$73.86 ","$0.00 ","$0.00 ","$62.05 ","$354.38 ","$0.00 ","$177.19 ","$280.67 ","$283.50 ","$0.00 ","$55.46 ","$0.00 ","$56.42 ","$0.00 "
"71661222","SUP","HCPCS C1713","","71661222  -  SCREW BN 4.5MM 22MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661224","SUP","HCPCS C1713","","71661224  -  SCREW BN 4.5MM 24MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661226","SUP","HCPCS C1713","","71661226  -  SCREW BN 4.5MM 26MM IMHS CP CPTR LCK HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661228","SUP","HCPCS C1713","","71661228  -  SCREW BN 4.5MM 28MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661230","SUP","HCPCS C1713","","71661230  -  SCREW BN 4.5MM 30MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661232","SUP","HCPCS C1713","","71661232  -  SCREW BN 4.5MM 32MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661234","SUP","HCPCS C1713","","71661234  -  SCREW BN 4.5MM 34MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661236","SUP","HCPCS C1713","","71661236  -  SCREW BN 4.5MM 36MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661238","SUP","HCPCS C1713","","71661238  -  SCREW BN 4.5MM 38MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661240","SUP","HCPCS C1713","","71661240  -  SCREW BN 4.5MM 40MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661242","SUP","HCPCS C1713","","71661242  -  SCREW BN 4.5MM 42MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661244","SUP","HCPCS C1713","","71661244  -  SCREW BN 4.5MM 44MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661246","SUP","HCPCS C1713","","71661246  -  SCREW BN 4.5MM 46MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661248","SUP","HCPCS C1713","","71661248  -  SCREW BN 4.5MM 48MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661250","SUP","HCPCS C1713","","71661250  -  SCREW BN 4.5MM 50MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661252","SUP","HCPCS C1713","","71661252  -  SCREW BN 4.5MM 52MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661254","SUP","HCPCS C1713","","71661254  -  SCREW BN 4.5MM 54MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661256","SUP","HCPCS C1713","","71661256  -  SCREW BN 4.5MM 56MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661258","SUP","HCPCS C1713","","71661258  -  SCREW BN 4.5MM 58MM IMHS CP LCK CPTR HIP IM NL SYS","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661260","SUP","HCPCS C1713","","71661260  -  SCREW BN 4.5MM 60MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661262","SUP","HCPCS C1713","","71661262  -  SCREW BN 4.5MM 62MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71661264","SUP","HCPCS C1713","","71661264  -  SCREW BN 4.5MM 64MM IMHS CP LCK CPTR HIP IM NL","BOTH IP/OP","$593.25 ","$439.01 ","$0.00 ","$593.25 ","$266.96 ","$0.00 ","$123.65 ","$0.00 ","$0.00 ","$103.87 ","$593.25 ","$0.00 ","$296.63 ","$469.85 ","$474.60 ","$0.00 ","$92.84 ","$0.00 ","$94.45 ","$0.00 "
"71665026","SUP","HCPCS C1769","","71665026  -  GUIDE ROD ORTHOPEDIC 3MM 600MM BALL TIP TRIGEN DISPOSABLE","BOTH IP/OP","$490.88 ","$363.25 ","$0.00 ","$490.88 ","$266.55 ","$0.00 ","$102.31 ","$0.00 ","$0.00 ","$85.95 ","$490.88 ","$0.00 ","$245.44 ","$388.78 ","$392.70 ","$0.00 ","$76.82 ","$0.00 ","$78.15 ","$0.00 "
"71672030","SUP","HCPCS C1713","","71672030  -  SCREW BONE 11MM 30MM COMPRESSION INTERTAN TROCHANTER","BOTH IP/OP","$659.25 ","$487.85 ","$0.00 ","$659.25 ","$296.66 ","$0.00 ","$137.40 ","$0.00 ","$0.00 ","$115.43 ","$659.25 ","$0.00 ","$329.63 ","$522.13 ","$527.40 ","$0.00 ","$103.17 ","$0.00 ","$104.95 ","$0.00 "
"71672035","SUP","HCPCS C1713","","71672035  -  SCREW BN 35MM CMPR ORTH","BOTH IP/OP","$676.00 ","$500.24 ","$0.00 ","$676.00 ","$304.20 ","$0.00 ","$140.90 ","$0.00 ","$0.00 ","$118.36 ","$676.00 ","$0.00 ","$338.00 ","$535.39 ","$540.80 ","$0.00 ","$105.79 ","$0.00 ","$107.62 ","$0.00 "
"71672040","SUP","HCPCS C1713","","71672040  -  SCREW BN 40MM CMPR ORTH","BOTH IP/OP","$460.13 ","$340.50 ","$0.00 ","$460.13 ","$207.06 ","$0.00 ","$95.90 ","$0.00 ","$0.00 ","$80.56 ","$460.13 ","$0.00 ","$230.06 ","$364.42 ","$368.10 ","$0.00 ","$72.01 ","$0.00 ","$73.25 ","$0.00 "
"71673040","SUP","HCPCS C1713","","71673040  -  NAIL IM 130D 10MM 40CM INTERTAN LT TROCH","BOTH IP/OP","$3,155.63 ","$2,335.17 ","$0.00 ","$3,155.63 ","$1,420.03 ","$0.00 ","$657.71 ","$0.00 ","$0.00 ","$552.52 ","$3,155.63 ","$0.00 ","$1,577.81 ","$2,499.26 ","$2,524.50 ","$0.00 ","$493.86 ","$0.00 ","$502.38 ","$0.00 "
"71673125","SUP","HCPCS C1713","","71673125  -  SCREW BN 11MM 125MM LG","BOTH IP/OP","$892.00 ","$660.08 ","$0.00 ","$892.00 ","$401.40 ","$0.00 ","$185.92 ","$0.00 ","$0.00 ","$156.18 ","$892.00 ","$0.00 ","$446.00 ","$706.46 ","$713.60 ","$0.00 ","$139.60 ","$0.00 ","$142.01 ","$0.00 "
"71674029","SUP","HCPCS C1713","","71674029  -  GUIDEPIN ORTH 343MM 3.2MM THRD","BOTH IP/OP","$335.65 ","$248.38 ","$0.00 ","$335.65 ","$151.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.77 ","$335.65 ","$0.00 ","$167.83 ","$265.83 ","$268.52 ","$0.00 ","$52.53 ","$0.00 ","$53.44 ","$0.00 "
"71674034","SUP","HCPCS C1713","","71674034  -  GUIDE SURG 7MM 7MM COMPRESSION SCREW TRIGEN INTERTAN","BOTH IP/OP","$381.38 ","$282.22 ","$0.00 ","$381.38 ","$171.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.78 ","$381.38 ","$0.00 ","$190.69 ","$302.05 ","$305.10 ","$0.00 ","$59.69 ","$0.00 ","$60.71 ","$0.00 "
"71674130","SUP","Custom 27203010","","71674130  -  GUIDE PIN ORTHOPEDIC 3.2MM 343MM BRAD POINT TIP THREADED","BOTH IP/OP","$308.25 ","$228.11 ","$0.00 ","$308.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.25 ","$0.00 ","$154.13 ","$244.13 ","$246.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71674540","SUP","HCPCS C1713","","71674540  -  INTERTAN LAG SCREW DRILL","BOTH IP/OP","$1,032.75 ","$764.24 ","$0.00 ","$1,032.75 ","$464.74 ","$0.00 ","$215.25 ","$0.00 ","$0.00 ","$180.83 ","$1,032.75 ","$0.00 ","$516.38 ","$817.94 ","$826.20 ","$0.00 ","$161.63 ","$0.00 ","$164.41 ","$0.00 "
"71675030","SUP","HCPCS C1713","","71675030  -  SCREW BN INTERTAN SET","BOTH IP/OP","$493.88 ","$365.47 ","$0.00 ","$493.88 ","$222.24 ","$0.00 ","$102.94 ","$0.00 ","$0.00 ","$86.47 ","$493.88 ","$0.00 ","$246.94 ","$391.15 ","$395.10 ","$0.00 ","$77.29 ","$0.00 ","$78.62 ","$0.00 "
"71675040","SUP","HCPCS C1713","","71675040  -  CAP END INTERTAN TROCH IM NL","BOTH IP/OP","$279.00 ","$206.46 ","$0.00 ","$279.00 ","$125.55 ","$0.00 ","$58.15 ","$0.00 ","$0.00 ","$48.85 ","$279.00 ","$0.00 ","$139.50 ","$220.97 ","$223.20 ","$0.00 ","$43.66 ","$0.00 ","$44.42 ","$0.00 "
"71675201","SUP","HCPCS C1713","","71675201  -  NAIL IM 125D SHRT 10MM 180MM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675202","SUP","HCPCS C1713","","71675202  -  NAIL IM 125D 11.5MM 18CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675203","SUP","HCPCS C1713","","71675203  -  NAIL IM 125D SHRT 13MM 18CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675204","SUP","HCPCS C1713","","71675204  -  NAIL IM 125D 10MM 20CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675205","SUP","HCPCS C1713","","71675205  -  NAIL IM 125D 11.5MM 20CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675206","SUP","HCPCS C1713","","71675206  -  NAIL IM 125D 13MM 20CM INTERTAN","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675207","SUP","HCPCS C1713","","71675207  -  NAIL IM 130D SHRT 10MM 18CM INTERTAN ANTGRD TI INTST","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675208","SUP","HCPCS C1713","","71675208  -  NAIL IM 130D SHRT 11.5MM 18CM INTERTAN ANTGRD TI INTST","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675209","SUP","HCPCS C1713","","71675209  -  NAIL IM 130D SHRT 13MM 18CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675210","SUP","HCPCS C1713","","71675210  -  NAIL IM 130D 10MM 20CM INTERTAN TI ORTH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675211","SUP","HCPCS C1713","","71675211  -  NAIL IM 130D 11.5MM 20CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675212","SUP","HCPCS C1713","","71675212  -  NAIL IM 130D 13MM 20CM INTERTAN TI TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675213","SUP","HCPCS C1713","","71675213  -  NAIL IM 125D 10MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675214","SUP","HCPCS C1713","","71675214  -  NAIL IM 125D 10MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675215","SUP","HCPCS C1713","","71675215  -  NAIL IM 125D 10MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675216","SUP","HCPCS C1713","","71675216  -  NAIL IM 125D 10MM 28CM INTERTAN TI RT ORTH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675217","SUP","HCPCS C1713","","71675217  -  NAIL IM 125D 10MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675218","SUP","HCPCS C1713","","71675218  -  NAIL IM 125D 10MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675219","SUP","HCPCS C1713","","71675219  -  NAIL IM 125D 10MM 32CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675220","SUP","HCPCS C1713","","71675220  -  NAIL IM 125D 10MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675221","SUP","HCPCS C1713","","71675221  -  NAIL IM 125D LG 10MM 34CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675222","SUP","HCPCS C1713","","71675222  -  NAIL IM 125D 10MM 34CM ROSE INTERTAN TI RT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675223","SUP","HCPCS C1713","","71675223  -  NAIL IM 125D 10MM 36CM LIME INTERTAN TI LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675224","SUP","HCPCS C1713","","71675224  -  NAIL IM 125D 10MM 36CM ROSE INTERTAN TI RT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675225","SUP","HCPCS C1713","","71675225  -  NAIL IM 125D LG 10MM 38CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675226","SUP","HCPCS C1713","","71675226  -  NAIL IM 125D LG 10MM 38CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675227","SUP","HCPCS C1713","","71675227  -  NAIL IM 125D LG 10MM 40CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675228","SUP","HCPCS C1713","","71675228  -  NAIL IM 125D LG 10MM 400MM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675229","SUP","HCPCS C1713","","71675229  -  NAIL IM 125D 10MM 42CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675230","SUP","HCPCS C1713","","71675230  -  NAIL IM 125D 10MM 42CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675231","SUP","HCPCS C1713","","71675231  -  NAIL IM 125D 10MM 44CM INTERTAN LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675232","SUP","HCPCS C1713","","71675232  -  NAIL IM 125D 10MM 44CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675233","SUP","HCPCS C1713","","71675233  -  NAIL IM 125D 10MM 46CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675234","SUP","HCPCS C1713","","71675234  -  NAIL IM 125D 10MM 46CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675235","SUP","HCPCS C1713","","71675235  -  NAIL IM 125D 11.5MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675236","SUP","HCPCS C1713","","71675236  -  NAIL IM 125D 11.5MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675237","SUP","HCPCS C1713","","71675237  -  NAIL IM 125D 11.5MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675238","SUP","HCPCS C1713","","71675238  -  NAIL IM 125D 11.5MM 28CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675239","SUP","HCPCS C1713","","71675239  -  NAIL IM 125D LG 11.5MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675240","SUP","HCPCS C1713","","71675240  -  NAIL IM 125D 11.5MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675241","SUP","HCPCS C1713","","71675241  -  NAIL IM 125D 11.5MM 32CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675242","SUP","HCPCS C1713","","71675242  -  NAIL IM 125D 11.5MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675243","SUP","HCPCS C1713","","71675243  -  NAIL IM 125D LG 11.5MM 34CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675244","SUP","HCPCS C1713","","71675244  -  NAIL IM 125D 11.5MM 34CM ROSE INTERTAN TI RT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675245","SUP","HCPCS C1713","","71675245  -  NAIL IM 125D LG 11.5MM 360MM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675246","SUP","HCPCS C1713","","71675246  -  NAIL IM 125D LG 11.5MM 36CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675247","SUP","HCPCS C1713","","71675247  -  NAIL IM 125D 11.5MM 38CM LIME INTERTAN TI LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675248","SUP","HCPCS C1713","","71675248  -  NAIL IM 125D LG 11.5MM 380MM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675249","SUP","HCPCS C1713","","71675249  -  NAIL IM 125D LG 11.5MM 40CM LIME TRGN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675250","SUP","HCPCS C1713","","71675250  -  NAIL IM 125D LG 11.5MM 400MM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675251","SUP","HCPCS C1713","","71675251  -  NAIL IM 125D 11.5MM 42CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675252","SUP","HCPCS C1713","","71675252  -  NAIL IM 125D 11.5MM 42CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675253","SUP","HCPCS C1713","","71675253  -  NAIL IM 125D 11.5MM 44CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675254","SUP","HCPCS C1713","","71675254  -  NAIL IM 125D 11.5MM 44CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675255","SUP","HCPCS C1713","","71675255  -  NAIL IM 125D 11.5MM 46CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675256","SUP","HCPCS C1713","","71675256  -  NAIL IM 125D 11.5MM 46CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675257","SUP","HCPCS C1713","","71675257  -  NAIL IM 130D 10MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675258","SUP","HCPCS C1713","","71675258  -  NAIL IM 130D 10MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675259","SUP","HCPCS C1713","","71675259  -  NAIL IM 130D 10MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675260","SUP","HCPCS C1713","","71675260  -  NAIL IM 130D 10MM 28CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675261","SUP","HCPCS C1713","","71675261  -  NAIL IM 130D 10MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675262","SUP","HCPCS C1713","","71675262  -  NAIL IM 130D 10MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675263","SUP","HCPCS C1713","","71675263  -  NAIL IM 130D 10MM 32CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675264","SUP","HCPCS C1713","","71675264  -  NAIL IM 130D 10MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675265","SUP","HCPCS C1713","","71675265  -  NAIL IM 130D LNG 10MM 34CM LIME ROSE INTERTAN TRGN NK ANG LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675266","SUP","HCPCS C1713","","71675266  -  NAIL IM 130D LNG 10MM 34CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675267","SUP","HCPCS C1713","","71675267  -  NAIL IM 130D LNG 10MM 36CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675268","SUP","HCPCS C1713","","71675268  -  NAIL IM 130D LNG 10MM 36CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675269","SUP","HCPCS C1713","","71675269  -  NAIL IM 130D 10MM 38CM LIME INTERTAN TI LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675270","SUP","HCPCS C1713","","71675270  -  NAIL IM 130D LNG 10MM 380MM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675271","SUP","HCPCS C1713","","71675271  -  NAIL IM 130D LNG 10MM 40CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675272","SUP","HCPCS C1713","","71675272  -  NAIL IM 130D LNG 10MM 40CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675273","SUP","HCPCS C1713","","71675273  -  NAIL IM 130D 10MM 42CM INTERTAN LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675274","SUP","HCPCS C1713","","71675274  -  NAIL IM 130D LNG 10MM 42CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675275","SUP","HCPCS C1713","","71675275  -  NAIL IM 130D 10MM 44CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675276","SUP","HCPCS C1713","","71675276  -  NAIL IM 130D 10MM 44CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675277","SUP","HCPCS C1713","","71675277  -  NAIL IM 130D 10MM 46CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675278","SUP","HCPCS C1713","","71675278  -  NAIL IM 130D 10MM 46CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675279","SUP","HCPCS C1713","","71675279  -  NAIL IM 130D 11.5MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675280","SUP","HCPCS C1713","","71675280  -  NAIL IM 130D 11.5MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675281","SUP","HCPCS C1713","","71675281  -  NAIL IM 130D 11.5MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675282","SUP","HCPCS C1713","","71675282  -  NAIL IM 130D 11.5MM 28CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675283","SUP","HCPCS C1713","","71675283  -  NAIL IM 130D 11.5MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675284","SUP","HCPCS C1713","","71675284  -  NAIL IM 130D 11.5MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675285","SUP","HCPCS C1713","","71675285  -  NAIL IM 130D 11.5MM 32CM INTERTAN LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675286","SUP","HCPCS C1713","","71675286  -  NAIL IM 130D 11.5MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675287","SUP","HCPCS C1713","","71675287  -  NAIL IM 130D 11.5MM 34CM INTERTAN ANTGRD TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675288","SUP","HCPCS C1713","","71675288  -  NAIL IM 130D LNG 11.5MM 34CM ROSE INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675289","SUP","HCPCS C1713","","71675289  -  NAIL IM 130D LNG 11.5MM 360MM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675290","SUP","HCPCS C1713","","71675290  -  NAIL IM 130D LNG 11.5MM 36CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675291","SUP","HCPCS C1713","","71675291  -  NAIL IM 130D LNG 11.5MM 380MM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675292","SUP","HCPCS C1713","","71675292  -  NAIL IM 130D LNG 11.5MM 380MM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675293","SUP","HCPCS C1713","","71675293  -  NAIL IM 130D LNG 11.5MM 40CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675294","SUP","HCPCS C1713","","71675294  -  NAIL IM 130D LNG 11.5MM 40CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675295","SUP","HCPCS C1713","","71675295  -  NAIL IM 130D LNG 11.5MM 42CM LIME INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675361","SUP","HCPCS C1713","","71675361  -  NAIL IM 135D 13MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675362","SUP","HCPCS C1713","","71675362  -  NAIL IM 135D 13MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675363","SUP","HCPCS C1713","","71675363  -  NAIL IM 135D 13MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675364","SUP","HCPCS C1713","","71675364  -  NAIL IM 135D 13MM 28CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675365","SUP","HCPCS C1713","","71675365  -  NAIL IM 135D 13MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675366","SUP","HCPCS C1713","","71675366  -  NAIL IM 135D 13MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675367","SUP","HCPCS C1713","","71675367  -  NAIL IM 135D 13MM 32CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675368","SUP","HCPCS C1713","","71675368  -  NAIL IM 135D 13MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675369","SUP","HCPCS C1713","","71675369  -  NAIL IM 135D 13MM 34CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675370","SUP","HCPCS C1713","","71675370  -  NAIL IM 135D 13MM 34CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675371","SUP","HCPCS C1713","","71675371  -  NAIL IM 135D 13MM 36CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675372","SUP","HCPCS C1713","","71675372  -  NAIL IM 135D 13MM 36CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675373","SUP","HCPCS C1713","","71675373  -  NAIL IM 135D 13MM 38CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675374","SUP","HCPCS C1713","","71675374  -  NAIL IM 135D 13MM 38CM INTERTAN TI RT TROCH","BOTH IP/OP","$6,220.00 ","$4,602.80 ","$0.00 ","$6,220.00 ","$2,799.00 ","$0.00 ","$1,296.40 ","$0.00 ","$0.00 ","$1,089.07 ","$6,220.00 ","$0.00 ","$3,110.00 ","$4,926.24 ","$4,976.00 ","$0.00 ","$973.43 ","$0.00 ","$990.22 ","$0.00 "
"71675375","SUP","HCPCS C1713","","71675375  -  NAIL IM 135D 13MM 40CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675376","SUP","HCPCS C1713","","71675376  -  NAIL IM 135D 13MM 40CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675377","SUP","HCPCS C1713","","71675377  -  NAIL IM 135D 13MM 42CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675378","SUP","HCPCS C1713","","71675378  -  NAIL IM 135D 13MM 42CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675379","SUP","HCPCS C1713","","71675379  -  NAIL IM 135D 13MM 44CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675380","SUP","HCPCS C1713","","71675380  -  NAIL IM 135D 13MM 44CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675381","SUP","HCPCS C1713","","71675381  -  NAIL IM 135D 13MM 46CM INTERTAN TI LT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675382","SUP","HCPCS C1713","","71675382  -  NAIL IM 135D 13MM 46CM INTERTAN TI RT TROCH","BOTH IP/OP","$5,550.00 ","$4,107.00 ","$0.00 ","$5,550.00 ","$2,497.50 ","$0.00 ","$1,156.76 ","$0.00 ","$0.00 ","$971.76 ","$5,550.00 ","$0.00 ","$2,775.00 ","$4,395.60 ","$4,440.00 ","$0.00 ","$868.58 ","$0.00 ","$883.56 ","$0.00 "
"71675383","SUP","HCPCS C1713","","71675383  -  NAIL IM 125D 10MM 18CM INTERTAN","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675384","SUP","HCPCS C1713","","71675384  -  NAIL IM 130D 10MM 18CM INTERTAN","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675385","SUP","HCPCS C1713","","71675385  -  NAIL IM 125D SHRT 10MM 20CM INTERTAN TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675386","SUP","HCPCS C1713","","71675386  -  NAIL IM 130D SHRT 10MM 20CM INTERTAN TROCH","BOTH IP/OP","$3,330.00 ","$2,464.20 ","$0.00 ","$3,330.00 ","$1,498.50 ","$0.00 ","$694.06 ","$0.00 ","$0.00 ","$583.06 ","$3,330.00 ","$0.00 ","$1,665.00 ","$2,637.36 ","$2,664.00 ","$0.00 ","$521.15 ","$0.00 ","$530.14 ","$0.00 "
"71675401","SUP","HCPCS C1713","","71675401  -  NAIL IM 125D 13MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675402","SUP","HCPCS C1713","","71675402  -  NAIL IM 125D 13MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675403","SUP","HCPCS C1713","","71675403  -  NAIL IM 125D 13MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675404","SUP","HCPCS C1713","","71675404  -  NAIL IM 125D 13MM 28CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675405","SUP","HCPCS C1713","","71675405  -  NAIL IM 125D 13MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675406","SUP","HCPCS C1713","","71675406  -  NAIL IM 125D 13MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675407","SUP","HCPCS C1713","","71675407  -  NAIL IM 125D LNG 13MM 32CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675408","SUP","HCPCS C1713","","71675408  -  NAIL IM 125D 13MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675409","SUP","HCPCS C1713","","71675409  -  NAIL IM 125D 13MM 34CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675410","SUP","HCPCS C1713","","71675410  -  NAIL IM 125D 13MM 34CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675411","SUP","HCPCS C1713","","71675411  -  NAIL IM 125D 13MM 36CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675412","SUP","HCPCS C1713","","71675412  -  NAIL IM 125D 13MM 36CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675413","SUP","HCPCS C1713","","71675413  -  NAIL IM 125D 13MM 38CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675414","SUP","HCPCS C1713","","71675414  -  NAIL IM 125D 13MM 38CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675415","SUP","HCPCS C1713","","71675415  -  NAIL IM 125D 13MM 40CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675416","SUP","HCPCS C1713","","71675416  -  NAIL IM 125D 13MM 40CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675417","SUP","HCPCS C1713","","71675417  -  NAIL IM 125D 13MM 42CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675418","SUP","HCPCS C1713","","71675418  -  NAIL IM 125D 13MM 42CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675419","SUP","HCPCS C1713","","71675419  -  NAIL IM 125D 13MM 44CM INTERTAN LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675420","SUP","HCPCS C1713","","71675420  -  NAIL IM 125D 13MM 44CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675421","SUP","HCPCS C1713","","71675421  -  NAIL IM 125D 13MM 46CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675422","SUP","HCPCS C1713","","71675422  -  NAIL IM 125D 13MM 46CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675423","SUP","HCPCS C1713","","71675423  -  NAIL IM 130D 13MM 26CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675424","SUP","HCPCS C1713","","71675424  -  NAIL IM 130D 13MM 26CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675425","SUP","HCPCS C1713","","71675425  -  NAIL IM 130D 13MM 28CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675426","SUP","HCPCS C1713","","71675426  -  NAIL IM 130D 13MM 28CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675427","SUP","HCPCS C1713","","71675427  -  NAIL IM 130D 13MM 30CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675428","SUP","HCPCS C1713","","71675428  -  NAIL IM 130D 13MM 30CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675429","SUP","HCPCS C1713","","71675429  -  NAIL IM 130D 13MM 32CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675430","SUP","HCPCS C1713","","71675430  -  NAIL IM 130D 13MM 32CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675431","SUP","HCPCS C1713","","71675431  -  NAIL IM 130D 13MM 34CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675432","SUP","HCPCS C1713","","71675432  -  NAIL IM 130D 13MM 34CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675433","SUP","HCPCS C1713","","71675433  -  NAIL IM 130D 13MM 36CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675434","SUP","HCPCS C1713","","71675434  -  NAIL IM 130D 13MM 36CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675435","SUP","HCPCS C1713","","71675435  -  NAIL IM 130D 13MM 38CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675436","SUP","HCPCS C1713","","71675436  -  NAIL IM 130D 13MM 38CM INTERTAN ANTGRD TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675437","SUP","HCPCS C1713","","71675437  -  NAIL IM 130D 13MM 40CM INTERTAN TI LT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675438","SUP","HCPCS C1713","","71675438  -  NAIL IM 130D 13MM 40CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675439","SUP","HCPCS C1713","","71675439  -  NAIL IM 130D 13MM 42CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675440","SUP","HCPCS C1713","","71675440  -  NAIL IM 130D 13MM 42CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675441","SUP","HCPCS C1713","","71675441  -  NAIL IM 130D 13MM 44CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675442","SUP","HCPCS C1713","","71675442  -  NAIL IM 130D 13MM 44CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675443","SUP","HCPCS C1713","","71675443  -  NAIL IM 130D 13MM 46CM INTERTAN TI LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675444","SUP","HCPCS C1713","","71675444  -  NAIL IM 130D 13MM 46CM INTERTAN TI RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675501","SUP","HCPCS C1713","","71675501  -  NAIL IM 125D 10MM 26CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675502","SUP","HCPCS C1713","","71675502  -  NAIL IM 130D 10MM 26CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675503","SUP","HCPCS C1713","","71675503  -  NAIL IM 125D 10MM 28CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675504","SUP","HCPCS C1713","","71675504  -  NAIL IM 130D 10MM 28CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675505","SUP","HCPCS C1713","","71675505  -  NAIL IM 125D 10MM 30CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675506","SUP","HCPCS C1713","","71675506  -  NAIL IM 130D 10MM 30CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675507","SUP","HCPCS C1713","","71675507  -  NAIL IM 125D 10MM 32CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675508","SUP","HCPCS C1713","","71675508  -  NAIL IM 130D 10MM 30CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675509","SUP","HCPCS C1713","","71675509  -  NAIL IM 125D 10MM 34CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675510","SUP","HCPCS C1713","","71675510  -  NAIL IM 130D 10MM 34CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675511","SUP","HCPCS C1713","","71675511  -  NAIL IM 125D 10MM 36CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675512","SUP","HCPCS C1713","","71675512  -  NAIL IM 130D 10MM 36CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675513","SUP","HCPCS C1713","","71675513  -  NAIL IM 125D 10MM 38CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675514","SUP","HCPCS C1713","","71675514  -  NAIL IM 130D 10MM 38CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675515","SUP","HCPCS C1713","","71675515  -  NAIL IM 125D 10MM 40CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675516","SUP","HCPCS C1713","","71675516  -  NAIL IM 130D 10MM 40CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675517","SUP","HCPCS C1713","","71675517  -  NAIL IM 125D 10MM 42CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675518","SUP","HCPCS C1713","","71675518  -  NAIL IM 130D 10MM 42CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675519","SUP","HCPCS C1713","","71675519  -  NAIL IM 125D 10MM 44CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675520","SUP","HCPCS C1713","","71675520  -  NAIL IM 130D 10MM 44CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675521","SUP","HCPCS C1713","","71675521  -  NAIL IM 125D 10MM 46CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675522","SUP","HCPCS C1713","","71675522  -  NAIL IM 130D 10MM 46CM INTERTAN LT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675523","SUP","HCPCS C1713","","71675523  -  NAIL IM 125D 10MM 26CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675524","SUP","HCPCS C1713","","71675524  -  NAIL IM 130D 10MM 26CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675525","SUP","HCPCS C1713","","71675525  -  NAIL IM 125D 10MM 28CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675526","SUP","HCPCS C1713","","71675526  -  NAIL IM 130D 10MM 28CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675527","SUP","HCPCS C1713","","71675527  -  NAIL IM 125D 10MM 30CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675528","SUP","HCPCS C1713","","71675528  -  NAIL IM 130D 10MM 30CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675529","SUP","HCPCS C1713","","71675529  -  NAIL IM 125D 10MM 36CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675530","SUP","HCPCS C1713","","71675530  -  NAIL IM 130D 10MM 32CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675531","SUP","HCPCS C1713","","71675531  -  NAIL IM 125D 10MM 34CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675532","SUP","HCPCS C1713","","71675532  -  NAIL IM 130D 10MM 34CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675533","SUP","HCPCS C1713","","71675533  -  NAIL IM 125D 10MM 36CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675534","SUP","HCPCS C1713","","71675534  -  NAIL IM 130D 10MM 36CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675535","SUP","HCPCS C1713","","71675535  -  NAIL IM 125D 10MM 38CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675536","SUP","HCPCS C1713","","71675536  -  NAIL IM 130D 10MM 38CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675537","SUP","HCPCS C1713","","71675537  -  NAIL IM 125D 10MM 40CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675538","SUP","HCPCS C1713","","71675538  -  NAIL IM 130D 10MM 40CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675539","SUP","HCPCS C1713","","71675539  -  NAIL IM 125D 10MM 42CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675540","SUP","HCPCS C1713","","71675540  -  NAIL IM 130D 10MM 42CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675541","SUP","HCPCS C1713","","71675541  -  NAIL IM 125D 10MM 44CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675542","SUP","HCPCS C1713","","71675542  -  NAIL IM 130D 10MM 44CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675543","SUP","HCPCS C1713","","71675543  -  NAIL IM 125D 10MM 46CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71675544","SUP","HCPCS C1713","","71675544  -  NAIL IM 130D 10MM 46CM INTERTAN RT TROCH","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676501","SUP","HCPCS C1713","","71676501  -  NAIL IM 125D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676502","SUP","HCPCS C1713","","71676502  -  NAIL IM 125D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676503","SUP","HCPCS C1713","","71676503  -  NAIL IM 125D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676504","SUP","HCPCS C1713","","71676504  -  NAIL IM 125D 1.5MM 10MM 28CM INTERTAN INTERTROCHANTER RT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676505","SUP","HCPCS C1713","","71676505  -  NAIL IM 125D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676506","SUP","HCPCS C1713","","71676506  -  NAIL IM 125D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676507","SUP","HCPCS C1713","","71676507  -  NAIL IM 125D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676508","SUP","HCPCS C1713","","71676508  -  NAIL IM 125D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676509","SUP","HCPCS C1713","","71676509  -  NAIL IM 125D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676510","SUP","HCPCS C1713","","71676510  -  NAIL IM 125D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676511","SUP","HCPCS C1713","","71676511  -  NAIL IM 125D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676512","SUP","HCPCS C1713","","71676512  -  NAIL IM 125D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676513","SUP","HCPCS C1713","","71676513  -  NAIL IM 125D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676514","SUP","HCPCS C1713","","71676514  -  NAIL IM 125D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676515","SUP","HCPCS C1713","","71676515  -  NAIL IM 125D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676516","SUP","HCPCS C1713","","71676516  -  NAIL IM 125D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676517","SUP","HCPCS C1713","","71676517  -  NAIL IM 125D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676518","SUP","HCPCS C1713","","71676518  -  NAIL IM 125D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676519","SUP","HCPCS C1713","","71676519  -  NAIL IM 125D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676520","SUP","HCPCS C1713","","71676520  -  NAIL IM 125D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676521","SUP","HCPCS C1713","","71676521  -  NAIL IM 125D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676522","SUP","HCPCS C1713","","71676522  -  NAIL IM 125D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676523","SUP","HCPCS C1713","","71676523  -  NAIL IM 130D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676524","SUP","HCPCS C1713","","71676524  -  NAIL IM 130D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676525","SUP","HCPCS C1713","","71676525  -  NAIL IM 130D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676526","SUP","HCPCS C1713","","71676526  -  NAIL IM 130D 1.5MM 28CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676527","SUP","HCPCS C1713","","71676527  -  NAIL IM 130D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676528","SUP","HCPCS C1713","","71676528  -  NAIL IM 130D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676529","SUP","HCPCS C1713","","71676529  -  NAIL IM 130D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676530","SUP","HCPCS C1713","","71676530  -  NAIL IM 130D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676531","SUP","HCPCS C1713","","71676531  -  NAIL IM 130D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676532","SUP","HCPCS C1713","","71676532  -  NAIL IM 130D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676533","SUP","HCPCS C1713","","71676533  -  NAIL IM 130D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676534","SUP","HCPCS C1713","","71676534  -  NAIL IM 130D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676535","SUP","HCPCS C1713","","71676535  -  NAIL IM 130D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676536","SUP","HCPCS C1713","","71676536  -  NAIL IM 130D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676537","SUP","HCPCS C1713","","71676537  -  NAIL IM 130D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676538","SUP","HCPCS C1713","","71676538  -  NAIL IM 130D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676539","SUP","HCPCS C1713","","71676539  -  NAIL IM 130D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676540","SUP","HCPCS C1713","","71676540  -  NAIL IM 130D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676541","SUP","HCPCS C1713","","71676541  -  NAIL IM 130D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676542","SUP","HCPCS C1713","","71676542  -  NAIL IM 130D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676543","SUP","HCPCS C1713","","71676543  -  NAIL IM 130D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676544","SUP","HCPCS C1713","","71676544  -  NAIL IM 130D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676545","SUP","HCPCS C1713","","71676545  -  NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676546","SUP","HCPCS C1713","","71676546  -  NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676547","SUP","HCPCS C1713","","71676547  -  NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676548","SUP","HCPCS C1713","","71676548  -  NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676549","SUP","HCPCS C1713","","71676549  -  NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676550","SUP","HCPCS C1713","","71676550  -  NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676551","SUP","HCPCS C1713","","71676551  -  NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676552","SUP","HCPCS C1713","","71676552  -  NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676553","SUP","HCPCS C1713","","71676553  -  NAIL INTRAMEDULLARY 125D 1.5MM 34CM 11.5MM INTERTAN LEFT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676554","SUP","HCPCS C1713","","71676554  -  NAIL IM 125D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676555","SUP","HCPCS C1713","","71676555  -  NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676556","SUP","HCPCS C1713","","71676556  -  NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676557","SUP","HCPCS C1713","","71676557  -  NAIL IM 125D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676558","SUP","HCPCS C1713","","71676558  -  NAIL INTRAMEDULLARY 125D 1.5MM 38CM 11.5MM INTERTAN RIGHT","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676559","SUP","HCPCS C1713","","71676559  -  NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676560","SUP","HCPCS C1713","","71676560  -  NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676561","SUP","HCPCS C1713","","71676561  -  NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676562","SUP","HCPCS C1713","","71676562  -  NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676563","SUP","HCPCS C1713","","71676563  -  NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676564","SUP","HCPCS C1713","","71676564  -  NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676565","SUP","HCPCS C1713","","71676565  -  NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676566","SUP","HCPCS C1713","","71676566  -  NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676567","SUP","HCPCS C1713","","71676567  -  NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676568","SUP","HCPCS C1713","","71676568  -  NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676569","SUP","HCPCS C1713","","71676569  -  NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676570","SUP","HCPCS C1713","","71676570  -  NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676571","SUP","HCPCS C1713","","71676571  -  NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676572","SUP","HCPCS C1713","","71676572  -  NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676573","SUP","HCPCS C1713","","71676573  -  NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676574","SUP","HCPCS C1713","","71676574  -  NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676575","SUP","HCPCS C1713","","71676575  -  NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676576","SUP","HCPCS C1713","","71676576  -  NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676577","SUP","HCPCS C1713","","71676577  -  NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676578","SUP","HCPCS C1713","","71676578  -  NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676579","SUP","HCPCS C1713","","71676579  -  NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676580","SUP","HCPCS C1713","","71676580  -  NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676581","SUP","HCPCS C1713","","71676581  -  NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676582","SUP","HCPCS C1713","","71676582  -  NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676583","SUP","HCPCS C1713","","71676583  -  NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676584","SUP","HCPCS C1713","","71676584  -  NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676585","SUP","HCPCS C1713","","71676585  -  NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676586","SUP","HCPCS C1713","","71676586  -  NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676587","SUP","HCPCS C1713","","71676587  -  NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676588","SUP","HCPCS C1713","","71676588  -  NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676589","SUP","HCPCS C1713","","71676589  -  NAIL IM 125D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676590","SUP","HCPCS C1713","","71676590  -  NAIL IM 125D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676591","SUP","HCPCS C1713","","71676591  -  NAIL IM 125D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676592","SUP","HCPCS C1713","","71676592  -  NAIL IM 125D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676593","SUP","HCPCS C1713","","71676593  -  NAIL IM 125D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676594","SUP","HCPCS C1713","","71676594  -  NAIL IM 125D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676595","SUP","HCPCS C1713","","71676595  -  NAIL IM 125D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676596","SUP","HCPCS C1713","","71676596  -  NAIL IM 125D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676597","SUP","HCPCS C1713","","71676597  -  NAIL IM 125D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676598","SUP","HCPCS C1713","","71676598  -  NAIL IM 125D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676599","SUP","HCPCS C1713","","71676599  -  NAIL IM 125D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676600","SUP","HCPCS C1713","","71676600  -  NAIL IM 125D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676601","SUP","HCPCS C1713","","71676601  -  NAIL IM 125D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676602","SUP","HCPCS C1713","","71676602  -  NAIL IM 125D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676603","SUP","HCPCS C1713","","71676603  -  NAIL IM 125D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676604","SUP","HCPCS C1713","","71676604  -  NAIL IM 125D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676605","SUP","HCPCS C1713","","71676605  -  NAIL IM 125D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676606","SUP","HCPCS C1713","","71676606  -  NAIL IM 125D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676607","SUP","HCPCS C1713","","71676607  -  NAIL IM 125D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676608","SUP","HCPCS C1713","","71676608  -  NAIL IM 125D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676609","SUP","HCPCS C1713","","71676609  -  NAIL IM 125D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676610","SUP","HCPCS C1713","","71676610  -  NAIL IM 125D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676611","SUP","HCPCS C1713","","71676611  -  NAIL IM 130D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676612","SUP","HCPCS C1713","","71676612  -  NAIL IM 130D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676613","SUP","HCPCS C1713","","71676613  -  NAIL IM 130D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676614","SUP","HCPCS C1713","","71676614  -  NAIL IM 130D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676615","SUP","HCPCS C1713","","71676615  -  NAIL IM 130D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676616","SUP","HCPCS C1713","","71676616  -  NAIL IM 130D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676617","SUP","HCPCS C1713","","71676617  -  NAIL IM 130D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676618","SUP","HCPCS C1713","","71676618  -  NAIL IM 130D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676619","SUP","HCPCS C1713","","71676619  -  NAIL IM 130D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676620","SUP","HCPCS C1713","","71676620  -  NAIL IM 130D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676621","SUP","HCPCS C1713","","71676621  -  NAIL IM 130D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676622","SUP","HCPCS C1713","","71676622  -  NAIL IM 130D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676623","SUP","HCPCS C1713","","71676623  -  NAIL IM 130D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676624","SUP","HCPCS C1713","","71676624  -  NAIL IM 130D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676625","SUP","HCPCS C1713","","71676625  -  NAIL IM 130D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676626","SUP","HCPCS C1713","","71676626  -  NAIL IM 130D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676627","SUP","HCPCS C1713","","71676627  -  NAIL IM 130D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676628","SUP","HCPCS C1713","","71676628  -  NAIL IM 130D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676629","SUP","HCPCS C1713","","71676629  -  NAIL IM 130D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676630","SUP","HCPCS C1713","","71676630  -  NAIL IM 130D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676631","SUP","HCPCS C1713","","71676631  -  NAIL IM 130D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71676632","SUP","HCPCS C1713","","71676632  -  NAIL IM 130D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER","BOTH IP/OP","$4,443.75 ","$3,288.38 ","$0.00 ","$4,443.75 ","$1,999.69 ","$0.00 ","$926.19 ","$0.00 ","$0.00 ","$778.07 ","$4,443.75 ","$0.00 ","$2,221.88 ","$3,519.45 ","$3,555.00 ","$0.00 ","$695.45 ","$0.00 ","$707.45 ","$0.00 "
"71677070","SUP","HCPCS C1713","","71677070  -  SCREW BN 70/65MM INTERTAN LG CMPR TROCH CMBN PK","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677075","SUP","HCPCS C1713","","71677075  -  SCREW BN 75/70MM INTERTAN LG CMPR TROCH CMBN PK","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677080","SUP","HCPCS C1713","","71677080  -  KIT SCR 80MMX70MM INTERTAN LG CMPR TROCH TI CMBN PK","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677085","SUP","HCPCS C1713","","71677085  -  SCREW BN 11MM 7MM 85MM 80MM INTERTAN KT CMPR LG INTGR INTLK","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677090","SUP","HCPCS C1713","","71677090  -  KIT SCREW 4.5MM 90MM 85MM LAG COMPRESSION INTEGRATE","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677095","SUP","HCPCS C1713","","71677095  -  KIT SCREW 4.5MM 95MM 90MM LAG COMPRESSION INTEGRATED INTLCK","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677120","SUP","HCPCS C1713","","71677120  -  SCREW BN 11MM 7MM 120MM 115MM INTERTAN KT CMPR LG INTGR","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71677125","SUP","HCPCS C1713","","71677125  -  SCREW BN 125/120MM INTERTAN LG CMPR TROCH CMBN PK","BOTH IP/OP","$1,417.50 ","$1,048.95 ","$0.00 ","$1,417.50 ","$637.88 ","$0.00 ","$295.44 ","$0.00 ","$0.00 ","$248.19 ","$1,417.50 ","$0.00 ","$708.75 ","$1,122.66 ","$1,134.00 ","$0.00 ","$221.84 ","$0.00 ","$225.67 ","$0.00 "
"71678005","SUP","HCPCS C1713","","71678005  -  SCREW BN 11MM 105MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678010","SUP","HCPCS C1713","","71678010  -  SCREW BN 11MM 100MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678011","SUP","HCPCS C1713","","71678011  -  SCREW BN 11MM 110MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678012","SUP","HCPCS C1713","","71678012  -  SCREW BN 11MM 120MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678015","SUP","HCPCS C1713","","71678015  -  SCREW BN 11MM 115MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678025","SUP","HCPCS C1713","","71678025  -  SCREW BN 11MM 125MM INTERTAN LG SBTCH","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678070","SUP","HCPCS C1713","","71678070  -  SCREW BN 11MM 70MM INTERTAN LG SBTCH","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678075","SUP","HCPCS C1713","","71678075  -  SCREW BN 11MM 75MM INTERTAN LG SBTCH","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678080","SUP","HCPCS C1713","","71678080  -  SCREW BN 11MM 80MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678085","SUP","HCPCS C1713","","71678085  -  SCREW BN 11MM 85MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678090","SUP","HCPCS C1713","","71678090  -  SCREW BN 11MM 90MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71678095","SUP","HCPCS C1713","","71678095  -  SCREW BN 11MM 95MM INTERTAN LG TI SUBTROCHANTER","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"71679002","SUP","HCPCS C1713","","71679002  -  PLATE BN 127D 80MM INTERTAN CHS 2 HL SS","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679003","SUP","HCPCS C1713","","71679003  -  PLATE BN 127D 92MM INTERTAN CHS 3 HL SS","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679004","SUP","HCPCS C1713","","71679004  -  PLATE BN 127D 104MM INTERTAN CHS 4 HL SS","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679005","SUP","HCPCS C1713","","71679005  -  PLATE BN 127D 116MM INTERTAN CHS 5 HL SS HIP","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679006","SUP","HCPCS C1713","","71679006  -  PLATE BN 127D 128MM INTERTAN CHS 6 HL SS HIP","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679102","SUP","HCPCS C1713","","71679102  -  PLATE BN 135D 84MM INTERTAN CHS 2 HL SS","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679103","SUP","HCPCS C1713","","71679103  -  PLATE BN 135D 96MM INTERTAN CHS 3 HL SS HIP","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679104","SUP","HCPCS C1713","","71679104  -  PLATE BN 135D 4 HL CMPR ORTH","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679105","SUP","HCPCS C1713","","71679105  -  PLATE BN 135D 120MM INTERTAN CHS 5 HL SS HIP","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679106","SUP","HCPCS C1713","","71679106  -  SCREW BN 135D 132MM INTERTAN CHS 6 HL SS","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"71679230","SUP","HCPCS C1713","","71679230  -  SCREW BN 30MM INTERTAN CHS CMPR SS","BOTH IP/OP","$904.00 ","$668.96 ","$0.00 ","$904.00 ","$406.80 ","$0.00 ","$188.42 ","$0.00 ","$0.00 ","$158.28 ","$904.00 ","$0.00 ","$452.00 ","$715.97 ","$723.20 ","$0.00 ","$141.48 ","$0.00 ","$143.92 ","$0.00 "
"71679265","SUP","HCPCS C1713","","71679265  -  SCREW BN 65/60 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679270","SUP","HCPCS C1713","","71679270  -  SCREW BN 70/65 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679275","SUP","HCPCS C1713","","71679275  -  SCREW BN 75/70 INTERTAN CHS CMPR LG SS HIP","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679280","SUP","HCPCS C1713","","71679280  -  SCREW BN 80/75 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679285","SUP","HCPCS C1713","","71679285  -  SCREW BN 85/80 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679290","SUP","HCPCS C1713","","71679290  -  SCREW BN 90/85 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679295","SUP","HCPCS C1713","","71679295  -  SCREW BN 95/90 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679300","SUP","HCPCS C1713","","71679300  -  SCREW BN 100/95 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679305","SUP","HCPCS C1713","","71679305  -  SCREW BN 105/100 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679310","SUP","HCPCS C1713","","71679310  -  SCREW BN 110/105 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679315","SUP","HCPCS C1713","","71679315  -  SCREW BN 115/110 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,642.00 ","$1,215.08 ","$0.00 ","$1,642.00 ","$738.90 ","$0.00 ","$342.23 ","$0.00 ","$0.00 ","$287.50 ","$1,642.00 ","$0.00 ","$821.00 ","$1,300.46 ","$1,313.60 ","$0.00 ","$256.97 ","$0.00 ","$261.41 ","$0.00 "
"71679320","SUP","HCPCS C1713","","71679320  -  SCREW BN 120/115 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$688.50 ","$0.00 ","$318.89 ","$0.00 ","$0.00 ","$267.89 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$239.45 ","$0.00 ","$243.58 ","$0.00 "
"71679325","SUP","HCPCS C1713","","71679325  -  SCREW BN 125/120 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$688.50 ","$0.00 ","$318.89 ","$0.00 ","$0.00 ","$267.89 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$239.45 ","$0.00 ","$243.58 ","$0.00 "
"71679330","SUP","HCPCS C1713","","71679330  -  SCREW BN 130/125 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$688.50 ","$0.00 ","$318.89 ","$0.00 ","$0.00 ","$267.89 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$239.45 ","$0.00 ","$243.58 ","$0.00 "
"71679335","SUP","HCPCS C1713","","71679335  -  SCREW BN 135/130MM INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$688.50 ","$0.00 ","$318.89 ","$0.00 ","$0.00 ","$267.89 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$239.45 ","$0.00 ","$243.58 ","$0.00 "
"71679340","SUP","HCPCS C1713","","71679340  -  SCREW BN 140/135 INTERTAN CHS LG CMPR SS","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$688.50 ","$0.00 ","$318.89 ","$0.00 ","$0.00 ","$267.89 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$239.45 ","$0.00 ","$243.58 ","$0.00 "
"71683935","SUP","HCPCS C1713","","71683935  -  CAP END IMHS CP HIP IM NL","BOTH IP/OP","$700.88 ","$518.65 ","$0.00 ","$700.88 ","$315.39 ","$0.00 ","$146.08 ","$0.00 ","$0.00 ","$122.72 ","$700.88 ","$0.00 ","$350.44 ","$555.10 ","$560.70 ","$0.00 ","$109.69 ","$0.00 ","$111.58 ","$0.00 "
"71683940","SUP","HCPCS C1713","","71683940  -  SET SCR IMHS CP CNN INTRAMEDULLARLY HIP SCR","BOTH IP/OP","$476.88 ","$352.89 ","$0.00 ","$476.88 ","$214.59 ","$0.00 ","$99.39 ","$0.00 ","$0.00 ","$83.50 ","$476.88 ","$0.00 ","$238.44 ","$377.69 ","$381.50 ","$0.00 ","$74.63 ","$0.00 ","$75.92 ","$0.00 "
"71683945","SUP","HCPCS C1713","","71683945  -  SCREW BN 19MM IMHS CP CPTR CMPR HIP IM NL SYS","BOTH IP/OP","$600.25 ","$444.19 ","$0.00 ","$600.25 ","$270.11 ","$0.00 ","$125.11 ","$0.00 ","$0.00 ","$105.10 ","$600.25 ","$0.00 ","$300.13 ","$475.40 ","$480.20 ","$0.00 ","$93.94 ","$0.00 ","$95.56 ","$0.00 "
"71684070","SUP","HCPCS C1713","","71684070  -  SCREW BN 12.7MM 70MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684075","SUP","HCPCS C1713","","71684075  -  SCREW BN 12.7MM 75MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684080","SUP","HCPCS C1713","","71684080  -  SCREW BN 12.7MM 80MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684085","SUP","HCPCS C1713","","71684085  -  SCREW BN 12.7MM 85MM IMHS CP LG SUBTROCHANTER IM NL SYS","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684090","SUP","HCPCS C1713","","71684090  -  SCREW BN 12.7MM 90MM IMHS CP LG SUBTROCHANTER IM NL SYS","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684095","SUP","HCPCS C1713","","71684095  -  SCREW BN 12.7MM 95MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684100","SUP","HCPCS C1713","","71684100  -  SCREW BN 12.7MM 100MM IMHS CP LG SUBTROCHANTER IM NL SYS","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684105","SUP","HCPCS C1713","","71684105  -  SCREW BN 12.7MM 105MM IMHS CP LG SUBTROCHANTER IM NL SYS","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684110","SUP","HCPCS C1713","","71684110  -  SCREW BN 12.7MM 110MM IMHS CP LG SUBTROCHANTER IM NL SYS","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684115","SUP","HCPCS C1713","","71684115  -  SCREW BN 12.7MM 115MM IMHS CP LG SUBTROCHANTER IM NL SYS","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684120","SUP","HCPCS C1713","","71684120  -  SCREW BN 12.7MM 120MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684125","SUP","HCPCS C1713","","71684125  -  SCREW BN 12.7MM 125MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684130","SUP","HCPCS C1713","","71684130  -  SCREW BN 12.7MM 130MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684135","SUP","HCPCS C1713","","71684135  -  SCREW BN 12.7MM 135MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71684140","SUP","HCPCS C1713","","71684140  -  SCREW BN 12.7MM 140MM IMHS CP LG SBTCH IM NL","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"71687000","SUP","Custom 27203010","","71687000  -  GUIDE PIN ORTHOPEDIC 3.2MM THREAD TIP IMHS CP INTRAMEDULLARY","BOTH IP/OP","$189.00 ","$139.86 ","$0.00 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.00 ","$0.00 ","$94.50 ","$149.69 ","$151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71751136","SUP","HCPCS C1713","","71751136  -  TROCAR SRG 3.2MM 3.2MM TRGN PIN HUM DISP","BOTH IP/OP","$353.25 ","$261.41 ","$0.00 ","$353.25 ","$158.96 ","$0.00 ","$73.63 ","$0.00 ","$0.00 ","$61.85 ","$353.25 ","$0.00 ","$176.63 ","$279.77 ","$282.60 ","$0.00 ","$55.28 ","$0.00 ","$56.24 ","$0.00 "
"71751148","SUP","Custom 27203010","","71751148  -  BIT DRL SHRT 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL","BOTH IP/OP","$505.13 ","$373.80 ","$0.00 ","$505.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.13 ","$0.00 ","$252.56 ","$400.06 ","$404.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71751149","SUP","Custom 27203010","","71751149  -  BIT DRL LNG 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL","BOTH IP/OP","$505.13 ","$373.80 ","$0.00 ","$505.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.13 ","$0.00 ","$252.56 ","$400.06 ","$404.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71754020","SUP","HCPCS C1713","","71754020  -  SCREW BN 4MM 20MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754022","SUP","HCPCS C1713","","71754022  -  SCREW BN 4MM 22MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754024","SUP","HCPCS C1713","","71754024  -  SCREW BN 4MM 24MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754026","SUP","HCPCS C1713","","71754026  -  SCREW BN 4MM 26MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754028","SUP","HCPCS C1713","","71754028  -  SCREW BN 4MM 28MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754030","SUP","HCPCS C1713","","71754030  -  SCREW BN 4MM 30MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754032","SUP","HCPCS C1713","","71754032  -  SCREW BN 4MM 32MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754034","SUP","HCPCS C1713","","71754034  -  SCREW BN 4MM 34MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754036","SUP","HCPCS C1713","","71754036  -  SCREW BN 4MM 36MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754038","SUP","HCPCS C1713","","71754038  -  SCREW BN 4MM 38MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754040","SUP","HCPCS C1713","","71754040  -  SCREW BN 4MM 40MM TRGN ST TI HUM CORT IM NL SYS","BOTH IP/OP","$360.00 ","$266.40 ","$0.00 ","$360.00 ","$162.00 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$360.00 ","$0.00 ","$180.00 ","$285.12 ","$288.00 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"71754042","SUP","HCPCS C1713","","71754042  -  SCREW BN 4MM 42MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"71754044","SUP","HCPCS C1713","","71754044  -  SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"71754046","SUP","HCPCS C1713","","71754046  -  SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"71754048","SUP","HCPCS C1713","","71754048  -  SCREW BN 4MM 48MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"71754050","SUP","HCPCS C1713","","71754050  -  SCREW BN 4MM 50MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"71754052","SUP","HCPCS C1713","","71754052  -  SCREW BN 4MM 52MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"71754054","SUP","HCPCS C1713","","71754054  -  SCREW BN 4MM 54MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$342.00 ","$253.08 ","$0.00 ","$342.00 ","$153.90 ","$0.00 ","$71.28 ","$0.00 ","$0.00 ","$59.88 ","$342.00 ","$0.00 ","$171.00 ","$270.86 ","$273.60 ","$0.00 ","$53.52 ","$0.00 ","$54.45 ","$0.00 "
"71754056","SUP","HCPCS C1713","","71754056  -  SCREW BN 4MM 56MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"71754058","SUP","HCPCS C1713","","71754058  -  SCREW BN 4MM 58MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"71754060","SUP","HCPCS C1713","","71754060  -  SCREW BN 4MM 60MM TRGN ST TI HUM CORT IM NL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"71755024","SUP","HCPCS C1713","","71755024  -  SCREW BN 5MM 24MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755026","SUP","HCPCS C1713","","71755026  -  SCREW BN 5MM 26MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755028","SUP","HCPCS C1713","","71755028  -  SCREW BN 5MM 28MM TRGN CNN ST TI HUM CANC IM NL","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755030","SUP","HCPCS C1713","","71755030  -  SCREW BN 5MM 30MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755032","SUP","HCPCS C1713","","71755032  -  SCREW BN 5MM 32MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755034","SUP","HCPCS C1713","","71755034  -  SCREW BN 5MM 34MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755036","SUP","HCPCS C1713","","71755036  -  SCREW BN 5MM 36MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755038","SUP","HCPCS C1713","","71755038  -  SCREW BN 5MM 38MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755040","SUP","HCPCS C1713","","71755040  -  SCREW BN 5MM 40MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755042","SUP","HCPCS C1713","","71755042  -  SCREW BN 5MM 42MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755044","SUP","HCPCS C1713","","71755044  -  SCREW BN 5MM 44MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755046","SUP","HCPCS C1713","","71755046  -  SCREW BN 5MM 46MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755048","SUP","HCPCS C1713","","71755048  -  SCREW BN 5MM 48MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755050","SUP","HCPCS C1713","","71755050  -  SCREW BN 5MM 50MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755052","SUP","HCPCS C1713","","71755052  -  SCREW BN 5MM 52MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755054","SUP","HCPCS C1713","","71755054  -  SCREW BN 5MM 54MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755056","SUP","HCPCS C1713","","71755056  -  SCREW BN 5MM 56MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755058","SUP","HCPCS C1713","","71755058  -  SCREW BN 5MM 58MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755060","SUP","HCPCS C1713","","71755060  -  SCREW BN 5MM 60MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755062","SUP","HCPCS C1713","","71755062  -  SCREW BN 5MM 62MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71755064","SUP","HCPCS C1713","","71755064  -  SCREW BN 5MM 64MM TRGN ST TI HUM CANC IM NL SYS","BOTH IP/OP","$437.63 ","$323.85 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$91.21 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$68.49 ","$0.00 ","$69.67 ","$0.00 "
"71760000","SUP","HCPCS C1713","","71760000  -  CAP END 0MM TRGN HUM IM NL","BOTH IP/OP","$221.63 ","$164.01 ","$0.00 ","$221.63 ","$99.73 ","$0.00 ","$46.19 ","$0.00 ","$0.00 ","$38.80 ","$221.63 ","$0.00 ","$110.81 ","$175.53 ","$177.30 ","$0.00 ","$34.68 ","$0.00 ","$35.28 ","$0.00 "
"71760816","SUP","HCPCS C1713","","71760816  -  NAIL IM 8/7MM 16CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760818","SUP","HCPCS C1713","","71760818  -  NAIL IM 8/7MM 18CM TRGN STRG TI HUM","BOTH IP/OP","$3,048.75 ","$2,256.08 ","$0.00 ","$3,048.75 ","$1,371.94 ","$0.00 ","$635.44 ","$0.00 ","$0.00 ","$533.81 ","$3,048.75 ","$0.00 ","$1,524.38 ","$2,414.61 ","$2,439.00 ","$0.00 ","$477.13 ","$0.00 ","$485.36 ","$0.00 "
"71760820","SUP","HCPCS C1713","","71760820  -  NAIL IM 8/7MM 20CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760822","SUP","HCPCS C1713","","71760822  -  NAIL IM 8/7MM 22CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760826","SUP","HCPCS C1713","","71760826  -  NAIL IM 8/7MM 26CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760828","SUP","HCPCS C1713","","71760828  -  NAIL IM 8/7MM 28CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760830","SUP","HCPCS C1713","","71760830  -  NAIL IM 8/7MM 30CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71760918","SUP","HCPCS C1713","","71760918  -  NAIL IM 8/7MM 18CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760920","SUP","HCPCS C1713","","71760920  -  NAIL IM 9/7.5MM 20CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760922","SUP","HCPCS C1713","","71760922  -  NAIL IM 9/7.5MM 22CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760924","SUP","HCPCS C1713","","71760924  -  NAIL IM 9/7.5MM 24CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760926","SUP","HCPCS C1713","","71760926  -  NAIL IM 9/7.5MM 26CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760928","SUP","HCPCS C1713","","71760928  -  NAIL IM 9/7.5MM 28CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71760930","SUP","HCPCS C1713","","71760930  -  NAIL IM 9/7MM 30CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761018","SUP","HCPCS C1713","","71761018  -  NAIL IM 10/8.5MM 18CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71761020","SUP","HCPCS C1713","","71761020  -  NAIL IM 10/8.5MM 20CM TRGN STRG TI HUM","BOTH IP/OP","$3,048.75 ","$2,256.08 ","$0.00 ","$3,048.75 ","$1,371.94 ","$0.00 ","$635.44 ","$0.00 ","$0.00 ","$533.81 ","$3,048.75 ","$0.00 ","$1,524.38 ","$2,414.61 ","$2,439.00 ","$0.00 ","$477.13 ","$0.00 ","$485.36 ","$0.00 "
"71761022","SUP","HCPCS C1713","","71761022  -  NAIL IM 10/8.5MM 22CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71761024","SUP","HCPCS C1713","","71761024  -  NAIL IM 10/8.5MM 24CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71761026","SUP","HCPCS C1713","","71761026  -  NAIL IM 10/8.5MM 26CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71761028","SUP","HCPCS C1713","","71761028  -  NAIL IM 10/8.5MM 28CM TRGN STRG TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71761030","SUP","HCPCS C1713","","71761030  -  NAIL IM 10/8.5MM 30CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761118","SUP","HCPCS C1713","","71761118  -  NAIL IM 11/9.5MM 18CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761120","SUP","HCPCS C1713","","71761120  -  NAIL IM 11/9.5MM 20CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761122","SUP","HCPCS C1713","","71761122  -  NAIL IM 11/9.5MM 22CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761124","SUP","HCPCS C1713","","71761124  -  NAIL IM 11/9.5MM 24CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761126","SUP","HCPCS C1713","","71761126  -  NAIL IM 11/9.5MM 26CM HUM","BOTH IP/OP","$3,048.75 ","$2,256.08 ","$0.00 ","$3,048.75 ","$1,371.94 ","$0.00 ","$635.44 ","$0.00 ","$0.00 ","$533.81 ","$3,048.75 ","$0.00 ","$1,524.38 ","$2,414.61 ","$2,439.00 ","$0.00 ","$477.13 ","$0.00 ","$485.36 ","$0.00 "
"71761128","SUP","HCPCS C1713","","71761128  -  NAIL IM 11/9.5MM 28CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71761130","SUP","HCPCS C1713","","71761130  -  NAIL IM 11/9.5MM 30CM HUM","BOTH IP/OP","$4,370.00 ","$3,233.80 ","$0.00 ","$4,370.00 ","$1,966.50 ","$0.00 ","$910.82 ","$0.00 ","$0.00 ","$765.15 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$683.91 ","$0.00 ","$695.70 ","$0.00 "
"71770816","SUP","HCPCS C1713","","71770816  -  NAIL IM LNG 8/7MM 16CM TRGN IMPL SET BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770818","SUP","HCPCS C1713","","71770818  -  NAIL IM 8/7MM 18CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770820","SUP","HCPCS C1713","","71770820  -  NAIL IM 8/7MM 20CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770822","SUP","HCPCS C1713","","71770822  -  NAIL IM 8/7MM 22CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770824","SUP","HCPCS C1713","","71770824  -  NAIL IM 8/7MM 24CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770826","SUP","HCPCS C1713","","71770826  -  NAIL IM LNG 8/7MM 26CM TRGN IMPL SET BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770828","SUP","HCPCS C1713","","71770828  -  NAIL IM 8/7MM 28CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770830","SUP","HCPCS C1713","","71770830  -  NAIL IM 8/7MM 30CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770918","SUP","HCPCS C1713","","71770918  -  NAIL IM 9/7.5MM 18CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770920","SUP","HCPCS C1713","","71770920  -  NAIL IM LNG 9/7.5MM 20CM TRGN IMPL SET BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770922","SUP","HCPCS C1713","","71770922  -  NAIL IM LNG 9/7.5MM 22CM TRGN IMPL SET BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770924","SUP","HCPCS C1713","","71770924  -  NAIL IM LNG 9/7.5MM 24CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770926","SUP","HCPCS C1713","","71770926  -  NAIL IM 9 7.5MM 26CM TRGN SET TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770928","SUP","HCPCS C1713","","71770928  -  NAIL IM 9/7.5MM 28CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71770930","SUP","HCPCS C1713","","71770930  -  NAIL IM 9/7.5MM 30CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771018","SUP","HCPCS C1713","","71771018  -  NAIL IM 10/8.5MM 18CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771020","SUP","HCPCS C1713","","71771020  -  NAIL IM 10/8.5MM 20CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771022","SUP","HCPCS C1713","","71771022  -  NAIL IM LNG 10MM 8.5MM 22CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771024","SUP","HCPCS C1713","","71771024  -  NAIL IM 10MM 8.5MM 24CM FRSGHT BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771026","SUP","HCPCS C1713","","71771026  -  NAIL IM 10MM 8.5MM 26CM TRGN IMPL SET TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771028","SUP","HCPCS C1713","","71771028  -  NAIL IM 10 8.5MM 28CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771030","SUP","HCPCS C1713","","71771030  -  NAIL IM 10/8.5MM 30CM TRGN BNT TI HUM","BOTH IP/OP","$3,656.25 ","$2,705.63 ","$0.00 ","$3,656.25 ","$1,645.31 ","$0.00 ","$762.05 ","$0.00 ","$0.00 ","$640.18 ","$3,656.25 ","$0.00 ","$1,828.13 ","$2,895.75 ","$2,925.00 ","$0.00 ","$572.20 ","$0.00 ","$582.08 ","$0.00 "
"71771118","SUP","HCPCS C1713","","71771118  -  NAIL IM 11/9.5MM 18CM HUM","BOTH IP/OP","$2,576.25 ","$1,906.43 ","$0.00 ","$2,576.25 ","$1,159.31 ","$0.00 ","$536.95 ","$0.00 ","$0.00 ","$451.08 ","$2,576.25 ","$0.00 ","$1,288.13 ","$2,040.39 ","$2,061.00 ","$0.00 ","$403.18 ","$0.00 ","$410.14 ","$0.00 "
"71771120","SUP","HCPCS C1713","","71771120  -  NAIL IM 11/9.5MM 20CM HUM","BOTH IP/OP","$2,576.25 ","$1,906.43 ","$0.00 ","$2,576.25 ","$1,159.31 ","$0.00 ","$536.95 ","$0.00 ","$0.00 ","$451.08 ","$2,576.25 ","$0.00 ","$1,288.13 ","$2,040.39 ","$2,061.00 ","$0.00 ","$403.18 ","$0.00 ","$410.14 ","$0.00 "
"71771122","SUP","HCPCS C1713","","71771122  -  NAIL IM 11/9.5MM 22CM HUM","BOTH IP/OP","$2,576.25 ","$1,906.43 ","$0.00 ","$2,576.25 ","$1,159.31 ","$0.00 ","$536.95 ","$0.00 ","$0.00 ","$451.08 ","$2,576.25 ","$0.00 ","$1,288.13 ","$2,040.39 ","$2,061.00 ","$0.00 ","$403.18 ","$0.00 ","$410.14 ","$0.00 "
"71771124","SUP","HCPCS C1713","","71771124  -  NAIL IM 11/9.5MM 24CM HUM","BOTH IP/OP","$2,576.25 ","$1,906.43 ","$0.00 ","$2,576.25 ","$1,159.31 ","$0.00 ","$536.95 ","$0.00 ","$0.00 ","$451.08 ","$2,576.25 ","$0.00 ","$1,288.13 ","$2,040.39 ","$2,061.00 ","$0.00 ","$403.18 ","$0.00 ","$410.14 ","$0.00 "
"71771126","SUP","HCPCS C1713","","71771126  -  NAIL IM 11/9.5MM 26CM HUM","BOTH IP/OP","$2,576.25 ","$1,906.43 ","$0.00 ","$2,576.25 ","$1,159.31 ","$0.00 ","$536.95 ","$0.00 ","$0.00 ","$451.08 ","$2,576.25 ","$0.00 ","$1,288.13 ","$2,040.39 ","$2,061.00 ","$0.00 ","$403.18 ","$0.00 ","$410.14 ","$0.00 "
"71771128","SUP","HCPCS C1713","","71771128  -  NAIL IM 11/9.5MM 28CM HUM","BOTH IP/OP","$2,576.25 ","$1,906.43 ","$0.00 ","$2,576.25 ","$1,159.31 ","$0.00 ","$536.95 ","$0.00 ","$0.00 ","$451.08 ","$2,576.25 ","$0.00 ","$1,288.13 ","$2,040.39 ","$2,061.00 ","$0.00 ","$403.18 ","$0.00 ","$410.14 ","$0.00 "
"71771130","SUP","HCPCS C1713","","71771130  -  NAIL IM 11/9.5MM 30CM HUM","BOTH IP/OP","$3,048.75 ","$2,256.08 ","$0.00 ","$3,048.75 ","$1,371.94 ","$0.00 ","$635.44 ","$0.00 ","$0.00 ","$533.81 ","$3,048.75 ","$0.00 ","$1,524.38 ","$2,414.61 ","$2,439.00 ","$0.00 ","$477.13 ","$0.00 ","$485.36 ","$0.00 "
"71800308","SUP","HCPCS C1713","","71800308  -  PLATE BN 165MM PRLC 8 HL LCK SS TIB RT PROX LAT 4.5MM SCR","BOTH IP/OP","$3,402.00 ","$2,517.48 ","$0.00 ","$3,402.00 ","$1,530.90 ","$0.00 ","$709.06 ","$0.00 ","$0.00 ","$595.66 ","$3,402.00 ","$0.00 ","$1,701.00 ","$2,694.38 ","$2,721.60 ","$0.00 ","$532.41 ","$0.00 ","$541.60 ","$0.00 "
"71800313","SUP","HCPCS C1713","","71800313  -  PLATE BN 255MM PRLC 13 HL LCK SS TIB RT PROX LAT 4.5MM SCR","BOTH IP/OP","$3,491.25 ","$2,583.53 ","$0.00 ","$3,491.25 ","$1,571.06 ","$0.00 ","$727.66 ","$0.00 ","$0.00 ","$611.29 ","$3,491.25 ","$0.00 ","$1,745.63 ","$2,765.07 ","$2,793.00 ","$0.00 ","$546.38 ","$0.00 ","$555.81 ","$0.00 "
"71800413","SUP","HCPCS C1713","","71800413  -  PLATE BN 187MM PRLC 13 HL LCK SS TIB LT PROX LAT 3.5MM SCR","BOTH IP/OP","$3,491.25 ","$2,583.53 ","$0.00 ","$3,491.25 ","$1,571.06 ","$0.00 ","$727.66 ","$0.00 ","$0.00 ","$611.29 ","$3,491.25 ","$0.00 ","$1,745.63 ","$2,765.07 ","$2,793.00 ","$0.00 ","$546.38 ","$0.00 ","$555.81 ","$0.00 "
"71800513","SUP","HCPCS C1713","","71800513  -  PLATE BN 187MM PRLC 13 HL LCK SS TIB RT PROX LAT 3.5MM SCR","BOTH IP/OP","$3,491.25 ","$2,583.53 ","$0.00 ","$3,491.25 ","$1,571.06 ","$0.00 ","$727.66 ","$0.00 ","$0.00 ","$611.29 ","$3,491.25 ","$0.00 ","$1,745.63 ","$2,765.07 ","$2,793.00 ","$0.00 ","$546.38 ","$0.00 ","$555.81 ","$0.00 "
"71801222","SUP","HCPCS C1713","","71801222  -  SCREW BN 3.5MM 22MM STRL PRLC VLP ST LCK FT FIB CORT","BOTH IP/OP","$244.65 ","$181.04 ","$0.00 ","$244.65 ","$110.09 ","$0.00 ","$50.99 ","$0.00 ","$0.00 ","$42.84 ","$244.65 ","$0.00 ","$122.33 ","$193.76 ","$195.72 ","$0.00 ","$38.29 ","$0.00 ","$38.95 ","$0.00 "
"71801320","SUP","HCPCS C1713","","71801320  -  SCREW BN HEX LOPRFL 3.5MM 20MM STRL PRLC VLP ST FT CORT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71801328","SUP","HCPCS C1713","","71801328  -  SCREW BN LOPRFL 3.5MM 28MM STRL VLP ST HEX DRV RCS CORT FT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71801332","SUP","HCPCS C1713","","71801332  -  SCREW BN HEX LOPRFL 3.5MM 32MM STRL PRLC VLP ST FT CORT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71801336","SUP","HCPCS C1713","","71801336  -  SCREW BN LOPRFL 3.5MM 36MM STRL VLP ST HEX DRV RCS CORT FT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71801340","SUP","HCPCS C1713","","71801340  -  SCREW BN LOPRFL 3.5MM 40MM STRL VLP ST HEX DRV RCS CORT FT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71801365","SUP","HCPCS C1713","","71801365  -  SCREW BN HEX LOPRFL 3.5MM 65MM STRL PRLC VLP ST FT CORT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71801375","SUP","HCPCS C1713","","71801375  -  SCREW BN HEX LOPRFL 3.5MM 75MM STRL PRLC VLP ST FT CORT","BOTH IP/OP","$43.58 ","$32.25 ","$0.00 ","$43.58 ","$19.61 ","$0.00 ","$9.08 ","$0.00 ","$0.00 ","$7.63 ","$43.58 ","$0.00 ","$21.79 ","$34.52 ","$34.86 ","$0.00 ","$6.82 ","$0.00 ","$6.94 ","$0.00 "
"71802506","SUP","HCPCS C1713","","71802506  -  SCREW BN 2.5MM 6MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802508","SUP","HCPCS C1713","","71802508  -  SCREW BN 2.5MM 8MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802532","SUP","HCPCS C1713","","71802532  -  SCREW BN 2.5MM 32MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802534","SUP","HCPCS C1713","","71802534  -  SCREW BN 2.5MM 34MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802536","SUP","HCPCS C1713","","71802536  -  SCREW BN 2.5MM 36MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802538","SUP","HCPCS C1713","","71802538  -  SCREW BN 2.5MM 38MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802540","SUP","HCPCS C1713","","71802540  -  SCREW BN 2.5MM 40MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802545","SUP","HCPCS C1713","","71802545  -  SCREW BN 2.5MM 45MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802550","SUP","HCPCS C1713","","71802550  -  SCREW BN 2.5MM 50MM ST CORT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71802606","SUP","HCPCS C1713","","71802606  -  PLATE BN 70MM PRLC 6 HL LCK RECON SS 3.5MM SCR","BOTH IP/OP","$1,060.50 ","$784.77 ","$0.00 ","$1,060.50 ","$477.23 ","$0.00 ","$221.03 ","$0.00 ","$0.00 ","$185.69 ","$1,060.50 ","$0.00 ","$530.25 ","$839.92 ","$848.40 ","$0.00 ","$165.97 ","$0.00 ","$168.83 ","$0.00 "
"71803006","SUP","HCPCS C1713","","71803006  -  SCREW BN 2.7MM 6MM STRL ST CORT FOREFOOT MIDFOOT","BOTH IP/OP","$75.58 ","$55.93 ","$0.00 ","$75.58 ","$34.01 ","$0.00 ","$15.75 ","$0.00 ","$0.00 ","$13.23 ","$75.58 ","$0.00 ","$37.79 ","$59.86 ","$60.46 ","$0.00 ","$11.83 ","$0.00 ","$12.03 ","$0.00 "
"71809006","SUP","HCPCS C1713","","71809006  -  PLATE BN TBLR RCHRD 6 HL LCK HIP 3.5MM SCR","BOTH IP/OP","$347.55 ","$257.19 ","$0.00 ","$347.55 ","$156.40 ","$0.00 ","$72.44 ","$0.00 ","$0.00 ","$60.85 ","$347.55 ","$0.00 ","$173.78 ","$275.26 ","$278.04 ","$0.00 ","$54.39 ","$0.00 ","$55.33 ","$0.00 "
"71823032","SUP","HCPCS C1713","","71823032  -  SCREW BN 2.7MM 32MM ST SS CORT PRLC VLP SM FRAG SYS","BOTH IP/OP","$44.90 ","$33.23 ","$0.00 ","$44.90 ","$20.21 ","$0.00 ","$9.36 ","$0.00 ","$0.00 ","$7.86 ","$44.90 ","$0.00 ","$22.45 ","$35.56 ","$35.92 ","$0.00 ","$7.03 ","$0.00 ","$7.15 ","$0.00 "
"71840112","SUP","HCPCS C1713","","71840112  -  TEMPLATE BNDRG TC100 12 HL CMPR LG FRAG PLT","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"71840202","SUP","HCPCS C1713","","71840202  -  PLATE BN 26MM 2 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$332.85 ","$246.31 ","$0.00 ","$332.85 ","$149.78 ","$0.00 ","$69.37 ","$0.00 ","$0.00 ","$58.28 ","$332.85 ","$0.00 ","$166.43 ","$263.62 ","$266.28 ","$0.00 ","$52.09 ","$0.00 ","$52.99 ","$0.00 "
"71840203","SUP","HCPCS C1713","","71840203  -  PLATE BN 39MM 3 HL CMPR ORTH 3.5MM SCR SM FRAG SET","BOTH IP/OP","$341.25 ","$252.53 ","$0.00 ","$341.25 ","$153.56 ","$0.00 ","$71.13 ","$0.00 ","$0.00 ","$59.75 ","$341.25 ","$0.00 ","$170.63 ","$270.27 ","$273.00 ","$0.00 ","$53.41 ","$0.00 ","$54.33 ","$0.00 "
"71840204","SUP","HCPCS C1713","","71840204  -  PLATE BN 52MM TC100 4 HL CMPR PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$354.90 ","$262.63 ","$0.00 ","$354.90 ","$159.71 ","$0.00 ","$73.97 ","$0.00 ","$0.00 ","$62.14 ","$354.90 ","$0.00 ","$177.45 ","$281.08 ","$283.92 ","$0.00 ","$55.54 ","$0.00 ","$56.50 ","$0.00 "
"71840205","SUP","HCPCS C1713","","71840205  -  PLATE BN 65MM TC100 5 HL CMPR PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$382.20 ","$282.83 ","$0.00 ","$382.20 ","$171.99 ","$0.00 ","$79.66 ","$0.00 ","$0.00 ","$66.92 ","$382.20 ","$0.00 ","$191.10 ","$302.70 ","$305.76 ","$0.00 ","$59.81 ","$0.00 ","$60.85 ","$0.00 "
"71840206","SUP","HCPCS C1713","","71840206  -  PLATE BN 78MM TC100 6 HL CMPR PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"71840207","SUP","HCPCS C1713","","71840207  -  PLATE BN 91MM TC100 7 HL CMPR PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$414.75 ","$306.92 ","$0.00 ","$414.75 ","$186.64 ","$0.00 ","$86.44 ","$0.00 ","$0.00 ","$72.62 ","$414.75 ","$0.00 ","$207.38 ","$328.48 ","$331.80 ","$0.00 ","$64.91 ","$0.00 ","$66.03 ","$0.00 "
"71840208","SUP","HCPCS C1713","","71840208  -  PLATE BN 104MM TC100 8 HL CMPR PLVC 3.5MM SCR SM FRAG SET","BOTH IP/OP","$446.25 ","$330.23 ","$0.00 ","$446.25 ","$200.81 ","$0.00 ","$93.01 ","$0.00 ","$0.00 ","$78.13 ","$446.25 ","$0.00 ","$223.13 ","$353.43 ","$357.00 ","$0.00 ","$69.84 ","$0.00 ","$71.04 ","$0.00 "
"71840209","SUP","HCPCS C1713","","71840209  -  PLATE BN 117MM 9 HL CMPR ORTH 3.5MM SCR SM FRAG SET","BOTH IP/OP","$454.65 ","$336.44 ","$0.00 ","$454.65 ","$204.59 ","$0.00 ","$94.76 ","$0.00 ","$0.00 ","$79.61 ","$454.65 ","$0.00 ","$227.33 ","$360.08 ","$363.72 ","$0.00 ","$71.15 ","$0.00 ","$72.38 ","$0.00 "
"71840210","SUP","HCPCS C1713","","71840210  -  PLATE BN 130MM 10 HL CMPR ORTH 3.5MM SCR SM FRAG SET","BOTH IP/OP","$470.40 ","$348.10 ","$0.00 ","$470.40 ","$211.68 ","$0.00 ","$98.04 ","$0.00 ","$0.00 ","$82.36 ","$470.40 ","$0.00 ","$235.20 ","$372.56 ","$376.32 ","$0.00 ","$73.62 ","$0.00 ","$74.89 ","$0.00 "
"71840211","SUP","HCPCS C1713","","71840211  -  PLATE BN 143MM 11 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$470.40 ","$348.10 ","$0.00 ","$470.40 ","$211.68 ","$0.00 ","$98.04 ","$0.00 ","$0.00 ","$82.36 ","$470.40 ","$0.00 ","$235.20 ","$372.56 ","$376.32 ","$0.00 ","$73.62 ","$0.00 ","$74.89 ","$0.00 "
"71840212","SUP","HCPCS C1713","","71840212  -  PLATE BN 156MM 12 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$520.80 ","$385.39 ","$0.00 ","$520.80 ","$234.36 ","$0.00 ","$108.55 ","$0.00 ","$0.00 ","$91.19 ","$520.80 ","$0.00 ","$260.40 ","$412.47 ","$416.64 ","$0.00 ","$81.51 ","$0.00 ","$82.91 ","$0.00 "
"71840214","SUP","HCPCS C1713","","71840214  -  PLATE BN 182MM 14 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,181.25 ","$874.13 ","$0.00 ","$1,181.25 ","$531.56 ","$0.00 ","$246.20 ","$0.00 ","$0.00 ","$206.83 ","$1,181.25 ","$0.00 ","$590.63 ","$935.55 ","$945.00 ","$0.00 ","$184.87 ","$0.00 ","$188.06 ","$0.00 "
"71840215","SUP","HCPCS C1713","","71840215  -  PLATE BN 195MM 15 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,233.75 ","$912.98 ","$0.00 ","$1,233.75 ","$555.19 ","$0.00 ","$257.14 ","$0.00 ","$0.00 ","$216.02 ","$1,233.75 ","$0.00 ","$616.88 ","$977.13 ","$987.00 ","$0.00 ","$193.08 ","$0.00 ","$196.41 ","$0.00 "
"71840216","SUP","HCPCS C1713","","71840216  -  PLATE BN 208MM 16 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,359.75 ","$1,006.22 ","$0.00 ","$1,359.75 ","$611.89 ","$0.00 ","$283.41 ","$0.00 ","$0.00 ","$238.08 ","$1,359.75 ","$0.00 ","$679.88 ","$1,076.92 ","$1,087.80 ","$0.00 ","$212.80 ","$0.00 ","$216.47 ","$0.00 "
"71840218","SUP","HCPCS C1713","","71840218  -  PLATE BN 234MM 18 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,517.25 ","$1,122.77 ","$0.00 ","$1,517.25 ","$682.76 ","$0.00 ","$316.23 ","$0.00 ","$0.00 ","$265.66 ","$1,517.25 ","$0.00 ","$758.63 ","$1,201.66 ","$1,213.80 ","$0.00 ","$237.45 ","$0.00 ","$241.55 ","$0.00 "
"71840220","SUP","HCPCS C1713","","71840220  -  PLATE BN 260MM 20 HL CMPR 3.5MM SCR SM FRAG SET","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"71841012","SUP","HCPCS C1713","","71841012  -  TEMPLATE BNDRG TC100 12 HL SM FRAG PLT","BOTH IP/OP","$88.68 ","$65.62 ","$0.00 ","$88.68 ","$39.90 ","$0.00 ","$18.48 ","$0.00 ","$0.00 ","$15.53 ","$88.68 ","$0.00 ","$44.34 ","$70.23 ","$70.94 ","$0.00 ","$13.88 ","$0.00 ","$14.12 ","$0.00 "
"71841206","SUP","HCPCS C1713","","71841206  -  PLATE BN BRD 108MM 6 HL CMPR 4.5MM SCR","BOTH IP/OP","$577.50 ","$427.35 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$120.37 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"71841207","SUP","HCPCS C1713","","71841207  -  PLATE BN BRD 126MM 7 HL CMPR 4.5MM SCR","BOTH IP/OP","$577.50 ","$427.35 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$120.37 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"71841208","SUP","HCPCS C1713","","71841208  -  PLATE BN BRD 144MM 8 HL CMPR 4.5MM SCR","BOTH IP/OP","$718.20 ","$531.47 ","$0.00 ","$718.20 ","$323.19 ","$0.00 ","$149.69 ","$0.00 ","$0.00 ","$125.75 ","$718.20 ","$0.00 ","$359.10 ","$568.81 ","$574.56 ","$0.00 ","$112.40 ","$0.00 ","$114.34 ","$0.00 "
"71841209","SUP","HCPCS C1713","","71841209  -  PLATE BN BRD 162MM 9 HL CMPR 4.5MM SCR","BOTH IP/OP","$718.20 ","$531.47 ","$0.00 ","$718.20 ","$323.19 ","$0.00 ","$149.69 ","$0.00 ","$0.00 ","$125.75 ","$718.20 ","$0.00 ","$359.10 ","$568.81 ","$574.56 ","$0.00 ","$112.40 ","$0.00 ","$114.34 ","$0.00 "
"71841210","SUP","HCPCS C1713","","71841210  -  PLATE BN BRD 180MM 10 HL CMPR 4.5MM SCR","BOTH IP/OP","$718.20 ","$531.47 ","$0.00 ","$718.20 ","$323.19 ","$0.00 ","$149.69 ","$0.00 ","$0.00 ","$125.75 ","$718.20 ","$0.00 ","$359.10 ","$568.81 ","$574.56 ","$0.00 ","$112.40 ","$0.00 ","$114.34 ","$0.00 "
"71841211","SUP","HCPCS C1713","","71841211  -  PLATE BN BRD 198MM 11 HL CMPR 4.5MM SCR","BOTH IP/OP","$904.05 ","$669.00 ","$0.00 ","$904.05 ","$406.82 ","$0.00 ","$188.43 ","$0.00 ","$0.00 ","$158.29 ","$904.05 ","$0.00 ","$452.03 ","$716.01 ","$723.24 ","$0.00 ","$141.48 ","$0.00 ","$143.92 ","$0.00 "
"71841212","SUP","HCPCS C1713","","71841212  -  PLATE BN BRD 216MM 12 HL CMPR ORTH 4.5MM SCR","BOTH IP/OP","$770.70 ","$570.32 ","$0.00 ","$770.70 ","$346.82 ","$0.00 ","$160.63 ","$0.00 ","$0.00 ","$134.94 ","$770.70 ","$0.00 ","$385.35 ","$610.39 ","$616.56 ","$0.00 ","$120.61 ","$0.00 ","$122.70 ","$0.00 "
"71841214","SUP","HCPCS C1713","","71841214  -  PLATE BN BRD 252MM 14 HL CMPR 4.5MM SCR","BOTH IP/OP","$770.70 ","$570.32 ","$0.00 ","$770.70 ","$346.82 ","$0.00 ","$160.63 ","$0.00 ","$0.00 ","$134.94 ","$770.70 ","$0.00 ","$385.35 ","$610.39 ","$616.56 ","$0.00 ","$120.61 ","$0.00 ","$122.70 ","$0.00 "
"71841218","SUP","HCPCS C1713","","71841218  -  PLATE BN BRD 324MM 18 HL CMPR 4.5MM SCR","BOTH IP/OP","$1,139.25 ","$843.05 ","$0.00 ","$1,139.25 ","$512.66 ","$0.00 ","$237.45 ","$0.00 ","$0.00 ","$199.47 ","$1,139.25 ","$0.00 ","$569.63 ","$902.29 ","$911.40 ","$0.00 ","$178.29 ","$0.00 ","$181.37 ","$0.00 "
"71841222","SUP","HCPCS C1713","","71841222  -  PLATE BN BRD 396MM 22 HL CMPR 4.5MM SCR","BOTH IP/OP","$1,722.00 ","$1,274.28 ","$0.00 ","$1,722.00 ","$774.90 ","$0.00 ","$358.91 ","$0.00 ","$0.00 ","$301.51 ","$1,722.00 ","$0.00 ","$861.00 ","$1,363.82 ","$1,377.60 ","$0.00 ","$269.49 ","$0.00 ","$274.14 ","$0.00 "
"71841402","SUP","HCPCS C1713","","71841402  -  PLATE BN NAR 36MM 2 HL CMPR 4.5MM SCR","BOTH IP/OP","$473.55 ","$350.43 ","$0.00 ","$473.55 ","$213.10 ","$0.00 ","$98.70 ","$0.00 ","$0.00 ","$82.91 ","$473.55 ","$0.00 ","$236.78 ","$375.05 ","$378.84 ","$0.00 ","$74.11 ","$0.00 ","$75.39 ","$0.00 "
"71841403","SUP","HCPCS C1713","","71841403  -  PLATE BN NAR 54MM 3 HL CMPR 4.5MM SCR","BOTH IP/OP","$387.45 ","$286.71 ","$0.00 ","$387.45 ","$174.35 ","$0.00 ","$80.75 ","$0.00 ","$0.00 ","$67.84 ","$387.45 ","$0.00 ","$193.73 ","$306.86 ","$309.96 ","$0.00 ","$60.64 ","$0.00 ","$61.68 ","$0.00 "
"71841404","SUP","HCPCS C1713","","71841404  -  PLATE BN NAR 72MM 4 HL CMPR 4.5MM SCR","BOTH IP/OP","$387.45 ","$286.71 ","$0.00 ","$387.45 ","$174.35 ","$0.00 ","$80.75 ","$0.00 ","$0.00 ","$67.84 ","$387.45 ","$0.00 ","$193.73 ","$306.86 ","$309.96 ","$0.00 ","$60.64 ","$0.00 ","$61.68 ","$0.00 "
"71841405","SUP","HCPCS C1713","","71841405  -  PLATE BN NAR 90MM 5 HL CMPR 4.5MM SCR","BOTH IP/OP","$387.45 ","$286.71 ","$0.00 ","$387.45 ","$174.35 ","$0.00 ","$80.75 ","$0.00 ","$0.00 ","$67.84 ","$387.45 ","$0.00 ","$193.73 ","$306.86 ","$309.96 ","$0.00 ","$60.64 ","$0.00 ","$61.68 ","$0.00 "
"71841406","SUP","HCPCS C1713","","71841406  -  PLATE BN NAR 108MM 6 HL CMPR 4.5MM SCR","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71841407","SUP","HCPCS C1713","","71841407  -  PLATE BN NAR 126MM 7 HL CMPR 4.5MM SCR","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71841408","SUP","HCPCS C1713","","71841408  -  PLATE BN NAR 144MM 8 HL CMPR 4.5MM SCR","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71841409","SUP","HCPCS C1713","","71841409  -  PLATE BN NAR 162MM 9 HL CMPR 4.5MM SCR","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$441.00 ","$198.45 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.22 ","$441.00 ","$0.00 ","$220.50 ","$349.27 ","$352.80 ","$0.00 ","$69.02 ","$0.00 ","$70.21 ","$0.00 "
"71841410","SUP","HCPCS C1713","","71841410  -  PLATE BN NAR 180MM 10 HL CMPR 4.5MM SCR","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"71841411","SUP","HCPCS C1713","","71841411  -  PLATE BN NAR 198MM 11 HL CMPR 4.5MM SCR","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"71841412","SUP","HCPCS C1713","","71841412  -  PLATE BN NAR 216MM 12 HL CMPR 4.5MM SCR","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"71841413","SUP","HCPCS C1713","","71841413  -  PLATE BN NAR 234MM 13 HL CMPR 4.5MM SCR","BOTH IP/OP","$820.05 ","$606.84 ","$0.00 ","$820.05 ","$369.02 ","$0.00 ","$170.92 ","$0.00 ","$0.00 ","$143.58 ","$820.05 ","$0.00 ","$410.03 ","$649.48 ","$656.04 ","$0.00 ","$128.34 ","$0.00 ","$130.55 ","$0.00 "
"71841414","SUP","HCPCS C1713","","71841414  -  PLATE BN NAR 252MM 14 HL CMPR 4.5MM SCR","BOTH IP/OP","$820.05 ","$606.84 ","$0.00 ","$820.05 ","$369.02 ","$0.00 ","$170.92 ","$0.00 ","$0.00 ","$143.58 ","$820.05 ","$0.00 ","$410.03 ","$649.48 ","$656.04 ","$0.00 ","$128.34 ","$0.00 ","$130.55 ","$0.00 "
"71841416","SUP","HCPCS C1713","","71841416  -  PLATE BN NAR 288MM 16 HL CMPR 4.5MM SCR","BOTH IP/OP","$866.25 ","$641.03 ","$0.00 ","$866.25 ","$389.81 ","$0.00 ","$180.55 ","$0.00 ","$0.00 ","$151.67 ","$866.25 ","$0.00 ","$433.13 ","$686.07 ","$693.00 ","$0.00 ","$135.57 ","$0.00 ","$137.91 ","$0.00 "
"71841418","SUP","HCPCS C1713","","71841418  -  PLATE BN NAR 324MM 18 HL CMPR 4.5MM SCR","BOTH IP/OP","$1,270.50 ","$940.17 ","$0.00 ","$1,270.50 ","$571.73 ","$0.00 ","$264.80 ","$0.00 ","$0.00 ","$222.45 ","$1,270.50 ","$0.00 ","$635.25 ","$1,006.24 ","$1,016.40 ","$0.00 ","$198.83 ","$0.00 ","$202.26 ","$0.00 "
"71841420","SUP","HCPCS C1713","","71841420  -  PLATE BN NAR 360MM 20 HL CMPR 4.5MM SCR","BOTH IP/OP","$1,396.50 ","$1,033.41 ","$0.00 ","$1,396.50 ","$628.43 ","$0.00 ","$291.07 ","$0.00 ","$0.00 ","$244.52 ","$1,396.50 ","$0.00 ","$698.25 ","$1,106.03 ","$1,117.20 ","$0.00 ","$218.55 ","$0.00 ","$222.32 ","$0.00 "
"71925062","SUP","Custom 27203010","","71925062  -  GUIDE PIN ORTHOPEDIC 2.4MM 450MM THREAD","BOTH IP/OP","$1,605.00 ","$1,187.70 ","$0.00 ","$1,022.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71931590","SUP","HCPCS C1713","","71931590  -  NAIL IM 11.5MM 60CM FEM","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931594","SUP","HCPCS C1713","","71931594  -  NAIL IM 11.5MM 80CM KN RT FEM","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931602","SUP","HCPCS C1713","","71931602  -  NAIL IM 11.5MM FAN FSN KN","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931604","SUP","HCPCS C1713","","71931604  -  NAIL IM 11.5MM 85MM LCK FSN FEM","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931663","SUP","HCPCS C1713","","71931663  -  NAIL IM 13MM 75CM FSN LT KN","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931664","SUP","HCPCS C1713","","71931664  -  NAIL IM 13MM 80CM KN FEM","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931665","SUP","HCPCS C1713","","71931665  -  NAIL IM 85CMX13MM ANTGRD FSN LT","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71931672","SUP","HCPCS C1713","","71931672  -  NAIL IM 13MM 75CM KN FEM","BOTH IP/OP","$6,918.75 ","$5,119.88 ","$0.00 ","$6,918.75 ","$3,113.44 ","$0.00 ","$1,442.04 ","$0.00 ","$0.00 ","$1,211.42 ","$6,918.75 ","$0.00 ","$3,459.38 ","$5,479.65 ","$5,535.00 ","$0.00 ","$1,082.78 ","$0.00 ","$1,101.47 ","$0.00 "
"71933134","SUP","HCPCS C1713","","71933134  -  SCREW BN 3MM 4MM 30MM 3MM SM HDLS SCR CNN SCR SYS TI ACPT","BOTH IP/OP","$6,283.13 ","$4,649.52 ","$0.00 ","$6,283.13 ","$2,827.41 ","$0.00 ","$1,309.56 ","$0.00 ","$0.00 ","$1,100.12 ","$6,283.13 ","$0.00 ","$3,141.56 ","$4,976.24 ","$5,026.50 ","$0.00 ","$983.31 ","$0.00 ","$1,000.27 ","$0.00 "
"71933306","SUP","Custom 27203010","","71933306  -  RING EXFIX 255MM 2/3 RING","BOTH IP/OP","$9,400.00 ","$6,956.00 ","$0.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,400.00 ","$0.00 ","$4,700.00 ","$7,444.80 ","$7,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933335","SUP","Custom 27203010","","71933335  -  RAIL XTRNFX STD SEG DIST MDLR SYS","BOTH IP/OP","$1,534.25 ","$1,135.35 ","$0.00 ","$1,534.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,534.25 ","$0.00 ","$767.13 ","$1,215.13 ","$1,227.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933336","SUP","Custom 27203010","","71933336  -  ARCH XTRNFX RAIL ROT CNCT","BOTH IP/OP","$2,443.75 ","$1,808.38 ","$0.00 ","$2,443.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,443.75 ","$0.00 ","$1,221.88 ","$1,935.45 ","$1,955.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933338","SUP","Custom 27203010","","71933338  -  ARCH XTRNFX RAIL ROT CNCT","BOTH IP/OP","$1,525.75 ","$1,129.06 ","$0.00 ","$1,525.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,525.75 ","$0.00 ","$762.88 ","$1,208.39 ","$1,220.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933339","SUP","Custom 27203010","","71933339  -  ARCH XTRNFX RAIL ROT CNCT","BOTH IP/OP","$1,323.88 ","$979.67 ","$0.00 ","$1,323.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,323.88 ","$0.00 ","$661.94 ","$1,048.51 ","$1,059.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933501","SUP","HCPCS C1713","","71933501  -  SCREW BN 4.5MM 48MM ST CORT","BOTH IP/OP","$38.50 ","$28.49 ","$0.00 ","$38.50 ","$17.33 ","$0.00 ","$8.02 ","$0.00 ","$0.00 ","$6.74 ","$38.50 ","$0.00 ","$19.25 ","$30.49 ","$30.80 ","$0.00 ","$6.03 ","$0.00 ","$6.13 ","$0.00 "
"71933626","SUP","Custom 27203010","","71933626  -  CONNECTOR XTRNFX RAIL CLP","BOTH IP/OP","$1,039.13 ","$768.96 ","$0.00 ","$1,039.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,039.13 ","$0.00 ","$519.56 ","$822.99 ","$831.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933940","SUP","Custom 27203010","","71933940  -  RAIL XTRNFX SM MDLR RL ARC CNCT","BOTH IP/OP","$1,564.00 ","$1,157.36 ","$0.00 ","$1,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,564.00 ","$0.00 ","$782.00 ","$1,238.69 ","$1,251.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933941","SUP","Custom 27203010","","71933941  -  RAIL XTRNFX SM","BOTH IP/OP","$2,613.75 ","$1,934.18 ","$0.00 ","$2,613.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,613.75 ","$0.00 ","$1,306.88 ","$2,070.09 ","$2,091.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71933943","SUP","Custom 27203010","","71933943  -  RAIL XTRNFX SM ARC ROT CNCT","BOTH IP/OP","$1,323.88 ","$979.67 ","$0.00 ","$1,323.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,323.88 ","$0.00 ","$661.94 ","$1,048.51 ","$1,059.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934046","SUP","Custom 27203010","","71934046  -  ARCH XTRNFX SHRT MDLR RL SM RAIL","BOTH IP/OP","$2,613.75 ","$1,934.18 ","$0.00 ","$2,613.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,613.75 ","$0.00 ","$1,306.88 ","$2,070.09 ","$2,091.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934155","SUP","Custom 27203010","","71934155  -  RAIL XTRNFX SM ARC PREASSEMBLE","BOTH IP/OP","$9,360.63 ","$6,926.87 ","$0.00 ","$9,360.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,360.63 ","$0.00 ","$4,680.31 ","$7,413.62 ","$7,488.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934479","SUP","HCPCS C1713","","71934479  -  NAIL IM 125D 10MM 24CM TRGN FEM","BOTH IP/OP","$3,780.00 ","$2,797.20 ","$0.00 ","$3,780.00 ","$1,701.00 ","$0.00 ","$787.85 ","$0.00 ","$0.00 ","$661.85 ","$3,780.00 ","$0.00 ","$1,890.00 ","$2,993.76 ","$3,024.00 ","$0.00 ","$591.57 ","$0.00 ","$601.78 ","$0.00 "
"71934482","SUP","HCPCS C1713","","71934482  -  NAIL IM 130D 11.5MM 24CM TRGN FEM","BOTH IP/OP","$3,780.00 ","$2,797.20 ","$0.00 ","$3,780.00 ","$1,701.00 ","$0.00 ","$787.85 ","$0.00 ","$0.00 ","$661.85 ","$3,780.00 ","$0.00 ","$1,890.00 ","$2,993.76 ","$3,024.00 ","$0.00 ","$591.57 ","$0.00 ","$601.78 ","$0.00 "
"71934624","SUP","Custom 27203010","","71934624  -  RAIL XTRNFX ARC CNCT THRD","BOTH IP/OP","$1,525.75 ","$1,129.06 ","$0.00 ","$1,525.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,525.75 ","$0.00 ","$762.88 ","$1,208.39 ","$1,220.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934625","SUP","Custom 27203010","","71934625  -  RAIL XTRNFX ARC","BOTH IP/OP","$2,496.88 ","$1,847.69 ","$0.00 ","$2,496.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,496.88 ","$0.00 ","$1,248.44 ","$1,977.53 ","$1,997.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934626","SUP","Custom 27203010","","71934626  -  RAIL XTRNFX SM ARC CNCT THRD","BOTH IP/OP","$1,525.75 ","$1,129.06 ","$0.00 ","$1,525.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,525.75 ","$0.00 ","$762.88 ","$1,208.39 ","$1,220.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934627","SUP","Custom 27203010","","71934627  -  RAIL XTRNFX SM ARC","BOTH IP/OP","$2,496.88 ","$1,847.69 ","$0.00 ","$2,496.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,496.88 ","$0.00 ","$1,248.44 ","$1,977.53 ","$1,997.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934628","SUP","Custom 27203010","","71934628  -  RAIL XTRNFX SM ARCH","BOTH IP/OP","$2,496.88 ","$1,847.69 ","$0.00 ","$2,496.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,496.88 ","$0.00 ","$1,248.44 ","$1,977.53 ","$1,997.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934629","SUP","Custom 27203010","","71934629  -  RAIL XTRNFX 180MM ARC","BOTH IP/OP","$2,496.88 ","$1,847.69 ","$0.00 ","$2,496.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,496.88 ","$0.00 ","$1,248.44 ","$1,977.53 ","$1,997.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934630","SUP","Custom 27203010","","71934630  -  RAIL XTRNFX SM 180MM ARC","BOTH IP/OP","$2,496.88 ","$1,847.69 ","$0.00 ","$2,496.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,496.88 ","$0.00 ","$1,248.44 ","$1,977.53 ","$1,997.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934647","SUP","Custom 27203010","","71934647  -  RAIL XTRNFX 50MM LCK","BOTH IP/OP","$1,071.00 ","$792.54 ","$0.00 ","$1,071.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,071.00 ","$0.00 ","$535.50 ","$848.23 ","$856.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934648","SUP","Custom 27203010","","71934648  -  RAIL XTRNFX 60MM LCK","BOTH IP/OP","$1,060.38 ","$784.68 ","$0.00 ","$1,060.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.38 ","$0.00 ","$530.19 ","$839.82 ","$848.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934649","SUP","Custom 27203010","","71934649  -  RAIL XTRNFX 70MM LCK","BOTH IP/OP","$1,071.00 ","$792.54 ","$0.00 ","$1,071.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,071.00 ","$0.00 ","$535.50 ","$848.23 ","$856.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934650","SUP","Custom 27203010","","71934650  -  RAIL XTRNFX 80MM LCK","BOTH IP/OP","$1,060.38 ","$784.68 ","$0.00 ","$1,060.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.38 ","$0.00 ","$530.19 ","$839.82 ","$848.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934651","SUP","Custom 27203010","","71934651  -  RAIL XTRNFX 90MM LCK","BOTH IP/OP","$1,060.38 ","$784.68 ","$0.00 ","$1,060.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.38 ","$0.00 ","$530.19 ","$839.82 ","$848.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934652","SUP","Custom 27203010","","71934652  -  RAIL XTRNFX 100MM LCK","BOTH IP/OP","$1,060.38 ","$784.68 ","$0.00 ","$1,060.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.38 ","$0.00 ","$530.19 ","$839.82 ","$848.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934776","SUP","HCPCS C1713","","71934776  -  NAIL 10MM 34CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934777","SUP","HCPCS C1713","","71934777  -  NAIL 10MM 36CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934778","SUP","HCPCS C1713","","71934778  -  NAIL 10MM 38CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934779","SUP","HCPCS C1713","","71934779  -  NAIL 10MM 40CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934780","SUP","HCPCS C1713","","71934780  -  NAIL 10MM 42CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934781","SUP","HCPCS C1713","","71934781  -  NAIL 10MM 44CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934782","SUP","HCPCS C1713","","71934782  -  NAIL 10MM 34CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934783","SUP","HCPCS C1713","","71934783  -  NAIL 10MM 36CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934784","SUP","HCPCS C1713","","71934784  -  NAIL 10MM 38CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934785","SUP","HCPCS C1713","","71934785  -  NAIL 10MM 40CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934787","SUP","HCPCS C1713","","71934787  -  NAIL 10MM 44CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934788","SUP","HCPCS C1713","","71934788  -  NAIL 11.5MM 36CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934789","SUP","HCPCS C1713","","71934789  -  NAIL 11.5MM 38CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934790","SUP","HCPCS C1713","","71934790  -  NAIL 11.5MM 40CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934791","SUP","HCPCS C1713","","71934791  -  NAIL 11.5MM 42CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934792","SUP","HCPCS C1713","","71934792  -  NAIL 11.5MM 44CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934793","SUP","HCPCS C1713","","71934793  -  NAIL 11.5MM 46CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934794","SUP","HCPCS C1713","","71934794  -  NAIL 11.5MM 36CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934795","SUP","HCPCS C1713","","71934795  -  NAIL 11.5MM 38CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934796","SUP","HCPCS C1713","","71934796  -  NAIL 11.5MM 40CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934797","SUP","HCPCS C1713","","71934797  -  NAIL 11.5MM 42CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934798","SUP","HCPCS C1713","","71934798  -  NAIL 11.5MM 44CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934799","SUP","HCPCS C1713","","71934799  -  NAIL 11.5MM 46CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934800","SUP","HCPCS C1713","","71934800  -  NAIL 13MM 36CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934801","SUP","HCPCS C1713","","71934801  -  NAIL 13MM 38CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934802","SUP","HCPCS C1713","","71934802  -  NAIL 13MM 40CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934803","SUP","HCPCS C1713","","71934803  -  NAIL 13MM 42CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934804","SUP","HCPCS C1713","","71934804  -  NAIL 13MM 44CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934805","SUP","HCPCS C1713","","71934805  -  NAIL 13MM 46CM FEM LEFT IM 25D ANTGRD LIME","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934806","SUP","HCPCS C1713","","71934806  -  NAIL 13MM 36CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934807","SUP","HCPCS C1713","","71934807  -  NAIL 13MM 38CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934808","SUP","HCPCS C1713","","71934808  -  NAIL 13MM 40CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934809","SUP","HCPCS C1713","","71934809  -  NAIL 13MM 42CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934810","SUP","HCPCS C1713","","71934810  -  NAIL 13MM 44CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934811","SUP","HCPCS C1713","","71934811  -  NAIL 13MM 46CM FEM RIGHT IM 25D ANTGRD ROSE","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934845","SUP","Custom 27203010","","71934845  -  RAIL XTRNFX 339MM","BOTH IP/OP","$2,666.88 ","$1,973.49 ","$0.00 ","$2,666.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,666.88 ","$0.00 ","$1,333.44 ","$2,112.17 ","$2,133.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934846","SUP","Custom 27203010","","71934846  -  RAIL XTRNFX SM 226MM","BOTH IP/OP","$2,666.88 ","$1,973.49 ","$0.00 ","$2,666.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,666.88 ","$0.00 ","$1,333.44 ","$2,112.17 ","$2,133.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71934996","SUP","HCPCS C1713","","71934996  -  NAIL 10MM 46CM LEFT FAN IM 25D LIME DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934997","SUP","HCPCS C1713","","71934997  -  NAIL 10MM 46CM RIGHT FAN IM 25D ROSE DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934998","SUP","HCPCS C1713","","71934998  -  NAIL 11.5MM 32CM LEFT FAN IM 25D LIME DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71934999","SUP","HCPCS C1713","","71934999  -  NAIL 11.5MM 34CM LEFT FAN IM 25D LIME DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71935001","SUP","HCPCS C1713","","71935001  -  NAIL 11.5MM 34CM RIGHT FAN IM 25D ROSE DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71935002","SUP","HCPCS C1713","","71935002  -  NAIL 13MM 32CM LEFT FAN IM 25D LIME DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71935003","SUP","HCPCS C1713","","71935003  -  NAIL 13MM 34CM LEFT FAN IM 25D LIME DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71935004","SUP","HCPCS C1713","","71935004  -  NAIL 13MM 32CM RIGHT FAN IM 25D ROSE DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"71935005","SUP","HCPCS C1713","","71935005  -  NAIL 13MM 34CM RIGHT FAN IM 25D ROSE DH","BOTH IP/OP","$4,522.50 ","$3,346.65 ","$0.00 ","$4,522.50 ","$2,035.13 ","$0.00 ","$942.60 ","$0.00 ","$0.00 ","$791.85 ","$4,522.50 ","$0.00 ","$2,261.25 ","$3,581.82 ","$3,618.00 ","$0.00 ","$707.77 ","$0.00 ","$719.98 ","$0.00 "
"72200634","SUP","Custom 27203010","","72200634  -  PAD PSTN 9IN 1.5IN 11IN SUPN POST HIP PERINEUM DISP","BOTH IP/OP","$208.70 ","$154.44 ","$0.00 ","$208.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$208.70 ","$0.00 ","$104.35 ","$165.29 ","$166.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72202468","SUP","HCPCS C1713","","72202468  -  DEVICE FX 360D CRV FSTFX 2 ANCH PRETIE 2-0 5MM SUT MNSCL","BOTH IP/OP","$1,163.90 ","$861.29 ","$0.00 ","$1,163.90 ","$523.76 ","$0.00 ","$242.59 ","$0.00 ","$0.00 ","$203.79 ","$1,163.90 ","$0.00 ","$581.95 ","$921.81 ","$931.12 ","$0.00 ","$182.15 ","$0.00 ","$185.29 ","$0.00 "
"72400024","SUP","HCPCS C1815","","72400024  -  IMPL URO A800 CONTINENCE URN CNTRL SYS INHBZN 61-70 CMW URN","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$796.00 ","$0.00 "
"72400025","SUP","HCPCS C1815","","72400025  -  IMPLANT UROLOGICAL 71-80CU CM PRESSURE BALLOON AMS 800","BOTH IP/OP","$5,867.50 ","$4,341.95 ","$0.00 ","$5,867.50 ","$2,640.38 ","$0.00 ","$1,222.93 ","$0.00 ","$0.00 ","$0.00 ","$5,867.50 ","$0.00 ","$2,933.75 ","$4,647.06 ","$4,694.00 ","$0.00 ","$0.00 ","$0.00 ","$934.11 ","$0.00 "
"72402006","SUP","HCPCS C1713","","72402006  -  SCREW BN T6 2MM 3MM 6MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402007","SUP","HCPCS C1713","","72402007  -  SCREW BN T6 2MM 3MM 7MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402008","SUP","HCPCS C1713","","72402008  -  SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402009","SUP","HCPCS C1713","","72402009  -  SCREW BN T6 2MM 3MM 9MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402010","SUP","HCPCS C1713","","72402010  -  SCREW BN T6 2MM 3MM 10MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402011","SUP","HCPCS C1713","","72402011  -  SCREW BN T6 2MM 3MM 11MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402012","SUP","HCPCS C1713","","72402012  -  SCREW BN T6 2MM 3MM 12MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402013","SUP","HCPCS C1713","","72402013  -  SCREW BN T6 2MM 3MM 13MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402014","SUP","HCPCS C1713","","72402014  -  SCREW BN T6 2MM 3MM 14MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402015","SUP","HCPCS C1713","","72402015  -  SCREW BN T6 2MM 3MM 15MM STRL EVOS MN ST CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402016","SUP","HCPCS C1713","","72402016  -  SCREW BN T6 2MM 3MM 16MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402017","SUP","HCPCS C1713","","72402017  -  SCREW BN T6 2MM 3MM 17MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402018","SUP","HCPCS C1713","","72402018  -  SCREW BN T6 2MM 3MM 18MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402019","SUP","HCPCS C1713","","72402019  -  SCREW BN T6 2MM 3MM 19MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402020","SUP","HCPCS C1713","","72402020  -  SCREW BN T6 2MM 3MM 20MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402021","SUP","HCPCS C1713","","72402021  -  SCREW BN T6 2MM 3MM 21MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402022","SUP","HCPCS C1713","","72402022  -  SCREW BN T6 2MM 3MM 22MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402023","SUP","HCPCS C1713","","72402023  -  SCREW BN T6 2MM 3MM 23MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402024","SUP","HCPCS C1713","","72402024  -  SCREW BN T6 2MM 3MM 24MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402026","SUP","HCPCS C1713","","72402026  -  SCREW BN T6 2MM 3MM 26MM STRL EVOS MN ST DRVR LNG BN SM BN","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402028","SUP","HCPCS C1713","","72402028  -  SCREW BN T6 2MM 3MM 28MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402030","SUP","HCPCS C1713","","72402030  -  SCREW BN T6 2MM 3MM 30MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402032","SUP","HCPCS C1713","","72402032  -  SCREW BN T6 2MM 3MM 32MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402034","SUP","HCPCS C1713","","72402034  -  SCREW BN T6 2MM 3MM 34MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402036","SUP","HCPCS C1713","","72402036  -  SCREW BN T6 2MM 3MM 36MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402038","SUP","HCPCS C1713","","72402038  -  SCREW BN T6 2MM 3MM 38MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402040","SUP","HCPCS C1713","","72402040  -  SCREW BN T6 2MM 3MM 40MM STRL SLFRET SCRDRVR ST FLT HD CORT","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72402406","SUP","HCPCS C1713","","72402406  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 6MM STRL SLFRET SCRDRVR ST FLT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402407","SUP","HCPCS C1713","","72402407  -  SCREW BN T7 2.4MM 7MM STRL EVOS MN SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402408","SUP","HCPCS C1713","","72402408  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 8MM STRL SLFRET SCRDRVR ST FLT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402409","SUP","HCPCS C1713","","72402409  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 9MM STRL SLFRET SCRDRVR ST FLT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402410","SUP","HCPCS C1713","","72402410  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 10MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402411","SUP","HCPCS C1713","","72402411  -  SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN ST DRVR LNG BN SM","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402412","SUP","HCPCS C1713","","72402412  -  SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN ST DRVR LNG BN SM","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402413","SUP","HCPCS C1713","","72402413  -  SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402414","SUP","HCPCS C1713","","72402414  -  SCREW BN T7 2.4MM 14MM EVOS ST SLFRET DRV SS SM BN LNG BN","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402415","SUP","HCPCS C1713","","72402415  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 15MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402416","SUP","HCPCS C1713","","72402416  -  SCREW BN T7 2.4MM 16MM EVOS ST SLFRET DRV SS SM BN LNG BN","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402417","SUP","HCPCS C1713","","72402417  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 17MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402418","SUP","HCPCS C1713","","72402418  -  SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN ST DRVR LNG BN SM","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402419","SUP","HCPCS C1713","","72402419  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 19MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402420","SUP","HCPCS C1713","","72402420  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 20MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402421","SUP","HCPCS C1713","","72402421  -  SCREW BN T7 2.4MM 21MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402422","SUP","HCPCS C1713","","72402422  -  SCREW BN T7 2.4MM 22MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402423","SUP","HCPCS C1713","","72402423  -  SCREW BN T7 2.4MM 23MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402424","SUP","HCPCS C1713","","72402424  -  SCREW BN T7 2.4MM 24MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402426","SUP","HCPCS C1713","","72402426  -  SCREW BN T7 2.4MM 26MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402430","SUP","HCPCS C1713","","72402430  -  SCREW BN T7 2.4MM 30MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402432","SUP","HCPCS C1713","","72402432  -  SCREW BN T7 2.4MM 32MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402434","SUP","HCPCS C1713","","72402434  -  SCREW BN T7 2.4MM 34MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402436","SUP","HCPCS C1713","","72402436  -  SCREW BN T7 2.4MM 36MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402438","SUP","HCPCS C1713","","72402438  -  SCREW BN T7 2.4MM 38MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402442","SUP","HCPCS C1713","","72402442  -  SCREW BN T7 2.4MM 42MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402444","SUP","HCPCS C1713","","72402444  -  SCREW BN T7 2.4MM 44MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402446","SUP","HCPCS C1713","","72402446  -  SCREW BN T7 2.4MM 46MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402448","SUP","HCPCS C1713","","72402448  -  SCREW BN T7 2.4MM 48MM STRL EVOS MN ST CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402455","SUP","HCPCS C1713","","72402455  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 55MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402460","SUP","HCPCS C1713","","72402460  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 60MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"72402465","SUP","HCPCS C1713","","72402465  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 65MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$106.15 ","$78.55 ","$0.00 ","$106.15 ","$47.77 ","$0.00 ","$22.12 ","$0.00 ","$0.00 ","$18.59 ","$106.15 ","$0.00 ","$53.08 ","$84.07 ","$84.92 ","$0.00 ","$16.61 ","$0.00 ","$16.90 ","$0.00 "
"72402470","SUP","HCPCS C1713","","72402470  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 70MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$106.15 ","$78.55 ","$0.00 ","$106.15 ","$47.77 ","$0.00 ","$22.12 ","$0.00 ","$0.00 ","$18.59 ","$106.15 ","$0.00 ","$53.08 ","$84.07 ","$84.92 ","$0.00 ","$16.61 ","$0.00 ","$16.90 ","$0.00 "
"72402475","SUP","HCPCS C1713","","72402475  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 75MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$106.15 ","$78.55 ","$0.00 ","$106.15 ","$47.77 ","$0.00 ","$22.12 ","$0.00 ","$0.00 ","$18.59 ","$106.15 ","$0.00 ","$53.08 ","$84.07 ","$84.92 ","$0.00 ","$16.61 ","$0.00 ","$16.90 ","$0.00 "
"72402480","SUP","HCPCS C1713","","72402480  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 80MM STRL SLFRET SCRDRVR ST","BOTH IP/OP","$106.15 ","$78.55 ","$0.00 ","$106.15 ","$47.77 ","$0.00 ","$22.12 ","$0.00 ","$0.00 ","$18.59 ","$106.15 ","$0.00 ","$53.08 ","$84.07 ","$84.92 ","$0.00 ","$16.61 ","$0.00 ","$16.90 ","$0.00 "
"72402706","SUP","HCPCS C1713","","72402706  -  SCREW BN T8 2MM 2.7MM 4.5MM 6MM ST CORT EVOS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402707","SUP","HCPCS C1713","","72402707  -  SCREW BN T7 2.7MM 4.5MM 7MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402708","SUP","HCPCS C1713","","72402708  -  SCREW BN T8 2.7MM 4.5MM 8MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402709","SUP","HCPCS C1713","","72402709  -  SCREW BN T8 2.7MM 9MM EVOS ST SLFRET DRV SS SM BN LNG BN","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402710","SUP","HCPCS C1713","","72402710  -  SCREW BN T8 2.7MM 4.5MM 10MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402711","SUP","HCPCS C1713","","72402711  -  SCREW BN 2.7MM 4.5MM 11MM EVOS T8 DRVR 2 END DRL GD ST CORT","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402712","SUP","HCPCS C1713","","72402712  -  SCREW BN T8 2.7MM 12MM STRL EVOS MN SS CORT","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402713","SUP","HCPCS C1713","","72402713  -  SCREW BN 2.7MM 4.5MM 13MM EVOS T8 DRVR 2 END DRL GD ST CORT","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402714","SUP","HCPCS C1713","","72402714  -  SCREW BN T7 2.7MM 4.5MM 14MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402715","SUP","HCPCS C1713","","72402715  -  SCREW BN T7 2.7MM 4.5MM 15MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402716","SUP","HCPCS C1713","","72402716  -  SCREW BN T8 2.7MM 4.5MM 16MM EVOS ST CORT MN PLT SYS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402717","SUP","HCPCS C1713","","72402717  -  SCREW BN T8 2.7MM 4.5MM 17MM NS EVOS ST CORT MN PLT SYS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402718","SUP","HCPCS C1713","","72402718  -  SCREW BN T8 2.7MM 4.5MM 18MM NS EVOS ST CORT MN PLT SYS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402719","SUP","HCPCS C1713","","72402719  -  SCREW BN T8 2MM 2.7MM 4.5MM 19MM ST CORT EVOS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402720","SUP","HCPCS C1713","","72402720  -  SCREW BN T7 2.7MM 4.5MM 20MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402721","SUP","HCPCS C1713","","72402721  -  SCREW BN T7 2.7MM 4.5MM 21MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402722","SUP","HCPCS C1713","","72402722  -  SCREW BN T7 2.7MM 4.5MM 22MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402723","SUP","HCPCS C1713","","72402723  -  SCREW BN T7 2.7MM 4.5MM 23MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402724","SUP","HCPCS C1713","","72402724  -  SCREW BN T7 2.7MM 4.5MM 24MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402726","SUP","HCPCS C1713","","72402726  -  SCREW BN T7 2.7MM 4.5MM 26MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402728","SUP","HCPCS C1713","","72402728  -  SCREW BN T8 2MM 2.7MM 4.5MM 28MM ST CORT EVOS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402730","SUP","HCPCS C1713","","72402730  -  SCREW BN T7 2.7MM 4.5MM 30MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402732","SUP","HCPCS C1713","","72402732  -  SCREW BN T8 2MM 2.7MM 4.5MM 32MM ST CORT EVOS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402734","SUP","HCPCS C1713","","72402734  -  SCREW BN T7 2.7MM 4.5MM 34MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402736","SUP","HCPCS C1713","","72402736  -  SCREW BN T8 2MM 2.7MM 4.5MM 36MM ST CORT EVOS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402738","SUP","HCPCS C1713","","72402738  -  SCREW BN T8 2.7MM 4.5MM 38MM STRL EVOS MN ST CORT","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402740","SUP","HCPCS C1713","","72402740  -  SCREW BN T8 2.7MM 4.5MM 40MM STRL EVOS MN ST DRVR LNG BN SM","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402742","SUP","HCPCS C1713","","72402742  -  SCREW BN T7 2.7MM 4.5MM 42MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402744","SUP","HCPCS C1713","","72402744  -  SCREW BN T8 2MM 2.7MM 4.5MM 44MM ST CORT EVOS","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402746","SUP","HCPCS C1713","","72402746  -  SCREW BN T7 2.7MM 4.5MM 46MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402748","SUP","HCPCS C1713","","72402748  -  SCREW BN T7 2.7MM 4.5MM 48MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402750","SUP","HCPCS C1713","","72402750  -  SCREW BN T7 2.7MM 4.5MM 50MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402755","SUP","HCPCS C1713","","72402755  -  SCREW BN T7 2.7MM 4.5MM 55MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402760","SUP","HCPCS C1713","","72402760  -  SCREW BN T7 2.7MM 4.5MM 60MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$81.68 ","$60.44 ","$0.00 ","$81.68 ","$36.75 ","$0.00 ","$17.02 ","$0.00 ","$0.00 ","$14.30 ","$81.68 ","$0.00 ","$40.84 ","$64.69 ","$65.34 ","$0.00 ","$12.78 ","$0.00 ","$13.00 ","$0.00 "
"72402765","SUP","HCPCS C1713","","72402765  -  SCREW BN T7 2.7MM 4.5MM 65MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$110.28 ","$81.61 ","$0.00 ","$110.28 ","$49.62 ","$0.00 ","$22.98 ","$0.00 ","$0.00 ","$19.31 ","$110.28 ","$0.00 ","$55.14 ","$87.34 ","$88.22 ","$0.00 ","$17.26 ","$0.00 ","$17.56 ","$0.00 "
"72402770","SUP","HCPCS C1713","","72402770  -  SCREW BN T7 2.7MM 4.5MM 70MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$110.28 ","$81.61 ","$0.00 ","$110.28 ","$49.62 ","$0.00 ","$22.98 ","$0.00 ","$0.00 ","$19.31 ","$110.28 ","$0.00 ","$55.14 ","$87.34 ","$88.22 ","$0.00 ","$17.26 ","$0.00 ","$17.56 ","$0.00 "
"72402775","SUP","HCPCS C1713","","72402775  -  SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST DRVR LNG BN SM","BOTH IP/OP","$110.28 ","$81.61 ","$0.00 ","$110.28 ","$49.62 ","$0.00 ","$22.98 ","$0.00 ","$0.00 ","$19.31 ","$110.28 ","$0.00 ","$55.14 ","$87.34 ","$88.22 ","$0.00 ","$17.26 ","$0.00 ","$17.56 ","$0.00 "
"72402780","SUP","HCPCS C1713","","72402780  -  SCREW BN T7 2.7MM 4.5MM 80MM STRL SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$110.28 ","$81.61 ","$0.00 ","$110.28 ","$49.62 ","$0.00 ","$22.98 ","$0.00 ","$0.00 ","$19.31 ","$110.28 ","$0.00 ","$55.14 ","$87.34 ","$88.22 ","$0.00 ","$17.26 ","$0.00 ","$17.56 ","$0.00 "
"72403513","SUP","HCPCS C1713","","72403513  -  SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL","BOTH IP/OP","$58.73 ","$43.46 ","$0.00 ","$58.73 ","$26.43 ","$0.00 ","$12.24 ","$0.00 ","$0.00 ","$10.28 ","$58.73 ","$0.00 ","$29.36 ","$46.51 ","$46.98 ","$0.00 ","$9.19 ","$0.00 ","$9.35 ","$0.00 "
"72403514","SUP","HCPCS C1713","","72403514  -  SCREW BN 1.7MM 4MM SLF DRL AX STAB LWR PRFL","BOTH IP/OP","$58.73 ","$43.46 ","$0.00 ","$58.73 ","$26.43 ","$0.00 ","$12.24 ","$0.00 ","$0.00 ","$10.28 ","$58.73 ","$0.00 ","$29.36 ","$46.51 ","$46.98 ","$0.00 ","$9.19 ","$0.00 ","$9.35 ","$0.00 "
"72403528","SUP","HCPCS C1713","","72403528  -  SCREW BN 3.5MM 28MM STRL EVOS ST CORT","BOTH IP/OP","$58.73 ","$43.46 ","$0.00 ","$58.73 ","$26.43 ","$0.00 ","$12.24 ","$0.00 ","$0.00 ","$10.28 ","$58.73 ","$0.00 ","$29.36 ","$46.51 ","$46.98 ","$0.00 ","$9.19 ","$0.00 ","$9.35 ","$0.00 "
"72403540","SUP","HCPCS C1713","","72403540  -  SCREW BN 3.5MM 40MM STRL EVOS ST CORT","BOTH IP/OP","$58.73 ","$43.46 ","$0.00 ","$58.73 ","$26.43 ","$0.00 ","$12.24 ","$0.00 ","$0.00 ","$10.28 ","$58.73 ","$0.00 ","$29.36 ","$46.51 ","$46.98 ","$0.00 ","$9.19 ","$0.00 ","$9.35 ","$0.00 "
"72403550","SUP","HCPCS C1713","","72403550  -  SCREW BN 3.5MM 50MM STRL EVOS ST CORT","BOTH IP/OP","$58.73 ","$43.46 ","$0.00 ","$58.73 ","$26.43 ","$0.00 ","$12.24 ","$0.00 ","$0.00 ","$10.28 ","$58.73 ","$0.00 ","$29.36 ","$46.51 ","$46.98 ","$0.00 ","$9.19 ","$0.00 ","$9.35 ","$0.00 "
"72403830","SUP","HCPCS C1771","","72403830  -  SLING PUBOVAGINAL MONARC FMALE","BOTH IP/OP","$3,177.50 ","$2,351.35 ","$0.00 ","$3,177.50 ","$1,429.88 ","$0.00 ","$662.27 ","$0.00 ","$0.00 ","$556.35 ","$3,177.50 ","$0.00 ","$1,588.75 ","$2,516.58 ","$2,542.00 ","$0.00 ","$497.28 ","$0.00 ","$505.86 ","$0.00 "
"72403867","SUP","HCPCS C1813","","72403867  -  PROS PENL AMS 700 DP PENOSCROTAL","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$725.00 ","$326.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$725.00 ","$0.00 ","$362.50 ","$574.20 ","$580.00 ","$0.00 ","$0.00 ","$0.00 ","$115.42 ","$0.00 "
"72404127","SUP","HCPCS C1813","","72404127  -  PROS PENL A800 PMP INHBZN","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$0.00 ","$0.00 ","$1,671.60 ","$0.00 "
"72404131","SUP","HCPCS C1815","","72404131  -  IMPLANT UROLOGICAL 4.5CM CUFF AMS 800 INHIBIZONE SPHINCTER","BOTH IP/OP","$9,010.63 ","$6,667.87 ","$0.00 ","$9,010.63 ","$4,054.78 ","$0.00 ","$1,878.04 ","$0.00 ","$0.00 ","$0.00 ","$9,010.63 ","$0.00 ","$4,505.31 ","$7,136.42 ","$7,208.50 ","$0.00 ","$0.00 ","$0.00 ","$1,434.49 ","$0.00 "
"72404132","SUP","HCPCS C1815","","72404132  -  IMPLANT UROLOGICAL 5CM CONTINENCE PUMP AMS 800 INHIBIZONE","BOTH IP/OP","$12,487.50 ","$9,240.75 ","$0.00 ","$12,487.50 ","$5,619.38 ","$0.00 ","$2,602.71 ","$0.00 ","$0.00 ","$0.00 ","$12,487.50 ","$0.00 ","$6,243.75 ","$9,890.10 ","$9,990.00 ","$0.00 ","$0.00 ","$0.00 ","$1,988.01 ","$0.00 "
"72404133","SUP","HCPCS C1815","","72404133  -  IMPLANT UROLOGICAL 5.5CM CONTINENCE PUMP AMS 800 INHIBIZONE","BOTH IP/OP","$12,487.50 ","$9,240.75 ","$0.00 ","$12,487.50 ","$5,619.38 ","$0.00 ","$2,602.71 ","$0.00 ","$0.00 ","$0.00 ","$12,487.50 ","$0.00 ","$6,243.75 ","$9,890.10 ","$9,990.00 ","$0.00 ","$0.00 ","$0.00 ","$1,988.01 ","$0.00 "
"72404250","SUP","HCPCS C1813","","72404250  -  PROSTHESIS PENILE 12/12MM PRECONNECT PUMP PRECON MS","BOTH IP/OP","$19,557.50 ","$14,472.55 ","$0.00 ","$19,557.50 ","$8,800.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,557.50 ","$0.00 ","$9,778.75 ","$15,489.54 ","$15,646.00 ","$0.00 ","$0.00 ","$0.00 ","$3,113.55 ","$0.00 "
"72404256","SUP","HCPCS C1813","","72404256  -  PROSTHESIS PENL AMS 700 LGX MS PMP 15CM 3 PC INFL","BOTH IP/OP","$23,330.00 ","$17,264.20 ","$0.00 ","$23,330.00 ","$10,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,330.00 ","$0.00 ","$11,665.00 ","$18,477.36 ","$18,664.00 ","$0.00 ","$0.00 ","$0.00 ","$3,714.14 ","$0.00 "
"72404257","SUP","HCPCS C1813","","72404257  -  PROSTHESIS PENILE 18CM INFLATABLE AMS 700 MS PUMP INHIBIZONE","BOTH IP/OP","$21,352.50 ","$15,800.85 ","$0.00 ","$21,352.50 ","$9,608.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,352.50 ","$0.00 ","$10,676.25 ","$16,911.18 ","$17,082.00 ","$0.00 ","$0.00 ","$0.00 ","$3,399.32 ","$0.00 "
"72412006","SUP","HCPCS C1713","","72412006  -  SCREW BN T6 2.7MM 4.5MM 6MM STRL LCK SLFRET SCRDRVR ST FLT","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412007","SUP","HCPCS C1713","","72412007  -  SCREW BN T6 2MM 3.3MM 7MM STRL LCK SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412008","SUP","HCPCS C1713","","72412008  -  SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412009","SUP","HCPCS C1713","","72412009  -  SCREW BN T6 2MM 3.3MM 9MM STRL LCK SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412010","SUP","HCPCS C1713","","72412010  -  SCREW BN T6 2MM 3.3MM 10MM STRL EVOS MN LCK DRVR LNG BN SM","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412011","SUP","HCPCS C1713","","72412011  -  SCREW BN T6 2MM 3.3MM 11MM STRL LCK SLFRET SCRDRVR ST FLT HD","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412012","SUP","HCPCS C1713","","72412012  -  SCREW BN T6 2MM 3.3MM 12MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412013","SUP","HCPCS C1713","","72412013  -  SCREW BN T6 2MM 3.3MM 13MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412014","SUP","HCPCS C1713","","72412014  -  SCREW BN T6 2MM 3.3MM 14MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412015","SUP","HCPCS C1713","","72412015  -  SCREW BN T6 2MM 3.3MM 15MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412016","SUP","HCPCS C1713","","72412016  -  SCREW BN T6 2MM 3.3MM 16MM STRL EVOS MN LCK DRVR LNG BN SM","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412017","SUP","HCPCS C1713","","72412017  -  SCREW BN T6 2MM 3.3MM 17MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412018","SUP","HCPCS C1713","","72412018  -  SCREW BN T6 2MM 3.3MM 18MM STRL EVOS MN LCK DRVR LNG BN SM","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412019","SUP","HCPCS C1713","","72412019  -  SCREW BN T6 2MM 3.3MM 19MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412020","SUP","HCPCS C1713","","72412020  -  SCREW BN T6 2MM 3.3MM 20MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412021","SUP","HCPCS C1713","","72412021  -  SCREW BN T6 2MM 3.3MM 21MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412022","SUP","HCPCS C1713","","72412022  -  SCREW BN T6 2MM 3.3MM 22MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412023","SUP","HCPCS C1713","","72412023  -  SCREW BN T6 2MM 3.3MM 23MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412024","SUP","HCPCS C1713","","72412024  -  SCREW BN T6 2MM 3.3MM 24MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412026","SUP","HCPCS C1713","","72412026  -  SCREW BN T6 2MM 3.3MM 26MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412028","SUP","HCPCS C1713","","72412028  -  SCREW BN T6 2MM 3.3MM 28MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412030","SUP","HCPCS C1713","","72412030  -  SCREW BN T6 2MM 3.3MM 30MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412032","SUP","HCPCS C1713","","72412032  -  SCREW BN T6 2MM 3.3MM 32MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412034","SUP","HCPCS C1713","","72412034  -  SCREW BN T6 2MM 3.3MM 34MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412036","SUP","HCPCS C1713","","72412036  -  SCREW BN T6 2MM 3.3MM 36MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412038","SUP","HCPCS C1713","","72412038  -  SCREW BN T6 2MM 3.3MM 38MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412040","SUP","HCPCS C1713","","72412040  -  SCREW BN T6 2MM 3.3MM 40MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$246.13 ","$182.14 ","$0.00 ","$246.13 ","$110.76 ","$0.00 ","$51.30 ","$0.00 ","$0.00 ","$43.09 ","$246.13 ","$0.00 ","$123.06 ","$194.93 ","$196.90 ","$0.00 ","$38.52 ","$0.00 ","$39.18 ","$0.00 "
"72412406","SUP","HCPCS C1713","","72412406  -  SCREW BN T7 2.4MM 3.8MM 6MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412407","SUP","HCPCS C1713","","72412407  -  SCREW BN T7 2.4MM 3.8MM 7MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412408","SUP","HCPCS C1713","","72412408  -  SCREW BN T7 2.4MM 3.8MM 8MM STRL EVOS LCK SM BN LNG BN MN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412409","SUP","HCPCS C1713","","72412409  -  SCREW BN T7 2.4MM 3.8MM 9MM STRL EVOS MN LCK SS LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412410","SUP","HCPCS C1713","","72412410  -  SCREW BN T7 2.4MM 3.8MM 10MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412411","SUP","HCPCS C1713","","72412411  -  SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412412","SUP","HCPCS C1713","","72412412  -  SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412413","SUP","HCPCS C1713","","72412413  -  SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN LCK DRVR LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412414","SUP","HCPCS C1713","","72412414  -  SCREW BN T7 2.4MM 3.8MM 14MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412415","SUP","HCPCS C1713","","72412415  -  SCREW BN T7 2.4MM 3.8MM 15MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412416","SUP","HCPCS C1713","","72412416  -  SCREW BN T7 2.4MM 3.8MM 16MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412417","SUP","HCPCS C1713","","72412417  -  SCREW BN T7 2.4MM 3.8MM 17MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412418","SUP","HCPCS C1713","","72412418  -  SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN LCK DRVR LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412419","SUP","HCPCS C1713","","72412419  -  SCREW BN T7 2.4MM 3.8MM 19MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412420","SUP","HCPCS C1713","","72412420  -  SCREW BN T7 2.4MM 3.8MM 20MM STRL EVOS LCK SM BN LNG BN MN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412421","SUP","HCPCS C1713","","72412421  -  SCREW BN T7 2.4MM 3.8MM 21MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412422","SUP","HCPCS C1713","","72412422  -  SCREW BN T7 2.4MM 3.8MM 22MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412423","SUP","HCPCS C1713","","72412423  -  SCREW BN T7 2.4MM 3.8MM 23MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412424","SUP","HCPCS C1713","","72412424  -  SCREW BN T7 2.4MM 3.8MM 24MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412426","SUP","HCPCS C1713","","72412426  -  SCREW BN T7 2.4MM 3.8MM 26MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412428","SUP","HCPCS C1713","","72412428  -  SCREW BN T7 2.4MM 3.8MM 28MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412430","SUP","HCPCS C1713","","72412430  -  SCREW BN T7 2.4MM 3.8MM 30MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412432","SUP","HCPCS C1713","","72412432  -  SCREW BN T7 2.4MM 3.8MM 32MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412434","SUP","HCPCS C1713","","72412434  -  SCREW BN T7 2.4MM 3.8MM 34MM STRL EVOS MN LCK SS LNG BN SM","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412436","SUP","HCPCS C1713","","72412436  -  SCREW BN T7 2.4MM 3.8MM 36MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412438","SUP","HCPCS C1713","","72412438  -  SCREW BN T7 2.4MM 3.8MM 38MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412440","SUP","HCPCS C1713","","72412440  -  SCREW BN T7 2.4MM 3.8MM 40MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412442","SUP","HCPCS C1713","","72412442  -  SCREW BN T7 2.4MM 3.8MM 42MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412444","SUP","HCPCS C1713","","72412444  -  SCREW BN T7 2.4MM 3.8MM 44MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412446","SUP","HCPCS C1713","","72412446  -  SCREW BN T7 2.4MM 3.8MM 46MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412448","SUP","HCPCS C1713","","72412448  -  SCREW BN T7 2.4MM 3.8MM 48MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412450","SUP","HCPCS C1713","","72412450  -  SCREW BN T7 2.4MM 3.8MM 50MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412455","SUP","HCPCS C1713","","72412455  -  SCREW BN T7 2.4MM 3.8MM 55MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412460","SUP","HCPCS C1713","","72412460  -  SCREW BN T7 2.4MM 3.8MM 60MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$251.63 ","$186.21 ","$0.00 ","$251.63 ","$113.23 ","$0.00 ","$52.44 ","$0.00 ","$0.00 ","$44.06 ","$251.63 ","$0.00 ","$125.81 ","$199.29 ","$201.30 ","$0.00 ","$39.38 ","$0.00 ","$40.06 ","$0.00 "
"72412465","SUP","HCPCS C1713","","72412465  -  SCREW BN T7 2.4MM 3.8MM 65MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$279.13 ","$206.56 ","$0.00 ","$279.13 ","$125.61 ","$0.00 ","$58.18 ","$0.00 ","$0.00 ","$48.87 ","$279.13 ","$0.00 ","$139.56 ","$221.07 ","$223.30 ","$0.00 ","$43.68 ","$0.00 ","$44.44 ","$0.00 "
"72412470","SUP","HCPCS C1713","","72412470  -  SCREW BN T7 2.4MM 3.8MM 70MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$279.13 ","$206.56 ","$0.00 ","$279.13 ","$125.61 ","$0.00 ","$58.18 ","$0.00 ","$0.00 ","$48.87 ","$279.13 ","$0.00 ","$139.56 ","$221.07 ","$223.30 ","$0.00 ","$43.68 ","$0.00 ","$44.44 ","$0.00 "
"72412475","SUP","HCPCS C1713","","72412475  -  SCREW BN T7 2.4MM 3.8MM 75MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$279.13 ","$206.56 ","$0.00 ","$279.13 ","$125.61 ","$0.00 ","$58.18 ","$0.00 ","$0.00 ","$48.87 ","$279.13 ","$0.00 ","$139.56 ","$221.07 ","$223.30 ","$0.00 ","$43.68 ","$0.00 ","$44.44 ","$0.00 "
"72412480","SUP","HCPCS C1713","","72412480  -  SCREW BN T7 2.4MM 3.8MM 80MM STRL EVOS MN LCK LNG BN SM BN","BOTH IP/OP","$279.13 ","$206.56 ","$0.00 ","$279.13 ","$125.61 ","$0.00 ","$58.18 ","$0.00 ","$0.00 ","$48.87 ","$279.13 ","$0.00 ","$139.56 ","$221.07 ","$223.30 ","$0.00 ","$43.68 ","$0.00 ","$44.44 ","$0.00 "
"72412706","SUP","HCPCS C1713","","72412706  -  SCREW BN T8 2.7MM 4.5MM 6MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412707","SUP","HCPCS C1713","","72412707  -  SCREW BN T8 2.7MM 4.5MM 7MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412708","SUP","HCPCS C1713","","72412708  -  SCREW BN T8 2.7MM 4.3MM 8MM STRL EVOS LCK SM BN LNG BN MN","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412709","SUP","HCPCS C1713","","72412709  -  SCREW BN T8 2.7MM 4.5MM 9MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412710","SUP","HCPCS C1713","","72412710  -  SCREW BN T8 2.7MM 4.5MM 10MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412711","SUP","HCPCS C1713","","72412711  -  SCREW BN T8 2.7MM 4.5MM 11MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412712","SUP","HCPCS C1713","","72412712  -  SCREW BN T8 2.7MM 4.5MM 12MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412713","SUP","HCPCS C1713","","72412713  -  SCREW BN T8 2.7MM 4.5MM 13MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412714","SUP","HCPCS C1713","","72412714  -  SCREW BN T8 2MM 2.7MM 4.3MM 14MM ST LCK SM BN LNG BN EVOS","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412715","SUP","HCPCS C1713","","72412715  -  SCREW BN T8 2.7MM 4.5MM 15MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412716","SUP","HCPCS C1713","","72412716  -  SCREW BN T8 2MM 2.7MM 4.3MM 16MM ST LCK EVOS","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412717","SUP","HCPCS C1713","","72412717  -  SCREW BN T8 2.7MM 4.5MM 17MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412718","SUP","HCPCS C1713","","72412718  -  SCREW BN T8 2MM 2.7MM 4.3MM 18MM ST LCK SM BN LNG BN EVOS","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412719","SUP","HCPCS C1713","","72412719  -  SCREW BN T8 2.7MM 4.5MM 19MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412720","SUP","HCPCS C1713","","72412720  -  SCREW BN T8 2.7MM 4.5MM 20MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412721","SUP","HCPCS C1713","","72412721  -  SCREW BN T8 2.7MM 4.5MM 21MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412722","SUP","HCPCS C1713","","72412722  -  SCREW BN T8 2.7MM 4.5MM 22MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412723","SUP","HCPCS C1713","","72412723  -  SCREW BN T8 2.7MM 4.5MM 23MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412724","SUP","HCPCS C1713","","72412724  -  SCREW BN T8 2MM 2.7MM 4.3MM 24MM ST LCK EVOS","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412726","SUP","HCPCS C1713","","72412726  -  SCREW BN T8 2.7MM 4.3MM 26MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412728","SUP","HCPCS C1713","","72412728  -  SCREW BN T8 2.7MM 4.3MM 28MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412730","SUP","HCPCS C1713","","72412730  -  SCREW BN T8 2.7MM 4.3MM 30MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412732","SUP","HCPCS C1713","","72412732  -  SCREW BN T8 2.7MM 4.3MM 32MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412734","SUP","HCPCS C1713","","72412734  -  SCREW BN T8 2.7MM 4.3MM 34MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412736","SUP","HCPCS C1713","","72412736  -  SCREW BN T8 2.7MM 4.3MM 36MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412738","SUP","HCPCS C1713","","72412738  -  SCREW BN T8 2.7MM 4.3MM 38MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412740","SUP","HCPCS C1713","","72412740  -  SCREW BN T8 2.7MM 4.3MM 40MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412742","SUP","HCPCS C1713","","72412742  -  SCREW BN T8 2.7MM 4.3MM 42MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412744","SUP","HCPCS C1713","","72412744  -  SCREW BN T8 2.7MM 4.3MM 44MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412746","SUP","HCPCS C1713","","72412746  -  SCREW BN T8 2.7MM 4.3MM 46MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412748","SUP","HCPCS C1713","","72412748  -  SCREW BN T8 2.7MM 4.3MM 48MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412750","SUP","HCPCS C1713","","72412750  -  SCREW BN T8 2.7MM 4.3MM 50MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412755","SUP","HCPCS C1713","","72412755  -  SCREW BN T8 2.7MM 4.3MM 55MM LCK SLF RTN FLT HD SS LNG BN SM","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412760","SUP","HCPCS C1713","","72412760  -  SCREW BN T8 2.7MM 4.5MM 60MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$254.38 ","$188.24 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"72412765","SUP","HCPCS C1713","","72412765  -  SCREW BN T8 2.7MM 4.5MM 65MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$287.38 ","$212.66 ","$0.00 ","$287.38 ","$129.32 ","$0.00 ","$59.90 ","$0.00 ","$0.00 ","$50.32 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$44.97 ","$0.00 ","$45.75 ","$0.00 "
"72412770","SUP","HCPCS C1713","","72412770  -  SCREW BN T8 2.7MM 4.5MM 70MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$287.38 ","$212.66 ","$0.00 ","$287.38 ","$129.32 ","$0.00 ","$59.90 ","$0.00 ","$0.00 ","$50.32 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$44.97 ","$0.00 ","$45.75 ","$0.00 "
"72412775","SUP","HCPCS C1713","","72412775  -  SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$287.38 ","$212.66 ","$0.00 ","$287.38 ","$129.32 ","$0.00 ","$59.90 ","$0.00 ","$0.00 ","$50.32 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$44.97 ","$0.00 ","$45.75 ","$0.00 "
"72412780","SUP","HCPCS C1713","","72412780  -  SCREW BN T8 2.7MM 4.5MM 80MM STRL EVOS MN ST SS CORT","BOTH IP/OP","$287.38 ","$212.66 ","$0.00 ","$287.38 ","$129.32 ","$0.00 ","$59.90 ","$0.00 ","$0.00 ","$50.32 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$44.97 ","$0.00 ","$45.75 ","$0.00 "
"72413565","SUP","HCPCS C1713","","72413565  -  SCREW BN 3.5MM 65MM STRL EVOS ST LCK","BOTH IP/OP","$305.25 ","$225.89 ","$0.00 ","$305.25 ","$137.36 ","$0.00 ","$63.62 ","$0.00 ","$0.00 ","$53.45 ","$305.25 ","$0.00 ","$152.63 ","$241.76 ","$244.20 ","$0.00 ","$47.77 ","$0.00 ","$48.60 ","$0.00 "
"72413570","SUP","HCPCS C1713","","72413570  -  SCREW BN 3.5MM 70MM STRL EVOS ST LCK","BOTH IP/OP","$305.25 ","$225.89 ","$0.00 ","$305.25 ","$137.36 ","$0.00 ","$63.62 ","$0.00 ","$0.00 ","$53.45 ","$305.25 ","$0.00 ","$152.63 ","$241.76 ","$244.20 ","$0.00 ","$47.77 ","$0.00 ","$48.60 ","$0.00 "
"72423010","SUP","HCPCS C1713","","72423010  -  SCREW BN T7 3MM 3.8MM 10MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423012","SUP","HCPCS C1713","","72423012  -  SCREW BN T7 3MM 3.8MM 12MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423014","SUP","HCPCS C1713","","72423014  -  SCREW BN T7 3MM 3.8MM 14MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423016","SUP","HCPCS C1713","","72423016  -  SCREW BN T7 3MM 3.8MM 16MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423018","SUP","HCPCS C1713","","72423018  -  SCREW BN T7 3MM 3.8MM 18MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423020","SUP","HCPCS C1713","","72423020  -  SCREW BN T7 3MM 3.8MM 20MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423022","SUP","HCPCS C1713","","72423022  -  SCREW BN T7 3MM 3.8MM 22MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423024","SUP","HCPCS C1713","","72423024  -  SCREW BN T7 3MM 3.8MM 24MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423026","SUP","HCPCS C1713","","72423026  -  SCREW BN T7 3MM 3.8MM 26MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423028","SUP","HCPCS C1713","","72423028  -  SCREW BN T7 3MM 3.8MM 28MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423030","SUP","HCPCS C1713","","72423030  -  SCREW BN T7 3MM 3.8MM 30MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423032","SUP","HCPCS C1713","","72423032  -  SCREW BN T7 3MM 3.8MM 32MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423034","SUP","HCPCS C1713","","72423034  -  SCREW BN T7 3MM 3.8MM 34MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423036","SUP","HCPCS C1713","","72423036  -  SCREW BN T7 3MM 3.8MM 36MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423038","SUP","HCPCS C1713","","72423038  -  SCREW BN T7 3MM 3.8MM 38MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423040","SUP","HCPCS C1713","","72423040  -  SCREW BN T7 3MM 3.8MM 40MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423042","SUP","HCPCS C1713","","72423042  -  SCREW BN T7 3MM 3.8MM 42MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423044","SUP","HCPCS C1713","","72423044  -  SCREW BN T7 3MM 3.8MM 44MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423046","SUP","HCPCS C1713","","72423046  -  SCREW BN T7 3MM 3.8MM 46MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423048","SUP","HCPCS C1713","","72423048  -  SCREW BN T7 3MM 3.8MM 48MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423050","SUP","HCPCS C1713","","72423050  -  SCREW BN T7 3MM 3.8MM 50MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423055","SUP","HCPCS C1713","","72423055  -  SCREW BN T7 3MM 3.8MM 55MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423060","SUP","HCPCS C1713","","72423060  -  SCREW BN T7 3MM 3.8MM 60MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"72423065","SUP","HCPCS C1713","","72423065  -  SCREW BN T7 3MM 3.8MM 65MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72423070","SUP","HCPCS C1713","","72423070  -  SCREW BN T7 3MM 3.8MM 70MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72423075","SUP","HCPCS C1713","","72423075  -  SCREW BN T7 3MM 3.8MM 75MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72423080","SUP","HCPCS C1713","","72423080  -  SCREW BN T7 3MM 3.8MM 80MM STRL EVOS MN SS LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424010","SUP","HCPCS C1713","","72424010  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424012","SUP","HCPCS C1713","","72424012  -  SCREW BN T8 FT 4MM 4.5MM 12MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424014","SUP","HCPCS C1713","","72424014  -  SCREW BN T8 FT 4MM 4.5MM 14MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424016","SUP","HCPCS C1713","","72424016  -  SCREW BN T8 FT 4MM 4.5MM 16MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424018","SUP","HCPCS C1713","","72424018  -  SCREW BN T8 FT 4MM 4.5MM 18MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424020","SUP","HCPCS C1713","","72424020  -  SCREW BN T8 FT 4MM 4.5MM 20MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424022","SUP","HCPCS C1713","","72424022  -  SCREW BN T8 FT 4MM 4.5MM 22MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424024","SUP","HCPCS C1713","","72424024  -  SCREW BN T8 FT 4MM 4.5MM 24MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424026","SUP","HCPCS C1713","","72424026  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424028","SUP","HCPCS C1713","","72424028  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424030","SUP","HCPCS C1713","","72424030  -  SCREW BN T8 FT 4MM 4.5MM 30MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424032","SUP","HCPCS C1713","","72424032  -  SCREW BN FT T8 4MM 4.5MM 32MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424034","SUP","HCPCS C1713","","72424034  -  SCREW BN FT T8 4MM 4.5MM 34MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424036","SUP","HCPCS C1713","","72424036  -  SCREW BN FT T8 4MM 4.5MM 36MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424038","SUP","HCPCS C1713","","72424038  -  SCREW BN FT T8 4MM 4.5MM 38MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424040","SUP","HCPCS C1713","","72424040  -  SCREW BN FT T8 4MM 4.5MM 40MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424042","SUP","HCPCS C1713","","72424042  -  SCREW BN FT T8 4MM 4.5MM 42MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424044","SUP","HCPCS C1713","","72424044  -  SCREW BN FT T8 4MM 4.5MM 44MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424046","SUP","HCPCS C1713","","72424046  -  SCREW BN FT T8 4MM 4.5MM 46MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424048","SUP","HCPCS C1713","","72424048  -  SCREW BN FT T8 4MM 4.5MM 48MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424050","SUP","HCPCS C1713","","72424050  -  SCREW BN FT T8 4MM 4.5MM 50MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424055","SUP","HCPCS C1713","","72424055  -  SCREW BN FT T8 4MM 4.5MM 55MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424060","SUP","HCPCS C1713","","72424060  -  SCREW BN FT T8 4MM 4.5MM 60MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424065","SUP","HCPCS C1713","","72424065  -  SCREW BN FT T8 4MM 4.5MM 65MM STRL EVOS MN VA SLFRET SCRDRVR","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424070","SUP","HCPCS C1713","","72424070  -  SCREW BN FT T8 4MM 4.5MM 70MM STRL EVOS MN LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424075","SUP","HCPCS C1713","","72424075  -  SCREW BN FT T8 4MM 4.5MM 75MM STRL EVOS MN LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72424080","SUP","HCPCS C1713","","72424080  -  SCREW BN FT T8 4MM 4.5MM 80MM STRL EVOS MN LNG BN SM BN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434026","SUP","HCPCS C1713","","72434026  -  SCREW BN T8 P/T 4MM 4.5MM 26MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434028","SUP","HCPCS C1713","","72434028  -  SCREW BN T8 P/T 4MM 4.5MM 28MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434030","SUP","HCPCS C1713","","72434030  -  SCREW BN T8 P/T 4MM 4.5MM 30MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434032","SUP","HCPCS C1713","","72434032  -  SCREW BN T8 P/T 4MM 4.5MM 32MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434034","SUP","HCPCS C1713","","72434034  -  SCREW BN T8 P/T 4MM 4.5MM 34MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434036","SUP","HCPCS C1713","","72434036  -  SCREW BN T8 P/T 4MM 4.5MM 36MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434038","SUP","HCPCS C1713","","72434038  -  SCREW BN T8 P/T 4MM 4.5MM 38MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434040","SUP","HCPCS C1713","","72434040  -  SCREW BN T8 P/T 4MM 4.5MM 40MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434042","SUP","HCPCS C1713","","72434042  -  SCREW BN T8 P/T 4MM 4.5MM 42MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434044","SUP","HCPCS C1713","","72434044  -  SCREW BN T8 P/T 4MM 4.5MM 44MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434046","SUP","HCPCS C1713","","72434046  -  SCREW BN T8 P/T 4MM 4.5MM 46MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434048","SUP","HCPCS C1713","","72434048  -  SCREW BN T8 P/T 4MM 4.5MM 48MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434050","SUP","HCPCS C1713","","72434050  -  SCREW BN T8 P/T 4MM 4.5MM 50MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434055","SUP","HCPCS C1713","","72434055  -  SCREW BN T8 P/T 4MM 4.5MM 55MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434060","SUP","HCPCS C1713","","72434060  -  SCREW BN T8 P/T 4MM 4.5MM 60MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$84.77 ","$0.00 ","$39.26 ","$0.00 ","$0.00 ","$32.98 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$29.48 ","$0.00 ","$29.99 ","$0.00 "
"72434065","SUP","HCPCS C1713","","72434065  -  SCREW BN T8 P/T 4MM 4.5MM 65MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$44.42 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"72434070","SUP","HCPCS C1713","","72434070  -  SCREW BN T8 P/T 4MM 4.5MM 70MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$44.42 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"72434075","SUP","HCPCS C1713","","72434075  -  SCREW BN T8 P/T 4MM 4.5MM 75MM SLFRET SCRDRVR TAP EVOS MN","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$44.42 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"72434080","SUP","HCPCS C1713","","72434080  -  SCREW BN T8 P/T 4MM 4.5MM 80MM SLFRET SCRDRVR EVOS MN","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$44.42 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"72441010","SUP","HCPCS C1713","","72441010  -  PLATE BN 127MM STRL EVOS 10 HL CMPR 3.5MM SCR","BOTH IP/OP","$456.50 ","$337.81 ","$0.00 ","$456.50 ","$205.43 ","$0.00 ","$95.15 ","$0.00 ","$0.00 ","$79.93 ","$456.50 ","$0.00 ","$228.25 ","$361.55 ","$365.20 ","$0.00 ","$71.44 ","$0.00 ","$72.67 ","$0.00 "
"72442050","SUP","HCPCS C1713","","72442050  -  PLATE BN T 36MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,225.13 ","$906.60 ","$0.00 ","$1,225.13 ","$551.31 ","$0.00 ","$255.35 ","$0.00 ","$0.00 ","$214.51 ","$1,225.13 ","$0.00 ","$612.56 ","$970.30 ","$980.10 ","$0.00 ","$191.73 ","$0.00 ","$195.04 ","$0.00 "
"72442052","SUP","HCPCS C1713","","72442052  -  PLATE BN T 46MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,225.13 ","$906.60 ","$0.00 ","$1,225.13 ","$551.31 ","$0.00 ","$255.35 ","$0.00 ","$0.00 ","$214.51 ","$1,225.13 ","$0.00 ","$612.56 ","$970.30 ","$980.10 ","$0.00 ","$191.73 ","$0.00 ","$195.04 ","$0.00 "
"72442054","SUP","HCPCS C1713","","72442054  -  PLATE BN 5MM SPC T 31X5-15.3X1.2MM STRL 71MM EVOS MN 3","BOTH IP/OP","$1,225.13 ","$906.60 ","$0.00 ","$1,225.13 ","$551.31 ","$0.00 ","$255.35 ","$0.00 ","$0.00 ","$214.51 ","$1,225.13 ","$0.00 ","$612.56 ","$970.30 ","$980.10 ","$0.00 ","$191.73 ","$0.00 ","$195.04 ","$0.00 "
"72442056","SUP","HCPCS C1713","","72442056  -  PLATE BN T 51MM EVOS MN 2 HLE/HD 9 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,225.13 ","$906.60 ","$0.00 ","$1,225.13 ","$551.31 ","$0.00 ","$255.35 ","$0.00 ","$0.00 ","$214.51 ","$1,225.13 ","$0.00 ","$612.56 ","$970.30 ","$980.10 ","$0.00 ","$191.73 ","$0.00 ","$195.04 ","$0.00 "
"72442058","SUP","HCPCS C1713","","72442058  -  PLATE BN 21MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2MM","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442060","SUP","HCPCS C1713","","72442060  -  PLATE BN 5MM SPC 31X5X1.2MM STRL EVOS LOPRFL 6 HL VA FLX SS","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442062","SUP","HCPCS C1713","","72442062  -  PLATE BN 41MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2MM","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442064","SUP","HCPCS C1713","","72442064  -  PLATE BN 51MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN 2","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442066","SUP","HCPCS C1713","","72442066  -  PLATE BN 101MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN 2","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442068","SUP","HCPCS C1713","","72442068  -  PLATE BN 21MM EVOS MN 4 HL STRTH LOPRFL VA SS SM BN LNG BN 2","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442070","SUP","HCPCS C1713","","72442070  -  PLATE BN 31MM EVOS MN 6 HL STRTH LOPRFL VA SS SM BN LNG BN 2","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442072","SUP","HCPCS C1713","","72442072  -  PLATE BN 41MM EVOS MN 8 HL STRTH LOPRFL VA SS SM BN LNG BN 2","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442074","SUP","HCPCS C1713","","72442074  -  PLATE BN 51MM EVOS MN 10 HL STRTH LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442076","SUP","HCPCS C1713","","72442076  -  PLATE BN 101MM EVOS MN 20 HL STRTH LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,266.38 ","$937.12 ","$0.00 ","$1,266.38 ","$569.87 ","$0.00 ","$263.94 ","$0.00 ","$0.00 ","$221.73 ","$1,266.38 ","$0.00 ","$633.19 ","$1,002.97 ","$1,013.10 ","$0.00 ","$198.19 ","$0.00 ","$201.61 ","$0.00 "
"72442078","SUP","HCPCS C1713","","72442078  -  PLATE BN STRG 28MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,512.50 ","$1,119.25 ","$0.00 ","$1,512.50 ","$680.63 ","$0.00 ","$315.24 ","$0.00 ","$0.00 ","$264.83 ","$1,512.50 ","$0.00 ","$756.25 ","$1,197.90 ","$1,210.00 ","$0.00 ","$236.71 ","$0.00 ","$240.79 ","$0.00 "
"72442080","SUP","HCPCS C1713","","72442080  -  PLATE BN STRG 38MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,512.50 ","$1,119.25 ","$0.00 ","$1,512.50 ","$680.63 ","$0.00 ","$315.24 ","$0.00 ","$0.00 ","$264.83 ","$1,512.50 ","$0.00 ","$756.25 ","$1,197.90 ","$1,210.00 ","$0.00 ","$236.71 ","$0.00 ","$240.79 ","$0.00 "
"72442120","SUP","HCPCS C1713","","72442120  -  WASHER ORTH 5MM EVOS 2MM SCR MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72442124","SUP","HCPCS C1713","","72442124  -  WASHER ORTH 6MM EVOS 2.4MM SCR MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72442127","SUP","HCPCS C1713","","72442127  -  WASHER ORTH 7MM EVOS 2.7MM SCR MN PLT SYS","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$33.08 ","$0.00 ","$15.32 ","$0.00 ","$0.00 ","$12.87 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$11.50 ","$0.00 ","$11.70 ","$0.00 "
"72442135","SUP","HCPCS C1713","","72442135  -  WASHER ORTH STRL EVOS 3.5 MM SCR","BOTH IP/OP","$83.60 ","$61.86 ","$0.00 ","$83.60 ","$37.62 ","$0.00 ","$17.42 ","$0.00 ","$0.00 ","$14.64 ","$83.60 ","$0.00 ","$41.80 ","$66.21 ","$66.88 ","$0.00 ","$13.08 ","$0.00 ","$13.31 ","$0.00 "
"72442220","SUP","HCPCS C1713","","72442220  -  WASHER ORTH 10MM EVOS 2 2.4MM SCR MN PLT SYS","BOTH IP/OP","$147.13 ","$108.88 ","$0.00 ","$147.13 ","$66.21 ","$0.00 ","$30.66 ","$0.00 ","$0.00 ","$25.76 ","$147.13 ","$0.00 ","$73.56 ","$116.53 ","$117.70 ","$0.00 ","$23.03 ","$0.00 ","$23.42 ","$0.00 "
"72442224","SUP","HCPCS C1713","","72442224  -  WASHER ORTH 11MM EVOS 2 2.4MM SCR MN PLT SYS","BOTH IP/OP","$147.13 ","$108.88 ","$0.00 ","$147.13 ","$66.21 ","$0.00 ","$30.66 ","$0.00 ","$0.00 ","$25.76 ","$147.13 ","$0.00 ","$73.56 ","$116.53 ","$117.70 ","$0.00 ","$23.03 ","$0.00 ","$23.42 ","$0.00 "
"72442227","SUP","HCPCS C1713","","72442227  -  WASHER ORTH 13MM EVOS 2 2.7MM SCR MN PLT SYS","BOTH IP/OP","$147.13 ","$108.88 ","$0.00 ","$147.13 ","$66.21 ","$0.00 ","$30.66 ","$0.00 ","$0.00 ","$25.76 ","$147.13 ","$0.00 ","$73.56 ","$116.53 ","$117.70 ","$0.00 ","$23.03 ","$0.00 ","$23.42 ","$0.00 "
"72442450","SUP","HCPCS C1713","","72442450  -  PLATE BN T 43MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,553.75 ","$1,149.78 ","$0.00 ","$1,553.75 ","$699.19 ","$0.00 ","$323.84 ","$0.00 ","$0.00 ","$272.05 ","$1,553.75 ","$0.00 ","$776.88 ","$1,230.57 ","$1,243.00 ","$0.00 ","$243.16 ","$0.00 ","$247.36 ","$0.00 "
"72442452","SUP","HCPCS C1713","","72442452  -  PLATE BN T 55MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,553.75 ","$1,149.78 ","$0.00 ","$1,553.75 ","$699.19 ","$0.00 ","$323.84 ","$0.00 ","$0.00 ","$272.05 ","$1,553.75 ","$0.00 ","$776.88 ","$1,230.57 ","$1,243.00 ","$0.00 ","$243.16 ","$0.00 ","$247.36 ","$0.00 "
"72442454","SUP","HCPCS C1713","","72442454  -  PLATE BN T 37MM EVOS MN 3 HLE/HD 5 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,553.75 ","$1,149.78 ","$0.00 ","$1,553.75 ","$699.19 ","$0.00 ","$323.84 ","$0.00 ","$0.00 ","$272.05 ","$1,553.75 ","$0.00 ","$776.88 ","$1,230.57 ","$1,243.00 ","$0.00 ","$243.16 ","$0.00 ","$247.36 ","$0.00 "
"72442456","SUP","HCPCS C1713","","72442456  -  PLATE BN T 61MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,553.75 ","$1,149.78 ","$0.00 ","$1,553.75 ","$699.19 ","$0.00 ","$323.84 ","$0.00 ","$0.00 ","$272.05 ","$1,553.75 ","$0.00 ","$776.88 ","$1,230.57 ","$1,243.00 ","$0.00 ","$243.16 ","$0.00 ","$247.36 ","$0.00 "
"72442458","SUP","HCPCS C1713","","72442458  -  PLATE BN 25MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.4","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442460","SUP","HCPCS C1713","","72442460  -  PLATE BN 37X6X1.4MM EVOS MN 6 HL FLX LOPRFL VA SS LG BN SM","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442462","SUP","HCPCS C1713","","72442462  -  PLATE BN 49MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.4","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442464","SUP","HCPCS C1713","","72442464  -  PLATE BN 61MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442466","SUP","HCPCS C1713","","72442466  -  PLATE BN 121MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442468","SUP","HCPCS C1713","","72442468  -  PLATE BN 25MM STRL EVOS MN 4 HL LOPRFL VA LCK SS 2.4MM SCR","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442470","SUP","HCPCS C1713","","72442470  -  PLATE BN 37MM EVOS MN 6 HL STRTH LOPRFL SS","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442472","SUP","HCPCS C1713","","72442472  -  PLATE BN 49MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442474","SUP","HCPCS C1713","","72442474  -  PLATE BN 61MM EVOS MN 10 HL STRENGHT LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442476","SUP","HCPCS C1713","","72442476  -  PLATE BN 121MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,595.00 ","$1,180.30 ","$0.00 ","$1,595.00 ","$717.75 ","$0.00 ","$332.44 ","$0.00 ","$0.00 ","$279.27 ","$1,595.00 ","$0.00 ","$797.50 ","$1,263.24 ","$1,276.00 ","$0.00 ","$249.62 ","$0.00 ","$253.92 ","$0.00 "
"72442478","SUP","HCPCS C1713","","72442478  -  PLATE BN STRG 34MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,677.50 ","$1,241.35 ","$0.00 ","$1,677.50 ","$754.88 ","$0.00 ","$349.63 ","$0.00 ","$0.00 ","$293.72 ","$1,677.50 ","$0.00 ","$838.75 ","$1,328.58 ","$1,342.00 ","$0.00 ","$262.53 ","$0.00 ","$267.06 ","$0.00 "
"72442482","SUP","HCPCS C1713","","72442482  -  PLATE BN 47MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.4MM","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442484","SUP","HCPCS C1713","","72442484  -  PLATE BN 59MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.4MM","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442486","SUP","HCPCS C1713","","72442486  -  PLATE BN Y 45MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,966.25 ","$1,455.03 ","$0.00 ","$1,966.25 ","$884.81 ","$0.00 ","$409.82 ","$0.00 ","$0.00 ","$344.27 ","$1,966.25 ","$0.00 ","$983.13 ","$1,557.27 ","$1,573.00 ","$0.00 ","$307.72 ","$0.00 ","$313.03 ","$0.00 "
"72442488","SUP","HCPCS C1713","","72442488  -  PLATE BN Y 57MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,966.25 ","$1,455.03 ","$0.00 ","$1,966.25 ","$884.81 ","$0.00 ","$409.82 ","$0.00 ","$0.00 ","$344.27 ","$1,966.25 ","$0.00 ","$983.13 ","$1,557.27 ","$1,573.00 ","$0.00 ","$307.72 ","$0.00 ","$313.03 ","$0.00 "
"72442490","SUP","HCPCS C1713","","72442490  -  PLATE BN 3ANG 55MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442492","SUP","HCPCS C1713","","72442492  -  PLATE BN 3ANG 67MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442494","SUP","HCPCS C1713","","72442494  -  PLATE BN TRPZD 24X18X1.4MM EVOS LOPRFL VA 5 HL SS 2.4MM SCR","BOTH IP/OP","$2,000.63 ","$1,480.47 ","$0.00 ","$2,000.63 ","$900.28 ","$0.00 ","$416.98 ","$0.00 ","$0.00 ","$350.29 ","$2,000.63 ","$0.00 ","$1,000.31 ","$1,584.50 ","$1,600.50 ","$0.00 ","$313.10 ","$0.00 ","$318.50 ","$0.00 "
"72442720","SUP","HCPCS C1713","","72442720  -  PLATE BN T 42X7.5-21.5X1.4MM STRL EVOS MN 3 HLE/HD 5 HL SHFT","BOTH IP/OP","$1,718.75 ","$1,271.88 ","$0.00 ","$1,718.75 ","$773.44 ","$0.00 ","$358.23 ","$0.00 ","$0.00 ","$300.94 ","$1,718.75 ","$0.00 ","$859.38 ","$1,361.25 ","$1,375.00 ","$0.00 ","$268.98 ","$0.00 ","$273.63 ","$0.00 "
"72442722","SUP","HCPCS C1713","","72442722  -  PLATE BN T 71MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM","BOTH IP/OP","$1,718.75 ","$1,271.88 ","$0.00 ","$1,718.75 ","$773.44 ","$0.00 ","$358.23 ","$0.00 ","$0.00 ","$300.94 ","$1,718.75 ","$0.00 ","$859.38 ","$1,361.25 ","$1,375.00 ","$0.00 ","$268.98 ","$0.00 ","$273.63 ","$0.00 "
"72442724","SUP","HCPCS C1713","","72442724  -  PLATE BN 28MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442726","SUP","HCPCS C1713","","72442726  -  PLATE BN 42MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442728","SUP","HCPCS C1713","","72442728  -  PLATE BN 56MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.7","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442760","SUP","HCPCS C1713","","72442760  -  PLATE BN 70MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442762","SUP","HCPCS C1713","","72442762  -  PLATE BN 140MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442764","SUP","HCPCS C1713","","72442764  -  PLATE BN 28MM EVOS MN 4 HL STRENGHT LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442766","SUP","HCPCS C1713","","72442766  -  PLATE BN 7MM SPC 42X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442768","SUP","HCPCS C1713","","72442768  -  PLATE BN 7MM SPC 56X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442770","SUP","HCPCS C1713","","72442770  -  PLATE BN 7MM SPC 70X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442772","SUP","HCPCS C1713","","72442772  -  PLATE BN 140MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,753.13 ","$1,297.32 ","$0.00 ","$1,753.13 ","$788.91 ","$0.00 ","$365.40 ","$0.00 ","$0.00 ","$306.96 ","$1,753.13 ","$0.00 ","$876.56 ","$1,388.48 ","$1,402.50 ","$0.00 ","$274.36 ","$0.00 ","$279.10 ","$0.00 "
"72442774","SUP","HCPCS C1713","","72442774  -  PLATE BN STRG 38MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,842.50 ","$1,363.45 ","$0.00 ","$1,842.50 ","$829.13 ","$0.00 ","$384.02 ","$0.00 ","$0.00 ","$322.61 ","$1,842.50 ","$0.00 ","$921.25 ","$1,459.26 ","$1,474.00 ","$0.00 ","$288.35 ","$0.00 ","$293.33 ","$0.00 "
"72442776","SUP","HCPCS C1713","","72442776  -  PLATE BN STRG 52MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG","BOTH IP/OP","$1,842.50 ","$1,363.45 ","$0.00 ","$1,842.50 ","$829.13 ","$0.00 ","$384.02 ","$0.00 ","$0.00 ","$322.61 ","$1,842.50 ","$0.00 ","$921.25 ","$1,459.26 ","$1,474.00 ","$0.00 ","$288.35 ","$0.00 ","$293.33 ","$0.00 "
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"72823128","SUP","HCPCS C1713","","72823128  -  SCREW BN 2.7MM 28MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT","BOTH IP/OP","$286.25 ","$211.83 ","$0.00 ","$286.25 ","$128.81 ","$0.00 ","$59.66 ","$0.00 ","$0.00 ","$50.12 ","$286.25 ","$0.00 ","$143.13 ","$226.71 ","$229.00 ","$0.00 ","$44.80 ","$0.00 ","$45.57 ","$0.00 "
"72823130","SUP","HCPCS C1713","","72823130  -  SCREW BN 2.7MM 30MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT","BOTH IP/OP","$286.25 ","$211.83 ","$0.00 ","$286.25 ","$128.81 ","$0.00 ","$59.66 ","$0.00 ","$0.00 ","$50.12 ","$286.25 ","$0.00 ","$143.13 ","$226.71 ","$229.00 ","$0.00 ","$44.80 ","$0.00 ","$45.57 ","$0.00 "
"72823132","SUP","HCPCS C1713","","72823132  -  SCREW BN 2.7MM 32MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT","BOTH IP/OP","$286.25 ","$211.83 ","$0.00 ","$286.25 ","$128.81 ","$0.00 ","$59.66 ","$0.00 ","$0.00 ","$50.12 ","$286.25 ","$0.00 ","$143.13 ","$226.71 ","$229.00 ","$0.00 ","$44.80 ","$0.00 ","$45.57 ","$0.00 "
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"72823138","SUP","HCPCS C1713","","72823138  -  SCREW BN 2.7MM 38MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT","BOTH IP/OP","$286.25 ","$211.83 ","$0.00 ","$286.25 ","$128.81 ","$0.00 ","$59.66 ","$0.00 ","$0.00 ","$50.12 ","$286.25 ","$0.00 ","$143.13 ","$226.71 ","$229.00 ","$0.00 ","$44.80 ","$0.00 ","$45.57 ","$0.00 "
"72823140","SUP","HCPCS C1713","","72823140  -  SCREW BN 2.7MM 40MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT","BOTH IP/OP","$286.25 ","$211.83 ","$0.00 ","$286.25 ","$128.81 ","$0.00 ","$59.66 ","$0.00 ","$0.00 ","$50.12 ","$286.25 ","$0.00 ","$143.13 ","$226.71 ","$229.00 ","$0.00 ","$44.80 ","$0.00 ","$45.57 ","$0.00 "
"72823210","SUP","HCPCS C1713","","72823210  -  SCREW BN FT 4MM 10MM PRLC VLP OSTEOPENIA CORT","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"72823212","SUP","HCPCS C1713","","72823212  -  SCREW BN FT 4MM 12MM PRLC VLP SS FOREFOOT MIDFOOT CORT","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"72823214","SUP","HCPCS C1713","","72823214  -  SCREW BN FT 4MM 14MM PRLC VLP OSTEOPENIA CORT FT","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"72823216","SUP","HCPCS C1713","","72823216  -  SCREW BN FT 4MM 16MM PRLC VLP OSTEOPENIA CORT","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
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"72823222","SUP","HCPCS C1713","","72823222  -  SCREW BN 4MM 22MM PRLC VLP FT OSTEOPENIA","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
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"72823234","SUP","HCPCS C1713","","72823234  -  SCREW BONE 4MM 34MM FULTHRD OSTEOPENIA PERI-LOC VLP","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
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"72823514","SUP","HCPCS C1713","","72823514  -  SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823516","SUP","HCPCS C1713","","72823516  -  SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823518","SUP","HCPCS C1713","","72823518  -  SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823520","SUP","HCPCS C1713","","72823520  -  SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823522","SUP","HCPCS C1713","","72823522  -  SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823524","SUP","HCPCS C1713","","72823524  -  SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823526","SUP","HCPCS C1713","","72823526  -  SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
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"72823532","SUP","HCPCS C1713","","72823532  -  SCREW BN 15D 2.5MM 5MM 5.4MM 32MM VLP LCK LOPRFL HD HEX RCS","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823534","SUP","HCPCS C1713","","72823534  -  SCREW BN 15D 2.5MM 5MM 5.4MM 34MM VLP LCK LOPRFL HD HEX RCS","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
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"72823544","SUP","HCPCS C1713","","72823544  -  SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823546","SUP","HCPCS C1713","","72823546  -  SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823548","SUP","HCPCS C1713","","72823548  -  SCREW BN 15D 2.5MM 5MM 5.4MM 48MM VLP LCK LOPRFL HD HEX RCS","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
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"72823555","SUP","HCPCS C1713","","72823555  -  SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823560","SUP","HCPCS C1713","","72823560  -  SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM VLP LCK LOPRFL HD","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"73804026","SUP","HCPCS C1713","","73804026  -  SCREW BN T20 3.5MM 26MM PRLC ST STRDR CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804028","SUP","HCPCS C1713","","73804028  -  SCREW BN 3.5MM 28MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804030","SUP","HCPCS C1713","","73804030  -  SCREW BN 3.5MM 30MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804032","SUP","HCPCS C1713","","73804032  -  SCREW BN 3.5MM 32MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804034","SUP","HCPCS C1713","","73804034  -  SCREW BN T20 3.5MM 34MM PRLC ST STRDR CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804038","SUP","HCPCS C1713","","73804038  -  SCREW BN 3.5MM 38MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804040","SUP","HCPCS C1713","","73804040  -  SCREW BN 3.5MM 40MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804044","SUP","HCPCS C1713","","73804044  -  SCREW BN 3.5MM 44MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73804050","SUP","HCPCS C1713","","73804050  -  SCREW BN 3.5MM 50MM PRLC ST T20 STRDR RCS CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73805026","SUP","HCPCS C1713","","73805026  -  SCREW BN T20 3.5MM 26MM PRLC ST LCK","BOTH IP/OP","$254.10 ","$188.03 ","$0.00 ","$254.10 ","$114.35 ","$0.00 ","$52.96 ","$0.00 ","$0.00 ","$44.49 ","$254.10 ","$0.00 ","$127.05 ","$201.25 ","$203.28 ","$0.00 ","$39.77 ","$0.00 ","$40.45 ","$0.00 "
"73805030","SUP","HCPCS C1713","","73805030  -  SCREW BN 3.5MM 30MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN","BOTH IP/OP","$254.10 ","$188.03 ","$0.00 ","$254.10 ","$114.35 ","$0.00 ","$52.96 ","$0.00 ","$0.00 ","$44.49 ","$254.10 ","$0.00 ","$127.05 ","$201.25 ","$203.28 ","$0.00 ","$39.77 ","$0.00 ","$40.45 ","$0.00 "
"73805065","SUP","HCPCS C1713","","73805065  -  SCREW BN 3.5MM 65MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN","BOTH IP/OP","$292.95 ","$216.78 ","$0.00 ","$292.95 ","$131.83 ","$0.00 ","$61.06 ","$0.00 ","$0.00 ","$51.29 ","$292.95 ","$0.00 ","$146.48 ","$232.02 ","$234.36 ","$0.00 ","$45.85 ","$0.00 ","$46.64 ","$0.00 "
"73805070","SUP","HCPCS C1713","","73805070  -  SCREW BN 3.5MM 70MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN","BOTH IP/OP","$292.95 ","$216.78 ","$0.00 ","$292.95 ","$131.83 ","$0.00 ","$61.06 ","$0.00 ","$0.00 ","$51.29 ","$292.95 ","$0.00 ","$146.48 ","$232.02 ","$234.36 ","$0.00 ","$45.85 ","$0.00 ","$46.64 ","$0.00 "
"73805075","SUP","HCPCS C1713","","73805075  -  SCREW BN 3.5MM 75MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN","BOTH IP/OP","$292.95 ","$216.78 ","$0.00 ","$292.95 ","$131.83 ","$0.00 ","$61.06 ","$0.00 ","$0.00 ","$51.29 ","$292.95 ","$0.00 ","$146.48 ","$232.02 ","$234.36 ","$0.00 ","$45.85 ","$0.00 ","$46.64 ","$0.00 "
"73805080","SUP","HCPCS C1713","","73805080  -  SCREW BN 3.5MM 80MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN","BOTH IP/OP","$292.95 ","$216.78 ","$0.00 ","$292.95 ","$131.83 ","$0.00 ","$61.06 ","$0.00 ","$0.00 ","$51.29 ","$292.95 ","$0.00 ","$146.48 ","$232.02 ","$234.36 ","$0.00 ","$45.85 ","$0.00 ","$46.64 ","$0.00 "
"73805230","SUP","HCPCS C1713","","73805230  -  SCREW BN FT 4MM 30MM PRLC T20 STRDR RCS CANC","BOTH IP/OP","$64.43 ","$47.68 ","$0.00 ","$64.43 ","$28.99 ","$0.00 ","$13.43 ","$0.00 ","$0.00 ","$11.28 ","$64.43 ","$0.00 ","$32.21 ","$51.03 ","$51.54 ","$0.00 ","$10.08 ","$0.00 ","$10.26 ","$0.00 "
"73806024","SUP","HCPCS C1713","","73806024  -  SCREW BN 4.5MM 24MM PRLC ST T25 STRDR RCS FT/ANKL CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73806026","SUP","HCPCS C1713","","73806026  -  SCREW BN 4.5MM 26MM PRLC ST T25 STRDR RCS FT/ANKL CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73806028","SUP","HCPCS C1713","","73806028  -  SCREW BN 4.5MM 28MM PRLC ST T25 STRDR RCS FT/ANKL CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73806030","SUP","HCPCS C1713","","73806030  -  SCREW BN 4.5MM 30MM PRLC ST T25 STRDR RCS FT/ANKL CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73806034","SUP","HCPCS C1713","","73806034  -  SCREW BN 4.5MM 34MM PRLC ST T25 STRDR RCS FT/ANKL CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73806040","SUP","HCPCS C1713","","73806040  -  SCREW BN 4.5MM 40MM PRLC ST T25 STRDR RCS FT/ANKL CORT","BOTH IP/OP","$48.83 ","$36.13 ","$0.00 ","$48.83 ","$21.97 ","$0.00 ","$10.18 ","$0.00 ","$0.00 ","$8.55 ","$48.83 ","$0.00 ","$24.41 ","$38.67 ","$39.06 ","$0.00 ","$7.64 ","$0.00 ","$7.77 ","$0.00 "
"73807060","SUP","HCPCS C1713","","73807060  -  SCREW BN 4.5MM 60MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$298.20 ","$220.67 ","$0.00 ","$298.20 ","$134.19 ","$0.00 ","$62.15 ","$0.00 ","$0.00 ","$52.21 ","$298.20 ","$0.00 ","$149.10 ","$236.17 ","$238.56 ","$0.00 ","$46.67 ","$0.00 ","$47.47 ","$0.00 "
"73807066","SUP","HCPCS C1713","","73807066  -  SCREW BN 4.5MM 66MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$298.20 ","$220.67 ","$0.00 ","$298.20 ","$134.19 ","$0.00 ","$62.15 ","$0.00 ","$0.00 ","$52.21 ","$298.20 ","$0.00 ","$149.10 ","$236.17 ","$238.56 ","$0.00 ","$46.67 ","$0.00 ","$47.47 ","$0.00 "
"73807070","SUP","HCPCS C1713","","73807070  -  SCREW BN 4.5MM 70MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$298.20 ","$220.67 ","$0.00 ","$298.20 ","$134.19 ","$0.00 ","$62.15 ","$0.00 ","$0.00 ","$52.21 ","$298.20 ","$0.00 ","$149.10 ","$236.17 ","$238.56 ","$0.00 ","$46.67 ","$0.00 ","$47.47 ","$0.00 "
"73807074","SUP","HCPCS C1713","","73807074  -  SCREW BN 4.5MM 74MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$298.20 ","$220.67 ","$0.00 ","$298.20 ","$134.19 ","$0.00 ","$62.15 ","$0.00 ","$0.00 ","$52.21 ","$298.20 ","$0.00 ","$149.10 ","$236.17 ","$238.56 ","$0.00 ","$46.67 ","$0.00 ","$47.47 ","$0.00 "
"73807076","SUP","HCPCS C1713","","73807076  -  SCREW BN 4.5MM 76MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$298.20 ","$220.67 ","$0.00 ","$298.20 ","$134.19 ","$0.00 ","$62.15 ","$0.00 ","$0.00 ","$52.21 ","$298.20 ","$0.00 ","$149.10 ","$236.17 ","$238.56 ","$0.00 ","$46.67 ","$0.00 ","$47.47 ","$0.00 "
"73807085","SUP","HCPCS C1713","","73807085  -  SCREW BN 4.5MM 85MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$298.20 ","$220.67 ","$0.00 ","$298.20 ","$134.19 ","$0.00 ","$62.15 ","$0.00 ","$0.00 ","$52.21 ","$298.20 ","$0.00 ","$149.10 ","$236.17 ","$238.56 ","$0.00 ","$46.67 ","$0.00 ","$47.47 ","$0.00 "
"73807090","SUP","HCPCS C1713","","73807090  -  SCREW BN 4.5MM 90MM PRLC ST LCK T25 STRDR RCS ANKL/FT","BOTH IP/OP","$309.75 ","$229.22 ","$0.00 ","$309.75 ","$139.39 ","$0.00 ","$64.56 ","$0.00 ","$0.00 ","$54.23 ","$309.75 ","$0.00 ","$154.88 ","$245.32 ","$247.80 ","$0.00 ","$48.48 ","$0.00 ","$49.31 ","$0.00 "
"74132105","SUP","HCPCS C1713","","74132105  -  SCREW BN 6.5MM 105MM 22MM CNN CNCL P/T SS","BOTH IP/OP","$481.50 ","$356.31 ","$0.00 ","$481.50 ","$216.68 ","$0.00 ","$100.36 ","$0.00 ","$0.00 ","$84.31 ","$481.50 ","$0.00 ","$240.75 ","$381.35 ","$385.20 ","$0.00 ","$75.35 ","$0.00 ","$76.65 ","$0.00 "
"74133070","SUP","HCPCS C1713","","74133070  -  SCREW BN FT 6.5MM 70MM CNN LCK SS","BOTH IP/OP","$554.63 ","$410.43 ","$0.00 ","$554.63 ","$249.58 ","$0.00 ","$115.60 ","$0.00 ","$0.00 ","$97.11 ","$554.63 ","$0.00 ","$277.31 ","$439.27 ","$443.70 ","$0.00 ","$86.80 ","$0.00 ","$88.30 ","$0.00 "
"74133075","SUP","HCPCS C1713","","74133075  -  SCREW BN FT 6.5MM 75MM CNN LCK SS","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$684.00 ","$307.80 ","$0.00 ","$142.56 ","$0.00 ","$0.00 ","$119.76 ","$684.00 ","$0.00 ","$342.00 ","$541.73 ","$547.20 ","$0.00 ","$107.05 ","$0.00 ","$108.89 ","$0.00 "
"74133080","SUP","HCPCS C1713","","74133080  -  SCREW BN FT 6.5MM 80MM CNN LCK SS","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$684.00 ","$307.80 ","$0.00 ","$142.56 ","$0.00 ","$0.00 ","$119.76 ","$684.00 ","$0.00 ","$342.00 ","$541.73 ","$547.20 ","$0.00 ","$107.05 ","$0.00 ","$108.89 ","$0.00 "
"74133085","SUP","HCPCS C1713","","74133085  -  SCREW BN FT 6.5MM 85MM CNN LCK SS","BOTH IP/OP","$684.00 ","$506.16 ","$0.00 ","$684.00 ","$307.80 ","$0.00 ","$142.56 ","$0.00 ","$0.00 ","$119.76 ","$684.00 ","$0.00 ","$342.00 ","$541.73 ","$547.20 ","$0.00 ","$107.05 ","$0.00 ","$108.89 ","$0.00 "
"74133411","SUP","HCPCS C1713","","74133411  -  PIN FX SHRT 4.5MM 80MM PRLC TRL","BOTH IP/OP","$480.00 ","$355.20 ","$0.00 ","$480.00 ","$216.00 ","$0.00 ","$100.04 ","$0.00 ","$0.00 ","$84.04 ","$480.00 ","$0.00 ","$240.00 ","$380.16 ","$384.00 ","$0.00 ","$75.12 ","$0.00 ","$76.42 ","$0.00 "
"74133412","SUP","HCPCS C1713","","74133412  -  PIN FX 3.5MM 18MM PRLC","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$520.00 ","$234.00 ","$0.00 ","$108.38 ","$0.00 ","$0.00 ","$91.05 ","$520.00 ","$0.00 ","$260.00 ","$411.84 ","$416.00 ","$0.00 ","$81.38 ","$0.00 ","$82.78 ","$0.00 "
"74133413","SUP","HCPCS C1713","","74133413  -  PIN FX SHRT 3.5MM 18MM PRLC PRV FX","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$520.00 ","$234.00 ","$0.00 ","$108.38 ","$0.00 ","$0.00 ","$91.05 ","$520.00 ","$0.00 ","$260.00 ","$411.84 ","$416.00 ","$0.00 ","$81.38 ","$0.00 ","$82.78 ","$0.00 "
"74133420","SUP","Custom 27203010","","74133420  -  BIT DRL 2.7MM 358MM TARGETER","BOTH IP/OP","$1,102.00 ","$815.48 ","$0.00 ","$1,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,102.00 ","$0.00 ","$551.00 ","$872.78 ","$881.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74133421","SUP","HCPCS C1713","","74133421  -  PIN FX SHRT 4.5MM 80MM PRLC TARGETER DRL TIP PRV FX","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$520.00 ","$234.00 ","$0.00 ","$108.38 ","$0.00 ","$0.00 ","$91.05 ","$520.00 ","$0.00 ","$260.00 ","$411.84 ","$416.00 ","$0.00 ","$81.38 ","$0.00 ","$82.78 ","$0.00 "
"74133424","SUP","HCPCS C1713","","74133424  -  PLATE BN TLL PRLC CBL SDL","BOTH IP/OP","$363.38 ","$268.90 ","$0.00 ","$363.38 ","$163.52 ","$0.00 ","$75.74 ","$0.00 ","$0.00 ","$63.62 ","$363.38 ","$0.00 ","$181.69 ","$287.80 ","$290.70 ","$0.00 ","$56.87 ","$0.00 ","$57.85 ","$0.00 "
"74133425","SUP","HCPCS C1713","","74133425  -  SCREW BN PRLC HL FIL","BOTH IP/OP","$492.00 ","$364.08 ","$0.00 ","$492.00 ","$221.40 ","$0.00 ","$102.55 ","$0.00 ","$0.00 ","$86.15 ","$492.00 ","$0.00 ","$246.00 ","$389.66 ","$393.60 ","$0.00 ","$77.00 ","$0.00 ","$78.33 ","$0.00 "
"74402001","SUP","HCPCS C1713","","74402001  -  WASHER ORTH VLP 2 MM SCR","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$65.70 ","$0.00 ","$30.43 ","$0.00 ","$0.00 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.85 ","$0.00 ","$23.24 ","$0.00 "
"74402006","SUP","HCPCS C1713","","74402006  -  SCREW BN T6 2MM 6MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402007","SUP","HCPCS C1713","","74402007  -  SCREW BN T6 2MM 7MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402008","SUP","HCPCS C1713","","74402008  -  SCREW BN T6 2MM 8MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402009","SUP","HCPCS C1713","","74402009  -  SCREW BN T6 2MM 9MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402011","SUP","HCPCS C1713","","74402011  -  SCREW BN T6 2MM 11MM VLP ST TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402012","SUP","HCPCS C1713","","74402012  -  SCREW BN T6 2MM 12MM VLP ST TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402013","SUP","HCPCS C1713","","74402013  -  SCREW BN T6 2MM 13MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402014","SUP","HCPCS C1713","","74402014  -  SCREW BN T6 2MM 14MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402015","SUP","HCPCS C1713","","74402015  -  SCREW BN T6 2MM 15MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402016","SUP","HCPCS C1713","","74402016  -  SCREW BN T6 2MM 16MM VLP ST TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402017","SUP","HCPCS C1713","","74402017  -  SCREW BN T6 2MM 17MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402018","SUP","HCPCS C1713","","74402018  -  SCREW BN T6 2MM 18MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402019","SUP","HCPCS C1713","","74402019  -  SCREW BN T6 2MM 19MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402020","SUP","HCPCS C1713","","74402020  -  SCREW BN T6 2MM 20MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402021","SUP","HCPCS C1713","","74402021  -  SCREW BN T6 2MM 21MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402022","SUP","HCPCS C1713","","74402022  -  SCREW BN T6 2MM 22MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402023","SUP","HCPCS C1713","","74402023  -  SCREW BN T6 2MM 23MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402024","SUP","HCPCS C1713","","74402024  -  SCREW BN T6 2MM 24MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402026","SUP","HCPCS C1713","","74402026  -  SCREW BN T6 2MM 26MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402028","SUP","HCPCS C1713","","74402028  -  SCREW BN T6 2MM 28MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402030","SUP","HCPCS C1713","","74402030  -  SCREW BN T6 2MM 30MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402032","SUP","HCPCS C1713","","74402032  -  SCREW BN T6 2MM 32MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402034","SUP","HCPCS C1713","","74402034  -  SCREW BN T6 2MM 34MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402036","SUP","HCPCS C1713","","74402036  -  SCREW BN T6 2MM 36MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402038","SUP","HCPCS C1713","","74402038  -  SCREW BN T6 2MM 38MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402040","SUP","HCPCS C1713","","74402040  -  SCREW BN T6 2MM 40MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402401","SUP","HCPCS C1713","","74402401  -  WASHER ORTH VLP 2.4 MM T7 SCR","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$65.70 ","$0.00 ","$30.43 ","$0.00 ","$0.00 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.85 ","$0.00 ","$23.24 ","$0.00 "
"74402406","SUP","HCPCS C1713","","74402406  -  SCREW BN T7 2.4MM 6MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402407","SUP","HCPCS C1713","","74402407  -  SCREW BN T7 2.4MM 7MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402408","SUP","HCPCS C1713","","74402408  -  SCREW BN T7 2.4MM 8MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402409","SUP","HCPCS C1713","","74402409  -  SCREW BN T7 2.4MM 9MM VLP ST TI FT CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
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"74412036","SUP","HCPCS C1713","","74412036  -  SCREW BN T6 2MM 36MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412038","SUP","HCPCS C1713","","74412038  -  SCREW BN T6 2MM 38MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412040","SUP","HCPCS C1713","","74412040  -  SCREW BN T6 2MM 40MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412406","SUP","HCPCS C1713","","74412406  -  SCREW BN T7 2.4MM 6MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412407","SUP","HCPCS C1713","","74412407  -  SCREW BN T7 2.4MM 7MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412408","SUP","HCPCS C1713","","74412408  -  SCREW BN T7 2.4MM 8MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412409","SUP","HCPCS C1713","","74412409  -  SCREW BN T7 2.4MM 9MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412410","SUP","HCPCS C1713","","74412410  -  SCREW BN T7 2.4MM 10MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412411","SUP","HCPCS C1713","","74412411  -  SCREW BN T7 2.4MM 11MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412412","SUP","HCPCS C1713","","74412412  -  SCREW BN T7 2.4MM 12MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412413","SUP","HCPCS C1713","","74412413  -  SCREW BN 2.4MM 13MM VLP LCK ST T7 DRVR TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412414","SUP","HCPCS C1713","","74412414  -  SCREW BN 2.4MM 14MM VLP LCK ST T7 DRVR TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412415","SUP","HCPCS C1713","","74412415  -  SCREW BN T7 2.4MM 15MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412416","SUP","HCPCS C1713","","74412416  -  SCREW BN T7 2.4MM 16MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412417","SUP","HCPCS C1713","","74412417  -  SCREW BN T7 2.4MM 17MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412418","SUP","HCPCS C1713","","74412418  -  SCREW BN 2.4MM 18MM VLP LCK ST T7 DRVR TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412419","SUP","HCPCS C1713","","74412419  -  SCREW BN T7 2.4MM 19MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412420","SUP","HCPCS C1713","","74412420  -  SCREW BN T7 2.4MM 20MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412421","SUP","HCPCS C1713","","74412421  -  SCREW BN T7 2.4MM 21MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412422","SUP","HCPCS C1713","","74412422  -  SCREW BN 2.4MM 22MM VLP LCK ST T7 DRVR TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412423","SUP","HCPCS C1713","","74412423  -  SCREW BN T7 2.4MM 23MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412424","SUP","HCPCS C1713","","74412424  -  SCREW BN T7 2.4MM 24MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412426","SUP","HCPCS C1713","","74412426  -  SCREW BN T7 2.4MM 26MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412428","SUP","HCPCS C1713","","74412428  -  SCREW BN T7 2.4MM 28MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412430","SUP","HCPCS C1713","","74412430  -  SCREW BN T7 2.4MM 30MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412432","SUP","HCPCS C1713","","74412432  -  SCREW BN T7 2.4MM 32MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412434","SUP","HCPCS C1713","","74412434  -  SCREW BN T7 2.4MM 34MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412436","SUP","HCPCS C1713","","74412436  -  SCREW BN T7 2.4MM 36MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412438","SUP","HCPCS C1713","","74412438  -  SCREW BN T7 2.4MM 38MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412440","SUP","HCPCS C1713","","74412440  -  SCREW BN T7 2.4MM 40MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412442","SUP","HCPCS C1713","","74412442  -  SCREW BN T7 2.4MM 42MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412444","SUP","HCPCS C1713","","74412444  -  SCREW BN T7 2.4MM 44MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412446","SUP","HCPCS C1713","","74412446  -  SCREW BN T7 2.4MM 46MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412448","SUP","HCPCS C1713","","74412448  -  SCREW BN T7 2.4MM 48MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412450","SUP","HCPCS C1713","","74412450  -  SCREW BN T7 2.4MM 50MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412455","SUP","HCPCS C1713","","74412455  -  SCREW BN T7 2.4MM 55MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412460","SUP","HCPCS C1713","","74412460  -  SCREW BN T7 2.4MM 60MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412465","SUP","HCPCS C1713","","74412465  -  SCREW BN T7 2.4MM 65MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412470","SUP","HCPCS C1713","","74412470  -  SCREW BN T7 2.4MM 70MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412475","SUP","HCPCS C1713","","74412475  -  SCREW BN T7 2.4MM 75MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412480","SUP","HCPCS C1713","","74412480  -  SCREW BN T7 2.4MM 80MM VLP LCK ST TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74423010","SUP","HCPCS C1713","","74423010  -  SCREW BN T7 3MM 10MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423012","SUP","HCPCS C1713","","74423012  -  SCREW BN T7 3MM 12MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423014","SUP","HCPCS C1713","","74423014  -  SCREW BN T7 3MM 14MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423016","SUP","HCPCS C1713","","74423016  -  SCREW BN T7 3MM 16MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423018","SUP","HCPCS C1713","","74423018  -  SCREW BN T7 3MM 18MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423020","SUP","HCPCS C1713","","74423020  -  SCREW BN T7 3MM 20MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423022","SUP","HCPCS C1713","","74423022  -  SCREW BN T7 3MM 22MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423024","SUP","HCPCS C1713","","74423024  -  SCREW BN T7 3MM 24MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423026","SUP","HCPCS C1713","","74423026  -  SCREW BN T7 3MM 26MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423028","SUP","HCPCS C1713","","74423028  -  SCREW BN T7 3MM 28MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423030","SUP","HCPCS C1713","","74423030  -  SCREW BN T7 3MM 30MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423032","SUP","HCPCS C1713","","74423032  -  SCREW BN T7 3MM 32MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423034","SUP","HCPCS C1713","","74423034  -  SCREW BN T7 3MM 34MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423036","SUP","HCPCS C1713","","74423036  -  SCREW BN T7 3MM 36MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423038","SUP","HCPCS C1713","","74423038  -  SCREW BN T7 3MM 38MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423040","SUP","HCPCS C1713","","74423040  -  SCREW BN T7 3MM 40MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423042","SUP","HCPCS C1713","","74423042  -  SCREW BN T7 3MM 42MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423044","SUP","HCPCS C1713","","74423044  -  SCREW BN T7 3MM 44MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423046","SUP","HCPCS C1713","","74423046  -  SCREW BN T7 3MM 46MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423048","SUP","HCPCS C1713","","74423048  -  SCREW BN T7 3MM 48MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423050","SUP","HCPCS C1713","","74423050  -  SCREW BN T7 3MM 50MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423055","SUP","HCPCS C1713","","74423055  -  SCREW BN T7 3MM 55MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423060","SUP","HCPCS C1713","","74423060  -  SCREW BN T7 3MM 60MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423065","SUP","HCPCS C1713","","74423065  -  SCREW BN T7 3MM 65MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423070","SUP","HCPCS C1713","","74423070  -  SCREW BN T7 3MM 70MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423075","SUP","HCPCS C1713","","74423075  -  SCREW BN T7 3MM 75MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74423080","SUP","HCPCS C1713","","74423080  -  SCREW BN T7 3MM 80MM VLP TI FT OSTEOPENIA","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$79.20 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"74442010","SUP","HCPCS C1713","","74442010  -  PLATE BN Y VLP MN-MOD 6 HL 2MM SCR","BOTH IP/OP","$1,608.75 ","$1,190.48 ","$0.00 ","$1,608.75 ","$723.94 ","$0.00 ","$335.30 ","$0.00 ","$0.00 ","$281.68 ","$1,608.75 ","$0.00 ","$804.38 ","$1,274.13 ","$1,287.00 ","$0.00 ","$251.77 ","$0.00 ","$256.11 ","$0.00 "
"74442012","SUP","HCPCS C1713","","74442012  -  PLATE BN Y VLP MN-MOD 8 HL 2MM SCR","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"74442014","SUP","HCPCS C1713","","74442014  -  PLATE BN T VLP MN-MOD 2X6 HL 2MM SCR","BOTH IP/OP","$1,124.75 ","$832.32 ","$0.00 ","$1,124.75 ","$506.14 ","$0.00 ","$234.43 ","$0.00 ","$0.00 ","$196.93 ","$1,124.75 ","$0.00 ","$562.38 ","$890.80 ","$899.80 ","$0.00 ","$176.02 ","$0.00 ","$179.06 ","$0.00 "
"74442016","SUP","HCPCS C1713","","74442016  -  PLATE BN T 1.2MM VLP MN-MOD 2 HLE/HD 8 HL SHFT TI SM BN 2MM","BOTH IP/OP","$1,443.75 ","$1,068.38 ","$0.00 ","$1,443.75 ","$649.69 ","$0.00 ","$300.91 ","$0.00 ","$0.00 ","$252.79 ","$1,443.75 ","$0.00 ","$721.88 ","$1,143.45 ","$1,155.00 ","$0.00 ","$225.95 ","$0.00 ","$229.85 ","$0.00 "
"74442018","SUP","HCPCS C1713","","74442018  -  PLATE BN T VLP MN-MOD 3X6 HL 2MM SCR","BOTH IP/OP","$1,608.75 ","$1,190.48 ","$0.00 ","$1,608.75 ","$723.94 ","$0.00 ","$335.30 ","$0.00 ","$0.00 ","$281.68 ","$1,608.75 ","$0.00 ","$804.38 ","$1,274.13 ","$1,287.00 ","$0.00 ","$251.77 ","$0.00 ","$256.11 ","$0.00 "
"74442020","SUP","HCPCS C1713","","74442020  -  PLATE BN T VLP MN-MOD 3X8 HL 2MM SCR","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"74442022","SUP","HCPCS C1713","","74442022  -  PLATE BN STRG VLP MN-MOD 6 HL 2MM SCR","BOTH IP/OP","$965.25 ","$714.29 ","$0.00 ","$965.25 ","$434.36 ","$0.00 ","$201.18 ","$0.00 ","$0.00 ","$169.01 ","$965.25 ","$0.00 ","$482.63 ","$764.48 ","$772.20 ","$0.00 ","$151.06 ","$0.00 ","$153.67 ","$0.00 "
"74442024","SUP","HCPCS C1713","","74442024  -  PLATE BN STRG VLP MN-MOD 8 HL 2MM SCR","BOTH IP/OP","$1,285.63 ","$951.37 ","$0.00 ","$1,285.63 ","$578.53 ","$0.00 ","$267.96 ","$0.00 ","$0.00 ","$225.10 ","$1,285.63 ","$0.00 ","$642.81 ","$1,018.22 ","$1,028.50 ","$0.00 ","$201.20 ","$0.00 ","$204.67 ","$0.00 "
"74442028","SUP","HCPCS C1713","","74442028  -  PLATE BN STOUT VLP MN-MOD 6 HL 2MM SCR","BOTH IP/OP","$1,124.75 ","$832.32 ","$0.00 ","$1,124.75 ","$506.14 ","$0.00 ","$234.43 ","$0.00 ","$0.00 ","$196.93 ","$1,124.75 ","$0.00 ","$562.38 ","$890.80 ","$899.80 ","$0.00 ","$176.02 ","$0.00 ","$179.06 ","$0.00 "
"74442030","SUP","HCPCS C1713","","74442030  -  PLATE BN STOUT VLP MN-MOD 8 HL 2MM SCR","BOTH IP/OP","$1,443.75 ","$1,068.38 ","$0.00 ","$1,443.75 ","$649.69 ","$0.00 ","$300.91 ","$0.00 ","$0.00 ","$252.79 ","$1,443.75 ","$0.00 ","$721.88 ","$1,143.45 ","$1,155.00 ","$0.00 ","$225.95 ","$0.00 ","$229.85 ","$0.00 "
"74442410","SUP","HCPCS C1713","","74442410  -  PLATE BN Y VLP MN-MOD 6 HL 2.4MM SCR","BOTH IP/OP","$1,608.75 ","$1,190.48 ","$0.00 ","$1,608.75 ","$723.94 ","$0.00 ","$335.30 ","$0.00 ","$0.00 ","$281.68 ","$1,608.75 ","$0.00 ","$804.38 ","$1,274.13 ","$1,287.00 ","$0.00 ","$251.77 ","$0.00 ","$256.11 ","$0.00 "
"74442412","SUP","HCPCS C1713","","74442412  -  PLATE BN Y VLP MN-MOD 8 HL 2.4MM SCR","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"74442414","SUP","HCPCS C1713","","74442414  -  PLATE BN T VLP MN-MOD 2X6 HL SM BN 2.4MM","BOTH IP/OP","$1,124.75 ","$832.32 ","$0.00 ","$1,124.75 ","$506.14 ","$0.00 ","$234.43 ","$0.00 ","$0.00 ","$196.93 ","$1,124.75 ","$0.00 ","$562.38 ","$890.80 ","$899.80 ","$0.00 ","$176.02 ","$0.00 ","$179.06 ","$0.00 "
"74442416","SUP","HCPCS C1713","","74442416  -  PLATE BN T VLP MN-MOD 2X8 HL 2.4MM SCR","BOTH IP/OP","$1,443.75 ","$1,068.38 ","$0.00 ","$1,443.75 ","$649.69 ","$0.00 ","$300.91 ","$0.00 ","$0.00 ","$252.79 ","$1,443.75 ","$0.00 ","$721.88 ","$1,143.45 ","$1,155.00 ","$0.00 ","$225.95 ","$0.00 ","$229.85 ","$0.00 "
"74442418","SUP","HCPCS C1713","","74442418  -  PLATE BN T VLP MN-MOD 3X6 HL 2.4MM SCR","BOTH IP/OP","$1,608.75 ","$1,190.48 ","$0.00 ","$1,608.75 ","$723.94 ","$0.00 ","$335.30 ","$0.00 ","$0.00 ","$281.68 ","$1,608.75 ","$0.00 ","$804.38 ","$1,274.13 ","$1,287.00 ","$0.00 ","$251.77 ","$0.00 ","$256.11 ","$0.00 "
"74442420","SUP","HCPCS C1713","","74442420  -  PLATE BN T VLP MN-MOD 3X8 HL 2.4MM SCR","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"74442422","SUP","HCPCS C1713","","74442422  -  PLATE BN STRG VLP MN-MOD 6 HL 2.4MM SCR","BOTH IP/OP","$965.25 ","$714.29 ","$0.00 ","$965.25 ","$434.36 ","$0.00 ","$201.18 ","$0.00 ","$0.00 ","$169.01 ","$965.25 ","$0.00 ","$482.63 ","$764.48 ","$772.20 ","$0.00 ","$151.06 ","$0.00 ","$153.67 ","$0.00 "
"74442424","SUP","HCPCS C1713","","74442424  -  PLATE BN STRG VLP MN-MOD 8 HL 2.4MM SCR","BOTH IP/OP","$1,285.63 ","$951.37 ","$0.00 ","$1,285.63 ","$578.53 ","$0.00 ","$267.96 ","$0.00 ","$0.00 ","$225.10 ","$1,285.63 ","$0.00 ","$642.81 ","$1,018.22 ","$1,028.50 ","$0.00 ","$201.20 ","$0.00 ","$204.67 ","$0.00 "
"74442426","SUP","HCPCS C1713","","74442426  -  PLATE BN STRG VLP MN-MOD 12 HL 2.4MM SCR","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"74442428","SUP","HCPCS C1713","","74442428  -  PLATE BN VLP MN-MOD 12X3 HL MESH 2.4 MM SCR","BOTH IP/OP","$2,413.13 ","$1,785.72 ","$0.00 ","$2,413.13 ","$1,085.91 ","$0.00 ","$502.96 ","$0.00 ","$0.00 ","$422.52 ","$2,413.13 ","$0.00 ","$1,206.56 ","$1,911.20 ","$1,930.50 ","$0.00 ","$377.65 ","$0.00 ","$384.17 ","$0.00 "
"74442430","SUP","HCPCS C1713","","74442430  -  PLATE BN STOUT VLP MN-MOD 6 HL 2.4MM SCR","BOTH IP/OP","$1,124.75 ","$832.32 ","$0.00 ","$1,124.75 ","$506.14 ","$0.00 ","$234.43 ","$0.00 ","$0.00 ","$196.93 ","$1,124.75 ","$0.00 ","$562.38 ","$890.80 ","$899.80 ","$0.00 ","$176.02 ","$0.00 ","$179.06 ","$0.00 "
"74442432","SUP","HCPCS C1713","","74442432  -  PLATE BN STOUT VLP MN-MOD 8 HL 2.4MM SCR","BOTH IP/OP","$1,443.75 ","$1,068.38 ","$0.00 ","$1,443.75 ","$649.69 ","$0.00 ","$300.91 ","$0.00 ","$0.00 ","$252.79 ","$1,443.75 ","$0.00 ","$721.88 ","$1,143.45 ","$1,155.00 ","$0.00 ","$225.95 ","$0.00 ","$229.85 ","$0.00 "
"74442434","SUP","HCPCS C1713","","74442434  -  PLATE BN STOUT VLP MN-MOD 12 HL 2.4MM SCR","BOTH IP/OP","$1,766.88 ","$1,307.49 ","$0.00 ","$1,766.88 ","$795.09 ","$0.00 ","$368.26 ","$0.00 ","$0.00 ","$309.37 ","$1,766.88 ","$0.00 ","$883.44 ","$1,399.37 ","$1,413.50 ","$0.00 ","$276.52 ","$0.00 ","$281.29 ","$0.00 "
"74444020","SUP","HCPCS C1713","","74444020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444025","SUP","HCPCS C1713","","74444025  -  SCREW BN 4MM 25MM LGC CD HZN MA TI SPNE 4.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444030","SUP","HCPCS C1713","","74444030  -  SCREW BN 4MM 30MM LGC CD HZN MA TI SPNE 4.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444035","SUP","HCPCS C1713","","74444035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444040","SUP","HCPCS C1713","","74444040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444520","SUP","HCPCS C1713","","74444520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444525","SUP","HCPCS C1713","","74444525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444530","SUP","HCPCS C1713","","74444530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444535","SUP","HCPCS C1713","","74444535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74444540","SUP","HCPCS C1713","","74444540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445025","SUP","HCPCS C1713","","74445025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445030","SUP","HCPCS C1713","","74445030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445035","SUP","HCPCS C1713","","74445035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445040","SUP","HCPCS C1713","","74445040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445045","SUP","HCPCS C1713","","74445045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445050","SUP","HCPCS C1713","","74445050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445525","SUP","HCPCS C1713","","74445525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445530","SUP","HCPCS C1713","","74445530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445535","SUP","HCPCS C1713","","74445535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445540","SUP","HCPCS C1713","","74445540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445545","SUP","HCPCS C1713","","74445545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74445550","SUP","HCPCS C1713","","74445550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446025","SUP","HCPCS C1713","","74446025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446030","SUP","HCPCS C1713","","74446030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446035","SUP","HCPCS C1713","","74446035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446040","SUP","HCPCS C1713","","74446040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446045","SUP","HCPCS C1713","","74446045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446050","SUP","HCPCS C1713","","74446050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446525","SUP","HCPCS C1713","","74446525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446530","SUP","HCPCS C1713","","74446530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446535","SUP","HCPCS C1713","","74446535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446540","SUP","HCPCS C1713","","74446540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446545","SUP","HCPCS C1713","","74446545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446550","SUP","HCPCS C1713","","74446550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74446555","SUP","HCPCS C1713","","74446555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447525","SUP","HCPCS C1713","","74447525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447530","SUP","HCPCS C1713","","74447530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447535","SUP","HCPCS C1713","","74447535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447540","SUP","HCPCS C1713","","74447540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447545","SUP","HCPCS C1713","","74447545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447550","SUP","HCPCS C1713","","74447550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74447555","SUP","HCPCS C1713","","74447555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74462002","SUP","Custom 27203010","","74462002  -  BIT DRL SHRT 1.5MM VLP MN-MOD QC","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.00 ","$0.00 ","$121.00 ","$191.66 ","$193.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74462004","SUP","Custom 27203010","","74462004  -  BIT DRL LNG 1.5MM VLP MN-MOD QC","BOTH IP/OP","$281.88 ","$208.59 ","$0.00 ","$281.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.88 ","$0.00 ","$140.94 ","$223.25 ","$225.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74462006","SUP","Custom 27203010","","74462006  -  BIT DRL 2MM VLP MN-MOD QC OVR","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.00 ","$0.00 ","$121.00 ","$191.66 ","$193.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74462410","SUP","Custom 27203010","","74462410  -  BIT DRL 2.4MM VLP MN-MOD AO QC OVR","BOTH IP/OP","$242.00 ","$179.08 ","$0.00 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.00 ","$0.00 ","$121.00 ","$191.66 ","$193.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74640132","SUP","HCPCS C1713","","74640132  -  SCREW BN 9MM 32MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640134","SUP","HCPCS C1713","","74640134  -  SCREW BN 9MM 34MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640136","SUP","HCPCS C1713","","74640136  -  SCREW BN 9MM 36MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640138","SUP","HCPCS C1713","","74640138  -  SCREW BN 9MM 38MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640234","SUP","HCPCS C1713","","74640234  -  SCREW BN 10MM 34MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640236","SUP","HCPCS C1713","","74640236  -  SCREW BN 10MM 36MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640238","SUP","HCPCS C1713","","74640238  -  SCREW BN 10MM 38MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640240","SUP","HCPCS C1713","","74640240  -  SCREW BN 10MM 40MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640336","SUP","HCPCS C1713","","74640336  -  SCREW BN 11.5MM 36MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640338","SUP","HCPCS C1713","","74640338  -  SCREW BN 11.5MM 38MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640340","SUP","HCPCS C1713","","74640340  -  SCREW BN 11.5MM 40MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640342","SUP","HCPCS C1713","","74640342  -  SCREW BN 11.5MM 42MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640440","SUP","HCPCS C1713","","74640440  -  SCREW BN 13MM 40MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74640442","SUP","HCPCS C1713","","74640442  -  SCREW BN 13MM 42MM TN SURESHOT RT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74644020","SUP","HCPCS C1713","","74644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644025","SUP","HCPCS C1713","","74644025  -  SCREW BN 4MM 25MM STRL LGC CD HZN MA SS SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644030","SUP","HCPCS C1713","","74644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644035","SUP","HCPCS C1713","","74644035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644040","SUP","HCPCS C1713","","74644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644520","SUP","HCPCS C1713","","74644520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644525","SUP","HCPCS C1713","","74644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644530","SUP","HCPCS C1713","","74644530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644535","SUP","HCPCS C1713","","74644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74644540","SUP","HCPCS C1713","","74644540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645025","SUP","HCPCS C1713","","74645025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645030","SUP","HCPCS C1713","","74645030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645035","SUP","HCPCS C1713","","74645035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645040","SUP","HCPCS C1713","","74645040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645045","SUP","HCPCS C1713","","74645045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645050","SUP","HCPCS C1713","","74645050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645525","SUP","HCPCS C1713","","74645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645530","SUP","HCPCS C1713","","74645530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645535","SUP","HCPCS C1713","","74645535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645540","SUP","HCPCS C1713","","74645540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645545","SUP","HCPCS C1713","","74645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74645550","SUP","HCPCS C1713","","74645550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646025","SUP","HCPCS C1713","","74646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646030","SUP","HCPCS C1713","","74646030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646035","SUP","HCPCS C1713","","74646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646040","SUP","HCPCS C1713","","74646040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646045","SUP","HCPCS C1713","","74646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646050","SUP","HCPCS C1713","","74646050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646525","SUP","HCPCS C1713","","74646525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646530","SUP","HCPCS C1713","","74646530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646535","SUP","HCPCS C1713","","74646535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646540","SUP","HCPCS C1713","","74646540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646545","SUP","HCPCS C1713","","74646545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646550","SUP","HCPCS C1713","","74646550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74646555","SUP","HCPCS C1713","","74646555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647525","SUP","HCPCS C1713","","74647525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647530","SUP","HCPCS C1713","","74647530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647535","SUP","HCPCS C1713","","74647535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647540","SUP","HCPCS C1713","","74647540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647545","SUP","HCPCS C1713","","74647545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647550","SUP","HCPCS C1713","","74647550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74647555","SUP","HCPCS C1713","","74647555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"74649132","SUP","HCPCS C1713","","74649132  -  SCREW BN 9MM 32MM SURESHOT TN LT EVAL","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649134","SUP","HCPCS C1713","","74649134  -  SCREW BN 9MM 34MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649136","SUP","HCPCS C1713","","74649136  -  SCREW BN 9MM 36MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649138","SUP","HCPCS C1713","","74649138  -  SCREW BN 9MM 38MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649234","SUP","HCPCS C1713","","74649234  -  SCREW BN 10MM 34MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649236","SUP","HCPCS C1713","","74649236  -  SCREW BN 10MM 36MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649238","SUP","HCPCS C1713","","74649238  -  SCREW BN 10MM 38MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649240","SUP","HCPCS C1713","","74649240  -  SCREW BN 10MM 40MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649336","SUP","HCPCS C1713","","74649336  -  SCREW BN 11.5MM 36MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649338","SUP","HCPCS C1713","","74649338  -  SCREW BN 11.5MM 38MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649340","SUP","HCPCS C1713","","74649340  -  SCREW BN 11.5MM 40MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649342","SUP","HCPCS C1713","","74649342  -  SCREW BN 11.5MM 42MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649440","SUP","HCPCS C1713","","74649440  -  SCREW BN 13MM 40MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74649442","SUP","HCPCS C1713","","74649442  -  SCREW BN 13MM 42MM TN SURESHOT LT TROCH","BOTH IP/OP","$5,270.00 ","$3,899.80 ","$0.00 ","$5,270.00 ","$2,371.50 ","$0.00 ","$1,098.40 ","$0.00 ","$0.00 ","$922.73 ","$5,270.00 ","$0.00 ","$2,635.00 ","$4,173.84 ","$4,216.00 ","$0.00 ","$824.76 ","$0.00 ","$838.98 ","$0.00 "
"74692424","SUP","HCPCS C1713","","74692424  -  SCREW BN 2.4MM 24MM D-RAD SMRT PK LCK ST T7 DRVR TI DIST","BOTH IP/OP","$182.70 ","$135.20 ","$0.00 ","$182.70 ","$82.22 ","$0.00 ","$38.08 ","$0.00 ","$0.00 ","$31.99 ","$182.70 ","$0.00 ","$91.35 ","$144.70 ","$146.16 ","$0.00 ","$28.59 ","$0.00 ","$29.09 ","$0.00 "
"74800060","SUP","HCPCS C1713","","74800060  -  SCREW BN CONE 6.5MM 60MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800065","SUP","HCPCS C1713","","74800065  -  SCREW BN CONE 6.5MM 65MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800070","SUP","HCPCS C1713","","74800070  -  SCREW BN CONE 6.5MM 70MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800075","SUP","HCPCS C1713","","74800075  -  SCREW BN CONE 6.5MM 75MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800080","SUP","HCPCS C1713","","74800080  -  SCREW BN CONE 6.5MM 80MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800085","SUP","HCPCS C1713","","74800085  -  SCREW BN CONE 6.5MM 85MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800095","SUP","HCPCS C1713","","74800095  -  SCREW BN CONE 6.5MM 95MM CNN SS PROX FEM","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74800100","SUP","HCPCS C1713","","74800100  -  SCREW BN CONE 6.5MM 100MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800105","SUP","HCPCS C1713","","74800105  -  SCREW BN CONE 6.5MM 105MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800110","SUP","HCPCS C1713","","74800110  -  SCREW BN CONE 6.5MM 110MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800115","SUP","HCPCS C1713","","74800115  -  SCREW BN CONE 6.5MM 115MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800120","SUP","HCPCS C1713","","74800120  -  SCREW BN CONE 6.5MM 120MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800125","SUP","HCPCS C1713","","74800125  -  SCREW BN CONE 6.5MM 125MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800130","SUP","HCPCS C1713","","74800130  -  SCREW BN CONE 6.5MM 130MM CNN SS PROX FEM","BOTH IP/OP","$559.13 ","$413.76 ","$0.00 ","$559.13 ","$251.61 ","$0.00 ","$116.54 ","$0.00 ","$0.00 ","$97.90 ","$559.13 ","$0.00 ","$279.56 ","$442.83 ","$447.30 ","$0.00 ","$87.50 ","$0.00 ","$89.01 ","$0.00 "
"74800260","SUP","HCPCS C1713","","74800260  -  SCREW BN 6.5MM 60MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800265","SUP","HCPCS C1713","","74800265  -  SCREW BN 6.5MM 65MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800270","SUP","HCPCS C1713","","74800270  -  SCREW BN 6.5MM 70MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800275","SUP","HCPCS C1713","","74800275  -  SCREW BN 6.5MM 75MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800280","SUP","HCPCS C1713","","74800280  -  SCREW BN 6.5MM 80MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800285","SUP","HCPCS C1713","","74800285  -  SCREW BN 6.5MM 85MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800290","SUP","HCPCS C1713","","74800290  -  SCREW BN 6.5MM 90MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800295","SUP","HCPCS C1713","","74800295  -  SCREW BN 6.5MM 95MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800300","SUP","HCPCS C1713","","74800300  -  SCREW BN 6.5MM 100MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800305","SUP","HCPCS C1713","","74800305  -  SCREW BN 6.5MM 105MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800310","SUP","HCPCS C1713","","74800310  -  SCREW BN 6.5MM 110MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800315","SUP","HCPCS C1713","","74800315  -  SCREW BN 6.5MM 115MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800320","SUP","HCPCS C1713","","74800320  -  SCREW BN 6.5MM 120MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800325","SUP","HCPCS C1713","","74800325  -  SCREW BN 6.5MM 125MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800330","SUP","HCPCS C1713","","74800330  -  SCREW BN 6.5MM 130MM CNN LCK SS PROX FEM","BOTH IP/OP","$645.75 ","$477.86 ","$0.00 ","$645.75 ","$290.59 ","$0.00 ","$134.59 ","$0.00 ","$0.00 ","$113.07 ","$645.75 ","$0.00 ","$322.88 ","$511.43 ","$516.60 ","$0.00 ","$101.06 ","$0.00 ","$102.80 ","$0.00 "
"74800402","SUP","HCPCS C1713","","74800402  -  PLATE BN 44MM 2 HL LCK SS LT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,380.63 ","$2,501.67 ","$0.00 ","$3,380.63 ","$1,521.28 ","$0.00 ","$704.61 ","$0.00 ","$0.00 ","$591.92 ","$3,380.63 ","$0.00 ","$1,690.31 ","$2,677.46 ","$2,704.50 ","$0.00 ","$529.07 ","$0.00 ","$538.20 ","$0.00 "
"74800404","SUP","HCPCS C1713","","74800404  -  PLATE BN 144MM 4 HL LCK SS LT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,431.25 ","$2,539.13 ","$0.00 ","$3,431.25 ","$1,544.06 ","$0.00 ","$715.16 ","$0.00 ","$0.00 ","$600.78 ","$3,431.25 ","$0.00 ","$1,715.63 ","$2,717.55 ","$2,745.00 ","$0.00 ","$536.99 ","$0.00 ","$546.26 ","$0.00 "
"74800406","SUP","HCPCS C1713","","74800406  -  PLATE BN 180MM 6 HL LCK SS LT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,498.75 ","$2,589.08 ","$0.00 ","$3,498.75 ","$1,574.44 ","$0.00 ","$729.23 ","$0.00 ","$0.00 ","$612.60 ","$3,498.75 ","$0.00 ","$1,749.38 ","$2,771.01 ","$2,799.00 ","$0.00 ","$547.55 ","$0.00 ","$557.00 ","$0.00 "
"74800409","SUP","HCPCS C1713","","74800409  -  PLATE BN 234MM 9 HL LCK SS LT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,633.75 ","$2,688.98 ","$0.00 ","$3,633.75 ","$1,635.19 ","$0.00 ","$757.36 ","$0.00 ","$0.00 ","$636.24 ","$3,633.75 ","$0.00 ","$1,816.88 ","$2,877.93 ","$2,907.00 ","$0.00 ","$568.68 ","$0.00 ","$578.49 ","$0.00 "
"74800412","SUP","HCPCS C1713","","74800412  -  PLATE BN 288MM 12 HL LCK SS LT PROX FEM 4.5MM SCR","BOTH IP/OP","$4,246.88 ","$3,142.69 ","$0.00 ","$4,246.88 ","$1,911.09 ","$0.00 ","$885.15 ","$0.00 ","$0.00 ","$743.59 ","$4,246.88 ","$0.00 ","$2,123.44 ","$3,363.53 ","$3,397.50 ","$0.00 ","$664.64 ","$0.00 ","$676.10 ","$0.00 "
"74800415","SUP","HCPCS C1713","","74800415  -  PLATE BN 15MM LCK SS LT PROX FEM","BOTH IP/OP","$4,584.38 ","$3,392.44 ","$0.00 ","$4,584.38 ","$2,062.97 ","$0.00 ","$955.50 ","$0.00 ","$0.00 ","$802.69 ","$4,584.38 ","$0.00 ","$2,292.19 ","$3,630.83 ","$3,667.50 ","$0.00 ","$717.45 ","$0.00 ","$729.83 ","$0.00 "
"74800418","SUP","HCPCS C1713","","74800418  -  PLATE BN 396MM 18 HL LCK SS LT PROX FEM 4.5MM SCR","BOTH IP/OP","$4,921.88 ","$3,642.19 ","$0.00 ","$4,921.88 ","$2,214.84 ","$0.00 ","$1,025.84 ","$0.00 ","$0.00 ","$861.78 ","$4,921.88 ","$0.00 ","$2,460.94 ","$3,898.13 ","$3,937.50 ","$0.00 ","$770.27 ","$0.00 ","$783.56 ","$0.00 "
"74800502","SUP","HCPCS C1713","","74800502  -  PLATE BN 99MM 2 HL LCK SS RT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,380.63 ","$2,501.67 ","$0.00 ","$3,380.63 ","$1,521.28 ","$0.00 ","$704.61 ","$0.00 ","$0.00 ","$591.92 ","$3,380.63 ","$0.00 ","$1,690.31 ","$2,677.46 ","$2,704.50 ","$0.00 ","$529.07 ","$0.00 ","$538.20 ","$0.00 "
"74800504","SUP","HCPCS C1713","","74800504  -  PLATE BN 144MM 4 HL LCK SS RT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,431.25 ","$2,539.13 ","$0.00 ","$3,431.25 ","$1,544.06 ","$0.00 ","$715.16 ","$0.00 ","$0.00 ","$600.78 ","$3,431.25 ","$0.00 ","$1,715.63 ","$2,717.55 ","$2,745.00 ","$0.00 ","$536.99 ","$0.00 ","$546.26 ","$0.00 "
"74800506","SUP","HCPCS C1713","","74800506  -  PLATE BN 180MM 6 HL LCK SS RT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,498.75 ","$2,589.08 ","$0.00 ","$3,498.75 ","$1,574.44 ","$0.00 ","$729.23 ","$0.00 ","$0.00 ","$612.60 ","$3,498.75 ","$0.00 ","$1,749.38 ","$2,771.01 ","$2,799.00 ","$0.00 ","$547.55 ","$0.00 ","$557.00 ","$0.00 "
"74800509","SUP","HCPCS C1713","","74800509  -  PLATE BN 234MM 9 HL LCK SS RT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,633.75 ","$2,688.98 ","$0.00 ","$3,633.75 ","$1,635.19 ","$0.00 ","$757.36 ","$0.00 ","$0.00 ","$636.24 ","$3,633.75 ","$0.00 ","$1,816.88 ","$2,877.93 ","$2,907.00 ","$0.00 ","$568.68 ","$0.00 ","$578.49 ","$0.00 "
"74800512","SUP","HCPCS C1713","","74800512  -  PLATE BN 288MM 12 HL LCK SS RT PROX FEM 4.5MM SCR","BOTH IP/OP","$4,246.88 ","$3,142.69 ","$0.00 ","$4,246.88 ","$1,911.09 ","$0.00 ","$885.15 ","$0.00 ","$0.00 ","$743.59 ","$4,246.88 ","$0.00 ","$2,123.44 ","$3,363.53 ","$3,397.50 ","$0.00 ","$664.64 ","$0.00 ","$676.10 ","$0.00 "
"74800515","SUP","HCPCS C1713","","74800515  -  PLATE BN 342MM 15 HL LCK SS RT PROX FEM 4.5MM SCR","BOTH IP/OP","$4,550.63 ","$3,367.47 ","$0.00 ","$4,550.63 ","$2,047.78 ","$0.00 ","$948.46 ","$0.00 ","$0.00 ","$796.78 ","$4,550.63 ","$0.00 ","$2,275.31 ","$3,604.10 ","$3,640.50 ","$0.00 ","$712.17 ","$0.00 ","$724.46 ","$0.00 "
"74800518","SUP","HCPCS C1713","","74800518  -  PLATE BN 396MM PRLC 18 HL LCK SS FEM RT PROX 4.5MM SCR","BOTH IP/OP","$4,882.50 ","$3,613.05 ","$0.00 ","$4,882.50 ","$2,197.13 ","$0.00 ","$1,017.64 ","$0.00 ","$0.00 ","$854.89 ","$4,882.50 ","$0.00 ","$2,441.25 ","$3,866.94 ","$3,906.00 ","$0.00 ","$764.11 ","$0.00 ","$777.29 ","$0.00 "
"74800601","SUP","HCPCS C1713","","74800601  -  PLATE BN SHRT PRLC CBL SDL SS","BOTH IP/OP","$408.38 ","$302.20 ","$0.00 ","$408.38 ","$183.77 ","$0.00 ","$85.12 ","$0.00 ","$0.00 ","$71.50 ","$408.38 ","$0.00 ","$204.19 ","$323.44 ","$326.70 ","$0.00 ","$63.91 ","$0.00 ","$65.01 ","$0.00 "
"74800602","SUP","HCPCS C1713","","74800602  -  PLATE BN TLL PRLC CBL SDL SS","BOTH IP/OP","$408.38 ","$302.20 ","$0.00 ","$408.38 ","$183.77 ","$0.00 ","$85.12 ","$0.00 ","$0.00 ","$71.50 ","$408.38 ","$0.00 ","$204.19 ","$323.44 ","$326.70 ","$0.00 ","$63.91 ","$0.00 ","$65.01 ","$0.00 "
"74800603","SUP","HCPCS C1713","","74800603  -  SCREW BN 4.5MM PRLC HL FIL SS FEM PROX","BOTH IP/OP","$319.50 ","$236.43 ","$0.00 ","$319.50 ","$143.78 ","$0.00 ","$66.59 ","$0.00 ","$0.00 ","$55.94 ","$319.50 ","$0.00 ","$159.75 ","$253.04 ","$255.60 ","$0.00 ","$50.00 ","$0.00 ","$50.86 ","$0.00 "
"74800607","SUP","HCPCS C1713","","74800607  -  PLATE BN PRLC LCK INS HEX SS HUM 4.5 MM SCR","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"74820060","SUP","HCPCS C1713","","74820060  -  SCREW BN CONE 6.5MM 60MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820065","SUP","HCPCS C1713","","74820065  -  SCREW BN CONE 6.5MM 65MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820070","SUP","HCPCS C1713","","74820070  -  SCREW BN CONE 6.5MM 70MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820075","SUP","HCPCS C1713","","74820075  -  SCREW BN CONE 6.5MM 75MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820080","SUP","HCPCS C1713","","74820080  -  SCREW BN CONE 6.5MM 80MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820085","SUP","HCPCS C1713","","74820085  -  SCREW BN CONE 6.5MM 85MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820090","SUP","HCPCS C1713","","74820090  -  SCREW BN CONE 6.5MM 90MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820095","SUP","HCPCS C1713","","74820095  -  SCREW BN CONE 6.5MM 95MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820100","SUP","HCPCS C1713","","74820100  -  SCREW BN CONE 6.5MM 100MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820105","SUP","HCPCS C1713","","74820105  -  SCREW BN CONE 6.5MM 105MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820110","SUP","HCPCS C1713","","74820110  -  SCREW BN CONE 6.5MM 110MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820115","SUP","HCPCS C1713","","74820115  -  SCREW BN CONE 6.5MM 115MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820120","SUP","HCPCS C1713","","74820120  -  SCREW BN CONE 6.5MM 120MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820125","SUP","HCPCS C1713","","74820125  -  SCREW BN CONE 6.5MM 125MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820130","SUP","HCPCS C1713","","74820130  -  SCREW BN CONE 6.5MM 130MM PRLC CNN SS FEM PROX","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$555.75 ","$250.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$97.31 ","$555.75 ","$0.00 ","$277.88 ","$440.15 ","$444.60 ","$0.00 ","$86.97 ","$0.00 ","$88.48 ","$0.00 "
"74820260","SUP","HCPCS C1713","","74820260  -  SCREW BN FT 6.5MM 60MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820265","SUP","HCPCS C1713","","74820265  -  SCREW BN FT 6.5MM 65MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820270","SUP","HCPCS C1713","","74820270  -  SCREW BN FT 6.5MM 70MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820275","SUP","HCPCS C1713","","74820275  -  SCREW BN FT 6.5MM 75MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820280","SUP","HCPCS C1713","","74820280  -  SCREW BN FT 6.5MM 80MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820285","SUP","HCPCS C1713","","74820285  -  SCREW BN FT 6.5MM 85MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820290","SUP","HCPCS C1713","","74820290  -  SCREW BN FT 6.5MM 90MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820295","SUP","HCPCS C1713","","74820295  -  SCREW BN FT 6.5MM 95MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820300","SUP","HCPCS C1713","","74820300  -  SCREW BN FT 6.5MM 100MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820305","SUP","HCPCS C1713","","74820305  -  SCREW BN FT 6.5MM 105MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820310","SUP","HCPCS C1713","","74820310  -  SCREW BN FT 6.5MM 110MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820315","SUP","HCPCS C1713","","74820315  -  SCREW BN FT 6.5MM 115MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820320","SUP","HCPCS C1713","","74820320  -  SCREW BN FT 6.5MM 120MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820325","SUP","HCPCS C1713","","74820325  -  SCREW BN FT 6.5MM 125MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820330","SUP","HCPCS C1713","","74820330  -  SCREW BN FT 6.5MM 130MM PRLC LCK CNN SS FEM PROX","BOTH IP/OP","$637.88 ","$472.03 ","$0.00 ","$637.88 ","$287.04 ","$0.00 ","$132.95 ","$0.00 ","$0.00 ","$111.69 ","$637.88 ","$0.00 ","$318.94 ","$505.20 ","$510.30 ","$0.00 ","$99.83 ","$0.00 ","$101.55 ","$0.00 "
"74820402","SUP","HCPCS C1713","","74820402  -  PLATE BN 99MMX2MM LCK FEM PROX 4.5MM SCR","BOTH IP/OP","$3,493.13 ","$2,584.92 ","$0.00 ","$3,493.13 ","$1,571.91 ","$0.00 ","$728.05 ","$0.00 ","$0.00 ","$611.62 ","$3,493.13 ","$0.00 ","$1,746.56 ","$2,766.56 ","$2,794.50 ","$0.00 ","$546.67 ","$0.00 ","$556.11 ","$0.00 "
"74820404","SUP","HCPCS C1713","","74820404  -  PLATE BN 144MM 4 HL LCK LT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,549.38 ","$2,626.54 ","$0.00 ","$3,549.38 ","$1,597.22 ","$0.00 ","$739.78 ","$0.00 ","$0.00 ","$621.47 ","$3,549.38 ","$0.00 ","$1,774.69 ","$2,811.11 ","$2,839.50 ","$0.00 ","$555.48 ","$0.00 ","$565.06 ","$0.00 "
"74820406","SUP","HCPCS C1713","","74820406  -  PLATE BN 180MMX6MM LCK FEM PROX 4.5MM SCR","BOTH IP/OP","$3,611.25 ","$2,672.33 ","$0.00 ","$3,611.25 ","$1,625.06 ","$0.00 ","$752.67 ","$0.00 ","$0.00 ","$632.30 ","$3,611.25 ","$0.00 ","$1,805.63 ","$2,860.11 ","$2,889.00 ","$0.00 ","$565.16 ","$0.00 ","$574.91 ","$0.00 "
"74820409","SUP","HCPCS C1713","","74820409  -  PLATE BN 234MM 9 HL LCK FEM PROX 4.5MM SCR","BOTH IP/OP","$3,746.25 ","$2,772.23 ","$0.00 ","$3,746.25 ","$1,685.81 ","$0.00 ","$780.81 ","$0.00 ","$0.00 ","$655.94 ","$3,746.25 ","$0.00 ","$1,873.13 ","$2,967.03 ","$2,997.00 ","$0.00 ","$586.29 ","$0.00 ","$596.40 ","$0.00 "
"74820412","SUP","HCPCS C1713","","74820412  -  PLATE BN 288MM 12 HL LCK LT PROX FEM 4.5MM SCR","BOTH IP/OP","$4,218.75 ","$3,121.88 ","$0.00 ","$4,218.75 ","$1,898.44 ","$0.00 ","$879.29 ","$0.00 ","$0.00 ","$738.67 ","$4,218.75 ","$0.00 ","$2,109.38 ","$3,341.25 ","$3,375.00 ","$0.00 ","$660.23 ","$0.00 ","$671.63 ","$0.00 "
"74820502","SUP","HCPCS C1713","","74820502  -  PLATE BN 4.5MM 99MM 2 HL LCK FEM RT","BOTH IP/OP","$3,493.13 ","$2,584.92 ","$0.00 ","$3,493.13 ","$1,571.91 ","$0.00 ","$728.05 ","$0.00 ","$0.00 ","$611.62 ","$3,493.13 ","$0.00 ","$1,746.56 ","$2,766.56 ","$2,794.50 ","$0.00 ","$546.67 ","$0.00 ","$556.11 ","$0.00 "
"74820504","SUP","HCPCS C1713","","74820504  -  PLATE BN 144MM 4 HL LCK FEM RT PROX 4.5MM SCR","BOTH IP/OP","$3,549.38 ","$2,626.54 ","$0.00 ","$3,549.38 ","$1,597.22 ","$0.00 ","$739.78 ","$0.00 ","$0.00 ","$621.47 ","$3,549.38 ","$0.00 ","$1,774.69 ","$2,811.11 ","$2,839.50 ","$0.00 ","$555.48 ","$0.00 ","$565.06 ","$0.00 "
"74820506","SUP","HCPCS C1713","","74820506  -  PLATE BN 180MM 6 HL LCK PROX FEM RT 4.5MM SCR","BOTH IP/OP","$3,611.25 ","$2,672.33 ","$0.00 ","$3,611.25 ","$1,625.06 ","$0.00 ","$752.67 ","$0.00 ","$0.00 ","$632.30 ","$3,611.25 ","$0.00 ","$1,805.63 ","$2,860.11 ","$2,889.00 ","$0.00 ","$565.16 ","$0.00 ","$574.91 ","$0.00 "
"74820509","SUP","HCPCS C1713","","74820509  -  PLATE BN 234MM 9 HL LCK RT PROX FEM 4.5MM SCR","BOTH IP/OP","$3,746.25 ","$2,772.23 ","$0.00 ","$3,746.25 ","$1,685.81 ","$0.00 ","$780.81 ","$0.00 ","$0.00 ","$655.94 ","$3,746.25 ","$0.00 ","$1,873.13 ","$2,967.03 ","$2,997.00 ","$0.00 ","$586.29 ","$0.00 ","$596.40 ","$0.00 "
"74820512","SUP","HCPCS C1713","","74820512  -  PLATE BN 288MM 12 HL LCK FEM RT PROX 4.5MM SCR","BOTH IP/OP","$4,218.75 ","$3,121.88 ","$0.00 ","$4,218.75 ","$1,898.44 ","$0.00 ","$879.29 ","$0.00 ","$0.00 ","$738.67 ","$4,218.75 ","$0.00 ","$2,109.38 ","$3,341.25 ","$3,375.00 ","$0.00 ","$660.23 ","$0.00 ","$671.63 ","$0.00 "
"75001233","SUP","HCPCS C1713","","75001233  -  PIN FX 34MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001234","SUP","HCPCS C1713","","75001234  -  PIN FX 36MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001235","SUP","HCPCS C1713","","75001235  -  PIN FX 38MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001236","SUP","HCPCS C1713","","75001236  -  PIN FX 40MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001237","SUP","HCPCS C1713","","75001237  -  PIN FX 42MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001238","SUP","HCPCS C1713","","75001238  -  PIN FX 44MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001239","SUP","HCPCS C1713","","75001239  -  PIN FX 46MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001240","SUP","HCPCS C1713","","75001240  -  PIN FX 50MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001241","SUP","HCPCS C1713","","75001241  -  PIN FX 60MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75001242","SUP","HCPCS C1713","","75001242  -  PIN FX 70MM LCK DIST","BOTH IP/OP","$602.50 ","$445.85 ","$0.00 ","$602.50 ","$271.13 ","$0.00 ","$125.58 ","$0.00 ","$0.00 ","$105.49 ","$602.50 ","$0.00 ","$301.25 ","$477.18 ","$482.00 ","$0.00 ","$94.29 ","$0.00 ","$95.92 ","$0.00 "
"75405535","SUP","HCPCS C1713","","75405535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75405540","SUP","HCPCS C1713","","75405540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75405545","SUP","HCPCS C1713","","75405545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75406535","SUP","HCPCS C1713","","75406535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75406540","SUP","HCPCS C1713","","75406540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75406545","SUP","HCPCS C1713","","75406545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75407535","SUP","HCPCS C1713","","75407535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75407540","SUP","HCPCS C1713","","75407540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75407545","SUP","HCPCS C1713","","75407545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75407550","SUP","HCPCS C1713","","75407550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444020","SUP","HCPCS C1713","","75444020  -  SCREW BN FLUT 4MM 20MM STRL LGC CD HZN G4 TCH MA ST LCK MECH","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444025","SUP","HCPCS C1713","","75444025  -  SCREW BN 4MM 25MM STRL CD HZN LGC MA TI PDCL SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444030","SUP","HCPCS C1713","","75444030  -  SCREW BN FLUT 4MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK MECH","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444040","SUP","HCPCS C1713","","75444040  -  SCREW BN FLUT 4MM 40MM STRL LGC CD HZN G4 TCH MA ST LCK MECH","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444045","SUP","HCPCS C1713","","75444045  -  SCREW BN 4MM 45MM STRL CD HZN LGC MA TI SPNE PDCL 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444050","SUP","HCPCS C1713","","75444050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444520","SUP","HCPCS C1713","","75444520  -  SCREW BN FLUT 4.5MM 20MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444525","SUP","HCPCS C1713","","75444525  -  SCREW BN FLUT 4.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444530","SUP","HCPCS C1713","","75444530  -  SCREW BN FLUT 4.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444535","SUP","HCPCS C1713","","75444535  -  SCREW BN FLUT 4.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444540","SUP","HCPCS C1713","","75444540  -  SCREW BN FLUT 4.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444545","SUP","HCPCS C1713","","75444545  -  SCREW BN FLUT 4.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75444550","SUP","HCPCS C1713","","75444550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445020","SUP","HCPCS C1713","","75445020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445025","SUP","HCPCS C1713","","75445025  -  SCREW BN FLUT 5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445030","SUP","HCPCS C1713","","75445030  -  SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445035","SUP","HCPCS C1713","","75445035  -  SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445040","SUP","HCPCS C1713","","75445040  -  SCREW BN FLUT 5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445045","SUP","HCPCS C1713","","75445045  -  SCREW BN FLUT 5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445050","SUP","HCPCS C1713","","75445050  -  SCREW BN FLUT 5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445520","SUP","HCPCS C1713","","75445520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445525","SUP","HCPCS C1713","","75445525  -  SCREW BN FLUT 5.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445530","SUP","HCPCS C1713","","75445530  -  SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445535","SUP","HCPCS C1713","","75445535  -  SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445540","SUP","HCPCS C1713","","75445540  -  SCREW BN FLUT 5.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445545","SUP","HCPCS C1713","","75445545  -  SCREW BN FLUT 5.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445550","SUP","HCPCS C1713","","75445550  -  SCREW BN FLUT 5.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445555","SUP","HCPCS C1713","","75445555  -  SCREW BN FLUT 5.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75445560","SUP","HCPCS C1713","","75445560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446025","SUP","HCPCS C1713","","75446025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446030","SUP","HCPCS C1713","","75446030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446035","SUP","HCPCS C1713","","75446035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446040","SUP","HCPCS C1713","","75446040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446045","SUP","HCPCS C1713","","75446045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446050","SUP","HCPCS C1713","","75446050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446055","SUP","HCPCS C1713","","75446055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446060","SUP","HCPCS C1713","","75446060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446070","SUP","HCPCS C1713","","75446070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446520","SUP","HCPCS C1713","","75446520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446525","SUP","HCPCS C1713","","75446525  -  SCREW BN FLUT 6.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446530","SUP","HCPCS C1713","","75446530  -  SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446535","SUP","HCPCS C1713","","75446535  -  SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446540","SUP","HCPCS C1713","","75446540  -  SCREW BN FLUT 6.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446545","SUP","HCPCS C1713","","75446545  -  SCREW BN FLUT 6.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446550","SUP","HCPCS C1713","","75446550  -  SCREW BN FLUT 6.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446555","SUP","HCPCS C1713","","75446555  -  SCREW BN FLUT 6.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446560","SUP","HCPCS C1713","","75446560  -  SCREW BN FLUT 6.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75446565","SUP","HCPCS C1713","","75446565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447525","SUP","HCPCS C1713","","75447525  -  SCREW BN FLUT 7.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447530","SUP","HCPCS C1713","","75447530  -  SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447535","SUP","HCPCS C1713","","75447535  -  SCREW BN FLUT 7.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447540","SUP","HCPCS C1713","","75447540  -  SCREW BN FLUT 7.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447545","SUP","HCPCS C1713","","75447545  -  SCREW BN FLUT 7.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447550","SUP","HCPCS C1713","","75447550  -  SCREW BN FLUT 7.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447555","SUP","HCPCS C1713","","75447555  -  SCREW BN FLUT 7.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447560","SUP","HCPCS C1713","","75447560  -  SCREW BN FLUT 7.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447565","SUP","HCPCS C1713","","75447565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75447570","SUP","HCPCS C1713","","75447570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448525","SUP","HCPCS C1713","","75448525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448530","SUP","HCPCS C1713","","75448530  -  SCREW BN FLUT 8.5MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448535","SUP","HCPCS C1713","","75448535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448540","SUP","HCPCS C1713","","75448540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448545","SUP","HCPCS C1713","","75448545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448550","SUP","HCPCS C1713","","75448550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448555","SUP","HCPCS C1713","","75448555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448560","SUP","HCPCS C1713","","75448560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75448565","SUP","HCPCS C1713","","75448565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75454020","SUP","HCPCS C1713","","75454020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454025","SUP","HCPCS C1713","","75454025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454030","SUP","HCPCS C1713","","75454030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454035","SUP","HCPCS C1713","","75454035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454040","SUP","HCPCS C1713","","75454040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454045","SUP","HCPCS C1713","","75454045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454050","SUP","HCPCS C1713","","75454050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454520","SUP","HCPCS C1713","","75454520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454525","SUP","HCPCS C1713","","75454525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454530","SUP","HCPCS C1713","","75454530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454535","SUP","HCPCS C1713","","75454535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454540","SUP","HCPCS C1713","","75454540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454545","SUP","HCPCS C1713","","75454545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75454550","SUP","HCPCS C1713","","75454550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455020","SUP","HCPCS C1713","","75455020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455025","SUP","HCPCS C1713","","75455025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455030","SUP","HCPCS C1713","","75455030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455035","SUP","HCPCS C1713","","75455035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455040","SUP","HCPCS C1713","","75455040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455045","SUP","HCPCS C1713","","75455045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455050","SUP","HCPCS C1713","","75455050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455520","SUP","HCPCS C1713","","75455520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455525","SUP","HCPCS C1713","","75455525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455530","SUP","HCPCS C1713","","75455530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455535","SUP","HCPCS C1713","","75455535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455540","SUP","HCPCS C1713","","75455540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455545","SUP","HCPCS C1713","","75455545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455550","SUP","HCPCS C1713","","75455550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455555","SUP","HCPCS C1713","","75455555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75455560","SUP","HCPCS C1713","","75455560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456020","SUP","HCPCS C1713","","75456020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456025","SUP","HCPCS C1713","","75456025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456030","SUP","HCPCS C1713","","75456030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456035","SUP","HCPCS C1713","","75456035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456040","SUP","HCPCS C1713","","75456040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456045","SUP","HCPCS C1713","","75456045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456050","SUP","HCPCS C1713","","75456050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456055","SUP","HCPCS C1713","","75456055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456060","SUP","HCPCS C1713","","75456060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456065","SUP","HCPCS C1713","","75456065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456070","SUP","HCPCS C1713","","75456070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456520","SUP","HCPCS C1713","","75456520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456525","SUP","HCPCS C1713","","75456525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456530","SUP","HCPCS C1713","","75456530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456535","SUP","HCPCS C1713","","75456535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456540","SUP","HCPCS C1713","","75456540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456545","SUP","HCPCS C1713","","75456545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456550","SUP","HCPCS C1713","","75456550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456555","SUP","HCPCS C1713","","75456555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456560","SUP","HCPCS C1713","","75456560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75456565","SUP","HCPCS C1713","","75456565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457525","SUP","HCPCS C1713","","75457525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457530","SUP","HCPCS C1713","","75457530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457535","SUP","HCPCS C1713","","75457535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457540","SUP","HCPCS C1713","","75457540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457545","SUP","HCPCS C1713","","75457545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457550","SUP","HCPCS C1713","","75457550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457555","SUP","HCPCS C1713","","75457555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457560","SUP","HCPCS C1713","","75457560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457565","SUP","HCPCS C1713","","75457565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75457570","SUP","HCPCS C1713","","75457570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458525","SUP","HCPCS C1713","","75458525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458530","SUP","HCPCS C1713","","75458530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458535","SUP","HCPCS C1713","","75458535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458540","SUP","HCPCS C1713","","75458540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458545","SUP","HCPCS C1713","","75458545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458550","SUP","HCPCS C1713","","75458550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458555","SUP","HCPCS C1713","","75458555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458560","SUP","HCPCS C1713","","75458560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75458565","SUP","HCPCS C1713","","75458565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,643.00 ","$1,955.82 ","$0.00 ","$2,643.00 ","$1,189.35 ","$0.00 ","$550.87 ","$0.00 ","$0.00 ","$462.77 ","$2,643.00 ","$0.00 ","$1,321.50 ","$2,093.26 ","$2,114.40 ","$0.00 ","$413.63 ","$0.00 ","$420.77 ","$0.00 "
"75464015","SUP","HCPCS C1713","","75464015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464020","SUP","HCPCS C1713","","75464020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464025","SUP","HCPCS C1713","","75464025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464030","SUP","HCPCS C1713","","75464030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464035","SUP","HCPCS C1713","","75464035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464040","SUP","HCPCS C1713","","75464040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464045","SUP","HCPCS C1713","","75464045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464050","SUP","HCPCS C1713","","75464050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464055","SUP","HCPCS C1713","","75464055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464060","SUP","HCPCS C1713","","75464060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464515","SUP","HCPCS C1713","","75464515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464520","SUP","HCPCS C1713","","75464520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464525","SUP","HCPCS C1713","","75464525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464530","SUP","HCPCS C1713","","75464530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464535","SUP","HCPCS C1713","","75464535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464540","SUP","HCPCS C1713","","75464540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464545","SUP","HCPCS C1713","","75464545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464550","SUP","HCPCS C1713","","75464550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464555","SUP","HCPCS C1713","","75464555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75464560","SUP","HCPCS C1713","","75464560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465015","SUP","HCPCS C1713","","75465015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465020","SUP","HCPCS C1713","","75465020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465025","SUP","HCPCS C1713","","75465025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465030","SUP","HCPCS C1713","","75465030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465035","SUP","HCPCS C1713","","75465035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465040","SUP","HCPCS C1713","","75465040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465045","SUP","HCPCS C1713","","75465045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465050","SUP","HCPCS C1713","","75465050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465055","SUP","HCPCS C1713","","75465055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465060","SUP","HCPCS C1713","","75465060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465515","SUP","HCPCS C1713","","75465515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465520","SUP","HCPCS C1713","","75465520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465525","SUP","HCPCS C1713","","75465525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75465530","SUP","HCPCS C1713","","75465530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75470735","SUP","Custom 27803010","","75470735  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470740","SUP","Custom 27803010","","75470740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470745","SUP","Custom 27803010","","75470745  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470750","SUP","Custom 27803010","","75470750  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470755","SUP","Custom 27803010","","75470755  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470760","SUP","Custom 27803010","","75470760  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470865","SUP","Custom 27803010","","75470865  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470870","SUP","Custom 27803010","","75470870  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75470875","SUP","Custom 27803010","","75470875  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75494520","SUP","HCPCS C1713","","75494520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75494525","SUP","HCPCS C1713","","75494525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75494530","SUP","HCPCS C1713","","75494530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75494535","SUP","HCPCS C1713","","75494535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75494540","SUP","HCPCS C1713","","75494540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75494545","SUP","HCPCS C1713","","75494545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75494550","SUP","HCPCS C1713","","75494550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495020","SUP","HCPCS C1713","","75495020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495025","SUP","HCPCS C1713","","75495025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495030","SUP","HCPCS C1713","","75495030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495035","SUP","HCPCS C1713","","75495035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495040","SUP","HCPCS C1713","","75495040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495045","SUP","HCPCS C1713","","75495045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495050","SUP","HCPCS C1713","","75495050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495520","SUP","HCPCS C1713","","75495520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495525","SUP","HCPCS C1713","","75495525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495530","SUP","HCPCS C1713","","75495530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495535","SUP","HCPCS C1713","","75495535  -  SCREW BN 5.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495540","SUP","HCPCS C1713","","75495540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495545","SUP","HCPCS C1713","","75495545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495550","SUP","HCPCS C1713","","75495550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495555","SUP","HCPCS C1713","","75495555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75495560","SUP","HCPCS C1713","","75495560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496520","SUP","HCPCS C1713","","75496520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496525","SUP","HCPCS C1713","","75496525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496530","SUP","HCPCS C1713","","75496530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496535","SUP","HCPCS C1713","","75496535  -  SCREW BN 6.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496540","SUP","HCPCS C1713","","75496540  -  SCREW BN 6.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496545","SUP","HCPCS C1713","","75496545  -  SCREW BN 6.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496550","SUP","HCPCS C1713","","75496550  -  SCREW BN 6.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496555","SUP","HCPCS C1713","","75496555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496560","SUP","HCPCS C1713","","75496560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75496565","SUP","HCPCS C1713","","75496565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497525","SUP","HCPCS C1713","","75497525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497530","SUP","HCPCS C1713","","75497530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497535","SUP","HCPCS C1713","","75497535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497540","SUP","HCPCS C1713","","75497540  -  SCREW BN 7.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497545","SUP","HCPCS C1713","","75497545  -  SCREW BN 7.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497550","SUP","HCPCS C1713","","75497550  -  SCREW BN 7.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497555","SUP","HCPCS C1713","","75497555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497560","SUP","HCPCS C1713","","75497560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497565","SUP","HCPCS C1713","","75497565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75497570","SUP","HCPCS C1713","","75497570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498525","SUP","HCPCS C1713","","75498525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498530","SUP","HCPCS C1713","","75498530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498535","SUP","HCPCS C1713","","75498535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498540","SUP","HCPCS C1713","","75498540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498545","SUP","HCPCS C1713","","75498545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498550","SUP","HCPCS C1713","","75498550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498555","SUP","HCPCS C1713","","75498555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498560","SUP","HCPCS C1713","","75498560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75498565","SUP","HCPCS C1713","","75498565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644020","SUP","HCPCS C1713","","75644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644025","SUP","HCPCS C1713","","75644025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644030","SUP","HCPCS C1713","","75644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644035","SUP","HCPCS C1713","","75644035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644040","SUP","HCPCS C1713","","75644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644045","SUP","HCPCS C1713","","75644045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644050","SUP","HCPCS C1713","","75644050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644520","SUP","HCPCS C1713","","75644520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644525","SUP","HCPCS C1713","","75644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644530","SUP","HCPCS C1713","","75644530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644535","SUP","HCPCS C1713","","75644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644540","SUP","HCPCS C1713","","75644540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644545","SUP","HCPCS C1713","","75644545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75644550","SUP","HCPCS C1713","","75644550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645020","SUP","HCPCS C1713","","75645020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645025","SUP","HCPCS C1713","","75645025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645030","SUP","HCPCS C1713","","75645030  -  SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645035","SUP","HCPCS C1713","","75645035  -  SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645040","SUP","HCPCS C1713","","75645040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645045","SUP","HCPCS C1713","","75645045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645050","SUP","HCPCS C1713","","75645050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645520","SUP","HCPCS C1713","","75645520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645525","SUP","HCPCS C1713","","75645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645530","SUP","HCPCS C1713","","75645530  -  SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645535","SUP","HCPCS C1713","","75645535  -  SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645540","SUP","HCPCS C1713","","75645540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645545","SUP","HCPCS C1713","","75645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645550","SUP","HCPCS C1713","","75645550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645555","SUP","HCPCS C1713","","75645555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75645560","SUP","HCPCS C1713","","75645560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646025","SUP","HCPCS C1713","","75646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646030","SUP","HCPCS C1713","","75646030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646035","SUP","HCPCS C1713","","75646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646040","SUP","HCPCS C1713","","75646040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646045","SUP","HCPCS C1713","","75646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646050","SUP","HCPCS C1713","","75646050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646055","SUP","HCPCS C1713","","75646055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646060","SUP","HCPCS C1713","","75646060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646065","SUP","HCPCS C1713","","75646065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646070","SUP","HCPCS C1713","","75646070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646520","SUP","HCPCS C1713","","75646520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646525","SUP","HCPCS C1713","","75646525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646530","SUP","HCPCS C1713","","75646530  -  SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646535","SUP","HCPCS C1713","","75646535  -  SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646540","SUP","HCPCS C1713","","75646540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646545","SUP","HCPCS C1713","","75646545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646550","SUP","HCPCS C1713","","75646550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646555","SUP","HCPCS C1713","","75646555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646560","SUP","HCPCS C1713","","75646560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75646565","SUP","HCPCS C1713","","75646565  -  SCREW BN FLUT 6.5MM 65MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647525","SUP","HCPCS C1713","","75647525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647530","SUP","HCPCS C1713","","75647530  -  SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647535","SUP","HCPCS C1713","","75647535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647540","SUP","HCPCS C1713","","75647540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647545","SUP","HCPCS C1713","","75647545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647550","SUP","HCPCS C1713","","75647550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647555","SUP","HCPCS C1713","","75647555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647560","SUP","HCPCS C1713","","75647560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647565","SUP","HCPCS C1713","","75647565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75647570","SUP","HCPCS C1713","","75647570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648525","SUP","HCPCS C1713","","75648525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648530","SUP","HCPCS C1713","","75648530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648535","SUP","HCPCS C1713","","75648535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648540","SUP","HCPCS C1713","","75648540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648545","SUP","HCPCS C1713","","75648545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648550","SUP","HCPCS C1713","","75648550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648555","SUP","HCPCS C1713","","75648555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648560","SUP","HCPCS C1713","","75648560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75648565","SUP","HCPCS C1713","","75648565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75654020","SUP","HCPCS C1713","","75654020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654025","SUP","HCPCS C1713","","75654025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654030","SUP","HCPCS C1713","","75654030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654035","SUP","HCPCS C1713","","75654035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654040","SUP","HCPCS C1713","","75654040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654045","SUP","HCPCS C1713","","75654045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654050","SUP","HCPCS C1713","","75654050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654520","SUP","HCPCS C1713","","75654520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654525","SUP","HCPCS C1713","","75654525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654530","SUP","HCPCS C1713","","75654530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654535","SUP","HCPCS C1713","","75654535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654540","SUP","HCPCS C1713","","75654540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654545","SUP","HCPCS C1713","","75654545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75654550","SUP","HCPCS C1713","","75654550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655020","SUP","HCPCS C1713","","75655020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655025","SUP","HCPCS C1713","","75655025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655030","SUP","HCPCS C1713","","75655030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655035","SUP","HCPCS C1713","","75655035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655040","SUP","HCPCS C1713","","75655040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655045","SUP","HCPCS C1713","","75655045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655050","SUP","HCPCS C1713","","75655050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655520","SUP","HCPCS C1713","","75655520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655525","SUP","HCPCS C1713","","75655525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655530","SUP","HCPCS C1713","","75655530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655535","SUP","HCPCS C1713","","75655535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655540","SUP","HCPCS C1713","","75655540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655545","SUP","HCPCS C1713","","75655545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655550","SUP","HCPCS C1713","","75655550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655555","SUP","HCPCS C1713","","75655555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75655560","SUP","HCPCS C1713","","75655560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656020","SUP","HCPCS C1713","","75656020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656025","SUP","HCPCS C1713","","75656025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656030","SUP","HCPCS C1713","","75656030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656035","SUP","HCPCS C1713","","75656035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656040","SUP","HCPCS C1713","","75656040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656045","SUP","HCPCS C1713","","75656045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656050","SUP","HCPCS C1713","","75656050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656055","SUP","HCPCS C1713","","75656055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656060","SUP","HCPCS C1713","","75656060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656065","SUP","HCPCS C1713","","75656065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656070","SUP","HCPCS C1713","","75656070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656520","SUP","HCPCS C1713","","75656520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656525","SUP","HCPCS C1713","","75656525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656530","SUP","HCPCS C1713","","75656530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656535","SUP","HCPCS C1713","","75656535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656540","SUP","HCPCS C1713","","75656540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656545","SUP","HCPCS C1713","","75656545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656550","SUP","HCPCS C1713","","75656550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656555","SUP","HCPCS C1713","","75656555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656560","SUP","HCPCS C1713","","75656560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75656565","SUP","HCPCS C1713","","75656565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657525","SUP","HCPCS C1713","","75657525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657530","SUP","HCPCS C1713","","75657530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657535","SUP","HCPCS C1713","","75657535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657540","SUP","HCPCS C1713","","75657540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657545","SUP","HCPCS C1713","","75657545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657550","SUP","HCPCS C1713","","75657550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657555","SUP","HCPCS C1713","","75657555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657560","SUP","HCPCS C1713","","75657560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657565","SUP","HCPCS C1713","","75657565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75657570","SUP","HCPCS C1713","","75657570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658525","SUP","HCPCS C1713","","75658525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658530","SUP","HCPCS C1713","","75658530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658535","SUP","HCPCS C1713","","75658535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658540","SUP","HCPCS C1713","","75658540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658545","SUP","HCPCS C1713","","75658545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658550","SUP","HCPCS C1713","","75658550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658555","SUP","HCPCS C1713","","75658555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658560","SUP","HCPCS C1713","","75658560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75658565","SUP","HCPCS C1713","","75658565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,452.50 ","$1,814.85 ","$0.00 ","$2,452.50 ","$1,103.63 ","$0.00 ","$511.16 ","$0.00 ","$0.00 ","$429.41 ","$2,452.50 ","$0.00 ","$1,226.25 ","$1,942.38 ","$1,962.00 ","$0.00 ","$383.82 ","$0.00 ","$390.44 ","$0.00 "
"75694520","SUP","HCPCS C1713","","75694520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75694525","SUP","HCPCS C1713","","75694525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75694530","SUP","HCPCS C1713","","75694530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75694535","SUP","HCPCS C1713","","75694535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75694540","SUP","HCPCS C1713","","75694540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75694545","SUP","HCPCS C1713","","75694545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75694550","SUP","HCPCS C1713","","75694550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695020","SUP","HCPCS C1713","","75695020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695025","SUP","HCPCS C1713","","75695025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695030","SUP","HCPCS C1713","","75695030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695035","SUP","HCPCS C1713","","75695035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695040","SUP","HCPCS C1713","","75695040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695045","SUP","HCPCS C1713","","75695045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695050","SUP","HCPCS C1713","","75695050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695520","SUP","HCPCS C1713","","75695520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695525","SUP","HCPCS C1713","","75695525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695530","SUP","HCPCS C1713","","75695530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695535","SUP","HCPCS C1713","","75695535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695540","SUP","HCPCS C1713","","75695540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695545","SUP","HCPCS C1713","","75695545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695550","SUP","HCPCS C1713","","75695550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695555","SUP","HCPCS C1713","","75695555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75695560","SUP","HCPCS C1713","","75695560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696520","SUP","HCPCS C1713","","75696520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696525","SUP","HCPCS C1713","","75696525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696530","SUP","HCPCS C1713","","75696530  -  SCREW BN FLUT 6.5MM 30MM CD HZN LGC MA RDC SS SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696535","SUP","HCPCS C1713","","75696535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696540","SUP","HCPCS C1713","","75696540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696545","SUP","HCPCS C1713","","75696545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696550","SUP","HCPCS C1713","","75696550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696555","SUP","HCPCS C1713","","75696555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696560","SUP","HCPCS C1713","","75696560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75696565","SUP","HCPCS C1713","","75696565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697525","SUP","HCPCS C1713","","75697525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697530","SUP","HCPCS C1713","","75697530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697535","SUP","HCPCS C1713","","75697535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697540","SUP","HCPCS C1713","","75697540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697545","SUP","HCPCS C1713","","75697545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697550","SUP","HCPCS C1713","","75697550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697555","SUP","HCPCS C1713","","75697555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697560","SUP","HCPCS C1713","","75697560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697565","SUP","HCPCS C1713","","75697565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75697570","SUP","HCPCS C1713","","75697570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698525","SUP","HCPCS C1713","","75698525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698530","SUP","HCPCS C1713","","75698530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698535","SUP","HCPCS C1713","","75698535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698540","SUP","HCPCS C1713","","75698540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698545","SUP","HCPCS C1713","","75698545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698550","SUP","HCPCS C1713","","75698550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698555","SUP","HCPCS C1713","","75698555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698560","SUP","HCPCS C1713","","75698560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"75698565","SUP","HCPCS C1713","","75698565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76440020","SUP","HCPCS C1713","","76440020  -  SCREW BONE 20MM CD HZN LGC PDCL TI MULTIAX 5.5MM ROD STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"76444020","SUP","HCPCS C1713","","76444020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444025","SUP","HCPCS C1713","","76444025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444030","SUP","HCPCS C1713","","76444030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444035","SUP","HCPCS C1713","","76444035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444040","SUP","HCPCS C1713","","76444040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444045","SUP","HCPCS C1713","","76444045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444050","SUP","HCPCS C1713","","76444050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444520","SUP","HCPCS C1713","","76444520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444525","SUP","HCPCS C1713","","76444525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444530","SUP","HCPCS C1713","","76444530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444535","SUP","HCPCS C1713","","76444535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444540","SUP","HCPCS C1713","","76444540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444545","SUP","HCPCS C1713","","76444545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76444550","SUP","HCPCS C1713","","76444550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445020","SUP","HCPCS C1713","","76445020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445025","SUP","HCPCS C1713","","76445025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445030","SUP","HCPCS C1713","","76445030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445035","SUP","HCPCS C1713","","76445035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445040","SUP","HCPCS C1713","","76445040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445045","SUP","HCPCS C1713","","76445045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445050","SUP","HCPCS C1713","","76445050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445520","SUP","HCPCS C1713","","76445520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445525","SUP","HCPCS C1713","","76445525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445530","SUP","HCPCS C1713","","76445530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445535","SUP","HCPCS C1713","","76445535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445540","SUP","HCPCS C1713","","76445540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445545","SUP","HCPCS C1713","","76445545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445550","SUP","HCPCS C1713","","76445550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445555","SUP","HCPCS C1713","","76445555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76445560","SUP","HCPCS C1713","","76445560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446025","SUP","HCPCS C1713","","76446025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446030","SUP","HCPCS C1713","","76446030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446035","SUP","HCPCS C1713","","76446035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446040","SUP","HCPCS C1713","","76446040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446045","SUP","HCPCS C1713","","76446045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446050","SUP","HCPCS C1713","","76446050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446055","SUP","HCPCS C1713","","76446055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446060","SUP","HCPCS C1713","","76446060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446065","SUP","HCPCS C1713","","76446065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446070","SUP","HCPCS C1713","","76446070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446075","SUP","HCPCS C1713","","76446075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446520","SUP","HCPCS C1713","","76446520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446525","SUP","HCPCS C1713","","76446525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446530","SUP","HCPCS C1713","","76446530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446535","SUP","HCPCS C1713","","76446535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446540","SUP","HCPCS C1713","","76446540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446545","SUP","HCPCS C1713","","76446545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446550","SUP","HCPCS C1713","","76446550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446555","SUP","HCPCS C1713","","76446555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446560","SUP","HCPCS C1713","","76446560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446565","SUP","HCPCS C1713","","76446565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446570","SUP","HCPCS C1713","","76446570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76446575","SUP","HCPCS C1713","","76446575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447525","SUP","HCPCS C1713","","76447525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447530","SUP","HCPCS C1713","","76447530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447535","SUP","HCPCS C1713","","76447535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447540","SUP","HCPCS C1713","","76447540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447545","SUP","HCPCS C1713","","76447545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447550","SUP","HCPCS C1713","","76447550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447555","SUP","HCPCS C1713","","76447555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447560","SUP","HCPCS C1713","","76447560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447565","SUP","HCPCS C1713","","76447565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447570","SUP","HCPCS C1713","","76447570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76447575","SUP","HCPCS C1713","","76447575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448525","SUP","HCPCS C1713","","76448525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448530","SUP","HCPCS C1713","","76448530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448535","SUP","HCPCS C1713","","76448535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448540","SUP","HCPCS C1713","","76448540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448545","SUP","HCPCS C1713","","76448545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448550","SUP","HCPCS C1713","","76448550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448555","SUP","HCPCS C1713","","76448555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448560","SUP","HCPCS C1713","","76448560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448565","SUP","HCPCS C1713","","76448565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448570","SUP","HCPCS C1713","","76448570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76448575","SUP","HCPCS C1713","","76448575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494520","SUP","HCPCS C1713","","76494520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494525","SUP","HCPCS C1713","","76494525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494530","SUP","HCPCS C1713","","76494530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494535","SUP","HCPCS C1713","","76494535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494540","SUP","HCPCS C1713","","76494540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494545","SUP","HCPCS C1713","","76494545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76494550","SUP","HCPCS C1713","","76494550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495020","SUP","HCPCS C1713","","76495020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495025","SUP","HCPCS C1713","","76495025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495030","SUP","HCPCS C1713","","76495030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495035","SUP","HCPCS C1713","","76495035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495040","SUP","HCPCS C1713","","76495040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495045","SUP","HCPCS C1713","","76495045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495050","SUP","HCPCS C1713","","76495050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495520","SUP","HCPCS C1713","","76495520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495525","SUP","HCPCS C1713","","76495525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495530","SUP","HCPCS C1713","","76495530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495535","SUP","HCPCS C1713","","76495535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495540","SUP","HCPCS C1713","","76495540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495545","SUP","HCPCS C1713","","76495545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495550","SUP","HCPCS C1713","","76495550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495555","SUP","HCPCS C1713","","76495555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76495560","SUP","HCPCS C1713","","76495560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496525","SUP","HCPCS C1713","","76496525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496530","SUP","HCPCS C1713","","76496530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496535","SUP","HCPCS C1713","","76496535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496540","SUP","HCPCS C1713","","76496540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496545","SUP","HCPCS C1713","","76496545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496550","SUP","HCPCS C1713","","76496550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496555","SUP","HCPCS C1713","","76496555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496560","SUP","HCPCS C1713","","76496560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496565","SUP","HCPCS C1713","","76496565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496570","SUP","HCPCS C1713","","76496570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76496575","SUP","HCPCS C1713","","76496575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497525","SUP","HCPCS C1713","","76497525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497530","SUP","HCPCS C1713","","76497530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497535","SUP","HCPCS C1713","","76497535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497540","SUP","HCPCS C1713","","76497540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497545","SUP","HCPCS C1713","","76497545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497550","SUP","HCPCS C1713","","76497550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497555","SUP","HCPCS C1713","","76497555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497560","SUP","HCPCS C1713","","76497560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497565","SUP","HCPCS C1713","","76497565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497570","SUP","HCPCS C1713","","76497570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76497575","SUP","HCPCS C1713","","76497575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498525","SUP","HCPCS C1713","","76498525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498530","SUP","HCPCS C1713","","76498530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498535","SUP","HCPCS C1713","","76498535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498540","SUP","HCPCS C1713","","76498540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498545","SUP","HCPCS C1713","","76498545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498550","SUP","HCPCS C1713","","76498550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498555","SUP","HCPCS C1713","","76498555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498560","SUP","HCPCS C1713","","76498560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498565","SUP","HCPCS C1713","","76498565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498570","SUP","HCPCS C1713","","76498570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76498575","SUP","HCPCS C1713","","76498575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644020","SUP","HCPCS C1713","","76644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644025","SUP","HCPCS C1713","","76644025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644030","SUP","HCPCS C1713","","76644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644035","SUP","HCPCS C1713","","76644035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644040","SUP","HCPCS C1713","","76644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644045","SUP","HCPCS C1713","","76644045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644050","SUP","HCPCS C1713","","76644050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644520","SUP","HCPCS C1713","","76644520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644525","SUP","HCPCS C1713","","76644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644530","SUP","HCPCS C1713","","76644530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644535","SUP","HCPCS C1713","","76644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644540","SUP","HCPCS C1713","","76644540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644545","SUP","HCPCS C1713","","76644545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76644550","SUP","HCPCS C1713","","76644550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645020","SUP","HCPCS C1713","","76645020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645025","SUP","HCPCS C1713","","76645025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645030","SUP","HCPCS C1713","","76645030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645035","SUP","HCPCS C1713","","76645035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645040","SUP","HCPCS C1713","","76645040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645045","SUP","HCPCS C1713","","76645045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645050","SUP","HCPCS C1713","","76645050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645520","SUP","HCPCS C1713","","76645520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645525","SUP","HCPCS C1713","","76645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645530","SUP","HCPCS C1713","","76645530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645535","SUP","HCPCS C1713","","76645535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645540","SUP","HCPCS C1713","","76645540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645545","SUP","HCPCS C1713","","76645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645550","SUP","HCPCS C1713","","76645550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645555","SUP","HCPCS C1713","","76645555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76645560","SUP","HCPCS C1713","","76645560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646025","SUP","HCPCS C1713","","76646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646030","SUP","HCPCS C1713","","76646030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646035","SUP","HCPCS C1713","","76646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646040","SUP","HCPCS C1713","","76646040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646045","SUP","HCPCS C1713","","76646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646050","SUP","HCPCS C1713","","76646050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646055","SUP","HCPCS C1713","","76646055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646060","SUP","HCPCS C1713","","76646060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646065","SUP","HCPCS C1713","","76646065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646070","SUP","HCPCS C1713","","76646070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646075","SUP","HCPCS C1713","","76646075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646525","SUP","HCPCS C1713","","76646525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646530","SUP","HCPCS C1713","","76646530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646535","SUP","HCPCS C1713","","76646535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646540","SUP","HCPCS C1713","","76646540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646545","SUP","HCPCS C1713","","76646545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646550","SUP","HCPCS C1713","","76646550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646555","SUP","HCPCS C1713","","76646555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646560","SUP","HCPCS C1713","","76646560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646565","SUP","HCPCS C1713","","76646565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646570","SUP","HCPCS C1713","","76646570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76646575","SUP","HCPCS C1713","","76646575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647525","SUP","HCPCS C1713","","76647525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647530","SUP","HCPCS C1713","","76647530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647535","SUP","HCPCS C1713","","76647535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647540","SUP","HCPCS C1713","","76647540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647545","SUP","HCPCS C1713","","76647545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647550","SUP","HCPCS C1713","","76647550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647555","SUP","HCPCS C1713","","76647555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647560","SUP","HCPCS C1713","","76647560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647565","SUP","HCPCS C1713","","76647565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647570","SUP","HCPCS C1713","","76647570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76647575","SUP","HCPCS C1713","","76647575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648525","SUP","HCPCS C1713","","76648525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648530","SUP","HCPCS C1713","","76648530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648535","SUP","HCPCS C1713","","76648535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648540","SUP","HCPCS C1713","","76648540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648545","SUP","HCPCS C1713","","76648545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648550","SUP","HCPCS C1713","","76648550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648555","SUP","HCPCS C1713","","76648555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648560","SUP","HCPCS C1713","","76648560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648565","SUP","HCPCS C1713","","76648565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648570","SUP","HCPCS C1713","","76648570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76648575","SUP","HCPCS C1713","","76648575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694520","SUP","HCPCS C1713","","76694520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694525","SUP","HCPCS C1713","","76694525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694530","SUP","HCPCS C1713","","76694530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694535","SUP","HCPCS C1713","","76694535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694540","SUP","HCPCS C1713","","76694540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694545","SUP","HCPCS C1713","","76694545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76694550","SUP","HCPCS C1713","","76694550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695020","SUP","HCPCS C1713","","76695020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695025","SUP","HCPCS C1713","","76695025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695030","SUP","HCPCS C1713","","76695030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695035","SUP","HCPCS C1713","","76695035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695040","SUP","HCPCS C1713","","76695040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695045","SUP","HCPCS C1713","","76695045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695050","SUP","HCPCS C1713","","76695050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695520","SUP","HCPCS C1713","","76695520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695525","SUP","HCPCS C1713","","76695525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695530","SUP","HCPCS C1713","","76695530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695535","SUP","HCPCS C1713","","76695535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695540","SUP","HCPCS C1713","","76695540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695545","SUP","HCPCS C1713","","76695545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695550","SUP","HCPCS C1713","","76695550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695555","SUP","HCPCS C1713","","76695555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76695560","SUP","HCPCS C1713","","76695560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696525","SUP","HCPCS C1713","","76696525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696530","SUP","HCPCS C1713","","76696530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696535","SUP","HCPCS C1713","","76696535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696540","SUP","HCPCS C1713","","76696540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696545","SUP","HCPCS C1713","","76696545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696550","SUP","HCPCS C1713","","76696550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696555","SUP","HCPCS C1713","","76696555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696560","SUP","HCPCS C1713","","76696560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696565","SUP","HCPCS C1713","","76696565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696570","SUP","HCPCS C1713","","76696570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76696575","SUP","HCPCS C1713","","76696575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697525","SUP","HCPCS C1713","","76697525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697530","SUP","HCPCS C1713","","76697530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697535","SUP","HCPCS C1713","","76697535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697540","SUP","HCPCS C1713","","76697540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697545","SUP","HCPCS C1713","","76697545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697550","SUP","HCPCS C1713","","76697550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697555","SUP","HCPCS C1713","","76697555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697560","SUP","HCPCS C1713","","76697560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697565","SUP","HCPCS C1713","","76697565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697570","SUP","HCPCS C1713","","76697570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76697575","SUP","HCPCS C1713","","76697575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698525","SUP","HCPCS C1713","","76698525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698530","SUP","HCPCS C1713","","76698530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698535","SUP","HCPCS C1713","","76698535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698540","SUP","HCPCS C1713","","76698540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698545","SUP","HCPCS C1713","","76698545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698550","SUP","HCPCS C1713","","76698550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698555","SUP","HCPCS C1713","","76698555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698560","SUP","HCPCS C1713","","76698560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698565","SUP","HCPCS C1713","","76698565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698570","SUP","HCPCS C1713","","76698570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"76698575","SUP","HCPCS C1713","","76698575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"77101050","SUP","HCPCS C1762","","77101050  -  GRAFT SFT TIS ALGRF","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"77101054","SUP","Custom 27803010","","77101054  -  SPACER CMNT 4D 14X12X5MM CERV SPNL BONE PLUG","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77101060","SUP","HCPCS C1713","","77101060  -  SPACER ALGRF 0D 14X12X6MM BIO AVS OPN PLG CRV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101064","SUP","Custom 27803010","","77101064  -  SPACER CMNT 4D 14X12X6MM CERV SPNL BONE PLUG","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77101070","SUP","HCPCS C1713","","77101070  -  PLATE 0D 8MM HOLE BONE CERV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101074","SUP","HCPCS C1713","","77101074  -  PLATE 4D 7IN HOLE BONE CERV SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101080","SUP","HCPCS C1713","","77101080  -  PLATE 0D 7MM HOLE BONE CERV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101084","SUP","HCPCS C1713","","77101084  -  SCREW BONE 8MM 14MM 12MM SPNL WDG","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101090","SUP","HCPCS C1713","","77101090  -  PLATE 0D 9MM HOLE BONE CERV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101094","SUP","HCPCS C1713","","77101094  -  SPACER ALGRF 4D 14X12X9MM BIO AVS OPN PLG CRV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77101100","SUP","Custom 27803010","","77101100  -  SPACER SPNL 14X12X10MM AVS 0D CAGE BIO","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102050","SUP","HCPCS C1713","","77102050  -  PLATE 0D 14X12IN N LORD CCANC 5 HOLE BONE","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77102054","SUP","Custom 27803010","","77102054  -  SPACER SPNL 5MM AVS 4D BONE PLUG BABSR","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102060","SUP","HCPCS C1713","","77102060  -  PLATE 0D 14X12IN N LORD CCANC 6 HOLE BONE","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77102064","SUP","Custom 27803010","","77102064  -  SPACER SPNL 6MM AVS 4D BONE PLUG BABSR","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102070","SUP","HCPCS C1713","","77102070  -  PLATE 0D 14X12IN N LORD CCANC 7 HOLE BONE","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77102074","SUP","Custom 27803010","","77102074  -  SPACER SPNL 7MM AVS 4D BONE PLUG BABSR","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102084","SUP","Custom 27803010","","77102084  -  SPACER SPNL 8MM AVS 4D BONE PLUG BABSR","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102090","SUP","HCPCS C1713","","77102090  -  PLATE 0D 14X12IN N LORD CCANC 9 HOLE BONE","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77102094","SUP","Custom 27803010","","77102094  -  SPACER ALGRF 4D LORDOSIS 12MM 14X9MM BIO AVS PRESERVON FRZDR","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102100","SUP","Custom 27803010","","77102100  -  SPACER ALGRF 4D 14X12X10MM BIO AVS OPN PLG CRV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77102104","SUP","HCPCS C1713","","77102104  -  SPACER ALGRF 4D LORDOSIS 12MM 14X10MM BIO AVS FRZDR C PLG 1","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$3,003.75 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$1,168.74 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$1,062.66 ","$0.00 "
"77562815","SUP","Custom 27203010","","77562815  -  BIT DRILL FLEXIBLE 3.2MM","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77805200","SUP","HCPCS C1887","","CATHETER GUID XB3 CURVE 7FR .078IN 100CM PTFE VSBR BLUE YLW","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"77805500","SUP","HCPCS C1887","","CATHETER GUID XB3.5 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"77805600","SUP","HCPCS C1887","","CATHETER GUID XB4 CURVE 7FR .078IN 100CM PTFE VSBR BLUE YLW","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"77827100","SUP","HCPCS C1887","","CATHETER GUID MPA1 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"80008455","SUP","HCPCS C1892","","612603 - INTRODUCER SHTH 7FR 19CM 16CM TRAW ADPR DILAT SET INDN SPNLK","BOTH IP/OP","$69.35 ","$51.32 ","$0.00 ","$69.35 ","$37.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.14 ","$69.35 ","$0.00 ","$34.68 ","$54.93 ","$55.48 ","$0.00 ","$10.85 ","$0.00 ","$11.04 ","$0.00 "
"80100100","SUP","HCPCS C1769","","80100100  -  GUIDEWIRE ORTH .045IN","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$20.36 ","$0.00 ","$7.82 ","$0.00 ","$0.00 ","$6.57 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$5.87 ","$0.00 ","$5.97 ","$0.00 "
"80100101","SUP","HCPCS C1769","","80100101  -  GUIDEWIRE SRG .035IN","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$20.36 ","$0.00 ","$7.82 ","$0.00 ","$0.00 ","$6.57 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$5.87 ","$0.00 ","$5.97 ","$0.00 "
"80100102","SUP","Custom 27203010","","80100102  -  WIRE FX .035IN 7IN KRSH STRG","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80100103","SUP","Custom 27203010","","80100103  -  WIRE FX .035IN KRSH BIOTRACK","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80100125","SUP","Custom 27203010","","80100125  -  HANDLE QRLSE SCRDRVR NONSTRL","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80200102","SUP","HCPCS C1713","","80200102  -  PIN FIX 203MM 4.8MM RUSH A IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200103","SUP","HCPCS C1713","","80200103  -  PIN FIX 222MM 4.8MM RUSH B IM SS NONSTRL","BOTH IP/OP","$1,183.00 ","$875.42 ","$0.00 ","$1,183.00 ","$642.37 ","$0.00 ","$246.57 ","$844.31 ","$844.31 ","$207.13 ","$1,183.00 ","$0.00 ","$591.50 ","$156.82 ","$946.40 ","$0.00 ","$185.14 ","$0.00 ","$188.33 ","$0.00 "
"80200104","SUP","HCPCS C1713","","80200104  -  PIN FIX 241MM 4.8MM RUSH C IM SS NONSTRL","BOTH IP/OP","$163.00 ","$120.62 ","$0.00 ","$163.00 ","$88.51 ","$0.00 ","$33.97 ","$116.33 ","$116.33 ","$28.54 ","$163.00 ","$0.00 ","$81.50 ","$156.82 ","$130.40 ","$0.00 ","$25.51 ","$0.00 ","$25.95 ","$0.00 "
"80200105","SUP","HCPCS C1713","","80200105  -  PIN FIX 260MM 4.8MM RUSH D IM SS NONSTRL","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$156.82 ","$47.78 ","$0.00 ","$18.34 ","$62.81 ","$62.81 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$156.82 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"80200106","SUP","HCPCS C1713","","80200106  -  PIN FIX 279MM 4.8MM RUSH E IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200107","SUP","HCPCS C1713","","80200107  -  PIN FIX 298MM 4.8MM RUSH F IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200108","SUP","HCPCS C1713","","80200108  -  PIN FIX 318MM 4.8MM RUSH G IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200109","SUP","HCPCS C1713","","80200109  -  PIN FIX 337MM 4.8MM RUSH H IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200110","SUP","HCPCS C1713","","80200110  -  PIN FIX 35.6CM 4.8MM RUSH I IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200111","SUP","HCPCS C1713","","80200111  -  PIN FIX 18.4CM 4.8MM RUSH A1 IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200112","SUP","HCPCS C1713","","80200112  -  PIN FIX 37.5CM 4.8MM RUSH J IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200113","SUP","HCPCS C1713","","80200113  -  PIN FIX 39.4CM 4.8MM RUSH K IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200114","SUP","HCPCS C1713","","80200114  -  PIN FIX 41.3CM 4.8MM RUSH L IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200115","SUP","HCPCS C1713","","80200115  -  PIN FIX 43.2CM 4.8MM RUSH M IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200116","SUP","HCPCS C1713","","80200116  -  PIN FIX 45.1CM 4.8MM RUSH N IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80200117","SUP","HCPCS C1713","","80200117  -  PIN FIX 47CM 4.8MM RUSH O IM SS NONSTRL","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$41.27 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"80202700","SUP","HCPCS C1713","","80202700  -  SET TRAUMA FIX 4.8MM RACK RUSH NONSTRL","BOTH IP/OP","$7,028.00 ","$5,200.72 ","$0.00 ","$7,028.00 ","$3,162.60 ","$0.00 ","$1,464.81 ","$0.00 ","$0.00 ","$1,230.55 ","$7,028.00 ","$0.00 ","$3,514.00 ","$5,566.18 ","$5,622.40 ","$0.00 ","$1,099.88 ","$0.00 ","$1,118.86 ","$0.00 "
"80300102","SUP","HCPCS C1713","","80300102  -  PIN FIX 102MM 3.2MM RUSH IM","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300103","SUP","HCPCS C1713","","80300103  -  PIN FX 1/8IN 4.5IN RUSH MDLRY","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300104","SUP","HCPCS C1713","","80300104  -  PIN FIX 127MM 3.2MM RUSH C IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300105","SUP","HCPCS C1713","","80300105  -  PIN FIX 140MM 3.2MM RUSH D IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300106","SUP","HCPCS C1713","","80300106  -  PIN FIX 152MM 3.2MM RUSH E IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300107","SUP","HCPCS C1713","","80300107  -  PIN FIX 165MM 3.2MM RUSH F IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300108","SUP","HCPCS C1713","","80300108  -  PIN FIX 178MM 3.2MM RUSH G IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300109","SUP","HCPCS C1713","","80300109  -  PIN FIX 191MM 3.2MM RUSH H IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300110","SUP","HCPCS C1713","","80300110  -  PIN FIX 203MM 3.2MM RUSH I IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300111","SUP","HCPCS C1713","","80300111  -  PIN FIX 216MM 3.2MM RUSH J IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300112","SUP","HCPCS C1713","","80300112  -  PIN FIX 229MM 3.2MM RUSH K IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300113","SUP","HCPCS C1713","","80300113  -  PIN FIX 241MM 3.2MM RUSH L IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300114","SUP","HCPCS C1713","","80300114  -  PIN FIX 254MM 3.2MM RUSH M IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80300120","SUP","HCPCS C1713","","80300120  -  PIN FIX 267MM 3.2MM RUSH N IM SS NONSTRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$168.30 ","$75.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$29.47 ","$168.30 ","$0.00 ","$84.15 ","$133.29 ","$134.64 ","$0.00 ","$26.34 ","$0.00 ","$26.79 ","$0.00 "
"80302700","SUP","HCPCS C1713","","80302700  -  SET TRAUMA FIX 3.2MM RACK RUSH NONSTRL","BOTH IP/OP","$5,604.00 ","$4,146.96 ","$0.00 ","$5,604.00 ","$2,521.80 ","$0.00 ","$1,168.01 ","$0.00 ","$0.00 ","$981.22 ","$5,604.00 ","$0.00 ","$2,802.00 ","$4,438.37 ","$4,483.20 ","$0.00 ","$877.03 ","$0.00 ","$892.16 ","$0.00 "
"80322944","SUP","HCPCS C1713","","186801020  -  PLATE BN 20MM NS SKYLINE 1 LVL SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"80400102","SUP","HCPCS C1713","","80400102  -  PIN FIX 2.5CM 2.4MM RUSH A IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400103","SUP","HCPCS C1713","","80400103  -  PIN FIX 3.2CM 2.4MM RUSH B IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400104","SUP","HCPCS C1713","","80400104  -  PIN FIX 3.8CM 2.4MM RUSH C IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400105","SUP","HCPCS C1713","","80400105  -  PIN FIX 4.5CM 2.4MM RUSH D IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400106","SUP","HCPCS C1713","","80400106  -  PIN FIX 5.1CM 2.4MM RUSH E IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400107","SUP","HCPCS C1713","","80400107  -  PIN FIX 5.7CM 2.4MM RUSH F IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400108","SUP","HCPCS C1713","","80400108  -  PIN FIX 6.4CM 2.4MM RUSH G IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400109","SUP","HCPCS C1713","","80400109  -  PIN FIX 7CM 2.4MM RUSH H IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400110","SUP","HCPCS C1713","","80400110  -  PIN FIX 7.6CM 2.4MM RUSH I IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400111","SUP","HCPCS C1713","","80400111  -  PIN FIX 8.3CM 2.4MM RUSH J IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400112","SUP","HCPCS C1713","","80400112  -  PIN FIX 8.9CM 2.4MM RUSH K IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400113","SUP","HCPCS C1713","","80400113  -  PIN FIX 9.5CM 2.4MM RUSH L IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80400114","SUP","HCPCS C1713","","80400114  -  PIN FIX 10.2CM 2.4MM RUSH M IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80402700","SUP","HCPCS C1713","","80402700  -  SET TRAUMA FIX 2.4MM RACK RUSH NONSTRL","BOTH IP/OP","$8,110.00 ","$6,001.40 ","$0.00 ","$8,110.00 ","$3,649.50 ","$0.00 ","$1,690.33 ","$0.00 ","$0.00 ","$1,420.00 ","$8,110.00 ","$0.00 ","$4,055.00 ","$6,423.12 ","$6,488.00 ","$0.00 ","$1,269.22 ","$0.00 ","$1,291.11 ","$0.00 "
"80600103","SUP","HCPCS C1713","","80600103  -  PIN FIX 11.4CM 2.4MM RUSH N LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600104","SUP","HCPCS C1713","","80600104  -  PIN FIX 12.7CM 2.4MM RUSH O LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600105","SUP","HCPCS C1713","","80600105  -  PIN FIX 14CM 2.4MM RUSH P LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600106","SUP","HCPCS C1713","","80600106  -  PIN FIX 15.2CM 2.4MM RUSH Q LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600107","SUP","HCPCS C1713","","80600107  -  PIN FIX 16.5CM 2.4MM RUSH R LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600108","SUP","HCPCS C1713","","80600108  -  PIN FIX 17.8CM 2.4MM RUSH S LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600109","SUP","HCPCS C1713","","80600109  -  PIN 19.1CM 2.4MM RUSH T LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600110","SUP","HCPCS C1713","","80600110  -  PIN FIX 20.3CM 2.4MM RUSH U LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600111","SUP","HCPCS C1713","","80600111  -  PIN FIX 21.6CM 2.4MM RUSH V LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600112","SUP","HCPCS C1713","","80600112  -  PIN FIX 22.9CM 2.4MM RUSH W LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600113","SUP","HCPCS C1713","","80600113  -  PIN FIX 24.1CM 2.4MM RUSH X LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"80600114","SUP","HCPCS C1713","","80600114  -  PIN FIX 25.4CM 2.4MM RUSH Y LNG IM SS NONSTRL","BOTH IP/OP","$150.70 ","$111.52 ","$0.00 ","$150.70 ","$67.82 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$26.39 ","$150.70 ","$0.00 ","$75.35 ","$119.35 ","$120.56 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"83545201","SUP","HCPCS C1713","","83545201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545251","SUP","HCPCS C1713","","83545251  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545301","SUP","HCPCS C1713","","83545301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545306","SUP","HCPCS C1713","","83545306  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545309","SUP","HCPCS C1713","","83545309  -  SCREW BN 4.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545351","SUP","HCPCS C1713","","83545351  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545356","SUP","HCPCS C1713","","83545356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545359","SUP","HCPCS C1713","","83545359  -  SCREW BN 4.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545401","SUP","HCPCS C1713","","83545401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545406","SUP","HCPCS C1713","","83545406  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545409","SUP","HCPCS C1713","","83545409  -  SCREW BN 4.5MM 40MM 3DX TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545451","SUP","HCPCS C1713","","83545451  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545456","SUP","HCPCS C1713","","83545456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545459","SUP","HCPCS C1713","","83545459  -  SCREW BN 4.5MM 45MM TSRH OSTEOGRIP THNLN SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545501","SUP","HCPCS C1713","","83545501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545506","SUP","HCPCS C1713","","83545506  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545509","SUP","HCPCS C1713","","83545509  -  SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545551","SUP","HCPCS C1713","","83545551  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545556","SUP","HCPCS C1713","","83545556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545559","SUP","HCPCS C1713","","83545559  -  SCREW BN 4.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545601","SUP","HCPCS C1713","","83545601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83545606","SUP","HCPCS C1713","","83545606  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83545609","SUP","HCPCS C1713","","83545609  -  SCREW BN 4.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555201","SUP","HCPCS C1713","","83555201  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555251","SUP","HCPCS C1713","","83555251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555301","SUP","HCPCS C1713","","83555301  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555306","SUP","HCPCS C1713","","83555306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555307","SUP","HCPCS C1713","","83555307  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555308","SUP","HCPCS C1713","","83555308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83555309","SUP","HCPCS C1713","","83555309  -  SCREW BN 5.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555351","SUP","HCPCS C1713","","83555351  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555356","SUP","HCPCS C1713","","83555356  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555357","SUP","HCPCS C1713","","83555357  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555358","SUP","HCPCS C1713","","83555358  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83555359","SUP","HCPCS C1713","","83555359  -  SCREW BN 5.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555401","SUP","HCPCS C1713","","83555401  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555406","SUP","HCPCS C1713","","83555406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555407","SUP","HCPCS C1713","","83555407  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555408","SUP","HCPCS C1713","","83555408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83555409","SUP","HCPCS C1713","","83555409  -  SCREW BN 5.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555451","SUP","HCPCS C1713","","83555451  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555456","SUP","HCPCS C1713","","83555456  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555457","SUP","HCPCS C1713","","83555457  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555458","SUP","HCPCS C1713","","83555458  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83555459","SUP","HCPCS C1713","","83555459  -  SCREW BN 5.5MM 45MM TSRH THNLN OSTEOGRIP SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555501","SUP","HCPCS C1713","","83555501  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555506","SUP","HCPCS C1713","","83555506  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555507","SUP","HCPCS C1713","","83555507  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555508","SUP","HCPCS C1713","","83555508  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83555509","SUP","HCPCS C1713","","83555509  -  SCREW BN 5.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555551","SUP","HCPCS C1713","","83555551  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555556","SUP","HCPCS C1713","","83555556  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555557","SUP","HCPCS C1713","","83555557  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555559","SUP","HCPCS C1713","","83555559  -  SCREW BN 5.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555601","SUP","HCPCS C1713","","83555601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83555606","SUP","HCPCS C1713","","83555606  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83555607","SUP","HCPCS C1713","","83555607  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83555608","SUP","HCPCS C1713","","83555608  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83555609","SUP","HCPCS C1713","","83555609  -  SCREW BN 5.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565201","SUP","HCPCS C1713","","83565201  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565251","SUP","HCPCS C1713","","83565251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565259","SUP","HCPCS C1713","","83565259  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565301","SUP","HCPCS C1713","","83565301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565306","SUP","HCPCS C1713","","83565306  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565307","SUP","HCPCS C1713","","83565307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565308","SUP","HCPCS C1713","","83565308  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565309","SUP","HCPCS C1713","","83565309  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565351","SUP","HCPCS C1713","","83565351  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565356","SUP","HCPCS C1713","","83565356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565357","SUP","HCPCS C1713","","83565357  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565358","SUP","HCPCS C1713","","83565358  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565359","SUP","HCPCS C1713","","83565359  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565401","SUP","HCPCS C1713","","83565401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565406","SUP","HCPCS C1713","","83565406  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565407","SUP","HCPCS C1713","","83565407  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565408","SUP","HCPCS C1713","","83565408  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565409","SUP","HCPCS C1713","","83565409  -  SCREW BN 6.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565451","SUP","HCPCS C1713","","83565451  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565454","SUP","HCPCS C1713","","83565454  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565456","SUP","HCPCS C1713","","83565456  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565457","SUP","HCPCS C1713","","83565457  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565458","SUP","HCPCS C1713","","83565458  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565459","SUP","HCPCS C1713","","83565459  -  SCREW BN 6.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565501","SUP","HCPCS C1713","","83565501  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565504","SUP","HCPCS C1713","","83565504  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565506","SUP","HCPCS C1713","","83565506  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565507","SUP","HCPCS C1713","","83565507  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565508","SUP","HCPCS C1713","","83565508  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565509","SUP","HCPCS C1713","","83565509  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565551","SUP","HCPCS C1713","","83565551  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565554","SUP","HCPCS C1713","","83565554  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565556","SUP","HCPCS C1713","","83565556  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565557","SUP","HCPCS C1713","","83565557  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565558","SUP","HCPCS C1713","","83565558  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565559","SUP","HCPCS C1713","","83565559  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565601","SUP","HCPCS C1713","","83565601  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83565606","SUP","HCPCS C1713","","83565606  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83565607","SUP","HCPCS C1713","","83565607  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83565608","SUP","HCPCS C1713","","83565608  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83565609","SUP","HCPCS C1713","","83565609  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575201","SUP","HCPCS C1713","","83575201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575251","SUP","HCPCS C1713","","83575251  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575301","SUP","HCPCS C1713","","83575301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575306","SUP","HCPCS C1713","","83575306  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575307","SUP","HCPCS C1713","","83575307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575308","SUP","HCPCS C1713","","83575308  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575309","SUP","HCPCS C1713","","83575309  -  SCREW BN 7.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575351","SUP","HCPCS C1713","","83575351  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575356","SUP","HCPCS C1713","","83575356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575357","SUP","HCPCS C1713","","83575357  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575358","SUP","HCPCS C1713","","83575358  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575359","SUP","HCPCS C1713","","83575359  -  SCREW BN 7.5MM 35MM TSRH OSTEOGRIP RECON TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575401","SUP","HCPCS C1713","","83575401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575406","SUP","HCPCS C1713","","83575406  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575407","SUP","HCPCS C1713","","83575407  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575408","SUP","HCPCS C1713","","83575408  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575409","SUP","HCPCS C1713","","83575409  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575451","SUP","HCPCS C1713","","83575451  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575456","SUP","HCPCS C1713","","83575456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575457","SUP","HCPCS C1713","","83575457  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575458","SUP","HCPCS C1713","","83575458  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575459","SUP","HCPCS C1713","","83575459  -  SCREW BN 7.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE PDCL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575501","SUP","HCPCS C1713","","83575501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575506","SUP","HCPCS C1713","","83575506  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575507","SUP","HCPCS C1713","","83575507  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575508","SUP","HCPCS C1713","","83575508  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575509","SUP","HCPCS C1713","","83575509  -  SCREW BN 7.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575551","SUP","HCPCS C1713","","83575551  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575556","SUP","HCPCS C1713","","83575556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575557","SUP","HCPCS C1713","","83575557  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575558","SUP","HCPCS C1713","","83575558  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575559","SUP","HCPCS C1713","","83575559  -  SCREW BN 7.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575601","SUP","HCPCS C1713","","83575601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83575606","SUP","HCPCS C1713","","83575606  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83575607","SUP","HCPCS C1713","","83575607  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83575608","SUP","HCPCS C1713","","83575608  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"83575609","SUP","HCPCS C1713","","83575609  -  SCREW BN 7.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585201","SUP","HCPCS C1713","","83585201  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585251","SUP","HCPCS C1713","","83585251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585301","SUP","HCPCS C1713","","83585301  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585306","SUP","HCPCS C1713","","83585306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585307","SUP","HCPCS C1713","","83585307  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585309","SUP","HCPCS C1713","","83585309  -  SCREW BN 8.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE PDCL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585351","SUP","HCPCS C1713","","83585351  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585356","SUP","HCPCS C1713","","83585356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585357","SUP","HCPCS C1713","","83585357  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585359","SUP","HCPCS C1713","","83585359  -  SCREW BN 8.5MM 35MM TSRH OSTEOGRIP THNLN SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585401","SUP","HCPCS C1713","","83585401  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585406","SUP","HCPCS C1713","","83585406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585407","SUP","HCPCS C1713","","83585407  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585409","SUP","HCPCS C1713","","83585409  -  SCREW BN 8.5MM 40MM TSRH OSTEOGRIP THNLN SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585451","SUP","HCPCS C1713","","83585451  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585456","SUP","HCPCS C1713","","83585456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585457","SUP","HCPCS C1713","","83585457  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585459","SUP","HCPCS C1713","","83585459  -  SCREW BN 8.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585501","SUP","HCPCS C1713","","83585501  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585506","SUP","HCPCS C1713","","83585506  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585507","SUP","HCPCS C1713","","83585507  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585509","SUP","HCPCS C1713","","83585509  -  SCREW BN 8.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585551","SUP","HCPCS C1713","","83585551  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585556","SUP","HCPCS C1713","","83585556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585557","SUP","HCPCS C1713","","83585557  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585559","SUP","HCPCS C1713","","83585559  -  SCREW BN 8.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585601","SUP","HCPCS C1713","","83585601  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"83585606","SUP","HCPCS C1713","","83585606  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$742.50 ","$0.00 ","$343.90 ","$0.00 ","$0.00 ","$288.90 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$258.23 ","$0.00 ","$262.68 ","$0.00 "
"83585607","SUP","HCPCS C1713","","83585607  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$810.00 ","$0.00 ","$375.17 ","$0.00 ","$0.00 ","$315.17 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$281.70 ","$0.00 ","$286.56 ","$0.00 "
"83585609","SUP","HCPCS C1713","","83585609  -  SCREW BN 8.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$1,072.50 ","$793.65 ","$0.00 ","$1,072.50 ","$482.63 ","$0.00 ","$223.54 ","$0.00 ","$0.00 ","$187.79 ","$1,072.50 ","$0.00 ","$536.25 ","$849.42 ","$858.00 ","$0.00 ","$167.85 ","$0.00 ","$170.74 ","$0.00 "
"86944520","SUP","HCPCS C1713","","86944520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86944525","SUP","HCPCS C1713","","86944525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86944530","SUP","HCPCS C1713","","86944530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86944535","SUP","HCPCS C1713","","86944535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86944540","SUP","HCPCS C1713","","86944540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86944545","SUP","HCPCS C1713","","86944545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86944550","SUP","HCPCS C1713","","86944550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945020","SUP","HCPCS C1713","","86945020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945025","SUP","HCPCS C1713","","86945025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945030","SUP","HCPCS C1713","","86945030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945035","SUP","HCPCS C1713","","86945035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945040","SUP","HCPCS C1713","","86945040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945045","SUP","HCPCS C1713","","86945045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945050","SUP","HCPCS C1713","","86945050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945520","SUP","HCPCS C1713","","86945520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945525","SUP","HCPCS C1713","","86945525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945530","SUP","HCPCS C1713","","86945530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945535","SUP","HCPCS C1713","","86945535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945540","SUP","HCPCS C1713","","86945540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945545","SUP","HCPCS C1713","","86945545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945550","SUP","HCPCS C1713","","86945550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945555","SUP","HCPCS C1713","","86945555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945560","SUP","HCPCS C1713","","86945560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86945565","SUP","HCPCS C1713","","86945565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946520","SUP","HCPCS C1713","","86946520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946530","SUP","HCPCS C1713","","86946530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946535","SUP","HCPCS C1713","","86946535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946540","SUP","HCPCS C1713","","86946540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946545","SUP","HCPCS C1713","","86946545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946550","SUP","HCPCS C1713","","86946550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946555","SUP","HCPCS C1713","","86946555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946560","SUP","HCPCS C1713","","86946560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946565","SUP","HCPCS C1713","","86946565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946570","SUP","HCPCS C1713","","86946570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86946575","SUP","HCPCS C1713","","86946575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947520","SUP","HCPCS C1713","","86947520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947525","SUP","HCPCS C1713","","86947525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947530","SUP","HCPCS C1713","","86947530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947535","SUP","HCPCS C1713","","86947535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947540","SUP","HCPCS C1713","","86947540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947545","SUP","HCPCS C1713","","86947545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947550","SUP","HCPCS C1713","","86947550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947555","SUP","HCPCS C1713","","86947555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947560","SUP","HCPCS C1713","","86947560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947565","SUP","HCPCS C1713","","86947565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947570","SUP","HCPCS C1713","","86947570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86947575","SUP","HCPCS C1713","","86947575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948520","SUP","HCPCS C1713","","86948520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948525","SUP","HCPCS C1713","","86948525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948530","SUP","HCPCS C1713","","86948530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948535","SUP","HCPCS C1713","","86948535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948540","SUP","HCPCS C1713","","86948540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948545","SUP","HCPCS C1713","","86948545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948550","SUP","HCPCS C1713","","86948550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948555","SUP","HCPCS C1713","","86948555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948560","SUP","HCPCS C1713","","86948560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948565","SUP","HCPCS C1713","","86948565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948570","SUP","HCPCS C1713","","86948570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86948575","SUP","HCPCS C1713","","86948575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992320","SUP","HCPCS C1713","","86992320  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992325","SUP","HCPCS C1713","","86992325  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992330","SUP","HCPCS C1713","","86992330  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992335","SUP","HCPCS C1713","","86992335  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992340","SUP","HCPCS C1713","","86992340  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992345","SUP","HCPCS C1713","","86992345  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992350","SUP","HCPCS C1713","","86992350  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992420","SUP","HCPCS C1713","","86992420  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992425","SUP","HCPCS C1713","","86992425  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992430","SUP","HCPCS C1713","","86992430  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992435","SUP","HCPCS C1713","","86992435  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992440","SUP","HCPCS C1713","","86992440  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992445","SUP","HCPCS C1713","","86992445  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992450","SUP","HCPCS C1713","","86992450  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992525","SUP","HCPCS C1713","","86992525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992530","SUP","HCPCS C1713","","86992530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992535","SUP","HCPCS C1713","","86992535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992540","SUP","HCPCS C1713","","86992540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992545","SUP","HCPCS C1713","","86992545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992550","SUP","HCPCS C1713","","86992550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992555","SUP","HCPCS C1713","","86992555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992625","SUP","HCPCS C1713","","86992625  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992630","SUP","HCPCS C1713","","86992630  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992635","SUP","HCPCS C1713","","86992635  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992640","SUP","HCPCS C1713","","86992640  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992645","SUP","HCPCS C1713","","86992645  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992650","SUP","HCPCS C1713","","86992650  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992655","SUP","HCPCS C1713","","86992655  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992725","SUP","HCPCS C1713","","86992725  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992730","SUP","HCPCS C1713","","86992730  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992735","SUP","HCPCS C1713","","86992735  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992740","SUP","HCPCS C1713","","86992740  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992745","SUP","HCPCS C1713","","86992745  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"86992750","SUP","HCPCS C1713","","86992750  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88900101","SUP","HCPCS C1713","","88900101  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900102","SUP","HCPCS C1713","","88900102  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900105","SUP","HCPCS C1713","","88900105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900107","SUP","HCPCS C1713","","88900107  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900108","SUP","HCPCS C1713","","88900108  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900109","SUP","HCPCS C1713","","88900109  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900110","SUP","HCPCS C1713","","88900110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900111","SUP","HCPCS C1713","","88900111  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900113","SUP","HCPCS C1713","","88900113  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900114","SUP","HCPCS C1713","","88900114  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900201","SUP","HCPCS C1713","","88900201  -  HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900202","SUP","HCPCS C1713","","88900202  -  HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900205","SUP","HCPCS C1713","","88900205  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900207","SUP","HCPCS C1713","","88900207  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900208","SUP","HCPCS C1713","","88900208  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900209","SUP","HCPCS C1713","","88900209  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900210","SUP","HCPCS C1713","","88900210  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900211","SUP","HCPCS C1713","","88900211  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900213","SUP","HCPCS C1713","","88900213  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88900214","SUP","HCPCS C1713","","88900214  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"88901000","SUP","HCPCS C1713","","88901000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"88905512","SUP","Custom 27803010","","88905512  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88905522","SUP","Custom 27803010","","88905522  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88905532","SUP","Custom 27803010","","88905532  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88924520","SUP","HCPCS C1713","","88924520  -  SCREW BN 4.5MM 20MM TSRH SILO FA TI SPNE 5.5MM ROD","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88924525","SUP","HCPCS C1713","","88924525  -  SCREW BN 4.5MM 25MM TSRH SILO FA TI SPNE 5.5MM ROD","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88924530","SUP","HCPCS C1713","","88924530  -  SCREW BN 4.5MM 30MM TSRH SILO FA TI SPNE 5.5MM ROD","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88924535","SUP","HCPCS C1713","","88924535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88924540","SUP","HCPCS C1713","","88924540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88924545","SUP","HCPCS C1713","","88924545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88924550","SUP","HCPCS C1713","","88924550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925025","SUP","HCPCS C1713","","88925025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925030","SUP","HCPCS C1713","","88925030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925035","SUP","HCPCS C1713","","88925035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925040","SUP","HCPCS C1713","","88925040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925045","SUP","HCPCS C1713","","88925045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925050","SUP","HCPCS C1713","","88925050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925055","SUP","HCPCS C1713","","88925055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925525","SUP","HCPCS C1713","","88925525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925530","SUP","HCPCS C1713","","88925530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925535","SUP","HCPCS C1713","","88925535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925540","SUP","HCPCS C1713","","88925540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925545","SUP","HCPCS C1713","","88925545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925550","SUP","HCPCS C1713","","88925550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88925555","SUP","HCPCS C1713","","88925555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926525","SUP","HCPCS C1713","","88926525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926530","SUP","HCPCS C1713","","88926530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926535","SUP","HCPCS C1713","","88926535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926540","SUP","HCPCS C1713","","88926540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926545","SUP","HCPCS C1713","","88926545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926550","SUP","HCPCS C1713","","88926550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926555","SUP","HCPCS C1713","","88926555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88926560","SUP","HCPCS C1713","","88926560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927530","SUP","HCPCS C1713","","88927530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927535","SUP","HCPCS C1713","","88927535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927540","SUP","HCPCS C1713","","88927540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927545","SUP","HCPCS C1713","","88927545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927550","SUP","HCPCS C1713","","88927550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927555","SUP","HCPCS C1713","","88927555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88927560","SUP","HCPCS C1713","","88927560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,906.50 ","$1,410.81 ","$0.00 ","$1,906.50 ","$857.93 ","$0.00 ","$397.36 ","$0.00 ","$0.00 ","$333.81 ","$1,906.50 ","$0.00 ","$953.25 ","$1,509.95 ","$1,525.20 ","$0.00 ","$298.37 ","$0.00 ","$303.51 ","$0.00 "
"88934520","SUP","Custom 27803010","","88934520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88934525","SUP","Custom 27803010","","88934525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88934530","SUP","HCPCS C1713","","88934530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88934535","SUP","Custom 27803010","","88934535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88935525","SUP","HCPCS C1713","","88935525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88935530","SUP","HCPCS C1713","","88935530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88935535","SUP","HCPCS C1713","","88935535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88935540","SUP","HCPCS C1713","","88935540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88935545","SUP","HCPCS C1713","","88935545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88935550","SUP","HCPCS C1713","","88935550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88935555","SUP","HCPCS C1713","","88935555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936525","SUP","HCPCS C1713","","88936525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936530","SUP","HCPCS C1713","","88936530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936535","SUP","HCPCS C1713","","88936535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936540","SUP","HCPCS C1713","","88936540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936545","SUP","HCPCS C1713","","88936545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936550","SUP","HCPCS C1713","","88936550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936555","SUP","HCPCS C1713","","88936555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88936560","SUP","HCPCS C1713","","88936560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937525","SUP","HCPCS C1713","","88937525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937530","SUP","HCPCS C1713","","88937530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937535","SUP","HCPCS C1713","","88937535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937540","SUP","HCPCS C1713","","88937540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937545","SUP","HCPCS C1713","","88937545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937550","SUP","HCPCS C1713","","88937550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937555","SUP","HCPCS C1713","","88937555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88937560","SUP","HCPCS C1713","","88937560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"88944520","SUP","HCPCS C1713","","88944520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88944525","SUP","HCPCS C1713","","88944525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88944530","SUP","HCPCS C1713","","88944530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88944535","SUP","HCPCS C1713","","88944535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88944540","SUP","HCPCS C1713","","88944540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88944545","SUP","HCPCS C1713","","88944545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88944550","SUP","HCPCS C1713","","88944550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945025","SUP","HCPCS C1713","","88945025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945030","SUP","HCPCS C1713","","88945030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945035","SUP","HCPCS C1713","","88945035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945040","SUP","HCPCS C1713","","88945040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945045","SUP","HCPCS C1713","","88945045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945050","SUP","HCPCS C1713","","88945050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945055","SUP","HCPCS C1713","","88945055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945525","SUP","HCPCS C1713","","88945525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945530","SUP","HCPCS C1713","","88945530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945535","SUP","HCPCS C1713","","88945535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945540","SUP","HCPCS C1713","","88945540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945545","SUP","HCPCS C1713","","88945545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945550","SUP","HCPCS C1713","","88945550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88945555","SUP","HCPCS C1713","","88945555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946525","SUP","HCPCS C1713","","88946525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946530","SUP","HCPCS C1713","","88946530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946535","SUP","HCPCS C1713","","88946535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946540","SUP","HCPCS C1713","","88946540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946545","SUP","HCPCS C1713","","88946545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946550","SUP","HCPCS C1713","","88946550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946555","SUP","HCPCS C1713","","88946555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88946560","SUP","HCPCS C1713","","88946560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947525","SUP","HCPCS C1713","","88947525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947530","SUP","HCPCS C1713","","88947530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947535","SUP","HCPCS C1713","","88947535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947540","SUP","HCPCS C1713","","88947540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947545","SUP","HCPCS C1713","","88947545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947550","SUP","HCPCS C1713","","88947550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947555","SUP","HCPCS C1713","","88947555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947560","SUP","HCPCS C1713","","88947560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947565","SUP","HCPCS C1713","","88947565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"88947570","SUP","HCPCS C1713","","88947570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,658.00 ","$1,966.92 ","$0.00 ","$2,658.00 ","$1,196.10 ","$0.00 ","$553.99 ","$0.00 ","$0.00 ","$465.39 ","$2,658.00 ","$0.00 ","$1,329.00 ","$2,105.14 ","$2,126.40 ","$0.00 ","$415.98 ","$0.00 ","$423.15 ","$0.00 "
"98716200","SUP","HCPCS C1713","","98716200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"98716250","SUP","HCPCS C1713","","98716250  -  SCREW BN 6.5MM 25MM PRMD VA TI SPNE ANT","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"98716300","SUP","HCPCS C1713","","98716300  -  SCREW BN 6.5MM 30MM PRMD VA TI SPNE ANT","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"98716350","SUP","HCPCS C1713","","98716350  -  SCREW BN 6.5MM 35MM PRMD VA TI SPNE ANT","BOTH IP/OP","$880.50 ","$651.57 ","$0.00 ","$880.50 ","$396.23 ","$0.00 ","$183.52 ","$0.00 ","$0.00 ","$154.17 ","$880.50 ","$0.00 ","$440.25 ","$697.36 ","$704.40 ","$0.00 ","$137.80 ","$0.00 ","$140.18 ","$0.00 "
"99415530","SUP","HCPCS C1713","","99415530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99415535","SUP","HCPCS C1713","","99415535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99415540","SUP","HCPCS C1713","","99415540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99415545","SUP","HCPCS C1713","","99415545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99415550","SUP","HCPCS C1713","","99415550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99415555","SUP","HCPCS C1713","","99415555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99416530","SUP","HCPCS C1713","","99416530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99416535","SUP","HCPCS C1713","","99416535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99416540","SUP","HCPCS C1713","","99416540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99416545","SUP","HCPCS C1713","","99416545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99416550","SUP","HCPCS C1713","","99416550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99417535","SUP","HCPCS C1713","","99417535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99417540","SUP","HCPCS C1713","","99417540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99417545","SUP","HCPCS C1713","","99417545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99417550","SUP","HCPCS C1713","","99417550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"99435530","SUP","Custom 27803010","","99435530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99435535","SUP","Custom 27803010","","99435535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99435540","SUP","Custom 27803010","","99435540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99435545","SUP","Custom 27803010","","99435545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99435550","SUP","Custom 27803010","","99435550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99435555","SUP","Custom 27803010","","99435555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436530","SUP","Custom 27803010","","99436530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436535","SUP","Custom 27803010","","99436535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436540","SUP","Custom 27803010","","99436540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436545","SUP","Custom 27803010","","99436545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436550","SUP","Custom 27803010","","99436550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436555","SUP","Custom 27803010","","99436555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99436560","SUP","Custom 27803010","","99436560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99437535","SUP","Custom 27803010","","99437535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99437540","SUP","HCPCS C1713","","99437540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$741.15 ","$0.00 ","$343.28 ","$0.00 ","$0.00 ","$288.38 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$257.76 ","$0.00 ","$262.20 ","$0.00 "
"99437545","SUP","HCPCS C1713","","99437545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$741.15 ","$0.00 ","$343.28 ","$0.00 ","$0.00 ","$288.38 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$257.76 ","$0.00 ","$262.20 ","$0.00 "
"99437550","SUP","Custom 27803010","","99437550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99437555","SUP","Custom 27803010","","99437555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99437560","SUP","Custom 27803010","","99437560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,647.00 ","$1,218.78 ","$0.00 ","$1,647.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,647.00 ","$0.00 ","$823.50 ","$1,304.42 ","$1,317.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453105","SUP","HCPCS C1713","","99453105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"99453110","SUP","HCPCS C1713","","99453110  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$201.00 ","$148.74 ","$0.00 ","$201.00 ","$90.45 ","$0.00 ","$41.89 ","$0.00 ","$0.00 ","$35.19 ","$201.00 ","$0.00 ","$100.50 ","$159.19 ","$160.80 ","$0.00 ","$31.46 ","$0.00 ","$32.00 ","$0.00 "
"99453115","SUP","HCPCS C1713","","99453115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"99453200","SUP","Custom 27803010","","99453200  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453201","SUP","Custom 27803010","","99453201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453202","SUP","Custom 27803010","","99453202  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453301","SUP","HCPCS C1713","","99453301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$718.39 ","$0.00 ","$332.73 ","$0.00 ","$0.00 ","$279.52 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$249.84 ","$0.00 ","$254.15 ","$0.00 "
"99453302","SUP","Custom 27803010","","99453302  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453305","SUP","Custom 27803010","","99453305  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453306","SUP","Custom 27803010","","99453306  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,596.43 ","$1,181.36 ","$0.00 ","$1,596.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.43 ","$0.00 ","$798.21 ","$1,264.37 ","$1,277.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453501","SUP","Custom 27803010","","99453501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,183.50 ","$875.79 ","$0.00 ","$1,183.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,183.50 ","$0.00 ","$591.75 ","$937.33 ","$946.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99453502","SUP","Custom 27803010","","99453502  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,183.50 ","$875.79 ","$0.00 ","$1,183.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,183.50 ","$0.00 ","$591.75 ","$937.33 ","$946.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99460035","SUP","HCPCS C1713","","99460035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460040","SUP","HCPCS C1713","","99460040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460045","SUP","HCPCS C1713","","99460045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460050","SUP","HCPCS C1713","","99460050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460055","SUP","HCPCS C1713","","99460055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460060","SUP","HCPCS C1713","","99460060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460065","SUP","HCPCS C1713","","99460065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460070","SUP","HCPCS C1713","","99460070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460075","SUP","HCPCS C1713","","99460075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99460080","SUP","HCPCS C1713","","99460080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461035","SUP","HCPCS C1713","","99461035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461040","SUP","HCPCS C1713","","99461040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461045","SUP","HCPCS C1713","","99461045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461050","SUP","HCPCS C1713","","99461050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461055","SUP","HCPCS C1713","","99461055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461060","SUP","HCPCS C1713","","99461060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461065","SUP","HCPCS C1713","","99461065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461070","SUP","HCPCS C1713","","99461070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461075","SUP","HCPCS C1713","","99461075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99461080","SUP","HCPCS C1713","","99461080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99462040","SUP","HCPCS C1713","","99462040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99462060","SUP","HCPCS C1713","","99462060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99462080","SUP","HCPCS C1713","","99462080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99464035","SUP","HCPCS C1713","","99464035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99464040","SUP","HCPCS C1713","","99464040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99464050","SUP","HCPCS C1713","","99464050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99464060","SUP","HCPCS C1713","","99464060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99464070","SUP","HCPCS C1713","","99464070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99465106","SUP","HCPCS C1713","","99465106  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"99465115","SUP","Custom 27803010","","99465115  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99465126","SUP","HCPCS C1713","","99465126  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"99465135","SUP","HCPCS C1713","","99465135  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$109.50 ","$81.03 ","$0.00 ","$109.50 ","$49.28 ","$0.00 ","$22.82 ","$0.00 ","$0.00 ","$19.17 ","$109.50 ","$0.00 ","$54.75 ","$86.72 ","$87.60 ","$0.00 ","$17.14 ","$0.00 ","$17.43 ","$0.00 "
"99465140","SUP","HCPCS C1713","","99465140  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$192.00 ","$142.08 ","$0.00 ","$192.00 ","$86.40 ","$0.00 ","$40.02 ","$0.00 ","$0.00 ","$33.62 ","$192.00 ","$0.00 ","$96.00 ","$152.06 ","$153.60 ","$0.00 ","$30.05 ","$0.00 ","$30.57 ","$0.00 "
"99466035","SUP","HCPCS C1713","","99466035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99466040","SUP","HCPCS C1713","","99466040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99466050","SUP","HCPCS C1713","","99466050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99466060","SUP","HCPCS C1713","","99466060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99466070","SUP","HCPCS C1713","","99466070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"99467085","SUP","HCPCS C1713","","99467085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99467090","SUP","HCPCS C1713","","99467090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99467095","SUP","HCPCS C1713","","99467095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99467100","SUP","HCPCS C1713","","99467100  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467105","SUP","HCPCS C1713","","99467105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467110","SUP","HCPCS C1713","","99467110  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467115","SUP","HCPCS C1713","","99467115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467120","SUP","HCPCS C1713","","99467120  -  PLATE BN STRG 120MM TI SPNE","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467125","SUP","HCPCS C1713","","99467125  -  PLATE BN STRG 125MM TI SPNE","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467130","SUP","HCPCS C1713","","99467130  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467135","SUP","HCPCS C1713","","99467135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467140","SUP","HCPCS C1713","","99467140  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467145","SUP","HCPCS C1713","","99467145  -  PLATE BN STRG 145MM TI SPNE","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467150","SUP","HCPCS C1713","","99467150  -  PLATE BN STRG 150MM TI SPNE","BOTH IP/OP","$2,425.50 ","$1,794.87 ","$0.00 ","$2,425.50 ","$1,091.48 ","$0.00 ","$505.53 ","$0.00 ","$0.00 ","$424.69 ","$2,425.50 ","$0.00 ","$1,212.75 ","$1,921.00 ","$1,940.40 ","$0.00 ","$379.59 ","$0.00 ","$386.14 ","$0.00 "
"99467170","SUP","HCPCS C1713","","99467170  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,887.50 ","$2,136.75 ","$0.00 ","$2,887.50 ","$1,299.38 ","$0.00 ","$601.83 ","$0.00 ","$0.00 ","$505.58 ","$2,887.50 ","$0.00 ","$1,443.75 ","$2,286.90 ","$2,310.00 ","$0.00 ","$451.89 ","$0.00 ","$459.69 ","$0.00 "
"99467180","SUP","HCPCS C1713","","99467180  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,887.50 ","$2,136.75 ","$0.00 ","$2,887.50 ","$1,299.38 ","$0.00 ","$601.83 ","$0.00 ","$0.00 ","$505.58 ","$2,887.50 ","$0.00 ","$1,443.75 ","$2,286.90 ","$2,310.00 ","$0.00 ","$451.89 ","$0.00 ","$459.69 ","$0.00 "
"99467190","SUP","HCPCS C1713","","99467190  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,887.50 ","$2,136.75 ","$0.00 ","$2,887.50 ","$1,299.38 ","$0.00 ","$601.83 ","$0.00 ","$0.00 ","$505.58 ","$2,887.50 ","$0.00 ","$1,443.75 ","$2,286.90 ","$2,310.00 ","$0.00 ","$451.89 ","$0.00 ","$459.69 ","$0.00 "
"99467200","SUP","HCPCS C1713","","99467200  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,887.50 ","$2,136.75 ","$0.00 ","$2,887.50 ","$1,299.38 ","$0.00 ","$601.83 ","$0.00 ","$0.00 ","$505.58 ","$2,887.50 ","$0.00 ","$1,443.75 ","$2,286.90 ","$2,310.00 ","$0.00 ","$451.89 ","$0.00 ","$459.69 ","$0.00 "
"99468085","SUP","HCPCS C1713","","99468085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99468090","SUP","HCPCS C1713","","99468090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99468095","SUP","HCPCS C1713","","99468095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"99468100","SUP","HCPCS C1713","","99468100  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,253.00 ","$1,667.22 ","$0.00 ","$2,253.00 ","$1,013.85 ","$0.00 ","$469.58 ","$0.00 ","$0.00 ","$394.48 ","$2,253.00 ","$0.00 ","$1,126.50 ","$1,784.38 ","$1,802.40 ","$0.00 ","$352.59 ","$0.00 ","$358.68 ","$0.00 "
"100003331","SUP","Custom 27203010","","100003331  -  KIT ELTRD NS LF ENSITE NAVX SRFC DISP","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"136521000","SUP","HCPCS C1776","","136521000  -  HEAD FEM +1MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP","BOTH IP/OP","$2,985.00 ","$2,208.90 ","$0.00 ","$2,985.00 ","$1,343.25 ","$0.00 ","$622.15 ","$0.00 ","$0.00 ","$522.65 ","$2,985.00 ","$0.00 ","$1,492.50 ","$2,364.12 ","$2,388.00 ","$0.00 ","$467.15 ","$0.00 ","$475.21 ","$0.00 "
"136522000","SUP","HCPCS C1776","","136522000  -  HEAD FEM +5MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP","BOTH IP/OP","$2,985.00 ","$2,208.90 ","$0.00 ","$2,985.00 ","$1,343.25 ","$0.00 ","$622.15 ","$0.00 ","$0.00 ","$522.65 ","$2,985.00 ","$0.00 ","$1,492.50 ","$2,364.12 ","$2,388.00 ","$0.00 ","$467.15 ","$0.00 ","$475.21 ","$0.00 "
"136523000","SUP","HCPCS C1776","","136523000  -  HEAD FEM +9MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP","BOTH IP/OP","$3,045.00 ","$2,253.30 ","$0.00 ","$3,045.00 ","$1,370.25 ","$0.00 ","$634.65 ","$0.00 ","$0.00 ","$533.16 ","$3,045.00 ","$0.00 ","$1,522.50 ","$2,411.64 ","$2,436.00 ","$0.00 ","$476.54 ","$0.00 ","$484.76 ","$0.00 "
"154106000","SUP","HCPCS C1776","","154106000  -  STEM FEMORAL 1 HIGH OFFST 105MM CEMENTED HIP","BOTH IP/OP","$14,182.50 ","$10,495.05 ","$0.00 ","$14,182.50 ","$6,382.13 ","$0.00 ","$2,955.99 ","$0.00 ","$0.00 ","$2,483.24 ","$14,182.50 ","$0.00 ","$7,091.25 ","$11,232.54 ","$11,346.00 ","$0.00 ","$2,219.56 ","$0.00 ","$2,257.85 ","$0.00 "
"154118000","SUP","HCPCS C1776","","154118000  -  STEM FEMORAL 3 150MM CEMENTED EXTN PROSTALAC HIP RIGHT","BOTH IP/OP","$14,820.00 ","$10,966.80 ","$0.00 ","$14,820.00 ","$6,669.00 ","$0.00 ","$3,088.86 ","$0.00 ","$0.00 ","$2,594.86 ","$14,820.00 ","$0.00 ","$7,410.00 ","$11,737.44 ","$11,856.00 ","$0.00 ","$2,319.33 ","$0.00 ","$2,359.34 ","$0.00 "
"177300130","SUP","Custom 27803010","","177300130  -  CAGE SPNL 12MM STD PRLL 14X30MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"177306122","SUP","Custom 27803010","","177306122  -  CAGE SPNL 12MM STD LRDTC 14X22MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"177306124","SUP","Custom 27803010","","177306124  -  CAGE SPNL STD LRDTC 24X14X12MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"177306126","SUP","Custom 27803010","","177306126  -  CAGE SPNL 12MM STD LRDTC 14X26MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"177306128","SUP","Custom 27803010","","177306128  -  CAGE SPNL 12MM STD LRDTC 14X28MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"177306130","SUP","Custom 27803010","","177306130  -  CAGE SPNL 12MM STD LRDTC 14X30MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179702000","SUP","HCPCS C1713","","179702000  -  SCREW SET 1 INNER MNOAX EXPEDIUM TITANIUM SPN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"179706070","SUP","HCPCS C1713","","179706070  -  SCREW BONE 10MM 70MM T27 VIPER TITANIUM ILIUM","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"179706870","SUP","HCPCS C1713","","179706870  -  SCREW BONE 8MM 70MM VIPER TITANIUM SPN ILIUM PEDICLE T27","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"179706880","SUP","HCPCS C1713","","179706880  -  SCREW BONE 8MM 80MM VIPER TITANIUM SPN ILIUM PEDICLE T27","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"179706970","SUP","HCPCS C1713","","179706970  -  SCREW BONE 9MM 70MM VIPER TITANIUM ILIUM T27","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"179712035","SUP","HCPCS C1713","","179712035  -  SCREW BN 7.5MM 35MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712040","SUP","HCPCS C1713","","179712040  -  SCREW BN 7.5MM 40MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712045","SUP","HCPCS C1713","","179712045  -  SCREW BN 7.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712050","SUP","HCPCS C1713","","179712050  -  SCREW BN 7.5MM 50MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712055","SUP","HCPCS C1713","","179712055  -  SCREW BN 7.5MM 55MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712080","SUP","HCPCS C1713","","179712080  -  SCREW BONE 7.5MM 80MM XPDM TI SPNL POLYAX 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712420","SUP","HCPCS C1713","","179712420  -  SCREW BONE 4.35MM 20MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712425","SUP","HCPCS C1713","","179712425  -  SCREW BONE 4.35MM 25MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712430","SUP","HCPCS C1713","","179712430  -  SCREW BONE 4.35MM 30MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712435","SUP","HCPCS C1713","","179712435  -  SCREW BONE 4.35MM 35MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712440","SUP","HCPCS C1713","","179712440  -  SCREW BONE 4.35MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712445","SUP","HCPCS C1713","","179712445  -  SCREW BN 4.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712530","SUP","HCPCS C1713","","179712530  -  SCREW BONE 5MM 30MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712535","SUP","HCPCS C1713","","179712535  -  SCREW BONE 5MM 35MM 1 INNIE POLYAX EXPEDIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712540","SUP","HCPCS C1713","","179712540  -  SCREW BONE 5MM 40MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712545","SUP","HCPCS C1713","","179712545  -  SCREW BONE 5MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712550","SUP","HCPCS C1713","","179712550  -  SCREW BONE 5MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712630","SUP","HCPCS C1713","","179712630  -  SCREW BONE 6MM 30MM POLYAX 1 INNIE EXPEDIUM TITANIUM SPN 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712635","SUP","HCPCS C1713","","179712635  -  SCREW BONE 6MM 35MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712640","SUP","HCPCS C1713","","179712640  -  SCREW BONE 6MM 40MM XPDM TI ANT CERV SPN POLYAX 1 INNIE 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712645","SUP","HCPCS C1713","","179712645  -  SCREW BONE 6MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712650","SUP","HCPCS C1713","","179712650  -  SCREW BONE 6MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN 5.5","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712735","SUP","HCPCS C1713","","179712735  -  SCREW BONE 7MM 35MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712740","SUP","HCPCS C1713","","179712740  -  SCREW BONE 7MM 40MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712745","SUP","HCPCS C1713","","179712745  -  SCREW BONE 7MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712750","SUP","HCPCS C1713","","179712750  -  SCREW BONE 7MM 50MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179712755","SUP","HCPCS C1713","","179712755  -  SCREW BONE 7MM 55MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179715540","SUP","HCPCS C1713","","179715540  -  SCREW BONE 5.5MM 40MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179715545","SUP","HCPCS C1713","","179715545  -  SCREW BONE 5.5MM 45MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179715635","SUP","HCPCS C1713","","179715635  -  SCREW BONE 6.5MM 35MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179715645","SUP","HCPCS C1713","","179715645  -  SCREW BONE 6.5MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"179722050","SUP","HCPCS C1713","","179722050  -  SET SCR DISTAL TI UNT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"179722890","SUP","HCPCS C1713","","179722890  -  SCREW DI POLYAXL 8 X 90MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"179762120","SUP","HCPCS C1713","","179762120  -  ROD SPINAL 5.5MM 120MM PRECUT HEXAGONAL END EXPEDIUM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179762300","SUP","HCPCS C1713","","179762300  -  ROD SPINAL 300MM NONSTRL","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$627.75 ","$0.00 ","$290.75 ","$0.00 ","$0.00 ","$244.25 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$218.32 ","$0.00 ","$222.08 ","$0.00 "
"179762480","SUP","HCPCS C1713","","179762480  -  ROD SPINAL 5.5MM 480MM PRECUT HEXAGONAL END EXPEDIUM","BOTH IP/OP","$1,395.00 ","$1,032.30 ","$0.00 ","$1,395.00 ","$627.75 ","$0.00 ","$290.75 ","$0.00 ","$0.00 ","$244.25 ","$1,395.00 ","$0.00 ","$697.50 ","$1,104.84 ","$1,116.00 ","$0.00 ","$218.32 ","$0.00 ","$222.08 ","$0.00 "
"179771055","SUP","HCPCS C1713","","179771055  -  ROD SPNL 5.5MM 55MM NS XPDM PREBNT LN TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179771065","SUP","HCPCS C1713","","179771065  -  ROD SPINAL 5.5MM 65MM PRELORDOSED LINE EXPEDIUM TITANIUM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179771075","SUP","HCPCS C1713","","179771075  -  ROD SPINAL 5.5MM 75MM PRELORDOSED LINE EXPEDIUM TITANIUM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179771085","SUP","HCPCS C1713","","179771085  -  ROD SPINAL 5.5MM 85MM PRELORDOSED LINE EXPEDIUM TITANIUM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179771090","SUP","HCPCS C1713","","179771090  -  ROD SPINAL 5.5MM 90MM PRELORDOSED LINE EXPEDIUM TITANIUM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179771095","SUP","HCPCS C1713","","179771095  -  ROD SPINAL 5.5MM 95MM PRELORDOSED LINE EXPEDIUM TITANIUM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"179772045","SUP","Custom 27803010","","179772045  -  ROD SPNL 45MM 5.5MM MS M SI TI PREBNT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179772055","SUP","Custom 27803010","","179772055  -  ROD SPNL 55MM 5.5MM MS M SI TI PREBNT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179793020","SUP","HCPCS C1713","","179793020  -  CONNECTOR ROD 5.5MM 20MM OPEN FIX TITANIUM LATERAL","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$968.63 ","$0.00 ","$448.63 ","$0.00 ","$0.00 ","$376.89 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$336.87 ","$0.00 ","$342.68 ","$0.00 "
"179797020","SUP","HCPCS C1713","","179797020  -  CONNECTOR ROD 5.5MM 20MM OPEN EXPEDIUM TITANIUM ILIAC SPN","BOTH IP/OP","$2,550.00 ","$1,887.00 ","$0.00 ","$2,550.00 ","$1,147.50 ","$0.00 ","$531.48 ","$0.00 ","$0.00 ","$446.48 ","$2,550.00 ","$0.00 ","$1,275.00 ","$2,019.60 ","$2,040.00 ","$0.00 ","$399.08 ","$0.00 ","$405.96 ","$0.00 "
"179797025","SUP","HCPCS C1713","","179797025  -  CONNECTOR ROD 5.5MM 20MM OPEN EXTENDED TAB EXPEDIUM TITANIUM","BOTH IP/OP","$2,550.00 ","$1,887.00 ","$0.00 ","$2,550.00 ","$1,147.50 ","$0.00 ","$531.48 ","$0.00 ","$0.00 ","$446.48 ","$2,550.00 ","$0.00 ","$1,275.00 ","$2,019.60 ","$2,040.00 ","$0.00 ","$399.08 ","$0.00 ","$405.96 ","$0.00 "
"179797040","SUP","HCPCS C1713","","179797040  -  CONNECTOR ROD 5.5MM 40MM OPEN EXPEDIUM TITANIUM ILIAC SPN","BOTH IP/OP","$2,550.00 ","$1,887.00 ","$0.00 ","$2,550.00 ","$1,147.50 ","$0.00 ","$531.48 ","$0.00 ","$0.00 ","$446.48 ","$2,550.00 ","$0.00 ","$1,275.00 ","$2,019.60 ","$2,040.00 ","$0.00 ","$399.08 ","$0.00 ","$405.96 ","$0.00 "
"179798020","SUP","HCPCS C1713","","179798020  -  CONNECTOR ROD 5.5MM 20MM XPDM CLS TI SPNE ILC","BOTH IP/OP","$2,550.00 ","$1,887.00 ","$0.00 ","$2,550.00 ","$1,147.50 ","$0.00 ","$531.48 ","$0.00 ","$0.00 ","$446.48 ","$2,550.00 ","$0.00 ","$1,275.00 ","$2,019.60 ","$2,040.00 ","$0.00 ","$399.08 ","$0.00 ","$405.96 ","$0.00 "
"183612032","SUP","HCPCS C1713","","183612032  -  PLATE 32MM LVL 2 EGL PLUS BONE ANT CERV SPN","BOTH IP/OP","$2,328.75 ","$1,723.28 ","$0.00 ","$2,328.75 ","$1,047.94 ","$0.00 ","$485.37 ","$0.00 ","$0.00 ","$407.75 ","$2,328.75 ","$0.00 ","$1,164.38 ","$1,844.37 ","$1,863.00 ","$0.00 ","$364.45 ","$0.00 ","$370.74 ","$0.00 "
"183651016","SUP","HCPCS C1713","","183651016  -  SCREW BONE 4.4MM 16MM EGL PLUS SWIFT PLUS ANT CERV SPN OVSZ","BOTH IP/OP","$388.13 ","$287.22 ","$0.00 ","$388.13 ","$174.66 ","$0.00 ","$80.89 ","$0.00 ","$0.00 ","$67.96 ","$388.13 ","$0.00 ","$194.06 ","$307.40 ","$310.50 ","$0.00 ","$60.74 ","$0.00 ","$61.79 ","$0.00 "
"183656016","SUP","HCPCS C1713","","183656016  -  SCREW BONE 4.25MM 16MM EGL PLUS SWIFT PLUS ANT CERV SPN PRIM","BOTH IP/OP","$388.13 ","$287.22 ","$0.00 ","$388.13 ","$174.66 ","$0.00 ","$80.89 ","$0.00 ","$0.00 ","$67.96 ","$388.13 ","$0.00 ","$194.06 ","$307.40 ","$310.50 ","$0.00 ","$60.74 ","$0.00 ","$61.79 ","$0.00 "
"185200320","SUP","HCPCS C1757","","185200320  -  TUBE NASOPHARYNGEAL 32FR 170MM ADJUSTABLE FLANGE ROUND TIP","BOTH IP/OP","$11.68 ","$8.64 ","$0.00 ","$11.68 ","$0.00 ","$0.00 ","$2.43 ","$0.00 ","$0.00 ","$0.00 ","$11.68 ","$0.00 ","$5.84 ","$9.25 ","$9.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186715000","SUP","HCPCS C1713","","186715000  -  SCREW SET TI SPNL 1 INNIE INR XPDM","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"186715080","SUP","HCPCS C1713","","186715080  -  SCREW BONE 7.5MM 80MM POLYAX CANN VIPER 2 TITANIUM SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715530","SUP","HCPCS C1713","","186715530  -  SCREW BONE 5MM 30MM VPR TI SPNL POLYAX CANN MN INV SRG","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715535","SUP","HCPCS C1713","","186715535  -  SCREW BONE 5MM 35MM VPR TI SPNL POLYAX CANN MN INV SRG","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715540","SUP","HCPCS C1713","","186715540  -  SCREW BONE 5MM 40MM VPR TI SPNL POLYAX CANN MN INV SRG","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715635","SUP","HCPCS C1713","","186715635  -  SCREW BONE 6MM 35MM VPR TI SPNL POLYAX CANN MN INV SRG","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715640","SUP","HCPCS C1713","","186715640  -  SCREW BONE 6MM 40MM POLYAX CANN VIPER TITANIUM SPN MIS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715645","SUP","HCPCS C1713","","186715645  -  SCREW BONE 6MM 45MM VPR TI SPNL POLYAX CANN MN INV SRG","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715730","SUP","HCPCS C1713","","186715730  -  SCREW BONE 7MM 30MM POLYAX CANN VIPER 2 TITANIUM SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186715855","SUP","HCPCS C1713","","186715855  -  SCREW BONE 8MM 55MM POLYAX VIPER TITANIUM SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186731530","SUP","HCPCS C1713","","186731530  -  SCREW BONE 5MM 30MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"186731535","SUP","HCPCS C1713","","186731535  -  SCREW BONE 5MM 35MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"186731540","SUP","HCPCS C1713","","186731540  -  SCREW BONE 5MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"186731635","SUP","HCPCS C1713","","186731635  -  SCREW BONE 6MM 35MM XPDM VPR TI SPN CORT FIX 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"186731640","SUP","HCPCS C1713","","186731640  -  SCREW BONE 6MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"186731650","SUP","HCPCS C1713","","186731650  -  SCREW BN 6MM 50MM VPR FX TI SPNE CORT 5.5MM ROD","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"186750030","SUP","HCPCS C1713","","186750030  -  SCREW BONE 5MM 30MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750035","SUP","HCPCS C1713","","186750035  -  SCREW BONE 5MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750040","SUP","HCPCS C1713","","186750040  -  SCREW BONE 5MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750045","SUP","HCPCS C1713","","186750045  -  SCREW BONE 5MM 45MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750050","SUP","HCPCS C1713","","186750050  -  SCREW BONE 5MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750230","SUP","HCPCS C1713","","186750230  -  SCREW BONE  5X30MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750235","SUP","HCPCS C1713","","186750235  -  SCREW BONE  5X35MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750250","SUP","HCPCS C1713","","186750250  -  SCREW BONE  5X50MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750255","SUP","HCPCS C1713","","186750255  -  SCREW BONE  5X55MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186750430","SUP","HCPCS C1713","","186750430  -  SCREW BONE  5X30MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186750435","SUP","HCPCS C1713","","186750435  -  SCREW BONE  5X35MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186750450","SUP","HCPCS C1713","","186750450  -  SCREW BONE  5X50MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186750455","SUP","HCPCS C1713","","186750455  -  SCREW BONE  5X55MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186760035","SUP","HCPCS C1713","","186760035  -  SCREW BONE 6MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186760040","SUP","HCPCS C1713","","186760040  -  SCREW BONE 6MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186760045","SUP","HCPCS C1713","","186760045  -  SCREW BONE 6MM 45MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186760050","SUP","HCPCS C1713","","186760050  -  SCREW BONE 6MM 50MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186760230","SUP","HCPCS C1713","","186760230  -  SCREW BONE  6X30MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186760255","SUP","HCPCS C1713","","186760255  -  SCREW BONE  6X55MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186760430","SUP","HCPCS C1713","","186760430  -  SCREW BONE  6X30MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186760455","SUP","HCPCS C1713","","186760455  -  SCREW BONE  6X55MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186770035","SUP","HCPCS C1713","","186770035  -  SCREW BONE 7MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186770040","SUP","HCPCS C1713","","186770040  -  SCREW BONE 7MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186770045","SUP","HCPCS C1713","","186770045  -  SCREW BONE 7MM 45MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186770050","SUP","HCPCS C1713","","186770050  -  SCREW BONE 7MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186770230","SUP","HCPCS C1713","","186770230  -  SCREW BONE  7X30MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186770235","SUP","HCPCS C1713","","186770235  -  SCREW BONE  7X35MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186770430","SUP","HCPCS C1713","","186770430  -  SCREW BONE  7X30MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186770435","SUP","HCPCS C1713","","186770435  -  SCREW BONE  7X35MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186770460","SUP","HCPCS C1713","","186770460  -  SCREW BONE  7X60MM VIPER PRIME CFXFEN XTAB","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"186775235","SUP","HCPCS C1713","","186775235  -  SCREW BONE  7.5X35MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186775240","SUP","HCPCS C1713","","186775240  -  SCREW BONE  7.5X40MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186775245","SUP","HCPCS C1713","","186775245  -  SCREW BONE  7.5X45MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186775250","SUP","HCPCS C1713","","186775250  -  SCREW BONE  7.5X50MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186775255","SUP","HCPCS C1713","","186775255  -  SCREW BONE  7.5X55MM TI VIPER PRIME X-TAB","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"186787040","SUP","Custom 27803010","","186787040  -  ROD SPNL 40MM VPR 2 TI KYPHOSED MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186787080","SUP","Custom 27803010","","186787080  -  ROD SPNL 80MM VPR 2 TI KYPHOSED MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186787090","SUP","Custom 27803010","","186787090  -  ROD SPNL 90MM VPR 2 TI KYPHOSED MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186787100","SUP","Custom 27803010","","186787100  -  ROD SPNL 100MM VPR 2 TI KYPHOSED MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186787110","SUP","Custom 27803010","","186787110  -  ROD SPNL 110MM VPR 2 TI KYPHOSED MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186787200","SUP","Custom 27803010","","186787200  -  ROD SPNL 200MM VPR 2 TI KYPHOSED MN INV SRG","BOTH IP/OP","$1,710.00 ","$1,265.40 ","$0.00 ","$1,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,710.00 ","$0.00 ","$855.00 ","$1,354.32 ","$1,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788035","SUP","HCPCS C1713","","186788035  -  ROD SPINAL 35MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"186788045","SUP","Custom 27803010","","186788045  -  ROD SPNL 45MM VPR 2 TI LRDTC MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788065","SUP","Custom 27803010","","186788065  -  ROD SPNL 65MM VPR 2 PRELORDOTIC MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788075","SUP","Custom 27803010","","186788075  -  ROD SPNL 75MM 5.5MM VPR 2 TI LRDTC MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788080","SUP","Custom 27803010","","186788080  -  ROD SPNL 80MM VPR 2 TI LRDTC MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788090","SUP","Custom 27803010","","186788090  -  ROD SPNL 90MM 5.5MM VPR 2 TI LRDTC MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788100","SUP","Custom 27803010","","186788100  -  ROD SPNL 100MM VPR 2 TI LRDTC MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186788120","SUP","HCPCS C1713","","186788120  -  ROD SPINAL 120MM LORDOTIC VIPER 2 TITANIUM MINIMALLY","BOTH IP/OP","$1,537.50 ","$1,137.75 ","$0.00 ","$1,537.50 ","$691.88 ","$0.00 ","$320.45 ","$0.00 ","$0.00 ","$269.20 ","$1,537.50 ","$0.00 ","$768.75 ","$1,217.70 ","$1,230.00 ","$0.00 ","$240.62 ","$0.00 ","$244.77 ","$0.00 "
"186788150","SUP","Custom 27803010","","186788150  -  ROD SPNL 150MM VPR 2 TI LRDTC MN INV SRG","BOTH IP/OP","$1,537.50 ","$1,137.75 ","$0.00 ","$1,537.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,537.50 ","$0.00 ","$768.75 ","$1,217.70 ","$1,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789040","SUP","Custom 27803010","","186789040  -  ROD SPNL 40MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789050","SUP","Custom 27803010","","186789050  -  ROD SPNL 50MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789070","SUP","Custom 27803010","","186789070  -  ROD SPNL 70MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789080","SUP","Custom 27803010","","186789080  -  ROD SPNL 80MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789100","SUP","Custom 27803010","","186789100  -  ROD SPNL 100MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789150","SUP","HCPCS C1713","","186789150  -  ROD SPINAL 150MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE","BOTH IP/OP","$1,537.50 ","$1,137.75 ","$0.00 ","$1,537.50 ","$691.88 ","$0.00 ","$320.45 ","$0.00 ","$0.00 ","$269.20 ","$1,537.50 ","$0.00 ","$768.75 ","$1,217.70 ","$1,230.00 ","$0.00 ","$240.62 ","$0.00 ","$244.77 ","$0.00 "
"186789200","SUP","Custom 27803010","","186789200  -  ROD SPNL 200MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$1,710.00 ","$1,265.40 ","$0.00 ","$1,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,710.00 ","$0.00 ","$855.00 ","$1,354.32 ","$1,368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789300","SUP","Custom 27803010","","186789300  -  ROD SPNL 300MM VPR 2 TI STR MN INV SRG","BOTH IP/OP","$1,882.50 ","$1,393.05 ","$0.00 ","$1,882.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,882.50 ","$0.00 ","$941.25 ","$1,490.94 ","$1,506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186789400","SUP","HCPCS C1713","","186789400  -  ROD SPINAL 400MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE","BOTH IP/OP","$2,055.00 ","$1,520.70 ","$0.00 ","$2,055.00 ","$924.75 ","$0.00 ","$428.31 ","$0.00 ","$0.00 ","$359.81 ","$2,055.00 ","$0.00 ","$1,027.50 ","$1,627.56 ","$1,644.00 ","$0.00 ","$321.61 ","$0.00 ","$327.16 ","$0.00 "
"186789480","SUP","HCPCS C1713","","186789480  -  ROD SPINAL STR 480MM VIPER 2 TITANIUM MINIMALLY INVASIVE","BOTH IP/OP","$2,055.00 ","$1,520.70 ","$0.00 ","$2,055.00 ","$924.75 ","$0.00 ","$428.31 ","$0.00 ","$0.00 ","$359.81 ","$2,055.00 ","$0.00 ","$1,027.50 ","$1,627.56 ","$1,644.00 ","$0.00 ","$321.61 ","$0.00 ","$327.16 ","$0.00 "
"186801012","SUP","HCPCS C1713","","186801012  -  PLATE BONE PRELORDOTIC 19.8X16X2.5MM 12MM LEVEL 1 MEDIAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186801014","SUP","HCPCS C1713","","186801014  -  PLATE BONE PRELORDOTIC 21.8X16X2.5MM 14MM LEVEL 1 MEDIAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186801016","SUP","HCPCS C1713","","186801016  -  PLATE BONE PRELORDOTIC 23.8X16X2.5MM 16MM LEVEL 1 MEDIAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186801024","SUP","HCPCS C1713","","186801024  -  PLATE BN 14MM PREBNT 24X16X2.5MM NS SKYLINE 1 LVL TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186801026","SUP","HCPCS C1713","","186801026  -  PLATE 26MM TI 1 LVL SKYLINE BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186801028","SUP","HCPCS C1713","","186801028  -  PLATE 28MM TI 1 LVL SKYLINE BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186801030","SUP","HCPCS C1713","","186801030  -  PLATE 30MM TI 1 LVL SKYLINE BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"186802028","SUP","HCPCS C1713","","186802028  -  PLATE BONE PRELORDOTIC 35.8X16X2.5MM 28MM LEVEL 2 MEDIAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186802030","SUP","HCPCS C1713","","186802030  -  PLATE 30MM TI 2 LVL SKYLINE BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186802032","SUP","HCPCS C1713","","186802032  -  PLATE 32MM TI 2 LVL SKYLINE BONE SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186802036","SUP","HCPCS C1713","","186802036  -  PLATE 36MM TI 2 LVL SKYLINE BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"186803039","SUP","HCPCS C1713","","186803039  -  PLATE BN 39MM NS SKYLINE 3 LVL SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"186803042","SUP","HCPCS C1713","","186803042  -  PLATE BONE PRELORDOTIC 49.8X16X2.5MM 42MM LEVEL 3 MEDIAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"186803045","SUP","HCPCS C1713","","186803045  -  PLATE BONE PRELORDOTIC 52.8X16X2.5MM 45MM LEVEL 3 MEDIAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"186803051","SUP","HCPCS C1713","","186803051  -  PLATE BONE PRELORDOTIC 58.8X16X2.5MM 51MM LEVEL 3 MEDIAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"186820012","SUP","Custom 27203010","","186820012  -  14MM DRILL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"186850012","SUP","HCPCS C1713","","186850012  -  SCREW BONE 12MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186850014","SUP","HCPCS C1713","","186850014  -  SCREW BONE 0-20D 4MM 14MM VARIABLE SLFDRILL SKYLINE GOLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186850016","SUP","HCPCS C1713","","186850016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFDRILL VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186850017","SUP","HCPCS C1713","","186850017  -  SCREW BN 0-20D 4MM 17MM LGHT GRN SKYLINE VAR SLFDRL TI ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186850018","SUP","HCPCS C1713","","186850018  -  SCREW BONE 18MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186852014","SUP","HCPCS C1713","","186852014  -  SCREW BONE 14MM SKYLINE TI SPNL SLFTAP VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186852015","SUP","HCPCS C1713","","186852015  -  SCREW BONE 15MM SLFTAP VAR ANG SKYLINE TITANIUM SPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186852016","SUP","HCPCS C1713","","186852016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFTAP VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186852017","SUP","HCPCS C1713","","186852017  -  SCREW BONE 17MM SLFTAP VAR ANG SKYLINE TITANIUM SPN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186852018","SUP","HCPCS C1713","","186852018  -  SCREW BONE 18MM SKYLINE TI SPNL SLFTAP VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186854014","SUP","HCPCS C1713","","186854014  -  SCREW BONE LARGE DIAMETER 14MM VAR ANG SELF TAP SKYLINE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186854016","SUP","HCPCS C1713","","186854016  -  SCREW BN OVSZ 4.5MM 16MM NS SKYLINE VAR SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186854018","SUP","HCPCS C1713","","186854018  -  SCREW BONE LARGE DIAMETER 18MM VAR ANG SELF TAP SKYLINE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186862014","SUP","HCPCS C1713","","186862014  -  SCREW BONE 4MM 14MM SKYLINE TI ANT CERV SPN SLFTAP CNSTRN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186862016","SUP","HCPCS C1713","","186862016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFTAP CNSTRN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"186864014","SUP","HCPCS C1713","","186864014  -  SCREW BONE 14MM SKYLINE TI SPNL SLFTAP CNSTRN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"187301105","SUP","Custom 27803010","","187301105  -  CAGE SPNL 7D STD 5MM NS LF BENGAL CFRP CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187301106","SUP","Custom 27803010","","187301106  -  CAGE SPNL 7D STD 6MM NS LF BENGAL CFRP CRV INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187301107","SUP","Custom 27803010","","187301107  -  CAGE SPNL 7D STD 7MM NS LF BENGAL CFRP CRV INTRBD FS","BOTH IP/OP","$2,458.13 ","$1,819.02 ","$0.00 ","$2,458.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,458.13 ","$0.00 ","$1,229.06 ","$1,946.84 ","$1,966.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187301108","SUP","Custom 27803010","","187301108  -  CAGE SPNL 7D STD 8MM NS LF BENGAL CFRP CRV INTRBD FS","BOTH IP/OP","$2,458.13 ","$1,819.02 ","$0.00 ","$2,458.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,458.13 ","$0.00 ","$1,229.06 ","$1,946.84 ","$1,966.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187301207","SUP","HCPCS C1713","","187301207  -  CAGE SPNL 7D LG LRDTC 7MM NS LF BENGAL CFBR LMBR INTRBD FS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"187823107","SUP","HCPCS C1713","","187823107  -  CAGE SPNL PRLL BLT 23X9X7MM NS LF CNCRD","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"187823108","SUP","Custom 27803010","","187823108  -  CAGE SPNL PRLL BLT NOSE 23X9X8MM NS LF CNCRD RADOPQ CFRP","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187823409","SUP","Custom 27803010","","187823409  -  CAGE SPNL 5D LRDTC BLT NOSE 23X9X9MM NS LF CNCRD RADOPQ CFRP","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187823410","SUP","Custom 27803010","","187823410  -  CAGE SPNL 5D LRDTC BLT NOSE 23X9X10MM NS LF CNCRD RADOPQ","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187827108","SUP","Custom 27803010","","187827108  -  CAGE SPNL PRLL BLT NOSE 27X9X8MM NS LF CNCRD RADOPQ CFRP","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187827212","SUP","Custom 27803010","","187827212  -  CAGE SPNL PRLL BLT NOSE 27X11X12MM NS LF CNCRD RADOPQ CFRP","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"187827409","SUP","Custom 27803010","","187827409  -  CAGE SPNL 5D LRDTC BLT NOSE 27X9X9MM NS LF CNCRD RADOPQ CFRP","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188311002","SUP","HCPCS C1713","","188311002  -  ROD SPINAL 3.5-5.5MM 420MM 2 OPENING MOUNTAINEER TITANIUM","BOTH IP/OP","$2,145.00 ","$1,587.30 ","$0.00 ","$2,145.00 ","$965.25 ","$0.00 ","$447.07 ","$0.00 ","$0.00 ","$375.57 ","$2,145.00 ","$0.00 ","$1,072.50 ","$1,698.84 ","$1,716.00 ","$0.00 ","$335.69 ","$0.00 ","$341.48 ","$0.00 "
"188311200","SUP","Custom 27803010","","188311200  -  CONCTR SPNL 3.5MM 3.5MM MTNR OCT WDBND","BOTH IP/OP","$1,740.00 ","$1,287.60 ","$0.00 ","$1,740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,740.00 ","$0.00 ","$870.00 ","$1,378.08 ","$1,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188312001","SUP","Custom 27803010","","188312001  -  CONCTR ROD MTNR OFFST ASMBLY OCT SPN LAT","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188312003","SUP","Custom 27803010","","188312003  -  CONCTR ROD MTNR J HOOK ASMBLY OCT SPN","BOTH IP/OP","$1,170.00 ","$865.80 ","$0.00 ","$1,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,170.00 ","$0.00 ","$585.00 ","$926.64 ","$936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316030","SUP","Custom 27803010","","188316030  -  ROD SPNL 30MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316035","SUP","Custom 27803010","","188316035  -  ROD SPNL 35MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316040","SUP","Custom 27803010","","188316040  -  ROD SPNL 40MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316045","SUP","Custom 27803010","","188316045  -  ROD SPNL 45MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316050","SUP","Custom 27803010","","188316050  -  ROD SPNL 50MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316055","SUP","Custom 27803010","","188316055  -  ROD SPNL 55MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316060","SUP","Custom 27803010","","188316060  -  ROD SPNL 60MM 3.5MM MTNR TI RGD STRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316065","SUP","Custom 27803010","","188316065  -  ROD SPNL 65MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316070","SUP","Custom 27803010","","188316070  -  ROD SPNL 70MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316075","SUP","Custom 27803010","","188316075  -  ROD SPNL 75MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316085","SUP","HCPCS C1713","","188316085  -  ROD SPINAL 3.5MM 85MM MOUNTAINEER","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"188316100","SUP","Custom 27803010","","188316100  -  ROD SPNL 100MM 3.5MM MTNR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188316120","SUP","Custom 27803010","","188316120  -  ROD SPNL 120MM 3.5MM MTNR TI RGD STRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188318310","SUP","HCPCS C1713","","188318310  -  SCREW BONE 3.5MM 10MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318312","SUP","HCPCS C1713","","188318312  -  SCREW BONE 3.5MM 12MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318314","SUP","HCPCS C1713","","188318314  -  SCREW BONE 3.5MM 14MM MTNR TI SPNL FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318316","SUP","HCPCS C1713","","188318316  -  SCREW BONE 3.5MM 16MM MTNR TI OCT SPN FIXANG MDLN FIX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318318","SUP","HCPCS C1713","","188318318  -  SCREW BONE 3.5MM 18MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318320","SUP","HCPCS C1713","","188318320  -  SCREW BONE 3.5MM 20MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318324","SUP","HCPCS C1713","","188318324  -  SCREW BONE 3.5MM 24MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318412","SUP","HCPCS C1713","","188318412  -  SCREW BONE 4MM 12MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318414","SUP","HCPCS C1713","","188318414  -  SCREW BONE 4MM 14MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318418","SUP","HCPCS C1713","","188318418  -  SCREW BONE 4MM 18MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318420","SUP","HCPCS C1713","","188318420  -  SCREW BONE 4MM 20MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188318426","SUP","HCPCS C1713","","188318426  -  SCREW BONE 4MM 26MM MTNR TI OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319310","SUP","HCPCS C1713","","188319310  -  SCREW BONE 3.5MM 10MM MTNR TI OCT SPN MDLN FIX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319312","SUP","HCPCS C1713","","188319312  -  SCREW BONE 3.5MM 12MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319314","SUP","HCPCS C1713","","188319314  -  SCREW BONE 3.5MM 14MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319316","SUP","HCPCS C1713","","188319316  -  SCREW BONE 3.5MM 16MM MTNR MDL LAT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319420","SUP","HCPCS C1713","","188319420  -  SCREW BONE 4MM 20MM MTNR TI OCT SPN MDLN FIX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319424","SUP","HCPCS C1713","","188319424  -  SCREW BONE 4MM 24MM MTNR TI OCT SPN MDLN FIX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319426","SUP","HCPCS C1713","","188319426  -  SCREW BONE 4MM 26MM MTNR TI OCT SPN MDLN FIX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319525","SUP","HCPCS C1713","","188319525  -  SCREW BONE 4.35MM 25MM MTNR TI ML OCT SPN FIXANG","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319530","SUP","HCPCS C1713","","188319530  -  SCREW BONE 4.35MM 30MM MTNR TI OCT SPN STRL MDLN FIX SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188319535","SUP","HCPCS C1713","","188319535  -  SCREW BONE 4.35MM 35MM FIX ANGLE MOUNTAINEER TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188341021","SUP","HCPCS C1713","","188341021  -  PLATE BN 21MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188341028","SUP","HCPCS C1713","","188341028  -  PLATE BN 28MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188341035","SUP","HCPCS C1713","","188341035  -  PLATE BN 35MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188341042","SUP","HCPCS C1713","","188341042  -  PLATE BN 42MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"188341100","SUP","Custom 27803010","","188341100  -  NUT OUTR MTNR OCT SPN TI HEAD TO HEAD CX CONECTION","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188341200","SUP","HCPCS C1713","","188341200  -  SCREW BONE 3.5MM 200MM MTNR TI OCT SPN INR HEAD TO HEAD CX","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"188341300","SUP","Custom 27803010","","188341300  -  CONCTR ROD CX HEAD TO HEAD HOOK","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188342200","SUP","HCPCS C1713","","188342200  -  SCREW BONE 3.5MM 20MM MTNR TI OCT SPN INR HEAD TO HEAD CX","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"188362006","SUP","HCPCS C1713","","188362006  -  SCREW BONE 4.5MM 6MM MTNR TI OCT SPN","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"188362007","SUP","HCPCS C1713","","188362007  -  SCREW BONE 4.5MM 7MM MTNR TI OCT SPN","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"188362008","SUP","HCPCS C1713","","188362008  -  SCREW BONE 4.5MM 8MM MTNR TI OCT SPN","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"188362010","SUP","HCPCS C1713","","188362010  -  SCREW BONE 4.5MM 10MM MTNR TI OCT SPN","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"188362012","SUP","HCPCS C1713","","188362012  -  SCREW BONE 4.5MM 12MM MTNR TI OCT SPN","BOTH IP/OP","$765.00 ","$566.10 ","$0.00 ","$765.00 ","$344.25 ","$0.00 ","$159.45 ","$0.00 ","$0.00 ","$133.95 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$119.72 ","$0.00 ","$121.79 ","$0.00 "
"188362025","SUP","HCPCS C1713","","188362025  -  SCREW BONE 4.5MM 25MM MTNR TI OCT SPN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"188362031","SUP","HCPCS C1713","","188362031  -  PLATE BN 31MM NS MTNR SPNE OC 3.5MM SCR","BOTH IP/OP","$8,130.00 ","$6,016.20 ","$0.00 ","$8,130.00 ","$3,658.50 ","$0.00 ","$1,694.50 ","$0.00 ","$0.00 ","$1,423.50 ","$8,130.00 ","$0.00 ","$4,065.00 ","$6,438.96 ","$6,504.00 ","$0.00 ","$1,272.35 ","$0.00 ","$1,294.30 ","$0.00 "
"188362106","SUP","HCPCS C1713","","188362106  -  SCREW BONE 5.25MM 6MM MTNR TI OCT SPN","BOTH IP/OP","$817.50 ","$604.95 ","$0.00 ","$817.50 ","$367.88 ","$0.00 ","$170.39 ","$0.00 ","$0.00 ","$143.14 ","$817.50 ","$0.00 ","$408.75 ","$647.46 ","$654.00 ","$0.00 ","$127.94 ","$0.00 ","$130.15 ","$0.00 "
"188363200","SUP","Custom 27803010","","188363200  -  ROD SPNL 120MM 3.5MM MTNR TI PREBNT STRL","BOTH IP/OP","$877.50 ","$649.35 ","$0.00 ","$877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188901040","SUP","Custom 27803010","","188901040  -  CAGE SPNL 0D MED 20MM 40-56MM NS LF X-MESH XPD FTPRNT TI","BOTH IP/OP","$13,737.50 ","$10,165.75 ","$0.00 ","$13,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,737.50 ","$0.00 ","$6,868.75 ","$10,880.10 ","$10,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"188920022","SUP","Custom 27803010","","188920022  -  CAGE SPNL 0D SM 16MM 22-30MM NS LF X-MESH XPD FTPRNT TI POST","BOTH IP/OP","$11,743.75 ","$8,690.38 ","$0.00 ","$11,743.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,743.75 ","$0.00 ","$5,871.88 ","$9,301.05 ","$9,395.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189401207","SUP","Custom 27803010","","189401207  -  CONCTR ROD F7 5.5MM SFX TI MDL SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189401208","SUP","Custom 27803010","","189401208  -  CONCTR ROD F8 5.5MM XPDM SFX CX MDL OFFST TI SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189401209","SUP","Custom 27803010","","189401209  -  CONCTR ROD F9 5.5MM SFX TI MDL SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189401302","SUP","HCPCS C1713","","189401302  -  CONNECTOR ROD A2 5.5MM EXPEDIUM SFX TITANIUM LATERAL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"189401404","SUP","Custom 27803010","","189401404  -  CONCTR ROD A4 5.5MM SFX TI MDL SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189401405","SUP","Custom 27803010","","189401405  -  CONCTR ROD A5 MED 5.5MM SFX XLNK TI SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189401406","SUP","Custom 27803010","","189401406  -  CONCTR ROD MED A6 5.5MM SFX XLNK TI SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189403303","SUP","Custom 27803010","","189403303  -  CONCTR ROD A3 6.35MM SFX TI LAT SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"189706012","SUP","HCPCS C1713","","189706012  -  SCREW BONE 4.6MM 12MM UNIPLATE 2 TI ANT CERV SPN SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"189707012","SUP","HCPCS C1713","","189707012  -  SCREW BONE 4.6MM 12MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"189707014","SUP","HCPCS C1713","","189707014  -  SCREW BONE 4.6MM 14MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"189707015","SUP","HCPCS C1713","","189707015  -  SCREW BONE 4.6MM 15MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"196789120","SUP","HCPCS C1713","","196789120  -  ROD SPINAL STR 120MM VIPER 2 COCR MIS","BOTH IP/OP","$1,612.50 ","$1,193.25 ","$0.00 ","$1,612.50 ","$725.63 ","$0.00 ","$336.09 ","$0.00 ","$0.00 ","$282.34 ","$1,612.50 ","$0.00 ","$806.25 ","$1,277.10 ","$1,290.00 ","$0.00 ","$252.36 ","$0.00 ","$256.71 ","$0.00 "
"206710000","SUP","HCPCS C1713","","0206710000  -  KIT BN CMNT STRL BIOPREP PREP PLG INSRTR BRSH CURT SCT FEM","BOTH IP/OP","$256.29 ","$189.65 ","$0.00 ","$256.29 ","$115.33 ","$0.00 ","$53.42 ","$0.00 ","$0.00 ","$44.87 ","$256.29 ","$0.00 ","$128.15 ","$202.98 ","$205.03 ","$0.00 ","$40.11 ","$0.00 ","$40.80 ","$0.00 "
"219501200","SUP","Custom 27203010","","00219501200  -  CARRIER GRAFT 1.5 1 PLATEAU GROOVE 8X3IN RATCHET HANDLE","BOTH IP/OP","$81.20 ","$60.09 ","$0.00 ","$81.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.20 ","$0.00 ","$40.60 ","$64.31 ","$64.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"234020053","SUP","HCPCS C1713","","234020053  -  PIN FIX 2.4MM 12IN TROCAR TIPPED EYE LOOP LATEX FREE FEMUR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"234800835","SUP","HCPCS C1713","","00234800835  -  SCREW BONE 3.5MM 2.7MM 8MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234802435","SUP","HCPCS C1713","","00234802435  -  SCREW BONE 3.5MM 2.7MM 24MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234802835","SUP","HCPCS C1713","","00234802835  -  SCREW BONE 3.5MM 2.7MM 28MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234803035","SUP","HCPCS C1713","","00234803035  -  SCREW BONE 3.5MM 2.7MM 30MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234803235","SUP","HCPCS C1713","","00234803235  -  SCREW BONE 3.5MM 2.7MM 32MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234803435","SUP","HCPCS C1713","","00234803435  -  SCREW BONE 3.5MM 2.7MM 34MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234803635","SUP","HCPCS C1713","","00234803635  -  SCREW BONE 3.5MM 2.7MM 36MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234803835","SUP","HCPCS C1713","","00234803835  -  SCREW BONE 3.5MM 2.7MM 38MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234804035","SUP","HCPCS C1713","","00234804035  -  SCREW BONE 3.5MM 2.7MM 40MM SLFTAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234804235","SUP","HCPCS C1713","","00234804235  -  SCREW BONE 3.5MM 2.7MM 42MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234804435","SUP","HCPCS C1713","","00234804435  -  SCREW BONE 3.5MM 2.7MM 44MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234804635","SUP","HCPCS C1713","","00234804635  -  SCREW BONE 3.5MM 2.7MM 46MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234804835","SUP","HCPCS C1713","","00234804835  -  SCREW BONE 3.5MM 2.7MM 48MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234805035","SUP","HCPCS C1713","","00234805035  -  SCREW BONE 3.5MM 2.7MM 50MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234805235","SUP","HCPCS C1713","","00234805235  -  SCREW BONE 3.5MM 2.7MM 52MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234805435","SUP","HCPCS C1713","","00234805435  -  SCREW BONE 3.5MM 2.7MM 54MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234805635","SUP","HCPCS C1713","","00234805635  -  SCREW BONE 2.5MM 3.5MM 2.7MM 56MM SELF TAP LOCK STAINLESS","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234805835","SUP","HCPCS C1713","","00234805835  -  SCREW BONE 3.5MM 2.7MM 58MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234806035","SUP","HCPCS C1713","","00234806035  -  SCREW BONE 3.5MM 2.7MM 60MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234806535","SUP","HCPCS C1713","","00234806535  -  SCREW BONE 3.5MM 2.7MM 65MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234807035","SUP","HCPCS C1713","","00234807035  -  SCREW BONE 3.5MM 2.7MM 70MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234807535","SUP","HCPCS C1713","","00234807535  -  SCREW BONE 3.5MM 2.7MM 75MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234808035","SUP","HCPCS C1713","","00234808035  -  SCREW BONE 3.5MM 2.7MM 80MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234808535","SUP","HCPCS C1713","","00234808535  -  SCREW BONE 3.5MM 2.7MM 85MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234809035","SUP","HCPCS C1713","","00234809035  -  SCREW BONE 3.5MM 2.7MM 90MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234809535","SUP","HCPCS C1713","","00234809535  -  SCREW BONE 3.5MM 2.7MM 95MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234810035","SUP","HCPCS C1713","","00234810035  -  SCREW BONE 3.5MM 2.7MM 100MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234810535","SUP","HCPCS C1713","","00234810535  -  SCREW BONE 3.5MM 2.7MM 105MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"234811035","SUP","HCPCS C1713","","00234811035  -  SCREW BONE 3.5MM 2.7MM 110MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"235701710","SUP","HCPCS C1713","","00235701710  -  PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA RIGHT","BOTH IP/OP","$1,404.15 ","$1,039.07 ","$0.00 ","$1,404.15 ","$631.87 ","$0.00 ","$292.66 ","$0.00 ","$0.00 ","$245.86 ","$1,404.15 ","$0.00 ","$702.08 ","$1,112.09 ","$1,123.32 ","$0.00 ","$219.75 ","$0.00 ","$223.54 ","$0.00 "
"235701808","SUP","HCPCS C1713","","00235701808  -  PLATE BONE 132MM 8 HOLE LOCK STAINLESS STEEL FIBULA LEFT","BOTH IP/OP","$1,319.05 ","$976.10 ","$0.00 ","$1,319.05 ","$593.57 ","$0.00 ","$274.92 ","$0.00 ","$0.00 ","$230.96 ","$1,319.05 ","$0.00 ","$659.53 ","$1,044.69 ","$1,055.24 ","$0.00 ","$206.43 ","$0.00 ","$209.99 ","$0.00 "
"235701810","SUP","HCPCS C1713","","00235701810  -  PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA LEFT","BOTH IP/OP","$1,404.15 ","$1,039.07 ","$0.00 ","$1,404.15 ","$631.87 ","$0.00 ","$292.66 ","$0.00 ","$0.00 ","$245.86 ","$1,404.15 ","$0.00 ","$702.08 ","$1,112.09 ","$1,123.32 ","$0.00 ","$219.75 ","$0.00 ","$223.54 ","$0.00 "
"248001040","SUP","HCPCS C1713","","00248001040  -  SCREW BONE 4MM 10MM 5MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001041","SUP","HCPCS C1713","","00248001041  -  SCREW BONE FULTHD 4MM 10MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001240","SUP","HCPCS C1713","","00248001240  -  SCREW BONE 4MM 12MM 5MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001241","SUP","HCPCS C1713","","00248001241  -  SCREW BONE FULTHD 4MM 12MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001440","SUP","HCPCS C1713","","00248001440  -  SCREW BONE 4MM 14MM 5MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001441","SUP","HCPCS C1713","","00248001441  -  SCREW BONE FULTHD 4MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001640","SUP","HCPCS C1713","","00248001640  -  SCREW BONE 4MM 16MM 6MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001641","SUP","HCPCS C1713","","00248001641  -  SCREW BONE FULTHD 4MM 16MM FORTE STAINLESS STEEL","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001840","SUP","HCPCS C1713","","00248001840  -  SCREW BONE 4MM 18MM 7MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248001841","SUP","HCPCS C1713","","00248001841  -  SCREW BONE FULTHD 4MM 18MM FORTE STAINLESS STEEL","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002040","SUP","HCPCS C1713","","00248002040  -  SCREW BONE 4MM 20MM 8MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002041","SUP","HCPCS C1713","","00248002041  -  SCREW BONE FULTHD 4MM 20MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002240","SUP","HCPCS C1713","","00248002240  -  SCREW BONE 4MM 22MM 9MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002241","SUP","HCPCS C1713","","00248002241  -  SCREW BONE FULTHD 4MM 22MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002440","SUP","HCPCS C1713","","00248002440  -  SCREW BONE 4MM 24MM 10MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002441","SUP","HCPCS C1713","","00248002441  -  SCREW BONE FULTHD 4MM 24MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002640","SUP","HCPCS C1713","","00248002640  -  SCREW BONE 4MM 26MM 12MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002641","SUP","HCPCS C1713","","00248002641  -  SCREW BONE FULTHD 4MM 26MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002840","SUP","HCPCS C1713","","00248002840  -  SCREW BONE 4MM 28MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248002841","SUP","HCPCS C1713","","00248002841  -  SCREW BONE FULTHD 4MM 28MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003040","SUP","HCPCS C1713","","00248003040  -  SCREW BONE 4MM 30MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003041","SUP","HCPCS C1713","","00248003041  -  SCREW BONE FULTHD 4MM 30MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003240","SUP","HCPCS C1713","","00248003240  -  SCREW BONE 4MM 32MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003241","SUP","HCPCS C1713","","00248003241  -  SCREW BONE FULTHD 4MM 32MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003440","SUP","HCPCS C1713","","00248003440  -  SCREW BONE 4MM 34MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003441","SUP","HCPCS C1713","","00248003441  -  SCREW BONE FULTHD 4MM 34MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003640","SUP","HCPCS C1713","","00248003640  -  SCREW BONE 4MM 36MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003641","SUP","HCPCS C1713","","00248003641  -  SCREW BONE FULTHD 4MM 36MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003840","SUP","HCPCS C1713","","00248003840  -  SCREW BONE 4MM 38MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248003841","SUP","HCPCS C1713","","00248003841  -  SCREW BONE FULTHD 4MM 38MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248004040","SUP","HCPCS C1713","","00248004040  -  SCREW BONE 4MM 40MM 14MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248004041","SUP","HCPCS C1713","","00248004041  -  SCREW BONE FULTHD 4MM 40MM FORTE STAINLESS STEEL CANCELLOUS","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"248781032","SUP","Custom 27203010","","248781032  -  STATION EYEWASH 17.5X15IN 4 SCREW HOLE SAFETY BOTTLE WALL","BOTH IP/OP","$141.66 ","$104.83 ","$0.00 ","$141.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.66 ","$0.00 ","$70.83 ","$112.19 ","$113.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"272350250","SUP","HCPCS C1769","","272350250  -  GUIDEWIRE ORTHOPEDIC 1.57MM SHARP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"279351100","SUP","Custom 27203010","","0279351100  -  ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX","BOTH IP/OP","$507.88 ","$375.83 ","$0.00 ","$507.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.88 ","$0.00 ","$253.94 ","$402.24 ","$406.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"279351300","SUP","Custom 27203010","","0279351300  -  PROBE SCT 90MM SERFAS ENRG 3.5MM LATEX FREE","BOTH IP/OP","$522.75 ","$386.84 ","$0.00 ","$522.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$522.75 ","$0.00 ","$261.38 ","$414.02 ","$418.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"283903611","SUP","HCPCS C1894","","283903611  -  NEEDLE SPNL 11GA 6IN INTRO CNFD DMD TIP","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$89.60 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"286565001","SUP","Custom 27803010","","286565001  -  HOLDER IMPL SWIFT PIN TEMP FIX THRD","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"286705200","SUP","Custom 27203010","","286705200  -  GWIRE ORTH 1.37MM VPR THRD BLNT DISP","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"286705220","SUP","Custom 27203010","","286705220  -  GWIRE ORTH 1.45MM VPR 2 BLNT","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"286820012","SUP","Custom 27203010","","286820012  -  BIT DRL 2.2MM 12MM NS SKYLINE REUSE ANT CRV PLT SYS","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"286820014","SUP","Custom 27203010","","286820014  -  DRILL SURG 14MM","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"286820016","SUP","Custom 27203010","","286820016  -  BIT DRILL FLAT 16MM CHUCK SKYLINE DISPOSABLE","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"286850100","SUP","HCPCS C1713","","286850100  -  PIN FIX STR TEMPORARY SKYLINE SPN","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"286850200","SUP","HCPCS C1713","","286850200  -  PIN FIX 200MM 50MM THREADED TEMPORARY SKYLINE SPN","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"288301114","SUP","Custom 27203010","","288301114  -  GUIDE DRILL 14MM FIX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288302030","SUP","Custom 27203010","","288302030  -  TAP SURG 3MM","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288302035","SUP","Custom 27203010","","288302035  -  TAP SPINAL 3.5MM STAINLESS STEEL DISPOSABLE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288302040","SUP","Custom 27203010","","288302040  -  TAP SURG 4MM MOUNTAINEER DISPOSABLE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"288310035","SUP","Custom 27100030","","288310035  -  BIT DRILL 3.5MM QC","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"292301001","SUP","Custom 27011340","","292301001  -  HALTER TRC 19-26IN 3DHLCR HEAD","BOTH IP/OP","$1,560.00 ","$1,154.40 ","$0.00 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,560.00 ","$0.00 ","$780.00 ","$1,235.52 ","$1,248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"306573000","SUP","HCPCS C1713","","306573000  -  KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM","BOTH IP/OP","$1,440.03 ","$1,065.62 ","$0.00 ","$1,440.03 ","$648.01 ","$0.00 ","$300.14 ","$0.00 ","$0.00 ","$252.14 ","$1,440.03 ","$0.00 ","$720.01 ","$185.55 ","$1,152.02 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"306573000","SUP","HCPCS C1713","","0306573000  -  KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM","BOTH IP/OP","$1,440.03 ","$1,065.62 ","$0.00 ","$1,440.03 ","$648.01 ","$0.00 ","$300.14 ","$0.00 ","$0.00 ","$252.14 ","$1,440.03 ","$0.00 ","$720.01 ","$1,140.50 ","$1,152.02 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"321500000","SUP","Custom 27203010","","AIRWAY ESPH 5 ADLT ARNC LRYNG MASK CUF CURVE UNQ LF PVC 40ML","BOTH IP/OP","$15.63 ","$11.57 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.63 ","$0.00 ","$7.81 ","$12.38 ","$12.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612008","SUP","Custom 27803010","","336612008  -  CAGE SPNL 12MM 8MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612009","SUP","Custom 27803010","","336612009  -  CAGE SPNL 12MM 9MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612010","SUP","Custom 27803010","","336612010  -  CAGE SPNL 12MM 10MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612011","SUP","Custom 27803010","","336612011  -  CAGE SPNL 12MM 11MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612012","SUP","Custom 27803010","","336612012  -  CAGE SPNL 12MM 12MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612040","SUP","Custom 27803010","","336612040  -  CAGE SPNL 12MM 40MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336612080","SUP","Custom 27803010","","336612080  -  CAGE SPNL 12MM 80MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614008","SUP","Custom 27803010","","336614008  -  CAGE SPNL 14MM 8MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614009","SUP","Custom 27803010","","336614009  -  CAGE SPNL 14MM 9MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614010","SUP","Custom 27803010","","336614010  -  CAGE SPNL 14MM 10MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614011","SUP","Custom 27803010","","336614011  -  CAGE SPNL 14MM 11MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614012","SUP","Custom 27803010","","336614012  -  CAGE SPNL 14MM 12MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614040","SUP","Custom 27803010","","336614040  -  CAGE SPNL 14MM 40MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336614080","SUP","Custom 27803010","","336614080  -  CAGE SPNL 14MM 80MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336616040","SUP","Custom 27803010","","336616040  -  CAGE SPNL 16MM 40MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336616080","SUP","Custom 27803010","","336616080  -  CAGE SPNL 16MM 80MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336620040","SUP","Custom 27803010","","336620040  -  CAGE SPNL 20MM 40MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336620080","SUP","Custom 27803010","","336620080  -  CAGE SPNL 20MM 80MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336620120","SUP","Custom 27803010","","336620120  -  CAGE SPNL 20MM 120MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336625040","SUP","Custom 27803010","","336625040  -  CAGE SPNL 25MM 40MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336625080","SUP","Custom 27803010","","336625080  -  CAGE SPNL 25MM 80MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"336625120","SUP","Custom 27803010","","336625120  -  CAGE SPNL 25MM 120MM VBOSS TI THORLMBR INTRBD FS","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"380544150","SUP","Custom 27203010","","380544150  -  CUTTER ENDSCP ANG AGRS+ FRML 4.5MM","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"381003004","SUP","HCPCS C1773","","381003004  -  KIT SNR 3.2FR 2-4MM 175CM 150CM ATRIEVE VASC SNR 3 LOOP SHRT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$678.75 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"381003008","SUP","HCPCS C1773","","381003008  -  KIT SNR 15D 3.2FR 4-8MM 175CM 150CM ATRIEVE VASC SNR 3 SHRT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$678.75 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"382006010","SUP","HCPCS C1773","","382006010  -  KIT SNR 6-10MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"382006015","SUP","HCPCS C1773","","382006015  -  KIT SNR 9-15MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"382006020","SUP","HCPCS C1757","","382006020  -  SNARE VASC STD 12-20MM 6FR 120CM 100CM ENSNR CATH","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"382007030","SUP","HCPCS C1773","","382007030  -  KIT SNR MN 18-30MM 7FR 120CM 100CM ATRIEVE VASC SNR DLV CATH","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"382007045","SUP","HCPCS C1773","","382007045  -  KIT SNR 27-45MM 7FR 120MM 100MM ATRIEVE VASC SNR DLV CATH","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"382412000","SUP","Custom 27203010","","382412000  -  KNEE  IMMOBILIZER MEDIUM","BOTH IP/OP","$48.24 ","$35.70 ","$0.00 ","$48.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.24 ","$0.00 ","$24.12 ","$38.21 ","$38.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"392006015","SUP","Custom 27203010","","SYSTEM SNARE 9 15MM TRIPLE LOOP STANDARD","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"408831100","SUP","Custom 27203010","","0408831100  -  TOGA SRG XL FLYTE SURGICOOL PLWY ZP","BOTH IP/OP","$27.27 ","$20.18 ","$0.00 ","$27.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.27 ","$0.00 ","$13.64 ","$21.60 ","$21.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"436020300","SUP","HCPCS C1713","","436020300  -  ENDCAP 436020300 EXTNDED 20 X 30MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020305","SUP","HCPCS C1713","","436020305  -  ENDCAP 436020305 EXTND 20 X 30MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020350","SUP","HCPCS C1713","","436020350  -  ENDCAP 436020350 EXTNDED 20 X 35MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020355","SUP","HCPCS C1713","","436020355  -  ENDCAP 436020355 EXTND 20 X 35MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020400","SUP","HCPCS C1713","","436020400  -  ENDCAP 436020400 EXTNDED 20 X 40MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020405","SUP","HCPCS C1713","","436020405  -  ENDCAP 436020405 EXTND 20 X 40MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020450","SUP","HCPCS C1713","","436020450  -  ENDCAP 436020450 EXTNDED 20 X 45MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436020455","SUP","HCPCS C1713","","436020455  -  ENDCAP 436020455 EXTND 20 X 45MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025300","SUP","HCPCS C1713","","436025300  -  ENDCAP 436025300 EXTNDED 25 X 30MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025305","SUP","HCPCS C1713","","436025305  -  ENDCAP 436025305 EXTND 25 X 30MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025350","SUP","HCPCS C1713","","436025350  -  ENDCAP 436025350 EXTNDED 25 X 35MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025355","SUP","HCPCS C1713","","436025355  -  ENDCAP 436025355 EXTND 25 X 35MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025400","SUP","HCPCS C1713","","436025400  -  ENDCAP 436025400 EXTNDED 25 X 40MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025405","SUP","HCPCS C1713","","436025405  -  ENDCAP 436025405 EXTND 25 X 40MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025450","SUP","HCPCS C1713","","436025450  -  ENDCAP 436025450 EXTNDED 25 X 45MM 0 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436025455","SUP","HCPCS C1713","","436025455  -  ENDCAP 436025455 EXTND 25 X 45MM 15 DEG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120300","SUP","HCPCS C1713","","436120300  -  ENDCAP 436120300 EXTENDED 20 X 30MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120305","SUP","HCPCS C1713","","436120305  -  ENDCAP 436120305 EXTND 20X30MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120350","SUP","HCPCS C1713","","436120350  -  ENDCAP 436120350 EXTENDED 20 X 35MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120355","SUP","HCPCS C1713","","436120355  -  ENDCAP 436120355 EXTND 20X35MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120400","SUP","HCPCS C1713","","436120400  -  ENDCAP 436120400 EXTENDED 20 X 40MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120405","SUP","HCPCS C1713","","436120405  -  ENDCAP 436120405 EXTND 20X40MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120450","SUP","HCPCS C1713","","436120450  -  ENDCAP 436120450 EXTENDED 20 X 45MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436120455","SUP","HCPCS C1713","","436120455  -  ENDCAP 436120455 EXTND 20X45MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125300","SUP","HCPCS C1713","","436125300  -  ENDCAP 436125300 EXTENDED 25 X 30MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125305","SUP","HCPCS C1713","","436125305  -  ENDCAP 436125305 EXTND 25X30MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125350","SUP","HCPCS C1713","","436125350  -  ENDCAP 436125350 EXTENDED 25 X 35MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125355","SUP","HCPCS C1713","","436125355  -  ENDCAP 436125355 EXTND 25X35MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125400","SUP","HCPCS C1713","","436125400  -  ENDCAP 436125400 EXTENDED 25 X 40MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125405","SUP","HCPCS C1713","","436125405  -  ENDCAP 436125405 EXTND 25X40MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125450","SUP","HCPCS C1713","","436125450  -  ENDCAP 436125450 EXTENDED 25 X 45MM STER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"436125455","SUP","HCPCS C1713","","436125455  -  ENDCAP 436125455 EXTND 25X45MM 15 DEG ST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"480316022","SUP","HCPCS C1713","","480316022  -  SCREW BONE LONG STANDARD 6MM 22MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316025","SUP","HCPCS C1713","","480316025  -  SCREW BONE LONG STANDARD 6MM 25MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316028","SUP","HCPCS C1713","","480316028  -  SCREW BONE LONG STANDARD 6MM 28MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316031","SUP","HCPCS C1713","","480316031  -  SCREW BONE LONG STANDARD 6MM 31MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316034","SUP","HCPCS C1713","","480316034  -  SCREW BONE LONG STANDARD 6MM 34MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316037","SUP","HCPCS C1713","","480316037  -  SCREW BONE LONG STANDARD 6MM 37MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316040","SUP","HCPCS C1713","","480316040  -  SCREW BONE LONG STANDARD 6MM 40MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316043","SUP","HCPCS C1713","","480316043  -  SCREW BONE LONG STANDARD 6MM 43MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316046","SUP","HCPCS C1713","","480316046  -  SCREW BONE LONG STANDARD 6MM 46MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316049","SUP","HCPCS C1713","","480316049  -  SCREW BONE LONG STANDARD 6MM 49MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316052","SUP","HCPCS C1713","","480316052  -  SCREW BONE LONG STANDARD 6MM 52MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316055","SUP","HCPCS C1713","","480316055  -  SCREW BONE LONG STANDARD 6MM 55MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316058","SUP","HCPCS C1713","","480316058  -  SCREW BONE LONG STANDARD 6MM 58MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316061","SUP","HCPCS C1713","","480316061  -  SCREW BONE LONG STANDARD 6MM 61MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316064","SUP","HCPCS C1713","","480316064  -  SCREW BONE LONG STANDARD 6MM 64MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316067","SUP","HCPCS C1713","","480316067  -  SCREW BONE LONG STANDARD 6MM 67MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316522","SUP","HCPCS C1713","","480316522  -  SCREW BONE STANDARD 6.5MM 22MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316525","SUP","HCPCS C1713","","480316525  -  SCREW BONE STANDARD 6.5MM 25MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316528","SUP","HCPCS C1713","","480316528  -  SCREW BONE STANDARD 6.5MM 28MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316531","SUP","HCPCS C1713","","480316531  -  SCREW BONE STANDARD 6.5MM 31MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316534","SUP","HCPCS C1713","","480316534  -  SCREW BONE STANDARD 6.5MM 34MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316537","SUP","HCPCS C1713","","480316537  -  SCREW BONE STANDARD 6.5MM 37MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316540","SUP","HCPCS C1713","","480316540  -  SCREW BONE LONG STANDARD 6.5MM 40MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316543","SUP","HCPCS C1713","","480316543  -  SCREW BONE LONG STANDARD 6.5MM 43MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316546","SUP","HCPCS C1713","","480316546  -  SCREW BONE LONG STANDARD 6.5MM 46MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316549","SUP","HCPCS C1713","","480316549  -  SCREW BONE LONG STANDARD 6.5MM 49MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316552","SUP","HCPCS C1713","","480316552  -  SCREW BONE LONG STANDARD 6.5MM 52MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316555","SUP","HCPCS C1713","","480316555  -  SCREW BONE LONG STANDARD 6.5MM 55MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316558","SUP","HCPCS C1713","","480316558  -  SCREW BONE LONG STANDARD 6.5MM 58MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316561","SUP","HCPCS C1713","","480316561  -  SCREW BONE LONG STANDARD 6.5MM 61MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316564","SUP","HCPCS C1713","","480316564  -  SCREW BONE LONG STANDARD 6.5MM 64MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"480316567","SUP","HCPCS C1713","","480316567  -  SCREW BONE LONG STANDARD 6.5MM 67MM SPN THORACIC","BOTH IP/OP","$914.88 ","$677.01 ","$0.00 ","$914.88 ","$411.69 ","$0.00 ","$190.68 ","$0.00 ","$0.00 ","$160.19 ","$914.88 ","$0.00 ","$457.44 ","$724.58 ","$731.90 ","$0.00 ","$143.18 ","$0.00 ","$145.65 ","$0.00 "
"481322040","SUP","HCPCS C1713","","481322040  -  ROD SPNL 4.5MM 40MM NS LF XIA PREBNT PCUT VIT SPNE","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"481322050","SUP","HCPCS C1713","","481322050  -  ROD SPNL 50MM 4.5MM XIA PREBNT VIT PCUT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"481322070","SUP","HCPCS C1713","","481322070  -  ROD SPNL PREBNT HEX 4.5MM 70MM PCUT VITALIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"482204020","SUP","HCPCS C1713","","482204020  -  SCREW BONE 4MM 20MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482204025","SUP","HCPCS C1713","","482204025  -  SCREW BONE 4MM 25MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482204030","SUP","HCPCS C1713","","482204030  -  SCREW BONE 4MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482204035","SUP","HCPCS C1713","","482204035  -  SCREW BONE 4MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482204040","SUP","HCPCS C1713","","482204040  -  SCREW BONE 4MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482205025","SUP","HCPCS C1713","","482205025  -  SCREW BONE 5MM 25MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482205030","SUP","HCPCS C1713","","482205030  -  SCREW BONE 5MM 30MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482205035","SUP","HCPCS C1713","","482205035  -  SCREW BONE 5MM 35MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482205040","SUP","HCPCS C1713","","482205040  -  SCREW BONE 5MM 40MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482205045","SUP","HCPCS C1713","","482205045  -  SCREW BONE 5MM 45MM MNOAX XIA STAINLESS STEEL SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"482214020","SUP","HCPCS C1713","","482214020  -  SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"482214025","SUP","HCPCS C1713","","482214025  -  SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"482214030","SUP","HCPCS C1713","","482214030  -  SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$1,195.84 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"482214035","SUP","HCPCS C1713","","482214035  -  SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"482214040","SUP","HCPCS C1713","","482214040  -  SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"482215025","SUP","HCPCS C1713","","482215025  -  SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"482215030","SUP","HCPCS C1713","","482215030  -  SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"482215035","SUP","HCPCS C1713","","482215035  -  SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$2,379.38 ","$0.00 ","$1,102.05 ","$0.00 ","$0.00 ","$925.80 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$827.49 ","$0.00 ","$841.77 ","$0.00 "
"482215040","SUP","HCPCS C1713","","482215040  -  SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"482215045","SUP","HCPCS C1713","","482215045  -  SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"482301500","SUP","HCPCS C1713","","482301500  -  SCREW BONE 1.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301540","SUP","HCPCS C1713","","482301540  -  SCREW BONE 1.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301545","SUP","HCPCS C1713","","482301545  -  SCREW BONE 1.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301550","SUP","HCPCS C1713","","482301550  -  SCREW BONE 1.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301555","SUP","HCPCS C1713","","482301555  -  SCREW BONE 1.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301560","SUP","HCPCS C1713","","482301560  -  SCREW BONE 1.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301565","SUP","HCPCS C1713","","482301565  -  SCREW BONE 1.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301570","SUP","HCPCS C1713","","482301570  -  SCREW BONE 1.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301580","SUP","HCPCS C1713","","482301580  -  SCREW BONE 1.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482301590","SUP","HCPCS C1713","","482301590  -  SCREW BONE 1.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"482304020","SUP","HCPCS C1713","","482304020  -  SCREW BONE 4MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304025","SUP","HCPCS C1713","","482304025  -  SCREW BONE 4MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304030","SUP","HCPCS C1713","","482304030  -  SCREW BONE 4MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304035","SUP","HCPCS C1713","","482304035  -  SCREW BONE 4MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304040","SUP","HCPCS C1713","","482304040  -  SCREW BONE 4MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304045","SUP","HCPCS C1713","","482304045  -  SCREW BONE 4MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304520","SUP","HCPCS C1713","","482304520  -  SCREW BONE 4.5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304525","SUP","HCPCS C1713","","482304525  -  SCREW BONE 4.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304530","SUP","HCPCS C1713","","482304530  -  SCREW BONE 4.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304535","SUP","HCPCS C1713","","482304535  -  SCREW BONE 4.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304540","SUP","HCPCS C1713","","482304540  -  SCREW BONE 4.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482304545","SUP","HCPCS C1713","","482304545  -  SCREW BONE 4.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305020","SUP","HCPCS C1713","","482305020  -  SCREW BONE 5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305025","SUP","HCPCS C1713","","482305025  -  SCREW BONE 5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305030","SUP","HCPCS C1713","","482305030  -  SCREW BONE 5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305035","SUP","HCPCS C1713","","482305035  -  SCREW BONE 5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305040","SUP","HCPCS C1713","","482305040  -  SCREW BONE 5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305045","SUP","HCPCS C1713","","482305045  -  SCREW BONE 5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305050","SUP","HCPCS C1713","","482305050  -  SCREW BONE 5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305525","SUP","HCPCS C1713","","482305525  -  SCREW BONE 5.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305530","SUP","HCPCS C1713","","482305530  -  SCREW BONE 5.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305535","SUP","HCPCS C1713","","482305535  -  SCREW BONE 5.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305540","SUP","HCPCS C1713","","482305540  -  SCREW BONE 5.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305545","SUP","HCPCS C1713","","482305545  -  SCREW BONE 5.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305550","SUP","HCPCS C1713","","482305550  -  SCREW BONE 5.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482305555","SUP","HCPCS C1713","","482305555  -  SCREW BONE 5.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306025","SUP","HCPCS C1713","","482306025  -  SCREW BONE 6MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306030","SUP","HCPCS C1713","","482306030  -  SCREW BONE 6MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306035","SUP","HCPCS C1713","","482306035  -  SCREW BONE 6MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306040","SUP","HCPCS C1713","","482306040  -  SCREW BONE 6MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306045","SUP","HCPCS C1713","","482306045  -  SCREW BONE 6MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306050","SUP","HCPCS C1713","","482306050  -  SCREW BONE 6MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306055","SUP","HCPCS C1713","","482306055  -  SCREW BONE 6MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306060","SUP","HCPCS C1713","","482306060  -  SCREW BONE 6MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306065","SUP","HCPCS C1713","","482306065  -  SCREW BONE 6MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306070","SUP","HCPCS C1713","","482306070  -  SCREW BONE 6MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306080","SUP","HCPCS C1713","","482306080  -  SCREW BONE 6MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306090","SUP","HCPCS C1713","","482306090  -  SCREW BONE 6MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306525","SUP","HCPCS C1713","","482306525  -  SCREW BONE 6.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306530","SUP","HCPCS C1713","","482306530  -  SCREW BONE 6.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306535","SUP","HCPCS C1713","","482306535  -  SCREW BONE 6.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306540","SUP","HCPCS C1713","","482306540  -  SCREW BONE 6.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306545","SUP","HCPCS C1713","","482306545  -  SCREW BONE 6.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306550","SUP","HCPCS C1713","","482306550  -  SCREW BONE 6.5MM 50MM MULTIAX XIA 3 TITANIUM SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306555","SUP","HCPCS C1713","","482306555  -  SCREW BONE 6.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306560","SUP","HCPCS C1713","","482306560  -  SCREW BONE 6.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306565","SUP","HCPCS C1713","","482306565  -  SCREW BONE 6.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306570","SUP","HCPCS C1713","","482306570  -  SCREW BONE 6.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306580","SUP","HCPCS C1713","","482306580  -  SCREW BONE 6.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482306590","SUP","HCPCS C1713","","482306590  -  SCREW BONE 6.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307025","SUP","HCPCS C1713","","482307025  -  SCREW BONE 7MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307030","SUP","HCPCS C1713","","482307030  -  SCREW BONE 7MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307035","SUP","HCPCS C1713","","482307035  -  SCREW BONE 7MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307040","SUP","HCPCS C1713","","482307040  -  SCREW BONE 7MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307045","SUP","HCPCS C1713","","482307045  -  SCREW BONE 7MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307050","SUP","HCPCS C1713","","482307050  -  SCREW BONE 7MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307055","SUP","HCPCS C1713","","482307055  -  SCREW BONE 7MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307060","SUP","HCPCS C1713","","482307060  -  SCREW BONE 7MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307065","SUP","HCPCS C1713","","482307065  -  SCREW BONE 7MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307070","SUP","HCPCS C1713","","482307070  -  SCREW BONE 7MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307080","SUP","HCPCS C1713","","482307080  -  SCREW BONE 7MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307090","SUP","HCPCS C1713","","482307090  -  SCREW BONE 7MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307525","SUP","HCPCS C1713","","482307525  -  SCREW BONE 7.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307530","SUP","HCPCS C1713","","482307530  -  SCREW BONE 7.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307535","SUP","HCPCS C1713","","482307535  -  SCREW BONE 7.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307540","SUP","HCPCS C1713","","482307540  -  SCREW BONE 7.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307545","SUP","HCPCS C1713","","482307545  -  SCREW BONE 7.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307550","SUP","HCPCS C1713","","482307550  -  SCREW BONE 7.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307555","SUP","HCPCS C1713","","482307555  -  SCREW BONE 7.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307560","SUP","HCPCS C1713","","482307560  -  SCREW BONE 7.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307565","SUP","HCPCS C1713","","482307565  -  SCREW BONE 7.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307570","SUP","HCPCS C1713","","482307570  -  SCREW BONE 7.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307580","SUP","HCPCS C1713","","482307580  -  SCREW BONE 7.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482307590","SUP","HCPCS C1713","","482307590  -  SCREW BONE 7.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308500","SUP","HCPCS C1713","","482308500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308525","SUP","HCPCS C1713","","482308525  -  SCREW BONE 8.5MM 25MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308530","SUP","HCPCS C1713","","482308530  -  SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308535","SUP","HCPCS C1713","","482308535  -  SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308540","SUP","HCPCS C1713","","482308540  -  SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308545","SUP","HCPCS C1713","","482308545  -  SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308550","SUP","HCPCS C1713","","482308550  -  SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308555","SUP","HCPCS C1713","","482308555  -  SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308560","SUP","HCPCS C1713","","482308560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308565","SUP","HCPCS C1713","","482308565  -  SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308570","SUP","HCPCS C1713","","482308570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308580","SUP","HCPCS C1713","","482308580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482308590","SUP","HCPCS C1713","","482308590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309500","SUP","HCPCS C1713","","482309500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309540","SUP","HCPCS C1713","","482309540  -  SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309545","SUP","HCPCS C1713","","482309545  -  SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309550","SUP","HCPCS C1713","","482309550  -  SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309555","SUP","HCPCS C1713","","482309555  -  SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309560","SUP","HCPCS C1713","","482309560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309565","SUP","HCPCS C1713","","482309565  -  SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309570","SUP","HCPCS C1713","","482309570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309580","SUP","HCPCS C1713","","482309580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482309590","SUP","HCPCS C1713","","482309590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"482311500","SUP","HCPCS C1713","","482311500  -  SCREW BONE 1.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311540","SUP","HCPCS C1713","","482311540  -  SCREW BONE 1.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311545","SUP","HCPCS C1713","","482311545  -  SCREW BONE 1.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311550","SUP","HCPCS C1713","","482311550  -  SCREW BONE 1.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311555","SUP","HCPCS C1713","","482311555  -  SCREW BONE 1.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311560","SUP","HCPCS C1713","","482311560  -  SCREW BONE 1.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311565","SUP","HCPCS C1713","","482311565  -  SCREW BONE 1.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311570","SUP","HCPCS C1713","","482311570  -  SCREW BONE 1.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311580","SUP","HCPCS C1713","","482311580  -  SCREW BONE 1.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482311590","SUP","HCPCS C1713","","482311590  -  SCREW BONE 1.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314020","SUP","HCPCS C1713","","482314020  -  SCREW BONE 4MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314025","SUP","HCPCS C1713","","482314025  -  SCREW BONE 4MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314030","SUP","HCPCS C1713","","482314030  -  SCREW BONE 4MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314035","SUP","HCPCS C1713","","482314035  -  SCREW BONE 4MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314040","SUP","HCPCS C1713","","482314040  -  SCREW BONE 4MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314045","SUP","HCPCS C1713","","482314045  -  SCREW BONE 4MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314520","SUP","HCPCS C1713","","482314520  -  SCREW BONE 4.5MM 20MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314525","SUP","HCPCS C1713","","482314525  -  SCREW BONE 4.5MM 25MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314530","SUP","HCPCS C1713","","482314530  -  SCREW BONE 4.5MM 30MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314535","SUP","HCPCS C1713","","482314535  -  SCREW BONE 4.5MM 35MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314540","SUP","HCPCS C1713","","482314540  -  SCREW BONE 4.5MM 40MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482314545","SUP","HCPCS C1713","","482314545  -  SCREW BONE 4.5MM 45MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315020","SUP","HCPCS C1713","","482315020  -  SCREW BONE 5MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315025","SUP","HCPCS C1713","","482315025  -  SCREW BONE 5MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315030","SUP","HCPCS C1713","","482315030  -  SCREW BONE 5MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315035","SUP","HCPCS C1713","","482315035  -  SCREW BONE 5MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315040","SUP","HCPCS C1713","","482315040  -  SCREW BONE 5MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315045","SUP","HCPCS C1713","","482315045  -  SCREW BONE 5MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315050","SUP","HCPCS C1713","","482315050  -  SCREW BONE 5MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315525","SUP","HCPCS C1713","","482315525  -  SCREW BONE 5.5MM 25MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315530","SUP","HCPCS C1713","","482315530  -  SCREW BONE 5.5MM 30MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315535","SUP","HCPCS C1713","","482315535  -  SCREW BONE 5.5MM 35MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315540","SUP","HCPCS C1713","","482315540  -  SCREW BONE 5.5MM 40MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315545","SUP","HCPCS C1713","","482315545  -  SCREW BONE 5.5MM 45MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315550","SUP","HCPCS C1713","","482315550  -  SCREW BONE 5.5MM 50MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482315555","SUP","HCPCS C1713","","482315555  -  SCREW BONE 5.5MM 55MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316025","SUP","HCPCS C1713","","482316025  -  SCREW BONE 6MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316030","SUP","HCPCS C1713","","482316030  -  SCREW BONE 6MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316035","SUP","HCPCS C1713","","482316035  -  SCREW BONE 6MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316040","SUP","HCPCS C1713","","482316040  -  SCREW BONE 6MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316045","SUP","HCPCS C1713","","482316045  -  SCREW BN 6MM 50MM XIA 3 PA TI SPNE THORLMBR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316050","SUP","HCPCS C1713","","482316050  -  SCREW BONE 6MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316055","SUP","HCPCS C1713","","482316055  -  SCREW BONE 6MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316060","SUP","HCPCS C1713","","482316060  -  SCREW BONE 6MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316065","SUP","HCPCS C1713","","482316065  -  SCREW BN 6MM 70MM XIA 3 PA TI SPNE THORLMBR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316070","SUP","HCPCS C1713","","482316070  -  SCREW BONE 6MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316080","SUP","HCPCS C1713","","482316080  -  SCREW BONE 6MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316090","SUP","HCPCS C1713","","482316090  -  SCREW BONE 6MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316525","SUP","HCPCS C1713","","482316525  -  SCREW BONE 6.5MM 25MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316530","SUP","HCPCS C1713","","482316530  -  SCREW BONE 6.5MM 30MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316535","SUP","HCPCS C1713","","482316535  -  SCREW BONE 6.5MM 35MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316540","SUP","HCPCS C1713","","482316540  -  SCREW BONE 6.5MM 40MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316545","SUP","HCPCS C1713","","482316545  -  SCREW BONE 6.5MM 45MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316550","SUP","HCPCS C1713","","482316550  -  SCREW BONE 6.5MM 50MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316555","SUP","HCPCS C1713","","482316555  -  SCREW BONE 6.5MM 55MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316560","SUP","HCPCS C1713","","482316560  -  SCREW BONE 6.5MM 60MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316565","SUP","HCPCS C1713","","482316565  -  SCREW BONE 6.5MM 65MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316570","SUP","HCPCS C1713","","482316570  -  SCREW BONE 6.5MM 70MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316580","SUP","HCPCS C1713","","482316580  -  SCREW BONE 6.5MM 80MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482316590","SUP","HCPCS C1713","","482316590  -  SCREW BONE 6.5MM 90MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317025","SUP","HCPCS C1713","","482317025  -  SCREW BONE 7MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317030","SUP","HCPCS C1713","","482317030  -  SCREW BONE 7MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317035","SUP","HCPCS C1713","","482317035  -  SCREW BONE 7MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317040","SUP","HCPCS C1713","","482317040  -  SCREW BONE 7MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317045","SUP","HCPCS C1713","","482317045  -  SCREW BONE 7MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317050","SUP","HCPCS C1713","","482317050  -  SCREW BONE 7MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317055","SUP","HCPCS C1713","","482317055  -  SCREW BONE 7MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317060","SUP","HCPCS C1713","","482317060  -  SCREW BONE 7MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317065","SUP","HCPCS C1713","","482317065  -  SCREW BONE 7MM 65MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317070","SUP","HCPCS C1713","","482317070  -  SCREW BONE 7MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317080","SUP","HCPCS C1713","","482317080  -  SCREW BONE 7MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317090","SUP","HCPCS C1713","","482317090  -  SCREW BONE 7MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317525","SUP","HCPCS C1713","","482317525  -  SCREW BONE 7.5MM 25MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317530","SUP","HCPCS C1713","","482317530  -  SCREW BONE 7.5MM 30MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317535","SUP","HCPCS C1713","","482317535  -  SCREW BONE 7.5MM 35MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317540","SUP","HCPCS C1713","","482317540  -  SCREW BONE 7.5MM 40MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317545","SUP","HCPCS C1713","","482317545  -  SCREW BONE 7.5MM 45MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317550","SUP","HCPCS C1713","","482317550  -  SCREW BONE 7.5MM 55MM CANN XIA TITANIUM SPN THORACOLUMBAR","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317555","SUP","HCPCS C1713","","482317555  -  SCREW BONE 7.5MM 55MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317560","SUP","HCPCS C1713","","482317560  -  SCREW BONE 7.5MM 60MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317565","SUP","HCPCS C1713","","482317565  -  SCREW BONE 7.5MM 65MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317570","SUP","HCPCS C1713","","482317570  -  SCREW BONE 7.5MM 70MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317580","SUP","HCPCS C1713","","482317580  -  SCREW BONE 7.5MM 80MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482317590","SUP","HCPCS C1713","","482317590  -  SCREW BONE 7.5MM 90MM POLYAX XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318500","SUP","HCPCS C1713","","482318500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318525","SUP","HCPCS C1713","","482318525  -  SCREW BONE 8.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318530","SUP","HCPCS C1713","","482318530  -  SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318535","SUP","HCPCS C1713","","482318535  -  SCREW BONE 8.5MM 35MM XIA 3 TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318540","SUP","HCPCS C1713","","482318540  -  SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318545","SUP","HCPCS C1713","","482318545  -  SCREW BONE 8.5MM 45MM POLYAX REVISION SPN ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318550","SUP","HCPCS C1713","","482318550  -  SCREW BONE 8.5MM 50MM POLYAX REVISION SPN ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318555","SUP","HCPCS C1713","","482318555  -  SCREW BONE 8.5MM 55MM POLYAX REVISION SPN ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318560","SUP","HCPCS C1713","","482318560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX SPN PEDICLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318565","SUP","HCPCS C1713","","482318565  -  SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318570","SUP","HCPCS C1713","","482318570  -  BOLT SPINAL 8.5MM 70MM POLYAX XIA ILIUM","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318580","SUP","HCPCS C1713","","482318580  -  SCREW BONE 80MM XIA TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482318590","SUP","HCPCS C1713","","482318590  -  SCREW BN 9.5MM 100MM REV PA ILSCRL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319500","SUP","HCPCS C1713","","482319500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319540","SUP","HCPCS C1713","","482319540  -  SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319545","SUP","HCPCS C1713","","482319545  -  SCREW BONE 9.5MM 45MM POLYAX REVISION SPN ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319550","SUP","HCPCS C1713","","482319550  -  SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319555","SUP","HCPCS C1713","","482319555  -  SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319560","SUP","HCPCS C1713","","482319560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319565","SUP","HCPCS C1713","","482319565  -  SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319570","SUP","HCPCS C1713","","482319570  -  SCREW BONE 9.5MM 70MM POLYAX RED PROFILE REVISION XIA SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319580","SUP","HCPCS C1713","","482319580  -  SCREW BONE 9.5MM 80MM POLYAX RED PROFILE REVISION XIA SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482319590","SUP","HCPCS C1713","","482319590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482326500","SUP","HCPCS C1713","","482326500  -  SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326530","SUP","HCPCS C1713","","482326530  -  SCREW BONE 6.5MM 30MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326535","SUP","HCPCS C1713","","482326535  -  SCREW BONE 6.5MM 35MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326540","SUP","HCPCS C1713","","482326540  -  SCREW BONE 6.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326545","SUP","HCPCS C1713","","482326545  -  SCREW BONE 6.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326550","SUP","HCPCS C1713","","482326550  -  SCREW BONE 6.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326555","SUP","HCPCS C1713","","482326555  -  SCREW BONE 6.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326560","SUP","HCPCS C1713","","482326560  -  SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326565","SUP","HCPCS C1713","","482326565  -  SCREW BONE 6.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326570","SUP","HCPCS C1713","","482326570  -  SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326580","SUP","HCPCS C1713","","482326580  -  SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482326590","SUP","HCPCS C1713","","482326590  -  SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327500","SUP","HCPCS C1713","","482327500  -  SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327530","SUP","HCPCS C1713","","482327530  -  SCREW BONE 7.5MM 30MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327535","SUP","HCPCS C1713","","482327535  -  SCREW BONE 7.5MM 35MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327540","SUP","HCPCS C1713","","482327540  -  SCREW BONE 7.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327545","SUP","HCPCS C1713","","482327545  -  SCREW BONE 7.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327550","SUP","HCPCS C1713","","482327550  -  SCREW BONE 7.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327555","SUP","HCPCS C1713","","482327555  -  SCREW BONE 7.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327560","SUP","HCPCS C1713","","482327560  -  SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327565","SUP","HCPCS C1713","","482327565  -  SCREW BONE 7.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327570","SUP","HCPCS C1713","","482327570  -  SCREW BONE 7.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327580","SUP","HCPCS C1713","","482327580  -  SCREW BONE 7.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482327590","SUP","HCPCS C1713","","482327590  -  SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328500","SUP","HCPCS C1713","","482328500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328530","SUP","HCPCS C1713","","482328530  -  SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328535","SUP","HCPCS C1713","","482328535  -  SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328540","SUP","HCPCS C1713","","482328540  -  SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328545","SUP","HCPCS C1713","","482328545  -  SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328550","SUP","HCPCS C1713","","482328550  -  SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328555","SUP","HCPCS C1713","","482328555  -  SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328560","SUP","HCPCS C1713","","482328560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328565","SUP","HCPCS C1713","","482328565  -  SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328570","SUP","HCPCS C1713","","482328570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328580","SUP","HCPCS C1713","","482328580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482328590","SUP","HCPCS C1713","","482328590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329500","SUP","HCPCS C1713","","482329500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329530","SUP","HCPCS C1713","","482329530  -  SCREW BONE 9.5MM 30MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329535","SUP","HCPCS C1713","","482329535  -  SCREW BONE 9.5MM 35MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329540","SUP","HCPCS C1713","","482329540  -  SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329545","SUP","HCPCS C1713","","482329545  -  SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329550","SUP","HCPCS C1713","","482329550  -  SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329555","SUP","HCPCS C1713","","482329555  -  SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329560","SUP","HCPCS C1713","","482329560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329565","SUP","HCPCS C1713","","482329565  -  SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329570","SUP","HCPCS C1713","","482329570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329580","SUP","HCPCS C1713","","482329580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482329590","SUP","HCPCS C1713","","482329590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482335020","SUP","HCPCS C1713","","482335020  -  SCREW BONE 5MM 20MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482335025","SUP","HCPCS C1713","","482335025  -  SCREW BONE 5MM 25MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482335030","SUP","HCPCS C1713","","482335030  -  SCREW BONE 5MM 30MM UNIPLNR XIA SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482335035","SUP","HCPCS C1713","","482335035  -  SCREW BONE 5MM 35MM UNIPLNR XIA SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482335040","SUP","HCPCS C1713","","482335040  -  SCREW BONE 5MM 40MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482335045","SUP","HCPCS C1713","","482335045  -  SCREW BONE 5MM 45MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336025","SUP","HCPCS C1713","","482336025  -  SCREW BONE 6MM 25MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336030","SUP","HCPCS C1713","","482336030  -  SCREW BONE 6MM 30MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336035","SUP","HCPCS C1713","","482336035  -  SCREW BONE 6MM 35MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336040","SUP","HCPCS C1713","","482336040  -  SCREW BONE 6MM 40MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336045","SUP","HCPCS C1713","","482336045  -  SCREW BONE 6MM 45MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336050","SUP","HCPCS C1713","","482336050  -  SCREW BONE 6MM 50MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336055","SUP","HCPCS C1713","","482336055  -  SCREW BONE 6MM 55MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482336060","SUP","HCPCS C1713","","482336060  -  SCREW BONE 6MM 60MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337030","SUP","HCPCS C1713","","482337030  -  SCREW BONE 7MM 30MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337035","SUP","HCPCS C1713","","482337035  -  SCREW BONE 7MM 35MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337040","SUP","HCPCS C1713","","482337040  -  SCREW BONE 7MM 40MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337045","SUP","HCPCS C1713","","482337045  -  SCREW BONE 7MM 45MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337050","SUP","HCPCS C1713","","482337050  -  SCREW BONE 7MM 50MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337055","SUP","HCPCS C1713","","482337055  -  SCREW BONE 7MM 55MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482337060","SUP","HCPCS C1713","","482337060  -  SCREW BONE 7MM 60MM UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
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"482367560","SUP","HCPCS C1713","","482367560  -  SCREW BONE 7.5MM 60MM REDX UNIPLNR XIA 3 SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376500","SUP","HCPCS C1713","","482376500  -  SCREW BONE 6.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376530","SUP","HCPCS C1713","","482376530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376535","SUP","HCPCS C1713","","482376535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376540","SUP","HCPCS C1713","","482376540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376545","SUP","HCPCS C1713","","482376545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376550","SUP","HCPCS C1713","","482376550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376555","SUP","HCPCS C1713","","482376555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376560","SUP","HCPCS C1713","","482376560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376565","SUP","HCPCS C1713","","482376565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376570","SUP","HCPCS C1713","","482376570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376580","SUP","HCPCS C1713","","482376580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482376590","SUP","HCPCS C1713","","482376590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377500","SUP","HCPCS C1713","","482377500  -  SCREW BONE 7.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377530","SUP","HCPCS C1713","","482377530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377535","SUP","HCPCS C1713","","482377535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377540","SUP","HCPCS C1713","","482377540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377545","SUP","HCPCS C1713","","482377545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377550","SUP","HCPCS C1713","","482377550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377555","SUP","HCPCS C1713","","482377555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377560","SUP","HCPCS C1713","","482377560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377565","SUP","HCPCS C1713","","482377565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377570","SUP","HCPCS C1713","","482377570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377580","SUP","HCPCS C1713","","482377580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482377590","SUP","HCPCS C1713","","482377590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378500","SUP","HCPCS C1713","","482378500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378530","SUP","HCPCS C1713","","482378530  -  SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378535","SUP","HCPCS C1713","","482378535  -  SCREW BONE 8.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378540","SUP","HCPCS C1713","","482378540  -  SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378545","SUP","HCPCS C1713","","482378545  -  SCREW BONE 8.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378550","SUP","HCPCS C1713","","482378550  -  SCREW BONE 8.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378555","SUP","HCPCS C1713","","482378555  -  SCREW BONE 8.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378560","SUP","HCPCS C1713","","482378560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378565","SUP","HCPCS C1713","","482378565  -  SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378570","SUP","HCPCS C1713","","482378570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378580","SUP","HCPCS C1713","","482378580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482378590","SUP","HCPCS C1713","","482378590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379500","SUP","HCPCS C1713","","482379500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379530","SUP","HCPCS C1713","","482379530  -  SCREW BONE 9.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379535","SUP","HCPCS C1713","","482379535  -  SCREW BONE 9.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379540","SUP","HCPCS C1713","","482379540  -  SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379545","SUP","HCPCS C1713","","482379545  -  SCREW BONE 9.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379550","SUP","HCPCS C1713","","482379550  -  SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379555","SUP","HCPCS C1713","","482379555  -  SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379560","SUP","HCPCS C1713","","482379560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379565","SUP","HCPCS C1713","","482379565  -  SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379570","SUP","HCPCS C1713","","482379570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379580","SUP","HCPCS C1713","","482379580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482379590","SUP","HCPCS C1713","","482379590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384020","SUP","HCPCS C1713","","482384020  -  SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384025","SUP","HCPCS C1713","","482384025  -  SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384030","SUP","HCPCS C1713","","482384030  -  SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384035","SUP","HCPCS C1713","","482384035  -  SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384040","SUP","HCPCS C1713","","482384040  -  SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384045","SUP","HCPCS C1713","","482384045  -  SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384520","SUP","HCPCS C1713","","482384520  -  SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384525","SUP","HCPCS C1713","","482384525  -  SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384530","SUP","HCPCS C1713","","482384530  -  SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384535","SUP","HCPCS C1713","","482384535  -  SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384540","SUP","HCPCS C1713","","482384540  -  SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482384545","SUP","HCPCS C1713","","482384545  -  SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385020","SUP","Custom 27803010","","482385020  -  CONNECTOR ROD 5MM 20MM ROD TO ROD RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"482385025","SUP","HCPCS C1713","","482385025  -  SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385030","SUP","HCPCS C1713","","482385030  -  SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385035","SUP","HCPCS C1713","","482385035  -  SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385040","SUP","HCPCS C1713","","482385040  -  SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385045","SUP","HCPCS C1713","","482385045  -  SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385050","SUP","HCPCS C1713","","482385050  -  SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385525","SUP","HCPCS C1713","","482385525  -  SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385530","SUP","HCPCS C1713","","482385530  -  SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385535","SUP","HCPCS C1713","","482385535  -  SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385540","SUP","HCPCS C1713","","482385540  -  SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385545","SUP","HCPCS C1713","","482385545  -  SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385550","SUP","HCPCS C1713","","482385550  -  SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482385555","SUP","HCPCS C1713","","482385555  -  SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386525","SUP","HCPCS C1713","","482386525  -  SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386530","SUP","HCPCS C1713","","482386530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386535","SUP","HCPCS C1713","","482386535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386540","SUP","HCPCS C1713","","482386540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386545","SUP","HCPCS C1713","","482386545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386550","SUP","HCPCS C1713","","482386550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386555","SUP","HCPCS C1713","","482386555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386560","SUP","HCPCS C1713","","482386560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386565","SUP","HCPCS C1713","","482386565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386570","SUP","HCPCS C1713","","482386570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386580","SUP","HCPCS C1713","","482386580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482386590","SUP","HCPCS C1713","","482386590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387525","SUP","HCPCS C1713","","482387525  -  SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387530","SUP","HCPCS C1713","","482387530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387535","SUP","HCPCS C1713","","482387535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387540","SUP","HCPCS C1713","","482387540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387545","SUP","HCPCS C1713","","482387545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387550","SUP","HCPCS C1713","","482387550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387555","SUP","HCPCS C1713","","482387555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387560","SUP","HCPCS C1713","","482387560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387565","SUP","HCPCS C1713","","482387565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387570","SUP","HCPCS C1713","","482387570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387580","SUP","HCPCS C1713","","482387580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482387590","SUP","HCPCS C1713","","482387590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482388500","SUP","HCPCS C1713","","482388500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482388560","SUP","HCPCS C1713","","482388560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482388570","SUP","HCPCS C1713","","482388570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482388580","SUP","HCPCS C1713","","482388580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482388590","SUP","HCPCS C1713","","482388590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482389500","SUP","HCPCS C1713","","482389500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482389560","SUP","HCPCS C1713","","482389560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482389570","SUP","HCPCS C1713","","482389570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482389580","SUP","HCPCS C1713","","482389580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482389590","SUP","HCPCS C1713","","482389590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX BIASED ANGLE","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"482396500","SUP","HCPCS C1713","","482396500  -  SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482396560","SUP","HCPCS C1713","","482396560  -  SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482396570","SUP","HCPCS C1713","","482396570  -  SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482396580","SUP","HCPCS C1713","","482396580  -  SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482396590","SUP","HCPCS C1713","","482396590  -  SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482397500","SUP","HCPCS C1713","","482397500  -  SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482397560","SUP","HCPCS C1713","","482397560  -  SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482397570","SUP","HCPCS C1713","","482397570  -  SCREW BONE 15D 7.5MM 70MM REVISION MNOAX BIASED ANGLE","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482397580","SUP","HCPCS C1713","","482397580  -  SCREW BONE 15D 7.5MM 80MM REVISION MNOAX BIASED ANGLE","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482397590","SUP","HCPCS C1713","","482397590  -  SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482398500","SUP","HCPCS C1713","","482398500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482398560","SUP","HCPCS C1713","","482398560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482398570","SUP","HCPCS C1713","","482398570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482398580","SUP","HCPCS C1713","","482398580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482398590","SUP","HCPCS C1713","","482398590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482399500","SUP","HCPCS C1713","","482399500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482399560","SUP","HCPCS C1713","","482399560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482399570","SUP","HCPCS C1713","","482399570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482399580","SUP","HCPCS C1713","","482399580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482399590","SUP","HCPCS C1713","","482399590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL","BOTH IP/OP","$3,654.83 ","$2,704.57 ","$0.00 ","$3,654.83 ","$1,644.67 ","$0.00 ","$761.76 ","$0.00 ","$0.00 ","$639.93 ","$3,654.83 ","$0.00 ","$1,827.41 ","$2,894.63 ","$2,923.86 ","$0.00 ","$571.98 ","$0.00 ","$581.85 ","$0.00 "
"482700601","SUP","HCPCS C1713","","00482700601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 6MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482700701","SUP","HCPCS C1713","","00482700701  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 7MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482700800","SUP","HCPCS C1713","","00482700800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482700801","SUP","HCPCS C1713","","00482700801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482700901","SUP","HCPCS C1713","","00482700901  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 9MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482701000","SUP","HCPCS C1713","","00482701000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482701001","SUP","HCPCS C1713","","00482701001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482701200","SUP","HCPCS C1713","","00482701200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482701201","SUP","HCPCS C1713","","00482701201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482701400","SUP","HCPCS C1713","","00482701400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482701401","SUP","HCPCS C1713","","00482701401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482701600","SUP","HCPCS C1713","","00482701600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482701601","SUP","HCPCS C1713","","00482701601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482701800","SUP","HCPCS C1713","","00482701800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482701801","SUP","HCPCS C1713","","00482701801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482702000","SUP","HCPCS C1713","","00482702000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 20MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482702200","SUP","HCPCS C1713","","00482702200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482702201","SUP","HCPCS C1713","","00482702201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482702400","SUP","HCPCS C1713","","00482702400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482702401","SUP","HCPCS C1713","","00482702401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482702600","SUP","HCPCS C1713","","00482702600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482702601","SUP","HCPCS C1713","","00482702601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482702800","SUP","HCPCS C1713","","00482702800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482702801","SUP","HCPCS C1713","","00482702801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482703000","SUP","HCPCS C1713","","00482703000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482703001","SUP","HCPCS C1713","","00482703001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482703200","SUP","HCPCS C1713","","00482703200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482703201","SUP","HCPCS C1713","","00482703201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482703400","SUP","HCPCS C1713","","00482703400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482703401","SUP","HCPCS C1713","","00482703401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482703600","SUP","HCPCS C1713","","00482703600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482703601","SUP","HCPCS C1713","","00482703601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482703800","SUP","HCPCS C1713","","00482703800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482703801","SUP","HCPCS C1713","","00482703801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482704000","SUP","HCPCS C1713","","00482704000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482704001","SUP","HCPCS C1713","","00482704001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482704201","SUP","HCPCS C1713","","00482704201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 42MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482704401","SUP","HCPCS C1713","","00482704401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 44MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482704500","SUP","HCPCS C1713","","00482704500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482704501","SUP","HCPCS C1713","","00482704501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482704601","SUP","HCPCS C1713","","00482704601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 46MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482704801","SUP","HCPCS C1713","","00482704801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 48MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482705000","SUP","HCPCS C1713","","00482705000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482705001","SUP","HCPCS C1713","","00482705001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482705201","SUP","HCPCS C1713","","00482705201  -  SCREW BONE SMALL HEXAGON 2.7MM 52MM SELF TAP CORTICAL","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482705401","SUP","HCPCS C1713","","00482705401  -  SCREW BONE SMALL HEXAGON 2.7MM 54MM SELF TAP CORTICAL","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482705500","SUP","HCPCS C1713","","00482705500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482705501","SUP","HCPCS C1713","","00482705501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482705601","SUP","HCPCS C1713","","00482705601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 56MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482705801","SUP","HCPCS C1713","","00482705801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 58MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482706000","SUP","HCPCS C1713","","00482706000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482706001","SUP","HCPCS C1713","","00482706001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482706500","SUP","HCPCS C1713","","00482706500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482706501","SUP","HCPCS C1713","","00482706501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482707000","SUP","HCPCS C1713","","00482707000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM STAINLESS STEEL","BOTH IP/OP","$32.20 ","$23.83 ","$0.00 ","$32.20 ","$14.49 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.64 ","$32.20 ","$0.00 ","$16.10 ","$25.50 ","$25.76 ","$0.00 ","$5.04 ","$0.00 ","$5.13 ","$0.00 "
"482707001","SUP","HCPCS C1713","","00482707001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM SELF TAP STAINLESS","BOTH IP/OP","$36.80 ","$27.23 ","$0.00 ","$36.80 ","$16.56 ","$0.00 ","$7.67 ","$0.00 ","$0.00 ","$6.44 ","$36.80 ","$0.00 ","$18.40 ","$29.15 ","$29.44 ","$0.00 ","$5.76 ","$0.00 ","$5.86 ","$0.00 "
"482802540","SUP","HCPCS C1713","","482802540  -  SCREW BONE 5.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482802640","SUP","HCPCS C1713","","482802640  -  SCREW BONE 6.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482802645","SUP","HCPCS C1713","","482802645  -  SCREW BONE 6.5MM 45MM 15MM ES2 LT XIA 3 SHRT BLADE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482802650","SUP","HCPCS C1713","","482802650  -  SCREW BN SHRT BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482802745","SUP","HCPCS C1713","","482802745  -  SCREW BN SHRT BLDE LOPRFL 7.5MM 45MM 15MM ES2 LT XIA 3 6 PNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482804545","SUP","HCPCS C1713","","482804545  -  SCREW BN LNG BLDE LOPRFL 5.5MM 45MM 15MM ES2 LT XIA 3 6 PNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482804645","SUP","HCPCS C1713","","482804645  -  SCREW BN LNG BLDE LOPRFL 6.5MM 45MM 15MM ES2 LT XIA 3 6 PNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482804650","SUP","HCPCS C1713","","482804650  -  SCREW BN LNG BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482804750","SUP","HCPCS C1713","","482804750  -  SCREW BN LNG BLDE LOPRFL 7.5MM 50MM 15MM ES2 LT XIA 3 6 PNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"482806050","SUP","HCPCS C1713","","482806050  -  ROD SPNL HEX 5.5MM 50MM ES2 RDS TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"482806055","SUP","HCPCS C1713","","482806055  -  ROD SPNL HEX 5.5MM 55MM ES2 RDS TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"482807060","SUP","HCPCS C1713","","482807060  -  TITANIUM STRAIGHT ROD, 5.5X60MM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"482807090","SUP","HCPCS C1713","","482807090  -  ROD SPNL 90MM 5.5MM ES2 STR HEX TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"482911180","SUP","HCPCS C1713","","482911180  -  ENDCAP SPNL 18MM 0D","BOTH IP/OP","$746.78 ","$552.62 ","$0.00 ","$746.78 ","$336.05 ","$0.00 ","$155.65 ","$0.00 ","$0.00 ","$130.75 ","$746.78 ","$0.00 ","$373.39 ","$591.45 ","$597.42 ","$0.00 ","$116.87 ","$0.00 ","$118.89 ","$0.00 "
"483510098","SUP","Custom 27803010","","483510098  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510108","SUP","Custom 27803010","","483510108  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510118","SUP","Custom 27803010","","483510118  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510128","SUP","Custom 27803010","","483510128  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510138","SUP","Custom 27803010","","483510138  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510140","SUP","Custom 27803010","","483510140  -  SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510144","SUP","Custom 27803010","","483510144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510148","SUP","Custom 27803010","","483510148  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510150","SUP","Custom 27803010","","483510150  -  SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510154","SUP","Custom 27803010","","483510154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510158","SUP","Custom 27803010","","483510158  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483510168","SUP","Custom 27803010","","483510168  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515098","SUP","Custom 27803010","","483515098  -  SPACER SPNL 8D WDG 25X11X9MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515108","SUP","Custom 27803010","","483515108  -  SPACER SPNL 8D WDG 25X11X10MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515118","SUP","Custom 27803010","","483515118  -  SPACER SPNL 8D WDG 25X11X11MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515128","SUP","Custom 27803010","","483515128  -  SPACER SPNL 8D WDG 25X11X12MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515138","SUP","Custom 27803010","","483515138  -  SPACER SPNL 8D WDG 25X11X13MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515140","SUP","Custom 27803010","","483515140  -  SPACER SPNL 0D RECT 25X11X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515144","SUP","Custom 27803010","","483515144  -  SPACER SPNL 4D WDG 25X11X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515148","SUP","Custom 27803010","","483515148  -  SPACER SPNL 8D WDG 25X11X14MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515150","SUP","Custom 27803010","","483515150  -  SPACER SPNL 0D RECT 25X11X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515154","SUP","Custom 27803010","","483515154  -  SPACER SPNL 4D WDG 25X11X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515158","SUP","Custom 27803010","","483515158  -  SPACER SPNL 8D WDG 25X11X15MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"483515168","SUP","Custom 27803010","","483515168  -  SPACER SPNL 8D WDG 25X11X16MM AVS PL HLW PEEK PLIF","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486610000","SUP","HCPCS C1713","","486610000  -  CAP LOCKING SPN","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"486610425","SUP","HCPCS C1713","","486610425  -  SCREW BONE STANDARD 4.75MM 25MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610430","SUP","HCPCS C1713","","486610430  -  SCREW BONE STANDARD 4.75MM 30MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610435","SUP","HCPCS C1713","","486610435  -  SCREW BONE STANDARD 4.75MM 35MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610440","SUP","HCPCS C1713","","486610440  -  SCREW BONE STANDARD 4.75MM 40MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610445","SUP","HCPCS C1713","","486610445  -  SCREW BONE STANDARD 4.75MM 45MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610450","SUP","HCPCS C1713","","486610450  -  SCREW BONE 4.75MM 50MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610455","SUP","HCPCS C1713","","486610455  -  SCREW BONE 4.75MM 55MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610525","SUP","HCPCS C1713","","486610525  -  SCREW BONE 5.75MM 25MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610530","SUP","HCPCS C1713","","486610530  -  SCREW BONE STANDARD 5.75MM 30MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610535","SUP","HCPCS C1713","","486610535  -  SCREW BONE STANDARD 5.75MM 35MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610540","SUP","HCPCS C1713","","486610540  -  SCREW BONE STANDARD 5.75MM 40MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610545","SUP","HCPCS C1713","","486610545  -  SCREW BONE STANDARD 5.75MM 45MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610550","SUP","HCPCS C1713","","486610550  -  SCREW BONE 5.75MM 50MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610555","SUP","HCPCS C1713","","486610555  -  SCREW BONE 5.75MM 55MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610560","SUP","HCPCS C1713","","486610560  -  SCREW BONE 5.75MM 60MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610565","SUP","HCPCS C1713","","486610565  -  SCREW BONE 5.75MM 65MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610600","SUP","HCPCS C1713","","486610600  -  SCREW BONE 6.75MM 100MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610625","SUP","HCPCS C1713","","486610625  -  SCREW BONE 6.75MM 25MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610630","SUP","HCPCS C1713","","486610630  -  SCREW BONE STANDARD 6.75MM 30MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610635","SUP","HCPCS C1713","","486610635  -  SCREW BONE STANDARD 6.75MM 35MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610640","SUP","HCPCS C1713","","486610640  -  SCREW BONE STANDARD 6.75MM 40MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610645","SUP","HCPCS C1713","","486610645  -  SCREW BONE STANDARD 6.75MM 45MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610650","SUP","HCPCS C1713","","486610650  -  SCREW BONE STANDARD 6.75MM 50MM RAD SPN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"486610655","SUP","HCPCS C1713","","486610655  -  SCREW BONE 6.75MM 55MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610660","SUP","HCPCS C1713","","486610660  -  SCREW BONE 6.75MM 60MM SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610665","SUP","HCPCS C1713","","486610665  -  SCREW BONE 6.75MM 65MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610670","SUP","HCPCS C1713","","486610670  -  SCREW BONE 6.75MM 70MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610680","SUP","HCPCS C1713","","486610680  -  SCREW BONE 6.75MM 80MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610690","SUP","HCPCS C1713","","486610690  -  SCREW BONE 6.75MM 90MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610700","SUP","HCPCS C1713","","486610700  -  SCREW BONE 7.75MM 100MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610725","SUP","HCPCS C1713","","486610725  -  SCREW BONE 7.75MM 25MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610730","SUP","HCPCS C1713","","486610730  -  SCREW BONE 7.75MM 30MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610735","SUP","HCPCS C1713","","486610735  -  SCREW BONE 7.75MM 35MM RADSTD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610740","SUP","HCPCS C1713","","486610740  -  SCREW BONE 7.75MM 40MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610745","SUP","HCPCS C1713","","486610745  -  SCREW BONE 7.75MM 45MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610750","SUP","HCPCS C1713","","486610750  -  SCREW BONE 7.75MM 50MM SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610755","SUP","HCPCS C1713","","486610755  -  SCREW BONE 7.75MM 55MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610760","SUP","HCPCS C1713","","486610760  -  SCREW BONE 7.75MM 60MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610765","SUP","HCPCS C1713","","486610765  -  SCREW BONE 7.75MM 65MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610770","SUP","HCPCS C1713","","486610770  -  SCREW BONE 7.75MM 70MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610780","SUP","HCPCS C1713","","486610780  -  SCREW BONE 7.75MM 80MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610790","SUP","HCPCS C1713","","486610790  -  SCREW BONE 7.75MM 90MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610800","SUP","HCPCS C1713","","486610800  -  SCREW BONE 8.75MM 100MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610830","SUP","HCPCS C1713","","486610830  -  SCREW BONE 8.75MM 30MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610835","SUP","HCPCS C1713","","486610835  -  SCREW BONE 8.75MM 35MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610840","SUP","HCPCS C1713","","486610840  -  SCREW BONE 8.75MM 40MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610845","SUP","HCPCS C1713","","486610845  -  SCREW BONE 8.75MM 45MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610850","SUP","HCPCS C1713","","486610850  -  SCREW BONE 8.75MM 50MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610855","SUP","HCPCS C1713","","486610855  -  SCREW BONE 8.75MM 55MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610860","SUP","HCPCS C1713","","486610860  -  SCREW BONE 8.75MM 60MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610865","SUP","HCPCS C1713","","486610865  -  SCREW BONE 8.75MM 65MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610870","SUP","HCPCS C1713","","486610870  -  SCREW BONE 8.75MM 70MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610880","SUP","HCPCS C1713","","486610880  -  SCREW BONE 8.75MM 80MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610890","SUP","HCPCS C1713","","486610890  -  SCREW BONE 8.75MM 90MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610900","SUP","HCPCS C1713","","486610900  -  SCREW BONE 9.75MM 100MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610960","SUP","HCPCS C1713","","486610960  -  SCREW BONE 9.75MM 60MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610970","SUP","HCPCS C1713","","486610970  -  SCREW BONE 9.75MM 70MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610980","SUP","HCPCS C1713","","486610980  -  SCREW BONE 9.75MM 80MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486610990","SUP","HCPCS C1713","","486610990  -  SCREW BONE 9.75MM 90MM RADSTD SPNL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486611425","SUP","HCPCS C1713","","486611425  -  SCREW BONE 4.75MM 25MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611430","SUP","HCPCS C1713","","486611430  -  SCREW BONE 4.75MM 30MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611435","SUP","HCPCS C1713","","486611435  -  SCREW BONE 4.75MM 35MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611440","SUP","HCPCS C1713","","486611440  -  SCREW BONE 4.75MM 40MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611445","SUP","HCPCS C1713","","486611445  -  SCREW BONE 4.75MM 45MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611450","SUP","HCPCS C1713","","486611450  -  SCREW BONE 4.75MM 50MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611455","SUP","HCPCS C1713","","486611455  -  SCREW BONE 4.75MM 55MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611525","SUP","HCPCS C1713","","486611525  -  SCREW BONE 5.75MM 25MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611530","SUP","HCPCS C1713","","486611530  -  SCREW BONE 5.75MM 30MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611535","SUP","HCPCS C1713","","486611535  -  SCREW BONE 5.75MM 35MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611540","SUP","HCPCS C1713","","486611540  -  SCREW BONE 5MM 40MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611545","SUP","HCPCS C1713","","486611545  -  SCREW BONE 5.75MM 45MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611550","SUP","HCPCS C1713","","486611550  -  SCREW BONE 5.75MM 50MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611555","SUP","HCPCS C1713","","486611555  -  SCREW BONE 5MM 55MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611560","SUP","HCPCS C1713","","486611560  -  SCREW BONE 5.75MM 60MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611565","SUP","HCPCS C1713","","486611565  -  SCREW BONE 5.75MM 65MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611600","SUP","HCPCS C1713","","486611600  -  SCREW BONE 6.75MM 100MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611625","SUP","HCPCS C1713","","486611625  -  SCREW BONE 6.75MM 25MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611630","SUP","HCPCS C1713","","486611630  -  SCREW BONE 6.75MM 30MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611635","SUP","HCPCS C1713","","486611635  -  SCREW BONE 6.75MM 35MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611640","SUP","HCPCS C1713","","486611640  -  SCREW BONE 6.75MM 40MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611645","SUP","HCPCS C1713","","486611645  -  SCREW BONE 6.75MM 45MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611650","SUP","HCPCS C1713","","486611650  -  SCREW BONE 6.75MM 50MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611655","SUP","HCPCS C1713","","486611655  -  SCREW BONE 6.75MM 55MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611660","SUP","HCPCS C1713","","486611660  -  SCREW BONE 6.75MM 60MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611665","SUP","HCPCS C1713","","486611665  -  SCREW BONE 6.75MM 65MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611670","SUP","HCPCS C1713","","486611670  -  SCREW BONE 6.75MM 70MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611680","SUP","HCPCS C1713","","486611680  -  SCREW BONE 6.75MM 80MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611690","SUP","HCPCS C1713","","486611690  -  SCREW BONE 6.75MM 90MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611700","SUP","HCPCS C1713","","486611700  -  SCREW BONE 7.75MM 100MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611725","SUP","HCPCS C1713","","486611725  -  SCREW BONE 7.75MM 25MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611730","SUP","HCPCS C1713","","486611730  -  SCREW BONE 7.75MM 30MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611735","SUP","HCPCS C1713","","486611735  -  SCREW BONE 7.75MM 35MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611740","SUP","HCPCS C1713","","486611740  -  SCREW BONE 7.75MM 40MM MULTIANG TITANIUM SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611745","SUP","HCPCS C1713","","486611745  -  SCREW BONE 7.75MM 45MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611750","SUP","HCPCS C1713","","486611750  -  SCREW BONE 7.75MM 50MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611755","SUP","HCPCS C1713","","486611755  -  SCREW BONE 7.75MM 55MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611760","SUP","HCPCS C1713","","486611760  -  SCREW BONE 7.75MM 60MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611765","SUP","HCPCS C1713","","486611765  -  SCREW BONE 7.75MM 65MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611770","SUP","HCPCS C1713","","486611770  -  SCREW BONE 7.75MM 70MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611780","SUP","HCPCS C1713","","486611780  -  SCREW BONE 7.75MM 80MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611790","SUP","HCPCS C1713","","486611790  -  SCREW BONE 7.75MM 90MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611800","SUP","HCPCS C1713","","486611800  -  SCREW BONE 8.75MM 100MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611830","SUP","HCPCS C1713","","486611830  -  SCREW BONE 8.75MM 30MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611835","SUP","HCPCS C1713","","486611835  -  SCREW BONE 8.75MM 35MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611840","SUP","HCPCS C1713","","486611840  -  SCREW BONE 8.75MM 40MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611845","SUP","HCPCS C1713","","486611845  -  SCREW BONE 8.75MM 45MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611850","SUP","HCPCS C1713","","486611850  -  SCREW BONE 8.75MM 50MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611855","SUP","HCPCS C1713","","486611855  -  SCREW BONE 8.75MM 55MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611860","SUP","HCPCS C1713","","486611860  -  SCREW BONE 8.75MM 60MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611865","SUP","HCPCS C1713","","486611865  -  SCREW BONE 8.75MM 65MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611870","SUP","HCPCS C1713","","486611870  -  SCREW BONE 8.75MM 70MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611880","SUP","HCPCS C1713","","486611880  -  SCREW BONE 8.75MM 80MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611890","SUP","HCPCS C1713","","486611890  -  SCREW BONE 8.75MM 90MM MULTIANG RAD SPN","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"486611900","SUP","HCPCS C1713","","486611900  -  SCREW BONE 9.75MM 100MM RAD SPNL MULTIANG","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486611960","SUP","HCPCS C1713","","486611960  -  SCREW BONE 9.75MM 60MM RADL SPNL MULTIANG","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486611970","SUP","HCPCS C1713","","486611970  -  SCREW BONE 9.75MM 70MM RAD SPNL CANN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486611980","SUP","HCPCS C1713","","486611980  -  SCREW BONE 9.75MM 80MM RAD SPNL MULTIANG","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486611990","SUP","HCPCS C1713","","486611990  -  SCREW BONE 9.75MM 90MM RAD SPNL MULTIANG","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"486612535","SUP","HCPCS C1713","","486612535  -  SCREW BONE 5.75MM 35MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612540","SUP","HCPCS C1713","","486612540  -  SCREW BONE 5.75MM 40MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612545","SUP","HCPCS C1713","","486612545  -  SCREW BONE 5.75MM 45MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612550","SUP","HCPCS C1713","","486612550  -  SCREW BONE 5.75MM 50MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612630","SUP","HCPCS C1713","","486612630  -  SCREW BONE 6.75MM 30MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612635","SUP","Custom 27203010","","486612635  -  SCREW BONE 6.75MM 35MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486612640","SUP","HCPCS C1713","","486612640  -  SCREW BONE 6.75MM 40MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612645","SUP","HCPCS C1713","","486612645  -  SCREW BONE 6.75MM 45MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612650","SUP","HCPCS C1713","","486612650  -  SCREW BONE 6.75MM 50MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612655","SUP","HCPCS C1713","","486612655  -  SCREW BONE 6.75MM 55MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612730","SUP","HCPCS C1713","","486612730  -  SCREW BONE 7.75MM 30MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612735","SUP","HCPCS C1713","","486612735  -  SCREW BONE 7.75MM 35MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612740","SUP","HCPCS C1713","","486612740  -  SCREW BONE 7.75MM 40MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612745","SUP","HCPCS C1713","","486612745  -  SCREW BONE 7.75MM 45MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612750","SUP","HCPCS C1713","","486612750  -  SCREW BONE 7.75MM 50MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486612755","SUP","HCPCS C1713","","486612755  -  SCREW BONE 7.75MM 55MM MULTIANG CANN RAD SPN","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"486613000","SUP","Custom 27803010","","486613000  -  ROD SPINAL 5.5MM 100MM NONHEXAGONAL TITANIUM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613003","SUP","Custom 27803010","","486613003  -  ROD SPINAL 5.5MM 30MM W/O HEXAGONAL RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613004","SUP","Custom 27803010","","486613004  -  ROD SPINAL 40MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613005","SUP","Custom 27803010","","486613005  -  ROD SPINAL 5.5MM 50MM NONHEXAGONAL RAD TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613006","SUP","Custom 27803010","","486613006  -  ROD SPINAL 5.5MM 60MM W/O HEXAGONAL RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613007","SUP","Custom 27803010","","486613007  -  ROD SPNL 5.5MM 70MM RDS NONHEXAGONAL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613008","SUP","Custom 27803010","","486613008  -  ROD SPINAL 5.5MM 80MM W/O HEXAGONAL RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613009","SUP","Custom 27803010","","486613009  -  ROD SPINAL 5.5MM 90MM NONHEXAGONAL RAD TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613010","SUP","Custom 27803010","","486613010  -  ROD SPINAL 5.5MM 110MM W/O HEXAGONAL RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613020","SUP","Custom 27803010","","486613020  -  ROD SPINAL 5.5MM 120MM RAD W/O HEXAGONAL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613050","SUP","Custom 27803010","","486613050  -  ROD SPINAL 5.5MM 50MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613053","SUP","Custom 27803010","","486613053  -  ROD SPINAL 5.5MM 35MM RAD NONHEXAGONAL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613054","SUP","Custom 27803010","","486613054  -  ROD SPINAL 5.5MM 45MM NONHEXAGONAL RAD TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613060","SUP","Custom 27803010","","486613060  -  ROD SPINAL 5.5MM 60MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613070","SUP","Custom 27803010","","486613070  -  ROD SPINAL 5.5MM 70MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613080","SUP","Custom 27803010","","486613080  -  ROD SPINAL 5.5MM 80MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613090","SUP","Custom 27803010","","486613090  -  ROD SPINAL 5.5MM 90MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613100","SUP","Custom 27803010","","486613100  -  ROD SPINAL 5.5MM 100MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613110","SUP","Custom 27803010","","486613110  -  ROD SPINAL 5.5MM 110MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613120","SUP","Custom 27803010","","486613120  -  ROD SPINAL 5.5MM 120MM HEXAGONAL RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613140","SUP","Custom 27803010","","486613140  -  ROD SPINAL 5.5MM 140MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613160","SUP","Custom 27803010","","486613160  -  ROD SPINAL 5.5MM 160MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613180","SUP","Custom 27803010","","486613180  -  ROD SPINAL 5.5MM 180MM HEXAGONAL RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613200","SUP","Custom 27803010","","486613200  -  ROD SPINAL 5.5MM 200MM HEXAGON RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613220","SUP","Custom 27803010","","486613220  -  ROD SPINAL 5.5MM 220MM RAD HEXAGONAL","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613240","SUP","Custom 27803010","","486613240  -  ROD SPINAL 5.5MM 240MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613260","SUP","Custom 27803010","","486613260  -  ROD SPINAL 5.5MM 260MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613280","SUP","Custom 27803010","","486613280  -  ROD SPINAL 5.5MM 280MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613300","SUP","Custom 27803010","","486613300  -  ROD SPINAL 5.5MM 300MM HEXAGONAL RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613320","SUP","Custom 27803010","","486613320  -  ROD SPINAL 5.5MM 320MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613340","SUP","Custom 27803010","","486613340  -  ROD SPINAL 5.5MM 340MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613360","SUP","Custom 27803010","","486613360  -  ROD SPINAL 5.5MM 360MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613380","SUP","Custom 27803010","","486613380  -  ROD SPINAL 5.5MM 380MM HEXAGON RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613400","SUP","Custom 27803010","","486613400  -  ROD SPINAL 5.5MM 400MM RAD HEXAGONAL","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613600","SUP","Custom 27803010","","486613600  -  ROD SPINAL 5.5MM 600MM HEXAGONAL RAD","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613601","SUP","Custom 27803010","","486613601  -  ROD SPINAL 6.5MM 600MM RAD VITALLIUM PEDICLE","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486613602","SUP","Custom 27803010","","486613602  -  ROD SPINAL 5.5MM HEXAGON VITALLIUM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614022","SUP","Custom 27803010","","486614022  -  CONNECTOR ROD 22MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614024","SUP","Custom 27803010","","486614024  -  CONNECTOR ROD 24MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614026","SUP","Custom 27803010","","486614026  -  CONNECTOR ROD 26MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614028","SUP","Custom 27803010","","486614028  -  CONNECTOR ROD 28MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614030","SUP","Custom 27803010","","486614030  -  CONNECTOR ROD 30MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614032","SUP","Custom 27803010","","486614032  -  CONNECTOR ROD 32MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614034","SUP","Custom 27803010","","486614034  -  CONNECTOR ROD 34MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614036","SUP","Custom 27803010","","486614036  -  CONNECTOR ROD 36MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614100","SUP","Custom 27803010","","486614100  -  CONNECTOR ROD SHORT CROSS VARIABLE RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614110","SUP","Custom 27803010","","486614110  -  CONNECTOR ROD MEDIUM CROSS RAD VARIABLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614120","SUP","Custom 27803010","","486614120  -  CONNECTOR ROD LONG CROSS VARIABLE RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614130","SUP","Custom 27803010","","486614130  -  CONNECTOR ROD MEDIUM CROSS CVD RAD VARIABLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614140","SUP","Custom 27803010","","486614140  -  CONNECTOR ROD LONG VARIABLE CROSS CVD RAD MA","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614170","SUP","Custom 27803010","","486614170  -  CONNECTOR ROD MEDIUM CROSS MULTIANGLED RAD VARIABLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614180","SUP","Custom 27803010","","486614180  -  CONNECTOR ROD LONG POLYAX CROSS VAR ANG RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614215","SUP","Custom 27803010","","486614215  -  CONNECTOR ROD 15MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614216","SUP","Custom 27803010","","486614216  -  CONNECTOR ROD 16MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614217","SUP","Custom 27803010","","486614217  -  CONNECTOR ROD 18MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614218","SUP","Custom 27803010","","486614218  -  CONNECTOR ROD 18MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614219","SUP","Custom 27803010","","486614219  -  CONNECTOR ROD 19MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614220","SUP","Custom 27803010","","486614220  -  CONNECTOR ROD 20MM CROSS RAD SPN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614300","SUP","Custom 27803010","","486614300  -  CONNECTOR ROD 0D SMALL ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614305","SUP","Custom 27803010","","486614305  -  CONNECTOR ROD 105D OFFST RAD BEN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614310","SUP","Custom 27803010","","486614310  -  CONNECTOR ROD NEUTRAL OFFST RAD","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614320","SUP","Custom 27803010","","486614320  -  CONNECTOR ROD NEUTRAL LONG OFFST RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614330","SUP","Custom 27803010","","486614330  -  CONNECTOR ROD 30D SMALL ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614375","SUP","Custom 27803010","","486614375  -  CONNECTOR ROD 75D SMALL ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614400","SUP","Custom 27803010","","486614400  -  CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614430","SUP","Custom 27803010","","486614430  -  CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614530","SUP","Custom 27803010","","486614530  -  CONCTR ROD 5MM RAD ROD TO ROD SPNL","BOTH IP/OP","$2,076.80 ","$1,536.83 ","$0.00 ","$2,076.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,076.80 ","$0.00 ","$1,038.40 ","$1,644.83 ","$1,661.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614550","SUP","Custom 27803010","","486614550  -  CONNECTOR ROD 5MM ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614555","SUP","Custom 27803010","","486614555  -  CONNECTOR ROD ROD TO ROD POLYAX RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614560","SUP","Custom 27803010","","486614560  -  CONNECTOR ROD 5MM ROD TO ROD RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486614565","SUP","Custom 27803010","","486614565  -  CONNECTOR ROD OFFST RAD SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615000","SUP","Custom 27803010","","486615000  -  ROD SPINAL 5.5MM 100MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615010","SUP","Custom 27803010","","486615010  -  ROD SPINAL 5.5MM 110MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615020","SUP","Custom 27803010","","486615020  -  ROD SPINAL 5.5MM 120MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615030","SUP","Custom 27803010","","486615030  -  ROD SPINAL 5.5MM 30MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615035","SUP","Custom 27803010","","486615035  -  ROD SPNL 35MM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615040","SUP","Custom 27803010","","486615040  -  ROD SPINAL 5.5MM 40MM TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615045","SUP","Custom 27803010","","486615045  -  ROD SPINAL 5.5MM 45MM TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615050","SUP","Custom 27803010","","486615050  -  ROD SPINAL 50X5.5MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615060","SUP","Custom 27803010","","486615060  -  ROD SPINAL 60X5.5MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615070","SUP","Custom 27803010","","486615070  -  ROD SPINAL 70X5.5MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615080","SUP","Custom 27803010","","486615080  -  ROD SPNL 5.5MM 80MM SPRL RDS","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615090","SUP","Custom 27803010","","486615090  -  ROD SPINAL 5.5MM 90MM TITANIUM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615500","SUP","Custom 27803010","","486615500  -  ROD SPINAL 5.5MM 100MM RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615510","SUP","Custom 27803010","","486615510  -  ROD SPINAL 5.5MM 110MM MAX RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615520","SUP","Custom 27803010","","486615520  -  ROD SPINAL 5.5MM 120MM RAD MAX","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615550","SUP","Custom 27803010","","486615550  -  ROD SPINAL 5.5MM 50MM RAD MAX","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615560","SUP","Custom 27803010","","486615560  -  ROD SPNL 60MM ISOBAR","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615570","SUP","Custom 27803010","","486615570  -  ROD SPNL 5.5MM 70MM MAX","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615580","SUP","Custom 27803010","","486615580  -  ROD SPINAL 5.5MM 80MM MAX RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486615590","SUP","Custom 27803010","","486615590  -  ROD SPINAL 5.5MM 90MM MAX RAD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616000","SUP","Custom 27803010","","486616000  -  HOOK SPNL RADSM LMNR STR BLADE","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616001","SUP","Custom 27803010","","486616001  -  HOOK SPNL RADSM LMNR NAR BLADE","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616002","SUP","Custom 27803010","","486616002  -  HOOK SPNL RADLG LMNR STR BLADE","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616003","SUP","Custom 27803010","","486616003  -  HOOK SPNL RADLG LMNR NAR BLADE","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616004","SUP","Custom 27803010","","486616004  -  HOOK SPNL RAD LMNR XTD BLADE","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616005","SUP","Custom 27803010","","486616005  -  HOOK SPNL RADLG LMNR RIGHT OFFST","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616006","SUP","Custom 27803010","","486616006  -  HOOK SPNL RADLG LMNR LEFT OFFST","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616007","SUP","Custom 27803010","","486616007  -  HOOK SPNL RAD LMNR ANG BLADE","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616008","SUP","Custom 27803010","","486616008  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616009","SUP","Custom 27803010","","486616009  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616010","SUP","Custom 27803010","","486616010  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616011","SUP","Custom 27803010","","486616011  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616012","SUP","Custom 27803010","","486616012  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616013","SUP","Custom 27803010","","486616013  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616014","SUP","Custom 27803010","","486616014  -  HOOK SPNL RADSM PDCL","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616015","SUP","Custom 27803010","","486616015  -  HOOK SPNL RADLG PDCL","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616016","SUP","Custom 27803010","","486616016  -  HOOK SPNL RAD RIGHT TRNSVRS PRC","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616017","SUP","Custom 27803010","","486616017  -  HOOK SPNL RAD LEFT TRNSVRS PRC","BOTH IP/OP","$2,392.80 ","$1,770.67 ","$0.00 ","$2,392.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,392.80 ","$0.00 ","$1,196.40 ","$1,895.10 ","$1,914.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616018","SUP","Custom 27803010","","486616018  -  HOOK SPNL RAD LMNR NAR BLADE","BOTH IP/OP","$2,686.30 ","$1,987.86 ","$0.00 ","$2,686.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,686.30 ","$0.00 ","$1,343.15 ","$2,127.55 ","$2,149.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616019","SUP","Custom 27803010","","486616019  -  HOOK SPNL RAD LMNR STD BLADE","BOTH IP/OP","$2,686.30 ","$1,987.86 ","$0.00 ","$2,686.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,686.30 ","$0.00 ","$1,343.15 ","$2,127.55 ","$2,149.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616020","SUP","Custom 27803010","","486616020  -  HOOK SPNL RAD LMNR ANG BLADE","BOTH IP/OP","$2,686.30 ","$1,987.86 ","$0.00 ","$2,686.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,686.30 ","$0.00 ","$1,343.15 ","$2,127.55 ","$2,149.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616021","SUP","Custom 27803010","","486616021  -  HOOK SPNL RAD LMNR THOR","BOTH IP/OP","$2,686.30 ","$1,987.86 ","$0.00 ","$2,686.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,686.30 ","$0.00 ","$1,343.15 ","$2,127.55 ","$2,149.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486616022","SUP","Custom 27803010","","486616022  -  HOOK SPNL RAD PDCL","BOTH IP/OP","$2,686.30 ","$1,987.86 ","$0.00 ","$2,686.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,686.30 ","$0.00 ","$1,343.15 ","$2,127.55 ","$2,149.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"486617005","SUP","HCPCS C1713","","486617005  -  STAPLE BONE DUAL RSTRL RADXS","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617006","SUP","HCPCS C1713","","486617006  -  STAPLE BONE DUAL CDL RADXS","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617010","SUP","HCPCS C1713","","486617010  -  STAPLE BONE DUAL CDL RADSM","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617015","SUP","HCPCS C1713","","486617015  -  STAPLE BONE DUAL RSTRL RADSM","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617020","SUP","HCPCS C1713","","486617020  -  STAPLE BONE DUAL CDL RADMED","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617025","SUP","HCPCS C1713","","486617025  -  STAPLE BONE DUAL RSTRL RADMED","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617030","SUP","HCPCS C1713","","486617030  -  STAPLE BONE DUAL CDL RADLG","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617035","SUP","HCPCS C1713","","486617035  -  STAPLE BONE DUAL RSTRL RADLG","BOTH IP/OP","$2,493.88 ","$1,845.47 ","$0.00 ","$2,493.88 ","$1,122.24 ","$0.00 ","$519.79 ","$0.00 ","$0.00 ","$436.66 ","$2,493.88 ","$0.00 ","$1,246.94 ","$1,975.15 ","$1,995.10 ","$0.00 ","$390.29 ","$0.00 ","$397.02 ","$0.00 "
"486617040","SUP","HCPCS C1713","","486617040  -  STAPLE BONE SGL TI RAD","BOTH IP/OP","$1,031.95 ","$763.64 ","$0.00 ","$1,031.95 ","$464.38 ","$0.00 ","$215.08 ","$0.00 ","$0.00 ","$180.69 ","$1,031.95 ","$0.00 ","$515.98 ","$817.30 ","$825.56 ","$0.00 ","$161.50 ","$0.00 ","$164.29 ","$0.00 "
"486617045","SUP","HCPCS C1713","","486617045  -  WASHER RAD ORTH","BOTH IP/OP","$780.43 ","$577.52 ","$0.00 ","$780.43 ","$351.19 ","$0.00 ","$162.66 ","$0.00 ","$0.00 ","$136.65 ","$780.43 ","$0.00 ","$390.21 ","$618.10 ","$624.34 ","$0.00 ","$122.14 ","$0.00 ","$124.24 ","$0.00 "
"486617050","SUP","HCPCS C1713","","486617050  -  WASHER 4.75MM RADTALL ORTH","BOTH IP/OP","$795.48 ","$588.66 ","$0.00 ","$795.48 ","$357.96 ","$0.00 ","$165.80 ","$0.00 ","$0.00 ","$139.28 ","$795.48 ","$0.00 ","$397.74 ","$630.02 ","$636.38 ","$0.00 ","$124.49 ","$0.00 ","$126.64 ","$0.00 "
"486617051","SUP","HCPCS C1713","","486617051  -  WASHER 5.75MM RADTALL ORTH","BOTH IP/OP","$795.48 ","$588.66 ","$0.00 ","$795.48 ","$357.96 ","$0.00 ","$165.80 ","$0.00 ","$0.00 ","$139.28 ","$795.48 ","$0.00 ","$397.74 ","$630.02 ","$636.38 ","$0.00 ","$124.49 ","$0.00 ","$126.64 ","$0.00 "
"486617052","SUP","HCPCS C1713","","486617052  -  WASHER 6.75MM RADTALL ORTH","BOTH IP/OP","$795.48 ","$588.66 ","$0.00 ","$795.48 ","$357.96 ","$0.00 ","$165.80 ","$0.00 ","$0.00 ","$139.28 ","$795.48 ","$0.00 ","$397.74 ","$630.02 ","$636.38 ","$0.00 ","$124.49 ","$0.00 ","$126.64 ","$0.00 "
"486617053","SUP","HCPCS C1713","","486617053  -  WASHER 7.75MM RADTALL ORTH","BOTH IP/OP","$795.48 ","$588.66 ","$0.00 ","$795.48 ","$357.96 ","$0.00 ","$165.80 ","$0.00 ","$0.00 ","$139.28 ","$795.48 ","$0.00 ","$397.74 ","$630.02 ","$636.38 ","$0.00 ","$124.49 ","$0.00 ","$126.64 ","$0.00 "
"486617054","SUP","HCPCS C1713","","486617054  -  WASHER 8.75MM RADTALL ORTH","BOTH IP/OP","$795.48 ","$588.66 ","$0.00 ","$795.48 ","$357.96 ","$0.00 ","$165.80 ","$0.00 ","$0.00 ","$139.28 ","$795.48 ","$0.00 ","$397.74 ","$630.02 ","$636.38 ","$0.00 ","$124.49 ","$0.00 ","$126.64 ","$0.00 "
"488514535","SUP","HCPCS C1713","","488514535  -  SCREW BN 4.5MM 35MM STRL XIA PA SPNE LMBR CORT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"488515035","SUP","HCPCS C1713","","488515035  -  SCREW BN 5MM 35MM XIA CT PA SPNE CORT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"488515540","SUP","HCPCS C1713","","488515540  -  SCREW BN 5.5MM 40MM STRL XIA PA SPNE LMBR CORT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"540133500","SUP","Custom 27803010","","540133500  -  SYSTEM BONE CEMENT CARTRIDGE SELF CLEAN MIXING PADDLES SNAP","BOTH IP/OP","$920.42 ","$681.11 ","$0.00 ","$920.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$920.42 ","$0.00 ","$460.21 ","$728.97 ","$736.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"582010140","SUP","Custom 27203010","","582010140  -  BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"606004102","SUP","HCPCS Q4130","","606004102  -  MATRIX TISS THK1MM RECT 20X10CM STRL SURGIMEND PRS","BOTH IP/OP","$9,000.00 ","$6,660.00 ","$0.00 ","$11,750.00 ","$0.00 ","$0.00 ","$1,875.83 ","$0.00 ","$0.00 ","$0.00 ","$11,750.00 ","$0.00 ","$5,875.00 ","$9,306.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"606200006","SUP","HCPCS C1713","","606200006  -  SCREW BONE 2.7MM 16MM SPN SNPOF","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$8,625.00 ","$3,881.25 ","$0.00 ","$1,172.39 ","$0.00 ","$0.00 ","$1,510.17 ","$8,625.00 ","$0.00 ","$4,312.50 ","$6,831.00 ","$6,900.00 ","$0.00 ","$1,349.81 ","$0.00 ","$1,373.10 ","$0.00 "
"630505036","SUP","HCPCS C1776","","630505036  -  LINER ACETAB STANDARD NEUTRAL 50/52/54MM 36MM 6.8MM PRIM","BOTH IP/OP","$2,978.75 ","$2,204.28 ","$0.00 ","$2,978.75 ","$1,340.44 ","$0.00 ","$620.85 ","$0.00 ","$0.00 ","$521.56 ","$2,978.75 ","$0.00 ","$1,489.38 ","$2,359.17 ","$2,383.00 ","$0.00 ","$466.17 ","$0.00 ","$474.22 ","$0.00 "
"630505636","SUP","HCPCS C1776","","630505636  -  LINER ACETAB STANDARD NEUTRAL 56MM 36MM 7.9MM PRIM MODULAR","BOTH IP/OP","$4,007.50 ","$2,965.55 ","$0.00 ","$4,007.50 ","$1,803.38 ","$0.00 ","$835.26 ","$0.00 ","$0.00 ","$701.68 ","$4,007.50 ","$0.00 ","$2,003.75 ","$3,173.94 ","$3,206.00 ","$0.00 ","$627.17 ","$0.00 ","$637.99 ","$0.00 "
"641003030","SUP","HCPCS C1713","","641003030  -  ROD SPNL 30MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003035","SUP","HCPCS C1713","","641003035  -  ROD SPNL 35MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003040","SUP","HCPCS C1713","","641003040  -  ROD SPNL 40MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003045","SUP","HCPCS C1713","","641003045  -  ROD SPNL 45MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003050","SUP","HCPCS C1713","","641003050  -  ROD SPNL 50MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003055","SUP","HCPCS C1713","","641003055  -  ROD SPNL 55MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003060","SUP","HCPCS C1713","","641003060  -  ROD SPNL 60MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003065","SUP","HCPCS C1713","","641003065  -  ROD SPNL 65MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003070","SUP","HCPCS C1713","","641003070  -  ROD SPNL 70MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003075","SUP","HCPCS C1713","","641003075  -  ROD SPNL 75MM 4.75MM CD HZN CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003080","SUP","HCPCS C1713","","641003080  -  ROD SPNL 80MM 4.75MM CD HZN COCRMO CAP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003085","SUP","HCPCS C1713","","641003085  -  ROD SPNL 85MM 4.75MM CD HZN COCRMO CAP STRL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003090","SUP","HCPCS C1713","","641003090  -  ROD SPNL 90MM 4.75MM CD HZN COCRMO CAP STRL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"641003095","SUP","HCPCS C1713","","641003095  -  ROD SPNL 95MM 4.75MM CD HZN COCRMO CAP STRL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"651506000","SUP","HCPCS C1894","","651506000  -  SYSTEM INTRO .018IN 80CM SKTR GW SS","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$109.96 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"654000100","SUP","HCPCS C1713","","654000100  -  ROD SPNL 5.5MM 100MM NS CD HZN SOLERA TI PERC","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$0.00 ","$0.00 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"673395000","SUP","Custom 27203010","","ADAPTER QCK 800 SER ANALY","BOTH IP/OP","$39.38 ","$29.14 ","$0.00 ","$39.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.38 ","$0.00 ","$19.69 ","$31.19 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"703046000","SUP","Custom 27203010","","0703046000  -  CTRY,PENCIL,PUSH BUTTON,SMOKE EVAC,70MM","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"755308040","SUP","HCPCS C1729","","755308040  -  CATHETER DRN 8FR 40CM STRL LF SKTR LCK PGTL RADOPQ BAND PU","BOTH IP/OP","$227.50 ","$168.35 ","$0.00 ","$227.50 ","$123.53 ","$0.00 ","$47.42 ","$0.00 ","$0.00 ","$39.83 ","$227.50 ","$0.00 ","$113.75 ","$180.18 ","$182.00 ","$0.00 ","$35.60 ","$0.00 ","$36.22 ","$0.00 "
"755608035","SUP","HCPCS C1729","","755608035  -  CATHETER NPHSTM PGTL CRV LOPRFL 8FR 35CM SKTR LCK KINK RST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$128.96 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"755610035","SUP","HCPCS C1729","","755610035  -  CATHETER NPHSTM .038IN PGTL CRV 10FR 35CM SKTR LCK GW PU BIL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"756506020","SUP","HCPCS C1729","","756506020  -  CATHETER DRN 6FR 20CM SKTR CHC LCK AP LOPRFL TROC STY","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$130.32 ","$0.00 ","$50.02 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"756510025","SUP","HCPCS C1729","","756510025  -  CATHETER DRN PGTL CRV 10FR 25CM SKTR CHC LCK LCK TROC STY LG","BOTH IP/OP","$234.95 ","$173.86 ","$0.00 ","$234.95 ","$127.58 ","$0.00 ","$48.97 ","$0.00 ","$0.00 ","$41.14 ","$234.95 ","$0.00 ","$117.47 ","$186.08 ","$187.96 ","$0.00 ","$36.77 ","$0.00 ","$37.40 ","$0.00 "
"756512025","SUP","HCPCS C1729","","756512025  -  CATHETER DRN PGTL CRV 12FR 25CM SKTR CHC LCK LCK TROC STY LG","BOTH IP/OP","$1,174.73 ","$869.30 ","$0.00 ","$1,174.73 ","$637.88 ","$0.00 ","$244.84 ","$0.00 ","$0.00 ","$205.68 ","$1,174.73 ","$0.00 ","$587.36 ","$930.39 ","$939.78 ","$0.00 ","$183.84 ","$0.00 ","$187.02 ","$0.00 "
"756514025","SUP","HCPCS C1729","","756514025  -  CATHETER DRN PGTL CRV 14FR 25CM SKTR CHC LCK LCK TROC STY LG","BOTH IP/OP","$1,135.00 ","$839.90 ","$0.00 ","$1,135.00 ","$616.31 ","$0.00 ","$236.56 ","$0.00 ","$0.00 ","$198.73 ","$1,135.00 ","$0.00 ","$567.50 ","$898.92 ","$908.00 ","$0.00 ","$177.63 ","$0.00 ","$180.69 ","$0.00 "
"771600010","SUP","Custom 27203010","","00771600010  -  CARRIER GRAFT 16X4IN BOARD LATEX FREE MESHGRAFT","BOTH IP/OP","$126.88 ","$93.89 ","$0.00 ","$126.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.88 ","$0.00 ","$63.44 ","$100.49 ","$101.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778114545","SUP","Custom 27803010","","778114545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778114555","SUP","Custom 27803010","","778114555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778114565","SUP","Custom 27803010","","778114565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778115545","SUP","Custom 27803010","","778115545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778115555","SUP","Custom 27803010","","778115555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778115565","SUP","Custom 27803010","","778115565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778116545","SUP","Custom 27803010","","778116545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778116555","SUP","Custom 27803010","","778116555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778116565","SUP","Custom 27803010","","778116565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778124545","SUP","Custom 27803010","","778124545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778124555","SUP","Custom 27803010","","778124555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778124565","SUP","Custom 27803010","","778124565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,052.75 ","$1,519.04 ","$0.00 ","$2,052.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,052.75 ","$0.00 ","$1,026.38 ","$1,625.78 ","$1,642.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778125555","SUP","Custom 27803010","","778125555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778125565","SUP","Custom 27803010","","778125565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778126565","SUP","Custom 27803010","","778126565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778144545","SUP","Custom 27803010","","778144545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778144565","SUP","Custom 27803010","","778144565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778145545","SUP","Custom 27803010","","778145545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778145555","SUP","Custom 27803010","","778145555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778145565","SUP","Custom 27803010","","778145565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778146545","SUP","Custom 27803010","","778146545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778146555","SUP","Custom 27803010","","778146555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778146565","SUP","Custom 27803010","","778146565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778161045","SUP","HCPCS C1713","","778161045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778161065","SUP","HCPCS C1713","","778161065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778162045","SUP","HCPCS C1713","","778162045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778162055","SUP","HCPCS C1713","","778162055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778162065","SUP","HCPCS C1713","","778162065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778164045","SUP","HCPCS C1713","","778164045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778164065","SUP","HCPCS C1713","","778164065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778167045","SUP","HCPCS C1713","","778167045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778167055","SUP","HCPCS C1713","","778167055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778167065","SUP","HCPCS C1713","","778167065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778170001","SUP","HCPCS C1713","","778170001  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"778214545","SUP","Custom 27803010","","778214545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778214555","SUP","Custom 27803010","","778214555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778214565","SUP","Custom 27803010","","778214565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778215545","SUP","Custom 27803010","","778215545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778215555","SUP","Custom 27803010","","778215555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778215565","SUP","Custom 27803010","","778215565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778216545","SUP","Custom 27803010","","778216545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778216555","SUP","Custom 27803010","","778216555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778216565","SUP","Custom 27803010","","778216565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778224545","SUP","Custom 27803010","","778224545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,969.50 ","$1,457.43 ","$0.00 ","$1,969.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.50 ","$0.00 ","$984.75 ","$1,559.84 ","$1,575.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778224555","SUP","Custom 27803010","","778224555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,969.50 ","$1,457.43 ","$0.00 ","$1,969.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.50 ","$0.00 ","$984.75 ","$1,559.84 ","$1,575.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778224565","SUP","Custom 27803010","","778224565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778225555","SUP","Custom 27803010","","778225555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,969.50 ","$1,457.43 ","$0.00 ","$1,969.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.50 ","$0.00 ","$984.75 ","$1,559.84 ","$1,575.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778225565","SUP","Custom 27803010","","778225565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,969.50 ","$1,457.43 ","$0.00 ","$1,969.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.50 ","$0.00 ","$984.75 ","$1,559.84 ","$1,575.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778226565","SUP","Custom 27803010","","778226565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,969.50 ","$1,457.43 ","$0.00 ","$1,969.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.50 ","$0.00 ","$984.75 ","$1,559.84 ","$1,575.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778244545","SUP","Custom 27803010","","778244545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778244555","SUP","Custom 27803010","","778244555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778244565","SUP","Custom 27803010","","778244565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778245545","SUP","Custom 27803010","","778245545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778245555","SUP","Custom 27803010","","778245555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778245565","SUP","Custom 27803010","","778245565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,175.95 ","$1,610.20 ","$0.00 ","$2,175.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.95 ","$0.00 ","$1,087.98 ","$1,723.35 ","$1,740.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778246545","SUP","Custom 27803010","","778246545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,052.75 ","$1,519.04 ","$0.00 ","$2,052.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,052.75 ","$0.00 ","$1,026.38 ","$1,625.78 ","$1,642.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778246555","SUP","Custom 27803010","","778246555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,052.75 ","$1,519.04 ","$0.00 ","$2,052.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,052.75 ","$0.00 ","$1,026.38 ","$1,625.78 ","$1,642.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778246565","SUP","Custom 27803010","","778246565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,981.85 ","$1,466.57 ","$0.00 ","$1,981.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,981.85 ","$0.00 ","$990.93 ","$1,569.63 ","$1,585.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"778261045","SUP","HCPCS C1713","","778261045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778261055","SUP","HCPCS C1713","","778261055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778261065","SUP","HCPCS C1713","","778261065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778262045","SUP","HCPCS C1713","","778262045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778262055","SUP","HCPCS C1713","","778262055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778262065","SUP","HCPCS C1713","","778262065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778264045","SUP","HCPCS C1713","","778264045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778264055","SUP","HCPCS C1713","","778264055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778264065","SUP","HCPCS C1713","","778264065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778267045","SUP","HCPCS C1713","","778267045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778267055","SUP","HCPCS C1713","","778267055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778267065","SUP","HCPCS C1713","","778267065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"778270001","SUP","HCPCS C1713","","778270001  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"779115545","SUP","Custom 27803010","","779115545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779115555","SUP","Custom 27803010","","779115555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779115565","SUP","Custom 27803010","","779115565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779124555","SUP","Custom 27803010","","779124555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779125555","SUP","Custom 27803010","","779125555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779125565","SUP","Custom 27803010","","779125565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779144555","SUP","Custom 27803010","","779144555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779145555","SUP","Custom 27803010","","779145555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779146555","SUP","Custom 27803010","","779146555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,251.70 ","$1,666.26 ","$0.00 ","$2,251.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,251.70 ","$0.00 ","$1,125.85 ","$1,783.35 ","$1,801.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"779170005","SUP","HCPCS C1713","","779170005  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"880000010","SUP","Custom 27203010","","00880000010  -  BLADE DERMATOME 1.25-4.25IN STERILE","BOTH IP/OP","$140.38 ","$103.88 ","$0.00 ","$121.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$121.25 ","$0.00 ","$60.63 ","$96.03 ","$97.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"998604014","SUP","HCPCS C1776","","998604014  -  SET TOT JOINT 11MM 8IN TREPHINE MRI NONSTRL","BOTH IP/OP","$2,037.50 ","$1,507.75 ","$0.00 ","$2,037.50 ","$916.88 ","$0.00 ","$424.67 ","$0.00 ","$0.00 ","$356.75 ","$2,037.50 ","$0.00 ","$1,018.75 ","$1,613.70 ","$1,630.00 ","$0.00 ","$318.87 ","$0.00 ","$324.37 ","$0.00 "
"1474000500","SUP","HCPCS C1713","","1474000500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475000500","SUP","HCPCS C1713","","1475000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001030","SUP","HCPCS C1713","","1475001030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001035","SUP","HCPCS C1713","","1475001035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001040","SUP","HCPCS C1713","","1475001040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001045","SUP","HCPCS C1713","","1475001045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001050","SUP","HCPCS C1713","","1475001050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001055","SUP","HCPCS C1713","","1475001055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001060","SUP","HCPCS C1713","","1475001060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001065","SUP","HCPCS C1713","","1475001065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001070","SUP","HCPCS C1713","","1475001070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001075","SUP","HCPCS C1713","","1475001075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001080","SUP","HCPCS C1713","","1475001080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001085","SUP","HCPCS C1713","","1475001085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001090","SUP","HCPCS C1713","","1475001090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001100","SUP","HCPCS C1713","","1475001100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001110","SUP","HCPCS C1713","","1475001110  -  ROD SPNL CRV PREBNT 4.75MM 110MM NS SOLERA CD HZN CCM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475001120","SUP","HCPCS C1713","","1475001120  -  ROD SPNL CRV 4.75MM 120MM NS SOLERA CD HZN COCR MLBDN","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475005040","SUP","HCPCS C1713","","1475005040  -  ROD SPNL CRV 4.75MM 40MM NS SXTNT COCR MLBDN","BOTH IP/OP","$2,820.00 ","$2,086.80 ","$0.00 ","$2,820.00 ","$1,269.00 ","$0.00 ","$587.76 ","$0.00 ","$0.00 ","$493.76 ","$2,820.00 ","$0.00 ","$1,410.00 ","$2,233.44 ","$2,256.00 ","$0.00 ","$441.33 ","$0.00 ","$448.94 ","$0.00 "
"1475005050","SUP","HCPCS C1713","","1475005050  -  ROD SPINAL CURVE 4.75MM 50MM SEXTANT COCR","BOTH IP/OP","$2,820.00 ","$2,086.80 ","$0.00 ","$2,820.00 ","$1,269.00 ","$0.00 ","$587.76 ","$0.00 ","$0.00 ","$493.76 ","$2,820.00 ","$0.00 ","$1,410.00 ","$2,233.44 ","$2,256.00 ","$0.00 ","$441.33 ","$0.00 ","$448.94 ","$0.00 "
"1475200500","SUP","HCPCS C1713","","1475200500  -  ROD SPINAL 500MM LINE STR COCR MOLYBDENUM 4.75MM","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$956.48 ","$0.00 ","$443.01 ","$0.00 ","$0.00 ","$372.16 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$332.64 ","$0.00 ","$338.38 ","$0.00 "
"1475501030","SUP","HCPCS C1713","","1475501030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501035","SUP","HCPCS C1713","","1475501035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501040","SUP","HCPCS C1713","","1475501040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501045","SUP","HCPCS C1713","","1475501045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501050","SUP","HCPCS C1713","","1475501050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501055","SUP","HCPCS C1713","","1475501055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501060","SUP","HCPCS C1713","","1475501060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501065","SUP","HCPCS C1713","","1475501065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501070","SUP","HCPCS C1713","","1475501070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501075","SUP","HCPCS C1713","","1475501075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501080","SUP","HCPCS C1713","","1475501080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501085","SUP","HCPCS C1713","","1475501085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501090","SUP","HCPCS C1713","","1475501090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501095","SUP","HCPCS C1713","","1475501095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501100","SUP","HCPCS C1713","","1475501100  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501105","SUP","HCPCS C1713","","1475501105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501110","SUP","HCPCS C1713","","1475501110  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501115","SUP","HCPCS C1713","","1475501115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1475501120","SUP","HCPCS C1713","","1475501120  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476000500","SUP","HCPCS C1713","","1476000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006040","SUP","HCPCS C1713","","1476006040  -  ROD SPNL 40MM 4.75MM LNGT II STR CCM PLUS PERC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006070","SUP","HCPCS C1713","","1476006070  -  ROD SPINAL 70MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006080","SUP","HCPCS C1713","","1476006080  -  ROD SPINAL 80MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006090","SUP","HCPCS C1713","","1476006090  -  ROD SPINAL STR 4.75MM 90MM CCM PLUS PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006100","SUP","HCPCS C1713","","1476006100  -  ROD SPINAL 100MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006110","SUP","HCPCS C1713","","1476006110  -  ROD SPINAL 110MM STR COCR 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006120","SUP","HCPCS C1713","","1476006120  -  ROD SPINAL 120MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006130","SUP","HCPCS C1713","","1476006130  -  ROD SPINAL STR 4.75MM 130MM CCM PLUS PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006140","SUP","HCPCS C1713","","1476006140  -  ROD SPINAL 140MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006150","SUP","HCPCS C1713","","1476006150  -  ROD SPINAL 150MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006160","SUP","HCPCS C1713","","1476006160  -  ROD SPINAL 160MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006170","SUP","HCPCS C1713","","1476006170  -  ROD SPINAL 170MM SOLERA STR COCR MOLYBDENUM 4.75MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006180","SUP","HCPCS C1713","","1476006180  -  ROD SPINAL 180MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006200","SUP","HCPCS C1713","","1476006200  -  ROD SPINAL 200MM STR CCM PLUS 4.75MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476006220","SUP","HCPCS C1713","","1476006220  -  ROD SPNL STRG 4.75MM 220MM CCM + PERC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1476200500","SUP","HCPCS C1713","","1476200500  -  ROD SPINAL 500MM LINE CD HORIZON CURVE COBALT 5.5MM STERILE","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$956.48 ","$0.00 ","$443.01 ","$0.00 ","$0.00 ","$372.16 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$332.64 ","$0.00 ","$338.38 ","$0.00 "
"1553200500","SUP","HCPCS C1713","","1553200500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201030","SUP","HCPCS C1713","","1553201030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201035","SUP","HCPCS C1713","","1553201035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201040","SUP","HCPCS C1713","","1553201040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201045","SUP","HCPCS C1713","","1553201045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201050","SUP","HCPCS C1713","","1553201050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201055","SUP","HCPCS C1713","","1553201055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201060","SUP","HCPCS C1713","","1553201060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201070","SUP","HCPCS C1713","","1553201070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201080","SUP","HCPCS C1713","","1553201080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201090","SUP","HCPCS C1713","","1553201090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201100","SUP","HCPCS C1713","","1553201100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201110","SUP","HCPCS C1713","","1553201110  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1553201120","SUP","HCPCS C1713","","1553201120  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1554200500","SUP","HCPCS C1713","","1554200500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555000500","SUP","HCPCS C1713","","1555000500  -  ROD SPNL STRG 5.5MM 500MM NS CD HZN COCRMO","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555006100","SUP","HCPCS C1713","","1555006100  -  ROD SPINAL 100MM PRECUT CD HORIZON STR COCR 5.5MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555006110","SUP","HCPCS C1713","","1555006110  -  ROD SPNL STRG 5.5MM 110MM CCM PERC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555006120","SUP","HCPCS C1713","","1555006120  -  ROD SPINAL 120MM STR CCM 5.5MM PERCUTANEOUS","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555006170","SUP","HCPCS C1713","","1555006170  -  ROD SPINAL 170MM PRECUT CD HORIZON STR COCR 5.5MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501030","SUP","HCPCS C1713","","1555501030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501035","SUP","HCPCS C1713","","1555501035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501040","SUP","HCPCS C1713","","1555501040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501045","SUP","HCPCS C1713","","1555501045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501050","SUP","HCPCS C1713","","1555501050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501055","SUP","HCPCS C1713","","1555501055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501060","SUP","HCPCS C1713","","1555501060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501070","SUP","HCPCS C1713","","1555501070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501080","SUP","HCPCS C1713","","1555501080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501090","SUP","HCPCS C1713","","1555501090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501100","SUP","HCPCS C1713","","1555501100  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501110","SUP","HCPCS C1713","","1555501110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1555501120","SUP","HCPCS C1713","","1555501120  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556000500","SUP","HCPCS C1713","","1556000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556000600","SUP","HCPCS C1713","","1556000600  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001030","SUP","HCPCS C1713","","1556001030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001035","SUP","HCPCS C1713","","1556001035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001040","SUP","HCPCS C1713","","1556001040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001045","SUP","HCPCS C1713","","1556001045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001050","SUP","HCPCS C1713","","1556001050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001055","SUP","HCPCS C1713","","1556001055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001060","SUP","HCPCS C1713","","1556001060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001065","SUP","HCPCS C1713","","1556001065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001070","SUP","HCPCS C1713","","1556001070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001075","SUP","HCPCS C1713","","1556001075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001080","SUP","HCPCS C1713","","1556001080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001085","SUP","HCPCS C1713","","1556001085  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001090","SUP","HCPCS C1713","","1556001090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001095","SUP","HCPCS C1713","","1556001095  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001100","SUP","HCPCS C1713","","1556001100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001105","SUP","HCPCS C1713","","1556001105  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001110","SUP","HCPCS C1713","","1556001110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1556001115","SUP","HCPCS C1713","","1556001115  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1603200500","SUP","HCPCS C1713","","1603200500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1604200500","SUP","HCPCS C1713","","1604200500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1605000500","SUP","HCPCS C1713","","1605000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1606000500","SUP","HCPCS C1713","","1606000500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1606000600","SUP","HCPCS C1713","","1606000600  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1606000700","SUP","HCPCS C1713","","1606000700  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1606200500","SUP","HCPCS C1713","","1606200500  -  ROD SPINAL 500MM LINE STR RED CCM PLUS 6MM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"1607002003","SUP","Custom 27203010","","1607002003  -  BURR SURG BARREL EGG 6MM STERILE","BOTH IP/OP","$145.75 ","$107.86 ","$0.00 ","$145.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.75 ","$0.00 ","$72.88 ","$115.43 ","$116.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1608002005","SUP","Custom 27203010","","1608002005  -  BURR SURG 6.1MM 54MM 9.5MM PEAR HEAD STAINLESS STEEL STERILE","BOTH IP/OP","$145.75 ","$107.86 ","$0.00 ","$145.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.75 ","$0.00 ","$72.88 ","$115.43 ","$116.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1705015006","SUP","Custom 27203010","","1705015006  -  PATCH CV THK.6MM 15X5CM STRL GRTX","BOTH IP/OP","$1,555.00 ","$1,150.70 ","$0.00 ","$1,555.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,555.00 ","$0.00 ","$777.50 ","$1,231.56 ","$1,244.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3571129240","SUP","HCPCS C1713","","3571129240  -  SCREW BN 4.5MM 40MM ST HEX HD HIP","BOTH IP/OP","$50.88 ","$37.65 ","$0.00 ","$50.88 ","$22.89 ","$0.00 ","$10.60 ","$0.00 ","$0.00 ","$8.91 ","$50.88 ","$0.00 ","$25.44 ","$40.30 ","$40.70 ","$0.00 ","$7.96 ","$0.00 ","$8.10 ","$0.00 "
"3571140003","SUP","HCPCS C1713","","3571140003  -  PLATE BN 45MM 3 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$798.00 ","$590.52 ","$0.00 ","$798.00 ","$359.10 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$139.72 ","$798.00 ","$0.00 ","$399.00 ","$632.02 ","$638.40 ","$0.00 ","$124.89 ","$0.00 ","$127.04 ","$0.00 "
"3571140004","SUP","HCPCS C1713","","3571140004  -  PLATE BN 61MM 4 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$846.30 ","$626.26 ","$0.00 ","$846.30 ","$380.84 ","$0.00 ","$176.39 ","$0.00 ","$0.00 ","$148.18 ","$846.30 ","$0.00 ","$423.15 ","$670.27 ","$677.04 ","$0.00 ","$132.45 ","$0.00 ","$134.73 ","$0.00 "
"3571140005","SUP","HCPCS C1713","","3571140005  -  PLATE BN 77MM STRL 5 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$910.35 ","$673.66 ","$0.00 ","$910.35 ","$409.66 ","$0.00 ","$189.74 ","$0.00 ","$0.00 ","$159.40 ","$910.35 ","$0.00 ","$455.18 ","$721.00 ","$728.28 ","$0.00 ","$142.47 ","$0.00 ","$144.93 ","$0.00 "
"3571140006","SUP","HCPCS C1713","","3571140006  -  PLATE BN 93MM STRL 6 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$972.30 ","$719.50 ","$0.00 ","$972.30 ","$437.54 ","$0.00 ","$202.65 ","$0.00 ","$0.00 ","$170.24 ","$972.30 ","$0.00 ","$486.15 ","$770.06 ","$777.84 ","$0.00 ","$152.16 ","$0.00 ","$154.79 ","$0.00 "
"3571140007","SUP","HCPCS C1713","","3571140007  -  PLATE BN 109MM STRL 7 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,025.85 ","$759.13 ","$0.00 ","$1,025.85 ","$461.63 ","$0.00 ","$213.81 ","$0.00 ","$0.00 ","$179.62 ","$1,025.85 ","$0.00 ","$512.93 ","$812.47 ","$820.68 ","$0.00 ","$160.55 ","$0.00 ","$163.32 ","$0.00 "
"3571140008","SUP","HCPCS C1713","","3571140008  -  PLATE BN 125MM STRL 8 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"3571140009","SUP","HCPCS C1713","","3571140009  -  PLATE BN 141MM STRL 9 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,391.25 ","$1,029.53 ","$0.00 ","$1,391.25 ","$626.06 ","$0.00 ","$289.97 ","$0.00 ","$0.00 ","$243.60 ","$1,391.25 ","$0.00 ","$695.63 ","$1,101.87 ","$1,113.00 ","$0.00 ","$217.73 ","$0.00 ","$221.49 ","$0.00 "
"3571140010","SUP","HCPCS C1713","","3571140010  -  PLATE BN 157MM STRL 10 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,464.75 ","$1,083.92 ","$0.00 ","$1,464.75 ","$659.14 ","$0.00 ","$305.29 ","$0.00 ","$0.00 ","$256.47 ","$1,464.75 ","$0.00 ","$732.38 ","$1,160.08 ","$1,171.80 ","$0.00 ","$229.23 ","$0.00 ","$233.19 ","$0.00 "
"3571140011","SUP","HCPCS C1713","","3571140011  -  PLATE BN 173MM STRL 11 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,506.75 ","$1,115.00 ","$0.00 ","$1,506.75 ","$678.04 ","$0.00 ","$314.04 ","$0.00 ","$0.00 ","$263.82 ","$1,506.75 ","$0.00 ","$753.38 ","$1,193.35 ","$1,205.40 ","$0.00 ","$235.81 ","$0.00 ","$239.87 ","$0.00 "
"3571140012","SUP","HCPCS C1713","","3571140012  -  PLATE BN 189MM STRL 12 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,302.00 ","$963.48 ","$0.00 ","$1,302.00 ","$585.90 ","$0.00 ","$271.37 ","$0.00 ","$0.00 ","$227.97 ","$1,302.00 ","$0.00 ","$651.00 ","$1,031.18 ","$1,041.60 ","$0.00 ","$203.76 ","$0.00 ","$207.28 ","$0.00 "
"3571140013","SUP","HCPCS C1713","","3571140013  -  PLATE BN 205MM STRL 13 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$0.00 ","$0.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"3571140014","SUP","HCPCS C1713","","3571140014  -  PLATE BN 221MM 14 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"3571140015","SUP","HCPCS C1713","","3571140015  -  PLATE BN 237MM STRL 15 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,806.00 ","$1,336.44 ","$0.00 ","$1,806.00 ","$812.70 ","$0.00 ","$376.42 ","$0.00 ","$0.00 ","$316.22 ","$1,806.00 ","$0.00 ","$903.00 ","$1,430.35 ","$1,444.80 ","$0.00 ","$282.64 ","$0.00 ","$287.52 ","$0.00 "
"3571140016","SUP","HCPCS C1713","","3571140016  -  PLATE BN 253MM STRL 16 HL RECON PLVC 4.5MM SCR","BOTH IP/OP","$1,869.00 ","$1,383.06 ","$0.00 ","$1,869.00 ","$841.05 ","$0.00 ","$389.55 ","$0.00 ","$0.00 ","$327.25 ","$1,869.00 ","$0.00 ","$934.50 ","$1,480.25 ","$1,495.20 ","$0.00 ","$292.50 ","$0.00 ","$297.54 ","$0.00 "
"3571140104","SUP","HCPCS C1713","","3571140104  -  PLATE BN 46MM STRL 4 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$875.70 ","$648.02 ","$0.00 ","$875.70 ","$394.07 ","$0.00 ","$182.52 ","$0.00 ","$0.00 ","$153.33 ","$875.70 ","$0.00 ","$437.85 ","$693.55 ","$700.56 ","$0.00 ","$137.05 ","$0.00 ","$139.41 ","$0.00 "
"3571140105","SUP","HCPCS C1713","","3571140105  -  PLATE BN 58MM 5 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$812.70 ","$601.40 ","$0.00 ","$812.70 ","$365.72 ","$0.00 ","$169.39 ","$0.00 ","$0.00 ","$142.30 ","$812.70 ","$0.00 ","$406.35 ","$643.66 ","$650.16 ","$0.00 ","$127.19 ","$0.00 ","$129.38 ","$0.00 "
"3571140106","SUP","HCPCS C1713","","3571140106  -  PLATE BN 70MM 6 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,022.70 ","$756.80 ","$0.00 ","$1,022.70 ","$460.22 ","$0.00 ","$213.16 ","$0.00 ","$0.00 ","$179.07 ","$1,022.70 ","$0.00 ","$511.35 ","$809.98 ","$818.16 ","$0.00 ","$160.05 ","$0.00 ","$162.81 ","$0.00 "
"3571140107","SUP","HCPCS C1713","","3571140107  -  PLATE BN 82MM 7 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$974.40 ","$721.06 ","$0.00 ","$974.40 ","$438.48 ","$0.00 ","$203.09 ","$0.00 ","$0.00 ","$170.61 ","$974.40 ","$0.00 ","$487.20 ","$771.72 ","$779.52 ","$0.00 ","$152.49 ","$0.00 ","$155.12 ","$0.00 "
"3571140108","SUP","HCPCS C1713","","3571140108  -  PLATE BN 94MM 8 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,118.25 ","$827.51 ","$0.00 ","$1,118.25 ","$503.21 ","$0.00 ","$233.07 ","$0.00 ","$0.00 ","$195.80 ","$1,118.25 ","$0.00 ","$559.13 ","$885.65 ","$894.60 ","$0.00 ","$175.01 ","$0.00 ","$178.03 ","$0.00 "
"3571140109","SUP","HCPCS C1713","","3571140109  -  PLATE BN 106MM 9 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$472.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$183.85 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$164.33 ","$0.00 ","$167.16 ","$0.00 "
"3571140110","SUP","HCPCS C1713","","3571140110  -  PLATE BN 118MM 10 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"3571140111","SUP","HCPCS C1713","","3571140111  -  PLATE BN 130MM STRL 11 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,118.25 ","$827.51 ","$0.00 ","$1,118.25 ","$503.21 ","$0.00 ","$233.07 ","$0.00 ","$0.00 ","$195.80 ","$1,118.25 ","$0.00 ","$559.13 ","$885.65 ","$894.60 ","$0.00 ","$175.01 ","$0.00 ","$178.03 ","$0.00 "
"3571140112","SUP","HCPCS C1713","","3571140112  -  PLATE BN 142MM 12 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"3571140113","SUP","HCPCS C1713","","3571140113  -  PLATE BN 154MM STRL 13 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"3571140114","SUP","HCPCS C1713","","3571140114  -  PLATE BN 166MM 14 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,380.75 ","$1,021.76 ","$0.00 ","$1,380.75 ","$621.34 ","$0.00 ","$287.78 ","$0.00 ","$0.00 ","$241.76 ","$1,380.75 ","$0.00 ","$690.38 ","$1,093.55 ","$1,104.60 ","$0.00 ","$216.09 ","$0.00 ","$219.82 ","$0.00 "
"3571140115","SUP","HCPCS C1713","","3571140115  -  PLATE BN 178MM STRL 15 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,648.50 ","$1,219.89 ","$0.00 ","$1,648.50 ","$741.83 ","$0.00 ","$343.59 ","$0.00 ","$0.00 ","$288.64 ","$1,648.50 ","$0.00 ","$824.25 ","$1,305.61 ","$1,318.80 ","$0.00 ","$257.99 ","$0.00 ","$262.44 ","$0.00 "
"3571140116","SUP","HCPCS C1713","","3571140116  -  PLATE BN 190MM 16 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,407.00 ","$1,041.18 ","$0.00 ","$1,407.00 ","$633.15 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$246.35 ","$1,407.00 ","$0.00 ","$703.50 ","$1,114.34 ","$1,125.60 ","$0.00 ","$220.20 ","$0.00 ","$223.99 ","$0.00 "
"3571140118","SUP","HCPCS C1713","","3571140118  -  PLATE BN 214MM 18 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,480.50 ","$1,095.57 ","$0.00 ","$1,480.50 ","$666.23 ","$0.00 ","$308.57 ","$0.00 ","$0.00 ","$259.22 ","$1,480.50 ","$0.00 ","$740.25 ","$1,172.56 ","$1,184.40 ","$0.00 ","$231.70 ","$0.00 ","$235.70 ","$0.00 "
"3571140120","SUP","HCPCS C1713","","3571140120  -  PLATE BN 238MM STRL 20 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$1,800.75 ","$1,332.56 ","$0.00 ","$1,800.75 ","$810.34 ","$0.00 ","$375.32 ","$0.00 ","$0.00 ","$315.30 ","$1,800.75 ","$0.00 ","$900.38 ","$1,426.19 ","$1,440.60 ","$0.00 ","$281.82 ","$0.00 ","$286.68 ","$0.00 "
"3571140122","SUP","HCPCS C1713","","3571140122  -  PLATE BN 263MM STRL 22 HL RECON PLVC 3.5MM SCR","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,283.75 ","$1,027.69 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$399.87 ","$2,283.75 ","$0.00 ","$1,141.88 ","$1,808.73 ","$1,827.00 ","$0.00 ","$357.41 ","$0.00 ","$363.57 ","$0.00 "
"3571140202","SUP","HCPCS C1713","","3571140202  -  PLATE BN 25MM STRL 2 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$296.10 ","$219.11 ","$0.00 ","$296.10 ","$133.25 ","$0.00 ","$61.71 ","$0.00 ","$0.00 ","$51.84 ","$296.10 ","$0.00 ","$148.05 ","$234.51 ","$236.88 ","$0.00 ","$46.34 ","$0.00 ","$47.14 ","$0.00 "
"3571140203","SUP","HCPCS C1713","","3571140203  -  PLATE BN 37MM STRL 3 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$309.75 ","$229.22 ","$0.00 ","$309.75 ","$139.39 ","$0.00 ","$64.56 ","$0.00 ","$0.00 ","$54.23 ","$309.75 ","$0.00 ","$154.88 ","$245.32 ","$247.80 ","$0.00 ","$48.48 ","$0.00 ","$49.31 ","$0.00 "
"3571140204","SUP","HCPCS C1713","","3571140204  -  PLATE BN 49MM STRL 4 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$316.05 ","$233.88 ","$0.00 ","$316.05 ","$142.22 ","$0.00 ","$65.87 ","$0.00 ","$0.00 ","$55.34 ","$316.05 ","$0.00 ","$158.03 ","$250.31 ","$252.84 ","$0.00 ","$49.46 ","$0.00 ","$50.32 ","$0.00 "
"3571140205","SUP","HCPCS C1713","","3571140205  -  PLATE BN 61MM STRL 5 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$345.45 ","$255.63 ","$0.00 ","$345.45 ","$155.45 ","$0.00 ","$72.00 ","$0.00 ","$0.00 ","$60.49 ","$345.45 ","$0.00 ","$172.73 ","$273.60 ","$276.36 ","$0.00 ","$54.06 ","$0.00 ","$55.00 ","$0.00 "
"3571140206","SUP","HCPCS C1713","","3571140206  -  PLATE BN 73MM STRL 6 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$361.20 ","$267.29 ","$0.00 ","$361.20 ","$162.54 ","$0.00 ","$75.28 ","$0.00 ","$0.00 ","$63.24 ","$361.20 ","$0.00 ","$180.60 ","$286.07 ","$288.96 ","$0.00 ","$56.53 ","$0.00 ","$57.50 ","$0.00 "
"3571140207","SUP","HCPCS C1713","","3571140207  -  PLATE BN 85MM STRL 7 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$170.10 ","$0.00 ","$78.78 ","$0.00 ","$0.00 ","$66.18 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$59.16 ","$0.00 ","$60.18 ","$0.00 "
"3571140208","SUP","HCPCS C1713","","3571140208  -  PLATE BN 97MM STRL 8 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$405.30 ","$299.92 ","$0.00 ","$405.30 ","$182.39 ","$0.00 ","$84.47 ","$0.00 ","$0.00 ","$70.96 ","$405.30 ","$0.00 ","$202.65 ","$321.00 ","$324.24 ","$0.00 ","$63.43 ","$0.00 ","$64.52 ","$0.00 "
"3571140209","SUP","HCPCS C1713","","3571140209  -  PLATE BN 109MM STRL 9 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$414.75 ","$306.92 ","$0.00 ","$414.75 ","$186.64 ","$0.00 ","$86.44 ","$0.00 ","$0.00 ","$72.62 ","$414.75 ","$0.00 ","$207.38 ","$328.48 ","$331.80 ","$0.00 ","$64.91 ","$0.00 ","$66.03 ","$0.00 "
"3571140210","SUP","HCPCS C1713","","3571140210  -  PLATE BN 121MM STRL 10 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$426.30 ","$315.46 ","$0.00 ","$426.30 ","$191.84 ","$0.00 ","$88.85 ","$0.00 ","$0.00 ","$74.64 ","$426.30 ","$0.00 ","$213.15 ","$337.63 ","$341.04 ","$0.00 ","$66.72 ","$0.00 ","$67.87 ","$0.00 "
"3571140212","SUP","HCPCS C1713","","3571140212  -  PLATE BN 145MM STRL 12 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$473.55 ","$350.43 ","$0.00 ","$473.55 ","$213.10 ","$0.00 ","$98.70 ","$0.00 ","$0.00 ","$82.91 ","$473.55 ","$0.00 ","$236.78 ","$375.05 ","$378.84 ","$0.00 ","$74.11 ","$0.00 ","$75.39 ","$0.00 "
"3571140214","SUP","HCPCS C1713","","3571140214  -  PLATE BN 169MM STRL 14 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$889.35 ","$658.12 ","$0.00 ","$889.35 ","$400.21 ","$0.00 ","$185.36 ","$0.00 ","$0.00 ","$155.72 ","$889.35 ","$0.00 ","$444.68 ","$704.37 ","$711.48 ","$0.00 ","$139.18 ","$0.00 ","$141.58 ","$0.00 "
"3571140216","SUP","HCPCS C1713","","3571140216  -  PLATE BN 194MM STRL 16 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$1,025.85 ","$759.13 ","$0.00 ","$1,025.85 ","$461.63 ","$0.00 ","$213.81 ","$0.00 ","$0.00 ","$179.62 ","$1,025.85 ","$0.00 ","$512.93 ","$812.47 ","$820.68 ","$0.00 ","$160.55 ","$0.00 ","$163.32 ","$0.00 "
"3571140218","SUP","HCPCS C1713","","3571140218  -  PLATE BN 217MM STRL 18 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$1,380.75 ","$1,021.76 ","$0.00 ","$1,380.75 ","$621.34 ","$0.00 ","$287.78 ","$0.00 ","$0.00 ","$241.76 ","$1,380.75 ","$0.00 ","$690.38 ","$1,093.55 ","$1,104.60 ","$0.00 ","$216.09 ","$0.00 ","$219.82 ","$0.00 "
"3571140220","SUP","HCPCS C1713","","3571140220  -  PLATE BN 242MM STRL 20 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$1,270.50 ","$940.17 ","$0.00 ","$1,270.50 ","$571.73 ","$0.00 ","$264.80 ","$0.00 ","$0.00 ","$222.45 ","$1,270.50 ","$0.00 ","$635.25 ","$1,006.24 ","$1,016.40 ","$0.00 ","$198.83 ","$0.00 ","$202.26 ","$0.00 "
"3571140222","SUP","HCPCS C1713","","3571140222  -  PLATE BN 265MM STRL 22 HL 3.5MM SCR SM FRAG","BOTH IP/OP","$1,701.00 ","$1,258.74 ","$0.00 ","$1,701.00 ","$765.45 ","$0.00 ","$354.53 ","$0.00 ","$0.00 ","$297.83 ","$1,701.00 ","$0.00 ","$850.50 ","$1,347.19 ","$1,360.80 ","$0.00 ","$266.21 ","$0.00 ","$270.80 ","$0.00 "
"3571140302","SUP","HCPCS C1713","","3571140302  -  PLATE BN 25MM STRL 1/3 TBLR 2 HL COLR","BOTH IP/OP","$169.05 ","$125.10 ","$0.00 ","$169.05 ","$76.07 ","$0.00 ","$35.23 ","$0.00 ","$0.00 ","$29.60 ","$169.05 ","$0.00 ","$84.53 ","$133.89 ","$135.24 ","$0.00 ","$26.46 ","$0.00 ","$26.91 ","$0.00 "
"3571140303","SUP","HCPCS C1713","","3571140303  -  PLATE BN 37MM STRL 1/3 TBLR 3 HL COLR","BOTH IP/OP","$143.85 ","$106.45 ","$0.00 ","$143.85 ","$64.73 ","$0.00 ","$29.98 ","$0.00 ","$0.00 ","$25.19 ","$143.85 ","$0.00 ","$71.93 ","$113.93 ","$115.08 ","$0.00 ","$22.51 ","$0.00 ","$22.90 ","$0.00 "
"3571140304","SUP","HCPCS C1713","","3571140304  -  PLATE BN 49MM STRL 1/3 TBLR 4 HL COLR","BOTH IP/OP","$169.05 ","$125.10 ","$0.00 ","$169.05 ","$76.07 ","$0.00 ","$35.23 ","$0.00 ","$0.00 ","$29.60 ","$169.05 ","$0.00 ","$84.53 ","$133.89 ","$135.24 ","$0.00 ","$26.46 ","$0.00 ","$26.91 ","$0.00 "
"3571140305","SUP","HCPCS C1713","","3571140305  -  PLATE BN 61MM STRL 1/3 TBLR 5 HL COLR","BOTH IP/OP","$211.05 ","$156.18 ","$0.00 ","$211.05 ","$94.97 ","$0.00 ","$43.99 ","$0.00 ","$0.00 ","$36.95 ","$211.05 ","$0.00 ","$105.53 ","$167.15 ","$168.84 ","$0.00 ","$33.03 ","$0.00 ","$33.60 ","$0.00 "
"3571140306","SUP","HCPCS C1713","","3571140306  -  PLATE BN 73MM STRL 1/3 TBLR 6 HL COLR DIST FIB","BOTH IP/OP","$175.35 ","$129.76 ","$0.00 ","$175.35 ","$78.91 ","$0.00 ","$36.55 ","$0.00 ","$0.00 ","$30.70 ","$175.35 ","$0.00 ","$87.68 ","$138.88 ","$140.28 ","$0.00 ","$27.44 ","$0.00 ","$27.92 ","$0.00 "
"3571140307","SUP","HCPCS C1713","","3571140307  -  PLATE BN 85MM STRL 1/3 TBLR 7 HL COLR DIST FIB","BOTH IP/OP","$175.35 ","$129.76 ","$0.00 ","$175.35 ","$78.91 ","$0.00 ","$36.55 ","$0.00 ","$0.00 ","$30.70 ","$175.35 ","$0.00 ","$87.68 ","$138.88 ","$140.28 ","$0.00 ","$27.44 ","$0.00 ","$27.92 ","$0.00 "
"3571140308","SUP","HCPCS C1713","","3571140308  -  PLATE BN 97MM STRL 1/3 TBLR 8 HL COLR DIST FIB","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"3571140309","SUP","HCPCS C1713","","3571140309  -  PLATE BN 109MM STRL 1/3 TBLR 9 HL COLR DIST FIB","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"3571140310","SUP","HCPCS C1713","","3571140310  -  PLATE BN 121MM STRL 1/3 TBLR 10 HL COLR DIST FIB","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"3571140312","SUP","HCPCS C1713","","3571140312  -  PLATE BN 145MM STRL 1/3 TBLR 12 HL COLR DIST FIB","BOTH IP/OP","$181.65 ","$134.42 ","$0.00 ","$181.65 ","$81.74 ","$0.00 ","$37.86 ","$0.00 ","$0.00 ","$31.81 ","$181.65 ","$0.00 ","$90.83 ","$143.87 ","$145.32 ","$0.00 ","$28.43 ","$0.00 ","$28.92 ","$0.00 "
"3571140403","SUP","HCPCS C1713","","3571140403  -  PLATE BN T RT ANG 50MM STRL 3X3 HL","BOTH IP/OP","$313.95 ","$232.32 ","$0.00 ","$313.95 ","$141.28 ","$0.00 ","$65.44 ","$0.00 ","$0.00 ","$54.97 ","$313.95 ","$0.00 ","$156.98 ","$248.65 ","$251.16 ","$0.00 ","$49.13 ","$0.00 ","$49.98 ","$0.00 "
"3571140404","SUP","HCPCS C1713","","3571140404  -  PLATE BN T RT ANG 56MM STRL 4X4 HL","BOTH IP/OP","$320.25 ","$236.99 ","$0.00 ","$320.25 ","$144.11 ","$0.00 ","$66.75 ","$0.00 ","$0.00 ","$56.07 ","$320.25 ","$0.00 ","$160.13 ","$253.64 ","$256.20 ","$0.00 ","$50.12 ","$0.00 ","$50.98 ","$0.00 "
"3571140405","SUP","HCPCS C1713","","3571140405  -  PLATE BN T RT ANG 67MM STRL 3X5 HL","BOTH IP/OP","$360.15 ","$266.51 ","$0.00 ","$360.15 ","$162.07 ","$0.00 ","$75.06 ","$0.00 ","$0.00 ","$63.06 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$56.36 ","$0.00 ","$57.34 ","$0.00 "
"3571140406","SUP","HCPCS C1713","","3571140406  -  PLATE BN T RT ANG 78MM STRL 4X6 HL","BOTH IP/OP","$414.75 ","$306.92 ","$0.00 ","$414.75 ","$186.64 ","$0.00 ","$86.44 ","$0.00 ","$0.00 ","$72.62 ","$414.75 ","$0.00 ","$207.38 ","$328.48 ","$331.80 ","$0.00 ","$64.91 ","$0.00 ","$66.03 ","$0.00 "
"3571140503","SUP","HCPCS C1713","","3571140503  -  PLATE BN T 53MM STRL 3X3 HL OBLQ","BOTH IP/OP","$563.85 ","$417.25 ","$0.00 ","$563.85 ","$253.73 ","$0.00 ","$117.52 ","$0.00 ","$0.00 ","$98.73 ","$563.85 ","$0.00 ","$281.93 ","$446.57 ","$451.08 ","$0.00 ","$88.24 ","$0.00 ","$89.76 ","$0.00 "
"3571140504","SUP","HCPCS C1713","","3571140504  -  PLATE BN T 63MM STRL 3X4 HL OBLQ","BOTH IP/OP","$588.00 ","$435.12 ","$0.00 ","$588.00 ","$264.60 ","$0.00 ","$122.55 ","$0.00 ","$0.00 ","$102.95 ","$588.00 ","$0.00 ","$294.00 ","$465.70 ","$470.40 ","$0.00 ","$92.02 ","$0.00 ","$93.61 ","$0.00 "
"3571140505","SUP","HCPCS C1713","","3571140505  -  PLATE BN T 73MM STRL 5X4 HL OBLQ","BOTH IP/OP","$609.00 ","$450.66 ","$0.00 ","$609.00 ","$274.05 ","$0.00 ","$126.93 ","$0.00 ","$0.00 ","$106.63 ","$609.00 ","$0.00 ","$304.50 ","$482.33 ","$487.20 ","$0.00 ","$95.31 ","$0.00 ","$96.95 ","$0.00 "
"3571140603","SUP","HCPCS C1713","","3571140603  -  PLATE BN CLVRLF 88MM STRL 3 HL","BOTH IP/OP","$744.45 ","$550.89 ","$0.00 ","$744.45 ","$335.00 ","$0.00 ","$155.16 ","$0.00 ","$0.00 ","$130.35 ","$744.45 ","$0.00 ","$372.23 ","$589.60 ","$595.56 ","$0.00 ","$116.51 ","$0.00 ","$118.52 ","$0.00 "
"3571140604","SUP","HCPCS C1713","","3571140604  -  PLATE BN CLVRLF 104MM STRL 4 HL","BOTH IP/OP","$798.00 ","$590.52 ","$0.00 ","$798.00 ","$359.10 ","$0.00 ","$166.32 ","$0.00 ","$0.00 ","$139.72 ","$798.00 ","$0.00 ","$399.00 ","$632.02 ","$638.40 ","$0.00 ","$124.89 ","$0.00 ","$127.04 ","$0.00 "
"3571140606","SUP","HCPCS C1713","","3571140606  -  PLATE BN CRV 70MM 6 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,039.50 ","$769.23 ","$0.00 ","$1,039.50 ","$467.78 ","$0.00 ","$216.66 ","$0.00 ","$0.00 ","$182.01 ","$1,039.50 ","$0.00 ","$519.75 ","$823.28 ","$831.60 ","$0.00 ","$162.68 ","$0.00 ","$165.49 ","$0.00 "
"3571140608","SUP","HCPCS C1713","","3571140608  -  PLATE BN CRV 94MM 8 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,134.00 ","$839.16 ","$0.00 ","$1,134.00 ","$510.30 ","$0.00 ","$236.35 ","$0.00 ","$0.00 ","$198.55 ","$1,134.00 ","$0.00 ","$567.00 ","$898.13 ","$907.20 ","$0.00 ","$177.47 ","$0.00 ","$180.53 ","$0.00 "
"3571140610","SUP","HCPCS C1713","","3571140610  -  PLATE BN CRV 118MM 10 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,186.50 ","$878.01 ","$0.00 ","$1,186.50 ","$533.93 ","$0.00 ","$247.30 ","$0.00 ","$0.00 ","$207.75 ","$1,186.50 ","$0.00 ","$593.25 ","$939.71 ","$949.20 ","$0.00 ","$185.69 ","$0.00 ","$188.89 ","$0.00 "
"3571140612","SUP","HCPCS C1713","","3571140612  -  PLATE BN CRV 142MM 12 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,244.25 ","$920.75 ","$0.00 ","$1,244.25 ","$559.91 ","$0.00 ","$259.33 ","$0.00 ","$0.00 ","$217.86 ","$1,244.25 ","$0.00 ","$622.13 ","$985.45 ","$995.40 ","$0.00 ","$194.73 ","$0.00 ","$198.08 ","$0.00 "
"3571140614","SUP","HCPCS C1713","","3571140614  -  PLATE BN CRV 166MM 14 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,401.75 ","$1,037.30 ","$0.00 ","$1,401.75 ","$630.79 ","$0.00 ","$292.16 ","$0.00 ","$0.00 ","$245.44 ","$1,401.75 ","$0.00 ","$700.88 ","$1,110.19 ","$1,121.40 ","$0.00 ","$219.37 ","$0.00 ","$223.16 ","$0.00 "
"3571140616","SUP","HCPCS C1713","","3571140616  -  PLATE BN CRV 190MM 16 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,485.75 ","$1,099.46 ","$0.00 ","$1,485.75 ","$668.59 ","$0.00 ","$309.67 ","$0.00 ","$0.00 ","$260.14 ","$1,485.75 ","$0.00 ","$742.88 ","$1,176.71 ","$1,188.60 ","$0.00 ","$232.52 ","$0.00 ","$236.53 ","$0.00 "
"3571140618","SUP","HCPCS C1713","","3571140618  -  PLATE BN CRV 214MM STRL 18 HL RECON SS 3.5MM SCR","BOTH IP/OP","$1,601.25 ","$1,184.93 ","$0.00 ","$1,601.25 ","$720.56 ","$0.00 ","$333.74 ","$0.00 ","$0.00 ","$280.37 ","$1,601.25 ","$0.00 ","$800.63 ","$1,268.19 ","$1,281.00 ","$0.00 ","$250.60 ","$0.00 ","$254.92 ","$0.00 "
"3571140704","SUP","HCPCS C1713","","3571140704  -  PLATE BN 80MM STRL 4 HL TBTRS","BOTH IP/OP","$926.10 ","$685.31 ","$0.00 ","$926.10 ","$416.75 ","$0.00 ","$193.02 ","$0.00 ","$0.00 ","$162.15 ","$926.10 ","$0.00 ","$463.05 ","$733.47 ","$740.88 ","$0.00 ","$144.93 ","$0.00 ","$147.44 ","$0.00 "
"3571140705","SUP","HCPCS C1713","","3571140705  -  PLATE BN 96MM STRL 5 HL TBTRS","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"3571140706","SUP","HCPCS C1713","","3571140706  -  PLATE BN 112MM STRL 6 HL TBTRS","BOTH IP/OP","$1,249.50 ","$924.63 ","$0.00 ","$1,249.50 ","$562.28 ","$0.00 ","$260.43 ","$0.00 ","$0.00 ","$218.78 ","$1,249.50 ","$0.00 ","$624.75 ","$989.60 ","$999.60 ","$0.00 ","$195.55 ","$0.00 ","$198.92 ","$0.00 "
"3571140804","SUP","HCPCS C1713","","3571140804  -  PLATE BN 86MM STRL 4 HL L BTRS TIB LT","BOTH IP/OP","$828.45 ","$613.05 ","$0.00 ","$828.45 ","$372.80 ","$0.00 ","$172.67 ","$0.00 ","$0.00 ","$145.05 ","$828.45 ","$0.00 ","$414.23 ","$656.13 ","$662.76 ","$0.00 ","$129.65 ","$0.00 ","$131.89 ","$0.00 "
"3571140904","SUP","HCPCS C1713","","3571140904  -  PLATE BN 86MM STRL 4 HL L BTRS TIB RT","BOTH IP/OP","$828.45 ","$613.05 ","$0.00 ","$828.45 ","$372.80 ","$0.00 ","$172.67 ","$0.00 ","$0.00 ","$145.05 ","$828.45 ","$0.00 ","$414.23 ","$656.13 ","$662.76 ","$0.00 ","$129.65 ","$0.00 ","$131.89 ","$0.00 "
"3571141003","SUP","HCPCS C1713","","3571141003  -  PLATE BN STRL 3 HL BTRS TIBHD RL","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"3571141005","SUP","HCPCS C1713","","3571141005  -  PLATE BN 118MM STRL 5 HL BTRS TIBHD RL","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"3571141007","SUP","HCPCS C1713","","3571141007  -  PLATE BN 149MM STRL 7 HL BTRS TIBHD RL","BOTH IP/OP","$1,785.00 ","$1,320.90 ","$0.00 ","$1,785.00 ","$803.25 ","$0.00 ","$372.04 ","$0.00 ","$0.00 ","$312.54 ","$1,785.00 ","$0.00 ","$892.50 ","$1,413.72 ","$1,428.00 ","$0.00 ","$279.35 ","$0.00 ","$284.17 ","$0.00 "
"3571141009","SUP","HCPCS C1713","","3571141009  -  PLATE BN 181MM STRL 9 HL BTRS TIBHD RL","BOTH IP/OP","$1,905.75 ","$1,410.26 ","$0.00 ","$1,905.75 ","$857.59 ","$0.00 ","$397.21 ","$0.00 ","$0.00 ","$333.68 ","$1,905.75 ","$0.00 ","$952.88 ","$1,509.35 ","$1,524.60 ","$0.00 ","$298.25 ","$0.00 ","$303.40 ","$0.00 "
"3571141011","SUP","HCPCS C1713","","3571141011  -  PLATE BN 214MM STRL 11 HL BTRS TIBHD RL","BOTH IP/OP","$2,499.00 ","$1,849.26 ","$0.00 ","$2,499.00 ","$1,124.55 ","$0.00 ","$520.85 ","$0.00 ","$0.00 ","$437.55 ","$2,499.00 ","$0.00 ","$1,249.50 ","$1,979.21 ","$1,999.20 ","$0.00 ","$391.09 ","$0.00 ","$397.84 ","$0.00 "
"3571141013","SUP","HCPCS C1713","","3571141013  -  PLATE BN 246MM STRL 13 HL BTRS TIBHD RL","BOTH IP/OP","$2,593.50 ","$1,919.19 ","$0.00 ","$2,593.50 ","$1,167.08 ","$0.00 ","$540.55 ","$0.00 ","$0.00 ","$454.10 ","$2,593.50 ","$0.00 ","$1,296.75 ","$2,054.05 ","$2,074.80 ","$0.00 ","$405.88 ","$0.00 ","$412.89 ","$0.00 "
"3571141103","SUP","HCPCS C1713","","3571141103  -  PLATE BN STRL 3 HL BTRS TIBHD L/L","BOTH IP/OP","$1,422.75 ","$1,052.84 ","$0.00 ","$1,422.75 ","$640.24 ","$0.00 ","$296.54 ","$0.00 ","$0.00 ","$249.11 ","$1,422.75 ","$0.00 ","$711.38 ","$1,126.82 ","$1,138.20 ","$0.00 ","$222.66 ","$0.00 ","$226.50 ","$0.00 "
"3571141105","SUP","HCPCS C1713","","3571141105  -  PLATE BN 118MM STRL 5 HL BTRS TIBHD L/L","BOTH IP/OP","$1,669.50 ","$1,235.43 ","$0.00 ","$1,669.50 ","$751.28 ","$0.00 ","$347.97 ","$0.00 ","$0.00 ","$292.32 ","$1,669.50 ","$0.00 ","$834.75 ","$1,322.24 ","$1,335.60 ","$0.00 ","$261.28 ","$0.00 ","$265.78 ","$0.00 "
"3571141107","SUP","HCPCS C1713","","3571141107  -  PLATE BN 149MM STRL 7 HL BTRS TIBHD L/L","BOTH IP/OP","$1,785.00 ","$1,320.90 ","$0.00 ","$1,785.00 ","$803.25 ","$0.00 ","$372.04 ","$0.00 ","$0.00 ","$312.54 ","$1,785.00 ","$0.00 ","$892.50 ","$1,413.72 ","$1,428.00 ","$0.00 ","$279.35 ","$0.00 ","$284.17 ","$0.00 "
"3571141109","SUP","HCPCS C1713","","3571141109  -  PLATE BN 181MM STRL 9 HL BTRS TIBHD L/L","BOTH IP/OP","$1,905.75 ","$1,410.26 ","$0.00 ","$1,905.75 ","$857.59 ","$0.00 ","$397.21 ","$0.00 ","$0.00 ","$333.68 ","$1,905.75 ","$0.00 ","$952.88 ","$1,509.35 ","$1,524.60 ","$0.00 ","$298.25 ","$0.00 ","$303.40 ","$0.00 "
"3571141111","SUP","HCPCS C1713","","3571141111  -  PLATE BN 214MM STRL 11 HL BTRS TIBHD L/L","BOTH IP/OP","$2,499.00 ","$1,849.26 ","$0.00 ","$2,499.00 ","$1,124.55 ","$0.00 ","$520.85 ","$0.00 ","$0.00 ","$437.55 ","$2,499.00 ","$0.00 ","$1,249.50 ","$1,979.21 ","$1,999.20 ","$0.00 ","$391.09 ","$0.00 ","$397.84 ","$0.00 "
"3571141113","SUP","HCPCS C1713","","3571141113  -  PLATE BN 246MM STRL 13 HL BTRS TIBHD L/L","BOTH IP/OP","$2,593.50 ","$1,919.19 ","$0.00 ","$2,593.50 ","$1,167.08 ","$0.00 ","$540.55 ","$0.00 ","$0.00 ","$454.10 ","$2,593.50 ","$0.00 ","$1,296.75 ","$2,054.05 ","$2,074.80 ","$0.00 ","$405.88 ","$0.00 ","$412.89 ","$0.00 "
"3571141206","SUP","HCPCS C1713","","3571141206  -  PLATE BN BRD 103MM STRL 6 HL 4.5MM SCR","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$245.70 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"3571141207","SUP","HCPCS C1713","","3571141207  -  PLATE BN BRD 119MM STRL 7 HL 4.5MM SCR","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$245.70 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"3571141208","SUP","HCPCS C1713","","3571141208  -  PLATE BN BRD 135MM STRL 8 HL 4.5MM SCR","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"3571141209","SUP","HCPCS C1713","","3571141209  -  PLATE BN BRD 151MM STRL 9 HL 4.5MM SCR","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"3571141210","SUP","HCPCS C1713","","3571141210  -  PLATE BN BRD 167MM STRL 10 HL 4.5MM SCR","BOTH IP/OP","$680.40 ","$503.50 ","$0.00 ","$680.40 ","$306.18 ","$0.00 ","$141.81 ","$0.00 ","$0.00 ","$119.13 ","$680.40 ","$0.00 ","$340.20 ","$538.88 ","$544.32 ","$0.00 ","$106.48 ","$0.00 ","$108.32 ","$0.00 "
"3571141212","SUP","HCPCS C1713","","3571141212  -  PLATE BN BRD 199MM STRL 12 HL 4.5MM SCR","BOTH IP/OP","$731.85 ","$541.57 ","$0.00 ","$731.85 ","$329.33 ","$0.00 ","$152.54 ","$0.00 ","$0.00 ","$128.14 ","$731.85 ","$0.00 ","$365.93 ","$579.63 ","$585.48 ","$0.00 ","$114.53 ","$0.00 ","$116.51 ","$0.00 "
"3571141214","SUP","HCPCS C1713","","3571141214  -  PLATE BN BRD 231MM STRL 14 HL 4.5MM SCR","BOTH IP/OP","$731.85 ","$541.57 ","$0.00 ","$731.85 ","$329.33 ","$0.00 ","$152.54 ","$0.00 ","$0.00 ","$128.14 ","$731.85 ","$0.00 ","$365.93 ","$579.63 ","$585.48 ","$0.00 ","$114.53 ","$0.00 ","$116.51 ","$0.00 "
"3571141216","SUP","HCPCS C1713","","3571141216  -  PLATE BN BRD 263MM STRL 16 HL 4.5MM SCR","BOTH IP/OP","$926.10 ","$685.31 ","$0.00 ","$926.10 ","$416.75 ","$0.00 ","$193.02 ","$0.00 ","$0.00 ","$162.15 ","$926.10 ","$0.00 ","$463.05 ","$733.47 ","$740.88 ","$0.00 ","$144.93 ","$0.00 ","$147.44 ","$0.00 "
"3571141218","SUP","HCPCS C1713","","3571141218  -  PLATE BN BRD 295MM STRL 18 HL 4.5MM SCR","BOTH IP/OP","$1,022.70 ","$756.80 ","$0.00 ","$1,022.70 ","$460.22 ","$0.00 ","$213.16 ","$0.00 ","$0.00 ","$179.07 ","$1,022.70 ","$0.00 ","$511.35 ","$809.98 ","$818.16 ","$0.00 ","$160.05 ","$0.00 ","$162.81 ","$0.00 "
"3571141220","SUP","HCPCS C1713","","3571141220  -  PLATE BN BRD 326MM STRL 20 HL 4.5MM SCR","BOTH IP/OP","$1,459.50 ","$1,080.03 ","$0.00 ","$1,459.50 ","$656.78 ","$0.00 ","$304.20 ","$0.00 ","$0.00 ","$255.55 ","$1,459.50 ","$0.00 ","$729.75 ","$1,155.92 ","$1,167.60 ","$0.00 ","$228.41 ","$0.00 ","$232.35 ","$0.00 "
"3571141222","SUP","HCPCS C1713","","3571141222  -  PLATE BN BRD 358MM STRL 22 HL 4.5MM SCR","BOTH IP/OP","$1,543.50 ","$1,142.19 ","$0.00 ","$1,543.50 ","$694.58 ","$0.00 ","$321.70 ","$0.00 ","$0.00 ","$270.25 ","$1,543.50 ","$0.00 ","$771.75 ","$1,222.45 ","$1,234.80 ","$0.00 ","$241.56 ","$0.00 ","$245.73 ","$0.00 "
"3571141224","SUP","HCPCS C1713","","3571141224  -  PLATE BN BRD 390MM STRL 24 HL 4.5MM SCR","BOTH IP/OP","$1,711.50 ","$1,266.51 ","$0.00 ","$1,711.50 ","$770.18 ","$0.00 ","$356.72 ","$0.00 ","$0.00 ","$299.67 ","$1,711.50 ","$0.00 ","$855.75 ","$1,355.51 ","$1,369.20 ","$0.00 ","$267.85 ","$0.00 ","$272.47 ","$0.00 "
"3571141302","SUP","HCPCS C1713","","3571141302  -  PLATE BN 39MM STRL 2 HL SMTB","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"3571141303","SUP","HCPCS C1713","","3571141303  -  PLATE BN 55MM STRL 3 HL SMTB","BOTH IP/OP","$147.00 ","$108.78 ","$0.00 ","$147.00 ","$66.15 ","$0.00 ","$30.64 ","$0.00 ","$0.00 ","$25.74 ","$147.00 ","$0.00 ","$73.50 ","$116.42 ","$117.60 ","$0.00 ","$23.01 ","$0.00 ","$23.40 ","$0.00 "
"3571141304","SUP","HCPCS C1713","","3571141304  -  PLATE BN 71MM STRL 4 HL SMTB","BOTH IP/OP","$159.60 ","$118.10 ","$0.00 ","$159.60 ","$71.82 ","$0.00 ","$33.26 ","$0.00 ","$0.00 ","$27.94 ","$159.60 ","$0.00 ","$79.80 ","$126.40 ","$127.68 ","$0.00 ","$24.98 ","$0.00 ","$25.41 ","$0.00 "
"3571141305","SUP","HCPCS C1713","","3571141305  -  PLATE BN 87MM STRL 5 HL SMTB","BOTH IP/OP","$166.95 ","$123.54 ","$0.00 ","$166.95 ","$75.13 ","$0.00 ","$34.80 ","$0.00 ","$0.00 ","$29.23 ","$166.95 ","$0.00 ","$83.48 ","$132.22 ","$133.56 ","$0.00 ","$26.13 ","$0.00 ","$26.58 ","$0.00 "
"3571141306","SUP","HCPCS C1713","","3571141306  -  PLATE BN 103MM STRL 6 HL SMTB","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"3571141307","SUP","HCPCS C1713","","3571141307  -  PLATE BN 119MM STRL 7 HL SMTB","BOTH IP/OP","$192.15 ","$142.19 ","$0.00 ","$192.15 ","$86.47 ","$0.00 ","$40.05 ","$0.00 ","$0.00 ","$33.64 ","$192.15 ","$0.00 ","$96.08 ","$152.18 ","$153.72 ","$0.00 ","$30.07 ","$0.00 ","$30.59 ","$0.00 "
"3571141308","SUP","HCPCS C1713","","3571141308  -  PLATE BN 135MM STRL 8 HL SMTB","BOTH IP/OP","$246.75 ","$182.60 ","$0.00 ","$246.75 ","$111.04 ","$0.00 ","$51.43 ","$0.00 ","$0.00 ","$43.20 ","$246.75 ","$0.00 ","$123.38 ","$195.43 ","$197.40 ","$0.00 ","$38.62 ","$0.00 ","$39.28 ","$0.00 "
"3571141309","SUP","HCPCS C1713","","3571141309  -  PLATE BN 151MM STRL 9 HL SMTB","BOTH IP/OP","$218.40 ","$161.62 ","$0.00 ","$218.40 ","$98.28 ","$0.00 ","$45.52 ","$0.00 ","$0.00 ","$38.24 ","$218.40 ","$0.00 ","$109.20 ","$172.97 ","$174.72 ","$0.00 ","$34.18 ","$0.00 ","$34.77 ","$0.00 "
"3571141310","SUP","HCPCS C1713","","3571141310  -  PLATE BN 167MM STRL 10 HL SMTB","BOTH IP/OP","$270.90 ","$200.47 ","$0.00 ","$270.90 ","$121.91 ","$0.00 ","$56.46 ","$0.00 ","$0.00 ","$47.43 ","$270.90 ","$0.00 ","$135.45 ","$214.55 ","$216.72 ","$0.00 ","$42.40 ","$0.00 ","$43.13 ","$0.00 "
"3571141311","SUP","HCPCS C1713","","3571141311  -  PLATE BN 183MM STRL 11 HL SMTB","BOTH IP/OP","$282.45 ","$209.01 ","$0.00 ","$282.45 ","$127.10 ","$0.00 ","$58.87 ","$0.00 ","$0.00 ","$49.45 ","$282.45 ","$0.00 ","$141.23 ","$223.70 ","$225.96 ","$0.00 ","$44.20 ","$0.00 ","$44.97 ","$0.00 "
"3571141312","SUP","HCPCS C1713","","3571141312  -  PLATE BN 199MM STRL 12 HL SMTB","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"3571141402","SUP","HCPCS C1713","","3571141402  -  PLATE BN NAR 39MM 2 HL SS 4.5MM SCR","BOTH IP/OP","$336.00 ","$248.64 ","$0.00 ","$336.00 ","$151.20 ","$0.00 ","$70.03 ","$0.00 ","$0.00 ","$58.83 ","$336.00 ","$0.00 ","$168.00 ","$266.11 ","$268.80 ","$0.00 ","$52.58 ","$0.00 ","$53.49 ","$0.00 "
"3571141403","SUP","HCPCS C1713","","3571141403  -  PLATE BN NAR 55MM 3 HL SS 4.5MM SCR","BOTH IP/OP","$352.80 ","$261.07 ","$0.00 ","$352.80 ","$158.76 ","$0.00 ","$73.53 ","$0.00 ","$0.00 ","$61.77 ","$352.80 ","$0.00 ","$176.40 ","$279.42 ","$282.24 ","$0.00 ","$55.21 ","$0.00 ","$56.17 ","$0.00 "
"3571141404","SUP","HCPCS C1713","","3571141404  -  PLATE BN NAR 71MM STRL 4 HL 4.5MM SCR","BOTH IP/OP","$368.55 ","$272.73 ","$0.00 ","$368.55 ","$165.85 ","$0.00 ","$76.82 ","$0.00 ","$0.00 ","$64.53 ","$368.55 ","$0.00 ","$184.28 ","$291.89 ","$294.84 ","$0.00 ","$57.68 ","$0.00 ","$58.67 ","$0.00 "
"3571141405","SUP","HCPCS C1713","","3571141405  -  PLATE BN NAR 87MM STRL 5 HL 4.5MM SCR","BOTH IP/OP","$368.55 ","$272.73 ","$0.00 ","$368.55 ","$165.85 ","$0.00 ","$76.82 ","$0.00 ","$0.00 ","$64.53 ","$368.55 ","$0.00 ","$184.28 ","$291.89 ","$294.84 ","$0.00 ","$57.68 ","$0.00 ","$58.67 ","$0.00 "
"3571141406","SUP","HCPCS C1713","","3571141406  -  PLATE BN NAR 103MM STRL 6 HL 4.5MM SCR","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"3571141407","SUP","HCPCS C1713","","3571141407  -  PLATE BN NAR 119MM STRL 7 HL 4.5MM SCR","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"3571141408","SUP","HCPCS C1713","","3571141408  -  PLATE BN NAR 135MM STRL 8 HL 4.5MM SCR","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"3571141409","SUP","HCPCS C1713","","3571141409  -  PLATE BN NAR 151MM STRL 9 HL 4.5MM SCR","BOTH IP/OP","$410.55 ","$303.81 ","$0.00 ","$410.55 ","$184.75 ","$0.00 ","$85.57 ","$0.00 ","$0.00 ","$71.88 ","$410.55 ","$0.00 ","$205.28 ","$325.16 ","$328.44 ","$0.00 ","$64.25 ","$0.00 ","$65.36 ","$0.00 "
"3571141410","SUP","HCPCS C1713","","3571141410  -  PLATE BN NAR 167MM STRL 10 HL 4.5MM SCR","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"3571141411","SUP","HCPCS C1713","","3571141411  -  PLATE BN NAR 183MM STRL 11 HL 4.5MM SCR","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"3571141412","SUP","HCPCS C1713","","3571141412  -  PLATE BN NAR 199MM STRL 12 HL 4.5MM SCR","BOTH IP/OP","$535.50 ","$396.27 ","$0.00 ","$535.50 ","$240.98 ","$0.00 ","$111.61 ","$0.00 ","$0.00 ","$93.76 ","$535.50 ","$0.00 ","$267.75 ","$424.12 ","$428.40 ","$0.00 ","$83.81 ","$0.00 ","$85.25 ","$0.00 "
"3571141413","SUP","HCPCS C1713","","3571141413  -  PLATE BN NAR 215MM STRL 13 HL 4.5MM SCR","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"3571141414","SUP","HCPCS C1713","","3571141414  -  PLATE BN NAR 231MM STRL 14 HL 4.5MM SCR","BOTH IP/OP","$763.35 ","$564.88 ","$0.00 ","$763.35 ","$343.51 ","$0.00 ","$159.10 ","$0.00 ","$0.00 ","$133.66 ","$763.35 ","$0.00 ","$381.68 ","$604.57 ","$610.68 ","$0.00 ","$119.46 ","$0.00 ","$121.53 ","$0.00 "
"3571141415","SUP","HCPCS C1713","","3571141415  -  PLATE BN NAR 247MM STRL 15 HL 4.5MM SCR","BOTH IP/OP","$805.35 ","$595.96 ","$0.00 ","$805.35 ","$362.41 ","$0.00 ","$167.86 ","$0.00 ","$0.00 ","$141.01 ","$805.35 ","$0.00 ","$402.68 ","$637.84 ","$644.28 ","$0.00 ","$126.04 ","$0.00 ","$128.21 ","$0.00 "
"3571141416","SUP","HCPCS C1713","","3571141416  -  PLATE BN NAR 263MM STRL 16 HL 4.5MM SCR","BOTH IP/OP","$805.35 ","$595.96 ","$0.00 ","$805.35 ","$362.41 ","$0.00 ","$167.86 ","$0.00 ","$0.00 ","$141.01 ","$805.35 ","$0.00 ","$402.68 ","$637.84 ","$644.28 ","$0.00 ","$126.04 ","$0.00 ","$128.21 ","$0.00 "
"3571141418","SUP","HCPCS C1713","","3571141418  -  PLATE BN NAR 295MM STRL 18 HL 4.5MM SCR","BOTH IP/OP","$1,149.75 ","$850.82 ","$0.00 ","$1,149.75 ","$517.39 ","$0.00 ","$239.64 ","$0.00 ","$0.00 ","$201.31 ","$1,149.75 ","$0.00 ","$574.88 ","$910.60 ","$919.80 ","$0.00 ","$179.94 ","$0.00 ","$183.04 ","$0.00 "
"3571141420","SUP","HCPCS C1713","","3571141420  -  PLATE BN NAR 326MM STRL 20 HL 4.5MM SCR","BOTH IP/OP","$1,038.45 ","$768.45 ","$0.00 ","$1,038.45 ","$467.30 ","$0.00 ","$216.44 ","$0.00 ","$0.00 ","$181.82 ","$1,038.45 ","$0.00 ","$519.23 ","$822.45 ","$830.76 ","$0.00 ","$162.52 ","$0.00 ","$165.32 ","$0.00 "
"3571141422","SUP","HCPCS C1713","","3571141422  -  PLATE BN NAR 358MM STRL 22 HL 4.5MM SCR","BOTH IP/OP","$1,401.75 ","$1,037.30 ","$0.00 ","$1,401.75 ","$630.79 ","$0.00 ","$292.16 ","$0.00 ","$0.00 ","$245.44 ","$1,401.75 ","$0.00 ","$700.88 ","$1,110.19 ","$1,121.40 ","$0.00 ","$219.37 ","$0.00 ","$223.16 ","$0.00 "
"3571141424","SUP","HCPCS C1713","","3571141424  -  PLATE BN NAR 390MM STRL 24 HL 4.5MM SCR","BOTH IP/OP","$1,517.25 ","$1,122.77 ","$0.00 ","$1,517.25 ","$682.76 ","$0.00 ","$316.23 ","$0.00 ","$0.00 ","$265.66 ","$1,517.25 ","$0.00 ","$758.63 ","$1,201.66 ","$1,213.80 ","$0.00 ","$237.45 ","$0.00 ","$241.55 ","$0.00 "
"3571141603","SUP","HCPCS C1713","","3571141603  -  PLATE BN T 68MM STRL 3 HL","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"3571141604","SUP","HCPCS C1713","","3571141604  -  PLATE BN T 84MM STRL 4 HL","BOTH IP/OP","$631.05 ","$466.98 ","$0.00 ","$631.05 ","$283.97 ","$0.00 ","$131.53 ","$0.00 ","$0.00 ","$110.49 ","$631.05 ","$0.00 ","$315.53 ","$499.79 ","$504.84 ","$0.00 ","$98.76 ","$0.00 ","$100.46 ","$0.00 "
"3571141605","SUP","HCPCS C1713","","3571141605  -  PLATE BN T 100MM STRL 5 HL","BOTH IP/OP","$670.95 ","$496.50 ","$0.00 ","$670.95 ","$301.93 ","$0.00 ","$139.84 ","$0.00 ","$0.00 ","$117.48 ","$670.95 ","$0.00 ","$335.48 ","$531.39 ","$536.76 ","$0.00 ","$105.00 ","$0.00 ","$106.82 ","$0.00 "
"3571141606","SUP","HCPCS C1713","","3571141606  -  PLATE BN T 116MM STRL 6 HL","BOTH IP/OP","$742.35 ","$549.34 ","$0.00 ","$742.35 ","$334.06 ","$0.00 ","$154.72 ","$0.00 ","$0.00 ","$129.98 ","$742.35 ","$0.00 ","$371.18 ","$587.94 ","$593.88 ","$0.00 ","$116.18 ","$0.00 ","$118.18 ","$0.00 "
"3571141608","SUP","HCPCS C1713","","3571141608  -  PLATE BN T 148MM STRL 8 HL","BOTH IP/OP","$1,025.85 ","$759.13 ","$0.00 ","$1,025.85 ","$461.63 ","$0.00 ","$213.81 ","$0.00 ","$0.00 ","$179.62 ","$1,025.85 ","$0.00 ","$512.93 ","$812.47 ","$820.68 ","$0.00 ","$160.55 ","$0.00 ","$163.32 ","$0.00 "
"3571142007","SUP","HCPCS C1713","","3571142007  -  PLATE BN 158MM STRL 7 HL BTRS CNDYL","BOTH IP/OP","$1,953.00 ","$1,445.22 ","$0.00 ","$1,953.00 ","$878.85 ","$0.00 ","$407.05 ","$0.00 ","$0.00 ","$341.95 ","$1,953.00 ","$0.00 ","$976.50 ","$1,546.78 ","$1,562.40 ","$0.00 ","$305.64 ","$0.00 ","$310.92 ","$0.00 "
"3571142009","SUP","HCPCS C1713","","3571142009  -  PLATE BN 190MM STRL 9 HL BTRS CNDYL","BOTH IP/OP","$2,026.50 ","$1,499.61 ","$0.00 ","$2,026.50 ","$911.93 ","$0.00 ","$422.37 ","$0.00 ","$0.00 ","$354.82 ","$2,026.50 ","$0.00 ","$1,013.25 ","$1,604.99 ","$1,621.20 ","$0.00 ","$317.15 ","$0.00 ","$322.62 ","$0.00 "
"3571142011","SUP","HCPCS C1713","","3571142011  -  PLATE BN 221MM STRL 11 HL BTRS CNDYL","BOTH IP/OP","$2,541.00 ","$1,880.34 ","$0.00 ","$2,541.00 ","$1,143.45 ","$0.00 ","$529.61 ","$0.00 ","$0.00 ","$444.91 ","$2,541.00 ","$0.00 ","$1,270.50 ","$2,012.47 ","$2,032.80 ","$0.00 ","$397.67 ","$0.00 ","$404.53 ","$0.00 "
"3571142013","SUP","HCPCS C1713","","3571142013  -  PLATE BN 253MM STRL 13 HL BTRS CNDYL","BOTH IP/OP","$2,136.75 ","$1,581.20 ","$0.00 ","$2,136.75 ","$961.54 ","$0.00 ","$445.35 ","$0.00 ","$0.00 ","$374.13 ","$2,136.75 ","$0.00 ","$1,068.38 ","$1,692.31 ","$1,709.40 ","$0.00 ","$334.40 ","$0.00 ","$340.17 ","$0.00 "
"3571142015","SUP","HCPCS C1713","","3571142015  -  PLATE BN 285MM STRL 15 HL BTRS CNDYL","BOTH IP/OP","$2,682.75 ","$1,985.24 ","$0.00 ","$2,682.75 ","$1,207.24 ","$0.00 ","$559.15 ","$0.00 ","$0.00 ","$469.73 ","$2,682.75 ","$0.00 ","$1,341.38 ","$2,124.74 ","$2,146.20 ","$0.00 ","$419.85 ","$0.00 ","$427.09 ","$0.00 "
"3571142107","SUP","HCPCS C1713","","3571142107  -  PLATE BN 158MM STRL 7 HL BTRS CNDYL","BOTH IP/OP","$2,367.75 ","$1,752.14 ","$0.00 ","$2,367.75 ","$1,065.49 ","$0.00 ","$493.50 ","$0.00 ","$0.00 ","$414.57 ","$2,367.75 ","$0.00 ","$1,183.88 ","$1,875.26 ","$1,894.20 ","$0.00 ","$370.55 ","$0.00 ","$376.95 ","$0.00 "
"3571142109","SUP","HCPCS C1713","","3571142109  -  PLATE BN 190MM STRL 9 HL BTRS CNDYL","BOTH IP/OP","$2,026.50 ","$1,499.61 ","$0.00 ","$2,026.50 ","$911.93 ","$0.00 ","$422.37 ","$0.00 ","$0.00 ","$354.82 ","$2,026.50 ","$0.00 ","$1,013.25 ","$1,604.99 ","$1,621.20 ","$0.00 ","$317.15 ","$0.00 ","$322.62 ","$0.00 "
"3571142111","SUP","HCPCS C1713","","3571142111  -  PLATE BN 221MM STRL 11 HL BTRS CNDYL","BOTH IP/OP","$2,541.00 ","$1,880.34 ","$0.00 ","$2,541.00 ","$1,143.45 ","$0.00 ","$529.61 ","$0.00 ","$0.00 ","$444.91 ","$2,541.00 ","$0.00 ","$1,270.50 ","$2,012.47 ","$2,032.80 ","$0.00 ","$397.67 ","$0.00 ","$404.53 ","$0.00 "
"3571142113","SUP","HCPCS C1713","","3571142113  -  PLATE BN 253MM STRL 13 HL BTRS CNDYL","BOTH IP/OP","$2,604.00 ","$1,926.96 ","$0.00 ","$2,604.00 ","$1,171.80 ","$0.00 ","$542.74 ","$0.00 ","$0.00 ","$455.94 ","$2,604.00 ","$0.00 ","$1,302.00 ","$2,062.37 ","$2,083.20 ","$0.00 ","$407.53 ","$0.00 ","$414.56 ","$0.00 "
"3571142115","SUP","HCPCS C1713","","3571142115  -  PLATE BN 285MM STRL 15 HL BTRS CNDYL","BOTH IP/OP","$2,682.75 ","$1,985.24 ","$0.00 ","$2,682.75 ","$1,207.24 ","$0.00 ","$559.15 ","$0.00 ","$0.00 ","$469.73 ","$2,682.75 ","$0.00 ","$1,341.38 ","$2,124.74 ","$2,146.20 ","$0.00 ","$419.85 ","$0.00 ","$427.09 ","$0.00 "
"3571143113","SUP","HCPCS C1713","","3571143113  -  WASHER BN 13MM SS","BOTH IP/OP","$85.20 ","$63.05 ","$0.00 ","$85.20 ","$38.34 ","$0.00 ","$17.76 ","$0.00 ","$0.00 ","$14.92 ","$85.20 ","$0.00 ","$42.60 ","$67.48 ","$68.16 ","$0.00 ","$13.33 ","$0.00 ","$13.56 ","$0.00 "
"3571145020","SUP","HCPCS C1713","","3571145020  -  PLATE BN STRG STRL 20 HL SS CNDYL 1.5MM SCR","BOTH IP/OP","$570.15 ","$421.91 ","$0.00 ","$570.15 ","$256.57 ","$0.00 ","$118.83 ","$0.00 ","$0.00 ","$99.83 ","$570.15 ","$0.00 ","$285.08 ","$451.56 ","$456.12 ","$0.00 ","$89.23 ","$0.00 ","$90.77 ","$0.00 "
"3571145022","SUP","HCPCS C1713","","3571145022  -  PLATE BN T 3X9 HL SS CNDYL 1.5MM SCR","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$226.80 ","$0.00 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$78.88 ","$0.00 ","$80.24 ","$0.00 "
"3571145024","SUP","HCPCS C1713","","3571145024  -  PLATE BN T 4X9 HL SS CNDYL 1.5MM SCR","BOTH IP/OP","$534.45 ","$395.49 ","$0.00 ","$534.45 ","$240.50 ","$0.00 ","$111.39 ","$0.00 ","$0.00 ","$93.58 ","$534.45 ","$0.00 ","$267.23 ","$423.28 ","$427.56 ","$0.00 ","$83.64 ","$0.00 ","$85.08 ","$0.00 "
"3571145026","SUP","HCPCS C1713","","3571145026  -  PLATE BN 6 HL SS CNDYL LT 1.5 MM SCR","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"3571145028","SUP","HCPCS C1713","","3571145028  -  PLATE BN 6 HL SS CNDYL RT 1.5 MM SCR","BOTH IP/OP","$708.75 ","$524.48 ","$0.00 ","$708.75 ","$318.94 ","$0.00 ","$147.72 ","$0.00 ","$0.00 ","$124.10 ","$708.75 ","$0.00 ","$354.38 ","$561.33 ","$567.00 ","$0.00 ","$110.92 ","$0.00 ","$112.83 ","$0.00 "
"3571145030","SUP","HCPCS C1713","","3571145030  -  PLATE BN H STRL 4 HL CNDYL 1.5MM SCR","BOTH IP/OP","$406.35 ","$300.70 ","$0.00 ","$406.35 ","$182.86 ","$0.00 ","$84.69 ","$0.00 ","$0.00 ","$71.15 ","$406.35 ","$0.00 ","$203.18 ","$321.83 ","$325.08 ","$0.00 ","$63.59 ","$0.00 ","$64.69 ","$0.00 "
"3571146020","SUP","HCPCS C1713","","3571146020  -  PLATE BN STRG 3 HL SS CNDYL 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"3571146022","SUP","HCPCS C1713","","3571146022  -  PLATE BN STRG 4 HL SS CNDYL 2MM SCR","BOTH IP/OP","$148.05 ","$109.56 ","$0.00 ","$148.05 ","$66.62 ","$0.00 ","$30.86 ","$0.00 ","$0.00 ","$25.92 ","$148.05 ","$0.00 ","$74.03 ","$117.26 ","$118.44 ","$0.00 ","$23.17 ","$0.00 ","$23.57 ","$0.00 "
"3571146024","SUP","HCPCS C1713","","3571146024  -  PLATE BN STRG 5 HL SS CNDYL 2MM SCR","BOTH IP/OP","$159.60 ","$118.10 ","$0.00 ","$159.60 ","$71.82 ","$0.00 ","$33.26 ","$0.00 ","$0.00 ","$27.94 ","$159.60 ","$0.00 ","$79.80 ","$126.40 ","$127.68 ","$0.00 ","$24.98 ","$0.00 ","$25.41 ","$0.00 "
"3571146026","SUP","HCPCS C1713","","3571146026  -  PLATE BN STRG STRL 6 HL CNDYL 2MM SCR","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"3571146028","SUP","HCPCS C1713","","3571146028  -  PLATE BN STRG 20 HL SS CNDYL 2MM SCR","BOTH IP/OP","$568.05 ","$420.36 ","$0.00 ","$568.05 ","$255.62 ","$0.00 ","$118.40 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"3571146030","SUP","HCPCS C1713","","3571146030  -  PLATE BN T 3X9 HL SS CNDYL 2MM SCR","BOTH IP/OP","$504.00 ","$372.96 ","$0.00 ","$504.00 ","$226.80 ","$0.00 ","$105.05 ","$0.00 ","$0.00 ","$88.25 ","$504.00 ","$0.00 ","$252.00 ","$399.17 ","$403.20 ","$0.00 ","$78.88 ","$0.00 ","$80.24 ","$0.00 "
"3571146032","SUP","HCPCS C1713","","3571146032  -  PLATE BN T 4X9 HL SS CNDYL 2MM SCR","BOTH IP/OP","$534.45 ","$395.49 ","$0.00 ","$534.45 ","$240.50 ","$0.00 ","$111.39 ","$0.00 ","$0.00 ","$93.58 ","$534.45 ","$0.00 ","$267.23 ","$423.28 ","$427.56 ","$0.00 ","$83.64 ","$0.00 ","$85.08 ","$0.00 "
"3571146034","SUP","HCPCS C1713","","3571146034  -  PLATE BN T 2X2 HL SS CNDYL 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"3571146036","SUP","HCPCS C1713","","3571146036  -  PLATE BN L 3 HL OBLQ SS CNDYL RT 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"3571146038","SUP","HCPCS C1713","","3571146038  -  PLATE BN L 3 HL OBLQ SS CNDYL LT 2MM SCR","BOTH IP/OP","$134.40 ","$99.46 ","$0.00 ","$134.40 ","$60.48 ","$0.00 ","$28.01 ","$0.00 ","$0.00 ","$23.53 ","$134.40 ","$0.00 ","$67.20 ","$106.44 ","$107.52 ","$0.00 ","$21.03 ","$0.00 ","$21.40 ","$0.00 "
"3571146040","SUP","HCPCS C1713","","3571146040  -  PLATE BN 6 HL OBLQ SS CNDYL LT 2 MM SCR","BOTH IP/OP","$678.30 ","$501.94 ","$0.00 ","$678.30 ","$305.24 ","$0.00 ","$141.37 ","$0.00 ","$0.00 ","$118.76 ","$678.30 ","$0.00 ","$339.15 ","$537.21 ","$542.64 ","$0.00 ","$106.15 ","$0.00 ","$107.99 ","$0.00 "
"3571146042","SUP","HCPCS C1713","","3571146042  -  PLATE BN 6 HL OBLQ SS CNDYL RT 2 MM SCR","BOTH IP/OP","$678.30 ","$501.94 ","$0.00 ","$678.30 ","$305.24 ","$0.00 ","$141.37 ","$0.00 ","$0.00 ","$118.76 ","$678.30 ","$0.00 ","$339.15 ","$537.21 ","$542.64 ","$0.00 ","$106.15 ","$0.00 ","$107.99 ","$0.00 "
"3571146048","SUP","HCPCS C1713","","3571146048  -  PLATE BN H STRL 4 HL CNDYL 2MM SCR","BOTH IP/OP","$406.35 ","$300.70 ","$0.00 ","$406.35 ","$182.86 ","$0.00 ","$84.69 ","$0.00 ","$0.00 ","$71.15 ","$406.35 ","$0.00 ","$203.18 ","$321.83 ","$325.08 ","$0.00 ","$63.59 ","$0.00 ","$64.69 ","$0.00 "
"3571147001","SUP","HCPCS C1713","","3571147001  -  PLATE BN L STRL CNDYL RT 2.7MM SCR","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"3571147002","SUP","HCPCS C1713","","3571147002  -  PLATE BN L 3 HL OBLQ SS CNDYL LT 2.7MM SCR","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"3571147003","SUP","HCPCS C1713","","3571147003  -  PLATE BN L STRL CNDYL LT 2.7MM SCR","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"3571147004","SUP","HCPCS C1713","","3571147004  -  PLATE BN L 3 HL OBLQ SS CNDYL RT 2.7MM SCR","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"3571147006","SUP","HCPCS C1713","","3571147006  -  PLATE BN T 3 HL SS CNDYL 2.7MM SCR","BOTH IP/OP","$142.80 ","$105.67 ","$0.00 ","$142.80 ","$64.26 ","$0.00 ","$29.76 ","$0.00 ","$0.00 ","$25.00 ","$142.80 ","$0.00 ","$71.40 ","$113.10 ","$114.24 ","$0.00 ","$22.35 ","$0.00 ","$22.73 ","$0.00 "
"3571147008","SUP","HCPCS C1713","","3571147008  -  PLATE BN 6 HL SS CNDYL LT 2.7 MM SCR","BOTH IP/OP","$720.30 ","$533.02 ","$0.00 ","$720.30 ","$324.14 ","$0.00 ","$150.13 ","$0.00 ","$0.00 ","$126.12 ","$720.30 ","$0.00 ","$360.15 ","$570.48 ","$576.24 ","$0.00 ","$112.73 ","$0.00 ","$114.67 ","$0.00 "
"3571147010","SUP","HCPCS C1713","","3571147010  -  PLATE BN 6 HL SS CNDYL RT 2.7 MM SCR","BOTH IP/OP","$720.30 ","$533.02 ","$0.00 ","$720.30 ","$324.14 ","$0.00 ","$150.13 ","$0.00 ","$0.00 ","$126.12 ","$720.30 ","$0.00 ","$360.15 ","$570.48 ","$576.24 ","$0.00 ","$112.73 ","$0.00 ","$114.67 ","$0.00 "
"3571147012","SUP","HCPCS C1713","","3571147012  -  PLATE BN STRL 7 HL MLT FRAG CNDYL 2.7 MM SCR","BOTH IP/OP","$169.05 ","$125.10 ","$0.00 ","$169.05 ","$76.07 ","$0.00 ","$35.23 ","$0.00 ","$0.00 ","$29.60 ","$169.05 ","$0.00 ","$84.53 ","$133.89 ","$135.24 ","$0.00 ","$26.46 ","$0.00 ","$26.91 ","$0.00 "
"3571148003","SUP","HCPCS C1713","","3571148003  -  PLATE BN STRL 3 HL QT TBLR SS CNDYL","BOTH IP/OP","$159.60 ","$118.10 ","$0.00 ","$159.60 ","$71.82 ","$0.00 ","$33.26 ","$0.00 ","$0.00 ","$27.94 ","$159.60 ","$0.00 ","$79.80 ","$126.40 ","$127.68 ","$0.00 ","$24.98 ","$0.00 ","$25.41 ","$0.00 "
"3571148004","SUP","HCPCS C1713","","3571148004  -  PLATE BN 4 HL QT TBLR SS CNDYL","BOTH IP/OP","$175.35 ","$129.76 ","$0.00 ","$175.35 ","$78.91 ","$0.00 ","$36.55 ","$0.00 ","$0.00 ","$30.70 ","$175.35 ","$0.00 ","$87.68 ","$138.88 ","$140.28 ","$0.00 ","$27.44 ","$0.00 ","$27.92 ","$0.00 "
"3571148005","SUP","HCPCS C1713","","3571148005  -  PLATE BN 5 HL QT TBLR SS CNDYL","BOTH IP/OP","$185.85 ","$137.53 ","$0.00 ","$185.85 ","$83.63 ","$0.00 ","$38.74 ","$0.00 ","$0.00 ","$32.54 ","$185.85 ","$0.00 ","$92.93 ","$147.19 ","$148.68 ","$0.00 ","$29.09 ","$0.00 ","$29.59 ","$0.00 "
"3571148006","SUP","HCPCS C1713","","3571148006  -  PLATE BN 6 HL QT TBLR SS CNDYL","BOTH IP/OP","$205.80 ","$152.29 ","$0.00 ","$205.80 ","$92.61 ","$0.00 ","$42.89 ","$0.00 ","$0.00 ","$36.03 ","$205.80 ","$0.00 ","$102.90 ","$162.99 ","$164.64 ","$0.00 ","$32.21 ","$0.00 ","$32.76 ","$0.00 "
"3571148007","SUP","HCPCS C1713","","3571148007  -  PLATE BN STRL 7 HL QT TBLR CNDYL","BOTH IP/OP","$214.20 ","$158.51 ","$0.00 ","$214.20 ","$96.39 ","$0.00 ","$44.64 ","$0.00 ","$0.00 ","$37.50 ","$214.20 ","$0.00 ","$107.10 ","$169.65 ","$171.36 ","$0.00 ","$33.52 ","$0.00 ","$34.10 ","$0.00 "
"3571148008","SUP","HCPCS C1713","","3571148008  -  PLATE BN STRL 8 HL QT TBLR CNDYL","BOTH IP/OP","$227.85 ","$168.61 ","$0.00 ","$227.85 ","$102.53 ","$0.00 ","$47.49 ","$0.00 ","$0.00 ","$39.89 ","$227.85 ","$0.00 ","$113.93 ","$180.46 ","$182.28 ","$0.00 ","$35.66 ","$0.00 ","$36.27 ","$0.00 "
"3571149106","SUP","HCPCS C1713","","3571149106  -  SCREW BN 1.5MM 6MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149107","SUP","HCPCS C1713","","3571149107  -  SCREW BN 1.5MM 7MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149108","SUP","HCPCS C1713","","3571149108  -  SCREW BN 1.5MM 8MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149109","SUP","HCPCS C1713","","3571149109  -  SCREW BN 1.5MM 9MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149110","SUP","HCPCS C1713","","3571149110  -  SCREW BN 1.5MM 10MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149111","SUP","HCPCS C1713","","3571149111  -  SCREW BN 1.5MM 11MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149112","SUP","HCPCS C1713","","3571149112  -  SCREW BN 1.5MM 12MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149114","SUP","HCPCS C1713","","3571149114  -  SCREW BN 1.5MM 14MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149116","SUP","HCPCS C1713","","3571149116  -  SCREW BN 1.5MM 16MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149118","SUP","HCPCS C1713","","3571149118  -  SCREW BN 1.5MM 18MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149120","SUP","HCPCS C1713","","3571149120  -  SCREW BN 1.5MM 20MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149122","SUP","HCPCS C1713","","3571149122  -  SCREW BN 1.5MM 22MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149124","SUP","HCPCS C1713","","3571149124  -  SCREW BN 1.5MM 24MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$77.55 ","$57.39 ","$0.00 ","$77.55 ","$34.90 ","$0.00 ","$16.16 ","$0.00 ","$0.00 ","$13.58 ","$77.55 ","$0.00 ","$38.78 ","$61.42 ","$62.04 ","$0.00 ","$12.14 ","$0.00 ","$12.35 ","$0.00 "
"3571149306","SUP","HCPCS C1713","","3571149306  -  SCREW BN 2MM 6MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149308","SUP","HCPCS C1713","","3571149308  -  SCREW BN 2MM 8MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149310","SUP","HCPCS C1713","","3571149310  -  SCREW BN 2MM 10MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149312","SUP","HCPCS C1713","","3571149312  -  SCREW BN 2MM 12MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149314","SUP","HCPCS C1713","","3571149314  -  SCREW BN 2MM 14MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149316","SUP","HCPCS C1713","","3571149316  -  SCREW BN 2MM 16MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149318","SUP","HCPCS C1713","","3571149318  -  SCREW BN 2MM 18MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149320","SUP","HCPCS C1713","","3571149320  -  SCREW BN 2MM 20MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149322","SUP","HCPCS C1713","","3571149322  -  SCREW BN 2MM 22MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149324","SUP","HCPCS C1713","","3571149324  -  SCREW BN 2MM 24MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149326","SUP","HCPCS C1713","","3571149326  -  SCREW BN 2MM 26MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149328","SUP","HCPCS C1713","","3571149328  -  SCREW BN 2MM 28MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149330","SUP","HCPCS C1713","","3571149330  -  SCREW BN 2MM 30MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$79.43 ","$58.78 ","$0.00 ","$79.43 ","$35.74 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.91 ","$79.43 ","$0.00 ","$39.71 ","$62.91 ","$63.54 ","$0.00 ","$12.43 ","$0.00 ","$12.64 ","$0.00 "
"3571149406","SUP","HCPCS C1713","","3571149406  -  SCREW BN 2.7MM 6MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149408","SUP","HCPCS C1713","","3571149408  -  SCREW BN 2.7MM 8MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149410","SUP","HCPCS C1713","","3571149410  -  SCREW BN 2.7MM 10MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149412","SUP","HCPCS C1713","","3571149412  -  SCREW BN 2.7MM 12MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149414","SUP","HCPCS C1713","","3571149414  -  SCREW BN 2.7MM 14MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149416","SUP","HCPCS C1713","","3571149416  -  SCREW BN 2.7MM 16MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149418","SUP","HCPCS C1713","","3571149418  -  SCREW BN 2.7MM 18MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149420","SUP","HCPCS C1713","","3571149420  -  SCREW BN 2.7MM 20MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149422","SUP","HCPCS C1713","","3571149422  -  SCREW BN 2.7MM 22MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149424","SUP","HCPCS C1713","","3571149424  -  SCREW BN 2.7MM 24MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149426","SUP","HCPCS C1713","","3571149426  -  SCREW BN 2.7MM 26MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149428","SUP","HCPCS C1713","","3571149428  -  SCREW BN 2.7MM 28MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149430","SUP","HCPCS C1713","","3571149430  -  SCREW BN 2.7MM 30MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149432","SUP","HCPCS C1713","","3571149432  -  SCREW BN 2.7MM 32MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149434","SUP","HCPCS C1713","","3571149434  -  SCREW BN 2.7MM 34MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149436","SUP","HCPCS C1713","","3571149436  -  SCREW BN 2.7MM 36MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149440","SUP","HCPCS C1713","","3571149440  -  SCREW BN 2.7MM 40MM STRL TC100 HEX HD ST SS CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149445","SUP","HCPCS C1713","","3571149445  -  SCREW BN 2.7MM 45MM STRL HEX HD ST CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149450","SUP","HCPCS C1713","","3571149450  -  SCREW BN 2.7MM 50MM STRL HEX HD ST CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149455","SUP","HCPCS C1713","","3571149455  -  SCREW BN 2.7MM 55MM STRL HEX HD ST CORT","BOTH IP/OP","$69.73 ","$51.60 ","$0.00 ","$69.73 ","$31.38 ","$0.00 ","$14.53 ","$0.00 ","$0.00 ","$12.21 ","$69.73 ","$0.00 ","$34.86 ","$55.23 ","$55.78 ","$0.00 ","$10.91 ","$0.00 ","$11.10 ","$0.00 "
"3571149510","SUP","HCPCS C1713","","3571149510  -  SCREW BN 3.5MM 10MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149512","SUP","HCPCS C1713","","3571149512  -  SCREW BN 3.5MM 12MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149514","SUP","HCPCS C1713","","3571149514  -  SCREW BN 3.5MM 14MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149516","SUP","HCPCS C1713","","3571149516  -  SCREW BN 3.5MM 16MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149518","SUP","HCPCS C1713","","3571149518  -  SCREW BN 3.5MM 18MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149520","SUP","HCPCS C1713","","3571149520  -  SCREW BN 3.5MM 20MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149522","SUP","HCPCS C1713","","3571149522  -  SCREW BN 3.5MM 22MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149524","SUP","HCPCS C1713","","3571149524  -  SCREW BN 3.5MM 24MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149526","SUP","HCPCS C1713","","3571149526  -  SCREW BN 3.5MM 26MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149528","SUP","HCPCS C1713","","3571149528  -  SCREW BN 3.5MM 28MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149530","SUP","HCPCS C1713","","3571149530  -  SCREW BN 3.5MM 30MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149532","SUP","HCPCS C1713","","3571149532  -  SCREW BN 3.5MM 32MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149534","SUP","HCPCS C1713","","3571149534  -  SCREW BN 3.5MM 34MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149536","SUP","HCPCS C1713","","3571149536  -  SCREW BN 3.5MM 36MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149538","SUP","HCPCS C1713","","3571149538  -  SCREW BN 3.5MM 38MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149540","SUP","HCPCS C1713","","3571149540  -  SCREW BN 3.5MM 40MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149545","SUP","HCPCS C1713","","3571149545  -  SCREW BN 3.5MM 45MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149550","SUP","HCPCS C1713","","3571149550  -  SCREW BN 3.5MM 50MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149555","SUP","HCPCS C1713","","3571149555  -  SCREW BN 3.5MM 55MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149560","SUP","HCPCS C1713","","3571149560  -  SCREW BN 3.5MM 60MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149565","SUP","HCPCS C1713","","3571149565  -  SCREW BN 3.5MM 65MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149570","SUP","HCPCS C1713","","3571149570  -  SCREW BN 3.5MM 70MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149575","SUP","HCPCS C1713","","3571149575  -  SCREW BN 3.5MM 75MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149580","SUP","HCPCS C1713","","3571149580  -  SCREW BN 3.5MM 80MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149585","SUP","HCPCS C1713","","3571149585  -  SCREW BN 3.5MM 85MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149590","SUP","HCPCS C1713","","3571149590  -  SCREW BN 3.5MM 90MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149595","SUP","HCPCS C1713","","3571149595  -  SCREW BN 3.5MM 95MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149600","SUP","HCPCS C1713","","3571149600  -  SCREW BN 3.5MM 100MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149605","SUP","HCPCS C1713","","3571149605  -  SCREW BN 3.5MM 105MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149610","SUP","HCPCS C1713","","3571149610  -  SCREW BN 3.5MM 110MM STRL HEX HD ST CORT","BOTH IP/OP","$91.45 ","$67.67 ","$0.00 ","$91.45 ","$41.15 ","$0.00 ","$19.06 ","$0.00 ","$0.00 ","$16.01 ","$91.45 ","$0.00 ","$45.73 ","$72.43 ","$73.16 ","$0.00 ","$14.31 ","$0.00 ","$14.56 ","$0.00 "
"3571149615","SUP","HCPCS C1713","","3571149615  -  SCREW BN 3.5MM 115MM STRL HEX HD ST CORT","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"3571149620","SUP","HCPCS C1713","","3571149620  -  SCREW BN 3.5MM 120MM STRL HEX HD ST CORT","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"3571149625","SUP","HCPCS C1713","","3571149625  -  SCREW BN 3.5MM 125MM STRL HEX HD ST CORT","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"3571149630","SUP","HCPCS C1713","","3571149630  -  SCREW BN 3.5MM 130MM STRL HEX HD ST CORT","BOTH IP/OP","$93.35 ","$69.08 ","$0.00 ","$93.35 ","$42.01 ","$0.00 ","$19.46 ","$0.00 ","$0.00 ","$16.34 ","$93.35 ","$0.00 ","$46.68 ","$73.93 ","$74.68 ","$0.00 ","$14.61 ","$0.00 ","$14.86 ","$0.00 "
"3571149714","SUP","HCPCS C1713","","3571149714  -  SCREW BN 4.5MM 14MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149716","SUP","HCPCS C1713","","3571149716  -  SCREW BN 4.5MM 16MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149718","SUP","HCPCS C1713","","3571149718  -  SCREW BN 4.5MM 18MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149720","SUP","HCPCS C1713","","3571149720  -  SCREW BN 4.5MM 20MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149722","SUP","HCPCS C1713","","3571149722  -  SCREW BN 4.5MM 22MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149724","SUP","HCPCS C1713","","3571149724  -  SCREW BN 4.5MM 24MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149726","SUP","HCPCS C1713","","3571149726  -  SCREW BN 4.5MM 26MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149728","SUP","HCPCS C1713","","3571149728  -  SCREW BN 4.5MM 28MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149730","SUP","HCPCS C1713","","3571149730  -  SCREW BN 4.5MM 30MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149732","SUP","HCPCS C1713","","3571149732  -  SCREW BN 4.5MM 32MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149734","SUP","HCPCS C1713","","3571149734  -  SCREW BN 4.5MM 34MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149736","SUP","HCPCS C1713","","3571149736  -  SCREW BN 4.5MM 36MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149738","SUP","HCPCS C1713","","3571149738  -  SCREW BN 4.5MM 38MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149740","SUP","HCPCS C1713","","3571149740  -  SCREW BN 4.5MM 40MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149742","SUP","HCPCS C1713","","3571149742  -  SCREW BN 4.5MM 42MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149744","SUP","HCPCS C1713","","3571149744  -  SCREW BN 4.5MM 44MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149746","SUP","HCPCS C1713","","3571149746  -  SCREW BN 4.5MM 46MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149748","SUP","HCPCS C1713","","3571149748  -  SCREW BN 4.5MM 48MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149750","SUP","HCPCS C1713","","3571149750  -  SCREW BN 4.5MM 50MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149752","SUP","HCPCS C1713","","3571149752  -  SCREW BN 4.5MM 52MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149754","SUP","HCPCS C1713","","3571149754  -  SCREW BN 4.5MM 54MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149756","SUP","HCPCS C1713","","3571149756  -  SCREW BN 4.5MM 56MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149758","SUP","HCPCS C1713","","3571149758  -  SCREW BN 4.5MM 58MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149760","SUP","HCPCS C1713","","3571149760  -  SCREW BN 4.5MM 60MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149762","SUP","HCPCS C1713","","3571149762  -  SCREW BN 4.5MM 62MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149764","SUP","HCPCS C1713","","3571149764  -  SCREW BN 4.5MM 64MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149766","SUP","HCPCS C1713","","3571149766  -  SCREW BN 4.5MM 66MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149768","SUP","HCPCS C1713","","3571149768  -  SCREW BN 4.5MM 68MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149770","SUP","HCPCS C1713","","3571149770  -  SCREW BN 4.5MM 70MM STRL HEX HD ST CORT","BOTH IP/OP","$75.70 ","$56.02 ","$0.00 ","$75.70 ","$34.07 ","$0.00 ","$15.78 ","$0.00 ","$0.00 ","$13.25 ","$75.70 ","$0.00 ","$37.85 ","$59.95 ","$60.56 ","$0.00 ","$11.85 ","$0.00 ","$12.05 ","$0.00 "
"3571149772","SUP","HCPCS C1713","","3571149772  -  SCREW BN 4.5MM 72MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149776","SUP","HCPCS C1713","","3571149776  -  SCREW BN 4.5MM 76MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149780","SUP","HCPCS C1713","","3571149780  -  SCREW BN 4.5MM 80MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149785","SUP","HCPCS C1713","","3571149785  -  SCREW BN 4.5MM 85MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149790","SUP","HCPCS C1713","","3571149790  -  SCREW BN 4.5MM 90MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149795","SUP","HCPCS C1713","","3571149795  -  SCREW BN 4.5MM 95MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149800","SUP","HCPCS C1713","","3571149800  -  SCREW BN 4.5MM 100MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149805","SUP","HCPCS C1713","","3571149805  -  SCREW BN 4.5MM 105MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149810","SUP","HCPCS C1713","","3571149810  -  SCREW BN 4.5MM 110MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149815","SUP","HCPCS C1713","","3571149815  -  SCREW BN 4.5MM 115MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149820","SUP","HCPCS C1713","","3571149820  -  SCREW BN 4.5MM 120MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149825","SUP","HCPCS C1713","","3571149825  -  SCREW BN 4.5MM 125MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149830","SUP","HCPCS C1713","","3571149830  -  SCREW BN 4.5MM 130MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149835","SUP","HCPCS C1713","","3571149835  -  SCREW BN 4.5MM 135MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149840","SUP","HCPCS C1713","","3571149840  -  SCREW BN 4.5MM 140MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571149845","SUP","HCPCS C1713","","3571149845  -  SCREW BN 4.5MM 145MM STRL HEX HD ST CORT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$56.70 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$22.06 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$19.72 ","$0.00 ","$20.06 ","$0.00 "
"3571223010","SUP","HCPCS C1713","","3571223010  -  SCREW BN FT 4MM 10MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223012","SUP","HCPCS C1713","","3571223012  -  SCREW BN FT 4MM 12MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223014","SUP","HCPCS C1713","","3571223014  -  SCREW BN FT 4MM 14MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223016","SUP","HCPCS C1713","","3571223016  -  SCREW BN FT 4MM 16MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223018","SUP","HCPCS C1713","","3571223018  -  SCREW BN FT 4MM 18MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223020","SUP","HCPCS C1713","","3571223020  -  SCREW BN FT 4MM 20MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223022","SUP","HCPCS C1713","","3571223022  -  SCREW BN FT 4MM 22MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223024","SUP","HCPCS C1713","","3571223024  -  SCREW BN FT 4MM 24MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223026","SUP","HCPCS C1713","","3571223026  -  SCREW BN FT 4MM 26MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223028","SUP","HCPCS C1713","","3571223028  -  SCREW BN FT 4MM 28MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223030","SUP","HCPCS C1713","","3571223030  -  SCREW BN FT 4MM 30MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223035","SUP","HCPCS C1713","","3571223035  -  SCREW BN FT 4MM 35MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223040","SUP","HCPCS C1713","","3571223040  -  SCREW BN FT 4MM 40MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223045","SUP","HCPCS C1713","","3571223045  -  SCREW BN FT 4MM 45MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223050","SUP","HCPCS C1713","","3571223050  -  SCREW BN FT 4MM 50MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223055","SUP","HCPCS C1713","","3571223055  -  SCREW BN FT 4MM 55MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223060","SUP","HCPCS C1713","","3571223060  -  SCREW BN FT 4MM 60MM STRL CANC","BOTH IP/OP","$57.03 ","$42.20 ","$0.00 ","$57.03 ","$25.66 ","$0.00 ","$11.89 ","$0.00 ","$0.00 ","$9.98 ","$57.03 ","$0.00 ","$28.51 ","$45.17 ","$45.62 ","$0.00 ","$8.92 ","$0.00 ","$9.08 ","$0.00 "
"3571223210","SUP","HCPCS C1713","","3571223210  -  SCREW BN P/T 4MM 10MM STRL CANC","BOTH IP/OP","$55.08 ","$40.76 ","$0.00 ","$55.08 ","$24.78 ","$0.00 ","$11.48 ","$0.00 ","$0.00 ","$9.64 ","$55.08 ","$0.00 ","$27.54 ","$43.62 ","$44.06 ","$0.00 ","$8.62 ","$0.00 ","$8.77 ","$0.00 "
"3571223212","SUP","HCPCS C1713","","3571223212  -  SCREW BN P/T 4MM 12MM STRL CANC","BOTH IP/OP","$55.08 ","$40.76 ","$0.00 ","$55.08 ","$24.78 ","$0.00 ","$11.48 ","$0.00 ","$0.00 ","$9.64 ","$55.08 ","$0.00 ","$27.54 ","$43.62 ","$44.06 ","$0.00 ","$8.62 ","$0.00 ","$8.77 ","$0.00 "
"3571223214","SUP","HCPCS C1713","","3571223214  -  SCREW BN P/T 4MM 14MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223216","SUP","HCPCS C1713","","3571223216  -  SCREW BN P/T 4MM 16MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223218","SUP","HCPCS C1713","","3571223218  -  SCREW BN P/T 4MM 18MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223220","SUP","HCPCS C1713","","3571223220  -  SCREW BN P/T 4MM 20MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223222","SUP","HCPCS C1713","","3571223222  -  SCREW BN P/T 4MM 22MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223226","SUP","HCPCS C1713","","3571223226  -  SCREW BN P/T 4MM 26MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223228","SUP","HCPCS C1713","","3571223228  -  SCREW BN P/T 4MM 28MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223230","SUP","HCPCS C1713","","3571223230  -  SCREW BN P/T 4MM 30MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223235","SUP","HCPCS C1713","","3571223235  -  SCREW BN P/T 4MM 35MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223240","SUP","HCPCS C1713","","3571223240  -  SCREW BN P/T 4MM 40MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223245","SUP","HCPCS C1713","","3571223245  -  SCREW BN P/T 4MM 45MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571223250","SUP","HCPCS C1713","","3571223250  -  SCREW BN P/T 4MM 50MM STRL CANC","BOTH IP/OP","$36.75 ","$27.20 ","$0.00 ","$36.75 ","$16.54 ","$0.00 ","$7.66 ","$0.00 ","$0.00 ","$6.43 ","$36.75 ","$0.00 ","$18.38 ","$29.11 ","$29.40 ","$0.00 ","$5.75 ","$0.00 ","$5.85 ","$0.00 "
"3571226030","SUP","HCPCS C1713","","3571226030  -  SCREW BN 6.5MM 30MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226035","SUP","HCPCS C1713","","3571226035  -  SCREW BN 6.5MM 35MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226040","SUP","HCPCS C1713","","3571226040  -  SCREW BN 6.5MM 40MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226045","SUP","HCPCS C1713","","3571226045  -  SCREW BN 6.5MM 45MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226050","SUP","HCPCS C1713","","3571226050  -  SCREW BN 6.5MM 50MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226055","SUP","HCPCS C1713","","3571226055  -  SCREW BN 6.5MM 55MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226060","SUP","HCPCS C1713","","3571226060  -  SCREW BN 6.5MM 60MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226065","SUP","HCPCS C1713","","3571226065  -  SCREW BN 6.5MM 65MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226070","SUP","HCPCS C1713","","3571226070  -  SCREW BN 6.5MM 70MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226075","SUP","HCPCS C1713","","3571226075  -  SCREW BN 6.5MM 75MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226080","SUP","HCPCS C1713","","3571226080  -  SCREW BN 6.5MM 80MM STRL 16MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571226085","SUP","HCPCS C1713","","3571226085  -  SCREW BN 6.5MM 85MM STRL 16MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571226090","SUP","HCPCS C1713","","3571226090  -  SCREW BN 6.5MM 90MM STRL 16MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571226095","SUP","HCPCS C1713","","3571226095  -  SCREW BN 6.5MM 95MM STRL 16MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571226100","SUP","HCPCS C1713","","3571226100  -  SCREW BN 6.5MM 100MM STRL 16MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571226105","SUP","HCPCS C1713","","3571226105  -  SCREW BN 6.5MM 105MM STRL 16MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571226110","SUP","HCPCS C1713","","3571226110  -  SCREW BN 6.5MM 110MM STRL 16MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571228045","SUP","HCPCS C1713","","3571228045  -  SCREW BN 6.5MM 45MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228050","SUP","HCPCS C1713","","3571228050  -  SCREW BN 6.5MM 50MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228055","SUP","HCPCS C1713","","3571228055  -  SCREW BN 6.5MM 55MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228060","SUP","HCPCS C1713","","3571228060  -  SCREW BN 6.5MM 60MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228065","SUP","HCPCS C1713","","3571228065  -  SCREW BN 6.5MM 65MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228070","SUP","HCPCS C1713","","3571228070  -  SCREW BN 6.5MM 70MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228075","SUP","HCPCS C1713","","3571228075  -  SCREW BN 6.5MM 75MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228080","SUP","HCPCS C1713","","3571228080  -  SCREW BN 6.5MM 80MM STRL 32MM THRD CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571228085","SUP","HCPCS C1713","","3571228085  -  SCREW BN 6.5MM 85MM STRL 32MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571228090","SUP","HCPCS C1713","","3571228090  -  SCREW BN 6.5MM 90MM STRL 32MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571228095","SUP","HCPCS C1713","","3571228095  -  SCREW BN 6.5MM 95MM STRL 32MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571228100","SUP","HCPCS C1713","","3571228100  -  SCREW BN 6.5MM 100MM STRL 32MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571228105","SUP","HCPCS C1713","","3571228105  -  SCREW BN 6.5MM 105MM STRL 32MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571228110","SUP","HCPCS C1713","","3571228110  -  SCREW BN 6.5MM 110MM STRL 32MM THRD CANC","BOTH IP/OP","$124.95 ","$92.46 ","$0.00 ","$124.95 ","$56.23 ","$0.00 ","$26.04 ","$0.00 ","$0.00 ","$21.88 ","$124.95 ","$0.00 ","$62.48 ","$98.96 ","$99.96 ","$0.00 ","$19.55 ","$0.00 ","$19.89 ","$0.00 "
"3571229025","SUP","HCPCS C1713","","3571229025  -  SCREW BN FT 6.5MM 25MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229030","SUP","HCPCS C1713","","3571229030  -  SCREW BN FT 6.5MM 30MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229035","SUP","HCPCS C1713","","3571229035  -  SCREW BN FT 6.5MM 35MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229040","SUP","HCPCS C1713","","3571229040  -  SCREW BN FT 6.5MM 40MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229045","SUP","HCPCS C1713","","3571229045  -  SCREW BN FT 6.5MM 45MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229050","SUP","HCPCS C1713","","3571229050  -  SCREW BN FT 6.5MM 50MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229055","SUP","HCPCS C1713","","3571229055  -  SCREW BN FT 6.5MM 55MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"3571229060","SUP","HCPCS C1713","","3571229060  -  SCREW BN FT 6.5MM 60MM STRL CANC","BOTH IP/OP","$113.40 ","$83.92 ","$0.00 ","$113.40 ","$51.03 ","$0.00 ","$23.64 ","$0.00 ","$0.00 ","$19.86 ","$113.40 ","$0.00 ","$56.70 ","$89.81 ","$90.72 ","$0.00 ","$17.75 ","$0.00 ","$18.05 ","$0.00 "
"4823714020","SUP","HCPCS C1713","","4823714020  -  SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714025","SUP","HCPCS C1713","","4823714025  -  SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714030","SUP","HCPCS C1713","","4823714030  -  SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714035","SUP","HCPCS C1713","","4823714035  -  SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714040","SUP","HCPCS C1713","","4823714040  -  SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714045","SUP","HCPCS C1713","","4823714045  -  SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714520","SUP","HCPCS C1713","","4823714520  -  SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714525","SUP","HCPCS C1713","","4823714525  -  SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714530","SUP","HCPCS C1713","","4823714530  -  SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714535","SUP","HCPCS C1713","","4823714535  -  SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714540","SUP","HCPCS C1713","","4823714540  -  SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823714545","SUP","HCPCS C1713","","4823714545  -  SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715020","SUP","HCPCS C1713","","4823715020  -  SCREW BONE 5MM 20MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715025","SUP","HCPCS C1713","","4823715025  -  SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715030","SUP","HCPCS C1713","","4823715030  -  SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715035","SUP","HCPCS C1713","","4823715035  -  SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715040","SUP","HCPCS C1713","","4823715040  -  SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715045","SUP","HCPCS C1713","","4823715045  -  SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715050","SUP","HCPCS C1713","","4823715050  -  SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715525","SUP","HCPCS C1713","","4823715525  -  SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715530","SUP","HCPCS C1713","","4823715530  -  SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715535","SUP","HCPCS C1713","","4823715535  -  SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715540","SUP","HCPCS C1713","","4823715540  -  SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715545","SUP","HCPCS C1713","","4823715545  -  SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715550","SUP","HCPCS C1713","","4823715550  -  SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823715555","SUP","HCPCS C1713","","4823715555  -  SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716525","SUP","HCPCS C1713","","4823716525  -  SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716530","SUP","HCPCS C1713","","4823716530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716535","SUP","HCPCS C1713","","4823716535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716540","SUP","HCPCS C1713","","4823716540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716545","SUP","HCPCS C1713","","4823716545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716550","SUP","HCPCS C1713","","4823716550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716555","SUP","HCPCS C1713","","4823716555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716560","SUP","HCPCS C1713","","4823716560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716565","SUP","HCPCS C1713","","4823716565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716570","SUP","HCPCS C1713","","4823716570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716580","SUP","HCPCS C1713","","4823716580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823716590","SUP","HCPCS C1713","","4823716590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717525","SUP","HCPCS C1713","","4823717525  -  SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717530","SUP","HCPCS C1713","","4823717530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717535","SUP","HCPCS C1713","","4823717535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX MEDIAL BIASED","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717540","SUP","HCPCS C1713","","4823717540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX MEDIAL BIASED","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717545","SUP","HCPCS C1713","","4823717545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717550","SUP","HCPCS C1713","","4823717550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717555","SUP","HCPCS C1713","","4823717555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717560","SUP","HCPCS C1713","","4823717560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717565","SUP","HCPCS C1713","","4823717565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717570","SUP","HCPCS C1713","","4823717570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717580","SUP","HCPCS C1713","","4823717580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823717590","SUP","HCPCS C1713","","4823717590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823718500","SUP","HCPCS C1713","","4823718500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823718560","SUP","HCPCS C1713","","4823718560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823718570","SUP","HCPCS C1713","","4823718570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823718580","SUP","HCPCS C1713","","4823718580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823718590","SUP","HCPCS C1713","","4823718590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823719500","SUP","HCPCS C1713","","4823719500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823719560","SUP","HCPCS C1713","","4823719560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823719570","SUP","HCPCS C1713","","4823719570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823719580","SUP","HCPCS C1713","","4823719580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"4823719590","SUP","HCPCS C1713","","4823719590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"5100060001","SUP","Custom 27203010","","5100060001  -  BIT DRILL LARGE 14MM PERFORATOR HUDSON END SHARP CRANIAL","BOTH IP/OP","$474.38 ","$351.04 ","$0.00 ","$474.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.38 ","$0.00 ","$237.19 ","$375.71 ","$379.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5130020060","SUP","Custom 27203010","","5130020060  -  BURR SURG LONG 6MM 7.9MM DRUM FLUTED","BOTH IP/OP","$244.38 ","$180.84 ","$0.00 ","$244.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$244.38 ","$0.00 ","$122.19 ","$193.55 ","$195.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5130130250","SUP","Custom 27203010","","5130130250  -  BURR SURG LONG .8MM 25.4MM DISK DIAMOND STERILE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5220030575","SUP","Custom 27203010","","5220030575  -  BURR SURG MEDIUM 7.5MM PRECISION ACORN","BOTH IP/OP","$488.75 ","$361.68 ","$0.00 ","$488.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$488.75 ","$0.00 ","$244.38 ","$387.09 ","$391.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5450800303","SUP","Custom 27203010","","5450800303  -  TIP ASPIRAT 25KHZ SUPERLONG SPETZLER MICRO CLAW BONE","BOTH IP/OP","$10,675.00 ","$7,899.50 ","$0.00 ","$10,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,675.00 ","$0.00 ","$5,337.50 ","$8,454.60 ","$8,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5450800306","SUP","Custom 27203010","","5450800306  -  TIP ASPIRAT 25KHZ UNIVERSAL ULTRASONIC LARGE DIAMETER SOFT","BOTH IP/OP","$8,455.28 ","$6,256.91 ","$0.00 ","$8,455.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,455.28 ","$0.00 ","$4,227.64 ","$6,696.58 ","$6,764.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5450800307","SUP","Custom 27203010","","5450800307  -  TIP ASPIRAT 25KHZ UNIVERSAL STR SONOPET DISPOSABLE","BOTH IP/OP","$7,750.00 ","$5,735.00 ","$0.00 ","$7,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,750.00 ","$0.00 ","$3,875.00 ","$6,138.00 ","$6,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5450800308","SUP","Custom 27203010","","5450800308  -  TIP ASP LG DIA STRG 4.6IN STRL LF SONOPET SFT TIS DISP","BOTH IP/OP","$1,649.99 ","$1,220.99 ","$0.00 ","$1,649.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,649.99 ","$0.00 ","$825.00 ","$1,306.79 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820009060","SUP","Custom 27203010","","5820009060  -  BURR SURG ROUND 6MM PRECISION","BOTH IP/OP","$505.88 ","$374.35 ","$0.00 ","$505.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.88 ","$0.00 ","$252.94 ","$400.66 ","$404.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820009075","SUP","Custom 27203010","","5820009075  -  BURR SURG ROUND 7.5MM RIM GLIDE PRECISION","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820010010","SUP","Custom 27203010","","5820010010  -  BURR SURG ROUND FLUTE 1MM TPS ELITE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820010125","SUP","Custom 27203010","","5820010125  -  BURR SURG 2.5MM ROUND SOFT TOUCH FLUTED ELITE STERILE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820010130","SUP","Custom 27203010","","5820010130  -  BURR SURG 3MM TPS ELT OSTN RND FLUT SFTCH 5 NTCH","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820010150","SUP","Custom 27203010","","5820010150  -  BURR SURG ROUND FLUTE 5MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820010160","SUP","Custom 27203010","","5820010160  -  BURR SURG ROUND FLUTE 6MM SOFT TOUCH ROUND FLUTED AGGRESSIVE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820010170","SUP","Custom 27203010","","5820010170  -  BURR SURG 7MM ROUND SOFT TOUCH ELITE STERILE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820012010","SUP","Custom 27203010","","5820012010  -  BURR SURG ROUND 1MM ROUND HEAD CUTTING TPS ELITE DIAMOND","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820012020","SUP","Custom 27203010","","5820012020  -  BURR SRG RND 2MM TPS ELT DMD","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820012025","SUP","Custom 27203010","","5820012025  -  BURR SURG ROUND 2.5MM TPS ELITE DIAMOND","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820012050","SUP","Custom 27203010","","5820012050  -  BURR SURG DIAMOND 5MM 5 STEP NOTCH NUMBER SAFETY MARK CUT","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820012060","SUP","Custom 27203010","","5820012060  -  BURR SURG ROUND 6MM LATEX FREE ELITE DIAMOND STERILE","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820013060","SUP","Custom 27203010","","5820013060  -  BURR SRG RND CRS DMD 6MM STRL LF TPS ELT DISP","BOTH IP/OP","$777.50 ","$575.35 ","$0.00 ","$777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$777.50 ","$0.00 ","$388.75 ","$615.78 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820070011","SUP","Custom 27203010","","5820070011  -  BURR SURG STR 1.1MM 6MM ROUTER STR","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820107020","SUP","Custom 27203010","","5820107020  -  BURR SRG 2MM 3.1MM STRL LF MTCH HD SFTCH DISP NEURO","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820107120","SUP","Custom 27203010","","5820107120  -  BURR SURG 2MM 3.1MM DIAMOND NEURO ELITE STERILE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820107125","SUP","Custom 27203010","","5820107125  -  BIT DRILL 2.5MM 3.4MM NEURO ELITE STERILE","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820107130","SUP","Custom 27203010","","5820107130  -  BURR SURG 3MM 3.8MM DIAMOND NEURO ELITE STERILE","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6279409577","SUP","Custom 27203010","","6279409577  -  DRESSING BURN ADH SIL NYL 15X10IN BBRN","BOTH IP/OP","$248.05 ","$183.56 ","$0.00 ","$248.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$248.05 ","$0.00 ","$124.03 ","$196.46 ","$198.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6770200005","SUP","Custom 27203010","","6770200005  -  FORCEPS BP .5MM 8IN SPTZLR MLS 2 IRR DISP","BOTH IP/OP","$1,209.99 ","$895.39 ","$0.00 ","$1,209.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,209.99 ","$0.00 ","$605.00 ","$958.31 ","$967.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6770200010","SUP","Custom 27203010","","6770200010  -  FORCEPS BP 1MM 8IN SPTZLR MLS 2 IRR DISP","BOTH IP/OP","$1,135.50 ","$840.27 ","$0.00 ","$1,135.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,135.50 ","$0.00 ","$567.75 ","$899.32 ","$908.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065149527","SUP","Custom 27203010","","8065149527  -  CANNULA OPHTHALMIC SHORT 23GA SOFT TIP STERILE DISPOSABLE","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065149530","SUP","Custom 27203010","","8065149530  -  CANNULA OPTH SHRT 25GA .8MM STRL GRSHBR SFTP DISP","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065740632","SUP","Custom 27203010","","8065740632  -  PACK PHACO 30D RND .9MM STRL LF ABS LGC MXV DISP","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065741080","SUP","Custom 27203010","","8065741080  -  PACK PHACO US BSC","BOTH IP/OP","$113.55 ","$84.03 ","$0.00 ","$113.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.55 ","$0.00 ","$56.78 ","$89.93 ","$90.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065741089","SUP","Custom 27203010","","8065741089  -  PACK PHACO 30D 1.1MM STRL INFNT RND US ABS TIP FLD MGMT SYS","BOTH IP/OP","$342.50 ","$253.45 ","$0.00 ","$342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.50 ","$0.00 ","$171.25 ","$271.26 ","$274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065750157","SUP","Custom 27203010","","8065750157  -  PACK VITRECTOMY INFINITI ANTERIOR STERILE DISPOSABLE","BOTH IP/OP","$434.00 ","$321.16 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065750159","SUP","Custom 27203010","","8065750159  -  KIT PHACOEMULSIFICATION .9MM SMALL PART MICROSMOOTH STERILE","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751176","SUP","Custom 27203010","","8065751176  -  TIP 30 DEG OZIL 12 PHACO","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751177","SUP","Custom 27203010","","8065751177  -  TIP PHACOEMULSIFICATION 45D .9MM 12MM MINIFLARE OZIL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751576","SUP","Custom 27203010","","8065751576  -  PROBE LASER 23GA ILLUMINATED PIK RFID","BOTH IP/OP","$3,570.90 ","$2,642.47 ","$0.00 ","$3,570.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,570.90 ","$0.00 ","$1,785.45 ","$2,828.15 ","$2,856.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751577","SUP","Custom 27203010","","8065751577  -  ILLUMINATOR OPHTHALMIC 25GA RADIO FREQUENCY IDENTIFICATION","BOTH IP/OP","$3,731.10 ","$2,761.01 ","$0.00 ","$3,731.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,731.10 ","$0.00 ","$1,865.55 ","$2,955.03 ","$2,984.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751592","SUP","Custom 27203010","","8065751592  -  PROBE LASER 78D 23GA 2IN ILLUMINATION CURVE TIP LARGE","BOTH IP/OP","$2,760.00 ","$2,042.40 ","$0.00 ","$2,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,760.00 ","$0.00 ","$1,380.00 ","$2,185.92 ","$2,208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751593","SUP","Custom 27203010","","8065751593  -  PROBE LASER 78D 25GA 2IN ILLUMINATION CURVE TIP LARGE","BOTH IP/OP","$540.75 ","$400.16 ","$0.00 ","$3,244.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,244.50 ","$0.00 ","$1,622.25 ","$2,569.64 ","$2,595.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065751922","SUP","Custom 27203010","","8065751922  -  SET OPHTHALMIC INTREPID IRRIGATION ASPIRATION BIMANUAL HANDP","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065752201","SUP","Custom 27203010","","8065752201  -  PACK PHACO 45D .9MM STRL ABS TIP FLD MGMT SYS ULT SLV DISP","BOTH IP/OP","$1,663.65 ","$1,231.10 ","$0.00 ","$1,663.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,663.65 ","$0.00 ","$831.83 ","$1,317.61 ","$1,330.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065754003","SUP","HCPCS L8610","","8065754003  -  SHUNT GLCM STRL LF CYPASS","BOTH IP/OP","$3,962.50 ","$2,932.25 ","$0.00 ","$3,962.50 ","$1,783.13 ","$0.00 ","$825.88 ","$0.00 ","$0.00 ","$693.80 ","$3,962.50 ","$0.00 ","$1,981.25 ","$3,138.30 ","$3,170.00 ","$0.00 ","$620.13 ","$0.00 ","$630.83 ","$0.00 "
"8065817001","SUP","Custom 27203010","","8065817001  -  TIP IRR/ASPIRAT .3MM ULFL 1 PC STR","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065900163","SUP","Custom 27203010","","8065900163  -  KIT ACCESSORY PROCEDURAL LIQUID PERFLUORON","BOTH IP/OP","$3,049.88 ","$2,256.91 ","$0.00 ","$3,049.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,049.88 ","$0.00 ","$1,524.94 ","$2,415.50 ","$2,439.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065992747","SUP","Custom 27203010","","8065992747  -  KNIFE OPHTHALMIC ANGLE 2 BEVEL 2.75MM SLIT SATIN FINISH FULL","BOTH IP/OP","$46.13 ","$34.14 ","$0.00 ","$46.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.13 ","$0.00 ","$23.06 ","$36.53 ","$36.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8065997001","SUP","HCPCS C1713","","8065997001  -  SCREW BN 2.3MM STRL IKNF II STNCRSNT TIP STRG DISP","BOTH IP/OP","$41.58 ","$30.77 ","$0.00 ","$41.58 ","$18.71 ","$0.00 ","$8.67 ","$0.00 ","$0.00 ","$7.28 ","$41.58 ","$0.00 ","$20.79 ","$32.93 ","$33.26 ","$0.00 ","$6.51 ","$0.00 ","$6.62 ","$0.00 "
"8450107030","SUP","Custom 27203010","","8450107030  -  BURR SURG 3MM MATCH HEAD LATEX FREE","BOTH IP/OP","$466.35 ","$345.10 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$466.35 ","$0.00 ","$233.18 ","$369.35 ","$373.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8815668007","SUP","Custom 27203010","","TRAY CATH 19.5CM 11.5FR MHRKR DUAL STRG NDLHLDR GZE SPNG SH","BOTH IP/OP","$314.88 ","$233.01 ","$0.00 ","$314.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.88 ","$0.00 ","$157.44 ","$249.38 ","$251.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8831663001","SUP","Custom 27203010","","TRAY CATH MHRKR INS 2LUM STRG EXTN","BOTH IP/OP","$314.88 ","$233.01 ","$0.00 ","$314.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.88 ","$0.00 ","$157.44 ","$249.38 ","$251.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8884200026","SUP","Custom 27203010","","PROBE THRMTR ORAL CORD ADLT FLC 2000 REUSE","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$114.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.85 ","$0.00 ","$57.43 ","$90.96 ","$91.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8886808300","SUP","Custom 27803010","","8886808300  -  RING ANSTM 2MM 25MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT","BOTH IP/OP","$829.45 ","$613.79 ","$0.00 ","$829.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$829.45 ","$0.00 ","$414.72 ","$656.92 ","$663.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8886808800","SUP","Custom 27803010","","8886808800  -  RING ANSTM 2MM 28MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT","BOTH IP/OP","$777.13 ","$575.08 ","$0.00 ","$777.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$777.13 ","$0.00 ","$388.56 ","$615.49 ","$621.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8887654088","SUP","HCPCS C1729","","CATHETER URTH DOV 8FR 2W FOLEY BLN SIL-EL 3ML LTX PED","BOTH IP/OP","$10.33 ","$7.64 ","$0.00 ","$10.33 ","$5.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.81 ","$10.33 ","$0.00 ","$5.16 ","$8.18 ","$8.26 ","$0.00 ","$1.62 ","$0.00 ","$1.64 ","$0.00 "
"8887654104","SUP","HCPCS C1729","","CATHETER URTH DOV 10FR FOLEY 2W SIL-EL 3ML LTX PED","BOTH IP/OP","$10.33 ","$7.64 ","$0.00 ","$10.33 ","$5.61 ","$0.00 ","$2.15 ","$0.00 ","$0.00 ","$1.81 ","$10.33 ","$0.00 ","$5.16 ","$8.18 ","$8.26 ","$0.00 ","$1.62 ","$0.00 ","$1.64 ","$0.00 "
"8888119362","SUP","HCPCS C1750","","8888119362  -  CATHETER HMDIAL 14.5FR 19CM MH MXD SPORTPACK 2 LUM KINK RST","BOTH IP/OP","$210.68 ","$155.90 ","$0.00 ","$210.68 ","$94.81 ","$0.00 ","$43.91 ","$0.00 ","$0.00 ","$36.89 ","$210.68 ","$0.00 ","$105.34 ","$166.86 ","$168.54 ","$0.00 ","$32.97 ","$0.00 ","$33.54 ","$0.00 "
"8888160333","SUP","Custom 27203010","","8888160333  -  CATHETER UMB 3.5FR 15IN .15ML CLR STRL LF ARG 1 LUM LL HUB","BOTH IP/OP","$86.01 ","$63.65 ","$0.00 ","$33.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$27.99 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8888160341","SUP","Custom 27203010","","8888160341  -  CAP TUBE 13MM BLU EZTPR DBL FLNG SL THB TAB PE","BOTH IP/OP","$34.28 ","$25.37 ","$0.00 ","$33.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.84 ","$0.00 ","$16.92 ","$27.99 ","$27.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8888160358","SUP","HCPCS C1729","","CATHETER UMB 3.5FR 15IN FLXB SMTH LUER LOCK LOCK HUB WNG ARG","BOTH IP/OP","$33.33 ","$24.66 ","$0.00 ","$33.33 ","$18.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.83 ","$33.33 ","$0.00 ","$16.66 ","$26.40 ","$26.66 ","$0.00 ","$5.22 ","$0.00 ","$5.31 ","$0.00 "
"8888160408","SUP","Custom 27203010","","8888160408  -  TRAY CATH LF A NEOS 2 TIER DSGN FN TIP FCP INS DEPH FR MGLN","BOTH IP/OP","$126.90 ","$93.91 ","$0.00 ","$126.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.66 ","$0.00 ","$63.33 ","$104.77 ","$101.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8888265108","SUP","Custom 27203010","","TUBE NG 36IN 10FR SNTNL LN A SLM SM SIL","BOTH IP/OP","$28.47 ","$21.07 ","$0.00 ","$28.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.73 ","$0.00 ","$14.36 ","$22.75 ","$22.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8888492120","SUP","HCPCS C1758","","8888492120  -  CATH URTH DV RBNL 20FR 16IN PVC STRL LATEX FREE","BOTH IP/OP","$1.38 ","$1.02 ","$0.00 ","$1.38 ","$0.75 ","$0.00 ","$0.29 ","$0.00 ","$0.00 ","$0.24 ","$1.38 ","$0.00 ","$0.69 ","$1.09 ","$1.11 ","$0.00 ","$0.22 ","$0.00 ","$0.22 ","$0.00 "
"8888560805","SUP","HCPCS C1729","","8888560805  -  CATHETER DRAIN 8FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK","BOTH IP/OP","$34.18 ","$25.29 ","$0.00 ","$36.23 ","$19.67 ","$0.00 ","$7.12 ","$0.00 ","$0.00 ","$6.34 ","$36.23 ","$0.00 ","$18.11 ","$28.69 ","$28.98 ","$0.00 ","$5.67 ","$0.00 ","$5.77 ","$0.00 "
"8888561019","SUP","HCPCS C1729","","8888561019  -  CATHETER DRN 10FR 3.3MM 9IN TROC STRG SFT PVC THOR","BOTH IP/OP","$34.18 ","$25.29 ","$0.00 ","$34.69 ","$18.84 ","$0.00 ","$7.12 ","$0.00 ","$0.00 ","$6.34 ","$34.69 ","$0.00 ","$17.34 ","$28.69 ","$27.75 ","$0.00 ","$5.67 ","$0.00 ","$5.52 ","$0.00 "
"8888561027","SUP","HCPCS C1729","","8888561027  -  CATHETER DRAIN 12FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK","BOTH IP/OP","$34.18 ","$25.29 ","$0.00 ","$34.69 ","$18.84 ","$0.00 ","$7.12 ","$0.00 ","$0.00 ","$6.34 ","$34.69 ","$0.00 ","$17.34 ","$28.69 ","$27.75 ","$0.00 ","$5.67 ","$0.00 ","$5.52 ","$0.00 "
"8888570515","SUP","HCPCS C1725","","CATHETER DRAIN 16FR 5.3MM 20IN 4 SD EYE STRG THOR THRMSNS","BOTH IP/OP","$12.63 ","$9.35 ","$0.00 ","$12.63 ","$6.86 ","$0.00 ","$2.63 ","$0.00 ","$0.00 ","$2.21 ","$12.63 ","$0.00 ","$6.31 ","$10.00 ","$10.10 ","$0.00 ","$1.98 ","$0.00 ","$2.01 ","$0.00 "
"8888570523","SUP","HCPCS C1725","","CATHETER DRAIN 20FR 6.7MM 20IN EYLT RT ANG THRMSNS DEPTH","BOTH IP/OP","$12.63 ","$9.35 ","$0.00 ","$12.63 ","$6.86 ","$0.00 ","$2.63 ","$0.00 ","$0.00 ","$2.21 ","$12.63 ","$0.00 ","$6.31 ","$10.00 ","$10.10 ","$0.00 ","$1.98 ","$0.00 ","$2.01 ","$0.00 "
"8888570572","SUP","HCPCS C1729","","8888570572  -  CATH DRAIN 40FR 20IN ARG 6 EYLT STR THRMSNS DEPTH MARK","BOTH IP/OP","$12.83 ","$9.49 ","$0.00 ","$123.13 ","$66.86 ","$0.00 ","$2.67 ","$0.00 ","$0.00 ","$21.56 ","$123.13 ","$0.00 ","$61.56 ","$97.52 ","$98.50 ","$0.00 ","$19.27 ","$0.00 ","$19.60 ","$0.00 "
"8888571042","SUP","HCPCS C1729","","8888571042  -  CATHETER DRAIN RIGHT ANG 28FR 20IN 6 SIDE EYE RADIOPQ TUBE","BOTH IP/OP","$185.03 ","$136.92 ","$0.00 ","$187.80 ","$101.98 ","$0.00 ","$38.56 ","$0.00 ","$0.00 ","$34.34 ","$187.80 ","$0.00 ","$93.90 ","$155.33 ","$150.24 ","$0.00 ","$30.69 ","$0.00 ","$29.90 ","$0.00 "
"8888577700","SUP","Custom 27803010","","8888577700  -  SHUNT CARDIO 11IN 8FR ARG CRTD 4 TUBE KIT PLSH TPR END","BOTH IP/OP","$86.51 ","$64.02 ","$0.00 ","$86.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.51 ","$0.00 ","$43.25 ","$68.52 ","$69.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8888577775","SUP","HCPCS C1877","","8888577775  -  SHUNT CARDIO 6IN 8-14FR ARG CRTD 4 TUBE KT PLSH TPR END","BOTH IP/OP","$137.21 ","$101.54 ","$0.00 ","$87.91 ","$39.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.39 ","$87.91 ","$0.00 ","$43.95 ","$69.62 ","$70.33 ","$0.00 ","$13.76 ","$0.00 ","$13.99 ","$0.00 "
"8888590018","SUP","HCPCS C1725","","CATHETER DRAIN 20IN 18FR FERG VNTRC PVC 4 EYLT VNT STRL LF","BOTH IP/OP","$123.61 ","$91.47 ","$0.00 ","$74.68 ","$40.55 ","$0.00 ","$25.76 ","$0.00 ","$0.00 ","$13.07 ","$74.68 ","$0.00 ","$37.34 ","$59.15 ","$59.74 ","$0.00 ","$11.69 ","$0.00 ","$11.89 ","$0.00 "
"54410004020","SUP","HCPCS C1713","","54410004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004025","SUP","HCPCS C1713","","54410004025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004030","SUP","HCPCS C1713","","54410004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004035","SUP","HCPCS C1713","","54410004035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004040","SUP","HCPCS C1713","","54410004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004045","SUP","HCPCS C1713","","54410004045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004520","SUP","HCPCS C1713","","54410004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004525","SUP","HCPCS C1713","","54410004525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004530","SUP","HCPCS C1713","","54410004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004535","SUP","HCPCS C1713","","54410004535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004540","SUP","HCPCS C1713","","54410004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410004545","SUP","HCPCS C1713","","54410004545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005020","SUP","HCPCS C1713","","54410005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005025","SUP","HCPCS C1713","","54410005025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005030","SUP","HCPCS C1713","","54410005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005035","SUP","HCPCS C1713","","54410005035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005040","SUP","HCPCS C1713","","54410005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005045","SUP","HCPCS C1713","","54410005045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005050","SUP","HCPCS C1713","","54410005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005520","SUP","HCPCS C1713","","54410005520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005525","SUP","HCPCS C1713","","54410005525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005530","SUP","HCPCS C1713","","54410005530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005535","SUP","HCPCS C1713","","54410005535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005540","SUP","HCPCS C1713","","54410005540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005545","SUP","HCPCS C1713","","54410005545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005550","SUP","HCPCS C1713","","54410005550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410005555","SUP","HCPCS C1713","","54410005555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006025","SUP","HCPCS C1713","","54410006025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006030","SUP","HCPCS C1713","","54410006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006035","SUP","HCPCS C1713","","54410006035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006040","SUP","HCPCS C1713","","54410006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006045","SUP","HCPCS C1713","","54410006045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006050","SUP","HCPCS C1713","","54410006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006055","SUP","HCPCS C1713","","54410006055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006520","SUP","HCPCS C1713","","54410006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006525","SUP","HCPCS C1713","","54410006525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006530","SUP","HCPCS C1713","","54410006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006535","SUP","HCPCS C1713","","54410006535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006540","SUP","HCPCS C1713","","54410006540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006545","SUP","HCPCS C1713","","54410006545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006550","SUP","HCPCS C1713","","54410006550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006555","SUP","HCPCS C1713","","54410006555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410006560","SUP","HCPCS C1713","","54410006560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007530","SUP","HCPCS C1713","","54410007530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007535","SUP","HCPCS C1713","","54410007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007540","SUP","HCPCS C1713","","54410007540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007545","SUP","HCPCS C1713","","54410007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007550","SUP","HCPCS C1713","","54410007550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007555","SUP","HCPCS C1713","","54410007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54410007560","SUP","HCPCS C1713","","54410007560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"54740044520","SUP","HCPCS C1713","","54740044520  -  SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044525","SUP","HCPCS C1713","","54740044525  -  SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044530","SUP","HCPCS C1713","","54740044530  -  SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044535","SUP","HCPCS C1713","","54740044535  -  SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044540","SUP","HCPCS C1713","","54740044540  -  SCREW BONE 4.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044545","SUP","HCPCS C1713","","54740044545  -  SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044550","SUP","HCPCS C1713","","54740044550  -  SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044555","SUP","HCPCS C1713","","54740044555  -  SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740044560","SUP","HCPCS C1713","","54740044560  -  SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045520","SUP","HCPCS C1713","","54740045520  -  SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045525","SUP","HCPCS C1713","","54740045525  -  SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045530","SUP","HCPCS C1713","","54740045530  -  SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045535","SUP","HCPCS C1713","","54740045535  -  SCREW BONE 5.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045540","SUP","HCPCS C1713","","54740045540  -  SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045545","SUP","HCPCS C1713","","54740045545  -  SCREW BONE 5.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045550","SUP","HCPCS C1713","","54740045550  -  SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045555","SUP","HCPCS C1713","","54740045555  -  SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740045560","SUP","HCPCS C1713","","54740045560  -  SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046520","SUP","HCPCS C1713","","54740046520  -  SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046525","SUP","HCPCS C1713","","54740046525  -  SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046530","SUP","HCPCS C1713","","54740046530  -  SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046535","SUP","HCPCS C1713","","54740046535  -  SCREW BONE 6.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046540","SUP","HCPCS C1713","","54740046540  -  SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046545","SUP","HCPCS C1713","","54740046545  -  SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046550","SUP","HCPCS C1713","","54740046550  -  SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046555","SUP","HCPCS C1713","","54740046555  -  SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740046560","SUP","HCPCS C1713","","54740046560  -  SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047520","SUP","HCPCS C1713","","54740047520  -  SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047525","SUP","HCPCS C1713","","54740047525  -  SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047530","SUP","HCPCS C1713","","54740047530  -  SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047535","SUP","HCPCS C1713","","54740047535  -  SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047540","SUP","HCPCS C1713","","54740047540  -  SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047545","SUP","HCPCS C1713","","54740047545  -  SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047550","SUP","HCPCS C1713","","54740047550  -  SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047555","SUP","HCPCS C1713","","54740047555  -  SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740047560","SUP","HCPCS C1713","","54740047560  -  SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54740105515","SUP","HCPCS C1713","","54740105515  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105520","SUP","HCPCS C1713","","54740105520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105525","SUP","HCPCS C1713","","54740105525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105530","SUP","HCPCS C1713","","54740105530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105535","SUP","HCPCS C1713","","54740105535  -  SCREW BN 5.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105540","SUP","HCPCS C1713","","54740105540  -  SCREW BN 5.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105545","SUP","HCPCS C1713","","54740105545  -  SCREW BN 5.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105550","SUP","HCPCS C1713","","54740105550  -  SCREW BN 5.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105555","SUP","HCPCS C1713","","54740105555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105560","SUP","HCPCS C1713","","54740105560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105565","SUP","HCPCS C1713","","54740105565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105570","SUP","HCPCS C1713","","54740105570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105575","SUP","HCPCS C1713","","54740105575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740105580","SUP","HCPCS C1713","","54740105580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106015","SUP","HCPCS C1713","","54740106015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106020","SUP","HCPCS C1713","","54740106020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106025","SUP","HCPCS C1713","","54740106025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106030","SUP","HCPCS C1713","","54740106030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106035","SUP","HCPCS C1713","","54740106035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106040","SUP","HCPCS C1713","","54740106040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106045","SUP","HCPCS C1713","","54740106045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106050","SUP","HCPCS C1713","","54740106050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106055","SUP","HCPCS C1713","","54740106055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106060","SUP","HCPCS C1713","","54740106060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106065","SUP","HCPCS C1713","","54740106065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106070","SUP","HCPCS C1713","","54740106070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106075","SUP","HCPCS C1713","","54740106075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106080","SUP","HCPCS C1713","","54740106080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106515","SUP","HCPCS C1713","","54740106515  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106520","SUP","HCPCS C1713","","54740106520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106525","SUP","HCPCS C1713","","54740106525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106530","SUP","HCPCS C1713","","54740106530  -  SCREW BN 6.5MM 30MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106535","SUP","HCPCS C1713","","54740106535  -  SCREW BN 6.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106540","SUP","HCPCS C1713","","54740106540  -  SCREW BN 6.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106545","SUP","HCPCS C1713","","54740106545  -  SCREW BN 6.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106550","SUP","HCPCS C1713","","54740106550  -  SCREW BN 6.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106555","SUP","HCPCS C1713","","54740106555  -  SCREW BN 6.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106560","SUP","HCPCS C1713","","54740106560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106565","SUP","HCPCS C1713","","54740106565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106570","SUP","HCPCS C1713","","54740106570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106575","SUP","HCPCS C1713","","54740106575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740106580","SUP","HCPCS C1713","","54740106580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107020","SUP","HCPCS C1713","","54740107020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107025","SUP","HCPCS C1713","","54740107025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107030","SUP","HCPCS C1713","","54740107030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107035","SUP","HCPCS C1713","","54740107035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107040","SUP","HCPCS C1713","","54740107040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107045","SUP","HCPCS C1713","","54740107045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107050","SUP","HCPCS C1713","","54740107050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107055","SUP","HCPCS C1713","","54740107055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107060","SUP","HCPCS C1713","","54740107060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107065","SUP","HCPCS C1713","","54740107065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107070","SUP","HCPCS C1713","","54740107070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107075","SUP","HCPCS C1713","","54740107075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107080","SUP","HCPCS C1713","","54740107080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107500","SUP","HCPCS C1713","","54740107500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107511","SUP","HCPCS C1713","","54740107511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107520","SUP","HCPCS C1713","","54740107520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107525","SUP","HCPCS C1713","","54740107525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107530","SUP","HCPCS C1713","","54740107530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107535","SUP","HCPCS C1713","","54740107535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107540","SUP","HCPCS C1713","","54740107540  -  SCREW BN 7.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107545","SUP","HCPCS C1713","","54740107545  -  SCREW BN 7.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107550","SUP","HCPCS C1713","","54740107550  -  SCREW BN 7.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107555","SUP","HCPCS C1713","","54740107555  -  SCREW BN 7.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107560","SUP","HCPCS C1713","","54740107560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107565","SUP","HCPCS C1713","","54740107565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107570","SUP","HCPCS C1713","","54740107570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107575","SUP","HCPCS C1713","","54740107575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107580","SUP","HCPCS C1713","","54740107580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107585","SUP","HCPCS C1713","","54740107585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107590","SUP","HCPCS C1713","","54740107590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740107595","SUP","HCPCS C1713","","54740107595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108000","SUP","HCPCS C1713","","54740108000  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108011","SUP","HCPCS C1713","","54740108011  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108020","SUP","HCPCS C1713","","54740108020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108025","SUP","HCPCS C1713","","54740108025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108030","SUP","HCPCS C1713","","54740108030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108035","SUP","HCPCS C1713","","54740108035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108040","SUP","HCPCS C1713","","54740108040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108045","SUP","HCPCS C1713","","54740108045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108050","SUP","HCPCS C1713","","54740108050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108055","SUP","HCPCS C1713","","54740108055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108060","SUP","HCPCS C1713","","54740108060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108065","SUP","HCPCS C1713","","54740108065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108070","SUP","HCPCS C1713","","54740108070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108075","SUP","HCPCS C1713","","54740108075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108080","SUP","HCPCS C1713","","54740108080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108085","SUP","HCPCS C1713","","54740108085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108090","SUP","HCPCS C1713","","54740108090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108095","SUP","HCPCS C1713","","54740108095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108500","SUP","HCPCS C1713","","54740108500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108511","SUP","HCPCS C1713","","54740108511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108520","SUP","HCPCS C1713","","54740108520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108525","SUP","HCPCS C1713","","54740108525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108530","SUP","HCPCS C1713","","54740108530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108535","SUP","HCPCS C1713","","54740108535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108540","SUP","HCPCS C1713","","54740108540  -  SCREW BN 8.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108545","SUP","HCPCS C1713","","54740108545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108550","SUP","HCPCS C1713","","54740108550  -  SCREW BN 8.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108555","SUP","HCPCS C1713","","54740108555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108560","SUP","HCPCS C1713","","54740108560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108565","SUP","HCPCS C1713","","54740108565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108570","SUP","HCPCS C1713","","54740108570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108575","SUP","HCPCS C1713","","54740108575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108580","SUP","HCPCS C1713","","54740108580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108585","SUP","HCPCS C1713","","54740108585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108590","SUP","HCPCS C1713","","54740108590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740108595","SUP","HCPCS C1713","","54740108595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109500","SUP","HCPCS C1713","","54740109500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109511","SUP","HCPCS C1713","","54740109511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109520","SUP","HCPCS C1713","","54740109520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109525","SUP","HCPCS C1713","","54740109525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109530","SUP","HCPCS C1713","","54740109530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109535","SUP","HCPCS C1713","","54740109535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109540","SUP","HCPCS C1713","","54740109540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109545","SUP","HCPCS C1713","","54740109545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109550","SUP","HCPCS C1713","","54740109550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109555","SUP","HCPCS C1713","","54740109555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109560","SUP","HCPCS C1713","","54740109560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109565","SUP","HCPCS C1713","","54740109565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109570","SUP","HCPCS C1713","","54740109570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109575","SUP","HCPCS C1713","","54740109575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109580","SUP","HCPCS C1713","","54740109580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109585","SUP","HCPCS C1713","","54740109585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109590","SUP","HCPCS C1713","","54740109590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54740109595","SUP","HCPCS C1713","","54740109595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54750014525","SUP","HCPCS C1713","","54750014525  -  SCREW BONE 4.5MM 25MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750014530","SUP","HCPCS C1713","","54750014530  -  SCREW BONE 4.5MM 30MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750014535","SUP","HCPCS C1713","","54750014535  -  SCREW BONE 4.5MM 35MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750014540","SUP","HCPCS C1713","","54750014540  -  SCREW BONE 4.5MM 40MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750014545","SUP","HCPCS C1713","","54750014545  -  SCREW BONE 4.5MM 45MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750014550","SUP","HCPCS C1713","","54750014550  -  SCREW BONE 4.5MM 50MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750014555","SUP","HCPCS C1713","","54750014555  -  SCREW BONE 4.5MM 55MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015525","SUP","HCPCS C1713","","54750015525  -  SCREW BONE 5.5MM 25MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015530","SUP","HCPCS C1713","","54750015530  -  SCREW BONE 5.5MM 30MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015535","SUP","HCPCS C1713","","54750015535  -  SCREW BONE 5.5MM 35MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015540","SUP","HCPCS C1713","","54750015540  -  SCREW BONE 5.5MM 40MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015545","SUP","HCPCS C1713","","54750015545  -  SCREW BONE 5.5MM 45MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015550","SUP","HCPCS C1713","","54750015550  -  SCREW BONE 5.5MM 50MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015555","SUP","HCPCS C1713","","54750015555  -  SCREW BONE 5.5MM 55MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015560","SUP","HCPCS C1713","","54750015560  -  SCREW BONE 5.5MM 60MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750015565","SUP","HCPCS C1713","","54750015565  -  SCREW BONE 5.5MM 65MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016530","SUP","HCPCS C1713","","54750016530  -  SCREW BONE 6.5MM 30MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016535","SUP","HCPCS C1713","","54750016535  -  SCREW BONE 6.5MM 35MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016540","SUP","HCPCS C1713","","54750016540  -  SCREW BONE 6.5MM 40MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016545","SUP","HCPCS C1713","","54750016545  -  SCREW BONE 6.5MM 45MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016550","SUP","HCPCS C1713","","54750016550  -  SCREW BONE 6.5MM 50MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016555","SUP","HCPCS C1713","","54750016555  -  SCREW BONE 6.5MM 55MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016560","SUP","HCPCS C1713","","54750016560  -  SCREW BONE 6.5MM 60MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750016565","SUP","HCPCS C1713","","54750016565  -  SCREW BONE 6.5MM 65MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017530","SUP","HCPCS C1713","","54750017530  -  SCREW BONE 7.5MM 30MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017535","SUP","HCPCS C1713","","54750017535  -  SCREW BONE 7.5MM 35MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017540","SUP","HCPCS C1713","","54750017540  -  SCREW BONE 7.5MM 40MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017545","SUP","HCPCS C1713","","54750017545  -  SCREW BONE 7.5MM 45MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017550","SUP","HCPCS C1713","","54750017550  -  SCREW BONE 7.5MM 50MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017555","SUP","HCPCS C1713","","54750017555  -  SCREW BONE 7.5MM 55MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017560","SUP","HCPCS C1713","","54750017560  -  SCREW BONE 7.5MM 60MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017565","SUP","HCPCS C1713","","54750017565  -  SCREW BONE 7.5MM 65MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750017570","SUP","HCPCS C1713","","54750017570  -  SCREW BONE 7.5MM 70MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018530","SUP","HCPCS C1713","","54750018530  -  SCREW BONE 8.5MM 30MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018535","SUP","HCPCS C1713","","54750018535  -  SCREW BONE 8.5MM 35MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018540","SUP","HCPCS C1713","","54750018540  -  SCREW BONE 8.5MM 40MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018545","SUP","HCPCS C1713","","54750018545  -  SCREW BONE 8.5MM 45MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018550","SUP","HCPCS C1713","","54750018550  -  SCREW BONE 8.5MM 50MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018555","SUP","HCPCS C1713","","54750018555  -  SCREW BONE 8.5MM 55MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018560","SUP","HCPCS C1713","","54750018560  -  SCREW BONE 8.5MM 60MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018565","SUP","HCPCS C1713","","54750018565  -  SCREW BONE 8.5MM 65MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54750018570","SUP","HCPCS C1713","","54750018570  -  SCREW BONE 8.5MM 70MM CD HZN SPN MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840004020","SUP","HCPCS C1713","","54840004020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004025","SUP","HCPCS C1713","","54840004025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004030","SUP","HCPCS C1713","","54840004030  -  SCREW BN 4MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004035","SUP","HCPCS C1713","","54840004035  -  SCREW BN 4MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004040","SUP","HCPCS C1713","","54840004040  -  SCREW BN 4MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004045","SUP","HCPCS C1713","","54840004045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004050","SUP","HCPCS C1713","","54840004050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004055","SUP","HCPCS C1713","","54840004055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004520","SUP","HCPCS C1713","","54840004520  -  SCREW BN 4.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004525","SUP","HCPCS C1713","","54840004525  -  SCREW BN 4.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004530","SUP","HCPCS C1713","","54840004530  -  SCREW BN 4.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004535","SUP","HCPCS C1713","","54840004535  -  SCREW BN 4.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004540","SUP","HCPCS C1713","","54840004540  -  SCREW BN 4.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004545","SUP","HCPCS C1713","","54840004545  -  SCREW BN 4.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004550","SUP","HCPCS C1713","","54840004550  -  SCREW BN 4.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840004555","SUP","HCPCS C1713","","54840004555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005020","SUP","HCPCS C1713","","54840005020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005025","SUP","HCPCS C1713","","54840005025  -  SCREW BN 5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005030","SUP","HCPCS C1713","","54840005030  -  SCREW BN 5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005035","SUP","HCPCS C1713","","54840005035  -  SCREW BN 5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005040","SUP","HCPCS C1713","","54840005040  -  SCREW BN 5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005045","SUP","HCPCS C1713","","54840005045  -  SCREW BN 5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005050","SUP","HCPCS C1713","","54840005050  -  SCREW BN 5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005055","SUP","HCPCS C1713","","54840005055  -  SCREW BN 5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005520","SUP","HCPCS C1713","","54840005520  -  SCREW BN 5.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005525","SUP","HCPCS C1713","","54840005525  -  SCREW BN 5.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005530","SUP","HCPCS C1713","","54840005530  -  SCREW BN 5.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005535","SUP","HCPCS C1713","","54840005535  -  SCREW BN 5.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005540","SUP","HCPCS C1713","","54840005540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005545","SUP","HCPCS C1713","","54840005545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005550","SUP","HCPCS C1713","","54840005550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005555","SUP","HCPCS C1713","","54840005555  -  SCREW BN 5.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840005560","SUP","HCPCS C1713","","54840005560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006020","SUP","HCPCS C1713","","54840006020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006025","SUP","HCPCS C1713","","54840006025  -  SCREW BN 6MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006030","SUP","HCPCS C1713","","54840006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006035","SUP","HCPCS C1713","","54840006035  -  SCREW BN 6MM 35MM NS CD HZN MA COCR SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006040","SUP","HCPCS C1713","","54840006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006045","SUP","HCPCS C1713","","54840006045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006050","SUP","HCPCS C1713","","54840006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006055","SUP","HCPCS C1713","","54840006055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006060","SUP","HCPCS C1713","","54840006060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006520","SUP","HCPCS C1713","","54840006520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006525","SUP","HCPCS C1713","","54840006525  -  SCREW BN 6.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006530","SUP","HCPCS C1713","","54840006530  -  SCREW BN 6.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006535","SUP","HCPCS C1713","","54840006535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006540","SUP","HCPCS C1713","","54840006540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006545","SUP","HCPCS C1713","","54840006545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006550","SUP","HCPCS C1713","","54840006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006555","SUP","HCPCS C1713","","54840006555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006560","SUP","HCPCS C1713","","54840006560  -  SCREW BN 6.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006565","SUP","HCPCS C1713","","54840006565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006570","SUP","HCPCS C1713","","54840006570  -  SCREW BN 6.5MM 70MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840006580","SUP","HCPCS C1713","","54840006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007500","SUP","HCPCS C1713","","54840007500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007520","SUP","HCPCS C1713","","54840007520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007525","SUP","HCPCS C1713","","54840007525  -  SCREW BN 7.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007530","SUP","HCPCS C1713","","54840007530  -  SCREW BN 7.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007535","SUP","HCPCS C1713","","54840007535  -  SCREW BN 7.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007540","SUP","HCPCS C1713","","54840007540  -  SCREW BN 7.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007545","SUP","HCPCS C1713","","54840007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007550","SUP","HCPCS C1713","","54840007550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007555","SUP","HCPCS C1713","","54840007555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007560","SUP","HCPCS C1713","","54840007560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007565","SUP","HCPCS C1713","","54840007565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007570","SUP","HCPCS C1713","","54840007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007580","SUP","HCPCS C1713","","54840007580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840007590","SUP","HCPCS C1713","","54840007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008500","SUP","HCPCS C1713","","54840008500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008525","SUP","HCPCS C1713","","54840008525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008530","SUP","HCPCS C1713","","54840008530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008535","SUP","HCPCS C1713","","54840008535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008540","SUP","HCPCS C1713","","54840008540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008545","SUP","HCPCS C1713","","54840008545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008550","SUP","HCPCS C1713","","54840008550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008555","SUP","HCPCS C1713","","54840008555  -  SCREW BN 8.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008560","SUP","HCPCS C1713","","54840008560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008565","SUP","HCPCS C1713","","54840008565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008570","SUP","HCPCS C1713","","54840008570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008580","SUP","HCPCS C1713","","54840008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840008590","SUP","HCPCS C1713","","54840008590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009500","SUP","HCPCS C1713","","54840009500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009525","SUP","HCPCS C1713","","54840009525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009530","SUP","HCPCS C1713","","54840009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009535","SUP","HCPCS C1713","","54840009535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009540","SUP","HCPCS C1713","","54840009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009545","SUP","HCPCS C1713","","54840009545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009550","SUP","HCPCS C1713","","54840009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009555","SUP","HCPCS C1713","","54840009555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009560","SUP","HCPCS C1713","","54840009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009565","SUP","HCPCS C1713","","54840009565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009570","SUP","HCPCS C1713","","54840009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009580","SUP","HCPCS C1713","","54840009580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840009590","SUP","HCPCS C1713","","54840009590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54840014530","SUP","HCPCS C1713","","54840014530  -  SCREW BONE 30MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840014535","SUP","HCPCS C1713","","54840014535  -  SCREW BONE 35MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840014540","SUP","HCPCS C1713","","54840014540  -  SCREW BONE 40MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840014545","SUP","HCPCS C1713","","54840014545  -  SCREW BONE 4.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840015535","SUP","HCPCS C1713","","54840015535  -  SCREW BONE 5.5MM 35MM MULTIAX CANN COCR SPN","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840015540","SUP","HCPCS C1713","","54840015540  -  SCREW BONE 5.5MM 40MM MULTIAX CANN SOLERA CD HORIZON COCR","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840015545","SUP","HCPCS C1713","","54840015545  -  SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA CD HORIZON","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840015550","SUP","HCPCS C1713","","54840015550  -  SCREW BONE 5.5MM 50MM MULTIAX CANN SOLERA CD HORIZON","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840016535","SUP","HCPCS C1713","","54840016535  -  SCREW BONE LP 6.5MM 35MM 2 LEAD MULTIAX CANN COLOR CODED","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840016540","SUP","HCPCS C1713","","54840016540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840016545","SUP","HCPCS C1713","","54840016545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840016550","SUP","HCPCS C1713","","54840016550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840016555","SUP","HCPCS C1713","","54840016555  -  SCREW BONE 6.5MM 55MM SOLERA CD HZN OSTEOGRIP TI","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840017540","SUP","HCPCS C1713","","54840017540  -  SCREW BONE 7.5MM 40MM MULTIAX CANN COCR SPN","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840017545","SUP","HCPCS C1713","","54840017545  -  SCREW BONE 7.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR","BOTH IP/OP","$6,492.50 ","$4,804.45 ","$0.00 ","$6,492.50 ","$2,921.63 ","$0.00 ","$1,353.20 ","$0.00 ","$0.00 ","$1,136.78 ","$6,492.50 ","$0.00 ","$3,246.25 ","$5,142.06 ","$5,194.00 ","$0.00 ","$1,016.08 ","$0.00 ","$1,033.61 ","$0.00 "
"54840044520","SUP","HCPCS C1713","","54840044520  -  SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044525","SUP","HCPCS C1713","","54840044525  -  SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044530","SUP","HCPCS C1713","","54840044530  -  SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044535","SUP","HCPCS C1713","","54840044535  -  SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044540","SUP","HCPCS C1713","","54840044540  -  SCREW BONE 4.5MM 40MM MULTIAX ATS SPN 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044545","SUP","HCPCS C1713","","54840044545  -  SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044550","SUP","HCPCS C1713","","54840044550  -  SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044555","SUP","HCPCS C1713","","54840044555  -  SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840044560","SUP","HCPCS C1713","","54840044560  -  SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045520","SUP","HCPCS C1713","","54840045520  -  SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045525","SUP","HCPCS C1713","","54840045525  -  SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045530","SUP","HCPCS C1713","","54840045530  -  SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045535","SUP","HCPCS C1713","","54840045535  -  SCREW BONE 5.5MM 35MM MULTIAX ATS SPN 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045540","SUP","HCPCS C1713","","54840045540  -  SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045545","SUP","HCPCS C1713","","54840045545  -  SCREW BONE 5.5MM 45MM MULTIAX ATS SPN 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045550","SUP","HCPCS C1713","","54840045550  -  SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045555","SUP","HCPCS C1713","","54840045555  -  SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840045560","SUP","HCPCS C1713","","54840045560  -  SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046520","SUP","HCPCS C1713","","54840046520  -  SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046525","SUP","HCPCS C1713","","54840046525  -  SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046530","SUP","HCPCS C1713","","54840046530  -  SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046535","SUP","HCPCS C1713","","54840046535  -  SCREW BONE 6.5MM 35MM MULTIAX ATS SPN 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046540","SUP","HCPCS C1713","","54840046540  -  SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046545","SUP","HCPCS C1713","","54840046545  -  SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046550","SUP","HCPCS C1713","","54840046550  -  SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046555","SUP","HCPCS C1713","","54840046555  -  SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840046560","SUP","HCPCS C1713","","54840046560  -  SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047520","SUP","HCPCS C1713","","54840047520  -  SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047525","SUP","HCPCS C1713","","54840047525  -  SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047530","SUP","HCPCS C1713","","54840047530  -  SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047535","SUP","HCPCS C1713","","54840047535  -  SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047540","SUP","HCPCS C1713","","54840047540  -  SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047545","SUP","HCPCS C1713","","54840047545  -  SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047550","SUP","HCPCS C1713","","54840047550  -  SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047555","SUP","HCPCS C1713","","54840047555  -  SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54840047560","SUP","HCPCS C1713","","54840047560  -  SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014530","SUP","HCPCS C1713","","54850014530  -  SCREW BONE 4.5MM 30MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014535","SUP","HCPCS C1713","","54850014535  -  SCREW BN 4.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014540","SUP","HCPCS C1713","","54850014540  -  SCREW BN 4.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014545","SUP","HCPCS C1713","","54850014545  -  SCREW BN 4.5MM 45MM MAS CNN XTN TAB SPNE 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014550","SUP","HCPCS C1713","","54850014550  -  SCREW BONE 4.5MM 50MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014555","SUP","HCPCS C1713","","54850014555  -  SCREW BONE 4.5MM 55MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014560","SUP","HCPCS C1713","","54850014560  -  SCREW BONE 4.5MM 60MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014565","SUP","HCPCS C1713","","54850014565  -  SCREW BONE 4.5MM 65MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014570","SUP","HCPCS C1713","","54850014570  -  SCREW BONE 4.5MM 70MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850014575","SUP","HCPCS C1713","","54850014575  -  SCREW BONE 4.5MM 75MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015530","SUP","HCPCS C1713","","54850015530  -  SCREW BONE 5.5MM 30MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015535","SUP","HCPCS C1713","","54850015535  -  SCREW BN 5.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015540","SUP","HCPCS C1713","","54850015540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015545","SUP","HCPCS C1713","","54850015545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015550","SUP","HCPCS C1713","","54850015550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015555","SUP","HCPCS C1713","","54850015555  -  SCREW BONE 5.5MM 55MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015560","SUP","HCPCS C1713","","54850015560  -  SCREW BONE 5.5MM 60MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015565","SUP","HCPCS C1713","","54850015565  -  SCREW BONE 5.5MM 65MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015570","SUP","HCPCS C1713","","54850015570  -  SCREW BONE 5.5MM 70MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850015575","SUP","HCPCS C1713","","54850015575  -  SCREW BONE 5.5MM 75MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016530","SUP","HCPCS C1713","","54850016530  -  SCREW BONE 6.5MM 30MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016535","SUP","HCPCS C1713","","54850016535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016540","SUP","HCPCS C1713","","54850016540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016545","SUP","HCPCS C1713","","54850016545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016550","SUP","HCPCS C1713","","54850016550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016555","SUP","HCPCS C1713","","54850016555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016560","SUP","HCPCS C1713","","54850016560  -  SCREW BONE 6.5MM 60MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850016565","SUP","HCPCS C1713","","54850016565  -  SCREW BONE 6.5MM 65MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017530","SUP","HCPCS C1713","","54850017530  -  SCREW BONE 7.5MM 30MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017535","SUP","HCPCS C1713","","54850017535  -  SCREW BONE 7.5MM 35MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017540","SUP","HCPCS C1713","","54850017540  -  SCREW BN 7.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017545","SUP","HCPCS C1713","","54850017545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017550","SUP","HCPCS C1713","","54850017550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017555","SUP","HCPCS C1713","","54850017555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017560","SUP","HCPCS C1713","","54850017560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA CNN XTD TAB SPNE","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850017565","SUP","HCPCS C1713","","54850017565  -  SCREW BONE 7.5MM 65MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018530","SUP","HCPCS C1713","","54850018530  -  SCREW BONE 8.5MM 30MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018535","SUP","HCPCS C1713","","54850018535  -  SCREW BONE 8.5MM 35MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018540","SUP","HCPCS C1713","","54850018540  -  SCREW BONE 8.5MM 40MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018545","SUP","HCPCS C1713","","54850018545  -  SCREW BONE 8.5MM 45MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018550","SUP","HCPCS C1713","","54850018550  -  SCREW BONE 8.5MM 50MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018555","SUP","HCPCS C1713","","54850018555  -  SCREW BONE 8.5MM 55MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018560","SUP","HCPCS C1713","","54850018560  -  SCREW BONE 8.5MM 60MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018565","SUP","HCPCS C1713","","54850018565  -  SCREW BONE 8.5MM 65MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018570","SUP","HCPCS C1713","","54850018570  -  SCREW BONE 8.5MM 70MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018575","SUP","HCPCS C1713","","54850018575  -  SCREW BONE 8.5MM 75MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54850018580","SUP","HCPCS C1713","","54850018580  -  SCREW BONE 8.5MM 80MM CD HZN SPNL MULTIAX CANN XTD","BOTH IP/OP","$3,895.50 ","$2,882.67 ","$0.00 ","$3,895.50 ","$1,752.98 ","$0.00 ","$811.92 ","$0.00 ","$0.00 ","$682.07 ","$3,895.50 ","$0.00 ","$1,947.75 ","$3,085.24 ","$3,116.40 ","$0.00 ","$609.65 ","$0.00 ","$620.16 ","$0.00 "
"54890004525","SUP","HCPCS C1713","","54890004525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890004530","SUP","HCPCS C1713","","54890004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890004535","SUP","HCPCS C1713","","54890004535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890004540","SUP","HCPCS C1713","","54890004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890005525","SUP","HCPCS C1713","","54890005525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890005530","SUP","HCPCS C1713","","54890005530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890005535","SUP","HCPCS C1713","","54890005535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890005540","SUP","HCPCS C1713","","54890005540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890005545","SUP","HCPCS C1713","","54890005545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890005550","SUP","HCPCS C1713","","54890005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890006530","SUP","HCPCS C1713","","54890006530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890006535","SUP","HCPCS C1713","","54890006535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890006540","SUP","HCPCS C1713","","54890006540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890006545","SUP","HCPCS C1713","","54890006545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890006550","SUP","HCPCS C1713","","54890006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA RDC COCR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890006555","SUP","HCPCS C1713","","54890006555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890007535","SUP","HCPCS C1713","","54890007535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890007540","SUP","HCPCS C1713","","54890007540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890007545","SUP","HCPCS C1713","","54890007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA RDC COCR SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890007550","SUP","HCPCS C1713","","54890007550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"54890007555","SUP","HCPCS C1713","","54890007555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55410004020","SUP","HCPCS C1713","","55410004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004025","SUP","HCPCS C1713","","55410004025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004030","SUP","HCPCS C1713","","55410004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004035","SUP","HCPCS C1713","","55410004035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004040","SUP","HCPCS C1713","","55410004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004045","SUP","HCPCS C1713","","55410004045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004520","SUP","HCPCS C1713","","55410004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004525","SUP","HCPCS C1713","","55410004525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004530","SUP","HCPCS C1713","","55410004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004535","SUP","HCPCS C1713","","55410004535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004540","SUP","HCPCS C1713","","55410004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410004545","SUP","HCPCS C1713","","55410004545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005020","SUP","HCPCS C1713","","55410005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005025","SUP","HCPCS C1713","","55410005025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005030","SUP","HCPCS C1713","","55410005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005035","SUP","HCPCS C1713","","55410005035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005040","SUP","HCPCS C1713","","55410005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005045","SUP","HCPCS C1713","","55410005045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005520","SUP","HCPCS C1713","","55410005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005525","SUP","HCPCS C1713","","55410005525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005530","SUP","HCPCS C1713","","55410005530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005535","SUP","HCPCS C1713","","55410005535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005540","SUP","HCPCS C1713","","55410005540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005545","SUP","HCPCS C1713","","55410005545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410005550","SUP","HCPCS C1713","","55410005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006025","SUP","HCPCS C1713","","55410006025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006030","SUP","HCPCS C1713","","55410006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006035","SUP","HCPCS C1713","","55410006035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006040","SUP","HCPCS C1713","","55410006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006045","SUP","HCPCS C1713","","55410006045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006050","SUP","HCPCS C1713","","55410006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006055","SUP","HCPCS C1713","","55410006055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006520","SUP","HCPCS C1713","","55410006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006525","SUP","HCPCS C1713","","55410006525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006530","SUP","HCPCS C1713","","55410006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006535","SUP","HCPCS C1713","","55410006535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006540","SUP","HCPCS C1713","","55410006540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006545","SUP","HCPCS C1713","","55410006545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006550","SUP","HCPCS C1713","","55410006550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410006555","SUP","HCPCS C1713","","55410006555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410007535","SUP","HCPCS C1713","","55410007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410007540","SUP","HCPCS C1713","","55410007540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410007545","SUP","HCPCS C1713","","55410007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410007550","SUP","HCPCS C1713","","55410007550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55410007555","SUP","HCPCS C1713","","55410007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,990.50 ","$1,472.97 ","$0.00 ","$1,990.50 ","$895.73 ","$0.00 ","$414.87 ","$0.00 ","$0.00 ","$348.52 ","$1,990.50 ","$0.00 ","$995.25 ","$1,576.48 ","$1,592.40 ","$0.00 ","$311.51 ","$0.00 ","$316.89 ","$0.00 "
"55740105535","SUP","HCPCS C1713","","55740105535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740105540","SUP","HCPCS C1713","","55740105540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740105545","SUP","HCPCS C1713","","55740105545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740105550","SUP","HCPCS C1713","","55740105550  -  SCREW BN 5.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740106540","SUP","HCPCS C1713","","55740106540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740106545","SUP","HCPCS C1713","","55740106545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740106550","SUP","HCPCS C1713","","55740106550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740106555","SUP","HCPCS C1713","","55740106555  -  SCREW BN 6.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740107540","SUP","HCPCS C1713","","55740107540  -  SCREW BN 7.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740107545","SUP","HCPCS C1713","","55740107545  -  SCREW BN 7.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740107550","SUP","HCPCS C1713","","55740107550  -  SCREW BN 7.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740107555","SUP","HCPCS C1713","","55740107555  -  SCREW BN 7.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740108535","SUP","HCPCS C1713","","55740108535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740108540","SUP","HCPCS C1713","","55740108540  -  SCREW BN 8.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740108545","SUP","HCPCS C1713","","55740108545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55740108550","SUP","HCPCS C1713","","55740108550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004025","SUP","HCPCS C1713","","55811004025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004030","SUP","HCPCS C1713","","55811004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004035","SUP","HCPCS C1713","","55811004035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004040","SUP","HCPCS C1713","","55811004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004045","SUP","HCPCS C1713","","55811004045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004520","SUP","HCPCS C1713","","55811004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004525","SUP","HCPCS C1713","","55811004525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004530","SUP","HCPCS C1713","","55811004530  -  SCREW BN 4.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004535","SUP","HCPCS C1713","","55811004535  -  SCREW BN 4.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004540","SUP","HCPCS C1713","","55811004540  -  SCREW BN 4.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811004545","SUP","HCPCS C1713","","55811004545  -  SCREW BN 4.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005020","SUP","HCPCS C1713","","55811005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005025","SUP","HCPCS C1713","","55811005025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005030","SUP","HCPCS C1713","","55811005030  -  SCREW BN 5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005035","SUP","HCPCS C1713","","55811005035  -  SCREW BN 5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005040","SUP","HCPCS C1713","","55811005040  -  SCREW BN 5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005045","SUP","HCPCS C1713","","55811005045  -  SCREW BN 5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005050","SUP","HCPCS C1713","","55811005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005520","SUP","HCPCS C1713","","55811005520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005525","SUP","HCPCS C1713","","55811005525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005530","SUP","HCPCS C1713","","55811005530  -  SCREW BN 5.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005535","SUP","HCPCS C1713","","55811005535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005540","SUP","HCPCS C1713","","55811005540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005545","SUP","HCPCS C1713","","55811005545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005550","SUP","HCPCS C1713","","55811005550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811005555","SUP","HCPCS C1713","","55811005555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006030","SUP","HCPCS C1713","","55811006030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006035","SUP","HCPCS C1713","","55811006035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006040","SUP","HCPCS C1713","","55811006040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006045","SUP","HCPCS C1713","","55811006045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006050","SUP","HCPCS C1713","","55811006050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006525","SUP","HCPCS C1713","","55811006525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006530","SUP","HCPCS C1713","","55811006530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006535","SUP","HCPCS C1713","","55811006535  -  SCREW BN 6.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006540","SUP","HCPCS C1713","","55811006540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006545","SUP","HCPCS C1713","","55811006545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006550","SUP","HCPCS C1713","","55811006550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006555","SUP","HCPCS C1713","","55811006555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811006560","SUP","HCPCS C1713","","55811006560  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811007535","SUP","HCPCS C1713","","55811007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811007540","SUP","HCPCS C1713","","55811007540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811007545","SUP","HCPCS C1713","","55811007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811007550","SUP","HCPCS C1713","","55811007550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811007555","SUP","HCPCS C1713","","55811007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811008540","SUP","HCPCS C1713","","55811008540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811008545","SUP","HCPCS C1713","","55811008545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55811008550","SUP","HCPCS C1713","","55811008550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840001540","SUP","HCPCS C1713","","55840001540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840001545","SUP","HCPCS C1713","","55840001545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840001550","SUP","HCPCS C1713","","55840001550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840001555","SUP","HCPCS C1713","","55840001555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004020","SUP","HCPCS C1713","","55840004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004025","SUP","HCPCS C1713","","55840004025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004030","SUP","HCPCS C1713","","55840004030  -  SCREW BN 4MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004035","SUP","HCPCS C1713","","55840004035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004040","SUP","HCPCS C1713","","55840004040  -  SCREW BN 4MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004045","SUP","HCPCS C1713","","55840004045  -  SCREW BN 4MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004050","SUP","HCPCS C1713","","55840004050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004055","SUP","HCPCS C1713","","55840004055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004520","SUP","HCPCS C1713","","55840004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004525","SUP","HCPCS C1713","","55840004525  -  SCREW BN 4.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004530","SUP","HCPCS C1713","","55840004530  -  SCREW BN 4.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004535","SUP","HCPCS C1713","","55840004535  -  SCREW BN 4.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004540","SUP","HCPCS C1713","","55840004540  -  SCREW BN 4.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004545","SUP","HCPCS C1713","","55840004545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004550","SUP","HCPCS C1713","","55840004550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840004555","SUP","HCPCS C1713","","55840004555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005020","SUP","HCPCS C1713","","55840005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005025","SUP","HCPCS C1713","","55840005025  -  SCREW BN 5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005030","SUP","HCPCS C1713","","55840005030  -  SCREW BN 5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005035","SUP","HCPCS C1713","","55840005035  -  SCREW BN 5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005040","SUP","HCPCS C1713","","55840005040  -  SCREW BN 5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005045","SUP","HCPCS C1713","","55840005045  -  SCREW BN 5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005050","SUP","HCPCS C1713","","55840005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005055","SUP","HCPCS C1713","","55840005055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005520","SUP","HCPCS C1713","","55840005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005525","SUP","HCPCS C1713","","55840005525  -  SCREW BN 5.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005530","SUP","HCPCS C1713","","55840005530  -  SCREW BN 5.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005535","SUP","HCPCS C1713","","55840005535  -  SCREW BN 5.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005540","SUP","HCPCS C1713","","55840005540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005545","SUP","HCPCS C1713","","55840005545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005550","SUP","HCPCS C1713","","55840005550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005555","SUP","HCPCS C1713","","55840005555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840005560","SUP","HCPCS C1713","","55840005560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006020","SUP","HCPCS C1713","","55840006020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006025","SUP","HCPCS C1713","","55840006025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006030","SUP","HCPCS C1713","","55840006030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006035","SUP","HCPCS C1713","","55840006035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006040","SUP","HCPCS C1713","","55840006040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006045","SUP","HCPCS C1713","","55840006045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006050","SUP","HCPCS C1713","","55840006050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006055","SUP","HCPCS C1713","","55840006055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006060","SUP","HCPCS C1713","","55840006060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006500","SUP","HCPCS C1713","","55840006500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006520","SUP","HCPCS C1713","","55840006520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006525","SUP","HCPCS C1713","","55840006525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006530","SUP","HCPCS C1713","","55840006530  -  SCREW BN 6.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006535","SUP","HCPCS C1713","","55840006535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006540","SUP","HCPCS C1713","","55840006540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006545","SUP","HCPCS C1713","","55840006545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006550","SUP","HCPCS C1713","","55840006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006555","SUP","HCPCS C1713","","55840006555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006560","SUP","HCPCS C1713","","55840006560  -  SCREW BN 6.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006565","SUP","HCPCS C1713","","55840006565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006570","SUP","HCPCS C1713","","55840006570  -  SCREW BN 6.5MM 70MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006580","SUP","HCPCS C1713","","55840006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840006590","SUP","HCPCS C1713","","55840006590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007500","SUP","HCPCS C1713","","55840007500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007525","SUP","HCPCS C1713","","55840007525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007530","SUP","HCPCS C1713","","55840007530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007535","SUP","HCPCS C1713","","55840007535  -  SCREW BN 7.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007540","SUP","HCPCS C1713","","55840007540  -  SCREW BN 7.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"55840007545","SUP","HCPCS C1713","","55840007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007550","SUP","HCPCS C1713","","55840007550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007555","SUP","HCPCS C1713","","55840007555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007560","SUP","HCPCS C1713","","55840007560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007565","SUP","HCPCS C1713","","55840007565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007570","SUP","HCPCS C1713","","55840007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007580","SUP","HCPCS C1713","","55840007580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840007590","SUP","HCPCS C1713","","55840007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008500","SUP","HCPCS C1713","","55840008500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008525","SUP","HCPCS C1713","","55840008525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008530","SUP","HCPCS C1713","","55840008530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008535","SUP","HCPCS C1713","","55840008535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008540","SUP","HCPCS C1713","","55840008540  -  SCREW BN 8.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008545","SUP","HCPCS C1713","","55840008545  -  SCREW BN 8.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008550","SUP","HCPCS C1713","","55840008550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008555","SUP","HCPCS C1713","","55840008555  -  SCREW BN 8.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008560","SUP","HCPCS C1713","","55840008560  -  SCREW BN 8.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008565","SUP","HCPCS C1713","","55840008565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008570","SUP","HCPCS C1713","","55840008570  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008580","SUP","HCPCS C1713","","55840008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840008590","SUP","HCPCS C1713","","55840008590  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009500","SUP","HCPCS C1713","","55840009500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009525","SUP","HCPCS C1713","","55840009525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009530","SUP","HCPCS C1713","","55840009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009535","SUP","HCPCS C1713","","55840009535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009540","SUP","HCPCS C1713","","55840009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009545","SUP","HCPCS C1713","","55840009545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009550","SUP","HCPCS C1713","","55840009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009555","SUP","HCPCS C1713","","55840009555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009560","SUP","HCPCS C1713","","55840009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009565","SUP","HCPCS C1713","","55840009565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009570","SUP","HCPCS C1713","","55840009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009580","SUP","HCPCS C1713","","55840009580  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840009590","SUP","HCPCS C1713","","55840009590  -  SCREW BN 9.5MM 90MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55840015545","SUP","HCPCS C1713","","55840015545  -  SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA COCR SPN 5.5/6MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"55840015550","SUP","HCPCS C1713","","55840015550  -  SCREW BONE 5.5MM 50MM CANN MULTIAX COCR SPN 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"55840016550","SUP","HCPCS C1713","","55840016550  -  SCREW BONE 6.5MM 50MM MULTIAX CANN SOLERA COCR SPN 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"55840016555","SUP","HCPCS C1713","","55840016555  -  SCREW BONE 6.5MM 55MM MULTIAX CANN COCR SPN 5.5 ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"55890004015","SUP","HCPCS C1713","","55890004015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004020","SUP","HCPCS C1713","","55890004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004025","SUP","HCPCS C1713","","55890004025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004030","SUP","HCPCS C1713","","55890004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004035","SUP","HCPCS C1713","","55890004035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004040","SUP","HCPCS C1713","","55890004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004045","SUP","HCPCS C1713","","55890004045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004050","SUP","HCPCS C1713","","55890004050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004055","SUP","HCPCS C1713","","55890004055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004060","SUP","HCPCS C1713","","55890004060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004065","SUP","HCPCS C1713","","55890004065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004070","SUP","HCPCS C1713","","55890004070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004075","SUP","HCPCS C1713","","55890004075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004080","SUP","HCPCS C1713","","55890004080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004515","SUP","HCPCS C1713","","55890004515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004520","SUP","HCPCS C1713","","55890004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004525","SUP","HCPCS C1713","","55890004525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004530","SUP","HCPCS C1713","","55890004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004535","SUP","HCPCS C1713","","55890004535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004540","SUP","HCPCS C1713","","55890004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004545","SUP","HCPCS C1713","","55890004545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004550","SUP","HCPCS C1713","","55890004550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004555","SUP","HCPCS C1713","","55890004555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004560","SUP","HCPCS C1713","","55890004560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004565","SUP","HCPCS C1713","","55890004565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004570","SUP","HCPCS C1713","","55890004570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004575","SUP","HCPCS C1713","","55890004575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890004580","SUP","HCPCS C1713","","55890004580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005015","SUP","HCPCS C1713","","55890005015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005020","SUP","HCPCS C1713","","55890005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005025","SUP","HCPCS C1713","","55890005025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005030","SUP","HCPCS C1713","","55890005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005035","SUP","HCPCS C1713","","55890005035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005040","SUP","HCPCS C1713","","55890005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005045","SUP","HCPCS C1713","","55890005045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005050","SUP","HCPCS C1713","","55890005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005055","SUP","HCPCS C1713","","55890005055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005060","SUP","HCPCS C1713","","55890005060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005065","SUP","HCPCS C1713","","55890005065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005070","SUP","HCPCS C1713","","55890005070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005075","SUP","HCPCS C1713","","55890005075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005080","SUP","HCPCS C1713","","55890005080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005085","SUP","HCPCS C1713","","55890005085  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005090","SUP","HCPCS C1713","","55890005090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005515","SUP","HCPCS C1713","","55890005515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005520","SUP","HCPCS C1713","","55890005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005525","SUP","HCPCS C1713","","55890005525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005530","SUP","HCPCS C1713","","55890005530  -  SCREW BN 5.5MM 30MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005535","SUP","HCPCS C1713","","55890005535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005540","SUP","HCPCS C1713","","55890005540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005545","SUP","HCPCS C1713","","55890005545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005550","SUP","HCPCS C1713","","55890005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005555","SUP","HCPCS C1713","","55890005555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005560","SUP","HCPCS C1713","","55890005560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005565","SUP","HCPCS C1713","","55890005565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005570","SUP","HCPCS C1713","","55890005570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005575","SUP","HCPCS C1713","","55890005575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890005580","SUP","HCPCS C1713","","55890005580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006015","SUP","HCPCS C1713","","55890006015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006020","SUP","HCPCS C1713","","55890006020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006025","SUP","HCPCS C1713","","55890006025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006030","SUP","HCPCS C1713","","55890006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006035","SUP","HCPCS C1713","","55890006035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006040","SUP","HCPCS C1713","","55890006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006045","SUP","HCPCS C1713","","55890006045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006050","SUP","HCPCS C1713","","55890006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006055","SUP","HCPCS C1713","","55890006055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006060","SUP","HCPCS C1713","","55890006060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006065","SUP","HCPCS C1713","","55890006065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006070","SUP","HCPCS C1713","","55890006070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006075","SUP","HCPCS C1713","","55890006075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006080","SUP","HCPCS C1713","","55890006080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006515","SUP","HCPCS C1713","","55890006515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006520","SUP","HCPCS C1713","","55890006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006525","SUP","HCPCS C1713","","55890006525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006530","SUP","HCPCS C1713","","55890006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006535","SUP","HCPCS C1713","","55890006535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006540","SUP","HCPCS C1713","","55890006540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006545","SUP","HCPCS C1713","","55890006545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006550","SUP","HCPCS C1713","","55890006550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006555","SUP","HCPCS C1713","","55890006555  -  SCREW BN 6.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006560","SUP","HCPCS C1713","","55890006560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006565","SUP","HCPCS C1713","","55890006565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006570","SUP","HCPCS C1713","","55890006570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006575","SUP","HCPCS C1713","","55890006575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890006580","SUP","HCPCS C1713","","55890006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007015","SUP","HCPCS C1713","","55890007015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007020","SUP","HCPCS C1713","","55890007020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007025","SUP","HCPCS C1713","","55890007025  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007030","SUP","HCPCS C1713","","55890007030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007035","SUP","HCPCS C1713","","55890007035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007040","SUP","HCPCS C1713","","55890007040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007045","SUP","HCPCS C1713","","55890007045  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007050","SUP","HCPCS C1713","","55890007050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007055","SUP","HCPCS C1713","","55890007055  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007060","SUP","HCPCS C1713","","55890007060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007065","SUP","HCPCS C1713","","55890007065  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007070","SUP","HCPCS C1713","","55890007070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007075","SUP","HCPCS C1713","","55890007075  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007080","SUP","HCPCS C1713","","55890007080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007500","SUP","HCPCS C1713","","55890007500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007511","SUP","HCPCS C1713","","55890007511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007515","SUP","HCPCS C1713","","55890007515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007520","SUP","HCPCS C1713","","55890007520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007525","SUP","HCPCS C1713","","55890007525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007530","SUP","HCPCS C1713","","55890007530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007535","SUP","HCPCS C1713","","55890007535  -  SCREW BN 7.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007540","SUP","HCPCS C1713","","55890007540  -  SCREW BN 7.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007545","SUP","HCPCS C1713","","55890007545  -  SCREW BN 7.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007550","SUP","HCPCS C1713","","55890007550  -  SCREW BN 7.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007555","SUP","HCPCS C1713","","55890007555  -  SCREW BN 7.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007560","SUP","HCPCS C1713","","55890007560  -  SCREW BN 7.5MM 60MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007565","SUP","HCPCS C1713","","55890007565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007570","SUP","HCPCS C1713","","55890007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007575","SUP","HCPCS C1713","","55890007575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007580","SUP","HCPCS C1713","","55890007580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007585","SUP","HCPCS C1713","","55890007585  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007590","SUP","HCPCS C1713","","55890007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890007595","SUP","HCPCS C1713","","55890007595  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008000","SUP","HCPCS C1713","","55890008000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008011","SUP","HCPCS C1713","","55890008011  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008015","SUP","HCPCS C1713","","55890008015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008020","SUP","HCPCS C1713","","55890008020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008025","SUP","HCPCS C1713","","55890008025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008030","SUP","HCPCS C1713","","55890008030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008035","SUP","HCPCS C1713","","55890008035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008040","SUP","HCPCS C1713","","55890008040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008045","SUP","HCPCS C1713","","55890008045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008050","SUP","HCPCS C1713","","55890008050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008055","SUP","HCPCS C1713","","55890008055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008060","SUP","HCPCS C1713","","55890008060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008065","SUP","HCPCS C1713","","55890008065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008070","SUP","HCPCS C1713","","55890008070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008075","SUP","HCPCS C1713","","55890008075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008080","SUP","HCPCS C1713","","55890008080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008085","SUP","HCPCS C1713","","55890008085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008090","SUP","HCPCS C1713","","55890008090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008095","SUP","HCPCS C1713","","55890008095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008500","SUP","HCPCS C1713","","55890008500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008511","SUP","HCPCS C1713","","55890008511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008515","SUP","HCPCS C1713","","55890008515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008520","SUP","HCPCS C1713","","55890008520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008525","SUP","HCPCS C1713","","55890008525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008530","SUP","HCPCS C1713","","55890008530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008535","SUP","HCPCS C1713","","55890008535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008540","SUP","HCPCS C1713","","55890008540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008545","SUP","HCPCS C1713","","55890008545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008550","SUP","HCPCS C1713","","55890008550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008555","SUP","HCPCS C1713","","55890008555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008560","SUP","HCPCS C1713","","55890008560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008565","SUP","HCPCS C1713","","55890008565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008570","SUP","HCPCS C1713","","55890008570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008575","SUP","HCPCS C1713","","55890008575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008580","SUP","HCPCS C1713","","55890008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008585","SUP","HCPCS C1713","","55890008585  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008590","SUP","HCPCS C1713","","55890008590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890008595","SUP","HCPCS C1713","","55890008595  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009000","SUP","HCPCS C1713","","55890009000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009011","SUP","HCPCS C1713","","55890009011  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009015","SUP","HCPCS C1713","","55890009015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009020","SUP","HCPCS C1713","","55890009020  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009025","SUP","HCPCS C1713","","55890009025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009030","SUP","HCPCS C1713","","55890009030  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009035","SUP","HCPCS C1713","","55890009035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009040","SUP","HCPCS C1713","","55890009040  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009045","SUP","HCPCS C1713","","55890009045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009050","SUP","HCPCS C1713","","55890009050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009055","SUP","HCPCS C1713","","55890009055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009060","SUP","HCPCS C1713","","55890009060  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009065","SUP","HCPCS C1713","","55890009065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009070","SUP","HCPCS C1713","","55890009070  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009075","SUP","HCPCS C1713","","55890009075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009080","SUP","HCPCS C1713","","55890009080  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009085","SUP","HCPCS C1713","","55890009085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009090","SUP","HCPCS C1713","","55890009090  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009095","SUP","HCPCS C1713","","55890009095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009500","SUP","HCPCS C1713","","55890009500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009511","SUP","HCPCS C1713","","55890009511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009515","SUP","HCPCS C1713","","55890009515  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009520","SUP","HCPCS C1713","","55890009520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009525","SUP","HCPCS C1713","","55890009525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009530","SUP","HCPCS C1713","","55890009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009535","SUP","HCPCS C1713","","55890009535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009540","SUP","HCPCS C1713","","55890009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009545","SUP","HCPCS C1713","","55890009545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009550","SUP","HCPCS C1713","","55890009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009555","SUP","HCPCS C1713","","55890009555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009560","SUP","HCPCS C1713","","55890009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009565","SUP","HCPCS C1713","","55890009565  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009570","SUP","HCPCS C1713","","55890009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009575","SUP","HCPCS C1713","","55890009575  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009580","SUP","HCPCS C1713","","55890009580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009585","SUP","HCPCS C1713","","55890009585  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009590","SUP","HCPCS C1713","","55890009590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55890009595","SUP","HCPCS C1713","","55890009595  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"60181210100","SUP","Custom 27203010","","ADAPTER TRNQT 36IN DUAL EXTN CPC CONNCTR STRL LF","BOTH IP/OP","$50.83 ","$37.61 ","$0.00 ","$50.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.83 ","$0.00 ","$25.41 ","$40.26 ","$40.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60707010400","SUP","Custom 27203010","","60707010400  -  CUFF TRNQT 24X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE","BOTH IP/OP","$73.39 ","$54.31 ","$0.00 ","$73.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.39 ","$0.00 ","$36.69 ","$58.12 ","$58.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60707010500","SUP","Custom 27203010","","60707010500  -  CUFF TRNQT 30X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE","BOTH IP/OP","$78.02 ","$57.73 ","$0.00 ","$78.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.02 ","$0.00 ","$39.01 ","$61.79 ","$62.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60707010600","SUP","Custom 27203010","","60707010600  -  CUFF TRNQT 34X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE","BOTH IP/OP","$84.46 ","$62.50 ","$0.00 ","$84.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.46 ","$0.00 ","$42.23 ","$66.89 ","$67.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60707010700","SUP","Custom 27203010","","60707010700  -  CUFF TRNQT CYL 42X4IN RUBY STRL LF ATS 3K 2 PORT BLDR POS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9.90E+11","SUP","Custom 27203010","","989803104341  -  TUBING MONITR SMALL STATURE 10FT NIBP LATEX FREE REUSABLE","BOTH IP/OP","$252.17 ","$186.61 ","$0.00 ","$124.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.31 ","$0.00 ","$62.16 ","$98.45 ","$99.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0.8P8","SUP","Custom 27803010","","0.8P8  -  PATCH VASCULAR 8X.8CM BIOLOGIC XENOSURE THK.45MM TAPER","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-0114-006-00","SUP","Custom 27203010","","00-0114-006-00  -  HOLDER PIN 3/16IN 21X11CM LF BHLR-STNM THB SCR SS SKL TRX","BOTH IP/OP","$442.00 ","$327.08 ","$0.00 ","$442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$442.00 ","$0.00 ","$221.00 ","$350.06 ","$353.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"000-2090","SUP","HCPCS C1781","","000-2090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,277.13 ","$945.08 ","$0.00 ","$1,277.13 ","$574.71 ","$0.00 ","$266.18 ","$0.00 ","$0.00 ","$223.61 ","$1,277.13 ","$0.00 ","$638.56 ","$1,011.49 ","$1,021.70 ","$0.00 ","$199.87 ","$0.00 ","$203.32 ","$0.00 "
"00085-4602-02","SUP","HCPCS C2626","","00085-4602-02  -  SCREW SYSTEM INSPIREASE DRUG DELIVERY EA","BOTH IP/OP","$111.93 ","$82.83 ","$0.00 ","$111.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.93 ","$0.00 ","$55.97 ","$88.65 ","$89.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0010DTR","SUP","Custom 27203010","","BAG LNDR RD 38X38IN DRAWTAPE 40GL","BOTH IP/OP","$1.40 ","$1.04 ","$0.00 ","$1.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.40 ","$0.00 ","$0.70 ","$1.11 ","$1.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00208-00","SUP","Custom 27203010","","ASSEMBLY ANTICOAGULATION/ASPIRATION TUBING FOR CELL SAVER PA","BOTH IP/OP","$63.38 ","$46.90 ","$0.00 ","$63.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.38 ","$0.00 ","$31.69 ","$50.20 ","$50.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-2348-010-35","SUP","HCPCS C1713","","00-2348-010-35  -  SCREW BONE 3.5MM 10MM SS 2.7MM HEAD CORT PERIART SLFTAP","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-012-35","SUP","HCPCS C1713","","00-2348-012-35  -  SCREW BONE 3.5MM 2.7MM 12MM SS 2.7MM HEAD PERIART SLFTAP","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-014-35","SUP","HCPCS C1713","","00-2348-014-35  -  SCREW BONE 3.5MM 2.7MM 14MM SS 2.7MM HEAD CORT PERIART","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-016-35","SUP","HCPCS C1713","","00-2348-016-35  -  SCREW BONE 3.5MM 2.7MM 16MM SS 2.7MM HEAD CORT PERIART","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-018-35","SUP","HCPCS C1713","","00-2348-018-35  -  SCREW BONE 3.5MM 2.7MM 18MM SS 2.7MM HEAD CORT PERIART","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-020-35","SUP","HCPCS C1713","","00-2348-020-35  -  SCREW BONE 3.5MM 2.7MM 20MM SS 2.7MM HEAD CORT PERIART","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-022-35","SUP","HCPCS C1713","","00-2348-022-35  -  SCREW BONE 3.5MM 2.7MM 22MM SS 2.7MM HEAD CORT PERIART","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2348-026-35","SUP","HCPCS C1713","","00-2348-026-35  -  SCREW BONE 3.5MM 2.7MM 26MM SS 2.7MM HEAD CORT PERIART","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$15.58 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"00-2357-017-04","SUP","HCPCS C1713","","00-2357-017-04  -  PLATE 80MM 4 HOLE LCK BONE RIGHT DISTAL LAT FIB","BOTH IP/OP","$1,378.00 ","$1,019.72 ","$0.00 ","$1,378.00 ","$620.10 ","$0.00 ","$287.21 ","$0.00 ","$0.00 ","$241.28 ","$1,378.00 ","$0.00 ","$689.00 ","$1,091.38 ","$1,102.40 ","$0.00 ","$215.66 ","$0.00 ","$219.38 ","$0.00 "
"00-2357-017-06","SUP","HCPCS C1713","","00-2357-017-06  -  PLATE 106MM 6 HOLE LCK BONE RIGHT DISTAL LAT FIB","BOTH IP/OP","$1,478.75 ","$1,094.28 ","$0.00 ","$1,478.75 ","$665.44 ","$0.00 ","$308.21 ","$0.00 ","$0.00 ","$258.92 ","$1,478.75 ","$0.00 ","$739.38 ","$1,171.17 ","$1,183.00 ","$0.00 ","$231.42 ","$0.00 ","$235.42 ","$0.00 "
"00-2357-017-08","SUP","HCPCS C1713","","00-2357-017-08  -  PLATE 132MM 8 HOLE LCK BONE RL DISTAL FIB","BOTH IP/OP","$1,579.50 ","$1,168.83 ","$0.00 ","$1,579.50 ","$710.78 ","$0.00 ","$329.21 ","$0.00 ","$0.00 ","$276.56 ","$1,579.50 ","$0.00 ","$789.75 ","$1,250.96 ","$1,263.60 ","$0.00 ","$247.19 ","$0.00 ","$251.46 ","$0.00 "
"00-2357-018-04","SUP","HCPCS C1713","","00-2357-018-04  -  PLATE 40 HOLE BONE RIGHT FIB","BOTH IP/OP","$1,378.00 ","$1,019.72 ","$0.00 ","$1,378.00 ","$620.10 ","$0.00 ","$287.21 ","$0.00 ","$0.00 ","$241.28 ","$1,378.00 ","$0.00 ","$689.00 ","$1,091.38 ","$1,102.40 ","$0.00 ","$215.66 ","$0.00 ","$219.38 ","$0.00 "
"00-2357-018-06","SUP","HCPCS C1713","","00-2357-018-06  -  PLATE 106MM 6 HOLE LCK BONE LEFT DISTAL LAT FIB","BOTH IP/OP","$1,478.75 ","$1,094.28 ","$0.00 ","$1,478.75 ","$665.44 ","$0.00 ","$308.21 ","$0.00 ","$0.00 ","$258.92 ","$1,478.75 ","$0.00 ","$739.38 ","$1,171.17 ","$1,183.00 ","$0.00 ","$231.42 ","$0.00 ","$235.42 ","$0.00 "
"00-2359-012-38","SUP","HCPCS C1713","","00-2359-012-38  -  SCREW BONE 3.5MM 2.7MM 12MM SS PERIART LCK HEAD NONSTRL","BOTH IP/OP","$201.50 ","$149.11 ","$0.00 ","$201.50 ","$90.68 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$35.28 ","$201.50 ","$0.00 ","$100.75 ","$159.59 ","$161.20 ","$0.00 ","$31.53 ","$0.00 ","$32.08 ","$0.00 "
"00-2359-014-38","SUP","HCPCS C1713","","00-2359-014-38  -  SCREW BONE 3.5MM 2.7MM 14MM SS PERIART LCK NONSTRL","BOTH IP/OP","$201.50 ","$149.11 ","$0.00 ","$201.50 ","$90.68 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$35.28 ","$201.50 ","$0.00 ","$100.75 ","$159.59 ","$161.20 ","$0.00 ","$31.53 ","$0.00 ","$32.08 ","$0.00 "
"00-2359-016-26","SUP","HCPCS C1713","","00-2359-016-26  -  SCREW BONE 2.7MM 16MM SS CONICAL NONSTRL","BOTH IP/OP","$113.75 ","$84.18 ","$0.00 ","$113.75 ","$51.19 ","$0.00 ","$23.71 ","$0.00 ","$0.00 ","$19.92 ","$113.75 ","$0.00 ","$56.88 ","$90.09 ","$91.00 ","$0.00 ","$17.80 ","$0.00 ","$18.11 ","$0.00 "
"00-2359-016-38","SUP","HCPCS C1713","","00-2359-016-38  -  SCREW BONE 3.5MM 2.7MM 16MM SS PERIART LCK NONSTRL","BOTH IP/OP","$201.50 ","$149.11 ","$0.00 ","$201.50 ","$90.68 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$35.28 ","$201.50 ","$0.00 ","$100.75 ","$159.59 ","$161.20 ","$0.00 ","$31.53 ","$0.00 ","$32.08 ","$0.00 "
"00-2359-018-35","SUP","HCPCS C1713","","00-2359-018-35  -  SCREW BONE 3.5MM 18MM SS PERIART LCK NONSTRL","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-2359-018-38","SUP","HCPCS C1713","","00-2359-018-38  -  SCREW BONE 3.5MM 2.7MM 18MM SS 2.7MM HEAD PERIART LCK","BOTH IP/OP","$201.50 ","$149.11 ","$0.00 ","$201.50 ","$90.68 ","$0.00 ","$42.00 ","$0.00 ","$0.00 ","$35.28 ","$201.50 ","$0.00 ","$100.75 ","$159.59 ","$161.20 ","$0.00 ","$31.53 ","$0.00 ","$32.08 ","$0.00 "
"00-2359-040-35","SUP","HCPCS C1713","","00-2359-040-35  -  SCREW BONE 3.5MM 40MM PRLC SS PERIART LCK NCLNLT NONSTRL PLT","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-2359-044-35","SUP","HCPCS C1713","","00-2359-044-35  -  SCREW BONE 3.5MM 44MM SS PERIART LCK NCLNLT NONSTRL PLT SYS","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-2359-046-35","SUP","HCPCS C1713","","00-2359-046-35  -  SCREW BONE 3.5MM 46MM SS PERIART NON CANN LCK NONSTRL PLT","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-2359-048-35","SUP","HCPCS C1713","","00-2359-048-35  -  SCREW BONE 3.5MM 48MM SS PERIART NCLNLT LCK NONSTRL PLT SYS","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-2359-050-37","SUP","HCPCS C1713","","00-2359-050-37  -  SCREW BONE 3.5MM 50MM PRLC SS PERIART CANN CONICAL LCK","BOTH IP/OP","$191.75 ","$141.90 ","$0.00 ","$191.75 ","$86.29 ","$0.00 ","$39.97 ","$0.00 ","$0.00 ","$33.57 ","$191.75 ","$0.00 ","$95.88 ","$151.87 ","$153.40 ","$0.00 ","$30.01 ","$0.00 ","$30.53 ","$0.00 "
"00-2410-029-00","SUP","Custom 27203010","","00-2410-029-00  -  BIT DRL 2.5MM 220MM QCK CNCT","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-2490-012-30","SUP","HCPCS C1713","","00-2490-012-30  -  PIN EXFIX 305MM 3MM NTR NAIL THRD","BOTH IP/OP","$211.25 ","$156.33 ","$0.00 ","$211.25 ","$95.06 ","$0.00 ","$44.03 ","$0.00 ","$0.00 ","$36.99 ","$211.25 ","$0.00 ","$105.63 ","$167.31 ","$169.00 ","$0.00 ","$33.06 ","$0.00 ","$33.63 ","$0.00 "
"00-2490-034-49","SUP","Custom 27203010","","00-2490-034-49  -  DRILL SRG 4.9MM RTRGD CLBRT FEM","BOTH IP/OP","$955.50 ","$707.07 ","$0.00 ","$955.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.50 ","$0.00 ","$477.75 ","$756.76 ","$764.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-2490-046-30","SUP","HCPCS C1713","","00-2490-046-30  -  PIN 3MM NTR NAIL THRD STD IM NAIL","BOTH IP/OP","$227.50 ","$168.35 ","$0.00 ","$227.50 ","$102.38 ","$0.00 ","$47.42 ","$0.00 ","$0.00 ","$39.83 ","$227.50 ","$0.00 ","$113.75 ","$180.18 ","$182.00 ","$0.00 ","$35.60 ","$0.00 ","$36.22 ","$0.00 "
"00-2490-047-30","SUP","HCPCS C1713","","00-2490-047-30  -  PIN FIX 355MM 3MM NTR NAIL NTHRD","BOTH IP/OP","$253.50 ","$187.59 ","$0.00 ","$253.50 ","$114.08 ","$0.00 ","$52.84 ","$0.00 ","$0.00 ","$44.39 ","$253.50 ","$0.00 ","$126.75 ","$200.77 ","$202.80 ","$0.00 ","$39.67 ","$0.00 ","$40.36 ","$0.00 "
"00-4806-100-20","SUP","Custom 27203010","","00-4806-100-20  -  BIT DRL 2MM 100MM QCK CNCT","BOTH IP/OP","$139.75 ","$103.42 ","$0.00 ","$139.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.75 ","$0.00 ","$69.88 ","$110.68 ","$111.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-4806-110-25","SUP","Custom 27203010","","00-4806-110-25  -  BIT DRL 2.5MM 110MM QCK CNCT","BOTH IP/OP","$139.75 ","$103.42 ","$0.00 ","$139.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.75 ","$0.00 ","$69.88 ","$110.68 ","$111.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-4806-110-35","SUP","Custom 27203010","","00-4806-110-35  -  BIT DRL 3.5MM","BOTH IP/OP","$139.75 ","$103.42 ","$0.00 ","$139.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.75 ","$0.00 ","$69.88 ","$110.68 ","$111.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-4827-020-01","SUP","HCPCS C1713","","00-4827-020-01  -  SCREW BONE 2.7MM 20MM ZPS SS SM CORT SLFTAP SM HEX RECESS","BOTH IP/OP","$45.50 ","$33.67 ","$0.00 ","$45.50 ","$20.48 ","$0.00 ","$9.48 ","$0.00 ","$0.00 ","$7.97 ","$45.50 ","$0.00 ","$22.75 ","$36.04 ","$36.40 ","$0.00 ","$7.12 ","$0.00 ","$7.24 ","$0.00 "
"00-4828-012-02","SUP","HCPCS C1713","","00-4828-012-02  -  SCREW BONE 2.7MM 12MM SS UNV LCK NONSTRL","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-4828-014-02","SUP","HCPCS C1713","","00-4828-014-02  -  SCREW BONE 2.7MM 14MM SS UNV LCK NONSTRL","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-4828-016-02","SUP","HCPCS C1713","","00-4828-016-02  -  SCREW BONE 2.7MM 16MM ORTH","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-4828-018-02","SUP","HCPCS C1713","","00-4828-018-02  -  SCREW BONE 2.7MM 18MM SS UNV LCK NONSTRL","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-4828-020-02","SUP","HCPCS C1713","","00-4828-020-02  -  SCREW BONE 2.7MM 20MM SS UNV PERIART ELB LCK NONSTRL","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$97.99 ","$0.00 ","$45.38 ","$0.00 ","$0.00 ","$38.13 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$34.08 ","$0.00 ","$34.67 ","$0.00 "
"00-4835-016-01","SUP","HCPCS C1713","","00-4835-016-01  -  SCREW BONE 3.5MM 16MM ZPS SS SM CORT SLFTAP SM HEX RECESS","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$10.84 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"00-4835-018-01","SUP","HCPCS C1713","","00-4835-018-01  -  SCREW BONE 3.5MM 18MM ZPS SS LNG CORT SLFTAP SM HEX RECESS","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$10.84 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"00-4835-026-01","SUP","HCPCS C1713","","00-4835-026-01  -  SCREW BONE 3.5MM 26MM ZPS SS CORT SLFTAP SM HEX RECESS","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$10.84 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"00-4835-040-01","SUP","HCPCS C1713","","00-4835-040-01  -  SCREW BONE 3.5MM 40MM ZPS SS CORT SLFTAP SM HEX RECESS SM","BOTH IP/OP","$52.00 ","$38.48 ","$0.00 ","$52.00 ","$23.40 ","$0.00 ","$10.84 ","$0.00 ","$0.00 ","$9.10 ","$52.00 ","$0.00 ","$26.00 ","$41.18 ","$41.60 ","$0.00 ","$8.14 ","$0.00 ","$8.28 ","$0.00 "
"00-4840-040-00","SUP","HCPCS C1713","","00-4840-040-00  -  SCREW BONE 4MM 40MM 14MM ZPS SS PTHRD CANC SM HEX RECESS","BOTH IP/OP","$42.25 ","$31.27 ","$0.00 ","$42.25 ","$19.01 ","$0.00 ","$8.81 ","$0.00 ","$0.00 ","$7.40 ","$42.25 ","$0.00 ","$21.13 ","$33.46 ","$33.80 ","$0.00 ","$6.61 ","$0.00 ","$6.73 ","$0.00 "
"00-4840-050-00","SUP","HCPCS C1713","","00-4840-050-00  -  SCREW BONE 4MM 50MM ZPS SS FULTHD CANC SM HEX RECESS NONSTRL","BOTH IP/OP","$42.25 ","$31.27 ","$0.00 ","$42.25 ","$19.01 ","$0.00 ","$8.81 ","$0.00 ","$0.00 ","$7.40 ","$42.25 ","$0.00 ","$21.13 ","$33.46 ","$33.80 ","$0.00 ","$6.61 ","$0.00 ","$6.73 ","$0.00 "
"00-4840-050-01","SUP","HCPCS C1713","","00-4840-050-01  -  SCREW BONE 4MM 15MM ZPS SS CANC PTTHRD SM HEX RECESS FRAG","BOTH IP/OP","$42.25 ","$31.27 ","$0.00 ","$42.25 ","$19.01 ","$0.00 ","$8.81 ","$0.00 ","$0.00 ","$7.40 ","$42.25 ","$0.00 ","$21.13 ","$33.46 ","$33.80 ","$0.00 ","$6.61 ","$0.00 ","$6.73 ","$0.00 "
"00-4901-016-15","SUP","Custom 27203010","","00-4901-016-15  -  WIRE 1.6MM .063IN 15.2CM KWIRE ZPS SS 1 END TROCAR PNT","BOTH IP/OP","$16.58 ","$12.27 ","$0.00 ","$16.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.58 ","$0.00 ","$8.29 ","$13.13 ","$13.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"005280-901","SUP","Custom 27203010","","005280-901  -  LGTR 8MM FRNG FLLPN TUBE BAND STRL DISP ENDSCP LATEX FREE","BOTH IP/OP","$36.09 ","$26.71 ","$0.00 ","$36.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.09 ","$0.00 ","$18.05 ","$28.58 ","$28.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"00-6202-066-20","SUP","HCPCS C1776","","00-6202-066-20  -  SHELL ACETAB 66MM HIP MLHL PRIM MDLR REV TRB MTL STRL","BOTH IP/OP","$7,315.00 ","$5,413.10 ","$0.00 ","$7,315.00 ","$3,291.75 ","$0.00 ","$1,524.63 ","$0.00 ","$0.00 ","$1,280.80 ","$7,315.00 ","$0.00 ","$3,657.50 ","$5,793.48 ","$5,852.00 ","$0.00 ","$1,144.80 ","$0.00 ","$1,164.55 ","$0.00 "
"00-6250-65-20","SUP","HCPCS C1713","","00-6250-65-20  -  SCREW BN 6.5MM 20MM TRLG ST","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"00-6250-65-35","SUP","HCPCS C1713","","00-6250-65-35  -  SCREW BN 6.5MM 35MM TRLG ST","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"00-6334-050-28","SUP","HCPCS C1776","","00-6334-050-28  -  LINER ACETAB TRLG 8.3MM 50/52/54MM 28MM LNGVT HIP","BOTH IP/OP","$14,925.00 ","$11,044.50 ","$0.00 ","$14,925.00 ","$6,716.25 ","$0.00 ","$3,110.74 ","$0.00 ","$0.00 ","$2,613.25 ","$14,925.00 ","$0.00 ","$7,462.50 ","$11,820.60 ","$11,940.00 ","$0.00 ","$2,335.76 ","$0.00 ","$2,376.06 ","$0.00 "
"00-7708-000-10","SUP","Custom 27203010","","00-7708-000-10  -  CRR GFT 8IN SKIN PVC BRD CRR STRL LATEX FREE","BOTH IP/OP","$67.79 ","$50.16 ","$0.00 ","$67.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.79 ","$0.00 ","$33.89 ","$53.69 ","$54.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"008556P","SUP","HCPCS C1733","","008556P  -  CATHETER EP 5FR 110CM BP TEMP PCNG BLN FLW AST","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"01-0001-S","SUP","Custom 27803010","","01-0001-S  -  CBL SLV ORTH 850MM 2MM HIP COCR SET STRL","BOTH IP/OP","$1,047.50 ","$775.15 ","$0.00 ","$1,047.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.50 ","$0.00 ","$523.75 ","$829.62 ","$838.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0002-S","SUP","Custom 27203010","","01-0002-S  -  SLEEVE CABLE 850MM 1.6MM ORTH COCR STRL","BOTH IP/OP","$1,047.50 ","$775.15 ","$0.00 ","$1,047.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.50 ","$0.00 ","$523.75 ","$829.62 ","$838.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0011-S","SUP","Custom 27803010","","01-0011-S  -  CABLE ORTH COCR 2MM 850MM","BOTH IP/OP","$715.00 ","$529.10 ","$0.00 ","$715.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$715.00 ","$0.00 ","$357.50 ","$566.28 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0012-S","SUP","Custom 27803010","","01-0012-S  -  CABLE ORTH COCR 1.6MM 850MM STRL","BOTH IP/OP","$715.00 ","$529.10 ","$0.00 ","$715.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$715.00 ","$0.00 ","$357.50 ","$566.28 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0013-S","SUP","Custom 27203010","","01-0013-S  -  SLEEVE CABLE 2MM COCR STRL","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0014-S","SUP","Custom 27203010","","01-0014-S  -  SLEEVE CABLE 1.6MM COCR STRL","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0020-S","SUP","Custom 27203010","","01-0020-S  -  SLEEVE CABLE 850MM 2MM SS STRL","BOTH IP/OP","$1,047.50 ","$775.15 ","$0.00 ","$1,047.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.50 ","$0.00 ","$523.75 ","$829.62 ","$838.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0022-S","SUP","Custom 27203010","","01-0022-S  -  SLEEVE CMPR SS 2MM","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"010-0604","SUP","Custom 27203010","","010-0604  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$225.25 ","$166.69 ","$0.00 ","$225.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.25 ","$0.00 ","$112.63 ","$178.40 ","$180.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"010-0806","SUP","Custom 27203010","","010-0806  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$272.00 ","$201.28 ","$0.00 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.00 ","$0.00 ","$136.00 ","$215.42 ","$217.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"010-103L","SUP","HCPCS C1713","","010-103L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"010-103R","SUP","HCPCS C1713","","010-103R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"010-2001-5","SUP","HCPCS C1781","","010-2001-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,606.50 ","$1,188.81 ","$0.00 ","$1,606.50 ","$722.93 ","$0.00 ","$334.83 ","$0.00 ","$0.00 ","$281.29 ","$1,606.50 ","$0.00 ","$803.25 ","$1,272.35 ","$1,285.20 ","$0.00 ","$251.42 ","$0.00 ","$255.75 ","$0.00 "
"010-2010","SUP","HCPCS C1781","","010-2010  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,115.63 ","$825.57 ","$0.00 ","$1,115.63 ","$502.03 ","$0.00 ","$232.52 ","$0.00 ","$0.00 ","$195.34 ","$1,115.63 ","$0.00 ","$557.81 ","$883.58 ","$892.50 ","$0.00 ","$174.60 ","$0.00 ","$177.61 ","$0.00 "
"010-234","SUP","HCPCS C1713","","010-234  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"01-02950","SUP","Custom 27803010","","01-02950  -  BAR ARCH 5IN ERICH SS FACE FX","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0298","SUP","HCPCS C1713","","01-0298  -  BAR ARCH PREFORM OMNIMAX MMF SYSTEM","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"01-0299","SUP","Custom 27203010","","01-0299  -  BAR ARCH 1MR ROLL WIRE INSTR ERICH","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102L12","SUP","HCPCS C1729","","0102L12  -  CATHETER URETHRAL 12FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE","BOTH IP/OP","$25.13 ","$18.60 ","$0.00 ","$25.50 ","$13.85 ","$0.00 ","$5.24 ","$0.00 ","$0.00 ","$4.47 ","$25.50 ","$0.00 ","$12.75 ","$20.20 ","$20.40 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"0102L14","SUP","HCPCS C1729","","0102L14  -  CATH URTH BDX LBR 14FR FOLEY 2W CDE RADIOPQ DDRGL 5ML STRL","BOTH IP/OP","$25.75 ","$19.06 ","$0.00 ","$26.15 ","$14.20 ","$0.00 ","$5.24 ","$0.00 ","$0.00 ","$4.58 ","$26.15 ","$0.00 ","$13.07 ","$20.71 ","$20.92 ","$0.00 ","$4.09 ","$0.00 ","$4.16 ","$0.00 "
"0102L16","SUP","HCPCS C1729","","0102L16  -  CATH URTH BDX LBR 16FR FOLEY 2W CDE 1 EYE DDRGL 5ML STRL","BOTH IP/OP","$26.15 ","$19.35 ","$0.00 ","$26.15 ","$14.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.58 ","$26.15 ","$0.00 ","$13.07 ","$20.71 ","$20.92 ","$0.00 ","$4.09 ","$0.00 ","$4.16 ","$0.00 "
"0102L18","SUP","HCPCS C1729","","0102L18  -  CATH URTH BDX LBR 18FR FOLEY 2W CDE RADIOPQ DDRGL 5ML STRL","BOTH IP/OP","$25.13 ","$18.60 ","$0.00 ","$26.14 ","$14.20 ","$0.00 ","$5.24 ","$0.00 ","$0.00 ","$4.58 ","$26.14 ","$0.00 ","$13.07 ","$20.70 ","$20.92 ","$0.00 ","$4.09 ","$0.00 ","$4.16 ","$0.00 "
"0102L20","SUP","HCPCS C1729","","0102L20  -  CATH URTH BDX LBR 20FR FOLEY 2W CDE 1 EYE DDRGL 5ML STRL","BOTH IP/OP","$25.75 ","$19.06 ","$0.00 ","$26.14 ","$14.20 ","$0.00 ","$5.24 ","$0.00 ","$0.00 ","$4.58 ","$26.14 ","$0.00 ","$13.07 ","$20.70 ","$20.92 ","$0.00 ","$4.09 ","$0.00 ","$4.16 ","$0.00 "
"0102L22","SUP","Custom 27203010","","0102L22  -  CATHETER URETHRAL 22FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE","BOTH IP/OP","$25.13 ","$18.60 ","$0.00 ","$25.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.13 ","$0.00 ","$12.56 ","$19.90 ","$20.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102L24","SUP","Custom 27203010","","0102L24  -  CATHETER URETHRAL 24FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE","BOTH IP/OP","$25.13 ","$18.60 ","$0.00 ","$25.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.13 ","$0.00 ","$12.56 ","$19.90 ","$20.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102SI16","SUP","Custom 27203010","","0102SI16  -  CATHETER URTH 16FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE","BOTH IP/OP","$35.13 ","$26.00 ","$0.00 ","$35.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.13 ","$0.00 ","$17.56 ","$27.82 ","$28.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102SI18","SUP","Custom 27203010","","0102SI18  -  CATHETER URTH 18FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE","BOTH IP/OP","$35.13 ","$26.00 ","$0.00 ","$35.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.13 ","$0.00 ","$17.56 ","$27.82 ","$28.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102SI20","SUP","Custom 27203010","","0102SI20  -  CATHETER URTH 20FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL","BOTH IP/OP","$35.13 ","$26.00 ","$0.00 ","$35.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.13 ","$0.00 ","$17.56 ","$27.82 ","$28.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102SI22","SUP","Custom 27203010","","0102SI22  -  CATHETER URTH 22FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE","BOTH IP/OP","$35.13 ","$26.00 ","$0.00 ","$35.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.13 ","$0.00 ","$17.56 ","$27.82 ","$28.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0102SI24","SUP","Custom 27203010","","0102SI24  -  CATHETER URTH 24FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL","BOTH IP/OP","$35.13 ","$26.00 ","$0.00 ","$35.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.13 ","$0.00 ","$17.56 ","$27.82 ","$28.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-0301","SUP","Custom 27203010","","01-0301  -  BAND RUBBER SMALL 4MM ARCH BAR","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-03490","SUP","Custom 27203010","","01-03490  -  WIRE FX .5MM 160MM LGT BLNT","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"01-03492","SUP","Custom 27203010","","01-03492  -  WIRE FX .64MM 160MM LGT BLNT","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0104-07","SUP","Custom 27203010","","MEDIA CULT TETRATHIONATE BROTH BASE 2KG","BOTH IP/OP","$547.50 ","$405.15 ","$0.00 ","$547.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$547.50 ","$0.00 ","$273.75 ","$433.62 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0112-18","SUP","Custom 27203010","","0112-18  -  TUBE GSTRM Y 18FR ORNG LF MGNPRT BLN RND SKN DISK DEHP-FR","BOTH IP/OP","$1,000.88 ","$740.65 ","$0.00 ","$66.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.61 ","$0.00 ","$33.31 ","$52.76 ","$53.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0112-20","SUP","HCPCS B4087","","0112-20  -  TUBE GSTRM UNV 20FR 7-10ML STRL ASMB VAL G SIL ENTRL","BOTH IP/OP","$45.31 ","$33.53 ","$0.00 ","$45.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.31 ","$0.00 ","$22.65 ","$35.89 ","$36.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0112-22","SUP","HCPCS B4087","","0112-22  -  TUBE GSTRM 22FR 14IN BLU LF MGNPRT YPRT BLN CNCT SIL DISP","BOTH IP/OP","$45.31 ","$33.53 ","$0.00 ","$45.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.31 ","$0.00 ","$22.65 ","$35.89 ","$36.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0112-24","SUP","HCPCS B4087","","0112-24  -  TUBE GSTRM 24FR 14IN PEACH LF MGNPRT SDPRT BLN REPL SIL","BOTH IP/OP","$45.31 ","$33.53 ","$0.00 ","$45.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.31 ","$0.00 ","$22.65 ","$35.89 ","$36.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0119L22","SUP","Custom 27203010","","0119L22  -  CATHETER URETHRAL STANDARD 22FR 3 WAY 2 OPPOSING DRAIN EYE","BOTH IP/OP","$21.05 ","$15.58 ","$0.00 ","$21.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.05 ","$0.00 ","$10.53 ","$16.67 ","$16.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0119SI18","SUP","Custom 27203010","","0119SI18  -  CATHETER URTH 18FR 5CC AMBR STRL LTX BDX IC 3W FL BLN INFCT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0120-14-1.7","SUP","Custom 27203010","","0120-14-1.7  -  KIT GASTROSTOMY LP TAPER 14FR 1.7CM 12IN ENTERAL FEED TUBE","BOTH IP/OP","$259.94 ","$192.36 ","$0.00 ","$259.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259.94 ","$0.00 ","$129.97 ","$209.07 ","$207.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0120-18-2.3","SUP","HCPCS C1713","","0120-18-2.3  -  KIT GASTROSTOMY 18FR 2.3CM INTERNAL RETENTION BALLOON","BOTH IP/OP","$260.08 ","$192.46 ","$0.00 ","$260.08 ","$117.03 ","$0.00 ","$54.21 ","$0.00 ","$0.00 ","$45.54 ","$260.08 ","$0.00 ","$130.04 ","$205.98 ","$208.06 ","$0.00 ","$40.70 ","$0.00 ","$41.40 ","$0.00 "
"0120-18-2.5","SUP","Custom 27203010","","0120-18-2.5  -  KIT GASTROSTOMY LP TAPER 18FR 2.5CM ENTERAL FEED TUBE DEHP","BOTH IP/OP","$494.62 ","$366.02 ","$0.00 ","$259.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259.94 ","$0.00 ","$129.97 ","$209.07 ","$207.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0120-18-4.5","SUP","HCPCS C1713","","0120-18-4.5  -  KIT GASTROSTOMY LP TAPER 18FR 4.5CM ENTERAL FEED TUBE DEHP","BOTH IP/OP","$260.08 ","$192.46 ","$0.00 ","$260.08 ","$117.03 ","$0.00 ","$54.21 ","$0.00 ","$0.00 ","$45.54 ","$260.08 ","$0.00 ","$130.04 ","$205.98 ","$208.06 ","$0.00 ","$40.70 ","$0.00 ","$41.40 ","$0.00 "
"012DTC","SUP","Custom 27203010","","012DTC  -  BAG DRAWTAPE 38 X38 CLEAR","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-016","SUP","HCPCS C1713","","015-016  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$452.63 ","$334.95 ","$0.00 ","$452.63 ","$203.68 ","$0.00 ","$94.34 ","$0.00 ","$0.00 ","$79.25 ","$452.63 ","$0.00 ","$226.31 ","$358.48 ","$362.10 ","$0.00 ","$70.84 ","$0.00 ","$72.06 ","$0.00 "
"015-016-C","SUP","HCPCS C1713","","015-016-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$488.75 ","$361.68 ","$0.00 ","$488.75 ","$219.94 ","$0.00 ","$101.87 ","$0.00 ","$0.00 ","$85.58 ","$488.75 ","$0.00 ","$244.38 ","$387.09 ","$391.00 ","$0.00 ","$76.49 ","$0.00 ","$77.81 ","$0.00 "
"015-017","SUP","HCPCS C1713","","015-017  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$435.63 ","$322.37 ","$0.00 ","$435.63 ","$196.03 ","$0.00 ","$90.80 ","$0.00 ","$0.00 ","$76.27 ","$435.63 ","$0.00 ","$217.81 ","$345.02 ","$348.50 ","$0.00 ","$68.18 ","$0.00 ","$69.35 ","$0.00 "
"015-017-C","SUP","HCPCS C1713","","015-017-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$463.25 ","$342.81 ","$0.00 ","$463.25 ","$208.46 ","$0.00 ","$96.55 ","$0.00 ","$0.00 ","$81.11 ","$463.25 ","$0.00 ","$231.63 ","$366.89 ","$370.60 ","$0.00 ","$72.50 ","$0.00 ","$73.75 ","$0.00 "
"015-018","SUP","HCPCS C1713","","015-018  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$461.13 ","$341.24 ","$0.00 ","$461.13 ","$207.51 ","$0.00 ","$96.11 ","$0.00 ","$0.00 ","$80.74 ","$461.13 ","$0.00 ","$230.56 ","$365.21 ","$368.90 ","$0.00 ","$72.17 ","$0.00 ","$73.41 ","$0.00 "
"015-018-C","SUP","HCPCS C1713","","015-018-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$463.25 ","$342.81 ","$0.00 ","$463.25 ","$208.46 ","$0.00 ","$96.55 ","$0.00 ","$0.00 ","$81.11 ","$463.25 ","$0.00 ","$231.63 ","$366.89 ","$370.60 ","$0.00 ","$72.50 ","$0.00 ","$73.75 ","$0.00 "
"015-032","SUP","HCPCS C1713","","015-032  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$654.50 ","$484.33 ","$0.00 ","$654.50 ","$294.53 ","$0.00 ","$136.41 ","$0.00 ","$0.00 ","$114.60 ","$654.50 ","$0.00 ","$327.25 ","$518.36 ","$523.60 ","$0.00 ","$102.43 ","$0.00 ","$104.20 ","$0.00 "
"015-040","SUP","HCPCS C1713","","015-040  -  PLATE BN STD STRG 4MM TIMESH 2 HL TI CRNL 1.5MM SCR","BOTH IP/OP","$93.50 ","$69.19 ","$0.00 ","$93.50 ","$42.08 ","$0.00 ","$19.49 ","$0.00 ","$0.00 ","$16.37 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$14.63 ","$0.00 ","$14.89 ","$0.00 "
"015-040-C","SUP","HCPCS C1713","","015-040-C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$95.63 ","$70.77 ","$0.00 ","$95.63 ","$43.03 ","$0.00 ","$19.93 ","$0.00 ","$0.00 ","$16.74 ","$95.63 ","$0.00 ","$47.81 ","$75.74 ","$76.50 ","$0.00 ","$14.97 ","$0.00 ","$15.22 ","$0.00 "
"015-042","SUP","HCPCS C1713","","015-042  -  PLATE BN STD STRG 8MM TIMESH 2 HL TI CRNL 1.5MM SCR","BOTH IP/OP","$95.63 ","$70.77 ","$0.00 ","$95.63 ","$43.03 ","$0.00 ","$19.93 ","$0.00 ","$0.00 ","$16.74 ","$95.63 ","$0.00 ","$47.81 ","$75.74 ","$76.50 ","$0.00 ","$14.97 ","$0.00 ","$15.22 ","$0.00 "
"015-042-C","SUP","HCPCS C1713","","015-042-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$95.63 ","$70.77 ","$0.00 ","$95.63 ","$43.03 ","$0.00 ","$19.93 ","$0.00 ","$0.00 ","$16.74 ","$95.63 ","$0.00 ","$47.81 ","$75.74 ","$76.50 ","$0.00 ","$14.97 ","$0.00 ","$15.22 ","$0.00 "
"015-044","SUP","HCPCS C1713","","015-044  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$93.50 ","$69.19 ","$0.00 ","$93.50 ","$42.08 ","$0.00 ","$19.49 ","$0.00 ","$0.00 ","$16.37 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$14.63 ","$0.00 ","$14.89 ","$0.00 "
"015-044-C","SUP","HCPCS C1713","","015-044-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$102.00 ","$75.48 ","$0.00 ","$102.00 ","$45.90 ","$0.00 ","$21.26 ","$0.00 ","$0.00 ","$17.86 ","$102.00 ","$0.00 ","$51.00 ","$80.78 ","$81.60 ","$0.00 ","$15.96 ","$0.00 ","$16.24 ","$0.00 "
"015-090","SUP","HCPCS C1713","","015-090  -  PLATE BN STD CRV TIMESH 12 HL TI CRNL","BOTH IP/OP","$486.63 ","$360.11 ","$0.00 ","$486.63 ","$218.98 ","$0.00 ","$101.42 ","$0.00 ","$0.00 ","$85.20 ","$486.63 ","$0.00 ","$243.31 ","$385.41 ","$389.30 ","$0.00 ","$76.16 ","$0.00 ","$77.47 ","$0.00 "
"015-090-C","SUP","HCPCS C1713","","015-090-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$486.63 ","$360.11 ","$0.00 ","$486.63 ","$218.98 ","$0.00 ","$101.42 ","$0.00 ","$0.00 ","$85.20 ","$486.63 ","$0.00 ","$243.31 ","$385.41 ","$389.30 ","$0.00 ","$76.16 ","$0.00 ","$77.47 ","$0.00 "
"015-1006","SUP","Custom 27203010","","015-1006  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$265.63 ","$196.57 ","$0.00 ","$265.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$265.63 ","$0.00 ","$132.81 ","$210.38 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-102L","SUP","HCPCS C1713","","015-102L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-102R","SUP","HCPCS C1713","","015-102R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-104L","SUP","HCPCS C1713","","015-104L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-104R","SUP","HCPCS C1713","","015-104R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-105L","SUP","HCPCS C1713","","015-105L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"015-105R","SUP","HCPCS C1713","","015-105R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"015-106L","SUP","HCPCS C1713","","015-106L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-106R","SUP","HCPCS C1713","","015-106R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-107R","SUP","HCPCS C1713","","015-107R  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"015-1206","SUP","Custom 27203010","","015-1206  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$267.75 ","$198.14 ","$0.00 ","$267.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-1208","SUP","Custom 27203010","","015-1208  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$267.75 ","$198.14 ","$0.00 ","$267.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-130","SUP","HCPCS C1713","","015-130  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"015-1304","SUP","Custom 27203010","","015-1304  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$252.88 ","$187.13 ","$0.00 ","$252.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.88 ","$0.00 ","$126.44 ","$200.28 ","$202.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-1306","SUP","Custom 27203010","","015-1306  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$252.88 ","$187.13 ","$0.00 ","$252.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.88 ","$0.00 ","$126.44 ","$200.28 ","$202.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-1308","SUP","Custom 27203010","","015-1308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$267.75 ","$198.14 ","$0.00 ","$267.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-1312","SUP","Custom 27203010","","015-1312  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$225.25 ","$166.69 ","$0.00 ","$225.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.25 ","$0.00 ","$112.63 ","$178.40 ","$180.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-132","SUP","HCPCS C1713","","015-132  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"015-160","SUP","HCPCS C1713","","015-160  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"015-161","SUP","HCPCS C1713","","015-161  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"015-2001-4","SUP","HCPCS C1781","","015-2001-4  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,519.38 ","$1,124.34 ","$0.00 ","$1,519.38 ","$683.72 ","$0.00 ","$316.68 ","$0.00 ","$0.00 ","$266.03 ","$1,519.38 ","$0.00 ","$759.69 ","$1,203.35 ","$1,215.50 ","$0.00 ","$237.78 ","$0.00 ","$241.88 ","$0.00 "
"015-2001-4-C","SUP","HCPCS C1713","","015-2001-4-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,468.38 ","$1,086.60 ","$0.00 ","$1,468.38 ","$660.77 ","$0.00 ","$306.05 ","$0.00 ","$0.00 ","$257.10 ","$1,468.38 ","$0.00 ","$734.19 ","$1,162.96 ","$1,174.70 ","$0.00 ","$229.80 ","$0.00 ","$233.77 ","$0.00 "
"015-2001-5","SUP","HCPCS C1713","","015-2001-5  -  PLATE BN 11CMX7.5CMX5MM GRIDMESH TI CRNM HERNIATED CRV DISK","BOTH IP/OP","$1,489.63 ","$1,102.33 ","$0.00 ","$1,489.63 ","$670.33 ","$0.00 ","$310.48 ","$0.00 ","$0.00 ","$260.82 ","$1,489.63 ","$0.00 ","$744.81 ","$1,179.79 ","$1,191.70 ","$0.00 ","$233.13 ","$0.00 ","$237.15 ","$0.00 "
"015-2001-5-C","SUP","HCPCS C1713","","015-2001-5-C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,538.50 ","$1,138.49 ","$0.00 ","$1,538.50 ","$692.33 ","$0.00 ","$320.66 ","$0.00 ","$0.00 ","$269.38 ","$1,538.50 ","$0.00 ","$769.25 ","$1,218.49 ","$1,230.80 ","$0.00 ","$240.78 ","$0.00 ","$244.93 ","$0.00 "
"015-2010","SUP","HCPCS C1713","","015-2010  -  PLATE BN SQ RECT 8MM TIMESH MESH TI CRNM 1.5MM SCR","BOTH IP/OP","$1,230.38 ","$910.48 ","$0.00 ","$1,230.38 ","$553.67 ","$0.00 ","$256.44 ","$0.00 ","$0.00 ","$215.43 ","$1,230.38 ","$0.00 ","$615.19 ","$974.46 ","$984.30 ","$0.00 ","$192.55 ","$0.00 ","$195.88 ","$0.00 "
"0152-0218S","SUP","Custom 27803010","","0152-0218S  -  WIRE FX 1.8MM 310MM STRL KRSH CNDYL SCR","BOTH IP/OP","$192.10 ","$142.15 ","$0.00 ","$207.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.63 ","$0.00 ","$103.81 ","$164.44 ","$166.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-2050","SUP","Custom 27203010","","015-2050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,241.00 ","$918.34 ","$0.00 ","$1,241.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,241.00 ","$0.00 ","$620.50 ","$982.87 ","$992.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-230","SUP","HCPCS C1713","","015-230  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$384.63 ","$284.63 ","$0.00 ","$384.63 ","$173.08 ","$0.00 ","$80.17 ","$0.00 ","$0.00 ","$67.34 ","$384.63 ","$0.00 ","$192.31 ","$304.63 ","$307.70 ","$0.00 ","$60.19 ","$0.00 ","$61.23 ","$0.00 "
"015-233","SUP","HCPCS C1713","","015-233  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$384.63 ","$284.63 ","$0.00 ","$384.63 ","$173.08 ","$0.00 ","$80.17 ","$0.00 ","$0.00 ","$67.34 ","$384.63 ","$0.00 ","$192.31 ","$304.63 ","$307.70 ","$0.00 ","$60.19 ","$0.00 ","$61.23 ","$0.00 "
"015-234","SUP","HCPCS C1713","","015-234  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$384.63 ","$284.63 ","$0.00 ","$384.63 ","$173.08 ","$0.00 ","$80.17 ","$0.00 ","$0.00 ","$67.34 ","$384.63 ","$0.00 ","$192.31 ","$304.63 ","$307.70 ","$0.00 ","$60.19 ","$0.00 ","$61.23 ","$0.00 "
"015-236","SUP","HCPCS C1713","","015-236  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$363.38 ","$268.90 ","$0.00 ","$363.38 ","$163.52 ","$0.00 ","$75.74 ","$0.00 ","$0.00 ","$63.62 ","$363.38 ","$0.00 ","$181.69 ","$287.80 ","$290.70 ","$0.00 ","$56.87 ","$0.00 ","$57.85 ","$0.00 "
"015-237","SUP","HCPCS C1713","","015-237  -  PLATE BN 2Y 5MM TIMESH 3X3 HL TI CRNL 1.5MM SCR","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$169.26 ","$0.00 ","$78.39 ","$0.00 ","$0.00 ","$65.86 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$58.86 ","$0.00 ","$59.88 ","$0.00 "
"015-246","SUP","HCPCS C1713","","015-246  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$233.75 ","$172.98 ","$0.00 ","$233.75 ","$105.19 ","$0.00 ","$48.72 ","$0.00 ","$0.00 ","$40.93 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$36.58 ","$0.00 ","$37.21 ","$0.00 "
"015-247","SUP","HCPCS C1713","","015-247  -  PLATE BN STRG 5MM TIMESH 2X2 HL TI CRNMXF 1.5MM SCR","BOTH IP/OP","$233.75 ","$172.98 ","$0.00 ","$233.75 ","$105.19 ","$0.00 ","$48.72 ","$0.00 ","$0.00 ","$40.93 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$36.58 ","$0.00 ","$37.21 ","$0.00 "
"015-255","SUP","HCPCS C1713","","015-255  -  PLATE BN X TIMESH TI CRNM 1.5MM SCR","BOTH IP/OP","$384.63 ","$284.63 ","$0.00 ","$384.63 ","$173.08 ","$0.00 ","$80.17 ","$0.00 ","$0.00 ","$67.34 ","$384.63 ","$0.00 ","$192.31 ","$304.63 ","$307.70 ","$0.00 ","$60.19 ","$0.00 ","$61.23 ","$0.00 "
"015-257","SUP","HCPCS C1713","","015-257  -  PLATE BN STD SM SQ TIMESH 4 HL TI CRNL 1.5MM SCR","BOTH IP/OP","$393.13 ","$290.92 ","$0.00 ","$393.13 ","$176.91 ","$0.00 ","$81.94 ","$0.00 ","$0.00 ","$68.83 ","$393.13 ","$0.00 ","$196.56 ","$311.36 ","$314.50 ","$0.00 ","$61.52 ","$0.00 ","$62.59 ","$0.00 "
"015-257-C","SUP","HCPCS C1713","","015-257-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$414.38 ","$306.64 ","$0.00 ","$414.38 ","$186.47 ","$0.00 ","$86.37 ","$0.00 ","$0.00 ","$72.55 ","$414.38 ","$0.00 ","$207.19 ","$328.19 ","$331.50 ","$0.00 ","$64.85 ","$0.00 ","$65.97 ","$0.00 "
"015-258","SUP","HCPCS C1713","","015-258  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$401.63 ","$297.21 ","$0.00 ","$401.63 ","$180.73 ","$0.00 ","$83.71 ","$0.00 ","$0.00 ","$70.32 ","$401.63 ","$0.00 ","$200.81 ","$318.09 ","$321.30 ","$0.00 ","$62.85 ","$0.00 ","$63.94 ","$0.00 "
"015-260-11","SUP","HCPCS C1781","","015-260-11  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$431.38 ","$319.22 ","$0.00 ","$431.38 ","$194.12 ","$0.00 ","$89.91 ","$0.00 ","$0.00 ","$75.53 ","$431.38 ","$0.00 ","$215.69 ","$341.65 ","$345.10 ","$0.00 ","$67.51 ","$0.00 ","$68.67 ","$0.00 "
"015-260-14","SUP","HCPCS C1781","","015-260-14  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$431.38 ","$319.22 ","$0.00 ","$431.38 ","$194.12 ","$0.00 ","$89.91 ","$0.00 ","$0.00 ","$75.53 ","$431.38 ","$0.00 ","$215.69 ","$341.65 ","$345.10 ","$0.00 ","$67.51 ","$0.00 ","$68.67 ","$0.00 "
"015-260-18","SUP","HCPCS C1781","","015-260-18  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$465.38 ","$344.38 ","$0.00 ","$465.38 ","$209.42 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$81.48 ","$465.38 ","$0.00 ","$232.69 ","$368.58 ","$372.30 ","$0.00 ","$72.83 ","$0.00 ","$74.09 ","$0.00 "
"015-260-25","SUP","Custom 27803010","","015-260-25  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$558.88 ","$413.57 ","$0.00 ","$558.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$558.88 ","$0.00 ","$279.44 ","$442.63 ","$447.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-262-14","SUP","Custom 27803010","","015-262-14  -  COVER BUR HL 14MM TIMESH FAN BLDE TI CRNL","BOTH IP/OP","$431.38 ","$319.22 ","$0.00 ","$431.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$431.38 ","$0.00 ","$215.69 ","$341.65 ","$345.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-262-16","SUP","Custom 27803010","","015-262-16  -  LG BURR HOLE CVR.","BOTH IP/OP","$320.63 ","$237.27 ","$0.00 ","$320.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.63 ","$0.00 ","$160.31 ","$253.94 ","$256.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-262-18","SUP","Custom 27803010","","015-262-18  -  COVER BUR HL 18MM TIMESH FAN BLDE TI CRNMXF 1.5MM SCR","BOTH IP/OP","$439.88 ","$325.51 ","$0.00 ","$439.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$439.88 ","$0.00 ","$219.94 ","$348.38 ","$351.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"015-273","SUP","HCPCS C1713","","015-273  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$618.38 ","$457.60 ","$0.00 ","$618.38 ","$278.27 ","$0.00 ","$128.88 ","$0.00 ","$0.00 ","$108.27 ","$618.38 ","$0.00 ","$309.19 ","$489.76 ","$494.70 ","$0.00 ","$96.78 ","$0.00 ","$98.45 ","$0.00 "
"015-275","SUP","HCPCS C1713","","015-275  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$433.50 ","$320.79 ","$0.00 ","$433.50 ","$195.08 ","$0.00 ","$90.35 ","$0.00 ","$0.00 ","$75.90 ","$433.50 ","$0.00 ","$216.75 ","$343.33 ","$346.80 ","$0.00 ","$67.84 ","$0.00 ","$69.01 ","$0.00 "
"015-276","SUP","HCPCS C1713","","015-276  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$454.75 ","$336.52 ","$0.00 ","$454.75 ","$204.64 ","$0.00 ","$94.78 ","$0.00 ","$0.00 ","$79.62 ","$454.75 ","$0.00 ","$227.38 ","$360.16 ","$363.80 ","$0.00 ","$71.17 ","$0.00 ","$72.40 ","$0.00 "
"016-100","SUP","Custom 27803010","","016-100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,436.50 ","$1,063.01 ","$0.00 ","$1,436.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,436.50 ","$0.00 ","$718.25 ","$1,137.71 ","$1,149.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"016-120","SUP","Custom 27803010","","016-120  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,967.75 ","$1,456.14 ","$0.00 ","$1,967.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,967.75 ","$0.00 ","$983.88 ","$1,558.46 ","$1,574.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"016-128","SUP","Custom 27803010","","016-128  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,646.88 ","$1,218.69 ","$0.00 ","$1,646.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,646.88 ","$0.00 ","$823.44 ","$1,304.33 ","$1,317.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"016-152","SUP","Custom 27803010","","016-152  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,171.75 ","$1,607.10 ","$0.00 ","$2,171.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,171.75 ","$0.00 ","$1,085.88 ","$1,720.03 ","$1,737.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"016-200","SUP","Custom 27803010","","016-200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,069.38 ","$3,011.34 ","$0.00 ","$4,069.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,069.38 ","$0.00 ","$2,034.69 ","$3,222.95 ","$3,255.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0166L30","SUP","HCPCS C1729","","CATHETER URINARY BARDEX LUBRICATH FOLEY 30FR 30ML 2 WAY 2 ST","BOTH IP/OP","$9.58 ","$7.09 ","$0.00 ","$9.58 ","$5.20 ","$0.00 ","$2.00 ","$0.00 ","$0.00 ","$1.68 ","$9.58 ","$0.00 ","$4.79 ","$7.59 ","$7.66 ","$0.00 ","$1.50 ","$0.00 ","$1.52 ","$0.00 "
"0166SI20","SUP","Custom 27203010","","0166SI20  -  CATHETER URTH 20FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0166SI28","SUP","Custom 27203010","","0166SI28  -  CATHETER URTH 28FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0167L18","SUP","Custom 27203010","","0167L18  -  CATHETER URETHRAL 18FR FOLEY 3 WAY ROUND TIP 2 STAGGERED EYE","BOTH IP/OP","$21.20 ","$15.69 ","$0.00 ","$21.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$0.00 ","$10.60 ","$16.79 ","$16.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0167L20","SUP","Custom 27203010","","0167L20  -  CATHETER URETHRAL STANDARD 20FR 3 WAY 2 STAGGER DRAIN EYE","BOTH IP/OP","$21.20 ","$15.69 ","$0.00 ","$21.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$0.00 ","$10.60 ","$16.79 ","$16.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0167L22","SUP","Custom 27203010","","0167L22  -  CATHETER URETHRAL STANDARD 22FR 3 WAY 2 STAGGER DRAIN EYE","BOTH IP/OP","$21.20 ","$15.69 ","$0.00 ","$21.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.20 ","$0.00 ","$10.60 ","$16.79 ","$16.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0196L16","SUP","Custom 27203010","","0196L16  -  CATHETER URTH 16FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$31.03 ","$0.00 ","$0.00 ","$6.13 ","$0.00 ","$0.00 ","$0.00 ","$31.03 ","$0.00 ","$15.51 ","$24.58 ","$24.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0196L18","SUP","Custom 27203010","","0196L18  -  CATHETER URTH 18FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0196L20","SUP","Custom 27203010","","0196L20  -  CATHETER URTH 20FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN","BOTH IP/OP","$352.80 ","$261.07 ","$0.00 ","$73.53 ","$0.00 ","$0.00 ","$73.53 ","$0.00 ","$0.00 ","$0.00 ","$29.55 ","$0.00 ","$14.78 ","$23.40 ","$23.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0196L22","SUP","Custom 27203010","","0196L22  -  CATHETER URTH 22FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN","BOTH IP/OP","$29.40 ","$21.76 ","$0.00 ","$29.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.40 ","$0.00 ","$14.70 ","$23.28 ","$23.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.00024.001","SUP","Custom 27203010","","02.00024.001  -  BIT DRILL 145MM 4.3MM NCB SHRT STD FEM SS QC NONSTRL","BOTH IP/OP","$230.75 ","$170.76 ","$0.00 ","$230.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.75 ","$0.00 ","$115.38 ","$182.75 ","$184.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.001.300","SUP","HCPCS C1713","","02.001.300  -  PLATE BONE CURVE 242X17.5X5.2MM 10 HOLE LP PRECONTOUR","BOTH IP/OP","$3,079.88 ","$2,279.11 ","$0.00 ","$2,990.18 ","$1,345.58 ","$0.00 ","$641.92 ","$0.00 ","$0.00 ","$523.56 ","$2,990.18 ","$0.00 ","$1,495.09 ","$2,368.22 ","$2,392.14 ","$0.00 ","$454.33 ","$0.00 ","$476.04 ","$0.00 "
"02.001.300S","SUP","HCPCS C1713","","02.001.300S  -  PLATE 242MM SS 4.5MM SCR 10 HOLE CVD LCP BONE LEFT CNDYLR","BOTH IP/OP","$3,171.25 ","$2,346.73 ","$0.00 ","$3,609.93 ","$1,624.47 ","$0.00 ","$660.97 ","$0.00 ","$0.00 ","$632.07 ","$3,609.93 ","$0.00 ","$1,804.96 ","$2,859.06 ","$2,887.94 ","$0.00 ","$564.95 ","$0.00 ","$574.70 ","$0.00 "
"02.001.302","SUP","HCPCS C1713","","02.001.302  -  PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL","BOTH IP/OP","$3,144.53 ","$2,326.95 ","$0.00 ","$3,052.95 ","$1,373.83 ","$0.00 ","$655.40 ","$0.00 ","$0.00 ","$534.55 ","$3,052.95 ","$0.00 ","$1,526.48 ","$2,417.94 ","$2,442.36 ","$0.00 ","$463.87 ","$0.00 ","$486.03 ","$0.00 "
"02.001.304","SUP","HCPCS C1713","","02.001.304  -  PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL","BOTH IP/OP","$3,210.60 ","$2,375.84 ","$0.00 ","$3,117.10 ","$1,402.70 ","$0.00 ","$669.17 ","$0.00 ","$0.00 ","$545.78 ","$3,117.10 ","$0.00 ","$1,558.55 ","$2,468.74 ","$2,493.68 ","$0.00 ","$473.62 ","$0.00 ","$496.24 ","$0.00 "
"02.001.304S","SUP","HCPCS C1713","","02.001.304S  -  PLATE 314MM SS 4.5MM SCR 14 HOLE CVD LCK LCP BONE LEFT","BOTH IP/OP","$3,301.98 ","$2,443.47 ","$0.00 ","$3,759.18 ","$1,691.63 ","$0.00 ","$688.21 ","$0.00 ","$0.00 ","$658.20 ","$3,759.18 ","$0.00 ","$1,879.59 ","$2,977.27 ","$3,007.34 ","$0.00 ","$588.31 ","$0.00 ","$598.46 ","$0.00 "
"02.001.306","SUP","HCPCS C1713","","02.001.306  -  PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL","BOTH IP/OP","$3,272.45 ","$2,421.61 ","$0.00 ","$3,177.15 ","$1,429.72 ","$0.00 ","$682.06 ","$0.00 ","$0.00 ","$556.29 ","$3,177.15 ","$0.00 ","$1,588.58 ","$2,516.30 ","$2,541.72 ","$0.00 ","$482.74 ","$0.00 ","$505.80 ","$0.00 "
"02.001.308","SUP","HCPCS C1713","","02.001.308  -  PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL","BOTH IP/OP","$3,453.78 ","$2,555.80 ","$0.00 ","$3,353.20 ","$1,508.94 ","$0.00 ","$719.85 ","$0.00 ","$0.00 ","$587.12 ","$3,353.20 ","$0.00 ","$1,676.60 ","$2,655.73 ","$2,682.56 ","$0.00 ","$509.49 ","$0.00 ","$533.83 ","$0.00 "
"02.001.308S","SUP","HCPCS C1713","","02.001.308S  -  PLATE 386MM SS 4.5MM SCR 18 HOLE CVD LCK LCP BONE LEFT","BOTH IP/OP","$3,545.15 ","$2,623.41 ","$0.00 ","$3,908.45 ","$1,758.80 ","$0.00 ","$738.90 ","$0.00 ","$0.00 ","$684.34 ","$3,908.45 ","$0.00 ","$1,954.23 ","$3,095.49 ","$3,126.76 ","$0.00 ","$611.67 ","$0.00 ","$622.23 ","$0.00 "
"02.001.320","SUP","HCPCS C1713","","02.001.320  -  PLATE BN CRV 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL","BOTH IP/OP","$3,079.88 ","$2,279.11 ","$0.00 ","$2,990.18 ","$1,345.58 ","$0.00 ","$641.92 ","$0.00 ","$0.00 ","$523.56 ","$2,990.18 ","$0.00 ","$1,495.09 ","$2,368.22 ","$2,392.14 ","$0.00 ","$454.33 ","$0.00 ","$476.04 ","$0.00 "
"02.001.322","SUP","HCPCS C1713","","02.001.322  -  PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL","BOTH IP/OP","$3,144.53 ","$2,326.95 ","$0.00 ","$3,052.95 ","$1,373.83 ","$0.00 ","$655.40 ","$0.00 ","$0.00 ","$534.55 ","$3,052.95 ","$0.00 ","$1,526.48 ","$2,417.94 ","$2,442.36 ","$0.00 ","$463.87 ","$0.00 ","$486.03 ","$0.00 "
"02.001.324","SUP","HCPCS C1713","","02.001.324  -  PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL","BOTH IP/OP","$3,210.60 ","$2,375.84 ","$0.00 ","$3,117.10 ","$1,402.70 ","$0.00 ","$669.17 ","$0.00 ","$0.00 ","$545.78 ","$3,117.10 ","$0.00 ","$1,558.55 ","$2,468.74 ","$2,493.68 ","$0.00 ","$473.62 ","$0.00 ","$496.24 ","$0.00 "
"02.001.326","SUP","HCPCS C1713","","02.001.326  -  PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL","BOTH IP/OP","$3,272.45 ","$2,421.61 ","$0.00 ","$3,177.15 ","$1,429.72 ","$0.00 ","$682.06 ","$0.00 ","$0.00 ","$556.29 ","$3,177.15 ","$0.00 ","$1,588.58 ","$2,516.30 ","$2,541.72 ","$0.00 ","$482.74 ","$0.00 ","$505.80 ","$0.00 "
"02.001.328","SUP","HCPCS C1713","","02.001.328  -  PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL","BOTH IP/OP","$3,453.78 ","$2,555.80 ","$0.00 ","$3,353.20 ","$1,508.94 ","$0.00 ","$719.85 ","$0.00 ","$0.00 ","$587.12 ","$3,353.20 ","$0.00 ","$1,676.60 ","$2,655.73 ","$2,682.56 ","$0.00 ","$509.49 ","$0.00 ","$533.83 ","$0.00 "
"02.001.330S","SUP","HCPCS C1713","","02.001.330S  -  PLATE BN CRV 422X17.5X5.2MM STRL LCP CMBN 20 HL LOPRFL","BOTH IP/OP","$3,597.18 ","$2,661.91 ","$0.00 ","$3,492.40 ","$1,571.58 ","$0.00 ","$749.74 ","$0.00 ","$0.00 ","$611.49 ","$3,492.40 ","$0.00 ","$1,746.20 ","$2,765.98 ","$2,793.92 ","$0.00 ","$530.64 ","$0.00 ","$555.99 ","$0.00 "
"02.001.332S","SUP","HCPCS C1713","","02.001.332S  -  PLATE BN CRV 458X17.5X5.2MM STRL LCP CMBN 22 HL LOPRFL","BOTH IP/OP","$3,654.80 ","$2,704.55 ","$0.00 ","$3,548.35 ","$1,596.76 ","$0.00 ","$761.75 ","$0.00 ","$0.00 ","$621.29 ","$3,548.35 ","$0.00 ","$1,774.18 ","$2,810.29 ","$2,838.68 ","$0.00 ","$539.14 ","$0.00 ","$564.90 ","$0.00 "
"02.007.000S","SUP","Custom 27203010","","02.007.000S  -  NAIL INTRAMEDULLARY END CAP STAINLESS STEEL OLECRANON","BOTH IP/OP","$1,210.30 ","$895.62 ","$0.00 ","$1,175.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,175.05 ","$0.00 ","$587.53 ","$930.64 ","$940.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.007.001","SUP","HCPCS C1713","","02.007.001  -  NAIL INTRAMEDULLARY OSTMY IMPLANT STAINLESS STEEL OLECRANON","BOTH IP/OP","$684.75 ","$506.72 ","$0.00 ","$684.75 ","$308.14 ","$0.00 ","$142.72 ","$0.00 ","$0.00 ","$119.89 ","$684.75 ","$0.00 ","$342.38 ","$542.32 ","$547.80 ","$0.00 ","$107.16 ","$0.00 ","$109.01 ","$0.00 "
"02.03150.044","SUP","HCPCS C1713","","02.03150.044  -  SCREW BONE 44MM CORT","BOTH IP/OP","$344.50 ","$254.93 ","$0.00 ","$344.50 ","$155.03 ","$0.00 ","$71.80 ","$0.00 ","$0.00 ","$60.32 ","$344.50 ","$0.00 ","$172.25 ","$272.84 ","$275.60 ","$0.00 ","$53.91 ","$0.00 ","$54.84 ","$0.00 "
"02.03150.048","SUP","HCPCS C1713","","02.03150.048  -  SCREW BONE 48MM TI CORT","BOTH IP/OP","$344.50 ","$254.93 ","$0.00 ","$344.50 ","$155.03 ","$0.00 ","$71.80 ","$0.00 ","$0.00 ","$60.32 ","$344.50 ","$0.00 ","$172.25 ","$272.84 ","$275.60 ","$0.00 ","$53.91 ","$0.00 ","$54.84 ","$0.00 "
"02.03150.055","SUP","HCPCS C1713","","02.03150.055  -  SCREW BONE 55MM CORT","BOTH IP/OP","$344.50 ","$254.93 ","$0.00 ","$344.50 ","$155.03 ","$0.00 ","$71.80 ","$0.00 ","$0.00 ","$60.32 ","$344.50 ","$0.00 ","$172.25 ","$272.84 ","$275.60 ","$0.00 ","$53.91 ","$0.00 ","$54.84 ","$0.00 "
"02.03150.300","SUP","HCPCS C1713","","02.03150.300  -  SCREW BONE 3.5MM 8MM NCB M8 PROX HUM PROTASUL-64 LCK IM NAIL","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$143.33 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"02.03152.055","SUP","HCPCS C1713","","02.03152.055  -  SCREW BONE 5MM 55MM 32MM NCB PROTASUL 64 CANC FEM SLFTAP","BOTH IP/OP","$295.75 ","$218.86 ","$0.00 ","$295.75 ","$133.09 ","$0.00 ","$61.64 ","$0.00 ","$0.00 ","$51.78 ","$295.75 ","$0.00 ","$147.88 ","$234.23 ","$236.60 ","$0.00 ","$46.28 ","$0.00 ","$47.08 ","$0.00 "
"02.03152.065","SUP","HCPCS C1713","","02.03152.065  -  SCREW BONE 5MM 65MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL","BOTH IP/OP","$295.75 ","$218.86 ","$0.00 ","$295.75 ","$133.09 ","$0.00 ","$61.64 ","$0.00 ","$0.00 ","$51.78 ","$295.75 ","$0.00 ","$147.88 ","$234.23 ","$236.60 ","$0.00 ","$46.28 ","$0.00 ","$47.08 ","$0.00 "
"02.03152.080","SUP","HCPCS C1713","","02.03152.080  -  SCREW BONE 5MM 80MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL","BOTH IP/OP","$295.75 ","$218.86 ","$0.00 ","$295.75 ","$133.09 ","$0.00 ","$61.64 ","$0.00 ","$0.00 ","$51.78 ","$295.75 ","$0.00 ","$147.88 ","$234.23 ","$236.60 ","$0.00 ","$46.28 ","$0.00 ","$47.08 ","$0.00 "
"02.03152.085","SUP","HCPCS C1713","","02.03152.085  -  SCREW BONE 5MM 85MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL","BOTH IP/OP","$295.75 ","$218.86 ","$0.00 ","$295.75 ","$133.09 ","$0.00 ","$61.64 ","$0.00 ","$0.00 ","$51.78 ","$295.75 ","$0.00 ","$147.88 ","$234.23 ","$236.60 ","$0.00 ","$46.28 ","$0.00 ","$47.08 ","$0.00 "
"02.03260.109","SUP","HCPCS C1713","","02.03260.109  -  PLATE 246MM PROTASUL-64 9 HOLE NCB-DF BONE LEFT FEM NONSTRL","BOTH IP/OP","$2,957.50 ","$2,188.55 ","$0.00 ","$2,957.50 ","$1,330.88 ","$0.00 ","$616.42 ","$0.00 ","$0.00 ","$517.83 ","$2,957.50 ","$0.00 ","$1,478.75 ","$2,342.34 ","$2,366.00 ","$0.00 ","$462.85 ","$0.00 ","$470.83 ","$0.00 "
"02.100.004","SUP","HCPCS C1713","","02.100.004  -  PLATE BN 57X10X3.4MM NS CMBN 4 HL LCK LOPRFL COAX SS PUBIC","BOTH IP/OP","$1,478.80 ","$1,094.31 ","$0.00 ","$1,435.73 ","$646.08 ","$0.00 ","$308.22 ","$0.00 ","$0.00 ","$251.38 ","$1,435.73 ","$0.00 ","$717.86 ","$1,137.10 ","$1,148.58 ","$0.00 ","$218.15 ","$0.00 ","$228.57 ","$0.00 "
"02.100.006","SUP","HCPCS C1713","","02.100.006  -  PLATE BN 78X10X3.4MM NS CMBN 6 HL LCK LOPRFL COAX SS PUBIC","BOTH IP/OP","$1,620.78 ","$1,199.38 ","$0.00 ","$1,573.55 ","$708.10 ","$0.00 ","$337.81 ","$0.00 ","$0.00 ","$275.52 ","$1,573.55 ","$0.00 ","$786.78 ","$1,246.25 ","$1,258.84 ","$0.00 ","$239.09 ","$0.00 ","$250.51 ","$0.00 "
"02.100.014","SUP","HCPCS C1713","","02.100.014  -  PLATE BONE 57MM 4 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS","BOTH IP/OP","$1,623.58 ","$1,201.45 ","$0.00 ","$1,576.28 ","$709.32 ","$0.00 ","$338.39 ","$0.00 ","$0.00 ","$275.99 ","$1,576.28 ","$0.00 ","$788.14 ","$1,248.41 ","$1,261.02 ","$0.00 ","$239.50 ","$0.00 ","$250.94 ","$0.00 "
"02.100.016","SUP","HCPCS C1713","","02.100.016  -  PLATE BONE 78MM 6 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS","BOTH IP/OP","$1,781.00 ","$1,317.94 ","$0.00 ","$1,729.15 ","$778.12 ","$0.00 ","$371.20 ","$0.00 ","$0.00 ","$302.76 ","$1,729.15 ","$0.00 ","$864.58 ","$1,369.49 ","$1,383.32 ","$0.00 ","$262.73 ","$0.00 ","$275.28 ","$0.00 "
"02.100.020","SUP","HCPCS C1713","","02.100.020  -  PLATE BONE LOCK LCP STAINLESS STEEL NAVICULAR NONSTRL","BOTH IP/OP","$1,464.73 ","$1,083.90 ","$0.00 ","$1,422.08 ","$639.93 ","$0.00 ","$305.29 ","$0.00 ","$0.00 ","$248.99 ","$1,422.08 ","$0.00 ","$711.04 ","$1,126.29 ","$1,137.66 ","$0.00 ","$216.07 ","$0.00 ","$226.39 ","$0.00 "
"02.100.021","SUP","HCPCS C1713","","02.100.021  -  PLATE BONE LOCK STAINLESS STEEL LEFT CUBOID NONSTRL 2.4/2.7","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"02.100.022","SUP","HCPCS C1713","","02.100.022  -  PLATE BONE LOCK STAINLESS STEEL RIGHT CUBOID NONSTRL 2.4/2.7","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"02.100.023","SUP","HCPCS C1713","","02.100.023  -  PLATE BONE LOCK STAINLESS STEEL TALAR NONSTRL 2.4/2.7 MM","BOTH IP/OP","$1,408.50 ","$1,042.29 ","$0.00 ","$1,367.48 ","$615.36 ","$0.00 ","$293.57 ","$0.00 ","$0.00 ","$239.43 ","$1,367.48 ","$0.00 ","$683.74 ","$1,083.04 ","$1,093.98 ","$0.00 ","$207.78 ","$0.00 ","$217.70 ","$0.00 "
"02.100.032S","SUP","HCPCS C1713","","02.100.032S  -  PLATE BN 100MM STRL LCP CMBN 6 HL SS ANKL ANT 4.5MM CORT","BOTH IP/OP","$2,015.98 ","$1,491.83 ","$0.00 ","$1,957.25 ","$880.76 ","$0.00 ","$420.18 ","$0.00 ","$0.00 ","$342.70 ","$1,957.25 ","$0.00 ","$978.63 ","$1,550.14 ","$1,565.80 ","$0.00 ","$297.39 ","$0.00 ","$311.59 ","$0.00 "
"02.100.033S","SUP","HCPCS C1713","","02.100.033S  -  PLATE BONE 116MM 7 HOLE LCP STAINLESS STEEL ANTERIOR ANKLE","BOTH IP/OP","$2,069.95 ","$1,531.76 ","$0.00 ","$2,009.65 ","$904.34 ","$0.00 ","$431.43 ","$0.00 ","$0.00 ","$351.87 ","$2,009.65 ","$0.00 ","$1,004.83 ","$1,591.64 ","$1,607.72 ","$0.00 ","$305.35 ","$0.00 ","$319.94 ","$0.00 "
"02.100.103","SUP","HCPCS C1713","","02.100.103  -  PLATE BN STRG 39X10.1X3.7MM NS CMBN 3 HL LCK LOPRFL RECON SS","BOTH IP/OP","$983.98 ","$728.15 ","$0.00 ","$955.33 ","$429.90 ","$0.00 ","$205.08 ","$0.00 ","$0.00 ","$167.27 ","$955.33 ","$0.00 ","$477.66 ","$756.62 ","$764.26 ","$0.00 ","$145.15 ","$0.00 ","$152.09 ","$0.00 "
"02.100.104","SUP","HCPCS C1713","","02.100.104  -  PLATE BN STRG 52X10.1X3.7MM NS CMBN 4 HL LCK LOPRFL RECON SS","BOTH IP/OP","$1,033.18 ","$764.55 ","$0.00 ","$1,003.10 ","$451.40 ","$0.00 ","$215.34 ","$0.00 ","$0.00 ","$175.63 ","$1,003.10 ","$0.00 ","$501.55 ","$794.46 ","$802.48 ","$0.00 ","$152.41 ","$0.00 ","$159.69 ","$0.00 "
"02.100.105","SUP","HCPCS C1713","","02.100.105  -  PLATE BN STRG 65X10.1X3.7MM NS CMBN 5 HL LCK LOPRFL RECON SS","BOTH IP/OP","$1,079.58 ","$798.89 ","$0.00 ","$1,048.13 ","$471.66 ","$0.00 ","$225.01 ","$0.00 ","$0.00 ","$183.52 ","$1,048.13 ","$0.00 ","$524.06 ","$830.12 ","$838.50 ","$0.00 ","$159.25 ","$0.00 ","$166.86 ","$0.00 "
"02.100.106","SUP","HCPCS C1713","","02.100.106  -  PLATE BN STRG 78X10.1X3.7MM NS CMBN 6 HL LCK LOPRFL RECON SS","BOTH IP/OP","$1,124.55 ","$832.17 ","$0.00 ","$1,091.80 ","$491.31 ","$0.00 ","$234.38 ","$0.00 ","$0.00 ","$191.17 ","$1,091.80 ","$0.00 ","$545.90 ","$864.71 ","$873.44 ","$0.00 ","$165.89 ","$0.00 ","$173.81 ","$0.00 "
"02.100.107","SUP","HCPCS C1713","","02.100.107  -  PLATE BN STRG 91X10.1X3.7MM NS CMBN 7 HL LCK LOPRFL RECON SS","BOTH IP/OP","$1,168.13 ","$864.42 ","$0.00 ","$1,134.10 ","$510.35 ","$0.00 ","$243.47 ","$0.00 ","$0.00 ","$198.57 ","$1,134.10 ","$0.00 ","$567.05 ","$898.21 ","$907.28 ","$0.00 ","$172.32 ","$0.00 ","$180.55 ","$0.00 "
"02.100.108","SUP","HCPCS C1713","","02.100.108  -  PLATE BN STRG 104X10.1X3.7MM NS CMBN 8 HL LCK LOPRFL RECON","BOTH IP/OP","$1,213.13 ","$897.72 ","$0.00 ","$1,177.78 ","$530.00 ","$0.00 ","$252.85 ","$0.00 ","$0.00 ","$206.22 ","$1,177.78 ","$0.00 ","$588.89 ","$932.80 ","$942.22 ","$0.00 ","$178.95 ","$0.00 ","$187.50 ","$0.00 "
"02.100.109","SUP","HCPCS C1713","","02.100.109  -  PLATE BN STRG 117X10.1X3.7MM NS CMBN 9 HL LCK LOPRFL RECON","BOTH IP/OP","$1,258.10 ","$930.99 ","$0.00 ","$1,221.45 ","$549.65 ","$0.00 ","$262.22 ","$0.00 ","$0.00 ","$213.87 ","$1,221.45 ","$0.00 ","$610.73 ","$967.39 ","$977.16 ","$0.00 ","$185.59 ","$0.00 ","$194.45 ","$0.00 "
"02.100.110","SUP","HCPCS C1713","","02.100.110  -  PLATE BN STRG 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL RECON","BOTH IP/OP","$1,304.48 ","$965.32 ","$0.00 ","$1,266.50 ","$569.93 ","$0.00 ","$271.89 ","$0.00 ","$0.00 ","$221.75 ","$1,266.50 ","$0.00 ","$633.25 ","$1,003.07 ","$1,013.20 ","$0.00 ","$192.43 ","$0.00 ","$201.63 ","$0.00 "
"02.100.111","SUP","HCPCS C1713","","02.100.111  -  PLATE BN STRG 143X10.1X3.7MM NS CMBN 11 HL LCK LOPRFL RECON","BOTH IP/OP","$1,349.48 ","$998.62 ","$0.00 ","$1,310.15 ","$589.57 ","$0.00 ","$281.26 ","$0.00 ","$0.00 ","$229.40 ","$1,310.15 ","$0.00 ","$655.08 ","$1,037.64 ","$1,048.12 ","$0.00 ","$199.07 ","$0.00 ","$208.58 ","$0.00 "
"02.100.112","SUP","HCPCS C1713","","02.100.112  -  PLATE BN STRG 156X10.1X3.7MM NS CMBN 12 HL LCK LOPRFL RECON","BOTH IP/OP","$1,393.05 ","$1,030.86 ","$0.00 ","$1,352.48 ","$608.61 ","$0.00 ","$290.35 ","$0.00 ","$0.00 ","$236.81 ","$1,352.48 ","$0.00 ","$676.24 ","$1,071.16 ","$1,081.98 ","$0.00 ","$205.50 ","$0.00 ","$215.31 ","$0.00 "
"02.100.113","SUP","HCPCS C1713","","02.100.113  -  PLATE BN STRG 169X10.1X3.7MM NS CMBN 13 HL LCK LOPRFL RECON","BOTH IP/OP","$1,439.43 ","$1,065.18 ","$0.00 ","$1,397.50 ","$628.88 ","$0.00 ","$300.01 ","$0.00 ","$0.00 ","$244.69 ","$1,397.50 ","$0.00 ","$698.75 ","$1,106.82 ","$1,118.00 ","$0.00 ","$212.34 ","$0.00 ","$222.48 ","$0.00 "
"02.100.114","SUP","HCPCS C1713","","02.100.114  -  PLATE BN STRG 182X10.1X3.7MM NS CMBN 14 HL LCK LOPRFL RECON","BOTH IP/OP","$1,487.23 ","$1,100.55 ","$0.00 ","$1,443.90 ","$649.76 ","$0.00 ","$309.97 ","$0.00 ","$0.00 ","$252.82 ","$1,443.90 ","$0.00 ","$721.95 ","$1,143.57 ","$1,155.12 ","$0.00 ","$219.39 ","$0.00 ","$229.87 ","$0.00 "
"02.100.115","SUP","HCPCS C1713","","02.100.115  -  PLATE BN STRG 195X10.1X3.7MM NS CMBN 15 HL LCK LOPRFL RECON","BOTH IP/OP","$1,532.20 ","$1,133.83 ","$0.00 ","$1,487.58 ","$669.41 ","$0.00 ","$319.35 ","$0.00 ","$0.00 ","$260.46 ","$1,487.58 ","$0.00 ","$743.79 ","$1,178.16 ","$1,190.06 ","$0.00 ","$226.03 ","$0.00 ","$236.82 ","$0.00 "
"02.100.116","SUP","HCPCS C1713","","02.100.116  -  PLATE BN STRG 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL RECON","BOTH IP/OP","$1,577.18 ","$1,167.11 ","$0.00 ","$1,531.25 ","$689.06 ","$0.00 ","$328.72 ","$0.00 ","$0.00 ","$268.11 ","$1,531.25 ","$0.00 ","$765.63 ","$1,212.75 ","$1,225.00 ","$0.00 ","$232.66 ","$0.00 ","$243.78 ","$0.00 "
"02.100.118","SUP","HCPCS C1713","","02.100.118  -  PLATE BN STRG 234X10.1X3.7MM NS CMBN 18 HL LCK LOPRFL RECON","BOTH IP/OP","$1,622.18 ","$1,200.41 ","$0.00 ","$1,574.93 ","$708.72 ","$0.00 ","$338.10 ","$0.00 ","$0.00 ","$275.76 ","$1,574.93 ","$0.00 ","$787.46 ","$1,247.34 ","$1,259.94 ","$0.00 ","$239.30 ","$0.00 ","$250.73 ","$0.00 "
"02.100.120","SUP","HCPCS C1713","","02.100.120  -  PLATE BN STRG 260X10.1X3.7MM NS CMBN 20 HL LCK LOPRFL RECON","BOTH IP/OP","$1,669.98 ","$1,235.79 ","$0.00 ","$1,621.33 ","$729.60 ","$0.00 ","$348.06 ","$0.00 ","$0.00 ","$283.88 ","$1,621.33 ","$0.00 ","$810.66 ","$1,284.09 ","$1,297.06 ","$0.00 ","$246.35 ","$0.00 ","$258.11 ","$0.00 "
"02.100.203","SUP","HCPCS C1713","","02.100.203  -  PLATE BONE WIDE ANGLE LP 39MM 3 HOLE RECONSTRUCTION","BOTH IP/OP","$607.25 ","$449.37 ","$0.00 ","$589.58 ","$265.31 ","$0.00 ","$126.57 ","$0.00 ","$0.00 ","$103.23 ","$589.58 ","$0.00 ","$294.79 ","$466.95 ","$471.66 ","$0.00 ","$89.58 ","$0.00 ","$93.86 ","$0.00 "
"02.100.204","SUP","HCPCS C1713","","02.100.204  -  PLATE BONE WIDE ANGLE LP 52MM 4 HOLE RECONSTRUCTION","BOTH IP/OP","$635.38 ","$470.18 ","$0.00 ","$616.88 ","$277.59 ","$0.00 ","$132.43 ","$0.00 ","$0.00 ","$108.01 ","$616.88 ","$0.00 ","$308.44 ","$488.57 ","$493.50 ","$0.00 ","$93.73 ","$0.00 ","$98.21 ","$0.00 "
"02.100.205","SUP","HCPCS C1713","","02.100.205  -  PLATE BONE WIDE ANGLE LP 65MM 5 HOLE RECONSTRUCTION","BOTH IP/OP","$662.08 ","$489.94 ","$0.00 ","$642.80 ","$289.26 ","$0.00 ","$137.99 ","$0.00 ","$0.00 ","$112.55 ","$642.80 ","$0.00 ","$321.40 ","$509.10 ","$514.24 ","$0.00 ","$97.67 ","$0.00 ","$102.33 ","$0.00 "
"02.100.206","SUP","HCPCS C1713","","02.100.206  -  PLATE BONE WIDE ANGLE LP 78MM 6 HOLE RECONSTRUCTION","BOTH IP/OP","$693.00 ","$512.82 ","$0.00 ","$672.83 ","$302.77 ","$0.00 ","$144.44 ","$0.00 ","$0.00 ","$117.81 ","$672.83 ","$0.00 ","$336.41 ","$532.88 ","$538.26 ","$0.00 ","$102.23 ","$0.00 ","$107.11 ","$0.00 "
"02.100.207","SUP","HCPCS C1713","","02.100.207  -  PLATE BONE WIDE ANGLE LP 91MM 7 HOLE RECONSTRUCTION","BOTH IP/OP","$721.13 ","$533.64 ","$0.00 ","$700.13 ","$315.06 ","$0.00 ","$150.30 ","$0.00 ","$0.00 ","$122.59 ","$700.13 ","$0.00 ","$350.06 ","$554.50 ","$560.10 ","$0.00 ","$106.38 ","$0.00 ","$111.46 ","$0.00 "
"02.100.208","SUP","HCPCS C1713","","02.100.208  -  PLATE BONE WIDE ANGLE 104MM 8 HOLE LP STAINLESS STEEL PELVIS","BOTH IP/OP","$747.83 ","$553.39 ","$0.00 ","$726.05 ","$326.72 ","$0.00 ","$155.87 ","$0.00 ","$0.00 ","$127.13 ","$726.05 ","$0.00 ","$363.03 ","$575.03 ","$580.84 ","$0.00 ","$110.32 ","$0.00 ","$115.59 ","$0.00 "
"02.100.209","SUP","HCPCS C1713","","02.100.209  -  PLATE BONE WIDE ANGLE LP 117MM 9 HOLE RECONSTRUCTION","BOTH IP/OP","$778.75 ","$576.28 ","$0.00 ","$756.08 ","$340.23 ","$0.00 ","$162.31 ","$0.00 ","$0.00 ","$132.38 ","$756.08 ","$0.00 ","$378.04 ","$598.82 ","$604.86 ","$0.00 ","$114.88 ","$0.00 ","$120.37 ","$0.00 "
"02.100.210","SUP","HCPCS C1713","","02.100.210  -  PLATE BONE WIDE ANGLE LP 130MM 10 HOLE RECONSTRUCTION","BOTH IP/OP","$808.28 ","$598.13 ","$0.00 ","$784.73 ","$353.13 ","$0.00 ","$168.46 ","$0.00 ","$0.00 ","$137.40 ","$784.73 ","$0.00 ","$392.36 ","$621.51 ","$627.78 ","$0.00 ","$119.23 ","$0.00 ","$124.93 ","$0.00 "
"02.100.211","SUP","HCPCS C1713","","02.100.211  -  PLATE BONE WIDE ANGLE LP 143MM 11 HOLE RECONSTRUCTION","BOTH IP/OP","$850.45 ","$629.33 ","$0.00 ","$825.68 ","$371.55 ","$0.00 ","$177.26 ","$0.00 ","$0.00 ","$144.57 ","$825.68 ","$0.00 ","$412.84 ","$653.94 ","$660.54 ","$0.00 ","$125.45 ","$0.00 ","$131.45 ","$0.00 "
"02.100.212","SUP","HCPCS C1713","","02.100.212  -  PLATE BN WA 156X10.1X3.85MM NS CMBN 12 HL RECON LOPRFL SS","BOTH IP/OP","$898.25 ","$664.71 ","$0.00 ","$872.08 ","$392.43 ","$0.00 ","$187.22 ","$0.00 ","$0.00 ","$152.69 ","$872.08 ","$0.00 ","$436.04 ","$690.69 ","$697.66 ","$0.00 ","$132.50 ","$0.00 ","$138.83 ","$0.00 "
"02.100.213","SUP","HCPCS C1713","","02.100.213  -  PLATE BONE WIDE ANGLE LP 169MM 13 HOLE RECONSTRUCTION","BOTH IP/OP","$944.63 ","$699.03 ","$0.00 ","$917.10 ","$412.70 ","$0.00 ","$196.88 ","$0.00 ","$0.00 ","$160.58 ","$917.10 ","$0.00 ","$458.55 ","$726.34 ","$733.68 ","$0.00 ","$139.35 ","$0.00 ","$146.00 ","$0.00 "
"02.100.214","SUP","HCPCS C1713","","02.100.214  -  PLATE BONE WIDE ANGLE LP 182MM 14 HOLE RECONSTRUCTION","BOTH IP/OP","$985.40 ","$729.20 ","$0.00 ","$956.70 ","$430.52 ","$0.00 ","$205.38 ","$0.00 ","$0.00 ","$167.51 ","$956.70 ","$0.00 ","$478.35 ","$757.71 ","$765.36 ","$0.00 ","$145.36 ","$0.00 ","$152.31 ","$0.00 "
"02.100.215","SUP","HCPCS C1713","","02.100.215  -  PLATE BONE WIDE ANGLE LP 195MM 15 HOLE RECONSTRUCTION","BOTH IP/OP","$1,034.60 ","$765.60 ","$0.00 ","$1,004.45 ","$452.00 ","$0.00 ","$215.64 ","$0.00 ","$0.00 ","$175.87 ","$1,004.45 ","$0.00 ","$502.23 ","$795.52 ","$803.56 ","$0.00 ","$152.62 ","$0.00 ","$159.91 ","$0.00 "
"02.100.216","SUP","HCPCS C1713","","02.100.216  -  PLATE BONE WIDE ANGLE LP 208MM 16 HOLE RECONSTRUCTION","BOTH IP/OP","$1,080.98 ","$799.93 ","$0.00 ","$1,049.50 ","$472.28 ","$0.00 ","$225.30 ","$0.00 ","$0.00 ","$183.76 ","$1,049.50 ","$0.00 ","$524.75 ","$831.20 ","$839.60 ","$0.00 ","$159.46 ","$0.00 ","$167.08 ","$0.00 "
"02.100.218","SUP","HCPCS C1713","","02.100.218  -  PLATE BONE WIDE ANGLE LP 234MM 18 HOLE RECONSTRUCTION","BOTH IP/OP","$1,127.38 ","$834.26 ","$0.00 ","$1,094.53 ","$492.54 ","$0.00 ","$234.97 ","$0.00 ","$0.00 ","$191.64 ","$1,094.53 ","$0.00 ","$547.26 ","$866.87 ","$875.62 ","$0.00 ","$166.30 ","$0.00 ","$174.25 ","$0.00 "
"02.100.220","SUP","HCPCS C1713","","02.100.220  -  PLATE BONE WIDE ANGLE LP 260MM 20 HOLE RECONSTRUCTION","BOTH IP/OP","$1,169.53 ","$865.45 ","$0.00 ","$1,135.48 ","$510.96 ","$0.00 ","$243.76 ","$0.00 ","$0.00 ","$198.81 ","$1,135.48 ","$0.00 ","$567.74 ","$899.30 ","$908.38 ","$0.00 ","$172.53 ","$0.00 ","$180.77 ","$0.00 "
"02.100.301","SUP","HCPCS C1713","","02.100.301  -  PLATE BONE 1 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL","BOTH IP/OP","$424.53 ","$314.15 ","$0.00 ","$412.15 ","$185.47 ","$0.00 ","$88.48 ","$0.00 ","$0.00 ","$72.16 ","$412.15 ","$0.00 ","$206.08 ","$326.42 ","$329.72 ","$0.00 ","$62.62 ","$0.00 ","$65.61 ","$0.00 "
"02.100.302","SUP","HCPCS C1713","","02.100.302  -  PLATE BONE 2 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL","BOTH IP/OP","$461.08 ","$341.20 ","$0.00 ","$447.65 ","$201.44 ","$0.00 ","$96.10 ","$0.00 ","$0.00 ","$78.38 ","$447.65 ","$0.00 ","$223.83 ","$354.54 ","$358.12 ","$0.00 ","$68.01 ","$0.00 ","$71.27 ","$0.00 "
"02.100.303","SUP","HCPCS C1713","","02.100.303  -  PLATE BONE 3 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL","BOTH IP/OP","$506.05 ","$374.48 ","$0.00 ","$491.30 ","$221.09 ","$0.00 ","$105.47 ","$0.00 ","$0.00 ","$86.02 ","$491.30 ","$0.00 ","$245.65 ","$389.11 ","$393.04 ","$0.00 ","$74.65 ","$0.00 ","$78.21 ","$0.00 "
"02.100.325S","SUP","HCPCS C1713","","02.100.325S  -  PLATE BONE STANDARD QUADRILATERAL SURFACE STAINLESS STEEL","BOTH IP/OP","$736.58 ","$545.07 ","$0.00 ","$715.13 ","$321.81 ","$0.00 ","$153.52 ","$0.00 ","$0.00 ","$125.21 ","$715.13 ","$0.00 ","$357.56 ","$566.38 ","$572.10 ","$0.00 ","$108.66 ","$0.00 ","$113.85 ","$0.00 "
"02.100.326S","SUP","HCPCS C1713","","02.100.326S  -  PLATE BONE LONG QUADRILATERAL SURFACE STAINLESS STEEL PELVIS","BOTH IP/OP","$811.08 ","$600.20 ","$0.00 ","$787.45 ","$354.35 ","$0.00 ","$169.05 ","$0.00 ","$0.00 ","$137.88 ","$787.45 ","$0.00 ","$393.73 ","$623.66 ","$629.96 ","$0.00 ","$119.65 ","$0.00 ","$125.36 ","$0.00 "
"02.100.327S","SUP","HCPCS C1713","","02.100.327S  -  PLATE BONE SHORT LP QUADRILATERAL SURFACE STAINLESS STEEL","BOTH IP/OP","$669.10 ","$495.13 ","$0.00 ","$649.63 ","$292.33 ","$0.00 ","$139.46 ","$0.00 ","$0.00 ","$113.74 ","$649.63 ","$0.00 ","$324.81 ","$514.51 ","$519.70 ","$0.00 ","$98.70 ","$0.00 ","$103.42 ","$0.00 "
"02.100.360","SUP","HCPCS C1713","","02.100.360  -  PLATE BONE J CVD 130X10.1X3.7MM 10 HOLE LOCKING COAXIAL","BOTH IP/OP","$1,356.50 ","$1,003.81 ","$0.00 ","$1,316.98 ","$592.64 ","$0.00 ","$282.73 ","$0.00 ","$0.00 ","$230.59 ","$1,316.98 ","$0.00 ","$658.49 ","$1,043.05 ","$1,053.58 ","$0.00 ","$200.10 ","$0.00 ","$209.66 ","$0.00 "
"02.100.361","SUP","HCPCS C1713","","02.100.361  -  PLATE BN 88MM RDS J 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL","BOTH IP/OP","$1,356.50 ","$1,003.81 ","$0.00 ","$1,316.98 ","$592.64 ","$0.00 ","$282.73 ","$0.00 ","$0.00 ","$230.59 ","$1,316.98 ","$0.00 ","$658.49 ","$1,043.05 ","$1,053.58 ","$0.00 ","$200.10 ","$0.00 ","$209.66 ","$0.00 "
"02.100.362","SUP","HCPCS C1713","","02.100.362  -  PLATE BONE 156MM 12 HOLE J LOCKING LP RECONSTRUCTION LCP","BOTH IP/OP","$1,432.40 ","$1,059.98 ","$0.00 ","$1,390.68 ","$625.80 ","$0.00 ","$298.55 ","$0.00 ","$0.00 ","$243.50 ","$1,390.68 ","$0.00 ","$695.34 ","$1,101.42 ","$1,112.54 ","$0.00 ","$211.30 ","$0.00 ","$221.40 ","$0.00 "
"02.100.363","SUP","HCPCS C1713","","02.100.363  -  PLATE BONE J CVD 156X10.1X3.7MM 12 HOLE LOCKING COAXIAL","BOTH IP/OP","$1,432.40 ","$1,059.98 ","$0.00 ","$1,390.68 ","$625.80 ","$0.00 ","$298.55 ","$0.00 ","$0.00 ","$243.50 ","$1,390.68 ","$0.00 ","$695.34 ","$1,101.42 ","$1,112.54 ","$0.00 ","$211.30 ","$0.00 ","$221.40 ","$0.00 "
"02.100.364","SUP","HCPCS C1713","","02.100.364  -  PLATE BONE J CVD 182X10.1X3.7MM 14 HOLE LOCKING COAXIAL","BOTH IP/OP","$1,509.73 ","$1,117.20 ","$0.00 ","$1,465.75 ","$659.59 ","$0.00 ","$314.66 ","$0.00 ","$0.00 ","$256.64 ","$1,465.75 ","$0.00 ","$732.88 ","$1,160.87 ","$1,172.60 ","$0.00 ","$222.71 ","$0.00 ","$233.35 ","$0.00 "
"02.100.365","SUP","HCPCS C1713","","02.100.365  -  PLATE BONE 182MM 14 HOLE J LOCKING LP RECONSTRUCTION LCP","BOTH IP/OP","$1,509.73 ","$1,117.20 ","$0.00 ","$1,465.75 ","$659.59 ","$0.00 ","$314.66 ","$0.00 ","$0.00 ","$256.64 ","$1,465.75 ","$0.00 ","$732.88 ","$1,160.87 ","$1,172.60 ","$0.00 ","$222.71 ","$0.00 ","$233.35 ","$0.00 "
"02.100.366","SUP","HCPCS C1713","","02.100.366  -  PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL","BOTH IP/OP","$1,596.88 ","$1,181.69 ","$0.00 ","$1,550.35 ","$697.66 ","$0.00 ","$332.83 ","$0.00 ","$0.00 ","$271.45 ","$1,550.35 ","$0.00 ","$775.18 ","$1,227.88 ","$1,240.28 ","$0.00 ","$235.56 ","$0.00 ","$246.82 ","$0.00 "
"02.100.367","SUP","HCPCS C1713","","02.100.367  -  PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL","BOTH IP/OP","$1,596.88 ","$1,181.69 ","$0.00 ","$1,550.35 ","$697.66 ","$0.00 ","$332.83 ","$0.00 ","$0.00 ","$271.45 ","$1,550.35 ","$0.00 ","$775.18 ","$1,227.88 ","$1,240.28 ","$0.00 ","$235.56 ","$0.00 ","$246.82 ","$0.00 "
"02.102.001","SUP","HCPCS C1713","","02.102.001  -  PLATE BONE UNIVERSAL 131MM LOCKING STABILIZATION LCP","BOTH IP/OP","$1,234.20 ","$913.31 ","$0.00 ","$1,198.25 ","$539.21 ","$0.00 ","$257.24 ","$0.00 ","$0.00 ","$209.80 ","$1,198.25 ","$0.00 ","$599.13 ","$949.01 ","$958.60 ","$0.00 ","$182.06 ","$0.00 ","$190.76 ","$0.00 "
"02.104.004","SUP","HCPCS C1713","","02.104.004  -  PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD","BOTH IP/OP","$2,292.68 ","$1,696.58 ","$0.00 ","$2,225.90 ","$1,001.66 ","$0.00 ","$477.85 ","$0.00 ","$0.00 ","$389.74 ","$2,225.90 ","$0.00 ","$1,112.95 ","$1,762.91 ","$1,780.72 ","$0.00 ","$338.21 ","$0.00 ","$354.36 ","$0.00 "
"02.104.006","SUP","HCPCS C1713","","02.104.006  -  PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$2,623.03 ","$1,941.04 ","$0.00 ","$2,546.63 ","$1,145.98 ","$0.00 ","$546.70 ","$0.00 ","$0.00 ","$445.89 ","$2,546.63 ","$0.00 ","$1,273.31 ","$2,016.93 ","$2,037.30 ","$0.00 ","$386.94 ","$0.00 ","$405.42 ","$0.00 "
"02.104.008","SUP","HCPCS C1713","","02.104.008  -  PLATE BONE 194MM 8 HOLE LOCKING TAPER HEAD LIMIT CONTACT","BOTH IP/OP","$2,783.28 ","$2,059.63 ","$0.00 ","$2,702.20 ","$1,215.99 ","$0.00 ","$580.10 ","$0.00 ","$0.00 ","$473.13 ","$2,702.20 ","$0.00 ","$1,351.10 ","$2,140.14 ","$2,161.76 ","$0.00 ","$410.58 ","$0.00 ","$430.19 ","$0.00 "
"02.104.010","SUP","HCPCS C1713","","02.104.010  -  PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL EXTART RIGHT","BOTH IP/OP","$2,946.33 ","$2,180.28 ","$0.00 ","$2,860.53 ","$1,287.24 ","$0.00 ","$614.09 ","$0.00 ","$0.00 ","$500.86 ","$2,860.53 ","$0.00 ","$1,430.26 ","$2,265.54 ","$2,288.42 ","$0.00 ","$434.63 ","$0.00 ","$455.40 ","$0.00 "
"02.104.012","SUP","HCPCS C1713","","02.104.012  -  PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD","BOTH IP/OP","$3,366.63 ","$2,491.31 ","$0.00 ","$3,268.58 ","$1,470.86 ","$0.00 ","$701.69 ","$0.00 ","$0.00 ","$572.30 ","$3,268.58 ","$0.00 ","$1,634.29 ","$2,588.72 ","$2,614.86 ","$0.00 ","$496.63 ","$0.00 ","$520.36 ","$0.00 "
"02.104.014","SUP","HCPCS C1713","","02.104.014  -  PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD","BOTH IP/OP","$3,705.40 ","$2,742.00 ","$0.00 ","$3,597.48 ","$1,618.86 ","$0.00 ","$772.30 ","$0.00 ","$0.00 ","$629.89 ","$3,597.48 ","$0.00 ","$1,798.74 ","$2,849.20 ","$2,877.98 ","$0.00 ","$546.61 ","$0.00 ","$572.72 ","$0.00 "
"02.104.024","SUP","HCPCS C1713","","02.104.024  -  PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD","BOTH IP/OP","$2,292.68 ","$1,696.58 ","$0.00 ","$2,225.90 ","$1,001.66 ","$0.00 ","$477.85 ","$0.00 ","$0.00 ","$389.74 ","$2,225.90 ","$0.00 ","$1,112.95 ","$1,762.91 ","$1,780.72 ","$0.00 ","$338.21 ","$0.00 ","$354.36 ","$0.00 "
"02.104.026","SUP","HCPCS C1713","","02.104.026  -  PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL LEFT DISTAL","BOTH IP/OP","$2,623.03 ","$1,941.04 ","$0.00 ","$2,546.63 ","$1,145.98 ","$0.00 ","$546.70 ","$0.00 ","$0.00 ","$445.89 ","$2,546.63 ","$0.00 ","$1,273.31 ","$2,016.93 ","$2,037.30 ","$0.00 ","$386.94 ","$0.00 ","$405.42 ","$0.00 "
"02.104.028","SUP","HCPCS C1713","","02.104.028  -  PLATE BONE 194MM 8 HOLE LCP STAINLESS STEEL LEFT DISTAL","BOTH IP/OP","$2,783.28 ","$2,059.63 ","$0.00 ","$2,702.20 ","$1,215.99 ","$0.00 ","$580.10 ","$0.00 ","$0.00 ","$473.13 ","$2,702.20 ","$0.00 ","$1,351.10 ","$2,140.14 ","$2,161.76 ","$0.00 ","$410.58 ","$0.00 ","$430.19 ","$0.00 "
"02.104.030","SUP","HCPCS C1713","","02.104.030  -  PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL LEFT DISTAL","BOTH IP/OP","$2,946.33 ","$2,180.28 ","$0.00 ","$2,860.53 ","$1,287.24 ","$0.00 ","$614.09 ","$0.00 ","$0.00 ","$500.86 ","$2,860.53 ","$0.00 ","$1,430.26 ","$2,265.54 ","$2,288.42 ","$0.00 ","$434.63 ","$0.00 ","$455.40 ","$0.00 "
"02.104.032","SUP","HCPCS C1713","","02.104.032  -  PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD","BOTH IP/OP","$3,366.63 ","$2,491.31 ","$0.00 ","$3,268.58 ","$1,470.86 ","$0.00 ","$701.69 ","$0.00 ","$0.00 ","$572.30 ","$3,268.58 ","$0.00 ","$1,634.29 ","$2,588.72 ","$2,614.86 ","$0.00 ","$496.63 ","$0.00 ","$520.36 ","$0.00 "
"02.104.034","SUP","HCPCS C1713","","02.104.034  -  PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD","BOTH IP/OP","$3,705.40 ","$2,742.00 ","$0.00 ","$3,597.48 ","$1,618.86 ","$0.00 ","$772.30 ","$0.00 ","$0.00 ","$629.89 ","$3,597.48 ","$0.00 ","$1,798.74 ","$2,849.20 ","$2,877.98 ","$0.00 ","$546.61 ","$0.00 ","$572.72 ","$0.00 "
"02.107.002","SUP","HCPCS C1713","","02.107.002  -  PLATE BN 73MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS OLCRN","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"02.107.002S","SUP","HCPCS C1713","","02.107.002S  -  PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"02.107.102","SUP","HCPCS C1713","","02.107.102  -  PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL ELBOW","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"02.107.102S","SUP","HCPCS C1713","","02.107.102S  -  PLATE BN 73MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"02.107.202S","SUP","HCPCS C1713","","02.107.202S  -  PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.204","SUP","HCPCS C1713","","02.107.204  -  PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN","BOTH IP/OP","$1,945.48 ","$1,439.66 ","$0.00 ","$1,888.83 ","$849.97 ","$0.00 ","$405.49 ","$0.00 ","$0.00 ","$330.72 ","$1,888.83 ","$0.00 ","$944.41 ","$1,495.95 ","$1,511.06 ","$0.00 ","$286.99 ","$0.00 ","$300.70 ","$0.00 "
"02.107.204S","SUP","HCPCS C1713","","02.107.204S  -  PLATE BONE 116MM 4 HOLE VAR ANG LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.206S","SUP","HCPCS C1713","","02.107.206S  -  PLATE BONE 142MM 2 HOLE VAR ANG RECONSTRUCTION SEGMENT","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.208S","SUP","HCPCS C1713","","02.107.208S  -  PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.302S","SUP","HCPCS C1713","","02.107.302S  -  PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL LEFT","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.304","SUP","HCPCS C1713","","02.107.304  -  PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN","BOTH IP/OP","$1,945.48 ","$1,439.66 ","$0.00 ","$1,888.83 ","$849.97 ","$0.00 ","$405.49 ","$0.00 ","$0.00 ","$330.72 ","$1,888.83 ","$0.00 ","$944.41 ","$1,495.95 ","$1,511.06 ","$0.00 ","$286.99 ","$0.00 ","$300.70 ","$0.00 "
"02.107.304S","SUP","HCPCS C1713","","02.107.304S  -  PLATE BONE 116MM 4 HOLE VAR ANG RECONSTRUCTION SEGMENT","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.306S","SUP","HCPCS C1713","","02.107.306S  -  PLATE BONE 142MM 6 HOLE VAR ANG STAINLESS STEEL LEFT","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.308S","SUP","HCPCS C1713","","02.107.308S  -  PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,036.85 ","$1,507.27 ","$0.00 ","$1,977.53 ","$889.89 ","$0.00 ","$424.53 ","$0.00 ","$0.00 ","$346.25 ","$1,977.53 ","$0.00 ","$988.76 ","$1,566.20 ","$1,582.02 ","$0.00 ","$300.47 ","$0.00 ","$314.82 ","$0.00 "
"02.107.408S","SUP","HCPCS C1713","","02.107.408S  -  PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT","BOTH IP/OP","$2,329.23 ","$1,723.63 ","$0.00 ","$2,261.40 ","$1,017.63 ","$0.00 ","$485.47 ","$0.00 ","$0.00 ","$395.95 ","$2,261.40 ","$0.00 ","$1,130.70 ","$1,791.03 ","$1,809.12 ","$0.00 ","$343.60 ","$0.00 ","$360.01 ","$0.00 "
"02.107.506S","SUP","HCPCS C1713","","02.107.506S  -  PLATE BN 131MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,261.40 ","$1,673.44 ","$0.00 ","$2,261.40 ","$1,017.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$395.95 ","$2,261.40 ","$0.00 ","$1,130.70 ","$1,791.03 ","$1,809.12 ","$0.00 ","$343.60 ","$0.00 ","$360.01 ","$0.00 "
"02.107.508","SUP","HCPCS C1713","","02.107.508  -  PLATE BN 157MM NS LCP CMBN 8 HL VA TPR TIP RND PRFL SS ULNA","BOTH IP/OP","$2,237.85 ","$1,656.01 ","$0.00 ","$2,172.68 ","$977.70 ","$0.00 ","$466.42 ","$0.00 ","$0.00 ","$380.42 ","$2,172.68 ","$0.00 ","$1,086.34 ","$1,720.76 ","$1,738.14 ","$0.00 ","$330.12 ","$0.00 ","$345.89 ","$0.00 "
"02.107.508S","SUP","HCPCS C1713","","02.107.508S  -  PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT","BOTH IP/OP","$2,329.23 ","$1,723.63 ","$0.00 ","$2,261.40 ","$1,017.63 ","$0.00 ","$485.47 ","$0.00 ","$0.00 ","$395.95 ","$2,261.40 ","$0.00 ","$1,130.70 ","$1,791.03 ","$1,809.12 ","$0.00 ","$343.60 ","$0.00 ","$360.01 ","$0.00 "
"02.107.512S","SUP","HCPCS C1713","","02.107.512S  -  PLATE BONE 211MM 12 HOLE VAR ANG RECONSTRUCTION SEGMENT","BOTH IP/OP","$2,329.23 ","$1,723.63 ","$0.00 ","$2,261.40 ","$1,017.63 ","$0.00 ","$485.47 ","$0.00 ","$0.00 ","$395.95 ","$2,261.40 ","$0.00 ","$1,130.70 ","$1,791.03 ","$1,809.12 ","$0.00 ","$343.60 ","$0.00 ","$360.01 ","$0.00 "
"02.108.200","SUP","Custom 27203010","","02.108.200  -  GUIDEWIRE ORTHOPEDIC THREAD 3MM 230MM DRILL TIP NONSTRL","BOTH IP/OP","$36.13 ","$26.74 ","$0.00 ","$35.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.08 ","$0.00 ","$17.54 ","$27.78 ","$28.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.108.310","SUP","HCPCS C1713","","02.108.310  -  PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP","BOTH IP/OP","$1,005.08 ","$743.76 ","$0.00 ","$975.80 ","$439.11 ","$0.00 ","$209.48 ","$0.00 ","$0.00 ","$170.85 ","$975.80 ","$0.00 ","$487.90 ","$772.83 ","$780.64 ","$0.00 ","$148.26 ","$0.00 ","$155.35 ","$0.00 "
"02.108.311","SUP","HCPCS C1713","","02.108.311  -  PLATE BONE 110D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP","BOTH IP/OP","$1,005.08 ","$743.76 ","$0.00 ","$975.80 ","$439.11 ","$0.00 ","$209.48 ","$0.00 ","$0.00 ","$170.85 ","$975.80 ","$0.00 ","$487.90 ","$772.83 ","$780.64 ","$0.00 ","$148.26 ","$0.00 ","$155.35 ","$0.00 "
"02.108.313","SUP","HCPCS C1713","","02.108.313  -  PLATE BN 120D 75X19-12MM NS LCP 4 HL SHFT SS PED HIP 3.5MM","BOTH IP/OP","$1,005.08 ","$743.76 ","$0.00 ","$975.80 ","$439.11 ","$0.00 ","$209.48 ","$0.00 ","$0.00 ","$170.85 ","$975.80 ","$0.00 ","$487.90 ","$772.83 ","$780.64 ","$0.00 ","$148.26 ","$0.00 ","$155.35 ","$0.00 "
"02.108.315","SUP","HCPCS C1713","","02.108.315  -  PLATE BONE 150D 60X18.5MM 3 HOLE LCP STAINLESS STEEL","BOTH IP/OP","$1,005.08 ","$743.76 ","$0.00 ","$975.80 ","$439.11 ","$0.00 ","$209.48 ","$0.00 ","$0.00 ","$170.85 ","$975.80 ","$0.00 ","$487.90 ","$772.83 ","$780.64 ","$0.00 ","$148.26 ","$0.00 ","$155.35 ","$0.00 "
"02.108.320","SUP","HCPCS C1713","","02.108.320  -  PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP","BOTH IP/OP","$1,044.43 ","$772.88 ","$0.00 ","$1,014.00 ","$456.30 ","$0.00 ","$217.68 ","$0.00 ","$0.00 ","$177.54 ","$1,014.00 ","$0.00 ","$507.00 ","$803.09 ","$811.20 ","$0.00 ","$154.07 ","$0.00 ","$161.43 ","$0.00 "
"02.108.321","SUP","HCPCS C1713","","02.108.321  -  PLATE BONE 110D 5 HOLE LCP STAINLESS STEEL PEDIATRIC HIP","BOTH IP/OP","$1,044.43 ","$772.88 ","$0.00 ","$1,014.00 ","$456.30 ","$0.00 ","$217.68 ","$0.00 ","$0.00 ","$177.54 ","$1,014.00 ","$0.00 ","$507.00 ","$803.09 ","$811.20 ","$0.00 ","$154.07 ","$0.00 ","$161.43 ","$0.00 "
"02.108.323","SUP","HCPCS C1713","","02.108.323  -  PLATE BN 120D 95X23-15MM NS LCP 4 HL SHFT SS PED HIP 5MM SCR","BOTH IP/OP","$1,044.43 ","$772.88 ","$0.00 ","$1,014.00 ","$456.30 ","$0.00 ","$217.68 ","$0.00 ","$0.00 ","$177.54 ","$1,014.00 ","$0.00 ","$507.00 ","$803.09 ","$811.20 ","$0.00 ","$154.07 ","$0.00 ","$161.43 ","$0.00 "
"02.108.325","SUP","HCPCS C1713","","02.108.325  -  PLATE BONE 150D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP","BOTH IP/OP","$1,044.43 ","$772.88 ","$0.00 ","$1,014.00 ","$456.30 ","$0.00 ","$217.68 ","$0.00 ","$0.00 ","$177.54 ","$1,014.00 ","$0.00 ","$507.00 ","$803.09 ","$811.20 ","$0.00 ","$154.07 ","$0.00 ","$161.43 ","$0.00 "
"02.110.005","SUP","HCPCS C1713","","02.110.005  -  PLATE BN NS LCP 5 HL SHFT SS RDS RT VOLR DIST","BOTH IP/OP","$2,921.03 ","$2,161.56 ","$0.00 ","$2,835.95 ","$1,276.18 ","$0.00 ","$608.81 ","$0.00 ","$0.00 ","$496.55 ","$2,835.95 ","$0.00 ","$1,417.98 ","$2,246.07 ","$2,268.76 ","$0.00 ","$430.90 ","$0.00 ","$451.48 ","$0.00 "
"02.110.007","SUP","HCPCS C1713","","02.110.007  -  PLATE BN NS LCP 7 HL SHFT SS RDS RT VOLR DIST","BOTH IP/OP","$2,992.73 ","$2,214.62 ","$0.00 ","$2,905.55 ","$1,307.50 ","$0.00 ","$623.76 ","$0.00 ","$0.00 ","$508.74 ","$2,905.55 ","$0.00 ","$1,452.78 ","$2,301.20 ","$2,324.44 ","$0.00 ","$441.47 ","$0.00 ","$462.56 ","$0.00 "
"02.110.009","SUP","HCPCS C1713","","02.110.009  -  PLATE BN NS LCP 9 HL SHFT SS RDS RT VOLR DIST","BOTH IP/OP","$3,063.00 ","$2,266.62 ","$0.00 ","$2,973.80 ","$1,338.21 ","$0.00 ","$638.41 ","$0.00 ","$0.00 ","$520.69 ","$2,973.80 ","$0.00 ","$1,486.90 ","$2,355.25 ","$2,379.04 ","$0.00 ","$451.84 ","$0.00 ","$473.43 ","$0.00 "
"02.110.011","SUP","HCPCS C1713","","02.110.011  -  PLATE BN NS LCP 11 HL SHFT SS RDS RT VOLR DIST","BOTH IP/OP","$3,251.38 ","$2,406.02 ","$0.00 ","$3,156.68 ","$1,420.50 ","$0.00 ","$677.67 ","$0.00 ","$0.00 ","$552.71 ","$3,156.68 ","$0.00 ","$1,578.34 ","$2,500.09 ","$2,525.34 ","$0.00 ","$479.63 ","$0.00 ","$502.54 ","$0.00 "
"02.110.013S","SUP","HCPCS C1713","","02.110.013S  -  PLATE BONE 13 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS","BOTH IP/OP","$3,432.70 ","$2,540.20 ","$0.00 ","$3,332.73 ","$1,499.73 ","$0.00 ","$715.46 ","$0.00 ","$0.00 ","$583.53 ","$3,332.73 ","$0.00 ","$1,666.36 ","$2,639.52 ","$2,666.18 ","$0.00 ","$506.38 ","$0.00 ","$530.57 ","$0.00 "
"02.110.015S","SUP","HCPCS C1713","","02.110.015S  -  PLATE BONE 15 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS","BOTH IP/OP","$3,611.23 ","$2,672.31 ","$0.00 ","$3,506.05 ","$1,577.72 ","$0.00 ","$752.67 ","$0.00 ","$0.00 ","$613.88 ","$3,506.05 ","$0.00 ","$1,753.03 ","$2,776.79 ","$2,804.84 ","$0.00 ","$532.71 ","$0.00 ","$558.16 ","$0.00 "
"02.110.105","SUP","HCPCS C1713","","02.110.105  -  PLATE BN NS LCP 5 HL SHFT SS RDS LT VOLR DIST","BOTH IP/OP","$2,921.03 ","$2,161.56 ","$0.00 ","$2,835.95 ","$1,276.18 ","$0.00 ","$608.81 ","$0.00 ","$0.00 ","$496.55 ","$2,835.95 ","$0.00 ","$1,417.98 ","$2,246.07 ","$2,268.76 ","$0.00 ","$430.90 ","$0.00 ","$451.48 ","$0.00 "
"02.110.107","SUP","HCPCS C1713","","02.110.107  -  PLATE BN NS LCP 7 HL SHFT SS RDS LT VOLR DIST","BOTH IP/OP","$2,992.73 ","$2,214.62 ","$0.00 ","$2,905.55 ","$1,307.50 ","$0.00 ","$623.76 ","$0.00 ","$0.00 ","$508.74 ","$2,905.55 ","$0.00 ","$1,452.78 ","$2,301.20 ","$2,324.44 ","$0.00 ","$441.47 ","$0.00 ","$462.56 ","$0.00 "
"02.110.109","SUP","HCPCS C1713","","02.110.109  -  PLATE BN NS LCP 9 HL SHFT SS RDS LT VOLR DIST","BOTH IP/OP","$3,063.00 ","$2,266.62 ","$0.00 ","$2,973.80 ","$1,338.21 ","$0.00 ","$638.41 ","$0.00 ","$0.00 ","$520.69 ","$2,973.80 ","$0.00 ","$1,486.90 ","$2,355.25 ","$2,379.04 ","$0.00 ","$451.84 ","$0.00 ","$473.43 ","$0.00 "
"02.110.111","SUP","HCPCS C1713","","02.110.111  -  PLATE BN NS LCP 11 HL SHFT SS RDS LT VOLR DIST","BOTH IP/OP","$3,133.30 ","$2,318.64 ","$0.00 ","$3,042.03 ","$1,368.91 ","$0.00 ","$653.06 ","$0.00 ","$0.00 ","$532.63 ","$3,042.03 ","$0.00 ","$1,521.01 ","$2,409.29 ","$2,433.62 ","$0.00 ","$462.21 ","$0.00 ","$484.29 ","$0.00 "
"02.110.113S","SUP","HCPCS C1713","","02.110.113S  -  PLATE BONE 13 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR","BOTH IP/OP","$3,497.38 ","$2,588.06 ","$0.00 ","$3,395.50 ","$1,527.98 ","$0.00 ","$728.94 ","$0.00 ","$0.00 ","$594.52 ","$3,395.50 ","$0.00 ","$1,697.75 ","$2,689.24 ","$2,716.40 ","$0.00 ","$515.92 ","$0.00 ","$540.56 ","$0.00 "
"02.110.115S","SUP","HCPCS C1713","","02.110.115S  -  PLATE BONE 15 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR","BOTH IP/OP","$3,611.23 ","$2,672.31 ","$0.00 ","$3,506.05 ","$1,577.72 ","$0.00 ","$752.67 ","$0.00 ","$0.00 ","$613.88 ","$3,506.05 ","$0.00 ","$1,753.03 ","$2,776.79 ","$2,804.84 ","$0.00 ","$532.71 ","$0.00 ","$558.16 ","$0.00 "
"02.110.150","SUP","HCPCS C1713","","02.110.150  -  PLATE BN STD BND 118MM NS LCP FSN SS WRST","BOTH IP/OP","$3,145.95 ","$2,328.00 ","$0.00 ","$3,054.30 ","$1,374.44 ","$0.00 ","$655.69 ","$0.00 ","$0.00 ","$534.78 ","$3,054.30 ","$0.00 ","$1,527.15 ","$2,419.01 ","$2,443.44 ","$0.00 ","$464.08 ","$0.00 ","$486.24 ","$0.00 "
"02.110.151","SUP","HCPCS C1713","","02.110.151  -  PLATE BN SHRT BND 118MM NS LCP FSN SS WRST","BOTH IP/OP","$3,145.95 ","$2,328.00 ","$0.00 ","$3,054.30 ","$1,374.44 ","$0.00 ","$655.69 ","$0.00 ","$0.00 ","$534.78 ","$3,054.30 ","$0.00 ","$1,527.15 ","$2,419.01 ","$2,443.44 ","$0.00 ","$464.08 ","$0.00 ","$486.24 ","$0.00 "
"02.110.152","SUP","HCPCS C1713","","02.110.152  -  PLATE BONE STR 112MM FUSION LCP STAINLESS STEEL WRIST","BOTH IP/OP","$3,145.95 ","$2,328.00 ","$0.00 ","$3,054.30 ","$1,374.44 ","$0.00 ","$655.69 ","$0.00 ","$0.00 ","$534.78 ","$3,054.30 ","$0.00 ","$1,527.15 ","$2,419.01 ","$2,443.44 ","$0.00 ","$464.08 ","$0.00 ","$486.24 ","$0.00 "
"02.110.201","SUP","HCPCS C1713","","02.110.201  -  PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS RT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.110.202","SUP","HCPCS C1713","","02.110.202  -  PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS RT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.110.203","SUP","HCPCS C1713","","02.110.203  -  PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS LT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.110.204","SUP","HCPCS C1713","","02.110.204  -  PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS LT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.110.205","SUP","HCPCS C1713","","02.110.205  -  PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS RT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.110.206","SUP","HCPCS C1713","","02.110.206  -  PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS RT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.110.207","SUP","HCPCS C1713","","02.110.207  -  PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS LT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.110.208","SUP","HCPCS C1713","","02.110.208  -  PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS LT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.110.300","SUP","Custom 27203010","","02.110.300  -  WIRE FIX 1.8MM 150MM TROCAR POINT KWIRE STAINLESS STEEL","BOTH IP/OP","$15.18 ","$11.23 ","$0.00 ","$14.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.74 ","$0.00 ","$7.37 ","$11.67 ","$11.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.110.330","SUP","HCPCS C1713","","02.110.330  -  PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.331","SUP","HCPCS C1713","","02.110.331  -  PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.340","SUP","HCPCS C1713","","02.110.340  -  PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.341","SUP","HCPCS C1713","","02.110.341  -  PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.350","SUP","HCPCS C1713","","02.110.350  -  PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.351","SUP","HCPCS C1713","","02.110.351  -  PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.430","SUP","HCPCS C1713","","02.110.430  -  PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.431","SUP","HCPCS C1713","","02.110.431  -  PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.440","SUP","HCPCS C1713","","02.110.440  -  PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.441","SUP","HCPCS C1713","","02.110.441  -  PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.450","SUP","HCPCS C1713","","02.110.450  -  PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.451","SUP","HCPCS C1713","","02.110.451  -  PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.730","SUP","HCPCS C1713","","02.110.730  -  PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.731","SUP","HCPCS C1713","","02.110.731  -  PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.740","SUP","HCPCS C1713","","02.110.740  -  PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.741","SUP","HCPCS C1713","","02.110.741  -  PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.750","SUP","HCPCS C1713","","02.110.750  -  PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.751","SUP","HCPCS C1713","","02.110.751  -  PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.830","SUP","HCPCS C1713","","02.110.830  -  PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.831","SUP","HCPCS C1713","","02.110.831  -  PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND","BOTH IP/OP","$1,570.15 ","$1,161.91 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$327.26 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"02.110.840","SUP","HCPCS C1713","","02.110.840  -  PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.841","SUP","HCPCS C1713","","02.110.841  -  PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND","BOTH IP/OP","$1,619.35 ","$1,198.32 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$337.51 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"02.110.850","SUP","HCPCS C1713","","02.110.850  -  PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.110.851","SUP","HCPCS C1713","","02.110.851  -  PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND","BOTH IP/OP","$1,667.15 ","$1,233.69 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$347.48 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"02.111.500.01S","SUP","HCPCS C1713","","02.111.500.01S  -  PLATE BONE 1.25MM 150MM REDX SMALL STOP WIRE THREADED","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"02.111.500.10","SUP","HCPCS C1713","","02.111.500.10  -  WIRE REDX SMALL 1.25MM 150MM THREAD STOP STAINLESS STEEL","BOTH IP/OP","$32.19 ","$23.82 ","$0.00 ","$31.25 ","$14.06 ","$0.00 ","$6.71 ","$0.00 ","$0.00 ","$5.47 ","$31.25 ","$0.00 ","$15.63 ","$24.75 ","$25.00 ","$0.00 ","$4.75 ","$0.00 ","$4.98 ","$0.00 "
"02.111.501.01S","SUP","HCPCS C1713","","02.111.501.01S  -  PLATE BONE 1.25MM REDX WIRE LARGE STOP THREADED TIP LCP","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"02.111.501.10","SUP","HCPCS C1713","","02.111.501.10  -  WIRE REDX 1.25MM 150MM THREAD TIP LARGE STOP STAINLESS STEEL","BOTH IP/OP","$31.25 ","$23.13 ","$0.00 ","$31.25 ","$14.06 ","$0.00 ","$6.51 ","$0.00 ","$0.00 ","$5.47 ","$31.25 ","$0.00 ","$15.63 ","$24.75 ","$25.00 ","$0.00 ","$4.75 ","$0.00 ","$4.98 ","$0.00 "
"02.111.520","SUP","HCPCS C1713","","02.111.520  -  PLATE BONE 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP STAINLESS","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"02.111.521","SUP","HCPCS C1713","","02.111.521  -  PLATE BN NAR 42MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"02.111.530","SUP","HCPCS C1713","","02.111.530  -  PLATE BN NAR 51MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.111.531","SUP","HCPCS C1713","","02.111.531  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.111.540","SUP","HCPCS C1713","","02.111.540  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG SET LCP","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"02.111.541","SUP","HCPCS C1713","","02.111.541  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"02.111.550","SUP","HCPCS C1713","","02.111.550  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.111.551","SUP","HCPCS C1713","","02.111.551  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG SET LCP","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.111.620","SUP","HCPCS C1713","","02.111.620  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"02.111.621","SUP","HCPCS C1713","","02.111.621  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"02.111.630","SUP","HCPCS C1713","","02.111.630  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.111.630S","SUP","HCPCS C1713","","02.111.630S  -  PLATE BONE 58MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS","BOTH IP/OP","$1,965.15 ","$1,454.21 ","$0.00 ","$1,907.93 ","$858.57 ","$0.00 ","$409.59 ","$0.00 ","$0.00 ","$334.06 ","$1,907.93 ","$0.00 ","$953.96 ","$1,511.08 ","$1,526.34 ","$0.00 ","$289.89 ","$0.00 ","$303.74 ","$0.00 "
"02.111.631","SUP","HCPCS C1713","","02.111.631  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.111.631S","SUP","HCPCS C1713","","02.111.631S  -  PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS","BOTH IP/OP","$1,965.15 ","$1,454.21 ","$0.00 ","$1,907.93 ","$858.57 ","$0.00 ","$409.59 ","$0.00 ","$0.00 ","$334.06 ","$1,907.93 ","$0.00 ","$953.96 ","$1,511.08 ","$1,526.34 ","$0.00 ","$289.89 ","$0.00 ","$303.74 ","$0.00 "
"02.111.640","SUP","HCPCS C1713","","02.111.640  -  PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"02.111.641","SUP","HCPCS C1713","","02.111.641  -  PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"02.111.650","SUP","HCPCS C1713","","02.111.650  -  PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.111.651","SUP","HCPCS C1713","","02.111.651  -  PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.111.720","SUP","HCPCS C1713","","02.111.720  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"02.111.721","SUP","HCPCS C1713","","02.111.721  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"02.111.730","SUP","HCPCS C1713","","02.111.730  -  PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.111.731","SUP","HCPCS C1713","","02.111.731  -  PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"02.111.740","SUP","HCPCS C1713","","02.111.740  -  PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"02.111.741","SUP","HCPCS C1713","","02.111.741  -  PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"02.111.750","SUP","HCPCS C1713","","02.111.750  -  PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.111.751","SUP","HCPCS C1713","","02.111.751  -  PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"02.112.006","SUP","HCPCS C1713","","02.112.006  -  PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,623.58 ","$1,201.45 ","$0.00 ","$1,576.28 ","$709.32 ","$0.00 ","$338.39 ","$0.00 ","$0.00 ","$275.99 ","$1,576.28 ","$0.00 ","$788.14 ","$1,248.41 ","$1,261.02 ","$0.00 ","$239.50 ","$0.00 ","$250.94 ","$0.00 "
"02.112.007","SUP","HCPCS C1713","","02.112.007  -  PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,623.58 ","$1,201.45 ","$0.00 ","$1,576.28 ","$709.32 ","$0.00 ","$338.39 ","$0.00 ","$0.00 ","$275.99 ","$1,576.28 ","$0.00 ","$788.14 ","$1,248.41 ","$1,261.02 ","$0.00 ","$239.50 ","$0.00 ","$250.94 ","$0.00 "
"02.112.008","SUP","HCPCS C1713","","02.112.008  -  PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.009","SUP","HCPCS C1713","","02.112.009  -  PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.010","SUP","HCPCS C1713","","02.112.010  -  PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"02.112.011","SUP","HCPCS C1713","","02.112.011  -  PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"02.112.012","SUP","HCPCS C1713","","02.112.012  -  PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,677.00 ","$1,240.98 ","$0.00 ","$1,628.15 ","$732.67 ","$0.00 ","$349.53 ","$0.00 ","$0.00 ","$285.08 ","$1,628.15 ","$0.00 ","$814.08 ","$1,289.49 ","$1,302.52 ","$0.00 ","$247.38 ","$0.00 ","$259.20 ","$0.00 "
"02.112.013","SUP","HCPCS C1713","","02.112.013  -  PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,677.00 ","$1,240.98 ","$0.00 ","$1,628.15 ","$732.67 ","$0.00 ","$349.53 ","$0.00 ","$0.00 ","$285.08 ","$1,628.15 ","$0.00 ","$814.08 ","$1,289.49 ","$1,302.52 ","$0.00 ","$247.38 ","$0.00 ","$259.20 ","$0.00 "
"02.112.018","SUP","HCPCS C1713","","02.112.018  -  PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.019","SUP","HCPCS C1713","","02.112.019  -  PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.020","SUP","HCPCS C1713","","02.112.020  -  PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.021","SUP","HCPCS C1713","","02.112.021  -  PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.026","SUP","HCPCS C1713","","02.112.026  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.027","SUP","HCPCS C1713","","02.112.027  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.028","SUP","HCPCS C1713","","02.112.028  -  PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.029","SUP","HCPCS C1713","","02.112.029  -  PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.030","SUP","HCPCS C1713","","02.112.030  -  PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.031","SUP","HCPCS C1713","","02.112.031  -  PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.040","SUP","HCPCS C1713","","02.112.040  -  PLATE BONE 79MM 6 HOLE LCP STAINLESS STEEL ANTERIOR MEDIAL","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.041","SUP","HCPCS C1713","","02.112.041  -  PLATE BONE 91MM 7 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.042","SUP","HCPCS C1713","","02.112.042  -  PLATE BONE 8 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.045","SUP","HCPCS C1713","","02.112.045  -  PLATE BONE 77MM 7 HOLE VAR ANG LCP STAINLESS STEEL LATERAL","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.046","SUP","HCPCS C1713","","02.112.046  -  PLATE BONE 89MM 9 HOLE VAR ANG LCP STAINLESS STEEL LATERAL","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.047","SUP","HCPCS C1713","","02.112.047  -  PLATE BONE 101MM 10 HOLE VAR ANG LCP STAINLESS STEEL LATERAL","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.048","SUP","HCPCS C1713","","02.112.048  -  PLATE BONE 113MM 11 HOLE VAR ANG LCP STAINLESS STEEL LATERAL","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.049","SUP","HCPCS C1713","","02.112.049  -  PLATE BONE 12 HOLE LCP STAINLESS STEEL LATERAL VOLAR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.080","SUP","HCPCS C1713","","02.112.080  -  PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.081","SUP","HCPCS C1713","","02.112.081  -  PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.082","SUP","HCPCS C1713","","02.112.082  -  PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.083","SUP","HCPCS C1713","","02.112.083  -  PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.084","SUP","HCPCS C1713","","02.112.084  -  PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.085","SUP","HCPCS C1713","","02.112.085  -  PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.090","SUP","HCPCS C1713","","02.112.090  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.091","SUP","HCPCS C1713","","02.112.091  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"02.112.092","SUP","HCPCS C1713","","02.112.092  -  PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.093","SUP","HCPCS C1713","","02.112.093  -  PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"02.112.094","SUP","HCPCS C1713","","02.112.094  -  PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.095","SUP","HCPCS C1713","","02.112.095  -  PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"02.112.106","SUP","HCPCS C1713","","02.112.106  -  PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$1,186.40 ","$877.94 ","$0.00 ","$1,151.85 ","$518.33 ","$0.00 ","$247.28 ","$0.00 ","$0.00 ","$201.68 ","$1,151.85 ","$0.00 ","$575.93 ","$912.27 ","$921.48 ","$0.00 ","$175.01 ","$0.00 ","$183.37 ","$0.00 "
"02.112.107","SUP","HCPCS C1713","","02.112.107  -  PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL LEFT DISTAL","BOTH IP/OP","$1,186.40 ","$877.94 ","$0.00 ","$1,151.85 ","$518.33 ","$0.00 ","$247.28 ","$0.00 ","$0.00 ","$201.68 ","$1,151.85 ","$0.00 ","$575.93 ","$912.27 ","$921.48 ","$0.00 ","$175.01 ","$0.00 ","$183.37 ","$0.00 "
"02.112.108","SUP","HCPCS C1713","","02.112.108  -  PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL RIGHT POSTLAT","BOTH IP/OP","$1,206.08 ","$892.50 ","$0.00 ","$1,170.95 ","$526.93 ","$0.00 ","$251.38 ","$0.00 ","$0.00 ","$205.02 ","$1,170.95 ","$0.00 ","$585.48 ","$927.39 ","$936.76 ","$0.00 ","$177.92 ","$0.00 ","$186.42 ","$0.00 "
"02.112.109","SUP","HCPCS C1713","","02.112.109  -  PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,206.08 ","$892.50 ","$0.00 ","$1,170.95 ","$526.93 ","$0.00 ","$251.38 ","$0.00 ","$0.00 ","$205.02 ","$1,170.95 ","$0.00 ","$585.48 ","$927.39 ","$936.76 ","$0.00 ","$177.92 ","$0.00 ","$186.42 ","$0.00 "
"02.112.110","SUP","HCPCS C1713","","02.112.110  -  PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$1,221.55 ","$903.95 ","$0.00 ","$1,185.98 ","$533.69 ","$0.00 ","$254.60 ","$0.00 ","$0.00 ","$207.65 ","$1,185.98 ","$0.00 ","$592.99 ","$939.30 ","$948.78 ","$0.00 ","$180.20 ","$0.00 ","$188.81 ","$0.00 "
"02.112.111","SUP","HCPCS C1713","","02.112.111  -  PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,221.55 ","$903.95 ","$0.00 ","$1,185.98 ","$533.69 ","$0.00 ","$254.60 ","$0.00 ","$0.00 ","$207.65 ","$1,185.98 ","$0.00 ","$592.99 ","$939.30 ","$948.78 ","$0.00 ","$180.20 ","$0.00 ","$188.81 ","$0.00 "
"02.112.112","SUP","HCPCS C1713","","02.112.112  -  PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL RIGHT POSTLAT","BOTH IP/OP","$1,241.23 ","$918.51 ","$0.00 ","$1,205.08 ","$542.28 ","$0.00 ","$258.70 ","$0.00 ","$0.00 ","$211.00 ","$1,205.08 ","$0.00 ","$602.54 ","$954.42 ","$964.06 ","$0.00 ","$183.10 ","$0.00 ","$191.85 ","$0.00 "
"02.112.113","SUP","HCPCS C1713","","02.112.113  -  PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,241.23 ","$918.51 ","$0.00 ","$1,205.08 ","$542.28 ","$0.00 ","$258.70 ","$0.00 ","$0.00 ","$211.00 ","$1,205.08 ","$0.00 ","$602.54 ","$954.42 ","$964.06 ","$0.00 ","$183.10 ","$0.00 ","$191.85 ","$0.00 "
"02.112.114","SUP","HCPCS C1713","","02.112.114  -  PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL RIGHT POSTLAT","BOTH IP/OP","$1,258.10 ","$930.99 ","$0.00 ","$1,221.45 ","$549.65 ","$0.00 ","$262.22 ","$0.00 ","$0.00 ","$213.87 ","$1,221.45 ","$0.00 ","$610.73 ","$967.39 ","$977.16 ","$0.00 ","$185.59 ","$0.00 ","$194.45 ","$0.00 "
"02.112.115","SUP","HCPCS C1713","","02.112.115  -  PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,258.10 ","$930.99 ","$0.00 ","$1,221.45 ","$549.65 ","$0.00 ","$262.22 ","$0.00 ","$0.00 ","$213.87 ","$1,221.45 ","$0.00 ","$610.73 ","$967.39 ","$977.16 ","$0.00 ","$185.59 ","$0.00 ","$194.45 ","$0.00 "
"02.112.118","SUP","HCPCS C1713","","02.112.118  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL RIGHT POSTLAT","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"02.112.119","SUP","HCPCS C1713","","02.112.119  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"02.112.122","SUP","HCPCS C1713","","02.112.122  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT POSTLAT","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"02.112.123","SUP","HCPCS C1713","","02.112.123  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"02.112.126","SUP","HCPCS C1713","","02.112.126  -  PLATE BONE 126MM 13 HOLE LCP STAINLESS STEEL RIGHT POSTLAT","BOTH IP/OP","$1,312.93 ","$971.57 ","$0.00 ","$1,274.68 ","$573.60 ","$0.00 ","$273.65 ","$0.00 ","$0.00 ","$223.19 ","$1,274.68 ","$0.00 ","$637.34 ","$1,009.55 ","$1,019.74 ","$0.00 ","$193.68 ","$0.00 ","$202.93 ","$0.00 "
"02.112.127","SUP","HCPCS C1713","","02.112.127  -  PLATE BONE 127MM 13 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,312.93 ","$971.57 ","$0.00 ","$1,274.68 ","$573.60 ","$0.00 ","$273.65 ","$0.00 ","$0.00 ","$223.19 ","$1,274.68 ","$0.00 ","$637.34 ","$1,009.55 ","$1,019.74 ","$0.00 ","$193.68 ","$0.00 ","$202.93 ","$0.00 "
"02.112.130","SUP","HCPCS C1713","","02.112.130  -  PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$1,329.78 ","$984.04 ","$0.00 ","$1,291.05 ","$580.97 ","$0.00 ","$277.16 ","$0.00 ","$0.00 ","$226.05 ","$1,291.05 ","$0.00 ","$645.53 ","$1,022.51 ","$1,032.84 ","$0.00 ","$196.16 ","$0.00 ","$205.54 ","$0.00 "
"02.112.131","SUP","HCPCS C1713","","02.112.131  -  PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL LEFT POSTLAT","BOTH IP/OP","$1,329.78 ","$984.04 ","$0.00 ","$1,291.05 ","$580.97 ","$0.00 ","$277.16 ","$0.00 ","$0.00 ","$226.05 ","$1,291.05 ","$0.00 ","$645.53 ","$1,022.51 ","$1,032.84 ","$0.00 ","$196.16 ","$0.00 ","$205.54 ","$0.00 "
"02.112.136","SUP","HCPCS C1713","","02.112.136  -  PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB RT DIST LAT","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"02.112.137","SUP","HCPCS C1713","","02.112.137  -  PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB LT DIST LAT","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"02.112.138","SUP","HCPCS C1713","","02.112.138  -  PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB RT DIST LAT","BOTH IP/OP","$1,166.73 ","$863.38 ","$0.00 ","$1,132.75 ","$509.74 ","$0.00 ","$243.17 ","$0.00 ","$0.00 ","$198.34 ","$1,132.75 ","$0.00 ","$566.38 ","$897.14 ","$906.20 ","$0.00 ","$172.11 ","$0.00 ","$180.33 ","$0.00 "
"02.112.138S","SUP","HCPCS C1713","","02.112.138S  -  PLATE BONE 86MM 4 HOLE LOCKING COMPRESSION LCP STAINLESS","BOTH IP/OP","$1,258.10 ","$930.99 ","$0.00 ","$1,221.45 ","$549.65 ","$0.00 ","$262.22 ","$0.00 ","$0.00 ","$213.87 ","$1,221.45 ","$0.00 ","$610.73 ","$967.39 ","$977.16 ","$0.00 ","$185.59 ","$0.00 ","$194.45 ","$0.00 "
"02.112.139","SUP","HCPCS C1713","","02.112.139  -  PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB LT DIST LAT","BOTH IP/OP","$1,166.73 ","$863.38 ","$0.00 ","$1,132.75 ","$509.74 ","$0.00 ","$243.17 ","$0.00 ","$0.00 ","$198.34 ","$1,132.75 ","$0.00 ","$566.38 ","$897.14 ","$906.20 ","$0.00 ","$172.11 ","$0.00 ","$180.33 ","$0.00 "
"02.112.140","SUP","HCPCS C1713","","02.112.140  -  PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB RT DIST LAT","BOTH IP/OP","$1,182.18 ","$874.81 ","$0.00 ","$1,147.75 ","$516.49 ","$0.00 ","$246.39 ","$0.00 ","$0.00 ","$200.96 ","$1,147.75 ","$0.00 ","$573.88 ","$909.02 ","$918.20 ","$0.00 ","$174.39 ","$0.00 ","$182.72 ","$0.00 "
"02.112.141","SUP","HCPCS C1713","","02.112.141  -  PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB LT DIST LAT","BOTH IP/OP","$1,182.18 ","$874.81 ","$0.00 ","$1,147.75 ","$516.49 ","$0.00 ","$246.39 ","$0.00 ","$0.00 ","$200.96 ","$1,147.75 ","$0.00 ","$573.88 ","$909.02 ","$918.20 ","$0.00 ","$174.39 ","$0.00 ","$182.72 ","$0.00 "
"02.112.142","SUP","HCPCS C1713","","02.112.142  -  PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB RT DIST LAT","BOTH IP/OP","$1,200.45 ","$888.33 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$250.20 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$177.09 ","$0.00 ","$185.55 ","$0.00 "
"02.112.143","SUP","HCPCS C1713","","02.112.143  -  PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB LT DIST LAT","BOTH IP/OP","$1,200.45 ","$888.33 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$250.20 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$177.09 ","$0.00 ","$185.55 ","$0.00 "
"02.112.144","SUP","HCPCS C1713","","02.112.144  -  PLATE BONE 125MM 7 HOLE LCP STAINLESS STEEL RIGHT DISTAL","BOTH IP/OP","$1,217.33 ","$900.82 ","$0.00 ","$1,181.88 ","$531.84 ","$0.00 ","$253.72 ","$0.00 ","$0.00 ","$206.94 ","$1,181.88 ","$0.00 ","$590.94 ","$936.05 ","$945.50 ","$0.00 ","$179.58 ","$0.00 ","$188.15 ","$0.00 "
"02.112.145","SUP","HCPCS C1713","","02.112.145  -  PLATE BN CNTR 125MM NS LCP CMBN 7 HL SS FIB LT DIST LAT","BOTH IP/OP","$1,217.33 ","$900.82 ","$0.00 ","$1,181.88 ","$531.84 ","$0.00 ","$253.72 ","$0.00 ","$0.00 ","$206.94 ","$1,181.88 ","$0.00 ","$590.94 ","$936.05 ","$945.50 ","$0.00 ","$179.58 ","$0.00 ","$188.15 ","$0.00 "
"02.112.148","SUP","HCPCS C1713","","02.112.148  -  PLATE BONE 151MM 9 HOLE ANATOMICALLY CNTOUR LCP STAINLESS","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"02.112.149","SUP","HCPCS C1713","","02.112.149  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT DISTAL","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"02.112.152","SUP","HCPCS C1713","","02.112.152  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT LATERAL","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"02.112.153","SUP","HCPCS C1713","","02.112.153  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT LATERAL","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"02.112.156","SUP","HCPCS C1713","","02.112.156  -  PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL RIGHT LATERAL","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"02.112.157","SUP","HCPCS C1713","","02.112.157  -  PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL LEFT LATERAL","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"02.112.160","SUP","HCPCS C1713","","02.112.160  -  PLATE BONE 299MM 15 HOLE LCP STAINLESS STEEL RIGHT LATERAL","BOTH IP/OP","$1,370.55 ","$1,014.21 ","$0.00 ","$1,330.63 ","$598.78 ","$0.00 ","$285.66 ","$0.00 ","$0.00 ","$232.98 ","$1,330.63 ","$0.00 ","$665.31 ","$1,053.86 ","$1,064.50 ","$0.00 ","$202.18 ","$0.00 ","$211.84 ","$0.00 "
"02.112.161","SUP","HCPCS C1713","","02.112.161  -  PLATE BONE 229MM 15 HOLE LCP STAINLESS STEEL LEFT LATERAL","BOTH IP/OP","$1,370.55 ","$1,014.21 ","$0.00 ","$1,330.63 ","$598.78 ","$0.00 ","$285.66 ","$0.00 ","$0.00 ","$232.98 ","$1,330.63 ","$0.00 ","$665.31 ","$1,053.86 ","$1,064.50 ","$0.00 ","$202.18 ","$0.00 ","$211.84 ","$0.00 "
"02.112.203","SUP","HCPCS C1713","","02.112.203  -  PLATE BONE T 64MM 3 HOLE LCP STAINLESS STEEL DISTAL TIBIA","BOTH IP/OP","$1,384.60 ","$1,024.60 ","$0.00 ","$1,344.28 ","$604.92 ","$0.00 ","$288.59 ","$0.00 ","$0.00 ","$235.37 ","$1,344.28 ","$0.00 ","$672.14 ","$1,064.67 ","$1,075.42 ","$0.00 ","$204.25 ","$0.00 ","$214.01 ","$0.00 "
"02.112.205S","SUP","HCPCS C1713","","02.112.205S  -  PLATE BONE T 90X4.5X1.5MM 5 HOLE 4 LOCKING ANGULAR STABILITY","BOTH IP/OP","$1,530.80 ","$1,132.79 ","$0.00 ","$1,486.23 ","$668.80 ","$0.00 ","$319.06 ","$0.00 ","$0.00 ","$260.23 ","$1,486.23 ","$0.00 ","$743.11 ","$1,177.09 ","$1,188.98 ","$0.00 ","$225.82 ","$0.00 ","$236.61 ","$0.00 "
"02.112.208","SUP","HCPCS C1713","","02.112.208  -  PLATE BONE T 13.2CM 8 HOLE LCP STAINLESS STEEL POSTERIOR","BOTH IP/OP","$2,396.70 ","$1,773.56 ","$0.00 ","$2,326.90 ","$1,047.11 ","$0.00 ","$499.53 ","$0.00 ","$0.00 ","$407.42 ","$2,326.90 ","$0.00 ","$1,163.45 ","$1,842.90 ","$1,861.52 ","$0.00 ","$353.55 ","$0.00 ","$370.44 ","$0.00 "
"02.112.212","SUP","HCPCS C1713","","02.112.212  -  PLATE BONE T 184MM 4 LOCKING 12 HOLE SHAFT PROFILE ANGULAR","BOTH IP/OP","$2,558.35 ","$1,893.18 ","$0.00 ","$2,483.85 ","$1,117.73 ","$0.00 ","$533.22 ","$0.00 ","$0.00 ","$434.90 ","$2,483.85 ","$0.00 ","$1,241.93 ","$1,967.21 ","$1,987.08 ","$0.00 ","$377.40 ","$0.00 ","$395.43 ","$0.00 "
"02.112.216","SUP","HCPCS C1713","","02.112.216  -  PLATE BONE T 236MM 4 LOCKING 16 HOLE SHAFT PROFILE ANGULAR","BOTH IP/OP","$2,652.55 ","$1,962.89 ","$0.00 ","$2,575.28 ","$1,158.87 ","$0.00 ","$552.86 ","$0.00 ","$0.00 ","$450.91 ","$2,575.28 ","$0.00 ","$1,287.64 ","$2,039.62 ","$2,060.22 ","$0.00 ","$391.29 ","$0.00 ","$409.98 ","$0.00 "
"02.112.510","SUP","HCPCS C1713","","02.112.510  -  PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB","BOTH IP/OP","$2,597.73 ","$1,922.32 ","$0.00 ","$2,522.05 ","$1,134.92 ","$0.00 ","$541.43 ","$0.00 ","$0.00 ","$441.59 ","$2,522.05 ","$0.00 ","$1,261.03 ","$1,997.46 ","$2,017.64 ","$0.00 ","$383.21 ","$0.00 ","$401.51 ","$0.00 "
"02.112.511","SUP","HCPCS C1713","","02.112.511  -  PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB","BOTH IP/OP","$2,597.73 ","$1,922.32 ","$0.00 ","$2,522.05 ","$1,134.92 ","$0.00 ","$541.43 ","$0.00 ","$0.00 ","$441.59 ","$2,522.05 ","$0.00 ","$1,261.03 ","$1,997.46 ","$2,017.64 ","$0.00 ","$383.21 ","$0.00 ","$401.51 ","$0.00 "
"02.112.514","SUP","HCPCS C1713","","02.112.514  -  PLATE BN LO BND 135MM NS LCP CMBN 6 HL LOPRFL RND EDG SS TIB","BOTH IP/OP","$2,627.25 ","$1,944.17 ","$0.00 ","$2,550.73 ","$1,147.83 ","$0.00 ","$547.58 ","$0.00 ","$0.00 ","$446.61 ","$2,550.73 ","$0.00 ","$1,275.36 ","$2,020.18 ","$2,040.58 ","$0.00 ","$387.56 ","$0.00 ","$406.08 ","$0.00 "
"02.112.514S","SUP","HCPCS C1713","","02.112.514S  -  PLATE BN 135MM STRL LCP CMBN 6 HL LO BND LOPRFL RND EDG SS","BOTH IP/OP","$2,718.60 ","$2,011.76 ","$0.00 ","$2,639.43 ","$1,187.74 ","$0.00 ","$566.62 ","$0.00 ","$0.00 ","$462.14 ","$2,639.43 ","$0.00 ","$1,319.71 ","$2,090.43 ","$2,111.54 ","$0.00 ","$401.04 ","$0.00 ","$420.20 ","$0.00 "
"02.112.515","SUP","HCPCS C1713","","02.112.515  -  PLATE BONE 135MM 6 HOLE LOW BEND LP HEAD ROUNDED EDGE LCP","BOTH IP/OP","$2,627.25 ","$1,944.17 ","$0.00 ","$2,550.73 ","$1,147.83 ","$0.00 ","$547.58 ","$0.00 ","$0.00 ","$446.61 ","$2,550.73 ","$0.00 ","$1,275.36 ","$2,020.18 ","$2,040.58 ","$0.00 ","$387.56 ","$0.00 ","$406.08 ","$0.00 "
"02.112.518","SUP","HCPCS C1713","","02.112.518  -  PLATE BN 161MM NS LCP CMBN 8 HL LO BND LOPRFL RND EDG SS TIB","BOTH IP/OP","$2,652.55 ","$1,962.89 ","$0.00 ","$2,575.28 ","$1,158.87 ","$0.00 ","$552.86 ","$0.00 ","$0.00 ","$450.91 ","$2,575.28 ","$0.00 ","$1,287.64 ","$2,039.62 ","$2,060.22 ","$0.00 ","$391.29 ","$0.00 ","$409.98 ","$0.00 "
"02.112.519","SUP","HCPCS C1713","","02.112.519  -  PLATE BONE 161MM 8 HOLE LOW BEND ROUNDED EDGE LP LCP","BOTH IP/OP","$2,652.55 ","$1,962.89 ","$0.00 ","$2,575.28 ","$1,158.87 ","$0.00 ","$552.86 ","$0.00 ","$0.00 ","$450.91 ","$2,575.28 ","$0.00 ","$1,287.64 ","$2,039.62 ","$2,060.22 ","$0.00 ","$391.29 ","$0.00 ","$409.98 ","$0.00 "
"02.112.522","SUP","HCPCS C1713","","02.112.522  -  PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP","BOTH IP/OP","$2,680.65 ","$1,983.68 ","$0.00 ","$2,602.58 ","$1,171.16 ","$0.00 ","$558.71 ","$0.00 ","$0.00 ","$455.69 ","$2,602.58 ","$0.00 ","$1,301.29 ","$2,061.24 ","$2,082.06 ","$0.00 ","$395.44 ","$0.00 ","$414.33 ","$0.00 "
"02.112.523","SUP","HCPCS C1713","","02.112.523  -  PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP","BOTH IP/OP","$2,680.65 ","$1,983.68 ","$0.00 ","$2,602.58 ","$1,171.16 ","$0.00 ","$558.71 ","$0.00 ","$0.00 ","$455.69 ","$2,602.58 ","$0.00 ","$1,301.29 ","$2,061.24 ","$2,082.06 ","$0.00 ","$395.44 ","$0.00 ","$414.33 ","$0.00 "
"02.112.526","SUP","HCPCS C1713","","02.112.526  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA","BOTH IP/OP","$2,710.18 ","$2,005.53 ","$0.00 ","$2,631.25 ","$1,184.06 ","$0.00 ","$564.87 ","$0.00 ","$0.00 ","$460.71 ","$2,631.25 ","$0.00 ","$1,315.63 ","$2,083.95 ","$2,105.00 ","$0.00 ","$399.79 ","$0.00 ","$418.90 ","$0.00 "
"02.112.527","SUP","HCPCS C1713","","02.112.527  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA","BOTH IP/OP","$2,710.18 ","$2,005.53 ","$0.00 ","$2,631.25 ","$1,184.06 ","$0.00 ","$564.87 ","$0.00 ","$0.00 ","$460.71 ","$2,631.25 ","$0.00 ","$1,315.63 ","$2,083.95 ","$2,105.00 ","$0.00 ","$399.79 ","$0.00 ","$418.90 ","$0.00 "
"02.112.530","SUP","HCPCS C1713","","02.112.530  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$2,745.33 ","$2,031.54 ","$0.00 ","$2,665.35 ","$1,199.41 ","$0.00 ","$572.19 ","$0.00 ","$0.00 ","$466.68 ","$2,665.35 ","$0.00 ","$1,332.68 ","$2,110.96 ","$2,132.28 ","$0.00 ","$404.98 ","$0.00 ","$424.32 ","$0.00 "
"02.112.531","SUP","HCPCS C1713","","02.112.531  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL TIBIA","BOTH IP/OP","$2,745.33 ","$2,031.54 ","$0.00 ","$2,665.35 ","$1,199.41 ","$0.00 ","$572.19 ","$0.00 ","$0.00 ","$466.68 ","$2,665.35 ","$0.00 ","$1,332.68 ","$2,110.96 ","$2,132.28 ","$0.00 ","$404.98 ","$0.00 ","$424.32 ","$0.00 "
"02.113.001","SUP","Custom 27203010","","02.113.001  -  GUIDEWIRE ORTHOPEDIC 1.6MM 200MM DRILL TIP LCP STAINLESS","BOTH IP/OP","$69.58 ","$51.49 ","$0.00 ","$67.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.55 ","$0.00 ","$33.78 ","$53.50 ","$54.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.113.103","SUP","HCPCS C1713","","02.113.103  -  PLATE BONE 62MM 3 HOLE SHARP HOOK LP PRECONTOUR SCALLOPED","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"02.114.002","SUP","HCPCS C1713","","02.114.002  -  PLATE BONE 23MM 4 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM","BOTH IP/OP","$410.45 ","$303.73 ","$0.00 ","$398.50 ","$179.33 ","$0.00 ","$85.55 ","$0.00 ","$0.00 ","$69.77 ","$398.50 ","$0.00 ","$199.25 ","$315.61 ","$318.80 ","$0.00 ","$60.55 ","$0.00 ","$63.44 ","$0.00 "
"02.114.003","SUP","HCPCS C1713","","02.114.003  -  PLATE BONE 29MM 6 HOLE ADAPTION LCP STAINLESS STEEL HAND","BOTH IP/OP","$752.05 ","$556.52 ","$0.00 ","$730.15 ","$328.57 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$127.84 ","$730.15 ","$0.00 ","$365.08 ","$578.28 ","$584.12 ","$0.00 ","$110.94 ","$0.00 ","$116.24 ","$0.00 "
"02.114.004","SUP","HCPCS C1713","","02.114.004  -  PLATE BONE 36MM 6 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM","BOTH IP/OP","$410.45 ","$303.73 ","$0.00 ","$398.50 ","$179.33 ","$0.00 ","$85.55 ","$0.00 ","$0.00 ","$69.77 ","$398.50 ","$0.00 ","$199.25 ","$315.61 ","$318.80 ","$0.00 ","$60.55 ","$0.00 ","$63.44 ","$0.00 "
"02.114.005","SUP","HCPCS C1713","","02.114.005  -  PLATE BONE 59MM 12 HOLE ADAPTION LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$752.05 ","$556.52 ","$0.00 ","$730.15 ","$328.57 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$127.84 ","$730.15 ","$0.00 ","$365.08 ","$578.28 ","$584.12 ","$0.00 ","$110.94 ","$0.00 ","$116.24 ","$0.00 "
"02.114.006","SUP","HCPCS C1713","","02.114.006  -  PLATE BONE 3X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$767.00 ","$345.15 ","$0.00 ","$164.66 ","$0.00 ","$0.00 ","$134.30 ","$767.00 ","$0.00 ","$383.50 ","$607.46 ","$613.60 ","$0.00 ","$116.54 ","$0.00 ","$122.11 ","$0.00 "
"02.114.007","SUP","HCPCS C1713","","02.114.007  -  PLATE BONE 4X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$767.00 ","$345.15 ","$0.00 ","$164.66 ","$0.00 ","$0.00 ","$134.30 ","$767.00 ","$0.00 ","$383.50 ","$607.46 ","$613.60 ","$0.00 ","$116.54 ","$0.00 ","$122.11 ","$0.00 "
"02.114.009","SUP","HCPCS C1713","","02.114.009  -  PLATE BONE H EXTENDED LCP STAINLESS STEEL LEFT NONSTRL 1.5","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"02.114.010","SUP","HCPCS C1713","","02.114.010  -  PLATE BONE H EXTENDED LCP STAINLESS STEEL RIGHT NONSTRL 1.5","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"02.114.013","SUP","HCPCS C1713","","02.114.013  -  PLATE BONE 3X8 HOLE Y LCP STAINLESS STEEL NONSTRL 1.5 MM","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"02.114.014","SUP","HCPCS C1713","","02.114.014  -  PLATE BONE 6 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL 1.5 MM","BOTH IP/OP","$944.63 ","$699.03 ","$0.00 ","$917.10 ","$412.70 ","$0.00 ","$196.88 ","$0.00 ","$0.00 ","$160.58 ","$917.10 ","$0.00 ","$458.55 ","$726.34 ","$733.68 ","$0.00 ","$139.35 ","$0.00 ","$146.00 ","$0.00 "
"02.114.502","SUP","HCPCS C1713","","02.114.502  -  PLATE BONE 2.3CM 4 HOLE SHORT THREADED DRILL GUIDE LP CUT TO","BOTH IP/OP","$490.58 ","$363.03 ","$0.00 ","$476.30 ","$214.34 ","$0.00 ","$102.25 ","$0.00 ","$0.00 ","$83.40 ","$476.30 ","$0.00 ","$238.15 ","$377.23 ","$381.04 ","$0.00 ","$72.37 ","$0.00 ","$75.83 ","$0.00 "
"02.114.503","SUP","HCPCS C1713","","02.114.503  -  PLATE BONE 2.9CM 6 HOLE SHORT THREADED DRILL GUIDE ADAPTION","BOTH IP/OP","$836.38 ","$618.92 ","$0.00 ","$812.03 ","$365.41 ","$0.00 ","$174.32 ","$0.00 ","$0.00 ","$142.18 ","$812.03 ","$0.00 ","$406.01 ","$643.13 ","$649.62 ","$0.00 ","$123.38 ","$0.00 ","$129.27 ","$0.00 "
"02.114.504","SUP","HCPCS C1713","","02.114.504  -  PLATE BONE 3.6CM 6 HOLE SHORT THREADED DRILL GUIDE LP CUT TO","BOTH IP/OP","$490.58 ","$363.03 ","$0.00 ","$476.30 ","$214.34 ","$0.00 ","$102.25 ","$0.00 ","$0.00 ","$83.40 ","$476.30 ","$0.00 ","$238.15 ","$377.23 ","$381.04 ","$0.00 ","$72.37 ","$0.00 ","$75.83 ","$0.00 "
"02.114.505","SUP","HCPCS C1713","","02.114.505  -  PLATE BONE 5.9CM 12 HOLE SHORT THREADED DRILL GUIDE ADAPTION","BOTH IP/OP","$836.38 ","$618.92 ","$0.00 ","$812.03 ","$365.41 ","$0.00 ","$174.32 ","$0.00 ","$0.00 ","$142.18 ","$812.03 ","$0.00 ","$406.01 ","$643.13 ","$649.62 ","$0.00 ","$123.38 ","$0.00 ","$129.27 ","$0.00 "
"02.114.506","SUP","HCPCS C1713","","02.114.506  -  PLATE BONE T 3X8 HOLE SHORT THREADED DRILL GUIDE LP CUT TO","BOTH IP/OP","$885.58 ","$655.33 ","$0.00 ","$859.80 ","$386.91 ","$0.00 ","$184.58 ","$0.00 ","$0.00 ","$150.54 ","$859.80 ","$0.00 ","$429.90 ","$680.96 ","$687.84 ","$0.00 ","$130.64 ","$0.00 ","$136.88 ","$0.00 "
"02.114.507","SUP","HCPCS C1713","","02.114.507  -  PLATE BONE T 4 HOLE HEAD 8 HOLE SHAFT LP CUT TO LENGTH LCP","BOTH IP/OP","$885.58 ","$655.33 ","$0.00 ","$859.80 ","$386.91 ","$0.00 ","$184.58 ","$0.00 ","$0.00 ","$150.54 ","$859.80 ","$0.00 ","$429.90 ","$680.96 ","$687.84 ","$0.00 ","$130.64 ","$0.00 ","$136.88 ","$0.00 "
"02.114.509","SUP","HCPCS C1713","","02.114.509  -  PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH","BOTH IP/OP","$846.23 ","$626.21 ","$0.00 ","$821.58 ","$369.71 ","$0.00 ","$176.37 ","$0.00 ","$0.00 ","$143.85 ","$821.58 ","$0.00 ","$410.79 ","$650.69 ","$657.26 ","$0.00 ","$124.83 ","$0.00 ","$130.79 ","$0.00 "
"02.114.510","SUP","HCPCS C1713","","02.114.510  -  PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH","BOTH IP/OP","$846.23 ","$626.21 ","$0.00 ","$821.58 ","$369.71 ","$0.00 ","$176.37 ","$0.00 ","$0.00 ","$143.85 ","$821.58 ","$0.00 ","$410.79 ","$650.69 ","$657.26 ","$0.00 ","$124.83 ","$0.00 ","$130.79 ","$0.00 "
"02.114.513","SUP","HCPCS C1713","","02.114.513  -  PLATE BONE Y 3X8 HOLE LP SHORT THREADED DRILL GUIDE CUT TO","BOTH IP/OP","$846.23 ","$626.21 ","$0.00 ","$821.58 ","$369.71 ","$0.00 ","$176.37 ","$0.00 ","$0.00 ","$143.85 ","$821.58 ","$0.00 ","$410.79 ","$650.69 ","$657.26 ","$0.00 ","$124.83 ","$0.00 ","$130.79 ","$0.00 "
"02.114.514","SUP","HCPCS C1713","","02.114.514  -  PLATE BONE 6 HOLE LP SHORT THREADED DRILL GUIDE CUT TO","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"02.115.130","SUP","HCPCS C1713","","02.115.130  -  PLATE BONE 90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"02.115.131","SUP","HCPCS C1713","","02.115.131  -  PLATE BONE -90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"02.115.150","SUP","HCPCS C1713","","02.115.150  -  PLATE BONE 90+ D L 51MM 2 HOLE HEAD 5 HOLE SHAFT VAR ANG LCP","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"02.115.150S","SUP","HCPCS C1713","","02.115.150S  -  PLATE BN +90D L 51MM STRL LCP CMBN 2 HLE/HD 5 HL SHFT VA SS","BOTH IP/OP","$1,135.48 ","$840.26 ","$0.00 ","$1,135.48 ","$510.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.81 ","$1,135.48 ","$0.00 ","$567.74 ","$899.30 ","$908.38 ","$0.00 ","$172.53 ","$0.00 ","$180.77 ","$0.00 "
"02.115.151","SUP","HCPCS C1713","","02.115.151  -  PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"02.115.230","SUP","HCPCS C1713","","02.115.230  -  PLATE BONE +90D L 37MM 3X3 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"02.115.231","SUP","HCPCS C1713","","02.115.231  -  PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"02.115.250","SUP","HCPCS C1713","","02.115.250  -  PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"02.115.251","SUP","HCPCS C1713","","02.115.251  -  PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"02.115.330","SUP","HCPCS C1713","","02.115.330  -  PLATE BONE 37MM 3X3 HOLE T VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,059.90 ","$784.33 ","$0.00 ","$1,029.03 ","$463.06 ","$0.00 ","$220.91 ","$0.00 ","$0.00 ","$180.17 ","$1,029.03 ","$0.00 ","$514.51 ","$814.99 ","$823.22 ","$0.00 ","$156.35 ","$0.00 ","$163.82 ","$0.00 "
"02.115.350","SUP","HCPCS C1713","","02.115.350  -  PLATE BONE 51MM 3X5 HOLE T VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"02.115.430","SUP","HCPCS C1713","","02.115.430  -  PLATE BONE 20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LCP STAINLESS","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"02.115.430S","SUP","HCPCS C1713","","02.115.430S  -  PLATE BN +20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$1,084.98 ","$802.89 ","$0.00 ","$1,084.98 ","$488.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$189.97 ","$1,084.98 ","$0.00 ","$542.49 ","$859.30 ","$867.98 ","$0.00 ","$164.85 ","$0.00 ","$172.73 ","$0.00 "
"02.115.431","SUP","HCPCS C1713","","02.115.431  -  PLATE BONE -20D L 41MM 3X3 HOLE VAR ANG OBLIQUE LCP","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"02.115.431S","SUP","HCPCS C1713","","02.115.431S  -  PLATE BN -20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT","BOTH IP/OP","$1,117.53 ","$826.97 ","$0.00 ","$1,084.98 ","$488.24 ","$0.00 ","$232.92 ","$0.00 ","$0.00 ","$189.97 ","$1,084.98 ","$0.00 ","$542.49 ","$859.30 ","$867.98 ","$0.00 ","$164.85 ","$0.00 ","$172.73 ","$0.00 "
"02.115.450","SUP","HCPCS C1713","","02.115.450  -  PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"02.115.451","SUP","HCPCS C1713","","02.115.451  -  PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"02.115.530","SUP","HCPCS C1713","","02.115.530  -  PLATE BONE 46MM 5 HOLE VAR ANG COLUMN LCP STAINLESS STEEL","BOTH IP/OP","$1,006.48 ","$744.80 ","$0.00 ","$977.15 ","$439.72 ","$0.00 ","$209.77 ","$0.00 ","$0.00 ","$171.09 ","$977.15 ","$0.00 ","$488.58 ","$773.90 ","$781.72 ","$0.00 ","$148.47 ","$0.00 ","$155.56 ","$0.00 "
"02.115.540","SUP","HCPCS C1713","","02.115.540  -  PLATE BONE 57MM 6 HOLE VAR ANG COLUMN LCP STAINLESS STEEL","BOTH IP/OP","$1,059.90 ","$784.33 ","$0.00 ","$1,029.03 ","$463.06 ","$0.00 ","$220.91 ","$0.00 ","$0.00 ","$180.17 ","$1,029.03 ","$0.00 ","$514.51 ","$814.99 ","$823.22 ","$0.00 ","$156.35 ","$0.00 ","$163.82 ","$0.00 "
"02.115.630","SUP","HCPCS C1713","","02.115.630  -  PLATE BONE 90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"02.115.631","SUP","HCPCS C1713","","02.115.631  -  PLATE BONE -90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"02.115.640","SUP","HCPCS C1713","","02.115.640  -  PLATE BONE +90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"02.115.641","SUP","HCPCS C1713","","02.115.641  -  PLATE BONE -90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"02.115.751S","SUP","HCPCS C1713","","02.115.751S  -  PLATE BN 57MM STRL LCP CMBN 6 HLE/HD 5 HL SHFT VA SS RDS LT","BOTH IP/OP","$1,834.23 ","$1,357.33 ","$0.00 ","$1,834.23 ","$825.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$321.16 ","$1,834.23 ","$0.00 ","$917.11 ","$1,452.71 ","$1,467.38 ","$0.00 ","$278.70 ","$0.00 ","$292.01 ","$0.00 "
"02.117.003S","SUP","HCPCS C1713","","02.117.003S  -  PLATE BN SHRT 75MM STRL LCP CMBN 3 HL VA TPR TIP LAT SPRT SS","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.004S","SUP","HCPCS C1713","","02.117.004S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.007S","SUP","HCPCS C1713","","02.117.007S  -  PLATE BONE LONG 127MM 7 HOLE VAR ANG TAPER TIP LATERAL","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.009S","SUP","HCPCS C1713","","02.117.009S  -  PLATE BONE XLONG 153MM 9 HOLE VAR ANG LATERAL SUPPORT","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.103S","SUP","HCPCS C1713","","02.117.103S  -  PLATE BONE SHORT 75MM 3 HOLE VAR ANG LATERAL SUPPORT LCP","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.104","SUP","HCPCS C1713","","02.117.104  -  PLATE BN MED 88MM NS LCP CMBN 4 HL VA TPR TIP LAT SPRT SS","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"02.117.104S","SUP","HCPCS C1713","","02.117.104S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.107S","SUP","HCPCS C1713","","02.117.107S  -  PLATE BONE LONG 127MM 7 HOLE VAR ANG LATERAL SUPPORT TAPERED","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.203S","SUP","HCPCS C1713","","02.117.203S  -  PLATE SHRT 75MM SS 2.7/3.5MM SCR 3 HOLE VAR ANG","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.204S","SUP","HCPCS C1713","","02.117.204S  -  PLATE BN MED 88MM STRL LCP CMBN 4 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.207S","SUP","HCPCS C1713","","02.117.207S  -  PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.303S","SUP","HCPCS C1713","","02.117.303S  -  PLATE BONE SHORT 75MM 3 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.304S","SUP","HCPCS C1713","","02.117.304S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.307S","SUP","HCPCS C1713","","02.117.307S  -  PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.309S","SUP","HCPCS C1713","","02.117.309S  -  PLATE BONE XLONG 153MM 9 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.401S","SUP","HCPCS C1713","","02.117.401S  -  PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.402S","SUP","HCPCS C1713","","02.117.402S  -  PLATE BN MED 82MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,164.50 ","$1,601.73 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.404S","SUP","HCPCS C1713","","02.117.404S  -  PLATE BONE LONG 108MM 4 HOLE VAR ANG TAPER TIP ROUND PROFILE","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.406S","SUP","HCPCS C1713","","02.117.406S  -  PLATE BONE XLONG 134MM 6 HOLE VAR ANG TAPER TIP ROUND","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.501S","SUP","HCPCS C1713","","02.117.501S  -  PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.502","SUP","HCPCS C1713","","02.117.502  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$2,138.05 ","$1,582.16 ","$0.00 ","$2,075.78 ","$934.10 ","$0.00 ","$445.62 ","$0.00 ","$0.00 ","$363.45 ","$2,075.78 ","$0.00 ","$1,037.89 ","$1,644.02 ","$1,660.62 ","$0.00 ","$315.40 ","$0.00 ","$330.46 ","$0.00 "
"02.117.502S","SUP","HCPCS C1713","","02.117.502S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.504","SUP","HCPCS C1713","","02.117.504  -  PLATE BN LNG 108MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,138.05 ","$1,582.16 ","$0.00 ","$2,075.78 ","$934.10 ","$0.00 ","$445.62 ","$0.00 ","$0.00 ","$363.45 ","$2,075.78 ","$0.00 ","$1,037.89 ","$1,644.02 ","$1,660.62 ","$0.00 ","$315.40 ","$0.00 ","$330.46 ","$0.00 "
"02.117.504S","SUP","HCPCS C1713","","02.117.504S  -  PLATE BONE LONG 108MM 4 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.506","SUP","HCPCS C1713","","02.117.506  -  PLATE BN XLNG 134MM NS LCP CMBN 6 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,138.05 ","$1,582.16 ","$0.00 ","$2,075.78 ","$934.10 ","$0.00 ","$445.62 ","$0.00 ","$0.00 ","$363.45 ","$2,075.78 ","$0.00 ","$1,037.89 ","$1,644.02 ","$1,660.62 ","$0.00 ","$315.40 ","$0.00 ","$330.46 ","$0.00 "
"02.117.506S","SUP","HCPCS C1713","","02.117.506S  -  PLATE BN XLNG 134MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.601S","SUP","HCPCS C1713","","02.117.601S  -  PLATE BONE LCP COMBI STAINLESS STEEL SHORT L72 MM HUMERUS RI","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.602","SUP","HCPCS C1713","","02.117.602  -  PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG LCP STAINLESS","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"02.117.602S","SUP","HCPCS C1713","","02.117.602S  -  PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM HUMERUS R","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.604","SUP","HCPCS C1713","","02.117.604  -  PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM RT","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"02.117.604S","SUP","HCPCS C1713","","02.117.604S  -  PLATE BONE LONG 111MM 4 HOLE EXTENDED VAR ANG ROUND PROFILE","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.606S","SUP","HCPCS C1713","","02.117.606S  -  PLATE BN XLNG 137MM STRL LCP CMBN 6 HL VA TPR TIP XTD SS HUM","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.701S","SUP","HCPCS C1713","","02.117.701S  -  PLATE BONE SHORT 72MM 1 HOLE VAR ANG EXTENDED LCP STAINLESS","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.702S","SUP","HCPCS C1713","","02.117.702S  -  PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG ROUND PROFILE","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.704","SUP","HCPCS C1713","","02.117.704  -  PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM LT","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"02.117.704S","SUP","HCPCS C1713","","02.117.704S  -  PLATE BN LNG 111MM STRL LCP CMBN 4 HL VA TPR TIP XTD SS HUM","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.706","SUP","HCPCS C1713","","02.117.706  -  PLATE BN XLNG 137MM NS LCP CMBN 6 HL VA TPR TIP XTD SS HUM","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"02.117.706S","SUP","HCPCS C1713","","02.117.706S  -  PLATE BONE XLONG 137MM 6 HOLE VAR ANG TAPER TIP EXTEND LCP","BOTH IP/OP","$2,295.50 ","$1,698.67 ","$0.00 ","$2,228.63 ","$1,002.88 ","$0.00 ","$478.44 ","$0.00 ","$0.00 ","$390.21 ","$2,228.63 ","$0.00 ","$1,114.31 ","$1,765.07 ","$1,782.90 ","$0.00 ","$338.62 ","$0.00 ","$354.80 ","$0.00 "
"02.117.802","SUP","HCPCS C1713","","02.117.802  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$2,138.05 ","$1,582.16 ","$0.00 ","$2,075.78 ","$934.10 ","$0.00 ","$445.62 ","$0.00 ","$0.00 ","$363.45 ","$2,075.78 ","$0.00 ","$1,037.89 ","$1,644.02 ","$1,660.62 ","$0.00 ","$315.40 ","$0.00 ","$330.46 ","$0.00 "
"02.117.802S","SUP","HCPCS C1713","","02.117.802S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.805S","SUP","HCPCS C1713","","02.117.805S  -  PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.807S","SUP","HCPCS C1713","","02.117.807S  -  PLATE BONE LCP COMBI STAINLESS STEEL XLONG L147 MM HUMERUS R","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.902","SUP","HCPCS C1713","","02.117.902  -  PLATE BN MED 82MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,138.05 ","$1,582.16 ","$0.00 ","$2,075.78 ","$934.10 ","$0.00 ","$445.62 ","$0.00 ","$0.00 ","$363.45 ","$2,075.78 ","$0.00 ","$1,037.89 ","$1,644.02 ","$1,660.62 ","$0.00 ","$315.40 ","$0.00 ","$330.46 ","$0.00 "
"02.117.902S","SUP","HCPCS C1713","","02.117.902S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG EXTENDED LCP STAINLESS","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.905","SUP","HCPCS C1713","","02.117.905  -  PLATE BN LNG 121MM NS LCP CMBN 5 HL VA TPR TIP RND PRFL SS","BOTH IP/OP","$2,138.05 ","$1,582.16 ","$0.00 ","$2,075.78 ","$934.10 ","$0.00 ","$445.62 ","$0.00 ","$0.00 ","$363.45 ","$2,075.78 ","$0.00 ","$1,037.89 ","$1,644.02 ","$1,660.62 ","$0.00 ","$315.40 ","$0.00 ","$330.46 ","$0.00 "
"02.117.905S","SUP","HCPCS C1713","","02.117.905S  -  PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED","BOTH IP/OP","$2,229.43 ","$1,649.78 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$464.67 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.117.909S","SUP","HCPCS C1713","","02.117.909S  -  PLATE BN 173MM STRL LCP CMBN 9 HL VA TPR TIP RND PRFL SS HUM","BOTH IP/OP","$2,164.50 ","$1,601.73 ","$0.00 ","$2,164.50 ","$974.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.99 ","$2,164.50 ","$0.00 ","$1,082.25 ","$1,714.28 ","$1,731.60 ","$0.00 ","$328.88 ","$0.00 ","$344.59 ","$0.00 "
"02.118.003S","SUP","HCPCS C1713","","02.118.003S  -  PLATE BN 112MM STRL LCP CMBN 4 HL VA LOPRFL SS TIB LT DIST","BOTH IP/OP","$2,857.78 ","$2,114.76 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$595.63 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"02.118.005S","SUP","HCPCS C1713","","02.118.005S  -  PLATE BN 142MM STRL LCP CMBN 6 HL VA LOPRFL SS TIB LT DIST","BOTH IP/OP","$2,888.70 ","$2,137.64 ","$0.00 ","$2,804.55 ","$1,262.05 ","$0.00 ","$602.08 ","$0.00 ","$0.00 ","$491.05 ","$2,804.55 ","$0.00 ","$1,402.28 ","$2,221.20 ","$2,243.64 ","$0.00 ","$426.13 ","$0.00 ","$446.48 ","$0.00 "
"02.118.006S","SUP","HCPCS C1713","","02.118.006S  -  PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB RT DIST","BOTH IP/OP","$2,916.80 ","$2,158.43 ","$0.00 ","$2,831.85 ","$1,274.33 ","$0.00 ","$607.93 ","$0.00 ","$0.00 ","$495.83 ","$2,831.85 ","$0.00 ","$1,415.93 ","$2,242.83 ","$2,265.48 ","$0.00 ","$430.28 ","$0.00 ","$450.83 ","$0.00 "
"02.118.007S","SUP","HCPCS C1713","","02.118.007S  -  PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB LT DIST","BOTH IP/OP","$2,916.80 ","$2,158.43 ","$0.00 ","$2,831.85 ","$1,274.33 ","$0.00 ","$607.93 ","$0.00 ","$0.00 ","$495.83 ","$2,831.85 ","$0.00 ","$1,415.93 ","$2,242.83 ","$2,265.48 ","$0.00 ","$430.28 ","$0.00 ","$450.83 ","$0.00 "
"02.118.011S","SUP","HCPCS C1713","","02.118.011S  -  PLATE BN 232MM STRL LCP CMBN 12 HL VA LOPRFL SS TIB LT DIST","BOTH IP/OP","$3,422.85 ","$2,532.91 ","$0.00 ","$3,323.18 ","$1,495.43 ","$0.00 ","$713.41 ","$0.00 ","$0.00 ","$581.86 ","$3,323.18 ","$0.00 ","$1,661.59 ","$2,631.96 ","$2,658.54 ","$0.00 ","$504.93 ","$0.00 ","$529.05 ","$0.00 "
"02.118.510","SUP","HCPCS C1713","","02.118.510  -  SCREW BN T8 2.7MM 10MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.512","SUP","HCPCS C1713","","02.118.512  -  SCREW BONE T8 LP 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.514","SUP","HCPCS C1713","","02.118.514  -  SCREW BONE T8 LP 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.516","SUP","HCPCS C1713","","02.118.516  -  SCREW BONE T8 LP 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.518","SUP","HCPCS C1713","","02.118.518  -  SCREW BONE T8 LP 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.520","SUP","HCPCS C1713","","02.118.520  -  SCREW BONE T8 LP 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.522","SUP","HCPCS C1713","","02.118.522  -  SCREW BONE T8 LP 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.524","SUP","HCPCS C1713","","02.118.524  -  SCREW BONE T8 2.7MM 24MM SELF TAP STARDRIVE LP LCP STAINLESS","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.526","SUP","HCPCS C1713","","02.118.526  -  SCREW BONE 2.7MM 26MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.528","SUP","HCPCS C1713","","02.118.528  -  SCREW BONE T8 LP 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.530","SUP","HCPCS C1713","","02.118.530  -  SCREW BONE T8 LP 2.7MM 30MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.532","SUP","HCPCS C1713","","02.118.532  -  SCREW BONE T8 LP 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.534","SUP","HCPCS C1713","","02.118.534  -  SCREW BONE T8 LP 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.536","SUP","HCPCS C1713","","02.118.536  -  SCREW BN T8 2.7MM 36MM NS ST STRDR LOPRFL HD SS MTPHSL","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.538","SUP","HCPCS C1713","","02.118.538  -  SCREW BONE T8 LP 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.540","SUP","HCPCS C1713","","02.118.540  -  SCREW BN T8 2.7MM 40MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.542","SUP","HCPCS C1713","","02.118.542  -  SCREW BONE T8 2.7MM 42MM SELF TAP STARDRIVE LP LCP STAINLESS","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.544","SUP","HCPCS C1713","","02.118.544  -  SCREW BONE 2.7MM 44MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.546","SUP","HCPCS C1713","","02.118.546  -  SCREW BONE T8 LP 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.548","SUP","HCPCS C1713","","02.118.548  -  SCREW BONE T8 LP 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.550","SUP","HCPCS C1713","","02.118.550  -  SCREW BONE T8 LP 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.552","SUP","HCPCS C1713","","02.118.552  -  SCREW BONE 2.7MM 52MM VAR ANG SELF TAP T8 STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.554","SUP","HCPCS C1713","","02.118.554  -  SCREW BONE T8 LP 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.556","SUP","HCPCS C1713","","02.118.556  -  SCREW BONE T8 LP 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.558","SUP","HCPCS C1713","","02.118.558  -  SCREW BONE T8 LP 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.560","SUP","HCPCS C1713","","02.118.560  -  SCREW BONE T8 LP 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.562","SUP","HCPCS C1713","","02.118.562  -  SCREW BONE T8 LP 2.7MM 62MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.564","SUP","HCPCS C1713","","02.118.564  -  SCREW BONE T8 LP 2.7MM 64MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.566","SUP","HCPCS C1713","","02.118.566  -  SCREW BONE T8 LP 2.7MM 66MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.568","SUP","HCPCS C1713","","02.118.568  -  SCREW BONE T8 LP 2.7MM 68MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.570","SUP","HCPCS C1713","","02.118.570  -  SCREW BONE T8 LP 2.7MM 70MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$37.46 ","$0.00 ","$17.87 ","$0.00 ","$0.00 ","$14.58 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$12.65 ","$0.00 ","$13.25 ","$0.00 "
"02.118.575S","SUP","HCPCS C1713","","02.118.575S  -  SCREW BN 2.7MM 75MM STRL LCP T8 STRDR RCS ST LOPRFL SS","BOTH IP/OP","$177.13 ","$131.08 ","$0.00 ","$171.95 ","$77.38 ","$0.00 ","$36.92 ","$0.00 ","$0.00 ","$30.11 ","$171.95 ","$0.00 ","$85.98 ","$136.18 ","$137.56 ","$0.00 ","$26.13 ","$0.00 ","$27.37 ","$0.00 "
"02.120.601","SUP","HCPCS C1713","","02.120.601  -  PLATE BONE 4 HOLE LOCKING LCP STAINLESS STEEL FEMUR PROXIMAL","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"02.120.602","SUP","HCPCS C1713","","02.120.602  -  PLATE BONE 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"02.120.603","SUP","HCPCS C1713","","02.120.603  -  PLATE BONE 4.5MM 4 HOLE ATTCH LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"02.120.604","SUP","HCPCS C1713","","02.120.604  -  PLATE BONE 4.5MM 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"02.120.606","SUP","HCPCS C1713","","02.120.606  -  SCREW BONE 2 PART CONNECT STARDRIVE LCP STAINLESS STEEL","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$294.78 ","$132.65 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$51.61 ","$294.78 ","$0.00 ","$147.39 ","$233.47 ","$235.82 ","$0.00 ","$44.79 ","$0.00 ","$46.93 ","$0.00 "
"02.120.701","SUP","HCPCS C1713","","02.120.701  -  PLATE BONE 69MM 1 HOLE SET W/O CASE LCP STAINLESS STEEL","BOTH IP/OP","$1,750.08 ","$1,295.06 ","$0.00 ","$1,699.13 ","$764.61 ","$0.00 ","$364.76 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$258.17 ","$0.00 ","$270.50 ","$0.00 "
"02.120.702","SUP","HCPCS C1713","","02.120.702  -  PLATE BONE 79MM 2 HOLE SET W/O CASE LCP STAINLESS STEEL","BOTH IP/OP","$1,769.78 ","$1,309.64 ","$0.00 ","$1,718.23 ","$773.20 ","$0.00 ","$368.87 ","$0.00 ","$0.00 ","$300.85 ","$1,718.23 ","$0.00 ","$859.11 ","$1,360.84 ","$1,374.58 ","$0.00 ","$261.07 ","$0.00 ","$273.54 ","$0.00 "
"02.120.704","SUP","HCPCS C1713","","02.120.704  -  PLATE BONE 105MM 4 HOLE LCP STAINLESS STEEL TIBIA","BOTH IP/OP","$1,788.05 ","$1,323.16 ","$0.00 ","$1,735.95 ","$781.18 ","$0.00 ","$372.67 ","$0.00 ","$0.00 ","$303.95 ","$1,735.95 ","$0.00 ","$867.98 ","$1,374.87 ","$1,388.76 ","$0.00 ","$263.77 ","$0.00 ","$276.36 ","$0.00 "
"02.120.706","SUP","HCPCS C1713","","02.120.706  -  PLATE BONE 131MM 6 HOLE LCP STAINLESS STEEL TIBIA","BOTH IP/OP","$1,804.90 ","$1,335.63 ","$0.00 ","$1,752.35 ","$788.56 ","$0.00 ","$376.19 ","$0.00 ","$0.00 ","$306.82 ","$1,752.35 ","$0.00 ","$876.18 ","$1,387.86 ","$1,401.88 ","$0.00 ","$266.25 ","$0.00 ","$278.97 ","$0.00 "
"02.120.708","SUP","HCPCS C1713","","02.120.708  -  PLATE BONE 157MM 8 HOLE SET W/O CASE LCP STAINLESS STEEL","BOTH IP/OP","$1,876.60 ","$1,388.68 ","$0.00 ","$1,821.95 ","$819.88 ","$0.00 ","$391.13 ","$0.00 ","$0.00 ","$319.01 ","$1,821.95 ","$0.00 ","$910.98 ","$1,442.98 ","$1,457.56 ","$0.00 ","$276.83 ","$0.00 ","$290.05 ","$0.00 "
"02.120.710","SUP","HCPCS C1713","","02.120.710  -  PLATE BONE 183MM 10 HOLE SET W/O CASE LCP STAINLESS STEEL","BOTH IP/OP","$1,896.28 ","$1,403.25 ","$0.00 ","$1,841.05 ","$828.47 ","$0.00 ","$395.23 ","$0.00 ","$0.00 ","$322.35 ","$1,841.05 ","$0.00 ","$920.53 ","$1,458.11 ","$1,472.84 ","$0.00 ","$279.73 ","$0.00 ","$293.10 ","$0.00 "
"02.123.020","SUP","HCPCS C1713","","02.123.020  -  PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM","BOTH IP/OP","$2,857.78 ","$2,114.76 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$595.63 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"02.123.021","SUP","HCPCS C1713","","02.123.021  -  PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM","BOTH IP/OP","$2,857.78 ","$2,114.76 ","$0.00 ","$2,774.53 ","$1,248.54 ","$0.00 ","$595.63 ","$0.00 ","$0.00 ","$485.80 ","$2,774.53 ","$0.00 ","$1,387.26 ","$2,197.43 ","$2,219.62 ","$0.00 ","$421.57 ","$0.00 ","$441.70 ","$0.00 "
"02.123.022","SUP","HCPCS C1713","","02.123.022  -  PLATE BONE 91MM 4 HOLE LCP STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$2,943.53 ","$2,178.21 ","$0.00 ","$2,857.78 ","$1,286.00 ","$0.00 ","$613.50 ","$0.00 ","$0.00 ","$500.37 ","$2,857.78 ","$0.00 ","$1,428.89 ","$2,263.36 ","$2,286.22 ","$0.00 ","$434.22 ","$0.00 ","$454.96 ","$0.00 "
"02.123.023","SUP","HCPCS C1713","","02.123.023  -  PLATE BN CNTR 127MM NS LCP CMBN 4 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$2,943.53 ","$2,178.21 ","$0.00 ","$2,857.78 ","$1,286.00 ","$0.00 ","$613.50 ","$0.00 ","$0.00 ","$500.37 ","$2,857.78 ","$0.00 ","$1,428.89 ","$2,263.36 ","$2,286.22 ","$0.00 ","$434.22 ","$0.00 ","$454.96 ","$0.00 "
"02.123.024","SUP","HCPCS C1713","","02.123.024  -  PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$3,100.95 ","$2,294.70 ","$0.00 ","$3,010.65 ","$1,354.79 ","$0.00 ","$646.32 ","$0.00 ","$0.00 ","$527.14 ","$3,010.65 ","$0.00 ","$1,505.33 ","$2,384.43 ","$2,408.52 ","$0.00 ","$457.44 ","$0.00 ","$479.30 ","$0.00 "
"02.123.025","SUP","HCPCS C1713","","02.123.025  -  PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL LEFT PROXIMAL","BOTH IP/OP","$3,100.95 ","$2,294.70 ","$0.00 ","$3,010.65 ","$1,354.79 ","$0.00 ","$646.32 ","$0.00 ","$0.00 ","$527.14 ","$3,010.65 ","$0.00 ","$1,505.33 ","$2,384.43 ","$2,408.52 ","$0.00 ","$457.44 ","$0.00 ","$479.30 ","$0.00 "
"02.123.026","SUP","HCPCS C1713","","02.123.026  -  PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$3,220.45 ","$2,383.13 ","$0.00 ","$3,126.65 ","$1,406.99 ","$0.00 ","$671.22 ","$0.00 ","$0.00 ","$547.45 ","$3,126.65 ","$0.00 ","$1,563.33 ","$2,476.31 ","$2,501.32 ","$0.00 ","$475.07 ","$0.00 ","$497.76 ","$0.00 "
"02.123.027","SUP","HCPCS C1713","","02.123.027  -  PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$3,220.45 ","$2,383.13 ","$0.00 ","$3,126.65 ","$1,406.99 ","$0.00 ","$671.22 ","$0.00 ","$0.00 ","$547.45 ","$3,126.65 ","$0.00 ","$1,563.33 ","$2,476.31 ","$2,501.32 ","$0.00 ","$475.07 ","$0.00 ","$497.76 ","$0.00 "
"02.123.028","SUP","HCPCS C1713","","02.123.028  -  PLATE BN CNTR 235MM NS LCP CMBN 10 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$3,341.33 ","$2,472.58 ","$0.00 ","$3,244.00 ","$1,459.80 ","$0.00 ","$696.42 ","$0.00 ","$0.00 ","$568.00 ","$3,244.00 ","$0.00 ","$1,622.00 ","$2,569.25 ","$2,595.20 ","$0.00 ","$492.90 ","$0.00 ","$516.44 ","$0.00 "
"02.123.029","SUP","HCPCS C1713","","02.123.029  -  PLATE BONE 235MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL","BOTH IP/OP","$3,341.33 ","$2,472.58 ","$0.00 ","$3,244.00 ","$1,459.80 ","$0.00 ","$696.42 ","$0.00 ","$0.00 ","$568.00 ","$3,244.00 ","$0.00 ","$1,622.00 ","$2,569.25 ","$2,595.20 ","$0.00 ","$492.90 ","$0.00 ","$516.44 ","$0.00 "
"02.123.030","SUP","HCPCS C1713","","02.123.030  -  PLATE BN CNTR 271MM NS LCP CMBN 12 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$3,448.18 ","$2,551.65 ","$0.00 ","$3,347.73 ","$1,506.48 ","$0.00 ","$718.69 ","$0.00 ","$0.00 ","$586.16 ","$3,347.73 ","$0.00 ","$1,673.86 ","$2,651.40 ","$2,678.18 ","$0.00 ","$508.66 ","$0.00 ","$532.96 ","$0.00 "
"02.123.031","SUP","HCPCS C1713","","02.123.031  -  PLATE BONE 271MM 12 HOLE LCP STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$3,448.18 ","$2,551.65 ","$0.00 ","$3,347.73 ","$1,506.48 ","$0.00 ","$718.69 ","$0.00 ","$0.00 ","$586.16 ","$3,347.73 ","$0.00 ","$1,673.86 ","$2,651.40 ","$2,678.18 ","$0.00 ","$508.66 ","$0.00 ","$532.96 ","$0.00 "
"02.123.032S","SUP","HCPCS C1713","","02.123.032S  -  PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$3,767.25 ","$2,787.77 ","$0.00 ","$3,657.53 ","$1,645.89 ","$0.00 ","$785.19 ","$0.00 ","$0.00 ","$640.40 ","$3,657.53 ","$0.00 ","$1,828.76 ","$2,896.76 ","$2,926.02 ","$0.00 ","$555.73 ","$0.00 ","$582.28 ","$0.00 "
"02.123.033S","SUP","HCPCS C1713","","02.123.033S  -  PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$3,767.25 ","$2,787.77 ","$0.00 ","$3,657.53 ","$1,645.89 ","$0.00 ","$785.19 ","$0.00 ","$0.00 ","$640.40 ","$3,657.53 ","$0.00 ","$1,828.76 ","$2,896.76 ","$2,926.02 ","$0.00 ","$555.73 ","$0.00 ","$582.28 ","$0.00 "
"02.123.040","SUP","HCPCS C1713","","02.123.040  -  PLATE BONE 109MM 3 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL","BOTH IP/OP","$2,898.55 ","$2,144.93 ","$0.00 ","$2,814.13 ","$1,266.36 ","$0.00 ","$604.13 ","$0.00 ","$0.00 ","$492.73 ","$2,814.13 ","$0.00 ","$1,407.06 ","$2,228.79 ","$2,251.30 ","$0.00 ","$427.58 ","$0.00 ","$448.01 ","$0.00 "
"02.123.041","SUP","HCPCS C1713","","02.123.041  -  PLATE BN CNTR 109MM NS LCP CMBN 3 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$2,898.55 ","$2,144.93 ","$0.00 ","$2,814.13 ","$1,266.36 ","$0.00 ","$604.13 ","$0.00 ","$0.00 ","$492.73 ","$2,814.13 ","$0.00 ","$1,407.06 ","$2,228.79 ","$2,251.30 ","$0.00 ","$427.58 ","$0.00 ","$448.01 ","$0.00 "
"02.123.042","SUP","HCPCS C1713","","02.123.042  -  PLATE BN CNTR 145MM NS LCP CMBN 5 HL LMT CNTCT TPR TIP SS","BOTH IP/OP","$3,016.63 ","$2,232.31 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$628.74 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$445.00 ","$0.00 ","$466.26 ","$0.00 "
"02.123.043","SUP","HCPCS C1713","","02.123.043  -  PLATE BONE 14.5CM 5 HOLE SET LCP STAINLESS STEEL LEFT","BOTH IP/OP","$3,016.63 ","$2,232.31 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$628.74 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$445.00 ","$0.00 ","$466.26 ","$0.00 "
"02.124.030S","SUP","HCPCS C1713","","02.124.030S  -  PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,318.85 ","$2,455.95 ","$0.00 ","$3,222.18 ","$1,449.98 ","$0.00 ","$691.73 ","$0.00 ","$0.00 ","$564.18 ","$3,222.18 ","$0.00 ","$1,611.09 ","$2,551.97 ","$2,577.74 ","$0.00 ","$489.58 ","$0.00 ","$512.97 ","$0.00 "
"02.124.031S","SUP","HCPCS C1713","","02.124.031S  -  PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,318.85 ","$2,455.95 ","$0.00 ","$3,222.18 ","$1,449.98 ","$0.00 ","$691.73 ","$0.00 ","$0.00 ","$564.18 ","$3,222.18 ","$0.00 ","$1,611.09 ","$2,551.97 ","$2,577.74 ","$0.00 ","$489.58 ","$0.00 ","$512.97 ","$0.00 "
"02.124.034S","SUP","HCPCS C1713","","02.124.034S  -  PLATE BN 396MM STRL LCP CMBN 17 HL PSHP RND TIP LOPRFL SS","BOTH IP/OP","$3,379.28 ","$2,500.67 ","$0.00 ","$3,280.85 ","$1,476.38 ","$0.00 ","$704.33 ","$0.00 ","$0.00 ","$574.45 ","$3,280.85 ","$0.00 ","$1,640.43 ","$2,598.43 ","$2,624.68 ","$0.00 ","$498.50 ","$0.00 ","$522.31 ","$0.00 "
"02.124.035S","SUP","HCPCS C1713","","02.124.035S  -  PLATE BONE 396MM 17 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,379.28 ","$2,500.67 ","$0.00 ","$3,280.85 ","$1,476.38 ","$0.00 ","$704.33 ","$0.00 ","$0.00 ","$574.45 ","$3,280.85 ","$0.00 ","$1,640.43 ","$2,598.43 ","$2,624.68 ","$0.00 ","$498.50 ","$0.00 ","$522.31 ","$0.00 "
"02.124.038S","SUP","HCPCS C1713","","02.124.038S  -  PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,441.13 ","$2,546.44 ","$0.00 ","$3,340.90 ","$1,503.41 ","$0.00 ","$717.22 ","$0.00 ","$0.00 ","$584.96 ","$3,340.90 ","$0.00 ","$1,670.45 ","$2,645.99 ","$2,672.72 ","$0.00 ","$507.62 ","$0.00 ","$531.87 ","$0.00 "
"02.124.039S","SUP","HCPCS C1713","","02.124.039S  -  PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR","BOTH IP/OP","$3,441.13 ","$2,546.44 ","$0.00 ","$3,340.90 ","$1,503.41 ","$0.00 ","$717.22 ","$0.00 ","$0.00 ","$584.96 ","$3,340.90 ","$0.00 ","$1,670.45 ","$2,645.99 ","$2,672.72 ","$0.00 ","$507.62 ","$0.00 ","$531.87 ","$0.00 "
"02.124.200","SUP","HCPCS C1713","","02.124.200  -  PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"02.124.200S","SUP","HCPCS C1713","","02.124.200S  -  PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB RT","BOTH IP/OP","$2,755.15 ","$2,038.81 ","$0.00 ","$2,674.90 ","$1,203.71 ","$0.00 ","$574.24 ","$0.00 ","$0.00 ","$468.35 ","$2,674.90 ","$0.00 ","$1,337.45 ","$2,118.52 ","$2,139.92 ","$0.00 ","$406.43 ","$0.00 ","$425.84 ","$0.00 "
"02.124.201","SUP","HCPCS C1713","","02.124.201  -  PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"02.124.201S","SUP","HCPCS C1713","","02.124.201S  -  PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB LT","BOTH IP/OP","$2,755.15 ","$2,038.81 ","$0.00 ","$2,674.90 ","$1,203.71 ","$0.00 ","$574.24 ","$0.00 ","$0.00 ","$468.35 ","$2,674.90 ","$0.00 ","$1,337.45 ","$2,118.52 ","$2,139.92 ","$0.00 ","$406.43 ","$0.00 ","$425.84 ","$0.00 "
"02.124.204","SUP","HCPCS C1713","","02.124.204  -  PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"02.124.205","SUP","HCPCS C1713","","02.124.205  -  PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"02.124.205S","SUP","HCPCS C1713","","02.124.205S  -  PLATE BN 102MM STRL LCP CMBN 6 HL LO BND LMT CNTCT SS TIB LT","BOTH IP/OP","$2,787.50 ","$2,062.75 ","$0.00 ","$2,706.30 ","$1,217.84 ","$0.00 ","$580.98 ","$0.00 ","$0.00 ","$473.85 ","$2,706.30 ","$0.00 ","$1,353.15 ","$2,143.39 ","$2,165.04 ","$0.00 ","$411.20 ","$0.00 ","$430.84 ","$0.00 "
"02.124.208","SUP","HCPCS C1713","","02.124.208  -  PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"02.124.209","SUP","HCPCS C1713","","02.124.209  -  PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"02.124.212","SUP","HCPCS C1713","","02.124.212  -  PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS","BOTH IP/OP","$2,756.58 ","$2,039.87 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$574.54 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"02.124.213","SUP","HCPCS C1713","","02.124.213  -  PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS","BOTH IP/OP","$2,756.58 ","$2,039.87 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$574.54 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"02.124.216","SUP","HCPCS C1713","","02.124.216  -  PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"02.124.217","SUP","HCPCS C1713","","02.124.217  -  PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"02.124.220","SUP","HCPCS C1713","","02.124.220  -  PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"02.124.220S","SUP","HCPCS C1713","","02.124.220S  -  PLATE BN 206MM STRL LCP CMBN 14 HL LO BND LMT CNTCT SS TIB","BOTH IP/OP","$3,009.60 ","$2,227.10 ","$0.00 ","$2,921.93 ","$1,314.87 ","$0.00 ","$627.28 ","$0.00 ","$0.00 ","$511.61 ","$2,921.93 ","$0.00 ","$1,460.96 ","$2,314.17 ","$2,337.54 ","$0.00 ","$443.96 ","$0.00 ","$465.17 ","$0.00 "
"02.124.221","SUP","HCPCS C1713","","02.124.221  -  PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"02.124.224","SUP","HCPCS C1713","","02.124.224  -  PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS","BOTH IP/OP","$3,020.83 ","$2,235.41 ","$0.00 ","$2,932.85 ","$1,319.78 ","$0.00 ","$629.62 ","$0.00 ","$0.00 ","$513.52 ","$2,932.85 ","$0.00 ","$1,466.43 ","$2,322.82 ","$2,346.28 ","$0.00 ","$445.62 ","$0.00 ","$466.91 ","$0.00 "
"02.124.225","SUP","HCPCS C1713","","02.124.225  -  PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS","BOTH IP/OP","$3,020.83 ","$2,235.41 ","$0.00 ","$2,932.85 ","$1,319.78 ","$0.00 ","$629.62 ","$0.00 ","$0.00 ","$513.52 ","$2,932.85 ","$0.00 ","$1,466.43 ","$2,322.82 ","$2,346.28 ","$0.00 ","$445.62 ","$0.00 ","$466.91 ","$0.00 "
"02.124.408S","SUP","HCPCS C1713","","02.124.408S  -  PLATE CURVE 195MM SS 4.5MM SCR 8 HOLE 4 CLMN THRD","BOTH IP/OP","$3,282.30 ","$2,428.90 ","$0.00 ","$3,186.70 ","$1,434.02 ","$0.00 ","$684.11 ","$0.00 ","$0.00 ","$557.97 ","$3,186.70 ","$0.00 ","$1,593.35 ","$2,523.87 ","$2,549.36 ","$0.00 ","$484.19 ","$0.00 ","$507.32 ","$0.00 "
"02.124.410S","SUP","HCPCS C1713","","02.124.410S  -  PLATE BONE CURVE 230MM 10 HOLE VAR ANG LCP COMBI STAINLESS","BOTH IP/OP","$3,431.30 ","$2,539.16 ","$0.00 ","$3,331.35 ","$1,499.11 ","$0.00 ","$715.17 ","$0.00 ","$0.00 ","$583.29 ","$3,331.35 ","$0.00 ","$1,665.68 ","$2,638.43 ","$2,665.08 ","$0.00 ","$506.17 ","$0.00 ","$530.35 ","$0.00 "
"02.124.411","SUP","HCPCS C1713","","02.124.411  -  PLATE BONE CURVE 23CM 10 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$3,339.93 ","$2,471.55 ","$0.00 ","$3,242.65 ","$1,459.19 ","$0.00 ","$696.12 ","$0.00 ","$0.00 ","$567.76 ","$3,242.65 ","$0.00 ","$1,621.33 ","$2,568.18 ","$2,594.12 ","$0.00 ","$492.69 ","$0.00 ","$516.23 ","$0.00 "
"02.124.412","SUP","HCPCS C1713","","02.124.412  -  PLATE BONE 267MM 12 HOLE VAR ANG CVD LCP STAINLESS STEEL","BOTH IP/OP","$3,410.20 ","$2,523.55 ","$0.00 ","$3,310.88 ","$1,489.89 ","$0.00 ","$710.77 ","$0.00 ","$0.00 ","$579.71 ","$3,310.88 ","$0.00 ","$1,655.44 ","$2,622.22 ","$2,648.70 ","$0.00 ","$503.06 ","$0.00 ","$527.09 ","$0.00 "
"02.124.412S","SUP","HCPCS C1713","","02.124.412S  -  PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS","BOTH IP/OP","$3,300.58 ","$2,442.43 ","$0.00 ","$3,300.58 ","$1,485.26 ","$0.00 ","$687.92 ","$0.00 ","$0.00 ","$577.90 ","$3,300.58 ","$0.00 ","$1,650.29 ","$2,614.06 ","$2,640.46 ","$0.00 ","$516.54 ","$0.00 ","$525.45 ","$0.00 "
"02.124.413","SUP","HCPCS C1713","","02.124.413  -  PLATE BN CRV 266MM NS LCP CMBN 12 HL 4 CLMN THRD VA SS CNDRL","BOTH IP/OP","$3,410.20 ","$2,523.55 ","$0.00 ","$3,310.88 ","$1,489.89 ","$0.00 ","$710.77 ","$0.00 ","$0.00 ","$579.71 ","$3,310.88 ","$0.00 ","$1,655.44 ","$2,622.22 ","$2,648.70 ","$0.00 ","$503.06 ","$0.00 ","$527.09 ","$0.00 "
"02.124.413S","SUP","HCPCS C1713","","02.124.413S  -  PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS","BOTH IP/OP","$3,501.58 ","$2,591.17 ","$0.00 ","$3,399.60 ","$1,529.82 ","$0.00 ","$729.82 ","$0.00 ","$0.00 ","$595.24 ","$3,399.60 ","$0.00 ","$1,699.80 ","$2,692.48 ","$2,719.68 ","$0.00 ","$516.54 ","$0.00 ","$541.22 ","$0.00 "
"02.124.414S","SUP","HCPCS C1713","","02.124.414S  -  PLATE BN CRV 301MM STRL LCP CMBN 14 HL 4 CLMN THRD VA SS","BOTH IP/OP","$3,730.70 ","$2,760.72 ","$0.00 ","$3,622.05 ","$1,629.92 ","$0.00 ","$777.57 ","$0.00 ","$0.00 ","$634.19 ","$3,622.05 ","$0.00 ","$1,811.03 ","$2,868.66 ","$2,897.64 ","$0.00 ","$550.34 ","$0.00 ","$576.63 ","$0.00 "
"02.124.415","SUP","HCPCS C1713","","02.124.415  -  PLATE BN CRV 301MM NS LCP CMBN 14 HL 4 CLMN THRD VA SS CNDRL","BOTH IP/OP","$3,639.35 ","$2,693.12 ","$0.00 ","$3,533.35 ","$1,590.01 ","$0.00 ","$758.53 ","$0.00 ","$0.00 ","$618.66 ","$3,533.35 ","$0.00 ","$1,766.68 ","$2,798.41 ","$2,826.68 ","$0.00 ","$536.86 ","$0.00 ","$562.51 ","$0.00 "
"02.124.416","SUP","HCPCS C1713","","02.124.416  -  PLATE BONE CURVE 336MM 16 HOLE LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$3,709.63 ","$2,745.13 ","$0.00 ","$3,601.58 ","$1,620.71 ","$0.00 ","$773.18 ","$0.00 ","$0.00 ","$630.61 ","$3,601.58 ","$0.00 ","$1,800.79 ","$2,852.45 ","$2,881.26 ","$0.00 ","$547.23 ","$0.00 ","$573.37 ","$0.00 "
"02.124.416S","SUP","HCPCS C1713","","02.124.416S  -  PLATE CURVE 336MM SS 4.5MM SCR 16 HOLE 4 CLMN THRD","BOTH IP/OP","$3,801.00 ","$2,812.74 ","$0.00 ","$3,690.28 ","$1,660.62 ","$0.00 ","$792.22 ","$0.00 ","$0.00 ","$646.14 ","$3,690.28 ","$0.00 ","$1,845.14 ","$2,922.70 ","$2,952.22 ","$0.00 ","$560.71 ","$0.00 ","$587.49 ","$0.00 "
"02.124.417S","SUP","HCPCS C1713","","02.124.417S  -  PLATE BONE CURVE 336MM 16 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$3,801.00 ","$2,812.74 ","$0.00 ","$3,690.28 ","$1,660.62 ","$0.00 ","$792.22 ","$0.00 ","$0.00 ","$646.14 ","$3,690.28 ","$0.00 ","$1,845.14 ","$2,922.70 ","$2,952.22 ","$0.00 ","$560.71 ","$0.00 ","$587.49 ","$0.00 "
"02.124.419","SUP","HCPCS C1713","","02.124.419  -  PLATE BONE 375MM 18 HOLE VAR ANG CVD LCP STAINLESS STEEL","BOTH IP/OP","$3,951.40 ","$2,924.04 ","$0.00 ","$3,836.30 ","$1,726.34 ","$0.00 ","$823.57 ","$0.00 ","$0.00 ","$671.71 ","$3,836.30 ","$0.00 ","$1,918.15 ","$3,038.35 ","$3,069.04 ","$0.00 ","$582.90 ","$0.00 ","$610.74 ","$0.00 "
"02.130.004","SUP","HCPCS C1713","","02.130.004  -  SCREW BN T4 1.3MM 4MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.005","SUP","HCPCS C1713","","02.130.005  -  SCREW BN T4 1.3MM 5MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.006","SUP","HCPCS C1713","","02.130.006  -  SCREW BN T4 1.3MM 6MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.007","SUP","HCPCS C1713","","02.130.007  -  SCREW BN T4 1.3MM 7MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.008","SUP","HCPCS C1713","","02.130.008  -  SCREW BN T4 1.3MM 8MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.009","SUP","HCPCS C1713","","02.130.009  -  SCREW BN T4 1.3MM 9MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.010","SUP","HCPCS C1713","","02.130.010  -  SCREW BN T4 1.3MM 10MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.011","SUP","HCPCS C1713","","02.130.011  -  SCREW BN T4 1.3MM 11MM NS SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.012","SUP","HCPCS C1713","","02.130.012  -  SCREW BN T4 1.3MM 12MM NS SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.013","SUP","HCPCS C1713","","02.130.013  -  SCREW BN T4 1.3MM 13MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.014","SUP","HCPCS C1713","","02.130.014  -  SCREW BN T4 1.3MM 14MM SLFRET ST TIP STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.015","SUP","HCPCS C1713","","02.130.015  -  SCREW BN T4 1.3MM 15MM SLFRET ST STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.016","SUP","HCPCS C1713","","02.130.016  -  SCREW BN T4 1.3MM 16MM ST TIP SLFRET STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.018","SUP","HCPCS C1713","","02.130.018  -  SCREW BN T4 1.3MM 18MM ST TIP SLFRET LCK STRDR SS CORT","BOTH IP/OP","$81.53 ","$60.33 ","$0.00 ","$79.15 ","$35.62 ","$0.00 ","$16.99 ","$0.00 ","$0.00 ","$13.86 ","$79.15 ","$0.00 ","$39.58 ","$62.69 ","$63.32 ","$0.00 ","$12.03 ","$0.00 ","$12.60 ","$0.00 "
"02.130.104","SUP","HCPCS C1713","","02.130.104  -  SCREW BN T4 1.3MM 4MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.105","SUP","HCPCS C1713","","02.130.105  -  SCREW BN T4 1.3MM 5MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.106","SUP","HCPCS C1713","","02.130.106  -  SCREW BN T4 1.3MM 6MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.107","SUP","HCPCS C1713","","02.130.107  -  SCREW BN T4 1.3MM 7MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.108","SUP","HCPCS C1713","","02.130.108  -  SCREW BN T4 1.3MM 8MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.109","SUP","HCPCS C1713","","02.130.109  -  SCREW BN T4 1.3MM 9MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.110","SUP","HCPCS C1713","","02.130.110  -  SCREW BN T4 1.3MM 10MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.111","SUP","HCPCS C1713","","02.130.111  -  SCREW BN T4 1.3MM 11MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.112","SUP","HCPCS C1713","","02.130.112  -  SCREW BN T4 1.3MM 12MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.113","SUP","HCPCS C1713","","02.130.113  -  SCREW BN T4 1.3MM 13MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.114","SUP","HCPCS C1713","","02.130.114  -  SCREW BN T4 1.3MM 14MM SLFRET ST TIP LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.115","SUP","HCPCS C1713","","02.130.115  -  SCREW BN T4 1.3MM 15MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.116","SUP","HCPCS C1713","","02.130.116  -  SCREW BN T4 1.3MM 16MM ST TIP SLFRET LCK STRDR SS HND","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.118","SUP","HCPCS C1713","","02.130.118  -  SCREW BN T4 1.3MM 18MM ST SLF RTN LCK STRDR SS","BOTH IP/OP","$215.08 ","$159.16 ","$0.00 ","$208.80 ","$93.96 ","$0.00 ","$44.83 ","$0.00 ","$0.00 ","$36.56 ","$208.80 ","$0.00 ","$104.40 ","$165.37 ","$167.04 ","$0.00 ","$31.73 ","$0.00 ","$33.24 ","$0.00 "
"02.130.150","SUP","HCPCS C1713","","02.130.150  -  PLATE BN STRG .75MM LCK 6 HL LOPRFL PRECONTOUR SS HND 1.3MM","BOTH IP/OP","$723.93 ","$535.71 ","$0.00 ","$702.85 ","$316.28 ","$0.00 ","$150.88 ","$0.00 ","$0.00 ","$123.06 ","$702.85 ","$0.00 ","$351.43 ","$556.66 ","$562.28 ","$0.00 ","$106.79 ","$0.00 ","$111.89 ","$0.00 "
"02.130.151","SUP","HCPCS C1713","","02.130.151  -  PLATE BN STRG .75MM LCK 12 HL LOPRFL PRECONTOUR SS HND 1.3MM","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$346.98 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$135.01 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$117.16 ","$0.00 ","$122.76 ","$0.00 "
"02.130.152","SUP","HCPCS C1713","","02.130.152  -  PLATE BN T .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$346.98 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$135.01 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$117.16 ","$0.00 ","$122.76 ","$0.00 "
"02.130.153","SUP","HCPCS C1713","","02.130.153  -  PLATE BN Y .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$346.98 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$135.01 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$117.16 ","$0.00 ","$122.76 ","$0.00 "
"02.130.154","SUP","HCPCS C1713","","02.130.154  -  PLATE BN .75MM LCK 2 HLE/HD 5 HL SHFT LOPRFL SS PHLNG BS 1.3","BOTH IP/OP","$905.28 ","$669.91 ","$0.00 ","$878.90 ","$395.51 ","$0.00 ","$188.68 ","$0.00 ","$0.00 ","$153.89 ","$878.90 ","$0.00 ","$439.45 ","$696.09 ","$703.12 ","$0.00 ","$133.54 ","$0.00 ","$139.92 ","$0.00 "
"02.130.156","SUP","HCPCS C1713","","02.130.156  -  PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.3","BOTH IP/OP","$905.28 ","$669.91 ","$0.00 ","$878.90 ","$395.51 ","$0.00 ","$188.68 ","$0.00 ","$0.00 ","$153.89 ","$878.90 ","$0.00 ","$439.45 ","$696.09 ","$703.12 ","$0.00 ","$133.54 ","$0.00 ","$139.92 ","$0.00 "
"02.130.157","SUP","HCPCS C1713","","02.130.157  -  PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.3","BOTH IP/OP","$905.28 ","$669.91 ","$0.00 ","$878.90 ","$395.51 ","$0.00 ","$188.68 ","$0.00 ","$0.00 ","$153.89 ","$878.90 ","$0.00 ","$439.45 ","$696.09 ","$703.12 ","$0.00 ","$133.54 ","$0.00 ","$139.92 ","$0.00 "
"02.130.158","SUP","HCPCS C1713","","02.130.158  -  PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$346.98 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$135.01 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$117.16 ","$0.00 ","$122.76 ","$0.00 "
"02.130.159","SUP","HCPCS C1713","","02.130.159  -  PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND","BOTH IP/OP","$794.23 ","$587.73 ","$0.00 ","$771.08 ","$346.98 ","$0.00 ","$165.54 ","$0.00 ","$0.00 ","$135.01 ","$771.08 ","$0.00 ","$385.54 ","$610.70 ","$616.86 ","$0.00 ","$117.16 ","$0.00 ","$122.76 ","$0.00 "
"02.130.161","SUP","HCPCS C1713","","02.130.161  -  PLATE BN WEB .75MM 14 HL LCK LOPRFL PRECONTOUR SS HND 1.3MM","BOTH IP/OP","$836.38 ","$618.92 ","$0.00 ","$812.03 ","$365.41 ","$0.00 ","$174.32 ","$0.00 ","$0.00 ","$142.18 ","$812.03 ","$0.00 ","$406.01 ","$643.13 ","$649.62 ","$0.00 ","$123.38 ","$0.00 ","$129.27 ","$0.00 "
"02.130.204","SUP","HCPCS C1713","","02.130.204  -  SCREW BN T4 1.5MM 4MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.205","SUP","HCPCS C1713","","02.130.205  -  SCREW BN T4 1.5MM 5MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.206","SUP","HCPCS C1713","","02.130.206  -  SCREW BN T4 1.5MM 6MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.207","SUP","HCPCS C1713","","02.130.207  -  SCREW BN T4 1.5MM 7MM PUR ST VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.208","SUP","HCPCS C1713","","02.130.208  -  SCREW BN T4 1.5MM 8MM ST LCK VA STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.209","SUP","HCPCS C1713","","02.130.209  -  SCREW BN T4 1.5MM 9MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.210","SUP","HCPCS C1713","","02.130.210  -  SCREW BN T4 1.5MM 10MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.211","SUP","HCPCS C1713","","02.130.211  -  SCREW BN T4 1.5MM 11MM ST LCK VA STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.212","SUP","HCPCS C1713","","02.130.212  -  SCREW BN T4 1.5MM 12MM ST LCK VA STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.213","SUP","HCPCS C1713","","02.130.213  -  SCREW BN T4 1.5MM 13MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.214","SUP","HCPCS C1713","","02.130.214  -  SCREW BN T4 1.5MM 14MM PUR ST TIP LCK VA STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.215","SUP","HCPCS C1713","","02.130.215  -  SCREW BN T4 1.5MM 15MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.216","SUP","HCPCS C1713","","02.130.216  -  SCREW BN T4 1.5MM 16MM PUR ST TIP LCK VA STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.218","SUP","HCPCS C1713","","02.130.218  -  SCREW BN T4 1.5MM 18MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.220","SUP","HCPCS C1713","","02.130.220  -  SCREW BN T4 1.5MM 20MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.222","SUP","HCPCS C1713","","02.130.222  -  SCREW BN T4 1.5MM 22MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.224","SUP","HCPCS C1713","","02.130.224  -  SCREW BN T4 1.5MM 24MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$238.98 ","$176.85 ","$0.00 ","$232.00 ","$104.40 ","$0.00 ","$49.81 ","$0.00 ","$0.00 ","$40.62 ","$232.00 ","$0.00 ","$116.00 ","$183.74 ","$185.60 ","$0.00 ","$35.25 ","$0.00 ","$36.93 ","$0.00 "
"02.130.250","SUP","HCPCS C1713","","02.130.250  -  PLATE BN STRG 1MM 6 HL VA LCK LOPRFL SS 1.5MM SCR","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"02.130.251","SUP","HCPCS C1713","","02.130.251  -  PLATE BN STRG 1MM NS 12 HL VA LCK LOPRFL SS 1.5MM SCR","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"02.130.252","SUP","HCPCS C1713","","02.130.252  -  PLATE BN T 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"02.130.253","SUP","HCPCS C1713","","02.130.253  -  PLATE BN Y 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"02.130.254","SUP","HCPCS C1713","","02.130.254  -  PLATE BN 1MM 2 HLE/HD 6 HL SHFT VA LCK PHLNG BS 1.5MM SCR","BOTH IP/OP","$969.93 ","$717.75 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$202.16 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"02.130.255","SUP","HCPCS C1713","","02.130.255  -  PLATE BN STRG 1MM 2 HLE/HD 6 HL SHFT VA LCK SS CNDRL 1.5MM","BOTH IP/OP","$927.75 ","$686.54 ","$0.00 ","$900.73 ","$405.33 ","$0.00 ","$193.37 ","$0.00 ","$0.00 ","$157.71 ","$900.73 ","$0.00 ","$450.36 ","$713.38 ","$720.58 ","$0.00 ","$136.86 ","$0.00 ","$143.40 ","$0.00 "
"02.130.256","SUP","HCPCS C1713","","02.130.256  -  PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.5","BOTH IP/OP","$969.93 ","$717.75 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$202.16 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"02.130.257","SUP","HCPCS C1713","","02.130.257  -  PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.5","BOTH IP/OP","$969.93 ","$717.75 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$202.16 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"02.130.258","SUP","HCPCS C1713","","02.130.258  -  PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND RT 1.5MM","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"02.130.259","SUP","HCPCS C1713","","02.130.259  -  PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND LT 1.5MM","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"02.130.260","SUP","HCPCS C1713","","02.130.260  -  PLATE BN STRUT 1MM VA LCK 12 HL LOPRFL SS HND 1.5MM SCR","BOTH IP/OP","$969.93 ","$717.75 ","$0.00 ","$941.68 ","$423.75 ","$0.00 ","$202.16 ","$0.00 ","$0.00 ","$164.88 ","$941.68 ","$0.00 ","$470.84 ","$745.81 ","$753.34 ","$0.00 ","$143.08 ","$0.00 ","$149.91 ","$0.00 "
"02.130.261","SUP","HCPCS C1713","","02.130.261  -  PLATE BN WEB 1MM VA LCK 14 HL LOPRFL SS HND 1.5MM SCR","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"02.130.263","SUP","HCPCS C1713","","02.130.263  -  PLATE BN CNTR 1MM VA LCK LOPRFL SS 1ST MTCRPL DRSL 1.5MM SCR","BOTH IP/OP","$941.83 ","$696.95 ","$0.00 ","$914.38 ","$411.47 ","$0.00 ","$196.30 ","$0.00 ","$0.00 ","$160.10 ","$914.38 ","$0.00 ","$457.19 ","$724.19 ","$731.50 ","$0.00 ","$138.93 ","$0.00 ","$145.57 ","$0.00 "
"02.130.264","SUP","HCPCS C1713","","02.130.264  -  PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MTCRPL RL 1.5MM SCR","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,200.98 ","$540.44 ","$0.00 ","$257.82 ","$0.00 ","$0.00 ","$210.28 ","$1,200.98 ","$0.00 ","$600.49 ","$951.18 ","$960.78 ","$0.00 ","$182.48 ","$0.00 ","$191.20 ","$0.00 "
"02.130.265","SUP","HCPCS C1713","","02.130.265  -  PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MATECARPAL L/L 1.5","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,200.98 ","$540.44 ","$0.00 ","$257.82 ","$0.00 ","$0.00 ","$210.28 ","$1,200.98 ","$0.00 ","$600.49 ","$951.18 ","$960.78 ","$0.00 ","$182.48 ","$0.00 ","$191.20 ","$0.00 "
"02.130.266","SUP","HCPCS C1713","","02.130.266  -  PLATE BN 1MM VA LCK 6 HL ROT CRRT SS MTCRPL PHALANGE 1.5MM","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,200.98 ","$540.44 ","$0.00 ","$257.82 ","$0.00 ","$0.00 ","$210.28 ","$1,200.98 ","$0.00 ","$600.49 ","$951.18 ","$960.78 ","$0.00 ","$182.48 ","$0.00 ","$191.20 ","$0.00 "
"02.130.268","SUP","HCPCS C1713","","02.130.268  -  PLATE BN 1MM VA LCK KWR HL SS MTCRPL NK 1.5MM SCR","BOTH IP/OP","$1,237.00 ","$915.38 ","$0.00 ","$1,200.98 ","$540.44 ","$0.00 ","$257.82 ","$0.00 ","$0.00 ","$210.28 ","$1,200.98 ","$0.00 ","$600.49 ","$951.18 ","$960.78 ","$0.00 ","$182.48 ","$0.00 ","$191.20 ","$0.00 "
"02.130.306","SUP","HCPCS C1713","","02.130.306  -  SCREW BN T6 2MM 6MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.307","SUP","HCPCS C1713","","02.130.307  -  SCREW BN T6 2MM 7MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.308","SUP","HCPCS C1713","","02.130.308  -  SCREW BN T6 2MM 8MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.309","SUP","HCPCS C1713","","02.130.309  -  SCREW BN T6 2MM 9MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.310","SUP","HCPCS C1713","","02.130.310  -  SCREW BN T6 2MM 10MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.311","SUP","HCPCS C1713","","02.130.311  -  SCREW BN T6 2MM 11MM PUR VA LCK ST TIP STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.312","SUP","HCPCS C1713","","02.130.312  -  SCREW BN T6 2MM 12MM PUR STRDR VA ST LCK SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.313","SUP","HCPCS C1713","","02.130.313  -  SCREW BN T6 2MM 13MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.314","SUP","HCPCS C1713","","02.130.314  -  SCREW BN T6 2MM 14MM PUR NS STRDR ST LCK VA SS","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.315","SUP","HCPCS C1713","","02.130.315  -  SCREW BN T6 2MM 15MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.316","SUP","HCPCS C1713","","02.130.316  -  SCREW BN T6 2MM 16MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.318","SUP","HCPCS C1713","","02.130.318  -  SCREW BN T6 2MM 18MM PUR STRDR VA ST LCK SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.320","SUP","HCPCS C1713","","02.130.320  -  SCREW BN T6 2MM 20MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.322","SUP","HCPCS C1713","","02.130.322  -  SCREW BN T6 2MM 22MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.324","SUP","HCPCS C1713","","02.130.324  -  SCREW BN T6 2MM 24MM PUR ST TIP VA LCK STRDR SS HND","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$108.09 ","$0.00 ","$51.56 ","$0.00 ","$0.00 ","$42.06 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$36.50 ","$0.00 ","$38.24 ","$0.00 "
"02.130.350","SUP","HCPCS C1713","","02.130.350  -  PLATE BN STRG 1.3MM 6 HL LCK VA LOPRFL HND 2MM SCR","BOTH IP/OP","$948.85 ","$702.15 ","$0.00 ","$921.20 ","$414.54 ","$0.00 ","$197.76 ","$0.00 ","$0.00 ","$161.29 ","$921.20 ","$0.00 ","$460.60 ","$729.59 ","$736.96 ","$0.00 ","$139.97 ","$0.00 ","$146.66 ","$0.00 "
"02.130.351","SUP","HCPCS C1713","","02.130.351  -  PLATE BN FT STRG 1.3MM 12 HL VA LCK COAX SS HND 2MM SCR","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"02.130.352","SUP","HCPCS C1713","","02.130.352  -  PLATE BN FT T 1.3MM 3 HLE/HD 7 HL SHFT VA LCK SS HND 2MM SCR","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"02.130.353","SUP","HCPCS C1713","","02.130.353  -  PLATE BN Y 1.3MM 3 HLE/HD 7 HL SHFT LCK VA SS HND 2MM SCR","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"02.130.354","SUP","HCPCS C1713","","02.130.354  -  PLATE BN CNTR 1.3MM 2 HLE/HD 6 HL SHFT LCK ELONGATE HL SS","BOTH IP/OP","$1,117.53 ","$826.97 ","$0.00 ","$1,084.98 ","$488.24 ","$0.00 ","$232.92 ","$0.00 ","$0.00 ","$189.97 ","$1,084.98 ","$0.00 ","$542.49 ","$859.30 ","$867.98 ","$0.00 ","$164.85 ","$0.00 ","$172.73 ","$0.00 "
"02.130.355","SUP","HCPCS C1713","","02.130.355  -  PLATE BN 1.3MM 2 HLE/HD 6 HL SHFT LCK VA SS CNDRL 2MM SCR","BOTH IP/OP","$1,089.40 ","$806.16 ","$0.00 ","$1,057.68 ","$475.95 ","$0.00 ","$227.06 ","$0.00 ","$0.00 ","$185.19 ","$1,057.68 ","$0.00 ","$528.84 ","$837.68 ","$846.14 ","$0.00 ","$160.71 ","$0.00 ","$168.38 ","$0.00 "
"02.130.360","SUP","HCPCS C1713","","02.130.360  -  PLATE BN STRUT 1.3MM 12 HL LCK VA LOPRFL SS HND 2MM SCR","BOTH IP/OP","$1,117.53 ","$826.97 ","$0.00 ","$1,084.98 ","$488.24 ","$0.00 ","$232.92 ","$0.00 ","$0.00 ","$189.97 ","$1,084.98 ","$0.00 ","$542.49 ","$859.30 ","$867.98 ","$0.00 ","$164.85 ","$0.00 ","$172.73 ","$0.00 "
"02.130.363","SUP","HCPCS C1713","","02.130.363  -  PLATE BN 1.3MM LCK VA LOPRFL ANTM CNTR SS 1ST MTCRPL DRSL 2","BOTH IP/OP","$1,398.68 ","$1,035.02 ","$0.00 ","$1,357.93 ","$611.07 ","$0.00 ","$291.52 ","$0.00 ","$0.00 ","$237.76 ","$1,357.93 ","$0.00 ","$678.96 ","$1,075.48 ","$1,086.34 ","$0.00 ","$206.33 ","$0.00 ","$216.18 ","$0.00 "
"02.130.366","SUP","HCPCS C1713","","02.130.366  -  PLATE BN 1.3MM 6 HL LCK VA ROT CRRT SS HND 2MM SCR","BOTH IP/OP","$1,398.68 ","$1,035.02 ","$0.00 ","$1,357.93 ","$611.07 ","$0.00 ","$291.52 ","$0.00 ","$0.00 ","$237.76 ","$1,357.93 ","$0.00 ","$678.96 ","$1,075.48 ","$1,086.34 ","$0.00 ","$206.33 ","$0.00 ","$216.18 ","$0.00 "
"02.161.210","SUP","HCPCS C1713","","02.161.210  -  PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$704.25 ","$521.15 ","$0.00 ","$683.75 ","$307.69 ","$0.00 ","$146.78 ","$0.00 ","$0.00 ","$119.72 ","$683.75 ","$0.00 ","$341.88 ","$541.53 ","$547.00 ","$0.00 ","$103.89 ","$0.00 ","$108.85 ","$0.00 "
"02.161.212","SUP","HCPCS C1713","","02.161.212  -  PLATE BONE NARROW CVD 12 HOLE LCP STAINLESS STEEL HUMERUS","BOTH IP/OP","$1,072.55 ","$793.69 ","$0.00 ","$1,041.30 ","$468.59 ","$0.00 ","$223.55 ","$0.00 ","$0.00 ","$182.32 ","$1,041.30 ","$0.00 ","$520.65 ","$824.71 ","$833.04 ","$0.00 ","$158.22 ","$0.00 ","$165.77 ","$0.00 "
"02.161.214","SUP","HCPCS C1713","","02.161.214  -  PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,241.23 ","$918.51 ","$0.00 ","$1,205.08 ","$542.28 ","$0.00 ","$258.70 ","$0.00 ","$0.00 ","$211.00 ","$1,205.08 ","$0.00 ","$602.54 ","$954.42 ","$964.06 ","$0.00 ","$183.10 ","$0.00 ","$191.85 ","$0.00 "
"02.161.216","SUP","HCPCS C1713","","02.161.216  -  PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,341.03 ","$992.36 ","$0.00 ","$1,301.98 ","$585.89 ","$0.00 ","$279.50 ","$0.00 ","$0.00 ","$227.97 ","$1,301.98 ","$0.00 ","$650.99 ","$1,031.17 ","$1,041.58 ","$0.00 ","$197.82 ","$0.00 ","$207.27 ","$0.00 "
"02.161.218","SUP","HCPCS C1713","","02.161.218  -  PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,509.73 ","$1,117.20 ","$0.00 ","$1,465.75 ","$659.59 ","$0.00 ","$314.66 ","$0.00 ","$0.00 ","$256.64 ","$1,465.75 ","$0.00 ","$732.88 ","$1,160.87 ","$1,172.60 ","$0.00 ","$222.71 ","$0.00 ","$233.35 ","$0.00 "
"02.161.220","SUP","HCPCS C1713","","02.161.220  -  PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,675.58 ","$1,239.93 ","$0.00 ","$1,626.78 ","$732.05 ","$0.00 ","$349.23 ","$0.00 ","$0.00 ","$284.84 ","$1,626.78 ","$0.00 ","$813.39 ","$1,288.41 ","$1,301.42 ","$0.00 ","$247.18 ","$0.00 ","$258.98 ","$0.00 "
"02.161.222","SUP","HCPCS C1713","","02.161.222  -  PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,675.58 ","$1,239.93 ","$0.00 ","$1,626.78 ","$732.05 ","$0.00 ","$349.23 ","$0.00 ","$0.00 ","$284.84 ","$1,626.78 ","$0.00 ","$813.39 ","$1,288.41 ","$1,301.42 ","$0.00 ","$247.18 ","$0.00 ","$258.98 ","$0.00 "
"02.161.240","SUP","HCPCS C1713","","02.161.240  -  PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,165.33 ","$862.34 ","$0.00 ","$1,131.38 ","$509.12 ","$0.00 ","$242.88 ","$0.00 ","$0.00 ","$198.09 ","$1,131.38 ","$0.00 ","$565.69 ","$896.05 ","$905.10 ","$0.00 ","$171.90 ","$0.00 ","$180.11 ","$0.00 "
"02.161.242","SUP","HCPCS C1713","","02.161.242  -  PLATE BONE NARROW 12 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,345.25 ","$995.49 ","$0.00 ","$1,306.08 ","$587.73 ","$0.00 ","$280.38 ","$0.00 ","$0.00 ","$228.68 ","$1,306.08 ","$0.00 ","$653.04 ","$1,034.42 ","$1,044.86 ","$0.00 ","$198.45 ","$0.00 ","$207.93 ","$0.00 "
"02.161.244","SUP","HCPCS C1713","","02.161.244  -  PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,435.20 ","$1,062.05 ","$0.00 ","$1,393.40 ","$627.03 ","$0.00 ","$299.13 ","$0.00 ","$0.00 ","$243.97 ","$1,393.40 ","$0.00 ","$696.70 ","$1,103.57 ","$1,114.72 ","$0.00 ","$211.72 ","$0.00 ","$221.83 ","$0.00 "
"02.161.246","SUP","HCPCS C1713","","02.161.246  -  PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,613.73 ","$1,194.16 ","$0.00 ","$1,566.73 ","$705.03 ","$0.00 ","$336.34 ","$0.00 ","$0.00 ","$274.32 ","$1,566.73 ","$0.00 ","$783.36 ","$1,240.85 ","$1,253.38 ","$0.00 ","$238.05 ","$0.00 ","$249.42 ","$0.00 "
"02.161.248","SUP","HCPCS C1713","","02.161.248  -  PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$1,969.38 ","$1,457.34 ","$0.00 ","$1,912.03 ","$860.41 ","$0.00 ","$410.47 ","$0.00 ","$0.00 ","$334.78 ","$1,912.03 ","$0.00 ","$956.01 ","$1,514.33 ","$1,529.62 ","$0.00 ","$290.51 ","$0.00 ","$304.39 ","$0.00 "
"02.161.250","SUP","HCPCS C1713","","02.161.250  -  PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$2,329.23 ","$1,723.63 ","$0.00 ","$2,261.40 ","$1,017.63 ","$0.00 ","$485.47 ","$0.00 ","$0.00 ","$395.95 ","$2,261.40 ","$0.00 ","$1,130.70 ","$1,791.03 ","$1,809.12 ","$0.00 ","$343.60 ","$0.00 ","$360.01 ","$0.00 "
"02.161.252","SUP","HCPCS C1713","","02.161.252  -  PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL","BOTH IP/OP","$2,597.73 ","$1,922.32 ","$0.00 ","$2,522.05 ","$1,134.92 ","$0.00 ","$541.43 ","$0.00 ","$0.00 ","$441.59 ","$2,522.05 ","$0.00 ","$1,261.03 ","$1,997.46 ","$2,017.64 ","$0.00 ","$383.21 ","$0.00 ","$401.51 ","$0.00 "
"02.161.270","SUP","HCPCS C1713","","02.161.270  -  PLATE BONE BROAD 10 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$889.80 ","$658.45 ","$0.00 ","$863.88 ","$388.74 ","$0.00 ","$185.46 ","$0.00 ","$0.00 ","$151.26 ","$863.88 ","$0.00 ","$431.94 ","$684.19 ","$691.10 ","$0.00 ","$131.26 ","$0.00 ","$137.53 ","$0.00 "
"02.161.272","SUP","HCPCS C1713","","02.161.272  -  PLATE BONE BROAD CVD 12 HOLE LCP STAINLESS STEEL TIBIA","BOTH IP/OP","$1,156.88 ","$856.09 ","$0.00 ","$1,123.20 ","$505.44 ","$0.00 ","$241.12 ","$0.00 ","$0.00 ","$196.66 ","$1,123.20 ","$0.00 ","$561.60 ","$889.57 ","$898.56 ","$0.00 ","$170.66 ","$0.00 ","$178.81 ","$0.00 "
"02.161.274","SUP","HCPCS C1713","","02.161.274  -  PLATE BONE BROAD 14 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,241.23 ","$918.51 ","$0.00 ","$1,205.08 ","$542.28 ","$0.00 ","$258.70 ","$0.00 ","$0.00 ","$211.00 ","$1,205.08 ","$0.00 ","$602.54 ","$954.42 ","$964.06 ","$0.00 ","$183.10 ","$0.00 ","$191.85 ","$0.00 "
"02.161.276","SUP","HCPCS C1713","","02.161.276  -  PLATE BN BRD CRV NS LCP CMBN 16 HL LMT CNTCT TPR END SS","BOTH IP/OP","$1,341.03 ","$992.36 ","$0.00 ","$1,301.98 ","$585.89 ","$0.00 ","$279.50 ","$0.00 ","$0.00 ","$227.97 ","$1,301.98 ","$0.00 ","$650.99 ","$1,031.17 ","$1,041.58 ","$0.00 ","$197.82 ","$0.00 ","$207.27 ","$0.00 "
"02.161.278","SUP","HCPCS C1713","","02.161.278  -  PLATE BONE BROAD 18 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,509.73 ","$1,117.20 ","$0.00 ","$1,465.75 ","$659.59 ","$0.00 ","$314.66 ","$0.00 ","$0.00 ","$256.64 ","$1,465.75 ","$0.00 ","$732.88 ","$1,160.87 ","$1,172.60 ","$0.00 ","$222.71 ","$0.00 ","$233.35 ","$0.00 "
"02.161.280","SUP","HCPCS C1713","","02.161.280  -  PLATE BONE BROAD 20 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,608.10 ","$1,189.99 ","$0.00 ","$1,561.28 ","$702.57 ","$0.00 ","$335.17 ","$0.00 ","$0.00 ","$273.37 ","$1,561.28 ","$0.00 ","$780.64 ","$1,236.53 ","$1,249.02 ","$0.00 ","$237.22 ","$0.00 ","$248.55 ","$0.00 "
"02.161.282","SUP","HCPCS C1713","","02.161.282  -  PLATE BONE BROAD 22 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"02.161.284","SUP","HCPCS C1713","","02.161.284  -  PLATE BONE BROAD 24 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"02.161.286","SUP","HCPCS C1713","","02.161.286  -  PLATE BONE BROAD 26 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,795.08 ","$1,328.36 ","$0.00 ","$1,742.78 ","$784.25 ","$0.00 ","$374.14 ","$0.00 ","$0.00 ","$305.15 ","$1,742.78 ","$0.00 ","$871.39 ","$1,380.28 ","$1,394.22 ","$0.00 ","$264.80 ","$0.00 ","$277.45 ","$0.00 "
"02.161.288","SUP","HCPCS C1713","","02.161.288  -  PLATE BONE BROAD 28 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$1,973.60 ","$1,460.46 ","$0.00 ","$1,916.10 ","$862.25 ","$0.00 ","$411.35 ","$0.00 ","$0.00 ","$335.49 ","$1,916.10 ","$0.00 ","$958.05 ","$1,517.55 ","$1,532.88 ","$0.00 ","$291.14 ","$0.00 ","$305.04 ","$0.00 "
"02.161.290","SUP","HCPCS C1713","","02.161.290  -  PLATE BONE BROAD 30 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5","BOTH IP/OP","$2,153.53 ","$1,593.61 ","$0.00 ","$2,090.80 ","$940.86 ","$0.00 ","$448.85 ","$0.00 ","$0.00 ","$366.08 ","$2,090.80 ","$0.00 ","$1,045.40 ","$1,655.91 ","$1,672.64 ","$0.00 ","$317.68 ","$0.00 ","$332.86 ","$0.00 "
"02.200.003","SUP","HCPCS C1713","","02.200.003  -  PLUG PLT 3.5MM NS LCP THRD STRDR RCS SS LOPRFL PLVC SYS","BOTH IP/OP","$203.83 ","$150.83 ","$0.00 ","$197.90 ","$89.06 ","$0.00 ","$42.48 ","$0.00 ","$0.00 ","$34.65 ","$197.90 ","$0.00 ","$98.95 ","$156.74 ","$158.32 ","$0.00 ","$30.07 ","$0.00 ","$31.51 ","$0.00 "
"02.200.010","SUP","HCPCS C1713","","02.200.010  -  SCREW BONE T15 LP 3.5MM 6MM 10MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.012","SUP","HCPCS C1713","","02.200.012  -  SCREW BONE FULTHD 3.5MM 6MM 12MM T15 STARDRIVE SELF TAP LP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.014","SUP","HCPCS C1713","","02.200.014  -  SCREW BONE T15 LP 3.5MM 6MM 14MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.016","SUP","HCPCS C1713","","02.200.016  -  SCREW BONE T15 LP 3.5MM 6MM 16MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.018","SUP","HCPCS C1713","","02.200.018  -  SCREW BONE T15 LP 3.5MM 6MM 18MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.020","SUP","HCPCS C1713","","02.200.020  -  SCREW BONE FULTHD 3.5MM 20MM T15 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.022","SUP","HCPCS C1713","","02.200.022  -  SCREW BONE T15 LP 3.5MM 6MM 22MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.024","SUP","HCPCS C1713","","02.200.024  -  SCREW BONE T15 LP 3.5MM 6MM 24MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.026","SUP","HCPCS C1713","","02.200.026  -  SCREW BONE T15 LP 3.5MM 6MM 26MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.028","SUP","HCPCS C1713","","02.200.028  -  SCREW BONE T15 LP 3.5MM 6MM 28MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.030","SUP","HCPCS C1713","","02.200.030  -  SCREW BONE FULTHD 3.5MM 6MM 30MM T15 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.032","SUP","HCPCS C1713","","02.200.032  -  SCREW BONE T15 LP 3.5MM 6MM 32MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.034","SUP","HCPCS C1713","","02.200.034  -  SCREW BONE T15 LP 3.5MM 6MM 34MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.036","SUP","HCPCS C1713","","02.200.036  -  SCREW BONE T15 LP 3.5MM 6MM 36MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.038","SUP","HCPCS C1713","","02.200.038  -  SCREW BONE FULTHD LP 3.5MM 6MM 38MM SELF TAP T15 STARDRIVE","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.040","SUP","HCPCS C1713","","02.200.040  -  SCREW BONE T15 LP 3.5MM 6MM 40MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.042","SUP","HCPCS C1713","","02.200.042  -  SCREW BONE T15 LP 3.5MM 6MM 42MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.044","SUP","HCPCS C1713","","02.200.044  -  SCREW BONE T15 LP 3.5MM 6MM 44MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.045","SUP","HCPCS C1713","","02.200.045  -  SCREW BONE 3.5MM 45MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.046","SUP","HCPCS C1713","","02.200.046  -  SCREW BONE T15 LP 3.5MM 6MM 46MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.048","SUP","HCPCS C1713","","02.200.048  -  SCREW BONE 3.5MM 48MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.050","SUP","HCPCS C1713","","02.200.050  -  SCREW BONE T15 LP 3.5MM 6MM 50MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.055","SUP","HCPCS C1713","","02.200.055  -  SCREW BONE T15 LP 3.5MM 6MM 55MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.060","SUP","HCPCS C1713","","02.200.060  -  SCREW BONE 3.5MM 60MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.065","SUP","HCPCS C1713","","02.200.065  -  SCREW BONE 3.5MM 65MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.070","SUP","HCPCS C1713","","02.200.070  -  SCREW BONE 3.5MM 70MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.075","SUP","HCPCS C1713","","02.200.075  -  SCREW BONE 3.5MM 75MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.080","SUP","HCPCS C1713","","02.200.080  -  SCREW BONE 3.5MM 80MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.085","SUP","HCPCS C1713","","02.200.085  -  SCREW BONE T15 LP 3.5MM 6MM 85MM SELF TAP STARDRIVE LCP","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.090","SUP","HCPCS C1713","","02.200.090  -  SCREW BONE 3.5MM 90MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.095","SUP","HCPCS C1713","","02.200.095  -  SCREW BONE 3.5MM 95MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"02.200.100","SUP","HCPCS C1713","","02.200.100  -  SCREW BONE 3.5MM 100MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$59.05 ","$43.70 ","$0.00 ","$57.33 ","$25.80 ","$0.00 ","$12.31 ","$0.00 ","$0.00 ","$10.04 ","$57.33 ","$0.00 ","$28.66 ","$45.41 ","$45.86 ","$0.00 ","$8.71 ","$0.00 ","$9.13 ","$0.00 "
"02.200.105","SUP","HCPCS C1713","","02.200.105  -  SCREW BONE 3.5MM 105MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$59.05 ","$43.70 ","$0.00 ","$57.33 ","$25.80 ","$0.00 ","$12.31 ","$0.00 ","$0.00 ","$10.04 ","$57.33 ","$0.00 ","$28.66 ","$45.41 ","$45.86 ","$0.00 ","$8.71 ","$0.00 ","$9.13 ","$0.00 "
"02.200.110","SUP","HCPCS C1713","","02.200.110  -  SCREW BONE 3.5MM 110MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$59.05 ","$43.70 ","$0.00 ","$57.33 ","$25.80 ","$0.00 ","$12.31 ","$0.00 ","$0.00 ","$10.04 ","$57.33 ","$0.00 ","$28.66 ","$45.41 ","$45.86 ","$0.00 ","$8.71 ","$0.00 ","$9.13 ","$0.00 "
"02.200.115","SUP","HCPCS C1713","","02.200.115  -  SCREW BONE 3.5MM 115MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$59.05 ","$43.70 ","$0.00 ","$57.33 ","$25.80 ","$0.00 ","$12.31 ","$0.00 ","$0.00 ","$10.04 ","$57.33 ","$0.00 ","$28.66 ","$45.41 ","$45.86 ","$0.00 ","$8.71 ","$0.00 ","$9.13 ","$0.00 "
"02.200.120","SUP","HCPCS C1713","","02.200.120  -  SCREW BONE 3.5MM 120MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$59.05 ","$43.70 ","$0.00 ","$57.33 ","$25.80 ","$0.00 ","$12.31 ","$0.00 ","$0.00 ","$10.04 ","$57.33 ","$0.00 ","$28.66 ","$45.41 ","$45.86 ","$0.00 ","$8.71 ","$0.00 ","$9.13 ","$0.00 "
"02.200.125","SUP","HCPCS C1713","","02.200.125  -  SCREW BONE 3.5MM 125MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$59.05 ","$43.70 ","$0.00 ","$57.33 ","$25.80 ","$0.00 ","$12.31 ","$0.00 ","$0.00 ","$10.04 ","$57.33 ","$0.00 ","$28.66 ","$45.41 ","$45.86 ","$0.00 ","$8.71 ","$0.00 ","$9.13 ","$0.00 "
"02.200.130","SUP","HCPCS C1713","","02.200.130  -  SCREW BONE 3.5MM 130MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$191.18 ","$141.47 ","$0.00 ","$185.60 ","$83.52 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$32.50 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$28.20 ","$0.00 ","$29.55 ","$0.00 "
"02.200.135","SUP","HCPCS C1713","","02.200.135  -  SCREW BONE 3.5MM 135MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$191.18 ","$141.47 ","$0.00 ","$185.60 ","$83.52 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$32.50 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$28.20 ","$0.00 ","$29.55 ","$0.00 "
"02.200.140","SUP","HCPCS C1713","","02.200.140  -  SCREW BONE 3.5MM 140MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$191.18 ","$141.47 ","$0.00 ","$185.60 ","$83.52 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$32.50 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$28.20 ","$0.00 ","$29.55 ","$0.00 "
"02.200.145","SUP","HCPCS C1713","","02.200.145  -  SCREW BONE 3.5MM 145MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$191.18 ","$141.47 ","$0.00 ","$185.60 ","$83.52 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$32.50 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$28.20 ","$0.00 ","$29.55 ","$0.00 "
"02.200.150","SUP","HCPCS C1713","","02.200.150  -  SCREW BONE 3.5MM 150MM SLFTAP LP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$191.18 ","$141.47 ","$0.00 ","$185.60 ","$83.52 ","$0.00 ","$39.85 ","$0.00 ","$0.00 ","$32.50 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$28.20 ","$0.00 ","$29.55 ","$0.00 "
"02.204.014","SUP","HCPCS C1713","","02.204.014  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 14MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.016","SUP","HCPCS C1713","","02.204.016  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 16MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.018","SUP","HCPCS C1713","","02.204.018  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 18MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.020","SUP","HCPCS C1713","","02.204.020  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 20MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.022","SUP","HCPCS C1713","","02.204.022  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 22MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.024","SUP","HCPCS C1713","","02.204.024  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 24MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.026","SUP","HCPCS C1713","","02.204.026  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 26MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.028","SUP","HCPCS C1713","","02.204.028  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 28MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.030","SUP","HCPCS C1713","","02.204.030  -  SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS SLFTAP TIP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.032","SUP","HCPCS C1713","","02.204.032  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 32MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.034","SUP","HCPCS C1713","","02.204.034  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 34MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.036","SUP","HCPCS C1713","","02.204.036  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 36MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.038","SUP","HCPCS C1713","","02.204.038  -  SCREW BONE FULTHD 4MM 38MM T25 STARDRIVE SELF TAP TIP LOCK","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.040","SUP","HCPCS C1713","","02.204.040  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 40MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.042","SUP","HCPCS C1713","","02.204.042  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 42MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.044","SUP","HCPCS C1713","","02.204.044  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 44MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.046","SUP","HCPCS C1713","","02.204.046  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 46MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.048","SUP","HCPCS C1713","","02.204.048  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 48MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.050","SUP","HCPCS C1713","","02.204.050  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 50MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.052","SUP","HCPCS C1713","","02.204.052  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 52MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.054","SUP","HCPCS C1713","","02.204.054  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 54MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.056","SUP","HCPCS C1713","","02.204.056  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 56MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.058","SUP","HCPCS C1713","","02.204.058  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 58MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.060","SUP","HCPCS C1713","","02.204.060  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 60MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.062","SUP","HCPCS C1713","","02.204.062  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 62MM FIX ANGLE SELF TAP","BOTH IP/OP","$269.90 ","$199.73 ","$0.00 ","$262.03 ","$117.91 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$45.88 ","$262.03 ","$0.00 ","$131.01 ","$207.53 ","$209.62 ","$0.00 ","$39.81 ","$0.00 ","$41.71 ","$0.00 "
"02.204.420","SUP","HCPCS C1713","","02.204.420  -  SCREW BONE 4MM 20MM LOCK STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.424","SUP","HCPCS C1713","","02.204.424  -  SCREW BONE 4MM 24MM LOCK STAINLESS STEEL PERIARTICULAR","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.428","SUP","HCPCS C1713","","02.204.428  -  SCREW BONE 4MM 3.4MM 28MM LOCKING SLFTAP TIP THREADED","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.432","SUP","HCPCS C1713","","02.204.432  -  SCREW BONE 4MM 32MM LOCKING SLFTAP TIP THREADED CONICAL HEAD","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.436","SUP","HCPCS C1713","","02.204.436  -  SCREW BONE 4MM 36MM LOCKING SLFTAP TIP THREADED CONICAL HEAD","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.440","SUP","HCPCS C1713","","02.204.440  -  SCREW BONE 4MM 40MM LOCKING SLFTAP TIP THREADED CONICAL HEAD","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.444","SUP","HCPCS C1713","","02.204.444  -  SCREW BONE 4MM 44MM LOCKING SLFTAP TIP THREADED CONICAL HEAD","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.448","SUP","HCPCS C1713","","02.204.448  -  SCREW BONE 4MM 48MM LOCKING HEX RECESS STAINLESS STEEL","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.452","SUP","HCPCS C1713","","02.204.452  -  SCREW BONE 4MM 52MM LOCKING HEX RECESS STAINLESS STEEL","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.456","SUP","HCPCS C1713","","02.204.456  -  SCREW BONE 4MM 56MM LOCKING HEX RECESS STAINLESS STEEL","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.204.460","SUP","HCPCS C1713","","02.204.460  -  SCREW BONE 4MM 60MM LOCKING HEX RECESS STAINLESS STEEL","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"02.205.025","SUP","HCPCS C1713","","02.205.025  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 25MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.030","SUP","HCPCS C1713","","02.205.030  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 30MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.035","SUP","HCPCS C1713","","02.205.035  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 35MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.040","SUP","HCPCS C1713","","02.205.040  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 40MM CANN LOCKING SLFDRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.045","SUP","HCPCS C1713","","02.205.045  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 45MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.050","SUP","HCPCS C1713","","02.205.050  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 50MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.055","SUP","HCPCS C1713","","02.205.055  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 55MM CANN LOCK DRILL SELF","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.060","SUP","HCPCS C1713","","02.205.060  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 60MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.065","SUP","HCPCS C1713","","02.205.065  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 65MM CANN LOCK DRILL SELF","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.070","SUP","HCPCS C1713","","02.205.070  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 70MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.075","SUP","HCPCS C1713","","02.205.075  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 75MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.080","SUP","HCPCS C1713","","02.205.080  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 80MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.085","SUP","HCPCS C1713","","02.205.085  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 85MM CANN LOCKING SLFDRILL","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.090","SUP","HCPCS C1713","","02.205.090  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 90MM SELF DRILL SELF TAP","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.095","SUP","HCPCS C1713","","02.205.095  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 95MM CANN LOCK DRILL SELF","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"02.205.100","SUP","HCPCS C1713","","02.205.100  -  SCREW BONE FULTHD 5MM 100MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.105","SUP","HCPCS C1713","","02.205.105  -  SCREW BONE FULTHD 5MM 105MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.110","SUP","HCPCS C1713","","02.205.110  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 110MM SELF DRILL SELF TAP","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.115","SUP","HCPCS C1713","","02.205.115  -  SCREW BONE FULTHD 5MM 115MM SELF TAP TIP SELF DRILL CANN","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.120","SUP","HCPCS C1713","","02.205.120  -  SCREW BONE FULTHD 5MM 120MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.125","SUP","HCPCS C1713","","02.205.125  -  SCREW BONE FULTHD 5MM 125MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.130","SUP","HCPCS C1713","","02.205.130  -  SCREW BONE FULTHD 5MM 130MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.135","SUP","HCPCS C1713","","02.205.135  -  SCREW BONE FULTHD 5MM 135MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.140","SUP","HCPCS C1713","","02.205.140  -  SCREW BONE FULTHD 5MM 140MM SELF TAP SELF DRILL CANN LOCK","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.145","SUP","HCPCS C1713","","02.205.145  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 145MM SELF DRILL SELF TAP","BOTH IP/OP","$379.53 ","$280.85 ","$0.00 ","$368.48 ","$165.81 ","$0.00 ","$79.10 ","$0.00 ","$0.00 ","$64.52 ","$368.48 ","$0.00 ","$184.24 ","$291.84 ","$294.78 ","$0.00 ","$55.99 ","$0.00 ","$58.66 ","$0.00 "
"02.205.240","SUP","HCPCS C1713","","02.205.240  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.245","SUP","HCPCS C1713","","02.205.245  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 45MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.250","SUP","HCPCS C1713","","02.205.250  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 50MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.255","SUP","HCPCS C1713","","02.205.255  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.260","SUP","HCPCS C1713","","02.205.260  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 60MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.265","SUP","HCPCS C1713","","02.205.265  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.270","SUP","HCPCS C1713","","02.205.270  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 70MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.275","SUP","HCPCS C1713","","02.205.275  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.280","SUP","HCPCS C1713","","02.205.280  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 80MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.285","SUP","HCPCS C1713","","02.205.285  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 85MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.290","SUP","HCPCS C1713","","02.205.290  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 90MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.205.295","SUP","HCPCS C1713","","02.205.295  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 95MM SELF DRILL","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"02.206.214","SUP","HCPCS C1713","","02.206.214  -  SCREW BONE T15 3.5MM 14MM LP HEAD STARDRIVE SELF TAP TIP","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.206.216","SUP","HCPCS C1713","","02.206.216  -  SCREW BONE T15 3.5MM 16MM SELF TAP LP STARDRIVE STAINLESS","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.206.218","SUP","HCPCS C1713","","02.206.218  -  SCREW BONE T15 LP 3.5MM 18MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.206.228","SUP","HCPCS C1713","","02.206.228  -  SCREW BONE T15 3.5MM 28MM LP HEAD STARDRIVE SELF TAP TIP","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.206.230","SUP","Custom 27203010","","02.206.230  -  SCREW BONE 3.5MM 30MM LCP SS MIDFT HINDFOOT TIB","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.206.232","SUP","HCPCS C1713","","02.206.232  -  SCREW BONE 3.5MM 32MM SS T15 LP CLVCL FEM HUM TIB","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.206.238","SUP","HCPCS C1713","","02.206.238  -  SCREW BONE T15 3.5MM 38MM LP HEAD STARDRIVE SELF TAP TIP","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.206.240","SUP","HCPCS C1713","","02.206.240  -  SCREW BONE 3.5MM 40MM SELF TAP LP HEAD TI5 STARDRIVE LCP","BOTH IP/OP","$67.48 ","$49.94 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$14.06 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$9.95 ","$0.00 ","$10.43 ","$0.00 "
"02.207.001","SUP","HCPCS C1769","","02.207.001  -  GUIDEWIRE ORTHOPEDIC FLUTE 2.8MM 450MM NONSTRL","BOTH IP/OP","$167.28 ","$123.79 ","$0.00 ","$162.40 ","$88.18 ","$0.00 ","$34.86 ","$0.00 ","$0.00 ","$28.43 ","$162.40 ","$0.00 ","$81.20 ","$128.62 ","$129.92 ","$0.00 ","$24.68 ","$0.00 ","$25.85 ","$0.00 "
"02.207.020","SUP","HCPCS C1713","","02.207.020  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 20MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.025","SUP","HCPCS C1713","","02.207.025  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 25MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.030","SUP","HCPCS C1713","","02.207.030  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 30MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.035","SUP","HCPCS C1713","","02.207.035  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 35MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.040","SUP","HCPCS C1713","","02.207.040  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 40MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.045","SUP","HCPCS C1713","","02.207.045  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 45MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.050","SUP","HCPCS C1713","","02.207.050  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 50MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.055","SUP","HCPCS C1713","","02.207.055  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 55MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.060","SUP","HCPCS C1713","","02.207.060  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 60MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.065","SUP","HCPCS C1713","","02.207.065  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 65MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.070","SUP","HCPCS C1713","","02.207.070  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 70MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.075","SUP","HCPCS C1713","","02.207.075  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 75MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.080","SUP","HCPCS C1713","","02.207.080  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 80MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.085","SUP","HCPCS C1713","","02.207.085  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 85MM SLFTAP TIP SLFDRILL","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.090","SUP","HCPCS C1713","","02.207.090  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 90MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.095","SUP","HCPCS C1713","","02.207.095  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 95MM SELF DRILL SELF TAP","BOTH IP/OP","$546.83 ","$404.65 ","$0.00 ","$530.90 ","$238.91 ","$0.00 ","$113.97 ","$0.00 ","$0.00 ","$92.96 ","$530.90 ","$0.00 ","$265.45 ","$420.47 ","$424.72 ","$0.00 ","$80.66 ","$0.00 ","$84.52 ","$0.00 "
"02.207.100","SUP","HCPCS C1713","","02.207.100  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 100MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.105","SUP","HCPCS C1713","","02.207.105  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 105MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.110","SUP","HCPCS C1713","","02.207.110  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 110MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.115","SUP","HCPCS C1713","","02.207.115  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 115MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.120","SUP","HCPCS C1713","","02.207.120  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 120MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.125","SUP","HCPCS C1713","","02.207.125  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 125MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.130","SUP","HCPCS C1713","","02.207.130  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 130MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.135","SUP","HCPCS C1713","","02.207.135  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 135MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.140","SUP","HCPCS C1713","","02.207.140  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 140MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.145","SUP","HCPCS C1713","","02.207.145  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 145MM SELF DRILL SELF TAP","BOTH IP/OP","$559.48 ","$414.02 ","$0.00 ","$543.18 ","$244.43 ","$0.00 ","$116.61 ","$0.00 ","$0.00 ","$95.11 ","$543.18 ","$0.00 ","$271.59 ","$430.20 ","$434.54 ","$0.00 ","$82.53 ","$0.00 ","$86.47 ","$0.00 "
"02.207.250","SUP","HCPCS C1713","","02.207.250  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 50MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.255","SUP","HCPCS C1713","","02.207.255  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 55MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.260","SUP","HCPCS C1713","","02.207.260  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 60MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.265","SUP","HCPCS C1713","","02.207.265  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 65MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.270","SUP","HCPCS C1713","","02.207.270  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 70MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.275","SUP","HCPCS C1713","","02.207.275  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 75MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.280","SUP","HCPCS C1713","","02.207.280  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 80MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.285","SUP","HCPCS C1713","","02.207.285  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 85MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.290","SUP","HCPCS C1713","","02.207.290  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 90MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.295","SUP","HCPCS C1713","","02.207.295  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 95MM SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.450","SUP","HCPCS C1713","","02.207.450  -  SCREW BONE CONICAL PTHRD 7.3MM 5MM 50MM SELF TAP SELF DRILL","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.455","SUP","HCPCS C1713","","02.207.455  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 55MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.460","SUP","HCPCS C1713","","02.207.460  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 60MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.465","SUP","HCPCS C1713","","02.207.465  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 65MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.470","SUP","HCPCS C1713","","02.207.470  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 70MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.475","SUP","HCPCS C1713","","02.207.475  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 75MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.480","SUP","HCPCS C1713","","02.207.480  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 80MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.485","SUP","HCPCS C1713","","02.207.485  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 85MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.490","SUP","HCPCS C1713","","02.207.490  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 90MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.495","SUP","HCPCS C1713","","02.207.495  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 95MM SELF DRILL SELF TAP","BOTH IP/OP","$487.78 ","$360.96 ","$0.00 ","$473.58 ","$213.11 ","$0.00 ","$101.66 ","$0.00 ","$0.00 ","$82.92 ","$473.58 ","$0.00 ","$236.79 ","$375.08 ","$378.86 ","$0.00 ","$71.95 ","$0.00 ","$75.39 ","$0.00 "
"02.207.500","SUP","HCPCS C1713","","02.207.500  -  SCREW BONE PTHRD 7.3MM 100MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.505","SUP","HCPCS C1713","","02.207.505  -  SCREW BONE PTHRD 7.3MM 105MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.510","SUP","HCPCS C1713","","02.207.510  -  SCREW BONE PTHRD 7.3MM 110MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.515","SUP","HCPCS C1713","","02.207.515  -  SCREW BONE PTHRD 7.3MM 115MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.520","SUP","HCPCS C1713","","02.207.520  -  SCREW BONE PTHRD 7.3MM 120MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.525","SUP","HCPCS C1713","","02.207.525  -  SCREW BONE PTHRD 7.3MM 125MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.530","SUP","HCPCS C1713","","02.207.530  -  SCREW BONE PTHRD 7.3MM 130MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.535","SUP","HCPCS C1713","","02.207.535  -  SCREW BONE PTHRD 7.3MM 135MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.540","SUP","HCPCS C1713","","02.207.540  -  SCREW BONE PTHRD 7.3MM 140MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.545","SUP","HCPCS C1713","","02.207.545  -  SCREW BONE PTHRD 7.3MM 145MM CANN SMOOTH CONICAL HEAD","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.60 ","$226.62 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.18 ","$503.60 ","$0.00 ","$251.80 ","$398.85 ","$402.88 ","$0.00 ","$76.52 ","$0.00 ","$80.17 ","$0.00 "
"02.207.600","SUP","HCPCS C1713","","02.207.600  -  SCREW BONE 7.3MM 45MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.601","SUP","HCPCS C1713","","02.207.601  -  SCREW BONE 7.3MM 50MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.602","SUP","HCPCS C1713","","02.207.602  -  SCREW BONE 7.3MM 55MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.603","SUP","HCPCS C1713","","02.207.603  -  SCREW BONE 7.3MM 60MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.604","SUP","HCPCS C1713","","02.207.604  -  SCREW BONE 7.3MM 65MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.605","SUP","HCPCS C1713","","02.207.605  -  SCREW BONE 7.3MM 70MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.606","SUP","HCPCS C1713","","02.207.606  -  SCREW BONE 7.3MM 75MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.607","SUP","HCPCS C1713","","02.207.607  -  SCREW BONE 7.3MM 80MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.608","SUP","HCPCS C1713","","02.207.608  -  SCREW BONE 7.3MM 85MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.609","SUP","HCPCS C1713","","02.207.609  -  SCREW BONE 7.3MM 90MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.610","SUP","HCPCS C1713","","02.207.610  -  SCREW BONE 7.3MM 95MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.611","SUP","HCPCS C1713","","02.207.611  -  SCREW BONE 7.3MM 100MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.612","SUP","HCPCS C1713","","02.207.612  -  SCREW BONE 7.3MM 105MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.613","SUP","HCPCS C1713","","02.207.613  -  SCREW BONE 7.3MM 110MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.614","SUP","HCPCS C1713","","02.207.614  -  SCREW BONE 7.3MM 115MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.615","SUP","HCPCS C1713","","02.207.615  -  SCREW BONE 7.3MM 120MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.616","SUP","HCPCS C1713","","02.207.616  -  SCREW BONE 7.3MM 125MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.617","SUP","HCPCS C1713","","02.207.617  -  SCREW BONE 7.3MM 103MM 10MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.618","SUP","HCPCS C1713","","02.207.618  -  SCREW BONE 7.3MM 45MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.619","SUP","HCPCS C1713","","02.207.619  -  SCREW BONE 7.3MM 50MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.620","SUP","HCPCS C1713","","02.207.620  -  SCREW BONE 7.3MM 55MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.621","SUP","HCPCS C1713","","02.207.621  -  SCREW BONE 7.3MM 60MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.622","SUP","HCPCS C1713","","02.207.622  -  SCREW BONE 7.3MM 65MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.623","SUP","HCPCS C1713","","02.207.623  -  SCREW BONE 7.3MM 70MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.624","SUP","HCPCS C1713","","02.207.624  -  SCREW BONE 7.3MM 75MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.625","SUP","HCPCS C1713","","02.207.625  -  SCREW BONE 7.3MM 80MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.626","SUP","HCPCS C1713","","02.207.626  -  SCREW BONE 7.3MM 85MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.627","SUP","HCPCS C1713","","02.207.627  -  SCREW BONE 7.3MM 90MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.628","SUP","HCPCS C1713","","02.207.628  -  SCREW BONE 7.3MM 95MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.629","SUP","HCPCS C1713","","02.207.629  -  SCREW BONE 7.3MM 100MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.630","SUP","HCPCS C1713","","02.207.630  -  SCREW BONE 7.3MM 105MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.631","SUP","HCPCS C1713","","02.207.631  -  SCREW BONE 7.3MM 110MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.632","SUP","HCPCS C1713","","02.207.632  -  SCREW BONE 7.3MM 115MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.633","SUP","HCPCS C1713","","02.207.633  -  SCREW BONE 7.3MM 120MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.634","SUP","HCPCS C1713","","02.207.634  -  SCREW BONE 7.3MM 125MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.635","SUP","HCPCS C1713","","02.207.635  -  SCREW BONE 7.3MM 130MM 20MM CANN THREADED SCFE STAINLESS","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.207.636","SUP","Custom 27803010","","02.207.636  -  WASHER ORTHOPEDIC OVAL 1MM STAINLESS STEEL FEMUR NONSTRL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.207.637","SUP","Custom 27803010","","02.207.637  -  WASHER ORTHOPEDIC OVAL 2MM STAINLESS STEEL FEMUR NONSTRL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.210.078","SUP","HCPCS C1713","","02.210.078  -  PIN FIX 1.8MM 8MM T8 STARDRIVE RECESS VAR ANG LOCKING","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.080","SUP","HCPCS C1713","","02.210.080  -  PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.082","SUP","HCPCS C1713","","02.210.082  -  PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.084","SUP","HCPCS C1713","","02.210.084  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.086","SUP","Custom 27203010","","02.210.086  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.210.088","SUP","Custom 27203010","","02.210.088  -  PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.210.090","SUP","HCPCS C1713","","02.210.090  -  PIN FIX 1.8MM 20MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.092","SUP","Custom 27203010","","02.210.092  -  PIN FIX 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.210.094","SUP","HCPCS C1713","","02.210.094  -  PIN FIX 1.8MM 24MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.096","SUP","HCPCS C1713","","02.210.096  -  PIN FIX 1.8MM 26MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.098","SUP","HCPCS C1713","","02.210.098  -  PIN FIX 1.8MM 28MM T8 STARDRIVE RECESS BUTTRESS VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.100","SUP","HCPCS C1713","","02.210.100  -  PIN FIX 1.8MM 30MM T8 STARDRIVE RECESS VAR ANG LOCKING","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.107","SUP","HCPCS C1713","","02.210.107  -  SCREW BONE 2.4MM 7MM STARDRIVE VAR ANG SLFTAP LOCKING LCP","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.108","SUP","HCPCS C1713","","02.210.108  -  SCREW BONE T8 2.4MM 8MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.109","SUP","HCPCS C1713","","02.210.109  -  SCREW BONE 2.4MM 9MM STARDRIVE VAR ANG SLFTAP LOCKING LCP","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.110","SUP","HCPCS C1713","","02.210.110  -  SCREW BONE T8 2.4MM 10MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.111","SUP","HCPCS C1713","","02.210.111  -  SCREW BONE 2.4MM 11MM STARDRIVE VAR ANG SLFTAP LOCKING LCP","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.112","SUP","HCPCS C1713","","02.210.112  -  SCREW BONE T8 2.4MM 12MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.113","SUP","HCPCS C1713","","02.210.113  -  SCREW BONE 2.4MM 13MM STARDRIVE VAR ANG SLFTAP LOCKING LCP","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.114","SUP","HCPCS C1713","","02.210.114  -  SCREW BONE T8 2.4MM 14MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.116","SUP","HCPCS C1713","","02.210.116  -  SCREW BONE T8 2.4MM 16MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.118","SUP","HCPCS C1713","","02.210.118  -  SCREW BONE T8 2.4MM 18MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.120","SUP","HCPCS C1713","","02.210.120  -  SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS LOCKING VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.122","SUP","HCPCS C1713","","02.210.122  -  SCREW BONE 2.4MM 22MM VAR ANG SELF TAP THREAD T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.124","SUP","HCPCS C1713","","02.210.124  -  SCREW BONE T8 2.4MM 24MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.126","SUP","HCPCS C1713","","02.210.126  -  SCREW BONE T8 2.4MM 26MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.128","SUP","HCPCS C1713","","02.210.128  -  SCREW BONE T8 2.4MM 28MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.130","SUP","HCPCS C1713","","02.210.130  -  SCREW BONE T8 2.4MM 30MM VAR ANG SELF TAP THREAD STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.132","SUP","HCPCS C1713","","02.210.132  -  SCREW BONE 2.4MM 32MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.134","SUP","HCPCS C1713","","02.210.134  -  SCREW BONE 2.4MM 34MM SLFTAP LOCKING VAR ANG T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.136","SUP","HCPCS C1713","","02.210.136  -  SCREW BONE 2.4MM 36MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.138","SUP","HCPCS C1713","","02.210.138  -  SCREW BONE 2.4MM 38MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.140","SUP","HCPCS C1713","","02.210.140  -  SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.142","SUP","HCPCS C1713","","02.210.142  -  SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.144","SUP","HCPCS C1713","","02.210.144  -  SCREW BONE 2.4MM 44MM SLFTAP LOCKING VAR ANG T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.146","SUP","HCPCS C1713","","02.210.146  -  SCREW BONE 2.4MM 46MM SLFTAP LOCKING VAR ANG T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.148","SUP","HCPCS C1713","","02.210.148  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.150","SUP","HCPCS C1713","","02.210.150  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.152","SUP","HCPCS C1713","","02.210.152  -  SCREW BONE 2.4MM 52MM SLFTAP LOCKING VAR ANG T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.154","SUP","HCPCS C1713","","02.210.154  -  SCREW BONE 2.4MM 54MM SLFTAP LOCKING VAR ANG T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.156","SUP","HCPCS C1713","","02.210.156  -  SCREW BONE 2.4MM 56MM SLFTAP LOCKING VAR ANG T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.158","SUP","HCPCS C1713","","02.210.158  -  SCREW BONE 2.4MM 58MM STARDRIVE SLFTAP LOCKING VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.160","SUP","HCPCS C1713","","02.210.160  -  SCREW BONE 2.4MM 60MM STARDRIVE SLFTAP LOCKING VAR ANG","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"02.210.942","SUP","HCPCS C1713","","02.210.942  -  SCREW BONE T8 2.4MM 42MM SLFTAP STARDRIVE RECESS STAINLESS","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.944","SUP","HCPCS C1713","","02.210.944  -  SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.946","SUP","HCPCS C1713","","02.210.946  -  SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.948","SUP","HCPCS C1713","","02.210.948  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.950","SUP","HCPCS C1713","","02.210.950  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.952","SUP","HCPCS C1713","","02.210.952  -  SCREW BONE T8 2.4MM 52MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.954","SUP","HCPCS C1713","","02.210.954  -  SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS SLFTAP LCP","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.956","SUP","HCPCS C1713","","02.210.956  -  SCREW BONE T8 2.4MM 56MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.958","SUP","HCPCS C1713","","02.210.958  -  SCREW BONE 2.4MM 58MM T8 STARDRIVE SLFTAP STAINLESS STEEL","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.210.960","SUP","HCPCS C1713","","02.210.960  -  SCREW BONE 2.4MM 60MM T8 STARDRIVE SLFTAP STAINLESS STEEL","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"02.211.008","SUP","HCPCS C1713","","02.211.008  -  SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.009","SUP","HCPCS C1713","","02.211.009  -  SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.010","SUP","HCPCS C1713","","02.211.010  -  SCREW BONE T8 2.7MM 10MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.011","SUP","HCPCS C1713","","02.211.011  -  SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.012","SUP","HCPCS C1713","","02.211.012  -  SCREW BONE T8 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.013","SUP","HCPCS C1713","","02.211.013  -  SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.014","SUP","HCPCS C1713","","02.211.014  -  SCREW BONE T8 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.016","SUP","HCPCS C1713","","02.211.016  -  SCREW BONE T8 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.018","SUP","HCPCS C1713","","02.211.018  -  SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.020","SUP","HCPCS C1713","","02.211.020  -  SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.022","SUP","HCPCS C1713","","02.211.022  -  SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.024","SUP","HCPCS C1713","","02.211.024  -  SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.026","SUP","HCPCS C1713","","02.211.026  -  SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.028","SUP","HCPCS C1713","","02.211.028  -  SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.030","SUP","HCPCS C1713","","02.211.030  -  SCREW BONE 2.7MM 30MM LOCK VAR ANG SELF TAP T8 STARDRIVE","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.032","SUP","HCPCS C1713","","02.211.032  -  SCREW BONE T8 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.034","SUP","HCPCS C1713","","02.211.034  -  SCREW BONE T8 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.036","SUP","HCPCS C1713","","02.211.036  -  SCREW BONE 2.7MM 36MM LOCK VAR ANG SELF TAP T8 STARDRIVE","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.038","SUP","HCPCS C1713","","02.211.038  -  SCREW BONE T8 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.040","SUP","HCPCS C1713","","02.211.040  -  SCREW BONE T8 2.7MM 40MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.042","SUP","HCPCS C1713","","02.211.042  -  SCREW BONE 2.7MM 42MM VAR ANG SELF TAP T8 STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.044","SUP","HCPCS C1713","","02.211.044  -  SCREW BONE T8 2.7MM 44MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.046","SUP","HCPCS C1713","","02.211.046  -  SCREW BONE T8 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.048","SUP","HCPCS C1713","","02.211.048  -  SCREW BONE T8 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.050","SUP","HCPCS C1713","","02.211.050  -  SCREW BONE T8 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.052","SUP","HCPCS C1713","","02.211.052  -  SCREW BONE T8 2.7MM 52MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.054","SUP","HCPCS C1713","","02.211.054  -  SCREW BONE T8 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.056","SUP","HCPCS C1713","","02.211.056  -  SCREW BONE T8 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.058","SUP","HCPCS C1713","","02.211.058  -  SCREW BONE T8 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.060","SUP","HCPCS C1713","","02.211.060  -  SCREW BONE T8 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$267.08 ","$197.64 ","$0.00 ","$259.30 ","$116.69 ","$0.00 ","$55.67 ","$0.00 ","$0.00 ","$45.40 ","$259.30 ","$0.00 ","$129.65 ","$205.37 ","$207.44 ","$0.00 ","$39.40 ","$0.00 ","$41.28 ","$0.00 "
"02.211.201","SUP","HCPCS C1713","","02.211.201  -  PLATE BN XS X 24MM NS LCP VA LCK LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"02.211.202","SUP","HCPCS C1713","","02.211.202  -  PLATE BN SM X 27MM NS LCP VA LCK LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"02.211.203","SUP","HCPCS C1713","","02.211.203  -  PLATE BN MED X 32MM NS LCP VA LCK LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,772.58 ","$1,311.71 ","$0.00 ","$1,720.95 ","$774.43 ","$0.00 ","$369.45 ","$0.00 ","$0.00 ","$301.32 ","$1,720.95 ","$0.00 ","$860.48 ","$1,362.99 ","$1,376.76 ","$0.00 ","$261.48 ","$0.00 ","$273.98 ","$0.00 "
"02.211.204","SUP","HCPCS C1713","","02.211.204  -  PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"02.211.210","SUP","HCPCS C1713","","02.211.210  -  PLATE BONE LP OPENING WEDGE LOCKING VAR ANG ANATOMIC LCP","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"02.211.211","SUP","HCPCS C1713","","02.211.211  -  PLATE BONE 3MM SPACER OPENING WEDGE LOCKING VAR ANG LCP","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"02.211.212","SUP","HCPCS C1713","","02.211.212  -  PLATE BONE 4MM SPACER OPENING WEDGE LOCKING VAR ANG LCP","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"02.211.213","SUP","HCPCS C1713","","02.211.213  -  PLATE BONE 5MM SPACER OPENING WEDGE LOCKING VAR ANG LCP","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"02.211.214","SUP","HCPCS C1713","","02.211.214  -  PLATE BONE 6MM SPACER OPENING WEDGE VAR ANG LOCKING LCP","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"02.211.215","SUP","HCPCS C1713","","02.211.215  -  PLATE BONE 7MM SPACER OPENING WEDGE VAR ANG LOCKING LCP","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"02.211.220","SUP","HCPCS C1713","","02.211.220  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS NAVICULAR 2.4/2.7MM","BOTH IP/OP","$2,109.95 ","$1,561.36 ","$0.00 ","$2,048.50 ","$921.83 ","$0.00 ","$439.77 ","$0.00 ","$0.00 ","$358.68 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$311.25 ","$0.00 ","$326.12 ","$0.00 "
"02.211.221","SUP","HCPCS C1713","","02.211.221  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID LT 2.4/2.7MM","BOTH IP/OP","$2,109.95 ","$1,561.36 ","$0.00 ","$2,048.50 ","$921.83 ","$0.00 ","$439.77 ","$0.00 ","$0.00 ","$358.68 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$311.25 ","$0.00 ","$326.12 ","$0.00 "
"02.211.222","SUP","HCPCS C1713","","02.211.222  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID RT 2.4/2.7MM","BOTH IP/OP","$2,109.95 ","$1,561.36 ","$0.00 ","$2,048.50 ","$921.83 ","$0.00 ","$439.77 ","$0.00 ","$0.00 ","$358.68 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$311.25 ","$0.00 ","$326.12 ","$0.00 "
"02.211.224","SUP","HCPCS C1713","","02.211.224  -  PLATE BONE 5X12 HOLE VAR ANG LOCK MESH LCP STAINLESS STEEL","BOTH IP/OP","$2,971.63 ","$2,199.01 ","$0.00 ","$2,885.08 ","$1,298.28 ","$0.00 ","$619.36 ","$0.00 ","$0.00 ","$505.15 ","$2,885.08 ","$0.00 ","$1,442.54 ","$2,284.98 ","$2,308.06 ","$0.00 ","$438.36 ","$0.00 ","$459.30 ","$0.00 "
"02.211.230","SUP","HCPCS C1713","","02.211.230  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.231","SUP","HCPCS C1713","","02.211.231  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.232","SUP","HCPCS C1713","","02.211.232  -  PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.233","SUP","HCPCS C1713","","02.211.233  -  PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.234","SUP","HCPCS C1713","","02.211.234  -  PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.235","SUP","HCPCS C1713","","02.211.235  -  PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.236","SUP","HCPCS C1713","","02.211.236  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.237","SUP","HCPCS C1713","","02.211.237  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.238","SUP","HCPCS C1713","","02.211.238  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.239","SUP","HCPCS C1713","","02.211.239  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.240","SUP","HCPCS C1713","","02.211.240  -  PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.241","SUP","HCPCS C1713","","02.211.241  -  PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.242","SUP","HCPCS C1713","","02.211.242  -  PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$2,109.95 ","$1,561.36 ","$0.00 ","$2,048.50 ","$921.83 ","$0.00 ","$439.77 ","$0.00 ","$0.00 ","$358.68 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$311.25 ","$0.00 ","$326.12 ","$0.00 "
"02.211.243","SUP","HCPCS C1713","","02.211.243  -  PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST","BOTH IP/OP","$2,109.95 ","$1,561.36 ","$0.00 ","$2,048.50 ","$921.83 ","$0.00 ","$439.77 ","$0.00 ","$0.00 ","$358.68 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$311.25 ","$0.00 ","$326.12 ","$0.00 "
"02.211.244","SUP","HCPCS C1713","","02.211.244  -  PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP","BOTH IP/OP","$2,341.88 ","$1,732.99 ","$0.00 ","$2,273.68 ","$1,023.15 ","$0.00 ","$488.11 ","$0.00 ","$0.00 ","$398.10 ","$2,273.68 ","$0.00 ","$1,136.84 ","$1,800.75 ","$1,818.94 ","$0.00 ","$345.47 ","$0.00 ","$361.97 ","$0.00 "
"02.211.245","SUP","HCPCS C1713","","02.211.245  -  PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP","BOTH IP/OP","$2,341.88 ","$1,732.99 ","$0.00 ","$2,273.68 ","$1,023.15 ","$0.00 ","$488.11 ","$0.00 ","$0.00 ","$398.10 ","$2,273.68 ","$0.00 ","$1,136.84 ","$1,800.75 ","$1,818.94 ","$0.00 ","$345.47 ","$0.00 ","$361.97 ","$0.00 "
"02.211.246","SUP","HCPCS C1713","","02.211.246  -  PLATE BN STD 39MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.247","SUP","HCPCS C1713","","02.211.247  -  PLATE BN LNG 48MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"02.211.250","SUP","HCPCS C1713","","02.211.250  -  PLATE BN SHRT CLVRLF 38MM NS LCP VA FSN LOPRFL CMPR WRE HL","BOTH IP/OP","$1,603.90 ","$1,186.89 ","$0.00 ","$1,557.18 ","$700.73 ","$0.00 ","$334.29 ","$0.00 ","$0.00 ","$272.65 ","$1,557.18 ","$0.00 ","$778.59 ","$1,233.29 ","$1,245.74 ","$0.00 ","$236.60 ","$0.00 ","$247.90 ","$0.00 "
"02.211.251","SUP","HCPCS C1713","","02.211.251  -  PLATE BN STD CLVRLF 45MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,646.08 ","$1,218.10 ","$0.00 ","$1,598.13 ","$719.16 ","$0.00 ","$343.08 ","$0.00 ","$0.00 ","$279.82 ","$1,598.13 ","$0.00 ","$799.06 ","$1,265.72 ","$1,278.50 ","$0.00 ","$242.82 ","$0.00 ","$254.42 ","$0.00 "
"02.211.252","SUP","HCPCS C1713","","02.211.252  -  PLATE BN LNG CLVRLF 64MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,686.83 ","$1,248.25 ","$0.00 ","$1,637.70 ","$736.97 ","$0.00 ","$351.58 ","$0.00 ","$0.00 ","$286.75 ","$1,637.70 ","$0.00 ","$818.85 ","$1,297.06 ","$1,310.16 ","$0.00 ","$248.84 ","$0.00 ","$260.72 ","$0.00 "
"02.211.253","SUP","HCPCS C1713","","02.211.253  -  PLATE BONE T SHORT 35MM 2 HOLE FUSION VAR ANG LCP STAINLESS","BOTH IP/OP","$1,603.90 ","$1,186.89 ","$0.00 ","$1,557.18 ","$700.73 ","$0.00 ","$334.29 ","$0.00 ","$0.00 ","$272.65 ","$1,557.18 ","$0.00 ","$778.59 ","$1,233.29 ","$1,245.74 ","$0.00 ","$236.60 ","$0.00 ","$247.90 ","$0.00 "
"02.211.254","SUP","HCPCS C1713","","02.211.254  -  PLATE BONE STANDARD 42MM 2 HOLE T FUSION VAR ANG LCP","BOTH IP/OP","$1,646.08 ","$1,218.10 ","$0.00 ","$1,598.13 ","$719.16 ","$0.00 ","$343.08 ","$0.00 ","$0.00 ","$279.82 ","$1,598.13 ","$0.00 ","$799.06 ","$1,265.72 ","$1,278.50 ","$0.00 ","$242.82 ","$0.00 ","$254.42 ","$0.00 "
"02.211.255","SUP","HCPCS C1713","","02.211.255  -  PLATE BONE T LONG 6.1CM 2 HOLE VAR ANG LCP STAINLESS STEEL","BOTH IP/OP","$1,686.83 ","$1,248.25 ","$0.00 ","$1,637.70 ","$736.97 ","$0.00 ","$351.58 ","$0.00 ","$0.00 ","$286.75 ","$1,637.70 ","$0.00 ","$818.85 ","$1,297.06 ","$1,310.16 ","$0.00 ","$248.84 ","$0.00 ","$260.72 ","$0.00 "
"02.211.256","SUP","HCPCS C1713","","02.211.256  -  PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"02.211.257","SUP","HCPCS C1713","","02.211.257  -  PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,603.90 ","$1,186.89 ","$0.00 ","$1,557.18 ","$700.73 ","$0.00 ","$334.29 ","$0.00 ","$0.00 ","$272.65 ","$1,557.18 ","$0.00 ","$778.59 ","$1,233.29 ","$1,245.74 ","$0.00 ","$236.60 ","$0.00 ","$247.90 ","$0.00 "
"02.211.258","SUP","HCPCS C1713","","02.211.258  -  PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"02.211.259","SUP","HCPCS C1713","","02.211.259  -  PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"02.211.260","SUP","HCPCS C1713","","02.211.260  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,734.63 ","$1,283.63 ","$0.00 ","$1,684.10 ","$757.85 ","$0.00 ","$361.54 ","$0.00 ","$0.00 ","$294.87 ","$1,684.10 ","$0.00 ","$842.05 ","$1,333.81 ","$1,347.28 ","$0.00 ","$255.89 ","$0.00 ","$268.11 ","$0.00 "
"02.211.261","SUP","HCPCS C1713","","02.211.261  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS","BOTH IP/OP","$1,734.63 ","$1,283.63 ","$0.00 ","$1,684.10 ","$757.85 ","$0.00 ","$361.54 ","$0.00 ","$0.00 ","$294.87 ","$1,684.10 ","$0.00 ","$842.05 ","$1,333.81 ","$1,347.28 ","$0.00 ","$255.89 ","$0.00 ","$268.11 ","$0.00 "
"02.211.262","SUP","HCPCS C1713","","02.211.262  -  PLATE BONE 27MM 2 HOLE STR FUSION VAR ANG LOCKING LCP","BOTH IP/OP","$1,435.20 ","$1,062.05 ","$0.00 ","$1,393.40 ","$627.03 ","$0.00 ","$299.13 ","$0.00 ","$0.00 ","$243.97 ","$1,393.40 ","$0.00 ","$696.70 ","$1,103.57 ","$1,114.72 ","$0.00 ","$211.72 ","$0.00 ","$221.83 ","$0.00 "
"02.211.263","SUP","HCPCS C1713","","02.211.263  -  PLATE BONE 43MM 4 HOLE STR FUSION VAR ANG LOCKING LCP","BOTH IP/OP","$1,518.15 ","$1,123.43 ","$0.00 ","$1,473.93 ","$663.27 ","$0.00 ","$316.42 ","$0.00 ","$0.00 ","$258.07 ","$1,473.93 ","$0.00 ","$736.96 ","$1,167.35 ","$1,179.14 ","$0.00 ","$223.95 ","$0.00 ","$234.65 ","$0.00 "
"02.211.265","SUP","HCPCS C1713","","02.211.265  -  PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP STAINLESS","BOTH IP/OP","$2,109.95 ","$1,561.36 ","$0.00 ","$2,048.50 ","$921.83 ","$0.00 ","$439.77 ","$0.00 ","$0.00 ","$358.68 ","$2,048.50 ","$0.00 ","$1,024.25 ","$1,622.41 ","$1,638.80 ","$0.00 ","$311.25 ","$0.00 ","$326.12 ","$0.00 "
"02.211.266","SUP","HCPCS C1713","","02.211.266  -  PLATE BN 43MM NS LCP VA FSN LOPRFL PRECONTOUR SS","BOTH IP/OP","$1,686.83 ","$1,248.25 ","$0.00 ","$1,637.70 ","$736.97 ","$0.00 ","$351.58 ","$0.00 ","$0.00 ","$286.75 ","$1,637.70 ","$0.00 ","$818.85 ","$1,297.06 ","$1,310.16 ","$0.00 ","$248.84 ","$0.00 ","$260.72 ","$0.00 "
"02.211.412S","SUP","HCPCS C1713","","02.211.412S  -  PLATE BN LNG 56MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC","BOTH IP/OP","$2,042.48 ","$1,511.44 ","$0.00 ","$1,982.98 ","$892.34 ","$0.00 ","$425.70 ","$0.00 ","$0.00 ","$347.20 ","$1,982.98 ","$0.00 ","$991.49 ","$1,570.52 ","$1,586.38 ","$0.00 ","$301.30 ","$0.00 ","$315.69 ","$0.00 "
"02.212.054","SUP","HCPCS C1713","","02.212.054  -  SCREW BONE T15 3.5MM 54MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"02.212.056","SUP","HCPCS C1713","","02.212.056  -  SCREW BONE T15 3.5MM 56MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"02.212.058","SUP","HCPCS C1713","","02.212.058  -  SCREW BONE T15 3.5MM 58MM SELF TAP STARDRIVE LCP STAINLESS","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"02.214.006","SUP","HCPCS C1713","","02.214.006  -  SCREW BONE 1.5MM 6MM T4 STARDRIVE RECESS LOCKING SLFTAP","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.007","SUP","HCPCS C1713","","02.214.007  -  SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.008","SUP","HCPCS C1713","","02.214.008  -  SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.009","SUP","HCPCS C1713","","02.214.009  -  SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.010","SUP","HCPCS C1713","","02.214.010  -  SCREW BONE T4 1.5MM 10MM SELF TAP SELF RETAINING LP","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.011","SUP","HCPCS C1713","","02.214.011  -  SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.012","SUP","HCPCS C1713","","02.214.012  -  SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.013","SUP","HCPCS C1713","","02.214.013  -  SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.014","SUP","HCPCS C1713","","02.214.014  -  SCREW BONE 1.5MM 14MM LOCK SELF TAP MODULAR T4 STARDRIVE LCP","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.015","SUP","HCPCS C1713","","02.214.015  -  SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.016","SUP","HCPCS C1713","","02.214.016  -  SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.018","SUP","HCPCS C1713","","02.214.018  -  SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.020","SUP","HCPCS C1713","","02.214.020  -  SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.022","SUP","HCPCS C1713","","02.214.022  -  SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.024","SUP","HCPCS C1713","","02.214.024  -  SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"02.214.104","SUP","HCPCS C1713","","02.214.104  -  SCREW BN T4 1.5MM 4MM ST TIP VA LCK STRDR SS CORT","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$84.63 ","$38.08 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$14.82 ","$84.63 ","$0.00 ","$42.31 ","$67.03 ","$67.70 ","$0.00 ","$12.86 ","$0.00 ","$13.47 ","$0.00 "
"02.214.105","SUP","HCPCS C1713","","02.214.105  -  SCREW BN T4 1.5MM 5MM SLFRET ST STRDR SS HND CORT VA LCK SYS","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$84.63 ","$38.08 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$14.82 ","$84.63 ","$0.00 ","$42.31 ","$67.03 ","$67.70 ","$0.00 ","$12.86 ","$0.00 ","$13.47 ","$0.00 "
"02.214.106","SUP","HCPCS C1713","","02.214.106  -  SCREW BONE T4 LP 1.5MM 6MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.107","SUP","HCPCS C1713","","02.214.107  -  SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.108","SUP","HCPCS C1713","","02.214.108  -  SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.109","SUP","HCPCS C1713","","02.214.109  -  SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.110","SUP","HCPCS C1713","","02.214.110  -  SCREW BONE T4 LP 1.5MM 10MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.111","SUP","HCPCS C1713","","02.214.111  -  SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.112","SUP","HCPCS C1713","","02.214.112  -  SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.113","SUP","HCPCS C1713","","02.214.113  -  SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.114","SUP","HCPCS C1713","","02.214.114  -  SCREW BONE T4 LP 1.5MM 14MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.115","SUP","HCPCS C1713","","02.214.115  -  SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.116","SUP","HCPCS C1713","","02.214.116  -  SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.118","SUP","HCPCS C1713","","02.214.118  -  SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.120","SUP","HCPCS C1713","","02.214.120  -  SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.122","SUP","HCPCS C1713","","02.214.122  -  SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.214.124","SUP","HCPCS C1713","","02.214.124  -  SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"02.221.002S","SUP","Custom 27803010","","02.221.002S  -  BUTTON CERCLAGE 2.5MM T15 STARDRIVE STAINLESS STEEL STERILE","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.221.003S","SUP","Custom 27803010","","02.221.003S  -  BUTTON FIX 3.5MM 3.5MM T25 STARDRIVE/HEXAGONAL RECESS","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.221.004S","SUP","Custom 27803010","","02.221.004S  -  BUTTON FIX 4MM CERCLAGE HEXAGONAL CANN STAINLESS STEEL","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.221.005S","SUP","Custom 27803010","","02.221.005S  -  PIN POSITIONING 5MM CRIMP STAINLESS STEEL STERILE","BOTH IP/OP","$515.90 ","$381.77 ","$0.00 ","$500.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.88 ","$0.00 ","$250.44 ","$396.70 ","$400.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.221.006S","SUP","HCPCS C1713","","02.221.006S  -  PIN POSITIONING 7.3MM CRIMP STAINLESS STEEL STERILE","BOTH IP/OP","$515.90 ","$381.77 ","$0.00 ","$500.88 ","$225.39 ","$0.00 ","$107.53 ","$0.00 ","$0.00 ","$87.70 ","$500.88 ","$0.00 ","$250.44 ","$396.70 ","$400.70 ","$0.00 ","$76.10 ","$0.00 ","$79.74 ","$0.00 "
"02.221.458","SUP","HCPCS C1713","","02.221.458  -  SCREW BONE 5MM 8MM SLFTAP LOCKING LCP STAINLESS STEEL DISTAL","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.460","SUP","HCPCS C1713","","02.221.460  -  SCREW BONE 5MM 10MM SLFTAP LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.462","SUP","HCPCS C1713","","02.221.462  -  SCREW BONE 5MM 12MM SLFTAP LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.508","SUP","HCPCS C1713","","02.221.508  -  SCREW BONE T25 BLUNT CONE 5MM 4.4MM 8MM SELF TAP THREAD HEAD","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.510","SUP","HCPCS C1713","","02.221.510  -  SCREW BONE FULTHD 5MM 4.4MM 10MM T25 STARDRIVE RECESS","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.510S","SUP","HCPCS C1713","","02.221.510S  -  SCREW BONE 5MM 10MM LCP SS PROX MDL PERIART FEM/TIB","BOTH IP/OP","$489.18 ","$361.99 ","$0.00 ","$531.55 ","$239.20 ","$0.00 ","$101.96 ","$0.00 ","$0.00 ","$93.07 ","$531.55 ","$0.00 ","$265.78 ","$420.99 ","$425.24 ","$0.00 ","$83.19 ","$0.00 ","$84.62 ","$0.00 "
"02.221.512","SUP","HCPCS C1713","","02.221.512  -  SCREW BONE T25 BLUNT CONE 5MM 4.4MM 12MM SELF TAP THREAD","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.514","SUP","HCPCS C1713","","02.221.514  -  SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.221.518","SUP","HCPCS C1713","","02.221.518  -  SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"02.224.030S","SUP","HCPCS C1713","","02.224.030S  -  SCREW BONE HELIX 30MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$173.60 ","$128.46 ","$0.00 ","$168.53 ","$75.84 ","$0.00 ","$36.18 ","$0.00 ","$0.00 ","$29.51 ","$168.53 ","$0.00 ","$84.26 ","$133.48 ","$134.82 ","$0.00 ","$25.61 ","$0.00 ","$26.83 ","$0.00 "
"02.226.000","SUP","HCPCS C1713","","02.226.000  -  GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT THREADED","BOTH IP/OP","$70.98 ","$52.53 ","$0.00 ","$68.90 ","$31.01 ","$0.00 ","$14.79 ","$0.00 ","$0.00 ","$12.06 ","$68.90 ","$0.00 ","$34.45 ","$54.57 ","$55.12 ","$0.00 ","$10.47 ","$0.00 ","$10.97 ","$0.00 "
"02.226.001","SUP","HCPCS C1713","","02.226.001  -  GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT NONTHREADED","BOTH IP/OP","$70.28 ","$52.01 ","$0.00 ","$68.25 ","$30.71 ","$0.00 ","$14.65 ","$0.00 ","$0.00 ","$11.95 ","$68.25 ","$0.00 ","$34.13 ","$54.05 ","$54.60 ","$0.00 ","$10.37 ","$0.00 ","$10.87 ","$0.00 "
"02.226.010","SUP","HCPCS C1713","","02.226.010  -  SCREW BONE T8 3MM 2MM 1.1MM 10MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.011","SUP","HCPCS C1713","","02.226.011  -  SCREW BONE T8 3MM 2MM 1.1MM 11MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.012","SUP","HCPCS C1713","","02.226.012  -  SCREW BONE T8 3MM 2MM 1.1MM 12MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.013","SUP","HCPCS C1713","","02.226.013  -  SCREW BONE T8 3MM 2MM 1.1MM 13MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.014","SUP","HCPCS C1713","","02.226.014  -  SCREW BONE T8 3MM 2MM 1.1MM 14MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.015","SUP","HCPCS C1713","","02.226.015  -  SCREW BONE T8 3MM 2MM 1.1MM 15MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.016","SUP","HCPCS C1713","","02.226.016  -  SCREW BONE T8 3MM 2MM 1.1MM 16MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.017","SUP","HCPCS C1713","","02.226.017  -  SCREW BONE T8 3MM 2MM 1.1MM 17MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.018","SUP","HCPCS C1713","","02.226.018  -  SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 18MM 4MM T8 STARDRIVE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.019","SUP","HCPCS C1713","","02.226.019  -  SCREW BONE T8 3MM 2MM 1.1MM 19MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.020","SUP","HCPCS C1713","","02.226.020  -  SCREW BONE T8 3MM 2MM 1.1MM 20MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.021","SUP","HCPCS C1713","","02.226.021  -  SCREW BONE T8 3MM 2MM 1.1MM 21MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.022","SUP","HCPCS C1713","","02.226.022  -  SCREW BONE T8 3MM 2MM 1.1MM 22MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.023","SUP","HCPCS C1713","","02.226.023  -  SCREW BONE T8 3MM 2MM 1.1MM 23MM 4MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.024","SUP","HCPCS C1713","","02.226.024  -  SCREW BONE T8 3MM 2MM 1.1MM 24MM 5MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.025","SUP","HCPCS C1713","","02.226.025  -  SCREW BONE T8 3MM 2MM 1.1MM 25MM 5MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.026","SUP","HCPCS C1713","","02.226.026  -  SCREW BONE T8 3MM 2MM 1.1MM 26MM 5MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.027","SUP","HCPCS C1713","","02.226.027  -  SCREW BONE T8 3MM 2MM 1.1MM 27MM 6MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.028","SUP","HCPCS C1713","","02.226.028  -  SCREW BONE T8 3MM 2MM 1.1MM 28MM 6MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.029","SUP","HCPCS C1713","","02.226.029  -  SCREW BONE T8 3MM 2MM 1.1MM 29MM 6MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.030","SUP","HCPCS C1713","","02.226.030  -  SCREW BONE T8 3MM 2MM 1.1MM 30MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.032","SUP","HCPCS C1713","","02.226.032  -  SCREW BONE T8 3MM 2MM 1.1MM 32MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.034","SUP","HCPCS C1713","","02.226.034  -  SCREW BONE T8 3MM 2MM 1.1MM 34MM 8MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.036","SUP","HCPCS C1713","","02.226.036  -  SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 36MM 9MM T8 STARDRIVE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.038","SUP","HCPCS C1713","","02.226.038  -  SCREW BONE T8 3MM 2MM 1.1MM 38MM 9MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.040","SUP","HCPCS C1713","","02.226.040  -  SCREW BONE T8 3MM 2MM 1.1MM 40MM 10MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.116","SUP","HCPCS C1713","","02.226.116  -  SCREW BONE LNGTHRD 3MM 2MM 16MM 5MM SELF TAP DRILL","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.117","SUP","HCPCS C1713","","02.226.117  -  SCREW BONE LNGTHRD 3MM 2MM 17MM 6MM T8 STARDRIVE CANN SELF","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.118","SUP","HCPCS C1713","","02.226.118  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 18MM 6MM T8 STARDRIVE CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.119","SUP","HCPCS C1713","","02.226.119  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 19MM 7MM T8 STARDRIVE CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.120","SUP","HCPCS C1713","","02.226.120  -  SCREW BONE LNGTHRD 3MM 2MM 20MM 7MM T8 STARDRIVE CANN SELF","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.121","SUP","HCPCS C1713","","02.226.121  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 21MM 8MM T8 STARDRIVE CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.122","SUP","HCPCS C1713","","02.226.122  -  SCREW BONE T8 3MM 2MM 1.1MM 22MM 8MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.123","SUP","HCPCS C1713","","02.226.123  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 23MM 8MM T8 STARDRIVE CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.124","SUP","HCPCS C1713","","02.226.124  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 24MM 8MM T8 STARDRIVE CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.125","SUP","HCPCS C1713","","02.226.125  -  SCREW BONE T8 3MM 2MM 1.1MM 25MM 8MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.126","SUP","HCPCS C1713","","02.226.126  -  SCREW BONE 1.1MM LNGTHRD 3MM 2MM 26MM 10MM T8 STARDRIVE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.127","SUP","HCPCS C1713","","02.226.127  -  SCREW BONE T8 3MM 2MM 1.1MM 27MM 10MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.128","SUP","HCPCS C1713","","02.226.128  -  SCREW BONE T8 3MM 2MM 1.1MM 28MM 10MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.129","SUP","HCPCS C1713","","02.226.129  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 29MM 10MM T8 STARDRIVE CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.130","SUP","HCPCS C1713","","02.226.130  -  SCREW BONE T8 3MM 2MM 1.1MM 30MM 12MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.132","SUP","HCPCS C1713","","02.226.132  -  SCREW BONE 1.1MM LNGTHRD 3MM 2MM 32MM 12MM COMPRESSION CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.134","SUP","HCPCS C1713","","02.226.134  -  SCREW BONE T8 3MM 2MM 1.1MM 34MM 14MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.136","SUP","HCPCS C1713","","02.226.136  -  SCREW BONE LNGTHRD 3MM 2MM 36MM 14MM COMPRESSION CANN T8","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.138","SUP","HCPCS C1713","","02.226.138  -  SCREW BN T8 L/T FLUT 3MM 2MM 38MM NS 16MM CMPR CNN ST HDLS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.140","SUP","HCPCS C1713","","02.226.140  -  SCREW BONE T8 3MM 2MM 1.1MM 40MM 16MM SELF DRILL SELF TAP","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.209","SUP","HCPCS C1713","","02.226.209  -  SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.210","SUP","HCPCS C1713","","02.226.210  -  SCREW BONE T8 2.4MM 10MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.211","SUP","HCPCS C1713","","02.226.211  -  SCREW BONE T8 2.4MM 11MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.212","SUP","HCPCS C1713","","02.226.212  -  SCREW BONE T8 2.4MM 12MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.213","SUP","HCPCS C1713","","02.226.213  -  SCREW BONE T8 2.4MM 13MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.214","SUP","HCPCS C1713","","02.226.214  -  SCREW BONE T8 2.4MM 14MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.215","SUP","HCPCS C1713","","02.226.215  -  SCREW BONE T8 2.4MM 15MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.216","SUP","HCPCS C1713","","02.226.216  -  SCREW BONE T8 2.4MM 16MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.217","SUP","HCPCS C1713","","02.226.217  -  SCREW BONE T8 2.4MM 17MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.218","SUP","HCPCS C1713","","02.226.218  -  SCREW BONE T8 2.4MM 18MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.219","SUP","HCPCS C1713","","02.226.219  -  SCREW BONE T8 2.4MM 19MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.220","SUP","HCPCS C1713","","02.226.220  -  SCREW BONE T8 2.4MM 20MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.221","SUP","HCPCS C1713","","02.226.221  -  SCREW BONE T8 2.4MM 21MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.222","SUP","HCPCS C1713","","02.226.222  -  SCREW BONE T8 2.4MM 22MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.223","SUP","HCPCS C1713","","02.226.223  -  SCREW BONE T8 2.4MM 23MM 4MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.224","SUP","HCPCS C1713","","02.226.224  -  SCREW BONE T8 2.4MM 24MM 5MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.225","SUP","HCPCS C1713","","02.226.225  -  SCREW BONE T8 2.4MM 25MM 5MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.226","SUP","HCPCS C1713","","02.226.226  -  SCREW BONE T8 2.4MM 26MM 5MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.227","SUP","HCPCS C1713","","02.226.227  -  SCREW BONE T8 2.4MM 27MM 6MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.228","SUP","HCPCS C1713","","02.226.228  -  SCREW BONE T8 2.4MM 28MM 6MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.229","SUP","HCPCS C1713","","02.226.229  -  SCREW BONE T8 2.4MM 29MM 6MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.230","SUP","HCPCS C1713","","02.226.230  -  SCREW BONE T8 2.4MM 30MM 7MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.232","SUP","HCPCS C1713","","02.226.232  -  SCREW BONE T8 2.4MM 32MM 7MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.234","SUP","HCPCS C1713","","02.226.234  -  SCREW BONE T8 2.4MM 34MM 8MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.236","SUP","HCPCS C1713","","02.226.236  -  SCREW BONE T8 2.4MM 36MM 9MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.238","SUP","HCPCS C1713","","02.226.238  -  SCREW BONE T8 2.4MM 38MM 9MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.240","SUP","HCPCS C1713","","02.226.240  -  SCREW BONE T8 2.4MM 40MM 10MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.317","SUP","HCPCS C1713","","02.226.317  -  SCREW BONE T8 2.4MM 17MM 6MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.318","SUP","HCPCS C1713","","02.226.318  -  SCREW BONE T8 2.4MM 18MM 6MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.319","SUP","HCPCS C1713","","02.226.319  -  SCREW BONE T8 2.4MM 19MM 7MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.320","SUP","HCPCS C1713","","02.226.320  -  SCREW BONE T8 2.4MM 20MM 7MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.321","SUP","HCPCS C1713","","02.226.321  -  SCREW BONE T8 2.4MM 21MM 8MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.322","SUP","HCPCS C1713","","02.226.322  -  SCREW BONE T8 2.4MM 22MM 8MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.323","SUP","HCPCS C1713","","02.226.323  -  SCREW BONE T8 2.4MM 23MM 8MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.324","SUP","HCPCS C1713","","02.226.324  -  SCREW BONE T8 2.4MM 24MM 8MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.325","SUP","HCPCS C1713","","02.226.325  -  SCREW BONE T8 2.4MM 25MM 8MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.326","SUP","HCPCS C1713","","02.226.326  -  SCREW BONE T8 2.4MM 26MM 10MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.327","SUP","HCPCS C1713","","02.226.327  -  SCREW BONE T8 2.4MM 27MM 10MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.328","SUP","HCPCS C1713","","02.226.328  -  SCREW BONE T8 2.4MM 28MM 10MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.329","SUP","HCPCS C1713","","02.226.329  -  SCREW BONE T8 2.4MM 29MM 10MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.330","SUP","HCPCS C1713","","02.226.330  -  SCREW BONE T8 2.4MM 30MM 12MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.332","SUP","HCPCS C1713","","02.226.332  -  SCREW BONE T8 2.4MM 32MM 12MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.334","SUP","HCPCS C1713","","02.226.334  -  SCREW BONE T8 2.4MM 34MM 14MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.336","SUP","HCPCS C1713","","02.226.336  -  SCREW BONE T8 2.4MM 36MM 14MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.338","SUP","HCPCS C1713","","02.226.338  -  SCREW BONE T8 2.4MM 38MM 16MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.340","SUP","HCPCS C1713","","02.226.340  -  SCREW BONE T8 2.4MM 40MM 16MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"02.226.620","SUP","HCPCS C1713","","02.226.620  -  SCREW BONE T15 4.5MM 20MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.622","SUP","HCPCS C1713","","02.226.622  -  SCREW BONE T15 4.5MM 22MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.624","SUP","HCPCS C1713","","02.226.624  -  SCREW BONE T15 4.5MM 24MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.626","SUP","HCPCS C1713","","02.226.626  -  SCREW BONE T15 4.5MM 26MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.628","SUP","HCPCS C1713","","02.226.628  -  SCREW BONE T15 4.5MM 28MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.630","SUP","HCPCS C1713","","02.226.630  -  SCREW BONE SHORT THREAD 4.5MM 30MM 7MM COMPRESSION HEADLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.632","SUP","HCPCS C1713","","02.226.632  -  SCREW BONE T15 4.5MM 32MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.634","SUP","HCPCS C1713","","02.226.634  -  SCREW BONE T15 4.5MM 34MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.636","SUP","HCPCS C1713","","02.226.636  -  SCREW BONE T15 4.5MM 36MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.638","SUP","HCPCS C1713","","02.226.638  -  SCREW BONE T15 4.5MM 38MM 7MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.640","SUP","HCPCS C1713","","02.226.640  -  SCREW BONE T15 4.5MM 40MM 8MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.642","SUP","HCPCS C1713","","02.226.642  -  SCREW BONE T15 4.5MM 42MM 8MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.644","SUP","HCPCS C1713","","02.226.644  -  SCREW BONE T15 4.5MM 44MM 9MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.646","SUP","HCPCS C1713","","02.226.646  -  SCREW BONE T15 4.5MM 46MM 9MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.648","SUP","HCPCS C1713","","02.226.648  -  SCREW BONE T15 4.5MM 48MM 9MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.650","SUP","HCPCS C1713","","02.226.650  -  SCREW BONE T15 4.5MM 50MM 10MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.652","SUP","HCPCS C1713","","02.226.652  -  SCREW BONE T15 4.5MM 52MM 10MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.654","SUP","HCPCS C1713","","02.226.654  -  SCREW BONE T15 4.5MM 54MM 11MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.656","SUP","HCPCS C1713","","02.226.656  -  SCREW BONE T15 4.5MM 56MM 11MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.658","SUP","HCPCS C1713","","02.226.658  -  SCREW BONE T15 4.5MM 58MM 11MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.660","SUP","HCPCS C1713","","02.226.660  -  SCREW BONE T15 4.5MM 60MM 12MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.665","SUP","HCPCS C1713","","02.226.665  -  SCREW BONE T15 4.5MM 65MM 13MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.670","SUP","HCPCS C1713","","02.226.670  -  SCREW BONE T15 4.5MM 70MM 14MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.675","SUP","HCPCS C1713","","02.226.675  -  SCREW BONE T15 4.5MM 75MM 15MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.680","SUP","HCPCS C1713","","02.226.680  -  SCREW BONE T15 4.5MM 80MM 16MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.685","SUP","HCPCS C1713","","02.226.685  -  SCREW BONE T15 4.5MM 85MM 17MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.690","SUP","HCPCS C1713","","02.226.690  -  SCREW BONE T15 4.5MM 90MM 18MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.695","SUP","HCPCS C1713","","02.226.695  -  SCREW BONE T15 4.5MM 95MM 19MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.700","SUP","HCPCS C1713","","02.226.700  -  SCREW BONE T15 4.5MM 100MM 20MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.730","SUP","HCPCS C1713","","02.226.730  -  SCREW BONE T15 4.5MM 30MM 12MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.732","SUP","HCPCS C1713","","02.226.732  -  SCREW BONE T15 4.5MM 32MM 12MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.734","SUP","HCPCS C1713","","02.226.734  -  SCREW BONE T15 4.5MM 34MM 12MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.736","SUP","HCPCS C1713","","02.226.736  -  SCREW BONE T15 4.5MM 36MM 14MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.738","SUP","HCPCS C1713","","02.226.738  -  SCREW BONE T15 4.5MM 38MM 14MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.740","SUP","HCPCS C1713","","02.226.740  -  SCREW BONE T15 4.5MM 40MM 16MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.742","SUP","HCPCS C1713","","02.226.742  -  SCREW BONE T15 4.5MM 42MM 16MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.744","SUP","HCPCS C1713","","02.226.744  -  SCREW BONE T15 4.5MM 44MM 18MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.746","SUP","HCPCS C1713","","02.226.746  -  SCREW BONE T15 4.5MM 46MM 18MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.748","SUP","HCPCS C1713","","02.226.748  -  SCREW BONE T15 4.5MM 48MM 18MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.750","SUP","HCPCS C1713","","02.226.750  -  SCREW BONE T15 4.5MM 50MM 20MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.752","SUP","HCPCS C1713","","02.226.752  -  SCREW BONE T15 4.5MM 52MM 20MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.754","SUP","HCPCS C1713","","02.226.754  -  SCREW BONE T15 4.5MM 54MM 22MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.756","SUP","HCPCS C1713","","02.226.756  -  SCREW BONE LNGTHRD 4.5MM 56MM 22MM SLFDRILL SLFTAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.758","SUP","HCPCS C1713","","02.226.758  -  SCREW BONE T15 4.5MM 58MM 22MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.760","SUP","HCPCS C1713","","02.226.760  -  SCREW BONE T15 4.5MM 60MM 24MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.765","SUP","HCPCS C1713","","02.226.765  -  SCREW BONE T15 4.5MM 65MM 26MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.770","SUP","HCPCS C1713","","02.226.770  -  SCREW BONE T15 4.5MM 70MM 28MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.775","SUP","HCPCS C1713","","02.226.775  -  SCREW BONE T15 4.5MM 75MM 30MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.780","SUP","HCPCS C1713","","02.226.780  -  SCREW BONE T15 4.5MM 80MM 32MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.785","SUP","HCPCS C1713","","02.226.785  -  SCREW BONE T15 4.5MM 85MM 34MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.790","SUP","HCPCS C1713","","02.226.790  -  SCREW BONE T15 4.5MM 90MM 36MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.795","SUP","HCPCS C1713","","02.226.795  -  SCREW BONE T15 4.5MM 95MM 38MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.226.800","SUP","HCPCS C1713","","02.226.800  -  SCREW BONE T15 4.5MM 100MM 40MM SELF DRILL SELF TAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.001","SUP","HCPCS C1713","","02.227.001  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM NONTHREADED TROCAR POINT","BOTH IP/OP","$79.40 ","$58.76 ","$0.00 ","$77.10 ","$34.70 ","$0.00 ","$16.55 ","$0.00 ","$0.00 ","$13.50 ","$77.10 ","$0.00 ","$38.55 ","$61.06 ","$61.68 ","$0.00 ","$11.71 ","$0.00 ","$12.27 ","$0.00 "
"02.227.030","SUP","HCPCS C1713","","02.227.030  -  SCREW BONE 6.5MM 30MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.035","SUP","HCPCS C1713","","02.227.035  -  SCREW BONE 6.5MM 35MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.040","SUP","HCPCS C1713","","02.227.040  -  SCREW BONE 6.5MM 40MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.045","SUP","HCPCS C1713","","02.227.045  -  SCREW BONE 6.5MM 45MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.050","SUP","HCPCS C1713","","02.227.050  -  SCREW BONE 6.5MM 50MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.055","SUP","HCPCS C1713","","02.227.055  -  SCREW BONE 6.5MM 55MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.060","SUP","HCPCS C1713","","02.227.060  -  SCREW BONE 6.5MM 60MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.065","SUP","HCPCS C1713","","02.227.065  -  SCREW BONE 6.5MM 65MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.070","SUP","HCPCS C1713","","02.227.070  -  SCREW BONE 6.5MM 70MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.075","SUP","HCPCS C1713","","02.227.075  -  SCREW BONE 6.5MM 75MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.080","SUP","HCPCS C1713","","02.227.080  -  SCREW BONE 6.5MM 80MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.085","SUP","HCPCS C1713","","02.227.085  -  SCREW BONE 6.5MM 85MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.090","SUP","HCPCS C1713","","02.227.090  -  SCREW BONE 6.5MM 90MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.095","SUP","HCPCS C1713","","02.227.095  -  SCREW BONE 6.5MM 95MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.100","SUP","HCPCS C1713","","02.227.100  -  SCREW BONE 6.5MM 100MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.105","SUP","HCPCS C1713","","02.227.105  -  SCREW BONE 6.5MM 105MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.110","SUP","HCPCS C1713","","02.227.110  -  SCREW BONE 6.5MM 110MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.115","SUP","HCPCS C1713","","02.227.115  -  SCREW BONE 6.5MM 115MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.120","SUP","HCPCS C1713","","02.227.120  -  SCREW BONE 6.5MM 120MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.125","SUP","HCPCS C1713","","02.227.125  -  SCREW BONE 6.5MM 125MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.130","SUP","HCPCS C1713","","02.227.130  -  SCREW BONE 6.5MM 130MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.135","SUP","HCPCS C1713","","02.227.135  -  SCREW BONE 6.5MM 135MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.140","SUP","HCPCS C1713","","02.227.140  -  SCREW BONE 6.5MM 140MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.145","SUP","HCPCS C1713","","02.227.145  -  SCREW BONE 6.5MM 145MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.150","SUP","HCPCS C1713","","02.227.150  -  SCREW BONE 6.5MM 150MM 16MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.245","SUP","HCPCS C1713","","02.227.245  -  SCREW BONE 6.5MM 45MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.250","SUP","HCPCS C1713","","02.227.250  -  SCREW BONE 6.5MM 50MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.255","SUP","HCPCS C1713","","02.227.255  -  SCREW BONE 6.5MM 55MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.260","SUP","HCPCS C1713","","02.227.260  -  SCREW BONE 6.5MM 60MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.265","SUP","HCPCS C1713","","02.227.265  -  SCREW BONE 6.5MM 65MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.270","SUP","HCPCS C1713","","02.227.270  -  SCREW BONE 6.5MM 70MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.275","SUP","HCPCS C1713","","02.227.275  -  SCREW BONE 6.5MM 75MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.280","SUP","HCPCS C1713","","02.227.280  -  SCREW BONE 6.5MM 80MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.285","SUP","HCPCS C1713","","02.227.285  -  SCREW BONE 6.5MM 7.5MM 85MM 32MM 2 LEAD COMPRESSION SLFTAP","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.290","SUP","HCPCS C1713","","02.227.290  -  SCREW BN 6.5MM 7.5MM 90MM NS 32MM CMPR ST SLF DRL HDLS SS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.295","SUP","HCPCS C1713","","02.227.295  -  SCREW BONE 6.5MM 95MM 32MM COMPRESSION HEADLESS STAINLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.300","SUP","HCPCS C1713","","02.227.300  -  SCREW BONE 6.5MM 100MM 32MM COMPRESSION HEADLESS STAINLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.305","SUP","HCPCS C1713","","02.227.305  -  SCREW BONE FLUTE 6.5MM 7.5MM 105MM 32MM 2 LEAD SELF TAP SELF","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.310","SUP","HCPCS C1713","","02.227.310  -  SCREW BONE FLUTE 6.5MM 7.5MM 110MM 32MM 2 LEAD SELF TAP SELF","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.315","SUP","HCPCS C1713","","02.227.315  -  SCREW BONE FLUTE 6.5MM 7.5MM 115MM 32MM 2 LEAD SELF TAP SELF","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.320","SUP","HCPCS C1713","","02.227.320  -  SCREW BN 4MM FLUT 6.5MM 7.5MM 120MM NS 32MM 2 LD ST SLF DRL","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.325","SUP","HCPCS C1713","","02.227.325  -  SCREW BN 4MM FLUT 6.5MM 7.5MM 125MM NS 32MM 2 LD ST SLF DRL","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.330","SUP","HCPCS C1713","","02.227.330  -  SCREW BONE FLUTE 6.5MM 7.5MM 130MM 32MM 2 LEAD SELF TAP SELF","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.335","SUP","HCPCS C1713","","02.227.335  -  SCREW BONE 6.5MM 135MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.340","SUP","HCPCS C1713","","02.227.340  -  SCREW BONE 6.5MM 140MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.345","SUP","HCPCS C1713","","02.227.345  -  SCREW BONE 6.5MM 145MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.227.350","SUP","HCPCS C1713","","02.227.350  -  SCREW BONE 6.5MM 150MM 32MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"02.230.109","SUP","HCPCS C1713","","02.230.109  -  SCREW BONE T4 1.5MM 9MM 4MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.110","SUP","HCPCS C1713","","02.230.110  -  SCREW BONE T4 1.5MM 10MM 4MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.111","SUP","HCPCS C1713","","02.230.111  -  SCREW BONE T4 1.5MM 11MM 4MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.112","SUP","HCPCS C1713","","02.230.112  -  SCREW BONE T4 1.5MM 12MM 4MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.113","SUP","HCPCS C1713","","02.230.113  -  SCREW BONE T4 1.5MM 13MM 4MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.114","SUP","HCPCS C1713","","02.230.114  -  SCREW BONE 1.5MM 1MM 14MM 4MM COMPRESSION THREAD HEADLESS T4","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.115","SUP","HCPCS C1713","","02.230.115  -  SCREW BONE T4 1.5MM 15MM 4MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.116","SUP","HCPCS C1713","","02.230.116  -  SCREW BONE T4 1.5MM 16MM 5MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.117","SUP","HCPCS C1713","","02.230.117  -  SCREW BONE T4 1.5MM 17MM 5MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.118","SUP","HCPCS C1713","","02.230.118  -  SCREW BONE T4 1.5MM 18MM 5MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.119","SUP","HCPCS C1713","","02.230.119  -  SCREW BONE T4 1.5MM 19MM 5MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.230.120","SUP","HCPCS C1713","","02.230.120  -  SCREW BONE T4 1.5MM 20MM 6MM SELF DRILL SELF TAP COMPRESSION","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"02.231.012","SUP","HCPCS C1713","","02.231.012  -  SCREW BONE T25 5MM 12MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$479.35 ","$354.72 ","$0.00 ","$465.38 ","$209.42 ","$0.00 ","$99.91 ","$0.00 ","$0.00 ","$81.48 ","$465.38 ","$0.00 ","$232.69 ","$368.58 ","$372.30 ","$0.00 ","$70.71 ","$0.00 ","$74.09 ","$0.00 "
"02.231.016","SUP","HCPCS C1713","","02.231.016  -  SCREW BONE T25 5MM 16MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$479.35 ","$354.72 ","$0.00 ","$465.38 ","$209.42 ","$0.00 ","$99.91 ","$0.00 ","$0.00 ","$81.48 ","$465.38 ","$0.00 ","$232.69 ","$368.58 ","$372.30 ","$0.00 ","$70.71 ","$0.00 ","$74.09 ","$0.00 "
"02.231.018S","SUP","HCPCS C1713","","02.231.018S  -  SCREW BN T25 5MM 18MM STRL ST LCK VA THRD RND HD SS CNDRL","BOTH IP/OP","$570.70 ","$422.32 ","$0.00 ","$554.10 ","$249.35 ","$0.00 ","$118.95 ","$0.00 ","$0.00 ","$97.02 ","$554.10 ","$0.00 ","$277.05 ","$438.85 ","$443.28 ","$0.00 ","$84.19 ","$0.00 ","$88.21 ","$0.00 "
"02.231.220","SUP","HCPCS C1713","","02.231.220  -  SCREW BONE T25 5MM 20MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.222","SUP","HCPCS C1713","","02.231.222  -  SCREW BONE T25 5MM 22MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.224","SUP","HCPCS C1713","","02.231.224  -  SCREW BONE T25 5MM 24MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.226","SUP","HCPCS C1713","","02.231.226  -  SCREW BONE T25 5MM 26MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.228","SUP","HCPCS C1713","","02.231.228  -  SCREW BONE T25 5MM 28MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.230","SUP","HCPCS C1713","","02.231.230  -  SCREW BONE T25 5MM 30MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.234","SUP","HCPCS C1713","","02.231.234  -  SCREW BONE T25 5MM 34MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.236","SUP","HCPCS C1713","","02.231.236  -  SCREW BONE T25 5MM 36MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.238","SUP","HCPCS C1713","","02.231.238  -  SCREW BONE T25 5MM 38MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.240","SUP","HCPCS C1713","","02.231.240  -  SCREW BONE T25 5MM 40MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.280","SUP","HCPCS C1713","","02.231.280  -  SCREW BONE T25 5MM 80MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.285","SUP","HCPCS C1713","","02.231.285  -  SCREW BONE T25 5MM 85MM VAR ANG SELF TAP STARDRIVE LCP","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"02.231.295S","SUP","HCPCS C1713","","02.231.295S  -  SCREW BN 5MM 95MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL","BOTH IP/OP","$435.78 ","$322.48 ","$0.00 ","$423.08 ","$190.38 ","$0.00 ","$90.83 ","$0.00 ","$0.00 ","$74.08 ","$423.08 ","$0.00 ","$211.54 ","$335.08 ","$338.46 ","$0.00 ","$64.28 ","$0.00 ","$67.35 ","$0.00 "
"02.231.300S","SUP","HCPCS C1713","","02.231.300S  -  SCREW BN 5MM 100MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL","BOTH IP/OP","$435.78 ","$322.48 ","$0.00 ","$423.08 ","$190.38 ","$0.00 ","$90.83 ","$0.00 ","$0.00 ","$74.08 ","$423.08 ","$0.00 ","$211.54 ","$335.08 ","$338.46 ","$0.00 ","$64.28 ","$0.00 ","$67.35 ","$0.00 "
"02.231.640","SUP","HCPCS C1713","","02.231.640  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 40MM VAR ANG SELF DRILL","BOTH IP/OP","$463.88 ","$343.27 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$96.68 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$68.43 ","$0.00 ","$71.70 ","$0.00 "
"02.231.675","SUP","HCPCS C1713","","02.231.675  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 75MM VAR ANG SELF DRILL","BOTH IP/OP","$463.88 ","$343.27 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$96.68 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$68.43 ","$0.00 ","$71.70 ","$0.00 "
"02.231.680","SUP","HCPCS C1713","","02.231.680  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 80MM VAR ANG SELF DRILL","BOTH IP/OP","$463.88 ","$343.27 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$96.68 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$50.39 ","$0.00 ","$71.70 ","$0.00 "
"02.231.685","SUP","HCPCS C1713","","02.231.685  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 85MM VAR ANG SELF DRILL","BOTH IP/OP","$463.88 ","$343.27 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$96.68 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$68.43 ","$0.00 ","$71.70 ","$0.00 "
"02.231.690","SUP","HCPCS C1713","","02.231.690  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 90MM VAR ANG SELF DRILL","BOTH IP/OP","$463.88 ","$343.27 ","$0.00 ","$450.38 ","$202.67 ","$0.00 ","$96.68 ","$0.00 ","$0.00 ","$78.86 ","$450.38 ","$0.00 ","$225.19 ","$356.70 ","$360.30 ","$0.00 ","$68.43 ","$0.00 ","$71.70 ","$0.00 "
"02.231.695S","SUP","HCPCS C1713","","02.231.695S  -  SCREW BN 5MM 3.5MM 95MM STRL VA ST TIP LCK CNN SS CNDRL","BOTH IP/OP","$560.88 ","$415.05 ","$0.00 ","$544.53 ","$245.04 ","$0.00 ","$116.90 ","$0.00 ","$0.00 ","$95.34 ","$544.53 ","$0.00 ","$272.26 ","$431.27 ","$435.62 ","$0.00 ","$82.74 ","$0.00 ","$86.69 ","$0.00 "
"02.240.010","SUP","HCPCS C1713","","02.240.010  -  SCREW BONE T15 FULTHD 3.7MM 10MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.012","SUP","HCPCS C1713","","02.240.012  -  SCREW BONE T15 FULTHD 3.7MM 12MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.014","SUP","HCPCS C1713","","02.240.014  -  SCREW BONE T15 FULTHD 3.7MM 14MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.016","SUP","HCPCS C1713","","02.240.016  -  SCREW BONE T15 FULTHD 3.7MM 16MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.018","SUP","HCPCS C1713","","02.240.018  -  SCREW BONE T15 FULTHD 3.7MM 18MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.020","SUP","HCPCS C1713","","02.240.020  -  SCREW BONE T15 FULTHD 3.7MM 20MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.022","SUP","HCPCS C1713","","02.240.022  -  SCREW BONE T15 FULTHD 3.7MM 22MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.024","SUP","HCPCS C1713","","02.240.024  -  SCREW BONE T15 FULTHD 3.7MM 24MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.026","SUP","HCPCS C1713","","02.240.026  -  SCREW BONE T15 FULTHD 3.7MM 26MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.028","SUP","HCPCS C1713","","02.240.028  -  SCREW BONE T15 FULTHD 3.7MM 28MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.030","SUP","HCPCS C1713","","02.240.030  -  SCREW BONE T15 FULTHD 3.7MM 30MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.032","SUP","HCPCS C1713","","02.240.032  -  SCREW BONE T15 FULTHD 3.7MM 32MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.034","SUP","HCPCS C1713","","02.240.034  -  SCREW BONE T15 FULTHD 3.7MM 34MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.036","SUP","HCPCS C1713","","02.240.036  -  SCREW BONE T15 FULTHD 3.7MM 36MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.038","SUP","HCPCS C1713","","02.240.038  -  SCREW BONE T15 FULTHD 3.7MM 38MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.040","SUP","HCPCS C1713","","02.240.040  -  SCREW BONE T15 FULTHD 3.7MM 40MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.042","SUP","HCPCS C1713","","02.240.042  -  SCREW BONE T15 FULTHD 3.7MM 42MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.044","SUP","HCPCS C1713","","02.240.044  -  SCREW BONE T15 FULTHD 3.7MM 44MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.046","SUP","HCPCS C1713","","02.240.046  -  SCREW BONE T15 FULTHD 3.7MM 46MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.048","SUP","HCPCS C1713","","02.240.048  -  SCREW BONE T15 FULTHD 3.7MM 48MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.050","SUP","HCPCS C1713","","02.240.050  -  SCREW BONE T15 FULTHD 3.7MM 50MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.052","SUP","HCPCS C1713","","02.240.052  -  SCREW BONE T15 FULTHD 3.7MM 52MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.054","SUP","HCPCS C1713","","02.240.054  -  SCREW BONE T15 FULTHD 3.7MM 54MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.056","SUP","HCPCS C1713","","02.240.056  -  SCREW BONE T15 FULTHD 3.7MM 56MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.058","SUP","HCPCS C1713","","02.240.058  -  SCREW BONE T15 FULTHD 3.7MM 58MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.060","SUP","HCPCS C1713","","02.240.060  -  SCREW BONE T15 FULTHD 3.7MM 60MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.065","SUP","HCPCS C1713","","02.240.065  -  SCREW BONE T15 FULTHD 3.7MM 65MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.070","SUP","HCPCS C1713","","02.240.070  -  SCREW BONE T15 FULTHD 3.7MM 70MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.075","SUP","HCPCS C1713","","02.240.075  -  SCREW BONE T15 FULTHD 3.7MM 75MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.080","SUP","HCPCS C1713","","02.240.080  -  SCREW BONE T15 FULTHD 3.7MM 80MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.085","SUP","HCPCS C1713","","02.240.085  -  SCREW BONE T15 FULTHD 3.7MM 85MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.090","SUP","HCPCS C1713","","02.240.090  -  SCREW BONE T15 FULTHD 3.7MM 90MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.095","SUP","HCPCS C1713","","02.240.095  -  SCREW BONE T15 FULTHD 3.7MM 95MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$358.45 ","$265.25 ","$0.00 ","$348.00 ","$156.60 ","$0.00 ","$74.71 ","$0.00 ","$0.00 ","$60.93 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$52.88 ","$0.00 ","$55.40 ","$0.00 "
"02.240.210","SUP","HCPCS C1713","","02.240.210  -  SCREW BONE CONE 3.7MM 10MM 6MM SELF DRILL SELF TAP LOCK CANN","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.212","SUP","HCPCS C1713","","02.240.212  -  SCREW BONE CONE 3.7MM 12MM 8MM SELF DRILL SELF TAP LOCK CANN","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.214","SUP","HCPCS C1713","","02.240.214  -  SCREW BONE CONE 3.7MM 14MM 8MM SELF DRILL SELF TAP LOCK CANN","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.216","SUP","HCPCS C1713","","02.240.216  -  SCREW BONE CONE 3.7MM 16MM 8MM SELF DRILL SELF TAP LOCK CANN","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.218","SUP","HCPCS C1713","","02.240.218  -  SCREW BONE CONE 3.7MM 18MM 8MM SELF DRILL SELF TAP LOCK CANN","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.220","SUP","HCPCS C1713","","02.240.220  -  SCREW BONE CONE 3.7MM 20MM 15MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.222","SUP","HCPCS C1713","","02.240.222  -  SCREW BONE CONE 3.7MM 22MM 15MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.224","SUP","HCPCS C1713","","02.240.224  -  SCREW BONE CONE 3.7MM 24MM 15MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.226","SUP","HCPCS C1713","","02.240.226  -  SCREW BONE CONE 3.7MM 26MM 15MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.228","SUP","HCPCS C1713","","02.240.228  -  SCREW BONE CONE 3.7MM 28MM 15MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.230","SUP","HCPCS C1713","","02.240.230  -  SCREW BONE CONE 3.7MM 30MM 15MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.232","SUP","HCPCS C1713","","02.240.232  -  SCREW BONE CONE 3.7MM 32MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.234","SUP","HCPCS C1713","","02.240.234  -  SCREW BONE CONE 3.7MM 34MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.236","SUP","HCPCS C1713","","02.240.236  -  SCREW BONE CONE 3.7MM 36MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.238","SUP","HCPCS C1713","","02.240.238  -  SCREW BONE CONE 3.7MM 38MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.240","SUP","HCPCS C1713","","02.240.240  -  SCREW BONE CONE 3.7MM 40MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.242","SUP","HCPCS C1713","","02.240.242  -  SCREW BONE CONE 3.7MM 42MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.244","SUP","HCPCS C1713","","02.240.244  -  SCREW BONE CONE 3.7MM 44MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.246","SUP","HCPCS C1713","","02.240.246  -  SCREW BONE CONE 3.7MM 46MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.248","SUP","HCPCS C1713","","02.240.248  -  SCREW BONE CONE 3.7MM 48MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.250","SUP","HCPCS C1713","","02.240.250  -  SCREW BONE CONE 3.7MM 50MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.252","SUP","HCPCS C1713","","02.240.252  -  SCREW BONE CONE 3.7MM 52MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.254","SUP","HCPCS C1713","","02.240.254  -  SCREW BONE CONE 3.7MM 54MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.256","SUP","HCPCS C1713","","02.240.256  -  SCREW BONE CONE 3.7MM 56MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.258","SUP","HCPCS C1713","","02.240.258  -  SCREW BONE CONE 3.7MM 58MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.260","SUP","HCPCS C1713","","02.240.260  -  SCREW BONE CONE 3.7MM 60MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.265","SUP","HCPCS C1713","","02.240.265  -  SCREW BONE CONE 3.7MM 65MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.270","SUP","HCPCS C1713","","02.240.270  -  SCREW BONE CONE 3.7MM 70MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.275","SUP","HCPCS C1713","","02.240.275  -  SCREW BONE CONE 3.7MM 75MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.280","SUP","HCPCS C1713","","02.240.280  -  SCREW BONE CONE 3.7MM 80MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.285","SUP","HCPCS C1713","","02.240.285  -  SCREW BONE CONE 3.7MM 85MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.290","SUP","HCPCS C1713","","02.240.290  -  SCREW BONE CONE 3.7MM 90MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.240.295","SUP","HCPCS C1713","","02.240.295  -  SCREW BONE CONE 3.7MM 95MM 25MM SELF DRILL SELF TAP LOCK","BOTH IP/OP","$313.48 ","$231.98 ","$0.00 ","$304.35 ","$136.96 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$53.29 ","$304.35 ","$0.00 ","$152.18 ","$241.05 ","$243.48 ","$0.00 ","$46.24 ","$0.00 ","$48.45 ","$0.00 "
"02.306.006","SUP","HCPCS C1713","","02.306.006  -  NAIL INTRAMEDULLARY SHORT CANN ORTHOPEDIC NONSTRL PELVIC","BOTH IP/OP","$967.13 ","$715.68 ","$0.00 ","$938.95 ","$422.53 ","$0.00 ","$201.57 ","$0.00 ","$0.00 ","$164.40 ","$938.95 ","$0.00 ","$469.48 ","$743.65 ","$751.16 ","$0.00 ","$142.67 ","$0.00 ","$149.48 ","$0.00 "
"02.306.007","SUP","HCPCS C1713","","02.306.007  -  NAIL INTRAMEDULLARY LONG CANN ORTHOPEDIC NONSTRL PELVIC","BOTH IP/OP","$967.13 ","$715.68 ","$0.00 ","$938.95 ","$422.53 ","$0.00 ","$201.57 ","$0.00 ","$0.00 ","$164.40 ","$938.95 ","$0.00 ","$469.48 ","$743.65 ","$751.16 ","$0.00 ","$142.67 ","$0.00 ","$149.48 ","$0.00 "
"02.600.020","SUP","Custom 27203010","","02.600.020  -  WIRE FX 1.6MM 400MM NS KRSH TROC PNT SS","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02.600.022.02S","SUP","HCPCS C1713","","02.600.022.02S  -  PIN 12MM DSTRCT STRL","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$204.75 ","$92.14 ","$0.00 ","$42.68 ","$0.00 ","$0.00 ","$35.85 ","$204.75 ","$0.00 ","$102.38 ","$162.16 ","$163.80 ","$0.00 ","$32.04 ","$0.00 ","$32.60 ","$0.00 "
"0200-12LV","SUP","Custom 27203010","","0200-12LV  -  TUBE JJNSTM 12FR 2-3ML STRL LF MC SLK MED PORT RADOPQ STRP","BOTH IP/OP","$337.35 ","$249.64 ","$0.00 ","$337.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.35 ","$0.00 ","$168.68 ","$267.18 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0200-18","SUP","Custom 27203010","","0200-18  -  TUBE JEJUNOSTOMY STANDARD J 18FR TRIMMABLE DISTAL TIP","BOTH IP/OP","$337.35 ","$249.64 ","$0.00 ","$342.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.41 ","$0.00 ","$171.21 ","$271.19 ","$273.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"022-001","SUP","Custom 27203010","","022-001  -  WIRE PACING 2-0 TAPER LOOP 1/8IN 61CM 89MM 1 ARM SNAP OFF","BOTH IP/OP","$49.32 ","$36.50 ","$0.00 ","$49.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.32 ","$0.00 ","$24.66 ","$39.06 ","$39.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"02-2005-S","SUP","HCPCS C1713","","02-2005-S  -  PLATE SS 5 HOLE CMPR BONE 6MM STRL","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"02-2007-S","SUP","HCPCS C1713","","02-2007-S  -  PLATE 203.2MM SS 7 HOLE 8 GRV CMPR BONE ORTH STRL","BOTH IP/OP","$1,342.50 ","$993.45 ","$0.00 ","$1,342.50 ","$604.13 ","$0.00 ","$279.81 ","$0.00 ","$0.00 ","$235.06 ","$1,342.50 ","$0.00 ","$671.25 ","$1,063.26 ","$1,074.00 ","$0.00 ","$210.10 ","$0.00 ","$213.73 ","$0.00 "
"02-2009-S","SUP","HCPCS C1713","","02-2009-S  -  PLATE 6 SS 9 HOLE CMPR BONE 10MM STRL","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"02-2011-S","SUP","HCPCS C1713","","02-2011-S  -  PLATE 6 12IN SS 11 HOLE 12 GRV CMPR BONE 12MM STRL","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"02-205-085","SUP","HCPCS C1713","","02-205-085  -  SCREW BONE 5MM 85MM LCP SS PROX FEM CANN LCK NONSTRL","BOTH IP/OP","$415.40 ","$307.40 ","$0.00 ","$415.40 ","$186.93 ","$0.00 ","$86.58 ","$0.00 ","$0.00 ","$72.73 ","$415.40 ","$0.00 ","$207.70 ","$329.00 ","$332.32 ","$0.00 ","$65.01 ","$0.00 ","$66.13 ","$0.00 "
"02-205-280","SUP","HCPCS C1713","","02-205-280  -  SCREW BONE 5MM 80MM LCP SS PERIART FEM/TIB CANN CONICAL","BOTH IP/OP","$354.75 ","$262.52 ","$0.00 ","$354.75 ","$159.64 ","$0.00 ","$73.94 ","$0.00 ","$0.00 ","$62.11 ","$354.75 ","$0.00 ","$177.38 ","$280.96 ","$283.80 ","$0.00 ","$55.52 ","$0.00 ","$56.48 ","$0.00 "
"02-210-122","SUP","HCPCS C1713","","02-210-122  -  SCREW BONE 2.4MM 22MM LCP SS DISTAL RADL LCK VAR ANG","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"023-001","SUP","Custom 27203010","","KIT IMMUN TST ELISA ANCRDLPN IGG IGM 96 TST","BOTH IP/OP","$962.50 ","$712.25 ","$0.00 ","$962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0250-18","SUP","HCPCS B4088","","0250-18  -  TUBE JJNSTM 18FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT","BOTH IP/OP","$564.68 ","$417.86 ","$0.00 ","$564.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.68 ","$0.00 ","$282.34 ","$447.23 ","$451.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.120.023","SUP","Custom 27203010","","03.120.023  -  DEVICE XTRNFX PUL RDC 4.3 MM PERC DRL GD","BOTH IP/OP","$979.78 ","$725.04 ","$0.00 ","$951.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$951.23 ","$0.00 ","$475.61 ","$753.37 ","$760.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.122.002","SUP","Custom 27203010","","03.122.002  -  BIT DRL 95MM 2.8MM 248MM NS QC CLBRT","BOTH IP/OP","$296.60 ","$219.48 ","$0.00 ","$287.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.95 ","$0.00 ","$143.98 ","$228.06 ","$230.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.122.056","SUP","Custom 27203010","","03.122.056  -  DEVICE MEASURING AIMING NOSE PHILOS NONSTRL","BOTH IP/OP","$2,745.33 ","$2,031.54 ","$0.00 ","$2,665.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,665.35 ","$0.00 ","$1,332.68 ","$2,110.96 ","$2,132.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.100","SUP","Custom 27203010","","03.130.100  -  BIT DRL 1MM 75MM KRSH THRD HL WRE HND 1.3MM SCR","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.102","SUP","Custom 27203010","","03.130.102  -  BIT DRL 1MM 61MM MNQK CPLNG THRD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.110","SUP","Custom 27203010","","03.130.110  -  BIT DRL 1.3MM 60MM KRSH THRD HL WRE GLD HND","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.112","SUP","Custom 27203010","","03.130.112  -  BIT DRL 1.3MM 46MM MNQK CPLNG GLD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.120","SUP","Custom 27203010","","03.130.120  -  GUIDE DRL 1MM THRD 1.3MM LCK PLT","BOTH IP/OP","$499.03 ","$369.28 ","$0.00 ","$484.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$484.48 ","$0.00 ","$242.24 ","$383.71 ","$387.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.125","SUP","Custom 27203010","","03.130.125  -  SLEEVE DRL 1.3MM 1MM YLW 2 1.3MM CORT SCR","BOTH IP/OP","$618.50 ","$457.69 ","$0.00 ","$600.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.50 ","$0.00 ","$300.25 ","$475.60 ","$480.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.130","SUP","HCPCS C1713","","03.130.130  -  HOLDER PLT 1.3-2 MM","BOTH IP/OP","$529.95 ","$392.16 ","$0.00 ","$514.50 ","$231.53 ","$0.00 ","$110.45 ","$0.00 ","$0.00 ","$90.08 ","$514.50 ","$0.00 ","$257.25 ","$407.48 ","$411.60 ","$0.00 ","$78.18 ","$0.00 ","$81.91 ","$0.00 "
"03.130.140","SUP","HCPCS C1713","","03.130.140  -  PIN BNDRG 1.3MM LCK PLT","BOTH IP/OP","$499.03 ","$369.28 ","$0.00 ","$484.48 ","$218.01 ","$0.00 ","$104.01 ","$0.00 ","$0.00 ","$84.83 ","$484.48 ","$0.00 ","$242.24 ","$383.71 ","$387.58 ","$0.00 ","$73.61 ","$0.00 ","$77.13 ","$0.00 "
"03.130.200","SUP","Custom 27203010","","03.130.200  -  BIT DRL 1.1MM 70MM KWR 1.5MM SCR THRD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.202","SUP","Custom 27203010","","03.130.202  -  BIT DRL 1.1MM 56MM MNQK CPLNG THRD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.210","SUP","Custom 27203010","","03.130.210  -  BIT DRL 1.5MM 62MM BLU KWR ATCH 2MM SCR GLD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.212","SUP","Custom 27203010","","03.130.212  -  BIT DRL 1.5MM 48MM MNQK CPLNG GLD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.215","SUP","Custom 27203010","","03.130.215  -  COUNTERSINK DRL 1.3 MM 1.5 MM 2 MM SCR","BOTH IP/OP","$414.68 ","$306.86 ","$0.00 ","$402.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.60 ","$0.00 ","$201.30 ","$318.86 ","$322.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.221","SUP","Custom 27203010","","03.130.221  -  GUIDE DRL 1.1MM 2 VA FRHD 1.5MM LCK PLT","BOTH IP/OP","$1,234.20 ","$913.31 ","$0.00 ","$1,198.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,198.25 ","$0.00 ","$599.13 ","$949.01 ","$958.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.225","SUP","Custom 27203010","","03.130.225  -  SLEEVE DRL 1.5MM 1.1MM RD 2 1.5MM CORT SCR","BOTH IP/OP","$618.50 ","$457.69 ","$0.00 ","$600.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.50 ","$0.00 ","$300.25 ","$475.60 ","$480.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.250","SUP","Custom 27203010","","03.130.250  -  GAUGE D 1.3/1.5/2 MM SCR","BOTH IP/OP","$2,242.08 ","$1,659.14 ","$0.00 ","$2,176.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,176.78 ","$0.00 ","$1,088.39 ","$1,724.01 ","$1,741.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.260","SUP","HCPCS C1713","","03.130.260  -  PLIERS PLT BNDRG RT 1.3 MM LCK 1.5/2 MM VA PLT","BOTH IP/OP","$833.58 ","$616.85 ","$0.00 ","$809.30 ","$364.19 ","$0.00 ","$173.74 ","$0.00 ","$0.00 ","$141.70 ","$809.30 ","$0.00 ","$404.65 ","$640.97 ","$647.44 ","$0.00 ","$122.97 ","$0.00 ","$128.84 ","$0.00 "
"03.130.261","SUP","HCPCS C1713","","03.130.261  -  PLIERS PLT BNDRG LT 1.3 MM LCK 1.5/2 MM VA PLT","BOTH IP/OP","$833.58 ","$616.85 ","$0.00 ","$809.30 ","$364.19 ","$0.00 ","$173.74 ","$0.00 ","$0.00 ","$141.70 ","$809.30 ","$0.00 ","$404.65 ","$640.97 ","$647.44 ","$0.00 ","$122.97 ","$0.00 ","$128.84 ","$0.00 "
"03.130.292","SUP","Custom 27203010","","03.130.292  -  GUIDE DRL YLW INS 1MM BIT","BOTH IP/OP","$217.88 ","$161.23 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.53 ","$0.00 ","$105.76 ","$167.53 ","$169.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.293","SUP","Custom 27203010","","03.130.293  -  GUIDE DRL RD INS 1.1MM BIT","BOTH IP/OP","$217.88 ","$161.23 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.53 ","$0.00 ","$105.76 ","$167.53 ","$169.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.294","SUP","Custom 27203010","","03.130.294  -  GUIDE DRL YLW INS 1.3MM BIT","BOTH IP/OP","$217.88 ","$161.23 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.53 ","$0.00 ","$105.76 ","$167.53 ","$169.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.295","SUP","Custom 27203010","","03.130.295  -  GUIDE DRL RD INS 1.5MM BIT","BOTH IP/OP","$217.88 ","$161.23 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.53 ","$0.00 ","$105.76 ","$167.53 ","$169.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.296","SUP","Custom 27203010","","03.130.296  -  GUIDE DRL BLU INS 1.5MM BIT","BOTH IP/OP","$217.88 ","$161.23 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.53 ","$0.00 ","$105.76 ","$167.53 ","$169.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.297","SUP","Custom 27203010","","03.130.297  -  GUIDE DRL BLU INS 2MM BIT","BOTH IP/OP","$217.88 ","$161.23 ","$0.00 ","$211.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.53 ","$0.00 ","$105.76 ","$167.53 ","$169.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.300","SUP","Custom 27203010","","03.130.300  -  BIT DRL 1.5MM 88MM BLU KRSH WRE ATCH 2MM SCR","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.302","SUP","Custom 27203010","","03.130.302  -  BIT DRL 1.5MM 74MM 57MM CLR CD PILT HL MNQK CPLNG","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.310","SUP","Custom 27203010","","03.130.310  -  BIT DRL 2MM 71MM 41MM CLR CD GLD HL JCHK","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.312","SUP","Custom 27203010","","03.130.312  -  BIT DRL 2MM 57MM MNQK CPLNG GLD HL","BOTH IP/OP","$161.65 ","$119.62 ","$0.00 ","$156.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.95 ","$0.00 ","$78.48 ","$124.30 ","$125.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.321","SUP","Custom 27203010","","03.130.321  -  GUIDE DRL 1.5MM 2 VA LCK FR HND 2MM PLT","BOTH IP/OP","$1,234.20 ","$913.31 ","$0.00 ","$1,198.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,198.25 ","$0.00 ","$599.13 ","$949.01 ","$958.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.130.325","SUP","Custom 27203010","","03.130.325  -  SLEEVE DRL 1.5MM BLU 2 2MM CORT SCR","BOTH IP/OP","$618.50 ","$457.69 ","$0.00 ","$600.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.50 ","$0.00 ","$300.25 ","$475.60 ","$480.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.161.024","SUP","Custom 27203010","","03.161.024  -  BIT DRL 3.2MM NS OCPTL CRV FSN SYS","BOTH IP/OP","$1,060.00 ","$784.40 ","$0.00 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.00 ","$0.00 ","$530.00 ","$839.52 ","$848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.161.026","SUP","HCPCS C1713","","03.161.026  -  TAP SURG NONSTRL 4.5 MM OCCPTL SCREW","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"03.161.027","SUP","Custom 27203010","","03.161.027  -  SCREWDRIVER SURG UNIVERSAL JOINT 4 MM OCCPTL SCREW","BOTH IP/OP","$3,267.50 ","$2,417.95 ","$0.00 ","$3,267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,267.50 ","$0.00 ","$1,633.75 ","$2,587.86 ","$2,614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.410","SUP","Custom 27203010","","03.211.410  -  WIRE FX 1.6MM 150MM NS 10MM LCP CMPR THRD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.415","SUP","Custom 27203010","","03.211.415  -  WIRE FX 1.6MM 150MM NS 15MM LCP CMPR THRD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.420","SUP","Custom 27203010","","03.211.420  -  WIRE FX 1.6MM 150MM NS 20MM LCP CMPR THRD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.425","SUP","Custom 27203010","","03.211.425  -  WIRE FX 1.6MM 150MM NS 25MM LCP CMPR THRD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.430","SUP","Custom 27203010","","03.211.430  -  WIRE FX 1.6MM 150MM NS 30MM LCP CMPR THRD","BOTH IP/OP","$85.75 ","$63.46 ","$0.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.25 ","$0.00 ","$41.63 ","$65.93 ","$66.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.435","SUP","Custom 27203010","","03.211.435  -  WIRE FX 1.6MM 150MM NS 35MM LCP CMPR THRD","BOTH IP/OP","$88.55 ","$65.53 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.98 ","$0.00 ","$42.99 ","$68.10 ","$68.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.211.440","SUP","Custom 27203010","","03.211.440  -  WIRE FX 1.6MM 150MM NS 40MM LCP CMPR THRD","BOTH IP/OP","$88.55 ","$65.53 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.98 ","$0.00 ","$42.99 ","$68.10 ","$68.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.226.039","SUP","Custom 27203010","","03.226.039  -  BIT DRILL 3.2MM CANN NONSTRL 4.5MM SCREW","BOTH IP/OP","$753.45 ","$557.55 ","$0.00 ","$731.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$731.50 ","$0.00 ","$365.75 ","$579.35 ","$585.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.226.042","SUP","Custom 27203010","","03.226.042  -  BIT DRILL 4MM DEVICE CANN","BOTH IP/OP","$811.08 ","$600.20 ","$0.00 ","$787.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$787.45 ","$0.00 ","$393.73 ","$623.66 ","$629.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.227.042","SUP","Custom 27203010","","03.227.042  -  BIT DRILL 6MM CANN NONSTRL 6.5MM HEADLESS COMPRESSION SCREW","BOTH IP/OP","$773.13 ","$572.12 ","$0.00 ","$750.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.63 ","$0.00 ","$375.31 ","$594.50 ","$600.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.301.010S","SUP","Custom 27203010","","03.301.010S  -  SET EXFIX LARGE FRAME ANKLE STERILE","BOTH IP/OP","$5,761.33 ","$4,263.38 ","$0.00 ","$5,593.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,593.53 ","$0.00 ","$2,796.76 ","$4,430.08 ","$4,474.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.301.011S","SUP","Custom 27203010","","03.301.011S  -  KIT TRAUMA LARGE EXFIX STERILE","BOTH IP/OP","$6,037.58 ","$4,467.81 ","$0.00 ","$5,861.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,861.73 ","$0.00 ","$2,930.86 ","$4,642.49 ","$4,689.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.301.012S","SUP","Custom 27203010","","03.301.012S  -  KIT FRAME LARGE EXFIX PELVIC STERILE","BOTH IP/OP","$8,095.05 ","$5,990.34 ","$0.00 ","$7,859.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,859.25 ","$0.00 ","$3,929.63 ","$6,224.53 ","$6,287.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.304.220S","SUP","HCPCS C1713","","03.304.220S  -  FIXATOR XTRNFX 2.5MM 4MM 200MM STRL LF SCHNZ LOPRFL ROD CFBR","BOTH IP/OP","$1,659.78 ","$1,228.24 ","$0.00 ","$1,611.43 ","$725.14 ","$0.00 ","$345.94 ","$0.00 ","$0.00 ","$282.15 ","$1,611.43 ","$0.00 ","$805.71 ","$1,276.25 ","$1,289.14 ","$0.00 ","$244.84 ","$0.00 ","$256.54 ","$0.00 "
"03.304.222S","SUP","HCPCS C1713","","03.304.222S  -  FIXATOR XTRNFX 2.5-4MM 220MM STRL LOPRFL ROD CFBR WRST","BOTH IP/OP","$1,659.78 ","$1,228.24 ","$0.00 ","$1,611.43 ","$725.14 ","$0.00 ","$345.94 ","$0.00 ","$0.00 ","$282.15 ","$1,611.43 ","$0.00 ","$805.71 ","$1,276.25 ","$1,289.14 ","$0.00 ","$244.84 ","$0.00 ","$256.54 ","$0.00 "
"03.304.320S","SUP","Custom 27203010","","03.304.320S  -  FIXATOR XTRNFX 3MM 4MM 200MM STRL LF SCHNZ ROD LOPRFL SLF","BOTH IP/OP","$2,106.48 ","$1,558.80 ","$0.00 ","$2,045.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,045.13 ","$0.00 ","$1,022.56 ","$1,619.74 ","$1,636.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.304.322S","SUP","Custom 27203010","","03.304.322S  -  ROD EXFIX 220MM MRI SAFE LOW-PROFILE WRIST FIXATOR","BOTH IP/OP","$2,106.48 ","$1,558.80 ","$0.00 ","$2,045.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,045.13 ","$0.00 ","$1,022.56 ","$1,619.74 ","$1,636.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.305.004","SUP","Custom 27203010","","03.305.004  -  BIT DRL 24MM 1.8/4MM NS MATRIXRIB JLTCH CPLNG STP STRYK","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.305.006","SUP","Custom 27203010","","03.305.006  -  CLAMP XTRNFX NS ADJ MNDB XTRNFXTR II","BOTH IP/OP","$1,392.50 ","$1,030.45 ","$0.00 ","$1,392.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,392.50 ","$0.00 ","$696.25 ","$1,102.86 ","$1,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.305.009","SUP","Custom 27203010","","03.305.009  -  TEMPLATE SIZING 4MM ROD","BOTH IP/OP","$917.50 ","$678.95 ","$0.00 ","$917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.305.500","SUP","Custom 27203010","","03.305.500  -  ROD EXFIX 500MM NONSTRL MANDIB FIXATOR","BOTH IP/OP","$4,300.00 ","$3,182.00 ","$0.00 ","$4,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,300.00 ","$0.00 ","$2,150.00 ","$3,405.60 ","$3,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.306.010","SUP","Custom 27203010","","03.306.010  -  SET ORTHOPEDIC C CLMP II PELVIC","BOTH IP/OP","$13,379.38 ","$9,900.74 ","$0.00 ","$12,989.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,989.70 ","$0.00 ","$6,494.85 ","$10,287.84 ","$10,391.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.307.001","SUP","Custom 27203010","","03.307.001  -  CLAMP EXFIX WIRE FIX EXTERNAL MIDFAC DISTRCT","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.307.010","SUP","Custom 27203010","","03.307.010  -  ROD EXFIX 100MM CARFBR NONSTRL MIDFAC DISTRCT","BOTH IP/OP","$515.00 ","$381.10 ","$0.00 ","$515.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.00 ","$0.00 ","$257.50 ","$407.88 ","$412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.307.105","SUP","Custom 27203010","","03.307.105  -  BAR EXFIX 50MM CONNCTNG EXTERNAL MIDFAC DISTRCT","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.307.112","SUP","Custom 27203010","","03.307.112  -  BAR EXFIX 120MM CONNCTNG EXTERNAL MIDFAC DISTRCT","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.011","SUP","Custom 27203010","","03.311.011  -  CLAMP EXFIX SCREW MR SAFE PIVOT SCHANZ NONSTRL","BOTH IP/OP","$680.63 ","$503.67 ","$0.00 ","$660.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$660.80 ","$0.00 ","$330.40 ","$523.35 ","$528.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.012","SUP","Custom 27803010","","03.311.012  -  HINGE XTRNFX NS LCK MRI SAFE","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.022","SUP","HCPCS C1713","","03.311.022  -  PLATE EXFIX 90D 2 HOLE OFFST CONNCTNG NONSTRL","BOTH IP/OP","$157.08 ","$116.24 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$32.74 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.17 ","$0.00 ","$24.28 ","$0.00 "
"03.311.023","SUP","HCPCS C1713","","03.311.023  -  PLATE EXFIX 90D 3 HOLE OFFST CONNCTNG NONSTRL","BOTH IP/OP","$168.20 ","$124.47 ","$0.00 ","$163.30 ","$73.49 ","$0.00 ","$35.06 ","$0.00 ","$0.00 ","$28.59 ","$163.30 ","$0.00 ","$81.65 ","$129.33 ","$130.64 ","$0.00 ","$24.81 ","$0.00 ","$26.00 ","$0.00 "
"03.311.024","SUP","HCPCS C1713","","03.311.024  -  PLATE EXFIX 90D 4 HOLE OFFST CONNCTNG NONSTRL","BOTH IP/OP","$180.45 ","$133.53 ","$0.00 ","$175.20 ","$78.84 ","$0.00 ","$37.61 ","$0.00 ","$0.00 ","$30.68 ","$175.20 ","$0.00 ","$87.60 ","$138.76 ","$140.16 ","$0.00 ","$26.62 ","$0.00 ","$27.89 ","$0.00 "
"03.311.025","SUP","HCPCS C1713","","03.311.025  -  PLATE EXFIX 90D 5 HOLE OFFST CONNCTNG NONSTRL","BOTH IP/OP","$192.70 ","$142.60 ","$0.00 ","$187.10 ","$84.20 ","$0.00 ","$40.16 ","$0.00 ","$0.00 ","$32.76 ","$187.10 ","$0.00 ","$93.55 ","$148.18 ","$149.68 ","$0.00 ","$28.43 ","$0.00 ","$29.79 ","$0.00 "
"03.311.031","SUP","Custom 27203010","","03.311.031  -  EXTRACTOR SRG 1.5MM 400MM NS SMTH MR SF DSTRCT OSTEOGENESIS","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.032","SUP","Custom 27203010","","03.311.032  -  WIRE FIX 1.8MM 400MM SMOOTH MRI SAFE NONSTRL","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.033","SUP","Custom 27203010","","03.311.033  -  WIRE FX 2MM 400MM NS SMTH MRI SAFE","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.036","SUP","Custom 27203010","","03.311.036  -  WIRE XTRNFX 1.5MM SMTH HLF PNT TIP MRI SAFE","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.037","SUP","Custom 27203010","","03.311.037  -  WIRE XTRNFX 1.8MM SMTH HLF PNT TIP MRI SAFE","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.038","SUP","Custom 27203010","","03.311.038  -  WIRE XTRNFX 2MM SMTH HLF PNT TIP MRI SAFE","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$115.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.73 ","$0.00 ","$57.86 ","$91.66 ","$92.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.041","SUP","Custom 27203010","","03.311.041  -  WIRE XTRNFX 1.5MM 400MM RDC MRI SAFE","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.042","SUP","Custom 27203010","","03.311.042  -  WIRE XTRNFX 1.8MM 400MM RDC MRI SAFE","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.043","SUP","Custom 27203010","","03.311.043  -  WIRE FX 2MM 400MM NS SMTH MRI SAFE","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.046","SUP","Custom 27203010","","03.311.046  -  WIRE XTRNFX 1.5MM RDC HLF PNT TIP MRI SAFE","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.047","SUP","Custom 27203010","","03.311.047  -  WIRE XTRNFX 1.8MM RDC HLF PNT TIP MRI SAFE","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.048","SUP","Custom 27203010","","03.311.048  -  WIRE XTRNFX 2MM RDC HLF PNT TIP MRI SAFE","BOTH IP/OP","$370.95 ","$274.50 ","$0.00 ","$360.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.15 ","$0.00 ","$180.08 ","$285.24 ","$288.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.060","SUP","Custom 27203010","","03.311.060  -  NUT XTRNFX SQ MRI SAFE","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$123.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.30 ","$0.00 ","$61.65 ","$97.65 ","$98.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.061.10","SUP","Custom 27203010","","03.311.061.10  -  NUT XTRNFX NS LF DISP","BOTH IP/OP","$6.09 ","$4.51 ","$0.00 ","$6.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.09 ","$0.00 ","$3.05 ","$4.82 ","$4.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.062","SUP","Custom 27803010","","03.311.062  -  NUT ORTHOPEDIC MRI SAFE NONSTRL","BOTH IP/OP","$246.18 ","$182.17 ","$0.00 ","$239.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$239.00 ","$0.00 ","$119.50 ","$189.29 ","$191.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.070","SUP","Custom 27203010","","03.311.070  -  POST EXFIX SHORT WIRE MRI SAFE NONSTRL","BOTH IP/OP","$305.23 ","$225.87 ","$0.00 ","$296.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$296.33 ","$0.00 ","$148.16 ","$234.69 ","$237.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.071","SUP","Custom 27203010","","03.311.071  -  POST XTRNFX TLL NS WRE MRI SAFE","BOTH IP/OP","$346.43 ","$256.36 ","$0.00 ","$336.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.35 ","$0.00 ","$168.18 ","$266.39 ","$269.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.090","SUP","Custom 27803010","","03.311.090  -  WASHER XTRNFX SPHRCL CPLNG MRI SAFE","BOTH IP/OP","$54.03 ","$39.98 ","$0.00 ","$52.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.45 ","$0.00 ","$26.23 ","$41.54 ","$41.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.091","SUP","Custom 27203010","","03.311.091  -  SUPPORT XTRNFX OBLQ NS","BOTH IP/OP","$859.98 ","$636.39 ","$0.00 ","$834.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$834.93 ","$0.00 ","$417.46 ","$661.26 ","$667.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.106","SUP","HCPCS C1713","","03.311.106  -  ROD EXFIX 60MM THREAD SLOT MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"03.311.108","SUP","HCPCS C1713","","03.311.108  -  ROD EXFIX 80MM THREAD SLOT MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"03.311.110","SUP","Custom 27203010","","03.311.110  -  ROD EXFIX 100MM THREAD SLOT MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.112","SUP","HCPCS C1713","","03.311.112  -  ROD EXFIX 120MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$21.82 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"03.311.115","SUP","HCPCS C1713","","03.311.115  -  ROD EXFIX 150MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$104.70 ","$77.48 ","$0.00 ","$101.65 ","$45.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.80 ","$101.65 ","$0.00 ","$50.83 ","$80.51 ","$81.32 ","$0.00 ","$15.45 ","$0.00 ","$16.18 ","$0.00 "
"03.311.120","SUP","Custom 27203010","","03.311.120  -  ROD EXFIX 200MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$113.63 ","$84.09 ","$0.00 ","$110.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.33 ","$0.00 ","$55.16 ","$87.38 ","$88.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.125","SUP","Custom 27203010","","03.311.125  -  ROD EXFIX 250MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$113.63 ","$84.09 ","$0.00 ","$110.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.33 ","$0.00 ","$55.16 ","$87.38 ","$88.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.130","SUP","Custom 27203010","","03.311.130  -  ROD EXFIX 300MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$131.45 ","$97.27 ","$0.00 ","$127.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.63 ","$0.00 ","$63.81 ","$101.08 ","$102.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.135","SUP","Custom 27203010","","03.311.135  -  ROD EXFIX 350MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$131.45 ","$97.27 ","$0.00 ","$127.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.63 ","$0.00 ","$63.81 ","$101.08 ","$102.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.140","SUP","Custom 27203010","","03.311.140  -  ROD EXFIX 400MM THREAD MR SAFE NONSTRL DISTRACTION","BOTH IP/OP","$172.65 ","$127.76 ","$0.00 ","$167.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$167.63 ","$0.00 ","$83.81 ","$132.76 ","$134.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.171","SUP","Custom 27203010","","03.311.171  -  POST XTRNFX NS 1 HL WRE FEM","BOTH IP/OP","$333.08 ","$246.48 ","$0.00 ","$323.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.38 ","$0.00 ","$161.69 ","$256.12 ","$258.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.172","SUP","Custom 27203010","","03.311.172  -  POST XTRNFX NS 2 HL WRE FEM","BOTH IP/OP","$346.43 ","$256.36 ","$0.00 ","$336.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.35 ","$0.00 ","$168.18 ","$266.39 ","$269.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.173","SUP","Custom 27203010","","03.311.173  -  POST XTRNFX NS 3 HL WRE FEM","BOTH IP/OP","$358.70 ","$265.44 ","$0.00 ","$348.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.25 ","$0.00 ","$174.13 ","$275.81 ","$278.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.174","SUP","Custom 27203010","","03.311.174  -  POST XTRNFX NS 4 HL WRE FEM","BOTH IP/OP","$373.18 ","$276.15 ","$0.00 ","$362.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.30 ","$0.00 ","$181.15 ","$286.94 ","$289.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.175","SUP","Custom 27203010","","03.311.175  -  POST XTRNFX NS 5 HL WRE FEM","BOTH IP/OP","$385.43 ","$285.22 ","$0.00 ","$374.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.20 ","$0.00 ","$187.10 ","$296.37 ","$299.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.200","SUP","HCPCS C1713","","03.311.200  -  PLATE XTRNFX FLT NS 1 HL CNCT MRI SAFE FEM CFBR RING","BOTH IP/OP","$118.08 ","$87.38 ","$0.00 ","$114.65 ","$51.59 ","$0.00 ","$24.61 ","$0.00 ","$0.00 ","$20.07 ","$114.65 ","$0.00 ","$57.33 ","$90.80 ","$91.72 ","$0.00 ","$17.42 ","$0.00 ","$18.25 ","$0.00 "
"03.311.201","SUP","HCPCS C1713","","03.311.201  -  PLATE XTRNFX NS 1 HL CNCT MRI SAFE FEM CFBR RING","BOTH IP/OP","$118.08 ","$87.38 ","$0.00 ","$114.65 ","$51.59 ","$0.00 ","$24.61 ","$0.00 ","$0.00 ","$20.07 ","$114.65 ","$0.00 ","$57.33 ","$90.80 ","$91.72 ","$0.00 ","$17.42 ","$0.00 ","$18.25 ","$0.00 "
"03.311.202","SUP","HCPCS C1713","","03.311.202  -  PLATE XTRNFX NS 2 HL CNCT MRI SAFE FEM CFBR RING","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$123.30 ","$55.49 ","$0.00 ","$26.47 ","$0.00 ","$0.00 ","$21.59 ","$123.30 ","$0.00 ","$61.65 ","$97.65 ","$98.64 ","$0.00 ","$18.73 ","$0.00 ","$19.63 ","$0.00 "
"03.311.203","SUP","HCPCS C1713","","03.311.203  -  PLATE XTRNFX NS 3 HL CNCT MRI SAFE FEM CFBR RING","BOTH IP/OP","$131.45 ","$97.27 ","$0.00 ","$127.63 ","$57.43 ","$0.00 ","$27.40 ","$0.00 ","$0.00 ","$22.35 ","$127.63 ","$0.00 ","$63.81 ","$101.08 ","$102.10 ","$0.00 ","$19.39 ","$0.00 ","$20.32 ","$0.00 "
"03.311.204","SUP","HCPCS C1713","","03.311.204  -  PLATE XTRNFX NS 4 HL CNCT MRI SAFE FEM CFBR RING","BOTH IP/OP","$149.28 ","$110.47 ","$0.00 ","$144.93 ","$65.22 ","$0.00 ","$31.11 ","$0.00 ","$0.00 ","$25.38 ","$144.93 ","$0.00 ","$72.46 ","$114.78 ","$115.94 ","$0.00 ","$22.02 ","$0.00 ","$23.07 ","$0.00 "
"03.311.205","SUP","HCPCS C1713","","03.311.205  -  PLATE XTRNFX NS 5 HL CNCT MRI SAFE FEM CFBR RING","BOTH IP/OP","$172.65 ","$127.76 ","$0.00 ","$167.63 ","$75.43 ","$0.00 ","$35.98 ","$0.00 ","$0.00 ","$29.35 ","$167.63 ","$0.00 ","$83.81 ","$132.76 ","$134.10 ","$0.00 ","$25.47 ","$0.00 ","$26.69 ","$0.00 "
"03.311.212","SUP","HCPCS C1713","","03.311.212  -  PLATE XTRNFX NS 2 HL CNCT","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$54.99 ","$0.00 ","$26.24 ","$0.00 ","$0.00 ","$21.40 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$18.57 ","$0.00 ","$19.45 ","$0.00 "
"03.311.213","SUP","HCPCS C1713","","03.311.213  -  PLATE XTRNFX NS 3 HL CNCT","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$135.20 ","$60.84 ","$0.00 ","$29.02 ","$0.00 ","$0.00 ","$23.67 ","$135.20 ","$0.00 ","$67.60 ","$107.08 ","$108.16 ","$0.00 ","$20.54 ","$0.00 ","$21.52 ","$0.00 "
"03.311.214","SUP","HCPCS C1713","","03.311.214  -  PLATE XTRNFX NS 4 HL CNCT","BOTH IP/OP","$150.38 ","$111.28 ","$0.00 ","$146.00 ","$65.70 ","$0.00 ","$31.34 ","$0.00 ","$0.00 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.18 ","$0.00 ","$23.24 ","$0.00 "
"03.311.215","SUP","HCPCS C1713","","03.311.215  -  PLATE XTRNFX NS 5 HL CNCT","BOTH IP/OP","$162.63 ","$120.35 ","$0.00 ","$157.90 ","$71.06 ","$0.00 ","$33.90 ","$0.00 ","$0.00 ","$27.65 ","$157.90 ","$0.00 ","$78.95 ","$125.06 ","$126.32 ","$0.00 ","$23.99 ","$0.00 ","$25.14 ","$0.00 "
"03.311.220","SUP","Custom 27203010","","03.311.220  -  SPACER XTRNFX 20MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS","BOTH IP/OP","$72.98 ","$54.01 ","$0.00 ","$70.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.230","SUP","Custom 27803010","","03.311.230  -  SPACER XTRNFX 30MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS","BOTH IP/OP","$79.10 ","$58.53 ","$0.00 ","$76.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.78 ","$0.00 ","$38.39 ","$60.81 ","$61.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.240","SUP","Custom 27203010","","03.311.240  -  SPACER XTRNFX 40MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS","BOTH IP/OP","$87.45 ","$64.71 ","$0.00 ","$84.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.90 ","$0.00 ","$42.45 ","$67.24 ","$67.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.250","SUP","Custom 27203010","","03.311.250  -  SPACER XTRNFX 50MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS","BOTH IP/OP","$118.08 ","$87.38 ","$0.00 ","$114.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.65 ","$0.00 ","$57.33 ","$90.80 ","$91.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.308","SUP","Custom 27203010","","03.311.308  -  RING EXFIX HALF 80MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$578.13 ","$427.82 ","$0.00 ","$561.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$561.30 ","$0.00 ","$280.65 ","$444.55 ","$449.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.310","SUP","Custom 27203010","","03.311.310  -  RING EXFIX HALF 100MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$623.80 ","$461.61 ","$0.00 ","$605.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.311","SUP","Custom 27203010","","03.311.311  -  RING EXFIX HALF 110MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$639.40 ","$473.16 ","$0.00 ","$620.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$620.78 ","$0.00 ","$310.39 ","$491.66 ","$496.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.312","SUP","Custom 27203010","","03.311.312  -  RING EXFIX HALF 120MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$666.15 ","$492.95 ","$0.00 ","$646.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$646.73 ","$0.00 ","$323.36 ","$512.21 ","$517.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.313","SUP","Custom 27203010","","03.311.313  -  RING EXFIX HALF 130MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$682.85 ","$505.31 ","$0.00 ","$662.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.95 ","$0.00 ","$331.48 ","$525.06 ","$530.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.314","SUP","Custom 27203010","","03.311.314  -  RING EXFIX HALF 140MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$709.58 ","$525.09 ","$0.00 ","$688.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$688.93 ","$0.00 ","$344.46 ","$545.63 ","$551.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.315","SUP","Custom 27203010","","03.311.315  -  RING EXFIX HALF 150MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$755.25 ","$558.89 ","$0.00 ","$733.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$733.25 ","$0.00 ","$366.63 ","$580.73 ","$586.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.316","SUP","Custom 27203010","","03.311.316  -  RING EXFIX HALF 160MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$823.20 ","$609.17 ","$0.00 ","$799.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$799.23 ","$0.00 ","$399.61 ","$632.99 ","$639.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.318","SUP","Custom 27203010","","03.311.318  -  RING EXFIX HALF 180MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$884.48 ","$654.52 ","$0.00 ","$858.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$858.70 ","$0.00 ","$429.35 ","$680.09 ","$686.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.320","SUP","Custom 27203010","","03.311.320  -  RING EXFIX HALF 200MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$958.00 ","$708.92 ","$0.00 ","$930.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$930.10 ","$0.00 ","$465.05 ","$736.64 ","$744.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.322","SUP","Custom 27203010","","03.311.322  -  RING EXFIX HALF 220MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,019.25 ","$754.25 ","$0.00 ","$989.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$989.58 ","$0.00 ","$494.79 ","$783.75 ","$791.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.324","SUP","Custom 27203010","","03.311.324  -  RING EXFIX HALF 240MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,063.83 ","$787.23 ","$0.00 ","$1,032.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,032.83 ","$0.00 ","$516.41 ","$818.00 ","$826.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.344","SUP","Custom 27203010","","03.311.344  -  RING EXFIX FULL 140MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,414.70 ","$1,046.88 ","$0.00 ","$1,373.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,373.50 ","$0.00 ","$686.75 ","$1,087.81 ","$1,098.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.346","SUP","Custom 27203010","","03.311.346  -  RING EXFIX FULL 160MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,645.30 ","$1,217.52 ","$0.00 ","$1,597.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,597.38 ","$0.00 ","$798.69 ","$1,265.12 ","$1,277.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.348","SUP","Custom 27203010","","03.311.348  -  RING EXFIX FULL 180MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,768.95 ","$1,309.02 ","$0.00 ","$1,717.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,717.43 ","$0.00 ","$858.71 ","$1,360.20 ","$1,373.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.350","SUP","Custom 27203010","","03.311.350  -  RING EXFIX FULL 200MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,920.45 ","$1,421.13 ","$0.00 ","$1,864.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,864.50 ","$0.00 ","$932.25 ","$1,476.68 ","$1,491.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.373","SUP","Custom 27203010","","03.311.373  -  RING EXFIX 5/8 130MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$930.15 ","$688.31 ","$0.00 ","$903.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$903.05 ","$0.00 ","$451.53 ","$715.22 ","$722.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.375","SUP","Custom 27203010","","03.311.375  -  RING EXFIX 5/8 150MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,019.25 ","$754.25 ","$0.00 ","$989.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$989.58 ","$0.00 ","$494.79 ","$783.75 ","$791.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.376","SUP","Custom 27203010","","03.311.376  -  RING EXFIX 5/8 160MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,106.15 ","$818.55 ","$0.00 ","$1,073.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,073.93 ","$0.00 ","$536.96 ","$850.55 ","$859.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.378","SUP","Custom 27203010","","03.311.378  -  RING EXFIX 5/8 180MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,284.38 ","$950.44 ","$0.00 ","$1,246.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.98 ","$0.00 ","$623.49 ","$987.61 ","$997.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.380","SUP","Custom 27203010","","03.311.380  -  RING EXFIX 5/8 200MM TITANIUM NONSTRL DISTRACTION","BOTH IP/OP","$1,327.83 ","$982.59 ","$0.00 ","$1,289.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,289.15 ","$0.00 ","$644.58 ","$1,021.01 ","$1,031.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.391","SUP","HCPCS C1713","","03.311.391  -  PLATE XTRNFX 90D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS","BOTH IP/OP","$1,592.95 ","$1,178.78 ","$0.00 ","$1,546.55 ","$695.95 ","$0.00 ","$332.01 ","$0.00 ","$0.00 ","$270.79 ","$1,546.55 ","$0.00 ","$773.28 ","$1,224.87 ","$1,237.24 ","$0.00 ","$234.98 ","$0.00 ","$246.21 ","$0.00 "
"03.311.392","SUP","HCPCS C1713","","03.311.392  -  PLATE XTRNFX 120D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS","BOTH IP/OP","$1,636.38 ","$1,210.92 ","$0.00 ","$1,588.73 ","$714.93 ","$0.00 ","$341.06 ","$0.00 ","$0.00 ","$278.17 ","$1,588.73 ","$0.00 ","$794.36 ","$1,258.27 ","$1,270.98 ","$0.00 ","$241.39 ","$0.00 ","$252.93 ","$0.00 "
"03.311.396","SUP","HCPCS C1713","","03.311.396  -  PLATE XTRNFX 90D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS","BOTH IP/OP","$1,727.73 ","$1,278.52 ","$0.00 ","$1,677.40 ","$754.83 ","$0.00 ","$360.10 ","$0.00 ","$0.00 ","$293.70 ","$1,677.40 ","$0.00 ","$838.70 ","$1,328.50 ","$1,341.92 ","$0.00 ","$254.87 ","$0.00 ","$267.04 ","$0.00 "
"03.311.397","SUP","HCPCS C1713","","03.311.397  -  PLATE XTRNFX 120D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS","BOTH IP/OP","$1,768.95 ","$1,309.02 ","$0.00 ","$1,717.43 ","$772.84 ","$0.00 ","$368.69 ","$0.00 ","$0.00 ","$300.71 ","$1,717.43 ","$0.00 ","$858.71 ","$1,360.20 ","$1,373.94 ","$0.00 ","$260.95 ","$0.00 ","$273.41 ","$0.00 "
"03.311.406","SUP","Custom 27803010","","03.311.406  -  DISTRACTOR SURG 60MM 25MM LINEAR NONSTRL","BOTH IP/OP","$1,019.25 ","$754.25 ","$0.00 ","$989.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$989.58 ","$0.00 ","$494.79 ","$783.75 ","$791.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.412","SUP","Custom 27803010","","03.311.412  -  DISTRACTOR SURG 85MM TRAVEL 120MM LINEAR MRI SAFE NONSTRL","BOTH IP/OP","$1,106.15 ","$818.55 ","$0.00 ","$1,073.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,073.93 ","$0.00 ","$536.96 ","$850.55 ","$859.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.418","SUP","Custom 27803010","","03.311.418  -  DISTRACTOR SURG 180MM LINEAR MRI SAFE NONSTRL","BOTH IP/OP","$1,239.83 ","$917.47 ","$0.00 ","$1,203.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,203.70 ","$0.00 ","$601.85 ","$953.33 ","$962.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.425","SUP","Custom 27803010","","03.311.425  -  DISTRACTOR SURG 215MM TRAVEL 250MM LINEAR MRI SAFE NONSTRL","BOTH IP/OP","$1,504.95 ","$1,113.66 ","$0.00 ","$1,461.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,461.10 ","$0.00 ","$730.55 ","$1,157.19 ","$1,168.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.450","SUP","Custom 27803010","","03.311.450  -  DISTRACTOR SURG ANGLE NONSTRL","BOTH IP/OP","$990.30 ","$732.82 ","$0.00 ","$961.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$961.45 ","$0.00 ","$480.73 ","$761.47 ","$769.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.451","SUP","Custom 27803010","","03.311.451  -  DISTRACTOR SURG ANGLE PIVOT NONSTRL","BOTH IP/OP","$432.20 ","$319.83 ","$0.00 ","$419.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$419.63 ","$0.00 ","$209.81 ","$332.35 ","$335.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.810","SUP","Custom 27203010","","03.311.810  -  RING EXFIX .5 100MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$709.58 ","$525.09 ","$0.00 ","$688.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$688.93 ","$0.00 ","$344.46 ","$545.63 ","$551.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.812","SUP","Custom 27203010","","03.311.812  -  RING EXFIX .5 120MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$755.25 ","$558.89 ","$0.00 ","$733.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$733.25 ","$0.00 ","$366.63 ","$580.73 ","$586.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.814","SUP","Custom 27203010","","03.311.814  -  RING EXFIX .5 140MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$798.70 ","$591.04 ","$0.00 ","$775.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$775.43 ","$0.00 ","$387.71 ","$614.14 ","$620.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.816","SUP","Custom 27203010","","03.311.816  -  RING EXFIX .5 160MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$884.48 ","$654.52 ","$0.00 ","$858.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$858.70 ","$0.00 ","$429.35 ","$680.09 ","$686.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.818","SUP","Custom 27203010","","03.311.818  -  RING EXFIX .5 180MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$930.15 ","$688.31 ","$0.00 ","$903.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$903.05 ","$0.00 ","$451.53 ","$715.22 ","$722.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.820","SUP","Custom 27203010","","03.311.820  -  RING EXFIX .5 200MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$974.70 ","$721.28 ","$0.00 ","$946.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$946.33 ","$0.00 ","$473.16 ","$749.49 ","$757.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.844","SUP","Custom 27203010","","03.311.844  -  RING EXFIX 140MM FULL RING MRI SAFE CARFBR","BOTH IP/OP","$1,592.95 ","$1,178.78 ","$0.00 ","$1,546.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,546.55 ","$0.00 ","$773.28 ","$1,224.87 ","$1,237.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.846","SUP","Custom 27203010","","03.311.846  -  RING EXFIX FULL 160MM FULL RING MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$1,768.95 ","$1,309.02 ","$0.00 ","$1,717.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,717.43 ","$0.00 ","$858.71 ","$1,360.20 ","$1,373.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.848","SUP","Custom 27203010","","03.311.848  -  RING EXFIX 180MM FULL RING MRI SAFE CARFBR","BOTH IP/OP","$1,947.18 ","$1,440.91 ","$0.00 ","$1,890.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,890.45 ","$0.00 ","$945.23 ","$1,497.24 ","$1,512.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.850","SUP","Custom 27203010","","03.311.850  -  RING EXFIX 200MM FULL RING MRI SAFE CARFBR","BOTH IP/OP","$2,122.08 ","$1,570.34 ","$0.00 ","$2,060.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.25 ","$0.00 ","$1,030.13 ","$1,631.72 ","$1,648.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.874","SUP","Custom 27203010","","03.311.874  -  RING EXFIX 5/8 140MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$930.15 ","$688.31 ","$0.00 ","$903.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$903.05 ","$0.00 ","$451.53 ","$715.22 ","$722.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.876","SUP","Custom 27203010","","03.311.876  -  RING EXFIX 5/8 160MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$974.70 ","$721.28 ","$0.00 ","$946.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$946.33 ","$0.00 ","$473.16 ","$749.49 ","$757.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.878","SUP","Custom 27203010","","03.311.878  -  RING EXFIX 5/8 180MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$1,019.25 ","$754.25 ","$0.00 ","$989.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$989.58 ","$0.00 ","$494.79 ","$783.75 ","$791.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.880","SUP","Custom 27203010","","03.311.880  -  RING EXFIX 5/8 200MM MRI SAFE CARFBR NONSTRL","BOTH IP/OP","$1,063.83 ","$787.23 ","$0.00 ","$1,032.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,032.83 ","$0.00 ","$516.41 ","$818.00 ","$826.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.891","SUP","HCPCS C1713","","03.311.891  -  PLATE XTRNFX 90D ARCH 180MM NS MRI SAFE CFBR FEM","BOTH IP/OP","$1,462.60 ","$1,082.32 ","$0.00 ","$1,420.00 ","$639.00 ","$0.00 ","$304.84 ","$0.00 ","$0.00 ","$248.63 ","$1,420.00 ","$0.00 ","$710.00 ","$1,124.64 ","$1,136.00 ","$0.00 ","$215.76 ","$0.00 ","$226.06 ","$0.00 "
"03.311.892","SUP","HCPCS C1713","","03.311.892  -  PLATE XTRNFX 120D ARCH 180MM NS MRI SAFE CFBR FEM","BOTH IP/OP","$1,511.63 ","$1,118.61 ","$0.00 ","$1,467.60 ","$660.42 ","$0.00 ","$315.06 ","$0.00 ","$0.00 ","$256.97 ","$1,467.60 ","$0.00 ","$733.80 ","$1,162.34 ","$1,174.08 ","$0.00 ","$222.99 ","$0.00 ","$233.64 ","$0.00 "
"03.311.896","SUP","HCPCS C1713","","03.311.896  -  PLATE XTRNFX 90D ARCH 240MM NS MRI SAFE CFBR FEM","BOTH IP/OP","$1,556.18 ","$1,151.57 ","$0.00 ","$1,510.85 ","$679.88 ","$0.00 ","$324.35 ","$0.00 ","$0.00 ","$264.54 ","$1,510.85 ","$0.00 ","$755.43 ","$1,196.59 ","$1,208.68 ","$0.00 ","$229.56 ","$0.00 ","$240.53 ","$0.00 "
"03.311.897","SUP","HCPCS C1713","","03.311.897  -  PLATE XTRNFX 120D ARCH 240MM NS MRI SAFE CFBR FEM","BOTH IP/OP","$1,646.40 ","$1,218.34 ","$0.00 ","$1,598.45 ","$719.30 ","$0.00 ","$343.15 ","$0.00 ","$0.00 ","$279.88 ","$1,598.45 ","$0.00 ","$799.23 ","$1,265.97 ","$1,278.76 ","$0.00 ","$242.87 ","$0.00 ","$254.47 ","$0.00 "
"03.311.910","SUP","Custom 27203010","","03.311.910  -  RING EXFIX SHORT 100MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,144.03 ","$846.58 ","$0.00 ","$1,110.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,110.70 ","$0.00 ","$555.35 ","$879.67 ","$888.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.914","SUP","Custom 27203010","","03.311.914  -  RING EXFIX SHORT 140MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,189.70 ","$880.38 ","$0.00 ","$1,155.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.05 ","$0.00 ","$577.53 ","$914.80 ","$924.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.916","SUP","Custom 27203010","","03.311.916  -  RING EXFIX SHORT 160MM FT RING MRI SAFE CARFBR","BOTH IP/OP","$1,236.48 ","$915.00 ","$0.00 ","$1,200.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.48 ","$0.00 ","$600.24 ","$950.78 ","$960.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.918","SUP","Custom 27203010","","03.311.918  -  RING EXFIX SHORT 180MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,282.15 ","$948.79 ","$0.00 ","$1,244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,244.80 ","$0.00 ","$622.40 ","$985.88 ","$995.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.940","SUP","Custom 27203010","","03.311.940  -  RING EXFIX LONG 100MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,144.03 ","$846.58 ","$0.00 ","$1,110.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,110.70 ","$0.00 ","$555.35 ","$879.67 ","$888.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.944","SUP","Custom 27203010","","03.311.944  -  RING EXFIX LONG 140MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,189.70 ","$880.38 ","$0.00 ","$1,155.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.05 ","$0.00 ","$577.53 ","$914.80 ","$924.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.946","SUP","Custom 27203010","","03.311.946  -  RING EXFIX 160MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,236.48 ","$915.00 ","$0.00 ","$1,200.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.48 ","$0.00 ","$600.24 ","$950.78 ","$960.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.948","SUP","Custom 27203010","","03.311.948  -  RING EXFIX LONG 180MM MRI SAFE CARFBR FT","BOTH IP/OP","$1,282.15 ","$948.79 ","$0.00 ","$1,244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,244.80 ","$0.00 ","$622.40 ","$985.88 ","$995.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.960","SUP","Custom 27203010","","03.311.960  -  RING EXFIX SHORT 100MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,504.95 ","$1,113.66 ","$0.00 ","$1,461.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,461.10 ","$0.00 ","$730.55 ","$1,157.19 ","$1,168.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.964","SUP","Custom 27203010","","03.311.964  -  RING EXFIX SHORT 140MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,566.20 ","$1,158.99 ","$0.00 ","$1,520.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,520.60 ","$0.00 ","$760.30 ","$1,204.32 ","$1,216.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.966","SUP","Custom 27203010","","03.311.966  -  RING EXFIX SHORT 160MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,628.60 ","$1,205.16 ","$0.00 ","$1,581.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,581.15 ","$0.00 ","$790.58 ","$1,252.27 ","$1,264.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.968","SUP","Custom 27203010","","03.311.968  -  RING EXFIX SHORT 180MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,689.85 ","$1,250.49 ","$0.00 ","$1,640.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,640.63 ","$0.00 ","$820.31 ","$1,299.38 ","$1,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.970","SUP","Custom 27203010","","03.311.970  -  RING EXFIX SHORT 200MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,699.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,699.03 ","$0.00 ","$849.51 ","$1,345.63 ","$1,359.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.980","SUP","Custom 27203010","","03.311.980  -  RING EXFIX LONG 100MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,504.95 ","$1,113.66 ","$0.00 ","$1,461.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,461.10 ","$0.00 ","$730.55 ","$1,157.19 ","$1,168.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.984","SUP","Custom 27203010","","03.311.984  -  RING EXFIX LONG 140MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,566.20 ","$1,158.99 ","$0.00 ","$1,520.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,520.60 ","$0.00 ","$760.30 ","$1,204.32 ","$1,216.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.986","SUP","Custom 27203010","","03.311.986  -  RING EXFIX LONG 160MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,628.60 ","$1,205.16 ","$0.00 ","$1,581.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,581.15 ","$0.00 ","$790.58 ","$1,252.27 ","$1,264.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.988","SUP","Custom 27203010","","03.311.988  -  RING EXFIX LONG 180+ MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,689.85 ","$1,250.49 ","$0.00 ","$1,640.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,640.63 ","$0.00 ","$820.31 ","$1,299.38 ","$1,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.311.990","SUP","Custom 27203010","","03.311.990  -  RING EXFIX LONG 200+ MM MRI SAFE TITANIUM FT NONSTRL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,699.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,699.03 ","$0.00 ","$849.51 ","$1,345.63 ","$1,359.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.390.052S","SUP","HCPCS C1713","","03.390.052S  -  FIXATOR XTRNFX 200MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR","BOTH IP/OP","$4,161.70 ","$3,079.66 ","$0.00 ","$4,040.48 ","$1,818.21 ","$0.00 ","$867.40 ","$0.00 ","$0.00 ","$707.45 ","$4,040.48 ","$0.00 ","$2,020.24 ","$3,200.06 ","$3,232.38 ","$0.00 ","$613.92 ","$0.00 ","$643.24 ","$0.00 "
"03.390.053S","SUP","Custom 27203010","","03.390.053S  -  SET EXFIX 220MM SCREW ROD MRI SAFE DISTAL RAD NONSTRL","BOTH IP/OP","$4,161.70 ","$3,079.66 ","$0.00 ","$4,040.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,040.48 ","$0.00 ","$2,020.24 ","$3,200.06 ","$3,232.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.390.054S","SUP","HCPCS C1713","","03.390.054S  -  FIXATOR XTRNFX 240MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR","BOTH IP/OP","$4,161.70 ","$3,079.66 ","$0.00 ","$4,040.48 ","$1,818.21 ","$0.00 ","$867.40 ","$0.00 ","$0.00 ","$707.45 ","$4,040.48 ","$0.00 ","$2,020.24 ","$3,200.06 ","$3,232.38 ","$0.00 ","$613.92 ","$0.00 ","$643.24 ","$0.00 "
"03.390.055S","SUP","HCPCS C1713","","03.390.055S  -  FIXATOR EXFIX 200MM SLFDRILL SCHANZ SCREW ROD MRI SAFE","BOTH IP/OP","$4,446.88 ","$3,290.69 ","$0.00 ","$4,317.35 ","$1,942.81 ","$0.00 ","$926.84 ","$0.00 ","$0.00 ","$755.93 ","$4,317.35 ","$0.00 ","$2,158.68 ","$3,419.34 ","$3,453.88 ","$0.00 ","$655.99 ","$0.00 ","$687.32 ","$0.00 "
"03.390.056S","SUP","HCPCS C1713","","03.390.056S  -  FIXATOR EXFIX 220MM SLFDRILL SCHANZ SCREW ROD MRI SAFE","BOTH IP/OP","$4,446.88 ","$3,290.69 ","$0.00 ","$4,317.35 ","$1,942.81 ","$0.00 ","$926.84 ","$0.00 ","$0.00 ","$755.93 ","$4,317.35 ","$0.00 ","$2,158.68 ","$3,419.34 ","$3,453.88 ","$0.00 ","$655.99 ","$0.00 ","$687.32 ","$0.00 "
"03.390.057S","SUP","Custom 27203010","","03.390.057S  -  SET EXFIX SLFDRILL SCHANZ SCREW CARFBR ROD MR SAFE TITANIUM","BOTH IP/OP","$4,446.88 ","$3,290.69 ","$0.00 ","$4,317.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,317.35 ","$0.00 ","$2,158.68 ","$3,419.34 ","$3,453.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.004","SUP","Custom 27203010","","03.500.004  -  BIT DRILL 44.5MM 1.25MM TI JLTCH STOP 4MM OTHDNTC BONE ANCH","BOTH IP/OP","$355.50 ","$263.07 ","$0.00 ","$355.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.50 ","$0.00 ","$177.75 ","$281.56 ","$284.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.006","SUP","Custom 27203010","","03.500.006  -  BIT DRILL 44.5MM 1.25MM TI JLTCH STOP 6MM OTHDNTC BONE ANCH","BOTH IP/OP","$355.50 ","$263.07 ","$0.00 ","$355.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.50 ","$0.00 ","$177.75 ","$281.56 ","$284.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.008","SUP","Custom 27203010","","03.500.008  -  1.25MM DRILL BIT J-LATCH/8MM STOP/44.5MM","BOTH IP/OP","$355.50 ","$263.07 ","$0.00 ","$355.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.50 ","$0.00 ","$177.75 ","$281.56 ","$284.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.010","SUP","Custom 27203010","","03.500.010  -  1.25MM DRILL BIT J-LATCH/10MM STOP/44.5MM","BOTH IP/OP","$355.50 ","$263.07 ","$0.00 ","$355.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.50 ","$0.00 ","$177.75 ","$281.56 ","$284.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.018","SUP","Custom 27203010","","03.500.018  -  TEMPLATE BENDING STR NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.030","SUP","Custom 27203010","","03.500.030  -  TEMPLATE BENDING 30MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.031","SUP","Custom 27203010","","03.500.031  -  TEMPLATE BENDING 30MM RAD LEFT NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.040","SUP","Custom 27203010","","03.500.040  -  TEMPLATE BENDING 40MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.041","SUP","Custom 27203010","","03.500.041  -  TEMPLATE BENDING 40MM RAD LEFT NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.050","SUP","Custom 27203010","","03.500.050  -  TEMPLATE BENDING 50MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.500.051","SUP","Custom 27203010","","03.500.051  -  TEMPLATE BENDING 50MM RAD LEFT NONSTRL CURVILINEAR DISTRCT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.501.022","SUP","Custom 27203010","","03.501.022  -  BIT DRILL 1.5MM 88MM 22MM J LATCH COUPLING SELF STOP","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.024","SUP","Custom 27203010","","03.501.024  -  BIT DRILL 88MM 1.5MM STRNL TI STOP JLTCH 24MM NONSTRL","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.501.038","SUP","Custom 27203010","","03.501.038  -  BIT DRL 8MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.040","SUP","Custom 27203010","","03.501.040  -  BIT DRILL 135MM 2.2MM JLTCH STOP 10MM","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.042","SUP","Custom 27203010","","03.501.042  -  BIT DRL 12MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.044","SUP","Custom 27203010","","03.501.044  -  BIT DRILL 135MM 2.2MM JLTCH STOP 14MM STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.046","SUP","Custom 27203010","","03.501.046  -  BIT DRL 16MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.048","SUP","Custom 27203010","","03.501.048  -  BIT DRL 18MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.072","SUP","HCPCS C1713","","03.501.072  -  TEMPLATE BENDING CNTOUR NONSTRL MATRIXRIB LOCK PLATE","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"03.501.210","SUP","Custom 27203010","","03.501.210  -  1.8MM DRILL BIT STRYKER J-LATCH/10MM STOP/82MM","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.212","SUP","Custom 27203010","","03.501.212  -  BIT DRILL 82MM 1.8MM 12MM STOP JLTCH NONSTRL","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.214","SUP","Custom 27203010","","03.501.214  -  BIT DRILL 82MM 1.8MM 14MM STOP STRNL JLTCH STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.501.220","SUP","Custom 27203010","","03.501.220  -  BIT DRILL 88MM 1.8MM JLTCH FIX STOP 20MM STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.222","SUP","Custom 27203010","","03.501.222  -  BIT DRILL 88MM 1.8MM JLTCH FIX STOP 22MM STRYK","BOTH IP/OP","$416.25 ","$308.03 ","$0.00 ","$416.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.25 ","$0.00 ","$208.13 ","$329.67 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.501.224","SUP","Custom 27203010","","03.501.224  -  1.8MM DRILL BIT STRYKER J-LATCH/24MM STOP/88MM","BOTH IP/OP","$398.25 ","$294.71 ","$0.00 ","$398.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398.25 ","$0.00 ","$199.13 ","$315.41 ","$318.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.103","SUP","Custom 27203010","","03.503.103  -  MATRIXMIDFACE 1.25MM DRILL BIT J-LATCH/3MM STOP/44.5MM","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.104","SUP","HCPCS C1713","","03.503.104  -  PLATE 44.5X4MM MIDFAC STOP BONE NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$191.36 ","$0.00 ","$88.63 ","$0.00 ","$0.00 ","$74.46 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$66.55 ","$0.00 ","$67.70 ","$0.00 "
"03.503.106","SUP","Custom 27203010","","03.503.106  -  BIT DRILL 44.5MM 1.25MM STOP JLTCH 6MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.108","SUP","Custom 27203010","","03.503.108  -  BIT DRILL 44.5MM 1.25MM JLTCH STOP 8MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.110","SUP","Custom 27203010","","03.503.110  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE 10MM STOP JLTCH","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.112","SUP","Custom 27203010","","03.503.112  -  BIT DRILL 12MM 44.5MM 1.25MM MTRXMDFACE CRNMXF JLTCH CPLNG","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.118","SUP","Custom 27203010","","03.503.118  -  BIT DRILL 18MM 44.5MM 1.25MM MTRXMDFACE CRNMXF JLTCH CPLNG","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.120","SUP","Custom 27203010","","03.503.120  -  BIT DRL 1.25MM 80MM NS MATRIXMIDFACE JLTCH CPLNG WO STP","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.121","SUP","Custom 27203010","","03.503.121  -  BIT DRILL 125MM 1.25MM MTRXMDFACE W/O STOP NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.122","SUP","Custom 27203010","","03.503.122  -  BIT DRILL 125MM 1.25MM MTRXMDFACE JLTCH STOP 8MM PLT SYS","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.123","SUP","Custom 27203010","","03.503.123  -  BIT DRILL 125MM 1.25MM MTRXMDFACE STOP JLTCH 18MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.133","SUP","Custom 27203010","","03.503.133  -  MATRIXMIDFACE 1.25MM DRILL BIT MQC/3MM STOP/44.5MM","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.136","SUP","Custom 27203010","","03.503.136  -  MATRIXMIDFACE 1.25MM DRILL BIT MQC/6MM STOP/44.5MM","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.140","SUP","Custom 27203010","","03.503.140  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 10MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.142","SUP","Custom 27203010","","03.503.142  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 12MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.148","SUP","Custom 27203010","","03.503.148  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 18MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.150","SUP","Custom 27203010","","03.503.150  -  BIT DRILL 80MM 1.25MM MTRXMDFACE 2 FLUT MNQK CPLNG NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.151","SUP","Custom 27203010","","03.503.151  -  BIT DRILL 125MM 1.25MM MTRXMDFACE 2 FLUT MNQK CPLNG NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.152","SUP","Custom 27203010","","03.503.152  -  BIT DRILL 125MM 1.25MM MTRXMDFACE MINI STOP QC 8MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.153","SUP","Custom 27203010","","03.503.153  -  BIT DRILL 125MM 1.25MM MTRXMDFACE MINI STOP QC 18MM NONSTRL","BOTH IP/OP","$425.25 ","$314.69 ","$0.00 ","$425.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.25 ","$0.00 ","$212.63 ","$336.80 ","$340.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.160","SUP","Custom 27203010","","03.503.160  -  TMPLT BNDRG MTRXMAND NAR TNSNBND PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.161","SUP","Custom 27203010","","03.503.161  -  TMPLT BNDRG MTRX MANDIB 1 MM BRD TNSNBND PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.162","SUP","Custom 27203010","","03.503.162  -  TMPLT BNDRG MTRXMAND 1 MM THK ADP PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.163","SUP","Custom 27203010","","03.503.163  -  TMPLT BNDRG MTRXMAND 1.25 MM THK STR PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.164","SUP","Custom 27203010","","03.503.164  -  TMPLT BNDRG MTRXMAND 1.25 MM 2X2 HOLE THK CRSNT PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.165","SUP","Custom 27203010","","03.503.165  -  TMPLT BNDRG MTRXMAND 1.25 MM THK CRSNT PLT 3X3 HOLE NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.166","SUP","Custom 27203010","","03.503.166  -  TMPLT BNDRG MTRXMAND 1.25MM NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.167","SUP","Custom 27203010","","03.503.167  -  TMPLT BNDRG MTRXMAND 1.25 MM THK ADP PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.168","SUP","Custom 27203010","","03.503.168  -  TMPLT BNDRG MTRXMAND","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.169","SUP","Custom 27203010","","03.503.169  -  TMPLT BNDRG MTRXMAND 1.5 MM PLT NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.170","SUP","Custom 27203010","","03.503.170  -  TMPLT BNDRG MTRXMAND THK1.5MM 3X3 HOLE ANG PLT","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.171","SUP","Custom 27203010","","03.503.171  -  TMPLT BNDRG MTRXMAND THK1.5MM CRSNT PLT 6 HOLE","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.172","SUP","Custom 27203010","","03.503.172  -  TMPLT BNDRG MTRXMAND THK1.5MM 2X2 HOLE 3X3 HOLE BRD NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.173","SUP","Custom 27203010","","03.503.173  -  TMPLT BNDRG 2MM MTRXMAND BRD CRSNT PLT","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.174","SUP","Custom 27203010","","03.503.174  -  TMPLT BNDRG MTRXMAND 1.25MM NONSTRL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.175","SUP","Custom 27203010","","03.503.175  -  TMPLT BNDRG MTRXMAND 2MM 3X3 HOLE BRD ANG PLT","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.176","SUP","HCPCS C1713","","03.503.176  -  TEMPLATE BNDRG NS MATRIXMANDIBLE 2 MM ANG RECON PLT","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"03.503.177","SUP","Custom 27203010","","03.503.177  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON SM PLT NONSTRL","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.178","SUP","Custom 27203010","","03.503.178  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON MED PLT NONSTRL","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.179","SUP","Custom 27203010","","03.503.179  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON LG PLT NONSTRL","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.180","SUP","Custom 27203010","","03.503.180  -  TMPLT BNDRG MATRIXMANDIBULAR RECON PLT","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.181","SUP","Custom 27203010","","03.503.181  -  TMPLT BNDRG 2.5-2.8MM RECON","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.182","SUP","Custom 27203010","","03.503.182  -  TMPLT BNDRG MTRXMAND PLT","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.183","SUP","Custom 27203010","","03.503.183  -  TMPLT BNDRG MTRXMAND 2 ANG 2.5 MM RECON PLT NONSTRL","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.184","SUP","Custom 27203010","","03.503.184  -  TMPLT BNDRG MTRXMAND 2.5 MM 2 ANG RECON LG PLT NONSTRL","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.201","SUP","Custom 27203010","","03.503.201  -  BLADE SHRT HEX CPLNG SLFRET 52MM MTRXMDFACE SCRDRVR NONSTRL","BOTH IP/OP","$1,586.25 ","$1,173.83 ","$0.00 ","$1,586.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,586.25 ","$0.00 ","$793.13 ","$1,256.31 ","$1,269.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.202","SUP","Custom 27203010","","03.503.202  -  BLADE MED HEX CPLNG SLFRET 76MM MTRXMDFACE SCRDRVR CRNMXF","BOTH IP/OP","$1,586.25 ","$1,173.83 ","$0.00 ","$1,586.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,586.25 ","$0.00 ","$793.13 ","$1,256.31 ","$1,269.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.203","SUP","Custom 27203010","","03.503.203  -  BLADE LNG HEX CPLNG SLFRET 96MM MTRXMDFACE SCRDRVR CRNMXF","BOTH IP/OP","$1,586.25 ","$1,173.83 ","$0.00 ","$1,586.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,586.25 ","$0.00 ","$793.13 ","$1,256.31 ","$1,269.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.244","SUP","Custom 27203010","","03.503.244  -  BIT DRILL 44.5MM 1.1MM MTRXMDFACE CRNMXF JLTCH CPLNG STOP 4","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.246","SUP","Custom 27203010","","03.503.246  -  BIT DRL 6MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.248","SUP","Custom 27203010","","03.503.248  -  BIT DRL 8MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.264","SUP","Custom 27203010","","03.503.264  -  MATRIX 1.1MM DRILL BIT/HXC 4MM STOP/52MM","BOTH IP/OP","$378.00 ","$279.72 ","$0.00 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.00 ","$0.00 ","$189.00 ","$299.38 ","$302.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.368","SUP","Custom 27203010","","03.503.368  -  BENDING TEMPLATE F/OBLIQUE L PLATES/2X3/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.369","SUP","Custom 27203010","","03.503.369  -  BENDING TEMPLATE F/OBLIQUE L PLATES/3X4/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.370","SUP","Custom 27203010","","03.503.370  -  TMPLT THK.5MM BNDRG 4X6 OBLQ L PLT MTRXMDFACE NONSTRL","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.371","SUP","Custom 27203010","","03.503.371  -  BENDING TEMPLATE F/Y-PLATES 1X3/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.372","SUP","Custom 27203010","","03.503.372  -  BENDING TEMPLATE F/X-PLATES MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.373","SUP","Custom 27203010","","03.503.373  -  BENDING TEMPLATE F/H-PLATES MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.374","SUP","Custom 27203010","","03.503.374  -  BENDING TEMPLATE F/T-PLATES MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.375","SUP","Custom 27203010","","03.503.375  -  BENDING TEMPLATE F/BOX PLATES 5MMX10MM/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.376","SUP","Custom 27203010","","03.503.376  -  TMPLT 10X10MM BNDRG","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.377","SUP","Custom 27203010","","03.503.377  -  BENDING TEMPLATE F/STRUT PLATES/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.378","SUP","Custom 27203010","","03.503.378  -  BENDING TEMPLATE F/SILVER DOUBLE Y-PLATE/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.379","SUP","Custom 27203010","","03.503.379  -  BENDING TEMPLATE F/BLUE DOUBLE Y-PLATE/MATRIXMIDFACE","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.406","SUP","Custom 27203010","","03.503.406  -  MATRIXMANDIBLE 1.5MM DRILL BIT J-LATCH W/6MM STOP/50MM","BOTH IP/OP","$380.25 ","$281.39 ","$0.00 ","$380.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.25 ","$0.00 ","$190.13 ","$301.16 ","$304.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.451","SUP","Custom 27203010","","03.503.451  -  BIT DRL 1.5MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.461","SUP","Custom 27203010","","03.503.461  -  BIT DRILL 90MM 1.8MM JLTCH NSTRL","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.462","SUP","Custom 27203010","","03.503.462  -  BIT DRILL 145MM 1.8MM JLTCH","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.503.471","SUP","Custom 27203010","","03.503.471  -  BIT DRL 2.4MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.479","SUP","Custom 27203010","","03.503.479  -  BIT DRILL 125MM 1.5MM MTRXMAND MINI CPLNG QC CLBRT NONSTRL","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.503.561","SUP","Custom 27203010","","03.503.561  -  MATRIXMANDIBLE 1.8MM DRILL BIT MQC/90MM FOR 03.503.044","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"03.507.003","SUP","Custom 27203010","","03.507.003  -  BIT DRILL 78MM 3.5MM SLFTAP REDX TL 3.5MM SCR NONSTRL","BOTH IP/OP","$614.25 ","$454.55 ","$0.00 ","$614.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$614.25 ","$0.00 ","$307.13 ","$486.49 ","$491.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03.614.015","SUP","HCPCS C1713","","03.614.015  -  TAP SURG 4.5MM 205MM 50MM CALIBRATED CANCELLOUS","BOTH IP/OP","$545.00 ","$403.30 ","$0.00 ","$545.00 ","$245.25 ","$0.00 ","$113.59 ","$0.00 ","$0.00 ","$95.43 ","$545.00 ","$0.00 ","$272.50 ","$431.64 ","$436.00 ","$0.00 ","$85.29 ","$0.00 ","$86.76 ","$0.00 "
"03.620.104","SUP","HCPCS C1713","","03.620.104  -  TAP 6MM HEX CPLNG SURG 4MM DUAL CORE SCR NONSTRL","BOTH IP/OP","$628.25 ","$464.91 ","$0.00 ","$628.25 ","$282.71 ","$0.00 ","$130.94 ","$0.00 ","$0.00 ","$110.00 ","$628.25 ","$0.00 ","$314.13 ","$497.57 ","$502.60 ","$0.00 ","$98.32 ","$0.00 ","$100.02 ","$0.00 "
"03.620.105","SUP","HCPCS C1713","","03.620.105  -  TAP 5MM 6MM HEX CPLNG SPNL DUAL CORE SCR NONSTRL","BOTH IP/OP","$628.25 ","$464.91 ","$0.00 ","$628.25 ","$282.71 ","$0.00 ","$130.94 ","$0.00 ","$0.00 ","$110.00 ","$628.25 ","$0.00 ","$314.13 ","$497.57 ","$502.60 ","$0.00 ","$98.32 ","$0.00 ","$100.02 ","$0.00 "
"03.620.106","SUP","HCPCS C1713","","03.620.106  -  TAP 6MM HEX CPLNG SURG NONSTRL","BOTH IP/OP","$628.25 ","$464.91 ","$0.00 ","$628.25 ","$282.71 ","$0.00 ","$130.94 ","$0.00 ","$0.00 ","$110.00 ","$628.25 ","$0.00 ","$314.13 ","$497.57 ","$502.60 ","$0.00 ","$98.32 ","$0.00 ","$100.02 ","$0.00 "
"0301-14","SUP","Custom 27203010","","0301-14  -  TUBE JJNSTM 14FR 9FR STRL LF MIC LL RADOPQ STRP TRM DIST TIP","BOTH IP/OP","$479.38 ","$354.74 ","$0.00 ","$563.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$479.38 ","$0.00 ","$239.69 ","$563.02 ","$383.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"03-10-0110","SUP","HCPCS C1713","","03-10-0110  -  PLATE BONE 10MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0112","SUP","HCPCS C1713","","03-10-0112  -  PLATE BONE 12MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0114","SUP","HCPCS C1713","","03-10-0114  -  PLATE BONE 14MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0116","SUP","HCPCS C1713","","03-10-0116  -  PLATE BONE 16MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0118","SUP","HCPCS C1713","","03-10-0118  -  PLATE BONE 18MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0120","SUP","HCPCS C1713","","03-10-0120  -  PLATE BONE 20MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0122","SUP","HCPCS C1713","","03-10-0122  -  PLATE BONE 22MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0124","SUP","HCPCS C1713","","03-10-0124  -  PLATE BONE 24MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0126","SUP","HCPCS C1713","","03-10-0126  -  PLATE BONE 26MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"03-10-0229","SUP","HCPCS C1713","","03-10-0229  -  PLATE 29MM TI 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"03-10-0232","SUP","HCPCS C1713","","03-10-0232  -  PLATE 32MM TI 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"03-10-0235","SUP","HCPCS C1713","","03-10-0235  -  PLATE 35MM TI 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"03-10-0238","SUP","HCPCS C1713","","03-10-0238  -  PLATE 38MM TI 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"03-10-0241","SUP","HCPCS C1713","","03-10-0241  -  PLATE 41MM TI 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"03-10-0244","SUP","HCPCS C1713","","03-10-0244  -  PLATE 44MM TI 2 LVL BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"03-10-0343","SUP","HCPCS C1713","","03-10-0343  -  PLATE BONE 43MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0346","SUP","HCPCS C1713","","03-10-0346  -  PLATE BONE 46MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0349","SUP","HCPCS C1713","","03-10-0349  -  PLATE BONE 49MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0352","SUP","HCPCS C1713","","03-10-0352  -  PLATE BONE 52MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0355","SUP","HCPCS C1713","","03-10-0355  -  PLATE BONE 55MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0358","SUP","HCPCS C1713","","03-10-0358  -  PLATE BONE 58MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0362","SUP","HCPCS C1713","","03-10-0362  -  PLATE BONE 62MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0366","SUP","HCPCS C1713","","03-10-0366  -  PLATE BONE 66MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"03-10-0460","SUP","HCPCS C1713","","03-10-0460  -  PLATE BONE 60MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-10-0464","SUP","HCPCS C1713","","03-10-0464  -  PLATE BONE 64MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-10-0468","SUP","HCPCS C1713","","03-10-0468  -  PLATE BONE 68MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-10-0472","SUP","HCPCS C1713","","03-10-0472  -  PLATE BONE 72MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-10-0476","SUP","HCPCS C1713","","03-10-0476  -  PLATE BONE 76MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-10-0480","SUP","HCPCS C1713","","03-10-0480  -  PLATE BONE 80MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-10-0484","SUP","HCPCS C1713","","03-10-0484  -  PLATE BONE 84MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"03-503-246","SUP","Custom 27203010","","03-503-246  -  BIT DRILL 44.5MM 1.1MM MTRX 6MM STOP JLTCH CPLNG NONSTRL","BOTH IP/OP","$285.75 ","$211.46 ","$0.00 ","$285.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.75 ","$0.00 ","$142.88 ","$226.31 ","$228.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"038-001","SUP","Custom 27203010","","KIT IMMUN TST ELISA B2-GLYPRTN 1 IGG 96 TST 038-001","BOTH IP/OP","$962.50 ","$712.25 ","$0.00 ","$962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0382-1425","SUP","HCPCS C1713","","0382-1425  -  SCREW BONE 4.5MM 25MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"0382-1430","SUP","HCPCS C1713","","0382-1430  -  SCREW BONE 4.5MM 30MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"0382-1445","SUP","HCPCS C1713","","0382-1445  -  SCREW BN 4.5MM 45MM X2 PA TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"0382-1525","SUP","HCPCS C1713","","0382-1525  -  SCREW BONE 5.5MM 25MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"0382-1535","SUP","HCPCS C1713","","0382-1535  -  SCREW BONE 5.5MM 35MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"0382-1650","SUP","HCPCS C1713","","0382-1650  -  SCREW BONE 6.5MM 50MM POLYAX XIA II TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.001.000","SUP","HCPCS C1713","","04.001.000  -  CAP END 0MM HUM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL","BOTH IP/OP","$330.25 ","$244.39 ","$0.00 ","$330.25 ","$148.61 ","$0.00 ","$68.83 ","$0.00 ","$0.00 ","$57.82 ","$330.25 ","$0.00 ","$165.13 ","$261.56 ","$264.20 ","$0.00 ","$51.68 ","$0.00 ","$52.58 ","$0.00 "
"04.001.000S","SUP","Custom 27803010","","04.001.000S  -  CAP END 0MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE","BOTH IP/OP","$389.48 ","$288.22 ","$0.00 ","$378.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.15 ","$0.00 ","$189.08 ","$299.49 ","$302.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.001.001S","SUP","Custom 27803010","","04.001.001S  -  CAP END 5MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE","BOTH IP/OP","$389.48 ","$288.22 ","$0.00 ","$378.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.15 ","$0.00 ","$189.08 ","$299.49 ","$302.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.001.002S","SUP","Custom 27803010","","04.001.002S  -  CAP END 10MM EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM","BOTH IP/OP","$389.48 ","$288.22 ","$0.00 ","$378.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.15 ","$0.00 ","$189.08 ","$299.49 ","$302.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.001.003S","SUP","Custom 27803010","","04.001.003S  -  CAP END 15MM 15MM EXTENDED SPIRAL BLADE SELF HOLDING T25","BOTH IP/OP","$389.48 ","$288.22 ","$0.00 ","$378.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.15 ","$0.00 ","$189.08 ","$299.49 ","$302.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.001.210S","SUP","HCPCS C1713","","04.001.210S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 15CM CANN","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.218S","SUP","HCPCS C1713","","04.001.218S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 19CM CANN","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.220S","SUP","HCPCS C1713","","04.001.220S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 20CM CANN","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.222S","SUP","HCPCS C1713","","04.001.222S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 210MM SOLID CANN EXPERT","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.224S","SUP","HCPCS C1713","","04.001.224S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 220MM CANN ROUND BARREL","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.226S","SUP","HCPCS C1713","","04.001.226S  -  NAIL INTRAMEDULLARY 7MM 230MM CANN NAIL-EX BLUE TITANIUM","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.228S","SUP","HCPCS C1713","","04.001.228S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 24CM CANN","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.230S","SUP","HCPCS C1713","","04.001.230S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 250MM SOLID CANN EXPERT","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.232S","SUP","HCPCS C1713","","04.001.232S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 26CM CANN","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.234S","SUP","HCPCS C1713","","04.001.234S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 27CM CANN","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.236S","SUP","HCPCS C1713","","04.001.236S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 28CM CANN","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.238S","SUP","HCPCS C1713","","04.001.238S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 29CM CANN","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.240S","SUP","HCPCS C1713","","04.001.240S  -  NAIL INTRAMEDULLARY 7MM 300MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.242S","SUP","HCPCS C1713","","04.001.242S  -  NAIL INTRAMEDULLARY 7MM 310MM CANN NAIL-EX BLUE TITANIUM","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.244S","SUP","HCPCS C1713","","04.001.244S  -  NAIL INTRAMEDULLARY 7MM 320MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.410S","SUP","HCPCS C1713","","04.001.410S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 150MM CANN ROUND BARREL","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.418S","SUP","HCPCS C1713","","04.001.418S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 19CM CANN","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.420S","SUP","HCPCS C1713","","04.001.420S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 20CM CANN","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.422S","SUP","HCPCS C1713","","04.001.422S  -  NAIL INTRAMEDULLARY 9MM 210MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.424S","SUP","HCPCS C1713","","04.001.424S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 220MM CANN","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.426S","SUP","HCPCS C1713","","04.001.426S  -  NAIL INTRAMEDULLARY 9MM 230MM CANN IMPLANT NAIL-EX TITANIUM","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.428S","SUP","HCPCS C1713","","04.001.428S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 24CM CANN","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.430S","SUP","HCPCS C1713","","04.001.430S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 250MM SOLID CANN EXPERT","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.432S","SUP","HCPCS C1713","","04.001.432S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID CANN EXPERT","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.434S","SUP","HCPCS C1713","","04.001.434S  -  NAIL INTRAMEDULLARY 9MM 270MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,589.95 ","$2,656.56 ","$0.00 ","$3,485.40 ","$1,568.43 ","$0.00 ","$748.24 ","$0.00 ","$0.00 ","$610.27 ","$3,485.40 ","$0.00 ","$1,742.70 ","$2,760.44 ","$2,788.32 ","$0.00 ","$529.58 ","$0.00 ","$554.88 ","$0.00 "
"04.001.436S","SUP","HCPCS C1713","","04.001.436S  -  NAIL INTRAMEDULLARY 9MM 280MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.438S","SUP","HCPCS C1713","","04.001.438S  -  NAIL INTRAMEDULLARY 9MM 290MM CANN NAIL-EX BLUE TITANIUM","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.440S","SUP","HCPCS C1713","","04.001.440S  -  NAIL INTRAMEDULLARY 9MM 300MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.442S","SUP","HCPCS C1713","","04.001.442S  -  NAIL INTRAMEDULLARY 9MM 310MM CANN NAIL-EX BLUE TITANIUM","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.444S","SUP","HCPCS C1713","","04.001.444S  -  NAIL INTRAMEDULLARY 9MM 320MM SOLID CANN EXPERT BLUE","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.610S","SUP","HCPCS C1713","","04.001.610S  -  NAIL INTRAMEDULLARY 11MM 150MM CANN EXPERT BLUE TITANIUM","BOTH IP/OP","$3,697.90 ","$2,736.45 ","$0.00 ","$3,590.20 ","$1,615.59 ","$0.00 ","$770.73 ","$0.00 ","$0.00 ","$628.62 ","$3,590.20 ","$0.00 ","$1,795.10 ","$2,843.44 ","$2,872.16 ","$0.00 ","$545.50 ","$0.00 ","$571.56 ","$0.00 "
"04.001.618S","SUP","HCPCS C1713","","04.001.618S  -  NAIL INTRAMEDULLARY 11MM 19CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.620S","SUP","HCPCS C1713","","04.001.620S  -  NAIL INTRAMEDULLARY 11MM 20CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.622S","SUP","HCPCS C1713","","04.001.622S  -  NAIL INTRAMEDULLARY 11MM 21CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.624S","SUP","HCPCS C1713","","04.001.624S  -  NAIL INTRAMEDULLARY 11MM 22CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.626S","SUP","HCPCS C1713","","04.001.626S  -  NAIL INTRAMEDULLARY 11MM 23CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.628S","SUP","HCPCS C1713","","04.001.628S  -  NAIL INTRAMEDULLARY 11MM 24CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.630S","SUP","HCPCS C1713","","04.001.630S  -  NAIL INTRAMEDULLARY 11MM 25CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.632S","SUP","HCPCS C1713","","04.001.632S  -  NAIL INTRAMEDULLARY 11MM 26CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.634S","SUP","HCPCS C1713","","04.001.634S  -  NAIL INTRAMEDULLARY 11MM 270MM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.636S","SUP","HCPCS C1713","","04.001.636S  -  NAIL INTRAMEDULLARY 11MM 28CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.638S","SUP","HCPCS C1713","","04.001.638S  -  NAIL INTRAMEDULLARY 11MM 29CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.640S","SUP","HCPCS C1713","","04.001.640S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.642S","SUP","HCPCS C1713","","04.001.642S  -  NAIL INTRAMEDULLARY 11MM 31CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.001.644S","SUP","HCPCS C1713","","04.001.644S  -  NAIL INTRAMEDULLARY 11MM 32CM CANN NAIL-EX TITANIUM HUMERUS","BOTH IP/OP","$3,823.35 ","$2,829.28 ","$0.00 ","$3,712.00 ","$1,670.40 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$649.94 ","$3,712.00 ","$0.00 ","$1,856.00 ","$2,939.90 ","$2,969.60 ","$0.00 ","$564.01 ","$0.00 ","$590.95 ","$0.00 "
"04.003.000S","SUP","Custom 27803010","","04.003.000S  -  CAP END 0MM T40 STARDRIVE RECESS CANN FLUSH SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.001S","SUP","Custom 27803010","","04.003.001S  -  CAP END 5MM T40 STARDRIVE RECESS CANN SELF RETAINING LATERAL","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.002S","SUP","Custom 27803010","","04.003.002S  -  CAP END 10MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.003S","SUP","Custom 27803010","","04.003.003S  -  CAP END 15MM 12MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.004S","SUP","Custom 27803010","","04.003.004S  -  CAP END 20MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.006S","SUP","Custom 27803010","","04.003.006S  -  CAP END 5MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.007S","SUP","Custom 27803010","","04.003.007S  -  CAP END 10MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.008S","SUP","Custom 27803010","","04.003.008S  -  CAP END 15MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.009S","SUP","Custom 27803010","","04.003.009S  -  CAP END 20MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.003.022","SUP","HCPCS C1713","","04.003.022  -  SCREW BONE 6.5MM 60MM TI FEM SLFTAP TIP RECON T25 STARDRIVE","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.022S","SUP","HCPCS C1713","","04.003.022S  -  SCREW BN T25 6.5MM 60MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.023","SUP","HCPCS C1713","","04.003.023  -  SCREW BONE 6.5MM 65MM TI FEM SLFTAP TIP RECON T25 STARDRIVE","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.023S","SUP","HCPCS C1713","","04.003.023S  -  SCREW BN T25 6.5MM 65MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.024","SUP","HCPCS C1713","","04.003.024  -  SCREW BONE 6.5MM 70MM TI FEM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.024S","SUP","HCPCS C1713","","04.003.024S  -  SCREW BN T25 6.5MM 70MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.025","SUP","HCPCS C1713","","04.003.025  -  SCREW BONE 6.5MM 75MM TI FEM SLFTAP TIP RECON T25 STARDRIVE","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.025S","SUP","HCPCS C1713","","04.003.025S  -  SCREW BN T25 6.5MM 75MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.026","SUP","HCPCS C1713","","04.003.026  -  SCREW BONE 6.5MM 80MM TI FEM SLFTAP RECON STARDRIVE RECESS","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.026S","SUP","HCPCS C1713","","04.003.026S  -  SCREW BN T25 6.5MM 80MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.027","SUP","HCPCS C1713","","04.003.027  -  SCREW BONE 6.5MM 85MM TI FEM SLFTAP TIP RECON T25 STARDRIVE","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.027S","SUP","HCPCS C1713","","04.003.027S  -  SCREW BN T25 6.5MM 85MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.028","SUP","HCPCS C1713","","04.003.028  -  SCREW BONE 6.5MM 90MM TI FEM SLFTAP TIP RECON T25 STARDRIVE","BOTH IP/OP","$424.75 ","$314.32 ","$0.00 ","$424.75 ","$191.14 ","$0.00 ","$88.53 ","$0.00 ","$0.00 ","$74.37 ","$424.75 ","$0.00 ","$212.38 ","$336.40 ","$339.80 ","$0.00 ","$66.47 ","$0.00 ","$67.62 ","$0.00 "
"04.003.028S","SUP","HCPCS C1713","","04.003.028S  -  SCREW BN T25 6.5MM 90MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.029","SUP","HCPCS C1713","","04.003.029  -  SCREW BONE 6.5MM 95MM TI FEM SLFTAP TIP RECON T25 STARDRIVE","BOTH IP/OP","$424.75 ","$314.32 ","$0.00 ","$424.75 ","$191.14 ","$0.00 ","$88.53 ","$0.00 ","$0.00 ","$74.37 ","$424.75 ","$0.00 ","$212.38 ","$336.40 ","$339.80 ","$0.00 ","$66.47 ","$0.00 ","$67.62 ","$0.00 "
"04.003.029S","SUP","HCPCS C1713","","04.003.029S  -  SCREW BN T25 6.5MM 95MM AU STRL ST BLNT TIP STRDR TI FEM LAT","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.030","SUP","HCPCS C1713","","04.003.030  -  SCREW BONE NONSTRL 6.5MM 100MM TI FEM T25 STARDRIVE RECESS","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.030S","SUP","HCPCS C1713","","04.003.030S  -  SCREW BN T25 6.5MM 100MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.031","SUP","HCPCS C1713","","04.003.031  -  SCREW BONE 6.5MM 105MM TI FEM T25 STARDRIVE RECESS RECON","BOTH IP/OP","$424.75 ","$314.32 ","$0.00 ","$424.75 ","$191.14 ","$0.00 ","$88.53 ","$0.00 ","$0.00 ","$74.37 ","$424.75 ","$0.00 ","$212.38 ","$336.40 ","$339.80 ","$0.00 ","$66.47 ","$0.00 ","$67.62 ","$0.00 "
"04.003.031S","SUP","HCPCS C1713","","04.003.031S  -  SCREW BN T25 6.5MM 105MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.032","SUP","HCPCS C1713","","04.003.032  -  SCREW BONE 6.5MM 110MM TI FEM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.032S","SUP","HCPCS C1713","","04.003.032S  -  SCREW BN T25 6.5MM 110MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.033","SUP","HCPCS C1713","","04.003.033  -  SCREW BONE 6.5MM 115MM TI FEM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.033S","SUP","HCPCS C1713","","04.003.033S  -  SCREW BN T25 6.5MM 115MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.034","SUP","HCPCS C1713","","04.003.034  -  SCREW BONE 6.5MM 120MM TI FEM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.034S","SUP","HCPCS C1713","","04.003.034S  -  SCREW BN T25 6.5MM 120MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.035","SUP","HCPCS C1713","","04.003.035  -  SCREW BONE 6.5MM 125MM TI FEM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.035S","SUP","HCPCS C1713","","04.003.035S  -  SCREW BN T25 6.5MM 125MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.036","SUP","HCPCS C1713","","04.003.036  -  SCREW BONE 6.5MM 130MM TI FEM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$400.38 ","$296.28 ","$0.00 ","$400.38 ","$180.17 ","$0.00 ","$83.45 ","$0.00 ","$0.00 ","$70.10 ","$400.38 ","$0.00 ","$200.19 ","$317.10 ","$320.30 ","$0.00 ","$62.66 ","$0.00 ","$63.74 ","$0.00 "
"04.003.036S","SUP","HCPCS C1713","","04.003.036S  -  SCREW BN T25 6.5MM 130MM AU STRL ST BLNT TIP STRDR TI FEM","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$437.63 ","$196.93 ","$0.00 ","$93.95 ","$0.00 ","$0.00 ","$76.62 ","$437.63 ","$0.00 ","$218.81 ","$346.60 ","$350.10 ","$0.00 ","$66.49 ","$0.00 ","$69.67 ","$0.00 "
"04.003.240S","SUP","HCPCS C1713","","04.003.240S  -  NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.241S","SUP","HCPCS C1713","","04.003.241S  -  NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.244S","SUP","HCPCS C1713","","04.003.244S  -  NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.245S","SUP","HCPCS C1713","","04.003.245S  -  NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.248S","SUP","HCPCS C1713","","04.003.248S  -  NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.249S","SUP","HCPCS C1713","","04.003.249S  -  NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.252S","SUP","HCPCS C1713","","04.003.252S  -  NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.253S","SUP","HCPCS C1713","","04.003.253S  -  NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.256S","SUP","HCPCS C1713","","04.003.256S  -  NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.257S","SUP","HCPCS C1713","","04.003.257S  -  NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.260S","SUP","HCPCS C1713","","04.003.260S  -  NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.261S","SUP","HCPCS C1713","","04.003.261S  -  NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.264S","SUP","HCPCS C1713","","04.003.264S  -  NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.265S","SUP","HCPCS C1713","","04.003.265S  -  NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.268S","SUP","HCPCS C1713","","04.003.268S  -  NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.269S","SUP","HCPCS C1713","","04.003.269S  -  NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.272S","SUP","HCPCS C1713","","04.003.272S  -  NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.273S","SUP","HCPCS C1713","","04.003.273S  -  NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.276S","SUP","HCPCS C1713","","04.003.276S  -  NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.277S","SUP","HCPCS C1713","","04.003.277S  -  NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.340S","SUP","HCPCS C1713","","04.003.340S  -  NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.341S","SUP","HCPCS C1713","","04.003.341S  -  NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.344S","SUP","HCPCS C1713","","04.003.344S  -  NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.345S","SUP","HCPCS C1713","","04.003.345S  -  NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.348S","SUP","HCPCS C1713","","04.003.348S  -  NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.349S","SUP","HCPCS C1713","","04.003.349S  -  NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.352S","SUP","HCPCS C1713","","04.003.352S  -  NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.353S","SUP","HCPCS C1713","","04.003.353S  -  NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.356S","SUP","HCPCS C1713","","04.003.356S  -  NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.357S","SUP","HCPCS C1713","","04.003.357S  -  NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.360S","SUP","HCPCS C1713","","04.003.360S  -  NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.361S","SUP","HCPCS C1713","","04.003.361S  -  NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$594.10 ","$0.00 ","$484.76 ","$0.00 "
"04.003.364S","SUP","HCPCS C1713","","04.003.364S  -  NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.365S","SUP","HCPCS C1713","","04.003.365S  -  NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.368S","SUP","HCPCS C1713","","04.003.368S  -  NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.369S","SUP","HCPCS C1713","","04.003.369S  -  NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.372S","SUP","HCPCS C1713","","04.003.372S  -  NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.373S","SUP","HCPCS C1713","","04.003.373S  -  NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.376S","SUP","HCPCS C1713","","04.003.376S  -  NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.377S","SUP","HCPCS C1713","","04.003.377S  -  NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.440S","SUP","HCPCS C1713","","04.003.440S  -  NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.441S","SUP","HCPCS C1713","","04.003.441S  -  NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.444S","SUP","HCPCS C1713","","04.003.444S  -  NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.445S","SUP","HCPCS C1713","","04.003.445S  -  NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.448S","SUP","HCPCS C1713","","04.003.448S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.449S","SUP","HCPCS C1713","","04.003.449S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.452S","SUP","HCPCS C1713","","04.003.452S  -  NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.453S","SUP","HCPCS C1713","","04.003.453S  -  NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.456S","SUP","HCPCS C1713","","04.003.456S  -  NAIL INTRAMEDULLARY 11MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.457S","SUP","HCPCS C1713","","04.003.457S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.460S","SUP","HCPCS C1713","","04.003.460S  -  NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.461S","SUP","HCPCS C1713","","04.003.461S  -  NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.464S","SUP","HCPCS C1713","","04.003.464S  -  NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.465S","SUP","HCPCS C1713","","04.003.465S  -  NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.468S","SUP","HCPCS C1713","","04.003.468S  -  NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.469S","SUP","HCPCS C1713","","04.003.469S  -  NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.472S","SUP","HCPCS C1713","","04.003.472S  -  NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.473S","SUP","HCPCS C1713","","04.003.473S  -  NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.476S","SUP","HCPCS C1713","","04.003.476S  -  NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.477S","SUP","HCPCS C1713","","04.003.477S  -  NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.540S","SUP","HCPCS C1713","","04.003.540S  -  NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.541S","SUP","HCPCS C1713","","04.003.541S  -  NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.544S","SUP","HCPCS C1713","","04.003.544S  -  NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.545S","SUP","HCPCS C1713","","04.003.545S  -  NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.548S","SUP","HCPCS C1713","","04.003.548S  -  NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.549S","SUP","HCPCS C1713","","04.003.549S  -  NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.552S","SUP","HCPCS C1713","","04.003.552S  -  NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.553S","SUP","HCPCS C1713","","04.003.553S  -  NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.556S","SUP","HCPCS C1713","","04.003.556S  -  NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.557S","SUP","HCPCS C1713","","04.003.557S  -  NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.560S","SUP","HCPCS C1713","","04.003.560S  -  NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.561S","SUP","HCPCS C1713","","04.003.561S  -  NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.564S","SUP","HCPCS C1713","","04.003.564S  -  NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.565S","SUP","HCPCS C1713","","04.003.565S  -  NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.568S","SUP","HCPCS C1713","","04.003.568S  -  NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.569S","SUP","HCPCS C1713","","04.003.569S  -  NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.572S","SUP","HCPCS C1713","","04.003.572S  -  NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.573S","SUP","HCPCS C1713","","04.003.573S  -  NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.576S","SUP","HCPCS C1713","","04.003.576S  -  NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.577S","SUP","HCPCS C1713","","04.003.577S  -  NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.640S","SUP","HCPCS C1713","","04.003.640S  -  NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.641S","SUP","HCPCS C1713","","04.003.641S  -  NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.644S","SUP","HCPCS C1713","","04.003.644S  -  NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.645S","SUP","HCPCS C1713","","04.003.645S  -  NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.648S","SUP","HCPCS C1713","","04.003.648S  -  NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.649S","SUP","HCPCS C1713","","04.003.649S  -  NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.652S","SUP","HCPCS C1713","","04.003.652S  -  NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.653S","SUP","HCPCS C1713","","04.003.653S  -  NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.656S","SUP","HCPCS C1713","","04.003.656S  -  NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.657S","SUP","HCPCS C1713","","04.003.657S  -  NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.660S","SUP","HCPCS C1713","","04.003.660S  -  NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.661S","SUP","HCPCS C1713","","04.003.661S  -  NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.664S","SUP","HCPCS C1713","","04.003.664S  -  NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.665S","SUP","HCPCS C1713","","04.003.665S  -  NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.668S","SUP","HCPCS C1713","","04.003.668S  -  NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.669S","SUP","HCPCS C1713","","04.003.669S  -  NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.672S","SUP","HCPCS C1713","","04.003.672S  -  NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.673S","SUP","HCPCS C1713","","04.003.673S  -  NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.676S","SUP","HCPCS C1713","","04.003.676S  -  NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,136.28 ","$2,320.85 ","$0.00 ","$3,044.95 ","$1,370.23 ","$0.00 ","$653.68 ","$0.00 ","$0.00 ","$533.15 ","$3,044.95 ","$0.00 ","$1,522.48 ","$2,411.60 ","$2,435.96 ","$0.00 ","$462.65 ","$0.00 ","$484.76 ","$0.00 "
"04.003.677S","SUP","HCPCS C1713","","04.003.677S  -  NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,242.78 ","$2,399.66 ","$0.00 ","$3,148.33 ","$1,416.75 ","$0.00 ","$675.88 ","$0.00 ","$0.00 ","$551.25 ","$3,148.33 ","$0.00 ","$1,574.16 ","$2,493.48 ","$2,518.66 ","$0.00 ","$478.36 ","$0.00 ","$501.21 ","$0.00 "
"04.003.740S","SUP","HCPCS C1713","","04.003.740S  -  NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.741S","SUP","HCPCS C1713","","04.003.741S  -  NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.744S","SUP","HCPCS C1713","","04.003.744S  -  NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.745S","SUP","HCPCS C1713","","04.003.745S  -  NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.748S","SUP","HCPCS C1713","","04.003.748S  -  NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.749S","SUP","HCPCS C1713","","04.003.749S  -  NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.752S","SUP","HCPCS C1713","","04.003.752S  -  NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.753S","SUP","HCPCS C1713","","04.003.753S  -  NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.756S","SUP","HCPCS C1713","","04.003.756S  -  NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.757S","SUP","HCPCS C1713","","04.003.757S  -  NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.760S","SUP","HCPCS C1713","","04.003.760S  -  NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.761S","SUP","HCPCS C1713","","04.003.761S  -  NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.764S","SUP","HCPCS C1713","","04.003.764S  -  NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.765S","SUP","HCPCS C1713","","04.003.765S  -  NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.768S","SUP","HCPCS C1713","","04.003.768S  -  NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.769S","SUP","HCPCS C1713","","04.003.769S  -  NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.772S","SUP","HCPCS C1713","","04.003.772S  -  NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.773S","SUP","HCPCS C1713","","04.003.773S  -  NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.776S","SUP","HCPCS C1713","","04.003.776S  -  NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.777S","SUP","HCPCS C1713","","04.003.777S  -  NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.840S","SUP","HCPCS C1713","","04.003.840S  -  NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.841S","SUP","HCPCS C1713","","04.003.841S  -  NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.844S","SUP","HCPCS C1713","","04.003.844S  -  NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.845S","SUP","HCPCS C1713","","04.003.845S  -  NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.848S","SUP","HCPCS C1713","","04.003.848S  -  NAIL INTRAMEDULLARY 15MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.849S","SUP","HCPCS C1713","","04.003.849S  -  NAIL INTRAMEDULLARY 15MM 340MM RECONSTRUCTION ANATOMIC CANN","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.852S","SUP","HCPCS C1713","","04.003.852S  -  NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.853S","SUP","HCPCS C1713","","04.003.853S  -  NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.856S","SUP","HCPCS C1713","","04.003.856S  -  NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.857S","SUP","HCPCS C1713","","04.003.857S  -  NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.860S","SUP","HCPCS C1713","","04.003.860S  -  NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.861S","SUP","HCPCS C1713","","04.003.861S  -  NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.864S","SUP","HCPCS C1713","","04.003.864S  -  NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.865S","SUP","HCPCS C1713","","04.003.865S  -  NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.868S","SUP","HCPCS C1713","","04.003.868S  -  NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.869S","SUP","HCPCS C1713","","04.003.869S  -  NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.872S","SUP","HCPCS C1713","","04.003.872S  -  NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.873S","SUP","HCPCS C1713","","04.003.873S  -  NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.876S","SUP","HCPCS C1713","","04.003.876S  -  NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.877S","SUP","HCPCS C1713","","04.003.877S  -  NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.940S","SUP","HCPCS C1713","","04.003.940S  -  NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.941S","SUP","HCPCS C1713","","04.003.941S  -  NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.944S","SUP","HCPCS C1713","","04.003.944S  -  NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.945S","SUP","HCPCS C1713","","04.003.945S  -  NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.948S","SUP","HCPCS C1713","","04.003.948S  -  NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.949S","SUP","HCPCS C1713","","04.003.949S  -  NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.952S","SUP","HCPCS C1713","","04.003.952S  -  NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.953S","SUP","HCPCS C1713","","04.003.953S  -  NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.956S","SUP","HCPCS C1713","","04.003.956S  -  NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.957S","SUP","HCPCS C1713","","04.003.957S  -  NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.960S","SUP","HCPCS C1713","","04.003.960S  -  NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.961S","SUP","HCPCS C1713","","04.003.961S  -  NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.964S","SUP","HCPCS C1713","","04.003.964S  -  NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.965S","SUP","HCPCS C1713","","04.003.965S  -  NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.968S","SUP","HCPCS C1713","","04.003.968S  -  NAIL INTRAMEDULLARY 16MM 440MM CANN LATERAL ENTRY","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.969S","SUP","HCPCS C1713","","04.003.969S  -  NAIL INTRAMEDULLARY 16MM 440MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.972S","SUP","HCPCS C1713","","04.003.972S  -  NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.973S","SUP","HCPCS C1713","","04.003.973S  -  NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.976S","SUP","HCPCS C1713","","04.003.976S  -  NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.003.977S","SUP","HCPCS C1713","","04.003.977S  -  NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED","BOTH IP/OP","$3,340.50 ","$2,471.97 ","$0.00 ","$3,243.23 ","$1,459.45 ","$0.00 ","$696.24 ","$0.00 ","$0.00 ","$567.86 ","$3,243.23 ","$0.00 ","$1,621.61 ","$2,568.64 ","$2,594.58 ","$0.00 ","$492.78 ","$0.00 ","$516.32 ","$0.00 "
"04.004.000S","SUP","Custom 27803010","","04.004.000S  -  CAP END 5MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GOLD","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.001S","SUP","Custom 27803010","","04.004.001S  -  CAP END 5MM STARDRIVE T40 RECESS EXTENDED EXPERT GOLD","BOTH IP/OP","$504.73 ","$373.50 ","$0.00 ","$490.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.03 ","$0.00 ","$245.01 ","$388.10 ","$392.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.002S","SUP","Custom 27803010","","04.004.002S  -  CAP END 10MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM","BOTH IP/OP","$504.73 ","$373.50 ","$0.00 ","$490.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.03 ","$0.00 ","$245.01 ","$388.10 ","$392.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.003S","SUP","Custom 27803010","","04.004.003S  -  CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM","BOTH IP/OP","$504.73 ","$373.50 ","$0.00 ","$490.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.03 ","$0.00 ","$245.01 ","$388.10 ","$392.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.008S","SUP","Custom 27803010","","04.004.008S  -  CAP END 0MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GRAY","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.009S","SUP","Custom 27803010","","04.004.009S  -  CAP END 5MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE","BOTH IP/OP","$504.73 ","$373.50 ","$0.00 ","$490.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.03 ","$0.00 ","$245.01 ","$388.10 ","$392.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.010S","SUP","Custom 27803010","","04.004.010S  -  CAP END 10MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE","BOTH IP/OP","$504.73 ","$373.50 ","$0.00 ","$490.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.03 ","$0.00 ","$245.01 ","$388.10 ","$392.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.011S","SUP","Custom 27803010","","04.004.011S  -  CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GRAY TITANIUM","BOTH IP/OP","$504.73 ","$373.50 ","$0.00 ","$490.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.03 ","$0.00 ","$245.01 ","$388.10 ","$392.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.004.231S","SUP","HCPCS C1713","","04.004.231S  -  NAIL INTRAMEDULLARY 8MM 25.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.234S","SUP","HCPCS C1713","","04.004.234S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 270MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.237S","SUP","HCPCS C1713","","04.004.237S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.240S","SUP","HCPCS C1713","","04.004.240S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 300MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.243S","SUP","HCPCS C1713","","04.004.243S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.246S","SUP","HCPCS C1713","","04.004.246S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 330MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.249S","SUP","HCPCS C1713","","04.004.249S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 345MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.252S","SUP","HCPCS C1713","","04.004.252S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 360MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.255S","SUP","HCPCS C1713","","04.004.255S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.258S","SUP","HCPCS C1713","","04.004.258S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.261S","SUP","HCPCS C1713","","04.004.261S  -  NAIL INTRAMEDULLARY 8MM 40.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,917.48 ","$2,158.94 ","$0.00 ","$2,832.50 ","$1,274.63 ","$0.00 ","$608.07 ","$0.00 ","$0.00 ","$495.95 ","$2,832.50 ","$0.00 ","$1,416.25 ","$2,243.34 ","$2,266.00 ","$0.00 ","$430.38 ","$0.00 ","$450.93 ","$0.00 "
"04.004.264S","SUP","HCPCS C1713","","04.004.264S  -  NAIL INTRAMEDULLARY 8MM 42CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,917.48 ","$2,158.94 ","$0.00 ","$2,832.50 ","$1,274.63 ","$0.00 ","$608.07 ","$0.00 ","$0.00 ","$495.95 ","$2,832.50 ","$0.00 ","$1,416.25 ","$2,243.34 ","$2,266.00 ","$0.00 ","$430.38 ","$0.00 ","$450.93 ","$0.00 "
"04.004.267S","SUP","HCPCS C1713","","04.004.267S  -  NAIL INTRAMEDULLARY 8MM 43.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.331S","SUP","HCPCS C1713","","04.004.331S  -  NAIL INTRAMEDULLARY 9MM 25.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.334S","SUP","HCPCS C1713","","04.004.334S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 270MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.337S","SUP","HCPCS C1713","","04.004.337S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.340S","SUP","HCPCS C1713","","04.004.340S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.343S","SUP","HCPCS C1713","","04.004.343S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.346S","SUP","HCPCS C1713","","04.004.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.349S","SUP","HCPCS C1713","","04.004.349S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.352S","SUP","HCPCS C1713","","04.004.352S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.355S","SUP","HCPCS C1713","","04.004.355S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.358S","SUP","HCPCS C1713","","04.004.358S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 390MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.361S","SUP","HCPCS C1713","","04.004.361S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 405MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.364S","SUP","HCPCS C1713","","04.004.364S  -  NAIL INTRAMEDULLARY 9MM 42CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.367S","SUP","HCPCS C1713","","04.004.367S  -  NAIL INTRAMEDULLARY 9MM 43.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.431S","SUP","HCPCS C1713","","04.004.431S  -  NAIL INTRAMEDULLARY 10MM 25.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,917.48 ","$2,158.94 ","$0.00 ","$2,832.50 ","$1,274.63 ","$0.00 ","$608.07 ","$0.00 ","$0.00 ","$495.95 ","$2,832.50 ","$0.00 ","$1,416.25 ","$2,243.34 ","$2,266.00 ","$0.00 ","$430.38 ","$0.00 ","$450.93 ","$0.00 "
"04.004.434S","SUP","HCPCS C1713","","04.004.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.437S","SUP","HCPCS C1713","","04.004.437S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.440S","SUP","HCPCS C1713","","04.004.440S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 10MM 300MM CANN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.443S","SUP","HCPCS C1713","","04.004.443S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 315MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.446S","SUP","HCPCS C1713","","04.004.446S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 33CM CANN EXPERT LIGHT","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.449S","SUP","HCPCS C1713","","04.004.449S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 34.5CM CANN EXPERT LIGHT","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.452S","SUP","HCPCS C1713","","04.004.452S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.455S","SUP","HCPCS C1713","","04.004.455S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 375MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.458S","SUP","HCPCS C1713","","04.004.458S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 390MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.461S","SUP","HCPCS C1713","","04.004.461S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.464S","SUP","HCPCS C1713","","04.004.464S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.467S","SUP","HCPCS C1713","","04.004.467S  -  NAIL INTRAMEDULLARY 10MM 43.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.531S","SUP","HCPCS C1713","","04.004.531S  -  NAIL INTRAMEDULLARY 11MM 25.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.534S","SUP","HCPCS C1713","","04.004.534S  -  NAIL INTRAMEDULLARY 11MM 27CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.537S","SUP","HCPCS C1713","","04.004.537S  -  NAIL INTRAMEDULLARY 11MM 28.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.540S","SUP","HCPCS C1713","","04.004.540S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.543S","SUP","HCPCS C1713","","04.004.543S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.546S","SUP","HCPCS C1713","","04.004.546S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN NAIL-EX LIGHT GREEN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.549S","SUP","HCPCS C1713","","04.004.549S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 345MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.552S","SUP","HCPCS C1713","","04.004.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.555S","SUP","HCPCS C1713","","04.004.555S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.558S","SUP","HCPCS C1713","","04.004.558S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 390MM CANN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.561S","SUP","HCPCS C1713","","04.004.561S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.564S","SUP","HCPCS C1713","","04.004.564S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.567S","SUP","HCPCS C1713","","04.004.567S  -  NAIL INTRAMEDULLARY 11MM 43.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.631S","SUP","HCPCS C1713","","04.004.631S  -  NAIL INTRAMEDULLARY 12MM 25.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.634S","SUP","HCPCS C1713","","04.004.634S  -  NAIL INTRAMEDULLARY 12MM 27CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.637S","SUP","HCPCS C1713","","04.004.637S  -  NAIL INTRAMEDULLARY 12MM 28.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.640S","SUP","HCPCS C1713","","04.004.640S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.643S","SUP","HCPCS C1713","","04.004.643S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE 12MM 315MM CANN EXPERT","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.646S","SUP","HCPCS C1713","","04.004.646S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 12MM 330MM CANN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.649S","SUP","HCPCS C1713","","04.004.649S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.652S","SUP","HCPCS C1713","","04.004.652S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.655S","SUP","HCPCS C1713","","04.004.655S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 375MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.658S","SUP","HCPCS C1713","","04.004.658S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN EXPERT LIGHT","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.661S","SUP","HCPCS C1713","","04.004.661S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.664S","SUP","HCPCS C1713","","04.004.664S  -  NAIL INTRAMEDULLARY 12MM 42CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.667S","SUP","HCPCS C1713","","04.004.667S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN FLUTED BARREL","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.731S","SUP","HCPCS C1713","","04.004.731S  -  NAIL INTRAMEDULLARY 13MM 25.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.734S","SUP","HCPCS C1713","","04.004.734S  -  NAIL INTRAMEDULLARY 13MM 27CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.737S","SUP","HCPCS C1713","","04.004.737S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN FLUTED BARREL","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.740S","SUP","HCPCS C1713","","04.004.740S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.743S","SUP","HCPCS C1713","","04.004.743S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 315MM CANN FLUTED BARREL","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.746S","SUP","HCPCS C1713","","04.004.746S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN FLUTED BARREL","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.749S","SUP","HCPCS C1713","","04.004.749S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.752S","SUP","HCPCS C1713","","04.004.752S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.755S","SUP","HCPCS C1713","","04.004.755S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 375MM CANN FLUTED BARREL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.004.758S","SUP","HCPCS C1713","","04.004.758S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN FLUTED BARREL","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.004.761S","SUP","HCPCS C1713","","04.004.761S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 405MM CANN FLUTED BARREL","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.764S","SUP","HCPCS C1713","","04.004.764S  -  NAIL INTRAMEDULLARY 13MM 42CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.004.767S","SUP","HCPCS C1713","","04.004.767S  -  NAIL INTRAMEDULLARY 13MM 43.5CM CANN NAIL-EX TITANIUM TIBIA","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.005.408","SUP","HCPCS C1713","","04.005.408  -  SCREW BONE NONSTRL 4MM 18MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.408S","SUP","HCPCS C1713","","04.005.408S  -  SCREW BN T25 FT 4MM 3.3MM 18MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.410","SUP","HCPCS C1713","","04.005.410  -  SCREW BONE NONSTRL 4MM 20MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.410S","SUP","HCPCS C1713","","04.005.410S  -  SCREW BN T25 FT 4MM 3.3MM 20MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.412","SUP","HCPCS C1713","","04.005.412  -  SCREW BONE NONSTRL 4MM 22MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.412S","SUP","HCPCS C1713","","04.005.412S  -  SCREW BN T25 FT 4MM 3.3MM 22MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.414","SUP","HCPCS C1713","","04.005.414  -  SCREW BONE NONSTRL 4MM 24MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.414S","SUP","HCPCS C1713","","04.005.414S  -  SCREW BN T25 FT 4MM 3.3MM 24MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.416","SUP","HCPCS C1713","","04.005.416  -  SCREW BONE NONSTRL 4MM 26MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.416S","SUP","HCPCS C1713","","04.005.416S  -  SCREW BN T25 FT 4MM 3.3MM 26MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.418","SUP","HCPCS C1713","","04.005.418  -  SCREW BONE 4MM 28MM NLEX TI HUM TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.418S","SUP","HCPCS C1713","","04.005.418S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.420","SUP","HCPCS C1713","","04.005.420  -  SCREW BONE 4MM 30MM NLEX TI HUM TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.420S","SUP","HCPCS C1713","","04.005.420S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 30MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.422","SUP","HCPCS C1713","","04.005.422  -  SCREW BONE 4MM 32MM NLEX TI HUM TIB LCK STARDRIVE RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.422S","SUP","HCPCS C1713","","04.005.422S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.424","SUP","HCPCS C1713","","04.005.424  -  SCREW BONE NONSTRL 4MM 34MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.424S","SUP","HCPCS C1713","","04.005.424S  -  SCREW BN T25 FT 4MM 3.3MM 34MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.426","SUP","HCPCS C1713","","04.005.426  -  SCREW BONE NONSTRL 4MM 36MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.426S","SUP","HCPCS C1713","","04.005.426S  -  SCREW BN T25 FT 4MM 3.3MM 36MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.428","SUP","HCPCS C1713","","04.005.428  -  SCREW BONE NONSTRL 4MM 38MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.428S","SUP","HCPCS C1713","","04.005.428S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.430","SUP","HCPCS C1713","","04.005.430  -  SCREW BONE NONSTRL 4MM 40MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.430S","SUP","HCPCS C1713","","04.005.430S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.432","SUP","HCPCS C1713","","04.005.432  -  SCREW BONE NONSTRL 4MM 42MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.432S","SUP","HCPCS C1713","","04.005.432S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 42MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.434","SUP","HCPCS C1713","","04.005.434  -  SCREW BONE 4MM 44MM NLEX TI FULTHD HUM TIB SLFTAP LCK","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.434S","SUP","HCPCS C1713","","04.005.434S  -  SCREW BN T25 FT 4MM 3.3MM 44MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.436","SUP","HCPCS C1713","","04.005.436  -  SCREW BONE NONSTRL 4MM 46MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.436S","SUP","HCPCS C1713","","04.005.436S  -  SCREW BN T25 FT 4MM 3.3MM 46MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.438","SUP","HCPCS C1713","","04.005.438  -  SCREW BONE NONSTRL 4MM 48MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.438S","SUP","HCPCS C1713","","04.005.438S  -  SCREW BN T25 FT 4MM 3.3MM 48MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.440","SUP","HCPCS C1713","","04.005.440  -  SCREW BONE NONSTRL 4MM 50MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.440S","SUP","HCPCS C1713","","04.005.440S  -  SCREW BN T25 FT 4MM 3.3MM 50MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.442","SUP","HCPCS C1713","","04.005.442  -  SCREW BONE NONSTRL 4MM 52MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.442S","SUP","HCPCS C1713","","04.005.442S  -  SCREW BN T25 FT 4MM 3.3MM 52MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.444","SUP","HCPCS C1713","","04.005.444  -  SCREW BONE NONSTRL 4MM 54MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.444S","SUP","HCPCS C1713","","04.005.444S  -  SCREW BN T25 FT 4MM 3.3MM 54MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.446","SUP","HCPCS C1713","","04.005.446  -  SCREW BONE NONSTRL 4MM 56MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.446S","SUP","HCPCS C1713","","04.005.446S  -  SCREW BN T25 FT 4MM 3.3MM 56MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.448","SUP","HCPCS C1713","","04.005.448  -  SCREW BONE NONSTRL 4MM 58MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.448S","SUP","HCPCS C1713","","04.005.448S  -  SCREW BN T25 FT 4MM 3.3MM 58MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.450","SUP","HCPCS C1713","","04.005.450  -  SCREW BONE NONSTRL 4MM 60MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.450S","SUP","HCPCS C1713","","04.005.450S  -  SCREW BN T25 FT 4MM 3.3MM 60MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.452","SUP","HCPCS C1713","","04.005.452  -  SCREW BONE NONSTRL 4MM 62MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.452S","SUP","HCPCS C1713","","04.005.452S  -  SCREW BN T25 FT 4MM 3.3MM 62MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.454","SUP","HCPCS C1713","","04.005.454  -  SCREW BONE NONSTRL 4MM 64MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.454S","SUP","HCPCS C1713","","04.005.454S  -  SCREW BN T25 FT 4MM 3.3MM 64MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.456","SUP","HCPCS C1713","","04.005.456  -  SCREW BONE NONSTRL 4MM 66MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.456S","SUP","HCPCS C1713","","04.005.456S  -  SCREW BN T25 FT 4MM 3.3MM 66MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.458","SUP","HCPCS C1713","","04.005.458  -  SCREW BONE NONSTRL 4MM 68MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.458S","SUP","HCPCS C1713","","04.005.458S  -  SCREW BN T25 FT 4MM 3.3MM 68MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.460","SUP","HCPCS C1713","","04.005.460  -  SCREW BONE NONSTRL 4MM 70MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.460S","SUP","HCPCS C1713","","04.005.460S  -  SCREW BN T25 FT 4MM 3.3MM 70MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.462","SUP","HCPCS C1713","","04.005.462  -  SCREW BONE NONSTRL 4MM 72MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.462S","SUP","HCPCS C1713","","04.005.462S  -  SCREW BN T25 FT 4MM 3.3MM 72MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.464","SUP","HCPCS C1713","","04.005.464  -  SCREW BONE NONSTRL 4MM 74MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.464S","SUP","HCPCS C1713","","04.005.464S  -  SCREW BN T25 FT 4MM 3.3MM 74MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.466","SUP","HCPCS C1713","","04.005.466  -  SCREW BONE NONSTRL 4MM 76MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.466S","SUP","HCPCS C1713","","04.005.466S  -  SCREW BN T25 FT 4MM 3.3MM 76MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.468","SUP","HCPCS C1713","","04.005.468  -  SCREW BONE NONSTRL 4MM 78MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.468S","SUP","HCPCS C1713","","04.005.468S  -  SCREW BN T25 FT 4MM 3.3MM 78MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.470","SUP","HCPCS C1713","","04.005.470  -  SCREW BONE NONSTRL 4MM 80MM NLEX TI FULTHD HUM TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.470S","SUP","HCPCS C1713","","04.005.470S  -  SCREW BN T25 FT 4MM 3.3MM 80MM BLU STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.516","SUP","HCPCS C1713","","04.005.516  -  SCREW BONE 5MM 26MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.516S","SUP","HCPCS C1713","","04.005.516S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 26MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.518","SUP","HCPCS C1713","","04.005.518  -  SCREW BONE 5MM 4.3MM 28MM NLEX TI FULTHD FEM/TIB T25","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.518S","SUP","HCPCS C1713","","04.005.518S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 28MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.520","SUP","HCPCS C1713","","04.005.520  -  SCREW BONE 5MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP LCK","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.520S","SUP","HCPCS C1713","","04.005.520S  -  SCREW BONE FULTHD 5MM 4.3MM 30MM T25 STARDRIVE RECESS","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.522","SUP","HCPCS C1713","","04.005.522  -  SCREW BONE NONSTRL 5MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.522S","SUP","HCPCS C1713","","04.005.522S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 32MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.524","SUP","HCPCS C1713","","04.005.524  -  SCREW BONE NONSTRL 5MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.524S","SUP","HCPCS C1713","","04.005.524S  -  SCREW BONE FULTHD 5MM 4.3MM 34MM T25 STARDRIVE RECESS","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.526","SUP","HCPCS C1713","","04.005.526  -  SCREW BONE NONSTRL 5MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.526S","SUP","HCPCS C1713","","04.005.526S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.528","SUP","HCPCS C1713","","04.005.528  -  SCREW BONE NONSTRL 5MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.528S","SUP","HCPCS C1713","","04.005.528S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.530","SUP","HCPCS C1713","","04.005.530  -  SCREW BONE NONSTRL 5MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.530S","SUP","HCPCS C1713","","04.005.530S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.532","SUP","HCPCS C1713","","04.005.532  -  SCREW BONE NONSTRL 5MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.532S","SUP","HCPCS C1713","","04.005.532S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 42MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.534","SUP","HCPCS C1713","","04.005.534  -  SCREW BONE NONSTRL 5MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.534S","SUP","HCPCS C1713","","04.005.534S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 44MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.536","SUP","HCPCS C1713","","04.005.536  -  SCREW BONE NONSTRL 5MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.536S","SUP","HCPCS C1713","","04.005.536S  -  SCREW BN T25 FT 5MM 4.3MM 46MM LGHT GRN STRL LCK ST BLNT TIP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.538","SUP","HCPCS C1713","","04.005.538  -  SCREW BONE NONSTRL 5MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.538S","SUP","HCPCS C1713","","04.005.538S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.540","SUP","HCPCS C1713","","04.005.540  -  SCREW BONE NONSTRL 5MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.540S","SUP","HCPCS C1713","","04.005.540S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 50MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.542","SUP","HCPCS C1713","","04.005.542  -  SCREW BONE NONSTRL 5MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.542S","SUP","HCPCS C1713","","04.005.542S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 52MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.544","SUP","HCPCS C1713","","04.005.544  -  SCREW BONE NONSTRL 5MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.544S","SUP","HCPCS C1713","","04.005.544S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.546","SUP","HCPCS C1713","","04.005.546  -  SCREW BONE NONSTRL 5MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.546S","SUP","HCPCS C1713","","04.005.546S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 56MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.548","SUP","HCPCS C1713","","04.005.548  -  SCREW BONE NONSTRL 5MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.548S","SUP","HCPCS C1713","","04.005.548S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 58MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.550","SUP","HCPCS C1713","","04.005.550  -  SCREW BONE NONSTRL 5MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.550S","SUP","HCPCS C1713","","04.005.550S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 60MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.552","SUP","HCPCS C1713","","04.005.552  -  SCREW BONE 5MM 62MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.552S","SUP","HCPCS C1713","","04.005.552S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 62MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.554","SUP","HCPCS C1713","","04.005.554  -  SCREW BONE 5MM 64MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.554S","SUP","HCPCS C1713","","04.005.554S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 64MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.556","SUP","HCPCS C1713","","04.005.556  -  SCREW BONE 5MM 66MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.556S","SUP","HCPCS C1713","","04.005.556S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 66MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.558","SUP","HCPCS C1713","","04.005.558  -  SCREW BONE 5MM 68MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$138.44 ","$0.00 ","$64.12 ","$0.00 ","$0.00 ","$53.87 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$48.15 ","$0.00 ","$48.98 ","$0.00 "
"04.005.558S","SUP","HCPCS C1713","","04.005.558S  -  SCREW BONE FULTHD 5MM 8MM 68MM T25 STARDRIVE RECESS LOCKING","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.560","SUP","HCPCS C1713","","04.005.560  -  SCREW BONE 5MM 70MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.560S","SUP","HCPCS C1713","","04.005.560S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 70MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.562","SUP","HCPCS C1713","","04.005.562  -  SCREW BONE 5MM 72MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.562S","SUP","HCPCS C1713","","04.005.562S  -  SCREW BN T25 FT 5MM 4.3MM 72MM LGHT GRN STRL LCK ST BLNT TIP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.564","SUP","HCPCS C1713","","04.005.564  -  SCREW BONE 5MM 74MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.564S","SUP","HCPCS C1713","","04.005.564S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 74MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.566","SUP","HCPCS C1713","","04.005.566  -  SCREW BONE 5MM 76MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.566S","SUP","HCPCS C1713","","04.005.566S  -  SCREW BONE FULTHD 5MM 8MM 76MM T25 STARDRIVE RECESS LOCKING","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.568","SUP","HCPCS C1713","","04.005.568  -  SCREW BONE 5MM 78MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.568S","SUP","HCPCS C1713","","04.005.568S  -  SCREW BONE FULTHD 5MM 8MM 78MM LOCK CANN SELF TAP BLUNT TIP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.570","SUP","HCPCS C1713","","04.005.570  -  SCREW BONE 5MM 80MM NLEX TI FEM/TIB LCK STARDRIVE RECESS","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.570S","SUP","HCPCS C1713","","04.005.570S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 80MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.575","SUP","HCPCS C1713","","04.005.575  -  SCREW BONE NONSTRL 5MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.575S","SUP","HCPCS C1713","","04.005.575S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM 2 LEAD SELF TAP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.580","SUP","HCPCS C1713","","04.005.580  -  SCREW BONE NONSTRL 5MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.580S","SUP","HCPCS C1713","","04.005.580S  -  SCREW BONE FULTHD 5MM 8MM 90MM T25 STARDRIVE RECESS LOCKING","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.585","SUP","HCPCS C1713","","04.005.585  -  SCREW BONE NONSTRL 5MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.585S","SUP","HCPCS C1713","","04.005.585S  -  SCREW BN T25 FT 5MM 4.3MM 95MM LGHT GRN STRL LCK ST BLNT TIP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.590","SUP","HCPCS C1713","","04.005.590  -  SCREW BONE NONSTRL 5MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.005.590S","SUP","HCPCS C1713","","04.005.590S  -  SCREW BONE FULTHD 5MM 8MM 100MM T25 STARDRIVE RECESS LOCKING","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.616","SUP","HCPCS C1713","","04.005.616  -  SCREW BONE NONSTRL 6MM 26MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.616S","SUP","HCPCS C1713","","04.005.616S  -  SCREW BN FT 6MM 8MM 26MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.618","SUP","HCPCS C1713","","04.005.618  -  SCREW BONE NONSTRL 6MM 28MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.618S","SUP","HCPCS C1713","","04.005.618S  -  SCREW BN FT 6MM 8MM 28MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.620","SUP","HCPCS C1713","","04.005.620  -  SCREW BONE NONSTRL 6MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.620S","SUP","HCPCS C1713","","04.005.620S  -  SCREW BN FT 6MM 8MM 30MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.622","SUP","HCPCS C1713","","04.005.622  -  SCREW BONE NONSTRL 6MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.622S","SUP","HCPCS C1713","","04.005.622S  -  SCREW BN T25 FT BLNT 6MM 8MM 32MM AQ STRL XPRT 2 LD ST LCK","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.624","SUP","HCPCS C1713","","04.005.624  -  SCREW BONE NONSTRL 6MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.624S","SUP","HCPCS C1713","","04.005.624S  -  SCREW BN FT 6MM 8MM 34MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.626","SUP","HCPCS C1713","","04.005.626  -  SCREW BONE NONSTRL 6MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.626S","SUP","HCPCS C1713","","04.005.626S  -  SCREW BN T25 FT BLNT 6MM 8MM 36MM AQ STRL XPRT 2 LD ST LCK","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.628","SUP","HCPCS C1713","","04.005.628  -  SCREW BONE NONSTRL 6MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.628S","SUP","HCPCS C1713","","04.005.628S  -  SCREW BN T25 FT 6MM 4.8MM 38MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.630","SUP","HCPCS C1713","","04.005.630  -  SCREW BONE NONSTRL 6MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.630S","SUP","HCPCS C1713","","04.005.630S  -  SCREW BN FT 6MM 8MM 40MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.632","SUP","HCPCS C1713","","04.005.632  -  SCREW BONE NONSTRL 6MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.632S","SUP","HCPCS C1713","","04.005.632S  -  SCREW BN FT 6MM 8MM 42MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.634","SUP","HCPCS C1713","","04.005.634  -  SCREW BONE NONSTRL 6MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.634S","SUP","HCPCS C1713","","04.005.634S  -  SCREW BN T25 FT 6MM 4.8MM 44MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.636","SUP","HCPCS C1713","","04.005.636  -  SCREW BONE NONSTRL 6MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.636S","SUP","HCPCS C1713","","04.005.636S  -  SCREW BN FT 6MM 8MM 46MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.638","SUP","HCPCS C1713","","04.005.638  -  SCREW BONE NONSTRL 6MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.638S","SUP","HCPCS C1713","","04.005.638S  -  SCREW BN FT 6MM 8MM 48MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.640","SUP","HCPCS C1713","","04.005.640  -  SCREW BONE NONSTRL 6MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.640S","SUP","HCPCS C1713","","04.005.640S  -  SCREW BN FT 6MM 8MM 50MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.642","SUP","HCPCS C1713","","04.005.642  -  SCREW BONE NONSTRL 6MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.642S","SUP","HCPCS C1713","","04.005.642S  -  SCREW BN T25 FT BLNT 6MM 8MM 52MM AQ STRL XPRT 2 LD ST LCK","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.644","SUP","HCPCS C1713","","04.005.644  -  SCREW BONE NONSTRL 6MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.644S","SUP","HCPCS C1713","","04.005.644S  -  SCREW BN T25 FT 6MM 8MM 54MM AQ STRL ST LCK BLNT TIP STRDR","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.646","SUP","HCPCS C1713","","04.005.646  -  SCREW BONE NONSTRL 6MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.646S","SUP","HCPCS C1713","","04.005.646S  -  SCREW BN T25 FT 6MM 8MM 56MM AQ STRL ST LCK 2 LD STRDR TI","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.648","SUP","HCPCS C1713","","04.005.648  -  SCREW BONE NONSTRL 6MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.648S","SUP","HCPCS C1713","","04.005.648S  -  SCREW BN T25 FT 6MM 4.8MM 58MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.650","SUP","HCPCS C1713","","04.005.650  -  SCREW BONE NONSTRL 6MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.650S","SUP","HCPCS C1713","","04.005.650S  -  SCREW BN T25 FT 6MM 4.8MM 60MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.654","SUP","HCPCS C1713","","04.005.654  -  SCREW BONE NONSTRL 6MM 64MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.654S","SUP","HCPCS C1713","","04.005.654S  -  SCREW BN T25 FT 6MM 4.8MM 64MM AQ STRL LCK CNN ST BLNT TIP","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.658","SUP","HCPCS C1713","","04.005.658  -  SCREW BONE 6MM 68MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.658S","SUP","HCPCS C1713","","04.005.658S  -  SCREW BN T25 FT 6MM 4.8MM 68MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.662","SUP","HCPCS C1713","","04.005.662  -  SCREW BONE NONSTRL 6MM 72MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.662S","SUP","HCPCS C1713","","04.005.662S  -  SCREW BN T25 FT 6MM 4.8MM 72MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.666","SUP","HCPCS C1713","","04.005.666  -  SCREW BONE NONSTRL 6MM 76MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.666S","SUP","HCPCS C1713","","04.005.666S  -  SCREW BN T25 FT BLNT 6MM 8MM 76MM AQ STRL XPRT 2 LD ST LCK","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.670","SUP","HCPCS C1713","","04.005.670  -  SCREW BONE 6MM 80MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.670S","SUP","HCPCS C1713","","04.005.670S  -  SCREW BN FT 6MM 8MM 80MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.675","SUP","HCPCS C1713","","04.005.675  -  SCREW BONE NONSTRL 6MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.675S","SUP","HCPCS C1713","","04.005.675S  -  SCREW BN T25 FT 6MM 4.8MM 85MM AQ STRL LCK ST BLNT TIP 2 LD","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.680","SUP","HCPCS C1713","","04.005.680  -  SCREW BONE NONSTRL 6MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.680S","SUP","HCPCS C1713","","04.005.680S  -  SCREW BN FT 6MM 8MM 90MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.685","SUP","HCPCS C1713","","04.005.685  -  SCREW BONE NONSTRL 6MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.685S","SUP","HCPCS C1713","","04.005.685S  -  SCREW BN FT 6MM 8MM 95MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.690","SUP","HCPCS C1713","","04.005.690  -  SCREW BONE 6MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP CANN LCK","BOTH IP/OP","$413.95 ","$306.32 ","$0.00 ","$413.95 ","$186.28 ","$0.00 ","$86.28 ","$0.00 ","$0.00 ","$72.48 ","$413.95 ","$0.00 ","$206.98 ","$327.85 ","$331.16 ","$0.00 ","$64.78 ","$0.00 ","$65.90 ","$0.00 "
"04.005.690S","SUP","HCPCS C1713","","04.005.690S  -  SCREW BN FT 6MM 8MM 100MM AQ STRL NLEX T25 STRDR RCS LCK CNN","BOTH IP/OP","$436.18 ","$322.77 ","$0.00 ","$423.45 ","$190.55 ","$0.00 ","$90.91 ","$0.00 ","$0.00 ","$74.14 ","$423.45 ","$0.00 ","$211.73 ","$335.37 ","$338.76 ","$0.00 ","$64.34 ","$0.00 ","$67.41 ","$0.00 "
"04.005.691","SUP","HCPCS C1713","","04.005.691  -  SCREW BONE FULTHD 6MM 105MM SLFTAP CANN LOCKING STARDRIVE","BOTH IP/OP","$341.35 ","$252.60 ","$0.00 ","$331.40 ","$149.13 ","$0.00 ","$71.15 ","$0.00 ","$0.00 ","$58.03 ","$331.40 ","$0.00 ","$165.70 ","$262.47 ","$265.12 ","$0.00 ","$50.35 ","$0.00 ","$52.76 ","$0.00 "
"04.005.692","SUP","HCPCS C1713","","04.005.692  -  SCREW BONE FULTHD 6MM 110MM SLFTAP CANN LOCKING STARDRIVE","BOTH IP/OP","$341.35 ","$252.60 ","$0.00 ","$331.40 ","$149.13 ","$0.00 ","$71.15 ","$0.00 ","$0.00 ","$58.03 ","$331.40 ","$0.00 ","$165.70 ","$262.47 ","$265.12 ","$0.00 ","$50.35 ","$0.00 ","$52.76 ","$0.00 "
"04.005.693","SUP","HCPCS C1713","","04.005.693  -  SCREW BONE FULTHD 6MM 115MM SLFTAP CANN LOCKING STARDRIVE","BOTH IP/OP","$341.35 ","$252.60 ","$0.00 ","$331.40 ","$149.13 ","$0.00 ","$71.15 ","$0.00 ","$0.00 ","$58.03 ","$331.40 ","$0.00 ","$165.70 ","$262.47 ","$265.12 ","$0.00 ","$50.35 ","$0.00 ","$52.76 ","$0.00 "
"04.005.694","SUP","HCPCS C1713","","04.005.694  -  SCREW BONE FULTHD 6MM 120MM SLFTAP CANN LOCKING STARDRIVE","BOTH IP/OP","$341.35 ","$252.60 ","$0.00 ","$331.40 ","$149.13 ","$0.00 ","$71.15 ","$0.00 ","$0.00 ","$58.03 ","$331.40 ","$0.00 ","$165.70 ","$262.47 ","$265.12 ","$0.00 ","$50.35 ","$0.00 ","$52.76 ","$0.00 "
"04.005.695","SUP","HCPCS C1713","","04.005.695  -  SCREW BONE FULTHD 6MM 125MM SLFTAP CANN LOCKING STARDRIVE","BOTH IP/OP","$341.35 ","$252.60 ","$0.00 ","$331.40 ","$149.13 ","$0.00 ","$71.15 ","$0.00 ","$0.00 ","$58.03 ","$331.40 ","$0.00 ","$165.70 ","$262.47 ","$265.12 ","$0.00 ","$50.35 ","$0.00 ","$52.76 ","$0.00 "
"04.008.000S","SUP","Custom 27803010","","04.008.000S  -  CAP END T25 STARDRIVE RECESS NAIL-EX GOLD TITANIUM HINDFOOT","BOTH IP/OP","$428.88 ","$317.37 ","$0.00 ","$416.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.38 ","$0.00 ","$208.19 ","$329.77 ","$333.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.008.001S","SUP","Custom 27803010","","04.008.001S  -  CAP END 0MM EXTENDED STARDRIVE RECESS NAIL-EX AQUA TITANIUM","BOTH IP/OP","$428.88 ","$317.37 ","$0.00 ","$416.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$416.38 ","$0.00 ","$208.19 ","$329.77 ","$333.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.008.010S","SUP","HCPCS C1713","","04.008.010S  -  NAIL INTRAMEDULLARY 10MM 150CM CANN EXPERT GREEN TITANIUM","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.016S","SUP","HCPCS C1713","","04.008.016S  -  NAIL INTRAMEDULLARY 12D 10MM 180MM CANN BALL TIPPED REAMING","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.028S","SUP","HCPCS C1713","","04.008.028S  -  NAIL INTRAMEDULLARY 12D 10MM 240MM CANN BALL TIPPED REAMING","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.060S","SUP","HCPCS C1713","","04.008.060S  -  NAIL INTRAMEDULLARY 10MM 15CM CANN NAIL-EX GREEN TITANIUM","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.066S","SUP","HCPCS C1713","","04.008.066S  -  NAIL INTRAMEDULLARY 10MM 180MM CANN NAIL-EX GREEN TITANIUM","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.078S","SUP","HCPCS C1713","","04.008.078S  -  NAIL INTRAMEDULLARY 10MM 24CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.210S","SUP","HCPCS C1713","","04.008.210S  -  NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM RIGHT","BOTH IP/OP","$3,096.90 ","$2,291.71 ","$0.00 ","$3,006.70 ","$1,353.02 ","$0.00 ","$645.47 ","$0.00 ","$0.00 ","$526.45 ","$3,006.70 ","$0.00 ","$1,503.35 ","$2,381.31 ","$2,405.36 ","$0.00 ","$456.84 ","$0.00 ","$478.67 ","$0.00 "
"04.008.216S","SUP","HCPCS C1713","","04.008.216S  -  NAIL INTRAMEDULLARY 12MM 180MM CANN NAIL-EX TITANIUM RIGHT","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.228S","SUP","HCPCS C1713","","04.008.228S  -  NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM RIGHT","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.260S","SUP","HCPCS C1713","","04.008.260S  -  NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,096.90 ","$2,291.71 ","$0.00 ","$3,006.70 ","$1,353.02 ","$0.00 ","$645.47 ","$0.00 ","$0.00 ","$526.45 ","$3,006.70 ","$0.00 ","$1,503.35 ","$2,381.31 ","$2,405.36 ","$0.00 ","$456.84 ","$0.00 ","$478.67 ","$0.00 "
"04.008.266S","SUP","HCPCS C1713","","04.008.266S  -  NAIL INTRAMEDULLARY 12MM 18CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.278S","SUP","HCPCS C1713","","04.008.278S  -  NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.310S","SUP","HCPCS C1713","","04.008.310S  -  NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM RIGHT","BOTH IP/OP","$3,096.90 ","$2,291.71 ","$0.00 ","$3,006.70 ","$1,353.02 ","$0.00 ","$645.47 ","$0.00 ","$0.00 ","$526.45 ","$3,006.70 ","$0.00 ","$1,503.35 ","$2,381.31 ","$2,405.36 ","$0.00 ","$456.84 ","$0.00 ","$478.67 ","$0.00 "
"04.008.316S","SUP","HCPCS C1713","","04.008.316S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM RIGHT","BOTH IP/OP","$3,096.90 ","$2,291.71 ","$0.00 ","$3,006.70 ","$1,353.02 ","$0.00 ","$645.47 ","$0.00 ","$0.00 ","$526.45 ","$3,006.70 ","$0.00 ","$1,503.35 ","$2,381.31 ","$2,405.36 ","$0.00 ","$456.84 ","$0.00 ","$478.67 ","$0.00 "
"04.008.328S","SUP","HCPCS C1713","","04.008.328S  -  NAIL INTRAMEDULLARY 13MM 240MM FLUTED EXPERT LIGHT GREEN","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.008.360S","SUP","HCPCS C1713","","04.008.360S  -  NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,096.90 ","$2,291.71 ","$0.00 ","$3,006.70 ","$1,353.02 ","$0.00 ","$645.47 ","$0.00 ","$0.00 ","$526.45 ","$3,006.70 ","$0.00 ","$1,503.35 ","$2,381.31 ","$2,405.36 ","$0.00 ","$456.84 ","$0.00 ","$478.67 ","$0.00 "
"04.008.366S","SUP","HCPCS C1713","","04.008.366S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,096.90 ","$2,291.71 ","$0.00 ","$3,006.70 ","$1,353.02 ","$0.00 ","$645.47 ","$0.00 ","$0.00 ","$526.45 ","$3,006.70 ","$0.00 ","$1,503.35 ","$2,381.31 ","$2,405.36 ","$0.00 ","$456.84 ","$0.00 ","$478.67 ","$0.00 "
"04.008.378S","SUP","HCPCS C1713","","04.008.378S  -  NAIL INTRAMEDULLARY 13MM 24CM CANN NAIL-EX TITANIUM LEFT","BOTH IP/OP","$3,006.45 ","$2,224.77 ","$0.00 ","$2,918.90 ","$1,313.51 ","$0.00 ","$626.62 ","$0.00 ","$0.00 ","$511.08 ","$2,918.90 ","$0.00 ","$1,459.45 ","$2,311.77 ","$2,335.12 ","$0.00 ","$443.50 ","$0.00 ","$464.69 ","$0.00 "
"04.013.000","SUP","HCPCS C1713","","04.013.000  -  CAP END 0MM FEM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL","BOTH IP/OP","$357.38 ","$264.46 ","$0.00 ","$357.38 ","$160.82 ","$0.00 ","$74.49 ","$0.00 ","$0.00 ","$62.57 ","$357.38 ","$0.00 ","$178.69 ","$283.04 ","$285.90 ","$0.00 ","$55.93 ","$0.00 ","$56.89 ","$0.00 "
"04.013.000S","SUP","Custom 27803010","","04.013.000S  -  CAP END 0MM T40 STARDRIVE NAIL-EX GOLD TITANIUM FEMUR","BOTH IP/OP","$414.28 ","$306.57 ","$0.00 ","$402.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$402.23 ","$0.00 ","$201.11 ","$318.57 ","$321.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.041S","SUP","Custom 27803010","","04.013.041S  -  BLADE INTRAMEDULLARY NAIL 45MM CANN SPIRAL RTRGRD NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.042S","SUP","Custom 27803010","","04.013.042S  -  BLADE INTRAMEDULLARY NAIL 50MM CANN SPIRAL RTRGRD NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.043S","SUP","Custom 27803010","","04.013.043S  -  BLADE INTRAMEDULLARY NAIL 55MM CANN SPIRAL RTRGRD NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.044S","SUP","Custom 27803010","","04.013.044S  -  BLADE INTRAMEDULLARY NAIL 60MM CANN SPIRAL RTRGRD NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.045S","SUP","Custom 27803010","","04.013.045S  -  BLADE INTRAMEDULLARY FIX SPIRAL 65MM RTRGRD EXPERT GOLD","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.046","SUP","HCPCS C1713","","04.013.046  -  BLADE IM NAIL 70MM NLEX FEM TI CANN SPRL RTRGRD NONSTRL","BOTH IP/OP","$1,214.65 ","$898.84 ","$0.00 ","$1,214.65 ","$546.59 ","$0.00 ","$253.16 ","$0.00 ","$0.00 ","$212.68 ","$1,214.65 ","$0.00 ","$607.33 ","$962.00 ","$971.72 ","$0.00 ","$190.09 ","$0.00 ","$193.37 ","$0.00 "
"04.013.046S","SUP","Custom 27803010","","04.013.046S  -  BLADE INTRAMEDULLARY NAIL 70MM SPIRAL RTRGRD NAIL-EX GOLD","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.047S","SUP","Custom 27803010","","04.013.047S  -  BLADE INTRAMEDULLARY FIX 12.5MM 75MM SPIRAL CANN NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.048S","SUP","Custom 27803010","","04.013.048S  -  BLADE INTRAMEDULLARY FIX 80MM SPIRAL NAIL-EX TITANIUM FEMUR","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.049S","SUP","Custom 27803010","","04.013.049S  -  BLADE INTRAMEDULLARY NAIL SPIRAL 12.5MM 85MM RTRGRD CANN","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.050S","SUP","Custom 27803010","","04.013.050S  -  BLADE INTRAMEDULLARY FIX SPIRAL 90MM CANN RTRGRD EXPERT GOLD","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.051S","SUP","Custom 27803010","","04.013.051S  -  BLADE INTRAMEDULLARY NAIL 95MM CANN SPIRAL RTRGRD NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.052S","SUP","Custom 27803010","","04.013.052S  -  BLADE INTRAMEDULLARY NAIL 100MM CANN SPIRAL RTRGRD NAIL-EX","BOTH IP/OP","$1,161.15 ","$859.25 ","$0.00 ","$1,127.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.33 ","$0.00 ","$563.66 ","$892.85 ","$901.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.013.312S","SUP","HCPCS C1713","","04.013.312S  -  NAIL INTRAMEDULLARY 9MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.316S","SUP","HCPCS C1713","","04.013.316S  -  NAIL INTRAMEDULLARY 9MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.320S","SUP","HCPCS C1713","","04.013.320S  -  NAIL INTRAMEDULLARY 9MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.324S","SUP","HCPCS C1713","","04.013.324S  -  NAIL INTRAMEDULLARY 9MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.328S","SUP","HCPCS C1713","","04.013.328S  -  NAIL INTRAMEDULLARY 9MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.332S","SUP","HCPCS C1713","","04.013.332S  -  NAIL INTRAMEDULLARY 9MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.336S","SUP","HCPCS C1713","","04.013.336S  -  NAIL INTRAMEDULLARY 9MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.340S","SUP","HCPCS C1713","","04.013.340S  -  NAIL INTRAMEDULLARY 9MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.344S","SUP","HCPCS C1713","","04.013.344S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 320MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.348S","SUP","HCPCS C1713","","04.013.348S  -  NAIL INTRAMEDULLARY 9MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.352S","SUP","HCPCS C1713","","04.013.352S  -  NAIL INTRAMEDULLARY 9MM 36CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.356S","SUP","HCPCS C1713","","04.013.356S  -  NAIL INTRAMEDULLARY 9MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.360S","SUP","HCPCS C1713","","04.013.360S  -  NAIL INTRAMEDULLARY 9MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.364S","SUP","HCPCS C1713","","04.013.364S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 420MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.368S","SUP","HCPCS C1713","","04.013.368S  -  NAIL INTRAMEDULLARY 9MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.372S","SUP","HCPCS C1713","","04.013.372S  -  NAIL INTRAMEDULLARY 9MM 46CM CANN ANTEGRADE/RTRGRD NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.376S","SUP","HCPCS C1713","","04.013.376S  -  NAIL INTRAMEDULLARY 9MM 48CM CANN ANTEGRADE/RTRGRD NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.412S","SUP","HCPCS C1713","","04.013.412S  -  NAIL INTRAMEDULLARY 10MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.416S","SUP","HCPCS C1713","","04.013.416S  -  NAIL INTRAMEDULLARY 10MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.420S","SUP","HCPCS C1713","","04.013.420S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.424S","SUP","HCPCS C1713","","04.013.424S  -  NAIL INTRAMEDULLARY 10MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.428S","SUP","HCPCS C1713","","04.013.428S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.432S","SUP","HCPCS C1713","","04.013.432S  -  NAIL INTRAMEDULLARY 10MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.436S","SUP","HCPCS C1713","","04.013.436S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.440S","SUP","HCPCS C1713","","04.013.440S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.444S","SUP","HCPCS C1713","","04.013.444S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.448S","SUP","HCPCS C1713","","04.013.448S  -  NAIL INTRAMEDULLARY 10MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.452S","SUP","HCPCS C1713","","04.013.452S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.456S","SUP","HCPCS C1713","","04.013.456S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.460S","SUP","HCPCS C1713","","04.013.460S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.464S","SUP","HCPCS C1713","","04.013.464S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND 10MM 420MM CANN RTRGRD","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.468S","SUP","HCPCS C1713","","04.013.468S  -  NAIL INTRAMEDULLARY 10MM 440MM CANN NAIL-EX GREEN TITANIUM","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.472S","SUP","HCPCS C1713","","04.013.472S  -  NAIL INTRAMEDULLARY 10MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.476S","SUP","HCPCS C1713","","04.013.476S  -  NAIL INTRAMEDULLARY 10MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.512S","SUP","HCPCS C1713","","04.013.512S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.516S","SUP","HCPCS C1713","","04.013.516S  -  NAIL INTRAMEDULLARY 11MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.520S","SUP","HCPCS C1713","","04.013.520S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.524S","SUP","HCPCS C1713","","04.013.524S  -  NAIL INTRAMEDULLARY 11MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.528S","SUP","HCPCS C1713","","04.013.528S  -  NAIL INTRAMEDULLARY 11MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.532S","SUP","HCPCS C1713","","04.013.532S  -  NAIL INTRAMEDULLARY 11MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.536S","SUP","HCPCS C1713","","04.013.536S  -  NAIL INTRAMEDULLARY 11MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.540S","SUP","HCPCS C1713","","04.013.540S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.544S","SUP","HCPCS C1713","","04.013.544S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTED BARREL 11MM 320MM CANN","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.548S","SUP","HCPCS C1713","","04.013.548S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.552S","SUP","HCPCS C1713","","04.013.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.556S","SUP","HCPCS C1713","","04.013.556S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.560S","SUP","HCPCS C1713","","04.013.560S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.564S","SUP","HCPCS C1713","","04.013.564S  -  NAIL INTRAMEDULLARY 11MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.568S","SUP","HCPCS C1713","","04.013.568S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.572S","SUP","HCPCS C1713","","04.013.572S  -  NAIL INTRAMEDULLARY 11MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.576S","SUP","HCPCS C1713","","04.013.576S  -  NAIL INTRAMEDULLARY 11MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.612S","SUP","HCPCS C1713","","04.013.612S  -  NAIL INTRAMEDULLARY 12MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.616S","SUP","HCPCS C1713","","04.013.616S  -  NAIL INTRAMEDULLARY 12MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.620S","SUP","HCPCS C1713","","04.013.620S  -  NAIL INTRAMEDULLARY 12MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.624S","SUP","HCPCS C1713","","04.013.624S  -  NAIL INTRAMEDULLARY 12MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.628S","SUP","HCPCS C1713","","04.013.628S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.632S","SUP","HCPCS C1713","","04.013.632S  -  NAIL INTRAMEDULLARY 12MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.636S","SUP","HCPCS C1713","","04.013.636S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.640S","SUP","HCPCS C1713","","04.013.640S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTED 12MM 300MM CANN RTRGRD","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.644S","SUP","HCPCS C1713","","04.013.644S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.648S","SUP","HCPCS C1713","","04.013.648S  -  NAIL INTRAMEDULLARY 12MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.652S","SUP","HCPCS C1713","","04.013.652S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 36CM CANN RTRGRD","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.656S","SUP","HCPCS C1713","","04.013.656S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.660S","SUP","HCPCS C1713","","04.013.660S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.664S","SUP","HCPCS C1713","","04.013.664S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN ROUND BARREL","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.668S","SUP","HCPCS C1713","","04.013.668S  -  NAIL INTRAMEDULLARY 12MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.672S","SUP","HCPCS C1713","","04.013.672S  -  NAIL INTRAMEDULLARY 12MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,331.75 ","$2,465.50 ","$0.00 ","$3,234.73 ","$1,455.63 ","$0.00 ","$694.42 ","$0.00 ","$0.00 ","$566.37 ","$3,234.73 ","$0.00 ","$1,617.36 ","$2,561.91 ","$2,587.78 ","$0.00 ","$491.49 ","$0.00 ","$514.97 ","$0.00 "
"04.013.676S","SUP","HCPCS C1713","","04.013.676S  -  NAIL INTRAMEDULLARY 12MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.712S","SUP","HCPCS C1713","","04.013.712S  -  NAIL INTRAMEDULLARY 13MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,331.75 ","$2,465.50 ","$0.00 ","$3,234.73 ","$1,455.63 ","$0.00 ","$694.42 ","$0.00 ","$0.00 ","$566.37 ","$3,234.73 ","$0.00 ","$1,617.36 ","$2,561.91 ","$2,587.78 ","$0.00 ","$491.49 ","$0.00 ","$514.97 ","$0.00 "
"04.013.716S","SUP","HCPCS C1713","","04.013.716S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,331.75 ","$2,465.50 ","$0.00 ","$3,234.73 ","$1,455.63 ","$0.00 ","$694.42 ","$0.00 ","$0.00 ","$566.37 ","$3,234.73 ","$0.00 ","$1,617.36 ","$2,561.91 ","$2,587.78 ","$0.00 ","$491.49 ","$0.00 ","$514.97 ","$0.00 "
"04.013.720S","SUP","HCPCS C1713","","04.013.720S  -  NAIL INTRAMEDULLARY 13MM 200CM CANN RTRGRD ANTEGRADE EXPERT","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.724S","SUP","HCPCS C1713","","04.013.724S  -  NAIL INTRAMEDULLARY 13MM 22CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.728S","SUP","HCPCS C1713","","04.013.728S  -  NAIL INTRAMEDULLARY 13MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.732S","SUP","HCPCS C1713","","04.013.732S  -  NAIL INTRAMEDULLARY 13MM 26CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.736S","SUP","HCPCS C1713","","04.013.736S  -  NAIL INTRAMEDULLARY 13MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.740S","SUP","HCPCS C1713","","04.013.740S  -  NAIL INTRAMEDULLARY 13MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.744S","SUP","HCPCS C1713","","04.013.744S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN RTRGRD NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.748S","SUP","HCPCS C1713","","04.013.748S  -  NAIL INTRAMEDULLARY 13MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.752S","SUP","HCPCS C1713","","04.013.752S  -  NAIL INTRAMEDULLARY 13MM 360CM CANN RTRGRD ANTEGRADE EXPERT","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.756S","SUP","HCPCS C1713","","04.013.756S  -  NAIL INTRAMEDULLARY 13MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.760S","SUP","HCPCS C1713","","04.013.760S  -  NAIL INTRAMEDULLARY 13MM 400CM CANN RTRGRD ANTEGRADE EXPERT","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.764S","SUP","HCPCS C1713","","04.013.764S  -  NAIL INTRAMEDULLARY 13MM 420MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.768S","SUP","HCPCS C1713","","04.013.768S  -  NAIL INTRAMEDULLARY 13MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.772S","SUP","HCPCS C1713","","04.013.772S  -  NAIL INTRAMEDULLARY 13MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,331.75 ","$2,465.50 ","$0.00 ","$3,234.73 ","$1,455.63 ","$0.00 ","$694.42 ","$0.00 ","$0.00 ","$566.37 ","$3,234.73 ","$0.00 ","$1,617.36 ","$2,561.91 ","$2,587.78 ","$0.00 ","$491.49 ","$0.00 ","$514.97 ","$0.00 "
"04.013.776S","SUP","HCPCS C1713","","04.013.776S  -  NAIL INTRAMEDULLARY 13MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.812S","SUP","HCPCS C1713","","04.013.812S  -  NAIL INTRAMEDULLARY 14MM 16CM CANN RTRGRD ANTEGRADE TITANIUM","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.816S","SUP","HCPCS C1713","","04.013.816S  -  NAIL INTRAMEDULLARY 14MM 18CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.820S","SUP","HCPCS C1713","","04.013.820S  -  NAIL INTRAMEDULLARY 14MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.824S","SUP","HCPCS C1713","","04.013.824S  -  NAIL INTRAMEDULLARY 14MM 22CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.828S","SUP","HCPCS C1713","","04.013.828S  -  NAIL INTRAMEDULLARY 14MM 240MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.832S","SUP","HCPCS C1713","","04.013.832S  -  NAIL INTRAMEDULLARY 14MM 26CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.836S","SUP","HCPCS C1713","","04.013.836S  -  NAIL INTRAMEDULLARY 14MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.840S","SUP","HCPCS C1713","","04.013.840S  -  NAIL INTRAMEDULLARY 14MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.844S","SUP","HCPCS C1713","","04.013.844S  -  NAIL INTRAMEDULLARY 14MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.848S","SUP","HCPCS C1713","","04.013.848S  -  NAIL INTRAMEDULLARY 14MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.852S","SUP","HCPCS C1713","","04.013.852S  -  NAIL INTRAMEDULLARY 14MM 360MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.856S","SUP","HCPCS C1713","","04.013.856S  -  NAIL INTRAMEDULLARY 14MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.860S","SUP","HCPCS C1713","","04.013.860S  -  NAIL INTRAMEDULLARY 14MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.864S","SUP","HCPCS C1713","","04.013.864S  -  NAIL INTRAMEDULLARY 14MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.868S","SUP","HCPCS C1713","","04.013.868S  -  NAIL INTRAMEDULLARY 14MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.872S","SUP","HCPCS C1713","","04.013.872S  -  NAIL INTRAMEDULLARY 14MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.876S","SUP","HCPCS C1713","","04.013.876S  -  NAIL INTRAMEDULLARY 14MM 480MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.912S","SUP","HCPCS C1713","","04.013.912S  -  NAIL INTRAMEDULLARY 15MM 160MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.916S","SUP","HCPCS C1713","","04.013.916S  -  NAIL INTRAMEDULLARY 15MM 18CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.013.920S","SUP","HCPCS C1713","","04.013.920S  -  NAIL INTRAMEDULLARY 15MM 200MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.924S","SUP","HCPCS C1713","","04.013.924S  -  NAIL INTRAMEDULLARY 15MM 22CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.928S","SUP","HCPCS C1713","","04.013.928S  -  NAIL INTRAMEDULLARY 15MM 24CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.932S","SUP","HCPCS C1713","","04.013.932S  -  NAIL INTRAMEDULLARY 15MM 26CM CANN RTRGRD NAIL-EX TITANIUM","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.936S","SUP","HCPCS C1713","","04.013.936S  -  NAIL INTRAMEDULLARY 15MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.940S","SUP","HCPCS C1713","","04.013.940S  -  NAIL INTRAMEDULLARY 15MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.944S","SUP","HCPCS C1713","","04.013.944S  -  NAIL INTRAMEDULLARY 15MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.948S","SUP","HCPCS C1713","","04.013.948S  -  NAIL INTRAMEDULLARY 15MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.952S","SUP","HCPCS C1713","","04.013.952S  -  NAIL INTRAMEDULLARY 15MM 360MM CANN RTRGRD ANTEGRADE FLUTED","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.956S","SUP","HCPCS C1713","","04.013.956S  -  NAIL INTRAMEDULLARY 15MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.960S","SUP","HCPCS C1713","","04.013.960S  -  NAIL INTRAMEDULLARY 15MM 40CM CANN RTRGRD/ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.964S","SUP","HCPCS C1713","","04.013.964S  -  NAIL INTRAMEDULLARY 15MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.968S","SUP","HCPCS C1713","","04.013.968S  -  NAIL INTRAMEDULLARY 15MM 44CM CANN RTRGRD/ANTEGRADE NAIL-EX","BOTH IP/OP","$3,232.55 ","$2,392.09 ","$0.00 ","$3,138.40 ","$1,412.28 ","$0.00 ","$673.74 ","$0.00 ","$0.00 ","$549.51 ","$3,138.40 ","$0.00 ","$1,569.20 ","$2,485.61 ","$2,510.72 ","$0.00 ","$476.86 ","$0.00 ","$499.63 ","$0.00 "
"04.013.972S","SUP","HCPCS C1713","","04.013.972S  -  NAIL INTRAMEDULLARY 15MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,341.98 ","$2,473.07 ","$0.00 ","$3,244.63 ","$1,460.08 ","$0.00 ","$696.55 ","$0.00 ","$0.00 ","$568.11 ","$3,244.63 ","$0.00 ","$1,622.31 ","$2,569.75 ","$2,595.70 ","$0.00 ","$492.99 ","$0.00 ","$516.54 ","$0.00 "
"04.013.976S","SUP","HCPCS C1713","","04.013.976S  -  NAIL INTRAMEDULLARY 15MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX","BOTH IP/OP","$3,444.08 ","$2,548.62 ","$0.00 ","$3,343.78 ","$1,504.70 ","$0.00 ","$717.83 ","$0.00 ","$0.00 ","$585.47 ","$3,343.78 ","$0.00 ","$1,671.89 ","$2,648.27 ","$2,675.02 ","$0.00 ","$508.06 ","$0.00 ","$532.33 ","$0.00 "
"04.015.518S","SUP","HCPCS C1713","","04.015.518S  -  SCREW BONE FULTHD 5MM 28MM 2 CORE LOCK GOLD TITANIUM KNEE","BOTH IP/OP","$477.00 ","$352.98 ","$0.00 ","$463.13 ","$208.41 ","$0.00 ","$99.42 ","$0.00 ","$0.00 ","$81.09 ","$463.13 ","$0.00 ","$231.56 ","$366.80 ","$370.50 ","$0.00 ","$70.37 ","$0.00 ","$73.73 ","$0.00 "
"04.015.520","SUP","HCPCS C1713","","04.015.520  -  SCREW BONE T25 BLUNT 5MM 8MM 30MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.522S","SUP","HCPCS C1713","","04.015.522S  -  SCREW BONE FULTHD 5MM 32MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.525","SUP","HCPCS C1713","","04.015.525  -  SCREW BONE T25 BLUNT 5MM 8MM 35MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.527S","SUP","HCPCS C1713","","04.015.527S  -  SCREW BONE FULTHD 5MM 37MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.530","SUP","HCPCS C1713","","04.015.530  -  SCREW BONE T25 BLUNT 5MM 8MM 40MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.532S","SUP","HCPCS C1713","","04.015.532S  -  SCREW BONE FULTHD 5MM 42MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.535","SUP","HCPCS C1713","","04.015.535  -  SCREW BONE T25 BLUNT 5MM 8MM 45MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.537S","SUP","HCPCS C1713","","04.015.537S  -  SCREW BONE FULTHD 5MM 47MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.540","SUP","HCPCS C1713","","04.015.540  -  SCREW BONE T25 BLUNT 5MM 8MM 50MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.542S","SUP","HCPCS C1713","","04.015.542S  -  SCREW BONE FULTHD 5MM 52MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.545","SUP","HCPCS C1713","","04.015.545  -  SCREW BONE T25 FULTHD 5MM 55MM 2 CORE LOCK STARDRIVE RECESS","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.547S","SUP","HCPCS C1713","","04.015.547S  -  SCREW BONE FULTHD 5MM 57MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.550","SUP","HCPCS C1713","","04.015.550  -  SCREW BONE T25 BLUNT 5MM 8MM 60MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.552S","SUP","HCPCS C1713","","04.015.552S  -  SCREW BONE FULTHD 5MM 62MM 2 CORE LOCK SELF TAP T25","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.555","SUP","HCPCS C1713","","04.015.555  -  SCREW BONE T25 BLUNT 5MM 8MM 65MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.555S","SUP","HCPCS C1713","","04.015.555S  -  SCREW BONE 5MM 65MM NLEX TI FULTHD TIB SLFTAP LCK 2 CORE","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$506.70 ","$228.02 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$88.72 ","$506.70 ","$0.00 ","$253.35 ","$401.31 ","$405.36 ","$0.00 ","$79.30 ","$0.00 ","$80.67 ","$0.00 "
"04.015.557S","SUP","HCPCS C1713","","04.015.557S  -  SCREW BONE FULTHD 5MM 67MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.560","SUP","HCPCS C1713","","04.015.560  -  SCREW BONE T25 BLUNT 5MM 8MM 70MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.562S","SUP","HCPCS C1713","","04.015.562S  -  SCREW BONE FULTHD 5MM 72MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.565","SUP","HCPCS C1713","","04.015.565  -  SCREW BONE T25 BLUNT 5MM 8MM 75MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.567S","SUP","HCPCS C1713","","04.015.567S  -  SCREW BONE FULTHD 5MM 77MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.570","SUP","HCPCS C1713","","04.015.570  -  SCREW BONE T25 BLUNT 5MM 8MM 80MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.572S","SUP","HCPCS C1713","","04.015.572S  -  SCREW BONE FULTHD 5MM 82MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.575","SUP","HCPCS C1713","","04.015.575  -  SCREW BONE T25 BLUNT 5MM 8MM 85MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.015.577S","SUP","HCPCS C1713","","04.015.577S  -  SCREW BONE FULTHD 5MM 87MM 2 CORE LOCK T25 STARDRIVE RECESS","BOTH IP/OP","$482.85 ","$357.31 ","$0.00 ","$468.78 ","$210.95 ","$0.00 ","$100.64 ","$0.00 ","$0.00 ","$82.08 ","$468.78 ","$0.00 ","$234.39 ","$371.27 ","$375.02 ","$0.00 ","$71.23 ","$0.00 ","$74.63 ","$0.00 "
"04.015.580","SUP","HCPCS C1713","","04.015.580  -  SCREW BONE T25 BLUNT 5MM 8MM 90MM 2 CORE SELF TAP LOCK","BOTH IP/OP","$388.03 ","$287.14 ","$0.00 ","$376.73 ","$169.53 ","$0.00 ","$80.87 ","$0.00 ","$0.00 ","$65.96 ","$376.73 ","$0.00 ","$188.36 ","$298.37 ","$301.38 ","$0.00 ","$57.24 ","$0.00 ","$59.97 ","$0.00 "
"04.016.034S","SUP","HCPCS C1713","","04.016.034S  -  NAIL INTRAMEDULLARY SHORT STR 8MM 9.5MM 160MM CANN MULTILOC","BOTH IP/OP","$3,667.28 ","$2,713.79 ","$0.00 ","$3,560.45 ","$1,602.20 ","$0.00 ","$764.35 ","$0.00 ","$0.00 ","$623.41 ","$3,560.45 ","$0.00 ","$1,780.23 ","$2,819.88 ","$2,848.36 ","$0.00 ","$540.98 ","$0.00 ","$566.82 ","$0.00 "
"04.016.255S","SUP","HCPCS C1713","","04.016.255S  -  NAIL INTRAMEDULLARY LONG STR 7MM 255MM CANN ROUND BARREL","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.017.240S","SUP","HCPCS C1713","","04.017.240S  -  NAIL INTRAMEDULLARY LONG STR 7MM 240MM CANN ROUND BARREL","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.018.225S","SUP","HCPCS C1713","","04.018.225S  -  NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.018.255S","SUP","HCPCS C1713","","04.018.255S  -  NAIL IM LNG STRG 8.5MM 9.5MM 255MM BLU STRL MULTILOC CNN TI","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.018.270S","SUP","HCPCS C1713","","04.018.270S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.019.030S","SUP","HCPCS C1713","","04.019.030S  -  SCREW BONE FULTHD 4.5MM 30MM BLUNT TIP SELF CUTTING","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.034S","SUP","HCPCS C1713","","04.019.034S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 34MM SELF CUT","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.036S","SUP","HCPCS C1713","","04.019.036S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 36MM SELF CUT","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.038S","SUP","HCPCS C1713","","04.019.038S  -  SCREW BONE FULTHD 4.5MM 38MM BLUNT TIP SELF CUTTING","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.040S","SUP","HCPCS C1713","","04.019.040S  -  SCREW BONE FULTHD 4.5MM 3.9MM 40MM BLUNT TIP SELF CUTTING","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.042S","SUP","HCPCS C1713","","04.019.042S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 42MM SELF CUT","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.044S","SUP","HCPCS C1713","","04.019.044S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 44MM SELF CUT","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.046S","SUP","HCPCS C1713","","04.019.046S  -  SCREW BONE FULTHD 4.5MM 46MM BLUNT TIP SELF CUTTING","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.050S","SUP","HCPCS C1713","","04.019.050S  -  SCREW BN FT 4.5MM 3.9MM 50MM AU STRL MULTILOC BLNT TIP SLF","BOTH IP/OP","$579.13 ","$428.56 ","$0.00 ","$562.25 ","$253.01 ","$0.00 ","$120.70 ","$0.00 ","$0.00 ","$98.45 ","$562.25 ","$0.00 ","$281.13 ","$445.30 ","$449.80 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"04.019.225S","SUP","HCPCS C1713","","04.019.225S  -  NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.019.240S","SUP","HCPCS C1713","","04.019.240S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 240MM CANN ROUND BARREL","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.019.255S","SUP","HCPCS C1713","","04.019.255S  -  NAIL INTRAMEDULLARY MULTILOC TITANIUM ALUMINUM NIOBIUM LONG","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.019.270S","SUP","HCPCS C1713","","04.019.270S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.019.285S","SUP","HCPCS C1713","","04.019.285S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 285MM CANN ROUND BARREL","BOTH IP/OP","$3,821.90 ","$2,828.21 ","$0.00 ","$3,710.58 ","$1,669.76 ","$0.00 ","$796.58 ","$0.00 ","$0.00 ","$649.69 ","$3,710.58 ","$0.00 ","$1,855.29 ","$2,938.78 ","$2,968.46 ","$0.00 ","$563.79 ","$0.00 ","$590.72 ","$0.00 "
"04.025.416S","SUP","HCPCS C1713","","04.025.416S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 26MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.418S","SUP","HCPCS C1713","","04.025.418S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.420S","SUP","HCPCS C1713","","04.025.420S  -  SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS LOCKING","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.422S","SUP","HCPCS C1713","","04.025.422S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.424S","SUP","HCPCS C1713","","04.025.424S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 34MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.426S","SUP","HCPCS C1713","","04.025.426S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 36MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.428S","SUP","HCPCS C1713","","04.025.428S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.430S","SUP","HCPCS C1713","","04.025.430S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.432S","SUP","HCPCS C1713","","04.025.432S  -  SCREW BONE 4MM 42MM T25 STARDRIVE RECESS ANGULAR STABLE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.434S","SUP","HCPCS C1713","","04.025.434S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 44MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.436S","SUP","HCPCS C1713","","04.025.436S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 46MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.438S","SUP","HCPCS C1713","","04.025.438S  -  SCREW BONE FULTHD 4MM 48MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.440S","SUP","HCPCS C1713","","04.025.440S  -  SCREW BONE FULTHD 4MM 50MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.442S","SUP","HCPCS C1713","","04.025.442S  -  SCREW BONE FULTHD 4MM 52MM T25 STARDRIVE RECESS LOCKING","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.444S","SUP","HCPCS C1713","","04.025.444S  -  SCREW BONE FULTHD 4MM 54MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.446S","SUP","HCPCS C1713","","04.025.446S  -  SCREW BONE FULTHD 4MM 56MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.448S","SUP","HCPCS C1713","","04.025.448S  -  SCREW BONE FULTHD 4MM 58MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.450S","SUP","HCPCS C1713","","04.025.450S  -  SCREW BONE FULTHD 4MM 60MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.452S","SUP","HCPCS C1713","","04.025.452S  -  SCREW BONE FULTHD 4MM 62MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.454S","SUP","HCPCS C1713","","04.025.454S  -  SCREW BONE FULTHD 4MM 64MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.456S","SUP","HCPCS C1713","","04.025.456S  -  SCREW BONE FULTHD 4MM 66MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.458S","SUP","HCPCS C1713","","04.025.458S  -  SCREW BONE FULTHD 4MM 68MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.460S","SUP","HCPCS C1713","","04.025.460S  -  SCREW BONE FULTHD 4MM 70MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.462S","SUP","HCPCS C1713","","04.025.462S  -  SCREW BONE FULTHD 4MM 72MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.464S","SUP","HCPCS C1713","","04.025.464S  -  SCREW BONE FULTHD 4MM 74MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.466S","SUP","HCPCS C1713","","04.025.466S  -  SCREW BONE FULTHD 4MM 76MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.468S","SUP","HCPCS C1713","","04.025.468S  -  SCREW BONE FULTHD 4MM 78MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.470S","SUP","HCPCS C1713","","04.025.470S  -  SCREW BONE FULTHD 4MM 80MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.520S","SUP","HCPCS C1713","","04.025.520S  -  SCREW BONE FULTHD 5MM 8MM 30MM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.522S","SUP","HCPCS C1713","","04.025.522S  -  SCREW BONE FULTHD 5MM 32MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.524S","SUP","HCPCS C1713","","04.025.524S  -  SCREW BONE FULTHD 5MM 34MM T25 STARDRIVE RECESS LOCKING ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.526S","SUP","HCPCS C1713","","04.025.526S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.528S","SUP","HCPCS C1713","","04.025.528S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.530S","SUP","HCPCS C1713","","04.025.530S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.532S","SUP","HCPCS C1713","","04.025.532S  -  SCREW BONE FULTHD 5MM 8MM 42MM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.534S","SUP","HCPCS C1713","","04.025.534S  -  SCREW BONE FULTHD 5MM 30MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.536S","SUP","HCPCS C1713","","04.025.536S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 46MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.538S","SUP","HCPCS C1713","","04.025.538S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.540S","SUP","HCPCS C1713","","04.025.540S  -  SCREW BONE FULTHD 5MM 50MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.542S","SUP","HCPCS C1713","","04.025.542S  -  SCREW BONE FULTHD 5MM 52MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.544S","SUP","HCPCS C1713","","04.025.544S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.546S","SUP","HCPCS C1713","","04.025.546S  -  SCREW BONE FULTHD 5MM 56MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.548S","SUP","HCPCS C1713","","04.025.548S  -  SCREW BONE FULTHD 5MM 58MM T25 STARDRIVE RECESS LOCKING ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.550S","SUP","HCPCS C1713","","04.025.550S  -  SCREW BONE FULTHD 5MM 8MM 60MM T25 STARDRIVE RECESS SLFTAP","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.552S","SUP","HCPCS C1713","","04.025.552S  -  SCREW BONE FULTHD 5MM 8MM 62MM SLFTAP BLUNT TIP T25","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.554S","SUP","HCPCS C1713","","04.025.554S  -  SCREW BONE FULTHD 5MM 64MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.556S","SUP","HCPCS C1713","","04.025.556S  -  SCREW BONE FULTHD 5MM 66MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.558S","SUP","HCPCS C1713","","04.025.558S  -  SCREW BONE FULTHD 5MM 68MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.560S","SUP","HCPCS C1713","","04.025.560S  -  SCREW BONE FULTHD 5MM 70MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.562S","SUP","HCPCS C1713","","04.025.562S  -  SCREW BONE FULTHD 5MM 72MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.564S","SUP","HCPCS C1713","","04.025.564S  -  SCREW BONE FULTHD 5MM 8MM 74MM SLFTAP BLUNT TIP T25","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.566S","SUP","HCPCS C1713","","04.025.566S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 76MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.568S","SUP","HCPCS C1713","","04.025.568S  -  SCREW BONE FULTHD 5MM 78MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.570S","SUP","HCPCS C1713","","04.025.570S  -  SCREW BONE FULTHD 5MM 80MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.575S","SUP","HCPCS C1713","","04.025.575S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM SELF TAP STARDRIVE","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.580S","SUP","HCPCS C1713","","04.025.580S  -  SCREW BONE FULTHD 5MM 90MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.585S","SUP","HCPCS C1713","","04.025.585S  -  SCREW BONE FULTHD 5MM 95MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.590S","SUP","HCPCS C1713","","04.025.590S  -  SCREW BONE FULTHD 5MM 100MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$418.65 ","$309.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$87.26 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.622S","SUP","HCPCS C1713","","04.025.622S  -  SCREW BONE FULTHD 6MM 32MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.624S","SUP","HCPCS C1713","","04.025.624S  -  SCREW BONE FULTHD 6MM 34MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.626S","SUP","HCPCS C1713","","04.025.626S  -  SCREW BONE FULTHD 6MM 36MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.628S","SUP","HCPCS C1713","","04.025.628S  -  SCREW BONE FULTHD 6MM 38MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.630S","SUP","HCPCS C1713","","04.025.630S  -  SCREW BONE FULTHD 6MM 40MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.632S","SUP","HCPCS C1713","","04.025.632S  -  SCREW BONE FULTHD 6MM 42MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.634S","SUP","HCPCS C1713","","04.025.634S  -  SCREW BONE FULTHD 6MM 44MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.636S","SUP","HCPCS C1713","","04.025.636S  -  SCREW BONE FULTHD 6MM 46MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.638S","SUP","HCPCS C1713","","04.025.638S  -  SCREW BONE FULTHD 6MM 48MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.640S","SUP","HCPCS C1713","","04.025.640S  -  SCREW BONE FULTHD 6MM 50MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.642S","SUP","HCPCS C1713","","04.025.642S  -  SCREW BONE FULTHD 6MM 52MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.644S","SUP","HCPCS C1713","","04.025.644S  -  SCREW BONE FULTHD 6MM 54MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.646S","SUP","HCPCS C1713","","04.025.646S  -  SCREW BONE FULTHD 6MM 56MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.648S","SUP","HCPCS C1713","","04.025.648S  -  SCREW BONE FULTHD 6MM 58MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.650S","SUP","HCPCS C1713","","04.025.650S  -  SCREW BONE FULTHD 6MM 60MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.652S","SUP","HCPCS C1713","","04.025.652S  -  SCREW BONE FULTHD 6MM 62MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.654S","SUP","HCPCS C1713","","04.025.654S  -  SCREW BONE FULTHD 6MM 64MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.656S","SUP","HCPCS C1713","","04.025.656S  -  SCREW BONE FULTHD 6MM 66MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.658S","SUP","HCPCS C1713","","04.025.658S  -  SCREW BONE FULTHD 6MM 68MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.660S","SUP","HCPCS C1713","","04.025.660S  -  SCREW BONE FULTHD 6MM 70MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.662S","SUP","HCPCS C1713","","04.025.662S  -  SCREW BONE FULTHD 6MM 72MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.664S","SUP","HCPCS C1713","","04.025.664S  -  SCREW BONE FULTHD 6MM 74MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.666S","SUP","HCPCS C1713","","04.025.666S  -  SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.668S","SUP","HCPCS C1713","","04.025.668S  -  SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.670S","SUP","HCPCS C1713","","04.025.670S  -  SCREW BONE FULTHD 6MM 80MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.675S","SUP","HCPCS C1713","","04.025.675S  -  SCREW BONE FULTHD 6MM 85MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.680S","SUP","HCPCS C1713","","04.025.680S  -  SCREW BONE FULTHD 6MM 90MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.685S","SUP","HCPCS C1713","","04.025.685S  -  SCREW BONE FULTHD 6MM 95MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.690S","SUP","HCPCS C1713","","04.025.690S  -  SCREW BONE FULTHD 6MM 100MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.695S","SUP","HCPCS C1713","","04.025.695S  -  SCREW BONE FULTHD 6MM 105MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.700S","SUP","HCPCS C1713","","04.025.700S  -  SCREW BONE FULTHD 6MM 110MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.705S","SUP","HCPCS C1713","","04.025.705S  -  SCREW BONE FULTHD 6MM 115MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.710S","SUP","HCPCS C1713","","04.025.710S  -  SCREW BONE FULTHD 6MM 120MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.025.715S","SUP","HCPCS C1713","","04.025.715S  -  SCREW BONE FULTHD 6MM 125MM LOCKING STARDRIVE RECESS ASLS","BOTH IP/OP","$406.48 ","$300.80 ","$0.00 ","$406.48 ","$182.91 ","$0.00 ","$84.72 ","$0.00 ","$0.00 ","$71.17 ","$406.48 ","$0.00 ","$203.24 ","$321.93 ","$325.18 ","$0.00 ","$61.76 ","$0.00 ","$64.71 ","$0.00 "
"04.030.030S","SUP","HCPCS C1713","","04.030.030S  -  NAIL 10MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.031S","SUP","HCPCS C1713","","04.030.031S  -  NAIL 10MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.032S","SUP","HCPCS C1713","","04.030.032S  -  NAIL 10MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.033S","SUP","HCPCS C1713","","04.030.033S  -  NAIL 10MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.034S","SUP","HCPCS C1713","","04.030.034S  -  NAIL 10MM 34CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.035S","SUP","HCPCS C1713","","04.030.035S  -  NAIL 10MM 34CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.036S","SUP","HCPCS C1713","","04.030.036S  -  NAIL 10MM 36CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.037S","SUP","HCPCS C1713","","04.030.037S  -  NAIL 10MM 36CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.038S","SUP","HCPCS C1713","","04.030.038S  -  NAIL 10MM 38CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.039S","SUP","HCPCS C1713","","04.030.039S  -  NAIL 10MM 38CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.040S","SUP","HCPCS C1713","","04.030.040S  -  NAIL 10MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.041S","SUP","HCPCS C1713","","04.030.041S  -  NAIL 10MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.042S","SUP","HCPCS C1713","","04.030.042S  -  NAIL 10MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.043S","SUP","HCPCS C1713","","04.030.043S  -  NAIL 10MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL GRN","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.044S","SUP","HCPCS C1713","","04.030.044S  -  NAIL 10MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.045S","SUP","HCPCS C1713","","04.030.045S  -  NAIL 10MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.046S","SUP","HCPCS C1713","","04.030.046S  -  NAIL 10MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.047S","SUP","HCPCS C1713","","04.030.047S  -  NAIL 10MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.048S","SUP","HCPCS C1713","","04.030.048S  -  NAIL 10MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.049S","SUP","HCPCS C1713","","04.030.049S  -  NAIL 10MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.130S","SUP","HCPCS C1713","","04.030.130S  -  NAIL 11MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.131S","SUP","HCPCS C1713","","04.030.131S  -  NAIL 11MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.132S","SUP","HCPCS C1713","","04.030.132S  -  NAIL 11MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.133S","SUP","HCPCS C1713","","04.030.133S  -  NAIL 11MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.134S","SUP","HCPCS C1713","","04.030.134S  -  NAIL IM 11MM 340MM LGHT GRN STRL NLEX CNN LAT ENTRY TI AL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.135S","SUP","HCPCS C1713","","04.030.135S  -  NAIL 11MM 34CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.136S","SUP","HCPCS C1713","","04.030.136S  -  NAIL 11MM 36CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.137S","SUP","HCPCS C1713","","04.030.137S  -  NAIL 11MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.138S","SUP","HCPCS C1713","","04.030.138S  -  NAIL 11MM 38CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.139S","SUP","HCPCS C1713","","04.030.139S  -  NAIL 11MM 38CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.140S","SUP","HCPCS C1713","","04.030.140S  -  NAIL 11MM 40CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.141S","SUP","HCPCS C1713","","04.030.141S  -  NAIL 11MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.142S","SUP","HCPCS C1713","","04.030.142S  -  NAIL 11MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.143S","SUP","HCPCS C1713","","04.030.143S  -  NAIL 11MM 42CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.144S","SUP","HCPCS C1713","","04.030.144S  -  NAIL 11MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.145S","SUP","HCPCS C1713","","04.030.145S  -  NAIL 11MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.146S","SUP","HCPCS C1713","","04.030.146S  -  NAIL 11MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.147S","SUP","HCPCS C1713","","04.030.147S  -  NAIL 11MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.148S","SUP","HCPCS C1713","","04.030.148S  -  NAIL 11MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.149S","SUP","HCPCS C1713","","04.030.149S  -  NAIL 11MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.230S","SUP","HCPCS C1713","","04.030.230S  -  NAIL 12MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.231S","SUP","HCPCS C1713","","04.030.231S  -  NAIL 12MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.232S","SUP","HCPCS C1713","","04.030.232S  -  NAIL 12MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.233S","SUP","HCPCS C1713","","04.030.233S  -  NAIL 12MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.234S","SUP","HCPCS C1713","","04.030.234S  -  NAIL 12MM 34CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.235S","SUP","HCPCS C1713","","04.030.235S  -  NAIL 12MM 34CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.236S","SUP","HCPCS C1713","","04.030.236S  -  NAIL 12MM 36CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.237S","SUP","HCPCS C1713","","04.030.237S  -  NAIL 12MM 36CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.238S","SUP","HCPCS C1713","","04.030.238S  -  NAIL 12MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.239S","SUP","HCPCS C1713","","04.030.239S  -  NAIL 12MM 38CM LEFT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.240S","SUP","HCPCS C1713","","04.030.240S  -  NAIL 12MM 40CM RIGHT FEM NLEX IM CANN TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.241S","SUP","HCPCS C1713","","04.030.241S  -  NAIL 12MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.242S","SUP","HCPCS C1713","","04.030.242S  -  NAIL 12MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.243S","SUP","HCPCS C1713","","04.030.243S  -  NAIL 12MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.244S","SUP","HCPCS C1713","","04.030.244S  -  NAIL 12MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.245S","SUP","HCPCS C1713","","04.030.245S  -  NAIL 12MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.246S","SUP","HCPCS C1713","","04.030.246S  -  NAIL 12MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.247S","SUP","HCPCS C1713","","04.030.247S  -  NAIL 12MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.248S","SUP","HCPCS C1713","","04.030.248S  -  NAIL 12MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.249S","SUP","HCPCS C1713","","04.030.249S  -  NAIL 12MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.330S","SUP","HCPCS C1713","","04.030.330S  -  NAIL 13MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.331S","SUP","HCPCS C1713","","04.030.331S  -  NAIL 13MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.332S","SUP","HCPCS C1713","","04.030.332S  -  NAIL 13MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.333S","SUP","HCPCS C1713","","04.030.333S  -  NAIL 13MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.334S","SUP","HCPCS C1713","","04.030.334S  -  NAIL 13MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.335S","SUP","HCPCS C1713","","04.030.335S  -  NAIL 13MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.336S","SUP","HCPCS C1713","","04.030.336S  -  NAIL 13MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.337S","SUP","HCPCS C1713","","04.030.337S  -  NAIL 13MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.338S","SUP","HCPCS C1713","","04.030.338S  -  NAIL 13MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.339S","SUP","HCPCS C1713","","04.030.339S  -  NAIL 13MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.340S","SUP","HCPCS C1713","","04.030.340S  -  NAIL 13MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.341S","SUP","HCPCS C1713","","04.030.341S  -  NAIL 13MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.342S","SUP","HCPCS C1713","","04.030.342S  -  NAIL 13MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.343S","SUP","HCPCS C1713","","04.030.343S  -  NAIL 13MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.344S","SUP","HCPCS C1713","","04.030.344S  -  NAIL 13MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.345S","SUP","HCPCS C1713","","04.030.345S  -  NAIL 13MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.346S","SUP","HCPCS C1713","","04.030.346S  -  NAIL 13MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.347S","SUP","HCPCS C1713","","04.030.347S  -  NAIL 13MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.348S","SUP","HCPCS C1713","","04.030.348S  -  NAIL 13MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.349S","SUP","HCPCS C1713","","04.030.349S  -  NAIL 13MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.430S","SUP","HCPCS C1713","","04.030.430S  -  NAIL 14MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.431S","SUP","HCPCS C1713","","04.030.431S  -  NAIL 14MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.432S","SUP","HCPCS C1713","","04.030.432S  -  NAIL 14MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.433S","SUP","HCPCS C1713","","04.030.433S  -  NAIL 14MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.434S","SUP","HCPCS C1713","","04.030.434S  -  NAIL 14MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.435S","SUP","HCPCS C1713","","04.030.435S  -  NAIL 14MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.436S","SUP","HCPCS C1713","","04.030.436S  -  NAIL 14MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.437S","SUP","HCPCS C1713","","04.030.437S  -  NAIL 14MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.438S","SUP","HCPCS C1713","","04.030.438S  -  NAIL 14MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.439S","SUP","HCPCS C1713","","04.030.439S  -  NAIL 14MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.440S","SUP","HCPCS C1713","","04.030.440S  -  NAIL 14MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.441S","SUP","HCPCS C1713","","04.030.441S  -  NAIL 14MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.442S","SUP","HCPCS C1713","","04.030.442S  -  NAIL 14MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.443S","SUP","HCPCS C1713","","04.030.443S  -  NAIL 14MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.444S","SUP","HCPCS C1713","","04.030.444S  -  NAIL 14MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.445S","SUP","HCPCS C1713","","04.030.445S  -  NAIL 14MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.446S","SUP","HCPCS C1713","","04.030.446S  -  NAIL 14MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.447S","SUP","HCPCS C1713","","04.030.447S  -  NAIL 14MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.448S","SUP","HCPCS C1713","","04.030.448S  -  NAIL 14MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.449S","SUP","HCPCS C1713","","04.030.449S  -  NAIL 14MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.530S","SUP","HCPCS C1713","","04.030.530S  -  NAIL 15MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.531S","SUP","HCPCS C1713","","04.030.531S  -  NAIL 15MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.532S","SUP","HCPCS C1713","","04.030.532S  -  NAIL 15MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.533S","SUP","HCPCS C1713","","04.030.533S  -  NAIL 15MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.534S","SUP","HCPCS C1713","","04.030.534S  -  NAIL 15MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.535S","SUP","HCPCS C1713","","04.030.535S  -  NAIL 15MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.536S","SUP","HCPCS C1713","","04.030.536S  -  NAIL 15MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.537S","SUP","HCPCS C1713","","04.030.537S  -  NAIL 15MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.538S","SUP","HCPCS C1713","","04.030.538S  -  NAIL 15MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.539S","SUP","HCPCS C1713","","04.030.539S  -  NAIL 15MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.540S","SUP","HCPCS C1713","","04.030.540S  -  NAIL 15MM 40CM FEM NLEX IM CANN PROX BND TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.541S","SUP","HCPCS C1713","","04.030.541S  -  NAIL 15MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.542S","SUP","HCPCS C1713","","04.030.542S  -  NAIL 15MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.543S","SUP","HCPCS C1713","","04.030.543S  -  NAIL 15MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.544S","SUP","HCPCS C1713","","04.030.544S  -  NAIL 15MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.545S","SUP","HCPCS C1713","","04.030.545S  -  NAIL 15MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.546S","SUP","HCPCS C1713","","04.030.546S  -  NAIL 15MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.547S","SUP","HCPCS C1713","","04.030.547S  -  NAIL 15MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.548S","SUP","HCPCS C1713","","04.030.548S  -  NAIL 15MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.549S","SUP","HCPCS C1713","","04.030.549S  -  NAIL 15MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.630S","SUP","HCPCS C1713","","04.030.630S  -  NAIL 16MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.631S","SUP","HCPCS C1713","","04.030.631S  -  NAIL 16MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.632S","SUP","HCPCS C1713","","04.030.632S  -  NAIL 16MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.633S","SUP","HCPCS C1713","","04.030.633S  -  NAIL 16MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.634S","SUP","HCPCS C1713","","04.030.634S  -  NAIL 16MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.635S","SUP","HCPCS C1713","","04.030.635S  -  NAIL 16MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.636S","SUP","HCPCS C1713","","04.030.636S  -  NAIL 16MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.637S","SUP","HCPCS C1713","","04.030.637S  -  NAIL 16MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.638S","SUP","HCPCS C1713","","04.030.638S  -  NAIL 16MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.639S","SUP","HCPCS C1713","","04.030.639S  -  NAIL 16MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.640S","SUP","HCPCS C1713","","04.030.640S  -  NAIL 16MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.641S","SUP","HCPCS C1713","","04.030.641S  -  NAIL 16MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.642S","SUP","HCPCS C1713","","04.030.642S  -  NAIL 16MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.643S","SUP","HCPCS C1713","","04.030.643S  -  NAIL 16MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.644S","SUP","HCPCS C1713","","04.030.644S  -  NAIL 16MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.645S","SUP","HCPCS C1713","","04.030.645S  -  NAIL 16MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.646S","SUP","HCPCS C1713","","04.030.646S  -  NAIL 16MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.647S","SUP","HCPCS C1713","","04.030.647S  -  NAIL 16MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.648S","SUP","HCPCS C1713","","04.030.648S  -  NAIL 16MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.649S","SUP","HCPCS C1713","","04.030.649S  -  NAIL 16MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.930S","SUP","HCPCS C1713","","04.030.930S  -  NAIL 9MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.931S","SUP","HCPCS C1713","","04.030.931S  -  NAIL 9MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.932S","SUP","HCPCS C1713","","04.030.932S  -  NAIL 9MM 320MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.933S","SUP","HCPCS C1713","","04.030.933S  -  NAIL 9MM 320MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.934S","SUP","HCPCS C1713","","04.030.934S  -  NAIL 9MM 340MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.935S","SUP","HCPCS C1713","","04.030.935S  -  NAIL 9MM 340MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.936S","SUP","HCPCS C1713","","04.030.936S  -  NAIL 9MM 360MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.937S","SUP","HCPCS C1713","","04.030.937S  -  NAIL 9MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.938S","SUP","HCPCS C1713","","04.030.938S  -  NAIL 9MM 380MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.939S","SUP","HCPCS C1713","","04.030.939S  -  NAIL 9MM 380MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.940S","SUP","HCPCS C1713","","04.030.940S  -  NAIL 9MM 400MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.941S","SUP","HCPCS C1713","","04.030.941S  -  NAIL 9MM 400MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.942S","SUP","HCPCS C1713","","04.030.942S  -  NAIL 9MM 420MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.943S","SUP","HCPCS C1713","","04.030.943S  -  NAIL 9MM 420MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.944S","SUP","HCPCS C1713","","04.030.944S  -  NAIL 9MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.945S","SUP","HCPCS C1713","","04.030.945S  -  NAIL 9MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.946S","SUP","HCPCS C1713","","04.030.946S  -  NAIL 9MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.947S","SUP","HCPCS C1713","","04.030.947S  -  NAIL 9MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.948S","SUP","HCPCS C1713","","04.030.948S  -  NAIL 9MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.030.949S","SUP","HCPCS C1713","","04.030.949S  -  NAIL 9MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL","BOTH IP/OP","$3,685.58 ","$2,727.33 ","$0.00 ","$3,685.58 ","$1,658.51 ","$0.00 ","$768.17 ","$0.00 ","$0.00 ","$645.31 ","$3,685.58 ","$0.00 ","$1,842.79 ","$2,918.98 ","$2,948.46 ","$0.00 ","$576.79 ","$0.00 ","$586.74 ","$0.00 "
"04.031.000S","SUP","HCPCS C1713","","04.031.000S  -  CAP END 0MM T40 STARDRIVE RECESS CANN LATERAL ENTRY NAIL-EX","BOTH IP/OP","$389.38 ","$288.14 ","$0.00 ","$378.03 ","$170.11 ","$0.00 ","$81.16 ","$0.00 ","$0.00 ","$66.19 ","$378.03 ","$0.00 ","$189.01 ","$299.40 ","$302.42 ","$0.00 ","$57.44 ","$0.00 ","$60.18 ","$0.00 "
"04.031.001S","SUP","HCPCS C1713","","04.031.001S  -  CAP END 5MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX","BOTH IP/OP","$389.38 ","$288.14 ","$0.00 ","$378.03 ","$170.11 ","$0.00 ","$81.16 ","$0.00 ","$0.00 ","$66.19 ","$378.03 ","$0.00 ","$189.01 ","$299.40 ","$302.42 ","$0.00 ","$57.44 ","$0.00 ","$60.18 ","$0.00 "
"04.031.002S","SUP","HCPCS C1713","","04.031.002S  -  CAP END 10MM T40 EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM","BOTH IP/OP","$389.38 ","$288.14 ","$0.00 ","$378.03 ","$170.11 ","$0.00 ","$81.16 ","$0.00 ","$0.00 ","$66.19 ","$378.03 ","$0.00 ","$189.01 ","$299.40 ","$302.42 ","$0.00 ","$57.44 ","$0.00 ","$60.18 ","$0.00 "
"04.031.003S","SUP","HCPCS C1713","","04.031.003S  -  CAP END 15MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX","BOTH IP/OP","$389.38 ","$288.14 ","$0.00 ","$378.03 ","$170.11 ","$0.00 ","$81.16 ","$0.00 ","$0.00 ","$66.19 ","$378.03 ","$0.00 ","$189.01 ","$299.40 ","$302.42 ","$0.00 ","$57.44 ","$0.00 ","$60.18 ","$0.00 "
"04.031.021","SUP","HCPCS C1713","","04.031.021  -  SCREW BONE PTHRD 5MM 55MM T25 STARDRIVE RECESS SLFTAP BLUNT","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.022","SUP","HCPCS C1713","","04.031.022  -  SCREW BONE PTHRD 5MM 60MM T25 STARDRIVE RECESS SLFTAP BLUNT","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.023","SUP","HCPCS C1713","","04.031.023  -  SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 65MM SELF TAP SELF","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.024","SUP","HCPCS C1713","","04.031.024  -  SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 70MM SELF TAP SELF","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.025","SUP","HCPCS C1713","","04.031.025  -  SCREW BONE PTHRD 5MM 75MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.026","SUP","HCPCS C1713","","04.031.026  -  SCREW BONE PTHRD 5MM 80MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.027","SUP","HCPCS C1713","","04.031.027  -  SCREW BONE PTHRD 5MM 85MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.028","SUP","HCPCS C1713","","04.031.028  -  SCREW BONE PTHRD 5MM 90MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.029","SUP","HCPCS C1713","","04.031.029  -  SCREW BONE PTHRD 5MM 3.2MM 95MM T25 STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.030","SUP","HCPCS C1713","","04.031.030  -  SCREW BONE PTHRD 5MM 100MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.031","SUP","HCPCS C1713","","04.031.031  -  SCREW BONE PTHRD 5MM 105MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.032","SUP","HCPCS C1713","","04.031.032  -  SCREW BONE PTHRD 5MM 110MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.033","SUP","HCPCS C1713","","04.031.033  -  SCREW BONE PTHRD 5MM 115MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.034","SUP","HCPCS C1713","","04.031.034  -  SCREW BONE PTHRD 5MM 120MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.035","SUP","HCPCS C1713","","04.031.035  -  SCREW BONE PTHRD 5MM 125MM RECONSTRUCTION STARDRIVE RECESS","BOTH IP/OP","$321.90 ","$238.21 ","$0.00 ","$312.53 ","$140.64 ","$0.00 ","$67.09 ","$0.00 ","$0.00 ","$54.72 ","$312.53 ","$0.00 ","$156.26 ","$247.52 ","$250.02 ","$0.00 ","$47.49 ","$0.00 ","$49.75 ","$0.00 "
"04.031.924S","SUP","HCPCS C1713","","04.031.924S  -  NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.925S","SUP","HCPCS C1713","","04.031.925S  -  NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.926S","SUP","HCPCS C1713","","04.031.926S  -  NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.927S","SUP","HCPCS C1713","","04.031.927S  -  NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.928S","SUP","HCPCS C1713","","04.031.928S  -  NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.929S","SUP","HCPCS C1713","","04.031.929S  -  NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.930S","SUP","HCPCS C1713","","04.031.930S  -  NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.931S","SUP","HCPCS C1713","","04.031.931S  -  NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.932S","SUP","HCPCS C1713","","04.031.932S  -  NAIL INTRAMEDULLARY 8.2MM 320MM LATERAL ENTRY TITANIUM","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.933S","SUP","HCPCS C1713","","04.031.933S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.934S","SUP","HCPCS C1713","","04.031.934S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.935S","SUP","HCPCS C1713","","04.031.935S  -  NAIL INTRAMEDULLARY 8.2MM 340MM LATERAL ENTRY NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.936S","SUP","HCPCS C1713","","04.031.936S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.937S","SUP","HCPCS C1713","","04.031.937S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.938S","SUP","HCPCS C1713","","04.031.938S  -  NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.939S","SUP","HCPCS C1713","","04.031.939S  -  NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.940S","SUP","HCPCS C1713","","04.031.940S  -  NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.941S","SUP","HCPCS C1713","","04.031.941S  -  NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.944S","SUP","HCPCS C1713","","04.031.944S  -  NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.945S","SUP","HCPCS C1713","","04.031.945S  -  NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.946S","SUP","HCPCS C1713","","04.031.946S  -  NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY CANN EXPERT DARK","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.947S","SUP","HCPCS C1713","","04.031.947S  -  NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.948S","SUP","HCPCS C1713","","04.031.948S  -  NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.949S","SUP","HCPCS C1713","","04.031.949S  -  NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.950S","SUP","HCPCS C1713","","04.031.950S  -  NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY CANN HELICAL","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.951S","SUP","HCPCS C1713","","04.031.951S  -  NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.952S","SUP","HCPCS C1713","","04.031.952S  -  NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.953S","SUP","HCPCS C1713","","04.031.953S  -  NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.954S","SUP","HCPCS C1713","","04.031.954S  -  NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY TITANIUM","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.955S","SUP","HCPCS C1713","","04.031.955S  -  NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.956S","SUP","HCPCS C1713","","04.031.956S  -  NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.957S","SUP","HCPCS C1713","","04.031.957S  -  NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY NAIL-EX TITANIUM","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.958S","SUP","HCPCS C1713","","04.031.958S  -  NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY NAIL-EX TITANIUM","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.959S","SUP","HCPCS C1713","","04.031.959S  -  NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.960S","SUP","HCPCS C1713","","04.031.960S  -  NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.961S","SUP","HCPCS C1713","","04.031.961S  -  NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,807.18 ","$2,077.31 ","$0.00 ","$2,725.40 ","$1,226.43 ","$0.00 ","$585.09 ","$0.00 ","$0.00 ","$477.20 ","$2,725.40 ","$0.00 ","$1,362.70 ","$2,158.52 ","$2,180.32 ","$0.00 ","$414.10 ","$0.00 ","$433.88 ","$0.00 "
"04.031.964S","SUP","HCPCS C1713","","04.031.964S  -  NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.965S","SUP","HCPCS C1713","","04.031.965S  -  NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.966S","SUP","HCPCS C1713","","04.031.966S  -  NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.967S","SUP","HCPCS C1713","","04.031.967S  -  NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.968S","SUP","HCPCS C1713","","04.031.968S  -  NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.969S","SUP","HCPCS C1713","","04.031.969S  -  NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.970S","SUP","HCPCS C1713","","04.031.970S  -  NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.971S","SUP","HCPCS C1713","","04.031.971S  -  NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.972S","SUP","HCPCS C1713","","04.031.972S  -  NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.973S","SUP","HCPCS C1713","","04.031.973S  -  NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.974S","SUP","HCPCS C1713","","04.031.974S  -  NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.975S","SUP","HCPCS C1713","","04.031.975S  -  NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.976S","SUP","HCPCS C1713","","04.031.976S  -  NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.977S","SUP","HCPCS C1713","","04.031.977S  -  NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.978S","SUP","HCPCS C1713","","04.031.978S  -  NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.979S","SUP","HCPCS C1713","","04.031.979S  -  NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.980S","SUP","HCPCS C1713","","04.031.980S  -  NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.031.981S","SUP","HCPCS C1713","","04.031.981S  -  NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX","BOTH IP/OP","$2,892.93 ","$2,140.77 ","$0.00 ","$2,808.65 ","$1,263.89 ","$0.00 ","$602.96 ","$0.00 ","$0.00 ","$491.77 ","$2,808.65 ","$0.00 ","$1,404.33 ","$2,224.45 ","$2,246.92 ","$0.00 ","$426.75 ","$0.00 ","$447.14 ","$0.00 "
"04.032.001S","SUP","HCPCS C1713","","04.032.001S  -  SCREW SET 130D TITANIUM INTRAMEDULLARY STERILE TROC NAIL","BOTH IP/OP","$322.38 ","$238.56 ","$0.00 ","$313.00 ","$140.85 ","$0.00 ","$67.19 ","$0.00 ","$0.00 ","$54.80 ","$313.00 ","$0.00 ","$156.50 ","$247.90 ","$250.40 ","$0.00 ","$47.56 ","$0.00 ","$49.83 ","$0.00 "
"04.032.070S","SUP","HCPCS C1713","","04.032.070S  -  SCREW BONE THREAD 11MM 70X130MM FIX SELFTAPPING INVERSE","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.075S","SUP","HCPCS C1713","","04.032.075S  -  SCREW BONE 11MM 75MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.080S","SUP","HCPCS C1713","","04.032.080S  -  SCREW BONE 11MM 80MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.085S","SUP","HCPCS C1713","","04.032.085S  -  SCREW BONE 11MM 85MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.090S","SUP","HCPCS C1713","","04.032.090S  -  SCREW BONE 11MM 90MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.095S","SUP","HCPCS C1713","","04.032.095S  -  SCREW BONE 11MM 95MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.100S","SUP","HCPCS C1713","","04.032.100S  -  SCREW BONE 11MM 100MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.105S","SUP","HCPCS C1713","","04.032.105S  -  SCREW BONE 11MM 105MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.110S","SUP","HCPCS C1713","","04.032.110S  -  SCREW BONE 11MM 110MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.115S","SUP","HCPCS C1713","","04.032.115S  -  SCREW BONE 11MM 115MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.120S","SUP","HCPCS C1713","","04.032.120S  -  SCREW BONE 11MM 120MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.125S","SUP","HCPCS C1713","","04.032.125S  -  SCREW BONE 11MM 125MM TITANIUM FEMUR TROCHANTER PROXIMAL","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.032.130S","SUP","HCPCS C1713","","04.032.130S  -  SCREW BN 11MM 130MM AU STRL CNN SELP TAP INVERSE ANG THRD TI","BOTH IP/OP","$1,102.80 ","$816.07 ","$0.00 ","$1,070.68 ","$481.80 ","$0.00 ","$229.85 ","$0.00 ","$0.00 ","$187.47 ","$1,070.68 ","$0.00 ","$535.34 ","$847.98 ","$856.54 ","$0.00 ","$162.68 ","$0.00 ","$170.45 ","$0.00 "
"04.034.231S","SUP","HCPCS C1713","","04.034.231S  -  NAIL INTRAMEDULLARY 8MM 255MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.034.234S","SUP","HCPCS C1713","","04.034.234S  -  NAIL INTRAMEDULLARY 8MM 27CM CANN PROXIMAL BEND NAIL-EX DARK","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.034.237S","SUP","HCPCS C1713","","04.034.237S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.240S","SUP","HCPCS C1713","","04.034.240S  -  NAIL INTRAMEDULLARY 8MM 30CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.243S","SUP","HCPCS C1713","","04.034.243S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.246S","SUP","HCPCS C1713","","04.034.246S  -  NAIL INTRAMEDULLARY 8MM 33CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.249S","SUP","HCPCS C1713","","04.034.249S  -  NAIL INTRAMEDULLARY 8MM 34.5CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.252S","SUP","HCPCS C1713","","04.034.252S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 8MM 36CM CANN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.255S","SUP","HCPCS C1713","","04.034.255S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.258S","SUP","HCPCS C1713","","04.034.258S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.261S","SUP","HCPCS C1713","","04.034.261S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 405MM CANN PROXIMAL BEND","BOTH IP/OP","$2,917.48 ","$2,158.94 ","$0.00 ","$2,832.50 ","$1,274.63 ","$0.00 ","$608.07 ","$0.00 ","$0.00 ","$495.95 ","$2,832.50 ","$0.00 ","$1,416.25 ","$2,243.34 ","$2,266.00 ","$0.00 ","$430.38 ","$0.00 ","$450.93 ","$0.00 "
"04.034.264S","SUP","HCPCS C1713","","04.034.264S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 420MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.267S","SUP","HCPCS C1713","","04.034.267S  -  NAIL INTRAMEDULLARY 8MM 43.5CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.331S","SUP","HCPCS C1713","","04.034.331S  -  NAIL INTRAMEDULLARY 9MM 25.5CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.334S","SUP","HCPCS C1713","","04.034.334S  -  NAIL INTRAMEDULLARY 9MM 27CM CANN PROXIMAL BEND NAIL-EX DARK","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.337S","SUP","HCPCS C1713","","04.034.337S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.340S","SUP","HCPCS C1713","","04.034.340S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.343S","SUP","HCPCS C1713","","04.034.343S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.346S","SUP","HCPCS C1713","","04.034.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.349S","SUP","HCPCS C1713","","04.034.349S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.352S","SUP","HCPCS C1713","","04.034.352S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND 9MM 36CM CANN PROXIMAL","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.355S","SUP","HCPCS C1713","","04.034.355S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.358S","SUP","HCPCS C1713","","04.034.358S  -  NAIL INTRAMEDULLARY 9MM 39CM PROXIMAL BEND CANN EXPERT","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.361S","SUP","HCPCS C1713","","04.034.361S  -  NAIL INTRAMEDULLARY 9MM 40.5CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.364S","SUP","HCPCS C1713","","04.034.364S  -  NAIL INTRAMEDULLARY 9MM 420MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.367S","SUP","HCPCS C1713","","04.034.367S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 435MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.431S","SUP","HCPCS C1713","","04.034.431S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.434S","SUP","HCPCS C1713","","04.034.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN PROXIMAL BEND","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.034.437S","SUP","HCPCS C1713","","04.034.437S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.440S","SUP","HCPCS C1713","","04.034.440S  -  NAIL INTRAMEDULLARY 10MM 30CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.443S","SUP","HCPCS C1713","","04.034.443S  -  NAIL INTRAMEDULLARY 10MM 315MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.446S","SUP","HCPCS C1713","","04.034.446S  -  NAIL INTRAMEDULLARY 10MM 33CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.449S","SUP","HCPCS C1713","","04.034.449S  -  NAIL INTRAMEDULLARY 10MM 34.5CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.452S","SUP","HCPCS C1713","","04.034.452S  -  NAIL INTRAMEDULLARY 10MM 360MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.455S","SUP","HCPCS C1713","","04.034.455S  -  NAIL INTRAMEDULLARY 10MM 375MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.458S","SUP","HCPCS C1713","","04.034.458S  -  NAIL INTRAMEDULLARY 10MM 390MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.461S","SUP","HCPCS C1713","","04.034.461S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.464S","SUP","HCPCS C1713","","04.034.464S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN PROXIMAL BEND","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.034.467S","SUP","HCPCS C1713","","04.034.467S  -  NAIL INTRAMEDULLARY 10MM 435MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.531S","SUP","HCPCS C1713","","04.034.531S  -  NAIL INTRAMEDULLARY 11MM 255MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.534S","SUP","HCPCS C1713","","04.034.534S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 270MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.537S","SUP","HCPCS C1713","","04.034.537S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 285MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.540S","SUP","HCPCS C1713","","04.034.540S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 300MM CANN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.543S","SUP","HCPCS C1713","","04.034.543S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.546S","SUP","HCPCS C1713","","04.034.546S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.549S","SUP","HCPCS C1713","","04.034.549S  -  NAIL INTRAMEDULLARY 11MM 345MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.552S","SUP","HCPCS C1713","","04.034.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.555S","SUP","HCPCS C1713","","04.034.555S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.558S","SUP","HCPCS C1713","","04.034.558S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 390MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.561S","SUP","HCPCS C1713","","04.034.561S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.564S","SUP","HCPCS C1713","","04.034.564S  -  NAIL INTRAMEDULLARY 11MM 420MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.567S","SUP","HCPCS C1713","","04.034.567S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 235MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.631S","SUP","HCPCS C1713","","04.034.631S  -  NAIL INTRAMEDULLARY 12MM 255MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.634S","SUP","HCPCS C1713","","04.034.634S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 270MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.637S","SUP","HCPCS C1713","","04.034.637S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 285MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.640S","SUP","HCPCS C1713","","04.034.640S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.643S","SUP","HCPCS C1713","","04.034.643S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 315MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.646S","SUP","HCPCS C1713","","04.034.646S  -  NAIL INTRAMEDULLARY 12MM 33CM CANN PROXIMAL BEND EXPERT","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.649S","SUP","HCPCS C1713","","04.034.649S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.652S","SUP","HCPCS C1713","","04.034.652S  -  NAIL INTRAMEDULLARY 12MM 360MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.655S","SUP","HCPCS C1713","","04.034.655S  -  NAIL INTRAMEDULLARY 12MM 375MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.658S","SUP","HCPCS C1713","","04.034.658S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.661S","SUP","HCPCS C1713","","04.034.661S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.664S","SUP","HCPCS C1713","","04.034.664S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.667S","SUP","HCPCS C1713","","04.034.667S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.731S","SUP","HCPCS C1713","","04.034.731S  -  NAIL INTRAMEDULLARY 13MM 255MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.734S","SUP","HCPCS C1713","","04.034.734S  -  NAIL INTRAMEDULLARY 13MM 270MM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.034.737S","SUP","HCPCS C1713","","04.034.737S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN PROXIMAL BEND","BOTH IP/OP","$2,917.48 ","$2,158.94 ","$0.00 ","$2,832.50 ","$1,274.63 ","$0.00 ","$608.07 ","$0.00 ","$0.00 ","$495.95 ","$2,832.50 ","$0.00 ","$1,416.25 ","$2,243.34 ","$2,266.00 ","$0.00 ","$430.38 ","$0.00 ","$450.93 ","$0.00 "
"04.034.740S","SUP","HCPCS C1713","","04.034.740S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.743S","SUP","HCPCS C1713","","04.034.743S  -  NAIL INTRAMEDULLARY 13MM 31.5CM CANN PROXIMAL BEND TITANIUM","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.746S","SUP","HCPCS C1713","","04.034.746S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.749S","SUP","HCPCS C1713","","04.034.749S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.752S","SUP","HCPCS C1713","","04.034.752S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.755S","SUP","HCPCS C1713","","04.034.755S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 13MM 37.5CM CANN","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.758S","SUP","HCPCS C1713","","04.034.758S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN PROXIMAL BEND","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.761S","SUP","HCPCS C1713","","04.034.761S  -  NAIL INTRAMEDULLARY 13MM 40.5CM CANN PROXIMAL BEND NAIL-EX","BOTH IP/OP","$2,831.40 ","$2,095.24 ","$0.00 ","$2,748.95 ","$1,237.03 ","$0.00 ","$590.13 ","$0.00 ","$0.00 ","$481.32 ","$2,748.95 ","$0.00 ","$1,374.48 ","$2,177.17 ","$2,199.16 ","$0.00 ","$417.68 ","$0.00 ","$437.63 ","$0.00 "
"04.034.764S","SUP","HCPCS C1713","","04.034.764S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN PROXIMAL BEND","BOTH IP/OP","$2,927.68 ","$2,166.48 ","$0.00 ","$2,842.43 ","$1,279.09 ","$0.00 ","$610.20 ","$0.00 ","$0.00 ","$497.69 ","$2,842.43 ","$0.00 ","$1,421.21 ","$2,251.20 ","$2,273.94 ","$0.00 ","$431.88 ","$0.00 ","$452.51 ","$0.00 "
"04.034.767S","SUP","HCPCS C1713","","04.034.767S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 435MM CANN PROXIMAL BEND","BOTH IP/OP","$3,016.68 ","$2,232.34 ","$0.00 ","$2,928.80 ","$1,317.96 ","$0.00 ","$628.75 ","$0.00 ","$0.00 ","$512.81 ","$2,928.80 ","$0.00 ","$1,464.40 ","$2,319.61 ","$2,343.04 ","$0.00 ","$445.01 ","$0.00 ","$466.26 ","$0.00 "
"04.037.142S","SUP","HCPCS C1713","","04.037.142S  -  NAIL IM 130D SHRT 11MM 170MM GRN STRL TFN-ADV CNN","BOTH IP/OP","$3,133.30 ","$2,318.64 ","$0.00 ","$3,042.03 ","$1,368.91 ","$0.00 ","$653.06 ","$0.00 ","$0.00 ","$532.63 ","$3,042.03 ","$0.00 ","$1,521.01 ","$2,409.29 ","$2,433.62 ","$0.00 ","$462.21 ","$0.00 ","$484.29 ","$0.00 "
"04.037.165S","SUP","HCPCS C1713","","04.037.165S  -  NAIL IM 130D LNG 11MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE","BOTH IP/OP","$4,391.38 ","$3,249.62 ","$0.00 ","$4,263.48 ","$1,918.56 ","$0.00 ","$915.27 ","$0.00 ","$0.00 ","$746.50 ","$4,263.48 ","$0.00 ","$2,131.74 ","$3,376.68 ","$3,410.78 ","$0.00 ","$647.80 ","$0.00 ","$678.75 ","$0.00 "
"04.037.167S","SUP","HCPCS C1713","","04.037.167S  -  NAIL IM 130D LNG 11MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN","BOTH IP/OP","$4,391.38 ","$3,249.62 ","$0.00 ","$4,263.48 ","$1,918.56 ","$0.00 ","$915.27 ","$0.00 ","$0.00 ","$746.50 ","$4,263.48 ","$0.00 ","$2,131.74 ","$3,376.68 ","$3,410.78 ","$0.00 ","$647.80 ","$0.00 ","$678.75 ","$0.00 "
"04.037.242S","SUP","HCPCS C1713","","04.037.242S  -  NAIL IM 130D SHRT 12MM 170MM GRN STRL TFN-ADV CNN","BOTH IP/OP","$3,133.30 ","$2,318.64 ","$0.00 ","$3,042.03 ","$1,368.91 ","$0.00 ","$653.06 ","$0.00 ","$0.00 ","$532.63 ","$3,042.03 ","$0.00 ","$1,521.01 ","$2,409.29 ","$2,433.62 ","$0.00 ","$462.21 ","$0.00 ","$484.29 ","$0.00 "
"04.037.257S","SUP","HCPCS C1713","","04.037.257S  -  NAIL IM 130D LNG 12MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN","BOTH IP/OP","$4,391.38 ","$3,249.62 ","$0.00 ","$4,263.48 ","$1,918.56 ","$0.00 ","$915.27 ","$0.00 ","$0.00 ","$746.50 ","$4,263.48 ","$0.00 ","$2,131.74 ","$3,376.68 ","$3,410.78 ","$0.00 ","$647.80 ","$0.00 ","$678.75 ","$0.00 "
"04.037.259S","SUP","HCPCS C1713","","04.037.259S  -  NAIL IM 130D LNG 12MM 380MM GRN STRL TFN-ADV LAT RLF CUT CNN","BOTH IP/OP","$4,391.38 ","$3,249.62 ","$0.00 ","$4,263.48 ","$1,918.56 ","$0.00 ","$915.27 ","$0.00 ","$0.00 ","$746.50 ","$4,263.48 ","$0.00 ","$2,131.74 ","$3,376.68 ","$3,410.78 ","$0.00 ","$647.80 ","$0.00 ","$678.75 ","$0.00 "
"04.037.261S","SUP","HCPCS C1713","","04.037.261S  -  NAIL IM 130D LNG 12MM 400MM GRN STRL TFN-ADV LAT RLF CUT CNN","BOTH IP/OP","$4,391.38 ","$3,249.62 ","$0.00 ","$4,263.48 ","$1,918.56 ","$0.00 ","$915.27 ","$0.00 ","$0.00 ","$746.50 ","$4,263.48 ","$0.00 ","$2,131.74 ","$3,376.68 ","$3,410.78 ","$0.00 ","$647.80 ","$0.00 ","$678.75 ","$0.00 "
"04.037.262S","SUP","HCPCS C1713","","04.037.262S  -  NAIL IM 130D LNG 12MM 420MM GRN STRL TFN-ADV LAT RLF CUT CNN","BOTH IP/OP","$4,391.38 ","$3,249.62 ","$0.00 ","$4,263.48 ","$1,918.56 ","$0.00 ","$915.27 ","$0.00 ","$0.00 ","$746.50 ","$4,263.48 ","$0.00 ","$2,131.74 ","$3,376.68 ","$3,410.78 ","$0.00 ","$647.80 ","$0.00 ","$678.75 ","$0.00 "
"04.038.105S","SUP","HCPCS C1713","","04.038.105S  -  SCREW BN 10.35MM 105MM AU STRL LF TFN-ADV CNN TI","BOTH IP/OP","$1,426.78 ","$1,055.82 ","$0.00 ","$1,385.23 ","$623.35 ","$0.00 ","$297.38 ","$0.00 ","$0.00 ","$242.54 ","$1,385.23 ","$0.00 ","$692.61 ","$1,097.10 ","$1,108.18 ","$0.00 ","$210.47 ","$0.00 ","$220.53 ","$0.00 "
"04.038.285S","SUP","Custom 27203010","","04.038.285S  -  BLADE IM NL HLCL 10.35MM 85MM AU STRL TFN-ADV CNN TI-6AL-7NB","BOTH IP/OP","$1,497.08 ","$1,107.84 ","$0.00 ","$1,453.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,453.45 ","$0.00 ","$726.73 ","$1,151.13 ","$1,162.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.038.290S","SUP","Custom 27203010","","04.038.290S  -  BLADE IM NL HLCL 90MM STRL TFN-ADV CNN TI FEM PROX","BOTH IP/OP","$1,497.08 ","$1,107.84 ","$0.00 ","$1,453.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,453.45 ","$0.00 ","$726.73 ","$1,151.13 ","$1,162.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.038.295S","SUP","Custom 27203010","","04.038.295S  -  BLADE IM NL HLCL 10.35MM 95MM AU STRL TFN-ADV CNN TI-6AL-7NB","BOTH IP/OP","$1,497.08 ","$1,107.84 ","$0.00 ","$1,453.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,453.45 ","$0.00 ","$726.73 ","$1,151.13 ","$1,162.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.038.305S","SUP","Custom 27203010","","04.038.305S  -  BLADE IM NL HLCL 10.35MM 105MM AU STRL TFN-ADV CNN TI-6AL-7","BOTH IP/OP","$1,497.08 ","$1,107.84 ","$0.00 ","$1,453.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,453.45 ","$0.00 ","$726.73 ","$1,151.13 ","$1,162.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.100.020","SUP","HCPCS C1713","","04.100.020  -  PLATE BONE LOCK TITANIUM FT NONSTRL 2.4-2.7 MM SCREWS","BOTH IP/OP","$1,464.73 ","$1,083.90 ","$0.00 ","$1,422.08 ","$639.93 ","$0.00 ","$305.29 ","$0.00 ","$0.00 ","$248.99 ","$1,422.08 ","$0.00 ","$711.04 ","$1,126.29 ","$1,137.66 ","$0.00 ","$216.07 ","$0.00 ","$226.39 ","$0.00 "
"04.100.021","SUP","HCPCS C1713","","04.100.021  -  PLATE BONE LOCK TITANIUM LEFT CUBOID FT NONSTRL 2.4-2.7 MM","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"04.100.022","SUP","HCPCS C1713","","04.100.022  -  PLATE BONE LOCK TITANIUM RIGHT CUBOID FT NONSTRL 2.4-2.7 MM","BOTH IP/OP","$1,425.38 ","$1,054.78 ","$0.00 ","$1,383.85 ","$622.73 ","$0.00 ","$297.08 ","$0.00 ","$0.00 ","$242.30 ","$1,383.85 ","$0.00 ","$691.93 ","$1,096.01 ","$1,107.08 ","$0.00 ","$210.27 ","$0.00 ","$220.31 ","$0.00 "
"04.100.023","SUP","HCPCS C1713","","04.100.023  -  PLATE BONE LOCK TITANIUM TALUS FT NONSTRL 2.4-2.7 MM SCREW","BOTH IP/OP","$1,408.50 ","$1,042.29 ","$0.00 ","$1,367.48 ","$615.36 ","$0.00 ","$293.57 ","$0.00 ","$0.00 ","$239.43 ","$1,367.48 ","$0.00 ","$683.74 ","$1,083.04 ","$1,093.98 ","$0.00 ","$207.78 ","$0.00 ","$217.70 ","$0.00 "
"04.100.032S","SUP","HCPCS C1713","","04.100.032S  -  PLATE 100MM TI 6 HOLE LCP BONE ANT ANKL FT STRL","BOTH IP/OP","$2,315.60 ","$1,713.54 ","$0.00 ","$2,315.60 ","$1,042.02 ","$0.00 ","$482.63 ","$0.00 ","$0.00 ","$405.44 ","$2,315.60 ","$0.00 ","$1,157.80 ","$1,833.96 ","$1,852.48 ","$0.00 ","$362.39 ","$0.00 ","$368.64 ","$0.00 "
"04.100.033S","SUP","HCPCS C1713","","04.100.033S  -  PLATE 116MM TI 7 HOLE LCP BONE ANT ANKL FT STRL","BOTH IP/OP","$2,380.43 ","$1,761.52 ","$0.00 ","$2,380.43 ","$1,071.19 ","$0.00 ","$496.14 ","$0.00 ","$0.00 ","$416.79 ","$2,380.43 ","$0.00 ","$1,190.21 ","$1,885.30 ","$1,904.34 ","$0.00 ","$372.54 ","$0.00 ","$378.96 ","$0.00 "
"04.104.004S","SUP","HCPCS C1713","","04.104.004S  -  PLATE BONE 122MM 4 HOLE LCP TITANIUM EXTART RIGHT HUMERUS","BOTH IP/OP","$2,384.05 ","$1,764.20 ","$0.00 ","$2,314.63 ","$1,041.58 ","$0.00 ","$496.90 ","$0.00 ","$0.00 ","$405.27 ","$2,314.63 ","$0.00 ","$1,157.31 ","$1,833.19 ","$1,851.70 ","$0.00 ","$351.69 ","$0.00 ","$368.49 ","$0.00 "
"04.104.006S","SUP","HCPCS C1713","","04.104.006S  -  PLATE BONE 158MM 6 HOLE LCP TITANIUM EXTART RIGHT HUMERUS","BOTH IP/OP","$2,714.40 ","$2,008.66 ","$0.00 ","$2,635.33 ","$1,185.90 ","$0.00 ","$565.75 ","$0.00 ","$0.00 ","$461.42 ","$2,635.33 ","$0.00 ","$1,317.66 ","$2,087.18 ","$2,108.26 ","$0.00 ","$400.42 ","$0.00 ","$419.54 ","$0.00 "
"04.104.008S","SUP","HCPCS C1713","","04.104.008S  -  PLATE BN 194MM STRL LCP CMBN 8 HL PRECONTOUR LMT CNTCT TI","BOTH IP/OP","$2,874.65 ","$2,127.24 ","$0.00 ","$2,790.93 ","$1,255.92 ","$0.00 ","$599.15 ","$0.00 ","$0.00 ","$488.67 ","$2,790.93 ","$0.00 ","$1,395.46 ","$2,210.42 ","$2,232.74 ","$0.00 ","$424.06 ","$0.00 ","$444.32 ","$0.00 "
"04.104.010S","SUP","HCPCS C1713","","04.104.010S  -  PLATE BONE 230MM 10 HOLE LCP TITANIUM EXTART RIGHT HUMERUS","BOTH IP/OP","$3,037.70 ","$2,247.90 ","$0.00 ","$2,949.23 ","$1,327.15 ","$0.00 ","$633.13 ","$0.00 ","$0.00 ","$516.39 ","$2,949.23 ","$0.00 ","$1,474.61 ","$2,335.79 ","$2,359.38 ","$0.00 ","$448.11 ","$0.00 ","$469.52 ","$0.00 "
"04.104.012S","SUP","HCPCS C1713","","04.104.012S  -  PLATE BONE 266MM 12 HOLE LCP TITANIUM EXTART RIGHT HUMERUS","BOTH IP/OP","$3,458.00 ","$2,558.92 ","$0.00 ","$3,357.28 ","$1,510.77 ","$0.00 ","$720.73 ","$0.00 ","$0.00 ","$587.83 ","$3,357.28 ","$0.00 ","$1,678.64 ","$2,658.97 ","$2,685.82 ","$0.00 ","$510.11 ","$0.00 ","$534.48 ","$0.00 "
"04.104.014S","SUP","HCPCS C1713","","04.104.014S  -  PLATE BONE 302MM 14 HOLE LCP TITANIUM EXTART RIGHT HUMERUS","BOTH IP/OP","$3,796.78 ","$2,809.62 ","$0.00 ","$3,686.20 ","$1,658.79 ","$0.00 ","$791.34 ","$0.00 ","$0.00 ","$645.42 ","$3,686.20 ","$0.00 ","$1,843.10 ","$2,919.47 ","$2,948.96 ","$0.00 ","$560.09 ","$0.00 ","$586.84 ","$0.00 "
"04.104.024S","SUP","HCPCS C1713","","04.104.024S  -  PLATE BONE 122MM 4 HOLE LCP TITANIUM LEFT DISTAL EXTART","BOTH IP/OP","$2,384.05 ","$1,764.20 ","$0.00 ","$2,314.63 ","$1,041.58 ","$0.00 ","$496.90 ","$0.00 ","$0.00 ","$405.27 ","$2,314.63 ","$0.00 ","$1,157.31 ","$1,833.19 ","$1,851.70 ","$0.00 ","$351.69 ","$0.00 ","$368.49 ","$0.00 "
"04.104.026S","SUP","HCPCS C1713","","04.104.026S  -  PLATE BONE 158MM 6 HOLE LCP TITANIUM LEFT DISTAL EXTART","BOTH IP/OP","$2,714.40 ","$2,008.66 ","$0.00 ","$2,635.33 ","$1,185.90 ","$0.00 ","$565.75 ","$0.00 ","$0.00 ","$461.42 ","$2,635.33 ","$0.00 ","$1,317.66 ","$2,087.18 ","$2,108.26 ","$0.00 ","$400.42 ","$0.00 ","$419.54 ","$0.00 "
"04.104.028S","SUP","HCPCS C1713","","04.104.028S  -  PLATE BONE 194MM 8 HOLE LCP TITANIUM LEFT DISTAL EXTART","BOTH IP/OP","$2,874.65 ","$2,127.24 ","$0.00 ","$2,790.93 ","$1,255.92 ","$0.00 ","$599.15 ","$0.00 ","$0.00 ","$488.67 ","$2,790.93 ","$0.00 ","$1,395.46 ","$2,210.42 ","$2,232.74 ","$0.00 ","$424.06 ","$0.00 ","$444.32 ","$0.00 "
"04.104.030S","SUP","HCPCS C1713","","04.104.030S  -  PLATE BONE 230MM 10 HOLE LCP TITANIUM LEFT DISTAL EXTART","BOTH IP/OP","$3,037.70 ","$2,247.90 ","$0.00 ","$2,949.23 ","$1,327.15 ","$0.00 ","$633.13 ","$0.00 ","$0.00 ","$516.39 ","$2,949.23 ","$0.00 ","$1,474.61 ","$2,335.79 ","$2,359.38 ","$0.00 ","$448.11 ","$0.00 ","$469.52 ","$0.00 "
"04.104.032S","SUP","HCPCS C1713","","04.104.032S  -  PLATE BONE 266MM 12 HOLE LCP TITANIUM LEFT DISTAL EXTART","BOTH IP/OP","$3,458.00 ","$2,558.92 ","$0.00 ","$3,357.28 ","$1,510.77 ","$0.00 ","$720.73 ","$0.00 ","$0.00 ","$587.83 ","$3,357.28 ","$0.00 ","$1,678.64 ","$2,658.97 ","$2,685.82 ","$0.00 ","$510.11 ","$0.00 ","$534.48 ","$0.00 "
"04.104.034S","SUP","HCPCS C1713","","04.104.034S  -  PLATE BONE 302MM 14 HOLE LCP TITANIUM LEFT DISTAL EXTART","BOTH IP/OP","$3,796.78 ","$2,809.62 ","$0.00 ","$3,686.20 ","$1,658.79 ","$0.00 ","$791.34 ","$0.00 ","$0.00 ","$645.42 ","$3,686.20 ","$0.00 ","$1,843.10 ","$2,919.47 ","$2,948.96 ","$0.00 ","$560.09 ","$0.00 ","$586.84 ","$0.00 "
"04.110.005","SUP","HCPCS C1713","","04.110.005  -  PLATE BONE 5 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL","BOTH IP/OP","$2,921.03 ","$2,161.56 ","$0.00 ","$2,835.95 ","$1,276.18 ","$0.00 ","$608.81 ","$0.00 ","$0.00 ","$496.55 ","$2,835.95 ","$0.00 ","$1,417.98 ","$2,246.07 ","$2,268.76 ","$0.00 ","$430.90 ","$0.00 ","$451.48 ","$0.00 "
"04.110.007","SUP","HCPCS C1713","","04.110.007  -  PLATE BONE 7 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL","BOTH IP/OP","$2,992.73 ","$2,214.62 ","$0.00 ","$2,905.55 ","$1,307.50 ","$0.00 ","$623.76 ","$0.00 ","$0.00 ","$508.74 ","$2,905.55 ","$0.00 ","$1,452.78 ","$2,301.20 ","$2,324.44 ","$0.00 ","$441.47 ","$0.00 ","$462.56 ","$0.00 "
"04.110.009","SUP","HCPCS C1713","","04.110.009  -  PLATE BONE 9 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,063.00 ","$2,266.62 ","$0.00 ","$2,973.80 ","$1,338.21 ","$0.00 ","$638.41 ","$0.00 ","$0.00 ","$520.69 ","$2,973.80 ","$0.00 ","$1,486.90 ","$2,355.25 ","$2,379.04 ","$0.00 ","$451.84 ","$0.00 ","$473.43 ","$0.00 "
"04.110.011","SUP","HCPCS C1713","","04.110.011  -  PLATE BONE 11 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,251.38 ","$2,406.02 ","$0.00 ","$3,156.68 ","$1,420.50 ","$0.00 ","$677.67 ","$0.00 ","$0.00 ","$552.71 ","$3,156.68 ","$0.00 ","$1,578.34 ","$2,500.09 ","$2,525.34 ","$0.00 ","$479.63 ","$0.00 ","$502.54 ","$0.00 "
"04.110.013S","SUP","HCPCS C1713","","04.110.013S  -  PLATE BONE 13 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,497.38 ","$2,588.06 ","$0.00 ","$3,395.50 ","$1,527.98 ","$0.00 ","$728.94 ","$0.00 ","$0.00 ","$594.52 ","$3,395.50 ","$0.00 ","$1,697.75 ","$2,689.24 ","$2,716.40 ","$0.00 ","$515.92 ","$0.00 ","$540.56 ","$0.00 "
"04.110.015S","SUP","HCPCS C1713","","04.110.015S  -  PLATE BONE 15 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,611.23 ","$2,672.31 ","$0.00 ","$3,506.05 ","$1,577.72 ","$0.00 ","$752.67 ","$0.00 ","$0.00 ","$613.88 ","$3,506.05 ","$0.00 ","$1,753.03 ","$2,776.79 ","$2,804.84 ","$0.00 ","$532.71 ","$0.00 ","$558.16 ","$0.00 "
"04.110.105","SUP","HCPCS C1713","","04.110.105  -  PLATE BONE 5 HOLE LCP TITANIUM LEFT DISTAL RADIAL NONSTRL","BOTH IP/OP","$2,921.03 ","$2,161.56 ","$0.00 ","$2,835.95 ","$1,276.18 ","$0.00 ","$608.81 ","$0.00 ","$0.00 ","$496.55 ","$2,835.95 ","$0.00 ","$1,417.98 ","$2,246.07 ","$2,268.76 ","$0.00 ","$430.90 ","$0.00 ","$451.48 ","$0.00 "
"04.110.107","SUP","HCPCS C1713","","04.110.107  -  PLATE BONE 7 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL","BOTH IP/OP","$2,992.73 ","$2,214.62 ","$0.00 ","$2,905.55 ","$1,307.50 ","$0.00 ","$623.76 ","$0.00 ","$0.00 ","$508.74 ","$2,905.55 ","$0.00 ","$1,452.78 ","$2,301.20 ","$2,324.44 ","$0.00 ","$441.47 ","$0.00 ","$462.56 ","$0.00 "
"04.110.109","SUP","HCPCS C1713","","04.110.109  -  PLATE BONE 9 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,063.00 ","$2,266.62 ","$0.00 ","$2,973.80 ","$1,338.21 ","$0.00 ","$638.41 ","$0.00 ","$0.00 ","$520.69 ","$2,973.80 ","$0.00 ","$1,486.90 ","$2,355.25 ","$2,379.04 ","$0.00 ","$451.84 ","$0.00 ","$473.43 ","$0.00 "
"04.110.111","SUP","HCPCS C1713","","04.110.111  -  PLATE BONE 11 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,251.38 ","$2,406.02 ","$0.00 ","$3,156.68 ","$1,420.50 ","$0.00 ","$677.67 ","$0.00 ","$0.00 ","$552.71 ","$3,156.68 ","$0.00 ","$1,578.34 ","$2,500.09 ","$2,525.34 ","$0.00 ","$479.63 ","$0.00 ","$502.54 ","$0.00 "
"04.110.113S","SUP","HCPCS C1713","","04.110.113S  -  PLATE BONE 13 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,497.38 ","$2,588.06 ","$0.00 ","$3,395.50 ","$1,527.98 ","$0.00 ","$728.94 ","$0.00 ","$0.00 ","$594.52 ","$3,395.50 ","$0.00 ","$1,697.75 ","$2,689.24 ","$2,716.40 ","$0.00 ","$515.92 ","$0.00 ","$540.56 ","$0.00 "
"04.110.115S","SUP","HCPCS C1713","","04.110.115S  -  PLATE BONE 15 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL","BOTH IP/OP","$3,611.23 ","$2,672.31 ","$0.00 ","$3,506.05 ","$1,577.72 ","$0.00 ","$752.67 ","$0.00 ","$0.00 ","$613.88 ","$3,506.05 ","$0.00 ","$1,753.03 ","$2,776.79 ","$2,804.84 ","$0.00 ","$532.71 ","$0.00 ","$558.16 ","$0.00 "
"04.110.150","SUP","HCPCS C1713","","04.110.150  -  PLATE BONE STANDARD BEND 118MM FUSION LCP TITANIUM WRIST","BOTH IP/OP","$3,145.95 ","$2,328.00 ","$0.00 ","$3,054.30 ","$1,374.44 ","$0.00 ","$655.69 ","$0.00 ","$0.00 ","$534.78 ","$3,054.30 ","$0.00 ","$1,527.15 ","$2,419.01 ","$2,443.44 ","$0.00 ","$464.08 ","$0.00 ","$486.24 ","$0.00 "
"04.110.151","SUP","HCPCS C1713","","04.110.151  -  PLATE BN SHRT BND 118MM NS LCP FSN TI WRST","BOTH IP/OP","$3,145.95 ","$2,328.00 ","$0.00 ","$3,054.30 ","$1,374.44 ","$0.00 ","$655.69 ","$0.00 ","$0.00 ","$534.78 ","$3,054.30 ","$0.00 ","$1,527.15 ","$2,419.01 ","$2,443.44 ","$0.00 ","$464.08 ","$0.00 ","$486.24 ","$0.00 "
"04.110.152","SUP","HCPCS C1713","","04.110.152  -  PLATE BONE 112MM STR FUSION LCP TITANIUM WRIST NONSTRL","BOTH IP/OP","$3,145.95 ","$2,328.00 ","$0.00 ","$3,054.30 ","$1,374.44 ","$0.00 ","$655.69 ","$0.00 ","$0.00 ","$534.78 ","$3,054.30 ","$0.00 ","$1,527.15 ","$2,419.01 ","$2,443.44 ","$0.00 ","$464.08 ","$0.00 ","$486.24 ","$0.00 "
"04.110.201","SUP","HCPCS C1713","","04.110.201  -  PLATE BONE 5X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.110.202","SUP","HCPCS C1713","","04.110.202  -  PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.110.203","SUP","HCPCS C1713","","04.110.203  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.110.204","SUP","HCPCS C1713","","04.110.204  -  PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.110.205","SUP","HCPCS C1713","","04.110.205  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.110.206","SUP","HCPCS C1713","","04.110.206  -  PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.110.207","SUP","HCPCS C1713","","04.110.207  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.110.208","SUP","HCPCS C1713","","04.110.208  -  PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.110.300","SUP","Custom 27203010","","04.110.300  -  WIRE FIX 1.8MM 150MM TROCAR POINT DEPTH MARKING KWIRE","BOTH IP/OP","$20.10 ","$14.87 ","$0.00 ","$19.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.52 ","$0.00 ","$9.76 ","$15.46 ","$15.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.110.330","SUP","HCPCS C1713","","04.110.330  -  PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.331","SUP","HCPCS C1713","","04.110.331  -  PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.340","SUP","HCPCS C1713","","04.110.340  -  PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.341","SUP","HCPCS C1713","","04.110.341  -  PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.350","SUP","HCPCS C1713","","04.110.350  -  PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.351","SUP","HCPCS C1713","","04.110.351  -  PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.430","SUP","HCPCS C1713","","04.110.430  -  PLATE BONE 50.5MM 8X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.431","SUP","HCPCS C1713","","04.110.431  -  PLATE BN 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND EDG","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.440","SUP","HCPCS C1713","","04.110.440  -  PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.441","SUP","HCPCS C1713","","04.110.441  -  PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.450","SUP","HCPCS C1713","","04.110.450  -  PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.451","SUP","HCPCS C1713","","04.110.451  -  PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.730","SUP","HCPCS C1713","","04.110.730  -  PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.731","SUP","HCPCS C1713","","04.110.731  -  PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.740","SUP","HCPCS C1713","","04.110.740  -  PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.741","SUP","HCPCS C1713","","04.110.741  -  PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.750","SUP","HCPCS C1713","","04.110.750  -  PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.751","SUP","HCPCS C1713","","04.110.751  -  PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.830","SUP","HCPCS C1713","","04.110.830  -  PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.831","SUP","HCPCS C1713","","04.110.831  -  PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM LEFT VOLAR","BOTH IP/OP","$1,524.43 ","$1,128.08 ","$0.00 ","$1,524.43 ","$685.99 ","$0.00 ","$317.73 ","$0.00 ","$0.00 ","$266.91 ","$1,524.43 ","$0.00 ","$762.21 ","$1,207.35 ","$1,219.54 ","$0.00 ","$231.62 ","$0.00 ","$242.69 ","$0.00 "
"04.110.840","SUP","HCPCS C1713","","04.110.840  -  PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.841","SUP","HCPCS C1713","","04.110.841  -  PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,572.20 ","$1,163.43 ","$0.00 ","$1,572.20 ","$707.49 ","$0.00 ","$327.69 ","$0.00 ","$0.00 ","$275.28 ","$1,572.20 ","$0.00 ","$786.10 ","$1,245.18 ","$1,257.76 ","$0.00 ","$238.88 ","$0.00 ","$250.29 ","$0.00 "
"04.110.850","SUP","HCPCS C1713","","04.110.850  -  PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.110.851","SUP","HCPCS C1713","","04.110.851  -  PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL","BOTH IP/OP","$1,618.60 ","$1,197.76 ","$0.00 ","$1,618.60 ","$728.37 ","$0.00 ","$337.36 ","$0.00 ","$0.00 ","$283.40 ","$1,618.60 ","$0.00 ","$809.30 ","$1,281.93 ","$1,294.88 ","$0.00 ","$245.93 ","$0.00 ","$257.68 ","$0.00 "
"04.111.520","SUP","HCPCS C1713","","04.111.520  -  PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"04.111.521","SUP","HCPCS C1713","","04.111.521  -  PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"04.111.530","SUP","HCPCS C1713","","04.111.530  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.111.531","SUP","HCPCS C1713","","04.111.531  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.111.540","SUP","HCPCS C1713","","04.111.540  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"04.111.541","SUP","HCPCS C1713","","04.111.541  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"04.111.550","SUP","HCPCS C1713","","04.111.550  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.111.551","SUP","HCPCS C1713","","04.111.551  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.111.620","SUP","HCPCS C1713","","04.111.620  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"04.111.621","SUP","HCPCS C1713","","04.111.621  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"04.111.630","SUP","HCPCS C1713","","04.111.630  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.111.631","SUP","HCPCS C1713","","04.111.631  -  PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.111.640","SUP","HCPCS C1713","","04.111.640  -  PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"04.111.641","SUP","HCPCS C1713","","04.111.641  -  PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"04.111.650","SUP","HCPCS C1713","","04.111.650  -  PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.111.651","SUP","HCPCS C1713","","04.111.651  -  PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.111.720","SUP","HCPCS C1713","","04.111.720  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"04.111.721","SUP","HCPCS C1713","","04.111.721  -  PLATE BONE 49MM 7X2 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,802.10 ","$1,333.55 ","$0.00 ","$1,749.60 ","$787.32 ","$0.00 ","$375.60 ","$0.00 ","$0.00 ","$306.34 ","$1,749.60 ","$0.00 ","$874.80 ","$1,385.68 ","$1,399.68 ","$0.00 ","$265.84 ","$0.00 ","$278.54 ","$0.00 "
"04.111.730","SUP","HCPCS C1713","","04.111.730  -  PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.111.731","SUP","HCPCS C1713","","04.111.731  -  PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,873.80 ","$1,386.61 ","$0.00 ","$1,819.20 ","$818.64 ","$0.00 ","$390.55 ","$0.00 ","$0.00 ","$318.53 ","$1,819.20 ","$0.00 ","$909.60 ","$1,440.81 ","$1,455.36 ","$0.00 ","$276.41 ","$0.00 ","$289.62 ","$0.00 "
"04.111.740","SUP","HCPCS C1713","","04.111.740  -  PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"04.111.741","SUP","HCPCS C1713","","04.111.741  -  PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT","BOTH IP/OP","$1,944.08 ","$1,438.62 ","$0.00 ","$1,887.45 ","$849.35 ","$0.00 ","$405.19 ","$0.00 ","$0.00 ","$330.48 ","$1,887.45 ","$0.00 ","$943.73 ","$1,494.86 ","$1,509.96 ","$0.00 ","$286.78 ","$0.00 ","$300.48 ","$0.00 "
"04.111.750","SUP","HCPCS C1713","","04.111.750  -  PLATE BONE 77MM 7X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.111.751","SUP","HCPCS C1713","","04.111.751  -  PLATE BONE 77MM 7X5 HOLE 2 COLUMN VARIABLE LCP TITANIUM LEFT","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"04.112.006","SUP","HCPCS C1713","","04.112.006  -  PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,623.58 ","$1,201.45 ","$0.00 ","$1,576.28 ","$709.32 ","$0.00 ","$338.39 ","$0.00 ","$0.00 ","$275.99 ","$1,576.28 ","$0.00 ","$788.14 ","$1,248.41 ","$1,261.02 ","$0.00 ","$239.50 ","$0.00 ","$250.94 ","$0.00 "
"04.112.007","SUP","HCPCS C1713","","04.112.007  -  PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,623.58 ","$1,201.45 ","$0.00 ","$1,576.28 ","$709.32 ","$0.00 ","$338.39 ","$0.00 ","$0.00 ","$275.99 ","$1,576.28 ","$0.00 ","$788.14 ","$1,248.41 ","$1,261.02 ","$0.00 ","$239.50 ","$0.00 ","$250.94 ","$0.00 "
"04.112.008","SUP","HCPCS C1713","","04.112.008  -  PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.009","SUP","HCPCS C1713","","04.112.009  -  PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.010","SUP","HCPCS C1713","","04.112.010  -  PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"04.112.011","SUP","HCPCS C1713","","04.112.011  -  PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"04.112.012","SUP","HCPCS C1713","","04.112.012  -  PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,677.00 ","$1,240.98 ","$0.00 ","$1,628.15 ","$732.67 ","$0.00 ","$349.53 ","$0.00 ","$0.00 ","$285.08 ","$1,628.15 ","$0.00 ","$814.08 ","$1,289.49 ","$1,302.52 ","$0.00 ","$247.38 ","$0.00 ","$259.20 ","$0.00 "
"04.112.013","SUP","HCPCS C1713","","04.112.013  -  PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,677.00 ","$1,240.98 ","$0.00 ","$1,628.15 ","$732.67 ","$0.00 ","$349.53 ","$0.00 ","$0.00 ","$285.08 ","$1,628.15 ","$0.00 ","$814.08 ","$1,289.49 ","$1,302.52 ","$0.00 ","$247.38 ","$0.00 ","$259.20 ","$0.00 "
"04.112.018","SUP","HCPCS C1713","","04.112.018  -  PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.019","SUP","HCPCS C1713","","04.112.019  -  PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.020","SUP","HCPCS C1713","","04.112.020  -  PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.021","SUP","HCPCS C1713","","04.112.021  -  PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.026","SUP","HCPCS C1713","","04.112.026  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.027","SUP","HCPCS C1713","","04.112.027  -  PLATE BONE 94MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.028","SUP","HCPCS C1713","","04.112.028  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.029","SUP","HCPCS C1713","","04.112.029  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.030","SUP","HCPCS C1713","","04.112.030  -  PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.031","SUP","HCPCS C1713","","04.112.031  -  PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.040S","SUP","HCPCS C1713","","04.112.040S  -  PLATE BONE 79MM 6 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE","BOTH IP/OP","$1,876.60 ","$1,388.68 ","$0.00 ","$1,821.95 ","$819.88 ","$0.00 ","$391.13 ","$0.00 ","$0.00 ","$319.01 ","$1,821.95 ","$0.00 ","$910.98 ","$1,442.98 ","$1,457.56 ","$0.00 ","$276.83 ","$0.00 ","$290.05 ","$0.00 "
"04.112.041","SUP","HCPCS C1713","","04.112.041  -  PLATE BONE 91MM 7 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.042","SUP","HCPCS C1713","","04.112.042  -  PLATE BONE 102MM 8 HOLE LCP TITANIUM MEDIAL ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.045","SUP","HCPCS C1713","","04.112.045  -  PLATE BONE 77MM 7 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.046","SUP","HCPCS C1713","","04.112.046  -  PLATE BONE 89MM 9 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.047","SUP","HCPCS C1713","","04.112.047  -  PLATE BONE 101MM 10 HOLE VAR ANG LCP TITANIUM LATERAL","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.048S","SUP","HCPCS C1713","","04.112.048S  -  PLATE BONE 113MM 11 HOLE VAR ANG LCP TITANIUM LATERAL","BOTH IP/OP","$1,876.60 ","$1,388.68 ","$0.00 ","$1,821.95 ","$819.88 ","$0.00 ","$391.13 ","$0.00 ","$0.00 ","$319.01 ","$1,821.95 ","$0.00 ","$910.98 ","$1,442.98 ","$1,457.56 ","$0.00 ","$276.83 ","$0.00 ","$290.05 ","$0.00 "
"04.112.049S","SUP","HCPCS C1713","","04.112.049S  -  PLATE BONE 124MM 12 HOLE VAR ANG LCP TITANIUM LATERAL","BOTH IP/OP","$1,876.60 ","$1,388.68 ","$0.00 ","$1,821.95 ","$819.88 ","$0.00 ","$391.13 ","$0.00 ","$0.00 ","$319.01 ","$1,821.95 ","$0.00 ","$910.98 ","$1,442.98 ","$1,457.56 ","$0.00 ","$276.83 ","$0.00 ","$290.05 ","$0.00 "
"04.112.080","SUP","HCPCS C1713","","04.112.080  -  PLATE BONE 85MM 6 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.081","SUP","HCPCS C1713","","04.112.081  -  PLATE BONE 85MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.082","SUP","HCPCS C1713","","04.112.082  -  PLATE BONE 100MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.083","SUP","HCPCS C1713","","04.112.083  -  PLATE BONE 100MM 7 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.084","SUP","HCPCS C1713","","04.112.084  -  PLATE BONE 115MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR CLAVICLE","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.085","SUP","HCPCS C1713","","04.112.085  -  PLATE BONE 115MM 8 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.090","SUP","HCPCS C1713","","04.112.090  -  PLATE BONE 105MM 6 HOLE LATERAL EXTN LCP TITANIUM RIGHT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.091","SUP","HCPCS C1713","","04.112.091  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT","BOTH IP/OP","$1,695.28 ","$1,254.51 ","$0.00 ","$1,645.90 ","$740.66 ","$0.00 ","$353.34 ","$0.00 ","$0.00 ","$288.18 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$250.08 ","$0.00 ","$262.03 ","$0.00 "
"04.112.092","SUP","HCPCS C1713","","04.112.092  -  PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM RIGHT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.093","SUP","HCPCS C1713","","04.112.093  -  PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,740.25 ","$1,287.79 ","$0.00 ","$1,689.55 ","$760.30 ","$0.00 ","$362.71 ","$0.00 ","$0.00 ","$295.83 ","$1,689.55 ","$0.00 ","$844.78 ","$1,338.12 ","$1,351.64 ","$0.00 ","$256.71 ","$0.00 ","$268.98 ","$0.00 "
"04.112.094","SUP","HCPCS C1713","","04.112.094  -  PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.095","SUP","HCPCS C1713","","04.112.095  -  PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT","BOTH IP/OP","$1,785.23 ","$1,321.07 ","$0.00 ","$1,733.23 ","$779.95 ","$0.00 ","$372.09 ","$0.00 ","$0.00 ","$303.47 ","$1,733.23 ","$0.00 ","$866.61 ","$1,372.72 ","$1,386.58 ","$0.00 ","$263.35 ","$0.00 ","$275.93 ","$0.00 "
"04.112.106","SUP","HCPCS C1713","","04.112.106  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,186.40 ","$877.94 ","$0.00 ","$1,151.85 ","$518.33 ","$0.00 ","$247.28 ","$0.00 ","$0.00 ","$201.68 ","$1,151.85 ","$0.00 ","$575.93 ","$912.27 ","$921.48 ","$0.00 ","$175.01 ","$0.00 ","$183.37 ","$0.00 "
"04.112.107","SUP","HCPCS C1713","","04.112.107  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,186.40 ","$877.94 ","$0.00 ","$1,151.85 ","$518.33 ","$0.00 ","$247.28 ","$0.00 ","$0.00 ","$201.68 ","$1,151.85 ","$0.00 ","$575.93 ","$912.27 ","$921.48 ","$0.00 ","$175.01 ","$0.00 ","$183.37 ","$0.00 "
"04.112.108","SUP","HCPCS C1713","","04.112.108  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,206.08 ","$892.50 ","$0.00 ","$1,170.95 ","$526.93 ","$0.00 ","$251.38 ","$0.00 ","$0.00 ","$205.02 ","$1,170.95 ","$0.00 ","$585.48 ","$927.39 ","$936.76 ","$0.00 ","$177.92 ","$0.00 ","$186.42 ","$0.00 "
"04.112.109","SUP","HCPCS C1713","","04.112.109  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,206.08 ","$892.50 ","$0.00 ","$1,170.95 ","$526.93 ","$0.00 ","$251.38 ","$0.00 ","$0.00 ","$205.02 ","$1,170.95 ","$0.00 ","$585.48 ","$927.39 ","$936.76 ","$0.00 ","$177.92 ","$0.00 ","$186.42 ","$0.00 "
"04.112.110","SUP","HCPCS C1713","","04.112.110  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,221.55 ","$903.95 ","$0.00 ","$1,185.98 ","$533.69 ","$0.00 ","$254.60 ","$0.00 ","$0.00 ","$207.65 ","$1,185.98 ","$0.00 ","$592.99 ","$939.30 ","$948.78 ","$0.00 ","$180.20 ","$0.00 ","$188.81 ","$0.00 "
"04.112.111","SUP","HCPCS C1713","","04.112.111  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,221.55 ","$903.95 ","$0.00 ","$1,185.98 ","$533.69 ","$0.00 ","$254.60 ","$0.00 ","$0.00 ","$207.65 ","$1,185.98 ","$0.00 ","$592.99 ","$939.30 ","$948.78 ","$0.00 ","$180.20 ","$0.00 ","$188.81 ","$0.00 "
"04.112.112","SUP","HCPCS C1713","","04.112.112  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,241.23 ","$918.51 ","$0.00 ","$1,205.08 ","$542.28 ","$0.00 ","$258.70 ","$0.00 ","$0.00 ","$211.00 ","$1,205.08 ","$0.00 ","$602.54 ","$954.42 ","$964.06 ","$0.00 ","$183.10 ","$0.00 ","$191.85 ","$0.00 "
"04.112.113","SUP","HCPCS C1713","","04.112.113  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,241.23 ","$918.51 ","$0.00 ","$1,205.08 ","$542.28 ","$0.00 ","$258.70 ","$0.00 ","$0.00 ","$211.00 ","$1,205.08 ","$0.00 ","$602.54 ","$954.42 ","$964.06 ","$0.00 ","$183.10 ","$0.00 ","$191.85 ","$0.00 "
"04.112.114","SUP","HCPCS C1713","","04.112.114  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,258.10 ","$930.99 ","$0.00 ","$1,221.45 ","$549.65 ","$0.00 ","$262.22 ","$0.00 ","$0.00 ","$213.87 ","$1,221.45 ","$0.00 ","$610.73 ","$967.39 ","$977.16 ","$0.00 ","$185.59 ","$0.00 ","$194.45 ","$0.00 "
"04.112.115","SUP","HCPCS C1713","","04.112.115  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,258.10 ","$930.99 ","$0.00 ","$1,221.45 ","$549.65 ","$0.00 ","$262.22 ","$0.00 ","$0.00 ","$213.87 ","$1,221.45 ","$0.00 ","$610.73 ","$967.39 ","$977.16 ","$0.00 ","$185.59 ","$0.00 ","$194.45 ","$0.00 "
"04.112.118","SUP","HCPCS C1713","","04.112.118  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"04.112.119","SUP","HCPCS C1713","","04.112.119  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"04.112.122","SUP","HCPCS C1713","","04.112.122  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"04.112.123","SUP","HCPCS C1713","","04.112.123  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT DISTAL POSTLAT","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"04.112.126","SUP","HCPCS C1713","","04.112.126  -  PLATE BONE 207MM 13 HOLE LCP TITANIUM RIGHT POSTLAT DISTAL","BOTH IP/OP","$1,312.93 ","$971.57 ","$0.00 ","$1,274.68 ","$573.60 ","$0.00 ","$273.65 ","$0.00 ","$0.00 ","$223.19 ","$1,274.68 ","$0.00 ","$637.34 ","$1,009.55 ","$1,019.74 ","$0.00 ","$193.68 ","$0.00 ","$202.93 ","$0.00 "
"04.112.127","SUP","HCPCS C1713","","04.112.127  -  PLATE BONE 207MM 13 HOLE LCP TITANIUM LEFT POSTLAT DISTAL","BOTH IP/OP","$1,312.93 ","$971.57 ","$0.00 ","$1,274.68 ","$573.60 ","$0.00 ","$273.65 ","$0.00 ","$0.00 ","$223.19 ","$1,274.68 ","$0.00 ","$637.34 ","$1,009.55 ","$1,019.74 ","$0.00 ","$193.68 ","$0.00 ","$202.93 ","$0.00 "
"04.112.130","SUP","HCPCS C1713","","04.112.130  -  PLATE BONE 233MM 15 HOLE LCP RIGHT POSTLAT DISTAL FIBULAR","BOTH IP/OP","$1,329.78 ","$984.04 ","$0.00 ","$1,291.05 ","$580.97 ","$0.00 ","$277.16 ","$0.00 ","$0.00 ","$226.05 ","$1,291.05 ","$0.00 ","$645.53 ","$1,022.51 ","$1,032.84 ","$0.00 ","$196.16 ","$0.00 ","$205.54 ","$0.00 "
"04.112.131","SUP","HCPCS C1713","","04.112.131  -  PLATE BONE 233MM 15 HOLE LCP LEFT POSTLAT DISTAL FIBULAR","BOTH IP/OP","$1,329.78 ","$984.04 ","$0.00 ","$1,291.05 ","$580.97 ","$0.00 ","$277.16 ","$0.00 ","$0.00 ","$226.05 ","$1,291.05 ","$0.00 ","$645.53 ","$1,022.51 ","$1,032.84 ","$0.00 ","$196.16 ","$0.00 ","$205.54 ","$0.00 "
"04.112.136","SUP","HCPCS C1713","","04.112.136  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"04.112.137","SUP","HCPCS C1713","","04.112.137  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL FIBULA","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"04.112.138","SUP","HCPCS C1713","","04.112.138  -  PLATE BONE 86MM LCP TITANIUM RIGHT LEFT DISTAL LATERAL","BOTH IP/OP","$1,166.73 ","$863.38 ","$0.00 ","$1,132.75 ","$509.74 ","$0.00 ","$243.17 ","$0.00 ","$0.00 ","$198.34 ","$1,132.75 ","$0.00 ","$566.38 ","$897.14 ","$906.20 ","$0.00 ","$172.11 ","$0.00 ","$180.33 ","$0.00 "
"04.112.139","SUP","HCPCS C1713","","04.112.139  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR","BOTH IP/OP","$1,166.73 ","$863.38 ","$0.00 ","$1,132.75 ","$509.74 ","$0.00 ","$243.17 ","$0.00 ","$0.00 ","$198.34 ","$1,132.75 ","$0.00 ","$566.38 ","$897.14 ","$906.20 ","$0.00 ","$172.11 ","$0.00 ","$180.33 ","$0.00 "
"04.112.140","SUP","HCPCS C1713","","04.112.140  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR","BOTH IP/OP","$1,182.18 ","$874.81 ","$0.00 ","$1,147.75 ","$516.49 ","$0.00 ","$246.39 ","$0.00 ","$0.00 ","$200.96 ","$1,147.75 ","$0.00 ","$573.88 ","$909.02 ","$918.20 ","$0.00 ","$174.39 ","$0.00 ","$182.72 ","$0.00 "
"04.112.141","SUP","HCPCS C1713","","04.112.141  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL FIBULAR","BOTH IP/OP","$1,182.18 ","$874.81 ","$0.00 ","$1,147.75 ","$516.49 ","$0.00 ","$246.39 ","$0.00 ","$0.00 ","$200.96 ","$1,147.75 ","$0.00 ","$573.88 ","$909.02 ","$918.20 ","$0.00 ","$174.39 ","$0.00 ","$182.72 ","$0.00 "
"04.112.142","SUP","HCPCS C1713","","04.112.142  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR","BOTH IP/OP","$1,200.45 ","$888.33 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$250.20 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$177.09 ","$0.00 ","$185.55 ","$0.00 "
"04.112.143","SUP","HCPCS C1713","","04.112.143  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT LATERAL DISTAL","BOTH IP/OP","$1,200.45 ","$888.33 ","$0.00 ","$1,165.50 ","$524.48 ","$0.00 ","$250.20 ","$0.00 ","$0.00 ","$204.07 ","$1,165.50 ","$0.00 ","$582.75 ","$923.08 ","$932.40 ","$0.00 ","$177.09 ","$0.00 ","$185.55 ","$0.00 "
"04.112.144","SUP","HCPCS C1713","","04.112.144  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT LATERAL DISTAL","BOTH IP/OP","$1,217.33 ","$900.82 ","$0.00 ","$1,181.88 ","$531.84 ","$0.00 ","$253.72 ","$0.00 ","$0.00 ","$206.94 ","$1,181.88 ","$0.00 ","$590.94 ","$936.05 ","$945.50 ","$0.00 ","$179.58 ","$0.00 ","$188.15 ","$0.00 "
"04.112.145","SUP","HCPCS C1713","","04.112.145  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT LATERAL DISTAL","BOTH IP/OP","$1,217.33 ","$900.82 ","$0.00 ","$1,181.88 ","$531.84 ","$0.00 ","$253.72 ","$0.00 ","$0.00 ","$206.94 ","$1,181.88 ","$0.00 ","$590.94 ","$936.05 ","$945.50 ","$0.00 ","$179.58 ","$0.00 ","$188.15 ","$0.00 "
"04.112.148","SUP","HCPCS C1713","","04.112.148  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"04.112.149","SUP","HCPCS C1713","","04.112.149  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT LATERAL DISTAL","BOTH IP/OP","$1,276.38 ","$944.52 ","$0.00 ","$1,239.20 ","$557.64 ","$0.00 ","$266.03 ","$0.00 ","$0.00 ","$216.97 ","$1,239.20 ","$0.00 ","$619.60 ","$981.45 ","$991.36 ","$0.00 ","$188.29 ","$0.00 ","$197.28 ","$0.00 "
"04.112.152","SUP","HCPCS C1713","","04.112.152  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"04.112.153","SUP","HCPCS C1713","","04.112.153  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT LATERAL DISTAL","BOTH IP/OP","$1,296.05 ","$959.08 ","$0.00 ","$1,258.30 ","$566.24 ","$0.00 ","$270.13 ","$0.00 ","$0.00 ","$220.32 ","$1,258.30 ","$0.00 ","$629.15 ","$996.57 ","$1,006.64 ","$0.00 ","$191.19 ","$0.00 ","$200.32 ","$0.00 "
"04.112.156","SUP","HCPCS C1713","","04.112.156  -  PLATE BONE 203MM 13 HOLE LCP RIGHT LATERAL DISTAL FIBULAR","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"04.112.157","SUP","HCPCS C1713","","04.112.157  -  PLATE BONE 203MM 13 HOLE LCP LEFT LATERAL DISTAL FIBULAR","BOTH IP/OP","$1,350.88 ","$999.65 ","$0.00 ","$1,311.53 ","$590.19 ","$0.00 ","$281.56 ","$0.00 ","$0.00 ","$229.64 ","$1,311.53 ","$0.00 ","$655.76 ","$1,038.73 ","$1,049.22 ","$0.00 ","$199.28 ","$0.00 ","$208.79 ","$0.00 "
"04.112.160","SUP","HCPCS C1713","","04.112.160  -  PLATE BONE 229MM LCP LATERAL DISTAL FIBULAR NONSTRL 2.7/3.5","BOTH IP/OP","$1,370.55 ","$1,014.21 ","$0.00 ","$1,330.63 ","$598.78 ","$0.00 ","$285.66 ","$0.00 ","$0.00 ","$232.98 ","$1,330.63 ","$0.00 ","$665.31 ","$1,053.86 ","$1,064.50 ","$0.00 ","$202.18 ","$0.00 ","$211.84 ","$0.00 "
"04.112.161","SUP","HCPCS C1713","","04.112.161  -  PLATE BONE 229MM 15 HOLE LCP LATERAL DISTAL FIBULAR NONSTRL","BOTH IP/OP","$1,370.55 ","$1,014.21 ","$0.00 ","$1,330.63 ","$598.78 ","$0.00 ","$285.66 ","$0.00 ","$0.00 ","$232.98 ","$1,330.63 ","$0.00 ","$665.31 ","$1,053.86 ","$1,064.50 ","$0.00 ","$202.18 ","$0.00 ","$211.84 ","$0.00 "
"04.112.510","SUP","HCPCS C1713","","04.112.510  -  PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM RIGHT MEDIAL","BOTH IP/OP","$2,684.88 ","$1,986.81 ","$0.00 ","$2,606.68 ","$1,173.00 ","$0.00 ","$559.60 ","$0.00 ","$0.00 ","$456.41 ","$2,606.68 ","$0.00 ","$1,303.34 ","$2,064.49 ","$2,085.34 ","$0.00 ","$396.06 ","$0.00 ","$414.98 ","$0.00 "
"04.112.511","SUP","HCPCS C1713","","04.112.511  -  PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,684.88 ","$1,986.81 ","$0.00 ","$2,606.68 ","$1,173.00 ","$0.00 ","$559.60 ","$0.00 ","$0.00 ","$456.41 ","$2,606.68 ","$0.00 ","$1,303.34 ","$2,064.49 ","$2,085.34 ","$0.00 ","$396.06 ","$0.00 ","$414.98 ","$0.00 "
"04.112.514","SUP","HCPCS C1713","","04.112.514  -  PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,627.25 ","$1,944.17 ","$0.00 ","$2,550.73 ","$1,147.83 ","$0.00 ","$547.58 ","$0.00 ","$0.00 ","$446.61 ","$2,550.73 ","$0.00 ","$1,275.36 ","$2,020.18 ","$2,040.58 ","$0.00 ","$387.56 ","$0.00 ","$406.08 ","$0.00 "
"04.112.515","SUP","HCPCS C1713","","04.112.515  -  PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM LEFT MEDIAL","BOTH IP/OP","$2,627.25 ","$1,944.17 ","$0.00 ","$2,550.73 ","$1,147.83 ","$0.00 ","$547.58 ","$0.00 ","$0.00 ","$446.61 ","$2,550.73 ","$0.00 ","$1,275.36 ","$2,020.18 ","$2,040.58 ","$0.00 ","$387.56 ","$0.00 ","$406.08 ","$0.00 "
"04.112.518","SUP","HCPCS C1713","","04.112.518  -  PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,652.55 ","$1,962.89 ","$0.00 ","$2,575.28 ","$1,158.87 ","$0.00 ","$552.86 ","$0.00 ","$0.00 ","$450.91 ","$2,575.28 ","$0.00 ","$1,287.64 ","$2,039.62 ","$2,060.22 ","$0.00 ","$391.29 ","$0.00 ","$409.98 ","$0.00 "
"04.112.519","SUP","HCPCS C1713","","04.112.519  -  PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,652.55 ","$1,962.89 ","$0.00 ","$2,575.28 ","$1,158.87 ","$0.00 ","$552.86 ","$0.00 ","$0.00 ","$450.91 ","$2,575.28 ","$0.00 ","$1,287.64 ","$2,039.62 ","$2,060.22 ","$0.00 ","$391.29 ","$0.00 ","$409.98 ","$0.00 "
"04.112.522","SUP","HCPCS C1713","","04.112.522  -  PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,680.65 ","$1,983.68 ","$0.00 ","$2,602.58 ","$1,171.16 ","$0.00 ","$558.71 ","$0.00 ","$0.00 ","$455.69 ","$2,602.58 ","$0.00 ","$1,301.29 ","$2,061.24 ","$2,082.06 ","$0.00 ","$395.44 ","$0.00 ","$414.33 ","$0.00 "
"04.112.523","SUP","HCPCS C1713","","04.112.523  -  PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,680.65 ","$1,983.68 ","$0.00 ","$2,602.58 ","$1,171.16 ","$0.00 ","$558.71 ","$0.00 ","$0.00 ","$455.69 ","$2,602.58 ","$0.00 ","$1,301.29 ","$2,061.24 ","$2,082.06 ","$0.00 ","$395.44 ","$0.00 ","$414.33 ","$0.00 "
"04.112.526","SUP","HCPCS C1713","","04.112.526  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,710.18 ","$2,005.53 ","$0.00 ","$2,631.25 ","$1,184.06 ","$0.00 ","$564.87 ","$0.00 ","$0.00 ","$460.71 ","$2,631.25 ","$0.00 ","$1,315.63 ","$2,083.95 ","$2,105.00 ","$0.00 ","$399.79 ","$0.00 ","$418.90 ","$0.00 "
"04.112.527","SUP","HCPCS C1713","","04.112.527  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,710.18 ","$2,005.53 ","$0.00 ","$2,631.25 ","$1,184.06 ","$0.00 ","$564.87 ","$0.00 ","$0.00 ","$460.71 ","$2,631.25 ","$0.00 ","$1,315.63 ","$2,083.95 ","$2,105.00 ","$0.00 ","$399.79 ","$0.00 ","$418.90 ","$0.00 "
"04.112.530","SUP","HCPCS C1713","","04.112.530  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,838.10 ","$2,100.19 ","$0.00 ","$2,755.43 ","$1,239.94 ","$0.00 ","$591.53 ","$0.00 ","$0.00 ","$482.45 ","$2,755.43 ","$0.00 ","$1,377.71 ","$2,182.30 ","$2,204.34 ","$0.00 ","$418.66 ","$0.00 ","$438.66 ","$0.00 "
"04.112.531","SUP","HCPCS C1713","","04.112.531  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,838.10 ","$2,100.19 ","$0.00 ","$2,755.43 ","$1,239.94 ","$0.00 ","$591.53 ","$0.00 ","$0.00 ","$482.45 ","$2,755.43 ","$0.00 ","$1,377.71 ","$2,182.30 ","$2,204.34 ","$0.00 ","$418.66 ","$0.00 ","$438.66 ","$0.00 "
"04.113.103","SUP","HCPCS C1713","","04.113.103  -  PLATE BONE 62MM 3 HOLE HOOK LCP TITANIUM NONSTRL 3.5MM","BOTH IP/OP","$1,019.13 ","$754.16 ","$0.00 ","$989.45 ","$445.25 ","$0.00 ","$212.41 ","$0.00 ","$0.00 ","$173.24 ","$989.45 ","$0.00 ","$494.73 ","$783.64 ","$791.56 ","$0.00 ","$150.34 ","$0.00 ","$157.52 ","$0.00 "
"04.114.002","SUP","HCPCS C1713","","04.114.002  -  PLATE BONE 23MM 4 HOLE PURE STR LCP TITANIUM HAND WRIST","BOTH IP/OP","$410.45 ","$303.73 ","$0.00 ","$398.50 ","$179.33 ","$0.00 ","$85.55 ","$0.00 ","$0.00 ","$69.77 ","$398.50 ","$0.00 ","$199.25 ","$315.61 ","$318.80 ","$0.00 ","$60.55 ","$0.00 ","$63.44 ","$0.00 "
"04.114.003","SUP","HCPCS C1713","","04.114.003  -  PLATE BONE 29MM 6 HOLE PURE STR LOCKING LCP TITANIUM HAND","BOTH IP/OP","$752.05 ","$556.52 ","$0.00 ","$730.15 ","$328.57 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$127.84 ","$730.15 ","$0.00 ","$365.08 ","$578.28 ","$584.12 ","$0.00 ","$110.94 ","$0.00 ","$116.24 ","$0.00 "
"04.114.004","SUP","HCPCS C1713","","04.114.004  -  PLATE BONE 36MM 6 HOLE PURE STR LCP TITANIUM HAND WRIST","BOTH IP/OP","$410.45 ","$303.73 ","$0.00 ","$398.50 ","$179.33 ","$0.00 ","$85.55 ","$0.00 ","$0.00 ","$69.77 ","$398.50 ","$0.00 ","$199.25 ","$315.61 ","$318.80 ","$0.00 ","$60.55 ","$0.00 ","$63.44 ","$0.00 "
"04.114.005","SUP","HCPCS C1713","","04.114.005  -  PLATE BONE 59MM 12 HOLE PURE STR LOCKING ADAPTION LCP","BOTH IP/OP","$752.05 ","$556.52 ","$0.00 ","$730.15 ","$328.57 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$127.84 ","$730.15 ","$0.00 ","$365.08 ","$578.28 ","$584.12 ","$0.00 ","$110.94 ","$0.00 ","$116.24 ","$0.00 "
"04.114.006","SUP","HCPCS C1713","","04.114.006  -  PLATE BONE T 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$767.00 ","$345.15 ","$0.00 ","$164.66 ","$0.00 ","$0.00 ","$134.30 ","$767.00 ","$0.00 ","$383.50 ","$607.46 ","$613.60 ","$0.00 ","$116.54 ","$0.00 ","$122.11 ","$0.00 "
"04.114.007","SUP","HCPCS C1713","","04.114.007  -  PLATE BONE T 4X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$767.00 ","$345.15 ","$0.00 ","$164.66 ","$0.00 ","$0.00 ","$134.30 ","$767.00 ","$0.00 ","$383.50 ","$607.46 ","$613.60 ","$0.00 ","$116.54 ","$0.00 ","$122.11 ","$0.00 "
"04.114.009","SUP","HCPCS C1713","","04.114.009  -  PLATE BONE H LEFT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"04.114.010","SUP","HCPCS C1713","","04.114.010  -  PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"04.114.013","SUP","HCPCS C1713","","04.114.013  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW","BOTH IP/OP","$760.48 ","$562.76 ","$0.00 ","$738.33 ","$332.25 ","$0.00 ","$158.50 ","$0.00 ","$0.00 ","$129.27 ","$738.33 ","$0.00 ","$369.16 ","$584.76 ","$590.66 ","$0.00 ","$112.18 ","$0.00 ","$117.54 ","$0.00 "
"04.114.014","SUP","HCPCS C1713","","04.114.014  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW","BOTH IP/OP","$884.18 ","$654.29 ","$0.00 ","$858.43 ","$386.29 ","$0.00 ","$184.28 ","$0.00 ","$0.00 ","$150.30 ","$858.43 ","$0.00 ","$429.21 ","$679.88 ","$686.74 ","$0.00 ","$130.43 ","$0.00 ","$136.66 ","$0.00 "
"04.114.502","SUP","HCPCS C1713","","04.114.502  -  PLATE BONE SHORT THREAD 23MM 4 HOLE ASSEMBLE DRILL GUIDE LCP","BOTH IP/OP","$490.58 ","$363.03 ","$0.00 ","$476.30 ","$214.34 ","$0.00 ","$102.25 ","$0.00 ","$0.00 ","$83.40 ","$476.30 ","$0.00 ","$238.15 ","$377.23 ","$381.04 ","$0.00 ","$72.37 ","$0.00 ","$75.83 ","$0.00 "
"04.114.503","SUP","HCPCS C1713","","04.114.503  -  PLATE BONE SHORT THREAD 29MM 6 HOLE ADAPTION LCP TITANIUM","BOTH IP/OP","$836.38 ","$618.92 ","$0.00 ","$812.03 ","$365.41 ","$0.00 ","$174.32 ","$0.00 ","$0.00 ","$142.18 ","$812.03 ","$0.00 ","$406.01 ","$643.13 ","$649.62 ","$0.00 ","$123.38 ","$0.00 ","$129.27 ","$0.00 "
"04.114.504","SUP","HCPCS C1713","","04.114.504  -  PLATE BONE 36MM 6 HOLE PURE STR PREASSEMBLED DRILL SLEEVE","BOTH IP/OP","$490.58 ","$363.03 ","$0.00 ","$476.30 ","$214.34 ","$0.00 ","$102.25 ","$0.00 ","$0.00 ","$83.40 ","$476.30 ","$0.00 ","$238.15 ","$377.23 ","$381.04 ","$0.00 ","$72.37 ","$0.00 ","$75.83 ","$0.00 "
"04.114.505","SUP","HCPCS C1713","","04.114.505  -  PLATE BONE 59MM 12 HOLE PURE STR PREASSEMBLED DRILL SLEEVE","BOTH IP/OP","$836.38 ","$618.92 ","$0.00 ","$812.03 ","$365.41 ","$0.00 ","$174.32 ","$0.00 ","$0.00 ","$142.18 ","$812.03 ","$0.00 ","$406.01 ","$643.13 ","$649.62 ","$0.00 ","$123.38 ","$0.00 ","$129.27 ","$0.00 "
"04.114.506","SUP","HCPCS C1713","","04.114.506  -  PLATE BONE 3X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP","BOTH IP/OP","$885.58 ","$655.33 ","$0.00 ","$859.80 ","$386.91 ","$0.00 ","$184.58 ","$0.00 ","$0.00 ","$150.54 ","$859.80 ","$0.00 ","$429.90 ","$680.96 ","$687.84 ","$0.00 ","$130.64 ","$0.00 ","$136.88 ","$0.00 "
"04.114.507","SUP","HCPCS C1713","","04.114.507  -  PLATE BONE 4X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP","BOTH IP/OP","$885.58 ","$655.33 ","$0.00 ","$859.80 ","$386.91 ","$0.00 ","$184.58 ","$0.00 ","$0.00 ","$150.54 ","$859.80 ","$0.00 ","$429.90 ","$680.96 ","$687.84 ","$0.00 ","$130.64 ","$0.00 ","$136.88 ","$0.00 "
"04.114.509","SUP","HCPCS C1713","","04.114.509  -  PLATE BONE 8 HOLE STRUT PREASSEMBLED DRILL SLEEVE LOCKING","BOTH IP/OP","$846.23 ","$626.21 ","$0.00 ","$821.58 ","$369.71 ","$0.00 ","$176.37 ","$0.00 ","$0.00 ","$143.85 ","$821.58 ","$0.00 ","$410.79 ","$650.69 ","$657.26 ","$0.00 ","$124.83 ","$0.00 ","$130.79 ","$0.00 "
"04.114.510","SUP","HCPCS C1713","","04.114.510  -  PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM","BOTH IP/OP","$846.23 ","$626.21 ","$0.00 ","$821.58 ","$369.71 ","$0.00 ","$176.37 ","$0.00 ","$0.00 ","$143.85 ","$821.58 ","$0.00 ","$410.79 ","$650.69 ","$657.26 ","$0.00 ","$124.83 ","$0.00 ","$130.79 ","$0.00 "
"04.114.513","SUP","HCPCS C1713","","04.114.513  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW","BOTH IP/OP","$846.23 ","$626.21 ","$0.00 ","$821.58 ","$369.71 ","$0.00 ","$176.37 ","$0.00 ","$0.00 ","$143.85 ","$821.58 ","$0.00 ","$410.79 ","$650.69 ","$657.26 ","$0.00 ","$124.83 ","$0.00 ","$130.79 ","$0.00 "
"04.114.514","SUP","HCPCS C1713","","04.114.514  -  PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 1.5 MM SCREWS","BOTH IP/OP","$968.53 ","$716.71 ","$0.00 ","$940.33 ","$423.15 ","$0.00 ","$201.86 ","$0.00 ","$0.00 ","$164.64 ","$940.33 ","$0.00 ","$470.16 ","$744.74 ","$752.26 ","$0.00 ","$142.87 ","$0.00 ","$149.70 ","$0.00 "
"04.115.130","SUP","HCPCS C1713","","04.115.130  -  PLATE BONE +90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"04.115.131","SUP","HCPCS C1713","","04.115.131  -  PLATE BONE -90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"04.115.150","SUP","HCPCS C1713","","04.115.150  -  PLATE BONE +90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"04.115.151","SUP","HCPCS C1713","","04.115.151  -  PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"04.115.230","SUP","HCPCS C1713","","04.115.230  -  PLATE BONE +90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"04.115.231","SUP","HCPCS C1713","","04.115.231  -  PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"04.115.250","SUP","HCPCS C1713","","04.115.250  -  PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"04.115.251","SUP","HCPCS C1713","","04.115.251  -  PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"04.115.330","SUP","HCPCS C1713","","04.115.330  -  PLATE BONE 37MM 3X3 HOLE T VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,059.90 ","$784.33 ","$0.00 ","$1,029.03 ","$463.06 ","$0.00 ","$220.91 ","$0.00 ","$0.00 ","$180.17 ","$1,029.03 ","$0.00 ","$514.51 ","$814.99 ","$823.22 ","$0.00 ","$156.35 ","$0.00 ","$163.82 ","$0.00 "
"04.115.350","SUP","HCPCS C1713","","04.115.350  -  PLATE BONE 51MM 3X5 HOLE T VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"04.115.430","SUP","HCPCS C1713","","04.115.430  -  PLATE BONE +20D 41MM 3X3 HOLE L VAR ANG OPLIQUE LOCKING LCP","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"04.115.431","SUP","HCPCS C1713","","04.115.431  -  PLATE BONE -20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LOCKING LCP","BOTH IP/OP","$1,026.15 ","$759.35 ","$0.00 ","$996.28 ","$448.32 ","$0.00 ","$213.88 ","$0.00 ","$0.00 ","$174.44 ","$996.28 ","$0.00 ","$498.14 ","$789.05 ","$797.02 ","$0.00 ","$151.37 ","$0.00 ","$158.61 ","$0.00 "
"04.115.450","SUP","HCPCS C1713","","04.115.450  -  PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"04.115.451","SUP","HCPCS C1713","","04.115.451  -  PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP","BOTH IP/OP","$1,078.18 ","$797.85 ","$0.00 ","$1,046.78 ","$471.05 ","$0.00 ","$224.72 ","$0.00 ","$0.00 ","$183.28 ","$1,046.78 ","$0.00 ","$523.39 ","$829.05 ","$837.42 ","$0.00 ","$159.05 ","$0.00 ","$166.65 ","$0.00 "
"04.115.530","SUP","HCPCS C1713","","04.115.530  -  PLATE BONE 46MM 3X5 HOLE VAR ANG COLUMN LOCKING LCP TITANIUM","BOTH IP/OP","$1,059.90 ","$784.33 ","$0.00 ","$1,029.03 ","$463.06 ","$0.00 ","$220.91 ","$0.00 ","$0.00 ","$180.17 ","$1,029.03 ","$0.00 ","$514.51 ","$814.99 ","$823.22 ","$0.00 ","$156.35 ","$0.00 ","$163.82 ","$0.00 "
"04.115.540","SUP","HCPCS C1713","","04.115.540  -  PLATE BONE 57MM 6 HOLE L VAR ANG COLUMN LCP TITANIUM DISTAL","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"04.115.630","SUP","HCPCS C1713","","04.115.630  -  PLATE BONE +90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"04.115.631","SUP","HCPCS C1713","","04.115.631  -  PLATE BONE -90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN","BOTH IP/OP","$1,106.28 ","$818.65 ","$0.00 ","$1,074.05 ","$483.32 ","$0.00 ","$230.58 ","$0.00 ","$0.00 ","$188.06 ","$1,074.05 ","$0.00 ","$537.03 ","$850.65 ","$859.24 ","$0.00 ","$163.19 ","$0.00 ","$170.99 ","$0.00 "
"04.115.640","SUP","HCPCS C1713","","04.115.640  -  PLATE BONE +90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"04.115.641","SUP","HCPCS C1713","","04.115.641  -  PLATE BONE -90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN","BOTH IP/OP","$1,147.05 ","$848.82 ","$0.00 ","$1,113.63 ","$501.13 ","$0.00 ","$239.07 ","$0.00 ","$0.00 ","$194.99 ","$1,113.63 ","$0.00 ","$556.81 ","$881.99 ","$890.90 ","$0.00 ","$169.21 ","$0.00 ","$177.29 ","$0.00 "
"04.120.601","SUP","HCPCS C1713","","04.120.601  -  PLATE BONE 4.5MM 4 HOLE LOCKING ATTCH LCP TITANIUM FEMUR","BOTH IP/OP","$940.40 ","$695.90 ","$0.00 ","$913.03 ","$410.86 ","$0.00 ","$196.00 ","$0.00 ","$0.00 ","$159.86 ","$913.03 ","$0.00 ","$456.51 ","$723.12 ","$730.42 ","$0.00 ","$138.73 ","$0.00 ","$145.35 ","$0.00 "
"04.120.602","SUP","HCPCS C1713","","04.120.602  -  PLATE BONE 4.5MM 8 HOLE LOCKING ATTCH LCP TITANIUM FEMUR","BOTH IP/OP","$1,030.38 ","$762.48 ","$0.00 ","$1,000.35 ","$450.16 ","$0.00 ","$214.76 ","$0.00 ","$0.00 ","$175.15 ","$1,000.35 ","$0.00 ","$500.18 ","$792.28 ","$800.28 ","$0.00 ","$152.00 ","$0.00 ","$159.26 ","$0.00 "
"04.120.606","SUP","HCPCS C1713","","04.120.606  -  SCREW BONE 6MM CONNCTNG STARDRIVE RECESS TITANIUM NONSTRL","BOTH IP/OP","$303.63 ","$224.69 ","$0.00 ","$294.78 ","$132.65 ","$0.00 ","$63.28 ","$0.00 ","$0.00 ","$51.61 ","$294.78 ","$0.00 ","$147.39 ","$233.47 ","$235.82 ","$0.00 ","$44.79 ","$0.00 ","$46.93 ","$0.00 "
"04.120.701","SUP","HCPCS C1713","","04.120.701  -  PLATE BONE 69MM 1 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL","BOTH IP/OP","$1,750.08 ","$1,295.06 ","$0.00 ","$1,699.13 ","$764.61 ","$0.00 ","$364.76 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$258.17 ","$0.00 ","$270.50 ","$0.00 "
"04.120.702","SUP","HCPCS C1713","","04.120.702  -  PLATE BONE 79MM 2 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL","BOTH IP/OP","$1,769.78 ","$1,309.64 ","$0.00 ","$1,718.23 ","$773.20 ","$0.00 ","$368.87 ","$0.00 ","$0.00 ","$300.85 ","$1,718.23 ","$0.00 ","$859.11 ","$1,360.84 ","$1,374.58 ","$0.00 ","$261.07 ","$0.00 ","$273.54 ","$0.00 "
"04.120.704","SUP","HCPCS C1713","","04.120.704  -  PLATE BONE 105MM 4 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL","BOTH IP/OP","$1,788.05 ","$1,323.16 ","$0.00 ","$1,735.95 ","$781.18 ","$0.00 ","$372.67 ","$0.00 ","$0.00 ","$303.95 ","$1,735.95 ","$0.00 ","$867.98 ","$1,374.87 ","$1,388.76 ","$0.00 ","$263.77 ","$0.00 ","$276.36 ","$0.00 "
"04.120.706","SUP","HCPCS C1713","","04.120.706  -  PLATE BONE 131MM 6 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL","BOTH IP/OP","$1,804.90 ","$1,335.63 ","$0.00 ","$1,752.35 ","$788.56 ","$0.00 ","$376.19 ","$0.00 ","$0.00 ","$306.82 ","$1,752.35 ","$0.00 ","$876.18 ","$1,387.86 ","$1,401.88 ","$0.00 ","$266.25 ","$0.00 ","$278.97 ","$0.00 "
"04.120.708","SUP","HCPCS C1713","","04.120.708  -  PLATE BONE 157MM 8 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL","BOTH IP/OP","$1,824.60 ","$1,350.20 ","$0.00 ","$1,771.45 ","$797.15 ","$0.00 ","$380.29 ","$0.00 ","$0.00 ","$310.17 ","$1,771.45 ","$0.00 ","$885.73 ","$1,402.99 ","$1,417.16 ","$0.00 ","$269.16 ","$0.00 ","$282.01 ","$0.00 "
"04.120.710","SUP","HCPCS C1713","","04.120.710  -  PLATE BONE 183MM 10 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL","BOTH IP/OP","$1,844.28 ","$1,364.77 ","$0.00 ","$1,790.55 ","$805.75 ","$0.00 ","$384.39 ","$0.00 ","$0.00 ","$313.51 ","$1,790.55 ","$0.00 ","$895.28 ","$1,418.12 ","$1,432.44 ","$0.00 ","$272.06 ","$0.00 ","$285.06 ","$0.00 "
"04.124.030S","SUP","HCPCS C1713","","04.124.030S  -  PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$3,318.85 ","$2,455.95 ","$0.00 ","$3,222.18 ","$1,449.98 ","$0.00 ","$691.73 ","$0.00 ","$0.00 ","$564.18 ","$3,222.18 ","$0.00 ","$1,611.09 ","$2,551.97 ","$2,577.74 ","$0.00 ","$489.58 ","$0.00 ","$512.97 ","$0.00 "
"04.124.031S","SUP","HCPCS C1713","","04.124.031S  -  PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$3,318.85 ","$2,455.95 ","$0.00 ","$3,222.18 ","$1,449.98 ","$0.00 ","$691.73 ","$0.00 ","$0.00 ","$564.18 ","$3,222.18 ","$0.00 ","$1,611.09 ","$2,551.97 ","$2,577.74 ","$0.00 ","$489.58 ","$0.00 ","$512.97 ","$0.00 "
"04.124.034S","SUP","HCPCS C1713","","04.124.034S  -  PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$3,379.28 ","$2,500.67 ","$0.00 ","$3,280.85 ","$1,476.38 ","$0.00 ","$704.33 ","$0.00 ","$0.00 ","$574.45 ","$3,280.85 ","$0.00 ","$1,640.43 ","$2,598.43 ","$2,624.68 ","$0.00 ","$498.50 ","$0.00 ","$522.31 ","$0.00 "
"04.124.035S","SUP","HCPCS C1713","","04.124.035S  -  PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$3,379.28 ","$2,500.67 ","$0.00 ","$3,280.85 ","$1,476.38 ","$0.00 ","$704.33 ","$0.00 ","$0.00 ","$574.45 ","$3,280.85 ","$0.00 ","$1,640.43 ","$2,598.43 ","$2,624.68 ","$0.00 ","$498.50 ","$0.00 ","$522.31 ","$0.00 "
"04.124.038S","SUP","HCPCS C1713","","04.124.038S  -  PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR RIGHT DISTAL","BOTH IP/OP","$3,441.13 ","$2,546.44 ","$0.00 ","$3,340.90 ","$1,503.41 ","$0.00 ","$717.22 ","$0.00 ","$0.00 ","$584.96 ","$3,340.90 ","$0.00 ","$1,670.45 ","$2,645.99 ","$2,672.72 ","$0.00 ","$507.62 ","$0.00 ","$531.87 ","$0.00 "
"04.124.039S","SUP","HCPCS C1713","","04.124.039S  -  PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR LEFT DISTAL","BOTH IP/OP","$3,441.13 ","$2,546.44 ","$0.00 ","$3,340.90 ","$1,503.41 ","$0.00 ","$717.22 ","$0.00 ","$0.00 ","$584.96 ","$3,340.90 ","$0.00 ","$1,670.45 ","$2,645.99 ","$2,672.72 ","$0.00 ","$507.62 ","$0.00 ","$531.87 ","$0.00 "
"04.124.200","SUP","HCPCS C1713","","04.124.200  -  PLATE BONE 76MM 4 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"04.124.201","SUP","HCPCS C1713","","04.124.201  -  PLATE BONE 76MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,663.78 ","$1,971.20 ","$0.00 ","$2,586.20 ","$1,163.79 ","$0.00 ","$555.20 ","$0.00 ","$0.00 ","$452.82 ","$2,586.20 ","$0.00 ","$1,293.10 ","$2,048.27 ","$2,068.96 ","$0.00 ","$392.95 ","$0.00 ","$411.72 ","$0.00 "
"04.124.204","SUP","HCPCS C1713","","04.124.204  -  PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"04.124.205","SUP","HCPCS C1713","","04.124.205  -  PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,696.13 ","$1,995.14 ","$0.00 ","$2,617.60 ","$1,177.92 ","$0.00 ","$561.94 ","$0.00 ","$0.00 ","$458.32 ","$2,617.60 ","$0.00 ","$1,308.80 ","$2,073.14 ","$2,094.08 ","$0.00 ","$397.72 ","$0.00 ","$416.72 ","$0.00 "
"04.124.208","SUP","HCPCS C1713","","04.124.208  -  PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"04.124.209","SUP","HCPCS C1713","","04.124.209  -  PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,727.05 ","$2,018.02 ","$0.00 ","$2,647.63 ","$1,191.43 ","$0.00 ","$568.39 ","$0.00 ","$0.00 ","$463.58 ","$2,647.63 ","$0.00 ","$1,323.81 ","$2,096.92 ","$2,118.10 ","$0.00 ","$402.28 ","$0.00 ","$421.50 ","$0.00 "
"04.124.212","SUP","HCPCS C1713","","04.124.212  -  PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,756.58 ","$2,039.87 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$574.54 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"04.124.213","SUP","HCPCS C1713","","04.124.213  -  PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,756.58 ","$2,039.87 ","$0.00 ","$2,676.28 ","$1,204.32 ","$0.00 ","$574.54 ","$0.00 ","$0.00 ","$468.59 ","$2,676.28 ","$0.00 ","$1,338.14 ","$2,119.61 ","$2,141.02 ","$0.00 ","$406.64 ","$0.00 ","$426.06 ","$0.00 "
"04.124.216","SUP","HCPCS C1713","","04.124.216  -  PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"04.124.217","SUP","HCPCS C1713","","04.124.217  -  PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,887.30 ","$2,136.60 ","$0.00 ","$2,803.20 ","$1,261.44 ","$0.00 ","$601.79 ","$0.00 ","$0.00 ","$490.82 ","$2,803.20 ","$0.00 ","$1,401.60 ","$2,220.13 ","$2,242.56 ","$0.00 ","$425.92 ","$0.00 ","$446.27 ","$0.00 "
"04.124.220","SUP","HCPCS C1713","","04.124.220  -  PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"04.124.221","SUP","HCPCS C1713","","04.124.221  -  PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$2,918.23 ","$2,159.49 ","$0.00 ","$2,833.23 ","$1,274.95 ","$0.00 ","$608.23 ","$0.00 ","$0.00 ","$496.08 ","$2,833.23 ","$0.00 ","$1,416.61 ","$2,243.92 ","$2,266.58 ","$0.00 ","$430.48 ","$0.00 ","$451.05 ","$0.00 "
"04.124.224","SUP","HCPCS C1713","","04.124.224  -  PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT","BOTH IP/OP","$3,020.83 ","$2,235.41 ","$0.00 ","$2,932.85 ","$1,319.78 ","$0.00 ","$629.62 ","$0.00 ","$0.00 ","$513.52 ","$2,932.85 ","$0.00 ","$1,466.43 ","$2,322.82 ","$2,346.28 ","$0.00 ","$445.62 ","$0.00 ","$466.91 ","$0.00 "
"04.124.225","SUP","HCPCS C1713","","04.124.225  -  PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA LEFT","BOTH IP/OP","$3,020.83 ","$2,235.41 ","$0.00 ","$2,932.85 ","$1,319.78 ","$0.00 ","$629.62 ","$0.00 ","$0.00 ","$513.52 ","$2,932.85 ","$0.00 ","$1,466.43 ","$2,322.82 ","$2,346.28 ","$0.00 ","$445.62 ","$0.00 ","$466.91 ","$0.00 "
"04.161.001","SUP","HCPCS C1713","","04.161.001  -  PLATE 50MM TI BONE OCCPTL NONSTRL","BOTH IP/OP","$8,232.00 ","$6,091.68 ","$0.00 ","$8,232.00 ","$3,704.40 ","$0.00 ","$1,715.75 ","$0.00 ","$0.00 ","$1,441.36 ","$8,232.00 ","$0.00 ","$4,116.00 ","$6,519.74 ","$6,585.60 ","$0.00 ","$1,288.31 ","$0.00 ","$1,310.53 ","$0.00 "
"04.161.032","SUP","HCPCS C1713","","04.161.032  -  ROD SPNL 240MM 3.5MM OCCPTL TI PREBNT","BOTH IP/OP","$892.50 ","$660.45 ","$0.00 ","$892.50 ","$401.63 ","$0.00 ","$186.02 ","$0.00 ","$0.00 ","$156.27 ","$892.50 ","$0.00 ","$446.25 ","$706.86 ","$714.00 ","$0.00 ","$139.68 ","$0.00 ","$142.09 ","$0.00 "
"04.161.210S","SUP","HCPCS C1713","","04.161.210S  -  PLATE BONE NARROW 10 HOLE CVD LCP TITANIUM STERILE 3.5MM","BOTH IP/OP","$795.63 ","$588.77 ","$0.00 ","$772.45 ","$347.60 ","$0.00 ","$165.83 ","$0.00 ","$0.00 ","$135.25 ","$772.45 ","$0.00 ","$386.23 ","$611.78 ","$617.96 ","$0.00 ","$117.37 ","$0.00 ","$122.97 ","$0.00 "
"04.161.212S","SUP","HCPCS C1713","","04.161.212S  -  PLATE BONE NARROW 12 HOLE CVD LCP TITANIUM PEDIATRIC STERILE","BOTH IP/OP","$1,163.93 ","$861.31 ","$0.00 ","$1,130.03 ","$508.51 ","$0.00 ","$242.59 ","$0.00 ","$0.00 ","$197.86 ","$1,130.03 ","$0.00 ","$565.01 ","$894.98 ","$904.02 ","$0.00 ","$171.70 ","$0.00 ","$179.90 ","$0.00 "
"04.161.214S","SUP","HCPCS C1713","","04.161.214S  -  PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,332.60 ","$986.12 ","$0.00 ","$1,293.78 ","$582.20 ","$0.00 ","$277.75 ","$0.00 ","$0.00 ","$226.53 ","$1,293.78 ","$0.00 ","$646.89 ","$1,024.67 ","$1,035.02 ","$0.00 ","$196.58 ","$0.00 ","$205.97 ","$0.00 "
"04.161.216S","SUP","HCPCS C1713","","04.161.216S  -  PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,432.40 ","$1,059.98 ","$0.00 ","$1,390.68 ","$625.80 ","$0.00 ","$298.55 ","$0.00 ","$0.00 ","$243.50 ","$1,390.68 ","$0.00 ","$695.34 ","$1,101.42 ","$1,112.54 ","$0.00 ","$211.30 ","$0.00 ","$221.40 ","$0.00 "
"04.161.218S","SUP","HCPCS C1713","","04.161.218S  -  PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,601.08 ","$1,184.80 ","$0.00 ","$1,554.45 ","$699.50 ","$0.00 ","$333.70 ","$0.00 ","$0.00 ","$272.17 ","$1,554.45 ","$0.00 ","$777.23 ","$1,231.12 ","$1,243.56 ","$0.00 ","$236.19 ","$0.00 ","$247.47 ","$0.00 "
"04.161.220S","SUP","HCPCS C1713","","04.161.220S  -  PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,766.95 ","$1,307.54 ","$0.00 ","$1,715.50 ","$771.98 ","$0.00 ","$368.28 ","$0.00 ","$0.00 ","$300.37 ","$1,715.50 ","$0.00 ","$857.75 ","$1,358.68 ","$1,372.40 ","$0.00 ","$260.65 ","$0.00 ","$273.11 ","$0.00 "
"04.161.222S","SUP","HCPCS C1713","","04.161.222S  -  PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,766.95 ","$1,307.54 ","$0.00 ","$1,715.50 ","$771.98 ","$0.00 ","$368.28 ","$0.00 ","$0.00 ","$300.37 ","$1,715.50 ","$0.00 ","$857.75 ","$1,358.68 ","$1,372.40 ","$0.00 ","$260.65 ","$0.00 ","$273.11 ","$0.00 "
"04.161.240S","SUP","HCPCS C1713","","04.161.240S  -  PLATE BONE CURVE NARROW 10 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,256.70 ","$929.96 ","$0.00 ","$1,220.08 ","$549.03 ","$0.00 ","$261.93 ","$0.00 ","$0.00 ","$213.63 ","$1,220.08 ","$0.00 ","$610.04 ","$966.30 ","$976.06 ","$0.00 ","$185.38 ","$0.00 ","$194.24 ","$0.00 "
"04.161.242S","SUP","HCPCS C1713","","04.161.242S  -  PLATE BONE CURVE NARROW 12 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,436.63 ","$1,063.11 ","$0.00 ","$1,394.78 ","$627.65 ","$0.00 ","$299.43 ","$0.00 ","$0.00 ","$244.21 ","$1,394.78 ","$0.00 ","$697.39 ","$1,104.67 ","$1,115.82 ","$0.00 ","$211.92 ","$0.00 ","$222.05 ","$0.00 "
"04.161.244S","SUP","HCPCS C1713","","04.161.244S  -  PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,526.58 ","$1,129.67 ","$0.00 ","$1,482.13 ","$666.96 ","$0.00 ","$318.18 ","$0.00 ","$0.00 ","$259.51 ","$1,482.13 ","$0.00 ","$741.06 ","$1,173.85 ","$1,185.70 ","$0.00 ","$225.20 ","$0.00 ","$235.95 ","$0.00 "
"04.161.246S","SUP","HCPCS C1713","","04.161.246S  -  PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,705.10 ","$1,261.77 ","$0.00 ","$1,655.45 ","$744.95 ","$0.00 ","$355.39 ","$0.00 ","$0.00 ","$289.86 ","$1,655.45 ","$0.00 ","$827.73 ","$1,311.12 ","$1,324.36 ","$0.00 ","$251.53 ","$0.00 ","$263.55 ","$0.00 "
"04.161.248S","SUP","HCPCS C1713","","04.161.248S  -  PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$2,060.75 ","$1,524.96 ","$0.00 ","$2,000.73 ","$900.33 ","$0.00 ","$429.51 ","$0.00 ","$0.00 ","$350.31 ","$2,000.73 ","$0.00 ","$1,000.36 ","$1,584.58 ","$1,600.58 ","$0.00 ","$303.99 ","$0.00 ","$318.52 ","$0.00 "
"04.161.250S","SUP","HCPCS C1713","","04.161.250S  -  PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$2,420.60 ","$1,791.24 ","$0.00 ","$2,350.10 ","$1,057.55 ","$0.00 ","$504.51 ","$0.00 ","$0.00 ","$411.48 ","$2,350.10 ","$0.00 ","$1,175.05 ","$1,861.28 ","$1,880.08 ","$0.00 ","$357.08 ","$0.00 ","$374.14 ","$0.00 "
"04.161.252S","SUP","HCPCS C1713","","04.161.252S  -  PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$2,689.10 ","$1,989.93 ","$0.00 ","$2,610.78 ","$1,174.85 ","$0.00 ","$560.48 ","$0.00 ","$0.00 ","$457.13 ","$2,610.78 ","$0.00 ","$1,305.39 ","$2,067.74 ","$2,088.62 ","$0.00 ","$396.68 ","$0.00 ","$415.64 ","$0.00 "
"04.161.270S","SUP","HCPCS C1713","","04.161.270S  -  PLATE BONE CURVE BROAD 10 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$981.18 ","$726.07 ","$0.00 ","$952.60 ","$428.67 ","$0.00 ","$204.50 ","$0.00 ","$0.00 ","$166.79 ","$952.60 ","$0.00 ","$476.30 ","$754.46 ","$762.08 ","$0.00 ","$144.74 ","$0.00 ","$151.65 ","$0.00 "
"04.161.272S","SUP","HCPCS C1713","","04.161.272S  -  PLATE BONE CURVE BROAD 12 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,248.25 ","$923.71 ","$0.00 ","$1,211.90 ","$545.36 ","$0.00 ","$260.17 ","$0.00 ","$0.00 ","$212.19 ","$1,211.90 ","$0.00 ","$605.95 ","$959.82 ","$969.52 ","$0.00 ","$184.14 ","$0.00 ","$192.93 ","$0.00 "
"04.161.274S","SUP","HCPCS C1713","","04.161.274S  -  PLATE BONE CURVE BROAD 14 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,332.60 ","$986.12 ","$0.00 ","$1,293.78 ","$582.20 ","$0.00 ","$277.75 ","$0.00 ","$0.00 ","$226.53 ","$1,293.78 ","$0.00 ","$646.89 ","$1,024.67 ","$1,035.02 ","$0.00 ","$196.58 ","$0.00 ","$205.97 ","$0.00 "
"04.161.276S","SUP","HCPCS C1713","","04.161.276S  -  PLATE BONE CURVE BROAD 16 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,432.40 ","$1,059.98 ","$0.00 ","$1,390.68 ","$625.80 ","$0.00 ","$298.55 ","$0.00 ","$0.00 ","$243.50 ","$1,390.68 ","$0.00 ","$695.34 ","$1,101.42 ","$1,112.54 ","$0.00 ","$211.30 ","$0.00 ","$221.40 ","$0.00 "
"04.161.278S","SUP","HCPCS C1713","","04.161.278S  -  PLATE BONE CURVE BROAD 18 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,601.08 ","$1,184.80 ","$0.00 ","$1,554.45 ","$699.50 ","$0.00 ","$333.70 ","$0.00 ","$0.00 ","$272.17 ","$1,554.45 ","$0.00 ","$777.23 ","$1,231.12 ","$1,243.56 ","$0.00 ","$236.19 ","$0.00 ","$247.47 ","$0.00 "
"04.161.280S","SUP","HCPCS C1713","","04.161.280S  -  PLATE BONE CURVE BROAD 20 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,699.48 ","$1,257.62 ","$0.00 ","$1,649.98 ","$742.49 ","$0.00 ","$354.21 ","$0.00 ","$0.00 ","$288.90 ","$1,649.98 ","$0.00 ","$824.99 ","$1,306.78 ","$1,319.98 ","$0.00 ","$250.70 ","$0.00 ","$262.68 ","$0.00 "
"04.161.282S","SUP","HCPCS C1713","","04.161.282S  -  PLATE BONE CURVE BROAD 22 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,783.83 ","$1,320.03 ","$0.00 ","$1,731.88 ","$779.34 ","$0.00 ","$371.79 ","$0.00 ","$0.00 ","$303.24 ","$1,731.88 ","$0.00 ","$865.94 ","$1,371.65 ","$1,385.50 ","$0.00 ","$263.14 ","$0.00 ","$275.71 ","$0.00 "
"04.161.284S","SUP","HCPCS C1713","","04.161.284S  -  PLATE BONE CURVE BROAD 24 HOLE LCP TITANIUM PEDIATRIC SPN","BOTH IP/OP","$1,783.83 ","$1,320.03 ","$0.00 ","$1,731.88 ","$779.34 ","$0.00 ","$371.79 ","$0.00 ","$0.00 ","$303.24 ","$1,731.88 ","$0.00 ","$865.94 ","$1,371.65 ","$1,385.50 ","$0.00 ","$263.14 ","$0.00 ","$275.71 ","$0.00 "
"04.161.286S","SUP","HCPCS C1713","","04.161.286S  -  PLATE BONE 26 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM","BOTH IP/OP","$1,886.45 ","$1,395.97 ","$0.00 ","$1,831.50 ","$824.18 ","$0.00 ","$393.18 ","$0.00 ","$0.00 ","$320.68 ","$1,831.50 ","$0.00 ","$915.75 ","$1,450.55 ","$1,465.20 ","$0.00 ","$278.28 ","$0.00 ","$291.57 ","$0.00 "
"04.161.288S","SUP","HCPCS C1713","","04.161.288S  -  PLATE BONE 28 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM","BOTH IP/OP","$2,064.95 ","$1,528.06 ","$0.00 ","$2,004.83 ","$902.17 ","$0.00 ","$430.39 ","$0.00 ","$0.00 ","$351.03 ","$2,004.83 ","$0.00 ","$1,002.41 ","$1,587.83 ","$1,603.86 ","$0.00 ","$304.62 ","$0.00 ","$319.17 ","$0.00 "
"04.161.290S","SUP","HCPCS C1713","","04.161.290S  -  PLATE BONE 30 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM","BOTH IP/OP","$2,244.90 ","$1,661.23 ","$0.00 ","$2,179.50 ","$980.78 ","$0.00 ","$467.89 ","$0.00 ","$0.00 ","$381.61 ","$2,179.50 ","$0.00 ","$1,089.75 ","$1,726.16 ","$1,743.60 ","$0.00 ","$331.16 ","$0.00 ","$346.98 ","$0.00 "
"04.200.010","SUP","HCPCS C1713","","04.200.010  -  SCREW BONE FULTHD 3.5MM 10MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.012","SUP","HCPCS C1713","","04.200.012  -  SCREW BONE FULTHD 3.5MM 12MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.014","SUP","HCPCS C1713","","04.200.014  -  SCREW BONE FULTHD 3.5MM 14MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.016","SUP","HCPCS C1713","","04.200.016  -  SCREW BONE FULTHD 3.5MM 16MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.018","SUP","HCPCS C1713","","04.200.018  -  SCREW BONE FULTHD 3.5MM 18MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.020","SUP","HCPCS C1713","","04.200.020  -  SCREW BONE FULTHD 3.5MM 20MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.022","SUP","HCPCS C1713","","04.200.022  -  SCREW BONE FULTHD 3.5MM 22MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.024","SUP","HCPCS C1713","","04.200.024  -  SCREW BONE FULTHD 3.5MM 25MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.026","SUP","HCPCS C1713","","04.200.026  -  SCREW BONE FULTHD 3.5MM 26MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.028","SUP","HCPCS C1713","","04.200.028  -  SCREW BONE FULTHD 3.5MM 28MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.030","SUP","HCPCS C1713","","04.200.030  -  SCREW BONE FULTHD 3.5MM 30MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.032","SUP","HCPCS C1713","","04.200.032  -  SCREW BONE FULTHD 3.5MM 32MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.034","SUP","HCPCS C1713","","04.200.034  -  SCREW BONE FULTHD 3.5MM 34MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.036","SUP","HCPCS C1713","","04.200.036  -  SCREW BONE FULTHD 3.5MM 36MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.038","SUP","HCPCS C1713","","04.200.038  -  SCREW BONE FULTHD 3.5MM 38MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.040","SUP","HCPCS C1713","","04.200.040  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.042","SUP","HCPCS C1713","","04.200.042  -  SCREW BONE FULTHD 3.5MM 42MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.044","SUP","HCPCS C1713","","04.200.044  -  SCREW BONE FULTHD 3.5MM 44MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.045","SUP","HCPCS C1713","","04.200.045  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.046","SUP","HCPCS C1713","","04.200.046  -  SCREW BONE FULTHD 3.5MM 46MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.048","SUP","HCPCS C1713","","04.200.048  -  SCREW BONE FULTHD 3.5MM 48MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.050","SUP","HCPCS C1713","","04.200.050  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.055","SUP","HCPCS C1713","","04.200.055  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.200.060","SUP","HCPCS C1713","","04.200.060  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$47.43 ","$35.10 ","$0.00 ","$46.05 ","$20.72 ","$0.00 ","$9.88 ","$0.00 ","$0.00 ","$8.06 ","$46.05 ","$0.00 ","$23.03 ","$36.47 ","$36.84 ","$0.00 ","$7.00 ","$0.00 ","$7.33 ","$0.00 "
"04.204.014","SUP","HCPCS C1713","","04.204.014  -  SCREW BONE 4MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.016","SUP","HCPCS C1713","","04.204.016  -  SCREW BONE 4MM 16MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.018","SUP","HCPCS C1713","","04.204.018  -  SCREW BONE 4MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.020","SUP","HCPCS C1713","","04.204.020  -  SCREW BONE 4MM 20MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.022","SUP","HCPCS C1713","","04.204.022  -  SCREW BONE 4MM 22MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.024","SUP","HCPCS C1713","","04.204.024  -  SCREW BONE 4MM 24MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.026","SUP","HCPCS C1713","","04.204.026  -  SCREW BONE 4MM 26MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.028","SUP","HCPCS C1713","","04.204.028  -  SCREW BONE 4MM 28MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.030","SUP","HCPCS C1713","","04.204.030  -  SCREW BONE 4MM 30MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.032","SUP","HCPCS C1713","","04.204.032  -  SCREW BONE 4MM 32MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.034","SUP","HCPCS C1713","","04.204.034  -  SCREW BONE 4MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.036","SUP","HCPCS C1713","","04.204.036  -  SCREW BONE 4MM 36MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.038","SUP","HCPCS C1713","","04.204.038  -  SCREW BONE 4MM 38MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.040","SUP","HCPCS C1713","","04.204.040  -  SCREW BONE 4MM 40MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.042","SUP","HCPCS C1713","","04.204.042  -  SCREW BONE 4MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.044","SUP","HCPCS C1713","","04.204.044  -  SCREW BONE 4MM 44MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.046","SUP","HCPCS C1713","","04.204.046  -  SCREW BONE 4MM 46MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.048","SUP","HCPCS C1713","","04.204.048  -  SCREW BONE 4MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.050","SUP","HCPCS C1713","","04.204.050  -  SCREW BONE 4MM 50MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.052","SUP","HCPCS C1713","","04.204.052  -  SCREW BONE 4MM 52MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.054","SUP","HCPCS C1713","","04.204.054  -  SCREW BONE 4MM 54MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.056","SUP","HCPCS C1713","","04.204.056  -  SCREW BONE 4MM 56MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.058","SUP","HCPCS C1713","","04.204.058  -  SCREW BONE 4MM 58MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.060","SUP","HCPCS C1713","","04.204.060  -  SCREW BONE 4MM 60MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.204.062","SUP","HCPCS C1713","","04.204.062  -  SCREW BONE 4MM 62MM SLFTAP LOCKING STARDRIVE RECESS LCP","BOTH IP/OP","$254.40 ","$188.26 ","$0.00 ","$254.40 ","$114.48 ","$0.00 ","$53.02 ","$0.00 ","$0.00 ","$44.54 ","$254.40 ","$0.00 ","$127.20 ","$201.48 ","$203.52 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"04.205.025","SUP","HCPCS C1713","","04.205.025  -  SCREW BONE 5MM 25MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.030","SUP","HCPCS C1713","","04.205.030  -  SCREW BONE 5MM 30MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.035","SUP","HCPCS C1713","","04.205.035  -  SCREW BONE 5MM 35MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.040","SUP","HCPCS C1713","","04.205.040  -  SCREW BONE 5MM 40MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.045","SUP","HCPCS C1713","","04.205.045  -  SCREW BONE 5MM 45MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.050","SUP","HCPCS C1713","","04.205.050  -  SCREW BONE 5MM 50MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.055","SUP","HCPCS C1713","","04.205.055  -  SCREW BONE 5MM 55MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.060","SUP","HCPCS C1713","","04.205.060  -  SCREW BONE 5MM 60MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.065","SUP","HCPCS C1713","","04.205.065  -  SCREW BONE 5MM 65MM CANN SELF DRILL LOCK THREAD CONICAL HEAD","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.070","SUP","HCPCS C1713","","04.205.070  -  SCREW BONE 5MM 70MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.075","SUP","HCPCS C1713","","04.205.075  -  SCREW BONE 5MM 75MM CANN SELF DRILL LOCK THREAD CONICAL HEAD","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.080","SUP","HCPCS C1713","","04.205.080  -  SCREW BONE 5MM 80MM CANN SELF DRILL LOCK THREAD CONICAL HEAD","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.085","SUP","HCPCS C1713","","04.205.085  -  SCREW BONE 5MM 85MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.090","SUP","HCPCS C1713","","04.205.090  -  SCREW BONE 5MM 90MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.095","SUP","HCPCS C1713","","04.205.095  -  SCREW BONE 5MM 95MM LOCK CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$368.30 ","$272.54 ","$0.00 ","$357.58 ","$160.91 ","$0.00 ","$76.76 ","$0.00 ","$0.00 ","$62.61 ","$357.58 ","$0.00 ","$178.79 ","$283.20 ","$286.06 ","$0.00 ","$54.33 ","$0.00 ","$56.93 ","$0.00 "
"04.205.240","SUP","HCPCS C1713","","04.205.240  -  SCREW BONE CONE 5MM 40MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.245","SUP","HCPCS C1713","","04.205.245  -  SCREW BONE CONE 5MM 45MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.250","SUP","HCPCS C1713","","04.205.250  -  SCREW BONE CONE 5MM 50MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.255","SUP","HCPCS C1713","","04.205.255  -  SCREW BONE CONE 5MM 55MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.260","SUP","HCPCS C1713","","04.205.260  -  SCREW BONE CONE 5MM 60MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.265","SUP","HCPCS C1713","","04.205.265  -  SCREW BONE CONE 5MM 65MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.270","SUP","HCPCS C1713","","04.205.270  -  SCREW BONE CONE 5MM 70MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.275","SUP","HCPCS C1713","","04.205.275  -  SCREW BONE CONE 5MM 75MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.280","SUP","HCPCS C1713","","04.205.280  -  SCREW BONE CONE 5MM 80MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.285","SUP","HCPCS C1713","","04.205.285  -  SCREW BONE CONE 5MM 85MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.290","SUP","HCPCS C1713","","04.205.290  -  SCREW BONE CONE 5MM 90MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.205.295","SUP","HCPCS C1713","","04.205.295  -  SCREW BONE CONE 5MM 95MM CANN LCP TITANIUM PERIARTICULAR","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"04.210.078","SUP","HCPCS C1713","","04.210.078  -  PIN FIX 1.8MM 8MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$254.43 ","$188.28 ","$0.00 ","$247.03 ","$111.16 ","$0.00 ","$53.03 ","$0.00 ","$0.00 ","$43.25 ","$247.03 ","$0.00 ","$123.51 ","$195.65 ","$197.62 ","$0.00 ","$37.53 ","$0.00 ","$39.33 ","$0.00 "
"04.210.080","SUP","HCPCS C1713","","04.210.080  -  PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.082","SUP","HCPCS C1713","","04.210.082  -  PIN FIX 1.8MM 12MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.084","SUP","HCPCS C1713","","04.210.084  -  PIN FIX 1.8MM 14MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.086","SUP","HCPCS C1713","","04.210.086  -  PIN FIX 1.8MM 16MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.088","SUP","HCPCS C1713","","04.210.088  -  PIN FIX 1.8MM 18MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.090","SUP","HCPCS C1713","","04.210.090  -  PIN FIX 1.8MM 20MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.092","SUP","HCPCS C1713","","04.210.092  -  PIN FIX 1.8MM 22MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.094","SUP","HCPCS C1713","","04.210.094  -  PIN FIX 1.8MM 24MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.096","SUP","HCPCS C1713","","04.210.096  -  PIN FIX 1.8MM 26MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.098","SUP","HCPCS C1713","","04.210.098  -  PIN FIX 1.8MM 28MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.100","SUP","HCPCS C1713","","04.210.100  -  PIN FIX 1.8MM 30MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.107","SUP","HCPCS C1713","","04.210.107  -  SCREW BONE 2.4MM 7MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.108","SUP","HCPCS C1713","","04.210.108  -  SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS LOCKING VAR ANG LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.109","SUP","HCPCS C1713","","04.210.109  -  SCREW BONE 2.4MM 9MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.110","SUP","HCPCS C1713","","04.210.110  -  SCREW BONE 2.4MM 10MM LOCKING VAR ANG STARDRIVE RECESS LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.111","SUP","HCPCS C1713","","04.210.111  -  SCREW BONE 2.4MM 11MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.112","SUP","HCPCS C1713","","04.210.112  -  SCREW BONE 2.4MM 12MM LOCKING VAR ANG STARDRIVE RECESS LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.113","SUP","HCPCS C1713","","04.210.113  -  SCREW BONE 2.4MM 13MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.114","SUP","HCPCS C1713","","04.210.114  -  SCREW BONE T8 2.4MM 14MM VAR ANG LOCK STARDRIVE LCP TITANIUM","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.116","SUP","HCPCS C1713","","04.210.116  -  SCREW BONE T8 2.4MM 16MM VAR ANG LOCK STARDRIVE LCP TITANIUM","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.118","SUP","HCPCS C1713","","04.210.118  -  SCREW BONE T8 2.4MM 18MM VAR ANG LOCK STARDRIVE LCP TITANIUM","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.120","SUP","HCPCS C1713","","04.210.120  -  SCREW BONE T8 2.4MM 20MM VAR ANG LOCK STARDRIVE LCP TITANIUM","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.122","SUP","HCPCS C1713","","04.210.122  -  SCREW BONE T8 2.4MM 22MM VAR ANG LOCK STARDRIVE LCP TITANIUM","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.124","SUP","HCPCS C1713","","04.210.124  -  SCREW BONE T8 2.4MM 24MM VAR ANG LOCK STARDRIVE LCP TITANIUM","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.126","SUP","HCPCS C1713","","04.210.126  -  SCREW BONE 2.4MM 26MM LOCKING VAR ANG STARDRIVE RECESS LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.128","SUP","HCPCS C1713","","04.210.128  -  SCREW BONE 2.4MM 28MM LOCKING STARDRIVE RECESS VAR ANG LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.130","SUP","HCPCS C1713","","04.210.130  -  SCREW BONE 2.4MM 30MM LOCKING STARDRIVE RECESS VAR ANG LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.132","SUP","HCPCS C1713","","04.210.132  -  SCREW BONE 2.4MM 32MM LOCKING VAR ANG STARDRIVE RECESS LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.134","SUP","HCPCS C1713","","04.210.134  -  SCREW BONE 2.4MM 34MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.136","SUP","HCPCS C1713","","04.210.136  -  SCREW BONE 2.4MM 36MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.138","SUP","HCPCS C1713","","04.210.138  -  SCREW BONE 2.4MM 38MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.140","SUP","HCPCS C1713","","04.210.140  -  SCREW BONE 2.4MM 40MM STARDRIVE LOCKING VAR ANG SLFTAP LCP","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.142","SUP","HCPCS C1713","","04.210.142  -  SCREW BONE 2.4MM 42MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.144","SUP","HCPCS C1713","","04.210.144  -  SCREW BONE 2.4MM 44MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.146","SUP","HCPCS C1713","","04.210.146  -  SCREW BONE 2.4MM 46MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.148","SUP","HCPCS C1713","","04.210.148  -  SCREW BONE 2.4MM 48MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.150","SUP","HCPCS C1713","","04.210.150  -  SCREW BONE 2.4MM 50MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.152","SUP","HCPCS C1713","","04.210.152  -  SCREW BONE 2.4MM 52MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.154","SUP","HCPCS C1713","","04.210.154  -  SCREW BONE 2.4MM 54MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.156","SUP","HCPCS C1713","","04.210.156  -  SCREW BONE 2.4MM 56MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.158","SUP","HCPCS C1713","","04.210.158  -  SCREW BONE 2.4MM 58MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.160","SUP","HCPCS C1713","","04.210.160  -  SCREW BONE 2.4MM 60MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$250.23 ","$185.17 ","$0.00 ","$242.93 ","$109.32 ","$0.00 ","$52.15 ","$0.00 ","$0.00 ","$42.53 ","$242.93 ","$0.00 ","$121.46 ","$192.40 ","$194.34 ","$0.00 ","$36.91 ","$0.00 ","$38.67 ","$0.00 "
"04.210.942","SUP","HCPCS C1713","","04.210.942  -  SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.944","SUP","HCPCS C1713","","04.210.944  -  SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.946","SUP","HCPCS C1713","","04.210.946  -  SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.948","SUP","HCPCS C1713","","04.210.948  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.950","SUP","HCPCS C1713","","04.210.950  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.952","SUP","HCPCS C1713","","04.210.952  -  SCREW BONE 2.4MM 52MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.954","SUP","HCPCS C1713","","04.210.954  -  SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.956","SUP","HCPCS C1713","","04.210.956  -  SCREW BONE 2.4MM 56MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.958","SUP","HCPCS C1713","","04.210.958  -  SCREW BONE 2.4MM 58MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.210.960","SUP","HCPCS C1713","","04.210.960  -  SCREW BONE 2.4MM 60MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP","BOTH IP/OP","$93.48 ","$69.18 ","$0.00 ","$90.75 ","$40.84 ","$0.00 ","$19.48 ","$0.00 ","$0.00 ","$15.89 ","$90.75 ","$0.00 ","$45.38 ","$71.87 ","$72.60 ","$0.00 ","$13.79 ","$0.00 ","$14.45 ","$0.00 "
"04.211.008","SUP","HCPCS C1713","","04.211.008  -  SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.009","SUP","HCPCS C1713","","04.211.009  -  SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.010","SUP","HCPCS C1713","","04.211.010  -  SCREW BONE 2.7MM 10MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.011","SUP","HCPCS C1713","","04.211.011  -  SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.012","SUP","HCPCS C1713","","04.211.012  -  SCREW BONE 2.7MM 12MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.013","SUP","HCPCS C1713","","04.211.013  -  SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.014","SUP","HCPCS C1713","","04.211.014  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.016","SUP","HCPCS C1713","","04.211.016  -  SCREW BONE 2.7MM 16MM LOCKING VAR ANG SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.018","SUP","HCPCS C1713","","04.211.018  -  SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.020","SUP","HCPCS C1713","","04.211.020  -  SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.022","SUP","HCPCS C1713","","04.211.022  -  SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.024","SUP","HCPCS C1713","","04.211.024  -  SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.026","SUP","HCPCS C1713","","04.211.026  -  SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.028","SUP","HCPCS C1713","","04.211.028  -  SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP LOCK STARDRIVE LCP","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.030","SUP","HCPCS C1713","","04.211.030  -  SCREW BONE 2.7MM 30MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.032","SUP","HCPCS C1713","","04.211.032  -  SCREW BONE 2.7MM 32MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.034","SUP","HCPCS C1713","","04.211.034  -  SCREW BONE 2.7MM 34MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.036","SUP","HCPCS C1713","","04.211.036  -  SCREW BONE 2.7MM 36MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.038","SUP","HCPCS C1713","","04.211.038  -  SCREW BONE 2.7MM 38MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.040","SUP","HCPCS C1713","","04.211.040  -  SCREW BONE 2.7MM 40MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.042","SUP","HCPCS C1713","","04.211.042  -  SCREW BONE 2.7MM 42MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.044","SUP","HCPCS C1713","","04.211.044  -  SCREW BONE 2.7MM 44MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.046","SUP","HCPCS C1713","","04.211.046  -  SCREW BONE 2.7MM 46MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.048","SUP","HCPCS C1713","","04.211.048  -  SCREW BONE 2.7MM 48MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.050","SUP","HCPCS C1713","","04.211.050  -  SCREW BONE 2.7MM 50MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.052","SUP","HCPCS C1713","","04.211.052  -  SCREW BONE 2.7MM 52MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.054","SUP","HCPCS C1713","","04.211.054  -  SCREW BONE 2.7MM 54MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.056","SUP","HCPCS C1713","","04.211.056  -  SCREW BONE 2.7MM 56MM VAR ANG LOCKING SLFTAP T8 STARDRIVE","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.058","SUP","HCPCS C1713","","04.211.058  -  SCREW BONE 2.4MM 58MM LOCKING T8 STARDRIVE RECESS VAR ANG","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.060","SUP","HCPCS C1713","","04.211.060  -  SCREW BONE 2.4MM 60MM LOCKING T8 STARDRIVE RECESS VAR ANG","BOTH IP/OP","$253.03 ","$187.24 ","$0.00 ","$245.65 ","$110.54 ","$0.00 ","$52.74 ","$0.00 ","$0.00 ","$43.01 ","$245.65 ","$0.00 ","$122.83 ","$194.55 ","$196.52 ","$0.00 ","$37.33 ","$0.00 ","$39.11 ","$0.00 "
"04.211.201","SUP","HCPCS C1713","","04.211.201  -  PLATE BONE XS 24MM VAR ANG LOCKING X LCP TITANIUM FRFT MIDFT","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"04.211.202","SUP","HCPCS C1713","","04.211.202  -  PLATE BONE SMALL 27MM VAR ANG LOCKING X LCP TITANIUM FRFT","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"04.211.203","SUP","HCPCS C1713","","04.211.203  -  PLATE BONE MEDIUM 32MM VAR ANG LOCKING X LCP TITANIUM FRFT","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"04.211.204","SUP","HCPCS C1713","","04.211.204  -  PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL TI","BOTH IP/OP","$1,821.78 ","$1,348.12 ","$0.00 ","$1,768.73 ","$795.93 ","$0.00 ","$379.70 ","$0.00 ","$0.00 ","$309.69 ","$1,768.73 ","$0.00 ","$884.36 ","$1,400.83 ","$1,414.98 ","$0.00 ","$268.74 ","$0.00 ","$281.58 ","$0.00 "
"04.211.210","SUP","HCPCS C1713","","04.211.210  -  PLATE BONE 0MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"04.211.211","SUP","HCPCS C1713","","04.211.211  -  PLATE BONE 3MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"04.211.212","SUP","HCPCS C1713","","04.211.212  -  PLATE BONE 4MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"04.211.213","SUP","HCPCS C1713","","04.211.213  -  PLATE BONE 5MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT","BOTH IP/OP","$1,730.40 ","$1,280.50 ","$0.00 ","$1,680.00 ","$756.00 ","$0.00 ","$360.66 ","$0.00 ","$0.00 ","$294.15 ","$1,680.00 ","$0.00 ","$840.00 ","$1,330.56 ","$1,344.00 ","$0.00 ","$255.26 ","$0.00 ","$267.46 ","$0.00 "
"04.211.214","SUP","HCPCS C1713","","04.211.214  -  PLATE BONE 6MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"04.211.215","SUP","HCPCS C1713","","04.211.215  -  PLATE BONE 7MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT","BOTH IP/OP","$1,778.20 ","$1,315.87 ","$0.00 ","$1,726.40 ","$776.88 ","$0.00 ","$370.62 ","$0.00 ","$0.00 ","$302.28 ","$1,726.40 ","$0.00 ","$863.20 ","$1,367.31 ","$1,381.12 ","$0.00 ","$262.31 ","$0.00 ","$274.84 ","$0.00 "
"04.211.220","SUP","HCPCS C1713","","04.211.220  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM NAVICULAR TARSAL","BOTH IP/OP","$2,168.98 ","$1,605.05 ","$0.00 ","$2,105.80 ","$947.61 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$368.71 ","$2,105.80 ","$0.00 ","$1,052.90 ","$1,667.79 ","$1,684.64 ","$0.00 ","$319.96 ","$0.00 ","$335.24 ","$0.00 "
"04.211.221","SUP","HCPCS C1713","","04.211.221  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM LEFT CUBOID TARSAL","BOTH IP/OP","$2,168.98 ","$1,605.05 ","$0.00 ","$2,105.80 ","$947.61 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$368.71 ","$2,105.80 ","$0.00 ","$1,052.90 ","$1,667.79 ","$1,684.64 ","$0.00 ","$319.96 ","$0.00 ","$335.24 ","$0.00 "
"04.211.222","SUP","HCPCS C1713","","04.211.222  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM RIGHT CUBOID TARSAL","BOTH IP/OP","$2,168.98 ","$1,605.05 ","$0.00 ","$2,105.80 ","$947.61 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$368.71 ","$2,105.80 ","$0.00 ","$1,052.90 ","$1,667.79 ","$1,684.64 ","$0.00 ","$319.96 ","$0.00 ","$335.24 ","$0.00 "
"04.211.224","SUP","HCPCS C1713","","04.211.224  -  PLATE BONE 5X12 HOLE MESH VAR ANG LOCKING LCP TITANIUM","BOTH IP/OP","$3,054.58 ","$2,260.39 ","$0.00 ","$2,965.60 ","$1,334.52 ","$0.00 ","$636.65 ","$0.00 ","$0.00 ","$519.25 ","$2,965.60 ","$0.00 ","$1,482.80 ","$2,348.76 ","$2,372.48 ","$0.00 ","$450.60 ","$0.00 ","$472.12 ","$0.00 "
"04.211.230","SUP","HCPCS C1713","","04.211.230  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.231","SUP","HCPCS C1713","","04.211.231  -  PLATE BONE 0D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.232","SUP","HCPCS C1713","","04.211.232  -  PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.233","SUP","HCPCS C1713","","04.211.233  -  PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.234","SUP","HCPCS C1713","","04.211.234  -  PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.235","SUP","HCPCS C1713","","04.211.235  -  PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.236","SUP","HCPCS C1713","","04.211.236  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.237","SUP","HCPCS C1713","","04.211.237  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.238","SUP","HCPCS C1713","","04.211.238  -  PLATE BONE 5D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.239","SUP","HCPCS C1713","","04.211.239  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.240","SUP","HCPCS C1713","","04.211.240  -  PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.241","SUP","HCPCS C1713","","04.211.241  -  PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.242","SUP","HCPCS C1713","","04.211.242  -  PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$2,168.98 ","$1,605.05 ","$0.00 ","$2,105.80 ","$947.61 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$368.71 ","$2,105.80 ","$0.00 ","$1,052.90 ","$1,667.79 ","$1,684.64 ","$0.00 ","$319.96 ","$0.00 ","$335.24 ","$0.00 "
"04.211.243","SUP","HCPCS C1713","","04.211.243  -  PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$2,168.98 ","$1,605.05 ","$0.00 ","$2,105.80 ","$947.61 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$368.71 ","$2,105.80 ","$0.00 ","$1,052.90 ","$1,667.79 ","$1,684.64 ","$0.00 ","$319.96 ","$0.00 ","$335.24 ","$0.00 "
"04.211.244","SUP","HCPCS C1713","","04.211.244  -  PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM","BOTH IP/OP","$2,341.88 ","$1,732.99 ","$0.00 ","$2,273.68 ","$1,023.15 ","$0.00 ","$488.11 ","$0.00 ","$0.00 ","$398.10 ","$2,273.68 ","$0.00 ","$1,136.84 ","$1,800.75 ","$1,818.94 ","$0.00 ","$345.47 ","$0.00 ","$361.97 ","$0.00 "
"04.211.245","SUP","HCPCS C1713","","04.211.245  -  PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$2,341.88 ","$1,732.99 ","$0.00 ","$2,273.68 ","$1,023.15 ","$0.00 ","$488.11 ","$0.00 ","$0.00 ","$398.10 ","$2,273.68 ","$0.00 ","$1,136.84 ","$1,800.75 ","$1,818.94 ","$0.00 ","$345.47 ","$0.00 ","$361.97 ","$0.00 "
"04.211.246","SUP","HCPCS C1713","","04.211.246  -  PLATE BONE LONG 39MM FUSION VAR ANG LCP TITANIUM FIRST","BOTH IP/OP","$1,855.53 ","$1,373.09 ","$0.00 ","$1,801.48 ","$810.66 ","$0.00 ","$386.74 ","$0.00 ","$0.00 ","$315.42 ","$1,801.48 ","$0.00 ","$900.74 ","$1,426.77 ","$1,441.18 ","$0.00 ","$273.72 ","$0.00 ","$286.79 ","$0.00 "
"04.211.247","SUP","HCPCS C1713","","04.211.247  -  PLATE BONE LONG 48MM FUSION VAR ANG LCP TITANIUM FIRST","BOTH IP/OP","$1,907.53 ","$1,411.57 ","$0.00 ","$1,851.98 ","$833.39 ","$0.00 ","$397.58 ","$0.00 ","$0.00 ","$324.27 ","$1,851.98 ","$0.00 ","$925.99 ","$1,466.77 ","$1,481.58 ","$0.00 ","$281.39 ","$0.00 ","$294.83 ","$0.00 "
"04.211.250","SUP","HCPCS C1713","","04.211.250  -  PLATE BONE SHORT 38MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"04.211.251","SUP","HCPCS C1713","","04.211.251  -  PLATE BONE STANDARD 45MM CLOVERLEAF FUSION VAR ANG LCP","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"04.211.252","SUP","HCPCS C1713","","04.211.252  -  PLATE BONE LONG 64MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM","BOTH IP/OP","$1,734.63 ","$1,283.63 ","$0.00 ","$1,684.10 ","$757.85 ","$0.00 ","$361.54 ","$0.00 ","$0.00 ","$294.87 ","$1,684.10 ","$0.00 ","$842.05 ","$1,333.81 ","$1,347.28 ","$0.00 ","$255.89 ","$0.00 ","$268.11 ","$0.00 "
"04.211.253","SUP","HCPCS C1713","","04.211.253  -  PLATE BONE SHORT 35MM T FUSION VAR ANG LCP TITANIUM FRFT","BOTH IP/OP","$1,603.90 ","$1,186.89 ","$0.00 ","$1,557.18 ","$700.73 ","$0.00 ","$334.29 ","$0.00 ","$0.00 ","$272.65 ","$1,557.18 ","$0.00 ","$778.59 ","$1,233.29 ","$1,245.74 ","$0.00 ","$236.60 ","$0.00 ","$247.90 ","$0.00 "
"04.211.254","SUP","HCPCS C1713","","04.211.254  -  PLATE BONE STANDARD 42MM T FUSION VAR ANG LCP TITANIUM FRFT","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"04.211.255","SUP","HCPCS C1713","","04.211.255  -  PLATE BONE LONG 61MM T FUSION VAR ANG LCP TITANIUM FRFT","BOTH IP/OP","$1,734.63 ","$1,283.63 ","$0.00 ","$1,684.10 ","$757.85 ","$0.00 ","$361.54 ","$0.00 ","$0.00 ","$294.87 ","$1,684.10 ","$0.00 ","$842.05 ","$1,333.81 ","$1,347.28 ","$0.00 ","$255.89 ","$0.00 ","$268.11 ","$0.00 "
"04.211.256","SUP","HCPCS C1713","","04.211.256  -  PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"04.211.257","SUP","HCPCS C1713","","04.211.257  -  PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,648.88 ","$1,220.17 ","$0.00 ","$1,600.85 ","$720.38 ","$0.00 ","$343.67 ","$0.00 ","$0.00 ","$280.30 ","$1,600.85 ","$0.00 ","$800.43 ","$1,267.87 ","$1,280.68 ","$0.00 ","$243.24 ","$0.00 ","$254.86 ","$0.00 "
"04.211.258","SUP","HCPCS C1713","","04.211.258  -  PLATE BONE STANDARD 37MM L FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"04.211.259","SUP","HCPCS C1713","","04.211.259  -  PLATE BONE STANDARD 44MM L FUSION VAR ANG LCP TITANIUM LEFT","BOTH IP/OP","$1,692.45 ","$1,252.41 ","$0.00 ","$1,643.15 ","$739.42 ","$0.00 ","$352.75 ","$0.00 ","$0.00 ","$287.70 ","$1,643.15 ","$0.00 ","$821.58 ","$1,301.37 ","$1,314.52 ","$0.00 ","$249.66 ","$0.00 ","$261.59 ","$0.00 "
"04.211.260","SUP","HCPCS C1713","","04.211.260  -  PLATE BONE LONG 62MM L FUSION VAR ANG LCP TITANIUM RIGHT","BOTH IP/OP","$1,734.63 ","$1,283.63 ","$0.00 ","$1,684.10 ","$757.85 ","$0.00 ","$361.54 ","$0.00 ","$0.00 ","$294.87 ","$1,684.10 ","$0.00 ","$842.05 ","$1,333.81 ","$1,347.28 ","$0.00 ","$255.89 ","$0.00 ","$268.11 ","$0.00 "
"04.211.261","SUP","HCPCS C1713","","04.211.261  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL TI","BOTH IP/OP","$1,734.63 ","$1,283.63 ","$0.00 ","$1,684.10 ","$757.85 ","$0.00 ","$361.54 ","$0.00 ","$0.00 ","$294.87 ","$1,684.10 ","$0.00 ","$842.05 ","$1,333.81 ","$1,347.28 ","$0.00 ","$255.89 ","$0.00 ","$268.11 ","$0.00 "
"04.211.262","SUP","HCPCS C1713","","04.211.262  -  PLATE BONE 27MM 2 HOLE STR FUSION LOCKING VAR ANG LCP","BOTH IP/OP","$1,475.98 ","$1,092.23 ","$0.00 ","$1,433.00 ","$644.85 ","$0.00 ","$307.63 ","$0.00 ","$0.00 ","$250.91 ","$1,433.00 ","$0.00 ","$716.50 ","$1,134.94 ","$1,146.40 ","$0.00 ","$217.73 ","$0.00 ","$228.13 ","$0.00 "
"04.211.263","SUP","HCPCS C1713","","04.211.263  -  PLATE BONE 40MM 4 HOLE STR FUSION LOCKING VAR ANG LCP","BOTH IP/OP","$1,560.33 ","$1,154.64 ","$0.00 ","$1,514.88 ","$681.69 ","$0.00 ","$325.21 ","$0.00 ","$0.00 ","$265.24 ","$1,514.88 ","$0.00 ","$757.44 ","$1,199.78 ","$1,211.90 ","$0.00 ","$230.17 ","$0.00 ","$241.17 ","$0.00 "
"04.211.265","SUP","HCPCS C1713","","04.211.265  -  PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP TITANIUM","BOTH IP/OP","$2,168.98 ","$1,605.05 ","$0.00 ","$2,105.80 ","$947.61 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$368.71 ","$2,105.80 ","$0.00 ","$1,052.90 ","$1,667.79 ","$1,684.64 ","$0.00 ","$319.96 ","$0.00 ","$335.24 ","$0.00 "
"04.211.266","SUP","HCPCS C1713","","04.211.266  -  PLATE BONE 43MM TMT FUSION VAR ANG LCP TITANIUM FRFT MIDFT","BOTH IP/OP","$1,686.83 ","$1,248.25 ","$0.00 ","$1,637.70 ","$736.97 ","$0.00 ","$351.58 ","$0.00 ","$0.00 ","$286.75 ","$1,637.70 ","$0.00 ","$818.85 ","$1,297.06 ","$1,310.16 ","$0.00 ","$248.84 ","$0.00 ","$260.72 ","$0.00 "
"04.212.054","SUP","HCPCS C1713","","04.212.054  -  SCREW BONE 3.5MM 54MM SELF TAP LOCK LCP TITANIUM FIBULA","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"04.212.056","SUP","HCPCS C1713","","04.212.056  -  SCREW BONE 3.5MM 56MM SELF TAP LOCK LCP TITANIUM FIBULA","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"04.212.058","SUP","HCPCS C1713","","04.212.058  -  SCREW BONE 3.5MM 58MM SELF TAP LOCK LCP TITANIUM FIBULA","BOTH IP/OP","$234.75 ","$173.72 ","$0.00 ","$227.93 ","$102.57 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$39.91 ","$227.93 ","$0.00 ","$113.96 ","$180.52 ","$182.34 ","$0.00 ","$34.63 ","$0.00 ","$36.29 ","$0.00 "
"04.214.006","SUP","HCPCS C1713","","04.214.006  -  SCREW BONE 1.5MM 6MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.007","SUP","HCPCS C1713","","04.214.007  -  SCREW BONE 1.5MM 7MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.008","SUP","HCPCS C1713","","04.214.008  -  SCREW BONE 1.5MM 8MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.009","SUP","HCPCS C1713","","04.214.009  -  SCREW BONE 1.5MM 9MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.010","SUP","HCPCS C1713","","04.214.010  -  SCREW BONE 1.5MM 10MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.011","SUP","HCPCS C1713","","04.214.011  -  SCREW BONE 1.5MM 11MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.012","SUP","HCPCS C1713","","04.214.012  -  SCREW BONE 1.5MM 12MM LOCKING SLFTAP T4 STARDRIVE RECESS","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.013","SUP","HCPCS C1713","","04.214.013  -  SCREW BONE 1.5MM 13MM SLFTAP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.014","SUP","HCPCS C1713","","04.214.014  -  SCREW BONE 1.5MM 14MM SLFTAP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.015","SUP","HCPCS C1713","","04.214.015  -  SCREW BONE 1.5MM 15MM SLFTAP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.016","SUP","HCPCS C1713","","04.214.016  -  SCREW BONE 1.5MM 16MM SLFTAP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.018","SUP","HCPCS C1713","","04.214.018  -  SCREW BONE 1.5MM 18MM SLFTAP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.020","SUP","HCPCS C1713","","04.214.020  -  SCREW BONE 1.5MM 20MM SLFTAP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.022","SUP","HCPCS C1713","","04.214.022  -  SCREW BONE 1.5MM 22MM LOCKING SLFTAP COMPACT STARDRIVE LCP","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.024","SUP","HCPCS C1713","","04.214.024  -  SCREW BONE 1.5MM 24MM LOCKING SLFTAP COMPACT STARDRIVE LCP","BOTH IP/OP","$208.05 ","$153.96 ","$0.00 ","$201.98 ","$90.89 ","$0.00 ","$43.36 ","$0.00 ","$0.00 ","$35.36 ","$201.98 ","$0.00 ","$100.99 ","$159.97 ","$161.58 ","$0.00 ","$30.69 ","$0.00 ","$32.15 ","$0.00 "
"04.214.106","SUP","HCPCS C1713","","04.214.106  -  SCREW BONE 1.5MM 6MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.107","SUP","HCPCS C1713","","04.214.107  -  SCREW BONE 1.5MM 7MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.108","SUP","HCPCS C1713","","04.214.108  -  SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.109","SUP","HCPCS C1713","","04.214.109  -  SCREW BONE 1.5MM 9MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.110","SUP","HCPCS C1713","","04.214.110  -  SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.111","SUP","HCPCS C1713","","04.214.111  -  SCREW BONE 1.5MM 11MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.112","SUP","HCPCS C1713","","04.214.112  -  SCREW BONE 1.5MM 12MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.113","SUP","HCPCS C1713","","04.214.113  -  SCREW BONE 1.5MM 13MM SLFTAP COMPACT STARDRIVE LCP TITANIUM","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.114","SUP","HCPCS C1713","","04.214.114  -  SCREW BONE 1.5MM 14MM SLFTAP LCP STARDRIVE TITANIUM ALLOY","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.115","SUP","HCPCS C1713","","04.214.115  -  SCREW BONE 1.5MM 15MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.116","SUP","HCPCS C1713","","04.214.116  -  SCREW BONE 1.5MM 16MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.118","SUP","HCPCS C1713","","04.214.118  -  SCREW BONE 1.5MM 18MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.120","SUP","HCPCS C1713","","04.214.120  -  SCREW BONE 1.5MM 20MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.122","SUP","HCPCS C1713","","04.214.122  -  SCREW BONE 1.5MM 22MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.214.124","SUP","HCPCS C1713","","04.214.124  -  SCREW BONE 1.5MM 24MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP","BOTH IP/OP","$84.35 ","$62.42 ","$0.00 ","$81.88 ","$36.84 ","$0.00 ","$17.58 ","$0.00 ","$0.00 ","$14.34 ","$81.88 ","$0.00 ","$40.94 ","$64.85 ","$65.50 ","$0.00 ","$12.44 ","$0.00 ","$13.03 ","$0.00 "
"04.221.002S","SUP","HCPCS C1713","","04.221.002S  -  BUTTON FIX 2.5MM CERCLAGE HEXAGONAL STARDRIVE RECESS","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"04.221.003S","SUP","HCPCS C1713","","04.221.003S  -  BUTTON FIX HEXAGON 3.5MM CERCLAGE T25 STARDRIVE TITANIUM","BOTH IP/OP","$341.58 ","$252.77 ","$0.00 ","$331.63 ","$149.23 ","$0.00 ","$71.19 ","$0.00 ","$0.00 ","$58.06 ","$331.63 ","$0.00 ","$165.81 ","$262.65 ","$265.30 ","$0.00 ","$50.39 ","$0.00 ","$52.79 ","$0.00 "
"04.221.004S","SUP","HCPCS C1713","","04.221.004S  -  NAIL INTRAMEDULLARY 4MM CANN HEXAGONAL TITANIUM ORTHOPEDIC","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$149.85 ","$0.00 ","$71.49 ","$0.00 ","$0.00 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$50.60 ","$0.00 ","$53.01 ","$0.00 "
"04.221.005S","SUP","Custom 27803010","","04.221.005S  -  CABLE ORTHOPEDIC 5MM POSITIONING PIN CRIMP STAINLESS STEEL","BOTH IP/OP","$515.90 ","$381.77 ","$0.00 ","$500.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.88 ","$0.00 ","$250.44 ","$396.70 ","$400.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.221.508","SUP","HCPCS C1713","","04.221.508  -  SCREW BONE 5MM 8MM SLFTAP LOCKING STARDRIVE PERIPROSTHETIC","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"04.221.510","SUP","HCPCS C1713","","04.221.510  -  SCREW BONE 5MM 10MM SLFTAP LOCKING STARDRIVE RECESS","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"04.221.512","SUP","HCPCS C1713","","04.221.512  -  SCREW BONE 5MM 12MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"04.221.514","SUP","HCPCS C1713","","04.221.514  -  SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"04.221.518","SUP","HCPCS C1713","","04.221.518  -  SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$386.23 ","$173.80 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$67.62 ","$386.23 ","$0.00 ","$193.11 ","$305.89 ","$308.98 ","$0.00 ","$58.68 ","$0.00 ","$61.49 ","$0.00 "
"04.226.010","SUP","HCPCS C1713","","04.226.010  -  SCREW BONE SHORT THREAD 3MM 10MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.011","SUP","HCPCS C1713","","04.226.011  -  SCREW BONE SHORT THREAD 3MM 11MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.012","SUP","HCPCS C1713","","04.226.012  -  SCREW BONE SHORT THREAD 3MM 12MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.013","SUP","HCPCS C1713","","04.226.013  -  SCREW BONE SHORT THREAD 3MM 13MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.014","SUP","HCPCS C1713","","04.226.014  -  SCREW BONE SHORT THREAD 3MM 14MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.015","SUP","HCPCS C1713","","04.226.015  -  SCREW BONE SHORT THREAD 3MM 15MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.016","SUP","HCPCS C1713","","04.226.016  -  SCREW BONE SHORT THREAD 3MM 16MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.017","SUP","HCPCS C1713","","04.226.017  -  SCREW BONE SHORT THREAD 3MM 17MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.018","SUP","HCPCS C1713","","04.226.018  -  SCREW BONE SHORT THREAD 3MM 18MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.019","SUP","HCPCS C1713","","04.226.019  -  SCREW BONE SHORT THREAD 3MM 19MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.020","SUP","HCPCS C1713","","04.226.020  -  SCREW BONE SHORT THREAD 3MM 20MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.021","SUP","HCPCS C1713","","04.226.021  -  SCREW BONE SHORT THREAD 3MM 21MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.022","SUP","HCPCS C1713","","04.226.022  -  SCREW BONE SHORT THREAD 3MM 22MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.023","SUP","HCPCS C1713","","04.226.023  -  SCREW BONE SHORT THREAD 3MM 23MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.024","SUP","HCPCS C1713","","04.226.024  -  SCREW BONE SHORT THREAD 3MM 24MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.025","SUP","HCPCS C1713","","04.226.025  -  SCREW BONE SHORT THREAD 3MM 25MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.026","SUP","HCPCS C1713","","04.226.026  -  SCREW BONE SHORT THREAD 3MM 26MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.027","SUP","HCPCS C1713","","04.226.027  -  SCREW BONE SHORT THREAD 3MM 27MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.028","SUP","HCPCS C1713","","04.226.028  -  SCREW BONE SHORT THREAD 3MM 28MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.029","SUP","HCPCS C1713","","04.226.029  -  SCREW BONE SHORT THREAD 3MM 29MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.030","SUP","HCPCS C1713","","04.226.030  -  SCREW BONE SHORT THREAD 3MM 30MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.032","SUP","HCPCS C1713","","04.226.032  -  SCREW BONE SHORT THREAD 3MM 32MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.034","SUP","HCPCS C1713","","04.226.034  -  SCREW BONE SHORT THREAD 3MM 34MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.036","SUP","HCPCS C1713","","04.226.036  -  SCREW BONE SHORT THREAD 3MM 36MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.038","SUP","HCPCS C1713","","04.226.038  -  SCREW BONE SHORT THREAD 3MM 38MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.040","SUP","HCPCS C1713","","04.226.040  -  SCREW BONE SHORT THREAD 3MM 40MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.116","SUP","HCPCS C1713","","04.226.116  -  SCREW BONE LNGTHRD 3MM 16MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.117","SUP","HCPCS C1713","","04.226.117  -  SCREW BONE 3MM 17MM 6MM COMPRESSION TITANIUM SMALL BONE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.118","SUP","HCPCS C1713","","04.226.118  -  SCREW BONE LNGTHRD 3MM 18MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.119","SUP","HCPCS C1713","","04.226.119  -  SCREW BONE LNGTHRD 3MM 19MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.120","SUP","HCPCS C1713","","04.226.120  -  SCREW BONE 3MM 20MM 7MM COMPRESSION TITANIUM SMALL BONE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.121","SUP","HCPCS C1713","","04.226.121  -  SCREW BONE LNGTHRD 3MM 21MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.122","SUP","HCPCS C1713","","04.226.122  -  SCREW BONE LNGTHRD 3MM 22MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.123","SUP","HCPCS C1713","","04.226.123  -  SCREW BONE LNGTHRD 3MM 23MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.124","SUP","HCPCS C1713","","04.226.124  -  SCREW BONE LNGTHRD 3MM 24MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.125","SUP","HCPCS C1713","","04.226.125  -  SCREW BONE LNGTHRD 3MM 25MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.126","SUP","HCPCS C1713","","04.226.126  -  SCREW BONE LNGTHRD 3MM 26MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.127","SUP","HCPCS C1713","","04.226.127  -  SCREW BONE LNGTHRD 3MM 27MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.128","SUP","HCPCS C1713","","04.226.128  -  SCREW BONE LNGTHRD 3MM 28MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.129","SUP","HCPCS C1713","","04.226.129  -  SCREW BONE LNGTHRD 3MM 29MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.130","SUP","HCPCS C1713","","04.226.130  -  SCREW BONE LNGTHRD 3MM 30MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.132","SUP","HCPCS C1713","","04.226.132  -  SCREW BONE LNGTHRD 3MM 32MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.134","SUP","HCPCS C1713","","04.226.134  -  SCREW BONE LNGTHRD 3MM 34MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.136","SUP","HCPCS C1713","","04.226.136  -  SCREW BONE LNGTHRD 3MM 36MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.138","SUP","HCPCS C1713","","04.226.138  -  SCREW BONE LNGTHRD 3MM 38MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.140","SUP","HCPCS C1713","","04.226.140  -  SCREW BONE LNGTHRD 3MM 40MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.209","SUP","HCPCS C1713","","04.226.209  -  SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.210","SUP","HCPCS C1713","","04.226.210  -  SCREW BONE SHORT THREAD 2.4MM 10MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.211","SUP","HCPCS C1713","","04.226.211  -  SCREW BONE SHORT THREAD 2.4MM 11MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.212","SUP","HCPCS C1713","","04.226.212  -  SCREW BONE SHORT THREAD 2.4MM 12MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.213","SUP","HCPCS C1713","","04.226.213  -  SCREW BONE SHORT THREAD 2.4MM 13MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.214","SUP","HCPCS C1713","","04.226.214  -  SCREW BONE SHORT THREAD 2.4MM 14MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.215","SUP","HCPCS C1713","","04.226.215  -  SCREW BONE SHORT THREAD 2.4MM 15MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.216","SUP","HCPCS C1713","","04.226.216  -  SCREW BONE SHORT THREAD 2.4MM 16MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.217","SUP","HCPCS C1713","","04.226.217  -  SCREW BONE SHORT THREAD 2.4MM 17MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.218","SUP","HCPCS C1713","","04.226.218  -  SCREW BONE 2.4MM 18MM 4MM COMPRESSION TITANIUM SMALL BONE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.219","SUP","HCPCS C1713","","04.226.219  -  SCREW BONE SHORT THREAD 2.4MM 19MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.220","SUP","HCPCS C1713","","04.226.220  -  SCREW BONE 2.4MM 20MM 4MM COMPRESSION TITANIUM SMALL BONE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.221","SUP","HCPCS C1713","","04.226.221  -  SCREW BONE SHORT THREAD 2.4MM 21MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.222","SUP","HCPCS C1713","","04.226.222  -  SCREW BONE SHORT THREAD 2.4MM 22MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.223","SUP","HCPCS C1713","","04.226.223  -  SCREW BONE SHORT THREAD 2.4MM 23MM 4MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.224","SUP","HCPCS C1713","","04.226.224  -  SCREW BONE SHORT THREAD 2.4MM 24MM 5MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.225","SUP","HCPCS C1713","","04.226.225  -  SCREW BONE SHORT THREAD 2.4MM 25MM 5MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.226","SUP","HCPCS C1713","","04.226.226  -  SCREW BONE SHORT THREAD 2.4MM 26MM 5MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.227","SUP","HCPCS C1713","","04.226.227  -  SCREW BONE SHORT THREAD 2.4MM 27MM 6MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.228","SUP","HCPCS C1713","","04.226.228  -  SCREW BONE SHORT THREAD 2.4MM 28MM 6MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.229","SUP","HCPCS C1713","","04.226.229  -  SCREW BONE SHORT THREAD 2.4MM 29MM 6MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.230","SUP","HCPCS C1713","","04.226.230  -  SCREW BONE 2.4MM 30MM 7MM COMPRESSION TITANIUM SMALL BONE","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.232","SUP","HCPCS C1713","","04.226.232  -  SCREW BONE SHORT THREAD 2.4MM 32MM 7MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.234","SUP","HCPCS C1713","","04.226.234  -  SCREW BONE SHORT THREAD 2.4MM 34MM 8MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.236","SUP","HCPCS C1713","","04.226.236  -  SCREW BONE SHORT THREAD 2.4MM 36MM 9MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.238","SUP","HCPCS C1713","","04.226.238  -  SCREW BONE SHORT THREAD 2.4MM 38MM 9MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.240","SUP","HCPCS C1713","","04.226.240  -  SCREW BONE 2.4MM 40MM 10MM COMPRESSION SHORT THREAD HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.317","SUP","HCPCS C1713","","04.226.317  -  SCREW BONE LNGTHRD 2.4MM 17MM 6MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.318","SUP","HCPCS C1713","","04.226.318  -  SCREW BONE LNGTHRD 2.4MM 18MM 6MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.319","SUP","HCPCS C1713","","04.226.319  -  SCREW BONE LNGTHRD 2.4MM 19MM 7MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.320","SUP","HCPCS C1713","","04.226.320  -  SCREW BONE LNGTHRD 2.4MM 20MM 7MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.321","SUP","HCPCS C1713","","04.226.321  -  SCREW BONE LNGTHRD 2.4MM 21MM 8MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.322","SUP","HCPCS C1713","","04.226.322  -  SCREW BONE LNGTHRD 2.4MM 22MM 8MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.323","SUP","HCPCS C1713","","04.226.323  -  SCREW BONE LNGTHRD 2.4MM 23MM 8MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.324","SUP","HCPCS C1713","","04.226.324  -  SCREW BONE LNGTHRD 2.4MM 24MM 8MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.325","SUP","HCPCS C1713","","04.226.325  -  SCREW BONE LNGTHRD 2.4MM 25MM 8MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.326","SUP","HCPCS C1713","","04.226.326  -  SCREW BONE LNGTHRD 2.4MM 26MM 10MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.327","SUP","HCPCS C1713","","04.226.327  -  SCREW BONE LNGTHRD 2.4MM 27MM 10MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.328","SUP","HCPCS C1713","","04.226.328  -  SCREW BONE LNGTHRD 2.4MM 28MM 10MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.329","SUP","HCPCS C1713","","04.226.329  -  SCREW BONE LNGTHRD 2.4MM 29MM 10MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.330","SUP","HCPCS C1713","","04.226.330  -  SCREW BONE LNGTHRD 2.4MM 30MM 12MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.332","SUP","HCPCS C1713","","04.226.332  -  SCREW BONE LNGTHRD 2.4MM 32MM 12MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.334","SUP","HCPCS C1713","","04.226.334  -  SCREW BONE LNGTHRD 2.4MM 34MM 14MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.336","SUP","HCPCS C1713","","04.226.336  -  SCREW BONE LNGTHRD 2.4MM 36MM 14MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.338","SUP","HCPCS C1713","","04.226.338  -  SCREW BONE LNGTHRD 2.4MM 38MM 16MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.340","SUP","HCPCS C1713","","04.226.340  -  SCREW BONE LNGTHRD 2.4MM 40MM 16MM COMPRESSION HEADLESS","BOTH IP/OP","$641.00 ","$474.34 ","$0.00 ","$622.33 ","$280.05 ","$0.00 ","$133.60 ","$0.00 ","$0.00 ","$108.96 ","$622.33 ","$0.00 ","$311.16 ","$492.89 ","$497.86 ","$0.00 ","$94.56 ","$0.00 ","$99.07 ","$0.00 "
"04.226.620","SUP","HCPCS C1713","","04.226.620  -  SCREW BONE SHORT THREAD 4.5MM 20MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.622","SUP","HCPCS C1713","","04.226.622  -  SCREW BONE SHORT THREAD 4.5MM 22MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.624","SUP","HCPCS C1713","","04.226.624  -  SCREW BONE SHORT THREAD 4.5MM 24MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.626","SUP","HCPCS C1713","","04.226.626  -  SCREW BONE SHORT THREAD 4.5MM 26MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.628","SUP","HCPCS C1713","","04.226.628  -  SCREW BONE SHORT THREAD 4.5MM 28MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.630","SUP","HCPCS C1713","","04.226.630  -  SCREW BONE SHORT THREAD 4.5MM 30MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.632","SUP","HCPCS C1713","","04.226.632  -  SCREW BONE SHORT THREAD 4.5MM 32MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.634","SUP","HCPCS C1713","","04.226.634  -  SCREW BONE SHORT THREAD 4.5MM 34MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.636","SUP","HCPCS C1713","","04.226.636  -  SCREW BONE SHORT THREAD 4.5MM 36MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.638","SUP","HCPCS C1713","","04.226.638  -  SCREW BONE SHORT THREAD 4.5MM 38MM 7MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.640","SUP","HCPCS C1713","","04.226.640  -  SCREW BONE SHORT THREAD 4.5MM 40MM 8MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.642","SUP","HCPCS C1713","","04.226.642  -  SCREW BONE SHORT THREAD 4.5MM 42MM 8MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.644","SUP","HCPCS C1713","","04.226.644  -  SCREW BONE SHORT THREAD 4.5MM 44MM 9MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.646","SUP","HCPCS C1713","","04.226.646  -  SCREW BONE SHORT THREAD 4.5MM 46MM 9MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.648","SUP","HCPCS C1713","","04.226.648  -  SCREW BONE SHORT THREAD 4.5MM 48MM 9MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.650","SUP","HCPCS C1713","","04.226.650  -  SCREW BONE SHORT THREAD 4.5MM 50MM 10MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.652","SUP","HCPCS C1713","","04.226.652  -  SCREW BONE SHORT THREAD 4.5MM 52MM 10MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.654","SUP","HCPCS C1713","","04.226.654  -  SCREW BONE SHORT THREAD 6.5MM 54MM 16MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.656","SUP","HCPCS C1713","","04.226.656  -  SCREW BONE SHORT THREAD 4.5MM 56MM 11MM COMPRESSION HEADLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.658","SUP","HCPCS C1713","","04.226.658  -  SCREW BONE SHORT THREAD 4.5MM 58MM 11MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.660","SUP","HCPCS C1713","","04.226.660  -  SCREW BONE SHORT THREAD 4.5MM 60MM 12MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.665","SUP","HCPCS C1713","","04.226.665  -  SCREW BONE SHORT THREAD 4.5MM 65MM 13MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.670","SUP","HCPCS C1713","","04.226.670  -  SCREW BONE SHORT THREAD 4.5MM 70MM 14MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.675","SUP","HCPCS C1713","","04.226.675  -  SCREW BONE SHORT THREAD 4.5MM 75MM 15MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.680","SUP","HCPCS C1713","","04.226.680  -  SCREW BONE SHORT THREAD 4.5MM 80MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.685","SUP","HCPCS C1713","","04.226.685  -  SCREW BONE SHORT THREAD 4.5MM 85MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.690","SUP","HCPCS C1713","","04.226.690  -  SCREW BONE SHORT THREAD 4.5MM 90MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.695","SUP","HCPCS C1713","","04.226.695  -  SCREW BONE SHORT THREAD 4.5MM 95MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.700","SUP","HCPCS C1713","","04.226.700  -  SCREW BONE SHORT THREAD 4.5MM 100MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.730","SUP","HCPCS C1713","","04.226.730  -  SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.732","SUP","HCPCS C1713","","04.226.732  -  SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.734","SUP","HCPCS C1713","","04.226.734  -  SCREW BONE LNGTHRD 4.5MM 34MM 12MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.736","SUP","HCPCS C1713","","04.226.736  -  SCREW BONE LNGTHRD 4.5MM 36MM 14MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.738","SUP","HCPCS C1713","","04.226.738  -  SCREW BONE LNGTHRD 4.5MM 38MM 14MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.740","SUP","HCPCS C1713","","04.226.740  -  SCREW BONE LNGTHRD 4.5MM 40MM 16MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.742","SUP","HCPCS C1713","","04.226.742  -  SCREW BONE LNGTHRD 4.5MM 42MM 16MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.744","SUP","HCPCS C1713","","04.226.744  -  SCREW BONE LNGTHRD 4.5MM 44MM 18MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.746","SUP","HCPCS C1713","","04.226.746  -  SCREW BONE LNGTHRD 4.5MM 46MM 18MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.748","SUP","HCPCS C1713","","04.226.748  -  SCREW BONE LNGTHRD 4.5MM 48MM 18MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.750","SUP","HCPCS C1713","","04.226.750  -  SCREW BONE LNGTHRD 4.5MM 50MM 20MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.752","SUP","HCPCS C1713","","04.226.752  -  SCREW BONE LNGTHRD 4.5MM 52MM 20MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.754","SUP","HCPCS C1713","","04.226.754  -  SCREW BONE LNGTHRD 4.5MM 54MM 22MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.756","SUP","HCPCS C1713","","04.226.756  -  SCREW BONE LNGTHRD 4.5MM 56MM 22MM COMPRESSION HEADLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.758","SUP","HCPCS C1713","","04.226.758  -  SCREW BONE LNGTHRD 4.5MM 58MM 22MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.760","SUP","HCPCS C1713","","04.226.760  -  SCREW BONE LNGTHRD 4.5MM 60MM 24MM COMPRESSION HEADLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.765","SUP","HCPCS C1713","","04.226.765  -  SCREW BONE LNGTHRD 4.5MM 65MM 26MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.770","SUP","HCPCS C1713","","04.226.770  -  SCREW BONE LNGTHRD 4.5MM 70MM 28MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.775","SUP","HCPCS C1713","","04.226.775  -  SCREW BONE LNGTHRD 4.5MM 75MM 30MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.780","SUP","HCPCS C1713","","04.226.780  -  SCREW BONE LNGTHRD 4.5MM 80MM 32MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.785","SUP","HCPCS C1713","","04.226.785  -  SCREW BONE LNGTHRD 4.5MM 85MM 34MM COMPRESSION HEADLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.790","SUP","HCPCS C1713","","04.226.790  -  SCREW BONE LNGTHRD 4.5MM 90MM 36MM COMPRESSION HEADLESS","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.795","SUP","HCPCS C1713","","04.226.795  -  SCREW BONE LNGTHRD 4.5MM 95MM 38MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.226.800","SUP","HCPCS C1713","","04.226.800  -  SCREW BONE LNGTHRD 4.5MM 100MM 40MM HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.030","SUP","HCPCS C1713","","04.227.030  -  SCREW BONE 6.5MM 30MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.035","SUP","HCPCS C1713","","04.227.035  -  SCREW BONE 6.5MM 35MM 16MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.040","SUP","HCPCS C1713","","04.227.040  -  SCREW BONE 6.5MM 40MM 16MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.045","SUP","HCPCS C1713","","04.227.045  -  SCREW BONE 6.5MM 45MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.050","SUP","HCPCS C1713","","04.227.050  -  SCREW BONE 6.5MM 50MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.055","SUP","HCPCS C1713","","04.227.055  -  SCREW BONE 6.5MM 55MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.060","SUP","HCPCS C1713","","04.227.060  -  SCREW BONE 6.5MM 60MM 16MM HEADLESS COMPRESSION THREADED SET","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.065","SUP","HCPCS C1713","","04.227.065  -  SCREW BONE 6.5MM 65MM 16MM HEADLESS COMPRESSION THREADED SET","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.070","SUP","HCPCS C1713","","04.227.070  -  SCREW BONE 6.5MM 70MM 16MM COMPRESSION THREAD TITANIUM FEMUR","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.075","SUP","HCPCS C1713","","04.227.075  -  SCREW BONE 6.5MM 75MM 16MM HEADLESS COMPRESSION THREADED SET","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.080","SUP","HCPCS C1713","","04.227.080  -  SCREW BONE 6.5MM 80MM 16MM HEADLESS COMPRESSION THREADED SET","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.085","SUP","HCPCS C1713","","04.227.085  -  SCREW BONE 6.5MM 85MM 16MM COMPRESSION HEADLESS THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.090","SUP","HCPCS C1713","","04.227.090  -  SCREW BONE 6.5MM 90MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.095","SUP","HCPCS C1713","","04.227.095  -  SCREW BONE 6.5MM 95MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.100","SUP","HCPCS C1713","","04.227.100  -  SCREW BONE 6.5MM 100MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.105","SUP","HCPCS C1713","","04.227.105  -  SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.110","SUP","HCPCS C1713","","04.227.110  -  SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.115","SUP","HCPCS C1713","","04.227.115  -  SCREW BONE 6.5MM 115MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.120","SUP","HCPCS C1713","","04.227.120  -  SCREW BONE 6.5MM 120MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.125","SUP","HCPCS C1713","","04.227.125  -  SCREW BONE 6.5MM 125MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.130","SUP","HCPCS C1713","","04.227.130  -  SCREW BONE 6.5MM 130MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.135","SUP","HCPCS C1713","","04.227.135  -  SCREW BONE 6.5MM 135MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.140","SUP","HCPCS C1713","","04.227.140  -  SCREW BONE 6.5MM 140MM 16MM HEADLESS COMPRESSION THREADED","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.145","SUP","HCPCS C1713","","04.227.145  -  SCREW BONE 6.5MM 145MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.150","SUP","HCPCS C1713","","04.227.150  -  SCREW BONE 6.5MM 150MM 16MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.245","SUP","HCPCS C1713","","04.227.245  -  SCREW BONE 6.5MM 45MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.250","SUP","HCPCS C1713","","04.227.250  -  SCREW BONE 6.5MM 50MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.255","SUP","HCPCS C1713","","04.227.255  -  SCREW BONE 6.5MM 55MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.260","SUP","HCPCS C1713","","04.227.260  -  SCREW BONE 6.5MM 60MM 32MM COMPRESSION HEADLESS TITANIUM","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.265","SUP","HCPCS C1713","","04.227.265  -  SCREW BONE 6.5MM 65MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.270","SUP","HCPCS C1713","","04.227.270  -  SCREW BONE 6.5MM 70MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.275","SUP","HCPCS C1713","","04.227.275  -  SCREW BONE 6.5MM 75MM 32MM COMPRESSION THREAD TITANIUM FEMUR","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.280","SUP","HCPCS C1713","","04.227.280  -  SCREW BONE 6.5MM 80MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.285","SUP","HCPCS C1713","","04.227.285  -  SCREW BONE 6.5MM 85MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.290","SUP","HCPCS C1713","","04.227.290  -  SCREW BONE 6.5MM 90MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.295","SUP","HCPCS C1713","","04.227.295  -  SCREW BONE 6.5MM 95MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.300","SUP","HCPCS C1713","","04.227.300  -  SCREW BONE 6.5MM 100MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.305","SUP","HCPCS C1713","","04.227.305  -  SCREW BONE 6.5MM 105MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.310","SUP","HCPCS C1713","","04.227.310  -  SCREW BONE 6.5MM 110MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.315","SUP","HCPCS C1713","","04.227.315  -  SCREW BONE 6.5MM 115MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.320","SUP","HCPCS C1713","","04.227.320  -  SCREW BONE 6.5MM 120MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.325","SUP","HCPCS C1713","","04.227.325  -  SCREW BONE 6.5MM 125MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.330","SUP","HCPCS C1713","","04.227.330  -  SCREW BONE 6.5MM 130MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.335","SUP","HCPCS C1713","","04.227.335  -  SCREW BONE 6.5MM 135MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.340","SUP","HCPCS C1713","","04.227.340  -  SCREW BONE 6.5MM 140MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.345","SUP","HCPCS C1713","","04.227.345  -  SCREW BONE 6.5MM 145MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.227.350","SUP","HCPCS C1713","","04.227.350  -  SCREW BONE 6.5MM 150MM 32MM THREADED HEADLESS COMPRESSION","BOTH IP/OP","$649.43 ","$480.58 ","$0.00 ","$630.53 ","$283.74 ","$0.00 ","$135.36 ","$0.00 ","$0.00 ","$110.40 ","$630.53 ","$0.00 ","$315.26 ","$499.38 ","$504.42 ","$0.00 ","$95.80 ","$0.00 ","$100.38 ","$0.00 "
"04.230.109","SUP","HCPCS C1713","","04.230.109  -  SCREW BONE 1.5MM 9MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.110","SUP","HCPCS C1713","","04.230.110  -  SCREW BONE 1.5MM 10MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.111","SUP","HCPCS C1713","","04.230.111  -  SCREW BONE 1.5MM 11MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.112","SUP","HCPCS C1713","","04.230.112  -  SCREW BONE 1.5MM 12MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.113","SUP","HCPCS C1713","","04.230.113  -  SCREW BONE 1.5MM 13MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.114","SUP","HCPCS C1713","","04.230.114  -  SCREW BONE 1.5MM 14MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.115","SUP","HCPCS C1713","","04.230.115  -  SCREW BONE 1.5MM 15MM 4MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.116","SUP","HCPCS C1713","","04.230.116  -  SCREW BONE 1.5MM 16MM 5MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.117","SUP","HCPCS C1713","","04.230.117  -  SCREW BONE 1.5MM 17MM 5MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.118","SUP","HCPCS C1713","","04.230.118  -  SCREW BONE 1.5MM 18MM 5MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.119","SUP","HCPCS C1713","","04.230.119  -  SCREW BONE 1.5MM 19MM 5MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.230.120","SUP","HCPCS C1713","","04.230.120  -  SCREW BONE 1.5MM 20MM 6MM HEADLESS COMPRESSION THREAD","BOTH IP/OP","$486.38 ","$359.92 ","$0.00 ","$472.20 ","$212.49 ","$0.00 ","$101.37 ","$0.00 ","$0.00 ","$82.68 ","$472.20 ","$0.00 ","$236.10 ","$373.98 ","$377.76 ","$0.00 ","$71.75 ","$0.00 ","$75.17 ","$0.00 "
"04.305.003","SUP","HCPCS C1713","","04.305.003  -  SCREW BONE 2.5/4MM 50MM BLUNT TIP SCHANZ TITANIUM MANDIB","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"04.305.004","SUP","HCPCS C1713","","04.305.004  -  SCREW BONE 2.5/4MM 60MM BLUNT TIP SCHANZ TITANIUM MANDIB","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"04.305.005","SUP","HCPCS C1713","","04.305.005  -  SCREW BONE 2.5/4MM 70MM BLUNT TIP SCHANZ TITANIUM MANDIB","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"04.305.010","SUP","HCPCS C1713","","04.305.010  -  SCREW BONE 2.5/4MM 50MM SLFDRILL SCHANZ TITANIUM MANDIB","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$474.75 ","$0.00 ","$219.89 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"04.305.011","SUP","HCPCS C1713","","04.305.011  -  SCREW BONE 2.5/4MM 60MM SLFDRILL SCHANZ TITANIUM MANDIB","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$474.75 ","$0.00 ","$219.89 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"04.305.012","SUP","HCPCS C1713","","04.305.012  -  SCREW BONE 2.5/4MM 70MM SLFDRILL SCHANZ TITANIUM MANDIB","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$474.75 ","$0.00 ","$219.89 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"04.305.100","SUP","Custom 27203010","","04.305.100  -  ROD EXFIX 4MM FULL PREBENT RAMUS TITANIUM MANDIB NONSTRL","BOTH IP/OP","$2,167.50 ","$1,603.95 ","$0.00 ","$2,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,167.50 ","$0.00 ","$1,083.75 ","$1,716.66 ","$1,734.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.305.101","SUP","Custom 27203010","","04.305.101  -  ROD EXFIX 4MM FULL PREBENT TITANIUM MANDIB NONSTRL MANDIB","BOTH IP/OP","$1,852.50 ","$1,370.85 ","$0.00 ","$1,852.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,852.50 ","$0.00 ","$926.25 ","$1,467.18 ","$1,482.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.305.102","SUP","Custom 27203010","","04.305.102  -  ROD EXFIX 4MM .75 PREBENT TITANIUM MANDIB NONSTRL MANDIB","BOTH IP/OP","$1,702.50 ","$1,259.85 ","$0.00 ","$1,702.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,702.50 ","$0.00 ","$851.25 ","$1,348.38 ","$1,362.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.305.103","SUP","HCPCS C1713","","04.305.103  -  ROD FIX 4MM .5 PREBENT TITANIUM MANDIB NONSTRL EXFIX SYSTEM","BOTH IP/OP","$1,552.50 ","$1,148.85 ","$0.00 ","$1,552.50 ","$698.63 ","$0.00 ","$323.58 ","$0.00 ","$0.00 ","$271.83 ","$1,552.50 ","$0.00 ","$776.25 ","$1,229.58 ","$1,242.00 ","$0.00 ","$242.97 ","$0.00 ","$247.16 ","$0.00 "
"04.305.128","SUP","HCPCS C1713","","04.305.128  -  SCREW BONE 2.5MM 4MM 8MM SELF DRILL SCHANZ TITANIUM MANDIB","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"04.305.130","SUP","HCPCS C1713","","04.305.130  -  SCREW XTRNFX 2.5MM 4MM 10MM SCHNZ SLF DRL TI MNDB RAMUS","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"04.305.134","SUP","HCPCS C1713","","04.305.134  -  SCREW XTRNFX 2.5MM 4MM 14MM SCHNZ SLF DRL TI MNDB XTRNFXTR","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"04.305.138","SUP","HCPCS C1713","","04.305.138  -  SCREW XTRNFX 2.5MM 4MM 18MM SCHNZ SLF DRL TI MNDB XTRNFXTR","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"04.305.140","SUP","HCPCS C1713","","04.305.140  -  SCREW BONE 2.5/4MM 20MM SLFDRILL SCHANZ TITANIUM RAMUS","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"04.305.142","SUP","HCPCS C1713","","04.305.142  -  SCREW BONE 2.5/4MM 22MM SLFDRILL SCHANZ TITANIUM MANDIB","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"04.307.001","SUP","Custom 27803010","","04.307.001  -  FOOTPLATE BONE 40MM TITANIUM MAXL NONSTRL","BOTH IP/OP","$1,277.50 ","$945.35 ","$0.00 ","$1,277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,277.50 ","$0.00 ","$638.75 ","$1,011.78 ","$1,022.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.307.008","SUP","HCPCS C1713","","04.307.008  -  ROD FIX 80MM TITANIUM MAXL NONSTRL","BOTH IP/OP","$767.50 ","$567.95 ","$0.00 ","$767.50 ","$345.38 ","$0.00 ","$159.97 ","$0.00 ","$0.00 ","$134.38 ","$767.50 ","$0.00 ","$383.75 ","$607.86 ","$614.00 ","$0.00 ","$120.11 ","$0.00 ","$122.19 ","$0.00 "
"04.307.108","SUP","HCPCS C1713","","04.307.108  -  ROD FIX 80MM TALL OFFST TITANIUM MAXL NONSTRL","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"04.307.111","SUP","HCPCS C1713","","04.307.111  -  ROD FIX 110MM TALL OFFST TITANIUM MAXL NONSTRL","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"04.315.000","SUP","HCPCS C1713","","04.315.000  -  SCREW MACHINE 2.7MM TITANIUM CMF DISTRCT","BOTH IP/OP","$647.50 ","$479.15 ","$0.00 ","$647.50 ","$291.38 ","$0.00 ","$134.96 ","$0.00 ","$0.00 ","$113.37 ","$647.50 ","$0.00 ","$323.75 ","$512.82 ","$518.00 ","$0.00 ","$101.33 ","$0.00 ","$103.08 ","$0.00 "
"04.315.001","SUP","Custom 27803010","","04.315.001  -  CAP END REMOVABLE CMF DISTRCT","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,070.00 ","$0.00 ","$535.00 ","$847.44 ","$856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.003","SUP","Custom 27803010","","04.315.003  -  AB DISTRACTOR BODY END ACT 15MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.004","SUP","Custom 27803010","","04.315.004  -  AB DISTRACTOR BODY END ACT. 20MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.005","SUP","Custom 27803010","","04.315.005  -  AB DISTRACTOR BODY END ACT. 25MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.006","SUP","Custom 27803010","","04.315.006  -  AB DISTRACTOR BODY END ACT. 30MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.023","SUP","Custom 27803010","","04.315.023  -  BC DISTRACTOR BODY END ACT. 15MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.024","SUP","Custom 27803010","","04.315.024  -  BC DISTRACTOR BODY END ACT. 20MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.025","SUP","Custom 27803010","","04.315.025  -  DISTRCT 25MM BODY SURG","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.026","SUP","Custom 27803010","","04.315.026  -  BC DISTRACTOR BODY END ACT. 30MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.027","SUP","Custom 27803010","","04.315.027  -  BC DISTRACTOR BODY END ACT 35MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.028","SUP","Custom 27803010","","04.315.028  -  BC DISTRACTOR BODY END ACT 40MM FOR CMF DISTRACTOR","BOTH IP/OP","$11,330.00 ","$8,384.20 ","$0.00 ","$11,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,330.00 ","$0.00 ","$5,665.00 ","$8,973.36 ","$9,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.053","SUP","Custom 27803010","","04.315.053  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 15MM FOR CMF DSTR","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.054","SUP","Custom 27803010","","04.315.054  -  DISTRCT 20MM CRNMXF U JNT BD END ACT SURG TI NONSTRL","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.055","SUP","Custom 27803010","","04.315.055  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 25MM FOR CMF DSTR","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.056","SUP","Custom 27803010","","04.315.056  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 30MM FOR CMF DSTR","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.063","SUP","Custom 27803010","","04.315.063  -  DISTRCT 15MM CRNMXF BD END ACT U JNT SURG TI BC NONSTRL","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.064","SUP","Custom 27803010","","04.315.064  -  DISTRCT 20MM BD END ACT U JNT SURG TI BC CMF NONSTRL","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.065","SUP","Custom 27803010","","04.315.065  -  DISTRCT U JNT BODY 25MM SURG","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.066","SUP","Custom 27803010","","04.315.066  -  DISTRCT 30MM SURG NONSTRL","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.067","SUP","Custom 27803010","","04.315.067  -  BC DISTRACTOR BODY END ACT W/U-JOINT 35MM FOR CMF DSTR","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.068","SUP","Custom 27803010","","04.315.068  -  BC DISTRACTOR BODY END ACT W/U-JOINT 40MM FOR CMF DSTR","BOTH IP/OP","$11,952.50 ","$8,844.85 ","$0.00 ","$11,952.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,952.50 ","$0.00 ","$5,976.25 ","$9,466.38 ","$9,562.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.104","SUP","Custom 27203010","","04.315.104  -  ARM DISTRCT 20MM EXTN RIGID","BOTH IP/OP","$2,282.50 ","$1,689.05 ","$0.00 ","$2,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,282.50 ","$0.00 ","$1,141.25 ","$1,807.74 ","$1,826.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.108","SUP","Custom 27203010","","04.315.108  -  SET EXTN 40MM REMOVABLE RIGID ARM NONSTRL","BOTH IP/OP","$2,282.50 ","$1,689.05 ","$0.00 ","$2,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,282.50 ","$0.00 ","$1,141.25 ","$1,807.74 ","$1,826.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.112","SUP","Custom 27803010","","04.315.112  -  ARM EXTN 60MM RIGID REMOVAL TITANIUM COCR SILICONE NONSTRL","BOTH IP/OP","$2,282.50 ","$1,689.05 ","$0.00 ","$2,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,282.50 ","$0.00 ","$1,141.25 ","$1,807.74 ","$1,826.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.125","SUP","Custom 27203010","","04.315.125  -  SET EXTN 30MM FLEXIBLE REMOVABLE ARM","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.127","SUP","Custom 27203010","","04.315.127  -  SET EXTN 40MM FLEXIBLE REMOVABLE ARM","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.132","SUP","Custom 27203010","","04.315.132  -  ARM DISTRCT 60MM EXTN FLEXIBLE REMOVABLE TITANIUM NONSTRL","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.201","SUP","Custom 27803010","","04.315.201  -  COMPONENT DISTRCT 1MM A TYPE MESH FEET TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.202","SUP","Custom 27803010","","04.315.202  -  COMPONENT DISTRCT 1MM MESH FT B TYPE INTERNAL MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.203","SUP","Custom 27803010","","04.315.203  -  COMPONENT DISTRCT 1MM MESH FT C TYPE INTERNAL MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.211","SUP","Custom 27803010","","04.315.211  -  FOOTPLATE BONE TYPE B CLOVERLEAF GREEN TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.212","SUP","Custom 27803010","","04.315.212  -  FOOTPLATE BONE CLOVERLEAF B TYPE INTERNAL MANDIB 1 MM SCREW","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.213","SUP","Custom 27803010","","04.315.213  -  FOOTPLATE BONE MESH C TYPE INTERNAL MANDIB 1 MM SCREW","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.301","SUP","Custom 27803010","","04.315.301  -  FOOTPLATE BONE TYPE A MESH PINK TITANIUM MANDIB NONSTRL 1.5","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.302","SUP","HCPCS C1713","","04.315.302  -  FOOTPLATE BONE B TYPE MESH TITANIUM MANDIB NONSTRL CMF","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"04.315.303","SUP","HCPCS C1713","","04.315.303  -  FOOTPLATE BONE C TYPE MESH TITANIUM MANDIB NONSTRL CMF","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"04.315.311","SUP","Custom 27803010","","04.315.311  -  FOOTPLATE BONE TYPE A CLOVERLEAF PINK TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.312","SUP","Custom 27803010","","04.315.312  -  FOOTPLATE BONE TYPE B CLOVERLEAF PINK TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.313","SUP","Custom 27803010","","04.315.313  -  FOOTPLATE BONE TYPE C CLOVERLEAF PINK TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.321","SUP","Custom 27803010","","04.315.321  -  FOOTPLATE BONE 5.5MM TYPE B ELEVATED MESH OFFST PINK","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.322","SUP","Custom 27803010","","04.315.322  -  FOOTPLATE BONE 7.5MM TYPE B ELEVATED MESH OFFST PINK","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.323","SUP","Custom 27803010","","04.315.323  -  FOOTPLATE BONE TYPE C ELEVATED MESH OFFST PINK TITANIUM","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.401","SUP","Custom 27803010","","04.315.401  -  FOOTPLATE BONE TYPE A MESH BLUE TITANIUM MANDIB NONSTRL 2MM","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.402","SUP","Custom 27803010","","04.315.402  -  FOOTPLATE BONE TYPE B MESH BLUE TITANIUM MANDIB NONSTRL 2MM","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.403","SUP","Custom 27803010","","04.315.403  -  FOOTPLATE BONE TYPE C MESH BLUE TITANIUM MANDIB NONSTRL 2MM","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.411","SUP","Custom 27803010","","04.315.411  -  FOOTPLATE BONE TYPE A CLOVERLEAF BLUE TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.412","SUP","Custom 27803010","","04.315.412  -  FOOTPLATE BONE TYPE B CLOVERLEAF BLUE TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.413","SUP","Custom 27803010","","04.315.413  -  FOOTPLATE BONE TYPE C CLOVERLEAF BLUE TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.421","SUP","Custom 27803010","","04.315.421  -  FOOTPLATE BONE 5.5MM TYPE B MESH OFFST BLUE TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.422","SUP","Custom 27803010","","04.315.422  -  FOOTPLATE BONE 7.5MM TYPE C MESH OFFST BLUE TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.423","SUP","Custom 27803010","","04.315.423  -  FOOTPLATE BONE TYPE C MESH OFFST BLUE TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.501","SUP","Custom 27803010","","04.315.501  -  FOOTPLATE BONE TYPE A MESH YELLOW TITANIUM MANDIB NONSTRL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.502","SUP","Custom 27803010","","04.315.502  -  COMPONENT DISTRCT 1.3MM MESH FEET INTERNAL B TYPE MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.503","SUP","Custom 27803010","","04.315.503  -  COMPONENT DISTRCT 1.3MM MESH FEET C TYPE INTERNAL MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.511","SUP","Custom 27803010","","04.315.511  -  FOOTPLATE BONE TYPE A CLOVERLEAF YELLOW TITANIUM MANDIB","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.315.512","SUP","HCPCS C1713","","04.315.512  -  PLATE BONE B MANDIB NONSTRL 1.3 MM SCREWS","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"04.315.513","SUP","HCPCS C1713","","04.315.513  -  PLATE BONE C MANDIB NONSTRL 1.3 MM SCREWS","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"04.402.007S","SUP","HCPCS C1713","","04.402.007S  -  STEM RADIAL STR 7MM 26MM TITANIUM STERILE","BOTH IP/OP","$3,286.33 ","$2,431.88 ","$0.00 ","$3,286.33 ","$1,478.85 ","$0.00 ","$684.95 ","$0.00 ","$0.00 ","$575.41 ","$3,286.33 ","$0.00 ","$1,643.16 ","$2,602.77 ","$2,629.06 ","$0.00 ","$499.33 ","$0.00 ","$523.18 ","$0.00 "
"04.449.000","SUP","HCPCS C1713","","04.449.000  -  HEAD SCR CNDYLR TI NONSTRL","BOTH IP/OP","$6,745.50 ","$4,991.67 ","$0.00 ","$6,745.50 ","$3,035.48 ","$0.00 ","$1,405.93 ","$0.00 ","$0.00 ","$1,181.08 ","$6,745.50 ","$0.00 ","$3,372.75 ","$5,342.44 ","$5,396.40 ","$0.00 ","$1,055.67 ","$0.00 ","$1,073.88 ","$0.00 "
"04.449.010","SUP","HCPCS C1713","","04.449.010  -  PLATE BONE 0MM CRNMXF TI LCK CNDYLR HEAD RECON NONSTRL","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"04.449.020","SUP","HCPCS C1713","","04.449.020  -  PLATE 2MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"04.449.030","SUP","HCPCS C1713","","04.449.030  -  PLATE 4MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"04.449.040","SUP","HCPCS C1713","","04.449.040  -  PLATE 6MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"04.497.000","SUP","HCPCS C1713","","04.497.000  -  SCREW TI CNDYLR HEAD BONE NONSTRL","BOTH IP/OP","$328.50 ","$243.09 ","$0.00 ","$328.50 ","$147.83 ","$0.00 ","$68.47 ","$0.00 ","$0.00 ","$57.52 ","$328.50 ","$0.00 ","$164.25 ","$260.17 ","$262.80 ","$0.00 ","$51.41 ","$0.00 ","$52.30 ","$0.00 "
"04.497.001","SUP","HCPCS C1713","","04.497.001  -  SCREW TI CNDYLR SLT HEAD BONE MTRXMAND","BOTH IP/OP","$384.75 ","$284.72 ","$0.00 ","$384.75 ","$173.14 ","$0.00 ","$80.19 ","$0.00 ","$0.00 ","$67.37 ","$384.75 ","$0.00 ","$192.38 ","$304.72 ","$307.80 ","$0.00 ","$60.21 ","$0.00 ","$61.25 ","$0.00 "
"04.500.000","SUP","HCPCS C1713","","04.500.000  -  ROD FIX 110MM TITANIUM MAXL NONSTRL","BOTH IP/OP","$767.50 ","$567.95 ","$0.00 ","$767.50 ","$345.38 ","$0.00 ","$159.97 ","$0.00 ","$0.00 ","$134.38 ","$767.50 ","$0.00 ","$383.75 ","$607.86 ","$614.00 ","$0.00 ","$120.11 ","$0.00 ","$122.19 ","$0.00 "
"04.500.001","SUP","HCPCS C1713","","04.500.001  -  SCREW SURG DISTRCT EXTERNAL TITANIUM MAXILLOMANDIBULAR","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$130.50 ","$0.00 ","$60.44 ","$0.00 ","$0.00 ","$50.78 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$45.39 ","$0.00 ","$46.17 ","$0.00 "
"04.500.002","SUP","HCPCS C1713","","04.500.002  -  SCREW BONE 27MM SLFDRILL WIRE FIX TITANIUM MANDIB NONSTRL","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$156.38 ","$0.00 ","$72.43 ","$0.00 ","$0.00 ","$60.84 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$54.38 ","$0.00 ","$55.32 ","$0.00 "
"04.500.006","SUP","HCPCS C1713","","04.500.006  -  ANCHOR SCR 6MM OTHDNTC BONE TI ANCHORAGE SLFDRILL","BOTH IP/OP","$274.50 ","$203.13 ","$0.00 ","$274.50 ","$123.53 ","$0.00 ","$57.21 ","$0.00 ","$0.00 ","$48.06 ","$274.50 ","$0.00 ","$137.25 ","$217.40 ","$219.60 ","$0.00 ","$42.96 ","$0.00 ","$43.70 ","$0.00 "
"04.500.008","SUP","HCPCS C1713","","04.500.008  -  ANCHOR SCR 8MM OTHDNTC BONE TI SLFDRILL NONSTRL","BOTH IP/OP","$274.50 ","$203.13 ","$0.00 ","$274.50 ","$123.53 ","$0.00 ","$57.21 ","$0.00 ","$0.00 ","$48.06 ","$274.50 ","$0.00 ","$137.25 ","$217.40 ","$219.60 ","$0.00 ","$42.96 ","$0.00 ","$43.70 ","$0.00 "
"04.500.010","SUP","HCPCS C1713","","04.500.010  -  SCREW ANCH 10MM TI ANCH SLFTAP OBA","BOTH IP/OP","$274.50 ","$203.13 ","$0.00 ","$274.50 ","$123.53 ","$0.00 ","$57.21 ","$0.00 ","$0.00 ","$48.06 ","$274.50 ","$0.00 ","$137.25 ","$217.40 ","$219.60 ","$0.00 ","$42.96 ","$0.00 ","$43.70 ","$0.00 "
"04.500.012","SUP","HCPCS C1713","","04.500.012  -  TI OBA PLATE ANCHOR BRACKET DESIGN 4 HOLES","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"04.500.013","SUP","HCPCS C1713","","04.500.013  -  PLATE ANCH TI 4 HOLE DOMED DSGN","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"04.500.014","SUP","HCPCS C1713","","04.500.014  -  PLATE OTHDNTC 4 HOLE ANCH MESH PAD DSGN BONE TI NONSTRL","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"04.500.015","SUP","HCPCS C1713","","04.500.015  -  TI OBA PLATE ANCHOR BRACKET DESIGN 5 HOLES","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"04.500.016","SUP","HCPCS C1713","","04.500.016  -  PLATE ANCH TI 5 HOLE DOMED DSGN","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"04.500.017","SUP","HCPCS C1713","","04.500.017  -  PLATE OTHDNTC 5 HOLE ANCH MESH PAD DSGN BONE TI NONSTRL","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"04.500.018","SUP","Custom 27803010","","04.500.018  -  BODY DISTRCT 100MM RAD STR CURVILINEAR TITANIUM MANDIB","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.024.01","SUP","HCPCS C1713","","04.500.024.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 4MM","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.500.026.01","SUP","HCPCS C1713","","04.500.026.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 6MM","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.500.028.01","SUP","HCPCS C1713","","04.500.028.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 8MM","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.500.034.01","SUP","HCPCS C1713","","04.500.034.01  -  SCREW TI 4MM MAXFACL OTHDNTC ER BONE NONSTRL","BOTH IP/OP","$214.88 ","$159.01 ","$0.00 ","$214.88 ","$96.69 ","$0.00 ","$44.79 ","$0.00 ","$0.00 ","$37.62 ","$214.88 ","$0.00 ","$107.44 ","$170.18 ","$171.90 ","$0.00 ","$33.63 ","$0.00 ","$34.21 ","$0.00 "
"04.500.036.01","SUP","HCPCS C1713","","04.500.036.01  -  TI OBA EMERGENCY SCREW 6MM","BOTH IP/OP","$214.88 ","$159.01 ","$0.00 ","$214.88 ","$96.69 ","$0.00 ","$44.79 ","$0.00 ","$0.00 ","$37.62 ","$214.88 ","$0.00 ","$107.44 ","$170.18 ","$171.90 ","$0.00 ","$33.63 ","$0.00 ","$34.21 ","$0.00 "
"04.500.038.01","SUP","HCPCS C1713","","04.500.038.01  -  SCREW TI 8MM MAXFACL ER BONE","BOTH IP/OP","$214.88 ","$159.01 ","$0.00 ","$214.88 ","$96.69 ","$0.00 ","$44.79 ","$0.00 ","$0.00 ","$37.62 ","$214.88 ","$0.00 ","$107.44 ","$170.18 ","$171.90 ","$0.00 ","$33.63 ","$0.00 ","$34.21 ","$0.00 "
"04.500.100","SUP","Custom 27803010","","04.500.100  -  BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.101","SUP","Custom 27803010","","04.500.101  -  BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.130","SUP","Custom 27803010","","04.500.130  -  BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.131","SUP","Custom 27803010","","04.500.131  -  BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.140","SUP","Custom 27803010","","04.500.140  -  BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.141","SUP","Custom 27803010","","04.500.141  -  BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.150","SUP","Custom 27803010","","04.500.150  -  BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.151","SUP","Custom 27803010","","04.500.151  -  BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.170","SUP","Custom 27803010","","04.500.170  -  BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.500.171","SUP","Custom 27803010","","04.500.171  -  BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK","BOTH IP/OP","$16,962.50 ","$12,552.25 ","$0.00 ","$16,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,962.50 ","$0.00 ","$8,481.25 ","$13,434.30 ","$13,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.501.001","SUP","HCPCS C1713","","04.501.001  -  PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3","BOTH IP/OP","$4,307.50 ","$3,187.55 ","$0.00 ","$4,307.50 ","$1,938.38 ","$0.00 ","$897.79 ","$0.00 ","$0.00 ","$754.21 ","$4,307.50 ","$0.00 ","$2,153.75 ","$3,411.54 ","$3,446.00 ","$0.00 ","$674.12 ","$0.00 ","$685.75 ","$0.00 "
"04.501.002","SUP","HCPCS C1713","","04.501.002  -  PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3","BOTH IP/OP","$4,307.50 ","$3,187.55 ","$0.00 ","$4,307.50 ","$1,938.38 ","$0.00 ","$897.79 ","$0.00 ","$0.00 ","$754.21 ","$4,307.50 ","$0.00 ","$2,153.75 ","$3,411.54 ","$3,446.00 ","$0.00 ","$674.12 ","$0.00 ","$685.75 ","$0.00 "
"04.501.003","SUP","HCPCS C1713","","04.501.003  -  PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4","BOTH IP/OP","$4,154.38 ","$3,074.24 ","$0.00 ","$4,154.38 ","$1,869.47 ","$0.00 ","$865.88 ","$0.00 ","$0.00 ","$727.40 ","$4,154.38 ","$0.00 ","$2,077.19 ","$3,290.27 ","$3,323.50 ","$0.00 ","$650.16 ","$0.00 ","$661.38 ","$0.00 "
"04.501.004","SUP","HCPCS C1713","","04.501.004  -  PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4","BOTH IP/OP","$4,154.38 ","$3,074.24 ","$0.00 ","$4,154.38 ","$1,869.47 ","$0.00 ","$865.88 ","$0.00 ","$0.00 ","$727.40 ","$4,154.38 ","$0.00 ","$2,077.19 ","$3,290.27 ","$3,323.50 ","$0.00 ","$650.16 ","$0.00 ","$661.38 ","$0.00 "
"04.501.005","SUP","HCPCS C1713","","04.501.005  -  PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6","BOTH IP/OP","$4,154.38 ","$3,074.24 ","$0.00 ","$4,154.38 ","$1,869.47 ","$0.00 ","$865.88 ","$0.00 ","$0.00 ","$727.40 ","$4,154.38 ","$0.00 ","$2,077.19 ","$3,290.27 ","$3,323.50 ","$0.00 ","$650.16 ","$0.00 ","$661.38 ","$0.00 "
"04.501.006","SUP","HCPCS C1713","","04.501.006  -  PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6","BOTH IP/OP","$4,154.38 ","$3,074.24 ","$0.00 ","$4,154.38 ","$1,869.47 ","$0.00 ","$865.88 ","$0.00 ","$0.00 ","$727.40 ","$4,154.38 ","$0.00 ","$2,077.19 ","$3,290.27 ","$3,323.50 ","$0.00 ","$650.16 ","$0.00 ","$661.38 ","$0.00 "
"04.501.007","SUP","HCPCS C1713","","04.501.007  -  PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI","BOTH IP/OP","$4,307.50 ","$3,187.55 ","$0.00 ","$4,307.50 ","$1,938.38 ","$0.00 ","$897.79 ","$0.00 ","$0.00 ","$754.21 ","$4,307.50 ","$0.00 ","$2,153.75 ","$3,411.54 ","$3,446.00 ","$0.00 ","$674.12 ","$0.00 ","$685.75 ","$0.00 "
"04.501.008","SUP","HCPCS C1713","","04.501.008  -  PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI","BOTH IP/OP","$4,307.50 ","$3,187.55 ","$0.00 ","$4,307.50 ","$1,938.38 ","$0.00 ","$897.79 ","$0.00 ","$0.00 ","$754.21 ","$4,307.50 ","$0.00 ","$2,153.75 ","$3,411.54 ","$3,446.00 ","$0.00 ","$674.12 ","$0.00 ","$685.75 ","$0.00 "
"04.501.009","SUP","HCPCS C1713","","04.501.009  -  PLATE BONE UNIVERSAL 8 HOLE MATRIXRIB TITANIUM RIB NONSTRL","BOTH IP/OP","$2,935.00 ","$2,171.90 ","$0.00 ","$2,935.00 ","$1,320.75 ","$0.00 ","$611.73 ","$0.00 ","$0.00 ","$513.90 ","$2,935.00 ","$0.00 ","$1,467.50 ","$2,324.52 ","$2,348.00 ","$0.00 ","$459.33 ","$0.00 ","$467.25 ","$0.00 "
"04.501.010","SUP","HCPCS C1713","","04.501.010  -  IMPLANT FIX SMALL 3MM SPLINT MATRIXRIB TITANIUM","BOTH IP/OP","$1,557.50 ","$1,152.55 ","$0.00 ","$1,557.50 ","$700.88 ","$0.00 ","$324.62 ","$0.00 ","$0.00 ","$272.71 ","$1,557.50 ","$0.00 ","$778.75 ","$1,233.54 ","$1,246.00 ","$0.00 ","$243.75 ","$0.00 ","$247.95 ","$0.00 "
"04.501.011","SUP","HCPCS C1713","","04.501.011  -  IMPLANT FIX MEDIUM 4MM SPLINT MATRIXRIB TITANIUM","BOTH IP/OP","$1,557.50 ","$1,152.55 ","$0.00 ","$1,557.50 ","$700.88 ","$0.00 ","$324.62 ","$0.00 ","$0.00 ","$272.71 ","$1,557.50 ","$0.00 ","$778.75 ","$1,233.54 ","$1,246.00 ","$0.00 ","$243.75 ","$0.00 ","$247.95 ","$0.00 "
"04.501.012","SUP","Custom 27803010","","04.501.012  -  IMPLANT FIX LARGE 5MM SPLINT MATRIXRIB TITANIUM","BOTH IP/OP","$1,557.50 ","$1,152.55 ","$0.00 ","$1,557.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,557.50 ","$0.00 ","$778.75 ","$1,233.54 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.501.016.01","SUP","HCPCS C1713","","04.501.016.01  -  SCREW BONE 2.9MM 6MM SELF TAP LOCK MATRIXRIB TITANIUM RIB","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$542.50 ","$244.13 ","$0.00 ","$113.07 ","$0.00 ","$0.00 ","$94.99 ","$542.50 ","$0.00 ","$271.25 ","$429.66 ","$434.00 ","$0.00 ","$84.90 ","$0.00 ","$86.37 ","$0.00 "
"04.501.018.01","SUP","HCPCS C1713","","04.501.018.01  -  SCREW BONE 2.9MM 8MM SELF TAP LOCK MATRIXRIB TITANIUM RIB","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$542.50 ","$244.13 ","$0.00 ","$113.07 ","$0.00 ","$0.00 ","$94.99 ","$542.50 ","$0.00 ","$271.25 ","$429.66 ","$434.00 ","$0.00 ","$84.90 ","$0.00 ","$86.37 ","$0.00 "
"04.501.020.01","SUP","HCPCS C1713","","04.501.020.01  -  SCREW BONE 2.9MM 10MM SELF TAP LOCK MATRIXRIB TITANIUM RIB","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$542.50 ","$244.13 ","$0.00 ","$113.07 ","$0.00 ","$0.00 ","$94.99 ","$542.50 ","$0.00 ","$271.25 ","$429.66 ","$434.00 ","$0.00 ","$84.90 ","$0.00 ","$86.37 ","$0.00 "
"04.501.022.01","SUP","HCPCS C1713","","04.501.022.01  -  SCREW BONE 2.9MM 12MM SELF TAP LOCK MATRIXRIB TITANIUM RIB","BOTH IP/OP","$524.88 ","$388.41 ","$0.00 ","$524.88 ","$236.19 ","$0.00 ","$109.40 ","$0.00 ","$0.00 ","$91.90 ","$524.88 ","$0.00 ","$262.44 ","$415.70 ","$419.90 ","$0.00 ","$82.14 ","$0.00 ","$83.56 ","$0.00 "
"04.501.024.01","SUP","HCPCS C1713","","04.501.024.01  -  IMPLANT FIX 14MM SYSTEM SET MATRIXRIB","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$542.50 ","$244.13 ","$0.00 ","$113.07 ","$0.00 ","$0.00 ","$94.99 ","$542.50 ","$0.00 ","$271.25 ","$429.66 ","$434.00 ","$0.00 ","$84.90 ","$0.00 ","$86.37 ","$0.00 "
"04.501.026.01","SUP","HCPCS C1713","","04.501.026.01  -  SCREW BONE 2.9MM 16MM ANGULAR STABLE SLFTAP LOCKING","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$542.50 ","$244.13 ","$0.00 ","$113.07 ","$0.00 ","$0.00 ","$94.99 ","$542.50 ","$0.00 ","$271.25 ","$429.66 ","$434.00 ","$0.00 ","$84.90 ","$0.00 ","$86.37 ","$0.00 "
"04.501.028.01","SUP","HCPCS C1713","","04.501.028.01  -  SCREW BONE 2.9MM 18MM ANGULAR STABLE SLFTAP LOCKING","BOTH IP/OP","$542.50 ","$401.45 ","$0.00 ","$542.50 ","$244.13 ","$0.00 ","$113.07 ","$0.00 ","$0.00 ","$94.99 ","$542.50 ","$0.00 ","$271.25 ","$429.66 ","$434.00 ","$0.00 ","$84.90 ","$0.00 ","$86.37 ","$0.00 "
"04.501.036.05","SUP","HCPCS C1713","","04.501.036.05  -  SCREW BONE 2.9MM 6MM MATRIXRIB TI RB SLFTAP NLCKG NONSTRL","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"04.501.094","SUP","HCPCS C1713","","04.501.094  -  PLATE BN I 2.8MM NS MATRIXRIB 9 HL TI RB","BOTH IP/OP","$3,170.00 ","$2,345.80 ","$0.00 ","$3,170.00 ","$1,426.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.04 ","$3,170.00 ","$0.00 ","$1,585.00 ","$2,510.64 ","$2,536.00 ","$0.00 ","$496.11 ","$0.00 ","$504.66 ","$0.00 "
"04.501.110.01","SUP","HCPCS C1713","","04.501.110.01  -  SCREW BONE 3MM 10MM LOCK SELF DRILL TITANIUM STERNAL NONSTRL","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"04.501.112.01","SUP","HCPCS C1713","","04.501.112.01  -  SCREW BONE 3MM 12MM SELF DRILL UNILOCK TITANIUM STERNUM","BOTH IP/OP","$490.88 ","$363.25 ","$0.00 ","$490.88 ","$220.89 ","$0.00 ","$102.31 ","$0.00 ","$0.00 ","$85.95 ","$490.88 ","$0.00 ","$245.44 ","$388.78 ","$392.70 ","$0.00 ","$76.82 ","$0.00 ","$78.15 ","$0.00 "
"04.501.114.01","SUP","HCPCS C1713","","04.501.114.01  -  SCREW BONE 3MM 14MM SELF DRILL UNILOCK TITANIUM STERNUM","BOTH IP/OP","$577.50 ","$427.35 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$120.37 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"04.501.116.01","SUP","HCPCS C1713","","04.501.116.01  -  SCREW BONE 3MM 16MM SELF DRILL UNILOCK TITANIUM STERNUM","BOTH IP/OP","$577.50 ","$427.35 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$120.37 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"04.501.118.01","SUP","HCPCS C1713","","04.501.118.01  -  SCREW BONE 3MM 18MM SELF DRILL UNILOCK TITANIUM STERNUM","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"04.501.120.01","SUP","HCPCS C1713","","04.501.120.01  -  SCREW BONE 3MM 20MM SLFDRILL TITANIUM STERNUM NONSTRL","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"04.503.021","SUP","Custom 27803010","","04.503.021  -  COVER BUR HOLE BLUE 12MM MATRIXNEURO TI NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.022","SUP","Custom 27803010","","04.503.022  -  COVER BUR HOLE 15MM MATRIXNEURO TI NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.023","SUP","Custom 27803010","","04.503.023  -  COVER BUR HOLE 17MM MATRIXNEURO MIDFAC CRANFCL TI NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.024","SUP","Custom 27803010","","04.503.024  -  COVER BUR HOLE 24MM MATRIXNEURO CRANIAL TI NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.026","SUP","Custom 27803010","","04.503.026  -  COVER BUR HOLE 12MM MATRIXNEURO CRNMXF TI SHNT NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.027","SUP","Custom 27803010","","04.503.027  -  COVER BUR HOLE 15MM MATRIXNEURO CRNMXF TI SHNT NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.028","SUP","Custom 27803010","","04.503.028  -  COVER BUR HOLE 17MM MATRIXNEURO TI SHNT NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.029","SUP","Custom 27803010","","04.503.029  -  COVER BUR HOLE 24MM MATRIXNEURO CRNMXF TI NONSTRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.056","SUP","HCPCS C1713","","04.503.056  -  PLATE BONE MATRIXNEURO CRANIAL TI MESH STRUT MALBLE NONSTRL","BOTH IP/OP","$1,665.00 ","$1,232.10 ","$0.00 ","$1,665.00 ","$749.25 ","$0.00 ","$347.03 ","$0.00 ","$0.00 ","$291.53 ","$1,665.00 ","$0.00 ","$832.50 ","$1,318.68 ","$1,332.00 ","$0.00 ","$260.57 ","$0.00 ","$265.07 ","$0.00 "
"04.503.057","SUP","HCPCS C1713","","04.503.057  -  PLATE BONE MATRIXNEURO TMPR TI MESH MALBLE NONSTRL","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$991.24 ","$0.00 ","$459.11 ","$0.00 ","$0.00 ","$385.68 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$344.73 ","$0.00 ","$350.68 ","$0.00 "
"04.503.061","SUP","HCPCS C1713","","04.503.061  -  PLATE BONE 9MM MATRIXNEURO CRNMXF TI 2 HOLE STR NONSTRL","BOTH IP/OP","$176.63 ","$130.71 ","$0.00 ","$176.63 ","$79.48 ","$0.00 ","$36.81 ","$0.00 ","$0.00 ","$30.93 ","$176.63 ","$0.00 ","$88.31 ","$139.89 ","$141.30 ","$0.00 ","$27.64 ","$0.00 ","$28.12 ","$0.00 "
"04.503.062","SUP","HCPCS C1713","","04.503.062  -  PLATE BN STRG 12MMX.4MM NS MATRIXNEURO 2 HL TI CRNL","BOTH IP/OP","$183.38 ","$135.70 ","$0.00 ","$183.38 ","$82.52 ","$0.00 ","$38.22 ","$0.00 ","$0.00 ","$32.11 ","$183.38 ","$0.00 ","$91.69 ","$145.24 ","$146.70 ","$0.00 ","$28.70 ","$0.00 ","$29.19 ","$0.00 "
"04.503.063","SUP","HCPCS C1713","","04.503.063  -  PLATE BN STRG 24MMX.4MM NS MATRIXNEURO 4 HL TI CRNL","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$209.25 ","$94.16 ","$0.00 ","$43.61 ","$0.00 ","$0.00 ","$36.64 ","$209.25 ","$0.00 ","$104.63 ","$165.73 ","$167.40 ","$0.00 ","$32.75 ","$0.00 ","$33.31 ","$0.00 "
"04.503.064","SUP","HCPCS C1713","","04.503.064  -  PLATE BN X .4MM NS MATRIXNEURO 4 HL TI CRNL","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.065","SUP","HCPCS C1713","","04.503.065  -  PLATE BN BX 14X14X.4MM NS MATRIXNEURO 4 HL TI CRNL","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.066","SUP","HCPCS C1713","","04.503.066  -  PLATE BONE 16X16MM MATRIXNEURO CRNMXF TI BOX NONSTRL","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.067","SUP","HCPCS C1713","","04.503.067  -  PLATE BN Y .4MM NS MATRIXNEURO 5 HL TI CRNL","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.068","SUP","HCPCS C1713","","04.503.068  -  PLATE BN 2Y 18MMX.4MM NS MATRIXNEURO 6 HL TI CRNL","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.069","SUP","HCPCS C1713","","04.503.069  -  PLATE BN 2Y 21MMX.4MM NS MATRIXNEURO 6 HL TI CRNL","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.070","SUP","HCPCS C1713","","04.503.070  -  PLATE BN .4MM NS MATRIXNEURO 5 HL ADP TI CRNL","BOTH IP/OP","$605.25 ","$447.89 ","$0.00 ","$605.25 ","$272.36 ","$0.00 ","$126.15 ","$0.00 ","$0.00 ","$105.97 ","$605.25 ","$0.00 ","$302.63 ","$479.36 ","$484.20 ","$0.00 ","$94.72 ","$0.00 ","$96.36 ","$0.00 "
"04.503.071","SUP","HCPCS C1713","","04.503.071  -  PLATE BONE MATRIXNEURO CRNMXF TI 7 HOLE ADP NONSTRL","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"04.503.072","SUP","HCPCS C1713","","04.503.072  -  PLATE BONE MATRIXNEURO CRNMXF TI 20 HOLE ADP NONSTRL","BOTH IP/OP","$1,498.50 ","$1,108.89 ","$0.00 ","$1,498.50 ","$674.33 ","$0.00 ","$312.32 ","$0.00 ","$0.00 ","$262.38 ","$1,498.50 ","$0.00 ","$749.25 ","$1,186.81 ","$1,198.80 ","$0.00 ","$234.52 ","$0.00 ","$238.56 ","$0.00 "
"04.503.073","SUP","HCPCS C1713","","04.503.073  -  PLATE BN BX 16X10X.4MM NS MATRIXNEURO 4 HL TI CRNL","BOTH IP/OP","$643.50 ","$476.19 ","$0.00 ","$643.50 ","$289.58 ","$0.00 ","$134.12 ","$0.00 ","$0.00 ","$112.67 ","$643.50 ","$0.00 ","$321.75 ","$509.65 ","$514.80 ","$0.00 ","$100.71 ","$0.00 ","$102.45 ","$0.00 "
"04.503.074","SUP","HCPCS C1713","","04.503.074  -  PLATE BONE 9MM MATRIXNEURO CRNMXF TI 2X3 HOLE STRUT NONSTRL","BOTH IP/OP","$1,170.00 ","$865.80 ","$0.00 ","$1,170.00 ","$526.50 ","$0.00 ","$243.86 ","$0.00 ","$0.00 ","$204.86 ","$1,170.00 ","$0.00 ","$585.00 ","$926.64 ","$936.00 ","$0.00 ","$183.11 ","$0.00 ","$186.26 ","$0.00 "
"04.503.075","SUP","HCPCS C1713","","04.503.075  -  PLATE BONE 34X14MM MATRIXNEURO CRNMXF TI 2X4 HOLE STRUT","BOTH IP/OP","$1,665.00 ","$1,232.10 ","$0.00 ","$1,665.00 ","$749.25 ","$0.00 ","$347.03 ","$0.00 ","$0.00 ","$291.53 ","$1,665.00 ","$0.00 ","$832.50 ","$1,318.68 ","$1,332.00 ","$0.00 ","$260.57 ","$0.00 ","$265.07 ","$0.00 "
"04.503.076","SUP","HCPCS C1713","","04.503.076  -  PLATE BONE MATRIXNEURO CRNMXF TI 2X3 HOLE STRUT CVD NONSTRL","BOTH IP/OP","$1,091.25 ","$807.53 ","$0.00 ","$1,091.25 ","$491.06 ","$0.00 ","$227.44 ","$0.00 ","$0.00 ","$191.07 ","$1,091.25 ","$0.00 ","$545.63 ","$864.27 ","$873.00 ","$0.00 ","$170.78 ","$0.00 ","$173.73 ","$0.00 "
"04.503.077","SUP","HCPCS C1713","","04.503.077  -  TI MATRIXNEURO CURVED STRUT PLATE/2 X 4 HOLE","BOTH IP/OP","$1,554.75 ","$1,150.52 ","$0.00 ","$1,554.75 ","$699.64 ","$0.00 ","$324.05 ","$0.00 ","$0.00 ","$272.22 ","$1,554.75 ","$0.00 ","$777.38 ","$1,231.36 ","$1,243.80 ","$0.00 ","$243.32 ","$0.00 ","$247.52 ","$0.00 "
"04.503.081","SUP","HCPCS C1713","","04.503.081  -  PLATE BONE 45X38X.4MM MATRIXNEURO TI CONTUR MESH MALBLE","BOTH IP/OP","$3,831.75 ","$2,835.50 ","$0.00 ","$3,831.75 ","$1,724.29 ","$0.00 ","$798.63 ","$0.00 ","$0.00 ","$670.91 ","$3,831.75 ","$0.00 ","$1,915.88 ","$3,034.75 ","$3,065.40 ","$0.00 ","$599.67 ","$0.00 ","$610.01 ","$0.00 "
"04.503.082","SUP","HCPCS C1713","","04.503.082  -  PLATE BONE 45X38X.4MM MATRIXNEURO TI CONTUR MESH RGD NONSTRL","BOTH IP/OP","$3,831.75 ","$2,835.50 ","$0.00 ","$3,831.75 ","$1,724.29 ","$0.00 ","$798.63 ","$0.00 ","$0.00 ","$670.91 ","$3,831.75 ","$0.00 ","$1,915.88 ","$3,034.75 ","$3,065.40 ","$0.00 ","$599.67 ","$0.00 ","$610.01 ","$0.00 "
"04.503.083","SUP","HCPCS C1713","","04.503.083  -  MESH CRNL CNTR 100X100X.4MM SLVR NS MATRIXNEURO RGD TI","BOTH IP/OP","$5,964.75 ","$4,413.92 ","$0.00 ","$5,964.75 ","$2,684.14 ","$0.00 ","$1,243.20 ","$0.00 ","$0.00 ","$1,044.38 ","$5,964.75 ","$0.00 ","$2,982.38 ","$4,724.08 ","$4,771.80 ","$0.00 ","$933.48 ","$0.00 ","$949.59 ","$0.00 "
"04.503.084","SUP","HCPCS C1713","","04.503.084  -  MESH CRNL CNTR 100X100X.4MM BLU NS MATRIXNEURO RGD TI","BOTH IP/OP","$5,964.75 ","$4,413.92 ","$0.00 ","$5,964.75 ","$2,684.14 ","$0.00 ","$1,243.20 ","$0.00 ","$0.00 ","$1,044.38 ","$5,964.75 ","$0.00 ","$2,982.38 ","$4,724.08 ","$4,771.80 ","$0.00 ","$933.48 ","$0.00 ","$949.59 ","$0.00 "
"04.503.085","SUP","HCPCS C1713","","04.503.085  -  PLATE BONE MATRIXNEURO CRNMXF TI CONTUR MESH RGD NONSTRL","BOTH IP/OP","$22,842.00 ","$16,903.08 ","$0.00 ","$22,842.00 ","$10,278.90 ","$0.00 ","$4,760.84 ","$0.00 ","$0.00 ","$3,999.45 ","$22,842.00 ","$0.00 ","$11,421.00 ","$18,090.86 ","$18,273.60 ","$0.00 ","$3,574.77 ","$0.00 ","$3,636.45 ","$0.00 "
"04.503.086","SUP","HCPCS C1713","","04.503.086  -  PLATE BONE MATRIXNEURO SM CRNMXF TI CONTUR MESH MALBLE ARC","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$991.24 ","$0.00 ","$459.11 ","$0.00 ","$0.00 ","$385.68 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$344.73 ","$0.00 ","$350.68 ","$0.00 "
"04.503.087","SUP","HCPCS C1713","","04.503.087  -  PLATE BONE MATRIXNEURO LG CRNMXF TI CONTUR MESH MALBLE ARC","BOTH IP/OP","$3,433.50 ","$2,540.79 ","$0.00 ","$3,433.50 ","$1,545.08 ","$0.00 ","$715.63 ","$0.00 ","$0.00 ","$601.18 ","$3,433.50 ","$0.00 ","$1,716.75 ","$2,719.33 ","$2,746.80 ","$0.00 ","$537.34 ","$0.00 ","$546.61 ","$0.00 "
"04.503.088","SUP","HCPCS C1713","","04.503.088  -  PLATE BONE MATRIXNEURO SM CRNMXF TI CONTUR MESH RGD ARC","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$991.24 ","$0.00 ","$459.11 ","$0.00 ","$0.00 ","$385.68 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$344.73 ","$0.00 ","$350.68 ","$0.00 "
"04.503.089","SUP","HCPCS C1713","","04.503.089  -  PLATE LG MIDFAC RGD ARC BONE MATRIXNEURO TI NONSTRL BLUE","BOTH IP/OP","$3,433.50 ","$2,540.79 ","$0.00 ","$3,433.50 ","$1,545.08 ","$0.00 ","$715.63 ","$0.00 ","$0.00 ","$601.18 ","$3,433.50 ","$0.00 ","$1,716.75 ","$2,719.33 ","$2,746.80 ","$0.00 ","$537.34 ","$0.00 ","$546.61 ","$0.00 "
"04.503.090","SUP","HCPCS C1713","","04.503.090  -  PLATE BONE 30MM MATRIXNEURO CRNMXF TI CONTUR MESH MALBLE","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$991.24 ","$0.00 ","$459.11 ","$0.00 ","$0.00 ","$385.68 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$344.73 ","$0.00 ","$350.68 ","$0.00 "
"04.503.091","SUP","HCPCS C1713","","04.503.091  -  PLATE BONE 70MM MATRIXNEURO CRNMXF TI CONTUR MESH MALBLE","BOTH IP/OP","$4,560.75 ","$3,374.96 ","$0.00 ","$4,560.75 ","$2,052.34 ","$0.00 ","$950.57 ","$0.00 ","$0.00 ","$798.55 ","$4,560.75 ","$0.00 ","$2,280.38 ","$3,612.11 ","$3,648.60 ","$0.00 ","$713.76 ","$0.00 ","$726.07 ","$0.00 "
"04.503.092","SUP","HCPCS C1713","","04.503.092  -  PLATE BONE 100MM MATRIXNEURO CRNMXF TI MESH CONTUR MALBLE","BOTH IP/OP","$5,688.00 ","$4,209.12 ","$0.00 ","$5,688.00 ","$2,559.60 ","$0.00 ","$1,185.52 ","$0.00 ","$0.00 ","$995.92 ","$5,688.00 ","$0.00 ","$2,844.00 ","$4,504.90 ","$4,550.40 ","$0.00 ","$890.17 ","$0.00 ","$905.53 ","$0.00 "
"04.503.093","SUP","HCPCS C1713","","04.503.093  -  PLATE BONE 30MM MATRIXNEURO CRNMXF TI CONTUR MESH RGD","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$991.24 ","$0.00 ","$459.11 ","$0.00 ","$0.00 ","$385.68 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$344.73 ","$0.00 ","$350.68 ","$0.00 "
"04.503.094","SUP","HCPCS C1713","","04.503.094  -  PLATE BONE 70MM MATRIXNEURO CRNMXF TI CONTUR MESH RGD","BOTH IP/OP","$4,560.75 ","$3,374.96 ","$0.00 ","$4,560.75 ","$2,052.34 ","$0.00 ","$950.57 ","$0.00 ","$0.00 ","$798.55 ","$4,560.75 ","$0.00 ","$2,280.38 ","$3,612.11 ","$3,648.60 ","$0.00 ","$713.76 ","$0.00 ","$726.07 ","$0.00 "
"04.503.095","SUP","HCPCS C1713","","04.503.095  -  PLATE BONE 100MM MATRIXNEURO .4MM CRNMXF TI CONTUR MESH RGD","BOTH IP/OP","$5,688.00 ","$4,209.12 ","$0.00 ","$5,688.00 ","$2,559.60 ","$0.00 ","$1,185.52 ","$0.00 ","$0.00 ","$995.92 ","$5,688.00 ","$0.00 ","$2,844.00 ","$4,504.90 ","$4,550.40 ","$0.00 ","$890.17 ","$0.00 ","$905.53 ","$0.00 "
"04.503.096","SUP","HCPCS C1713","","04.503.096  -  PLATE SM .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI","BOTH IP/OP","$2,135.25 ","$1,580.09 ","$0.00 ","$2,135.25 ","$960.86 ","$0.00 ","$445.04 ","$0.00 ","$0.00 ","$373.87 ","$2,135.25 ","$0.00 ","$1,067.63 ","$1,691.12 ","$1,708.20 ","$0.00 ","$334.17 ","$0.00 ","$339.93 ","$0.00 "
"04.503.097","SUP","HCPCS C1713","","04.503.097  -  PLATE MED .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI","BOTH IP/OP","$2,416.50 ","$1,788.21 ","$0.00 ","$2,416.50 ","$1,087.43 ","$0.00 ","$503.66 ","$0.00 ","$0.00 ","$423.11 ","$2,416.50 ","$0.00 ","$1,208.25 ","$1,913.87 ","$1,933.20 ","$0.00 ","$378.18 ","$0.00 ","$384.71 ","$0.00 "
"04.503.098","SUP","HCPCS C1713","","04.503.098  -  PLATE LG .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI","BOTH IP/OP","$2,664.00 ","$1,971.36 ","$0.00 ","$2,664.00 ","$1,198.80 ","$0.00 ","$555.24 ","$0.00 ","$0.00 ","$466.45 ","$2,664.00 ","$0.00 ","$1,332.00 ","$2,109.89 ","$2,131.20 ","$0.00 ","$416.92 ","$0.00 ","$424.11 ","$0.00 "
"04.503.103.01","SUP","HCPCS C1713","","04.503.103.01  -  SCREW BONE 3MM MATRIXNEURO CRNMXF TI SLFDRILL NONSTRL","BOTH IP/OP","$217.13 ","$160.68 ","$0.00 ","$217.13 ","$97.71 ","$0.00 ","$45.25 ","$0.00 ","$0.00 ","$38.02 ","$217.13 ","$0.00 ","$108.56 ","$171.97 ","$173.70 ","$0.00 ","$33.98 ","$0.00 ","$34.57 ","$0.00 "
"04.503.104.01","SUP","HCPCS C1713","","04.503.104.01  -  SCREW BN 4MM NS MATRIXNEURO SLF DRL TI CRNMXF","BOTH IP/OP","$217.13 ","$160.68 ","$0.00 ","$217.13 ","$97.71 ","$0.00 ","$45.25 ","$0.00 ","$0.00 ","$38.02 ","$217.13 ","$0.00 ","$108.56 ","$171.97 ","$173.70 ","$0.00 ","$33.98 ","$0.00 ","$34.57 ","$0.00 "
"04.503.105.01","SUP","HCPCS C1713","","04.503.105.01  -  SCREW BN 5MM NS MATRIXNEURO SLF DRL TI CRNMXF","BOTH IP/OP","$217.13 ","$160.68 ","$0.00 ","$217.13 ","$97.71 ","$0.00 ","$45.25 ","$0.00 ","$0.00 ","$38.02 ","$217.13 ","$0.00 ","$108.56 ","$171.97 ","$173.70 ","$0.00 ","$33.98 ","$0.00 ","$34.57 ","$0.00 "
"04.503.113.01","SUP","HCPCS C1713","","04.503.113.01  -  SCREW BONE 3MM MATRIXNEURO CRNMXF TI ER NONSTRL","BOTH IP/OP","$217.13 ","$160.68 ","$0.00 ","$217.13 ","$97.71 ","$0.00 ","$45.25 ","$0.00 ","$0.00 ","$38.02 ","$217.13 ","$0.00 ","$108.56 ","$171.97 ","$173.70 ","$0.00 ","$33.98 ","$0.00 ","$34.57 ","$0.00 "
"04.503.114.01","SUP","HCPCS C1713","","04.503.114.01  -  SCREW BN 4MM NS MATRIXNEURO ER TI CRNMXF","BOTH IP/OP","$217.13 ","$160.68 ","$0.00 ","$217.13 ","$97.71 ","$0.00 ","$45.25 ","$0.00 ","$0.00 ","$38.02 ","$217.13 ","$0.00 ","$108.56 ","$171.97 ","$173.70 ","$0.00 ","$33.98 ","$0.00 ","$34.57 ","$0.00 "
"04.503.115.01","SUP","HCPCS C1713","","04.503.115.01  -  SCREW BONE 5MM MATRIXNEURO CRNMXF TI ER NONSTRL","BOTH IP/OP","$217.13 ","$160.68 ","$0.00 ","$217.13 ","$97.71 ","$0.00 ","$45.25 ","$0.00 ","$0.00 ","$38.02 ","$217.13 ","$0.00 ","$108.56 ","$171.97 ","$173.70 ","$0.00 ","$33.98 ","$0.00 ","$34.57 ","$0.00 "
"04.503.120","SUP","HCPCS C1713","","04.503.120  -  PLATE BONE 45X38MM MATRIXNEURO .6MM CRNMXF TI CONTUR MESH","BOTH IP/OP","$3,831.75 ","$2,835.50 ","$0.00 ","$3,831.75 ","$1,724.29 ","$0.00 ","$798.63 ","$0.00 ","$0.00 ","$670.91 ","$3,831.75 ","$0.00 ","$1,915.88 ","$3,034.75 ","$3,065.40 ","$0.00 ","$599.67 ","$0.00 ","$610.01 ","$0.00 "
"04.503.121","SUP","HCPCS C1713","","04.503.121  -  PLATE 100X100X.6MM TI CONTUR MESH RGD MATRIXNEURO BONE","BOTH IP/OP","$5,964.75 ","$4,413.92 ","$0.00 ","$5,964.75 ","$2,684.14 ","$0.00 ","$1,243.20 ","$0.00 ","$0.00 ","$1,044.38 ","$5,964.75 ","$0.00 ","$2,982.38 ","$4,724.08 ","$4,771.80 ","$0.00 ","$933.48 ","$0.00 ","$949.59 ","$0.00 "
"04.503.122","SUP","Custom 27803010","","04.503.122  -  TI MATRIXNEURO CONTOUR MESH 200MM X 200MM/0.6MM RIGID","BOTH IP/OP","$22,842.00 ","$16,903.08 ","$0.00 ","$22,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,842.00 ","$0.00 ","$11,421.00 ","$18,090.86 ","$18,273.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.123","SUP","Custom 27803010","","04.503.123  -  TI MATRIXNEURO CONTOUR MESH SMALL ARC/0.6MM RIGID","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.124","SUP","Custom 27803010","","04.503.124  -  TI MATRIXNEURO CONTOUR MESH LARGE ARC/0.6MM RIGID","BOTH IP/OP","$3,433.50 ","$2,540.79 ","$0.00 ","$3,433.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,433.50 ","$0.00 ","$1,716.75 ","$2,719.33 ","$2,746.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.125","SUP","HCPCS C1713","","04.503.125  -  PLATE BONE PNK .6MM 30MM MATRIXNEURO TI CONTUR MESH RGD","BOTH IP/OP","$2,202.75 ","$1,630.04 ","$0.00 ","$2,202.75 ","$991.24 ","$0.00 ","$459.11 ","$0.00 ","$0.00 ","$385.68 ","$2,202.75 ","$0.00 ","$1,101.38 ","$1,744.58 ","$1,762.20 ","$0.00 ","$344.73 ","$0.00 ","$350.68 ","$0.00 "
"04.503.126","SUP","HCPCS C1713","","04.503.126  -  PLATE BONE PNK .6MM 70MM MATRIXNEURO TI CONTUR MESH RGD","BOTH IP/OP","$4,560.75 ","$3,374.96 ","$0.00 ","$4,560.75 ","$2,052.34 ","$0.00 ","$950.57 ","$0.00 ","$0.00 ","$798.55 ","$4,560.75 ","$0.00 ","$2,280.38 ","$3,612.11 ","$3,648.60 ","$0.00 ","$713.76 ","$0.00 ","$726.07 ","$0.00 "
"04.503.127","SUP","Custom 27803010","","04.503.127  -  TI MATRIXNEURO CONTOUR MESH 100MM DIA/0.6MM RIGID","BOTH IP/OP","$5,688.00 ","$4,209.12 ","$0.00 ","$5,688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,688.00 ","$0.00 ","$2,844.00 ","$4,504.90 ","$4,550.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.131S","SUP","Custom 27803010","","04.503.131S  -  KIT SCR MATRIXNEURO 4MM STD RTU LP RPD INS CRANIAL BONE FLP","BOTH IP/OP","$1,842.75 ","$1,363.64 ","$0.00 ","$1,842.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,842.75 ","$0.00 ","$921.38 ","$1,459.46 ","$1,474.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.134S","SUP","Custom 27803010","","04.503.134S  -  MATRIXNEURO STERILE KIT 17MM BURR HOLE COVER/4MM","BOTH IP/OP","$2,781.00 ","$2,057.94 ","$0.00 ","$2,781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,781.00 ","$0.00 ","$1,390.50 ","$2,202.55 ","$2,224.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.503.203.01","SUP","HCPCS C1713","","04.503.203.01  -  SCREW TI 3MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.204.01","SUP","HCPCS C1713","","04.503.204.01  -  SCREW TI 4MM SLFTAP ER BONE MTRXMDFACE BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.205.01","SUP","HCPCS C1713","","04.503.205.01  -  SCREW TI 5MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.206.01","SUP","HCPCS C1713","","04.503.206.01  -  SCREW TI 6MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.208.01","SUP","HCPCS C1713","","04.503.208.01  -  SCREW TI BRNZ 8MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.210.01","SUP","HCPCS C1713","","04.503.210.01  -  SCREW TI 10MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.212.01","SUP","HCPCS C1713","","04.503.212.01  -  SCREW TI 12MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.214.01","SUP","HCPCS C1713","","04.503.214.01  -  SCREW TI 14MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.216.01","SUP","HCPCS C1713","","04.503.216.01  -  SCREW TI 16MM MIDFAC SLFTAP BONE NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.218.01","SUP","HCPCS C1713","","04.503.218.01  -  TI MATRIXMIDFACE SCREW SELF-TAPPING 18MM","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.223.01","SUP","HCPCS C1713","","04.503.223.01  -  SCREW BONE SLVR 3MM MTRXMDFACE CRNMXF TI SLFDRILL NONSTRL","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.224","SUP","HCPCS C1713","","04.503.224  -  SCREW TI 4MM CRNMXF ORBTL FLR SLFDRILL BONE MTRX MIDFAC","BOTH IP/OP","$164.25 ","$121.55 ","$0.00 ","$164.25 ","$73.91 ","$0.00 ","$34.23 ","$0.00 ","$0.00 ","$28.76 ","$164.25 ","$0.00 ","$82.13 ","$130.09 ","$131.40 ","$0.00 ","$25.71 ","$0.00 ","$26.15 ","$0.00 "
"04.503.224.01","SUP","HCPCS C1713","","04.503.224.01  -  SCREW TI 4MM 1.5MM MIDFAC SLFDRILL BONE MTRXMDFACE NONSTRL","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.225","SUP","HCPCS C1713","","04.503.225  -  SCREW TI 5MM MIDFAC BONE MTRXMDFACE NONSTRL","BOTH IP/OP","$164.25 ","$121.55 ","$0.00 ","$164.25 ","$73.91 ","$0.00 ","$34.23 ","$0.00 ","$0.00 ","$28.76 ","$164.25 ","$0.00 ","$82.13 ","$130.09 ","$131.40 ","$0.00 ","$25.71 ","$0.00 ","$26.15 ","$0.00 "
"04.503.225.01","SUP","HCPCS C1713","","04.503.225.01  -  SCREW TI 5MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.226","SUP","HCPCS C1713","","04.503.226  -  SCREW TI 6MM CRNMXF ORBTL FLR SLFDRILL BONE MTRXMDFACE","BOTH IP/OP","$164.25 ","$121.55 ","$0.00 ","$164.25 ","$73.91 ","$0.00 ","$34.23 ","$0.00 ","$0.00 ","$28.76 ","$164.25 ","$0.00 ","$82.13 ","$130.09 ","$131.40 ","$0.00 ","$25.71 ","$0.00 ","$26.15 ","$0.00 "
"04.503.226.01","SUP","HCPCS C1713","","04.503.226.01  -  SCREW TI 6MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.228.01","SUP","HCPCS C1713","","04.503.228.01  -  SCREW TI 8MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.233.01","SUP","HCPCS C1713","","04.503.233.01  -  SCREW TI 3MM ER BONE MTRXMDFACE LBLU","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.234.01","SUP","HCPCS C1713","","04.503.234.01  -  SCREW_ TI MATRIXMIDFACE EMERGENCY  4MM","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.235.01","SUP","HCPCS C1713","","04.503.235.01  -  SCREW TI 5MM 1.5MM ORBTL FLR ER BONE MTRXMDFACE NONSTRL LBLU","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.236.01","SUP","HCPCS C1713","","04.503.236.01  -  SCREW TI 6MM 1.5MM ORBTL FLR ER BONE MTRXMDFACE NONSTRL","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.238.01","SUP","HCPCS C1713","","04.503.238.01  -  SCREW TI 8MM ER BONE MTRXMDFACE NONSTRL","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.240.01","SUP","HCPCS C1713","","04.503.240.01  -  SCREW TI 10MM ER BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.242.01","SUP","HCPCS C1713","","04.503.242.01  -  SCREW TI 12MM ER BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.244.01","SUP","HCPCS C1713","","04.503.244.01  -  SCREW TI 14MM ER BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.246.01","SUP","HCPCS C1713","","04.503.246.01  -  SCREW TI 16MM ER BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.248.01","SUP","HCPCS C1713","","04.503.248.01  -  SCREW TI 18MM ER BONE MTRXMDFACE","BOTH IP/OP","$218.25 ","$161.51 ","$0.00 ","$218.25 ","$98.21 ","$0.00 ","$45.49 ","$0.00 ","$0.00 ","$38.21 ","$218.25 ","$0.00 ","$109.13 ","$172.85 ","$174.60 ","$0.00 ","$34.16 ","$0.00 ","$34.75 ","$0.00 "
"04.503.301","SUP","HCPCS C1713","","04.503.301  -  PLATE BN SM .3MM NS MATRIXMIDFACE TI ORBT FLR","BOTH IP/OP","$3,201.75 ","$2,369.30 ","$0.00 ","$3,201.75 ","$1,440.79 ","$0.00 ","$667.32 ","$0.00 ","$0.00 ","$560.60 ","$3,201.75 ","$0.00 ","$1,600.88 ","$2,535.79 ","$2,561.40 ","$0.00 ","$501.07 ","$0.00 ","$509.72 ","$0.00 "
"04.503.302","SUP","HCPCS C1713","","04.503.302  -  PLATE BN MED .3MM NS MATRIXMIDFACE TI ORBT FLR","BOTH IP/OP","$3,201.75 ","$2,369.30 ","$0.00 ","$3,201.75 ","$1,440.79 ","$0.00 ","$667.32 ","$0.00 ","$0.00 ","$560.60 ","$3,201.75 ","$0.00 ","$1,600.88 ","$2,535.79 ","$2,561.40 ","$0.00 ","$501.07 ","$0.00 ","$509.72 ","$0.00 "
"04.503.303","SUP","HCPCS C1713","","04.503.303  -  PLATE BN LG .3MM NS MATRIXMIDFACE TI ORBT FLR","BOTH IP/OP","$3,201.75 ","$2,369.30 ","$0.00 ","$3,201.75 ","$1,440.79 ","$0.00 ","$667.32 ","$0.00 ","$0.00 ","$560.60 ","$3,201.75 ","$0.00 ","$1,600.88 ","$2,535.79 ","$2,561.40 ","$0.00 ","$501.07 ","$0.00 ","$509.72 ","$0.00 "
"04.503.304","SUP","HCPCS C1713","","04.503.304  -  PLATE BN UNV .4MM NS MATRIXMIDFACE TI ORBT FLR","BOTH IP/OP","$3,201.75 ","$2,369.30 ","$0.00 ","$3,201.75 ","$1,440.79 ","$0.00 ","$667.32 ","$0.00 ","$0.00 ","$560.60 ","$3,201.75 ","$0.00 ","$1,600.88 ","$2,535.79 ","$2,561.40 ","$0.00 ","$501.07 ","$0.00 ","$509.72 ","$0.00 "
"04.503.305","SUP","HCPCS C1713","","04.503.305  -  PLATE BN UNV .5MM NS MATRIXMIDFACE TI ORBT FLR MDL WL","BOTH IP/OP","$3,201.75 ","$2,369.30 ","$0.00 ","$3,201.75 ","$1,440.79 ","$0.00 ","$667.32 ","$0.00 ","$0.00 ","$560.60 ","$3,201.75 ","$0.00 ","$1,600.88 ","$2,535.79 ","$2,561.40 ","$0.00 ","$501.07 ","$0.00 ","$509.72 ","$0.00 "
"04.503.306","SUP","HCPCS C1713","","04.503.306  -  PLATE BN .2MM NS MATRIXMIDFACE MESH TI ORBT FLR","BOTH IP/OP","$3,323.25 ","$2,459.21 ","$0.00 ","$3,323.25 ","$1,495.46 ","$0.00 ","$692.65 ","$0.00 ","$0.00 ","$581.87 ","$3,323.25 ","$0.00 ","$1,661.63 ","$2,632.01 ","$2,658.60 ","$0.00 ","$520.09 ","$0.00 ","$529.06 ","$0.00 "
"04.503.307","SUP","HCPCS C1713","","04.503.307  -  PLATE BN .3MM NS MATRIXMIDFACE MESH TI ORBT FLR","BOTH IP/OP","$3,323.25 ","$2,459.21 ","$0.00 ","$3,323.25 ","$1,495.46 ","$0.00 ","$692.65 ","$0.00 ","$0.00 ","$581.87 ","$3,323.25 ","$0.00 ","$1,661.63 ","$2,632.01 ","$2,658.60 ","$0.00 ","$520.09 ","$0.00 ","$529.06 ","$0.00 "
"04.503.308","SUP","HCPCS C1713","","04.503.308  -  PLATE BN .4MM NS MATRIXMIDFACE MESH TI ORBT FLR","BOTH IP/OP","$3,323.25 ","$2,459.21 ","$0.00 ","$3,323.25 ","$1,495.46 ","$0.00 ","$692.65 ","$0.00 ","$0.00 ","$581.87 ","$3,323.25 ","$0.00 ","$1,661.63 ","$2,632.01 ","$2,658.60 ","$0.00 ","$520.09 ","$0.00 ","$529.06 ","$0.00 "
"04.503.313","SUP","HCPCS C1713","","04.503.313  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 12 HL TI ORBT RIM","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$927.00 ","$417.15 ","$0.00 ","$193.21 ","$0.00 ","$0.00 ","$162.31 ","$927.00 ","$0.00 ","$463.50 ","$734.18 ","$741.60 ","$0.00 ","$145.08 ","$0.00 ","$147.58 ","$0.00 "
"04.503.314","SUP","HCPCS C1713","","04.503.314  -  PLATE BONE .4MM MTRXMDFACE CRNMXF TI 6 HOLE ADP NONSTRL","BOTH IP/OP","$679.50 ","$502.83 ","$0.00 ","$679.50 ","$305.78 ","$0.00 ","$141.62 ","$0.00 ","$0.00 ","$118.98 ","$679.50 ","$0.00 ","$339.75 ","$538.16 ","$543.60 ","$0.00 ","$106.34 ","$0.00 ","$108.18 ","$0.00 "
"04.503.315","SUP","HCPCS C1713","","04.503.315  -  PLATE BN STD MIC .4MM SLVR NS MATRIXMIDFACE 8 HL ADP TI MDFC","BOTH IP/OP","$841.50 ","$622.71 ","$0.00 ","$841.50 ","$378.68 ","$0.00 ","$175.39 ","$0.00 ","$0.00 ","$147.34 ","$841.50 ","$0.00 ","$420.75 ","$666.47 ","$673.20 ","$0.00 ","$131.69 ","$0.00 ","$133.97 ","$0.00 "
"04.503.316","SUP","HCPCS C1713","","04.503.316  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 20 HL ADP TI MDFC","BOTH IP/OP","$1,680.75 ","$1,243.76 ","$0.00 ","$1,680.75 ","$756.34 ","$0.00 ","$350.31 ","$0.00 ","$0.00 ","$294.29 ","$1,680.75 ","$0.00 ","$840.38 ","$1,331.15 ","$1,344.60 ","$0.00 ","$263.04 ","$0.00 ","$267.58 ","$0.00 "
"04.503.317","SUP","HCPCS C1713","","04.503.317  -  PLATE BN STD MIC Y .4MM NS MATRIXMIDFACE 1X3 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.318","SUP","HCPCS C1713","","04.503.318  -  PLATE BN STD MIC 2Y .4MM NS MATRIXMIDFACE 6 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.322","SUP","HCPCS C1713","","04.503.322  -  PLATE BN STD MN H .5MM NS MATRIXMIDFACE 11 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.323","SUP","HCPCS C1713","","04.503.323  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.324","SUP","HCPCS C1713","","04.503.324  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.325","SUP","HCPCS C1713","","04.503.325  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.326","SUP","HCPCS C1713","","04.503.326  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.327","SUP","HCPCS C1713","","04.503.327  -  PLATE BN STD MN T .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.330","SUP","HCPCS C1713","","04.503.330  -  PLATE BN STD MIC BX 10X5X.4MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.331","SUP","HCPCS C1713","","04.503.331  -  PLATE BN STD MN BX 10X10X.4MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.332","SUP","HCPCS C1713","","04.503.332  -  PLATE BN STD MIC X .4MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.333","SUP","HCPCS C1713","","04.503.333  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC","BOTH IP/OP","$1,599.75 ","$1,183.82 ","$0.00 ","$1,599.75 ","$719.89 ","$0.00 ","$333.43 ","$0.00 ","$0.00 ","$280.10 ","$1,599.75 ","$0.00 ","$799.88 ","$1,267.00 ","$1,279.80 ","$0.00 ","$250.36 ","$0.00 ","$254.68 ","$0.00 "
"04.503.334","SUP","HCPCS C1713","","04.503.334  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC","BOTH IP/OP","$803.25 ","$594.41 ","$0.00 ","$803.25 ","$361.46 ","$0.00 ","$167.42 ","$0.00 ","$0.00 ","$140.64 ","$803.25 ","$0.00 ","$401.63 ","$636.17 ","$642.60 ","$0.00 ","$125.71 ","$0.00 ","$127.88 ","$0.00 "
"04.503.335","SUP","HCPCS C1713","","04.503.335  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC","BOTH IP/OP","$803.25 ","$594.41 ","$0.00 ","$803.25 ","$361.46 ","$0.00 ","$167.42 ","$0.00 ","$0.00 ","$140.64 ","$803.25 ","$0.00 ","$401.63 ","$636.17 ","$642.60 ","$0.00 ","$125.71 ","$0.00 ","$127.88 ","$0.00 "
"04.503.343","SUP","HCPCS C1713","","04.503.343  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 12 HL TI ORBT RIM","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$927.00 ","$417.15 ","$0.00 ","$193.21 ","$0.00 ","$0.00 ","$162.31 ","$927.00 ","$0.00 ","$463.50 ","$734.18 ","$741.60 ","$0.00 ","$145.08 ","$0.00 ","$147.58 ","$0.00 "
"04.503.344","SUP","HCPCS C1713","","04.503.344  -  PLATE .5MM ORBTL RIM 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL","BOTH IP/OP","$679.50 ","$502.83 ","$0.00 ","$679.50 ","$305.78 ","$0.00 ","$141.62 ","$0.00 ","$0.00 ","$118.98 ","$679.50 ","$0.00 ","$339.75 ","$538.16 ","$543.60 ","$0.00 ","$106.34 ","$0.00 ","$108.18 ","$0.00 "
"04.503.345","SUP","HCPCS C1713","","04.503.345  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 8 HL ADP TI MDFC","BOTH IP/OP","$841.50 ","$622.71 ","$0.00 ","$841.50 ","$378.68 ","$0.00 ","$175.39 ","$0.00 ","$0.00 ","$147.34 ","$841.50 ","$0.00 ","$420.75 ","$666.47 ","$673.20 ","$0.00 ","$131.69 ","$0.00 ","$133.97 ","$0.00 "
"04.503.346","SUP","HCPCS C1713","","04.503.346  -  PLATE BONE BLUE .5MM MTRXMDFACE CRNMXF TI 20 HOLE ADP","BOTH IP/OP","$1,680.75 ","$1,243.76 ","$0.00 ","$1,494.00 ","$672.30 ","$0.00 ","$350.31 ","$0.00 ","$0.00 ","$261.59 ","$1,494.00 ","$0.00 ","$747.00 ","$1,183.25 ","$1,195.20 ","$0.00 ","$233.81 ","$0.00 ","$237.84 ","$0.00 "
"04.503.347","SUP","HCPCS C1713","","04.503.347  -  PLATE BN STD MN Y .5MM NS MATRIXMIDFACE 1X3 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.348","SUP","HCPCS C1713","","04.503.348  -  PLATE BN STD MN 2Y .5MM NS MATRIXMIDFACE 6 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.352","SUP","HCPCS C1713","","04.503.352  -  PLATE BN STD MED H .7MM NS MATRIXMIDFACE 11 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.353","SUP","HCPCS C1713","","04.503.353  -  PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.354","SUP","HCPCS C1713","","04.503.354  -  PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.355","SUP","HCPCS C1713","","04.503.355  -  PLATE BN STD MN OB L L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.356","SUP","HCPCS C1713","","04.503.356  -  PLATE BN STD MN OB R L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.357","SUP","HCPCS C1713","","04.503.357  -  PLATE BN STD MED T .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.360","SUP","HCPCS C1713","","04.503.360  -  PLATE BN STD MN BX 10X5X.5MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.361","SUP","HCPCS C1713","","04.503.361  -  PLATE BN STD MN BX 10X10X.5MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.362","SUP","HCPCS C1713","","04.503.362  -  PLATE BN STD MN X .5MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.363","SUP","HCPCS C1713","","04.503.363  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC","BOTH IP/OP","$1,599.75 ","$1,183.82 ","$0.00 ","$1,599.75 ","$719.89 ","$0.00 ","$333.43 ","$0.00 ","$0.00 ","$280.10 ","$1,599.75 ","$0.00 ","$799.88 ","$1,267.00 ","$1,279.80 ","$0.00 ","$250.36 ","$0.00 ","$254.68 ","$0.00 "
"04.503.364","SUP","HCPCS C1713","","04.503.364  -  PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC","BOTH IP/OP","$803.25 ","$594.41 ","$0.00 ","$803.25 ","$361.46 ","$0.00 ","$167.42 ","$0.00 ","$0.00 ","$140.64 ","$803.25 ","$0.00 ","$401.63 ","$636.17 ","$642.60 ","$0.00 ","$125.71 ","$0.00 ","$127.88 ","$0.00 "
"04.503.365","SUP","HCPCS C1713","","04.503.365  -  PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC","BOTH IP/OP","$803.25 ","$594.41 ","$0.00 ","$803.25 ","$361.46 ","$0.00 ","$167.42 ","$0.00 ","$0.00 ","$140.64 ","$803.25 ","$0.00 ","$401.63 ","$636.17 ","$642.60 ","$0.00 ","$125.71 ","$0.00 ","$127.88 ","$0.00 "
"04.503.373","SUP","HCPCS C1713","","04.503.373  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 12 HL TI ORBT RIM","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$927.00 ","$417.15 ","$0.00 ","$193.21 ","$0.00 ","$0.00 ","$162.31 ","$927.00 ","$0.00 ","$463.50 ","$734.18 ","$741.60 ","$0.00 ","$145.08 ","$0.00 ","$147.58 ","$0.00 "
"04.503.374","SUP","HCPCS C1713","","04.503.374  -  PLATE .7MM CRANFCL 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL","BOTH IP/OP","$679.50 ","$502.83 ","$0.00 ","$679.50 ","$305.78 ","$0.00 ","$141.62 ","$0.00 ","$0.00 ","$118.98 ","$679.50 ","$0.00 ","$339.75 ","$538.16 ","$543.60 ","$0.00 ","$106.34 ","$0.00 ","$108.18 ","$0.00 "
"04.503.375","SUP","HCPCS C1713","","04.503.375  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 8 HL ADP TI MDFC","BOTH IP/OP","$841.50 ","$622.71 ","$0.00 ","$841.50 ","$378.68 ","$0.00 ","$175.39 ","$0.00 ","$0.00 ","$147.34 ","$841.50 ","$0.00 ","$420.75 ","$666.47 ","$673.20 ","$0.00 ","$131.69 ","$0.00 ","$133.97 ","$0.00 "
"04.503.376","SUP","HCPCS C1713","","04.503.376  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 20 HL ADP TI MDFC","BOTH IP/OP","$1,680.75 ","$1,243.76 ","$0.00 ","$1,680.75 ","$756.34 ","$0.00 ","$350.31 ","$0.00 ","$0.00 ","$294.29 ","$1,680.75 ","$0.00 ","$840.38 ","$1,331.15 ","$1,344.60 ","$0.00 ","$263.04 ","$0.00 ","$267.58 ","$0.00 "
"04.503.377","SUP","HCPCS C1713","","04.503.377  -  PLATE BN STD MED Y .7MM NS MATRIXMIDFACE 1X3 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.378","SUP","HCPCS C1713","","04.503.378  -  PLATE BN STD MED 2Y .7MM NS MATRIXMIDFACE 6 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.382","SUP","HCPCS C1713","","04.503.382  -  PLATE BN STD LG H .8MM NS MATRIXMIDFACE 11 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.383","SUP","HCPCS C1713","","04.503.383  -  PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.384","SUP","HCPCS C1713","","04.503.384  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.385","SUP","HCPCS C1713","","04.503.385  -  PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.386","SUP","HCPCS C1713","","04.503.386  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.387","SUP","HCPCS C1713","","04.503.387  -  PLATE BN STD LG T .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"04.503.390","SUP","HCPCS C1713","","04.503.390  -  PLATE BN STD MED BX 10X5X.7MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.391","SUP","HCPCS C1713","","04.503.391  -  PLATE BN STD MED BX 10X10X.7MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$758.25 ","$561.11 ","$0.00 ","$758.25 ","$341.21 ","$0.00 ","$158.04 ","$0.00 ","$0.00 ","$132.76 ","$758.25 ","$0.00 ","$379.13 ","$600.53 ","$606.60 ","$0.00 ","$118.67 ","$0.00 ","$120.71 ","$0.00 "
"04.503.392","SUP","HCPCS C1713","","04.503.392  -  PLATE BN STD MED X .7MM NS MATRIXMIDFACE 4 HL TI MDFC","BOTH IP/OP","$747.00 ","$552.78 ","$0.00 ","$747.00 ","$336.15 ","$0.00 ","$155.69 ","$0.00 ","$0.00 ","$130.79 ","$747.00 ","$0.00 ","$373.50 ","$591.62 ","$597.60 ","$0.00 ","$116.91 ","$0.00 ","$118.92 ","$0.00 "
"04.503.393","SUP","HCPCS C1713","","04.503.393  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC","BOTH IP/OP","$1,599.75 ","$1,183.82 ","$0.00 ","$1,599.75 ","$719.89 ","$0.00 ","$333.43 ","$0.00 ","$0.00 ","$280.10 ","$1,599.75 ","$0.00 ","$799.88 ","$1,267.00 ","$1,279.80 ","$0.00 ","$250.36 ","$0.00 ","$254.68 ","$0.00 "
"04.503.394","SUP","HCPCS C1713","","04.503.394  -  PLATE BN L OB L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC","BOTH IP/OP","$803.25 ","$594.41 ","$0.00 ","$803.25 ","$361.46 ","$0.00 ","$167.42 ","$0.00 ","$0.00 ","$140.64 ","$803.25 ","$0.00 ","$401.63 ","$636.17 ","$642.60 ","$0.00 ","$125.71 ","$0.00 ","$127.88 ","$0.00 "
"04.503.395","SUP","HCPCS C1713","","04.503.395  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC","BOTH IP/OP","$803.25 ","$594.41 ","$0.00 ","$803.25 ","$361.46 ","$0.00 ","$167.42 ","$0.00 ","$0.00 ","$140.64 ","$803.25 ","$0.00 ","$401.63 ","$636.17 ","$642.60 ","$0.00 ","$125.71 ","$0.00 ","$127.88 ","$0.00 "
"04.503.396","SUP","HCPCS C1713","","04.503.396  -  PLATE BN LG .8MM NS MATRIXMIDFACE 20 HL ADP TI MDFC","BOTH IP/OP","$1,680.75 ","$1,243.76 ","$0.00 ","$1,680.75 ","$756.34 ","$0.00 ","$350.31 ","$0.00 ","$0.00 ","$294.29 ","$1,680.75 ","$0.00 ","$840.38 ","$1,331.15 ","$1,344.60 ","$0.00 ","$263.04 ","$0.00 ","$267.58 ","$0.00 "
"04.503.397","SUP","HCPCS C1713","","04.503.397  -  PLATE BONE .8MM MTRXMDFACE ORBTL RIM TI 12 HOLE NONSTRL","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$927.00 ","$417.15 ","$0.00 ","$193.21 ","$0.00 ","$0.00 ","$162.31 ","$927.00 ","$0.00 ","$463.50 ","$734.18 ","$741.60 ","$0.00 ","$145.08 ","$0.00 ","$147.58 ","$0.00 "
"04.503.398","SUP","HCPCS C1713","","04.503.398  -  PLATE .8MM ORBTL RIM 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL","BOTH IP/OP","$679.50 ","$502.83 ","$0.00 ","$679.50 ","$305.78 ","$0.00 ","$141.62 ","$0.00 ","$0.00 ","$118.98 ","$679.50 ","$0.00 ","$339.75 ","$538.16 ","$543.60 ","$0.00 ","$106.34 ","$0.00 ","$108.18 ","$0.00 "
"04.503.399","SUP","HCPCS C1713","","04.503.399  -  PLATE .8MM ORBTL RIM 8 HOLE ADP BONE MTRXMDFACE TI NONSTRL","BOTH IP/OP","$841.50 ","$622.71 ","$0.00 ","$841.50 ","$378.68 ","$0.00 ","$175.39 ","$0.00 ","$0.00 ","$147.34 ","$841.50 ","$0.00 ","$420.75 ","$666.47 ","$673.20 ","$0.00 ","$131.69 ","$0.00 ","$133.97 ","$0.00 "
"04.503.405.01","SUP","HCPCS C1713","","04.503.405.01  -  SCREW BONE 5MM 2MM MTRXMAND CRNMXF TI SLFTAP NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.406","SUP","HCPCS C1713","","04.503.406  -  SCREW TI 6MM 2MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$60.75 ","$0.00 ","$28.14 ","$0.00 ","$0.00 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"04.503.406.01","SUP","HCPCS C1713","","04.503.406.01  -  SCREW TI 6MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.408","SUP","HCPCS C1713","","04.503.408  -  SCREW TI 8MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$60.75 ","$0.00 ","$28.14 ","$0.00 ","$0.00 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"04.503.408.01","SUP","HCPCS C1713","","04.503.408.01  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.408.01E","SUP","HCPCS C1713","","04.503.408.01E  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$60.75 ","$0.00 ","$28.14 ","$0.00 ","$0.00 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"04.503.410.01","SUP","HCPCS C1713","","04.503.410.01  -  SCREW TI 10MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.412","SUP","HCPCS C1713","","04.503.412  -  SCREW TI 12MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$60.75 ","$0.00 ","$28.14 ","$0.00 ","$0.00 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"04.503.412.01","SUP","HCPCS C1713","","04.503.412.01  -  SCREW TI 12MM 2MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.414.01","SUP","HCPCS C1713","","04.503.414.01  -  SCREW TI 14MM 2MM MANDIB SLFTAP BONE MTRX","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.416.01","SUP","HCPCS C1713","","04.503.416.01  -  SCREW TI 16MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.418.01","SUP","HCPCS C1713","","04.503.418.01  -  SCREW TI 18MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$168.75 ","$124.88 ","$0.00 ","$168.75 ","$75.94 ","$0.00 ","$35.17 ","$0.00 ","$0.00 ","$29.55 ","$168.75 ","$0.00 ","$84.38 ","$133.65 ","$135.00 ","$0.00 ","$26.41 ","$0.00 ","$26.87 ","$0.00 "
"04.503.435.01","SUP","HCPCS C1713","","04.503.435.01  -  SCREW TI 5MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.436.01","SUP","HCPCS C1713","","04.503.436.01  -  SCREW TI 6MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.438.01","SUP","HCPCS C1713","","04.503.438.01  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.440.01","SUP","HCPCS C1713","","04.503.440.01  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.442.01","SUP","HCPCS C1713","","04.503.442.01  -  SCREW TI 12MM 2.4MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.444","SUP","HCPCS C1713","","04.503.444  -  SCREW TI 14MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$193.50 ","$143.19 ","$0.00 ","$193.50 ","$87.08 ","$0.00 ","$40.33 ","$0.00 ","$0.00 ","$33.88 ","$193.50 ","$0.00 ","$96.75 ","$153.25 ","$154.80 ","$0.00 ","$30.28 ","$0.00 ","$30.81 ","$0.00 "
"04.503.444.01","SUP","HCPCS C1713","","04.503.444.01  -  SCREW BONE 14MM 2.4MM MTRXMAND CRNMXF TI SLFTAP NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.446","SUP","HCPCS C1713","","04.503.446  -  SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$193.50 ","$143.19 ","$0.00 ","$193.50 ","$87.08 ","$0.00 ","$40.33 ","$0.00 ","$0.00 ","$33.88 ","$193.50 ","$0.00 ","$96.75 ","$153.25 ","$154.80 ","$0.00 ","$30.28 ","$0.00 ","$30.81 ","$0.00 "
"04.503.446.01","SUP","HCPCS C1713","","04.503.446.01  -  SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.448.01","SUP","HCPCS C1713","","04.503.448.01  -  SCREW TI 18MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$243.00 ","$179.82 ","$0.00 ","$243.00 ","$109.35 ","$0.00 ","$50.65 ","$0.00 ","$0.00 ","$42.55 ","$243.00 ","$0.00 ","$121.50 ","$192.46 ","$194.40 ","$0.00 ","$38.03 ","$0.00 ","$38.69 ","$0.00 "
"04.503.465.01","SUP","HCPCS C1713","","04.503.465.01  -  SCREW TI 5MM 2.7MM SLFTAP BONE MTRXMAND NONSTRL ER","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.466.01","SUP","HCPCS C1713","","04.503.466.01  -  SCREW TI 6MM 2.7MM ER SLFTAP BONE MTRXMAND","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.468","SUP","HCPCS C1713","","04.503.468  -  SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.468.01","SUP","HCPCS C1713","","04.503.468.01  -  SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.470","SUP","HCPCS C1713","","04.503.470  -  SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.503.470.01","SUP","HCPCS C1713","","04.503.470.01  -  SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.472.01","SUP","HCPCS C1713","","04.503.472.01  -  SCREW TI 12MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.474.01","SUP","HCPCS C1713","","04.503.474.01  -  SCREW TI 14MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.476.01","SUP","HCPCS C1713","","04.503.476.01  -  SCREW TI 16MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.478.01","SUP","HCPCS C1713","","04.503.478.01  -  SCREW TI 18MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$119.48 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$46.49 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$41.55 ","$0.00 ","$42.27 ","$0.00 "
"04.503.506.01","SUP","HCPCS C1713","","04.503.506.01  -  SCREW TI 6MM 2MM MANDIB SLFDRILL MTRX BONE MTRXMAND NONSTRL","BOTH IP/OP","$187.88 ","$139.03 ","$0.00 ","$187.88 ","$84.54 ","$0.00 ","$39.16 ","$0.00 ","$0.00 ","$32.90 ","$187.88 ","$0.00 ","$93.94 ","$148.80 ","$150.30 ","$0.00 ","$29.40 ","$0.00 ","$29.91 ","$0.00 "
"04.503.508.01","SUP","HCPCS C1713","","04.503.508.01  -  SCREW TI 8MM 2MM MANDIB SLFDRILL MTRX BONE MTRXMAND NONSTRL","BOTH IP/OP","$187.88 ","$139.03 ","$0.00 ","$187.88 ","$84.54 ","$0.00 ","$39.16 ","$0.00 ","$0.00 ","$32.90 ","$187.88 ","$0.00 ","$93.94 ","$148.80 ","$150.30 ","$0.00 ","$29.40 ","$0.00 ","$29.91 ","$0.00 "
"04.503.546.01","SUP","HCPCS C1713","","04.503.546.01  -  SCREW BONE 6MM 2MM MTRXMAND CRNMXF TI LCK SLFDRILL NONSTRL","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$145.80 ","$0.00 ","$67.53 ","$0.00 ","$0.00 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"04.503.548.01","SUP","HCPCS C1713","","04.503.548.01  -  SCREW BONE 8MM 2MM MTRXMAND CRNMXF TI LCK SLFDRILL NONSTRL","BOTH IP/OP","$324.00 ","$239.76 ","$0.00 ","$324.00 ","$145.80 ","$0.00 ","$67.53 ","$0.00 ","$0.00 ","$56.73 ","$324.00 ","$0.00 ","$162.00 ","$256.61 ","$259.20 ","$0.00 ","$50.71 ","$0.00 ","$51.58 ","$0.00 "
"04.503.605","SUP","HCPCS C1713","","04.503.605  -  SCREW TI 5MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.605.01","SUP","HCPCS C1713","","04.503.605.01  -  SCREW TI 5MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.606.01","SUP","HCPCS C1713","","04.503.606.01  -  SCREW TI 6MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.608","SUP","HCPCS C1713","","04.503.608  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.608.01","SUP","HCPCS C1713","","04.503.608.01  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.608.01E","SUP","HCPCS C1713","","04.503.608.01E  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.610","SUP","HCPCS C1713","","04.503.610  -  SCREW TI 10MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.610.01","SUP","HCPCS C1713","","04.503.610.01  -  SCREW TI 10MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.612","SUP","HCPCS C1713","","04.503.612  -  SCREW TI 12MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.612.01","SUP","HCPCS C1713","","04.503.612.01  -  SCREW BONE 2MM 12MM TI MAXFACL SLFTAP LCK NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.614","SUP","HCPCS C1713","","04.503.614  -  SCREW TI 14MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.614.01","SUP","HCPCS C1713","","04.503.614.01  -  SCREW BONE 2MM 14MM TI MAXFACL SLFTAP LCK NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.616","SUP","HCPCS C1713","","04.503.616  -  SCREW TI 16MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$252.00 ","$186.48 ","$0.00 ","$252.00 ","$113.40 ","$0.00 ","$52.52 ","$0.00 ","$0.00 ","$44.12 ","$252.00 ","$0.00 ","$126.00 ","$199.58 ","$201.60 ","$0.00 ","$39.44 ","$0.00 ","$40.12 ","$0.00 "
"04.503.616.01","SUP","HCPCS C1713","","04.503.616.01  -  SCREW TI 16MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.618.01","SUP","HCPCS C1713","","04.503.618.01  -  SCREW TI 18MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$317.25 ","$234.77 ","$0.00 ","$317.25 ","$142.76 ","$0.00 ","$66.12 ","$0.00 ","$0.00 ","$55.55 ","$317.25 ","$0.00 ","$158.63 ","$251.26 ","$253.80 ","$0.00 ","$49.65 ","$0.00 ","$50.51 ","$0.00 "
"04.503.638.01","SUP","HCPCS C1713","","04.503.638.01  -  SCREW TI 8MM 2.4MM MIDFAC SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"04.503.640","SUP","HCPCS C1713","","04.503.640  -  SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"04.503.640.01","SUP","HCPCS C1713","","04.503.640.01  -  SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"04.503.642.01","SUP","HCPCS C1713","","04.503.642.01  -  SCREW TI 12MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"04.503.644","SUP","HCPCS C1713","","04.503.644  -  SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"04.503.644.01","SUP","HCPCS C1713","","04.503.644.01  -  SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"04.503.646","SUP","HCPCS C1713","","04.503.646  -  SCREW TI 16MM 2.4MM LCK SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$139.73 ","$0.00 ","$64.72 ","$0.00 ","$0.00 ","$54.37 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$48.59 ","$0.00 ","$49.43 ","$0.00 "
"04.503.646.01","SUP","HCPCS C1713","","04.503.646.01  -  SCREW TI 16MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"04.503.648.01","SUP","HCPCS C1713","","04.503.648.01  -  SCREW TI 18MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"04.503.668.01","SUP","HCPCS C1713","","04.503.668.01  -  SCREW BONE 2.8MM 8MM TI LCK","BOTH IP/OP","$447.75 ","$331.34 ","$0.00 ","$447.75 ","$201.49 ","$0.00 ","$93.32 ","$0.00 ","$0.00 ","$78.40 ","$447.75 ","$0.00 ","$223.88 ","$354.62 ","$358.20 ","$0.00 ","$70.07 ","$0.00 ","$71.28 ","$0.00 "
"04.503.670","SUP","HCPCS C1713","","04.503.670  -  SCREW TI 10MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"04.503.670.01","SUP","HCPCS C1713","","04.503.670.01  -  SCREW BONE 2.8MM 10MM TI LCK","BOTH IP/OP","$447.75 ","$331.34 ","$0.00 ","$447.75 ","$201.49 ","$0.00 ","$93.32 ","$0.00 ","$0.00 ","$78.40 ","$447.75 ","$0.00 ","$223.88 ","$354.62 ","$358.20 ","$0.00 ","$70.07 ","$0.00 ","$71.28 ","$0.00 "
"04.503.672","SUP","HCPCS C1713","","04.503.672  -  SCREW TI 12MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"04.503.672.01","SUP","HCPCS C1713","","04.503.672.01  -  SCREW BONE 2.9MM 12MM TI LCK","BOTH IP/OP","$447.75 ","$331.34 ","$0.00 ","$447.75 ","$201.49 ","$0.00 ","$93.32 ","$0.00 ","$0.00 ","$78.40 ","$447.75 ","$0.00 ","$223.88 ","$354.62 ","$358.20 ","$0.00 ","$70.07 ","$0.00 ","$71.28 ","$0.00 "
"04.503.674.01","SUP","HCPCS C1713","","04.503.674.01  -  SCREW BONE 2.9MM 14MM TI LCK","BOTH IP/OP","$447.75 ","$331.34 ","$0.00 ","$447.75 ","$201.49 ","$0.00 ","$93.32 ","$0.00 ","$0.00 ","$78.40 ","$447.75 ","$0.00 ","$223.88 ","$354.62 ","$358.20 ","$0.00 ","$70.07 ","$0.00 ","$71.28 ","$0.00 "
"04.503.676.01","SUP","HCPCS C1713","","04.503.676.01  -  SCREW BONE 2.8MM 16MM TI LCK","BOTH IP/OP","$447.75 ","$331.34 ","$0.00 ","$447.75 ","$201.49 ","$0.00 ","$93.32 ","$0.00 ","$0.00 ","$78.40 ","$447.75 ","$0.00 ","$223.88 ","$354.62 ","$358.20 ","$0.00 ","$70.07 ","$0.00 ","$71.28 ","$0.00 "
"04.503.678.01","SUP","HCPCS C1713","","04.503.678.01  -  SCREW TI 18MM 2.9MM SLFTAP LCK BONE MTRXMAND","BOTH IP/OP","$447.75 ","$331.34 ","$0.00 ","$447.75 ","$201.49 ","$0.00 ","$93.32 ","$0.00 ","$0.00 ","$78.40 ","$447.75 ","$0.00 ","$223.88 ","$354.62 ","$358.20 ","$0.00 ","$70.07 ","$0.00 ","$71.28 ","$0.00 "
"04.503.701","SUP","HCPCS C1713","","04.503.701  -  PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 2X2 HL TNSNBND MLBL TI","BOTH IP/OP","$922.50 ","$682.65 ","$0.00 ","$922.50 ","$415.13 ","$0.00 ","$192.27 ","$0.00 ","$0.00 ","$161.52 ","$922.50 ","$0.00 ","$461.25 ","$730.62 ","$738.00 ","$0.00 ","$144.37 ","$0.00 ","$146.86 ","$0.00 "
"04.503.702","SUP","HCPCS C1713","","04.503.702  -  PLATE MINI NAR 1MM MANDIB 2X2 HOLE TNSNBND BONE MTRXMAND TI","BOTH IP/OP","$922.50 ","$682.65 ","$0.00 ","$922.50 ","$415.13 ","$0.00 ","$192.27 ","$0.00 ","$0.00 ","$161.52 ","$922.50 ","$0.00 ","$461.25 ","$730.62 ","$738.00 ","$0.00 ","$144.37 ","$0.00 ","$146.86 ","$0.00 "
"04.503.703","SUP","HCPCS C1713","","04.503.703  -  PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 3X3 HL TNSNBND MLBL TI","BOTH IP/OP","$1,005.75 ","$744.26 ","$0.00 ","$1,005.75 ","$452.59 ","$0.00 ","$209.62 ","$0.00 ","$0.00 ","$176.10 ","$1,005.75 ","$0.00 ","$502.88 ","$796.55 ","$804.60 ","$0.00 ","$157.40 ","$0.00 ","$160.12 ","$0.00 "
"04.503.704","SUP","HCPCS C1713","","04.503.704  -  PLATE MINI NAR NONSTRL 1MM 2X2 HOLE TNSNBND MALBLE BONE","BOTH IP/OP","$1,005.75 ","$744.26 ","$0.00 ","$1,005.75 ","$452.59 ","$0.00 ","$209.62 ","$0.00 ","$0.00 ","$176.10 ","$1,005.75 ","$0.00 ","$502.88 ","$796.55 ","$804.60 ","$0.00 ","$157.40 ","$0.00 ","$160.12 ","$0.00 "
"04.503.705","SUP","HCPCS C1713","","04.503.705  -  PLATE BN 1MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB","BOTH IP/OP","$1,651.50 ","$1,222.11 ","$0.00 ","$1,651.50 ","$743.18 ","$0.00 ","$344.21 ","$0.00 ","$0.00 ","$289.16 ","$1,651.50 ","$0.00 ","$825.75 ","$1,307.99 ","$1,321.20 ","$0.00 ","$258.46 ","$0.00 ","$262.92 ","$0.00 "
"04.503.706","SUP","HCPCS C1713","","04.503.706  -  PLATE BN 1MM NS MATRIXMANDIBLE 20 HL ADP TI MNDB","BOTH IP/OP","$1,809.00 ","$1,338.66 ","$0.00 ","$1,809.00 ","$814.05 ","$0.00 ","$377.04 ","$0.00 ","$0.00 ","$316.74 ","$1,809.00 ","$0.00 ","$904.50 ","$1,432.73 ","$1,447.20 ","$0.00 ","$283.11 ","$0.00 ","$287.99 ","$0.00 "
"04.503.707","SUP","HCPCS C1713","","04.503.707  -  PLATE BN BX 1MM NS MATRIXMANDIBLE 4 HL MLBL TI MNDB","BOTH IP/OP","$722.25 ","$534.47 ","$0.00 ","$722.25 ","$325.01 ","$0.00 ","$150.53 ","$0.00 ","$0.00 ","$126.46 ","$722.25 ","$0.00 ","$361.13 ","$572.02 ","$577.80 ","$0.00 ","$113.03 ","$0.00 ","$114.98 ","$0.00 "
"04.503.708","SUP","HCPCS C1713","","04.503.708  -  PLATE BN 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI MNDB","BOTH IP/OP","$1,419.75 ","$1,050.62 ","$0.00 ","$1,419.75 ","$638.89 ","$0.00 ","$295.91 ","$0.00 ","$0.00 ","$248.59 ","$1,419.75 ","$0.00 ","$709.88 ","$1,124.44 ","$1,135.80 ","$0.00 ","$222.19 ","$0.00 ","$226.02 ","$0.00 "
"04.503.709","SUP","HCPCS C1713","","04.503.709  -  PLATE BN MN CRV 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI","BOTH IP/OP","$1,419.75 ","$1,050.62 ","$0.00 ","$1,419.75 ","$638.89 ","$0.00 ","$295.91 ","$0.00 ","$0.00 ","$248.59 ","$1,419.75 ","$0.00 ","$709.88 ","$1,124.44 ","$1,135.80 ","$0.00 ","$222.19 ","$0.00 ","$226.02 ","$0.00 "
"04.503.710","SUP","HCPCS C1713","","04.503.710  -  PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB","BOTH IP/OP","$893.25 ","$661.01 ","$0.00 ","$893.25 ","$401.96 ","$0.00 ","$186.18 ","$0.00 ","$0.00 ","$156.40 ","$893.25 ","$0.00 ","$446.63 ","$707.45 ","$714.60 ","$0.00 ","$139.79 ","$0.00 ","$142.21 ","$0.00 "
"04.503.711","SUP","HCPCS C1713","","04.503.711  -  PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE 2X2 HL TI MNDB","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$0.00 ","$0.00 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"04.503.712","SUP","HCPCS C1713","","04.503.712  -  PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB","BOTH IP/OP","$1,050.75 ","$777.56 ","$0.00 ","$1,050.75 ","$472.84 ","$0.00 ","$219.00 ","$0.00 ","$0.00 ","$183.98 ","$1,050.75 ","$0.00 ","$525.38 ","$832.19 ","$840.60 ","$0.00 ","$164.44 ","$0.00 ","$167.28 ","$0.00 "
"04.503.713","SUP","HCPCS C1713","","04.503.713  -  PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB","BOTH IP/OP","$1,264.50 ","$935.73 ","$0.00 ","$1,264.50 ","$569.03 ","$0.00 ","$263.55 ","$0.00 ","$0.00 ","$221.40 ","$1,264.50 ","$0.00 ","$632.25 ","$1,001.48 ","$1,011.60 ","$0.00 ","$197.89 ","$0.00 ","$201.31 ","$0.00 "
"04.503.714","SUP","HCPCS C1713","","04.503.714  -  PLATE BN ANG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB","BOTH IP/OP","$1,323.00 ","$979.02 ","$0.00 ","$1,323.00 ","$595.35 ","$0.00 ","$275.75 ","$0.00 ","$0.00 ","$231.65 ","$1,323.00 ","$0.00 ","$661.50 ","$1,047.82 ","$1,058.40 ","$0.00 ","$207.05 ","$0.00 ","$210.62 ","$0.00 "
"04.503.715","SUP","HCPCS C1713","","04.503.715  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 6 HL TI MNDB","BOTH IP/OP","$1,784.25 ","$1,320.35 ","$0.00 ","$1,784.25 ","$802.91 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$312.41 ","$1,784.25 ","$0.00 ","$892.13 ","$1,413.13 ","$1,427.40 ","$0.00 ","$279.24 ","$0.00 ","$284.05 ","$0.00 "
"04.503.716","SUP","HCPCS C1713","","04.503.716  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB","BOTH IP/OP","$1,784.25 ","$1,320.35 ","$0.00 ","$1,784.25 ","$802.91 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$312.41 ","$1,784.25 ","$0.00 ","$892.13 ","$1,413.13 ","$1,427.40 ","$0.00 ","$279.24 ","$0.00 ","$284.05 ","$0.00 "
"04.503.717","SUP","HCPCS C1713","","04.503.717  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 12 HL TI MNDB","BOTH IP/OP","$2,043.00 ","$1,511.82 ","$0.00 ","$2,043.00 ","$919.35 ","$0.00 ","$425.81 ","$0.00 ","$0.00 ","$357.71 ","$2,043.00 ","$0.00 ","$1,021.50 ","$1,618.06 ","$1,634.40 ","$0.00 ","$319.73 ","$0.00 ","$325.25 ","$0.00 "
"04.503.718","SUP","HCPCS C1713","","04.503.718  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 20 HL TI MNDB","BOTH IP/OP","$2,819.25 ","$2,086.25 ","$0.00 ","$2,819.25 ","$1,268.66 ","$0.00 ","$587.60 ","$0.00 ","$0.00 ","$493.63 ","$2,819.25 ","$0.00 ","$1,409.63 ","$2,232.85 ","$2,255.40 ","$0.00 ","$441.21 ","$0.00 ","$448.82 ","$0.00 "
"04.503.721","SUP","HCPCS C1713","","04.503.721  -  PLATE BN ANG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB","BOTH IP/OP","$2,457.00 ","$1,818.18 ","$0.00 ","$2,457.00 ","$1,105.65 ","$0.00 ","$512.10 ","$0.00 ","$0.00 ","$430.20 ","$2,457.00 ","$0.00 ","$1,228.50 ","$1,945.94 ","$1,965.60 ","$0.00 ","$384.52 ","$0.00 ","$391.15 ","$0.00 "
"04.503.722","SUP","HCPCS C1713","","04.503.722  -  PLATE BN CRSNT 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB","BOTH IP/OP","$2,457.00 ","$1,818.18 ","$0.00 ","$2,457.00 ","$1,105.65 ","$0.00 ","$512.10 ","$0.00 ","$0.00 ","$430.20 ","$2,457.00 ","$0.00 ","$1,228.50 ","$1,945.94 ","$1,965.60 ","$0.00 ","$384.52 ","$0.00 ","$391.15 ","$0.00 "
"04.503.723","SUP","HCPCS C1713","","04.503.723  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB","BOTH IP/OP","$1,590.75 ","$1,177.16 ","$0.00 ","$1,590.75 ","$715.84 ","$0.00 ","$331.55 ","$0.00 ","$0.00 ","$278.53 ","$1,590.75 ","$0.00 ","$795.38 ","$1,259.87 ","$1,272.60 ","$0.00 ","$248.95 ","$0.00 ","$253.25 ","$0.00 "
"04.503.724","SUP","HCPCS C1713","","04.503.724  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB","BOTH IP/OP","$1,683.00 ","$1,245.42 ","$0.00 ","$1,683.00 ","$757.35 ","$0.00 ","$350.78 ","$0.00 ","$0.00 ","$294.68 ","$1,683.00 ","$0.00 ","$841.50 ","$1,332.94 ","$1,346.40 ","$0.00 ","$263.39 ","$0.00 ","$267.93 ","$0.00 "
"04.503.726","SUP","HCPCS C1713","","04.503.726  -  PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 2X2 HL TI MNDB","BOTH IP/OP","$1,732.50 ","$1,282.05 ","$0.00 ","$1,732.50 ","$779.63 ","$0.00 ","$361.10 ","$0.00 ","$0.00 ","$303.35 ","$1,732.50 ","$0.00 ","$866.25 ","$1,372.14 ","$1,386.00 ","$0.00 ","$271.14 ","$0.00 ","$275.81 ","$0.00 "
"04.503.727","SUP","HCPCS C1713","","04.503.727  -  PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB","BOTH IP/OP","$1,863.00 ","$1,378.62 ","$0.00 ","$1,863.00 ","$838.35 ","$0.00 ","$388.30 ","$0.00 ","$0.00 ","$326.20 ","$1,863.00 ","$0.00 ","$931.50 ","$1,475.50 ","$1,490.40 ","$0.00 ","$291.56 ","$0.00 ","$296.59 ","$0.00 "
"04.503.728","SUP","HCPCS C1713","","04.503.728  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 6 HL TI MNDB","BOTH IP/OP","$1,732.50 ","$1,282.05 ","$0.00 ","$1,732.50 ","$779.63 ","$0.00 ","$361.10 ","$0.00 ","$0.00 ","$303.35 ","$1,732.50 ","$0.00 ","$866.25 ","$1,372.14 ","$1,386.00 ","$0.00 ","$271.14 ","$0.00 ","$275.81 ","$0.00 "
"04.503.729","SUP","HCPCS C1713","","04.503.729  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 12 HL TI MNDB","BOTH IP/OP","$2,342.25 ","$1,733.27 ","$0.00 ","$2,342.25 ","$1,054.01 ","$0.00 ","$488.18 ","$0.00 ","$0.00 ","$410.11 ","$2,342.25 ","$0.00 ","$1,171.13 ","$1,855.06 ","$1,873.80 ","$0.00 ","$366.56 ","$0.00 ","$372.89 ","$0.00 "
"04.503.730","SUP","HCPCS C1713","","04.503.730  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 20 HL TI MNDB","BOTH IP/OP","$2,954.25 ","$2,186.15 ","$0.00 ","$2,954.25 ","$1,329.41 ","$0.00 ","$615.74 ","$0.00 ","$0.00 ","$517.27 ","$2,954.25 ","$0.00 ","$1,477.13 ","$2,339.77 ","$2,363.40 ","$0.00 ","$462.34 ","$0.00 ","$470.32 ","$0.00 "
"04.503.731","SUP","HCPCS C1713","","04.503.731  -  PLATE BN BRD ANG 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB","BOTH IP/OP","$2,556.00 ","$1,891.44 ","$0.00 ","$2,556.00 ","$1,150.20 ","$0.00 ","$532.73 ","$0.00 ","$0.00 ","$447.54 ","$2,556.00 ","$0.00 ","$1,278.00 ","$2,024.35 ","$2,044.80 ","$0.00 ","$400.01 ","$0.00 ","$406.92 ","$0.00 "
"04.503.732","SUP","HCPCS C1713","","04.503.732  -  PLATE BN LT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB","BOTH IP/OP","$4,887.00 ","$3,616.38 ","$0.00 ","$4,887.00 ","$2,199.15 ","$0.00 ","$1,018.57 ","$0.00 ","$0.00 ","$855.67 ","$4,887.00 ","$0.00 ","$2,443.50 ","$3,870.50 ","$3,909.60 ","$0.00 ","$764.82 ","$0.00 ","$778.01 ","$0.00 "
"04.503.733","SUP","HCPCS C1713","","04.503.733  -  PLATE BN RT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB","BOTH IP/OP","$4,887.00 ","$3,616.38 ","$0.00 ","$4,887.00 ","$2,199.15 ","$0.00 ","$1,018.57 ","$0.00 ","$0.00 ","$855.67 ","$4,887.00 ","$0.00 ","$2,443.50 ","$3,870.50 ","$3,909.60 ","$0.00 ","$764.82 ","$0.00 ","$778.01 ","$0.00 "
"04.503.734","SUP","HCPCS C1713","","04.503.734  -  PLATE BN 2 ANG SM 2MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI","BOTH IP/OP","$5,656.50 ","$4,185.81 ","$0.00 ","$5,656.50 ","$2,545.43 ","$0.00 ","$1,178.96 ","$0.00 ","$0.00 ","$990.41 ","$5,656.50 ","$0.00 ","$2,828.25 ","$4,479.95 ","$4,525.20 ","$0.00 ","$885.24 ","$0.00 ","$900.51 ","$0.00 "
"04.503.735","SUP","HCPCS C1713","","04.503.735  -  PLATE BN 2 ANG MED 2MM NS MATRIXMANDIBLE 5X22X5 HL RECON TI","BOTH IP/OP","$5,973.75 ","$4,420.58 ","$0.00 ","$5,973.75 ","$2,688.19 ","$0.00 ","$1,245.08 ","$0.00 ","$0.00 ","$1,045.96 ","$5,973.75 ","$0.00 ","$2,986.88 ","$4,731.21 ","$4,779.00 ","$0.00 ","$934.89 ","$0.00 ","$951.02 ","$0.00 "
"04.503.736","SUP","HCPCS C1713","","04.503.736  -  PLATE BN 2 ANG LG 2MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI","BOTH IP/OP","$6,293.25 ","$4,657.01 ","$0.00 ","$6,293.25 ","$2,831.96 ","$0.00 ","$1,311.67 ","$0.00 ","$0.00 ","$1,101.90 ","$6,293.25 ","$0.00 ","$3,146.63 ","$4,984.25 ","$5,034.60 ","$0.00 ","$984.89 ","$0.00 ","$1,001.89 ","$0.00 "
"04.503.737","SUP","HCPCS C1713","","04.503.737  -  PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB","BOTH IP/OP","$2,520.00 ","$1,864.80 ","$0.00 ","$2,520.00 ","$1,134.00 ","$0.00 ","$525.23 ","$0.00 ","$0.00 ","$441.23 ","$2,520.00 ","$0.00 ","$1,260.00 ","$1,995.84 ","$2,016.00 ","$0.00 ","$394.38 ","$0.00 ","$401.18 ","$0.00 "
"04.503.738","SUP","HCPCS C1713","","04.503.738  -  PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB","BOTH IP/OP","$3,492.00 ","$2,584.08 ","$0.00 ","$3,492.00 ","$1,571.40 ","$0.00 ","$727.82 ","$0.00 ","$0.00 ","$611.42 ","$3,492.00 ","$0.00 ","$1,746.00 ","$2,765.66 ","$2,793.60 ","$0.00 ","$546.50 ","$0.00 ","$555.93 ","$0.00 "
"04.503.739","SUP","HCPCS C1713","","04.503.739  -  PLATE BN LT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI","BOTH IP/OP","$5,260.50 ","$3,892.77 ","$0.00 ","$5,260.50 ","$2,367.23 ","$0.00 ","$1,096.42 ","$0.00 ","$0.00 ","$921.07 ","$5,260.50 ","$0.00 ","$2,630.25 ","$4,166.32 ","$4,208.40 ","$0.00 ","$823.27 ","$0.00 ","$837.47 ","$0.00 "
"04.503.740","SUP","HCPCS C1713","","04.503.740  -  PLATE BN RT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI","BOTH IP/OP","$5,260.50 ","$3,892.77 ","$0.00 ","$5,260.50 ","$2,367.23 ","$0.00 ","$1,096.42 ","$0.00 ","$0.00 ","$921.07 ","$5,260.50 ","$0.00 ","$2,630.25 ","$4,166.32 ","$4,208.40 ","$0.00 ","$823.27 ","$0.00 ","$837.47 ","$0.00 "
"04.503.741","SUP","HCPCS C1713","","04.503.741  -  PLATE BN 2 ANG SM 2.5MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI","BOTH IP/OP","$6,090.75 ","$4,507.16 ","$0.00 ","$6,090.75 ","$2,740.84 ","$0.00 ","$1,269.46 ","$0.00 ","$0.00 ","$1,066.44 ","$6,090.75 ","$0.00 ","$3,045.38 ","$4,823.87 ","$4,872.60 ","$0.00 ","$953.20 ","$0.00 ","$969.65 ","$0.00 "
"04.503.742","SUP","HCPCS C1713","","04.503.742  -  PLATE BN 2 ANG MED 2.5MM NS MATRIXMANDIBLE 5X22X5 HL RECON","BOTH IP/OP","$6,428.25 ","$4,756.91 ","$0.00 ","$6,428.25 ","$2,892.71 ","$0.00 ","$1,339.81 ","$0.00 ","$0.00 ","$1,125.54 ","$6,428.25 ","$0.00 ","$3,214.13 ","$5,091.17 ","$5,142.60 ","$0.00 ","$1,006.02 ","$0.00 ","$1,023.38 ","$0.00 "
"04.503.743","SUP","HCPCS C1713","","04.503.743  -  PLATE BN 2 ANG LG 2.5MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI","BOTH IP/OP","$6,783.75 ","$5,019.98 ","$0.00 ","$6,783.75 ","$3,052.69 ","$0.00 ","$1,413.90 ","$0.00 ","$0.00 ","$1,187.78 ","$6,783.75 ","$0.00 ","$3,391.88 ","$5,372.73 ","$5,427.00 ","$0.00 ","$1,061.66 ","$0.00 ","$1,079.97 ","$0.00 "
"04.503.750","SUP","HCPCS C1713","","04.503.750  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X2 HL MLBL TNSNBND TI","BOTH IP/OP","$1,152.00 ","$852.48 ","$0.00 ","$1,152.00 ","$518.40 ","$0.00 ","$240.11 ","$0.00 ","$0.00 ","$201.71 ","$1,152.00 ","$0.00 ","$576.00 ","$912.38 ","$921.60 ","$0.00 ","$180.29 ","$0.00 ","$183.40 ","$0.00 "
"04.503.751","SUP","HCPCS C1713","","04.503.751  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X3 HL MLBL TNSNBND TI","BOTH IP/OP","$1,197.00 ","$885.78 ","$0.00 ","$1,197.00 ","$538.65 ","$0.00 ","$249.48 ","$0.00 ","$0.00 ","$209.59 ","$1,197.00 ","$0.00 ","$598.50 ","$948.02 ","$957.60 ","$0.00 ","$187.33 ","$0.00 ","$190.56 ","$0.00 "
"04.503.752","SUP","HCPCS C1713","","04.503.752  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 3X3 HL MLBL TNSNBND TI","BOTH IP/OP","$1,244.25 ","$920.75 ","$0.00 ","$1,244.25 ","$559.91 ","$0.00 ","$259.33 ","$0.00 ","$0.00 ","$217.86 ","$1,244.25 ","$0.00 ","$622.13 ","$985.45 ","$995.40 ","$0.00 ","$194.73 ","$0.00 ","$198.08 ","$0.00 "
"04.503.756","SUP","HCPCS C1713","","04.503.756  -  PLATE BN 1.25MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB","BOTH IP/OP","$1,773.00 ","$1,312.02 ","$0.00 ","$1,773.00 ","$797.85 ","$0.00 ","$369.54 ","$0.00 ","$0.00 ","$310.44 ","$1,773.00 ","$0.00 ","$886.50 ","$1,404.22 ","$1,418.40 ","$0.00 ","$277.47 ","$0.00 ","$282.26 ","$0.00 "
"04.503.761","SUP","HCPCS C1713","","04.503.761  -  PLATE BONE STR 1.25MM 2X2 HOLE MTRXMAND DCP SILVER TITANIUM","BOTH IP/OP","$1,188.00 ","$879.12 ","$0.00 ","$1,188.00 ","$534.60 ","$0.00 ","$247.61 ","$0.00 ","$0.00 ","$208.01 ","$1,188.00 ","$0.00 ","$594.00 ","$940.90 ","$950.40 ","$0.00 ","$185.92 ","$0.00 ","$189.13 ","$0.00 "
"04.503.770","SUP","HCPCS C1713","","04.503.770  -  PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB","BOTH IP/OP","$2,965.50 ","$2,194.47 ","$0.00 ","$2,965.50 ","$1,334.48 ","$0.00 ","$618.08 ","$0.00 ","$0.00 ","$519.24 ","$2,965.50 ","$0.00 ","$1,482.75 ","$2,348.68 ","$2,372.40 ","$0.00 ","$464.10 ","$0.00 ","$472.11 ","$0.00 "
"04.503.771","SUP","HCPCS C1713","","04.503.771  -  PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB","BOTH IP/OP","$4,338.00 ","$3,210.12 ","$0.00 ","$4,338.00 ","$1,952.10 ","$0.00 ","$904.15 ","$0.00 ","$0.00 ","$759.55 ","$4,338.00 ","$0.00 ","$2,169.00 ","$3,435.70 ","$3,470.40 ","$0.00 ","$678.90 ","$0.00 ","$690.61 ","$0.00 "
"04.503.772","SUP","HCPCS C1713","","04.503.772  -  PLATE BN LT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI","BOTH IP/OP","$6,444.00 ","$4,768.56 ","$0.00 ","$6,444.00 ","$2,899.80 ","$0.00 ","$1,343.09 ","$0.00 ","$0.00 ","$1,128.29 ","$6,444.00 ","$0.00 ","$3,222.00 ","$5,103.65 ","$5,155.20 ","$0.00 ","$1,008.49 ","$0.00 ","$1,025.88 ","$0.00 "
"04.503.773","SUP","HCPCS C1713","","04.503.773  -  PLATE BN RT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI","BOTH IP/OP","$6,444.00 ","$4,768.56 ","$0.00 ","$6,444.00 ","$2,899.80 ","$0.00 ","$1,343.09 ","$0.00 ","$0.00 ","$1,128.29 ","$6,444.00 ","$0.00 ","$3,222.00 ","$5,103.65 ","$5,155.20 ","$0.00 ","$1,008.49 ","$0.00 ","$1,025.88 ","$0.00 "
"04.503.780","SUP","HCPCS C1713","","04.503.780  -  PLATE 1MM RIGHT MANDIB 2 HOLE LCK TNSNBND PREBNT BONE","BOTH IP/OP","$987.75 ","$730.94 ","$0.00 ","$987.75 ","$444.49 ","$0.00 ","$205.87 ","$0.00 ","$0.00 ","$172.95 ","$987.75 ","$0.00 ","$493.88 ","$782.30 ","$790.20 ","$0.00 ","$154.58 ","$0.00 ","$157.25 ","$0.00 "
"04.503.781","SUP","HCPCS C1713","","04.503.781  -  PLATE 1MM LEFT MANDIB 2 HOLE LCK TNSNBND PREBNT BONE","BOTH IP/OP","$987.75 ","$730.94 ","$0.00 ","$987.75 ","$444.49 ","$0.00 ","$205.87 ","$0.00 ","$0.00 ","$172.95 ","$987.75 ","$0.00 ","$493.88 ","$782.30 ","$790.20 ","$0.00 ","$154.58 ","$0.00 ","$157.25 ","$0.00 "
"04.503.783","SUP","HCPCS C1713","","04.503.783  -  PLATE BONE 1MM 4 HOLE ADAPTION MTRXMAND SILVER TITANIUM","BOTH IP/OP","$927.00 ","$685.98 ","$0.00 ","$927.00 ","$417.15 ","$0.00 ","$193.21 ","$0.00 ","$0.00 ","$162.31 ","$927.00 ","$0.00 ","$463.50 ","$734.18 ","$741.60 ","$0.00 ","$145.08 ","$0.00 ","$147.58 ","$0.00 "
"04.503.801","SUP","HCPCS C1713","","04.503.801  -  PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM","BOTH IP/OP","$4,167.00 ","$3,083.58 ","$0.00 ","$4,167.00 ","$1,875.15 ","$0.00 ","$868.51 ","$0.00 ","$0.00 ","$729.61 ","$4,167.00 ","$0.00 ","$2,083.50 ","$3,300.26 ","$3,333.60 ","$0.00 ","$652.14 ","$0.00 ","$663.39 ","$0.00 "
"04.503.802","SUP","HCPCS C1713","","04.503.802  -  PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM","BOTH IP/OP","$4,311.00 ","$3,190.14 ","$0.00 ","$4,311.00 ","$1,939.95 ","$0.00 ","$898.52 ","$0.00 ","$0.00 ","$754.82 ","$4,311.00 ","$0.00 ","$2,155.50 ","$3,414.31 ","$3,448.80 ","$0.00 ","$674.67 ","$0.00 ","$686.31 ","$0.00 "
"04.503.811","SUP","HCPCS C1713","","04.503.811  -  PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM","BOTH IP/OP","$4,167.00 ","$3,083.58 ","$0.00 ","$4,167.00 ","$1,875.15 ","$0.00 ","$868.51 ","$0.00 ","$0.00 ","$729.61 ","$4,167.00 ","$0.00 ","$2,083.50 ","$3,300.26 ","$3,333.60 ","$0.00 ","$652.14 ","$0.00 ","$663.39 ","$0.00 "
"04.503.812","SUP","HCPCS C1713","","04.503.812  -  PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM","BOTH IP/OP","$4,311.00 ","$3,190.14 ","$0.00 ","$4,311.00 ","$1,939.95 ","$0.00 ","$898.52 ","$0.00 ","$0.00 ","$754.82 ","$4,311.00 ","$0.00 ","$2,155.50 ","$3,414.31 ","$3,448.80 ","$0.00 ","$674.67 ","$0.00 ","$686.31 ","$0.00 "
"04.503.820","SUP","HCPCS C1713","","04.503.820  -  PLATE BN SHRT NS MATRIXWAVE 10 HL TI MXLMNDB","BOTH IP/OP","$776.25 ","$574.43 ","$0.00 ","$776.25 ","$349.31 ","$0.00 ","$161.79 ","$0.00 ","$0.00 ","$135.92 ","$776.25 ","$0.00 ","$388.13 ","$614.79 ","$621.00 ","$0.00 ","$121.48 ","$0.00 ","$123.58 ","$0.00 "
"04.503.824.01","SUP","HCPCS C1713","","04.503.824.01  -  MATRIXWAVE MMF TI 1.85MM SCREW SELF-DRILLING/6MM LENGTH","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"04.503.825.01","SUP","HCPCS C1713","","04.503.825.01  -  SCREW BONE 8MM SELF DRILL MATRIXWAVE TITANIUM 1.85MM","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"04.503.830","SUP","HCPCS C1713","","04.503.830  -  PLATE RIGHT SUBCONDYLAR 7 HOLE MALBLE LMBD BONE MTRXMAND","BOTH IP/OP","$2,099.25 ","$1,553.45 ","$0.00 ","$2,099.25 ","$944.66 ","$0.00 ","$437.54 ","$0.00 ","$0.00 ","$367.56 ","$2,099.25 ","$0.00 ","$1,049.63 ","$1,662.61 ","$1,679.40 ","$0.00 ","$328.53 ","$0.00 ","$334.20 ","$0.00 "
"04.503.831","SUP","HCPCS C1713","","04.503.831  -  PLATE LEFT SUBCONDYLAR 7 HOLE MALBLE LMBD BONE MTRXMAND","BOTH IP/OP","$2,099.25 ","$1,553.45 ","$0.00 ","$2,099.25 ","$944.66 ","$0.00 ","$437.54 ","$0.00 ","$0.00 ","$367.56 ","$2,099.25 ","$0.00 ","$1,049.63 ","$1,662.61 ","$1,679.40 ","$0.00 ","$328.53 ","$0.00 ","$334.20 ","$0.00 "
"04.503.834","SUP","HCPCS C1713","","04.503.834  -  PLATE THK1MM SM SUBCONDYLAR 4 HOLE TRPZD MALBLE BONE","BOTH IP/OP","$2,099.25 ","$1,553.45 ","$0.00 ","$2,099.25 ","$944.66 ","$0.00 ","$437.54 ","$0.00 ","$0.00 ","$367.56 ","$2,099.25 ","$0.00 ","$1,049.63 ","$1,662.61 ","$1,679.40 ","$0.00 ","$328.53 ","$0.00 ","$334.20 ","$0.00 "
"04.503.900","SUP","HCPCS C1713","","04.503.900  -  PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT","BOTH IP/OP","$7,143.75 ","$5,286.38 ","$0.00 ","$7,143.75 ","$3,214.69 ","$0.00 ","$1,488.94 ","$0.00 ","$0.00 ","$1,250.81 ","$7,143.75 ","$0.00 ","$3,571.88 ","$5,657.85 ","$5,715.00 ","$0.00 ","$1,118.00 ","$0.00 ","$1,137.29 ","$0.00 "
"04.503.901","SUP","HCPCS C1713","","04.503.901  -  PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT","BOTH IP/OP","$7,143.75 ","$5,286.38 ","$0.00 ","$7,143.75 ","$3,214.69 ","$0.00 ","$1,488.94 ","$0.00 ","$0.00 ","$1,250.81 ","$7,143.75 ","$0.00 ","$3,571.88 ","$5,657.85 ","$5,715.00 ","$0.00 ","$1,118.00 ","$0.00 ","$1,137.29 ","$0.00 "
"04.503.902","SUP","HCPCS C1713","","04.503.902  -  PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT","BOTH IP/OP","$7,411.50 ","$5,484.51 ","$0.00 ","$7,411.50 ","$3,335.18 ","$0.00 ","$1,544.74 ","$0.00 ","$0.00 ","$1,297.69 ","$7,411.50 ","$0.00 ","$3,705.75 ","$5,869.91 ","$5,929.20 ","$0.00 ","$1,159.90 ","$0.00 ","$1,179.91 ","$0.00 "
"04.503.903","SUP","HCPCS C1713","","04.503.903  -  PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT","BOTH IP/OP","$7,411.50 ","$5,484.51 ","$0.00 ","$7,411.50 ","$3,335.18 ","$0.00 ","$1,544.74 ","$0.00 ","$0.00 ","$1,297.69 ","$7,411.50 ","$0.00 ","$3,705.75 ","$5,869.91 ","$5,929.20 ","$0.00 ","$1,159.90 ","$0.00 ","$1,179.91 ","$0.00 "
"04.503.904","SUP","HCPCS C1713","","04.503.904  -  PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT","BOTH IP/OP","$7,679.25 ","$5,682.65 ","$0.00 ","$7,679.25 ","$3,455.66 ","$0.00 ","$1,600.55 ","$0.00 ","$0.00 ","$1,344.58 ","$7,679.25 ","$0.00 ","$3,839.63 ","$6,081.97 ","$6,143.40 ","$0.00 ","$1,201.80 ","$0.00 ","$1,222.54 ","$0.00 "
"04.503.905","SUP","HCPCS C1713","","04.503.905  -  PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT","BOTH IP/OP","$7,679.25 ","$5,682.65 ","$0.00 ","$7,679.25 ","$3,455.66 ","$0.00 ","$1,600.55 ","$0.00 ","$0.00 ","$1,344.58 ","$7,679.25 ","$0.00 ","$3,839.63 ","$6,081.97 ","$6,143.40 ","$0.00 ","$1,201.80 ","$0.00 ","$1,222.54 ","$0.00 "
"04.511.204.01","SUP","HCPCS C1713","","04.511.204.01  -  SCREW TI 4MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.205.01","SUP","HCPCS C1713","","04.511.205.01  -  SCREW BONE 1.85MM 15MM MTRX TI LEFT SLFDRILL NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.206.01","SUP","HCPCS C1713","","04.511.206.01  -  SCREW TI 6MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.208.01","SUP","HCPCS C1713","","04.511.208.01  -  SCREW TI 8MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.210.01","SUP","HCPCS C1713","","04.511.210.01  -  SCREW TI 10MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.212.01","SUP","HCPCS C1713","","04.511.212.01  -  SCREW TI 12MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.214.01","SUP","HCPCS C1713","","04.511.214.01  -  SCREW TI 14MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.216.01","SUP","HCPCS C1713","","04.511.216.01  -  SCREW TI 16MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.218.01","SUP","HCPCS C1713","","04.511.218.01  -  SCREW TI 18MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX","BOTH IP/OP","$211.50 ","$156.51 ","$0.00 ","$211.50 ","$95.18 ","$0.00 ","$44.08 ","$0.00 ","$0.00 ","$37.03 ","$211.50 ","$0.00 ","$105.75 ","$167.51 ","$169.20 ","$0.00 ","$33.10 ","$0.00 ","$33.67 ","$0.00 "
"04.511.224.01","SUP","HCPCS C1713","","04.511.224.01  -  SCREW TI 4MM 1.85MM MANDIB SLFDRILL ORTHGNAT BONE MTRX","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.225.01","SUP","HCPCS C1713","","04.511.225.01  -  SCREW TI 5MM 1.85MM SLFDRILL BONE MATRIXORTHOGNATHIC NONSTRL","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.226.01","SUP","HCPCS C1713","","04.511.226.01  -  SCREW BONE 1.85MM 6MM MTRX TI CRNMXF SLFDRILL ORTHGNAT","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.228.01","SUP","HCPCS C1713","","04.511.228.01  -  SCREW TI 8MM 1.85MM MANDIB SLFDRILL ORTHGNAT BONE MTRX","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.234.01","SUP","HCPCS C1713","","04.511.234.01  -  SCREW TI 4MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.235.01","SUP","HCPCS C1713","","04.511.235.01  -  SCREW BONE 2.1MM 5MM MTRX TI LEFT STR NONSTRL","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.236.01","SUP","HCPCS C1713","","04.511.236.01  -  SCREW TI 6MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.238.01","SUP","HCPCS C1713","","04.511.238.01  -  SCREW TI 8MM 2.1MM MANDIB SLFDRILL ORTHGNAT BONE MTRX","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.240.01","SUP","HCPCS C1713","","04.511.240.01  -  SCREW TI 10MM 2.1MM COARSE PTCH SLFTAP ORTHGNAT BONE MTRX","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.242.01","SUP","HCPCS C1713","","04.511.242.01  -  SCREW TI 12MM 2.1MM SLFTAP COARSE PTCH BONE MTRX NONSTRL PNK","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.244.01","SUP","HCPCS C1713","","04.511.244.01  -  SCREW TI 14MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.246.01","SUP","HCPCS C1713","","04.511.246.01  -  SCREW BONE PNK 16MM 2.1MM MTRX CRNMXF TI SLFTAP COARSE PTCH","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.248.01","SUP","HCPCS C1713","","04.511.248.01  -  SCREW TI 18MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"04.511.301","SUP","HCPCS C1713","","04.511.301  -  PLATE BN 90D L 2MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.302","SUP","HCPCS C1713","","04.511.302  -  PLATE BN 90D L 6MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.303","SUP","HCPCS C1713","","04.511.303  -  PLATE BN 90D L 11MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.304","SUP","HCPCS C1713","","04.511.304  -  PLATE BN 90D L 2MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.305","SUP","HCPCS C1713","","04.511.305  -  PLATE BN 90D L 6MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.306","SUP","HCPCS C1713","","04.511.306  -  PLATE BN 90D L 11MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.307","SUP","HCPCS C1713","","04.511.307  -  PLATE 90D .8MM 2X2 HOLE L RVRS SHRT BAR BONE","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.308","SUP","HCPCS C1713","","04.511.308  -  PLATE 90D MED .8MM MAXL 2X2 HOLE L RVRS ORTHGNAT BONE MTRX","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.309","SUP","HCPCS C1713","","04.511.309  -  PLATE BN 90D L 11MMX.8MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS","BOTH IP/OP","$657.00 ","$486.18 ","$0.00 ","$657.00 ","$295.65 ","$0.00 ","$136.94 ","$0.00 ","$0.00 ","$115.04 ","$657.00 ","$0.00 ","$328.50 ","$520.34 ","$525.60 ","$0.00 ","$102.82 ","$0.00 ","$104.59 ","$0.00 "
"04.511.321","SUP","HCPCS C1713","","04.511.321  -  PLATE BN L OBLQ 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.322","SUP","HCPCS C1713","","04.511.322  -  PLATE BN L OBLQ 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.323","SUP","HCPCS C1713","","04.511.323  -  PLATE BN L OBLQ 13MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.324","SUP","HCPCS C1713","","04.511.324  -  PLATE BN L OBLQ 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.325","SUP","HCPCS C1713","","04.511.325  -  PLATE BN L OBLQ 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.326","SUP","HCPCS C1713","","04.511.326  -  PLATE BN L OBLQ 13MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.327","SUP","HCPCS C1713","","04.511.327  -  PLATE BN L OBLQ 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.328","SUP","HCPCS C1713","","04.511.328  -  PLATE BN L OBLQ 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.329","SUP","HCPCS C1713","","04.511.329  -  PLATE BN L OBLQ 13MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$308.81 ","$0.00 ","$143.03 ","$0.00 ","$0.00 ","$120.16 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$107.40 ","$0.00 ","$109.25 ","$0.00 "
"04.511.341","SUP","HCPCS C1713","","04.511.341  -  PLATE BN L 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.342","SUP","HCPCS C1713","","04.511.342  -  PLATE BN L 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.343","SUP","HCPCS C1713","","04.511.343  -  PLATE BN L 12MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.344","SUP","HCPCS C1713","","04.511.344  -  PLATE BN L 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.345","SUP","HCPCS C1713","","04.511.345  -  PLATE BN L 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.346","SUP","HCPCS C1713","","04.511.346  -  PLATE BN L 12MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.347","SUP","HCPCS C1713","","04.511.347  -  PLATE BN L 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.348","SUP","HCPCS C1713","","04.511.348  -  PLATE BN L 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.349","SUP","HCPCS C1713","","04.511.349  -  PLATE BN L 12MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS","BOTH IP/OP","$717.75 ","$531.14 ","$0.00 ","$717.75 ","$322.99 ","$0.00 ","$149.60 ","$0.00 ","$0.00 ","$125.67 ","$717.75 ","$0.00 ","$358.88 ","$568.46 ","$574.20 ","$0.00 ","$112.33 ","$0.00 ","$114.27 ","$0.00 "
"04.511.381","SUP","HCPCS C1713","","04.511.381  -  PLATE BN 2MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.382","SUP","HCPCS C1713","","04.511.382  -  PLATE BN 2MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.383","SUP","HCPCS C1713","","04.511.383  -  PLATE BN 4MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.384","SUP","HCPCS C1713","","04.511.384  -  PLATE BN 4MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.385","SUP","HCPCS C1713","","04.511.385  -  PLATE BN 6MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.386","SUP","HCPCS C1713","","04.511.386  -  PLATE BN 6MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.387","SUP","HCPCS C1713","","04.511.387  -  PLATE BN 8MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.388","SUP","HCPCS C1713","","04.511.388  -  PLATE BN 8MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.389","SUP","HCPCS C1713","","04.511.389  -  PLATE BN 10MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.390","SUP","HCPCS C1713","","04.511.390  -  PLATE BN 10MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC","BOTH IP/OP","$1,100.25 ","$814.19 ","$0.00 ","$1,100.25 ","$495.11 ","$0.00 ","$229.32 ","$0.00 ","$0.00 ","$192.64 ","$1,100.25 ","$0.00 ","$550.13 ","$871.40 ","$880.20 ","$0.00 ","$172.19 ","$0.00 ","$175.16 ","$0.00 "
"04.511.401","SUP","HCPCS C1713","","04.511.401  -  PLATE BN CRV 6MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL","BOTH IP/OP","$956.25 ","$707.63 ","$0.00 ","$956.25 ","$430.31 ","$0.00 ","$199.31 ","$0.00 ","$0.00 ","$167.43 ","$956.25 ","$0.00 ","$478.13 ","$757.35 ","$765.00 ","$0.00 ","$149.65 ","$0.00 ","$152.24 ","$0.00 "
"04.511.402","SUP","HCPCS C1713","","04.511.402  -  PLATE BN CRV 8MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL","BOTH IP/OP","$956.25 ","$707.63 ","$0.00 ","$956.25 ","$430.31 ","$0.00 ","$199.31 ","$0.00 ","$0.00 ","$167.43 ","$956.25 ","$0.00 ","$478.13 ","$757.35 ","$765.00 ","$0.00 ","$149.65 ","$0.00 ","$152.24 ","$0.00 "
"04.511.403","SUP","HCPCS C1713","","04.511.403  -  PLATE BN CRV 10MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL","BOTH IP/OP","$956.25 ","$707.63 ","$0.00 ","$956.25 ","$430.31 ","$0.00 ","$199.31 ","$0.00 ","$0.00 ","$167.43 ","$956.25 ","$0.00 ","$478.13 ","$757.35 ","$765.00 ","$0.00 ","$149.65 ","$0.00 ","$152.24 ","$0.00 "
"04.511.404","SUP","HCPCS C1713","","04.511.404  -  PLATE BN CRV 12MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL","BOTH IP/OP","$956.25 ","$707.63 ","$0.00 ","$956.25 ","$430.31 ","$0.00 ","$199.31 ","$0.00 ","$0.00 ","$167.43 ","$956.25 ","$0.00 ","$478.13 ","$757.35 ","$765.00 ","$0.00 ","$149.65 ","$0.00 ","$152.24 ","$0.00 "
"04.511.421","SUP","HCPCS C1713","","04.511.421  -  PLATE BN STRG 6MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL","BOTH IP/OP","$940.50 ","$695.97 ","$0.00 ","$940.50 ","$423.23 ","$0.00 ","$196.02 ","$0.00 ","$0.00 ","$164.67 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$147.19 ","$0.00 ","$149.73 ","$0.00 "
"04.511.422","SUP","HCPCS C1713","","04.511.422  -  PLATE BN STRG 8MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL","BOTH IP/OP","$940.50 ","$695.97 ","$0.00 ","$940.50 ","$423.23 ","$0.00 ","$196.02 ","$0.00 ","$0.00 ","$164.67 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$147.19 ","$0.00 ","$149.73 ","$0.00 "
"04.511.423","SUP","HCPCS C1713","","04.511.423  -  PLATE BN STRG 10MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL","BOTH IP/OP","$940.50 ","$695.97 ","$0.00 ","$940.50 ","$423.23 ","$0.00 ","$196.02 ","$0.00 ","$0.00 ","$164.67 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$147.19 ","$0.00 ","$149.73 ","$0.00 "
"04.511.424","SUP","HCPCS C1713","","04.511.424  -  PLATE BN STRG 12MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL","BOTH IP/OP","$940.50 ","$695.97 ","$0.00 ","$940.50 ","$423.23 ","$0.00 ","$196.02 ","$0.00 ","$0.00 ","$164.67 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$147.19 ","$0.00 ","$149.73 ","$0.00 "
"04.511.444","SUP","HCPCS C1713","","04.511.444  -  PLATE BN 33MMX.7MM NS MATRIXORTHOGNATHIC 4 HL SGTL SPLT ADJ","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$577.13 ","$0.00 ","$267.31 ","$0.00 ","$0.00 ","$224.56 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$200.71 ","$0.00 ","$204.17 ","$0.00 "
"04.511.445","SUP","Custom 27203010","","04.511.445  -  INSRTR SURG LINR CNSTRN TI MTRX 40MMX.7MM NONSTRL","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.511.461","SUP","HCPCS C1713","","04.511.461  -  PLATE BN 4MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL","BOTH IP/OP","$897.75 ","$664.34 ","$0.00 ","$897.75 ","$403.99 ","$0.00 ","$187.11 ","$0.00 ","$0.00 ","$157.19 ","$897.75 ","$0.00 ","$448.88 ","$711.02 ","$718.20 ","$0.00 ","$140.50 ","$0.00 ","$142.92 ","$0.00 "
"04.511.462","SUP","HCPCS C1713","","04.511.462  -  PLATE BN 6MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL","BOTH IP/OP","$897.75 ","$664.34 ","$0.00 ","$897.75 ","$403.99 ","$0.00 ","$187.11 ","$0.00 ","$0.00 ","$157.19 ","$897.75 ","$0.00 ","$448.88 ","$711.02 ","$718.20 ","$0.00 ","$140.50 ","$0.00 ","$142.92 ","$0.00 "
"04.511.463","SUP","HCPCS C1713","","04.511.463  -  PLATE BN 8MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL","BOTH IP/OP","$897.75 ","$664.34 ","$0.00 ","$897.75 ","$403.99 ","$0.00 ","$187.11 ","$0.00 ","$0.00 ","$157.19 ","$897.75 ","$0.00 ","$448.88 ","$711.02 ","$718.20 ","$0.00 ","$140.50 ","$0.00 ","$142.92 ","$0.00 "
"04.511.464","SUP","HCPCS C1713","","04.511.464  -  PLATE BN 10MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL","BOTH IP/OP","$897.75 ","$664.34 ","$0.00 ","$897.75 ","$403.99 ","$0.00 ","$187.11 ","$0.00 ","$0.00 ","$157.19 ","$897.75 ","$0.00 ","$448.88 ","$711.02 ","$718.20 ","$0.00 ","$140.50 ","$0.00 ","$142.92 ","$0.00 "
"04.600.022.02S","SUP","HCPCS C1713","","04.600.022.02S  -  PIN 12MM DSTRCT TI STRL","BOTH IP/OP","$896.00 ","$663.04 ","$0.00 ","$896.00 ","$403.20 ","$0.00 ","$186.75 ","$0.00 ","$0.00 ","$156.88 ","$896.00 ","$0.00 ","$448.00 ","$709.63 ","$716.80 ","$0.00 ","$140.22 ","$0.00 ","$142.64 ","$0.00 "
"04.600.023.02S","SUP","HCPCS C1713","","04.600.023.02S  -  PIN 14MM DSTRCT TI STRL","BOTH IP/OP","$448.00 ","$331.52 ","$0.00 ","$448.00 ","$201.60 ","$0.00 ","$93.37 ","$0.00 ","$0.00 ","$78.44 ","$448.00 ","$0.00 ","$224.00 ","$354.82 ","$358.40 ","$0.00 ","$70.11 ","$0.00 ","$71.32 ","$0.00 "
"04.600.029.02S","SUP","HCPCS C1713","","04.600.029.02S  -  PIN 16MM DSTRCT TI STRL","BOTH IP/OP","$448.00 ","$331.52 ","$0.00 ","$448.00 ","$201.60 ","$0.00 ","$93.37 ","$0.00 ","$0.00 ","$78.44 ","$448.00 ","$0.00 ","$224.00 ","$354.82 ","$358.40 ","$0.00 ","$70.11 ","$0.00 ","$71.32 ","$0.00 "
"04.601.108","SUP","HCPCS C1713","","04.601.108  -  SCREW BN T15 4.5MM 3.2MM 8MM NS SLF RTN STRDR BLNT TIP TI","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"04.601.110","SUP","HCPCS C1713","","04.601.110  -  SCREW BONE 4.5MM 10MM TI OCCPTL NONSTRL","BOTH IP/OP","$392.00 ","$290.08 ","$0.00 ","$392.00 ","$176.40 ","$0.00 ","$81.70 ","$0.00 ","$0.00 ","$68.64 ","$392.00 ","$0.00 ","$196.00 ","$310.46 ","$313.60 ","$0.00 ","$61.35 ","$0.00 ","$62.41 ","$0.00 "
"04.601.112","SUP","HCPCS C1713","","04.601.112  -  SCREW BONE 4.5MM 12MM TITANIUM OCCIPITOCERVICAL SPN NONSTRL","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"04.601.208","SUP","HCPCS C1713","","04.601.208  -  SCREW BN T15 5MM 3.2MM 8MM NS SLFRET STRDR BLNT TIP 7%","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"04.601.210","SUP","HCPCS C1713","","04.601.210  -  SCREW BN T15 5MM 3.2MM 10MM NS SLFRET STRDR BLNT TIP 7%","BOTH IP/OP","$399.00 ","$295.26 ","$0.00 ","$399.00 ","$179.55 ","$0.00 ","$83.16 ","$0.00 ","$0.00 ","$69.86 ","$399.00 ","$0.00 ","$199.50 ","$316.01 ","$319.20 ","$0.00 ","$62.44 ","$0.00 ","$63.52 ","$0.00 "
"04.613.014","SUP","HCPCS C1713","","04.613.014  -  PLATE 23MM TI 1 LVL VCTR BONE 14MM ANT CERV SPN NONSTRL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"04.613.016","SUP","HCPCS C1713","","04.613.016  -  PLATE 25MM TI 1 LVL VCTR BONE 16MM ANT CERV SPN NONSTRL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"04.613.130","SUP","HCPCS C1713","","04.613.130  -  PLATE BN BNT GRV PREBNT 39X16.5X2.5MM NS 30MM VCTR 2 LVL 1","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"04.613.132","SUP","HCPCS C1713","","04.613.132  -  PLATE BN BNT GRV PREBNT 41X16.5X2.5MM NS 32MM VCTR 2 LVL 1","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"04.613.516","SUP","HCPCS C1713","","04.613.516  -  SCREW BONE 4MM 16MM VCT-T TI ANT CERV SPN SLFRET SLFDRILL","BOTH IP/OP","$498.10 ","$368.59 ","$0.00 ","$498.10 ","$224.15 ","$0.00 ","$103.82 ","$0.00 ","$0.00 ","$87.21 ","$498.10 ","$0.00 ","$249.05 ","$394.50 ","$398.48 ","$0.00 ","$77.95 ","$0.00 ","$79.30 ","$0.00 "
"04.613.616","SUP","HCPCS C1713","","04.613.616  -  SCREW BONE 4MM 16MM VCT-T TI ANT CERV SPN SLFTAP SLFRET VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"04.613.618","SUP","HCPCS C1713","","04.613.618  -  SCREW BONE 4MM 18MM VCT-T TI ANT CERV SPN SLFTAP SLFRET VAR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"04.613.666","SUP","HCPCS C1713","","04.613.666  -  SCREW BONE 4.5MM 16MM VCT-T TI ANT CERV SPN SLFTAP SLFRET","BOTH IP/OP","$477.70 ","$353.50 ","$0.00 ","$477.70 ","$214.97 ","$0.00 ","$99.56 ","$0.00 ","$0.00 ","$83.64 ","$477.70 ","$0.00 ","$238.85 ","$378.34 ","$382.16 ","$0.00 ","$74.76 ","$0.00 ","$76.05 ","$0.00 "
"04.614.010","SUP","HCPCS C1713","","04.614.010  -  SCREW BONE 3.5MM 10MM SYNAPSE TI CANC SPNL POLYAX NONSTRL","BOTH IP/OP","$2,576.00 ","$1,906.24 ","$0.00 ","$2,576.00 ","$1,159.20 ","$0.00 ","$536.90 ","$0.00 ","$0.00 ","$451.04 ","$2,576.00 ","$0.00 ","$1,288.00 ","$2,040.19 ","$2,060.80 ","$0.00 ","$403.14 ","$0.00 ","$410.10 ","$0.00 "
"04.614.012","SUP","HCPCS C1713","","04.614.012  -  SCREW BONE 3.5MM 12MM SYNAPSE TI CANC SPNL POLYAX NONSTRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.614.014","SUP","HCPCS C1713","","04.614.014  -  SCREW BONE 3.5MM 14MM SYNAPSE TI CANC SPNL POLYAX NONSTRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.614.016","SUP","HCPCS C1713","","04.614.016  -  SCREW BONE 3.5MM 16MM SYNAPSE TI CANC SPNL POLYAX NONSTRL","BOTH IP/OP","$2,576.00 ","$1,906.24 ","$0.00 ","$2,576.00 ","$1,159.20 ","$0.00 ","$536.90 ","$0.00 ","$0.00 ","$451.04 ","$2,576.00 ","$0.00 ","$1,288.00 ","$2,040.19 ","$2,060.80 ","$0.00 ","$403.14 ","$0.00 ","$410.10 ","$0.00 "
"04.614.020","SUP","HCPCS C1713","","04.614.020  -  SCREW BONE 3.5MM 20MM SYNAPSE TI CANC SPNL POLYAX NONSTRL","BOTH IP/OP","$2,576.00 ","$1,906.24 ","$0.00 ","$2,576.00 ","$1,159.20 ","$0.00 ","$536.90 ","$0.00 ","$0.00 ","$451.04 ","$2,576.00 ","$0.00 ","$1,288.00 ","$2,040.19 ","$2,060.80 ","$0.00 ","$403.14 ","$0.00 ","$410.10 ","$0.00 "
"04.614.110","SUP","HCPCS C1713","","04.614.110  -  SCREW BONE 4MM 10MM SYNAPSE TI CANC SPNL POLYAX","BOTH IP/OP","$2,576.00 ","$1,906.24 ","$0.00 ","$2,576.00 ","$1,159.20 ","$0.00 ","$536.90 ","$0.00 ","$0.00 ","$451.04 ","$2,576.00 ","$0.00 ","$1,288.00 ","$2,040.19 ","$2,060.80 ","$0.00 ","$403.14 ","$0.00 ","$410.10 ","$0.00 "
"04.614.112","SUP","HCPCS C1713","","04.614.112  -  SCREW BONE 0-50D 4MM 2.4MM 12MM T15 STARDRIVE POLYAX SLFTAP","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.614.114","SUP","HCPCS C1713","","04.614.114  -  SCREW BONE 4MM 2.4MM 14MM SYNAPSE TI 50- D T15 SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.614.118","SUP","HCPCS C1713","","04.614.118  -  SCREW BN 50- D T15 4MM 2.4MM 18MM GRN GRY NS SYNAPSE PA ST","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.614.124","SUP","HCPCS C1713","","04.614.124  -  SCREW BONE 4MM 24MM SYNAPSE TI CANC SPNL POLYAX","BOTH IP/OP","$2,576.00 ","$1,906.24 ","$0.00 ","$2,576.00 ","$1,159.20 ","$0.00 ","$536.90 ","$0.00 ","$0.00 ","$451.04 ","$2,576.00 ","$0.00 ","$1,288.00 ","$2,040.19 ","$2,060.80 ","$0.00 ","$403.14 ","$0.00 ","$410.10 ","$0.00 "
"04.614.126","SUP","HCPCS C1713","","04.614.126  -  SCREW BONE 4MM 26MM SYNAPSE TI CANC SPNL POLYAX NONSTRL","BOTH IP/OP","$2,576.00 ","$1,906.24 ","$0.00 ","$2,576.00 ","$1,159.20 ","$0.00 ","$536.90 ","$0.00 ","$0.00 ","$451.04 ","$2,576.00 ","$0.00 ","$1,288.00 ","$2,040.19 ","$2,060.80 ","$0.00 ","$403.14 ","$0.00 ","$410.10 ","$0.00 "
"04.614.226","SUP","HCPCS C1713","","04.614.226  -  SCREW BONE 40D LARGE DIAMETER T15 SQUARE 4.5MM 3.2MM 26MM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"04.614.508","SUP","HCPCS C1713","","04.614.508  -  SCREW BONE 5MM 8MM TI SPNL LCK NONSTRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"04.614.510","SUP","HCPCS C1713","","04.614.510  -  ROD SPNL 120-175MM 3.5-6MM TI HRD NONSTRL","BOTH IP/OP","$1,748.25 ","$1,293.71 ","$0.00 ","$1,748.25 ","$786.71 ","$0.00 ","$364.38 ","$0.00 ","$0.00 ","$306.10 ","$1,748.25 ","$0.00 ","$874.13 ","$1,384.61 ","$1,398.60 ","$0.00 ","$273.60 ","$0.00 ","$278.32 ","$0.00 "
"04.614.513","SUP","Custom 27803010","","04.614.513  -  TRNCON ROD 60MM SPNL TI NONSTRL","BOTH IP/OP","$2,709.00 ","$2,004.66 ","$0.00 ","$2,709.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,709.00 ","$0.00 ","$1,354.50 ","$2,145.53 ","$2,167.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.614.516","SUP","Custom 27803010","","04.614.516  -  TRNCON ROD MED TI TOP LD NONSTRL","BOTH IP/OP","$3,150.00 ","$2,331.00 ","$0.00 ","$3,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,150.00 ","$0.00 ","$1,575.00 ","$2,494.80 ","$2,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.614.521","SUP","HCPCS C1713","","04.614.521  -  SCREW BONE 7.5MM SYNAPSE TI SPNL LCK TRNCON NONSTRL","BOTH IP/OP","$218.75 ","$161.88 ","$0.00 ","$218.75 ","$98.44 ","$0.00 ","$45.59 ","$0.00 ","$0.00 ","$38.30 ","$218.75 ","$0.00 ","$109.38 ","$173.25 ","$175.00 ","$0.00 ","$34.23 ","$0.00 ","$34.83 ","$0.00 "
"04.614.522","SUP","HCPCS C1713","","04.614.522  -  SCREW BONE SYNAPSE TI SPNL LCK TRNCON NONSTRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"04.614.745","SUP","HCPCS C1713","","04.614.745  -  ROD SPNL 45MM 3.5MM CURVE TI NONSTRL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"04.617.129S","SUP","Custom 27803010","","04.617.129S  -  SPACER SPNL STD LRDTC 9MM STRL ZERO-PPEEK-OPTM TI","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.617.814","SUP","HCPCS C1713","","04.617.814  -  SCREW BONE 3MM 14MM TI CERV SPN LCK NONSTRL","BOTH IP/OP","$722.50 ","$534.65 ","$0.00 ","$722.50 ","$325.13 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$126.50 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$113.07 ","$0.00 ","$115.02 ","$0.00 "
"04.620.000","SUP","Custom 27803010","","04.620.000  -  CAP LCK PANGEA SPNL TI NONSTRL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.620.170","SUP","HCPCS C1713","","04.620.170  -  ROD SPNL 70MM 6MM PANGEA USS PDCL TI CVD SFT PRECONTOURED","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$217.35 ","$0.00 ","$100.67 ","$0.00 ","$0.00 ","$84.57 ","$483.00 ","$0.00 ","$241.50 ","$382.54 ","$386.40 ","$0.00 ","$75.59 ","$0.00 ","$76.89 ","$0.00 "
"04.620.203","SUP","Custom 27803010","","04.620.203  -  TRNCON ROD 33-36.5MM PANGEA PDCL TI LP 6MM ROD NONSTRL","BOTH IP/OP","$2,432.50 ","$1,800.05 ","$0.00 ","$2,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,432.50 ","$0.00 ","$1,216.25 ","$1,926.54 ","$1,946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.620.204","SUP","Custom 27803010","","04.620.204  -  TRNCON ROD 38.5-48MM 6MM PANGEA USS SPNL PDCL TI LP NONSTRL","BOTH IP/OP","$2,432.50 ","$1,800.05 ","$0.00 ","$2,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,432.50 ","$0.00 ","$1,216.25 ","$1,926.54 ","$1,946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.620.205","SUP","Custom 27803010","","04.620.205  -  TRNCON ROD 49-69MM 6MM PANGEA USS SPNL PDCL TI LP NONSTRL","BOTH IP/OP","$2,432.50 ","$1,800.05 ","$0.00 ","$2,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,432.50 ","$0.00 ","$1,216.25 ","$1,926.54 ","$1,946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"04.620.425","SUP","HCPCS C1713","","04.620.425  -  SCREW BONE 4MM 25MM PANGEA TI PDCL POLYAX STARDRIVE RECESS 2","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.430","SUP","HCPCS C1713","","04.620.430  -  SCREW BONE 4MM 30MM PANGEA TI PDCL POLYAX STARDRIVE RECESS 2","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.530","SUP","HCPCS C1713","","04.620.530  -  SCREW BONE 5MM 30MM PANGEA TI PDCL POLYAX DUAL CORE THRD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.535","SUP","HCPCS C1713","","04.620.535  -  SCREW BONE 5MM 35MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.540","SUP","HCPCS C1713","","04.620.540  -  SCREW BONE 5MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.630","SUP","HCPCS C1713","","04.620.630  -  SCREW BONE 6MM 30MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.635","SUP","HCPCS C1713","","04.620.635  -  SCREW BONE 6MM 35MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.640","SUP","HCPCS C1713","","04.620.640  -  SCREW BONE 6MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.645","SUP","HCPCS C1713","","04.620.645  -  SCREW BONE 6MM 45MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.650","SUP","HCPCS C1713","","04.620.650  -  SCREW BONE 6MM 50MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.740","SUP","HCPCS C1713","","04.620.740  -  SCREW BONE 7MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.745","SUP","HCPCS C1713","","04.620.745  -  SCREW BONE 7MM 45MM PANGEA TI PDCL POLYAX 2 CORE NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.620.750","SUP","HCPCS C1713","","04.620.750  -  SCREW BONE 7MM 50MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"04.808.003","SUP","HCPCS C1713","","04.808.003  -  CAGE SPNL 29X21MM SYNEX 2 TI ALIF NONSTRL","BOTH IP/OP","$10,017.00 ","$7,412.58 ","$0.00 ","$10,017.00 ","$4,507.65 ","$0.00 ","$2,087.79 ","$0.00 ","$0.00 ","$1,753.90 ","$10,017.00 ","$0.00 ","$5,008.50 ","$7,933.46 ","$8,013.60 ","$0.00 ","$1,567.66 ","$0.00 ","$1,594.71 ","$0.00 "
"04.808.004","SUP","HCPCS C1713","","04.808.004  -  CAGE SPNL 25-33MM SYNEX 2 TI LMBR INTRBD FS CENTRL BODY","BOTH IP/OP","$11,408.25 ","$8,442.11 ","$0.00 ","$11,408.25 ","$5,133.71 ","$0.00 ","$2,377.76 ","$0.00 ","$0.00 ","$1,997.49 ","$11,408.25 ","$0.00 ","$5,704.13 ","$9,035.33 ","$9,126.60 ","$0.00 ","$1,785.39 ","$0.00 ","$1,816.19 ","$0.00 "
"04.808.018","SUP","HCPCS C1713","","04.808.018  -  EPLT SPNL GOLD 20X19MM SYNEX 2 SM 0","BOTH IP/OP","$2,040.50 ","$1,509.97 ","$0.00 ","$2,040.50 ","$918.23 ","$0.00 ","$425.29 ","$0.00 ","$0.00 ","$357.28 ","$2,040.50 ","$0.00 ","$1,020.25 ","$1,616.08 ","$1,632.40 ","$0.00 ","$319.34 ","$0.00 ","$324.85 ","$0.00 "
"04.808.027","SUP","HCPCS C1713","","04.808.027  -  EPLT SPNL 25MM 22MM 0D TI NONSTRL","BOTH IP/OP","$2,040.50 ","$1,509.97 ","$0.00 ","$2,040.50 ","$918.23 ","$0.00 ","$425.29 ","$0.00 ","$0.00 ","$357.28 ","$2,040.50 ","$0.00 ","$1,020.25 ","$1,616.08 ","$1,632.40 ","$0.00 ","$319.34 ","$0.00 ","$324.85 ","$0.00 "
"04-503-228","SUP","HCPCS C1713","","04-503-228  -  SCREW TI 8MM SLFDRILL BONE MTRXMDFACE PLT SYS","BOTH IP/OP","$164.25 ","$121.55 ","$0.00 ","$164.25 ","$73.91 ","$0.00 ","$34.23 ","$0.00 ","$0.00 ","$28.76 ","$164.25 ","$0.00 ","$82.13 ","$130.09 ","$131.40 ","$0.00 ","$25.71 ","$0.00 ","$26.15 ","$0.00 "
"04-503-346","SUP","HCPCS C1713","","04-503-346  -  PLATE .5MM 20 HOLE ADP BONE MATRIXMIDFACE TI NSTRL BLUE","BOTH IP/OP","$1,206.00 ","$892.44 ","$0.00 ","$1,206.00 ","$542.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.16 ","$1,206.00 ","$0.00 ","$603.00 ","$955.15 ","$964.80 ","$0.00 ","$188.74 ","$0.00 ","$192.00 ","$0.00 "
"04-503-396","SUP","HCPCS C1713","","04-503-396  -  PLATE STD MINI .8MM 20 HOLE ADP BONE MATRIXMIDFACE TI NSTRL","BOTH IP/OP","$1,206.00 ","$892.44 ","$0.00 ","$1,206.00 ","$542.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.16 ","$1,206.00 ","$0.00 ","$603.00 ","$955.15 ","$964.80 ","$0.00 ","$188.74 ","$0.00 ","$192.00 ","$0.00 "
"046-237","SUP","Custom 27803010","","046-237  -  WIRE SUTURE 6 CCS-1 14IN 2 MONOFILAMENT MYO/WIRE II","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"050-508-000","SUP","Custom 27203010","","CONNECTOR PRFSN STRG EQL .5IN X.5IN STRL","BOTH IP/OP","$19.90 ","$14.73 ","$0.00 ","$19.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.90 ","$0.00 ","$9.95 ","$15.76 ","$15.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"050-526-000","SUP","Custom 27011340","","050-526-000  -  CONNECTOR PERFUSION 3/8INX3/8INX3/8IN 3/8INX3/8INX3/8IN Y","BOTH IP/OP","$0.53 ","$0.39 ","$0.00 ","$0.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.53 ","$0.00 ","$0.26 ","$0.42 ","$0.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"050-604-000","SUP","Custom 27203010","","CONNECTOR PRFSN STRG LUER LOCK LOCK .25IN X.25IN","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0523-48","SUP","Custom 27203010","","ADHESIVE LQ VL AMPULE MSTSL STRL 2/3ML SKN","BOTH IP/OP","$3.25 ","$2.41 ","$0.00 ","$3.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.25 ","$0.00 ","$1.63 ","$2.57 ","$2.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"05-538-51","SUP","Custom 27203010","","TUBE CNTRF 119MM 17MM 15ML POLYPRO GRAD SKRT BTM SCR CAP","BOTH IP/OP","$1.18 ","$0.87 ","$0.00 ","$1.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.18 ","$0.00 ","$0.59 ","$0.93 ","$0.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0580-0-200","SUP","HCPCS C1776","","0580-0-200  -  STEM FEM 200MM OFFST EXTR 3 LNG","BOTH IP/OP","$6,271.00 ","$4,640.54 ","$0.00 ","$6,271.00 ","$2,821.95 ","$0.00 ","$1,307.03 ","$0.00 ","$0.00 ","$1,098.00 ","$6,271.00 ","$0.00 ","$3,135.50 ","$4,966.63 ","$5,016.80 ","$0.00 ","$981.41 ","$0.00 ","$998.34 ","$0.00 "
"0580-0-220","SUP","HCPCS C1776","","0580-0-220  -  STEM FEM 220MM OFFST EXTR 3 LNG","BOTH IP/OP","$6,271.00 ","$4,640.54 ","$0.00 ","$6,271.00 ","$2,821.95 ","$0.00 ","$1,307.03 ","$0.00 ","$0.00 ","$1,098.00 ","$6,271.00 ","$0.00 ","$3,135.50 ","$4,966.63 ","$5,016.80 ","$0.00 ","$981.41 ","$0.00 ","$998.34 ","$0.00 "
"0580-0-240","SUP","HCPCS C1776","","0580-0-240  -  STEM FEM 240MM OFFST EXTR 3 LNG","BOTH IP/OP","$6,271.00 ","$4,640.54 ","$0.00 ","$6,271.00 ","$2,821.95 ","$0.00 ","$1,307.03 ","$0.00 ","$0.00 ","$1,098.00 ","$6,271.00 ","$0.00 ","$3,135.50 ","$4,966.63 ","$5,016.80 ","$0.00 ","$981.41 ","$0.00 ","$998.34 ","$0.00 "
"0580-0-260","SUP","HCPCS C1776","","0580-0-260  -  STEM FEM 260MM OFFST EXTR 3 LNG","BOTH IP/OP","$6,271.00 ","$4,640.54 ","$0.00 ","$6,271.00 ","$2,821.95 ","$0.00 ","$1,307.03 ","$0.00 ","$0.00 ","$1,098.00 ","$6,271.00 ","$0.00 ","$3,135.50 ","$4,966.63 ","$5,016.80 ","$0.00 ","$981.41 ","$0.00 ","$998.34 ","$0.00 "
"0580-0-330","SUP","HCPCS C1776","","0580-0-330  -  STEM FEM 120MM EXTR 2 ANT POST","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-351","SUP","HCPCS C1776","","0580-0-351  -  STEM FEM OFFST EXTR 1 35.5MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-352","SUP","HCPCS C1776","","0580-0-352  -  STEM FEM OFFST SYS EXTR ORTHNX 37.5MM LG TOT HIP","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-371","SUP","HCPCS C1776","","0580-0-371  -  STEM FEM OFFST EXTR ORTHNX 1 37.5MM HIP","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-372","SUP","HCPCS C1776","","0580-0-372  -  STEM FEM OFFST EXTR 2 37.5MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-373","SUP","HCPCS C1776","","0580-0-373  -  STEM FEM OFFST EXTR 3 37.5MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-374","SUP","HCPCS C1776","","0580-0-374  -  STEM FEM OFFST EXTR 4 37.5MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-441","SUP","HCPCS C1776","","0580-0-441  -  STEM FEM 44MM OFFST EXTR 1","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-442","SUP","HCPCS C1776","","0580-0-442  -  STEM FEM OFFST EXTR 2 44MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-443","SUP","HCPCS C1776","","0580-0-443  -  STEM FEM OFFST EXTR 3 44MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-444","SUP","HCPCS C1776","","0580-0-444  -  STEM FEM OFFST EXTR 4 44MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-445","SUP","HCPCS C1776","","0580-0-445  -  STEM FEM OFFST EXTR 5 44MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-446","SUP","HCPCS C1776","","0580-0-446  -  STEM FEM OFFST EXTR 6 44MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-503","SUP","HCPCS C1776","","0580-0-503  -  STEM FEM OFFST EXTR 3 50MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-504","SUP","HCPCS C1776","","0580-0-504  -  STEM FEM 50MM OFFST EXTR 4","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-505","SUP","HCPCS C1776","","0580-0-505  -  STEM FEM OFFST EXTR 5 50MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-0-506","SUP","HCPCS C1776","","0580-0-506  -  STEM FEM OFFST EXTR 6 50MM","BOTH IP/OP","$4,264.00 ","$3,155.36 ","$0.00 ","$4,264.00 ","$1,918.80 ","$0.00 ","$888.72 ","$0.00 ","$0.00 ","$746.59 ","$4,264.00 ","$0.00 ","$2,132.00 ","$3,377.09 ","$3,411.20 ","$0.00 ","$667.32 ","$0.00 ","$678.83 ","$0.00 "
"0580-1-044","SUP","HCPCS C1776","","0580-1-044  -  STEM FEMORAL 0 44MM OFFST LONG CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-200","SUP","HCPCS C1776","","0580-1-200  -  STEM FEMORAL 3 44MM OFFST LONG 200MM CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-220","SUP","HCPCS C1776","","0580-1-220  -  STEM FEMORAL 3 44MM OFFST LONG 220MM CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-240","SUP","HCPCS C1776","","0580-1-240  -  STEM FEMORAL 3 44MM OFFST LONG 240MM CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-260","SUP","HCPCS C1776","","0580-1-260  -  STEM FEMORAL 3 44MM OFFST LONG 260MM CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-300","SUP","HCPCS C1776","","0580-1-300  -  STEM FEMORAL 30MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-330","SUP","HCPCS C1776","","0580-1-330  -  STEM FEMORAL 33MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-351","SUP","HCPCS C1776","","0580-1-351  -  STEM FEMORAL 35.5MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-352","SUP","HCPCS C1776","","0580-1-352  -  STEM FEMORAL 0 35.5MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-371","SUP","HCPCS C1776","","0580-1-371  -  STEM FEMORAL 1 37.5MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-372","SUP","HCPCS C1776","","0580-1-372  -  STEM FEMORAL 2 37.5MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-373","SUP","HCPCS C1776","","0580-1-373  -  STEM FEMORAL 3 37.5MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-374","SUP","HCPCS C1776","","0580-1-374  -  STEM FEMORAL 4 37.5MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-440","SUP","HCPCS C1776","","0580-1-440  -  STEM FEMORAL 0 44MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-441","SUP","HCPCS C1776","","0580-1-441  -  STEM FEMORAL 1 44MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-442","SUP","HCPCS C1776","","0580-1-442  -  STEM FEMORAL 2 44MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-443","SUP","HCPCS C1776","","0580-1-443  -  STEM FEMORAL 3 44MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-444","SUP","HCPCS C1776","","0580-1-444  -  STEM FEMORAL 4 44MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-445","SUP","HCPCS C1776","","0580-1-445  -  STEM FEMORAL 5 45MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-446","SUP","HCPCS C1776","","0580-1-446  -  STEM FEMORAL 6 45MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-501","SUP","HCPCS C1776","","0580-1-501  -  STEM FEMORAL 1 50MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-502","SUP","HCPCS C1776","","0580-1-502  -  STEM FEMORAL 2 50MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-503","SUP","HCPCS C1776","","0580-1-503  -  STEM FEMORAL 3 50MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-504","SUP","HCPCS C1776","","0580-1-504  -  STEM FEMORAL 4 50MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-1-505","SUP","HCPCS C1776","","0580-1-505  -  STEM FEMORAL 5 50MM OFFST CEMENTED EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-2-442","SUP","HCPCS C1776","","0580-2-442  -  STEM FEM 205MM TPR EXTR V40 2 LNG 44MM","BOTH IP/OP","$6,271.00 ","$4,640.54 ","$0.00 ","$6,271.00 ","$2,821.95 ","$0.00 ","$1,307.03 ","$0.00 ","$0.00 ","$1,098.00 ","$6,271.00 ","$0.00 ","$3,135.50 ","$4,966.63 ","$5,016.80 ","$0.00 ","$981.41 ","$0.00 ","$998.34 ","$0.00 "
"0580-3-371","SUP","HCPCS C1776","","0580-3-371  -  STEM FEM 1 37.5MM OFST 125MM STRL EXTR V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-3-422","SUP","HCPCS C1776","","0580-3-422  -  STEM FEMORAL 2 44MM TAPER 44MM 205MM EXETER V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-3-441","SUP","HCPCS C1776","","0580-3-441  -  STEM FEM 1 44MM OFST 125MM STRL EXTR V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-3-501","SUP","HCPCS C1776","","0580-3-501  -  STEM FEM 1 50MM OFST 125MM STRL EXTR V40 HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"0580-9-300","SUP","Custom 27803010","","0580-9-300  -  STEM SURG 30MM EXTR ANTEROPOSTERIOR ORTHNX AP1 TCHQ OFFST","BOTH IP/OP","$721.00 ","$533.54 ","$0.00 ","$721.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$721.00 ","$0.00 ","$360.50 ","$571.03 ","$576.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-022","SUP","Custom 27803010","","0586-0-022  -  HEAD FEMORAL +0MM 22MM CEMENTED EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-026","SUP","Custom 27803010","","0586-0-026  -  HEAD FEMORAL +0MM 26MM CEMENTED EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-028","SUP","Custom 27803010","","0586-0-028  -  HEAD FEMORAL +0MM 28MM CEMENTED EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-032","SUP","Custom 27803010","","0586-0-032  -  HEAD FEMORAL +0MM 32MM CEMENTED EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-326","SUP","Custom 27803010","","0586-0-326  -  HEAD FEMORAL -3MM 26MM CEMENTED EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-328","SUP","Custom 27803010","","0586-0-328  -  HEAD FEMORAL -3MM 28MM NECK EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-0-332","SUP","Custom 27803010","","0586-0-332  -  HEAD FEMORAL -3MM 32MM NECK EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-5-026","SUP","Custom 27803010","","0586-5-026  -  HEAD FEMORAL +5MM 26MM NECK EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-5-028","SUP","Custom 27803010","","0586-5-028  -  HEAD FEMORAL +5MM 28MM NECK EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0586-5-032","SUP","Custom 27803010","","0586-5-032  -  HEAD FEMORAL 5MM 35MM NECK EXETER ORTHINOX HIP","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"05CR000029","SUP","Custom 27203010","","REAGENT ANALY RNS SOL ALC BLND 3.6L","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"05CR000037","SUP","Custom 27203010","","REAGENT CYTO CYSTOLITH FLUID PRSV GYN 4L","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0650HYB0605A","SUP","HCPCS C1768","","0650HYB0605A  -  GRAFT CARDIO 50CM 6MM 6MM 5CM HBRD REINF GORE NTNL","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$2,756.25 ","$0.00 ","$1,276.60 ","$0.00 ","$0.00 ","$1,072.44 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$958.56 ","$0.00 ","$975.10 ","$0.00 "
"0650HYB0610A","SUP","HCPCS C1768","","0650HYB0610A  -  GRAFT VASCULAR 50CM HYBRID REINFORCED COATED NITINOL PTFE 10","BOTH IP/OP","$7,125.00 ","$5,272.50 ","$0.00 ","$7,125.00 ","$3,206.25 ","$0.00 ","$1,485.03 ","$0.00 ","$0.00 ","$1,247.53 ","$7,125.00 ","$0.00 ","$3,562.50 ","$5,643.00 ","$5,700.00 ","$0.00 ","$1,115.06 ","$0.00 ","$1,134.30 ","$0.00 "
"0650HYB0705A","SUP","HCPCS C1768","","0650HYB0705A  -  GRAFT VASC 50CM 7MM 6MM GORE NTNL HBRD REINF CNFIG 5CM","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$2,756.25 ","$0.00 ","$1,276.60 ","$0.00 ","$0.00 ","$1,072.44 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$958.56 ","$0.00 ","$975.10 ","$0.00 "
"0650HYB0805A","SUP","HCPCS C1768","","0650HYB0805A  -  GRAFT VASC 50CM 8MM 6MM GORE NTNL HBRD REINF CNFIG 5CM","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$2,756.25 ","$0.00 ","$1,276.60 ","$0.00 ","$0.00 ","$1,072.44 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$958.56 ","$0.00 ","$975.10 ","$0.00 "
"0684-00-0568-01","SUP","Custom 27803010","","0684-00-0568-01  -  CATHETER IAB 7.5FR 6IN 40ML SNS + 2 STLK DEV FO INS KT INTRO","BOTH IP/OP","$2,725.00 ","$2,016.50 ","$0.00 ","$2,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,725.00 ","$0.00 ","$1,362.50 ","$2,158.20 ","$2,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0684-00-0576-01","SUP","Custom 27803010","","0684-00-0576-01  -  CATHETER IAB .025IN 8FR 17.4MM .027IN 6IN 50CC 258MM SNS +","BOTH IP/OP","$2,613.63 ","$1,934.09 ","$0.00 ","$2,613.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,613.63 ","$0.00 ","$1,306.81 ","$2,069.99 ","$2,090.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"07.704.105S","SUP","HCPCS C1713","","07.704.105S  -  FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 5ML STERILE","BOTH IP/OP","$3,678.00 ","$2,721.72 ","$0.00 ","$3,570.88 ","$1,606.89 ","$0.00 ","$766.59 ","$0.00 ","$0.00 ","$625.23 ","$3,570.88 ","$0.00 ","$1,785.44 ","$2,828.14 ","$2,856.70 ","$0.00 ","$542.57 ","$0.00 ","$568.48 ","$0.00 "
"07.704.110S","SUP","HCPCS C1713","","07.704.110S  -  FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 10ML","BOTH IP/OP","$7,228.70 ","$5,349.24 ","$0.00 ","$7,018.18 ","$3,158.18 ","$0.00 ","$1,506.64 ","$0.00 ","$0.00 ","$1,228.83 ","$7,018.18 ","$0.00 ","$3,509.09 ","$5,558.40 ","$5,614.54 ","$0.00 ","$1,066.35 ","$0.00 ","$1,117.29 ","$0.00 "
"07.704-003S","SUP","HCPCS C1713","","07.704-003S  -  CEMENT BONE NRN SRS 3ML VOID FILR ROT MX STRL","BOTH IP/OP","$2,018.60 ","$1,493.76 ","$0.00 ","$2,018.60 ","$908.37 ","$0.00 ","$420.73 ","$0.00 ","$0.00 ","$353.44 ","$2,018.60 ","$0.00 ","$1,009.30 ","$1,598.73 ","$1,614.88 ","$0.00 ","$315.91 ","$0.00 ","$321.36 ","$0.00 "
"07.704-005S","SUP","HCPCS C1713","","07.704-005S  -  FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE","BOTH IP/OP","$3,678.00 ","$2,721.72 ","$0.00 ","$3,570.88 ","$1,606.89 ","$0.00 ","$766.59 ","$0.00 ","$0.00 ","$625.23 ","$3,570.88 ","$0.00 ","$1,785.44 ","$2,828.14 ","$2,856.70 ","$0.00 ","$518.81 ","$0.00 ","$568.48 ","$0.00 "
"07.704-010S","SUP","HCPCS C1713","","07.704-010S  -  FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE","BOTH IP/OP","$7,228.70 ","$5,349.24 ","$0.00 ","$7,018.18 ","$3,158.18 ","$0.00 ","$1,506.64 ","$0.00 ","$0.00 ","$1,228.83 ","$7,018.18 ","$0.00 ","$3,509.09 ","$5,558.40 ","$5,614.54 ","$0.00 ","$1,066.35 ","$0.00 ","$1,117.29 ","$0.00 "
"07-036P","SUP","HCPCS C1713","","07-036P  -  7 MM WASHER","BOTH IP/OP","$28.50 ","$21.09 ","$0.00 ","$28.50 ","$12.83 ","$0.00 ","$5.94 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"07-150-10","SUP","Custom 27203010","","07-150-10  -  PROBE DOPPLER 20MHZ 280MM BAYONETED STERILE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,547.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,547.50 ","$0.00 ","$1,273.75 ","$2,017.62 ","$2,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"07-150-12","SUP","Custom 27203010","","07-150-12  -  PROBE DOPPLER MINI NEURO DISPOSABLE","BOTH IP/OP","$4,015.00 ","$2,971.10 ","$0.00 ","$3,897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,897.50 ","$0.00 ","$1,948.75 ","$3,086.82 ","$3,118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"073701-CD","SUP","Custom 27203010","","073701-CD  -  SET DILAT S-CURVE HYDPHI PLMR SDPRT LFRIC SLIP SRFC 37CM","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"07-40230","SUP","Custom 27803010","","07-40230  -  DRILL DRL 2.4MM CNN D STP","BOTH IP/OP","$463.25 ","$342.81 ","$0.00 ","$489.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$489.50 ","$0.00 ","$244.75 ","$387.68 ","$391.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"07-40232","SUP","Custom 27803010","","07-40232  -  TAP CANN DEPTH STOP SURG","BOTH IP/OP","$417.00 ","$308.58 ","$0.00 ","$375.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.38 ","$0.00 ","$187.69 ","$297.30 ","$300.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"07-40280","SUP","HCPCS C1713","","07-40280  -  WIRE FIX 1MM 160MM KWIRE SS ORTH LEIBINGER","BOTH IP/OP","$44.25 ","$32.75 ","$0.00 ","$9.22 ","$1.86 ","$0.00 ","$9.22 ","$0.00 ","$0.00 ","$0.72 ","$4.13 ","$0.00 ","$2.06 ","$3.27 ","$3.30 ","$0.00 ","$0.65 ","$0.00 ","$0.66 ","$0.00 "
"07-40281","SUP","HCPCS C1713","","07-40281  -  WIRE FX 1.1MM 160MM NS KRSH LGTH MRK SS","BOTH IP/OP","$37.40 ","$27.68 ","$0.00 ","$38.50 ","$17.33 ","$0.00 ","$7.80 ","$0.00 ","$0.00 ","$6.74 ","$38.50 ","$0.00 ","$19.25 ","$30.49 ","$30.80 ","$0.00 ","$6.03 ","$0.00 ","$6.13 ","$0.00 "
"07782G","SUP","Custom 27203010","","CORK GRAD LAB 4","BOTH IP/OP","$0.25 ","$0.19 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.25 ","$0.00 ","$0.13 ","$0.20 ","$0.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"08.510.543S","SUP","HCPCS C1713","","08.510.543S  -  PLATE BONE 24MMX1.5MM SYNPOR POLYETHYLENE POROUS ORBTL FLOOR","BOTH IP/OP","$1,447.50 ","$1,071.15 ","$0.00 ","$1,447.50 ","$651.38 ","$0.00 ","$301.70 ","$0.00 ","$0.00 ","$253.45 ","$1,447.50 ","$0.00 ","$723.75 ","$1,146.42 ","$1,158.00 ","$0.00 ","$226.53 ","$0.00 ","$230.44 ","$0.00 "
"08.520.221S","SUP","HCPCS C1713","","08.520.221S  -  PLATE BN FAN .8MM STRL SYNPOR SMTH EXPOSE FX HL RADGR VSB TI","BOTH IP/OP","$4,292.50 ","$3,176.45 ","$0.00 ","$4,292.50 ","$1,931.63 ","$0.00 ","$894.66 ","$0.00 ","$0.00 ","$751.58 ","$4,292.50 ","$0.00 ","$2,146.25 ","$3,399.66 ","$3,434.00 ","$0.00 ","$671.78 ","$0.00 ","$683.37 ","$0.00 "
"08.803.209","SUP","HCPCS C1713","","08.803.209  -  SPACER SPNL BLT NOSE 32X10X9MM NS OPAL REVOLVE RADOPQ SLF","BOTH IP/OP","$13,782.50 ","$10,199.05 ","$0.00 ","$13,782.50 ","$6,202.13 ","$0.00 ","$2,872.62 ","$0.00 ","$0.00 ","$2,413.21 ","$13,782.50 ","$0.00 ","$6,891.25 ","$10,915.74 ","$11,026.00 ","$0.00 ","$2,156.96 ","$0.00 ","$2,194.17 ","$0.00 "
"08A020","SUP","Custom 27804086","","08A020  -  GRAFT BONE CANC 30ML 4-10MM FRZDR","BOTH IP/OP","$1,165.00 ","$862.10 ","$0.00 ","$1,190.70 ","$0.00 ","$0.00 ","$242.82 ","$0.00 ","$0.00 ","$0.00 ","$1,190.70 ","$0.00 ","$595.35 ","$943.03 ","$952.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"08A022","SUP","Custom 27803010","","08A022  -  GRAFT BN 15ML CHP CANC","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"08A024","SUP","Custom 27804086","","08A024  -  GRAFT BN 4-10MM 5ML CHP CANC TBA 013470059 09","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"09.402.022S","SUP","HCPCS C1713","","09.402.022S  -  HEAD RADIAL STANDARD 22MM 12MM COCR ELBOW STERILE","BOTH IP/OP","$3,286.33 ","$2,431.88 ","$0.00 ","$3,286.33 ","$1,478.85 ","$0.00 ","$684.95 ","$0.00 ","$0.00 ","$575.41 ","$3,286.33 ","$0.00 ","$1,643.16 ","$2,602.77 ","$2,629.06 ","$0.00 ","$499.33 ","$0.00 ","$523.18 ","$0.00 "
"0900-05","SUP","Custom 27203010","","NUNC NULL STRIPS","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0920-2-920","SUP","Custom 27803010","","0920-2-920  -  CENTRALIZER STEM EXETER PMMA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"0939-0-106","SUP","HCPCS C1713","","0939-0-106  -  PLUG BONE CEMENT 6MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-108","SUP","HCPCS C1713","","0939-0-108  -  PLUG BONE CEMENT 8MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-110","SUP","HCPCS C1713","","0939-0-110  -  PLUG BONE CEMENT 10MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-112","SUP","HCPCS C1713","","0939-0-112  -  PLUG BONE CEMENT 12MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-114","SUP","HCPCS C1713","","0939-0-114  -  PLUG BONE CEMENT 14MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-116","SUP","HCPCS C1713","","0939-0-116  -  PLUG BONE CEMENT 16MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-118","SUP","HCPCS C1713","","0939-0-118  -  PLUG BONE CEMENT 18MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0939-0-120","SUP","HCPCS C1713","","0939-0-120  -  PLUG BONE CEMENT 20MM EXETER PMMA INTRAMEDULLARY","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"0942-2-110","SUP","HCPCS C1713","","0942-2-110  -  PLUG BONE CEMENT 10MM EXETER X-CHANGE","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-2-112","SUP","HCPCS C1713","","0942-2-112  -  PLUG BONE CEMENT 12MM EXETER X-CHANGE","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-2-114","SUP","HCPCS C1713","","0942-2-114  -  SPACER CEMENT 14MM 14MM BONE PLUGS ACCESSORIES EXETER","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-2-116","SUP","HCPCS C1713","","0942-2-116  -  PLUG BONE CEMENT 16MM EXETER X-CHANGE","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-2-118","SUP","HCPCS C1713","","0942-2-118  -  SPACER CEMENT 18MM BONE PLUGS ACCESSORIES EXETER X-CHANGE","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-2-120","SUP","HCPCS C1713","","0942-2-120  -  PLUG BONE CEMENT 20MM 20MM EXETER X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-000","SUP","HCPCS C1713","","0942-8-000  -  SCREW BONE 3.5MM 10MM SELF TAP SELF DRILL X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-001","SUP","HCPCS C1713","","0942-8-001  -  SCREW BONE 3.5MM 15MM SELF TAP SELF DRILL X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-002","SUP","HCPCS C1713","","0942-8-002  -  SCREW BONE 3.5MM 20MM SELF TAP SELF DRILL X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-003","SUP","HCPCS C1713","","0942-8-003  -  SCREW BONE 3.5MM 25MM SELF TAP SELF DRILL X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-004","SUP","HCPCS C1713","","0942-8-004  -  SCREW BONE 3.5MM 30MM SELF TAP SELF DRILL X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-005","SUP","HCPCS C1713","","0942-8-005  -  SCREW BONE 3.5MM 35MM SELF TAP SELF DRILL X-CHANGE HIP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"0942-8-010","SUP","HCPCS C1781","","0942-8-010  -  MESH ACETAB CURVE X-CHANGE RSTOR HIP","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-020","SUP","HCPCS C1781","","0942-8-020  -  MESH ACETAB LARGE X-CHANGE RSTOR HIP MEDIAL WALL","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-025","SUP","HCPCS C1781","","0942-8-025  -  MESH ACETAB SMALL X-CHANGE RSTOR HIP MEDIAL WALL","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-030","SUP","HCPCS C1781","","0942-8-030  -  MESH ACETAB FLAT X-CHANGE RSTOR HIP","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-040","SUP","HCPCS C1781","","0942-8-040  -  MESH ACETAB SMALL X-CHANGE RSTOR HIP RIM","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-050","SUP","HCPCS C1781","","0942-8-050  -  MESH ACETAB MEDIUM X-CHANGE RSTOR HIP RIM","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-060","SUP","HCPCS C1781","","0942-8-060  -  MESH ACETAB LARGE X-CHANGE RSTOR HIP RIM","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0942-8-070","SUP","HCPCS C1781","","0942-8-070  -  MESH ACETAB ANATOMIC X-CHANGE RSTOR HIP FEMURAL","BOTH IP/OP","$1,285.00 ","$950.90 ","$0.00 ","$1,285.00 ","$578.25 ","$0.00 ","$267.83 ","$0.00 ","$0.00 ","$224.99 ","$1,285.00 ","$0.00 ","$642.50 ","$1,017.72 ","$1,028.00 ","$0.00 ","$201.10 ","$0.00 ","$204.57 ","$0.00 "
"0994-001","SUP","HCPCS C1887","","0994-001  -  CATHETER GD 6FR 140CM VNTR OTW RADOPQ STRBL ML LR COIL TRQ","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$882.38 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"1000-00-0614","SUP","HCPCS C1713","","1000-00-0614  -  CAGE SPNL 7D LRDTC 14X12X6MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0616","SUP","HCPCS C1713","","1000-00-0616  -  CAGE SPNL 7D LRDTC 16X14X6MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0714","SUP","HCPCS C1713","","1000-00-0714  -  CAGE SPNL 7D LRDTC 14X12X7MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0716","SUP","HCPCS C1713","","1000-00-0716  -  CAGE SPNL 7D LRDTC 16X14X7MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0814","SUP","HCPCS C1713","","1000-00-0814  -  CAGE SPNL 7D LRDTC 14X12X8MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0816","SUP","HCPCS C1713","","1000-00-0816  -  CAGE SPNL 7D LRDTC 16X14X8MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0914","SUP","HCPCS C1713","","1000-00-0914  -  CAGE SPNL 7D LRDTC 14X12X9MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-0916","SUP","HCPCS C1713","","1000-00-0916  -  CAGE SPNL 7D LRDTC 16X14X9MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-1014","SUP","HCPCS C1713","","1000-00-1014  -  CAGE SPNL 7D LRDTC 14X12X10MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"1000-00-1016","SUP","HCPCS C1713","","1000-00-1016  -  CAGE SPNL 7D LRDTC 16X14X10MM COHERE LOPRFL MATTE FNSH PEEK","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"100-06","SUP","HCPCS C1713","","100-06  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$248.63 ","$183.99 ","$0.00 ","$248.63 ","$111.88 ","$0.00 ","$51.82 ","$0.00 ","$0.00 ","$43.53 ","$248.63 ","$0.00 ","$124.31 ","$196.91 ","$198.90 ","$0.00 ","$38.91 ","$0.00 ","$39.58 ","$0.00 "
"1001-2200","SUP","Custom 27803010","","1001-2200  -  HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2205","SUP","Custom 27803010","","1001-2205  -  HEAD FEMORAL +05MM MORSE TAPER 22MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2600","SUP","Custom 27803010","","1001-2600  -  HEAD FEMORAL +00MM MORSE TAPER 26MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2605","SUP","Custom 27803010","","1001-2605  -  HEAD FEMORAL +05MM MORSE TAPER 26MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2610","SUP","Custom 27803010","","1001-2610  -  HEAD FEMORAL +10MM MORSE TAPER 26MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2800","SUP","Custom 27803010","","1001-2800  -  HEAD FEMORAL +00MM MORSE TAPER 28MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2805","SUP","Custom 27803010","","1001-2805  -  HEAD FEMORAL +5MM 28MM MORSE TAPERED LFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-2810","SUP","Custom 27803010","","1001-2810  -  HEAD FEM +10 28MM HIP MRS TPR COCR LFIT","BOTH IP/OP","$814.00 ","$602.36 ","$0.00 ","$814.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$814.00 ","$0.00 ","$407.00 ","$644.69 ","$651.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-3200","SUP","Custom 27803010","","1001-3200  -  HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-3205","SUP","Custom 27803010","","1001-3205  -  HEAD FEMORAL +05MM MORSE TAPER 32MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-3210","SUP","Custom 27803010","","1001-3210  -  HEAD FEMORAL +10MM MORSE TAPER 32MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-3299","SUP","Custom 27803010","","1001-3299  -  HEAD FEMORAL +99MM MORSE TAPER 32MM OMNIFIT COCR HIP","BOTH IP/OP","$1,297.50 ","$960.15 ","$0.00 ","$1,297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,297.50 ","$0.00 ","$648.75 ","$1,027.62 ","$1,038.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1001-532","SUP","Custom 27203010","","1001-532  -  CLAMP SURG 75-80GM CLAMPING PRESSURE MIDI STR BULLDOG","BOTH IP/OP","$209.50 ","$155.03 ","$0.00 ","$209.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.50 ","$0.00 ","$104.75 ","$165.92 ","$167.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1003381-13","SUP","HCPCS C1874","","1003381-13  -  STENT CORON .014IN LP 4.5MM 13MM RAPEX SMOOTH SURFACE MARKER","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1003381-18","SUP","HCPCS C1874","","1003381-18  -  SYSTEM COR STNT 4.5MM 18MM MTLNK UL RX LOPRFL RADOPQ SMTH","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1003381-28","SUP","HCPCS C1874","","1003381-28  -  STENT CORON .014IN LP 4.5MM 28MM RAPEX SMOOTH SURFACE MARKER","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"100-36-01","SUP","Custom 27203010","","100-36-01  -  CHEST TUBE INSERTION DEVICE MINIMALLY INVASIVE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1005359H","SUP","HCPCS C1760","","1005359H  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$79.88 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$31.08 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$27.78 ","$0.00 ","$28.26 ","$0.00 "
"1005359H NEW ITEM # 80322174","SUP","HCPCS C1760","","1005359H NEW ITEM # 80322174  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"1007-00","SUP","Custom 27203010","","1007-00  -  VALVULOTOME ANGIOSCOPIC 98CM EXPANDABLE OTW 1.5MM","BOTH IP/OP","$4,197.50 ","$3,106.15 ","$0.00 ","$4,197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,197.50 ","$0.00 ","$2,098.75 ","$3,324.42 ","$3,358.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1007822-08","SUP","HCPCS C1874","","1007822-08  -  STENT CORON 2.25MM 8MM 2 RADIOPQ MARKER BALLOON EXPANDABLE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007823-08","SUP","HCPCS C1874","","1007823-08  -  STENT CORON 2.5MM 8MM .014IN RAPEX FLXB LP MTLNK MVSN COCR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"1007823-15","SUP","HCPCS C1874","","1007823-15  -  STENT CORON LP 2.5MM 15MM 2 RADIOPQ MARKER BALLOON","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007823-28","SUP","HCPCS C1874","","1007823-28  -  STENT CORON LP 2.5MM 28MM 2 RADIOPQ MARKER BALLOON","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007848-08","SUP","HCPCS C1874","","1007848-08  -  SYSTEM CORON STENT 3MM 8MM RAPEX MULTI-LINK VISION BARE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007848-12","SUP","HCPCS C1874","","1007848-12  -  SYSTEM CORON STENT 3MM 12MM RAPEX MULTI-LINK VISION BARE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007848-23","SUP","HCPCS C1874","","1007848-23  -  STENT CORON LP 3MM 23MM 2 RADIOPQ MARKER BALLOON EXPANDABLE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007848-28","SUP","HCPCS C1874","","1007848-28  -  SYSTEM CORON STENT 3MM 28MM RAPEX MULTI-LINK VISION BARE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007849-12","SUP","HCPCS C1874","","1007849-12  -  SYSTEM COR STNT 3.5MM 12MM MTLNK VSN RX LOPRFL RADOPQ BLN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007849-18","SUP","HCPCS C1874","","1007849-18  -  STENT CORON LP 3.5MM 18MM 2 RADIOPQ MARKER BALLOON","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007849-23","SUP","HCPCS C1874","","1007849-23  -  STENT CORON LP 3.5MM 23MM 2 RADIOPQ MARKER BALLOON","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007849-28","SUP","HCPCS C1874","","1007849-28  -  SYSTEM COR STNT 3.5MM 28MM MTLNK VSN RX LOPRFL RADOPQ BLN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007850-08","SUP","HCPCS C1874","","1007850-08  -  STENT CORON 4MM 8MM .014IN RAPEX FLXB LP MTLNK VSN COCR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"1007850-12","SUP","HCPCS C1874","","1007850-12  -  STENT CORON LP 4MM 12MM 2 RADIOPQ MARKER BALLOON EXPANDABLE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1007850-15","SUP","HCPCS C1874","","1007850-15  -  STENT CORON LP 4MM 15MM 2 RADIOPQ MARKER BALLOON EXPANDABLE","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1008193-20","SUP","HCPCS C1725","","1008193-20  -  CATHETER BLNDIL 5MM 135CM 20MM VTRC14 + RX LOPRFL FLXB KINK","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$0.00 ","$0.00 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"1009539-08","SUP","HCPCS C1874","","1009539-08  -  STENT COR 2.5MM 8MM 143CM XIENCE V DLV SYS RX RADOPQ TPR BLN","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009539-12","SUP","HCPCS C1874","","1009539-12  -  SYSTEM COR STNT 2.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009539-15","SUP","HCPCS C1874","","1009539-15  -  SYSTEM COR STNT 2.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009539-18","SUP","HCPCS C1874","","1009539-18  -  SYSTEM COR STNT 2.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009539-23","SUP","HCPCS C1874","","1009539-23  -  SYSTEM COR STNT 2.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009539-28","SUP","HCPCS C1874","","1009539-28  -  SYSTEM COR STNT 2.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009540-12","SUP","HCPCS C1874","","1009540-12  -  SYSTEM COR STNT 2.75MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009540-15","SUP","HCPCS C1874","","1009540-15  -  SYSTEM COR STNT 2.75MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009540-18","SUP","HCPCS C1874","","1009540-18  -  SYSTEM COR STNT 2.75MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009540-23","SUP","HCPCS C1874","","1009540-23  -  SYSTEM COR STNT 2.75MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009540-28","SUP","HCPCS C1874","","1009540-28  -  SYSTEM COR STNT 2.75MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009541-12","SUP","HCPCS C1874","","1009541-12  -  SYSTEM COR STNT 3MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009541-15","SUP","HCPCS C1874","","1009541-15  -  SYSTEM COR STNT 3MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009541-18","SUP","HCPCS C1874","","1009541-18  -  SYSTEM COR STNT 3MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009541-23","SUP","HCPCS C1874","","1009541-23  -  SYSTEM COR STNT 3MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009541-28","SUP","HCPCS C1874","","1009541-28  -  SYSTEM COR STNT 3MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009542-08","SUP","HCPCS C1874","","1009542-08  -  SYSTEM COR STNT 3.5MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009542-12","SUP","HCPCS C1874","","1009542-12  -  SYSTEM COR STNT 3.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009542-15","SUP","HCPCS C1874","","1009542-15  -  SYSTEM COR STNT 3.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009542-18","SUP","HCPCS C1874","","1009542-18  -  SYSTEM COR STNT 3.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009542-23","SUP","HCPCS C1874","","1009542-23  -  SYSTEM COR STNT 3.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009542-28","SUP","HCPCS C1874","","1009542-28  -  SYSTEM COR STNT 3.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009543-08","SUP","HCPCS C1874","","1009543-08  -  SYSTEM COR STNT 4MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ TPR","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009543-12","SUP","HCPCS C1874","","1009543-12  -  SYSTEM COR STNT 4MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009543-15","SUP","HCPCS C1874","","1009543-15  -  SYSTEM COR STNT 4MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009543-18","SUP","HCPCS C1874","","1009543-18  -  SYSTEM COR STNT 4MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009543-23","SUP","HCPCS C1874","","1009543-23  -  SYSTEM COR STNT 4MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009543-28","SUP","HCPCS C1874","","1009543-28  -  SYSTEM COR STNT 4MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009544-08","SUP","HCPCS C1874","","1009544-08  -  SYSTEM COR STNT 2.25MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009544-15","SUP","HCPCS C1874","","1009544-15  -  SYSTEM COR STNT 2.25MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009544-18","SUP","HCPCS C1874","","1009544-18  -  SYSTEM COR STNT 2.25MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1009544-28","SUP","HCPCS C1874","","1009544-28  -  SYSTEM COR STNT 2.25MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"1010-10-PAD","SUP","HCPCS A4565","","1010-10-PAD  -  SLING ORTH XL","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1010-10-PAD-30","SUP","HCPCS A4565","","1010-10-PAD-30  -  SLING ORTH MED","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1010-10-PAD-40","SUP","HCPCS A4565","","1010-10-PAD-40  -  SLING ORTH LG","BOTH IP/OP","$7.07 ","$5.23 ","$0.00 ","$7.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.07 ","$0.00 ","$3.54 ","$5.60 ","$5.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1010480H","SUP","HCPCS C1769","","GUIDEWIRE VASC .014IN 190CM 3CM STRG HTORQ PILT 50 HDRCT","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"10-1073","SUP","Custom 27203010","","10-1073  -  SET BONE BIOP 16CM BONOPTY CORT CANNU STY EJTR PIN DEPTH GA","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1011337-40","SUP","HCPCS C1876","","1011337-40  -  STENT VASCULAR STR LP 5MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011338-40","SUP","HCPCS C1876","","1011338-40  -  STENT VASCULAR STR LP 6MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011339-40","SUP","HCPCS C1876","","1011339-40  -  STENT VASCULAR STR LP 7MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011340-40","SUP","HCPCS C1876","","1011340-40  -  STENT VASCULAR STR LP 8MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011341-40","SUP","HCPCS C1876","","1011341-40  -  STENT VASCULAR STR LP 9MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011342-40","SUP","HCPCS C1876","","1011342-40  -  STENT VASCULAR STR LP 10MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011343-30","SUP","HCPCS C1876","","1011343-30  -  STENT VASCULAR LP TAPER 6-8MM 8FR 30MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011343-40","SUP","HCPCS C1876","","1011343-40  -  STENT VASCULAR LP TAPER 6-8MM 8FR 40MM 132CM SELF EXPANDABLE","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011344-40","SUP","HCPCS C1876","","1011344-40  -  STENT VASCULAR LP TAPER 7-10MM 8FR 40MM 132CM SELF","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"1011650-55","SUP","HCPCS C1760","","1011650-55  -  SYSTEM EMBOLIC PROTECTION LP 4.5MM 6-8FR 300CM GWIRE","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"1012402-15A","SUP","HCPCS C1725","","1012402-15A  -  CATHETER BLNDIL 1.5MM 145CM 15MM MN TREK II OTW 2 LUM ULT","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$212.50 ","$115.39 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"1012534-100","SUP","HCPCS C1876","","1012534-100  -  STENT BILIARY 6MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"1012535-100","SUP","HCPCS C1876","","1012535-100  -  STENT BILIARY 7MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"1016-17","SUP","HCPCS Q4116","","1016-17  -  GRAFT SKIN MEDIUM FROZEN CADAVER NONMESHED 232 SQ CM/ � SQ F","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$504.00 ","$0.00 ","$233.44 ","$0.00 ","$0.00 ","$196.10 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$175.28 ","$0.00 ","$178.30 ","$0.00 "
"1017-17","SUP","HCPCS Q4116","","1017-17  -  GRAFT SKN 154SQ CM NONMESHED CRPRS","BOTH IP/OP","$645.00 ","$477.30 ","$0.00 ","$645.00 ","$290.25 ","$0.00 ","$134.43 ","$0.00 ","$0.00 ","$112.93 ","$645.00 ","$0.00 ","$322.50 ","$510.84 ","$516.00 ","$0.00 ","$100.94 ","$0.00 ","$102.68 ","$0.00 "
"101-L05-C","SUP","HCPCS C1713","","101-L05-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"101-L25","SUP","HCPCS C1713","","101-L25  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"101-R25","SUP","HCPCS C1713","","101-R25  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"1022-0004","SUP","Custom 27803010","","1022-0004  -  STEM FEM COLLAR SMTH OMFLX 4","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0005","SUP","Custom 27803010","","1022-0005  -  STEM FEM COLLAR SMTH OMFLX 5","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0006","SUP","Custom 27803010","","1022-0006  -  STEM FEM COLLAR SMTH OMFLX 6","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0007","SUP","Custom 27803010","","1022-0007  -  STEM FEM COLLAR SMTH OMFLX 7","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0008","SUP","Custom 27803010","","1022-0008  -  STEM FEM COLLAR SMTH OMFLX 8","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0009","SUP","Custom 27803010","","1022-0009  -  STEM FEM COLLAR SMTH OMFLX 9","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0010","SUP","Custom 27803010","","1022-0010  -  STEM FEM COLLAR SMTH OMFLX 10","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0011","SUP","Custom 27803010","","1022-0011  -  STEM FEM COLLAR SMTH OMFLX 11","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0012","SUP","Custom 27803010","","1022-0012  -  STEM FEM COLLAR SMTH OMFLX 12","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0013","SUP","Custom 27803010","","1022-0013  -  STEM FEM COLLAR SMTH OMFLX 13","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1022-0014","SUP","Custom 27803010","","1022-0014  -  STEM FEM COLLAR SMTH OMFLX 14","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103.25.180","SUP","Custom 27203010","","103.25.180  -  BIT DRL 2 FLUT 2.5MM 180MM 154MM QC","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$208.00 ","$0.00 ","$104.00 ","$164.74 ","$166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103-0304","SUP","Custom 27203010","","103-0304  -  DEVICE CADENCE PRCS 1ML SYR INJECTOR INFLAT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$249.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$249.50 ","$0.00 ","$124.75 ","$197.60 ","$199.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"103-0601-200","SUP","HCPCS C1769","","103-0601-200  -  GWIRE VASC .01IN 200CM 10CM SILVERSPEED HYDPHI","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$312.23 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"103-0602-300","SUP","HCPCS C1769","","103-0602-300  -  GWIRE VASC .014IN 300CM 20CM FLXB EXCH XCLRT HYDPHI","BOTH IP/OP","$867.50 ","$641.95 ","$0.00 ","$867.50 ","$471.05 ","$0.00 ","$180.81 ","$0.00 ","$0.00 ","$151.89 ","$867.50 ","$0.00 ","$433.75 ","$687.06 ","$694.00 ","$0.00 ","$135.76 ","$0.00 ","$138.11 ","$0.00 "
"103-0603-200","SUP","HCPCS C1769","","103-0603-200  -  GWIRE VASC .016IN 200CM FLXB SILVERSPEED HYDPHI","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$291.86 ","$0.00 ","$112.03 ","$0.00 ","$0.00 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"103-0605-200","SUP","HCPCS C1769","","103-0605-200  -  GWIRE VASC 175CM 20CM .014IN SFT COIL TIP HYDPHI XPDN","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$357.02 ","$0.00 ","$137.04 ","$0.00 ","$0.00 ","$115.12 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$102.90 ","$0.00 ","$104.67 ","$0.00 "
"103-0608","SUP","HCPCS C1769","","103-0608  -  GWIRE VASC .008IN 200CM 10CM SFT COIL TIP TPR X SPRT MRG","BOTH IP/OP","$1,090.00 ","$806.60 ","$0.00 ","$1,090.00 ","$591.87 ","$0.00 ","$227.18 ","$0.00 ","$0.00 ","$190.85 ","$1,090.00 ","$0.00 ","$545.00 ","$863.28 ","$872.00 ","$0.00 ","$170.59 ","$0.00 ","$173.53 ","$0.00 "
"103-L05","SUP","HCPCS C1713","","103-L05  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$403.75 ","$298.78 ","$0.00 ","$403.75 ","$181.69 ","$0.00 ","$84.15 ","$0.00 ","$0.00 ","$70.69 ","$403.75 ","$0.00 ","$201.88 ","$319.77 ","$323.00 ","$0.00 ","$63.19 ","$0.00 ","$64.28 ","$0.00 "
"103-R05","SUP","HCPCS C1713","","103-R05  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$408.00 ","$301.92 ","$0.00 ","$408.00 ","$183.60 ","$0.00 ","$85.04 ","$0.00 ","$0.00 ","$71.44 ","$408.00 ","$0.00 ","$204.00 ","$323.14 ","$326.40 ","$0.00 ","$63.85 ","$0.00 ","$64.95 ","$0.00 "
"10-403FC","SUP","Custom 27203010","","10-403FC -  DEVICE SPECIMEN RETRIEVAL TISSUE REMOVAL MYOSURE","BOTH IP/OP","$3,890.00 ","$2,878.60 ","$0.00 ","$3,890.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,890.00 ","$0.00 ","$1,945.00 ","$3,080.88 ","$3,112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4112","SUP","HCPCS C2628","","104-4112  -  CATH BLNOCC 2.8-2.2FR 4MM 150CM 15MM REINF SHFT HYDPHI","BOTH IP/OP","$2,675.00 ","$1,979.50 ","$0.00 ","$2,675.00 ","$0.00 ","$0.00 ","$557.54 ","$0.00 ","$0.00 ","$0.00 ","$2,675.00 ","$0.00 ","$1,337.50 ","$2,118.60 ","$2,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4127","SUP","HCPCS C2628","","104-4127  -  CATH BLNOCC 2.8-2.2FR 20MM 150CM 4MM REINF SHFT HYDPHI","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$0.00 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$0.00 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4132","SUP","HCPCS C2628","","104-4132  -  CATH BLNOCC 2.3FR 4MM 150CM 30MM REINF SHFT HYDPHI","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$0.00 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$0.00 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4310","SUP","HCPCS C1726","","104-4310  -  HYPERGLIDE 3.0 X 10MM","BOTH IP/OP","$2,675.00 ","$1,979.50 ","$0.00 ","$2,675.00 ","$1,452.53 ","$0.00 ","$557.54 ","$0.00 ","$0.00 ","$468.37 ","$2,675.00 ","$0.00 ","$1,337.50 ","$2,118.60 ","$2,140.00 ","$0.00 ","$418.64 ","$0.00 ","$425.86 ","$0.00 "
"104-4315","SUP","HCPCS C2628","","104-4315  -  CATHETER BALLOON  HYPERGLIDE .010 IN L150 CM L15 MM","BOTH IP/OP","$2,675.00 ","$1,979.50 ","$0.00 ","$2,675.00 ","$0.00 ","$0.00 ","$557.54 ","$0.00 ","$0.00 ","$0.00 ","$2,675.00 ","$0.00 ","$1,337.50 ","$2,118.60 ","$2,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4470","SUP","HCPCS C1751","","104-4470  -  CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM 7MM HYPERFORM","BOTH IP/OP","$3,312.50 ","$2,451.25 ","$0.00 ","$3,312.50 ","$1,798.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.99 ","$3,312.50 ","$0.00 ","$1,656.25 ","$2,623.50 ","$2,650.00 ","$0.00 ","$518.41 ","$0.00 ","$527.35 ","$0.00 "
"104-44770","SUP","HCPCS C2628","","104-44770  -  BALLOON, HYPERFORM 4MM X 7MM","BOTH IP/OP","$3,312.50 ","$2,451.25 ","$0.00 ","$3,312.50 ","$0.00 ","$0.00 ","$690.41 ","$0.00 ","$0.00 ","$0.00 ","$3,312.50 ","$0.00 ","$1,656.25 ","$2,623.50 ","$2,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4515","SUP","HCPCS C1757","","104-4515  -  CATHETER BLNOCC .01IN 4MM 2.8-2.2FR 5MM 150CM 15MM","BOTH IP/OP","$2,675.00 ","$1,979.50 ","$0.00 ","$2,675.00 ","$0.00 ","$0.00 ","$557.54 ","$0.00 ","$0.00 ","$0.00 ","$2,675.00 ","$0.00 ","$1,337.50 ","$2,118.60 ","$2,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4520","SUP","HCPCS C1757","","104-4520  -  CATHETER BLNOCC 4MM 2.8-2.2FR 5MM 150CM 20MM HYPERGLIDE 1","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$0.00 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$0.00 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104-4770","SUP","HCPCS C2628","","104-4770  -  CATH BLNOCC .01IN 7MM 150CM 7MM GWIRE SL ASYM VASCULATURE","BOTH IP/OP","$3,312.50 ","$2,451.25 ","$0.00 ","$3,312.50 ","$0.00 ","$0.00 ","$690.41 ","$0.00 ","$0.00 ","$0.00 ","$3,312.50 ","$0.00 ","$1,656.25 ","$2,623.50 ","$2,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104834-001","SUP","Custom 27203010","","104834-001  -  CATHETER THROMBECTOMY Y SPIKE 6FR LATEX FREE ANGIOJET POWER","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"104834-002","SUP","HCPCS C1757","","104834-002  -  KIT THRMB 1.5MM 3-4FR 145CM LF 15MM ANGJT ULT ULT SYS OTW","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$17.72 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1050-02","SUP","Custom 27203010","","1050-02  -  VLVLTM ANGIOSCOPIC ANTGRD 12.5CM LEMILLS","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1050-0523","SUP","HCPCS C1776","","1050-0523  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0531","SUP","HCPCS C1776","","1050-0531  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0727","SUP","HCPCS C1776","","1050-0727  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0737","SUP","HCPCS C1776","","1050-0737  -  STEM FEM 37MM OMFT 7 HIP","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0747","SUP","HCPCS C1776","","1050-0747  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0932","SUP","HCPCS C1776","","1050-0932  -  STEM FEM 32MM OMFT 9 HIP","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0943","SUP","HCPCS C1776","","1050-0943  -  STEM FEM 43MM OMFT 9 HIP","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-0955","SUP","HCPCS C1776","","1050-0955  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-1136","SUP","HCPCS C1776","","1050-1136  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-1149","SUP","HCPCS C1776","","1050-1149  -  STEM FEM 49MM OMFT 11 HIP","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"1050-1163","SUP","HCPCS C1776","","1050-1163  -  STEM FEM HDNK OMFT","BOTH IP/OP","$5,486.00 ","$4,059.64 ","$0.00 ","$5,486.00 ","$2,468.70 ","$0.00 ","$1,143.42 ","$0.00 ","$0.00 ","$960.55 ","$5,486.00 ","$0.00 ","$2,743.00 ","$4,344.91 ","$4,388.80 ","$0.00 ","$858.56 ","$0.00 ","$873.37 ","$0.00 "
"105039-001","SUP","HCPCS C1757","","105039-001  -  KIT CATH 50CM 6FR AVX ANGJT ULT .035IN CMPT SYS SHFT VSL OTW","BOTH IP/OP","$1,850.00 ","$1,369.00 ","$0.00 ","$1,850.00 ","$0.00 ","$0.00 ","$385.59 ","$0.00 ","$0.00 ","$0.00 ","$1,850.00 ","$0.00 ","$925.00 ","$1,465.20 ","$1,480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105040-001","SUP","HCPCS C1757","","105040-001  -  SET THRMB 6FR 3MM 120CM LF ANGJT ULT XPEEDIOR 1 LUM OTW CATH","BOTH IP/OP","$3,287.50 ","$2,432.75 ","$0.00 ","$3,287.50 ","$0.00 ","$0.00 ","$685.20 ","$0.00 ","$0.00 ","$0.00 ","$3,287.50 ","$0.00 ","$1,643.75 ","$2,603.70 ","$2,630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105042-001","SUP","HCPCS C1757","","105042-001  -  SET THROMBECTOMY XVC","BOTH IP/OP","$4,362.50 ","$3,228.25 ","$0.00 ","$4,362.50 ","$0.00 ","$0.00 ","$909.25 ","$0.00 ","$0.00 ","$0.00 ","$4,362.50 ","$0.00 ","$2,181.25 ","$3,455.10 ","$3,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105-5055","SUP","HCPCS C1757","","105-5055  -  CATHETER INFUS .010IN MICRO 2.7-1.5FR .013IN 170CM 25CM COIL","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$0.00 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$0.00 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105-5056","SUP","HCPCS C1757","","105-5056  -  CATHETER INFS .010IN MIC 2.7-1.5FR .013IN 170CM 25CM MRTHN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105-5091-150","SUP","HCPCS C1751","","105-5091-150  -  CATH INFUS 250 PSI 5FR .014IN 155CM 150CM STR GWIRE NTNL","BOTH IP/OP","$1,587.50 ","$1,174.75 ","$0.00 ","$1,667.50 ","$905.45 ","$0.00 ","$330.87 ","$0.00 ","$0.00 ","$291.97 ","$1,667.50 ","$0.00 ","$833.75 ","$1,320.66 ","$1,334.00 ","$0.00 ","$260.96 ","$0.00 ","$265.47 ","$0.00 "
"105-5092-150","SUP","HCPCS C1751","","105-5092-150  -  CATH INFUS 45D MIC 2.4-1.9FR .014IN 150CM STR GWIRE BRAID","BOTH IP/OP","$1,587.50 ","$1,174.75 ","$0.00 ","$1,667.50 ","$905.45 ","$0.00 ","$330.87 ","$0.00 ","$0.00 ","$291.97 ","$1,667.50 ","$0.00 ","$833.75 ","$1,320.66 ","$1,334.00 ","$0.00 ","$260.96 ","$0.00 ","$265.47 ","$0.00 "
"105-5094-153","SUP","HCPCS C1757","","105-5094-153  -  MICROCATHETER GD 2.8-2.2FR 155CM NAUTICA 14XL OTW REINF ACPT","BOTH IP/OP","$1,310.00 ","$969.40 ","$0.00 ","$1,310.00 ","$0.00 ","$0.00 ","$273.04 ","$0.00 ","$0.00 ","$0.00 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1057-0018","SUP","HCPCS C1713","","1057-0018  -  SPACER CMNT 18MM KNEE CMNT","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"1057-0019","SUP","HCPCS C1713","","1057-0019  -  SPACER CMNT 19MM KNEE CMNT","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"1057-0020","SUP","HCPCS C1713","","1057-0020  -  SPACER CMNT 20MM KNEE CMNT","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"1057-0021","SUP","HCPCS C1713","","1057-0021  -  SPACER CMNT 21MM KNEE CMNT","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"1057-0022","SUP","HCPCS C1713","","1057-0022  -  SPACER CMNT 22MM KNEE CMNT","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"105-7100-060","SUP","Custom 27803010","","105-7100-060  -  SYSTEM EMBL 1.5ML 1ML ONX18 SYR DMTH SLFXD","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"105-7100-080","SUP","HCPCS C1760","","105-7100-080  -  PRTCL EMBL NADH LQ ONX34 8% EVOH","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,907.50 ","$2,658.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,034.36 ","$5,907.50 ","$0.00 ","$2,953.75 ","$4,678.74 ","$4,726.00 ","$0.00 ","$924.52 ","$0.00 ","$940.47 ","$0.00 "
"1058-0005","SUP","Custom 27803010","","1058-0005  -  SPACER FEMORAL 5MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1058-0006","SUP","Custom 27803010","","1058-0006  -  SPACER FEMORAL 6MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1058-0007","SUP","Custom 27803010","","1058-0007  -  SPACER FEMORAL 7MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1058-0008","SUP","Custom 27803010","","1058-0008  -  SPACER FEMORAL 8MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1058-0009","SUP","Custom 27803010","","1058-0009  -  SPACER FEMORAL 9MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1058-0010","SUP","Custom 27803010","","1058-0010  -  SPACER FEMORAL 10MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1058-0011","SUP","Custom 27803010","","1058-0011  -  SPACER FEMORAL 11MM OMNIFIT BARIUM HIP PROXIMAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-2310","SUP","Custom 27803010","","1059-2310  -  SPACER FEMORAL SMALL 10MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-2311","SUP","Custom 27803010","","1059-2311  -  SPACER FEMORAL SMALL 11MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-2312","SUP","Custom 27803010","","1059-2312  -  SPACER FEMORAL SMALL 12MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-2313","SUP","Custom 27803010","","1059-2313  -  SPACER FEMORAL SMALL 13MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-2314","SUP","Custom 27803010","","1059-2314  -  SPACER FEMORAL SMALL 14MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-2315","SUP","Custom 27803010","","1059-2315  -  SPACER FEMORAL SMALL 15MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-4512","SUP","Custom 27803010","","1059-4512  -  SPACER FEMORAL MEDIUM 12MM RING STYLE CEMENTED ACCOLADE C","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-4513","SUP","Custom 27803010","","1059-4513  -  SPACER FEMORAL MEDIUM 13MM RING STYLE CEMENTED ACCOLADE C","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-4514","SUP","Custom 27803010","","1059-4514  -  SPACER FEMORAL MEDIUM 14MM RING STYLE CEMENTED ACCOLADE C","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-4515","SUP","Custom 27803010","","1059-4515  -  SPACER FEMORAL MEDIUM 15MM RING STYLE CEMENTED ACCOLADE C","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-4516","SUP","Custom 27803010","","1059-4516  -  SPACER FEMORAL MEDIUM 16MM RING STYLE CEMENTED ACCOLADE C","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-4517","SUP","Custom 27803010","","1059-4517  -  SPACER FEMORAL MEDIUM 17MM RING STYLE CEMENTED ACCOLADE C","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-6713","SUP","Custom 27803010","","1059-6713  -  SPACER FEMORAL LARGE 13MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-6714","SUP","Custom 27803010","","1059-6714  -  SPACER FEMORAL LARGE 14MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-6715","SUP","Custom 27803010","","1059-6715  -  SPACER FEMORAL LARGE 15MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-6716","SUP","Custom 27803010","","1059-6716  -  SPACER FEMORAL LARGE 16MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-6717","SUP","Custom 27803010","","1059-6717  -  SPACER FEMORAL LARGE 17MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1059-6718","SUP","Custom 27803010","","1059-6718  -  SPACER FEMORAL LARGE 18MM RING STYLE CEMENTED ACCOLADE C HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1064-0425","SUP","HCPCS C1776","","1064-0425  -  STEM FEM CMNT OMFT EON HIP","BOTH IP/OP","$5,062.00 ","$3,745.88 ","$0.00 ","$5,062.00 ","$2,277.90 ","$0.00 ","$1,055.05 ","$0.00 ","$0.00 ","$886.32 ","$5,062.00 ","$0.00 ","$2,531.00 ","$4,009.10 ","$4,049.60 ","$0.00 ","$792.20 ","$0.00 ","$805.87 ","$0.00 "
"1064-0525","SUP","HCPCS C1776","","1064-0525  -  OMNIFIT CEMENTED STEM (MT)","BOTH IP/OP","$5,062.00 ","$3,745.88 ","$0.00 ","$5,062.00 ","$2,277.90 ","$0.00 ","$1,055.05 ","$0.00 ","$0.00 ","$886.32 ","$5,062.00 ","$0.00 ","$2,531.00 ","$4,009.10 ","$4,049.60 ","$0.00 ","$792.20 ","$0.00 ","$805.87 ","$0.00 "
"1064-0625","SUP","HCPCS C1776","","1064-0625  -  STEM FEM CMNT OMFT EON HIP","BOTH IP/OP","$3,657.00 ","$2,706.18 ","$0.00 ","$3,657.00 ","$1,645.65 ","$0.00 ","$762.21 ","$0.00 ","$0.00 ","$640.31 ","$3,657.00 ","$0.00 ","$1,828.50 ","$2,896.34 ","$2,925.60 ","$0.00 ","$572.32 ","$0.00 ","$582.19 ","$0.00 "
"1064-0730","SUP","HCPCS C1776","","1064-0730  -  STEM FEM CMNT OMFT EON HIP","BOTH IP/OP","$5,062.00 ","$3,745.88 ","$0.00 ","$5,062.00 ","$2,277.90 ","$0.00 ","$1,055.05 ","$0.00 ","$0.00 ","$886.32 ","$5,062.00 ","$0.00 ","$2,531.00 ","$4,009.10 ","$4,049.60 ","$0.00 ","$792.20 ","$0.00 ","$805.87 ","$0.00 "
"1064-0830","SUP","HCPCS C1776","","1064-0830  -  STEM FEM CMNT OMFT EON HIP","BOTH IP/OP","$5,062.00 ","$3,745.88 ","$0.00 ","$5,062.00 ","$2,277.90 ","$0.00 ","$1,055.05 ","$0.00 ","$0.00 ","$886.32 ","$5,062.00 ","$0.00 ","$2,531.00 ","$4,009.10 ","$4,049.60 ","$0.00 ","$792.20 ","$0.00 ","$805.87 ","$0.00 "
"106552-001","SUP","HCPCS C1757","","106552-001  -  CATH THRMB 90CM 6FR ANGJT DVX ULT .035IN OTW LP TIP RADIOPQ","BOTH IP/OP","$3,787.50 ","$2,802.75 ","$0.00 ","$3,787.50 ","$0.00 ","$0.00 ","$789.41 ","$0.00 ","$0.00 ","$0.00 ","$3,787.50 ","$0.00 ","$1,893.75 ","$2,999.70 ","$3,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106553-001","SUP","HCPCS C1757","","106553-001  -  SET THROMBECTOMY LONG TAPER 4FR 2MM 135CM OTW RAPEX CATHETER","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$0.00 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$0.00 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"106608-001","SUP","HCPCS C1757","","106608-001  -  SET CATH 135CM 5FR 3MM SPIROFLEX VG ANGJT .014IN THRMB GWIRE","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$0.00 ","$0.00 ","$1,120.28 ","$0.00 ","$0.00 ","$0.00 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1067-0002","SUP","HCPCS C1713","","1067-0002  -  SPACER FEMORAL UNIVERSAL HOLE PLUG CEMENTED OMNIFIT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0008","SUP","HCPCS C1713","","1067-0008  -  SPACER FEMORAL UNIVERSAL 8MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0009","SUP","HCPCS C1713","","1067-0009  -  SPACER FEMORAL UNIVERSAL 9MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0010","SUP","Custom 27803010","","1067-0010  -  SPACER CMNT UNV 10MM HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1067-0011","SUP","HCPCS C1713","","1067-0011  -  SPACER FEMORAL UNIVERSAL 11MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0012","SUP","Custom 27803010","","1067-0012  -  SPACER FEMORAL UNIVERSAL 12MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1067-0013","SUP","HCPCS C1713","","1067-0013  -  SPACER FEMORAL UNIVERSAL 13MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0014","SUP","HCPCS C1713","","1067-0014  -  SPACER CMNT UNV 14MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0015","SUP","HCPCS C1713","","1067-0015  -  SPACER FEMORAL UNIVERSAL 15MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0016","SUP","HCPCS C1713","","1067-0016  -  SPACER CMNT UNV 16MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0017","SUP","HCPCS C1713","","1067-0017  -  SPACER CMNT UNV 17MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0018","SUP","HCPCS C1713","","1067-0018  -  SPACER FEMORAL UNIVERSAL 18MM CEMENTED ACCOLADE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0019","SUP","HCPCS C1713","","1067-0019  -  SPACER CMNT UNV 19MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0020","SUP","HCPCS C1713","","1067-0020  -  SPACER FEMORAL UNIVERSAL 20MM PRIM C-STEM HIP DISTAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0021","SUP","HCPCS C1713","","1067-0021  -  SPACER CMNT UNV 21MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0022","SUP","HCPCS C1713","","1067-0022  -  SPACER CMNT UNV 22MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0023","SUP","HCPCS C1713","","1067-0023  -  SPACER CMNT UNV 23MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0024","SUP","HCPCS C1713","","1067-0024  -  SPACER CMNT UNV 24MM ACLD HIP DIST","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1067-0025","SUP","HCPCS C1713","","1067-0025  -  SPACER FEM UNV 25MM ACLD POLYMETHYLMETHACRYLATE DIST HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"1074225-08","SUP","HCPCS C1874","","1074225-08  -  STENT CORON .014IN TAPER 2.25MM 8MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074225-12","SUP","HCPCS C1874","","1074225-12  -  STENT CORON .014IN TAPER 2.25MM 12MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074225-15","SUP","HCPCS C1874","","1074225-15  -  STENT CORON .014IN TAPER 2.25MM 15MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074225-18","SUP","HCPCS C1874","","1074225-18  -  STENT CORON .014IN TAPER 2.25MM 18MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074225-23","SUP","HCPCS C1874","","1074225-23  -  STENT CORON .014IN TAPER 2.25MM 23MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074225-28","SUP","HCPCS C1874","","1074225-28  -  STENT CORON .014IN TAPER 2.25MM 28MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-08","SUP","HCPCS C1874","","1074250-08  -  STENT CORON .014IN TAPER 2.5MM 8MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-12","SUP","HCPCS C1874","","1074250-12  -  STENT CORON .014IN TAPER 2.5MM 12MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-15","SUP","HCPCS C1874","","1074250-15  -  STENT CORON .014IN TAPER 2.5MM 15MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-18","SUP","HCPCS C1874","","1074250-18  -  STENT CORON .014IN TAPER 2.5MM 18MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-23","SUP","HCPCS C1874","","1074250-23  -  STENT CORON .014IN TAPER 2.5MM 23MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-28","SUP","HCPCS C1874","","1074250-28  -  STENT CORON .014IN TAPER 2.5MM 28MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-33","SUP","HCPCS C1874","","1074250-33  -  STENT CORON .014IN TAPER 2.5MM 33MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074250-38","SUP","HCPCS C1874","","1074250-38  -  STENT CORON .014IN TAPER 2.5MM 38MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-08","SUP","HCPCS C1874","","1074275-08  -  STENT CORON .014IN TAPER 2.75MM 8MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-12","SUP","HCPCS C1874","","1074275-12  -  STENT CORON .014IN TAPER 2.75MM 12MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-15","SUP","HCPCS C1874","","1074275-15  -  STENT CORON .014IN TAPER 2.75MM 15MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-18","SUP","HCPCS C1874","","1074275-18  -  STENT CORON .014IN TAPER 2.75MM 18MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-23","SUP","HCPCS C1874","","1074275-23  -  STENT CORON .014IN TAPER 2.75MM 23MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-28","SUP","HCPCS C1874","","1074275-28  -  STENT CORON .014IN TAPER 2.75MM 28MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-33","SUP","HCPCS C1874","","1074275-33  -  STENT CORON .014IN TAPER 2.75MM 33MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074275-38","SUP","HCPCS C1874","","1074275-38  -  STENT CORON .014IN TAPER 2.75MM 38MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-08","SUP","HCPCS C1874","","1074300-08  -  STENT CORON .014IN TAPER 3MM 8MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-12","SUP","HCPCS C1874","","1074300-12  -  STENT CORON .014IN TAPER 3MM 12MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-15","SUP","HCPCS C1874","","1074300-15  -  STENT CORON .014IN TAPER 3MM 15MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-18","SUP","HCPCS C1874","","1074300-18  -  STENT CORON .014IN TAPER 3MM 18MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-23","SUP","HCPCS C1874","","1074300-23  -  STENT CORON .014IN TAPER 3MM 23MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-28","SUP","HCPCS C1874","","1074300-28  -  STENT CORON .014IN TAPER 3MM 28MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-33","SUP","HCPCS C1874","","1074300-33  -  STENT CORON .014IN TAPER 3MM 33MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074300-38","SUP","HCPCS C1874","","1074300-38  -  STENT CORON .014IN TAPER 3MM 38MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-08","SUP","HCPCS C1874","","1074325-08  -  STENT CORON .014IN TAPER 3.25MM .028IN 5FR 8MM 145CM 2","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-12","SUP","HCPCS C1874","","1074325-12  -  STENT CORON .014IN TAPER 3.25MM .028IN 5FR 12MM 145CM 2","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-18","SUP","HCPCS C1874","","1074325-18  -  STENT CORON .014IN TAPER 3.25MM 18MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-23","SUP","HCPCS C1874","","1074325-23  -  STENT CORON .014IN TAPER 3.25MM 23MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-28","SUP","HCPCS C1874","","1074325-28  -  STENT CORON .014IN TAPER 3.25MM 28MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-33","SUP","HCPCS C1874","","1074325-33  -  STENT CORON .014IN TAPER 3.25MM 33MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074325-38","SUP","HCPCS C1874","","1074325-38  -  STENT CORON .014IN TAPER 3.25MM 38MM 145CM 2 RADIOPQ MARKER","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-08","SUP","HCPCS C1874","","1074350-08  -  STENT CORON .014IN TAPER 3.5MM 8MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-12","SUP","HCPCS C1874","","1074350-12  -  STENT CORON .014IN TAPER 3.5MM 12MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-15","SUP","HCPCS C1874","","1074350-15  -  STENT CORON .014IN TAPER 3.5MM 15MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-18","SUP","HCPCS C1874","","1074350-18  -  STENT CORON .014IN TAPER 3.5MM 18MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-23","SUP","HCPCS C1874","","1074350-23  -  STENT CORON .014IN TAPER 3.5MM 23MM 145CM 2 RADIOPQ 1 ACCES","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-28","SUP","HCPCS C1874","","1074350-28  -  STENT CORON .014IN TAPER 3.5MM 28MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-33","SUP","HCPCS C1874","","1074350-33  -  STENT CORON .014IN TAPER 3.5MM 33MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074350-38","SUP","HCPCS C1874","","1074350-38  -  STENT CORON .014IN TAPER 3.5MM 38MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-08","SUP","HCPCS C1874","","1074400-08  -  STENT CORON .014IN TAPER 4MM 8MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-12","SUP","HCPCS C1874","","1074400-12  -  STENT CORON .014IN TAPER 4MM 12MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-15","SUP","HCPCS C1874","","1074400-15  -  STENT CORON .014IN TAPER 4MM 15MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-18","SUP","HCPCS C1874","","1074400-18  -  STENT CORON .014IN TAPER 4MM 18MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-23","SUP","HCPCS C1874","","1074400-23  -  STENT CORON .014IN TAPER 4MM 23MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-28","SUP","HCPCS C1874","","1074400-28  -  STENT CORON .014IN TAPER 4MM 28MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-33","SUP","HCPCS C1874","","1074400-33  -  STENT CORON .014IN TAPER 4MM 33MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1074400-38","SUP","HCPCS C1874","","1074400-38  -  STENT CORON .014IN TAPER 4MM 38MM 145CM 2 RADIOPQ MARKER 1","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"1082-MED","SUP","HCPCS L3702","","1082-MED  -  SPRT ORTH MED 10IN LS CRST ELAST VLCR CLSR WHT","BOTH IP/OP","$44.75 ","$33.12 ","$0.00 ","$208.54 ","$20.14 ","$198.92 ","$208.54 ","$0.00 ","$0.00 ","$7.84 ","$44.75 ","$0.00 ","$22.38 ","$35.44 ","$35.80 ","$26.85 ","$198.56 ","$0.00 ","$202.65 ","$0.00 "
"109681-001","SUP","HCPCS C1757","","109681-001  -  SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT","BOTH IP/OP","$4,225.00 ","$3,126.50 ","$0.00 ","$4,225.00 ","$0.00 ","$0.00 ","$880.60 ","$0.00 ","$0.00 ","$0.00 ","$4,225.00 ","$0.00 ","$2,112.50 ","$3,346.20 ","$3,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10A001","SUP","Custom 27804086","","10A001  -  GRAFT BONE 1-4MM CANCELLOUS CORTICAL 30ML","BOTH IP/OP","$1,042.50 ","$771.45 ","$0.00 ","$1,042.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,042.50 ","$0.00 ","$521.25 ","$825.66 ","$834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10A002","SUP","Custom 27804086","","10A002  -  GRAFT BONE 1-4MM CANCELLOUS CORTICAL 15ML","BOTH IP/OP","$595.00 ","$440.30 ","$0.00 ","$595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$595.00 ","$0.00 ","$297.50 ","$471.24 ","$476.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10AC50","SUP","Custom 27203010","","10AC50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$314.50 ","$232.73 ","$0.00 ","$314.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.50 ","$0.00 ","$157.25 ","$249.08 ","$251.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10AC60","SUP","Custom 27203010","","10AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$314.50 ","$232.73 ","$0.00 ","$314.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.50 ","$0.00 ","$157.25 ","$249.08 ","$251.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA10","SUP","Custom 27203010","","10BA10  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA10D","SUP","Custom 27203010","","10BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA10D-MN","SUP","Custom 27203010","","10BA10D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA10-MN","SUP","Custom 27203010","","10BA10-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA20","SUP","Custom 27203010","","10BA20  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA20D","SUP","Custom 27203010","","10BA20D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA20D-MN","SUP","Custom 27203010","","10BA20D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA20-MN","SUP","Custom 27203010","","10BA20-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA30","SUP","Custom 27203010","","10BA30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA30D","SUP","Custom 27203010","","10BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA30DC","SUP","Custom 27203010","","10BA30DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA30D-MN","SUP","Custom 27203010","","10BA30D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA30-MN","SUP","Custom 27203010","","10BA30-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA40","SUP","Custom 27203010","","10BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA40D","SUP","Custom 27203010","","10BA40D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA40DC","SUP","Custom 27203010","","10BA40DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$335.75 ","$248.46 ","$0.00 ","$335.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.75 ","$0.00 ","$167.88 ","$265.91 ","$268.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA40D-MN","SUP","Custom 27203010","","10BA40D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA40DX","SUP","Custom 27203010","","10BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$346.38 ","$256.32 ","$0.00 ","$346.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$346.38 ","$0.00 ","$173.19 ","$274.33 ","$277.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA40-MN","SUP","Custom 27203010","","10BA40-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$314.50 ","$232.73 ","$0.00 ","$314.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$314.50 ","$0.00 ","$157.25 ","$249.08 ","$251.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA50","SUP","Custom 27203010","","10BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA50D","SUP","Custom 27203010","","10BA50D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA50DC","SUP","Custom 27203010","","10BA50DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA50D-MN","SUP","Custom 27203010","","10BA50D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA50DX","SUP","Custom 27203010","","10BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$335.75 ","$248.46 ","$0.00 ","$335.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.75 ","$0.00 ","$167.88 ","$265.91 ","$268.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA50-MN","SUP","Custom 27203010","","10BA50-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA60","SUP","Custom 27203010","","10BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA60D","SUP","Custom 27203010","","10BA60D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA60D-MN","SUP","Custom 27203010","","10BA60D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA60DX","SUP","Custom 27203010","","10BA60DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10BA60-MN","SUP","Custom 27203010","","10BA60-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY40","SUP","Custom 27203010","","10CY40  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY40BR","SUP","Custom 27203010","","10CY40BR  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY50","SUP","Custom 27203010","","10CY50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY50BR","SUP","Custom 27203010","","10CY50BR  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY50L","SUP","Custom 27203010","","10CY50L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY60","SUP","Custom 27203010","","10CY60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY60BR","SUP","Custom 27203010","","10CY60BR  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10CY65DX","SUP","Custom 27203010","","10CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10DCT","SUP","Custom 27203010","","10DCT  -  TUBE TRCH 10 13.8MM 8.9MM 79MM STRL LF SHLY CUF DISP INR CNN","BOTH IP/OP","$93.68 ","$69.32 ","$0.00 ","$95.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.08 ","$0.00 ","$47.54 ","$75.30 ","$76.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10DFEN","SUP","Custom 27203010","","10DFEN  -  TUBE TRACHEOSTOMY 10 13MM 8.9MM 79MM CUFF DISPOSABLE INNER","BOTH IP/OP","$91.35 ","$67.60 ","$0.00 ","$91.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.35 ","$0.00 ","$45.68 ","$72.35 ","$73.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10LGT","SUP","Custom 27203010","","10LGT  -  TUBE TRACHEOSTOMY 10 13.7MM 8.9MM 50MM SMOOTH INNER CANNU","BOTH IP/OP","$114.73 ","$84.90 ","$0.00 ","$116.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.45 ","$0.00 ","$58.22 ","$92.23 ","$93.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10LGT","SUP","Custom 27203010","","TUBE 8.9MM UNCUF LRNTMY INR CANNU SHLY TRCH 10 DISP","BOTH IP/OP","$114.73 ","$84.90 ","$0.00 ","$116.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.45 ","$0.00 ","$58.22 ","$95.02 ","$93.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH17","SUP","Custom 27203010","","10MH17  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$284.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$284.75 ","$0.00 ","$142.38 ","$225.52 ","$227.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH17D","SUP","Custom 27203010","","10MH17D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH22","SUP","Custom 27203010","","10MH22  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$278.38 ","$206.00 ","$0.00 ","$278.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$278.38 ","$0.00 ","$139.19 ","$220.48 ","$222.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH22D","SUP","Custom 27203010","","10MH22D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH30","SUP","Custom 27203010","","10MH30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$286.88 ","$212.29 ","$0.00 ","$286.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$286.88 ","$0.00 ","$143.44 ","$227.21 ","$229.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH30DC","SUP","Custom 27203010","","10MH30DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$310.25 ","$229.59 ","$0.00 ","$310.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.25 ","$0.00 ","$155.13 ","$245.72 ","$248.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH30D-MN","SUP","Custom 27203010","","10MH30D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH30L","SUP","Custom 27203010","","10MH30L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10MH30-MN","SUP","Custom 27203010","","10MH30-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10OV40","SUP","Custom 27203010","","10OV40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10OV40L","SUP","Custom 27203010","","10OV40L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$342.13 ","$253.18 ","$0.00 ","$342.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.13 ","$0.00 ","$171.06 ","$270.97 ","$273.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10SCT","SUP","Custom 27203010","","10SCT  -  TUBE TRACHEOSTOMY 10 13.3MM 10MM 105MM CANNU CUFF LOW","BOTH IP/OP","$71.38 ","$52.82 ","$0.00 ","$72.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.45 ","$0.00 ","$36.22 ","$57.38 ","$57.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10TA23","SUP","Custom 27203010","","10TA23  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$295.38 ","$218.58 ","$0.00 ","$295.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.38 ","$0.00 ","$147.69 ","$233.94 ","$236.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10X52","SUP","Custom 27203010","","10X52  -  SUTURE NONABSORBABLE 2-0 V-5 30IN 2 ARM BRAID 10 STRAND","BOTH IP/OP","$137.82 ","$101.99 ","$0.00 ","$139.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.88 ","$0.00 ","$69.94 ","$110.78 ","$111.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"10X72","SUP","Custom 27203010","","10X72  -  SUTURE NONABSORBABLE 2-0 V-7 30IN 2 ARM BRAID 10 STRAND","BOTH IP/OP","$137.91 ","$102.05 ","$0.00 ","$139.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.98 ","$0.00 ","$69.99 ","$110.86 ","$111.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110-08","SUP","HCPCS C1713","","110-08  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$248.63 ","$183.99 ","$0.00 ","$248.63 ","$111.88 ","$0.00 ","$51.82 ","$0.00 ","$0.00 ","$43.53 ","$248.63 ","$0.00 ","$124.31 ","$196.91 ","$198.90 ","$0.00 ","$38.91 ","$0.00 ","$39.58 ","$0.00 "
"11-0401-CA","SUP","Custom 27203010","","11-0401-CA  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,600.00 ","$2,664.00 ","$0.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,600.00 ","$0.00 ","$1,800.00 ","$2,851.20 ","$2,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11-0401-CAL","SUP","Custom 27203010","","11-0401-CAL  -  KIT CRANIOTOMY SEPS SLIDOCAINE EPINEPHRINE STERILE","BOTH IP/OP","$4,221.00 ","$3,123.54 ","$0.00 ","$4,221.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,221.00 ","$0.00 ","$2,110.50 ","$3,343.03 ","$3,376.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"11-0401-CE","SUP","Custom 27203010","","11-0401-CE  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,712.50 ","$2,747.25 ","$0.00 ","$3,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,712.50 ","$0.00 ","$1,856.25 ","$2,940.30 ","$2,970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1104B","SUP","Custom 27803010","","1104B  -  KIT PRESSURE MONITR TRANSDUCER TIPPED CATHETER DRILL BIT","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110-4HMC","SUP","Custom 27203010","","110-4HMC  -  KIT PRSS MNTR MIC 4FR 12FR STRL CMN TRNDCR TIP CATH DRN STY","BOTH IP/OP","$5,034.00 ","$3,725.16 ","$0.00 ","$5,034.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,034.00 ","$0.00 ","$2,517.00 ","$3,986.93 ","$4,027.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"110-4L","SUP","Custom 27803010","","110-4L  -  KIT PRESSURE MONITR 4FR TRANSDUCER TIPPED CATHETER BOLT","BOTH IP/OP","$2,007.50 ","$1,485.55 ","$0.00 ","$2,007.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,007.50 ","$0.00 ","$1,003.75 ","$1,589.94 ","$1,606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1111-1-501","SUP","HCPCS C1713","","1111-1-501  -  TRAY STRL ML NUT GRS-K LCK NAIL SYS","BOTH IP/OP","$368.50 ","$272.69 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$76.80 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"111303-001","SUP","Custom 27203010","","111303-001  -  SET THROMBECTOMY .014IN 3FR 1.5MM 145CM OTW DISTAL SHAFT","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1120-1810","SUP","Custom 27203010","","TIP PIP 1-20UL TIPONE BVL RK STRL NTR","BOTH IP/OP","$132.50 ","$98.05 ","$0.00 ","$132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.50 ","$0.00 ","$66.25 ","$104.94 ","$106.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1156T/75","SUP","HCPCS C1900","","1156T/75  -  LEAD PCNG S LOPRFL 5-5.6FR 7FR 75CM 8MM QUICKFLEX IS-1 BP","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$0.00 ","$0.00 "
"1156T/86","SUP","HCPCS C1900","","1156T/86  -  QUICKFLEX+++PMM#:89271","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$0.00 ","$0.00 "
"1158T/75","SUP","HCPCS C1900","","1158T/75  -  QUICKFLEX+++PMM#:89272","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$0.00 ","$0.00 "
"1158T/86","SUP","HCPCS C1900","","1158T/86  -  LEAD PCNG 16MM S 7FR 86CM QUICKFLEX IS 1 BP CNCT STRBL TIP","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$0.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$0.00 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$0.00 ","$0.00 "
"1174108D","SUP","HCPCS C1751","","1174108D  -  CATHETER CV 4FR P PICC SHRLK 3CG LUM MAXIMAL BRR TPS STY PP","BOTH IP/OP","$516.28 ","$382.05 ","$0.00 ","$521.50 ","$283.17 ","$0.00 ","$107.60 ","$0.00 ","$0.00 ","$91.31 ","$521.50 ","$0.00 ","$260.75 ","$413.03 ","$417.20 ","$0.00 ","$81.61 ","$0.00 ","$83.02 ","$0.00 "
"11-996-16","SUP","Custom 27203010","","SCISSORS 6.25IN SMTH SRR NTCH SURG TC","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1200-01-1022","SUP","HCPCS C1713","","1200-01-1022  -  DYNANAIL, 10 MM X 22 CM","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,000.00 ","$4,950.00 ","$0.00 ","$2,292.68 ","$0.00 ","$0.00 ","$1,926.01 ","$11,000.00 ","$0.00 ","$5,500.00 ","$8,712.00 ","$8,800.00 ","$0.00 ","$1,721.50 ","$0.00 ","$1,751.20 ","$0.00 "
"1200-01-1222","SUP","HCPCS C1713","","1200-01-1222  -  DYNANAIL, 12 MM X 22 CM","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,000.00 ","$4,950.00 ","$0.00 ","$2,292.68 ","$0.00 ","$0.00 ","$1,926.01 ","$11,000.00 ","$0.00 ","$5,500.00 ","$8,712.00 ","$8,800.00 ","$0.00 ","$1,721.50 ","$0.00 ","$1,751.20 ","$0.00 "
"1200-02-5020","SUP","HCPCS C1713","","1200-02-5020  -  SCREW BONE 5MM 20MM CORT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5025","SUP","HCPCS C1713","","1200-02-5025  -  HEADED CORTICAL SCREW, 5.0 MM X 25 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5030","SUP","HCPCS C1713","","1200-02-5030  -  SCREW BONE 5MM 30MM HEADED SECURE FIX DYNANAIL HINDFOOT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5035","SUP","HCPCS C1713","","1200-02-5035  -  HEADED CORTICAL SCREW, 5.0 MM X 35 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5040","SUP","HCPCS C1713","","1200-02-5040  -  HEADED CORTICAL SCREW, 5.0 MM X 40 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5045","SUP","HCPCS C1713","","1200-02-5045  -  HEADED CORTICAL SCREW, 5.0 MM X 45 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5050","SUP","HCPCS C1713","","1200-02-5050  -  HEADED CORTICAL SCREW, 5.0 MM X 50 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5055","SUP","HCPCS C1713","","1200-02-5055  -  HEADED CORTICAL SCREW, 5.0 MM X 55 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-02-5060","SUP","HCPCS C1713","","1200-02-5060  -  HEADED CORTICAL SCREW, 5.0 MM X 60 MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"1200-03-5065","SUP","HCPCS C1713","","1200-03-5065  -  SCREW BONE 5MM 65MM CORT","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5070","SUP","HCPCS C1713","","1200-03-5070  -  HEADLESS PA SCREW, 5.0 MM X 70 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5075","SUP","HCPCS C1713","","1200-03-5075  -  HEADLESS PA SCREW, 5.0 MM X 75 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5080","SUP","HCPCS C1713","","1200-03-5080  -  HEADLESS PA SCREW, 5.0 MM X 80 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5085","SUP","HCPCS C1713","","1200-03-5085  -  HEADLESS PA SCREW, 5.0 MM X 85 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5090","SUP","HCPCS C1713","","1200-03-5090  -  HEADLESS PA SCREW, 5.0 MM X 90 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5095","SUP","HCPCS C1713","","1200-03-5095  -  HEADLESS PA SCREW, 5.0 MM X 95 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5100","SUP","HCPCS C1713","","1200-03-5100  -  HEADLESS PA SCREW, 5.0 MM X 100 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5105","SUP","HCPCS C1713","","1200-03-5105  -  HEADLESS PA SCREW, 5.0 MM X 105 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"1200-03-5110","SUP","HCPCS C1713","","1200-03-5110  -  HEADLESS PA SCREW, 5.0 MM X 110 MM","BOTH IP/OP","$428.13 ","$316.82 ","$0.00 ","$428.13 ","$192.66 ","$0.00 ","$89.23 ","$0.00 ","$0.00 ","$74.96 ","$428.13 ","$0.00 ","$214.06 ","$339.08 ","$342.50 ","$0.00 ","$67.00 ","$0.00 ","$68.16 ","$0.00 "
"120602F","SUP","HCPCS C1884","","120602F  -  CATHETER EMBL RND 2FR 4MM 60CM STRL LTX FGRTY BLN REINF SMTH","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$174.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.24 ","$0.00 ","$0.00 ","$34.43 ","$0.00 ","$0.00 ","$0.00 "
"120803F","SUP","HCPCS C1757","","120803F  -  CATHETER EMBL RND 3FR 5MM 80CM .1ML STRL LTX FGRTY BLN REINF","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120804F","SUP","Custom 27203010","","120804F  -  CATHETER EMBL RND 4FR 9MM 80CM .5ML STRL LTX FGRTY BLN REINF","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120805F","SUP","HCPCS C1757","","120805F  -  CATHETER EMBL RND 5FR 11MM 80CM STRL LTX FGRTY BLN REINF","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120806F","SUP","HCPCS C1757","","120806F  -  CATHETER EMBL RND 6FR 13MM 80CM STRL LTX FGRTY BLN REINF","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"120807F","SUP","HCPCS C1757","","120807F  -  CATHETER EMBL RND 7FR 14MM 80CM 2ML STRL LTX FGRTY BLN REINF","BOTH IP/OP","$129.95 ","$96.16 ","$0.00 ","$102.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$102.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1210-3","SUP","HCPCS C1713","","1210-3  -  ""MRI PRESSURE PIN SET FOR TRACTION TONGS, 3""""""","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$613.13 ","$0.00 ","$283.98 ","$0.00 ","$0.00 ","$238.56 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$213.23 ","$0.00 ","$216.91 ","$0.00 "
"1210-5-250","SUP","HCPCS C1769","","1210-5-250  -  GWIRE ORTH KWIRE GAMA","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$268.79 ","$0.00 ","$103.17 ","$0.00 ","$0.00 ","$86.67 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$77.47 ","$0.00 ","$78.80 ","$0.00 "
"1210-6450","SUP","HCPCS C1713","","1210-6450  -  WIRE FIX 3.2MM 450MM KWIRE SS ORTH GAMA","BOTH IP/OP","$127.88 ","$94.63 ","$0.00 ","$127.88 ","$57.54 ","$0.00 ","$26.65 ","$0.00 ","$0.00 ","$22.39 ","$127.88 ","$0.00 ","$63.94 ","$101.28 ","$102.30 ","$0.00 ","$20.01 ","$0.00 ","$20.36 ","$0.00 "
"1210-6450S","SUP","Custom 27203010","","1210-6450S  -  WIRE FX 3.2MM 450MM STRL KRSH","BOTH IP/OP","$192.50 ","$142.45 ","$0.00 ","$192.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12-1113","SUP","HCPCS C1713","","12-1113  -  SCREW BN STD .5IN 9MM 120MM 21MM AMBI CLS IMHS LG","BOTH IP/OP","$1,134.00 ","$839.16 ","$0.00 ","$1,134.00 ","$510.30 ","$0.00 ","$236.35 ","$0.00 ","$0.00 ","$198.55 ","$1,134.00 ","$0.00 ","$567.00 ","$898.13 ","$907.20 ","$0.00 ","$177.47 ","$0.00 ","$180.53 ","$0.00 "
"12-1114","SUP","HCPCS C1713","","12-1114  -  SCREW BN STD .5IN 9MM 125MM 21MM AMBI CLS IMHS LG","BOTH IP/OP","$1,134.00 ","$839.16 ","$0.00 ","$1,134.00 ","$510.30 ","$0.00 ","$236.35 ","$0.00 ","$0.00 ","$198.55 ","$1,134.00 ","$0.00 ","$567.00 ","$898.13 ","$907.20 ","$0.00 ","$177.47 ","$0.00 ","$180.53 ","$0.00 "
"1211-3055","SUP","Custom 27203010","","1211-3055  -  DRILL SRG 5.5MM GMA NL DIST","BOTH IP/OP","$203.50 ","$150.59 ","$0.00 ","$203.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.50 ","$0.00 ","$101.75 ","$161.17 ","$162.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12-1180","SUP","HCPCS C1713","","12-1180  -  SCREW BN 9/16IN 9MM 55MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1182","SUP","HCPCS C1713","","12-1182  -  SCREW BN 9/16IN 9MM 65MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1183","SUP","HCPCS C1713","","12-1183  -  SCREW BN 9/16IN 9MM 70MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1184","SUP","HCPCS C1713","","12-1184  -  SCREW BN 9/16IN 9MM 75MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1185","SUP","HCPCS C1713","","12-1185  -  SCREW BN 9/16IN 9MM 80MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1186","SUP","HCPCS C1713","","12-1186  -  SCREW BN 9/16IN 9MM 85MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1187","SUP","HCPCS C1713","","12-1187  -  SCREW BN 9/16IN 9MM 90MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1188","SUP","HCPCS C1713","","12-1188  -  SCREW BN 9/16IN 9MM 95MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1189","SUP","HCPCS C1713","","12-1189  -  SCREW BN 9/16IN 9MM 100MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"12-1190","SUP","HCPCS C1713","","12-1190  -  SCREW BN 9/16IN 9MM 105MM 21MM AMBI CLS SPLG","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"1212-5160S","SUP","Custom 27203010","","1212-5160S  -  DRILL SURG 160MM AO HIP GAMA 5.5MM STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1212-5300S","SUP","Custom 27203010","","1212-5300S  -  DRILL SURG 300MM AO CLBRT GAMA 5.5MM STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1213-9091S","SUP","HCPCS C1713","","1213-9091S  -  GDPN ORTH 400MM 4MM GAMMA3 HIP CANN CANN CTR STRL","BOTH IP/OP","$192.50 ","$142.45 ","$0.00 ","$192.50 ","$86.63 ","$0.00 ","$40.12 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"1214-5055","SUP","Custom 27203010","","1214-5055  -  BIT DRILL 300MM 5.2MM GAMA SS STRL","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1214-5160S","SUP","Custom 27203010","","1214-5160S  -  BIT DRILL 165MM 5.5MM GAMA SS STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1214-5-180","SUP","Custom 27203010","","1214-5-180  -  BIT DRILL 220MM 5.5MM GAMA SS STRL","BOTH IP/OP","$203.50 ","$150.59 ","$0.00 ","$203.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.50 ","$0.00 ","$101.75 ","$161.17 ","$162.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1214-5300S","SUP","Custom 27203010","","1214-5300S  -  BIT DRILL 300MM 5.5MM GAMA SS STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-461","SUP","Custom 27803010","","1235-2-461  -  CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-462","SUP","Custom 27803010","","1235-2-462  -  CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-481","SUP","Custom 27803010","","1235-2-481  -  CUP ACETAB 48MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-482","SUP","Custom 27803010","","1235-2-482  -  CUP ACTB 48MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-501","SUP","Custom 27803010","","1235-2-501  -  CUP ACETAB 50MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-502","SUP","Custom 27803010","","1235-2-502  -  CUP ACTB 50MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-521","SUP","Custom 27803010","","1235-2-521  -  CUP ACETAB 52MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-522","SUP","Custom 27803010","","1235-2-522  -  SHELL ACETAB 52MM ANATOMIC DUAL MOBILITY MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-541","SUP","Custom 27803010","","1235-2-541  -  CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-542","SUP","Custom 27803010","","1235-2-542  -  CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-561","SUP","Custom 27803010","","1235-2-561  -  CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-562","SUP","Custom 27803010","","1235-2-562  -  CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-581","SUP","Custom 27803010","","1235-2-581  -  CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-582","SUP","Custom 27803010","","1235-2-582  -  CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-601","SUP","Custom 27803010","","1235-2-601  -  CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-602","SUP","Custom 27803010","","1235-2-602  -  CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-621","SUP","Custom 27803010","","1235-2-621  -  CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-622","SUP","Custom 27803010","","1235-2-622  -  CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-641","SUP","Custom 27803010","","1235-2-641  -  CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-642","SUP","Custom 27803010","","1235-2-642  -  CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-848","SUP","Custom 27803010","","1235-2-848  -  INSERT ACETAB 0D 48MM 28MM 6.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-850","SUP","Custom 27803010","","1235-2-850  -  INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR DRTN","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-852","SUP","Custom 27803010","","1235-2-852  -  INSERT ACETAB 0D 52MM 28MM 8.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-854","SUP","Custom 27803010","","1235-2-854  -  INSERT ACETAB 0D 54MM 28MM 9.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-856","SUP","Custom 27803010","","1235-2-856  -  INSERT ACETAB 0D 56MM 28MM 10.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-858","SUP","Custom 27803010","","1235-2-858  -  INSERT ACETAB 0D 58MM 28MM 11.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-860","SUP","Custom 27803010","","1235-2-860  -  INSERT ACETAB 0D 60MM 28MM 12.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-862","SUP","Custom 27803010","","1235-2-862  -  INSERT ACETAB 0D 62MM 28MM 13.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1235-2-864","SUP","Custom 27803010","","1235-2-864  -  INSERT ACETAB 0D 64MM 28MM 14.9MM ADM MOBILE BEARING HIP","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1236-2-242","SUP","HCPCS C1776","","1236-2-242  -  INSERT ACTB MBL BR HIP ANTM DL MBL MDLR X3 HIP 22.2 MM FEM","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-244","SUP","HCPCS C1776","","1236-2-244  -  INSERT ACTB 38MM ADM MDM MBL BR HIP RSTR X3 HIP 22.2MM FEM","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-846","SUP","HCPCS C1776","","1236-2-846  -  INSERT ACTB 0D 46MM 28MM 5.9MM ADM MBL BR HIP RSTR X3","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-848","SUP","Custom 27803010","","1236-2-848  -  INSERT, X3 FOR ADM/ MDM, RESTORATION","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1236-2-850","SUP","HCPCS C1776","","1236-2-850  -  INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR X3","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-856","SUP","HCPCS C1776","","1236-2-856  -  INSERT ACTB 0D 56MM 28MM 10.9MM ADM MBL BR HIP RSTR X3","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-858","SUP","HCPCS C1776","","1236-2-858  -  INSERT ACTB 58MM 14.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-860","SUP","HCPCS C1776","","1236-2-860  -  INSERT ACTB 0D 60MM 28MM 12.9MM DRTN ADM X3","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-862","SUP","HCPCS C1776","","1236-2-862  -  INSERT ACTB 62MM 13.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"1236-2-864","SUP","HCPCS C1776","","1236-2-864  -  INSERT ACTB 0D 64MM 28MM 14.9MM ADM MBL BR HIP RSTR X3","BOTH IP/OP","$2,015.00 ","$1,491.10 ","$0.00 ","$2,015.00 ","$906.75 ","$0.00 ","$419.98 ","$0.00 ","$0.00 ","$352.81 ","$2,015.00 ","$0.00 ","$1,007.50 ","$1,595.88 ","$1,612.00 ","$0.00 ","$315.35 ","$0.00 ","$320.79 ","$0.00 "
"125-150P","SUP","Custom 27203010","","125-150P  -  GUIDEPIN1.25 MM","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1258T/75","SUP","HCPCS C1900","","1258T/75  -  LEAD PACING MICRO S CURVE 4.3FR 75CM BIPOL STEERABLE TIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$4,275.00 ","$0.00 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$0.00 ","$4,275.00 ","$0.00 ","$2,137.50 ","$3,385.80 ","$3,420.00 ","$0.00 ","$669.04 ","$0.00 ","$0.00 ","$0.00 "
"1258T/86","SUP","HCPCS C1900","","1258T/86  -  LEAD PCNG MIC S 4.3FR 86CM QUICKFLEX BP STRBL TIP OPTIM INSL","BOTH IP/OP","$4,275.00 ","$3,163.50 ","$0.00 ","$4,275.00 ","$0.00 ","$0.00 ","$891.02 ","$0.00 ","$0.00 ","$0.00 ","$4,275.00 ","$0.00 ","$2,137.50 ","$3,385.80 ","$3,420.00 ","$0.00 ","$669.04 ","$0.00 ","$0.00 ","$0.00 "
"1258T/92","SUP","HCPCS C1900","","1258T/92  -  LEAD PACING MICRO S CURVE 4.3FR 92CM BIPOL STEERABLE TIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$4,275.00 ","$0.00 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$0.00 ","$4,275.00 ","$0.00 ","$2,137.50 ","$3,385.80 ","$3,420.00 ","$0.00 ","$669.04 ","$0.00 ","$0.00 ","$0.00 "
"1259BOP16","SUP","Custom 27203010","","1259BOP16  -  IMMOBILIZER ORTH THK3/8IN 16IN KNEE EZ WRP FOAM","BOTH IP/OP","$56.13 ","$41.54 ","$0.00 ","$85.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.90 ","$0.00 ","$42.95 ","$68.03 ","$68.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1259BOP18","SUP","Custom 27203010","","1259BOP18  -  IMMOBILIZER ORTH THK3/8IN 18IN KNEE EZ WRP FOAM","BOTH IP/OP","$63.58 ","$47.05 ","$0.00 ","$89.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.63 ","$0.00 ","$44.82 ","$70.99 ","$71.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12673-03","SUP","HCPCS C1760","","12673-03  -  DEVICE CLOSURE 6FR SUTURE MEDIATE KNOT PUSHER LATEX FREE","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"12744-16","SUP","HCPCS C1875","","12744-16  -  STENT COR 3MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12745-16","SUP","HCPCS C1875","","12745-16  -  STENT COR 3.5MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12746-19","SUP","HCPCS C1874","","12746-19  -  STENT COR 4MM 19MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$2,694.38 ","$0.00 ","$1,247.94 ","$0.00 ","$0.00 ","$1,048.36 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$937.04 ","$0.00 ","$953.21 ","$0.00 "
"1275108D","SUP","HCPCS C1751","","1275108D  -  CATHETER CV 5FR LF P PICC SHRLK 3CG 2 LUM MAXIMAL BRR TRY","BOTH IP/OP","$533.13 ","$394.52 ","$0.00 ","$538.50 ","$292.41 ","$0.00 ","$111.12 ","$0.00 ","$0.00 ","$94.29 ","$538.50 ","$0.00 ","$269.25 ","$426.49 ","$430.80 ","$0.00 ","$84.28 ","$0.00 ","$85.73 ","$0.00 "
"12A0806F","SUP","HCPCS C1757","","12A0806F  -  CATH EMBL 80CM 6FR FGRTY ART BLN INFLAT PORT TUBE PK STRL","BOTH IP/OP","$134.50 ","$99.53 ","$0.00 ","$106.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA30","SUP","Custom 27203010","","12BA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA30D","SUP","Custom 27203010","","12BA30D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA40","SUP","Custom 27203010","","12BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA40D","SUP","Custom 27203010","","12BA40D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA40DX","SUP","Custom 27203010","","12BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$395.25 ","$292.49 ","$0.00 ","$395.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$395.25 ","$0.00 ","$197.63 ","$313.04 ","$316.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA50","SUP","Custom 27203010","","12BA50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA50D","SUP","Custom 27203010","","12BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA60","SUP","Custom 27203010","","12BA60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA60D","SUP","Custom 27203010","","12BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$329.38 ","$243.74 ","$0.00 ","$329.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$329.38 ","$0.00 ","$164.69 ","$260.87 ","$263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12BA60DX","SUP","Custom 27203010","","12BA60DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$401.63 ","$297.21 ","$0.00 ","$401.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$401.63 ","$0.00 ","$200.81 ","$318.09 ","$321.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12MH22","SUP","Custom 27203010","","12MH22  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$295.38 ","$218.58 ","$0.00 ","$295.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.38 ","$0.00 ","$147.69 ","$233.94 ","$236.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12MH30","SUP","Custom 27203010","","12MH30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$299.63 ","$221.73 ","$0.00 ","$299.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.63 ","$0.00 ","$149.81 ","$237.31 ","$239.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12MH30D","SUP","Custom 27203010","","12MH30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"12TLW805F35","SUP","HCPCS C1757","","12TLW805F35  -  CATHETER EMBOLECTOMY 5.5FR 11MM 80CM OTW RADIOPACITY LATEX","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13016540P3","SUP","HCPCS C1713","","13016540P3  -  SCREW BN 6.5MM 40MM NS RELINE PA SPNL 2S","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016545P3","SUP","HCPCS C1713","","13016545P3  -  SCREW BN 6.5MM 45MM NS RELINE PA SPNL 2S","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13016550P3","SUP","HCPCS C1713","","13016550P3  -  SCREW BN 6.5MM 50MM NS RELINE PA SPNL 2S","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"13-066P","SUP","HCPCS C1713","","13-066P  -  WASHERS 13MM","BOTH IP/OP","$28.50 ","$21.09 ","$0.00 ","$28.50 ","$12.83 ","$0.00 ","$5.94 ","$0.00 ","$0.00 ","$4.99 ","$28.50 ","$0.00 ","$14.25 ","$22.57 ","$22.80 ","$0.00 ","$4.46 ","$0.00 ","$4.54 ","$0.00 "
"1314-3042","SUP","Custom 27203010","","1314-3042  -  BIT DRL 4.2MM 300MM TRFLT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"131712-01","SUP","HCPCS Q4130","","131712-01  -  DRESSING BIO 12X3IN EZ DERM MSH","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$215.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$215.74 ","$0.00 ","$107.87 ","$170.87 ","$172.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1320-0125S","SUP","Custom 27203010","","1320-0125S  -  CLIP SURG CLOSE TUBE STRL GAMMA3","BOTH IP/OP","$226.88 ","$167.89 ","$0.00 ","$226.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1320-0190","SUP","Custom 27203010","","1320-0190  -  BIT DRILL 3 LAG STP STRL","BOTH IP/OP","$2,695.00 ","$1,994.30 ","$0.00 ","$2,695.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,695.00 ","$0.00 ","$1,347.50 ","$2,134.44 ","$2,156.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1320-3030S","SUP","Custom 27203010","","1320-3030S  -  BIT DRILL 300MM 3MM GAMA SS STRL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1320-3042S","SUP","Custom 27203010","","1320-3042S  -  BIT DRL 4.2MM 300MM STRL QC DISP","BOTH IP/OP","$281.88 ","$208.59 ","$0.00 ","$281.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.88 ","$0.00 ","$140.94 ","$223.25 ","$225.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"132-40-53","SUP","HCPCS C1776","","132-40-53  -  LINER ACETAB LIPPED NOVATION CROWN CUP CONNEXION GXL GRAY 40","BOTH IP/OP","$4,118.13 ","$3,047.42 ","$0.00 ","$4,118.13 ","$1,853.16 ","$0.00 ","$858.32 ","$0.00 ","$0.00 ","$721.05 ","$4,118.13 ","$0.00 ","$2,059.06 ","$3,261.56 ","$3,294.50 ","$0.00 ","$644.49 ","$0.00 ","$655.61 ","$0.00 "
"134046J","SUP","Custom 27203010","","134046J  -  APPLIER IN CLP SM 9IN LF PRM SGCLP SUP INTLK 20 ATO CLIP LGT","BOTH IP/OP","$20.79 ","$15.38 ","$0.00 ","$20.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.79 ","$0.00 ","$10.40 ","$16.47 ","$16.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1365-24-000","SUP","HCPCS C1776","","1365-24-000  -  HEAD FEM +13MM 12/14 STD 32MM STRL LF ART/EZE SKRT COCR HIP","BOTH IP/OP","$2,897.50 ","$2,144.15 ","$0.00 ","$2,897.50 ","$1,303.88 ","$0.00 ","$603.91 ","$0.00 ","$0.00 ","$507.33 ","$2,897.50 ","$0.00 ","$1,448.75 ","$2,294.82 ","$2,318.00 ","$0.00 ","$453.46 ","$0.00 ","$461.28 ","$0.00 "
"13-678-31F","SUP","Custom 27203010","","PIPETTE SERO BOROSIL GLS 1ML GRAD NONPLUGGED REG TIP NSTRL","BOTH IP/OP","$0.35 ","$0.26 ","$0.00 ","$0.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.35 ","$0.00 ","$0.18 ","$0.28 ","$0.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"13-678-31J","SUP","Custom 27203010","","PIPETTE SERO BOROSIL GLS 10ML GRAD NONPLUGGED REG TIP NSTRL","BOTH IP/OP","$0.55 ","$0.41 ","$0.00 ","$0.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.55 ","$0.00 ","$0.28 ","$0.44 ","$0.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"138-36-53","SUP","HCPCS C1776","","138-36-53  -  LINER ACETAB FACE NOVATION CONNEXION GXL 10D 53MM 36MM HIP","BOTH IP/OP","$4,118.13 ","$3,047.42 ","$0.00 ","$4,118.13 ","$1,853.16 ","$0.00 ","$858.32 ","$0.00 ","$0.00 ","$721.05 ","$4,118.13 ","$0.00 ","$2,059.06 ","$3,261.56 ","$3,294.50 ","$0.00 ","$644.49 ","$0.00 ","$655.61 ","$0.00 "
"1385108QD","SUP","HCPCS C1751","","1385108QD  -  CATHETER CV 5FR LF P PICC SHRLK 3CG 3 LUM MAXIMAL BRR TRY","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$624.25 ","$338.97 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$109.30 ","$624.25 ","$0.00 ","$312.13 ","$494.41 ","$499.40 ","$0.00 ","$97.70 ","$0.00 ","$99.38 ","$0.00 "
"14 377 259","SUP","Custom 27203010","","SLIDE DECISLIDE URISYS ACRL INTGR CVRSLP UA 10 TST","BOTH IP/OP","$247.90 ","$183.45 ","$0.00 ","$247.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.90 ","$0.00 ","$123.95 ","$196.34 ","$198.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14-375-560","SUP","Custom 27203010","","PIPETTE KOVA DECANTING BLB SED SYS UA","BOTH IP/OP","$133.18 ","$98.55 ","$0.00 ","$133.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.18 ","$0.00 ","$66.59 ","$105.48 ","$106.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14-521014","SUP","Custom 27203010","","14-521014  -  BIT DRL 4MM 14MM MAXAN SPNE ANT CRV PLT SYS","BOTH IP/OP","$752.00 ","$556.48 ","$0.00 ","$752.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.00 ","$0.00 ","$376.00 ","$595.58 ","$601.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14-521614","SUP","HCPCS C1713","","14-521614  -  SCREW BN 4MM 14MM MAXAN VA SLF DRL SPNE","BOTH IP/OP","$1,064.00 ","$787.36 ","$0.00 ","$1,064.00 ","$478.80 ","$0.00 ","$221.76 ","$0.00 ","$0.00 ","$186.30 ","$1,064.00 ","$0.00 ","$532.00 ","$842.69 ","$851.20 ","$0.00 ","$166.52 ","$0.00 ","$169.39 ","$0.00 "
"14-521616","SUP","HCPCS C1713","","14-521616  -  SCREW BONE 4MM 16MM MAXAN SPN VAR ANG","BOTH IP/OP","$1,064.00 ","$787.36 ","$0.00 ","$1,064.00 ","$478.80 ","$0.00 ","$221.76 ","$0.00 ","$0.00 ","$186.30 ","$1,064.00 ","$0.00 ","$532.00 ","$842.69 ","$851.20 ","$0.00 ","$166.52 ","$0.00 ","$169.39 ","$0.00 "
"14-524004","SUP","HCPCS C1713","","14-524004  -  ROD SPINAL 40MM PRECUT LINEUM UNIVERSAL BLUE TITANIUM 3.5MM","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"14-524008","SUP","HCPCS C1713","","14-524008  -  ROD SPNL UNV 3.5MM 80MM BLU NS LINEUM PCUT TI OCT","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"14-524018","SUP","HCPCS C1713","","14-524018  -  ROD SPINAL UNIVERSAL 3.5MM 180MM PRECUT LINEUM BLUE TITANIUM","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"14-524024","SUP","HCPCS C1713","","14-524024  -  ROD SPNL UNV 3.5MM 240MM BLU NS LINEUM PCUT TI OCT","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$472.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$183.85 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$164.33 ","$0.00 ","$167.16 ","$0.00 "
"14-524038","SUP","HCPCS C1713","","14-524038  -  SCREW SET PLUG LINEUM HELICAL FLANGE TITANIUM SPN CERV UPPER","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$193.50 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"14-524212","SUP","HCPCS C1713","","14-524212  -  SCREW BN 3.5MM 12MM AU NS LINEUM TRNSL HLCL FLNG ST TOP LD","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-524214","SUP","HCPCS C1713","","14-524214  -  SCREW BONE 14MM SELF TAP TOP LOAD FRICTION FIT SMOOTH SHANK","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-524218","SUP","HCPCS C1713","","14-524218  -  SCREW BONE STANDARD 3.5MM 18MM SLFTAP TOP LOADING FRICTION","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-524378","SUP","HCPCS C1713","","14-524378  -  SCREW BONE LINEUM TITANIUM L28 MM OD3.5 MM OCCIPITOCERVICOTH","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-524380","SUP","HCPCS C1713","","14-524380  -  SCREW BONE 3.5MM 30MM SMOOTH SHANK TRANSLATION TECHNOLOGY","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-524512","SUP","HCPCS C1713","","14-524512  -  SCREW BONE 12MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM","BOTH IP/OP","$5,867.50 ","$4,341.95 ","$0.00 ","$5,867.50 ","$2,640.38 ","$0.00 ","$1,222.93 ","$0.00 ","$0.00 ","$1,027.35 ","$5,867.50 ","$0.00 ","$2,933.75 ","$4,647.06 ","$4,694.00 ","$0.00 ","$918.26 ","$0.00 ","$934.11 ","$0.00 "
"14-524514","SUP","HCPCS C1713","","14-524514  -  SCREW BN 4MM 14MM LINEUM TRNSL TCH GRN HD TI OCT SPNE","BOTH IP/OP","$5,867.50 ","$4,341.95 ","$0.00 ","$5,867.50 ","$2,640.38 ","$0.00 ","$1,222.93 ","$0.00 ","$0.00 ","$1,027.35 ","$5,867.50 ","$0.00 ","$2,933.75 ","$4,647.06 ","$4,694.00 ","$0.00 ","$918.26 ","$0.00 ","$934.11 ","$0.00 "
"14-524530","SUP","HCPCS C1713","","14-524530  -  SCREW BONE 30MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-524728","SUP","HCPCS C1713","","14-524728  -  SCREW BONE 4.35MM 28MM TRANSLATION TECHNOLOGY BLUE HEAD","BOTH IP/OP","$4,694.00 ","$3,473.56 ","$0.00 ","$4,694.00 ","$2,112.30 ","$0.00 ","$978.35 ","$0.00 ","$0.00 ","$821.88 ","$4,694.00 ","$0.00 ","$2,347.00 ","$3,717.65 ","$3,755.20 ","$0.00 ","$734.61 ","$0.00 ","$747.28 ","$0.00 "
"14-525000","SUP","HCPCS C1713","","14-525000  -  DRILL SURG SLEEVE LINEUM STANDARD GOLD TITANIUM 3.5MM","BOTH IP/OP","$892.50 ","$660.45 ","$0.00 ","$892.50 ","$401.63 ","$0.00 ","$186.02 ","$0.00 ","$0.00 ","$156.27 ","$892.50 ","$0.00 ","$446.25 ","$706.86 ","$714.00 ","$0.00 ","$139.68 ","$0.00 ","$142.09 ","$0.00 "
"14-525055","SUP","HCPCS C1713","","14-525055  -  TAP SURGICAL LINEUM STANDARD OD3 MM OCCIPITOCERVICOTHORACIC","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$472.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$183.85 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$164.33 ","$0.00 ","$167.16 ","$0.00 "
"145-351","SUP","HCPCS C1768","","145-351  -  STENT URET 4.8FR 24CM W/O GWIRE PRCFLX HDR+","BOTH IP/OP","$315.53 ","$233.49 ","$0.00 ","$315.53 ","$141.99 ","$0.00 ","$65.76 ","$0.00 ","$0.00 ","$55.25 ","$315.53 ","$0.00 ","$157.76 ","$249.90 ","$252.42 ","$0.00 ","$49.38 ","$0.00 ","$50.23 ","$0.00 "
"145-5091-150","SUP","HCPCS C1751","","145-5091-150  -  CATH INFUS 45D .014IN 2.1FR 1.7FR 150CM 3MM GWIRE TIP MCTH","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,772.50 ","$962.47 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$310.35 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$277.40 ","$0.00 ","$282.18 ","$0.00 "
"145-5092-150","SUP","HCPCS C1751","","145-5092-150  -  CATH INFUS .014IN 45D 250 PSI 2.4-1.9FR .017IN 150CM 3MM","BOTH IP/OP","$1,772.50 ","$1,311.65 ","$0.00 ","$1,772.50 ","$962.47 ","$0.00 ","$369.43 ","$0.00 ","$0.00 ","$310.35 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$277.40 ","$0.00 ","$282.18 ","$0.00 "
"14574-01","SUP","HCPCS C2617","","14574-01  -  STENT BIL 5MM 30MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$898.83 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"14575-01","SUP","HCPCS C2617","","14575-01  -  STENT BIL 5MM 40MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$898.83 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"14577-01","SUP","HCPCS C2617","","14577-01  -  STENT BIL 6MM 30MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$898.83 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"14578-01","SUP","HCPCS C2617","","14578-01  -  STENT BIL 6MM 40MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$898.83 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"145FS38","SUP","HCPCS C1769","","145FS38  -  GWIRE ENDSCP .038IN 145CM STR TIP HDRGLD HYDPHI STRL DISP","BOTH IP/OP","$157.50 ","$116.55 ","$0.00 ","$157.50 ","$85.52 ","$0.00 ","$32.83 ","$0.00 ","$0.00 ","$27.58 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$24.65 ","$0.00 ","$25.07 ","$0.00 "
"14679-01","SUP","HCPCS C1760","","14679-01  -  DEVICE CLOSURE 6FR CLIP LATEX FREE STARCLOSE SE NITINOL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"14937-01","SUP","HCPCS C1769","","14937-01  -  GUIDEWIRE VASC .014IN 300CM STRL 11CM ASAHI MRCLBRS 3 RADOPQ","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$32.58 ","$0.00 ","$12.51 ","$0.00 ","$0.00 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"149R","SUP","Custom 27203010","","149R  -  BRUSH CYTOLOGY RING HANDLE 3MM LATEX FREE PULMONARY STERILE","BOTH IP/OP","$24.33 ","$18.00 ","$0.00 ","$24.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.33 ","$0.00 ","$12.16 ","$19.27 ","$19.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14AC50","SUP","Custom 27203010","","14AC50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14AC60","SUP","Custom 27203010","","14AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14AC90","SUP","Custom 27203010","","14AC90  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA20","SUP","Custom 27203010","","14BA20  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA25","SUP","Custom 27203010","","14BA25  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA25D","SUP","Custom 27203010","","14BA25D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$371.88 ","$275.19 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.88 ","$0.00 ","$185.94 ","$294.53 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA30","SUP","Custom 27203010","","14BA30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA30D","SUP","Custom 27203010","","14BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$371.88 ","$275.19 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.88 ","$0.00 ","$185.94 ","$294.53 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA30DC","SUP","Custom 27203010","","14BA30DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA40D","SUP","Custom 27203010","","14BA40D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA40DC","SUP","Custom 27203010","","14BA40DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA40DX","SUP","Custom 27203010","","14BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA50","SUP","Custom 27203010","","14BA50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$363.38 ","$268.90 ","$0.00 ","$363.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$363.38 ","$0.00 ","$181.69 ","$287.80 ","$290.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA50D","SUP","Custom 27203010","","14BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA50DC","SUP","Custom 27203010","","14BA50DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA50DX","SUP","Custom 27203010","","14BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA60","SUP","Custom 27203010","","14BA60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA60D","SUP","Custom 27203010","","14BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$371.88 ","$275.19 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.88 ","$0.00 ","$185.94 ","$294.53 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA60DC","SUP","Custom 27203010","","14BA60DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA60DX","SUP","Custom 27203010","","14BA60DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA70DX","SUP","Custom 27203010","","14BA70DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA75","SUP","Custom 27203010","","14BA75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA75D","SUP","Custom 27203010","","14BA75D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$371.88 ","$275.19 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.88 ","$0.00 ","$185.94 ","$294.53 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA80DX","SUP","Custom 27203010","","14BA80DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14BA90","SUP","Custom 27203010","","14BA90  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY50","SUP","Custom 27203010","","14CY50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY50B","SUP","Custom 27203010","","14CY50B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY50DCSH","SUP","Custom 27203010","","14CY50DCSH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY60DCSH","SUP","Custom 27203010","","14CY60DCSH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY65DX","SUP","Custom 27203010","","14CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY70DCSH","SUP","Custom 27203010","","14CY70DCSH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY75","SUP","Custom 27203010","","14CY75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY76L","SUP","Custom 27203010","","14CY76L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$388.88 ","$287.77 ","$0.00 ","$388.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$388.88 ","$0.00 ","$194.44 ","$307.99 ","$311.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14CY90","SUP","Custom 27203010","","14CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14HM126","SUP","Custom 27203010","","14HM126  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14HM95","SUP","Custom 27203010","","14HM95  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14MH30DC","SUP","Custom 27203010","","14MH30DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14OV55","SUP","Custom 27203010","","14OV55  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14TA30","SUP","Custom 27203010","","14TA30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"14TA31","SUP","Custom 27203010","","14TA31  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1501652SP","SUP","HCPCS C9250","","1501652SP  -  KIT TISS CLSR FRZN SLNT ARTISS 4ML","BOTH IP/OP","$741.80 ","$548.93 ","$0.00 ","$741.80 ","$333.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$129.88 ","$741.80 ","$173.09 ","$370.90 ","$587.51 ","$593.44 ","$239.03 ","$116.09 ","$0.00 ","$118.09 ","$164.85 "
"1501653SP","SUP","Custom 27203010","","1501653SP  -  KIT TISS CLSR 10ML ARTISS DUO PREFL SYR HMN FBRN SLNT SPRY","BOTH IP/OP","$1,494.23 ","$1,105.73 ","$0.00 ","$1,868.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.63 ","$0.00 ","$934.31 ","$1,479.95 ","$1,494.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"151F7","SUP","Custom 27203010","","151F7  -  CATHETER ART LN STD 7FR 110CM SG 4 LUM S TIP TD FEM VN","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15-28126","SUP","Custom 27203010","","15-28126  -  SPLINT NSL MED FOAM RBR LTWT AL LNNG WTR RS ADH XTRN SKNPRP","BOTH IP/OP","$20.50 ","$15.17 ","$0.00 ","$20.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.50 ","$0.00 ","$10.25 ","$16.24 ","$16.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1541-01-000","SUP","HCPCS C1776","","1541-01-000  -  STEM FEM 1 STD OFST 105MM LF PROSTALAC CMNT XTN HIP","BOTH IP/OP","$13,132.50 ","$9,718.05 ","$0.00 ","$13,132.50 ","$5,909.63 ","$0.00 ","$2,737.14 ","$0.00 ","$0.00 ","$2,299.40 ","$13,132.50 ","$0.00 ","$6,566.25 ","$10,400.94 ","$10,506.00 ","$0.00 ","$2,055.24 ","$0.00 ","$2,090.69 ","$0.00 "
"1541-28-000","SUP","HCPCS C1776","","1541-28-000  -  STEM FEM 3 RT HIP","BOTH IP/OP","$10,425.00 ","$7,714.50 ","$0.00 ","$10,425.00 ","$4,691.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.33 ","$10,425.00 ","$0.00 ","$5,212.50 ","$8,256.60 ","$8,340.00 ","$0.00 ","$1,631.51 ","$0.00 ","$1,659.66 ","$0.00 "
"1541-42-320","SUP","HCPCS C1776","","1541-42-320  -  CUP ACETAB 42MM 32MM CEMENTED PROSTALAC ALL POLY HIP","BOTH IP/OP","$2,615.00 ","$1,935.10 ","$0.00 ","$2,615.00 ","$1,176.75 ","$0.00 ","$545.03 ","$0.00 ","$0.00 ","$457.87 ","$2,615.00 ","$0.00 ","$1,307.50 ","$2,071.08 ","$2,092.00 ","$0.00 ","$409.25 ","$0.00 ","$416.31 ","$0.00 "
"15-711","SUP","HCPCS C1894","","INTRODUCER SHTH 5FR 2.5CM 10CM MINI GUIDEWIRE DILAT PNCL","BOTH IP/OP","$24.38 ","$18.04 ","$0.00 ","$24.38 ","$13.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.27 ","$24.38 ","$0.00 ","$12.19 ","$19.31 ","$19.50 ","$0.00 ","$3.81 ","$0.00 ","$3.88 ","$0.00 "
"1584S","SUP","Custom 27203010","","1584S  -  WRAP COMPRESSION 5YDX4IN ELAST SELF ADHERENT FULL STRETCH","BOTH IP/OP","$69.35 ","$51.32 ","$0.00 ","$70.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.39 ","$0.00 ","$35.20 ","$55.75 ","$56.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15AC50","SUP","Custom 27203010","","15AC50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15AC60","SUP","Custom 27203010","","15AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15BA40D","SUP","Custom 27203010","","15BA40D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15BA40DX","SUP","Custom 27203010","","15BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$386.75 ","$286.20 ","$0.00 ","$386.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.75 ","$0.00 ","$193.38 ","$306.31 ","$309.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15BA50","SUP","Custom 27203010","","15BA50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15BA50D","SUP","Custom 27203010","","15BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15BA60","SUP","Custom 27203010","","15BA60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$354.88 ","$262.61 ","$0.00 ","$354.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$354.88 ","$0.00 ","$177.44 ","$281.06 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15BA60D","SUP","Custom 27203010","","15BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15CY50","SUP","Custom 27203010","","15CY50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15CY50L","SUP","Custom 27203010","","15CY50L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15CY60","SUP","Custom 27203010","","15CY60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15CY65DX","SUP","Custom 27203010","","15CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15MH17","SUP","Custom 27203010","","15MH17  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15MH17D","SUP","Custom 27203010","","15MH17D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$327.25 ","$242.17 ","$0.00 ","$327.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.25 ","$0.00 ","$163.63 ","$259.18 ","$261.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15MH22","SUP","Custom 27203010","","15MH22  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15MH30D","SUP","Custom 27203010","","15MH30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$363.38 ","$268.90 ","$0.00 ","$363.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$363.38 ","$0.00 ","$181.69 ","$287.80 ","$290.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15TA23","SUP","Custom 27203010","","15TA23  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$342.13 ","$253.18 ","$0.00 ","$342.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.13 ","$0.00 ","$171.06 ","$270.97 ","$273.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"15TA23L","SUP","Custom 27203010","","15TA23L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$342.13 ","$253.18 ","$0.00 ","$342.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.13 ","$0.00 ","$171.06 ","$270.97 ","$273.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1601-04132","SUP","HCPCS C1776","","1601-04132  -  STEM FEM 132D 4 31.5MM OFST 5.1MM 110MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-05132","SUP","HCPCS C1776","","1601-05132  -  STEM FEM 132D 5 32.5MM OFST 6MM 115MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-06127","SUP","HCPCS C1776","","1601-06127  -  STEM FEM 127D 6 37.2MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-06132","SUP","HCPCS C1776","","1601-06132  -  STEM FEM 132D 6 33.6MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-07127","SUP","HCPCS C1776","","1601-07127  -  STEM FEM 127D 7 41.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-07132","SUP","HCPCS C1776","","1601-07132  -  STEM FEM 132D 7 37.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-08127","SUP","HCPCS C1776","","1601-08127  -  STEM FEM 127D 8 42.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-08132","SUP","HCPCS C1776","","1601-08132  -  STEM FEM 132D 8 38.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-09127","SUP","HCPCS C1776","","1601-09127  -  STEM FEM 127D 9 46.9MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-09132","SUP","HCPCS C1776","","1601-09132  -  STEM FEM 132D 9 42.6MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-10127","SUP","HCPCS C1776","","1601-10127  -  STEM FEM 127D 10 48.1MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-10132","SUP","HCPCS C1776","","1601-10132  -  STEM FEM 132D 10 43.8MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-11127","SUP","HCPCS C1776","","1601-11127  -  STEM FEM 127D 11 52.6MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-11132","SUP","HCPCS C1776","","1601-11132  -  STEM FEM 132D 11 47.9MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-12127","SUP","HCPCS C1776","","1601-12127  -  STEM FEM 127D 12 53.7MM OFST 10.7MM 160MM STRL SCRFT ADV","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"1601-12132","SUP","HCPCS C1776","","1601-12132  -  STEM FEM 132D 12 49MM OFST 10.7MM 160MM STRL SCRFT ADV PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"16-3663","SUP","HCPCS C1776","","16-3663  -  HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"1663H","SUP","Custom 27203010","","1663H  -  SUTURE NABSB 3-0 PS1 18IN BLK ETH MTPS MFL","BOTH IP/OP","$29.35 ","$21.72 ","$0.00 ","$29.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.35 ","$0.00 ","$14.68 ","$23.25 ","$23.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1698G","SUP","Custom 27203010","","1698G  -  SUTURE NABSB 6-0 P-3 18IN BLK ETH MTPS MFL","BOTH IP/OP","$9.77 ","$7.23 ","$0.00 ","$9.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.92 ","$0.00 ","$4.96 ","$7.86 ","$7.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1699T/40","SUP","HCPCS C1898","","1699T/40  -  OPTISENSE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1699T/58","SUP","HCPCS C1898","","1699T/58  -  OPTISENSE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1699TC/40","SUP","HCPCS C1898","","1699TC/40  -  LEAD PCNG 6.2FR 40CM LF TNDRL FSR STRD ELUT ATR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"1699TC/46","SUP","HCPCS C1898","","1699TC/46  -  OPTISENSE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1699TC/52","SUP","HCPCS C1898","","1699TC/52  -  LEAD PCNG 1.1MM SPC 6.2FR 52CM LF OPTISENSE 1 PASS VDD BP","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"16MH18","SUP","Custom 27203010","","16MH18  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16MH18L","SUP","Custom 27203010","","16MH18L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16MH22","SUP","Custom 27203010","","16MH22  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16TA11","SUP","Custom 27203010","","16TA11  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16TA13","SUP","Custom 27203010","","16TA13  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16TA15","SUP","Custom 27203010","","16TA15  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16TA17","SUP","Custom 27203010","","16TA17  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16TA23","SUP","Custom 27203010","","16TA23  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"16TA24","SUP","Custom 27203010","","16TA24  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-0000E","SUP","Custom 27803010","","17-0000E  -  SLEEVE ADAPTER V40 TITANIUM ALUM CERAMIC NONSTRL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-001-01","SUP","HCPCS C1713","","17-001-01  -  CLIP ANEURYSM 1 8.5MM OPENING STANDARD 7MM STR SUGITA","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-02","SUP","HCPCS C1713","","17-001-02  -  CLIP ANEURYSM 10.5MM STANDARD 10MM STR SUGITA TITANIUM 2","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-03","SUP","HCPCS C1713","","17-001-03  -  CLIP ANEURYSM 11MM STANDARD 7MM BAYONET SUGITA TITANIUM 2","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-04","SUP","HCPCS C1713","","17-001-04  -  CLIP ANEURYSM 9.5MM STANDARD 8MM BENT SUGITA TITANIUM 2","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-05","SUP","HCPCS C1713","","17-001-05  -  CLIP ANRSM 8MM SGTA 11MM STD TI 2 SDWRD BNT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-06","SUP","HCPCS C1713","","17-001-06  -  CLIP ANEURYSM 6 10MM OPENING STANDARD 9MM SIDEWARD CVD","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-07","SUP","HCPCS C1713","","17-001-07  -  CLIP ANEURYSM 12MM STANDARD 8.5MM SLIGHTLY CVD BAYONET","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-08","SUP","HCPCS C1713","","17-001-08  -  CLIP ANRSM 9MM SGTA 9.5MM STD TI 2 CVD NONSTRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-09","SUP","HCPCS C1713","","17-001-09  -  CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-10","SUP","HCPCS C1713","","17-001-10  -  CLIP ANEURYSM 11.5MM STANDARD 12MM STR SUGITA TITANIUM 2","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$742.50 ","$974.00 ","$0.00 ","$146.72 ","$0.00 ","$193.83 ","$0.00 "
"17-001-11","SUP","HCPCS C1713","","17-001-11  -  CLIP ANRSM 12MM SGTA 13.5MM STD TI 2 SDWRD BNT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-13","SUP","HCPCS C1713","","17-001-13  -  CLIP ANEURYSM 13MM STANDARD 10MM BAYONET SUGITA TITANIUM 2","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-15","SUP","HCPCS C1713","","17-001-15  -  CLIP ANRSM 15MM SGTA 13.5MM STD TI 2 STR NONSTRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-18","SUP","HCPCS C1713","","17-001-18  -  CLIP ANRSM 18MM SGTA 15.5MM STD TI 2 STR","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-20","SUP","HCPCS C1713","","17-001-20  -  CLIP ANEURYSM 8MM STANDARD 5MM L SUGITA TITANIUM 2 NONSTRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-23","SUP","HCPCS C1713","","17-001-23  -  CLIP ANRSM 6MM SGTA 9MM STD TI 2 J","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-26","SUP","HCPCS C1713","","17-001-26  -  CLIP ANEURYSM 26 11MM OPENING STANDARD STR FENST SUGITA","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-27","SUP","HCPCS C1713","","17-001-27  -  CLIP ANRSM 9MM 3.5MM SGTA 13MM STD TI 2 STR FENST","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-29","SUP","HCPCS C1713","","17-001-29  -  CLIP ANEURYSM 29 12MM OPENING STANDARD 5MM 6MM STR FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-30","SUP","HCPCS C1713","","17-001-30  -  CLIP ANEURYSM 14MM STANDARD 5MM 9MM STR FENST SUGITA","BOTH IP/OP","$1,182.50 ","$875.05 ","$0.00 ","$1,182.50 ","$532.13 ","$0.00 ","$246.46 ","$0.00 ","$0.00 ","$207.05 ","$1,182.50 ","$0.00 ","$591.25 ","$936.54 ","$946.00 ","$0.00 ","$185.06 ","$0.00 ","$188.25 ","$0.00 "
"17-001-31","SUP","HCPCS C1713","","17-001-31  -  CLIP ANEURYSM 15.5MM STANDARD 5MM 12MM STR FENST SUGITA","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-35","SUP","HCPCS C1713","","17-001-35  -  CLIP ANRSM 5MM 5MM SGTA 9.5MM STD TI 2 BNT FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-36","SUP","HCPCS C1713","","17-001-36  -  CLIP ANRSM 7.5MM 5MM SGTA 10MM STD TI 2 BNT FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-37","SUP","HCPCS C1713","","17-001-37  -  CLIP ANRSM 10MM 5MM SGTA 11MM STD TI 2 BNT FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-38","SUP","HCPCS C1713","","17-001-38  -  CLIP ANRSM 5MM 3.5MM SGTA 7.5MM STD TI 2 L FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-41","SUP","HCPCS C1713","","17-001-41  -  CLIP ANRSM 5MM 5MM SGTA 8.5MM STD TI 2 L FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-48","SUP","HCPCS C1713","","17-001-48  -  CLIP ANRSM 7.5MM SGTA 45D 11.5MM STD TI 2 ANG","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-50","SUP","HCPCS C1713","","17-001-50  -  CLIP ANEURYSM 13MM STANDARD 14MM CVD SUGITA TITANIUM 2","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-51","SUP","HCPCS C1713","","17-001-51  -  CLIP ANEURYSM 9MM STANDARD 7MM STR TEMPORARY SUGITA TITANIUM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-52","SUP","HCPCS C1713","","17-001-52  -  CLIP ANEURYSM 10.5MM STANDARD 10MM STR TEMPORARY SUGITA","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-53","SUP","HCPCS C1713","","17-001-53  -  CLIP ANEURYSM 11.5MM STANDARD 7MM BAYONET TEMPORARY SUGITA","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-54","SUP","HCPCS C1713","","17-001-54  -  CLIP ANRSM 8MM SGTA 9.5MM STD TI 2 BNT TEMP","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-55","SUP","HCPCS C1713","","17-001-55  -  CLIP ANRSM 11MM SGTA 11MM STD TI 2 SLT CVD TEMP","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-56","SUP","HCPCS C1713","","17-001-56  -  CLIP ANEURYSM 56 7MM MINI STR 6MM TEMPORARY WIDE OPENING","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-57","SUP","HCPCS C1713","","17-001-57  -  CLIP ANEURYSM 7MM MINI 5MM BENT TEMPORARY SUGITA TITANIUM 2","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-58","SUP","HCPCS C1713","","17-001-58  -  CLIP ANEURYSM 7MM MINI 6MM STR TEMPORARY SLIM TIP SUGITA","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-64","SUP","HCPCS C1713","","17-001-64  -  CLIP ANRSM 8MM SGTA 10.5MM STD TI 2 SLT BNT","BOTH IP/OP","$1,182.50 ","$875.05 ","$0.00 ","$1,182.50 ","$532.13 ","$0.00 ","$246.46 ","$0.00 ","$0.00 ","$207.05 ","$1,182.50 ","$0.00 ","$591.25 ","$936.54 ","$946.00 ","$0.00 ","$185.06 ","$0.00 ","$188.25 ","$0.00 "
"17-001-65","SUP","HCPCS C1713","","17-001-65  -  CLIP ANEURYSM 11MM STANDARD 11MM SLIGHTLY CVD SUGITA","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-66","SUP","HCPCS C1713","","17-001-66  -  CLIP ANRSM 11MM SGTA 11MM STD TI 2 CVD NONSTRL","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-68","SUP","HCPCS C1713","","17-001-68  -  CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-69","SUP","HCPCS C1713","","17-001-69  -  CLIP ANRSM 9MM SGTA 69 9.5MM OPN STD TI 2 CVD","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-72","SUP","HCPCS C1713","","17-001-72  -  TII 18.0 STRAIGHT 25MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-76","SUP","HCPCS C1713","","17-001-76  -  CLIP ANRSM 10MM 5MM 8.5MM STD LEFT TI 2 L FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-79","SUP","HCPCS C1713","","17-001-79  -  CLIP ANRSM 10MM 5MM 8.5MM STD RIGHT TI 2 L FENST","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-80","SUP","HCPCS C1713","","17-001-80  -  CLIP ANEURYSM 5.5MM MINI 4MM STR SUGITA TITANIUM 2 NONSTRL","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-81","SUP","HCPCS C1713","","17-001-81  -  CLIP ANEURYSM 7MM MINI 6MM STR SUGITA TITANIUM 2 NONSTRL","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-83","SUP","HCPCS C1713","","17-001-83  -  CLIP ANRSM 5MM SGTA 6.5MM MINI TI 2 CVD NONSTRL","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-84","SUP","HCPCS C1713","","17-001-84  -  CLIP ANEURYSM 7MM MINI 5MM BENT SUGITA TITANIUM 2 NONSTRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-85","SUP","HCPCS C1713","","17-001-85  -  CLIP ANRSM 4MM SGTA 5.5MM MINI TI 2 CVD NONSTRL","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-86","SUP","HCPCS C1713","","17-001-86  -  CLIP ANRSM 7MM SGTA 7.5MM MINI TI 2 SDWRD CVD","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-88","SUP","HCPCS C1713","","17-001-88  -  CLIP ANEURYSM 7.5MM MINI 7MM CVD SUGITA TITANIUM 2 NONSTRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-89","SUP","HCPCS C1713","","17-001-89  -  CLIP ANRSM 5MM SGTA 89 8.5MM OPN MINI TI 2 BYNT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-001-90","SUP","HCPCS C1713","","17-001-90  -  T2 20.5 STRAIGHT 30MM","BOTH IP/OP","$1,740.05 ","$1,287.64 ","$0.00 ","$1,740.05 ","$783.02 ","$0.00 ","$362.67 ","$0.00 ","$0.00 ","$304.67 ","$1,740.05 ","$0.00 ","$870.03 ","$1,378.12 ","$1,392.04 ","$0.00 ","$272.32 ","$0.00 ","$277.02 ","$0.00 "
"17-001-91","SUP","HCPCS C1713","","17-001-91  -  T2 23.5 STRAIGHT 35MM","BOTH IP/OP","$1,740.05 ","$1,287.64 ","$0.00 ","$1,740.05 ","$783.02 ","$0.00 ","$362.67 ","$0.00 ","$0.00 ","$304.67 ","$1,740.05 ","$0.00 ","$870.03 ","$1,378.12 ","$1,392.04 ","$0.00 ","$272.32 ","$0.00 ","$277.02 ","$0.00 "
"17-001-92","SUP","HCPCS C1713","","17-001-92  -  CLIP ANRSM 92 26MM OPN LNG STRG 40MM TI 2","BOTH IP/OP","$1,740.05 ","$1,287.64 ","$0.00 ","$1,740.05 ","$783.02 ","$0.00 ","$362.67 ","$0.00 ","$0.00 ","$304.67 ","$1,740.05 ","$0.00 ","$870.03 ","$1,378.12 ","$1,392.04 ","$0.00 ","$272.32 ","$0.00 ","$277.02 ","$0.00 "
"17-001-95","SUP","HCPCS C1713","","17-001-95  -  CLIP ANEURYSM 5.5MM MINI 4MM STR SLIM TIP SUGITA TITANIUM 2","BOTH IP/OP","$1,182.50 ","$875.05 ","$0.00 ","$1,182.50 ","$532.13 ","$0.00 ","$246.46 ","$0.00 ","$0.00 ","$207.05 ","$1,182.50 ","$0.00 ","$591.25 ","$936.54 ","$946.00 ","$0.00 ","$185.06 ","$0.00 ","$188.25 ","$0.00 "
"17-001-96","SUP","HCPCS C1713","","17-001-96  -  CLIP ANEURYSM 7MM MINI 6MM STR SLIM TIP SUGITA TITANIUM 2","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-001-97","SUP","HCPCS C1713","","17-001-97  -  CLIP ANRSM 6.7MM SGTA 7MM MINI TI 2 CVD SLIM TIP","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-001-99","SUP","HCPCS C1713","","17-001-99  -  CLIP ANRSM 5.2MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-002-03","SUP","HCPCS C1713","","17-002-03  -  CLIP ANRSM 10 T2 STD TLL 4MM SGTA CRANK SHFT TI","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-002-05","SUP","HCPCS C1713","","17-002-05  -  CLIP ANRSM 12MM 5MM HEAD STRNG 7.5MM STD TI 2","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-002-15","SUP","HCPCS C1713","","17-002-15  -  CLIP ANEURYSM 8MM MINI 8MM STR SUGITA TITANIUM 2","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$742.50 ","$974.00 ","$0.00 ","$146.72 ","$0.00 ","$193.83 ","$0.00 "
"17-002-16","SUP","HCPCS C1713","","17-002-16  -  CLIP ANRSM 6.5MM SGTA 7MM MINI TI 2 CVD","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"17-002-17","SUP","HCPCS C1713","","17-002-17  -  CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 SLT CVD","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-002-19","SUP","Custom 27011340","","17-002-19  -  CLIP ANRSM 6MM SGTA 8.5MM MINI TI 2 SDWRD BNT","BOTH IP/OP","$1,182.50 ","$875.05 ","$0.00 ","$1,182.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,182.50 ","$0.00 ","$591.25 ","$936.54 ","$946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-002-20","SUP","HCPCS C1713","","17-002-20  -  CLIP ANRSM 7MM SGTA 10MM MINI TI 2 BYNT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-002-21","SUP","HCPCS C1713","","17-002-21  -  CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"170-03-25008","SUP","HCPCS C1874","","170-03-25008  -  SYSTEM COR STNT 2.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-25012","SUP","HCPCS C1874","","170-03-25012  -  SYSTEM COR STNT 2.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-25015","SUP","HCPCS C1874","","170-03-25015  -  SYSTEM COR STNT 2.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-25018","SUP","HCPCS C1874","","170-03-25018  -  SYSTEM COR STNT 2.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-25024","SUP","HCPCS C1874","","170-03-25024  -  SYSTEM COR STNT 2.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-25030","SUP","HCPCS C1874","","170-03-25030  -  SYSTEM COR STNT 2.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-27508","SUP","HCPCS C1874","","170-03-27508  -  SYSTEM COR STNT 2.75MM 8MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-27512","SUP","HCPCS C1874","","170-03-27512  -  SYSTEM COR STNT 2.75MM 12MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-27515","SUP","HCPCS C1874","","170-03-27515  -  SYSTEM COR STNT 2.75MM 15MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-27518","SUP","HCPCS C1874","","170-03-27518  -  SYSTEM COR STNT 2.75MM 18MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-27524","SUP","HCPCS C1874","","170-03-27524  -  SYSTEM COR STNT 2.75MM 24MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-27530","SUP","HCPCS C1874","","170-03-27530  -  SYSTEM COR STNT 2.75MM 30MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-30008","SUP","HCPCS C1874","","170-03-30008  -  SYSTEM COR STNT 3MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-30012","SUP","HCPCS C1874","","170-03-30012  -  SYSTEM COR STNT 3MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-30015","SUP","HCPCS C1874","","170-03-30015  -  SYSTEM COR STNT 3MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-30018","SUP","HCPCS C1874","","170-03-30018  -  SYSTEM COR STNT 3MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-30024","SUP","HCPCS C1874","","170-03-30024  -  SYSTEM COR STNT 3MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-30030","SUP","HCPCS C1874","","170-03-30030  -  SYSTEM COR STNT 3MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-35008","SUP","HCPCS C1874","","170-03-35008  -  SYSTEM COR STNT 3.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-35012","SUP","HCPCS C1874","","170-03-35012  -  SYSTEM COR STNT 3.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-35015","SUP","HCPCS C1876","","170-03-35015  -  SYSTEM COR STNT 3.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-35018","SUP","HCPCS C1876","","170-03-35018  -  SYSTEM COR STNT 3.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-35024","SUP","HCPCS C1874","","170-03-35024  -  SYSTEM COR STNT 3.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-35030","SUP","HCPCS C1874","","170-03-35030  -  SYSTEM COR STNT 3.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-40008","SUP","HCPCS C1874","","170-03-40008  -  SYSTEM COR STNT 4MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-40012","SUP","HCPCS C1874","","170-03-40012  -  SYSTEM COR STNT 4MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-40015","SUP","HCPCS C1874","","170-03-40015  -  SYSTEM COR STNT 4MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-40018","SUP","HCPCS C1874","","170-03-40018  -  SYSTEM COR STNT 4MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-40024","SUP","HCPCS C1874","","170-03-40024  -  SYSTEM COR STNT 4MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"170-03-40030","SUP","HCPCS C1874","","170-03-40030  -  SYSTEM COR STNT 4MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"17-006-03","SUP","HCPCS C1713","","17-006-03  -  CLIP ANRSM 11 T2 STD L 5MM SGTA WDW TI","BOTH IP/OP","$1,302.30 ","$963.70 ","$0.00 ","$1,302.30 ","$586.04 ","$0.00 ","$271.43 ","$0.00 ","$0.00 ","$228.02 ","$1,302.30 ","$0.00 ","$651.15 ","$1,031.42 ","$1,041.84 ","$0.00 ","$203.81 ","$0.00 ","$207.33 ","$0.00 "
"17-006-36","SUP","HCPCS C1713","","17-006-36  -  CLIP ANRSM 142 006-36 STD BNT 5MM 3MM FENESTRATE TI","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"17-006-39","SUP","HCPCS C1713","","17-006-39  -  CLIP ANRSM STRG 3.5MM 4MM SGTA T2 FENESTRATE TI","BOTH IP/OP","$1,217.50 ","$900.95 ","$0.00 ","$1,217.50 ","$547.88 ","$0.00 ","$253.76 ","$0.00 ","$0.00 ","$213.17 ","$1,217.50 ","$0.00 ","$608.75 ","$964.26 ","$974.00 ","$0.00 ","$190.54 ","$0.00 ","$193.83 ","$0.00 "
"17-006-40","SUP","HCPCS C1713","","17-006-40  -  CLIP ANRSM STRG 5MM 4MM SGTA T2 FENESTRATE TI","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"1714G","SUP","Custom 27203010","","1714G  -  SUTURE NONABSORBABLE 8-0 TG100-8 12IN 2 ARM MONOFILAMENT","BOTH IP/OP","$33.48 ","$24.78 ","$0.00 ","$33.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.98 ","$0.00 ","$16.99 ","$26.91 ","$27.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1716G","SUP","Custom 27203010","","1716G  -  SUTURE NONABSORBABLE 8-0 TG175-8 12IN 2 ARM MONOFILAMENT","BOTH IP/OP","$33.61 ","$24.87 ","$0.00 ","$34.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.11 ","$0.00 ","$17.06 ","$27.02 ","$27.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D600","SUP","Custom 27203010","","17200D600  -  PUNCH SURG 6MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D650","SUP","Custom 27203010","","17200D650  -  PUNCH SURG 6.5MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D700","SUP","Custom 27203010","","17200D700  -  PUNCH SURG 7MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D725","SUP","Custom 27203010","","17200D725  -  PUNCH SURG 7.25MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D750","SUP","Custom 27203010","","17200D750  -  PUNCH SURG 7.5MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D775","SUP","Custom 27203010","","17200D775  -  PUNCH SURG 7.75MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D800","SUP","Custom 27203010","","17200D800  -  PUNCH SURG 8MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D825","SUP","Custom 27203010","","17200D825  -  PUNCH SURG 8.25MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D850","SUP","Custom 27203010","","17200D850  -  PUNCH SURG 8.5MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D875","SUP","Custom 27203010","","17200D875  -  PUNCH SURG 8.75MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D900","SUP","Custom 27203010","","17200D900  -  PUNCH SURG 9MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17200D950","SUP","Custom 27203010","","17200D950  -  PUNCH SURG 9.5MM CORNEUM 2 PC VAC UL SHRP BLADE","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1722G","SUP","Custom 27203010","","1722G  -  SUTURE MERS 6-0 S-14 18IN WVN TPE BRAID DBL ARM WHT NABSB","BOTH IP/OP","$33.57 ","$24.84 ","$0.00 ","$33.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.57 ","$0.00 ","$16.78 ","$26.59 ","$26.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-2800E","SUP","Custom 27803010","","17-2800E  -  HEAD FEMORAL C TAPER ALUM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-2805E","SUP","Custom 27803010","","17-2805E  -  HEAD FEMORAL +5MM 28MM C TAPER ALUM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-28-3E","SUP","Custom 27803010","","17-28-3E  -  HEAD FEMORAL +3MM 28MM C TAPER ALUM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"173050G","SUP","Custom 27203010","","173050G  -  POUCH SPECIMEN RETRIEVAL 10MM 34.5CM MINIMIZE SPILLAGE","BOTH IP/OP","$147.95 ","$109.48 ","$0.00 ","$150.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.17 ","$0.00 ","$75.08 ","$118.93 ","$120.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-3200E","SUP","Custom 27803010","","17-3200E  -  HEAD FEM +0MM OFST CTPR 32MM STRL AL CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-3205E","SUP","Custom 27803010","","17-3205E  -  HEAD FEMORAL +5MM 32MM C TAPER ALUM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-32-3E","SUP","Custom 27803010","","17-32-3E  -  HEAD FEM -2.5MM CTPR 32MM STRL AL CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1735G","SUP","Custom 27203010","","1735G  -  SUTURE ABSORBABLE 6-0 TG140-8 18IN 2 ARM MONOFILAMENT","BOTH IP/OP","$55.72 ","$41.23 ","$0.00 ","$56.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.56 ","$0.00 ","$28.28 ","$44.80 ","$45.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-3600E","SUP","Custom 27803010","","17-3600E  -  HEAD FEM +0MM OFST CTPR 36MM STRL AL CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-3605E","SUP","Custom 27803010","","17-3605E  -  HEAD FEMORAL +5MM 36MM C TAPER ALUM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"17-36-5E","SUP","HCPCS C1713","","17-36-5E  -  HEAD FEMORAL -5MM C-TAPER 36MM OFFST ALUM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"174105-2","SUP","Custom 27203010","","174105-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"175031EN","SUP","Custom 27203010","","175031EN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.00 ","$0.00 ","$12.00 ","$19.01 ","$19.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1754G","SUP","Custom 27203010","","1754G  -  SUTURE NONABSORBABLE 9-0 TG140-8 6IN 2 ARM MONOFILAMENT","BOTH IP/OP","$42.02 ","$31.09 ","$0.00 ","$42.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.02 ","$0.00 ","$21.01 ","$33.28 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1758SI16","SUP","Custom 27203010","","1758SI16  -  CATHETER URTH 16FR 5CC STRL LF BARD LBRSL IC 2W FL BLN","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1762G","SUP","Custom 27203010","","1762G  -  SUTURE NONABSORBABLE 4-0 S-24 18IN MONOFILAMENT PLIABILIZE","BOTH IP/OP","$37.27 ","$27.58 ","$0.00 ","$37.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.83 ","$0.00 ","$18.91 ","$29.96 ","$30.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1764G","SUP","Custom 27203010","","1764G  -  SUTURE NABSB 5-0 S-24 18IN WHT MERS SABRELOC 2 ARM BRD","BOTH IP/OP","$36.90 ","$27.31 ","$0.00 ","$37.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.45 ","$0.00 ","$18.73 ","$29.66 ","$29.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1773.00.126","SUP","HCPCS C1713","","1773.00.126  -  CAGE SPNL 12MM STD PRLL 14X26MM NS LF BENGAL STKBL RDLCNT","BOTH IP/OP","$8,790.00 ","$6,504.60 ","$0.00 ","$8,790.00 ","$3,955.50 ","$0.00 ","$1,832.06 ","$0.00 ","$0.00 ","$1,539.06 ","$8,790.00 ","$0.00 ","$4,395.00 ","$6,961.68 ","$7,032.00 ","$0.00 ","$1,375.64 ","$0.00 ","$1,399.37 ","$0.00 "
"1779G","SUP","Custom 27203010","","1779G  -  SUTURE NONABSORBABLE 4-0 S-2 18IN MONOFILAMENT PLIABILIZE","BOTH IP/OP","$33.94 ","$25.12 ","$0.00 ","$33.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.94 ","$0.00 ","$16.97 ","$26.88 ","$27.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179071P","SUP","Custom 27203010","","179071P  -  TROCAR LAPSCOP 100MM 5-12MM VPRT+ RPF BLADED CNVTRLS RDLCNT","BOTH IP/OP","$128.52 ","$95.10 ","$0.00 ","$128.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.52 ","$0.00 ","$64.26 ","$101.79 ","$102.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179075P","SUP","Custom 27203010","","179075P  -  TROCAR LAPSCOP 5-12MM BLNTPRT PLUS VRSPRT SLV CNVTRLS STAB","BOTH IP/OP","$35.84 ","$26.52 ","$0.00 ","$35.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.84 ","$0.00 ","$17.92 ","$28.39 ","$28.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179078P","SUP","Custom 27203010","","179078P  -  TROCAR LAPSCOP PYRAMID 10-15MM 100MM 5MM SAFETY SHIELD SELF","BOTH IP/OP","$120.15 ","$88.91 ","$0.00 ","$120.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.15 ","$0.00 ","$60.08 ","$95.16 ","$96.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179094F","SUP","Custom 27203010","","179094F  -  TROCAR LAPSCP 5MM LVN VPRT+ V2 VERSASEAL + FX CNN CNVTRLS","BOTH IP/OP","$73.95 ","$54.72 ","$0.00 ","$73.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.95 ","$0.00 ","$36.98 ","$58.57 ","$59.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179096PF","SUP","Custom 27203010","","179096PF  -  TROCAR LAPSCOP 12MM VPRT+ V2 BLADED FIX CANNU STRL DISP","BOTH IP/OP","$86.28 ","$63.85 ","$0.00 ","$123.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.01 ","$0.00 ","$61.51 ","$97.42 ","$98.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"179097P","SUP","Custom 27203010","","179097P  -  TROCAR LAPSCOP LONG 5-12MM 150MM SHARP LINEAR BLADE SPRING","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1797.12.765","SUP","HCPCS C1713","","1797.12.765  -  SCREW BONE 7MM 65MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"1797.71.150","SUP","HCPCS C1713","","1797.71.150  -  ROD SPNL PREBNT 5.5MM 150MM NS XPDM LN TI","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"1797.71.555","SUP","HCPCS C1713","","1797.71.555  -  CONNECTOR ROD 5.5MM TOP NOTCH OUTER TO OUTER SIDE SPN","BOTH IP/OP","$2,752.50 ","$2,036.85 ","$0.00 ","$2,752.50 ","$1,238.63 ","$0.00 ","$573.69 ","$0.00 ","$0.00 ","$481.94 ","$2,752.50 ","$0.00 ","$1,376.25 ","$2,179.98 ","$2,202.00 ","$0.00 ","$430.77 ","$0.00 ","$438.20 ","$0.00 "
"1797G","SUP","Custom 27203010","","1797G  -  SUTURE ABSORBABLE 7-0 TG140-8 18IN 2 ARM MONOFILAMENT","BOTH IP/OP","$67.02 ","$49.59 ","$0.00 ","$68.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.03 ","$0.00 ","$34.01 ","$53.88 ","$54.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"180204HC-S-V","SUP","HCPCS C1884","","COIL MICROPLEX 18SOFT 2MM X 4CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"180208HC-S-V","SUP","HCPCS C1884","","COIL MICROPLEX 18SOFT 2MM X 8CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"180308HC-S-V","SUP","HCPCS C1884","","COIL MICROPLEX 18SOFT 3MM X 8CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"180320-1","SUP","HCPCS C1776","","180320-1  -  COMPONENT PTLR RND 26MM RSRFC KN MCK SYS","BOTH IP/OP","$2,192.50 ","$1,622.45 ","$0.00 ","$2,192.50 ","$986.63 ","$0.00 ","$456.97 ","$0.00 ","$0.00 ","$383.89 ","$2,192.50 ","$0.00 ","$1,096.25 ","$1,736.46 ","$1,754.00 ","$0.00 ","$343.13 ","$0.00 ","$349.05 ","$0.00 "
"180320-2","SUP","HCPCS C1776","","180320-2  -  COMPONENT PTLR RND 29MM RSRFC KN MCK SYS","BOTH IP/OP","$2,192.50 ","$1,622.45 ","$0.00 ","$2,192.50 ","$986.63 ","$0.00 ","$456.97 ","$0.00 ","$0.00 ","$383.89 ","$2,192.50 ","$0.00 ","$1,096.25 ","$1,736.46 ","$1,754.00 ","$0.00 ","$343.13 ","$0.00 ","$349.05 ","$0.00 "
"180320-3","SUP","HCPCS C1776","","180320-3  -  COMPONENT PTLR RND 32MM RSRFC KN MCK SYS","BOTH IP/OP","$2,192.50 ","$1,622.45 ","$0.00 ","$2,192.50 ","$986.63 ","$0.00 ","$456.97 ","$0.00 ","$0.00 ","$383.89 ","$2,192.50 ","$0.00 ","$1,096.25 ","$1,736.46 ","$1,754.00 ","$0.00 ","$343.13 ","$0.00 ","$349.05 ","$0.00 "
"180320-4","SUP","HCPCS C1776","","180320-4  -  DOME PTLR RND 35MM RSRFC KN MCK SYS","BOTH IP/OP","$2,192.50 ","$1,622.45 ","$0.00 ","$2,192.50 ","$986.63 ","$0.00 ","$456.97 ","$0.00 ","$0.00 ","$383.89 ","$2,192.50 ","$0.00 ","$1,096.25 ","$1,736.46 ","$1,754.00 ","$0.00 ","$343.13 ","$0.00 ","$349.05 ","$0.00 "
"180320-6","SUP","HCPCS C1776","","180320-6  -  DOME PTLR RND 41MM RSRFC KN MCK SYS","BOTH IP/OP","$2,192.50 ","$1,622.45 ","$0.00 ","$2,192.50 ","$986.63 ","$0.00 ","$456.97 ","$0.00 ","$0.00 ","$383.89 ","$2,192.50 ","$0.00 ","$1,096.25 ","$1,736.46 ","$1,754.00 ","$0.00 ","$343.13 ","$0.00 ","$349.05 ","$0.00 "
"180406HC-S-V","SUP","HCPCS C1884","","COIL MICROPLEX 18SOFT 4MM X 6CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"180512HC-S-V","SUP","HCPCS C1884","","COIL MICROPLEX 18SOFT 5MM X 12CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"180520HC-R-V","SUP","HCPCS C1884","","COIL MICROPLEX 18REG 5MM X 20CM","BOTH IP/OP","$1,536.65 ","$1,137.12 ","$0.00 ","$1,536.65 ","$691.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.06 ","$1,536.65 ","$0.00 ","$768.33 ","$1,217.03 ","$1,229.32 ","$0.00 ","$240.49 ","$0.00 ","$244.63 ","$0.00 "
"1806-0004","SUP","HCPCS C1713","","1806-0004  -  SCREW BONE T2 LCK INS","BOTH IP/OP","$460.63 ","$340.87 ","$0.00 ","$460.63 ","$207.28 ","$0.00 ","$96.01 ","$0.00 ","$0.00 ","$80.65 ","$460.63 ","$0.00 ","$230.31 ","$364.82 ","$368.50 ","$0.00 ","$72.09 ","$0.00 ","$73.33 ","$0.00 "
"1806-0007","SUP","HCPCS C1713","","1806-0007  -  SCREW BONE T2 CNDYLR INS","BOTH IP/OP","$426.25 ","$315.43 ","$0.00 ","$426.25 ","$191.81 ","$0.00 ","$88.84 ","$0.00 ","$0.00 ","$74.63 ","$426.25 ","$0.00 ","$213.13 ","$337.59 ","$341.00 ","$0.00 ","$66.71 ","$0.00 ","$67.86 ","$0.00 "
"1806-0009","SUP","HCPCS C1713","","1806-0009  -  SCREW BONE T2 FEM/TIB INS CMPR","BOTH IP/OP","$526.63 ","$389.71 ","$0.00 ","$526.63 ","$236.98 ","$0.00 ","$109.76 ","$0.00 ","$0.00 ","$92.21 ","$526.63 ","$0.00 ","$263.31 ","$417.09 ","$421.30 ","$0.00 ","$82.42 ","$0.00 ","$83.84 ","$0.00 "
"1806-0050S","SUP","HCPCS C1713","","1806-0050S  -  WIRE FX 3MM 285MM STRL KRSH T2 SS","BOTH IP/OP","$195.50 ","$144.67 ","$0.00 ","$200.75 ","$90.34 ","$0.00 ","$40.75 ","$0.00 ","$0.00 ","$35.15 ","$200.75 ","$0.00 ","$100.38 ","$158.99 ","$160.60 ","$0.00 ","$31.42 ","$0.00 ","$31.96 ","$0.00 "
"1806-0073S","SUP","Custom 27203010","","1806-0073S  -  TUBE ORTH TFLN T2 HUM NL SYS","BOTH IP/OP","$387.75 ","$286.94 ","$0.00 ","$387.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.75 ","$0.00 ","$193.88 ","$307.10 ","$310.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1806-0080S","SUP","HCPCS C1769","","1806-0080S  -  GWIRE ORTH 800MM 3MM T2 TI BALL TIP FEM NAIL SYS STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$160.52 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"1806-0083S","SUP","HCPCS C1769","","1806-0083S  -  GWIRE ORTH 800MM 2.5MM T2 TI BALL TIP FEM NAIL SYS STRL","BOTH IP/OP","$290.70 ","$215.12 ","$0.00 ","$294.25 ","$159.78 ","$0.00 ","$60.59 ","$0.00 ","$0.00 ","$51.52 ","$294.25 ","$0.00 ","$147.13 ","$233.05 ","$235.40 ","$0.00 ","$46.05 ","$0.00 ","$46.84 ","$0.00 "
"1806-0085S","SUP","HCPCS C1769","","1806-0085S  -  GWIRE ORTH 1000MM 3MM T2 TI BALL TIP FEM NAIL SYS STRL","BOTH IP/OP","$312.80 ","$231.47 ","$0.00 ","$336.88 ","$182.92 ","$0.00 ","$65.20 ","$0.00 ","$0.00 ","$58.98 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$52.72 ","$0.00 ","$53.63 ","$0.00 "
"1806-0090S","SUP","HCPCS C1769","","1806-0090S  -  GWIRE ORTH 800MM 3MM T2 TI SMTH TIP FEM NAIL SYS STRL","BOTH IP/OP","$294.10 ","$217.63 ","$0.00 ","$302.50 ","$164.26 ","$0.00 ","$61.30 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"1806-0093S","SUP","HCPCS C1769","","1806-0093S  -  GWIRE ORTH 800MM 2.2MM T2 TI SMTH TIP FEM NAIL SYS STRL","BOTH IP/OP","$283.05 ","$209.46 ","$0.00 ","$294.25 ","$159.78 ","$0.00 ","$58.99 ","$0.00 ","$0.00 ","$51.52 ","$294.25 ","$0.00 ","$147.13 ","$233.05 ","$235.40 ","$0.00 ","$46.05 ","$0.00 ","$46.84 ","$0.00 "
"1806-0225","SUP","Custom 27203010","","1806-0225  -  BIT DRILL 3.5MM T2 LNG DRVR AO","BOTH IP/OP","$716.38 ","$530.12 ","$0.00 ","$716.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$716.38 ","$0.00 ","$358.19 ","$567.37 ","$573.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1806-1005","SUP","Custom 27203010","","1806-1005  -  SET ORTH FEM TRGT DEV","BOTH IP/OP","$6,639.88 ","$4,913.51 ","$0.00 ","$6,639.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,639.88 ","$0.00 ","$3,319.94 ","$5,258.78 ","$5,311.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1806-1250S","SUP","HCPCS C1769","","1806-1250S  -  GWIRE ORTH 1250MM 3MM T2 BALL TIP STRL","BOTH IP/OP","$294.95 ","$218.26 ","$0.00 ","$302.50 ","$164.26 ","$0.00 ","$61.47 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"180615HC-S-V","SUP","HCPCS C1884","","COIL MICROPLEX 18SOFT 6MM X 15CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"1806-2020","SUP","Custom 27203010","","1806-2020  -  DRILL SURG CRWN T2 NONSTRL","BOTH IP/OP","$598.13 ","$442.62 ","$0.00 ","$598.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$598.13 ","$0.00 ","$299.06 ","$473.72 ","$478.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"180620HC-R-V","SUP","HCPCS C1884","","COIL MICROPLEX 18REG 6MM X 20CM","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"1806-3025","SUP","Custom 27203010","","1806-3025  -  BIT DRILL T2 CANN STP","BOTH IP/OP","$2,151.88 ","$1,592.39 ","$0.00 ","$2,151.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,151.88 ","$0.00 ","$1,075.94 ","$1,704.29 ","$1,721.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1806-3030","SUP","HCPCS C1713","","1806-3030  -  WIRE FX 3.2MM 400MM NS KRSH T2 RECON SS NL SYS","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"1806-3030S","SUP","HCPCS C1713","","1806-3030S  -  WIRE 400MM 3.2MM KWIRE T2 SS RECON NL SYS STRL","BOTH IP/OP","$373.15 ","$276.13 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$77.77 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"1806-3031S","SUP","HCPCS C1713","","1806-3031S  -  WIRE FX 3.2MM 400MM STRL KRSH T2 RECON COCR NL SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"1806-3500S","SUP","Custom 27203010","","1806-3500S  -  BIT DRILL 130MM 3.5MM T2 AO STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1806-3505","SUP","Custom 27203010","","1806-3505  -  BIT DRILL 130MM 3.5MM T2 TRFLT","BOTH IP/OP","$226.88 ","$167.89 ","$0.00 ","$226.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1806-3510S","SUP","Custom 27203010","","1806-3510S  -  BIT DRILL 230MM 3.5MM T2 AO STRL","BOTH IP/OP","$207.63 ","$153.65 ","$0.00 ","$207.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.63 ","$0.00 ","$103.81 ","$164.44 ","$166.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"180705-8","SUP","HCPCS C1776","","180705-8  -  INSERT TIB 5 15MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180705-9","SUP","HCPCS C1776","","180705-9  -  INSERT TIB 5 16MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-1","SUP","HCPCS C1776","","180706-1  -  INSERT TIB 6 8MM ONLAY KN MCK SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-2","SUP","HCPCS C1776","","180706-2  -  INSERT TIB 6 9MM ONLAY KN MCK SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-3","SUP","HCPCS C1776","","180706-3  -  INSERT TIB 6 10MM ONLAY","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-4","SUP","HCPCS C1776","","180706-4  -  INSERT TIB 6 11MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-6","SUP","HCPCS C1776","","180706-6  -  INSERT TIB 6 13MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-7","SUP","HCPCS C1776","","180706-7  -  INSERT TIB 6 14MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-8","SUP","HCPCS C1776","","180706-8  -  INSERT TIB 6 15MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180706-9","SUP","HCPCS C1776","","180706-9  -  INSERT TIB 6 16MM ONLAY MULTICOMPARTMENTAL KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-1","SUP","HCPCS C1776","","180707-1  -  INSERT TIB 7 8MM ONLAY KN MCK SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-2","SUP","HCPCS C1776","","180707-2  -  INSERT TIB 7 9MM ONLAY KN MCK SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-3","SUP","HCPCS C1776","","180707-3  -  INSERT TIB 7 10MM ONLAY KN MCK SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-4","SUP","HCPCS C1776","","180707-4  -  INSERT TIB 7 11MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-6","SUP","HCPCS C1776","","180707-6  -  INSERT TIB 7 13MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-7","SUP","HCPCS C1776","","180707-7  -  INSERT TIB 7 14MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-8","SUP","HCPCS C1776","","180707-8  -  INSERT TIB 7 15MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180707-9","SUP","HCPCS C1776","","180707-9  -  INSERT TIB 7 16MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180708-4","SUP","HCPCS C1776","","180708-4  -  INSERT TIB 8 11MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180708-6","SUP","HCPCS C1776","","180708-6  -  INSERT TIB 8 13MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180708-7","SUP","HCPCS C1776","","180708-7  -  INSERT TIB 8 14MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180708-8","SUP","HCPCS C1776","","180708-8  -  INSERT TIB 8 15MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180708-9","SUP","HCPCS C1776","","180708-9  -  INSERT TIB 8 16MM ONLAY KN MULTICOMPARTMENTAL SYS","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"180731-1","SUP","HCPCS C1776","","180731-1  -  INSERT TIB 1 8MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-1-E","SUP","HCPCS C1776","","180731-1-E  -  INSERT TIB 1 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-2","SUP","HCPCS C1776","","180731-2  -  INSERT TIB 1 9MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-2-E","SUP","HCPCS C1776","","180731-2-E  -  INSERT TIB 1 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-3","SUP","HCPCS C1776","","180731-3  -  INSERT TIB 1 10MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-3-E","SUP","HCPCS C1776","","180731-3-E  -  INSERT TIB 1 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-5","SUP","HCPCS C1776","","180731-5  -  INSERT TIB 1 12MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180731-5-E","SUP","HCPCS C1776","","180731-5-E  -  INSERT TIB 1 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-1","SUP","HCPCS C1776","","180732-1  -  INSERT TIB 2 8MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-1-E","SUP","HCPCS C1776","","180732-1-E  -  INSERT TIB 2 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-2","SUP","HCPCS C1776","","180732-2  -  INSERT TIB 2 9MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-2-E","SUP","HCPCS C1776","","180732-2-E  -  INSERT TIB 2 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-3","SUP","HCPCS C1776","","180732-3  -  INSERT TIB 2 10MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-3-E","SUP","HCPCS C1776","","180732-3-E  -  INSERT TIB 2 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-5","SUP","HCPCS C1776","","180732-5  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180732-5-E","SUP","HCPCS C1776","","180732-5-E  -  INSERT TIB 2 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-1","SUP","HCPCS C1776","","180733-1  -  INSERT TIB 3 8MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-1-E","SUP","HCPCS C1776","","180733-1-E  -  INSERT TIB 3 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-2","SUP","HCPCS C1776","","180733-2  -  INSERT TIB 3 9MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-2-E","SUP","HCPCS C1776","","180733-2-E  -  INSERT TIB 3 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-3","SUP","HCPCS C1776","","180733-3  -  INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-3-E","SUP","HCPCS C1776","","180733-3-E  -  INSERT TIB 3 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-5","SUP","HCPCS C1776","","180733-5  -  INSERT TIB 3 12MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180733-5-E","SUP","HCPCS C1776","","180733-5-E  -  INSERT TIB 3 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-1","SUP","HCPCS C1776","","180734-1  -  INSERT TIB 4 8MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-1-E","SUP","HCPCS C1776","","180734-1-E  -  INSERT TIB 4 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-2","SUP","HCPCS C1776","","180734-2  -  INSERT TIB 4 9MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-2-E","SUP","HCPCS C1776","","180734-2-E  -  INSERT TIB 4 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-3","SUP","HCPCS C1776","","180734-3  -  INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-3-E","SUP","HCPCS C1776","","180734-3-E  -  INSERT TIB 4 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180734-5","SUP","HCPCS C1776","","180734-5  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-1","SUP","HCPCS C1776","","180735-1  -  INSERT TIB 5 8MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-1-E","SUP","HCPCS C1776","","180735-1-E  -  INSERT TIB 5 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-2","SUP","HCPCS C1776","","180735-2  -  INSERT TIB 5 9MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-2-E","SUP","HCPCS C1776","","180735-2-E  -  INSERT TIB 5 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-3","SUP","HCPCS C1776","","180735-3  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-5","SUP","HCPCS C1776","","180735-5  -  INSERT TIB 5 12MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180735-5-E","SUP","HCPCS C1776","","180735-5-E  -  INSERT TIB 5 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-1","SUP","HCPCS C1776","","180736-1  -  INSERT TIB 6 8MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-1-E","SUP","HCPCS C1776","","180736-1-E  -  INSERT TIB 6 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-2","SUP","HCPCS C1776","","180736-2  -  INSERT TIB 6 9MM MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-2-E","SUP","HCPCS C1776","","180736-2-E  -  INSERT TIB 6 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-3","SUP","HCPCS C1776","","180736-3  -  INSERT TIB 6 10MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-3-E","SUP","HCPCS C1776","","180736-3-E  -  INSERT TIB 6 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-5","SUP","HCPCS C1776","","180736-5  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180736-5-E","SUP","HCPCS C1776","","180736-5-E  -  INSERT TIB 6 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-1","SUP","HCPCS C1776","","180737-1  -  INSERT TIB 8MM STRL MAKO BRNG ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-1-E","SUP","HCPCS C1776","","180737-1-E  -  INSERT TIB 7 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-2","SUP","HCPCS C1776","","180737-2  -  INSERT TIB 7 9MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-2-E","SUP","HCPCS C1776","","180737-2-E  -  INSERT TIB 7 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-3","SUP","HCPCS C1776","","180737-3  -  INSERT TIB 7 10MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-3-E","SUP","HCPCS C1776","","180737-3-E  -  INSERT TIB 7 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-5","SUP","HCPCS C1776","","180737-5  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180737-5-E","SUP","HCPCS C1776","","180737-5-E  -  INSERT TIB 7 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-1","SUP","HCPCS C1776","","180738-1  -  INSERT TIB 8 8MM MAKO X3 UNCMP ONLAY KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-1-E","SUP","HCPCS C1776","","180738-1-E  -  INSERT TIB 8 8MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-2","SUP","HCPCS C1776","","180738-2  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-2-E","SUP","HCPCS C1776","","180738-2-E  -  INSERT TIB 8 9MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-3","SUP","HCPCS C1776","","180738-3  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-3-E","SUP","HCPCS C1776","","180738-3-E  -  INSERT TIB 8 10MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-5","SUP","HCPCS C1776","","180738-5  -  INSERT TIB","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"180738-5-E","SUP","HCPCS C1776","","180738-5-E  -  INSERT TIB 8 12MM STRL MAKO UNCMP ONLAY X3 KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"18-131","SUP","HCPCS C1887","","18-131  -  CATH GUID 130CM 20CM MCTH STR HYDPHI RNGD STC-18","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$665.18 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"1818-0001S","SUP","HCPCS C1713","","1818-0001S  -  SCREW BONE 8MM 14.5MM T2 TI ANKL CMPR CANN PRELD ARTHDES","BOTH IP/OP","$300.90 ","$222.67 ","$0.00 ","$276.38 ","$124.37 ","$0.00 ","$62.72 ","$0.00 ","$0.00 ","$48.39 ","$276.38 ","$0.00 ","$138.19 ","$218.89 ","$221.10 ","$0.00 ","$43.25 ","$0.00 ","$44.00 ","$0.00 "
"1818-1015S","SUP","HCPCS C1713","","1818-1015S  -  NAIL 10MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1020S","SUP","HCPCS C1713","","1818-1020S  -  NAIL 10MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1030S","SUP","HCPCS C1713","","1818-1030S  -  NAIL 10MM 30CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1115S","SUP","HCPCS C1713","","1818-1115S  -  NAIL 11MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1120S","SUP","HCPCS C1713","","1818-1120S  -  NAIL 11MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1130S","SUP","HCPCS C1713","","1818-1130S  -  NAIL 11MM 30CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1215S","SUP","HCPCS C1713","","1818-1215S  -  NAIL 12MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1220S","SUP","HCPCS C1713","","1818-1220S  -  NAIL 12MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1818-1230S","SUP","HCPCS C1713","","1818-1230S  -  T2 ANKLE ARTHRODESIS NAIL LEFT 12MM X 300MM","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1015S","SUP","HCPCS C1713","","1819-1015S  -  NAIL 10MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1020S","SUP","HCPCS C1713","","1819-1020S  -  NAIL 10MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1030S","SUP","HCPCS C1713","","1819-1030S  -  NAIL 10MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1115S","SUP","HCPCS C1713","","1819-1115S  -  NAIL 11MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1120S","SUP","HCPCS C1713","","1819-1120S  -  NAIL 11MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1130S","SUP","HCPCS C1713","","1819-1130S  -  NAIL 11MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1215S","SUP","HCPCS C1713","","1819-1215S  -  NAIL 12MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1220S","SUP","HCPCS C1713","","1819-1220S  -  NAIL 12MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1819-1230S","SUP","HCPCS C1713","","1819-1230S  -  NAIL 12MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL","BOTH IP/OP","$3,744.25 ","$2,770.75 ","$0.00 ","$3,485.63 ","$1,568.53 ","$0.00 ","$780.40 ","$0.00 ","$0.00 ","$610.31 ","$3,485.63 ","$0.00 ","$1,742.81 ","$2,760.62 ","$2,788.50 ","$0.00 ","$545.50 ","$0.00 ","$554.91 ","$0.00 "
"1822-0001S","SUP","HCPCS C1713","","1822-0001S  -  SCREW BONE 8MM T2 TI TIB CMPR STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1822-0003S","SUP","HCPCS C1713","","1822-0003S  -  CAP END STD STRL T2 8MM","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1822-0004S","SUP","HCPCS C1713","","1822-0004S  -  CAP END FULTHRD T2","BOTH IP/OP","$239.25 ","$177.05 ","$0.00 ","$239.25 ","$107.66 ","$0.00 ","$49.87 ","$0.00 ","$0.00 ","$41.89 ","$239.25 ","$0.00 ","$119.63 ","$189.49 ","$191.40 ","$0.00 ","$37.44 ","$0.00 ","$38.09 ","$0.00 "
"1822-0005S","SUP","HCPCS C1713","","1822-0005S  -  CAP END +5MM STRL T2 11.5MM","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1822-0010S","SUP","HCPCS C1713","","1822-0010S  -  CAP END 10MM 10+ MM HUM IM NAIL STRL T2 11.5MM","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1822-0015S","SUP","HCPCS C1713","","1822-0015S  -  CAP END 15MM FEM IM NAIL TI STRL T2","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1822-0824S","SUP","HCPCS C1713","","1822-0824S  -  NAIL 8MM 24CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0825S","SUP","HCPCS C1713","","1822-0825S  -  NAIL 8MM 25.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0827S","SUP","HCPCS C1713","","1822-0827S  -  NAIL 8MM 27CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0828S","SUP","HCPCS C1713","","1822-0828S  -  NAIL 8MM 28.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0830S","SUP","HCPCS C1713","","1822-0830S  -  NAIL 8MM 30CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0831S","SUP","HCPCS C1713","","1822-0831S  -  NAIL 8MM 31.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0833S","SUP","HCPCS C1713","","1822-0833S  -  NAIL 8MM 330MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0834S","SUP","HCPCS C1713","","1822-0834S  -  NAIL 8MM 345MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0836S","SUP","HCPCS C1713","","1822-0836S  -  NAIL 8MM 36CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0837S","SUP","HCPCS C1713","","1822-0837S  -  NAIL 8MM 37.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0839S","SUP","HCPCS C1713","","1822-0839S  -  NAIL 8MM 39CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0840S","SUP","HCPCS C1713","","1822-0840S  -  NAIL 8MM 40.5CM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0842S","SUP","HCPCS C1713","","1822-0842S  -  NAIL 8MM 42CM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0924S","SUP","HCPCS C1713","","1822-0924S  -  NAIL 9MM 24CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0925S","SUP","HCPCS C1713","","1822-0925S  -  NAIL 9MM 25.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0927S","SUP","HCPCS C1713","","1822-0927S  -  NAIL 9MM 27CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0928S","SUP","HCPCS C1713","","1822-0928S  -  NAIL 0D9MM 28.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0930S","SUP","HCPCS C1713","","1822-0930S  -  NAIL 9MM 30CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0931S","SUP","HCPCS C1713","","1822-0931S  -  NAIL 9MM 31.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0933S","SUP","HCPCS C1713","","1822-0933S  -  NAIL 9MM 33CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0934S","SUP","HCPCS C1713","","1822-0934S  -  NAIL 9MM 345MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0936S","SUP","HCPCS C1713","","1822-0936S  -  NAIL 9MM 360MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0937S","SUP","HCPCS C1713","","1822-0937S  -  NAIL 9MM 37.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0939S","SUP","HCPCS C1713","","1822-0939S  -  NAIL 9MM 39CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0940S","SUP","HCPCS C1713","","1822-0940S  -  NAIL 9MM 40.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0942S","SUP","HCPCS C1713","","1822-0942S  -  NAIL 9MM 42CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-0945S","SUP","HCPCS C1713","","1822-0945S  -  NAIL 9MM 450MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1024S","SUP","HCPCS C1713","","1822-1024S  -  NAIL 10MM 24CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1025S","SUP","HCPCS C1713","","1822-1025S  -  NAIL 10MM 25.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1027S","SUP","HCPCS C1713","","1822-1027S  -  NAIL 10MM 27CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1028S","SUP","HCPCS C1713","","1822-1028S  -  NAIL 10MM 28.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1030S","SUP","HCPCS C1713","","1822-1030S  -  NAIL 10MM 300MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1031S","SUP","HCPCS C1713","","1822-1031S  -  NAIL 10MM 31.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1033S","SUP","HCPCS C1713","","1822-1033S  -  NAIL 10MM 33CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1034S","SUP","HCPCS C1713","","1822-1034S  -  NAIL 10MM 34.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1036S","SUP","HCPCS C1713","","1822-1036S  -  NAIL 10MM 36CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1037S","SUP","HCPCS C1713","","1822-1037S  -  NAIL 10MM 37.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1039S","SUP","HCPCS C1713","","1822-1039S  -  NAIL 11MM 390MM TIB T2 IM STD STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1040S","SUP","HCPCS C1713","","1822-1040S  -  NAIL 10MM 40.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1042S","SUP","HCPCS C1713","","1822-1042S  -  NAIL 10MM 420MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1043S","SUP","HCPCS C1713","","1822-1043S  -  NAIL 10MM 435MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1045S","SUP","HCPCS C1713","","1822-1045S  -  NAIL 10MM 450MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1046S","SUP","HCPCS C1713","","1822-1046S  -  NAIL 10MM 465MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1048S","SUP","HCPCS C1713","","1822-1048S  -  NAIL 10MM 480MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1124S","SUP","HCPCS C1713","","1822-1124S  -  NAIL 11MM 240MM TIB T2 IM STD IMPL TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1125S","SUP","HCPCS C1713","","1822-1125S  -  NAIL 11MM 25.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1127S","SUP","HCPCS C1713","","1822-1127S  -  NAIL 11MM 27CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1128S","SUP","HCPCS C1713","","1822-1128S  -  NAIL 11MM 28CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1130S","SUP","HCPCS C1713","","1822-1130S  -  NAIL 11MM 300MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1131S","SUP","HCPCS C1713","","1822-1131S  -  NAIL 11MM 315MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1133S","SUP","HCPCS C1713","","1822-1133S  -  NAIL 11MM 330MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1134S","SUP","HCPCS C1713","","1822-1134S  -  NAIL 11MM 345MM TIB T2 IM STD TI ALLOY STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1136S","SUP","HCPCS C1713","","1822-1136S  -  NAIL 11MM 36CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1137S","SUP","HCPCS C1713","","1822-1137S  -  NAIL 11MM 375MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1139S","SUP","HCPCS C1713","","1822-1139S  -  NAIL 11MM 390MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1140S","SUP","HCPCS C1713","","1822-1140S  -  NAIL 11MM 40.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1142S","SUP","HCPCS C1713","","1822-1142S  -  NAIL 11MM 42CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1143S","SUP","HCPCS C1713","","1822-1143S  -  NAIL 11MM 435MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1145S","SUP","HCPCS C1713","","1822-1145S  -  NAIL 11MM 450MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1146S","SUP","HCPCS C1713","","1822-1146S  -  NAIL 11MM 465MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1148S","SUP","HCPCS C1713","","1822-1148S  -  NAIL 11MM 480MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1224S","SUP","HCPCS C1713","","1822-1224S  -  NAIL 12MM 24CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1225S","SUP","HCPCS C1713","","1822-1225S  -  NAIL 12MM 25.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1227S","SUP","HCPCS C1713","","1822-1227S  -  NAIL 12MM 27CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1228S","SUP","HCPCS C1713","","1822-1228S  -  NAIL 12MM 28.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1230S","SUP","HCPCS C1713","","1822-1230S  -  NAIL 12MM 300MM TIB T2 IM STD TI","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1231S","SUP","HCPCS C1713","","1822-1231S  -  NAIL 12MM 31.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1233S","SUP","HCPCS C1713","","1822-1233S  -  NAIL 12MM 33CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1234S","SUP","HCPCS C1713","","1822-1234S  -  NAIL 12MM 345MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1236S","SUP","HCPCS C1713","","1822-1236S  -  NAIL 12MM 360MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1237S","SUP","HCPCS C1713","","1822-1237S  -  NAIL 12MM 370MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1239S","SUP","HCPCS C1713","","1822-1239S  -  NAIL 12MM 390MM TIB T2 IM STD TI","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1240S","SUP","HCPCS C1713","","1822-1240S  -  NAIL 12MM 405MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1242S","SUP","HCPCS C1713","","1822-1242S  -  NAIL 12MM 420MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1245S","SUP","HCPCS C1713","","1822-1245S  -  NAIL 12MM 450MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1324S","SUP","HCPCS C1713","","1822-1324S  -  NAIL 13MM 240MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1325S","SUP","HCPCS C1713","","1822-1325S  -  NAIL 13MM 255MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1327S","SUP","HCPCS C1713","","1822-1327S  -  NAIL 13MM 270MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1328S","SUP","HCPCS C1713","","1822-1328S  -  NAIL 13MM 285MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1330S","SUP","HCPCS C1713","","1822-1330S  -  NAIL 13MM 30CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1331S","SUP","HCPCS C1713","","1822-1331S  -  NAIL 13MM 31.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1333S","SUP","HCPCS C1713","","1822-1333S  -  NAIL 13MM 33CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1334S","SUP","HCPCS C1713","","1822-1334S  -  NAIL 13MM 34.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1336S","SUP","HCPCS C1713","","1822-1336S  -  NAIL 13MM 36CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1337S","SUP","HCPCS C1713","","1822-1337S  -  NAIL 13MM 37.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1339S","SUP","HCPCS C1713","","1822-1339S  -  NAIL 13MM 39CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1340S","SUP","HCPCS C1713","","1822-1340S  -  NAIL 13MM 40.5CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1342S","SUP","HCPCS C1713","","1822-1342S  -  NAIL 13MM 42CM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1424S","SUP","HCPCS C1713","","1822-1424S  -  NAIL 14MM 240MM TIB T2 IM STD","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1425S","SUP","HCPCS C1713","","1822-1425S  -  NAIL 14MM 255MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1427S","SUP","Custom 27803010","","1822-1427S  -  CMPNT PATLR 15MM CONC SGL T2 MDL LAT STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1822-1428S","SUP","HCPCS C1713","","1822-1428S  -  NAIL 14MM 285MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1430S","SUP","HCPCS C1713","","1822-1430S  -  NAIL 14MM 300MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1431S","SUP","HCPCS C1713","","1822-1431S  -  NAIL 14MM 315MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1433S","SUP","HCPCS C1713","","1822-1433S  -  NAIL 14MM 330MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1434S","SUP","HCPCS C1713","","1822-1434S  -  NAIL 14MM 34.5CM TIB T2 IM STD STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1436S","SUP","HCPCS C1713","","1822-1436S  -  NAIL 14MM 360MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1437S","SUP","HCPCS C1713","","1822-1437S  -  NAIL 14MM 375MM TIB T2 IM STD LCK TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1439S","SUP","HCPCS C1713","","1822-1439S  -  NAIL 14MM 390MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1440S","SUP","HCPCS C1713","","1822-1440S  -  NAIL 14MM 405MM TIB T2 IM STD TI STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1442S","SUP","HCPCS C1713","","1822-1442S  -  NAIL 14MM 420MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1524S","SUP","HCPCS C1713","","1822-1524S  -  NAIL 15MM 240MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1525S","SUP","HCPCS C1713","","1822-1525S  -  NAIL 15MM 255MM TIB T2 IM STD IMPL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1527S","SUP","HCPCS C1713","","1822-1527S  -  NAIL 15MM 270MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1528S","SUP","HCPCS C1713","","1822-1528S  -  NAIL 15MM 285MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1530S","SUP","HCPCS C1713","","1822-1530S  -  NAIL 15MM 300MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1531S","SUP","HCPCS C1713","","1822-1531S  -  NAIL 15MM 315MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1533S","SUP","HCPCS C1713","","1822-1533S  -  NAIL 15MM 330MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1534S","SUP","HCPCS C1713","","1822-1534S  -  NAIL 15MM 345MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1536S","SUP","HCPCS C1713","","1822-1536S  -  NAIL 15MM 360MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1537S","SUP","HCPCS C1713","","1822-1537S  -  NAIL 15MM 375MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1539S","SUP","HCPCS C1713","","1822-1539S  -  NAIL 15MM 390MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1540S","SUP","HCPCS C1713","","1822-1540S  -  NAIL 15MM 330MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1822-1542S","SUP","HCPCS C1713","","1822-1542S  -  NAIL 15MM 420MM TIB T2 IM STD IMPL STRL","BOTH IP/OP","$2,322.38 ","$1,718.56 ","$0.00 ","$2,322.38 ","$1,045.07 ","$0.00 ","$484.04 ","$0.00 ","$0.00 ","$406.63 ","$2,322.38 ","$0.00 ","$1,161.19 ","$1,839.32 ","$1,857.90 ","$0.00 ","$363.45 ","$0.00 ","$369.72 ","$0.00 "
"1825-0000S","SUP","HCPCS C1713","","1825-0000S  -  SCREW BONE 8MM T2 TI STD FEM CMPR STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1825-0001S","SUP","HCPCS C1713","","1825-0001S  -  SCREW BONE 8MM T2 TI +0MM FEM CMPR STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1825-0005S","SUP","HCPCS C1713","","1825-0005S  -  SCREW BONE 8MM T2 TI +5MM FEM CMPR STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1825-0010S","SUP","HCPCS C1713","","1825-0010S  -  SCREW BONE 8MM T2 TI +10MM FEM CMPR STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1825-0015S","SUP","HCPCS C1713","","1825-0015S  -  SCREW BONE 8MM T2 TI +15MM FEM CMPR STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1825-0814S","SUP","HCPCS C1713","","1825-0814S  -  NAIL 8MM 14CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0816S","SUP","HCPCS C1713","","1825-0816S  -  NAIL 8MM 16CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0818S","SUP","HCPCS C1713","","1825-0818S  -  NAIL 8MM 18CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0820S","SUP","HCPCS C1713","","1825-0820S  -  NAIL 8MM 20CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0822S","SUP","HCPCS C1713","","1825-0822S  -  NAIL 8MM 22CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0824S","SUP","HCPCS C1713","","1825-0824S  -  NAIL 8MM 24CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0826S","SUP","HCPCS C1713","","1825-0826S  -  NAIL 8MM 26CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0828S","SUP","HCPCS C1713","","1825-0828S  -  NAIL 8MM 28CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0830S","SUP","HCPCS C1713","","1825-0830S  -  NAIL 8MM 30CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0832S","SUP","HCPCS C1713","","1825-0832S  -  NAIL 8MM 32CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0834S","SUP","HCPCS C1713","","1825-0834S  -  NAIL 8MM 34CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0836S","SUP","HCPCS C1713","","1825-0836S  -  NAIL 8MM 36CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0838S","SUP","HCPCS C1713","","1825-0838S  -  NAIL 8MM 38CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0840S","SUP","HCPCS C1713","","1825-0840S  -  NAIL 8MM 40CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0842S","SUP","HCPCS C1713","","1825-0842S  -  NAIL 8MM 42CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0844S","SUP","HCPCS C1713","","1825-0844S  -  NAIL 8MM 44CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0846S","SUP","HCPCS C1713","","1825-0846S  -  NAIL 8MM 46CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0848S","SUP","HCPCS C1713","","1825-0848S  -  NAIL 8MM 48CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0914S","SUP","HCPCS C1713","","1825-0914S  -  NAIL 9MM 140MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0916S","SUP","HCPCS C1713","","1825-0916S  -  NAIL 9MM 160MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0918S","SUP","HCPCS C1713","","1825-0918S  -  NAIL 9MM 18CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0920S","SUP","HCPCS C1713","","1825-0920S  -  NAIL 9MM 20CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0922S","SUP","HCPCS C1713","","1825-0922S  -  NAIL 9MM 22CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0924S","SUP","HCPCS C1713","","1825-0924S  -  NAIL 9MM 24CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0926S","SUP","HCPCS C1713","","1825-0926S  -  NAIL 9MM 26CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0928S","SUP","HCPCS C1713","","1825-0928S  -  NAIL 9MM 28CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0930S","SUP","HCPCS C1713","","1825-0930S  -  NAIL 9MM 30CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0932S","SUP","HCPCS C1713","","1825-0932S  -  NAIL 9MM 32CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0934S","SUP","HCPCS C1713","","1825-0934S  -  NAIL 9MM 34CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0936S","SUP","HCPCS C1713","","1825-0936S  -  NAIL 9MM 360MM FEM T2 IM TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0938S","SUP","HCPCS C1713","","1825-0938S  -  NAIL 9MM 380MM FEM T2 IM TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0940S","SUP","HCPCS C1713","","1825-0940S  -  NAIL 9MM 40CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0942S","SUP","HCPCS C1713","","1825-0942S  -  NAIL 9MM 42CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0944S","SUP","HCPCS C1713","","1825-0944S  -  NAIL 9MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0946S","SUP","HCPCS C1713","","1825-0946S  -  NAIL 9MM 46CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-0948S","SUP","HCPCS C1713","","1825-0948S  -  NAIL 9MM 48CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1014S","SUP","HCPCS C1713","","1825-1014S  -  NAIL 10MM 140MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1016S","SUP","HCPCS C1713","","1825-1016S  -  NAIL 10MM 160MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1018S","SUP","HCPCS C1713","","1825-1018S  -  NAIL 10MM 18CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1020S","SUP","HCPCS C1713","","1825-1020S  -  NAIL 10MM 20CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1022S","SUP","HCPCS C1713","","1825-1022S  -  NAIL 10MM 22CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1024S","SUP","HCPCS C1713","","1825-1024S  -  NAIL 10MM 24CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1026S","SUP","HCPCS C1713","","1825-1026S  -  NAIL 10MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1028S","SUP","HCPCS C1713","","1825-1028S  -  NAIL 10MM 60MM FEM T2 IM TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1030S","SUP","HCPCS C1713","","1825-1030S  -  NAIL 10MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1032S","SUP","HCPCS C1713","","1825-1032S  -  NAIL 10MM 320MM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1034S","SUP","HCPCS C1713","","1825-1034S  -  NAIL 10MM 340MM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1036S","SUP","HCPCS C1713","","1825-1036S  -  NAIL 10MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1038S","SUP","HCPCS C1713","","1825-1038S  -  NAIL 10MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1040S","SUP","HCPCS C1713","","1825-1040S  -  NAIL 10MM 400MM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1042S","SUP","HCPCS C1713","","1825-1042S  -  NAIL 10MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1044S","SUP","HCPCS C1713","","1825-1044S  -  NAIL 10MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1046S","SUP","HCPCS C1713","","1825-1046S  -  NAIL 10MM 46CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1048S","SUP","HCPCS C1713","","1825-1048S  -  NAIL 10MM 48CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1114S","SUP","HCPCS C1713","","1825-1114S  -  NAIL 11MM 140MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1116S","SUP","HCPCS C1713","","1825-1116S  -  NAIL 11MM 160MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1118S","SUP","HCPCS C1713","","1825-1118S  -  NAIL 11MM 18CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1120S","SUP","HCPCS C1713","","1825-1120S  -  NAIL 11MM 20CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1122S","SUP","HCPCS C1713","","1825-1122S  -  NAIL 11MM 22CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1124S","SUP","HCPCS C1713","","1825-1124S  -  NAIL 11MM 24CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1126S","SUP","HCPCS C1713","","1825-1126S  -  NAIL 11MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1128S","SUP","HCPCS C1713","","1825-1128S  -  NAIL 11MM 280MM FEM T2 IM TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1130S","SUP","HCPCS C1713","","1825-1130S  -  NAIL 11MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1132S","SUP","HCPCS C1713","","1825-1132S  -  NAIL 11MM 320MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1134S","SUP","HCPCS C1713","","1825-1134S  -  NAIL 11MM 340MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1136S","SUP","HCPCS C1713","","1825-1136S  -  NAIL 11MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1138S","SUP","HCPCS C1713","","1825-1138S  -  NAIL 11MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1140S","SUP","HCPCS C1713","","1825-1140S  -  NAIL 11MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1142S","SUP","HCPCS C1713","","1825-1142S  -  NAIL 11MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1144S","SUP","HCPCS C1713","","1825-1144S  -  NAIL 11MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1146S","SUP","HCPCS C1713","","1825-1146S  -  NAIL 11MM 46CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1148S","SUP","HCPCS C1713","","1825-1148S  -  NAIL 11MM 48CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1214S","SUP","HCPCS C1713","","1825-1214S  -  NAIL 12MM 14CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1216S","SUP","HCPCS C1713","","1825-1216S  -  NAIL 12MM 160MM FEM T2 IM ANTGRD RTRGRD STR LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1218S","SUP","HCPCS C1713","","1825-1218S  -  NAIL 12MM 18CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1220S","SUP","HCPCS C1713","","1825-1220S  -  NAIL 12MM 20CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1222S","SUP","HCPCS C1713","","1825-1222S  -  NAIL 12MM 22CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1224S","SUP","HCPCS C1713","","1825-1224S  -  NAIL 12MM 24CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1226S","SUP","HCPCS C1713","","1825-1226S  -  NAIL 12MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1228S","SUP","HCPCS C1713","","1825-1228S  -  NAIL 12MM 28CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1230S","SUP","HCPCS C1713","","1825-1230S  -  NAIL 12MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1232S","SUP","HCPCS C1713","","1825-1232S  -  NAIL 12MM 320MM FEM T2 IM TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1234S","SUP","HCPCS C1713","","1825-1234S  -  NAIL 12MM 340MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1236S","SUP","HCPCS C1713","","1825-1236S  -  NAIL 12MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1238S","SUP","HCPCS C1713","","1825-1238S  -  NAIL 12MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1240S","SUP","HCPCS C1713","","1825-1240S  -  NAIL 12MM 400MM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1242S","SUP","HCPCS C1713","","1825-1242S  -  NAIL 12MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1244S","SUP","HCPCS C1713","","1825-1244S  -  NAIL 12MM 440MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1246S","SUP","HCPCS C1713","","1825-1246S  -  NAIL 12MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1248S","SUP","HCPCS C1713","","1825-1248S  -  NAIL 12MM 48CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1314S","SUP","HCPCS C1713","","1825-1314S  -  NAIL 13MM 140MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1316S","SUP","HCPCS C1713","","1825-1316S  -  NAIL 13MM 160MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1318S","SUP","HCPCS C1713","","1825-1318S  -  NAIL 13MM 18CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1320S","SUP","HCPCS C1713","","1825-1320S  -  NAIL 13MM 20CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1322S","SUP","HCPCS C1713","","1825-1322S  -  NAIL 13MM 22CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1324S","SUP","HCPCS C1713","","1825-1324S  -  NAIL 13MM 24CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1326S","SUP","HCPCS C1713","","1825-1326S  -  NAIL 13MM 26CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1328S","SUP","HCPCS C1713","","1825-1328S  -  NAIL 13MM 28CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1330S","SUP","HCPCS C1713","","1825-1330S  -  NAIL 13MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1332S","SUP","HCPCS C1713","","1825-1332S  -  NAIL 13MM 32CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1334S","SUP","HCPCS C1713","","1825-1334S  -  NAIL 13MM 34CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1336S","SUP","HCPCS C1713","","1825-1336S  -  NAIL 13MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1338S","SUP","HCPCS C1713","","1825-1338S  -  NAIL 13MM 380MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1340S","SUP","HCPCS C1713","","1825-1340S  -  NAIL 13MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1342S","SUP","HCPCS C1713","","1825-1342S  -  NAIL 13MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1344S","SUP","HCPCS C1713","","1825-1344S  -  NAIL 13MM 440MM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1346S","SUP","HCPCS C1713","","1825-1346S  -  NAIL 13MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1348S","SUP","HCPCS C1713","","1825-1348S  -  NAIL 13MM 48CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1414S","SUP","HCPCS C1713","","1825-1414S  -  NAIL 14MM 160MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1416S","SUP","HCPCS C1713","","1825-1416S  -  NAIL 14MM 160MM FEM T2 IM","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1418S","SUP","HCPCS C1713","","1825-1418S  -  NAIL 14MM 18CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1420S","SUP","HCPCS C1713","","1825-1420S  -  NAIL 14MM 20CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1422S","SUP","HCPCS C1713","","1825-1422S  -  NAIL 14MM 22CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1424S","SUP","HCPCS C1713","","1825-1424S  -  NAIL 14MM 24CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1426S","SUP","HCPCS C1713","","1825-1426S  -  NAIL 14MM 26CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1428S","SUP","HCPCS C1713","","1825-1428S  -  NAIL 14MM 28CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1430S","SUP","HCPCS C1713","","1825-1430S  -  NAIL 14MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1432S","SUP","HCPCS C1713","","1825-1432S  -  NAIL 14MM 32CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1434S","SUP","HCPCS C1713","","1825-1434S  -  NAIL 14MM 34CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1436S","SUP","HCPCS C1713","","1825-1436S  -  NAIL 14MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1438S","SUP","HCPCS C1713","","1825-1438S  -  NAIL 14MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1440S","SUP","HCPCS C1713","","1825-1440S  -  NAIL 14MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1442S","SUP","HCPCS C1713","","1825-1442S  -  NAIL 14MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1444S","SUP","HCPCS C1713","","1825-1444S  -  NAIL 14MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1446S","SUP","HCPCS C1713","","1825-1446S  -  NAIL 14MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1448S","SUP","HCPCS C1713","","1825-1448S  -  NAIL 14MM 48CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1514S","SUP","HCPCS C1713","","1825-1514S  -  NAIL 15MM 140MM FEM T2 IM LCK STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1516S","SUP","HCPCS C1713","","1825-1516S  -  NAIL 15MM 160MM FEM T2 IM LCK STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1518S","SUP","HCPCS C1713","","1825-1518S  -  NAIL 15MM 18CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1520S","SUP","HCPCS C1713","","1825-1520S  -  NAIL 15MM 20CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1522S","SUP","HCPCS C1713","","1825-1522S  -  NAIL 15MM 22CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1524S","SUP","HCPCS C1713","","1825-1524S  -  NAIL 15MM 24CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1526S","SUP","HCPCS C1713","","1825-1526S  -  NAIL 15MM 26CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1528S","SUP","HCPCS C1713","","1825-1528S  -  NAIL 15MM 28CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1530S","SUP","HCPCS C1713","","1825-1530S  -  NAIL 15MM 30CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1532S","SUP","HCPCS C1713","","1825-1532S  -  NAIL 15MM 32CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1534S","SUP","HCPCS C1713","","1825-1534S  -  NAIL 15MM 34CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1536S","SUP","HCPCS C1713","","1825-1536S  -  NAIL 15MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1538S","SUP","HCPCS C1713","","1825-1538S  -  NAIL 15MM 38CM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1540S","SUP","HCPCS C1713","","1825-1540S  -  NAIL 15MM 400MM FEM T2 IM LCK TI STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1542S","SUP","HCPCS C1713","","1825-1542S  -  NAIL 15MM 420MM FEM T2 IM LCK TI ALLOY STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1544S","SUP","HCPCS C1713","","1825-1544S  -  NAIL 15MM 44CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1546S","SUP","HCPCS C1713","","1825-1546S  -  NAIL 15MM 46CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1825-1548S","SUP","HCPCS C1713","","1825-1548S  -  NAIL 15MM 48CM FEM T2 IM STRL","BOTH IP/OP","$2,442.00 ","$1,807.08 ","$0.00 ","$2,442.00 ","$1,098.90 ","$0.00 ","$508.97 ","$0.00 ","$0.00 ","$427.57 ","$2,442.00 ","$0.00 ","$1,221.00 ","$1,934.06 ","$1,953.60 ","$0.00 ","$382.17 ","$0.00 ","$388.77 ","$0.00 "
"1826-0003S","SUP","HCPCS C1713","","1826-0003S  -  CAP END 4MM ANKL INS ARTHDES NAIL STRL T2 8MM","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1826-0917S","SUP","HCPCS C1713","","1826-0917S  -  NAIL 9MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0920S","SUP","HCPCS C1713","","1826-0920S  -  NAIL 9MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0924S","SUP","HCPCS C1713","","1826-0924S  -  NAIL 9MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0926S","SUP","HCPCS C1713","","1826-0926S  -  NAIL 9MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0928S","SUP","HCPCS C1713","","1826-0928S  -  NAIL 9MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0930S","SUP","HCPCS C1713","","1826-0930S  -  NAIL 9MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0932S","SUP","HCPCS C1713","","1826-0932S  -  NAIL 9MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0934S","SUP","HCPCS C1713","","1826-0934S  -  NAIL 9MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0936S","SUP","HCPCS C1713","","1826-0936S  -  NAIL 9MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0938S","SUP","HCPCS C1713","","1826-0938S  -  NAIL 9MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0940S","SUP","HCPCS C1713","","1826-0940S  -  NAIL 9MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0942S","SUP","HCPCS C1713","","1826-0942S  -  NAIL 9MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-0944S","SUP","HCPCS C1713","","1826-0944S  -  NAIL 9MM 440MM SPCNDYL T2 IM","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1017S","SUP","HCPCS C1713","","1826-1017S  -  NAIL 10MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1020S","SUP","HCPCS C1713","","1826-1020S  -  NAIL 10MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1024S","SUP","HCPCS C1713","","1826-1024S  -  NAIL 10MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1026S","SUP","HCPCS C1713","","1826-1026S  -  NAIL 10MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1028S","SUP","HCPCS C1713","","1826-1028S  -  NAIL 10MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1030S","SUP","HCPCS C1713","","1826-1030S  -  NAIL 10MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1032S","SUP","HCPCS C1713","","1826-1032S  -  NAIL 10MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1034S","SUP","HCPCS C1713","","1826-1034S  -  NAIL 10MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1036S","SUP","HCPCS C1713","","1826-1036S  -  NAIL 10MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1038S","SUP","HCPCS C1713","","1826-1038S  -  NAIL 10MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1040S","SUP","HCPCS C1713","","1826-1040S  -  NAIL 10MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1042S","SUP","HCPCS C1713","","1826-1042S  -  NAIL 10MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1044S","SUP","HCPCS C1713","","1826-1044S  -  NAIL 10MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1117S","SUP","HCPCS C1713","","1826-1117S  -  NAIL 11MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1120S","SUP","HCPCS C1713","","1826-1120S  -  NAIL 11MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1124S","SUP","HCPCS C1713","","1826-1124S  -  NAIL 11MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1126S","SUP","HCPCS C1713","","1826-1126S  -  NAIL 11MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1128S","SUP","HCPCS C1713","","1826-1128S  -  NAIL 11MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1130S","SUP","HCPCS C1713","","1826-1130S  -  NAIL 11MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1132S","SUP","HCPCS C1713","","1826-1132S  -  NAIL 11MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1134S","SUP","HCPCS C1713","","1826-1134S  -  NAIL 11MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1136S","SUP","HCPCS C1713","","1826-1136S  -  NAIL 11MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1138S","SUP","HCPCS C1713","","1826-1138S  -  NAIL 11MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1140S","SUP","HCPCS C1713","","1826-1140S  -  NAIL 11MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1142S","SUP","HCPCS C1713","","1826-1142S  -  NAIL 11MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1144S","SUP","HCPCS C1713","","1826-1144S  -  NAIL 11MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1217S","SUP","HCPCS C1713","","1826-1217S  -  NAIL 12MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1220S","SUP","HCPCS C1713","","1826-1220S  -  NAIL 12MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1224S","SUP","HCPCS C1713","","1826-1224S  -  NAIL 12MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1226S","SUP","HCPCS C1713","","1826-1226S  -  NAIL 12MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1228S","SUP","HCPCS C1713","","1826-1228S  -  NAIL 12MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1230S","SUP","HCPCS C1713","","1826-1230S  -  NAIL 12MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1232S","SUP","HCPCS C1713","","1826-1232S  -  NAIL 12MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1234S","SUP","HCPCS C1713","","1826-1234S  -  NAIL 12MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1236S","SUP","HCPCS C1713","","1826-1236S  -  NAIL 12MM 360MM SPCNDYL T2 IM","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1238S","SUP","HCPCS C1713","","1826-1238S  -  NAIL 12MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1240S","SUP","HCPCS C1713","","1826-1240S  -  NAIL 12MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1242S","SUP","HCPCS C1713","","1826-1242S  -  NAIL 12MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1244S","SUP","HCPCS C1713","","1826-1244S  -  NAIL 12MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1317S","SUP","HCPCS C1713","","1826-1317S  -  NAIL 13MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1320S","SUP","HCPCS C1713","","1826-1320S  -  NAIL 13MM 200MM SPCNDYL T2 IM SHRT TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1324S","SUP","HCPCS C1713","","1826-1324S  -  NAIL 13MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1326S","SUP","HCPCS C1713","","1826-1326S  -  NAIL 13MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1328S","SUP","HCPCS C1713","","1826-1328S  -  NAIL 13MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1330S","SUP","HCPCS C1713","","1826-1330S  -  NAIL 13MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1332S","SUP","HCPCS C1713","","1826-1332S  -  NAIL 13MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1334S","SUP","HCPCS C1713","","1826-1334S  -  NAIL 13MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1336S","SUP","HCPCS C1713","","1826-1336S  -  NAIL 13MM 360MM SPCNDYL T2 IM LNG TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1338S","SUP","HCPCS C1713","","1826-1338S  -  NAIL 13MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1340S","SUP","HCPCS C1713","","1826-1340S  -  NAIL 13MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1342S","SUP","HCPCS C1713","","1826-1342S  -  NAIL 13MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1344S","SUP","HCPCS C1713","","1826-1344S  -  NAIL 13MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1417S","SUP","HCPCS C1713","","1826-1417S  -  NAIL 14MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1420S","SUP","HCPCS C1713","","1826-1420S  -  NAIL 14MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1424S","SUP","HCPCS C1713","","1826-1424S  -  NAIL 14MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1426S","SUP","HCPCS C1713","","1826-1426S  -  NAIL 14MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1428S","SUP","HCPCS C1713","","1826-1428S  -  NAIL 14MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1430S","SUP","HCPCS C1713","","1826-1430S  -  NAIL 14MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1432S","SUP","HCPCS C1713","","1826-1432S  -  NAIL 14MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1434S","SUP","HCPCS C1713","","1826-1434S  -  NAIL 14MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1436S","SUP","HCPCS C1713","","1826-1436S  -  NAIL 14MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1438S","SUP","HCPCS C1713","","1826-1438S  -  NAIL 14MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1440S","SUP","HCPCS C1713","","1826-1440S  -  NAIL 14MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1442S","SUP","HCPCS C1713","","1826-1442S  -  NAIL 14MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"1826-1444S","SUP","HCPCS C1713","","1826-1444S  -  NAIL 14MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL","BOTH IP/OP","$3,022.25 ","$2,236.47 ","$0.00 ","$3,022.25 ","$1,360.01 ","$0.00 ","$629.91 ","$0.00 ","$0.00 ","$529.17 ","$3,022.25 ","$0.00 ","$1,511.13 ","$2,393.62 ","$2,417.80 ","$0.00 ","$472.98 ","$0.00 ","$481.14 ","$0.00 "
"18-2800","SUP","Custom 27803010","","18-2800  -  HEAD FEMORAL +0MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-2805","SUP","Custom 27803010","","18-2805  -  HEAD FEMORAL +5MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1828-0824S","SUP","HCPCS C1713","","1828-0824S  -  NAIL 8MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0826S","SUP","HCPCS C1713","","1828-0826S  -  NAIL 8MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0828S","SUP","HCPCS C1713","","1828-0828S  -  NAIL 8MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0830S","SUP","HCPCS C1713","","1828-0830S  -  NAIL 8MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0832S","SUP","HCPCS C1713","","1828-0832S  -  NAIL 8MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0834S","SUP","HCPCS C1713","","1828-0834S  -  NAIL 8MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0836S","SUP","HCPCS C1713","","1828-0836S  -  NAIL 8MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0838S","SUP","HCPCS C1713","","1828-0838S  -  NAIL 8MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0840S","SUP","HCPCS C1713","","1828-0840S  -  NAIL 8MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0842S","SUP","HCPCS C1713","","1828-0842S  -  NAIL 8MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0844S","SUP","HCPCS C1713","","1828-0844S  -  NAIL 8MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0846S","SUP","HCPCS C1713","","1828-0846S  -  NAIL 8MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0848S","SUP","HCPCS C1713","","1828-0848S  -  NAIL 8MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0924S","SUP","HCPCS C1713","","1828-0924S  -  NAIL 9MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0926S","SUP","HCPCS C1713","","1828-0926S  -  NAIL 9MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0928S","SUP","HCPCS C1713","","1828-0928S  -  NAIL 9MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0930S","SUP","HCPCS C1713","","1828-0930S  -  NAIL 9MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0932S","SUP","HCPCS C1713","","1828-0932S  -  NAIL 9MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0934S","SUP","HCPCS C1713","","1828-0934S  -  NAIL 9MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0936S","SUP","HCPCS C1713","","1828-0936S  -  NAIL 9MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0938S","SUP","HCPCS C1713","","1828-0938S  -  NAIL 9MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0940S","SUP","HCPCS C1713","","1828-0940S  -  NAIL 9MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0942S","SUP","HCPCS C1713","","1828-0942S  -  NAIL 9MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0944S","SUP","HCPCS C1713","","1828-0944S  -  NAIL 9MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0946S","SUP","HCPCS C1713","","1828-0946S  -  NAIL 9MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-0948S","SUP","HCPCS C1713","","1828-0948S  -  NAIL 9MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1024S","SUP","HCPCS C1713","","1828-1024S  -  NAIL 10MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1026S","SUP","HCPCS C1713","","1828-1026S  -  NAIL 10MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1028S","SUP","HCPCS C1713","","1828-1028S  -  NAIL 10MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1030S","SUP","HCPCS C1713","","1828-1030S  -  NAIL 10MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1032S","SUP","HCPCS C1713","","1828-1032S  -  NAIL 10MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1034S","SUP","HCPCS C1713","","1828-1034S  -  NAIL 10MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1036S","SUP","HCPCS C1713","","1828-1036S  -  NAIL 10MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1038S","SUP","HCPCS C1713","","1828-1038S  -  NAIL 10MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1040S","SUP","HCPCS C1713","","1828-1040S  -  NAIL 10MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1042S","SUP","HCPCS C1713","","1828-1042S  -  NAIL 10MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1044S","SUP","HCPCS C1713","","1828-1044S  -  NAIL 10MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1046S","SUP","HCPCS C1713","","1828-1046S  -  NAIL 10MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1048S","SUP","HCPCS C1713","","1828-1048S  -  NAIL 10MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1124S","SUP","HCPCS C1713","","1828-1124S  -  NAIL 11MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1126S","SUP","HCPCS C1713","","1828-1126S  -  NAIL 11MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1128S","SUP","HCPCS C1713","","1828-1128S  -  NAIL 11MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1130S","SUP","HCPCS C1713","","1828-1130S  -  NAIL 11MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1132S","SUP","HCPCS C1713","","1828-1132S  -  T2 FEMORAL NAIL R1500 11MMX320MM","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1134S","SUP","HCPCS C1713","","1828-1134S  -  NAIL 11MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1136S","SUP","HCPCS C1713","","1828-1136S  -  NAIL 11MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1138S","SUP","HCPCS C1713","","1828-1138S  -  NAIL 11MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1140S","SUP","HCPCS C1713","","1828-1140S  -  NAIL 11MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1142S","SUP","HCPCS C1713","","1828-1142S  -  NAIL 11MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1144S","SUP","HCPCS C1713","","1828-1144S  -  NAIL 11MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1146S","SUP","HCPCS C1713","","1828-1146S  -  NAIL 11MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1148S","SUP","HCPCS C1713","","1828-1148S  -  NAIL 11MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1224S","SUP","HCPCS C1713","","1828-1224S  -  NAIL 12MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1226S","SUP","HCPCS C1713","","1828-1226S  -  NAIL 12MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1228S","SUP","HCPCS C1713","","1828-1228S  -  NAIL 12MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1230S","SUP","HCPCS C1713","","1828-1230S  -  NAIL 12MM 20CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1232S","SUP","HCPCS C1713","","1828-1232S  -  NAIL 12MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1234S","SUP","HCPCS C1713","","1828-1234S  -  NAIL 12MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1236S","SUP","HCPCS C1713","","1828-1236S  -  NAIL 12MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1238S","SUP","HCPCS C1713","","1828-1238S  -  NAIL 12MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1240S","SUP","HCPCS C1713","","1828-1240S  -  NAIL 12MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1242S","SUP","HCPCS C1713","","1828-1242S  -  NAIL 12MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1244S","SUP","HCPCS C1713","","1828-1244S  -  NAIL 12MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1246S","SUP","HCPCS C1713","","1828-1246S  -  NAIL 12MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1248S","SUP","HCPCS C1713","","1828-1248S  -  NAIL 12MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1324S","SUP","HCPCS C1713","","1828-1324S  -  NAIL 13MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1326S","SUP","HCPCS C1713","","1828-1326S  -  NAIL 13MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1328S","SUP","HCPCS C1713","","1828-1328S  -  NAIL 13MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1330S","SUP","HCPCS C1713","","1828-1330S  -  NAIL 13MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1332S","SUP","HCPCS C1713","","1828-1332S  -  NAIL 13MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1334S","SUP","HCPCS C1713","","1828-1334S  -  NAIL 13MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1336S","SUP","HCPCS C1713","","1828-1336S  -  NAIL 13MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1338S","SUP","HCPCS C1713","","1828-1338S  -  NAIL 13MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1340S","SUP","HCPCS C1713","","1828-1340S  -  NAIL 13MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1342S","SUP","HCPCS C1713","","1828-1342S  -  NAIL 13MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1344S","SUP","HCPCS C1713","","1828-1344S  -  NAIL 13MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1346S","SUP","HCPCS C1713","","1828-1346S  -  NAIL 13MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1348S","SUP","HCPCS C1713","","1828-1348S  -  NAIL 13MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1424S","SUP","HCPCS C1713","","1828-1424S  -  NAIL 14MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1426S","SUP","HCPCS C1713","","1828-1426S  -  NAIL 14MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1428S","SUP","HCPCS C1713","","1828-1428S  -  NAIL 14MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1430S","SUP","HCPCS C1713","","1828-1430S  -  NAIL 14MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1432S","SUP","HCPCS C1713","","1828-1432S  -  NAIL 14MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1434S","SUP","HCPCS C1713","","1828-1434S  -  NAIL 14MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1436S","SUP","HCPCS C1713","","1828-1436S  -  NAIL 14MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1438S","SUP","HCPCS C1713","","1828-1438S  -  NAIL 14MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1440S","SUP","HCPCS C1713","","1828-1440S  -  NAIL 14MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1442S","SUP","HCPCS C1713","","1828-1442S  -  NAIL 14MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1444S","SUP","HCPCS C1713","","1828-1444S  -  NAIL 14MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1446S","SUP","HCPCS C1713","","1828-1446S  -  NAIL 14MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1448S","SUP","HCPCS C1713","","1828-1448S  -  NAIL 14MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1524S","SUP","HCPCS C1713","","1828-1524S  -  NAIL 15MM 24CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1526S","SUP","HCPCS C1713","","1828-1526S  -  NAIL 15MM 26CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1528S","SUP","HCPCS C1713","","1828-1528S  -  NAIL 15MM 28CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1530S","SUP","HCPCS C1713","","1828-1530S  -  NAIL 15MM 30CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1532S","SUP","HCPCS C1713","","1828-1532S  -  NAIL 15MM 32CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1534S","SUP","HCPCS C1713","","1828-1534S  -  NAIL 15MM 34CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1536S","SUP","HCPCS C1713","","1828-1536S  -  NAIL 15MM 36CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1538S","SUP","HCPCS C1713","","1828-1538S  -  NAIL 15MM 38CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1540S","SUP","HCPCS C1713","","1828-1540S  -  NAIL 15MM 40CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1542S","SUP","HCPCS C1713","","1828-1542S  -  NAIL 15MM 42CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1544S","SUP","HCPCS C1713","","1828-1544S  -  NAIL 15MM 44CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1546S","SUP","HCPCS C1713","","1828-1546S  -  NAIL 15MM 46CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"1828-1548S","SUP","HCPCS C1713","","1828-1548S  -  NAIL 15MM 48CM FEM T2 IM LCK TI STRL R1.5","BOTH IP/OP","$2,601.50 ","$1,925.11 ","$0.00 ","$2,601.50 ","$1,170.68 ","$0.00 ","$542.22 ","$0.00 ","$0.00 ","$455.50 ","$2,601.50 ","$0.00 ","$1,300.75 ","$2,060.39 ","$2,081.20 ","$0.00 ","$407.13 ","$0.00 ","$414.16 ","$0.00 "
"18-2825","SUP","Custom 27803010","","18-2825  -  HEAD FEMORAL +2.5MM OFFST C TAPER 28MM HIGH PERFORMANCE","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-28-3","SUP","Custom 27803010","","18-28-3  -  HEAD FEM -2.5MM OFST CTPR 28MM HPRFR BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1829-1104S","SUP","HCPCS C1713","","1829-1104S  -  NAIL 11.5MM 54CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1108S","SUP","HCPCS C1713","","1829-1108S  -  NAIL 11.5MM 58CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1112S","SUP","HCPCS C1713","","1829-1112S  -  NAIL 11.5MM 62CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1116S","SUP","HCPCS C1713","","1829-1116S  -  NAIL 11.5MM 66CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1120S","SUP","HCPCS C1713","","1829-1120S  -  NAIL 11.5MM 70CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1124S","SUP","HCPCS C1713","","1829-1124S  -  NAIL 11.5MM 74CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1128S","SUP","HCPCS C1713","","1829-1128S  -  NAIL 11.5MM 78CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1154S","SUP","HCPCS C1713","","1829-1154S  -  NAIL 11.5MM 54CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1158S","SUP","HCPCS C1713","","1829-1158S  -  NAIL 11.5MM 58CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1162S","SUP","HCPCS C1713","","1829-1162S  -  NAIL 11.5MM 62CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1166S","SUP","HCPCS C1713","","1829-1166S  -  NAIL 11.5MM 66CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1170S","SUP","HCPCS C1713","","1829-1170S  -  NAIL 11.5MM 70CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1174S","SUP","HCPCS C1713","","1829-1174S  -  NAIL 11.5MM 75CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1178S","SUP","HCPCS C1713","","1829-1178S  -  NAIL 11.5MM 78CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1304S","SUP","HCPCS C1713","","1829-1304S  -  NAIL 13MM 54CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1308S","SUP","HCPCS C1713","","1829-1308S  -  NAIL 13MM 58CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1312S","SUP","HCPCS C1713","","1829-1312S  -  NAIL 13MM 62CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1316S","SUP","HCPCS C1713","","1829-1316S  -  NAIL 13MM 66CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1320S","SUP","HCPCS C1713","","1829-1320S  -  NAIL 13MM 70CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1324S","SUP","HCPCS C1713","","1829-1324S  -  NAIL 13MM 74CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1328S","SUP","HCPCS C1713","","1829-1328S  -  NAIL 13MM 78CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1354S","SUP","HCPCS C1713","","1829-1354S  -  NAIL 13MM 54CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1358S","SUP","HCPCS C1713","","1829-1358S  -  NAIL 13MM 58CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1362S","SUP","HCPCS C1713","","1829-1362S  -  NAIL 13MM 62CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1366S","SUP","HCPCS C1713","","1829-1366S  -  NAIL 13MM 66CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1370S","SUP","HCPCS C1713","","1829-1370S  -  NAIL 13MM 70CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1374S","SUP","HCPCS C1713","","1829-1374S  -  NAIL 13MM 74CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-1378S","SUP","HCPCS C1713","","1829-1378S  -  NAIL 13MM 78CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2004S","SUP","HCPCS C1713","","1829-2004S  -  NAIL 10MM 54CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2008S","SUP","HCPCS C1713","","1829-2008S  -  NAIL 10MM 58CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2012S","SUP","HCPCS C1713","","1829-2012S  -  NAIL 10MM 62CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2016S","SUP","HCPCS C1713","","1829-2016S  -  NAIL 10MM 66CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2020S","SUP","HCPCS C1713","","1829-2020S  -  NAIL 10MM 70CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2024S","SUP","HCPCS C1713","","1829-2024S  -  NAIL 10MM 74CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2028S","SUP","HCPCS C1713","","1829-2028S  -  NAIL 10MM 78CM LEFT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2054S","SUP","HCPCS C1713","","1829-2054S  -  NAIL 10MM 54CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2058S","SUP","HCPCS C1713","","1829-2058S  -  NAIL 10MM 58CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2062S","SUP","HCPCS C1713","","1829-2062S  -  NAIL 10MM 62CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2066S","SUP","HCPCS C1713","","1829-2066S  -  NAIL 10MM 66CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2070S","SUP","HCPCS C1713","","1829-2070S  -  NAIL 10MM 70CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2074S","SUP","HCPCS C1713","","1829-2074S  -  NAIL 10MM 74CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1829-2078S","SUP","HCPCS C1713","","1829-2078S  -  NAIL 10MM 78CM RIGHT T2 IM ARTHDES TI STRL","BOTH IP/OP","$10,267.15 ","$7,597.69 ","$0.00 ","$8,658.38 ","$3,896.27 ","$0.00 ","$2,139.93 ","$0.00 ","$0.00 ","$1,516.01 ","$8,658.38 ","$0.00 ","$4,329.19 ","$6,857.44 ","$6,926.70 ","$0.00 ","$1,355.04 ","$0.00 ","$1,378.41 ","$0.00 "
"1830-0001S","SUP","HCPCS C1713","","1830-0001S  -  SCREW BONE T2 TI CMPR ADV STRL IM NAIL","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0003S","SUP","HCPCS C1713","","1830-0003S  -  CAP END 6MM HUM IM NAIL TI STRL T2 9MM","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0005S","SUP","HCPCS C1713","","1830-0005S  -  CAP END +5MM HUM IM NAIL TI STRL T2 9MM","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0008S","SUP","HCPCS C1713","","1830-0008S  -  WASHER HUM RND T2 ORTH TI IM NAIL STRL","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0009S","SUP","HCPCS C1713","","1830-0009S  -  WASHER HUM SQ T2 ORTH TI IM NAIL STRL","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0010S","SUP","HCPCS C1713","","1830-0010S  -  CAP END +10MM HUM IM NAIL TI STRL T2","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0015S","SUP","HCPCS C1713","","1830-0015S  -  CAP END +15MM HUM IM NAIL TI STRL T2","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0020S","SUP","HCPCS C1713","","1830-0020S  -  CAP END +20MM HUM IM NAIL TI STRL T2","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0025S","SUP","HCPCS C1713","","1830-0025S  -  CAP END +25MM HUM IM NAIL TI STRL T2","BOTH IP/OP","$282.20 ","$208.83 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$58.82 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1830-0714S","SUP","HCPCS C1713","","1830-0714S  -  NAIL 7MM 14CM HUM T2 IM LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0716S","SUP","HCPCS C1713","","1830-0716S  -  NAIL 7MM 16CM HUM T2 IM LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0718S","SUP","HCPCS C1713","","1830-0718S  -  NAIL 7MM 18CM HUM T2 IM LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0719S","SUP","HCPCS C1713","","1830-0719S  -  NAIL 7MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0720S","SUP","HCPCS C1713","","1830-0720S  -  NAIL 7MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0721S","SUP","HCPCS C1713","","1830-0721S  -  NAIL 7MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0722S","SUP","HCPCS C1713","","1830-0722S  -  NAIL 7MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0723S","SUP","HCPCS C1713","","1830-0723S  -  NAIL 7MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0724S","SUP","HCPCS C1713","","1830-0724S  -  NAIL 7MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0725S","SUP","HCPCS C1713","","1830-0725S  -  NAIL 7MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0726S","SUP","HCPCS C1713","","1830-0726S  -  NAIL 7MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0727S","SUP","HCPCS C1713","","1830-0727S  -  NAIL 7MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0728S","SUP","HCPCS C1713","","1830-0728S  -  NAIL 7MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0729S","SUP","HCPCS C1713","","1830-0729S  -  NAIL 7MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0730S","SUP","HCPCS C1713","","1830-0730S  -  NAIL 7MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0731S","SUP","HCPCS C1713","","1830-0731S  -  NAIL 7MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0732S","SUP","HCPCS C1713","","1830-0732S  -  NAIL 7MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0814S","SUP","HCPCS C1713","","1830-0814S  -  NAIL 8MM 14CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0816S","SUP","HCPCS C1713","","1830-0816S  -  NAIL 8MM 16CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0818S","SUP","HCPCS C1713","","1830-0818S  -  NAIL 8MM 18CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0819S","SUP","HCPCS C1713","","1830-0819S  -  NAIL 8MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0820S","SUP","HCPCS C1713","","1830-0820S  -  NAIL 8MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0821S","SUP","HCPCS C1713","","1830-0821S  -  NAIL 8MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0822S","SUP","HCPCS C1713","","1830-0822S  -  NAIL 8MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0823S","SUP","HCPCS C1713","","1830-0823S  -  NAIL 8MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0824S","SUP","HCPCS C1713","","1830-0824S  -  NAIL 8MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0825S","SUP","HCPCS C1713","","1830-0825S  -  NAIL 8MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0826S","SUP","HCPCS C1713","","1830-0826S  -  NAIL 8MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0827S","SUP","HCPCS C1713","","1830-0827S  -  NAIL 8MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0828S","SUP","HCPCS C1713","","1830-0828S  -  NAIL 8MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0829S","SUP","HCPCS C1713","","1830-0829S  -  NAIL 8MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0830S","SUP","HCPCS C1713","","1830-0830S  -  NAIL 8MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0831S","SUP","HCPCS C1713","","1830-0831S  -  NAIL 8MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0832S","SUP","HCPCS C1713","","1830-0832S  -  NAIL 8MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0914S","SUP","HCPCS C1713","","1830-0914S  -  NAIL 9MM 14CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0916S","SUP","HCPCS C1713","","1830-0916S  -  NAIL 9MM 16CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0918S","SUP","HCPCS C1713","","1830-0918S  -  NAIL 9MM 18CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0919S","SUP","HCPCS C1713","","1830-0919S  -  NAIL 9MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0920S","SUP","HCPCS C1713","","1830-0920S  -  NAIL 9MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0921S","SUP","HCPCS C1713","","1830-0921S  -  NAIL 9MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0922S","SUP","HCPCS C1713","","1830-0922S  -  NAIL 9MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0923S","SUP","HCPCS C1713","","1830-0923S  -  NAIL 9MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0924S","SUP","HCPCS C1713","","1830-0924S  -  NAIL 9MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0925S","SUP","HCPCS C1713","","1830-0925S  -  NAIL 9MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0926S","SUP","HCPCS C1713","","1830-0926S  -  NAIL 9MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0927S","SUP","HCPCS C1713","","1830-0927S  -  NAIL 9MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0928S","SUP","HCPCS C1713","","1830-0928S  -  NAIL 9MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0929S","SUP","HCPCS C1713","","1830-0929S  -  NAIL 9MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0930S","SUP","HCPCS C1713","","1830-0930S  -  NAIL 9MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0931S","SUP","HCPCS C1713","","1830-0931S  -  NAIL 9MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"1830-0932S","SUP","HCPCS C1713","","1830-0932S  -  NAIL 9MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL","BOTH IP/OP","$2,353.65 ","$1,741.70 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$490.56 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"18-3200","SUP","Custom 27803010","","18-3200  -  HEAD FEMORAL +0MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1832-0002S","SUP","HCPCS C1713","","1832-0002S  -  CAP END +2MM PROX HUM IM NAIL TI STRL T2","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$59.35 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1832-0003S","SUP","HCPCS C1713","","1832-0003S  -  CAP END +3MM PROX HUM IM NAIL TI STRL T2","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$59.35 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1832-0004S","SUP","HCPCS C1713","","1832-0004S  -  CAP END +4MM PROX HUM IM NAIL TI STRL T2","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$59.35 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"18-3205","SUP","Custom 27803010","","18-3205  -  HEAD FEMORAL +5MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-3225","SUP","Custom 27803010","","18-3225  -  HEAD FEMORAL +2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1832-2822S","SUP","HCPCS C1713","","1832-2822S  -  NAIL 8MM 22CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-2824S","SUP","HCPCS C1713","","1832-2824S  -  NAIL 8MM 240MM LEFT PROX HUM T2 IM LG","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-2826S","SUP","HCPCS C1713","","1832-2826S  -  NAIL 8MM 26CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-2828S","SUP","HCPCS C1713","","1832-2828S  -  NAIL 8MM 28CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-2830S","SUP","HCPCS C1713","","1832-2830S  -  NAIL 8MM 30CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"18-32-3","SUP","Custom 27803010","","18-32-3  -  HEAD FEMORAL -2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1832-3822S","SUP","HCPCS C1713","","1832-3822S  -  NAIL 8MM 22CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-3824S","SUP","HCPCS C1713","","1832-3824S  -  NAIL 8MM 24CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-3826S","SUP","HCPCS C1713","","1832-3826S  -  NAIL 8MM 26CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-3828S","SUP","HCPCS C1713","","1832-3828S  -  NAIL 8MM 28CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"1832-3830S","SUP","HCPCS C1713","","1832-3830S  -  NAIL 8MM 30CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI","BOTH IP/OP","$2,918.05 ","$2,159.36 ","$0.00 ","$2,928.75 ","$1,317.94 ","$0.00 ","$608.19 ","$0.00 ","$0.00 ","$512.80 ","$2,928.75 ","$0.00 ","$1,464.38 ","$2,319.57 ","$2,343.00 ","$0.00 ","$458.35 ","$0.00 ","$466.26 ","$0.00 "
"18-3600","SUP","Custom 27803010","","18-3600  -  HEAD FEMORAL 0MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-3605","SUP","Custom 27803010","","18-3605  -  HEAD FEMORAL +5MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-3625","SUP","Custom 27803010","","18-3625  -  HEAD FEMORAL +2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-36-3","SUP","Custom 27803010","","18-36-3  -  HEAD FEMORAL -2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-36-5","SUP","Custom 27803010","","18-36-5  -  HEAD FEMORAL -5MM OFFST C TAPER 36MM HIGH PERFORMANCE","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"18-3675","SUP","Custom 27803010","","18-3675  -  HEAD FEMORAL +7.5MM 36MM C TAPER BIOLOX DELTA HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1846-0928S","SUP","HCPCS C1713","","1846-0928S  -  NAIL 9MM 28CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0930S","SUP","HCPCS C1713","","1846-0930S  -  NAIL 9MM 30CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0932S","SUP","HCPCS C1713","","1846-0932S  -  NAIL 9MM 32CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0934S","SUP","HCPCS C1713","","1846-0934S  -  NAIL 9MM 34CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0936S","SUP","HCPCS C1713","","1846-0936S  -  NAIL 9MM 36CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0938S","SUP","HCPCS C1713","","1846-0938S  -  NAIL 9MM 38CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0940S","SUP","HCPCS C1713","","1846-0940S  -  NAIL 9MM 40CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0942S","SUP","HCPCS C1713","","1846-0942S  -  NAIL 9MM 42CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0944S","SUP","HCPCS C1713","","1846-0944S  -  NAIL 9MM 44CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0946S","SUP","HCPCS C1713","","1846-0946S  -  NAIL 9MM 460MM LEFT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-0948S","SUP","HCPCS C1713","","1846-0948S  -  NAIL 9MM 480MM LEFT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1128S","SUP","HCPCS C1713","","1846-1128S  -  NAIL 11MM 28CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1130S","SUP","HCPCS C1713","","1846-1130S  -  NAIL 11MM 30CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1132S","SUP","HCPCS C1713","","1846-1132S  -  NAIL 11MM 32CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1134S","SUP","HCPCS C1713","","1846-1134S  -  NAIL 11MM 34CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1136S","SUP","HCPCS C1713","","1846-1136S  -  NAIL 11MM 36CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1138S","SUP","HCPCS C1713","","1846-1138S  -  NAIL 11MM 38CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1140S","SUP","HCPCS C1713","","1846-1140S  -  NAIL 11MM 40CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1142S","SUP","HCPCS C1713","","1846-1142S  -  NAIL 11MM 42CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1144S","SUP","HCPCS C1713","","1846-1144S  -  NAIL 11MM 44CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1146S","SUP","HCPCS C1713","","1846-1146S  -  NAIL 11MM 460MM LEFT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1148S","SUP","HCPCS C1713","","1846-1148S  -  NAIL 11MM 480MM LEFT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1334S","SUP","HCPCS C1713","","1846-1334S  -  NAIL 13MM 34CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1336S","SUP","HCPCS C1713","","1846-1336S  -  NAIL 13MM 36CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1338S","SUP","HCPCS C1713","","1846-1338S  -  NAIL 13MM 38CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1340S","SUP","HCPCS C1713","","1846-1340S  -  NAIL 13MM 40CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1342S","SUP","HCPCS C1713","","1846-1342S  -  NAIL 13MM 42CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1344S","SUP","HCPCS C1713","","1846-1344S  -  NAIL 13MM 44CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1346S","SUP","HCPCS C1713","","1846-1346S  -  NAIL 13MM 46CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1348S","SUP","HCPCS C1713","","1846-1348S  -  NAIL 13MM 48CM LEFT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1534S","SUP","HCPCS C1713","","1846-1534S  -  NAIL 15MM 340MM LEFT T2 IM RECON","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1536S","SUP","HCPCS C1713","","1846-1536S  -  NAIL 360MM LEFT IM LCK ANTEGADE","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1538S","SUP","HCPCS C1713","","1846-1538S  -  NAIL 15MM 380MM LEFT ORTH T2 IM ANTGRD RECON TI 5MM STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1540S","SUP","HCPCS C1713","","1846-1540S  -  NAIL 400MM LEFT IM LCK ANTEGADE","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1542S","SUP","HCPCS C1713","","1846-1542S  -  NAIL 420MM LEFT IM LCK ANTEGADE","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1544S","SUP","HCPCS C1713","","1846-1544S  -  NAIL 440MM LEFT IM LCK ANTEGADE","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1546S","SUP","HCPCS C1713","","1846-1546S  -  NAIL 460MM LEFT IM LCK RECON TI","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1846-1548S","SUP","HCPCS C1713","","1846-1548S  -  NAIL 15MM 480MM LEFT T2 IM RECON","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0001S","SUP","HCPCS C1713","","1847-0001S  -  SCREW SET T2 8MM STRL LCK RECON ANGL STAB TI PROX IM NL","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"1847-0002S","SUP","HCPCS C1713","","1847-0002S  -  SCREW SET TI 8MM PROX RECON MODE T2 STRL IM NAIL","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"1847-0003S","SUP","HCPCS C1713","","1847-0003S  -  SCREW SET TI 8MM PROX ANTGRD T2 STRL IM NAIL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"1847-0005S","SUP","HCPCS C1713","","1847-0005S  -  CAP END +5MM RECON IM NAIL TI STRL T2","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$59.35 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"1847-0010S","SUP","HCPCS C1713","","1847-0010S  -  CAP END +10MM RECON IM NAIL TI STRL T2","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$59.35 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"1847-0015S","SUP","HCPCS C1713","","1847-0015S  -  CAP END +15MM RECON IM NAIL TI STRL T2","BOTH IP/OP","$284.75 ","$210.72 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$59.35 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"1847-0928S","SUP","HCPCS C1713","","1847-0928S  -  NAIL 9MM 28CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0930S","SUP","HCPCS C1713","","1847-0930S  -  NAIL 9MM 30CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0932S","SUP","HCPCS C1713","","1847-0932S  -  NAIL 9MM 32CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0934S","SUP","HCPCS C1713","","1847-0934S  -  NAIL 9MM 34CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0936S","SUP","HCPCS C1713","","1847-0936S  -  NAIL 9MM 36CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0938S","SUP","HCPCS C1713","","1847-0938S  -  NAIL 9MM 38CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0940S","SUP","HCPCS C1713","","1847-0940S  -  NAIL 9MM 40CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0942S","SUP","HCPCS C1713","","1847-0942S  -  NAIL 9MM 42CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0944S","SUP","HCPCS C1713","","1847-0944S  -  NAIL 9MM 44CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0946S","SUP","HCPCS C1713","","1847-0946S  -  NAIL 9MM 460MM RIGHT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-0948S","SUP","HCPCS C1713","","1847-0948S  -  NAIL 9MM 480MM RIGHT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1128S","SUP","HCPCS C1713","","1847-1128S  -  NAIL 11MM 28CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1130S","SUP","HCPCS C1713","","1847-1130S  -  NAIL 11MM 30CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1132S","SUP","HCPCS C1713","","1847-1132S  -  NAIL 11MM 32CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1134S","SUP","HCPCS C1713","","1847-1134S  -  NAIL 11MM 34CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1136S","SUP","HCPCS C1713","","1847-1136S  -  NAIL 11MM 36CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1138S","SUP","HCPCS C1713","","1847-1138S  -  NAIL 11MM 38CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1140S","SUP","HCPCS C1713","","1847-1140S  -  NAIL 11MM 40CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1142S","SUP","HCPCS C1713","","1847-1142S  -  NAIL 11MM 42CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1144S","SUP","HCPCS C1713","","1847-1144S  -  NAIL 11MM 44CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1146S","SUP","HCPCS C1713","","1847-1146S  -  NAIL 11MM 460MM RIGHT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1148S","SUP","HCPCS C1713","","1847-1148S  -  NAIL 11MM 480MM RIGHT T2 IM RECON STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1334S","SUP","HCPCS C1713","","1847-1334S  -  NAIL 13MM 34CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1336S","SUP","HCPCS C1713","","1847-1336S  -  NAIL 13MM 36CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1338S","SUP","HCPCS C1713","","1847-1338S  -  NAIL 13MM 38CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1340S","SUP","HCPCS C1713","","1847-1340S  -  NAIL 13MM 40CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1342S","SUP","HCPCS C1713","","1847-1342S  -  NAIL 13MM 42CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1344S","SUP","HCPCS C1713","","1847-1344S  -  NAIL 13MM 44CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1346S","SUP","HCPCS C1713","","1847-1346S  -  NAIL 13MM 46CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1348S","SUP","HCPCS C1713","","1847-1348S  -  NAIL 13MM 48CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1534S","SUP","HCPCS C1713","","1847-1534S  -  NAIL 15MM 340MM RIGHT T2 IM RECON ANTEGADE TI","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1536S","SUP","HCPCS C1713","","1847-1536S  -  NAIL 15MM 36CM RIGHT ORTH T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1538S","SUP","HCPCS C1713","","1847-1538S  -  NAIL 15MM 38CM RIGHT T2 IM RECON TI STRL","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1540S","SUP","HCPCS C1713","","1847-1540S  -  NAIL 15MM 400MM RIGHT T2 IM ANTGRD RECON TI","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1542S","SUP","HCPCS C1713","","1847-1542S  -  NAIL 15MM 420MM RIGHT T2 IM LCK ANTEGADE RECON TI 5MM","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1544S","SUP","HCPCS C1713","","1847-1544S  -  NAIL 15MM 440MM RIGHT T2 IM ANTGRD RECON TI","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1546S","SUP","HCPCS C1713","","1847-1546S  -  NAIL 15MM 460MM RIGHT T2 IM RECON IMPL TI","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1847-1548S","SUP","HCPCS C1713","","1847-1548S  -  NAIL 480MM IM LCK","BOTH IP/OP","$3,196.88 ","$2,365.69 ","$0.00 ","$3,196.88 ","$1,438.59 ","$0.00 ","$666.31 ","$0.00 ","$0.00 ","$559.75 ","$3,196.88 ","$0.00 ","$1,598.44 ","$2,531.93 ","$2,557.50 ","$0.00 ","$500.31 ","$0.00 ","$508.94 ","$0.00 "
"1850-0002S","SUP","HCPCS C1713","","1850-0002S  -  END CAP PLUS 0 MM","BOTH IP/OP","$278.80 ","$206.31 ","$0.00 ","$309.38 ","$139.22 ","$0.00 ","$58.11 ","$0.00 ","$0.00 ","$54.17 ","$309.38 ","$0.00 ","$154.69 ","$245.03 ","$247.50 ","$0.00 ","$48.42 ","$0.00 ","$49.25 ","$0.00 "
"1850-0003S","SUP","HCPCS C1713","","1850-0003S  -  T2 CANNULATED COMP. SCREW","BOTH IP/OP","$304.30 ","$225.18 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$63.42 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"1850-0005S","SUP","HCPCS C1713","","1850-0005S  -  END CAP PLUS 5 MM","BOTH IP/OP","$278.80 ","$206.31 ","$0.00 ","$309.38 ","$139.22 ","$0.00 ","$58.11 ","$0.00 ","$0.00 ","$54.17 ","$309.38 ","$0.00 ","$154.69 ","$245.03 ","$247.50 ","$0.00 ","$48.42 ","$0.00 ","$49.25 ","$0.00 "
"1850-0010S","SUP","HCPCS C1713","","1850-0010S  -  END CAP PLUS 10  MM","BOTH IP/OP","$278.80 ","$206.31 ","$0.00 ","$309.38 ","$139.22 ","$0.00 ","$58.11 ","$0.00 ","$0.00 ","$54.17 ","$309.38 ","$0.00 ","$154.69 ","$245.03 ","$247.50 ","$0.00 ","$48.42 ","$0.00 ","$49.25 ","$0.00 "
"1850-0015S","SUP","HCPCS C1713","","1850-0015S  -  END CAP PLUS 15 MM","BOTH IP/OP","$278.80 ","$206.31 ","$0.00 ","$309.38 ","$139.22 ","$0.00 ","$58.11 ","$0.00 ","$0.00 ","$54.17 ","$309.38 ","$0.00 ","$154.69 ","$245.03 ","$247.50 ","$0.00 ","$48.42 ","$0.00 ","$49.25 ","$0.00 "
"186002-44","SUP","HCPCS C1776","","186002-44  -  SHELL ACTB 44MM CH POR HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-46","SUP","HCPCS C1776","","186002-46  -  SHELL ACTB HMSPHR 46MM 3.1MM PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-48","SUP","HCPCS C1776","","186002-48  -  SHELL ACTB HMSPHR 48MM 3.2MM PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-50","SUP","HCPCS C1776","","186002-50  -  SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-52","SUP","HCPCS C1776","","186002-52  -  SHELL ACTB HMSPHR 52MM 3.1MM STRL PST RESTORIS CH TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-54","SUP","HCPCS C1776","","186002-54  -  SHELL ACTB HMSPHR 54MM 3.5MM STRL PST RESTORIS TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-56","SUP","HCPCS C1776","","186002-56  -  SHELL ACTB HMSPHR 56MM 3.7MM STRL PST RESTORIS TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-58","SUP","HCPCS C1776","","186002-58  -  SHELL ACTB 58MM CH POR HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-60","SUP","HCPCS C1776","","186002-60  -  SHELL ACTB HMSPHR 60MM 4.8MM PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-62","SUP","HCPCS C1776","","186002-62  -  SHELL ACTB HMSPHR 62MM 4MM STRL PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-64","SUP","HCPCS C1776","","186002-64  -  SHELL ACTB HMSPHR 64MM 5MM PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-66","SUP","HCPCS C1776","","186002-66  -  SHELL ACTB HMSPHR 66MM 4.6MM PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186002-68","SUP","HCPCS C1776","","186002-68  -  SHELL ACTB HMSPHR 68MM 5.6MM PST RESTORIS CH CUP TI HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"186003-02","SUP","HCPCS C1776","","186003-02  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-03","SUP","HCPCS C1776","","186003-03  -  STEM FEM 3 12/14 TPR STRL RESTORIS STD NK HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-04","SUP","HCPCS C1776","","186003-04  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-05","SUP","HCPCS C1776","","186003-05  -  STEM FEM 5 12/14 TPR STRL RESTORIS STD NK HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-06","SUP","HCPCS C1776","","186003-06  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-07","SUP","HCPCS C1776","","186003-07  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-08","SUP","HCPCS C1776","","186003-08  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-09","SUP","HCPCS C1776","","186003-09  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-10","SUP","HCPCS C1776","","186003-10  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-11","SUP","HCPCS C1776","","186003-11  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186003-12","SUP","HCPCS C1776","","186003-12  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-02","SUP","HCPCS C1776","","186004-02  -  STEM FEM 2 12/14 TPR STRL RESTORIS HI OFST NK HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-03","SUP","HCPCS C1776","","186004-03  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-04","SUP","HCPCS C1776","","186004-04  -  STEM FEM 4 12/14 TPR STRL RESTORIS HI OFST NK HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-05","SUP","HCPCS C1776","","186004-05  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-06","SUP","HCPCS C1776","","186004-06  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-07","SUP","HCPCS C1776","","186004-07  -  STEM FEM 7 12/14 TPR STRL RESTORIS XTD OFST NK HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-08","SUP","HCPCS C1776","","186004-08  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-09","SUP","HCPCS C1776","","186004-09  -  STEM FEM 9 12/14 TPR STRL RESTORIS HI OFST NK HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-10","SUP","HCPCS C1776","","186004-10  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-11","SUP","HCPCS C1776","","186004-11  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186004-12","SUP","HCPCS C1776","","186004-12  -  STEM FEM","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"186005-15","SUP","HCPCS C1713","","186005-15  -  SCREW ACTB 6.5MM 15MM ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"186005-20","SUP","HCPCS C1713","","186005-20  -  SCREW ACTB 6.5MM 20MM ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"186005-25","SUP","HCPCS C1713","","186005-25  -  SCREW ACTB 6.5MM 25MM ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"186005-30","SUP","HCPCS C1713","","186005-30  -  SCREW ACTB 6.5MM 30MM ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"186005-35","SUP","HCPCS C1713","","186005-35  -  SCREW ACTB 6.5MM 35MM ACTB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"186005-40","SUP","HCPCS C1713","","186005-40  -  SCREW ACTB 6.5MM 40MM STRL RESTORIS","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"186128-44","SUP","HCPCS C1776","","186128-44  -  LINER ACTB 44MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186128-46","SUP","HCPCS C1776","","186128-46  -  LINER ACTB 46MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186128-48","SUP","HCPCS C1776","","186128-48  -  LINER ACTB 48MM 28MM 7.6MM RESTORIS WR RST OXDT STAB XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186128-50","SUP","HCPCS C1776","","186128-50  -  LINER ACTB 50MM 28MM 8.6MM RESTORIS WR RST OXDT STAB XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186132-48","SUP","HCPCS C1776","","186132-48  -  LINER ACTB NTRL 48MM 32MM E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186132-50","SUP","HCPCS C1776","","186132-50  -  LINER ACTB HMSPHR 50MM 32MM 6.9MM STRL 4.5MM RESTORIS XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186132-52","SUP","HCPCS C1776","","186132-52  -  LINER ACTB NTRL 52MM 32MM E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186132-54","SUP","HCPCS C1776","","186132-54  -  LINER ACTB 54MM 32MM 7.8MM RESTORIS WR RST OXDT STAB XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186136-52","SUP","HCPCS C1776","","186136-52  -  LINER ACTB HMSPHR 52MM 36MM 6.6MM STRL 3.7MM RESTORIS XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186136-54","SUP","HCPCS C1776","","186136-54  -  LINER ACTB HMSPHR 36MM 54MM 6.7MM STRL RESTORIS XLVE HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186136-56","SUP","HCPCS C1776","","186136-56  -  LINER ACTB HMSPHR 36MM 56MM 7.1MM STRL RESTORIS XLVE HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186136-58","SUP","HCPCS C1776","","186136-58  -  LINER ACTB NTRL DOME TPR 58-60MM 36MM 7.7MM LD BRNG XLVE HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186136-62","SUP","HCPCS C1776","","186136-62  -  LINER ACTB 62-64MM 36MM 9.3MM RESTORIS WR RST OXDT STAB XLVE","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186136-66","SUP","HCPCS C1776","","186136-66  -  LINER ACTB 66-68MM 36MM 10.9MM RESTORIS WR RST OXDT STAB","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186140-56","SUP","HCPCS C1776","","186140-56  -  LINER ACTB 7.5MM","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186140-58","SUP","HCPCS C1776","","186140-58  -  LINER ACTB 8.4MM","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186140-62","SUP","HCPCS C1776","","186140-62  -  LINER ACTB 10.3MM","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186140-66","SUP","HCPCS C1776","","186140-66  -  LINER ACTB 11.9MM","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186228-44","SUP","HCPCS C1776","","186228-44  -  LINER ACTB 44MM 28MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186228-46","SUP","HCPCS C1776","","186228-46  -  LINER ACTB 46MM 28MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186228-48","SUP","HCPCS C1776","","186228-48  -  LINER ACTB","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186228-50","SUP","HCPCS C1776","","186228-50  -  LINER ACTB","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186232-48","SUP","HCPCS C1776","","186232-48  -  LINER ACTB 48MM 32MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186232-50","SUP","HCPCS C1776","","186232-50  -  LINER ACTB 50MM PST RESTORIS HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186232-52","SUP","HCPCS C1776","","186232-52  -  LINER ACTB 52MM 32MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186232-54","SUP","HCPCS C1776","","186232-54  -  LINER ACTB","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186236-52","SUP","HCPCS C1776","","186236-52  -  LINER ACTB 52MM 36MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186236-54","SUP","HCPCS C1776","","186236-54  -  LINER ACTB 54MM 36MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186236-56","SUP","HCPCS C1776","","186236-56  -  LINER ACTB 56MM 36MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186236-58","SUP","HCPCS C1776","","186236-58  -  LINER ACTB 58-60MM 36MM HW E-POLY HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186236-62","SUP","HCPCS C1776","","186236-62  -  LINER ACTB 62/63/64MM 36MM STRL RESTORIS HW XLVE HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186236-66","SUP","HCPCS C1776","","186236-66  -  LINER ACTB","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$648.00 ","$0.00 ","$300.13 ","$0.00 ","$0.00 ","$252.13 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$225.36 ","$0.00 ","$229.25 ","$0.00 "
"186628-00","SUP","HCPCS C1776","","186628-00  -  HEAD FEM","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186628-01","SUP","HCPCS C1776","","186628-01  -  HEAD FEM","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186628-02","SUP","HCPCS C1776","","186628-02  -  HEAD FEM","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186632-00","SUP","HCPCS C1776","","186632-00  -  HEAD FEM SM 32MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186632-01","SUP","HCPCS C1776","","186632-01  -  SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186632-02","SUP","HCPCS C1776","","186632-02  -  HEAD FEM","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186632-03","SUP","HCPCS C1776","","186632-03  -  HEAD FEM","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186636-00","SUP","HCPCS C1776","","186636-00  -  HEAD FEM","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186636-01","SUP","HCPCS C1776","","186636-01  -  HEAD FEM +0MM 12/14 TPR MED 36MM STRL RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186636-02","SUP","HCPCS C1776","","186636-02  -  HEAD FEM LG 36MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186636-03","SUP","HCPCS C1776","","186636-03  -  HEAD FEM XL 36MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186640-00","SUP","HCPCS C1776","","186640-00  -  HEAD FEM SM 40MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186640-01","SUP","HCPCS C1776","","186640-01  -  HEAD FEM MED 40MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186640-02","SUP","HCPCS C1776","","186640-02  -  HEAD FEM LG 40MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"186640-03","SUP","HCPCS C1776","","186640-03  -  HEAD FEM XL 40MM RESTORIS CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$776.25 ","$0.00 ","$359.53 ","$0.00 ","$0.00 ","$302.03 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$269.96 ","$0.00 ","$274.62 ","$0.00 "
"1867.31.430","SUP","HCPCS C1713","","1867.31.430  -  SCREW BN 4.35MM 30MM NS VPR FX PA TI SPNE CORT 5.5MM ROD","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867.31.435","SUP","HCPCS C1713","","1867.31.435  -  SCREW BN 4.35MM 35MM NS VPR FX PA TI SPNE CORT 5.5MM ROD","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867.31.525","SUP","HCPCS C1713","","1867.31.525  -  SCREW BN 5MM 25MM NS VPR XPDM FX PA TI SPNE CORT 5.5MM ROD","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867.31.645","SUP","HCPCS C1713","","1867.31.645  -  SCREW BONE 6MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867.31.675","SUP","HCPCS C1713","","1867.31.675  -  SCREW BONE 7MM 50MM XPDM TI SPN CORT FIX 5.5MM ROD","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867.31.845","SUP","HCPCS C1713","","1867.31.845  -  SCREW BONE 8MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867.31.850","SUP","HCPCS C1713","","1867.31.850  -  SCREW BONE 8MM 50MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"1867-15-780","SUP","HCPCS C1713","","1867-15-780  -  SCREW BN 7MM 80MM VPR 2 PA CNN TI SPNE MIS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"1882TC/46","SUP","HCPCS C1898","","1882TC/46  -  TENDRIL ST OPTIM","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1882TC/52","SUP","HCPCS C1898","","1882TC/52  -  TENDRIL ST OPTIM","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"18-83525","SUP","Custom 27203010","","18-83525  -  BLADE SHVR 18CM 3.5MM SKMR 15D LRYNG 2 CVD ANG TIP LP IRR","BOTH IP/OP","$2,137.50 ","$1,581.75 ","$0.00 ","$2,137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,137.50 ","$0.00 ","$1,068.75 ","$1,692.90 ","$1,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1888TC/46","SUP","HCPCS C1898","","1888TC/46  -  LEAD PCNG 46CM VNTRC LUBRICITY FLXB DRBLTY BIOSTABILITY","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1888TC/52","SUP","HCPCS C1898","","1888TC/52  -  LEAD PCNG 52CM VNTRC LUBRICITY FLXB DRBLTY BIOSTABILITY","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1888TC/58","SUP","HCPCS C1898","","1888TC/58  -  LEAD PCNG STRG THN 6FR 58CM TNDRL ST IS-1 BP CNCT XTD-RETRAC","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1888TC/65","SUP","HCPCS C1898","","1888TC/65  -  LEAD PCNG THN STRG 6FR 65CM TNDRL ST IS-1 BP CNCT XTD-RETRAC","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1891-4020S","SUP","HCPCS C1713","","1891-4020S  -  SCREW BONE 4MM 20MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4022S","SUP","HCPCS C1713","","1891-4022S  -  SCREW BONE 4MM 22MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4024S","SUP","HCPCS C1713","","1891-4024S  -  SCREW BONE 4MM 24MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4025S","SUP","HCPCS C1713","","1891-4025S  -  SCREW BONE 4MM 25MM T2 TI ORTH SHFT PTHRD STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4026S","SUP","HCPCS C1713","","1891-4026S  -  SCREW BONE 4MM 26MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4028S","SUP","HCPCS C1713","","1891-4028S  -  SCREW BONE 4MM 28MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4030S","SUP","HCPCS C1713","","1891-4030S  -  SCREW BONE 4MM 30MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4032S","SUP","HCPCS C1713","","1891-4032S  -  SCREW BONE 4MM 32MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4034S","SUP","HCPCS C1713","","1891-4034S  -  SCREW BONE 4MM 34MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4035S","SUP","HCPCS C1713","","1891-4035S  -  SCREW BONE 4MM 35MM T2 TI ORTH SHFT PTHRD STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4036S","SUP","HCPCS C1713","","1891-4036S  -  SCREW BONE 4MM 36MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4038S","SUP","HCPCS C1713","","1891-4038S  -  SCREW BONE 4MM 38MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4040S","SUP","HCPCS C1713","","1891-4040S  -  SCREW BONE 4MM 40MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4045S","SUP","HCPCS C1713","","1891-4045S  -  SCREW BONE 4MM 45MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4050S","SUP","HCPCS C1713","","1891-4050S  -  SCREW BONE 4MM 50MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4055S","SUP","HCPCS C1713","","1891-4055S  -  SCREW BONE 4MM 55MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-4060S","SUP","HCPCS C1713","","1891-4060S  -  SCREW BONE 4MM 60MM T2 TI PTHRD HUM SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5025S","SUP","HCPCS C1713","","1891-5025S  -  SCREW BONE 5MM 25MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5030S","SUP","HCPCS C1713","","1891-5030S  -  SCREW BONE 5MM 30MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5035S","SUP","HCPCS C1713","","1891-5035S  -  SCREW BONE 5MM 35MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5040S","SUP","HCPCS C1713","","1891-5040S  -  SCREW BONE 5MM 40MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5045S","SUP","HCPCS C1713","","1891-5045S  -  SCREW BONE 5MM 45MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5050S","SUP","HCPCS C1713","","1891-5050S  -  SCREW BONE 5MM 50MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5055S","SUP","HCPCS C1713","","1891-5055S  -  SCREW BONE 5MM 55MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5060S","SUP","HCPCS C1713","","1891-5060S  -  SCREW BONE 5MM 60MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5065S","SUP","HCPCS C1713","","1891-5065S  -  SCREW BONE 5MM 65MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5070S","SUP","HCPCS C1713","","1891-5070S  -  SCREW BONE 5MM 70MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5075S","SUP","HCPCS C1713","","1891-5075S  -  SCREW BONE 5MM 75MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5080S","SUP","HCPCS C1713","","1891-5080S  -  SCREW BONE 5MM 80MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5085S","SUP","HCPCS C1713","","1891-5085S  -  SCREW BONE 5MM 85MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5090S","SUP","HCPCS C1713","","1891-5090S  -  SCREW BONE 5MM 90MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5095S","SUP","HCPCS C1713","","1891-5095S  -  SCREW BONE 5MM 95MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5100S","SUP","HCPCS C1713","","1891-5100S  -  SCREW BONE 5MM 100MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5105S","SUP","HCPCS C1713","","1891-5105S  -  SCREW BONE 5MM 105MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5110S","SUP","HCPCS C1713","","1891-5110S  -  SCREW BONE 5MM 110MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5115S","SUP","HCPCS C1713","","1891-5115S  -  SCREW BONE 5MM 115MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1891-5120S","SUP","HCPCS C1713","","1891-5120S  -  SCREW BONE 5MM 120MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5001S","SUP","HCPCS C1713","","1895-5001S  -  NUT ORTH 5MM T2 CNDYLR TI CNDYLR SCR STRL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5040S","SUP","HCPCS C1713","","1895-5040S  -  SCREW BONE 5MM 40MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5045S","SUP","HCPCS C1713","","1895-5045S  -  SCREW BONE 5MM 45MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5050S","SUP","HCPCS C1713","","1895-5050S  -  SCREW BONE 5MM 50MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5055S","SUP","HCPCS C1713","","1895-5055S  -  SCREW BONE 5MM 55MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5060S","SUP","HCPCS C1713","","1895-5060S  -  SCREW BONE 5MM 60MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5065S","SUP","HCPCS C1713","","1895-5065S  -  SCREW BONE 5MM 65MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5070S","SUP","HCPCS C1713","","1895-5070S  -  SCREW BONE 5MM 70MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5075S","SUP","HCPCS C1713","","1895-5075S  -  SCREW BONE 5MM 75MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5080S","SUP","HCPCS C1713","","1895-5080S  -  SCREW BONE 5MM 80MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5085S","SUP","HCPCS C1713","","1895-5085S  -  SCREW BONE 5MM 85MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5090S","SUP","HCPCS C1713","","1895-5090S  -  SCREW BONE 5MM 90MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5095S","SUP","HCPCS C1713","","1895-5095S  -  SCREW BONE 5MM 95MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5100S","SUP","HCPCS C1713","","1895-5100S  -  SCREW BONE 5MM 100MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5105S","SUP","HCPCS C1713","","1895-5105S  -  SCREW BONE 5MM 105MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5110S","SUP","HCPCS C1713","","1895-5110S  -  SCREW BONE 5MM 110MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5115S","SUP","HCPCS C1713","","1895-5115S  -  SCREW BONE 5MM 115MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1895-5120S","SUP","HCPCS C1713","","1895-5120S  -  SCREW BONE 5MM 120MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4020S","SUP","HCPCS C1713","","1896-4020S  -  SCREW BONE 4MM 20MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4022S","SUP","HCPCS C1713","","1896-4022S  -  SCREW BONE 4MM 22MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4024S","SUP","HCPCS C1713","","1896-4024S  -  SCREW BONE 4MM 24MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4025S","SUP","HCPCS C1713","","1896-4025S  -  SCREW BN FT 4MM 25MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4026S","SUP","HCPCS C1713","","1896-4026S  -  SCREW BONE 4MM 26MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4028S","SUP","HCPCS C1713","","1896-4028S  -  SCREW BONE 4MM 28MM T2 TI DISTAL LCK FULTHRD STRL IM NL SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4030S","SUP","HCPCS C1713","","1896-4030S  -  SCREW BONE 4MM 30MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4032S","SUP","HCPCS C1713","","1896-4032S  -  SCREW BONE 4MM 32MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4034S","SUP","HCPCS C1713","","1896-4034S  -  SCREW BONE 4MM 34MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4035S","SUP","HCPCS C1713","","1896-4035S  -  SCREW BONE 4MM 35MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4036S","SUP","HCPCS C1713","","1896-4036S  -  SCREW BONE 4MM 36MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4038S","SUP","HCPCS C1713","","1896-4038S  -  SCREW BONE 4MM 38MM T2 TI FULTHD LCK","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4040S","SUP","HCPCS C1713","","1896-4040S  -  SCREW BONE 4MM 40MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4045S","SUP","HCPCS C1713","","1896-4045S  -  SCREW BONE 4MM 45MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4050S","SUP","HCPCS C1713","","1896-4050S  -  SCREW BONE 4MM 50MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4055S","SUP","HCPCS C1713","","1896-4055S  -  SCREW BONE 4MM 55MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-4060S","SUP","HCPCS C1713","","1896-4060S  -  SCREW BONE 4MM 60MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5025S","SUP","HCPCS C1713","","1896-5025S  -  SCREW BONE 5MM 25MM T2 TI6AL4V PROX LCK FULTHRD STRL IM NL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5027S","SUP","HCPCS C1713","","1896-5027S  -  SCREW BN FT 5MM 27.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5030S","SUP","HCPCS C1713","","1896-5030S  -  SCREW BONE 5MM 30MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5032S","SUP","HCPCS C1713","","1896-5032S  -  SCREW BN FT 5MM 32.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5035S","SUP","HCPCS C1713","","1896-5035S  -  SCREW BONE 5MM 35MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5037S","SUP","HCPCS C1713","","1896-5037S  -  SCREW BN FT 5MM 37.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5040S","SUP","HCPCS C1713","","1896-5040S  -  SCREW BONE 5MM 40MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5042S","SUP","HCPCS C1713","","1896-5042S  -  SCREW BN FT 5MM 42.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5045S","SUP","HCPCS C1713","","1896-5045S  -  SCREW BONE 5MM 45MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5047S","SUP","HCPCS C1713","","1896-5047S  -  SCREW BN FT 5MM 47.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5050S","SUP","HCPCS C1713","","1896-5050S  -  SCREW BONE 5MM 50MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5052S","SUP","HCPCS C1713","","1896-5052S  -  SCREW BN FT 5MM 52.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5055S","SUP","HCPCS C1713","","1896-5055S  -  SCREW BONE 5MM 55MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5057S","SUP","HCPCS C1713","","1896-5057S  -  SCREW BN FT 5MM 57.5MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5060S","SUP","HCPCS C1713","","1896-5060S  -  SCREW BONE 5MM 60MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5065S","SUP","HCPCS C1713","","1896-5065S  -  SCREW BN FT 5MM 65MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5070S","SUP","HCPCS C1713","","1896-5070S  -  SCREW BONE 5MM 70MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5075S","SUP","HCPCS C1713","","1896-5075S  -  SCREW BONE 5MM 75MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5080S","SUP","HCPCS C1713","","1896-5080S  -  SCREW BONE 5MM 80MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5085S","SUP","HCPCS C1713","","1896-5085S  -  SCREW BONE 5MM 85MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5090S","SUP","HCPCS C1713","","1896-5090S  -  SCREW BONE 5MM 90MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5095S","SUP","HCPCS C1713","","1896-5095S  -  SCREW BONE 5MM 95MM T2 TI FULTHD LCK STRL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5100S","SUP","HCPCS C1713","","1896-5100S  -  SCREW BONE 5MM 100MM T2 FULTHD FEM HIP LCK STRL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5105S","SUP","HCPCS C1713","","1896-5105S  -  SCREW BONE 5MM 105MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5110S","SUP","HCPCS C1713","","1896-5110S  -  SCREW BONE 5MM 110MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5115S","SUP","HCPCS C1713","","1896-5115S  -  SCREW BONE 5MM 115MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1896-5120S","SUP","HCPCS C1713","","1896-5120S  -  SCREW BN FT 5MM 120MM STRL LCK TI T2 NL SYS UNV SYS","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$131.18 ","$0.00 ","$60.76 ","$0.00 ","$0.00 ","$51.04 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$45.62 ","$0.00 ","$46.41 ","$0.00 "
"1897-6065S","SUP","HCPCS C1713","","1897-6065S  -  SCREW BONE 6.5MM 65MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6070S","SUP","HCPCS C1713","","1897-6070S  -  SCREW BONE 6.5MM 70MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6075S","SUP","HCPCS C1713","","1897-6075S  -  SCREW BN 6.5MM 75MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6080S","SUP","HCPCS C1713","","1897-6080S  -  SCREW BN 6.5MM 80MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6085S","SUP","HCPCS C1713","","1897-6085S  -  SCREW BN 6.5MM 85MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6090S","SUP","HCPCS C1713","","1897-6090S  -  SCREW BN 6.5MM 90MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6095S","SUP","HCPCS C1713","","1897-6095S  -  SCREW BN 6.5MM 95MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6100S","SUP","HCPCS C1713","","1897-6100S  -  SCREW BN 6.5MM 100MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6105S","SUP","HCPCS C1713","","1897-6105S  -  SCREW BN 6.5MM 105MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6110S","SUP","HCPCS C1713","","1897-6110S  -  SCREW BONE 6.5MM 110MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6115S","SUP","HCPCS C1713","","1897-6115S  -  SCREW BONE 6.5MM 115MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6120S","SUP","HCPCS C1713","","1897-6120S  -  SCREW BONE 6.5MM 120MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6125S","SUP","HCPCS C1713","","1897-6125S  -  SCREW BONE 6.5MM 125MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"1897-6130S","SUP","HCPCS C1713","","1897-6130S  -  SCREW BONE 6.5MM 130MM T2 TI FEM LAG RECON STRL IM NAIL","BOTH IP/OP","$380.80 ","$281.79 ","$0.00 ","$398.75 ","$179.44 ","$0.00 ","$79.37 ","$0.00 ","$0.00 ","$69.82 ","$398.75 ","$0.00 ","$199.38 ","$315.81 ","$319.00 ","$0.00 ","$62.40 ","$0.00 ","$63.48 ","$0.00 "
"19-0000T","SUP","Custom 27203010","","19-0000T  -  SLEEVE ADPR +0MM OFST UNV CTPR TI","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19-0005T","SUP","Custom 27203010","","19-0005T  -  SLEEVE ADPR 5MM OFST UNV CTPR STRL LF HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19-0025T","SUP","Custom 27203010","","19-0025T  -  SLEEVE ADAPTER +2.5MM OFFST UNIVERSAL C TAPER TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"190-151","SUP","HCPCS C2617","","190-151  -  STENT URET 8FR 22CM W/O GWIRE DUAL DRMTR PLRS HDR+","BOTH IP/OP","$306.25 ","$226.63 ","$0.00 ","$306.25 ","$137.81 ","$0.00 ","$63.83 ","$0.00 ","$0.00 ","$53.62 ","$306.25 ","$0.00 ","$153.13 ","$242.55 ","$245.00 ","$0.00 ","$47.93 ","$0.00 ","$48.76 ","$0.00 "
"19-0325T","SUP","Custom 27203010","","19-0325T  -  UNIVERSAL C-TAPER -2.5mm ADAPTER SLEEVE (Ti)","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"190-5091-150","SUP","HCPCS C1751","","190-5091-150  -  CATH INFUS 90D .014IN ANG 2.1-1.7FR .017IN 150CM 5MM MCTH","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,772.50 ","$962.47 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$310.35 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$277.40 ","$0.00 ","$282.18 ","$0.00 "
"190-5092-150","SUP","HCPCS C1751","","190-5092-150  -  CATH INFUS 90D 2.4-1.9FR .017IN 150CM 5MM MCTH ANG PSHP NTNL","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,772.50 ","$962.47 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$310.35 ","$1,772.50 ","$0.00 ","$886.25 ","$1,403.82 ","$1,418.00 ","$0.00 ","$277.40 ","$0.00 ","$282.18 ","$0.00 "
"19-1005","SUP","HCPCS C1713","","19-1005  -  PLATE BN STRG 15MM THINFLAP 2 HL TI CRNMXF","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"19-1010","SUP","HCPCS C1713","","19-1010  -  PLATE BONE WIDE 2 HOLE THINFLAP TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"19-1015","SUP","HCPCS C1713","","19-1015  -  PLATE BN SQ 13MM THINFLAP 4 HL TI CRNMXF","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$351.00 ","$0.00 ","$162.57 ","$0.00 ","$0.00 ","$136.57 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$122.07 ","$0.00 ","$124.18 ","$0.00 "
"19-1019","SUP","HCPCS C1713","","19-1019  -  COVER BURR HOLE 13.5MM BENT SPN","BOTH IP/OP","$847.50 ","$627.15 ","$0.00 ","$847.50 ","$381.38 ","$0.00 ","$176.64 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$132.63 ","$0.00 ","$134.92 ","$0.00 "
"19-1020","SUP","HCPCS C1713","","19-1020  -  PLATE BONE 18.5MM BURR HOLE THINFLAP TITANIUM","BOTH IP/OP","$847.50 ","$627.15 ","$0.00 ","$847.50 ","$381.38 ","$0.00 ","$176.64 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$132.63 ","$0.00 ","$134.92 ","$0.00 "
"19-1021","SUP","HCPCS C1713","","19-1021  -  COVER BURR HOLE BENT LP 24MM THINFLAP CRANIOMAXILLOFACIAL","BOTH IP/OP","$847.50 ","$627.15 ","$0.00 ","$847.50 ","$381.38 ","$0.00 ","$176.64 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$132.63 ","$0.00 ","$134.92 ","$0.00 "
"19-1030","SUP","HCPCS C1713","","19-1030  -  PLATE BONE 85X53X.5MM GRID PANEL THINFLAP TITANIUM","BOTH IP/OP","$4,047.50 ","$2,995.15 ","$0.00 ","$4,047.50 ","$1,821.38 ","$0.00 ","$843.60 ","$0.00 ","$0.00 ","$708.68 ","$4,047.50 ","$0.00 ","$2,023.75 ","$3,205.62 ","$3,238.00 ","$0.00 ","$633.43 ","$0.00 ","$644.36 ","$0.00 "
"19-1040","SUP","HCPCS C1713","","19-1040  -  PLATE BONE LONG 6 HOLE STR THINFLAP TITANIUM","BOTH IP/OP","$820.00 ","$606.80 ","$0.00 ","$820.00 ","$369.00 ","$0.00 ","$170.91 ","$0.00 ","$0.00 ","$143.58 ","$820.00 ","$0.00 ","$410.00 ","$649.44 ","$656.00 ","$0.00 ","$128.33 ","$0.00 ","$130.54 ","$0.00 "
"19-1045","SUP","HCPCS C1713","","19-1045  -  PLATE BONE LONG 4 HOLE STR THINFLAP TITANIUM","BOTH IP/OP","$405.00 ","$299.70 ","$0.00 ","$405.00 ","$182.25 ","$0.00 ","$84.41 ","$0.00 ","$0.00 ","$70.91 ","$405.00 ","$0.00 ","$202.50 ","$320.76 ","$324.00 ","$0.00 ","$63.38 ","$0.00 ","$64.48 ","$0.00 "
"19-1050","SUP","HCPCS C1713","","19-1050  -  PLATE BONE STANDARD 6 HOLE CVD THINFLAP TITANIUM CRANFCL","BOTH IP/OP","$820.00 ","$606.80 ","$0.00 ","$820.00 ","$369.00 ","$0.00 ","$170.91 ","$0.00 ","$0.00 ","$143.58 ","$820.00 ","$0.00 ","$410.00 ","$649.44 ","$656.00 ","$0.00 ","$128.33 ","$0.00 ","$130.54 ","$0.00 "
"19-1060","SUP","HCPCS C1713","","19-1060  -  PLATE BN 2Y 16MM THINFLAP 6 HL TI CRNMXF","BOTH IP/OP","$820.00 ","$606.80 ","$0.00 ","$820.00 ","$369.00 ","$0.00 ","$170.91 ","$0.00 ","$0.00 ","$143.58 ","$820.00 ","$0.00 ","$410.00 ","$649.44 ","$656.00 ","$0.00 ","$128.33 ","$0.00 ","$130.54 ","$0.00 "
"19-1065","SUP","HCPCS C1713","","19-1065  -  PLATE BONE STANDARD 6 HOLE Y THINFLAP TITANIUM","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$880.00 ","$396.00 ","$0.00 ","$183.41 ","$0.00 ","$0.00 ","$154.08 ","$880.00 ","$0.00 ","$440.00 ","$696.96 ","$704.00 ","$0.00 ","$137.72 ","$0.00 ","$140.10 ","$0.00 "
"19-1200AU","SUP","Custom 27203010","","19-1200AU  -  FORCEP BIPOL 8-.7MM HARDY BAYONETTE DISP","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1924-508","SUP","Custom 27203010","","1924-508  -  CIRCUIT BRTHG CSTM RESP HMD LN UNHT 1.5FT INF 10MM","BOTH IP/OP","$6.22 ","$4.60 ","$0.00 ","$6.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.22 ","$0.00 ","$3.11 ","$4.93 ","$4.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1944/46","SUP","HCPCS C1898","","1944/46  -  LEAD PCNG 10MM SPC S J 7FR 46CM ISFLX ATCPT IS-1 BP CNCT PSV","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1944/52","SUP","HCPCS C1898","","1944/52  -  LEAD PCNG J 7FR 52CM ISFLX IS-1 BP CNCT TINE FX OPTIM STRD","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1948/46","SUP","HCPCS C1898","","1948/46  -  LEAD PCNG STRG 46CM STRL LF ISFLX ATCPT TINE FX IS-1 BP CNCT","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1948/52","SUP","HCPCS C1898","","1948/52  -  LEAD PCNG 7FR 52CM ISFLX BP PSV FX TINE IS 1 OPTIM STRD","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"1948/58","SUP","HCPCS C1898","","1948/58  -  LEAD PCNG STRG 7FR 58CM ISFLX ABRSN RST IS-1 BP CNCT TINE FX","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"195-7112-6","SUP","Custom 27203010","","REAGENT DPS EXCH BUFF RMD HS ANALY","BOTH IP/OP","$2,335.00 ","$1,727.90 ","$0.00 ","$2,335.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,335.00 ","$0.00 ","$1,167.50 ","$1,849.32 ","$1,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"195-7115","SUP","Custom 27203010","","REAGENT WSH SOL CHM","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$840.00 ","$0.00 ","$420.00 ","$665.28 ","$672.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"195-7119HS","SUP","Custom 27203010","","REAGENT CHK MX ANALY","BOTH IP/OP","$36.88 ","$27.29 ","$0.00 ","$36.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.88 ","$0.00 ","$18.44 ","$29.21 ","$29.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"195-7137","SUP","Custom 27203010","","REAGENT DILU ANALY","BOTH IP/OP","$133.00 ","$98.42 ","$0.00 ","$133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.00 ","$0.00 ","$66.50 ","$105.34 ","$106.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"195-7150","SUP","Custom 27203010","","CARTRIDGE ANALY PURF","BOTH IP/OP","$777.50 ","$575.35 ","$0.00 ","$777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$777.50 ","$0.00 ","$388.75 ","$615.78 ","$622.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1967.89.300","SUP","HCPCS C1713","","1967.89.300  -  ROD SPINAL STR 300MM HEXAGON VIPER 2 COCR","BOTH IP/OP","$1,957.50 ","$1,448.55 ","$0.00 ","$1,957.50 ","$880.88 ","$0.00 ","$407.99 ","$0.00 ","$0.00 ","$342.74 ","$1,957.50 ","$0.00 ","$978.75 ","$1,550.34 ","$1,566.00 ","$0.00 ","$306.35 ","$0.00 ","$311.63 ","$0.00 "
"1967.89.480","SUP","HCPCS C1713","","1967.89.480  -  ROD SPINAL STR 480MM VIPER 2 COCR","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"197230FLA","SUP","HCPCS C1894","","197230FLA  -  SHEATH IRRIGATION ENDO-SCRUB 2 45D 4MM LEFT STERILE","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"199.933S","SUP","Custom 27203010","","199.933S  -  KIT SCRL BAR THRD 6MM 200MM STRL","BOTH IP/OP","$2,308.15 ","$1,708.03 ","$0.00 ","$2,240.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,240.93 ","$0.00 ","$1,120.46 ","$1,774.82 ","$1,792.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"199.936S","SUP","HCPCS C1713","","199.936S  -  BAR SACRAL 6MM 260MM THREAD SPN STERILE","BOTH IP/OP","$2,308.15 ","$1,708.03 ","$0.00 ","$2,240.93 ","$1,008.42 ","$0.00 ","$481.08 ","$0.00 ","$0.00 ","$392.37 ","$2,240.93 ","$0.00 ","$1,120.46 ","$1,774.82 ","$1,792.74 ","$0.00 ","$340.49 ","$0.00 ","$356.76 ","$0.00 "
"19A001","SUP","Custom 27804086","","19A001  -  GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 30ML","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19A002","SUP","Custom 27804086","","19A002  -  GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 15ML","BOTH IP/OP","$582.50 ","$431.05 ","$0.00 ","$582.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$582.50 ","$0.00 ","$291.25 ","$461.34 ","$466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"19AGFN-756","SUP","Custom 27803010","","19AGFN-756  -  VALVE AORTIC 85D 19MM 17.8MM 1 DIGIT GRADIENT MECHANICAL","BOTH IP/OP","$11,750.00 ","$8,695.00 ","$0.00 ","$11,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,750.00 ","$0.00 ","$5,875.00 ","$9,306.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"1DLMC03","SUP","HCPCS C1781","","1DLMC03  -  MESH SURG THK1MM 15X10CM BIOMATERIAL DUALMESH GORE-TEX SOFT","BOTH IP/OP","$982.50 ","$727.05 ","$0.00 ","$982.50 ","$442.13 ","$0.00 ","$204.78 ","$0.00 ","$0.00 ","$172.03 ","$982.50 ","$0.00 ","$491.25 ","$778.14 ","$786.00 ","$0.00 ","$153.76 ","$0.00 ","$156.41 ","$0.00 "
"1MTD202","SUP","Custom 27203010","","1MTD202  -  DEVICE THYRPL 20CMX.4CMX.6MM VOCAL CORD SFT INERT NALRG","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2000-49","SUP","HCPCS C1877","","2000-49  -  SHUNT CARDIO 9FR P-I CRTD OUTLYING T PORT 31CM STRL","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"200-120","SUP","Custom 27203010","","200-120  -  KIT DIL .035IN 18GA 180CM GW INS NDL SCPL PCTV SHTH FLSH","BOTH IP/OP","$421.68 ","$312.04 ","$0.00 ","$421.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$421.68 ","$0.00 ","$210.84 ","$333.97 ","$337.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2240","SUP","Custom 27803010","","2001-2240  -  INSERT ACETAB 10D 40MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2242","SUP","Custom 27803010","","2001-2242  -  INSERT ACETAB 10D 42MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2244","SUP","Custom 27803010","","2001-2244  -  INSERT ACETAB 10D 44MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2246","SUP","Custom 27803010","","2001-2246  -  INSERT ACETAB 10D 46MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2248","SUP","Custom 27803010","","2001-2248  -  INSERT ACETAB 10D 48MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2250","SUP","Custom 27803010","","2001-2250  -  INSERT ACETAB 10D 50MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2252","SUP","Custom 27803010","","2001-2252  -  INSERT ACETAB 10D 52MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2254","SUP","Custom 27803010","","2001-2254  -  INSERT ACETAB 10D 54MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2256","SUP","Custom 27803010","","2001-2256  -  INSERT ACETAB 10D 56MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2258","SUP","Custom 27803010","","2001-2258  -  INSERT ACETAB 10D 58MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2261","SUP","Custom 27803010","","2001-2261  -  INSERT ACETAB 10D 61MM 22MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2644","SUP","Custom 27803010","","2001-2644  -  INSERT ACETAB 10D 44MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2646","SUP","Custom 27803010","","2001-2646  -  INSERT ACETAB 10D 46MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2648","SUP","Custom 27803010","","2001-2648  -  INSERT ACETAB 10D 48MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2650","SUP","Custom 27803010","","2001-2650  -  INSERT ACETAB 10D 50MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2652","SUP","Custom 27803010","","2001-2652  -  INSERT ACETAB 10D 52MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2654","SUP","Custom 27803010","","2001-2654  -  INSERT ACETAB 10D 54MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2656","SUP","Custom 27803010","","2001-2656  -  INSERT ACETAB 10D 56MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2658","SUP","Custom 27803010","","2001-2658  -  INSERT ACETAB 10D 58MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2661","SUP","Custom 27803010","","2001-2661  -  INSERT ACETAB 10D 61MM 26MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2844","SUP","Custom 27803010","","2001-2844  -  INSERT ACETAB 10D 44MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2846","SUP","Custom 27803010","","2001-2846  -  INSERT ACETAB 10D 46MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2848","SUP","Custom 27803010","","2001-2848  -  INSERT ACETAB 10D 48MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2850","SUP","Custom 27803010","","2001-2850  -  INSERT ACETAB 10D 50MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2852","SUP","Custom 27803010","","2001-2852  -  INSERT ACETAB 10D 52MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2854","SUP","Custom 27803010","","2001-2854  -  INSERT ACETAB 10D 54MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2856","SUP","Custom 27803010","","2001-2856  -  INSERT ACETAB 10D 56MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2858","SUP","Custom 27803010","","2001-2858  -  INSERT ACETAB 10D 58MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-2861","SUP","Custom 27803010","","2001-2861  -  INSERT ACETAB 10D 61MM 28MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-3250","SUP","Custom 27803010","","2001-3250  -  INSERT ACETAB 10D 50MM 32MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-3252","SUP","Custom 27803010","","2001-3252  -  INSERT ACETAB 10D 52MM 32MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-3254","SUP","Custom 27803010","","2001-3254  -  INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-3256","SUP","Custom 27803010","","2001-3256  -  INSERT ACETAB 10D 56MM 32MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-3258","SUP","Custom 27803010","","2001-3258  -  INSERT ACETAB 10D 58MM 32MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2001-3261","SUP","Custom 27803010","","2001-3261  -  INSERT ACETAB 10D 61MM 32MM OMNIFIT HIP SERIES I","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2002-000","SUP","HCPCS C1729","","2002-000  -  DRAIN INCISION SMALL STATURE 1 CHAMBER SUCTION CONTROL","BOTH IP/OP","$53.29 ","$39.43 ","$0.00 ","$53.29 ","$28.94 ","$0.00 ","$11.11 ","$0.00 ","$0.00 ","$9.33 ","$53.29 ","$0.00 ","$26.64 ","$42.21 ","$42.63 ","$0.00 ","$8.34 ","$0.00 ","$8.48 ","$0.00 "
"20022 B-M","SUP","Custom 27803010","","20022 B-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$7,326.88 ","$5,421.89 ","$0.00 ","$7,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,326.88 ","$0.00 ","$3,663.44 ","$5,802.89 ","$5,861.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20026 A-H","SUP","Custom 27803010","","20026 A-H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,543.75 ","$1,142.38 ","$0.00 ","$1,543.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,543.75 ","$0.00 ","$771.88 ","$1,222.65 ","$1,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20026 A-M","SUP","Custom 27803010","","20026 A-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,700.50 ","$1,258.37 ","$0.00 ","$1,700.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,700.50 ","$0.00 ","$850.25 ","$1,346.80 ","$1,360.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2003-01","SUP","Custom 27203010","","2003-01  -  STABILIT FIRST FRACTURE KIT WITH POWERCURVE","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20038 B","SUP","Custom 27803010","","20038 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20038 C","SUP","Custom 27803010","","20038 C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20038 D","SUP","Custom 27803010","","20038 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20040 L","SUP","Custom 27203010","","20040 L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,374.88 ","$2,497.41 ","$0.00 ","$3,374.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,374.88 ","$0.00 ","$1,687.44 ","$2,672.90 ","$2,699.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20040 M","SUP","Custom 27203010","","20040 M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,374.88 ","$2,497.41 ","$0.00 ","$3,374.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,374.88 ","$0.00 ","$1,687.44 ","$2,672.90 ","$2,699.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20049 A-H","SUP","Custom 27803010","","20049 A-H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,615.00 ","$1,195.10 ","$0.00 ","$1,615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.00 ","$0.00 ","$807.50 ","$1,279.08 ","$1,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20049 C-H","SUP","Custom 27803010","","20049 C-H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,615.00 ","$1,195.10 ","$0.00 ","$1,615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.00 ","$0.00 ","$807.50 ","$1,279.08 ","$1,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2240","SUP","Custom 27803010","","2006-2240  -  INSERT ACETAB 40MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2242","SUP","Custom 27803010","","2006-2242  -  INSERT ACETAB 42MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2244","SUP","Custom 27803010","","2006-2244  -  INSERT ACETAB 20D 44MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2246","SUP","Custom 27803010","","2006-2246  -  INSERT ACETAB 46MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2248","SUP","Custom 27803010","","2006-2248  -  INSERT ACETAB 20D 48MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2250","SUP","Custom 27803010","","2006-2250  -  INSERT ACETAB 50MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2252","SUP","Custom 27803010","","2006-2252  -  INSERT ACETAB 20D 52MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2254","SUP","Custom 27803010","","2006-2254  -  INSERT ACETAB 54MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2256","SUP","Custom 27803010","","2006-2256  -  INSERT ACETAB 20D 56MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2258","SUP","Custom 27803010","","2006-2258  -  INSERT ACETAB 58MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2261","SUP","Custom 27803010","","2006-2261  -  INSERT ACETAB 20D 61MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2644","SUP","Custom 27803010","","2006-2644  -  INSERT ACETAB 20D 44MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2646","SUP","Custom 27803010","","2006-2646  -  INSERT ACETAB 46MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2648","SUP","Custom 27803010","","2006-2648  -  INSERT ACETAB 20D 48MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2650","SUP","Custom 27803010","","2006-2650  -  INSERT ACETAB 50MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2652","SUP","Custom 27803010","","2006-2652  -  INSERT ACETAB 20D 52MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2654","SUP","Custom 27803010","","2006-2654  -  INSERT ACETAB 54MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2656","SUP","Custom 27803010","","2006-2656  -  INSERT ACETAB 20D 56MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2658","SUP","Custom 27803010","","2006-2658  -  INSERT ACETAB 58MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2661","SUP","Custom 27803010","","2006-2661  -  INSERT ACETAB 20D 61MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2846","SUP","Custom 27803010","","2006-2846  -  INSERT ACETAB 46MM 28MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2848","SUP","Custom 27803010","","2006-2848  -  INSERT ACETAB 20D 48MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2850","SUP","Custom 27803010","","2006-2850  -  INSERT ACETAB 50MM 28MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2852","SUP","Custom 27803010","","2006-2852  -  INSERT ACETAB 20D 52MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2854","SUP","Custom 27803010","","2006-2854  -  INSERT ACETAB 54MM 28MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2856","SUP","Custom 27803010","","2006-2856  -  INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2858","SUP","Custom 27803010","","2006-2858  -  INSERT ACETAB 58MM 28MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-2861","SUP","Custom 27803010","","2006-2861  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-3250","SUP","Custom 27803010","","2006-3250  -  INSERT ACETAB 50MM 32MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-3252","SUP","Custom 27803010","","2006-3252  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-3254","SUP","Custom 27803010","","2006-3254  -  INSERT ACETAB 54MM 32MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-3256","SUP","Custom 27803010","","2006-3256  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-3258","SUP","Custom 27803010","","2006-3258  -  INSERT ACETAB 58MM 32MM 20D HIP OMFT","BOTH IP/OP","$1,925.63 ","$1,424.97 ","$0.00 ","$1,925.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,925.63 ","$0.00 ","$962.81 ","$1,525.10 ","$1,540.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2006-3261","SUP","Custom 27803010","","2006-3261  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$2,002.50 ","$1,481.85 ","$0.00 ","$2,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,002.50 ","$0.00 ","$1,001.25 ","$1,585.98 ","$1,602.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2007-4-211","SUP","Custom 27203010","","2007-4-211  -  VITALLIUM ALLERGY DISC","BOTH IP/OP","$60.13 ","$44.50 ","$0.00 ","$60.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.13 ","$0.00 ","$30.06 ","$47.62 ","$48.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2007-4-212","SUP","Custom 27203010","","2007-4-212  -  TITANIUM ALLERGY DISC","BOTH IP/OP","$60.13 ","$44.50 ","$0.00 ","$60.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.13 ","$0.00 ","$30.06 ","$47.62 ","$48.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2008774-001","SUP","Custom 27203010","","PROBE ORAL TEMP CLR CD TRB TMP THRMTR LF REUSE","BOTH IP/OP","$298.08 ","$220.58 ","$0.00 ","$298.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$298.08 ","$0.00 ","$149.04 ","$236.08 ","$238.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"201.356.97","SUP","HCPCS C1713","","201.356.97  -  SCREW BONE T6 LP 2MM 6MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.357.97","SUP","HCPCS C1713","","201.357.97  -  SCREW BONE T6 LP 2MM 7MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.358.97","SUP","HCPCS C1713","","201.358.97  -  SCREW BONE T6 LP 2MM 8MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.359.97","SUP","HCPCS C1713","","201.359.97  -  SCREW BONE T6 LP 2MM 9MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.360.97","SUP","HCPCS C1713","","201.360.97  -  SCREW BONE T6 LP 2MM 10MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.361.97","SUP","HCPCS C1713","","201.361.97  -  SCREW BONE T6 LP 2MM 11MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.362.97","SUP","HCPCS C1713","","201.362.97  -  SCREW BONE T6 LP 2MM 12MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.363.97","SUP","HCPCS C1713","","201.363.97  -  SCREW BONE T6 LP 2MM 13MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.364.97","SUP","HCPCS C1713","","201.364.97  -  SCREW BONE T6 LP 2MM 14MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.365.97","SUP","HCPCS C1713","","201.365.97  -  SCREW BN T6 2MM 15MM ST SLF RTN STRDR SS CORT","BOTH IP/OP","$68.50 ","$50.69 ","$0.00 ","$66.50 ","$29.93 ","$0.00 ","$14.28 ","$0.00 ","$0.00 ","$11.64 ","$66.50 ","$0.00 ","$33.25 ","$52.67 ","$53.20 ","$0.00 ","$10.11 ","$0.00 ","$10.59 ","$0.00 "
"201.366.97","SUP","HCPCS C1713","","201.366.97  -  SCREW BONE T6 LP 2MM 16MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.368.97","SUP","HCPCS C1713","","201.368.97  -  SCREW BONE T6 LP 2MM 18MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.370.97","SUP","HCPCS C1713","","201.370.97  -  SCREW BONE T6 LP 2MM 20MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.372.97","SUP","HCPCS C1713","","201.372.97  -  SCREW BONE T6 LP 2MM 22MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.374.97","SUP","HCPCS C1713","","201.374.97  -  SCREW BONE T6 LP 2MM 24MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.375.97","SUP","HCPCS C1713","","201.375.97  -  SCREW BONE T6 LP 2MM 26MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.376.97","SUP","HCPCS C1713","","201.376.97  -  SCREW BONE T6 LP 2MM 28MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.377.97","SUP","HCPCS C1713","","201.377.97  -  SCREW BONE T6 LP 2MM 30MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.378.97","SUP","HCPCS C1713","","201.378.97  -  SCREW BONE T6 LP 2MM 32MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.379.97","SUP","HCPCS C1713","","201.379.97  -  SCREW BONE T6 LP 2MM 34MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.380.97","SUP","HCPCS C1713","","201.380.97  -  SCREW BONE T6 LP 2MM 36MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.381.97","SUP","HCPCS C1713","","201.381.97  -  SCREW BONE T6 LP 2MM 38MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.382.97","SUP","HCPCS C1713","","201.382.97  -  SCREW BONE T6 LP 2MM 40MM SELF TAP MODULAR STARDRIVE LCP","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"201.804.98","SUP","HCPCS C1713","","201.804.98  -  SCREW BONE 2MM 3.5MM 4MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$119.38 ","$88.34 ","$0.00 ","$119.38 ","$53.72 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.38 ","$0.00 ","$59.69 ","$94.55 ","$95.50 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"201.806.98","SUP","HCPCS C1713","","201.806.98  -  SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$119.38 ","$88.34 ","$0.00 ","$119.38 ","$53.72 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.38 ","$0.00 ","$59.69 ","$94.55 ","$95.50 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"201.808.98","SUP","HCPCS C1713","","201.808.98  -  SCREW BONE 2MM 3.5MM 8MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$119.38 ","$88.34 ","$0.00 ","$119.38 ","$53.72 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.38 ","$0.00 ","$59.69 ","$94.55 ","$95.50 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"201.810.98","SUP","HCPCS C1713","","201.810.98  -  SCREW BONE 2MM 3.5MM 10MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$119.38 ","$88.34 ","$0.00 ","$119.38 ","$53.72 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.38 ","$0.00 ","$59.69 ","$94.55 ","$95.50 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"201.812.98","SUP","HCPCS C1713","","201.812.98  -  SCREW BONE 2MM 3.5MM 12MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$119.38 ","$88.34 ","$0.00 ","$119.38 ","$53.72 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.38 ","$0.00 ","$59.69 ","$94.55 ","$95.50 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"201.814.98","SUP","HCPCS C1713","","201.814.98  -  SCREW BONE 2MM 3.5MM 14MM SLFTAP CRCIFRM RECESS STAINLESS","BOTH IP/OP","$119.38 ","$88.34 ","$0.00 ","$119.38 ","$53.72 ","$0.00 ","$24.88 ","$0.00 ","$0.00 ","$20.90 ","$119.38 ","$0.00 ","$59.69 ","$94.55 ","$95.50 ","$0.00 ","$18.68 ","$0.00 ","$19.00 ","$0.00 "
"201.932E","SUP","HCPCS C1713","","201.932E  -  SCREW BONE 12MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL","BOTH IP/OP","$288.00 ","$213.12 ","$0.00 ","$288.00 ","$129.60 ","$0.00 ","$60.03 ","$0.00 ","$0.00 ","$50.43 ","$288.00 ","$0.00 ","$144.00 ","$228.10 ","$230.40 ","$0.00 ","$45.07 ","$0.00 ","$45.85 ","$0.00 "
"2010-01","SUP","Custom 27203010","","2010-01  -  LARYNGECTOMY PULMONARY KIT 9/36","BOTH IP/OP","$970.00 ","$717.80 ","$0.00 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$970.00 ","$0.00 ","$485.00 ","$768.24 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20100-190","SUP","HCPCS C1884","","20100-190  -  SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5MM 190CM F EZ","BOTH IP/OP","$4,187.50 ","$3,098.75 ","$0.00 ","$4,187.50 ","$1,884.38 ","$0.00 ","$872.78 ","$0.00 ","$0.00 ","$733.20 ","$4,187.50 ","$0.00 ","$2,093.75 ","$3,316.50 ","$3,350.00 ","$0.00 ","$655.34 ","$0.00 ","$666.65 ","$0.00 "
"20-1226","SUP","Custom 27203010","","20-1226  -  TUBE NASOGASTRIC 6FR 22IN 2 LUMEN Y PORT RADIOPQ STRIPE","BOTH IP/OP","$23.55 ","$17.43 ","$0.00 ","$20.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.61 ","$0.00 ","$10.31 ","$16.32 ","$16.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2012-320","SUP","HCPCS C1729","","2012-320  -  DRAIN INCISION C220ML .25IN 1 COLLECT SUCTION CONTROL","BOTH IP/OP","$77.27 ","$57.18 ","$0.00 ","$77.27 ","$41.96 ","$0.00 ","$16.10 ","$0.00 ","$0.00 ","$13.53 ","$77.27 ","$0.00 ","$38.63 ","$61.20 ","$61.81 ","$0.00 ","$12.09 ","$0.00 ","$12.30 ","$0.00 "
"20132-214","SUP","Custom 27203010","","20132-214  -  PROBE ELECTROSURGICAL 2.3MM 220CM FLEXIBLE STR FIRE FIAPC","BOTH IP/OP","$547.38 ","$405.06 ","$0.00 ","$547.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$547.38 ","$0.00 ","$273.69 ","$433.52 ","$437.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20-1384KI","SUP","Custom 27203010","","20-1384KI  -  KIT ESURG .75MM BYNT STRG 7.75IN STRL 3IN OLSN BP FCP SMTH","BOTH IP/OP","$118.41 ","$87.62 ","$0.00 ","$118.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.41 ","$0.00 ","$59.20 ","$93.78 ","$94.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"20-2050","SUP","Custom 27203010","","20-2050  -  SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE","BOTH IP/OP","$8,626.25 ","$6,383.43 ","$0.00 ","$8,626.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,626.25 ","$0.00 ","$4,313.13 ","$6,831.99 ","$6,901.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2020-6520-1","SUP","HCPCS C1713","","2020-6520-1  -  SCREW BONE 6.5MM 20MM CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6525-1","SUP","HCPCS C1713","","2020-6525-1  -  SCREW ACETAB 6.5MM 25MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6530-1","SUP","HCPCS C1713","","2020-6530-1  -  SCREW BONE 6.5MM 30MM CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6535-1","SUP","HCPCS C1713","","2020-6535-1  -  SCREW ACETAB 6.5MM 35MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6540-1","SUP","HCPCS C1713","","2020-6540-1  -  SCREW ACETAB 6.5MM 40MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6545-1","SUP","HCPCS C1713","","2020-6545-1  -  SCREW ACETAB 6.5MM 45MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6550-1","SUP","HCPCS C1713","","2020-6550-1  -  SCREW ACETAB 6.5MM 50MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6555-1","SUP","HCPCS C1713","","2020-6555-1  -  SCREW ACETAB 6.5MM 55MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2020-6560-1","SUP","HCPCS C1713","","2020-6560-1  -  SCREW ACETAB 6.5MM 60MM PRIM HIP CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2028-4520-1","SUP","HCPCS C1713","","2028-4520-1  -  SCREW BONE 4.5MM 20MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4525-1","SUP","HCPCS C1713","","2028-4525-1  -  SCREW BONE 4.5MM 25MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4530-1","SUP","HCPCS C1713","","2028-4530-1  -  SCREW BONE 4.5MM 30MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4535","SUP","HCPCS C1713","","2028-4535  -  S-FIT X-TRA BN SCRW 4.5 MM","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$57.15 ","$0.00 ","$26.47 ","$0.00 ","$0.00 ","$22.24 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$19.88 ","$0.00 ","$20.22 ","$0.00 "
"2028-4535-1","SUP","HCPCS C1713","","2028-4535-1  -  SCREW BONE 4.5MM 35MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4540-1","SUP","HCPCS C1713","","2028-4540-1  -  SCREW BONE 4.5MM 40MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4545-1","SUP","HCPCS C1713","","2028-4545-1  -  SCREW BONE 4.5MM 45MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4550-1","SUP","HCPCS C1713","","2028-4550-1  -  SCREW BONE 4.5MM 50MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4555-1","SUP","HCPCS C1713","","2028-4555-1  -  SCREW BONE 4.5MM 55MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2028-4560-1","SUP","HCPCS C1713","","2028-4560-1  -  SCREW BONE 4.5MM 60MM SECFIT X CANC","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"2029-5515-1","SUP","HCPCS C1713","","2029-5515-1  -  SCREW BONE 5.5MM 15MM CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5520-1","SUP","HCPCS C1713","","2029-5520-1  -  SCREW ACETAB 5.5MM 20MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5525-1","SUP","HCPCS C1713","","2029-5525-1  -  SCREW ACETAB 5.5MM 25MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5530-1","SUP","HCPCS C1713","","2029-5530-1  -  SCREW ACETAB 5.5MM 30MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5535-1","SUP","HCPCS C1713","","2029-5535-1  -  SCREW ACETAB 5.5MM 35MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5540-1","SUP","HCPCS C1713","","2029-5540-1  -  SCREW ACETAB 5.5MM 40MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5545-1","SUP","HCPCS C1713","","2029-5545-1  -  SCREW ACETAB 5.5MM 45MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5550-1","SUP","HCPCS C1713","","2029-5550-1  -  SCREW ACETAB 5.5MM 50MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5555-1","SUP","HCPCS C1713","","2029-5555-1  -  SCREW ACETAB 5.5MM 55MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2029-5560-1","SUP","HCPCS C1713","","2029-5560-1  -  SCREW ACETAB 5.5MM 60MM SECFIT TRIDENT TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-1125S","SUP","HCPCS C1713","","2030-1125S  -  NAIL 300MM HIP GAMMA3 IM R2 LNG STRL STSCR","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2030-1130S","SUP","HCPCS C1713","","2030-1130S  -  NAIL 11MM 30CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2030-1135S","SUP","HCPCS C1713","","2030-1135S  -  NAIL 11MM 300MM RIGHT GAMA IM 135D R2 LNG LCK STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2030-1330S","SUP","HCPCS C1713","","2030-1330S  -  NAIL 300MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"203-060-200","SUP","HCPCS C1769","","203-060-200  -  GUILDWIRE X PEION -142","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$357.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.12 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$102.90 ","$0.00 ","$104.67 ","$0.00 "
"2030-6516-1","SUP","HCPCS C1713","","2030-6516-1  -  SCREW BN 6.5MM 16MM NS TX TI ACTB CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6520-1","SUP","HCPCS C1713","","2030-6520-1  -  SCREW BN 6.5MM 20MM NS TX TI ACTB CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6525-1","SUP","HCPCS C1713","","2030-6525-1  -  SCREW ACETAB 6.5MM 25MM SECFIT TRIDENT TITANIUM CANCELLOUS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6530-1","SUP","HCPCS C1713","","2030-6530-1  -  SCREW BONE 6.5MM 30MM TRIDENT SECFIT TORX TITANIUM ACETAB","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6535-1","SUP","HCPCS C1713","","2030-6535-1  -  SCREW BN 6.5MM 35MM NS TX TI ACTB CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6540-1","SUP","HCPCS C1713","","2030-6540-1  -  SCREW BN 6.5MM 40MM NS TX TI ACTB CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6545-1","SUP","HCPCS C1713","","2030-6545-1  -  SCREW BN 6.5MM 45MM NS TX TI ACTB CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6550-1","SUP","HCPCS C1713","","2030-6550-1  -  SCREW BONE HEMISPHERE 6.5MM 50MM TRIDENT TITANIUM ACETAB","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6555-1","SUP","HCPCS C1713","","2030-6555-1  -  SCREW BONE HEMISPHERE 6.5MM 55MM TRIDENT TITANIUM ACETAB","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2030-6560-1","SUP","HCPCS C1713","","2030-6560-1  -  SCREW BONE HEMISPHERE 6.5MM 60MM TRIDENT TITANIUM ACETAB","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"2032-1125S","SUP","HCPCS C1713","","2032-1125S  -  NAIL 320MM HIP RIGHT GAMMA3 IM R2 LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2032-1130S","SUP","HCPCS C1713","","2032-1130S  -  NAIL 11MM 32CM RIGHT FEM GAMA IM 130D LNG KIT STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2032-1135S","SUP","HCPCS C1713","","2032-1135S  -  NAIL 11MM 320MM HIP RIGHT GAMMA3 IM 135D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2032-1330S","SUP","HCPCS C1713","","2032-1330S  -  NAIL 13MM 32CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2034-1125S","SUP","HCPCS C1713","","2034-1125S  -  NAIL 11MM 340MM HIP RIGHT GAMMA3 IM 125D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2034-1130S","SUP","HCPCS C1713","","2034-1130S  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 130D LNG KIT TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2034-1135S","SUP","HCPCS C1713","","2034-1135S  -  NAIL 11MM 340MM RIGHT GAMA IM 135D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2034-1330S","SUP","HCPCS C1713","","2034-1330S  -  NAIL 13MM 34CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2036-1125S","SUP","HCPCS C1713","","2036-1125S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 125D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2036-1130S","SUP","HCPCS C1713","","2036-1130S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2036-1135S","SUP","HCPCS C1713","","2036-1135S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2036-1330S","SUP","HCPCS C1713","","2036-1330S  -  NAIL 13MM 36CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2038-1125S","SUP","HCPCS C1713","","2038-1125S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2038-1130S","SUP","HCPCS C1713","","2038-1130S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2038-1135S","SUP","HCPCS C1713","","2038-1135S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2038-1330S","SUP","HCPCS C1713","","2038-1330S  -  NAIL 13MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2040-1125S","SUP","HCPCS C1713","","2040-1125S  -  NAIL 400MM HIP LEFT GAMMA3 IM R2 LNG STRL STSCR","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2040-1130S","SUP","HCPCS C1713","","2040-1130S  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2040-1135S","SUP","HCPCS C1713","","2040-1135S  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2040-1330S","SUP","HCPCS C1713","","2040-1330S  -  NAIL 400MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2041-2240","SUP","Custom 27803010","","2041-2240  -  INSERT ACETAB 40MM 22MM 10D HIP S2 OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2242","SUP","Custom 27803010","","2041-2242  -  INSERT ACETAB 42MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2246","SUP","Custom 27803010","","2041-2246  -  INSERT ACETAB 46MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2250","SUP","Custom 27803010","","2041-2250  -  INSERT ACETAB 50MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2254","SUP","Custom 27803010","","2041-2254  -  INSERT ACETAB 54MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2258","SUP","Custom 27803010","","2041-2258  -  INSERT ACETAB 58MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2262","SUP","Custom 27803010","","2041-2262  -  INSERT ACETAB 62MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2266","SUP","Custom 27803010","","2041-2266  -  INSERT ACETAB 66MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2270","SUP","Custom 27803010","","2041-2270  -  INSERT ACETAB 70MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2274","SUP","Custom 27803010","","2041-2274  -  INSERT ACETAB 74MM 22MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2642","SUP","Custom 27803010","","2041-2642  -  INSERT ACETAB 42MM 26MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2646","SUP","Custom 27803010","","2041-2646  -  INSERT ACETAB 46MM 26MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2650","SUP","Custom 27803010","","2041-2650  -  INSERT ACETAB 50-52MM 26MM 10D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2654","SUP","Custom 27803010","","2041-2654  -  INSERT ACETAB 54-56MM 26MM 10D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2658","SUP","Custom 27803010","","2041-2658  -  INSERT ACETAB 58MM 26MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2662","SUP","Custom 27803010","","2041-2662  -  INSERT ACETAB 62MM 26MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2666","SUP","Custom 27803010","","2041-2666  -  INSERT ACETAB 66MM 26MM -10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2670","SUP","Custom 27803010","","2041-2670  -  INSERT ACETAB 70MM 26MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2674","SUP","Custom 27803010","","2041-2674  -  INSERT ACETAB 74MM 26MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2846","SUP","Custom 27803010","","2041-2846  -  INSERT ACETAB 46MM 28MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2850","SUP","Custom 27803010","","2041-2850  -  INSERT ACETAB 50MM 28MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2854","SUP","Custom 27803010","","2041-2854  -  INSERT ACETAB 55-56MM 28MM 10D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2858","SUP","Custom 27803010","","2041-2858  -  INSERT ACETAB 58MM 28MM 10D HIP S2 OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2862","SUP","Custom 27803010","","2041-2862  -  INSERT ACETAB 62MM 28MM 10D HIP S2 OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2866","SUP","Custom 27803010","","2041-2866  -  INSERT ACETAB 66MM 28MM -10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2870","SUP","Custom 27803010","","2041-2870  -  INSERT ACETAB 70MM 28MM -10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-2874","SUP","Custom 27803010","","2041-2874  -  INSERT ACETAB 74MM 28MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3250","SUP","Custom 27803010","","2041-3250  -  INSERT ACETAB 10D 50-52MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3254","SUP","Custom 27803010","","2041-3254  -  INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3258","SUP","Custom 27803010","","2041-3258  -  INSERT ACETAB 58MM 32MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3262","SUP","Custom 27803010","","2041-3262  -  INSERT ACETAB 62MM 32MM 10D HIP S2 OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3266","SUP","Custom 27803010","","2041-3266  -  INSERT ACETAB 66MM 32MM -10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3270","SUP","Custom 27803010","","2041-3270  -  INSERT ACETAB 70MM 32MM -10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-3274","SUP","Custom 27803010","","2041-3274  -  INSERT ACETAB 74MM 32MM 10D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2244","SUP","Custom 27803010","","2041C-2244  -  INSERT ACETAB 10D 44MM 22MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2248","SUP","Custom 27803010","","2041C-2248  -  INSERT ACETAB 10D 48MM 22MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2252","SUP","Custom 27803010","","2041C-2252  -  INSERT ACETAB 10D 52MM 22MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2256","SUP","Custom 27803010","","2041C-2256  -  INSERT ACETAB 10D 56MM 22MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2642","SUP","Custom 27803010","","2041C-2642  -  INSERT ACETAB 26MM 10D HIP S2 XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2646","SUP","Custom 27803010","","2041C-2646  -  INSERT ACETAB 10D 46MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2648","SUP","Custom 27803010","","2041C-2648  -  INSERT ACETAB 10D 48MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2650","SUP","Custom 27803010","","2041C-2650  -  INSERT ACETAB 10D 50MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2652","SUP","Custom 27803010","","2041C-2652  -  INSERT ACETAB 10D 52MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2654","SUP","Custom 27803010","","2041C-2654  -  INSERT ACETAB 10D 54MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2656","SUP","Custom 27803010","","2041C-2656  -  INSERT ACETAB 10D 56MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2658","SUP","Custom 27803010","","2041C-2658  -  INSERT ACETAB 10D 58MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2662","SUP","Custom 27803010","","2041C-2662  -  INSERT ACETAB 10D 62MM 26MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2846","SUP","Custom 27803010","","2041C-2846  -  INSERT ACETAB 10D 46MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2848","SUP","Custom 27803010","","2041C-2848  -  INSERT ACETAB 10D 48MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2850","SUP","Custom 27803010","","2041C-2850  -  INSERT ACETAB 10D 50MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2852","SUP","Custom 27803010","","2041C-2852  -  INSERT ACETAB 10D 52MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2854","SUP","Custom 27803010","","2041C-2854  -  INSERT ACETAB 10D 54-56MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2856","SUP","Custom 27803010","","2041C-2856  -  INSERT ACETAB 10D 56MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2858","SUP","Custom 27803010","","2041C-2858  -  INSERT ACETAB 10D 58MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-2862","SUP","Custom 27803010","","2041C-2862  -  INSERT ACETAB 10D 62-72MM 28MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3250","SUP","Custom 27803010","","2041C-3250  -  INSERT ACETAB 10D 50-52MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3254","SUP","Custom 27803010","","2041C-3254  -  INSERT ACETAB 10D 54MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3256","SUP","Custom 27803010","","2041C-3256  -  INSERT ACETAB 10D 56MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3258","SUP","Custom 27803010","","2041C-3258  -  INSERT ACETAB 10D 58-60MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3262","SUP","Custom 27803010","","2041C-3262  -  INSERT ACETAB 10D 62MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3266","SUP","Custom 27803010","","2041C-3266  -  INSERT ACETAB 10D 66MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3270","SUP","Custom 27803010","","2041C-3270  -  INSERT ACETAB 10D 70MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041C-3274","SUP","Custom 27803010","","2041C-3274  -  INSERT ACETAB 10D 74MM 32MM XFIRE HIP SERIES II","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-H-228","SUP","Custom 27803010","","2041-H-228  -  LINER ACETAB 46-48MM 28MM HIP S2 CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041J-2246","SUP","Custom 27803010","","2041J-2246  -  INSERT ACETAB 10D S2 OMFT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-N-228","SUP","Custom 27803010","","2041-N-228  -  LINER ACETAB 46-48MM 28MM HIP S2 CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2041-N-532","SUP","Custom 27803010","","2041-N-532  -  LINER ACETAB 58-60MM 32MM HIP S2 CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-1125S","SUP","HCPCS C1713","","2042-1125S  -  NAIL 11MM 42CM HIP RIGHT FEM GAMMA3 IM 125D LNG TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2042-1130S","SUP","HCPCS C1713","","2042-1130S  -  NAIL 11MM 420MM RIGHT FEM GAMA IM 130D R2 LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2042-1135S","SUP","HCPCS C1713","","2042-1135S  -  NAIL 11MM 420MM HIP RIGHT GAMMA3 IM 135D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2042-1330S","SUP","HCPCS C1713","","2042-1330S  -  NAIL 13MM 42CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2042-2240","SUP","Custom 27803010","","2042-2240  -  INSERT ACETAB 20D 40MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2242","SUP","Custom 27803010","","2042-2242  -  INSERT ACETAB 42MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2246","SUP","Custom 27803010","","2042-2246  -  INSERT ACETAB 46MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2250","SUP","Custom 27803010","","2042-2250  -  INSERT ACETAB 20D 50MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2254","SUP","Custom 27803010","","2042-2254  -  INSERT ACETAB 54MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2258","SUP","Custom 27803010","","2042-2258  -  INSERT ACETAB 58MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2262","SUP","Custom 27803010","","2042-2262  -  INSERT ACETAB 62MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2266","SUP","Custom 27803010","","2042-2266  -  INSERT ACETAB 66MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2270","SUP","Custom 27803010","","2042-2270  -  INSERT ACETAB 70MM 22MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2274","SUP","Custom 27803010","","2042-2274  -  INSERT ACETAB 20D 74MM 22MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2642","SUP","Custom 27803010","","2042-2642  -  INSERT ACETAB 20D 42MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2646","SUP","Custom 27803010","","2042-2646  -  INSERT ACETAB 46MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2650","SUP","Custom 27803010","","2042-2650  -  INSERT ACETAB 20D 50MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2654","SUP","Custom 27803010","","2042-2654  -  INSERT ACETAB 20D 54MM 26MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2658","SUP","Custom 27803010","","2042-2658  -  INSERT ACETAB 58MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2662","SUP","Custom 27803010","","2042-2662  -  INSERT ACETAB 62MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2666","SUP","Custom 27803010","","2042-2666  -  INSERT ACETAB 66MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2670","SUP","Custom 27803010","","2042-2670  -  INSERT ACETAB 70MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2674","SUP","Custom 27803010","","2042-2674  -  INSERT ACETAB 74MM 26MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2846","SUP","Custom 27803010","","2042-2846  -  INSERT ACETAB 20D 46MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2850","SUP","Custom 27803010","","2042-2850  -  INSERT ACETAB 20D 50MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2854","SUP","Custom 27803010","","2042-2854  -  INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2858","SUP","Custom 27803010","","2042-2858  -  INSERT ACETAB 20D 58MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2862","SUP","Custom 27803010","","2042-2862  -  INSERT ACETAB 20D 62-72MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2866","SUP","Custom 27803010","","2042-2866  -  INSERT ACETAB 20D 66MM 28MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2870","SUP","Custom 27803010","","2042-2870  -  INSERT ACETAB 70MM 28MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-2874","SUP","Custom 27803010","","2042-2874  -  INSERT ACETAB 74MM 28MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3250","SUP","Custom 27803010","","2042-3250  -  INSERT ACETAB 20D 50MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3254","SUP","Custom 27803010","","2042-3254  -  INSERT ACETAB 20D 54MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3258","SUP","Custom 27803010","","2042-3258  -  INSERT ACETAB 20D 58-60MM 32MM OMNIFIT HIP","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3262","SUP","Custom 27803010","","2042-3262  -  INSERT ACETAB 20D 62MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3266","SUP","Custom 27803010","","2042-3266  -  INSERT ACETAB 20D 66MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3270","SUP","Custom 27803010","","2042-3270  -  INSERT ACETAB 20D 70MM 32MM OMNIFIT HIP SERIES II","BOTH IP/OP","$1,767.50 ","$1,307.95 ","$0.00 ","$1,767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,767.50 ","$0.00 ","$883.75 ","$1,399.86 ","$1,414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042-3274","SUP","Custom 27803010","","2042-3274  -  INSERT ACETAB 74MM 32MM 20D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2244","SUP","Custom 27803010","","2042C-2244  -  INSERT ACETAB 22MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2248","SUP","Custom 27803010","","2042C-2248  -  INSERT ACETAB 22MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2252","SUP","Custom 27803010","","2042C-2252  -  INSERT ACETAB 22MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2256","SUP","Custom 27803010","","2042C-2256  -  INSERT ACETAB 22MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2648","SUP","Custom 27803010","","2042C-2648  -  INSERT ACETAB 26MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2652","SUP","Custom 27803010","","2042C-2652  -  INSERT ACETAB 26MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2656","SUP","Custom 27803010","","2042C-2656  -  INSERT ACETAB 26MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2848","SUP","Custom 27803010","","2042C-2848  -  INSERT ACETAB 28MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2852","SUP","Custom 27803010","","2042C-2852  -  INSERT ACETAB 28MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-2856","SUP","Custom 27803010","","2042C-2856  -  INSERT ACETAB 56MM 28MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2042C-3256","SUP","Custom 27803010","","2042C-3256  -  INSERT ACETAB 56MM 32MM 20D HIP XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2240","SUP","Custom 27803010","","2043-2240  -  INSERT ACETAB 40MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2242","SUP","Custom 27803010","","2043-2242  -  INSERT ACETAB 42MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2246","SUP","Custom 27803010","","2043-2246  -  INSERT ACETAB 46-48MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2250","SUP","Custom 27803010","","2043-2250  -  INSERT ACETAB 50-52MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2254","SUP","Custom 27803010","","2043-2254  -  INSERT ACETAB 54-56MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2258","SUP","Custom 27803010","","2043-2258  -  INSERT ACETAB 58-60MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2262","SUP","Custom 27803010","","2043-2262  -  INSERT ACETAB 62-72MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2266","SUP","Custom 27803010","","2043-2266  -  INSERT ACETAB 66MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2270","SUP","Custom 27803010","","2043-2270  -  INSERT ACETAB 70MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2274","SUP","Custom 27803010","","2043-2274  -  INSERT ACETAB 74MM 22MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2642","SUP","Custom 27803010","","2043-2642  -  INSERT ACETAB 42MM 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2646","SUP","Custom 27803010","","2043-2646  -  INSERT ACETAB 46-48MM 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2650","SUP","Custom 27803010","","2043-2650  -  INSERT ACETAB 50-52MM 26MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2654","SUP","Custom 27803010","","2043-2654  -  INSERT ACETAB 54-56MM 26MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2658","SUP","Custom 27803010","","2043-2658  -  INSERT ACETAB 58MM ID 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2662","SUP","Custom 27803010","","2043-2662  -  INSERT ACETAB 62-72MM 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2666","SUP","Custom 27803010","","2043-2666  -  INSERT ACETAB 66MM 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2670","SUP","Custom 27803010","","2043-2670  -  INSERT ACETAB 70MM 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2674","SUP","Custom 27803010","","2043-2674  -  INSERT ACETAB 74MM 26MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2846","SUP","Custom 27803010","","2043-2846  -  INSERT ACETAB 46-48MM 28MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2850","SUP","Custom 27803010","","2043-2850  -  INSERT ACETAB 50-52MM 28MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2854","SUP","Custom 27803010","","2043-2854  -  INSERT ACETAB 54-56MM 28MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2858","SUP","Custom 27803010","","2043-2858  -  INSERT ACETAB 58-60MM 28MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2862","SUP","Custom 27803010","","2043-2862  -  INSERT ACETAB 62-72MM 28MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2866","SUP","Custom 27803010","","2043-2866  -  INSERT ACETAB 66MM 28MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2870","SUP","Custom 27803010","","2043-2870  -  INSERT ACETAB 70MM 28MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-2874","SUP","Custom 27803010","","2043-2874  -  INSERT ACETAB 74MM 28MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3246","SUP","Custom 27803010","","2043-3246  -  INSERT ACETAB 46-48MM 32MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3250","SUP","Custom 27803010","","2043-3250  -  INSERT ACETAB 50-52MM 32MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3254","SUP","Custom 27803010","","2043-3254  -  INSERT ACETAB 54-56MM 32MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3258","SUP","Custom 27803010","","2043-3258  -  INSERT ACETAB 58-60MM 32MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3262","SUP","Custom 27803010","","2043-3262  -  INSERT ACETAB 62-70MM 32MM 0D HIP S2 UHMWPE OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3266","SUP","Custom 27803010","","2043-3266  -  INSERT ACETAB 66MM 32MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3270","SUP","Custom 27803010","","2043-3270  -  INSERT ACETAB 70MM 32MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043-3274","SUP","Custom 27803010","","2043-3274  -  INSERT ACETAB 74MM 32MM 0D HIP OMFT","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2642","SUP","Custom 27803010","","2043C-2642  -  INSERT ACETAB 42MM 26MM 0D HIP S2 XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2646","SUP","Custom 27803010","","2043C-2646  -  INSERT ACETAB 46MM 26MM 0D HIP S2 XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2650","SUP","Custom 27803010","","2043C-2650  -  INSERT ACETAB 26MM 0D HIP S2 XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2654","SUP","Custom 27803010","","2043C-2654  -  INSERT ACETAB 26MM 0D HIP S2 XFIRE","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2846","SUP","Custom 27803010","","2043C-2846  -  INSERT ACETAB 0D 46MM 28MM XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2850","SUP","Custom 27803010","","2043C-2850  -  INSERT ACETAB 0D 50-52MM 28MM SERIES II XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2854","SUP","Custom 27803010","","2043C-2854  -  INSERT ACETAB 0D 54-56MM 28MM 11.4MM SERIES II OMNIFIT XFIRE","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2858","SUP","Custom 27803010","","2043C-2858  -  INSERT ACETAB 0D 58-60MM 28MM SERIES II XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2862","SUP","Custom 27803010","","2043C-2862  -  INSERT ACETAB 0D 62-72MM 28MM SERIES II XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-2866","SUP","Custom 27803010","","2043C-2866  -  INSERT ACETAB 0D 66MM 28MM XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3250","SUP","Custom 27803010","","2043C-3250  -  INSERT ACETAB 0D 50MM 32MM XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3254","SUP","Custom 27803010","","2043C-3254  -  INSERT ACETAB 0D 32MM LINER XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3258","SUP","Custom 27803010","","2043C-3258  -  INSERT ACETAB 0D 58-60MM 32MM SERIES II XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3262","SUP","Custom 27803010","","2043C-3262  -  INSERT ACETAB 10D 62MM 32MM XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3266","SUP","Custom 27803010","","2043C-3266  -  INSERT ACETAB 0D 66MM 32MM XFIRE HIP","BOTH IP/OP","$2,397.50 ","$1,774.15 ","$0.00 ","$2,397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,397.50 ","$0.00 ","$1,198.75 ","$1,898.82 ","$1,918.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3270","SUP","Custom 27803010","","2043C-3270  -  INSERT ACETAB 0D 70MM 32MM XFIRE HIP","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2043C-3274","SUP","Custom 27803010","","2043C-3274  -  INSERT ACETAB 0D 74MM 32MM XFIRE HIP","BOTH IP/OP","$2,720.00 ","$2,012.80 ","$0.00 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,720.00 ","$0.00 ","$1,360.00 ","$2,154.24 ","$2,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2044-1125S","SUP","HCPCS C1713","","2044-1125S  -  NAIL 440MM HIP RIGHT GAMMA3 IM R2 LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2044-1130S","SUP","HCPCS C1713","","2044-1130S  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2044-1135S","SUP","HCPCS C1713","","2044-1135S  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2044-1330S","SUP","HCPCS C1713","","2044-1330S  -  NAIL 440MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2050-2040","SUP","Custom 27803010","","2050-2040  -  SHELL ACETAB 40MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2040CS","SUP","Custom 27803010","","2050-2040CS  -  SHELL ACETAB 40MM HIP SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2042","SUP","Custom 27803010","","2050-2042  -  SHELL ACETAB 42MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2042CS","SUP","Custom 27803010","","2050-2042CS  -  SHELL ACETAB 42MM HIP SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2044","SUP","Custom 27803010","","2050-2044  -  SHELL ACETAB 44MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2044CS","SUP","Custom 27803010","","2050-2044CS  -  SHELL ACETAB 44MM HIP SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2046","SUP","Custom 27803010","","2050-2046  -  SHELL ACETAB 46MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2048","SUP","Custom 27803010","","2050-2048  -  SHELL ACETAB 48MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2050","SUP","Custom 27803010","","2050-2050  -  SHELL ACETAB 50MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2052","SUP","Custom 27803010","","2050-2052  -  SHELL ACETAB 52MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2054","SUP","Custom 27803010","","2050-2054  -  SHELL ACETAB 54MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2056","SUP","Custom 27803010","","2050-2056  -  SHELL ACETAB 56MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2058","SUP","Custom 27803010","","2050-2058  -  SHELL ACETAB 58MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2060","SUP","Custom 27803010","","2050-2060  -  SHELL ACETAB 60MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2062","SUP","Custom 27803010","","2050-2062  -  SHELL ACETAB 62MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2064","SUP","Custom 27803010","","2050-2064  -  SHELL ACETAB HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,377.00 ","$1,758.98 ","$0.00 ","$2,377.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,377.00 ","$0.00 ","$1,188.50 ","$1,882.58 ","$1,901.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2066","SUP","Custom 27803010","","2050-2066  -  SHELL ACETAB 66MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2068","SUP","Custom 27803010","","2050-2068  -  SHELL ACETAB 68MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2070","SUP","Custom 27803010","","2050-2070  -  SHELL ACETAB 70MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-2072","SUP","Custom 27803010","","2050-2072  -  SHELL ACETAB 72MM HIP CLSHOLE SECFIT PSL","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3040","SUP","Custom 27803010","","2050-3040  -  SHELL ACETAB 40MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3042","SUP","Custom 27803010","","2050-3042  -  SHELL ACETAB 42MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3044","SUP","Custom 27803010","","2050-3044  -  SHELL ACETAB 44MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3046","SUP","Custom 27803010","","2050-3046  -  SHELL ACETAB 46MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3048","SUP","Custom 27803010","","2050-3048  -  SHELL ACETAB 48MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3050","SUP","Custom 27803010","","2050-3050  -  SHELL ACETAB 50MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3052","SUP","Custom 27803010","","2050-3052  -  SHELL ACETAB 52MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3054","SUP","Custom 27803010","","2050-3054  -  SHELL ACETAB 54MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3056","SUP","Custom 27803010","","2050-3056  -  SHELL ACETAB 56MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3058","SUP","Custom 27803010","","2050-3058  -  SHELL ACETAB 58MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3060","SUP","Custom 27803010","","2050-3060  -  SHELL ACETAB 60MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3062","SUP","Custom 27803010","","2050-3062  -  SHELL ACETAB 62MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3064","SUP","Custom 27803010","","2050-3064  -  SHELL ACETAB 64MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3066","SUP","Custom 27803010","","2050-3066  -  SHELL ACETAB 66MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3068","SUP","Custom 27803010","","2050-3068  -  SHELL ACETAB 68MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3070","SUP","Custom 27803010","","2050-3070  -  SHELL ACETAB 70MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-3072","SUP","Custom 27803010","","2050-3072  -  SHELL ACETAB 72MM HIP SCRLES SECFIT PSL","BOTH IP/OP","$2,505.00 ","$1,853.70 ","$0.00 ","$2,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,505.00 ","$0.00 ","$1,252.50 ","$1,983.96 ","$2,004.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2050-5060P","SUP","Custom 27803010","","2050-5060P  -  SHELL ACETAB ARC DEPOSITED OPTN SECFIT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2040","SUP","Custom 27803010","","2051-2040  -  SHELL ACETAB 40MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2040P","SUP","Custom 27803010","","2051-2040P  -  CUP ACETAB 40MM CLSHOLE SECFIT PSL HA HIP","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2042","SUP","Custom 27803010","","2051-2042  -  SHELL ACETAB 42MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2042P","SUP","Custom 27803010","","2051-2042P  -  SHELL ACETAB 42MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2044","SUP","Custom 27803010","","2051-2044  -  SHELL ACETAB 44MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2044P","SUP","Custom 27803010","","2051-2044P  -  SHELL ACETAB 44MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2046","SUP","Custom 27803010","","2051-2046  -  SHELL ACETAB 46MM HIP CLSHOLE HYDRXAPT SECFIT","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2046P","SUP","Custom 27803010","","2051-2046P  -  CUP ACETAB 46MM CLSHOLE SECFIT PSL HA HIP","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2048","SUP","Custom 27803010","","2051-2048  -  SHELL ACETAB 48MM CLSTR SH HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2048P","SUP","Custom 27803010","","2051-2048P  -  SHELL ACETAB 48MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2050","SUP","Custom 27803010","","2051-2050  -  SHELL ACETAB 50MM CLSTR SH HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2050P","SUP","Custom 27803010","","2051-2050P  -  SHELL ACETAB 50MM HIP CLSHOLE HYDRXAPT PSL SECFIT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2052","SUP","Custom 27803010","","2051-2052  -  SHELL ACETAB 52MM CLSTR SH HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2052P","SUP","Custom 27803010","","2051-2052P  -  SHELL ACETAB 52MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2054","SUP","Custom 27803010","","2051-2054  -  SHELL ACETAB 54MM CLSTR SH HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2054P","SUP","Custom 27803010","","2051-2054P  -  CUP ACETAB 54MM SECFIT PSL CLSTR HIP HYDRXAPT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2056","SUP","Custom 27803010","","2051-2056  -  SHELL ACETAB 56MM CLSTR CUP SH HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2056P","SUP","Custom 27803010","","2051-2056P  -  CUP ACETAB 56MM SECFIT PSL CLSTR HIP HYDRXAPT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2058","SUP","Custom 27803010","","2051-2058  -  CUP ACETAB 58MM SECFIT CLSTR SCR HOLE HIP HYDRXAPT","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2058P","SUP","Custom 27803010","","2051-2058P  -  CUP ACETAB 58MM SECFIT PSL CLSTR HIP HYDRXAPT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2060","SUP","Custom 27803010","","2051-2060  -  SHELL ACETAB 60MM CLSTR CUP SH HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2060P","SUP","Custom 27803010","","2051-2060P  -  CUP ACETAB 60MM SECFIT PSL CLSTR HIP HYDRXAPT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2062","SUP","Custom 27803010","","2051-2062  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2062P","SUP","Custom 27803010","","2051-2062P  -  CUP ACETAB 62MM SECFIT PSL CLSTR HIP HYDRXAPT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2064","SUP","Custom 27803010","","2051-2064  -  SHELL ACETAB 64MM HIP CLSHOLE PUREFIX HYDRXAPT SECFIT","BOTH IP/OP","$2,102.00 ","$1,555.48 ","$0.00 ","$2,102.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,102.00 ","$0.00 ","$1,051.00 ","$1,664.78 ","$1,681.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2064P","SUP","Custom 27803010","","2051-2064P  -  CUP ACETAB 64MM SECFIT PSL CLSTR HIP HYDRXAPT","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2066","SUP","Custom 27803010","","2051-2066  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2066P","SUP","Custom 27803010","","2051-2066P  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2068","SUP","Custom 27803010","","2051-2068  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2068P","SUP","Custom 27803010","","2051-2068P  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2070","SUP","Custom 27803010","","2051-2070  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2070P","SUP","Custom 27803010","","2051-2070P  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2072","SUP","Custom 27803010","","2051-2072  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,135.00 ","$1,579.90 ","$0.00 ","$2,135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,135.00 ","$0.00 ","$1,067.50 ","$1,690.92 ","$1,708.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-2072P","SUP","Custom 27803010","","2051-2072P  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,228.00 ","$1,648.72 ","$0.00 ","$2,228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,228.00 ","$0.00 ","$1,114.00 ","$1,764.58 ","$1,782.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3040","SUP","Custom 27803010","","2051-3040  -  SHELL ACETAB 40MM HIP SCRLES HYDRXAPT SECFIT","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3042","SUP","Custom 27803010","","2051-3042  -  SHELL ACETAB 42MM HIP SCRLES HYDRXAPT SECFIT","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3044","SUP","Custom 27803010","","2051-3044  -  CUP ACETAB 44MM SECFIT PSL SCRLES HIP HYDRXAPT","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3046","SUP","Custom 27803010","","2051-3046  -  CUP ACETAB 46MM SECFIT PSL SCRLES HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3048","SUP","Custom 27803010","","2051-3048  -  CUP ACETAB 48MM SECFIT PSL SCRLES HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3050","SUP","Custom 27803010","","2051-3050  -  CUP ACETAB 50MM SECFIT PSL SCRLES HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3052","SUP","Custom 27803010","","2051-3052  -  CUP ACETAB 52MM SECFIT PSL SCRLES HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3054","SUP","Custom 27803010","","2051-3054  -  SHELL ACETAB 54MM HIP NO HOLE SLD PUREFIX HYDRXAPT SECFIT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3056","SUP","Custom 27803010","","2051-3056  -  CUP ACETAB 56MM SECFIT NO HOLE SLD HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3058","SUP","Custom 27803010","","2051-3058  -  CUP ACETAB 58MM SECFIT NO HOLE SLD HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3060","SUP","Custom 27803010","","2051-3060  -  CUP ACETAB 60MM SECFIT NO HOLE SLD HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3062","SUP","Custom 27803010","","2051-3062  -  SHELL ACETAB 62MM HIP SCRLES HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3064","SUP","Custom 27803010","","2051-3064  -  CUP ACETAB 64MM SECFIT PSL SCRLES HIP HYDRXAPT","BOTH IP/OP","$2,227.00 ","$1,647.98 ","$0.00 ","$2,227.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,227.00 ","$0.00 ","$1,113.50 ","$1,763.78 ","$1,781.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3066","SUP","Custom 27803010","","2051-3066  -  SHELL ACETAB 66MM HIP SCRLES HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3068","SUP","Custom 27803010","","2051-3068  -  SHELL ACETAB 68MM HIP SCRLES HYDRXAPT SECFIT PSL","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3070","SUP","Custom 27803010","","2051-3070  -  SHELL ACETAB 70MM HIP SCRLES HYDRXAPT SECFIT","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2051-3072","SUP","Custom 27803010","","2051-3072  -  SHELL ACETAB 72MM HIP SCRLES HYDRXAPT SECFIT","BOTH IP/OP","$2,260.00 ","$1,672.40 ","$0.00 ","$2,260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,260.00 ","$0.00 ","$1,130.00 ","$1,789.92 ","$1,808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2048","SUP","Custom 27803010","","2053-2048  -  SHELL ACETAB 48MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2050","SUP","Custom 27803010","","2053-2050  -  SHELL ACETAB 50MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2052","SUP","Custom 27803010","","2053-2052  -  SHELL ACETAB 52MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2054","SUP","Custom 27803010","","2053-2054  -  SHELL ACETAB 54MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2056","SUP","Custom 27803010","","2053-2056  -  SHELL ACETAB 56MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2058","SUP","Custom 27803010","","2053-2058  -  SHELL ACETAB 58MM CLSHOLE HYDRXAPT SECFIT PSL","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2060","SUP","Custom 27803010","","2053-2060  -  SHELL ACETAB 60MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2062","SUP","Custom 27803010","","2053-2062  -  SHELL ACETAB 62MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2064","SUP","Custom 27803010","","2053-2064  -  SHELL ACETAB 64MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2066","SUP","Custom 27803010","","2053-2066  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2068","SUP","Custom 27803010","","2053-2068  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2070","SUP","Custom 27803010","","2053-2070  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2072","SUP","Custom 27803010","","2053-2072  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2074","SUP","Custom 27803010","","2053-2074  -  SHELL ACETAB 74MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2076","SUP","Custom 27803010","","2053-2076  -  SHELL ACETAB 76MM HIP CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2078","SUP","Custom 27803010","","2053-2078  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-2080","SUP","Custom 27803010","","2053-2080  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,190.88 ","$3,101.25 ","$0.00 ","$4,190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,190.88 ","$0.00 ","$2,095.44 ","$3,319.18 ","$3,352.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3048","SUP","Custom 27803010","","2053-3048  -  SHELL ACETAB 48MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3050","SUP","Custom 27803010","","2053-3050  -  SHELL ACETAB 50MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3052","SUP","Custom 27803010","","2053-3052  -  SHELL ACETAB 52MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3054","SUP","Custom 27803010","","2053-3054  -  SHELL ACETAB 54MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3056","SUP","Custom 27803010","","2053-3056  -  SHELL ACETAB 56MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3058","SUP","Custom 27803010","","2053-3058  -  SHELL ACETAB 58MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3060","SUP","Custom 27803010","","2053-3060  -  SHELL ACETAB 60MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3062","SUP","Custom 27803010","","2053-3062  -  SHELL ACETAB 62MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3064","SUP","Custom 27803010","","2053-3064  -  SHELL ACETAB 64MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3066","SUP","Custom 27803010","","2053-3066  -  SHELL ACETAB 66MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3068","SUP","Custom 27803010","","2053-3068  -  SHELL ACETAB 68MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3070","SUP","Custom 27803010","","2053-3070  -  SHELL ACETAB 70MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3072","SUP","Custom 27803010","","2053-3072  -  SHELL ACETAB 72MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3074","SUP","Custom 27803010","","2053-3074  -  SHELL ACETAB 74MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3076","SUP","Custom 27803010","","2053-3076  -  SHELL ACETAB 76MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3078","SUP","Custom 27803010","","2053-3078  -  SHELL ACETAB 78MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2053-3080","SUP","Custom 27803010","","2053-3080  -  SHELL ACETAB 80MM HIP NO DOME HOLE HYDRXAPT SECFIT X","BOTH IP/OP","$4,423.25 ","$3,273.21 ","$0.00 ","$4,423.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,423.25 ","$0.00 ","$2,211.63 ","$3,503.21 ","$3,538.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2060-0000","SUP","Custom 27803010","","2060-0000  -  PLUG DOME HOLE ACETAB DOME","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2060-0000-1","SUP","Custom 27803010","","2060-0000-1  -  PLUG DOME HL ACTB","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2078-1330S","SUP","HCPCS C1713","","2078-1330S  -  NAIL 280MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,090.00 ","$1,546.60 ","$0.00 ","$2,090.00 ","$940.50 ","$0.00 ","$435.61 ","$0.00 ","$0.00 ","$365.94 ","$2,090.00 ","$0.00 ","$1,045.00 ","$1,655.28 ","$1,672.00 ","$0.00 ","$327.09 ","$0.00 ","$332.73 ","$0.00 "
"2078-1530S","SUP","HCPCS C1713","","2078-1530S  -  NAIL 280MM HIP LEFT GAMMA3 IM R2 LNG STRL STSCR","BOTH IP/OP","$2,090.00 ","$1,546.60 ","$0.00 ","$2,090.00 ","$940.50 ","$0.00 ","$435.61 ","$0.00 ","$0.00 ","$365.94 ","$2,090.00 ","$0.00 ","$1,045.00 ","$1,655.28 ","$1,672.00 ","$0.00 ","$327.09 ","$0.00 ","$332.73 ","$0.00 "
"207-G","SUP","Custom 27203010","","REMOVER STAIN ERANDO-SOL 1 GAL","BOTH IP/OP","$194.18 ","$143.69 ","$0.00 ","$194.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$194.18 ","$0.00 ","$97.09 ","$153.79 ","$155.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2080-0015","SUP","HCPCS C1713","","2080-0015  -  SCREW BN 6.5MM 15MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0020","SUP","HCPCS C1713","","2080-0020  -  SCREW BN 6.5MM 20MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0025","SUP","HCPCS C1713","","2080-0025  -  SCREW BN 6.5MM 25MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0030","SUP","HCPCS C1713","","2080-0030  -  SCREW BN 6.5MM 30MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0035","SUP","HCPCS C1713","","2080-0035  -  SCREW BN 6.5MM 35MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0040","SUP","HCPCS C1713","","2080-0040  -  SCREW BN 6.5MM 40MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0045","SUP","HCPCS C1713","","2080-0045  -  SCREW BN 6.5MM 45MM TX ACTB CANC TRITANIUM MLHL SHL","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0050","SUP","HCPCS C1713","","2080-0050  -  SCREW ACETAB 6.5MM 50MM GAP HIP CANCELLOUS","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0055","SUP","HCPCS C1713","","2080-0055  -  SCREW ACETAB 6.5MM 55MM PLATE TORX GAP II CANCELLOUS","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-0060","SUP","HCPCS C1713","","2080-0060  -  SCREW ACETAB 6.5MM 60MM GAP II HIP STERILE","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$128.25 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$49.90 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$44.60 ","$0.00 ","$45.37 ","$0.00 "
"2080-1125S","SUP","HCPCS C1713","","2080-1125S  -  NAIL 300MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2080-1130S","SUP","HCPCS C1713","","2080-1130S  -  NAIL 11MM 30CM LEFT FEM GAMA IM 130D LNG TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2080-1135S","SUP","HCPCS C1713","","2080-1135S  -  NAIL 11MM 300MM HIP LEFT GAMMA3 IM 135D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2080-1330S","SUP","HCPCS C1713","","2080-1330S  -  NAIL 300MM HIP GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2082-0048L","SUP","Custom 27803010","","2082-0048L  -  SHELL ACETAB 48MM 45MM RSTOR GAP II TITANIUM HIP LEFT","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0048R","SUP","Custom 27803010","","2082-0048R  -  SHELL ACETAB 48MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0052L","SUP","Custom 27803010","","2082-0052L  -  SHELL ACETAB 52MM RSTOR GAP II TITANIUM LEFT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0052R","SUP","Custom 27803010","","2082-0052R  -  SHELL ACETAB 52MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0056L","SUP","Custom 27803010","","2082-0056L  -  SHELL ACETAB 56MM 53MM RSTOR GAP II TITANIUM HIP LEFT","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0056R","SUP","Custom 27803010","","2082-0056R  -  SHELL ACETAB 56MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0060L","SUP","Custom 27803010","","2082-0060L  -  SHELL ACETAB 60MM 56MM RSTOR GAP II TITANIUM HIP LEFT","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0060R","SUP","Custom 27803010","","2082-0060R  -  SHELL ACETAB 60MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0064L","SUP","Custom 27803010","","2082-0064L  -  SHELL ACETAB 64MM 61MM RSTOR GAP II TITANIUM HIP LEFT","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0064R","SUP","Custom 27803010","","2082-0064R  -  SHELL ACETAB 64MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0068L","SUP","Custom 27803010","","2082-0068L  -  SHELL ACETAB 68MM 64MM RSTOR GAP II TITANIUM HIP LEFT","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0068R","SUP","Custom 27803010","","2082-0068R  -  SHELL ACETAB 68MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0072L","SUP","Custom 27803010","","2082-0072L  -  SHELL ACETAB 72MM 69MM RSTOR GAP II TITANIUM HIP LEFT","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-0072R","SUP","Custom 27803010","","2082-0072R  -  SHELL ACETAB 72MM RSTOR GAP II TITANIUM RIGHT HIP","BOTH IP/OP","$6,930.00 ","$5,128.20 ","$0.00 ","$6,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,930.00 ","$0.00 ","$3,465.00 ","$5,488.56 ","$5,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2082-1125S","SUP","HCPCS C1713","","2082-1125S  -  NAIL 11MM 320MM LEFT GAMA IM LNG 125D LCK SCR STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2082-1130S","SUP","HCPCS C1713","","2082-1130S  -  NAIL 11MM 32CM LEFT FEM GAMA IM 130D LNG TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2082-1135S","SUP","HCPCS C1713","","2082-1135S  -  NAIL 11MM 32CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2082-1330S","SUP","HCPCS C1713","","2082-1330S  -  NAIL 13MM 320MM LEFT GAMA IM LNG 130D LCK SCR STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2083-0048","SUP","Custom 27803010","","2083-0048  -  SHELL ACETAB 48MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083-0052","SUP","Custom 27803010","","2083-0052  -  RING ACETAB 52MM RSTOR GAP TITANIUM HIP","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083-0056","SUP","Custom 27803010","","2083-0056  -  RING ACETAB 56MM RSTOR GAP II TITANIUM HIP","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083-0060","SUP","Custom 27803010","","2083-0060  -  RING ACETAB 60MM RSTOR GAP II TITANIUM HIP","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083-0064","SUP","Custom 27803010","","2083-0064  -  RING ACETAB 64MM RSTOR GAP II TITANIUM HIP","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083-0068","SUP","Custom 27803010","","2083-0068  -  SHELL ACETAB 68MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2083-0072","SUP","Custom 27803010","","2083-0072  -  RING ACETAB 72MM RSTOR GAP II TITANIUM HIP","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2084-1125S","SUP","HCPCS C1713","","2084-1125S  -  NAIL 11MM 34CM LEFT HIP GAMA IM 125D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2084-1130S","SUP","HCPCS C1713","","2084-1130S  -  NAIL 11MM 34CM LEFT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2084-1135S","SUP","HCPCS C1713","","2084-1135S  -  NAIL 11MM 34CM LEFT ORTH GAMA IM 135D LNG STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2084-1330S","SUP","HCPCS C1713","","2084-1330S  -  NAIL 13MM 340MM HIP LEFT GAMMA3 IM 130D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2086-1125S","SUP","HCPCS C1713","","2086-1125S  -  NAIL 11MM 36CM HIP LEFT FEM GAMMA3 IM 125D LNG TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2086-1130S","SUP","HCPCS C1713","","2086-1130S  -  NAIL 11MM 36CM LEFT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2086-1135S","SUP","HCPCS C1713","","2086-1135S  -  NAIL 11MM 36CM LEFT ORTH GAMA IM 135D LNG STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2086-1330S","SUP","HCPCS C1713","","2086-1330S  -  NAIL 13MM 360MM LEFT GAMA IM LNG 130D LCK SCR STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2088-1125S","SUP","HCPCS C1713","","2088-1125S  -  NAIL 11MM 380MM HIP LEFT GAMMA3 IM 125D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2088-1130S","SUP","HCPCS C1713","","2088-1130S  -  NAIL 11MM 38CM LEFT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2088-1135S","SUP","HCPCS C1713","","2088-1135S  -  NAIL 11MM 38CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2088-1330S","SUP","HCPCS C1713","","2088-1330S  -  NAIL 13MM 380MM HIP LEFT GAMMA3 IM 130D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2088TC/100","SUP","HCPCS C1898","","2088TC/100  -  LEAD PCNG HLX 6FR 100CM TNDRL STS IS 1 BP CNCT RING ELTRD","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"2088TC/46","SUP","HCPCS C1898","","2088TC/46  -  LEAD PCNG HLX 6FR 46CM TNDRL STS IS-1 CNCT BP ACTFX XTD STRD","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"2088TC/52","SUP","HCPCS C1898","","2088TC/52  -  LEAD PCNG 6FR 52CM TNDRL STS IS-1 BP CNCT ACT RTRCT XTD HLX","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"2088TC/58","SUP","HCPCS C1898","","2088TC/58  -  LEAD PCNG HLX 6FR 58CM TNDRL STS IS 1 CNCT ACTFX BP SFT STRD","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"2088TC/65","SUP","HCPCS C1898","","2088TC/65  -  TENDRIL STS 2088TC/65","BOTH IP/OP","$680.00 ","$503.20 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$141.73 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"209.740S","SUP","HCPCS C1713","","209.740S  -  SCREW BN FT 7.3MM 140MM STRL CNN SS","BOTH IP/OP","$579.15 ","$428.57 ","$0.00 ","$562.28 ","$253.02 ","$0.00 ","$120.71 ","$0.00 ","$0.00 ","$98.45 ","$562.28 ","$0.00 ","$281.14 ","$445.33 ","$449.82 ","$0.00 ","$85.43 ","$0.00 ","$89.51 ","$0.00 "
"2090-1125S","SUP","HCPCS C1713","","2090-1125S  -  NAIL 400MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2090-1130S","SUP","HCPCS C1713","","2090-1130S  -  NAIL 11MM 40CM LEFT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2090-1135S","SUP","HCPCS C1713","","2090-1135S  -  NAIL 11MM 40CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2090-1330S","SUP","HCPCS C1713","","2090-1330S  -  NAIL 13MM 400MM HIP LEFT GAMMA3 IM 130D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2092-1125S","SUP","HCPCS C1713","","2092-1125S  -  NAIL 11MM 420MM HIP LEFT GAMMA3 IM LNG 125D","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2092-1130S","SUP","HCPCS C1713","","2092-1130S  -  NAIL 11MM 42CM LEFT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2092-1135S","SUP","HCPCS C1713","","2092-1135S  -  NAIL 11MM 42CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2092-1330S","SUP","HCPCS C1713","","2092-1330S  -  NAIL 13MM 42CM LEFT HIP GAMA IM 130D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2092-1530S","SUP","HCPCS C1713","","2092-1530S  -  NAIL 15MM 420MM HIP LEFT GAMMA3 IM 130D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2092-3-963","SUP","HCPCS C1713","","2092-3-963  -  PIN HALF 240MM 5MM APEX SLFDRILL 50MM","BOTH IP/OP","$119.85 ","$88.69 ","$0.00 ","$122.38 ","$55.07 ","$0.00 ","$24.98 ","$0.00 ","$0.00 ","$21.43 ","$122.38 ","$0.00 ","$61.19 ","$96.92 ","$97.90 ","$0.00 ","$19.15 ","$0.00 ","$19.48 ","$0.00 "
"2094-1125S","SUP","HCPCS C1713","","2094-1125S  -  NAIL 11MM 44CM LEFT HIP GAMA IM 125D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2094-1130S","SUP","HCPCS C1713","","2094-1130S  -  NAIL 11MM 44CM LEFT FEM GAMA IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2094-1135S","SUP","HCPCS C1713","","2094-1135S  -  NAIL 11MM 44CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2094-1330S","SUP","HCPCS C1713","","2094-1330S  -  NAIL 13MM 440MM HIP LEFT GAMMA3 IM 130D LNG","BOTH IP/OP","$2,908.13 ","$2,152.02 ","$0.00 ","$2,908.13 ","$1,308.66 ","$0.00 ","$606.13 ","$0.00 ","$0.00 ","$509.19 ","$2,908.13 ","$0.00 ","$1,454.06 ","$2,303.24 ","$2,326.50 ","$0.00 ","$455.12 ","$0.00 ","$462.97 ","$0.00 "
"2099-2250","SUP","Custom 27803010","","2099-2250  -  INSERT ACETAB 50MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2252","SUP","Custom 27803010","","2099-2252  -  INSERT ACETAB 52MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2254","SUP","Custom 27803010","","2099-2254  -  INSERT ACETAB 54MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2256","SUP","Custom 27803010","","2099-2256  -  INSERT ACETAB 56MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2258","SUP","Custom 27803010","","2099-2258  -  INSERT ACETAB 58MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2261","SUP","Custom 27803010","","2099-2261  -  INSERT ACETAB 61MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2266","SUP","Custom 27803010","","2099-2266  -  INSERT ACETAB 66MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2270","SUP","Custom 27803010","","2099-2270  -  INSERT ACETAB 70MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2274","SUP","Custom 27803010","","2099-2274  -  INSERT ACETAB 74MM 22MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2656","SUP","Custom 27803010","","2099-2656  -  INSERT ACETAB 56MM 26MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2658","SUP","Custom 27803010","","2099-2658  -  INSERT ACETAB 58MM 26MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2661","SUP","Custom 27803010","","2099-2661  -  INSERT ACETAB 61MM 26MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2666","SUP","Custom 27803010","","2099-2666  -  INSERT ACETAB 66MM 26MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2670","SUP","Custom 27803010","","2099-2670  -  INSERT ACETAB 70MM 26MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2674","SUP","Custom 27803010","","2099-2674  -  INSERT ACETAB 74MM 26MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2858","SUP","Custom 27803010","","2099-2858  -  INSERT ACETAB 58MM 28MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2861","SUP","Custom 27803010","","2099-2861  -  INSERT ACETAB 61MM 28MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2866","SUP","Custom 27803010","","2099-2866  -  INSERT ACETAB 66MM 28MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2870","SUP","Custom 27803010","","2099-2870  -  INSERT ACETAB 70MM 28MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2099-2874","SUP","Custom 27803010","","2099-2874  -  INSERT ACETAB 74MM 28MM CONSTRAIN HIP","BOTH IP/OP","$6,550.00 ","$4,847.00 ","$0.00 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,550.00 ","$0.00 ","$3,275.00 ","$5,187.60 ","$5,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21000 A","SUP","Custom 27803010","","21000 A  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$888.25 ","$657.31 ","$0.00 ","$888.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$888.25 ","$0.00 ","$444.13 ","$703.49 ","$710.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21000 B","SUP","Custom 27803010","","21000 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$997.50 ","$738.15 ","$0.00 ","$997.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$997.50 ","$0.00 ","$498.75 ","$790.02 ","$798.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21020 A-M","SUP","Custom 27803010","","21020 A-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,037.88 ","$768.03 ","$0.00 ","$1,037.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.88 ","$0.00 ","$518.94 ","$822.00 ","$830.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21020 B-M","SUP","Custom 27803010","","21020 B-M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,037.88 ","$768.03 ","$0.00 ","$1,037.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.88 ","$0.00 ","$518.94 ","$822.00 ","$830.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1500","SUP","HCPCS C9359","","2102-1500  -  SUBSTITUTE BNGFT 100X25X4MM VOID FILR FOAM STRIP BIOACTIVE","BOTH IP/OP","$3,857.50 ","$2,854.55 ","$0.00 ","$3,857.50 ","$0.00 ","$0.00 ","$804.00 ","$0.00 ","$0.00 ","$0.00 ","$3,857.50 ","$0.00 ","$1,928.75 ","$3,055.14 ","$3,086.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1505","SUP","HCPCS C9359","","2102-1505  -  SUBSTITUTE BNGFT 240X25X4MM VOID FILR FOAM STRIP BIOACTIVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1510","SUP","HCPCS C9359","","2102-1510  -  SUBSTITUTE BNGFT 50X25X8MM VOID FILR FOAM STRIP COMPRESSION","BOTH IP/OP","$3,997.00 ","$2,957.78 ","$0.00 ","$3,997.00 ","$0.00 ","$0.00 ","$833.07 ","$0.00 ","$0.00 ","$0.00 ","$3,997.00 ","$0.00 ","$1,998.50 ","$3,165.62 ","$3,197.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1520","SUP","HCPCS C9359","","2102-1520  -  SUBSTITUTE BNGFT 25MMX100MMX8MM 100X25X8MM VOID FILR FOAM","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1601","SUP","HCPCS C9359","","2102-1601  -  SUBSTITUTE BNGFT FOAM PACK BIOACTIVE VITOSS BTCP COLLAGEN","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1602","SUP","HCPCS C9359","","2102-1602  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1605","SUP","HCPCS C9359","","2102-1605  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1610","SUP","HCPCS C9359","","2102-1610  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$0.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$0.00 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2102-1901","SUP","HCPCS C1713","","2102-1901  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"2102-1902","SUP","HCPCS C1713","","2102-1902  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"2102-1905","SUP","HCPCS C1713","","2102-1905  -  SUBSTITUTE BNGFT BIMODAL FOAM PACK VITOSS","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2102-1910","SUP","HCPCS C1713","","2102-1910  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"2102-2110","SUP","HCPCS C1713","","2102-2110  -  SUBSTITUTE BNGFT VOID FILR PACK BIOACTIVE COMPRESSION","BOTH IP/OP","$4,589.50 ","$3,396.23 ","$0.00 ","$6,300.00 ","$2,835.00 ","$0.00 ","$956.57 ","$0.00 ","$0.00 ","$1,103.08 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$985.95 ","$0.00 ","$1,002.96 ","$0.00 "
"2108-110","SUP","Custom 27203010","","BLADE SW W THK SGTL","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-110-000","SUP","Custom 27203010","","2108-110-000  -  BLADE SAW THK1.3MM 73MM WIDE 25MM 2 CUT SAGITTAL STAINLESS","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-120","SUP","Custom 27203010","","BLADE SW SHRT SGTL THN","BOTH IP/OP","$191.40 ","$141.64 ","$0.00 ","$191.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.40 ","$0.00 ","$95.70 ","$151.59 ","$153.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-120-000","SUP","Custom 27203010","","2108-120-000  -  BLADE SAW SHORT NARROW THIN 60.5X18.5X.64MM SAGITTAL","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-120-006","SUP","Custom 27203010","","2108-120-006  -  BLADE SAW THK.64MM 63X18.5MM SAGITTAL HEAVY DUTY STAINLESS","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-131-000","SUP","Custom 27203010","","2108-131-000  -  BLADE SAW THK.6MM 46X17MM SAGITTAL CUT EDGE SAFEDGE","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-148","SUP","Custom 27203010","","BLADE SW 34.5X9X.64MM SHRT NAR THN SGTL STRL","BOTH IP/OP","$191.40 ","$141.64 ","$0.00 ","$191.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.40 ","$0.00 ","$95.70 ","$151.59 ","$153.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-148-000","SUP","Custom 27203010","","2108-148-000  -  BLADE SAW THK.64MM SHORT NARROW THIN 34.5X9MM SAGITTAL","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-151","SUP","Custom 27203010","","BLADE SW 85X25.4X1.19MM W THK STANILESS STL SGTL WO OFST","BOTH IP/OP","$191.40 ","$141.64 ","$0.00 ","$191.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.40 ","$0.00 ","$95.70 ","$151.59 ","$153.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-151-000","SUP","Custom 27203010","","2108-151-000  -  BLADE SAW THK1.19MM WIDE THICK 85X25MM SAGITTAL STAINLESS","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-175-000","SUP","Custom 27203010","","2108-175-000  -  BLADE SAW THK1.5MM SHORT NARROW THIN 79.5X25MM SAGITTAL","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-182-000","SUP","Custom 27203010","","2108-182-000  -  BLADE SAW LONG THICK 18MM SAGITTAL NO OFFST STAINLESS STEEL","BOTH IP/OP","$72.89 ","$53.94 ","$0.00 ","$72.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.89 ","$0.00 ","$36.44 ","$57.73 ","$58.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2108-193-000","SUP","Custom 27203010","","2108-193-000  -  BLADE SAW THK.96MM MEDIUM WIDE 81.5X25MM SAGITTAL STAINLESS","BOTH IP/OP","$77.25 ","$57.17 ","$0.00 ","$77.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.25 ","$0.00 ","$38.63 ","$61.18 ","$61.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21-2000-24","SUP","HCPCS C1752","","21-2000-24  -  CATHETER DLYS STRG BLNT 14.7FR 4.9MM 2.6MM 48CM DELTEC","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2120F","SUP","HCPCS C1880","","2120F  -  FILTER CARDIO 7FR 48CM SIM VC SNF/SL FEM DLV KIT NTNL","BOTH IP/OP","$1,937.50 ","$1,433.75 ","$0.00 ","$1,937.50 ","$871.88 ","$0.00 ","$403.82 ","$0.00 ","$0.00 ","$339.24 ","$1,937.50 ","$0.00 ","$968.75 ","$1,534.50 ","$1,550.00 ","$0.00 ","$303.22 ","$0.00 ","$308.45 ","$0.00 "
"21-2369","SUP","HCPCS C1751","","21-2369  -  TRAY CATH 9FR 72.5CM 72.5L VENTRA 2 LUM SIL PERC","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$174.38 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"21-343","SUP","Custom 27203010","","TIP PIP 1ML MLA 3 TRY AUTOCLAV","BOTH IP/OP","$146.65 ","$108.52 ","$0.00 ","$146.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$146.65 ","$0.00 ","$73.33 ","$116.15 ","$117.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21-4055","SUP","HCPCS C1788","","21-4055  -  TRAY INFS PORT 7.8FR 11.4MM 1MM 76CM 30.5MMX14.7MM PRTACTH","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$247.50 ","$0.00 ","$114.63 ","$0.00 ","$0.00 ","$96.30 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$86.08 ","$0.00 ","$87.56 ","$0.00 "
"21-4065-24","SUP","HCPCS C1788","","21-4065-24  -  TRAY INFS PORT 8.5FR STRL PRTACTH II 1 LUM CATHETHER PRTL","BOTH IP/OP","$769.35 ","$569.32 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$160.35 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"21-4082","SUP","HCPCS C1788","","21-4082  -  PORT-A-CATHETER II","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"21-4165-24","SUP","HCPCS C1788","","21-4165-24  -  PROPORT PLASTIC","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$2.61 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"21-4483-24","SUP","Custom 27203010","","21-4483-24  -  TRAY INFUS PORT LP 6FR 1.9MM 1MM 76CM 1 LUMEN INTROD NEEDLE","BOTH IP/OP","$1,693.28 ","$1,253.03 ","$0.00 ","$1,612.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,612.65 ","$0.00 ","$806.33 ","$1,277.22 ","$1,290.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21-4572","SUP","HCPCS C1788","","DEVICE  PAST-PORT","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"21-4572-24","SUP","HCPCS C1788","","21-4572-24  -  KIT INFS PORT 5.8FR PSPRT T2 1 LUM PLFLW CATH INTRO UNAS","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"21-4590","SUP","HCPCS C1788","","PASPORT ELITE KIT","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$5.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"21-8067","SUP","HCPCS C1751","","21-8067  -  KIT INFS PORT LOPRFL 10FR 3.2MM 1.4MM 760MM PCTH2 PLFL 2 LUM","BOTH IP/OP","$1,070.00 ","$791.80 ","$0.00 ","$1,070.00 ","$481.50 ","$0.00 ","$223.01 ","$0.00 ","$0.00 ","$187.35 ","$1,070.00 ","$0.00 ","$535.00 ","$847.44 ","$856.00 ","$0.00 ","$167.46 ","$0.00 ","$170.34 ","$0.00 "
"219.952S","SUP","Custom 27803010","","219.952S  -  WASHER ORTHOPEDIC SMALL OVAL STAINLESS STEEL STERILE 6.5/7.3","BOTH IP/OP","$373.93 ","$276.71 ","$0.00 ","$363.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$363.03 ","$0.00 ","$181.51 ","$287.52 ","$290.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"219.953S","SUP","Custom 27803010","","219.953S  -  WASHER ORTHOPEDIC LARGE ROUND STAINLESS STEEL STERILE","BOTH IP/OP","$373.93 ","$276.71 ","$0.00 ","$363.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$363.03 ","$0.00 ","$181.51 ","$287.52 ","$290.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21AC60","SUP","Custom 27203010","","21AC60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$337.88 ","$250.03 ","$0.00 ","$337.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.88 ","$0.00 ","$168.94 ","$267.60 ","$270.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21AC75","SUP","Custom 27203010","","21AC75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$337.88 ","$250.03 ","$0.00 ","$337.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.88 ","$0.00 ","$168.94 ","$267.60 ","$270.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21AC90","SUP","Custom 27203010","","21AC90  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$337.88 ","$250.03 ","$0.00 ","$337.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.88 ","$0.00 ","$168.94 ","$267.60 ","$270.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21AGFN-756","SUP","Custom 27803010","","21AGFN-756  -  VALVE AORTIC 85D 21MM 19.6MM 1 DIGIT GRADIENT MECHANICAL","BOTH IP/OP","$11,750.00 ","$8,695.00 ","$0.00 ","$11,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,750.00 ","$0.00 ","$5,875.00 ","$9,306.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21AJ-501","SUP","Custom 27803010","","21AJ-501  -  VALVE AOR 85D 2.06SQ CM 1.51SQ CM 21MM 16.7MM MSTR SER MECH","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21BA50","SUP","Custom 27203010","","21BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$484.50 ","$358.53 ","$0.00 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$484.50 ","$0.00 ","$242.25 ","$383.72 ","$387.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21BA50DX","SUP","Custom 27203010","","21BA50DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$401.63 ","$297.21 ","$0.00 ","$401.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$401.63 ","$0.00 ","$200.81 ","$318.09 ","$321.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21BA60","SUP","Custom 27203010","","21BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$401.63 ","$297.21 ","$0.00 ","$401.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$401.63 ","$0.00 ","$200.81 ","$318.09 ","$321.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21BA70DX","SUP","Custom 27203010","","21BA70DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$401.63 ","$297.21 ","$0.00 ","$401.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$401.63 ","$0.00 ","$200.81 ","$318.09 ","$321.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21BA75","SUP","Custom 27203010","","21BA75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$391.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.00 ","$0.00 ","$195.50 ","$309.67 ","$312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21BA90","SUP","Custom 27203010","","21BA90  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$384.63 ","$284.63 ","$0.00 ","$384.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$384.63 ","$0.00 ","$192.31 ","$304.63 ","$307.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21CY64BC","SUP","Custom 27203010","","21CY64BC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.00 ","$0.00 ","$187.00 ","$296.21 ","$299.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21CY65DX","SUP","Custom 27203010","","21CY65DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$386.75 ","$286.20 ","$0.00 ","$386.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.75 ","$0.00 ","$193.38 ","$306.31 ","$309.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21CY90","SUP","Custom 27203010","","21CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$335.75 ","$248.46 ","$0.00 ","$335.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$335.75 ","$0.00 ","$167.88 ","$265.91 ","$268.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21MH30","SUP","Custom 27203010","","21MH30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$337.88 ","$250.03 ","$0.00 ","$337.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.88 ","$0.00 ","$168.94 ","$267.60 ","$270.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21MJ-501","SUP","Custom 27803010","","21MJ-501  -  VALVE MTRL 85D STD RING 21MM 16.7MM MSTR MECH LFLT ORFC","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"21TA30","SUP","Custom 27203010","","21TA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$371.88 ","$275.19 ","$0.00 ","$371.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.88 ","$0.00 ","$185.94 ","$294.53 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2200-09-0040","SUP","Custom 27203010","","2200-09-0040  -  DRILL SURG DYNANAIL 4MM DISP TIBIOTALOCALCANEAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2200-09-0050","SUP","Custom 27203010","","2200-09-0050  -  DRILL SURG STP DYNANAIL 5MM DISP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2200-18-4031","SUP","Custom 27203010","","2200-18-4031  -  GUIDEWIRE ORTH 400MM 3.1MM DYNANAIL TROCAR TIP","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2200-18-5031","SUP","Custom 27203010","","2200-18-5031  -  GUIDEWIRE ORTH 500MM 3.1MM DYNANAIL BEAD TIP","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2200-19-0031","SUP","Custom 27203010","","2200-19-0031  -  PIN FIX 3.1MM DYNANAIL STNM DISP","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22002 H","SUP","Custom 27803010","","22002 H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$748.13 ","$553.62 ","$0.00 ","$748.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$748.13 ","$0.00 ","$374.06 ","$592.52 ","$598.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22002 L","SUP","Custom 27803010","","22002 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$748.13 ","$553.62 ","$0.00 ","$748.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$748.13 ","$0.00 ","$374.06 ","$592.52 ","$598.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22002 M","SUP","Custom 27803010","","22002 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$748.13 ","$553.62 ","$0.00 ","$748.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$748.13 ","$0.00 ","$374.06 ","$592.52 ","$598.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22-004-186","SUP","Custom 27203010","","KIT SYR LUER LOCK SLIP NDL PRDVC SPRT FLTRPRO 23.5IU/ML 5/8","BOTH IP/OP","$313.60 ","$232.06 ","$0.00 ","$313.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$313.60 ","$0.00 ","$156.80 ","$248.37 ","$250.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22017 A-L","SUP","Custom 27803010","","22017 A-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,750.25 ","$2,035.19 ","$0.00 ","$2,750.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.25 ","$0.00 ","$1,375.13 ","$2,178.20 ","$2,200.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22017 A-M","SUP","Custom 27803010","","22017 A-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,750.25 ","$2,035.19 ","$0.00 ","$2,750.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.25 ","$0.00 ","$1,375.13 ","$2,178.20 ","$2,200.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22017 B-L","SUP","Custom 27803010","","22017 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22017 B-M","SUP","Custom 27803010","","22017 B-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22017A-LL","SUP","HCPCS C1713","","22017A-LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"22017B-LL","SUP","Custom 27803010","","22017B-LL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22-046-221","SUP","Custom 27203010","","RENOL OSMOLALITY CONTROL","BOTH IP/OP","$385.63 ","$285.37 ","$0.00 ","$385.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$385.63 ","$0.00 ","$192.81 ","$305.42 ","$308.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22-046346","SUP","Custom 27203010","","REAGENT METHNL ISOPRPNL FLX 95 1GL DEHYDRANT BTL HISTOLGY","BOTH IP/OP","$95.25 ","$70.49 ","$0.00 ","$95.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.25 ","$0.00 ","$47.63 ","$75.44 ","$76.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22-046-781","SUP","Custom 27203010","","CONTROL PROTINOL 280 OSMOLALITY 3X3ML","BOTH IP/OP","$412.65 ","$305.36 ","$0.00 ","$412.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.65 ","$0.00 ","$206.33 ","$326.82 ","$330.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22050 B","SUP","Custom 27803010","","22050 B  -  KIT VNCLSTM STD DOME 6MM STRL CSF SNP","BOTH IP/OP","$629.38 ","$465.74 ","$0.00 ","$629.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$629.38 ","$0.00 ","$314.69 ","$498.47 ","$503.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22082 F","SUP","Custom 27803010","","22082 F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22082 G","SUP","Custom 27803010","","22082 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22082 H","SUP","Custom 27803010","","22082 H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22082 I","SUP","Custom 27803010","","22082 I  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22082 K","SUP","Custom 27803010","","22082 K  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$513.00 ","$379.62 ","$0.00 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$513.00 ","$0.00 ","$256.50 ","$406.30 ","$410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22097 A-L","SUP","Custom 27803010","","22097 A-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22097 A-M","SUP","Custom 27803010","","22097 A-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22097 B-L","SUP","Custom 27803010","","22097 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22097 B-M","SUP","Custom 27803010","","22097 B-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22098 B-L","SUP","Custom 27803010","","22098 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22098 B-M","SUP","Custom 27803010","","22098 B-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22098 C-L","SUP","Custom 27803010","","22098 C-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,415.25 ","$2,527.29 ","$0.00 ","$3,415.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,415.25 ","$0.00 ","$1,707.63 ","$2,704.88 ","$2,732.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22098 C-M","SUP","Custom 27803010","","22098 C-M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,028.13 ","$2,240.82 ","$0.00 ","$3,028.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,028.13 ","$0.00 ","$1,514.06 ","$2,398.28 ","$2,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22101 A","SUP","Custom 27803010","","22101 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22101 B","SUP","Custom 27803010","","22101 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22101 C","SUP","Custom 27803010","","22101 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22101 D","SUP","Custom 27803010","","22101 D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22-1266","SUP","Custom 27203010","","22-1266  -  PROBE ESURG STR BIPOL TPR BLNT PNT WTFLD STRL 20-23GA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22-143-975","SUP","Custom 27203010","","REAGENT XYLN CTRSLV 1GL CLR AGNT HISTOLGY","BOTH IP/OP","$481.98 ","$356.67 ","$0.00 ","$481.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$481.98 ","$0.00 ","$240.99 ","$381.73 ","$385.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2220J","SUP","HCPCS C1880","","2220J  -  FILTER CV 7FR 83CM SIM SBCLV DLV KT NTNL JUG VN VC","BOTH IP/OP","$2,544.16 ","$1,882.68 ","$0.00 ","$2,544.16 ","$1,144.87 ","$0.00 ","$530.27 ","$0.00 ","$0.00 ","$445.46 ","$2,544.16 ","$0.00 ","$1,272.08 ","$2,014.97 ","$2,035.33 ","$0.00 ","$398.16 ","$0.00 ","$405.03 ","$0.00 "
"22-267-013","SUP","Custom 27203010","","SLIDE 3X2IN MSCP X THK FRST END PRECLN PLN THK1.2MM","BOTH IP/OP","$245.15 ","$181.41 ","$0.00 ","$245.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.15 ","$0.00 ","$122.58 ","$194.16 ","$196.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"224.510.","SUP","Custom 27803010","","224.510.  -  ROD SPNL 100MM 5.5MM REVERE SS STR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"22438-19","SUP","HCPCS C1884","","22438-19  -  SYSTEM EMBOLIC PROTECTION .014IN LARGE 4-7MM 5-6FR 190CM","BOTH IP/OP","$3,425.00 ","$2,534.50 ","$0.00 ","$3,425.00 ","$1,541.25 ","$0.00 ","$713.86 ","$0.00 ","$0.00 ","$599.69 ","$3,425.00 ","$0.00 ","$1,712.50 ","$2,712.60 ","$2,740.00 ","$0.00 ","$536.01 ","$0.00 ","$545.26 ","$0.00 "
"22-553","SUP","HCPCS C2617","","22-553  -  STENT URET 8FR 28CM REG DRMTR LG DRAIN HOLE LCK PGTL 22-553","BOTH IP/OP","$270.75 ","$200.36 ","$0.00 ","$270.75 ","$121.84 ","$0.00 ","$56.43 ","$0.00 ","$0.00 ","$47.41 ","$270.75 ","$0.00 ","$135.38 ","$214.43 ","$216.60 ","$0.00 ","$42.37 ","$0.00 ","$43.10 ","$0.00 "
"226.662S","SUP","HCPCS C1713","","226.662S  -  PLATE BRD 300MM SS 4.5MM SCR 16 HOLE CVD LCP BONE ORTH STRL","BOTH IP/OP","$1,903.30 ","$1,408.44 ","$0.00 ","$2,151.03 ","$967.96 ","$0.00 ","$396.70 ","$0.00 ","$0.00 ","$376.63 ","$2,151.03 ","$0.00 ","$1,075.51 ","$1,703.62 ","$1,720.82 ","$0.00 ","$336.64 ","$0.00 ","$342.44 ","$0.00 "
"226.702S","SUP","HCPCS C1713","","226.702S  -  PLATE BONE BROAD 372MM 20 HOLE CVD LCP STAINLESS STEEL","BOTH IP/OP","$2,443.10 ","$1,807.89 ","$0.00 ","$2,371.93 ","$1,067.37 ","$0.00 ","$509.20 ","$0.00 ","$0.00 ","$415.31 ","$2,371.93 ","$0.00 ","$1,185.96 ","$1,878.57 ","$1,897.54 ","$0.00 ","$360.40 ","$0.00 ","$377.61 ","$0.00 "
"226.722S","SUP","HCPCS C1713","","226.722S  -  PLATE BONE BROAD 408MM 22 HOLE CVD LCP STAINLESS STEEL","BOTH IP/OP","$2,759.38 ","$2,041.94 ","$0.00 ","$2,679.00 ","$1,205.55 ","$0.00 ","$575.12 ","$0.00 ","$0.00 ","$469.07 ","$2,679.00 ","$0.00 ","$1,339.50 ","$2,121.77 ","$2,143.20 ","$0.00 ","$407.05 ","$0.00 ","$426.50 ","$0.00 "
"226.742S","SUP","HCPCS C1713","","226.742S  -  PLATE BONE BROAD 443MM 24 HOLE CVD LCP STAINLESS STEEL","BOTH IP/OP","$2,995.53 ","$2,216.69 ","$0.00 ","$2,908.28 ","$1,308.72 ","$0.00 ","$624.34 ","$0.00 ","$0.00 ","$509.22 ","$2,908.28 ","$0.00 ","$1,454.14 ","$2,303.36 ","$2,326.62 ","$0.00 ","$441.89 ","$0.00 ","$463.00 ","$0.00 "
"226.762S","SUP","HCPCS C1713","","226.762S  -  PLATE BONE BROAD 479MM 26 HOLE CVD LCP STAINLESS STEEL","BOTH IP/OP","$3,234.50 ","$2,393.53 ","$0.00 ","$3,140.30 ","$1,413.14 ","$0.00 ","$674.15 ","$0.00 ","$0.00 ","$549.84 ","$3,140.30 ","$0.00 ","$1,570.15 ","$2,487.12 ","$2,512.24 ","$0.00 ","$477.14 ","$0.00 ","$499.94 ","$0.00 "
"2284-0-426","SUP","Custom 27803010","","2284-0-426  -  HEAD FEMORAL 15MM OFFST 26MM PCA HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2284-0-428","SUP","Custom 27803010","","2284-0-428  -  HEAD FEM +15MM OFST 28MM STRL PCA HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2284-0-432","SUP","Custom 27803010","","2284-0-432  -  HEAD FEMORAL +15MM OFFST 32MM PCA HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296003109S2","SUP","Custom 27203010","","2296003109S2  -  BLADE SW LF CMND II MODIFICATION HVDTY SGTL MNT RT","BOTH IP/OP","$206.00 ","$152.44 ","$0.00 ","$206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.00 ","$0.00 ","$103.00 ","$163.15 ","$164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-003-115","SUP","Custom 27203010","","2296-003-115  -  BLADE SW 29.5X7X.38MM PRCS LNG MIC NAR THN SS OSC/SAG STRL","BOTH IP/OP","$90.10 ","$66.67 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-003-414","SUP","Custom 27203010","","2296-003-414  -  BLADE SW MIC THN 25X5.5X.38MM STRL PRCS OSC/SAG SS","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-102","SUP","Custom 27203010","","2296-033-102  -  BLADE SW MED W AGRS","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-103","SUP","Custom 27203010","","2296-033-103  -  BLADE SW 25X7X.51MM CORE SS OSC/SAG AGRS STRL","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-104","SUP","Custom 27203010","","2296-033-104  -  BLADE SW 16.5MM CORE TPS 34.5MM THK.51MM MIC OSC/SAG","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-105","SUP","Custom 27203010","","2296-033-105  -  BLADE SAW THK.4MM MEDIUM 18.5X9MM OSCILLATING SAGITTAL","BOTH IP/OP","$90.10 ","$66.67 ","$0.00 ","$90.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.10 ","$0.00 ","$45.05 ","$71.36 ","$72.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-111","SUP","Custom 27203010","","2296-033-111  -  BLADE SAW MEDIUM LONG 25X9MM SAGITTAL LATEX FREE STAINLESS","BOTH IP/OP","$90.10 ","$66.67 ","$0.00 ","$90.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.10 ","$0.00 ","$45.05 ","$71.36 ","$72.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-114","SUP","Custom 27203010","","2296-033-114  -  BLADE SAW MEDIUM 18.5X7X.51MM SAGITTAL OSCILLATE AGGRESSIVE","BOTH IP/OP","$90.10 ","$66.67 ","$0.00 ","$90.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.10 ","$0.00 ","$45.05 ","$71.36 ","$72.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-125","SUP","Custom 27203010","","2296-033-125  -  BLADE SW 31X9X.51MM LNG MED SS OSC/SAG AGRS","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-212","SUP","Custom 27203010","","2296-033-212  -  BLADE SAW MEDIUM NARROW 18.5X5.5X.51MM AGGRESSIVE CORE TPS","BOTH IP/OP","$90.10 ","$66.67 ","$0.00 ","$90.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.10 ","$0.00 ","$45.05 ","$71.36 ","$72.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-033-411","SUP","Custom 27203010","","2296-033-411  -  BLADE SW 9MM CORE TPS 11.5MM THK.51MM MIC OSC/SAG","BOTH IP/OP","$90.10 ","$66.67 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-191","SUP","Custom 27203010","","2296-100-191  -  BURR SURG 39MM 3MM RND DMD STRL","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-193","SUP","Custom 27203010","","2296-100-193  -  BURR SURG 3MM 3.5MM RND DMD STRL","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-195","SUP","Custom 27203010","","2296-100-195  -  BURR SURG 39MM 4MM RND DMD STRL","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-210","SUP","Custom 27203010","","2296-100-210  -  BURR SURG 44.5MM 1MM CRB XCUT FSSR STRL","BOTH IP/OP","$18.02 ","$13.33 ","$0.00 ","$18.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.02 ","$0.00 ","$9.01 ","$14.27 ","$14.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-212","SUP","Custom 27203010","","2296-100-212  -  BURR SURG 1.2MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE","BOTH IP/OP","$15.90 ","$11.77 ","$0.00 ","$15.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.90 ","$0.00 ","$7.95 ","$12.59 ","$12.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-216","SUP","Custom 27203010","","2296-100-216  -  BURR SURG 1.6MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE","BOTH IP/OP","$15.90 ","$11.77 ","$0.00 ","$15.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.90 ","$0.00 ","$7.95 ","$12.59 ","$12.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-221","SUP","Custom 27203010","","2296-100-221  -  BURR SURG 2.1MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE","BOTH IP/OP","$15.90 ","$11.77 ","$0.00 ","$15.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.90 ","$0.00 ","$7.95 ","$12.59 ","$12.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-240","SUP","Custom 27203010","","2296-100-240  -  BURR SURG 39MM 4MM CRB RND 6 FLUT STRL","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-245","SUP","Custom 27203010","","2296-100-245  -  BURR SURG 39MM 4.5MM CRB RND STRL","BOTH IP/OP","$138.00 ","$102.12 ","$0.00 ","$138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.00 ","$0.00 ","$69.00 ","$109.30 ","$110.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-418","SUP","Custom 27203010","","2296-100-418  -  BURR SURG 1.8MM ROUND HEAD CARBIDE STERILE","BOTH IP/OP","$15.90 ","$11.77 ","$0.00 ","$15.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.90 ","$0.00 ","$7.95 ","$12.59 ","$12.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-100-423","SUP","Custom 27203010","","2296-100-423  -  BURR SURG 2.3MM 45MM 8 FLUTED ROUND HEAD CARBIDE STERILE","BOTH IP/OP","$15.90 ","$11.77 ","$0.00 ","$15.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.90 ","$0.00 ","$7.95 ","$12.59 ","$12.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-101-230","SUP","Custom 27203010","","2296-101-230  -  BURR SURG 3MM 55MM 6 FLUTED ROUND HEAD CARBIDE STERILE","BOTH IP/OP","$84.80 ","$62.75 ","$0.00 ","$84.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.80 ","$0.00 ","$42.40 ","$67.16 ","$67.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-101-418","SUP","Custom 27203010","","2296-101-418  -  BURR SURG 1.8MM ROUND CARBIDE STERILE","BOTH IP/OP","$16.38 ","$12.12 ","$0.00 ","$16.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.38 ","$0.00 ","$8.19 ","$12.97 ","$13.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2296-101-421","SUP","Custom 27203010","","2296-101-421  -  BURR SURG 2.1MM 58.5MM ROUND HEAD CROSS CUT FISSURE CARBIDE","BOTH IP/OP","$16.38 ","$12.12 ","$0.00 ","$16.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.38 ","$0.00 ","$8.19 ","$12.97 ","$13.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23011 L","SUP","Custom 27803010","","23011 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,562.50 ","$2,636.25 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23011 M","SUP","Custom 27803010","","23011 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,738.25 ","$2,766.31 ","$0.00 ","$3,738.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,738.25 ","$0.00 ","$1,869.13 ","$2,960.69 ","$2,990.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23038 A","SUP","Custom 27803010","","23038 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23038 B","SUP","Custom 27803010","","23038 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23038 C","SUP","Custom 27803010","","23038 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23038 D","SUP","Custom 27803010","","23038 D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23038 E","SUP","Custom 27803010","","23038 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-038-386","SUP","Custom 27203010","","MAS CSF TRK LIQCNTL 2X3.3.5ML","BOTH IP/OP","$196.88 ","$145.69 ","$0.00 ","$196.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.88 ","$0.00 ","$98.44 ","$155.93 ","$157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23059 L","SUP","Custom 27803010","","23059 L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23059 M","SUP","Custom 27803010","","23059 M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23064 B","SUP","Custom 27803010","","23064 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23066 B","SUP","Custom 27803010","","23066 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,401.25 ","$1,036.93 ","$0.00 ","$1,401.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,401.25 ","$0.00 ","$700.63 ","$1,109.79 ","$1,121.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23066 C","SUP","Custom 27803010","","23066 C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,258.75 ","$931.48 ","$0.00 ","$1,258.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,258.75 ","$0.00 ","$629.38 ","$996.93 ","$1,007.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"231120M5","SUP","HCPCS C1713","","231120M5  -  SCREW INTERFERENCE 20MM PROVEN BONE INGROWTH UNIFORMLY","BOTH IP/OP","$653.63 ","$483.69 ","$0.00 ","$653.63 ","$294.13 ","$0.00 ","$136.23 ","$0.00 ","$0.00 ","$114.44 ","$653.63 ","$0.00 ","$326.81 ","$517.67 ","$522.90 ","$0.00 ","$102.29 ","$0.00 ","$104.06 ","$0.00 "
"23-112-1","SUP","Custom 27011340","","23-112-1  -  SEALER BIPOL 5.1IN .226IN 2 ELTRD HMST DISP","BOTH IP/OP","$1,450.78 ","$1,073.58 ","$0.00 ","$1,450.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,450.78 ","$0.00 ","$725.39 ","$1,149.02 ","$1,160.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-139109","SUP","Custom 27203010","","CONTROL MLANLT MAS URCHMTK LVL 1 15ML UA","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-139110","SUP","Custom 27203010","","CONTROL MLANLT MAS URCHMTK LVL 2 15ML UA","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2320A","SUP","HCPCS C1884","","2320A  -  SYSTEM EMBL PRTC 103CM VC FEM AC APRCH INTROD GWIRE 7FR NTNL","BOTH IP/OP","$2,544.16 ","$1,882.68 ","$0.00 ","$2,544.16 ","$1,144.87 ","$0.00 ","$530.27 ","$0.00 ","$0.00 ","$445.46 ","$2,544.16 ","$0.00 ","$1,272.08 ","$2,014.97 ","$2,035.33 ","$0.00 ","$398.16 ","$0.00 ","$405.03 ","$0.00 "
"23-247056","SUP","Custom 27203010","","STAIN WRTS PRC HMTK 1GL REG HMTL","BOTH IP/OP","$360.70 ","$266.92 ","$0.00 ","$360.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.70 ","$0.00 ","$180.35 ","$285.67 ","$288.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-309178","SUP","Custom 27203010","","REAGENT .85% NA CHLOR 20L PH 7.2 BUFF BLOOD BANK","BOTH IP/OP","$71.13 ","$52.64 ","$0.00 ","$71.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.13 ","$0.00 ","$35.56 ","$56.33 ","$56.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-453-18","SUP","Custom 27203010","","ELEVATOR SURG 9 KNURL HNDL PROST","BOTH IP/OP","$131.25 ","$97.13 ","$0.00 ","$131.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.25 ","$0.00 ","$65.63 ","$103.95 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2347-15-02","SUP","HCPCS C1713","","2347-15-02  -  PLATE 51MM SS 2 HOLE BONE PERIART RIGHT FIB DISTAL","BOTH IP/OP","$846.40 ","$626.34 ","$0.00 ","$846.40 ","$380.88 ","$0.00 ","$176.41 ","$0.00 ","$0.00 ","$148.20 ","$846.40 ","$0.00 ","$423.20 ","$670.35 ","$677.12 ","$0.00 ","$132.46 ","$0.00 ","$134.75 ","$0.00 "
"2347-15-04","SUP","HCPCS C1713","","2347-15-04  -  PLATE 74MM SS 4 HOLE BONE PERIART RIGHT FIB DISTAL","BOTH IP/OP","$852.15 ","$630.59 ","$0.00 ","$852.15 ","$383.47 ","$0.00 ","$177.61 ","$0.00 ","$0.00 ","$149.20 ","$852.15 ","$0.00 ","$426.08 ","$674.90 ","$681.72 ","$0.00 ","$133.36 ","$0.00 ","$135.66 ","$0.00 "
"2347-15-06","SUP","HCPCS C1713","","2347-15-06  -  PLATE 95MM SS 6 HOLE BONE PERIART RIGHT FIB DISTAL","BOTH IP/OP","$863.65 ","$639.10 ","$0.00 ","$863.65 ","$388.64 ","$0.00 ","$180.01 ","$0.00 ","$0.00 ","$151.22 ","$863.65 ","$0.00 ","$431.83 ","$684.01 ","$690.92 ","$0.00 ","$135.16 ","$0.00 ","$137.49 ","$0.00 "
"2347-15-08","SUP","HCPCS C1713","","2347-15-08  -  PLATE 116MM SS 8 HOLE BONE PERIART RIGHT FIB DISTAL","BOTH IP/OP","$876.20 ","$648.39 ","$0.00 ","$876.20 ","$394.29 ","$0.00 ","$182.62 ","$0.00 ","$0.00 ","$153.42 ","$876.20 ","$0.00 ","$438.10 ","$693.95 ","$700.96 ","$0.00 ","$137.13 ","$0.00 ","$139.49 ","$0.00 "
"2347-15-10","SUP","HCPCS C1713","","2347-15-10  -  PLATE 136MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$891.00 ","$659.34 ","$0.00 ","$891.00 ","$400.95 ","$0.00 ","$185.71 ","$0.00 ","$0.00 ","$156.01 ","$891.00 ","$0.00 ","$445.50 ","$705.67 ","$712.80 ","$0.00 ","$139.44 ","$0.00 ","$141.85 ","$0.00 "
"2347-15-12","SUP","HCPCS C1713","","2347-15-12  -  PLATE 157MM SS 12 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$1,054.55 ","$780.37 ","$0.00 ","$1,054.55 ","$474.55 ","$0.00 ","$219.79 ","$0.00 ","$0.00 ","$184.64 ","$1,054.55 ","$0.00 ","$527.28 ","$835.20 ","$843.64 ","$0.00 ","$165.04 ","$0.00 ","$167.88 ","$0.00 "
"2347-15-14","SUP","HCPCS C1713","","2347-15-14  -  PLATE 178MM SS 14 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$1,125.85 ","$833.13 ","$0.00 ","$1,125.85 ","$506.63 ","$0.00 ","$234.66 ","$0.00 ","$0.00 ","$197.13 ","$1,125.85 ","$0.00 ","$562.93 ","$891.67 ","$900.68 ","$0.00 ","$176.20 ","$0.00 ","$179.24 ","$0.00 "
"2347-15-16","SUP","HCPCS C1713","","2347-15-16  -  PLATE 199MM SS 16 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$1,220.15 ","$902.91 ","$0.00 ","$1,220.15 ","$549.07 ","$0.00 ","$254.31 ","$0.00 ","$0.00 ","$213.64 ","$1,220.15 ","$0.00 ","$610.08 ","$966.36 ","$976.12 ","$0.00 ","$190.95 ","$0.00 ","$194.25 ","$0.00 "
"2347-15-18","SUP","HCPCS C1713","","2347-15-18  -  PLATE 220MM SS 18 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$1,315.60 ","$973.54 ","$0.00 ","$1,315.60 ","$592.02 ","$0.00 ","$274.20 ","$0.00 ","$0.00 ","$230.35 ","$1,315.60 ","$0.00 ","$657.80 ","$1,041.96 ","$1,052.48 ","$0.00 ","$205.89 ","$0.00 ","$209.44 ","$0.00 "
"2347-15-20","SUP","HCPCS C1713","","2347-15-20  -  PLATE 241MM SS 20 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$1,434.05 ","$1,061.20 ","$0.00 ","$1,434.05 ","$645.32 ","$0.00 ","$298.89 ","$0.00 ","$0.00 ","$251.09 ","$1,434.05 ","$0.00 ","$717.03 ","$1,135.77 ","$1,147.24 ","$0.00 ","$224.43 ","$0.00 ","$228.30 ","$0.00 "
"2347-16-02","SUP","HCPCS C1713","","2347-16-02  -  PLATE 51MM SS 2 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$846.40 ","$626.34 ","$0.00 ","$846.40 ","$380.88 ","$0.00 ","$176.41 ","$0.00 ","$0.00 ","$148.20 ","$846.40 ","$0.00 ","$423.20 ","$670.35 ","$677.12 ","$0.00 ","$132.46 ","$0.00 ","$134.75 ","$0.00 "
"2347-16-04","SUP","HCPCS C1713","","2347-16-04  -  PLATE 74MM SS 2.7MM 3.5MM CORT PERIART 2.7MM CANC","BOTH IP/OP","$852.15 ","$630.59 ","$0.00 ","$852.15 ","$383.47 ","$0.00 ","$177.61 ","$0.00 ","$0.00 ","$149.20 ","$852.15 ","$0.00 ","$426.08 ","$674.90 ","$681.72 ","$0.00 ","$133.36 ","$0.00 ","$135.66 ","$0.00 "
"2347-16-06","SUP","HCPCS C1713","","2347-16-06  -  PLATE 95MM 6 HOLE BONE FIB L/L","BOTH IP/OP","$863.90 ","$639.29 ","$0.00 ","$863.90 ","$388.76 ","$0.00 ","$180.06 ","$0.00 ","$0.00 ","$151.26 ","$863.90 ","$0.00 ","$431.95 ","$684.21 ","$691.12 ","$0.00 ","$135.20 ","$0.00 ","$137.53 ","$0.00 "
"2347-16-08","SUP","HCPCS C1713","","2347-16-08  -  PLATE 116MM 8 HOLE BONE FIB L/L","BOTH IP/OP","$876.20 ","$648.39 ","$0.00 ","$876.20 ","$394.29 ","$0.00 ","$182.62 ","$0.00 ","$0.00 ","$153.42 ","$876.20 ","$0.00 ","$438.10 ","$693.95 ","$700.96 ","$0.00 ","$137.13 ","$0.00 ","$139.49 ","$0.00 "
"2347-16-10","SUP","HCPCS C1713","","2347-16-10  -  PLATE 135MM 10 HOLE BONE FIB L/L","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"2347-16-12","SUP","HCPCS C1713","","2347-16-12  -  PLATE 157MM 12 HOLE BONE FIB L/L","BOTH IP/OP","$1,054.55 ","$780.37 ","$0.00 ","$1,054.55 ","$474.55 ","$0.00 ","$219.79 ","$0.00 ","$0.00 ","$184.64 ","$1,054.55 ","$0.00 ","$527.28 ","$835.20 ","$843.64 ","$0.00 ","$165.04 ","$0.00 ","$167.88 ","$0.00 "
"2347-16-14","SUP","HCPCS C1713","","2347-16-14  -  PLATE 178MM 14 HOLE BONE FIB L/L","BOTH IP/OP","$1,125.85 ","$833.13 ","$0.00 ","$1,125.85 ","$506.63 ","$0.00 ","$234.66 ","$0.00 ","$0.00 ","$197.13 ","$1,125.85 ","$0.00 ","$562.93 ","$891.67 ","$900.68 ","$0.00 ","$176.20 ","$0.00 ","$179.24 ","$0.00 "
"2347-16-16","SUP","HCPCS C1713","","2347-16-16  -  PLATE 199MM 16 HOLE BONE FIB L/L","BOTH IP/OP","$1,220.15 ","$902.91 ","$0.00 ","$1,220.15 ","$549.07 ","$0.00 ","$254.31 ","$0.00 ","$0.00 ","$213.64 ","$1,220.15 ","$0.00 ","$610.08 ","$966.36 ","$976.12 ","$0.00 ","$190.95 ","$0.00 ","$194.25 ","$0.00 "
"2347-16-18","SUP","HCPCS C1713","","2347-16-18  -  PLATE 220MM 18 HOLE BONE FIB L/L","BOTH IP/OP","$1,315.60 ","$973.54 ","$0.00 ","$1,315.60 ","$592.02 ","$0.00 ","$274.20 ","$0.00 ","$0.00 ","$230.35 ","$1,315.60 ","$0.00 ","$657.80 ","$1,041.96 ","$1,052.48 ","$0.00 ","$205.89 ","$0.00 ","$209.44 ","$0.00 "
"2347-16-20","SUP","HCPCS C1713","","2347-16-20  -  PLATE 241MM 20 HOLE BONE FIB L/L","BOTH IP/OP","$1,434.05 ","$1,061.20 ","$0.00 ","$1,434.05 ","$645.32 ","$0.00 ","$298.89 ","$0.00 ","$0.00 ","$251.09 ","$1,434.05 ","$0.00 ","$717.03 ","$1,135.77 ","$1,147.24 ","$0.00 ","$224.43 ","$0.00 ","$228.30 ","$0.00 "
"2347-17-02","SUP","HCPCS C1713","","2347-17-02  -  PLATE 51MM 2 HOLE BONE FIB RIGHT","BOTH IP/OP","$846.40 ","$626.34 ","$0.00 ","$846.40 ","$380.88 ","$0.00 ","$176.41 ","$0.00 ","$0.00 ","$148.20 ","$846.40 ","$0.00 ","$423.20 ","$670.35 ","$677.12 ","$0.00 ","$132.46 ","$0.00 ","$134.75 ","$0.00 "
"2347-17-04","SUP","HCPCS C1713","","2347-17-04  -  PLATE 73MM SS 4 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$852.15 ","$630.59 ","$0.00 ","$852.15 ","$383.47 ","$0.00 ","$177.61 ","$0.00 ","$0.00 ","$149.20 ","$852.15 ","$0.00 ","$426.08 ","$674.90 ","$681.72 ","$0.00 ","$133.36 ","$0.00 ","$135.66 ","$0.00 "
"2347-17-06","SUP","HCPCS C1713","","2347-17-06  -  PLATE 94MM SS 6 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$863.65 ","$639.10 ","$0.00 ","$863.65 ","$388.64 ","$0.00 ","$180.01 ","$0.00 ","$0.00 ","$151.22 ","$863.65 ","$0.00 ","$431.83 ","$684.01 ","$690.92 ","$0.00 ","$135.16 ","$0.00 ","$137.49 ","$0.00 "
"2347-17-08","SUP","HCPCS C1713","","2347-17-08  -  PLATE 115MM SS 8 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$876.20 ","$648.39 ","$0.00 ","$876.20 ","$394.29 ","$0.00 ","$182.62 ","$0.00 ","$0.00 ","$153.42 ","$876.20 ","$0.00 ","$438.10 ","$693.95 ","$700.96 ","$0.00 ","$137.13 ","$0.00 ","$139.49 ","$0.00 "
"2347-17-10","SUP","HCPCS C1713","","2347-17-10  -  PLATE 135MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"2347-17-12","SUP","HCPCS C1713","","2347-17-12  -  PLATE 156MM SS 12 HOLE BONE PERIART RIGHT FIB","BOTH IP/OP","$1,054.55 ","$780.37 ","$0.00 ","$1,054.55 ","$474.55 ","$0.00 ","$219.79 ","$0.00 ","$0.00 ","$184.64 ","$1,054.55 ","$0.00 ","$527.28 ","$835.20 ","$843.64 ","$0.00 ","$165.04 ","$0.00 ","$167.88 ","$0.00 "
"2347-17-14","SUP","HCPCS C1713","","2347-17-14  -  PLATE 177MM SS 14 HOLE BONE PERIART RIGHT FIB","BOTH IP/OP","$1,125.85 ","$833.13 ","$0.00 ","$1,125.85 ","$506.63 ","$0.00 ","$234.66 ","$0.00 ","$0.00 ","$197.13 ","$1,125.85 ","$0.00 ","$562.93 ","$891.67 ","$900.68 ","$0.00 ","$176.20 ","$0.00 ","$179.24 ","$0.00 "
"2347-17-16","SUP","HCPCS C1713","","2347-17-16  -  PLATE 198MM SS 16 HOLE BONE PERIART RIGHT FIB","BOTH IP/OP","$1,220.15 ","$902.91 ","$0.00 ","$1,220.15 ","$549.07 ","$0.00 ","$254.31 ","$0.00 ","$0.00 ","$213.64 ","$1,220.15 ","$0.00 ","$610.08 ","$966.36 ","$976.12 ","$0.00 ","$190.95 ","$0.00 ","$194.25 ","$0.00 "
"2347-17-18","SUP","HCPCS C1713","","2347-17-18  -  PLATE 219MM SS 18 HOLE BONE PERIART RIGHT FIB","BOTH IP/OP","$1,315.60 ","$973.54 ","$0.00 ","$1,315.60 ","$592.02 ","$0.00 ","$274.20 ","$0.00 ","$0.00 ","$230.35 ","$1,315.60 ","$0.00 ","$657.80 ","$1,041.96 ","$1,052.48 ","$0.00 ","$205.89 ","$0.00 ","$209.44 ","$0.00 "
"2347-17-20","SUP","HCPCS C1713","","2347-17-20  -  PLATE 239MM SS 20 HOLE BONE PERIART RIGHT FIB","BOTH IP/OP","$1,284.05 ","$950.20 ","$0.00 ","$1,284.05 ","$577.82 ","$0.00 ","$267.63 ","$0.00 ","$0.00 ","$224.83 ","$1,284.05 ","$0.00 ","$642.03 ","$1,016.97 ","$1,027.24 ","$0.00 ","$200.95 ","$0.00 ","$204.42 ","$0.00 "
"2347-18-02","SUP","HCPCS C1713","","2347-18-02  -  PLATE 51MM SS 2 HOLE BONE PERIART LEFT FIB","BOTH IP/OP","$846.40 ","$626.34 ","$0.00 ","$846.40 ","$380.88 ","$0.00 ","$176.41 ","$0.00 ","$0.00 ","$148.20 ","$846.40 ","$0.00 ","$423.20 ","$670.35 ","$677.12 ","$0.00 ","$132.46 ","$0.00 ","$134.75 ","$0.00 "
"2347-18-04","SUP","HCPCS C1713","","2347-18-04  -  PLATE BN 73MM STRL 4 HL SS FIB LT DIST LAT PERIART","BOTH IP/OP","$852.15 ","$630.59 ","$0.00 ","$852.15 ","$383.47 ","$0.00 ","$177.61 ","$0.00 ","$0.00 ","$149.20 ","$852.15 ","$0.00 ","$426.08 ","$674.90 ","$681.72 ","$0.00 ","$133.36 ","$0.00 ","$135.66 ","$0.00 "
"2347-18-06","SUP","HCPCS C1713","","2347-18-06  -  PLATE 94MM 6 HOLE BONE LEFT DISTAL LAT FIB","BOTH IP/OP","$863.65 ","$639.10 ","$0.00 ","$863.65 ","$388.64 ","$0.00 ","$180.01 ","$0.00 ","$0.00 ","$151.22 ","$863.65 ","$0.00 ","$431.83 ","$684.01 ","$690.92 ","$0.00 ","$135.16 ","$0.00 ","$137.49 ","$0.00 "
"2347-18-08","SUP","HCPCS C1713","","2347-18-08  -  PLATE 115MM SS 8 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$876.20 ","$648.39 ","$0.00 ","$876.20 ","$394.29 ","$0.00 ","$182.62 ","$0.00 ","$0.00 ","$153.42 ","$876.20 ","$0.00 ","$438.10 ","$693.95 ","$700.96 ","$0.00 ","$137.13 ","$0.00 ","$139.49 ","$0.00 "
"2347-18-10","SUP","HCPCS C1713","","2347-18-10  -  PLATE 135MM SS 10 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$966.00 ","$714.84 ","$0.00 ","$966.00 ","$434.70 ","$0.00 ","$201.34 ","$0.00 ","$0.00 ","$169.14 ","$966.00 ","$0.00 ","$483.00 ","$765.07 ","$772.80 ","$0.00 ","$151.18 ","$0.00 ","$153.79 ","$0.00 "
"2347-18-12","SUP","HCPCS C1713","","2347-18-12  -  PLATE 156MM SS 12 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$1,054.55 ","$780.37 ","$0.00 ","$1,054.55 ","$474.55 ","$0.00 ","$219.79 ","$0.00 ","$0.00 ","$184.64 ","$1,054.55 ","$0.00 ","$527.28 ","$835.20 ","$843.64 ","$0.00 ","$165.04 ","$0.00 ","$167.88 ","$0.00 "
"2347-18-14","SUP","HCPCS C1713","","2347-18-14  -  PLATE 177MM SS 14 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$1,125.85 ","$833.13 ","$0.00 ","$1,125.85 ","$506.63 ","$0.00 ","$234.66 ","$0.00 ","$0.00 ","$197.13 ","$1,125.85 ","$0.00 ","$562.93 ","$891.67 ","$900.68 ","$0.00 ","$176.20 ","$0.00 ","$179.24 ","$0.00 "
"2347-18-16","SUP","HCPCS C1713","","2347-18-16  -  PLATE 198MM SS 16 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$1,220.15 ","$902.91 ","$0.00 ","$1,220.15 ","$549.07 ","$0.00 ","$254.31 ","$0.00 ","$0.00 ","$213.64 ","$1,220.15 ","$0.00 ","$610.08 ","$966.36 ","$976.12 ","$0.00 ","$190.95 ","$0.00 ","$194.25 ","$0.00 "
"2347-18-18","SUP","HCPCS C1713","","2347-18-18  -  PLATE 219MM SS 18 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$1,300.60 ","$962.44 ","$0.00 ","$1,300.60 ","$585.27 ","$0.00 ","$271.08 ","$0.00 ","$0.00 ","$227.72 ","$1,300.60 ","$0.00 ","$650.30 ","$1,030.08 ","$1,040.48 ","$0.00 ","$203.54 ","$0.00 ","$207.06 ","$0.00 "
"2347-18-20","SUP","HCPCS C1713","","2347-18-20  -  PLATE 239MM SS 20 HOLE BONE FIB LEFT DISTAL LAT","BOTH IP/OP","$1,434.05 ","$1,061.20 ","$0.00 ","$1,434.05 ","$645.32 ","$0.00 ","$298.89 ","$0.00 ","$0.00 ","$251.09 ","$1,434.05 ","$0.00 ","$717.03 ","$1,135.77 ","$1,147.24 ","$0.00 ","$224.43 ","$0.00 ","$228.30 ","$0.00 "
"2348-12-35","SUP","HCPCS C1713","","2348-12-35  -  SCREW BN 3.5MM 2.7MM 12MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-14-35","SUP","HCPCS C1713","","2348-14-35  -  SCREW BN 3.5MM 2.7MM 14MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-16-35","SUP","HCPCS C1713","","2348-16-35  -  SCREW BN 3.5MM 2.7MM 16MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-18-35","SUP","HCPCS C1713","","2348-18-35  -  SCREW BONE 3.5MM 2.7MM 18MM SELF TAP STAINLESS STEEL","BOTH IP/OP","$74.75 ","$55.32 ","$0.00 ","$74.75 ","$33.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.09 ","$74.75 ","$0.00 ","$37.38 ","$59.20 ","$59.80 ","$0.00 ","$11.70 ","$0.00 ","$11.90 ","$0.00 "
"2348-20-35","SUP","HCPCS C1713","","2348-20-35  -  SCREW BN 2.7MM 3.5MM 20MM ST CORT","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-22-35","SUP","HCPCS C1713","","2348-22-35  -  SCREW BN 3.5MM 2.7MM 22MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-24-35","SUP","HCPCS C1713","","2348-24-35  -  SCREW BN 3.5MM 2.7MM 24MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-26-35","SUP","HCPCS C1713","","2348-26-35  -  SCREW BN 3.5MM 2.7MM 26MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-28-35","SUP","HCPCS C1713","","2348-28-35  -  SCREW BN 3.5MM 2.7MM 28MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-30-35","SUP","HCPCS C1713","","2348-30-35  -  SCREW BN 3.5MM 2.7MM 30MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-32-35","SUP","HCPCS C1713","","2348-32-35  -  SCREW BN 3.5MM 2.7MM 32MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-34-35","SUP","HCPCS C1713","","2348-34-35  -  SCREW BN 3.5MM 2.7MM 34MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-36-35","SUP","HCPCS C1713","","2348-36-35  -  SCREW BN 3.5MM 2.7MM 36MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-38-35","SUP","HCPCS C1713","","2348-38-35  -  SCREW BN 3.5MM 2.7MM 38MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-40-35","SUP","HCPCS C1713","","2348-40-35  -  SCREW BN 3.5MM 2.7MM 40MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-42-35","SUP","HCPCS C1713","","2348-42-35  -  SCREW BN 3.5MM 2.7MM 42MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-44-35","SUP","HCPCS C1713","","2348-44-35  -  SCREW BN 3.5MM 2.7MM 44MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$62.10 ","$45.95 ","$0.00 ","$62.10 ","$27.95 ","$0.00 ","$12.94 ","$0.00 ","$0.00 ","$10.87 ","$62.10 ","$0.00 ","$31.05 ","$49.18 ","$49.68 ","$0.00 ","$9.72 ","$0.00 ","$9.89 ","$0.00 "
"2348-46-35","SUP","HCPCS C1713","","2348-46-35  -  SCREW BN 3.5MM 2.7MM 46MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-48-35","SUP","HCPCS C1713","","2348-48-35  -  SCREW BN 3.5MM 2.7MM 48MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-50-35","SUP","HCPCS C1713","","2348-50-35  -  SCREW BN 3.5MM 2.7MM 50MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-52-35","SUP","HCPCS C1713","","2348-52-35  -  SCREW BN 3.5MM 2.7MM 52MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-54-35","SUP","HCPCS C1713","","2348-54-35  -  SCREW BN 3.5MM 2.7MM 54MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-56-35","SUP","HCPCS C1713","","2348-56-35  -  SCREW BN 3.5MM 2.7MM 56MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-58-35","SUP","HCPCS C1713","","2348-58-35  -  SCREW BN 3.5MM 58MM PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-60-35","SUP","HCPCS C1713","","2348-60-35  -  SCREW BN 3.5MM 2.7MM 60MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-65-35","SUP","HCPCS C1713","","2348-65-35  -  SCREW BN 3.5MM 2.7MM 65MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-70-35","SUP","HCPCS C1713","","2348-70-35  -  SCREW BN 3.5MM 2.7MM 70MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-75-35","SUP","HCPCS C1713","","2348-75-35  -  SCREW BN 3.5MM 2.7MM 75MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-80-35","SUP","HCPCS C1713","","2348-80-35  -  SCREW BN 3.5MM 2.7MM 80MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-85-35","SUP","HCPCS C1713","","2348-85-35  -  SCREW BN 3.5MM 2.7MM 85MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-90-35","SUP","HCPCS C1713","","2348-90-35  -  SCREW BN 3.5MM 2.7MM 90MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"2348-95-35","SUP","HCPCS C1713","","2348-95-35  -  SCREW BN 3.5MM 2.7MM 95MM NS ST SS ELB CORT PERIART","BOTH IP/OP","$60.85 ","$45.03 ","$0.00 ","$60.85 ","$27.38 ","$0.00 ","$12.68 ","$0.00 ","$0.00 ","$10.65 ","$60.85 ","$0.00 ","$30.43 ","$48.19 ","$48.68 ","$0.00 ","$9.52 ","$0.00 ","$9.69 ","$0.00 "
"235-F","SUP","Custom 27803010","","235-F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,623.50 ","$1,201.39 ","$0.00 ","$1,623.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,623.50 ","$0.00 ","$811.75 ","$1,285.81 ","$1,298.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"236.504S","SUP","HCPCS C1713","","236.504S  -  PLATE BN CNTR 112MM STRL LCP CMBN 4 HL ELONGATE HL PROX TAB","BOTH IP/OP","$1,807.73 ","$1,337.72 ","$0.00 ","$1,755.08 ","$789.78 ","$0.00 ","$376.78 ","$0.00 ","$0.00 ","$307.30 ","$1,755.08 ","$0.00 ","$877.54 ","$1,390.02 ","$1,404.06 ","$0.00 ","$266.67 ","$0.00 ","$279.41 ","$0.00 "
"236-01","SUP","HCPCS C1713","","236-01  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$490.88 ","$363.25 ","$0.00 ","$490.88 ","$220.89 ","$0.00 ","$102.31 ","$0.00 ","$0.00 ","$85.95 ","$490.88 ","$0.00 ","$245.44 ","$388.78 ","$392.70 ","$0.00 ","$76.82 ","$0.00 ","$78.15 ","$0.00 "
"236-02","SUP","HCPCS C1713","","236-02  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$575.88 ","$426.15 ","$0.00 ","$575.88 ","$259.14 ","$0.00 ","$120.03 ","$0.00 ","$0.00 ","$100.83 ","$575.88 ","$0.00 ","$287.94 ","$456.10 ","$460.70 ","$0.00 ","$90.12 ","$0.00 ","$91.68 ","$0.00 "
"236-04","SUP","HCPCS C1713","","236-04  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$735.25 ","$544.09 ","$0.00 ","$735.25 ","$330.86 ","$0.00 ","$153.24 ","$0.00 ","$0.00 ","$128.74 ","$735.25 ","$0.00 ","$367.63 ","$582.32 ","$588.20 ","$0.00 ","$115.07 ","$0.00 ","$117.05 ","$0.00 "
"23-640-000","SUP","Custom 27203010","","MAS CARDIOIMMUNE XL LVL 1 3ML 6/PK","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-640-001","SUP","Custom 27203010","","MAS CARDIOIMMUNE XL LVL 2 3ML 6/PK","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-640-002","SUP","Custom 27203010","","MAS CARDIOIMMUNE XL LVL 3 3ML 6/PK","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-640-003","SUP","Custom 27203010","","MAS CARDIOIMMUNE XL LVL L 3ML 6/PK","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-666471","SUP","Custom 27203010","","REAGENT B-OHB R1 R2 50ML ANALY","BOTH IP/OP","$854.13 ","$632.06 ","$0.00 ","$854.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$854.13 ","$0.00 ","$427.06 ","$676.47 ","$683.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23-666472","SUP","Custom 27203010","","CONTROL CHM 5ML SET B-OHB","BOTH IP/OP","$723.00 ","$535.02 ","$0.00 ","$723.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$723.00 ","$0.00 ","$361.50 ","$572.62 ","$578.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"237.043S","SUP","HCPCS C1713","","237.043S  -  PLATE BONE 90D 30MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.044S","SUP","HCPCS C1713","","237.044S  -  PLATE BONE 90D 40MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.053S","SUP","HCPCS C1713","","237.053S  -  PLATE BN 90D 30X11.7MM STRL 5 HL LMT CNTCT CNN SS 4.5MM SCR","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.054S","SUP","HCPCS C1713","","237.054S  -  PLATE BONE 90D 40MM 5 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.063S","SUP","HCPCS C1713","","237.063S  -  PLATE BONE 90D 30MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.064S","SUP","HCPCS C1713","","237.064S  -  PLATE BONE 90D 40MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.083S","SUP","HCPCS C1713","","237.083S  -  PLATE BONE 90D 30MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.084S","SUP","HCPCS C1713","","237.084S  -  PLATE BONE 90D 40MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.085S","SUP","HCPCS C1713","","237.085S  -  PLATE BONE 90D 50MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.086S","SUP","HCPCS C1713","","237.086S  -  PLATE BN 90D 60X11.7MM STRL 8 HL LMT CNTCT CNN SS 4.5MM SCR","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"237.103S","SUP","HCPCS C1713","","237.103S  -  PLATE BONE 90D 30MM 10 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.104S","SUP","HCPCS C1713","","237.104S  -  PLATE BONE 90D 40MM 10 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.105S","SUP","HCPCS C1713","","237.105S  -  PLATE BONE 90D 50MM 10 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.106S","SUP","HCPCS C1713","","237.106S  -  PLATE BONE 90D 60MM 10 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.123S","SUP","HCPCS C1713","","237.123S  -  PLATE BONE 90D 30MM 12 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.124S","SUP","HCPCS C1713","","237.124S  -  PLATE BONE 90D 40MM 220MM 12 HOLE SHAFT LCP STAINLESS STEEL","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.125S","SUP","HCPCS C1713","","237.125S  -  PLATE BONE 90D 50MM 12 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.126S","SUP","HCPCS C1713","","237.126S  -  PLATE BONE 90D 60MM 12 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,134.58 ","$1,579.59 ","$0.00 ","$2,134.58 ","$960.56 ","$0.00 ","$444.90 ","$0.00 ","$0.00 ","$373.75 ","$2,134.58 ","$0.00 ","$1,067.29 ","$1,690.59 ","$1,707.66 ","$0.00 ","$334.06 ","$0.00 ","$339.82 ","$0.00 "
"237.143S","SUP","HCPCS C1713","","237.143S  -  PLATE BONE 90D 30MM 14 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,709.63 ","$2,005.13 ","$0.00 ","$2,709.63 ","$1,219.33 ","$0.00 ","$564.75 ","$0.00 ","$0.00 ","$474.43 ","$2,709.63 ","$0.00 ","$1,354.81 ","$2,146.03 ","$2,167.70 ","$0.00 ","$424.06 ","$0.00 ","$431.37 ","$0.00 "
"237.144S","SUP","HCPCS C1713","","237.144S  -  PLATE BONE 90D 40MM 14 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,709.63 ","$2,005.13 ","$0.00 ","$2,709.63 ","$1,219.33 ","$0.00 ","$564.75 ","$0.00 ","$0.00 ","$474.43 ","$2,709.63 ","$0.00 ","$1,354.81 ","$2,146.03 ","$2,167.70 ","$0.00 ","$424.06 ","$0.00 ","$431.37 ","$0.00 "
"237.145S","SUP","HCPCS C1713","","237.145S  -  PLATE BONE 90D 50MM 14 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,709.63 ","$2,005.13 ","$0.00 ","$2,709.63 ","$1,219.33 ","$0.00 ","$564.75 ","$0.00 ","$0.00 ","$474.43 ","$2,709.63 ","$0.00 ","$1,354.81 ","$2,146.03 ","$2,167.70 ","$0.00 ","$424.06 ","$0.00 ","$431.37 ","$0.00 "
"237.146S","SUP","HCPCS C1713","","237.146S  -  PLATE BONE 90D 60MM 14 HOLE LIMITED CONTACT ANGLED BLADE","BOTH IP/OP","$2,709.63 ","$2,005.13 ","$0.00 ","$2,709.63 ","$1,219.33 ","$0.00 ","$564.75 ","$0.00 ","$0.00 ","$474.43 ","$2,709.63 ","$0.00 ","$1,354.81 ","$2,146.03 ","$2,167.70 ","$0.00 ","$424.06 ","$0.00 ","$431.37 ","$0.00 "
"237020T5","SUP","HCPCS C1713","","237020T5  -  SCREW INTFR PLA 20MM 7.3MM ACL BABSR SLF REINF MATRYX STRL","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$725.00 ","$326.25 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$126.94 ","$725.00 ","$0.00 ","$362.50 ","$574.20 ","$580.00 ","$0.00 ","$113.46 ","$0.00 ","$115.42 ","$0.00 "
"238020T5","SUP","HCPCS C1713","","238020T5  -  SCREW BABSR 20MM 8MM MATRYX","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$725.00 ","$326.25 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$126.94 ","$725.00 ","$0.00 ","$362.50 ","$574.20 ","$580.00 ","$0.00 ","$113.46 ","$0.00 ","$115.42 ","$0.00 "
"23-875-595","SUP","Custom 27203010","","KIT BIOSTAR ACV HCG CNTRL POS NEG MCBLTST","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"239.955S","SUP","HCPCS C1713","","239.955S  -  PLATE 93MM SS 3.5MM SCR 4 HOLE SM FRAG LCP BONE OD LEFT MDL","BOTH IP/OP","$2,746.73 ","$2,032.58 ","$0.00 ","$3,143.98 ","$1,414.79 ","$0.00 ","$572.49 ","$0.00 ","$0.00 ","$550.48 ","$3,143.98 ","$0.00 ","$1,571.99 ","$2,490.03 ","$2,515.18 ","$0.00 ","$492.03 ","$0.00 ","$500.52 ","$0.00 "
"239.986S","SUP","HCPCS C1713","","239.986S  -  PLATE BN CNTR 142MM STRL LCP CMBN 6 HL LMT CNTCT SS TIB RT","BOTH IP/OP","$2,788.90 ","$2,063.79 ","$0.00 ","$2,707.68 ","$1,218.45 ","$0.00 ","$581.28 ","$0.00 ","$0.00 ","$474.09 ","$2,707.68 ","$0.00 ","$1,353.84 ","$2,144.48 ","$2,166.14 ","$0.00 ","$411.41 ","$0.00 ","$431.06 ","$0.00 "
"23AGFN-756","SUP","Custom 27803010","","23AGFN-756  -  VALVE AOR 85D 23MM 21.4MM REGENT FLEXCUFF 1 DGT GRDNT LFLT","BOTH IP/OP","$11,750.00 ","$8,695.00 ","$0.00 ","$11,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,750.00 ","$0.00 ","$5,875.00 ","$9,306.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"23AJ-501","SUP","Custom 27803010","","23AJ-501  -  VALVE AOR 85D STD 23MM 18.6MM MSTR-SER CUF LFLT OPN CNTRL","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"240.048S","SUP","HCPCS C1713","","240.048S  -  PLATE BN CNTR 298MM STRL LCP CMBN 4 HL LMT CNTCT TPR END SS","BOTH IP/OP","$3,023.65 ","$2,237.50 ","$0.00 ","$2,935.58 ","$1,321.01 ","$0.00 ","$630.20 ","$0.00 ","$0.00 ","$514.00 ","$2,935.58 ","$0.00 ","$1,467.79 ","$2,324.98 ","$2,348.46 ","$0.00 ","$446.04 ","$0.00 ","$467.34 ","$0.00 "
"240.049S","SUP","HCPCS C1713","","240.049S  -  PLATE BONE 298MM 16 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,023.65 ","$2,237.50 ","$0.00 ","$2,935.58 ","$1,321.01 ","$0.00 ","$630.20 ","$0.00 ","$0.00 ","$514.00 ","$2,935.58 ","$0.00 ","$1,467.79 ","$2,324.98 ","$2,348.46 ","$0.00 ","$446.04 ","$0.00 ","$467.34 ","$0.00 "
"240.052S","SUP","HCPCS C1713","","240.052S  -  PLATE BONE 334MM 18 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"240.053S","SUP","HCPCS C1713","","240.053S  -  PLATE BONE 334MM 18 HOLE LCP STAINLESS STEEL TIBIA LEFT","BOTH IP/OP","$3,081.28 ","$2,280.15 ","$0.00 ","$2,991.53 ","$1,346.19 ","$0.00 ","$642.21 ","$0.00 ","$0.00 ","$523.79 ","$2,991.53 ","$0.00 ","$1,495.76 ","$2,369.29 ","$2,393.22 ","$0.00 ","$454.54 ","$0.00 ","$476.25 ","$0.00 "
"240.054S","SUP","HCPCS C1713","","240.054S  -  PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$3,140.33 ","$2,323.84 ","$0.00 ","$3,048.85 ","$1,371.98 ","$0.00 ","$654.52 ","$0.00 ","$0.00 ","$533.83 ","$3,048.85 ","$0.00 ","$1,524.43 ","$2,414.69 ","$2,439.08 ","$0.00 ","$463.25 ","$0.00 ","$485.38 ","$0.00 "
"240.055S","SUP","HCPCS C1713","","240.055S  -  PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL","BOTH IP/OP","$3,140.33 ","$2,323.84 ","$0.00 ","$3,048.85 ","$1,371.98 ","$0.00 ","$654.52 ","$0.00 ","$0.00 ","$533.83 ","$3,048.85 ","$0.00 ","$1,524.43 ","$2,414.69 ","$2,439.08 ","$0.00 ","$463.25 ","$0.00 ","$485.38 ","$0.00 "
"24003 L","SUP","Custom 27803010","","24003 L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24003 LL","SUP","Custom 27803010","","24003 LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24003 M","SUP","Custom 27803010","","24003 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,147.00 ","$1,588.78 ","$0.00 ","$2,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.00 ","$0.00 ","$1,073.50 ","$1,700.42 ","$1,717.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24004 B","SUP","Custom 27803010","","24004 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2400-58","SUP","Custom 27203010","","2400-58  -  CATHETER CHOLANGIOGRAM 50CM REDDICK CYSTIC DUCT STERILE","BOTH IP/OP","$1,499.38 ","$1,109.54 ","$0.00 ","$1,499.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,499.38 ","$0.00 ","$749.69 ","$1,187.51 ","$1,199.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24013-1","SUP","Custom 27803010","","24013-1  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24013-2","SUP","Custom 27803010","","24013-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24013-5","SUP","Custom 27803010","","24013-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24-025-01-09","SUP","HCPCS C1713","","24-025-01-09  -  STERNAL LCK PLATE 6 HOLE XIPHOID PLATE 2.0MM THICK","BOTH IP/OP","$718.25 ","$531.51 ","$0.00 ","$718.25 ","$323.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.76 ","$718.25 ","$0.00 ","$359.13 ","$568.85 ","$574.60 ","$0.00 ","$112.41 ","$0.00 ","$114.35 ","$0.00 "
"24-025-03-09","SUP","HCPCS C1713","","24-025-03-09  -  STERNAL LOCK PLATE 10 HOLE BODY PLATE 2.0MM THICK","BOTH IP/OP","$967.20 ","$715.73 ","$0.00 ","$967.20 ","$435.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.35 ","$967.20 ","$0.00 ","$483.60 ","$766.02 ","$773.76 ","$0.00 ","$151.37 ","$0.00 ","$153.98 ","$0.00 "
"24-025-04-09","SUP","HCPCS C1713","","24-025-04-09  -  STERNAL LOCK PLATE 14 HOLE MANUBRIUM PLATE 2.0MM THICK","BOTH IP/OP","$1,212.53 ","$897.27 ","$0.00 ","$1,212.53 ","$545.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.30 ","$1,212.53 ","$0.00 ","$606.26 ","$960.32 ","$970.02 ","$0.00 ","$189.76 ","$0.00 ","$193.03 ","$0.00 "
"24027-1","SUP","Custom 27803010","","24027-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24027-2","SUP","Custom 27803010","","24027-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24027-4","SUP","Custom 27803010","","24027-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,657.38 ","$3,446.46 ","$0.00 ","$4,657.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,657.38 ","$0.00 ","$2,328.69 ","$3,688.64 ","$3,725.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24027-5","SUP","Custom 27803010","","24027-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24028-1","SUP","Custom 27803010","","24028-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24028-2","SUP","Custom 27803010","","24028-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24028-5","SUP","Custom 27803010","","24028-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24039-1","SUP","Custom 27803010","","24039-1  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,094.50 ","$3,029.93 ","$0.00 ","$4,094.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,094.50 ","$0.00 ","$2,047.25 ","$3,242.84 ","$3,275.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24039-2","SUP","Custom 27803010","","24039-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,094.50 ","$3,029.93 ","$0.00 ","$4,094.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,094.50 ","$0.00 ","$2,047.25 ","$3,242.84 ","$3,275.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24039-5","SUP","Custom 27203010","","24039-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,094.50 ","$3,029.93 ","$0.00 ","$4,094.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,094.50 ","$0.00 ","$2,047.25 ","$3,242.84 ","$3,275.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24079-1","SUP","Custom 27803010","","24079-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24079-2","SUP","Custom 27803010","","24079-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$5,526.63 ","$4,089.71 ","$0.00 ","$5,526.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,526.63 ","$0.00 ","$2,763.31 ","$4,377.09 ","$4,421.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24079-5","SUP","Custom 27803010","","24079-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24088 C","SUP","Custom 27803010","","24088 C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24088 D","SUP","Custom 27803010","","24088 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$501.13 ","$370.84 ","$0.00 ","$501.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.13 ","$0.00 ","$250.56 ","$396.89 ","$400.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"241.072S","SUP","HCPCS C1713","","241.072S  -  PLATE BN 12MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,473.18 ","$1,090.15 ","$0.00 ","$1,430.25 ","$643.61 ","$0.00 ","$307.05 ","$0.00 ","$0.00 ","$250.43 ","$1,430.25 ","$0.00 ","$715.13 ","$1,132.76 ","$1,144.20 ","$0.00 ","$217.32 ","$0.00 ","$227.70 ","$0.00 "
"241.073S","SUP","HCPCS C1713","","241.073S  -  PLATE BONE 12MM 4 HOLE HOOK LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,473.18 ","$1,090.15 ","$0.00 ","$1,430.25 ","$643.61 ","$0.00 ","$307.05 ","$0.00 ","$0.00 ","$250.43 ","$1,430.25 ","$0.00 ","$715.13 ","$1,132.76 ","$1,144.20 ","$0.00 ","$217.32 ","$0.00 ","$227.70 ","$0.00 "
"241.074S","SUP","HCPCS C1713","","241.074S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,473.18 ","$1,090.15 ","$0.00 ","$1,430.25 ","$643.61 ","$0.00 ","$307.05 ","$0.00 ","$0.00 ","$250.43 ","$1,430.25 ","$0.00 ","$715.13 ","$1,132.76 ","$1,144.20 ","$0.00 ","$217.32 ","$0.00 ","$227.70 ","$0.00 "
"241.075S","SUP","HCPCS C1713","","241.075S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,473.18 ","$1,090.15 ","$0.00 ","$1,430.25 ","$643.61 ","$0.00 ","$307.05 ","$0.00 ","$0.00 ","$250.43 ","$1,430.25 ","$0.00 ","$715.13 ","$1,132.76 ","$1,144.20 ","$0.00 ","$217.32 ","$0.00 ","$227.70 ","$0.00 "
"241.076S","SUP","HCPCS C1713","","241.076S  -  PLATE BN 18MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,473.18 ","$1,090.15 ","$0.00 ","$1,430.25 ","$643.61 ","$0.00 ","$307.05 ","$0.00 ","$0.00 ","$250.43 ","$1,430.25 ","$0.00 ","$715.13 ","$1,132.76 ","$1,144.20 ","$0.00 ","$217.32 ","$0.00 ","$227.70 ","$0.00 "
"241.077S","SUP","HCPCS C1713","","241.077S  -  PLATE BONE 18MM 4 HOLE HOOK PRECONTOUR LCP STAINLESS STEEL","BOTH IP/OP","$1,473.18 ","$1,090.15 ","$0.00 ","$1,430.25 ","$643.61 ","$0.00 ","$307.05 ","$0.00 ","$0.00 ","$250.43 ","$1,430.25 ","$0.00 ","$715.13 ","$1,132.76 ","$1,144.20 ","$0.00 ","$217.32 ","$0.00 ","$227.70 ","$0.00 "
"241.082S","SUP","HCPCS C1713","","241.082S  -  PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,540.65 ","$1,140.08 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$321.11 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"241.083S","SUP","HCPCS C1713","","241.083S  -  PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,540.65 ","$1,140.08 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$321.11 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"241.084S","SUP","HCPCS C1713","","241.084S  -  PLATE BN 15MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,540.65 ","$1,140.08 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$321.11 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"241.085S","SUP","HCPCS C1713","","241.085S  -  PLATE BONE 15MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,540.65 ","$1,140.08 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$321.11 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"241.086S","SUP","HCPCS C1713","","241.086S  -  PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,540.65 ","$1,140.08 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$321.11 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"241.087S","SUP","HCPCS C1713","","241.087S  -  PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,540.65 ","$1,140.08 ","$0.00 ","$1,495.78 ","$673.10 ","$0.00 ","$321.11 ","$0.00 ","$0.00 ","$261.90 ","$1,495.78 ","$0.00 ","$747.89 ","$1,184.66 ","$1,196.62 ","$0.00 ","$227.27 ","$0.00 ","$238.13 ","$0.00 "
"241.094S","SUP","HCPCS C1713","","241.094S  -  PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"241.095S","SUP","HCPCS C1713","","241.095S  -  PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"241.096S","SUP","HCPCS C1713","","241.096S  -  PLATE BN 18MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"241.097S","SUP","HCPCS C1713","","241.097S  -  PLATE BONE 18MM 6 HOLE HOOK LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"241.104S","SUP","HCPCS C1713","","241.104S  -  PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,651.70 ","$1,222.26 ","$0.00 ","$1,603.58 ","$721.61 ","$0.00 ","$344.26 ","$0.00 ","$0.00 ","$280.77 ","$1,603.58 ","$0.00 ","$801.79 ","$1,270.04 ","$1,282.86 ","$0.00 ","$243.65 ","$0.00 ","$255.29 ","$0.00 "
"241.105S","SUP","HCPCS C1713","","241.105S  -  PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,651.70 ","$1,222.26 ","$0.00 ","$1,603.58 ","$721.61 ","$0.00 ","$344.26 ","$0.00 ","$0.00 ","$280.77 ","$1,603.58 ","$0.00 ","$801.79 ","$1,270.04 ","$1,282.86 ","$0.00 ","$243.65 ","$0.00 ","$255.29 ","$0.00 "
"241.106S","SUP","HCPCS C1713","","241.106S  -  PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT","BOTH IP/OP","$1,651.70 ","$1,222.26 ","$0.00 ","$1,603.58 ","$721.61 ","$0.00 ","$344.26 ","$0.00 ","$0.00 ","$280.77 ","$1,603.58 ","$0.00 ","$801.79 ","$1,270.04 ","$1,282.86 ","$0.00 ","$243.65 ","$0.00 ","$255.29 ","$0.00 "
"241.107S","SUP","HCPCS C1713","","241.107S  -  PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT","BOTH IP/OP","$1,651.70 ","$1,222.26 ","$0.00 ","$1,603.58 ","$721.61 ","$0.00 ","$344.26 ","$0.00 ","$0.00 ","$280.77 ","$1,603.58 ","$0.00 ","$801.79 ","$1,270.04 ","$1,282.86 ","$0.00 ","$243.65 ","$0.00 ","$255.29 ","$0.00 "
"241.266S","SUP","HCPCS C1713","","241.266S  -  PLATE BN 116X11X2.5MM STRL LCP CMBN 7 HL PRECONTOUR LMT","BOTH IP/OP","$2,204.13 ","$1,631.06 ","$0.00 ","$2,139.93 ","$962.97 ","$0.00 ","$459.39 ","$0.00 ","$0.00 ","$374.68 ","$2,139.93 ","$0.00 ","$1,069.96 ","$1,694.82 ","$1,711.94 ","$0.00 ","$325.14 ","$0.00 ","$340.68 ","$0.00 "
"241.919S","SUP","HCPCS C1713","","241.919S  -  PLATE BONE LONG 160X12X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS","BOTH IP/OP","$3,185.30 ","$2,357.12 ","$0.00 ","$3,092.53 ","$1,391.64 ","$0.00 ","$663.90 ","$0.00 ","$0.00 ","$541.48 ","$3,092.53 ","$0.00 ","$1,546.26 ","$2,449.28 ","$2,474.02 ","$0.00 ","$469.88 ","$0.00 ","$492.33 ","$0.00 "
"241.921S","SUP","HCPCS C1713","","241.921S  -  PLATE LNG 196MM SS 3.5MM SCR SM FRAG SET 8 HOLE LCP BONE","BOTH IP/OP","$3,304.78 ","$2,445.54 ","$0.00 ","$3,788.60 ","$1,704.87 ","$0.00 ","$688.80 ","$0.00 ","$0.00 ","$663.35 ","$3,788.60 ","$0.00 ","$1,894.30 ","$3,000.57 ","$3,030.88 ","$0.00 ","$592.92 ","$0.00 ","$603.15 ","$0.00 "
"241-01","SUP","HCPCS C1781","","241-01  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$465.38 ","$344.38 ","$0.00 ","$465.38 ","$209.42 ","$0.00 ","$97.00 ","$0.00 ","$0.00 ","$81.48 ","$465.38 ","$0.00 ","$232.69 ","$368.58 ","$372.30 ","$0.00 ","$72.83 ","$0.00 ","$74.09 ","$0.00 "
"241-02","SUP","HCPCS C1781","","241-02  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$571.63 ","$423.01 ","$0.00 ","$571.63 ","$257.23 ","$0.00 ","$119.14 ","$0.00 ","$0.00 ","$100.09 ","$571.63 ","$0.00 ","$285.81 ","$452.73 ","$457.30 ","$0.00 ","$89.46 ","$0.00 ","$91.00 ","$0.00 "
"241-02-C","SUP","HCPCS C1781","","241-02-C  -  PLATE BN 121MM FLEXMESH 2 HL STRP SKL","BOTH IP/OP","$575.88 ","$426.15 ","$0.00 ","$575.88 ","$259.14 ","$0.00 ","$120.03 ","$0.00 ","$0.00 ","$100.83 ","$575.88 ","$0.00 ","$287.94 ","$456.10 ","$460.70 ","$0.00 ","$90.12 ","$0.00 ","$91.68 ","$0.00 "
"241-03","SUP","HCPCS C1781","","241-03  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$652.38 ","$482.76 ","$0.00 ","$652.38 ","$293.57 ","$0.00 ","$135.97 ","$0.00 ","$0.00 ","$114.23 ","$652.38 ","$0.00 ","$326.19 ","$516.68 ","$521.90 ","$0.00 ","$102.10 ","$0.00 ","$103.86 ","$0.00 "
"241-04","SUP","HCPCS C1713","","241-04  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$735.25 ","$544.09 ","$0.00 ","$735.25 ","$330.86 ","$0.00 ","$153.24 ","$0.00 ","$0.00 ","$128.74 ","$735.25 ","$0.00 ","$367.63 ","$582.32 ","$588.20 ","$0.00 ","$115.07 ","$0.00 ","$117.05 ","$0.00 "
"24106 A","SUP","Custom 27803010","","24106 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24106 B","SUP","Custom 27803010","","24106 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24106 C","SUP","Custom 27803010","","24106 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24106 D","SUP","Custom 27803010","","24106 D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24106 E","SUP","Custom 27803010","","24106 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"24106 H","SUP","HCPCS C1725","","24106 H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,220.75 ","$903.36 ","$0.00 ","$1,220.75 ","$662.87 ","$0.00 ","$254.43 ","$0.00 ","$0.00 ","$213.74 ","$1,220.75 ","$0.00 ","$610.38 ","$966.83 ","$976.60 ","$0.00 ","$191.05 ","$0.00 ","$194.34 ","$0.00 "
"24133-1","SUP","Custom 27803010","","24133-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$5,241.63 ","$3,878.81 ","$0.00 ","$5,241.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,241.63 ","$0.00 ","$2,620.81 ","$4,151.37 ","$4,193.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"242.531S","SUP","HCPCS C1713","","242.531S  -  PLATE BONE 46MM 7 HOLE LCP STAINLESS STEEL DISTAL ULNA","BOTH IP/OP","$1,561.73 ","$1,155.68 ","$0.00 ","$1,516.23 ","$682.30 ","$0.00 ","$325.50 ","$0.00 ","$0.00 ","$265.48 ","$1,516.23 ","$0.00 ","$758.11 ","$1,200.85 ","$1,212.98 ","$0.00 ","$230.38 ","$0.00 ","$241.38 ","$0.00 "
"24-2050","SUP","Custom 27203010","","24-2050  -  DRILL SURG 1.8MM 50MM 26MM STOP BLADE LORENZ MANDIB","BOTH IP/OP","$432.50 ","$320.05 ","$0.00 ","$432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$432.50 ","$0.00 ","$216.25 ","$342.54 ","$346.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"246.354S","SUP","HCPCS C1713","","246.354S  -  PLATE BONE 27MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS","BOTH IP/OP","$1,516.23 ","$1,122.01 ","$0.00 ","$1,516.23 ","$682.30 ","$0.00 ","$316.02 ","$0.00 ","$0.00 ","$265.48 ","$1,516.23 ","$0.00 ","$758.11 ","$1,200.85 ","$1,212.98 ","$0.00 ","$230.38 ","$0.00 ","$241.38 ","$0.00 "
"246.355S","SUP","HCPCS C1713","","246.355S  -  PLATE BONE 32MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS","BOTH IP/OP","$1,516.23 ","$1,122.01 ","$0.00 ","$1,516.23 ","$682.30 ","$0.00 ","$316.02 ","$0.00 ","$0.00 ","$265.48 ","$1,516.23 ","$0.00 ","$758.11 ","$1,200.85 ","$1,212.98 ","$0.00 ","$230.38 ","$0.00 ","$241.38 ","$0.00 "
"247.354S","SUP","HCPCS C1713","","247.354S  -  PLATE BONE 34MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS","BOTH IP/OP","$1,561.73 ","$1,155.68 ","$0.00 ","$1,516.23 ","$682.30 ","$0.00 ","$325.50 ","$0.00 ","$0.00 ","$265.48 ","$1,516.23 ","$0.00 ","$758.11 ","$1,200.85 ","$1,212.98 ","$0.00 ","$230.38 ","$0.00 ","$241.38 ","$0.00 "
"247.355S","SUP","HCPCS C1713","","247.355S  -  PLATE BONE 40MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS","BOTH IP/OP","$1,561.73 ","$1,155.68 ","$0.00 ","$1,516.23 ","$682.30 ","$0.00 ","$325.50 ","$0.00 ","$0.00 ","$265.48 ","$1,516.23 ","$0.00 ","$758.11 ","$1,200.85 ","$1,212.98 ","$0.00 ","$230.38 ","$0.00 ","$241.38 ","$0.00 "
"2480-10-41","SUP","HCPCS C1713","","2480-10-41  -  SCREW BN FT 4MM 10MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-12-41","SUP","HCPCS C1713","","2480-12-41  -  SCREW BN FT 4MM 12MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-14-41","SUP","HCPCS C1713","","2480-14-41  -  SCREW BN FT 4MM 14MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-16-41","SUP","HCPCS C1713","","2480-16-41  -  SCREW BN FT 4MM 16MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-18-41","SUP","HCPCS C1713","","2480-18-41  -  SCREW BN FT 4MM 18MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-20-41","SUP","HCPCS C1713","","2480-20-41  -  SCREW BN FT 4MM 20MM NS FORTE SS PERIART CANC","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-22-41","SUP","HCPCS C1713","","2480-22-41  -  SCREW BN FT 4MM 22MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-24-41","SUP","HCPCS C1713","","2480-24-41  -  SCREW BN FT 4MM 24MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-26-41","SUP","HCPCS C1713","","2480-26-41  -  SCREW BN FT 4MM 26MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-28-41","SUP","HCPCS C1713","","2480-28-41  -  SCREW BN FT 4MM 28MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-30-41","SUP","HCPCS C1713","","2480-30-41  -  SCREW BN FT 4MM 30MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-32-41","SUP","HCPCS C1713","","2480-32-41  -  SCREW BN FT 4MM 32MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-34-41","SUP","HCPCS C1713","","2480-34-41  -  SCREW BN FT 4MM 34MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-36-41","SUP","HCPCS C1713","","2480-36-41  -  SCREW BN FT 4MM 36MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-38-41","SUP","HCPCS C1713","","2480-38-41  -  SCREW BN FT 4MM 38MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"2480-40-41","SUP","HCPCS C1713","","2480-40-41  -  SCREW BN FT 4MM 40MM NS FORTE SS CANC PERIART","BOTH IP/OP","$111.55 ","$82.55 ","$0.00 ","$111.55 ","$50.20 ","$0.00 ","$23.25 ","$0.00 ","$0.00 ","$19.53 ","$111.55 ","$0.00 ","$55.78 ","$88.35 ","$89.24 ","$0.00 ","$17.46 ","$0.00 ","$17.76 ","$0.00 "
"24B002","SUP","HCPCS C9359","","24B002  -  GRAFT BONE PROX FEM HD FRZN ALLOWASH TCH GAMA IRR","BOTH IP/OP","$3,260.00 ","$2,412.40 ","$0.00 ","$3,260.00 ","$0.00 ","$0.00 ","$679.47 ","$0.00 ","$0.00 ","$0.00 ","$3,260.00 ","$0.00 ","$1,630.00 ","$2,581.92 ","$2,608.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"250.25S","SUP","HCPCS C1713","","250.25S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM STAINLESS STEEL","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"250.27S","SUP","HCPCS C1713","","250.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM STAINLESS STEEL","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"250.28S","SUP","HCPCS C1713","","250.28S  -  NAIL 10MM 285MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"250.30S","SUP","HCPCS C1713","","250.30S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM TITANIUM TIBIA","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"250.31S","SUP","HCPCS C1713","","250.31S  -  NAIL 10MM 315MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"250.33S","SUP","HCPCS C1713","","250.33S  -  NAIL 10MM 330MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"250.34S","SUP","HCPCS C1713","","250.34S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 345MM STAINLESS STEEL","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"250.36S","SUP","HCPCS C1713","","250.36S  -  NAIL 10MM 360MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"250.38S","SUP","HCPCS C1713","","250.38S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"250.40S","SUP","HCPCS C1713","","250.40S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"250.42S","SUP","HCPCS C1713","","250.42S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"25000C+10.00","SUP","HCPCS V2632","","25000C+10.00  -  LENS IOL +10 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+10.50","SUP","HCPCS V2632","","25000C+10.50  -  LENS IOL +10.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+11.00","SUP","HCPCS V2632","","25000C+11.00  -  LENS IOL +11 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+11.50","SUP","HCPCS V2632","","25000C+11.50  -  LENS IOL +11.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+12.00","SUP","HCPCS V2632","","25000C+12.00  -  LENS IOL +12 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+12.50","SUP","HCPCS V2632","","25000C+12.50  -  LENS IOL +12.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+13.00","SUP","HCPCS V2632","","25000C+13.00  -  LENS IOL +13 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+13.50","SUP","HCPCS V2632","","25000C+13.50  -  LENS IOL +13.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+14.00","SUP","HCPCS V2632","","25000C+14.00  -  LENS IOL +14 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+14.50","SUP","HCPCS V2632","","25000C+14.50  -  LENS IOL +14.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+15.00","SUP","HCPCS V2632","","25000C+15.00  -  LENS IOL +15 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+15.50","SUP","HCPCS V2632","","25000C+15.50  -  LENS IOL +15.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+16.00","SUP","HCPCS V2632","","25000C+16.00  -  LENS IOL +16 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+16.50","SUP","HCPCS V2632","","25000C+16.50  -  LENS IOL +16.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+17.00","SUP","HCPCS V2632","","25000C+17.00  -  LENS IOL +17 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+17.50","SUP","HCPCS V2632","","25000C+17.50  -  LENS IOL +17.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+18.00","SUP","HCPCS V2632","","25000C+18.00  -  LENS IOL +18 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+18.50","SUP","HCPCS V2632","","25000C+18.50  -  LENS IOL +18.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+19.00","SUP","HCPCS V2632","","25000C+19.00  -  LENS IOL +19 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+19.50","SUP","HCPCS V2632","","25000C+19.50  -  LENS IOL +19.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+20.00","SUP","HCPCS V2632","","25000C+20.00  -  LENS IOL +20 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+20.50","SUP","HCPCS V2632","","25000C+20.50  -  LENS IOL +20.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+21.00","SUP","HCPCS V2632","","25000C+21.00  -  LENS IOL +21 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+21.50","SUP","HCPCS V2632","","25000C+21.50  -  LENS IOL +21.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+22.00","SUP","HCPCS V2632","","25000C+22.00  -  LENS IOL +22 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+22.50","SUP","HCPCS V2632","","25000C+22.50  -  LENS IOL +22.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+23.00","SUP","HCPCS V2632","","25000C+23.00  -  LENS IOL +23 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+23.50","SUP","HCPCS V2632","","25000C+23.50  -  LENS IOL +23.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+24.00","SUP","HCPCS V2632","","25000C+24.00  -  LENS IOL +24 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+24.50","SUP","HCPCS V2632","","25000C+24.50  -  LENS IOL +24.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+25.00","SUP","HCPCS V2632","","25000C+25.00  -  LENS IOL +25 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+25.50","SUP","HCPCS V2632","","25000C+25.50  -  LENS IOL +25.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+26.00","SUP","HCPCS V2632","","25000C+26.00  -  LENS IOL +26 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+26.50","SUP","HCPCS V2632","","25000C+26.50  -  LENS IOL +26.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+27.00","SUP","HCPCS V2632","","25000C+27.00  -  LENS IOL +27 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+27.50","SUP","HCPCS V2632","","25000C+27.50  -  LENS IOL +27.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+28.00","SUP","HCPCS V2632","","25000C+28.00  -  LENS IOL +28 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+28.50","SUP","HCPCS V2632","","25000C+28.50  -  LENS IOL +28.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+29.00","SUP","HCPCS V2632","","25000C+29.00  -  LENS IOL +29 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+29.50","SUP","HCPCS V2632","","25000C+29.50  -  LENS IOL +29.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+30.00","SUP","HCPCS V2632","","25000C+30.00  -  LENS IOL +30 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+6.00","SUP","HCPCS V2632","","25000C+6.00  -  LENS IOL +6 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+6.50","SUP","HCPCS V2632","","25000C+6.50  -  LENS IOL +6.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+7.00","SUP","HCPCS V2632","","25000C+7.00  -  LENS IOL +7 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+7.50","SUP","HCPCS V2632","","25000C+7.50  -  LENS IOL +7.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+8.00","SUP","HCPCS V2632","","25000C+8.00  -  LENS IOL +8 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+8.50","SUP","HCPCS V2632","","25000C+8.50  -  LENS IOL +8.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+9.00","SUP","HCPCS V2632","","25000C+9.00  -  LENS IOL +9 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25000C+9.50","SUP","HCPCS V2632","","25000C+9.50  -  LENS IOL +9.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25-003-10-09","SUP","HCPCS C1713","","25-003-10-09  -  MESH CRNL 85X50X.3MM SM GRID PNL TI 1.5MM SCR","BOTH IP/OP","$1,823.00 ","$1,349.02 ","$0.00 ","$1,823.00 ","$820.35 ","$0.00 ","$379.96 ","$0.00 ","$0.00 ","$319.19 ","$1,823.00 ","$0.00 ","$911.50 ","$1,443.82 ","$1,458.40 ","$0.00 ","$285.30 ","$0.00 ","$290.22 ","$0.00 "
"25-003-14-09","SUP","HCPCS C1713","","25-003-14-09  -  NEURO PLATE  ULTRA LOW PROFILE BOX STYLE  2X2-HOLE  W/TAB","BOTH IP/OP","$701.53 ","$519.13 ","$0.00 ","$701.53 ","$315.69 ","$0.00 ","$146.22 ","$0.00 ","$0.00 ","$122.83 ","$701.53 ","$0.00 ","$350.76 ","$555.61 ","$561.22 ","$0.00 ","$109.79 ","$0.00 ","$111.68 ","$0.00 "
"25-003-21-09","SUP","Custom 27803010","","25-003-21-09  -  COVER BURR HOLE MEDIUM 15MM .3MM HOLE ULTRA LP SMOOTH","BOTH IP/OP","$789.55 ","$584.27 ","$0.00 ","$789.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$789.55 ","$0.00 ","$394.78 ","$625.32 ","$631.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-003-25-09","SUP","Custom 27803010","","25-003-25-09  -  COVER BURR HOLE LARGE 25MM .3MM HOLE ULTRA LP SMOOTH ROUNDED","BOTH IP/OP","$789.55 ","$584.27 ","$0.00 ","$789.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$789.55 ","$0.00 ","$394.78 ","$625.32 ","$631.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-004-70-09","SUP","HCPCS C1781","","25-004-70-09  -  PLATE BONE ROUND MICRO MESH 73MM .6MM PANEL CNTOUR TITANIUM","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"25-007-80-09","SUP","HCPCS C1713","","25-007-80-09  -  MESH CRNL 3D 80X80X.3MM TI 1.5MM SCR","BOTH IP/OP","$4,042.10 ","$2,991.15 ","$0.00 ","$4,042.10 ","$1,818.95 ","$0.00 ","$842.47 ","$0.00 ","$0.00 ","$707.74 ","$4,042.10 ","$0.00 ","$2,021.05 ","$3,201.34 ","$3,233.68 ","$0.00 ","$632.59 ","$0.00 ","$643.50 ","$0.00 "
"25-008-12-09","SUP","HCPCS C1781","","25-008-12-09  -  PLATE BONE 3D MICRO MESH 120X120X.6MM TITANIUM FRONTAL MAXL","BOTH IP/OP","$5,736.28 ","$4,244.85 ","$0.00 ","$5,736.28 ","$2,581.32 ","$0.00 ","$1,195.58 ","$0.00 ","$0.00 ","$1,004.38 ","$5,736.28 ","$0.00 ","$2,868.14 ","$4,543.13 ","$4,589.02 ","$0.00 ","$897.73 ","$0.00 ","$913.21 ","$0.00 "
"25-008-80-09","SUP","HCPCS C1713","","25-008-80-09  -  PLATE BONE 3D MESH 80X80X.6MM TITANIUM MANDIB 1.5MM SCREW","BOTH IP/OP","$3,664.13 ","$2,711.46 ","$0.00 ","$3,664.13 ","$1,648.86 ","$0.00 ","$763.70 ","$0.00 ","$0.00 ","$641.56 ","$3,664.13 ","$0.00 ","$1,832.06 ","$2,901.99 ","$2,931.30 ","$0.00 ","$573.44 ","$0.00 ","$583.33 ","$0.00 "
"25014-1","SUP","Custom 27803010","","25014-1  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25014-2","SUP","Custom 27803010","","25014-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25014-5","SUP","Custom 27803010","","25014-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,723.88 ","$3,495.67 ","$0.00 ","$4,723.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,723.88 ","$0.00 ","$2,361.94 ","$3,741.31 ","$3,779.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-015-04-09","SUP","HCPCS C1713","","25-015-04-09  -  PLATE BONE MICRO SQUARE .6MM 2X2 HOLE TITANIUM FRONTAL MAXL","BOTH IP/OP","$377.18 ","$279.11 ","$0.00 ","$377.18 ","$169.73 ","$0.00 ","$78.61 ","$0.00 ","$0.00 ","$66.04 ","$377.18 ","$0.00 ","$188.59 ","$298.73 ","$301.74 ","$0.00 ","$59.03 ","$0.00 ","$60.05 ","$0.00 "
"25-015-06-09","SUP","HCPCS C1713","","25-015-06-09  -  PLATE BONE MICRO SQUARE .6MM 3X2 HOLE TITANIUM MAXFACL 1.5MM","BOTH IP/OP","$452.60 ","$334.92 ","$0.00 ","$452.60 ","$203.67 ","$0.00 ","$94.33 ","$0.00 ","$0.00 ","$79.25 ","$452.60 ","$0.00 ","$226.30 ","$358.46 ","$362.08 ","$0.00 ","$70.83 ","$0.00 ","$72.05 ","$0.00 "
"250-202","SUP","HCPCS C1892","","SHEATH ACCES 35CM 12FR URETERAL FLEXOR","BOTH IP/OP","$296.10 ","$219.11 ","$0.00 ","$296.10 ","$160.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.84 ","$296.10 ","$0.00 ","$148.05 ","$234.51 ","$236.88 ","$0.00 ","$46.34 ","$0.00 ","$47.14 ","$0.00 "
"250-208","SUP","HCPCS C1892","","SHEATH ACCES 36CM 13/15FR NVGTR URET DUAL TPR TIP HYDPHI","BOTH IP/OP","$286.00 ","$211.64 ","$0.00 ","$286.00 ","$155.30 ","$0.00 ","$59.61 ","$0.00 ","$0.00 ","$50.08 ","$286.00 ","$0.00 ","$143.00 ","$226.51 ","$228.80 ","$0.00 ","$44.76 ","$0.00 ","$45.53 ","$0.00 "
"25-022-28-09","SUP","HCPCS C1713","","25-022-28-09  -  PLATE BONE 2MMX1MM 2 STRIP MESH BLUE TITANIUM MAXFACL 2MM","BOTH IP/OP","$608.65 ","$450.40 ","$0.00 ","$608.65 ","$273.89 ","$0.00 ","$126.86 ","$0.00 ","$0.00 ","$106.57 ","$608.65 ","$0.00 ","$304.33 ","$482.05 ","$486.92 ","$0.00 ","$95.25 ","$0.00 ","$96.90 ","$0.00 "
"25-040-25-09","SUP","HCPCS C1713","","25-040-25-09  -  MESH CRNL 85X54X.2MM SCRN PNL TI 1MM SCR","BOTH IP/OP","$1,191.80 ","$881.93 ","$0.00 ","$1,191.80 ","$536.31 ","$0.00 ","$248.40 ","$0.00 ","$0.00 ","$208.67 ","$1,191.80 ","$0.00 ","$595.90 ","$943.91 ","$953.44 ","$0.00 ","$186.52 ","$0.00 ","$189.73 ","$0.00 "
"25-043-01-09","SUP","HCPCS C1713","","25-043-01-09  -  MESH CRNL .3MM TI ORBT FLR 1.5MM SCR","BOTH IP/OP","$1,010.08 ","$747.46 ","$0.00 ","$1,010.08 ","$454.53 ","$0.00 ","$210.52 ","$0.00 ","$0.00 ","$176.86 ","$1,010.08 ","$0.00 ","$505.04 ","$799.98 ","$808.06 ","$0.00 ","$158.08 ","$0.00 ","$160.80 ","$0.00 "
"25-043-02-09","SUP","HCPCS C1713","","25-043-02-09  -  MESH CRNL .5MM AU TI ORBT FLR 1.5MM SCR","BOTH IP/OP","$1,010.08 ","$747.46 ","$0.00 ","$1,010.08 ","$454.53 ","$0.00 ","$210.52 ","$0.00 ","$0.00 ","$176.86 ","$1,010.08 ","$0.00 ","$505.04 ","$799.98 ","$808.06 ","$0.00 ","$158.08 ","$0.00 ","$160.80 ","$0.00 "
"25-044-02-09","SUP","HCPCS C1713","","25-044-02-09  -  PLATE BN 3D PSHP .4MM TI LT ORBT FLR","BOTH IP/OP","$2,758.28 ","$2,041.13 ","$0.00 ","$2,758.28 ","$1,241.22 ","$0.00 ","$574.89 ","$0.00 ","$0.00 ","$482.95 ","$2,758.28 ","$0.00 ","$1,379.14 ","$2,184.56 ","$2,206.62 ","$0.00 ","$431.67 ","$0.00 ","$439.12 ","$0.00 "
"25-045-40-09","SUP","HCPCS C1713","","25-045-40-09  -  PLATE BN NS LF LVL 1 CRNMXF ORBT FLR","BOTH IP/OP","$3,512.30 ","$2,599.10 ","$0.00 ","$3,512.30 ","$1,580.54 ","$0.00 ","$732.05 ","$0.00 ","$0.00 ","$614.98 ","$3,512.30 ","$0.00 ","$1,756.15 ","$2,781.74 ","$2,809.84 ","$0.00 ","$549.67 ","$0.00 ","$559.16 ","$0.00 "
"25-092-38-91","SUP","HCPCS C1713","","25-092-38-91  -  DRILL FREE MAXDRIVE MMF SCREW  2.0MM X 12MM  8MM THD LNGTH","BOTH IP/OP","$264.55 ","$195.77 ","$0.00 ","$264.55 ","$119.05 ","$0.00 ","$55.14 ","$0.00 ","$0.00 ","$46.32 ","$264.55 ","$0.00 ","$132.28 ","$209.52 ","$211.64 ","$0.00 ","$41.40 ","$0.00 ","$42.12 ","$0.00 "
"25-092-42-91","SUP","HCPCS C1713","","25-092-42-91  -  DRILL FREE MAXDRIVE MMF SCREW  2.0MM X 16MM  12MM THD LNGTH","BOTH IP/OP","$264.55 ","$195.77 ","$0.00 ","$264.55 ","$119.05 ","$0.00 ","$55.14 ","$0.00 ","$0.00 ","$46.32 ","$264.55 ","$0.00 ","$132.28 ","$209.52 ","$211.64 ","$0.00 ","$41.40 ","$0.00 ","$42.12 ","$0.00 "
"251.25S","SUP","HCPCS C1713","","251.25S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER TUBULAR 11MM","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"251.28S","SUP","HCPCS C1713","","251.28S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 285MMX1.2MM 1","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"251.30S","SUP","HCPCS C1713","","251.30S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"251.31S","SUP","HCPCS C1713","","251.31S  -  NAIL 11MM 315MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"251.33S","SUP","HCPCS C1713","","251.33S  -  NAIL 11MM 330MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"251.34S","SUP","HCPCS C1713","","251.34S  -  NAIL 11MM 345MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"251.36S","SUP","HCPCS C1713","","251.36S  -  NAIL 11MM 360MM TIB IM UNV SS STRL","BOTH IP/OP","$2,533.98 ","$1,875.15 ","$0.00 ","$2,533.98 ","$1,140.29 ","$0.00 ","$528.14 ","$0.00 ","$0.00 ","$443.68 ","$2,533.98 ","$0.00 ","$1,266.99 ","$2,006.91 ","$2,027.18 ","$0.00 ","$396.57 ","$0.00 ","$403.41 ","$0.00 "
"251.38S","SUP","HCPCS C1713","","251.38S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM","BOTH IP/OP","$2,131.25 ","$1,577.13 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$444.21 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"251.40S","SUP","HCPCS C1713","","251.40S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 400MMX1.2MM 1","BOTH IP/OP","$2,135.38 ","$1,580.18 ","$0.00 ","$2,135.38 ","$960.92 ","$0.00 ","$445.07 ","$0.00 ","$0.00 ","$373.89 ","$2,135.38 ","$0.00 ","$1,067.69 ","$1,691.22 ","$1,708.30 ","$0.00 ","$334.19 ","$0.00 ","$339.95 ","$0.00 "
"251.42S","SUP","HCPCS C1713","","251.42S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 420MMX1.2MM 1","BOTH IP/OP","$2,135.38 ","$1,580.18 ","$0.00 ","$2,135.38 ","$960.92 ","$0.00 ","$445.07 ","$0.00 ","$0.00 ","$373.89 ","$2,135.38 ","$0.00 ","$1,067.69 ","$1,691.22 ","$1,708.30 ","$0.00 ","$334.19 ","$0.00 ","$339.95 ","$0.00 "
"25100C+10.00","SUP","HCPCS V2632","","25100C+10.00  -  LENS IOL +10 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+10.50","SUP","HCPCS V2632","","25100C+10.50  -  LENS IOL +10.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+11.00","SUP","HCPCS V2632","","25100C+11.00  -  LENS IOL +11 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+11.50","SUP","HCPCS V2632","","25100C+11.50  -  LENS IOL +11.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+12.00","SUP","HCPCS V2632","","25100C+12.00  -  LENS IOL +12 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+12.50","SUP","HCPCS V2632","","25100C+12.50  -  LENS IOL +12.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+13.00","SUP","HCPCS V2632","","25100C+13.00  -  LENS IOL +13 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+13.50","SUP","HCPCS V2632","","25100C+13.50  -  LENS IOL +13.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+14.00","SUP","HCPCS V2632","","25100C+14.00  -  LENS IOL +14 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+14.50","SUP","HCPCS V2632","","25100C+14.50  -  LENS IOL +14.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+15.00","SUP","HCPCS V2632","","25100C+15.00  -  LENS IOL +15 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+15.50","SUP","HCPCS V2632","","25100C+15.50  -  LENS IOL +15.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+16.00","SUP","HCPCS V2632","","25100C+16.00  -  LENS IOL +16 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+16.50","SUP","HCPCS V2632","","25100C+16.50  -  LENS IOL +16.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+17.00","SUP","HCPCS V2632","","25100C+17.00  -  LENS IOL +17 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+17.50","SUP","HCPCS V2632","","25100C+17.50  -  LENS IOL +17.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+18.00","SUP","HCPCS V2632","","25100C+18.00  -  LENS IOL +18 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+18.50","SUP","HCPCS V2632","","25100C+18.50  -  LENS IOL +18.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+19.00","SUP","HCPCS V2632","","25100C+19.00  -  LENS IOL +19 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+19.50","SUP","HCPCS V2632","","25100C+19.50  -  LENS IOL +19.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+20.00","SUP","HCPCS V2632","","25100C+20.00  -  LENS IOL +20 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+20.50","SUP","HCPCS V2632","","25100C+20.50  -  LENS IOL +20.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+21.00","SUP","HCPCS V2632","","25100C+21.00  -  LENS IOL +21 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+21.50","SUP","HCPCS V2632","","25100C+21.50  -  LENS IOL +21.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+22.00","SUP","HCPCS V2632","","25100C+22.00  -  LENS IOL +22 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+22.50","SUP","HCPCS V2632","","25100C+22.50  -  LENS IOL +22.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+23.00","SUP","HCPCS V2632","","25100C+23.00  -  LENS IOL +23 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+23.50","SUP","HCPCS V2632","","25100C+23.50  -  LENS IOL +23.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+24.00","SUP","HCPCS V2632","","25100C+24.00  -  LENS IOL +24 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+24.50","SUP","HCPCS V2632","","25100C+24.50  -  LENS IOL +24.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+25.00","SUP","HCPCS V2632","","25100C+25.00  -  LENS IOL +25 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+25.50","SUP","HCPCS V2632","","25100C+25.50  -  LENS IOL +25.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+26.00","SUP","HCPCS V2632","","25100C+26.00  -  LENS IOL +26 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+26.50","SUP","HCPCS V2632","","25100C+26.50  -  LENS IOL +26.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+27.00","SUP","HCPCS V2632","","25100C+27.00  -  LENS IOL +27 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+27.50","SUP","HCPCS V2632","","25100C+27.50  -  LENS IOL +27.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+28.00","SUP","HCPCS V2632","","25100C+28.00  -  LENS IOL +28 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+28.50","SUP","HCPCS V2632","","25100C+28.50  -  LENS IOL +28.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+29.00","SUP","HCPCS V2632","","25100C+29.00  -  LENS IOL +29 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+29.50","SUP","HCPCS V2632","","25100C+29.50  -  LENS IOL +29.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+30.00","SUP","HCPCS V2632","","25100C+30.00  -  LENS IOL +30 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+6.00","SUP","HCPCS V2632","","25100C+6.00  -  LENS IOL +6 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+6.50","SUP","HCPCS V2632","","25100C+6.50  -  LENS IOL +6.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+7.00","SUP","HCPCS V2632","","25100C+7.00  -  LENS IOL +7 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+7.50","SUP","HCPCS V2632","","25100C+7.50  -  LENS IOL +7.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+8.50","SUP","HCPCS V2632","","25100C+8.50  -  LENS IOL +8.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+9.00","SUP","HCPCS V2632","","25100C+9.00  -  LENS IOL +9 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C+9.50","SUP","HCPCS V2632","","25100C+9.50  -  LENS IOL +9.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25100C-8.00","SUP","HCPCS V2632","","25100C-8.00  -  LENS IOL +8 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"25121-1","SUP","Custom 27203010","","25121-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25121-2","SUP","Custom 27803010","","25121-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25121-5","SUP","Custom 27203010","","25121-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-197-07-71","SUP","HCPCS C1713","","25-197-07-71  -  PLATE BN STRL LVL 1 HBRD CRNMXF","BOTH IP/OP","$828.00 ","$612.72 ","$0.00 ","$828.00 ","$372.60 ","$0.00 ","$172.58 ","$0.00 ","$0.00 ","$144.98 ","$828.00 ","$0.00 ","$414.00 ","$655.78 ","$662.40 ","$0.00 ","$129.58 ","$0.00 ","$131.82 ","$0.00 "
"25-198-06-71","SUP","HCPCS C1713","","25-198-06-71  -  SCREW BN STRL LVL 1 MAXDRIVE CRNMXF","BOTH IP/OP","$358.00 ","$264.92 ","$0.00 ","$358.00 ","$161.10 ","$0.00 ","$74.62 ","$0.00 ","$0.00 ","$62.68 ","$358.00 ","$0.00 ","$179.00 ","$283.54 ","$286.40 ","$0.00 ","$56.03 ","$0.00 ","$56.99 ","$0.00 "
"25-198-06-75","SUP","HCPCS C1713","","25-198-06-75  -  SCREW BN STRL LVL 1 MAXDRIVE CRNMXF","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"25221B","SUP","Custom 27203010","","SARSTEDT TUBES","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25222B","SUP","Custom 27203010","","CAP TUBE 2ML","BOTH IP/OP","$157.50 ","$116.55 ","$0.00 ","$157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.50 ","$0.00 ","$78.75 ","$124.74 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"252-952","SUP","Custom 27203010","","MASK INFANT BMV AMBU","BOTH IP/OP","$176.50 ","$130.61 ","$0.00 ","$176.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.50 ","$0.00 ","$88.25 ","$139.79 ","$141.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"253.27S","SUP","HCPCS C1713","","253.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 270MM STAINLESS STEEL","BOTH IP/OP","$2,135.38 ","$1,580.18 ","$0.00 ","$2,135.38 ","$960.92 ","$0.00 ","$445.07 ","$0.00 ","$0.00 ","$373.89 ","$2,135.38 ","$0.00 ","$1,067.69 ","$1,691.22 ","$1,708.30 ","$0.00 ","$334.19 ","$0.00 ","$339.95 ","$0.00 "
"25-302-70-91","SUP","HCPCS C1713","","25-302-70-91  -  PLATE BONE MICRO STR MEDIUM .6MM 2 HOLE TITANIUM FRONTAL","BOTH IP/OP","$113.18 ","$83.75 ","$0.00 ","$113.18 ","$50.93 ","$0.00 ","$23.59 ","$0.00 ","$0.00 ","$19.82 ","$113.18 ","$0.00 ","$56.59 ","$89.64 ","$90.54 ","$0.00 ","$17.71 ","$0.00 ","$18.02 ","$0.00 "
"25-304-00-91","SUP","HCPCS C1713","","25-304-00-91  -  PLATE BONE MICRO REGULAR STR .6MM 4 HOLE TITANIUM MAXFACL","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"25-304-55-91","SUP","HCPCS C1713","","25-304-55-91  -  PLATE BONE MICRO MEDIUM STR .6MM 4 HOLE TITANIUM MAXFACL 1.5","BOTH IP/OP","$176.13 ","$130.34 ","$0.00 ","$176.13 ","$79.26 ","$0.00 ","$36.71 ","$0.00 ","$0.00 ","$30.84 ","$176.13 ","$0.00 ","$88.06 ","$139.49 ","$140.90 ","$0.00 ","$27.56 ","$0.00 ","$28.04 ","$0.00 "
"25-306-00-91","SUP","HCPCS C1713","","25-306-00-91  -  PLATE BN MIC STRG .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM","BOTH IP/OP","$230.50 ","$170.57 ","$0.00 ","$230.50 ","$103.73 ","$0.00 ","$48.04 ","$0.00 ","$0.00 ","$40.36 ","$230.50 ","$0.00 ","$115.25 ","$182.56 ","$184.40 ","$0.00 ","$36.07 ","$0.00 ","$36.70 ","$0.00 "
"25-306-55-91","SUP","HCPCS C1713","","25-306-55-91  -  PLATE BONE MICRO STR MEDIUM .6MM 6 HOLE TITANIUM MIDFAC 1.5","BOTH IP/OP","$230.50 ","$170.57 ","$0.00 ","$230.50 ","$103.73 ","$0.00 ","$48.04 ","$0.00 ","$0.00 ","$40.36 ","$230.50 ","$0.00 ","$115.25 ","$182.56 ","$184.40 ","$0.00 ","$36.07 ","$0.00 ","$36.70 ","$0.00 "
"25-308-00-91","SUP","HCPCS C1713","","25-308-00-91  -  PLATE BONE MICRO STR REGULAR .6MM 8 HOLE TITANIUM RIGHT","BOTH IP/OP","$253.80 ","$187.81 ","$0.00 ","$253.80 ","$114.21 ","$0.00 ","$52.90 ","$0.00 ","$0.00 ","$44.44 ","$253.80 ","$0.00 ","$126.90 ","$201.01 ","$203.04 ","$0.00 ","$39.72 ","$0.00 ","$40.40 ","$0.00 "
"25-308-16-09","SUP","HCPCS C1713","","25-308-16-09  -  MIDFACE PLATE  MEDIUM  6 HOLE  DOUBLE Y  0.8MM THICK","BOTH IP/OP","$660.40 ","$488.70 ","$0.00 ","$660.40 ","$297.18 ","$0.00 ","$137.64 ","$0.00 ","$0.00 ","$115.63 ","$660.40 ","$0.00 ","$330.20 ","$523.04 ","$528.32 ","$0.00 ","$103.35 ","$0.00 ","$105.14 ","$0.00 "
"25-310-09-09","SUP","HCPCS C1713","","25-310-09-09  -  PLATE LARGE L-SHAPE W/ TAB 10 HOLE 5X4 1MM","BOTH IP/OP","$608.65 ","$450.40 ","$0.00 ","$608.65 ","$273.89 ","$0.00 ","$126.86 ","$0.00 ","$0.00 ","$106.57 ","$608.65 ","$0.00 ","$304.33 ","$482.05 ","$486.92 ","$0.00 ","$95.25 ","$0.00 ","$96.90 ","$0.00 "
"25-310-70-91","SUP","HCPCS C1713","","25-310-70-91  -  PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-311-70-91","SUP","HCPCS C1713","","25-311-70-91  -  PLATE BONE L MICRO MEDIUM .6MM TITANIUM RIGHT MIDFAC STERILE","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-311-85-91","SUP","HCPCS C1713","","25-311-85-91  -  PLATE BONE L MICRO LONG .6MM TITANIUM RIGHT MIDFAC STERILE","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-314-85-91","SUP","HCPCS C1713","","25-314-85-91  -  PLATE BN 100D LNG MIC L .6MM THREADLOCK TS 3X2 HL TI MXLFCL","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-315-06-91","SUP","HCPCS C1713","","25-315-06-91  -  PLATE BONE T MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-315-85-91","SUP","HCPCS C1713","","25-315-85-91  -  PLATE BONE 100D L MICRO .6MM TITANIUM RIGHT MIDFAC STERILE","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-316-00-91","SUP","HCPCS C1713","","25-316-00-91  -  PLATE BONE MICRO .6MM 16 HOLE TITANIUM MIDFAC STERILE 1.5MM","BOTH IP/OP","$414.88 ","$307.01 ","$0.00 ","$414.88 ","$186.69 ","$0.00 ","$86.47 ","$0.00 ","$0.00 ","$72.64 ","$414.88 ","$0.00 ","$207.44 ","$328.58 ","$331.90 ","$0.00 ","$64.93 ","$0.00 ","$66.05 ","$0.00 "
"25-320-70-91","SUP","HCPCS C1713","","25-320-70-91  -  PLATE BONE Y MICRO LONG .6MM TITANIUM MIDFAC STERILE 1.5MM","BOTH IP/OP","$389.73 ","$288.40 ","$0.00 ","$389.73 ","$175.38 ","$0.00 ","$81.23 ","$0.00 ","$0.00 ","$68.24 ","$389.73 ","$0.00 ","$194.86 ","$308.67 ","$311.78 ","$0.00 ","$60.99 ","$0.00 ","$62.04 ","$0.00 "
"25-322-55-91","SUP","HCPCS C1713","","25-322-55-91  -  PLATE BN MIC SHRT 2Y .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM","BOTH IP/OP","$453.23 ","$335.39 ","$0.00 ","$453.23 ","$203.95 ","$0.00 ","$94.46 ","$0.00 ","$0.00 ","$79.36 ","$453.23 ","$0.00 ","$226.61 ","$358.96 ","$362.58 ","$0.00 ","$70.93 ","$0.00 ","$72.15 ","$0.00 "
"25-322-70-91","SUP","HCPCS C1713","","25-322-70-91  -  PLATE BONE 2Y MICRO MEDIUM .6MM TITANIUM RIGHT FRONTAL MAXL","BOTH IP/OP","$440.03 ","$325.62 ","$0.00 ","$440.03 ","$198.01 ","$0.00 ","$91.71 ","$0.00 ","$0.00 ","$77.04 ","$440.03 ","$0.00 ","$220.01 ","$348.50 ","$352.02 ","$0.00 ","$68.86 ","$0.00 ","$70.05 ","$0.00 "
"25-325-10-91","SUP","HCPCS C1713","","25-325-10-91  -  PLATE BN MIC CRV .6MM THREADLOCK TS 10 HL TI MXLFCL 1.5MM","BOTH IP/OP","$427.33 ","$316.22 ","$0.00 ","$427.33 ","$192.30 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$74.82 ","$427.33 ","$0.00 ","$213.66 ","$338.45 ","$341.86 ","$0.00 ","$66.88 ","$0.00 ","$68.03 ","$0.00 "
"25-326-55-91","SUP","HCPCS C1713","","25-326-55-91  -  PLATE BONE X MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5","BOTH IP/OP","$427.33 ","$316.22 ","$0.00 ","$427.33 ","$192.30 ","$0.00 ","$89.07 ","$0.00 ","$0.00 ","$74.82 ","$427.33 ","$0.00 ","$213.66 ","$338.45 ","$341.86 ","$0.00 ","$66.88 ","$0.00 ","$68.03 ","$0.00 "
"25-329-05-09","SUP","HCPCS C1713","","25-329-05-09  -  PLATE BONE Y MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW","BOTH IP/OP","$414.38 ","$306.64 ","$0.00 ","$414.38 ","$186.47 ","$0.00 ","$86.37 ","$0.00 ","$0.00 ","$72.55 ","$414.38 ","$0.00 ","$207.19 ","$328.19 ","$331.50 ","$0.00 ","$64.85 ","$0.00 ","$65.97 ","$0.00 "
"25-330-05-09","SUP","HCPCS C1713","","25-330-05-09  -  PLATE BONE 100D L MICRO LEFT ANGLE .6MM 7 HOLE TITANIUM","BOTH IP/OP","$414.38 ","$306.64 ","$0.00 ","$414.38 ","$186.47 ","$0.00 ","$86.37 ","$0.00 ","$0.00 ","$72.55 ","$414.38 ","$0.00 ","$207.19 ","$328.19 ","$331.50 ","$0.00 ","$64.85 ","$0.00 ","$65.97 ","$0.00 "
"25-330-07-09","SUP","HCPCS C1713","","25-330-07-09  -  PLATE BONE T MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"25-330-24-09","SUP","HCPCS C1713","","25-330-24-09  -  PLATE BN MIC STRG .6MM THREADLOCK TS 24 HL TI MXLFCL 1.5MM","BOTH IP/OP","$582.75 ","$431.24 ","$0.00 ","$582.75 ","$262.24 ","$0.00 ","$121.46 ","$0.00 ","$0.00 ","$102.03 ","$582.75 ","$0.00 ","$291.38 ","$461.54 ","$466.20 ","$0.00 ","$91.20 ","$0.00 ","$92.77 ","$0.00 "
"25-331-05-09","SUP","HCPCS C1713","","25-331-05-09  -  PLATE BONE 100D L MICRO RIGHT ANG .6MM 7 HOLE TITANIUM","BOTH IP/OP","$414.38 ","$306.64 ","$0.00 ","$414.38 ","$186.47 ","$0.00 ","$86.37 ","$0.00 ","$0.00 ","$72.55 ","$414.38 ","$0.00 ","$207.19 ","$328.19 ","$331.50 ","$0.00 ","$64.85 ","$0.00 ","$65.97 ","$0.00 "
"25-331-85-91","SUP","HCPCS C1713","","25-331-85-91  -  PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW","BOTH IP/OP","$414.38 ","$306.64 ","$0.00 ","$414.38 ","$186.47 ","$0.00 ","$86.37 ","$0.00 ","$0.00 ","$72.55 ","$414.38 ","$0.00 ","$207.19 ","$328.19 ","$331.50 ","$0.00 ","$64.85 ","$0.00 ","$65.97 ","$0.00 "
"25-332-08-09","SUP","HCPCS C1713","","25-332-08-09  -  PLATE BONE MICRO .6MM 8 HOLE INSERT TITANIUM ORBTL FLOOR","BOTH IP/OP","$401.43 ","$297.06 ","$0.00 ","$401.43 ","$180.64 ","$0.00 ","$83.67 ","$0.00 ","$0.00 ","$70.29 ","$401.43 ","$0.00 ","$200.71 ","$317.93 ","$321.14 ","$0.00 ","$62.82 ","$0.00 ","$63.91 ","$0.00 "
"25-377-04","SUP","HCPCS C1713","","25-377-04  -  PLATE MED LEFT MAXFACL L BONE .6MM","BOTH IP/OP","$325.50 ","$240.87 ","$0.00 ","$325.50 ","$146.48 ","$0.00 ","$67.84 ","$0.00 ","$0.00 ","$56.99 ","$325.50 ","$0.00 ","$162.75 ","$257.80 ","$260.40 ","$0.00 ","$50.94 ","$0.00 ","$51.82 ","$0.00 "
"254.27S","SUP","HCPCS C1713","","254.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 270MM STAINLESS STEEL","BOTH IP/OP","$2,220.63 ","$1,643.27 ","$0.00 ","$2,220.63 ","$999.28 ","$0.00 ","$462.83 ","$0.00 ","$0.00 ","$388.81 ","$2,220.63 ","$0.00 ","$1,110.31 ","$1,758.74 ","$1,776.50 ","$0.00 ","$347.53 ","$0.00 ","$353.52 ","$0.00 "
"254.28S","SUP","HCPCS C1713","","254.28S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 285MM STAINLESS STEEL","BOTH IP/OP","$2,220.63 ","$1,643.27 ","$0.00 ","$2,220.63 ","$999.28 ","$0.00 ","$462.83 ","$0.00 ","$0.00 ","$388.81 ","$2,220.63 ","$0.00 ","$1,110.31 ","$1,758.74 ","$1,776.50 ","$0.00 ","$347.53 ","$0.00 ","$353.52 ","$0.00 "
"25-438-35-07","SUP","HCPCS C1713","","25-438-35-07  -  SCREW BYRD MIDFACE LARGE","BOTH IP/OP","$640.00 ","$473.60 ","$0.00 ","$640.00 ","$288.00 ","$0.00 ","$133.39 ","$0.00 ","$0.00 ","$112.06 ","$640.00 ","$0.00 ","$320.00 ","$506.88 ","$512.00 ","$0.00 ","$100.16 ","$0.00 ","$101.89 ","$0.00 "
"25-449-07-91","SUP","Custom 27203010","","25-449-07-91  -  DRILL TWIST 1.5MM 50MM 7MM STOP","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-449-16-91","SUP","Custom 27100030","","25-449-16-91  -  DRILL TWIST 1.5MM 50MM 20MM NOTCH STOP STAINLESS STEEL","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-452-00-91","SUP","Custom 27100030","","25-452-00-91  -  DRILL TWIST 1.1MM 50MM NOTCH STAINLESS STEEL","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-452-05-91","SUP","Custom 27100030","","25-452-05-91  -  DRILL TWST 5MM 1.1MM 50MM J NTCH STP DISP","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-452-07-91","SUP","Custom 27100030","","25-452-07-91  -  BIT DRILL 1.1MM 50MM 7MM J NOTCH STOP TWIST STAINLESS STEEL","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25452-525","SUP","Custom 27203010","","25452-525  -  LEAD CONNCTNG WIRE SNP","BOTH IP/OP","$10.94 ","$8.10 ","$0.00 ","$10.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.94 ","$0.00 ","$5.47 ","$8.66 ","$8.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-458-19-07","SUP","Custom 27100030","","25-458-19-07  -  DRILL TWIST J 1.9MM 50MM NOTCH DISPOSABLE 2.3MM FRAC SYSTEM","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-460-19-07","SUP","Custom 27100030","","25-460-19-07  -  DRILL TWIST 1.9MM 70MM STAINLESS STEEL","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25-469-11-07","SUP","Custom 27100030","","25-469-11-07  -  BIT DRILL TWIST 1.5MM 115MM J NOTCH 2MM SCREW","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"255-000-001","SUP","Custom 27203010","","255-000-001  -  GRSPR LAPSCOP ALGTR 250MM 2.3MM AL MINI STRL LATEX FREE","BOTH IP/OP","$534.86 ","$395.80 ","$0.00 ","$534.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$534.86 ","$0.00 ","$267.43 ","$423.61 ","$427.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2552-06-L","SUP","HCPCS L3935","","2552-06-L  -  TRIGGER FINGER SPLINTS LARGE","BOTH IP/OP","$0.42 ","$0.31 ","$0.00 ","$159.57 ","$0.19 ","$152.21 ","$159.57 ","$0.00 ","$0.00 ","$0.07 ","$0.42 ","$0.00 ","$0.21 ","$0.33 ","$0.33 ","$0.25 ","$151.93 ","$0.00 ","$155.06 ","$0.00 "
"2552-06-M","SUP","HCPCS L3935","","2552-06-M  -  TRIGGER FINGER SPLINTS ME","BOTH IP/OP","$0.42 ","$0.31 ","$0.00 ","$159.57 ","$0.19 ","$152.21 ","$159.57 ","$0.00 ","$0.00 ","$0.07 ","$0.42 ","$0.00 ","$0.21 ","$0.33 ","$0.33 ","$0.25 ","$151.93 ","$0.00 ","$155.06 ","$0.00 "
"2552-06-S","SUP","HCPCS L3935","","2552-06-S  -  TRIGGER FINGER SPLINTS SMALL","BOTH IP/OP","$0.42 ","$0.31 ","$0.00 ","$159.57 ","$0.19 ","$152.21 ","$159.57 ","$0.00 ","$0.00 ","$0.07 ","$0.42 ","$0.00 ","$0.21 ","$0.33 ","$0.33 ","$0.25 ","$151.93 ","$0.00 ","$155.06 ","$0.00 "
"25-550-04-91","SUP","HCPCS C1713","","25-550-04-91  -  PLATE BONE MINI REGULAR 1MM 4 HOLE TITANIUM MANDIB 2MM SCREW","BOTH IP/OP","$178.73 ","$132.26 ","$0.00 ","$178.73 ","$80.43 ","$0.00 ","$37.25 ","$0.00 ","$0.00 ","$31.29 ","$178.73 ","$0.00 ","$89.36 ","$141.55 ","$142.98 ","$0.00 ","$27.97 ","$0.00 ","$28.45 ","$0.00 "
"25-550-08-91","SUP","HCPCS C1713","","25-550-08-91  -  PLATE BONE MINI REGULAR 1MM 8 HOLE TITANIUM MANDIB 2MM SCREW","BOTH IP/OP","$220.13 ","$162.90 ","$0.00 ","$220.13 ","$99.06 ","$0.00 ","$45.88 ","$0.00 ","$0.00 ","$38.54 ","$220.13 ","$0.00 ","$110.06 ","$174.34 ","$176.10 ","$0.00 ","$34.45 ","$0.00 ","$35.04 ","$0.00 "
"25-551-04-91","SUP","HCPCS C1713","","25-551-04-91  -  PLATE BONE MINI MEDIUM STANDARD 1MM 4 HOLE TITANIUM MAXFACL","BOTH IP/OP","$173.53 ","$128.41 ","$0.00 ","$173.53 ","$78.09 ","$0.00 ","$36.17 ","$0.00 ","$0.00 ","$30.38 ","$173.53 ","$0.00 ","$86.76 ","$137.44 ","$138.82 ","$0.00 ","$27.16 ","$0.00 ","$27.63 ","$0.00 "
"25-552-04-91","SUP","HCPCS C1713","","25-552-04-91  -  PLATE BONE MINI LONG STANDARD 1MM 4 HOLE TITANIUM MANDIB 2MM","BOTH IP/OP","$176.13 ","$130.34 ","$0.00 ","$176.13 ","$79.26 ","$0.00 ","$36.71 ","$0.00 ","$0.00 ","$30.84 ","$176.13 ","$0.00 ","$88.06 ","$139.49 ","$140.90 ","$0.00 ","$27.56 ","$0.00 ","$28.04 ","$0.00 "
"25-552-06-91","SUP","HCPCS C1713","","25-552-06-91  -  PLATE BONE MINI LONG STANDARD 1MM 6 HOLE TITANIUM MAXFACL 2","BOTH IP/OP","$204.58 ","$151.39 ","$0.00 ","$204.58 ","$92.06 ","$0.00 ","$42.64 ","$0.00 ","$0.00 ","$35.82 ","$204.58 ","$0.00 ","$102.29 ","$162.03 ","$163.66 ","$0.00 ","$32.02 ","$0.00 ","$32.57 ","$0.00 "
"25-592-04-1","SUP","HCPCS C1713","","25-592-04-1  -  LOCKING PLATE  4 HOLE","BOTH IP/OP","$158.10 ","$116.99 ","$0.00 ","$158.10 ","$71.15 ","$0.00 ","$32.95 ","$0.00 ","$0.00 ","$27.68 ","$158.10 ","$0.00 ","$79.05 ","$125.22 ","$126.48 ","$0.00 ","$24.74 ","$0.00 ","$25.17 ","$0.00 "
"25-672-15-1","SUP","HCPCS C1713","","25-672-15-1  -  SCREW TI 15MM 2MM MAXFACL XDR BONE","BOTH IP/OP","$99.98 ","$73.99 ","$0.00 ","$99.98 ","$44.99 ","$0.00 ","$20.84 ","$0.00 ","$0.00 ","$17.50 ","$99.98 ","$0.00 ","$49.99 ","$79.18 ","$79.98 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"25-673-49-1","SUP","HCPCS C1713","","25-673-49-1  -  SCREW TI 9MM 2.3MM MAXFACL XDR ER BONE","BOTH IP/OP","$592.88 ","$438.73 ","$0.00 ","$592.88 ","$266.79 ","$0.00 ","$123.57 ","$0.00 ","$0.00 ","$103.81 ","$592.88 ","$0.00 ","$296.44 ","$469.56 ","$474.30 ","$0.00 ","$92.78 ","$0.00 ","$94.39 ","$0.00 "
"25-677-12","SUP","HCPCS C1713","","25-677-12  -  SCREW TI 12MM 2.7MM MAXFACL XDR ER BONE","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$107.10 ","$0.00 ","$49.61 ","$0.00 ","$0.00 ","$41.67 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$37.25 ","$0.00 ","$37.89 ","$0.00 "
"25-677-12-91","SUP","HCPCS C1713","","25-677-12-91  -  SCREW BONE 2.7MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-677-14","SUP","HCPCS C1713","","25-677-14  -  SCREW TI 14MM 2.7MM MAXFACL XDR ER BONE","BOTH IP/OP","$238.00 ","$176.12 ","$0.00 ","$238.00 ","$107.10 ","$0.00 ","$49.61 ","$0.00 ","$0.00 ","$41.67 ","$238.00 ","$0.00 ","$119.00 ","$188.50 ","$190.40 ","$0.00 ","$37.25 ","$0.00 ","$37.89 ","$0.00 "
"25-677-14-91","SUP","HCPCS C1713","","25-677-14-91  -  SCREW BONE 2.7MM 14MM NONLOCKING CROSS DRIVE THREADLOCK TS","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-677-16-91","SUP","HCPCS C1713","","25-677-16-91  -  SCREW BONE 2.7MM 16MM NONLOCKING CROSS DRIVE THREADLOCK TS","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-677-52-91","SUP","HCPCS C1713","","25-677-52-91  -  SCREW BONE 3.2MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$321.15 ","$237.65 ","$0.00 ","$321.15 ","$144.52 ","$0.00 ","$66.94 ","$0.00 ","$0.00 ","$56.23 ","$321.15 ","$0.00 ","$160.58 ","$254.35 ","$256.92 ","$0.00 ","$50.26 ","$0.00 ","$51.13 ","$0.00 "
"25-677-56-1","SUP","HCPCS C1713","","25-677-56-1  -  SCREW TI 16MM 3.2MM MAXFACL XDR ER BONE","BOTH IP/OP","$230.50 ","$170.57 ","$0.00 ","$230.50 ","$103.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.36 ","$230.50 ","$0.00 ","$115.25 ","$182.56 ","$184.40 ","$0.00 ","$36.07 ","$0.00 ","$36.70 ","$0.00 "
"25-750-04-09","SUP","HCPCS C1713","","25-750-04-09  -  PLATE BONE 3D 1MM 4 HOLE THREADLOCK TITANIUM MANDIB","BOTH IP/OP","$668.38 ","$494.60 ","$0.00 ","$668.38 ","$300.77 ","$0.00 ","$139.31 ","$0.00 ","$0.00 ","$117.03 ","$668.38 ","$0.00 ","$334.19 ","$529.36 ","$534.70 ","$0.00 ","$104.60 ","$0.00 ","$106.41 ","$0.00 "
"25-750-14-09","SUP","HCPCS C1713","","25-750-14-09  -  PLATE BONE 3D REGULAR 1MM 14 HOLE THREADLOCK TITANIUM MANDIB","BOTH IP/OP","$1,308.90 ","$968.59 ","$0.00 ","$1,308.90 ","$589.01 ","$0.00 ","$272.81 ","$0.00 ","$0.00 ","$229.18 ","$1,308.90 ","$0.00 ","$654.45 ","$1,036.65 ","$1,047.12 ","$0.00 ","$204.84 ","$0.00 ","$208.38 ","$0.00 "
"25-752-04-09","SUP","HCPCS C1713","","25-752-04-09  -  PLATE BN LNG MN 1MM THREADLOCK TS 4 HL LCK TI MNDB","BOTH IP/OP","$710.13 ","$525.50 ","$0.00 ","$710.13 ","$319.56 ","$0.00 ","$148.01 ","$0.00 ","$0.00 ","$124.34 ","$710.13 ","$0.00 ","$355.06 ","$562.42 ","$568.10 ","$0.00 ","$111.13 ","$0.00 ","$113.05 ","$0.00 "
"25-752-06-09","SUP","HCPCS C1713","","25-752-06-09  -  PLATE BONE MINI LONG 1MM 6 HOLE THREADLOCK GREEN TITANIUM","BOTH IP/OP","$779.75 ","$577.02 ","$0.00 ","$779.75 ","$350.89 ","$0.00 ","$162.52 ","$0.00 ","$0.00 ","$136.53 ","$779.75 ","$0.00 ","$389.88 ","$617.56 ","$623.80 ","$0.00 ","$122.03 ","$0.00 ","$124.14 ","$0.00 "
"25-774-07-91","SUP","HCPCS C1713","","25-774-07-91  -  SCREW BONE 2.7MM 7MM LOCKING CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"25-774-09-91","SUP","HCPCS C1713","","25-774-09-91  -  SCREW BONE 2.7MM 9MM LOCKING CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"25-774-11-91","SUP","HCPCS C1713","","25-774-11-91  -  SCREW BONE 2.7MM 11MM LOCKING CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"25-774-13-91","SUP","HCPCS C1713","","25-774-13-91  -  SCREW BONE 2.7MM 13MM LOCKING CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"25-774-15-91","SUP","HCPCS C1713","","25-774-15-91  -  SCREW BONE 2.7MM 15MM LOCKING CROSS DRIVE TITANIUM MANDIB","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"25-780-04-91","SUP","HCPCS C1713","","25-780-04-91  -  NEURO SCREW  ULTRA LOW PROFILE 1.5 X 4.0MM","BOTH IP/OP","$201.15 ","$148.85 ","$0.00 ","$201.15 ","$90.52 ","$0.00 ","$41.92 ","$0.00 ","$0.00 ","$35.22 ","$201.15 ","$0.00 ","$100.58 ","$159.31 ","$160.92 ","$0.00 ","$31.48 ","$0.00 ","$32.02 ","$0.00 "
"25-872-05-91","SUP","HCPCS C1713","","25-872-05-91  -  SCREW BN 2MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI","BOTH IP/OP","$124.33 ","$92.00 ","$0.00 ","$124.33 ","$55.95 ","$0.00 ","$25.91 ","$0.00 ","$0.00 ","$21.77 ","$124.33 ","$0.00 ","$62.16 ","$98.47 ","$99.46 ","$0.00 ","$19.46 ","$0.00 ","$19.79 ","$0.00 "
"25-872-07-91","SUP","HCPCS C1713","","25-872-07-91  -  SCREW BN 2MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI","BOTH IP/OP","$124.33 ","$92.00 ","$0.00 ","$124.33 ","$55.95 ","$0.00 ","$25.91 ","$0.00 ","$0.00 ","$21.77 ","$124.33 ","$0.00 ","$62.16 ","$98.47 ","$99.46 ","$0.00 ","$19.46 ","$0.00 ","$19.79 ","$0.00 "
"25-872-09-91","SUP","HCPCS C1713","","25-872-09-91  -  SCREW BN 2MM 9MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI","BOTH IP/OP","$124.33 ","$92.00 ","$0.00 ","$124.33 ","$55.95 ","$0.00 ","$25.91 ","$0.00 ","$0.00 ","$21.77 ","$124.33 ","$0.00 ","$62.16 ","$98.47 ","$99.46 ","$0.00 ","$19.46 ","$0.00 ","$19.79 ","$0.00 "
"25-872-11-91","SUP","HCPCS C1713","","25-872-11-91  -  SCREW BN 2MM 11MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI","BOTH IP/OP","$124.33 ","$92.00 ","$0.00 ","$124.33 ","$55.95 ","$0.00 ","$25.91 ","$0.00 ","$0.00 ","$21.77 ","$124.33 ","$0.00 ","$62.16 ","$98.47 ","$99.46 ","$0.00 ","$19.46 ","$0.00 ","$19.79 ","$0.00 "
"25-872-13-91","SUP","HCPCS C1713","","25-872-13-91  -  SCREW BN 2MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI","BOTH IP/OP","$124.33 ","$92.00 ","$0.00 ","$124.33 ","$55.95 ","$0.00 ","$25.91 ","$0.00 ","$0.00 ","$21.77 ","$124.33 ","$0.00 ","$62.16 ","$98.47 ","$99.46 ","$0.00 ","$19.46 ","$0.00 ","$19.79 ","$0.00 "
"25-873-05-91","SUP","HCPCS C1713","","25-873-05-91  -  SCREW BONE 2.3MM 5MM MAXDRIVE TITANIUM ORAL MAXFACL","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$160.58 ","$72.26 ","$0.00 ","$33.47 ","$0.00 ","$0.00 ","$28.12 ","$160.58 ","$0.00 ","$80.29 ","$127.18 ","$128.46 ","$0.00 ","$25.13 ","$0.00 ","$25.56 ","$0.00 "
"25-873-07-91","SUP","HCPCS C1713","","25-873-07-91  -  SCREW BONE 2.3MM 7MM MAXDRIVE TITANIUM ORAL MAXFACL","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$160.58 ","$72.26 ","$0.00 ","$33.47 ","$0.00 ","$0.00 ","$28.12 ","$160.58 ","$0.00 ","$80.29 ","$127.18 ","$128.46 ","$0.00 ","$25.13 ","$0.00 ","$25.56 ","$0.00 "
"25-873-09-91","SUP","HCPCS C1713","","25-873-09-91  -  SCREW BONE 2.3MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$160.58 ","$72.26 ","$0.00 ","$33.47 ","$0.00 ","$0.00 ","$28.12 ","$160.58 ","$0.00 ","$80.29 ","$127.18 ","$128.46 ","$0.00 ","$25.13 ","$0.00 ","$25.56 ","$0.00 "
"25-873-13-91","SUP","HCPCS C1713","","25-873-13-91  -  SCREW BONE 2.3MM 13MM MAXDRIVE TITANIUM ORAL MAXFACL","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$160.58 ","$72.26 ","$0.00 ","$33.47 ","$0.00 ","$0.00 ","$28.12 ","$160.58 ","$0.00 ","$80.29 ","$127.18 ","$128.46 ","$0.00 ","$25.13 ","$0.00 ","$25.56 ","$0.00 "
"25-873-45-91","SUP","HCPCS C1713","","25-873-45-91  -  SCREW BN 2.3MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$160.58 ","$72.26 ","$0.00 ","$33.47 ","$0.00 ","$0.00 ","$28.12 ","$160.58 ","$0.00 ","$80.29 ","$127.18 ","$128.46 ","$0.00 ","$25.13 ","$0.00 ","$25.56 ","$0.00 "
"25-873-47-91","SUP","HCPCS C1713","","25-873-47-91  -  SCREW BN 2.3MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER","BOTH IP/OP","$160.58 ","$118.83 ","$0.00 ","$160.58 ","$72.26 ","$0.00 ","$33.47 ","$0.00 ","$0.00 ","$28.12 ","$160.58 ","$0.00 ","$80.29 ","$127.18 ","$128.46 ","$0.00 ","$25.13 ","$0.00 ","$25.56 ","$0.00 "
"25-874-13-91","SUP","HCPCS C1713","","25-874-13-91  -  SCREW BN 2.5MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET","BOTH IP/OP","$163.18 ","$120.75 ","$0.00 ","$163.18 ","$73.43 ","$0.00 ","$34.01 ","$0.00 ","$0.00 ","$28.57 ","$163.18 ","$0.00 ","$81.59 ","$129.24 ","$130.54 ","$0.00 ","$25.54 ","$0.00 ","$25.98 ","$0.00 "
"25-875-09-91","SUP","HCPCS C1713","","25-875-09-91  -  SCREW BONE MICRO 1.5MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL","BOTH IP/OP","$124.33 ","$92.00 ","$0.00 ","$124.33 ","$55.95 ","$0.00 ","$25.91 ","$0.00 ","$0.00 ","$21.77 ","$124.33 ","$0.00 ","$62.16 ","$98.47 ","$99.46 ","$0.00 ","$19.46 ","$0.00 ","$19.79 ","$0.00 "
"25-876-05-91","SUP","HCPCS C1713","","25-876-05-91  -  SCREW BN MIC 1.8MM 5MM NS LVL 1 MAXDRIVE DRLFR ER TI-6AL-4V","BOTH IP/OP","$142.43 ","$105.40 ","$0.00 ","$142.43 ","$64.09 ","$0.00 ","$29.68 ","$0.00 ","$0.00 ","$24.94 ","$142.43 ","$0.00 ","$71.21 ","$112.80 ","$113.94 ","$0.00 ","$22.29 ","$0.00 ","$22.67 ","$0.00 "
"25-876-07-91","SUP","HCPCS C1713","","25-876-07-91  -  SCREW BONE MICRO 1.8MM 5MM EMERGENCY DRILL FREE MAXDRIVE","BOTH IP/OP","$142.43 ","$105.40 ","$0.00 ","$142.43 ","$64.09 ","$0.00 ","$29.68 ","$0.00 ","$0.00 ","$24.94 ","$142.43 ","$0.00 ","$71.21 ","$112.80 ","$113.94 ","$0.00 ","$22.29 ","$0.00 ","$22.67 ","$0.00 "
"25-878-04-91","SUP","HCPCS C1713","","25-878-04-91  -  SCREW BN MIC 1.5MM 4MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V","BOTH IP/OP","$142.43 ","$105.40 ","$0.00 ","$142.43 ","$64.09 ","$0.00 ","$29.68 ","$0.00 ","$0.00 ","$24.94 ","$142.43 ","$0.00 ","$71.21 ","$112.80 ","$113.94 ","$0.00 ","$22.29 ","$0.00 ","$22.67 ","$0.00 "
"25-878-05-91","SUP","HCPCS C1713","","25-878-05-91  -  SCREW BN MIC 1.5MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V","BOTH IP/OP","$142.43 ","$105.40 ","$0.00 ","$142.43 ","$64.09 ","$0.00 ","$29.68 ","$0.00 ","$0.00 ","$24.94 ","$142.43 ","$0.00 ","$71.21 ","$112.80 ","$113.94 ","$0.00 ","$22.29 ","$0.00 ","$22.67 ","$0.00 "
"25-878-07-91","SUP","HCPCS C1713","","25-878-07-91  -  SCREW BONE MICRO 1.5MM 7MM DRILL FREE MAXDRIVE TITANIUM ORAL","BOTH IP/OP","$142.43 ","$105.40 ","$0.00 ","$142.43 ","$64.09 ","$0.00 ","$29.68 ","$0.00 ","$0.00 ","$24.94 ","$142.43 ","$0.00 ","$71.21 ","$112.80 ","$113.94 ","$0.00 ","$22.29 ","$0.00 ","$22.67 ","$0.00 "
"25-879-05-91","SUP","HCPCS C1713","","25-879-05-91  -  SCREW BN MN 2MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF","BOTH IP/OP","$134.68 ","$99.66 ","$0.00 ","$134.68 ","$60.60 ","$0.00 ","$28.07 ","$0.00 ","$0.00 ","$23.58 ","$134.68 ","$0.00 ","$67.34 ","$106.67 ","$107.74 ","$0.00 ","$21.08 ","$0.00 ","$21.44 ","$0.00 "
"25-879-07-91","SUP","HCPCS C1713","","25-879-07-91  -  SCREW BN MN 2MM 7MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF","BOTH IP/OP","$134.68 ","$99.66 ","$0.00 ","$134.68 ","$60.60 ","$0.00 ","$28.07 ","$0.00 ","$0.00 ","$23.58 ","$134.68 ","$0.00 ","$67.34 ","$106.67 ","$107.74 ","$0.00 ","$21.08 ","$0.00 ","$21.44 ","$0.00 "
"25-882-07-91","SUP","HCPCS C1713","","25-882-07-91  -  SCREW BN 2MM 7MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-882-09-91","SUP","HCPCS C1713","","25-882-09-91  -  SCREW BN 2MM 9MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-882-11-91","SUP","HCPCS C1713","","25-882-11-91  -  SCREW BN 2MM 11MM NS LVL 1 MAXDRIVE LCK TI CRNMXF","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-882-13-91","SUP","HCPCS C1713","","25-882-13-91  -  SCREW BONE 2MM 13MM LOCKING MAXDRIVE TITANIUM ORAL MAXFACL","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-882-15-91","SUP","HCPCS C1713","","25-882-15-91  -  SCREW BN 2MM 15MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET","BOTH IP/OP","$270.15 ","$199.91 ","$0.00 ","$270.15 ","$121.57 ","$0.00 ","$56.31 ","$0.00 ","$0.00 ","$47.30 ","$270.15 ","$0.00 ","$135.08 ","$213.96 ","$216.12 ","$0.00 ","$42.28 ","$0.00 ","$43.01 ","$0.00 "
"25-883-11-91","SUP","HCPCS C1713","","25-883-11-91  -  SCREW BN 2.3MM 11MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE","BOTH IP/OP","$300.75 ","$222.56 ","$0.00 ","$300.75 ","$135.34 ","$0.00 ","$62.68 ","$0.00 ","$0.00 ","$52.66 ","$300.75 ","$0.00 ","$150.38 ","$238.19 ","$240.60 ","$0.00 ","$47.07 ","$0.00 ","$47.88 ","$0.00 "
"25AGFN-756","SUP","Custom 27803010","","25AGFN-756  -  VALVE AORTIC 85D 25MM 23MM 1 DIGIT GRADIENT MECHANICAL","BOTH IP/OP","$11,750.00 ","$8,695.00 ","$0.00 ","$11,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,750.00 ","$0.00 ","$5,875.00 ","$9,306.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25AJ-501","SUP","Custom 27803010","","25AJ-501  -  VALVE AOR 25MM MSTR MECH STD CUF ROT","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"25MJ-501","SUP","Custom 27803010","","25MJ-501  -  VALVE AORTIC 25MM MSTR HRT MECH","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"260-120","SUP","Custom 27203010","","260-120  -  DILAT SURG AMPTZ PTFE COAX STY SF WIRE INTROD 8-10FR","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"260-250-","SUP","Custom 27203010","","DILATOR SURG AMPTZ SET RNL STRL DISP","BOTH IP/OP","$566.60 ","$419.28 ","$0.00 ","$566.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$566.60 ","$0.00 ","$283.30 ","$448.75 ","$453.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26026-2","SUP","Custom 27803010","","26026-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,997.13 ","$2,957.88 ","$0.00 ","$3,997.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,997.13 ","$0.00 ","$1,998.56 ","$3,165.73 ","$3,197.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26026-5","SUP","Custom 27803010","","26026-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,134.88 ","$3,059.81 ","$0.00 ","$4,134.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,134.88 ","$0.00 ","$2,067.44 ","$3,274.82 ","$3,307.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2627-2-905","SUP","Custom 27803010","","2627-2-905  -  INSERT TIB STD 5MM KNEE CRUC RET HI","BOTH IP/OP","$3,536.00 ","$2,616.64 ","$0.00 ","$3,536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,536.00 ","$0.00 ","$1,768.00 ","$2,800.51 ","$2,828.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2627-2-915","SUP","Custom 27803010","","2627-2-915  -  INSERT TIB STD 15MM KNEE CRUC RET HI","BOTH IP/OP","$3,536.00 ","$2,616.64 ","$0.00 ","$3,536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,536.00 ","$0.00 ","$1,768.00 ","$2,800.51 ","$2,828.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2627-6-901","SUP","HCPCS C1713","","2627-6-901  -  PIN FIX VAK LCK ASMBLY ORTH SM","BOTH IP/OP","$342.88 ","$253.73 ","$0.00 ","$342.88 ","$154.29 ","$0.00 ","$71.46 ","$0.00 ","$0.00 ","$60.03 ","$342.88 ","$0.00 ","$171.44 ","$271.56 ","$274.30 ","$0.00 ","$53.66 ","$0.00 ","$54.59 ","$0.00 "
"2642-1-109","SUP","Custom 27803010","","2642-1-109  -  INSERT TIBIAL SMALL 9MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-111","SUP","Custom 27803010","","2642-1-111  -  INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-113","SUP","Custom 27803010","","2642-1-113  -  INSERT TIBIAL SMALL 13MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-116","SUP","Custom 27803010","","2642-1-116  -  INSERT TIBIAL SMALL 16MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-119","SUP","Custom 27803010","","2642-1-119  -  INSERT TIBIAL SMALL 19MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-122","SUP","Custom 27803010","","2642-1-122  -  INSERT TIBIAL SMALL 22MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-125","SUP","Custom 27803010","","2642-1-125  -  INSERT TIBIAL PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-128","SUP","Custom 27803010","","2642-1-128  -  INSERT TIBIAL SMALL 28MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-1-131","SUP","Custom 27803010","","2642-1-131  -  INSERT TIBIAL SMALL 31MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-111","SUP","Custom 27803010","","2642-3-111  -  INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-113","SUP","Custom 27803010","","2642-3-113  -  INSERT TIBIAL MEDIUM 13MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-116","SUP","Custom 27803010","","2642-3-116  -  INSERT TIBIAL MEDIUM 16MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-119","SUP","Custom 27803010","","2642-3-119  -  INSERT TIBIAL MEDIUM 19MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-122","SUP","Custom 27803010","","2642-3-122  -  INSERT TIBIAL MEDIUM 22MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-125","SUP","Custom 27803010","","2642-3-125  -  INSERT TIBIAL MEDIUM 25MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-128","SUP","Custom 27803010","","2642-3-128  -  INSERT TIBIAL MEDIUM 28MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-3-131","SUP","Custom 27803010","","2642-3-131  -  INSERT TIBIAL MEDIUM 31MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-109","SUP","Custom 27803010","","2642-5-109  -  INSERT TIBIAL LARGE 19MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-111","SUP","Custom 27803010","","2642-5-111  -  INSERT TIBIAL LARGE 11MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-113","SUP","Custom 27803010","","2642-5-113  -  INSERT TIBIAL LARGE 13MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-116","SUP","Custom 27803010","","2642-5-116  -  INSERT TIBIAL LARGE 16MM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-119","SUP","Custom 27803010","","2642-5-119  -  INSERT TIBIAL LARGE 19MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-122","SUP","Custom 27803010","","2642-5-122  -  INSERT TIBIAL LARGE 22MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-125","SUP","Custom 27803010","","2642-5-125  -  INSERT TIBIAL LARGE 25MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-128","SUP","Custom 27803010","","2642-5-128  -  INSERT TIBIAL LARGE 28MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-5-131","SUP","Custom 27803010","","2642-5-131  -  INSERT TIBIAL LARGE 31MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-109","SUP","Custom 27803010","","2642-6-109  -  INSERT TIBIAL XL 9MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-111","SUP","Custom 27803010","","2642-6-111  -  INSERT TIBIAL PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-113","SUP","Custom 27803010","","2642-6-113  -  INSERT TIBIAL PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-116","SUP","Custom 27803010","","2642-6-116  -  INSERT TIBIAL XL 16MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-119","SUP","Custom 27803010","","2642-6-119  -  INSERT TIBIAL XL 19MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-122","SUP","Custom 27803010","","2642-6-122  -  INSERT TIBIAL XL 22MM PRIM PCA KNEE","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-125","SUP","Custom 27803010","","2642-6-125  -  INSERT TIBIAL XL 25MM PRIM PCA KNEE","BOTH IP/OP","$2,065.00 ","$1,528.10 ","$0.00 ","$2,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,065.00 ","$0.00 ","$1,032.50 ","$1,635.48 ","$1,652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-128","SUP","Custom 27803010","","2642-6-128  -  INSERT TIBIAL XL 28MM PRIM PCA KNEE","BOTH IP/OP","$2,065.00 ","$1,528.10 ","$0.00 ","$2,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,065.00 ","$0.00 ","$1,032.50 ","$1,635.48 ","$1,652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2642-6-131","SUP","Custom 27803010","","2642-6-131  -  INSERT TIBIAL XL 31MM PRIM PCA KNEE","BOTH IP/OP","$2,065.00 ","$1,528.10 ","$0.00 ","$2,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,065.00 ","$0.00 ","$1,032.50 ","$1,635.48 ","$1,652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26AC60","SUP","Custom 27203010","","26AC60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26AC75","SUP","Custom 27203010","","26AC75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26AC90","SUP","Custom 27203010","","26AC90  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26BA50DX","SUP","Custom 27203010","","26BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26BA60","SUP","Custom 27203010","","26BA60  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$384.63 ","$284.63 ","$0.00 ","$384.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$384.63 ","$0.00 ","$192.31 ","$304.63 ","$307.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26BA70DX","SUP","Custom 27203010","","26BA70DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26BA75","SUP","Custom 27203010","","26BA75  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26BA90","SUP","Custom 27203010","","26BA90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$376.13 ","$278.34 ","$0.00 ","$376.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.13 ","$0.00 ","$188.06 ","$297.89 ","$300.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26CY75","SUP","Custom 27203010","","26CY75  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26CY90","SUP","Custom 27203010","","26CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26L2","SUP","Custom 27203010","","KIT MNLTX MONO LTX AGGL SERTST 50 TST","BOTH IP/OP","$355.10 ","$262.77 ","$0.00 ","$355.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.10 ","$0.00 ","$177.55 ","$281.24 ","$284.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26MH30","SUP","Custom 27203010","","26MH30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$346.38 ","$256.32 ","$0.00 ","$346.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$346.38 ","$0.00 ","$173.19 ","$274.33 ","$277.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"26TA30","SUP","Custom 27203010","","26TA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$380.38 ","$281.48 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.38 ","$0.00 ","$190.19 ","$301.26 ","$304.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27-0120","SUP","HCPCS C1713","","27-0120  -  SCREW BN 2.7MM 12MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"27-0140","SUP","HCPCS C1713","","27-0140  -  SCREW BN 2.7MM 14MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"27-0160","SUP","HCPCS C1713","","27-0160  -  SCREW BN 2.7MM 16MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"27-0180","SUP","HCPCS C1713","","27-0180  -  SCREW BN 2.7MM 18MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"27020 M","SUP","Custom 27803010","","27020 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,080.38 ","$2,279.48 ","$0.00 ","$3,080.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,080.38 ","$0.00 ","$1,540.19 ","$2,439.66 ","$2,464.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27-0200","SUP","HCPCS C1713","","27-0200  -  SCREW BN 2.7MM 20MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"270-2149","SUP","Custom 27203010","","VIAL VAR 2 SMPL PRC CAP ANALY","BOTH IP/OP","$78.75 ","$58.28 ","$0.00 ","$78.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.75 ","$0.00 ","$39.38 ","$62.37 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"270-2154","SUP","Custom 27203010","","REAGENT B THAL VAR 2 RCDR PK 500 TST ANALY","BOTH IP/OP","$4,392.50 ","$3,250.45 ","$0.00 ","$4,392.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,392.50 ","$0.00 ","$2,196.25 ","$3,478.86 ","$3,514.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27-0220","SUP","HCPCS C1713","","27-0220  -  SCREW BN 2.7MM 22MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"27-0240","SUP","HCPCS C1713","","27-0240  -  SCREW BN 2.7MM 24MM CNN XTRMT","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$200.25 ","$0.00 ","$92.75 ","$0.00 ","$0.00 ","$77.92 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$69.64 ","$0.00 ","$70.84 ","$0.00 "
"2703-3-626","SUP","Custom 27203010","","2703-3-626  -  WIRE FX .015IN 72IN VIT","BOTH IP/OP","$284.38 ","$210.44 ","$0.00 ","$284.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$284.38 ","$0.00 ","$142.19 ","$225.23 ","$227.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2704-1-024","SUP","Custom 27203010","","2704-1-024  -  WIRE FX .04IN 24MM VIT","BOTH IP/OP","$11.38 ","$8.42 ","$0.00 ","$11.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.38 ","$0.00 ","$5.69 ","$9.01 ","$9.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2704-3-018","SUP","Custom 27203010","","2704-3-018  -  WIRE FX .046IN 18IN DLMLS VIT 6 PER TUBE","BOTH IP/OP","$58.50 ","$43.29 ","$0.00 ","$58.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.50 ","$0.00 ","$29.25 ","$46.33 ","$46.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27050K/6","SUP","Custom 27203010","","27050K/6  -  ELTRD ESURG 27FR 1 PR PNT","BOTH IP/OP","$285.80 ","$211.49 ","$0.00 ","$285.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.80 ","$0.00 ","$142.90 ","$226.35 ","$228.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27050KG/6","SUP","Custom 27203010","","27050KG/6  -  ELTRD ESURG YLW 24-26FR URO RLLR CUT STRL DISP","BOTH IP/OP","$392.93 ","$290.77 ","$0.00 ","$392.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.93 ","$0.00 ","$196.46 ","$311.20 ","$314.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 A","SUP","Custom 27803010","","27065 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 B","SUP","Custom 27803010","","27065 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 C","SUP","Custom 27803010","","27065 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 D","SUP","Custom 27803010","","27065 D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 E","SUP","Custom 27803010","","27065 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 F","SUP","Custom 27803010","","27065 F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 G","SUP","Custom 27803010","","27065 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 H","SUP","Custom 27803010","","27065 H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 J","SUP","Custom 27803010","","27065 J  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$826.50 ","$611.61 ","$0.00 ","$826.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$826.50 ","$0.00 ","$413.25 ","$654.59 ","$661.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 K","SUP","Custom 27803010","","27065 K  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 L","SUP","Custom 27803010","","27065 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$665.00 ","$492.10 ","$0.00 ","$665.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$665.00 ","$0.00 ","$332.50 ","$526.68 ","$532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 M","SUP","Custom 27803010","","27065 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$826.50 ","$611.61 ","$0.00 ","$826.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$826.50 ","$0.00 ","$413.25 ","$654.59 ","$661.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 N","SUP","Custom 27803010","","27065 N  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$603.25 ","$446.41 ","$0.00 ","$603.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$603.25 ","$0.00 ","$301.63 ","$477.77 ","$482.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 R","SUP","Custom 27803010","","27065 R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$826.50 ","$611.61 ","$0.00 ","$826.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$826.50 ","$0.00 ","$413.25 ","$654.59 ","$661.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27065 T","SUP","Custom 27803010","","27065 T  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$826.50 ","$611.61 ","$0.00 ","$826.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$826.50 ","$0.00 ","$413.25 ","$654.59 ","$661.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27097-1","SUP","Custom 27803010","","27097-1  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,009.13 ","$2,226.76 ","$0.00 ","$3,009.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,009.13 ","$0.00 ","$1,504.56 ","$2,383.23 ","$2,407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27167 L","SUP","Custom 27803010","","27167 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27167 M","SUP","Custom 27803010","","27167 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27183-1","SUP","Custom 27803010","","27183-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$5,080.13 ","$3,759.30 ","$0.00 ","$5,080.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.13 ","$0.00 ","$2,540.06 ","$4,023.46 ","$4,064.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27183-2","SUP","Custom 27803010","","27183-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$5,080.13 ","$3,759.30 ","$0.00 ","$5,080.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.13 ","$0.00 ","$2,540.06 ","$4,023.46 ","$4,064.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27183-4","SUP","Custom 27803010","","27183-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$5,080.13 ","$3,759.30 ","$0.00 ","$5,080.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.13 ","$0.00 ","$2,540.06 ","$4,023.46 ","$4,064.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27183-5","SUP","Custom 27803010","","27183-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$5,080.13 ","$3,759.30 ","$0.00 ","$5,080.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.13 ","$0.00 ","$2,540.06 ","$4,023.46 ","$4,064.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27202-01","SUP","HCPCS C1765","","27202-01  -  BRR ADH PLLC ACD BIORESBL SHT SURGIWRAP 130X100X.02MM","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$0.00 ","$0.00 "
"27202-05","SUP","HCPCS C1765","","27202-05  -  BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$0.00 ","$0.00 "
"27203-5","SUP","Custom 27203010","","27203-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$5,472.00 ","$4,049.28 ","$0.00 ","$5,472.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,472.00 ","$0.00 ","$2,736.00 ","$4,333.82 ","$4,377.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27204-05","SUP","HCPCS C1765","","27204-05  -  BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP","BOTH IP/OP","$642.50 ","$475.45 ","$0.00 ","$642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$642.50 ","$0.00 ","$321.25 ","$508.86 ","$514.00 ","$0.00 ","$100.55 ","$0.00 ","$0.00 ","$0.00 "
"27219-1","SUP","Custom 27803010","","27219-1  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219-2","SUP","Custom 27803010","","27219-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27219-5","SUP","Custom 27803010","","27219-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27224-1","SUP","Custom 27203010","","27224-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27224-2","SUP","Custom 27203010","","27224-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27224-4","SUP","Custom 27203010","","27224-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27224-5","SUP","Custom 27203010","","27224-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27241 L","SUP","Custom 27803010","","27241 L  -  SHUNT NS 10MM 50MM PRTNL CATH NEO","BOTH IP/OP","$1,211.25 ","$896.33 ","$0.00 ","$1,211.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,211.25 ","$0.00 ","$605.63 ","$959.31 ","$969.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27242 L","SUP","Custom 27803010","","27242 L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,562.63 ","$1,896.35 ","$0.00 ","$2,562.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,562.63 ","$0.00 ","$1,281.31 ","$2,029.60 ","$2,050.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27242 LL","SUP","Custom 27803010","","27242 LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,562.63 ","$1,896.35 ","$0.00 ","$2,562.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,562.63 ","$0.00 ","$1,281.31 ","$2,029.60 ","$2,050.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"274.00S","SUP","HCPCS C1713","","274.00S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.01S","SUP","HCPCS C1713","","274.01S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 36CM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.02S","SUP","HCPCS C1713","","274.02S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.03S","SUP","HCPCS C1713","","274.03S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.04S","SUP","HCPCS C1713","","274.04S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.05S","SUP","HCPCS C1713","","274.05S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.06S","SUP","HCPCS C1713","","274.06S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.07S","SUP","HCPCS C1713","","274.07S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.08S","SUP","HCPCS C1713","","274.08S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.09S","SUP","HCPCS C1713","","274.09S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.10S","SUP","HCPCS C1713","","274.10S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.11S","SUP","HCPCS C1713","","274.11S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.12S","SUP","HCPCS C1713","","274.12S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.13S","SUP","HCPCS C1713","","274.13S  -  NAIL INTRAMEDULLARY 400MM 11MM 40CM STAINLEES STEEL FEMUR","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.14S","SUP","HCPCS C1713","","274.14S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.15S","SUP","HCPCS C1713","","274.15S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.16S","SUP","HCPCS C1713","","274.16S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.17S","SUP","HCPCS C1713","","274.17S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.18S","SUP","HCPCS C1713","","274.18S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.19S","SUP","HCPCS C1713","","274.19S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.20S","SUP","HCPCS C1713","","274.20S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 34CMX.12CM","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.21S","SUP","HCPCS C1713","","274.21S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.22S","SUP","HCPCS C1713","","274.22S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.23S","SUP","HCPCS C1713","","274.23S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 4000CM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.24S","SUP","HCPCS C1713","","274.24S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,101.73 ","$1,555.28 ","$0.00 ","$2,101.73 ","$945.78 ","$0.00 ","$438.05 ","$0.00 ","$0.00 ","$368.00 ","$2,101.73 ","$0.00 ","$1,050.86 ","$1,664.57 ","$1,681.38 ","$0.00 ","$331.39 ","$0.00 ","$334.59 ","$0.00 "
"274.25S","SUP","HCPCS C1713","","274.25S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 44CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.26S","SUP","HCPCS C1713","","274.26S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 46CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.27S","SUP","HCPCS C1713","","274.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.28S","SUP","HCPCS C1713","","274.28S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.29S","SUP","HCPCS C1713","","274.29S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.30S","SUP","HCPCS C1713","","274.30S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 34CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.31S","SUP","HCPCS C1713","","274.31S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.32S","SUP","HCPCS C1713","","274.32S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 38CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.33S","SUP","HCPCS C1713","","274.33S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 40CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.34S","SUP","HCPCS C1713","","274.34S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 42CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.35S","SUP","HCPCS C1713","","274.35S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 44CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.36S","SUP","HCPCS C1713","","274.36S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 46CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.37S","SUP","HCPCS C1713","","274.37S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 480CM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.38S","SUP","HCPCS C1713","","274.38S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.39S","SUP","HCPCS C1713","","274.39S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM FEMUR STERILE","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.40S","SUP","HCPCS C1713","","274.40S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 34CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.41S","SUP","HCPCS C1713","","274.41S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 36CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.42S","SUP","HCPCS C1713","","274.42S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 38CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.43S","SUP","HCPCS C1713","","274.43S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 40CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.44S","SUP","HCPCS C1713","","274.44S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 42CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.45S","SUP","HCPCS C1713","","274.45S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 44CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.46S","SUP","HCPCS C1713","","274.46S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 46CMX.12CM","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.47S","SUP","HCPCS C1713","","274.47S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.48S","SUP","HCPCS C1713","","274.48S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.49S","SUP","HCPCS C1713","","274.49S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$441.34 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"274.50S","SUP","HCPCS C1713","","274.50S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 34CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.51S","SUP","HCPCS C1713","","274.51S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 36CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.52S","SUP","HCPCS C1713","","274.52S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.53S","SUP","HCPCS C1713","","274.53S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 40CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.54S","SUP","HCPCS C1713","","274.54S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 42CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.55S","SUP","HCPCS C1713","","274.55S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 44CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.56S","SUP","HCPCS C1713","","274.56S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 46CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.57S","SUP","HCPCS C1713","","274.57S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.58S","SUP","HCPCS C1713","","274.58S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.59S","SUP","HCPCS C1713","","274.59S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.60S","SUP","HCPCS C1713","","274.60S  -  NAIL INTRAMEDULLARY UNIVERSAL CONE THREAD TUBE BARREL 16MM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.61S","SUP","HCPCS C1713","","274.61S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 36CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.62S","SUP","HCPCS C1713","","274.62S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 38CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.63S","SUP","HCPCS C1713","","274.63S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 40CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.64S","SUP","HCPCS C1713","","274.64S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 42CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.65S","SUP","HCPCS C1713","","274.65S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 44CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.66S","SUP","HCPCS C1713","","274.66S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 46CMX.12CM","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.67S","SUP","HCPCS C1713","","274.67S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.68S","SUP","HCPCS C1713","","274.68S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.69S","SUP","HCPCS C1713","","274.69S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.70S","SUP","HCPCS C1713","","274.70S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 34CM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.71S","SUP","HCPCS C1713","","274.71S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 360MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.72S","SUP","HCPCS C1713","","274.72S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.73S","SUP","HCPCS C1713","","274.73S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 400MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.74S","SUP","HCPCS C1713","","274.74S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.75S","SUP","HCPCS C1713","","274.75S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 440MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.76S","SUP","HCPCS C1713","","274.76S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 460MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.77S","SUP","HCPCS C1713","","274.77S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.78S","SUP","HCPCS C1713","","274.78S  -  NAIL INTRAMEDULLARY 300MM 17MM 30CM STAINLEES STEEL FEMUR","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.79S","SUP","HCPCS C1713","","274.79S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.80S","SUP","HCPCS C1713","","274.80S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 340MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.81S","SUP","HCPCS C1713","","274.81S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 360MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.82S","SUP","HCPCS C1713","","274.82S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.83S","SUP","HCPCS C1713","","274.83S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 400MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.84S","SUP","HCPCS C1713","","274.84S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.85S","SUP","HCPCS C1713","","274.85S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 18MM 440MM STAINLESS","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.86S","SUP","HCPCS C1713","","274.86S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 460MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.87S","SUP","HCPCS C1713","","274.87S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 480MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.88S","SUP","HCPCS C1713","","274.88S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 300MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.89S","SUP","HCPCS C1713","","274.89S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 320MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.92S","SUP","HCPCS C1713","","274.92S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 380MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.93S","SUP","HCPCS C1713","","274.93S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 400MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.94S","SUP","HCPCS C1713","","274.94S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 420MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.95S","SUP","HCPCS C1713","","274.95S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 440MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.96S","SUP","HCPCS C1713","","274.96S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 460MM STAINLESS STEEL","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"274.97S","SUP","HCPCS C1713","","274.97S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 480MM DCP LC-DCP","BOTH IP/OP","$2,277.00 ","$1,684.98 ","$0.00 ","$2,277.00 ","$1,024.65 ","$0.00 ","$474.58 ","$0.00 ","$0.00 ","$398.68 ","$2,277.00 ","$0.00 ","$1,138.50 ","$1,803.38 ","$1,821.60 ","$0.00 ","$356.35 ","$0.00 ","$362.50 ","$0.00 "
"27448 B","SUP","Custom 27803010","","27448 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$418.00 ","$309.32 ","$0.00 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$418.00 ","$0.00 ","$209.00 ","$331.06 ","$334.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27451-5","SUP","Custom 27803010","","27451-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,662.13 ","$3,449.98 ","$0.00 ","$4,662.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,662.13 ","$0.00 ","$2,331.06 ","$3,692.41 ","$3,729.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27490 L","SUP","Custom 27803010","","27490 L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,614.88 ","$1,935.01 ","$0.00 ","$2,614.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,614.88 ","$0.00 ","$1,307.44 ","$2,070.98 ","$2,091.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27496 L","SUP","Custom 27803010","","27496 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27496 M","SUP","Custom 27803010","","27496 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27499-1","SUP","Custom 27803010","","27499-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27499-5","SUP","Custom 27803010","","27499-5  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,754.75 ","$3,518.52 ","$0.00 ","$4,754.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,754.75 ","$0.00 ","$2,377.38 ","$3,765.76 ","$3,803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27505-1","SUP","Custom 27803010","","27505-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,944.88 ","$2,919.21 ","$0.00 ","$3,944.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,944.88 ","$0.00 ","$1,972.44 ","$3,124.34 ","$3,155.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27553 H","SUP","Custom 27803010","","27553 H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,415.25 ","$2,527.29 ","$0.00 ","$3,415.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,415.25 ","$0.00 ","$1,707.63 ","$2,704.88 ","$2,732.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27553 L","SUP","Custom 27803010","","27553 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,415.25 ","$2,527.29 ","$0.00 ","$3,415.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,415.25 ","$0.00 ","$1,707.63 ","$2,704.88 ","$2,732.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27553 M","SUP","Custom 27803010","","27553 M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,415.25 ","$2,527.29 ","$0.00 ","$3,415.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,415.25 ","$0.00 ","$1,707.63 ","$2,704.88 ","$2,732.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27554-1","SUP","Custom 27803010","","27554-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$5,170.38 ","$3,826.08 ","$0.00 ","$5,170.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,170.38 ","$0.00 ","$2,585.19 ","$4,094.94 ","$4,136.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27554-2","SUP","Custom 27803010","","27554-2  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$5,170.38 ","$3,826.08 ","$0.00 ","$5,170.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,170.38 ","$0.00 ","$2,585.19 ","$4,094.94 ","$4,136.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27554-5","SUP","Custom 27803010","","27554-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$5,170.38 ","$3,826.08 ","$0.00 ","$5,170.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,170.38 ","$0.00 ","$2,585.19 ","$4,094.94 ","$4,136.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"275-637-000","SUP","Custom 27203010","","275-637-000  -  BLADE SHVR 3.5MM FULL RAD ARTHRO STRL","BOTH IP/OP","$136.70 ","$101.16 ","$0.00 ","$136.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.70 ","$0.00 ","$68.35 ","$108.27 ","$109.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"275-641-000","SUP","Custom 27203010","","275-641-000  -  BURR SURG 2MM TMJ RND ARTHRO STRL","BOTH IP/OP","$144.78 ","$107.14 ","$0.00 ","$144.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.78 ","$0.00 ","$72.39 ","$114.67 ","$115.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27573A","SUP","Custom 27803010","","27573A  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589A","SUP","Custom 27803010","","27589A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$938.13 ","$694.22 ","$0.00 ","$938.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.13 ","$0.00 ","$469.06 ","$743.00 ","$750.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589B","SUP","Custom 27803010","","27589B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589C","SUP","Custom 27803010","","27589C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589D","SUP","Custom 27803010","","27589D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$938.13 ","$694.22 ","$0.00 ","$938.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.13 ","$0.00 ","$469.06 ","$743.00 ","$750.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589E","SUP","Custom 27803010","","27589E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$938.13 ","$694.22 ","$0.00 ","$938.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.13 ","$0.00 ","$469.06 ","$743.00 ","$750.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589F","SUP","Custom 27803010","","27589F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$938.13 ","$694.22 ","$0.00 ","$938.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.13 ","$0.00 ","$469.06 ","$743.00 ","$750.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27589H","SUP","Custom 27803010","","27589H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$938.13 ","$694.22 ","$0.00 ","$938.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.13 ","$0.00 ","$469.06 ","$743.00 ","$750.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27607 A","SUP","Custom 27803010","","27607 A  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27607 B","SUP","Custom 27803010","","27607 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27607 C","SUP","Custom 27803010","","27607 C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27607 D","SUP","Custom 27803010","","27607 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27643L","SUP","Custom 27803010","","27643L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27643M","SUP","Custom 27803010","","27643M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27644DL","SUP","Custom 27803010","","27644DL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,237.13 ","$2,395.48 ","$0.00 ","$3,237.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.13 ","$0.00 ","$1,618.56 ","$2,563.81 ","$2,589.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27644DM","SUP","Custom 27803010","","27644DM  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,237.13 ","$2,395.48 ","$0.00 ","$3,237.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.13 ","$0.00 ","$1,618.56 ","$2,563.81 ","$2,589.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27644HM","SUP","Custom 27803010","","27644HM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,237.13 ","$2,395.48 ","$0.00 ","$3,237.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.13 ","$0.00 ","$1,618.56 ","$2,563.81 ","$2,589.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27645L","SUP","Custom 27803010","","27645L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27645M","SUP","Custom 27803010","","27645M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27683H","SUP","Custom 27803010","","27683H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27683L","SUP","Custom 27803010","","27683L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27683M","SUP","Custom 27803010","","27683M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,051.88 ","$2,258.39 ","$0.00 ","$3,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,051.88 ","$0.00 ","$1,525.94 ","$2,417.09 ","$2,441.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27862M","SUP","Custom 27803010","","27862M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27-9020","SUP","HCPCS C1713","","27-9020  -  CNTRSNK DRILL 2.7MM XTRMT 2.7MM SCR","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"279-251-101","SUP","Custom 27203010","","279-251-101  -  ELTRD ESURG 2.5MM SERFAS ENRG PRB AARDVARK","BOTH IP/OP","$413.09 ","$305.69 ","$0.00 ","$413.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$413.09 ","$0.00 ","$206.54 ","$327.17 ","$330.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"279-351-100","SUP","Custom 27203010","","279-351-100  -  ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX","BOTH IP/OP","$433.02 ","$320.43 ","$0.00 ","$433.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$433.02 ","$0.00 ","$216.51 ","$342.95 ","$346.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"279-351-300","SUP","Custom 27203010","","279-351-300  -  PROBE SCT 90MM LF 3.5MM SERFAS ENRG","BOTH IP/OP","$433.02 ","$320.43 ","$0.00 ","$433.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$433.02 ","$0.00 ","$216.51 ","$342.95 ","$346.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2793G","SUP","Custom 27203010","","2793G  -  SUTURE NABSB 9-0 BV100-4 5IN BLU PRLN MFL","BOTH IP/OP","$57.38 ","$42.46 ","$0.00 ","$58.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.24 ","$0.00 ","$29.12 ","$46.13 ","$46.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"279-401-100","SUP","Custom 27203010","","279-401-100  -  PROBE SUCTION 90D 4MM ARTHRO SERFAS ENERGY MAXL STERILE","BOTH IP/OP","$393.03 ","$290.84 ","$0.00 ","$393.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$393.03 ","$0.00 ","$196.51 ","$311.28 ","$314.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"279-401-200","SUP","Custom 27203010","","279-401-200  -  SURGICAL ARTHROSCOPIC SERFAS 90-S 4.0MM CRUISE ENERG PROBE","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2794G","SUP","Custom 27203010","","2794G  -  SUTURE NONABSORBABLE 10-0 BV100-3 5CM MONOFILAMENT PROLENE","BOTH IP/OP","$63.69 ","$47.13 ","$0.00 ","$63.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.69 ","$0.00 ","$31.84 ","$50.44 ","$50.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27AGFN-756","SUP","Custom 27803010","","27AGFN-756  -  VALVE AORTIC 85D 27MM 24.9MM 1 DIGIT GRADIENT MECHANICAL","BOTH IP/OP","$11,750.00 ","$8,695.00 ","$0.00 ","$11,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,750.00 ","$0.00 ","$5,875.00 ","$9,306.00 ","$9,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27AJ-501","SUP","Custom 27803010","","27AJ-501  -  VALVE AOR 85D 3.67SQ CM 3.08SQ CM 27MM 22.5MM MSTR SER MECH","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27B006","SUP","Custom 27804086","","27B006  -  GRAFT BONE FEMORAL SHAFT","BOTH IP/OP","$2,847.50 ","$2,107.15 ","$0.00 ","$2,847.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,847.50 ","$0.00 ","$1,423.75 ","$2,255.22 ","$2,278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"27MJ-501","SUP","Custom 27803010","","27MJ-501  -  VALVE MTRL 85D 3.67SQ CM STD RING 27MM 22.5MM MSTR SER LFLT","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"280.651S","SUP","HCPCS C1713","","280.651S  -  SCREW BONE 14MM 50MM LAG DHS/DCS STAINLESS STEEL HIP CONDYLE","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.655S","SUP","HCPCS C1713","","280.655S  -  SCREW BONE 14MM 55MM LAG CANN DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.665S","SUP","HCPCS C1713","","280.665S  -  SCREW BONE 14MM 65MM LAG CANN DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.675S","SUP","HCPCS C1713","","280.675S  -  SCREW BONE 14MM 75MM LAG CANN DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.685S","SUP","HCPCS C1713","","280.685S  -  SCREW BONE 14MM 85MM LAG CANN DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.695S","SUP","HCPCS C1713","","280.695S  -  SCREW BONE 14MM 95MM LAG CANN DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.701S","SUP","HCPCS C1713","","280.701S  -  SCREW BONE 14MM 100MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.705S","SUP","HCPCS C1713","","280.705S  -  SCREW BONE 14MM 105MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.715S","SUP","HCPCS C1713","","280.715S  -  SCREW BONE 14MM 115MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.725S","SUP","HCPCS C1713","","280.725S  -  SCREW BONE 14MM 8.2MM 125MM 22MM 1 STEP LAG CANN DHS/DCS","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.735S","SUP","HCPCS C1713","","280.735S  -  SCREW BONE 14MM 135MM 22MM LAG CANN DHS/DCS STAINLESS STEEL","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"280.745S","SUP","HCPCS C1713","","280.745S  -  SCREW BONE 14MM 145MM LAG DHS/DCS STAINLESS STEEL HIP","BOTH IP/OP","$813.90 ","$602.29 ","$0.00 ","$790.20 ","$355.59 ","$0.00 ","$169.64 ","$0.00 ","$0.00 ","$138.36 ","$790.20 ","$0.00 ","$395.10 ","$625.84 ","$632.16 ","$0.00 ","$120.06 ","$0.00 ","$125.80 ","$0.00 "
"2808G","SUP","Custom 27203010","","2808G  -  SUTURE NABSB 8-0 BV130-5 5IN BLK ETH MTPS MFL","BOTH IP/OP","$40.53 ","$29.99 ","$0.00 ","$41.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.14 ","$0.00 ","$20.57 ","$32.58 ","$32.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"281.502S","SUP","HCPCS C1713","","281.502S  -  PLATE 130D SHRT BRL 46MM SS 2 HOLE DHS/DCP BONE 25MM CNDYLR","BOTH IP/OP","$1,162.60 ","$860.32 ","$0.00 ","$1,162.60 ","$523.17 ","$0.00 ","$242.31 ","$0.00 ","$0.00 ","$203.56 ","$1,162.60 ","$0.00 ","$581.30 ","$920.78 ","$930.08 ","$0.00 ","$181.95 ","$0.00 ","$185.09 ","$0.00 "
"2813G","SUP","Custom 27203010","","2813G  -  SUTURE NABSB 9-0 BV130-4 5IN BLK ETH MFL","BOTH IP/OP","$40.86 ","$30.24 ","$0.00 ","$41.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.47 ","$0.00 ","$20.74 ","$32.84 ","$33.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28164FGM","SUP","Custom 27203010","","28164FGM  -  FORCEPS BIPOLAR 45 D L20 CM L1 MM OD3 MM INSERT ANGLED DISTA","BOTH IP/OP","$2,490.00 ","$1,842.60 ","$0.00 ","$2,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,490.00 ","$0.00 ","$1,245.00 ","$1,972.08 ","$1,992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.234S","SUP","Custom 27803010","","282.234S  -  BLADE INTRAMEDULLARY NAIL HELIX 75MM LCP DHHS STERILE","BOTH IP/OP","$732.38 ","$541.96 ","$0.00 ","$711.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.03 ","$0.00 ","$355.51 ","$563.14 ","$568.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.235S","SUP","Custom 27803010","","282.235S  -  BLADE INTRAMEDULLARY NAIL 80MM LCP DHHS STAINLESS STEEL HIP","BOTH IP/OP","$732.38 ","$541.96 ","$0.00 ","$711.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.03 ","$0.00 ","$355.51 ","$563.14 ","$568.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.236S","SUP","Custom 27803010","","282.236S  -  BLADE SURG 85MM HELICAL STERILE","BOTH IP/OP","$732.38 ","$541.96 ","$0.00 ","$711.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.03 ","$0.00 ","$355.51 ","$563.14 ","$568.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.237S","SUP","Custom 27803010","","282.237S  -  BLADE FIX 90MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$732.38 ","$541.96 ","$0.00 ","$711.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.03 ","$0.00 ","$355.51 ","$563.14 ","$568.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.238S","SUP","Custom 27803010","","282.238S  -  BLADE FIX 95MM HELICAL LCP DHHS STAINLESS STEEL STERILE","BOTH IP/OP","$732.38 ","$541.96 ","$0.00 ","$711.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.03 ","$0.00 ","$355.51 ","$563.14 ","$568.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.239S","SUP","Custom 27803010","","282.239S  -  BLADE FIX 100MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC","BOTH IP/OP","$740.80 ","$548.19 ","$0.00 ","$719.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.23 ","$0.00 ","$359.61 ","$569.63 ","$575.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.240S","SUP","Custom 27803010","","282.240S  -  BLADE FIX 105MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$740.80 ","$548.19 ","$0.00 ","$719.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.23 ","$0.00 ","$359.61 ","$569.63 ","$575.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.241S","SUP","Custom 27803010","","282.241S  -  BLADE INTRAMEDULLARY NAIL HELIX 110MM LCP DHHS STERILE","BOTH IP/OP","$740.80 ","$548.19 ","$0.00 ","$719.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.23 ","$0.00 ","$359.61 ","$569.63 ","$575.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.242S","SUP","Custom 27803010","","282.242S  -  BLADE INTRAMEDULLARY NAIL HELIX 115MM LCP DHHS STERILE","BOTH IP/OP","$740.80 ","$548.19 ","$0.00 ","$719.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.23 ","$0.00 ","$359.61 ","$569.63 ","$575.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.243S","SUP","Custom 27803010","","282.243S  -  BLADE FIX 120MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$740.80 ","$548.19 ","$0.00 ","$719.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.23 ","$0.00 ","$359.61 ","$569.63 ","$575.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.244S","SUP","Custom 27803010","","282.244S  -  BLADE FIX 125MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$740.80 ","$548.19 ","$0.00 ","$719.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.23 ","$0.00 ","$359.61 ","$569.63 ","$575.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.245S","SUP","Custom 27803010","","282.245S  -  BLADE FIX 130MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$749.23 ","$554.43 ","$0.00 ","$727.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$727.40 ","$0.00 ","$363.70 ","$576.10 ","$581.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.246S","SUP","Custom 27803010","","282.246S  -  BLADE FIX 135MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$749.23 ","$554.43 ","$0.00 ","$727.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$727.40 ","$0.00 ","$363.70 ","$576.10 ","$581.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.247S","SUP","Custom 27803010","","282.247S  -  BLADE FIX 140MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$749.23 ","$554.43 ","$0.00 ","$727.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$727.40 ","$0.00 ","$363.70 ","$576.10 ","$581.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.248S","SUP","Custom 27803010","","282.248S  -  BLADE FIX 145MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$749.23 ","$554.43 ","$0.00 ","$727.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$727.40 ","$0.00 ","$363.70 ","$576.10 ","$581.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.249S","SUP","Custom 27803010","","282.249S  -  BLADE FIX 150MM LCP DHHS STAINLESS STEEL HIP STERILE","BOTH IP/OP","$749.23 ","$554.43 ","$0.00 ","$727.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$727.40 ","$0.00 ","$363.70 ","$576.10 ","$581.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"282.605S","SUP","HCPCS C1713","","282.605S  -  SIDEPLATE BONE 130D STANDARD BARREL 162MM 38MM 8 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.606S","SUP","HCPCS C1713","","282.606S  -  SIDEPLATE BONE 130D STANDARD BARREL 198MM 38MM 10 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.607S","SUP","HCPCS C1713","","282.607S  -  SIDEPLATE BONE 130D STANDARD BARREL 234MM 38MM 12 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.608S","SUP","HCPCS C1713","","282.608S  -  SIDEPLATE BONE 130D STANDARD BARREL 270MM 38MM 14 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.615S","SUP","HCPCS C1713","","282.615S  -  SIDEPLATE BONE 135D STANDARD BARREL 162MM 38MM 8 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.616S","SUP","HCPCS C1713","","282.616S  -  SIDEPLATE BONE 135D STANDARD BARREL 198MM 38MM 10 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.617S","SUP","HCPCS C1713","","282.617S  -  SIDEPLATE BONE 135D STANDARD BARREL 234MM 38MM 12 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.618S","SUP","HCPCS C1713","","282.618S  -  SIDEPLATE BONE 135D STANDARD BARREL 270MM 38MM 14 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.619S","SUP","HCPCS C1713","","282.619S  -  SIDEPLATE BONE 135D STANDARD BARREL 306MM 38MM 16 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.620S","SUP","HCPCS C1713","","282.620S  -  SIDEPLATE BONE 135D STANDARD BARREL 342MM 38MM 18 HOLE LCP","BOTH IP/OP","$1,915.95 ","$1,417.80 ","$0.00 ","$1,860.15 ","$837.07 ","$0.00 ","$399.33 ","$0.00 ","$0.00 ","$325.70 ","$1,860.15 ","$0.00 ","$930.08 ","$1,473.24 ","$1,488.12 ","$0.00 ","$282.64 ","$0.00 ","$296.14 ","$0.00 "
"282.621S","SUP","HCPCS C1713","","282.621S  -  SIDEPLATE BONE 135D STANDARD BARREL 378MM 38MM 20 HOLE LCP","BOTH IP/OP","$1,915.95 ","$1,417.80 ","$0.00 ","$1,860.15 ","$837.07 ","$0.00 ","$399.33 ","$0.00 ","$0.00 ","$325.70 ","$1,860.15 ","$0.00 ","$930.08 ","$1,473.24 ","$1,488.12 ","$0.00 ","$282.64 ","$0.00 ","$296.14 ","$0.00 "
"282.635S","SUP","HCPCS C1713","","282.635S  -  SIDEPLATE BONE 140D STANDARD BARREL 162MM 38MM 8 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.636S","SUP","HCPCS C1713","","282.636S  -  SIDEPLATE BONE 140D STANDARD BARREL 198MM 38MM 10 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.637S","SUP","HCPCS C1713","","282.637S  -  SIDEPLATE BONE 140D STANDARD BARREL 234MM 38MM 12 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.638S","SUP","HCPCS C1713","","282.638S  -  SIDEPLATE BONE 140D STANDARD BARREL 270MM 38MM 14 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.639S","SUP","HCPCS C1713","","282.639S  -  SIDEPLATE BONE 140D STANDARD BARREL 306MM 38MM 16 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.645S","SUP","HCPCS C1713","","282.645S  -  SIDEPLATE BONE 145D STANDARD BARREL 162MM 38MM 8 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.646S","SUP","HCPCS C1713","","282.646S  -  SIDEPLATE BONE 145D STANDARD BARREL 198MM 38MM 10 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.647S","SUP","HCPCS C1713","","282.647S  -  SIDEPLATE BONE 145D STANDARD BARREL 234MM 38MM 12 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.648S","SUP","HCPCS C1713","","282.648S  -  SIDEPLATE BONE 145D STANDARD BARREL 270MM 38MM 14 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.649S","SUP","HCPCS C1713","","282.649S  -  SIDEPLATE BONE 145D STANDARD BARREL 306MM 38MM 16 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.655S","SUP","HCPCS C1713","","282.655S  -  SIDEPLATE BONE 150D STANDARD BARREL 162MM 38MM 8 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.656S","SUP","HCPCS C1713","","282.656S  -  SIDEPLATE BONE 150D STANDARD BARREL 198MM 38MM 10 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.657S","SUP","HCPCS C1713","","282.657S  -  SIDEPLATE BONE 150D STANDARD BARREL 234MM 38MM 12 HOLE LCP","BOTH IP/OP","$1,453.48 ","$1,075.58 ","$0.00 ","$1,411.15 ","$635.02 ","$0.00 ","$302.94 ","$0.00 ","$0.00 ","$247.08 ","$1,411.15 ","$0.00 ","$705.58 ","$1,117.63 ","$1,128.92 ","$0.00 ","$214.41 ","$0.00 ","$224.66 ","$0.00 "
"282.658S","SUP","HCPCS C1713","","282.658S  -  SIDEPLATE BONE 150D STANDARD BARREL 270MM 38MM 14 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.659S","SUP","HCPCS C1713","","282.659S  -  SIDEPLATE BONE 150D STANDARD BARREL 306MM 38MM 16 HOLE LCP","BOTH IP/OP","$1,862.55 ","$1,378.29 ","$0.00 ","$1,808.30 ","$813.74 ","$0.00 ","$388.20 ","$0.00 ","$0.00 ","$316.62 ","$1,808.30 ","$0.00 ","$904.15 ","$1,432.17 ","$1,446.64 ","$0.00 ","$274.76 ","$0.00 ","$287.88 ","$0.00 "
"282.660S","SUP","HCPCS C1713","","282.660S  -  SIDEPLATE BONE 150D STANDARD BARREL 342MM 38MM 18 HOLE LCP","BOTH IP/OP","$1,915.95 ","$1,417.80 ","$0.00 ","$1,860.15 ","$837.07 ","$0.00 ","$399.33 ","$0.00 ","$0.00 ","$325.70 ","$1,860.15 ","$0.00 ","$930.08 ","$1,473.24 ","$1,488.12 ","$0.00 ","$282.64 ","$0.00 ","$296.14 ","$0.00 "
"282.661S","SUP","HCPCS C1713","","282.661S  -  SIDEPLATE BONE 150D STANDARD BARREL 378MM 38MM 20 HOLE LCP","BOTH IP/OP","$1,915.95 ","$1,417.80 ","$0.00 ","$1,860.15 ","$837.07 ","$0.00 ","$399.33 ","$0.00 ","$0.00 ","$325.70 ","$1,860.15 ","$0.00 ","$930.08 ","$1,473.24 ","$1,488.12 ","$0.00 ","$282.64 ","$0.00 ","$296.14 ","$0.00 "
"282.671S","SUP","HCPCS C1713","","282.671S  -  SIDEPLATE BONE 130D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.673S","SUP","HCPCS C1713","","282.673S  -  SIDEPLATE BONE 130D SHORT BARREL 5 HOLE LCP DHHS STAINLESS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.674S","SUP","HCPCS C1713","","282.674S  -  SIDEPLATE BONE 130D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.677S","SUP","HCPCS C1713","","282.677S  -  SIDEPLATE BONE 135D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.679S","SUP","HCPCS C1713","","282.679S  -  SIDEPLATE BONE 135D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.680S","SUP","HCPCS C1713","","282.680S  -  SIDEPLATE BONE 135D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.681S","SUP","HCPCS C1713","","282.681S  -  SIDEPLATE BONE 140D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.682S","SUP","HCPCS C1713","","282.682S  -  SIDEPLATE BONE 140D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.684S","SUP","HCPCS C1713","","282.684S  -  SIDEPLATE BONE 140D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.685S","SUP","HCPCS C1713","","282.685S  -  SIDEPLATE BONE 140D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.686S","SUP","HCPCS C1713","","282.686S  -  SIDEPLATE BONE 145D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.687S","SUP","HCPCS C1713","","282.687S  -  SIDEPLATE BONE 145D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.689S","SUP","HCPCS C1713","","282.689S  -  SIDEPLATE BONE 145D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.690S","SUP","HCPCS C1713","","282.690S  -  SIDEPLATE BONE 145D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.692S","SUP","HCPCS C1713","","282.692S  -  SIDEPLATE BONE 150D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.694S","SUP","HCPCS C1713","","282.694S  -  SIDEPLATE BONE 150D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"282.695S","SUP","HCPCS C1713","","282.695S  -  SIDEPLATE BONE 150D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS","BOTH IP/OP","$1,179.38 ","$872.74 ","$0.00 ","$1,145.03 ","$515.26 ","$0.00 ","$245.81 ","$0.00 ","$0.00 ","$200.48 ","$1,145.03 ","$0.00 ","$572.51 ","$906.86 ","$916.02 ","$0.00 ","$173.98 ","$0.00 ","$182.29 ","$0.00 "
"28-300","SUP","Custom 27203010","","28-300  -  GUIDEPIN THREAD-TIPPED 2.8MM X 300MM","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2836-47","SUP","Custom 27203010","","REAGENT MCBL ANSR SHIG BYD2 GRP C 1-7 LYPH 3ML","BOTH IP/OP","$262.83 ","$194.49 ","$0.00 ","$262.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.83 ","$0.00 ","$131.41 ","$208.16 ","$210.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2837-47","SUP","Custom 27203010","","REAGENT MCBL ANSR SHIG BYD2 GRP D LYPH DFC 3ML","BOTH IP/OP","$279.20 ","$206.61 ","$0.00 ","$279.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$279.20 ","$0.00 ","$139.60 ","$221.13 ","$223.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2850G","SUP","Custom 27203010","","2850G  -  SUTURE NONABSORBABLE 10-0 BV75-4 5IN MONOFILAMENT ETHILON","BOTH IP/OP","$69.48 ","$51.42 ","$0.00 ","$70.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.52 ","$0.00 ","$35.26 ","$55.85 ","$56.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2867-05-230","SUP","HCPCS C1769","","2867-05-230  -  GUIDEWIRE ORTH 1.37MM VPR 2 SHRP","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$312.23 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"2887B","SUP","Custom 27203010","","PROBE ORAL LNG CORD THRMTR BLUE TRB TMP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2894G","SUP","Custom 27203010","","2894G  -  SUTURE NONABSORBABLE 9-0 V100-3 5IN MONOFILAMENT ETHILON","BOTH IP/OP","$55.97 ","$41.42 ","$0.00 ","$56.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.81 ","$0.00 ","$28.40 ","$44.99 ","$45.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"28-M322090222290U","SUP","HCPCS C2625","","28-M322090222290U  -  GRAFT EVAS 22MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M322150222290U","SUP","HCPCS C2625","","28-M322150222290U  -  GRAFT EVAS 22MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M322190222290U","SUP","HCPCS C2625","","28-M322190222290U  -  GRAFT EVAS 22MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M322250222390U","SUP","HCPCS C2625","","28-M322250222390U  -  GRAFT EVAS 22MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M324090242290U","SUP","HCPCS C2625","","28-M324090242290U  -  GRAFT EVAS 24MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M324150242290U","SUP","HCPCS C2625","","28-M324150242290U  -  GRAFT EVAS 24MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M324190242290U","SUP","HCPCS C2625","","28-M324190242290U  -  GRAFT EVAS 24MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M324250222390U","SUP","HCPCS C2625","","28-M324250222390U  -  GRAFT EVAS 24MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M326095262290U","SUP","HCPCS C2625","","28-M326095262290U  -  GRAFT EVAS 26MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M326155262290U","SUP","HCPCS C2625","","28-M326155262290U  -  GRAFT EVAS 26MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M326195262290U","SUP","HCPCS C2625","","28-M326195262290U  -  GRAFT EVAS 26MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M326250262390U","SUP","HCPCS C2625","","28-M326250262390U  -  GRAFT EVAS 26MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M328095282290U","SUP","HCPCS C2625","","28-M328095282290U  -  GRAFT EVAS 28MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M328155242290U","SUP","HCPCS C2625","","28-M328155242290U  -  GRAFT EVAS 28/24X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M328155282290U","SUP","HCPCS C2625","","28-M328155282290U  -  GRAFT EVAS 28MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M328195242290U","SUP","HCPCS C2625","","28-M328195242290U  -  GRAFT EVAS 28/24X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M328195282290U","SUP","HCPCS C2625","","28-M328195282290U  -  GRAFT EVAS 28MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M328250242390U","SUP","HCPCS C2625","","28-M328250242390U  -  GRAFT EVAS 28/24X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M328250282390U","SUP","HCPCS C2625","","28-M328250282390U  -  GRAFT EVAS 28MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M330095302290U","SUP","HCPCS C2625","","28-M330095302290U  -  GRAFT EVAS 30MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M330155262290U","SUP","HCPCS C2625","","28-M330155262290U  -  GRAFT EVAS 30/26X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M330155302290U","SUP","HCPCS C2625","","28-M330155302290U  -  GRAFT EVAS 30MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M330200262390U","SUP","HCPCS C2625","","28-M330200262390U  -  GRAFT EVAS 30/26X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M330200302390U","SUP","HCPCS C2625","","28-M330200302390U  -  GRAFT EVAS 30MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M330250262390U","SUP","HCPCS C2625","","28-M330250262390U  -  GRAFT EVAS 30/26X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M330250302390U","SUP","HCPCS C2625","","28-M330250302390U  -  GRAFT EVAS 30MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M332095322290U","SUP","HCPCS C2625","","28-M332095322290U  -  GRAFT EVAS 32MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M332155282290U","SUP","HCPCS C2625","","28-M332155282290U  -  GRAFT EVAS 32/28X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M332155322290U","SUP","HCPCS C2625","","28-M332155322290U  -  GRAFT EVAS 32MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M332200282390U","SUP","HCPCS C2625","","28-M332200282390U  -  GRAFT EVAS 32/28X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M332200322390U","SUP","HCPCS C2625","","28-M332200322390U  -  GRAFT EVAS 32MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M332250282490U","SUP","HCPCS C2625","","28-M332250282490U  -  GRAFT EVAS 32/28X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M332250322490U","SUP","HCPCS C2625","","28-M332250322490U  -  GRAFT EVAS 32MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M334100342390U","SUP","HCPCS C2625","","28-M334100342390U  -  GRAFT EVAS 34MMX100MM RESR MAIN","BOTH IP/OP","$42,375.00 ","$31,357.50 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$8,832.01 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M334145302390U","SUP","HCPCS C2625","","28-M334145302390U  -  GRAFT EVAS 34/30X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M334145342390U","SUP","HCPCS C2625","","28-M334145342390U  -  GRAFT EVAS 34MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M334200302490U","SUP","HCPCS C2625","","28-M334200302490U  -  GRAFT EVAS 34/30X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M334200342490U","SUP","HCPCS C2625","","28-M334200342490U  -  GRAFT EVAS 34MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M334250302490U","SUP","HCPCS C2625","","28-M334250302490U  -  GRAFT EVAS 34/30X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M334250342490U","SUP","HCPCS C2625","","28-M334250342490U  -  GRAFT EVAS 34MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M336100362390U","SUP","HCPCS C2625","","28-M336100362390U  -  GRAFT EVAS 36MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M336145322490U","SUP","HCPCS C2625","","28-M336145322490U  -  GRAFT EVAS 36/32X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M336145362490U","SUP","HCPCS C2625","","28-M336145362490U  -  GRAFT EVAS 36MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M336190322490U","SUP","HCPCS C2625","","28-M336190322490U  -  GRAFT EVAS 36/32X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M336190362490U","SUP","HCPCS C2625","","28-M336190362490U  -  GRAFT EVAS 36MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M336250322490U","SUP","HCPCS C2625","","28-M336250322490U  -  GRAFT EVAS 36/32X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M336250362490U","SUP","HCPCS C2625","","28-M336250362490U  -  GRAFT EVAS 36MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M338100382490U","SUP","HCPCS C2625","","28-M338100382490U  -  GRAFT EVAS 38MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M338145342490U","SUP","HCPCS C2625","","28-M338145342490U  -  GRAFT EVAS 38/34X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M338145382490U","SUP","HCPCS C2625","","28-M338145382490U  -  GRAFT EVAS 38MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M338190342590U","SUP","HCPCS C2625","","28-M338190342590U  -  GRAFT EVAS 38/34X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M338190382590U","SUP","HCPCS C2625","","28-M338190382590U  -  GRAFT EVAS 38MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M338250342590U","SUP","HCPCS C2625","","28-M338250342590U  -  GRAFT EVAS 38/34X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M338250382590U","SUP","HCPCS C2625","","28-M338250382590U  -  GRAFT EVAS 38MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M340105402490U","SUP","HCPCS C2625","","28-M340105402490U  -  GRAFT EVAS 40MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M340145362590U","SUP","HCPCS C2625","","28-M340145362590U  -  GRAFT EVAS 40/36X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M340145402590U","SUP","HCPCS C2625","","28-M340145402590U  -  GRAFT EVAS 40MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M340195362590U","SUP","HCPCS C2625","","28-M340195362590U  -  GRAFT EVAS 40/36X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M340195402590U","SUP","HCPCS C2625","","28-M340195402590U  -  GRAFT EVAS 40MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M340250362590U","SUP","HCPCS C2625","","28-M340250362590U  -  GRAFT EVAS 40/36X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M340250402590U","SUP","HCPCS C2625","","28-M340250402590U  -  GRAFT EVAS 40MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M342105422590U","SUP","HCPCS C2625","","28-M342105422590U  -  GRAFT EVAS 42MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M342150382590U","SUP","HCPCS C2625","","28-M342150382590U  -  GRAFT EVAS 42/38X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M342150422590U","SUP","HCPCS C2625","","28-M342150422590U  -  GRAFT EVAS 42MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M342195382590U","SUP","HCPCS C2625","","28-M342195382590U  -  GRAFT EVAS 42/38X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M342195422590U","SUP","HCPCS C2625","","28-M342195422590U  -  GRAFT EVAS 42MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M342250382590U","SUP","HCPCS C2625","","28-M342250382590U  -  GRAFT EVAS 42/38X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M342250422590U","SUP","HCPCS C2625","","28-M342250422590U  -  GRAFT EVAS 42MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M344105442590U","SUP","HCPCS C2625","","28-M344105442590U  -  GRAFT EVAS 44MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M344155402590U","SUP","HCPCS C2625","","28-M344155402590U  -  GRAFT EVAS 44/40X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M344155442590U","SUP","HCPCS C2625","","28-M344155442590U  -  GRAFT EVAS 44MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M344200402590U","SUP","HCPCS C2625","","28-M344200402590U  -  GRAFT EVAS 44/40X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M344200442590U","SUP","HCPCS C2625","","28-M344200442590U  -  GRAFT EVAS 44MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M344250402690U","SUP","HCPCS C2625","","28-M344250402690U  -  GRAFT EVAS 44/40X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M344250442690U","SUP","HCPCS C2625","","28-M344250442690U  -  GRAFT EVAS 44MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M346105462690U","SUP","HCPCS C2625","","28-M346105462690U  -  GRAFT EVAS 46MMX100MM RESR MAIN","BOTH IP/OP","$25,000.00 ","$18,500.00 ","$0.00 ","$25,000.00 ","$11,250.00 ","$0.00 ","$5,210.63 ","$0.00 ","$0.00 ","$4,377.30 ","$25,000.00 ","$0.00 ","$12,500.00 ","$19,800.00 ","$20,000.00 ","$0.00 ","$3,912.50 ","$0.00 ","$3,980.00 ","$0.00 "
"28-M346155422690U","SUP","HCPCS C2625","","28-M346155422690U  -  GRAFT EVAS 46/42X150 TAPERED","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M346155462690U","SUP","HCPCS C2625","","28-M346155462690U  -  GRAFT EVAS 46MMX150MM RESR MAIN","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$13,500.00 ","$0.00 ","$6,252.75 ","$0.00 ","$0.00 ","$5,252.76 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$4,695.00 ","$0.00 ","$4,776.00 ","$0.00 "
"28-M346200422690U","SUP","HCPCS C2625","","28-M346200422690U  -  GRAFT EVAS 46/42X200 TAPERED","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M346200462690U","SUP","HCPCS C2625","","28-M346200462690U  -  GRAFT EVAS 46MMX200MM RESR MAIN","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$15,750.00 ","$0.00 ","$7,294.88 ","$0.00 ","$0.00 ","$6,128.22 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$5,477.50 ","$0.00 ","$5,572.00 ","$0.00 "
"28-M346250422690U","SUP","HCPCS C2625","","28-M346250422690U  -  GRAFT EVAS 46/42X250 TAPERED","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"28-M346250462690U","SUP","HCPCS C2625","","28-M346250462690U  -  GRAFT EVAS 46MMX250MM RESR MAIN","BOTH IP/OP","$40,000.00 ","$29,600.00 ","$0.00 ","$40,000.00 ","$18,000.00 ","$0.00 ","$8,337.00 ","$0.00 ","$0.00 ","$7,003.68 ","$40,000.00 ","$0.00 ","$20,000.00 ","$31,680.00 ","$32,000.00 ","$0.00 ","$6,260.00 ","$0.00 ","$6,368.00 ","$0.00 "
"290.20.280","SUP","Custom 27203010","","290.20.280  -  WIRE FX STD 2MM 280MM NS KRSH SS","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.75 ","$0.00 ","$24.38 ","$38.61 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.230.98","SUP","Custom 27203010","","291.230.98  -  WIRE CERCLAGE .5MM 175MM PRECUT STAINLESS STEEL MANDIB","BOTH IP/OP","$31.50 ","$23.31 ","$0.00 ","$31.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.50 ","$0.00 ","$15.75 ","$24.95 ","$25.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.240.98","SUP","Custom 27203010","","291.240.98  -  WIRE FIX 175MM .6MM MANDIB SS CRLGE PCUT NONSTRL","BOTH IP/OP","$27.00 ","$19.98 ","$0.00 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.00 ","$0.00 ","$13.50 ","$21.38 ","$21.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.911.01S","SUP","Custom 27803010","","291.911.01S  -  CABLE ORTH SS 1MM 750MM STRNL W/O NDL CRIMPING FRL PRLL END","BOTH IP/OP","$223.75 ","$165.58 ","$0.00 ","$223.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.75 ","$0.00 ","$111.88 ","$177.21 ","$179.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.916.01S","SUP","Custom 27803010","","291.916.01S  -  CABLE ORTH SS 1MM 750MM STRNL NDL CRIMPING FRL PRLL END FIT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"291.916.03S","SUP","Custom 27803010","","291.916.03S  -  CABLE ORTH SS 1MM 750MM STRNL NDL CRIMPING FRL PRLL END FIT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29-15044","SUP","HCPCS C1713","","29-15044  -  DISK IMPL 4MM SLFTAP PRELD NONSTRL 1.5MM SCR","BOTH IP/OP","$18,936.55 ","$14,013.05 ","$0.00 ","$18,936.55 ","$8,521.45 ","$0.00 ","$3,946.85 ","$0.00 ","$0.00 ","$3,315.64 ","$18,936.55 ","$0.00 ","$9,468.28 ","$14,997.75 ","$15,149.24 ","$0.00 ","$2,963.57 ","$0.00 ","$3,014.70 ","$0.00 "
"293.48L","SUP","Custom 27203010","","293.48L  -  PIN FIX 4.5MM 275MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"293.48X","SUP","Custom 27203010","","293.48X  -  PIN FIX 4.5MM 300MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT","BOTH IP/OP","$125.88 ","$93.15 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.20 ","$0.00 ","$61.10 ","$96.78 ","$97.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"294.30SHA","SUP","HCPCS C1713","","294.30SHA  -  SCREW XTRNFX 4MM 3MM 80MM STRL 20MM SCHNZ SPD PNT SS HA SEF","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.43SHA","SUP","HCPCS C1713","","294.43SHA  -  SCREW XTRNFX 4MM 60MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.44SHA","SUP","HCPCS C1713","","294.44SHA  -  SCREW XTRNFX 4MM 80MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.45SHA","SUP","HCPCS C1713","","294.45SHA  -  SCREW XTRNFX 4MM 100MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.46SHA","SUP","HCPCS C1713","","294.46SHA  -  SCREW XTRNFX 4MM 120MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.52SHA","SUP","HCPCS C1713","","294.52SHA  -  SCREW XTRNFX XLNG 5MM 100MM STRL 50MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.53SHA","SUP","HCPCS C1713","","294.53SHA  -  SCREW XTRNFX XLNG 5MM 125MM STRL 50MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.54SHA","SUP","HCPCS C1713","","294.54SHA  -  SCREW XTRNFX XLNG 5MM 150MM STRL 50MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.55SHA","SUP","HCPCS C1713","","294.55SHA  -  PIN HALF 5MM 170MM TROCAR BLUNT SCHANZ STAINLESS STEEL","BOTH IP/OP","$226.13 ","$167.34 ","$0.00 ","$219.55 ","$98.80 ","$0.00 ","$47.13 ","$0.00 ","$0.00 ","$38.44 ","$219.55 ","$0.00 ","$109.78 ","$173.88 ","$175.64 ","$0.00 ","$33.36 ","$0.00 ","$34.95 ","$0.00 "
"294.56SHA","SUP","HCPCS C1713","","294.56SHA  -  SCREW XTRNFX XLNG 5MM 200MM STRL 50MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$226.13 ","$167.34 ","$0.00 ","$219.55 ","$98.80 ","$0.00 ","$47.13 ","$0.00 ","$0.00 ","$38.44 ","$219.55 ","$0.00 ","$109.78 ","$173.88 ","$175.64 ","$0.00 ","$33.36 ","$0.00 ","$34.95 ","$0.00 "
"294.57SHA","SUP","HCPCS C1713","","294.57SHA  -  SCREW XTRNFX XLNG 5MM 250MM STRL 50MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$226.13 ","$167.34 ","$0.00 ","$219.55 ","$98.80 ","$0.00 ","$47.13 ","$0.00 ","$0.00 ","$38.44 ","$219.55 ","$0.00 ","$109.78 ","$173.88 ","$175.64 ","$0.00 ","$33.36 ","$0.00 ","$34.95 ","$0.00 "
"294.67SHA","SUP","HCPCS C1713","","294.67SHA  -  SCREW XTRNFX 6MM 160MM STRL 50MM SCHNZ SPD PNT SS HA LG","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.68SHA","SUP","HCPCS C1713","","294.68SHA  -  SCREW XTRNFX 6MM 190MM STRL 50MM SCHNZ SPD PNT SS HA LG","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.73SHA","SUP","HCPCS C1713","","294.73SHA  -  SCREW XTRNFX ST 4.5MM 125MM STRL 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.74SHA","SUP","HCPCS C1713","","294.74SHA  -  SCREW XTRNFX ST 4.5MM 150MM STRL 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$210.53 ","$155.79 ","$0.00 ","$204.40 ","$91.98 ","$0.00 ","$43.88 ","$0.00 ","$0.00 ","$35.79 ","$204.40 ","$0.00 ","$102.20 ","$161.88 ","$163.52 ","$0.00 ","$31.06 ","$0.00 ","$32.54 ","$0.00 "
"294.75SHA","SUP","HCPCS C1713","","294.75SHA  -  SCREW XTRNFX ST 4.5MM 175MM STRL 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$218.33 ","$161.56 ","$0.00 ","$211.98 ","$95.39 ","$0.00 ","$45.50 ","$0.00 ","$0.00 ","$37.12 ","$211.98 ","$0.00 ","$105.99 ","$167.89 ","$169.58 ","$0.00 ","$32.21 ","$0.00 ","$33.75 ","$0.00 "
"294.76SHA","SUP","HCPCS C1713","","294.76SHA  -  SCREW XTRNFX ST 4.5MM 200MM STRL 18MM SCHNZ BLNT TROC PNT SS","BOTH IP/OP","$218.33 ","$161.56 ","$0.00 ","$211.98 ","$95.39 ","$0.00 ","$45.50 ","$0.00 ","$0.00 ","$37.12 ","$211.98 ","$0.00 ","$105.99 ","$167.89 ","$169.58 ","$0.00 ","$32.21 ","$0.00 ","$33.75 ","$0.00 "
"294.771SHA","SUP","HCPCS C1713","","294.771SHA  -  SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ STAINLESS STEEL DISTAL","BOTH IP/OP","$308.58 ","$228.35 ","$0.00 ","$299.58 ","$134.81 ","$0.00 ","$64.31 ","$0.00 ","$0.00 ","$52.45 ","$299.58 ","$0.00 ","$149.79 ","$237.27 ","$239.66 ","$0.00 ","$45.52 ","$0.00 ","$47.69 ","$0.00 "
"294.775SHA","SUP","HCPCS C1713","","294.775SHA  -  SCREW XTRNFX 4MM 80MM STRL 20MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$308.58 ","$228.35 ","$0.00 ","$299.58 ","$134.81 ","$0.00 ","$64.31 ","$0.00 ","$0.00 ","$52.45 ","$299.58 ","$0.00 ","$149.79 ","$237.27 ","$239.66 ","$0.00 ","$45.52 ","$0.00 ","$47.69 ","$0.00 "
"294.776SHA","SUP","HCPCS C1713","","294.776SHA  -  SCREW XTRNFX 4MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$308.58 ","$228.35 ","$0.00 ","$299.58 ","$134.81 ","$0.00 ","$64.31 ","$0.00 ","$0.00 ","$52.45 ","$299.58 ","$0.00 ","$149.79 ","$237.27 ","$239.66 ","$0.00 ","$45.52 ","$0.00 ","$47.69 ","$0.00 "
"294.777SHA","SUP","HCPCS C1713","","294.777SHA  -  SCREW XTRNFX 4MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$308.58 ","$228.35 ","$0.00 ","$299.58 ","$134.81 ","$0.00 ","$64.31 ","$0.00 ","$0.00 ","$52.45 ","$299.58 ","$0.00 ","$149.79 ","$237.27 ","$239.66 ","$0.00 ","$45.52 ","$0.00 ","$47.69 ","$0.00 "
"294.778SHA","SUP","HCPCS C1713","","294.778SHA  -  SCREW XTRNFX 4MM 150MM STRL 40MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$308.58 ","$228.35 ","$0.00 ","$299.58 ","$134.81 ","$0.00 ","$64.31 ","$0.00 ","$0.00 ","$52.45 ","$299.58 ","$0.00 ","$149.79 ","$237.27 ","$239.66 ","$0.00 ","$45.52 ","$0.00 ","$47.69 ","$0.00 "
"294.779SHA","SUP","HCPCS C1713","","294.779SHA  -  SCREW BONE 4MM 175MM SLFDRILL SCHANZ STAINLESS STEEL HA","BOTH IP/OP","$308.58 ","$228.35 ","$0.00 ","$299.58 ","$134.81 ","$0.00 ","$64.31 ","$0.00 ","$0.00 ","$52.45 ","$299.58 ","$0.00 ","$149.79 ","$237.27 ","$239.66 ","$0.00 ","$45.52 ","$0.00 ","$47.69 ","$0.00 "
"294.782SHA","SUP","HCPCS C1713","","294.782SHA  -  SCREW XTRNFX 5MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$148.93 ","$0.00 ","$71.05 ","$0.00 ","$0.00 ","$57.95 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$50.28 ","$0.00 ","$52.69 ","$0.00 "
"294.783SHA","SUP","HCPCS C1713","","294.783SHA  -  SCREW XTRNFX 5MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$148.93 ","$0.00 ","$71.05 ","$0.00 ","$0.00 ","$57.95 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$50.28 ","$0.00 ","$52.69 ","$0.00 "
"294.784SHA","SUP","HCPCS C1713","","294.784SHA  -  SCREW BONE 5MM 150MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$148.93 ","$0.00 ","$71.05 ","$0.00 ","$0.00 ","$57.95 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$50.28 ","$0.00 ","$52.69 ","$0.00 "
"294.785SHA","SUP","HCPCS C1713","","294.785SHA  -  SCREW BONE 5MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$148.93 ","$0.00 ","$71.05 ","$0.00 ","$0.00 ","$57.95 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$50.28 ","$0.00 ","$52.69 ","$0.00 "
"294.786SHA","SUP","HCPCS C1713","","294.786SHA  -  SCREW BONE 5MM 200MM 80MM SLFDRILL SCHANZ STAINLESS STEEL HA","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$148.93 ","$0.00 ","$71.05 ","$0.00 ","$0.00 ","$57.95 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$50.28 ","$0.00 ","$52.69 ","$0.00 "
"294.788SHA","SUP","HCPCS C1713","","294.788SHA  -  SCREW XTRNFX 5MM 250MM STRL 80MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$340.88 ","$252.25 ","$0.00 ","$330.95 ","$148.93 ","$0.00 ","$71.05 ","$0.00 ","$0.00 ","$57.95 ","$330.95 ","$0.00 ","$165.48 ","$262.11 ","$264.76 ","$0.00 ","$50.28 ","$0.00 ","$52.69 ","$0.00 "
"294.796SHA","SUP","HCPCS C1713","","294.796SHA  -  SCREW XTRNFX 6MM 200MM STRL 80MM SCHNZ SLF DRL SS HA HIP","BOTH IP/OP","$360.93 ","$267.09 ","$0.00 ","$350.40 ","$157.68 ","$0.00 ","$75.23 ","$0.00 ","$0.00 ","$61.35 ","$350.40 ","$0.00 ","$175.20 ","$277.52 ","$280.32 ","$0.00 ","$53.24 ","$0.00 ","$55.78 ","$0.00 "
"2940511S","SUP","HCPCS C1713","","2940511S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940512S","SUP","HCPCS C1713","","2940512S  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940513S","SUP","HCPCS C1713","","2940513S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940514S","SUP","HCPCS C1713","","2940514S  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940515S","SUP","HCPCS C1713","","2940515S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940516S","SUP","HCPCS C1713","","2940516S  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940517S","SUP","HCPCS C1713","","2940517S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940521M","SUP","HCPCS C1713","","2940521M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940522M","SUP","HCPCS C1713","","2940522M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940523M","SUP","HCPCS C1713","","2940523M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940524M","SUP","HCPCS C1713","","2940524M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940525M","SUP","HCPCS C1713","","2940525M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940526M","SUP","HCPCS C1713","","2940526M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940527M","SUP","HCPCS C1713","","2940527M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940528M","SUP","HCPCS C1713","","2940528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940531L","SUP","HCPCS C1713","","2940531L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940532L","SUP","HCPCS C1713","","2940532L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940533L","SUP","HCPCS C1713","","2940533L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940534L","SUP","HCPCS C1713","","2940534L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940535L","SUP","HCPCS C1713","","2940535L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940536L","SUP","HCPCS C1713","","2940536L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940537L","SUP","HCPCS C1713","","2940537L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"2940538L","SUP","HCPCS C1713","","2940538L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"298.801.01S","SUP","Custom 27803010","","298.801.01S  -  CABLE ORTHOPEDIC 1.7MM 750MM CRIMP CERCLAGE LCP STAINLESS","BOTH IP/OP","$919.33 ","$680.30 ","$0.00 ","$892.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.55 ","$0.00 ","$446.28 ","$706.90 ","$714.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"298.803S","SUP","Custom 27203010","","298.803S  -  PIN POSITIONING 4.5MM CERCLAGE THREADED LCP STAINLESS STEEL","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29AJ-501","SUP","Custom 27803010","","29AJ-501  -  VALVE AOR 85D 29MM 24.2MM MSTR SER MECH STD CUF LFLT OPN","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"29MJ-501","SUP","Custom 27803010","","29MJ-501  -  VALVE MTRL 85D 4.41SQ CM STD RING 29MM 24.2MM MSTR SER LFLT","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0061","SUP","Custom 25803010","","SOLUTION IV 5% DEX 150ML VFLX LF","BOTH IP/OP","$2.23 ","$1.65 ","$0.00 ","$2.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.23 ","$0.00 ","$1.11 ","$1.77 ","$1.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0062Q","SUP","Custom 25803010","","SOLUTION IV 5% DEX 250ML VFLX LF","BOTH IP/OP","$2.13 ","$1.58 ","$0.00 ","$2.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.13 ","$0.00 ","$1.06 ","$1.69 ","$1.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0063Q","SUP","Custom 25803010","","SOLUTION IV 5% DEX 500ML VFLX LF","BOTH IP/OP","$2.15 ","$1.59 ","$0.00 ","$2.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.15 ","$0.00 ","$1.08 ","$1.70 ","$1.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0064X","SUP","Custom 25803010","","SOLUTION IV 5% DEX 1L VFLX LF","BOTH IP/OP","$2.65 ","$1.96 ","$0.00 ","$2.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.65 ","$0.00 ","$1.33 ","$2.10 ","$2.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0089","SUP","Custom 25803010","","SOLUTION IV 5% DEX 100ML MPK VFLX LF","BOTH IP/OP","$2.60 ","$1.92 ","$0.00 ","$2.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.60 ","$0.00 ","$1.30 ","$2.06 ","$2.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0163Q","SUP","Custom 25803010","","SOLUTION IV 10% DEX 500ML VFLX LF","BOTH IP/OP","$2.73 ","$2.02 ","$0.00 ","$2.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.73 ","$0.00 ","$1.36 ","$2.16 ","$2.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B0164X","SUP","Custom 25803010","","SOLUTION IV 10% DEX 1L VFLX LF","BOTH IP/OP","$3.75 ","$2.78 ","$0.00 ","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.75 ","$0.00 ","$1.88 ","$2.97 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1063Q","SUP","Custom 25803010","","SOLUTION IV 5% DEX 0.9% NA CHLOR 500ML VFLX LF","BOTH IP/OP","$1.63 ","$1.21 ","$0.00 ","$1.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.63 ","$0.00 ","$0.81 ","$1.29 ","$1.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1064X","SUP","Custom 25803010","","SOLUTION IV 5% DEX 0.9% NA CHLOR 1L VFLX LF","BOTH IP/OP","$2.68 ","$1.98 ","$0.00 ","$2.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.68 ","$0.00 ","$1.34 ","$2.12 ","$2.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1073Q","SUP","Custom 25803010","","SOLUTION IV 5% DEX 0.45% NA CHLOR 500ML VFLX LF","BOTH IP/OP","$2.23 ","$1.65 ","$0.00 ","$2.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.23 ","$0.00 ","$1.11 ","$1.77 ","$1.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1074X","SUP","Custom 25803010","","SOLUTION IV 5% DEX 0.45% NA CHLOR 1L VFLX LF","BOTH IP/OP","$2.70 ","$2.00 ","$0.00 ","$2.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.70 ","$0.00 ","$1.35 ","$2.14 ","$2.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1309","SUP","Custom 25803010","","SOLUTION IV 0.9% NA CHLOR 100ML MPK VFLX LF","BOTH IP/OP","$41.25 ","$30.53 ","$0.00 ","$41.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.25 ","$0.00 ","$20.63 ","$32.67 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1313Q","SUP","Custom 25803010","","SOLUTION IV 0.45% NA CHLOR 500ML VFLX LF","BOTH IP/OP","$2.23 ","$1.65 ","$0.00 ","$2.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.23 ","$0.00 ","$1.11 ","$1.77 ","$1.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1314X","SUP","Custom 25803010","","SOLUTION IV 0.45% NA CHLOR 1L VFLX LF","BOTH IP/OP","$2.83 ","$2.09 ","$0.00 ","$2.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.83 ","$0.00 ","$1.41 ","$2.24 ","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1321","SUP","Custom 25803010","","SOLUTION IV 0.9% NA CHLOR 150ML VFLX LF","BOTH IP/OP","$2.23 ","$1.65 ","$0.00 ","$2.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.23 ","$0.00 ","$1.11 ","$1.77 ","$1.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B1654X","SUP","Custom 25803010","","SOLUTION IV 20 MEQ K CHLOR 5% DEX 0.45% NA CHLOR VFLX 1L LF","BOTH IP/OP","$3.45 ","$2.55 ","$0.00 ","$3.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.45 ","$0.00 ","$1.73 ","$2.73 ","$2.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B2074X","SUP","Custom 25803010","","SOLUTION IV 5% DEX LR 1L VFLX LF","BOTH IP/OP","$2.68 ","$1.98 ","$0.00 ","$2.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.68 ","$0.00 ","$1.34 ","$2.12 ","$2.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B2324X","SUP","Custom 25803010","","SOLUTION IV LR 1L VFLX LF","BOTH IP/OP","$2.83 ","$2.09 ","$0.00 ","$2.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.83 ","$0.00 ","$1.41 ","$2.24 ","$2.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B2544X","SUP","Custom 25803010","","SOLUTION IV PLSMLT A VFLX MLT ELCLY VFLX 1L LF","BOTH IP/OP","$5.10 ","$3.77 ","$0.00 ","$5.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.10 ","$0.00 ","$2.55 ","$4.04 ","$4.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2B7231","SUP","Custom 25803010","","2B7231  -  SOLUTION IRRIGATION BAG USP CONTAINER 0.9% SODIUM CHLORIDE 1","BOTH IP/OP","$188.28 ","$139.33 ","$0.00 ","$188.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.28 ","$0.00 ","$94.14 ","$149.12 ","$150.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2C2164","SUP","Custom 27203010","","2C2164  -  TUBINGIRRIGATION-LAPAROS","BOTH IP/OP","$36.89 ","$27.30 ","$0.00 ","$36.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.89 ","$0.00 ","$18.44 ","$29.22 ","$29.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2N03A","SUP","Custom 27803010","","2N03A  -  SUTURE NABSB CV-2 THX-22 36IN WHT MFL GRTX","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$66.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.46 ","$0.00 ","$33.23 ","$52.64 ","$53.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2N05A","SUP","Custom 27803010","","2N05A  -  SUTURE NABSB CV-2 THX-26 36IN WHT MFL GRTX","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$66.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.46 ","$0.00 ","$33.23 ","$52.64 ","$53.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"2N1116","SUP","HCPCS C1753","","CATHETER INTRAVASCULAR QUIK CATH 22G X 1IN LUER PLUG","BOTH IP/OP","$1.83 ","$1.35 ","$0.00 ","$1.83 ","$0.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.32 ","$1.83 ","$0.00 ","$0.91 ","$1.45 ","$1.46 ","$0.00 ","$0.29 ","$0.00 ","$0.29 ","$0.00 "
"2P9","SUP","Custom 27803010","","2P9  -  PATCH VASCULAR 9X2CM XENOSURE THK.45MM BOVINE PERICARDIUM","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3.0 NEO","SUP","Custom 27203010","","3.0 NEO  -  TUBE 30MM 4.5MM 3MM UNCUF OBT TRCH PLVN CHLOR NEO","BOTH IP/OP","$94.29 ","$69.77 ","$0.00 ","$94.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.29 ","$0.00 ","$47.14 ","$74.68 ","$75.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0001","SUP","Custom 27203010","","30-0001  -  GUIDE TRGT SCPHD ASMBLY NONSTRL","BOTH IP/OP","$61.25 ","$45.33 ","$0.00 ","$4,370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,370.00 ","$0.00 ","$2,185.00 ","$3,461.04 ","$3,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0017-S","SUP","Custom 27203010","","30-0017-S  -  GUIDE TRGT 1 .035IN SCPHD DISK STRL DISP","BOTH IP/OP","$652.50 ","$482.85 ","$0.00 ","$652.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.50 ","$0.00 ","$326.25 ","$516.78 ","$522.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0018-S","SUP","Custom 27203010","","30-0018-S  -  GUIDE MINI TRGT SURG SCPHD","BOTH IP/OP","$652.50 ","$482.85 ","$0.00 ","$652.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.50 ","$0.00 ","$326.25 ","$516.78 ","$522.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0019-S","SUP","Custom 27203010","","30-0019-S  -  GUIDE TRGT 3 .054IN SCPHD DISK STRL","BOTH IP/OP","$652.50 ","$482.85 ","$0.00 ","$652.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$652.50 ","$0.00 ","$326.25 ","$516.78 ","$522.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0021-S","SUP","HCPCS C1713","","30-0021-S  -  SCREW BN 5.5MM 25MM ACTRK2 MTP MIDFOOT","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0023-S","SUP","HCPCS C1713","","30-0023-S  -  SCREW BN 5.5MM 30MM ACTRK2 MTP MIDFOOT","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0025-S","SUP","HCPCS C1713","","30-0025-S  -  SCREW BN 5.5MM 35MM ACUTRACK II","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0027-S","SUP","HCPCS C1713","","30-0027-S  -  SCREW BN 5.5MM 40MM ACUTRACK II","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0029-S","SUP","HCPCS C1713","","30-0029-S  -  SCREW BN 5.5MM 45MM ACTRK2 MTP MIDFOOT","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0031-S","SUP","HCPCS C1713","","30-0031-S  -  SCREW BN 50MM ACTRK2","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0033-S","SUP","HCPCS C1713","","30-0033-S  -  SCREW BONE 6MM 30MM ACTRK FSN DEV HMRTOE SYS","BOTH IP/OP","$895.00 ","$662.30 ","$0.00 ","$895.00 ","$402.75 ","$0.00 ","$186.54 ","$0.00 ","$0.00 ","$156.71 ","$895.00 ","$0.00 ","$447.50 ","$708.84 ","$716.00 ","$0.00 ","$140.07 ","$0.00 ","$142.48 ","$0.00 "
"300-070","SUP","Custom 27203010","","300-070  -  BONE GRAFT HARVESTER, COREX 7MM","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0084-S","SUP","HCPCS C1713","","30-0084-S  -  SCREW BN 5.5MM 55MM ACTRK","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"30-0085-S","SUP","HCPCS C1713","","30-0085-S  -  SCREW BN 5.5MM 60MM ACTRK","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"300-090","SUP","Custom 27203010","","300-090  -  HARVESTER BN 9MM STRL LF COREX CANC BN DISP","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0093","SUP","HCPCS C1713","","30-0093  -  PLATE SCR ACLC 2 BONE DISTAL VOLR RADL","BOTH IP/OP","$590.00 ","$436.60 ","$0.00 ","$590.00 ","$265.50 ","$0.00 ","$122.97 ","$0.00 ","$0.00 ","$103.30 ","$590.00 ","$0.00 ","$295.00 ","$467.28 ","$472.00 ","$0.00 ","$92.34 ","$0.00 ","$93.93 ","$0.00 "
"30-0098","SUP","HCPCS C1713","","30-0098  -  PIN FX 70MM NS TNSNBND","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$61.88 ","$0.00 ","$28.66 ","$0.00 ","$0.00 ","$24.08 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$21.52 ","$0.00 ","$21.89 ","$0.00 "
"30-0099","SUP","HCPCS C1713","","30-0099  -  PIN FX 90MM NS TNSNBND","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$61.88 ","$0.00 ","$28.66 ","$0.00 ","$0.00 ","$24.08 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$21.52 ","$0.00 ","$21.89 ","$0.00 "
"30-0232","SUP","HCPCS C1713","","30-0232  -  SCREW BONE 3.5MM 8MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0233","SUP","HCPCS C1713","","30-0233  -  SCREW BONE 3.5MM 10MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0234","SUP","HCPCS C1713","","30-0234  -  SCREW BONE 3.5MM 12MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0235","SUP","HCPCS C1713","","30-0235  -  SCREW BONE 3.5MM 14MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0236","SUP","HCPCS C1713","","30-0236  -  SCREW BONE 3.5MM 16MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0237","SUP","HCPCS C1713","","30-0237  -  SCREW BONE 3.5MM 18MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0238","SUP","HCPCS C1713","","30-0238  -  SCREW BONE 3.5MM 20MM LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0239","SUP","HCPCS C1713","","30-0239  -  SCREW BONE 3.5MM 22MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0240","SUP","HCPCS C1713","","30-0240  -  SCREW BONE 3.5MM 24MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0241","SUP","HCPCS C1713","","30-0241  -  SCREW BONE 3.5MM 26MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0242","SUP","HCPCS C1713","","30-0242  -  SCREW BONE 3.5MM 28MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0243","SUP","HCPCS C1713","","30-0243  -  SCREW BONE 3.5MM 30MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0244","SUP","HCPCS C1713","","30-0244  -  SCREW BONE 3.5MM 32MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0245","SUP","HCPCS C1713","","30-0245  -  SCREW BONE 3.5MM 34MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0246","SUP","HCPCS C1713","","30-0246  -  SCREW BONE 3.5MM 36MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0247","SUP","HCPCS C1713","","30-0247  -  SCREW BONE 3.5MM 38MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0248","SUP","HCPCS C1713","","30-0248  -  SCREW BONE 3.5MM 40MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0249","SUP","HCPCS C1713","","30-0249  -  SCREW BONE 3.5MM 45MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0250","SUP","HCPCS C1713","","30-0250  -  SCREW BONE 3.5MM 50MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0251","SUP","HCPCS C1713","","30-0251  -  SCREW BONE 3.5MM 55MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0252","SUP","HCPCS C1713","","30-0252  -  SCREW BONE 3.5MM 60MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0255","SUP","HCPCS C1713","","30-0255  -  SCREW BONE 3.5MM 8MM CORT ELB NLCKG HEXALOBE HEAD","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0256","SUP","HCPCS C1713","","30-0256  -  SCREW BN 3.5MM 10MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0257","SUP","HCPCS C1713","","30-0257  -  SCREW BN 3.5MM 12MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0258","SUP","HCPCS C1713","","30-0258  -  SCREW BN 3.5MM 14MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0259","SUP","HCPCS C1713","","30-0259  -  SCREW BONE 3.5MM 16MM ELB NLCKG TRAUMA","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0260","SUP","HCPCS C1713","","30-0260  -  SCREW BONE 3.5MM 18MM NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0261","SUP","HCPCS C1713","","30-0261  -  SCREW BONE 3.5MM 20MM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0262","SUP","HCPCS C1713","","30-0262  -  SCREW BONE 3.5MM 22MM NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0263","SUP","HCPCS C1713","","30-0263  -  SCREW BONE 3.5MM 24MM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0264","SUP","HCPCS C1713","","30-0264  -  SCREW BONE 3.5MM 26MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0265","SUP","HCPCS C1713","","30-0265  -  SCREW BONE 3.5MM 28MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0266","SUP","HCPCS C1713","","30-0266  -  SCREW BN 3.5MM 30MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0267","SUP","HCPCS C1713","","30-0267  -  SCREW BONE 3.5MM 32MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0268","SUP","HCPCS C1713","","30-0268  -  SCREW BONE 3.5MM 34MM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0269","SUP","HCPCS C1713","","30-0269  -  SCREW BONE 3.5MM 36MM CORT ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0270","SUP","HCPCS C1713","","30-0270  -  SCREW BONE 3.5MM 38MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0271","SUP","HCPCS C1713","","30-0271  -  SCREW BONE 3.5MM 40MM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0272","SUP","HCPCS C1713","","30-0272  -  SCREW BONE 3.5MM 45MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0273","SUP","HCPCS C1713","","30-0273  -  SCREW BONE 3.5MM 50MM DISTAL HUM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0274","SUP","HCPCS C1713","","30-0274  -  SCREW BONE 3.5MM 55MM CORT ELB NLCKG HEXALOBE HEAD","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0275","SUP","HCPCS C1713","","30-0275  -  SCREW BONE 3.5MM 60MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0276","SUP","HCPCS C1713","","30-0276  -  SCREW BONE 3.5MM 65MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0278","SUP","HCPCS C1713","","30-0278  -  SCREW BONE 3MM 8MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0279","SUP","HCPCS C1713","","30-0279  -  SCREW BONE 2.7MM 10MM ELB LCK","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0280","SUP","HCPCS C1713","","30-0280  -  SCREW BONE 3MM 12MM ELB LCK","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0281","SUP","HCPCS C1713","","30-0281  -  SCREW BONE 3MM 14MM CORT LCK","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0282","SUP","HCPCS C1713","","30-0282  -  SCREW BONE 3MM 16MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0283","SUP","HCPCS C1713","","30-0283  -  SCREW BONE 3MM 18MM LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0284","SUP","HCPCS C1713","","30-0284  -  SCREW BONE 3MM 20MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0285","SUP","HCPCS C1713","","30-0285  -  SCREW BONE 3MM 22MM CORT ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0286","SUP","HCPCS C1713","","30-0286  -  SCREW BONE 3MM 24MM CORT ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0287","SUP","HCPCS C1713","","30-0287  -  SCREW BONE 3MM 26MM CORT ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0288","SUP","HCPCS C1713","","30-0288  -  SCREW BONE 3MM 28MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0289","SUP","HCPCS C1713","","30-0289  -  SCREW BONE 3MM 30MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0290","SUP","HCPCS C1713","","30-0290  -  SCREW BONE 3MM 32MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0291","SUP","HCPCS C1713","","30-0291  -  SCREW BONE 3.5MM 34MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0292","SUP","HCPCS C1713","","30-0292  -  SCREW BONE 3MM 36MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0293","SUP","HCPCS C1713","","30-0293  -  SCREW BONE 3MM 38MM CORT ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0294","SUP","HCPCS C1713","","30-0294  -  SCREW BONE 3MM 40MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0295","SUP","HCPCS C1713","","30-0295  -  SCREW BONE 3MM 45MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0296","SUP","HCPCS C1713","","30-0296  -  SCREW BONE 3MM 50MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0297","SUP","HCPCS C1713","","30-0297  -  SCREW BN 3MM 55MM LCK HEXALOBE ELB","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0298","SUP","HCPCS C1713","","30-0298  -  SCREW BONE 3MM 60MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0301","SUP","HCPCS C1713","","30-0301  -  SCREW BONE 3MM 8MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0302","SUP","HCPCS C1713","","30-0302  -  SCREW BONE 3MM 10MM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0303","SUP","HCPCS C1713","","30-0303  -  SCREW BONE 3MM 12MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0304","SUP","HCPCS C1713","","30-0304  -  SCREW BONE 3MM 14MM DISTAL HUM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0305","SUP","HCPCS C1713","","30-0305  -  SCREW BONE 3MM 16MM CORT ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0306","SUP","HCPCS C1713","","30-0306  -  SCREW BN 3MM 18MM NONLOCK HEXALOBE HD","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0307","SUP","HCPCS C1713","","30-0307  -  SCREW BONE 3MM 20MM CORT ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0308","SUP","HCPCS C1713","","30-0308  -  SCREW BN 3MM 22MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3003-0822S","SUP","HCPCS C1713","","3003-0822S  -  SCREW SET TI 17.5MM 8MM TROC HIP GAMMA3 STRL LNG NAIL","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"30-0309","SUP","HCPCS C1713","","30-0309  -  SCREW BONE 3MM 24MM CORT ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0310","SUP","HCPCS C1713","","30-0310  -  SCREW BONE 3MM 26MM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0311","SUP","HCPCS C1713","","30-0311  -  SCREW BONE 3.5MM 28MM ELB NLCKG","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0312","SUP","HCPCS C1713","","30-0312  -  SCREW BONE 3.5MM 30MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0313","SUP","HCPCS C1713","","30-0313  -  SCREW BONE 3MM 32MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0314","SUP","HCPCS C1713","","30-0314  -  SCREW BONE 3MM 34MM DISTAL HUM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0315","SUP","HCPCS C1713","","30-0315  -  SCREW BONE 3MM 36MM CORT ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0316","SUP","HCPCS C1713","","30-0316  -  SCREW BONE 3MM 38MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0317","SUP","HCPCS C1713","","30-0317  -  SCREW BONE 3MM 40MM DISTAL HUM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0318","SUP","HCPCS C1713","","30-0318  -  SCREW BONE 3MM 45MM CORT ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0319","SUP","HCPCS C1713","","30-0319  -  SCREW BN 3MM 50MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0320","SUP","HCPCS C1713","","30-0320  -  SCREW BONE 3MM 55MM DISTAL HUM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0321","SUP","HCPCS C1713","","30-0321  -  SCREW BONE 3MM 60MM DISTAL VOLR RADL NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0322","SUP","HCPCS C1713","","30-0322  -  SCREW BONE 3MM 65MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0324","SUP","HCPCS C1713","","30-0324  -  SCREW BONE 2.7MM 8MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0325","SUP","HCPCS C1713","","30-0325  -  SCREW BONE 2.7MM 10MM ELB LCK","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0326","SUP","HCPCS C1713","","30-0326  -  SCREW BONE 2.7MM 12MM TRAUMA LCK","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0327","SUP","HCPCS C1713","","30-0327  -  SCREW BONE 2.7MM 14MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0328","SUP","HCPCS C1713","","30-0328  -  SCREW BN 2.7MM 16MM NS LCK HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0329","SUP","HCPCS C1713","","30-0329  -  SCREW BONE 2.7MM 18MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0330","SUP","HCPCS C1713","","30-0330  -  SCREW BONE 2.7MM 20MM DISTAL HUM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0331","SUP","HCPCS C1713","","30-0331  -  SCREW BN 2.7MM 22MM NS LCK HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0332","SUP","HCPCS C1713","","30-0332  -  SCREW BONE 2.7MM 24MM ELB LCK HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0333","SUP","HCPCS C1713","","30-0333  -  SCREW BONE 2.7MM 26MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0334","SUP","HCPCS C1713","","30-0334  -  SCREW BONE 2.7MM 28MM DISTAL HUM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0335","SUP","HCPCS C1713","","30-0335  -  SCREW BONE 2.7MM 30MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0336","SUP","HCPCS C1713","","30-0336  -  SCREW BONE 2.7MM 32MM ELB LCK HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0343","SUP","HCPCS C1713","","30-0343  -  SCREW BONE 2.7MM 8MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0344","SUP","HCPCS C1713","","30-0344  -  SCREW BONE 2.7MM 10MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0345","SUP","HCPCS C1713","","30-0345  -  SCREW BONE 2.7MM 12MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0346","SUP","HCPCS C1713","","30-0346  -  SCREW BONE 2.7MM 14MM NLCKG TRAUMA","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0347","SUP","HCPCS C1713","","30-0347  -  SCREW BONE 2.7MM 16MM TI NLCKG","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0348","SUP","HCPCS C1713","","30-0348  -  SCREW BONE 2.7MM 18MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0349","SUP","HCPCS C1713","","30-0349  -  SCREW BONE 2.7MM 20MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0350","SUP","HCPCS C1713","","30-0350  -  SCREW BN 2.7MM 22MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0351","SUP","HCPCS C1713","","30-0351  -  SCREW BN 2.7MM 24MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0352","SUP","HCPCS C1713","","30-0352  -  SCREW BONE 2.7MM 26MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0353","SUP","HCPCS C1713","","30-0353  -  SCREW BONE 2.7MM 28MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0354","SUP","HCPCS C1713","","30-0354  -  SCREW BN 2.7MM 30MM NS HEXALOBE TI SM FRAG BS SET","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0355","SUP","HCPCS C1713","","30-0355  -  SCREW BONE 2.7MM 32MM ELB NLCKG HEXALOBE","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0370","SUP","Custom 27203010","","30-0370  -  SLEEVE CMPR NS FRAG-LOC BN SCR","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0371","SUP","HCPCS C1713","","30-0371  -  SCREW BN STRL FRAG-LOC CMPR","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$395.00 ","$177.75 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$69.16 ","$395.00 ","$0.00 ","$197.50 ","$312.84 ","$316.00 ","$0.00 ","$61.82 ","$0.00 ","$62.88 ","$0.00 "
"3004-15010","SUP","HCPCS C1713","","3004-15010  -  SCREW BONE 10MM HEXALOBE MULTI TITANIUM 1.5MM HAND","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-15011","SUP","HCPCS C1713","","3004-15011  -  SCREW BONE 1.5MM 11MM HEXALOBE MULTI TITANIUM HAND","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23009","SUP","HCPCS C1713","","3004-23009  -  SCREW BONE 9MM MULTI HEXALOBE 2.3MM ELBOW NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23010","SUP","HCPCS C1713","","3004-23010  -  SCREW BONE 10MM MULTI HEXALOBE TITANIUM 2.3MM HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23011","SUP","HCPCS C1713","","3004-23011  -  SCREW BONE 11MM HEXALOBE DRIVER 2.3MM ELBOW","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23012","SUP","HCPCS C1713","","3004-23012  -  SCREW BONE 12MM MULTI HEXALOBE 2.3MM WRIST","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23013","SUP","HCPCS C1713","","3004-23013  -  SCREW BN 2.3MM 13MM MLLK VA HEXALOBE TI HND FX SYS","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23014","SUP","HCPCS C1713","","3004-23014  -  SCREW BONE 14MM HEXALOBE DRIVER 2.3MM ELBOW","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3004-23016","SUP","HCPCS C1713","","3004-23016  -  SCREW BONE 2.3MM 16MM ELB HEXALOBE DRVR","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"30-0426","SUP","HCPCS C1713","","30-0426  -  SCREW BONE 5.7MM 26MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0428","SUP","HCPCS C1713","","30-0428  -  SCREW BONE 5.7MM 28MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0430","SUP","HCPCS C1713","","30-0430  -  SCREW BONE 5.7MM 30MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0432","SUP","HCPCS C1713","","30-0432  -  SCREW BONE 5.7MM 32MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0434","SUP","HCPCS C1713","","30-0434  -  SCREW BONE 5.7MM 34MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0436","SUP","HCPCS C1713","","30-0436  -  SCREW BONE 5.7MM 36MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0438","SUP","HCPCS C1713","","30-0438  -  SCREW BONE 5.7MM 38MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0440","SUP","HCPCS C1713","","30-0440  -  SCREW BONE 5.7MM 40MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0442","SUP","HCPCS C1713","","30-0442  -  SCREW BONE 5.7MM 42MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0444","SUP","HCPCS C1713","","30-0444  -  SCREW BONE 5.7MM 44MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0446","SUP","HCPCS C1713","","30-0446  -  SCREW BONE 5.7MM 46MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0448","SUP","HCPCS C1713","","30-0448  -  SCREW BONE 5.7MM 48MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0450","SUP","HCPCS C1713","","30-0450  -  SCREW BONE 5.7MM 50MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0452","SUP","HCPCS C1713","","30-0452  -  SCREW BONE 5.7MM 52MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"30-0454","SUP","HCPCS C1713","","30-0454  -  SCREW BONE 5.7MM 54MM PLRS TI PROX CANC HUM LCK","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"3005-1100S","SUP","HCPCS C1713","","3005-1100S  -  CAP END STD 15.3MM HIP FEM IM NAIL TI STRL GAMMA3 11MM","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"3005-1105S","SUP","HCPCS C1713","","3005-1105S  -  CAP END +5MM HIP FEM IM NAIL TI STRL GAMMA3","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"3005-1110S","SUP","HCPCS C1713","","3005-1110S  -  CAP END +10MM HIP FEM IM NAIL TI STRL GAMMA3","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$129.94 ","$0.00 ","$60.18 ","$0.00 ","$0.00 ","$50.56 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$45.19 ","$0.00 ","$45.97 ","$0.00 "
"3006-00","SUP","Custom 27203010","","3006-00  -  PIN SKL BLU STRL DORO ADLT","BOTH IP/OP","$49.67 ","$36.76 ","$0.00 ","$49.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.67 ","$0.00 ","$24.83 ","$39.34 ","$39.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3006-20","SUP","Custom 27203010","","3006-20  -  PIN SKL TI ADLT CRNL DISP","BOTH IP/OP","$67.59 ","$50.02 ","$0.00 ","$67.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.59 ","$0.00 ","$33.80 ","$53.53 ","$54.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-0650","SUP","HCPCS C1713","","30-0650  -  SCREW BONE 50MM CANN COMPRESSION SELF CUTTING HELICAL RELIEF","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"3006570-06","SUP","Custom 27203010","","CABLE QUIK-COMBO THERAPY","BOTH IP/OP","$648.13 ","$479.62 ","$0.00 ","$648.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$648.13 ","$0.00 ","$324.06 ","$513.32 ","$518.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3008 A","SUP","HCPCS C1713","","3008 A  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"3008 B","SUP","HCPCS C1713","","3008 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"301130B","SUP","Custom 27203010","","REAGENT MCBL KT AP CMB 2 250 TST","BOTH IP/OP","$19,000.00 ","$14,060.00 ","$0.00 ","$19,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,000.00 ","$0.00 ","$9,500.00 ","$15,048.00 ","$15,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3012-15008","SUP","HCPCS C1713","","3012-15008  -  SCREW BONE HEXALOBE PTHRD 1.5MM 8MM LAG HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-15009","SUP","HCPCS C1713","","3012-15009  -  SCREW BONE 9MM LAG HEXALOBE PTHRD 1.5MM HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-15010","SUP","HCPCS C1713","","3012-15010  -  SCREW BONE 10MM LAG HEXALOBE PTHRD 1.5MM HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-15011","SUP","HCPCS C1713","","3012-15011  -  SCREW BONE 11MM HEXALOBE DRIVER LAG 1.5MM ELBOW","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-15013","SUP","HCPCS C1713","","3012-15013  -  SCREW BONE 13MM HEXALOBE DRIVER LAG 1.5MM ELBOW","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-15014","SUP","HCPCS C1713","","3012-15014  -  SCREW BONE 14MM HEXALOBE DRIVER LAG 1.5MM ELBOW","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23008","SUP","HCPCS C1713","","3012-23008  -  SCREW BONE 8MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23009","SUP","HCPCS C1713","","3012-23009  -  SCREW BONE 9MM LAG HEXALOBE 2.3MM HAND","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23010","SUP","HCPCS C1713","","3012-23010  -  SCREW BONE 10MM HEXALOBE LAG TITANIUM 2.3MM HAND METACARPAL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23012","SUP","HCPCS C1713","","3012-23012  -  SCREW BONE 12MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23013","SUP","HCPCS C1713","","3012-23013  -  SCREW BONE 2.3MM 13MM ACUMED TI HEXALOBE MTCRPL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23016","SUP","HCPCS C1713","","3012-23016  -  SCREW BN HEXALOBE 2.3MM 16MM YLW NS ACUMED LG LOPRFL TI","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3012-23018","SUP","HCPCS C1713","","3012-23018  -  SCREW BONE 18MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"3013SP","SUP","Custom 27203010","","3013SP  -  HEMOSTAT ABS SRGCL OXD REGENERATED CLU PWDR","BOTH IP/OP","$394.57 ","$291.98 ","$0.00 ","$394.57 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$394.57 ","$0.00 ","$197.28 ","$312.50 ","$315.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3016-16","SUP","Custom 27203010","","CHEMICAL MTHY ALC ANHY 4L ACS LAB","BOTH IP/OP","$431.58 ","$319.37 ","$0.00 ","$431.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$431.58 ","$0.00 ","$215.79 ","$341.81 ","$345.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30170007-S","SUP","HCPCS C1713","","30170007-S  -  SCREW BONE 3.6/4.3MM 16MM BIOTRAK .045IN STD KNEE RESORB","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170008-S","SUP","HCPCS C1713","","30170008-S  -  SCREW BN 18MM BIOTRAK","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170009-S","SUP","HCPCS C1713","","30170009-S  -  SCREW BONE 20MM BIOTRAK CALC","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170010-S","SUP","HCPCS C1713","","30170010-S  -  SCREW BN 22MM BIOTRAK","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170011-S","SUP","HCPCS C1713","","30170011-S  -  SCREW BN 24MM BIOTRAK","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170057-S","SUP","HCPCS C1713","","30170057-S  -  SCREW BN MN 16MM BIOTRAK","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170058-S","SUP","HCPCS C1713","","30170058-S  -  SCREW BN MN 18MM BIOTRAK","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170059-S","SUP","HCPCS C1713","","30170059-S  -  SCREW BN MN FT TPR 3.2-3.6MM 20MM STRL BIOTRAK RSRB RDLCNT","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170060-S","SUP","HCPCS C1713","","30170060-S  -  SCREW BN MN FT TPR 3.2-3.7MM 22MM STRL BIOTRAK RSRB RDLCNT","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170061-S","SUP","HCPCS C1713","","30170061-S  -  SCREW BONE 3.2/3.5MM 24MM BIOTRAK .035IN MINI WRST ANKL HAND","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$727.88 ","$0.00 ","$337.13 ","$0.00 ","$0.00 ","$283.21 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$253.14 ","$0.00 ","$257.51 ","$0.00 "
"30170320-S","SUP","Custom 27203010","","30170320-S  -  PIN FX 20MM BIOTRAK","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30170330-S","SUP","Custom 27203010","","30170330-S  -  PIN FX 30MM BIOTRAK","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30170340-S","SUP","Custom 27203010","","30170340-S  -  PIN FX 40MM BIOTRAK","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3044-0026","SUP","Custom 27803010","","3044-0026  -  COMPONENT PATLR 26MM RECESSED UHMWPE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3044-0028","SUP","Custom 27803010","","3044-0028  -  COMPONENT PATLR 28MM RECESSED UHMWPE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3044-0030","SUP","Custom 27803010","","3044-0030  -  COMPONENT PATLR 30MM RECESSED UHMWPE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3044-0032","SUP","Custom 27803010","","3044-0032  -  COMPONENT PATLR 32MM RECESSED UHMWPE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3045-0026","SUP","Custom 27803010","","3045-0026  -  CMPNT PATLR MTLBLK RCSS","BOTH IP/OP","$1,211.00 ","$896.14 ","$0.00 ","$1,211.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,211.00 ","$0.00 ","$605.50 ","$959.11 ","$968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3045-0028","SUP","Custom 27803010","","3045-0028  -  CMPNT PATLR MTLBLK RCSS","BOTH IP/OP","$1,211.00 ","$896.14 ","$0.00 ","$1,211.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,211.00 ","$0.00 ","$605.50 ","$959.11 ","$968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3045-0030","SUP","Custom 27803010","","3045-0030  -  CMPNT PATLR MTLBLK RCSS","BOTH IP/OP","$1,211.00 ","$896.14 ","$0.00 ","$1,211.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,211.00 ","$0.00 ","$605.50 ","$959.11 ","$968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3045-0032","SUP","Custom 27803010","","3045-0032  -  CMPNT PATLR MTLBLK RCSS","BOTH IP/OP","$1,211.00 ","$896.14 ","$0.00 ","$1,211.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,211.00 ","$0.00 ","$605.50 ","$959.11 ","$968.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-5052122","SUP","Custom 27203010","","MILTEX HANK DILATOR SZ. 21-22","BOTH IP/OP","$174.38 ","$129.04 ","$0.00 ","$174.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.38 ","$0.00 ","$87.19 ","$138.11 ","$139.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-5052324","SUP","Custom 27203010","","MILTEX HANK DILATOR SZ. 23-24","BOTH IP/OP","$174.38 ","$129.04 ","$0.00 ","$174.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.38 ","$0.00 ","$87.19 ","$138.11 ","$139.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"30-505-2526","SUP","Custom 27203010","","MILTEX HANK DILATOR SZ. 25-26","BOTH IP/OP","$181.85 ","$134.57 ","$0.00 ","$181.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$181.85 ","$0.00 ","$90.93 ","$144.03 ","$145.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3051-0308","SUP","Custom 27803010","","3051-0308  -  INSERT TIB LG KNEE SER 1 BRNG","BOTH IP/OP","$985.00 ","$728.90 ","$0.00 ","$985.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$985.00 ","$0.00 ","$492.50 ","$780.12 ","$788.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0308","SUP","Custom 27803010","","3052-0308  -  INSERT TIBIAL 3 8MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0310","SUP","Custom 27803010","","3052-0310  -  INSERT TIBIAL 3 10MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0312","SUP","Custom 27803010","","3052-0312  -  INSERT TIBIAL 3 12MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0315","SUP","Custom 27803010","","3052-0315  -  INSERT TIBIAL 3 15MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0318","SUP","Custom 27803010","","3052-0318  -  INSERT TIBIAL 3 18MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0321","SUP","Custom 27803010","","3052-0321  -  INSERT TIBIAL 3 21MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0324","SUP","Custom 27803010","","3052-0324  -  INSERT TIBIAL 3 24MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0508","SUP","Custom 27803010","","3052-0508  -  INSERT TIBIAL 5 8MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0510","SUP","Custom 27803010","","3052-0510  -  INSERT TIBIAL 5 10MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0512","SUP","Custom 27803010","","3052-0512  -  INSERT TIBIAL 5 12MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0515","SUP","Custom 27803010","","3052-0515  -  INSERT TIBIAL 5 15MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0518","SUP","Custom 27803010","","3052-0518  -  INSERT TIBIAL 5 18MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0521","SUP","Custom 27803010","","3052-0521  -  INSERT TIBIAL 5 21MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0524","SUP","Custom 27803010","","3052-0524  -  INSERT TIBIAL 5 24MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0708","SUP","Custom 27803010","","3052-0708  -  INSERT TIBIAL 7 8MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0710","SUP","Custom 27803010","","3052-0710  -  INSERT TIBIAL 7 10MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0712","SUP","Custom 27803010","","3052-0712  -  INSERT TIBIAL 7 12MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0715","SUP","Custom 27803010","","3052-0715  -  INSERT TIBIAL 7 15MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0718","SUP","Custom 27803010","","3052-0718  -  INSERT TIBIAL 7 18MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0721","SUP","Custom 27803010","","3052-0721  -  INSERT TIBIAL 7 21MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0724","SUP","Custom 27803010","","3052-0724  -  INSERT TIBIAL 7 24MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0908","SUP","Custom 27803010","","3052-0908  -  INSERT TIBIAL 9 8MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0910","SUP","Custom 27803010","","3052-0910  -  INSERT TIBIAL 9 10MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0912","SUP","Custom 27803010","","3052-0912  -  INSERT TIBIAL 9 12MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0915","SUP","Custom 27803010","","3052-0915  -  INSERT TIBIAL 9 15MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0918","SUP","Custom 27803010","","3052-0918  -  INSERT TIBIAL 9 18MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0921","SUP","Custom 27803010","","3052-0921  -  INSERT TIBIAL 9 21MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-0924","SUP","Custom 27803010","","3052-0924  -  INSERT TIBIAL 9 24MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1108","SUP","Custom 27803010","","3052-1108  -  INSERT TIBIAL 11 8MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1110","SUP","Custom 27803010","","3052-1110  -  INSERT TIBIAL 11 10MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1112","SUP","Custom 27803010","","3052-1112  -  INSERT TIBIAL 11 12MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1115","SUP","Custom 27803010","","3052-1115  -  INSERT TIBIAL 11 15MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1118","SUP","Custom 27803010","","3052-1118  -  INSERT TIBIAL 11 18MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1121","SUP","Custom 27803010","","3052-1121  -  INSERT TIBIAL 11 21MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3052-1124","SUP","Custom 27803010","","3052-1124  -  INSERT TIBIAL 11 24MM BEARING KNEE SERIES II","BOTH IP/OP","$2,060.00 ","$1,524.40 ","$0.00 ","$2,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,060.00 ","$0.00 ","$1,030.00 ","$1,631.52 ","$1,648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"305C2101","SUP","Custom 27803010","","305C2101  -  VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL","BOTH IP/OP","$19,000.00 ","$14,060.00 ","$0.00 ","$19,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,000.00 ","$0.00 ","$9,500.00 ","$15,048.00 ","$15,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"305C219","SUP","Custom 27803010","","305C219  -  VALVE AORTIC 19MM MSC BPRTH CNCH HLDR MODL 305 STRL","BOTH IP/OP","$2,022.50 ","$1,496.65 ","$0.00 ","$2,022.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,022.50 ","$0.00 ","$1,011.25 ","$1,601.82 ","$1,618.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"305C221","SUP","Custom 27803010","","305C221  -  VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"305C223","SUP","Custom 27803010","","305C223  -  VALVE AORTIC 23MM MSC CNCH BPRTH CNCH HLDR MODL 305","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"305C227","SUP","Custom 27803010","","305C227  -  VALVE AORTIC 27MM MSC BPRTH CNCH HLDR MODL 305","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"305C229","SUP","Custom 27803010","","305C229  -  VALVE AORTIC 29MM MSC BPRTH CNCH HLDR MODL 305 STRL","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3060-0070S","SUP","HCPCS C1713","","3060-0070S  -  SCREW BONE 10.5MM 70MM GAMMA3 TI TROC HIP LAG STRL LNG NAIL","BOTH IP/OP","$694.38 ","$513.84 ","$0.00 ","$694.38 ","$312.47 ","$0.00 ","$144.73 ","$0.00 ","$0.00 ","$121.58 ","$694.38 ","$0.00 ","$347.19 ","$549.95 ","$555.50 ","$0.00 ","$108.67 ","$0.00 ","$110.54 ","$0.00 "
"3060-0075S","SUP","HCPCS C1713","","3060-0075S  -  SCREW BN 10.5MM 75MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0080S","SUP","HCPCS C1713","","3060-0080S  -  SCREW BONE 10.5MM 80MM GAMMA3 TI TROC HIP LAG STRL LNG NAIL","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0085S","SUP","HCPCS C1713","","3060-0085S  -  SCREW BN 10.5MM 85MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0090S","SUP","HCPCS C1713","","3060-0090S  -  SCREW BN 10.5MM 90MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0095S","SUP","HCPCS C1713","","3060-0095S  -  SCREW BN 10.5MM 95MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0100S","SUP","HCPCS C1713","","3060-0100S  -  SCREW BN 10.5MM 100MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0105S","SUP","HCPCS C1713","","3060-0105S  -  SCREW BN 10.5MM 105MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0110S","SUP","HCPCS C1713","","3060-0110S  -  SCREW BN 10.5MM 110MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0115S","SUP","HCPCS C1713","","3060-0115S  -  SCREW BN 10.5MM 115MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0120S","SUP","HCPCS C1713","","3060-0120S  -  SCREW BN 10.5MM 120MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$361.97 ","$0.00 ","$167.65 ","$0.00 ","$0.00 ","$140.84 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$125.88 ","$0.00 ","$128.06 ","$0.00 "
"3060-0125S","SUP","HCPCS C1713","","3060-0125S  -  SCREW BN 10.5MM 125MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"3060-0130S","SUP","HCPCS C1713","","3060-0130S  -  SCREW BN 10.5MM 130MM STRL GAMMA3 LG TI HIP TROCH NL 180","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"3060L","SUP","Custom 27203010","","RESTRAINT VST 65IN MED QRLSE TIE BACK CLSR STRAP","BOTH IP/OP","$42.03 ","$31.10 ","$0.00 ","$42.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.03 ","$0.00 ","$21.01 ","$33.29 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3060M","SUP","Custom 27203010","","RESTRAINT VST 65IN MED CTTN QRLSE TIE BACK CLSR STRAP","BOTH IP/OP","$42.03 ","$31.10 ","$0.00 ","$42.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.03 ","$0.00 ","$21.01 ","$33.29 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3060S","SUP","Custom 27203010","","RESTRAINT VST 65IN SM QRLSE TIE BACK CLSR STRAP","BOTH IP/OP","$42.03 ","$31.10 ","$0.00 ","$42.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.03 ","$0.00 ","$21.01 ","$33.29 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3060XL","SUP","Custom 27203010","","RESTRAINT VST 75IN XL QRLSE TIE BACK CLSR STRAP","BOTH IP/OP","$42.03 ","$31.10 ","$0.00 ","$42.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.03 ","$0.00 ","$21.01 ","$33.29 ","$33.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3060XXXL","SUP","Custom 27203010","","RESTRAINT VST 3XL ZP QRLSE STRAP MESH","BOTH IP/OP","$61.23 ","$45.31 ","$0.00 ","$61.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.23 ","$0.00 ","$30.61 ","$48.49 ","$48.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"309.004S","SUP","Custom 27203010","","309.004S  -  BIT DRL 4MM STRL CRB 3.5MM SCR","BOTH IP/OP","$524.33 ","$388.00 ","$0.00 ","$509.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$509.05 ","$0.00 ","$254.53 ","$403.17 ","$407.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"309.006S","SUP","Custom 27203010","","309.006S  -  BIT DRL 6MM STRL CRB","BOTH IP/OP","$597.43 ","$442.10 ","$0.00 ","$580.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$580.03 ","$0.00 ","$290.01 ","$459.38 ","$464.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3092-040","SUP","HCPCS C1713","","CEMENT BONE ENDRN SST 40GM HVISC STRL","BOTH IP/OP","$365.00 ","$270.10 ","$0.00 ","$365.00 ","$164.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.91 ","$365.00 ","$0.00 ","$182.50 ","$289.08 ","$292.00 ","$0.00 ","$57.12 ","$0.00 ","$58.11 ","$0.00 "
"310.11.98","SUP","Custom 27203010","","310.11.98  -  BIT DRILL 60MM 1.1MM QC NONSTRL","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$209.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.25 ","$0.00 ","$104.63 ","$165.73 ","$167.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.15.98","SUP","Custom 27203010","","310.15.98  -  BIT DRILL 85MM 1.5MM QC W/O STOP NONSTRL","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$209.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.25 ","$0.00 ","$104.63 ","$165.73 ","$167.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.16.98","SUP","Custom 27203010","","310.16.98  -  BIT DRILL 110MM 1.5MM QC W/O STOP NONSTRL","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$209.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.25 ","$0.00 ","$104.63 ","$165.73 ","$167.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.16J","SUP","Custom 27203010","","310.16J  -  BIT DRILL 1.5MM 95MM JACOBS CHUCK NONSTRL","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.21.98","SUP","Custom 27203010","","310.21.98  -  BIT DRILL 125MM 2MM QC W/O STOP NONSTRL","BOTH IP/OP","$234.00 ","$173.16 ","$0.00 ","$234.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$234.00 ","$0.00 ","$117.00 ","$185.33 ","$187.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.21J","SUP","Custom 27203010","","310.21J  -  BIT DRILL LONG 2MM 110MM JACOBS CHUCK DCP STAINLESS STEEL","BOTH IP/OP","$135.63 ","$100.37 ","$0.00 ","$131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.68 ","$0.00 ","$65.84 ","$104.29 ","$105.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.-288","SUP","Custom 27203010","","BIT DRILL 165MM 2.8MM QC NSTRL","BOTH IP/OP","$238.60 ","$176.56 ","$0.00 ","$238.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.60 ","$0.00 ","$119.30 ","$188.97 ","$190.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.28J","SUP","Custom 27203010","","310.28J  -  BIT DRILL 2.7MM 110MM JACOBS CHUCK STERILE","BOTH IP/OP","$143.38 ","$106.10 ","$0.00 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.20 ","$0.00 ","$69.60 ","$110.25 ","$111.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.31.","SUP","Custom 27203010","","310.31.  -  DRILL BIT  3.2MM X 145MM QUICK COUPLING","BOTH IP/OP","$91.79 ","$67.92 ","$0.00 ","$91.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.79 ","$0.00 ","$45.90 ","$72.70 ","$73.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310.60J","SUP","Custom 27203010","","310.60J  -  BIT DRILL 6MM 195MM JACOBS CHUCK NONSTRL","BOTH IP/OP","$282.55 ","$209.09 ","$0.00 ","$274.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$274.33 ","$0.00 ","$137.16 ","$217.27 ","$219.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3100-25","SUP","Custom 27203010","","KIT SYR ART LN 25 UN 1ML BAL HEP","BOTH IP/OP","$1.35 ","$1.00 ","$0.00 ","$1.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.35 ","$0.00 ","$0.68 ","$1.07 ","$1.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31004U","SUP","Custom 27203010","","KIT IMMUN TST ELISA SPHL IGG 96 TST","BOTH IP/OP","$343.20 ","$253.97 ","$0.00 ","$343.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.20 ","$0.00 ","$171.60 ","$271.81 ","$274.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310-25M","SUP","Custom 27803010","","310-25M  -  VALVE MTRL 25MM MSC CNCH PIG","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310-31M","SUP","Custom 27803010","","310-31M  -  VALVE MTRL 31MM MSC CNCH PIG","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310-33M","SUP","Custom 27803010","","310-33M  -  VALVE MTRL 33MM MSC CNCH PIG","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"310C29","SUP","Custom 27803010","","310C29  -  VALVE MTRL 29MM MSC HRT PIG CNCH HLDR 310","BOTH IP/OP","$19,500.00 ","$14,430.00 ","$0.00 ","$19,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,500.00 ","$0.00 ","$9,750.00 ","$15,444.00 ","$15,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"311.031.01S","SUP","HCPCS C1713","","311.031.01S  -  TAP 4MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.032.01S","SUP","HCPCS C1713","","311.032.01S  -  TAP 6MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.033.01S","SUP","HCPCS C1713","","311.033.01S  -  TAP 3MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.034.01S","SUP","HCPCS C1713","","311.034.01S  -  TAP 2MM RESORB CORTEX SCR 4MM SLFDRILL MNQK CPLNG STOP SURG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.035.01S","SUP","HCPCS C1713","","311.035.01S  -  TAP 5MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.035.97S","SUP","HCPCS C1713","","311.035.97S  -  TAP SURG 1.5MM 5MM RESORB STOP STERILE CORTICAL SCREW","BOTH IP/OP","$700.20 ","$518.15 ","$0.00 ","$679.80 ","$305.91 ","$0.00 ","$145.94 ","$0.00 ","$0.00 ","$119.03 ","$679.80 ","$0.00 ","$339.90 ","$538.40 ","$543.84 ","$0.00 ","$103.29 ","$0.00 ","$108.22 ","$0.00 "
"311.036.01S","SUP","HCPCS C1713","","311.036.01S  -  TAP 2MM RESORB CORTEX SCR 6MM SLFDRILL MNQK CPLNG STOP SURG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.037.01S","SUP","HCPCS C1713","","311.037.01S  -  TAP 8MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.038.01S","SUP","HCPCS C1713","","311.038.01S  -  TAP 2MM RESORB CORTEX SCR 8MM SLFDRILL MNQK CPLNG STOP SURG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.044.01S","SUP","HCPCS C1713","","311.044.01S  -  TAP 4MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.046.01S","SUP","HCPCS C1713","","311.046.01S  -  TAP 6MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.048.01S","SUP","HCPCS C1713","","311.048.01S  -  TAP 8MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.054.01S","SUP","HCPCS C1713","","311.054.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 4MM SLFDRILL MNQK CPLNG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.056.01S","SUP","HCPCS C1713","","311.056.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 6MM SLFDRILL MNQK CPLNG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.056.97S","SUP","HCPCS C1713","","311.056.97S  -  TAP SURG 6MM STERILE 2MM RESORB CORTICAL SCREW","BOTH IP/OP","$700.20 ","$518.15 ","$0.00 ","$679.80 ","$305.91 ","$0.00 ","$145.94 ","$0.00 ","$0.00 ","$119.03 ","$679.80 ","$0.00 ","$339.90 ","$538.40 ","$543.84 ","$0.00 ","$103.29 ","$0.00 ","$108.22 ","$0.00 "
"311.058.01S","SUP","HCPCS C1713","","311.058.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 8MM SLFDRILL MNQK CPLNG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.060.01S","SUP","HCPCS C1713","","311.060.01S  -  TAP 4MM STOP SLFDRILL HEX CPLNG SURG 1.5MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.061.01S","SUP","HCPCS C1713","","311.061.01S  -  TAP 6MM STOP SLFDRILL HEX CPLNG SURG 1.5MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.062.01S","SUP","HCPCS C1713","","311.062.01S  -  TAP 3MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.063.01S","SUP","HCPCS C1713","","311.063.01S  -  TAP 4MM STOP SLFDRILL HEX CPLNG SURG 2MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.064.01S","SUP","HCPCS C1713","","311.064.01S  -  TAP 6MM STOP SLFDRILL HEX CPLNG SURG 2MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.065.01S","SUP","HCPCS C1713","","311.065.01S  -  TAP 2MM RESORB CORTEX SCR 8MM SLFDRILL HEX CPLNG STOP SURG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.067.01S","SUP","HCPCS C1713","","311.067.01S  -  TAP 4MM SLFDRILL HEX CPLNG STOP SURG 2MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.068.01S","SUP","HCPCS C1713","","311.068.01S  -  TAP 6MM SLFDRILL HEX CPLNG STOP SURG 2MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.069.01S","SUP","HCPCS C1713","","311.069.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 8MM SLFDRILL HEX CPLNG","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.071.01S","SUP","HCPCS C1713","","311.071.01S  -  TAP 4MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.072.01S","SUP","HCPCS C1713","","311.072.01S  -  TAP 6MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.073.01S","SUP","HCPCS C1713","","311.073.01S  -  TAP 8MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.093.01S","SUP","HCPCS C1713","","311.093.01S  -  TAP 5MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.094.01S","SUP","HCPCS C1713","","311.094.01S  -  TAP 8MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR","BOTH IP/OP","$751.50 ","$556.11 ","$0.00 ","$751.50 ","$338.18 ","$0.00 ","$156.63 ","$0.00 ","$0.00 ","$131.58 ","$751.50 ","$0.00 ","$375.75 ","$595.19 ","$601.20 ","$0.00 ","$117.61 ","$0.00 ","$119.64 ","$0.00 "
"311.100.01S","SUP","HCPCS C1713","","311.100.01S  -  TAP SLFDRILL ADJ LGTH SURG 1.5 MM SCR STRL","BOTH IP/OP","$1,021.50 ","$755.91 ","$0.00 ","$1,021.50 ","$459.68 ","$0.00 ","$212.91 ","$0.00 ","$0.00 ","$178.86 ","$1,021.50 ","$0.00 ","$510.75 ","$809.03 ","$817.20 ","$0.00 ","$159.86 ","$0.00 ","$162.62 ","$0.00 "
"311.101.01S","SUP","HCPCS C1713","","311.101.01S  -  TAP SLFDRILL ADJ LGTH SURG 2 MM SCR STRL","BOTH IP/OP","$1,021.50 ","$755.91 ","$0.00 ","$1,021.50 ","$459.68 ","$0.00 ","$212.91 ","$0.00 ","$0.00 ","$178.86 ","$1,021.50 ","$0.00 ","$510.75 ","$809.03 ","$817.20 ","$0.00 ","$159.86 ","$0.00 ","$162.62 ","$0.00 "
"311.102.01S","SUP","HCPCS C1713","","311.102.01S  -  TAP SLFDRILL ADJ LGTH SURG 2.5 MM SCR STRL","BOTH IP/OP","$1,021.50 ","$755.91 ","$0.00 ","$1,021.50 ","$459.68 ","$0.00 ","$212.91 ","$0.00 ","$0.00 ","$178.86 ","$1,021.50 ","$0.00 ","$510.75 ","$809.03 ","$817.20 ","$0.00 ","$159.86 ","$0.00 ","$162.62 ","$0.00 "
"311.110.01S","SUP","HCPCS C1713","","311.110.01S  -  TAP SLFDRILL HEX CPLNG ADJ SURG 1.5 MM RESORB CORTEX SCR","BOTH IP/OP","$1,021.50 ","$755.91 ","$0.00 ","$1,021.50 ","$459.68 ","$0.00 ","$212.91 ","$0.00 ","$0.00 ","$178.86 ","$1,021.50 ","$0.00 ","$510.75 ","$809.03 ","$817.20 ","$0.00 ","$159.86 ","$0.00 ","$162.62 ","$0.00 "
"311.111.01S","SUP","HCPCS C1713","","311.111.01S  -  TAP SLFDRILL HEX CPLNG ADJ SURG 2 MM RESORB CORTEX SCR STRL","BOTH IP/OP","$1,021.50 ","$755.91 ","$0.00 ","$1,021.50 ","$459.68 ","$0.00 ","$212.91 ","$0.00 ","$0.00 ","$178.86 ","$1,021.50 ","$0.00 ","$510.75 ","$809.03 ","$817.20 ","$0.00 ","$159.86 ","$0.00 ","$162.62 ","$0.00 "
"311.112.01S","SUP","HCPCS C1713","","311.112.01S  -  TAP SLFDRILL ADJ LGTH HEX CPLNG SURG 2.5 MM SCR STRL","BOTH IP/OP","$1,021.50 ","$755.91 ","$0.00 ","$1,021.50 ","$459.68 ","$0.00 ","$212.91 ","$0.00 ","$0.00 ","$178.86 ","$1,021.50 ","$0.00 ","$510.75 ","$809.03 ","$817.20 ","$0.00 ","$159.86 ","$0.00 ","$162.62 ","$0.00 "
"311.21.98","SUP","HCPCS C1713","","311.21.98  -  TAP LNG MNQK CPLNG SURG 2MM CORTEX SCR","BOTH IP/OP","$283.50 ","$209.79 ","$0.00 ","$283.50 ","$127.58 ","$0.00 ","$59.09 ","$0.00 ","$0.00 ","$49.64 ","$283.50 ","$0.00 ","$141.75 ","$224.53 ","$226.80 ","$0.00 ","$44.37 ","$0.00 ","$45.13 ","$0.00 "
"3120-0170S","SUP","HCPCS C1713","","3120-0170S  -  NAIL 10MM 170MM TROC HIP GAMMA3 IM 120D TI STRL","BOTH IP/OP","$2,710.65 ","$2,005.88 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$564.97 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3120-1180S","SUP","HCPCS C1713","","3120-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 120D TI STRL","BOTH IP/OP","$2,124.38 ","$1,572.04 ","$0.00 ","$2,124.38 ","$955.97 ","$0.00 ","$442.77 ","$0.00 ","$0.00 ","$371.96 ","$2,124.38 ","$0.00 ","$1,062.19 ","$1,682.51 ","$1,699.50 ","$0.00 ","$332.46 ","$0.00 ","$338.20 ","$0.00 "
"3125-0170S","SUP","HCPCS C1713","","3125-0170S  -  NAIL 10MM 170MM TROC HIP GAMMA3 IM 125D TI STRL","BOTH IP/OP","$2,710.65 ","$2,005.88 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$564.97 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3125-1180S","SUP","HCPCS C1713","","3125-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 125D TI STRL","BOTH IP/OP","$2,124.38 ","$1,572.04 ","$0.00 ","$2,124.38 ","$955.97 ","$0.00 ","$442.77 ","$0.00 ","$0.00 ","$371.96 ","$2,124.38 ","$0.00 ","$1,062.19 ","$1,682.51 ","$1,699.50 ","$0.00 ","$332.46 ","$0.00 ","$338.20 ","$0.00 "
"31287751A","SUP","Custom 27203010","","CABLE EKG 5 LEAD 12 PNDN PT MONITR D-1585","BOTH IP/OP","$327.50 ","$242.35 ","$0.00 ","$327.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3130-0170S","SUP","HCPCS C1713","","3130-0170S  -  NAIL 10MM 170MM HIP TROC GAMMA3 IM 130D KIT TI STRL","BOTH IP/OP","$2,710.65 ","$2,005.88 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$564.97 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3130-1180S","SUP","HCPCS C1713","","3130-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 130D TI STRL","BOTH IP/OP","$2,124.38 ","$1,572.04 ","$0.00 ","$2,124.38 ","$955.97 ","$0.00 ","$442.77 ","$0.00 ","$0.00 ","$371.96 ","$2,124.38 ","$0.00 ","$1,062.19 ","$1,682.51 ","$1,699.50 ","$0.00 ","$332.46 ","$0.00 ","$338.20 ","$0.00 "
"313-7034EA","SUP","Custom 27203010","","313-7034EA  -  MASK CPAP 02 RESQ BITRAC ED WITH 7.5 CM VALVE & FLOW GENERAT","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"314.746S","SUP","Custom 27203010","","314.746S  -  ASSEMBLY TUBE 520MM REAMER IRRIGATOR ASPIRAT STERILE","BOTH IP/OP","$824.18 ","$609.89 ","$0.00 ","$800.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$800.18 ","$0.00 ","$400.09 ","$633.74 ","$640.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31-462","SUP","HCPCS C1887","","31-462  -  CATHETER 5FR 65CM COBRA 1","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"31-466","SUP","HCPCS C1887","","31-466  -  CATHETER 5FR 65CM COBRA 2","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"315.40S","SUP","Custom 27203010","","315.40S  -  BIT DRILL 195MM 4MM QC 3 FLT STRL","BOTH IP/OP","$380.73 ","$281.74 ","$0.00 ","$369.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$369.65 ","$0.00 ","$184.83 ","$292.76 ","$295.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31560-950","SUP","Custom 27203010","","BULB SCP 3.5V FBROP LGHT HEAD ANOSCP SGSCP KLNSPC DISP","BOTH IP/OP","$1,092.50 ","$808.45 ","$0.00 ","$1,092.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,092.50 ","$0.00 ","$546.25 ","$865.26 ","$874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"315-92","SUP","Custom 27203010","","BIT DRILL 230MM 2.5MM 200MM CLBRT QC 3 FLT NSTRL","BOTH IP/OP","$456.10 ","$337.51 ","$0.00 ","$456.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$456.10 ","$0.00 ","$228.05 ","$361.23 ","$364.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.114.96","SUP","Custom 27203010","","316.114.96  -  BIT DRILL 14MM STOP .76MM 44.5MM J LATCH NONSTRL","BOTH IP/OP","$246.00 ","$182.04 ","$0.00 ","$238.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.83 ","$0.00 ","$119.41 ","$189.15 ","$191.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.235.96","SUP","Custom 27203010","","316.235.96  -  BIT DRILL 35MM STOP 1MM 60MM J LATCH NONSTRL","BOTH IP/OP","$246.00 ","$182.04 ","$0.00 ","$238.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.83 ","$0.00 ","$119.41 ","$189.15 ","$191.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"316.335.96","SUP","Custom 27203010","","316.335.96  -  BIT DRILL 40MM STOP 1.3MM 65MM J LATCH NONSTRL","BOTH IP/OP","$246.00 ","$182.04 ","$0.00 ","$238.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.83 ","$0.00 ","$119.41 ","$189.15 ","$191.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.235.96","SUP","Custom 27203010","","317.235.96  -  BIT DRILL 40MM STOP 1.1MM 65MM J LATCH TITANIUM NONSTRL","BOTH IP/OP","$246.00 ","$182.04 ","$0.00 ","$238.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.83 ","$0.00 ","$119.41 ","$189.15 ","$191.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"317.435.96","SUP","Custom 27203010","","317.435.96  -  BIT DRILL 60MM STOP 1.5MM 85MM J LATCH NONSTRL","BOTH IP/OP","$246.00 ","$182.04 ","$0.00 ","$238.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$238.83 ","$0.00 ","$119.41 ","$189.15 ","$191.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"319416AM","SUP","Custom 27203010","","319416AM  -  TRAY CATHETERIZATION 16FR 2 CONCTR TEMPERATURE SENSE","BOTH IP/OP","$66.48 ","$49.20 ","$0.00 ","$68.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.56 ","$0.00 ","$34.28 ","$54.30 ","$54.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31AJ-501","SUP","Custom 27803010","","31AJ-501  -  VALVE AORTIC 85D 5.18SQ CM 31MM 26.1MM MECHANICAL HEART","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"31MJ-501","SUP","Custom 27803010","","31MJ-501  -  VALVE MTRL 85D 5.18SQ CM STD 31MM 26.1MM MSTR-SER CUF LFLT","BOTH IP/OP","$17,425.00 ","$12,894.50 ","$0.00 ","$17,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,425.00 ","$0.00 ","$8,712.50 ","$13,800.60 ","$13,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3220-0240S","SUP","HCPCS C1713","","3220-0240S  -  NAIL 11MM 240MM RIGHT FEM HIP GAMMA3 IM 120D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3220-0260S","SUP","HCPCS C1713","","3220-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 120D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3220-0280S","SUP","HCPCS C1713","","3220-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3220-0300S","SUP","HCPCS C1713","","3220-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0320S","SUP","HCPCS C1713","","3220-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0340S","SUP","HCPCS C1713","","3220-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0360S","SUP","HCPCS C1713","","3220-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0380S","SUP","HCPCS C1713","","3220-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0400S","SUP","HCPCS C1713","","3220-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0420S","SUP","HCPCS C1713","","3220-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0440S","SUP","HCPCS C1713","","3220-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3220-0460S","SUP","HCPCS C1713","","3220-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3220-3340S","SUP","HCPCS C1713","","3220-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-3360S","SUP","HCPCS C1713","","3220-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-3380S","SUP","HCPCS C1713","","3220-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-3400S","SUP","HCPCS C1713","","3220-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-3420S","SUP","HCPCS C1713","","3220-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-3440S","SUP","HCPCS C1713","","3220-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-3460S","SUP","HCPCS C1713","","3220-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5340S","SUP","HCPCS C1713","","3220-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5360S","SUP","HCPCS C1713","","3220-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5380S","SUP","HCPCS C1713","","3220-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5400S","SUP","HCPCS C1713","","3220-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5420S","SUP","HCPCS C1713","","3220-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5440S","SUP","HCPCS C1713","","3220-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3220-5460S","SUP","HCPCS C1713","","3220-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"32-250","SUP","HCPCS C1713","","32-250  -  HOLDER NDL CRV 9IN STRATTE INS SHNK TC","BOTH IP/OP","$373.33 ","$276.26 ","$0.00 ","$373.33 ","$168.00 ","$0.00 ","$77.81 ","$0.00 ","$0.00 ","$65.37 ","$373.33 ","$0.00 ","$186.66 ","$295.68 ","$298.66 ","$0.00 ","$58.43 ","$0.00 ","$59.43 ","$0.00 "
"3225-0240S","SUP","HCPCS C1713","","3225-0240S  -  NAIL 11MM 240MM HIP RIGHT GAMMA3 IM 125D LNG","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3225-0260S","SUP","HCPCS C1713","","3225-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,688.13 ","$1,989.22 ","$0.00 ","$2,688.13 ","$1,209.66 ","$0.00 ","$560.27 ","$0.00 ","$0.00 ","$470.67 ","$2,688.13 ","$0.00 ","$1,344.06 ","$2,129.00 ","$2,150.50 ","$0.00 ","$420.69 ","$0.00 ","$427.95 ","$0.00 "
"3225-0280S","SUP","HCPCS C1713","","3225-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3225-0300S","SUP","HCPCS C1713","","3225-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0320S","SUP","HCPCS C1713","","3225-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0340S","SUP","HCPCS C1713","","3225-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0360S","SUP","HCPCS C1713","","3225-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0380S","SUP","HCPCS C1713","","3225-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0400S","SUP","HCPCS C1713","","3225-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0420S","SUP","HCPCS C1713","","3225-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0440S","SUP","HCPCS C1713","","3225-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3225-0460S","SUP","HCPCS C1713","","3225-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3225-3300S","SUP","HCPCS C1713","","3225-3300S  -  NAIL 13MM 300MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,688.13 ","$1,989.22 ","$0.00 ","$2,688.13 ","$1,209.66 ","$0.00 ","$560.27 ","$0.00 ","$0.00 ","$470.67 ","$2,688.13 ","$0.00 ","$1,344.06 ","$2,129.00 ","$2,150.50 ","$0.00 ","$420.69 ","$0.00 ","$427.95 ","$0.00 "
"3225-3320S","SUP","HCPCS C1713","","3225-3320S  -  NAIL 13MM 32CM HIP RIGHT FEM GAMMA3 IM 125D LNG TI STRL","BOTH IP/OP","$2,688.13 ","$1,989.22 ","$0.00 ","$2,688.13 ","$1,209.66 ","$0.00 ","$560.27 ","$0.00 ","$0.00 ","$470.67 ","$2,688.13 ","$0.00 ","$1,344.06 ","$2,129.00 ","$2,150.50 ","$0.00 ","$420.69 ","$0.00 ","$427.95 ","$0.00 "
"3225-3340S","SUP","HCPCS C1713","","3225-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-3360S","SUP","HCPCS C1713","","3225-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-3380S","SUP","HCPCS C1713","","3225-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-3400S","SUP","HCPCS C1713","","3225-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-3420S","SUP","HCPCS C1713","","3225-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-3440S","SUP","HCPCS C1713","","3225-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-3460S","SUP","HCPCS C1713","","3225-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5300S","SUP","HCPCS C1713","","3225-5300S  -  NAIL 15MM 300MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3225-5320S","SUP","HCPCS C1713","","3225-5320S  -  NAIL 15MM 320MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3225-5340S","SUP","HCPCS C1713","","3225-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5360S","SUP","HCPCS C1713","","3225-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5380S","SUP","HCPCS C1713","","3225-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5400S","SUP","HCPCS C1713","","3225-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5420S","SUP","HCPCS C1713","","3225-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5440S","SUP","HCPCS C1713","","3225-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3225-5460S","SUP","HCPCS C1713","","3225-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-0240S","SUP","HCPCS C1713","","3230-0240S  -  NAIL 11MM 240MM RIGHT FEM HIP GAMMA3 IM LNG 130D STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3230-0260S","SUP","HCPCS C1713","","3230-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 130D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3230-0280S","SUP","HCPCS C1713","","3230-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3230-0300S","SUP","HCPCS C1713","","3230-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0320S","SUP","HCPCS C1713","","3230-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0340S","SUP","HCPCS C1713","","3230-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0360S","SUP","HCPCS C1713","","3230-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0380S","SUP","HCPCS C1713","","3230-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0400S","SUP","HCPCS C1713","","3230-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0420S","SUP","HCPCS C1713","","3230-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0440S","SUP","HCPCS C1713","","3230-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-0460S","SUP","HCPCS C1713","","3230-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3230-3300S","SUP","HCPCS C1713","","3230-3300S  -  NAIL 13MM 300MM RIGHT FEM HIP GAMMA3 IM 130D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3230-3320S","SUP","HCPCS C1713","","3230-3320S  -  NAIL 13MM 32CM HIP RIGHT GAMMA3 IM LNG 130D","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3230-3340S","SUP","HCPCS C1713","","3230-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-3360S","SUP","HCPCS C1713","","3230-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-3380S","SUP","HCPCS C1713","","3230-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-3400S","SUP","HCPCS C1713","","3230-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-3420S","SUP","HCPCS C1713","","3230-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-3440S","SUP","HCPCS C1713","","3230-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-3460S","SUP","HCPCS C1713","","3230-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"323040R","SUP","Custom 27803010","","323040R  -  KEEL LARYNGEAL 12MM UMBRELLA SHAPE RADIOPQ MONTGOMERY","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"323050R","SUP","Custom 27803010","","323050R  -  KEEL LARYNGEAL 14MM UMBRELLA SHAPE RADIOPQ MONTGOMERY","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3230-5340S","SUP","HCPCS C1713","","3230-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-5360S","SUP","HCPCS C1713","","3230-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-5380S","SUP","HCPCS C1713","","3230-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-5400S","SUP","HCPCS C1713","","3230-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-5420S","SUP","HCPCS C1713","","3230-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-5440S","SUP","HCPCS C1713","","3230-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3230-5460S","SUP","HCPCS C1713","","3230-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"325014S","SUP","HCPCS C1713","","325014S  -  SCREW BN P/T LOPRFL RVRS CUT FLUT FLT HEX 4MM 5MM 14MM STRL","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325016S","SUP","HCPCS C1713","","325016S  -  SCREW BONE 4MM 16MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325018S","SUP","HCPCS C1713","","325018S  -  SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325020S","SUP","HCPCS C1713","","325020S  -  SCREW BONE 4MM 20MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325022S","SUP","HCPCS C1713","","325022S  -  SCREW BONE 4MM 22MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325024S","SUP","HCPCS C1713","","325024S  -  SCREW BONE 4MM 24MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325026S","SUP","HCPCS C1713","","325026S  -  SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325028S","SUP","HCPCS C1713","","325028S  -  SCREW BN 4MM 28MM STRL 9.5MM ASNS III SLF DRL ST CNN SS HIP","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325030S","SUP","HCPCS C1713","","325030S  -  SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$120.04 ","$0.00 ","$55.60 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"325210S","SUP","HCPCS C1713","","325210S  -  SCREW BONE 4MM 10MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325212S","SUP","HCPCS C1713","","325212S  -  SCREW BONE 4MM 12MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325214S","SUP","HCPCS C1713","","325214S  -  SCREW BONE 4MM 14MM ASNS 3 SS FULTHRD CANN IMPL STRL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325216S","SUP","HCPCS C1713","","325216S  -  SCREW BONE 4MM 16MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325218S","SUP","HCPCS C1713","","325218S  -  SCREW BONE 4MM 18MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325220S","SUP","HCPCS C1713","","325220S  -  SCREW BONE 4MM 20MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325222S","SUP","HCPCS C1713","","325222S  -  SCREW BONE 4MM 22MM ASNS 3 SS FULTHRD CANN IMPL STRL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325224S","SUP","HCPCS C1713","","325224S  -  SCREW BONE 4MM 24MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325226S","SUP","HCPCS C1713","","325226S  -  SCREW BONE 4MM 26MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325228S","SUP","HCPCS C1713","","325228S  -  SCREW BONE 4MM 28MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325230S","SUP","HCPCS C1713","","325230S  -  SCREW BONE 4MM 30MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325232S","SUP","HCPCS C1713","","325232S  -  SCREW BONE 4MM 32MM ASNS 3 SS CANN","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325234S","SUP","HCPCS C1713","","325234S  -  SCREW BONE 4MM 34MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325236S","SUP","HCPCS C1713","","325236S  -  SCREW BONE 4MM 36MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325238S","SUP","HCPCS C1713","","325238S  -  SCREW BONE 4MM 38MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325240S","SUP","HCPCS C1713","","325240S  -  SCREW BONE 4MM 40MM ASNS 3 SS FULTHD HIP CANN SLFTAP","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325242S","SUP","HCPCS C1713","","325242S  -  SCREW BONE 4MM 42MM ASNS 3 SS CANN","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325244S","SUP","HCPCS C1713","","325244S  -  SCREW BONE 4MM 44MM ASNS 3 SS FULTHD HIP CANN SLFTAP","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325246S","SUP","HCPCS C1713","","325246S  -  SCREW BONE 4MM 46MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325248S","SUP","HCPCS C1713","","325248S  -  SCREW BONE 4MM 48MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325250S","SUP","HCPCS C1713","","325250S  -  SCREW BONE 4MM 50MM ASNS 3 SS PTHRD HIP CANN STRL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"325260S","SUP","HCPCS C1713","","325260S  -  SCREW BONE 6.5MM 60MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325265S","SUP","HCPCS C1713","","325265S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$206.25 ","$152.63 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$42.99 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325270S","SUP","HCPCS C1713","","325270S  -  SCREW BONE 6.5MM 70MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$206.25 ","$152.63 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$42.99 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"325422S","SUP","HCPCS C1713","","325422S  -  SCREW BONE 5MM 22MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325424S","SUP","HCPCS C1713","","325424S  -  SCREW BONE 5MM 24MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325426S","SUP","HCPCS C1713","","325426S  -  SCREW BONE 5MM 26MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325428S","SUP","HCPCS C1713","","325428S  -  SCREW BONE 5MM 28MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325430S","SUP","HCPCS C1713","","325430S  -  SCREW BONE 5MM 30MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325432S","SUP","HCPCS C1713","","325432S  -  SCREW BONE 5MM 32MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325434S","SUP","HCPCS C1713","","325434S  -  SCREW BONE 5MM 34MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325436S","SUP","HCPCS C1713","","325436S  -  SCREW BONE 5MM 36MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325438S","SUP","HCPCS C1713","","325438S  -  SCREW BONE 5MM 38MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325440S","SUP","HCPCS C1713","","325440S  -  SCREW BONE 5MM 40MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325442S","SUP","HCPCS C1713","","325442S  -  SCREW BONE 5MM 42MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325444S","SUP","HCPCS C1713","","325444S  -  SCREW BONE 5MM 44MM ASNS 3 SS CANN","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325446S","SUP","HCPCS C1713","","325446S  -  SCREW BONE 5MM 46MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325448S","SUP","HCPCS C1713","","325448S  -  SCREW BONE 5MM 48MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325450S","SUP","HCPCS C1713","","325450S  -  SCREW BONE 5MM 50MM 17MM ASNS 3 SS CANN PTHRD SLFDRILL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325455S","SUP","HCPCS C1713","","325455S  -  SCREW BONE 5MM 55MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325460S","SUP","HCPCS C1713","","325460S  -  SCREW BONE 5MM 60MM ASNS 3 SS PTHRD HIP CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325465S","SUP","HCPCS C1713","","325465S  -  SCREW BONE 5MM 65MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325470S","SUP","HCPCS C1713","","325470S  -  SCREW BONE 5MM 70MM ASNS 3 SS ORTH CANN PTHRD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325475S","SUP","HCPCS C1713","","325475S  -  SCREW BONE 5MM 75MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325480S","SUP","HCPCS C1713","","325480S  -  SCREW BONE 5MM 80MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325620S","SUP","HCPCS C1713","","325620S  -  SCREW BONE 5MM 20MM ASNS 3 SS CANN","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325622S","SUP","HCPCS C1713","","325622S  -  SCREW BONE 5MM 22MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325624S","SUP","HCPCS C1713","","325624S  -  SCREW BONE 5MM 24MM ASNS 3 SS FULTHD CANN SLFDRILL TAP","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325626S","SUP","HCPCS C1713","","325626S  -  SCREW BONE 5MM 26MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325628S","SUP","HCPCS C1713","","325628S  -  SCREW BONE 5MM 28MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
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"325638S","SUP","HCPCS C1713","","325638S  -  SCREW BONE 5MM 38MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
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"325642S","SUP","HCPCS C1713","","325642S  -  SCREW BONE 5MM 42MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325644S","SUP","HCPCS C1713","","325644S  -  SCREW BONE 5MM 44MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325646S","SUP","HCPCS C1713","","325646S  -  SCREW BONE 5MM 46MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325650S","SUP","HCPCS C1713","","325650S  -  SCREW BONE 5MM 50MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325655S","SUP","HCPCS C1713","","325655S  -  SCREW BONE 5MM 55MM ASNS 3 SS FULTHD HIP CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325660S","SUP","HCPCS C1713","","325660S  -  SCREW BONE 5MM 60MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325665S","SUP","HCPCS C1713","","325665S  -  SCREW BONE 5MM 65MM ASNS 3 SS FULTHD ORTH CANN STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"325670S","SUP","HCPCS C1713","","325670S  -  SCREW BONE 5MM 70MM ASNS 3 SS ORTH CANN FULTHD STRL","BOTH IP/OP","$299.75 ","$221.82 ","$0.00 ","$299.75 ","$134.89 ","$0.00 ","$62.48 ","$0.00 ","$0.00 ","$52.48 ","$299.75 ","$0.00 ","$149.88 ","$237.40 ","$239.80 ","$0.00 ","$46.91 ","$0.00 ","$47.72 ","$0.00 "
"326040S","SUP","HCPCS C1713","","326040S  -  SCREW BONE 6.5MM 40MM 20MM ASNS 3 SS ORTH SLFTAP SLFDRILL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326045S","SUP","HCPCS C1713","","326045S  -  SCREW BONE 6.5MM 45MM ASNS 3 SS ORTH CANN THRD STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326050S","SUP","HCPCS C1713","","326050S  -  SCREW BONE 6.5MM 50MM ASNS 3 SS ORTH CANN THRD STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326055S","SUP","HCPCS C1713","","326055S  -  SCREW BONE 6.5MM 55MM ASNS 3 SS ORTH CANN THRD STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326060S","SUP","HCPCS C1713","","326060S  -  SCREW BONE 6.5MM 60MM 20MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326065S","SUP","HCPCS C1713","","326065S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS ORTH CANN THRD STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326070S","SUP","HCPCS C1713","","326070S  -  SCREW BONE 6.5MM 70MM 20MM ASNS SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326075S","SUP","HCPCS C1713","","326075S  -  SCREW BONE 6.5MM 75MM 20MM ASNS SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326080S","SUP","HCPCS C1713","","326080S  -  SCREW BONE 6.5MM 80MM 20MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326085S","SUP","HCPCS C1713","","326085S  -  SCREW BONE 6.5MM 85MM 20MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326090S","SUP","HCPCS C1713","","326090S  -  SCREW BONE 6.5MM 90MM 20MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326095S","SUP","HCPCS C1713","","326095S  -  SCREW BONE 6.5MM 95MM 20MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326100S","SUP","HCPCS C1713","","326100S  -  SCREW BONE 6.5MM 100MM 20MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326105S","SUP","HCPCS C1713","","326105S  -  SCREW BONE 6.5MM 105MM 20MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326110S","SUP","HCPCS C1713","","326110S  -  SCREW BONE 6.5MM 110MM 20MM ASNS SS FEM HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326115S","SUP","HCPCS C1713","","326115S  -  SCREW BONE 6.5MM 115MM 20MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326120S","SUP","HCPCS C1713","","326120S  -  SCREW BONE 6.5MM 120MM 20MM ASNS 3 SS ORTH SLFTAP SLFDRILL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326255S","SUP","HCPCS C1713","","326255S  -  SCREW BONE 6.5MM 55MM 40MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326260S","SUP","HCPCS C1713","","326260S  -  SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326265S","SUP","HCPCS C1713","","326265S  -  SCREW BONE 6.5MM 65MM 40MM ASNS SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326270S","SUP","HCPCS C1713","","326270S  -  SCREW BONE 6.5MM 70MM 40MM ASNS SS PTHRD ORTH CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326275S","SUP","HCPCS C1713","","326275S  -  SCREW BONE 6.5MM 75MM 40MM ASNS 3 SS ORTH SLFTAP SLFDRILL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326280S","SUP","HCPCS C1713","","326280S  -  SCREW BONE 6.5MM 80MM 40MM ASNS 3 SS PTHRD HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326285S","SUP","HCPCS C1713","","326285S  -  SCREW BONE 6.5MM 85MM 40MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326290S","SUP","HCPCS C1713","","326290S  -  SCREW BONE 6.5MM 90MM 40MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326295S","SUP","HCPCS C1713","","326295S  -  SCREW BONE 6.5MM 95MM 20MM ASNS 3 SS HIP CANN THRD IMPL STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326300S","SUP","HCPCS C1713","","326300S  -  SCREW BONE 6.5MM 100MM 40MM ASNS 3 SS HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326305S","SUP","HCPCS C1713","","326305S  -  SCREW BONE 6.5MM 105MM 40MM ASNS SS FEM HIP CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326310S","SUP","HCPCS C1713","","326310S  -  SCREW BONE 6.5MM 110MM 40MM ASNS SS CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326315S","SUP","HCPCS C1713","","326315S  -  SCREW BONE 6.5MM 115MM 40MM ASNS SS CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326320S","SUP","HCPCS C1713","","326320S  -  SCREW BONE 6.5MM 120MM 40MM ASNS SS CANN STRL","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"326325S","SUP","HCPCS C1713","","326325S  -  ASNIS III SS CANN SCR6.5X125MM","BOTH IP/OP","$436.90 ","$323.31 ","$0.00 ","$440.00 ","$198.00 ","$0.00 ","$91.06 ","$0.00 ","$0.00 ","$77.04 ","$440.00 ","$0.00 ","$220.00 ","$348.48 ","$352.00 ","$0.00 ","$68.86 ","$0.00 ","$70.05 ","$0.00 "
"326330S","SUP","HCPCS C1713","","326330S  -  ASNIS III SS CANN SCR6.5X130MM","BOTH IP/OP","$436.90 ","$323.31 ","$0.00 ","$440.00 ","$198.00 ","$0.00 ","$91.06 ","$0.00 ","$0.00 ","$77.04 ","$440.00 ","$0.00 ","$220.00 ","$348.48 ","$352.00 ","$0.00 ","$68.86 ","$0.00 ","$70.05 ","$0.00 "
"326430S","SUP","HCPCS C1713","","326430S  -  SCREW BONE 6.5MM 30MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
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"326725S","SUP","HCPCS C1713","","326725S  -  SCREW BONE 8MM 125MM 25MM ASNS 3 SS HIP STRL","BOTH IP/OP","$436.90 ","$323.31 ","$0.00 ","$728.75 ","$327.94 ","$0.00 ","$91.06 ","$0.00 ","$0.00 ","$127.60 ","$728.75 ","$0.00 ","$364.38 ","$577.17 ","$583.00 ","$0.00 ","$114.05 ","$0.00 ","$116.02 ","$0.00 "
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"326885S","SUP","HCPCS C1713","","326885S  -  SCREW BONE 8MM 85MM ASNS 3 TI ORTH CANN PTHRD STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
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"326895S","SUP","HCPCS C1713","","326895S  -  SCREW BONE 8MM 95MM ASNS 3 SS FULTHD HIP CANN STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"326900S","SUP","HCPCS C1713","","326900S  -  SCREW BONE 8MM 100MM ASNS 3 SS FULTHD HIP CANN STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"326905S","SUP","HCPCS C1713","","326905S  -  SCREW BONE 8MM 105MM ASNS 3 SS FULTHD HIP CANN STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"326910S","SUP","HCPCS C1713","","326910S  -  SCREW BONE 8MM 110MM ASNS 3 SS FULTHD HIP CANN STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"326915S","SUP","HCPCS C1713","","326915S  -  SCREW BONE 8MM 115MM ASNS 3 SS FEM HIP CANN STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"326920S","SUP","HCPCS C1713","","326920S  -  SCREW BONE 8MM 120MM ASNS 3 TI ORTH CANN PTHRD STRL","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"326925S","SUP","HCPCS C1713","","326925S  -  SCREW BONE 8MM 125MM ASNS 3 SS FULTHRD STRL","BOTH IP/OP","$385.50 ","$285.27 ","$0.00 ","$378.13 ","$170.16 ","$0.00 ","$80.35 ","$0.00 ","$0.00 ","$66.21 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$59.18 ","$0.00 ","$60.20 ","$0.00 "
"326930S","SUP","HCPCS C1713","","326930S  -  SCREW BONE 8MM 130MM ASNS 3 SS FULTHRD CANN STRL","BOTH IP/OP","$385.50 ","$285.27 ","$0.00 ","$378.13 ","$170.16 ","$0.00 ","$80.35 ","$0.00 ","$0.00 ","$66.21 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$59.18 ","$0.00 ","$60.20 ","$0.00 "
"327-1010","SUP","HCPCS C1713","","327-1010  -  SCREW BN 2.7MM 10MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1012","SUP","HCPCS C1713","","327-1012  -  SCREW BN 2.7MM 12MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1014","SUP","HCPCS C1713","","327-1014  -  SCREW BN 2.7MM 14MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1016","SUP","HCPCS C1713","","327-1016  -  SCREW BN 2.7MM 16MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1018","SUP","HCPCS C1713","","327-1018  -  SCREW BN 2.7MM 18MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1020","SUP","HCPCS C1713","","327-1020  -  SCREW BN 2.7MM 20MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1022","SUP","HCPCS C1713","","327-1022  -  SCREW BN 2.7MM 22MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1024","SUP","HCPCS C1713","","327-1024  -  SCREW BN 2.7MM 24MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1026","SUP","HCPCS C1713","","327-1026  -  SCREW BN 2.7MM 26MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1028","SUP","HCPCS C1713","","327-1028  -  SCREW BN 2.7MM 28MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1030","SUP","HCPCS C1713","","327-1030  -  SCREW BN 2.7MM 30MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"327-1032","SUP","HCPCS C1713","","327-1032  -  SCREW BN 2.7MM 32MM ST CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"3300TFX19MM","SUP","Custom 27803010","","3300TFX19MM  -  VALVE AOR LOPRFL 19MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3300TFX21MM","SUP","Custom 27803010","","3300TFX21MM  -  VALVE AOR 21MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH SUP","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3300TFX23MM","SUP","Custom 27803010","","3300TFX23MM  -  VALVE AOR 23MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH STNT BS","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3300TFX25MM","SUP","Custom 27803010","","3300TFX25MM  -  VALVE AORTIC LP 25MM BIOPROSTHESIS THERMAFIX PROCESS STENT","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3300TFX27MM","SUP","Custom 27803010","","3300TFX27MM  -  VALVE AORTIC LP 27MM BIOPROSTHESIS THERMAFIX PROCESS STENT","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3300TFX29MM","SUP","Custom 27803010","","3300TFX29MM  -  VALVE AOR LOPRFL 29MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3304-G","SUP","Custom 27203010","","3304-G  -  RING RTRCTR LNSTR NORYL RSN PLST CATH CLIP DISP STRL LATEX","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3307-G","SUP","Custom 27203010","","3307-G  -  RING RTRCTR SM G2 NORYL RSN W/O STAY KIT RCTL BLUE DISP STRL","BOTH IP/OP","$121.28 ","$89.75 ","$0.00 ","$121.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$121.28 ","$0.00 ","$60.64 ","$96.05 ","$97.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"331 443","SUP","HCPCS C1900","","331 443  -  PHILOS DR","BOTH IP/OP","$7,250.00 ","$5,365.00 ","$0.00 ","$7,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,250.00 ","$0.00 ","$3,625.00 ","$5,742.00 ","$5,800.00 ","$0.00 ","$1,134.63 ","$0.00 ","$0.00 ","$0.00 "
"331 446","SUP","HCPCS C1900","","331 446  -  PHILOS SR","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$1,095.50 ","$0.00 ","$0.00 ","$0.00 "
"3320-0240S","SUP","HCPCS C1713","","3320-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 120D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3320-0260S","SUP","HCPCS C1713","","3320-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 120D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3320-0280S","SUP","HCPCS C1713","","3320-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3320-0300S","SUP","HCPCS C1713","","3320-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0320S","SUP","HCPCS C1713","","3320-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0340S","SUP","HCPCS C1713","","3320-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0360S","SUP","HCPCS C1713","","3320-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0380S","SUP","HCPCS C1713","","3320-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0400S","SUP","HCPCS C1713","","3320-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0420S","SUP","HCPCS C1713","","3320-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0440S","SUP","HCPCS C1713","","3320-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3320-0460S","SUP","HCPCS C1713","","3320-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3320-3340S","SUP","HCPCS C1713","","3320-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-3360S","SUP","HCPCS C1713","","3320-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-3380S","SUP","HCPCS C1713","","3320-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-3400S","SUP","HCPCS C1713","","3320-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-3420S","SUP","HCPCS C1713","","3320-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-3440S","SUP","HCPCS C1713","","3320-3440S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-3460S","SUP","HCPCS C1713","","3320-3460S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5340S","SUP","HCPCS C1713","","3320-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5360S","SUP","HCPCS C1713","","3320-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5380S","SUP","HCPCS C1713","","3320-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5400S","SUP","HCPCS C1713","","3320-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5420S","SUP","HCPCS C1713","","3320-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5440S","SUP","HCPCS C1713","","3320-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3320-5460S","SUP","HCPCS C1713","","3320-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-0240S","SUP","HCPCS C1713","","3325-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3325-0260S","SUP","HCPCS C1713","","3325-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,688.13 ","$1,989.22 ","$0.00 ","$2,688.13 ","$1,209.66 ","$0.00 ","$560.27 ","$0.00 ","$0.00 ","$470.67 ","$2,688.13 ","$0.00 ","$1,344.06 ","$2,129.00 ","$2,150.50 ","$0.00 ","$420.69 ","$0.00 ","$427.95 ","$0.00 "
"3325-0280S","SUP","HCPCS C1713","","3325-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3325-0300S","SUP","HCPCS C1713","","3325-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0320S","SUP","HCPCS C1713","","3325-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0340S","SUP","HCPCS C1713","","3325-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0360S","SUP","HCPCS C1713","","3325-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0380S","SUP","HCPCS C1713","","3325-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0400S","SUP","HCPCS C1713","","3325-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0420S","SUP","HCPCS C1713","","3325-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0440S","SUP","HCPCS C1713","","3325-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3325-0460S","SUP","HCPCS C1713","","3325-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3325-3280S","SUP","HCPCS C1713","","3325-3280S  -  NAIL 13MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3325-3300S","SUP","HCPCS C1713","","3325-3300S  -  NAIL 13MM 30CM HIP LEFT GAMMA3 IM 125D LNG TI STRL","BOTH IP/OP","$2,688.13 ","$1,989.22 ","$0.00 ","$2,688.13 ","$1,209.66 ","$0.00 ","$560.27 ","$0.00 ","$0.00 ","$470.67 ","$2,688.13 ","$0.00 ","$1,344.06 ","$2,129.00 ","$2,150.50 ","$0.00 ","$420.69 ","$0.00 ","$427.95 ","$0.00 "
"3325-3320S","SUP","HCPCS C1713","","3325-3320S  -  NAIL 13MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,688.13 ","$1,989.22 ","$0.00 ","$2,688.13 ","$1,209.66 ","$0.00 ","$560.27 ","$0.00 ","$0.00 ","$470.67 ","$2,688.13 ","$0.00 ","$1,344.06 ","$2,129.00 ","$2,150.50 ","$0.00 ","$420.69 ","$0.00 ","$427.95 ","$0.00 "
"3325-3340S","SUP","HCPCS C1713","","3325-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-3360S","SUP","HCPCS C1713","","3325-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-3380S","SUP","HCPCS C1713","","3325-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-3400S","SUP","HCPCS C1713","","3325-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-3420S","SUP","HCPCS C1713","","3325-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-3440S","SUP","HCPCS C1713","","3325-3440S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-3460S","SUP","HCPCS C1713","","3325-3460S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5280S","SUP","HCPCS C1713","","3325-5280S  -  NAIL 15MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3325-5300S","SUP","HCPCS C1713","","3325-5300S  -  NAIL 15MM 300MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3325-5320S","SUP","HCPCS C1713","","3325-5320S  -  NAIL 15MM 320MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3325-5340S","SUP","HCPCS C1713","","3325-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5360S","SUP","HCPCS C1713","","3325-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5380S","SUP","HCPCS C1713","","3325-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5400S","SUP","HCPCS C1713","","3325-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5420S","SUP","HCPCS C1713","","3325-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5440S","SUP","HCPCS C1713","","3325-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3325-5460S","SUP","HCPCS C1713","","3325-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-0240S","SUP","HCPCS C1713","","3330-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3330-0260S","SUP","HCPCS C1713","","3330-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3330-0280S","SUP","HCPCS C1713","","3330-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3330-0300S","SUP","HCPCS C1713","","3330-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0320S","SUP","HCPCS C1713","","3330-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0340S","SUP","HCPCS C1713","","3330-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0360S","SUP","HCPCS C1713","","3330-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0380S","SUP","HCPCS C1713","","3330-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG KIT TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0400S","SUP","HCPCS C1713","","3330-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0420S","SUP","HCPCS C1713","","3330-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0440S","SUP","HCPCS C1713","","3330-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,093.75 ","$2,289.38 ","$0.00 ","$3,093.75 ","$1,392.19 ","$0.00 ","$644.81 ","$0.00 ","$0.00 ","$541.69 ","$3,093.75 ","$0.00 ","$1,546.88 ","$2,450.25 ","$2,475.00 ","$0.00 ","$484.17 ","$0.00 ","$492.53 ","$0.00 "
"3330-0460S","SUP","HCPCS C1713","","3330-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$2,798.13 ","$2,070.62 ","$0.00 ","$2,798.13 ","$1,259.16 ","$0.00 ","$583.20 ","$0.00 ","$0.00 ","$489.93 ","$2,798.13 ","$0.00 ","$1,399.06 ","$2,216.12 ","$2,238.50 ","$0.00 ","$437.91 ","$0.00 ","$445.46 ","$0.00 "
"3330-3300S","SUP","HCPCS C1713","","3330-3300S  -  NAIL 13MM 300MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3330-3320S","SUP","HCPCS C1713","","3330-3320S  -  NAIL 13MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL","BOTH IP/OP","$2,447.50 ","$1,811.15 ","$0.00 ","$2,447.50 ","$1,101.38 ","$0.00 ","$510.12 ","$0.00 ","$0.00 ","$428.54 ","$2,447.50 ","$0.00 ","$1,223.75 ","$1,938.42 ","$1,958.00 ","$0.00 ","$383.03 ","$0.00 ","$389.64 ","$0.00 "
"3330-3340S","SUP","HCPCS C1713","","3330-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-3360S","SUP","HCPCS C1713","","3330-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-3380S","SUP","HCPCS C1713","","3330-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-3400S","SUP","HCPCS C1713","","3330-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-3420S","SUP","HCPCS C1713","","3330-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-3440S","SUP","HCPCS C1713","","3330-3440S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-3460S","SUP","HCPCS C1713","","3330-3460S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5340S","SUP","HCPCS C1713","","3330-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5360S","SUP","HCPCS C1713","","3330-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5380S","SUP","HCPCS C1713","","3330-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5400S","SUP","HCPCS C1713","","3330-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5420S","SUP","HCPCS C1713","","3330-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5440S","SUP","HCPCS C1713","","3330-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"3330-5460S","SUP","HCPCS C1713","","3330-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,293.13 ","$2,436.92 ","$0.00 ","$3,293.13 ","$1,481.91 ","$0.00 ","$686.37 ","$0.00 ","$0.00 ","$576.60 ","$3,293.13 ","$0.00 ","$1,646.56 ","$2,608.16 ","$2,634.50 ","$0.00 ","$515.37 ","$0.00 ","$524.27 ","$0.00 "
"333-070-003","SUP","Custom 27203010","","333-070-003  -  OBT ENDSCP 70MM DRAIN CANNU","BOTH IP/OP","$203.06 ","$150.26 ","$0.00 ","$203.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.06 ","$0.00 ","$101.53 ","$160.82 ","$162.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"334 051","SUP","HCPCS C1900","","334 051  -  PHILOS SR SYSTEM","BOTH IP/OP","$8,000.00 ","$5,920.00 ","$0.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,000.00 ","$0.00 ","$4,000.00 ","$6,336.00 ","$6,400.00 ","$0.00 ","$1,252.00 ","$0.00 ","$0.00 ","$0.00 "
"335-1012","SUP","HCPCS C1713","","335-1012  -  SCREW BN 3.5MM 12MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1014","SUP","HCPCS C1713","","335-1014  -  SCREW BN 3.5MM 14MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1016","SUP","HCPCS C1713","","335-1016  -  SCREW BN 3.5MM 16MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1018","SUP","HCPCS C1713","","335-1018  -  SCREW BN 3.5MM 18MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1020","SUP","HCPCS C1713","","335-1020  -  SCREW BN 3.5MM 20MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1022","SUP","HCPCS C1713","","335-1022  -  SCREW BN 3.5MM 22MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1024","SUP","HCPCS C1713","","335-1024  -  SCREW BN 3.5MM 24MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1026","SUP","HCPCS C1713","","335-1026  -  SCREW BN 3.5MM 26MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1028","SUP","HCPCS C1713","","335-1028  -  SCREW BN 3.5MM 28MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1030","SUP","HCPCS C1713","","335-1030  -  SCREW BN 3.5MM 30MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1032","SUP","HCPCS C1713","","335-1032  -  SCREW BN 3.5MM 32MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1034","SUP","HCPCS C1713","","335-1034  -  SCREW BN 3.5MM 34MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1036","SUP","HCPCS C1713","","335-1036  -  SCREW BN 3.5MM 36MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1038","SUP","HCPCS C1713","","335-1038  -  SCREW BN 3.5MM 38MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1040","SUP","HCPCS C1713","","335-1040  -  SCREW BN 3.5MM 40MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1042","SUP","HCPCS C1713","","335-1042  -  SCREW BN 3.5MM 42MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1044","SUP","HCPCS C1713","","335-1044  -  SCREW BN 3.5MM 44MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1046","SUP","HCPCS C1713","","335-1046  -  SCREW BN 3.5MM 46MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1048","SUP","HCPCS C1713","","335-1048  -  SCREW BN 3.5MM 48MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1050","SUP","HCPCS C1713","","335-1050  -  SCREW BN 3.5MM 50MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1055","SUP","HCPCS C1713","","335-1055  -  SCREW BN 3.5MM 55MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"335-1060","SUP","HCPCS C1713","","335-1060  -  SCREW BN 3.5MM 60MM NS ST SS CORT","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"3362-0-304","SUP","HCPCS C1713","","3362-0-304  -  SDPLT BONE OMEGA+ 130D SHRT BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-305","SUP","HCPCS C1713","","3362-0-305  -  SDPLT BONE OMEGA+ 130D SHRT BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-354","SUP","HCPCS C1713","","3362-0-354  -  SDPLT BONE OMEGA+ 135D SHRT BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-355","SUP","HCPCS C1713","","3362-0-355  -  SDPLT BONE OMEGA+ 135D SHRT BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-404","SUP","HCPCS C1713","","3362-0-404  -  SDPLT BONE OMEGA+ 140D SHRT BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-405","SUP","HCPCS C1713","","3362-0-405  -  SDPLT BONE OMEGA+ 140D SHRT BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-454","SUP","HCPCS C1713","","3362-0-454  -  SDPLT BONE OMEGA+ 145D SHRT BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-455","SUP","HCPCS C1713","","3362-0-455  -  SDPLT BONE OMEGA+ 145D SHRT BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-504","SUP","HCPCS C1713","","3362-0-504  -  SDPLT BONE OMEGA+ 150D SHRT BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-0-505","SUP","HCPCS C1713","","3362-0-505  -  SDPLT BONE OMEGA+ 150D SHRT BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-002","SUP","HCPCS C1713","","3362-1-002  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 2 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-003","SUP","HCPCS C1713","","3362-1-003  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 3 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-004","SUP","HCPCS C1713","","3362-1-004  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-005","SUP","HCPCS C1713","","3362-1-005  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-006","SUP","HCPCS C1713","","3362-1-006  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 6 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-008","SUP","HCPCS C1713","","3362-1-008  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 8 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-010","SUP","HCPCS C1713","","3362-1-010  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 10 HOLE CMPR","BOTH IP/OP","$1,054.63 ","$780.43 ","$0.00 ","$1,054.63 ","$474.58 ","$0.00 ","$219.81 ","$0.00 ","$0.00 ","$184.66 ","$1,054.63 ","$0.00 ","$527.31 ","$835.27 ","$843.70 ","$0.00 ","$165.05 ","$0.00 ","$167.90 ","$0.00 "
"3362-1-012","SUP","HCPCS C1713","","3362-1-012  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 12 HOLE CMPR","BOTH IP/OP","$1,054.63 ","$780.43 ","$0.00 ","$1,054.63 ","$474.58 ","$0.00 ","$219.81 ","$0.00 ","$0.00 ","$184.66 ","$1,054.63 ","$0.00 ","$527.31 ","$835.27 ","$843.70 ","$0.00 ","$165.05 ","$0.00 ","$167.90 ","$0.00 "
"3362-1-102","SUP","HCPCS C1713","","3362-1-102  -  SDPLT BONE OMEGA+ 135D HIP 2 HOLE","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-103","SUP","HCPCS C1713","","3362-1-103  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 3 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-104","SUP","HCPCS C1713","","3362-1-104  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-105","SUP","HCPCS C1713","","3362-1-105  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-106","SUP","HCPCS C1713","","3362-1-106  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 6 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-108","SUP","HCPCS C1713","","3362-1-108  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 8 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-110","SUP","HCPCS C1713","","3362-1-110  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 10 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-112","SUP","HCPCS C1713","","3362-1-112  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 12 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-202","SUP","HCPCS C1713","","3362-1-202  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 2 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-203","SUP","HCPCS C1713","","3362-1-203  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 3 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-204","SUP","HCPCS C1713","","3362-1-204  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-205","SUP","HCPCS C1713","","3362-1-205  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-206","SUP","HCPCS C1713","","3362-1-206  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 6 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-208","SUP","HCPCS C1713","","3362-1-208  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 8 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-210","SUP","HCPCS C1713","","3362-1-210  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 10 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-212","SUP","HCPCS C1713","","3362-1-212  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 12 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-302","SUP","HCPCS C1713","","3362-1-302  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 2 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-303","SUP","HCPCS C1713","","3362-1-303  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 3 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-304","SUP","HCPCS C1713","","3362-1-304  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-305","SUP","HCPCS C1713","","3362-1-305  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$856.63 ","$633.91 ","$0.00 ","$856.63 ","$385.48 ","$0.00 ","$178.54 ","$0.00 ","$0.00 ","$149.99 ","$856.63 ","$0.00 ","$428.31 ","$678.45 ","$685.30 ","$0.00 ","$134.06 ","$0.00 ","$136.37 ","$0.00 "
"3362-1-306","SUP","HCPCS C1713","","3362-1-306  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 6 HOLE CMPR","BOTH IP/OP","$856.63 ","$633.91 ","$0.00 ","$856.63 ","$385.48 ","$0.00 ","$178.54 ","$0.00 ","$0.00 ","$149.99 ","$856.63 ","$0.00 ","$428.31 ","$678.45 ","$685.30 ","$0.00 ","$134.06 ","$0.00 ","$136.37 ","$0.00 "
"3362-1-308","SUP","HCPCS C1713","","3362-1-308  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 8 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-310","SUP","HCPCS C1713","","3362-1-310  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 10 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-312","SUP","HCPCS C1713","","3362-1-312  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 12 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-402","SUP","HCPCS C1713","","3362-1-402  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 2 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-403","SUP","HCPCS C1713","","3362-1-403  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 3 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-404","SUP","HCPCS C1713","","3362-1-404  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 4 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-405","SUP","HCPCS C1713","","3362-1-405  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 5 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-406","SUP","HCPCS C1713","","3362-1-406  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 6 HOLE CMPR","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-1-408","SUP","HCPCS C1713","","3362-1-408  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 8 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-1-410","SUP","HCPCS C1713","","3362-1-410  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 10 HOLE CMPR","BOTH IP/OP","$1,054.63 ","$780.43 ","$0.00 ","$1,054.63 ","$474.58 ","$0.00 ","$219.81 ","$0.00 ","$0.00 ","$184.66 ","$1,054.63 ","$0.00 ","$527.31 ","$835.27 ","$843.70 ","$0.00 ","$165.05 ","$0.00 ","$167.90 ","$0.00 "
"3362-1-412","SUP","HCPCS C1713","","3362-1-412  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 12 HOLE CMPR","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-002","SUP","HCPCS C1713","","3362-3-002  -  PLATE 130D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-003","SUP","HCPCS C1713","","3362-3-003  -  PLATE 130D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-004","SUP","HCPCS C1713","","3362-3-004  -  PLATE 130D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-005","SUP","HCPCS C1713","","3362-3-005  -  PLATE 130D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-006","SUP","HCPCS C1713","","3362-3-006  -  PLATE 130D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$856.63 ","$633.91 ","$0.00 ","$856.63 ","$385.48 ","$0.00 ","$178.54 ","$0.00 ","$0.00 ","$149.99 ","$856.63 ","$0.00 ","$428.31 ","$678.45 ","$685.30 ","$0.00 ","$134.06 ","$0.00 ","$136.37 ","$0.00 "
"3362-3-008","SUP","HCPCS C1713","","3362-3-008  -  PLATE 130D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-010","SUP","HCPCS C1713","","3362-3-010  -  PLATE 130D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-012","SUP","HCPCS C1713","","3362-3-012  -  PLATE 130D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-102","SUP","HCPCS C1713","","3362-3-102  -  PLATE 135D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-103","SUP","HCPCS C1713","","3362-3-103  -  PLATE 135D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-104","SUP","HCPCS C1713","","3362-3-104  -  PLATE 135D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-105","SUP","HCPCS C1713","","3362-3-105  -  PLATE 135D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-106","SUP","HCPCS C1713","","3362-3-106  -  PLATE 135D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-108","SUP","HCPCS C1713","","3362-3-108  -  PLATE 135D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-110","SUP","HCPCS C1713","","3362-3-110  -  PLATE 135D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-112","SUP","HCPCS C1713","","3362-3-112  -  PLATE 135D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-202","SUP","HCPCS C1713","","3362-3-202  -  PLATE 140D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-203","SUP","HCPCS C1713","","3362-3-203  -  PLATE 140D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-204","SUP","HCPCS C1713","","3362-3-204  -  PLATE 140D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-205","SUP","HCPCS C1713","","3362-3-205  -  PLATE 140D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-206","SUP","HCPCS C1713","","3362-3-206  -  PLATE 140D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-208","SUP","HCPCS C1713","","3362-3-208  -  PLATE 140D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-210","SUP","HCPCS C1713","","3362-3-210  -  PLATE 140D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,054.63 ","$780.43 ","$0.00 ","$1,054.63 ","$474.58 ","$0.00 ","$219.81 ","$0.00 ","$0.00 ","$184.66 ","$1,054.63 ","$0.00 ","$527.31 ","$835.27 ","$843.70 ","$0.00 ","$165.05 ","$0.00 ","$167.90 ","$0.00 "
"3362-3-212","SUP","HCPCS C1713","","3362-3-212  -  PLATE 140D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-302","SUP","HCPCS C1713","","3362-3-302  -  PLATE 145D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-303","SUP","HCPCS C1713","","3362-3-303  -  PLATE 145D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-304","SUP","HCPCS C1713","","3362-3-304  -  PLATE 145D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-305","SUP","HCPCS C1713","","3362-3-305  -  PLATE 145D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-306","SUP","HCPCS C1713","","3362-3-306  -  PLATE 145D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-308","SUP","HCPCS C1713","","3362-3-308  -  PLATE 145D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-310","SUP","HCPCS C1713","","3362-3-310  -  PLATE 145D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-312","SUP","HCPCS C1713","","3362-3-312  -  PLATE 145D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-402","SUP","HCPCS C1713","","3362-3-402  -  PLATE 150D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-403","SUP","HCPCS C1713","","3362-3-403  -  PLATE 150D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-404","SUP","HCPCS C1713","","3362-3-404  -  PLATE 150D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-405","SUP","HCPCS C1713","","3362-3-405  -  PLATE 150D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-406","SUP","HCPCS C1713","","3362-3-406  -  PLATE 150D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-3-408","SUP","HCPCS C1713","","3362-3-408  -  PLATE 150D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-410","SUP","HCPCS C1713","","3362-3-410  -  PLATE 150D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-3-412","SUP","HCPCS C1713","","3362-3-412  -  PLATE 150D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$1,058.75 ","$783.48 ","$0.00 ","$1,058.75 ","$476.44 ","$0.00 ","$220.67 ","$0.00 ","$0.00 ","$185.38 ","$1,058.75 ","$0.00 ","$529.38 ","$838.53 ","$847.00 ","$0.00 ","$165.69 ","$0.00 ","$168.55 ","$0.00 "
"3362-4-304","SUP","HCPCS C1713","","3362-4-304  -  PLATE 130D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-305","SUP","HCPCS C1713","","3362-4-305  -  PLATE 130D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-354","SUP","HCPCS C1713","","3362-4-354  -  PLATE 135D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-355","SUP","HCPCS C1713","","3362-4-355  -  PLATE 135D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-404","SUP","HCPCS C1713","","3362-4-404  -  PLATE 140D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-405","SUP","HCPCS C1713","","3362-4-405  -  PLATE 140D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-454","SUP","HCPCS C1713","","3362-4-454  -  PLATE 145D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-455","SUP","HCPCS C1713","","3362-4-455  -  PLATE 145D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-504","SUP","HCPCS C1713","","3362-4-504  -  PLATE 150D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-4-505","SUP","HCPCS C1713","","3362-4-505  -  PLATE 150D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP","BOTH IP/OP","$859.38 ","$635.94 ","$0.00 ","$859.38 ","$386.72 ","$0.00 ","$179.12 ","$0.00 ","$0.00 ","$150.47 ","$859.38 ","$0.00 ","$429.69 ","$680.63 ","$687.50 ","$0.00 ","$134.49 ","$0.00 ","$136.81 ","$0.00 "
"3362-5-050","SUP","HCPCS C1713","","3362-5-050  -  SCREW BONE 13MM 50MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-055","SUP","HCPCS C1713","","3362-5-055  -  SCREW BONE 13MM 55MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-060","SUP","HCPCS C1713","","3362-5-060  -  SCREW BONE 13MM 60MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-065","SUP","HCPCS C1713","","3362-5-065  -  SCREW BONE 13MM 65MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-070","SUP","HCPCS C1713","","3362-5-070  -  SCREW BONE 13MM 70MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-075","SUP","HCPCS C1713","","3362-5-075  -  SCREW BONE 75MM OMEGA+ HIP LAG","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-080","SUP","HCPCS C1713","","3362-5-080  -  SCREW BONE 13MM 80MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-085","SUP","HCPCS C1713","","3362-5-085  -  SCREW BONE 13MM 85MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-090","SUP","HCPCS C1713","","3362-5-090  -  SCREW BONE 13MM 90MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-095","SUP","HCPCS C1713","","3362-5-095  -  SCREW BONE 13MM 95MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-100","SUP","HCPCS C1713","","3362-5-100  -  SCREW BONE 13MM 100MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-105","SUP","HCPCS C1713","","3362-5-105  -  SCREW BONE 13MM 105MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-110","SUP","HCPCS C1713","","3362-5-110  -  SCREW BONE 13MM 110MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-115","SUP","HCPCS C1713","","3362-5-115  -  SCREW BONE 13MM 115MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-120","SUP","HCPCS C1713","","3362-5-120  -  SCREW BONE 13MM 120MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-125","SUP","HCPCS C1713","","3362-5-125  -  SCREW BONE 13MM 125MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-5-130","SUP","HCPCS C1713","","3362-5-130  -  SCREW BONE 13MM 130MM OMEGA+ SS STD FEM HIP LAG STRL","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3362-6-055","SUP","HCPCS C1713","","3362-6-055  -  SCREW BONE 55MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$313.50 ","$231.99 ","$0.00 ","$313.50 ","$141.08 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$54.89 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$49.06 ","$0.00 ","$49.91 ","$0.00 "
"3362-6-060","SUP","HCPCS C1713","","3362-6-060  -  SCREW BONE 60MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$229.63 ","$169.93 ","$0.00 ","$229.63 ","$103.33 ","$0.00 ","$47.86 ","$0.00 ","$0.00 ","$40.21 ","$229.63 ","$0.00 ","$114.81 ","$181.87 ","$183.70 ","$0.00 ","$35.94 ","$0.00 ","$36.56 ","$0.00 "
"3362-6-070","SUP","HCPCS C1713","","3362-6-070  -  SCREW BONE 70MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$313.50 ","$231.99 ","$0.00 ","$313.50 ","$141.08 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$54.89 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$49.06 ","$0.00 ","$49.91 ","$0.00 "
"3362-6-080","SUP","HCPCS C1713","","3362-6-080  -  SCREW BONE 80MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$280.50 ","$207.57 ","$0.00 ","$280.50 ","$126.23 ","$0.00 ","$58.46 ","$0.00 ","$0.00 ","$49.11 ","$280.50 ","$0.00 ","$140.25 ","$222.16 ","$224.40 ","$0.00 ","$43.90 ","$0.00 ","$44.66 ","$0.00 "
"3362-6-090","SUP","HCPCS C1713","","3362-6-090  -  SCREW BONE 90MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$209.00 ","$154.66 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$43.56 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"3362-6-100","SUP","HCPCS C1713","","3362-6-100  -  SCREW BONE 100MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$345.13 ","$255.40 ","$0.00 ","$345.13 ","$155.31 ","$0.00 ","$71.93 ","$0.00 ","$0.00 ","$60.43 ","$345.13 ","$0.00 ","$172.56 ","$273.34 ","$276.10 ","$0.00 ","$54.01 ","$0.00 ","$54.94 ","$0.00 "
"3362-6-105","SUP","HCPCS C1713","","3362-6-105  -  SCREW BONE 105MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"3362-6-110","SUP","HCPCS C1713","","3362-6-110  -  SCREW BONE 110MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$378.13 ","$279.82 ","$0.00 ","$378.13 ","$170.16 ","$0.00 ","$78.81 ","$0.00 ","$0.00 ","$66.21 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$59.18 ","$0.00 ","$60.20 ","$0.00 "
"3362-6-115","SUP","HCPCS C1713","","3362-6-115  -  SCREW BONE 115MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$345.13 ","$255.40 ","$0.00 ","$345.13 ","$155.31 ","$0.00 ","$71.93 ","$0.00 ","$0.00 ","$60.43 ","$345.13 ","$0.00 ","$172.56 ","$273.34 ","$276.10 ","$0.00 ","$54.01 ","$0.00 ","$54.94 ","$0.00 "
"3362-6-120","SUP","HCPCS C1713","","3362-6-120  -  SCREW BONE 120MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$313.50 ","$231.99 ","$0.00 ","$313.50 ","$141.08 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$54.89 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$49.06 ","$0.00 ","$49.91 ","$0.00 "
"3362-6-130","SUP","HCPCS C1713","","3362-6-130  -  SCREW BONE 130MM OMEGA+ SS HIP SUPLAG","BOTH IP/OP","$313.50 ","$231.99 ","$0.00 ","$313.50 ","$141.08 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$54.89 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$49.06 ","$0.00 ","$49.91 ","$0.00 "
"3363-0-354","SUP","HCPCS C1713","","3363-0-354  -  PLATE 135D 25MM SS 4 HOLE CMPR OMEGA+ BONE HIP NONSTRL","BOTH IP/OP","$563.75 ","$417.18 ","$0.00 ","$563.75 ","$253.69 ","$0.00 ","$117.50 ","$0.00 ","$0.00 ","$98.71 ","$563.75 ","$0.00 ","$281.88 ","$446.49 ","$451.00 ","$0.00 ","$88.23 ","$0.00 ","$89.75 ","$0.00 "
"3363-1-203","SUP","HCPCS C1713","","3363-1-203  -  PLATE 140D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL","BOTH IP/OP","$501.88 ","$371.39 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$104.60 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3363-1-303","SUP","HCPCS C1713","","3363-1-303  -  PLATE 145D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL","BOTH IP/OP","$529.38 ","$391.74 ","$0.00 ","$529.38 ","$238.22 ","$0.00 ","$110.33 ","$0.00 ","$0.00 ","$92.69 ","$529.38 ","$0.00 ","$264.69 ","$419.27 ","$423.50 ","$0.00 ","$82.85 ","$0.00 ","$84.28 ","$0.00 "
"3363-1-403","SUP","HCPCS C1713","","3363-1-403  -  PLATE 150D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL","BOTH IP/OP","$501.88 ","$371.39 ","$0.00 ","$501.88 ","$225.84 ","$0.00 ","$104.60 ","$0.00 ","$0.00 ","$87.87 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$78.54 ","$0.00 ","$79.90 ","$0.00 "
"3363-5-085","SUP","HCPCS C1713","","3363-5-085  -  SCREW BONE 85MM OMEGA+ HIP LAG NONSTRL","BOTH IP/OP","$488.13 ","$361.22 ","$0.00 ","$488.13 ","$219.66 ","$0.00 ","$101.74 ","$0.00 ","$0.00 ","$85.47 ","$488.13 ","$0.00 ","$244.06 ","$386.60 ","$390.50 ","$0.00 ","$76.39 ","$0.00 ","$77.71 ","$0.00 "
"3363-7-000","SUP","HCPCS C1713","","3363-7-000  -  SCREW BONE OMEGA+ SS HIP CMPR NONSTRL","BOTH IP/OP","$52.25 ","$38.67 ","$0.00 ","$52.25 ","$23.51 ","$0.00 ","$10.89 ","$0.00 ","$0.00 ","$9.15 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$8.18 ","$0.00 ","$8.32 ","$0.00 "
"33661200MR","SUP","HCPCS C1713","","33661200MR  -  CAP LOCKING LARGE ROUND 12MM SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"33661200SR","SUP","HCPCS C1713","","33661200SR  -  CAP LOCKING SMALL ROUND 12MM SPN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"33661205MR","SUP","HCPCS C1713","","33661205MR  -  ENDCAP SPINAL 5D LARGE ROUND 12MM MODULAR VBOSS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"33661205SR","SUP","Custom 27803010","","33661205SR  -  ENDCAP SPINAL 5D SMALL ROUND 12MM MODULAR VBOSS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661400MR","SUP","Custom 27803010","","33661400MR  -  ENDCAP SPINAL 0D LARGE ROUND 14MM MODULAR VBOSS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661400SR","SUP","Custom 27803010","","33661400SR  -  ENDCAP SPINAL 0D SMALL ROUND 14MM MODULAR VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661405MR","SUP","Custom 27803010","","33661405MR  -  ENDCAP SPINAL 5D LARGE ROUND 14MM MODULAR VBOSS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661405SR","SUP","Custom 27803010","","33661405SR  -  ENDCAP SPINAL 5D SMALL ROUND 14MM MODULAR VBOSS","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661600MR","SUP","Custom 27803010","","33661600MR  -  ENDCAP SPINAL LARGE 16MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661600SR","SUP","Custom 27803010","","33661600SR  -  ENDCAP SPINAL SMALL 16MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661605MR","SUP","Custom 27803010","","33661605MR  -  ENDCAP SPINAL 5D LARGE 16MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33661605SR","SUP","Custom 27803010","","33661605SR  -  ENDCAP SPINAL 5D SMALL 16MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662000MO","SUP","Custom 27803010","","33662000MO  -  ENDCAP SPINAL LARGE 20MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662000MR","SUP","Custom 27803010","","33662000MR  -  ENDCAP SPINAL LARGE 20MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662000SO","SUP","Custom 27803010","","33662000SO  -  ENDCAP SPINAL SMALL 20MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662000SR","SUP","Custom 27803010","","33662000SR  -  ENDCAP SPINAL SMALL 20MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662005MO","SUP","Custom 27803010","","33662005MO  -  ENDCAP SPINAL 5D LARGE 20MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662005MR","SUP","Custom 27803010","","33662005MR  -  ENDCAP SPINAL 5D LARGE 20MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662005SO","SUP","Custom 27803010","","33662005SO  -  ENDCAP SPINAL 5D SMALL 20MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662005SR","SUP","Custom 27803010","","33662005SR  -  ENDCAP SPINAL 5D SMALL 20MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662010MO","SUP","Custom 27803010","","33662010MO  -  ENDCAP SPINAL 10D LARGE 20MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662010SO","SUP","Custom 27803010","","33662010SO  -  ENDCAP SPINAL 10D SMALL 20MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662500MO","SUP","Custom 27803010","","33662500MO  -  ENDCAP SPINAL LARGE 25MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662500MR","SUP","Custom 27803010","","33662500MR  -  ENDCAP SPINAL LARGE 25MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662500SO","SUP","Custom 27803010","","33662500SO  -  ENDCAP SPINAL SMALL 25MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662500SR","SUP","Custom 27803010","","33662500SR  -  ENDCAP SPINAL SMALL 25MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662505MO","SUP","Custom 27803010","","33662505MO  -  ENDCAP SPINAL 5D LARGE 25MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662505MR","SUP","Custom 27803010","","33662505MR  -  ENDCAP SPINAL 5D LARGE 25MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662505SO","SUP","Custom 27803010","","33662505SO  -  ENDCAP SPINAL 5D SMALL 25MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662505SR","SUP","Custom 27803010","","33662505SR  -  ENDCAP SPINAL 5D SMALL 25MM ROUND VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662510MO","SUP","Custom 27803010","","33662510MO  -  ENDCAP SPINAL 10D LARGE 25MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"33662510SO","SUP","Custom 27803010","","33662510SO  -  ENDCAP SPINAL 10D SMALL 25MM OVAL VBOSS TITANIUM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3370-0-230","SUP","HCPCS C1713","","3370-0-230  -  NAIL 12MM 21CM HIP GAMA IM 130D STD GAMA SYS STYKER ORTH","BOTH IP/OP","$1,498.75 ","$1,109.08 ","$0.00 ","$1,498.75 ","$674.44 ","$0.00 ","$312.38 ","$0.00 ","$0.00 ","$262.42 ","$1,498.75 ","$0.00 ","$749.38 ","$1,187.01 ","$1,199.00 ","$0.00 ","$234.55 ","$0.00 ","$238.60 ","$0.00 "
"3370-0-235","SUP","HCPCS C1713","","3370-0-235  -  NAIL 12MM 21MM HIP GAMA IM 135D STD GAMA SYS","BOTH IP/OP","$1,155.00 ","$854.70 ","$0.00 ","$1,155.00 ","$519.75 ","$0.00 ","$240.73 ","$0.00 ","$0.00 ","$202.23 ","$1,155.00 ","$0.00 ","$577.50 ","$914.76 ","$924.00 ","$0.00 ","$180.76 ","$0.00 ","$183.88 ","$0.00 "
"3370-0-430","SUP","HCPCS C1713","","3370-0-430  -  NAIL 14MM 21CM HIP GAMA IM 130D STD GAMA SYS STRYK ORTH","BOTH IP/OP","$1,051.88 ","$778.39 ","$0.00 ","$1,051.88 ","$473.34 ","$0.00 ","$219.24 ","$0.00 ","$0.00 ","$184.17 ","$1,051.88 ","$0.00 ","$525.94 ","$833.09 ","$841.50 ","$0.00 ","$164.62 ","$0.00 ","$167.46 ","$0.00 "
"3370-0-435","SUP","HCPCS C1713","","3370-0-435  -  NAIL 14MM 21CM HIP GAMA IM 135D STD SS GAMA SYS","BOTH IP/OP","$1,361.25 ","$1,007.33 ","$0.00 ","$1,361.25 ","$612.56 ","$0.00 ","$283.72 ","$0.00 ","$0.00 ","$238.34 ","$1,361.25 ","$0.00 ","$680.63 ","$1,078.11 ","$1,089.00 ","$0.00 ","$213.04 ","$0.00 ","$216.71 ","$0.00 "
"3370-1-000","SUP","HCPCS C1713","","3370-1-000  -  SCREW SET 8MM 27MM GMA HIP IM NL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"3370-1-050","SUP","HCPCS C1713","","3370-1-050  -  SCREW BONE GAMA CAP NAIL","BOTH IP/OP","$195.25 ","$144.49 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$40.69 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"3370-1-060","SUP","HCPCS C1713","","3370-1-060  -  SCREW BONE 12MM 60MM GAMA SS FEM LAG IM NAIL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"3370-2-080","SUP","HCPCS C1713","","3370-2-080  -  SCREW BONE 12MM 80MM GAMA LAG IM NAIL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-085","SUP","HCPCS C1713","","3370-2-085  -  NAIL 12MM 85MM GAMA IM NAIL LAG","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-090","SUP","HCPCS C1713","","3370-2-090  -  NAIL 12MM 90MM GAMA IM NAIL LAG","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-095","SUP","HCPCS C1713","","3370-2-095  -  NAIL 12MM 95MM HIP GAMA IM NAIL LAG TI","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-100","SUP","HCPCS C1713","","3370-2-100  -  SCREW BONE 12MM 100MM GAMA FEM LAG IM NAIL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-105","SUP","HCPCS C1713","","3370-2-105  -  SCREW BONE 105MM 12MM GAMA FEM LAG SCR IM NAIL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-110","SUP","HCPCS C1713","","3370-2-110  -  SCREW BONE 12MM 110MM GAMA FEM LAG IM NAIL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-120","SUP","HCPCS C1713","","3370-2-120  -  SCREW BONE 12MM 120MM GAMA SS FEM LAG IM NAIL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-2-130","SUP","HCPCS C1713","","3370-2-130  -  SCREW BONE 12MM 130MM GAMMA3 SS HIP FEM LAG IM NAIL","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$293.91 ","$0.00 ","$136.13 ","$0.00 ","$0.00 ","$114.36 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$102.21 ","$0.00 ","$103.98 ","$0.00 "
"3370-3-035","SUP","HCPCS C1713","","3370-3-035  -  SCREW BONE 6.28MM 35MM GAMMA3 HIP DISTAL NAIL","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$178.75 ","$80.44 ","$0.00 ","$37.26 ","$0.00 ","$0.00 ","$31.30 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$27.97 ","$0.00 ","$28.46 ","$0.00 "
"3370-3-040","SUP","HCPCS C1713","","3370-3-040  -  SCREW BONE 6.28MM 40MM GAMA DISTAL IM NAIL","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$178.75 ","$80.44 ","$0.00 ","$37.26 ","$0.00 ","$0.00 ","$31.30 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$27.97 ","$0.00 ","$28.46 ","$0.00 "
"3370-6-025","SUP","HCPCS C1713","","3370-6-025  -  NAIL 11MM 34CM HIP LEFT FEM GAMMA3 IM 125D LNG LCK TI","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-030","SUP","HCPCS C1713","","3370-6-030  -  NAIL 11MM 34CM HIP LEFT FEM GAMMA3 IM 130D LNG LCK TI","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-035","SUP","HCPCS C1713","","3370-6-035  -  NAIL 11MM 34CM LEFT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-125","SUP","HCPCS C1713","","3370-6-125  -  NAIL 11MM 36CM LEFT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-130","SUP","HCPCS C1713","","3370-6-130  -  NAIL 11MM 360MM LEFT GAMA IM 130D LNG","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-135","SUP","HCPCS C1713","","3370-6-135  -  NAIL 11MM 36CM LEFT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-225","SUP","HCPCS C1713","","3370-6-225  -  NAIL 11MM 38CM LEFT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-230","SUP","HCPCS C1713","","3370-6-230  -  NAIL 11MM 38CM LEFT FEM GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-235","SUP","HCPCS C1713","","3370-6-235  -  NAIL 11MM 38CM LEFT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-325","SUP","HCPCS C1713","","3370-6-325  -  NAIL 11MM 40CM LEFT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-330","SUP","HCPCS C1713","","3370-6-330  -  NAIL 11MM 400MM LEFT GAMA IM 130D LNG","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-335","SUP","HCPCS C1713","","3370-6-335  -  NAIL 11MM 40CM LEFT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-425","SUP","HCPCS C1713","","3370-6-425  -  NAIL 11MM 42CM LEFT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-430","SUP","HCPCS C1713","","3370-6-430  -  NAIL 11MM 42CM LEFT FEM GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-435","SUP","HCPCS C1713","","3370-6-435  -  NAIL 11MM 42CM LEFT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-525","SUP","HCPCS C1713","","3370-6-525  -  NAIL 11MM 44CM LEFT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-530","SUP","HCPCS C1713","","3370-6-530  -  NAIL 11MM 44CM LEFT FEM GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-6-535","SUP","HCPCS C1713","","3370-6-535  -  NAIL 11MM 44CM LEFT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,413.13 ","$1,785.72 ","$0.00 ","$2,413.13 ","$1,085.91 ","$0.00 ","$502.96 ","$0.00 ","$0.00 ","$422.52 ","$2,413.13 ","$0.00 ","$1,206.56 ","$1,911.20 ","$1,930.50 ","$0.00 ","$377.65 ","$0.00 ","$384.17 ","$0.00 "
"3370-7-025","SUP","HCPCS C1713","","3370-7-025  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-030","SUP","HCPCS C1713","","3370-7-030  -  NAIL 11MM 34CM RIGHT HIP GAMMA3 IM 130D LNG LCK TI","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-035","SUP","HCPCS C1713","","3370-7-035  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-125","SUP","HCPCS C1713","","3370-7-125  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-130","SUP","HCPCS C1713","","3370-7-130  -  NAIL 11MM 360MM RIGHT TROC GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-135","SUP","HCPCS C1713","","3370-7-135  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-225","SUP","HCPCS C1713","","3370-7-225  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-230","SUP","HCPCS C1713","","3370-7-230  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-235","SUP","HCPCS C1713","","3370-7-235  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-325","SUP","HCPCS C1713","","3370-7-325  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-330","SUP","HCPCS C1713","","3370-7-330  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 130D LNG LCK STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-335","SUP","HCPCS C1713","","3370-7-335  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-425","SUP","HCPCS C1713","","3370-7-425  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-430","SUP","HCPCS C1713","","3370-7-430  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-435","SUP","HCPCS C1713","","3370-7-435  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-525","SUP","HCPCS C1713","","3370-7-525  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-530","SUP","HCPCS C1713","","3370-7-530  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-7-535","SUP","HCPCS C1713","","3370-7-535  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL","BOTH IP/OP","$2,293.50 ","$1,697.19 ","$0.00 ","$2,293.50 ","$1,032.08 ","$0.00 ","$478.02 ","$0.00 ","$0.00 ","$401.57 ","$2,293.50 ","$0.00 ","$1,146.75 ","$1,816.45 ","$1,834.80 ","$0.00 ","$358.93 ","$0.00 ","$365.13 ","$0.00 "
"3370-8-125","SUP","HCPCS C1713","","3370-8-125  -  NAIL 11MM 18CM TROC GAMA IM 125D LCK SS STRL","BOTH IP/OP","$1,863.13 ","$1,378.72 ","$0.00 ","$1,863.13 ","$838.41 ","$0.00 ","$388.32 ","$0.00 ","$0.00 ","$326.22 ","$1,863.13 ","$0.00 ","$931.56 ","$1,475.60 ","$1,490.50 ","$0.00 ","$291.58 ","$0.00 ","$296.61 ","$0.00 "
"3370-8-130","SUP","HCPCS C1713","","3370-8-130  -  NAIL TROC IM 130D","BOTH IP/OP","$1,863.13 ","$1,378.72 ","$0.00 ","$1,863.13 ","$838.41 ","$0.00 ","$388.32 ","$0.00 ","$0.00 ","$326.22 ","$1,863.13 ","$0.00 ","$931.56 ","$1,475.60 ","$1,490.50 ","$0.00 ","$291.58 ","$0.00 ","$296.61 ","$0.00 "
"3370-8-135","SUP","HCPCS C1713","","3370-8-135  -  NAIL 11MM 18CM TROC GAMA IM 135D LCK SS","BOTH IP/OP","$1,863.13 ","$1,378.72 ","$0.00 ","$1,863.13 ","$838.41 ","$0.00 ","$388.32 ","$0.00 ","$0.00 ","$326.22 ","$1,863.13 ","$0.00 ","$931.56 ","$1,475.60 ","$1,490.50 ","$0.00 ","$291.58 ","$0.00 ","$296.61 ","$0.00 "
"3371-1-015","SUP","HCPCS C1769","","3371-1-015  -  GUIDEWIRE ORTH 3MM STRL BLNT TIP PACKAGED","BOTH IP/OP","$233.75 ","$172.98 ","$0.00 ","$233.75 ","$126.93 ","$0.00 ","$48.72 ","$0.00 ","$0.00 ","$40.93 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$36.58 ","$0.00 ","$37.21 ","$0.00 "
"3371-1-060","SUP","HCPCS C1713","","3371-1-060  -  WIRE FX 3.2MM 450MM KRSH SS GMA NL SYS","BOTH IP/OP","$192.50 ","$142.45 ","$0.00 ","$192.50 ","$86.63 ","$0.00 ","$40.12 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"3371-1-078","SUP","Custom 27203010","","3371-1-078  -  HEAD FEM +5MM OFST 36MM V40 LFIT COCR HIP","BOTH IP/OP","$1,684.38 ","$1,246.44 ","$0.00 ","$1,684.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,684.38 ","$0.00 ","$842.19 ","$1,334.03 ","$1,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3371-1-085","SUP","Custom 27803010","","3371-1-085  -  TAP LAG SCR SURG","BOTH IP/OP","$1,313.13 ","$971.72 ","$0.00 ","$1,313.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,313.13 ","$0.00 ","$656.56 ","$1,040.00 ","$1,050.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3371-1-180","SUP","Custom 27203010","","3371-1-180  -  BIT DRILL 5.5MM","BOTH IP/OP","$203.50 ","$150.59 ","$0.00 ","$203.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.50 ","$0.00 ","$101.75 ","$161.17 ","$162.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3371-1-185","SUP","Custom 27203010","","3371-1-185  -  SLEEVE DRILL 5.5MM GAMA GUIDE NAIL","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"338 021","SUP","HCPCS C1900","","338 021  -  AROX 60 BP LEAD","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$0.00 ","$0.00 "
"338 022","SUP","HCPCS C1900","","338 022  -  AROX 45 JBP LEAD","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$0.00 ","$0.00 "
"338 023","SUP","HCPCS C1900","","338 023  -  AROX 53 BP LEAD","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$0.00 ","$0.00 "
"33MJ-501","SUP","Custom 27803010","","33MJ-501  -  VALVE MTRL 85D 5.18SQ CM 33MM 26.1MM MSTR SER MECH STD CUF","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3420-0260S","SUP","HCPCS C1713","","3420-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0280S","SUP","HCPCS C1713","","3420-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0300S","SUP","HCPCS C1713","","3420-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0320S","SUP","HCPCS C1713","","3420-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0340S","SUP","HCPCS C1713","","3420-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0360S","SUP","HCPCS C1713","","3420-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0380S","SUP","HCPCS C1713","","3420-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0400S","SUP","HCPCS C1713","","3420-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0420S","SUP","HCPCS C1713","","3420-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 120","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0440S","SUP","HCPCS C1713","","3420-0440S  -  NAIL IM 120D 10MM 440MM STRL GAMMA3 RT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3420-0460S","SUP","HCPCS C1713","","3420-0460S  -  NAIL IM 120D 10MM 460MM STRL GAMMA3 RT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0260S","SUP","HCPCS C1713","","3425-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0280S","SUP","HCPCS C1713","","3425-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0300S","SUP","HCPCS C1713","","3425-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0320S","SUP","HCPCS C1713","","3425-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0340S","SUP","HCPCS C1713","","3425-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0360S","SUP","HCPCS C1713","","3425-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0380S","SUP","HCPCS C1713","","3425-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0400S","SUP","HCPCS C1713","","3425-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0420S","SUP","HCPCS C1713","","3425-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 125","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0440S","SUP","HCPCS C1713","","3425-0440S  -  GAMMA 3 S NAIL RIGHT 10X440MM X 125","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0460S","SUP","HCPCS C1713","","3425-0460S  -  NAIL IM 125D 10MM 460MM STRL GAMMA3 RT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3425-0480S","SUP","HCPCS C1713","","3425-0480S  -  NAIL IM 10MM 480MM STRL 125MM GAMMA3 RT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$4,703.88 ","$2,116.74 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$823.61 ","$4,703.88 ","$0.00 ","$2,351.94 ","$3,725.47 ","$3,763.10 ","$0.00 ","$736.16 ","$0.00 ","$748.86 ","$0.00 "
"3430-0260S","SUP","HCPCS C1713","","3430-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0280S","SUP","HCPCS C1713","","3430-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0300S","SUP","HCPCS C1713","","3430-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0320S","SUP","HCPCS C1713","","3430-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0340S","SUP","HCPCS C1713","","3430-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0360S","SUP","HCPCS C1713","","3430-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0380S","SUP","HCPCS C1713","","3430-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0400S","SUP","HCPCS C1713","","3430-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0420S","SUP","HCPCS C1713","","3430-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 130","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0440S","SUP","HCPCS C1713","","3430-0440S  -  GAMMA 3 S NAIL RIGHT 10X440MM X 130","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3430-0460S","SUP","HCPCS C1713","","3430-0460S  -  NAIL IM 130D 10MM 460MM STRL GAMMA3 RT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"346 366","SUP","HCPCS C1898","","346 366  -  SELOX ST 53 LEAD","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"346 367","SUP","HCPCS C1898","","346 367  -  SELOX ST 60 LEAD","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"346 368","SUP","HCPCS C1898","","346 368  -  SELOX JT 53 LEAD","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"346 369","SUP","HCPCS C1898","","346 369  -  SELOX JT 45 LEAD","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"3460-7-006","SUP","HCPCS C1713","","3460-7-006  -  SCREW BONE 8MM 19MM PED HIP OSTMY","BOTH IP/OP","$572.00 ","$423.28 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$119.22 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"3460-7-007","SUP","HCPCS C1713","","3460-7-007  -  SCREW BONE 8MM 22MM PED ORTH OSTMY PEDI HIP SYS","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"3460-7-030","SUP","HCPCS C1713","","3460-7-030  -  SCREW BONE 8MM 76MM PED PDCL HIP OSTMY","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"349 799","SUP","HCPCS C1900","","349 799  -  CYLOS DR WITH CLS AUTONOMIC RESPONSE","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$0.00 ","$0.00 "
"349 811","SUP","HCPCS C1900","","349 811  -  CYLOS VR WITH CLS AUTONOMIC RESPONSE","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$0.00 ","$0.00 "
"350 053","SUP","HCPCS C1895","","350 053  -  LINOX SD STEROID 65/16","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"350 056","SUP","HCPCS C1895","","350 056  -  LINOX SD STEROID 75/18","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"350 975","SUP","HCPCS C1895","","350 975  -  SETROX S 60 LEAD","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"35-0002","SUP","Custom 27203010","","35-0002  -  PIN FIX 4MM LCK CALCANEUS STNM SS","BOTH IP/OP","$142.50 ","$105.45 ","$0.00 ","$142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.50 ","$0.00 ","$71.25 ","$112.86 ","$114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35-0003","SUP","Custom 27203010","","35-0003  -  PIN FIX 5MM ORTH STNM SS","BOTH IP/OP","$142.50 ","$105.45 ","$0.00 ","$142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.50 ","$0.00 ","$71.25 ","$112.86 ","$114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"35-0011","SUP","HCPCS C1769","","35-0011  -  GUIDEWIRE ORTHOPEDIC STR .045IN 5.75IN THREAD TITANIUM","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$3.65 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"350-2001 BC","SUP","HCPCS C1789","","350-2001 BC  -  IMPL BRST 200ML GEL SMTH SIL P3.2CM MODEARTE PRFL RND 10.5CM","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"350-2500","SUP","HCPCS C1789","","350-2500  -  IMPL BRST 500-600ML STY 2000 SMTH RND SAL P5.9CM MDRT PLUS","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"350-2501BC","SUP","HCPCS C1789","","350-2501BC  -  IMPLANT BRST P3.4CM MDRT + HI PRFL RND 11.3CM 250ML STRL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"350-3001BC","SUP","HCPCS C1789","","350-3001BC  -  IMPLANT BRST P3.6CM RND MDRT + PRFL 12CM 300ML STRL","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"350-3004BC","SUP","HCPCS C1789","","350-3004BC  -  IMPLANT BRST P4.5CM HI PRFL RND NAR BS 11.1CM 300CC","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"350-3501 BC","SUP","HCPCS C1789","","350-3501 BC  -  IMPL BRST 350ML GEL SMTH SIL P3.9CM MDRT PLUS PRFL RND 12.5","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"350-3504BC","SUP","HCPCS C1789","","350-3504BC  -  IMPL BRST 350ML GEL SMTH MEMORYGEL SIL P4.8CM HI PRFL RND","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"350-4001 BC","SUP","HCPCS C1789","","350-4001 BC  -  IMPLANT BRST P4CM MDRT + PRFL RND 13.1CM 400CC MEMORYGEL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"350-4004 BC","SUP","HCPCS C1789","","350-4004 BC  -  IMPLANT BRST P5CM HI PRFL RND NAR BS 12.2CM 400CC MEMORYGEL","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$0.00 ","$2,325.00 ","$1,046.25 ","$0.00 ","$484.59 ","$0.00 ","$0.00 ","$407.09 ","$2,325.00 ","$0.00 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$0.00 ","$363.86 ","$0.00 ","$370.14 ","$0.00 "
"350-4501BC","SUP","HCPCS C1789","","350-4501BC  -  IMPLANT BRST P4.2CM MDRT + PRFL 13.6CM 450ML CHSV I GEL RND","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"350-4504BC","SUP","HCPCS C1789","","350-4504BC  -  IMPLANT BRST P5.1CM RND 12.8CM 450ML STRL MEMORYGEL SMTH HI","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"350-5001 BC","SUP","HCPCS C1789","","350-5001 BC  -  IMPLANT BREAST P4.3CM MODERATE PLUS PROFILE ROUND MODERATE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"350-5004BC","SUP","HCPCS C1789","","350-5004BC  -  IMPL BRST 500ML GEL SMTH MEMORYGEL SIL P5.3CM HI PRFL RND","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"350-5501 BC","SUP","HCPCS C1789","","350-5501 BC  -  IMPL BRST 550ML GEL SMTH SIL P4.5CM MDRT PRFL RND 14.6CM","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"350-5504 BC","SUP","HCPCS C1789","","350-5504 BC  -  IMPL BRST 550ML GEL SMTH MEMORYGEL SIL P5.5CM HI PRFL RND","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"350-800 1BC","SUP","HCPCS C1789","","350-800 1BC  -  IMPLANT BRST P5.1CM MDRT + PRFL RND 16.5CM 800ML STRL CHSV I","BOTH IP/OP","$2,262.50 ","$1,674.25 ","$0.00 ","$2,262.50 ","$1,018.13 ","$0.00 ","$471.56 ","$0.00 ","$0.00 ","$396.15 ","$2,262.50 ","$0.00 ","$1,131.25 ","$1,791.90 ","$1,810.00 ","$0.00 ","$354.08 ","$0.00 ","$360.19 ","$0.00 "
"351 337","SUP","HCPCS C1895","","351 337  -  LINOX TD STEROID 65/16 CM","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"351.16J","SUP","Custom 27203010","","351.16J  -  CHUCK DRILL CONCTR CANN QUICK COUPLING JACOBS","BOTH IP/OP","$789.18 ","$583.99 ","$0.00 ","$766.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$766.20 ","$0.00 ","$383.10 ","$606.83 ","$612.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.27S","SUP","Custom 27203010","","351.27S  -  BIT DRL 13MM 300MM STRL CNN","BOTH IP/OP","$1,212.20 ","$897.03 ","$0.00 ","$1,176.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,176.90 ","$0.00 ","$588.45 ","$932.10 ","$941.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.704S","SUP","Custom 27203010","","351.704S  -  ROD REAMER 2.5MM 1150MM BALL TIP EXTN STERILE","BOTH IP/OP","$241.78 ","$178.92 ","$0.00 ","$234.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$234.73 ","$0.00 ","$117.36 ","$185.91 ","$187.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.706S","SUP","Custom 27203010","","351.706S  -  ROD REAMING 2.5MM 950MM BALL TIP GWIRE STERILE DISPOSABLE","BOTH IP/OP","$223.18 ","$165.15 ","$0.00 ","$216.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.68 ","$0.00 ","$108.34 ","$171.61 ","$173.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.707S","SUP","Custom 27203010","","351.707S  -  ROD REAMING 2.5MM 950MM BALL TIP EXTN STERILE DISPOSABLE","BOTH IP/OP","$223.18 ","$165.15 ","$0.00 ","$216.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.68 ","$0.00 ","$108.34 ","$171.61 ","$173.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.708S","SUP","Custom 27203010","","351.708S  -  ROD REAMING BALL 2.5MM 1150MM STERILE INTRAMEDULLARY NAIL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$262.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.00 ","$0.00 ","$131.00 ","$207.50 ","$209.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.709S","SUP","Custom 27203010","","351.709S  -  ROD REAMER 2.5MM 650MM BALL TIP STERILE","BOTH IP/OP","$237.78 ","$175.96 ","$0.00 ","$230.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$230.85 ","$0.00 ","$115.43 ","$182.83 ","$184.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"351.718S","SUP","Custom 27203010","","351.718S  -  SEAL DRIVE SHAFT ELASTOMERIC STERILE DISPOSABLE RIA","BOTH IP/OP","$20.96 ","$15.51 ","$0.00 ","$19.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.76 ","$0.00 ","$9.88 ","$15.65 ","$15.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3515-9-100","SUP","HCPCS C1713","","3515-9-100  -  NAIL ORTH IM","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$44.42 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"352.229S","SUP","Custom 27203010","","352.229S  -  FILTER GRAFT PLUNGER GRADUATED 100ML STERILE DISPOSABLE RIA","BOTH IP/OP","$617.05 ","$456.62 ","$0.00 ","$599.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$599.08 ","$0.00 ","$299.54 ","$474.47 ","$479.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.250S","SUP","Custom 27203010","","352.250S  -  REAMER SURG 12MM HEAD STERILE DISPOSABLE RIA","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.251S","SUP","Custom 27203010","","352.251S  -  REAMER SURG 12.5MM HEAD STERILE DISPOSABLE RIA","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.252S","SUP","Custom 27203010","","352.252S  -  HEAD RMR DP FLUT 13MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.253S","SUP","Custom 27203010","","352.253S  -  REAMER SURG 13.5MM HEAD STERILE DISPOSABLE RIA","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.254S","SUP","Custom 27203010","","352.254S  -  REAMER SURG 14MM HEAD STERILE DISPOSABLE RIA","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.255S","SUP","Custom 27203010","","352.255S  -  REAMER SURG 14.5MM CONICAL TIP DEEP FLUTE SHARP EDGE","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.256S","SUP","Custom 27203010","","352.256S  -  HEAD RMR DP FLUT 15MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.257S","SUP","HCPCS C1713","","352.257S  -  HEAD REAMER 15.5MM STERILE IRRIGATOR ASPIRAT","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$298.90 ","$0.00 ","$142.59 ","$0.00 ","$0.00 ","$116.30 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$100.92 ","$0.00 ","$105.74 ","$0.00 "
"352.258S","SUP","Custom 27203010","","352.258S  -  REAMER SURG 16MM HEAD STERILE DISPOSABLE RIA","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.259S","SUP","Custom 27203010","","352.259S  -  REAMER SURG 16.5MM HEAD STERILE DISPOSABLE RIA","BOTH IP/OP","$684.15 ","$506.27 ","$0.00 ","$664.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.23 ","$0.00 ","$332.11 ","$526.07 ","$531.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"352.260S","SUP","Custom 27203010","","352.260S  -  CLIP LOCKING SECURE ATTCH DRIVE SHAFT TUBE ASMBLY STERILE","BOTH IP/OP","$137.13 ","$101.48 ","$0.00 ","$133.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.13 ","$0.00 ","$66.56 ","$105.44 ","$106.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3520-0240S","SUP","HCPCS C1713","","3520-0240S  -  NAIL IM 120D 10MM 240MM STRL GAMMA3 LT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0260S","SUP","HCPCS C1713","","3520-0260S  -  NAIL 10MM 260MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$4,296.88 ","$1,933.59 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$752.35 ","$4,296.88 ","$0.00 ","$2,148.44 ","$3,403.13 ","$3,437.50 ","$0.00 ","$672.46 ","$0.00 ","$684.06 ","$0.00 "
"3520-0280S","SUP","HCPCS C1713","","3520-0280S  -  NAIL 10MM 280MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0300S","SUP","HCPCS C1713","","3520-0300S  -  NAIL 10MM 300MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0320S","SUP","HCPCS C1713","","3520-0320S  -  NAIL 10MM 320MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0340S","SUP","HCPCS C1713","","3520-0340S  -  NAIL 10MM 340MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0360S","SUP","HCPCS C1713","","3520-0360S  -  NAIL 10MM 360MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0380S","SUP","HCPCS C1713","","3520-0380S  -  NAIL 10MM 380MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0400S","SUP","HCPCS C1713","","3520-0400S  -  NAIL 10MM 400MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0420S","SUP","HCPCS C1713","","3520-0420S  -  NAIL IM 120D 10MM 420MM STRL GAMMA3 LT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0440S","SUP","HCPCS C1713","","3520-0440S  -  NAIL IM 120D 10MM 440MM STRL GAMMA3 LT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-0460S","SUP","HCPCS C1713","","3520-0460S  -  NAIL IM 120D 10MM 460MM STRL GAMMA3 LT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3520-9-180","SUP","HCPCS C1713","","3520-9-180  -  NAIL 9MM 180MM HUM L/R IM RECON SDL SYS","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-200","SUP","HCPCS C1713","","3520-9-200  -  NAIL 16MM 48CM HUM IM HUM R/L RECON GRS-K SYS","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-220","SUP","HCPCS C1713","","3520-9-220  -  NAIL 9MM 220CM IM RECON","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-240","SUP","HCPCS C1713","","3520-9-240  -  NAIL 9MM 240MM L/R HUM IM RECON SDL SYS STR","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-250","SUP","HCPCS C1713","","3520-9-250  -  NAIL HUM 250MM 9MM LCK","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-260","SUP","HCPCS C1713","","3520-9-260  -  NAIL 9MM 260CM HUM IM R/L RECON","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-270","SUP","HCPCS C1713","","3520-9-270  -  NAIL 9MM 270MM LEFT HUM IM RIGHT RECON SDL SYS","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-280","SUP","HCPCS C1713","","3520-9-280  -  NAIL 9MM 280MM HUM LEFT IM RIGHT RECON SDL SYS","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-300","SUP","HCPCS C1713","","3520-9-300  -  NAIL 9MM 300MM HUM IM RECON STRL","BOTH IP/OP","$2,942.50 ","$2,177.45 ","$0.00 ","$2,942.50 ","$1,324.13 ","$0.00 ","$613.29 ","$0.00 ","$0.00 ","$515.21 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$460.50 ","$0.00 ","$468.45 ","$0.00 "
"3520-9-945","SUP","HCPCS C1713","","3520-9-945  -  NAIL 5MM 45CM HUM IM LCK SPRD SCR","BOTH IP/OP","$818.13 ","$605.42 ","$0.00 ","$818.13 ","$368.16 ","$0.00 ","$170.52 ","$0.00 ","$0.00 ","$143.25 ","$818.13 ","$0.00 ","$409.06 ","$647.96 ","$654.50 ","$0.00 ","$128.04 ","$0.00 ","$130.25 ","$0.00 "
"3525-0260S","SUP","HCPCS C1713","","3525-0260S  -  NAIL 10MM 26CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0280S","SUP","HCPCS C1713","","3525-0280S  -  NAIL 10MM 28CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0300S","SUP","HCPCS C1713","","3525-0300S  -  NAIL 10MM 30CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0320S","SUP","HCPCS C1713","","3525-0320S  -  NAIL 10MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0340S","SUP","HCPCS C1713","","3525-0340S  -  NAIL 10MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0360S","SUP","HCPCS C1713","","3525-0360S  -  NAIL 10MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0380S","SUP","HCPCS C1713","","3525-0380S  -  NAIL 10MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0400S","SUP","HCPCS C1713","","3525-0400S  -  NAIL 10MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0420S","SUP","HCPCS C1713","","3525-0420S  -  GAMMA 3 S NAIL LEFT 10X420MM X 125","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0440S","SUP","HCPCS C1713","","3525-0440S  -  GAMMA 3 S NAIL LEFT 10X440MM X 125","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3525-0460S","SUP","HCPCS C1713","","3525-0460S  -  NAIL IM 125D 10MM 460MM STRL GAMMA3 LT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"352506070E","SUP","HCPCS C1880","","352506070E  -  SYSTEM EMBOLIC PROTECTION 6.5FR 0-32MM 5FR 70CM FILTER KIT","BOTH IP/OP","$1,812.50 ","$1,341.25 ","$0.00 ","$1,812.50 ","$815.63 ","$0.00 ","$377.77 ","$0.00 ","$0.00 ","$317.35 ","$1,812.50 ","$0.00 ","$906.25 ","$1,435.50 ","$1,450.00 ","$0.00 ","$283.66 ","$0.00 ","$288.55 ","$0.00 "
"352506100E","SUP","HCPCS C1880","","352506100E  -  FILTER EMBL 30- MM 5FR 100CM STRL LF OPTIONELITE INTRO SHTH","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"3530-0260S","SUP","HCPCS C1713","","3530-0260S  -  NAIL 10MM 26CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0280S","SUP","HCPCS C1713","","3530-0280S  -  NAIL 10MM 28CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0300S","SUP","HCPCS C1713","","3530-0300S  -  NAIL 10MM 30CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0320S","SUP","HCPCS C1713","","3530-0320S  -  NAIL 10MM 32CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0340S","SUP","HCPCS C1713","","3530-0340S  -  NAIL 10MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0360S","SUP","HCPCS C1713","","3530-0360S  -  NAIL 10MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0380S","SUP","HCPCS C1713","","3530-0380S  -  NAIL 10MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0400S","SUP","HCPCS C1713","","3530-0400S  -  NAIL 10MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0420S","SUP","HCPCS C1713","","3530-0420S  -  GAMMA 3 S NAIL LEFT 10X420MM X 130","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0440S","SUP","HCPCS C1713","","3530-0440S  -  GAMMA 3 S NAIL LEFT 10X440MM X 130","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"3530-0460S","SUP","HCPCS C1713","","3530-0460S  -  NAIL IM 130D 10MM 460MM STRL GAMMA3 LT","BOTH IP/OP","$3,668.60 ","$2,714.76 ","$0.00 ","$3,698.75 ","$1,664.44 ","$0.00 ","$764.63 ","$0.00 ","$0.00 ","$647.62 ","$3,698.75 ","$0.00 ","$1,849.38 ","$2,929.41 ","$2,959.00 ","$0.00 ","$578.85 ","$0.00 ","$588.84 ","$0.00 "
"354 805","SUP","HCPCS C1900","","354 805  -  COROX OTW 75 BP LEAD","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"354 807","SUP","HCPCS C1900","","354 807  -  COROX OTW 85 BP LEAD","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"354-7212","SUP","HCPCS C1789","","354-7212  -  EXPANDER TISS P6.6CM CNTR PRFL 11.7X10CM 350ML SLTX CPX3 STY","BOTH IP/OP","$3,412.50 ","$2,525.25 ","$0.00 ","$3,412.50 ","$1,535.63 ","$0.00 ","$711.25 ","$0.00 ","$0.00 ","$597.50 ","$3,412.50 ","$0.00 ","$1,706.25 ","$2,702.70 ","$2,730.00 ","$0.00 ","$534.06 ","$0.00 ","$543.27 ","$0.00 "
"354-7213","SUP","HCPCS C1789","","354-7213  -  EXPANDER TISS P7CM MED HT 12.7X10.8CM 450CC STRL SLTX CNTR","BOTH IP/OP","$3,312.50 ","$2,451.25 ","$0.00 ","$3,312.50 ","$1,490.63 ","$0.00 ","$690.41 ","$0.00 ","$0.00 ","$579.99 ","$3,312.50 ","$0.00 ","$1,656.25 ","$2,623.50 ","$2,650.00 ","$0.00 ","$518.41 ","$0.00 ","$527.35 ","$0.00 "
"354-7214","SUP","HCPCS C1789","","354-7214  -  EXPANDER TISS P7.4CM CNTR PRFL 13.5X11.7CM 550ML SLTX CPX3","BOTH IP/OP","$3,412.50 ","$2,525.25 ","$0.00 ","$3,412.50 ","$1,535.63 ","$0.00 ","$711.25 ","$0.00 ","$0.00 ","$597.50 ","$3,412.50 ","$0.00 ","$1,706.25 ","$2,702.70 ","$2,730.00 ","$0.00 ","$534.06 ","$0.00 ","$543.27 ","$0.00 "
"354-7215","SUP","HCPCS C1789","","354-7215  -  EXPANDER TISS P7.6CM CNTR PRFL 14.6X12.6CM 650ML SLTX CPX3","BOTH IP/OP","$3,412.50 ","$2,525.25 ","$0.00 ","$3,412.50 ","$1,535.63 ","$0.00 ","$711.25 ","$0.00 ","$0.00 ","$597.50 ","$3,412.50 ","$0.00 ","$1,706.25 ","$2,702.70 ","$2,730.00 ","$0.00 ","$534.06 ","$0.00 ","$543.27 ","$0.00 "
"354-9212","SUP","HCPCS C1789","","354-9212  -  EXPANDER TISS P6.6CM CNTR PRFL MED HT 11.7X10CM 350ML CPX4","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"355 148","SUP","HCPCS C1900","","355 148  -  COROX OTW 75 BP-S LEAD","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$0.00 ","$0.00 "
"355.399S","SUP","Custom 27203010","","355.399S  -  HOOK EXTRACTION 650MM STERILE CANN INTRAMEDULLARY NAIL","BOTH IP/OP","$650.60 ","$481.44 ","$0.00 ","$631.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$631.65 ","$0.00 ","$315.83 ","$500.27 ","$505.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3550-0-035","SUP","HCPCS C1713","","3550-0-035  -  SCREW BONE 6.5MM 35MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-040","SUP","HCPCS C1713","","3550-0-040  -  SCREW BONE 6.5MM 40MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-045","SUP","HCPCS C1713","","3550-0-045  -  SCREW BONE 6.5MM 45MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-050","SUP","HCPCS C1713","","3550-0-050  -  SCREW BONE 6.5MM 50MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-055","SUP","HCPCS C1713","","3550-0-055  -  SCREW BONE 6.5MM 55MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-060","SUP","HCPCS C1713","","3550-0-060  -  SCREW BONE 6.5MM 60MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-065","SUP","HCPCS C1713","","3550-0-065  -  SCREW BONE 6.5MM 65MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-070","SUP","HCPCS C1713","","3550-0-070  -  SCREW BONE 6.5MM 70MM ASNS 2 CORT GD","BOTH IP/OP","$365.75 ","$270.66 ","$0.00 ","$365.75 ","$164.59 ","$0.00 ","$76.23 ","$0.00 ","$0.00 ","$64.04 ","$365.75 ","$0.00 ","$182.88 ","$289.67 ","$292.60 ","$0.00 ","$57.24 ","$0.00 ","$58.23 ","$0.00 "
"3550-0-075","SUP","HCPCS C1713","","3550-0-075  -  SCREW BONE 6.5MM 75MM ASNS 2 CORT GD","BOTH IP/OP","$402.88 ","$298.13 ","$0.00 ","$402.88 ","$181.29 ","$0.00 ","$83.97 ","$0.00 ","$0.00 ","$70.54 ","$402.88 ","$0.00 ","$201.44 ","$319.08 ","$322.30 ","$0.00 ","$63.05 ","$0.00 ","$64.14 ","$0.00 "
"3550-0-080","SUP","HCPCS C1713","","3550-0-080  -  SCREW BONE 6.5MM 80MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-085","SUP","HCPCS C1713","","3550-0-085  -  SCREW BONE 6.5MM 85MM ASNS 2 CORT GD","BOTH IP/OP","$402.88 ","$298.13 ","$0.00 ","$402.88 ","$181.29 ","$0.00 ","$83.97 ","$0.00 ","$0.00 ","$70.54 ","$402.88 ","$0.00 ","$201.44 ","$319.08 ","$322.30 ","$0.00 ","$63.05 ","$0.00 ","$64.14 ","$0.00 "
"3550-0-090","SUP","HCPCS C1713","","3550-0-090  -  SCREW BONE 6.5MM 90MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-095","SUP","HCPCS C1713","","3550-0-095  -  SCREW BONE 6.5MM 95MM ASNS 2 CORT GD","BOTH IP/OP","$402.88 ","$298.13 ","$0.00 ","$402.88 ","$181.29 ","$0.00 ","$83.97 ","$0.00 ","$0.00 ","$70.54 ","$402.88 ","$0.00 ","$201.44 ","$319.08 ","$322.30 ","$0.00 ","$63.05 ","$0.00 ","$64.14 ","$0.00 "
"3550-0-100","SUP","HCPCS C1713","","3550-0-100  -  SCREW BONE 6.5MM 100MM ASNS 2 CORT GD","BOTH IP/OP","$402.88 ","$298.13 ","$0.00 ","$402.88 ","$181.29 ","$0.00 ","$83.97 ","$0.00 ","$0.00 ","$70.54 ","$402.88 ","$0.00 ","$201.44 ","$319.08 ","$322.30 ","$0.00 ","$63.05 ","$0.00 ","$64.14 ","$0.00 "
"3550-0-105","SUP","HCPCS C1713","","3550-0-105  -  SCREW BONE 6.5MM 105MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-110","SUP","HCPCS C1713","","3550-0-110  -  SCREW BONE 6.5MM 110MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-115","SUP","HCPCS C1713","","3550-0-115  -  SCREW BONE 6.5MM 115MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-120","SUP","HCPCS C1713","","3550-0-120  -  SCREW BONE 6.5MM 120MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-125","SUP","HCPCS C1713","","3550-0-125  -  SCREW BONE 6.5MM 125MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-0-130","SUP","HCPCS C1713","","3550-0-130  -  SCREW BONE 6.5MM 130MM ASNS 2 CORT GD","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"3550-4-024","SUP","HCPCS C1713","","3550-4-024  -  ASNIS2 GUIDED SCREW 5.0CANC 24","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-026","SUP","HCPCS C1713","","3550-4-026  -  SCREW BONE 5MM 2MM ASNS 2 CANC GD","BOTH IP/OP","$257.13 ","$190.28 ","$0.00 ","$257.13 ","$115.71 ","$0.00 ","$53.59 ","$0.00 ","$0.00 ","$45.02 ","$257.13 ","$0.00 ","$128.56 ","$203.65 ","$205.70 ","$0.00 ","$40.24 ","$0.00 ","$40.93 ","$0.00 "
"3550-4-028","SUP","HCPCS C1713","","3550-4-028  -  ASNIS2 GUIDED SCREW 5.0CANC 28","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-030","SUP","HCPCS C1713","","3550-4-030  -  ASNIS2 GUIDED SCREW 5.0CANC 30","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-032","SUP","HCPCS C1713","","3550-4-032  -  ASNIS2 GUIDED SCREW 5.0CANC 32","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-034","SUP","HCPCS C1713","","3550-4-034  -  SCREW BONE 5MM 34MM ASNS 2 SS PTTHRD GD CANC STRL","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-036","SUP","HCPCS C1713","","3550-4-036  -  SCREW BONE 5MM 3MM ASNS 2 CANC GD","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-038","SUP","HCPCS C1713","","3550-4-038  -  ASNIS2 GUIDED SCREW 5.0CANC 38","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-040","SUP","HCPCS C1713","","3550-4-040  -  ASNIS2 GUIDED SCREW 5.0CANC 40","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-042","SUP","HCPCS C1713","","3550-4-042  -  SCREW BONE 5MM 4MM ASNS 2 CANC GD","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-045","SUP","HCPCS C1713","","3550-4-045  -  SCREW BONE 5MM 4MM ASNS 2 CANC GD","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-055","SUP","HCPCS C1713","","3550-4-055  -  SCREW BONE 5MM 55MM ASNS 2 CANC GD","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-060","SUP","HCPCS C1713","","3550-4-060  -  SCREW BONE 5MM 60MM ASNS 2 CANC GD","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-065","SUP","HCPCS C1713","","3550-4-065  -  SCREW BONE 5MM 6MM ASNS 2 CANC GD","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-4-070","SUP","HCPCS C1713","","3550-4-070  -  ASNIS2 GUIDED SCREW 5.0CANC 70","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$123.13 ","$0.00 ","$57.03 ","$0.00 ","$0.00 ","$47.91 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$42.82 ","$0.00 ","$43.56 ","$0.00 "
"3550-5-000","SUP","Custom 27803010","","3550-5-000  -  SMALL WASHER","BOTH IP/OP","$64.63 ","$47.83 ","$0.00 ","$64.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.63 ","$0.00 ","$32.31 ","$51.19 ","$51.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3600-100","SUP","HCPCS C1729","","3600-100  -  DRAIN INCISION 1 COLLECT 1 CHAMBER 1 PATIENT TUBE DRY","BOTH IP/OP","$75.13 ","$55.60 ","$0.00 ","$71.94 ","$39.06 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.60 ","$71.94 ","$0.00 ","$35.97 ","$56.98 ","$57.55 ","$0.00 ","$11.26 ","$0.00 ","$11.45 ","$0.00 "
"3611ED","SUP","Custom 27203010","","MATTRESS COMPLETE UNIT /F","BOTH IP/OP","$2,006.95 ","$1,485.14 ","$0.00 ","$2,006.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,006.95 ","$0.00 ","$1,003.48 ","$1,589.50 ","$1,605.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3634LF","SUP","Custom 27203010","","STOCKING CMPR THG HI LG SHRT ANEMB INSP TOE TED NYL","BOTH IP/OP","$707.48 ","$523.54 ","$0.00 ","$707.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.48 ","$0.00 ","$353.74 ","$560.32 ","$565.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-0-040","SUP","Custom 27803010","","3704-0-040  -  CABLE/SLEEVE ORTHOPEDIC 1.6MM BEAD SET DALL-MILES STAINLESS","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-0-050","SUP","Custom 27803010","","3704-0-050  -  CABLE/SLEEVE ORTHOPEDIC LP 2MM BEAD SET DALL-MILES STAINLESS","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-0-410","SUP","Custom 27803010","","3704-0-410  -  CABLE/SLEEVE ORTHOPEDIC FLAT 1.6MM SET LP DALL-MILES","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-0-510","SUP","Custom 27803010","","3704-0-510  -  CABLE/SLEEVE ORTHOPEDIC 2MM BEAD SET DALL-MILES STAINLESS","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-1-100","SUP","Custom 27803010","","3704-1-100  -  SLEEVE CABLE SMALL DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-1-110","SUP","Custom 27803010","","3704-1-110  -  SLEEVE CABLE MEDIUM DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-070","SUP","Custom 27803010","","3704-2-070  -  GRIP CABLE SMALL 43MM DALL-MILES STAINLESS STEEL HIP TROC","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-080","SUP","Custom 27803010","","3704-2-080  -  GRIP CABLE MEDIUM 48MM DALL-MILES STAINLESS STEEL HIP TROC","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-081","SUP","HCPCS C1713","","3704-2-081  -  PLATE BONE MEDIUM 100MM GRIP DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$2,610.00 ","$1,931.40 ","$0.00 ","$2,610.00 ","$1,174.50 ","$0.00 ","$543.99 ","$0.00 ","$0.00 ","$456.99 ","$2,610.00 ","$0.00 ","$1,305.00 ","$2,067.12 ","$2,088.00 ","$0.00 ","$408.47 ","$0.00 ","$415.51 ","$0.00 "
"3704-2-082","SUP","Custom 27803010","","3704-2-082  -  PLATE BONE MEDIUM 150MM GRIP DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$3,422.50 ","$2,532.65 ","$0.00 ","$3,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,422.50 ","$0.00 ","$1,711.25 ","$2,710.62 ","$2,738.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-083","SUP","Custom 27803010","","3704-2-083  -  PLATE BONE MEDIUM 200MM GRIP DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$4,240.00 ","$3,137.60 ","$0.00 ","$4,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,240.00 ","$0.00 ","$2,120.00 ","$3,358.08 ","$3,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-090","SUP","Custom 27803010","","3704-2-090  -  GRIP CABLE LARGE 200MM DALL-MILES STAINLESS STEEL HIP TROC","BOTH IP/OP","$1,800.00 ","$1,332.00 ","$0.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,800.00 ","$0.00 ","$900.00 ","$1,425.60 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-091","SUP","Custom 27803010","","3704-2-091  -  PLATE BONE LARGE 110MM GRIP DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$2,217.50 ","$1,640.95 ","$0.00 ","$2,217.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,217.50 ","$0.00 ","$1,108.75 ","$1,756.26 ","$1,774.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-092","SUP","Custom 27803010","","3704-2-092  -  PLATE BONE LARGE 160MM GRIP DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$3,422.50 ","$2,532.65 ","$0.00 ","$3,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,422.50 ","$0.00 ","$1,711.25 ","$2,710.62 ","$2,738.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-2-093","SUP","Custom 27803010","","3704-2-093  -  PLATE BONE LARGE 210MM GRIP DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$4,240.00 ","$3,137.60 ","$0.00 ","$4,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,240.00 ","$0.00 ","$2,120.00 ","$3,358.08 ","$3,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-3-100","SUP","HCPCS C1713","","3704-3-100  -  PLATE BONE BROAD 6.5IN 5 HOLE 6 GROOVE COMPRESSION ROUND END","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$1,190.00 ","$535.50 ","$0.00 ","$248.03 ","$0.00 ","$0.00 ","$208.36 ","$1,190.00 ","$0.00 ","$595.00 ","$942.48 ","$952.00 ","$0.00 ","$186.24 ","$0.00 ","$189.45 ","$0.00 "
"3704-3-110","SUP","HCPCS C1713","","3704-3-110  -  PLATE BONE BROAD 8IN 7 HOLE 8 GROOVE COMPRESSION ROUND END","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$1,190.00 ","$535.50 ","$0.00 ","$248.03 ","$0.00 ","$0.00 ","$208.36 ","$1,190.00 ","$0.00 ","$595.00 ","$942.48 ","$952.00 ","$0.00 ","$186.24 ","$0.00 ","$189.45 ","$0.00 "
"3704-3-120","SUP","HCPCS C1713","","3704-3-120  -  PLATE BONE BROAD 10IN 9 HOLE 10 GROOVE COMPRESSION ROUND END","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$1,190.00 ","$535.50 ","$0.00 ","$248.03 ","$0.00 ","$0.00 ","$208.36 ","$1,190.00 ","$0.00 ","$595.00 ","$942.48 ","$952.00 ","$0.00 ","$186.24 ","$0.00 ","$189.45 ","$0.00 "
"3704-3-130","SUP","HCPCS C1713","","3704-3-130  -  PLATE BONE BROAD 12IN 11 HOLE 12 GROOVE COMPRESSION ROUND","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$1,190.00 ","$535.50 ","$0.00 ","$248.03 ","$0.00 ","$0.00 ","$208.36 ","$1,190.00 ","$0.00 ","$595.00 ","$942.48 ","$952.00 ","$0.00 ","$186.24 ","$0.00 ","$189.45 ","$0.00 "
"3704-8-236","SUP","Custom 27803010","","3704-8-236  -  CABLE ORTHOPEDIC 1.6MM SLEEVE RECONSTRUCTION TRAUMA","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3704-8-240","SUP","Custom 27803010","","3704-8-240  -  CABLE ORTHOPEDIC 2MM 650MM DALL-MILES STAINLESS STEEL HIP","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"370605.S","SUP","HCPCS A6209","","370605.S  -  DRESSING WND THK10MM 6IN 665X802MM STRL LF ABTHERA VSCR PCTV","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$475.13 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"370642.S","SUP","HCPCS A6209","","370642.S  -  SET TBG ABTHERA QCK ACC STABLIZED","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"37-11068","SUP","Custom 27203010","","FORCEPS SURG 45D 5.2IN ANG UP PEAR SHP CUP HRZN","BOTH IP/OP","$1,722.50 ","$1,274.65 ","$0.00 ","$1,722.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,722.50 ","$0.00 ","$861.25 ","$1,364.22 ","$1,378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-535-000","SUP","Custom 27203010","","375-535-000  -  BLADE SHVR 3.5MM FRML ARTHRO TOMCAT STRL","BOTH IP/OP","$186.55 ","$138.05 ","$0.00 ","$186.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.55 ","$0.00 ","$93.28 ","$147.75 ","$149.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-542-000","SUP","Custom 27203010","","375-542-000  -  BLADE SHVR 4MM FRML RESCT F LATEX FREE","BOTH IP/OP","$143.43 ","$106.14 ","$0.00 ","$143.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.43 ","$0.00 ","$71.72 ","$113.60 ","$114.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-544-000","SUP","Custom 27203010","","375-544-000  -  BLADE SHVR 4MM FRML STR CTR AGRS+ ARTHRO F STRL LATEX FREE","BOTH IP/OP","$143.43 ","$106.14 ","$0.00 ","$143.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.43 ","$0.00 ","$71.72 ","$113.60 ","$114.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-545-000","SUP","Custom 27203010","","375-545-000  -  BLADE SHAVER 4MM ARTHRO TOMCAT STERILE","BOTH IP/OP","$138.58 ","$102.55 ","$0.00 ","$138.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.58 ","$0.00 ","$69.29 ","$109.76 ","$110.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-554-000","SUP","Custom 27203010","","375-554-000  -  BLADE SHVR 5MM FRML AGRS+ ARTHRO STRL","BOTH IP/OP","$186.55 ","$138.05 ","$0.00 ","$186.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.55 ","$0.00 ","$93.28 ","$147.75 ","$149.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-555-000","SUP","Custom 27203010","","375-555-000  -  CUTTER ENDSCP 5MM TOMCAT FORMULA STERILE","BOTH IP/OP","$134.94 ","$99.86 ","$0.00 ","$134.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.94 ","$0.00 ","$67.47 ","$106.87 ","$107.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-562-000","SUP","Custom 27203010","","375-562-000  -  CUTTER ENDSCP 5.5MM RESECTOR LATEX FREE FORMULA STERILE","BOTH IP/OP","$138.58 ","$102.55 ","$0.00 ","$138.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.58 ","$0.00 ","$69.29 ","$109.76 ","$110.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-564-000","SUP","Custom 27203010","","375-564-000  -  BLADE SURG 5.5MM AGRS+ AGRS+ F SER STRL","BOTH IP/OP","$186.55 ","$138.05 ","$0.00 ","$186.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.55 ","$0.00 ","$93.28 ","$147.75 ","$149.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-565-000","SUP","Custom 27203010","","375-565-000  -  CUTTER ENDSCP ARTHRO FRML STRL 5.5MM","BOTH IP/OP","$186.55 ","$138.05 ","$0.00 ","$186.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.55 ","$0.00 ","$93.28 ","$147.75 ","$149.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-628-000","SUP","Custom 27203010","","375-628-000  -  BLADE SHVR 2.5MM FRML S JNT AGRS STRL","BOTH IP/OP","$143.43 ","$106.14 ","$0.00 ","$143.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.43 ","$0.00 ","$71.72 ","$113.60 ","$114.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-636-000","SUP","Custom 27203010","","375-636-000  -  BLADE SHVR 3.5MM FRML S JNT FULL RAD STRL","BOTH IP/OP","$186.55 ","$138.05 ","$0.00 ","$186.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.55 ","$0.00 ","$93.28 ","$147.75 ","$149.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-638-000","SUP","Custom 27203010","","375-638-000  -  BLADE SHVR 3.5MM FRML S JNT AGRS STRL","BOTH IP/OP","$186.55 ","$138.05 ","$0.00 ","$186.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.55 ","$0.00 ","$93.28 ","$147.75 ","$149.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-641-000","SUP","Custom 27203010","","375-641-000  -  BLADE SHVR 2MM FRML ABRSN HOOD ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-647-000","SUP","Custom 27203010","","375-647-000  -  BURR SHVR 3MM FRML S JNT ABRSN HOOD ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-930-000","SUP","Custom 27203010","","375-930-000  -  BURR SHVR 3.5MM FRML RND 6 FLUT ABRSN RPD STRL","BOTH IP/OP","$151.50 ","$112.11 ","$0.00 ","$151.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.50 ","$0.00 ","$75.75 ","$119.99 ","$121.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-940-000","SUP","Custom 27203010","","375-940-000  -  BURR SURG 4MM ROUND 6 FLUTED ARTHRO FORMULA STERILE","BOTH IP/OP","$146.38 ","$108.32 ","$0.00 ","$146.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$146.38 ","$0.00 ","$73.19 ","$115.93 ","$117.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-940-012","SUP","Custom 27203010","","375-940-012  -  BURR SHVR 4MM FRML RND HLW 12 FLUT ARTHRO STRL","BOTH IP/OP","$151.50 ","$112.11 ","$0.00 ","$151.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.50 ","$0.00 ","$75.75 ","$119.99 ","$121.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-941-000","SUP","Custom 27203010","","375-941-000  -  BURR SRG 6 FLUT BRL 4MM STRL FRML F SER","BOTH IP/OP","$151.50 ","$112.11 ","$0.00 ","$151.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.50 ","$0.00 ","$75.75 ","$119.99 ","$121.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-941-012","SUP","Custom 27203010","","375-941-012  -  BURR SHVR 4MM FRML BRL 12 FLUT ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-950-012","SUP","Custom 27203010","","375-950-012  -  BURR SHVR 5.5MM FRML 12 FLUT RND ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-950-100","SUP","Custom 27203010","","375-950-100  -  BURR SHVR 5MM FRML 6 FLUT RND ARTHRO STRL","BOTH IP/OP","$151.50 ","$112.11 ","$0.00 ","$151.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$151.50 ","$0.00 ","$75.75 ","$119.99 ","$121.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-950-112","SUP","Custom 27203010","","375-950-112  -  BURR SHVR 5MM FRML 12 FLUT RND ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-951-000","SUP","Custom 27203010","","375-951-000  -  BURR SHAVER 6 FLUTE ROUND BARREL 5.5MM ARTHRO FORMULA","BOTH IP/OP","$146.38 ","$108.32 ","$0.00 ","$146.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$146.38 ","$0.00 ","$73.19 ","$115.93 ","$117.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-951-012","SUP","Custom 27203010","","375-951-012  -  BURR SHVR 5.5MM FRML BRL 12 FLUT ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-951-100","SUP","Custom 27203010","","375-951-100  -  BURR SHVR 5MM FRML 6 FLUT BRL ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"375-951-112","SUP","Custom 27203010","","375-951-112  -  BURR SHVR 5MM FRML 12 FLUT BRL ARTHRO STRL","BOTH IP/OP","$197.05 ","$145.82 ","$0.00 ","$197.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.05 ","$0.00 ","$98.53 ","$156.06 ","$157.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38-051-65","SUP","Custom 27203010","","38-051-65  -  BURR SURG 70MM 2.2MM LNDMN MED NTCH STRL","BOTH IP/OP","$142.50 ","$105.45 ","$0.00 ","$142.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$142.50 ","$0.00 ","$71.25 ","$112.86 ","$114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"380-544-100","SUP","Custom 27203010","","380-544-100  -  BLADE SHVR 4MM FRML ANG AGRS+ ARTHRO STRL","BOTH IP/OP","$201.95 ","$149.44 ","$0.00 ","$201.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.95 ","$0.00 ","$100.98 ","$159.94 ","$161.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"380-545-100","SUP","Custom 27203010","","380-545-100  -  BLADE SHVR 4MM TOMCAT ANG TOMCAT STRL","BOTH IP/OP","$201.95 ","$149.44 ","$0.00 ","$201.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.95 ","$0.00 ","$100.98 ","$159.94 ","$161.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"380-545-150","SUP","Custom 27203010","","380-545-150  -  BLADE SHVR 4.5MM TOMCAT ANG TOMCAT STRL LATEX FREE","BOTH IP/OP","$201.95 ","$149.44 ","$0.00 ","$201.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.95 ","$0.00 ","$100.98 ","$159.94 ","$161.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"380-554-100","SUP","Custom 27203010","","380-554-100  -  CUTTER ENDSCP ANG AGRS+ FRML STRL 5MM","BOTH IP/OP","$201.95 ","$149.44 ","$0.00 ","$201.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.95 ","$0.00 ","$100.98 ","$159.94 ","$161.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"380-555-100","SUP","Custom 27203010","","380-555-100  -  CUTTER ENDSCP TOMCAT FRML ANG STRL 5MM","BOTH IP/OP","$201.95 ","$149.44 ","$0.00 ","$201.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.95 ","$0.00 ","$100.98 ","$159.94 ","$161.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38-130-56","SUP","Custom 27203010","","38-130-56  -  PROP MTH PED DNTL SET BLK","BOTH IP/OP","$35.63 ","$26.37 ","$0.00 ","$35.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.63 ","$0.00 ","$17.81 ","$28.22 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3815-8-920","SUP","HCPCS C1713","","3815-8-920  -  PIN FIX 4MM STNM","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$68.75 ","$30.94 ","$0.00 ","$14.33 ","$0.00 ","$0.00 ","$12.04 ","$68.75 ","$0.00 ","$34.38 ","$54.45 ","$55.00 ","$0.00 ","$10.76 ","$0.00 ","$10.95 ","$0.00 "
"3855-4-000","SUP","Custom 27203010","","3855-4-000  -  DRILL SURG STP CORT","BOTH IP/OP","$474.38 ","$351.04 ","$0.00 ","$474.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$474.38 ","$0.00 ","$237.19 ","$375.71 ","$379.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"38-709-03-07","SUP","HCPCS C1713","","38-709-03-07  -  INSTRUMENT RDC LG 5IN BYRD ZYG RDC SCR SS OSTSYN","BOTH IP/OP","$374.38 ","$277.04 ","$0.00 ","$374.38 ","$168.47 ","$0.00 ","$78.03 ","$0.00 ","$0.00 ","$65.55 ","$374.38 ","$0.00 ","$187.19 ","$296.51 ","$299.50 ","$0.00 ","$58.59 ","$0.00 ","$59.60 ","$0.00 "
"390-110","SUP","Custom 27803010","","390-110  -  STONE CONE COIL","BOTH IP/OP","$506.00 ","$374.44 ","$0.00 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$506.00 ","$0.00 ","$253.00 ","$400.75 ","$404.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3910-900-020","SUP","HCPCS C1713","","3910-900-020  -  ANCHOR SUTURE 2 FRC FBR NDL STRN 38IN","BOTH IP/OP","$69.38 ","$51.34 ","$0.00 ","$69.38 ","$31.22 ","$0.00 ","$14.46 ","$0.00 ","$0.00 ","$12.15 ","$69.38 ","$0.00 ","$34.69 ","$54.95 ","$55.50 ","$0.00 ","$10.86 ","$0.00 ","$11.04 ","$0.00 "
"3910-900-050","SUP","HCPCS C1713","","3910-900-050  -  SUTURE NABSB 5 3/8 CRC 38IN WHT BLU STRL FRC FBR NDL CO BRD","BOTH IP/OP","$88.30 ","$65.34 ","$0.00 ","$80.00 ","$36.00 ","$0.00 ","$18.40 ","$0.00 ","$0.00 ","$14.01 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$12.52 ","$0.00 ","$12.74 ","$0.00 "
"394500S","SUP","Custom 27203010","","394500S  -  HOOK BONE 25MM OMEGA 3 HANSSON HIP SS CMPR SCR TWN STRL","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$178.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3A1505","SUP","Custom 27203010","","LEADWIRE EKG 5 LEAD SET SNP 40IN","BOTH IP/OP","$26.25 ","$19.43 ","$0.00 ","$26.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.25 ","$0.00 ","$13.13 ","$20.79 ","$21.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3HSK-3038","SUP","Custom 27203010","","3HSK-3038  -  HEARTSTRING III PROXIMAL SEAL SYSTEM 3.8 MM","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3MA005","SUP","Custom 27203010","","STANDARD ADV OSMTR CLBRT AMPULE 2ML 3300 SER CHM 50 MOSM/KG","BOTH IP/OP","$11.98 ","$8.87 ","$0.00 ","$11.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.98 ","$0.00 ","$5.99 ","$9.49 ","$9.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3MA029","SUP","Custom 27203010","","CONTROL OSMTR CLNTRL 290 MOSM REF SOL OSM 2ML","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3MA800","SUP","Custom 27203010","","SAMPLER ADV CHMBR CLNR SMPL TIP MODL 3300/3320 ANALY","BOTH IP/OP","$767.28 ","$567.79 ","$0.00 ","$767.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$767.28 ","$0.00 ","$383.64 ","$607.69 ","$613.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3MAXC","SUP","HCPCS C1757","","3MAXC  -  CATHETER REPERFUSION 3MAX","BOTH IP/OP","$3,725.00 ","$2,756.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$776.38 ","$0.00 ","$0.00 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3MAXCKIT","SUP","HCPCS C1757","","3MAXCKIT  -  CATHETER THROMBECTOMY .014IN 4.7-3.8FR .035IN 153CM 157CM","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3N02A","SUP","Custom 27203010","","3N02A  -  SUTURE NONABSORBABLE CV-3 TT-17 36IN 2 ARM MONOFILAMENT","BOTH IP/OP","$677.50 ","$501.35 ","$0.00 ","$677.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.50 ","$0.00 ","$338.75 ","$536.58 ","$542.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"3X611","SUP","Custom 27203010","","BELT 5 56X21/32X7/16IN B53 TYPE","BOTH IP/OP","$48.33 ","$35.76 ","$0.00 ","$48.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.33 ","$0.00 ","$24.16 ","$38.28 ","$38.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4.0PED","SUP","Custom 27203010","","4.0PED  -  TUBE 41MM 5.9MM 4MM UNCUF OBT TRCH PLVN CHLOR PED","BOTH IP/OP","$94.29 ","$69.77 ","$0.00 ","$94.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.29 ","$0.00 ","$47.14 ","$74.68 ","$75.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4.5PED","SUP","Custom 27203010","","4.5PED  -  TUBE 42MM 6.5MM 4.5MM UNCUF OBT TRCH PLVN CHLOR PED","BOTH IP/OP","$94.29 ","$69.77 ","$0.00 ","$94.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.29 ","$0.00 ","$47.14 ","$74.68 ","$75.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"400.040E","SUP","HCPCS C1713","","400.040E  -  SCREW BONE 10MM 1.5MM CORT CRANFCL TI SLFTAP +DR RECESS","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$64.80 ","$0.00 ","$30.01 ","$0.00 ","$0.00 ","$25.21 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$22.54 ","$0.00 ","$22.92 ","$0.00 "
"400.046E","SUP","HCPCS C1713","","400.046E  -  1.5MM TI CORTEX SCR SLF-TPNG WITH PLUSDRIVE(TM) RECESS 16MM","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$64.80 ","$0.00 ","$30.01 ","$0.00 ","$0.00 ","$25.21 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$22.54 ","$0.00 ","$22.92 ","$0.00 "
"400.048E","SUP","HCPCS C1713","","400.048E  -  1.5MM TI CORTEX SCR SLF-TPNG WITH PLUSDRIVE(TM) RECESS 18MM","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$64.80 ","$0.00 ","$30.01 ","$0.00 ","$0.00 ","$25.21 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$22.54 ","$0.00 ","$22.92 ","$0.00 "
"400.054E","SUP","HCPCS C1713","","400.054E  -  SCREW BONE 4MM 1.5MM CORT CRANIOMAXILOFACIAL TI +DR RECESS","BOTH IP/OP","$173.25 ","$128.21 ","$0.00 ","$173.25 ","$77.96 ","$0.00 ","$36.11 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"400.055E","SUP","HCPCS C1713","","400.055E  -  SCREW BONE 5MM 1.5MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$173.25 ","$128.21 ","$0.00 ","$173.25 ","$77.96 ","$0.00 ","$36.11 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"400.056E","SUP","HCPCS C1713","","400.056E  -  SCREW BONE 6MM 1.5MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$173.25 ","$128.21 ","$0.00 ","$173.25 ","$77.96 ","$0.00 ","$36.11 ","$0.00 ","$0.00 ","$30.33 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$27.11 ","$0.00 ","$27.58 ","$0.00 "
"400.280E","SUP","HCPCS C1713","","400.280E  -  SCREW BONE 2MM 10MM TI CRNMXF ER +DR RECESS STRL","BOTH IP/OP","$151.88 ","$112.39 ","$0.00 ","$151.88 ","$68.34 ","$0.00 ","$31.65 ","$0.00 ","$0.00 ","$26.59 ","$151.88 ","$0.00 ","$75.94 ","$120.29 ","$121.50 ","$0.00 ","$23.77 ","$0.00 ","$24.18 ","$0.00 "
"400.282E","SUP","HCPCS C1713","","400.282E  -  SCREW BONE 2MM 12MM TI CRNMXF ER +DR RECESS STRL","BOTH IP/OP","$151.88 ","$112.39 ","$0.00 ","$151.88 ","$68.34 ","$0.00 ","$31.65 ","$0.00 ","$0.00 ","$26.59 ","$151.88 ","$0.00 ","$75.94 ","$120.29 ","$121.50 ","$0.00 ","$23.77 ","$0.00 ","$24.18 ","$0.00 "
"400.284E","SUP","HCPCS C1713","","400.284E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM","BOTH IP/OP","$151.88 ","$112.39 ","$0.00 ","$151.88 ","$68.34 ","$0.00 ","$31.65 ","$0.00 ","$0.00 ","$26.59 ","$151.88 ","$0.00 ","$75.94 ","$120.29 ","$121.50 ","$0.00 ","$23.77 ","$0.00 ","$24.18 ","$0.00 "
"400.286E","SUP","HCPCS C1713","","400.286E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 16MM","BOTH IP/OP","$151.88 ","$112.39 ","$0.00 ","$151.88 ","$68.34 ","$0.00 ","$31.65 ","$0.00 ","$0.00 ","$26.59 ","$151.88 ","$0.00 ","$75.94 ","$120.29 ","$121.50 ","$0.00 ","$23.77 ","$0.00 ","$24.18 ","$0.00 "
"400.288E","SUP","HCPCS C1713","","400.288E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 18MM","BOTH IP/OP","$151.88 ","$112.39 ","$0.00 ","$151.88 ","$68.34 ","$0.00 ","$31.65 ","$0.00 ","$0.00 ","$26.59 ","$151.88 ","$0.00 ","$75.94 ","$120.29 ","$121.50 ","$0.00 ","$23.77 ","$0.00 ","$24.18 ","$0.00 "
"400.404E","SUP","HCPCS C1713","","400.404E  -  SCREW BONE STRL GOLD 4MM 1MM CORT CRANFCL TI SLFTAP +DR","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$96.19 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"400.405E","SUP","HCPCS C1713","","400.405E  -  SCREW BONE STRL GOLD 5MM 1MM CORT CRANFCL TI SLFTAP +DR","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$96.19 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"400.407E","SUP","HCPCS C1713","","400.407E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 7MM","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$191.25 ","$86.06 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$33.49 ","$191.25 ","$0.00 ","$95.63 ","$151.47 ","$153.00 ","$0.00 ","$29.93 ","$0.00 ","$30.45 ","$0.00 "
"400.408E","SUP","HCPCS C1713","","400.408E  -  SCREW BONE 1MM 8MM TI CORT SLFTAP NONSTRL","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$96.19 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"400.409E","SUP","HCPCS C1713","","400.409E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 9MM","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$191.25 ","$86.06 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$33.49 ","$191.25 ","$0.00 ","$95.63 ","$151.47 ","$153.00 ","$0.00 ","$29.93 ","$0.00 ","$30.45 ","$0.00 "
"400.410E","SUP","HCPCS C1713","","400.410E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 10MM","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$96.19 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"400.411E","SUP","HCPCS C1713","","400.411E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 11MM","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$191.25 ","$86.06 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$33.49 ","$191.25 ","$0.00 ","$95.63 ","$151.47 ","$153.00 ","$0.00 ","$29.93 ","$0.00 ","$30.45 ","$0.00 "
"400.412E","SUP","HCPCS C1713","","400.412E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 12MM","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$96.19 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"400.414E","SUP","HCPCS C1713","","400.414E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 14MM","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$96.19 ","$0.00 ","$44.55 ","$0.00 ","$0.00 ","$37.43 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$33.45 ","$0.00 ","$34.03 ","$0.00 "
"400.437E","SUP","HCPCS C1713","","400.437E  -  SCREW BONE 7MM 1.3MM CORTEX TI SLFTAP DRV RECESS 3MM","BOTH IP/OP","$178.88 ","$132.37 ","$0.00 ","$178.88 ","$80.49 ","$0.00 ","$37.28 ","$0.00 ","$0.00 ","$31.32 ","$178.88 ","$0.00 ","$89.44 ","$141.67 ","$143.10 ","$0.00 ","$27.99 ","$0.00 ","$28.48 ","$0.00 "
"400.439E","SUP","HCPCS C1713","","400.439E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 9MM","BOTH IP/OP","$178.88 ","$132.37 ","$0.00 ","$178.88 ","$80.49 ","$0.00 ","$37.28 ","$0.00 ","$0.00 ","$31.32 ","$178.88 ","$0.00 ","$89.44 ","$141.67 ","$143.10 ","$0.00 ","$27.99 ","$0.00 ","$28.48 ","$0.00 "
"400.440E","SUP","HCPCS C1713","","400.440E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 10MM","BOTH IP/OP","$199.13 ","$147.36 ","$0.00 ","$199.13 ","$89.61 ","$0.00 ","$41.50 ","$0.00 ","$0.00 ","$34.87 ","$199.13 ","$0.00 ","$99.56 ","$157.71 ","$159.30 ","$0.00 ","$31.16 ","$0.00 ","$31.70 ","$0.00 "
"400.442E","SUP","HCPCS C1713","","400.442E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 12MM","BOTH IP/OP","$199.13 ","$147.36 ","$0.00 ","$199.13 ","$89.61 ","$0.00 ","$41.50 ","$0.00 ","$0.00 ","$34.87 ","$199.13 ","$0.00 ","$99.56 ","$157.71 ","$159.30 ","$0.00 ","$31.16 ","$0.00 ","$31.70 ","$0.00 "
"400.444E","SUP","HCPCS C1713","","400.444E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 14MM","BOTH IP/OP","$199.13 ","$147.36 ","$0.00 ","$199.13 ","$89.61 ","$0.00 ","$41.50 ","$0.00 ","$0.00 ","$34.87 ","$199.13 ","$0.00 ","$99.56 ","$157.71 ","$159.30 ","$0.00 ","$31.16 ","$0.00 ","$31.70 ","$0.00 "
"400.446E","SUP","HCPCS C1713","","400.446E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 16MM","BOTH IP/OP","$199.13 ","$147.36 ","$0.00 ","$199.13 ","$89.61 ","$0.00 ","$41.50 ","$0.00 ","$0.00 ","$34.87 ","$199.13 ","$0.00 ","$99.56 ","$157.71 ","$159.30 ","$0.00 ","$31.16 ","$0.00 ","$31.70 ","$0.00 "
"400.448E","SUP","HCPCS C1713","","400.448E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 18MM","BOTH IP/OP","$199.13 ","$147.36 ","$0.00 ","$199.13 ","$89.61 ","$0.00 ","$41.50 ","$0.00 ","$0.00 ","$34.87 ","$199.13 ","$0.00 ","$99.56 ","$157.71 ","$159.30 ","$0.00 ","$31.16 ","$0.00 ","$31.70 ","$0.00 "
"400.454E","SUP","HCPCS C1713","","400.454E  -  SCREW BONE STRL SLVR 4MM 1.3MM CORT CRANFCL TI SLFDRILL +DR","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$204.75 ","$92.14 ","$0.00 ","$42.68 ","$0.00 ","$0.00 ","$35.85 ","$204.75 ","$0.00 ","$102.38 ","$162.16 ","$163.80 ","$0.00 ","$32.04 ","$0.00 ","$32.60 ","$0.00 "
"400.455E","SUP","HCPCS C1713","","400.455E  -  SCREW BONE SLVR 5MM 1.3MM CRANFCL TI SLFDRILL +DR RECESS","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$204.75 ","$92.14 ","$0.00 ","$42.68 ","$0.00 ","$0.00 ","$35.85 ","$204.75 ","$0.00 ","$102.38 ","$162.16 ","$163.80 ","$0.00 ","$32.04 ","$0.00 ","$32.60 ","$0.00 "
"400.456E","SUP","HCPCS C1713","","400.456E  -  SCREW BONE SLVR 6MM 1.3MM CRANFCL TI SLFDRILL +DR RECESS","BOTH IP/OP","$204.75 ","$151.52 ","$0.00 ","$204.75 ","$92.14 ","$0.00 ","$42.68 ","$0.00 ","$0.00 ","$35.85 ","$204.75 ","$0.00 ","$102.38 ","$162.16 ","$163.80 ","$0.00 ","$32.04 ","$0.00 ","$32.60 ","$0.00 "
"400.465E","SUP","HCPCS C1713","","400.465E  -  SCREW BONE TEAL 5MM 1.2MM CRANFCL TI SLFDRILL +DR RECESS","BOTH IP/OP","$220.50 ","$163.17 ","$0.00 ","$220.50 ","$99.23 ","$0.00 ","$45.96 ","$0.00 ","$0.00 ","$38.61 ","$220.50 ","$0.00 ","$110.25 ","$174.64 ","$176.40 ","$0.00 ","$34.51 ","$0.00 ","$35.10 ","$0.00 "
"400.467E","SUP","HCPCS C1713","","400.467E  -  SCREW BONE 7MM 1.2MM CRNMXF TI NONSTRL","BOTH IP/OP","$195.75 ","$144.86 ","$0.00 ","$195.75 ","$88.09 ","$0.00 ","$40.80 ","$0.00 ","$0.00 ","$34.27 ","$195.75 ","$0.00 ","$97.88 ","$155.03 ","$156.60 ","$0.00 ","$30.63 ","$0.00 ","$31.16 ","$0.00 "
"400.469E","SUP","HCPCS C1713","","400.469E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 9MM","BOTH IP/OP","$195.75 ","$144.86 ","$0.00 ","$195.75 ","$88.09 ","$0.00 ","$40.80 ","$0.00 ","$0.00 ","$34.27 ","$195.75 ","$0.00 ","$97.88 ","$155.03 ","$156.60 ","$0.00 ","$30.63 ","$0.00 ","$31.16 ","$0.00 "
"400.470E","SUP","HCPCS C1713","","400.470E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 10MM","BOTH IP/OP","$220.50 ","$163.17 ","$0.00 ","$220.50 ","$99.23 ","$0.00 ","$45.96 ","$0.00 ","$0.00 ","$38.61 ","$220.50 ","$0.00 ","$110.25 ","$174.64 ","$176.40 ","$0.00 ","$34.51 ","$0.00 ","$35.10 ","$0.00 "
"400.471E","SUP","HCPCS C1713","","400.471E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 11MM","BOTH IP/OP","$195.75 ","$144.86 ","$0.00 ","$195.75 ","$88.09 ","$0.00 ","$40.80 ","$0.00 ","$0.00 ","$34.27 ","$195.75 ","$0.00 ","$97.88 ","$155.03 ","$156.60 ","$0.00 ","$30.63 ","$0.00 ","$31.16 ","$0.00 "
"400.472E","SUP","HCPCS C1713","","400.472E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 12MM","BOTH IP/OP","$220.50 ","$163.17 ","$0.00 ","$220.50 ","$99.23 ","$0.00 ","$45.96 ","$0.00 ","$0.00 ","$38.61 ","$220.50 ","$0.00 ","$110.25 ","$174.64 ","$176.40 ","$0.00 ","$34.51 ","$0.00 ","$35.10 ","$0.00 "
"400.474E","SUP","HCPCS C1713","","400.474E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM","BOTH IP/OP","$220.50 ","$163.17 ","$0.00 ","$220.50 ","$99.23 ","$0.00 ","$45.96 ","$0.00 ","$0.00 ","$38.61 ","$220.50 ","$0.00 ","$110.25 ","$174.64 ","$176.40 ","$0.00 ","$34.51 ","$0.00 ","$35.10 ","$0.00 "
"400.483E","SUP","HCPCS C1713","","400.483E  -  SCREW BONE 3MM 1.7MM CRANFCL TI ER +DR RECESS STRL","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.487E","SUP","HCPCS C1713","","400.487E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 7MM","BOTH IP/OP","$186.75 ","$138.20 ","$0.00 ","$186.75 ","$84.04 ","$0.00 ","$38.92 ","$0.00 ","$0.00 ","$32.70 ","$186.75 ","$0.00 ","$93.38 ","$147.91 ","$149.40 ","$0.00 ","$29.23 ","$0.00 ","$29.73 ","$0.00 "
"400.488E","SUP","HCPCS C1713","","400.488E  -  SCREW BN 1.5MM 8MM NS TI CORT","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.489E","SUP","HCPCS C1713","","400.489E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 9MM","BOTH IP/OP","$186.75 ","$138.20 ","$0.00 ","$186.75 ","$84.04 ","$0.00 ","$38.92 ","$0.00 ","$0.00 ","$32.70 ","$186.75 ","$0.00 ","$93.38 ","$147.91 ","$149.40 ","$0.00 ","$29.23 ","$0.00 ","$29.73 ","$0.00 "
"400.490E","SUP","HCPCS C1713","","400.490E  -  SCREW TI 10IN 1.7MM CRANFCL ER +DR RECESS BONE","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.492E","SUP","HCPCS C1713","","400.492E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 12MM","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.494E","SUP","HCPCS C1713","","400.494E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.496E","SUP","HCPCS C1713","","400.496E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 16MM","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.498E","SUP","HCPCS C1713","","400.498E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 18MM","BOTH IP/OP","$207.00 ","$153.18 ","$0.00 ","$207.00 ","$93.15 ","$0.00 ","$43.14 ","$0.00 ","$0.00 ","$36.24 ","$207.00 ","$0.00 ","$103.50 ","$163.94 ","$165.60 ","$0.00 ","$32.40 ","$0.00 ","$32.95 ","$0.00 "
"400.806.96","SUP","HCPCS C1713","","400.806.96  -  SCREW BONE LP 1.5MM 3MM 6MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$14.79 ","$0.00 ","$10.10 ","$0.00 "
"400.807.96","SUP","HCPCS C1713","","400.807.96  -  SCREW BONE LP 1.5MM 3MM 7MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.808.96","SUP","HCPCS C1713","","400.808.96  -  SCREW BONE 1.5MM 3MM 8MM SLFTAP TITANIUM HAND CORTICAL","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.809.96","SUP","HCPCS C1713","","400.809.96  -  SCREW BONE 1.5MM 9MM SLFTAP TITANIUM CORTICAL HAND NONSTRL","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.810.96","SUP","HCPCS C1713","","400.810.96  -  SCREW BONE LP 1.5MM 3MM 10MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.811.96","SUP","HCPCS C1713","","400.811.96  -  SCREW BONE LP 1.5MM 3MM 11MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.812.96","SUP","HCPCS C1713","","400.812.96  -  SCREW BONE 1.5MM 3MM 12MM SLFTAP TITANIUM HAND CORTICAL","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.813.96","SUP","HCPCS C1713","","400.813.96  -  SCREW BONE 1.5MM 3MM 13MM SLFTAP LP HEAD THREADED TITANIUM","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.814.96","SUP","HCPCS C1713","","400.814.96  -  SCREW BONE LP 1.5MM 3MM 14MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.816.96","SUP","HCPCS C1713","","400.816.96  -  SCREW BONE 1.5MM 16MM SLFTAP TITANIUM CORTICAL HAND NONSTRL","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.818.96","SUP","HCPCS C1713","","400.818.96  -  SCREW BONE LP 1.5MM 3MM 18MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.820.96","SUP","HCPCS C1713","","400.820.96  -  SCREW BONE LP 1.5MM 3MM 20MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.822.96","SUP","HCPCS C1713","","400.822.96  -  SCREW BONE LP 1.5MM 3MM 22MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.824.96","SUP","HCPCS C1713","","400.824.96  -  SCREW BONE LP 1.5MM 3MM 24MM SELF TAP THREAD TITANIUM HAND","BOTH IP/OP","$65.35 ","$48.36 ","$0.00 ","$63.45 ","$28.55 ","$0.00 ","$13.62 ","$0.00 ","$0.00 ","$11.11 ","$63.45 ","$0.00 ","$31.73 ","$50.25 ","$50.76 ","$0.00 ","$9.64 ","$0.00 ","$10.10 ","$0.00 "
"400.843E","SUP","HCPCS C1713","","400.843E  -  SCREW BONE 3MM 1.6MM CRNMXF TI ALLOY SLFTAP LP STRL","BOTH IP/OP","$196.88 ","$145.69 ","$0.00 ","$196.88 ","$88.59 ","$0.00 ","$41.03 ","$0.00 ","$0.00 ","$34.47 ","$196.88 ","$0.00 ","$98.44 ","$155.93 ","$157.50 ","$0.00 ","$30.81 ","$0.00 ","$31.34 ","$0.00 "
"400.846E","SUP","HCPCS C1713","","400.846E  -  TI LOW PROFILE NEURO SCREW SELF-TAPPING 6MM","BOTH IP/OP","$196.88 ","$145.69 ","$0.00 ","$196.88 ","$88.59 ","$0.00 ","$41.03 ","$0.00 ","$0.00 ","$34.47 ","$196.88 ","$0.00 ","$98.44 ","$155.93 ","$157.50 ","$0.00 ","$30.81 ","$0.00 ","$31.34 ","$0.00 "
"400.855E","SUP","HCPCS C1713","","400.855E  -  SCREW BONE 5MM 2MM CRANFCL TI SLFTAP LP ER STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"400.856E","SUP","HCPCS C1713","","400.856E  -  SCREW BONE 6MM 2MM CRANFCL TI SLFTAP LP ER STRL","BOTH IP/OP","$196.88 ","$145.69 ","$0.00 ","$196.88 ","$88.59 ","$0.00 ","$41.03 ","$0.00 ","$0.00 ","$34.47 ","$196.88 ","$0.00 ","$98.44 ","$155.93 ","$157.50 ","$0.00 ","$30.81 ","$0.00 ","$31.34 ","$0.00 "
"40-0001-S","SUP","HCPCS C1713","","40-0001-S  -  ROD XTRNFX CMPR OLCRN","BOTH IP/OP","$2,480.00 ","$1,835.20 ","$0.00 ","$2,480.00 ","$1,116.00 ","$0.00 ","$516.89 ","$0.00 ","$0.00 ","$434.23 ","$2,480.00 ","$0.00 ","$1,240.00 ","$1,964.16 ","$1,984.00 ","$0.00 ","$388.12 ","$0.00 ","$394.82 ","$0.00 "
"40-0003","SUP","Custom 27203010","","40-0003  -  NUT EXFIX OLCRN GUIDE ASMBLY NONSTRL","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,140.00 ","$0.00 ","$570.00 ","$902.88 ","$912.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0006","SUP","HCPCS C1713","","40-0006  -  BOLT LCK OLCRN NONSTRL","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$295.88 ","$0.00 ","$137.04 ","$0.00 ","$0.00 ","$115.12 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$102.90 ","$0.00 ","$104.67 ","$0.00 "
"40-0007","SUP","HCPCS C1713","","40-0007  -  CANNU ORTH TRGT ROD NONSTRL OLCRN","BOTH IP/OP","$1,005.00 ","$743.70 ","$0.00 ","$1,005.00 ","$452.25 ","$0.00 ","$209.47 ","$0.00 ","$0.00 ","$175.97 ","$1,005.00 ","$0.00 ","$502.50 ","$795.96 ","$804.00 ","$0.00 ","$157.28 ","$0.00 ","$160.00 ","$0.00 "
"40-0008","SUP","Custom 27203010","","40-0008  -  GUIDE TRGT ASMBLY CMPR NUT SURG OLCRN NONSTRL","BOTH IP/OP","$1,992.50 ","$1,474.45 ","$0.00 ","$1,992.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,992.50 ","$0.00 ","$996.25 ","$1,578.06 ","$1,594.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0012","SUP","Custom 27203010","","40-0012  -  DRILL SRG NUT CMPR OLCRN","BOTH IP/OP","$827.50 ","$612.35 ","$0.00 ","$827.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$827.50 ","$0.00 ","$413.75 ","$655.38 ","$662.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0013-S","SUP","Custom 27203010","","40-0013-S  -  NUT XTRNFX 6MM CMPR OLCRN","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0014-S","SUP","Custom 27203010","","40-0014-S  -  NUT XTRNFX 8MM CMPR OLCRN","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0015-S","SUP","Custom 27203010","","40-0015-S  -  NUT XTRNFX 10MM CMPR OLCRN","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0016-S","SUP","Custom 27803010","","40-0016-S  -  WASHER ORTH SMTH OLCRN","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0021-S","SUP","HCPCS C1713","","40-0021-S  -  WASHER ORTH THRD OLCRN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"40-0026-S","SUP","HCPCS C1713","","40-0026-S  -  ROD ORTH 110MM 3MM FIB IM IMPL","BOTH IP/OP","$2,705.00 ","$2,001.70 ","$0.00 ","$2,705.00 ","$1,217.25 ","$0.00 ","$563.79 ","$0.00 ","$0.00 ","$473.62 ","$2,705.00 ","$0.00 ","$1,352.50 ","$2,142.36 ","$2,164.00 ","$0.00 ","$423.33 ","$0.00 ","$430.64 ","$0.00 "
"40-0027-S","SUP","HCPCS C1713","","40-0027-S  -  ROD ORTH 145MM 3MM FIB ANKL FIB IM IMPL STRL","BOTH IP/OP","$2,705.00 ","$2,001.70 ","$0.00 ","$2,705.00 ","$1,217.25 ","$0.00 ","$563.79 ","$0.00 ","$0.00 ","$473.62 ","$2,705.00 ","$0.00 ","$1,352.50 ","$2,142.36 ","$2,164.00 ","$0.00 ","$423.33 ","$0.00 ","$430.64 ","$0.00 "
"40-0028-S","SUP","HCPCS C1713","","40-0028-S  -  ROD ORTH 180MM 3MM FIB FIB IM IMPL STRL","BOTH IP/OP","$2,705.00 ","$2,001.70 ","$0.00 ","$2,705.00 ","$1,217.25 ","$0.00 ","$563.79 ","$0.00 ","$0.00 ","$473.62 ","$2,705.00 ","$0.00 ","$1,352.50 ","$2,142.36 ","$2,164.00 ","$0.00 ","$423.33 ","$0.00 ","$430.64 ","$0.00 "
"40-0029-S","SUP","HCPCS C1713","","40-0029-S  -  ROD ORTH 110MM 3.6MM FIB FIB IM IMPL STRL","BOTH IP/OP","$2,705.00 ","$2,001.70 ","$0.00 ","$2,705.00 ","$1,217.25 ","$0.00 ","$563.79 ","$0.00 ","$0.00 ","$473.62 ","$2,705.00 ","$0.00 ","$1,352.50 ","$2,142.36 ","$2,164.00 ","$0.00 ","$423.33 ","$0.00 ","$430.64 ","$0.00 "
"40-0030-S","SUP","HCPCS C1713","","40-0030-S  -  ROD XTRNFX 3.6MM 145MM FIB","BOTH IP/OP","$2,705.00 ","$2,001.70 ","$0.00 ","$2,705.00 ","$1,217.25 ","$0.00 ","$563.79 ","$0.00 ","$0.00 ","$473.62 ","$2,705.00 ","$0.00 ","$1,352.50 ","$2,142.36 ","$2,164.00 ","$0.00 ","$423.33 ","$0.00 ","$430.64 ","$0.00 "
"40-0031-S","SUP","Custom 27203010","","40-0031-S  -  ROD EXFIX 180MM 3.6MM FIB","BOTH IP/OP","$2,705.00 ","$2,001.70 ","$0.00 ","$2,705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,705.00 ","$0.00 ","$1,352.50 ","$2,142.36 ","$2,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0034","SUP","HCPCS C1713","","40-0034  -  BASEPLATE ROD FIB","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"40-0136","SUP","HCPCS C1713","","40-0136  -  SCREW BONE 3MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0137","SUP","HCPCS C1713","","40-0137  -  SCREW BONE 3MM 90MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0138","SUP","HCPCS C1713","","40-0138  -  SCREW BONE 3MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0139","SUP","HCPCS C1713","","40-0139  -  SCREW BONE 3MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"400-14","SUP","Custom 27203010","","400-14  -  BANDAGE ADH MRDH","BOTH IP/OP","$2,470.00 ","$1,827.80 ","$0.00 ","$2,470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,470.00 ","$0.00 ","$1,235.00 ","$1,956.24 ","$1,976.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-0140","SUP","HCPCS C1713","","40-0140  -  SCREW BONE 3MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0143","SUP","HCPCS C1713","","40-0143  -  SCREW BONE 3.8MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0144","SUP","HCPCS C1713","","40-0144  -  SCREW BONE 3.8MM 90MM CLVCL DL TRK","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0145","SUP","HCPCS C1713","","40-0145  -  SCREW BONE 3.8MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0146","SUP","HCPCS C1713","","40-0146  -  SCREW BONE 3.8MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"40-0147","SUP","HCPCS C1713","","40-0147  -  SCREW BONE 3.8MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"4002C0306","SUP","Custom 27803010","","4002C0306  -  COIL EMBL .02IN STD CMPLX 3MM 6CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,525.00 ","$4,088.50 ","$0.00 ","$5,525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,525.00 ","$0.00 ","$2,762.50 ","$4,375.80 ","$4,420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0310","SUP","Custom 27803010","","4002C0310  -  COIL 400 COMPLEX STANDARD, 3 MM X 10 CM","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0408","SUP","Custom 27803010","","4002C0408  -  COIL EMBL .02IN STD CMPLX 4MM 8CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,017.50 ","$3,712.95 ","$0.00 ","$5,017.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,017.50 ","$0.00 ","$2,508.75 ","$3,973.86 ","$4,014.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0412","SUP","Custom 27803010","","4002C0412  -  COIL 400 COMPLEX STANDARD, 4 MM X 12 CM","BOTH IP/OP","$5,675.00 ","$4,199.50 ","$0.00 ","$5,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,675.00 ","$0.00 ","$2,837.50 ","$4,494.60 ","$4,540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0506","SUP","Custom 27803010","","4002C0506  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 5MM 6CM COMPLEX THE","BOTH IP/OP","$4,972.50 ","$3,679.65 ","$0.00 ","$4,972.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,972.50 ","$0.00 ","$2,486.25 ","$3,938.22 ","$3,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0510","SUP","Custom 27803010","","4002C0510  -  COIL EMBL STD 5MM 10CM PENUMBRA COIL 400 CMPLX","BOTH IP/OP","$5,062.50 ","$3,746.25 ","$0.00 ","$5,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,062.50 ","$0.00 ","$2,531.25 ","$4,009.50 ","$4,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0610","SUP","Custom 27803010","","4002C0610  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 6MM 10CM COMPLEX","BOTH IP/OP","$5,062.50 ","$3,746.25 ","$0.00 ","$5,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,062.50 ","$0.00 ","$2,531.25 ","$4,009.50 ","$4,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0615","SUP","Custom 27803010","","4002C0615  -  COIL EMBL STD 6MM 15CM PENUMBRA COIL 400 CMPLX","BOTH IP/OP","$5,175.00 ","$3,829.50 ","$0.00 ","$5,175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,175.00 ","$0.00 ","$2,587.50 ","$4,098.60 ","$4,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0710","SUP","Custom 27803010","","4002C0710  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 10CM COMPLEX","BOTH IP/OP","$5,062.50 ","$3,746.25 ","$0.00 ","$5,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,062.50 ","$0.00 ","$2,531.25 ","$4,009.50 ","$4,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0715","SUP","Custom 27803010","","4002C0715  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 15CM COMPLEX","BOTH IP/OP","$5,175.00 ","$3,829.50 ","$0.00 ","$5,175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,175.00 ","$0.00 ","$2,587.50 ","$4,098.60 ","$4,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0720","SUP","Custom 27803010","","4002C0720  -  COIL EMBL STD 7MM 20CM PENUMBRA COIL 400 CMPLX","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0815","SUP","Custom 27803010","","4002C0815  -  COIL 400 COMPLEX STANDARD, 8 MM X 15 CM","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0820","SUP","Custom 27803010","","4002C0820  -  COIL EMBL .02IN STD CMPLX 8MM 20CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0830","SUP","Custom 27803010","","4002C0830  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 8MM 30CM COMPLEX","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0915","SUP","Custom 27803010","","4002C0915  -  COIL EMBL .02IN STD CMPLX 9MM 15CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0925","SUP","Custom 27803010","","4002C0925  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 9MM 25CM COMPLEX","BOTH IP/OP","$5,400.00 ","$3,996.00 ","$0.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,400.00 ","$0.00 ","$2,700.00 ","$4,276.80 ","$4,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C0935","SUP","Custom 27803010","","4002C0935  -  COIL EMBL .02IN STD CMPLX 9MM 35CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,570.00 ","$4,121.80 ","$0.00 ","$5,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,570.00 ","$0.00 ","$2,785.00 ","$4,411.44 ","$4,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1020","SUP","Custom 27803010","","4002C1020  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 20CM COMPLEX","BOTH IP/OP","$5,287.50 ","$3,912.75 ","$0.00 ","$5,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,287.50 ","$0.00 ","$2,643.75 ","$4,187.70 ","$4,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1030","SUP","Custom 27803010","","4002C1030  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 30CM COMPLEX","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1040","SUP","Custom 27803010","","4002C1040  -  COIL EMBL .02IN STD CMPLX 10MM 40CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1135","SUP","Custom 27803010","","4002C1135  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 35CM COMPLEX","BOTH IP/OP","$5,570.00 ","$4,121.80 ","$0.00 ","$5,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,570.00 ","$0.00 ","$2,785.00 ","$4,411.44 ","$4,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1145","SUP","Custom 27803010","","4002C1145  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 45CM COMPLEX","BOTH IP/OP","$5,682.50 ","$4,205.05 ","$0.00 ","$5,682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,682.50 ","$0.00 ","$2,841.25 ","$4,500.54 ","$4,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1235","SUP","Custom 27803010","","4002C1235  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 35CM COMPLEX","BOTH IP/OP","$5,570.00 ","$4,121.80 ","$0.00 ","$5,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,570.00 ","$0.00 ","$2,785.00 ","$4,411.44 ","$4,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1245","SUP","Custom 27803010","","4002C1245  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 45CM COMPLEX","BOTH IP/OP","$5,682.50 ","$4,205.05 ","$0.00 ","$5,682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,682.50 ","$0.00 ","$2,841.25 ","$4,500.54 ","$4,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1335","SUP","Custom 27803010","","4002C1335  -  COIL 400 COMPLEX STANDARD, 13MM X 35CM","BOTH IP/OP","$6,187.50 ","$4,578.75 ","$0.00 ","$6,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,187.50 ","$0.00 ","$3,093.75 ","$4,900.50 ","$4,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1348","SUP","Custom 27803010","","4002C1348  -  COIL EMBL STD .02IN 13MM 48CM DTCH CMPLX STRCH RS PLTN","BOTH IP/OP","$5,715.00 ","$4,229.10 ","$0.00 ","$5,715.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,715.00 ","$0.00 ","$2,857.50 ","$4,526.28 ","$4,572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1450","SUP","Custom 27803010","","4002C1450  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 14MM 50CM COMPLEX","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1557","SUP","Custom 27803010","","4002C1557  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 15MM 57CM COMPLEX","BOTH IP/OP","$5,817.50 ","$4,304.95 ","$0.00 ","$5,817.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,817.50 ","$0.00 ","$2,908.75 ","$4,607.46 ","$4,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1660","SUP","Custom 27803010","","4002C1660  -  COIL EMBL .02IN STD CMPLX 16MM 60CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,850.00 ","$4,329.00 ","$0.00 ","$5,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,850.00 ","$0.00 ","$2,925.00 ","$4,633.20 ","$4,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C1857","SUP","Custom 27803010","","4002C1857  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 18MM 57CM COMPLEX","BOTH IP/OP","$5,817.50 ","$4,304.95 ","$0.00 ","$5,817.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,817.50 ","$0.00 ","$2,908.75 ","$4,607.46 ","$4,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C2060","SUP","Custom 27803010","","4002C2060  -  COIL EMBL .02IN STD CMPLX 20MM 60CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,850.00 ","$4,329.00 ","$0.00 ","$5,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,850.00 ","$0.00 ","$2,925.00 ","$4,633.20 ","$4,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C2260","SUP","Custom 27803010","","4002C2260  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 22MM 60CM COMPLEX","BOTH IP/OP","$5,850.00 ","$4,329.00 ","$0.00 ","$5,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,850.00 ","$0.00 ","$2,925.00 ","$4,633.20 ","$4,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C2457","SUP","Custom 27803010","","4002C2457  -  COIL EMBL .02IN STD CMPLX 24MM 57CM THE PENUMBRA COIL 400","BOTH IP/OP","$5,817.50 ","$4,304.95 ","$0.00 ","$5,817.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,817.50 ","$0.00 ","$2,908.75 ","$4,607.46 ","$4,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C2860","SUP","Custom 27803010","","4002C2860  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 28MM 60CM COMPLEX","BOTH IP/OP","$6,525.00 ","$4,828.50 ","$0.00 ","$6,525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,525.00 ","$0.00 ","$3,262.50 ","$5,167.80 ","$5,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4002C3260","SUP","Custom 27803010","","4002C3260  -  COIL EMBL .02IN STD CMPLX 32MM 60CM THE PENUMBRA COIL 400","BOTH IP/OP","$6,525.00 ","$4,828.50 ","$0.00 ","$6,525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,525.00 ","$0.00 ","$3,262.50 ","$5,167.80 ","$5,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0303","SUP","Custom 27803010","","4004C0303  -  COIL 400 COMPLEX SOFT, 3 MM X 3 CM","BOTH IP/OP","$5,950.00 ","$4,403.00 ","$0.00 ","$5,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,950.00 ","$0.00 ","$2,975.00 ","$4,712.40 ","$4,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0304","SUP","Custom 27803010","","4004C0304  -  COIL 400 COMPLEX SOFT, 3 MM X 4 CM","BOTH IP/OP","$5,975.00 ","$4,421.50 ","$0.00 ","$5,975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,975.00 ","$0.00 ","$2,987.50 ","$4,732.20 ","$4,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0306","SUP","Custom 27803010","","4004C0306  -  COIL EMBL .02IN CMPLX 3MM 6CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,422.50 ","$4,012.65 ","$0.00 ","$5,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,422.50 ","$0.00 ","$2,711.25 ","$4,294.62 ","$4,338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0310","SUP","Custom 27803010","","4004C0310  -  COIL EMBOLIZATION .02IN COMPLEX 3MM 10CM SOFT THE PENUMBRA","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0404","SUP","Custom 27803010","","4004C0404  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 4CM SOFT THE PENUMBRA","BOTH IP/OP","$5,377.50 ","$3,979.35 ","$0.00 ","$5,377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,377.50 ","$0.00 ","$2,688.75 ","$4,258.98 ","$4,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0406","SUP","Custom 27803010","","4004C0406  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM SOFT THE PENUMBRA","BOTH IP/OP","$5,422.50 ","$4,012.65 ","$0.00 ","$5,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,422.50 ","$0.00 ","$2,711.25 ","$4,294.62 ","$4,338.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0408","SUP","Custom 27803010","","4004C0408  -  COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,467.50 ","$4,045.95 ","$0.00 ","$5,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,467.50 ","$0.00 ","$2,733.75 ","$4,330.26 ","$4,374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0412","SUP","Custom 27803010","","4004C0412  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 12CM SOFT THE PENUMBRA","BOTH IP/OP","$5,557.50 ","$4,112.55 ","$0.00 ","$5,557.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,557.50 ","$0.00 ","$2,778.75 ","$4,401.54 ","$4,446.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0509","SUP","Custom 27803010","","4004C0509  -  COIL EMBL .02IN CMPLX 5MM 9CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,490.00 ","$4,062.60 ","$0.00 ","$5,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,490.00 ","$0.00 ","$2,745.00 ","$4,348.08 ","$4,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0513","SUP","Custom 27803010","","4004C0513  -  COIL EMBOLIZATION .02IN COMPLEX 5MM 13CM SOFT THE PENUMBRA","BOTH IP/OP","$5,580.00 ","$4,129.20 ","$0.00 ","$5,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,580.00 ","$0.00 ","$2,790.00 ","$4,419.36 ","$4,464.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0610","SUP","Custom 27803010","","4004C0610  -  COIL EMBL .02IN CMPLX 6MM 10CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0615","SUP","Custom 27803010","","4004C0615  -  COIL EMBOLIZATION .02IN COMPLEX 6MM 15CM SOFT THE PENUMBRA","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0620","SUP","Custom 27803010","","4004C0620  -  COIL EMBL .02IN CMPLX 6MM 20CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$6,375.00 ","$4,717.50 ","$0.00 ","$6,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,375.00 ","$0.00 ","$3,187.50 ","$5,049.00 ","$5,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0710","SUP","Custom 27803010","","4004C0710  -  COIL EMBL .02IN CMPLX 7MM 10CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0715","SUP","Custom 27803010","","4004C0715  -  COIL EMBL .02IN CMPLX 7MM 15CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0720","SUP","Custom 27803010","","4004C0720  -  COIL EMBOLIZATION .02IN COMPLEX 7MM 20CM SOFT THE PENUMBRA","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0815","SUP","Custom 27803010","","4004C0815  -  COIL EMBL .02IN CMPLX 8MM 15CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0820","SUP","Custom 27803010","","4004C0820  -  COIL EMBL .02IN CMPLX 8MM 20CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0830","SUP","Custom 27803010","","4004C0830  -  COIL 400 COMPLEX SOFT, 8MM X 30CM","BOTH IP/OP","$6,625.00 ","$4,902.50 ","$0.00 ","$6,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,625.00 ","$0.00 ","$3,312.50 ","$5,247.00 ","$5,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0925","SUP","Custom 27803010","","4004C0925  -  COIL EMBL .02IN CMPLX 9MM 25CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,850.00 ","$4,329.00 ","$0.00 ","$5,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,850.00 ","$0.00 ","$2,925.00 ","$4,633.20 ","$4,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C0935","SUP","Custom 27803010","","4004C0935  -  COIL 400 COMPLEX SOFT, 9MM X 35CM","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1020","SUP","Custom 27803010","","4004C1020  -  COIL EMBL .02IN CMPLX 10MM 20CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1030","SUP","Custom 27803010","","4004C1030  -  COIL EMBOLIZATION .02IN COMPLEX 10MM 30CM SOFT THE PENUMBRA","BOTH IP/OP","$5,962.50 ","$4,412.25 ","$0.00 ","$5,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,962.50 ","$0.00 ","$2,981.25 ","$4,722.30 ","$4,770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1040","SUP","Custom 27803010","","4004C1040  -  COIL EMBL .02IN CMPLX 10MM 40CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1135","SUP","Custom 27803010","","4004C1135  -  COIL EMBOLIZATION .02IN COMPLEX 11MM 35CM SOFT THE PENUMBRA","BOTH IP/OP","$6,075.00 ","$4,495.50 ","$0.00 ","$6,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,075.00 ","$0.00 ","$3,037.50 ","$4,811.40 ","$4,860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1145","SUP","Custom 27803010","","4004C1145  -  COIL EMBL .02IN CMPLX 11MM 45CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1235","SUP","Custom 27803010","","4004C1235  -  COIL EMBL .02IN CMPLX 12MM 35CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$6,075.00 ","$4,495.50 ","$0.00 ","$6,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,075.00 ","$0.00 ","$3,037.50 ","$4,811.40 ","$4,860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1245","SUP","Custom 27803010","","4004C1245  -  COIL 400 COMPLEX SOFT, 12MM X 45CM","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1335","SUP","Custom 27803010","","4004C1335  -  COIL EMBOLIZATION .02IN COMPLEX 13MM 35CM SOFT THE PENUMBRA","BOTH IP/OP","$6,075.00 ","$4,495.50 ","$0.00 ","$6,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,075.00 ","$0.00 ","$3,037.50 ","$4,811.40 ","$4,860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1348","SUP","Custom 27803010","","4004C1348  -  COIL EMBL .02IN CMPLX 13MM 48CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$7,075.00 ","$5,235.50 ","$0.00 ","$7,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,075.00 ","$0.00 ","$3,537.50 ","$5,603.40 ","$5,660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1440","SUP","Custom 27803010","","4004C1440  -  COIL EMBOLIZATION .02IN COMPLEX 14MM 40CM SOFT THE PENUMBRA","BOTH IP/OP","$6,187.50 ","$4,578.75 ","$0.00 ","$6,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,187.50 ","$0.00 ","$3,093.75 ","$4,900.50 ","$4,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1450","SUP","Custom 27803010","","4004C1450  -  COIL EMBL .02IN CMPLX 14MM 50CM THE PENUMBRA COIL 400 SFT","BOTH IP/OP","$7,125.00 ","$5,272.50 ","$0.00 ","$7,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,125.00 ","$0.00 ","$3,562.50 ","$5,643.00 ","$5,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004C1645","SUP","Custom 27803010","","4004C1645  -  COIL EMBOLIZATION 16MM 45CM COMPLEX SOFT","BOTH IP/OP","$6,300.00 ","$4,662.00 ","$0.00 ","$6,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,300.00 ","$0.00 ","$3,150.00 ","$4,989.60 ","$5,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004J10","SUP","Custom 27803010","","4004J10  -  COIL EMBOLIZATION 10CM J SOFT FILL COIL 400 NITINOL","BOTH IP/OP","$5,670.00 ","$4,195.80 ","$0.00 ","$5,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,670.00 ","$0.00 ","$2,835.00 ","$4,490.64 ","$4,536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004J15","SUP","Custom 27803010","","4004J15  -  COIL EMBOLIZATION 15CM J COIL 400","BOTH IP/OP","$5,895.00 ","$4,362.30 ","$0.00 ","$5,895.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,895.00 ","$0.00 ","$2,947.50 ","$4,668.84 ","$4,716.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004J25","SUP","Custom 27803010","","4004J25  -  COIL EMBL 25CM THE PENUMBRA COIL 400 J SFT FIL NTNL","BOTH IP/OP","$5,537.50 ","$4,097.75 ","$0.00 ","$6,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,345.00 ","$0.00 ","$3,172.50 ","$5,025.24 ","$5,076.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4004J7","SUP","Custom 27803010","","4004J7  -  COIL EMBL 7CM PENUMBRA COIL 400 J SFT FIL NTNL","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0202","SUP","Custom 27803010","","4006C0202  -  COIL EMBOLIZATION .02IN COMPLEX 2MM 2CM EXTRA SOFT THE","BOTH IP/OP","$4,320.00 ","$3,196.80 ","$0.00 ","$4,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,320.00 ","$0.00 ","$2,160.00 ","$3,421.44 ","$3,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0203","SUP","Custom 27803010","","4006C0203  -  COIL EMBOLIZATION .02IN COMPLEX .02IN 2MM 3CM EXTRA SOFT","BOTH IP/OP","$4,557.50 ","$3,372.55 ","$0.00 ","$4,557.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,557.50 ","$0.00 ","$2,278.75 ","$3,609.54 ","$3,646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0204","SUP","Custom 27803010","","4006C0204  -  COIL EMBOLIZATION .02IN COMPLEX 2MM 4CM XSOFT THE PENUMBRA","BOTH IP/OP","$4,792.50 ","$3,546.45 ","$0.00 ","$4,792.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,792.50 ","$0.00 ","$2,396.25 ","$3,795.66 ","$3,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0303","SUP","Custom 27803010","","4006C0303  -  COIL EMBL .02IN CMPLX 3MM 3CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$4,557.50 ","$3,372.55 ","$0.00 ","$4,557.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,557.50 ","$0.00 ","$2,278.75 ","$3,609.54 ","$3,646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0304","SUP","Custom 27803010","","4006C0304  -  COIL EMBOLIZATION .02IN COMPLEX 3MM 4CM XSOFT THE PENUMBRA","BOTH IP/OP","$4,792.50 ","$3,546.45 ","$0.00 ","$4,792.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,792.50 ","$0.00 ","$2,396.25 ","$3,795.66 ","$3,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0305","SUP","Custom 27803010","","4006C0305  -  COIL EMBL .02IN CMPLX 3MM 5CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$5,030.00 ","$3,722.20 ","$0.00 ","$5,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,030.00 ","$0.00 ","$2,515.00 ","$3,983.76 ","$4,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0306","SUP","Custom 27803010","","4006C0306  -  COIL EMBOLIZATION .02IN COMPLEX .02IN 3MM 6CM EXTRA SOFT","BOTH IP/OP","$5,265.00 ","$3,896.10 ","$0.00 ","$5,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,265.00 ","$0.00 ","$2,632.50 ","$4,169.88 ","$4,212.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0308","SUP","Custom 27803010","","4006C0308  -  COIL EMBL .02IN CMPLX 3MM 8CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0310","SUP","Custom 27803010","","4006C0310  -  COIL 400 COMPLEX EXTRA SOFT, 3MM X 10CM","BOTH IP/OP","$6,900.00 ","$5,106.00 ","$0.00 ","$6,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,900.00 ","$0.00 ","$3,450.00 ","$5,464.80 ","$5,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0404","SUP","Custom 27803010","","4006C0404  -  COIL EMBL .02IN CMPLX 4MM 4CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$4,792.50 ","$3,546.45 ","$0.00 ","$4,792.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,792.50 ","$0.00 ","$2,396.25 ","$3,795.66 ","$3,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0406","SUP","Custom 27803010","","4006C0406  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM XSOFT THE PENUMBRA","BOTH IP/OP","$5,265.00 ","$3,896.10 ","$0.00 ","$5,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,265.00 ","$0.00 ","$2,632.50 ","$4,169.88 ","$4,212.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0408","SUP","Custom 27803010","","4006C0408  -  COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006C0410","SUP","Custom 27803010","","4006C0410  -  COIL EMBL .02IN CMPLX 4MM 10CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$6,210.00 ","$4,595.40 ","$0.00 ","$6,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,210.00 ","$0.00 ","$3,105.00 ","$4,918.32 ","$4,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0201","SUP","Custom 27803010","","4006U0201  -  COIL EMBOLIZATION CURVE 2MM 1CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$3,860.00 ","$2,856.40 ","$0.00 ","$3,860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,860.00 ","$0.00 ","$1,930.00 ","$3,057.12 ","$3,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0202","SUP","Custom 27803010","","4006U0202  -  COIL EMBL CRV 2MM 2CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$4,095.00 ","$3,030.30 ","$0.00 ","$4,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,095.00 ","$0.00 ","$2,047.50 ","$3,243.24 ","$3,276.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0203","SUP","Custom 27803010","","4006U0203  -  COIL EMBOLIZATION CURVE 2MM 3CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$4,332.50 ","$3,206.05 ","$0.00 ","$4,332.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,332.50 ","$0.00 ","$2,166.25 ","$3,431.34 ","$3,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0204","SUP","Custom 27803010","","4006U0204  -  COIL EMBL CRV 2MM 4CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$4,567.50 ","$3,379.95 ","$0.00 ","$4,567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,567.50 ","$0.00 ","$2,283.75 ","$3,617.46 ","$3,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0302","SUP","Custom 27803010","","4006U0302  -  COIL EMBOLIZATION CURVE 3MM 2CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$4,095.00 ","$3,030.30 ","$0.00 ","$4,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,095.00 ","$0.00 ","$2,047.50 ","$3,243.24 ","$3,276.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0303","SUP","Custom 27803010","","4006U0303  -  COIL EMBL CRV 3MM 3CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$4,332.50 ","$3,206.05 ","$0.00 ","$4,332.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,332.50 ","$0.00 ","$2,166.25 ","$3,431.34 ","$3,466.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0304","SUP","Custom 27803010","","4006U0304  -  COIL EMBOLIZATION CURVE 3MM 4CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$4,567.50 ","$3,379.95 ","$0.00 ","$4,567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,567.50 ","$0.00 ","$2,283.75 ","$3,617.46 ","$3,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0305","SUP","Custom 27803010","","4006U0305  -  COIL EMBL CRV 3MM 5CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$4,805.00 ","$3,555.70 ","$0.00 ","$4,805.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,805.00 ","$0.00 ","$2,402.50 ","$3,805.56 ","$3,844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0306","SUP","Custom 27803010","","4006U0306  -  COIL EMBOLIZATION CURVE 3MM 6CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$5,040.00 ","$3,729.60 ","$0.00 ","$5,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,040.00 ","$0.00 ","$2,520.00 ","$3,991.68 ","$4,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0308","SUP","Custom 27803010","","4006U0308  -  COIL EMBOLIZATION CURVE 3MM 8CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0310","SUP","Custom 27803010","","4006U0310  -  COIL EMBL CRV 3MM 10CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$6,512.50 ","$4,819.25 ","$0.00 ","$6,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,512.50 ","$0.00 ","$3,256.25 ","$5,157.90 ","$5,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0404","SUP","Custom 27803010","","4006U0404  -  COIL EMBOLIZATION CURVE 4MM 4CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$4,567.50 ","$3,379.95 ","$0.00 ","$4,567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,567.50 ","$0.00 ","$2,283.75 ","$3,617.46 ","$3,654.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0406","SUP","Custom 27803010","","4006U0406  -  COIL EMBL CRV 4MM 6CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$5,040.00 ","$3,729.60 ","$0.00 ","$5,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,040.00 ","$0.00 ","$2,520.00 ","$3,991.68 ","$4,032.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0408","SUP","Custom 27803010","","4006U0408  -  COIL EMBOLIZATION CURVE 4MM 8CM XSOFT THE PENUMBRA COIL 400","BOTH IP/OP","$5,512.50 ","$4,079.25 ","$0.00 ","$5,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,512.50 ","$0.00 ","$2,756.25 ","$4,365.90 ","$4,410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4006U0410","SUP","Custom 27803010","","4006U0410  -  COIL EMBL CRV 4MM 10CM THE PENUMBRA COIL 400 XSFT","BOTH IP/OP","$5,862.50 ","$4,338.25 ","$0.00 ","$5,862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,862.50 ","$0.00 ","$2,931.25 ","$4,643.10 ","$4,690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"401.042E","SUP","HCPCS C1713","","401.042E  -  SCREW BONE SLFTAP +DR RECESS GOLD 5MM 2MM CORT CRANFCL TI","BOTH IP/OP","$158.63 ","$117.39 ","$0.00 ","$158.63 ","$71.38 ","$0.00 ","$33.06 ","$0.00 ","$0.00 ","$27.77 ","$158.63 ","$0.00 ","$79.31 ","$125.63 ","$126.90 ","$0.00 ","$24.82 ","$0.00 ","$25.25 ","$0.00 "
"401.050E","SUP","HCPCS C1713","","401.050E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 20MM","BOTH IP/OP","$158.63 ","$117.39 ","$0.00 ","$158.63 ","$71.38 ","$0.00 ","$33.06 ","$0.00 ","$0.00 ","$27.77 ","$158.63 ","$0.00 ","$79.31 ","$125.63 ","$126.90 ","$0.00 ","$24.82 ","$0.00 ","$25.25 ","$0.00 "
"401.051E","SUP","HCPCS C1713","","401.051E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 22MM","BOTH IP/OP","$158.63 ","$117.39 ","$0.00 ","$158.63 ","$71.38 ","$0.00 ","$33.06 ","$0.00 ","$0.00 ","$27.77 ","$158.63 ","$0.00 ","$79.31 ","$125.63 ","$126.90 ","$0.00 ","$24.82 ","$0.00 ","$25.25 ","$0.00 "
"401.052E","SUP","HCPCS C1713","","401.052E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 24MM","BOTH IP/OP","$158.63 ","$117.39 ","$0.00 ","$158.63 ","$71.38 ","$0.00 ","$33.06 ","$0.00 ","$0.00 ","$27.77 ","$158.63 ","$0.00 ","$79.31 ","$125.63 ","$126.90 ","$0.00 ","$24.82 ","$0.00 ","$25.25 ","$0.00 "
"401.061E","SUP","HCPCS C1713","","401.061E  -  SCREW BONE SLVR 4MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$169.88 ","$125.71 ","$0.00 ","$169.88 ","$76.44 ","$0.00 ","$35.41 ","$0.00 ","$0.00 ","$29.74 ","$169.88 ","$0.00 ","$84.94 ","$134.54 ","$135.90 ","$0.00 ","$26.59 ","$0.00 ","$27.04 ","$0.00 "
"401.062E","SUP","HCPCS C1713","","401.062E  -  SCREW BONE SLVR 5MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.063E","SUP","HCPCS C1713","","401.063E  -  SCREW BONE SLVR 6MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.064E","SUP","HCPCS C1713","","401.064E  -  SCREW BONE SLVR 7MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$169.88 ","$125.71 ","$0.00 ","$169.88 ","$76.44 ","$0.00 ","$35.41 ","$0.00 ","$0.00 ","$29.74 ","$169.88 ","$0.00 ","$84.94 ","$134.54 ","$135.90 ","$0.00 ","$26.59 ","$0.00 ","$27.04 ","$0.00 "
"401.065E","SUP","HCPCS C1713","","401.065E  -  SCREW BONE SLVR 8MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.134.99","SUP","HCPCS C1713","","401.134.99  -  SCREW BONE 2MM 4MM ARCH TI CORT SPNL SLFDRILL STARDRIVE","BOTH IP/OP","$101.50 ","$75.11 ","$0.00 ","$101.50 ","$45.68 ","$0.00 ","$21.16 ","$0.00 ","$0.00 ","$17.77 ","$101.50 ","$0.00 ","$50.75 ","$80.39 ","$81.20 ","$0.00 ","$15.88 ","$0.00 ","$16.16 ","$0.00 "
"401.136.99","SUP","HCPCS C1713","","401.136.99  -  SCREW BONE 2MM 6MM ARCH TI CORT SPNL SLFDRILL STARDRIVE","BOTH IP/OP","$101.50 ","$75.11 ","$0.00 ","$101.50 ","$45.68 ","$0.00 ","$21.16 ","$0.00 ","$0.00 ","$17.77 ","$101.50 ","$0.00 ","$50.75 ","$80.39 ","$81.20 ","$0.00 ","$15.88 ","$0.00 ","$16.16 ","$0.00 "
"401.138.99","SUP","HCPCS C1713","","401.138.99  -  SCREW BONE 2MM 8MM ARCH TI CORT SPNL SLFDRILL STARDRIVE","BOTH IP/OP","$101.50 ","$75.11 ","$0.00 ","$101.50 ","$45.68 ","$0.00 ","$21.16 ","$0.00 ","$0.00 ","$17.77 ","$101.50 ","$0.00 ","$50.75 ","$80.39 ","$81.20 ","$0.00 ","$15.88 ","$0.00 ","$16.16 ","$0.00 "
"401.306E","SUP","HCPCS C1713","","401.306E  -  SCREW TI 6MM 2.4MM CRANFCL ER CRCIFRM RECESS BONE STRL TEAL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.307E","SUP","HCPCS C1713","","401.307E  -  SCREW BONE TEAL 7MM 2.4MM 2MM CORT CRANFCL TI SLFTAP ER STRP","BOTH IP/OP","$148.50 ","$109.89 ","$0.00 ","$148.50 ","$66.83 ","$0.00 ","$30.95 ","$0.00 ","$0.00 ","$26.00 ","$148.50 ","$0.00 ","$74.25 ","$117.61 ","$118.80 ","$0.00 ","$23.24 ","$0.00 ","$23.64 ","$0.00 "
"401.308E","SUP","HCPCS C1713","","401.308E  -  SCREW TI 8MM 2.4MM CRANFCL ER CRCIFRM RECESS BONE NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.309E","SUP","HCPCS C1713","","401.309E  -  SCREW BONE TEAL 9MM 2.4MM 2MM CORT CRANFCL TI SLFTAP ER STRP","BOTH IP/OP","$148.50 ","$109.89 ","$0.00 ","$148.50 ","$66.83 ","$0.00 ","$30.95 ","$0.00 ","$0.00 ","$26.00 ","$148.50 ","$0.00 ","$74.25 ","$117.61 ","$118.80 ","$0.00 ","$23.24 ","$0.00 ","$23.64 ","$0.00 "
"401.311E","SUP","HCPCS C1713","","401.311E  -  SCREW BONE 2.4MM 11MM TI ER STRL","BOTH IP/OP","$148.50 ","$109.89 ","$0.00 ","$148.50 ","$66.83 ","$0.00 ","$30.95 ","$0.00 ","$0.00 ","$26.00 ","$148.50 ","$0.00 ","$74.25 ","$117.61 ","$118.80 ","$0.00 ","$23.24 ","$0.00 ","$23.64 ","$0.00 "
"401.314E","SUP","HCPCS C1713","","401.314E  -  SCREW TI 14MM 2.4MM MANDIB ER CRCIFRM RECESS BONE STRL TEAL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.316E","SUP","HCPCS C1713","","401.316E  -  SCREW BONE 16MM 2.4MM CRANFCL TI ER CRCIFRM RECESS NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.318E","SUP","HCPCS C1713","","401.318E  -  SCREW BONE 2.4MM 18MM TI ER CRCIFRM RECESS","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.356.97","SUP","HCPCS C1713","","401.356.97  -  SCREW BONE 2MM 6MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.357.97","SUP","HCPCS C1713","","401.357.97  -  SCREW BONE 2MM 7MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.358.97","SUP","HCPCS C1713","","401.358.97  -  SCREW BONE T6 STARDRIVE 2MM 8MM SELF TAP TITANIUM CORTICAL","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.359.97","SUP","HCPCS C1713","","401.359.97  -  SCREW BONE 2MM 9MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.360.97","SUP","HCPCS C1713","","401.360.97  -  SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.361.97","SUP","HCPCS C1713","","401.361.97  -  SCREW BONE 2MM 11MM SLFTAP SELF RETAINING T6 STARDRIVE","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.362.97","SUP","HCPCS C1713","","401.362.97  -  SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.363.97","SUP","HCPCS C1713","","401.363.97  -  SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP TITANIUM RAD","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.364.97","SUP","HCPCS C1713","","401.364.97  -  SCREW BONE 2MM 14MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.366.97","SUP","HCPCS C1713","","401.366.97  -  SCREW BONE 2MM 16MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.368.97","SUP","HCPCS C1713","","401.368.97  -  SCREW BONE 2MM 18MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.370.97","SUP","HCPCS C1713","","401.370.97  -  SCREW BONE 2MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.372.97","SUP","HCPCS C1713","","401.372.97  -  SCREW BONE 2MM 22MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.374.97","SUP","HCPCS C1713","","401.374.97  -  SCREW BONE 2MM 24MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.375.97","SUP","HCPCS C1713","","401.375.97  -  SCREW BONE 2MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.376.97","SUP","HCPCS C1713","","401.376.97  -  SCREW BONE 2MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.377.97","SUP","HCPCS C1713","","401.377.97  -  SCREW BONE 2MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.378.97","SUP","HCPCS C1713","","401.378.97  -  SCREW BONE 2MM 32MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.379.97","SUP","HCPCS C1713","","401.379.97  -  SCREW BONE 2MM 34MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.380.97","SUP","HCPCS C1713","","401.380.97  -  SCREW BONE 2MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.381.97","SUP","HCPCS C1713","","401.381.97  -  SCREW BONE 2MM 38MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.382.97","SUP","HCPCS C1713","","401.382.97  -  SCREW BONE 2MM 40MM SLFTAP STARDRIVE RECESS LCP TITANIUM","BOTH IP/OP","$66.40 ","$49.14 ","$0.00 ","$64.48 ","$29.01 ","$0.00 ","$13.84 ","$0.00 ","$0.00 ","$11.29 ","$64.48 ","$0.00 ","$32.24 ","$51.07 ","$51.58 ","$0.00 ","$9.80 ","$0.00 ","$10.26 ","$0.00 "
"401.506.96","SUP","HCPCS C1713","","401.506.96  -  SCREW BONE 2.4MM 4MM 6MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.507.96","SUP","HCPCS C1713","","401.507.96  -  SCREW BONE 2.4MM 4MM 7MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.508.96","SUP","HCPCS C1713","","401.508.96  -  SCREW BONE 2.4MM 4.5MM 8MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.509.96","SUP","HCPCS C1713","","401.509.96  -  SCREW BONE 2.4MM 4MM 9MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.510.96","SUP","HCPCS C1713","","401.510.96  -  SCREW BONE 2.4MM 4.5MM 10MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.511.96","SUP","HCPCS C1713","","401.511.96  -  SCREW BONE 2.4MM 4.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.512.96","SUP","HCPCS C1713","","401.512.96  -  SCREW BONE 2.4MM 4.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.513.96","SUP","HCPCS C1713","","401.513.96  -  SCREW BONE 2.4MM 4.5MM 13MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.514.96","SUP","HCPCS C1713","","401.514.96  -  SCREW BONE 2.4MM 4.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.516.96","SUP","HCPCS C1713","","401.516.96  -  SCREW BONE 2.4MM 4.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.518.96","SUP","HCPCS C1713","","401.518.96  -  SCREW BONE 2.4MM 4.5MM 18MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.520.96","SUP","HCPCS C1713","","401.520.96  -  SCREW BONE 2.4MM 4.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.520E","SUP","HCPCS C1713","","401.520E  -  SCREW BONE 20MM SLFTAP CRCIFRM RECESS TITANIUM 2.4MM 4MM","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.522.96","SUP","HCPCS C1713","","401.522.96  -  SCREW BONE 2.4MM 4.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.524.96","SUP","HCPCS C1713","","401.524.96  -  SCREW BONE 2.4MM 4.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.524E","SUP","HCPCS C1713","","401.524E  -  SCREW BONE 2.4MM 24MM TI CORT HAND SLFTAP NONSTRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.526.96","SUP","HCPCS C1713","","401.526.96  -  SCREW BONE 2.4MM 4.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.526E","SUP","HCPCS C1713","","401.526E  -  SCREW BONE 2.4MM 26MM TI CORT HAND SLFTAP NONSTRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.528.96","SUP","HCPCS C1713","","401.528.96  -  SCREW BONE 2.4MM 4.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.528E","SUP","HCPCS C1713","","401.528E  -  SCREW BONE 2.4MM 28MM TI CORT HAND SLFTAP NONSTRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.530.96","SUP","HCPCS C1713","","401.530.96  -  SCREW BONE 2.4MM 4.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.530E","SUP","HCPCS C1713","","401.530E  -  SCREW BONE GOLD 30MM 2.4MM CRNMXF TI SLFTAP MDLR STRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.532.96","SUP","HCPCS C1713","","401.532.96  -  SCREW BONE 2.4MM 4.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.534.96","SUP","HCPCS C1713","","401.534.96  -  SCREW BONE 2.4MM 4.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.534E","SUP","HCPCS C1713","","401.534E  -  SCREW BONE GOLD 34MM 2.4MM CRNMXF TI SLFTAP MDLR STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.536.96","SUP","HCPCS C1713","","401.536.96  -  SCREW BONE 2.4MM 4.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.538.96","SUP","HCPCS C1713","","401.538.96  -  SCREW BONE 2.4MM 4.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.540.96","SUP","HCPCS C1713","","401.540.96  -  SCREW BONE 2.4MM 4.5MM 40MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$150.40 ","$111.30 ","$0.00 ","$146.03 ","$65.71 ","$0.00 ","$31.35 ","$0.00 ","$0.00 ","$25.57 ","$146.03 ","$0.00 ","$73.01 ","$115.66 ","$116.82 ","$0.00 ","$22.19 ","$0.00 ","$23.25 ","$0.00 "
"401.542E","SUP","HCPCS C1713","","401.542E  -  SCREW BONE 2.4MM 42MM CORT MANDIB SLFTAP MDLR FIX SYS","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.544E","SUP","HCPCS C1713","","401.544E  -  SCREW TI 44MM 2.4MM CORT MANDIB SLFTAP BONE NONSTRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.546E","SUP","HCPCS C1713","","401.546E  -  SCREW TI 46MM 2.4MM CORT MANDIB SLFTAP LCK RECON BONE STRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.548E","SUP","HCPCS C1713","","401.548E  -  SCREW TI 48MM 2.4MM CORT MANDIB SLFTAP LCK RECON BONE STRL","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$231.75 ","$104.29 ","$0.00 ","$48.30 ","$0.00 ","$0.00 ","$40.58 ","$231.75 ","$0.00 ","$115.88 ","$183.55 ","$185.40 ","$0.00 ","$36.27 ","$0.00 ","$36.89 ","$0.00 "
"401.558E","SUP","HCPCS C1713","","401.558E  -  SCREW TI 8MM 2.7MM MANDIB ER LCK BONE STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.560E","SUP","HCPCS C1713","","401.560E  -  SCREW TI 10MM 2.7MM MANDIB ER LCK BONE STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.566E","SUP","HCPCS C1713","","401.566E  -  SCREW TI 16MM 2.7MM MANDIB ER LCK BONE STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.568E","SUP","HCPCS C1713","","401.568E  -  SCREW TI 18MM 2.7MM MANDIB ER LCK BONE STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.594E","SUP","HCPCS C1713","","401.594E  -  2.0MM TI TENSION BAND SCREW SELF-TAPPING 4MM","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$191.25 ","$86.06 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$33.49 ","$191.25 ","$0.00 ","$95.63 ","$151.47 ","$153.00 ","$0.00 ","$29.93 ","$0.00 ","$30.45 ","$0.00 "
"401.596E","SUP","HCPCS C1713","","401.596E  -  2.0MM TI TENSION BAND SCREW SELF-TAPPING 6MM","BOTH IP/OP","$191.25 ","$141.53 ","$0.00 ","$191.25 ","$86.06 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$33.49 ","$191.25 ","$0.00 ","$95.63 ","$151.47 ","$153.00 ","$0.00 ","$29.93 ","$0.00 ","$30.45 ","$0.00 "
"401.797E","SUP","HCPCS C1713","","401.797E  -  SCREW BONE TEAL 14MM 2.4MM CRANFCL TI ER +DR RECESS NONSTRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"401.806.96","SUP","HCPCS C1713","","401.806.96  -  SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.807.96","SUP","HCPCS C1713","","401.807.96  -  SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.808.96","SUP","HCPCS C1713","","401.808.96  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.809.96","SUP","HCPCS C1713","","401.809.96  -  SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$14.70 ","$0.00 ","$10.05 ","$0.00 "
"401.810.96","SUP","HCPCS C1713","","401.810.96  -  SCREW BONE 2MM 10MM SLFTAP TITANIUM CORTICAL NONSTRL","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$14.70 ","$0.00 ","$10.05 ","$0.00 "
"401.811.96","SUP","HCPCS C1713","","401.811.96  -  SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.812.96","SUP","HCPCS C1713","","401.812.96  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.813.96","SUP","HCPCS C1713","","401.813.96  -  SCREW BONE 2MM 3.5MM 13MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.814.96","SUP","HCPCS C1713","","401.814.96  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$14.70 ","$0.00 ","$10.05 ","$0.00 "
"401.816.96","SUP","HCPCS C1713","","401.816.96  -  SCREW BONE 2MM 3.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$14.70 ","$0.00 ","$10.05 ","$0.00 "
"401.818.96","SUP","HCPCS C1713","","401.818.96  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$14.70 ","$0.00 ","$10.05 ","$0.00 "
"401.820.96","SUP","HCPCS C1713","","401.820.96  -  SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.822.96","SUP","HCPCS C1713","","401.822.96  -  SCREW BONE 2MM 3.5MM 22MM SLFTAP CRCIFRM RECESS TITANIUM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.824.96","SUP","HCPCS C1713","","401.824.96  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.826.96","SUP","HCPCS C1713","","401.826.96  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.828.96","SUP","HCPCS C1713","","401.828.96  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.830.96","SUP","HCPCS C1713","","401.830.96  -  SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.832.96","SUP","HCPCS C1713","","401.832.96  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.834.96","SUP","HCPCS C1713","","401.834.96  -  SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.836.96","SUP","HCPCS C1713","","401.836.96  -  SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.838.96","SUP","HCPCS C1713","","401.838.96  -  SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$63.13 ","$28.41 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$11.05 ","$63.13 ","$0.00 ","$31.56 ","$50.00 ","$50.50 ","$0.00 ","$9.59 ","$0.00 ","$10.05 ","$0.00 "
"401.968.96","SUP","Custom 27203010","","401.968.96  -  PIN FIX 1.8MM 18MM BUTTRESS TITANIUM HAND NONSTRL","BOTH IP/OP","$114.55 ","$84.77 ","$0.00 ","$111.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.23 ","$0.00 ","$55.61 ","$88.09 ","$88.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-10102","SUP","HCPCS C1713","","40-10102  -  PLATE BN SM NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS","BOTH IP/OP","$1,449.00 ","$1,072.26 ","$0.00 ","$972.13 ","$437.46 ","$0.00 ","$302.01 ","$0.00 ","$0.00 ","$170.21 ","$972.13 ","$0.00 ","$486.06 ","$769.93 ","$777.70 ","$0.00 ","$152.14 ","$0.00 ","$154.76 ","$0.00 "
"40-10104","SUP","HCPCS C1713","","40-10104  -  PLATE BN MED 69MM NS VARIAX MESH PA LCK LOPRFL TI FT","BOTH IP/OP","$1,449.00 ","$1,072.26 ","$0.00 ","$972.13 ","$437.46 ","$0.00 ","$302.01 ","$0.00 ","$0.00 ","$170.21 ","$972.13 ","$0.00 ","$486.06 ","$769.93 ","$777.70 ","$0.00 ","$152.14 ","$0.00 ","$154.76 ","$0.00 "
"40-10106","SUP","HCPCS C1713","","40-10106  -  PLATE BN LG NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS","BOTH IP/OP","$1,449.00 ","$1,072.26 ","$0.00 ","$972.13 ","$437.46 ","$0.00 ","$302.01 ","$0.00 ","$0.00 ","$170.21 ","$972.13 ","$0.00 ","$486.06 ","$769.93 ","$777.70 ","$0.00 ","$152.14 ","$0.00 ","$154.76 ","$0.00 "
"40-10112","SUP","HCPCS C1713","","40-10112  -  PLATE BN SM STD 1.5MM NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,449.00 ","$1,072.26 ","$0.00 ","$972.13 ","$437.46 ","$0.00 ","$302.01 ","$0.00 ","$0.00 ","$170.21 ","$972.13 ","$0.00 ","$486.06 ","$769.93 ","$777.70 ","$0.00 ","$152.14 ","$0.00 ","$154.76 ","$0.00 "
"40-10114","SUP","HCPCS C1713","","40-10114  -  PLATE BN MED STD 64MM NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,449.00 ","$1,072.26 ","$0.00 ","$972.13 ","$437.46 ","$0.00 ","$302.01 ","$0.00 ","$0.00 ","$170.21 ","$972.13 ","$0.00 ","$486.06 ","$769.93 ","$777.70 ","$0.00 ","$152.14 ","$0.00 ","$154.76 ","$0.00 "
"40-10116","SUP","HCPCS C1713","","40-10116  -  PLATE BN LG STD NS VARIAX PA LCK LOPRFL TI FT CALCANEUS","BOTH IP/OP","$1,449.00 ","$1,072.26 ","$0.00 ","$972.13 ","$437.46 ","$0.00 ","$302.01 ","$0.00 ","$0.00 ","$170.21 ","$972.13 ","$0.00 ","$486.06 ","$769.93 ","$777.70 ","$0.00 ","$152.14 ","$0.00 ","$154.76 ","$0.00 "
"40-12016S","SUP","HCPCS C1713","","40-12016S  -  16MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12018S","SUP","HCPCS C1713","","40-12018S  -  18 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12020S","SUP","HCPCS C1713","","40-12020S  -  20 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12022S","SUP","HCPCS C1713","","40-12022S  -  22 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12024S","SUP","HCPCS C1713","","40-12024S  -  24 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12026S","SUP","HCPCS C1713","","40-12026S  -  26 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12028S","SUP","HCPCS C1713","","40-12028S  -  28 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12030S","SUP","HCPCS C1713","","40-12030S  -  30 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12032S","SUP","HCPCS C1713","","40-12032S  -  32 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12034S","SUP","HCPCS C1713","","40-12034S  -  34 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12036S","SUP","HCPCS C1713","","40-12036S  -  36 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12038S","SUP","HCPCS C1713","","40-12038S  -  38MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12040S","SUP","HCPCS C1713","","40-12040S  -  40MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12042S","SUP","HCPCS C1713","","40-12042S  -  42 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12044S","SUP","HCPCS C1713","","40-12044S  -  44 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12046S","SUP","HCPCS C1713","","40-12046S  -  46 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12048S","SUP","HCPCS C1713","","40-12048S  -  48 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-12050S","SUP","HCPCS C1713","","40-12050S  -  50 MM LONG THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13010S","SUP","HCPCS C1713","","40-13010S  -  10 MM  SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13012S","SUP","HCPCS C1713","","40-13012S  -  CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM X 12 MM","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$83.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$28.95 ","$0.00 ","$29.45 ","$0.00 "
"40-13014S","SUP","HCPCS C1713","","40-13014S  -  14MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13016S","SUP","HCPCS C1713","","40-13016S  -  16MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13018S","SUP","HCPCS C1713","","40-13018S  -  18 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13020S","SUP","HCPCS C1713","","40-13020S  -  20 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13022S","SUP","HCPCS C1713","","40-13022S  -  22 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13024S","SUP","HCPCS C1713","","40-13024S  -  24 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13026S","SUP","HCPCS C1713","","40-13026S  -  26 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13028S","SUP","HCPCS C1713","","40-13028S  -  28 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13030S","SUP","HCPCS C1713","","40-13030S  -  30 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13032S","SUP","HCPCS C1713","","40-13032S  -  32 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13034S","SUP","HCPCS C1713","","40-13034S  -  34 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13036S","SUP","HCPCS C1713","","40-13036S  -  36 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13038S","SUP","HCPCS C1713","","40-13038S  -  38MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13040S","SUP","HCPCS C1713","","40-13040S  -  40MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13042S","SUP","HCPCS C1713","","40-13042S  -  42 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13044S","SUP","HCPCS C1713","","40-13044S  -  44 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13046S","SUP","HCPCS C1713","","40-13046S  -  46 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13048S","SUP","HCPCS C1713","","40-13048S  -  48 MM SHORT THREAD","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$87.75 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"40-13050S","SUP","HCPCS C1713","","40-13050S  -  CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM X 50 MM","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$110.25 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"40-15011","SUP","HCPCS C1713","","40-15011  -  PLATE BN CRV NS VARIAX 4 HL PA LCK LOPRFL TI FT","BOTH IP/OP","$1,082.00 ","$800.68 ","$0.00 ","$598.13 ","$269.16 ","$0.00 ","$225.52 ","$0.00 ","$0.00 ","$104.73 ","$598.13 ","$0.00 ","$299.06 ","$473.72 ","$478.50 ","$0.00 ","$93.61 ","$0.00 ","$95.22 ","$0.00 "
"40-15012","SUP","HCPCS C1713","","40-15012  -  PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT RT","BOTH IP/OP","$1,175.00 ","$869.50 ","$0.00 ","$650.38 ","$292.67 ","$0.00 ","$244.90 ","$0.00 ","$0.00 ","$113.88 ","$650.38 ","$0.00 ","$325.19 ","$515.10 ","$520.30 ","$0.00 ","$101.78 ","$0.00 ","$103.54 ","$0.00 "
"40-15013","SUP","HCPCS C1713","","40-15013  -  PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT LT","BOTH IP/OP","$1,175.00 ","$869.50 ","$0.00 ","$650.38 ","$292.67 ","$0.00 ","$244.90 ","$0.00 ","$0.00 ","$113.88 ","$650.38 ","$0.00 ","$325.19 ","$515.10 ","$520.30 ","$0.00 ","$101.78 ","$0.00 ","$103.54 ","$0.00 "
"40-15014","SUP","HCPCS C1713","","40-15014  -  PLATE BN CRV NS VARIAX 6 HL PA LCK LOPRFL TI FT","BOTH IP/OP","$1,321.00 ","$977.54 ","$0.00 ","$731.50 ","$329.18 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$128.08 ","$731.50 ","$0.00 ","$365.75 ","$579.35 ","$585.20 ","$0.00 ","$114.48 ","$0.00 ","$116.45 ","$0.00 "
"40-15021","SUP","HCPCS C1713","","40-15021  -  PLATE BN SM H NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$918.00 ","$679.32 ","$0.00 ","$515.63 ","$232.03 ","$0.00 ","$191.33 ","$0.00 ","$0.00 ","$90.28 ","$515.63 ","$0.00 ","$257.81 ","$408.38 ","$412.50 ","$0.00 ","$80.70 ","$0.00 ","$82.09 ","$0.00 "
"40-15022","SUP","HCPCS C1713","","40-15022  -  PLATE BN MED H NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,297.00 ","$959.78 ","$0.00 ","$731.50 ","$329.18 ","$0.00 ","$270.33 ","$0.00 ","$0.00 ","$128.08 ","$731.50 ","$0.00 ","$365.75 ","$579.35 ","$585.20 ","$0.00 ","$114.48 ","$0.00 ","$116.45 ","$0.00 "
"40-15023","SUP","HCPCS C1713","","40-15023  -  PLATE BN LG H NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,097.00 ","$811.78 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$228.64 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"40-15031","SUP","HCPCS C1713","","40-15031  -  PLATE TI RECT CMPR VARIAX BONE FT","BOTH IP/OP","$1,082.00 ","$800.68 ","$0.00 ","$609.13 ","$274.11 ","$0.00 ","$225.52 ","$0.00 ","$0.00 ","$106.65 ","$609.13 ","$0.00 ","$304.56 ","$482.43 ","$487.30 ","$0.00 ","$95.33 ","$0.00 ","$96.97 ","$0.00 "
"40-15032","SUP","HCPCS C1713","","40-15032  -  PLATE BN 2 RECT NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,097.00 ","$811.78 ","$0.00 ","$618.75 ","$278.44 ","$0.00 ","$228.64 ","$0.00 ","$0.00 ","$108.34 ","$618.75 ","$0.00 ","$309.38 ","$490.05 ","$495.00 ","$0.00 ","$96.83 ","$0.00 ","$98.51 ","$0.00 "
"40-15033","SUP","HCPCS C1713","","40-15033  -  PLATE BN 2 RECT NS VARIAX PA LCK CMPR LOPRFL TI FT","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$671.00 ","$301.95 ","$0.00 ","$248.03 ","$0.00 ","$0.00 ","$117.49 ","$671.00 ","$0.00 ","$335.50 ","$531.43 ","$536.80 ","$0.00 ","$105.01 ","$0.00 ","$106.82 ","$0.00 "
"40-15041","SUP","HCPCS C1713","","40-15041  -  PLATE BN SHRT BRD STRG NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,092.00 ","$808.08 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$227.60 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"40-15042","SUP","HCPCS C1713","","40-15042  -  PLATE BN MED BRD STRG NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,140.00 ","$843.60 ","$0.00 ","$602.25 ","$271.01 ","$0.00 ","$237.60 ","$0.00 ","$0.00 ","$105.45 ","$602.25 ","$0.00 ","$301.13 ","$476.98 ","$481.80 ","$0.00 ","$94.25 ","$0.00 ","$95.88 ","$0.00 "
"40-15043","SUP","HCPCS C1713","","40-15043  -  PLATE BN LNG BRD STRG NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$1,254.00 ","$927.96 ","$0.00 ","$662.75 ","$298.24 ","$0.00 ","$261.36 ","$0.00 ","$0.00 ","$116.04 ","$662.75 ","$0.00 ","$331.38 ","$524.90 ","$530.20 ","$0.00 ","$103.72 ","$0.00 ","$105.51 ","$0.00 "
"40-15061","SUP","HCPCS C1713","","40-15061  -  PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT LT","BOTH IP/OP","$1,384.00 ","$1,024.16 ","$0.00 ","$731.50 ","$329.18 ","$0.00 ","$288.46 ","$0.00 ","$0.00 ","$128.08 ","$731.50 ","$0.00 ","$365.75 ","$579.35 ","$585.20 ","$0.00 ","$114.48 ","$0.00 ","$116.45 ","$0.00 "
"40-15062","SUP","HCPCS C1713","","40-15062  -  PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT RT","BOTH IP/OP","$1,384.00 ","$1,024.16 ","$0.00 ","$731.50 ","$329.18 ","$0.00 ","$288.46 ","$0.00 ","$0.00 ","$128.08 ","$731.50 ","$0.00 ","$365.75 ","$579.35 ","$585.20 ","$0.00 ","$114.48 ","$0.00 ","$116.45 ","$0.00 "
"40-15071","SUP","HCPCS C1713","","40-15071  -  PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT LT","BOTH IP/OP","$1,101.00 ","$814.74 ","$0.00 ","$609.13 ","$274.11 ","$0.00 ","$229.48 ","$0.00 ","$0.00 ","$106.65 ","$609.13 ","$0.00 ","$304.56 ","$482.43 ","$487.30 ","$0.00 ","$95.33 ","$0.00 ","$96.97 ","$0.00 "
"40-15072","SUP","HCPCS C1713","","40-15072  -  PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT RT","BOTH IP/OP","$1,101.00 ","$814.74 ","$0.00 ","$609.13 ","$274.11 ","$0.00 ","$229.48 ","$0.00 ","$0.00 ","$106.65 ","$609.13 ","$0.00 ","$304.56 ","$482.43 ","$487.30 ","$0.00 ","$95.33 ","$0.00 ","$96.97 ","$0.00 "
"40-15081","SUP","HCPCS C1713","","40-15081  -  PLATE BN T NS VARIAX PA LCK LOPRFL TI FT","BOTH IP/OP","$778.00 ","$575.72 ","$0.00 ","$430.38 ","$193.67 ","$0.00 ","$162.15 ","$0.00 ","$0.00 ","$75.36 ","$430.38 ","$0.00 ","$215.19 ","$340.86 ","$344.30 ","$0.00 ","$67.35 ","$0.00 ","$68.52 ","$0.00 "
"40-15091","SUP","HCPCS C1713","","40-15091  -  PLATE BN L NS VARIAX PA LCK LOPRFL TI FT LT","BOTH IP/OP","$778.00 ","$575.72 ","$0.00 ","$430.38 ","$193.67 ","$0.00 ","$162.15 ","$0.00 ","$0.00 ","$75.36 ","$430.38 ","$0.00 ","$215.19 ","$340.86 ","$344.30 ","$0.00 ","$67.35 ","$0.00 ","$68.52 ","$0.00 "
"40-15092","SUP","HCPCS C1713","","40-15092  -  PLATE BN L NS VARIAX PA LCK LOPRFL TI FT RT","BOTH IP/OP","$778.00 ","$575.72 ","$0.00 ","$430.38 ","$193.67 ","$0.00 ","$162.15 ","$0.00 ","$0.00 ","$75.36 ","$430.38 ","$0.00 ","$215.19 ","$340.86 ","$344.30 ","$0.00 ","$67.35 ","$0.00 ","$68.52 ","$0.00 "
"402.110E","SUP","HCPCS C1713","","402.110E  -  SCREW TI 10MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL","BOTH IP/OP","$130.50 ","$96.57 ","$0.00 ","$130.50 ","$58.73 ","$0.00 ","$27.20 ","$0.00 ","$0.00 ","$22.85 ","$130.50 ","$0.00 ","$65.25 ","$103.36 ","$104.40 ","$0.00 ","$20.42 ","$0.00 ","$20.78 ","$0.00 "
"402.112E","SUP","HCPCS C1713","","402.112E  -  SCREW TI 12MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL","BOTH IP/OP","$130.50 ","$96.57 ","$0.00 ","$130.50 ","$58.73 ","$0.00 ","$27.20 ","$0.00 ","$0.00 ","$22.85 ","$130.50 ","$0.00 ","$65.25 ","$103.36 ","$104.40 ","$0.00 ","$20.42 ","$0.00 ","$20.78 ","$0.00 "
"402.114E","SUP","HCPCS C1713","","402.114E  -  SCREW TI 14MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL","BOTH IP/OP","$130.50 ","$96.57 ","$0.00 ","$130.50 ","$58.73 ","$0.00 ","$27.20 ","$0.00 ","$0.00 ","$22.85 ","$130.50 ","$0.00 ","$65.25 ","$103.36 ","$104.40 ","$0.00 ","$20.42 ","$0.00 ","$20.78 ","$0.00 "
"402.116E","SUP","HCPCS C1713","","402.116E  -  SCREW TI 16MM 2.7MM CORT MAXFACL BONE THORP NONSTRL","BOTH IP/OP","$130.50 ","$96.57 ","$0.00 ","$130.50 ","$58.73 ","$0.00 ","$27.20 ","$0.00 ","$0.00 ","$22.85 ","$130.50 ","$0.00 ","$65.25 ","$103.36 ","$104.40 ","$0.00 ","$20.42 ","$0.00 ","$20.78 ","$0.00 "
"402.118E","SUP","HCPCS C1713","","402.118E  -  SCREW TI 18MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL","BOTH IP/OP","$130.50 ","$96.57 ","$0.00 ","$130.50 ","$58.73 ","$0.00 ","$27.20 ","$0.00 ","$0.00 ","$22.85 ","$130.50 ","$0.00 ","$65.25 ","$103.36 ","$104.40 ","$0.00 ","$20.42 ","$0.00 ","$20.78 ","$0.00 "
"4020-005R","SUP","HCPCS C1713","","4020-005R  -  CMPNT TIBTRY 5 KNEE RIGHT","BOTH IP/OP","$1,213.00 ","$897.62 ","$0.00 ","$1,213.00 ","$545.85 ","$0.00 ","$252.82 ","$0.00 ","$0.00 ","$212.39 ","$1,213.00 ","$0.00 ","$606.50 ","$960.70 ","$970.40 ","$0.00 ","$189.83 ","$0.00 ","$193.11 ","$0.00 "
"40-20108","SUP","HCPCS C1713","","40-20108  -  SCREW BONE 2MM 8MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20109","SUP","HCPCS C1713","","40-20109  -  SCREW BONE 2MM 9MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20110","SUP","HCPCS C1713","","40-20110  -  SCREW BONE 2MM 10MM 4MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20111","SUP","HCPCS C1713","","40-20111  -  SCREW BONE 2MM 11MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20112","SUP","HCPCS C1713","","40-20112  -  SCREW BONE 2MM 12MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20113","SUP","HCPCS C1713","","40-20113  -  SCREW BONE 2MM 13MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20114","SUP","HCPCS C1713","","40-20114  -  SCREW BONE 2MM 14MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20115","SUP","HCPCS C1713","","40-20115  -  SCREW BONE 2MM 15MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20116","SUP","HCPCS C1713","","40-20116  -  SCREW BONE 2MM 16MM 7MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20117","SUP","HCPCS C1713","","40-20117  -  SCREW BONE 2MM 17MM 5MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20118","SUP","HCPCS C1713","","40-20118  -  SCREW BONE 2MM 18MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20119","SUP","HCPCS C1713","","40-20119  -  SCREW BONE 2MM 19MM 5MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20120","SUP","HCPCS C1713","","40-20120  -  SCREW BN MIC RVRS CUT FLUT 2MM 20MM NS 5MM ASNS SLF CUT CNN","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20122","SUP","HCPCS C1713","","40-20122  -  SCREW BONE 2MM 22MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20124","SUP","HCPCS C1713","","40-20124  -  SCREW BONE 2MM 24MM 6MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20126","SUP","HCPCS C1713","","40-20126  -  SCREW BONE 2MM 26MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20128","SUP","HCPCS C1713","","40-20128  -  SCREW BONE 2MM 28MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20130","SUP","HCPCS C1713","","40-20130  -  SCREW BONE 2MM 32MM 6MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20217","SUP","HCPCS C1713","","40-20217  -  SCREW BONE 2MM 17MM 8MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20218","SUP","HCPCS C1713","","40-20218  -  SCREW BONE 2MM 18MM 8MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20219","SUP","HCPCS C1713","","40-20219  -  SCREW BONE 2MM 19MM 9MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20220","SUP","HCPCS C1713","","40-20220  -  SCREW BONE 2MM 20MM 9MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20222","SUP","HCPCS C1713","","40-20222  -  SCREW BONE 2MM 22MM 10MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20224","SUP","HCPCS C1713","","40-20224  -  SCREW BONE 2MM 24MM 9MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20226","SUP","HCPCS C1713","","40-20226  -  SCREW BONE 2MM 26MM 12MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20228","SUP","HCPCS C1713","","40-20228  -  SCREW BONE 2MM 28MM 12MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20230","SUP","HCPCS C1713","","40-20230  -  SCREW BONE 2MM 30MM 14MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$133.65 ","$0.00 ","$61.90 ","$0.00 ","$0.00 ","$52.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$46.48 ","$0.00 ","$47.28 ","$0.00 "
"40-20805","SUP","HCPCS C1713","","40-20805  -  PLATE BN STRG 72MMX2MM NS VARIAX 5 HL LCK LOPRFL TI FIB","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$162.57 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"40-20900","SUP","HCPCS C1713","","40-20900  -  WASHER 2MM MIC ASNS ORTH NONSTRL","BOTH IP/OP","$98.60 ","$72.96 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$20.55 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"40-20903","SUP","HCPCS C1713","","40-20903  -  PLATE BN 77X10X2MM NS 16X1.3MM VARIAX 3 HL LCK LOPRFL TI FIB","BOTH IP/OP","$1,143.00 ","$845.82 ","$0.00 ","$874.50 ","$393.53 ","$0.00 ","$238.23 ","$0.00 ","$0.00 ","$153.12 ","$874.50 ","$0.00 ","$437.25 ","$692.60 ","$699.60 ","$0.00 ","$136.86 ","$0.00 ","$139.22 ","$0.00 "
"40-20904","SUP","HCPCS C1713","","40-20904  -  PLATE BN 89X10X2MM NS 16X1.3MM VARIAX 4 HL LCK LOPRFL TI FIB","BOTH IP/OP","$1,143.00 ","$845.82 ","$0.00 ","$874.50 ","$393.53 ","$0.00 ","$238.23 ","$0.00 ","$0.00 ","$153.12 ","$874.50 ","$0.00 ","$437.25 ","$692.60 ","$699.60 ","$0.00 ","$136.86 ","$0.00 ","$139.22 ","$0.00 "
"40-20905","SUP","HCPCS C1713","","40-20905  -  PLATE BN 101X10X2MM NS 16X1.3MM VARIAX 5 HL LCK LOPRFL TI","BOTH IP/OP","$1,143.00 ","$845.82 ","$0.00 ","$874.50 ","$393.53 ","$0.00 ","$238.23 ","$0.00 ","$0.00 ","$153.12 ","$874.50 ","$0.00 ","$437.25 ","$692.60 ","$699.60 ","$0.00 ","$136.86 ","$0.00 ","$139.22 ","$0.00 "
"40-20906","SUP","HCPCS C1713","","40-20906  -  PLATE BN 113X10X2MM NS 16X1.3MM VARIAX 6 HL LCK LOPRFL TI","BOTH IP/OP","$1,187.00 ","$878.38 ","$0.00 ","$874.50 ","$393.53 ","$0.00 ","$247.40 ","$0.00 ","$0.00 ","$153.12 ","$874.50 ","$0.00 ","$437.25 ","$692.60 ","$699.60 ","$0.00 ","$136.86 ","$0.00 ","$139.22 ","$0.00 "
"40-20907","SUP","HCPCS C1713","","40-20907  -  PLATE BN 125X10X2MM NS 16X1.3MM VARIAX 7 HL LCK LOPRFL TI","BOTH IP/OP","$1,288.00 ","$953.12 ","$0.00 ","$951.50 ","$428.18 ","$0.00 ","$268.45 ","$0.00 ","$0.00 ","$166.60 ","$951.50 ","$0.00 ","$475.75 ","$753.59 ","$761.20 ","$0.00 ","$148.91 ","$0.00 ","$151.48 ","$0.00 "
"40-20908","SUP","HCPCS C1713","","40-20908  -  PLATE BN 137X10X2MM NS 16X1.3MM VARIAX 8 HL LCK LOPRFL TI","BOTH IP/OP","$1,288.00 ","$953.12 ","$0.00 ","$951.50 ","$428.18 ","$0.00 ","$268.45 ","$0.00 ","$0.00 ","$166.60 ","$951.50 ","$0.00 ","$475.75 ","$753.59 ","$761.20 ","$0.00 ","$148.91 ","$0.00 ","$151.48 ","$0.00 "
"40-20909","SUP","HCPCS C1713","","40-20909  -  PLATE BN 149X10X2MM NS 16X1.3MM VARIAX 9 HL LCK LOPRFL TI","BOTH IP/OP","$1,288.00 ","$953.12 ","$0.00 ","$951.50 ","$428.18 ","$0.00 ","$268.45 ","$0.00 ","$0.00 ","$166.60 ","$951.50 ","$0.00 ","$475.75 ","$753.59 ","$761.20 ","$0.00 ","$148.91 ","$0.00 ","$151.48 ","$0.00 "
"40-20910S","SUP","HCPCS C1713","","40-20910S  -  PLATE 161MM 10 HOLE VARIAX BONE LAT FIB STRL","BOTH IP/OP","$1,457.00 ","$1,078.18 ","$0.00 ","$1,075.25 ","$483.86 ","$0.00 ","$303.68 ","$0.00 ","$0.00 ","$188.27 ","$1,075.25 ","$0.00 ","$537.63 ","$851.60 ","$860.20 ","$0.00 ","$168.28 ","$0.00 ","$171.18 ","$0.00 "
"40-20912S","SUP","HCPCS C1713","","40-20912S  -  PLATE 185MM 12 HOLE VARIAX BONE LAT FIB STRL","BOTH IP/OP","$1,457.00 ","$1,078.18 ","$0.00 ","$1,075.25 ","$483.86 ","$0.00 ","$303.68 ","$0.00 ","$0.00 ","$188.27 ","$1,075.25 ","$0.00 ","$537.63 ","$851.60 ","$860.20 ","$0.00 ","$168.28 ","$0.00 ","$171.18 ","$0.00 "
"40-22800","SUP","Custom 27203010","","RULER SURG 15MM SIL MCGRD MTRC SCL BKGRND RADIOPQ STRL 30MM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"402609T","SUP","HCPCS C1894","","INTRODUCER SHTH 9FR 23CM WO GUIDEWIRE AVNT++ .035IN BLK","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"40-27008","SUP","HCPCS C1713","","40-27008  -  SCREW BN T7 2.7MM 8MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27010","SUP","HCPCS C1713","","40-27010  -  SCREW BN T7 2.7MM 10MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27012","SUP","HCPCS C1713","","40-27012  -  SCREW BN T7 2.7MM 12MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27014","SUP","HCPCS C1713","","40-27014  -  SCREW BN T7 2.7MM 14MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27016","SUP","HCPCS C1713","","40-27016  -  SCREW BN T7 2.7MM 16MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27018","SUP","HCPCS C1713","","40-27018  -  SCREW BN T7 2.7MM 18MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27020","SUP","HCPCS C1713","","40-27020  -  SCREW BN T7 2.7MM 20MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27022","SUP","HCPCS C1713","","40-27022  -  SCREW BN T7 2.7MM 22MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27024","SUP","HCPCS C1713","","40-27024  -  SCREW BN T7 2.7MM 24MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27026","SUP","HCPCS C1713","","40-27026  -  SCREW BN T7 2.7MM 26MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27028","SUP","HCPCS C1713","","40-27028  -  SCREW BN T7 2.7MM 28MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27030","SUP","HCPCS C1713","","40-27030  -  SCREW BN T7 2.7MM 30MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27032","SUP","HCPCS C1713","","40-27032  -  SCREW BN T7 2.7MM 32MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27034","SUP","HCPCS C1713","","40-27034  -  SCREW BN T7 2.7MM 34MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27036","SUP","HCPCS C1713","","40-27036  -  SCREW BN T7 2.7MM 36MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27038","SUP","HCPCS C1713","","40-27038  -  SCREW BN T7 2.7MM 38MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27040","SUP","HCPCS C1713","","40-27040  -  SCREW BN T7 2.7MM 40MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27045","SUP","HCPCS C1713","","40-27045  -  SCREW BN T7 2.7MM 45MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27050","SUP","HCPCS C1713","","40-27050  -  SCREW BN T7 2.7MM 50MM YLW NS VARIAX ST TI FT LCK PLT SYS","BOTH IP/OP","$100.80 ","$74.59 ","$0.00 ","$89.38 ","$40.22 ","$0.00 ","$21.01 ","$0.00 ","$0.00 ","$15.65 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$13.99 ","$0.00 ","$14.23 ","$0.00 "
"40-27608","SUP","HCPCS C1713","","40-27608  -  SCREW BN T7 2.7MM 8MM BLU NS VARIAX LCK ST TI FT LCK PLT SYS","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27610","SUP","HCPCS C1713","","40-27610  -  SCREW BONE 2.7MM 10MM VARIAX FT LCK T7 NONSTRL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27612","SUP","HCPCS C1713","","40-27612  -  SCREW BN T7 2.7MM 12MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27614","SUP","HCPCS C1713","","40-27614  -  SCREW BN T7 2.7MM 14MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27616","SUP","HCPCS C1713","","40-27616  -  SCREW BN T7 2.7MM 16MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27618","SUP","HCPCS C1713","","40-27618  -  SCREW BN T7 2.7MM 18MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27620","SUP","HCPCS C1713","","40-27620  -  SCREW BN T7 2.7MM 20MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27622","SUP","HCPCS C1713","","40-27622  -  SCREW BN T7 2.7MM 22MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27624","SUP","HCPCS C1713","","40-27624  -  SCREW BN T7 2.7MM 24MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27626","SUP","HCPCS C1713","","40-27626  -  SCREW BN T7 2.7MM 26MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27628","SUP","HCPCS C1713","","40-27628  -  SCREW BN T7 2.7MM 28MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27630","SUP","HCPCS C1713","","40-27630  -  SCREW BN T7 2.7MM 30MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27632","SUP","HCPCS C1713","","40-27632  -  SCREW BN T7 2.7MM 32MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27634","SUP","HCPCS C1713","","40-27634  -  SCREW BN T7 2.7MM 34MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27636","SUP","HCPCS C1713","","40-27636  -  SCREW BN T7 2.7MM 36MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27638","SUP","HCPCS C1713","","40-27638  -  SCREW BN T7 2.7MM 38MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27640","SUP","HCPCS C1713","","40-27640  -  SCREW BN T7 2.7MM 40MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27645","SUP","HCPCS C1713","","40-27645  -  SCREW BN T7 2.7MM 45MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27650","SUP","HCPCS C1713","","40-27650  -  SCREW BN T7 2.7MM 50MM BLU NS VARIAX LCK ST TI FT LCK PLT","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"40-27900","SUP","HCPCS C1713","","40-27900  -  WASHER ORTH 2.7 MM SCR","BOTH IP/OP","$124.10 ","$91.83 ","$0.00 ","$125.13 ","$56.31 ","$0.00 ","$25.87 ","$0.00 ","$0.00 ","$21.91 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$19.58 ","$0.00 ","$19.92 ","$0.00 "
"403.318E","SUP","HCPCS C1713","","403.318E  -  3.2MM TI EMERGENCY SCREW 18MM","BOTH IP/OP","$200.25 ","$148.19 ","$0.00 ","$200.25 ","$90.11 ","$0.00 ","$41.74 ","$0.00 ","$0.00 ","$35.06 ","$200.25 ","$0.00 ","$100.13 ","$158.60 ","$160.20 ","$0.00 ","$31.34 ","$0.00 ","$31.88 ","$0.00 "
"40-30108","SUP","HCPCS C1713","","40-30108  -  SCREW BONE 3MM 8MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30109","SUP","HCPCS C1713","","40-30109  -  SCREW BONE 3MM ASNS MIC CANN","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30110","SUP","HCPCS C1713","","40-30110  -  SCREW BONE 3MM 10MM 4MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30111","SUP","HCPCS C1713","","40-30111  -  SCREW BONE 3MM 11MM 4MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30112","SUP","HCPCS C1713","","40-30112  -  SCREW BONE 3MM 12MM 4MM ASNS TI MIC HAND FT CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30113","SUP","HCPCS C1713","","40-30113  -  SCREW BONE 3MM 13MM 4MM ASNS TI MIC HAND FT CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30114","SUP","HCPCS C1713","","40-30114  -  SCREW BONE 3MM 14MM 4MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30115","SUP","HCPCS C1713","","40-30115  -  SCREW BONE 3MM 15MM 4MM ASNS TI MIC HAND FT CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30116","SUP","HCPCS C1713","","40-30116  -  SCREW BONE 3MM 16MM 4MM ASNS TI MIC HAND FT CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30117","SUP","HCPCS C1713","","40-30117  -  SCREW BONE 3MM 17MM 4MM ASNS TI MIC HAND FT CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30118","SUP","HCPCS C1713","","40-30118  -  SCREW BONE 3MM 18MM 5MM ASNS TI MIC HAND FT CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30119","SUP","HCPCS C1713","","40-30119  -  SCREW BONE 3MM 19MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30120","SUP","HCPCS C1713","","40-30120  -  SCREW BONE 3MM 20MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30121","SUP","HCPCS C1713","","40-30121  -  SCREW BONE 3MM 21MM 5MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30122","SUP","HCPCS C1713","","40-30122  -  SCREW BONE 3MM 22MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30123","SUP","HCPCS C1713","","40-30123  -  SCREW BONE 3MM 23MM 5MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30124","SUP","HCPCS C1713","","40-30124  -  SCREW BONE 3MM 24MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30125","SUP","HCPCS C1713","","40-30125  -  SCREW BONE 3MM 25MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30126","SUP","HCPCS C1713","","40-30126  -  SCREW BONE 3MM 26MM 6MM ASNS MIC CANN NONSTRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30127","SUP","HCPCS C1713","","40-30127  -  SCREW BONE 3MM 27MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30128","SUP","HCPCS C1713","","40-30128  -  SCREW BONE 3MM 28MM 6MM ASNS TI MIC FT HAND CANN NONSTRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30129","SUP","HCPCS C1713","","40-30129  -  SCREW BONE 3MM 29MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30130","SUP","HCPCS C1713","","40-30130  -  SCREW BONE 3MM 30MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30132","SUP","HCPCS C1713","","40-30132  -  SCREW BONE 3MM 32MM 6MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30134","SUP","HCPCS C1713","","40-30134  -  SCREW BONE 3MM 34MM 7MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30136","SUP","HCPCS C1713","","40-30136  -  SCREW BONE 3MM 36MM 7MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30138","SUP","HCPCS C1713","","40-30138  -  SCREW BONE 3MM 38MM 8MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30140","SUP","HCPCS C1713","","40-30140  -  SCREW BN MIC RVRS CUT FLUT 3MM 40MM NS 8MM ASNS SLF CUT CNN","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30214","SUP","HCPCS C1713","","40-30214  -  SCREW BONE 3MM 14MM 6MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30215","SUP","HCPCS C1713","","40-30215  -  SCREW BONE 3MM 15MM 7MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30216","SUP","HCPCS C1713","","40-30216  -  SCREW BONE 3MM 16MM 7MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30217","SUP","HCPCS C1713","","40-30217  -  SCREW BONE 3MM 17MM 8MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30218","SUP","HCPCS C1713","","40-30218  -  SCREW BONE 3MM 18MM 8MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30219","SUP","HCPCS C1713","","40-30219  -  SCREW BONE 3MM 21MM 5MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30220","SUP","HCPCS C1713","","40-30220  -  SCREW BONE 3MM 20MM 9MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30221","SUP","HCPCS C1713","","40-30221  -  SCREW BONE 3MM 21MM 9MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30222","SUP","HCPCS C1713","","40-30222  -  SCREW BN MIC RVRS CUT FLUT 3MM 22MM NS 10MM ASNS SLF CUT CNN","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30223","SUP","HCPCS C1713","","40-30223  -  SCREW BONE 3MM 23MM 10MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30224","SUP","HCPCS C1713","","40-30224  -  SCREW BONE 3MM 24MM 10MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30225","SUP","HCPCS C1713","","40-30225  -  SCREW BONE 3MM 25MM 10MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30226","SUP","HCPCS C1713","","40-30226  -  SCREW BONE 3MM 26MM 12MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30227","SUP","HCPCS C1713","","40-30227  -  SCREW BONE 3MM 27MM 12MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30228","SUP","HCPCS C1713","","40-30228  -  SCREW BONE 3MM 28MM 12MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30229","SUP","HCPCS C1713","","40-30229  -  SCREW BONE 3MM 29MM 12MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30230","SUP","HCPCS C1713","","40-30230  -  SCREW BONE 3MM 30MM 14MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30232","SUP","HCPCS C1713","","40-30232  -  SCREW BONE 32MM 14MM TI MIC CANC","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30234","SUP","HCPCS C1713","","40-30234  -  SCREW BONE 3MM 34MM 16MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30236","SUP","HCPCS C1713","","40-30236  -  SCREW BONE 3MM 36MM 16MM ASNS TI MIC FT HAND CANN THRD STRL","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30238","SUP","HCPCS C1713","","40-30238  -  SCREW BONE 2MM 38MM 16MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30240","SUP","HCPCS C1713","","40-30240  -  SCREW BONE 3MM 40MM 18MM ASNS TI MIC FT HAND CANN THRD","BOTH IP/OP","$295.63 ","$218.77 ","$0.00 ","$295.63 ","$133.03 ","$0.00 ","$61.62 ","$0.00 ","$0.00 ","$51.76 ","$295.63 ","$0.00 ","$147.81 ","$234.14 ","$236.50 ","$0.00 ","$46.27 ","$0.00 ","$47.06 ","$0.00 "
"40-30900","SUP","Custom 27803010","","40-30900  -  WASHER ORTH MIC 3MM ASNS","BOTH IP/OP","$109.65 ","$81.14 ","$0.00 ","$127.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.88 ","$0.00 ","$63.94 ","$101.28 ","$102.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-35010","SUP","HCPCS C1713","","40-35010  -  SCREW BN T10 FT 3.5MM 10MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35012","SUP","HCPCS C1713","","40-35012  -  SCREW BN T10 FT 3.5MM 12MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35014","SUP","HCPCS C1713","","40-35014  -  SCREW BN T10 FT 3.5MM 14MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35016","SUP","HCPCS C1713","","40-35016  -  SCREW BN T10 FT 3.5MM 16MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35018","SUP","HCPCS C1713","","40-35018  -  SCREW BN T10 FT 3.5MM 18MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35020","SUP","HCPCS C1713","","40-35020  -  SCREW BN T10 FT 3.5MM 20MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35022","SUP","HCPCS C1713","","40-35022  -  SCREW BN T10 FT 3.5MM 22MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35024","SUP","HCPCS C1713","","40-35024  -  SCREW BN T10 FT 3.5MM 24MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35026","SUP","HCPCS C1713","","40-35026  -  SCREW BN T10 FT 3.5MM 26MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35028","SUP","HCPCS C1713","","40-35028  -  SCREW BN T10 FT 3.5MM 28MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35030","SUP","HCPCS C1713","","40-35030  -  SCREW BN T10 FT 3.5MM 30MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35032","SUP","HCPCS C1713","","40-35032  -  SCREW BN T10 FT 3.5MM 32MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35034","SUP","HCPCS C1713","","40-35034  -  SCREW BN T10 FT 3.5MM 34MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35036","SUP","HCPCS C1713","","40-35036  -  SCREW BN T10 FT 3.5MM 36MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35038","SUP","HCPCS C1713","","40-35038  -  SCREW BN T10 FT 3.5MM 38MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35040","SUP","HCPCS C1713","","40-35040  -  SCREW BN T10 FT 3.5MM 40MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35042","SUP","HCPCS C1713","","40-35042  -  SCREW BN T10 FT 3.5MM 42MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35044","SUP","HCPCS C1713","","40-35044  -  SCREW BN T10 FT 3.5MM 44MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35046","SUP","HCPCS C1713","","40-35046  -  SCREW BN T10 FT 3.5MM 46MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35048","SUP","HCPCS C1713","","40-35048  -  SCREW BN T10 FT 3.5MM 48MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35050","SUP","HCPCS C1713","","40-35050  -  SCREW BN T10 FT 3.5MM 50MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35055","SUP","HCPCS C1713","","40-35055  -  SCREW BN T10 FT 3.5MM 55MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35060","SUP","HCPCS C1713","","40-35060  -  SCREW BN T10 FT 3.5MM 60MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35065","SUP","HCPCS C1713","","40-35065  -  SCREW BN T10 FT 3.5MM 65MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35070","SUP","HCPCS C1713","","40-35070  -  SCREW BN T10 FT 3.5MM 70MM YLW NS VARIAX ST TI FT/ANKL LCK","BOTH IP/OP","$112.00 ","$82.88 ","$0.00 ","$103.13 ","$46.41 ","$0.00 ","$23.34 ","$0.00 ","$0.00 ","$18.06 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$16.14 ","$0.00 ","$16.42 ","$0.00 "
"40-35610","SUP","HCPCS C1713","","40-35610  -  SCREW BN T10 FT 3.5MM 10MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35612","SUP","HCPCS C1713","","40-35612  -  SCREW BN T10 FT 3.5MM 12MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35614","SUP","HCPCS C1713","","40-35614  -  SCREW BN T10 FT 3.5MM 14MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35616","SUP","HCPCS C1713","","40-35616  -  SCREW BN T10 FT 3.5MM 16MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35618","SUP","HCPCS C1713","","40-35618  -  SCREW BN T10 FT 3.5MM 18MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35620","SUP","HCPCS C1713","","40-35620  -  SCREW BN T10 FT 3.5MM 20MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35622","SUP","HCPCS C1713","","40-35622  -  SCREW BN T10 FT 3.5MM 22MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35624","SUP","HCPCS C1713","","40-35624  -  SCREW BN T10 FT 3.5MM 24MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35626","SUP","HCPCS C1713","","40-35626  -  SCREW BN T10 FT 3.5MM 26MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35628","SUP","HCPCS C1713","","40-35628  -  SCREW BN T10 FT 3.5MM 28MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35630","SUP","HCPCS C1713","","40-35630  -  SCREW BN T10 FT 3.5MM 30MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35632","SUP","HCPCS C1713","","40-35632  -  SCREW BN T10 FT 3.5MM 32MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35634","SUP","HCPCS C1713","","40-35634  -  SCREW BONE 3.5MM 34MM VARIAX TI FT T10 LCK NONSTRL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35636","SUP","HCPCS C1713","","40-35636  -  SCREW BN T10 FT 3.5MM 36MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35638","SUP","HCPCS C1713","","40-35638  -  SCREW BN T10 FT 3.5MM 38MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35640","SUP","HCPCS C1713","","40-35640  -  SCREW BN T10 FT 3.5MM 40MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35642","SUP","HCPCS C1713","","40-35642  -  SCREW BN T10 FT 3.5MM 42MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35644","SUP","HCPCS C1713","","40-35644  -  SCREW BN T10 FT 3.5MM 44MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35646","SUP","HCPCS C1713","","40-35646  -  SCREW BN T10 FT 3.5MM 46MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35648","SUP","HCPCS C1713","","40-35648  -  SCREW BN T10 FT 3.5MM 48MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35650","SUP","HCPCS C1713","","40-35650  -  SCREW BN T10 FT 3.5MM 50MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35655","SUP","HCPCS C1713","","40-35655  -  SCREW BN T10 FT 3.5MM 55MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35660","SUP","HCPCS C1713","","40-35660  -  SCREW BN T10 FT 3.5MM 60MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35665","SUP","HCPCS C1713","","40-35665  -  SCREW BN T10 FT 3.5MM 65MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35670","SUP","HCPCS C1713","","40-35670  -  SCREW BN T10 FT 3.5MM 70MM BLU NS VARIAX LCK ST TI FT/ANKL","BOTH IP/OP","$221.20 ","$163.69 ","$0.00 ","$209.00 ","$94.05 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$36.59 ","$209.00 ","$0.00 ","$104.50 ","$165.53 ","$167.20 ","$0.00 ","$32.71 ","$0.00 ","$33.27 ","$0.00 "
"40-35900","SUP","HCPCS C1713","","40-35900  -  WASHER ORTH 3.5 MM SCR","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$143.00 ","$64.35 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$25.04 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$22.38 ","$0.00 ","$22.77 ","$0.00 "
"4040-0510R","SUP","Custom 27803010","","4040-0510R  -  INSERT TIB 5 10MM RIGHT KNEE","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4040-0908R","SUP","Custom 27803010","","4040-0908R  -  INSERT TIB 9 RIGHT KNEE MDLR UNICOMP 8MM","BOTH IP/OP","$894.00 ","$661.56 ","$0.00 ","$894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$894.00 ","$0.00 ","$447.00 ","$708.05 ","$715.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"40-5011","SUP","HCPCS C1725","","40-5011  -  CATH ANGIO RADIALTIGER CURVE 5FR 4MM 100CM CORON 1 SH DX","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$47.51 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"40-5012","SUP","HCPCS C1725","","40-5012  -  CATH ANGIO RADIALTIGER CURVE 5FR 4.5MM 100CM CORON 1 SH DX","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$47.51 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"4076-STDJ-185","SUP","HCPCS C1769","","4076-STDJ-185  -  4076-STDJ-185","BOTH IP/OP","$183.75 ","$135.98 ","$0.00 ","$183.75 ","$99.78 ","$0.00 ","$38.30 ","$0.00 ","$0.00 ","$32.17 ","$183.75 ","$0.00 ","$91.88 ","$145.53 ","$147.00 ","$0.00 ","$28.76 ","$0.00 ","$29.25 ","$0.00 "
"4076-STDJ-300","SUP","HCPCS C1769","","4076-STDJ-300  -  4076-STDJ-300","BOTH IP/OP","$183.75 ","$135.98 ","$0.00 ","$183.75 ","$99.78 ","$0.00 ","$38.30 ","$0.00 ","$0.00 ","$32.17 ","$183.75 ","$0.00 ","$91.88 ","$145.53 ","$147.00 ","$0.00 ","$28.76 ","$0.00 ","$29.25 ","$0.00 "
"40A002","SUP","HCPCS C1762","","40A002  -  GRAFT BONE SMALL 25X9X14MM WEDGE ILIAC CREST","BOTH IP/OP","$2,005.00 ","$1,483.70 ","$0.00 ","$2,005.00 ","$0.00 ","$0.00 ","$417.89 ","$0.00 ","$0.00 ","$0.00 ","$2,005.00 ","$0.00 ","$1,002.50 ","$1,587.96 ","$1,604.00 ","$0.00 ","$313.78 ","$0.00 ","$0.00 ","$0.00 "
"40A74","SUP","HCPCS C1768","","40A74  -  GRAFT VASC 40CM 7-4MM IMPR CBFL PTFE HMDIAL ACCES SHRT TPR","BOTH IP/OP","$1,317.85 ","$975.21 ","$0.00 ","$1,317.85 ","$593.03 ","$0.00 ","$274.67 ","$0.00 ","$0.00 ","$230.74 ","$1,317.85 ","$0.00 ","$658.93 ","$1,043.74 ","$1,054.28 ","$0.00 ","$206.24 ","$0.00 ","$209.80 ","$0.00 "
"40S08","SUP","HCPCS C1768","","40S08  -  GRAFT VASC 8MM 40CM IMPRA CARBOFLO PTFE","BOTH IP/OP","$955.50 ","$707.07 ","$0.00 ","$955.50 ","$429.98 ","$0.00 ","$199.15 ","$0.00 ","$0.00 ","$167.30 ","$955.50 ","$0.00 ","$477.75 ","$756.76 ","$764.40 ","$0.00 ","$149.54 ","$0.00 ","$152.12 ","$0.00 "
"4100M24","SUP","Custom 27803010","","4100M24  -  RING ANLPLS 24MM MTRL C-M-A IMR E TI","BOTH IP/OP","$9,112.50 ","$6,743.25 ","$0.00 ","$9,112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,112.50 ","$0.00 ","$4,556.25 ","$7,217.10 ","$7,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4100M34","SUP","Custom 27803010","","4100M34  -  RING ANLPLS 34MM MTRL C-M-A IMR E TI SIL PLSTR","BOTH IP/OP","$9,112.50 ","$6,743.25 ","$0.00 ","$9,112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,112.50 ","$0.00 ","$4,556.25 ","$7,217.10 ","$7,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41045-01","SUP","HCPCS C1887","","41045-01  -  CATH INFUS 5FR 40CM 20CM VLV DRG DLV CRGG-MCNAM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$109.96 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"41046-01","SUP","HCPCS C1887","","41046-01  -  CATH INFUS .038IN 5FR 100CM 20CM PERI VLV CRGG-MCNAM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$109.96 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"41050-01","SUP","HCPCS C1769","","41050-01  -  CATHETER INFS 5FR 100CM 10CM CRGG-MCNAM CRGG MICROVALVE 1","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$142.54 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"41053-01","SUP","HCPCS C1769","","41053-01  -  CATHETER INFS .038IN 5FR 100CM 40CM CRGG-MCNAM CRGG","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$160.19 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41055-01","SUP","HCPCS C1887","","41055-01  -  CATHETER INFS 5FR 135CM 5CM CRGG-MCNAM CRGG-MICROVALVE 1 LUM","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$142.54 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"4105535XL","SUP","HCPCS C1713","","4105535XL  -  SCREW BONE 5.5MM 35MM XL SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"4105540XL","SUP","HCPCS C1713","","4105540XL  -  SCREW BONE 5.5MM 40MM XL SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"4105545XL","SUP","HCPCS C1713","","4105545XL  -  SCREW BONE 5.5MM 45MM XL SPNL","BOTH IP/OP","$1,520.88 ","$1,125.45 ","$0.00 ","$1,520.88 ","$684.39 ","$0.00 ","$316.99 ","$0.00 ","$0.00 ","$266.29 ","$1,520.88 ","$0.00 ","$760.44 ","$1,204.54 ","$1,216.70 ","$0.00 ","$238.02 ","$0.00 ","$242.12 ","$0.00 "
"41057-01","SUP","HCPCS C1769","","41057-01  -  CATHETER IV .038IN 5FR 135CM 20CM CRGG-MCNAM CRGG MICROVALVE","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$109.96 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"41059-01","SUP","HCPCS C1887","","41059-01  -  CATH INFUS .038IN 5FR 135CM 40CM VLV CRGG-MCNAM","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$160.19 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"4106545XL","SUP","HCPCS C1713","","4106545XL  -  SCREW BONE 6.5IN 45IN XL SPNL","BOTH IP/OP","$1,734.30 ","$1,283.38 ","$0.00 ","$1,734.30 ","$780.44 ","$0.00 ","$361.47 ","$0.00 ","$0.00 ","$303.66 ","$1,734.30 ","$0.00 ","$867.15 ","$1,373.57 ","$1,387.44 ","$0.00 ","$271.42 ","$0.00 ","$276.10 ","$0.00 "
"4106550XL","SUP","HCPCS C1713","","4106550XL  -  SCREW BONE 6.5MM 50MM XL SPNL","BOTH IP/OP","$1,651.18 ","$1,221.87 ","$0.00 ","$1,651.18 ","$743.03 ","$0.00 ","$344.15 ","$0.00 ","$0.00 ","$289.11 ","$1,651.18 ","$0.00 ","$825.59 ","$1,307.73 ","$1,320.94 ","$0.00 ","$258.41 ","$0.00 ","$262.87 ","$0.00 "
"4107540XL","SUP","HCPCS C1713","","4107540XL  -  SCREW BONE 7.5MM 40MM XL SPNL","BOTH IP/OP","$1,651.18 ","$1,221.87 ","$0.00 ","$1,651.18 ","$743.03 ","$0.00 ","$344.15 ","$0.00 ","$0.00 ","$289.11 ","$1,651.18 ","$0.00 ","$825.59 ","$1,307.73 ","$1,320.94 ","$0.00 ","$258.41 ","$0.00 ","$262.87 ","$0.00 "
"4107545XL","SUP","HCPCS C1713","","4107545XL  -  SCREW BONE 7.5MM 45MM XL SPNL","BOTH IP/OP","$1,734.30 ","$1,283.38 ","$0.00 ","$1,734.30 ","$780.44 ","$0.00 ","$361.47 ","$0.00 ","$0.00 ","$303.66 ","$1,734.30 ","$0.00 ","$867.15 ","$1,373.57 ","$1,387.44 ","$0.00 ","$271.42 ","$0.00 ","$276.10 ","$0.00 "
"4108540XL","SUP","HCPCS C1713","","4108540XL  -  SCREW BONE 8.5MM 40MM XL SPNL","BOTH IP/OP","$1,651.18 ","$1,221.87 ","$0.00 ","$1,651.18 ","$743.03 ","$0.00 ","$344.15 ","$0.00 ","$0.00 ","$289.11 ","$1,651.18 ","$0.00 ","$825.59 ","$1,307.73 ","$1,320.94 ","$0.00 ","$258.41 ","$0.00 ","$262.87 ","$0.00 "
"4108545XL","SUP","HCPCS C1713","","4108545XL  -  SCREW BONE 8.5MM 45MM XL SPNL","BOTH IP/OP","$1,651.18 ","$1,221.87 ","$0.00 ","$1,651.18 ","$743.03 ","$0.00 ","$344.15 ","$0.00 ","$0.00 ","$289.11 ","$1,651.18 ","$0.00 ","$825.59 ","$1,307.73 ","$1,320.94 ","$0.00 ","$258.41 ","$0.00 ","$262.87 ","$0.00 "
"412.113S","SUP","HCPCS C1713","","412.113S  -  SCREW BN SD15 FT 3.5MM 2.9MM 34MM GRN STRL MULTILOC LCK","BOTH IP/OP","$326.13 ","$241.34 ","$0.00 ","$316.63 ","$142.48 ","$0.00 ","$67.97 ","$0.00 ","$0.00 ","$55.44 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$48.11 ","$0.00 ","$50.41 ","$0.00 "
"41-2005","SUP","HCPCS C1713","","41-2005  -  SCREW 5MM 2MM MANDIB XDR NLCKG BONE LORENZ SLVR","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$72.00 ","$0.00 ","$33.35 ","$0.00 ","$0.00 ","$28.01 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$25.04 ","$0.00 ","$25.47 ","$0.00 "
"41-2006","SUP","HCPCS C1713","","41-2006  -  SCREW BN 2MM 6MM BLU SLVR X-DRV NONLOCK XDR MNDB LORENZ","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2008","SUP","HCPCS C1713","","41-2008  -  SCREW BONE 2MM 8MM X DRIVE TRAUMAONE SILVER MANDIB","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2010","SUP","HCPCS C1713","","41-2010  -  SCREW BONE 2MM 10MM NONLOCKING XDRIVE LORENZ SILVER MANDIB","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2012","SUP","HCPCS C1713","","41-2012  -  SCREW BONE 2MM 12MM X DRIVE TRAUMAONE SILVER MANDIB","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2014","SUP","HCPCS C1713","","41-2014  -  SCREW BONE 2MM 14MM CROSS DRIVE NONLOCKING TRAUMAONE SILVER","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2016","SUP","HCPCS C1713","","41-2016  -  SCREW BONE 2MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2018","SUP","HCPCS C1713","","41-2018  -  SCREW BONE 2MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"41-2106","SUP","HCPCS C1713","","41-2106  -  SCREW BN 2.3MM 6MM SLVR X-DRV LCK","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2108","SUP","HCPCS C1713","","41-2108  -  SCREW BONE 2MM 8MM CROSS DRIVE LOCKING TRAUMAONE SILVER","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2110","SUP","HCPCS C1713","","41-2110  -  SCREW BONE 2MM 10MM LOCKING CROSS DRIVE TRAUMAONE LORENZ","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2112","SUP","HCPCS C1713","","41-2112  -  SCREW BONE 2MM 12MM CROSS DRIVE LOCKING TRAUMAONE SILVER","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2114","SUP","HCPCS C1713","","41-2114  -  SCREW BONE 2MM 14MM CROSS DRIVE LOCKING TRAUMAONE SILVER","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2116","SUP","HCPCS C1713","","41-2116  -  SCREW BONE 2MM 16MM X-DRIVE LOCKING TRAUMAONE SILVER MANDIB","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2118","SUP","HCPCS C1713","","41-2118  -  SCREW BONE 2MM 18MM LOCKING CROSS DRIVE MANDUBULAR","BOTH IP/OP","$390.00 ","$288.60 ","$0.00 ","$390.00 ","$175.50 ","$0.00 ","$81.29 ","$0.00 ","$0.00 ","$68.29 ","$390.00 ","$0.00 ","$195.00 ","$308.88 ","$312.00 ","$0.00 ","$61.04 ","$0.00 ","$62.09 ","$0.00 "
"41-2205","SUP","HCPCS C1713","","41-2205  -  SCREW 5MM 2MM MANDIB SLFDRILL XDR NLCKG BONE TRAUMAONE BLUE","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"41-2305","SUP","HCPCS C1713","","41-2305  -  SCREW BONE 2.3MM 5MM CROSS DRIVE NONLOCKING TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2306","SUP","HCPCS C1713","","41-2306  -  SCREW BN 2.3MM 6MM AU X-DRV NONLOCK","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2308","SUP","HCPCS C1713","","41-2308  -  SCREW BONE 2.3MM 8MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2310","SUP","HCPCS C1713","","41-2310  -  SCREW BONE 2.3MM 10MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2312","SUP","HCPCS C1713","","41-2312  -  SCREW BONE 2.3MM 12MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2314","SUP","HCPCS C1713","","41-2314  -  SCREW BONE 2.3MM 14MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2316","SUP","HCPCS C1713","","41-2316  -  SCREW BONE 2.3MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2318","SUP","HCPCS C1713","","41-2318  -  SCREW BONE 2.3MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD","BOTH IP/OP","$295.00 ","$218.30 ","$0.00 ","$295.00 ","$132.75 ","$0.00 ","$61.49 ","$0.00 ","$0.00 ","$51.65 ","$295.00 ","$0.00 ","$147.50 ","$233.64 ","$236.00 ","$0.00 ","$46.17 ","$0.00 ","$46.96 ","$0.00 "
"41-2406","SUP","HCPCS C1713","","41-2406  -  SCREW BONE 2.3MM 6MM LOCK CROSS DRIVE TRAUMAONE LORENZ GOLD","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$153.00 ","$0.00 ","$70.86 ","$0.00 ","$0.00 ","$59.53 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$53.21 ","$0.00 ","$54.13 ","$0.00 "
"41-2408","SUP","HCPCS C1713","","41-2408  -  SCREW BONE 2.3MM 8MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"41-2410","SUP","HCPCS C1713","","41-2410  -  SCREW BONE 2.3MM 10MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"41-2412","SUP","HCPCS C1713","","41-2412  -  SCREW BONE 2.3MM 12MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"41-2414","SUP","HCPCS C1713","","41-2414  -  SCREW BONE 2.3MM 14MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"41-2416","SUP","HCPCS C1713","","41-2416  -  SCREW BONE 2.3MM 16MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"41-2418","SUP","HCPCS C1713","","41-2418  -  SCREW BN 2.3MM 18MM AU X-DRV LCK","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$210.38 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$81.86 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$73.16 ","$0.00 ","$74.43 ","$0.00 "
"4125-127-100","SUP","Custom 27203010","","4125-127-100  -  BLADE SAW THK.05IN MEDIUM 3.937X.984IN 2 CUT SAGITTAL","BOTH IP/OP","$116.85 ","$86.47 ","$0.00 ","$116.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.85 ","$0.00 ","$58.43 ","$92.55 ","$93.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41-2708","SUP","HCPCS C1713","","41-2708  -  SCREW BONE 2.7MM 8MM EMERGENCY CROSS DRIVE TRAUMAONE MAGENTA","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$133.88 ","$0.00 ","$62.01 ","$0.00 ","$0.00 ","$52.09 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$46.56 ","$0.00 ","$47.36 ","$0.00 "
"41-2710","SUP","HCPCS C1713","","41-2710  -  SCREW BN 2.7MM 10MM MAG NLCKG X DRV","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$133.88 ","$0.00 ","$62.01 ","$0.00 ","$0.00 ","$52.09 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$46.56 ","$0.00 ","$47.36 ","$0.00 "
"41-2712","SUP","HCPCS C1713","","41-2712  -  SCREW BONE 2.7MM 12MM NONLOCKING X DRIVE LORENZ MAGENTA","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$133.88 ","$0.00 ","$62.01 ","$0.00 ","$0.00 ","$52.09 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$46.56 ","$0.00 ","$47.36 ","$0.00 "
"41-2714","SUP","HCPCS C1713","","41-2714  -  SCREW BONE 2.7MM 14MM NONLOCKING X DRIVE LORENZ MAGENTA","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$133.88 ","$0.00 ","$62.01 ","$0.00 ","$0.00 ","$52.09 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$46.56 ","$0.00 ","$47.36 ","$0.00 "
"41-2716","SUP","HCPCS C1713","","41-2716  -  SCREW BN 2.7MM 17MM LCK XDR ER","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$133.88 ","$0.00 ","$62.01 ","$0.00 ","$0.00 ","$52.09 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$46.56 ","$0.00 ","$47.36 ","$0.00 "
"41-2718","SUP","HCPCS C1713","","41-2718  -  SCREW BONE 2.7MM 18MM NONLOCKING X DRIVE LORENZ MAGENTA","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$133.88 ","$0.00 ","$62.01 ","$0.00 ","$0.00 ","$52.09 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$46.56 ","$0.00 ","$47.36 ","$0.00 "
"413.590E","SUP","HCPCS C1713","","413.590E  -  SCREW BONE 3MM 20MM LOCK TITANIUM STERNUM NONSTRL","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$505.00 ","$227.25 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$88.42 ","$505.00 ","$0.00 ","$252.50 ","$399.96 ","$404.00 ","$0.00 ","$79.03 ","$0.00 ","$80.40 ","$0.00 "
"413.592E","SUP","HCPCS C1713","","413.592E  -  SCREW BONE 3MM 22MM LOCK TITANIUM STERNUM NONSTRL","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$505.00 ","$227.25 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$88.42 ","$505.00 ","$0.00 ","$252.50 ","$399.96 ","$404.00 ","$0.00 ","$79.03 ","$0.00 ","$80.40 ","$0.00 "
"413.594E","SUP","HCPCS C1713","","413.594E  -  SCREW BONE 3MM 24MM LOCK TITANIUM STERNUM STERILE","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$505.00 ","$227.25 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$88.42 ","$505.00 ","$0.00 ","$252.50 ","$399.96 ","$404.00 ","$0.00 ","$79.03 ","$0.00 ","$80.40 ","$0.00 "
"416-022A","SUP","Custom 27203010","","KIT BINAXNOW FLU A B CLIA WVD NASO SWB CNTRL VIR TST 22 TST","BOTH IP/OP","$660.75 ","$488.96 ","$0.00 ","$660.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$660.75 ","$0.00 ","$330.38 ","$523.31 ","$528.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"41645B","SUP","Custom 27803010","","41645B  -  RELOAD STPLR 3.5MM 45MM BLU STRL LF DVNC SI EWRST REG TISS","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4170-223","SUP","Custom 27203010","","4170-223  -  TUBING SUCT/IRR FLD MNG INFL STRL DISP","BOTH IP/OP","$72.94 ","$53.98 ","$0.00 ","$72.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.94 ","$0.00 ","$36.47 ","$57.77 ","$58.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.952S","SUP","Custom 27803010","","419.952S  -  WASHER OVL SM ORTH TI 6.5/7.3MM CANN SCR STRL","BOTH IP/OP","$328.50 ","$243.09 ","$0.00 ","$328.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$328.50 ","$0.00 ","$164.25 ","$260.17 ","$262.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"419.953S","SUP","Custom 27803010","","419.953S  -  WASHER ORTHOPEDIC LARGE ROUND TITANIUM STERILE 6.5/7.3MM","BOTH IP/OP","$369.70 ","$273.58 ","$0.00 ","$358.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$358.93 ","$0.00 ","$179.46 ","$284.27 ","$287.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4195-78","SUP","HCPCS C1898","","4195-78  -  LEAD PACING 5FR 78CM IS-1 UNIPOLAR DEPLOYABLE LOBE FIX","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"4200-10","SUP","Custom 27203010","","4200-10  -  DISSECTOR SURG MODELING CATHETER MARTIN UNBALLOON","BOTH IP/OP","$3,987.50 ","$2,950.75 ","$0.00 ","$3,987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,987.50 ","$0.00 ","$1,993.75 ","$3,158.10 ","$3,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4200-20","SUP","HCPCS C1773","","4200-20  -  DEVICE RETRIEVAL REMOVAL ENDSCP HELIX","BOTH IP/OP","$5,237.50 ","$3,875.75 ","$0.00 ","$5,237.50 ","$2,843.96 ","$0.00 ","$1,091.63 ","$0.00 ","$0.00 ","$917.04 ","$5,237.50 ","$0.00 ","$2,618.75 ","$4,148.10 ","$4,190.00 ","$0.00 ","$819.67 ","$0.00 ","$833.81 ","$0.00 "
"4200927F","SUP","Custom 27803010","","4200927F  -  CAGE SPNL 0D 9MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4201127F","SUP","Custom 27803010","","4201127F  -  CAGE SPNL 0D 11MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4201327F","SUP","Custom 27803010","","4201327F  -  CAGE SPNL 0D 13MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4201527F","SUP","Custom 27803010","","4201527F  -  CAGE SPNL 0D 15MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4201727F","SUP","Custom 27803010","","4201727F  -  CAGE SPNL 0D 17MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420404F","SUP","Custom 27203010","","420404F  -  CATHETER CHLGM 4FR 40CM STRL 3W LL BVL BIL","BOTH IP/OP","$67.65 ","$50.06 ","$0.00 ","$67.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.65 ","$0.00 ","$33.83 ","$53.58 ","$54.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"420406F","SUP","Custom 27203010","","420406F  -  CATHETER CHLGM 6FR 40CM BIL","BOTH IP/OP","$67.65 ","$50.06 ","$0.00 ","$67.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.65 ","$0.00 ","$33.83 ","$53.58 ","$54.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42-1002","SUP","HCPCS C1713","","42-1002  -  PLATE LNG 1MM MANDIB 6 HOLE Y 2MM/2.3MM SCR BONE TRAUMAONE","BOTH IP/OP","$1,402.50 ","$1,037.85 ","$0.00 ","$1,402.50 ","$631.13 ","$0.00 ","$292.32 ","$0.00 ","$0.00 ","$245.57 ","$1,402.50 ","$0.00 ","$701.25 ","$1,110.78 ","$1,122.00 ","$0.00 ","$219.49 ","$0.00 ","$223.28 ","$0.00 "
"42-1003","SUP","HCPCS C1713","","42-1003  -  PLATE 1MM MANDIB 7 HOLE CVD 2MM/2.3MM SCR BONE TRAUMAONE TI","BOTH IP/OP","$1,402.50 ","$1,037.85 ","$0.00 ","$1,402.50 ","$631.13 ","$0.00 ","$292.32 ","$0.00 ","$0.00 ","$245.57 ","$1,402.50 ","$0.00 ","$701.25 ","$1,110.78 ","$1,122.00 ","$0.00 ","$219.49 ","$0.00 ","$223.28 ","$0.00 "
"42-1004","SUP","HCPCS C1713","","42-1004  -  PLATE BONE STR 1MM 4 HOLE GAP TRAUMAONE SILVER TITANIUM","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$868.50 ","$0.00 ","$402.26 ","$0.00 ","$0.00 ","$337.93 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$302.05 ","$0.00 ","$307.26 ","$0.00 "
"42-1005","SUP","HCPCS C1713","","42-1005  -  PLATE 1MM MANDIB 2X7 HOLE MTRX STR BONE TRAUMAONE SLVR","BOTH IP/OP","$1,402.50 ","$1,037.85 ","$0.00 ","$1,402.50 ","$631.13 ","$0.00 ","$292.32 ","$0.00 ","$0.00 ","$245.57 ","$1,402.50 ","$0.00 ","$701.25 ","$1,110.78 ","$1,122.00 ","$0.00 ","$219.49 ","$0.00 ","$223.28 ","$0.00 "
"42-1006","SUP","HCPCS C1713","","42-1006  -  PLATE  2X7 CRVD MATRIX  1.0MM","BOTH IP/OP","$1,402.50 ","$1,037.85 ","$0.00 ","$1,402.50 ","$631.13 ","$0.00 ","$292.32 ","$0.00 ","$0.00 ","$245.57 ","$1,402.50 ","$0.00 ","$701.25 ","$1,110.78 ","$1,122.00 ","$0.00 ","$219.49 ","$0.00 ","$223.28 ","$0.00 "
"42-1007","SUP","HCPCS C1713","","42-1007  -  PLATE BONE STR 1MM 7 HOLE TRAUMAONE LORENZ TITANIUM MANDIB","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$868.50 ","$0.00 ","$402.26 ","$0.00 ","$0.00 ","$337.93 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$302.05 ","$0.00 ","$307.26 ","$0.00 "
"42-1016","SUP","HCPCS C1713","","42-1016  -  PLATE  16 HOLE STR  1.0MM","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$1,032.75 ","$0.00 ","$478.34 ","$0.00 ","$0.00 ","$401.84 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$359.17 ","$0.00 ","$365.36 ","$0.00 "
"4241327F","SUP","Custom 27803010","","4241327F  -  CAGE SPNL 4D 13MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4241521F","SUP","Custom 27803010","","4241521F  -  CAGE SPNL 4D 15MM 21MM FRNTL STNDALN","BOTH IP/OP","$2,021.88 ","$1,496.19 ","$0.00 ","$2,021.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,021.88 ","$0.00 ","$1,010.94 ","$1,601.33 ","$1,617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4241527B","SUP","Custom 27803010","","4241527B  -  CAGE SPNL 4D 15MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4241527F","SUP","Custom 27803010","","4241527F  -  CAGE SPNL 4D 15MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4241727B","SUP","Custom 27803010","","4241727B  -  CAGE SPNL 4D 17MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4241727F","SUP","Custom 27803010","","4241727F  -  CAGE SPNL 4D 17MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"426.702S","SUP","HCPCS C1713","","426.702S  -  PLATE BONE BROAD 372MM 20 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,443.10 ","$1,807.89 ","$0.00 ","$2,371.93 ","$1,067.37 ","$0.00 ","$509.20 ","$0.00 ","$0.00 ","$415.31 ","$2,371.93 ","$0.00 ","$1,185.96 ","$1,878.57 ","$1,897.54 ","$0.00 ","$360.40 ","$0.00 ","$377.61 ","$0.00 "
"426.722S","SUP","HCPCS C1713","","426.722S  -  PLATE BONE BROAD 408MM 22 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,669.40 ","$1,975.36 ","$0.00 ","$2,591.65 ","$1,166.24 ","$0.00 ","$556.37 ","$0.00 ","$0.00 ","$453.78 ","$2,591.65 ","$0.00 ","$1,295.83 ","$2,052.59 ","$2,073.32 ","$0.00 ","$393.78 ","$0.00 ","$412.59 ","$0.00 "
"426.742S","SUP","HCPCS C1713","","426.742S  -  PLATE BONE BROAD 443MM 24 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$2,897.13 ","$2,143.88 ","$0.00 ","$2,812.75 ","$1,265.74 ","$0.00 ","$603.83 ","$0.00 ","$0.00 ","$492.49 ","$2,812.75 ","$0.00 ","$1,406.38 ","$2,227.70 ","$2,250.20 ","$0.00 ","$427.37 ","$0.00 ","$447.79 ","$0.00 "
"426.762S","SUP","HCPCS C1713","","426.762S  -  PLATE BONE BROAD 479MM 26 HOLE CVD LCP TITANIUM ORTHOPEDIC","BOTH IP/OP","$3,129.08 ","$2,315.52 ","$0.00 ","$3,037.93 ","$1,367.07 ","$0.00 ","$652.18 ","$0.00 ","$0.00 ","$531.92 ","$3,037.93 ","$0.00 ","$1,518.96 ","$2,406.04 ","$2,430.34 ","$0.00 ","$461.59 ","$0.00 ","$483.64 ","$0.00 "
"42615-05","SUP","Custom 27203010","","42615-05  -  KIT PRESSURE MONITR 3ML/HR 48IN 2 LINE TRANSDUCER MALE TO","BOTH IP/OP","$36.36 ","$26.91 ","$0.00 ","$36.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.36 ","$0.00 ","$18.18 ","$28.80 ","$29.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"42650-06","SUP","Custom 27203010","","42650-06  -  KIT PRESSURE MONITR 84IN TRANSDUCER FLUSH DEVICE TUBE","BOTH IP/OP","$73.16 ","$54.14 ","$0.00 ","$73.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.16 ","$0.00 ","$36.58 ","$57.94 ","$58.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"427022S","SUP","HCPCS C1713","","427022S  -  PLATE BN 292MM STRL 22 HL CMPR LCK","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"427069S","SUP","HCPCS C1713","","427069S  -  PLATE 3MM 115MM SS 9 HOLE 1/3 TBLR SM FRAG IMPL AXSOS BONE","BOTH IP/OP","$236.80 ","$175.23 ","$0.00 ","$236.50 ","$106.43 ","$0.00 ","$49.36 ","$0.00 ","$0.00 ","$41.41 ","$236.50 ","$0.00 ","$118.25 ","$187.31 ","$189.20 ","$0.00 ","$37.01 ","$0.00 ","$37.65 ","$0.00 "
"4281127B","SUP","Custom 27803010","","4281127B  -  CAGE SPNL 8D 11MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4281127F","SUP","Custom 27803010","","4281127F  -  CAGE SPNL 8D 11MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4281327B","SUP","Custom 27803010","","4281327B  -  CAGE SPNL 8D 13MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4281327F","SUP","Custom 27803010","","4281327F  -  CAGE SPNL 8D 13MM 27MM WHL BD STNDALN","BOTH IP/OP","$4,245.88 ","$3,141.95 ","$0.00 ","$4,245.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,245.88 ","$0.00 ","$2,122.94 ","$3,362.74 ","$3,396.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4296-78","SUP","HCPCS C1900","","4296-78  -  LEAD PACING 2 CURVE 5.3FR 78CM BIPOL 2 ELECTRODE 2 FIX IS-1","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$0.00 ","$0.00 "
"43-1001","SUP","HCPCS C1713","","43-1001  -  PLATE BONE SMALL 1MM ANGLED TRAUMAONE GOLD TITANIUM MANDIB 2","BOTH IP/OP","$3,127.50 ","$2,314.35 ","$0.00 ","$3,127.50 ","$1,407.38 ","$0.00 ","$651.85 ","$0.00 ","$0.00 ","$547.60 ","$3,127.50 ","$0.00 ","$1,563.75 ","$2,476.98 ","$2,502.00 ","$0.00 ","$489.45 ","$0.00 ","$497.90 ","$0.00 "
"43-1004","SUP","HCPCS C1713","","43-1004  -  PLATE BONE STR 4 HOLE GAP CRANIOMAXILLOFACIAL","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$868.50 ","$0.00 ","$402.26 ","$0.00 ","$0.00 ","$337.93 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$302.05 ","$0.00 ","$307.26 ","$0.00 "
"43-1005","SUP","HCPCS C1713","","43-1005  -  PLATE BONE 1MM 4 HOLE STR TRAUMAONE GOLD TITANIUM MANDIB","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$868.50 ","$0.00 ","$402.26 ","$0.00 ","$0.00 ","$337.93 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$302.05 ","$0.00 ","$307.26 ","$0.00 "
"43-1007","SUP","HCPCS C1713","","43-1007  -  PLATE BONE 1.6MM 7 HOLE STR","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$1,032.75 ","$0.00 ","$478.34 ","$0.00 ","$0.00 ","$401.84 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$359.17 ","$0.00 ","$365.36 ","$0.00 "
"43-1008","SUP","HCPCS C1713","","43-1008  -  PLATE BONE THK1.6MM CVD 7 HOLE LORENZ GOLD MANDIB","BOTH IP/OP","$3,127.50 ","$2,314.35 ","$0.00 ","$3,127.50 ","$1,407.38 ","$0.00 ","$651.85 ","$0.00 ","$0.00 ","$547.60 ","$3,127.50 ","$0.00 ","$1,563.75 ","$2,476.98 ","$2,502.00 ","$0.00 ","$489.45 ","$0.00 ","$497.90 ","$0.00 "
"43-1016","SUP","HCPCS C1713","","43-1016  -  PLATE BONE 1.6MM 16 HOLE STR TRAUMAONE GOLD MANDIB","BOTH IP/OP","$3,552.50 ","$2,628.85 ","$0.00 ","$3,552.50 ","$1,598.63 ","$0.00 ","$740.43 ","$0.00 ","$0.00 ","$622.01 ","$3,552.50 ","$0.00 ","$1,776.25 ","$2,813.58 ","$2,842.00 ","$0.00 ","$555.97 ","$0.00 ","$565.56 ","$0.00 "
"43-1280","SUP","Custom 27203010","","43-1280  -  KIT RSN REPR 75 PPM CRNPLST CMPLT SET TY 2 PWDR CRNL","BOTH IP/OP","$4,296.40 ","$3,179.34 ","$0.00 ","$4,296.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,296.40 ","$0.00 ","$2,148.20 ","$3,402.75 ","$3,437.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"43154-060","SUP","Custom 27203010","","43154-060  -  TUBE ENDOTRAC 6MM NSL/ORL TRK REINF CUF MRPH SIL SS","BOTH IP/OP","$312.93 ","$231.57 ","$0.00 ","$312.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.93 ","$0.00 ","$156.47 ","$247.84 ","$250.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4324A","SUP","Custom 27203010","","4324A  -  TRAY PROCEDURE 20GA 3.5IN MYELOGRAM PH WATER SOLUBLE CLEAR","BOTH IP/OP","$24.70 ","$18.28 ","$0.00 ","$25.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.07 ","$0.00 ","$12.54 ","$19.86 ","$20.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"433-01","SUP","Custom 27203010","","433-01  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,064.63 ","$787.83 ","$0.00 ","$1,064.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,064.63 ","$0.00 ","$532.31 ","$843.19 ","$851.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"435002S","SUP","HCPCS C1713","","435002S  -  PLATE 34MM SS 3.5/4MM SCR 2 HOLE BONE LEFT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435004S","SUP","HCPCS C1713","","435004S  -  PLATE 60MM SS 3.5/4MM SCR 4 HOLE BONE LEFT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435006S","SUP","HCPCS C1713","","435006S  -  PLATE 86MM SS 3.5/4MM SCR 6 HOLE BONE LEFT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435008S","SUP","HCPCS C1713","","435008S  -  PLATE 112MM SS 3.5/4MM SCR 8 HOLE BONE LEFT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435010S","SUP","HCPCS C1713","","435010S  -  PLATE 138MM SS 3.5/4MM SCR 10 HOLE BONE LEFT PERIART TIB","BOTH IP/OP","$1,149.50 ","$850.63 ","$0.00 ","$1,149.50 ","$517.28 ","$0.00 ","$239.58 ","$0.00 ","$0.00 ","$201.27 ","$1,149.50 ","$0.00 ","$574.75 ","$910.40 ","$919.60 ","$0.00 ","$179.90 ","$0.00 ","$183.00 ","$0.00 "
"435012S","SUP","HCPCS C1713","","435012S  -  PLATE 164MM SS 3.5/4MM SCR 12 HOLE BONE LEFT PERIART TIB","BOTH IP/OP","$1,149.50 ","$850.63 ","$0.00 ","$1,149.50 ","$517.28 ","$0.00 ","$239.58 ","$0.00 ","$0.00 ","$201.27 ","$1,149.50 ","$0.00 ","$574.75 ","$910.40 ","$919.60 ","$0.00 ","$179.90 ","$0.00 ","$183.00 ","$0.00 "
"435014S","SUP","HCPCS C1713","","435014S  -  PLATE 190MM SS 3.5/4MM SCR 14 HOLE BONE LEFT PERIART TIB","BOTH IP/OP","$1,193.50 ","$883.19 ","$0.00 ","$1,193.50 ","$537.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.97 ","$1,193.50 ","$0.00 ","$596.75 ","$945.25 ","$954.80 ","$0.00 ","$186.78 ","$0.00 ","$190.01 ","$0.00 "
"435022S","SUP","HCPCS C1713","","435022S  -  PLATE 34MM SS 3.5/4MM SCR 2 HOLE BONE RIGHT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435024S","SUP","HCPCS C1713","","435024S  -  PLATE 60MM SS 3.5/4MM SCR 4 HOLE BONE RIGHT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435026S","SUP","HCPCS C1713","","435026S  -  PLATE 86MM SS 3.5/4MM SCR 6 HOLE BONE RIGHT PERIART TIB STRL","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435028S","SUP","HCPCS C1713","","435028S  -  PLATE 112MM SS 3.5/4MM SCR 8 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,113.75 ","$824.18 ","$0.00 ","$1,113.75 ","$501.19 ","$0.00 ","$232.13 ","$0.00 ","$0.00 ","$195.01 ","$1,113.75 ","$0.00 ","$556.88 ","$882.09 ","$891.00 ","$0.00 ","$174.30 ","$0.00 ","$177.31 ","$0.00 "
"435030S","SUP","HCPCS C1713","","435030S  -  PLATE 138MM SS 3.5/4MM SCR 10 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,149.50 ","$850.63 ","$0.00 ","$1,149.50 ","$517.28 ","$0.00 ","$239.58 ","$0.00 ","$0.00 ","$201.27 ","$1,149.50 ","$0.00 ","$574.75 ","$910.40 ","$919.60 ","$0.00 ","$179.90 ","$0.00 ","$183.00 ","$0.00 "
"435032S","SUP","HCPCS C1713","","435032S  -  PLATE 164MM SS 3.5/4MM SCR 12 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,149.50 ","$850.63 ","$0.00 ","$1,149.50 ","$517.28 ","$0.00 ","$239.58 ","$0.00 ","$0.00 ","$201.27 ","$1,149.50 ","$0.00 ","$574.75 ","$910.40 ","$919.60 ","$0.00 ","$179.90 ","$0.00 ","$183.00 ","$0.00 "
"435034S","SUP","HCPCS C1713","","435034S  -  PLATE 190MM SS 3.5/4MM SCR 14 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,193.50 ","$883.19 ","$0.00 ","$1,193.50 ","$537.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.97 ","$1,193.50 ","$0.00 ","$596.75 ","$945.25 ","$954.80 ","$0.00 ","$186.78 ","$0.00 ","$190.01 ","$0.00 "
"435506S","SUP","HCPCS C1713","","435506S  -  PLATE SS 6 HL SHFT BONE LEFT PERIART FEM STRL","BOTH IP/OP","$1,080.75 ","$799.76 ","$0.00 ","$1,080.75 ","$486.34 ","$0.00 ","$225.26 ","$0.00 ","$0.00 ","$189.23 ","$1,080.75 ","$0.00 ","$540.38 ","$855.95 ","$864.60 ","$0.00 ","$169.14 ","$0.00 ","$172.06 ","$0.00 "
"435508S","SUP","HCPCS C1713","","435508S  -  PLATE 193MM SS 4.5/6.5MM SCR 8 HOLE BONE LEFT PERIART FEM","BOTH IP/OP","$1,080.75 ","$799.76 ","$0.00 ","$1,080.75 ","$486.34 ","$0.00 ","$225.26 ","$0.00 ","$0.00 ","$189.23 ","$1,080.75 ","$0.00 ","$540.38 ","$855.95 ","$864.60 ","$0.00 ","$169.14 ","$0.00 ","$172.06 ","$0.00 "
"435526S","SUP","HCPCS C1713","","435526S  -  PLATE 157MM SS 4.5/6.5MM SCR 6 HOLE BONE RIGHT PERIART FEM","BOTH IP/OP","$1,080.75 ","$799.76 ","$0.00 ","$1,080.75 ","$486.34 ","$0.00 ","$225.26 ","$0.00 ","$0.00 ","$189.23 ","$1,080.75 ","$0.00 ","$540.38 ","$855.95 ","$864.60 ","$0.00 ","$169.14 ","$0.00 ","$172.06 ","$0.00 "
"435528S","SUP","HCPCS C1713","","435528S  -  PLATE 193MM SS 4.5/6.5MM SCR 8 HOLE BONE RIGHT PERIART FEM","BOTH IP/OP","$1,080.75 ","$799.76 ","$0.00 ","$1,080.75 ","$486.34 ","$0.00 ","$225.26 ","$0.00 ","$0.00 ","$189.23 ","$1,080.75 ","$0.00 ","$540.38 ","$855.95 ","$864.60 ","$0.00 ","$169.14 ","$0.00 ","$172.06 ","$0.00 "
"435604S","SUP","HCPCS C1713","","435604S  -  PLATE 78MM SS 4.5/6.5MM SCR 4 HOLE BONE LEFT PERIART TIB","BOTH IP/OP","$1,127.50 ","$834.35 ","$0.00 ","$1,127.50 ","$507.38 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$197.42 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$176.45 ","$0.00 ","$179.50 ","$0.00 "
"435606S","SUP","HCPCS C1713","","435606S  -  PLATE 114MM SS 4.5/6.5MM SCR 6 HOLE BONE LEFT PERIART TIB","BOTH IP/OP","$1,056.00 ","$781.44 ","$0.00 ","$1,127.50 ","$507.38 ","$0.00 ","$220.10 ","$0.00 ","$0.00 ","$197.42 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$176.45 ","$0.00 ","$179.50 ","$0.00 "
"435608S","SUP","HCPCS C1713","","435608S  -  PLATE 150MM SS 4.5/6.5MM SCR 8 HOLE BONE LEFT PERIART TIB","BOTH IP/OP","$1,171.50 ","$866.91 ","$0.00 ","$1,171.50 ","$527.18 ","$0.00 ","$244.17 ","$0.00 ","$0.00 ","$205.12 ","$1,171.50 ","$0.00 ","$585.75 ","$927.83 ","$937.20 ","$0.00 ","$183.34 ","$0.00 ","$186.50 ","$0.00 "
"435624S","SUP","HCPCS C1713","","435624S  -  PLATE 78MM SS 4.5/6.5MM SCR 4 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,127.50 ","$834.35 ","$0.00 ","$1,127.50 ","$507.38 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$197.42 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$176.45 ","$0.00 ","$179.50 ","$0.00 "
"435626S","SUP","HCPCS C1713","","435626S  -  PLATE 114MM SS 4.5/6.5MM SCR 6 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,127.50 ","$834.35 ","$0.00 ","$1,127.50 ","$507.38 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$197.42 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$176.45 ","$0.00 ","$179.50 ","$0.00 "
"435628S","SUP","HCPCS C1713","","435628S  -  PLATE 150MM SS 4.5/6.5MM SCR 8 HOLE BONE RIGHT PERIART TIB","BOTH IP/OP","$1,171.50 ","$866.91 ","$0.00 ","$1,171.50 ","$527.18 ","$0.00 ","$244.17 ","$0.00 ","$0.00 ","$205.12 ","$1,171.50 ","$0.00 ","$585.75 ","$927.83 ","$937.20 ","$0.00 ","$183.34 ","$0.00 ","$186.50 ","$0.00 "
"436.504S","SUP","HCPCS C1713","","436.504S  -  PLATE BONE 4 LCP TITANIUM OLECRANON STERILE 3.5MM SCREWS","BOTH IP/OP","$1,865.35 ","$1,380.36 ","$0.00 ","$1,811.03 ","$814.96 ","$0.00 ","$388.79 ","$0.00 ","$0.00 ","$317.10 ","$1,811.03 ","$0.00 ","$905.51 ","$1,434.34 ","$1,448.82 ","$0.00 ","$275.17 ","$0.00 ","$288.32 ","$0.00 "
"436.505S","SUP","HCPCS C1713","","436.505S  -  PLATE BONE 112MM 4 HOLE LCP TITANIUM LEFT OLECRANON STERILE","BOTH IP/OP","$1,865.35 ","$1,380.36 ","$0.00 ","$1,811.03 ","$814.96 ","$0.00 ","$388.79 ","$0.00 ","$0.00 ","$317.10 ","$1,811.03 ","$0.00 ","$905.51 ","$1,434.34 ","$1,448.82 ","$0.00 ","$275.17 ","$0.00 ","$288.32 ","$0.00 "
"436.508S","SUP","HCPCS C1713","","436.508S  -  PLATE BONE 164MM 8 HOLE LCP TITANIUM RIGHT OLECRANON STERILE","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"436.509S","SUP","HCPCS C1713","","436.509S  -  PLATE BONE 164MM 8 HOLE LCP TITANIUM LEFT OLECRANON STERILE","BOTH IP/OP","$2,015.78 ","$1,491.68 ","$0.00 ","$1,957.05 ","$880.67 ","$0.00 ","$420.14 ","$0.00 ","$0.00 ","$342.66 ","$1,957.05 ","$0.00 ","$978.53 ","$1,549.98 ","$1,565.64 ","$0.00 ","$297.36 ","$0.00 ","$311.56 ","$0.00 "
"436013B","SUP","HCPCS C1713","","436013B  -  CENTERPIECE 436013B 13MM B-SIZE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436013C","SUP","HCPCS C1713","","436013C  -  CENTERPIECE 436013C 13MM C-SIZE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436013D","SUP","HCPCS C1713","","436013D  -  CENTERPIECE 436013D 13MM D-SIZE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436013E","SUP","HCPCS C1713","","436013E  -  CENTERPIECE 436013E 13MM E-SIZE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436020A","SUP","HCPCS C1713","","436020A  -  CENTERPIECE 436020A 20MM A-SIZE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436020B","SUP","HCPCS C1713","","436020B  -  CENTERPIECE 436020B 20MM B-SIZE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436020C","SUP","HCPCS C1713","","436020C  -  CENTERPIECE 436020C 20MM C-SIZE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436020D","SUP","HCPCS C1713","","436020D  -  CENTERPIECE 436020D 20MM D-SIZE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436020E","SUP","HCPCS C1713","","436020E  -  CENTERPIECE 436020E 20MM E-SIZE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436025A","SUP","HCPCS C1713","","436025A  -  CENTERPIECE 436025A 25MM A-SIZE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436025B","SUP","HCPCS C1713","","436025B  -  CENTERPIECE 436025B 25MM B-SIZE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436025C","SUP","HCPCS C1713","","436025C  -  CENTERPIECE 436025C 25MM C-SIZE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436025D","SUP","HCPCS C1713","","436025D  -  CENTERPIECE 436025D 25MM D-SIZE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436025E","SUP","HCPCS C1713","","436025E  -  CENTERPIECE 436025E 25MM E-SIZE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436113A","SUP","HCPCS C1713","","436113A  -  CAGE 436113A 13MM A-SIZE STERILE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436113B","SUP","HCPCS C1713","","436113B  -  CAGE 436113B 13MM B-SIZE STERILE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436113C","SUP","HCPCS C1713","","436113C  -  CAGE 436113C 13MM C-SIZE STERILE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436113D","SUP","HCPCS C1713","","436113D  -  CAGE 436113D 13MM D-SIZE STERILE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436113E","SUP","HCPCS C1713","","436113E  -  CAGE 436113E 13MM E-SIZE STERILE","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436120A","SUP","HCPCS C1713","","436120A  -  CAGE 436120A 20MM A-SIZE STERILE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436120B","SUP","HCPCS C1713","","436120B  -  CAGE 436120B 20MM B-SIZE STERILE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436120C","SUP","HCPCS C1713","","436120C  -  CAGE 436120C 20MM C-SIZE STERILE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436120D","SUP","HCPCS C1713","","436120D  -  CAGE 436120D 20MM D-SIZE STERILE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436120E","SUP","HCPCS C1713","","436120E  -  CAGE 436120E 20MM E-SIZE STERILE","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"436125A","SUP","HCPCS C1713","","436125A  -  CAGE 436125A 25MM A-SIZE STERILE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436125B","SUP","HCPCS C1713","","436125B  -  CAGE 436125B 25MM B-SIZE STERILE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436125C","SUP","HCPCS C1713","","436125C  -  CAGE 436125C 25MM C-SIZE STERILE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436125D","SUP","HCPCS C1713","","436125D  -  CAGE 436125D 25MM D-SIZE STERILE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436125E","SUP","HCPCS C1713","","436125E  -  CAGE 436125E 25MM E-SIZE STERILE","BOTH IP/OP","$14,500.00 ","$10,730.00 ","$0.00 ","$14,500.00 ","$6,525.00 ","$0.00 ","$3,022.16 ","$0.00 ","$0.00 ","$2,538.83 ","$14,500.00 ","$0.00 ","$7,250.00 ","$11,484.00 ","$11,600.00 ","$0.00 ","$2,269.25 ","$0.00 ","$2,308.40 ","$0.00 "
"436213A","SUP","HCPCS C1713","","436213A  -  CENTERPIECE 436213A 13MM A-SIZE CERVICAL","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436213B","SUP","HCPCS C1713","","436213B  -  CENTERPIECE 436213B 13MM B-SIZE CERVICAL","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436213C","SUP","HCPCS C1713","","436213C  -  CENTERPIECE 436213C 13MM C-SIZE CERVICAL","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436213D","SUP","HCPCS C1713","","436213D  -  CENTERPIECE 436213D 13MM D-SIZE CERVICAL","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436213E","SUP","HCPCS C1713","","436213E  -  CENTERPIECE 436213E 13MM E-SIZE CERVICAL","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436313A","SUP","HCPCS C1713","","436313A  -  CENTERPIECE 436313A 13MM A-SIZE CRV STER","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436313B","SUP","HCPCS C1713","","436313B  -  CENTERPIECE 436313B 13MM B-SIZE CRV STER","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436313C","SUP","HCPCS C1713","","436313C  -  CENTERPIECE 436313C 13MM C-SIZE CRV STER","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436313D","SUP","HCPCS C1713","","436313D  -  CENTERPIECE 436313D 13MM D-SIZE CRV STER","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"436313E","SUP","HCPCS C1713","","436313E  -  CENTERPIECE 436313E 13MM E-SIZE CRV STER","BOTH IP/OP","$11,500.00 ","$8,510.00 ","$0.00 ","$11,500.00 ","$5,175.00 ","$0.00 ","$2,396.89 ","$0.00 ","$0.00 ","$2,013.56 ","$11,500.00 ","$0.00 ","$5,750.00 ","$9,108.00 ","$9,200.00 ","$0.00 ","$1,799.75 ","$0.00 ","$1,830.80 ","$0.00 "
"437.043S","SUP","HCPCS C1713","","437.043S  -  PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.044S","SUP","HCPCS C1713","","437.044S  -  PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.053S","SUP","HCPCS C1713","","437.053S  -  PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.054S","SUP","HCPCS C1713","","437.054S  -  PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.063S","SUP","HCPCS C1713","","437.063S  -  PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.064S","SUP","HCPCS C1713","","437.064S  -  PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.083S","SUP","HCPCS C1713","","437.083S  -  PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.084S","SUP","HCPCS C1713","","437.084S  -  PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.085S","SUP","HCPCS C1713","","437.085S  -  PLATE BONE 90D 50MM 8 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.086S","SUP","HCPCS C1713","","437.086S  -  PLATE BONE 90D 60MM 8 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$1,629.75 ","$1,206.02 ","$0.00 ","$1,629.75 ","$733.39 ","$0.00 ","$339.68 ","$0.00 ","$0.00 ","$285.36 ","$1,629.75 ","$0.00 ","$814.88 ","$1,290.76 ","$1,303.80 ","$0.00 ","$255.06 ","$0.00 ","$259.46 ","$0.00 "
"437.103S","SUP","HCPCS C1713","","437.103S  -  PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.104S","SUP","HCPCS C1713","","437.104S  -  PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.105S","SUP","HCPCS C1713","","437.105S  -  PLATE BONE 90D 50MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.106S","SUP","HCPCS C1713","","437.106S  -  PLATE BONE 90D 60MM 10 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.123S","SUP","HCPCS C1713","","437.123S  -  PLATE BONE 90D 30MM 12 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.124S","SUP","HCPCS C1713","","437.124S  -  PLATE BONE 90D 40MM 12 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.125S","SUP","HCPCS C1713","","437.125S  -  PLATE BONE 90D 50MM 12 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.126S","SUP","HCPCS C1713","","437.126S  -  PLATE BONE 90D 60MM 12 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,126.63 ","$1,573.71 ","$0.00 ","$2,126.63 ","$956.98 ","$0.00 ","$443.24 ","$0.00 ","$0.00 ","$372.36 ","$2,126.63 ","$0.00 ","$1,063.31 ","$1,684.29 ","$1,701.30 ","$0.00 ","$332.82 ","$0.00 ","$338.56 ","$0.00 "
"437.143S","SUP","HCPCS C1713","","437.143S  -  PLATE BONE 90D 30MM 14 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,705.65 ","$2,002.18 ","$0.00 ","$2,705.65 ","$1,217.54 ","$0.00 ","$563.93 ","$0.00 ","$0.00 ","$473.74 ","$2,705.65 ","$0.00 ","$1,352.83 ","$2,142.87 ","$2,164.52 ","$0.00 ","$423.43 ","$0.00 ","$430.74 ","$0.00 "
"437.144S","SUP","HCPCS C1713","","437.144S  -  PLATE BONE 90D 40MM 14 HOLE CANN LC ANGLED TITANIUM","BOTH IP/OP","$2,705.65 ","$2,002.18 ","$0.00 ","$2,705.65 ","$1,217.54 ","$0.00 ","$563.93 ","$0.00 ","$0.00 ","$473.74 ","$2,705.65 ","$0.00 ","$1,352.83 ","$2,142.87 ","$2,164.52 ","$0.00 ","$423.43 ","$0.00 ","$430.74 ","$0.00 "
"437.146S","SUP","HCPCS C1713","","437.146S  -  PLATE BONE 90D 256MM 60X11.7MM 14 HOLE CANN LC ANGLED BLADE","BOTH IP/OP","$2,705.65 ","$2,002.18 ","$0.00 ","$2,705.65 ","$1,217.54 ","$0.00 ","$563.93 ","$0.00 ","$0.00 ","$473.74 ","$2,705.65 ","$0.00 ","$1,352.83 ","$2,142.87 ","$2,164.52 ","$0.00 ","$423.43 ","$0.00 ","$430.74 ","$0.00 "
"4396-78","SUP","HCPCS C1900","","4396-78  -  LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN","BOTH IP/OP","$3,562.50 ","$2,636.25 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$742.51 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$0.00 ","$0.00 "
"4396-88","SUP","HCPCS C1900","","4396-88  -  LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN","BOTH IP/OP","$3,562.50 ","$2,636.25 ","$0.00 ","$3,562.50 ","$0.00 ","$0.00 ","$742.51 ","$0.00 ","$0.00 ","$0.00 ","$3,562.50 ","$0.00 ","$1,781.25 ","$2,821.50 ","$2,850.00 ","$0.00 ","$557.53 ","$0.00 ","$0.00 ","$0.00 "
"441.072S","SUP","HCPCS C1713","","441.072S  -  PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,513.93 ","$1,120.31 ","$0.00 ","$1,469.83 ","$661.42 ","$0.00 ","$315.54 ","$0.00 ","$0.00 ","$257.35 ","$1,469.83 ","$0.00 ","$734.91 ","$1,164.11 ","$1,175.86 ","$0.00 ","$223.33 ","$0.00 ","$234.00 ","$0.00 "
"441.073S","SUP","HCPCS C1713","","441.073S  -  PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,513.93 ","$1,120.31 ","$0.00 ","$1,469.83 ","$661.42 ","$0.00 ","$315.54 ","$0.00 ","$0.00 ","$257.35 ","$1,469.83 ","$0.00 ","$734.91 ","$1,164.11 ","$1,175.86 ","$0.00 ","$223.33 ","$0.00 ","$234.00 ","$0.00 "
"441.074S","SUP","HCPCS C1713","","441.074S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT","BOTH IP/OP","$1,513.93 ","$1,120.31 ","$0.00 ","$1,469.83 ","$661.42 ","$0.00 ","$315.54 ","$0.00 ","$0.00 ","$257.35 ","$1,469.83 ","$0.00 ","$734.91 ","$1,164.11 ","$1,175.86 ","$0.00 ","$223.33 ","$0.00 ","$234.00 ","$0.00 "
"441.075S","SUP","HCPCS C1713","","441.075S  -  PLATE BONE 15MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,513.93 ","$1,120.31 ","$0.00 ","$1,469.83 ","$661.42 ","$0.00 ","$315.54 ","$0.00 ","$0.00 ","$257.35 ","$1,469.83 ","$0.00 ","$734.91 ","$1,164.11 ","$1,175.86 ","$0.00 ","$223.33 ","$0.00 ","$234.00 ","$0.00 "
"441.076S","SUP","HCPCS C1713","","441.076S  -  PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,513.93 ","$1,120.31 ","$0.00 ","$1,469.83 ","$661.42 ","$0.00 ","$315.54 ","$0.00 ","$0.00 ","$257.35 ","$1,469.83 ","$0.00 ","$734.91 ","$1,164.11 ","$1,175.86 ","$0.00 ","$223.33 ","$0.00 ","$234.00 ","$0.00 "
"441.077S","SUP","HCPCS C1713","","441.077S  -  PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,513.93 ","$1,120.31 ","$0.00 ","$1,469.83 ","$661.42 ","$0.00 ","$315.54 ","$0.00 ","$0.00 ","$257.35 ","$1,469.83 ","$0.00 ","$734.91 ","$1,164.11 ","$1,175.86 ","$0.00 ","$223.33 ","$0.00 ","$234.00 ","$0.00 "
"441.082S","SUP","HCPCS C1713","","441.082S  -  PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"441.083S","SUP","HCPCS C1713","","441.083S  -  PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"441.084S","SUP","HCPCS C1713","","441.084S  -  PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"441.085S","SUP","HCPCS C1713","","441.085S  -  PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"441.086S","SUP","HCPCS C1713","","441.086S  -  PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"441.087S","SUP","HCPCS C1713","","441.087S  -  PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,584.23 ","$1,172.33 ","$0.00 ","$1,538.08 ","$692.13 ","$0.00 ","$330.19 ","$0.00 ","$0.00 ","$269.30 ","$1,538.08 ","$0.00 ","$769.04 ","$1,218.16 ","$1,230.46 ","$0.00 ","$233.70 ","$0.00 ","$244.86 ","$0.00 "
"441.094S","SUP","HCPCS C1713","","441.094S  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,629.20 ","$1,205.61 ","$0.00 ","$1,581.75 ","$711.79 ","$0.00 ","$339.57 ","$0.00 ","$0.00 ","$276.95 ","$1,581.75 ","$0.00 ","$790.88 ","$1,252.75 ","$1,265.40 ","$0.00 ","$240.33 ","$0.00 ","$251.81 ","$0.00 "
"441.095S","SUP","HCPCS C1713","","441.095S  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,629.20 ","$1,205.61 ","$0.00 ","$1,581.75 ","$711.79 ","$0.00 ","$339.57 ","$0.00 ","$0.00 ","$276.95 ","$1,581.75 ","$0.00 ","$790.88 ","$1,252.75 ","$1,265.40 ","$0.00 ","$240.33 ","$0.00 ","$251.81 ","$0.00 "
"441.096S","SUP","HCPCS C1713","","441.096S  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,629.20 ","$1,205.61 ","$0.00 ","$1,581.75 ","$711.79 ","$0.00 ","$339.57 ","$0.00 ","$0.00 ","$276.95 ","$1,581.75 ","$0.00 ","$790.88 ","$1,252.75 ","$1,265.40 ","$0.00 ","$240.33 ","$0.00 ","$251.81 ","$0.00 "
"441.097S","SUP","HCPCS C1713","","441.097S  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,629.20 ","$1,205.61 ","$0.00 ","$1,581.75 ","$711.79 ","$0.00 ","$339.57 ","$0.00 ","$0.00 ","$276.95 ","$1,581.75 ","$0.00 ","$790.88 ","$1,252.75 ","$1,265.40 ","$0.00 ","$240.33 ","$0.00 ","$251.81 ","$0.00 "
"441.104S","SUP","HCPCS C1713","","441.104S  -  PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,698.08 ","$1,256.58 ","$0.00 ","$1,648.63 ","$741.88 ","$0.00 ","$353.92 ","$0.00 ","$0.00 ","$288.66 ","$1,648.63 ","$0.00 ","$824.31 ","$1,305.71 ","$1,318.90 ","$0.00 ","$250.49 ","$0.00 ","$262.46 ","$0.00 "
"441.105S","SUP","HCPCS C1713","","441.105S  -  PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,698.08 ","$1,256.58 ","$0.00 ","$1,648.63 ","$741.88 ","$0.00 ","$353.92 ","$0.00 ","$0.00 ","$288.66 ","$1,648.63 ","$0.00 ","$824.31 ","$1,305.71 ","$1,318.90 ","$0.00 ","$250.49 ","$0.00 ","$262.46 ","$0.00 "
"441.106S","SUP","HCPCS C1713","","441.106S  -  PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE","BOTH IP/OP","$1,698.08 ","$1,256.58 ","$0.00 ","$1,648.63 ","$741.88 ","$0.00 ","$353.92 ","$0.00 ","$0.00 ","$288.66 ","$1,648.63 ","$0.00 ","$824.31 ","$1,305.71 ","$1,318.90 ","$0.00 ","$250.49 ","$0.00 ","$262.46 ","$0.00 "
"441.107S","SUP","HCPCS C1713","","441.107S  -  PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE","BOTH IP/OP","$1,698.08 ","$1,256.58 ","$0.00 ","$1,648.63 ","$741.88 ","$0.00 ","$353.92 ","$0.00 ","$0.00 ","$288.66 ","$1,648.63 ","$0.00 ","$824.31 ","$1,305.71 ","$1,318.90 ","$0.00 ","$250.49 ","$0.00 ","$262.46 ","$0.00 "
"44-1001","SUP","HCPCS C1713","","44-1001  -  PLATE BONE LARGE 2MM ANGLED TRAUMAONE BLUE TITANIUM MANDIB 2","BOTH IP/OP","$6,255.00 ","$4,628.70 ","$0.00 ","$6,255.00 ","$2,814.75 ","$0.00 ","$1,303.70 ","$0.00 ","$0.00 ","$1,095.20 ","$6,255.00 ","$0.00 ","$3,127.50 ","$4,953.96 ","$5,004.00 ","$0.00 ","$978.91 ","$0.00 ","$995.80 ","$0.00 "
"44-1002","SUP","HCPCS C1713","","44-1002  -  PLATE BONE SMALL 2MM 2 ANGLED TRAUMAONE BLUE TITANIUM MANDIB","BOTH IP/OP","$7,630.00 ","$5,646.20 ","$0.00 ","$7,630.00 ","$3,433.50 ","$0.00 ","$1,590.28 ","$0.00 ","$0.00 ","$1,335.95 ","$7,630.00 ","$0.00 ","$3,815.00 ","$6,042.96 ","$6,104.00 ","$0.00 ","$1,194.10 ","$0.00 ","$1,214.70 ","$0.00 "
"44-1003","SUP","HCPCS C1713","","44-1003  -  PLATE BONE THK2MM MEDIUM 2 ANGLED LORENZ BLUE MANDIB","BOTH IP/OP","$8,075.00 ","$5,975.50 ","$0.00 ","$8,075.00 ","$3,633.75 ","$0.00 ","$1,683.03 ","$0.00 ","$0.00 ","$1,413.87 ","$8,075.00 ","$0.00 ","$4,037.50 ","$6,395.40 ","$6,460.00 ","$0.00 ","$1,263.74 ","$0.00 ","$1,285.54 ","$0.00 "
"44-1005","SUP","HCPCS C1713","","44-1005  -  PLATE BONE LARGE 2.6MM ANGLED TRAUMAONE MAGENTA TITANIUM","BOTH IP/OP","$6,727.50 ","$4,978.35 ","$0.00 ","$6,727.50 ","$3,027.38 ","$0.00 ","$1,402.18 ","$0.00 ","$0.00 ","$1,177.93 ","$6,727.50 ","$0.00 ","$3,363.75 ","$5,328.18 ","$5,382.00 ","$0.00 ","$1,052.85 ","$0.00 ","$1,071.02 ","$0.00 "
"44-1012","SUP","HCPCS C1713","","44-1012  -  PLATE BONE 2MM 12 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2","BOTH IP/OP","$2,765.00 ","$2,046.10 ","$0.00 ","$2,765.00 ","$1,244.25 ","$0.00 ","$576.30 ","$0.00 ","$0.00 ","$484.13 ","$2,765.00 ","$0.00 ","$1,382.50 ","$2,189.88 ","$2,212.00 ","$0.00 ","$432.72 ","$0.00 ","$440.19 ","$0.00 "
"44-1022","SUP","HCPCS C1713","","44-1022  -  PLATE BN MED 2 ANG 2MM BLU TRAUMAONE STRG TI MNDB 2MM/2.3MM","BOTH IP/OP","$8,072.50 ","$5,973.65 ","$0.00 ","$5,865.00 ","$2,639.25 ","$0.00 ","$1,682.51 ","$0.00 ","$0.00 ","$1,026.91 ","$5,865.00 ","$0.00 ","$2,932.50 ","$4,645.08 ","$4,692.00 ","$0.00 ","$917.87 ","$0.00 ","$933.71 ","$0.00 "
"44-1023","SUP","HCPCS C1713","","44-1023  -  PLATE BN LG ANG 2.6MM MAG TRAUMAONE STRG TI MNDB 2MM/2.3MM","BOTH IP/OP","$6,727.50 ","$4,978.35 ","$0.00 ","$6,727.50 ","$3,027.38 ","$0.00 ","$1,402.18 ","$0.00 ","$0.00 ","$1,177.93 ","$6,727.50 ","$0.00 ","$3,363.75 ","$5,328.18 ","$5,382.00 ","$0.00 ","$1,052.85 ","$0.00 ","$1,071.02 ","$0.00 "
"44-1024","SUP","HCPCS C1713","","44-1024  -  PLATE BONE 2MM 24 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2","BOTH IP/OP","$3,805.00 ","$2,815.70 ","$0.00 ","$3,805.00 ","$1,712.25 ","$0.00 ","$793.06 ","$0.00 ","$0.00 ","$666.23 ","$3,805.00 ","$0.00 ","$1,902.50 ","$3,013.56 ","$3,044.00 ","$0.00 ","$595.48 ","$0.00 ","$605.76 ","$0.00 "
"442.458TM","SUP","HCPCS C1713","","442.458TM  -  PLATE 48MM TI 2.4MM SCR 5 HLE/HD 3 HL SHFT LCP BONE RIGHT","BOTH IP/OP","$1,819.53 ","$1,346.45 ","$0.00 ","$1,819.53 ","$818.79 ","$0.00 ","$379.23 ","$0.00 ","$0.00 ","$318.58 ","$1,819.53 ","$0.00 ","$909.76 ","$1,441.07 ","$1,455.62 ","$0.00 ","$284.76 ","$0.00 ","$289.67 ","$0.00 "
"442.459TM","SUP","HCPCS C1713","","442.459TM  -  PLATE 66MM TI 2.4MM SCR 5 HLE/HD 5 HL SHFT LCP BONE RIGHT","BOTH IP/OP","$1,928.98 ","$1,427.45 ","$0.00 ","$1,928.98 ","$868.04 ","$0.00 ","$402.05 ","$0.00 ","$0.00 ","$337.75 ","$1,928.98 ","$0.00 ","$964.49 ","$1,527.75 ","$1,543.18 ","$0.00 ","$301.88 ","$0.00 ","$307.09 ","$0.00 "
"442.461TM","SUP","HCPCS C1713","","442.461TM  -  PLATE 48MM TI 2.4MM SCR 5X3 HOLE LCP BONE LEFT DISTAL VOLR","BOTH IP/OP","$1,819.53 ","$1,346.45 ","$0.00 ","$1,819.53 ","$818.79 ","$0.00 ","$379.23 ","$0.00 ","$0.00 ","$318.58 ","$1,819.53 ","$0.00 ","$909.76 ","$1,441.07 ","$1,455.62 ","$0.00 ","$284.76 ","$0.00 ","$289.67 ","$0.00 "
"442.462TM","SUP","HCPCS C1713","","442.462TM  -  PLATE 66MM TI 2.4MM SCR 5 HLE/HD 5 HL SHFT LCP BONE LEFT","BOTH IP/OP","$1,928.98 ","$1,427.45 ","$0.00 ","$1,928.98 ","$868.04 ","$0.00 ","$402.05 ","$0.00 ","$0.00 ","$337.75 ","$1,928.98 ","$0.00 ","$964.49 ","$1,527.75 ","$1,543.18 ","$0.00 ","$301.88 ","$0.00 ","$307.09 ","$0.00 "
"442.464TM","SUP","HCPCS C1713","","442.464TM  -  PLATE BN 47X6.3X1.6MM LCP 4 HLE/HD 3 HL SHFT TI RDS RT DIST","BOTH IP/OP","$1,819.53 ","$1,346.45 ","$0.00 ","$1,819.53 ","$818.79 ","$0.00 ","$379.23 ","$0.00 ","$0.00 ","$318.58 ","$1,819.53 ","$0.00 ","$909.76 ","$1,441.07 ","$1,455.62 ","$0.00 ","$284.76 ","$0.00 ","$289.67 ","$0.00 "
"442.465TM","SUP","HCPCS C1713","","442.465TM  -  PLATE 65MM TI 2.4MM SCR 4 HLE/HD 5 HL SHFT LCP BONE RIGHT","BOTH IP/OP","$1,928.98 ","$1,427.45 ","$0.00 ","$1,928.98 ","$868.04 ","$0.00 ","$402.05 ","$0.00 ","$0.00 ","$337.75 ","$1,928.98 ","$0.00 ","$964.49 ","$1,527.75 ","$1,543.18 ","$0.00 ","$301.88 ","$0.00 ","$307.09 ","$0.00 "
"442.467TM","SUP","HCPCS C1713","","442.467TM  -  PLATE 47MM TI 2.4MM SCR 3X4 HOLE LCP BONE LEFT DISTAL EXTART","BOTH IP/OP","$1,819.53 ","$1,346.45 ","$0.00 ","$1,819.53 ","$818.79 ","$0.00 ","$379.23 ","$0.00 ","$0.00 ","$318.58 ","$1,819.53 ","$0.00 ","$909.76 ","$1,441.07 ","$1,455.62 ","$0.00 ","$284.76 ","$0.00 ","$289.67 ","$0.00 "
"442.468TM","SUP","HCPCS C1713","","442.468TM  -  PLATE 65MM TI 4 HOLE LCK LCP BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,928.98 ","$1,427.45 ","$0.00 ","$1,928.98 ","$868.04 ","$0.00 ","$402.05 ","$0.00 ","$0.00 ","$337.75 ","$1,928.98 ","$0.00 ","$964.49 ","$1,527.75 ","$1,543.18 ","$0.00 ","$301.88 ","$0.00 ","$307.09 ","$0.00 "
"442.531S","SUP","HCPCS C1713","","442.531S  -  PLATE BONE 46MM 7 HOLE LCP TITANIUM DISTAL ULNAR STERILE 2MM","BOTH IP/OP","$1,591.25 ","$1,177.53 ","$0.00 ","$1,544.90 ","$695.21 ","$0.00 ","$331.66 ","$0.00 ","$0.00 ","$270.50 ","$1,544.90 ","$0.00 ","$772.45 ","$1,223.56 ","$1,235.92 ","$0.00 ","$234.73 ","$0.00 ","$245.95 ","$0.00 "
"443.61.96","SUP","HCPCS C1713","","443.61.96  -  PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL","BOTH IP/OP","$567.90 ","$420.25 ","$0.00 ","$551.35 ","$248.11 ","$0.00 ","$118.36 ","$0.00 ","$0.00 ","$96.54 ","$551.35 ","$0.00 ","$275.68 ","$436.67 ","$441.08 ","$0.00 ","$107.41 ","$0.00 ","$87.77 ","$0.00 "
"443.62.96","SUP","HCPCS C1713","","443.62.96  -  PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDRL","BOTH IP/OP","$567.90 ","$420.25 ","$0.00 ","$551.35 ","$248.11 ","$0.00 ","$118.36 ","$0.00 ","$0.00 ","$96.54 ","$551.35 ","$0.00 ","$275.68 ","$436.67 ","$441.08 ","$0.00 ","$107.41 ","$0.00 ","$87.77 ","$0.00 "
"4450M26","SUP","Custom 27803010","","4450M26  -  RING ANNULOPLASTY KIDNEY 26MM 30.7MM 24.9MM FLEXIBLE HOLDER","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450M28","SUP","Custom 27803010","","4450M28  -  RING ANLPLS 28MM C-E PH","BOTH IP/OP","$8,295.00 ","$6,138.30 ","$0.00 ","$8,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,295.00 ","$0.00 ","$4,147.50 ","$6,569.64 ","$6,636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450M30","SUP","Custom 27803010","","4450M30  -  RING ANLPLS 30MM C-E PH","BOTH IP/OP","$8,295.00 ","$6,138.30 ","$0.00 ","$8,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,295.00 ","$0.00 ","$4,147.50 ","$6,569.64 ","$6,636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450M32","SUP","Custom 27803010","","4450M32  -  RING ANLPLS 32MM C-E PH","BOTH IP/OP","$8,295.00 ","$6,138.30 ","$0.00 ","$8,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,295.00 ","$0.00 ","$4,147.50 ","$6,569.64 ","$6,636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450M34","SUP","Custom 27803010","","4450M34  -  RING ANLPLS 34MM C-E PH","BOTH IP/OP","$8,295.00 ","$6,138.30 ","$0.00 ","$8,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,295.00 ","$0.00 ","$4,147.50 ","$6,569.64 ","$6,636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4450M36","SUP","Custom 27803010","","4450M36  -  RING ANLPLS KNDY 36MM 41.2MM 34.8MM STRL C-E PH FLXB HLDR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"446.354S","SUP","HCPCS C1713","","446.354S  -  PLATE BONE 27MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION","BOTH IP/OP","$1,544.90 ","$1,143.23 ","$0.00 ","$1,544.90 ","$695.21 ","$0.00 ","$322.00 ","$0.00 ","$0.00 ","$270.50 ","$1,544.90 ","$0.00 ","$772.45 ","$1,223.56 ","$1,235.92 ","$0.00 ","$234.73 ","$0.00 ","$245.95 ","$0.00 "
"446.355S","SUP","HCPCS C1713","","446.355S  -  PLATE BONE 32MM 2 HOLE HEAD 5 HOLE SHAFT ROTATION CORRECTION","BOTH IP/OP","$1,544.90 ","$1,143.23 ","$0.00 ","$1,544.90 ","$695.21 ","$0.00 ","$322.00 ","$0.00 ","$0.00 ","$270.50 ","$1,544.90 ","$0.00 ","$772.45 ","$1,223.56 ","$1,235.92 ","$0.00 ","$234.73 ","$0.00 ","$245.95 ","$0.00 "
"446.63.96","SUP","HCPCS C1713","","446.63.96  -  PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL","BOTH IP/OP","$539.78 ","$399.44 ","$0.00 ","$524.08 ","$235.83 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$91.76 ","$524.08 ","$0.00 ","$262.04 ","$415.07 ","$419.26 ","$0.00 ","$79.63 ","$0.00 ","$83.43 ","$0.00 "
"446.64.96","SUP","HCPCS C1713","","446.64.96  -  PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL","BOTH IP/OP","$539.78 ","$399.44 ","$0.00 ","$524.08 ","$235.83 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$91.76 ","$524.08 ","$0.00 ","$262.04 ","$415.07 ","$419.26 ","$0.00 ","$79.63 ","$0.00 ","$83.43 ","$0.00 "
"447.354S","SUP","HCPCS C1713","","447.354S  -  PLATE BONE 34MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION","BOTH IP/OP","$1,591.25 ","$1,177.53 ","$0.00 ","$1,544.90 ","$695.21 ","$0.00 ","$331.66 ","$0.00 ","$0.00 ","$270.50 ","$1,544.90 ","$0.00 ","$772.45 ","$1,223.56 ","$1,235.92 ","$0.00 ","$234.73 ","$0.00 ","$245.95 ","$0.00 "
"447.355S","SUP","HCPCS C1713","","447.355S  -  PLATE BONE 40MM 2 HOLE HEAD 2 HOLE SHAFT ROTATION CORRECTION","BOTH IP/OP","$1,591.25 ","$1,177.53 ","$0.00 ","$1,544.90 ","$695.21 ","$0.00 ","$331.66 ","$0.00 ","$0.00 ","$270.50 ","$1,544.90 ","$0.00 ","$772.45 ","$1,223.56 ","$1,235.92 ","$0.00 ","$234.73 ","$0.00 ","$245.95 ","$0.00 "
"450.701S","SUP","HCPCS C1713","","450.701S  -  NAIL INTRAMEDULLARY 9MM 16CM SOLID AQUA TITANIUM FEMUR","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.702S","SUP","HCPCS C1713","","450.702S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 20CM SOLID EXPERT AQUA","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.703S","SUP","HCPCS C1713","","450.703S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 24CM SOLID EXPERT AQUA","BOTH IP/OP","$3,299.98 ","$2,441.99 ","$0.00 ","$3,299.98 ","$1,484.99 ","$0.00 ","$687.80 ","$0.00 ","$0.00 ","$577.80 ","$3,299.98 ","$0.00 ","$1,649.99 ","$2,613.58 ","$2,639.98 ","$0.00 ","$599.36 ","$0.00 ","$525.36 ","$0.00 "
"450.704S","SUP","HCPCS C1713","","450.704S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 28CM SOLID EXPERT AQUA","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.705S","SUP","HCPCS C1713","","450.705S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 30CM SOLID EXPERT AQUA","BOTH IP/OP","$3,299.98 ","$2,441.99 ","$0.00 ","$3,299.98 ","$1,484.99 ","$0.00 ","$687.80 ","$0.00 ","$0.00 ","$577.80 ","$3,299.98 ","$0.00 ","$1,649.99 ","$2,613.58 ","$2,639.98 ","$0.00 ","$599.36 ","$0.00 ","$525.36 ","$0.00 "
"450.706S","SUP","HCPCS C1713","","450.706S  -  NAIL 9MM 32CM DISTAL FEM IM SLD TI STRL","BOTH IP/OP","$3,829.78 ","$2,834.04 ","$0.00 ","$3,829.78 ","$1,723.40 ","$0.00 ","$798.22 ","$0.00 ","$0.00 ","$670.56 ","$3,829.78 ","$0.00 ","$1,914.89 ","$3,033.19 ","$3,063.82 ","$0.00 ","$599.36 ","$0.00 ","$609.70 ","$0.00 "
"450.707S","SUP","HCPCS C1713","","450.707S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 34CM SOLID EXPERT AQUA","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.708S","SUP","HCPCS C1713","","450.708S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM SOLID ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$506.12 ","$0.00 ","$511.02 ","$0.00 "
"450.709S","SUP","HCPCS C1713","","450.709S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 380MM SOLID ROUND BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.710S","SUP","HCPCS C1713","","450.710S  -  NAIL 9MM 40CM DISTAL FEM IM SLD TI STRL AQ","BOTH IP/OP","$3,829.78 ","$2,834.04 ","$0.00 ","$3,829.78 ","$1,723.40 ","$0.00 ","$798.22 ","$0.00 ","$0.00 ","$670.56 ","$3,829.78 ","$0.00 ","$1,914.89 ","$3,033.19 ","$3,063.82 ","$0.00 ","$599.36 ","$0.00 ","$609.70 ","$0.00 "
"450.711S","SUP","HCPCS C1713","","450.711S  -  NAIL INTRAMEDULLARY 9MM 42CM SOLID AQUA TITANIUM FEMUR","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.712S","SUP","HCPCS C1713","","450.712S  -  NAIL INTRAMEDULLARY 9MM 44CM SOLID AQUA TITANIUM FEMUR","BOTH IP/OP","$3,299.98 ","$2,441.99 ","$0.00 ","$3,299.98 ","$1,484.99 ","$0.00 ","$687.80 ","$0.00 ","$0.00 ","$577.80 ","$3,299.98 ","$0.00 ","$1,649.99 ","$2,613.58 ","$2,639.98 ","$0.00 ","$599.36 ","$0.00 ","$525.36 ","$0.00 "
"450.713S","SUP","HCPCS C1713","","450.713S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 460MM SOLID ROUND BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.714S","SUP","HCPCS C1713","","450.714S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 180MM SOLID ROUND BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.715S","SUP","HCPCS C1713","","450.715S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 220MM SOLID ROUND BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.716S","SUP","HCPCS C1713","","450.716S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID ROUND BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.781S","SUP","HCPCS C1713","","450.781S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 160MM CANN ROUND BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.782S","SUP","HCPCS C1713","","450.782S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.783S","SUP","HCPCS C1713","","450.783S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.784S","SUP","HCPCS C1713","","450.784S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.785S","SUP","HCPCS C1713","","450.785S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.786S","SUP","HCPCS C1713","","450.786S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.787S","SUP","HCPCS C1713","","450.787S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.788S","SUP","HCPCS C1713","","450.788S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.789S","SUP","HCPCS C1713","","450.789S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.790S","SUP","HCPCS C1713","","450.790S  -  NAIL 10MM 40CM DISTAL FEM IM CANN TI STRL AQ","BOTH IP/OP","$3,829.78 ","$2,834.04 ","$0.00 ","$3,829.78 ","$1,723.40 ","$0.00 ","$798.22 ","$0.00 ","$0.00 ","$670.56 ","$3,829.78 ","$0.00 ","$1,914.89 ","$3,033.19 ","$3,063.82 ","$0.00 ","$599.36 ","$0.00 ","$609.70 ","$0.00 "
"450.791S","SUP","HCPCS C1713","","450.791S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.792S","SUP","HCPCS C1713","","450.792S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM CANN ROUND BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.793S","SUP","HCPCS C1713","","450.793S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.794S","SUP","HCPCS C1713","","450.794S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 180MM CANN ROUND BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.795S","SUP","HCPCS C1713","","450.795S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 220MM CANN ROUND BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.796S","SUP","HCPCS C1713","","450.796S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 260MM CANN ROUND BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.801S","SUP","HCPCS C1713","","450.801S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.802S","SUP","HCPCS C1713","","450.802S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.803S","SUP","HCPCS C1713","","450.803S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 240MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.804S","SUP","HCPCS C1713","","450.804S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 280MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.805S","SUP","HCPCS C1713","","450.805S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.806S","SUP","HCPCS C1713","","450.806S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.807S","SUP","HCPCS C1713","","450.807S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.808S","SUP","HCPCS C1713","","450.808S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.809S","SUP","HCPCS C1713","","450.809S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.810S","SUP","HCPCS C1713","","450.810S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.811S","SUP","HCPCS C1713","","450.811S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.812S","SUP","HCPCS C1713","","450.812S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.813S","SUP","HCPCS C1713","","450.813S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM CANN FLUTED BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.814S","SUP","HCPCS C1713","","450.814S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 180MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.815S","SUP","HCPCS C1713","","450.815S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 220MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.816S","SUP","HCPCS C1713","","450.816S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 260MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.821S","SUP","HCPCS C1713","","450.821S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 160MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.822S","SUP","HCPCS C1713","","450.822S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 200MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.823S","SUP","HCPCS C1713","","450.823S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.824S","SUP","HCPCS C1713","","450.824S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.825S","SUP","HCPCS C1713","","450.825S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 30CM CANN EXPERT AQUA","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.826S","SUP","HCPCS C1713","","450.826S  -  NAIL 12MM 32CM DISTAL FEM IM CANN TI STRL AQ","BOTH IP/OP","$3,829.78 ","$2,834.04 ","$0.00 ","$3,829.78 ","$1,723.40 ","$0.00 ","$798.22 ","$0.00 ","$0.00 ","$670.56 ","$3,829.78 ","$0.00 ","$1,914.89 ","$3,033.19 ","$3,063.82 ","$0.00 ","$599.36 ","$0.00 ","$609.70 ","$0.00 "
"450.827S","SUP","HCPCS C1713","","450.827S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.828S","SUP","HCPCS C1713","","450.828S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.829S","SUP","HCPCS C1713","","450.829S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.830S","SUP","HCPCS C1713","","450.830S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.831S","SUP","HCPCS C1713","","450.831S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.832S","SUP","HCPCS C1713","","450.832S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 440MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.833S","SUP","HCPCS C1713","","450.833S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 460MM CANN FLUTED BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.834S","SUP","HCPCS C1713","","450.834S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 180MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.835S","SUP","HCPCS C1713","","450.835S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 220MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.836S","SUP","HCPCS C1713","","450.836S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 260MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.841S","SUP","HCPCS C1713","","450.841S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 160MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.842S","SUP","HCPCS C1713","","450.842S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 200MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.843S","SUP","HCPCS C1713","","450.843S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 240MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.844S","SUP","HCPCS C1713","","450.844S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 280MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.845S","SUP","HCPCS C1713","","450.845S  -  NAIL 13MM 30CM DISTAL FEM IM CANN TI STRL AQ","BOTH IP/OP","$3,829.78 ","$2,834.04 ","$0.00 ","$3,829.78 ","$1,723.40 ","$0.00 ","$798.22 ","$0.00 ","$0.00 ","$670.56 ","$3,829.78 ","$0.00 ","$1,914.89 ","$3,033.19 ","$3,063.82 ","$0.00 ","$599.36 ","$0.00 ","$609.70 ","$0.00 "
"450.846S","SUP","HCPCS C1713","","450.846S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.847S","SUP","HCPCS C1713","","450.847S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 340MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.848S","SUP","HCPCS C1713","","450.848S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.849S","SUP","HCPCS C1713","","450.849S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 380MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.850S","SUP","HCPCS C1713","","450.850S  -  NAIL 13MM 40CM DISTAL FEM IM CANN TI STRL AQ","BOTH IP/OP","$3,829.78 ","$2,834.04 ","$0.00 ","$3,829.78 ","$1,723.40 ","$0.00 ","$798.22 ","$0.00 ","$0.00 ","$670.56 ","$3,829.78 ","$0.00 ","$1,914.89 ","$3,033.19 ","$3,063.82 ","$0.00 ","$599.36 ","$0.00 ","$609.70 ","$0.00 "
"450.851S","SUP","HCPCS C1713","","450.851S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$599.36 ","$0.00 ","$511.02 ","$0.00 "
"450.852S","SUP","HCPCS C1713","","450.852S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.853S","SUP","HCPCS C1713","","450.853S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL","BOTH IP/OP","$3,324.75 ","$2,460.32 ","$0.00 ","$3,324.75 ","$1,496.14 ","$0.00 ","$692.96 ","$0.00 ","$0.00 ","$582.14 ","$3,324.75 ","$0.00 ","$1,662.38 ","$2,633.20 ","$2,659.80 ","$0.00 ","$520.32 ","$0.00 ","$529.30 ","$0.00 "
"450.854S","SUP","HCPCS C1713","","450.854S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 180MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.855S","SUP","HCPCS C1713","","450.855S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 220MM CANN FLUTED BARREL","BOTH IP/OP","$3,209.90 ","$2,375.33 ","$0.00 ","$3,209.90 ","$1,444.46 ","$0.00 ","$669.02 ","$0.00 ","$0.00 ","$562.03 ","$3,209.90 ","$0.00 ","$1,604.95 ","$2,542.24 ","$2,567.92 ","$0.00 ","$506.12 ","$0.00 ","$511.02 ","$0.00 "
"450.856S","SUP","HCPCS C1713","","450.856S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 260MM CANN FLUTED BARREL","BOTH IP/OP","$3,234.00 ","$2,393.16 ","$0.00 ","$3,234.00 ","$1,455.30 ","$0.00 ","$674.05 ","$0.00 ","$0.00 ","$566.25 ","$3,234.00 ","$0.00 ","$1,617.00 ","$2,561.33 ","$2,587.20 ","$0.00 ","$506.12 ","$0.00 ","$514.85 ","$0.00 "
"450.896S","SUP","Custom 27803010","","450.896S  -  CAP END DISTAL FEM IM NAIL TI STRL AQ","BOTH IP/OP","$518.33 ","$383.56 ","$0.00 ","$518.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$518.33 ","$0.00 ","$259.16 ","$410.52 ","$414.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-0010","SUP","Custom 27203010","","REAGENT BLOOD LEAD METEXCHANGE KT ANALY","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-0032","SUP","Custom 27203010","","REAGENT NA CHLOR SOL CHM","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-0058","SUP","Custom 27203010","","REAGENT PLT SOL LEAD POISONING ANALY","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450120-20","SUP","Custom 27203010","","CONTROL PRTN IMG VGL LVL 1 5ML IMMUN","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450125-20","SUP","Custom 27203010","","CONTROL PRTN IMG VGL LVL 2 5ML IMMUN","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450-1329","SUP","HCPCS L8699","","450-1329  -  PROSTHESIS TESTICULAR 4.9X2.9CM INFUS LINE NEEDLE LARGE","BOTH IP/OP","$4,622.50 ","$3,420.65 ","$0.00 ","$4,622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,622.50 ","$0.00 ","$2,311.25 ","$3,661.02 ","$3,698.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450162-20","SUP","Custom 27203010","","CONTROL ASO CRP RF VIGIL LVL 1 5ML SERO","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450163-20","SUP","Custom 27203010","","CONTROL ASO CRP RF VIGIL LVL 2 5ML SERO","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450164-20","SUP","Custom 27203010","","VIGIL SEROLOGY ASO/CRP/RHF CNTRL LEVEL 3","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-018-E2S","SUP","Custom 27203010","","45-018-E2S  -  CATHETER INFS 2 2/3FR 45CM CLARIVEIN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-0225","SUP","Custom 27203010","","CALIBRATOR CHM 68 TST LOW BLOOD METEXCHANGE SA","BOTH IP/OP","$717.50 ","$530.95 ","$0.00 ","$717.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$717.50 ","$0.00 ","$358.75 ","$568.26 ","$574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-0230","SUP","Custom 27203010","","CALIBRATOR CHM 68 TST HI BLOOD METEXCHANGE SA","BOTH IP/OP","$717.50 ","$530.95 ","$0.00 ","$717.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$717.50 ","$0.00 ","$358.75 ","$568.26 ","$574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-0250A","SUP","Custom 27203010","","CONTROL LINEAR VRF KT TOX","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450-4251-1","SUP","Custom 27803010","","450-4251-1  -  CLAMP SURG HALIFAX SPNL THRD C1","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$483.00 ","$0.00 ","$241.50 ","$382.54 ","$386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"450-4253-1","SUP","Custom 27803010","","450-4253-1  -  CLAMP SURG HALIFAX 7MM SPNL THRD","BOTH IP/OP","$483.00 ","$357.42 ","$0.00 ","$483.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$483.00 ","$0.00 ","$241.50 ","$382.54 ","$386.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"451514H0","SUP","HCPCS C1725","","451514H0  -  CATHETER ANGIO VERT CRV 5FR .042IN 100CM CRDS TMP RADOPQ BRD","BOTH IP/OP","$44.85 ","$33.19 ","$0.00 ","$44.85 ","$24.35 ","$0.00 ","$9.35 ","$0.00 ","$0.00 ","$7.85 ","$44.85 ","$0.00 ","$22.43 ","$35.52 ","$35.88 ","$0.00 ","$7.02 ","$0.00 ","$7.14 ","$0.00 "
"45-20005","SUP","Custom 27203010","","45-20005  -  BIT DRILL 1.7MM ASNS MIC AO CPLNG CANN STRL DISP","BOTH IP/OP","$336.75 ","$249.20 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20006","SUP","Custom 27803010","","45-20006  -  TAP 2MM MIC CANN AO CPLNG SURG ASNS DISP","BOTH IP/OP","$333.00 ","$246.42 ","$0.00 ","$154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$154.00 ","$0.00 ","$77.00 ","$121.97 ","$123.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20007","SUP","Custom 27203010","","45-20007  -  CNTRSNK DRILL 2MM ASNS MIC CANN AO CPLNG DISP","BOTH IP/OP","$419.90 ","$310.73 ","$0.00 ","$438.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$438.63 ","$0.00 ","$219.31 ","$347.39 ","$350.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20008","SUP","Custom 27203010","","45-20008  -  SLEEVE DRILL ASNS MIC HLD 2MM SCR","BOTH IP/OP","$273.63 ","$202.49 ","$0.00 ","$273.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$273.63 ","$0.00 ","$136.81 ","$216.71 ","$218.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20009","SUP","Custom 27203010","","45-20009  -  GUIDE DRILL .8MM 1.7MM ASNS MIC DBL","BOTH IP/OP","$672.38 ","$497.56 ","$0.00 ","$672.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$672.38 ","$0.00 ","$336.19 ","$532.52 ","$537.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20011","SUP","Custom 27203010","","45-20011  -  BIT DRILL 1.7MM ASNS 2MM AO CPLNG SLD NONSTRL","BOTH IP/OP","$121.55 ","$89.95 ","$0.00 ","$125.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20014","SUP","Custom 27203010","","45-20014  -  STYLET SURG INSTR .8MM ASNS CLEAN","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-20015","SUP","HCPCS C1713","","45-20015  -  WIRE FX .8MM 100MM NS KRSH DISP 2MM ASNS MIC SCR","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$35.75 ","$16.09 ","$0.00 ","$14.33 ","$0.00 ","$0.00 ","$6.26 ","$35.75 ","$0.00 ","$17.88 ","$28.31 ","$28.60 ","$0.00 ","$5.59 ","$0.00 ","$5.69 ","$0.00 "
"45-27005","SUP","Custom 27803010","","45-27005  -  TAP 50MM SURG 2.7MM SCR","BOTH IP/OP","$159.75 ","$118.22 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-27010","SUP","Custom 27203010","","45-27010  -  DRILL TWST 102MM 2MM VARIAX AO SHFT END 50MM NONSTRL","BOTH IP/OP","$159.75 ","$118.22 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30005","SUP","Custom 27203010","","45-30005  -  DRILL SRG MIC 2.1MM STRL AO CPLNG CNN HND FT DISP 3MM ASNS","BOTH IP/OP","$416.50 ","$308.21 ","$0.00 ","$434.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$434.50 ","$0.00 ","$217.25 ","$344.12 ","$347.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30006","SUP","Custom 27803010","","45-30006  -  TAP 3MM MIC CANN AO CPLNG SURG ASNS DISP","BOTH IP/OP","$319.50 ","$236.43 ","$0.00 ","$160.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.88 ","$0.00 ","$80.44 ","$127.42 ","$128.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30007","SUP","Custom 27203010","","45-30007  -  CNTRSNK DRILL 3MM AO CPLNG CANN DISP","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$405.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.63 ","$0.00 ","$202.81 ","$321.26 ","$324.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30008","SUP","Custom 27203010","","45-30008  -  SLEEVE DRILL ASNS MIC HLD 3MM SCR","BOTH IP/OP","$270.88 ","$200.45 ","$0.00 ","$270.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.88 ","$0.00 ","$135.44 ","$214.54 ","$216.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30009","SUP","Custom 27203010","","45-30009  -  GUIDE DRILL 1.2MM 2.1MM ASNS DBL","BOTH IP/OP","$334.13 ","$247.26 ","$0.00 ","$334.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$334.13 ","$0.00 ","$167.06 ","$264.63 ","$267.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30011","SUP","Custom 27203010","","45-30011  -  BIT DRILL 2.1MM ASNS MIC SLD AO CPLNG NONSTRL","BOTH IP/OP","$123.25 ","$91.21 ","$0.00 ","$127.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.88 ","$0.00 ","$63.94 ","$101.28 ","$102.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30014","SUP","Custom 27203010","","45-30014  -  STYLET SURG INSTR 1.2MM ASNS CLEAN","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-30015","SUP","HCPCS C1713","","45-30015  -  WIRE FX 1.2MM 100MM NS KRSH 3MM ASNS MIC SCR","BOTH IP/OP","$68.75 ","$50.88 ","$0.00 ","$39.88 ","$17.94 ","$0.00 ","$14.33 ","$0.00 ","$0.00 ","$6.98 ","$39.88 ","$0.00 ","$19.94 ","$31.58 ","$31.90 ","$0.00 ","$6.24 ","$0.00 ","$6.35 ","$0.00 "
"45-35001","SUP","Custom 27203010","","45-35001  -  GAUGE DEPTH MSR 3.5 MM SCR","BOTH IP/OP","$760.38 ","$562.68 ","$0.00 ","$760.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$760.38 ","$0.00 ","$380.19 ","$602.22 ","$608.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-35005","SUP","Custom 27803010","","45-35005  -  TAP 70MM SURG 3.5MM SCR","BOTH IP/OP","$188.25 ","$139.31 ","$0.00 ","$185.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-35010","SUP","Custom 27203010","","45-35010  -  DRILL TWST 122MM 2.6MM VARIAX AO SHFT END 70MM NONSTRL","BOTH IP/OP","$188.25 ","$139.31 ","$0.00 ","$185.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-35015","SUP","Custom 27203010","","45-35015  -  BLADE AO FIT ASNS SCRDRVR T10","BOTH IP/OP","$297.00 ","$219.78 ","$0.00 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.00 ","$0.00 ","$148.50 ","$235.22 ","$237.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-35030","SUP","Custom 27203010","","45-35030  -  SLEEVE DRILL ASNS MIC HLD INSTR 3.5MM SCR","BOTH IP/OP","$664.13 ","$491.46 ","$0.00 ","$664.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$664.13 ","$0.00 ","$332.06 ","$525.99 ","$531.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.010S","SUP","HCPCS C1713","","456.010S  -  SLEEVE LCK 100D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"456.011S","SUP","HCPCS C1713","","456.011S  -  SLEEVE LOCKING 110D 15MM LIGHT BLUE TITANIUM FEMUR STERILE","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"456.012S","SUP","HCPCS C1713","","456.012S  -  SLEEVE LCK 120D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"456.013S","SUP","HCPCS C1713","","456.013S  -  SLEEVE LOCKING 130D 15MM PINK TITANIUM FEMUR STERILE SPIRAL","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"456.100S","SUP","Custom 27803010","","456.100S  -  BLADE FIX 100MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.105S","SUP","Custom 27803010","","456.105S  -  BLADE FIX 105MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.110S","SUP","Custom 27803010","","456.110S  -  BLADE FIX 110MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.115S","SUP","Custom 27803010","","456.115S  -  BLADE FIX 115MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.120S","SUP","Custom 27803010","","456.120S  -  BLADE FIX 120MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.300S","SUP","Custom 27803010","","456.300S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 75MM HELICAL GOLD","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.301S","SUP","Custom 27803010","","456.301S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 80MM GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.302S","SUP","Custom 27803010","","456.302S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 85MM CANN GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.303S","SUP","Custom 27803010","","456.303S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 90MM GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.304S","SUP","Custom 27803010","","456.304S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 95MM GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.305S","SUP","Custom 27803010","","456.305S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 100MM GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.306S","SUP","HCPCS C1713","","456.306S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 105MM CANN GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$549.36 ","$0.00 ","$262.08 ","$0.00 ","$0.00 ","$213.75 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$185.49 ","$0.00 ","$194.35 ","$0.00 "
"456.307S","SUP","Custom 27803010","","456.307S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 110MM CANN GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.308S","SUP","Custom 27803010","","456.308S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 115MM GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.309S","SUP","Custom 27803010","","456.309S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 120MM GOLD TITANIUM","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.310S","SUP","Custom 27803010","","456.310S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 125MM HELICAL GOLD","BOTH IP/OP","$1,257.43 ","$930.50 ","$0.00 ","$1,220.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,220.80 ","$0.00 ","$610.40 ","$966.87 ","$976.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.311S","SUP","Custom 27803010","","456.311S  -  CAP END 0MM GREEN TITANIUM STERILE","BOTH IP/OP","$404.08 ","$299.02 ","$0.00 ","$392.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.30 ","$0.00 ","$196.15 ","$310.70 ","$313.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.312S","SUP","Custom 27803010","","456.312S  -  CAP END 5MM EXTEND GREEN TITANIUM TROC STERILE","BOTH IP/OP","$404.08 ","$299.02 ","$0.00 ","$392.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.30 ","$0.00 ","$196.15 ","$310.70 ","$313.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.313S","SUP","Custom 27803010","","456.313S  -  CAP END 10MM EXTEND GREEN TITANIUM TROC STERILE CANN","BOTH IP/OP","$404.08 ","$299.02 ","$0.00 ","$392.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$392.30 ","$0.00 ","$196.15 ","$310.70 ","$313.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.314S","SUP","HCPCS C1713","","456.314S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 170MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.315S","SUP","HCPCS C1713","","456.315S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 170MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$497.96 ","$0.00 ","$406.52 ","$0.00 "
"456.316S","SUP","HCPCS C1713","","456.316S  -  NAIL FIX 135D 10MM 17CM CANN GREEN TITANIUM TROCHANTER","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.317S","SUP","HCPCS C1713","","456.317S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 11MM 170MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.318S","SUP","HCPCS C1713","","456.318S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 170MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.319S","SUP","HCPCS C1713","","456.319S  -  NAIL INTRAMEDULLARY 135D SHORT UNIVERSAL 11MM 170MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.321S","SUP","HCPCS C1713","","456.321S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 12MM 170MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.322S","SUP","HCPCS C1713","","456.322S  -  NAIL INTRAMEDULLARY 130D SHORT 12MM 170MM CANN STATIC INTLCK","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.323S","SUP","HCPCS C1713","","456.323S  -  NAIL FIX 135D SHORT 12MM 170MM CANN STATIC INTLCK GREEN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.324S","SUP","HCPCS C1713","","456.324S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 235MM CANN","BOTH IP/OP","$2,719.08 ","$2,012.12 ","$0.00 ","$2,639.90 ","$1,187.96 ","$0.00 ","$566.72 ","$0.00 ","$0.00 ","$462.23 ","$2,639.90 ","$0.00 ","$1,319.95 ","$2,090.80 ","$2,111.92 ","$0.00 ","$401.11 ","$0.00 ","$420.27 ","$0.00 "
"456.325S","SUP","HCPCS C1713","","456.325S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 235MM CANN","BOTH IP/OP","$2,719.08 ","$2,012.12 ","$0.00 ","$2,639.90 ","$1,187.96 ","$0.00 ","$566.72 ","$0.00 ","$0.00 ","$462.23 ","$2,639.90 ","$0.00 ","$1,319.95 ","$2,090.80 ","$2,111.92 ","$0.00 ","$401.11 ","$0.00 ","$420.27 ","$0.00 "
"456.326S","SUP","HCPCS C1713","","456.326S  -  NAIL FIX 135D SHORT 10MM 23.5CM CANN GREEN TITANIUM TROC","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.327S","SUP","HCPCS C1713","","456.327S  -  NAIL FIX 125D SHORT 11MM 23.5CM CANN GREEN TITANIUM","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.328S","SUP","HCPCS C1713","","456.328S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 235MM CANN","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.329S","SUP","HCPCS C1713","","456.329S  -  NAIL FIX 135D SHORT 11MM 23.5CM CANN GREEN TITANIUM","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.330S","SUP","HCPCS C1713","","456.330S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 30CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.331S","SUP","HCPCS C1713","","456.331S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 30CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.332S","SUP","HCPCS C1713","","456.332S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.333S","SUP","HCPCS C1713","","456.333S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.334S","SUP","HCPCS C1713","","456.334S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 34CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.335S","SUP","HCPCS C1713","","456.335S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 34CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.336S","SUP","HCPCS C1713","","456.336S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 36CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.337S","SUP","HCPCS C1713","","456.337S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 36CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.338S","SUP","HCPCS C1713","","456.338S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 38CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.339S","SUP","HCPCS C1713","","456.339S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 38CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.340S","SUP","HCPCS C1713","","456.340S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 40CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.341S","SUP","HCPCS C1713","","456.341S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 40CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.342S","SUP","HCPCS C1713","","456.342S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 42CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.343S","SUP","HCPCS C1713","","456.343S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 42CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.344S","SUP","HCPCS C1713","","456.344S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 44CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.345S","SUP","HCPCS C1713","","456.345S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.346S","SUP","HCPCS C1713","","456.346S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 46CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.347S","SUP","HCPCS C1713","","456.347S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.350S","SUP","HCPCS C1713","","456.350S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 30CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.351S","SUP","HCPCS C1713","","456.351S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 30CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.352S","SUP","HCPCS C1713","","456.352S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.353S","SUP","HCPCS C1713","","456.353S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 320MM CANN PREASSEMBLED","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.354S","SUP","HCPCS C1713","","456.354S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 34CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.355S","SUP","HCPCS C1713","","456.355S  -  NAIL INTRAMEDULLARY 130D 10MM 34CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.356S","SUP","HCPCS C1713","","456.356S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 36CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.357S","SUP","HCPCS C1713","","456.357S  -  NAIL FIX 130D 10MM 360MM CANN STATIC INTLCK GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.358S","SUP","HCPCS C1713","","456.358S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 38CM CANN INTERLOCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.359S","SUP","HCPCS C1713","","456.359S  -  NAIL INTRAMEDULLARY 130D 10MM 380MM CANN STATIC INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.360S","SUP","HCPCS C1713","","456.360S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 40CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.361S","SUP","HCPCS C1713","","456.361S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 400MM CANN PREASSEMBLED","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.362S","SUP","HCPCS C1713","","456.362S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 42CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.363S","SUP","HCPCS C1713","","456.363S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 42CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.364S","SUP","HCPCS C1713","","456.364S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 44CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.365S","SUP","HCPCS C1713","","456.365S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.366S","SUP","HCPCS C1713","","456.366S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 46CM CANN INTLCK GREEN","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.367S","SUP","HCPCS C1713","","456.367S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.370S","SUP","HCPCS C1713","","456.370S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.371S","SUP","HCPCS C1713","","456.371S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.372S","SUP","HCPCS C1713","","456.372S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 320MM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.373S","SUP","HCPCS C1713","","456.373S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.374S","SUP","HCPCS C1713","","456.374S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.375S","SUP","HCPCS C1713","","456.375S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.376S","SUP","HCPCS C1713","","456.376S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.377S","SUP","HCPCS C1713","","456.377S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.378S","SUP","HCPCS C1713","","456.378S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.379S","SUP","HCPCS C1713","","456.379S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.380S","SUP","HCPCS C1713","","456.380S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.381S","SUP","HCPCS C1713","","456.381S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.382S","SUP","HCPCS C1713","","456.382S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.383S","SUP","HCPCS C1713","","456.383S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.384S","SUP","HCPCS C1713","","456.384S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.385S","SUP","HCPCS C1713","","456.385S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.386S","SUP","HCPCS C1713","","456.386S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.387S","SUP","HCPCS C1713","","456.387S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,578.28 ","$2,647.93 ","$0.00 ","$3,474.05 ","$1,563.32 ","$0.00 ","$745.80 ","$0.00 ","$0.00 ","$608.28 ","$3,474.05 ","$0.00 ","$1,737.03 ","$2,751.45 ","$2,779.24 ","$0.00 ","$527.85 ","$0.00 ","$553.07 ","$0.00 "
"456.390S","SUP","HCPCS C1713","","456.390S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 33CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.391S","SUP","HCPCS C1713","","456.391S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 33CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.392S","SUP","HCPCS C1713","","456.392S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.393S","SUP","HCPCS C1713","","456.393S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.394S","SUP","HCPCS C1713","","456.394S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 34CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.395S","SUP","HCPCS C1713","","456.395S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 34CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.396S","SUP","HCPCS C1713","","456.396S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 36CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.397S","SUP","HCPCS C1713","","456.397S  -  NAIL INTRAMEDULLARY 125D 11MM 36CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.398S","SUP","HCPCS C1713","","456.398S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 38CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.399S","SUP","HCPCS C1713","","456.399S  -  NAIL INTRAMEDULLARY 125D 11MM 38CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.400S","SUP","HCPCS C1713","","456.400S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 40CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.401S","SUP","HCPCS C1713","","456.401S  -  NAIL INTRAMEDULLARY 125D 11MM 40CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.402S","SUP","HCPCS C1713","","456.402S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 42CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.403S","SUP","HCPCS C1713","","456.403S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 42CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.404S","SUP","HCPCS C1713","","456.404S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 44CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.405S","SUP","HCPCS C1713","","456.405S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.406S","SUP","HCPCS C1713","","456.406S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 46CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.407S","SUP","HCPCS C1713","","456.407S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.410S","SUP","HCPCS C1713","","456.410S  -  NAIL INTRAMEDULLARY 130D LONG 11MM 30CM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.411S","SUP","HCPCS C1713","","456.411S  -  NAIL FIX 130D SHORT 11MM 300MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.412S","SUP","HCPCS C1713","","456.412S  -  NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.413S","SUP","HCPCS C1713","","456.413S  -  NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.414S","SUP","HCPCS C1713","","456.414S  -  NAIL FIX 130D 11MM 340MM CANN TITANIUM RIGHT TROCHANTER","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.415S","SUP","HCPCS C1713","","456.415S  -  NAIL FIX 130D SHORT 11MM 340MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.416S","SUP","HCPCS C1713","","456.416S  -  NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.417S","SUP","HCPCS C1713","","456.417S  -  NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.418S","SUP","HCPCS C1713","","456.418S  -  NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.419S","SUP","HCPCS C1713","","456.419S  -  NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.420S","SUP","HCPCS C1713","","456.420S  -  NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.421S","SUP","HCPCS C1713","","456.421S  -  NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.422S","SUP","HCPCS C1713","","456.422S  -  NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.423S","SUP","HCPCS C1713","","456.423S  -  NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.424S","SUP","HCPCS C1713","","456.424S  -  NAIL FIX 130D SHORT 11MM 440MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.425S","SUP","HCPCS C1713","","456.425S  -  NAIL INTRAMEDULLARY 130D LONG 11MM 440MM CANN PREASSEMBLED","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.426S","SUP","HCPCS C1713","","456.426S  -  NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.427S","SUP","HCPCS C1713","","456.427S  -  NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.430S","SUP","HCPCS C1713","","456.430S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 33CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.431S","SUP","HCPCS C1713","","456.431S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 33CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.432S","SUP","HCPCS C1713","","456.432S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.433S","SUP","HCPCS C1713","","456.433S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.434S","SUP","HCPCS C1713","","456.434S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 34CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.435S","SUP","HCPCS C1713","","456.435S  -  NAIL INTRAMEDULLARY 135D 11MM 34CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.436S","SUP","HCPCS C1713","","456.436S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 36CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.437S","SUP","HCPCS C1713","","456.437S  -  NAIL INTRAMEDULLARY 135D 11MM 36CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.438S","SUP","HCPCS C1713","","456.438S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 38CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.439S","SUP","HCPCS C1713","","456.439S  -  NAIL INTRAMEDULLARY 135D 11MM 38CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.440S","SUP","HCPCS C1713","","456.440S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 40CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.441S","SUP","HCPCS C1713","","456.441S  -  NAIL INTRAMEDULLARY 135D 11MM 40CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.442S","SUP","HCPCS C1713","","456.442S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 42CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.443S","SUP","HCPCS C1713","","456.443S  -  NAIL INTRAMEDULLARY 135D 11MM 42CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.444S","SUP","HCPCS C1713","","456.444S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 44CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.445S","SUP","HCPCS C1713","","456.445S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.446S","SUP","HCPCS C1713","","456.446S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 46CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.447S","SUP","HCPCS C1713","","456.447S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.450S","SUP","HCPCS C1713","","456.450S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 30CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.451S","SUP","HCPCS C1713","","456.451S  -  NAIL INTRAMEDULLARY 125D 12MM 30CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.452S","SUP","HCPCS C1713","","456.452S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.453S","SUP","HCPCS C1713","","456.453S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.454S","SUP","HCPCS C1713","","456.454S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 34CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.455S","SUP","HCPCS C1713","","456.455S  -  NAIL INTRAMEDULLARY 125D 12MM 34CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.456S","SUP","HCPCS C1713","","456.456S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 36CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.457S","SUP","HCPCS C1713","","456.457S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 36CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.458S","SUP","HCPCS C1713","","456.458S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 38CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.459S","SUP","HCPCS C1713","","456.459S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 38CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.460S","SUP","HCPCS C1713","","456.460S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 40CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.461S","SUP","HCPCS C1713","","456.461S  -  NAIL INTRAMEDULLARY 125D 12MM 40CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.462S","SUP","HCPCS C1713","","456.462S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 42CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.463S","SUP","HCPCS C1713","","456.463S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 42CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.464S","SUP","HCPCS C1713","","456.464S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 44CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.465S","SUP","HCPCS C1713","","456.465S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.466S","SUP","HCPCS C1713","","456.466S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 46CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.467S","SUP","HCPCS C1713","","456.467S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.470S","SUP","HCPCS C1713","","456.470S  -  NAIL INTRAMEDULLARY 130D LONG 17-12MM 30CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.471S","SUP","HCPCS C1713","","456.471S  -  NAIL INTRAMEDULLARY 130D 12MM 30CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.472S","SUP","HCPCS C1713","","456.472S  -  NAIL INTRAMEDULLARY 130D LONG 17-12MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.473S","SUP","HCPCS C1713","","456.473S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.474S","SUP","HCPCS C1713","","456.474S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.475S","SUP","HCPCS C1713","","456.475S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.476S","SUP","HCPCS C1713","","456.476S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.477S","SUP","HCPCS C1713","","456.477S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.478S","SUP","HCPCS C1713","","456.478S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.479S","SUP","HCPCS C1713","","456.479S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLED","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.480S","SUP","HCPCS C1713","","456.480S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 400MM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.481S","SUP","HCPCS C1713","","456.481S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 40CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.482S","SUP","HCPCS C1713","","456.482S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.483S","SUP","HCPCS C1713","","456.483S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.484S","SUP","HCPCS C1713","","456.484S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 440MM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.485S","SUP","HCPCS C1713","","456.485S  -  NAIL INTRAMEDULLARY 130D 12MM 44CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.486S","SUP","HCPCS C1713","","456.486S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 460MM CANN PREASSEMBLE","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.487S","SUP","HCPCS C1713","","456.487S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.490S","SUP","HCPCS C1713","","456.490S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 30CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.491S","SUP","HCPCS C1713","","456.491S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 33CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.492S","SUP","HCPCS C1713","","456.492S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 32CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.493S","SUP","HCPCS C1713","","456.493S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 32CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.494S","SUP","HCPCS C1713","","456.494S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 34CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.495S","SUP","HCPCS C1713","","456.495S  -  NAIL INTRAMEDULLARY 135D 12MM 34CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.496S","SUP","HCPCS C1713","","456.496S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 36CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.497S","SUP","HCPCS C1713","","456.497S  -  NAIL INTRAMEDULLARY 135D 12MM 36CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.498S","SUP","HCPCS C1713","","456.498S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 38CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.499S","SUP","HCPCS C1713","","456.499S  -  NAIL INTRAMEDULLARY 135D 12MM 38CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.500S","SUP","HCPCS C1713","","456.500S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 40CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.501S","SUP","HCPCS C1713","","456.501S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 40CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.502S","SUP","HCPCS C1713","","456.502S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 42CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.503S","SUP","HCPCS C1713","","456.503S  -  NAIL INTRAMEDULLARY 135D 12MM 42CM CANN TITANIUM LEFT TROC","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.504S","SUP","HCPCS C1713","","456.504S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 44CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.505S","SUP","HCPCS C1713","","456.505S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.506S","SUP","HCPCS C1713","","456.506S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 46CM CANN INTLCK GREEN","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.507S","SUP","HCPCS C1713","","456.507S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,461.58 ","$2,561.57 ","$0.00 ","$3,360.75 ","$1,512.34 ","$0.00 ","$721.48 ","$0.00 ","$0.00 ","$588.44 ","$3,360.75 ","$0.00 ","$1,680.38 ","$2,661.71 ","$2,688.60 ","$0.00 ","$510.64 ","$0.00 ","$535.03 ","$0.00 "
"456.510S","SUP","HCPCS C1713","","456.510S  -  NAIL FIX 125D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.511S","SUP","HCPCS C1713","","456.511S  -  NAIL FIX 130D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.512S","SUP","HCPCS C1713","","456.512S  -  NAIL FIX 135D SHORT 12MM 23.5CM CANN GREEN TITANIUM TROC","BOTH IP/OP","$2,630.10 ","$1,946.27 ","$0.00 ","$2,553.50 ","$1,149.08 ","$0.00 ","$548.18 ","$0.00 ","$0.00 ","$447.10 ","$2,553.50 ","$0.00 ","$1,276.75 ","$2,022.37 ","$2,042.80 ","$0.00 ","$387.98 ","$0.00 ","$406.52 ","$0.00 "
"456.630S","SUP","HCPCS C1713","","456.630S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.631S","SUP","HCPCS C1713","","456.631S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.632S","SUP","HCPCS C1713","","456.632S  -  NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM RIGHT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.633S","SUP","HCPCS C1713","","456.633S  -  NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.634S","SUP","HCPCS C1713","","456.634S  -  NAIL INTRAMEDULLARY 130D 14MM 130MM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.635S","SUP","HCPCS C1713","","456.635S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 34CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.636S","SUP","HCPCS C1713","","456.636S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 36CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.637S","SUP","HCPCS C1713","","456.637S  -  NAIL INTRAMEDULLARY 130D 14MM 360MM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.638S","SUP","HCPCS C1713","","456.638S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 38CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.639S","SUP","HCPCS C1713","","456.639S  -  NAIL INTRAMEDULLARY 130D 14MM 380MM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.640S","SUP","HCPCS C1713","","456.640S  -  NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM RIGHT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.641S","SUP","HCPCS C1713","","456.641S  -  NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.642S","SUP","HCPCS C1713","","456.642S  -  NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM RIGHT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.643S","SUP","HCPCS C1713","","456.643S  -  NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.644S","SUP","HCPCS C1713","","456.644S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 44CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.645S","SUP","HCPCS C1713","","456.645S  -  NAIL INTRAMEDULLARY 130D 14MM 44CM CANN GREEN TITANIUM LEFT","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.646S","SUP","HCPCS C1713","","456.646S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.647S","SUP","HCPCS C1713","","456.647S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM","BOTH IP/OP","$3,687.70 ","$2,728.90 ","$0.00 ","$3,580.28 ","$1,611.12 ","$0.00 ","$768.61 ","$0.00 ","$0.00 ","$626.88 ","$3,580.28 ","$0.00 ","$1,790.14 ","$2,835.58 ","$2,864.22 ","$0.00 ","$543.99 ","$0.00 ","$569.98 ","$0.00 "
"456.650S","SUP","Custom 27803010","","456.650S  -  BLADE FIX 11MM 130MM HELICAL TITANIUM TROC STERILE","BOTH IP/OP","$1,254.53 ","$928.35 ","$0.00 ","$1,217.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,217.98 ","$0.00 ","$608.99 ","$964.64 ","$974.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.70S","SUP","Custom 27803010","","456.70S  -  BLADE FIX 70MM SPIRAL TITANIUM TROC STERILE INTRAMEDULLARY","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.75S","SUP","Custom 27803010","","456.75S  -  BLADE INTRAMEDULLARY FIX 75MM SPIRAL TITANIUM FEMUR STERILE","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.80S","SUP","Custom 27803010","","456.80S  -  BLADE INTRAMEDULLARY FIX 80MM SPIRAL TITANIUM FEMUR STERILE","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.85S","SUP","Custom 27803010","","456.85S  -  BLADE INTRAMEDULLARY FIX 85MM SPIRAL TITANIUM FEMUR STERILE","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.90S","SUP","Custom 27803010","","456.90S  -  BLADE INTRAMEDULLARY FIX 90MM SPIRAL TITANIUM FEMUR STERILE","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"456.95S","SUP","Custom 27803010","","456.95S  -  BLADE INTRAMEDULLARY FIX 95MM SPIRAL TITANIUM FEMUR STERILE","BOTH IP/OP","$1,326.88 ","$981.89 ","$0.00 ","$1,326.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.88 ","$0.00 ","$663.44 ","$1,050.89 ","$1,061.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-600","SUP","HCPCS C1769","","45-600  -  CATH CEN VEN 5FR 50CM 1 LUM GWIRE VXCL PU .035IN","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"457.010S","SUP","Custom 27803010","","457.010S  -  CAP END 0MM 15MM FEM XTD IM NAIL SPRL BLDE TI STRL LBLU","BOTH IP/OP","$542.30 ","$401.30 ","$0.00 ","$542.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$542.30 ","$0.00 ","$271.15 ","$429.50 ","$433.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"457.011S","SUP","Custom 27803010","","457.011S  -  CAP END 10MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE SPIRAL","BOTH IP/OP","$470.25 ","$347.99 ","$0.00 ","$470.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.25 ","$0.00 ","$235.13 ","$372.44 ","$376.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"457.012S","SUP","Custom 27803010","","457.012S  -  CAP END 20MM 15MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE","BOTH IP/OP","$470.25 ","$347.99 ","$0.00 ","$470.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.25 ","$0.00 ","$235.13 ","$372.44 ","$376.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"457.210S","SUP","Custom 27803010","","457.210S  -  CAP END 0MM FEM XTD LCK IM NAIL TI STRL PNK 15MM","BOTH IP/OP","$513.53 ","$380.01 ","$0.00 ","$513.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$513.53 ","$0.00 ","$256.76 ","$406.72 ","$410.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"457.211S","SUP","Custom 27803010","","457.211S  -  CAP END 130D 10MM 15MM LOCK PINK TITANIUM FEMUR STERILE","BOTH IP/OP","$446.88 ","$330.69 ","$0.00 ","$446.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.88 ","$0.00 ","$223.44 ","$353.93 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"457.212S","SUP","Custom 27803010","","457.212S  -  CAP END 130D 20MM 15MM LOCK PINK TITANIUM FEMUR STERILE","BOTH IP/OP","$446.88 ","$330.69 ","$0.00 ","$446.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.88 ","$0.00 ","$223.44 ","$353.93 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"458.10S","SUP","Custom 27803010","","458.10S  -  CAP END 6MM 15MM EXTEND BLUE TITANIUM TIBIA STERILE SOLID","BOTH IP/OP","$331.38 ","$245.22 ","$0.00 ","$331.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.38 ","$0.00 ","$165.69 ","$262.45 ","$265.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"458.110S","SUP","Custom 27803010","","458.110S  -  CAP END 15MM 15MM EXTN BLUE TITANIUM TIBIA STERILE SOLID","BOTH IP/OP","$541.75 ","$400.90 ","$0.00 ","$541.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$541.75 ","$0.00 ","$270.88 ","$429.07 ","$433.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"458.120S","SUP","Custom 27803010","","458.120S  -  CAP END 8MM 15MM TIB XTD HEX DRV CANN IM NAIL TI STRL GRN 8","BOTH IP/OP","$307.65 ","$227.66 ","$0.00 ","$307.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.65 ","$0.00 ","$153.83 ","$243.66 ","$246.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"458.926S","SUP","HCPCS C1713","","458.926S  -  SCREW BN 3.5MM FT 5MM 8MM 26MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.928S","SUP","HCPCS C1713","","458.928S  -  SCREW BN 3.5MM FT 5MM 8MM 28MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.930S","SUP","HCPCS C1713","","458.930S  -  SCREW BN 3.5MM FT 5MM 8MM 30MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.932S","SUP","HCPCS C1713","","458.932S  -  SCREW BN 3.5MM FT 5MM 8MM 32MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.934S","SUP","HCPCS C1713","","458.934S  -  SCREW BN 3.5MM FT 5MM 8MM 34MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.936S","SUP","HCPCS C1713","","458.936S  -  SCREW BN 3.5MM FT 5MM 8MM 36MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.938S","SUP","HCPCS C1713","","458.938S  -  SCREW BN 3.5MM FT 5MM 8MM 38MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.940S","SUP","HCPCS C1713","","458.940S  -  SCREW BN 3.5MM FT 5MM 8MM 40MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.942S","SUP","HCPCS C1713","","458.942S  -  SCREW BN 3.5MM FT 5MM 8MM 42MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.944S","SUP","HCPCS C1713","","458.944S  -  SCREW BN 3.5MM FT 5MM 8MM 44MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.946S","SUP","HCPCS C1713","","458.946S  -  SCREW BN 3.5MM FT 5MM 8MM 46MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.948S","SUP","HCPCS C1713","","458.948S  -  SCREW BN 3.5MM FT 5MM 8MM 48MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.950S","SUP","HCPCS C1713","","458.950S  -  SCREW BN 3.5MM FT 5MM 8MM 50MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.952S","SUP","HCPCS C1713","","458.952S  -  SCREW BN 3.5MM FT 5MM 8MM 52MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.954S","SUP","HCPCS C1713","","458.954S  -  SCREW BN 3.5MM FT 5MM 8MM 54MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.956S","SUP","HCPCS C1713","","458.956S  -  SCREW BN 3.5MM FT 5MM 8MM 56MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.958S","SUP","HCPCS C1713","","458.958S  -  SCREW BN 3.5MM FT 5MM 8MM 58MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.960S","SUP","HCPCS C1713","","458.960S  -  SCREW BN 3.5MM FT 5MM 8MM 60MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.964S","SUP","HCPCS C1713","","458.964S  -  SCREW BN 3.5MM FT 5MM 8MM 64MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.968S","SUP","HCPCS C1713","","458.968S  -  SCREW BN 3.5MM FT 5MM 8MM 68MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.972S","SUP","HCPCS C1713","","458.972S  -  SCREW BN 3.5MM FT 5MM 8MM 72MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.976S","SUP","HCPCS C1713","","458.976S  -  SCREW BN 3.5MM FT 5MM 8MM 76MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.980S","SUP","HCPCS C1713","","458.980S  -  SCREW BN 3.5MM FT 5MM 8MM 80MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.985S","SUP","HCPCS C1713","","458.985S  -  SCREW BN 3.5MM FT 5MM 8MM 85MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.990S","SUP","HCPCS C1713","","458.990S  -  SCREW BN 3.5MM FT 5MM 8MM 90MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.995S","SUP","HCPCS C1713","","458.995S  -  SCREW BN 3.5MM FT 5MM 8MM 95MM GRN STRL ST LCK 2 LD HEX TI","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"458.999S","SUP","HCPCS C1713","","458.999S  -  SCREW BN 5MM 100MM GRN STRL NLEX LCK HEX RCS TI FEM TIB","BOTH IP/OP","$444.93 ","$329.25 ","$0.00 ","$431.95 ","$194.38 ","$0.00 ","$92.73 ","$0.00 ","$0.00 ","$75.63 ","$431.95 ","$0.00 ","$215.98 ","$342.10 ","$345.56 ","$0.00 ","$65.63 ","$0.00 ","$68.77 ","$0.00 "
"45-80001","SUP","Custom 27203010","","45-80001  -  GUIDE DRILL CIRC LCK HOLE","BOTH IP/OP","$851.13 ","$629.84 ","$0.00 ","$851.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$851.13 ","$0.00 ","$425.56 ","$674.09 ","$680.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-80005","SUP","Custom 27203010","","45-80005  -  GUIDE DRILL OVL CMPR HOLE","BOTH IP/OP","$955.63 ","$707.17 ","$0.00 ","$955.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$955.63 ","$0.00 ","$477.81 ","$756.86 ","$764.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"45-80010","SUP","HCPCS C1713","","45-80010  -  PLATE BNDRG PLR BONE","BOTH IP/OP","$907.50 ","$671.55 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$189.15 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"45-80100","SUP","HCPCS C1713","","45-80100  -  WIRE FX FT 1.6MM 200MM NS KRSH VARIAX FT LCK PLT SYS","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$42.63 ","$19.18 ","$0.00 ","$14.38 ","$0.00 ","$0.00 ","$7.46 ","$42.63 ","$0.00 ","$21.31 ","$33.76 ","$34.10 ","$0.00 ","$6.67 ","$0.00 ","$6.79 ","$0.00 "
"45-80200","SUP","HCPCS C1713","","45-80200  -  WIRE FX 1.4MM 100MM NS KRSH SMTH VARIAX FT LCK PLT SYS","BOTH IP/OP","$29.25 ","$21.65 ","$0.00 ","$27.50 ","$12.38 ","$0.00 ","$6.10 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"45-80300","SUP","Custom 27203010","","45-80300  -  PIN FIX 100MM 2.5MM STNM SS SMTH NONSTRL","BOTH IP/OP","$55.50 ","$41.07 ","$0.00 ","$52.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"459.012S","SUP","Custom 27803010","","459.012S  -  CAP END 0MM XTD 9-12MM IM NAIL STD LCK TI STRL GRN 12MM","BOTH IP/OP","$494.33 ","$365.80 ","$0.00 ","$494.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$494.33 ","$0.00 ","$247.16 ","$391.51 ","$395.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"459.013S","SUP","Custom 27803010","","459.013S  -  CAP END 10MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"459.014S","SUP","Custom 27803010","","459.014S  -  CAP END 20MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.001.01S","SUP","Custom 27803010","","460.001.01S  -  CLAMP TUBE 13MM CRANIAL FLP TI STRL","BOTH IP/OP","$940.50 ","$695.97 ","$0.00 ","$940.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.002.01S","SUP","Custom 27803010","","460.002.01S  -  CLAMP TUBE 18MM CRANIAL FLP TI STRL","BOTH IP/OP","$974.25 ","$720.95 ","$0.00 ","$974.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$974.25 ","$0.00 ","$487.13 ","$771.61 ","$779.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.003.01S","SUP","Custom 27803010","","460.003.01S  -  CLAMP TUBE 22MM CRANIAL FLP TI STRL","BOTH IP/OP","$1,010.25 ","$747.59 ","$0.00 ","$1,010.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,010.25 ","$0.00 ","$505.13 ","$800.12 ","$808.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.008.01S","SUP","Custom 27803010","","460.008.01S  -  CLAMP TUBE 13MM CRANIAL FLP TI TXTR STRL","BOTH IP/OP","$974.25 ","$720.95 ","$0.00 ","$974.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$974.25 ","$0.00 ","$487.13 ","$771.61 ","$779.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.009.01S","SUP","Custom 27803010","","460.009.01S  -  CLAMP TUBE 18MM CRANIAL FLP TI TXTR STRL","BOTH IP/OP","$1,010.25 ","$747.59 ","$0.00 ","$1,010.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,010.25 ","$0.00 ","$505.13 ","$800.12 ","$808.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.010.01S","SUP","Custom 27803010","","460.010.01S  -  CLAMP TUBE 22MM CRANIAL FLP TI TXTR STRL","BOTH IP/OP","$1,050.75 ","$777.56 ","$0.00 ","$1,050.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,050.75 ","$0.00 ","$525.38 ","$832.19 ","$840.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.022.05S","SUP","HCPCS C1713","","460.022.05S  -  PIN ER RELS STRNL TI STRL","BOTH IP/OP","$218.00 ","$161.32 ","$0.00 ","$218.00 ","$98.10 ","$0.00 ","$45.44 ","$0.00 ","$0.00 ","$38.17 ","$218.00 ","$0.00 ","$109.00 ","$172.66 ","$174.40 ","$0.00 ","$34.12 ","$0.00 ","$34.71 ","$0.00 "
"460.100.01S","SUP","Custom 27803010","","460.100.01S  -  TI CRANIAL FLAP TUBE CLAMP 11MM DIA-STERILE","BOTH IP/OP","$893.25 ","$661.01 ","$0.00 ","$893.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$893.25 ","$0.00 ","$446.63 ","$707.45 ","$714.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"460.107.01S","SUP","Custom 27803010","","460.107.01S  -  TI CRANIAL FLAP TUBE CLAMP TEXTURED 11MM DIA-STERILE","BOTH IP/OP","$924.75 ","$684.32 ","$0.00 ","$924.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$924.75 ","$0.00 ","$462.38 ","$732.40 ","$739.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1001T","SUP","Custom 27203010","","46-1001T  -  TEMPLATE SZ LG ANG PLT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1002T","SUP","Custom 27203010","","46-1002T  -  TEMPLATE SZ 2 ANG LCK PLT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1003T","SUP","Custom 27203010","","46-1003T  -  TEMPLATE SZ ANG LCK PLT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1004","SUP","Custom 27203010","","46-1004  -  DRILL TWIST 1.8MM MICRO 26MM 115MM STOP","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1006","SUP","Custom 27203010","","46-1006  -  BIT DRL 1.6MM 50MM 22MM TWST STP LORENZ TRAUMAONE","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1007","SUP","Custom 27203010","","46-1007  -  DRILL SURG 1.6MM 115MM 26MM STOP TRAUMAONE MANDIB","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-1024T","SUP","Custom 27203010","","46-1024T  -  TEMPLATE SZ STRG 24 HL PLT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-123","SUP","Custom 27203010","","46-123  -  DRESSING WOUND LARGE ABSORBENT VEST NONADHERENT MULTILAYER","BOTH IP/OP","$26.47 ","$19.59 ","$0.00 ","$26.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.60 ","$0.00 ","$13.30 ","$21.07 ","$21.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-130","SUP","Custom 27203010","","46-130  -  DRESSING HYDROCOLLOID XL ABSORBENT LATEX FREE SOFSORB","BOTH IP/OP","$750.02 ","$555.01 ","$0.00 ","$50.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.24 ","$0.00 ","$25.12 ","$39.79 ","$40.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-133","SUP","Custom 27203010","","46-133  -  DRESSING BURN ABSORBENT HIP LEG","BOTH IP/OP","$52.10 ","$38.55 ","$0.00 ","$63.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.89 ","$0.00 ","$31.94 ","$50.60 ","$51.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-138","SUP","Custom 27203010","","DRESSING BURN 17 PLY GZE 36X36IN","BOTH IP/OP","$56.63 ","$41.91 ","$0.00 ","$56.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.63 ","$0.00 ","$28.31 ","$44.85 ","$45.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-152","SUP","Custom 27203010","","46-152  -  DRESSING WOUND XL ABSORBENT VEST HIGH PERFORMANCE","BOTH IP/OP","$28.03 ","$20.74 ","$0.00 ","$28.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.44 ","$0.00 ","$14.22 ","$22.52 ","$22.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-155","SUP","Custom 27203010","","46-155  -  DRESSING WND STRL LF SFSRB ABS STDR LINR ADLT HIP LG","BOTH IP/OP","$31.02 ","$22.95 ","$0.00 ","$31.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.02 ","$0.00 ","$15.51 ","$24.57 ","$24.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.634S","SUP","Custom 27803010","","462.634S  -  BLADE FIX 34MM SPIRAL SOLID TITANIUM HUMERUS STERILE","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.636S","SUP","Custom 27803010","","462.636S  -  BLADE INTRAMEDULLARY FIX 13MM 36MMX3.9MM SPIRAL CUTTING","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.638S","SUP","Custom 27803010","","462.638S  -  BLADE FIX 38MM SPIRAL SOLID TITANIUM HUMERUS STERILE","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.640S","SUP","HCPCS C1713","","462.640S  -  NAIL INTRAMEDULLARY 40MM SPIRAL BLADE TITANIUM STERILE","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.642S","SUP","HCPCS C1713","","462.642S  -  BLADE INTRAMEDULLARY FIX 13MM 42MMX3.9MM SPIRAL CUTTING","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.644S","SUP","HCPCS C1713","","462.644S  -  BLADE INTRAMEDULLARY FIX 44MM SPIRAL GOLD TITANIUM ALUMINUM","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.646S","SUP","HCPCS C1713","","462.646S  -  BLADE INTRAMEDULLARY FIX 13MM 46MMX3.9MM SPIRAL CUTTING","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.648S","SUP","HCPCS C1713","","462.648S  -  BLADE INTRAMEDULLARY FIX 48MM SPIRAL NAIL-EX TITANIUM","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.650S","SUP","HCPCS C1713","","462.650S  -  BLADE INTRAMEDULLARY FIX 50MM SPIRAL GOLD TITANIUM ALUMINUM","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.652S","SUP","HCPCS C1713","","462.652S  -  BLADE FIX 52MM CANN SPIRAL SOLID GOLD TITANIUM HUMERUS","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.654S","SUP","HCPCS C1713","","462.654S  -  BLADE FIX 54MM CANN SPIRAL NAIL-EX TITANIUM HUMERUS STERILE","BOTH IP/OP","$1,226.80 ","$907.83 ","$0.00 ","$1,191.08 ","$535.98 ","$0.00 ","$255.70 ","$0.00 ","$0.00 ","$208.55 ","$1,191.08 ","$0.00 ","$595.54 ","$943.34 ","$952.86 ","$0.00 ","$180.97 ","$0.00 ","$189.62 ","$0.00 "
"462.660S","SUP","HCPCS C1713","","462.660S  -  CAP END 0MM T25 STARDRIVE RECESS GOLD TITANIUM HUMERUS","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$194.91 ","$0.00 ","$90.27 ","$0.00 ","$0.00 ","$75.84 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$67.78 ","$0.00 ","$68.95 ","$0.00 "
"462.665S","SUP","HCPCS C1713","","462.665S  -  CAP END 5MM HUM XTD IM NAIL SPRL BLDE TI STRL","BOTH IP/OP","$494.33 ","$365.80 ","$0.00 ","$494.33 ","$222.45 ","$0.00 ","$103.03 ","$0.00 ","$0.00 ","$86.55 ","$494.33 ","$0.00 ","$247.16 ","$391.51 ","$395.46 ","$0.00 ","$77.36 ","$0.00 ","$78.70 ","$0.00 "
"462.666S","SUP","HCPCS C1713","","462.666S  -  CAP END 10MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$194.91 ","$0.00 ","$90.27 ","$0.00 ","$0.00 ","$75.84 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$67.78 ","$0.00 ","$68.95 ","$0.00 "
"462.667S","SUP","HCPCS C1713","","462.667S  -  CAP END 15MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$194.91 ","$0.00 ","$90.27 ","$0.00 ","$0.00 ","$75.84 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$67.78 ","$0.00 ","$68.95 ","$0.00 "
"462.719S","SUP","HCPCS C1713","","462.719S  -  NAIL INTRAMEDULLARY UNIVERSAL 7.5MM 19CM SOLID ROUND CROSS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.723S","SUP","HCPCS C1713","","462.723S  -  NAIL 7.5MM 23CM HUM IM SLD TI STRL","BOTH IP/OP","$3,802.15 ","$2,813.59 ","$0.00 ","$3,802.15 ","$1,710.97 ","$0.00 ","$792.46 ","$0.00 ","$0.00 ","$665.73 ","$3,802.15 ","$0.00 ","$1,901.08 ","$3,011.30 ","$3,041.72 ","$0.00 ","$595.04 ","$0.00 ","$605.30 ","$0.00 "
"462.728S","SUP","HCPCS C1713","","462.728S  -  NAIL INTRAMEDULLARY 7.5MM 280MM SOLID ROUND CROSS SECTION","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.729S","SUP","HCPCS C1713","","462.729S  -  NAIL INTRAMEDULLARY 7.5MM 29.5CM SOLID BLUE TITANIUM HUMERUS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.731S","SUP","HCPCS C1713","","462.731S  -  NAIL INTRAMEDULLARY 7.5MM 31CM SOLID TITANIUM HUMERUS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.732S","SUP","HCPCS C1713","","462.732S  -  NAIL INTRAMEDULLARY 7.5MM 32.5CM SOLID TITANIUM HUMERUS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.919S","SUP","HCPCS C1713","","462.919S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 19CM SOLID FLUTED CROSS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.920S","SUP","HCPCS C1713","","462.920S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 20.5CM SOLID FLUTED","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.922S","SUP","HCPCS C1713","","462.922S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 22CM SOLID FLUTED CROSS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.923S","SUP","HCPCS C1713","","462.923S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 23CM SOLID FLUTED CROSS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.924S","SUP","HCPCS C1713","","462.924S  -  NAIL INTRAMEDULLARY 9.5MM 240MM SOLID FLUTED CROSS SECTION","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.925S","SUP","HCPCS C1713","","462.925S  -  NAIL 9.5MM 25CM HUM IM SLD TI STRL","BOTH IP/OP","$3,802.15 ","$2,813.59 ","$0.00 ","$3,802.15 ","$1,710.97 ","$0.00 ","$792.46 ","$0.00 ","$0.00 ","$665.73 ","$3,802.15 ","$0.00 ","$1,901.08 ","$3,011.30 ","$3,041.72 ","$0.00 ","$595.04 ","$0.00 ","$605.30 ","$0.00 "
"462.927S","SUP","HCPCS C1713","","462.927S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 27CM SOLID FLUTED CROSS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.928S","SUP","HCPCS C1713","","462.928S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 28CM SOLID FLUTED CROSS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.929S","SUP","HCPCS C1713","","462.929S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 29.5CM SOLID FLUTED","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.931S","SUP","HCPCS C1713","","462.931S  -  NAIL INTRAMEDULLARY 9.5MM 31CM SOLID TITANIUM HUMERUS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.932S","SUP","HCPCS C1713","","462.932S  -  NAIL INTRAMEDULLARY 9.5MM 32.5CM SOLID TITANIUM HUMERUS","BOTH IP/OP","$3,261.50 ","$2,413.51 ","$0.00 ","$3,261.50 ","$1,467.68 ","$0.00 ","$679.78 ","$0.00 ","$0.00 ","$571.06 ","$3,261.50 ","$0.00 ","$1,630.75 ","$2,583.11 ","$2,609.20 ","$0.00 ","$510.42 ","$0.00 ","$519.23 ","$0.00 "
"462.950S","SUP","Custom 27803010","","462.950S  -  CAP END 5MM 2.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS","BOTH IP/OP","$484.00 ","$358.16 ","$0.00 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$484.00 ","$0.00 ","$242.00 ","$383.33 ","$387.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.955S","SUP","Custom 27803010","","462.955S  -  CAP END 5MM HUM XTD IM NAIL TI STRL","BOTH IP/OP","$559.10 ","$413.73 ","$0.00 ","$559.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$559.10 ","$0.00 ","$279.55 ","$442.81 ","$447.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.960S","SUP","Custom 27803010","","462.960S  -  CAP END HUM SLD IM NAIL TI STRL 10MM","BOTH IP/OP","$559.10 ","$413.73 ","$0.00 ","$559.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$559.10 ","$0.00 ","$279.55 ","$442.81 ","$447.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"462.965S","SUP","Custom 27803010","","462.965S  -  CAP END 15MM 3.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS","BOTH IP/OP","$484.00 ","$358.16 ","$0.00 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$484.00 ","$0.00 ","$242.00 ","$383.33 ","$387.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"46-305","SUP","HCPCS C1769","","46-305  -  GWIRE VASC STD .035IN 150CM 3CM ANG TIP STF SHFT GLDWR","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$64.48 ","$0.00 ","$24.75 ","$0.00 ","$0.00 ","$20.79 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$18.58 ","$0.00 ","$18.91 ","$0.00 "
"464.30S","SUP","HCPCS C1713","","464.30S  -  NAIL INTRAMEDULLARY 9MM 30CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.32S","SUP","HCPCS C1713","","464.32S  -  NAIL INTRAMEDULLARY 9MM 32CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.34S","SUP","HCPCS C1713","","464.34S  -  NAIL INTRAMEDULLARY 9MM 34CM SOLID TITANIUM FEMUR STERILE","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.36S","SUP","HCPCS C1713","","464.36S  -  NAIL INTRAMEDULLARY 9MM 36CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.38S","SUP","HCPCS C1713","","464.38S  -  NAIL INTRAMEDULLARY 9MM 38CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.40S","SUP","HCPCS C1713","","464.40S  -  NAIL 9MM 40CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"464.42S","SUP","HCPCS C1713","","464.42S  -  NAIL INTRAMEDULLARY 9MM 420MM CANN SOLID TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.44S","SUP","HCPCS C1713","","464.44S  -  NAIL 9MM 44CM FEM IM SLD TI STRL","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"464.46S","SUP","HCPCS C1713","","464.46S  -  NAIL INTRAMEDULLARY 9MM 46CM SOLID TITANIUM FEMUR STERILE","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"464.48S","SUP","HCPCS C1713","","464.48S  -  NAIL INTRAMEDULLARY 9MM 48CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.30S","SUP","HCPCS C1713","","465.30S  -  NAIL 10MM 30CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"465.32S","SUP","HCPCS C1713","","465.32S  -  NAIL INTRAMEDULLARY 10MM 32CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.34S","SUP","HCPCS C1713","","465.34S  -  NAIL INTRAMEDULLARY 10MM 34CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.36S","SUP","HCPCS C1713","","465.36S  -  NAIL INTRAMEDULLARY 10MM 36CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.38S","SUP","HCPCS C1713","","465.38S  -  NAIL 10MM 380MM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"465.40S","SUP","HCPCS C1713","","465.40S  -  NAIL INTRAMEDULLARY 10MM 40CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.42S","SUP","HCPCS C1713","","465.42S  -  NAIL INTRAMEDULLARY 10MM 42CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.44S","SUP","HCPCS C1713","","465.44S  -  NAIL INTRAMEDULLARY 10MM 44CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465.46S","SUP","HCPCS C1713","","465.46S  -  NAIL 10MM 46CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"465.48S","SUP","HCPCS C1713","","465.48S  -  NAIL INTRAMEDULLARY 10MM 48CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"465440-20","SUP","Custom 27203010","","CONTROL CRP SYN VIGIL HI SNS LVL C LOW MDLR DATA RDC 5ML LX","BOTH IP/OP","$366.68 ","$271.34 ","$0.00 ","$366.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.68 ","$0.00 ","$183.34 ","$290.41 ","$293.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4655-03","SUP","HCPCS C1776","","4655-03  -  HEAD FEM +5 UNV 32MM","BOTH IP/OP","$2,607.50 ","$1,929.55 ","$0.00 ","$2,607.50 ","$1,173.38 ","$0.00 ","$543.47 ","$0.00 ","$0.00 ","$456.55 ","$2,607.50 ","$0.00 ","$1,303.75 ","$2,065.14 ","$2,086.00 ","$0.00 ","$408.07 ","$0.00 ","$415.11 ","$0.00 "
"466.30S","SUP","HCPCS C1713","","466.30S  -  NAIL INTRAMEDULLARY 11MM 30CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.32S","SUP","HCPCS C1713","","466.32S  -  NAIL INTRAMEDULLARY 11MM 32CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.34S","SUP","HCPCS C1713","","466.34S  -  NAIL INTRAMEDULLARY 11MM 34CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.36S","SUP","HCPCS C1713","","466.36S  -  NAIL 11MM 36CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"466.38S","SUP","HCPCS C1713","","466.38S  -  NAIL INTRAMEDULLARY 11MM 38CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.40S","SUP","HCPCS C1713","","466.40S  -  NAIL 11MM 40CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"466.42S","SUP","HCPCS C1713","","466.42S  -  NAIL INTRAMEDULLARY 11MM 42CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.44S","SUP","HCPCS C1713","","466.44S  -  NAIL INTRAMEDULLARY 11MM 44CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.46S","SUP","HCPCS C1713","","466.46S  -  NAIL INTRAMEDULLARY 11MM 46CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"466.48S","SUP","HCPCS C1713","","466.48S  -  NAIL INTRAMEDULLARY 11MM 48CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"46-605","SUP","HCPCS C1769","","46-605  -  GWIRE VASC .018IN 260CM 3CM TIP SHRT TPR SPCL PLTN PLUS GLDX","BOTH IP/OP","$45.18 ","$33.43 ","$0.00 ","$45.18 ","$24.53 ","$0.00 ","$9.42 ","$0.00 ","$0.00 ","$7.91 ","$45.18 ","$0.00 ","$22.59 ","$35.78 ","$36.14 ","$0.00 ","$7.07 ","$0.00 ","$7.19 ","$0.00 "
"466P306A","SUP","HCPCS C1884","","466P306A  -  FILTER EMBL 55CM LF TRPS CATH SHTH INTRO KT","BOTH IP/OP","$3,112.50 ","$2,303.25 ","$0.00 ","$3,112.50 ","$1,400.63 ","$0.00 ","$648.72 ","$0.00 ","$0.00 ","$544.97 ","$3,112.50 ","$0.00 ","$1,556.25 ","$2,465.10 ","$2,490.00 ","$0.00 ","$487.11 ","$0.00 ","$495.51 ","$0.00 "
"467.30S","SUP","HCPCS C1713","","467.30S  -  NAIL 12MM 30CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"467.32S","SUP","HCPCS C1713","","467.32S  -  NAIL INTRAMEDULLARY 12MM 32CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"467.34S","SUP","HCPCS C1713","","467.34S  -  NAIL INTRAMEDULLARY 12MM 34CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"467.36S","SUP","HCPCS C1713","","467.36S  -  NAIL INTRAMEDULLARY 12MM 36CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"467.38S","SUP","HCPCS C1713","","467.38S  -  NAIL INTRAMEDULLARY 12MM 38CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"467.40S","SUP","HCPCS C1713","","467.40S  -  NAIL 12MM 40CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"467.42S","SUP","HCPCS C1713","","467.42S  -  NAIL INTRAMEDULLARY 12MM 420MM SOLID GREEN TITANIUM FEMORAL","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"467.44S","SUP","HCPCS C1713","","467.44S  -  NAIL INTRAMEDULLARY 12MM 44CM SOLID GREEN TITANIUM FEMUR","BOTH IP/OP","$2,054.25 ","$1,520.15 ","$0.00 ","$2,054.25 ","$924.41 ","$0.00 ","$428.16 ","$0.00 ","$0.00 ","$359.68 ","$2,054.25 ","$0.00 ","$1,027.13 ","$1,626.97 ","$1,643.40 ","$0.00 ","$321.49 ","$0.00 ","$327.04 ","$0.00 "
"467.46S","SUP","HCPCS C1713","","467.46S  -  NAIL 12MM 46CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"467.48S","SUP","HCPCS C1713","","467.48S  -  NAIL 12MM 48CM FEM IM SLD TI STRL GRN","BOTH IP/OP","$2,344.43 ","$1,734.88 ","$0.00 ","$2,344.43 ","$1,054.99 ","$0.00 ","$488.64 ","$0.00 ","$0.00 ","$410.49 ","$2,344.43 ","$0.00 ","$1,172.21 ","$1,856.79 ","$1,875.54 ","$0.00 ","$366.90 ","$0.00 ","$373.23 ","$0.00 "
"46-804","SUP","HCPCS C1769","","46-804  -  GUIDEWIRE TRANSEND EX .014","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$509.06 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"46-806","SUP","HCPCS C1769","","GUIDEWIRE VASC .014IN 205CM 2CM SHP TIP SFTP TRNSD EX HYDPHI","BOTH IP/OP","$20.30 ","$15.02 ","$0.00 ","$20.30 ","$11.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.55 ","$20.30 ","$0.00 ","$10.15 ","$16.08 ","$16.24 ","$0.00 ","$3.18 ","$0.00 ","$3.23 ","$0.00 "
"46B005","SUP","HCPCS V2790","","46B005  -  GRAFT SFT TIS 25X15X15MM PATLR TNDN TIB STRUT WHL","BOTH IP/OP","$8,265.00 ","$6,116.10 ","$0.00 ","$8,265.00 ","$3,719.25 ","$0.00 ","$1,722.63 ","$0.00 ","$0.00 ","$1,447.14 ","$8,265.00 ","$0.00 ","$4,132.50 ","$6,545.88 ","$6,612.00 ","$0.00 ","$1,293.47 ","$0.00 ","$1,315.79 ","$0.00 "
"47-2255-008-01","SUP","Custom 27203010","","47-2255-008-01  -  GWIRE ORTH 100CM 3MM SS ANTGRD IM FIX SYS STRL","BOTH IP/OP","$251.25 ","$185.93 ","$0.00 ","$251.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$251.25 ","$0.00 ","$125.63 ","$198.99 ","$201.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"47-2483-060-50","SUP","HCPCS C1713","","47-2483-060-50  -  SCREW BONE 3.5MM 5MM 60MM NTR NAIL TI6AL4V ALLOY CORT PTTHRD","BOTH IP/OP","$381.35 ","$282.20 ","$0.00 ","$381.35 ","$171.61 ","$0.00 ","$79.48 ","$0.00 ","$0.00 ","$66.77 ","$381.35 ","$0.00 ","$190.68 ","$302.03 ","$305.08 ","$0.00 ","$59.68 ","$0.00 ","$60.71 ","$0.00 "
"47-2483-095-60","SUP","HCPCS C1713","","47-2483-095-60  -  SCREW BONE 6MM 3.5MM 95MM NTR NAIL TI6AL4V ALLOY CANC PTTHRD","BOTH IP/OP","$426.30 ","$315.46 ","$0.00 ","$426.30 ","$191.84 ","$0.00 ","$88.85 ","$0.00 ","$0.00 ","$74.64 ","$426.30 ","$0.00 ","$213.15 ","$337.63 ","$341.04 ","$0.00 ","$66.72 ","$0.00 ","$67.87 ","$0.00 "
"47-2484-042-50","SUP","HCPCS C1713","","47-2484-042-50  -  SCREW BONE 5MM 42.5MM NTR NAIL TI6AL4V ALLOY FULTHD CORT","BOTH IP/OP","$381.35 ","$282.20 ","$0.00 ","$381.35 ","$171.61 ","$0.00 ","$79.48 ","$0.00 ","$0.00 ","$66.77 ","$381.35 ","$0.00 ","$190.68 ","$302.03 ","$305.08 ","$0.00 ","$59.68 ","$0.00 ","$60.71 ","$0.00 "
"47-2484-045-50","SUP","HCPCS C1713","","47-2484-045-50  -  SCREW BONE 5MM 45MM TI 3.5MM CORT FIXANG HX HD","BOTH IP/OP","$381.35 ","$282.20 ","$0.00 ","$381.35 ","$171.61 ","$0.00 ","$79.48 ","$0.00 ","$0.00 ","$66.77 ","$381.35 ","$0.00 ","$190.68 ","$302.03 ","$305.08 ","$0.00 ","$59.68 ","$0.00 ","$60.71 ","$0.00 "
"47-2484-070-60","SUP","HCPCS C1713","","47-2484-070-60  -  SCREW BONE 6MM 3.5MM 70MM NTR NAIL TI6AL4V ALLOY CANC FIXANG","BOTH IP/OP","$395.85 ","$292.93 ","$0.00 ","$395.85 ","$178.13 ","$0.00 ","$82.51 ","$0.00 ","$0.00 ","$69.31 ","$395.85 ","$0.00 ","$197.93 ","$313.51 ","$316.68 ","$0.00 ","$61.95 ","$0.00 ","$63.02 ","$0.00 "
"47-2484-075-50","SUP","HCPCS C1713","","47-2484-075-50  -  SCREW BONE 5MM 3.5MM 75MM NTR NAIL TI6AL4V ALLOY CORT FIXANG","BOTH IP/OP","$381.35 ","$282.20 ","$0.00 ","$381.35 ","$171.61 ","$0.00 ","$79.48 ","$0.00 ","$0.00 ","$66.77 ","$381.35 ","$0.00 ","$190.68 ","$302.03 ","$305.08 ","$0.00 ","$59.68 ","$0.00 ","$60.71 ","$0.00 "
"47-2484-075-60","SUP","HCPCS C1713","","47-2484-075-60  -  SCREW BONE 6MM 3.5MM 75MM NTR NAIL TI CANC FIXANG HEX HEAD","BOTH IP/OP","$395.85 ","$292.93 ","$0.00 ","$395.85 ","$178.13 ","$0.00 ","$82.51 ","$0.00 ","$0.00 ","$69.31 ","$395.85 ","$0.00 ","$197.93 ","$313.51 ","$316.68 ","$0.00 ","$61.95 ","$0.00 ","$63.02 ","$0.00 "
"47-2484-095-60","SUP","HCPCS C1713","","47-2484-095-60  -  SCREW BONE 6MM 3.5MM 95MM NTR NAIL TI CANC FIXANG HEX HEAD","BOTH IP/OP","$395.85 ","$292.93 ","$0.00 ","$395.85 ","$178.13 ","$0.00 ","$82.51 ","$0.00 ","$0.00 ","$69.31 ","$395.85 ","$0.00 ","$197.93 ","$313.51 ","$316.68 ","$0.00 ","$61.95 ","$0.00 ","$63.02 ","$0.00 "
"47-2485-095-10","SUP","HCPCS C1713","","47-2485-095-10  -  SCREW BONE 10.5MM 95MM NTR NAIL TI6AL4V ALLOY LAG","BOTH IP/OP","$1,074.45 ","$795.09 ","$0.00 ","$1,074.45 ","$483.50 ","$0.00 ","$223.94 ","$0.00 ","$0.00 ","$188.13 ","$1,074.45 ","$0.00 ","$537.23 ","$850.96 ","$859.56 ","$0.00 ","$168.15 ","$0.00 ","$171.05 ","$0.00 "
"47-2487-001-00","SUP","HCPCS C1713","","47-2487-001-00  -  NAIL FEM IM 0MM ANTGRD CAP","BOTH IP/OP","$411.80 ","$304.73 ","$0.00 ","$411.80 ","$185.31 ","$0.00 ","$85.83 ","$0.00 ","$0.00 ","$72.10 ","$411.80 ","$0.00 ","$205.90 ","$326.15 ","$329.44 ","$0.00 ","$64.45 ","$0.00 ","$65.56 ","$0.00 "
"47-2487-002-00","SUP","HCPCS C1713","","47-2487-002-00  -  CAP END 0MM CEPHALOMEDULLARY NAIL TI6AL4V ALLOY NTR NAIL","BOTH IP/OP","$395.85 ","$292.93 ","$0.00 ","$395.85 ","$178.13 ","$0.00 ","$82.51 ","$0.00 ","$0.00 ","$69.31 ","$395.85 ","$0.00 ","$197.93 ","$313.51 ","$316.68 ","$0.00 ","$61.95 ","$0.00 ","$63.02 ","$0.00 "
"47-2487-005-00","SUP","HCPCS C1713","","47-2487-005-00  -  CAP END 0MM TIB Z NTR NAIL","BOTH IP/OP","$411.80 ","$304.73 ","$0.00 ","$411.80 ","$185.31 ","$0.00 ","$85.83 ","$0.00 ","$0.00 ","$72.10 ","$411.80 ","$0.00 ","$205.90 ","$326.15 ","$329.44 ","$0.00 ","$64.45 ","$0.00 ","$65.56 ","$0.00 "
"47-2487-008-00","SUP","HCPCS C1713","","47-2487-008-00  -  CAP END 0MM FEM RTRGRD TI ALLOY NTR NAIL","BOTH IP/OP","$411.80 ","$304.73 ","$0.00 ","$411.80 ","$185.31 ","$0.00 ","$85.83 ","$0.00 ","$0.00 ","$72.10 ","$411.80 ","$0.00 ","$205.90 ","$326.15 ","$329.44 ","$0.00 ","$64.45 ","$0.00 ","$65.56 ","$0.00 "
"47-2488-000-01","SUP","HCPCS C1713","","47-2488-000-01  -  NUT ORTH CORT FEM KNEE TI RTRGRD 6 MM CANC SCR NTR NAIL SYS","BOTH IP/OP","$208.00 ","$153.92 ","$0.00 ","$208.00 ","$93.60 ","$0.00 ","$43.35 ","$0.00 ","$0.00 ","$36.42 ","$208.00 ","$0.00 ","$104.00 ","$164.74 ","$166.40 ","$0.00 ","$32.55 ","$0.00 ","$33.11 ","$0.00 "
"47-2488-000-02","SUP","HCPCS C1713","","47-2488-000-02  -  WASHER CORT NTR NAIL ORTH TI ALLOY STRL","BOTH IP/OP","$175.50 ","$129.87 ","$0.00 ","$175.50 ","$78.98 ","$0.00 ","$36.58 ","$0.00 ","$0.00 ","$30.73 ","$175.50 ","$0.00 ","$87.75 ","$139.00 ","$140.40 ","$0.00 ","$27.47 ","$0.00 ","$27.94 ","$0.00 "
"47-2491-360-12","SUP","HCPCS C1713","","47-2491-360-12  -  NAIL 12MM 36CM PIRIFORMIS FOSSA FEM NTR NAIL IM UNV ANTGRD","BOTH IP/OP","$3,408.95 ","$2,522.62 ","$0.00 ","$3,408.95 ","$1,534.03 ","$0.00 ","$710.51 ","$0.00 ","$0.00 ","$596.88 ","$3,408.95 ","$0.00 ","$1,704.48 ","$2,699.89 ","$2,727.16 ","$0.00 ","$533.50 ","$0.00 ","$542.70 ","$0.00 "
"47-2492-360-12","SUP","HCPCS C1713","","47-2492-360-12  -  NAIL 12MM 36CM RIGHT GT IM","BOTH IP/OP","$3,408.95 ","$2,522.62 ","$0.00 ","$3,408.95 ","$1,534.03 ","$0.00 ","$710.51 ","$0.00 ","$0.00 ","$596.88 ","$3,408.95 ","$0.00 ","$1,704.48 ","$2,699.89 ","$2,727.16 ","$0.00 ","$533.50 ","$0.00 ","$542.70 ","$0.00 "
"47-2493-210-11","SUP","HCPCS C1713","","47-2493-210-11  -  NAIL 11.5MM 21.5CM RIGHT DPHSL CEPHALOMEDULLARY NTR NAIL IM","BOTH IP/OP","$2,965.25 ","$2,194.29 ","$0.00 ","$2,965.25 ","$1,334.36 ","$0.00 ","$618.03 ","$0.00 ","$0.00 ","$519.19 ","$2,965.25 ","$0.00 ","$1,482.63 ","$2,348.48 ","$2,372.20 ","$0.00 ","$464.06 ","$0.00 ","$472.07 ","$0.00 "
"47-2493-360-11","SUP","HCPCS C1713","","47-2493-360-11  -  NAIL 11.5MM 36CM RIGHT DPHSL CEPHALOMEDULLARY NTR NAIL IM","BOTH IP/OP","$4,463.10 ","$3,302.69 ","$0.00 ","$4,463.10 ","$2,008.40 ","$0.00 ","$930.22 ","$0.00 ","$0.00 ","$781.45 ","$4,463.10 ","$0.00 ","$2,231.55 ","$3,534.78 ","$3,570.48 ","$0.00 ","$698.48 ","$0.00 ","$710.53 ","$0.00 "
"47-2494-200-11","SUP","HCPCS C1713","","47-2494-200-11  -  NAIL 11.5MM 20CM FEM NTR NAIL IM UNV SHRT RTRGRD TI ALLOY","BOTH IP/OP","$4,218.05 ","$3,121.36 ","$0.00 ","$4,218.05 ","$1,898.12 ","$0.00 ","$879.15 ","$0.00 ","$0.00 ","$738.55 ","$4,218.05 ","$0.00 ","$2,109.03 ","$3,340.70 ","$3,374.44 ","$0.00 ","$660.12 ","$0.00 ","$671.51 ","$0.00 "
"47-2494-360-11","SUP","HCPCS C1713","","47-2494-360-11  -  NAIL 11.5MM 36CM FEM NTR NAIL IM UNV LNG RTRGRD TI","BOTH IP/OP","$4,218.05 ","$3,121.36 ","$0.00 ","$4,218.05 ","$1,898.12 ","$0.00 ","$879.15 ","$0.00 ","$0.00 ","$738.55 ","$4,218.05 ","$0.00 ","$2,109.03 ","$3,340.70 ","$3,374.44 ","$0.00 ","$660.12 ","$0.00 ","$671.51 ","$0.00 "
"47-2495-320-12","SUP","HCPCS C1713","","47-2495-320-12  -  NAIL 12MM 32CM TIB NTR NAIL IM UNV TI6AL4V","BOTH IP/OP","$3,240.75 ","$2,398.16 ","$0.00 ","$3,240.75 ","$1,458.34 ","$0.00 ","$675.45 ","$0.00 ","$0.00 ","$567.43 ","$3,240.75 ","$0.00 ","$1,620.38 ","$2,566.67 ","$2,592.60 ","$0.00 ","$507.18 ","$0.00 ","$515.93 ","$0.00 "
"474.031S","SUP","HCPCS C1713","","474.031S  -  NAIL 10MM 30CM FEM IM CANN TI STRL GRN","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.032S","SUP","HCPCS C1713","","474.032S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.034S","SUP","HCPCS C1713","","474.034S  -  NAIL INTRAMEDULLARY 10MM 34CM CANN GREEN TITANIUM FEMUR","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.036S","SUP","HCPCS C1713","","474.036S  -  NAIL 10MM 36CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.038S","SUP","HCPCS C1713","","474.038S  -  NAIL 10MM 38CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.041S","SUP","HCPCS C1713","","474.041S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.042S","SUP","HCPCS C1713","","474.042S  -  NAIL 10MM 42CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.044S","SUP","HCPCS C1713","","474.044S  -  NAIL 10MM 44CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.046S","SUP","HCPCS C1713","","474.046S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.048S","SUP","HCPCS C1713","","474.048S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM CANN ROUND BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.131S","SUP","HCPCS C1713","","474.131S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.132S","SUP","HCPCS C1713","","474.132S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.134S","SUP","HCPCS C1713","","474.134S  -  NAIL 11MM 34CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.136S","SUP","HCPCS C1713","","474.136S  -  NAIL 11MM 36CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.138S","SUP","HCPCS C1713","","474.138S  -  NAIL 11MM 38CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.141S","SUP","HCPCS C1713","","474.141S  -  NAIL 11MM 41CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.142S","SUP","HCPCS C1713","","474.142S  -  NAIL 11MM 42CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.144S","SUP","HCPCS C1713","","474.144S  -  NAIL 11MM 44CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.146S","SUP","HCPCS C1713","","474.146S  -  NAIL 11MM 46CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.148S","SUP","HCPCS C1713","","474.148S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.231S","SUP","HCPCS C1713","","474.231S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.232S","SUP","HCPCS C1713","","474.232S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.234S","SUP","HCPCS C1713","","474.234S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.236S","SUP","HCPCS C1713","","474.236S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.238S","SUP","HCPCS C1713","","474.238S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.241S","SUP","HCPCS C1713","","474.241S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.242S","SUP","HCPCS C1713","","474.242S  -  NAIL 12MM 42CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.244S","SUP","HCPCS C1713","","474.244S  -  NAIL 12MM 44CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.246S","SUP","HCPCS C1713","","474.246S  -  NAIL INTRAMEDULLARY 12MM 460MM CANN GREEN TITANIUM FEMUR","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.248S","SUP","HCPCS C1713","","474.248S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.331S","SUP","HCPCS C1713","","474.331S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.332S","SUP","HCPCS C1713","","474.332S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.334S","SUP","HCPCS C1713","","474.334S  -  NAIL 13MM 34CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.336S","SUP","HCPCS C1713","","474.336S  -  NAIL 13MM 36CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.338S","SUP","HCPCS C1713","","474.338S  -  NAIL 13MM 38CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.341S","SUP","HCPCS C1713","","474.341S  -  NAIL 13MM 40CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.342S","SUP","HCPCS C1713","","474.342S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.344S","SUP","HCPCS C1713","","474.344S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.346S","SUP","HCPCS C1713","","474.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.348S","SUP","HCPCS C1713","","474.348S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 480MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.431S","SUP","HCPCS C1713","","474.431S  -  NAIL 14MM 30CM FEM IM CANN TI STRL GRN","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.432S","SUP","HCPCS C1713","","474.432S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.434S","SUP","HCPCS C1713","","474.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 340MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.436S","SUP","HCPCS C1713","","474.436S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 360MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.438S","SUP","HCPCS C1713","","474.438S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 380MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.441S","SUP","HCPCS C1713","","474.441S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 400MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.442S","SUP","HCPCS C1713","","474.442S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.444S","SUP","HCPCS C1713","","474.444S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 440MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.446S","SUP","HCPCS C1713","","474.446S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 460MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.448S","SUP","HCPCS C1713","","474.448S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM CANN FLUTED BARREL","BOTH IP/OP","$2,492.88 ","$1,844.73 ","$0.00 ","$2,492.88 ","$1,121.79 ","$0.00 ","$519.58 ","$0.00 ","$0.00 ","$436.48 ","$2,492.88 ","$0.00 ","$1,246.44 ","$1,974.36 ","$1,994.30 ","$0.00 ","$390.13 ","$0.00 ","$396.87 ","$0.00 "
"474.531S","SUP","HCPCS C1713","","474.531S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM CANN FLUTED BARREL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$1,158.30 ","$0.00 ","$536.49 ","$0.00 ","$0.00 ","$450.69 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$402.83 ","$0.00 ","$409.78 ","$0.00 "
"474.532S","SUP","HCPCS C1713","","474.532S  -  NAIL 15MM 32CM FEM IM CANN TI STRL GRN","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.534S","SUP","HCPCS C1713","","474.534S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 340MM CANN FLUTED BARREL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$1,158.30 ","$0.00 ","$536.49 ","$0.00 ","$0.00 ","$450.69 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$402.83 ","$0.00 ","$409.78 ","$0.00 "
"474.536S","SUP","HCPCS C1713","","474.536S  -  NAIL 15MM 36CM FEM IM CANN TI STRL GRN","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.538S","SUP","HCPCS C1713","","474.538S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM CANN FLUTED BARREL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$1,158.30 ","$0.00 ","$536.49 ","$0.00 ","$0.00 ","$450.69 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$402.83 ","$0.00 ","$409.78 ","$0.00 "
"474.541S","SUP","HCPCS C1713","","474.541S  -  NAIL 15MM 40CM FEM IM CANN TI STRL","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.542S","SUP","HCPCS C1713","","474.542S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 420MM CANN FLUTED BARREL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$1,158.30 ","$0.00 ","$536.49 ","$0.00 ","$0.00 ","$450.69 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$402.83 ","$0.00 ","$409.78 ","$0.00 "
"474.544S","SUP","HCPCS C1713","","474.544S  -  NAIL 15MM 44CM FEM IM CANN TI STRL GRN","BOTH IP/OP","$2,956.30 ","$2,187.66 ","$0.00 ","$2,956.30 ","$1,330.34 ","$0.00 ","$616.17 ","$0.00 ","$0.00 ","$517.62 ","$2,956.30 ","$0.00 ","$1,478.15 ","$2,341.39 ","$2,365.04 ","$0.00 ","$462.66 ","$0.00 ","$470.64 ","$0.00 "
"474.546S","SUP","HCPCS C1713","","474.546S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 460MM CANN FLUTED BARREL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$1,158.30 ","$0.00 ","$536.49 ","$0.00 ","$0.00 ","$450.69 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$402.83 ","$0.00 ","$409.78 ","$0.00 "
"474.548S","SUP","HCPCS C1713","","474.548S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM CANN FLUTED BARREL","BOTH IP/OP","$2,574.00 ","$1,904.76 ","$0.00 ","$2,574.00 ","$1,158.30 ","$0.00 ","$536.49 ","$0.00 ","$0.00 ","$450.69 ","$2,574.00 ","$0.00 ","$1,287.00 ","$2,038.61 ","$2,059.20 ","$0.00 ","$402.83 ","$0.00 ","$409.78 ","$0.00 "
"474.900S","SUP","HCPCS C1713","","474.900S  -  SLEEVE LCK STD GRN STRL TI FEM 13-15MM NL","BOTH IP/OP","$669.63 ","$495.53 ","$0.00 ","$669.63 ","$301.33 ","$0.00 ","$139.57 ","$0.00 ","$0.00 ","$117.25 ","$669.63 ","$0.00 ","$334.81 ","$530.35 ","$535.70 ","$0.00 ","$104.80 ","$0.00 ","$106.60 ","$0.00 "
"474.910S","SUP","HCPCS C1713","","474.910S  -  SLEEVE LOCKING 100D BLUE TITANIUM FEMUR STERILE 13-15MM CANN","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"474.911S","SUP","HCPCS C1713","","474.911S  -  SLEEVE LOCKING 110D BLUE TITANIUM FEMUR STERILE 13-15MM CANN","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"474.912S","SUP","HCPCS C1713","","474.912S  -  SLEEVE LOCKING 120D BLUE TITANIUM FEMUR STERILE 13-15MM CANN","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"474.913S","SUP","HCPCS C1713","","474.913S  -  SLEEVE LOCKING 130D ANTEGRADE PINK TITANIUM FEMUR STERILE","BOTH IP/OP","$756.25 ","$559.63 ","$0.00 ","$756.25 ","$340.31 ","$0.00 ","$157.62 ","$0.00 ","$0.00 ","$132.41 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$118.35 ","$0.00 ","$120.40 ","$0.00 "
"474.920S","SUP","Custom 27803010","","474.920S  -  CAP END 0MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15MM","BOTH IP/OP","$446.88 ","$330.69 ","$0.00 ","$446.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.88 ","$0.00 ","$223.44 ","$353.93 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"474.921S","SUP","Custom 27803010","","474.921S  -  CAP END 10MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15","BOTH IP/OP","$446.88 ","$330.69 ","$0.00 ","$446.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.88 ","$0.00 ","$223.44 ","$353.93 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"474.922S","SUP","Custom 27803010","","474.922S  -  CAP END 20MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15","BOTH IP/OP","$446.88 ","$330.69 ","$0.00 ","$446.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.88 ","$0.00 ","$223.44 ","$353.93 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"475.900S","SUP","Custom 27803010","","475.900S  -  CAP END GREEN TITANIUM STERILE 3-4MM ELAST INTRAMEDULLARY","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"475.905S","SUP","Custom 27803010","","475.905S  -  CAP END ROSE RED TAN STERILE TEN SYSTEM","BOTH IP/OP","$247.40 ","$183.08 ","$0.00 ","$240.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.20 ","$0.00 ","$120.10 ","$190.24 ","$192.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"475.915S","SUP","HCPCS C1713","","475.915S  -  NAIL INTRAMEDULLARY 1.5MM 300MM ELAST PURPLE TITANIUM","BOTH IP/OP","$572.13 ","$423.38 ","$0.00 ","$555.45 ","$249.95 ","$0.00 ","$119.25 ","$0.00 ","$0.00 ","$97.25 ","$555.45 ","$0.00 ","$277.73 ","$439.92 ","$444.36 ","$0.00 ","$84.40 ","$0.00 ","$88.43 ","$0.00 "
"475.920S","SUP","HCPCS C1713","","475.920S  -  NAIL INTRAMEDULLARY 2MM 440MM ELAST GREEN TITANIUM OLECRANON","BOTH IP/OP","$604.45 ","$447.29 ","$0.00 ","$586.85 ","$264.08 ","$0.00 ","$125.98 ","$0.00 ","$0.00 ","$102.75 ","$586.85 ","$0.00 ","$293.43 ","$464.79 ","$469.48 ","$0.00 ","$89.17 ","$0.00 ","$93.43 ","$0.00 "
"475.925S","SUP","HCPCS C1713","","475.925S  -  NAIL INTRAMEDULLARY 2.5MM 440MM ELAST PINK TITANIUM","BOTH IP/OP","$642.40 ","$475.38 ","$0.00 ","$623.70 ","$280.67 ","$0.00 ","$133.89 ","$0.00 ","$0.00 ","$109.20 ","$623.70 ","$0.00 ","$311.85 ","$493.97 ","$498.96 ","$0.00 ","$94.76 ","$0.00 ","$99.29 ","$0.00 "
"475.930S","SUP","HCPCS C1713","","475.930S  -  NAIL INTRAMEDULLARY 3MM 440MM ELAST GOLD TITANIUM OLECRANON","BOTH IP/OP","$674.73 ","$499.30 ","$0.00 ","$655.08 ","$294.78 ","$0.00 ","$140.63 ","$0.00 ","$0.00 ","$114.70 ","$655.08 ","$0.00 ","$327.54 ","$518.82 ","$524.06 ","$0.00 ","$99.53 ","$0.00 ","$104.29 ","$0.00 "
"475.935S","SUP","HCPCS C1713","","475.935S  -  NAIL INTRAMEDULLARY 3.5MM 440MM ELAST BLUE TITANIUM","BOTH IP/OP","$707.08 ","$523.24 ","$0.00 ","$686.48 ","$308.91 ","$0.00 ","$147.37 ","$0.00 ","$0.00 ","$120.20 ","$686.48 ","$0.00 ","$343.24 ","$543.69 ","$549.18 ","$0.00 ","$104.30 ","$0.00 ","$109.29 ","$0.00 "
"475.940S","SUP","HCPCS C1713","","475.940S  -  NAIL INTRAMEDULLARY 4MM 440MM ELAST PURPLE TITANIUM","BOTH IP/OP","$752.05 ","$556.52 ","$0.00 ","$730.15 ","$328.57 ","$0.00 ","$156.75 ","$0.00 ","$0.00 ","$127.84 ","$730.15 ","$0.00 ","$365.08 ","$578.28 ","$584.12 ","$0.00 ","$110.94 ","$0.00 ","$116.24 ","$0.00 "
"47525P","SUP","HCPCS C1713","","47525P  -  SCREW BN 4.75MM 25MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47525S","SUP","HCPCS C1713","","47525S  -  SCREW BN STD 4.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47530P","SUP","HCPCS C1713","","47530P  -  SCREW BN 4.75MM 30MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47530S","SUP","HCPCS C1713","","47530S  -  SCREW BN STD 4.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47535P","SUP","HCPCS C1713","","47535P  -  SCREW BN 4.75MM 35MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47535S","SUP","HCPCS C1713","","47535S  -  SCREW BN STD 4.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47540P","SUP","HCPCS C1713","","47540P  -  SCREW BN 4.75MM 40MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47540S","SUP","HCPCS C1713","","47540S  -  SCREW BN STD 4.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47545P","SUP","HCPCS C1713","","47545P  -  SCREW BN 4.75MM 45MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47545S","SUP","HCPCS C1713","","47545S  -  SCREW BN STD 4.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47550P","SUP","HCPCS C1713","","47550P  -  SCREW BN 4.75MM 50MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47550S","SUP","HCPCS C1713","","47550S  -  SCREW BN STD 4.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47555P","SUP","HCPCS C1713","","47555P  -  SCREW BN 4.75MM 55MM SPRL R90D MULTIANGLE LCK TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"47555S","SUP","HCPCS C1713","","47555S  -  SCREW BN STD 4.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"476.25S","SUP","HCPCS C1713","","476.25S  -  NAIL INTRAMEDULLARY 10MM 25.5CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.27S","SUP","HCPCS C1713","","476.27S  -  NAIL INTRAMEDULLARY 10MM 27CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.28S","SUP","HCPCS C1713","","476.28S  -  NAIL INTRAMEDULLARY 10MM 28.5CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.30S","SUP","HCPCS C1713","","476.30S  -  NAIL INTRAMEDULLARY 10MM 30CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.31S","SUP","HCPCS C1713","","476.31S  -  NAIL INTRAMEDULLARY 10MM 31.5CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.33S","SUP","HCPCS C1713","","476.33S  -  NAIL INTRAMEDULLARY 10MM 33CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.34S","SUP","HCPCS C1713","","476.34S  -  NAIL INTRAMEDULLARY 10MM 34.5CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.36S","SUP","HCPCS C1713","","476.36S  -  NAIL INTRAMEDULLARY 10MM 36CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.38S","SUP","HCPCS C1713","","476.38S  -  NAIL INTRAMEDULLARY 10MM 38CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.40S","SUP","HCPCS C1713","","476.40S  -  NAIL INTRAMEDULLARY 10MM 40CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"476.42S","SUP","HCPCS C1713","","476.42S  -  NAIL INTRAMEDULLARY 10MM 42CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"478.25S","SUP","HCPCS C1713","","478.25S  -  NAIL INTRAMEDULLARY 8MM 25.5CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"478.27S","SUP","HCPCS C1713","","478.27S  -  NAIL 8MM 27CM TIB IM SLD TI STRL","BOTH IP/OP","$2,814.73 ","$2,082.90 ","$0.00 ","$2,814.73 ","$1,266.63 ","$0.00 ","$586.66 ","$0.00 ","$0.00 ","$492.84 ","$2,814.73 ","$0.00 ","$1,407.36 ","$2,229.27 ","$2,251.78 ","$0.00 ","$440.50 ","$0.00 ","$448.10 ","$0.00 "
"478.28S","SUP","HCPCS C1713","","478.28S  -  NAIL INTRAMEDULLARY 8MM 28.5CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"478.30S","SUP","HCPCS C1713","","478.30S  -  NAIL INTRAMEDULLARY 8MM 30CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"478.31S","SUP","HCPCS C1713","","478.31S  -  NAIL 8MM 31.5CM TIB IM SLD TI STRL","BOTH IP/OP","$2,814.73 ","$2,082.90 ","$0.00 ","$2,814.73 ","$1,266.63 ","$0.00 ","$586.66 ","$0.00 ","$0.00 ","$492.84 ","$2,814.73 ","$0.00 ","$1,407.36 ","$2,229.27 ","$2,251.78 ","$0.00 ","$440.50 ","$0.00 ","$448.10 ","$0.00 "
"478.33S","SUP","HCPCS C1713","","478.33S  -  NAIL 8MM 33CM TIB IM SLD TI STRL","BOTH IP/OP","$2,814.73 ","$2,082.90 ","$0.00 ","$2,814.73 ","$1,266.63 ","$0.00 ","$586.66 ","$0.00 ","$0.00 ","$492.84 ","$2,814.73 ","$0.00 ","$1,407.36 ","$2,229.27 ","$2,251.78 ","$0.00 ","$440.50 ","$0.00 ","$448.10 ","$0.00 "
"478.34S","SUP","HCPCS C1713","","478.34S  -  NAIL 8MM 34.5CM TIB IM SLD TI STRL","BOTH IP/OP","$2,814.73 ","$2,082.90 ","$0.00 ","$2,814.73 ","$1,266.63 ","$0.00 ","$586.66 ","$0.00 ","$0.00 ","$492.84 ","$2,814.73 ","$0.00 ","$1,407.36 ","$2,229.27 ","$2,251.78 ","$0.00 ","$440.50 ","$0.00 ","$448.10 ","$0.00 "
"478.36S","SUP","HCPCS C1713","","478.36S  -  NAIL 8MM 36CM TIB IM SLD TI STRL","BOTH IP/OP","$2,814.73 ","$2,082.90 ","$0.00 ","$2,814.73 ","$1,266.63 ","$0.00 ","$586.66 ","$0.00 ","$0.00 ","$492.84 ","$2,814.73 ","$0.00 ","$1,407.36 ","$2,229.27 ","$2,251.78 ","$0.00 ","$440.50 ","$0.00 ","$448.10 ","$0.00 "
"478.38S","SUP","HCPCS C1713","","478.38S  -  NAIL INTRAMEDULLARY 8MM 38CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"478.40S","SUP","HCPCS C1713","","478.40S  -  NAIL 8MM 40CM TIB IM SLD TI STRL","BOTH IP/OP","$2,814.73 ","$2,082.90 ","$0.00 ","$2,814.73 ","$1,266.63 ","$0.00 ","$586.66 ","$0.00 ","$0.00 ","$492.84 ","$2,814.73 ","$0.00 ","$1,407.36 ","$2,229.27 ","$2,251.78 ","$0.00 ","$440.50 ","$0.00 ","$448.10 ","$0.00 "
"478.42S","SUP","HCPCS C1713","","478.42S  -  NAIL INTRAMEDULLARY 8MM 42CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"479.25S","SUP","HCPCS C1713","","479.25S  -  NAIL INTRAMEDULLARY 9MM 25.5CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"479.27S","SUP","HCPCS C1713","","479.27S  -  NAIL INTRAMEDULLARY 9MM 27CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"479.28S","SUP","HCPCS C1713","","479.28S  -  NAIL INTRAMEDULLARY 9MM 28.5CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"479.30S","SUP","HCPCS C1713","","479.30S  -  NAIL INTRAMEDULLARY 9MM 30CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"479.31S","SUP","HCPCS C1713","","479.31S  -  NAIL INTRAMEDULLARY 9MM 315MM SOLID BLUE TITANIUM TIBIAL","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"479.33S","SUP","HCPCS C1713","","479.33S  -  NAIL INTRAMEDULLARY 9MM 330MM SOLID BLUE TITANIUM TIBIAL","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"479.34S","SUP","HCPCS C1713","","479.34S  -  NAIL INTRAMEDULLARY 9MM 34.5CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"479.36S","SUP","HCPCS C1713","","479.36S  -  NAIL INTRAMEDULLARY 9MM 36CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"479.38S","SUP","HCPCS C1713","","479.38S  -  NAIL INTRAMEDULLARY 9MM 38CM SOLID TITANIUM TIBIA STERILE","BOTH IP/OP","$2,450.25 ","$1,813.19 ","$0.00 ","$2,450.25 ","$1,102.61 ","$0.00 ","$510.69 ","$0.00 ","$0.00 ","$429.02 ","$2,450.25 ","$0.00 ","$1,225.13 ","$1,940.60 ","$1,960.20 ","$0.00 ","$383.46 ","$0.00 ","$390.08 ","$0.00 "
"479.40S","SUP","HCPCS C1713","","479.40S  -  NAIL INTRAMEDULLARY 9MM 40CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"479.42S","SUP","HCPCS C1713","","479.42S  -  NAIL INTRAMEDULLARY 9MM 42CM SOLID BLUE TITANIUM TIBIA","BOTH IP/OP","$2,517.63 ","$1,863.05 ","$0.00 ","$2,517.63 ","$1,132.93 ","$0.00 ","$524.74 ","$0.00 ","$0.00 ","$440.82 ","$2,517.63 ","$0.00 ","$1,258.81 ","$1,993.96 ","$2,014.10 ","$0.00 ","$394.01 ","$0.00 ","$400.81 ","$0.00 "
"4806-100-20","SUP","Custom 27203010","","4806-100-20  -  BIT DRL 2MM 100MM QCK CNCT","BOTH IP/OP","$136.85 ","$101.27 ","$0.00 ","$136.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.85 ","$0.00 ","$68.43 ","$108.39 ","$109.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4806-100-27","SUP","Custom 27203010","","4806-100-27  -  BIT DRL 2.7MM","BOTH IP/OP","$136.85 ","$101.27 ","$0.00 ","$136.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.85 ","$0.00 ","$68.43 ","$108.39 ","$109.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4806-110-25","SUP","Custom 27203010","","4806-110-25  -  BIT DRL 2.5MM 110MM QCK CNCT","BOTH IP/OP","$136.85 ","$101.27 ","$0.00 ","$136.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.85 ","$0.00 ","$68.43 ","$108.39 ","$109.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4806-110-35","SUP","Custom 27203010","","4806-110-35  -  BIT DRL 3.5MM","BOTH IP/OP","$136.85 ","$101.27 ","$0.00 ","$136.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.85 ","$0.00 ","$68.43 ","$108.39 ","$109.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4807-180-25","SUP","Custom 27203010","","4807-180-25  -  BIT DRILL 180MM 2.5MM SS QC NONSTRL","BOTH IP/OP","$136.85 ","$101.27 ","$0.00 ","$136.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.85 ","$0.00 ","$68.43 ","$108.39 ","$109.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4809-27","SUP","Custom 27203010","","4809-27  -  COUNTERSINK, Q-C, FOR 2.7MM SCREWS","BOTH IP/OP","$211.60 ","$156.58 ","$0.00 ","$211.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.60 ","$0.00 ","$105.80 ","$167.59 ","$169.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4811-100-27","SUP","Custom 27203010","","4811-100-27  -  TAP 100MM QC SURG SS PERIART 2.7MM SCR NONSTRL","BOTH IP/OP","$163.30 ","$120.84 ","$0.00 ","$163.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.30 ","$0.00 ","$81.65 ","$129.33 ","$130.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4811-110-35","SUP","Custom 27203010","","4811-110-35  -  TAP 110MM QC SURG SS PERIART 3.5MM SCR NONSTRL","BOTH IP/OP","$163.30 ","$120.84 ","$0.00 ","$163.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.30 ","$0.00 ","$81.65 ","$129.33 ","$130.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4811-110-40","SUP","Custom 27203010","","4811-110-40  -  TAP 110MM QC SURG SS PERIART 4MM SCR NONSTRL","BOTH IP/OP","$163.30 ","$120.84 ","$0.00 ","$163.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.30 ","$0.00 ","$81.65 ","$129.33 ","$130.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48210-025","SUP","Custom 27203010","","48210-025  -  TAPE DRSG 72YDX.5IN TWL BLCH CTTN WHT","BOTH IP/OP","$156.02 ","$115.45 ","$0.00 ","$156.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.02 ","$0.00 ","$78.01 ","$123.57 ","$124.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"48230260R","SUP","Custom 27803010","","48230260R  -  HOOK SPNL XIA 3 TI AL VNDM SCRL RT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4845-0101","SUP","HCPCS C1776","","4845-0101  -  STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0102","SUP","HCPCS C1776","","4845-0102  -  STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0103","SUP","HCPCS C1776","","4845-0103  -  STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0104","SUP","HCPCS C1776","","4845-0104  -  STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0105","SUP","HCPCS C1776","","4845-0105  -  STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0106","SUP","HCPCS C1776","","4845-0106  -  STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0107","SUP","HCPCS C1776","","4845-0107  -  STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0108","SUP","HCPCS C1776","","4845-0108  -  STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP RT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0201","SUP","HCPCS C1776","","4845-0201  -  STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0202","SUP","HCPCS C1776","","4845-0202  -  STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0203","SUP","HCPCS C1776","","4845-0203  -  STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0204","SUP","HCPCS C1776","","4845-0204  -  STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0205","SUP","HCPCS C1776","","4845-0205  -  STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0206","SUP","HCPCS C1776","","4845-0206  -  STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0207","SUP","HCPCS C1776","","4845-0207  -  STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-0208","SUP","HCPCS C1776","","4845-0208  -  STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP LT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"4845-7-101","SUP","HCPCS C1776","","4845-7-101  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-102","SUP","HCPCS C1776","","4845-7-102  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-103","SUP","HCPCS C1776","","4845-7-103  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-104","SUP","HCPCS C1776","","4845-7-104  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-105","SUP","HCPCS C1776","","4845-7-105  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-106","SUP","HCPCS C1776","","4845-7-106  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-107","SUP","HCPCS C1776","","4845-7-107  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-108","SUP","HCPCS C1776","","4845-7-108  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-111","SUP","HCPCS C1776","","4845-7-111  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-112","SUP","HCPCS C1776","","4845-7-112  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-114","SUP","HCPCS C1776","","4845-7-114  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-115","SUP","HCPCS C1776","","4845-7-115  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-116","SUP","HCPCS C1776","","4845-7-116  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-117","SUP","HCPCS C1776","","4845-7-117  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-118","SUP","HCPCS C1776","","4845-7-118  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP RT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-201","SUP","HCPCS C1776","","4845-7-201  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-202","SUP","HCPCS C1776","","4845-7-202  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-203","SUP","HCPCS C1776","","4845-7-203  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-204","SUP","HCPCS C1776","","4845-7-204  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-205","SUP","HCPCS C1776","","4845-7-205  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-206","SUP","HCPCS C1776","","4845-7-206  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-207","SUP","HCPCS C1776","","4845-7-207  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-208","SUP","HCPCS C1776","","4845-7-208  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-211","SUP","HCPCS C1776","","4845-7-211  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-212","SUP","HCPCS C1776","","4845-7-212  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-213","SUP","HCPCS C1776","","4845-7-213  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-214","SUP","HCPCS C1776","","4845-7-214  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-215","SUP","HCPCS C1776","","4845-7-215  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-216","SUP","HCPCS C1776","","4845-7-216  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-217","SUP","HCPCS C1776","","4845-7-217  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"4845-7-218","SUP","HCPCS C1776","","4845-7-218  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP LT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"48485540XL","SUP","HCPCS C1713","","48485540XL  -  SCREW BONE 5.5MM 40MM DIAPASON OSS THOR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48485545XL","SUP","HCPCS C1713","","48485545XL  -  SCREW BONE 5.5MM 45MM DIAPASON OSS THOR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486735XL","SUP","HCPCS C1713","","48486735XL  -  SCREW BONE 6.7MM 35MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486740XL","SUP","HCPCS C1713","","48486740XL  -  SCREW BONE 6.7MM 40MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486745XL","SUP","HCPCS C1713","","48486745XL  -  SCREW BONE 6.7MM 45MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486750XL","SUP","HCPCS C1713","","48486750XL  -  SCREW BONE 6.7MM 50MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486755XL","SUP","HCPCS C1713","","48486755XL  -  SCREW BONE 6.7MM 55MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48486760XL","SUP","HCPCS C1713","","48486760XL  -  SCREW BONE 6.7MM 60MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487740XL","SUP","HCPCS C1713","","48487740XL  -  SCREW BONE 7.7MM 40MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487745XL","SUP","HCPCS C1713","","48487745XL  -  SCREW BONE 7.7MM 45MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487750XL","SUP","HCPCS C1713","","48487750XL  -  SCREW BONE 7.7MM 50MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487755XL","SUP","HCPCS C1713","","48487755XL  -  SCREW BONE 7.7MM 55MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48487760XL","SUP","HCPCS C1713","","48487760XL  -  SCREW BONE 7.7MM 60MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488050XL","SUP","HCPCS C1713","","48488050XL  -  SCREW BONE 8MM 50MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488055XL","SUP","HCPCS C1713","","48488055XL  -  SCREW BONE 8MM 55MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"48488060XL","SUP","HCPCS C1713","","48488060XL  -  SCREW BONE 8MM 60MM DIAPASON OSS LMBR SPN LNG ARM","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"485.025S","SUP","HCPCS C1713","","485.025S  -  NAIL INTRAMEDULLARY 10MM 25.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.027S","SUP","HCPCS C1713","","485.027S  -  NAIL INTRAMEDULLARY 10MM 27CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.028S","SUP","HCPCS C1713","","485.028S  -  NAIL INTRAMEDULLARY 10MM 28.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.030S","SUP","HCPCS C1713","","485.030S  -  NAIL INTRAMEDULLARY 10MM 30CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.031S","SUP","HCPCS C1713","","485.031S  -  NAIL INTRAMEDULLARY 10MM 31.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.033S","SUP","HCPCS C1713","","485.033S  -  NAIL INTRAMEDULLARY 10MM 33CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.034S","SUP","HCPCS C1713","","485.034S  -  NAIL INTRAMEDULLARY 10MM 34.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.036S","SUP","HCPCS C1713","","485.036S  -  NAIL 10MM 36CM TIB IM CANN TI STRL","BOTH IP/OP","$2,853.10 ","$2,111.29 ","$0.00 ","$2,853.10 ","$1,283.90 ","$0.00 ","$594.66 ","$0.00 ","$0.00 ","$499.55 ","$2,853.10 ","$0.00 ","$1,426.55 ","$2,259.66 ","$2,282.48 ","$0.00 ","$446.51 ","$0.00 ","$454.21 ","$0.00 "
"485.038S","SUP","HCPCS C1713","","485.038S  -  NAIL INTRAMEDULLARY 10MM 380MM CANN TITANIUM TIBIA STERILE","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.040S","SUP","HCPCS C1713","","485.040S  -  NAIL INTRAMEDULLARY 10MM 40CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.042S","SUP","HCPCS C1713","","485.042S  -  NAIL INTRAMEDULLARY 10MM 42CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.125S","SUP","HCPCS C1713","","485.125S  -  NAIL INTRAMEDULLARY 11MM 25.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.127S","SUP","HCPCS C1713","","485.127S  -  NAIL INTRAMEDULLARY 11MM 27CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.128S","SUP","HCPCS C1713","","485.128S  -  NAIL INTRAMEDULLARY 11MM 28.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.130S","SUP","HCPCS C1713","","485.130S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.131S","SUP","HCPCS C1713","","485.131S  -  NAIL INTRAMEDULLARY 11MM 315MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.133S","SUP","HCPCS C1713","","485.133S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.134S","SUP","HCPCS C1713","","485.134S  -  NAIL INTRAMEDULLARY 11MM 34.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.136S","SUP","HCPCS C1713","","485.136S  -  NAIL INTRAMEDULLARY 11MM 360MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.138S","SUP","HCPCS C1713","","485.138S  -  NAIL INTRAMEDULLARY 11MM 38CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.140S","SUP","HCPCS C1713","","485.140S  -  NAIL INTRAMEDULLARY 11MM 400MM CANN GREEN TITANIUM TIBIAL","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.142S","SUP","HCPCS C1713","","485.142S  -  NAIL INTRAMEDULLARY 11MM 42CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.225S","SUP","HCPCS C1713","","485.225S  -  NAIL INTRAMEDULLARY 12MM 25.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.227S","SUP","HCPCS C1713","","485.227S  -  NAIL INTRAMEDULLARY 12MM 27CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.228S","SUP","HCPCS C1713","","485.228S  -  NAIL INTRAMEDULLARY 12MM 285MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.230S","SUP","HCPCS C1713","","485.230S  -  NAIL INTRAMEDULLARY 12MM 30CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.231S","SUP","HCPCS C1713","","485.231S  -  NAIL INTRAMEDULLARY 12MM 31.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.233S","SUP","HCPCS C1713","","485.233S  -  NAIL INTRAMEDULLARY 12MM 33CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.234S","SUP","HCPCS C1713","","485.234S  -  NAIL INTRAMEDULLARY 12MM 34.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.236S","SUP","HCPCS C1713","","485.236S  -  NAIL INTRAMEDULLARY 12MM 36CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.238S","SUP","HCPCS C1713","","485.238S  -  NAIL INTRAMEDULLARY 12MM 38CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.240S","SUP","HCPCS C1713","","485.240S  -  NAIL INTRAMEDULLARY 12MM 40CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.242S","SUP","HCPCS C1713","","485.242S  -  NAIL INTRAMEDULLARY 12MM 42CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.325S","SUP","HCPCS C1713","","485.325S  -  NAIL INTRAMEDULLARY 13MM 25.5CM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.327S","SUP","HCPCS C1713","","485.327S  -  NAIL 13MM 27CM TIB IM CANN TI STRL BLUE","BOTH IP/OP","$2,853.10 ","$2,111.29 ","$0.00 ","$2,853.10 ","$1,283.90 ","$0.00 ","$594.66 ","$0.00 ","$0.00 ","$499.55 ","$2,853.10 ","$0.00 ","$1,426.55 ","$2,259.66 ","$2,282.48 ","$0.00 ","$446.51 ","$0.00 ","$454.21 ","$0.00 "
"485.328S","SUP","HCPCS C1713","","485.328S  -  NAIL INTRAMEDULLARY 13MM 285MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"485.330S","SUP","HCPCS C1713","","485.330S  -  NAIL INTRAMEDULLARY 13MM 300MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.331S","SUP","HCPCS C1713","","485.331S  -  NAIL INTRAMEDULLARY 13MM 315MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.333S","SUP","HCPCS C1713","","485.333S  -  NAIL INTRAMEDULLARY 13MM 330MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.334S","SUP","HCPCS C1713","","485.334S  -  NAIL INTRAMEDULLARY 13MM 345MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.336S","SUP","HCPCS C1713","","485.336S  -  NAIL 13MM 36CM TIB IM CANN TI STRL","BOTH IP/OP","$2,853.10 ","$2,111.29 ","$0.00 ","$2,853.10 ","$1,283.90 ","$0.00 ","$594.66 ","$0.00 ","$0.00 ","$499.55 ","$2,853.10 ","$0.00 ","$1,426.55 ","$2,259.66 ","$2,282.48 ","$0.00 ","$446.51 ","$0.00 ","$454.21 ","$0.00 "
"485.338S","SUP","HCPCS C1713","","485.338S  -  NAIL INTRAMEDULLARY 13MM 380MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,484.63 ","$1,838.63 ","$0.00 ","$2,484.63 ","$1,118.08 ","$0.00 ","$517.86 ","$0.00 ","$0.00 ","$435.04 ","$2,484.63 ","$0.00 ","$1,242.31 ","$1,967.83 ","$1,987.70 ","$0.00 ","$388.84 ","$0.00 ","$395.55 ","$0.00 "
"485.340S","SUP","HCPCS C1713","","485.340S  -  NAIL 13MM 40CM TIB IM CANN TI STRL BLUE","BOTH IP/OP","$2,853.10 ","$2,111.29 ","$0.00 ","$2,853.10 ","$1,283.90 ","$0.00 ","$594.66 ","$0.00 ","$0.00 ","$499.55 ","$2,853.10 ","$0.00 ","$1,426.55 ","$2,259.66 ","$2,282.48 ","$0.00 ","$446.51 ","$0.00 ","$454.21 ","$0.00 "
"485.342S","SUP","HCPCS C1713","","485.342S  -  NAIL INTRAMEDULLARY 13MM 420MM CANN GREEN TITANIUM TIBIA","BOTH IP/OP","$2,553.38 ","$1,889.50 ","$0.00 ","$2,553.38 ","$1,149.02 ","$0.00 ","$532.19 ","$0.00 ","$0.00 ","$447.08 ","$2,553.38 ","$0.00 ","$1,276.69 ","$2,022.28 ","$2,042.70 ","$0.00 ","$399.60 ","$0.00 ","$406.50 ","$0.00 "
"48551041L","SUP","HCPCS C1713","","48551041L  -  PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551041R","SUP","HCPCS C1713","","48551041R  -  PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551043L","SUP","HCPCS C1713","","48551043L  -  PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"48551043R","SUP","HCPCS C1713","","48551043R  -  PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"4900-40-51","SUP","HCPCS C1713","","4900-40-51  -  WASHER 7MM SM ORTH 2.7-4MM SCR NONSTRL","BOTH IP/OP","$71.30 ","$52.76 ","$0.00 ","$71.30 ","$32.09 ","$0.00 ","$14.86 ","$0.00 ","$0.00 ","$12.48 ","$71.30 ","$0.00 ","$35.65 ","$56.47 ","$57.04 ","$0.00 ","$11.16 ","$0.00 ","$11.35 ","$0.00 "
"4900T26","SUP","Custom 27803010","","4900T26  -  RING ANLPLS 26MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR","BOTH IP/OP","$7,995.00 ","$5,916.30 ","$0.00 ","$7,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,995.00 ","$0.00 ","$3,997.50 ","$6,332.04 ","$6,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4900T28","SUP","Custom 27803010","","4900T28  -  RING ANLPLS 28MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4900T30","SUP","Custom 27803010","","4900T30  -  RING ANLPLS 30MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR","BOTH IP/OP","$7,995.00 ","$5,916.30 ","$0.00 ","$7,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,995.00 ","$0.00 ","$3,997.50 ","$6,332.04 ","$6,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4900T32","SUP","Custom 27803010","","4900T32  -  RING ANLPLS 3D ANG DNWRD 32MM ED MC3 RGD TRCSD","BOTH IP/OP","$7,995.00 ","$5,916.30 ","$0.00 ","$7,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,995.00 ","$0.00 ","$3,997.50 ","$6,332.04 ","$6,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4900T34","SUP","Custom 27803010","","4900T34  -  RING ANLPLS 34MM TRCSD ED MC3","BOTH IP/OP","$7,995.00 ","$5,916.30 ","$0.00 ","$7,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,995.00 ","$0.00 ","$3,997.50 ","$6,332.04 ","$6,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4900T36","SUP","HCPCS C1713","","4900T36  -  RING ANLPLS 36MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$3,937.50 ","$0.00 ","$1,823.72 ","$0.00 ","$0.00 ","$1,532.06 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$1,369.38 ","$0.00 ","$1,393.00 ","$0.00 "
"491B","SUP","Custom 27203010","","491B  -  PROBE THRMTR SM STAT STRL STRPRB TEMP ESPH RCTM DISP","BOTH IP/OP","$12.74 ","$9.43 ","$0.00 ","$12.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.74 ","$0.00 ","$6.37 ","$10.09 ","$10.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-0-000","SUP","Custom 27203010","","4920-0-000  -  ROD EXFIX HFMN2 DYN","BOTH IP/OP","$3,734.50 ","$2,763.53 ","$0.00 ","$3,734.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,734.50 ","$0.00 ","$1,867.25 ","$2,957.72 ","$2,987.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-0-015","SUP","Custom 27203010","","4920-0-015  -  TUBE XTRNFX STD 40MM HFMN2 CMPR DSTRCT","BOTH IP/OP","$965.25 ","$714.29 ","$0.00 ","$965.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$965.25 ","$0.00 ","$482.63 ","$764.48 ","$772.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-010","SUP","Custom 27203010","","4920-1-010  -  CLAMP EXFIX HFMN2 STD CARFBR NONMRI SAFE","BOTH IP/OP","$853.88 ","$631.87 ","$0.00 ","$853.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.88 ","$0.00 ","$426.94 ","$676.27 ","$683.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-010R","SUP","Custom 27203010","","4920-1-010R  -  HOFF2 COUPLING 8/8MM RECERT","BOTH IP/OP","$853.88 ","$631.87 ","$0.00 ","$853.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.88 ","$0.00 ","$426.94 ","$676.27 ","$683.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-020","SUP","Custom 27203010","","4920-1-020  -  CPLNG EXFIX HFMN2 4-5MM 8MM ARTC","BOTH IP/OP","$853.88 ","$631.87 ","$0.00 ","$853.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.88 ","$0.00 ","$426.94 ","$676.27 ","$683.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-020R","SUP","Custom 27203010","","4920-1-020R  -  HOFF2 ARTIC COUPLING 8/4+5MM","BOTH IP/OP","$853.88 ","$631.87 ","$0.00 ","$853.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.88 ","$0.00 ","$426.94 ","$676.27 ","$683.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-030","SUP","Custom 27203010","","4920-1-030  -  COUPLING XTRNFX 4 5/8MM HFMN2 INVERT PIN TO ROD","BOTH IP/OP","$853.88 ","$631.87 ","$0.00 ","$853.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.88 ","$0.00 ","$426.94 ","$676.27 ","$683.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-030R","SUP","Custom 27203010","","4920-1-030R  -  HOFF2 INVERT COUPLING 8/4+5MM","BOTH IP/OP","$853.88 ","$631.87 ","$0.00 ","$853.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.88 ","$0.00 ","$426.94 ","$676.27 ","$683.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-1-100","SUP","Custom 27203010","","4920-1-100  -  COUPLING XTRNFX STD 20MM 8MM HFMN2 TUBE TO ROD DYN","BOTH IP/OP","$948.75 ","$702.08 ","$0.00 ","$948.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-020","SUP","Custom 27203010","","4920-2-020  -  CLAMP EXFIX HFMN2 8MM 4-5MM CARFBR PIN ASMBLY 5 HOLE W/O","BOTH IP/OP","$900.63 ","$666.47 ","$0.00 ","$900.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$900.63 ","$0.00 ","$450.31 ","$713.30 ","$720.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-060","SUP","Custom 27203010","","4920-2-060  -  CLAMP EXFIX HFMN2 10 HOLE","BOTH IP/OP","$1,516.63 ","$1,122.31 ","$0.00 ","$1,516.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.63 ","$0.00 ","$758.31 ","$1,201.17 ","$1,213.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-060R","SUP","Custom 27203010","","4920-2-060R  -  HOFF2 10 HOLE CLAMP","BOTH IP/OP","$1,516.63 ","$1,122.31 ","$0.00 ","$1,516.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,516.63 ","$0.00 ","$758.31 ","$1,201.17 ","$1,213.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-080","SUP","Custom 27203010","","4920-2-080  -  CLAMP EXFIX HFMN2 PLVC CMPNT 4 MM 5 MM 6 MM PIN","BOTH IP/OP","$1,328.25 ","$982.91 ","$0.00 ","$1,328.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,328.25 ","$0.00 ","$664.13 ","$1,051.97 ","$1,062.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-120","SUP","Custom 27203010","","4920-2-120  -  POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-120R","SUP","Custom 27203010","","4920-2-120R  -  POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP REPRO","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-140","SUP","Custom 27203010","","4920-2-140  -  POST XTRNFX 30D HFMN2 AL SS CFBR","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-140R","SUP","Custom 27203010","","4920-2-140R  -  POST XTRNFX 30D 8MM NS LF HFMN2 CMPNT SS DISP REPRO","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-160","SUP","Custom 27203010","","4920-2-160  -  POST EXFIX HFMN2 90D 8MM SS ANG CMPNT","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-160R","SUP","Custom 27203010","","4920-2-160R  -  POST XTRNFX 90D NS LF HFMN2 CMPNT SS DISP REPRO","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-2-180","SUP","Custom 27203010","","4920-2-180  -  POST EXFIX HFMN2 MI","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-3-010","SUP","Custom 27203010","","4920-3-010  -  COUPLING XTRNFX ROD TO WRE","BOTH IP/OP","$936.38 ","$692.92 ","$0.00 ","$936.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$936.38 ","$0.00 ","$468.19 ","$741.61 ","$749.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-9-810","SUP","Custom 27203010","","4920-9-810  -  SET EXFIX HFMN2 ANKL KIT ROD TO ROD CPLNG MLPN CLMP SFT TIS","BOTH IP/OP","$6,227.38 ","$4,608.26 ","$0.00 ","$6,227.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,227.38 ","$0.00 ","$3,113.69 ","$4,932.08 ","$4,981.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-9-830","SUP","Custom 27203010","","4920-9-830  -  SET EXFIX HFMN2 430MMX307MMX65MM TIB KIT ROD TO ROD CPLNG","BOTH IP/OP","$6,539.50 ","$4,839.23 ","$0.00 ","$6,539.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,539.50 ","$0.00 ","$3,269.75 ","$5,179.28 ","$5,231.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-9-900","SUP","Custom 27203010","","4920-9-900  -  KIT EXFIX HFMN2 STRL","BOTH IP/OP","$4,116.75 ","$3,046.40 ","$0.00 ","$4,116.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,116.75 ","$0.00 ","$2,058.38 ","$3,260.47 ","$3,293.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-9-920","SUP","Custom 27203010","","4920-9-920  -  KIT EXFIX HFMN2 STRL","BOTH IP/OP","$3,430.63 ","$2,538.67 ","$0.00 ","$3,430.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,430.63 ","$0.00 ","$1,715.31 ","$2,717.06 ","$2,744.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-9-930","SUP","Custom 27203010","","4920-9-930  -  SET EXFIX HFMN2 PLVC KIT ROD TO ROD CPLNG MLPN CLMP SFT TIS","BOTH IP/OP","$8,417.75 ","$6,229.14 ","$0.00 ","$8,417.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,417.75 ","$0.00 ","$4,208.88 ","$6,666.86 ","$6,734.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4920-9-952","SUP","Custom 27203010","","4920-9-952  -  SET EXFIX HFMN2 KIT MLTR MUL PIN CLMP SLFDRILL APEX PIN ANG","BOTH IP/OP","$4,138.75 ","$3,062.68 ","$0.00 ","$4,138.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,138.75 ","$0.00 ","$2,069.38 ","$3,277.89 ","$3,311.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-0-000","SUP","Custom 27203010","","4921-0-000  -  TUBE XTRNFX HFMN 3 DYN MRI SAFE","BOTH IP/OP","$4,233.63 ","$3,132.89 ","$0.00 ","$4,233.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,233.63 ","$0.00 ","$2,116.81 ","$3,353.03 ","$3,386.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-0-015","SUP","Custom 27203010","","4921-0-015  -  TUBE XTRNFX 20MM HFMN2 CMPR DSTRCT MRI SAFE","BOTH IP/OP","$946.00 ","$700.04 ","$0.00 ","$946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$946.00 ","$0.00 ","$473.00 ","$749.23 ","$756.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-1-010","SUP","Custom 27203010","","4921-1-010  -  CPLNG EXFIX HFMN2 ROD TO ROD","BOTH IP/OP","$975.88 ","$722.15 ","$0.00 ","$1,586.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,586.00 ","$0.00 ","$793.00 ","$1,256.11 ","$1,268.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-1-020","SUP","Custom 27203010","","4921-1-020  -  CLAMP EXFIX HFMN2 CLR CD REASSEMBLE GOLD HEAD BOLT","BOTH IP/OP","$909.28 ","$672.87 ","$0.00 ","$1,478.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,478.00 ","$0.00 ","$739.00 ","$1,170.58 ","$1,182.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-1-030","SUP","Custom 27203010","","4921-1-030  -  COUPLING XTRNFX HFMN2 INVERT PIN TO ROD MRI CLR CD 4-5 MM","BOTH IP/OP","$875.88 ","$648.15 ","$0.00 ","$875.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.88 ","$0.00 ","$437.94 ","$693.70 ","$700.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-1-100","SUP","Custom 27203010","","4921-1-100  -  DEVICE EXFIX YLW HFMN2 MRI FRM 6 PIN","BOTH IP/OP","$875.88 ","$648.15 ","$0.00 ","$875.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.88 ","$0.00 ","$437.94 ","$693.70 ","$700.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-1-140","SUP","Custom 27203010","","4921-1-140  -  POST EXFIX 8MM HFMN2 30D MRI SAFE CMPNT GOLD TIP","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-2-020","SUP","Custom 27203010","","4921-2-020  -  CLAMP EXFIX 6MM HFMN2 5 HOLE PIN MRI SAFE","BOTH IP/OP","$1,035.08 ","$765.96 ","$0.00 ","$1,684.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,684.00 ","$0.00 ","$842.00 ","$1,333.73 ","$1,347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-2-060","SUP","Custom 27203010","","4921-2-060  -  CLAMP EXFIX HFMN2 C 10 HOLE PIN","BOTH IP/OP","$1,379.18 ","$1,020.59 ","$0.00 ","$2,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,246.00 ","$0.00 ","$1,123.00 ","$1,778.83 ","$1,796.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-2-080","SUP","Custom 27203010","","4921-2-080  -  CLAMP EXFIX HFMN2 MRI PLVC","BOTH IP/OP","$1,496.00 ","$1,107.04 ","$0.00 ","$1,130.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,130.25 ","$0.00 ","$565.13 ","$895.16 ","$904.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-2-120","SUP","Custom 27203010","","4921-2-120  -  POST XTRNFX STRG 8MM HFMN 3 CLR CD MRI SAFE","BOTH IP/OP","$225.70 ","$167.02 ","$0.00 ","$366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.00 ","$0.00 ","$183.00 ","$289.87 ","$292.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-2-140","SUP","Custom 27203010","","4921-2-140  -  POST XTRNFX 30D 8MM HFMN2 CLR CD MRI SAFE","BOTH IP/OP","$172.98 ","$128.01 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-2-160","SUP","Custom 27203010","","4921-2-160  -  POST XTRNFX 90D 8MM HFMN2 MRI SAFE H","BOTH IP/OP","$264.55 ","$195.77 ","$0.00 ","$434.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$434.00 ","$0.00 ","$217.00 ","$343.73 ","$347.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4921-9-985","SUP","Custom 27203010","","4921-9-985  -  BAR XTRNFX 30D HFMN2 STOR LWR","BOTH IP/OP","$779.63 ","$576.93 ","$0.00 ","$779.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$779.63 ","$0.00 ","$389.81 ","$617.47 ","$623.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-1-010","SUP","Custom 27203010","","4922-1-010  -  COUPLING EXFIX 5MM 8MM ROD TO ROD","BOTH IP/OP","$1,360.45 ","$1,006.73 ","$0.00 ","$1,686.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,686.95 ","$0.00 ","$843.48 ","$1,336.06 ","$1,349.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-1-020","SUP","Custom 27203010","","4922-1-020  -  COUPLING EXFIX 5/8IN 4IN 5 HOLE PIN TO ROD APEX PIN CLMP","BOTH IP/OP","$1,245.45 ","$921.63 ","$0.00 ","$1,686.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,686.95 ","$0.00 ","$843.48 ","$1,336.06 ","$1,349.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-1-030","SUP","Custom 27203010","","4922-1-030  -  COUPLING EXFIX 5MM 8MM PIN TO ROD","BOTH IP/OP","$1,360.45 ","$1,006.73 ","$0.00 ","$1,686.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,686.95 ","$0.00 ","$843.48 ","$1,336.06 ","$1,349.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-2-020","SUP","Custom 27203010","","4922-2-020  -  CLAMP EXFIX 4/5/6MM 5 HOLE MULTIPIN MODULAR HOFFMANN III","BOTH IP/OP","$1,401.85 ","$1,037.37 ","$0.00 ","$1,770.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,770.13 ","$0.00 ","$885.06 ","$1,401.94 ","$1,416.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-2-140","SUP","Custom 27203010","","4922-2-140  -  POST XTRNFX 30D 11MM HFMN 3","BOTH IP/OP","$246.10 ","$182.11 ","$0.00 ","$308.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.88 ","$0.00 ","$154.44 ","$244.63 ","$247.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-2-240","SUP","Custom 27203010","","4922-2-240  -  CLAMP EXFIX 30D 11MM 5 HOLE PIN POST MODULAR HOFFMANN III","BOTH IP/OP","$1,481.70 ","$1,096.46 ","$0.00 ","$1,958.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,958.23 ","$0.00 ","$979.11 ","$1,550.92 ","$1,566.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-150","SUP","Custom 27203010","","4922-8-150  -  ROD EXFIX 11MM 150MM CONNCTNG","BOTH IP/OP","$645.70 ","$477.82 ","$0.00 ","$892.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.98 ","$0.00 ","$446.49 ","$707.24 ","$714.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-200","SUP","Custom 27203010","","4922-8-200  -  ROD EXFIX 11MM 200MM CONNCTNG MRI HOFFMANN 3 CARB","BOTH IP/OP","$662.20 ","$490.03 ","$0.00 ","$918.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$918.73 ","$0.00 ","$459.36 ","$727.63 ","$734.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-250","SUP","Custom 27203010","","4922-8-250  -  ROD EXFIX 11MM 250MM CONNCTNG","BOTH IP/OP","$662.20 ","$490.03 ","$0.00 ","$918.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$918.73 ","$0.00 ","$459.36 ","$727.63 ","$734.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-300","SUP","Custom 27203010","","4922-8-300  -  ROD EXFIX 11MM 300MM CONNCTNG MRI SAFE HOFFMANN III CARB","BOTH IP/OP","$679.80 ","$503.05 ","$0.00 ","$940.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-350","SUP","Custom 27203010","","4922-8-350  -  ROD EXFIX 11MM 350MM CONNCTNG MRI HOFFMANN 3 CARB","BOTH IP/OP","$679.80 ","$503.05 ","$0.00 ","$940.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$940.50 ","$0.00 ","$470.25 ","$744.88 ","$752.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-400","SUP","Custom 27203010","","4922-8-400  -  ROD EXFIX 11MM 400MM CONNCTNG MRI HOFFMANN 3 CARB","BOTH IP/OP","$777.70 ","$575.50 ","$0.00 ","$1,025.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.65 ","$0.00 ","$512.83 ","$812.31 ","$820.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4922-8-500","SUP","HCPCS C1713","","4922-8-500  -  ROD EXFIX 11MM 500MM CONNECT MRI SAFE MODULAR HOFFMANN III","BOTH IP/OP","$887.70 ","$656.90 ","$0.00 ","$1,128.60 ","$507.87 ","$0.00 ","$185.02 ","$0.00 ","$0.00 ","$197.61 ","$1,128.60 ","$0.00 ","$564.30 ","$893.85 ","$902.88 ","$0.00 ","$176.63 ","$0.00 ","$179.67 ","$0.00 "
"493.100.01S","SUP","Custom 27803010","","493.100.01S  -  WIRE FX 26GA 500MM STRL NDL TI","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"493.101.01S","SUP","Custom 27803010","","493.101.01S  -  WIRE FX 28GA 500MM STRL NDL TI","BOTH IP/OP","$229.50 ","$169.83 ","$0.00 ","$229.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$229.50 ","$0.00 ","$114.75 ","$181.76 ","$183.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"493.102.01S","SUP","Custom 27803010","","493.102.01S  -  WIRE SPINAL .25MM 500MM NEEDLE TITANIUM STERILE","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"493.103.01S","SUP","Custom 27803010","","493.103.01S  -  WIRE SPINAL .2MM 500MM NEEDLE TITANIUM STERILE","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"493.104.01S","SUP","Custom 27803010","","493.104.01S  -  WIRE FX 28GA 500MM STRL BRB NDL TI","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"49-36-1550","SUP","Custom 27203010","","PAD FLRMCHN FOAM THK2IN 8IN CMPD MILWAUKEE","BOTH IP/OP","$42.58 ","$31.51 ","$0.00 ","$42.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.58 ","$0.00 ","$21.29 ","$33.72 ","$34.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"494.771SHA","SUP","HCPCS C1713","","494.771SHA  -  SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC","BOTH IP/OP","$337.53 ","$249.77 ","$0.00 ","$327.70 ","$147.47 ","$0.00 ","$70.35 ","$0.00 ","$0.00 ","$57.38 ","$327.70 ","$0.00 ","$163.85 ","$259.54 ","$262.16 ","$0.00 ","$49.79 ","$0.00 ","$52.17 ","$0.00 "
"494.784SHA","SUP","HCPCS C1713","","494.784SHA  -  SCREW BONE 5MM 150MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC","BOTH IP/OP","$382.08 ","$282.74 ","$0.00 ","$370.95 ","$166.93 ","$0.00 ","$79.63 ","$0.00 ","$0.00 ","$64.95 ","$370.95 ","$0.00 ","$185.48 ","$293.79 ","$296.76 ","$0.00 ","$56.36 ","$0.00 ","$59.06 ","$0.00 "
"494.785SHA","SUP","HCPCS C1713","","494.785SHA  -  SCREW BONE 5MM 175MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC","BOTH IP/OP","$382.08 ","$282.74 ","$0.00 ","$370.95 ","$166.93 ","$0.00 ","$79.63 ","$0.00 ","$0.00 ","$64.95 ","$370.95 ","$0.00 ","$185.48 ","$293.79 ","$296.76 ","$0.00 ","$56.36 ","$0.00 ","$59.06 ","$0.00 "
"494.786SHA","SUP","HCPCS C1713","","494.786SHA  -  SCREW BONE 5MM 200MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC","BOTH IP/OP","$382.08 ","$282.74 ","$0.00 ","$370.95 ","$166.93 ","$0.00 ","$79.63 ","$0.00 ","$0.00 ","$64.95 ","$370.95 ","$0.00 ","$185.48 ","$293.79 ","$296.76 ","$0.00 ","$56.36 ","$0.00 ","$59.06 ","$0.00 "
"4940-0-015","SUP","Custom 27203010","","4940-0-015  -  TUBE XTRNFX SM 15MM 5MM HFMN2 C CMPR DSTRCT C","BOTH IP/OP","$844.25 ","$624.75 ","$0.00 ","$844.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$844.25 ","$0.00 ","$422.13 ","$668.65 ","$675.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-1-010","SUP","Custom 27203010","","4940-1-010  -  COUPLING XTRNFX NS HFMN2 C ROD TO ROD 5 MM ROD/POST","BOTH IP/OP","$522.50 ","$386.65 ","$0.00 ","$522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$522.50 ","$0.00 ","$261.25 ","$413.82 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-1-015","SUP","Custom 27203010","","4940-1-015  -  CLAMP EXFIX HFMN2 C KNEE CPLNG","BOTH IP/OP","$584.38 ","$432.44 ","$0.00 ","$584.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$584.38 ","$0.00 ","$292.19 ","$462.83 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-1-020","SUP","Custom 27203010","","4940-1-020  -  CPLNG EXFIX 5MM HFMN2 C 5MM 3-4MM PIN TO ROD","BOTH IP/OP","$522.50 ","$386.65 ","$0.00 ","$522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$522.50 ","$0.00 ","$261.25 ","$413.82 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-1-058","SUP","Custom 27203010","","4940-1-058  -  CPLNG EXFIX 5MM HFMN2 C 5MM 8-8MM PIN TO ROD","BOTH IP/OP","$807.13 ","$597.28 ","$0.00 ","$807.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$807.13 ","$0.00 ","$403.56 ","$639.25 ","$645.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-1-100","SUP","Custom 27203010","","4940-1-100  -  DEVICE EXFIX HFMN2 C CMPR DSTRCT ROD TO TUBE CPLNG","BOTH IP/OP","$522.50 ","$386.65 ","$0.00 ","$522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$522.50 ","$0.00 ","$261.25 ","$413.82 ","$418.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-2-020","SUP","Custom 27203010","","4940-2-020  -  CLAMP EXFIX HFMN2 4 HOLE MLPN","BOTH IP/OP","$1,575.90 ","$1,166.17 ","$0.00 ","$617.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.38 ","$0.00 ","$308.69 ","$488.96 ","$493.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-2-120","SUP","Custom 27203010","","4940-2-120  -  POST XTRNFX STRG 5MM HFMN2 C SS","BOTH IP/OP","$298.70 ","$221.04 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4940-2-140","SUP","Custom 27203010","","4940-2-140  -  POST XTRNFX 30D 5MM HFMN2 C SS","BOTH IP/OP","$298.70 ","$221.04 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-0-015","SUP","Custom 27203010","","4941-0-015  -  TUBE XTRNFX 15MM 350MM YLW HFMN2 C CMPR DSTRCT MRI SAFE C","BOTH IP/OP","$737.00 ","$545.38 ","$0.00 ","$737.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.00 ","$0.00 ","$368.50 ","$583.70 ","$589.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-1-010","SUP","Custom 27203010","","4941-1-010  -  CPLNG EXFIX HFMN2 ROD TO ROD CMPCT 5 MM ROD OR POST","BOTH IP/OP","$514.25 ","$380.55 ","$0.00 ","$514.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$514.25 ","$0.00 ","$257.13 ","$407.29 ","$411.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-1-020","SUP","Custom 27203010","","4941-1-020  -  CLAMP EXFIX HFMN2 MRI PIN TO ROD CPLNG MRI 5 MM ROD OR POST","BOTH IP/OP","$514.25 ","$380.55 ","$0.00 ","$514.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$514.25 ","$0.00 ","$257.13 ","$407.29 ","$411.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-1-058","SUP","Custom 27203010","","4941-1-058  -  COUPLING XTRNFX HFMN2 C MR SF 5 MM 8 MM ROD","BOTH IP/OP","$746.63 ","$552.51 ","$0.00 ","$746.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$746.63 ","$0.00 ","$373.31 ","$591.33 ","$597.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-1-100","SUP","Custom 27203010","","4941-1-100  -  SYSTEM EXFIX 15MM 5MM DSTRCT TUBE ROD CPLNG POSTS","BOTH IP/OP","$456.50 ","$337.81 ","$0.00 ","$456.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$456.50 ","$0.00 ","$228.25 ","$361.55 ","$365.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-2-020","SUP","Custom 27203010","","4941-2-020  -  CLAMP EXFIX HFMN2 C 4 HOLE PIN 3-4 MM PIN","BOTH IP/OP","$621.50 ","$459.91 ","$0.00 ","$621.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$621.50 ","$0.00 ","$310.75 ","$492.23 ","$497.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-2-120","SUP","Custom 27203010","","4941-2-120  -  POST XTRNFX 30D STRG AU HFMN2 C MDLR MRI SAFE AL TI","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-2-140","SUP","Custom 27203010","","4941-2-140  -  POST XTRNFX 30D HFMN2 C MRI SAFE","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4941-2-200","SUP","Custom 27203010","","4941-2-200  -  CLAMP EXFIX HFMN2 MRI PERIART PIN CMPCT","BOTH IP/OP","$621.50 ","$459.91 ","$0.00 ","$621.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$621.50 ","$0.00 ","$310.75 ","$492.23 ","$497.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-1-010","SUP","Custom 27203010","","4960-1-010  -  CPLNG EXFIX 3MM 3MM HFMN2 ROD TO ROD","BOTH IP/OP","$841.50 ","$622.71 ","$0.00 ","$734.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$734.25 ","$0.00 ","$367.13 ","$581.53 ","$587.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-1-020","SUP","Custom 27203010","","4960-1-020  -  CPLNG EXFIX 1.65-2MM 3MM HFMN2 MIC HAND PIN TO ROD","BOTH IP/OP","$734.25 ","$543.35 ","$0.00 ","$734.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$734.25 ","$0.00 ","$367.13 ","$581.53 ","$587.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-1-060","SUP","Custom 27203010","","4960-1-060  -  CPLNG EXFIX 5MM 3MM HFMN2 ROD TO ROD","BOTH IP/OP","$855.75 ","$633.26 ","$0.00 ","$746.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$746.63 ","$0.00 ","$373.31 ","$591.33 ","$597.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-2-020","SUP","Custom 27203010","","4960-2-020  -  CLAMP EXFIX HFMN2 STR MLPN","BOTH IP/OP","$855.75 ","$633.26 ","$0.00 ","$746.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$746.63 ","$0.00 ","$373.31 ","$591.33 ","$597.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-3-000","SUP","Custom 27203010","","4960-3-000  -  DEVICE EXFIX HFMN2 MIC LNTHNR","BOTH IP/OP","$4,581.00 ","$3,389.94 ","$0.00 ","$4,449.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,449.50 ","$0.00 ","$2,224.75 ","$3,524.00 ","$3,559.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-3-015","SUP","Custom 27203010","","4960-3-015  -  CLAMP EXFIX HFMN2 MIC MLPN LNTHNR CMPNT","BOTH IP/OP","$64.50 ","$47.73 ","$0.00 ","$59.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.13 ","$0.00 ","$29.56 ","$46.83 ","$47.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-3-020","SUP","Custom 27203010","","4960-3-020  -  CLAMP EXFIX HFMN2 MIC MLPN LNTHNR CMPNT","BOTH IP/OP","$1,524.00 ","$1,127.76 ","$0.00 ","$651.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$651.75 ","$0.00 ","$325.88 ","$516.19 ","$521.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-3-025","SUP","Custom 27203010","","4960-3-025  -  CLAMP EXFIX HFMN2 PERIART MLPN LNTHNR","BOTH IP/OP","$1,524.00 ","$1,127.76 ","$0.00 ","$651.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$651.75 ","$0.00 ","$325.88 ","$516.19 ","$521.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4960-3-030","SUP","Custom 27203010","","4960-3-030  -  HII MICRO LENGTHENER THUMBWHEEL","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$174.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.63 ","$0.00 ","$87.31 ","$138.31 ","$139.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"497.668E","SUP","HCPCS C1713","","497.668E  -  SCREW TI 8MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.670E","SUP","HCPCS C1713","","497.670E  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.672E","SUP","HCPCS C1713","","497.672E  -  SCREW TI 12MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.674E","SUP","HCPCS C1713","","497.674E  -  SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.676E","SUP","HCPCS C1713","","497.676E  -  SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.678E","SUP","HCPCS C1713","","497.678E  -  SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.680E","SUP","HCPCS C1713","","497.680E  -  2.4MM TI LOCKING SCREW 20MM F/LOCKING RECONSTRUCTION PLATE","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"497.682E","SUP","HCPCS C1713","","497.682E  -  2.4MM TI LOCKING SCREW 22MM F/LOCKING RECONSTRUCTION PLATE","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"497.684E","SUP","HCPCS C1713","","497.684E  -  2.4MM TI LOCKING SCREW 24MM F/LOCKING RECONSTRUCTION PLATE","BOTH IP/OP","$389.25 ","$288.05 ","$0.00 ","$389.25 ","$175.16 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$68.15 ","$389.25 ","$0.00 ","$194.63 ","$308.29 ","$311.40 ","$0.00 ","$60.92 ","$0.00 ","$61.97 ","$0.00 "
"497.689E","SUP","HCPCS C1713","","497.689E  -  TI BENDING INSERT SCREW F/LOCKING RECONSTRUCTION PLATE","BOTH IP/OP","$113.63 ","$84.09 ","$0.00 ","$113.63 ","$51.13 ","$0.00 ","$23.68 ","$0.00 ","$0.00 ","$19.89 ","$113.63 ","$0.00 ","$56.81 ","$89.99 ","$90.90 ","$0.00 ","$17.78 ","$0.00 ","$18.09 ","$0.00 "
"497.690E","SUP","HCPCS C1713","","497.690E  -  SCREW TI 8MM 3MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.691E","SUP","HCPCS C1713","","497.691E  -  SCREW TI 10MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.692E","SUP","HCPCS C1713","","497.692E  -  SCREW TI 12MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.693E","SUP","HCPCS C1713","","497.693E  -  SCREW TI 14MM 3MM MANDIB SLFTAP LCK BONE STRL RECON PLT","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.694E","SUP","HCPCS C1713","","497.694E  -  SCREW BONE 16MM 3MM CRNMXF TI SLFTAP LCK RECON PLT STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.695E","SUP","HCPCS C1713","","497.695E  -  SCREW BONE 18MM 3MM CRNMXF TI SLFTAP LCK RECON PLT STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.45 ","$0.00 ","$0.21 ","$0.00 ","$0.00 ","$0.18 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.16 ","$0.00 ","$0.16 ","$0.00 "
"497.696E","SUP","HCPCS C1713","","497.696E  -  SCREW TI 20MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"497.697E","SUP","HCPCS C1713","","497.697E  -  SCREW BONE 3MM 22MM TI ORTH LCK NONSTRL","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"497.698E","SUP","HCPCS C1713","","497.698E  -  3.0MM TI LOCKING SCREW 24MM F/LOCKING RECONSTRUCTION PLATE","BOTH IP/OP","$452.25 ","$334.67 ","$0.00 ","$452.25 ","$203.51 ","$0.00 ","$94.26 ","$0.00 ","$0.00 ","$79.19 ","$452.25 ","$0.00 ","$226.13 ","$358.18 ","$361.80 ","$0.00 ","$70.78 ","$0.00 ","$72.00 ","$0.00 "
"497.78.98","SUP","HCPCS C1713","","497.78.98  -  SCREW TI 5MM 1.8MM MAXFACL LCK BONE THORP NONSTRL","BOTH IP/OP","$85.50 ","$63.27 ","$0.00 ","$85.50 ","$38.48 ","$0.00 ","$17.82 ","$0.00 ","$0.00 ","$14.97 ","$85.50 ","$0.00 ","$42.75 ","$67.72 ","$68.40 ","$0.00 ","$13.38 ","$0.00 ","$13.61 ","$0.00 "
"497-670","SUP","HCPCS C1713","","497-670  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK RECON BONE NONSTRL","BOTH IP/OP","$272.25 ","$201.47 ","$0.00 ","$272.25 ","$122.51 ","$0.00 ","$56.74 ","$0.00 ","$0.00 ","$47.67 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$42.61 ","$0.00 ","$43.34 ","$0.00 "
"498.800.01S","SUP","Custom 27803010","","498.800.01S  -  CABLE ORTHOPEDIC 1MM 750MM CRIMP TITANIUM STERILE","BOTH IP/OP","$919.33 ","$680.30 ","$0.00 ","$892.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.55 ","$0.00 ","$446.28 ","$706.90 ","$714.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.803S","SUP","Custom 27203010","","498.803S  -  POSITIONER IMPLANT 4.5MM THREAD CERCLAGE TITANIUM STERILE","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.806S","SUP","Custom 27803010","","498.806S  -  SYSTEM CABLE STANDARD REATTACHMENT DEVICE TITANIUM COCR","BOTH IP/OP","$3,644.95 ","$2,697.26 ","$0.00 ","$3,538.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,538.80 ","$0.00 ","$1,769.40 ","$2,802.73 ","$2,831.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.807S","SUP","Custom 27803010","","498.807S  -  SYSTEM CABLE LONG TITANIUM COCR TROC STERILE REATTACHMENT","BOTH IP/OP","$5,251.68 ","$3,886.24 ","$0.00 ","$5,098.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,098.70 ","$0.00 ","$2,549.35 ","$4,038.17 ","$4,078.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.821S","SUP","Custom 27803010","","498.821S  -  CABLE ORTHOPEDIC 1MM 750MM NEEDLE CRIMP TITANIUM STERILE","BOTH IP/OP","$1,031.78 ","$763.52 ","$0.00 ","$1,001.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,001.73 ","$0.00 ","$500.86 ","$793.37 ","$801.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.822S","SUP","Custom 27803010","","498.822S  -  CABLE ORTHOPEDIC CRIMP TITANIUM STERILE","BOTH IP/OP","$67.83 ","$50.19 ","$0.00 ","$65.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.85 ","$0.00 ","$32.93 ","$52.15 ","$52.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.837S","SUP","Custom 27203010","","498.837S  -  PIN FIX 3.5MM CERCLAGE POSITION STR TITANIUM ORTHOPEDIC","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"498.838S","SUP","HCPCS C1713","","498.838S  -  PIN FIX 3.5MM THREADED CERCLAGE POSITIONING TITANIUM","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$149.85 ","$0.00 ","$71.49 ","$0.00 ","$0.00 ","$58.31 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$50.60 ","$0.00 ","$53.01 ","$0.00 "
"498.839S","SUP","Custom 27203010","","498.839S  -  POSITIONER SURG 4.5MM CERCLAGE NONTHREADED PIN TITANIUM","BOTH IP/OP","$343.00 ","$253.82 ","$0.00 ","$333.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.00 ","$0.00 ","$166.50 ","$263.74 ","$266.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4981-1-010S","SUP","Custom 27203010","","4981-1-010S  -  CPLNG EXFIX 15/15MM 4 5/15MM HFMN XPRESS UNV STRL","BOTH IP/OP","$696.50 ","$515.41 ","$0.00 ","$790.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4981-1-020S","SUP","Custom 27203010","","4981-1-020S  -  COUPLING XTRNFX UNV 5MM 6MM","BOTH IP/OP","$845.63 ","$625.77 ","$0.00 ","$845.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$845.63 ","$0.00 ","$422.81 ","$669.74 ","$676.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4A0002","SUP","HCPCS C1725","","4A0002  -  CATHETER ANGIO JR4 CRV 4FR 100CM STSR","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"4A0004","SUP","HCPCS C1887","","4A0004  -  CATHETER ANGIOGRAPHIC JR5 CURVE 4FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"4A001","SUP","HCPCS C1725","","CATHETER 4FR JR 3.5","BOTH IP/OP","$0.80 ","$0.59 ","$0.00 ","$0.80 ","$0.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.14 ","$0.80 ","$0.00 ","$0.40 ","$0.63 ","$0.64 ","$0.00 ","$0.13 ","$0.00 ","$0.13 ","$0.00 "
"4A0010","SUP","HCPCS C1725","","4A0010  -  CATHETER ANGIOGRAPHIC JL3.5 CURVE 4FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"4A0011","SUP","HCPCS C1725","","4A0011  -  CATHETER ANGIO JL4 CRV 4FR 100CM STSR","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"4A0012","SUP","HCPCS C1725","","4A0012  -  CATHETER ANGIOGRAPHIC JL5 CURVE 4FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"4A002","SUP","HCPCS C1887","","4A002  -  CATHETER GD JR CRV 4FR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$3.65 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"4A0022","SUP","HCPCS C1725","","4A0022  -  CATHETER ANGIOGRAPHIC MPA2 CURVE 4FR 100CM 2 SIDEHOLE","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"4A101","SUP","Custom 27203010","","HAMMER TL 12.25IN 1.25IN NUPLA FBGLS PLMR DEAD BLOW 4IN 16OZ","BOTH IP/OP","$62.90 ","$46.55 ","$0.00 ","$62.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.90 ","$0.00 ","$31.45 ","$49.82 ","$50.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4DCFN","SUP","Custom 27203010","","4DCFN  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN","BOTH IP/OP","$83.74 ","$61.97 ","$0.00 ","$83.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.74 ","$0.00 ","$41.87 ","$66.32 ","$66.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4DCFS","SUP","Custom 27203010","","4DCFS  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN","BOTH IP/OP","$89.90 ","$66.53 ","$0.00 ","$89.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.90 ","$0.00 ","$44.95 ","$71.20 ","$71.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4DFEN","SUP","Custom 27203010","","4DFEN  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUF DISP INR CNN RND","BOTH IP/OP","$99.43 ","$73.58 ","$0.00 ","$100.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.92 ","$0.00 ","$50.46 ","$79.93 ","$80.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4MAXC","SUP","HCPCS C1757","","4MAXC  -  CATHETER REPERFUSION 4MAX","BOTH IP/OP","$3,725.00 ","$2,756.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$776.38 ","$0.00 ","$0.00 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4MAXCKIT","SUP","HCPCS C1757","","4MAXCKIT  -  CATHETER REPERFUSION 4MAX","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4N06A","SUP","Custom 27803010","","4N06A  -  SUTURE NABSB CV-4 TH-26 36IN WHT 2 ARM MFL GRTX","BOTH IP/OP","$67.50 ","$49.95 ","$0.00 ","$66.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.46 ","$0.00 ","$33.23 ","$52.64 ","$53.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"4R5126","SUP","Custom 27203010","","DEVICE HMTP SEG NDL PRTC BLOOD BANK STRL","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50000LTS","SUP","HCPCS C1713","","50000LTS  -  CAP LCK SPRL R90D TI SPNE WDG LCK CLSR MECH","BOTH IP/OP","$696.43 ","$515.36 ","$0.00 ","$696.43 ","$313.39 ","$0.00 ","$145.15 ","$0.00 ","$0.00 ","$121.94 ","$696.43 ","$0.00 ","$348.21 ","$551.57 ","$557.14 ","$0.00 ","$108.99 ","$0.00 ","$110.87 ","$0.00 "
"500-01-42A","SUP","Custom 27803010","","500-01-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-44B","SUP","Custom 27803010","","500-01-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-46C","SUP","Custom 27803010","","500-01-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-48D","SUP","Custom 27803010","","500-01-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-50D","SUP","Custom 27803010","","500-01-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-52E","SUP","Custom 27803010","","500-01-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-54E","SUP","Custom 27803010","","500-01-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-56F","SUP","Custom 27803010","","500-01-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-58F","SUP","Custom 27803010","","500-01-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-60G","SUP","Custom 27803010","","500-01-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-62G","SUP","Custom 27803010","","500-01-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-64H","SUP","Custom 27803010","","500-01-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-66H","SUP","Custom 27803010","","500-01-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-68I","SUP","Custom 27803010","","500-01-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-70I","SUP","Custom 27803010","","500-01-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-72J","SUP","Custom 27803010","","500-01-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-01-74J","SUP","Custom 27803010","","500-01-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-44A","SUP","Custom 27803010","","500-03-44A  -  SHELL ACETAB A HEMISPHERICAL 44MM SOLID BACK TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-46B","SUP","Custom 27803010","","500-03-46B  -  SHELL ACETAB B HEMISPHERICAL 46MM SOLID BACK TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-48C","SUP","Custom 27803010","","500-03-48C  -  SHELL ACETAB C HEMISPHERICAL 48MM SOLID BACK TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-50D","SUP","Custom 27803010","","500-03-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-52D","SUP","Custom 27803010","","500-03-52D  -  SHELL ACETAB D HEMISPHERICAL 52MM SOLID BACK TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-54E","SUP","Custom 27803010","","500-03-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-56E","SUP","Custom 27803010","","500-03-56E  -  SHELL ACETAB E HEMISPHERICAL 56MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-58F","SUP","Custom 27803010","","500-03-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-60F","SUP","Custom 27803010","","500-03-60F  -  SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-62G","SUP","Custom 27803010","","500-03-62G  -  SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-64G","SUP","Custom 27803010","","500-03-64G  -  SHELL ACETAB G HEMISPHERICAL 64MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-03-66H","SUP","Custom 27803010","","500-03-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK PRIM TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5000L","SUP","Custom 27803010","","5000L  -  CONNECTOR ROD LNG SPRL R90D VAR CX TI SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5000M","SUP","Custom 27803010","","5000M  -  CONNECTOR ROD MED SPRL R90D VAR CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5000S","SUP","Custom 27803010","","5000S  -  CONNECTOR ROD SM SPRL R90D VAR CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50010X","SUP","Custom 27803010","","50010X  -  CONNECTOR ROD 10MM SPRL R90D FX CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-42A","SUP","Custom 27803010","","500-11-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-44B","SUP","Custom 27803010","","500-11-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-46C","SUP","Custom 27803010","","500-11-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-48D","SUP","Custom 27803010","","500-11-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-50D","SUP","Custom 27803010","","500-11-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-52E","SUP","Custom 27803010","","500-11-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-54E","SUP","Custom 27803010","","500-11-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-56F","SUP","Custom 27803010","","500-11-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-58F","SUP","Custom 27803010","","500-11-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-60G","SUP","Custom 27803010","","500-11-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-62G","SUP","Custom 27803010","","500-11-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-64H","SUP","Custom 27803010","","500-11-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-66H","SUP","Custom 27803010","","500-11-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-68I","SUP","Custom 27803010","","500-11-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-70I","SUP","Custom 27803010","","500-11-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-72J","SUP","Custom 27803010","","500-11-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-11-74J","SUP","Custom 27803010","","500-11-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT METAL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50012X","SUP","Custom 27803010","","50012X  -  CONNECTOR ROD 12MM SPRL R90D FX CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50014X","SUP","Custom 27803010","","50014X  -  CONNECTOR ROD 14MM SPRL R90D FX CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50016X","SUP","Custom 27803010","","50016X  -  CONNECTOR ROD 16MM SPRL R90D FX CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50018X","SUP","Custom 27803010","","50018X  -  CONNECTOR ROD 18MM SPRL R90D FX CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50020X","SUP","Custom 27803010","","50020X  -  CONNECTOR ROD 20MM SPRL R90D VAR CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-022-01-07","SUP","Custom 27100030","","50-022-01-07  -  DRILL TWIST 2.7MM 2.2MM 70MM J NOTCH GLIDING 2.7MM SCREW 2.1","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-022-15-07","SUP","Custom 27100030","","50-022-15-07  -  DRILL TWIST 2.2MM 115MM STERILE","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50022X","SUP","Custom 27803010","","50022X  -  CONNECTOR ROD 22MM SPRL R90D VAR CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50024X","SUP","Custom 27803010","","50024X  -  CONNECTOR ROD 24MM SPRL R90D VAR CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50026X","SUP","Custom 27803010","","50026X  -  CONNECTOR ROD 26MM SPRL R90D CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50028X","SUP","Custom 27803010","","50028X  -  CONNECTOR ROD 28MM SPRL R90D CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50030X","SUP","Custom 27803010","","50030X  -  CONNECTOR ROD 30MM SPRL R90D CX TI THORLMBR SPNE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 A","SUP","Custom 27803010","","5005 A  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 B","SUP","Custom 27803010","","5005 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 C","SUP","Custom 27803010","","5005 C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 E","SUP","Custom 27803010","","5005 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 F","SUP","Custom 27803010","","5005 F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 G","SUP","Custom 27803010","","5005 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 H","SUP","Custom 27803010","","5005 H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5005 I","SUP","Custom 27803010","","5005 I  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"500-580C-10U","SUP","Custom 27803010","","500-580C-10U  -  CLIP HMSTS 5FR BMRNG CTLST 2 SYS ART VASC CATH ACCES ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50100-1500","SUP","HCPCS C1884","","50100-1500  -  SHEATH RTRVL 4FR F EZ .014IN BNTP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"50-12003","SUP","HCPCS C1713","","50-12003  -  SCREW BONE 1.2MM 3MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL","BOTH IP/OP","$27.75 ","$20.54 ","$0.00 ","$27.75 ","$12.49 ","$0.00 ","$5.78 ","$0.00 ","$0.00 ","$4.86 ","$27.75 ","$0.00 ","$13.88 ","$21.98 ","$22.20 ","$0.00 ","$4.34 ","$0.00 ","$4.42 ","$0.00 "
"50-12004","SUP","HCPCS C1713","","50-12004  -  SCREW BONE 1.2MM 4MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$57.84 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12005","SUP","HCPCS C1713","","50-12005  -  SCREW BONE 1.2MM 5MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$57.84 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12006","SUP","HCPCS C1713","","50-12006  -  SCREW BONE 1.2MM 6MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$57.84 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12007","SUP","HCPCS C1713","","50-12007  -  SCREW BONE 1.2MM 7MM SLFTAP TITANIUM UPPERFACIAL","BOTH IP/OP","$111.25 ","$82.33 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$23.19 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12008","SUP","HCPCS C1713","","50-12008  -  SCREW BONE 1.2MM 8MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL","BOTH IP/OP","$111.25 ","$82.33 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$23.19 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12010","SUP","HCPCS C1713","","50-12010  -  SCREW BONE 1.2MM 10MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL","BOTH IP/OP","$111.25 ","$82.33 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$23.19 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12012","SUP","HCPCS C1713","","50-12012  -  SCREW BONE 1.2MM 12MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL","BOTH IP/OP","$111.25 ","$82.33 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$23.19 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"50-12903","SUP","HCPCS C1713","","50-12903  -  SCREW BONE 1.2MM 3MM SLFDRILL XPIN HEAD LEIBINGER UNIVERSAL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"50-12904","SUP","HCPCS C1713","","50-12904  -  SCREW BONE 1.2MM 4MM SELF DRILL XPIN TITANIUM UPPERFACIAL","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$28.13 ","$0.00 ","$13.03 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"5013-2-120S","SUP","HCPCS C1713","","5013-2-120S  -  PIN 120MM 4MM APEX HA SS SLFTAP DRL THRD SHFT 20MM STRL","BOTH IP/OP","$228.65 ","$169.20 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$47.66 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"5013-3-090S","SUP","HCPCS C1713","","5013-3-090S  -  PIN 90MM 4MM APEX HA SS SLFTAP DRL THRD SHFT 30MM STRL","BOTH IP/OP","$228.65 ","$169.20 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$47.66 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-14003","SUP","HCPCS C1713","","50-14003  -  SCREW BONE 1.4MM 3MM SELF TAP XPIN EMERGENCY TITANIUM","BOTH IP/OP","$282.50 ","$209.05 ","$0.00 ","$282.50 ","$127.13 ","$0.00 ","$58.88 ","$0.00 ","$0.00 ","$49.46 ","$282.50 ","$0.00 ","$141.25 ","$223.74 ","$226.00 ","$0.00 ","$44.21 ","$0.00 ","$44.97 ","$0.00 "
"50-14005","SUP","HCPCS C1713","","50-14005  -  SCREW BONE 1.4MM 5MM SELF TAP XPIN HEAD EMERGENCY LEIBINGER","BOTH IP/OP","$282.50 ","$209.05 ","$0.00 ","$282.50 ","$127.13 ","$0.00 ","$58.88 ","$0.00 ","$0.00 ","$49.46 ","$282.50 ","$0.00 ","$141.25 ","$223.74 ","$226.00 ","$0.00 ","$44.21 ","$0.00 ","$44.97 ","$0.00 "
"50-14007","SUP","HCPCS C1713","","50-14007  -  SCREW BONE 1.4MM 7MM SLFTAP XPIN EMERGENCY TITANIUM","BOTH IP/OP","$120.38 ","$89.08 ","$0.00 ","$282.50 ","$127.13 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$49.46 ","$282.50 ","$0.00 ","$141.25 ","$223.74 ","$226.00 ","$0.00 ","$44.21 ","$0.00 ","$44.97 ","$0.00 "
"50-14009","SUP","HCPCS C1713","","50-14009  -  SCREW BONE 1.4MM 9MM SLFTAP XPIN EMERGENCY TITANIUM","BOTH IP/OP","$120.38 ","$89.08 ","$0.00 ","$282.50 ","$127.13 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$49.46 ","$282.50 ","$0.00 ","$141.25 ","$223.74 ","$226.00 ","$0.00 ","$44.21 ","$0.00 ","$44.97 ","$0.00 "
"5014-2-120S","SUP","HCPCS C1713","","5014-2-120S  -  PIN 6MM SLFTAP/DRL THRD SHFT 120MM APEX HA SS 30MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-3-150S","SUP","HCPCS C1713","","5014-3-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 30MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-3-180S","SUP","HCPCS C1713","","5014-3-180S  -  PIN HALF 180MM 6MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 30MM","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-3-200S","SUP","HCPCS C1713","","5014-3-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 30MM STRL","BOTH IP/OP","$268.13 ","$198.42 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$55.88 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"5014-4-150S","SUP","HCPCS C1713","","5014-4-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 40MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-4-180S","SUP","HCPCS C1713","","5014-4-180S  -  PIN 6MM SLFTAP/DRL THRD SHFT 180MM APEX HA SS 40MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-4-200S","SUP","HCPCS C1713","","5014-4-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 40MM STRL","BOTH IP/OP","$268.13 ","$198.42 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$55.88 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"5014-5-150S","SUP","HCPCS C1713","","5014-5-150S  -  PIN HALF 150MM 6MM APEX HA SS SLFDRILL SLFTAP 50MM FIX SYS","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-5-180S","SUP","HCPCS C1713","","5014-5-180S  -  PIN HALF 180MM 6MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 50MM","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-5-200S","SUP","HCPCS C1713","","5014-5-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 50MM STRL","BOTH IP/OP","$268.13 ","$198.42 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$55.88 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"5014-6-150S","SUP","HCPCS C1713","","5014-6-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 60MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-6-180S","SUP","HCPCS C1713","","5014-6-180S  -  PIN 6MM SLFTAP/DRL THRD SHFT 180MM APEX HA SS 60MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-6-200S","SUP","HCPCS C1713","","5014-6-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 60MM STRL","BOTH IP/OP","$268.13 ","$198.42 ","$0.00 ","$268.13 ","$120.66 ","$0.00 ","$55.88 ","$0.00 ","$0.00 ","$46.95 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$41.96 ","$0.00 ","$42.69 ","$0.00 "
"5014-7-250S","SUP","HCPCS C1713","","5014-7-250S  -  PIN HALF 250MM 6MM APEX SS HA SLFDRILL SLFTAP THRD 70MM STRL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"5014-8-150S","SUP","HCPCS C1713","","5014-8-150S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 25MM STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5014-8-250S","SUP","HCPCS C1713","","5014-8-250S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 80MM STRL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"5014-9-250S","SUP","HCPCS C1713","","5014-9-250S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 250MM APEX HA SS 90MM STRL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"50-15006","SUP","HCPCS C1713","","50-15006  -  SCREW BN 1.5MM 6MM ST CROSSPIN TI CRNMXF","BOTH IP/OP","$140.68 ","$104.10 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$29.32 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"5015-3-120","SUP","HCPCS C1713","","5015-3-120  -  SCREW BONE 5MM 120MM 35MM APEX THRD CANC","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"5015-4-150","SUP","HCPCS C1713","","5015-4-150  -  PIN 5MM 150MM CANC APEX TI 40MM","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"5015-5-150","SUP","HCPCS C1713","","5015-5-150  -  SCREW BONE 5MM 150MM 50MM APEX THRD CANC","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"5015-6-180","SUP","HCPCS C1713","","5015-6-180  -  SCREW BONE 5MM 180MM 60MM APEX SS CANC","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"5015-7-250","SUP","HCPCS C1713","","5015-7-250  -  PIN HALF 250MM 5MM APEX HFMN2 CANC SS THRD 70MM","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"50-15904","SUP","HCPCS C1713","","50-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL XPIN HEAD TITANIUM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-15905","SUP","HCPCS C1713","","50-15905  -  SCREW BONE 1.5MM 5MM SELF DRILL XPIN HEAD TITANIUM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"5016-5-111","SUP","HCPCS C1713","","5016-5-111  -  PIN HALF HFMN 5MMX120MM 35MM THRD TI SLFDRL ST F/EXFIX","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"5016-5-117","SUP","HCPCS C1713","","5016-5-117  -  PIN 5MM SLFDRILL SLFTAP 150MM APEX TI 40MM","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"5016-5-118","SUP","HCPCS C1713","","5016-5-118  -  PIN HALF HFMN 50MM 5MMX150MM TI SLFDRL ST F/EXFIX","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"5016-5-122","SUP","HCPCS C1713","","5016-5-122  -  PIN HALF HFMN 50MM 5MMX180MM TI SLFDRL ST F/EXFIX","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$213.13 ","$95.91 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$37.32 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$33.35 ","$0.00 ","$33.93 ","$0.00 "
"50-17003","SUP","HCPCS C1713","","50-17003  -  SCREW BONE 1.7MM 3MM SLFTAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$49.50 ","$36.63 ","$0.00 ","$49.50 ","$22.28 ","$0.00 ","$10.32 ","$0.00 ","$0.00 ","$8.67 ","$49.50 ","$0.00 ","$24.75 ","$39.20 ","$39.60 ","$0.00 ","$7.75 ","$0.00 ","$7.88 ","$0.00 "
"50-17004","SUP","HCPCS C1713","","50-17004  -  SCREW BONE 1.7MM 4MM SLFTAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-17006","SUP","HCPCS C1713","","50-17006  -  SCREW BONE 1.7MM 6MM SLFTAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-17007","SUP","HCPCS C1713","","50-17007  -  SCREW BONE 1.7MM 7MM SLFTAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$94.25 ","$69.75 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$19.64 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-17008","SUP","HCPCS C1713","","50-17008  -  SCREW BONE 1.7MM 8MM SELF TAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-17010","SUP","HCPCS C1713","","50-17010  -  SCREW BONE 1.7MM 10MM SELF TAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"50-17012","SUP","HCPCS C1713","","50-17012  -  SCREW BONE 1.7MM 12MM SLFTAP XPIN TITANIUM MIDFAC","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"5017-2-150S","SUP","HCPCS C1713","","5017-2-150S  -  PIN 5MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 20MM STRL","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"50-17304","SUP","HCPCS C1713","","50-17304  -  SCREW BN 1.7MM 4MM NS UNV NEURO 2 ST XPN ER CRNMXF","BOTH IP/OP","$125.70 ","$93.02 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$26.20 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"5017-3-150S","SUP","Custom 27203010","","5017-3-150S  -  PIN XTRNFX 5MM 150MM STRL 30MM APX SLF DRL ST SS HA","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5017-3-180S","SUP","HCPCS C1713","","5017-3-180S  -  PIN HALF 180MM 5MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 30MM","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"50-174-01-09","SUP","HCPCS C1713","","50-174-01-09  -  IMPLANT PRT JNT TI RT CNDYL 3 MM RECON PLT","BOTH IP/OP","$3,141.33 ","$2,324.58 ","$0.00 ","$3,141.33 ","$1,413.60 ","$0.00 ","$654.73 ","$0.00 ","$0.00 ","$550.02 ","$3,141.33 ","$0.00 ","$1,570.66 ","$2,487.93 ","$2,513.06 ","$0.00 ","$491.62 ","$0.00 ","$500.10 ","$0.00 "
"50-174-03-09","SUP","HCPCS C1713","","50-174-03-09  -  SCREW BN FX XDR TI CNDYL 3 MM RECON PLT","BOTH IP/OP","$1,008.13 ","$746.02 ","$0.00 ","$1,008.13 ","$453.66 ","$0.00 ","$210.12 ","$0.00 ","$0.00 ","$176.51 ","$1,008.13 ","$0.00 ","$504.06 ","$798.44 ","$806.50 ","$0.00 ","$157.77 ","$0.00 ","$160.49 ","$0.00 "
"5017-4-150S","SUP","HCPCS C1713","","5017-4-150S  -  PIN HALF STRL 150MM 5MM APEX SS SLFTAP SLFDRILL 40MM EXFIX","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"5017-4-180S","SUP","HCPCS C1713","","5017-4-180S  -  PIN HALF 180MM 5MM APEX HYDRXAPT EXFIX","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"50-17504","SUP","HCPCS C1713","","50-17504  -  SCREW BONE 1.7MM 4MM LOCK GRAY TITANIUM MIDFAC","BOTH IP/OP","$139.70 ","$103.38 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$29.12 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"50-17505","SUP","HCPCS C1713","","50-17505  -  SCREW BONE 1.7MM 5MM LOCKING XPIN GRAY TITANIUM MIDFAC","BOTH IP/OP","$139.70 ","$103.38 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$29.12 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"50-17506","SUP","HCPCS C1713","","50-17506  -  SCREW BONE 1.7MM 6MM SLFDRILL SLFTAP LOCKING XPIN TITANIUM","BOTH IP/OP","$139.70 ","$103.38 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$29.12 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"5017-5-150S","SUP","HCPCS C1713","","5017-5-150S  -  PIN HLF SLFDRL ORTH","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"5017-5-180S","SUP","HCPCS C1713","","5017-5-180S  -  PIN HALF 180MM 5MM APEX SS HA SLFDRILL SLFTAP THRD 50MM STRL","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"5017-6-150S","SUP","HCPCS C1713","","5017-6-150S  -  PIN 5MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 60MM STRL","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"5017-6-200S","SUP","HCPCS C1713","","5017-6-200S  -  PIN HALF 200MM 5MM APEX ORTH SS SLFTAP SLFDRILL 60MM EXFIX","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5017-7-200S","SUP","HCPCS C1713","","5017-7-200S  -  PIN HALF 200MM 5MM APEX ORTH SS SLFTAP SLFDRILL 70MM EXFIX","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$116.94 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"5017-8-150S","SUP","HCPCS C1713","","5017-8-150S  -  PIN HALF 150MM 5MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 25MM","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"50-17903","SUP","HCPCS C1713","","50-17903  -  SCREW BONE 1.7MM 3MM SELF DRILL XPIN TITANIUM MIDFAC","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$630.00 ","$0.00 ","$291.80 ","$0.00 ","$0.00 ","$245.13 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$219.10 ","$0.00 ","$222.88 ","$0.00 "
"50-17904","SUP","HCPCS C1713","","50-17904  -  SCREW BONE 1.7MM 4MM SELF DRILL XPIN TITANIUM MIDFAC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"50-17905","SUP","HCPCS C1713","","50-17905  -  SCREW BONE 1.7MM 5MM SLFDRILL XPIN TITANIUM MIDFAC","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$630.00 ","$0.00 ","$291.80 ","$0.00 ","$0.00 ","$245.13 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$219.10 ","$0.00 ","$222.88 ","$0.00 "
"50-17906","SUP","HCPCS C1713","","50-17906  -  SCREW BONE 1.7MM 6MM SLFDRILL XPIN TITANIUM MIDFAC","BOTH IP/OP","$103.40 ","$76.52 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$21.55 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"5017-9-120S","SUP","HCPCS C1713","","5017-9-120S  -  PIN 5MM SLFDRILL SLFTAP THRD SHFT 120MM APEX HA SS 35MM STRL","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"5017-9-150S","SUP","HCPCS C1713","","5017-9-150S  -  PIN HALF 150MM 5MM APEX HYDRXAPT SLFDRILL EXFIX","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$113.85 ","$0.00 ","$52.73 ","$0.00 ","$0.00 ","$44.30 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$39.59 ","$0.00 ","$40.28 ","$0.00 "
"5018-3-120","SUP","Custom 27203010","","5018-3-120  -  PIN HLF 5MM 120MM 30MM APX ST SLFDRL THRD SS FT/ANKL","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-3-180","SUP","HCPCS C1713","","5018-3-180  -  PIN HALF 180MM 5MM APEX ORTH SS SLFDRILL","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"5018-5-120","SUP","Custom 27203010","","5018-5-120  -  PIN HALF 120MM 5MM APEX SS SLFTAP SLFDRILL 35MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-5-150","SUP","Custom 27203010","","5018-5-150  -  PIN HALF 150MM 5MM APEX SS SLFTAP SLFDRILL 40MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-5-200","SUP","Custom 27203010","","5018-5-200  -  PIN HALF 200MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-5-250","SUP","Custom 27203010","","5018-5-250  -  PIN HALF 250MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-6-150","SUP","Custom 27203010","","5018-6-150  -  PIN HALF 150MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-6-180S","SUP","HCPCS C1713","","5018-6-180S  -  PIN HALF 180MM 5MM APEX ORTH SS SLFTAP SLFDRILL 50MM STRL","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$218.63 ","$98.38 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$38.28 ","$218.63 ","$0.00 ","$109.31 ","$173.15 ","$174.90 ","$0.00 ","$34.21 ","$0.00 ","$34.81 ","$0.00 "
"5018-6-200","SUP","Custom 27203010","","5018-6-200  -  PIN HALF 200MM 5MM APEX SS SLFTAP SLFDRILL 60MM EXFIX SYS","BOTH IP/OP","$205.70 ","$152.22 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-7-250","SUP","Custom 27203010","","5018-7-250  -  PIN HALF 250MM 5MM APEX SS SLFTAP SLFDRILL 70MM EXFIX SYS","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5018-8-180","SUP","Custom 27203010","","5018-8-180  -  PIN HALF 180MM 5MM APEX SS SLFTAP SLFDRILL 60MM EXFIX SYS","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-19003","SUP","HCPCS C1713","","50-19003  -  SCREW BONE 1.9MM 3MM EMERGENCY TITANIUM MIDFAC","BOTH IP/OP","$1,362.50 ","$1,008.25 ","$0.00 ","$1,362.50 ","$613.13 ","$0.00 ","$283.98 ","$0.00 ","$0.00 ","$238.56 ","$1,362.50 ","$0.00 ","$681.25 ","$1,079.10 ","$1,090.00 ","$0.00 ","$213.23 ","$0.00 ","$216.91 ","$0.00 "
"50-19005","SUP","HCPCS C1713","","50-19005  -  SCREW BONE 1.9MM 5MM EMERGENCY TITANIUM MIDFAC","BOTH IP/OP","$54.50 ","$40.33 ","$0.00 ","$54.50 ","$24.53 ","$0.00 ","$11.36 ","$0.00 ","$0.00 ","$9.54 ","$54.50 ","$0.00 ","$27.25 ","$43.16 ","$43.60 ","$0.00 ","$8.53 ","$0.00 ","$8.68 ","$0.00 "
"50-19007","SUP","HCPCS C1713","","50-19007  -  SCREW BONE 1.9MM 7MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL","BOTH IP/OP","$106.93 ","$79.13 ","$0.00 ","$272.50 ","$122.63 ","$0.00 ","$22.29 ","$0.00 ","$0.00 ","$47.71 ","$272.50 ","$0.00 ","$136.25 ","$215.82 ","$218.00 ","$0.00 ","$42.65 ","$0.00 ","$43.38 ","$0.00 "
"50-19009","SUP","HCPCS C1713","","50-19009  -  SCREW BONE 1.9MM 9MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL","BOTH IP/OP","$106.93 ","$79.13 ","$0.00 ","$272.50 ","$122.63 ","$0.00 ","$22.29 ","$0.00 ","$0.00 ","$47.71 ","$272.50 ","$0.00 ","$136.25 ","$215.82 ","$218.00 ","$0.00 ","$42.65 ","$0.00 ","$43.38 ","$0.00 "
"5019-1-180","SUP","HCPCS C1713","","5019-1-180  -  PIN HALF 120MM 5MM APEX SS SLFTAP CONTIN THRD 50MM","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"5019-7-120","SUP","HCPCS C1713","","5019-7-120  -  PIN HALF 120MM 6MM APEX SS SLFTAP CONTIN THRD 50MM","BOTH IP/OP","$258.50 ","$191.29 ","$0.00 ","$258.50 ","$116.33 ","$0.00 ","$53.88 ","$0.00 ","$0.00 ","$45.26 ","$258.50 ","$0.00 ","$129.25 ","$204.73 ","$206.80 ","$0.00 ","$40.46 ","$0.00 ","$41.15 ","$0.00 "
"5019-7-150","SUP","HCPCS C1713","","5019-7-150  -  PIN HALF 150MM 6MM APEX SS CONTIN THRD BLNT TIP 50MM EXFIX","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$49.43 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"502-01-42A","SUP","Custom 27803010","","502-01-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-44B","SUP","Custom 27803010","","502-01-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-46C","SUP","Custom 27803010","","502-01-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-48D","SUP","Custom 27803010","","502-01-48D  -  SHELL ACETAB 48MM HIP HMSPHR CLSTR TRDNT D","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-50D","SUP","Custom 27803010","","502-01-50D  -  SHELL ACETAB 50MM HIP HMSPHR CLSTR TRDNT D","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-52E","SUP","Custom 27803010","","502-01-52E  -  SHELL ACETAB 52MM HIP HMSPHR CLSTR TRDNT E","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-54E","SUP","Custom 27803010","","502-01-54E  -  SHELL ACETAB 54MM HIP HMSPHR CLSTR TRDNT E","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-56F","SUP","Custom 27803010","","502-01-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-58F","SUP","Custom 27803010","","502-01-58F  -  SHELL ACETAB 58MM HIP HMSPHR CLSTR TRDNT F","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-60G","SUP","Custom 27803010","","502-01-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-62G","SUP","Custom 27803010","","502-01-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-64H","SUP","Custom 27803010","","502-01-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-66H","SUP","Custom 27803010","","502-01-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-68I","SUP","Custom 27803010","","502-01-68I  -  SHELL ACTB I HMSPHR 68MM TRDNT 5 SCR HL CLSTR MTL HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-70I","SUP","Custom 27803010","","502-01-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-72J","SUP","Custom 27803010","","502-01-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-01-74J","SUP","Custom 27803010","","502-01-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-2-150","SUP","Custom 27203010","","5020-2-150  -  PIN HLF 5MM 150MM 20MM APX BLNT","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-2-180","SUP","Custom 27203010","","5020-2-180  -  PIN HLF 5MM 180MM 20MM APX BLNT","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-2-200","SUP","Custom 27203010","","5020-2-200  -  PIN HLF 5MM 200MM 20MM APX BLNT","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-2-250","SUP","Custom 27203010","","5020-2-250  -  PIN HLF 5MM 250MM 20MM APX BLNT","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-3-120","SUP","Custom 27203010","","5020-3-120  -  PIN HALF 120MM 5MM APEX SS CONTIN THRD BLNT TIP 30MM EXFIX","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-3-150","SUP","Custom 27203010","","5020-3-150  -  PIN HALF 150MM 5MM APEX SS CONTIN THRD BLNT TIP 40MM EXFIX","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-44A","SUP","Custom 27803010","","502-03-44A  -  SHELL ACETAB A HEMISPHERICAL 44MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-46B","SUP","Custom 27803010","","502-03-46B  -  SHELL ACETAB B HEMISPHERICAL 46MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-48C","SUP","Custom 27803010","","502-03-48C  -  SHELL ACETAB C HEMISPHERICAL 48MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-50D","SUP","Custom 27803010","","502-03-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-52D","SUP","Custom 27803010","","502-03-52D  -  SHELL ACETAB D 52MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-54E","SUP","Custom 27803010","","502-03-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-56E","SUP","Custom 27803010","","502-03-56E  -  SHELL ACETAB E HEMISPHERICAL 56MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20358","SUP","HCPCS C1713","","50-20358  -  SCREW BN 2MM 8MM NS LEIBINGER UNV 2 MMF SLF DRL XPN LGT WRE","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$252.00 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"502-03-58F","SUP","Custom 27803010","","502-03-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-60F","SUP","Custom 27803010","","502-03-60F  -  SHELL ACETAB F HEMISPHERICAL 60MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20362","SUP","HCPCS C1713","","50-20362  -  SCREW BONE 2MM 12MM SELF DRILL TITANIUM MANDIB","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$252.00 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"502-03-62G","SUP","Custom 27803010","","502-03-62G  -  SHELL ACETAB G 62MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-64G","SUP","Custom 27803010","","502-03-64G  -  SHELL ACETAB G HEMISPHERICAL 64MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-03-66H","SUP","Custom 27803010","","502-03-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM PRIM RIM CLSHOLE TRITANIUM","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20404","SUP","HCPCS C1713","","50-20404  -  SCREW BONE 2MM 4MM XPIN TITANIUM MAXFACL","BOTH IP/OP","$125.93 ","$93.19 ","$0.00 ","$125.93 ","$56.67 ","$0.00 ","$26.25 ","$0.00 ","$0.00 ","$22.05 ","$125.93 ","$0.00 ","$62.96 ","$99.74 ","$100.74 ","$0.00 ","$19.71 ","$0.00 ","$20.05 ","$0.00 "
"50-20405","SUP","HCPCS C1713","","50-20405  -  SCREW BONE 2MM 5MM XPIN TITANIUM MAXFACL","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$50.02 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20407","SUP","HCPCS C1713","","50-20407  -  SCREW BONE 2MM 7MM XPIN TITANIUM MAXFACL","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$50.02 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20408","SUP","HCPCS C1713","","50-20408  -  SCREW BONE 2MM 8MM XPIN TITANIUM MAXFACL","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$50.02 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20410","SUP","HCPCS C1713","","50-20410  -  SCREW BN 2MM 10MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20412","SUP","HCPCS C1713","","50-20412  -  SCREW BONE 2MM 12MM XPIN TITANIUM MAXFACL","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$50.02 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20414","SUP","HCPCS C1713","","50-20414  -  SCREW BONE 2MM 14MM XPIN TITANIUM MANDIB","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$50.02 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20416","SUP","HCPCS C1713","","50-20416  -  SCREW BONE 2MM 16MM XPIN TITANIUM MANDIB","BOTH IP/OP","$89.60 ","$66.30 ","$0.00 ","$240.00 ","$108.00 ","$0.00 ","$18.67 ","$0.00 ","$0.00 ","$42.02 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$37.56 ","$0.00 ","$38.21 ","$0.00 "
"50-20418","SUP","HCPCS C1713","","50-20418  -  SCREW BONE 2MM 18MM XPIN TITANIUM MANDIB","BOTH IP/OP","$113.30 ","$83.84 ","$0.00 ","$267.50 ","$120.38 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$46.84 ","$267.50 ","$0.00 ","$133.75 ","$211.86 ","$214.00 ","$0.00 ","$41.86 ","$0.00 ","$42.59 ","$0.00 "
"50-20420","SUP","HCPCS C1713","","50-20420  -  SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MANDIB","BOTH IP/OP","$113.30 ","$83.84 ","$0.00 ","$267.50 ","$120.38 ","$0.00 ","$23.61 ","$0.00 ","$0.00 ","$46.84 ","$267.50 ","$0.00 ","$133.75 ","$211.86 ","$214.00 ","$0.00 ","$41.86 ","$0.00 ","$42.59 ","$0.00 "
"50-20504","SUP","HCPCS C1713","","50-20504  -  SCREW BONE 2MM 4MM LOCKING XPIN TITANIUM MAXFACL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"50-20505","SUP","HCPCS C1713","","50-20505  -  SCREW BN 2MM 5MM GRY NS LEIBINGER UNV 2 LCK XPN TI MXLFCL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20506","SUP","HCPCS C1713","","50-20506  -  SCREW BONE 2MM 6MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20507","SUP","HCPCS C1713","","50-20507  -  SCREW BONE 2MM 7MM LOCKING XPIN TITANIUM MAXFACL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$192.38 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"50-20508","SUP","HCPCS C1713","","50-20508  -  SCREW BN 2MM 8MM GRY NS LEIBINGER UNV 2 LCK XPN TI MNDB","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20510","SUP","HCPCS C1713","","50-20510  -  SCREW BONE 2MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20512","SUP","HCPCS C1713","","50-20512  -  SCREW BONE 2MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20514","SUP","HCPCS C1713","","50-20514  -  SCREW BONE 2MM 14MM LOCKING XPIN TITANIUM MAXFACL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"5020-5-150","SUP","Custom 27203010","","5020-5-150  -  PIN HALF 150MM 5MM APEX ORTH BLNT TIP 25MM","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20516","SUP","HCPCS C1713","","50-20516  -  SCREW BONE 2MM 16MM LOCKING XPIN LEIBINGER UNIVERSAL 2","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-205-16","SUP","Custom 27203010","","50-205-16  -  FORCEPS SURG UNV PLT HLD 2 BALLS","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20518","SUP","HCPCS C1713","","50-20518  -  SCREW BONE 2MM 18MM LOCKING XPIN TITANIUM MANDIB","BOTH IP/OP","$162.23 ","$120.05 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$33.81 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20520","SUP","HCPCS C1713","","50-20520  -  SCREW BONE 2MM 20MM LOCKING XPIN TITANIUM MAXFACL","BOTH IP/OP","$162.23 ","$120.05 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$33.81 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"50-20596","SUP","HCPCS C1713","","50-20596  -  SCREW BN 2MM 6MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"50-20598","SUP","HCPCS C1713","","50-20598  -  SCREW BN 2MM 8MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"5020-6-120","SUP","Custom 27203010","","5020-6-120  -  PIN HALF 120MM 5MM APEX SS THRD SHFT BLNT PREDRILLING 35MM","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-6-200","SUP","Custom 27203010","","5020-6-200  -  PIN HALF 200MM 5MM APEX SS THRD SHFT BLNT PREDRILLING 60MM","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20704","SUP","HCPCS C1713","","50-20704  -  SCREW BONE 2MM 4MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-20705","SUP","HCPCS C1713","","50-20705  -  SCREW BONE 2MM 5MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-20706","SUP","HCPCS C1713","","50-20706  -  SCREW BONE 2MM 6MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-20708","SUP","HCPCS C1713","","50-20708  -  SCREW BONE 2MM 8MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-20710","SUP","HCPCS C1713","","50-20710  -  SCREW BONE 2MM 10MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-20712","SUP","HCPCS C1713","","50-20712  -  SCREW BONE 2MM 12MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$57.50 ","$25.88 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$10.07 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$9.00 ","$0.00 ","$9.15 ","$0.00 "
"50-20714","SUP","HCPCS C1713","","50-20714  -  SCREW BONE 2MM 14MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$149.92 ","$67.46 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$26.25 ","$149.92 ","$0.00 ","$74.96 ","$118.74 ","$119.93 ","$0.00 ","$23.46 ","$0.00 ","$23.87 ","$0.00 "
"5020-7-150","SUP","Custom 27203010","","5020-7-150  -  PIN HALF 150MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20716","SUP","HCPCS C1713","","50-20716  -  SCREW BONE 2MM 16MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-20718","SUP","HCPCS C1713","","50-20718  -  SCREW BONE 2MM 18MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"5020-7-180","SUP","Custom 27203010","","5020-7-180  -  PIN HALF 180MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20720","SUP","HCPCS C1713","","50-20720  -  SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.13 ","$87.42 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.62 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"5020-7-200","SUP","Custom 27203010","","5020-7-200  -  PIN HALF 200MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-7-250","SUP","Custom 27203010","","5020-7-250  -  PIN HALF 250MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS","BOTH IP/OP","$237.15 ","$175.49 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-8-180","SUP","Custom 27203010","","5020-8-180  -  PIN HALF 180MM 5MM APEX SS BLNT TIP 60MM EXFIX SYS","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5020-8-250","SUP","Custom 27203010","","5020-8-250  -  PIN HALF 250MM 5MM APEX SS BLNT TIP 70MM EXFIX SYS","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-20904","SUP","HCPCS C1713","","50-20904  -  SCREW BONE 2MM 4MM SLFDRILL XPIN TITANIUM MAXFACL","BOTH IP/OP","$144.50 ","$106.93 ","$0.00 ","$342.50 ","$154.13 ","$0.00 ","$30.12 ","$0.00 ","$0.00 ","$59.97 ","$342.50 ","$0.00 ","$171.25 ","$271.26 ","$274.00 ","$0.00 ","$53.60 ","$0.00 ","$54.53 ","$0.00 "
"50-20905","SUP","HCPCS C1713","","50-20905  -  SCREW BONE 2MM 5MM SLFDRILL XPIN TITANIUM MAXFACL","BOTH IP/OP","$342.50 ","$253.45 ","$0.00 ","$342.50 ","$154.13 ","$0.00 ","$71.39 ","$0.00 ","$0.00 ","$59.97 ","$342.50 ","$0.00 ","$171.25 ","$271.26 ","$274.00 ","$0.00 ","$53.60 ","$0.00 ","$54.53 ","$0.00 "
"50-20906","SUP","HCPCS C1713","","50-20906  -  SCREW BONE 2MM 6MM SLFDRILL XPIN TITANIUM MAXFACL","BOTH IP/OP","$126.35 ","$93.50 ","$0.00 ","$342.50 ","$154.13 ","$0.00 ","$26.33 ","$0.00 ","$0.00 ","$59.97 ","$342.50 ","$0.00 ","$171.25 ","$271.26 ","$274.00 ","$0.00 ","$53.60 ","$0.00 ","$54.53 ","$0.00 "
"502-11-42A","SUP","Custom 27803010","","502-11-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-44B","SUP","Custom 27803010","","502-11-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-46C","SUP","Custom 27803010","","502-11-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-48D","SUP","Custom 27803010","","502-11-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-50D","SUP","Custom 27803010","","502-11-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM 3 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-52E","SUP","Custom 27803010","","502-11-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-54E","SUP","Custom 27803010","","502-11-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-56F","SUP","Custom 27803010","","502-11-56F  -  SHELL ACTB F HMSPHR 56MM TRDNT CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-58F","SUP","Custom 27803010","","502-11-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-60G","SUP","Custom 27803010","","502-11-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-62G","SUP","Custom 27803010","","502-11-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-64H","SUP","Custom 27803010","","502-11-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-66H","SUP","Custom 27803010","","502-11-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-68I","SUP","Custom 27803010","","502-11-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-70I","SUP","Custom 27803010","","502-11-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-72J","SUP","Custom 27803010","","502-11-72J  -  SHELL ACETAB D HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-74J","SUP","Custom 27803010","","502-11-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-80L","SUP","Custom 27803010","","502-11-80L  -  SHELL ACETAB 80MM HIP CLSHOLE HMSPHR TRDNT L","BOTH IP/OP","$2,506.00 ","$1,854.44 ","$0.00 ","$2,506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,506.00 ","$0.00 ","$1,253.00 ","$1,984.75 ","$2,004.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"502-11-82L","SUP","Custom 27803010","","502-11-82L  -  SHELL ACETAB 82MM HIP CLSHOLE HMSPHR TRDNT L","BOTH IP/OP","$2,506.00 ","$1,854.44 ","$0.00 ","$2,506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,506.00 ","$0.00 ","$1,253.00 ","$1,984.75 ","$2,004.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5021-7-150","SUP","Custom 27203010","","5021-7-150  -  PIN HALF 150MM 6MM APEX SS SLFDRILL THRD SHFT SLFTAP 50MM","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5021-7-200","SUP","Custom 27203010","","5021-7-200  -  PIN HALF 200MM 6MM APEX SS SLFDRILL THRD 60MM","BOTH IP/OP","$209.25 ","$154.85 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-1-090","SUP","Custom 27203010","","5023-1-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 10MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-2-090","SUP","Custom 27203010","","5023-2-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 20MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-3-090","SUP","Custom 27203010","","5023-3-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 30MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-3-120","SUP","Custom 27203010","","5023-3-120  -  PIN HALF 120MM 4MM APEX SS SLFDRILL SLFTAP THRD 30MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23404","SUP","HCPCS C1713","","50-23404  -  SCREW BONE 2.3MM 4MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"50-23406","SUP","HCPCS C1713","","50-23406  -  SCREW BONE 2.3MM 6MM SELF TAP XPIN TITANIUM MAXFACL NONSTRL","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"50-23408","SUP","HCPCS C1713","","50-23408  -  SCREW BONE 2.3MM 8MM SELF TAP XPIN TITANIUM MANDIB","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"50-23410","SUP","HCPCS C1713","","50-23410  -  SCREW BONE 2.3MM 10MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"50-23412","SUP","HCPCS C1713","","50-23412  -  SCREW BONE 2.3MM 12MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"5023-4-120","SUP","Custom 27203010","","5023-4-120  -  PIN HALF 120MM 4MM APEX ORTH SS 45MM","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$160.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.88 ","$0.00 ","$80.44 ","$127.42 ","$128.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23414","SUP","HCPCS C1713","","50-23414  -  SCREW TI 14MM 2.3MM MANDIB SLFTAP XPIN BONE","BOTH IP/OP","$115.50 ","$85.47 ","$0.00 ","$151.93 ","$68.37 ","$0.00 ","$24.07 ","$0.00 ","$0.00 ","$26.60 ","$151.93 ","$0.00 ","$75.96 ","$120.33 ","$121.54 ","$0.00 ","$23.78 ","$0.00 ","$24.19 ","$0.00 "
"50-23416","SUP","HCPCS C1713","","50-23416  -  SCREW BONE 2.3MM 16MM SELF TAP XPIN TITANIUM MANDIB","BOTH IP/OP","$115.50 ","$85.47 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$24.07 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"50-23418","SUP","HCPCS C1713","","50-23418  -  SCREW BONE 2.3MM 18MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$118.45 ","$87.65 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.69 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"5023-4-180","SUP","Custom 27203010","","5023-4-180  -  PIN HLF 4MM 180MM 40MM HFMN2 APX SLF DRL ST THRD SS FT/ANKL","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23420","SUP","HCPCS C1713","","50-23420  -  SCREW BONE 2.3MM 20MM SLFTAP XPIN TITANIUM MANDIB","BOTH IP/OP","$118.45 ","$87.65 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$24.69 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"50-23504","SUP","HCPCS C1713","","50-23504  -  SCREW BONE 2.3MM 4MM LOCKING XPIN TITANIUM MAXFACL","BOTH IP/OP","$1,299.22 ","$961.42 ","$0.00 ","$1,299.22 ","$584.65 ","$0.00 ","$270.79 ","$0.00 ","$0.00 ","$227.48 ","$1,299.22 ","$0.00 ","$649.61 ","$1,028.98 ","$1,039.37 ","$0.00 ","$203.33 ","$0.00 ","$206.84 ","$0.00 "
"50-23506","SUP","HCPCS C1713","","50-23506  -  SCREW BONE 2.3MM 6MM LOCKING XPIN LEIBINGER UNIVERSAL 2","BOTH IP/OP","$197.35 ","$146.04 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$41.13 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"50-23508","SUP","HCPCS C1713","","50-23508  -  SCREW BONE 2.3MM 8MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"5023-5-090","SUP","Custom 27203010","","5023-5-090  -  PIN HALF 90MM 4MM ORTH MDLR 40MM","BOTH IP/OP","$192.10 ","$142.15 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23510","SUP","HCPCS C1713","","50-23510  -  SCREW BONE 2.3MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"50-23512","SUP","HCPCS C1713","","50-23512  -  SCREW BONE 2.3MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"5023-5-120","SUP","Custom 27203010","","5023-5-120  -  PIN HALF 120MM 4MM APEX SS SLFTAP SLFDRILL THRD 35MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23514","SUP","HCPCS C1713","","50-23514  -  SCREW BONE 2.3MM 14MM LOCKING XPIN LEIBINGER UNIVERSAL 2","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"5023-5-150","SUP","Custom 27203010","","5023-5-150  -  PIN HALF 150MM 4MM APEX SS SLFTAP SLFDRILL THRD 40MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23516","SUP","HCPCS C1713","","50-23516  -  SCREW BONE 2.3MM 16MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"50-23518","SUP","HCPCS C1713","","50-23518  -  SCREW BONE 2.3MM 18MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$197.35 ","$146.04 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$41.13 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"50-23520","SUP","HCPCS C1713","","50-23520  -  SCREW BONE 2.3MM 20MM LOCKING XPIN TITANIUM MAXFACL","BOTH IP/OP","$197.35 ","$146.04 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$41.13 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"5023-6-150","SUP","Custom 27203010","","5023-6-150  -  PIN HALF 150MM 4MM APEX SS SLFTAP SLFDRILL THRD 50MM EXFIX","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-6-180","SUP","Custom 27203010","","5023-6-180  -  PIN 4MM TROCAR PNT 1 END THRD 180X50MM APEX SS 50MM XTRN","BOTH IP/OP","$169.50 ","$125.43 ","$0.00 ","$169.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$169.13 ","$0.00 ","$84.56 ","$133.95 ","$135.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-6-200","SUP","Custom 27203010","","5023-6-200  -  PIN HALF 200MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 40MM","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5023-6-250","SUP","Custom 27203010","","5023-6-250  -  PIN HALF 250MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 50MM","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-23706","SUP","HCPCS C1713","","50-23706  -  SCREW BONE 2.3MM 6MM SLFTAP XFIT TITANIUM MAXFACL","BOTH IP/OP","$132.03 ","$97.70 ","$0.00 ","$307.50 ","$138.38 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$53.84 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$48.12 ","$0.00 ","$48.95 ","$0.00 "
"50-23708","SUP","HCPCS C1713","","50-23708  -  SCREW BONE 2.3MM 8MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL","BOTH IP/OP","$132.03 ","$97.70 ","$0.00 ","$307.50 ","$138.38 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$53.84 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$48.12 ","$0.00 ","$48.95 ","$0.00 "
"50-23710","SUP","HCPCS C1713","","50-23710  -  SCREW BONE 2.3MM 10MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL","BOTH IP/OP","$132.03 ","$97.70 ","$0.00 ","$307.50 ","$138.38 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$53.84 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$48.12 ","$0.00 ","$48.95 ","$0.00 "
"50-23712","SUP","HCPCS C1713","","50-23712  -  SCREW BONE 2.3MM 12MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL","BOTH IP/OP","$132.03 ","$97.70 ","$0.00 ","$307.50 ","$138.38 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$53.84 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$48.12 ","$0.00 ","$48.95 ","$0.00 "
"50-23714","SUP","HCPCS C1713","","50-23714  -  SCREW BONE 2.3MM 14MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL","BOTH IP/OP","$132.03 ","$97.70 ","$0.00 ","$307.50 ","$138.38 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$53.84 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$48.12 ","$0.00 ","$48.95 ","$0.00 "
"50-23716","SUP","HCPCS C1713","","50-23716  -  SCREW BONE 2.3MM 16MM EMERGENCY XPIN TITANIUM MAXFACL","BOTH IP/OP","$132.03 ","$97.70 ","$0.00 ","$307.50 ","$138.38 ","$0.00 ","$27.52 ","$0.00 ","$0.00 ","$53.84 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$48.12 ","$0.00 ","$48.95 ","$0.00 "
"5023-7-250","SUP","Custom 27203010","","5023-7-250  -  PIN HALF 250MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 70MM","BOTH IP/OP","$96.25 ","$71.23 ","$0.00 ","$96.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5027-1-040","SUP","Custom 27803010","","5027-1-040  -  CAP PCTV HFMN XPRESS NONSTRL TIP WHT 4MM 4MM 4MM DISP","BOTH IP/OP","$69.70 ","$51.58 ","$0.00 ","$72.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.88 ","$0.00 ","$36.44 ","$57.72 ","$58.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5027-1-050","SUP","Custom 27803010","","5027-1-050  -  CAP PCTV TIP BLUE 5MM","BOTH IP/OP","$72.25 ","$53.47 ","$0.00 ","$74.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.25 ","$0.00 ","$37.13 ","$58.81 ","$59.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5027-1-090","SUP","Custom 27203010","","5027-1-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 10MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5027-2-090","SUP","Custom 27203010","","5027-2-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 20MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5027-3-090","SUP","Custom 27203010","","5027-3-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 30MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5027-3-120","SUP","Custom 27203010","","5027-3-120  -  PIN HALF 120MM 4MM APEX SS BLNT TIP 30MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-27405","SUP","HCPCS C1713","","50-27405  -  SCREW BONE 2.7MM 5MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$327.50 ","$242.35 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$68.26 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"50-27408","SUP","HCPCS C1713","","50-27408  -  SCREW BONE 2.7MM 8MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$65.50 ","$48.47 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$13.65 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"50-27410","SUP","HCPCS C1713","","50-27410  -  SCREW BONE 2.7MM 10MM SELF TAP XPIN EMERGENCY TITANIUM","BOTH IP/OP","$139.88 ","$103.51 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$29.15 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"50-27412","SUP","HCPCS C1713","","50-27412  -  SCREW BONE 2 UNIVERSAL 2.7MM 12MM SELF TAP XPIN EMERGENCY","BOTH IP/OP","$327.50 ","$242.35 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$68.26 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"5027-4-120","SUP","Custom 27203010","","5027-4-120  -  PIN HALF 120MM 4MM APEX SS BLNT TIP 35MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-27414","SUP","HCPCS C1713","","50-27414  -  SCREW BONE 2.7MM 14MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$327.50 ","$242.35 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$68.26 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"5027-4-150","SUP","Custom 27203010","","5027-4-150  -  PIN HALF 150MM 4MM APEX SS BLNT TIP 40MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-27416","SUP","HCPCS C1713","","50-27416  -  SCREW BONE 2.7MM 16MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$139.88 ","$103.51 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$29.15 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"50-27418","SUP","HCPCS C1713","","50-27418  -  SCREW BONE 2.7MM 18MM SLFTAP XPIN TITANIUM MAXFACL","BOTH IP/OP","$139.88 ","$103.51 ","$0.00 ","$65.50 ","$29.48 ","$0.00 ","$29.15 ","$0.00 ","$0.00 ","$11.47 ","$65.50 ","$0.00 ","$32.75 ","$51.88 ","$52.40 ","$0.00 ","$10.25 ","$0.00 ","$10.43 ","$0.00 "
"5027-4-180","SUP","Custom 27203010","","5027-4-180  -  PIN HALF 180MM 4MM APEX SS BLNT TIP 40MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-27420","SUP","HCPCS C1713","","50-27420  -  SCREW BONE 2.7MM 20MM XPIN EMERGENCY TITANIUM MAXFACL","BOTH IP/OP","$139.88 ","$103.51 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$29.15 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"50-27505","SUP","HCPCS C1713","","50-27505  -  SCREW BONE 2.7MM 5MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"50-27508","SUP","HCPCS C1713","","50-27508  -  SCREW BONE 2.7MM 8MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$105.00 ","$47.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"50-27510","SUP","HCPCS C1713","","50-27510  -  SCREW BONE 2.7MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"50-27512","SUP","HCPCS C1713","","50-27512  -  SCREW BONE 2.7MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"50-27514","SUP","HCPCS C1713","","50-27514  -  SCREW BONE 2.7MM 14MM LOCKING XPIN EMERGENCY TITANIUM","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"5027-5-150","SUP","Custom 27203010","","5027-5-150  -  PIN HALF 150MM 4MM APEX SS BLNT TIP 50MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-27516","SUP","HCPCS C1713","","50-27516  -  SCREW BONE 2.7MM 16MM LOCKING XPIN EMERGENCY TITANIUM","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"50-27518","SUP","HCPCS C1713","","50-27518  -  SCREW BONE 2.7MM 18MM LOCKING XPIN EMERGENCY TITANIUM","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"5027-5-180","SUP","Custom 27203010","","5027-5-180  -  PIN HALF 180MM 4MM APEX CONTIN THRD 50MM","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-27520","SUP","HCPCS C1713","","50-27520  -  SCREW BONE 2.7MM 20MM LOCKING XPIN EMERGENCY TITANIUM","BOTH IP/OP","$233.85 ","$173.05 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$48.74 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"5028-7-030","SUP","Custom 27203010","","5028-7-030  -  ROD EXFIX 174MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$595.10 ","$440.37 ","$0.00 ","$444.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$444.13 ","$0.00 ","$222.06 ","$351.75 ","$355.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5028-8-065","SUP","Custom 27203010","","5028-8-065  -  ROD EXFIX 65MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$415.50 ","$307.47 ","$0.00 ","$312.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5028-8-100","SUP","HCPCS C1713","","ROD 100MM 8MM CONNCTNG HFMN2 MRI CARB FBR EXFIXA","BOTH IP/OP","$312.13 ","$230.98 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"5028-8-150","SUP","Custom 27203010","","5028-8-150  -  ROD EXFIX 150MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$415.50 ","$307.47 ","$0.00 ","$312.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5028-8-200","SUP","Custom 27203010","","5028-8-200  -  ROD EXFIX 200MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$426.75 ","$315.80 ","$0.00 ","$320.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.38 ","$0.00 ","$160.19 ","$253.74 ","$256.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5028-8-250","SUP","Custom 27203010","","5028-8-250  -  ROD EXFIX 250MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$426.75 ","$315.80 ","$0.00 ","$320.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.38 ","$0.00 ","$160.19 ","$253.74 ","$256.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5028-8-350","SUP","Custom 27203010","","5028-8-350  -  ROD EXFIX 350MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$439.50 ","$325.23 ","$0.00 ","$328.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-720","SUP","Custom 27203010","","5029-8-720  -  ROD EXFIX 200MM 8MM HFMN2 CARB CONNCTNG","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-725","SUP","Custom 27203010","","5029-8-725  -  ROD EXFIX 250MM 8MM HFMN2 CARB CONNCTNG","BOTH IP/OP","$253.00 ","$187.22 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-805","SUP","Custom 27203010","","5029-8-805  -  ROD EXFIX 65MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$302.25 ","$223.67 ","$0.00 ","$233.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-810","SUP","Custom 27203010","","5029-8-810  -  ROD EXFIX 100MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$302.25 ","$223.67 ","$0.00 ","$233.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-815","SUP","Custom 27203010","","5029-8-815  -  ROD EXFIX 150MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$302.25 ","$223.67 ","$0.00 ","$233.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.75 ","$0.00 ","$116.88 ","$185.13 ","$187.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-820","SUP","Custom 27203010","","5029-8-820  -  ROD EXFIX 200MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$329.25 ","$243.65 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-825","SUP","Custom 27203010","","5029-8-825  -  ROD EXFIX 250MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$329.25 ","$243.65 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-830","SUP","Custom 27203010","","5029-8-830  -  ROD EXFIX 300MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$329.25 ","$243.65 ","$0.00 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.00 ","$0.00 ","$126.50 ","$200.38 ","$202.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-835","SUP","Custom 27203010","","5029-8-835  -  ROD XTRNFX 8MM 350MM HFMN2 CNCT BRD CFBR","BOTH IP/OP","$353.25 ","$261.41 ","$0.00 ","$272.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-840","SUP","Custom 27203010","","5029-8-840  -  ROD EXFIX 400MM 8MM HFMN2 CARFBR CONNCTNG","BOTH IP/OP","$353.25 ","$261.41 ","$0.00 ","$272.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.25 ","$0.00 ","$136.13 ","$215.62 ","$217.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-845","SUP","Custom 27203010","","5029-8-845  -  ROD EXFIX 450MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$403.50 ","$298.59 ","$0.00 ","$313.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5029-8-850","SUP","Custom 27203010","","5029-8-850  -  ROD EXFIX 500MM 8MM HFMN2 CARFBR CONNCTNG BRAID","BOTH IP/OP","$403.50 ","$298.59 ","$0.00 ","$313.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-3-200","SUP","Custom 27203010","","5030-3-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 35MM EXFIX SYS","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-3-250","SUP","Custom 27203010","","5030-3-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 35MM EXFIX SYS","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-4-200","SUP","Custom 27203010","","5030-4-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 40MM EXFIX SYS","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-4-250","SUP","Custom 27203010","","5030-4-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 40MM EXFIX SYS","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-4-300","SUP","Custom 27203010","","5030-4-300  -  PIN HLF 5MM 4MM 300MM NS 50MM APX TRNFX ST SLF DRL CNTR THRD","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-5-200","SUP","Custom 27203010","","5030-5-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 50MM EXFIX SYS","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-5-250","SUP","HCPCS C1713","","5030-5-250  -  TRAY STRL MDLR TRNFX 4 MM 250 MM PIN THRD","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$89.10 ","$0.00 ","$46.06 ","$0.00 ","$0.00 ","$34.67 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$30.99 ","$0.00 ","$31.52 ","$0.00 "
"5030-5-300","SUP","Custom 27203010","","5030-5-300  -  PIN HLF 5MM 4MM 300MM NS 50MM HFMN2 APX TRNFX ST SLF DRL","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$255.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.75 ","$0.00 ","$127.88 ","$202.55 ","$204.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-6-250","SUP","Custom 27203010","","5030-6-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 60MM EXFIX SYS","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-306-40-04","SUP","Custom 27803010","","50-306-40-04  -  RESORB MESH ORBITAL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5030-7-300","SUP","Custom 27203010","","5030-7-300  -  PIN FX 5MM 4MM 300MM 70MM APX TRNFX SS FT/ANKL CANC","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-310-27-09","SUP","Custom 27803010","","50-310-27-09  -  COVER BURR HOLE 17MM .3MM CNTOUR TITANIUM CRANIUM 1.5MM","BOTH IP/OP","$465.18 ","$344.23 ","$0.00 ","$465.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.18 ","$0.00 ","$232.59 ","$368.42 ","$372.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-320-08-09","SUP","HCPCS C1713","","50-320-08-09  -  PLATE BONE MINI REGULAR 1MM 8 HOLE RIGID LIGHTWEIGHT BLUE","BOTH IP/OP","$271.95 ","$201.24 ","$0.00 ","$271.95 ","$122.38 ","$0.00 ","$56.68 ","$0.00 ","$0.00 ","$47.62 ","$271.95 ","$0.00 ","$135.98 ","$215.38 ","$217.56 ","$0.00 ","$42.56 ","$0.00 ","$43.29 ","$0.00 "
"50-321-04-09","SUP","HCPCS C1713","","50-321-04-09  -  PLATE BONE MINI MEDIUM 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"50-322-04-09","SUP","HCPCS C1713","","50-322-04-09  -  PLATE BONE LONG 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE TITANIUM","BOTH IP/OP","$222.75 ","$164.84 ","$0.00 ","$222.75 ","$100.24 ","$0.00 ","$46.43 ","$0.00 ","$0.00 ","$39.00 ","$222.75 ","$0.00 ","$111.38 ","$176.42 ","$178.20 ","$0.00 ","$34.86 ","$0.00 ","$35.46 ","$0.00 "
"50-325-01-07","SUP","Custom 27100030","","50-325-01-07  -  CLAMP SURG 6IN SHARP STAINLESS STEEL","BOTH IP/OP","$576.23 ","$426.41 ","$0.00 ","$576.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$576.23 ","$0.00 ","$288.11 ","$456.37 ","$460.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-330-06-09","SUP","HCPCS C1713","","50-330-06-09  -  PLATE BONE MINI MEDIUM CVD FLAT 1MM 6 HOLE SAGITTAL RIGID","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"50-331-06-09","SUP","HCPCS C1713","","50-331-06-09  -  PLATE BONE LONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"50-332-06-09","SUP","HCPCS C1713","","50-332-06-09  -  PLATE BONE XLONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"5036-1-080","SUP","Custom 27203010","","5036-1-080  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5036-1-110","SUP","Custom 27203010","","5036-1-110  -  PIN HALF 110MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5036-1-580","SUP","Custom 27203010","","5036-1-580  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 15MM EXFIX SYS","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5036-2-060","SUP","Custom 27203010","","5036-2-060  -  PIN HALF 60MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5036-2-080","SUP","Custom 27203010","","5036-2-080  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 20MM EXFIX SYS","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5036-2-110","SUP","Custom 27203010","","5036-2-110  -  PIN HLF 3MM 110MM 25MM HFMN2 APX BLNT TIP SS","BOTH IP/OP","$312.00 ","$230.88 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-368-16-91","SUP","HCPCS C1713","","50-368-16-91  -  PLATE BONE MINI REGULAR .6MM 16 HOLE LP TITANIUM MANDIB 2MM","BOTH IP/OP","$323.75 ","$239.58 ","$0.00 ","$323.75 ","$145.69 ","$0.00 ","$67.48 ","$0.00 ","$0.00 ","$56.69 ","$323.75 ","$0.00 ","$161.88 ","$256.41 ","$259.00 ","$0.00 ","$50.67 ","$0.00 ","$51.54 ","$0.00 "
"50-369-06","SUP","HCPCS C1713","","50-369-06  -  X PLATE","BOTH IP/OP","$348.75 ","$258.08 ","$0.00 ","$348.75 ","$156.94 ","$0.00 ","$72.69 ","$0.00 ","$0.00 ","$61.06 ","$348.75 ","$0.00 ","$174.38 ","$276.21 ","$279.00 ","$0.00 ","$54.58 ","$0.00 ","$55.52 ","$0.00 "
"50-375-04-91","SUP","HCPCS C1713","","50-375-04-91  -  PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-377-04-91","SUP","HCPCS C1713","","50-377-04-91  -  PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-379-04-91","SUP","HCPCS C1713","","50-379-04-91  -  PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-381-04-91","SUP","HCPCS C1713","","50-381-04-91  -  PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-381-05-09","SUP","HCPCS C1713","","50-381-05-09  -  PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"5038-1-080","SUP","Custom 27203010","","5038-1-080  -  PIN 3MM SLFDRILL SLFTAP THRD 80MM APEX SS 10MM","BOTH IP/OP","$214.83 ","$158.97 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5038-1-110","SUP","Custom 27203010","","5038-1-110  -  PIN HALF 110MM 3MM APEX SS SLFDRILL SLFTAP THRD 10MM EXFIX","BOTH IP/OP","$214.83 ","$158.97 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5038-2-080","SUP","Custom 27203010","","5038-2-080  -  PIN HALF 80MM 3MM APEX SS SLFDRILL SLFTAP THRD 15MM EXFIX","BOTH IP/OP","$214.83 ","$158.97 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5038-2-110","SUP","Custom 27203010","","5038-2-110  -  PIN HALF 110MM 3MM APEX SS SLFDRILL SLFTAP THRD 25MM EXFIX","BOTH IP/OP","$214.83 ","$158.97 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-383-05-09","SUP","HCPCS C1713","","50-383-05-09  -  PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"5038-5-060","SUP","Custom 27203010","","5038-5-060  -  PIN HALF 60MM 3MM APEX SS SLFDRILL SLFTAP THRD 10MM EXFIX","BOTH IP/OP","$214.83 ","$158.97 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5038-5-080","SUP","Custom 27203010","","5038-5-080  -  PIN HALF 80MM 3MM APEX SS SLFDRILL SLFTAP THRD 20MM EXFIX","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5038-5-110","SUP","Custom 27203010","","5038-5-110  -  PIN HALF 11CM 3MM APEX HFMN2 ORTH CONTIN THRD 22MM EXFIX SYS","BOTH IP/OP","$89.38 ","$66.14 ","$0.00 ","$89.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-386-06-91","SUP","HCPCS C1713","","50-386-06-91  -  PLATE BONE T MINI REGULAR .6MM LP TITANIUM MANDIB 2MM SCREW","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-390-05-91","SUP","HCPCS C1713","","50-390-05-91  -  PLATE BN MN SHRT Y .6MM THREADLOCK TS 5 HL LOPRFL TI MXLFCL","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-395-04","SUP","HCPCS C1713","","50-395-04  -  L PLATE RIGHT","BOTH IP/OP","$325.50 ","$240.87 ","$0.00 ","$325.50 ","$146.48 ","$0.00 ","$67.84 ","$0.00 ","$0.00 ","$56.99 ","$325.50 ","$0.00 ","$162.75 ","$257.80 ","$260.40 ","$0.00 ","$50.94 ","$0.00 ","$51.82 ","$0.00 "
"50-396-06-91","SUP","HCPCS C1713","","50-396-06-91  -  PLATE BONE MINI REGULAR Y LP .6MM 2 TITANIUM MANDIB 2MM","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$174.83 ","$0.00 ","$80.97 ","$0.00 ","$0.00 ","$68.02 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$60.80 ","$0.00 ","$61.85 ","$0.00 "
"504-02-54C-L","SUP","HCPCS C1776","","504-02-54C-L  -  SHELL ACTB 54MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-54C-R","SUP","HCPCS C1776","","504-02-54C-R  -  SHELL ACTB 54MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-56D-L","SUP","HCPCS C1776","","504-02-56D-L  -  SHELL ACTB 56MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-56D-R","SUP","HCPCS C1776","","504-02-56D-R  -  SHELL ACTB 56MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-58D-L","SUP","HCPCS C1776","","504-02-58D-L  -  SHELL ACTB 58MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-58D-R","SUP","HCPCS C1776","","504-02-58D-R  -  SHELL ACTB 58MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-60D-L","SUP","HCPCS C1776","","504-02-60D-L  -  SHELL ACTB 60MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-60D-R","SUP","HCPCS C1776","","504-02-60D-R  -  SHELL ACTB 60MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-62E-L","SUP","HCPCS C1776","","504-02-62E-L  -  SHELL ACTB 62MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-62E-R","SUP","HCPCS C1776","","504-02-62E-R  -  SHELL ACTB 62MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-64E-L","SUP","HCPCS C1776","","504-02-64E-L  -  SHELL ACTB 64MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-64E-R","SUP","HCPCS C1776","","504-02-64E-R  -  SHELL ACTB 64MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-66F-L","SUP","HCPCS C1776","","504-02-66F-L  -  SHELL ACTB 66MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-66F-R","SUP","HCPCS C1776","","504-02-66F-R  -  SHELL ACTB 66MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-68F-L","SUP","HCPCS C1776","","504-02-68F-L  -  SHELL ACTB 68MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-68F-R","SUP","HCPCS C1776","","504-02-68F-R  -  SHELL ACTB 68MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-70G-L","SUP","HCPCS C1776","","504-02-70G-L  -  SHELL ACTB 70MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-70G-R","SUP","HCPCS C1776","","504-02-70G-R  -  SHELL ACTB 70MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-72G-L","SUP","HCPCS C1776","","504-02-72G-L  -  SHELL ACTB 72MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-72G-R","SUP","HCPCS C1776","","504-02-72G-R  -  SHELL ACTB 72MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-74H-L","SUP","HCPCS C1776","","504-02-74H-L  -  SHELL ACTB 74MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-74H-R","SUP","HCPCS C1776","","504-02-74H-R  -  SHELL ACTB 74MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-76H-L","SUP","HCPCS C1776","","504-02-76H-L  -  SHELL ACTB 76MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-76H-R","SUP","HCPCS C1776","","504-02-76H-R  -  SHELL ACTB 76MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-78H-L","SUP","HCPCS C1776","","504-02-78H-L  -  SHELL ACTB 78MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-78H-R","SUP","HCPCS C1776","","504-02-78H-R  -  SHELL ACTB 78MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-80H-L","SUP","HCPCS C1776","","504-02-80H-L  -  SHELL ACTB 80MM RSTR ANTM HIP LT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"504-02-80H-R","SUP","HCPCS C1776","","504-02-80H-R  -  SHELL ACTB 80MM RSTR ANTM HIP RT","BOTH IP/OP","$9,457.50 ","$6,998.55 ","$0.00 ","$9,457.50 ","$4,255.88 ","$0.00 ","$1,971.18 ","$0.00 ","$0.00 ","$1,655.93 ","$9,457.50 ","$0.00 ","$4,728.75 ","$7,490.34 ","$7,566.00 ","$0.00 ","$1,480.10 ","$0.00 ","$1,505.63 ","$0.00 "
"50-405-07-09","SUP","HCPCS C1713","","50-405-07-09  -  PLATE BONE 100D L MINI .7MM 7 HOLE TITANIUM MANDIB 2MM SCREW","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-405-09-09","SUP","HCPCS C1713","","50-405-09-09  -  PLATE BONE 100D L MINI .7MM 9 HOLE INSERT FRAC TITANIUM","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-405-12-09","SUP","HCPCS C1713","","50-405-12-09  -  PLATE BN MN .7MM THREADLOCK TS 12 HL LOPRFL TI ORBT FLR 2MM","BOTH IP/OP","$401.43 ","$297.06 ","$0.00 ","$401.43 ","$180.64 ","$0.00 ","$83.67 ","$0.00 ","$0.00 ","$70.29 ","$401.43 ","$0.00 ","$200.71 ","$317.93 ","$321.14 ","$0.00 ","$62.82 ","$0.00 ","$63.91 ","$0.00 "
"50-405-17-09","SUP","HCPCS C1713","","50-405-17-09  -  PLATE BN MN STRG 1MM NS THREADLOCK TS 20 HL LOPRFL CMPR TI","BOTH IP/OP","$569.80 ","$421.65 ","$0.00 ","$569.80 ","$256.41 ","$0.00 ","$118.76 ","$0.00 ","$0.00 ","$99.77 ","$569.80 ","$0.00 ","$284.90 ","$451.28 ","$455.84 ","$0.00 ","$89.17 ","$0.00 ","$90.71 ","$0.00 "
"50-406-04-91","SUP","HCPCS C1713","","50-406-04-91  -  PLATE BONE Z MINI 6MM LP TITANIUM LEFT MANDIB 2MM SCREW","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-406-17-09","SUP","HCPCS C1713","","50-406-17-09  -  PLATE BONE STR 1MM 17 HOLE RIGID LIGHTWEIGHT LP BLUE","BOTH IP/OP","$530.95 ","$392.90 ","$0.00 ","$530.95 ","$238.93 ","$0.00 ","$110.66 ","$0.00 ","$0.00 ","$92.97 ","$530.95 ","$0.00 ","$265.48 ","$420.51 ","$424.76 ","$0.00 ","$83.09 ","$0.00 ","$84.53 ","$0.00 "
"50-407-07-09","SUP","HCPCS C1713","","50-407-07-09  -  PLATE BN MN STRG L .7MM THREADLOCK TS 20 HL LOPRFL TI MXLFCL","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-407-09-09","SUP","HCPCS C1713","","50-407-09-09  -  PLATE BONE 100D L MINI 9 HOLE INSERT FRAC TITANIUM MANDIB 2","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-408-04-91","SUP","HCPCS C1713","","50-408-04-91  -  PLATE BONE Z LEFT ANGLE LONG .6MM LP FRAC TITANIUM MANDIB","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"50-409-04-91","SUP","HCPCS C1713","","50-409-04-91  -  PLATE BN 100D LNG MN Z .6MM THREADLOCK TS 4 HL LOPRFL TI","BOTH IP/OP","$362.60 ","$268.32 ","$0.00 ","$362.60 ","$163.17 ","$0.00 ","$75.57 ","$0.00 ","$0.00 ","$63.49 ","$362.60 ","$0.00 ","$181.30 ","$287.18 ","$290.08 ","$0.00 ","$56.75 ","$0.00 ","$57.73 ","$0.00 "
"5045-5-150","SUP","Custom 27203010","","5045-5-150  -  PIN HALF 150MM 3MM APEX SMTH TRNFX EXFIX SYS","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5045-5-200","SUP","Custom 27203010","","5045-5-200  -  PIN HLF 3MM 200MM NS APX TRNFX ST SLF DRL THRD SS","BOTH IP/OP","$207.63 ","$153.65 ","$0.00 ","$207.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.63 ","$0.00 ","$103.81 ","$164.44 ","$166.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-4561","SUP","Custom 27203010","","BLADE RTRCTR 6X2IN BKWLTR MLBL","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-4567","SUP","Custom 27203010","","BLADE RTRCTR 6X3IN BKWLTR MLBL","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"504605A","SUP","HCPCS C1894","","504605A  -  INTRODUCER SHTH STD HEXACUSPID 5FR 11CM GRY AVNT+ ROT SUT","BOTH IP/OP","$19.88 ","$14.71 ","$0.00 ","$19.88 ","$10.79 ","$0.00 ","$4.14 ","$0.00 ","$0.00 ","$3.48 ","$19.88 ","$0.00 ","$9.94 ","$15.74 ","$15.90 ","$0.00 ","$3.11 ","$0.00 ","$3.16 ","$0.00 "
"504606A","SUP","HCPCS C1894","","504606A  -  INTROD SHTH 6FR 11CM W/O MINI GWIRE NO OBT AVNT+ .038IN GRN","BOTH IP/OP","$99.38 ","$73.54 ","$0.00 ","$99.38 ","$53.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.40 ","$99.38 ","$0.00 ","$49.69 ","$78.71 ","$79.50 ","$0.00 ","$15.55 ","$0.00 ","$15.82 ","$0.00 "
"504606T","SUP","HCPCS C1894","","504606T  -  INTRODUCER SHTH MID LGTH 6FR 23CM GRN AVNT+ NO MN GW NO OBT","BOTH IP/OP","$54.88 ","$40.61 ","$0.00 ","$54.88 ","$29.80 ","$0.00 ","$11.44 ","$0.00 ","$0.00 ","$9.61 ","$54.88 ","$0.00 ","$27.44 ","$43.46 ","$43.90 ","$0.00 ","$8.59 ","$0.00 ","$8.74 ","$0.00 "
"5047-1-030","SUP","Custom 27203010","","5047-1-030  -  CAP END ORTH 3MM DISP","BOTH IP/OP","$70.55 ","$52.21 ","$0.00 ","$72.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.88 ","$0.00 ","$36.44 ","$57.72 ","$58.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5048-5-065","SUP","Custom 27203010","","5048-5-065  -  ROD EXFIX 65MM 5MM HFMN2 MRI CMPCT CARB CONNCTNG STRL","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5048-5-100","SUP","Custom 27203010","","5048-5-100  -  ROD EXFIX YLW 100MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5048-5-150","SUP","Custom 27203010","","5048-5-150  -  ROD EXFIX YLW 150MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5048-5-200","SUP","Custom 27203010","","5048-5-200  -  ROD EXFIX YLW 200MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5048-5-250","SUP","Custom 27203010","","5048-5-250  -  ROD EXFIX 250MM 5MM HFMN2 MRI CMPCT CONNCTNG MRI SAFE","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5048-5-300","SUP","Custom 27203010","","5048-5-300  -  ROD EXFIX 100MM 8MM HFMN2 C MRI CONNCTNG","BOTH IP/OP","$200.75 ","$148.56 ","$0.00 ","$200.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.75 ","$0.00 ","$100.38 ","$158.99 ","$160.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-5-505","SUP","Custom 27203010","","5049-5-505  -  ROD EXFIX 100MM 5MM HFMN2 C CARFBR CONNCTNG","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$103.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-5-510","SUP","Custom 27203010","","5049-5-510  -  ROD EXFIX 150MM 5MM HFMN2 C CARFBR CONNCTNG","BOTH IP/OP","$177.00 ","$130.98 ","$0.00 ","$103.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-5-515","SUP","Custom 27203010","","5049-5-515  -  ROD EXFIX 150MM 5MM HFMN2 C CARFBR CONNCTNG","BOTH IP/OP","$199.50 ","$147.63 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-5-520","SUP","Custom 27203010","","5049-5-520  -  ROD EXFIX 200MM 5MM HFMN2 C CARFBR CONNCTNG","BOTH IP/OP","$199.50 ","$147.63 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-5-525","SUP","Custom 27803010","","5049-5-525  -  CONCTR ROD 250MM 5MM CMPCT CARB","BOTH IP/OP","$301.28 ","$222.95 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-5-530","SUP","Custom 27203010","","5049-5-530  -  ROD EXFIX 300MM 5MM HFMN2 C CARFBR CONNCTNG","BOTH IP/OP","$375.95 ","$278.20 ","$0.00 ","$125.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-7-018","SUP","Custom 27203010","","5049-7-018  -  ROD EXFIX 111MM HFMN2 C CVD SEM CIR CARFBR","BOTH IP/OP","$367.13 ","$271.68 ","$0.00 ","$191.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.13 ","$0.00 ","$95.56 ","$151.37 ","$152.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5049-7-020","SUP","Custom 27203010","","5049-7-020  -  ROD EXFIX 146MM HFMN2 C CVD SEM CIR CARFBR","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$178.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-501-31-07","SUP","HCPCS C1713","","50-501-31-07  -  GUIDE DRILL LONG 2.7MM RECONSTRUCTION THREADLOCK TS","BOTH IP/OP","$348.13 ","$257.62 ","$0.00 ","$348.13 ","$156.66 ","$0.00 ","$72.56 ","$0.00 ","$0.00 ","$60.95 ","$348.13 ","$0.00 ","$174.06 ","$275.72 ","$278.50 ","$0.00 ","$54.48 ","$0.00 ","$55.42 ","$0.00 "
"50-504-23-07","SUP","HCPCS C1713","","50-504-23-07  -  CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK","BOTH IP/OP","$2,478.55 ","$1,834.13 ","$0.00 ","$2,478.55 ","$1,115.35 ","$0.00 ","$516.59 ","$0.00 ","$0.00 ","$433.97 ","$2,478.55 ","$0.00 ","$1,239.28 ","$1,963.01 ","$1,982.84 ","$0.00 ","$387.89 ","$0.00 ","$394.59 ","$0.00 "
"50-504-24-07","SUP","HCPCS C1713","","50-504-24-07  -  CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK","BOTH IP/OP","$2,562.08 ","$1,895.94 ","$0.00 ","$2,562.08 ","$1,152.93 ","$0.00 ","$534.00 ","$0.00 ","$0.00 ","$448.60 ","$2,562.08 ","$0.00 ","$1,281.04 ","$2,029.17 ","$2,049.66 ","$0.00 ","$400.96 ","$0.00 ","$407.88 ","$0.00 "
"5050-4-300","SUP","HCPCS C1713","","5050-4-300  -  PIN FIX 5/6MM 300MM 40MM SLFDRILL THREAD APEX TRANSFIX","BOTH IP/OP","$221.00 ","$163.54 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$46.06 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"5050-5-250","SUP","Custom 27203010","","5050-5-250  -  PIN HALF 250MM 5MM 4MM APEX SS TRNFX 50MM NONSTRL","BOTH IP/OP","$262.65 ","$194.36 ","$0.00 ","$258.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$258.50 ","$0.00 ","$129.25 ","$204.73 ","$206.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5050-5-300","SUP","Custom 27203010","","5050-5-300  -  PIN EXFIX 300MM 5MM HFMN2 THRD TRNFX 50MM NONSTRL","BOTH IP/OP","$249.05 ","$184.30 ","$0.00 ","$244.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$244.75 ","$0.00 ","$122.38 ","$193.84 ","$195.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-519-15-07","SUP","Custom 27100030","","50-519-15-07  -  DRILL TWIST 1.9MM 115MM J NOTCH STEEL 2/2.3MM SCREW","BOTH IP/OP","$290.05 ","$214.64 ","$0.00 ","$290.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.05 ","$0.00 ","$145.03 ","$229.72 ","$232.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-2-001","SUP","Custom 27203010","","5054-2-001  -  INSRTR SURG THDL PIN","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-2-002","SUP","Custom 27203010","","5054-2-002  -  SET EXFIX 2 DRLBT W/O CHK REUSE","BOTH IP/OP","$804.38 ","$595.24 ","$0.00 ","$804.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$804.38 ","$0.00 ","$402.19 ","$637.07 ","$643.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-3-080","SUP","Custom 27203010","","5054-3-080  -  SLEEVE XTRNFX 3MM 80MM HFMN2 2 TROC","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-3-093","SUP","Custom 27203010","","5054-3-093  -  TROCAR 3MM 93MM 2 SLV ASMBLY SURG","BOTH IP/OP","$378.13 ","$279.82 ","$0.00 ","$378.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-4-120","SUP","Custom 27203010","","5054-4-120  -  SLEEVE XTRNFX 4MM 120MM HFMN2 2 TROC","BOTH IP/OP","$426.25 ","$315.43 ","$0.00 ","$426.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$426.25 ","$0.00 ","$213.13 ","$337.59 ","$341.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-4-150","SUP","Custom 27203010","","5054-4-150  -  SLEEVE XTRNFX 4MM 150MM HFMN2 2 TROC","BOTH IP/OP","$422.13 ","$312.38 ","$0.00 ","$422.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$422.13 ","$0.00 ","$211.06 ","$334.33 ","$337.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-4-180","SUP","Custom 27203010","","5054-4-180  -  SLEEVE XTRNFX 4MM 180MM HFMN2 2 TROC","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-6-120","SUP","Custom 27203010","","5054-6-120  -  SET EXFIX 6MM HFMN2 TROCAR DUAL SLV ASMBLY","BOTH IP/OP","$479.88 ","$355.11 ","$0.00 ","$479.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$479.88 ","$0.00 ","$239.94 ","$380.06 ","$383.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-6-150","SUP","Custom 27203010","","5054-6-150  -  TROCAR 6MM 150MM 2 SLV ASMBLY SURG","BOTH IP/OP","$479.88 ","$355.11 ","$0.00 ","$479.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$479.88 ","$0.00 ","$239.94 ","$380.06 ","$383.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-6-180","SUP","Custom 27203010","","5054-6-180  -  TROCAR 6MM 180MM 2 SLV ASMBLY SURG","BOTH IP/OP","$479.88 ","$355.11 ","$0.00 ","$479.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$479.88 ","$0.00 ","$239.94 ","$380.06 ","$383.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5054-6-200","SUP","Custom 27203010","","5054-6-200  -  TROCAR 6MM 200MM 2 SLV ASMBLY SURG","BOTH IP/OP","$479.88 ","$355.11 ","$0.00 ","$479.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$479.88 ","$0.00 ","$239.94 ","$380.06 ","$383.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-0-100","SUP","Custom 27203010","","5057-0-100  -  GUIDE DRILL APEX ASMBLY","BOTH IP/OP","$173.25 ","$128.21 ","$0.00 ","$173.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.25 ","$0.00 ","$86.63 ","$137.21 ","$138.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-0-200","SUP","Custom 27203010","","5057-0-200  -  ASMBLY DRILL BRC APEX","BOTH IP/OP","$816.75 ","$604.40 ","$0.00 ","$816.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.75 ","$0.00 ","$408.38 ","$646.87 ","$653.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-0-300","SUP","Custom 27203010","","5057-0-300  -  ASMBLY DRILL 3-6MM BRC APEX","BOTH IP/OP","$765.88 ","$566.75 ","$0.00 ","$765.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.88 ","$0.00 ","$382.94 ","$606.58 ","$612.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-1-117","SUP","Custom 27203010","","5057-1-117  -  GUIDE DRILL HFMN2 4 HOLE BLOCK CMPCT","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-1-118","SUP","Custom 27203010","","5057-1-118  -  GUIDE DRILL HFMN2 C PERIART 4 HOLE BLOCK CLMP","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-1-119","SUP","Custom 27203010","","5057-1-119  -  GUIDE DRILL BLUE RED MNTB TRX APEX 4 HOLE BLOCK","BOTH IP/OP","$468.88 ","$346.97 ","$0.00 ","$468.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$468.88 ","$0.00 ","$234.44 ","$371.35 ","$375.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-1-120","SUP","Custom 27203010","","5057-1-120  -  GUIDE DRILL YLW MNTB TRX APEX 2 HOLE BLOCK","BOTH IP/OP","$468.88 ","$346.97 ","$0.00 ","$468.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$468.88 ","$0.00 ","$234.44 ","$371.35 ","$375.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-3-000","SUP","Custom 27203010","","5057-3-000  -  ASSEMBLY DRL XSH 3MM PREDRILLING","BOTH IP/OP","$218.63 ","$161.79 ","$0.00 ","$218.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$218.63 ","$0.00 ","$109.31 ","$173.15 ","$174.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-3-100","SUP","Custom 27203010","","5057-3-100  -  SLEEVE DRILL 3MM APEX SHRT PREDRILL","BOTH IP/OP","$511.43 ","$378.46 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$231.00 ","$0.00 ","$115.50 ","$182.95 ","$184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-3-200","SUP","Custom 27203010","","5057-3-200  -  SLEEVE DRILL 3MM APEX LNG PREDRILL","BOTH IP/OP","$511.43 ","$378.46 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$231.00 ","$0.00 ","$115.50 ","$182.95 ","$184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-4-000","SUP","Custom 27203010","","5057-4-000  -  GUIDE DRILL 35MM 4MM APEX XSH HYDRXAPT PREDRILLING ASMBLY","BOTH IP/OP","$235.13 ","$174.00 ","$0.00 ","$235.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$235.13 ","$0.00 ","$117.56 ","$186.22 ","$188.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-4-100","SUP","Custom 27203010","","5057-4-100  -  SLEEVE DRILL 4MM APEX SHRT PREDRILL","BOTH IP/OP","$231.00 ","$170.94 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$231.00 ","$0.00 ","$115.50 ","$182.95 ","$184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-4-200","SUP","Custom 27203010","","5057-4-200  -  GUIDE DRILL 100MM 4MM APEX LNG HA PREDRILLING ASMBLY PRTC","BOTH IP/OP","$231.00 ","$170.94 ","$0.00 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$231.00 ","$0.00 ","$115.50 ","$182.95 ","$184.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-5-000","SUP","Custom 27203010","","5057-5-000  -  ASMBLY DRILL XSH 50MM PREDRILLING PRTC LGTH 5MM","BOTH IP/OP","$250.25 ","$185.19 ","$0.00 ","$250.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.25 ","$0.00 ","$125.13 ","$198.20 ","$200.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-5-100","SUP","Custom 27203010","","5057-5-100  -  GUIDE 5MM SHRT PREDRILL TROCAR ASMBLY APEX SURG","BOTH IP/OP","$250.25 ","$185.19 ","$0.00 ","$250.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.25 ","$0.00 ","$125.13 ","$198.20 ","$200.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-5-200","SUP","Custom 27203010","","5057-5-200  -  ASMBLY DRILL LNG 5MM","BOTH IP/OP","$250.25 ","$185.19 ","$0.00 ","$250.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.25 ","$0.00 ","$125.13 ","$198.20 ","$200.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-6-000","SUP","Custom 27203010","","5057-6-000  -  ASMBLY DRILL XSH 60MM PREDRILLING PRTC LGTH 6MM","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-6-100","SUP","Custom 27203010","","5057-6-100  -  ASMBLY DRILL 6MM SHRT PREDRILLING","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-6-200","SUP","Custom 27203010","","5057-6-200  -  GUIDE DRILL 120MM 6MM APEX LNG HA PREDRILLING ASMBLY","BOTH IP/OP","$266.75 ","$197.40 ","$0.00 ","$266.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-6-300","SUP","Custom 27203010","","5057-6-300  -  CUTTER PIN APEX 4-6MM EXTN HNDL","BOTH IP/OP","$3,898.13 ","$2,884.62 ","$0.00 ","$3,898.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,898.13 ","$0.00 ","$1,949.06 ","$3,087.32 ","$3,118.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5057-9-900","SUP","Custom 27203010","","5057-9-900  -  TRAY STRL PIN AND INSTRUMENTATION STOR APEX","BOTH IP/OP","$3,267.00 ","$2,417.58 ","$0.00 ","$3,267.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,267.00 ","$0.00 ","$1,633.50 ","$2,587.46 ","$2,613.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50638-311","SUP","Custom 27203010","","50638-311  -  BRACE PSTN GTT STOP ECON SPAN+AIDS 300 SER ANKL FT LATEX","BOTH IP/OP","$37.23 ","$27.55 ","$0.00 ","$37.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.97 ","$0.00 ","$18.99 ","$30.07 ","$30.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-3-312","SUP","Custom 27203010","","5065-3-312  -  PIN HALF 12MM 2MM APEX SM BONE SS BLNT SLFTAP CONTIN THRD","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-3-615","SUP","Custom 27203010","","5065-3-615  -  PIN HALF 36MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 15MM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-3-918","SUP","Custom 27203010","","5065-3-918  -  PIN HALF 39MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 18MM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-4-520","SUP","Custom 27203010","","5065-4-520  -  PIN HALF 45MM 2MM APEX MINI SS BLNT SLFTAP CONTIN THRD 20MM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-5-020","SUP","Custom 27203010","","5065-5-020  -  PIN HALF 50MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 20MM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-6-020","SUP","Custom 27203010","","5065-6-020  -  PIN HALF 60MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 20MM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5065-9-015","SUP","Custom 27203010","","5065-9-015  -  PIN HALF 90MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 15MM","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7000B","SUP","HCPCS A7042","","50-7000B  -  KIT DRAIN 15.5FR PLEURAL CATHETER CHLORAPREP APPLICATOR","BOTH IP/OP","$2,412.70 ","$1,785.40 ","$0.00 ","$2,412.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,412.71 ","$0.00 ","$1,206.35 ","$1,910.87 ","$1,930.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-3-310","SUP","Custom 27203010","","5070-3-310  -  PIN EXFIX 33MM 2MM TRNFX SS SMTH 10MM","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-3-810","SUP","Custom 27203010","","5070-3-810  -  PIN XTRNFX 2MM 38MM 10MM TRNFX SMTH SS","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$130.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-4-312","SUP","Custom 27203010","","5070-4-312  -  PIN EXFIX 43MM 2MM TRNFX SS SMTH 13MM","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$130.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-4-812","SUP","Custom 27203010","","5070-4-812  -  PIN EXFIX 48MM 2MM TRNFX SS SMTH 13MM","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$130.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-5-312","SUP","Custom 27203010","","5070-5-312  -  PIN EXFIX 53MM 2MM TRNFX SS SMTH 13MM","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$130.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-5-815","SUP","Custom 27203010","","5070-5-815  -  PIN EXFIX 58MM 2MM TRNFX SS SMTH 16MM","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$130.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-6-315","SUP","Custom 27203010","","5070-6-315  -  PIN EXFIX 63MM 2MM TRNFX SS SMTH 16MM","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5070-7-820","SUP","Custom 27203010","","5070-7-820  -  PIN EXFIX 78MM 2MM TRNFX SS SMTH 20MM","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-712-04-09","SUP","HCPCS C1713","","50-712-04-09  -  PLATE BONE 28MM 4 HOLE LOCKING FRAC TITANIUM MANDIB STERILE","BOTH IP/OP","$932.93 ","$690.37 ","$0.00 ","$932.93 ","$419.82 ","$0.00 ","$194.44 ","$0.00 ","$0.00 ","$163.35 ","$932.93 ","$0.00 ","$466.46 ","$738.88 ","$746.34 ","$0.00 ","$146.00 ","$0.00 ","$148.52 ","$0.00 "
"5071-35","SUP","HCPCS C1898","","5071-35  -  LEAD PCNG 6.6FR 35CM IS-1 UNPLR FX SCR SIL MYOCARDIUM","BOTH IP/OP","$992.50 ","$734.45 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$206.86 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"50-714-04-09","SUP","HCPCS C1713","","50-714-04-09  -  PLATE BONE 33MM 4 HOLE FRAC TITANIUM MANDIB STERILE","BOTH IP/OP","$974.73 ","$721.30 ","$0.00 ","$974.73 ","$438.63 ","$0.00 ","$203.16 ","$0.00 ","$0.00 ","$170.67 ","$974.73 ","$0.00 ","$487.36 ","$771.99 ","$779.78 ","$0.00 ","$152.54 ","$0.00 ","$155.18 ","$0.00 "
"50-716-06-09","SUP","HCPCS C1713","","50-716-06-09  -  PLATE BONE 16MMX1.5IN 6 HOLE FRAC TITANIUM MANDIB","BOTH IP/OP","$1,127.88 ","$834.63 ","$0.00 ","$1,127.88 ","$507.54 ","$0.00 ","$235.08 ","$0.00 ","$0.00 ","$197.48 ","$1,127.88 ","$0.00 ","$563.94 ","$893.28 ","$902.30 ","$0.00 ","$176.51 ","$0.00 ","$179.56 ","$0.00 "
"50-722-12-09","SUP","HCPCS C1713","","50-722-12-09  -  PLATE BONE 1.5IN 2X6 HOLE LOCKING FRAC TITANIUM MANDIB","BOTH IP/OP","$1,072.18 ","$793.41 ","$0.00 ","$1,072.18 ","$482.48 ","$0.00 ","$223.47 ","$0.00 ","$0.00 ","$187.73 ","$1,072.18 ","$0.00 ","$536.09 ","$849.17 ","$857.74 ","$0.00 ","$167.80 ","$0.00 ","$170.69 ","$0.00 "
"50-723-12-09","SUP","HCPCS C1713","","50-723-12-09  -  PLATE BONE MINI CVD 1MM 12 HOLE LOCKING THREADLOCK TITANIUM","BOTH IP/OP","$1,100.03 ","$814.02 ","$0.00 ","$1,100.03 ","$495.01 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.61 ","$1,100.03 ","$0.00 ","$550.01 ","$871.22 ","$880.02 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"50-730-04-09","SUP","HCPCS C1713","","50-730-04-09  -  PLATE BONE CVD SHORT 1.5MM LOCKING FRAC TITANIUM MANDIB","BOTH IP/OP","$1,281.03 ","$947.96 ","$0.00 ","$1,281.03 ","$576.46 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$224.30 ","$1,281.03 ","$0.00 ","$640.51 ","$1,014.58 ","$1,024.82 ","$0.00 ","$200.48 ","$0.00 ","$203.94 ","$0.00 "
"50-730-06-09","SUP","HCPCS C1713","","50-730-06-09  -  PLATE BONE CVD MEDIUM 1MM 6 HOLE LOCKING FRAC TITANIUM","BOTH IP/OP","$877.23 ","$649.15 ","$0.00 ","$877.23 ","$394.75 ","$0.00 ","$182.84 ","$0.00 ","$0.00 ","$153.60 ","$877.23 ","$0.00 ","$438.61 ","$694.77 ","$701.78 ","$0.00 ","$137.29 ","$0.00 ","$139.65 ","$0.00 "
"50-731-06-09","SUP","HCPCS C1713","","50-731-06-09  -  PLATE BN CRV LNG 1MM THREADLOCK TS 6 HL LCK TI MNDB 2MM SCR","BOTH IP/OP","$877.23 ","$649.15 ","$0.00 ","$877.23 ","$394.75 ","$0.00 ","$182.84 ","$0.00 ","$0.00 ","$153.60 ","$877.23 ","$0.00 ","$438.61 ","$694.77 ","$701.78 ","$0.00 ","$137.29 ","$0.00 ","$139.65 ","$0.00 "
"50-732-04-09","SUP","HCPCS C1713","","50-732-04-09  -  PLATE BONE CVD LONG 1.5MM 6 HOLE LOCKING FRAC TITANIUM","BOTH IP/OP","$1,281.03 ","$947.96 ","$0.00 ","$1,281.03 ","$576.46 ","$0.00 ","$267.00 ","$0.00 ","$0.00 ","$224.30 ","$1,281.03 ","$0.00 ","$640.51 ","$1,014.58 ","$1,024.82 ","$0.00 ","$200.48 ","$0.00 ","$203.94 ","$0.00 "
"50-732-06-09","SUP","HCPCS C1713","","50-732-06-09  -  PLATE BONE CVD XLONG 1MM 6 HOLE LOCKING FRAC TITANIUM MANDIB","BOTH IP/OP","$877.23 ","$649.15 ","$0.00 ","$877.23 ","$394.75 ","$0.00 ","$182.84 ","$0.00 ","$0.00 ","$153.60 ","$877.23 ","$0.00 ","$438.61 ","$694.77 ","$701.78 ","$0.00 ","$137.29 ","$0.00 ","$139.65 ","$0.00 "
"50-746-22-09","SUP","HCPCS C1713","","50-746-22-09  -  PLATE SM 2.8MM SMRT BONE RIGHT","BOTH IP/OP","$7,531.88 ","$5,573.59 ","$0.00 ","$7,531.88 ","$3,389.34 ","$0.00 ","$1,569.83 ","$0.00 ","$0.00 ","$1,318.77 ","$7,531.88 ","$0.00 ","$3,765.94 ","$5,965.25 ","$6,025.50 ","$0.00 ","$1,178.74 ","$0.00 ","$1,199.07 ","$0.00 "
"50-747-22-09","SUP","HCPCS C1713","","50-747-22-09  -  PLATE BN SM 2.8MM SMRT LT","BOTH IP/OP","$7,531.88 ","$5,573.59 ","$0.00 ","$7,531.88 ","$3,389.34 ","$0.00 ","$1,569.83 ","$0.00 ","$0.00 ","$1,318.77 ","$7,531.88 ","$0.00 ","$3,765.94 ","$5,965.25 ","$6,025.50 ","$0.00 ","$1,178.74 ","$0.00 ","$1,199.07 ","$0.00 "
"50-750-06-09","SUP","HCPCS C1713","","50-750-06-09  -  PLATE BONE ANGLED 1.5MM 3X3 HOLE LOCKING FRAC TITANIUM","BOTH IP/OP","$1,782.30 ","$1,318.90 ","$0.00 ","$1,782.30 ","$802.04 ","$0.00 ","$371.48 ","$0.00 ","$0.00 ","$312.07 ","$1,782.30 ","$0.00 ","$891.15 ","$1,411.58 ","$1,425.84 ","$0.00 ","$278.93 ","$0.00 ","$283.74 ","$0.00 "
"50-750-08-09","SUP","HCPCS C1713","","50-750-08-09  -  PLATE BONE ANGLED 1.5MM 4X4 HOLE LOCKING FRAC TITANIUM","BOTH IP/OP","$1,810.18 ","$1,339.53 ","$0.00 ","$1,810.18 ","$814.58 ","$0.00 ","$377.29 ","$0.00 ","$0.00 ","$316.95 ","$1,810.18 ","$0.00 ","$905.09 ","$1,433.66 ","$1,448.14 ","$0.00 ","$283.29 ","$0.00 ","$288.18 ","$0.00 "
"50-7505","SUP","Custom 27203010","","50-7505  -  DILATOR LARYNGEAL METAL 20F","BOTH IP/OP","$346.25 ","$256.23 ","$0.00 ","$346.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$346.25 ","$0.00 ","$173.13 ","$274.23 ","$277.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7507","SUP","Custom 27203010","","50-7507  -  DILATOR LARYNGEAL METAL 24F","BOTH IP/OP","$332.60 ","$246.12 ","$0.00 ","$332.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$332.60 ","$0.00 ","$166.30 ","$263.42 ","$266.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7509","SUP","Custom 27203010","","50-7509  -  DILATOR LARYNGEAL METAL 28F","BOTH IP/OP","$374.90 ","$277.43 ","$0.00 ","$374.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.90 ","$0.00 ","$187.45 ","$296.92 ","$299.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7511","SUP","Custom 27203010","","50-7511  -  DILATOR LARYNGEAL METAL 32F","BOTH IP/OP","$355.73 ","$263.24 ","$0.00 ","$355.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.73 ","$0.00 ","$177.86 ","$281.74 ","$284.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7513","SUP","Custom 27203010","","50-7513  -  DILATOR LARYNGEAL METAL 36F","BOTH IP/OP","$350.88 ","$259.65 ","$0.00 ","$350.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.88 ","$0.00 ","$175.44 ","$277.90 ","$280.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7515","SUP","Custom 27203010","","50-7515  -  DILATOR LARYNGEAL METAL 40F","BOTH IP/OP","$337.20 ","$249.53 ","$0.00 ","$337.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.20 ","$0.00 ","$168.60 ","$267.06 ","$269.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-7517","SUP","Custom 27203010","","50-7517  -  DILATOR LARYNGEAL METAL 44F","BOTH IP/OP","$336.10 ","$248.71 ","$0.00 ","$336.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.10 ","$0.00 ","$168.05 ","$266.19 ","$268.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-754-05-09","SUP","HCPCS C1713","","50-754-05-09  -  PLATE BN MN LNG 110MM THREADLOCK TS LVL 1 4 HL LCK BAR TI","BOTH IP/OP","$854.95 ","$632.66 ","$0.00 ","$854.95 ","$384.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$149.69 ","$854.95 ","$0.00 ","$427.48 ","$677.12 ","$683.96 ","$0.00 ","$133.80 ","$0.00 ","$136.11 ","$0.00 "
"50-760-12-09","SUP","HCPCS C1713","","50-760-12-09  -  PLATE BONE STR 2.5MM LOCK 12 HOLE TITANIUM","BOTH IP/OP","$2,796.00 ","$2,069.04 ","$0.00 ","$2,796.00 ","$1,258.20 ","$0.00 ","$582.76 ","$0.00 ","$0.00 ","$489.56 ","$2,796.00 ","$0.00 ","$1,398.00 ","$2,214.43 ","$2,236.80 ","$0.00 ","$437.57 ","$0.00 ","$445.12 ","$0.00 "
"50-760-20-09","SUP","HCPCS C1713","","50-760-20-09  -  PLATE BN STRG 2.5MM 20 HL LCK TI","BOTH IP/OP","$4,074.25 ","$3,014.95 ","$0.00 ","$4,074.25 ","$1,833.41 ","$0.00 ","$849.18 ","$0.00 ","$0.00 ","$713.37 ","$4,074.25 ","$0.00 ","$2,037.13 ","$3,226.81 ","$3,259.40 ","$0.00 ","$637.62 ","$0.00 ","$648.62 ","$0.00 "
"50-764-04-09","SUP","HCPCS C1713","","50-764-04-09  -  LOCKING FRACTURE PLATE  4 HOLE  33MM  NON-COMPRESSION  2.0MM","BOTH IP/OP","$1,241.75 ","$918.90 ","$0.00 ","$1,241.75 ","$558.79 ","$0.00 ","$258.81 ","$0.00 ","$0.00 ","$217.42 ","$1,241.75 ","$0.00 ","$620.88 ","$983.47 ","$993.40 ","$0.00 ","$194.33 ","$0.00 ","$197.69 ","$0.00 "
"5076-52","SUP","HCPCS C1898","","5076-52  -  LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 52CM 20-110CM","BOTH IP/OP","$992.50 ","$734.45 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$206.86 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"5076-58","SUP","HCPCS C1898","","5076-58  -  LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 58CM 20-110CM","BOTH IP/OP","$992.50 ","$734.45 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$206.86 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"50-766-06-09","SUP","HCPCS C1713","","50-766-06-09  -  PLATE BN 43MMX2MM NS LVL 1 6 HL LCK TI CRNMXF 2MM SCR","BOTH IP/OP","$1,241.75 ","$918.90 ","$0.00 ","$1,241.75 ","$558.79 ","$0.00 ","$258.81 ","$0.00 ","$0.00 ","$217.42 ","$1,241.75 ","$0.00 ","$620.88 ","$983.47 ","$993.40 ","$0.00 ","$194.33 ","$0.00 ","$197.69 ","$0.00 "
"50-771-26-09","SUP","HCPCS C1713","","50-771-26-09  -  PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING","BOTH IP/OP","$3,550.70 ","$2,627.52 ","$0.00 ","$3,550.70 ","$1,597.82 ","$0.00 ","$740.05 ","$0.00 ","$0.00 ","$621.70 ","$3,550.70 ","$0.00 ","$1,775.35 ","$2,812.15 ","$2,840.56 ","$0.00 ","$555.68 ","$0.00 ","$565.27 ","$0.00 "
"50-773-26-09","SUP","HCPCS C1713","","50-773-26-09  -  PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING","BOTH IP/OP","$3,550.70 ","$2,627.52 ","$0.00 ","$3,550.70 ","$1,597.82 ","$0.00 ","$740.05 ","$0.00 ","$0.00 ","$621.70 ","$3,550.70 ","$0.00 ","$1,775.35 ","$2,812.15 ","$2,840.56 ","$0.00 ","$555.68 ","$0.00 ","$565.27 ","$0.00 "
"50-774-20-09","SUP","HCPCS C1713","","50-774-20-09  -  PLATE BN STRG 2MM THREADLOCK TS 20 HL RECON BRDG LCK TI MNDB","BOTH IP/OP","$2,186.13 ","$1,617.74 ","$0.00 ","$2,186.13 ","$983.76 ","$0.00 ","$455.64 ","$0.00 ","$0.00 ","$382.77 ","$2,186.13 ","$0.00 ","$1,093.06 ","$1,731.41 ","$1,748.90 ","$0.00 ","$342.13 ","$0.00 ","$348.03 ","$0.00 "
"50-775-26-09","SUP","HCPCS C1713","","50-775-26-09  -  PLATE BONE 2MM 26 HOLE PRIM RECONSTRUCTION THREADLOCK GREEN","BOTH IP/OP","$3,481.10 ","$2,576.01 ","$0.00 ","$3,481.10 ","$1,566.50 ","$0.00 ","$725.55 ","$0.00 ","$0.00 ","$609.51 ","$3,481.10 ","$0.00 ","$1,740.55 ","$2,757.03 ","$2,784.88 ","$0.00 ","$544.79 ","$0.00 ","$554.19 ","$0.00 "
"50-777-26-09","SUP","HCPCS C1713","","50-777-26-09  -  PLATE BONE LEFT ANGLE 2MM 26 HOLE LOCKING RECONSTRUCTION","BOTH IP/OP","$3,481.10 ","$2,576.01 ","$0.00 ","$3,481.10 ","$1,566.50 ","$0.00 ","$725.55 ","$0.00 ","$0.00 ","$609.51 ","$3,481.10 ","$0.00 ","$1,740.55 ","$2,757.03 ","$2,784.88 ","$0.00 ","$544.79 ","$0.00 ","$554.19 ","$0.00 "
"50-781-76-09","SUP","HCPCS C1713","","50-781-76-09  -  TEMPLATE SIZING PREBENT 26 HOLE RECONSTRUCTION LOCKING","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$139.25 ","$62.66 ","$0.00 ","$29.02 ","$0.00 ","$0.00 ","$24.38 ","$139.25 ","$0.00 ","$69.63 ","$110.29 ","$111.40 ","$0.00 ","$21.79 ","$0.00 ","$22.17 ","$0.00 "
"50-784-70-09","SUP","HCPCS C1713","","50-784-70-09  -  TEMPLATE BNDRG 20MMX2.3MM LCK PLT","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$139.25 ","$62.66 ","$0.00 ","$29.02 ","$0.00 ","$0.00 ","$24.38 ","$139.25 ","$0.00 ","$69.63 ","$110.29 ","$111.40 ","$0.00 ","$21.79 ","$0.00 ","$22.17 ","$0.00 "
"50-785-76-09","SUP","HCPCS C1713","","50-785-76-09  -  TEMPLATE BENDING 26 HOLE PRIM PLATE RECONSTRUCTION TITANIUM","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$139.25 ","$62.66 ","$0.00 ","$29.02 ","$0.00 ","$0.00 ","$24.38 ","$139.25 ","$0.00 ","$69.63 ","$110.29 ","$111.40 ","$0.00 ","$21.79 ","$0.00 ","$22.17 ","$0.00 "
"50-790-06-09","SUP","HCPCS C1713","","50-790-06-09  -  PLATE BN 155D 3MM GRN NS THREADLOCK TS 6 HL RECON CX TI MNDB","BOTH IP/OP","$2,339.28 ","$1,731.07 ","$0.00 ","$2,339.28 ","$1,052.67 ","$0.00 ","$487.56 ","$0.00 ","$0.00 ","$409.59 ","$2,339.28 ","$0.00 ","$1,169.64 ","$1,852.71 ","$1,871.42 ","$0.00 ","$366.10 ","$0.00 ","$372.41 ","$0.00 "
"5079-1-010","SUP","Custom 27203010","","5079-1-010  -  CLAMP EXFIX HFMN2 MINI SS SWVL","BOTH IP/OP","$1,339.50 ","$991.23 ","$0.00 ","$1,285.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,285.63 ","$0.00 ","$642.81 ","$1,018.22 ","$1,028.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-1-020","SUP","Custom 27203010","","5079-1-020  -  CLAMP EXFIX HFMN MINI SMPL HM20","BOTH IP/OP","$970.50 ","$718.17 ","$0.00 ","$948.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-791-26-09","SUP","HCPCS C1713","","50-791-26-09  -  PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION TITANIUM","BOTH IP/OP","$4,177.30 ","$3,091.20 ","$0.00 ","$4,177.30 ","$1,879.79 ","$0.00 ","$870.65 ","$0.00 ","$0.00 ","$731.41 ","$4,177.30 ","$0.00 ","$2,088.65 ","$3,308.42 ","$3,341.84 ","$0.00 ","$653.75 ","$0.00 ","$665.03 ","$0.00 "
"50-791-76-09","SUP","HCPCS C1713","","50-791-76-09  -  TEMPLATE BENDING PREBENT 26 HOLE THREADLOCK TITANIUM MANDIB","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$139.25 ","$62.66 ","$0.00 ","$29.02 ","$0.00 ","$0.00 ","$24.38 ","$139.25 ","$0.00 ","$69.63 ","$110.29 ","$111.40 ","$0.00 ","$21.79 ","$0.00 ","$22.17 ","$0.00 "
"5079-2-031","SUP","Custom 27203010","","5079-2-031  -  FXTR EXFIX HFMN 31MM MINI HIP INSL VISE SMTH","BOTH IP/OP","$264.75 ","$195.92 ","$0.00 ","$254.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-2-032","SUP","Custom 27203010","","5079-2-032  -  PIN XTRNFX 32MM MN HFMN INSL","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-2-034","SUP","Custom 27203010","","5079-2-034  -  FIXATOR XTRNFX MN HFMN2 INSL","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$178.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-2-035","SUP","Custom 27203010","","5079-2-035  -  VISE XTRNFX 35MM HFMN2 ROD 3 HL MDLR HM","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$378.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-2-036","SUP","Custom 27203010","","5079-2-036  -  DEVICE EXFIX HFMN2 MINI 3 HOLE VISE 2 ROD","BOTH IP/OP","$378.13 ","$279.82 ","$0.00 ","$378.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.13 ","$0.00 ","$189.06 ","$299.48 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-792-06-09","SUP","HCPCS C1713","","50-792-06-09  -  PLATE BONE 120D 3MM 6 HOLE RECONSTRUCTION THREADLOCK GREEN","BOTH IP/OP","$2,339.28 ","$1,731.07 ","$0.00 ","$2,339.28 ","$1,052.67 ","$0.00 ","$487.56 ","$0.00 ","$0.00 ","$409.59 ","$2,339.28 ","$0.00 ","$1,169.64 ","$1,852.71 ","$1,871.42 ","$0.00 ","$366.10 ","$0.00 ","$372.41 ","$0.00 "
"50-792-08-09","SUP","HCPCS C1713","","50-792-08-09  -  PLATE BONE 120D 3MM 8 HOLE RECONSTRUCTION THREADLOCK GREEN","BOTH IP/OP","$2,422.85 ","$1,792.91 ","$0.00 ","$2,422.85 ","$1,090.28 ","$0.00 ","$504.98 ","$0.00 ","$0.00 ","$424.22 ","$2,422.85 ","$0.00 ","$1,211.43 ","$1,918.90 ","$1,938.28 ","$0.00 ","$379.18 ","$0.00 ","$385.72 ","$0.00 "
"5079-2-113","SUP","Custom 27203010","","5079-2-113  -  CPLNG EXFIX 3X3MM HFMN 13MM LCK","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$756.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$756.25 ","$0.00 ","$378.13 ","$598.95 ","$605.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-2-123","SUP","Custom 27203010","","5079-2-123  -  COUPLING XTRNFX 2MM MN 3MM HFMN ARTC CPL","BOTH IP/OP","$797.50 ","$590.15 ","$0.00 ","$797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$797.50 ","$0.00 ","$398.75 ","$631.62 ","$638.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-3-040","SUP","Custom 27203010","","5079-3-040  -  HOLDER IMPL HFMN2 PIN STR HM40 STRL","BOTH IP/OP","$273.00 ","$202.02 ","$0.00 ","$261.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$261.25 ","$0.00 ","$130.63 ","$206.91 ","$209.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-3-041","SUP","Custom 27203010","","5079-3-041  -  HOLDER IMPL HFMN MINI OFFST HM41","BOTH IP/OP","$336.88 ","$249.29 ","$0.00 ","$336.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-3-042","SUP","Custom 27203010","","5079-3-042  -  HOLDER IMPL HFMN2 MINI PIN OFFST STR","BOTH IP/OP","$336.88 ","$249.29 ","$0.00 ","$336.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-793-26-09","SUP","HCPCS C1713","","50-793-26-09  -  PLATE BONE PREBENT ANGLED 3MM 26 HOLE RECONSTRUCTION LOCKING","BOTH IP/OP","$4,177.30 ","$3,091.20 ","$0.00 ","$4,177.30 ","$1,879.79 ","$0.00 ","$870.65 ","$0.00 ","$0.00 ","$731.41 ","$4,177.30 ","$0.00 ","$2,088.65 ","$3,308.42 ","$3,341.84 ","$0.00 ","$653.75 ","$0.00 ","$665.03 ","$0.00 "
"5079-3-413","SUP","Custom 27203010","","5079-3-413  -  BURR SURG 3MM HFMN MINI SHNK OFST HLD STRL","BOTH IP/OP","$351.75 ","$260.30 ","$0.00 ","$336.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-4-012","SUP","Custom 27203010","","5079-4-012  -  DEVICE EXFIX HFMN2 2MMX3MM MINI PVT LINKING","BOTH IP/OP","$294.00 ","$217.56 ","$0.00 ","$281.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.88 ","$0.00 ","$140.94 ","$223.25 ","$225.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-4-050","SUP","Custom 27203010","","5079-4-050  -  SOCKET XTRNFX 4MM MN 5MM HFMN INSL","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$178.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$178.75 ","$0.00 ","$89.38 ","$141.57 ","$143.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-794-20-09","SUP","HCPCS C1713","","50-794-20-09  -  PLATE BONE STR 3MM 20 HOLE RECONSTRUCTION THREADLOCK GREEN","BOTH IP/OP","$2,770.93 ","$2,050.49 ","$0.00 ","$2,770.93 ","$1,246.92 ","$0.00 ","$577.53 ","$0.00 ","$0.00 ","$485.17 ","$2,770.93 ","$0.00 ","$1,385.46 ","$2,194.58 ","$2,216.74 ","$0.00 ","$433.65 ","$0.00 ","$441.13 ","$0.00 "
"50-794-70-09","SUP","HCPCS C1713","","50-794-70-09  -  TEMPLATE BENDING STR 20 HOLE THREADLOCK TITANIUM","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$139.25 ","$62.66 ","$0.00 ","$29.02 ","$0.00 ","$0.00 ","$24.38 ","$139.25 ","$0.00 ","$69.63 ","$110.29 ","$111.40 ","$0.00 ","$21.79 ","$0.00 ","$22.17 ","$0.00 "
"5079-5-030","SUP","Custom 27203010","","5079-5-030  -  ROD EXFIX 30MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-040","SUP","Custom 27203010","","5079-5-040  -  ROD EXFIX 40MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-050","SUP","Custom 27203010","","5079-5-050  -  ROD EXFIX 50MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-060","SUP","Custom 27203010","","5079-5-060  -  ROD EXFIX 60MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$68.25 ","$50.51 ","$0.00 ","$48.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-070","SUP","Custom 27203010","","5079-5-070  -  ROD EXFIX 70MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-080","SUP","Custom 27203010","","5079-5-080  -  HM33/80 3MMX80MM","BOTH IP/OP","$68.25 ","$50.51 ","$0.00 ","$34.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-090","SUP","Custom 27203010","","5079-5-090  -  ROD EXFIX 90MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-120","SUP","Custom 27203010","","5079-5-120  -  ROD EXFIX 120MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-150","SUP","Custom 27203010","","5079-5-150  -  ROD EXFIX 150MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-180","SUP","Custom 27203010","","5079-5-180  -  3X180MM CONNECTING ROD","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-5-250","SUP","Custom 27203010","","5079-5-250  -  ROD EXFIX 250MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$78.00 ","$57.72 ","$0.00 ","$75.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.63 ","$0.00 ","$37.81 ","$59.90 ","$60.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-795-26-09","SUP","HCPCS C1713","","50-795-26-09  -  PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION THREADLOCK","BOTH IP/OP","$4,274.75 ","$3,163.32 ","$0.00 ","$4,274.75 ","$1,923.64 ","$0.00 ","$890.96 ","$0.00 ","$0.00 ","$748.47 ","$4,274.75 ","$0.00 ","$2,137.38 ","$3,385.60 ","$3,419.80 ","$0.00 ","$669.00 ","$0.00 ","$680.54 ","$0.00 "
"5079-5-300","SUP","Custom 27203010","","5079-5-300  -  ROD EXFIX 300MM 3MM HFMN2 MIC SS CONNCTNG","BOTH IP/OP","$78.00 ","$57.72 ","$0.00 ","$68.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.75 ","$0.00 ","$34.38 ","$54.45 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-795-76-09","SUP","Custom 27203010","","50-795-76-09  -  TEMPLATE BENDING 26 HOLE THREADLOCK TITANIUM MANDIB","BOTH IP/OP","$139.25 ","$103.05 ","$0.00 ","$139.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.25 ","$0.00 ","$69.63 ","$110.29 ","$111.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-6-030","SUP","Custom 27203010","","5079-6-030  -  ROD EXFIX 30MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-6-040","SUP","Custom 27203010","","5079-6-040  -  ROD EXFIX 40MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-6-050","SUP","Custom 27203010","","5079-6-050  -  ROD EXFIX 50MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-6-060","SUP","Custom 27203010","","5079-6-060  -  ROD EXFIX 60MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-796-06-09","SUP","HCPCS C1713","","50-796-06-09  -  PLATE BN STRG 3MM GRN NS THREADLOCK TS 6 HL RECON BAR CX TI","BOTH IP/OP","$1,991.18 ","$1,473.47 ","$0.00 ","$1,991.18 ","$896.03 ","$0.00 ","$415.01 ","$0.00 ","$0.00 ","$348.64 ","$1,991.18 ","$0.00 ","$995.59 ","$1,577.01 ","$1,592.94 ","$0.00 ","$311.62 ","$0.00 ","$317.00 ","$0.00 "
"5079-6-090","SUP","Custom 27203010","","5079-6-090  -  ROD EXFIX 90MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-6-120","SUP","Custom 27203010","","5079-6-120  -  ROD EXFIX 120MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5079-6-150","SUP","Custom 27203010","","5079-6-150  -  ROD EXFIX 150MM 3MM HFMN2 MIC CARB CONNCTNG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-797-26-09","SUP","HCPCS C1713","","50-797-26-09  -  PLATE BONE 3MM RECONSTRUCTION THREADLOCK GREEN TITANIUM LEFT","BOTH IP/OP","$4,274.75 ","$3,163.32 ","$0.00 ","$4,274.75 ","$1,923.64 ","$0.00 ","$890.96 ","$0.00 ","$0.00 ","$748.47 ","$4,274.75 ","$0.00 ","$2,137.38 ","$3,385.60 ","$3,419.80 ","$0.00 ","$669.00 ","$0.00 ","$680.54 ","$0.00 "
"50-799-32-09","SUP","HCPCS C1713","","50-799-32-09  -  PLATE BONE 3MM 32 HOLE LOCKING RECONSTRUCTION TITANIUM","BOTH IP/OP","$4,748.20 ","$3,513.67 ","$0.00 ","$4,748.20 ","$2,136.69 ","$0.00 ","$989.64 ","$0.00 ","$0.00 ","$831.37 ","$4,748.20 ","$0.00 ","$2,374.10 ","$3,760.57 ","$3,798.56 ","$0.00 ","$743.09 ","$0.00 ","$755.91 ","$0.00 "
"50-799-34-09","SUP","HCPCS C1713","","50-799-34-09  -  PLATE BN ANG 3MM LVL 1 34 HL LCK RECON TI CRNMXF 2.7MM SCR","BOTH IP/OP","$5,082.38 ","$3,760.96 ","$0.00 ","$5,082.38 ","$2,287.07 ","$0.00 ","$1,059.29 ","$0.00 ","$0.00 ","$889.88 ","$5,082.38 ","$0.00 ","$2,541.19 ","$4,025.24 ","$4,065.90 ","$0.00 ","$795.39 ","$0.00 ","$809.11 ","$0.00 "
"50-8001","SUP","Custom 27011340","","50-8001  -  OXYGEN DELIVERY SYSTEM W/ADLT MASK 10/CS","BOTH IP/OP","$40.81 ","$30.20 ","$0.00 ","$40.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.81 ","$0.00 ","$20.40 ","$32.32 ","$32.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5080-1-612","SUP","Custom 27203010","","5080-1-612  -  PIN HALF 12MM 45MM 1.65MM HFMN2 APEX MIC SS SLFDRILL SLFTAP","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5080-1-620","SUP","Custom 27203010","","5080-1-620  -  PIN HALF 20MM 45MM 1.65MM HFMN2 APEX MIC SS SLFDRILL SLFTAP","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5080-2-012","SUP","Custom 27203010","","5080-2-012  -  PIN HALF 45MM 2MM HFMN2 APEX MIC SS SLFDRILL SLFTAP THRD 12","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5080-2-020","SUP","Custom 27203010","","5080-2-020  -  PIN HALF 45MM 2MM HFMN2 APEX MIC SS SLFDRILL SLFTAP THRD 20","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-42A","SUP","Custom 27803010","","508-11-42A  -  SHELL ACETAB A HEMISPHERE 42MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-44B","SUP","Custom 27803010","","508-11-44B  -  SHELL ACETAB B HEMISPHERE 44MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-46C","SUP","Custom 27803010","","508-11-46C  -  SHELL ACETAB C HEMISPHERE 46MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-48D","SUP","Custom 27803010","","508-11-48D  -  SHELL ACETAB D HEMISPHERE 48MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-50D","SUP","Custom 27803010","","508-11-50D  -  SHELL ACETAB D HEMISPHERE 50MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-52E","SUP","Custom 27803010","","508-11-52E  -  SHELL ACETAB E HEMISPHERE 52MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-54E","SUP","Custom 27803010","","508-11-54E  -  SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-56F","SUP","Custom 27803010","","508-11-56F  -  SHELL ACETAB F HEMISPHERE 56MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-58F","SUP","Custom 27803010","","508-11-58F  -  SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-60G","SUP","Custom 27803010","","508-11-60G  -  SHELL ACETAB G HEMISPHERE 60MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-62G","SUP","Custom 27803010","","508-11-62G  -  SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-64H","SUP","Custom 27803010","","508-11-64H  -  SHELL ACETAB H HEMISPHERE 64MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-66H","SUP","Custom 27803010","","508-11-66H  -  SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-68I","SUP","Custom 27803010","","508-11-68I  -  SHELL ACETAB I HEMISPHERE 68MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-70I","SUP","Custom 27803010","","508-11-70I  -  SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-72J","SUP","Custom 27803010","","508-11-72J  -  SHELL ACETAB J HEMISPHERE 72MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"508-11-74J","SUP","Custom 27803010","","508-11-74J  -  SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE TRIDENT HIP","BOTH IP/OP","$4,207.50 ","$3,113.55 ","$0.00 ","$4,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,207.50 ","$0.00 ","$2,103.75 ","$3,332.34 ","$3,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50-820-07-07","SUP","Custom 27100030","","50-820-07-07  -  DRILL TWIST 1.5MM 40MM 7MM HEXAGONAL ATTCH STOP STAINLESS","BOTH IP/OP","$311.90 ","$230.81 ","$0.00 ","$311.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$311.90 ","$0.00 ","$155.95 ","$247.02 ","$249.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5082-200","SUP","Custom 27203010","","5082-200  -  BLOOD PRESSURE CONNECTOR/MALE","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5084-1-100","SUP","Custom 27203010","","5084-1-100  -  GUIDE DRILL 1.5-2MM MINI","BOTH IP/OP","$515.63 ","$381.57 ","$0.00 ","$515.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.63 ","$0.00 ","$257.81 ","$408.38 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5085-2-015","SUP","Custom 27203010","","5085-2-015  -  BIT DRILL 75MM 1.5MM STRL","BOTH IP/OP","$86.70 ","$64.16 ","$0.00 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5090-2-120","SUP","Custom 27203010","","5090-2-120  -  PIN HALF 120MM 3MM 4MM APEX SLFDRILL","BOTH IP/OP","$146.20 ","$108.19 ","$0.00 ","$207.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.63 ","$0.00 ","$103.81 ","$164.44 ","$166.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-54E","SUP","Custom 27803010","","509-02-54E  -  SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-56E","SUP","Custom 27803010","","509-02-56E  -  SHELL ACETAB E HEMISPHERE 56MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-58F","SUP","Custom 27803010","","509-02-58F  -  SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-60F","SUP","Custom 27803010","","509-02-60F  -  SHELL ACETAB F HEMISPHERE 60MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-62G","SUP","Custom 27803010","","509-02-62G  -  SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-64G","SUP","Custom 27803010","","509-02-64G  -  SHELL ACETAB G HEMISPHERE 64MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-66H","SUP","Custom 27803010","","509-02-66H  -  SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-68H","SUP","Custom 27803010","","509-02-68H  -  SHELL ACETAB H HEMISPHERE 68MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-70I","SUP","Custom 27803010","","509-02-70I  -  SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-72I","SUP","Custom 27803010","","509-02-72I  -  SHELL ACETAB I HEMISPHERE 72MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-74J","SUP","Custom 27803010","","509-02-74J  -  SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE RIM MDM TRIDENT","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-76J","SUP","Custom 27803010","","509-02-76J  -  SHELL ACETAB 76MM MULTIHOLE REVISION TRITANIUM","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-78J","SUP","Custom 27803010","","509-02-78J  -  SHELL ACETAB 78MM MULTIHOLE REVISION TRITANIUM","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-02-80J","SUP","Custom 27803010","","509-02-80J  -  SHELL ACETAB 80MM MULTIHOLE REVISION TRITANIUM","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"509-250-605","SUP","Custom 27203010","","SPECULUM 7X1.75IN GRV 2XL RT OPN VAG LTX","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5094-0-202","SUP","Custom 27203010","","5094-0-202  -  FIXATOR XTRNFX HFMN2 LENGTHEN SS","BOTH IP/OP","$4,054.50 ","$3,000.33 ","$0.00 ","$3,973.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,973.75 ","$0.00 ","$1,986.88 ","$3,147.21 ","$3,179.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"50960-584","SUP","Custom 27203010","","MATTRESS OVRLY 72X34X3.5IN FULL SFT SKN COVER LF GM","BOTH IP/OP","$108.83 ","$80.53 ","$0.00 ","$108.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.83 ","$0.00 ","$54.41 ","$86.19 ","$87.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5096-4615","SUP","HCPCS C1776","","5096-4615  -  AUGMENT ACTB WDG 46MM 15MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-4620","SUP","HCPCS C1776","","5096-4620  -  AUGMENT ACTB WDG 46MM 20MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-5015","SUP","HCPCS C1776","","5096-5015  -  AUGMENT ACTB WDG 50MM 15MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-5020","SUP","HCPCS C1776","","5096-5020  -  AUGMENT ACTB WDG 50MM 20MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-5025","SUP","HCPCS C1776","","5096-5025  -  AUGMENT ACTB WDG 50MM 25MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-5415","SUP","HCPCS C1776","","5096-5415  -  AUGMENT ACTB WDG 54MM 15MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-5815","SUP","HCPCS C1776","","5096-5815  -  AUGMENT ACTB WDG 58MM 15MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-5825","SUP","HCPCS C1776","","5096-5825  -  AUGMENT ACTB WDG 58MM 25MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-6220","SUP","HCPCS C1776","","5096-6220  -  AUGMENT ACTB WDG 62MM 20MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-6225","SUP","HCPCS C1776","","5096-6225  -  AUGMENT ACTB WDG 62MM 25MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-6615","SUP","HCPCS C1776","","5096-6615  -  AUGMENT ACTB WDG 66MM 15MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-6620","SUP","HCPCS C1776","","5096-6620  -  AUGMENT ACTB WDG 66MM 20MM RSTR","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5096-6625","SUP","HCPCS C1776","","5096-6625  -  AUGMENT ACTB WDG 66MM 25MM RSTR HIP","BOTH IP/OP","$4,817.50 ","$3,564.95 ","$0.00 ","$4,817.50 ","$2,167.88 ","$0.00 ","$1,004.09 ","$0.00 ","$0.00 ","$843.51 ","$4,817.50 ","$0.00 ","$2,408.75 ","$3,815.46 ","$3,854.00 ","$0.00 ","$753.94 ","$0.00 ","$766.95 ","$0.00 "
"5100-001","SUP","HCPCS Q4116","","5100-001  -  GRAFT SKIN 0-175SQ CM CRYOPRESERVED SPLIT NONMESHED","BOTH IP/OP","$1,184.05 ","$876.20 ","$0.00 ","$945.00 ","$425.25 ","$0.00 ","$246.79 ","$0.00 ","$0.00 ","$165.46 ","$945.00 ","$0.00 ","$472.50 ","$748.44 ","$756.00 ","$0.00 ","$147.89 ","$0.00 ","$150.44 ","$0.00 "
"5100-037-012","SUP","Custom 27203010","","5100-037-012  -  BLADE SAW SHORT LONG MICRO 33.5X.64MM RECIPROCATE TPS","BOTH IP/OP","$196.10 ","$145.11 ","$0.00 ","$196.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.10 ","$0.00 ","$98.05 ","$155.31 ","$156.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5100-137-233","SUP","Custom 27203010","","5100-137-233  -  BLADE SAW SHORT 27X.38MM RECIPROCATING TAPERED PRECISION","BOTH IP/OP","$196.10 ","$145.11 ","$0.00 ","$196.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.10 ","$0.00 ","$98.05 ","$155.31 ","$156.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"510038SIM2","SUP","HCPCS C1725","","510038SIM2  -  CATHETER ANGIOGRAPHIC SIDEWINDER SIMMONS TECHNIQUE 2 CURVE 5","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"5101-1-450","SUP","HCPCS C1713","","5101-1-450  -  WIRE XTRNFX 1.5MM 450MM KRSH","BOTH IP/OP","$103.70 ","$76.74 ","$0.00 ","$108.63 ","$48.88 ","$0.00 ","$21.61 ","$0.00 ","$0.00 ","$19.02 ","$108.63 ","$0.00 ","$54.31 ","$86.03 ","$86.90 ","$0.00 ","$17.00 ","$0.00 ","$17.29 ","$0.00 "
"5101-2-450","SUP","HCPCS C1713","","5101-2-450  -  WIRE XTRNFX 2MM 450MM KRSH","BOTH IP/OP","$103.70 ","$76.74 ","$0.00 ","$108.63 ","$48.88 ","$0.00 ","$21.61 ","$0.00 ","$0.00 ","$19.02 ","$108.63 ","$0.00 ","$54.31 ","$86.03 ","$86.90 ","$0.00 ","$17.00 ","$0.00 ","$17.29 ","$0.00 "
"5101302P2","SUP","HCPCS C1713","","5101302P2  -  CAGE SPNL 12D 30X10X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5101308P2","SUP","HCPCS C1713","","5101308P2  -  CAGE SPNL 8D 30X10X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5102-1-246","SUP","Custom 27203010","","5102-1-246  -  HOLDER IMPL M-S KWR SPCR KWR","BOTH IP/OP","$383.63 ","$283.89 ","$0.00 ","$383.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$383.63 ","$0.00 ","$191.81 ","$303.83 ","$306.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5102-1-250","SUP","Custom 27203010","","5102-1-250  -  CLAMP XTRNFX M-S HBRD","BOTH IP/OP","$1,218.25 ","$901.51 ","$0.00 ","$1,218.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,218.25 ","$0.00 ","$609.13 ","$964.85 ","$974.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5102-1-260","SUP","Custom 27203010","","5102-1-260  -  HOLDER KWR 60MM M-S 2","BOTH IP/OP","$1,215.50 ","$899.47 ","$0.00 ","$1,215.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,215.50 ","$0.00 ","$607.75 ","$962.68 ","$972.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5102-1-270","SUP","Custom 27203010","","5102-1-270  -  HOLDER KWR 80MM M-S 2","BOTH IP/OP","$1,215.50 ","$899.47 ","$0.00 ","$1,215.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,215.50 ","$0.00 ","$607.75 ","$962.68 ","$972.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5102-1-330","SUP","Custom 27203010","","5102-1-330  -  FIXATOR XTRNFX 70D M-S BALL JNT","BOTH IP/OP","$803.00 ","$594.22 ","$0.00 ","$803.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$803.00 ","$0.00 ","$401.50 ","$635.98 ","$642.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5102-8-330","SUP","Custom 27203010","","5102-8-330  -  ROD EXFIX 330MM 8MM MNTB CONNCTNG THRD","BOTH IP/OP","$81.13 ","$60.04 ","$0.00 ","$81.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.13 ","$0.00 ","$40.56 ","$64.25 ","$64.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5102-8-395","SUP","Custom 27203010","","5102-8-395  -  FXTR EXFIX 395MM 8MM M-S CONNCTNG ROD THRD","BOTH IP/OP","$82.50 ","$61.05 ","$0.00 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.50 ","$0.00 ","$41.25 ","$65.34 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"510410R","SUP","HCPCS C1758","","510410R  -  CATHETER URETHRAL 10FR LATEX ROBINSON RED RUBBER STERILE RRL","BOTH IP/OP","$10.58 ","$7.83 ","$0.00 ","$10.58 ","$5.74 ","$0.00 ","$2.20 ","$0.00 ","$0.00 ","$1.85 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$1.65 ","$0.00 ","$1.68 ","$0.00 "
"510420R","SUP","HCPCS C1758","","510420R  -  CATHETER URTH RBNSN 20FR 16IN 2 STGR EYLT XRY","BOTH IP/OP","$10.58 ","$7.83 ","$0.00 ","$10.58 ","$5.74 ","$0.00 ","$2.20 ","$0.00 ","$0.00 ","$1.85 ","$10.58 ","$0.00 ","$5.29 ","$8.38 ","$8.46 ","$0.00 ","$1.65 ","$0.00 ","$1.68 ","$0.00 "
"5104308P2","SUP","HCPCS C1713","","5104308P2  -  CAGE SPNL 8D 30X10X14MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5109302P2","SUP","HCPCS C1713","","5109302P2  -  CAGE SPNL 12D 30X10X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5109308P2","SUP","HCPCS C1713","","5109308P2  -  CAGE SPNL 8D 30X10X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5111302P2","SUP","HCPCS C1713","","5111302P2  -  CAGE SPNL 12D 30X11X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5111308P2","SUP","HCPCS C1713","","5111308P2  -  CAGE SPNL 8D 30X11X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"51114V","SUP","Custom 27203010","","51114V  -  CLIP INTNL MED LG SMTR VESOLOCK","BOTH IP/OP","$851.23 ","$629.91 ","$0.00 ","$851.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$851.23 ","$0.00 ","$425.61 ","$674.17 ","$680.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51-17304","SUP","HCPCS C1713","","51-17304  -  SCREW BONE 1.7MM 4MM EMERGENCY TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"5118-1-300","SUP","Custom 27203010","","5118-1-300  -  RING XTRNFX SM 147MM BLU M-S .75 HP","BOTH IP/OP","$642.13 ","$475.18 ","$0.00 ","$642.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$642.13 ","$0.00 ","$321.06 ","$508.57 ","$513.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-301","SUP","Custom 27203010","","5118-1-301  -  RING XTRNFX SM 165MM GRN M-S .75 HP","BOTH IP/OP","$738.38 ","$546.40 ","$0.00 ","$738.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$738.38 ","$0.00 ","$369.19 ","$584.80 ","$590.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-302","SUP","Custom 27203010","","5118-1-302  -  RING XTRNFX SM 187MM WHT M-S .75 HP","BOTH IP/OP","$796.13 ","$589.14 ","$0.00 ","$796.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$796.13 ","$0.00 ","$398.06 ","$630.53 ","$636.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-303","SUP","Custom 27203010","","5118-1-303  -  RING XTRNFX SM 147MM BLU M-S .25 HP","BOTH IP/OP","$374.00 ","$276.76 ","$0.00 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$374.00 ","$0.00 ","$187.00 ","$296.21 ","$299.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-304","SUP","Custom 27203010","","5118-1-304  -  RING XTRNFX MED 165MM GRN M-S .25 HP","BOTH IP/OP","$441.38 ","$326.62 ","$0.00 ","$441.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$441.38 ","$0.00 ","$220.69 ","$349.57 ","$353.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-305","SUP","Custom 27203010","","5118-1-305  -  RING XTRNFX LG 187MM WHT M-S .25 HP","BOTH IP/OP","$566.50 ","$419.21 ","$0.00 ","$566.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$566.50 ","$0.00 ","$283.25 ","$448.67 ","$453.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-306","SUP","Custom 27203010","","5118-1-306  -  PIN XTRNFX 50MM KRSH M-S RECON CLP WRE HLDR","BOTH IP/OP","$265.38 ","$196.38 ","$0.00 ","$265.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$265.38 ","$0.00 ","$132.69 ","$210.18 ","$212.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-307","SUP","Custom 27203010","","5118-1-307  -  PIN EXFIX 100MM CLMP","BOTH IP/OP","$320.38 ","$237.08 ","$0.00 ","$320.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.38 ","$0.00 ","$160.19 ","$253.74 ","$256.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-308","SUP","Custom 27203010","","5118-1-308  -  CPLNG EXFIX ARTC","BOTH IP/OP","$735.63 ","$544.37 ","$0.00 ","$735.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.63 ","$0.00 ","$367.81 ","$582.62 ","$588.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-311","SUP","Custom 27203010","","5118-1-311  -  HOLDER XTRNFX KRSH M-S ARTC CPLNG","BOTH IP/OP","$948.75 ","$702.08 ","$0.00 ","$948.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5118-1-320","SUP","HCPCS C1713","","5118-1-320  -  WIRE XTRNFX OLV 1.5MM 450MM KRSH STP NUT SS","BOTH IP/OP","$216.75 ","$160.40 ","$0.00 ","$217.25 ","$97.76 ","$0.00 ","$45.18 ","$0.00 ","$0.00 ","$38.04 ","$217.25 ","$0.00 ","$108.63 ","$172.06 ","$173.80 ","$0.00 ","$34.00 ","$0.00 ","$34.59 ","$0.00 "
"5118-1-340","SUP","HCPCS C1713","","5118-1-340  -  WIRE XTRNFX OLV 2MM 450MM KRSH STP SS","BOTH IP/OP","$216.75 ","$160.40 ","$0.00 ","$217.25 ","$97.76 ","$0.00 ","$45.18 ","$0.00 ","$0.00 ","$38.04 ","$217.25 ","$0.00 ","$108.63 ","$172.06 ","$173.80 ","$0.00 ","$34.00 ","$0.00 ","$34.59 ","$0.00 "
"5118-1-350","SUP","Custom 27203010","","5118-1-350  -  HINGE XTRNFX M-S","BOTH IP/OP","$481.25 ","$356.13 ","$0.00 ","$481.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$481.25 ","$0.00 ","$240.63 ","$381.15 ","$385.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5119302P2","SUP","HCPCS C1713","","5119302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5119308P2","SUP","HCPCS C1713","","5119308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5120-0-010","SUP","Custom 27203010","","5120-0-010  -  RING EXFIX GRY 100MM M-S .75 RING","BOTH IP/OP","$515.63 ","$381.57 ","$0.00 ","$515.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.63 ","$0.00 ","$257.81 ","$408.38 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5120-0-040","SUP","Custom 27203010","","5120-0-040  -  RING EXFIX 115MM M-S .25","BOTH IP/OP","$323.13 ","$239.12 ","$0.00 ","$323.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.13 ","$0.00 ","$161.56 ","$255.92 ","$258.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5120-0-050","SUP","Custom 27203010","","5120-0-050  -  RING EXFIX 130MM M-S .75","BOTH IP/OP","$591.25 ","$437.53 ","$0.00 ","$591.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$591.25 ","$0.00 ","$295.63 ","$468.27 ","$473.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5120-0-060","SUP","Custom 27203010","","5120-0-060  -  RING EXFIX RED 130MM M-S .25 RING","BOTH IP/OP","$367.13 ","$271.68 ","$0.00 ","$367.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$367.13 ","$0.00 ","$183.56 ","$290.77 ","$293.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5120-0-070","SUP","Custom 27203010","","5120-0-070  -  RING EXFIX BRNZ 210MM M-S .75 RING","BOTH IP/OP","$782.38 ","$578.96 ","$0.00 ","$782.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$782.38 ","$0.00 ","$391.19 ","$619.64 ","$625.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5120-0-080","SUP","Custom 27203010","","5120-0-080  -  RING EXFIX BRNZ 210MM M-S .25 RING","BOTH IP/OP","$622.88 ","$460.93 ","$0.00 ","$622.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$622.88 ","$0.00 ","$311.44 ","$493.32 ","$498.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5121302P2","SUP","HCPCS C1713","","5121302P2  -  CAGE SPNL 12D 30X12X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5121308P2","SUP","HCPCS C1713","","5121308P2  -  CAGE SPNL 8D 30X12X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5124308P2","SUP","HCPCS C1713","","5124308P2  -  CAGE SPNL 8D 30X12X14MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5128-1220","SUP","Custom 27203010","","REAGENT MOL BIO HC2 TRNSPT MED 30ML","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5129302P2","SUP","HCPCS C1713","","5129302P2  -  CAGE SPNL 12D 30X12X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5129308P2","SUP","HCPCS C1713","","5129308P2  -  CAGE SPNL 8D 30X12X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5130-080-030","SUP","Custom 27203010","","5130-080-030  -  RASP SURG LONG 3.2MM HELICOIDAL 3.2MM 18.3MM","BOTH IP/OP","$316.25 ","$234.03 ","$0.00 ","$316.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.25 ","$0.00 ","$158.13 ","$250.47 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5141302P2","SUP","HCPCS C1713","","5141302P2  -  CAGE SPNL 12D 30X14X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5141308P2","SUP","HCPCS C1713","","5141308P2  -  CAGE SPNL 8D 30X14X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5144308P2","SUP","HCPCS C1713","","5144308P2  -  CAGE SPNL 8D 30X14X14MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5149302P2","SUP","HCPCS C1713","","5149302P2  -  CAGE SPNL 12D 30X14X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5149308P2","SUP","HCPCS C1713","","5149308P2  -  CAGE SPNL 8D 30X9X14MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5150-0-400","SUP","Custom 27203010","","5150-0-400  -  TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C","BOTH IP/OP","$2,083.13 ","$1,541.52 ","$0.00 ","$2,083.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,083.13 ","$0.00 ","$1,041.56 ","$1,649.84 ","$1,666.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-0-410","SUP","Custom 27203010","","5150-0-410  -  TUBE XTRNFX 20MM RD MNTB TRX XTD DYNMC C","BOTH IP/OP","$2,186.25 ","$1,617.83 ","$0.00 ","$2,186.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,186.25 ","$0.00 ","$1,093.13 ","$1,731.51 ","$1,749.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-0-420","SUP","Custom 27203010","","5150-0-420  -  TUBE XTRNFX 15MM RD MNTB TRX XTD DYNMC C","BOTH IP/OP","$2,186.25 ","$1,617.83 ","$0.00 ","$2,186.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,186.25 ","$0.00 ","$1,093.13 ","$1,731.51 ","$1,749.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-0-465","SUP","Custom 27203010","","5150-0-465  -  TUBE XTRNFX SM 15MM YLW MNTB TRX DYNMC SNPFT C","BOTH IP/OP","$2,844.88 ","$2,105.21 ","$0.00 ","$2,844.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,844.88 ","$0.00 ","$1,422.44 ","$2,253.14 ","$2,275.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-0-470","SUP","Custom 27203010","","5150-0-470  -  TUBE XTRNFX MED 20MM BLU MNTB TRX DYNMC C","BOTH IP/OP","$2,996.88 ","$2,217.69 ","$0.00 ","$3,011.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,011.25 ","$0.00 ","$1,505.63 ","$2,384.91 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-0-475","SUP","Custom 27203010","","5150-0-475  -  TUBE XTRNFX 25MM RD MNTB TRX DYNMC C","BOTH IP/OP","$3,067.75 ","$2,270.14 ","$0.00 ","$3,081.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,081.38 ","$0.00 ","$1,540.69 ","$2,440.45 ","$2,465.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-0-575","SUP","Custom 27203010","","5150-0-575  -  TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C","BOTH IP/OP","$3,650.63 ","$2,701.47 ","$0.00 ","$3,650.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,650.63 ","$0.00 ","$1,825.31 ","$2,891.30 ","$2,920.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-2-520","SUP","HCPCS C1713","","5150-2-520  -  CAP END SPR 20MM TUBE MNTB TRX BLUE","BOTH IP/OP","$88.00 ","$65.12 ","$0.00 ","$88.00 ","$39.60 ","$0.00 ","$18.34 ","$0.00 ","$0.00 ","$15.41 ","$88.00 ","$0.00 ","$44.00 ","$69.70 ","$70.40 ","$0.00 ","$13.77 ","$0.00 ","$14.01 ","$0.00 "
"5150-2-615","SUP","Custom 27203010","","5150-2-615  -  TUBE XTRNFX 15MM YLW MNTB TRX END CAP UNLAT C","BOTH IP/OP","$38.25 ","$28.31 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-2-620","SUP","Custom 27203010","","5150-2-620  -  SET EXFIX BLUE 20MM CARB TUBE END CAP ASMBLY","BOTH IP/OP","$35.75 ","$26.46 ","$0.00 ","$35.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.75 ","$0.00 ","$17.88 ","$28.31 ","$28.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-2-625","SUP","Custom 27203010","","5150-2-625  -  SET EXFIX RED CAP ASMBLY CARB TUBE","BOTH IP/OP","$38.50 ","$28.49 ","$0.00 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.00 ","$0.00 ","$22.00 ","$34.85 ","$35.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-015","SUP","Custom 27203010","","5150-3-015  -  CLAMP SURG 15MM PIN YLW","BOTH IP/OP","$823.63 ","$609.49 ","$0.00 ","$823.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$823.63 ","$0.00 ","$411.81 ","$652.31 ","$658.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-020","SUP","Custom 27203010","","5150-3-020  -  CLAMP EXFIX BLUE 20MM MNTB TRX PIN","BOTH IP/OP","$1,154.13 ","$854.06 ","$0.00 ","$1,157.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,157.75 ","$0.00 ","$578.88 ","$916.94 ","$926.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-025","SUP","Custom 27203010","","5150-3-025  -  CLAMP EXFIX RED 25MM MNTB TRX PIN","BOTH IP/OP","$1,273.25 ","$942.21 ","$0.00 ","$1,273.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,273.25 ","$0.00 ","$636.63 ","$1,008.41 ","$1,018.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-065","SUP","Custom 27203010","","5150-3-065  -  CLAMP EXFIX YLW 15MM MNTB TRX 1 PIN","BOTH IP/OP","$969.38 ","$717.34 ","$0.00 ","$969.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$969.38 ","$0.00 ","$484.69 ","$767.75 ","$775.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-070","SUP","Custom 27203010","","5150-3-070  -  CLAMP EXFIX BLUE 20MM MNTB TRX 1 PIN","BOTH IP/OP","$1,687.00 ","$1,248.38 ","$0.00 ","$1,692.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,692.63 ","$0.00 ","$846.31 ","$1,340.56 ","$1,354.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-075","SUP","Custom 27203010","","5150-3-075  -  CLAMP EXFIX RED 25MM MNTB TRX 1 PIN","BOTH IP/OP","$1,992.38 ","$1,474.36 ","$0.00 ","$2,000.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.63 ","$0.00 ","$1,000.31 ","$1,584.50 ","$1,600.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-165","SUP","Custom 27203010","","5150-3-165  -  CLAMP EXFIX YLW 15MM MNTB TRX 1 PIN","BOTH IP/OP","$1,045.00 ","$773.30 ","$0.00 ","$1,045.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,045.00 ","$0.00 ","$522.50 ","$827.64 ","$836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-170","SUP","Custom 27203010","","5150-3-170  -  CLAMP EXFIX BLUE 20MM MNTB TRX 1 PIN","BOTH IP/OP","$1,069.25 ","$791.25 ","$0.00 ","$1,073.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,073.88 ","$0.00 ","$536.94 ","$850.51 ","$859.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-175","SUP","Custom 27203010","","5150-3-175  -  CLAMP EXFIX RED 25MM MNTB TRX 1 PIN","BOTH IP/OP","$1,101.63 ","$815.21 ","$0.00 ","$1,105.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,105.50 ","$0.00 ","$552.75 ","$875.56 ","$884.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-315","SUP","Custom 27203010","","5150-3-315  -  CLAMP EXFIX YLW MNTB TRX SM T ASMBLY","BOTH IP/OP","$1,278.75 ","$946.28 ","$0.00 ","$1,278.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,278.75 ","$0.00 ","$639.38 ","$1,012.77 ","$1,023.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-320","SUP","Custom 27203010","","5150-3-320  -  T-CLAMP ASSEMBLY MED. (BLUE)","BOTH IP/OP","$1,362.63 ","$1,008.35 ","$0.00 ","$1,362.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,362.63 ","$0.00 ","$681.31 ","$1,079.20 ","$1,090.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-415","SUP","Custom 27203010","","5150-3-415  -  CPLNG EXFIX YLW SM TUBE TO TUBE","BOTH IP/OP","$1,344.75 ","$995.12 ","$0.00 ","$1,344.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,344.75 ","$0.00 ","$672.38 ","$1,065.04 ","$1,075.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-420","SUP","Custom 27203010","","5150-3-420  -  CPLNG EXFIX BLUE MED TUBE TO TUBE","BOTH IP/OP","$1,393.88 ","$1,031.47 ","$0.00 ","$1,398.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.38 ","$0.00 ","$699.19 ","$1,107.52 ","$1,118.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-425","SUP","Custom 27203010","","5150-3-425  -  CPLNG EXFIX RED LG TUBE TO TUBE","BOTH IP/OP","$1,408.75 ","$1,042.48 ","$0.00 ","$1,414.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,414.88 ","$0.00 ","$707.44 ","$1,120.58 ","$1,131.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-435","SUP","Custom 27203010","","5150-3-435  -  CPLNG EXFIX BLUE YLW S/MED TUBE TO TUBE","BOTH IP/OP","$1,398.38 ","$1,034.80 ","$0.00 ","$1,398.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.38 ","$0.00 ","$699.19 ","$1,107.52 ","$1,118.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-3-445","SUP","Custom 27203010","","5150-3-445  -  CPLNG EXFIX BLUE RED MED LG TUBE TO TUBE","BOTH IP/OP","$1,408.75 ","$1,042.48 ","$0.00 ","$1,414.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,414.88 ","$0.00 ","$707.44 ","$1,120.58 ","$1,131.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-4-065","SUP","Custom 27203010","","5150-4-065  -  ADAPTER XTRNFX T 15MM YLW MNTB TRX PIN CLP","BOTH IP/OP","$676.50 ","$500.61 ","$0.00 ","$676.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$676.50 ","$0.00 ","$338.25 ","$535.79 ","$541.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-4-070","SUP","Custom 27203010","","5150-4-070  -  CLAMP EXFIX BLUE 20MM MNTB TRX T ADPR","BOTH IP/OP","$694.75 ","$514.12 ","$0.00 ","$702.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$702.63 ","$0.00 ","$351.31 ","$556.48 ","$562.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-4-075","SUP","Custom 27203010","","5150-4-075  -  CLAMP EXFIX RED 25MM MNTB TRX T ADPR","BOTH IP/OP","$710.50 ","$525.77 ","$0.00 ","$719.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$719.13 ","$0.00 ","$359.56 ","$569.55 ","$575.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-5-020","SUP","Custom 27203010","","5150-5-020  -  HOLDER XTRNFX 20MM BLU MNTB TRX PIN","BOTH IP/OP","$2,864.13 ","$2,119.46 ","$0.00 ","$2,864.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,864.13 ","$0.00 ","$1,432.06 ","$2,268.39 ","$2,291.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-5-025","SUP","Custom 27203010","","5150-5-025  -  HOLDER XTRNFX 25MM RD MNTB TRX PIN","BOTH IP/OP","$2,864.13 ","$2,119.46 ","$0.00 ","$2,864.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,864.13 ","$0.00 ","$1,432.06 ","$2,268.39 ","$2,291.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-7-020","SUP","Custom 27203010","","5150-7-020  -  O RING XTRNFX YLW MNTB TRX","BOTH IP/OP","$24.08 ","$17.82 ","$0.00 ","$24.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.08 ","$0.00 ","$12.04 ","$19.07 ","$19.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-9-465","SUP","Custom 27203010","","5150-9-465  -  DEVICE CMPR DSTRCT 15MM MNTB TRX YLW","BOTH IP/OP","$1,696.75 ","$1,255.60 ","$0.00 ","$1,696.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,696.75 ","$0.00 ","$848.38 ","$1,343.83 ","$1,357.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-9-535","SUP","Custom 27203010","","5150-9-535  -  SLEEVE DRILL MNTB SM 3 MMBLOCKS","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-9-545","SUP","Custom 27203010","","5150-9-545  -  SLEEVE DRILL MNTB SM 4 MMBLOCKS","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-9-950","SUP","Custom 27203010","","5150-9-950  -  KIT EXFIX YLW MNTB STRL","BOTH IP/OP","$2,715.63 ","$2,009.57 ","$0.00 ","$2,715.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,715.63 ","$0.00 ","$1,357.81 ","$2,150.78 ","$2,172.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5150-9-960","SUP","Custom 27203010","","5150-9-960  -  SET EXFIX YLW 310X130X36MM 15MM MNTB TRX 310MMX130MMX36MM","BOTH IP/OP","$2,570.25 ","$1,901.99 ","$0.00 ","$2,509.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,509.38 ","$0.00 ","$1,254.69 ","$1,987.43 ","$2,007.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"515-203","SUP","HCPCS C1713","","515-203  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$91.73 ","$67.88 ","$0.00 ","$91.73 ","$41.28 ","$0.00 ","$19.12 ","$0.00 ","$0.00 ","$16.06 ","$91.73 ","$0.00 ","$45.86 ","$72.65 ","$73.38 ","$0.00 ","$14.35 ","$0.00 ","$14.60 ","$0.00 "
"515-204","SUP","HCPCS C1713","","515-204  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$91.73 ","$67.88 ","$0.00 ","$91.73 ","$41.28 ","$0.00 ","$19.12 ","$0.00 ","$0.00 ","$16.06 ","$91.73 ","$0.00 ","$45.86 ","$72.65 ","$73.38 ","$0.00 ","$14.35 ","$0.00 ","$14.60 ","$0.00 "
"515-205","SUP","HCPCS C1713","","515-205  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$96.33 ","$71.28 ","$0.00 ","$96.33 ","$43.35 ","$0.00 ","$20.08 ","$0.00 ","$0.00 ","$16.87 ","$96.33 ","$0.00 ","$48.16 ","$76.29 ","$77.06 ","$0.00 ","$15.07 ","$0.00 ","$15.33 ","$0.00 "
"515-206","SUP","HCPCS C1713","","515-206  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"515-633","SUP","HCPCS C1781","","515-633  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$813.88 ","$602.27 ","$0.00 ","$813.88 ","$366.24 ","$0.00 ","$169.63 ","$0.00 ","$0.00 ","$142.50 ","$813.88 ","$0.00 ","$406.94 ","$644.59 ","$651.10 ","$0.00 ","$127.37 ","$0.00 ","$129.57 ","$0.00 "
"5157M/S","SUP","HCPCS C1786","","5157M/S  -  PACEMAKER CARDIAC THK6MM 52X42MM 1 CHAMBER RATE RESPONSIVE","BOTH IP/OP","$7,425.00 ","$5,494.50 ","$0.00 ","$7,425.00 ","$0.00 ","$0.00 ","$1,547.56 ","$0.00 ","$0.00 ","$0.00 ","$7,425.00 ","$0.00 ","$3,712.50 ","$5,880.60 ","$5,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51-672-01-09","SUP","Custom 27803010","","51-672-01-09  -  ROD EXFIX FULL PREBENT MANDIB","BOTH IP/OP","$1,843.58 ","$1,364.25 ","$0.00 ","$1,843.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,843.58 ","$0.00 ","$921.79 ","$1,460.12 ","$1,474.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51-672-05-09","SUP","Custom 27803010","","51-672-05-09  -  ROD EXFIX .5 PREBENT MANDIB","BOTH IP/OP","$1,317.25 ","$974.77 ","$0.00 ","$1,317.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,317.25 ","$0.00 ","$658.63 ","$1,043.26 ","$1,053.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51-673-09-09","SUP","Custom 27803010","","51-673-09-09  -  PIN XTRNFX 4MM 2.7MM 80MM LF 9MM X-FX THRD TI CRNMXF","BOTH IP/OP","$543.05 ","$401.86 ","$0.00 ","$543.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.05 ","$0.00 ","$271.53 ","$430.10 ","$434.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"51-673-13-09","SUP","Custom 27803010","","51-673-13-09  -  PIN XTRNFX 4MM 2.7MM 80MM LF 13MM X-FX THRD TI CRNMXF","BOTH IP/OP","$543.05 ","$401.86 ","$0.00 ","$543.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$543.05 ","$0.00 ","$271.53 ","$430.10 ","$434.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"518-032","SUP","HCPCS C1887","","518-032  -  CATH GUID .014IN 6FR 5MM 135CM GWIRE RADIOPQ MRKR STRL QKCRS","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-033","SUP","HCPCS C1887","","518-033  -  CATH GUID .018IN 3.4-2.2FR 90CM LOW CX PRFL 3 RADIOPQ MRKR","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-034","SUP","HCPCS C1887","","518-034  -  CATH GUID .018IN 3.4-2.3FR 135CM RADIOPQ MRKR GWIRE SHFT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-035","SUP","HCPCS C1887","","518-035  -  CATH GUID .018IN 15MM SPC 1.8FR 150CM RADIOPQ MRKR SMLS LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-036","SUP","HCPCS C1887","","518-036  -  CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING PROFILE 3","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"518-037","SUP","HCPCS C1887","","518-037  -  CATH GUID .035IN 50MM SPC 3.1FR 135CM RADIOPQ MRKR SMLS LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-038","SUP","HCPCS C1887","","518-038  -  CATHETER GUID .035IN 5MM SPACING 3.1FR 150CM LP TAPERED TIP","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"518-065","SUP","HCPCS C1887","","518-065  -  CATH GUID .014IN 3-1.9FR 150CM 3 RADIOPQ MRKR LOW CX PRFL","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-066","SUP","HCPCS C1887","","518-066  -  CATH GUID .035IN 4.8-3.7FR 65CM LOW CX PRFL 3 RADIOPQ MRKR","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$233.49 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$75.29 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$67.30 ","$0.00 ","$68.46 ","$0.00 "
"518-076","SUP","HCPCS C1887","","518-076  -  CATH GUID .035IN 50MM SPC 4.5FR 65CM STR TIP RADIOPQ MRKR","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-077","SUP","HCPCS C1887","","518-077  -  CATH GUID .035IN 4FR 65CM ANG TIP QKCRS","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-078","SUP","HCPCS C1887","","518-078  -  CATH GUID .035IN 50MM SPC 4.5FR 90CM 70CM STR TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-079","SUP","HCPCS C1887","","518-079  -  CATH GUID .035IN 4FR 90CM SPRT ANG TIP QKCRS","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-080","SUP","HCPCS C1887","","518-080  -  CATHETER SPRT .035IN STRG 135CM QKCRS","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-081","SUP","HCPCS C1887","","518-081  -  CATH GUID 45D 50MM SPC LP .052-.059IN 135CM 7MM LV 3 RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-082","SUP","HCPCS C1887","","518-082  -  CATH GUID .035IN 50MM SPC 4.5FR 150CM 130CM STR TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-083","SUP","HCPCS C1887","","518-083  -  CATH GUID .035IN 4FR 150CM 3 RADIOPQ MRKR SPRT ANG TIP","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-084","SUP","HCPCS C1887","","518-084  -  CATHETER GD 15MM SPC 1.9FR 135CM STRL QKCRS XTRM RADOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-085","SUP","HCPCS C1887","","518-085  -  CATH GUID 45D .014IN 15MM SPC 3.2FR 135CM 100CM ANG TIP","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-086","SUP","HCPCS C1887","","518-086  -  CATH GUID .014IN 15MM SPC 3.2FR 150CM 100CM STR TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-087","SUP","HCPCS C1887","","518-087  -  CATH GUID .014IN 150CM 3 RADIOPQ MRKR LOW CX PRFL SPRT QKCRS","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-088","SUP","HCPCS C1887","","518-088  -  CATH GUID .018IN 15MM SPC 3.4FR 90CM 60CM STR TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-089","SUP","HCPCS C1887","","518-089  -  CATH GUID .018IN 15MM SPC 3.4FR 90CM 60CM ANG TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-090","SUP","HCPCS C1887","","518-090  -  CATH GUID .018IN 15MM SPC 3.2FR 135CM 100CM STR TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-091","SUP","HCPCS C1887","","518-091  -  CATH GUID .018IN 15MM SPC 3.4FR 135CM 100CM ANG TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"518-092","SUP","HCPCS C1887","","518-092  -  CATH GUID .018IN 15MM SPC 3.4FR 150CM 100CM STR TIP RADIOPQ","BOTH IP/OP","$507.50 ","$375.55 ","$0.00 ","$507.50 ","$275.57 ","$0.00 ","$105.78 ","$0.00 ","$0.00 ","$88.86 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$79.42 ","$0.00 ","$80.79 ","$0.00 "
"5181302P2","SUP","HCPCS C1713","","5181302P2  -  CAGE SPNL 12D 30X8X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5181308P2","SUP","HCPCS C1713","","5181308P2  -  CAGE SPNL 8D 30X8X11MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"518-203","SUP","HCPCS C1713","","518-203  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$96.33 ","$71.28 ","$0.00 ","$96.33 ","$43.35 ","$0.00 ","$20.08 ","$0.00 ","$0.00 ","$16.87 ","$96.33 ","$0.00 ","$48.16 ","$76.29 ","$77.06 ","$0.00 ","$15.07 ","$0.00 ","$15.33 ","$0.00 "
"518-205","SUP","HCPCS C1713","","518-205  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$96.33 ","$71.28 ","$0.00 ","$96.33 ","$43.35 ","$0.00 ","$20.08 ","$0.00 ","$0.00 ","$16.87 ","$96.33 ","$0.00 ","$48.16 ","$76.29 ","$77.06 ","$0.00 ","$15.07 ","$0.00 ","$15.33 ","$0.00 "
"518-306","SUP","HCPCS C1713","","518-306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$79.70 ","$58.98 ","$0.00 ","$79.70 ","$35.87 ","$0.00 ","$16.61 ","$0.00 ","$0.00 ","$13.95 ","$79.70 ","$0.00 ","$39.85 ","$63.12 ","$63.76 ","$0.00 ","$12.47 ","$0.00 ","$12.69 ","$0.00 "
"5184308P2","SUP","HCPCS C1713","","5184308P2  -  CAGE SPNL 8D 30X8X14MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5189302P2","SUP","HCPCS C1713","","5189302P2  -  CAGE SPNL 12D 30X8X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5189308P2","SUP","HCPCS C1713","","5189308P2  -  CAGE SPNL 8D 30X8X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5190-0-010","SUP","Custom 27203010","","5190-0-010  -  SET ORTH Y BODY ASMBLY","BOTH IP/OP","$1,588.13 ","$1,175.22 ","$0.00 ","$1,588.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,588.13 ","$0.00 ","$794.06 ","$1,257.80 ","$1,270.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5190-0-020","SUP","Custom 27203010","","5190-0-020  -  CPLNG EXFIX PIN TO ROD","BOTH IP/OP","$598.13 ","$442.62 ","$0.00 ","$598.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$598.13 ","$0.00 ","$299.06 ","$473.72 ","$478.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5190-0-110","SUP","Custom 27203010","","5190-0-110  -  SET ORTH STR BODY ASMBLY","BOTH IP/OP","$1,051.88 ","$778.39 ","$0.00 ","$1,051.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,051.88 ","$0.00 ","$525.94 ","$833.09 ","$841.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5190-0-200","SUP","HCPCS C1713","","5190-0-200  -  PIN STOP COLLAR DSTRCT","BOTH IP/OP","$240.63 ","$178.07 ","$0.00 ","$240.63 ","$108.28 ","$0.00 ","$50.15 ","$0.00 ","$0.00 ","$42.13 ","$240.63 ","$0.00 ","$120.31 ","$190.58 ","$192.50 ","$0.00 ","$37.66 ","$0.00 ","$38.31 ","$0.00 "
"5190-0-210","SUP","Custom 27203010","","5190-0-210  -  ROD EXFIX STR THRD","BOTH IP/OP","$130.63 ","$96.67 ","$0.00 ","$130.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5191302P2","SUP","HCPCS C1713","","5191302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5191308P2","SUP","HCPCS C1713","","5191308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5195-000-010","SUP","Custom 27203010","","5195-000-010  -  BODY XTRNFX NS DJD II CMPNT","BOTH IP/OP","$3,081.38 ","$2,280.22 ","$0.00 ","$3,081.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,081.38 ","$0.00 ","$1,540.69 ","$2,440.45 ","$2,465.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5195-1-011","SUP","Custom 27203010","","5195-1-011  -  SCREW XTRNFX DJD II GD HUM","BOTH IP/OP","$70.13 ","$51.90 ","$0.00 ","$70.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.13 ","$0.00 ","$35.06 ","$55.54 ","$56.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5195-1-020","SUP","Custom 27203010","","5195-1-020  -  DRILL SURG OSTEOSTAT STRL","BOTH IP/OP","$158.13 ","$117.02 ","$0.00 ","$158.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.13 ","$0.00 ","$79.06 ","$125.24 ","$126.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5195-1-030","SUP","Custom 27203010","","5195-1-030  -  GUIDE 4MM HING INS DJD 2 SURG DYNMC ELB JNT DISTRCT","BOTH IP/OP","$158.13 ","$117.02 ","$0.00 ","$158.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.13 ","$0.00 ","$79.06 ","$125.24 ","$126.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5195-1-035","SUP","Custom 27203010","","5195-1-035  -  GUIDE FOR HALF-PINS","BOTH IP/OP","$158.13 ","$117.02 ","$0.00 ","$158.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.13 ","$0.00 ","$79.06 ","$125.24 ","$126.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5199302P2","SUP","HCPCS C1713","","5199302P2  -  CAGE SPNL 12D 30X9X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5199308P2","SUP","HCPCS C1713","","5199308P2  -  CAGE SPNL 8D 30X9X9MM NS CRNT PEEK ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5201300P2","SUP","HCPCS C1713","","5201300P2  -  CAGE SPNL 0D 30X10X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5201302P2","SUP","HCPCS C1713","","5201302P2  -  CAGE SPNL 12D 30X10X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5201308P2","SUP","HCPCS C1713","","5201308P2  -  CAGE SPNL 8D 30X10X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"52-022-01","SUP","Custom 27203010","","52-022-01  -  DRILL BIT 2.7","BOTH IP/OP","$260.40 ","$192.70 ","$0.00 ","$260.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$260.40 ","$0.00 ","$130.20 ","$206.24 ","$208.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5204300P2","SUP","HCPCS C1713","","5204300P2  -  CAGE SPNL 0D 30X10X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5204308P2","SUP","HCPCS C1713","","5204308P2  -  CAGE SPNL 8D 30X10X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5209300P2","SUP","HCPCS C1713","","5209300P2  -  CAGE SPNL 0D 30X10X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5209302P2","SUP","HCPCS C1713","","5209302P2  -  CAGE SPNL 12D 30X10X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5209308P2","SUP","HCPCS C1713","","5209308P2  -  CAGE SPNL 8D 30X10X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5210-3-165","SUP","HCPCS C1713","","5210-3-165  -  SCREW BONE 5MM 65MM FULTHD","BOTH IP/OP","$203.50 ","$150.59 ","$0.00 ","$203.50 ","$91.58 ","$0.00 ","$42.41 ","$0.00 ","$0.00 ","$35.63 ","$203.50 ","$0.00 ","$101.75 ","$161.17 ","$162.80 ","$0.00 ","$31.85 ","$0.00 ","$32.40 ","$0.00 "
"5210-3-190","SUP","HCPCS C1713","","5210-3-190  -  SCREW BONE 5MM 90MM FULTHD","BOTH IP/OP","$203.50 ","$150.59 ","$0.00 ","$203.50 ","$91.58 ","$0.00 ","$42.41 ","$0.00 ","$0.00 ","$35.63 ","$203.50 ","$0.00 ","$101.75 ","$161.17 ","$162.80 ","$0.00 ","$31.85 ","$0.00 ","$32.40 ","$0.00 "
"5211300P2","SUP","HCPCS C1713","","5211300P2  -  CAGE SPNL 0D 30X11X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5211302P2","SUP","HCPCS C1713","","5211302P2  -  CAGE SPNL 12D 30X11X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5211308P2","SUP","HCPCS C1713","","5211308P2  -  CAGE SPNL 8D 30X11X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5213-42","SUP","HCPCS C1776","","5213-42  -  COMPONENT GLENOID 40MM 42MM UHMWPE STERILE","BOTH IP/OP","$2,055.08 ","$1,520.76 ","$0.00 ","$2,055.08 ","$924.78 ","$0.00 ","$428.33 ","$0.00 ","$0.00 ","$359.83 ","$2,055.08 ","$0.00 ","$1,027.54 ","$1,627.62 ","$1,644.06 ","$0.00 ","$321.62 ","$0.00 ","$327.17 ","$0.00 "
"5213-44","SUP","HCPCS C1776","","5213-44  -  SOCKET GLENOID 44MM SHOULDER STERILE","BOTH IP/OP","$2,055.08 ","$1,520.76 ","$0.00 ","$2,055.08 ","$924.78 ","$0.00 ","$428.33 ","$0.00 ","$0.00 ","$359.83 ","$2,055.08 ","$0.00 ","$1,027.54 ","$1,627.62 ","$1,644.06 ","$0.00 ","$321.62 ","$0.00 ","$327.17 ","$0.00 "
"5213-46","SUP","HCPCS C1776","","5213-46  -  COMPONENT GLENOID 46MM UHMWPE STERILE","BOTH IP/OP","$2,055.08 ","$1,520.76 ","$0.00 ","$2,055.08 ","$924.78 ","$0.00 ","$428.33 ","$0.00 ","$0.00 ","$359.83 ","$2,055.08 ","$0.00 ","$1,027.54 ","$1,627.62 ","$1,644.06 ","$0.00 ","$321.62 ","$0.00 ","$327.17 ","$0.00 "
"5213-48","SUP","HCPCS C1776","","5213-48  -  COMPONENT GLENOID 48MM UHMWPE NONSTRL","BOTH IP/OP","$2,055.08 ","$1,520.76 ","$0.00 ","$2,055.08 ","$924.78 ","$0.00 ","$428.33 ","$0.00 ","$0.00 ","$359.83 ","$2,055.08 ","$0.00 ","$1,027.54 ","$1,627.62 ","$1,644.06 ","$0.00 ","$321.62 ","$0.00 ","$327.17 ","$0.00 "
"5213-50","SUP","HCPCS C1776","","5213-50  -  COMPONENT GLENOID 50MM UHMWPE NONSTRL","BOTH IP/OP","$2,055.08 ","$1,520.76 ","$0.00 ","$2,055.08 ","$924.78 ","$0.00 ","$428.33 ","$0.00 ","$0.00 ","$359.83 ","$2,055.08 ","$0.00 ","$1,027.54 ","$1,627.62 ","$1,644.06 ","$0.00 ","$321.62 ","$0.00 ","$327.17 ","$0.00 "
"5213-52","SUP","HCPCS C1776","","5213-52  -  COMPONENT GLENOID 52MM UHMWPE STERILE","BOTH IP/OP","$2,055.08 ","$1,520.76 ","$0.00 ","$2,055.08 ","$924.78 ","$0.00 ","$428.33 ","$0.00 ","$0.00 ","$359.83 ","$2,055.08 ","$0.00 ","$1,027.54 ","$1,627.62 ","$1,644.06 ","$0.00 ","$321.62 ","$0.00 ","$327.17 ","$0.00 "
"5213-54","SUP","HCPCS C1776","","5213-54  -  SOCKET GLENOID 54MM SHOULDER STERILE","BOTH IP/OP","$2,094.83 ","$1,550.17 ","$0.00 ","$2,094.83 ","$942.67 ","$0.00 ","$436.61 ","$0.00 ","$0.00 ","$366.79 ","$2,094.83 ","$0.00 ","$1,047.41 ","$1,659.11 ","$1,675.86 ","$0.00 ","$327.84 ","$0.00 ","$333.50 ","$0.00 "
"5213-56","SUP","HCPCS C1776","","5213-56  -  COMPONENT GLENOID 56MM UHMWPE STERILE","BOTH IP/OP","$2,094.83 ","$1,550.17 ","$0.00 ","$2,094.83 ","$942.67 ","$0.00 ","$436.61 ","$0.00 ","$0.00 ","$366.79 ","$2,094.83 ","$0.00 ","$1,047.41 ","$1,659.11 ","$1,675.86 ","$0.00 ","$327.84 ","$0.00 ","$333.50 ","$0.00 "
"5213-58","SUP","HCPCS C1776","","5213-58  -  COMPONENT GLENOID 58MM UHMWPE STERILE","BOTH IP/OP","$2,094.83 ","$1,550.17 ","$0.00 ","$2,094.83 ","$942.67 ","$0.00 ","$436.61 ","$0.00 ","$0.00 ","$366.79 ","$2,094.83 ","$0.00 ","$1,047.41 ","$1,659.11 ","$1,675.86 ","$0.00 ","$327.84 ","$0.00 ","$333.50 ","$0.00 "
"5219300P2","SUP","HCPCS C1713","","5219300P2  -  CAGE SPNL 0D 30X11X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5219302P2","SUP","HCPCS C1713","","5219302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5219308P2","SUP","HCPCS C1713","","5219308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"52-20358","SUP","HCPCS C1713","","52-20358  -  SCREW BONE 2MM 8MM SLFTAP XFIT TITANIUM INTERMAXILLARY","BOTH IP/OP","$221.15 ","$163.65 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$46.09 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"52-20364","SUP","HCPCS C1713","","52-20364  -  SCREW BONE 2MM 14MM SLFTAP XFIT CROSS-FIT TITANIUM","BOTH IP/OP","$221.15 ","$163.65 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$46.09 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"52-20616","SUP","HCPCS C1713","","52-20616  -  PEG 2MM 16MM DISTAL RADL LCK XPIN TI VARIAX NONSTRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-20618","SUP","HCPCS C1713","","52-20618  -  PEG FIX 2MM 18MM DISTAL RADL LCK VARIAX","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-20618E","SUP","HCPCS C1713","","52-20618E  -  PEG 2MM 18MM DISTAL RADL LCK XPIN TI VARIAX STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-20620","SUP","HCPCS C1713","","52-20620  -  PEG FIX 2MM 20MM DISTAL RADL LCK VARIAX","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-20622","SUP","HCPCS C1713","","52-20622  -  PEG 2MM 22MM RADL LCK TI","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-20624","SUP","HCPCS C1713","","52-20624  -  PEG 2MM 24MM DISTAL RADL LCK XPIN TI VARIAX NONSTRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-20626","SUP","HCPCS C1713","","52-20626  -  PEG 2MM 26MM RADL LCK TI","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"5221300P2","SUP","HCPCS C1713","","5221300P2  -  CAGE SPNL 0D 30X12X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5221302P2","SUP","HCPCS C1713","","5221302P2  -  CAGE SPNL 12D 30X12X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5221308P2","SUP","HCPCS C1713","","5221308P2  -  CAGE SPNL 8D 30X12X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"52-23010","SUP","HCPCS C1713","","52-23010  -  SCREW BN 2.3MM 10MM VARIAX ST XPN TI DIST RDS LCK PLT SYS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23010E","SUP","HCPCS C1713","","52-23010E  -  SCREW BONE 2.3MM 10MM VARIAX TI DISTAL RADL HAND XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23012","SUP","HCPCS C1713","","52-23012  -  SCREW BONE 2.3MM 12MM TI RADL SLFTAP XPIN","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23012E","SUP","HCPCS C1713","","52-23012E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL HAND XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23014","SUP","HCPCS C1713","","52-23014  -  SCREW BONE 2.3MM 14MM SMARTLOCK VARIAX TI DISTAL RADL SLFTAP","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23016","SUP","HCPCS C1713","","52-23016  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RAD XPIN","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23016E","SUP","HCPCS C1713","","52-23016E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL HAND XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23018","SUP","HCPCS C1713","","52-23018  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23018E","SUP","HCPCS C1713","","52-23018E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL HAND XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23020E","SUP","HCPCS C1713","","52-23020E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL HAND XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23022","SUP","HCPCS C1713","","52-23022  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RAD LCK XPIN","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23022E","SUP","HCPCS C1713","","52-23022E  -  SCREW BONE 2.3MM 22MM VARIAX TI ORTH LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23024","SUP","HCPCS C1713","","52-23024  -  SCREW TI 24MM 2.3MM MAXFACL LCK XPIN BONE VARIAX DISTAL RAD","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23024E","SUP","HCPCS C1713","","52-23024E  -  SCREW BONE 2.3MM 24MM VARIAX TI LCK STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23026","SUP","HCPCS C1713","","52-23026  -  SCREW BONE 2.3MM 26MM SMARTLOCK TI RADL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23028","SUP","HCPCS C1713","","52-23028  -  SCREW BN 2.3MM 28MM VARIAX LCK TI DIST RADL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23028E","SUP","HCPCS C1713","","52-23028E  -  SCREW BN XPN BLNT 2.3MM 28MM STRL VARIAX OPTM AX STAB TI RDS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23030","SUP","HCPCS C1713","","52-23030  -  SCREW BONE 2.3MM 30MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23030E","SUP","HCPCS C1713","","52-23030E  -  SCREW BONE 2.3MM 30MM VARIAX TI LCK STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23032","SUP","HCPCS C1713","","52-23032  -  SCREW BONE 2.3MM 32MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23032E","SUP","HCPCS C1713","","52-23032E  -  SCREW BONE 2.3MM 32MM VARIAX TI RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23034","SUP","HCPCS C1713","","52-23034  -  SCREW BONE 2.3MM 34MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23034E","SUP","HCPCS C1713","","52-23034E  -  SCREW BONE 2.3MM 34MM VARIAX TI RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23036","SUP","HCPCS C1713","","52-23036  -  SCREW BONE 2.3MM 36MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23036E","SUP","HCPCS C1713","","52-23036E  -  SCREW BONE 2.3MM 36MM VARIAX TI RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23038","SUP","HCPCS C1713","","52-23038  -  SCREW BONE 2.3MM 38MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23038E","SUP","HCPCS C1713","","52-23038E  -  SCREW BONE 2.3MM 38MM VARIAX TI RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-23610","SUP","HCPCS C1713","","52-23610  -  SCREW BONE 2.3MM 10MM SMARTLOCK TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23610E","SUP","HCPCS C1713","","52-23610E  -  SCREW BONE 2.3MM 10MM TI LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23612","SUP","HCPCS C1713","","52-23612  -  SCREW BONE 2.3MM 12MM SMARTLOCK TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23612E","SUP","HCPCS C1713","","52-23612E  -  SCREW BONE 2.3MM 12MM LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23614","SUP","HCPCS C1713","","52-23614  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL LCK XPIN","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23614E","SUP","HCPCS C1713","","52-23614E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23616","SUP","HCPCS C1713","","52-23616  -  SCREW BONE 2.3MM 16MM SMARTLOCK TI DISTAL RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23616E","SUP","HCPCS C1713","","52-23616E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL LCK XPIN","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23618","SUP","HCPCS C1713","","52-23618  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK XPIN","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23618E","SUP","HCPCS C1713","","52-23618E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK XPIN","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23620","SUP","HCPCS C1713","","52-23620  -  SCREW BONE 2.3MM 20MM SMARTLOCK VARIAX TI DISTAL RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23620E","SUP","HCPCS C1713","","52-23620E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL XPIN LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23622","SUP","HCPCS C1713","","52-23622  -  SCREW BONE 2.3MM 22MM SMARTLOCK VARIAX TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23624","SUP","HCPCS C1713","","52-23624  -  SCREW BONE 2.3MM 24MM SMARTLOCK VARIAX TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23626","SUP","HCPCS C1713","","52-23626  -  SCREW BONE 2.3MM 26MM SMARTLOCK TI DISTAL RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23626E","SUP","HCPCS C1713","","52-23626E  -  SCREW BONE 2.3MM 26MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23628","SUP","HCPCS C1713","","52-23628  -  SCREW BONE 2.3MM 28MM SMARTLOCK VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23628E","SUP","HCPCS C1713","","52-23628E  -  PLATE 28MM TI LCK SYS VARIAX BONE 2.3MM DISTAL RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23630","SUP","HCPCS C1713","","52-23630  -  SCREW BONE 2.3MM 30MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23632","SUP","HCPCS C1713","","52-23632  -  SCREW BONE 2.3MM 32MM SMARTLOCK TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23634","SUP","HCPCS C1713","","52-23634  -  SCREW BONE 2.3MM 34MM VARIAX TI DISTAL RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23636","SUP","HCPCS C1713","","52-23636  -  SCREW BONE 2.3MM 36MM TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-23638","SUP","HCPCS C1713","","52-23638  -  SCREW BONE 2.3MM 38MM TI RADL LCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"5224300P2","SUP","HCPCS C1713","","5224300P2  -  CAGE SPNL 0D 30X12X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5224308P2","SUP","HCPCS C1713","","5224308P2  -  CAGE SPNL 8D 30X12X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"52-27010","SUP","HCPCS C1713","","52-27010  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL XPIN NONSTRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27010E","SUP","HCPCS C1713","","52-27010E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27012","SUP","HCPCS C1713","","52-27012  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27012E","SUP","HCPCS C1713","","52-27012E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27014","SUP","HCPCS C1713","","52-27014  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND XPIN","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27014E","SUP","HCPCS C1713","","52-27014E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND XPIN","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27016","SUP","HCPCS C1713","","52-27016  -  2.7X16MM BONE SCREW_ RADIUS","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27016E","SUP","HCPCS C1713","","52-27016E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL WR HND XPIN","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27018","SUP","HCPCS C1713","","52-27018  -  SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27018E","SUP","HCPCS C1713","","52-27018E  -  SCREW BN 2.7MM 18MM STRL VARIAX XPN NLCKG TI DIST RADL WR","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27020","SUP","HCPCS C1713","","52-27020  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27022","SUP","HCPCS C1713","","52-27022  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL XPIN NONSTRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27022E","SUP","HCPCS C1713","","52-27022E  -  SCREW BONE 2.7MM 22MM SMARTLOCK TI CORT RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27024","SUP","HCPCS C1713","","52-27024  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL XPIN NONSTRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27024E","SUP","HCPCS C1713","","52-27024E  -  SCREW BONE 2.7MM 24MM SMARTLOCK TI CORT RADL LCK","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27026","SUP","HCPCS C1713","","52-27026  -  SCREW BONE 2.7MM 26MM SMARTLOCK TI RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27026E","SUP","HCPCS C1713","","52-27026E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL XPIN STRL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$55.69 ","$0.00 ","$25.79 ","$0.00 ","$0.00 ","$21.67 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"52-27116","SUP","HCPCS C1713","","52-27116  -  SCREW BN 2.7MM 16MM VARIAX LCK P/T TI DIST RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27116E","SUP","HCPCS C1713","","52-27116E  -  SCREW BN P/T 2.7MM 16MM VARIAX NLCKG XPN TI DIST RDS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27118","SUP","HCPCS C1713","","52-27118  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL PTTHRD XPIN","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27120","SUP","HCPCS C1713","","52-27120  -  SCREW BN 2.7MM 20MM VARIAX LCK P/T TI DIST RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27120E","SUP","HCPCS C1713","","52-27120E  -  SCREW BN P/T 2.7MM 20MM VARIAX NLCKG XPN TI DIST RDS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27122","SUP","HCPCS C1713","","52-27122  -  SCREW BN 2.7MM 22MM VARIAX LCK P/T TI DIST RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27122E","SUP","HCPCS C1713","","52-27122E  -  SCREW BN P/T 2.7MM 22MM VARIAX NLCKG XPN TI DIST RDS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27124","SUP","HCPCS C1713","","52-27124  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL PTTHRD XPIN","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27126","SUP","HCPCS C1713","","52-27126  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL PTTHRD XPIN STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27208","SUP","HCPCS C1713","","52-27208  -  SCREW BONE 2.7MM 8MM TI RADL SLFTAP XFIT","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$130.63 ","$58.78 ","$0.00 ","$27.57 ","$0.00 ","$0.00 ","$22.87 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$20.44 ","$0.00 ","$20.80 ","$0.00 "
"52-27210","SUP","HCPCS C1713","","52-27210  -  SCREW BONE 2.7MM 10MM TI RADL SLFTAP XFIT","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$130.63 ","$58.78 ","$0.00 ","$27.57 ","$0.00 ","$0.00 ","$22.87 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$20.44 ","$0.00 ","$20.80 ","$0.00 "
"52-27212","SUP","HCPCS C1713","","52-27212  -  SCREW BONE 2.7MM 12MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$130.63 ","$58.78 ","$0.00 ","$27.57 ","$0.00 ","$0.00 ","$22.87 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$20.44 ","$0.00 ","$20.80 ","$0.00 "
"52-27214","SUP","HCPCS C1713","","52-27214  -  SCREW BONE 2.7MM 14MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$130.63 ","$58.78 ","$0.00 ","$27.57 ","$0.00 ","$0.00 ","$22.87 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$20.44 ","$0.00 ","$20.80 ","$0.00 "
"52-27216","SUP","HCPCS C1713","","52-27216  -  SCREW BONE 2.7MM 16MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$132.30 ","$97.90 ","$0.00 ","$130.63 ","$58.78 ","$0.00 ","$27.57 ","$0.00 ","$0.00 ","$22.87 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$20.44 ","$0.00 ","$20.80 ","$0.00 "
"52-27218","SUP","HCPCS C1713","","52-27218  -  SCREW BONE 2.7MM 18MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27220","SUP","HCPCS C1713","","52-27220  -  SCREW BONE 2.7MM 20MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27222","SUP","HCPCS C1713","","52-27222  -  SCREW BONE 2.7MM 22MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27224","SUP","HCPCS C1713","","52-27224  -  SCREW BONE 2.7MM 24MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27226","SUP","HCPCS C1713","","52-27226  -  SCREW BONE 2.7MM 26MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27228","SUP","HCPCS C1713","","52-27228  -  SCREW BONE 2.7MM 28MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27230","SUP","HCPCS C1713","","52-27230  -  SCREW BONE 2.7MM 30MM TI RADL SLFTAP XFIT","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27232","SUP","HCPCS C1713","","52-27232  -  SCREW BONE 2.7MM 32MM TI RADL SLFTAP XFIT","BOTH IP/OP","$151.25 ","$111.93 ","$0.00 ","$151.25 ","$68.06 ","$0.00 ","$31.52 ","$0.00 ","$0.00 ","$26.48 ","$151.25 ","$0.00 ","$75.63 ","$119.79 ","$121.00 ","$0.00 ","$23.67 ","$0.00 ","$24.08 ","$0.00 "
"52-27234","SUP","HCPCS C1713","","52-27234  -  SCREW BONE 2.7MM 34MM MTRX-SMARTLOCK DISTAL RADL SLFTAP","BOTH IP/OP","$160.65 ","$118.88 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$33.48 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"52-27236","SUP","HCPCS C1713","","52-27236  -  SCREW BONE 2.7MM 36MM TI RADL SLFTAP XFIT","BOTH IP/OP","$160.65 ","$118.88 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$33.48 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"52-27238","SUP","HCPCS C1713","","52-27238  -  SCREW BONE 2.7MM 38MM TI RADL SLFTAP XFIT","BOTH IP/OP","$160.65 ","$118.88 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$33.48 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"52-27610","SUP","HCPCS C1713","","52-27610  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL PTTHRD LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27610E","SUP","HCPCS C1713","","52-27610E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL PTTHRD LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27612","SUP","HCPCS C1713","","52-27612  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27614","SUP","HCPCS C1713","","52-27614  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL XPIN LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27614E","SUP","HCPCS C1713","","52-27614E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL XPIN LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27616","SUP","HCPCS C1713","","52-27616  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27618","SUP","HCPCS C1713","","52-27618  -  SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27618E","SUP","HCPCS C1713","","52-27618E  -  SCREW BN 2.7MM 18MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27620","SUP","HCPCS C1713","","52-27620  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL PTTHRD LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27620E","SUP","HCPCS C1713","","52-27620E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL XPIN LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27622","SUP","HCPCS C1713","","52-27622  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27624","SUP","HCPCS C1713","","52-27624  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27626","SUP","HCPCS C1713","","52-27626  -  SCREW BN 2.7MM 26MM VARIAX LCK TI DIST RADL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27626E","SUP","HCPCS C1713","","52-27626E  -  SCREW BN 2.7MM 26MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27716","SUP","HCPCS C1713","","52-27716  -  PEG 2.7MM 16MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27716E","SUP","HCPCS C1713","","52-27716E  -  PEG 2.7MM 16MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27718","SUP","HCPCS C1713","","52-27718  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27718E","SUP","HCPCS C1713","","52-27718E  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27720","SUP","HCPCS C1713","","52-27720  -  PEG 2.7MM 20MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27722","SUP","HCPCS C1713","","52-27722  -  PEG 2.7MM 22MM ORTH LCK PTHRD TI SMARTLOCK","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27722E","SUP","HCPCS C1713","","52-27722E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL PTTHRD LCK STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27724","SUP","HCPCS C1713","","52-27724  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27724E","SUP","HCPCS C1713","","52-27724E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27726","SUP","HCPCS C1713","","52-27726  -  PEG 2.7MM 26MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27726E","SUP","HCPCS C1713","","52-27726E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$144.38 ","$106.84 ","$0.00 ","$144.38 ","$64.97 ","$0.00 ","$30.09 ","$0.00 ","$0.00 ","$25.28 ","$144.38 ","$0.00 ","$72.19 ","$114.35 ","$115.50 ","$0.00 ","$22.59 ","$0.00 ","$22.98 ","$0.00 "
"52-27844","SUP","HCPCS C1713","","52-27844  -  SCREW BONE 2.7MM 14MM TI FRFT HEX","BOTH IP/OP","$125.13 ","$92.60 ","$0.00 ","$125.13 ","$56.31 ","$0.00 ","$26.08 ","$0.00 ","$0.00 ","$21.91 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$19.58 ","$0.00 ","$19.92 ","$0.00 "
"52-27846","SUP","HCPCS C1713","","52-27846  -  SCREW BONE 2.7MM 16MM TI FRFT HEX","BOTH IP/OP","$125.13 ","$92.60 ","$0.00 ","$125.13 ","$56.31 ","$0.00 ","$26.08 ","$0.00 ","$0.00 ","$21.91 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$19.58 ","$0.00 ","$19.92 ","$0.00 "
"52-27850","SUP","HCPCS C1713","","52-27850  -  SCREW BONE 2.7MM 20MM TI FRFT HEX","BOTH IP/OP","$125.13 ","$92.60 ","$0.00 ","$125.13 ","$56.31 ","$0.00 ","$26.08 ","$0.00 ","$0.00 ","$21.91 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$19.58 ","$0.00 ","$19.92 ","$0.00 "
"52-27852","SUP","HCPCS C1713","","52-27852  -  SCREW BONE 2.7MM 22MM TI FRFT HEX BUN TIAL","BOTH IP/OP","$121.00 ","$89.54 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$25.22 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"5229300P2","SUP","HCPCS C1713","","5229300P2  -  CAGE SPNL 0D 30X12X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5229302P2","SUP","HCPCS C1713","","5229302P2  -  CAGE SPNL 12D 30X12X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5229308P2","SUP","HCPCS C1713","","5229308P2  -  CAGE SPNL 8D 30X12X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"52-30056","SUP","HCPCS C1713","","52-30056  -  SCREW BONE 3MM 16MM TI FRFT HEX","BOTH IP/OP","$125.13 ","$92.60 ","$0.00 ","$125.13 ","$56.31 ","$0.00 ","$26.08 ","$0.00 ","$0.00 ","$21.91 ","$125.13 ","$0.00 ","$62.56 ","$99.10 ","$100.10 ","$0.00 ","$19.58 ","$0.00 ","$19.92 ","$0.00 "
"52-30308","SUP","HCPCS C1713","","52-30308  -  SCREW BONE 3MM 8MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$165.90 ","$122.77 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.58 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"52-30310","SUP","HCPCS C1713","","52-30310  -  SCREW BONE 3MM 10MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"52-30312","SUP","HCPCS C1713","","52-30312  -  SCREW BONE 3MM 12MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"52-30314","SUP","HCPCS C1713","","52-30314  -  SCREW BONE 3MM 14MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"52-30316","SUP","HCPCS C1713","","52-30316  -  SCREW BONE 3MM 16MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"52-30318","SUP","HCPCS C1713","","52-30318  -  SCREW BONE 3MM 18MM CANC","BOTH IP/OP","$206.25 ","$152.63 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$42.99 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30320","SUP","HCPCS C1713","","52-30320  -  SCREW BONE 3MM 20MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$206.25 ","$152.63 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$42.99 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30322","SUP","HCPCS C1713","","52-30322  -  SCREW BONE 3MM 22MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$206.25 ","$152.63 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$42.99 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30324","SUP","HCPCS C1713","","52-30324  -  SCREW BONE 3MM 24MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$206.25 ","$152.63 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$42.99 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30326","SUP","HCPCS C1713","","52-30326  -  SCREW BONE 3MM 26MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$199.75 ","$147.82 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$41.63 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30328","SUP","HCPCS C1713","","52-30328  -  SCREW BONE 3MM 28MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$199.75 ","$147.82 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$41.63 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30330","SUP","HCPCS C1713","","52-30330  -  SCREW BONE 3MM 30MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$199.75 ","$147.82 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$41.63 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30332","SUP","HCPCS C1713","","52-30332  -  SCREW BONE 3MM 32MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$199.75 ","$147.82 ","$0.00 ","$206.25 ","$92.81 ","$0.00 ","$41.63 ","$0.00 ","$0.00 ","$36.11 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$32.28 ","$0.00 ","$32.84 ","$0.00 "
"52-30334","SUP","HCPCS C1713","","52-30334  -  SCREW BONE 3MM 34MM TI CANC RADL SLFTAP XFIT","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"52-306-23","SUP","HCPCS C1781","","52-306-23  -  MESH SURG 26.2X.6MM PRFL 3ANG RX ORBTL FLR","BOTH IP/OP","$1,416.25 ","$1,048.03 ","$0.00 ","$1,416.25 ","$637.31 ","$0.00 ","$295.18 ","$0.00 ","$0.00 ","$247.97 ","$1,416.25 ","$0.00 ","$708.13 ","$1,121.67 ","$1,133.00 ","$0.00 ","$221.64 ","$0.00 ","$225.47 ","$0.00 "
"52-306-23-04","SUP","HCPCS C1781","","52-306-23-04  -  MESH CRNL 3ANG 23MMX.6MM STRL RSRBX PDLLA ORBT FLR","BOTH IP/OP","$1,531.68 ","$1,133.44 ","$0.00 ","$1,531.68 ","$689.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.18 ","$1,531.68 ","$0.00 ","$765.84 ","$1,213.09 ","$1,225.34 ","$0.00 ","$239.71 ","$0.00 ","$243.84 ","$0.00 "
"52-306-40-04","SUP","HCPCS C1713","","52-306-40-04  -  MESH SURG 40X40X.6MM RX ORBTL FLOOR","BOTH IP/OP","$1,670.93 ","$1,236.49 ","$0.00 ","$1,670.93 ","$751.92 ","$0.00 ","$348.26 ","$0.00 ","$0.00 ","$292.57 ","$1,670.93 ","$0.00 ","$835.46 ","$1,323.38 ","$1,336.74 ","$0.00 ","$261.50 ","$0.00 ","$266.01 ","$0.00 "
"52-306-51-04","SUP","HCPCS C1781","","52-306-51-04  -  MESH DYNAMIC 51X51X.6MM RESORB LARGE GRID FLEXIBLE ROUNDED","BOTH IP/OP","$2,227.90 ","$1,648.65 ","$0.00 ","$2,227.90 ","$1,002.56 ","$0.00 ","$464.35 ","$0.00 ","$0.00 ","$390.09 ","$2,227.90 ","$0.00 ","$1,113.95 ","$1,764.50 ","$1,782.32 ","$0.00 ","$348.67 ","$0.00 ","$354.68 ","$0.00 "
"52-310-31-04","SUP","HCPCS C1713","","52-310-31-04  -  MESH CRANIAL 106X31X1MM RESORB SMALL GRID RESORB-X SONICWELD","BOTH IP/OP","$3,202.60 ","$2,369.92 ","$0.00 ","$3,202.60 ","$1,441.17 ","$0.00 ","$667.50 ","$0.00 ","$0.00 ","$560.75 ","$3,202.60 ","$0.00 ","$1,601.30 ","$2,536.46 ","$2,562.08 ","$0.00 ","$501.21 ","$0.00 ","$509.85 ","$0.00 "
"5235-1-846","SUP","Custom 27203010","","5235-1-846  -  BIT DRILL 250MM 4.3MM ALTA TRFLT","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5235-1-916","SUP","Custom 27203010","","5235-1-916  -  GUIDE DRILL 4.3MM SLV","BOTH IP/OP","$468.88 ","$346.97 ","$0.00 ","$468.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$468.88 ","$0.00 ","$234.44 ","$371.35 ","$375.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5235-7-110","SUP","HCPCS C1713","","5235-7-110  -  SCREW BONE ALTA LAG RMR ASSY","BOTH IP/OP","$5,328.13 ","$3,942.82 ","$0.00 ","$5,328.13 ","$2,397.66 ","$0.00 ","$1,110.51 ","$0.00 ","$0.00 ","$932.91 ","$5,328.13 ","$0.00 ","$2,664.06 ","$4,219.88 ","$4,262.50 ","$0.00 ","$833.85 ","$0.00 ","$848.24 ","$0.00 "
"52-400-00","SUP","Custom 27203010","","52-400-00  -  PEN MRKNG TIP HEAT RSRBX","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5241300P2","SUP","HCPCS C1713","","5241300P2  -  CAGE SPNL 0D 30X14X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5241302P2","SUP","HCPCS C1713","","5241302P2  -  CAGE SPNL 12D 30X14X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5241308P2","SUP","HCPCS C1713","","5241308P2  -  CAGE SPNL 8D 30X14X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"52432-U","SUP","Custom 27203010","","SPECULUM OTSCP KLNSPC 2.75MM UNV 2.75MM PLST DX DISP","BOTH IP/OP","$0.05 ","$0.04 ","$0.00 ","$0.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.05 ","$0.00 ","$0.03 ","$0.04 ","$0.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5244300P2","SUP","HCPCS C1713","","5244300P2  -  CAGE SPNL 0D 30X14X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5244308P2","SUP","HCPCS C1713","","5244308P2  -  CAGE SPNL 8D 30X14X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5249300P2","SUP","HCPCS C1713","","5249300P2  -  CAGE SPNL 0D 30X14X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5249302P2","SUP","HCPCS C1713","","5249302P2  -  CAGE SPNL 12D 30X14X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5249308P2","SUP","HCPCS C1713","","5249308P2  -  CAGE SPNL 8D 30X14X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5255-1-255","SUP","Custom 27203010","","5255-1-255  -  BIT DRILL 250MM 3.2MM AO","BOTH IP/OP","$188.38 ","$139.40 ","$0.00 ","$188.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.38 ","$0.00 ","$94.19 ","$149.20 ","$150.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5260-4-000","SUP","Custom 27803010","","5260-4-000  -  SHELL ACETAB HIP SCR PLUG OSTLK APCL","BOTH IP/OP","$141.00 ","$104.34 ","$0.00 ","$141.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$141.00 ","$0.00 ","$70.50 ","$111.67 ","$112.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5260-5-012","SUP","HCPCS C1713","","5260-5-012  -  SCREW ACETAB 6.5MM 12MM HEXAGON OSTEOLOCK TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-014","SUP","HCPCS C1713","","5260-5-014  -  SCREW ACETAB 6.5MM 14MM HEXAGON OSTEOLOCK TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-016","SUP","HCPCS C1713","","5260-5-016  -  SCREW BN 6.5MM 16MM OSTLK CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-018","SUP","HCPCS C1713","","5260-5-018  -  SCREW ACETAB 6.5MM 18MM HEXAGON OSTEOLOCK TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-020","SUP","HCPCS C1713","","5260-5-020  -  SCREW ACETAB 6.5MM 20MM HEXAGON OSTEOLOCK TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-022","SUP","HCPCS C1713","","5260-5-022  -  SCREW ACETAB 6.5MM 22MM HEXAGON OSTEOLOCK TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-024","SUP","HCPCS C1713","","5260-5-024  -  SCREW ACETAB 6.5MM 24MM HEXAGON OSTEOLOCK TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-026","SUP","HCPCS C1713","","5260-5-026  -  SCREW BONE HEXAGON 6.5MM 26MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-028","SUP","HCPCS C1713","","5260-5-028  -  SCREW BONE HEXAGON 6.5MM 28MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-030","SUP","HCPCS C1713","","5260-5-030  -  SCREW BONE HEXAGON 6.5MM 30MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-035","SUP","HCPCS C1713","","5260-5-035  -  SCREW BONE HEXAGON 6.5MM 35MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-040","SUP","HCPCS C1713","","5260-5-040  -  SCREW BONE HEXAGON 6.5MM 40MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-045","SUP","HCPCS C1713","","5260-5-045  -  SCREW BONE HEXAGON 6.5MM 45MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5260-5-050","SUP","HCPCS C1713","","5260-5-050  -  SCREW BONE HEXAGON 6.5MM 50MM WEDGE RSTOR OSTEOLOCK TITANIUM","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5281300P2","SUP","HCPCS C1713","","5281300P2  -  CAGE SPNL 0D 30X8X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5281302P2","SUP","HCPCS C1713","","5281302P2  -  CAGE SPNL 12D 30X8X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5281308P2","SUP","HCPCS C1713","","5281308P2  -  CAGE SPNL 8D 30X8X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5284300P2","SUP","HCPCS C1713","","5284300P2  -  CAGE SPNL 0D 30X8X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5284308P2","SUP","HCPCS C1713","","5284308P2  -  CAGE SPNL 8D 30X8X14MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5289300P2","SUP","HCPCS C1713","","5289300P2  -  CAGE SPNL 0D 30X8X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5289302P2","SUP","HCPCS C1713","","5289302P2  -  CAGE SPNL 12D 30X8X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5289308P2","SUP","HCPCS C1713","","5289308P2  -  CAGE SPNL 8D 30X8X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5291300P2","SUP","HCPCS C1713","","5291300P2  -  CAGE SPNL 0D 30X9X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5291302P2","SUP","HCPCS C1713","","5291302P2  -  CAGE SPNL 12D 30X9X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5291308P2","SUP","HCPCS C1713","","5291308P2  -  CAGE SPNL 8D 30X9X11MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5299300P2","SUP","HCPCS C1713","","5299300P2  -  CAGE SPNL 0D 30X9X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5299302P2","SUP","HCPCS C1713","","5299302P2  -  CAGE SPNL 12D 30X9X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5299308P2","SUP","HCPCS C1713","","5299308P2  -  CAGE SPNL 8D 30X9X9MM NS CRNT TI ANT TLIF","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"5300-010-941","SUP","Custom 27203010","","5300-010-941  -  DERMABRADER SURG MEDIUM STR 4MM STR TPS STERILE","BOTH IP/OP","$190.80 ","$141.19 ","$0.00 ","$190.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.80 ","$0.00 ","$95.40 ","$151.11 ","$152.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5300-010-943","SUP","Custom 27203010","","5300-010-943  -  DERMABRADER SURG MEDIUM STR 7MM STR X-CHANGE III","BOTH IP/OP","$190.80 ","$141.19 ","$0.00 ","$190.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.80 ","$0.00 ","$95.40 ","$151.11 ","$152.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5300-010-945","SUP","Custom 27203010","","5300-010-945  -  DERMABRADER SURG MEDIUM STR 12MM 50MM BUR STR TPS STERILE","BOTH IP/OP","$190.80 ","$141.19 ","$0.00 ","$190.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.80 ","$0.00 ","$95.40 ","$151.11 ","$152.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5300-010-947","SUP","Custom 27203010","","5300-010-947  -  DERMABRADER SURG MEDIUM 10MM TAPERED TPS STERILE","BOTH IP/OP","$190.80 ","$141.19 ","$0.00 ","$190.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.80 ","$0.00 ","$95.40 ","$151.11 ","$152.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53-00324","SUP","HCPCS C1713","","53-00324  -  PLATE BN 47X29X.3MM UNV NEURO III CLS OUTR FRM TI TMPR 1.5MM","BOTH IP/OP","$3,067.50 ","$2,269.95 ","$0.00 ","$3,067.50 ","$1,380.38 ","$0.00 ","$639.34 ","$0.00 ","$0.00 ","$537.09 ","$3,067.50 ","$0.00 ","$1,533.75 ","$2,429.46 ","$2,454.00 ","$0.00 ","$480.06 ","$0.00 ","$488.35 ","$0.00 "
"53-00466","SUP","HCPCS C1713","","53-00466  -  PLATE BN LG RND 58MM .4MM NS UNV NEURO III CLS OUTR FRM RGD","BOTH IP/OP","$3,675.00 ","$2,719.50 ","$0.00 ","$3,675.00 ","$1,653.75 ","$0.00 ","$765.96 ","$0.00 ","$0.00 ","$643.46 ","$3,675.00 ","$0.00 ","$1,837.50 ","$2,910.60 ","$2,940.00 ","$0.00 ","$575.14 ","$0.00 ","$585.06 ","$0.00 "
"53-05164","SUP","HCPCS C1713","","53-05164  -  PLATE BONE STR LP 16 HOLE TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$478.13 ","$353.82 ","$0.00 ","$1,080.00 ","$486.00 ","$0.00 ","$99.65 ","$0.00 ","$0.00 ","$189.10 ","$1,080.00 ","$0.00 ","$540.00 ","$855.36 ","$864.00 ","$0.00 ","$169.02 ","$0.00 ","$171.94 ","$0.00 "
"53-05212","SUP","HCPCS C1713","","53-05212  -  PLATE BN 12MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$187.88 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"53-05216","SUP","HCPCS C1713","","53-05216  -  PLATE BN 16MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$42.73 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"53-05228","SUP","HCPCS C1713","","53-05228  -  PLATE BN 3D BX 28MM NS UNV NEURO II 2X2 HL LOPRFL TI CRNMXF","BOTH IP/OP","$327.38 ","$242.26 ","$0.00 ","$680.00 ","$306.00 ","$0.00 ","$68.23 ","$0.00 ","$0.00 ","$119.06 ","$680.00 ","$0.00 ","$340.00 ","$538.56 ","$544.00 ","$0.00 ","$106.42 ","$0.00 ","$108.26 ","$0.00 "
"53-05240","SUP","HCPCS C1713","","53-05240  -  PLATE BN 3D LG BX 40MM NS UNV NEURO II 2X2 HL LOPRFL TI","BOTH IP/OP","$1,012.50 ","$749.25 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$211.03 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"53-05406","SUP","HCPCS C1713","","53-05406  -  PLATE BONE 6MM 4 HOLE LP BAR TITANIUM CRANIUM NONSTRL 1.5MM","BOTH IP/OP","$199.50 ","$147.63 ","$0.00 ","$455.00 ","$204.75 ","$0.00 ","$41.58 ","$0.00 ","$0.00 ","$79.67 ","$455.00 ","$0.00 ","$227.50 ","$360.36 ","$364.00 ","$0.00 ","$71.21 ","$0.00 ","$72.44 ","$0.00 "
"53-05507","SUP","Custom 27803010","","53-05507  -  COVER BURR HOLE 7MM LP TAB TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$807.50 ","$597.55 ","$0.00 ","$807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$807.50 ","$0.00 ","$403.75 ","$639.54 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53-05510","SUP","Custom 27803010","","53-05510  -  COVER BURR HOLE MEDIUM 10MM LP TAB TITANIUM CRANIAL NONSTRL","BOTH IP/OP","$807.50 ","$597.55 ","$0.00 ","$807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$807.50 ","$0.00 ","$403.75 ","$639.54 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53-05514","SUP","Custom 27803010","","53-05514  -  COVER BURR HOLE LP 14MM TAB TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$807.50 ","$597.55 ","$0.00 ","$807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$807.50 ","$0.00 ","$403.75 ","$639.54 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53-05520","SUP","Custom 27803010","","53-05520  -  COVER BURR HOLE 20MM LP TAB TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$892.50 ","$660.45 ","$0.00 ","$892.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$892.50 ","$0.00 ","$446.25 ","$706.86 ","$714.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53-05608","SUP","HCPCS C1713","","53-05608  -  PLATE BONE 2Y LP 8MM 6 HOLE GAP TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$965.00 ","$714.10 ","$0.00 ","$965.00 ","$434.25 ","$0.00 ","$201.13 ","$0.00 ","$0.00 ","$168.96 ","$965.00 ","$0.00 ","$482.50 ","$764.28 ","$772.00 ","$0.00 ","$151.02 ","$0.00 ","$153.63 ","$0.00 "
"53-05612","SUP","HCPCS C1713","","53-05612  -  PLATE BONE SMALL LP GAP TITANIUM CRANIOMAXILLOFACIAL NONSTRL","BOTH IP/OP","$493.53 ","$365.21 ","$0.00 ","$1,137.50 ","$511.88 ","$0.00 ","$102.86 ","$0.00 ","$0.00 ","$199.17 ","$1,137.50 ","$0.00 ","$568.75 ","$900.90 ","$910.00 ","$0.00 ","$178.02 ","$0.00 ","$181.09 ","$0.00 "
"53-05622","SUP","HCPCS C1713","","53-05622  -  PLATE BN LG GAP 22MM NS UNV NEURO II LOPRFL TI CRNMXF 1.5MM","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$561.38 ","$0.00 ","$260.01 ","$0.00 ","$0.00 ","$218.43 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$195.23 ","$0.00 ","$198.60 ","$0.00 "
"53-05630","SUP","HCPCS C1713","","53-05630  -  PLATE BONE X LP TITANIUM CRANIOMAXILLOFACIAL NONSTRL","BOTH IP/OP","$965.00 ","$714.10 ","$0.00 ","$965.00 ","$434.25 ","$0.00 ","$201.13 ","$0.00 ","$0.00 ","$168.96 ","$965.00 ","$0.00 ","$482.50 ","$764.28 ","$772.00 ","$0.00 ","$151.02 ","$0.00 ","$153.63 ","$0.00 "
"53-05804","SUP","HCPCS C1713","","53-05804  -  PLATE BONE STR LP 8 HOLE TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"53-06212","SUP","HCPCS C1713","","53-06212  -  PLATE BN 12MM NS UNV NEURO II QUIKFLAP 2 HL BAR X RGD LOPRFL","BOTH IP/OP","$141.25 ","$104.53 ","$0.00 ","$249.85 ","$112.43 ","$0.00 ","$29.44 ","$0.00 ","$0.00 ","$43.75 ","$249.85 ","$0.00 ","$124.93 ","$197.88 ","$199.88 ","$0.00 ","$39.10 ","$0.00 ","$39.78 ","$0.00 "
"53-1125","SUP","Custom 27203010","","RONGUER SURG 9IN LKSL 5MM CURVE REG DBL ACT LMI","BOTH IP/OP","$2,175.23 ","$1,609.67 ","$0.00 ","$2,175.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,175.23 ","$0.00 ","$1,087.61 ","$1,722.78 ","$1,740.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"53-17005","SUP","HCPCS C1713","","53-17005  -  SCREW BONE 1.7MM 5MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17005E","SUP","HCPCS C1713","","53-17005E  -  SCREW BONE 1.7MM 5MM VARIAX TI HAND LCK SLFTAP CROSSPIN STRL","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17006E","SUP","HCPCS C1713","","53-17006E  -  SCREW BONE 1.7MM 6MM HAND LCK SLFTAP CROSSPIN STRL","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17007E","SUP","HCPCS C1713","","53-17007E  -  SCREW BONE 1.7MM 7MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17008E","SUP","HCPCS C1713","","53-17008E  -  SCREW BONE 1.7MM 8MM CANC HIP LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17009E","SUP","HCPCS C1713","","53-17009E  -  SCREW BONE 1.7MM 9MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17010","SUP","HCPCS C1713","","53-17010  -  1.7X10MM LOCKING SCREWS_CROSS-PIN_SELF-T","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17010E","SUP","HCPCS C1713","","53-17010E  -  SCREW BONE 1.7MM 10MM VARIAX HAND SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17011E","SUP","HCPCS C1713","","53-17011E  -  SCREW BONE 1.7MM 11MM ORTH LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17012E","SUP","HCPCS C1713","","53-17012E  -  SCREW BONE 1.7MM 12MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17013E","SUP","HCPCS C1713","","53-17013E  -  SCREW BONE 1.7MM 13MM ORTH SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17014E","SUP","HCPCS C1713","","53-17014E  -  SCREW BONE 1.7MM 14MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17015","SUP","HCPCS C1713","","53-17015  -  SCREW BONE 1.7MM 15MM LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17015E","SUP","HCPCS C1713","","53-17015E  -  SCREW BONE 1.7MM 15MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17016","SUP","HCPCS C1713","","53-17016  -  SCREW BONE 1.7MM 16MM LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17016E","SUP","HCPCS C1713","","53-17016E  -  SCREW BONE 1.7MM 16MM ORTH SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17018","SUP","HCPCS C1713","","53-17018  -  SCREW BONE 1.7MM 18MM LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17018E","SUP","HCPCS C1713","","53-17018E  -  SCREW BONE 1.7MM 18MM VARIAX HAND SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17020","SUP","HCPCS C1713","","53-17020  -  SCREW BONE 1.7MM 20MM LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17020E","SUP","HCPCS C1713","","53-17020E  -  SCREW BONE 1.7MM 20MM ORTH SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17022","SUP","HCPCS C1713","","53-17022  -  SCREW BN 1.7MM 22MM NS VARIAX ST LCK XPN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17022E","SUP","HCPCS C1713","","53-17022E  -  SCREW BONE 1.7MM 22MM ORTH SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17024","SUP","HCPCS C1713","","53-17024  -  SCREW BN 1.7MM 24MM NS VARIAX ST LCK XPN","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-17024E","SUP","HCPCS C1713","","53-17024E  -  SCREW BONE 1.7MM 24MM ORTH SLFTAP LCK","BOTH IP/OP","$140.70 ","$104.12 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-20424","SUP","HCPCS C1713","","53-20424  -  SCREW BONE 2MM 24MM SLFTAP XPIN LAG TITANIUM MAXFACL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20427","SUP","HCPCS C1713","","53-20427  -  SCREW BONE 2MM 27MM SLFTAP XPIN LAG CRANIOMAXILLOFACIAL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20430","SUP","HCPCS C1713","","53-20430  -  SCREW BONE 2MM 30MM SLFTAP XPIN LAG TITANIUM MAXFACL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20433","SUP","HCPCS C1713","","53-20433  -  SCREW BONE 2MM 33MM SLFTAP XPIN LAG MAXFACL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20436","SUP","HCPCS C1713","","53-20436  -  SCREW BONE 2MM 36MM SLFTAP XPIN LAG TITANIUM MAXFACL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20439","SUP","HCPCS C1713","","53-20439  -  SCREW BONE 2MM 39MM SLFTAP XPIN LAG MANDIB NONSTRL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20442","SUP","HCPCS C1713","","53-20442  -  SCREW BONE 2MM 42MM SLFTAP XPIN LAG MANDIB NONSTRL","BOTH IP/OP","$117.00 ","$86.58 ","$0.00 ","$277.50 ","$124.88 ","$0.00 ","$24.39 ","$0.00 ","$0.00 ","$48.59 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$43.43 ","$0.00 ","$44.18 ","$0.00 "
"53-20616E","SUP","HCPCS C1713","","53-20616E  -  SCREW BONE 2MM 16MM TI LCK PG T7 DRV","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-20618E","SUP","HCPCS C1713","","53-20618E  -  SCREW BONE 2MM 18MM TI LCK PG T7 DRV","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-20620E","SUP","HCPCS C1713","","53-20620E  -  SCREW BONE 2MM 20MM TI LCK PG T7 DRV","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-20622E","SUP","HCPCS C1713","","53-20622E  -  SCREW BONE 2MM 22MM TI LCK PG T7 DRV","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-20624E","SUP","HCPCS C1713","","53-20624E  -  SCREW BONE 2MM 24MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-20626E","SUP","HCPCS C1713","","53-20626E  -  SCREW BONE 2MM 26MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23006","SUP","HCPCS C1713","","53-23006  -  SCREW BONE 2.3MM 6MM HAND LCK","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23006E","SUP","HCPCS C1713","","53-23006E  -  SCREW BONE 2.3MM 6MM CANC LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23008","SUP","HCPCS C1713","","53-23008  -  SCREW BONE 2.3MM 8MM VARIAX HAND SLFTAP XPIN","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23008E","SUP","HCPCS C1713","","53-23008E  -  SCREW BN 2.3MM 8MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23009","SUP","HCPCS C1713","","53-23009  -  SCREW BN BLNT 2.3MM 9MM LCK ST XPN HD LOPRFL HND","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23009E","SUP","HCPCS C1713","","53-23009E  -  SCREW BN LOPRFL 2.3MM 9MM NS VARIAX ST LCK XPN HD TI HND","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23010","SUP","HCPCS C1713","","53-23010  -  SCREW BONE 2.3MM 10MM HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23010E","SUP","HCPCS C1713","","53-23010E  -  SCREW BN 2.3MM 10MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23011","SUP","HCPCS C1713","","53-23011  -  SCREW BONE 2.3MM 11MM VARIAX HAND SLFTAP XPIN","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23011E","SUP","HCPCS C1713","","53-23011E  -  SCREW BONE 2.3MM 11MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23012","SUP","HCPCS C1713","","53-23012  -  SCREW BONE 2.3MM 12MM VARIAX HAND LCK XPIN","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23012E","SUP","HCPCS C1713","","53-23012E  -  SCREW BN 2.3MM 12MM STRL VARIAX ST LCK LOPRFL CROSSPIN HD TI","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23013E","SUP","HCPCS C1713","","53-23013E  -  SCREW BONE 2.3MM 13MM VARIAX TI HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23014","SUP","HCPCS C1713","","53-23014  -  SCREW BONE 2.3MM 14MM HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23015E","SUP","HCPCS C1713","","53-23015E  -  SCREW BONE 2.3MM 15MM HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23016","SUP","HCPCS C1713","","53-23016  -  SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23016E","SUP","HCPCS C1713","","53-23016E  -  SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23018","SUP","HCPCS C1713","","53-23018  -  SCREW BONE 2.3MM 18MM VARIAX HAND LCK SLFTAP XPIN","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23018E","SUP","HCPCS C1713","","53-23018E  -  SCREW BONE 2.3MM 18MM HAND LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23020","SUP","HCPCS C1713","","53-23020  -  SCREW BONE 2.3MM 20MM LCK","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23020E","SUP","HCPCS C1713","","53-23020E  -  SCREW BONE 2.3MM 20MM LCK SLFTAP CROSSPIN","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23022","SUP","HCPCS C1713","","53-23022  -  SCREW BONE 2MM 22MM RADL","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23022E","SUP","HCPCS C1713","","53-23022E  -  SCREW BONE 2.3MM 22MM VARIAX HAND SLFTAP LCK","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23024","SUP","HCPCS C1713","","53-23024  -  SCREW BN LOPRFL BLNT RND 2.3MM 24MM GRN VARIAX PRFL 1 STP","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23024E","SUP","HCPCS C1713","","53-23024E  -  SCREW BN 2.3MM 24MM VARIAX LCK ST XPN HD LOPRFL TI WR HND","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23026","SUP","HCPCS C1713","","53-23026  -  SCREW BONE 2.3MM 26MM LCK","BOTH IP/OP","$145.60 ","$107.74 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$30.35 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23026E","SUP","HCPCS C1713","","53-23026E  -  SCREW BONE 2.3MM 26MM VARIAX HAND SLFTAP LCK","BOTH IP/OP","$141.40 ","$104.64 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$29.47 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"53-23210E","SUP","HCPCS C1713","","53-23210E  -  SCREW BONE 2.3MM 10MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23212E","SUP","HCPCS C1713","","53-23212E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23214E","SUP","HCPCS C1713","","53-23214E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23216E","SUP","HCPCS C1713","","53-23216E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23218E","SUP","HCPCS C1713","","53-23218E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23220E","SUP","HCPCS C1713","","53-23220E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL WR HND NLCKG T7","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23222E","SUP","HCPCS C1713","","53-23222E  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23224E","SUP","HCPCS C1713","","53-23224E  -  SCREW BONE 2.3MM 24MM VARIAX TI DISTAL RADL LCK T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23226E","SUP","HCPCS C1713","","53-23226E  -  SCREW BONE 2.3MM 26MM VARIAX TI DISTAL RADL NLCKG T7 DRV","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23228E","SUP","HCPCS C1713","","53-23228E  -  SCREW BONE 2.3MM 28MM VARIAX TI T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23230E","SUP","HCPCS C1713","","53-23230E  -  SCREW BONE 2.3MM 30MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23232E","SUP","HCPCS C1713","","53-23232E  -  SCREW BONE 2.3MM 32MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23234E","SUP","HCPCS C1713","","53-23234E  -  SCREW BONE 2.3MM 34MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23236E","SUP","HCPCS C1713","","53-23236E  -  SCREW BONE 2.3MM 36MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23238E","SUP","HCPCS C1713","","53-23238E  -  SCREW BONE 2.3MM 38MM TI LCK PG T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-23610E","SUP","HCPCS C1713","","53-23610E  -  SCREW BONE 2.3MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23612E","SUP","HCPCS C1713","","53-23612E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23614E","SUP","HCPCS C1713","","53-23614E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL WR HND LCK T7","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23616E","SUP","HCPCS C1713","","53-23616E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23618E","SUP","HCPCS C1713","","53-23618E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23620E","SUP","HCPCS C1713","","53-23620E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23622E","SUP","HCPCS C1713","","53-23622E  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23624E","SUP","HCPCS C1713","","53-23624E  -  SCREW BONE 2.3MM 24MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23626E","SUP","HCPCS C1713","","53-23626E  -  SCREW BONE 2.3MM 26MM VARIAX TI LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23628E","SUP","HCPCS C1713","","53-23628E  -  SCREW BONE 2.3MM 28MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23630E","SUP","HCPCS C1713","","53-23630E  -  SCREW BONE 2.3MM 30MM TI LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23632E","SUP","HCPCS C1713","","53-23632E  -  SCREW BONE 2.3MM 32MM TI LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23634E","SUP","HCPCS C1713","","53-23634E  -  SCREW BONE 2.3MM 34MM TI LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23636E","SUP","HCPCS C1713","","53-23636E  -  SCREW BONE 2.3MM 36MM TI LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-23638E","SUP","HCPCS C1713","","53-23638E  -  SCREW BONE 2.3MM 38MM TI LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"532650S","SUP","HCPCS C1725","","532650S  -  CATHETER ANGIO PGTL CRV 6FR 110CM ST 6 SH BRD PU VNTRC ACPT","BOTH IP/OP","$105.63 ","$78.17 ","$0.00 ","$105.63 ","$57.35 ","$0.00 ","$22.01 ","$0.00 ","$0.00 ","$18.49 ","$105.63 ","$0.00 ","$52.81 ","$83.66 ","$84.50 ","$0.00 ","$16.53 ","$0.00 ","$16.82 ","$0.00 "
"53-27116E","SUP","HCPCS C1713","","53-27116E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL PTTHRD T7 DRV","BOTH IP/OP","$174.25 ","$128.95 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$36.32 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27118E","SUP","HCPCS C1713","","53-27118E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL PTTHRD T7 DRV","BOTH IP/OP","$174.25 ","$128.95 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$36.32 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27120E","SUP","HCPCS C1713","","53-27120E  -  SCREW BONE 2.7MM 20MM TI PTHRD T7 DRV","BOTH IP/OP","$174.25 ","$128.95 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$36.32 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27122E","SUP","HCPCS C1713","","53-27122E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL PTTHRD T7 DRV","BOTH IP/OP","$174.25 ","$128.95 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$36.32 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27124E","SUP","HCPCS C1713","","53-27124E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL PTTHRD T7 DRV","BOTH IP/OP","$174.25 ","$128.95 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$36.32 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27126E","SUP","HCPCS C1713","","53-27126E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL PTTHRD T7 DRV","BOTH IP/OP","$174.25 ","$128.95 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$36.32 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27210E","SUP","HCPCS C1713","","53-27210E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27212E","SUP","HCPCS C1713","","53-27212E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL WR HND NLCKG T7","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27214E","SUP","HCPCS C1713","","53-27214E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND NLCKG T7","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27216E","SUP","HCPCS C1713","","53-27216E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27218E","SUP","HCPCS C1713","","53-27218E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL LCK T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27220E","SUP","HCPCS C1713","","53-27220E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27222E","SUP","HCPCS C1713","","53-27222E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL NLCKG T7 DRV","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27224E","SUP","HCPCS C1713","","53-27224E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL LCK T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27226E","SUP","HCPCS C1713","","53-27226E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL LCK T7 DRV STRL","BOTH IP/OP","$134.30 ","$99.38 ","$0.00 ","$171.88 ","$77.34 ","$0.00 ","$27.99 ","$0.00 ","$0.00 ","$30.09 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$26.90 ","$0.00 ","$27.36 ","$0.00 "
"53-27610E","SUP","HCPCS C1713","","53-27610E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27612E","SUP","HCPCS C1713","","53-27612E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27614E","SUP","HCPCS C1713","","53-27614E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27616E","SUP","HCPCS C1713","","53-27616E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27618E","SUP","HCPCS C1713","","53-27618E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27620E","SUP","HCPCS C1713","","53-27620E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL LCK T7 DRV STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27622E","SUP","HCPCS C1713","","53-27622E  -  SCREW BN T7 FT 2.7MM 22MM NS VARIAX LCK TI DIST RDS LCK PLT","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27624E","SUP","HCPCS C1713","","53-27624E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL T7 DRV LCK","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27626E","SUP","HCPCS C1713","","53-27626E  -  SCREW BONE 2.7MM 26MM TI T7 DRV","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27716E","SUP","HCPCS C1713","","53-27716E  -  PEG 2.7MM 16MM PTTHRD LCK TI NONSTRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27718E","SUP","HCPCS C1713","","53-27718E  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27720E","SUP","HCPCS C1713","","53-27720E  -  PEG 2.7MM 20MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27722E","SUP","HCPCS C1713","","53-27722E  -  PEG 2.7MM 22MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27724E","SUP","HCPCS C1713","","53-27724E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"53-27726E","SUP","HCPCS C1713","","53-27726E  -  PEG 2.7MM 26MM DISTAL RADL PTTHRD LCK TI VARIAX STRL","BOTH IP/OP","$179.35 ","$132.72 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$37.38 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"5331-40/15","SUP","HCPCS C1776","","5331-40/15  -  HEAD HUMERAL 40MM 15MM EPOCA COCR ALLOY SHOULDER STERILE","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-42/15","SUP","HCPCS C1776","","5331-42/15  -  HEAD HUMERAL 42MM 15.75MM COCR SHOULDER NONSTRL","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-44/16","SUP","HCPCS C1776","","5331-44/16  -  HEAD HUM 44MM 16.5MM STRL COCR SHLDR","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-46/17","SUP","HCPCS C1776","","5331-46/17  -  HEAD HUM 46MM 17.25MM STRL COCR SHLDR","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-48/18","SUP","HCPCS C1776","","5331-48/18  -  HEAD HUM 48MM 18MM STRL COCR SHLDR","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-50/18","SUP","HCPCS C1776","","5331-50/18  -  HEAD HUM 50MM 18.75MM STRL COCR SHLDR","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-52/19","SUP","HCPCS C1776","","5331-52/19  -  HEAD HUMERAL 52MM 19.5MM EPOCA COCR SHOULDER STERILE","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-54/20","SUP","HCPCS C1776","","5331-54/20  -  HEAD HUMERAL 54MM 20.25MM COCR SHOULDER NONSTRL","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-56/21","SUP","HCPCS C1776","","5331-56/21  -  HEAD FEMORAL 56MM 21MM COCR HIP STERILE","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"5331-58/22","SUP","HCPCS C1776","","5331-58/22  -  HEAD FEMORAL 58MM 21.75MM COCR HIP STERILE","BOTH IP/OP","$4,287.70 ","$3,172.90 ","$0.00 ","$4,287.70 ","$1,929.47 ","$0.00 ","$893.66 ","$0.00 ","$0.00 ","$750.74 ","$4,287.70 ","$0.00 ","$2,143.85 ","$3,395.86 ","$3,430.16 ","$0.00 ","$671.03 ","$0.00 ","$682.60 ","$0.00 "
"53-34164","SUP","HCPCS C1713","","53-34164  -  PLATE BN STRG .4MM NS UNV NEURO III 16 HL LOPRFL TI CRNMXF","BOTH IP/OP","$1,147.50 ","$849.15 ","$0.00 ","$1,147.50 ","$516.38 ","$0.00 ","$239.17 ","$0.00 ","$0.00 ","$200.92 ","$1,147.50 ","$0.00 ","$573.75 ","$908.82 ","$918.00 ","$0.00 ","$179.58 ","$0.00 ","$182.68 ","$0.00 "
"53-34212","SUP","HCPCS C1713","","53-34212  -  PLATE BN STRG .4MM NS UNV NEURO III 2 HL LOPRFL BAR TAB TI","BOTH IP/OP","$457.50 ","$338.55 ","$0.00 ","$457.50 ","$205.88 ","$0.00 ","$95.35 ","$0.00 ","$0.00 ","$80.10 ","$457.50 ","$0.00 ","$228.75 ","$362.34 ","$366.00 ","$0.00 ","$71.60 ","$0.00 ","$72.83 ","$0.00 "
"53-34216","SUP","HCPCS C1713","","53-34216  -  PLATE BN DOG 16MMX.4MM NS UNV NEURO III 2 HL LOPRFL BAR TI","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"53-34228","SUP","HCPCS C1713","","53-34228  -  PLATE BN SM BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF","BOTH IP/OP","$717.50 ","$530.95 ","$0.00 ","$717.50 ","$322.88 ","$0.00 ","$149.54 ","$0.00 ","$0.00 ","$125.63 ","$717.50 ","$0.00 ","$358.75 ","$568.26 ","$574.00 ","$0.00 ","$112.29 ","$0.00 ","$114.23 ","$0.00 "
"53-34240","SUP","HCPCS C1713","","53-34240  -  PLATE BN LG BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF","BOTH IP/OP","$1,112.50 ","$823.25 ","$0.00 ","$1,112.50 ","$500.63 ","$0.00 ","$231.87 ","$0.00 ","$0.00 ","$194.79 ","$1,112.50 ","$0.00 ","$556.25 ","$881.10 ","$890.00 ","$0.00 ","$174.11 ","$0.00 ","$177.11 ","$0.00 "
"53-34300","SUP","HCPCS C1713","","53-34300  -  PLATE BN RECT .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF","BOTH IP/OP","$1,092.50 ","$808.45 ","$0.00 ","$1,092.50 ","$491.63 ","$0.00 ","$227.70 ","$0.00 ","$0.00 ","$191.29 ","$1,092.50 ","$0.00 ","$546.25 ","$865.26 ","$874.00 ","$0.00 ","$170.98 ","$0.00 ","$173.93 ","$0.00 "
"53-34406","SUP","HCPCS C1713","","53-34406  -  PLATE BN STRG 6MMX.4MM NS UNV NEURO III 4 HL LOPRFL BAR TI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$505.00 ","$227.25 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$88.42 ","$505.00 ","$0.00 ","$252.50 ","$399.96 ","$404.00 ","$0.00 ","$79.03 ","$0.00 ","$80.40 ","$0.00 "
"53-34507","SUP","HCPCS C1713","","53-34507  -  COVER BUR HL LOPRFL 7MM STRL MDPR TAB TI","BOTH IP/OP","$915.00 ","$677.10 ","$0.00 ","$915.00 ","$411.75 ","$0.00 ","$190.71 ","$0.00 ","$0.00 ","$160.21 ","$915.00 ","$0.00 ","$457.50 ","$724.68 ","$732.00 ","$0.00 ","$143.20 ","$0.00 ","$145.67 ","$0.00 "
"53-34510","SUP","HCPCS C1713","","53-34510  -  COVER BURR HOLE LP 10MM TAB UNIVERSAL NEURO III","BOTH IP/OP","$915.00 ","$677.10 ","$0.00 ","$915.00 ","$411.75 ","$0.00 ","$190.71 ","$0.00 ","$0.00 ","$160.21 ","$915.00 ","$0.00 ","$457.50 ","$724.68 ","$732.00 ","$0.00 ","$143.20 ","$0.00 ","$145.67 ","$0.00 "
"53-34514","SUP","HCPCS C1713","","53-34514  -  COVER BURR HOLE LP 14MM TAB UNIVERSAL NEURO III","BOTH IP/OP","$915.00 ","$677.10 ","$0.00 ","$915.00 ","$411.75 ","$0.00 ","$190.71 ","$0.00 ","$0.00 ","$160.21 ","$915.00 ","$0.00 ","$457.50 ","$724.68 ","$732.00 ","$0.00 ","$143.20 ","$0.00 ","$145.67 ","$0.00 "
"53-34608","SUP","HCPCS C1713","","53-34608  -  PLATE BN 2Y .4MM NS UNV NEURO III 6 HL LOPRFL BAR TI CRNMXF","BOTH IP/OP","$1,002.50 ","$741.85 ","$0.00 ","$1,002.50 ","$451.13 ","$0.00 ","$208.95 ","$0.00 ","$0.00 ","$175.53 ","$1,002.50 ","$0.00 ","$501.25 ","$793.98 ","$802.00 ","$0.00 ","$156.89 ","$0.00 ","$159.60 ","$0.00 "
"53-34612","SUP","HCPCS C1713","","53-34612  -  PLATE BN SM GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF","BOTH IP/OP","$1,240.00 ","$917.60 ","$0.00 ","$1,240.00 ","$558.00 ","$0.00 ","$258.45 ","$0.00 ","$0.00 ","$217.11 ","$1,240.00 ","$0.00 ","$620.00 ","$982.08 ","$992.00 ","$0.00 ","$194.06 ","$0.00 ","$197.41 ","$0.00 "
"53-34614","SUP","HCPCS C1713","","53-34614  -  COVER BUR HL 14MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI","BOTH IP/OP","$1,002.50 ","$741.85 ","$0.00 ","$1,002.50 ","$451.13 ","$0.00 ","$208.95 ","$0.00 ","$0.00 ","$175.53 ","$1,002.50 ","$0.00 ","$501.25 ","$793.98 ","$802.00 ","$0.00 ","$156.89 ","$0.00 ","$159.60 ","$0.00 "
"53-34620","SUP","HCPCS C1713","","53-34620  -  COVER BUR HL 20MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"53-34622","SUP","HCPCS C1713","","53-34622  -  PLATE BN LG GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$594.00 ","$0.00 ","$275.12 ","$0.00 ","$0.00 ","$231.12 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$206.58 ","$0.00 ","$210.14 ","$0.00 "
"53-34804","SUP","HCPCS C1713","","53-34804  -  PLATE BN STRG .4MM NS UNV NEURO III 8 HL LOPRFL TI CRNMXF","BOTH IP/OP","$655.00 ","$484.70 ","$0.00 ","$655.00 ","$294.75 ","$0.00 ","$136.52 ","$0.00 ","$0.00 ","$114.69 ","$655.00 ","$0.00 ","$327.50 ","$518.76 ","$524.00 ","$0.00 ","$102.51 ","$0.00 ","$104.28 ","$0.00 "
"53-36212","SUP","HCPCS C1713","","53-36212  -  PLATE BN DOG 12MMX.6MM NS UNV NEURO III 2 HL LOPRFL RGD TI","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"5-34-002","SUP","Custom 27203010","","CHEMICAL ALGAECIDE LQ 4OZ","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5357M/S","SUP","HCPCS C1785","","5357M/S  -  PACEMAKER CRD 11ML VR XL 2 CHMBR","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"539G","SUP","Custom 27203010","","539G  -  SUTURE SS 4-0 5-26 TS 14IN MFL DBL ARM BLK NABSB","BOTH IP/OP","$22.74 ","$16.83 ","$0.00 ","$22.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.74 ","$0.00 ","$11.37 ","$18.01 ","$18.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"54-00261","SUP","HCPCS C1713","","54-00261  -  PLATE BONE 120X60X.1MM MICROMESH TITANIUM","BOTH IP/OP","$1,872.65 ","$1,385.76 ","$0.00 ","$3,305.00 ","$1,487.25 ","$0.00 ","$390.31 ","$0.00 ","$0.00 ","$578.68 ","$3,305.00 ","$0.00 ","$1,652.50 ","$2,617.56 ","$2,644.00 ","$0.00 ","$517.23 ","$0.00 ","$526.16 ","$0.00 "
"54-00262","SUP","HCPCS C1713","","54-00262  -  MESH DYNAMIC MICRO ULTRA-THIN 60X60X.1MM MALBLE UNIVERSAL","BOTH IP/OP","$1,085.40 ","$803.20 ","$0.00 ","$2,195.00 ","$987.75 ","$0.00 ","$226.22 ","$0.00 ","$0.00 ","$384.33 ","$2,195.00 ","$0.00 ","$1,097.50 ","$1,738.44 ","$1,756.00 ","$0.00 ","$343.52 ","$0.00 ","$349.44 ","$0.00 "
"54-00272","SUP","HCPCS C1713","","54-00272  -  MESH CRNL MIC 60X60X.2MM NS UNV NEURO III TI CRNMXF 1.2MM","BOTH IP/OP","$1,085.40 ","$803.20 ","$0.00 ","$2,195.00 ","$987.75 ","$0.00 ","$226.22 ","$0.00 ","$0.00 ","$384.33 ","$2,195.00 ","$0.00 ","$1,097.50 ","$1,738.44 ","$1,756.00 ","$0.00 ","$343.52 ","$0.00 ","$349.44 ","$0.00 "
"54-00345","SUP","HCPCS C1713","","54-00345  -  MESH DYNAMIC LP 120X120X.3MM MALBLE BLUE TITANIUM","BOTH IP/OP","$10,045.00 ","$7,433.30 ","$0.00 ","$10,045.00 ","$4,520.25 ","$0.00 ","$2,093.63 ","$0.00 ","$0.00 ","$1,758.80 ","$10,045.00 ","$0.00 ","$5,022.50 ","$7,955.64 ","$8,036.00 ","$0.00 ","$1,572.04 ","$0.00 ","$1,599.16 ","$0.00 "
"54-00346","SUP","HCPCS C1713","","54-00346  -  MESH DYNAMIC LP 90X90X.3MM MALBLE BLUE TITANIUM","BOTH IP/OP","$2,448.48 ","$1,811.88 ","$0.00 ","$6,375.00 ","$2,868.75 ","$0.00 ","$510.32 ","$0.00 ","$0.00 ","$1,116.21 ","$6,375.00 ","$0.00 ","$3,187.50 ","$5,049.00 ","$5,100.00 ","$0.00 ","$997.69 ","$0.00 ","$1,014.90 ","$0.00 "
"54-00642","SUP","HCPCS C1713","","54-00642  -  PLATE BONE 90X90X.6MM DYNAMIC MESH TITANIUM","BOTH IP/OP","$2,989.85 ","$2,212.49 ","$0.00 ","$6,382.50 ","$2,872.13 ","$0.00 ","$623.16 ","$0.00 ","$0.00 ","$1,117.52 ","$6,382.50 ","$0.00 ","$3,191.25 ","$5,054.94 ","$5,106.00 ","$0.00 ","$998.86 ","$0.00 ","$1,016.09 ","$0.00 "
"54-00643","SUP","HCPCS C1713","","54-00643  -  PLATE BONE STANDARD 120X120X.6MM DYNAMIC MESH TITANIUM","BOTH IP/OP","$5,197.40 ","$3,846.08 ","$0.00 ","$10,365.00 ","$4,664.25 ","$0.00 ","$1,083.27 ","$0.00 ","$0.00 ","$1,814.83 ","$10,365.00 ","$0.00 ","$5,182.50 ","$8,209.08 ","$8,292.00 ","$0.00 ","$1,622.12 ","$0.00 ","$1,650.11 ","$0.00 "
"54-00645","SUP","HCPCS C1713","","54-00645  -  MESH DYNAMIC STANDARD 120X120X.6MM GOLD TITANIUM","BOTH IP/OP","$10,365.00 ","$7,670.10 ","$0.00 ","$10,365.00 ","$4,664.25 ","$0.00 ","$2,160.33 ","$0.00 ","$0.00 ","$1,814.83 ","$10,365.00 ","$0.00 ","$5,182.50 ","$8,209.08 ","$8,292.00 ","$0.00 ","$1,622.12 ","$0.00 ","$1,650.11 ","$0.00 "
"54-00646","SUP","HCPCS C1713","","54-00646  -  MESH DYNAMIC STANDARD 90X90X.6MM GOLD TITANIUM","BOTH IP/OP","$2,448.48 ","$1,811.88 ","$0.00 ","$6,382.50 ","$2,872.13 ","$0.00 ","$510.32 ","$0.00 ","$0.00 ","$1,117.52 ","$6,382.50 ","$0.00 ","$3,191.25 ","$5,054.94 ","$5,106.00 ","$0.00 ","$998.86 ","$0.00 ","$1,016.09 ","$0.00 "
"54-00647","SUP","HCPCS C1713","","54-00647  -  MESH DYNAMIC STANDARD 200X200X.6MM GOLD TITANIUM","BOTH IP/OP","$13,363.95 ","$9,889.32 ","$0.00 ","$29,330.00 ","$13,198.50 ","$0.00 ","$2,785.38 ","$0.00 ","$0.00 ","$5,135.45 ","$29,330.00 ","$0.00 ","$14,665.00 ","$23,229.36 ","$23,464.00 ","$0.00 ","$4,590.15 ","$0.00 ","$4,669.34 ","$0.00 "
"5400-701-000","SUP","Custom 27203010","","5400-701-000  -  MILL BONE BIOP MED BIOP DISP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-40A","SUP","Custom 27803010","","540-11-40A  -  SHELL ACETAB A 40MM 41.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-42B","SUP","Custom 27803010","","540-11-42B  -  SHELL ACETAB B 42MM 43.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-44C","SUP","Custom 27803010","","540-11-44C  -  SHELL ACETAB C 44MM 45.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-46D","SUP","Custom 27803010","","540-11-46D  -  SHELL ACETAB D 46MM 47.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-48D","SUP","Custom 27803010","","540-11-48D  -  SHELL ACETAB D 48MM 49.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-50E","SUP","Custom 27803010","","540-11-50E  -  SHELL ACETAB E 50MM 51.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-52E","SUP","Custom 27803010","","540-11-52E  -  SHELL ACETAB E 52MM SOLID BACK DOME HOLE PLUG TRIDENT PSL HA","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-54F","SUP","Custom 27803010","","540-11-54F  -  SHELL ACETAB F 54MM 55.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-56F","SUP","Custom 27803010","","540-11-56F  -  SHELL ACETAB F 56MM 57.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-58G","SUP","Custom 27803010","","540-11-58G  -  SHELL ACETAB G 58MM 59.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-60G","SUP","Custom 27803010","","540-11-60G  -  SHELL ACETAB G 60MM 61.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-62H","SUP","Custom 27803010","","540-11-62H  -  SHELL ACETAB H 62MM 63.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-64H","SUP","Custom 27803010","","540-11-64H  -  SHELL ACETAB H 64MM 65.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-66I","SUP","Custom 27803010","","540-11-66I  -  SHELL ACETAB I 66MM 67.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-68I","SUP","Custom 27803010","","540-11-68I  -  SHELL ACETAB I 68MM 69.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-70J","SUP","Custom 27803010","","540-11-70J  -  SHELL ACETAB J 70MM 71.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"540-11-72J","SUP","Custom 27803010","","540-11-72J  -  SHELL ACETAB J 72MM 73.8MM SOLID BACK RIM TRIDENT PSL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"54-03000","SUP","HCPCS C1713","","54-03000  -  TEMPLATE SZ SM STD 1.2MM CMBN ORBT PLT","BOTH IP/OP","$101.80 ","$75.33 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$21.22 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"54-03001","SUP","HCPCS C1713","","54-03001  -  PLATE BONE LARGE 39X34X.3MM COMPLEX TITANIUM ORBTL FLOOR 1.2","BOTH IP/OP","$1,618.33 ","$1,197.56 ","$0.00 ","$3,705.00 ","$1,667.25 ","$0.00 ","$337.30 ","$0.00 ","$0.00 ","$648.72 ","$3,705.00 ","$0.00 ","$1,852.50 ","$2,934.36 ","$2,964.00 ","$0.00 ","$579.83 ","$0.00 ","$589.84 ","$0.00 "
"54-03002","SUP","HCPCS C1713","","54-03002  -  PLATE BONE MEDIUM .3MM MALBLE BASIC UPPER FACE ORBTL FLOOR","BOTH IP/OP","$3,477.50 ","$2,573.35 ","$0.00 ","$3,477.50 ","$1,564.88 ","$0.00 ","$724.80 ","$0.00 ","$0.00 ","$608.88 ","$3,477.50 ","$0.00 ","$1,738.75 ","$2,754.18 ","$2,782.00 ","$0.00 ","$544.23 ","$0.00 ","$553.62 ","$0.00 "
"54-03003","SUP","HCPCS C1713","","54-03003  -  PLATE BONE SMALL 20X18X.3MM ISOLATED TITANIUM ORBTL FLOOR","BOTH IP/OP","$3,260.00 ","$2,412.40 ","$0.00 ","$3,260.00 ","$1,467.00 ","$0.00 ","$679.47 ","$0.00 ","$0.00 ","$570.80 ","$3,260.00 ","$0.00 ","$1,630.00 ","$2,581.92 ","$2,608.00 ","$0.00 ","$510.19 ","$0.00 ","$518.99 ","$0.00 "
"54-04000","SUP","HCPCS C1713","","54-04000  -  TEMPLATE SZ LG STD 1.2MM CMBN ORBT PLT","BOTH IP/OP","$97.45 ","$72.11 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$20.31 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"54-04001","SUP","HCPCS C1713","","54-04001  -  PLATE BONE LARGE 30X32X.4MM COMPLEX TITANIUM ORBTL FLOOR 1.2","BOTH IP/OP","$3,705.00 ","$2,741.70 ","$0.00 ","$3,705.00 ","$1,667.25 ","$0.00 ","$772.21 ","$0.00 ","$0.00 ","$648.72 ","$3,705.00 ","$0.00 ","$1,852.50 ","$2,934.36 ","$2,964.00 ","$0.00 ","$579.83 ","$0.00 ","$589.84 ","$0.00 "
"54-04002","SUP","HCPCS C1713","","54-04002  -  PLATE BN MED BSC STD .4MM NS LEIBINGER UNV 2 TI ORBT FLR 1.2","BOTH IP/OP","$1,517.68 ","$1,123.08 ","$0.00 ","$3,477.50 ","$1,564.88 ","$0.00 ","$316.32 ","$0.00 ","$0.00 ","$608.88 ","$3,477.50 ","$0.00 ","$1,738.75 ","$2,754.18 ","$2,782.00 ","$0.00 ","$544.23 ","$0.00 ","$553.62 ","$0.00 "
"54-04004","SUP","HCPCS C1713","","54-04004  -  PLATE BONE 3D SMALL PREBENT ORBTL FLOOR RIGHT","BOTH IP/OP","$3,482.20 ","$2,576.83 ","$0.00 ","$4,145.00 ","$1,865.25 ","$0.00 ","$725.78 ","$0.00 ","$0.00 ","$725.76 ","$4,145.00 ","$0.00 ","$2,072.50 ","$3,282.84 ","$3,316.00 ","$0.00 ","$648.69 ","$0.00 ","$659.88 ","$0.00 "
"54-04007","SUP","HCPCS C1713","","54-04007  -  PLATE BONE 3D LARGE PREBENT ORBTL FLOOR LEFT","BOTH IP/OP","$3,482.20 ","$2,576.83 ","$0.00 ","$4,145.00 ","$1,865.25 ","$0.00 ","$725.78 ","$0.00 ","$0.00 ","$725.76 ","$4,145.00 ","$0.00 ","$2,072.50 ","$3,282.84 ","$3,316.00 ","$0.00 ","$648.69 ","$0.00 ","$659.88 ","$0.00 "
"54-05100","SUP","Custom 27803010","","54-05100  -  CLIP FIX TITANIUM CRANIAL 1.5 MM 1.7 MM SCREW","BOTH IP/OP","$351.80 ","$260.33 ","$0.00 ","$351.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$351.80 ","$0.00 ","$175.90 ","$278.63 ","$281.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"54051T","SUP","HCPCS Q4108","","54051T  -  DRESSING WND THN 5X4IN STRL BVN CLGN GAG DISP","BOTH IP/OP","$457.19 ","$338.32 ","$0.00 ","$457.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.19 ","$0.00 ","$228.60 ","$362.09 ","$365.75 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$0.00 "
"5407FA1015","SUP","Custom 27203010","","5407FA1015  -  ROUTER POWER TAPER 1.5MM 12MM LATEX FREE","BOTH IP/OP","$301.68 ","$223.24 ","$0.00 ","$301.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$301.68 ","$0.00 ","$150.84 ","$238.93 ","$241.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5407FA2023","SUP","Custom 27203010","","5407FA2023  -  ROUTER POWER TAPER 2.3MM LATEX FREE","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5407FA3030","SUP","Custom 27203010","","5407FA3030  -  BURR SRG TPR 3MM WHT ROUT","BOTH IP/OP","$288.78 ","$213.70 ","$0.00 ","$288.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.78 ","$0.00 ","$144.39 ","$228.71 ","$231.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5413-20/5","SUP","HCPCS C1713","","5413-20/5  -  COMPONENT HUM STD ECCENTER STRL EPOCA TI SHLDR","BOTH IP/OP","$1,004.35 ","$743.22 ","$0.00 ","$1,004.35 ","$451.96 ","$0.00 ","$209.33 ","$0.00 ","$0.00 ","$175.85 ","$1,004.35 ","$0.00 ","$502.18 ","$795.45 ","$803.48 ","$0.00 ","$157.18 ","$0.00 ","$159.89 ","$0.00 "
"542-11-40A","SUP","Custom 27803010","","542-11-40A  -  SHELL ACETAB A 40MM 41.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-42B","SUP","Custom 27803010","","542-11-42B  -  SHELL ACETAB B 42MM 43.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-44C","SUP","Custom 27803010","","542-11-44C  -  SHELL ACETAB C 44MM 45.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-46D","SUP","Custom 27803010","","542-11-46D  -  SHELL ACETAB D 46MM 47.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-48D","SUP","Custom 27803010","","542-11-48D  -  SHELL ACETAB D 48MM 49.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-50E","SUP","Custom 27803010","","542-11-50E  -  SHELL ACETAB E 50MM 51.8MM 5 HOLE CLUSTER TRIDENT PSL","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-52E","SUP","Custom 27803010","","542-11-52E  -  SHELL ACETAB E 52MM 53.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-54F","SUP","Custom 27803010","","542-11-54F  -  SHELL ACETAB F 54MM 55.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-56F","SUP","Custom 27803010","","542-11-56F  -  SHELL ACETAB F 56MM 57.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-58G","SUP","Custom 27803010","","542-11-58G  -  SHELL ACETAB G 58MM 59.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-60G","SUP","Custom 27803010","","542-11-60G  -  SHELL ACETAB G 60MM 61.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-62H","SUP","Custom 27803010","","542-11-62H  -  SHELL ACETAB H 62MM 63.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-64H","SUP","Custom 27803010","","542-11-64H  -  SHELL ACETAB H 64MM 65.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-66I","SUP","Custom 27803010","","542-11-66I  -  SHELL ACETAB I 66MM 67.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-68I","SUP","Custom 27803010","","542-11-68I  -  SHELL ACETAB I 68MM 69.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-70J","SUP","Custom 27803010","","542-11-70J  -  SHELL ACETAB J 70MM 71.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542-11-72J","SUP","Custom 27803010","","542-11-72J  -  SHELL ACETAB J 72MM 73.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"54-25240","SUP","HCPCS C1713","","54-25240  -  PLATE SHRT 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$222.75 ","$0.00 ","$103.17 ","$0.00 ","$0.00 ","$86.67 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$77.47 ","$0.00 ","$78.80 ","$0.00 "
"54-25241","SUP","HCPCS C1713","","54-25241  -  PLATE SM 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$222.75 ","$0.00 ","$103.17 ","$0.00 ","$0.00 ","$86.67 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$77.47 ","$0.00 ","$78.80 ","$0.00 "
"54-25242","SUP","HCPCS C1713","","54-25242  -  PLATE SHRT 2.7MM SCR 8 HOLE RECON BONE LEFT RADL","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$222.75 ","$0.00 ","$103.17 ","$0.00 ","$0.00 ","$86.67 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$77.47 ","$0.00 ","$78.80 ","$0.00 "
"54-25243","SUP","HCPCS C1713","","54-25243  -  PLATE SM 2.7MM SCR 8 HOLE RECON BONE LEFT RADL","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$222.75 ","$0.00 ","$103.17 ","$0.00 ","$0.00 ","$86.67 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$77.47 ","$0.00 ","$78.80 ","$0.00 "
"54-25244","SUP","HCPCS C1713","","54-25244  -  PLATE LNG 2.7MM SCR 11 HOLE RECON BONE RIGHT RADL","BOTH IP/OP","$591.25 ","$437.53 ","$0.00 ","$591.25 ","$266.06 ","$0.00 ","$123.23 ","$0.00 ","$0.00 ","$103.52 ","$591.25 ","$0.00 ","$295.63 ","$468.27 ","$473.00 ","$0.00 ","$92.53 ","$0.00 ","$94.13 ","$0.00 "
"54-25246","SUP","HCPCS C1713","","54-25246  -  PLATE LNG 2.7MM SCR 11 HOLE RECON BONE LEFT RADL","BOTH IP/OP","$591.25 ","$437.53 ","$0.00 ","$591.25 ","$266.06 ","$0.00 ","$123.23 ","$0.00 ","$0.00 ","$103.52 ","$591.25 ","$0.00 ","$295.63 ","$468.27 ","$473.00 ","$0.00 ","$92.53 ","$0.00 ","$94.13 ","$0.00 "
"54-25250","SUP","HCPCS C1713","","54-25250  -  PLATE REG 2.7MM SCR 6 HOLE RECON BONE RIGHT RADL","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$194.91 ","$0.00 ","$90.27 ","$0.00 ","$0.00 ","$75.84 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$67.78 ","$0.00 ","$68.95 ","$0.00 "
"54-25251","SUP","HCPCS C1713","","54-25251  -  PLATE REG 2.7MM SCR 6 HOLE RECON BONE LEFT RADL","BOTH IP/OP","$433.13 ","$320.52 ","$0.00 ","$433.13 ","$194.91 ","$0.00 ","$90.27 ","$0.00 ","$0.00 ","$75.84 ","$433.13 ","$0.00 ","$216.56 ","$343.04 ","$346.50 ","$0.00 ","$67.78 ","$0.00 ","$68.95 ","$0.00 "
"54-25252","SUP","HCPCS C1713","","54-25252  -  PLATE REG 2.7MM SCR 7 HOLE RECON BONE RIGHT RADL","BOTH IP/OP","$474.38 ","$351.04 ","$0.00 ","$474.38 ","$213.47 ","$0.00 ","$98.87 ","$0.00 ","$0.00 ","$83.06 ","$474.38 ","$0.00 ","$237.19 ","$375.71 ","$379.50 ","$0.00 ","$74.24 ","$0.00 ","$75.52 ","$0.00 "
"54-25253","SUP","HCPCS C1713","","54-25253  -  PLATE REG 2.7MM SCR 7 HOLE RECON BONE LEFT RADL","BOTH IP/OP","$474.38 ","$351.04 ","$0.00 ","$474.38 ","$213.47 ","$0.00 ","$98.87 ","$0.00 ","$0.00 ","$83.06 ","$474.38 ","$0.00 ","$237.19 ","$375.71 ","$379.50 ","$0.00 ","$74.24 ","$0.00 ","$75.52 ","$0.00 "
"54-25254","SUP","HCPCS C1713","","54-25254  -  PLATE REG 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL","BOTH IP/OP","$577.50 ","$427.35 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$120.37 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"54-25255","SUP","HCPCS C1713","","54-25255  -  PLATE REG 2.7MM SCR 8 HOLE RECON BONE LEFT RADL","BOTH IP/OP","$577.50 ","$427.35 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$120.37 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"54-25270","SUP","HCPCS C1713","","54-25270  -  PLATE MED BONE PLMR RADL","BOTH IP/OP","$790.63 ","$585.07 ","$0.00 ","$790.63 ","$355.78 ","$0.00 ","$164.79 ","$0.00 ","$0.00 ","$138.43 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$123.73 ","$0.00 ","$125.87 ","$0.00 "
"54-25271","SUP","HCPCS C1713","","54-25271  -  PLATE MED BONE LEFT DORSAL RADL","BOTH IP/OP","$790.63 ","$585.07 ","$0.00 ","$790.63 ","$355.78 ","$0.00 ","$164.79 ","$0.00 ","$0.00 ","$138.43 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$123.73 ","$0.00 ","$125.87 ","$0.00 "
"54-25272","SUP","HCPCS C1713","","54-25272  -  PLATE MED BONE LEFT DORSAL RADL","BOTH IP/OP","$790.63 ","$585.07 ","$0.00 ","$790.63 ","$355.78 ","$0.00 ","$164.79 ","$0.00 ","$0.00 ","$138.43 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$123.73 ","$0.00 ","$125.87 ","$0.00 "
"54-25273","SUP","HCPCS C1713","","54-25273  -  PLATE LG BONE LEFT DORSAL RADL","BOTH IP/OP","$790.63 ","$585.07 ","$0.00 ","$790.63 ","$355.78 ","$0.00 ","$164.79 ","$0.00 ","$0.00 ","$138.43 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$123.73 ","$0.00 ","$125.87 ","$0.00 "
"54-25274","SUP","HCPCS C1713","","54-25274  -  PLATE MED BONE RIGHT DORSAL RADL","BOTH IP/OP","$790.63 ","$585.07 ","$0.00 ","$790.63 ","$355.78 ","$0.00 ","$164.79 ","$0.00 ","$0.00 ","$138.43 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$123.73 ","$0.00 ","$125.87 ","$0.00 "
"54-25275","SUP","HCPCS C1713","","54-25275  -  PLATE LG BONE RIGHT DORSAL RADL","BOTH IP/OP","$790.63 ","$585.07 ","$0.00 ","$790.63 ","$355.78 ","$0.00 ","$164.79 ","$0.00 ","$0.00 ","$138.43 ","$790.63 ","$0.00 ","$395.31 ","$626.18 ","$632.50 ","$0.00 ","$123.73 ","$0.00 ","$125.87 ","$0.00 "
"54-25290","SUP","HCPCS C1713","","54-25290  -  PLATE BN STD VARIAX LCK TI RDS RT DIST DRSL","BOTH IP/OP","$1,656.00 ","$1,225.44 ","$0.00 ","$1,135.75 ","$511.09 ","$0.00 ","$345.15 ","$0.00 ","$0.00 ","$198.86 ","$1,135.75 ","$0.00 ","$567.88 ","$899.51 ","$908.60 ","$0.00 ","$177.74 ","$0.00 ","$180.81 ","$0.00 "
"54-25291","SUP","HCPCS C1713","","54-25291  -  PLATE MED STD ORBTL FLR BONE SMARTLOCK TI","BOTH IP/OP","$1,656.00 ","$1,225.44 ","$0.00 ","$1,135.75 ","$511.09 ","$0.00 ","$345.15 ","$0.00 ","$0.00 ","$198.86 ","$1,135.75 ","$0.00 ","$567.88 ","$899.51 ","$908.60 ","$0.00 ","$177.74 ","$0.00 ","$180.81 ","$0.00 "
"54-25292","SUP","HCPCS C1713","","54-25292  -  PLATE W TI LCK VARIAX BONE RIGHT DISTAL DORSAL RADL","BOTH IP/OP","$1,656.00 ","$1,225.44 ","$0.00 ","$1,135.75 ","$511.09 ","$0.00 ","$345.15 ","$0.00 ","$0.00 ","$198.86 ","$1,135.75 ","$0.00 ","$567.88 ","$899.51 ","$908.60 ","$0.00 ","$177.74 ","$0.00 ","$180.81 ","$0.00 "
"54-25293","SUP","HCPCS C1713","","54-25293  -  PLATE W LCK VARIAX BONE LEFT DISTAL DORSAL RADL","BOTH IP/OP","$1,656.00 ","$1,225.44 ","$0.00 ","$1,135.75 ","$511.09 ","$0.00 ","$345.15 ","$0.00 ","$0.00 ","$198.86 ","$1,135.75 ","$0.00 ","$567.88 ","$899.51 ","$908.60 ","$0.00 ","$177.74 ","$0.00 ","$180.81 ","$0.00 "
"54-25294","SUP","HCPCS C1713","","54-25294  -  PLATE STD XLNG LCK VARIAX BONE RIGHT DISTAL DORSAL RADL","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25295","SUP","HCPCS C1713","","54-25295  -  PLATE STD XLNG LCK VARIAX BONE LEFT DISTAL DORSAL RADL","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25296","SUP","HCPCS C1713","","54-25296  -  PLATE XLNG LCK W VARIAX BONE RIGHT DISTAL DORSAL RADL","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25297","SUP","HCPCS C1713","","54-25297  -  PLATE XLNG LCK W VARIAX BONE LEFT DISTAL DORSAL RADL","BOTH IP/OP","$1,911.00 ","$1,414.14 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$398.30 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25374","SUP","HCPCS C1713","","54-25374  -  PLATE NAR LCK PLT SYS ANTM VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25375","SUP","HCPCS C1713","","54-25375  -  PLATE NAR LNG LCK ANTM VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,877.00 ","$1,388.98 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$391.21 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25376","SUP","HCPCS C1713","","54-25376  -  PLATE STD LCK SYS ANTM VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25377","SUP","HCPCS C1713","","54-25377  -  PLATE STD LNG LCK PLT SYS ANTM VARIAX BONE LEFT DISTAL VOLR","BOTH IP/OP","$1,877.00 ","$1,388.98 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$391.21 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25384","SUP","HCPCS C1713","","54-25384  -  PLATE NAR LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR RADL","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25385","SUP","HCPCS C1713","","54-25385  -  PLATE BN NAR LNG VARIAX ANTM LCK TI RADL RT DIST VOLR","BOTH IP/OP","$1,877.00 ","$1,388.98 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$391.21 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25386","SUP","HCPCS C1713","","54-25386  -  PLATE STD LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR RADL","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25387","SUP","HCPCS C1713","","54-25387  -  PLATE STD LNG LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR","BOTH IP/OP","$1,877.00 ","$1,388.98 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$391.21 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25391","SUP","HCPCS C1713","","54-25391  -  PLATE NAR XLNG UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,469.00 ","$1,087.06 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$306.18 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25392","SUP","HCPCS C1713","","54-25392  -  PLATE XLNG STD UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,469.00 ","$1,087.06 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$306.18 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25393","SUP","HCPCS C1713","","54-25393  -  PLATE XLNG UNV TI LCK W VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,469.00 ","$1,087.06 ","$0.00 ","$1,373.63 ","$618.13 ","$0.00 ","$306.18 ","$0.00 ","$0.00 ","$240.51 ","$1,373.63 ","$0.00 ","$686.81 ","$1,087.91 ","$1,098.90 ","$0.00 ","$214.97 ","$0.00 ","$218.68 ","$0.00 "
"54-25394","SUP","HCPCS C1713","","54-25394  -  PLATE NAR SHRT TI LCK VARIAX BONE DISTAL VOLR RADL","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$286.17 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25395","SUP","HCPCS C1713","","54-25395  -  PLATE NAR LNG UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$286.17 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25396","SUP","HCPCS C1713","","54-25396  -  PLATE UNV STD SHRT LCK VARIAX BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$286.17 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25397","SUP","HCPCS C1713","","54-25397  -  PLATE UNV STD LNG LCK VARIAX BONE RADL DISTAL VOLR","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$286.17 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25398","SUP","HCPCS C1713","","54-25398  -  PLATE UNV W SHRT LCK VARIAX BONE RADL DISTAL VOLR","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$286.17 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25399","SUP","HCPCS C1713","","54-25399  -  PLATE UNV W LNG LCK VARIAX BONE RADL DISTAL VOLR","BOTH IP/OP","$1,373.00 ","$1,016.02 ","$0.00 ","$1,291.13 ","$581.01 ","$0.00 ","$286.17 ","$0.00 ","$0.00 ","$226.07 ","$1,291.13 ","$0.00 ","$645.56 ","$1,022.57 ","$1,032.90 ","$0.00 ","$202.06 ","$0.00 ","$205.55 ","$0.00 "
"54-25400","SUP","HCPCS C1713","","54-25400  -  PLATE SHRT TI CLMN FRAG SPC VARIAX BONE RADL","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$928.13 ","$417.66 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$162.51 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$145.25 ","$0.00 ","$147.76 ","$0.00 "
"54-25401","SUP","HCPCS C1713","","54-25401  -  PLATE LNG TI CLMN SMARTLOCK BONE VOLR RADL","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$928.13 ","$417.66 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$162.51 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$145.25 ","$0.00 ","$147.76 ","$0.00 "
"54-25402","SUP","HCPCS C1713","","54-25402  -  PLATE SHRT TI CLMN SMARTLOCK BONE RIGHT DISTAL ULN","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$928.13 ","$417.66 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$162.51 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$145.25 ","$0.00 ","$147.76 ","$0.00 "
"54-25403","SUP","HCPCS C1713","","54-25403  -  PLATE BN SHRT 40MMX1MM VARIAX LCK CLMN TI ULNA LT FRAG SPC","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$928.13 ","$417.66 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$162.51 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$145.25 ","$0.00 ","$147.76 ","$0.00 "
"54-25404","SUP","HCPCS C1713","","54-25404  -  PLATE LNG LCK CLMN FRAG SPC VARIAX BONE RIGHT RADL DISTAL","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$928.13 ","$417.66 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$162.51 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$145.25 ","$0.00 ","$147.76 ","$0.00 "
"54-25405","SUP","HCPCS C1713","","54-25405  -  PLATE LNG TI CLMN SMARTLOCK BONE LEFT RADL DISTAL ULN","BOTH IP/OP","$1,210.00 ","$895.40 ","$0.00 ","$928.13 ","$417.66 ","$0.00 ","$252.19 ","$0.00 ","$0.00 ","$162.51 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$145.25 ","$0.00 ","$147.76 ","$0.00 "
"54-25420S","SUP","HCPCS C1713","","54-25420S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM STND BONE 2.7MM LEFT","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,708.75 ","$1,218.94 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$474.28 ","$2,708.75 ","$0.00 ","$1,354.38 ","$2,145.33 ","$2,167.00 ","$0.00 ","$423.92 ","$0.00 ","$431.23 ","$0.00 "
"54-25422S","SUP","HCPCS C1713","","54-25422S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM STND BONE 2.7MM RIGHT","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,708.75 ","$1,218.94 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$474.28 ","$2,708.75 ","$0.00 ","$1,354.38 ","$2,145.33 ","$2,167.00 ","$0.00 ","$423.92 ","$0.00 ","$431.23 ","$0.00 "
"54-25424S","SUP","HCPCS C1713","","54-25424S  -  PLATE BN 2XL 189MMX3MM STRL 15 HL ANTM STND RADL RT DIST","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,585.00 ","$1,163.25 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$452.61 ","$2,585.00 ","$0.00 ","$1,292.50 ","$2,047.32 ","$2,068.00 ","$0.00 ","$404.55 ","$0.00 ","$411.53 ","$0.00 "
"54-25426S","SUP","HCPCS C1713","","54-25426S  -  PLATE STD 145MM 2.7MM SCR 11 HOLE BONE RIGHT DISTAL VOLR","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,585.00 ","$1,163.25 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$452.61 ","$2,585.00 ","$0.00 ","$1,292.50 ","$2,047.32 ","$2,068.00 ","$0.00 ","$404.55 ","$0.00 ","$411.53 ","$0.00 "
"54-25428S","SUP","HCPCS C1713","","54-25428S  -  PLATE 2XL THK3MM STD 100MM 8 HOLE ANTM BONE LEFT DISTAL VOLR","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,502.50 ","$1,126.13 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$438.17 ","$2,502.50 ","$0.00 ","$1,251.25 ","$1,981.98 ","$2,002.00 ","$0.00 ","$391.64 ","$0.00 ","$398.40 ","$0.00 "
"54-25430S","SUP","HCPCS C1713","","54-25430S  -  PLATE 2XL STD 100MMX3MM 2.7MM SCR 8 HOLE ANTM BONE RIGHT","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,502.50 ","$1,126.13 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$438.17 ","$2,502.50 ","$0.00 ","$1,251.25 ","$1,981.98 ","$2,002.00 ","$0.00 ","$391.64 ","$0.00 ","$398.40 ","$0.00 "
"54-25432S","SUP","HCPCS C1713","","54-25432S  -  PLATE 2XL THK3MM 74MM 2.7MM SCR 5 HOLE VARIAX BONE 2.7MM","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,420.00 ","$1,089.00 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$423.72 ","$2,420.00 ","$0.00 ","$1,210.00 ","$1,916.64 ","$1,936.00 ","$0.00 ","$378.73 ","$0.00 ","$385.26 ","$0.00 "
"54-25434S","SUP","HCPCS C1713","","54-25434S  -  PLATE 2XL THK3MM 74MM 5 HOLE ANTM STND BONE 2.7MM RIGHT VOLR","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,420.00 ","$1,089.00 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$423.72 ","$2,420.00 ","$0.00 ","$1,210.00 ","$1,916.64 ","$1,936.00 ","$0.00 ","$378.73 ","$0.00 ","$385.26 ","$0.00 "
"54-25436S","SUP","HCPCS C1713","","54-25436S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM NAR BONE 2.7MM LEFT VOLR","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,640.00 ","$1,188.00 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$462.24 ","$2,640.00 ","$0.00 ","$1,320.00 ","$2,090.88 ","$2,112.00 ","$0.00 ","$413.16 ","$0.00 ","$420.29 ","$0.00 "
"54-25438S","SUP","HCPCS C1713","","54-25438S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM NAR BONE 2.7MM RIGHT","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,640.00 ","$1,188.00 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$462.24 ","$2,640.00 ","$0.00 ","$1,320.00 ","$2,090.88 ","$2,112.00 ","$0.00 ","$413.16 ","$0.00 ","$420.29 ","$0.00 "
"54-25440S","SUP","HCPCS C1713","","54-25440S  -  PLATE 2XL THK3MM 145MM 11 HOLE ANTM NAR BONE 2.7MM LEFT VOLR","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,516.25 ","$1,132.31 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$440.58 ","$2,516.25 ","$0.00 ","$1,258.13 ","$1,992.87 ","$2,013.00 ","$0.00 ","$393.79 ","$0.00 ","$400.59 ","$0.00 "
"54-25442S","SUP","HCPCS C1713","","54-25442S  -  PLATE 2XL 145MMX3MM 2.7MM SCR 11 HOLE ANTM NAR VARIAX BONE","BOTH IP/OP","$3,145.00 ","$2,327.30 ","$0.00 ","$2,516.25 ","$1,132.31 ","$0.00 ","$655.50 ","$0.00 ","$0.00 ","$440.58 ","$2,516.25 ","$0.00 ","$1,258.13 ","$1,992.87 ","$2,013.00 ","$0.00 ","$393.79 ","$0.00 ","$400.59 ","$0.00 "
"54-25444S","SUP","HCPCS C1713","","54-25444S  -  PLATE 2XL NAR 2.7MM SCR 8 HOLE ANTM BONE LEFT DISTAL VOLR","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,433.75 ","$1,095.19 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$426.13 ","$2,433.75 ","$0.00 ","$1,216.88 ","$1,927.53 ","$1,947.00 ","$0.00 ","$380.88 ","$0.00 ","$387.45 ","$0.00 "
"54-25446S","SUP","HCPCS C1713","","54-25446S  -  PLATE 2XL 100MMX3MM 2.7MM SCR 8 HOLE ANTM NAR VARIAX BONE","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,433.75 ","$1,095.19 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$426.13 ","$2,433.75 ","$0.00 ","$1,216.88 ","$1,927.53 ","$1,947.00 ","$0.00 ","$380.88 ","$0.00 ","$387.45 ","$0.00 "
"54-25448S","SUP","HCPCS C1713","","54-25448S  -  PLATE 2XL NAR 2.7MM SCR 5 HOLE ANTM BONE LEFT DISTAL VOLR","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,351.25 ","$1,058.06 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$411.69 ","$2,351.25 ","$0.00 ","$1,175.63 ","$1,862.19 ","$1,881.00 ","$0.00 ","$367.97 ","$0.00 ","$374.32 ","$0.00 "
"54-25450S","SUP","HCPCS C1713","","54-25450S  -  PLATE 2XL 74MMX3MM 2.7MM SCR 5 HOLE ANTM NAR VARIAX BONE","BOTH IP/OP","$2,751.00 ","$2,035.74 ","$0.00 ","$2,351.25 ","$1,058.06 ","$0.00 ","$573.38 ","$0.00 ","$0.00 ","$411.69 ","$2,351.25 ","$0.00 ","$1,175.63 ","$1,862.19 ","$1,881.00 ","$0.00 ","$367.97 ","$0.00 ","$374.32 ","$0.00 "
"542T-11-42A","SUP","Custom 27803010","","542T-11-42A  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-44B","SUP","Custom 27803010","","542T-11-44B  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-46C","SUP","Custom 27803010","","542T-11-46C  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-50D","SUP","Custom 27803010","","542T-11-50D  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-54E","SUP","Custom 27803010","","542T-11-54E  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-58F","SUP","Custom 27803010","","542T-11-58F  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-62G","SUP","Custom 27803010","","542T-11-62G  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-66H","SUP","Custom 27803010","","542T-11-66H  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"542T-11-70I","SUP","Custom 27803010","","542T-11-70I  -  SHELL ACETAB HYDRXAPT TR PSL T","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5444-0-110","SUP","HCPCS C1895","","5444-0-110  -  GRAFT SYNTH TISSUE SMALL CUSTOMIZE MEDPOR","BOTH IP/OP","$25,393.75 ","$18,791.38 ","$0.00 ","$32,157.50 ","$14,470.88 ","$0.00 ","$5,292.69 ","$0.00 ","$0.00 ","$5,630.52 ","$32,157.50 ","$0.00 ","$16,078.75 ","$25,468.74 ","$25,726.00 ","$0.00 ","$5,032.65 ","$0.00 ","$5,119.47 ","$0.00 "
"5444-0-210","SUP","HCPCS C1895","","5444-0-210  -  GRAFT SYNTH TISSUE MEDIUM CUSTOMIZE MEDPOR","BOTH IP/OP","$38,395.00 ","$28,412.30 ","$0.00 ","$38,395.00 ","$17,277.75 ","$0.00 ","$8,002.48 ","$0.00 ","$0.00 ","$6,722.66 ","$38,395.00 ","$0.00 ","$19,197.50 ","$30,408.84 ","$30,716.00 ","$0.00 ","$6,008.82 ","$0.00 ","$6,112.48 ","$0.00 "
"5444-0-310","SUP","HCPCS C1895","","5444-0-310  -  GRAFT SYNTH TISSUE LARGE CUSTOMIZE MEDPOR","BOTH IP/OP","$45,842.50 ","$33,923.45 ","$0.00 ","$45,842.50 ","$20,629.13 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,026.66 ","$45,842.50 ","$0.00 ","$22,921.25 ","$36,307.26 ","$36,674.00 ","$0.00 ","$7,174.35 ","$0.00 ","$7,298.13 ","$0.00 "
"5444-0-410","SUP","HCPCS C1895","","5444-0-410  -  GRAFT SYNTH TISSUE XL CUSTOMIZE MEDPOR","BOTH IP/OP","$54,737.50 ","$40,505.75 ","$0.00 ","$54,737.50 ","$24,631.88 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$54,737.50 ","$0.00 ","$27,368.75 ","$43,352.10 ","$43,790.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"5444-0-510","SUP","HCPCS C1895","","5444-0-510  -  GRAFT SYNTH TISSUE CUSTOMIZE MEDPOR MIDFAC","BOTH IP/OP","$42,120.00 ","$31,168.80 ","$0.00 ","$42,120.00 ","$18,954.00 ","$0.00 ","$8,778.86 ","$0.00 ","$0.00 ","$7,374.88 ","$42,120.00 ","$0.00 ","$21,060.00 ","$33,359.04 ","$33,696.00 ","$0.00 ","$6,591.78 ","$0.00 ","$6,705.50 ","$0.00 "
"5444-0-610","SUP","HCPCS C1895","","5444-0-610  -  GRAFT SYNTH TISSUE CUSTOMIZE AUGMENTATION LATEX FREE MEDPOR","BOTH IP/OP","$20,182.50 ","$14,935.05 ","$0.00 ","$20,182.50 ","$9,082.13 ","$0.00 ","$4,206.54 ","$0.00 ","$0.00 ","$3,533.79 ","$20,182.50 ","$0.00 ","$10,091.25 ","$15,984.54 ","$16,146.00 ","$0.00 ","$3,158.56 ","$0.00 ","$3,213.05 ","$0.00 "
"5450-800-315","SUP","Custom 27203010","","5450-800-315  -  TIP ASP LNG 4.6IN STRL LF SPTZLR MIC CLW MIC CLW BN DISP","BOTH IP/OP","$8,925.00 ","$6,604.50 ","$0.00 ","$8,925.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,925.00 ","$0.00 ","$4,462.50 ","$7,068.60 ","$7,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"55.26.25E","SUP","Custom 27203010","","55.26.25E  -  PROBE LSR 25GA STRL DRCT XTD DISP","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"55-0001","SUP","HCPCS C1713","","55-0001  -  NAIL HELICAL 20 MM IMPLANT","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$295.88 ","$0.00 ","$137.04 ","$0.00 ","$0.00 ","$115.12 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$102.90 ","$0.00 ","$104.67 ","$0.00 "
"55-0002","SUP","HCPCS C1713","","55-0002  -  NAIL HELICAL 30 MM IMPLANT","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$295.88 ","$0.00 ","$137.04 ","$0.00 ","$0.00 ","$115.12 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$102.90 ","$0.00 ","$104.67 ","$0.00 "
"55-0003","SUP","HCPCS C1713","","55-0003  -  NAIL HELICAL 40 MM IMPLANT","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$295.88 ","$0.00 ","$137.04 ","$0.00 ","$0.00 ","$115.12 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$102.90 ","$0.00 ","$104.67 ","$0.00 "
"550-120","SUP","HCPCS C1713","","550-120  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$242.25 ","$179.27 ","$0.00 ","$242.25 ","$109.01 ","$0.00 ","$50.49 ","$0.00 ","$0.00 ","$42.42 ","$242.25 ","$0.00 ","$121.13 ","$191.86 ","$193.80 ","$0.00 ","$37.91 ","$0.00 ","$38.57 ","$0.00 "
"55-02950","SUP","HCPCS C1713","","55-02950  -  PLATE BN NS HBRD MMF MXLMNDB","BOTH IP/OP","$870.00 ","$643.80 ","$0.00 ","$870.00 ","$391.50 ","$0.00 ","$181.33 ","$0.00 ","$0.00 ","$152.33 ","$870.00 ","$0.00 ","$435.00 ","$689.04 ","$696.00 ","$0.00 ","$136.16 ","$0.00 ","$138.50 ","$0.00 "
"55-02951","SUP","HCPCS C1713","","55-02951  -  PLATE BONE SMARTLOCK SMALL MAXILLOFACIAL HYBRID","BOTH IP/OP","$870.00 ","$643.80 ","$0.00 ","$870.00 ","$391.50 ","$0.00 ","$181.33 ","$0.00 ","$0.00 ","$152.33 ","$870.00 ","$0.00 ","$435.00 ","$689.04 ","$696.00 ","$0.00 ","$136.16 ","$0.00 ","$138.50 ","$0.00 "
"55-03731","SUP","HCPCS C1713","","55-03731  -  PLATE BONE 3D LP .55MM 2X2 HOLE MALBLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$767.50 ","$567.95 ","$0.00 ","$767.50 ","$345.38 ","$0.00 ","$159.97 ","$0.00 ","$0.00 ","$134.38 ","$767.50 ","$0.00 ","$383.75 ","$607.86 ","$614.00 ","$0.00 ","$120.11 ","$0.00 ","$122.19 ","$0.00 "
"55-03733","SUP","HCPCS C1713","","55-03733  -  PLATE BONE 3D LP .55MM 6X2 HOLE MALBLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$947.50 ","$701.15 ","$0.00 ","$1,970.00 ","$886.50 ","$0.00 ","$197.48 ","$0.00 ","$0.00 ","$344.93 ","$1,970.00 ","$0.00 ","$985.00 ","$1,560.24 ","$1,576.00 ","$0.00 ","$308.31 ","$0.00 ","$313.62 ","$0.00 "
"55-04218","SUP","HCPCS C1713","","55-04218  -  PLATE BONE STR LP .5MM 18 HOLE MALBLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$958.35 ","$709.18 ","$0.00 ","$2,117.50 ","$952.88 ","$0.00 ","$199.74 ","$0.00 ","$0.00 ","$370.76 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$331.39 ","$0.00 ","$337.11 ","$0.00 "
"55-04231","SUP","HCPCS C1713","","55-04231  -  PLATE BONE 3D .5MM 2X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL","BOTH IP/OP","$439.13 ","$324.96 ","$0.00 ","$967.50 ","$435.38 ","$0.00 ","$91.52 ","$0.00 ","$0.00 ","$169.40 ","$967.50 ","$0.00 ","$483.75 ","$766.26 ","$774.00 ","$0.00 ","$151.41 ","$0.00 ","$154.03 ","$0.00 "
"55-04233","SUP","HCPCS C1713","","55-04233  -  PLATE BONE .5MM 6X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL 1.2","BOTH IP/OP","$789.25 ","$584.05 ","$0.00 ","$1,742.50 ","$784.13 ","$0.00 ","$164.50 ","$0.00 ","$0.00 ","$305.10 ","$1,742.50 ","$0.00 ","$871.25 ","$1,380.06 ","$1,394.00 ","$0.00 ","$272.70 ","$0.00 ","$277.41 ","$0.00 "
"55-04235","SUP","HCPCS C1713","","55-04235  -  PLATE BONE 3D .5MM 6X6 HOLE MALBLE 3D UNIVERSAL2 TITANIUM","BOTH IP/OP","$1,818.43 ","$1,345.64 ","$0.00 ","$4,010.00 ","$1,804.50 ","$0.00 ","$379.01 ","$0.00 ","$0.00 ","$702.12 ","$4,010.00 ","$0.00 ","$2,005.00 ","$3,175.92 ","$3,208.00 ","$0.00 ","$627.57 ","$0.00 ","$638.39 ","$0.00 "
"55-04237","SUP","HCPCS C1713","","55-04237  -  PLATE BONE .5MM 10X10 HOLE MALBLE 3D TITANIUM UPPERFACIAL","BOTH IP/OP","$2,480.68 ","$1,835.70 ","$0.00 ","$5,475.00 ","$2,463.75 ","$0.00 ","$517.03 ","$0.00 ","$0.00 ","$958.63 ","$5,475.00 ","$0.00 ","$2,737.50 ","$4,336.20 ","$4,380.00 ","$0.00 ","$856.84 ","$0.00 ","$871.62 ","$0.00 "
"55-04240","SUP","HCPCS C1713","","55-04240  -  PLATE BONE 2Y LP .5MM 7 HOLE MALBLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$837.50 ","$619.75 ","$0.00 ","$837.50 ","$376.88 ","$0.00 ","$174.56 ","$0.00 ","$0.00 ","$146.64 ","$837.50 ","$0.00 ","$418.75 ","$663.30 ","$670.00 ","$0.00 ","$131.07 ","$0.00 ","$133.33 ","$0.00 "
"55-04250","SUP","HCPCS C1713","","55-04250  -  PLATE BONE CURVE .5MM 10 HOLE MALBLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$426.33 ","$315.48 ","$0.00 ","$947.50 ","$426.38 ","$0.00 ","$88.86 ","$0.00 ","$0.00 ","$165.90 ","$947.50 ","$0.00 ","$473.75 ","$750.42 ","$758.00 ","$0.00 ","$148.28 ","$0.00 ","$150.84 ","$0.00 "
"55-04424","SUP","HCPCS C1713","","55-04424  -  PLATE BONE .5MM 24 HOLE STR MALBLE CONDENSED TITANIUM","BOTH IP/OP","$1,021.25 ","$755.73 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$212.85 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"55-04720","SUP","HCPCS C1713","","55-04720  -  PLATE BONE STR .5MM 20 HOLE MALBLE TITANIUM MIDFAC 1.7MM","BOTH IP/OP","$1,002.25 ","$741.67 ","$0.00 ","$2,247.50 ","$1,011.38 ","$0.00 ","$208.89 ","$0.00 ","$0.00 ","$393.52 ","$2,247.50 ","$0.00 ","$1,123.75 ","$1,780.02 ","$1,798.00 ","$0.00 ","$351.73 ","$0.00 ","$357.80 ","$0.00 "
"55-04724","SUP","HCPCS C1713","","55-04724  -  PLATE BONE 24 HOLE STR MALBLE CONDENSED TITANIUM MIDFAC 1.7","BOTH IP/OP","$1,037.18 ","$767.51 ","$0.00 ","$2,320.00 ","$1,044.00 ","$0.00 ","$216.17 ","$0.00 ","$0.00 ","$406.21 ","$2,320.00 ","$0.00 ","$1,160.00 ","$1,837.44 ","$1,856.00 ","$0.00 ","$363.08 ","$0.00 ","$369.34 ","$0.00 "
"55-04760","SUP","HCPCS C1713","","55-04760  -  PLATE BONE 100D 2MM ADVANCEMENT 5 HOLE L MALBLE TITANIUM","BOTH IP/OP","$391.20 ","$289.49 ","$0.00 ","$865.00 ","$389.25 ","$0.00 ","$81.54 ","$0.00 ","$0.00 ","$151.45 ","$865.00 ","$0.00 ","$432.50 ","$685.08 ","$692.00 ","$0.00 ","$135.37 ","$0.00 ","$137.71 ","$0.00 "
"55-04761","SUP","HCPCS C1713","","55-04761  -  PLATE BONE 100D 2MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED","BOTH IP/OP","$391.20 ","$289.49 ","$0.00 ","$865.00 ","$389.25 ","$0.00 ","$81.54 ","$0.00 ","$0.00 ","$151.45 ","$865.00 ","$0.00 ","$432.50 ","$685.08 ","$692.00 ","$0.00 ","$135.37 ","$0.00 ","$137.71 ","$0.00 "
"55-04762","SUP","HCPCS C1713","","55-04762  -  PLATE BONE 100D LEFT 5MM L 5 HOLE MALBLE TITANIUM MIDFAC 1.7","BOTH IP/OP","$402.00 ","$297.48 ","$0.00 ","$890.00 ","$400.50 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$155.83 ","$890.00 ","$0.00 ","$445.00 ","$704.88 ","$712.00 ","$0.00 ","$139.29 ","$0.00 ","$141.69 ","$0.00 "
"55-04763","SUP","HCPCS C1713","","55-04763  -  PLATE BONE 100D 5MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED","BOTH IP/OP","$402.00 ","$297.48 ","$0.00 ","$890.00 ","$400.50 ","$0.00 ","$83.79 ","$0.00 ","$0.00 ","$155.83 ","$890.00 ","$0.00 ","$445.00 ","$704.88 ","$712.00 ","$0.00 ","$139.29 ","$0.00 ","$141.69 ","$0.00 "
"55-04764","SUP","HCPCS C1713","","55-04764  -  PLATE BONE 100D 8MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM","BOTH IP/OP","$415.20 ","$307.25 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$86.54 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"55-04765","SUP","HCPCS C1713","","55-04765  -  PLATE BONE 100D 8MM L 6 HOLE MALBLE TITANIUM MIDFAC RIGHT","BOTH IP/OP","$415.20 ","$307.25 ","$0.00 ","$917.50 ","$412.88 ","$0.00 ","$86.54 ","$0.00 ","$0.00 ","$160.65 ","$917.50 ","$0.00 ","$458.75 ","$726.66 ","$734.00 ","$0.00 ","$143.59 ","$0.00 ","$146.07 ","$0.00 "
"55-04766","SUP","HCPCS C1713","","55-04766  -  PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM","BOTH IP/OP","$426.00 ","$315.24 ","$0.00 ","$942.50 ","$424.13 ","$0.00 ","$88.79 ","$0.00 ","$0.00 ","$165.02 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$147.50 ","$0.00 ","$150.05 ","$0.00 "
"55-04767","SUP","HCPCS C1713","","55-04767  -  PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM","BOTH IP/OP","$426.00 ","$315.24 ","$0.00 ","$942.50 ","$424.13 ","$0.00 ","$88.79 ","$0.00 ","$0.00 ","$165.02 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$147.50 ","$0.00 ","$150.05 ","$0.00 "
"55-05151","SUP","HCPCS C1713","","55-05151  -  PLATE BONE STANDARD Y 4MMX.6MM 5 HOLE BAR UNIVERSAL 2","BOTH IP/OP","$329.15 ","$243.57 ","$0.00 ","$745.00 ","$335.25 ","$0.00 ","$68.60 ","$0.00 ","$0.00 ","$130.44 ","$745.00 ","$0.00 ","$372.50 ","$590.04 ","$596.00 ","$0.00 ","$116.59 ","$0.00 ","$118.60 ","$0.00 "
"55-05152","SUP","HCPCS C1713","","55-05152  -  PLATE BONE STANDARD Y 8MMX.6MM 5 HOLE BAR UNIVERSAL 2","BOTH IP/OP","$349.63 ","$258.73 ","$0.00 ","$772.50 ","$347.63 ","$0.00 ","$72.87 ","$0.00 ","$0.00 ","$135.26 ","$772.50 ","$0.00 ","$386.25 ","$611.82 ","$618.00 ","$0.00 ","$120.90 ","$0.00 ","$122.98 ","$0.00 "
"55-05164","SUP","HCPCS C1713","","55-05164  -  PLATE BONE UNIVERSAL STANDARD 2Y .6MM 7 HOLE MALBLE TITANIUM","BOTH IP/OP","$877.50 ","$649.35 ","$0.00 ","$877.50 ","$394.88 ","$0.00 ","$182.89 ","$0.00 ","$0.00 ","$153.64 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$137.33 ","$0.00 ","$139.70 ","$0.00 "
"55-05188","SUP","HCPCS C1713","","55-05188  -  PLATE BONE STANDARD CURVE .6MM 6 HOLE BAR UNIVERSAL 2","BOTH IP/OP","$982.50 ","$727.05 ","$0.00 ","$982.50 ","$442.13 ","$0.00 ","$204.78 ","$0.00 ","$0.00 ","$172.03 ","$982.50 ","$0.00 ","$491.25 ","$778.14 ","$786.00 ","$0.00 ","$153.76 ","$0.00 ","$156.41 ","$0.00 "
"55-05716","SUP","HCPCS C1713","","55-05716  -  PLATE BONE 16 HOLE LOCKING TITANIUM MIDFAC 1.7 MM SCREW","BOTH IP/OP","$730.50 ","$540.57 ","$0.00 ","$1,665.00 ","$749.25 ","$0.00 ","$152.25 ","$0.00 ","$0.00 ","$291.53 ","$1,665.00 ","$0.00 ","$832.50 ","$1,318.68 ","$1,332.00 ","$0.00 ","$260.57 ","$0.00 ","$265.07 ","$0.00 "
"55-05731","SUP","HCPCS C1713","","55-05731  -  PLATE BONE 3D .8MM 2X2 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC","BOTH IP/OP","$502.08 ","$371.54 ","$0.00 ","$1,170.00 ","$526.50 ","$0.00 ","$104.64 ","$0.00 ","$0.00 ","$204.86 ","$1,170.00 ","$0.00 ","$585.00 ","$926.64 ","$936.00 ","$0.00 ","$183.11 ","$0.00 ","$186.26 ","$0.00 "
"55-05733","SUP","HCPCS C1713","","55-05733  -  PLATE BONE 2X6 HOLE LOCKING 3D TITANIUM MIDFAC 1.7 MM SCREW","BOTH IP/OP","$1,159.48 ","$858.02 ","$0.00 ","$2,622.50 ","$1,180.13 ","$0.00 ","$241.66 ","$0.00 ","$0.00 ","$459.18 ","$2,622.50 ","$0.00 ","$1,311.25 ","$2,077.02 ","$2,098.00 ","$0.00 ","$410.42 ","$0.00 ","$417.50 ","$0.00 "
"55-05742","SUP","HCPCS C1713","","55-05742  -  PLATE BONE 2Y .8MM 7 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC","BOTH IP/OP","$574.08 ","$424.82 ","$0.00 ","$1,310.00 ","$589.50 ","$0.00 ","$119.65 ","$0.00 ","$0.00 ","$229.37 ","$1,310.00 ","$0.00 ","$655.00 ","$1,037.52 ","$1,048.00 ","$0.00 ","$205.02 ","$0.00 ","$208.55 ","$0.00 "
"55-05751","SUP","HCPCS C1713","","55-05751  -  PLATE BONE Y 4MMX.8MM 5 HOLE LOCK BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$450.88 ","$333.65 ","$0.00 ","$1,032.50 ","$464.63 ","$0.00 ","$93.97 ","$0.00 ","$0.00 ","$180.78 ","$1,032.50 ","$0.00 ","$516.25 ","$817.74 ","$826.00 ","$0.00 ","$161.59 ","$0.00 ","$164.37 ","$0.00 "
"55-05752","SUP","HCPCS C1713","","55-05752  -  PLATE BONE 8MM ADVANCEMENT 8MM 5 HOLE Y LOCKING BAR TITANIUM","BOTH IP/OP","$450.88 ","$333.65 ","$0.00 ","$1,032.50 ","$464.63 ","$0.00 ","$93.97 ","$0.00 ","$0.00 ","$180.78 ","$1,032.50 ","$0.00 ","$516.25 ","$817.74 ","$826.00 ","$0.00 ","$161.59 ","$0.00 ","$164.37 ","$0.00 "
"55-05758","SUP","HCPCS C1713","","55-05758  -  PLATE BONE 8 HOLE CVD LOCKING TITANIUM MIDFAC 1.7 MM SCREW","BOTH IP/OP","$354.80 ","$262.55 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$73.95 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"55-05761","SUP","HCPCS C1713","","55-05761  -  PLATE BONE 2MM ADVANCEMENT 2MMX.8MM 5 HOLE L LOCKING","BOTH IP/OP","$413.55 ","$306.03 ","$0.00 ","$942.50 ","$424.13 ","$0.00 ","$86.19 ","$0.00 ","$0.00 ","$165.02 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$147.50 ","$0.00 ","$150.05 ","$0.00 "
"55-05763","SUP","HCPCS C1713","","55-05763  -  PLATE BONE 5MM ADVANCEMENT L 5MMX.8MM 5 HOLE LOCK TITANIUM","BOTH IP/OP","$439.13 ","$324.96 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$91.52 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"55-05765","SUP","HCPCS C1713","","55-05765  -  PLATE BONE 100D L 8MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2","BOTH IP/OP","$463.73 ","$343.16 ","$0.00 ","$1,055.00 ","$474.75 ","$0.00 ","$96.65 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"55-05767","SUP","HCPCS C1713","","55-05767  -  PLATE BONE 100D L 12MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2","BOTH IP/OP","$474.80 ","$351.35 ","$0.00 ","$1,082.50 ","$487.13 ","$0.00 ","$98.96 ","$0.00 ","$0.00 ","$189.54 ","$1,082.50 ","$0.00 ","$541.25 ","$857.34 ","$866.00 ","$0.00 ","$169.41 ","$0.00 ","$172.33 ","$0.00 "
"55-05779","SUP","HCPCS C1713","","55-05779  -  PLATE BONE Y .8MM 8 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC","BOTH IP/OP","$523.88 ","$387.67 ","$0.00 ","$1,197.50 ","$538.88 ","$0.00 ","$109.19 ","$0.00 ","$0.00 ","$209.67 ","$1,197.50 ","$0.00 ","$598.75 ","$948.42 ","$958.00 ","$0.00 ","$187.41 ","$0.00 ","$190.64 ","$0.00 "
"55-06208","SUP","HCPCS C1713","","55-06208  -  PLATE BONE STANDARD STR .6MM 8 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$474.75 ","$0.00 ","$219.89 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"55-06224","SUP","HCPCS C1713","","55-06224  -  PLATE BONE STANDARD STR .6MM 24 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$883.38 ","$653.70 ","$0.00 ","$1,970.00 ","$886.50 ","$0.00 ","$184.12 ","$0.00 ","$0.00 ","$344.93 ","$1,970.00 ","$0.00 ","$985.00 ","$1,560.24 ","$1,576.00 ","$0.00 ","$308.31 ","$0.00 ","$313.62 ","$0.00 "
"55-06231","SUP","HCPCS C1713","","55-06231  -  PLATE BONE STANDARD 3D .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"55-06233","SUP","HCPCS C1713","","55-06233  -  PLATE BONE STANDARD .6MM 6X2 HOLE 3D TITANIUM UPPERFACIAL","BOTH IP/OP","$735.58 ","$544.33 ","$0.00 ","$1,610.00 ","$724.50 ","$0.00 ","$153.31 ","$0.00 ","$0.00 ","$281.90 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$251.97 ","$0.00 ","$256.31 ","$0.00 "
"55-06235","SUP","HCPCS C1713","","55-06235  -  PLATE BONE STANDARD 3D .6MM 6X6 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$1,788.75 ","$1,323.68 ","$0.00 ","$3,890.00 ","$1,750.50 ","$0.00 ","$372.82 ","$0.00 ","$0.00 ","$681.11 ","$3,890.00 ","$0.00 ","$1,945.00 ","$3,080.88 ","$3,112.00 ","$0.00 ","$608.79 ","$0.00 ","$619.29 ","$0.00 "
"55-06237","SUP","HCPCS C1713","","55-06237  -  PLATE BONE 10X10 HOLE 3D TITANIUM UPPERFACIAL 1.2 MM SCREW","BOTH IP/OP","$2,420.00 ","$1,790.80 ","$0.00 ","$5,260.00 ","$2,367.00 ","$0.00 ","$504.39 ","$0.00 ","$0.00 ","$920.98 ","$5,260.00 ","$0.00 ","$2,630.00 ","$4,165.92 ","$4,208.00 ","$0.00 ","$823.19 ","$0.00 ","$837.39 ","$0.00 "
"55-06240","SUP","HCPCS C1713","","55-06240  -  PLATE BONE STANDARD 2Y .6MM 7 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$760.00 ","$342.00 ","$0.00 ","$158.40 ","$0.00 ","$0.00 ","$133.07 ","$760.00 ","$0.00 ","$380.00 ","$601.92 ","$608.00 ","$0.00 ","$118.94 ","$0.00 ","$120.99 ","$0.00 "
"55-06250","SUP","HCPCS C1713","","55-06250  -  PLATE BONE STANDARD CURVE .6MM 10 HOLE LEIBINGER UNIVERSAL 2","BOTH IP/OP","$947.50 ","$701.15 ","$0.00 ","$947.50 ","$426.38 ","$0.00 ","$197.48 ","$0.00 ","$0.00 ","$165.90 ","$947.50 ","$0.00 ","$473.75 ","$750.42 ","$758.00 ","$0.00 ","$148.28 ","$0.00 ","$150.84 ","$0.00 "
"55-06254","SUP","HCPCS C1713","","55-06254  -  PLATE BONE STANDARD CURVE .6MM 4 HOLE LEIBINGER UNIVERSAL 2","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$211.50 ","$0.00 ","$97.96 ","$0.00 ","$0.00 ","$82.29 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$73.56 ","$0.00 ","$74.82 ","$0.00 "
"55-06260","SUP","HCPCS C1713","","55-06260  -  PLATE BONE 90D .6MM 8 HOLE L TITANIUM LEFT UPPERFACIAL 1.2MM","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"55-06261","SUP","HCPCS C1713","","55-06261  -  PLATE BONE 90D STANDARD L .6MM 8 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$331.35 ","$245.20 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$69.06 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"55-06270","SUP","HCPCS C1713","","55-06270  -  PLATE BONE STANDARD T .6MM 7 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$336.65 ","$249.12 ","$0.00 ","$747.50 ","$336.38 ","$0.00 ","$70.17 ","$0.00 ","$0.00 ","$130.88 ","$747.50 ","$0.00 ","$373.75 ","$592.02 ","$598.00 ","$0.00 ","$116.98 ","$0.00 ","$119.00 ","$0.00 "
"55-06310","SUP","HCPCS C1713","","55-06310  -  PLATE BONE MINI 3D SQUARE .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$398.25 ","$294.71 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$83.01 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"55-06312","SUP","HCPCS C1713","","55-06312  -  PLATE BONE MINI 3D RECTANGLE .6MM 2X2 HOLE UNIVERSAL 2","BOTH IP/OP","$398.25 ","$294.71 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$83.01 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"55-06320","SUP","HCPCS C1713","","55-06320  -  PLATE BONE MINI 3D SQUARE .6MM 3X2 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$442.13 ","$327.18 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$92.15 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"55-06370","SUP","HCPCS C1713","","55-06370  -  PLATE BONE STANDARD 14MM BURR HOLE COVER TITANIUM MAXFACL","BOTH IP/OP","$405.25 ","$299.89 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$84.46 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"55-06371","SUP","HCPCS C1713","","55-06371  -  PLATE BONE 20MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2","BOTH IP/OP","$452.18 ","$334.61 ","$0.00 ","$1,005.00 ","$452.25 ","$0.00 ","$94.24 ","$0.00 ","$0.00 ","$175.97 ","$1,005.00 ","$0.00 ","$502.50 ","$795.96 ","$804.00 ","$0.00 ","$157.28 ","$0.00 ","$160.00 ","$0.00 "
"55-06372","SUP","HCPCS C1713","","55-06372  -  PLATE BONE STANDARD 10MM .6MM BURR HOLE COVER UNIVERSAL 2","BOTH IP/OP","$405.25 ","$299.89 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$84.46 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"55-06373","SUP","HCPCS C1713","","55-06373  -  PLATE BONE 14MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2","BOTH IP/OP","$454.05 ","$336.00 ","$0.00 ","$1,005.00 ","$452.25 ","$0.00 ","$94.64 ","$0.00 ","$0.00 ","$175.97 ","$1,005.00 ","$0.00 ","$502.50 ","$795.96 ","$804.00 ","$0.00 ","$157.28 ","$0.00 ","$160.00 ","$0.00 "
"55-06374","SUP","HCPCS C1713","","55-06374  -  PLATE BONE 10MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2","BOTH IP/OP","$454.05 ","$336.00 ","$0.00 ","$1,005.00 ","$452.25 ","$0.00 ","$94.64 ","$0.00 ","$0.00 ","$175.97 ","$1,005.00 ","$0.00 ","$502.50 ","$795.96 ","$804.00 ","$0.00 ","$157.28 ","$0.00 ","$160.00 ","$0.00 "
"55-06375","SUP","HCPCS C1713","","55-06375  -  PLATE BONE STANDARD 7MM BURR HOLE COVER TITANIUM MAXFACL 1.2","BOTH IP/OP","$405.25 ","$299.89 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$84.46 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"55-06376","SUP","HCPCS C1713","","55-06376  -  PLATE BONE 7MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2MM","BOTH IP/OP","$450.88 ","$333.65 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$93.97 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"55-06704","SUP","HCPCS C1713","","55-06704  -  PLATE BONE STANDARD STR .55MM 4 HOLE BAR UNIVERSAL 2","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$222.75 ","$0.00 ","$103.17 ","$0.00 ","$0.00 ","$86.67 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$77.47 ","$0.00 ","$78.80 ","$0.00 "
"55-06708","SUP","HCPCS C1713","","55-06708  -  PLATE BONE STANDARD STR 8 HOLE UNIVERSAL 2 TITANIUM MIDFAC","BOTH IP/OP","$1,090.00 ","$806.60 ","$0.00 ","$1,090.00 ","$490.50 ","$0.00 ","$227.18 ","$0.00 ","$0.00 ","$190.85 ","$1,090.00 ","$0.00 ","$545.00 ","$863.28 ","$872.00 ","$0.00 ","$170.59 ","$0.00 ","$173.53 ","$0.00 "
"55-06724","SUP","HCPCS C1713","","55-06724  -  PLATE BONE STANDARD .6MM 24 HOLE STR TITANIUM MIDFAC 1.7MM","BOTH IP/OP","$2,080.00 ","$1,539.20 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$433.52 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"55-06731","SUP","HCPCS C1713","","55-06731  -  PLATE BONE STANDARD .6MM 2X2 HOLE 3D TITANIUM MIDFAC 1.7MM","BOTH IP/OP","$480.98 ","$355.93 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$100.25 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"55-06733","SUP","HCPCS C1713","","55-06733  -  PLATE BONE STANDARD .6MM 2X6 HOLE 3D TITANIUM MIDFAC 1.7MM","BOTH IP/OP","$1,810.00 ","$1,339.40 ","$0.00 ","$1,810.00 ","$814.50 ","$0.00 ","$377.25 ","$0.00 ","$0.00 ","$316.92 ","$1,810.00 ","$0.00 ","$905.00 ","$1,433.52 ","$1,448.00 ","$0.00 ","$283.27 ","$0.00 ","$288.15 ","$0.00 "
"55-06750","SUP","HCPCS C1713","","55-06750  -  PLATE BONE STANDARD CURVE .6MM 10 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$239.69 ","$0.00 ","$0.00 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"55-06754","SUP","HCPCS C1713","","55-06754  -  PLATE BONE STANDARD 4 HOLE CVD BAR TITANIUM MIDFAC 1.7MM","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$274.50 ","$0.00 ","$127.14 ","$0.00 ","$0.00 ","$106.81 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$95.47 ","$0.00 ","$97.11 ","$0.00 "
"55-06760","SUP","HCPCS C1713","","55-06760  -  PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM","BOTH IP/OP","$349.60 ","$258.70 ","$0.00 ","$795.00 ","$357.75 ","$0.00 ","$72.87 ","$0.00 ","$0.00 ","$139.20 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$124.42 ","$0.00 ","$126.56 ","$0.00 "
"55-06761","SUP","HCPCS C1713","","55-06761  -  PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM","BOTH IP/OP","$349.60 ","$258.70 ","$0.00 ","$795.00 ","$357.75 ","$0.00 ","$72.87 ","$0.00 ","$0.00 ","$139.20 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$124.42 ","$0.00 ","$126.56 ","$0.00 "
"55-06762","SUP","HCPCS C1713","","55-06762  -  PLATE BONE 100D 5 HOLE L TITANIUM LEFT MIDFAC","BOTH IP/OP","$361.10 ","$267.21 ","$0.00 ","$822.50 ","$370.13 ","$0.00 ","$75.26 ","$0.00 ","$0.00 ","$144.01 ","$822.50 ","$0.00 ","$411.25 ","$651.42 ","$658.00 ","$0.00 ","$128.72 ","$0.00 ","$130.94 ","$0.00 "
"55-06763","SUP","HCPCS C1713","","55-06763  -  PLATE BONE 100D STANDARD 5MM 5 HOLE L BAR TITANIUM RIGHT","BOTH IP/OP","$361.10 ","$267.21 ","$0.00 ","$822.50 ","$370.13 ","$0.00 ","$75.26 ","$0.00 ","$0.00 ","$144.01 ","$822.50 ","$0.00 ","$411.25 ","$651.42 ","$658.00 ","$0.00 ","$128.72 ","$0.00 ","$130.94 ","$0.00 "
"55-06764","SUP","HCPCS C1713","","55-06764  -  PLATE BONE 100D 6 HOLE L TITANIUM LEFT MIDFAC 1.7MM SCREW","BOTH IP/OP","$384.10 ","$284.23 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$80.06 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"55-06765","SUP","HCPCS C1713","","55-06765  -  PLATE BONE 100D 8MM 6 HOLE L TITANIUM RIGHT MAXFACL 1.7MM","BOTH IP/OP","$384.10 ","$284.23 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$80.06 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"55-06766","SUP","HCPCS C1713","","55-06766  -  PLATE BONE 100D STANDARD 12MM ADVANCEMENT 12MM 6 HOLE LEFT L","BOTH IP/OP","$392.15 ","$290.19 ","$0.00 ","$920.00 ","$414.00 ","$0.00 ","$81.73 ","$0.00 ","$0.00 ","$161.08 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$143.98 ","$0.00 ","$146.46 ","$0.00 "
"55-06767","SUP","HCPCS C1713","","55-06767  -  PLATE BONE 100D STANDARD 12MM BAR L .6MM 6 HOLE LEIBINGER","BOTH IP/OP","$392.15 ","$290.19 ","$0.00 ","$920.00 ","$414.00 ","$0.00 ","$81.73 ","$0.00 ","$0.00 ","$161.08 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$143.98 ","$0.00 ","$146.46 ","$0.00 "
"55-06771","SUP","HCPCS C1713","","55-06771  -  PLATE BONE STANDARD T 5 HOLE T TITANIUM MIDFAC 1.7MM SCREWS","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$695.00 ","$312.75 ","$0.00 ","$61.12 ","$0.00 ","$0.00 ","$121.69 ","$695.00 ","$0.00 ","$347.50 ","$550.44 ","$556.00 ","$0.00 ","$108.77 ","$0.00 ","$110.64 ","$0.00 "
"55-07760","SUP","HCPCS C1713","","55-07760  -  PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT","BOTH IP/OP","$382.30 ","$282.90 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$79.68 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"55-07761","SUP","HCPCS C1713","","55-07761  -  PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT","BOTH IP/OP","$382.30 ","$282.90 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$79.68 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"55-07762","SUP","HCPCS C1713","","55-07762  -  PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$887.50 ","$399.38 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$155.39 ","$887.50 ","$0.00 ","$443.75 ","$702.90 ","$710.00 ","$0.00 ","$138.89 ","$0.00 ","$141.29 ","$0.00 "
"55-07763","SUP","HCPCS C1713","","55-07763  -  PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$887.50 ","$399.38 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$155.39 ","$887.50 ","$0.00 ","$443.75 ","$702.90 ","$710.00 ","$0.00 ","$138.89 ","$0.00 ","$141.29 ","$0.00 "
"55-07764","SUP","HCPCS C1713","","55-07764  -  PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM LEFT","BOTH IP/OP","$409.73 ","$303.20 ","$0.00 ","$920.00 ","$414.00 ","$0.00 ","$85.40 ","$0.00 ","$0.00 ","$161.08 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$143.98 ","$0.00 ","$146.46 ","$0.00 "
"55-07765","SUP","HCPCS C1713","","55-07765  -  PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM RIGHT","BOTH IP/OP","$409.73 ","$303.20 ","$0.00 ","$920.00 ","$414.00 ","$0.00 ","$85.40 ","$0.00 ","$0.00 ","$161.08 ","$920.00 ","$0.00 ","$460.00 ","$728.64 ","$736.00 ","$0.00 ","$143.98 ","$0.00 ","$146.46 ","$0.00 "
"55-07766","SUP","HCPCS C1713","","55-07766  -  PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"55-07767","SUP","HCPCS C1713","","55-07767  -  PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"55-08203","SUP","HCPCS C1713","","55-08203  -  PLATE BONE MINI STR 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$742.50 ","$334.13 ","$0.00 ","$64.22 ","$0.00 ","$0.00 ","$130.01 ","$742.50 ","$0.00 ","$371.25 ","$588.06 ","$594.00 ","$0.00 ","$116.20 ","$0.00 ","$118.21 ","$0.00 "
"55-08204","SUP","HCPCS C1713","","55-08204  -  PLATE BONE MINI REGULAR STR 1MM 4 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$255.38 ","$188.98 ","$0.00 ","$635.00 ","$285.75 ","$0.00 ","$53.23 ","$0.00 ","$0.00 ","$111.18 ","$635.00 ","$0.00 ","$317.50 ","$502.92 ","$508.00 ","$0.00 ","$99.38 ","$0.00 ","$101.09 ","$0.00 "
"55-08205","SUP","HCPCS C1713","","55-08205  -  PLATE BONE MINI STR 8MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$742.50 ","$334.13 ","$0.00 ","$64.22 ","$0.00 ","$0.00 ","$130.01 ","$742.50 ","$0.00 ","$371.25 ","$588.06 ","$594.00 ","$0.00 ","$116.20 ","$0.00 ","$118.21 ","$0.00 "
"55-08206","SUP","HCPCS C1713","","55-08206  -  PLATE BONE MINI STR 6 HOLE STR TITANIUM LEFT","BOTH IP/OP","$465.68 ","$344.60 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$97.06 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"55-08216","SUP","HCPCS C1713","","55-08216  -  PLATE BONE MINI REGULAR STR 1MM 16 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$905.70 ","$670.22 ","$0.00 ","$2,080.00 ","$936.00 ","$0.00 ","$188.77 ","$0.00 ","$0.00 ","$364.19 ","$2,080.00 ","$0.00 ","$1,040.00 ","$1,647.36 ","$1,664.00 ","$0.00 ","$325.52 ","$0.00 ","$331.14 ","$0.00 "
"55-08230","SUP","HCPCS C1713","","55-08230  -  PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$382.13 ","$282.78 ","$0.00 ","$877.50 ","$394.88 ","$0.00 ","$79.64 ","$0.00 ","$0.00 ","$153.64 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$137.33 ","$0.00 ","$139.70 ","$0.00 "
"55-08231","SUP","HCPCS C1713","","55-08231  -  PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$382.13 ","$282.78 ","$0.00 ","$877.50 ","$394.88 ","$0.00 ","$79.64 ","$0.00 ","$0.00 ","$153.64 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$137.33 ","$0.00 ","$139.70 ","$0.00 "
"55-08232","SUP","HCPCS C1713","","55-08232  -  PLATE BONE 8MM 4 HOLE L BAR TITANIUM RIGHT","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$922.50 ","$415.13 ","$0.00 ","$81.49 ","$0.00 ","$0.00 ","$161.52 ","$922.50 ","$0.00 ","$461.25 ","$730.62 ","$738.00 ","$0.00 ","$144.37 ","$0.00 ","$146.86 ","$0.00 "
"55-08233","SUP","HCPCS C1713","","55-08233  -  PLATE BONE 8MM 4 HOLE L BAR TITANIUM LEFT","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$922.50 ","$415.13 ","$0.00 ","$81.49 ","$0.00 ","$0.00 ","$161.52 ","$922.50 ","$0.00 ","$461.25 ","$730.62 ","$738.00 ","$0.00 ","$144.37 ","$0.00 ","$146.86 ","$0.00 "
"55-08234","SUP","HCPCS C1713","","55-08234  -  PLATE BONE MINI L 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$406.90 ","$301.11 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$84.81 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"55-08235","SUP","HCPCS C1713","","55-08235  -  PLATE BONE 4MM 4 HOLE L BAR TITANIUM LEFT","BOTH IP/OP","$406.90 ","$301.11 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$84.81 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"55-08236","SUP","HCPCS C1713","","55-08236  -  PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$421.83 ","$312.15 ","$0.00 ","$1,002.50 ","$451.13 ","$0.00 ","$87.92 ","$0.00 ","$0.00 ","$175.53 ","$1,002.50 ","$0.00 ","$501.25 ","$793.98 ","$802.00 ","$0.00 ","$156.89 ","$0.00 ","$159.60 ","$0.00 "
"55-08237","SUP","HCPCS C1713","","55-08237  -  PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$421.83 ","$312.15 ","$0.00 ","$1,002.50 ","$451.13 ","$0.00 ","$87.92 ","$0.00 ","$0.00 ","$175.53 ","$1,002.50 ","$0.00 ","$501.25 ","$793.98 ","$802.00 ","$0.00 ","$156.89 ","$0.00 ","$159.60 ","$0.00 "
"55-08240","SUP","HCPCS C1713","","55-08240  -  PLATE BONE MINI REGULAR T 1MM 6 HOLE UNIVERSAL 2 TITANIUM","BOTH IP/OP","$319.73 ","$236.60 ","$0.00 ","$715.00 ","$321.75 ","$0.00 ","$66.64 ","$0.00 ","$0.00 ","$125.19 ","$715.00 ","$0.00 ","$357.50 ","$566.28 ","$572.00 ","$0.00 ","$111.90 ","$0.00 ","$113.83 ","$0.00 "
"55-08250","SUP","HCPCS C1713","","55-08250  -  PLATE BONE MINI 5 HOLE Y W/O BAR TITANIUM MAXFACL","BOTH IP/OP","$364.98 ","$270.09 ","$0.00 ","$845.00 ","$380.25 ","$0.00 ","$76.07 ","$0.00 ","$0.00 ","$147.95 ","$845.00 ","$0.00 ","$422.50 ","$669.24 ","$676.00 ","$0.00 ","$132.24 ","$0.00 ","$134.52 ","$0.00 "
"55-08251","SUP","HCPCS C1713","","55-08251  -  PLATE BONE MINI Y 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$364.98 ","$270.09 ","$0.00 ","$845.00 ","$380.25 ","$0.00 ","$76.07 ","$0.00 ","$0.00 ","$147.95 ","$845.00 ","$0.00 ","$422.50 ","$669.24 ","$676.00 ","$0.00 ","$132.24 ","$0.00 ","$134.52 ","$0.00 "
"55-08260","SUP","HCPCS C1713","","55-08260  -  PLATE BONE 2Y 6 HOLE TITANIUM MAXFACL 2MM SCREW","BOTH IP/OP","$397.25 ","$293.97 ","$0.00 ","$942.50 ","$424.13 ","$0.00 ","$82.80 ","$0.00 ","$0.00 ","$165.02 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$147.50 ","$0.00 ","$150.05 ","$0.00 "
"55-08262","SUP","HCPCS C1713","","55-08262  -  PLATE BONE MINI 2Y 8MMX1MM 6 HOLE BAR UNIVERSAL 2 TITANIUM","BOTH IP/OP","$397.25 ","$293.97 ","$0.00 ","$942.50 ","$424.13 ","$0.00 ","$82.80 ","$0.00 ","$0.00 ","$165.02 ","$942.50 ","$0.00 ","$471.25 ","$746.46 ","$754.00 ","$0.00 ","$147.50 ","$0.00 ","$150.05 ","$0.00 "
"55-08510","SUP","HCPCS C1713","","55-08510  -  PLATE BONE .75MM 30 HOLE STR LP TITANIUM MAXFACL","BOTH IP/OP","$1,029.93 ","$762.15 ","$0.00 ","$2,352.50 ","$1,058.63 ","$0.00 ","$214.66 ","$0.00 ","$0.00 ","$411.90 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$368.17 ","$0.00 ","$374.52 ","$0.00 "
"55-08520","SUP","HCPCS C1713","","55-08520  -  PLATE BONE 100D L .75MM 9 HOLE LP RIGHT ANGLED TITANIUM","BOTH IP/OP","$488.65 ","$361.60 ","$0.00 ","$1,117.50 ","$502.88 ","$0.00 ","$101.85 ","$0.00 ","$0.00 ","$195.67 ","$1,117.50 ","$0.00 ","$558.75 ","$885.06 ","$894.00 ","$0.00 ","$174.89 ","$0.00 ","$177.91 ","$0.00 "
"55-08521","SUP","HCPCS C1713","","55-08521  -  PLATE BONE 100D L .75MM 9 HOLE LP LEFT ANGLED TITANIUM","BOTH IP/OP","$488.65 ","$361.60 ","$0.00 ","$1,117.50 ","$502.88 ","$0.00 ","$101.85 ","$0.00 ","$0.00 ","$195.67 ","$1,117.50 ","$0.00 ","$558.75 ","$885.06 ","$894.00 ","$0.00 ","$174.89 ","$0.00 ","$177.91 ","$0.00 "
"55-08542","SUP","HCPCS C1713","","55-08542  -  PLATE BONE .75MM 8 HOLE T LP TITANIUM MAXFACL","BOTH IP/OP","$480.75 ","$355.76 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$100.20 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"55-08579","SUP","HCPCS C1713","","55-08579  -  PLATE BONE .75MM 8 HOLE Y TITANIUM MAXFACL","BOTH IP/OP","$480.75 ","$355.76 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$100.20 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"55-08586","SUP","HCPCS C1713","","55-08586  -  PLATE BONE CURVE .75MM 12 HOLE LP TITANIUM MAXFACL","BOTH IP/OP","$488.65 ","$361.60 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$101.85 ","$0.00 ","$0.00 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"55-09104","SUP","HCPCS C1713","","55-09104  -  PLATE BONE 4MM BAR TITANIUM CHIN 2MM SCREW","BOTH IP/OP","$480.75 ","$355.76 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$100.20 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"55-09106","SUP","HCPCS C1713","","55-09106  -  PLATE BONE 6MM BAR TITANIUM CHIN","BOTH IP/OP","$488.65 ","$361.60 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$101.85 ","$0.00 ","$0.00 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"55-09108","SUP","HCPCS C1713","","55-09108  -  PLATE BONE 8MM BAR TITANIUM CHIN 2MM SCREW","BOTH IP/OP","$527.33 ","$390.22 ","$0.00 ","$1,210.00 ","$544.50 ","$0.00 ","$109.91 ","$0.00 ","$0.00 ","$211.86 ","$1,210.00 ","$0.00 ","$605.00 ","$958.32 ","$968.00 ","$0.00 ","$189.37 ","$0.00 ","$192.63 ","$0.00 "
"55-09110","SUP","HCPCS C1713","","55-09110  -  PLATE BONE 10MM BAR TITANIUM CHIN 2MM SCREW","BOTH IP/OP","$550.78 ","$407.58 ","$0.00 ","$1,240.00 ","$558.00 ","$0.00 ","$114.80 ","$0.00 ","$0.00 ","$217.11 ","$1,240.00 ","$0.00 ","$620.00 ","$982.08 ","$992.00 ","$0.00 ","$194.06 ","$0.00 ","$197.41 ","$0.00 "
"55-10503","SUP","HCPCS C1713","","55-10503  -  PLATE BONE LONG 4 HOLE LOCKING STR BAR TITANIUM MANDIB 2MM","BOTH IP/OP","$595.00 ","$440.30 ","$0.00 ","$595.00 ","$267.75 ","$0.00 ","$124.01 ","$0.00 ","$0.00 ","$104.18 ","$595.00 ","$0.00 ","$297.50 ","$471.24 ","$476.00 ","$0.00 ","$93.12 ","$0.00 ","$94.72 ","$0.00 "
"55-10504","SUP","HCPCS C1713","","55-10504  -  PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL TI","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"55-10505","SUP","HCPCS C1713","","55-10505  -  PLATE BN MN STRG 4MMX1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL","BOTH IP/OP","$452.50 ","$334.85 ","$0.00 ","$452.50 ","$203.63 ","$0.00 ","$94.31 ","$0.00 ","$0.00 ","$79.23 ","$452.50 ","$0.00 ","$226.25 ","$358.38 ","$362.00 ","$0.00 ","$70.82 ","$0.00 ","$72.04 ","$0.00 "
"55-10506","SUP","HCPCS C1713","","55-10506  -  PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL TI","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"55-10507","SUP","HCPCS C1713","","55-10507  -  PLATE BN MN STRG 8MMX1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"55-10515","SUP","HCPCS C1713","","55-10515  -  PLATE BONE MINI 8MM 16 HOLE STR CONDENSED TITANIUM MANDIB 2","BOTH IP/OP","$755.75 ","$559.26 ","$0.00 ","$1,802.50 ","$811.13 ","$0.00 ","$157.52 ","$0.00 ","$0.00 ","$315.60 ","$1,802.50 ","$0.00 ","$901.25 ","$1,427.58 ","$1,442.00 ","$0.00 ","$282.09 ","$0.00 ","$286.96 ","$0.00 "
"55-10516","SUP","HCPCS C1713","","55-10516  -  PLATE BONE STR MINI 16 HOLE LOCK TITANIUM MAXFACL 2/2.3MM","BOTH IP/OP","$302.88 ","$224.13 ","$0.00 ","$707.50 ","$318.38 ","$0.00 ","$63.13 ","$0.00 ","$0.00 ","$123.88 ","$707.50 ","$0.00 ","$353.75 ","$560.34 ","$566.00 ","$0.00 ","$110.72 ","$0.00 ","$112.63 ","$0.00 "
"55-10532","SUP","HCPCS C1713","","55-10532  -  PLATE BONE MINI RECTANGLE 3X2 HOLE RECTANGULAR 3D TITANIUM","BOTH IP/OP","$612.18 ","$453.01 ","$0.00 ","$1,385.00 ","$623.25 ","$0.00 ","$127.59 ","$0.00 ","$0.00 ","$242.50 ","$1,385.00 ","$0.00 ","$692.50 ","$1,096.92 ","$1,108.00 ","$0.00 ","$216.75 ","$0.00 ","$220.49 ","$0.00 "
"55-10542","SUP","HCPCS C1713","","55-10542  -  PLATE BONE 4X2 HOLE 3D LOCKING TITANIUM MAXFACL 2/2.3 MM","BOTH IP/OP","$688.55 ","$509.53 ","$0.00 ","$1,600.00 ","$720.00 ","$0.00 ","$143.51 ","$0.00 ","$0.00 ","$280.15 ","$1,600.00 ","$0.00 ","$800.00 ","$1,267.20 ","$1,280.00 ","$0.00 ","$250.40 ","$0.00 ","$254.72 ","$0.00 "
"55-10562","SUP","HCPCS C1713","","55-10562  -  PLATE BONE MINI CVD 6X2 HOLE 3D LOCKING CVD TITANIUM MAXFACL","BOTH IP/OP","$769.63 ","$569.53 ","$0.00 ","$1,742.50 ","$784.13 ","$0.00 ","$160.41 ","$0.00 ","$0.00 ","$305.10 ","$1,742.50 ","$0.00 ","$871.25 ","$1,380.06 ","$1,394.00 ","$0.00 ","$272.70 ","$0.00 ","$277.41 ","$0.00 "
"55-10563","SUP","HCPCS C1713","","55-10563  -  PLATE BONE MINI 4 HOLE REINFORCED BAR TITANIUM MANDIB 2/2.3","BOTH IP/OP","$709.10 ","$524.73 ","$0.00 ","$1,627.50 ","$732.38 ","$0.00 ","$147.79 ","$0.00 ","$0.00 ","$284.96 ","$1,627.50 ","$0.00 ","$813.75 ","$1,288.98 ","$1,302.00 ","$0.00 ","$254.70 ","$0.00 ","$259.10 ","$0.00 "
"5510-F-101","SUP","HCPCS C1776","","5510-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-102","SUP","HCPCS C1776","","5510-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-201","SUP","HCPCS C1776","","5510-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-202","SUP","HCPCS C1776","","5510-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-301","SUP","HCPCS C1776","","5510-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-302","SUP","HCPCS C1776","","5510-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-401","SUP","HCPCS C1776","","5510-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-402","SUP","HCPCS C1776","","5510-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-501","SUP","HCPCS C1776","","5510-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-502","SUP","HCPCS C1776","","5510-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-601","SUP","HCPCS C1776","","5510-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-602","SUP","HCPCS C1776","","5510-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-701","SUP","HCPCS C1776","","5510-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-702","SUP","HCPCS C1776","","5510-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-801","SUP","HCPCS C1776","","5510-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5510-F-802","SUP","HCPCS C1776","","5510-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5512-F-101","SUP","HCPCS C1776","","5512-F-101  -  COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-102","SUP","HCPCS C1776","","5512-F-102  -  COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-201","SUP","HCPCS C1776","","5512-F-201  -  COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-202","SUP","HCPCS C1776","","5512-F-202  -  COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-301","SUP","HCPCS C1776","","5512-F-301  -  COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-302","SUP","HCPCS C1776","","5512-F-302  -  COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-401","SUP","HCPCS C1776","","5512-F-401  -  COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-402","SUP","HCPCS C1776","","5512-F-402  -  COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-501","SUP","HCPCS C1776","","5512-F-501  -  COMPONENT FEMORAL 5 TOT STABILIZE TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-502","SUP","HCPCS C1776","","5512-F-502  -  COMPONENT FEMORAL 5 TOT STABILIZER TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-601","SUP","HCPCS C1776","","5512-F-601  -  COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-602","SUP","HCPCS C1776","","5512-F-602  -  COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-701","SUP","HCPCS C1776","","5512-F-701  -  COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-702","SUP","HCPCS C1776","","5512-F-702  -  COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-801","SUP","HCPCS C1776","","5512-F-801  -  COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE LEFT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5512-F-802","SUP","HCPCS C1776","","5512-F-802  -  COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE RIGHT","BOTH IP/OP","$13,967.50 ","$10,335.95 ","$0.00 ","$13,967.50 ","$6,285.38 ","$0.00 ","$2,911.18 ","$0.00 ","$0.00 ","$2,445.60 ","$13,967.50 ","$0.00 ","$6,983.75 ","$11,062.26 ","$11,174.00 ","$0.00 ","$2,185.91 ","$0.00 ","$2,223.63 ","$0.00 "
"5513-F-101","SUP","HCPCS C1776","","5513-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-102","SUP","HCPCS C1776","","5513-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-201","SUP","HCPCS C1776","","5513-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-202","SUP","HCPCS C1776","","5513-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-301","SUP","HCPCS C1776","","5513-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-302","SUP","HCPCS C1776","","5513-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-401","SUP","HCPCS C1776","","5513-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-402","SUP","HCPCS C1776","","5513-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-501","SUP","HCPCS C1776","","5513-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-502","SUP","HCPCS C1776","","5513-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-601","SUP","HCPCS C1776","","5513-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-602","SUP","HCPCS C1776","","5513-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-701","SUP","HCPCS C1776","","5513-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-702","SUP","HCPCS C1776","","5513-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-801","SUP","HCPCS C1776","","5513-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5513-F-802","SUP","HCPCS C1776","","5513-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-101","SUP","HCPCS C1776","","5514-F-101  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-102","SUP","HCPCS C1776","","5514-F-102  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-201","SUP","HCPCS C1776","","5514-F-201  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-202","SUP","HCPCS C1776","","5514-F-202  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-301","SUP","HCPCS C1776","","5514-F-301  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-302","SUP","HCPCS C1776","","5514-F-302  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-401","SUP","HCPCS C1776","","5514-F-401  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-402","SUP","HCPCS C1776","","5514-F-402  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-501","SUP","HCPCS C1776","","5514-F-501  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-502","SUP","HCPCS C1776","","5514-F-502  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-601","SUP","HCPCS C1776","","5514-F-601  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-602","SUP","HCPCS C1776","","5514-F-602  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-701","SUP","HCPCS C1776","","5514-F-701  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-702","SUP","HCPCS C1776","","5514-F-702  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-801","SUP","HCPCS C1776","","5514-F-801  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5514-F-802","SUP","HCPCS C1776","","5514-F-802  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"55-15504","SUP","HCPCS C1713","","55-15504  -  PLATE BONE STR MINI 1.5MM 4 HOLE TITANIUM MAXFACL 2.3MM","BOTH IP/OP","$1,600.00 ","$1,184.00 ","$0.00 ","$1,600.00 ","$720.00 ","$0.00 ","$333.48 ","$0.00 ","$0.00 ","$280.15 ","$1,600.00 ","$0.00 ","$800.00 ","$1,267.20 ","$1,280.00 ","$0.00 ","$250.40 ","$0.00 ","$254.72 ","$0.00 "
"55-15505","SUP","HCPCS C1713","","55-15505  -  PLATE BONE 4 HOLE BAR LOCKING TITANIUM MAXFACL","BOTH IP/OP","$1,610.00 ","$1,191.40 ","$0.00 ","$1,610.00 ","$724.50 ","$0.00 ","$335.56 ","$0.00 ","$0.00 ","$281.90 ","$1,610.00 ","$0.00 ","$805.00 ","$1,275.12 ","$1,288.00 ","$0.00 ","$251.97 ","$0.00 ","$256.31 ","$0.00 "
"55-15506","SUP","HCPCS C1713","","55-15506  -  PLATE BONE 6 HOLE LOCKING TITANIUM MANDIB 2 MM SCREW","BOTH IP/OP","$1,887.50 ","$1,396.75 ","$0.00 ","$1,887.50 ","$849.38 ","$0.00 ","$393.40 ","$0.00 ","$0.00 ","$330.49 ","$1,887.50 ","$0.00 ","$943.75 ","$1,494.90 ","$1,510.00 ","$0.00 ","$295.39 ","$0.00 ","$300.49 ","$0.00 "
"55-15507","SUP","HCPCS C1713","","55-15507  -  PLATE BONE 6 HOLE BAR TITANIUM MANDIB 2.3/2.7 MM SCREW","BOTH IP/OP","$2,045.00 ","$1,513.30 ","$0.00 ","$2,045.00 ","$920.25 ","$0.00 ","$426.23 ","$0.00 ","$0.00 ","$358.06 ","$2,045.00 ","$0.00 ","$1,022.50 ","$1,619.64 ","$1,636.00 ","$0.00 ","$320.04 ","$0.00 ","$325.56 ","$0.00 "
"55-15514","SUP","HCPCS C1713","","55-15514  -  PLATE BONE 14 HOLE LOCKING TITANIUM MAXFACL 2.3/2.7 MM SCREW","BOTH IP/OP","$1,270.23 ","$939.97 ","$0.00 ","$3,010.00 ","$1,354.50 ","$0.00 ","$264.75 ","$0.00 ","$0.00 ","$527.03 ","$3,010.00 ","$0.00 ","$1,505.00 ","$2,383.92 ","$2,408.00 ","$0.00 ","$471.07 ","$0.00 ","$479.19 ","$0.00 "
"55-15524","SUP","HCPCS C1713","","55-15524  -  PLATE BONE 4 HOLE TITANIUM MAXFACL","BOTH IP/OP","$1,710.00 ","$1,265.40 ","$0.00 ","$1,710.00 ","$769.50 ","$0.00 ","$356.41 ","$0.00 ","$0.00 ","$299.41 ","$1,710.00 ","$0.00 ","$855.00 ","$1,354.32 ","$1,368.00 ","$0.00 ","$267.62 ","$0.00 ","$272.23 ","$0.00 "
"55-15526","SUP","HCPCS C1713","","55-15526  -  PLATE BONE 115D 1.5MM 4 HOLE ANGLED TITANIUM MANDIB 2MM","BOTH IP/OP","$2,840.00 ","$2,101.60 ","$0.00 ","$2,840.00 ","$1,278.00 ","$0.00 ","$591.93 ","$0.00 ","$0.00 ","$497.26 ","$2,840.00 ","$0.00 ","$1,420.00 ","$2,249.28 ","$2,272.00 ","$0.00 ","$444.46 ","$0.00 ","$452.13 ","$0.00 "
"55-15536","SUP","HCPCS C1713","","55-15536  -  PLATE BN 140D 1.5MM NS LEIBINGER UNV 2 6 HL BAR TI MNDB","BOTH IP/OP","$2,820.00 ","$2,086.80 ","$0.00 ","$2,820.00 ","$1,269.00 ","$0.00 ","$587.76 ","$0.00 ","$0.00 ","$493.76 ","$2,820.00 ","$0.00 ","$1,410.00 ","$2,233.44 ","$2,256.00 ","$0.00 ","$441.33 ","$0.00 ","$448.94 ","$0.00 "
"55-15570","SUP","HCPCS C1713","","55-15570  -  PLATE BONE UNIVERSAL 1.5MM 4 HOLE COMPRESSION TITANIUM","BOTH IP/OP","$586.33 ","$433.88 ","$0.00 ","$1,325.00 ","$596.25 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"55-15575","SUP","HCPCS C1713","","55-15575  -  PLATE BONE 4 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS","BOTH IP/OP","$586.33 ","$433.88 ","$0.00 ","$1,325.00 ","$596.25 ","$0.00 ","$122.20 ","$0.00 ","$0.00 ","$232.00 ","$1,325.00 ","$0.00 ","$662.50 ","$1,049.40 ","$1,060.00 ","$0.00 ","$207.36 ","$0.00 ","$210.94 ","$0.00 "
"55-15580","SUP","HCPCS C1713","","55-15580  -  PLATE BONE STR 6 HOLE COMPRESSION TITANIUM MAXFACL 2MM SCREW","BOTH IP/OP","$893.03 ","$660.84 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$186.13 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"55-15585","SUP","HCPCS C1713","","55-15585  -  PLATE BONE 6 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS","BOTH IP/OP","$893.03 ","$660.84 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$186.13 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"55-15911","SUP","HCPCS C1713","","55-15911  -  PLATE BONE STR 11 HOLE PRIM RECONSTRUCTION TITANIUM MANDIB","BOTH IP/OP","$1,365.68 ","$1,010.60 ","$0.00 ","$3,082.50 ","$1,387.13 ","$0.00 ","$284.64 ","$0.00 ","$0.00 ","$539.72 ","$3,082.50 ","$0.00 ","$1,541.25 ","$2,441.34 ","$2,466.00 ","$0.00 ","$482.41 ","$0.00 ","$490.73 ","$0.00 "
"55-15917","SUP","HCPCS C1713","","55-15917  -  PLATE BONE STR 17 HOLE PRIM RECONSTRUCTION TEMPLATE TITANIUM","BOTH IP/OP","$1,735.33 ","$1,284.14 ","$0.00 ","$3,912.50 ","$1,760.63 ","$0.00 ","$361.69 ","$0.00 ","$0.00 ","$685.05 ","$3,912.50 ","$0.00 ","$1,956.25 ","$3,098.70 ","$3,130.00 ","$0.00 ","$612.31 ","$0.00 ","$622.87 ","$0.00 "
"55-15920","SUP","HCPCS C1713","","55-15920  -  PLATE BN HMSPHR 1.5MM AU SMRT LCK LEIBINGER UNV 2 5X17 HL TI","BOTH IP/OP","$2,445.23 ","$1,809.47 ","$0.00 ","$5,305.00 ","$2,387.25 ","$0.00 ","$509.65 ","$0.00 ","$0.00 ","$928.86 ","$5,305.00 ","$0.00 ","$2,652.50 ","$4,201.56 ","$4,244.00 ","$0.00 ","$830.23 ","$0.00 ","$844.56 ","$0.00 "
"55-15922","SUP","HCPCS C1713","","55-15922  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 5X17 HL TI","BOTH IP/OP","$2,445.23 ","$1,809.47 ","$0.00 ","$5,305.00 ","$2,387.25 ","$0.00 ","$509.65 ","$0.00 ","$0.00 ","$928.86 ","$5,305.00 ","$0.00 ","$2,652.50 ","$4,201.56 ","$4,244.00 ","$0.00 ","$830.23 ","$0.00 ","$844.56 ","$0.00 "
"5515-F-101","SUP","HCPCS C1776","","5515-F-101  -  COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-102","SUP","HCPCS C1776","","5515-F-102  -  COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-201","SUP","HCPCS C1776","","5515-F-201  -  COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-202","SUP","HCPCS C1776","","5515-F-202  -  COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-301","SUP","HCPCS C1776","","5515-F-301  -  COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-302","SUP","HCPCS C1776","","5515-F-302  -  COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-401","SUP","HCPCS C1776","","5515-F-401  -  COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-402","SUP","HCPCS C1776","","5515-F-402  -  COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-501","SUP","HCPCS C1776","","5515-F-501  -  COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-502","SUP","HCPCS C1776","","5515-F-502  -  COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-601","SUP","HCPCS C1776","","5515-F-601  -  COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-602","SUP","HCPCS C1776","","5515-F-602  -  COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-701","SUP","HCPCS C1776","","5515-F-701  -  COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-702","SUP","HCPCS C1776","","5515-F-702  -  COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-801","SUP","HCPCS C1776","","5515-F-801  -  COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5515-F-802","SUP","HCPCS C1776","","5515-F-802  -  COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5516-F-101","SUP","HCPCS C1776","","5516-F-101  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-102","SUP","HCPCS C1776","","5516-F-102  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-201","SUP","HCPCS C1776","","5516-F-201  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-202","SUP","HCPCS C1776","","5516-F-202  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-301","SUP","HCPCS C1776","","5516-F-301  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-302","SUP","HCPCS C1776","","5516-F-302  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-401","SUP","HCPCS C1776","","5516-F-401  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-402","SUP","HCPCS C1776","","5516-F-402  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-501","SUP","HCPCS C1776","","5516-F-501  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-502","SUP","HCPCS C1776","","5516-F-502  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-601","SUP","HCPCS C1776","","5516-F-601  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-602","SUP","HCPCS C1776","","5516-F-602  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-701","SUP","HCPCS C1776","","5516-F-701  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-702","SUP","HCPCS C1776","","5516-F-702  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-801","SUP","HCPCS C1776","","5516-F-801  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5516-F-802","SUP","HCPCS C1776","","5516-F-802  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-101","SUP","HCPCS C1776","","5517-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-102","SUP","HCPCS C1776","","5517-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-201","SUP","HCPCS C1776","","5517-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-202","SUP","HCPCS C1776","","5517-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-301","SUP","HCPCS C1776","","5517-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-302","SUP","HCPCS C1776","","5517-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-401","SUP","HCPCS C1776","","5517-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-402","SUP","HCPCS C1776","","5517-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-501","SUP","HCPCS C1776","","5517-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-502","SUP","HCPCS C1776","","5517-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-601","SUP","HCPCS C1776","","5517-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-602","SUP","HCPCS C1776","","5517-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-701","SUP","HCPCS C1776","","5517-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-702","SUP","HCPCS C1776","","5517-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-801","SUP","HCPCS C1776","","5517-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5517-F-802","SUP","HCPCS C1776","","5517-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"5520-B-100","SUP","HCPCS C1776","","5520-B-100  -  BASEPLATE TIBIAL 1 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-200","SUP","HCPCS C1776","","5520-B-200  -  BASEPLATE TIBIAL 2 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-300","SUP","HCPCS C1776","","5520-B-300  -  BASEPLATE TIB 3 TRTHLN PRM CMNT KN","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-400","SUP","HCPCS C1776","","5520-B-400  -  BASEPLATE TIBIAL 4 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-500","SUP","HCPCS C1776","","5520-B-500  -  BASEPLATE TIBIAL 5 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-600","SUP","HCPCS C1776","","5520-B-600  -  BASEPLATE TIBIAL 6 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-700","SUP","HCPCS C1776","","5520-B-700  -  BASEPLATE TIBIAL 7 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-B-800","SUP","HCPCS C1776","","5520-B-800  -  BASEPLATE TIBIAL 8 PRIM CEMENT TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-100","SUP","HCPCS C1776","","5520-M-100  -  BASEPLATE TIBIAL 1 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-200","SUP","HCPCS C1776","","5520-M-200  -  BASEPLATE TIBIAL 2 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-300","SUP","HCPCS C1776","","5520-M-300  -  BASEPLATE TIBIAL 3 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-400","SUP","HCPCS C1776","","5520-M-400  -  BASEPLATE TIBIAL 4 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-500","SUP","HCPCS C1776","","5520-M-500  -  BASEPLATE TIBIAL 5 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-600","SUP","HCPCS C1776","","5520-M-600  -  BASEPLATE TIBIAL 6 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-700","SUP","HCPCS C1776","","5520-M-700  -  BASEPLATE TIBIAL 7 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5520-M-800","SUP","HCPCS C1776","","5520-M-800  -  BASEPLATE TIBIAL 8 LP TRIATHLON KNEE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"5521-B-100","SUP","HCPCS C1776","","5521-B-100  -  BASEPLATE TIB 1 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-200","SUP","HCPCS C1776","","5521-B-200  -  BASEPLATE TIB 2 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-300","SUP","HCPCS C1776","","5521-B-300  -  BASEPLATE TIB 3 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-400","SUP","HCPCS C1776","","5521-B-400  -  BASEPLATE TIB 4 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-500","SUP","HCPCS C1776","","5521-B-500  -  BASEPLATE TIB 5 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-600","SUP","HCPCS C1776","","5521-B-600  -  BASEPLATE TIB 6 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-700","SUP","HCPCS C1776","","5521-B-700  -  BASEPLATE TIB 7 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5521-B-800","SUP","HCPCS C1776","","5521-B-800  -  BASEPLATE TIB 8 UNV TRTHLN COCR KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-100","SUP","HCPCS C1776","","5523-B-100  -  BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-200","SUP","HCPCS C1776","","5523-B-200  -  BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-300","SUP","HCPCS C1776","","5523-B-300  -  BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-400","SUP","HCPCS C1776","","5523-B-400  -  BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-500","SUP","HCPCS C1776","","5523-B-500  -  BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-600","SUP","HCPCS C1776","","5523-B-600  -  BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-700","SUP","HCPCS C1776","","5523-B-700  -  BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5523-B-800","SUP","HCPCS C1776","","5523-B-800  -  BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-100","SUP","HCPCS C1776","","5524-B-100  -  BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-200","SUP","HCPCS C1776","","5524-B-200  -  BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-300","SUP","HCPCS C1776","","5524-B-300  -  BASEPLATE TIBIAL 3 BEAD TRIATHLON VITALLIUM KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-400","SUP","HCPCS C1776","","5524-B-400  -  BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-500","SUP","HCPCS C1776","","5524-B-500  -  BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-600","SUP","HCPCS C1776","","5524-B-600  -  BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-700","SUP","HCPCS C1776","","5524-B-700  -  BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5524-B-800","SUP","HCPCS C1776","","5524-B-800  -  BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON KNEE SCREW FIX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-100","SUP","HCPCS C1776","","5526-B-100  -  BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-200","SUP","HCPCS C1776","","5526-B-200  -  BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-300","SUP","HCPCS C1776","","5526-B-300  -  BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-400","SUP","HCPCS C1776","","5526-B-400  -  BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-500","SUP","HCPCS C1776","","5526-B-500  -  BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-600","SUP","HCPCS C1776","","5526-B-600  -  BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-700","SUP","HCPCS C1776","","5526-B-700  -  BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5526-B-800","SUP","HCPCS C1776","","5526-B-800  -  BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON PERIAPT KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-100","SUP","HCPCS C1776","","5527-B-100  -  BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-200","SUP","HCPCS C1776","","5527-B-200  -  BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-300","SUP","HCPCS C1776","","5527-B-300  -  BASEPLATE TIBIAL 3 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-400","SUP","HCPCS C1776","","5527-B-400  -  BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-500","SUP","HCPCS C1776","","5527-B-500  -  BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-600","SUP","HCPCS C1776","","5527-B-600  -  BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-700","SUP","HCPCS C1776","","5527-B-700  -  BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5527-B-800","SUP","HCPCS C1776","","5527-B-800  -  BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"55-28911","SUP","HCPCS C1713","","55-28911  -  PLATE BONE 11 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL","BOTH IP/OP","$1,609.38 ","$1,190.94 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$335.43 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"55-28917","SUP","HCPCS C1713","","55-28917  -  PLATE BONE 17 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL","BOTH IP/OP","$2,167.63 ","$1,604.05 ","$0.00 ","$5,395.00 ","$2,427.75 ","$0.00 ","$451.79 ","$0.00 ","$0.00 ","$944.62 ","$5,395.00 ","$0.00 ","$2,697.50 ","$4,272.84 ","$4,316.00 ","$0.00 ","$844.32 ","$0.00 ","$858.88 ","$0.00 "
"55-28920","SUP","HCPCS C1713","","55-28920  -  PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE","BOTH IP/OP","$2,724.95 ","$2,016.46 ","$0.00 ","$5,907.50 ","$2,658.38 ","$0.00 ","$567.95 ","$0.00 ","$0.00 ","$1,034.36 ","$5,907.50 ","$0.00 ","$2,953.75 ","$4,678.74 ","$4,726.00 ","$0.00 ","$924.52 ","$0.00 ","$940.47 ","$0.00 "
"55-28922","SUP","HCPCS C1713","","55-28922  -  PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE","BOTH IP/OP","$2,724.95 ","$2,016.46 ","$0.00 ","$5,907.50 ","$2,658.38 ","$0.00 ","$567.95 ","$0.00 ","$0.00 ","$1,034.36 ","$5,907.50 ","$0.00 ","$2,953.75 ","$4,678.74 ","$4,726.00 ","$0.00 ","$924.52 ","$0.00 ","$940.47 ","$0.00 "
"55-28925","SUP","HCPCS C1713","","55-28925  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI","BOTH IP/OP","$5,907.50 ","$4,371.55 ","$0.00 ","$5,907.50 ","$2,658.38 ","$0.00 ","$1,231.27 ","$0.00 ","$0.00 ","$1,034.36 ","$5,907.50 ","$0.00 ","$2,953.75 ","$4,678.74 ","$4,726.00 ","$0.00 ","$924.52 ","$0.00 ","$940.47 ","$0.00 "
"55-28926","SUP","HCPCS C1713","","55-28926  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI","BOTH IP/OP","$5,907.50 ","$4,371.55 ","$0.00 ","$5,907.50 ","$2,658.38 ","$0.00 ","$1,231.27 ","$0.00 ","$0.00 ","$1,034.36 ","$5,907.50 ","$0.00 ","$2,953.75 ","$4,678.74 ","$4,726.00 ","$0.00 ","$924.52 ","$0.00 ","$940.47 ","$0.00 "
"55-28930","SUP","HCPCS C1713","","55-28930  -  PLATE BONE 6+17+6 HOLE FULL TITANIUM MANDIB","BOTH IP/OP","$3,495.70 ","$2,586.82 ","$0.00 ","$7,240.00 ","$3,258.00 ","$0.00 ","$728.59 ","$0.00 ","$0.00 ","$1,267.67 ","$7,240.00 ","$0.00 ","$3,620.00 ","$5,734.08 ","$5,792.00 ","$0.00 ","$1,133.06 ","$0.00 ","$1,152.61 ","$0.00 "
"55-28932","SUP","HCPCS C1713","","55-28932  -  PLATE BONE 6X15X6 HOLE FULL RECONSTRUCTION TEMPLATE TITANIUM","BOTH IP/OP","$3,369.60 ","$2,493.50 ","$0.00 ","$6,977.50 ","$3,139.88 ","$0.00 ","$702.31 ","$0.00 ","$0.00 ","$1,221.70 ","$6,977.50 ","$0.00 ","$3,488.75 ","$5,526.18 ","$5,582.00 ","$0.00 ","$1,091.98 ","$0.00 ","$1,110.82 ","$0.00 "
"55-28934","SUP","HCPCS C1713","","55-28934  -  PLATE BONE 6+13+6 HOLE SECONDARY RECONSTRUCTION FULL","BOTH IP/OP","$3,304.78 ","$2,445.54 ","$0.00 ","$6,372.50 ","$2,867.63 ","$0.00 ","$688.80 ","$0.00 ","$0.00 ","$1,115.77 ","$6,372.50 ","$0.00 ","$3,186.25 ","$5,047.02 ","$5,098.00 ","$0.00 ","$997.30 ","$0.00 ","$1,014.50 ","$0.00 "
"5530-G-109","SUP","Custom 27803010","","5530-G-109  -  INSERT TIBIAL 1 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-109-E","SUP","HCPCS C1776","","5530-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-110-E","SUP","HCPCS C1776","","5530-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-111","SUP","Custom 27803010","","5530-G-111  -  INSERT TIBIAL 1 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-111-E","SUP","HCPCS C1776","","5530-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-112-E","SUP","HCPCS C1776","","5530-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-113","SUP","Custom 27803010","","5530-G-113  -  INSERT TIBIAL 1 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-113-E","SUP","HCPCS C1776","","5530-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-114-E","SUP","HCPCS C1776","","5530-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-116","SUP","Custom 27803010","","5530-G-116  -  INSERT TIBIAL 1 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-116-E","SUP","HCPCS C1776","","5530-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-119","SUP","Custom 27803010","","5530-G-119  -  INSERT TIBIAL 1 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-119-E","SUP","HCPCS C1776","","5530-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-209","SUP","Custom 27803010","","5530-G-209  -  INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-209-E","SUP","HCPCS C1776","","5530-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-210-E","SUP","HCPCS C1776","","5530-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-211","SUP","Custom 27803010","","5530-G-211  -  INSERT TIBIAL 2 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-211-E","SUP","HCPCS C1776","","5530-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-212-E","SUP","HCPCS C1776","","5530-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-213","SUP","Custom 27803010","","5530-G-213  -  INSERT TIBIAL 2 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-213-E","SUP","HCPCS C1776","","5530-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-214-E","SUP","HCPCS C1776","","5530-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-216","SUP","Custom 27803010","","5530-G-216  -  INSERT TIBIAL 2 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-216-E","SUP","HCPCS C1776","","5530-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-219","SUP","Custom 27803010","","5530-G-219  -  INSERT TIBIAL 2 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-219-E","SUP","HCPCS C1776","","5530-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-309","SUP","Custom 27803010","","5530-G-309  -  INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-309-E","SUP","HCPCS C1776","","5530-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-310-E","SUP","HCPCS C1776","","5530-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-311","SUP","Custom 27803010","","5530-G-311  -  INSERT TIBIAL 3 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-311-E","SUP","HCPCS C1776","","5530-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-312-E","SUP","HCPCS C1776","","5530-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-313","SUP","Custom 27803010","","5530-G-313  -  INSERT TIBIAL 3 13MM CRUCIATE RETAIN TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-313-E","SUP","HCPCS C1776","","5530-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-314-E","SUP","HCPCS C1776","","5530-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-316","SUP","Custom 27803010","","5530-G-316  -  INSERT TIBIAL 3 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-316-E","SUP","HCPCS C1776","","5530-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-319","SUP","Custom 27803010","","5530-G-319  -  INSERT TIBIAL 3 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-319-E","SUP","HCPCS C1776","","5530-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-409","SUP","Custom 27803010","","5530-G-409  -  INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-409-E","SUP","HCPCS C1776","","5530-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-410-E","SUP","HCPCS C1776","","5530-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-411","SUP","Custom 27803010","","5530-G-411  -  INSERT TIBIAL 4 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-411-E","SUP","HCPCS C1776","","5530-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-412-E","SUP","HCPCS C1776","","5530-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-413","SUP","Custom 27803010","","5530-G-413  -  INSERT TIBIAL 4 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-413-E","SUP","HCPCS C1776","","5530-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-414-E","SUP","HCPCS C1776","","5530-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-416","SUP","Custom 27803010","","5530-G-416  -  INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-416-E","SUP","HCPCS C1776","","5530-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-419","SUP","Custom 27803010","","5530-G-419  -  INSERT TIBIAL 4 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-419-E","SUP","HCPCS C1776","","5530-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-509","SUP","Custom 27803010","","5530-G-509  -  INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-509-E","SUP","HCPCS C1776","","5530-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-510-E","SUP","HCPCS C1776","","5530-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-511","SUP","Custom 27803010","","5530-G-511  -  INSERT TIBIAL 5 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-511-E","SUP","HCPCS C1776","","5530-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-512-E","SUP","HCPCS C1776","","5530-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-513","SUP","Custom 27803010","","5530-G-513  -  INSERT TIBIAL 5 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-513-E","SUP","HCPCS C1776","","5530-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-514-E","SUP","HCPCS C1776","","5530-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-516","SUP","Custom 27803010","","5530-G-516  -  INSERT TIBIAL 5 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-516-E","SUP","HCPCS C1776","","5530-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-519","SUP","Custom 27803010","","5530-G-519  -  INSERT TIBIAL 5 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-519-E","SUP","HCPCS C1776","","5530-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-609","SUP","Custom 27803010","","5530-G-609  -  INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-609-E","SUP","HCPCS C1776","","5530-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-610-E","SUP","HCPCS C1776","","5530-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-611","SUP","Custom 27803010","","5530-G-611  -  INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-611-E","SUP","HCPCS C1776","","5530-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-612-E","SUP","HCPCS C1776","","5530-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-613","SUP","Custom 27803010","","5530-G-613  -  INSERT TIBIAL 6 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-613-E","SUP","HCPCS C1776","","5530-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-614-E","SUP","HCPCS C1776","","5530-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-616","SUP","Custom 27803010","","5530-G-616  -  INSERT TIBIAL 6 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-616-E","SUP","HCPCS C1776","","5530-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-619","SUP","Custom 27803010","","5530-G-619  -  INSERT TIBIAL 6 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-619-E","SUP","HCPCS C1776","","5530-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-709","SUP","Custom 27803010","","5530-G-709  -  INSERT TIBIAL 7 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-709-E","SUP","HCPCS C1776","","5530-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-710-E","SUP","HCPCS C1776","","5530-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-711","SUP","Custom 27803010","","5530-G-711  -  INSERT TIBIAL 7 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-711-E","SUP","HCPCS C1776","","5530-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-712-E","SUP","HCPCS C1776","","5530-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-713","SUP","Custom 27803010","","5530-G-713  -  INSERT TIBIAL 7 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-713-E","SUP","HCPCS C1776","","5530-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-714-E","SUP","HCPCS C1776","","5530-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-716","SUP","Custom 27803010","","5530-G-716  -  INSERT TIBIAL 7 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-716-E","SUP","HCPCS C1776","","5530-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-719","SUP","Custom 27803010","","5530-G-719  -  INSERT TIBIAL 7 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-719-E","SUP","HCPCS C1776","","5530-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-809","SUP","Custom 27803010","","5530-G-809  -  INSERT TIBIAL 8 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-809-E","SUP","HCPCS C1776","","5530-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-810-E","SUP","HCPCS C1776","","5530-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-811","SUP","Custom 27803010","","5530-G-811  -  INSERT TIBIAL 8 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-811-E","SUP","HCPCS C1776","","5530-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-812-E","SUP","HCPCS C1776","","5530-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-813","SUP","Custom 27803010","","5530-G-813  -  INSERT TIBIAL 8 13MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-813-E","SUP","HCPCS C1776","","5530-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-814-E","SUP","HCPCS C1776","","5530-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-816","SUP","Custom 27803010","","5530-G-816  -  INSERT TIBIAL 8 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-816-E","SUP","HCPCS C1776","","5530-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-G-819","SUP","Custom 27803010","","5530-G-819  -  INSERT TIBIAL 8 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-G-819-E","SUP","HCPCS C1776","","5530-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5530-P-109","SUP","Custom 27803010","","5530-P-109  -  INSERT TIBIAL 1 9MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-110","SUP","HCPCS C1776","","5530-P-110  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-111","SUP","Custom 27803010","","5530-P-111  -  INSERT TIBIAL 1 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-112","SUP","HCPCS C1776","","5530-P-112  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-113","SUP","Custom 27803010","","5530-P-113  -  INSERT TIBIAL 1 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-114","SUP","HCPCS C1776","","5530-P-114  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-116","SUP","Custom 27803010","","5530-P-116  -  INSERT TIBIAL 1 P 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-119","SUP","Custom 27803010","","5530-P-119  -  INSERT TIBIAL 1 P 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-209","SUP","Custom 27803010","","5530-P-209  -  INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-210","SUP","HCPCS C1776","","5530-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-211","SUP","Custom 27803010","","5530-P-211  -  INSERT TIBIAL 2 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-212","SUP","HCPCS C1776","","5530-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-213","SUP","Custom 27803010","","5530-P-213  -  INSERT TIBIAL 2 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-214","SUP","HCPCS C1776","","5530-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-216","SUP","Custom 27803010","","5530-P-216  -  INSERT TIBIAL 2 16MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-219","SUP","Custom 27803010","","5530-P-219  -  INSERT TIBIAL 2 P 19MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-309","SUP","Custom 27803010","","5530-P-309  -  INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-310","SUP","HCPCS C1776","","5530-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-311","SUP","Custom 27803010","","5530-P-311  -  INSERT TIBIAL 3 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-312","SUP","HCPCS C1776","","5530-P-312  -  INSERT TIB 3 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-313","SUP","Custom 27803010","","5530-P-313  -  INSERT TIBIAL 3 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-314","SUP","HCPCS C1776","","5530-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-316","SUP","Custom 27803010","","5530-P-316  -  INSERT TIBIAL 3 16MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-319","SUP","Custom 27803010","","5530-P-319  -  INSERT TIBIAL 3 19MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-409","SUP","Custom 27803010","","5530-P-409  -  INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-410","SUP","HCPCS C1776","","5530-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-411","SUP","Custom 27803010","","5530-P-411  -  INSERT TIBIAL 4 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-412","SUP","HCPCS C1776","","5530-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-413","SUP","Custom 27803010","","5530-P-413  -  INSERT TIBIAL 4 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-414","SUP","HCPCS C1776","","5530-P-414  -  INSERT TIB 4 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-416","SUP","Custom 27803010","","5530-P-416  -  INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-419","SUP","Custom 27803010","","5530-P-419  -  INSERT TIBIAL 4 19MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-509","SUP","Custom 27803010","","5530-P-509  -  INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-510","SUP","HCPCS C1776","","5530-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-511","SUP","Custom 27803010","","5530-P-511  -  INSERT TIBIAL 5 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-512","SUP","HCPCS C1776","","5530-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-513","SUP","Custom 27803010","","5530-P-513  -  INSERT TIBIAL 5 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-514","SUP","HCPCS C1776","","5530-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-516","SUP","Custom 27803010","","5530-P-516  -  INSERT TIBIAL 5 16MM CRUCIATE RETAIN TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-519","SUP","Custom 27803010","","5530-P-519  -  INSERT TIBIAL 5 19MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-609","SUP","Custom 27803010","","5530-P-609  -  INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-610","SUP","HCPCS C1776","","5530-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-611","SUP","Custom 27803010","","5530-P-611  -  INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-612","SUP","HCPCS C1776","","5530-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-613","SUP","Custom 27803010","","5530-P-613  -  INSERT TIBIAL 6 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-614","SUP","HCPCS C1776","","5530-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-616","SUP","Custom 27803010","","5530-P-616  -  INSERT TIBIAL 6 16MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-619","SUP","Custom 27803010","","5530-P-619  -  INSERT TIBIAL 6 19MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-709","SUP","Custom 27803010","","5530-P-709  -  INSERT TIBIAL 7 9MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-710","SUP","HCPCS C1776","","5530-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-711","SUP","Custom 27803010","","5530-P-711  -  INSERT TIBIAL 7 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-712","SUP","HCPCS C1776","","5530-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-713","SUP","Custom 27803010","","5530-P-713  -  INSERT TIBIAL 7 13MM CRUCIATE RETAIN TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-714","SUP","HCPCS C1776","","5530-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-716","SUP","Custom 27803010","","5530-P-716  -  INSERT TIBIAL 7 16MM CRUCIATE RETAIN TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-719","SUP","Custom 27803010","","5530-P-719  -  INSERT TIBIAL 7 19MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-809","SUP","Custom 27803010","","5530-P-809  -  INSERT TIBIAL 8 9MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-810","SUP","HCPCS C1776","","5530-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-811","SUP","Custom 27803010","","5530-P-811  -  INSERT TIBIAL 8 11MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-812","SUP","HCPCS C1776","","5530-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-813","SUP","Custom 27803010","","5530-P-813  -  INSERT TIBIAL 8 13MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-814","SUP","HCPCS C1776","","5530-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG CRCTE RTN KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5530-P-816","SUP","Custom 27803010","","5530-P-816  -  INSERT TIBIAL 8 16MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5530-P-819","SUP","Custom 27803010","","5530-P-819  -  INSERT TIBIAL 8 19MM CRUC RET TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-109","SUP","Custom 27803010","","5531-G-109  -  INSERT TIBIAL 1 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-109-E","SUP","HCPCS C1776","","5531-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-110-E","SUP","HCPCS C1776","","5531-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-111","SUP","Custom 27803010","","5531-G-111  -  INSERT TIBIAL 1 G 11MM TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-111-E","SUP","HCPCS C1776","","5531-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-112-E","SUP","HCPCS C1776","","5531-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-113","SUP","Custom 27803010","","5531-G-113  -  INSERT TIBIAL 1 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-113-E","SUP","HCPCS C1776","","5531-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-114-E","SUP","HCPCS C1776","","5531-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-116","SUP","Custom 27803010","","5531-G-116  -  INSERT TIBIAL 1 16MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-116-E","SUP","HCPCS C1776","","5531-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-119","SUP","Custom 27803010","","5531-G-119  -  INSERT TIBIAL 1 19MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-119-E","SUP","HCPCS C1776","","5531-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-122","SUP","Custom 27803010","","5531-G-122  -  INSERT TIBIAL 1 22MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-122-E","SUP","HCPCS C1776","","5531-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-125","SUP","Custom 27803010","","5531-G-125  -  INSERT TIBIAL 1 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-209","SUP","Custom 27803010","","5531-G-209  -  INSERT TIBIAL 2 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-209-E","SUP","HCPCS C1776","","5531-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-210-E","SUP","HCPCS C1776","","5531-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-211","SUP","Custom 27803010","","5531-G-211  -  INSERT TIBIAL 2 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-211-E","SUP","HCPCS C1776","","5531-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-212-E","SUP","HCPCS C1776","","5531-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-213","SUP","Custom 27803010","","5531-G-213  -  INSERT TIBIAL 2 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-213-E","SUP","HCPCS C1776","","5531-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-214-E","SUP","HCPCS C1776","","5531-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-216","SUP","Custom 27803010","","5531-G-216  -  INSERT TIBIAL 2 16MM CRUC SUB REVISION FLEXION TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-216-E","SUP","HCPCS C1776","","5531-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-219","SUP","Custom 27803010","","5531-G-219  -  INSERT TIBIAL 2 19MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-219-E","SUP","HCPCS C1776","","5531-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-222","SUP","Custom 27803010","","5531-G-222  -  INSERT TIBIAL 2 22MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-222-E","SUP","HCPCS C1776","","5531-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-225","SUP","Custom 27803010","","5531-G-225  -  INSERT TIBIAL 2 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-309","SUP","Custom 27803010","","5531-G-309  -  INSERT TIBIAL 3 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-309-E","SUP","HCPCS C1776","","5531-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-310-E","SUP","HCPCS C1776","","5531-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-311","SUP","Custom 27803010","","5531-G-311  -  INSERT TIBIAL 3 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-311-E","SUP","HCPCS C1776","","5531-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-312-E","SUP","HCPCS C1776","","5531-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-313","SUP","Custom 27803010","","5531-G-313  -  INSERT TIBIAL 3 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-313-E","SUP","HCPCS C1776","","5531-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-314-E","SUP","HCPCS C1776","","5531-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-316","SUP","Custom 27803010","","5531-G-316  -  INSERT TIBIAL 3 16MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-316-E","SUP","HCPCS C1776","","5531-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-319","SUP","Custom 27803010","","5531-G-319  -  INSERT TIBIAL 3 19MM CNDYLR STABILIZED PRIM TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-319-E","SUP","HCPCS C1776","","5531-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-322","SUP","Custom 27803010","","5531-G-322  -  INSERT TIBIAL 3 22MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-322-E","SUP","HCPCS C1776","","5531-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-325","SUP","Custom 27803010","","5531-G-325  -  INSERT TIBIAL 3 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-409","SUP","Custom 27803010","","5531-G-409  -  INSERT TIBIAL 4 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-409-E","SUP","HCPCS C1776","","5531-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-410-E","SUP","HCPCS C1776","","5531-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-411","SUP","Custom 27803010","","5531-G-411  -  INSERT TIBIAL 4 11MM CNDYLR STABILIZED PRIM TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-411-E","SUP","HCPCS C1776","","5531-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-412-E","SUP","HCPCS C1776","","5531-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-413","SUP","Custom 27803010","","5531-G-413  -  INSERT TIBIAL 4 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-413-E","SUP","HCPCS C1776","","5531-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-414-E","SUP","HCPCS C1776","","5531-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-416","SUP","Custom 27803010","","5531-G-416  -  INSERT TIBIAL 4 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-416-E","SUP","HCPCS C1776","","5531-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-419","SUP","Custom 27803010","","5531-G-419  -  INSERT TIBIAL 4 19MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-419-E","SUP","HCPCS C1776","","5531-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-422","SUP","Custom 27803010","","5531-G-422  -  INSERT TIBIAL 4 22MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-422-E","SUP","HCPCS C1776","","5531-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-425","SUP","Custom 27803010","","5531-G-425  -  INSERT TIBIAL 4 25MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-509","SUP","Custom 27803010","","5531-G-509  -  INSERT TIBIAL 5 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-509-E","SUP","HCPCS C1776","","5531-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-510-E","SUP","HCPCS C1776","","5531-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-511","SUP","Custom 27803010","","5531-G-511  -  INSERT TIBIAL 5 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-511-E","SUP","HCPCS C1776","","5531-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-512-E","SUP","HCPCS C1776","","5531-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-513","SUP","Custom 27803010","","5531-G-513  -  INSERT TIBIAL 5 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-513-E","SUP","HCPCS C1776","","5531-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-514-E","SUP","HCPCS C1776","","5531-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-516","SUP","Custom 27803010","","5531-G-516  -  INSERT TIBIAL 5 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-516-E","SUP","HCPCS C1776","","5531-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-519","SUP","Custom 27803010","","5531-G-519  -  INSERT TIBIAL 5 19MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-519-E","SUP","HCPCS C1776","","5531-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-522","SUP","Custom 27803010","","5531-G-522  -  INSERT TIBIAL 5 22MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-522-E","SUP","HCPCS C1776","","5531-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-525","SUP","Custom 27803010","","5531-G-525  -  INSERT TIBIAL 5 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-609","SUP","Custom 27803010","","5531-G-609  -  INSERT TIBIAL 6 9MM CNDYLR STABILIZED PRIM TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-609-E","SUP","HCPCS C1776","","5531-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-610-E","SUP","HCPCS C1776","","5531-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-611","SUP","Custom 27803010","","5531-G-611  -  INSERT TIBIAL 6 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-611-E","SUP","HCPCS C1776","","5531-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-612-E","SUP","HCPCS C1776","","5531-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-613","SUP","Custom 27803010","","5531-G-613  -  INSERT TIBIAL 6 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-613-E","SUP","HCPCS C1776","","5531-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-614-E","SUP","HCPCS C1776","","5531-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-616","SUP","Custom 27803010","","5531-G-616  -  INSERT TIBIAL 6 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-616-E","SUP","HCPCS C1776","","5531-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-619","SUP","Custom 27803010","","5531-G-619  -  INSERT TIBIAL 6 19MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-619-E","SUP","HCPCS C1776","","5531-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-622","SUP","Custom 27803010","","5531-G-622  -  INSERT TIBIAL 6 22MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-622-E","SUP","HCPCS C1776","","5531-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-625","SUP","Custom 27803010","","5531-G-625  -  INSERT TIBIAL 6 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-709","SUP","Custom 27803010","","5531-G-709  -  INSERT TIBIAL 7 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-709-E","SUP","HCPCS C1776","","5531-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-710-E","SUP","HCPCS C1776","","5531-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-711","SUP","Custom 27803010","","5531-G-711  -  INSERT TIBIAL 7 11MM CNDYLR STABILIZED PRIM TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-711-E","SUP","HCPCS C1776","","5531-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-712-E","SUP","HCPCS C1776","","5531-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-713","SUP","Custom 27803010","","5531-G-713  -  INSERT TIBIAL 7 13MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-713-E","SUP","HCPCS C1776","","5531-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-714-E","SUP","HCPCS C1776","","5531-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-716","SUP","Custom 27803010","","5531-G-716  -  INSERT TIBIAL 7 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-716-E","SUP","HCPCS C1776","","5531-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-719","SUP","Custom 27803010","","5531-G-719  -  INSERT TIBIAL 7 19MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-719-E","SUP","HCPCS C1776","","5531-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-722","SUP","Custom 27803010","","5531-G-722  -  INSERT TIBIAL 7 22MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-722-E","SUP","HCPCS C1776","","5531-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-725","SUP","Custom 27803010","","5531-G-725  -  INSERT TIBIAL 7 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-809","SUP","Custom 27803010","","5531-G-809  -  INSERT TIBIAL 8 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-809-E","SUP","HCPCS C1776","","5531-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-810-E","SUP","HCPCS C1776","","5531-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-811","SUP","Custom 27803010","","5531-G-811  -  INSERT TIBIAL 8 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-811-E","SUP","HCPCS C1776","","5531-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-812-E","SUP","HCPCS C1776","","5531-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-813","SUP","Custom 27803010","","5531-G-813  -  INSERT TIBIAL 8 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-813-E","SUP","HCPCS C1776","","5531-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-814-E","SUP","HCPCS C1776","","5531-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-816","SUP","Custom 27803010","","5531-G-816  -  INSERT TIBIAL 8 16MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-816-E","SUP","HCPCS C1776","","5531-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-819","SUP","Custom 27803010","","5531-G-819  -  INSERT TIBIAL 8 19MM CRUC SUB TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-819-E","SUP","HCPCS C1776","","5531-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-822","SUP","Custom 27803010","","5531-G-822  -  INSERT TIBIAL 8 22MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-G-822-E","SUP","HCPCS C1776","","5531-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5531-G-825","SUP","Custom 27803010","","5531-G-825  -  INSERT TIBIAL 8 25MM CRUC SUB TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-109","SUP","Custom 27803010","","5531-P-109  -  INSERT TIBIAL 1 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-110","SUP","HCPCS C1776","","5531-P-110  -  INSERT TIB 1 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-111","SUP","Custom 27803010","","5531-P-111  -  INSERT TIBIAL 1 11MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-112","SUP","HCPCS C1776","","5531-P-112  -  INSERT TIB 1 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-113","SUP","Custom 27803010","","5531-P-113  -  INSERT TIBIAL 1 13MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-114","SUP","HCPCS C1776","","5531-P-114  -  INSERT TIB 1 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-116","SUP","Custom 27803010","","5531-P-116  -  INSERT TIBIAL 1 16MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-119","SUP","Custom 27803010","","5531-P-119  -  INSERT TIBIAL 1 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-122","SUP","Custom 27803010","","5531-P-122  -  INSERT TIBIAL 1 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-125","SUP","Custom 27803010","","5531-P-125  -  INSERT TIBIAL 1 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-209","SUP","Custom 27803010","","5531-P-209  -  INSERT TIBIAL 2 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-210","SUP","HCPCS C1776","","5531-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-211","SUP","Custom 27803010","","5531-P-211  -  INSERT TIBIAL 2 11MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-212","SUP","HCPCS C1776","","5531-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-213","SUP","Custom 27803010","","5531-P-213  -  INSERT TIBIAL 2 13MM CRUC SUB TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-214","SUP","HCPCS C1776","","5531-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-216","SUP","Custom 27803010","","5531-P-216  -  INSERT TIBIAL 2 16MM CRUC SUB TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-219","SUP","Custom 27803010","","5531-P-219  -  INSERT TIBIAL 2 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-222","SUP","Custom 27803010","","5531-P-222  -  INSERT TIBIAL 2 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-225","SUP","Custom 27803010","","5531-P-225  -  INSERT TIBIAL 2 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-309","SUP","Custom 27803010","","5531-P-309  -  INSERT TIBIAL 3 8-9MM TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-310","SUP","HCPCS C1776","","5531-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-311","SUP","Custom 27803010","","5531-P-311  -  INSERT TIBIAL 3 11MM BEARING TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-312","SUP","HCPCS C1776","","5531-P-312  -  INSERT TIB 3 13MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-313","SUP","Custom 27803010","","5531-P-313  -  INSERT TIBIAL 3 13MM TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-314","SUP","HCPCS C1776","","5531-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-316","SUP","Custom 27803010","","5531-P-316  -  INSERT TIBIAL 3 16MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-319","SUP","Custom 27803010","","5531-P-319  -  INSERT TIBIAL 3 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-322","SUP","Custom 27803010","","5531-P-322  -  INSERT TIBIAL 3 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-325","SUP","Custom 27803010","","5531-P-325  -  INSERT TIBIAL 3 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-409","SUP","Custom 27803010","","5531-P-409  -  INSERT TIBIAL 4 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-410","SUP","HCPCS C1776","","5531-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-411","SUP","Custom 27803010","","5531-P-411  -  INSERT TIBIAL 4 11MM CRUC SUB TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-412","SUP","HCPCS C1776","","5531-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-413","SUP","Custom 27803010","","5531-P-413  -  INSERT TIBIAL 4 13MM CRUC SUB TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-414","SUP","HCPCS C1776","","5531-P-414  -  INSERT TIB 4 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-416","SUP","Custom 27803010","","5531-P-416  -  INSERT TIBIAL 4 16MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-419","SUP","Custom 27803010","","5531-P-419  -  INSERT TIBIAL 4 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-422","SUP","Custom 27803010","","5531-P-422  -  INSERT TIBIAL 4 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-425","SUP","Custom 27803010","","5531-P-425  -  INSERT TIBIAL 4 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-509","SUP","Custom 27803010","","5531-P-509  -  INSERT TIBIAL 5 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-510","SUP","HCPCS C1776","","5531-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-511","SUP","Custom 27803010","","5531-P-511  -  INSERT TIBIAL 5 11MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-512","SUP","HCPCS C1776","","5531-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-513","SUP","Custom 27803010","","5531-P-513  -  INSERT TIBIAL 5 13MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-514","SUP","HCPCS C1776","","5531-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-516","SUP","Custom 27803010","","5531-P-516  -  INSERT TIBIAL 5 16MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-519","SUP","Custom 27803010","","5531-P-519  -  INSERT TIBIAL 5 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-522","SUP","Custom 27803010","","5531-P-522  -  INSERT TIBIAL 5 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-525","SUP","Custom 27803010","","5531-P-525  -  INSERT TIBIAL 5 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-609","SUP","Custom 27803010","","5531-P-609  -  INSERT TIBIAL 6 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-610","SUP","HCPCS C1776","","5531-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-611","SUP","Custom 27803010","","5531-P-611  -  INSERT TIBIAL 6 11MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-612","SUP","HCPCS C1776","","5531-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-613","SUP","Custom 27803010","","5531-P-613  -  INSERT TIBIAL 6 13MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-614","SUP","HCPCS C1776","","5531-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-616","SUP","Custom 27803010","","5531-P-616  -  INSERT TIBIAL 6 16MM CRUC SUB TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-619","SUP","Custom 27803010","","5531-P-619  -  INSERT TIBIAL 6 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-622","SUP","Custom 27803010","","5531-P-622  -  INSERT TIBIAL 6 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-625","SUP","Custom 27803010","","5531-P-625  -  INSERT TIBIAL 6 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-709","SUP","Custom 27803010","","5531-P-709  -  INSERT TIBIAL 7 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-710","SUP","HCPCS C1776","","5531-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-711","SUP","Custom 27803010","","5531-P-711  -  INSERT TIBIAL 7 11MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-712","SUP","HCPCS C1776","","5531-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-713","SUP","Custom 27803010","","5531-P-713  -  INSERT TIBIAL 7 13MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-714","SUP","HCPCS C1776","","5531-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-716","SUP","Custom 27803010","","5531-P-716  -  INSERT TIBIAL 7 16MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-719","SUP","Custom 27803010","","5531-P-719  -  INSERT TIBIAL 7 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-722","SUP","Custom 27803010","","5531-P-722  -  INSERT TIBIAL 7 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-725","SUP","Custom 27803010","","5531-P-725  -  INSERT TIBIAL 7 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-809","SUP","Custom 27803010","","5531-P-809  -  INSERT TIBIAL 8 9MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-810","SUP","HCPCS C1776","","5531-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-811","SUP","Custom 27803010","","5531-P-811  -  INSERT TIBIAL 8 11MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-812","SUP","HCPCS C1776","","5531-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-813","SUP","Custom 27803010","","5531-P-813  -  INSERT TIBIAL 8 13MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-814","SUP","HCPCS C1776","","5531-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG CNDRL STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5531-P-816","SUP","Custom 27803010","","5531-P-816  -  INSERT TIBIAL 8 16MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-819","SUP","Custom 27803010","","5531-P-819  -  INSERT TIBIAL 8 19MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-822","SUP","Custom 27803010","","5531-P-822  -  INSERT TIBIAL 8 22MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5531-P-825","SUP","Custom 27803010","","5531-P-825  -  INSERT TIBIAL 8 25MM STABILIZE TRIATHLON KNEE CONDYLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-109","SUP","Custom 27803010","","5532-G-109  -  INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-109-E","SUP","HCPCS C1776","","5532-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-110-E","SUP","HCPCS C1776","","5532-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-111","SUP","Custom 27803010","","5532-G-111  -  INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-111-E","SUP","HCPCS C1776","","5532-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-112-E","SUP","HCPCS C1776","","5532-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-113","SUP","Custom 27803010","","5532-G-113  -  INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-113-E","SUP","HCPCS C1776","","5532-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-114-E","SUP","HCPCS C1776","","5532-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-116","SUP","Custom 27803010","","5532-G-116  -  INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-116-E","SUP","HCPCS C1776","","5532-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-119","SUP","Custom 27803010","","5532-G-119  -  INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-119-E","SUP","HCPCS C1776","","5532-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-122","SUP","Custom 27803010","","5532-G-122  -  INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-122-E","SUP","HCPCS C1776","","5532-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-125","SUP","Custom 27803010","","5532-G-125  -  INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-209","SUP","Custom 27803010","","5532-G-209  -  INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-209-E","SUP","HCPCS C1776","","5532-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-210-E","SUP","HCPCS C1776","","5532-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-211","SUP","Custom 27803010","","5532-G-211  -  INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-211-E","SUP","HCPCS C1776","","5532-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-212-E","SUP","HCPCS C1776","","5532-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-213","SUP","Custom 27803010","","5532-G-213  -  INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-213-E","SUP","HCPCS C1776","","5532-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-214-E","SUP","HCPCS C1776","","5532-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-216","SUP","Custom 27803010","","5532-G-216  -  INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-216-E","SUP","HCPCS C1776","","5532-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-219","SUP","Custom 27803010","","5532-G-219  -  INSERT TIBIAL 2 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-219-E","SUP","HCPCS C1776","","5532-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-222","SUP","Custom 27803010","","5532-G-222  -  INSERT TIBIAL 2 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-222-E","SUP","HCPCS C1776","","5532-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-225","SUP","Custom 27803010","","5532-G-225  -  INSERT TIBIAL 2 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-309","SUP","Custom 27803010","","5532-G-309  -  INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-309-E","SUP","HCPCS C1776","","5532-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-310-E","SUP","HCPCS C1776","","5532-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-311","SUP","Custom 27803010","","5532-G-311  -  INSERT TIBIAL 3 11MM POSTERIOR STABILIZED PRIM TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-311-E","SUP","HCPCS C1776","","5532-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-312-E","SUP","HCPCS C1776","","5532-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-313","SUP","Custom 27803010","","5532-G-313  -  INSERT TIBIAL 3 13MM BEARING POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-313-E","SUP","HCPCS C1776","","5532-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-314-E","SUP","HCPCS C1776","","5532-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-316","SUP","Custom 27803010","","5532-G-316  -  INSERT TIBIAL 3 16MM BEARING POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-316-E","SUP","HCPCS C1776","","5532-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-319","SUP","Custom 27803010","","5532-G-319  -  INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-319-E","SUP","HCPCS C1776","","5532-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-322","SUP","Custom 27803010","","5532-G-322  -  INSERT TIBIAL 3 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-322-E","SUP","HCPCS C1776","","5532-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-325","SUP","Custom 27803010","","5532-G-325  -  INSERT TIBIAL 3 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-409","SUP","Custom 27803010","","5532-G-409  -  INSERT TIBIAL 4 9MM POSTERIOR STABILIZE TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-409-E","SUP","HCPCS C1776","","5532-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-410-E","SUP","HCPCS C1776","","5532-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-411","SUP","Custom 27803010","","5532-G-411  -  INSERT TIBIAL 4 11MM BEARING POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-411-E","SUP","HCPCS C1776","","5532-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-412-E","SUP","HCPCS C1776","","5532-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-413","SUP","Custom 27803010","","5532-G-413  -  INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-413-E","SUP","HCPCS C1776","","5532-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-414-E","SUP","HCPCS C1776","","5532-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-416","SUP","Custom 27803010","","5532-G-416  -  INSERT TIBIAL 4 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-416-E","SUP","HCPCS C1776","","5532-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-419","SUP","Custom 27803010","","5532-G-419  -  INSERT TIBIAL 4 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-419-E","SUP","HCPCS C1776","","5532-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-422","SUP","Custom 27803010","","5532-G-422  -  INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-422-E","SUP","HCPCS C1776","","5532-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-425","SUP","Custom 27803010","","5532-G-425  -  INSERT TIBIAL 4 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-509","SUP","Custom 27803010","","5532-G-509  -  INSERT TIBIAL 5 9MM BEARING POSTERIOR STABILIZE TRIATHLON X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-509-E","SUP","HCPCS C1776","","5532-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-510-E","SUP","HCPCS C1776","","5532-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-511","SUP","Custom 27803010","","5532-G-511  -  INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-511-E","SUP","HCPCS C1776","","5532-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-512-E","SUP","HCPCS C1776","","5532-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-513","SUP","Custom 27803010","","5532-G-513  -  INSERT TIBIAL 5 13MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-513-E","SUP","HCPCS C1776","","5532-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-514-E","SUP","HCPCS C1776","","5532-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-516","SUP","Custom 27803010","","5532-G-516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-516-E","SUP","HCPCS C1776","","5532-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-519","SUP","Custom 27803010","","5532-G-519  -  INSERT TIBIAL 5 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-519-E","SUP","HCPCS C1776","","5532-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-522","SUP","Custom 27803010","","5532-G-522  -  INSERT TIBIAL 5 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-522-E","SUP","HCPCS C1776","","5532-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-525","SUP","Custom 27803010","","5532-G-525  -  INSERT TIBIAL 5 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-609","SUP","Custom 27803010","","5532-G-609  -  INSERT TIBIAL 6 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-609-E","SUP","HCPCS C1776","","5532-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-610-E","SUP","HCPCS C1776","","5532-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-611","SUP","Custom 27803010","","5532-G-611  -  INSERT TIBIAL 6 11MM BEARING POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-611-E","SUP","HCPCS C1776","","5532-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-612-E","SUP","HCPCS C1776","","5532-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-613","SUP","Custom 27803010","","5532-G-613  -  INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-613-E","SUP","HCPCS C1776","","5532-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-614-E","SUP","HCPCS C1776","","5532-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-616","SUP","Custom 27803010","","5532-G-616  -  INSERT TIBIAL 6 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-616-E","SUP","HCPCS C1776","","5532-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-619","SUP","Custom 27803010","","5532-G-619  -  INSERT TIBIAL 6 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-619-E","SUP","HCPCS C1776","","5532-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-622","SUP","Custom 27803010","","5532-G-622  -  INSERT TIBIAL 6 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-622-E","SUP","HCPCS C1776","","5532-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-625","SUP","Custom 27803010","","5532-G-625  -  INSERT TIBIAL 6 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-709","SUP","Custom 27803010","","5532-G-709  -  INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-709-E","SUP","HCPCS C1776","","5532-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-710-E","SUP","HCPCS C1776","","5532-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-711","SUP","Custom 27803010","","5532-G-711  -  INSERT TIBIAL 7 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-711-E","SUP","HCPCS C1776","","5532-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-712-E","SUP","HCPCS C1776","","5532-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-713","SUP","Custom 27803010","","5532-G-713  -  INSERT TIBIAL 7 13MM POSTERIOR STABILIZE TRIATHLON X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-713-E","SUP","HCPCS C1776","","5532-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-714-E","SUP","HCPCS C1776","","5532-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-716","SUP","Custom 27803010","","5532-G-716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-716-E","SUP","HCPCS C1776","","5532-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-719","SUP","Custom 27803010","","5532-G-719  -  INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-719-E","SUP","HCPCS C1776","","5532-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-722","SUP","Custom 27803010","","5532-G-722  -  INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-722-E","SUP","HCPCS C1776","","5532-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-725","SUP","Custom 27803010","","5532-G-725  -  INSERT TIBIAL 7 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-809","SUP","Custom 27803010","","5532-G-809  -  INSERT TIBIAL 8 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-809-E","SUP","HCPCS C1776","","5532-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-810-E","SUP","HCPCS C1776","","5532-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-811","SUP","Custom 27803010","","5532-G-811  -  INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-811-E","SUP","HCPCS C1776","","5532-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-812-E","SUP","HCPCS C1776","","5532-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-813","SUP","Custom 27803010","","5532-G-813  -  INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-813-E","SUP","HCPCS C1776","","5532-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-814-E","SUP","HCPCS C1776","","5532-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-816","SUP","Custom 27803010","","5532-G-816  -  INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-816-E","SUP","HCPCS C1776","","5532-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-819","SUP","Custom 27803010","","5532-G-819  -  INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-819-E","SUP","HCPCS C1776","","5532-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-822","SUP","Custom 27803010","","5532-G-822  -  INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-G-822-E","SUP","HCPCS C1776","","5532-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"5532-G-825","SUP","Custom 27803010","","5532-G-825  -  INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-109","SUP","Custom 27803010","","5532-P-109  -  INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-110","SUP","HCPCS C1776","","5532-P-110  -  INSERT TIB 1 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-111","SUP","Custom 27803010","","5532-P-111  -  INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-112","SUP","HCPCS C1776","","5532-P-112  -  INSERT TIB 1 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-113","SUP","Custom 27803010","","5532-P-113  -  INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-114","SUP","HCPCS C1776","","5532-P-114  -  INSERT TIB 1 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-116","SUP","Custom 27803010","","5532-P-116  -  INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-119","SUP","Custom 27803010","","5532-P-119  -  INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-122","SUP","Custom 27803010","","5532-P-122  -  INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-125","SUP","Custom 27803010","","5532-P-125  -  INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-209","SUP","Custom 27803010","","5532-P-209  -  INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-210","SUP","HCPCS C1776","","5532-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-211","SUP","Custom 27803010","","5532-P-211  -  INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-212","SUP","HCPCS C1776","","5532-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-213","SUP","Custom 27803010","","5532-P-213  -  INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-214","SUP","HCPCS C1776","","5532-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-216","SUP","Custom 27803010","","5532-P-216  -  INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-219","SUP","Custom 27803010","","5532-P-219  -  INSERT TIBIAL 2 P 19MM POSTERIOR STABILIZE TRIATHLON X3 KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-222","SUP","Custom 27803010","","5532-P-222  -  INSERT TIBIAL 2 22MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-225","SUP","Custom 27803010","","5532-P-225  -  INSERT TIBIAL 2 25MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-309","SUP","Custom 27803010","","5532-P-309  -  INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-310","SUP","HCPCS C1776","","5532-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-311","SUP","Custom 27803010","","5532-P-311  -  INSERT TIBIAL 3 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-312","SUP","HCPCS C1776","","5532-P-312  -  INSERT TIB 3 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-313","SUP","Custom 27803010","","5532-P-313  -  INSERT TIBIAL 3 13MM POSTERIOR STABILIZED PRIM TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-314","SUP","HCPCS C1776","","5532-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-316","SUP","Custom 27803010","","5532-P-316  -  INSERT TIBIAL 3 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-319","SUP","Custom 27803010","","5532-P-319  -  INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-322","SUP","Custom 27803010","","5532-P-322  -  INSERT TIBIAL 3 22MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-325","SUP","Custom 27803010","","5532-P-325  -  INSERT TIBIAL 3 25MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-409","SUP","Custom 27803010","","5532-P-409  -  INSERT TIBIAL 4 9MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-410","SUP","HCPCS C1776","","5532-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-411","SUP","Custom 27803010","","5532-P-411  -  INSERT TIBIAL 4 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-412","SUP","HCPCS C1776","","5532-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-413","SUP","Custom 27803010","","5532-P-413  -  INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-416","SUP","Custom 27803010","","5532-P-416  -  INSERT TIBIAL 4 16MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-419","SUP","Custom 27803010","","5532-P-419  -  INSERT TIBIAL 4 19MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-422","SUP","Custom 27803010","","5532-P-422  -  INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-425","SUP","Custom 27803010","","5532-P-425  -  INSERT TIBIAL 4 25MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-509","SUP","Custom 27803010","","5532-P-509  -  INSERT TIBIAL 5 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-510","SUP","HCPCS C1776","","5532-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-511","SUP","Custom 27803010","","5532-P-511  -  INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-512","SUP","HCPCS C1776","","5532-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-513","SUP","Custom 27803010","","5532-P-513  -  INSERT TIBIAL 5 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-514","SUP","HCPCS C1776","","5532-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-516","SUP","Custom 27803010","","5532-P-516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZED PRIM TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-519","SUP","Custom 27803010","","5532-P-519  -  INSERT TIBIAL 5 P 19MM POSTERIOR STABILIZE TRIATHLON N2/VAC","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-522","SUP","Custom 27803010","","5532-P-522  -  INSERT TIBIAL 5 22MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-525","SUP","Custom 27803010","","5532-P-525  -  INSERT TIBIAL 5 25MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-609","SUP","Custom 27803010","","5532-P-609  -  INSERT TIBIAL 6 9IN POSTERIOR STABILIZED PLASMA SPRAY","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-610","SUP","HCPCS C1776","","5532-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-611","SUP","Custom 27803010","","5532-P-611  -  INSERT TIBIAL 6 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-612","SUP","HCPCS C1776","","5532-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-613","SUP","Custom 27803010","","5532-P-613  -  INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-614","SUP","HCPCS C1776","","5532-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-616","SUP","Custom 27803010","","5532-P-616  -  INSERT TIBIAL 6 16MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-619","SUP","Custom 27803010","","5532-P-619  -  INSERT TIBIAL 6 19MM POSTERIOR STABILIZE TRIATHLON NONSTRL","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-622","SUP","Custom 27803010","","5532-P-622  -  INSERT TIBIAL 6 22MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-625","SUP","Custom 27803010","","5532-P-625  -  INSERT TIBIAL POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-709","SUP","Custom 27803010","","5532-P-709  -  INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-710","SUP","HCPCS C1776","","5532-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-711","SUP","Custom 27803010","","5532-P-711  -  INSERT TIBIAL 7 11MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-712","SUP","HCPCS C1776","","5532-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-713","SUP","Custom 27803010","","5532-P-713  -  INSERT TIBIAL 13MM POSTERIOR STABILIZE TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-714","SUP","HCPCS C1776","","5532-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-716","SUP","Custom 27803010","","5532-P-716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-719","SUP","Custom 27803010","","5532-P-719  -  INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-722","SUP","Custom 27803010","","5532-P-722  -  INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-725","SUP","Custom 27803010","","5532-P-725  -  INSERT TIBIAL 7 25MM POSTERIOR STABILIZE TRIATHLON KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-809","SUP","Custom 27803010","","5532-P-809  -  INSERT TIBIAL 8 9MM POSTERIOR STABILIZE BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-810","SUP","HCPCS C1776","","5532-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-811","SUP","Custom 27803010","","5532-P-811  -  INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-812","SUP","HCPCS C1776","","5532-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-813","SUP","Custom 27803010","","5532-P-813  -  INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-814","SUP","HCPCS C1776","","5532-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG POST STAB KN","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$540.00 ","$0.00 ","$250.11 ","$0.00 ","$0.00 ","$210.11 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$187.80 ","$0.00 ","$191.04 ","$0.00 "
"5532-P-816","SUP","Custom 27803010","","5532-P-816  -  INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-819","SUP","Custom 27803010","","5532-P-819  -  INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-822","SUP","Custom 27803010","","5532-P-822  -  INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5532-P-825","SUP","Custom 27803010","","5532-P-825  -  INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5534-A-109","SUP","HCPCS C1776","","5534-A-109  -  COMPONENT TIB 1 9MM CRCTE STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-111","SUP","HCPCS C1776","","5534-A-111  -  INSERT TIB 1 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-113","SUP","HCPCS C1776","","5534-A-113  -  INSERT TIB 1 13MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-116","SUP","HCPCS C1776","","5534-A-116  -  INSERT TIB 1 16MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-209","SUP","HCPCS C1776","","5534-A-209  -  INSERT TIB 2 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-211","SUP","HCPCS C1776","","5534-A-211  -  INSERT TIB 2 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-213","SUP","HCPCS C1776","","5534-A-213  -  INSERT TIB 2 13MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-216","SUP","HCPCS C1776","","5534-A-216  -  INSERT TIB 2 16MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-309","SUP","HCPCS C1776","","5534-A-309  -  INSERT TIB 3 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-311","SUP","HCPCS C1776","","5534-A-311  -  INSERT TIB 3 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-313","SUP","HCPCS C1776","","5534-A-313  -  COMPONENT TIB 3 13MM CRCTE STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-316","SUP","HCPCS C1776","","5534-A-316  -  COMPONENT TIB 3 16MM CRCTE STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-409","SUP","HCPCS C1776","","5534-A-409  -  INSERT TIB 4 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-411","SUP","HCPCS C1776","","5534-A-411  -  INSERT TIB 4 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-413","SUP","HCPCS C1776","","5534-A-413  -  INSERT TIB 4 13MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-416","SUP","HCPCS C1776","","5534-A-416  -  COMPONENT TIB 4 16MM CRCTE STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-509","SUP","HCPCS C1776","","5534-A-509  -  INSERT TIB 5 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-511","SUP","HCPCS C1776","","5534-A-511  -  INSERT TIB 5 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-513","SUP","HCPCS C1776","","5534-A-513  -  TRAY TIB 5 13MM STRL TRTHLN CNDRL STAB ALPLY KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-516","SUP","HCPCS C1776","","5534-A-516  -  INSERT TIB 5 16MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-609","SUP","HCPCS C1776","","5534-A-609  -  INSERT TIB 6 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-611","SUP","HCPCS C1776","","5534-A-611  -  INSERT TIB 6 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-613","SUP","HCPCS C1776","","5534-A-613  -  INSERT TIB 6 13MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-616","SUP","HCPCS C1776","","5534-A-616  -  INSERT TIB 6 16MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-709","SUP","HCPCS C1776","","5534-A-709  -  INSERT TIB 7 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-711","SUP","HCPCS C1776","","5534-A-711  -  INSERT TIB 7 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-713","SUP","HCPCS C1776","","5534-A-713  -  INSERT TIB 7 13MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-716","SUP","HCPCS C1776","","5534-A-716  -  TRAY TIB 7 16MM STRL TRTHLN CNDRL STAB ALPLY KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-809","SUP","HCPCS C1776","","5534-A-809  -  INSERT TIB 8 9MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-811","SUP","HCPCS C1776","","5534-A-811  -  INSERT TIB 8 11MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-813","SUP","HCPCS C1776","","5534-A-813  -  INSERT TIB 8 13MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5534-A-816","SUP","HCPCS C1776","","5534-A-816  -  INSERT TIB 8 16MM CNDRL STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-109","SUP","HCPCS C1776","","5535-A-109  -  INSERT TIB 1 9MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-111","SUP","HCPCS C1776","","5535-A-111  -  INSERT TIB 1 11MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-113","SUP","HCPCS C1776","","5535-A-113  -  INSERT TIB 1 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-116","SUP","HCPCS C1776","","5535-A-116  -  INSERT TIB 1 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-209","SUP","HCPCS C1776","","5535-A-209  -  INSERT TIB 2 9MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-211","SUP","HCPCS C1776","","5535-A-211  -  INSERT TIB 2 11MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-213","SUP","HCPCS C1776","","5535-A-213  -  INSERT TIB 2 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-216","SUP","HCPCS C1776","","5535-A-216  -  INSERT TIB 2 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-309","SUP","HCPCS C1776","","5535-A-309  -  INSERT TIB 3 9MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-311","SUP","HCPCS C1776","","5535-A-311  -  COMPONENT TIB 3 11MM POST STAB PE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-313","SUP","HCPCS C1776","","5535-A-313  -  INSERT TIB 3 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-316","SUP","HCPCS C1776","","5535-A-316  -  INSERT TIB 3 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-409","SUP","HCPCS C1776","","5535-A-409  -  INSERT TIB 4 9MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-411","SUP","HCPCS C1776","","5535-A-411  -  COMPONENT TIB 4 11MM POST STAB ALPLY KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-413","SUP","HCPCS C1776","","5535-A-413  -  TRAY TIB 4 13MM STRL TRTHLN POST STAB ALPLY KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-416","SUP","HCPCS C1776","","5535-A-416  -  INSERT TIB 4 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-509","SUP","HCPCS C1776","","5535-A-509  -  INSERT TIB 5 9MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-511","SUP","HCPCS C1776","","5535-A-511  -  COMPONENT TIB 5 11MM POST STAB ALPLY KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-513","SUP","HCPCS C1776","","5535-A-513  -  INSERT TIB 5 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-516","SUP","HCPCS C1776","","5535-A-516  -  INSERT TIB 5 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-609","SUP","HCPCS C1776","","5535-A-609  -  COMPONENT TIB 6 9MM POST STAB PE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-611","SUP","HCPCS C1776","","5535-A-611  -  COMPONENT TIB 6 11MM POST STAB PE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-613","SUP","HCPCS C1776","","5535-A-613  -  INSERT TIB 6 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-616","SUP","HCPCS C1776","","5535-A-616  -  INSERT TIB 6 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-709","SUP","HCPCS C1776","","5535-A-709  -  TRAY TIB 7 9MM STRL TRTHLN POST STAB ALPLY KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-711","SUP","HCPCS C1776","","5535-A-711  -  INSERT TIB 7 11MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-713","SUP","HCPCS C1776","","5535-A-713  -  INSERT TIB 7 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-716","SUP","HCPCS C1776","","5535-A-716  -  INSERT TIB 7 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-809","SUP","HCPCS C1776","","5535-A-809  -  INSERT TIB 8 9MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-811","SUP","HCPCS C1776","","5535-A-811  -  INSERT TIB 8 11MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-813","SUP","HCPCS C1776","","5535-A-813  -  INSERT TIB 8 13MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5535-A-816","SUP","HCPCS C1776","","5535-A-816  -  INSERT TIB 8 16MM POST STAB ALL PE KN","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"5536-B-100","SUP","HCPCS C1776","","5536-B-100  -  BASEPLATE TIB 1 7MM 40X40MM 61MM TRTHLN 4 CRFRM PG KEEL","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-200","SUP","HCPCS C1776","","5536-B-200  -  COMPONENT TIB 2 STRL LF TRTHLN KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-300","SUP","HCPCS C1776","","5536-B-300  -  BASEPLATE TIB 3 TRTHLN TRITANIUM KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-400","SUP","HCPCS C1776","","5536-B-400  -  BASEPLATE TIB 4 TRTHLN TRITANIUM KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-500","SUP","HCPCS C1776","","5536-B-500  -  BASEPLATE TIB 5 TRTHLN TRITANIUM KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-600","SUP","HCPCS C1776","","5536-B-600  -  BASEPLATE TIB 6 TRTHLN TRITANIUM KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-700","SUP","HCPCS C1776","","5536-B-700  -  BASEPLATE TIB 7 TRTHLN TRITANIUM KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5536-B-800","SUP","HCPCS C1776","","5536-B-800  -  BASEPLATE TIB 8 TRTHLN TRITANIUM KN","BOTH IP/OP","$3,602.50 ","$2,665.85 ","$0.00 ","$3,602.50 ","$1,621.13 ","$0.00 ","$750.85 ","$0.00 ","$0.00 ","$630.77 ","$3,602.50 ","$0.00 ","$1,801.25 ","$2,853.18 ","$2,882.00 ","$0.00 ","$563.79 ","$0.00 ","$573.52 ","$0.00 "
"5537-14/13","SUP","HCPCS C1776","","5537-14/13  -  STEM HUMERAL 14MM 135MM PRESS FIT HUMERAL TITANIUM SHOULDER","BOTH IP/OP","$6,566.70 ","$4,859.36 ","$0.00 ","$6,566.70 ","$2,955.02 ","$0.00 ","$1,368.66 ","$0.00 ","$0.00 ","$1,149.78 ","$6,566.70 ","$0.00 ","$3,283.35 ","$5,200.83 ","$5,253.36 ","$0.00 ","$1,027.69 ","$0.00 ","$1,045.42 ","$0.00 "
"5537-G-109","SUP","HCPCS C1776","","5537-G-109  -  INSERT TIBIAL 1 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-109-E","SUP","HCPCS C1776","","5537-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-111","SUP","HCPCS C1776","","5537-G-111  -  INSERT TIBIAL 1 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-111-E","SUP","HCPCS C1776","","5537-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-113","SUP","HCPCS C1776","","5537-G-113  -  INSERT TIBIAL 1 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-113-E","SUP","HCPCS C1776","","5537-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-116","SUP","HCPCS C1776","","5537-G-116  -  INSERT TIBIAL 1 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-116-E","SUP","HCPCS C1776","","5537-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-119","SUP","HCPCS C1776","","5537-G-119  -  INSERT TIBIAL 1 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-119-E","SUP","HCPCS C1776","","5537-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-122","SUP","HCPCS C1776","","5537-G-122  -  INSERT TIBIAL 1 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-122-E","SUP","HCPCS C1776","","5537-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-125","SUP","HCPCS C1776","","5537-G-125  -  INSERT TIBIAL 1 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-125-E","SUP","HCPCS C1776","","5537-G-125-E  -  INSERT TIB 1 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-128","SUP","HCPCS C1776","","5537-G-128  -  INSERT TIBIAL 1 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-128-E","SUP","HCPCS C1776","","5537-G-128-E  -  INSERT TIB 1 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-131","SUP","HCPCS C1776","","5537-G-131  -  INSERT TIBIAL 1 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-131-E","SUP","HCPCS C1776","","5537-G-131-E  -  INSERT TIB 1 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-209","SUP","HCPCS C1776","","5537-G-209  -  INSERT TIBIAL 2 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-209-E","SUP","HCPCS C1776","","5537-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-211","SUP","HCPCS C1776","","5537-G-211  -  INSERT TIBIAL 2 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-211-E","SUP","HCPCS C1776","","5537-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-213","SUP","HCPCS C1776","","5537-G-213  -  INSERT TIBIAL 2 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-213-E","SUP","HCPCS C1776","","5537-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-216","SUP","HCPCS C1776","","5537-G-216  -  INSERT TIBIAL 2 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-216-E","SUP","HCPCS C1776","","5537-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-219","SUP","HCPCS C1776","","5537-G-219  -  INSERT TIBIAL 2 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-219-E","SUP","HCPCS C1776","","5537-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-222","SUP","HCPCS C1776","","5537-G-222  -  INSERT TIBIAL 2 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-222-E","SUP","HCPCS C1776","","5537-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-225","SUP","HCPCS C1776","","5537-G-225  -  INSERT TIBIAL 2 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-225-E","SUP","HCPCS C1776","","5537-G-225-E  -  INSERT TIB 2 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-228","SUP","HCPCS C1776","","5537-G-228  -  INSERT TIBIAL 2 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-228-E","SUP","HCPCS C1776","","5537-G-228-E  -  INSERT TIB 2 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-231","SUP","HCPCS C1776","","5537-G-231  -  INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-231-E","SUP","HCPCS C1776","","5537-G-231-E  -  INSERT TIB 2 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-309","SUP","HCPCS C1776","","5537-G-309  -  INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-309-E","SUP","HCPCS C1776","","5537-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-311","SUP","HCPCS C1776","","5537-G-311  -  INSERT TIBIAL 3 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-311-E","SUP","HCPCS C1776","","5537-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-313","SUP","HCPCS C1776","","5537-G-313  -  INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-313-E","SUP","HCPCS C1776","","5537-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-316","SUP","HCPCS C1776","","5537-G-316  -  INSERT TIBIAL 3 16MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-316-E","SUP","HCPCS C1776","","5537-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-319","SUP","HCPCS C1776","","5537-G-319  -  INSERT TIBIAL 3 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-319-E","SUP","HCPCS C1776","","5537-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-322","SUP","HCPCS C1776","","5537-G-322  -  INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-322-E","SUP","HCPCS C1776","","5537-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN TS + X3 KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-325","SUP","HCPCS C1776","","5537-G-325  -  INSERT TIBIAL 3 25MM TOT STABILIZED PLUS TRIATHLON X3","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-325-E","SUP","HCPCS C1776","","5537-G-325-E  -  INSERT TIB 3 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-328","SUP","HCPCS C1776","","5537-G-328  -  INSERT TIBIAL 3 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-328-E","SUP","HCPCS C1776","","5537-G-328-E  -  INSERT TIB 3 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-331","SUP","HCPCS C1776","","5537-G-331  -  INSERT TIBIAL 3 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-331-E","SUP","HCPCS C1776","","5537-G-331-E  -  INSERT TIB 3 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-409","SUP","HCPCS C1776","","5537-G-409  -  INSERT TIBIAL 4 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-409-E","SUP","HCPCS C1776","","5537-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-411","SUP","HCPCS C1776","","5537-G-411  -  INSERT TIBIAL 4 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-411-E","SUP","HCPCS C1776","","5537-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-413","SUP","HCPCS C1776","","5537-G-413  -  INSERT TIBIAL 4 13MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-413-E","SUP","HCPCS C1776","","5537-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-416","SUP","HCPCS C1776","","5537-G-416  -  INSERT TIBIAL 4 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-416-E","SUP","HCPCS C1776","","5537-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-419","SUP","HCPCS C1776","","5537-G-419  -  INSERT TIBIAL 4 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-419-E","SUP","HCPCS C1776","","5537-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-422","SUP","HCPCS C1776","","5537-G-422  -  INSERT TIBIAL 4 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-422-E","SUP","HCPCS C1776","","5537-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-425","SUP","HCPCS C1776","","5537-G-425  -  INSERT TIBIAL 4 25MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-425-E","SUP","HCPCS C1776","","5537-G-425-E  -  INSERT TIB 4 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-428","SUP","HCPCS C1776","","5537-G-428  -  INSERT TIBIAL 4 28MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-428-E","SUP","HCPCS C1776","","5537-G-428-E  -  INSERT TIB 4 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-431","SUP","HCPCS C1776","","5537-G-431  -  INSERT TIBIAL 4 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-431-E","SUP","HCPCS C1776","","5537-G-431-E  -  INSERT TIB 4 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-509","SUP","HCPCS C1776","","5537-G-509  -  INSERT TIBIAL 5 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-509-E","SUP","HCPCS C1776","","5537-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-511","SUP","HCPCS C1776","","5537-G-511  -  INSERT TIBIAL 5 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-511-E","SUP","HCPCS C1776","","5537-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-513","SUP","HCPCS C1776","","5537-G-513  -  INSERT TIBIAL 5 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-513-E","SUP","HCPCS C1776","","5537-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-516","SUP","HCPCS C1776","","5537-G-516  -  INSERT TIBIAL 5 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-516-E","SUP","HCPCS C1776","","5537-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-519","SUP","HCPCS C1776","","5537-G-519  -  INSERT TIBIAL 5 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-519-E","SUP","HCPCS C1776","","5537-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-522","SUP","HCPCS C1776","","5537-G-522  -  INSERT TIBIAL 5 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-522-E","SUP","HCPCS C1776","","5537-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-525","SUP","HCPCS C1776","","5537-G-525  -  INSERT TIBIAL 5 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-525-E","SUP","HCPCS C1776","","5537-G-525-E  -  INSERT TIB 5 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-528","SUP","HCPCS C1776","","5537-G-528  -  INSERT TIBIAL 5 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-528-E","SUP","HCPCS C1776","","5537-G-528-E  -  INSERT TIB 5 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-531","SUP","HCPCS C1776","","5537-G-531  -  INSERT TIBIAL 5 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-531-E","SUP","HCPCS C1776","","5537-G-531-E  -  INSERT TIB 5 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-609","SUP","HCPCS C1776","","5537-G-609  -  INSERT TIBIAL 6 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-609-E","SUP","HCPCS C1776","","5537-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-611","SUP","HCPCS C1776","","5537-G-611  -  INSERT TIBIAL 6 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-611-E","SUP","HCPCS C1776","","5537-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-613","SUP","HCPCS C1776","","5537-G-613  -  INSERT TIBIAL 6 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-613-E","SUP","HCPCS C1776","","5537-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-616","SUP","HCPCS C1776","","5537-G-616  -  INSERT TIBIAL 6 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-616-E","SUP","HCPCS C1776","","5537-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-619","SUP","HCPCS C1776","","5537-G-619  -  INSERT TIBIAL 6 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-619-E","SUP","HCPCS C1776","","5537-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-622","SUP","HCPCS C1776","","5537-G-622  -  INSERT TIBIAL 6 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-622-E","SUP","HCPCS C1776","","5537-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-625","SUP","HCPCS C1776","","5537-G-625  -  INSERT TIBIAL 6 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-625-E","SUP","HCPCS C1776","","5537-G-625-E  -  INSERT TIB 6 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-628","SUP","HCPCS C1776","","5537-G-628  -  INSERT TIBIAL 6 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-628-E","SUP","HCPCS C1776","","5537-G-628-E  -  INSERT TIB 6 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-631","SUP","HCPCS C1776","","5537-G-631  -  INSERT TIBIAL 6 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-631-E","SUP","HCPCS C1776","","5537-G-631-E  -  INSERT TIB 6 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-709","SUP","HCPCS C1776","","5537-G-709  -  INSERT TIBIAL 7 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-709-E","SUP","HCPCS C1776","","5537-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-711","SUP","HCPCS C1776","","5537-G-711  -  INSERT TIBIAL 7 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-711-E","SUP","HCPCS C1776","","5537-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-713","SUP","HCPCS C1776","","5537-G-713  -  INSERT TIBIAL 7 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-713-E","SUP","HCPCS C1776","","5537-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-716","SUP","HCPCS C1776","","5537-G-716  -  INSERT TIBIAL 7 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-716-E","SUP","HCPCS C1776","","5537-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-719","SUP","HCPCS C1776","","5537-G-719  -  INSERT TIBIAL 7 19MM TOT STABILIZE TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-719-E","SUP","HCPCS C1776","","5537-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-722","SUP","HCPCS C1776","","5537-G-722  -  INSERT TIBIAL 7 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-722-E","SUP","HCPCS C1776","","5537-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-725","SUP","HCPCS C1776","","5537-G-725  -  INSERT TIBIAL 7 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-725-E","SUP","HCPCS C1776","","5537-G-725-E  -  INSERT TIB 7 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-728","SUP","HCPCS C1776","","5537-G-728  -  INSERT TIBIAL 7 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-728-E","SUP","HCPCS C1776","","5537-G-728-E  -  INSERT TIB 7 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-731","SUP","HCPCS C1776","","5537-G-731  -  INSERT TIBIAL 7 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-731-E","SUP","HCPCS C1776","","5537-G-731-E  -  INSERT TIB 7 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-809","SUP","HCPCS C1776","","5537-G-809  -  INSERT TIBIAL 8 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-809-E","SUP","HCPCS C1776","","5537-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-811","SUP","HCPCS C1776","","5537-G-811  -  INSERT TIBIAL 8 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-811-E","SUP","HCPCS C1776","","5537-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-813","SUP","HCPCS C1776","","5537-G-813  -  INSERT TIBIAL 8 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-813-E","SUP","HCPCS C1776","","5537-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-816","SUP","HCPCS C1776","","5537-G-816  -  INSERT TIBIAL 8 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-816-E","SUP","HCPCS C1776","","5537-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-819","SUP","HCPCS C1776","","5537-G-819  -  INSERT TIBIAL 8 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-819-E","SUP","HCPCS C1776","","5537-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-822","SUP","HCPCS C1776","","5537-G-822  -  INSERT TIBIAL 8 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-822-E","SUP","HCPCS C1776","","5537-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-825","SUP","HCPCS C1776","","5537-G-825  -  INSERT TIBIAL 8 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-825-E","SUP","HCPCS C1776","","5537-G-825-E  -  INSERT TIB 8 25MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-828","SUP","HCPCS C1776","","5537-G-828  -  INSERT TIBIAL 8 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-828-E","SUP","HCPCS C1776","","5537-G-828-E  -  INSERT TIB 8 28MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-831","SUP","HCPCS C1776","","5537-G-831  -  INSERT TIBIAL 8 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5537-G-831-E","SUP","HCPCS C1776","","5537-G-831-E  -  INSERT TIB 8 31MM STRL TRTHLN TS + KN","BOTH IP/OP","$5,255.00 ","$3,888.70 ","$0.00 ","$5,255.00 ","$2,364.75 ","$0.00 ","$1,095.27 ","$0.00 ","$0.00 ","$920.11 ","$5,255.00 ","$0.00 ","$2,627.50 ","$4,161.96 ","$4,204.00 ","$0.00 ","$822.41 ","$0.00 ","$836.60 ","$0.00 "
"5539-91","SUP","HCPCS C1725","","CATHETER ANGIO .035IN 5FR .052IN 90CM PGTL FLSH 10 SDPRT","BOTH IP/OP","$33.75 ","$24.98 ","$0.00 ","$33.75 ","$18.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.91 ","$33.75 ","$0.00 ","$16.88 ","$26.73 ","$27.00 ","$0.00 ","$5.28 ","$0.00 ","$5.37 ","$0.00 "
"5540-14/13","SUP","HCPCS C1776","","5540-14/13  -  STEM HUMERAL 14MM 135MM PRESS FIT TITANIUM HA STERILE","BOTH IP/OP","$6,943.00 ","$5,137.82 ","$0.00 ","$6,943.00 ","$3,124.35 ","$0.00 ","$1,447.09 ","$0.00 ","$0.00 ","$1,215.66 ","$6,943.00 ","$0.00 ","$3,471.50 ","$5,498.86 ","$5,554.40 ","$0.00 ","$1,086.58 ","$0.00 ","$1,105.33 ","$0.00 "
"5540-A-101","SUP","Custom 27803010","","5540-A-101  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-102","SUP","Custom 27803010","","5540-A-102  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-201","SUP","Custom 27803010","","5540-A-201  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-202","SUP","Custom 27803010","","5540-A-202  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-301","SUP","Custom 27803010","","5540-A-301  -  AUGMENT FEMORAL 3 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-302","SUP","Custom 27803010","","5540-A-302  -  AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-401","SUP","Custom 27803010","","5540-A-401  -  AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-402","SUP","Custom 27803010","","5540-A-402  -  AUGMENT FEMORAL 4 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-501","SUP","Custom 27803010","","5540-A-501  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-502","SUP","Custom 27803010","","5540-A-502  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-601","SUP","Custom 27803010","","5540-A-601  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-602","SUP","Custom 27803010","","5540-A-602  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-701","SUP","Custom 27803010","","5540-A-701  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-702","SUP","Custom 27803010","","5540-A-702  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-801","SUP","Custom 27803010","","5540-A-801  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5540-A-802","SUP","Custom 27803010","","5540-A-802  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-101","SUP","Custom 27803010","","5541-A-101  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-102","SUP","Custom 27803010","","5541-A-102  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-201","SUP","Custom 27803010","","5541-A-201  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-202","SUP","Custom 27803010","","5541-A-202  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-301","SUP","Custom 27803010","","5541-A-301  -  AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-302","SUP","Custom 27803010","","5541-A-302  -  AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-401","SUP","Custom 27803010","","5541-A-401  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-402","SUP","Custom 27803010","","5541-A-402  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-501","SUP","Custom 27803010","","5541-A-501  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-502","SUP","Custom 27803010","","5541-A-502  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-601","SUP","Custom 27803010","","5541-A-601  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-602","SUP","Custom 27803010","","5541-A-602  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-701","SUP","Custom 27803010","","5541-A-701  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-702","SUP","Custom 27803010","","5541-A-702  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-801","SUP","Custom 27803010","","5541-A-801  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5541-A-802","SUP","Custom 27803010","","5541-A-802  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-101","SUP","Custom 27803010","","5542-A-101  -  AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-102","SUP","Custom 27803010","","5542-A-102  -  AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-201","SUP","Custom 27803010","","5542-A-201  -  AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-202","SUP","Custom 27803010","","5542-A-202  -  AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-301","SUP","Custom 27803010","","5542-A-301  -  AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-302","SUP","Custom 27803010","","5542-A-302  -  AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-401","SUP","Custom 27803010","","5542-A-401  -  AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-402","SUP","Custom 27803010","","5542-A-402  -  AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEEL RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-501","SUP","Custom 27803010","","5542-A-501  -  AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-502","SUP","Custom 27803010","","5542-A-502  -  AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-601","SUP","Custom 27803010","","5542-A-601  -  AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-602","SUP","Custom 27803010","","5542-A-602  -  AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-701","SUP","Custom 27803010","","5542-A-701  -  AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-702","SUP","Custom 27803010","","5542-A-702  -  AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-801","SUP","Custom 27803010","","5542-A-801  -  AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE LEFT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5542-A-802","SUP","Custom 27803010","","5542-A-802  -  AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE RIGHT","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-100","SUP","Custom 27803010","","5543-A-100  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-200","SUP","Custom 27803010","","5543-A-200  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-300","SUP","Custom 27803010","","5543-A-300  -  AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-400","SUP","Custom 27803010","","5543-A-400  -  AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-500","SUP","Custom 27803010","","5543-A-500  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-600","SUP","Custom 27803010","","5543-A-600  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-700","SUP","Custom 27803010","","5543-A-700  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5543-A-800","SUP","Custom 27803010","","5543-A-800  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-100","SUP","Custom 27803010","","5544-A-100  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-200","SUP","Custom 27803010","","5544-A-200  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-300","SUP","Custom 27803010","","5544-A-300  -  AUGMENT FEMORAL 3 10MM TOT STABILIZED BACKWARD BLOCK","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-400","SUP","Custom 27803010","","5544-A-400  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-500","SUP","Custom 27803010","","5544-A-500  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-600","SUP","Custom 27803010","","5544-A-600  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-700","SUP","Custom 27803010","","5544-A-700  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5544-A-800","SUP","Custom 27803010","","5544-A-800  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,352.50 ","$1,740.85 ","$0.00 ","$2,352.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,352.50 ","$0.00 ","$1,176.25 ","$1,863.18 ","$1,882.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-101","SUP","Custom 27803010","","5545-A-101  -  AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-102","SUP","Custom 27803010","","5545-A-102  -  AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-201","SUP","Custom 27803010","","5545-A-201  -  AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-202","SUP","Custom 27803010","","5545-A-202  -  AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-301","SUP","Custom 27803010","","5545-A-301  -  AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-302","SUP","Custom 27803010","","5545-A-302  -  AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-401","SUP","Custom 27803010","","5545-A-401  -  AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-402","SUP","Custom 27803010","","5545-A-402  -  AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-501","SUP","Custom 27803010","","5545-A-501  -  AUGMENT TIBIAL 5 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-502","SUP","Custom 27803010","","5545-A-502  -  AUGMENT TIBIAL 5 5MM TRIATHLON RIGHT MEDIAL LEFT LATERAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-601","SUP","Custom 27803010","","5545-A-601  -  AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-602","SUP","Custom 27803010","","5545-A-602  -  AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-701","SUP","Custom 27803010","","5545-A-701  -  AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-702","SUP","Custom 27803010","","5545-A-702  -  AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-801","SUP","Custom 27803010","","5545-A-801  -  AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5545-A-802","SUP","Custom 27803010","","5545-A-802  -  AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-101","SUP","Custom 27803010","","5546-A-101  -  AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-102","SUP","Custom 27803010","","5546-A-102  -  AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-201","SUP","Custom 27803010","","5546-A-201  -  AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-202","SUP","Custom 27803010","","5546-A-202  -  AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-301","SUP","Custom 27803010","","5546-A-301  -  AUGMENT TIBIAL 3 10MM TOT STABILIZED FIXING SCREW TRIATHLON","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-302","SUP","Custom 27803010","","5546-A-302  -  AUGMENT TIBIAL 3 10MM TOAL STABILIZED TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-401","SUP","Custom 27803010","","5546-A-401  -  AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-402","SUP","Custom 27803010","","5546-A-402  -  AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-501","SUP","Custom 27803010","","5546-A-501  -  AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-502","SUP","Custom 27803010","","5546-A-502  -  AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-601","SUP","Custom 27803010","","5546-A-601  -  AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-602","SUP","Custom 27803010","","5546-A-602  -  AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-701","SUP","Custom 27803010","","5546-A-701  -  AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-702","SUP","Custom 27803010","","5546-A-702  -  AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-801","SUP","Custom 27803010","","5546-A-801  -  AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5546-A-802","SUP","Custom 27803010","","5546-A-802  -  AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL","BOTH IP/OP","$2,095.00 ","$1,550.30 ","$0.00 ","$2,095.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.00 ","$0.00 ","$1,047.50 ","$1,659.24 ","$1,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5549-A-110","SUP","HCPCS C1776","","5549-A-110  -  AUGMENT TIB A CONE STRL LF TRTHLN SMTR TRITANIUM","BOTH IP/OP","$8,495.00 ","$6,286.30 ","$0.00 ","$8,495.00 ","$3,822.75 ","$0.00 ","$1,770.57 ","$0.00 ","$0.00 ","$1,487.41 ","$8,495.00 ","$0.00 ","$4,247.50 ","$6,728.04 ","$6,796.00 ","$0.00 ","$1,329.47 ","$0.00 ","$1,352.40 ","$0.00 "
"5549-A-120","SUP","HCPCS C1776","","5549-A-120  -  AUGMENT TIB B CONE STRL LF TRTHLN SMTR TRITANIUM","BOTH IP/OP","$8,495.00 ","$6,286.30 ","$0.00 ","$8,495.00 ","$3,822.75 ","$0.00 ","$1,770.57 ","$0.00 ","$0.00 ","$1,487.41 ","$8,495.00 ","$0.00 ","$4,247.50 ","$6,728.04 ","$6,796.00 ","$0.00 ","$1,329.47 ","$0.00 ","$1,352.40 ","$0.00 "
"5549-A-140","SUP","HCPCS C1776","","5549-A-140  -  AUGMENT TIB D CONE TRTHLN SMTR REV TRITANIUM KN","BOTH IP/OP","$8,495.00 ","$6,286.30 ","$0.00 ","$8,495.00 ","$3,822.75 ","$0.00 ","$1,770.57 ","$0.00 ","$0.00 ","$1,487.41 ","$8,495.00 ","$0.00 ","$4,247.50 ","$6,728.04 ","$6,796.00 ","$0.00 ","$1,329.47 ","$0.00 ","$1,352.40 ","$0.00 "
"5549-A-150","SUP","HCPCS C1776","","5549-A-150  -  AUGMENT TIB E CONE TRTHLN SMTR REV TRITANIUM KN","BOTH IP/OP","$8,495.00 ","$6,286.30 ","$0.00 ","$8,495.00 ","$3,822.75 ","$0.00 ","$1,770.57 ","$0.00 ","$0.00 ","$1,487.41 ","$8,495.00 ","$0.00 ","$4,247.50 ","$6,728.04 ","$6,796.00 ","$0.00 ","$1,329.47 ","$0.00 ","$1,352.40 ","$0.00 "
"5549-A-221","SUP","HCPCS C1776","","5549-A-221  -  AUGMENT TIB B CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-222","SUP","HCPCS C1776","","5549-A-222  -  AUGMENT TIB B CONE STRL TRTHLN ASYM TRITANIUM KN RMLL","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-231","SUP","HCPCS C1776","","5549-A-231  -  AUGMENT TIB C CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-232","SUP","HCPCS C1776","","5549-A-232  -  AUGMENT TIB C CONE TRTHLN ASYM REV TRITANIUM KN RMLL","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-241","SUP","HCPCS C1776","","5549-A-241  -  AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-242","SUP","HCPCS C1776","","5549-A-242  -  AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN RMLL REV SYS","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-251","SUP","HCPCS C1776","","5549-A-251  -  AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN LT MDL RL","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-252","SUP","HCPCS C1776","","5549-A-252  -  AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN RMLL","BOTH IP/OP","$9,085.00 ","$6,722.90 ","$0.00 ","$9,085.00 ","$4,088.25 ","$0.00 ","$1,893.54 ","$0.00 ","$0.00 ","$1,590.71 ","$9,085.00 ","$0.00 ","$4,542.50 ","$7,195.32 ","$7,268.00 ","$0.00 ","$1,421.80 ","$0.00 ","$1,446.33 ","$0.00 "
"5549-A-321","SUP","HCPCS C1776","","5549-A-321  -  AUGMENT FEM 1 2 CONE TRTHLN TRITANIUM KN LT REV SYS","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-322","SUP","HCPCS C1776","","5549-A-322  -  AUGMENT FEM 1 2 CONE TRTHLN REV TRITANIUM KN RT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-331","SUP","HCPCS C1776","","5549-A-331  -  AUGMENT FEM 3 CONE TRTHLN REV TRITANIUM KN LT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-332","SUP","HCPCS C1776","","5549-A-332  -  AUGMENT FEM 3 CONE TRTHLN TRITANIUM KN RT REV SYS","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-341","SUP","HCPCS C1776","","5549-A-341  -  AUGMENT FEM 4 CONE TRTHLN REV TRITANIUM KN LT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-342","SUP","HCPCS C1776","","5549-A-342  -  AUGMENT FEM 4 CONE TRTHLN TRITANIUM KN RT REV SYS","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-351","SUP","HCPCS C1776","","5549-A-351  -  AUGMENT FEM 5 CONE TRTHLN TRITANIUM KN LT REV SYS","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-352","SUP","HCPCS C1776","","5549-A-352  -  AUGMENT FEM 5 CONE TRTHLN REV TRITANIUM KN RT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-361","SUP","HCPCS C1776","","5549-A-361  -  AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN LT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-362","SUP","HCPCS C1776","","5549-A-362  -  AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN RT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-371","SUP","HCPCS C1776","","5549-A-371  -  AUGMENT FEM 7 8 CONE TRTHLN TRITANIUM KN LT REV SYS","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5549-A-372","SUP","HCPCS C1776","","5549-A-372  -  AUGMENT FEM 7 8 CONE TRTHLN REV TRITANIUM KN RT","BOTH IP/OP","$9,675.00 ","$7,159.50 ","$0.00 ","$9,675.00 ","$4,353.75 ","$0.00 ","$2,016.51 ","$0.00 ","$0.00 ","$1,694.02 ","$9,675.00 ","$0.00 ","$4,837.50 ","$7,662.60 ","$7,740.00 ","$0.00 ","$1,514.14 ","$0.00 ","$1,540.26 ","$0.00 "
"5550-G-278","SUP","Custom 27803010","","5550-G-278  -  COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-G-278-E","SUP","HCPCS C1776","","5550-G-278-E  -  COMPONENT PTLR 27MM 8MM STRL TRTHLN SMTR KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5550-G-298","SUP","Custom 27803010","","5550-G-298  -  COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 TOT KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-G-298-E","SUP","HCPCS C1776","","5550-G-298-E  -  COMPONENT PTLR 29MM 8MM STRL TRTHLN SMTR KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5550-G-319","SUP","Custom 27803010","","5550-G-319  -  COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-G-319-E","SUP","HCPCS C1776","","5550-G-319-E  -  COMPONENT PTLR 31MM 9MM STRL TRTHLN SMTR KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5550-G-339","SUP","Custom 27803010","","5550-G-339  -  COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-G-339-E","SUP","HCPCS C1776","","5550-G-339-E  -  COMPONENT PTLR 33MM 9MM STRL TRTHLN SMTR KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5550-G-360","SUP","Custom 27803010","","5550-G-360  -  COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-G-360-E","SUP","HCPCS C1776","","5550-G-360-E  -  COMPONENT PTLR 36MM 10MM STRL TRTHLN SMTR KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5550-G-391","SUP","Custom 27803010","","5550-G-391  -  COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-G-391-E","SUP","HCPCS C1776","","5550-G-391-E  -  COMPONENT PTLR 39MM 11MM STRL TRTHLN SMTR KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5550-L-278","SUP","Custom 27803010","","5550-L-278  -  COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-L-298","SUP","Custom 27803010","","5550-L-298  -  COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-L-319","SUP","Custom 27803010","","5550-L-319  -  COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-L-339","SUP","Custom 27803010","","5550-L-339  -  COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-L-360","SUP","Custom 27803010","","5550-L-360  -  COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5550-L-391","SUP","Custom 27803010","","5550-L-391  -  COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-G-299","SUP","Custom 27803010","","5551-G-299  -  COMPONENT PATLR ASYMMETRIC 29MM 9MM TRIATHLON X3 TOT KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-G-299-E","SUP","HCPCS C1776","","5551-G-299-E  -  COMPONENT PTLR 29MM 9MM STRL TRTHLN ASYM KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5551-G-320","SUP","Custom 27803010","","5551-G-320  -  COMPONENT PATLR ASYMMETRIC 32MM 10MM TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-G-320-E","SUP","HCPCS C1776","","5551-G-320-E  -  COMPONENT PTLR 32MM 10MM STRL TRTHLN ASYM KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5551-G-350","SUP","Custom 27803010","","5551-G-350  -  COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-G-350-E","SUP","HCPCS C1776","","5551-G-350-E  -  COMPONENT PTLR 35MM 10MM STRL TRTHLN ASYM KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5551-G-381","SUP","Custom 27803010","","5551-G-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-G-381-E","SUP","HCPCS C1776","","5551-G-381-E  -  COMPONENT PTLR 38MM 11MM STRL TRTHLN ASYM KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5551-G-401","SUP","Custom 27803010","","5551-G-401  -  COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-G-401-E","SUP","HCPCS C1776","","5551-G-401-E  -  COMPONENT PTLR 40MM 11MM STRL TRTHLN ASYM KN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"5551-L-299","SUP","Custom 27803010","","5551-L-299  -  COMPONENT PATLR 29MM 9MM ASYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-L-320","SUP","Custom 27803010","","5551-L-320  -  COMPONENT PATLR 32MM 10MM ASYMMETRIC TRIATHLON KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-L-350","SUP","Custom 27803010","","5551-L-350  -  COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-L-381","SUP","Custom 27803010","","5551-L-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5551-L-401","SUP","Custom 27803010","","5551-L-401  -  COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5552-L-299","SUP","HCPCS C1776","","5552-L-299  -  COMPONENT PTLR 29MM 9MM TRITANIUM ASYM MTL KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5552-L-320","SUP","HCPCS C1776","","5552-L-320  -  COMPONENT PTLR 32MM 10MM ASYM TRITANIUM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5552-L-350","SUP","HCPCS C1776","","5552-L-350  -  COMPONENT PTLR 35MM 10MM ASYM TRITANIUM MTL KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5552-L-381","SUP","HCPCS C1776","","5552-L-381  -  COMPONENT PTLR 38MM 11MM TRITANIUM ASYM MTL KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5552-L-401","SUP","HCPCS C1776","","5552-L-401  -  COMPONENT PTLR 40MM 11MM TRITANIUM ASYM MTL KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5554-L-320","SUP","Custom 27803010","","5554-L-320  -  COMPONENT PATLR 32MM 10MM ASYMMETRIC METAL BACKED BEADED","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5554-L-350","SUP","Custom 27803010","","5554-L-350  -  COMPONENT PATLR 35MM BEAD","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5554-L-381","SUP","Custom 27803010","","5554-L-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC METAL BACKED BEADED","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5554-L-401","SUP","Custom 27803010","","5554-L-401  -  COMPONENT PATLR 40MM BEAD TRIATHLON PERI-APATITE KNEE","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2901","SUP","Custom 27203010","","5555-2901  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2902","SUP","Custom 27203010","","5555-2902  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2903","SUP","Custom 27203010","","5555-2903  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2904","SUP","Custom 27203010","","5555-2904  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2905","SUP","Custom 27203010","","5555-2905  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2906","SUP","Custom 27203010","","5555-2906  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2907","SUP","Custom 27203010","","5555-2907  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-2908","SUP","Custom 27203010","","5555-2908  -  BLOCK CUT TRTHLN PRCS","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.00 ","$0.00 ","$44.50 ","$70.49 ","$71.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3201","SUP","Custom 27203010","","5555-3201  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3202","SUP","Custom 27203010","","5555-3202  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3203","SUP","Custom 27203010","","5555-3203  -  SET TRAUMA FIX 3 TIB PRCS PREP KIT CR STD","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3204","SUP","Custom 27203010","","5555-3204  -  SET TRAUMA FIX 4 STD TIB CRUC RET PRCS PREP KIT TRTHLN","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3205","SUP","Custom 27203010","","5555-3205  -  SET ORTH TRTHLN 5 PRP","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3206","SUP","Custom 27203010","","5555-3206  -  KIT PRP TRTHLN 6 PRCS TIB CRUC RET STD","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3207","SUP","Custom 27203010","","5555-3207  -  SET TRAUMA FIX 7 STD TIB CRUC RET PRCS PREP KIT TRTHLN","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3208","SUP","HCPCS C1713","","5555-3208  -  SYSTEM BONE CMNT PRP KIT TIB BIOPREP","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$75.60 ","$0.00 ","$35.02 ","$0.00 ","$0.00 ","$29.42 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$26.29 ","$0.00 ","$26.75 ","$0.00 "
"5555-3301","SUP","Custom 27203010","","5555-3301  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3302","SUP","Custom 27203010","","5555-3302  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3303","SUP","Custom 27203010","","5555-3303  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3305","SUP","Custom 27203010","","5555-3305  -  SET ORTH TRTHLN ECT 5 PRP","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3306","SUP","Custom 27203010","","5555-3306  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3307","SUP","Custom 27203010","","5555-3307  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3308","SUP","Custom 27203010","","5555-3308  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$126.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.00 ","$0.00 ","$63.00 ","$99.79 ","$100.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3501","SUP","Custom 27203010","","5555-3501  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3502","SUP","Custom 27203010","","5555-3502  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3503","SUP","HCPCS C1713","","5555-3503  -  SYSTEM BONE CMNT PREP KIT TIB 3","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$82.80 ","$0.00 ","$38.35 ","$0.00 ","$0.00 ","$32.22 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$28.80 ","$0.00 ","$29.29 ","$0.00 "
"5555-3504","SUP","Custom 27203010","","5555-3504  -  SET TRAUMA FIX 4 STD TIB PS PRCS PREP KIT TRTHLN","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3505","SUP","Custom 27203010","","5555-3505  -  SET TRAUMA FIX 5 STD TIB PS PRCS PREP KIT TRTHLN","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3506","SUP","Custom 27203010","","5555-3506  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3507","SUP","Custom 27203010","","5555-3507  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3508","SUP","HCPCS C1713","","5555-3508  -  SYSTEM BONE CMNT PREP KIT TIB 8","BOTH IP/OP","$184.00 ","$136.16 ","$0.00 ","$184.00 ","$82.80 ","$0.00 ","$38.35 ","$0.00 ","$0.00 ","$32.22 ","$184.00 ","$0.00 ","$92.00 ","$145.73 ","$147.20 ","$0.00 ","$28.80 ","$0.00 ","$29.29 ","$0.00 "
"5555-3701","SUP","Custom 27803010","","5555-3701  -  CMPNT TIB TRTHLN KNEE PS","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3702","SUP","Custom 27803010","","5555-3702  -  CMPNT TIB TRTHLN KNEE PS","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3703","SUP","Custom 27203010","","5555-3703  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3704","SUP","Custom 27203010","","5555-3704  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3705","SUP","Custom 27203010","","5555-3705  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3706","SUP","Custom 27203010","","5555-3706  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3707","SUP","Custom 27203010","","5555-3707  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-3708","SUP","Custom 27803010","","5555-3708  -  CMPNT TIB TRTHLN KNEE PS","BOTH IP/OP","$158.00 ","$116.92 ","$0.00 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$158.00 ","$0.00 ","$79.00 ","$125.14 ","$126.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4201","SUP","Custom 27203010","","5555-4201  -  SET TRAUMA FIX FEM KNEE CRUC RET PRCS TRTHLN","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4202","SUP","Custom 27203010","","5555-4202  -  KIT THR TRTHLN 2 CRUC RET","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4203","SUP","Custom 27203010","","5555-4203  -  SET ORTH TRTHLN 3 FEM PRP","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4204","SUP","Custom 27203010","","5555-4204  -  SET TRAUMA FIX 4 FEM CRUC RET PRCS PREP KIT TRTHLN","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4205","SUP","Custom 27203010","","5555-4205  -  SET ORTH TRTHLN 5 TIB PRP","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4206","SUP","Custom 27203010","","5555-4206  -  SET TRAUMA FIX 6 FEM CRUC RET PRCS PREP KIT TRTHLN","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4207","SUP","Custom 27203010","","5555-4207  -  KIT PRP TRTHLN 7 PRCS FEM CRUC RET STD","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4208","SUP","HCPCS C1713","","5555-4208  -  SYSTEM BONE CMNT PRP KIT FEM BIOPREP","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$141.75 ","$0.00 ","$65.65 ","$0.00 ","$0.00 ","$55.15 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$49.30 ","$0.00 ","$50.15 ","$0.00 "
"5555-4301","SUP","Custom 27203010","","5555-4301  -  TRIATHLON PS PRECISION FEMORAL PREP KIT SIZE 1","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4302","SUP","Custom 27203010","","5555-4302  -  SET TRAUMA FIX FEM KNEE PS PRCS TRTHLN","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4303","SUP","HCPCS C1713","","5555-4303  -  SYSTEM BONE CMNT PREP KIT FEM 3","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$153.45 ","$0.00 ","$71.07 ","$0.00 ","$0.00 ","$59.71 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$53.37 ","$0.00 ","$54.29 ","$0.00 "
"5555-4304","SUP","Custom 27203010","","5555-4304  -  SET TRAUMA FIX 4 FEM PS PRCS PREP KIT TRTHLN","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4305","SUP","Custom 27203010","","5555-4305  -  SET TRAUMA FIX 5 FEM PS PRCS PREP KIT TRTHLN","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4306","SUP","HCPCS C1713","","5555-4306  -  SYSTEM BONE CMNT PREP KIT FEM 6","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$153.45 ","$0.00 ","$71.07 ","$0.00 ","$0.00 ","$59.71 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$53.37 ","$0.00 ","$54.29 ","$0.00 "
"5555-4307","SUP","Custom 27203010","","5555-4307  -  SET TRAUMA FIX FEM KNEE PS PRCS TRTHLN","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5555-4308","SUP","HCPCS C1713","","5555-4308  -  SYSTEM BONE CMNT PREP KIT FEM 8","BOTH IP/OP","$341.00 ","$252.34 ","$0.00 ","$341.00 ","$153.45 ","$0.00 ","$71.07 ","$0.00 ","$0.00 ","$59.71 ","$341.00 ","$0.00 ","$170.50 ","$270.07 ","$272.80 ","$0.00 ","$53.37 ","$0.00 ","$54.29 ","$0.00 "
"5555-4600","SUP","Custom 27203010","","5555-4600  -  SYSTEM KN TRL 1-8 TRTHLN TIB","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5556-L-319","SUP","HCPCS C1776","","5556-L-319  -  COMPONENT PTLR S 31X9MM STRL LF TRITANIUM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5556-L-339","SUP","HCPCS C1776","","5556-L-339  -  COMPONENT PTLR 33MM 9MM SMTR TRITANIUM KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5556-L-360","SUP","HCPCS C1776","","5556-L-360  -  COMPONENT PTLR 36MM 10MM TRITANIUM SMTR MTL KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5556-L-391","SUP","HCPCS C1776","","5556-L-391  -  COMPONENT PTLR 39MM 11MM TRITANIUM SMTR MTL KN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"5560-S-109","SUP","Custom 27803010","","5560-S-109  -  STEM FEMORAL 9MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-112","SUP","Custom 27803010","","5560-S-112  -  STEM FEMORAL 12MM 50MM CEMENTED TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-115","SUP","Custom 27803010","","5560-S-115  -  STEM FEMORAL 15MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-209","SUP","Custom 27803010","","5560-S-209  -  STEM FEMORAL 9MM 100MM CEMENTED TOT STABILIZE TRIATHLON COCR","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-212","SUP","Custom 27803010","","5560-S-212  -  STEM FEMORAL 12MM 100MM CEMENTED TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-215","SUP","Custom 27803010","","5560-S-215  -  STEM FEMORAL 15MM 100MM CEMENTED TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-309","SUP","Custom 27803010","","5560-S-309  -  STEM FEMORAL 9MM 150MM CEMENTED TOT STABILIZE TRIATHLON COCR","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-312","SUP","Custom 27803010","","5560-S-312  -  STEM FEMORAL 12MM 150MM CEMENTED TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5560-S-315","SUP","Custom 27803010","","5560-S-315  -  STEM FEMORAL 15MM 150MM CEMENTED TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"556-25890","SUP","HCPCS C1887","","556-25890  -  CATH GUID MPD CURVE 5FR .056IN 90CM PTFE ENV","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"5565-S-010","SUP","Custom 27803010","","5565-S-010  -  STEM FEMORAL 10MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-011","SUP","Custom 27803010","","5565-S-011  -  STEM FEMORAL 11MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-012","SUP","Custom 27803010","","5565-S-012  -  STEM FEMORAL 12MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-013","SUP","Custom 27803010","","5565-S-013  -  STEM FEMORAL 13MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-014","SUP","Custom 27803010","","5565-S-014  -  STEM FEMORAL 14MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-015","SUP","Custom 27803010","","5565-S-015  -  STEM FEMORAL 15MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-016","SUP","Custom 27803010","","5565-S-016  -  STEM FEMORAL 16MM 105MM CEMENTLESS TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-017","SUP","Custom 27803010","","5565-S-017  -  STEM FEMORAL 17MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-018","SUP","Custom 27803010","","5565-S-018  -  STEM FEMORAL 18MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-019","SUP","Custom 27803010","","5565-S-019  -  STEM FEMORAL 19MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-020","SUP","Custom 27803010","","5565-S-020  -  STEM FEMORAL 20MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-021","SUP","Custom 27803010","","5565-S-021  -  STEM FEMORAL 21MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-022","SUP","Custom 27803010","","5565-S-022  -  STEM FEMORAL 22MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-023","SUP","Custom 27803010","","5565-S-023  -  STEM FEMORAL 23MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-024","SUP","Custom 27803010","","5565-S-024  -  STEM FEMORAL 24MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5565-S-025","SUP","Custom 27803010","","5565-S-025  -  STEM FEMORAL 25MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,530.00 ","$1,872.20 ","$0.00 ","$2,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.00 ","$0.00 ","$1,265.00 ","$2,003.76 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-010","SUP","Custom 27803010","","5566-S-010  -  STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-011","SUP","Custom 27803010","","5566-S-011  -  STEM FEMORAL 11MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-012","SUP","Custom 27803010","","5566-S-012  -  STEM FEMORAL 12MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-013","SUP","Custom 27803010","","5566-S-013  -  STEM FEMORAL 13MM 150MM CEMENTLESS TOT STABILIZED TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-014","SUP","Custom 27803010","","5566-S-014  -  STEM FEMORAL 14MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-015","SUP","Custom 27803010","","5566-S-015  -  STEM FEMORAL 15MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-016","SUP","Custom 27803010","","5566-S-016  -  STEM FEMORAL 16MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-017","SUP","Custom 27803010","","5566-S-017  -  STEM FEMORAL 17MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-018","SUP","Custom 27803010","","5566-S-018  -  STEM FEMORAL 18MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-019","SUP","Custom 27803010","","5566-S-019  -  STEM FEMORAL 19MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-020","SUP","Custom 27803010","","5566-S-020  -  STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-021","SUP","Custom 27803010","","5566-S-021  -  STEM FEMORAL 21MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-022","SUP","Custom 27803010","","5566-S-022  -  STEM FEMORAL 22MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-023","SUP","Custom 27803010","","5566-S-023  -  STEM FEMORAL 23MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-024","SUP","Custom 27803010","","5566-S-024  -  STEM FEMORAL 24MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5566-S-025","SUP","Custom 27803010","","5566-S-025  -  STEM FEMORAL 25MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5570-S-020","SUP","Custom 27803010","","5570-S-020  -  ADAPTER FEMORAL 2MM OFFST TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,582.50 ","$1,911.05 ","$0.00 ","$2,582.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,582.50 ","$0.00 ","$1,291.25 ","$2,045.34 ","$2,066.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5570-S-040","SUP","Custom 27803010","","5570-S-040  -  ADAPTER FEMORAL 4MM OFFST TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,582.50 ","$1,911.05 ","$0.00 ","$2,582.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,582.50 ","$0.00 ","$1,291.25 ","$2,045.34 ","$2,066.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5570-S-060","SUP","Custom 27803010","","5570-S-060  -  ADAPTER FEMORAL 6MM OFFST TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,582.50 ","$1,911.05 ","$0.00 ","$2,582.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,582.50 ","$0.00 ","$1,291.25 ","$2,045.34 ","$2,066.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5570-S-080","SUP","Custom 27803010","","5570-S-080  -  ADAPTER FEMORAL 8MM OFFST TOT STABILIZE TRIATHLON KNEE","BOTH IP/OP","$2,582.50 ","$1,911.05 ","$0.00 ","$2,582.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,582.50 ","$0.00 ","$1,291.25 ","$2,045.34 ","$2,066.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5571-S-025","SUP","Custom 27803010","","5571-S-025  -  EXTENSION STEM 25MM TOT STABILIZE TRIATHLON KNEE FEMUR","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5571-S-050","SUP","Custom 27803010","","5571-S-050  -  EXTENSION STEM 50MM TOT STABILIZE TRIATHLON KNEE FEMUR","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5575-X-000","SUP","HCPCS C1713","","5575-X-000  -  PEG FIX MODULAR TRIATHLON DISTAL FEMUR KNEE","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$880.00 ","$396.00 ","$0.00 ","$183.41 ","$0.00 ","$0.00 ","$154.08 ","$880.00 ","$0.00 ","$440.00 ","$696.96 ","$704.00 ","$0.00 ","$137.72 ","$0.00 ","$140.10 ","$0.00 "
"558-10-48D","SUP","Custom 27803010","","558-10-48D  -  SHELL ACETAB 48MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT D","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-50D","SUP","Custom 27803010","","558-10-50D  -  SHELL ACETAB 50MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT D","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-52E","SUP","Custom 27803010","","558-10-52E  -  SHELL ACETAB 52MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT E","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-54E","SUP","Custom 27803010","","558-10-54E  -  SHELL ACETAB 54MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT E","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-56F","SUP","Custom 27803010","","558-10-56F  -  SHELL ACETAB 56MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT F","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-58F","SUP","Custom 27803010","","558-10-58F  -  SHELL ACETAB 58MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT F","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-60G","SUP","Custom 27803010","","558-10-60G  -  SHELL ACETAB 60MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT G","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-62G","SUP","Custom 27803010","","558-10-62G  -  SHELL ACETAB 62MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT G","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-64H","SUP","Custom 27803010","","558-10-64H  -  SHELL ACETAB 62MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT H","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-66H","SUP","Custom 27803010","","558-10-66H  -  SHELL ACETAB 66MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT H","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-68I","SUP","Custom 27803010","","558-10-68I  -  SHELL ACETAB 68MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT 1","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"558-10-70I","SUP","Custom 27803010","","558-10-70I  -  SHELL ACETAB 70MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT 1","BOTH IP/OP","$2,409.00 ","$1,782.66 ","$0.00 ","$2,409.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,409.00 ","$0.00 ","$1,204.50 ","$1,907.93 ","$1,927.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5583-A3","SUP","HCPCS C1725","","5583-A3  -  CATH ANGIO .035IN VERT CURVE 5FR .044IN 100CM BRAID SFTCH","BOTH IP/OP","$30.50 ","$22.57 ","$0.00 ","$30.50 ","$16.56 ","$0.00 ","$6.36 ","$0.00 ","$0.00 ","$5.34 ","$30.50 ","$0.00 ","$15.25 ","$24.16 ","$24.40 ","$0.00 ","$4.77 ","$0.00 ","$4.86 ","$0.00 "
"5585-C-016","SUP","HCPCS C1713","","5585-C-016  -  SCREW BN 6.5MM 16MM TRTHLN VIT CANC T/K SYS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-020","SUP","HCPCS C1713","","5585-C-020  -  SCREW BASEPLATE 6.5MM 20MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-025","SUP","HCPCS C1713","","5585-C-025  -  SCREW BASEPLATE 6.5MM 25MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-030","SUP","HCPCS C1713","","5585-C-030  -  SCREW BASEPLATE 6.5MM 30MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-035","SUP","HCPCS C1713","","5585-C-035  -  SCREW BASEPLATE 6.5MM 35MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-040","SUP","HCPCS C1713","","5585-C-040  -  SCREW BASEPLATE 6.5MM 40MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-045","SUP","HCPCS C1713","","5585-C-045  -  SCREW BASEPLATE 6.5MM 45MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-050","SUP","HCPCS C1713","","5585-C-050  -  SCREW BASEPLATE 6.5MM 50MM TRIATHLON VITALLIUM KNEE TIBIA","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-055","SUP","HCPCS C1713","","5585-C-055  -  SCREW BN 6.5MM 55MM TRTHLN VIT CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5585-C-060","SUP","HCPCS C1713","","5585-C-060  -  SCREW BN 6.5MM 60MM TRTHLN VIT CANC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"5591-B3","SUP","HCPCS C1725","","5591-B3  -  CATHETER ANGIOGRAPHIC MOTARJEME CURVE 5FR .046IN 100CM BRAID","BOTH IP/OP","$29.65 ","$21.94 ","$0.00 ","$29.65 ","$16.10 ","$0.00 ","$6.18 ","$0.00 ","$0.00 ","$5.19 ","$29.65 ","$0.00 ","$14.83 ","$23.48 ","$23.72 ","$0.00 ","$4.64 ","$0.00 ","$4.72 ","$0.00 "
"55-969-30-04","SUP","HCPCS C1713","","55-969-30-04  -  TRAY 30CM X30CM W/O LID FOR LEV 1 INST","BOTH IP/OP","$2,412.78 ","$1,785.46 ","$0.00 ","$2,412.78 ","$1,085.75 ","$0.00 ","$502.88 ","$0.00 ","$0.00 ","$422.46 ","$2,412.78 ","$0.00 ","$1,206.39 ","$1,910.92 ","$1,930.22 ","$0.00 ","$377.60 ","$0.00 ","$384.11 ","$0.00 "
"55-969-98-04","SUP","Custom 27803010","","55-969-98-04  -  LOCK MOD 3 STACK LEFT LEVEL 1 SYSTEM","BOTH IP/OP","$579.38 ","$428.74 ","$0.00 ","$579.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.38 ","$0.00 ","$289.69 ","$458.87 ","$463.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"55-969-99-04","SUP","Custom 27803010","","55-969-99-04  -  LOCK MOD 3 STACK RIGHT LEVEL 1 SYSTEM","BOTH IP/OP","$579.38 ","$428.74 ","$0.00 ","$579.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$579.38 ","$0.00 ","$289.69 ","$458.87 ","$463.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"56-00400","SUP","HCPCS C1713","","56-00400  -  WASHER SPINAL BICONCAVE 4MM SALZBURG TITANIUM","BOTH IP/OP","$74.08 ","$54.82 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$15.44 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"5601-0-901","SUP","HCPCS C1713","","5601-0-901  -  TRAY STRL ICS SMTB PLT","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"5601-0-902","SUP","HCPCS C1713","","5601-0-902  -  TRAY STRL ICS NAR PLT","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"5601-0-903","SUP","HCPCS C1713","","5601-0-903  -  TRAY STRL ICS BRD PLT","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$136.13 ","$0.00 ","$63.05 ","$0.00 ","$0.00 ","$52.97 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$47.34 ","$0.00 ","$48.16 ","$0.00 "
"5601-0-904","SUP","Custom 27203010","","5601-0-904  -  CASE STRL LG SCR","BOTH IP/OP","$459.25 ","$339.85 ","$0.00 ","$459.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$459.25 ","$0.00 ","$229.63 ","$363.73 ","$367.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-0-908","SUP","Custom 27203010","","5601-0-908  -  TRAY STRL ICS DRILL TAPS","BOTH IP/OP","$481.25 ","$356.13 ","$0.00 ","$481.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$481.25 ","$0.00 ","$240.63 ","$381.15 ","$385.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-0-909","SUP","Custom 27203010","","5601-0-909  -  TRAY STRL ICS DRILL GD","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-1-900","SUP","Custom 27203010","","5601-1-900  -  CASE STRL ICS FRAGMENTATION","BOTH IP/OP","$460.63 ","$340.87 ","$0.00 ","$460.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.63 ","$0.00 ","$230.31 ","$364.82 ","$368.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-1-901","SUP","Custom 27203010","","5601-1-901  -  RACK STRL SCR ICS SM","BOTH IP/OP","$726.00 ","$537.24 ","$0.00 ","$726.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$726.00 ","$0.00 ","$363.00 ","$574.99 ","$580.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-1-902","SUP","HCPCS C1713","","5601-1-902  -  TRAY STRL ICS SM PLT","BOTH IP/OP","$481.25 ","$356.13 ","$0.00 ","$481.25 ","$216.56 ","$0.00 ","$100.30 ","$0.00 ","$0.00 ","$84.26 ","$481.25 ","$0.00 ","$240.63 ","$381.15 ","$385.00 ","$0.00 ","$75.32 ","$0.00 ","$76.62 ","$0.00 "
"5601-1-911","SUP","Custom 27203010","","5601-1-911  -  TRAY STRL ICS SM TAP DRILL SLV","BOTH IP/OP","$357.50 ","$264.55 ","$0.00 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$357.50 ","$0.00 ","$178.75 ","$283.14 ","$286.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-1-912","SUP","Custom 27203010","","5601-1-912  -  TRAY STRL ICS FORCEP","BOTH IP/OP","$357.50 ","$264.55 ","$0.00 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$357.50 ","$0.00 ","$178.75 ","$283.14 ","$286.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5601-1-913","SUP","Custom 27203010","","5601-1-913  -  TRAY STRL ICS SM DRILL TAPS","BOTH IP/OP","$357.50 ","$264.55 ","$0.00 ","$357.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$357.50 ","$0.00 ","$178.75 ","$283.14 ","$286.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5610-F-101","SUP","HCPCS C1776","","5610-F-101  -  COMPONENT FEM 1 TRTHLN PRT KN RSRFC KN LT MDL RL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-102","SUP","HCPCS C1776","","5610-F-102  -  COMPONENT FEM 1 TRTHLN RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-201","SUP","HCPCS C1776","","5610-F-201  -  COMPONENT FEM 2 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-202","SUP","HCPCS C1776","","5610-F-202  -  COMPONENT FEM 2 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-301","SUP","HCPCS C1776","","5610-F-301  -  COMPONENT FEM 3 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-302","SUP","HCPCS C1776","","5610-F-302  -  COMPONENT FEM 3 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-401","SUP","HCPCS C1776","","5610-F-401  -  COMPONENT FEM 4 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-402","SUP","HCPCS C1776","","5610-F-402  -  COMPONENT FEM 4 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-501","SUP","HCPCS C1776","","5610-F-501  -  COMPONENT FEM 5 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-502","SUP","HCPCS C1776","","5610-F-502  -  COMPONENT FEM 5 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-601","SUP","HCPCS C1776","","5610-F-601  -  COMPONENT FEM 6 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"5610-F-602","SUP","HCPCS C1776","","5610-F-602  -  COMPONENT FEM 6 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$3,302.50 ","$2,443.85 ","$0.00 ","$3,302.50 ","$1,486.13 ","$0.00 ","$688.32 ","$0.00 ","$0.00 ","$578.24 ","$3,302.50 ","$0.00 ","$1,651.25 ","$2,615.58 ","$2,642.00 ","$0.00 ","$516.84 ","$0.00 ","$525.76 ","$0.00 "
"56-15904","SUP","HCPCS C1713","","56-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL UN3 CRANIOMAXILLOFACIAL","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"56-15934","SUP","HCPCS C1713","","56-15934  -  SCREW BN 1.5MM 4MM NS LF UNV NEURO 3 SLF DRL AX STAB","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"56-15935","SUP","HCPCS C1713","","56-15935  -  SCREW BN 1.5MM 5MM NS LF UNV NEURO 3 SLF DRL AX STAB","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"56-17005","SUP","HCPCS C1713","","56-17005  -  SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL","BOTH IP/OP","$120.38 ","$89.08 ","$0.00 ","$272.50 ","$122.63 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$47.71 ","$272.50 ","$0.00 ","$136.25 ","$215.82 ","$218.00 ","$0.00 ","$42.65 ","$0.00 ","$43.38 ","$0.00 "
"56-17904","SUP","HCPCS C1713","","56-17904  -  SCREW BN 1.9MM 5MM ER AX STAB LWR PRFL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$305.00 ","$137.25 ","$0.00 ","$28.14 ","$0.00 ","$0.00 ","$53.40 ","$305.00 ","$0.00 ","$152.50 ","$241.56 ","$244.00 ","$0.00 ","$47.73 ","$0.00 ","$48.56 ","$0.00 "
"56-19005","SUP","HCPCS C1713","","56-19005  -  NAIL IM 11.5MM 36CM STRL TRGN 2M POST BW RT HINDFOOT FSN","BOTH IP/OP","$132.75 ","$98.24 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$27.67 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"5620-B-101","SUP","HCPCS C1776","","5620-B-101  -  BASEPLATE TIB 1 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-102","SUP","HCPCS C1776","","5620-B-102  -  BASEPLATE TIB 1 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-201","SUP","HCPCS C1776","","5620-B-201  -  BASEPLATE TIB 2 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-202","SUP","HCPCS C1776","","5620-B-202  -  BASEPLATE TIB 2 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-301","SUP","HCPCS C1776","","5620-B-301  -  BASEPLATE TIB 3 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-302","SUP","HCPCS C1776","","5620-B-302  -  BASEPLATE TIB 3 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-401","SUP","HCPCS C1776","","5620-B-401  -  BASEPLATE TIB 4 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-402","SUP","HCPCS C1776","","5620-B-402  -  BASEPLATE TIB 4 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-501","SUP","HCPCS C1776","","5620-B-501  -  BASEPLATE TIB 5 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-502","SUP","HCPCS C1776","","5620-B-502  -  BASEPLATE TIB 5 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-601","SUP","HCPCS C1776","","5620-B-601  -  BASEPLATE TIB 6 TRTHLN PRT KN RSRFC LT MDL RL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5620-B-602","SUP","HCPCS C1776","","5620-B-602  -  BASEPLATE TIB 6 TRTHLN PRT KN RSRFC RMLL","BOTH IP/OP","$2,402.50 ","$1,777.85 ","$0.00 ","$2,402.50 ","$1,081.13 ","$0.00 ","$500.74 ","$0.00 ","$0.00 ","$420.66 ","$2,402.50 ","$0.00 ","$1,201.25 ","$1,902.78 ","$1,922.00 ","$0.00 ","$375.99 ","$0.00 ","$382.48 ","$0.00 "
"5624-10/16L","SUP","HCPCS C1776","","5624-10/16L  -  STEM HUMERAL 10MM 165MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$6,511.05 ","$4,818.18 ","$0.00 ","$6,511.05 ","$2,929.97 ","$0.00 ","$1,357.07 ","$0.00 ","$0.00 ","$1,140.03 ","$6,511.05 ","$0.00 ","$3,255.53 ","$5,156.75 ","$5,208.84 ","$0.00 ","$1,018.98 ","$0.00 ","$1,036.56 ","$0.00 "
"5624-10/20XL","SUP","HCPCS C1776","","5624-10/20XL  -  STEM HUMERAL 10MM 205MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$7,003.95 ","$5,182.92 ","$0.00 ","$7,003.95 ","$3,151.78 ","$0.00 ","$1,459.80 ","$0.00 ","$0.00 ","$1,226.34 ","$7,003.95 ","$0.00 ","$3,501.98 ","$5,547.13 ","$5,603.16 ","$0.00 ","$1,096.12 ","$0.00 ","$1,115.03 ","$0.00 "
"5624-12/17L","SUP","HCPCS C1776","","5624-12/17L  -  STEM HUMERAL 12MM 170MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$6,511.05 ","$4,818.18 ","$0.00 ","$6,511.05 ","$2,929.97 ","$0.00 ","$1,357.07 ","$0.00 ","$0.00 ","$1,140.03 ","$6,511.05 ","$0.00 ","$3,255.53 ","$5,156.75 ","$5,208.84 ","$0.00 ","$1,018.98 ","$0.00 ","$1,036.56 ","$0.00 "
"5624-12/21XL","SUP","HCPCS C1776","","5624-12/21XL  -  STEM HUMERAL 12MM 210MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$7,003.95 ","$5,182.92 ","$0.00 ","$7,003.95 ","$3,151.78 ","$0.00 ","$1,459.80 ","$0.00 ","$0.00 ","$1,226.34 ","$7,003.95 ","$0.00 ","$3,501.98 ","$5,547.13 ","$5,603.16 ","$0.00 ","$1,096.12 ","$0.00 ","$1,115.03 ","$0.00 "
"5624-14/13","SUP","HCPCS C1776","","5624-14/13  -  STEM HUMERAL 14 135MM CEMENTED ANATOMICAL COCR STERILE","BOTH IP/OP","$5,769.05 ","$4,269.10 ","$0.00 ","$5,769.05 ","$2,596.07 ","$0.00 ","$1,202.41 ","$0.00 ","$0.00 ","$1,010.11 ","$5,769.05 ","$0.00 ","$2,884.53 ","$4,569.09 ","$4,615.24 ","$0.00 ","$902.86 ","$0.00 ","$918.43 ","$0.00 "
"5624-14/17L","SUP","HCPCS C1776","","5624-14/17L  -  STEM HUMERAL 14MM 175MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$6,511.05 ","$4,818.18 ","$0.00 ","$6,511.05 ","$2,929.97 ","$0.00 ","$1,357.07 ","$0.00 ","$0.00 ","$1,140.03 ","$6,511.05 ","$0.00 ","$3,255.53 ","$5,156.75 ","$5,208.84 ","$0.00 ","$1,018.98 ","$0.00 ","$1,036.56 ","$0.00 "
"5624-14/21XL","SUP","HCPCS C1776","","5624-14/21XL  -  STEM HUMERAL 14MM 215MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$7,003.95 ","$5,182.92 ","$0.00 ","$7,003.95 ","$3,151.78 ","$0.00 ","$1,459.80 ","$0.00 ","$0.00 ","$1,226.34 ","$7,003.95 ","$0.00 ","$3,501.98 ","$5,547.13 ","$5,603.16 ","$0.00 ","$1,096.12 ","$0.00 ","$1,115.03 ","$0.00 "
"5624-6/15L","SUP","HCPCS C1776","","5624-6/15L  -  STEM HUMERAL 6MM 155MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$6,511.05 ","$4,818.18 ","$0.00 ","$6,511.05 ","$2,929.97 ","$0.00 ","$1,357.07 ","$0.00 ","$0.00 ","$1,140.03 ","$6,511.05 ","$0.00 ","$3,255.53 ","$5,156.75 ","$5,208.84 ","$0.00 ","$1,018.98 ","$0.00 ","$1,036.56 ","$0.00 "
"5624-6/19XL","SUP","HCPCS C1776","","5624-6/19XL  -  STEM HUMERAL 6MM 195MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$7,003.95 ","$5,182.92 ","$0.00 ","$7,003.95 ","$3,151.78 ","$0.00 ","$1,459.80 ","$0.00 ","$0.00 ","$1,226.34 ","$7,003.95 ","$0.00 ","$3,501.98 ","$5,547.13 ","$5,603.16 ","$0.00 ","$1,096.12 ","$0.00 ","$1,115.03 ","$0.00 "
"5624-8/16L","SUP","HCPCS C1776","","5624-8/16L  -  STEM HUMERAL 8MM 160MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$6,511.05 ","$4,818.18 ","$0.00 ","$6,511.05 ","$2,929.97 ","$0.00 ","$1,357.07 ","$0.00 ","$0.00 ","$1,140.03 ","$6,511.05 ","$0.00 ","$3,255.53 ","$5,156.75 ","$5,208.84 ","$0.00 ","$1,018.98 ","$0.00 ","$1,036.56 ","$0.00 "
"5624-8/20XL","SUP","HCPCS C1776","","5624-8/20XL  -  STEM HUMERAL 8MM 200MM CEMENTED IMPLANT COCR STERILE","BOTH IP/OP","$7,003.95 ","$5,182.92 ","$0.00 ","$7,003.95 ","$3,151.78 ","$0.00 ","$1,459.80 ","$0.00 ","$0.00 ","$1,226.34 ","$7,003.95 ","$0.00 ","$3,501.98 ","$5,547.13 ","$5,603.16 ","$0.00 ","$1,096.12 ","$0.00 ","$1,115.03 ","$0.00 "
"56-25000","SUP","HCPCS C1713","","56-25000  -  SCREW BONE FASTENING TITANIUM CONDYLE MANDIB","BOTH IP/OP","$246.50 ","$182.41 ","$0.00 ","$560.00 ","$252.00 ","$0.00 ","$51.38 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"56-25001","SUP","Custom 27803010","","56-25001  -  PROSTHESIS TEMPORARY MARX CONDYLE LEFT","BOTH IP/OP","$2,382.23 ","$1,762.85 ","$0.00 ","$4,770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,770.00 ","$0.00 ","$2,385.00 ","$3,777.84 ","$3,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"56-25002","SUP","Custom 27803010","","56-25002  -  PROSTHESIS TEMPORARY MARX CONDYLE RIGHT","BOTH IP/OP","$2,382.23 ","$1,762.85 ","$0.00 ","$4,770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,770.00 ","$0.00 ","$2,385.00 ","$3,777.84 ","$3,816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5630-G-108","SUP","HCPCS C1776","","5630-G-108  -  INSERT TIB 1 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-109","SUP","HCPCS C1776","","5630-G-109  -  INSERT TIB 1 9MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-110","SUP","HCPCS C1776","","5630-G-110  -  INSERT TIB 1 10MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-112","SUP","HCPCS C1776","","5630-G-112  -  INSERT TIB 1 12MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-120","SUP","HCPCS C1776","","5630-G-120  -  INSERT TIB 1 10MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-122","SUP","HCPCS C1776","","5630-G-122  -  INSERT TIB 1 12MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-128","SUP","HCPCS C1776","","5630-G-128  -  INSERT TIB 1 8MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-129","SUP","HCPCS C1776","","5630-G-129  -  INSERT TIB 1 9MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-208","SUP","HCPCS C1776","","5630-G-208  -  INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-209","SUP","HCPCS C1776","","5630-G-209  -  INSERT TIB 2 9MM TRTHLN STRG KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-210","SUP","HCPCS C1776","","5630-G-210  -  INSERT TIB 2 10MM TRTHLN PRT KN RSRFC X3 LT MDL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-212","SUP","HCPCS C1776","","5630-G-212  -  INSERT TIB 2 12MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-220","SUP","HCPCS C1776","","5630-G-220  -  INSERT TIB 2 10MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-222","SUP","HCPCS C1776","","5630-G-222  -  INSERT TIB 2 12MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-228","SUP","HCPCS C1776","","5630-G-228  -  INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-229","SUP","HCPCS C1776","","5630-G-229  -  INSERT TIB 2 29MM TRTHLN PRT RSRFC X3 KN RT MDL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-308","SUP","HCPCS C1776","","5630-G-308  -  INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-309","SUP","HCPCS C1776","","5630-G-309  -  INSERT TIB 3 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-310","SUP","HCPCS C1776","","5630-G-310  -  INSERT TIB 3 10MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-312","SUP","HCPCS C1776","","5630-G-312  -  INSERT TIB 3 12MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-320","SUP","HCPCS C1776","","5630-G-320  -  INSERT TIB 3 20MM TRTHLN PRT RSRFC X3 KN RT MDL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-322","SUP","HCPCS C1776","","5630-G-322  -  INSERT TIB 3 12MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-328","SUP","HCPCS C1776","","5630-G-328  -  INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-329","SUP","HCPCS C1776","","5630-G-329  -  INSERT TIB 3 29MM TRTHLN PRT RSRFC X3 KN RT MDL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-408","SUP","HCPCS C1776","","5630-G-408  -  INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-409","SUP","HCPCS C1776","","5630-G-409  -  INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-410","SUP","HCPCS C1776","","5630-G-410  -  INSERT TIB 4 10MM TRTHLN X3 LT MDL RL KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-412","SUP","HCPCS C1776","","5630-G-412  -  INSERT TIB 4 12MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-420","SUP","HCPCS C1776","","5630-G-420  -  INSERT TIB 4 10MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-422","SUP","HCPCS C1776","","5630-G-422  -  INSERT TIB 4 12MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-428","SUP","HCPCS C1776","","5630-G-428  -  INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-429","SUP","HCPCS C1776","","5630-G-429  -  INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-508","SUP","HCPCS C1776","","5630-G-508  -  INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-509","SUP","HCPCS C1776","","5630-G-509  -  INSERT TIB 5 9MM TRTHLN X3 LT MDL RL KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-510","SUP","HCPCS C1776","","5630-G-510  -  INSERT TIB 5 10MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-512","SUP","HCPCS C1776","","5630-G-512  -  INSERT TIB 5 12MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-520","SUP","HCPCS C1776","","5630-G-520  -  INSERT TIB 5 10MM TRTHLN X3 RMLL KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-522","SUP","HCPCS C1776","","5630-G-522  -  INSERT TIB 5 12MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-528","SUP","HCPCS C1776","","5630-G-528  -  INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-529","SUP","HCPCS C1776","","5630-G-529  -  INSERT TIB 5 9MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-608","SUP","HCPCS C1776","","5630-G-608  -  INSERT TIB 6 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-609","SUP","HCPCS C1776","","5630-G-609  -  INSERT TIB 9 60MM TRTHLN STRG KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-610","SUP","HCPCS C1776","","5630-G-610  -  INSERT TIB 6 10MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-612","SUP","HCPCS C1776","","5630-G-612  -  INSERT TIB 6 12MM TRTHLN X3 LT MDL RL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-620","SUP","HCPCS C1776","","5630-G-620  -  INSERT TIB 62MM TRTHLN STRG KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-622","SUP","HCPCS C1776","","5630-G-622  -  INSERT TIB 6 12MM TRTHLN X3 RMLL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-628","SUP","HCPCS C1776","","5630-G-628  -  INSERT TIB 6 TRTHLN PRT RSRFC X3 KN RT MDL","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5630-G-629","SUP","HCPCS C1776","","5630-G-629  -  INSERT TIB 6 9MM TRTHLN KN","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"5639-0-010","SUP","HCPCS C1713","","5639-0-010  -  SCREW BONE 4MM 10MM 5MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-012","SUP","HCPCS C1713","","5639-0-012  -  SCREW BONE 4MM 12MM 5MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-014","SUP","HCPCS C1713","","5639-0-014  -  SCREW BONE 4MM 14MM 5MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-016","SUP","HCPCS C1713","","5639-0-016  -  SCREW BONE 4MM 16MM 6MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-018","SUP","HCPCS C1713","","5639-0-018  -  SCREW BONE 4MM 18MM 7MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-020","SUP","HCPCS C1713","","5639-0-020  -  SCREW BONE 4MM 20MM 8MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-022","SUP","HCPCS C1713","","5639-0-022  -  SCREW BONE 4MM 22MM 9MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-024","SUP","HCPCS C1713","","5639-0-024  -  SCREW BONE 4MM 24MM 10MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-026","SUP","HCPCS C1713","","5639-0-026  -  SCREW BONE 4MM 26MM 12MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-028","SUP","HCPCS C1713","","5639-0-028  -  SCREW BONE 4MM 28MM 14MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-030","SUP","HCPCS C1713","","5639-0-030  -  SCREW BONE 4MM 30MM 14MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-035","SUP","HCPCS C1713","","5639-0-035  -  SCREW BONE 4MM 35MM 14MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-040","SUP","HCPCS C1713","","5639-0-040  -  SCREW BONE 4MM 40MM 14MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-045","SUP","HCPCS C1713","","5639-0-045  -  SCREW BONE 4MM 45MM 15MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"5639-0-050","SUP","HCPCS C1713","","5639-0-050  -  SCREW BONE 4MM 50MM 15MM PTHRD CANC HEX HEAD","BOTH IP/OP","$34.38 ","$25.44 ","$0.00 ","$34.38 ","$15.47 ","$0.00 ","$7.16 ","$0.00 ","$0.00 ","$6.02 ","$34.38 ","$0.00 ","$17.19 ","$27.23 ","$27.50 ","$0.00 ","$5.38 ","$0.00 ","$5.47 ","$0.00 "
"563CAL","SUP","Custom 27203010","","MATTRESS COMPLETE UNIT /5","BOTH IP/OP","$712.00 ","$526.88 ","$0.00 ","$712.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.00 ","$0.00 ","$356.00 ","$563.90 ","$569.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"56-40281","SUP","Custom 27803010","","56-40281  -  WIRE FX 1.4MM 17MM KRSH OLV STP DIST RDS LCK PLT SYS","BOTH IP/OP","$45.75 ","$33.86 ","$0.00 ","$38.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.50 ","$0.00 ","$19.25 ","$30.49 ","$30.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5645-0-0160","SUP","HCPCS C1713","","5645-0-0160  -  SCREW BONE 4.5MM 16MM SLFTAP CORTICAL","BOTH IP/OP","$22.00 ","$16.28 ","$0.00 ","$22.00 ","$9.90 ","$0.00 ","$4.59 ","$0.00 ","$0.00 ","$3.85 ","$22.00 ","$0.00 ","$11.00 ","$17.42 ","$17.60 ","$0.00 ","$3.44 ","$0.00 ","$3.50 ","$0.00 "
"5645-1-014","SUP","HCPCS C1713","","5645-1-014  -  SCREW BONE 4.5MM 14MM TI CORTEX ORTH FULTHRD HEX HEAD SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-016","SUP","HCPCS C1713","","5645-1-016  -  SCREW BONE 4.5MM 16MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-018","SUP","HCPCS C1713","","5645-1-018  -  SCREW BONE 4.5MM 18MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-020","SUP","HCPCS C1713","","5645-1-020  -  SCREW BONE 4.5MM 20MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-022","SUP","HCPCS C1713","","5645-1-022  -  SCREW BONE 4.5MM 22MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-024","SUP","HCPCS C1713","","5645-1-024  -  SCREW BONE 4.5MM 24MM FULTHD CORTEX SLFTAP HEX HEAD","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-026","SUP","HCPCS C1713","","5645-1-026  -  SCREW BONE 4.5MM 26MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-028","SUP","HCPCS C1713","","5645-1-028  -  SCREW BONE 4.5MM 28MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-030","SUP","HCPCS C1713","","5645-1-030  -  SCREW BONE 4.5MM 30MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-032","SUP","HCPCS C1713","","5645-1-032  -  SCREW BONE 4.5MM 32MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-034","SUP","HCPCS C1713","","5645-1-034  -  SCREW BONE 4.5MM 34MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-036","SUP","HCPCS C1713","","5645-1-036  -  SCREW BONE 4.5MM 36MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-038","SUP","HCPCS C1713","","5645-1-038  -  SCREW BONE 4.5MM 38MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-040","SUP","HCPCS C1713","","5645-1-040  -  SCREW BONE 4.5MM 40MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-042","SUP","HCPCS C1713","","5645-1-042  -  SCREW BONE 4.5MM 42MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-044","SUP","HCPCS C1713","","5645-1-044  -  SCREW BONE 4.5MM 44MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-046","SUP","HCPCS C1713","","5645-1-046  -  SCREW BONE 4.5MM 46MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-048","SUP","HCPCS C1713","","5645-1-048  -  SCREW BONE 4.5MM 48MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-050","SUP","HCPCS C1713","","5645-1-050  -  SCREW BONE 4.5MM 50MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-052","SUP","HCPCS C1713","","5645-1-052  -  SCREW BONE 4.5MM 52MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-054","SUP","HCPCS C1713","","5645-1-054  -  SCREW BONE 4.5MM 54MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-056","SUP","HCPCS C1713","","5645-1-056  -  SCREW BONE 4.5MM 56MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-058","SUP","HCPCS C1713","","5645-1-058  -  SCREW BONE 4.5MM 58MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-060","SUP","HCPCS C1713","","5645-1-060  -  SCREW BONE 4.5MM 60MM CORT SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-064","SUP","HCPCS C1713","","5645-1-064  -  SCREW BONE 4.5MM 64MM CORTEX HEX HEAD FULTHD SLFTAP","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5645-1-070","SUP","HCPCS C1713","","5645-1-070  -  SCREW BONE 4.5MM 70MM FULTHD CORTEX SLFTAP HEX HEAD","BOTH IP/OP","$39.20 ","$29.01 ","$0.00 ","$46.75 ","$21.04 ","$0.00 ","$8.17 ","$0.00 ","$0.00 ","$8.19 ","$46.75 ","$0.00 ","$23.38 ","$37.03 ","$37.40 ","$0.00 ","$7.32 ","$0.00 ","$7.44 ","$0.00 "
"5678-1-005","SUP","HCPCS C1713","","5678-1-005  -  PLATE 3.5 MM SCR 5 HOLE BONE CORT","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"5678-1-010","SUP","HCPCS C1713","","5678-1-010  -  PLATE 3.5 MM SCR 10 HOLE BONE CORT","BOTH IP/OP","$156.75 ","$116.00 ","$0.00 ","$156.75 ","$70.54 ","$0.00 ","$32.67 ","$0.00 ","$0.00 ","$27.45 ","$156.75 ","$0.00 ","$78.38 ","$124.15 ","$125.40 ","$0.00 ","$24.53 ","$0.00 ","$24.95 ","$0.00 "
"5680-0-025","SUP","HCPCS C1713","","5680-0-025  -  SCREW BONE 6.5MM 25MM 16MM CANC CANC HEX HEAD PTTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-030","SUP","HCPCS C1713","","5680-0-030  -  SCREW BONE 6.5MM 30MM 16MM CANC HEX HEAD PTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-035","SUP","HCPCS C1713","","5680-0-035  -  SCREW BONE 6.5MM 35MM 16MM CANC HEX HEAD PTTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-040","SUP","HCPCS C1713","","5680-0-040  -  SCREW BONE 6.5MM 40MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-045","SUP","HCPCS C1713","","5680-0-045  -  SCREW BONE 6.5MM 45MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-050","SUP","HCPCS C1713","","5680-0-050  -  SCREW BONE 6.5MM 50MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-055","SUP","HCPCS C1713","","5680-0-055  -  SCREW BONE 6.5MM 55MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-060","SUP","HCPCS C1713","","5680-0-060  -  SCREW BONE 6.5MM 60MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-065","SUP","HCPCS C1713","","5680-0-065  -  SCREW BONE 6.5MM 65MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-070","SUP","HCPCS C1713","","5680-0-070  -  SCREW BONE 6.5MM 70MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-075","SUP","HCPCS C1713","","5680-0-075  -  SCREW BONE 6.5MM 75MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-080","SUP","HCPCS C1713","","5680-0-080  -  SCREW BONE 6.5MM 80MM 16MM PTHRD CANC HEX HEAD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-085","SUP","HCPCS C1713","","5680-0-085  -  SCREW BONE 6.5MM 85MM 16MM CANC HX HD PRTL THRED","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-090","SUP","HCPCS C1713","","5680-0-090  -  SCREW BONE 6.5MM 90MM 16MM CANC PTHRD HX HD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-095","SUP","HCPCS C1713","","5680-0-095  -  SCREW BONE 6.5MM 95MM 16MM CANC HEX HEAD PTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-100","SUP","HCPCS C1713","","5680-0-100  -  SCREW BONE 6.5MM 110MM 16MM ALTA CANC HEX HEAD PTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-105","SUP","HCPCS C1713","","5680-0-105  -  SCREW BONE 6.5MM 105MM 16MM CANC PTHRD HEX THRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5680-0-110","SUP","HCPCS C1713","","5680-0-110  -  SCREW BONE 6.5MM 110MM 16MM TI CANC HEX HEAD PTTHRD STRYK","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-030","SUP","HCPCS C1713","","5681-0-030  -  SCREW BONE 6.5MM 30MM 20MM CANC HX HD PTHRD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-035","SUP","HCPCS C1713","","5681-0-035  -  SCREW BONE 6.5MM 27MM CANC HEX HEAD PRTL THRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-040","SUP","HCPCS C1713","","5681-0-040  -  SCREW BONE 6.5MM 40MM 32MM CANC HX HD PTHRD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-045","SUP","HCPCS C1713","","5681-0-045  -  SCREW BONE 6.5MM 45MM 32MM CANC PTTHRD HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-050","SUP","HCPCS C1713","","5681-0-050  -  SCREW BONE 6.5MM 50MM 32MM CANC CANC HAEXGONAL HEAD PRTL","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-055","SUP","HCPCS C1713","","5681-0-055  -  SCREW BONE 6.5MM 55MM 32MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-060","SUP","HCPCS C1713","","5681-0-060  -  SCREW BONE 6.5MM 60MM 32MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-065","SUP","HCPCS C1713","","5681-0-065  -  SCREW BONE 6.5MM 65MM 32MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-070","SUP","HCPCS C1713","","5681-0-070  -  SCREW BONE 6.5MM 70MM 32MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-075","SUP","HCPCS C1713","","5681-0-075  -  SCREW BONE 6.5MM 75MM 32MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-080","SUP","HCPCS C1713","","5681-0-080  -  SCREW BONE 6.5MM 80MM 32MM PTHRD CANC HEX HEAD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-085","SUP","HCPCS C1713","","5681-0-085  -  SCREW BONE 6.5MM 85MM 32MM CANC HX HD PTHRD","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-090","SUP","HCPCS C1713","","5681-0-090  -  SCREW BONE 6.5MM 90MM 32MM CANC HX HD PTTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-095","SUP","HCPCS C1713","","5681-0-095  -  SCREW BONE 6.5MM 95MM 32MM TI CANC PTTHRD HX HD SLFTAP","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-100","SUP","HCPCS C1713","","5681-0-100  -  SCREW BONE 4.2MM 100MM 32MM TI CANC HEX HEAD PTTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-105","SUP","HCPCS C1713","","5681-0-105  -  SCREW BONE 6.5MM 32MM 32MM CANC HX HD PRTL THRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"5681-0-110","SUP","HCPCS C1713","","5681-0-110  -  SCREW BONE 6.5MM 110MM 32MM CANC HEX HEAD PTHRD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"57-05101","SUP","HCPCS C1713","","57-05101  -  PLATE XS HYDRXAPT TI 1.2MM SCR 4 HOLE STR PRFL BONE","BOTH IP/OP","$321.30 ","$237.76 ","$0.00 ","$215.88 ","$97.14 ","$0.00 ","$66.97 ","$0.00 ","$0.00 ","$37.80 ","$215.88 ","$0.00 ","$107.94 ","$170.98 ","$172.70 ","$0.00 ","$33.78 ","$0.00 ","$34.37 ","$0.00 "
"57-05116","SUP","HCPCS C1713","","57-05116  -  PLATE XS .55MM TI 1.2MM SCR 16 HOLE STR PRFL BONE HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$482.63 ","$217.18 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$84.50 ","$482.63 ","$0.00 ","$241.31 ","$382.24 ","$386.10 ","$0.00 ","$75.53 ","$0.00 ","$76.83 ","$0.00 "
"57-05140","SUP","HCPCS C1713","","57-05140  -  PLATE XS NAR STD .55MM TI 1.2MM SCR 5 HOLE T PRFL BONE HAND","BOTH IP/OP","$321.30 ","$237.76 ","$0.00 ","$287.38 ","$129.32 ","$0.00 ","$66.97 ","$0.00 ","$0.00 ","$50.32 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$44.97 ","$0.00 ","$45.75 ","$0.00 "
"57-05142","SUP","HCPCS C1713","","57-05142  -  PLATE XS NAR STD .55MM 1.2MM SCR 8 HOLE T PRFL PRFL BONE","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$347.88 ","$156.54 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$60.91 ","$347.88 ","$0.00 ","$173.94 ","$275.52 ","$278.30 ","$0.00 ","$54.44 ","$0.00 ","$55.38 ","$0.00 "
"57-05150","SUP","HCPCS C1713","","57-05150  -  PLATE XS STD .55MM TI 1.2MM SCR T 5 HOLE OBLQ PRFL PRFL BONE","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"57-05151","SUP","HCPCS C1713","","57-05151  -  PLATE XS STD .55MM TI 1.2MM SCR 5 HOLE T OBLQ PRFL BONE LEFT","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"57-05170","SUP","HCPCS C1713","","57-05170  -  PLATE XS STD NAR .55MM TI 1.2MM SCR 5 HOLE Y PRFL BONE HAND","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-05190","SUP","HCPCS C1713","","57-05190  -  PLATE XS TI SM FRAG SYS 2X2 HOLE 3D MDLR FIX PRFL BONE HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"57-05191","SUP","HCPCS C1713","","57-05191  -  PLATE XS STD .55MM TI 1.2MM SCR 3D 3X2HOLE PRFL PRFL BONE","BOTH IP/OP","$554.13 ","$410.06 ","$0.00 ","$554.13 ","$249.36 ","$0.00 ","$115.49 ","$0.00 ","$0.00 ","$97.02 ","$554.13 ","$0.00 ","$277.06 ","$438.87 ","$443.30 ","$0.00 ","$86.72 ","$0.00 ","$88.22 ","$0.00 "
"57-05192","SUP","HCPCS C1713","","57-05192  -  PLATE XS STD .55MM TI 1.2MM SCR 4X2 HOLE 3D PRFL BONE HAND","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$666.88 ","$300.09 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$116.76 ","$666.88 ","$0.00 ","$333.44 ","$528.17 ","$533.50 ","$0.00 ","$104.37 ","$0.00 ","$106.17 ","$0.00 "
"57-05195","SUP","HCPCS C1713","","57-05195  -  PLATE XS STD .55MM TI 1.2MM SCR 3D 4X2 HOLE REPLANTATION","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$625.63 ","$281.53 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$109.54 ","$625.63 ","$0.00 ","$312.81 ","$495.50 ","$500.50 ","$0.00 ","$97.91 ","$0.00 ","$99.60 ","$0.00 "
"57-05197","SUP","HCPCS C1713","","57-05197  -  PLATE XS TI 1.2MM SCR 2X2+2 HOLE 3D PRFL PRFL BONE HAND WRST","BOTH IP/OP","$554.13 ","$410.06 ","$0.00 ","$554.13 ","$249.36 ","$0.00 ","$115.49 ","$0.00 ","$0.00 ","$97.02 ","$554.13 ","$0.00 ","$277.06 ","$438.87 ","$443.30 ","$0.00 ","$86.72 ","$0.00 ","$88.22 ","$0.00 "
"57-05201","SUP","HCPCS C1713","","57-05201  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 4 HOLE FIX STR MDLR","BOTH IP/OP","$321.30 ","$237.76 ","$0.00 ","$226.88 ","$102.09 ","$0.00 ","$66.97 ","$0.00 ","$0.00 ","$39.72 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$35.51 ","$0.00 ","$36.12 ","$0.00 "
"57-05202","SUP","HCPCS C1713","","57-05202  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 4 HOLE FIX STR BAR MDLR","BOTH IP/OP","$321.30 ","$237.76 ","$0.00 ","$226.88 ","$102.09 ","$0.00 ","$66.97 ","$0.00 ","$0.00 ","$39.72 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$35.51 ","$0.00 ","$36.12 ","$0.00 "
"57-05210","SUP","HCPCS C1713","","57-05210  -  PLATE W STD .55MM 1.7MM SCR 8 HOLE T S MOD PRFL BONE HAND","BOTH IP/OP","$489.00 ","$361.86 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$101.92 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"57-05216","SUP","HCPCS C1713","","57-05216  -  PLATE SM .55MM 1.7MM SCR FRAG SYS 16 HOLE FIX STR MDLR PRFL","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$492.25 ","$221.51 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$86.19 ","$492.25 ","$0.00 ","$246.13 ","$389.86 ","$393.80 ","$0.00 ","$77.04 ","$0.00 ","$78.37 ","$0.00 "
"57-05220","SUP","HCPCS C1713","","57-05220  -  PLATE 90D REG SM HYDRXAPT TI 1.7MM SCR 6 HOLE RIGHT L PRFL","BOTH IP/OP","$321.30 ","$237.76 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$66.97 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-05221","SUP","HCPCS C1713","","57-05221  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 6 HOLE FIX L MDLR PRFL","BOTH IP/OP","$321.30 ","$237.76 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$66.97 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-05230","SUP","HCPCS C1713","","57-05230  -  PLATE SM .55MM TI 1.7MM SCR 6 HOLE L OBLQ PRFL BONE RIGHT","BOTH IP/OP","$366.10 ","$270.91 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$76.30 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-05231","SUP","HCPCS C1713","","57-05231  -  PLATE SM .55MM TI 1.7MM SCR 6 HOLE PRFL BONE LEFT OBLQ","BOTH IP/OP","$366.10 ","$270.91 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$76.30 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-05240","SUP","HCPCS C1713","","57-05240  -  PLATE SM TI 1.7MM SCR SM FRAG SYS 6 HOLE T MDLR FIX PRFL","BOTH IP/OP","$328.63 ","$243.19 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"57-05250","SUP","HCPCS C1713","","57-05250  -  PLATE SM TI SM FRAG SYS 6 HOLE T FX MDLR PRFL BONE HAND","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"57-05251","SUP","HCPCS C1713","","57-05251  -  PLATE SM NAR TI 1.7MM SCR 6 HOLE T OBLQ PRFL BONE LEFT HAND","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"57-05260","SUP","HCPCS C1713","","57-05260  -  PLATE STD TI 1.7MM SCR 7 HOLE T PRFL BONE HAND","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$328.63 ","$147.88 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$57.54 ","$328.63 ","$0.00 ","$164.31 ","$260.27 ","$262.90 ","$0.00 ","$51.43 ","$0.00 ","$52.32 ","$0.00 "
"57-05262","SUP","HCPCS C1713","","57-05262  -  PLATE SM STD NAR .55MM TI 1.7MM SCR 10 HOLE T FX PRFL BONE","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$347.88 ","$156.54 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$60.91 ","$347.88 ","$0.00 ","$173.94 ","$275.52 ","$278.30 ","$0.00 ","$54.44 ","$0.00 ","$55.38 ","$0.00 "
"57-05270","SUP","HCPCS C1713","","57-05270  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 7 HOLE FIX Y MDLR PRFL","BOTH IP/OP","$371.00 ","$274.54 ","$0.00 ","$360.25 ","$162.11 ","$0.00 ","$77.33 ","$0.00 ","$0.00 ","$63.08 ","$360.25 ","$0.00 ","$180.13 ","$285.32 ","$288.20 ","$0.00 ","$56.38 ","$0.00 ","$57.35 ","$0.00 "
"57-05279","SUP","HCPCS C1713","","57-05279  -  PLATE SM .55MM TI 1.7MM SCR 9 HOLE Z FIX PRFL BONE HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$430.38 ","$193.67 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$75.36 ","$430.38 ","$0.00 ","$215.19 ","$340.86 ","$344.30 ","$0.00 ","$67.35 ","$0.00 ","$68.52 ","$0.00 "
"57-05280","SUP","HCPCS C1713","","57-05280  -  PLATE SM RIGHT CNDYLR HAND .55MM TI 1.7MM SCR FRAG SYS 5","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$347.88 ","$156.54 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$60.91 ","$347.88 ","$0.00 ","$173.94 ","$275.52 ","$278.30 ","$0.00 ","$54.44 ","$0.00 ","$55.38 ","$0.00 "
"57-05281","SUP","HCPCS C1713","","57-05281  -  PLATE SM LEFT CNDYLR HAND .55MM TI 1.7MM SCR FRAG SYS 5 HOLE","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$347.88 ","$156.54 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$60.91 ","$347.88 ","$0.00 ","$173.94 ","$275.52 ","$278.30 ","$0.00 ","$54.44 ","$0.00 ","$55.38 ","$0.00 "
"57-05282","SUP","HCPCS C1713","","57-05282  -  PLATE SM STD .55MM TI 1.7MM SCR 5 HOLE BLADE PRFL BONE RIGHT","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$347.88 ","$156.54 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$60.91 ","$347.88 ","$0.00 ","$173.94 ","$275.52 ","$278.30 ","$0.00 ","$54.44 ","$0.00 ","$55.38 ","$0.00 "
"57-05283","SUP","HCPCS C1713","","57-05283  -  PLATE SM STD .55MM TI 1.7MM SCR 5 HOLE BLADE PRFL BONE LEFT","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$347.88 ","$156.54 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$60.91 ","$347.88 ","$0.00 ","$173.94 ","$275.52 ","$278.30 ","$0.00 ","$54.44 ","$0.00 ","$55.38 ","$0.00 "
"57-05285","SUP","HCPCS C1713","","57-05285  -  PLATE SM STD .55MM TI 1.7MM SCR 1 HOLE PR PRFL BONE HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$360.25 ","$162.11 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$63.08 ","$360.25 ","$0.00 ","$180.13 ","$285.32 ","$288.20 ","$0.00 ","$56.38 ","$0.00 ","$57.35 ","$0.00 "
"57-05290","SUP","HCPCS C1713","","57-05290  -  PLATE SM HYDRXAPT TI 1.7MM SCR 2X2 HOLE 3D PRFL BONE","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$379.50 ","$170.78 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$66.45 ","$379.50 ","$0.00 ","$189.75 ","$300.56 ","$303.60 ","$0.00 ","$59.39 ","$0.00 ","$60.42 ","$0.00 "
"57-05291","SUP","HCPCS C1713","","57-05291  -  PLATE SM STD .55MM TI 1.7MM SCR 3X2 HOLE 3D PRFL BONE HAND","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$563.75 ","$253.69 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$98.71 ","$563.75 ","$0.00 ","$281.88 ","$446.49 ","$451.00 ","$0.00 ","$88.23 ","$0.00 ","$89.75 ","$0.00 "
"57-05292","SUP","HCPCS C1713","","57-05292  -  PLATE SM STD .55MM TI 1.7MM SCR 4X2 HOLE 3D PRFL BONE HAND","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$677.88 ","$305.04 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$118.69 ","$677.88 ","$0.00 ","$338.94 ","$536.88 ","$542.30 ","$0.00 ","$106.09 ","$0.00 ","$107.92 ","$0.00 "
"57-05295","SUP","HCPCS C1713","","57-05295  -  PLATE SM STD .55MM TI 1.7MM SCR 4X2 HOLE 3D REPLANTATION","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$677.88 ","$305.04 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$118.69 ","$677.88 ","$0.00 ","$338.94 ","$536.88 ","$542.30 ","$0.00 ","$106.09 ","$0.00 ","$107.92 ","$0.00 "
"57-05297","SUP","HCPCS C1713","","57-05297  -  PLATE SM STD .55MM TI 1.7MM SCR 2X2+ 2 HOLE 3D PRFL BONE","BOTH IP/OP","$555.75 ","$411.26 ","$0.00 ","$563.75 ","$253.69 ","$0.00 ","$115.83 ","$0.00 ","$0.00 ","$98.71 ","$563.75 ","$0.00 ","$281.88 ","$446.49 ","$451.00 ","$0.00 ","$88.23 ","$0.00 ","$89.75 ","$0.00 "
"57-08212","SUP","HCPCS C1713","","57-08212  -  PLATE TI 1.7 MM SCR 12 HOLE STR PRFL BONE RIGHT HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$482.63 ","$217.18 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$84.50 ","$482.63 ","$0.00 ","$241.31 ","$382.24 ","$386.10 ","$0.00 ","$75.53 ","$0.00 ","$76.83 ","$0.00 "
"57-08213","SUP","HCPCS C1713","","57-08213  -  PLATE TI 1.7 MM SCR 12 HOLE STR PRFL BONE LEFT HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$482.63 ","$217.18 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$84.50 ","$482.63 ","$0.00 ","$241.31 ","$382.24 ","$386.10 ","$0.00 ","$75.53 ","$0.00 ","$76.83 ","$0.00 "
"57-08216","SUP","HCPCS C1713","","57-08216  -  PLATE TI 1.7 MM SCR 16 HOLE STR PRFL BONE HAND","BOTH IP/OP","$518.70 ","$383.84 ","$0.00 ","$503.25 ","$226.46 ","$0.00 ","$108.11 ","$0.00 ","$0.00 ","$88.12 ","$503.25 ","$0.00 ","$251.63 ","$398.57 ","$402.60 ","$0.00 ","$78.76 ","$0.00 ","$80.12 ","$0.00 "
"57-10101","SUP","HCPCS C1713","","57-10101  -  PLATE MED STD 1MM 2.3MM SCR 4 HOLE STR PRFL BONE HAND","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"57-10102","SUP","HCPCS C1713","","57-10102  -  PLATE TI SM FRAG SYS 4 HOLE STR BAR FIX MDLR PRFL BONE HAND","BOTH IP/OP","$459.00 ","$339.66 ","$0.00 ","$195.25 ","$87.86 ","$0.00 ","$95.67 ","$0.00 ","$0.00 ","$34.19 ","$195.25 ","$0.00 ","$97.63 ","$154.64 ","$156.20 ","$0.00 ","$30.56 ","$0.00 ","$31.08 ","$0.00 "
"57-10116","SUP","HCPCS C1713","","57-10116  -  PLATE MED STD 1MM TI 2.3MM SCR 16 HOLE STR PRFL BONE HAND","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$512.88 ","$230.79 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$89.80 ","$512.88 ","$0.00 ","$256.44 ","$406.20 ","$410.30 ","$0.00 ","$80.26 ","$0.00 ","$81.65 ","$0.00 "
"57-10120","SUP","HCPCS C1713","","57-10120  -  PLATE MED STD 1MM TI 2.3MM SCR 6 HOLE L PRFL PRFL BONE RIGHT","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-10121","SUP","HCPCS C1713","","57-10121  -  PLATE MED STD 1MM TI 2.3MM SCR 6 HOLE L PRFL BONE LEFT HAND","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-10130","SUP","HCPCS C1713","","57-10130  -  PLATE MED 1MM 2.3MM SCR SM FRAG SYS 6 HOLE L PRFL BONE HAND","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-10131","SUP","HCPCS C1713","","57-10131  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ PRFL BONE LEFT HAND","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$298.38 ","$134.27 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$52.24 ","$298.38 ","$0.00 ","$149.19 ","$236.32 ","$238.70 ","$0.00 ","$46.70 ","$0.00 ","$47.50 ","$0.00 "
"57-10140","SUP","HCPCS C1713","","57-10140  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 6 HOLE T PRFL","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10150","SUP","HCPCS C1713","","57-10150  -  PLATE MED 1MM 2.3MM SCR SM FRAG SYS 6 HOLE T PRFL BONE HAND","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10151","SUP","HCPCS C1713","","57-10151  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ PRFL BONE LEFT HAND","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10160","SUP","HCPCS C1713","","57-10160  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 7 HOLE T PRFL BONE","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10161","SUP","HCPCS C1713","","57-10161  -  PLATE MED W STD 1MM 2.3MM SCR 8 HOLE T PRFL PRFL BONE HAND","BOTH IP/OP","$489.00 ","$361.86 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$101.92 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"57-10170","SUP","HCPCS C1713","","57-10170  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 7 HOLE Y PRFL","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$389.13 ","$175.11 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$68.13 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$60.90 ","$0.00 ","$61.95 ","$0.00 "
"57-10179","SUP","HCPCS C1713","","57-10179  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 13 HOLE Z PRFL","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$430.38 ","$193.67 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$75.36 ","$430.38 ","$0.00 ","$215.19 ","$340.86 ","$344.30 ","$0.00 ","$67.35 ","$0.00 ","$68.52 ","$0.00 "
"57-10180","SUP","HCPCS C1713","","57-10180  -  PLATE MED TI OBLQ FRAC M ROT PRFL BONE PHLNG MTCRPL","BOTH IP/OP","$734.00 ","$543.16 ","$0.00 ","$809.88 ","$364.44 ","$0.00 ","$152.98 ","$0.00 ","$0.00 ","$141.80 ","$809.88 ","$0.00 ","$404.94 ","$641.42 ","$647.90 ","$0.00 ","$126.75 ","$0.00 ","$128.93 ","$0.00 "
"57-10185","SUP","HCPCS C1713","","57-10185  -  PLATE STD MED 1MM 2.3MM SCR 5 HOLE ROT PRFL BONE HAND","BOTH IP/OP","$944.00 ","$698.56 ","$0.00 ","$721.88 ","$324.84 ","$0.00 ","$196.75 ","$0.00 ","$0.00 ","$126.39 ","$721.88 ","$0.00 ","$360.94 ","$571.73 ","$577.50 ","$0.00 ","$112.97 ","$0.00 ","$114.92 ","$0.00 "
"57-10190","SUP","HCPCS C1713","","57-10190  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 2X2 HOLE 3D PRFL","BOTH IP/OP","$530.00 ","$392.20 ","$0.00 ","$379.50 ","$170.78 ","$0.00 ","$110.47 ","$0.00 ","$0.00 ","$66.45 ","$379.50 ","$0.00 ","$189.75 ","$300.56 ","$303.60 ","$0.00 ","$59.39 ","$0.00 ","$60.42 ","$0.00 "
"57-10191","SUP","HCPCS C1713","","57-10191  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 3X2 HOLE 3D PRFL","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$563.75 ","$253.69 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$98.71 ","$563.75 ","$0.00 ","$281.88 ","$446.49 ","$451.00 ","$0.00 ","$88.23 ","$0.00 ","$89.75 ","$0.00 "
"57-10192","SUP","HCPCS C1713","","57-10192  -  PLATE MED HYDRXAPT TI 2.3MM SCR 4X2 HOLE 3D PRFL BONE","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$677.88 ","$305.04 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$118.69 ","$677.88 ","$0.00 ","$338.94 ","$536.88 ","$542.30 ","$0.00 ","$106.09 ","$0.00 ","$107.92 ","$0.00 "
"57-10193","SUP","HCPCS C1713","","57-10193  -  PLATE MED TI 2.3MM SCR 3D PRFL BONE HAND WRST","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$677.88 ","$305.04 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$118.69 ","$677.88 ","$0.00 ","$338.94 ","$536.88 ","$542.30 ","$0.00 ","$106.09 ","$0.00 ","$107.92 ","$0.00 "
"57-10195","SUP","HCPCS C1713","","57-10195  -  PLATE MED 1MM TI 2.3MM SCR SM FRAG SYS 4X2 HOLE 3D FIX PRFL","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$636.63 ","$286.48 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$111.47 ","$636.63 ","$0.00 ","$318.31 ","$504.21 ","$509.30 ","$0.00 ","$99.63 ","$0.00 ","$101.35 ","$0.00 "
"57-10197","SUP","HCPCS C1713","","57-10197  -  PLATE MED 1MM TI 2.3MM SCR SM FRAG SYS 2X2+ 2 HOLE 3D FIX","BOTH IP/OP","$741.00 ","$548.34 ","$0.00 ","$563.75 ","$253.69 ","$0.00 ","$154.44 ","$0.00 ","$0.00 ","$98.71 ","$563.75 ","$0.00 ","$281.88 ","$446.49 ","$451.00 ","$0.00 ","$88.23 ","$0.00 ","$89.75 ","$0.00 "
"57-10201","SUP","HCPCS C1713","","57-10201  -  PLATE MED TI 2.3MM SCR 4 HOLE STR CMPR PRFL BONE HAND WRST","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"57-10202","SUP","HCPCS C1713","","57-10202  -  PLATE MED TI 2.3MM SCR 4 HOLE STR CMPR BAR PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"57-10204","SUP","HCPCS C1713","","57-10204  -  PLATE MED 1MM TI SM FRAG SYS 5 HOLE CMPR STR PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"57-10207","SUP","HCPCS C1713","","57-10207  -  PLATE MED 1MM TI SM FRAG SYS 6 HOLE CMPR STR PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10208","SUP","HCPCS C1713","","57-10208  -  PLATE MED TI 2.3MM SCR 7 HOLE STR CMPR PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10220","SUP","HCPCS C1713","","57-10220  -  PLATE 90D MED TI 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10221","SUP","HCPCS C1713","","57-10221  -  PLATE 90D MED TI 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10230","SUP","HCPCS C1713","","57-10230  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ CMPR PRFL BONE RIGHT","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10231","SUP","HCPCS C1713","","57-10231  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ CMPR PRFL BONE LEFT","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-10240","SUP","HCPCS C1713","","57-10240  -  PLATE MED 1MM TI SM FRAG SYS 6 HOLE CMPR T PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10250","SUP","HCPCS C1713","","57-10250  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ CMPR PRFL BONE","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10251","SUP","HCPCS C1713","","57-10251  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ CMPR PRFL BONE LEFT","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10260","SUP","HCPCS C1713","","57-10260  -  PLATE 90D MED REG TI 2.3MM SCR 7 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$360.25 ","$162.11 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$63.08 ","$360.25 ","$0.00 ","$180.13 ","$285.32 ","$288.20 ","$0.00 ","$56.38 ","$0.00 ","$57.35 ","$0.00 "
"57-10262","SUP","HCPCS C1713","","57-10262  -  PLATE 90D REG TI 2.3MM SCR 10 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$400.13 ","$180.06 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$70.06 ","$400.13 ","$0.00 ","$200.06 ","$316.90 ","$320.10 ","$0.00 ","$62.62 ","$0.00 ","$63.70 ","$0.00 "
"57-10270","SUP","HCPCS C1713","","57-10270  -  PLATE MED 1MM TI SM FRAG SYS 7 HOLE CMPR Y PRFL BONE HAND","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$400.13 ","$180.06 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$70.06 ","$400.13 ","$0.00 ","$200.06 ","$316.90 ","$320.10 ","$0.00 ","$62.62 ","$0.00 ","$63.70 ","$0.00 "
"57-10280","SUP","HCPCS C1713","","57-10280  -  PLATE MED TI 2.3MM SCR 5 HOLE PRFL BONE RIGHT CNDYLR","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10281","SUP","HCPCS C1713","","57-10281  -  PLATE MED TI 2.3MM SCR 5 HOLE PRFL BONE LEFT CNDYLR","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10282","SUP","HCPCS C1713","","57-10282  -  PLATE MED TI 2.3MM SCR 6 HOLE PRFL BONE RIGHT CNDYLR","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10283","SUP","HCPCS C1713","","57-10283  -  PLATE MED TI 2.3MM SCR 6 HOLE PRFL BONE LEFT CNDYLR","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$339.63 ","$152.83 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$59.47 ","$339.63 ","$0.00 ","$169.81 ","$268.99 ","$271.70 ","$0.00 ","$53.15 ","$0.00 ","$54.07 ","$0.00 "
"57-10284","SUP","HCPCS C1713","","57-10284  -  PLATE MED TI 2.3MM SCR 6 HOLE LNG PIN PRFL BONE RIGHT CNDYLR","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$389.13 ","$175.11 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$68.13 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$60.90 ","$0.00 ","$61.95 ","$0.00 "
"57-10285","SUP","HCPCS C1713","","57-10285  -  PLATE MED TI 2.3MM SCR 6 HOLE LNG PIN PRFL BONE LEFT CNDYLR","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$389.13 ","$175.11 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$68.13 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$60.90 ","$0.00 ","$61.95 ","$0.00 "
"57-10304","SUP","HCPCS C1713","","57-10304  -  PLATE SM 1MM 1.7MM SCR 4 HOLE STR LCK VARIAX BONE HAND","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$254.38 ","$114.47 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$44.54 ","$254.38 ","$0.00 ","$127.19 ","$201.47 ","$203.50 ","$0.00 ","$39.81 ","$0.00 ","$40.50 ","$0.00 "
"57-10310","SUP","HCPCS C1713","","57-10310  -  PLATE SM NAR 1MM 1.7MM SCR 10 HOLE T LCK PRFL VARIAX BONE","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$391.88 ","$176.34 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$68.61 ","$391.88 ","$0.00 ","$195.94 ","$310.37 ","$313.50 ","$0.00 ","$61.33 ","$0.00 ","$62.39 ","$0.00 "
"57-10316","SUP","HCPCS C1713","","57-10316  -  PLATE SM 1MM 1.7MM SCR 16 HOLE STR LCK PRFL VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$556.88 ","$250.59 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$97.50 ","$556.88 ","$0.00 ","$278.44 ","$441.05 ","$445.50 ","$0.00 ","$87.15 ","$0.00 ","$88.65 ","$0.00 "
"57-10320","SUP","HCPCS C1713","","57-10320  -  PLATE SM 1MM 1.7MM SCR 6 HOLE L LCK VARIAX BONE 1.7MM RIGHT","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$336.88 ","$151.59 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$58.98 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$52.72 ","$0.00 ","$53.63 ","$0.00 "
"57-10321","SUP","HCPCS C1713","","57-10321  -  PLATE SM 1MM 1.7MM SCR 6 HOLE L LCK VARIAX BONE 1.7MM LEFT","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$336.88 ","$151.59 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$58.98 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$52.72 ","$0.00 ","$53.63 ","$0.00 "
"57-10340","SUP","HCPCS C1713","","57-10340  -  PLATE SM NAR 1MM 1.7MM SCR 6 HOLE T LCK PRFL VARIAX BONE","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"57-10360","SUP","HCPCS C1713","","57-10360  -  PLATE SM 1MM 1.7MM SCR 7 HOLE T LCK PRFL VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$371.25 ","$167.06 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$65.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$58.10 ","$0.00 ","$59.10 ","$0.00 "
"57-10368","SUP","HCPCS C1713","","57-10368  -  PLATE SM W 1MM 1.7MM SCR 8 HOLE T LCK PRFL VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$405.63 ","$182.53 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$71.02 ","$405.63 ","$0.00 ","$202.81 ","$321.26 ","$324.50 ","$0.00 ","$63.48 ","$0.00 ","$64.58 ","$0.00 "
"57-10379","SUP","HCPCS C1713","","57-10379  -  PLATE SM NAR 1MM 1.7MM SCR 9 HOLE Z LCK PRFL VARIAX BONE","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$488.13 ","$219.66 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$85.47 ","$488.13 ","$0.00 ","$244.06 ","$386.60 ","$390.50 ","$0.00 ","$76.39 ","$0.00 ","$77.71 ","$0.00 "
"57-10380","SUP","HCPCS C1713","","57-10380  -  PLATE SM 1MM 1.7MM SCR 5 HOLE ROT LCK VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$763.13 ","$343.41 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$133.62 ","$763.13 ","$0.00 ","$381.56 ","$604.40 ","$610.50 ","$0.00 ","$119.43 ","$0.00 ","$121.49 ","$0.00 "
"57-10390","SUP","HCPCS C1713","","57-10390  -  PLATE SM 1MM 1.7MM SCR 2X2 HOLE 3D LCK VARIAX BONE 1.7MM","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$426.25 ","$191.81 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$74.63 ","$426.25 ","$0.00 ","$213.13 ","$337.59 ","$341.00 ","$0.00 ","$66.71 ","$0.00 ","$67.86 ","$0.00 "
"57-10391","SUP","HCPCS C1713","","57-10391  -  PLATE 1MM 3X2 HOLE 3D VARIAX BONE 1.7MM HAND WRST","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$632.50 ","$284.63 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$110.75 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$98.99 ","$0.00 ","$100.69 ","$0.00 "
"57-10392","SUP","HCPCS C1713","","57-10392  -  PLATE SM 1MM 1.7MM SCR 4X2 HOLE 3D LCK VARIAX BONE 1.7MM","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$763.13 ","$343.41 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$133.62 ","$763.13 ","$0.00 ","$381.56 ","$604.40 ","$610.50 ","$0.00 ","$119.43 ","$0.00 ","$121.49 ","$0.00 "
"57-10395","SUP","HCPCS C1713","","57-10395  -  PLATE SM 1MM 1.7MM SCR 8 HOLE 3D LCK PRFL REPLANTATION","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$763.13 ","$343.41 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$133.62 ","$763.13 ","$0.00 ","$381.56 ","$604.40 ","$610.50 ","$0.00 ","$119.43 ","$0.00 ","$121.49 ","$0.00 "
"57-10397","SUP","HCPCS C1713","","57-10397  -  PLATE SM 1MM 1.7MM SCR 2X2+2 HOLE 3D LCK VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$632.50 ","$284.63 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$110.75 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$98.99 ","$0.00 ","$100.69 ","$0.00 "
"57-10402","SUP","HCPCS C1713","","57-10402  -  PLATE MED 1MM 2.3MM SCR 4 HOLE STR CMPR PRFL BONE HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$281.88 ","$126.84 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$49.35 ","$281.88 ","$0.00 ","$140.94 ","$223.25 ","$225.50 ","$0.00 ","$44.11 ","$0.00 ","$44.87 ","$0.00 "
"57-10407","SUP","HCPCS C1713","","57-10407  -  PLATE MED 1MM 2.3MM SCR 6 HOLE STR CMPR PRFL PRFL BONE HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$350.63 ","$157.78 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$61.39 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$54.87 ","$0.00 ","$55.82 ","$0.00 "
"57-10420","SUP","HCPCS C1713","","57-10420  -  PLATE MED 1MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$350.63 ","$157.78 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$61.39 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$54.87 ","$0.00 ","$55.82 ","$0.00 "
"57-10421","SUP","HCPCS C1713","","57-10421  -  PLATE MED 1MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$350.63 ","$157.78 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$61.39 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$54.87 ","$0.00 ","$55.82 ","$0.00 "
"57-10440","SUP","HCPCS C1713","","57-10440  -  PLATE MED NAR 1MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"57-10460","SUP","HCPCS C1713","","57-10460  -  PLATE MED 1MM 2.3MM SCR 7 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$405.63 ","$182.53 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$71.02 ","$405.63 ","$0.00 ","$202.81 ","$321.26 ","$324.50 ","$0.00 ","$63.48 ","$0.00 ","$64.58 ","$0.00 "
"57-10470","SUP","HCPCS C1713","","57-10470  -  PLATE NAR MED 1MM 2.3MM SCR 7 HOLE Y CMPR PRFL BONE HAND","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$453.75 ","$204.19 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$79.45 ","$453.75 ","$0.00 ","$226.88 ","$359.37 ","$363.00 ","$0.00 ","$71.01 ","$0.00 ","$72.24 ","$0.00 "
"57-10482","SUP","HCPCS C1713","","57-10482  -  PLATE MED 1MM 2.3MM SCR 6 HOLE BLADE CMPR PRFL BONE 2.3MM","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"57-10483","SUP","HCPCS C1713","","57-10483  -  PLATE MED 1MM 2.3MM SCR 6 HOLE BLADE CMPR PRFL BONE LEFT","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"57-13102","SUP","HCPCS C1713","","57-13102  -  PLATE LG 1.3MM TI SM FRAG SYS 4 HOLE STR BAR CMPR PRFL BONE","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$287.38 ","$129.32 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$50.32 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$44.97 ","$0.00 ","$45.75 ","$0.00 "
"57-13105","SUP","HCPCS C1713","","57-13105  -  PLATE LG 1.3MM TI SM FRAG SYS 5 HOLE STR BAR CMPR PRFL BONE","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$308.00 ","$138.60 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"57-13108","SUP","HCPCS C1713","","57-13108  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE STR BAR CMPR PRFL BONE","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$360.25 ","$162.11 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$63.08 ","$360.25 ","$0.00 ","$180.13 ","$285.32 ","$288.20 ","$0.00 ","$56.38 ","$0.00 ","$57.35 ","$0.00 "
"57-13109","SUP","HCPCS C1713","","57-13109  -  PLATE LG 1.3MM TI SM FRAG SYS 7 HOLE STR BAR CMPR PRFL BONE","BOTH IP/OP","$634.00 ","$469.16 ","$0.00 ","$389.13 ","$175.11 ","$0.00 ","$132.14 ","$0.00 ","$0.00 ","$68.13 ","$389.13 ","$0.00 ","$194.56 ","$308.19 ","$311.30 ","$0.00 ","$60.90 ","$0.00 ","$61.95 ","$0.00 "
"57-13110","SUP","HCPCS C1713","","57-13110  -  PLATE LG 1.3MM TI SM FRAG SYS 8 HOLE STR BAR CMPR PRFL BONE","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$420.75 ","$189.34 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$73.67 ","$420.75 ","$0.00 ","$210.38 ","$333.23 ","$336.60 ","$0.00 ","$65.85 ","$0.00 ","$66.98 ","$0.00 "
"57-13120","SUP","HCPCS C1713","","57-13120  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE L CMPR PRFL BONE HAND","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"57-13121","SUP","HCPCS C1713","","57-13121  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE L CMPR PRFL BONE HAND","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"57-13140","SUP","HCPCS C1713","","57-13140  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"57-13142","SUP","HCPCS C1713","","57-13142  -  PLATE LG 1.3MM TI SM FRAG SYS 10 HOLE T BAR CMPR PRFL BONE","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$400.13 ","$180.06 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$70.06 ","$400.13 ","$0.00 ","$200.06 ","$316.90 ","$320.10 ","$0.00 ","$62.62 ","$0.00 ","$63.70 ","$0.00 "
"57-13150","SUP","HCPCS C1713","","57-13150  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"57-13151","SUP","HCPCS C1713","","57-13151  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$443.80 ","$328.41 ","$0.00 ","$368.50 ","$165.83 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$64.52 ","$368.50 ","$0.00 ","$184.25 ","$291.85 ","$294.80 ","$0.00 ","$57.67 ","$0.00 ","$58.67 ","$0.00 "
"57-13180","SUP","HCPCS C1713","","57-13180  -  PLATE LG TI SM FRAG SET 5 HOLE MDLR ROT PRFL BONE HAND","BOTH IP/OP","$550.50 ","$407.37 ","$0.00 ","$809.88 ","$364.44 ","$0.00 ","$114.74 ","$0.00 ","$0.00 ","$141.80 ","$809.88 ","$0.00 ","$404.94 ","$641.42 ","$647.90 ","$0.00 ","$126.75 ","$0.00 ","$128.93 ","$0.00 "
"57-13185","SUP","HCPCS C1713","","57-13185  -  PLATE STD W MED 1MM 5 HOLE ROT PRFL PRFL BONE 2.3MM HAND","BOTH IP/OP","$944.00 ","$698.56 ","$0.00 ","$721.88 ","$324.84 ","$0.00 ","$196.75 ","$0.00 ","$0.00 ","$126.39 ","$721.88 ","$0.00 ","$360.94 ","$571.73 ","$577.50 ","$0.00 ","$112.97 ","$0.00 ","$114.92 ","$0.00 "
"57-13402","SUP","HCPCS C1713","","57-13402  -  PLATE 1.3MM 2.3MM SCR 4 HOLE L CMPR STR PRFL BONE HAND","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$330.00 ","$148.50 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"57-13405","SUP","HCPCS C1713","","57-13405  -  PLATE 1.3MM 2.3MM SCR 5 HOLE L CMPR STR PRFL BONE HAND","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$350.63 ","$157.78 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$61.39 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$54.87 ","$0.00 ","$55.82 ","$0.00 "
"57-13408","SUP","HCPCS C1713","","57-13408  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR STR PRFL BONE 2.3MM","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$405.63 ","$182.53 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$71.02 ","$405.63 ","$0.00 ","$202.81 ","$321.26 ","$324.50 ","$0.00 ","$63.48 ","$0.00 ","$64.58 ","$0.00 "
"57-13410","SUP","HCPCS C1713","","57-13410  -  PLATE LG 1.3MM 2.3MM SCR 8 HOLE L CMPR STR PRFL BONE HAND","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$440.00 ","$198.00 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$77.04 ","$440.00 ","$0.00 ","$220.00 ","$348.48 ","$352.00 ","$0.00 ","$68.86 ","$0.00 ","$70.05 ","$0.00 "
"57-13420","SUP","HCPCS C1713","","57-13420  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"57-13421","SUP","HCPCS C1713","","57-13421  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"57-13440","SUP","HCPCS C1713","","57-13440  -  PLATE NAR 1.3MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"57-13442","SUP","HCPCS C1713","","57-13442  -  PLATE NAR 1.3MM 2.3MM SCR 10 HOLE T CMPR PRFL BONE 2.3MM","BOTH IP/OP","$453.75 ","$335.78 ","$0.00 ","$453.75 ","$204.19 ","$0.00 ","$94.57 ","$0.00 ","$0.00 ","$79.45 ","$453.75 ","$0.00 ","$226.88 ","$359.37 ","$363.00 ","$0.00 ","$71.01 ","$0.00 ","$72.24 ","$0.00 "
"57-13450","SUP","HCPCS C1713","","57-13450  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR OBLQ PRFL BONE RIGHT","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"57-13451","SUP","HCPCS C1713","","57-13451  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR OBLQ PRFL BONE LEFT","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"57-13906","SUP","HCPCS C1713","","57-13906  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND","BOTH IP/OP","$441.00 ","$326.34 ","$0.00 ","$419.38 ","$188.72 ","$0.00 ","$91.92 ","$0.00 ","$0.00 ","$73.43 ","$419.38 ","$0.00 ","$209.69 ","$332.15 ","$335.50 ","$0.00 ","$65.63 ","$0.00 ","$66.76 ","$0.00 "
"57-15301","SUP","HCPCS C1713","","57-15301  -  PLATE BN MED STRG 1.5MM VARIAX 4 HL LCK PRECONTOUR HND 2.3MM","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"57-15302","SUP","HCPCS C1713","","57-15302  -  PLATE MED 1.5MM 2.3MM SCR 4 HOLE LCK STR BAR VARIAX BONE","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$281.88 ","$126.84 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$49.35 ","$281.88 ","$0.00 ","$140.94 ","$223.25 ","$225.50 ","$0.00 ","$44.11 ","$0.00 ","$44.87 ","$0.00 "
"57-15316","SUP","HCPCS C1713","","57-15316  -  PLATE MED 1.5MM 2.3MM SCR 16 HOLE LCK STR PRFL VARIAX BONE","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$577.50 ","$259.88 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$101.12 ","$577.50 ","$0.00 ","$288.75 ","$457.38 ","$462.00 ","$0.00 ","$90.38 ","$0.00 ","$91.94 ","$0.00 "
"57-15320","SUP","HCPCS C1713","","57-15320  -  PLATE MED RIGHT HAND 1.5MM 2.3MM SCR 6 HOLE L LCK VARIAX","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$336.88 ","$151.59 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$58.98 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$52.72 ","$0.00 ","$53.63 ","$0.00 "
"57-15321","SUP","HCPCS C1713","","57-15321  -  PLATE MED LEFT HAND 1.5MM 2.3MM SCR 6 HOLE L LCK VARIAX BONE","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$336.88 ","$151.59 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$58.98 ","$336.88 ","$0.00 ","$168.44 ","$266.81 ","$269.50 ","$0.00 ","$52.72 ","$0.00 ","$53.63 ","$0.00 "
"57-15324","SUP","HCPCS C1713","","57-15324  -  PLATE 1.5MM 5 HOLE 5 VARIAX BONE 2.3MM LEFT HAND WRST","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$914.38 ","$411.47 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$160.10 ","$914.38 ","$0.00 ","$457.19 ","$724.19 ","$731.50 ","$0.00 ","$143.10 ","$0.00 ","$145.57 ","$0.00 "
"57-15325","SUP","HCPCS C1713","","57-15325  -  PLATE MED 1.5MM 2.3MM SCR 5 HOLE MC5 LCK VARIAX BONE 2.3MM","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$914.38 ","$411.47 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$160.10 ","$914.38 ","$0.00 ","$457.19 ","$724.19 ","$731.50 ","$0.00 ","$143.10 ","$0.00 ","$145.57 ","$0.00 "
"57-15340","SUP","HCPCS C1713","","57-15340  -  PLATE BN MED NAR T 1.5MM VARIAX 6 HL LCK PRECONTOUR HND 2.3","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$350.63 ","$157.78 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$61.39 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$54.87 ","$0.00 ","$55.82 ","$0.00 "
"57-15360","SUP","HCPCS C1713","","57-15360  -  PLATE MED 1.5MM 2.3MM SCR 7 HOLE T LCK VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$385.00 ","$173.25 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"57-15361","SUP","HCPCS C1713","","57-15361  -  PLATE MED W 1.5MM 2.3MM SCR 8 HOLE T LCK VARIAX BONE HAND","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$405.63 ","$182.53 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$71.02 ","$405.63 ","$0.00 ","$202.81 ","$321.26 ","$324.50 ","$0.00 ","$63.48 ","$0.00 ","$64.58 ","$0.00 "
"57-15370","SUP","HCPCS C1713","","57-15370  -  PLATE BN MED NAR T 1.5MM VARIAX 7 HL LCK PRECONTOUR HND 2.3","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$440.00 ","$198.00 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$77.04 ","$440.00 ","$0.00 ","$220.00 ","$348.48 ","$352.00 ","$0.00 ","$68.86 ","$0.00 ","$70.05 ","$0.00 "
"57-15379","SUP","HCPCS C1713","","57-15379  -  PLATE MED NAR 1.5MM 2.3MM SCR 13 HOLE Z LCK PRFL VARIAX BONE","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$488.13 ","$219.66 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$85.47 ","$488.13 ","$0.00 ","$244.06 ","$386.60 ","$390.50 ","$0.00 ","$76.39 ","$0.00 ","$77.71 ","$0.00 "
"57-15385","SUP","HCPCS C1713","","57-15385  -  PLATE MED 1.5MM 2.3MM SCR 5 HOLE LCK ROT PRFL VARIAX BONE","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$907.50 ","$408.38 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$158.90 ","$907.50 ","$0.00 ","$453.75 ","$718.74 ","$726.00 ","$0.00 ","$142.02 ","$0.00 ","$144.47 ","$0.00 "
"57-15390","SUP","HCPCS C1713","","57-15390  -  PLATE MED 1.5MM 2.3MM SCR 2X2 HOLE 3D LCK VARIAX BONE 2.3MM","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$591.25 ","$266.06 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$103.52 ","$591.25 ","$0.00 ","$295.63 ","$468.27 ","$473.00 ","$0.00 ","$92.53 ","$0.00 ","$94.13 ","$0.00 "
"57-15391","SUP","HCPCS C1713","","57-15391  -  PLATE MED 1.5MM 2.3MM SCR 3X2 HOLE 3D LCK VARIAX BONE 2.3MM","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$632.50 ","$284.63 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$110.75 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$98.99 ","$0.00 ","$100.69 ","$0.00 "
"57-15392","SUP","HCPCS C1713","","57-15392  -  PLATE MED 1.5MM 2.3MM SCR 4X2 HOLE 3D LCK PRFL VARIAX BONE","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$763.13 ","$343.41 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$133.62 ","$763.13 ","$0.00 ","$381.56 ","$604.40 ","$610.50 ","$0.00 ","$119.43 ","$0.00 ","$121.49 ","$0.00 "
"57-15395","SUP","HCPCS C1713","","57-15395  -  PLATE MED 1.5MM 2.3MM SCR 4X2 HOLE 3D LCK REPLANTATION PRFL","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$715.00 ","$321.75 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$125.19 ","$715.00 ","$0.00 ","$357.50 ","$566.28 ","$572.00 ","$0.00 ","$111.90 ","$0.00 ","$113.83 ","$0.00 "
"57-15397","SUP","HCPCS C1713","","57-15397  -  PLATE MED 1.5MM 2.3MM SCR 2X2+ 2 HOLE 3D LCK VARIAX BONE 2.3","BOTH IP/OP","$979.00 ","$724.46 ","$0.00 ","$632.50 ","$284.63 ","$0.00 ","$204.05 ","$0.00 ","$0.00 ","$110.75 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$98.99 ","$0.00 ","$100.69 ","$0.00 "
"57525P","SUP","HCPCS C1713","","57525P  -  SCREW BN 5.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57525S","SUP","HCPCS C1713","","57525S  -  SCREW BN STD 5.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57530P","SUP","HCPCS C1713","","57530P  -  SCREW BN 5.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57530S","SUP","HCPCS C1713","","57530S  -  SCREW BN STD 5.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57535P","SUP","HCPCS C1713","","57535P  -  SCREW BN 5.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57535S","SUP","HCPCS C1713","","57535S  -  SCREW BN STD 5.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57540P","SUP","HCPCS C1713","","57540P  -  SCREW BN 5.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57540S","SUP","HCPCS C1713","","57540S  -  SCREW BN STD 5.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57545P","SUP","HCPCS C1713","","57545P  -  SCREW BN 5.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57545S","SUP","HCPCS C1713","","57545S  -  SCREW BN STD 5.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57550P","SUP","HCPCS C1713","","57550P  -  SCREW BN 5.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57550S","SUP","HCPCS C1713","","57550S  -  SCREW BN STD 5.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57555P","SUP","HCPCS C1713","","57555P  -  SCREW BN 5.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57555S","SUP","HCPCS C1713","","57555S  -  SCREW BN STD 5.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57560P","SUP","HCPCS C1713","","57560P  -  SCREW BN 5.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"57560S","SUP","HCPCS C1713","","57560S  -  SCREW BN STD 5.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,233.33 ","$912.66 ","$0.00 ","$1,233.33 ","$555.00 ","$0.00 ","$257.06 ","$0.00 ","$0.00 ","$215.95 ","$1,233.33 ","$0.00 ","$616.66 ","$976.80 ","$986.66 ","$0.00 ","$193.02 ","$0.00 ","$196.35 ","$0.00 "
"57565P","SUP","HCPCS C1713","","57565P  -  SCREW BN 5.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$1,621.98 ","$1,200.27 ","$0.00 ","$1,621.98 ","$729.89 ","$0.00 ","$338.06 ","$0.00 ","$0.00 ","$283.99 ","$1,621.98 ","$0.00 ","$810.99 ","$1,284.61 ","$1,297.58 ","$0.00 ","$253.84 ","$0.00 ","$258.22 ","$0.00 "
"57565S","SUP","HCPCS C1713","","57565S  -  SCREW BN STD 5.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,233.33 ","$912.66 ","$0.00 ","$1,233.33 ","$555.00 ","$0.00 ","$257.06 ","$0.00 ","$0.00 ","$215.95 ","$1,233.33 ","$0.00 ","$616.66 ","$976.80 ","$986.66 ","$0.00 ","$193.02 ","$0.00 ","$196.35 ","$0.00 "
"5770-1-000","SUP","Custom 27203010","","5770-1-000  -  SET ORTH 3.2MM DRILL GUIDE","BOTH IP/OP","$382.25 ","$282.87 ","$0.00 ","$382.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.25 ","$0.00 ","$191.13 ","$302.74 ","$305.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5770-3-000","SUP","Custom 27203010","","5770-3-000  -  SET ORTH 3.2MM DRILL GUIDE NTRL","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5770-4-000","SUP","Custom 27203010","","5770-4-000  -  SET ORTH 3.6MM DRILL GUIDE","BOTH IP/OP","$493.63 ","$365.29 ","$0.00 ","$493.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$493.63 ","$0.00 ","$246.81 ","$390.95 ","$394.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5770-5-000","SUP","Custom 27203010","","5770-5-000  -  SET ORTH 2MM DRILL GUIDE","BOTH IP/OP","$422.13 ","$312.38 ","$0.00 ","$422.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$422.13 ","$0.00 ","$211.06 ","$334.33 ","$337.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5780-0-035","SUP","HCPCS C1713","","5780-0-035  -  SCREW BONE CORT TAP","BOTH IP/OP","$105.88 ","$78.35 ","$0.00 ","$105.88 ","$47.64 ","$0.00 ","$22.07 ","$0.00 ","$0.00 ","$18.54 ","$105.88 ","$0.00 ","$52.94 ","$83.86 ","$84.70 ","$0.00 ","$16.57 ","$0.00 ","$16.86 ","$0.00 "
"5780-0-045","SUP","HCPCS C1713","","5780-0-045  -  SCREW BONE CORT TAP","BOTH IP/OP","$411.13 ","$304.24 ","$0.00 ","$411.13 ","$185.01 ","$0.00 ","$85.69 ","$0.00 ","$0.00 ","$71.98 ","$411.13 ","$0.00 ","$205.56 ","$325.61 ","$328.90 ","$0.00 ","$64.34 ","$0.00 ","$65.45 ","$0.00 "
"5780-1-045","SUP","Custom 27803010","","5780-1-045  -  TAP CORTICAL BONE SCREW","BOTH IP/OP","$411.13 ","$304.24 ","$0.00 ","$411.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$411.13 ","$0.00 ","$205.56 ","$325.61 ","$328.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-0-014","SUP","Custom 27203010","","5781-0-014  -  SLEEVE DRILL 1.4-2MM ICS","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-0-027","SUP","Custom 27203010","","5781-0-027  -  SLEEVE DRILL 2MM INS","BOTH IP/OP","$103.13 ","$76.32 ","$0.00 ","$103.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.13 ","$0.00 ","$51.56 ","$81.68 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-0-045","SUP","Custom 27203010","","5781-0-045  -  SLEEVE DRILL 4.5MM TAP","BOTH IP/OP","$180.13 ","$133.30 ","$0.00 ","$180.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.13 ","$0.00 ","$90.06 ","$142.66 ","$144.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-0-480","SUP","Custom 27203010","","5781-0-480  -  SLEEVE DRILL 48MM","BOTH IP/OP","$89.38 ","$66.14 ","$0.00 ","$89.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-0-530","SUP","Custom 27203010","","5781-0-530  -  SLEEVE DRILL 53MM","BOTH IP/OP","$89.38 ","$66.14 ","$0.00 ","$89.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.38 ","$0.00 ","$44.69 ","$70.79 ","$71.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-3-035","SUP","Custom 27203010","","5781-3-035  -  GUIDE DRILL SM PNT","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5781-3-045","SUP","Custom 27203010","","5781-3-045  -  GUIDE DRILL PNT","BOTH IP/OP","$240.63 ","$178.07 ","$0.00 ","$240.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.63 ","$0.00 ","$120.31 ","$190.58 ","$192.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5785-0-002","SUP","Custom 27203010","","5785-0-002  -  FORCEP SURG LNG SCR","BOTH IP/OP","$67.38 ","$49.86 ","$0.00 ","$67.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.38 ","$0.00 ","$33.69 ","$53.36 ","$53.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5785-0-003","SUP","Custom 27203010","","5785-0-003  -  FORCEP SURG ICS PLT","BOTH IP/OP","$287.38 ","$212.66 ","$0.00 ","$287.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.38 ","$0.00 ","$143.69 ","$227.60 ","$229.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"58-12004E","SUP","HCPCS C1713","","58-12004E  -  SCREW BONE 1.2MM 4MM HAND WRST STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12005E","SUP","HCPCS C1713","","58-12005E  -  SCREW BONE 1.2MM 5MM HAND WRST STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12006E","SUP","HCPCS C1713","","58-12006E  -  SCREW BONE 1.2MM 6MM HAND WRST STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12007E","SUP","HCPCS C1713","","58-12007E  -  SCREW BONE 1.2MM 7MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12008E","SUP","HCPCS C1713","","58-12008E  -  SCREW BONE 1.2MM 8MM HAND","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12009E","SUP","HCPCS C1713","","58-12009E  -  SCREW BONE 1.2MM 9MM STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12010E","SUP","HCPCS C1713","","58-12010E  -  SCREW BONE 1.2MM 10MM","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12012E","SUP","HCPCS C1713","","58-12012E  -  SCREW BONE 1.2MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12014E","SUP","HCPCS C1713","","58-12014E  -  SCREW BONE 1.2MM 14MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12016E","SUP","HCPCS C1713","","58-12016E  -  SCREW BONE 1.2MM 16MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12018E","SUP","HCPCS C1713","","58-12018E  -  SCREW BONE 1.2MM 18MM WR HND NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-12020E","SUP","HCPCS C1713","","58-12020E  -  SCREW BONE 1.2MM 20MM WR HND NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-14003E","SUP","HCPCS C1713","","58-14003E  -  SCREW BONE 1.4MM 3MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-14005E","SUP","HCPCS C1713","","58-14005E  -  SCREW BONE 1.4MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-14007E","SUP","HCPCS C1713","","58-14007E  -  SCREW BONE 1.4MM 7MM WR HND ER NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-14009E","SUP","HCPCS C1713","","58-14009E  -  SCREW BONE 1.4MM 9MM IMPL ER STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-17005","SUP","HCPCS C1713","","58-17005  -  SCREW BONE 1.7MM 5MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17005E","SUP","HCPCS C1713","","58-17005E  -  SCREW BONE 1.7MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17006","SUP","HCPCS C1713","","58-17006  -  SCREW BONE 1.7MM 6MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17007","SUP","HCPCS C1713","","58-17007  -  SCREW BN 1.7MM 7MM HND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17008","SUP","HCPCS C1713","","58-17008  -  SCREW BONE 1.7MM 8MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17008E","SUP","HCPCS C1713","","58-17008E  -  SCREW BONE 1.7MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$22.93 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17009","SUP","HCPCS C1713","","58-17009  -  SCREW BONE 1.7MM 9MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17010","SUP","HCPCS C1713","","58-17010  -  SCREW BONE 1.7MM 10MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17011","SUP","HCPCS C1713","","58-17011  -  SCREW BONE 1.7MM 11MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17012","SUP","HCPCS C1713","","58-17012  -  SCREW BONE 1.7MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17013","SUP","HCPCS C1713","","58-17013  -  SCREW BONE 1.7MM 13MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17013E","SUP","HCPCS C1713","","58-17013E  -  SCREW BONE 1.7MM 13MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17014","SUP","HCPCS C1713","","58-17014  -  SCREW BONE 1.7MM 14MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17015","SUP","HCPCS C1713","","58-17015  -  SCREW BONE 1.7MM 15MM XPIN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17015E","SUP","HCPCS C1713","","58-17015E  -  SCREW BONE 1.7MM 15MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17016","SUP","HCPCS C1713","","58-17016  -  SCREW BONE 1.7MM 16MM XPIN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17018","SUP","HCPCS C1713","","58-17018  -  SCREW BONE 1.7MM 18MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17018E","SUP","HCPCS C1713","","58-17018E  -  SCREW BONE 1.7MM 18MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17020","SUP","HCPCS C1713","","58-17020  -  SCREW BN 1.7MM 20MM NS VARIAX ST XPN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17020E","SUP","HCPCS C1713","","58-17020E  -  SCREW BONE 1.7MM 20MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17022","SUP","HCPCS C1713","","58-17022  -  SCREW BONE 1.7MM 22MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17022E","SUP","HCPCS C1713","","58-17022E  -  SCREW BONE 1.7MM 22MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-17024","SUP","HCPCS C1713","","58-17024  -  SCREW BONE 1.7MM 24MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-17024E","SUP","HCPCS C1713","","58-17024E  -  SCREW BONE 1.7MM 24MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.20 ","$85.99 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.22 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-19005","SUP","HCPCS C1713","","58-19005  -  SCREW BONE 1.9MM 5MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-19005E","SUP","HCPCS C1713","","58-19005E  -  SCREW BONE 1.9MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-19008","SUP","HCPCS C1713","","58-19008  -  SCREW BONE 1.9MM 8MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-19008E","SUP","HCPCS C1713","","58-19008E  -  SCREW BONE 1.9MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-19010","SUP","HCPCS C1713","","58-19010  -  SCREW BONE 2.5MM 10MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"58-19010E","SUP","HCPCS C1713","","58-19010E  -  SCREW BONE 1.9MM 10MM CANC WR HND ER NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-19012","SUP","HCPCS C1713","","58-19012  -  SCREW BONE 1.9MM 12MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"5820-009-030","SUP","Custom 27203010","","5820-009-030  -  BURR SURG 3MM PRECISION","BOTH IP/OP","$505.88 ","$374.35 ","$0.00 ","$505.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.88 ","$0.00 ","$252.94 ","$400.66 ","$404.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-009-040","SUP","Custom 27203010","","5820-009-040  -  BURR SURG 4MM PRECISION","BOTH IP/OP","$505.88 ","$374.35 ","$0.00 ","$505.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.88 ","$0.00 ","$252.94 ","$400.66 ","$404.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-009-050","SUP","Custom 27203010","","5820-009-050  -  BURR SURG 5MM PRECISION","BOTH IP/OP","$505.88 ","$374.35 ","$0.00 ","$505.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.88 ","$0.00 ","$252.94 ","$400.66 ","$404.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-010-120","SUP","Custom 27203010","","5820-010-120  -  BURR SURG ROUND FLUTE 2MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-010-130","SUP","Custom 27203010","","5820-010-130  -  BURR SURG ROUND FLUTE 3MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-010-140","SUP","Custom 27203010","","5820-010-140  -  BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-012-030","SUP","Custom 27203010","","5820-012-030  -  BURR SURG ROUND DIAMOND 3MM 5 STEP NOTCH NUMBERED SAFETY","BOTH IP/OP","$303.78 ","$224.80 ","$0.00 ","$264.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.43 ","$0.00 ","$132.21 ","$209.43 ","$211.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-012-040","SUP","Custom 27203010","","5820-012-040  -  BURR SURG ROUND DIAMOND 4MM 5 NOTCH SMOOTH CUT GOOD CONTROL","BOTH IP/OP","$303.78 ","$224.80 ","$0.00 ","$303.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.78 ","$0.00 ","$151.89 ","$240.59 ","$243.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-015-050","SUP","Custom 27203010","","5820-015-050  -  BURR 5.0MM EGG BURR","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820-015-060","SUP","Custom 27203010","","5820-015-060  -  BURR 6.0MM EGG","BOTH IP/OP","$310.50 ","$229.77 ","$0.00 ","$310.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.50 ","$0.00 ","$155.25 ","$245.92 ","$248.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820107430S1","SUP","Custom 27203010","","5820107430S1  -  BIT DRILL 3MM 3.8MM LESS AGGRESSIVE NEURO STERILE","BOTH IP/OP","$300.30 ","$222.22 ","$0.00 ","$300.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.30 ","$0.00 ","$150.15 ","$237.84 ","$240.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5820107530S3","SUP","Custom 27203010","","5820107530S3  -  BIT DRILL 1.7MM NEURO","BOTH IP/OP","$288.75 ","$213.68 ","$0.00 ","$288.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.75 ","$0.00 ","$144.38 ","$228.69 ","$231.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"58-23006","SUP","HCPCS C1713","","58-23006  -  SCREW BONE 2.3MM 6MM HAND NLCKG SLFTAP CROSSPIN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23008","SUP","HCPCS C1713","","58-23008  -  SCREW BONE 2.3MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23009","SUP","HCPCS C1713","","58-23009  -  SCREW BONE 2.3MM 9MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23009E","SUP","HCPCS C1713","","58-23009E  -  SCREW BONE 2.3MM 9MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23010","SUP","HCPCS C1713","","58-23010  -  SCREW BONE 2.3MM 10MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23011","SUP","HCPCS C1713","","58-23011  -  SCREW BONE 2.3MM 11MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23011E","SUP","HCPCS C1713","","58-23011E  -  SCREW BONE 2.3MM 11MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23012","SUP","HCPCS C1713","","58-23012  -  SCREW BONE 2.3MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23012E","SUP","HCPCS C1713","","58-23012E  -  SCREW BN 2.3MM 12MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23013E","SUP","HCPCS C1713","","58-23013E  -  SCREW BONE 2.3MM 13MM NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23014","SUP","HCPCS C1713","","58-23014  -  SCREW BONE 2.3MM 14MM NLCKG XPIN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23014E","SUP","HCPCS C1713","","58-23014E  -  SCREW BN 2.3MM 14MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23015","SUP","HCPCS C1713","","58-23015  -  SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$22.93 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23015E","SUP","HCPCS C1713","","58-23015E  -  SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23016","SUP","HCPCS C1713","","58-23016  -  SCREW BONE 2.3MM 16MM NLCKG XPIN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23016E","SUP","HCPCS C1713","","58-23016E  -  SCREW BONE 2.3MM 16MM NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23018","SUP","HCPCS C1713","","58-23018  -  SCREW BONE 2.3MM 18MM HAND NLCKG SLFTAP CROSSPIN","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23018E","SUP","HCPCS C1713","","58-23018E  -  SCREW BONE 2.3MM 18MM NLCKG SLFTAP CROSSPIN","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23020","SUP","HCPCS C1713","","58-23020  -  SCREW BONE 2.3MM 20MM HAND","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23020E","SUP","HCPCS C1713","","58-23020E  -  SCREW BONE 2.3MM 20MM WR HND NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23022","SUP","HCPCS C1713","","58-23022  -  SCREW BONE 2.3MM 22MM ORTH","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23022E","SUP","HCPCS C1713","","58-23022E  -  SCREW BONE 2.3MM 22MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23024","SUP","HCPCS C1713","","58-23024  -  SCREW BONE 2.3MM 24MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23024E","SUP","HCPCS C1713","","58-23024E  -  SCREW BONE 2.3MM 24MM HAND WRST SLFTAP STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23026","SUP","HCPCS C1713","","58-23026  -  SCREW BONE 2.3MM 26MM","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-23026E","SUP","HCPCS C1713","","58-23026E  -  SCREW BONE 2.3MM 26MM WR HND NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.90 ","$86.51 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-25006","SUP","HCPCS C1713","","58-25006  -  SCREW BONE 2.5MM 6MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-25006E","SUP","HCPCS C1713","","58-25006E  -  SCREW BONE 2.5MM 6MM CANC WR HND ER NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-25008","SUP","HCPCS C1713","","58-25008  -  SCREW BONE 2.5MM 8MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-25008E","SUP","HCPCS C1713","","58-25008E  -  SCREW BONE 2.5MM 8MM CANC WR HND ER NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-25010","SUP","HCPCS C1713","","58-25010  -  SCREW BONE 2.5MM 10MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-25010E","SUP","HCPCS C1713","","58-25010E  -  SCREW BONE 2.5MM 10MM NLCKG SLFTAP CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"58-25012","SUP","HCPCS C1713","","58-25012  -  SCREW BONE 2.5MM 12MM ER","BOTH IP/OP","$120.40 ","$89.10 ","$0.00 ","$110.00 ","$49.50 ","$0.00 ","$25.09 ","$0.00 ","$0.00 ","$19.26 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$17.22 ","$0.00 ","$17.51 ","$0.00 "
"58-25012E","SUP","HCPCS C1713","","58-25012E  -  SCREW BONE 2.5MM 12MM CANC WR HND ER NLCKG STR CROSSPIN STRL","BOTH IP/OP","$116.88 ","$86.49 ","$0.00 ","$116.88 ","$52.59 ","$0.00 ","$24.36 ","$0.00 ","$0.00 ","$20.46 ","$116.88 ","$0.00 ","$58.44 ","$92.57 ","$93.50 ","$0.00 ","$18.29 ","$0.00 ","$18.61 ","$0.00 "
"5858-0-000","SUP","Custom 27203010","","5858-0-000  -  GAUGE DEPTH SCR","BOTH IP/OP","$1,024.38 ","$758.04 ","$0.00 ","$1,024.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,024.38 ","$0.00 ","$512.19 ","$811.31 ","$819.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5866-45","SUP","Custom 27203010","","5866-45  -  SLEEVE LEAD ACCES","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5867-3M","SUP","Custom 27203010","","5867-3M  -  CAP LEAD 4.6-8.4FR 5MM 3.2MM IMPLTABLE PIN LOW PROFILE IS-1","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"59-12004","SUP","HCPCS C1713","","59-12004  -  SCREW BONE 1.2MM 4MM PRFL TI HAND MDLR SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12005","SUP","HCPCS C1713","","59-12005  -  SCREW BONE 1.2MM 5MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12006","SUP","HCPCS C1713","","59-12006  -  SCREW BONE 1.2MM 6MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12007","SUP","HCPCS C1713","","59-12007  -  SCREW BONE 1.2MM 7MM PRFL TI HAND MDLR SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12008","SUP","HCPCS C1713","","59-12008  -  SCREW BONE 1.2MM 8MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12009","SUP","HCPCS C1713","","59-12009  -  SCREW BONE 1.2MM 9MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12010","SUP","HCPCS C1713","","59-12010  -  SCREW BONE 1.2MM 10MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12011","SUP","HCPCS C1713","","59-12011  -  SCREW BONE 1.2MM 11MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12012","SUP","HCPCS C1713","","59-12012  -  SCREW BONE 1.2MM 12MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12013","SUP","HCPCS C1713","","59-12013  -  SCREW BONE 1.2MM 13MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12014","SUP","HCPCS C1713","","59-12014  -  SCREW BONE 1.2MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12016","SUP","HCPCS C1713","","59-12016  -  SCREW BONE 1.2MM 16MM PRFL TI HAND WRST SLFTAP XFIT SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12018","SUP","HCPCS C1713","","59-12018  -  PLATE 18MM TI SLFTAP XFIT PRFL BONE 1.2MM HAND","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12020","SUP","HCPCS C1713","","59-12020  -  PLATE 20MM TI SLFTAP XFIT PRFL BONE 1.2MM HAND","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-12049","SUP","HCPCS C1713","","59-12049  -  WASHER 1.2MM WRST PRFL ORTH","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$11.09 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"59-12049E","SUP","HCPCS C1713","","59-12049E  -  WASHER FOR 1.2 MM BONE SCREWS","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$41.25 ","$18.56 ","$0.00 ","$11.09 ","$0.00 ","$0.00 ","$7.22 ","$41.25 ","$0.00 ","$20.63 ","$32.67 ","$33.00 ","$0.00 ","$6.46 ","$0.00 ","$6.57 ","$0.00 "
"59-14003","SUP","HCPCS C1713","","59-14003  -  SCREW BONE 1.4MM 3MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-14005","SUP","HCPCS C1713","","59-14005  -  SCREW BONE 1.4MM 5MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-14007","SUP","HCPCS C1713","","59-14007  -  SCREW BONE 1.4MM 7MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-14009","SUP","HCPCS C1713","","59-14009  -  SCREW BONE 1.4MM 9MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-17005","SUP","HCPCS C1713","","59-17005  -  SCREW BONE 1.7MM 5MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17006","SUP","HCPCS C1713","","59-17006  -  SCREW BONE 1.7MM 6MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17007","SUP","HCPCS C1713","","59-17007  -  SCREW BONE 1.7MM 7MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17008","SUP","HCPCS C1713","","59-17008  -  SCREW BONE 1.7MM 8MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17009","SUP","HCPCS C1713","","59-17009  -  SCREW BONE 1.7MM 9MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17010","SUP","HCPCS C1713","","59-17010  -  SCREW BONE 1.7MM 10MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17011","SUP","HCPCS C1713","","59-17011  -  SCREW BONE 1.7MM 11MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17012","SUP","HCPCS C1713","","59-17012  -  SCREW BONE 1.7MM 12MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$112.75 ","$83.44 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$23.50 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17013","SUP","HCPCS C1713","","59-17013  -  SCREW BONE 1.7MM 13MM PRFL TI HAND MDLR","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17014","SUP","HCPCS C1713","","59-17014  -  SCREW BONE 1.7MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17015","SUP","HCPCS C1713","","59-17015  -  SCREW BONE 1.7MM 15MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$96.25 ","$43.31 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$16.85 ","$96.25 ","$0.00 ","$48.13 ","$76.23 ","$77.00 ","$0.00 ","$15.06 ","$0.00 ","$15.32 ","$0.00 "
"59-17016","SUP","HCPCS C1713","","59-17016  -  SCREW BONE 1.7MM 16MM PRFL TI HAND MDLR SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17017","SUP","HCPCS C1713","","59-17017  -  SCREW BONE 1.7MM 17MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17018","SUP","HCPCS C1713","","59-17018  -  SCREW BONE 1.7MM 18MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17019","SUP","HCPCS C1713","","59-17019  -  SCREW BONE 1.7MM 19MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17020","SUP","HCPCS C1713","","59-17020  -  SCREW BONE 1.7MM 20MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17021","SUP","HCPCS C1713","","59-17021  -  SCREW BONE 1.7MM 21MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17022","SUP","HCPCS C1713","","59-17022  -  SCREW BONE 1.7MM 22MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17023","SUP","HCPCS C1713","","59-17023  -  SCREW BONE 1.7MM 23MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17024","SUP","HCPCS C1713","","59-17024  -  SCREW BONE 1.7MM 24MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-17049","SUP","HCPCS C1713","","59-17049  -  WASHER 1.7MM PRFL ORTH TI","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$11.09 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"59-17049E","SUP","HCPCS C1713","","59-17049E  -  WASHER HAND WRST ORTH 1.7 MM SCR STRL","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$41.25 ","$18.56 ","$0.00 ","$11.09 ","$0.00 ","$0.00 ","$7.22 ","$41.25 ","$0.00 ","$20.63 ","$32.67 ","$33.00 ","$0.00 ","$6.46 ","$0.00 ","$6.57 ","$0.00 "
"59-19005","SUP","HCPCS C1713","","59-19005  -  SCREW BONE 1.9MM 5MM PRFL TI HAND XFIT SLFTAP ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-19008","SUP","HCPCS C1713","","59-19008  -  SCREW BONE 1.9MM 8MM PRFL TI HAND XFIT SLFTAP ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-19010","SUP","HCPCS C1713","","59-19010  -  SCREW BONE 1.9MM 10MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-19012","SUP","HCPCS C1713","","59-19012  -  SCREW BONE 1.9MM 12MM PRFL TI HAND XFIT SLFTAP ER SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-23006","SUP","HCPCS C1713","","59-23006  -  SCREW BONE 2.3MM 6MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23007","SUP","HCPCS C1713","","59-23007  -  SCREW BONE 2.3MM 7MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23008","SUP","HCPCS C1713","","59-23008  -  SCREW BONE 2.3MM 8MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23009","SUP","HCPCS C1713","","59-23009  -  SCREW BONE 2.3MM 9MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23010","SUP","HCPCS C1713","","59-23010  -  SCREW BONE 2.3MM 10MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23011","SUP","HCPCS C1713","","59-23011  -  SCREW BONE 2.3MM 11MM PRFL TI HAND SLFTAP XFIT SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23012","SUP","HCPCS C1713","","59-23012  -  SCREW BONE 2.3MM 12MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23013","SUP","HCPCS C1713","","59-23013  -  SCREW BONE 2.3MM 13MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23014","SUP","HCPCS C1713","","59-23014  -  SCREW BONE 2.3MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23015","SUP","HCPCS C1713","","59-23015  -  SCREW BONE 2.3MM 15MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23016","SUP","HCPCS C1713","","59-23016  -  SCREW BONE 2.3MM 16MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23017","SUP","HCPCS C1713","","59-23017  -  SCREW BONE 2.3MM 17MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23018","SUP","HCPCS C1713","","59-23018  -  SCREW BONE 2.3MM 18MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23019","SUP","HCPCS C1713","","59-23019  -  SCREW BONE 2.3MM 19MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23020","SUP","HCPCS C1713","","59-23020  -  SCREW BONE 2.3MM 20MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23021","SUP","HCPCS C1713","","59-23021  -  SCREW BONE 2.3MM 21MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23022","SUP","HCPCS C1713","","59-23022  -  SCREW BONE 2.3MM 22MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23023","SUP","HCPCS C1713","","59-23023  -  SCREW BONE 2.3MM 23MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23024","SUP","HCPCS C1713","","59-23024  -  SCREW BONE 2.3MM 24MM PRFL TI HAND SLFTAP XFIT","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23026","SUP","HCPCS C1713","","59-23026  -  SCREW BONE 2.3MM 26MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23028","SUP","HCPCS C1713","","59-23028  -  SCREW BONE 2.3MM 28MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23030","SUP","HCPCS C1713","","59-23030  -  SCREW BONE 2.3MM 30MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23032","SUP","HCPCS C1713","","59-23032  -  SCREW BONE 2.3MM 32MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23034","SUP","HCPCS C1713","","59-23034  -  SCREW BONE 2.3MM 34MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23036","SUP","HCPCS C1713","","59-23036  -  SCREW BONE 2.3MM 36MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23038","SUP","HCPCS C1713","","59-23038  -  SCREW BONE 2.3MM 38MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$112.75 ","$50.74 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$19.74 ","$112.75 ","$0.00 ","$56.38 ","$89.30 ","$90.20 ","$0.00 ","$17.65 ","$0.00 ","$17.95 ","$0.00 "
"59-23049","SUP","HCPCS C1713","","59-23049  -  WASHER 2.3MM PLT PRFL ORTH NONSTRL","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$11.09 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"59-23049E","SUP","HCPCS C1713","","59-23049E  -  WASHER BONE ORTH 2.3 MM SCR STRL","BOTH IP/OP","$53.20 ","$39.37 ","$0.00 ","$41.25 ","$18.56 ","$0.00 ","$11.09 ","$0.00 ","$0.00 ","$7.22 ","$41.25 ","$0.00 ","$20.63 ","$32.67 ","$33.00 ","$0.00 ","$6.46 ","$0.00 ","$6.57 ","$0.00 "
"59-25006","SUP","HCPCS C1713","","59-25006  -  SCREW BONE 2.5MM 6MM PRFL TI HAND MDLR XFIT SLFTAP ER SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-25008","SUP","HCPCS C1713","","59-25008  -  SCREW BONE 2.5MM 8MM PRFL TI HAND ER SM FRAG SYS","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-25010","SUP","HCPCS C1713","","59-25010  -  SCREW BONE 2.5MM 10MM PRFL TI HAND MDLR XFIT SLFTAP ER SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"59-25012","SUP","HCPCS C1713","","59-25012  -  SCREW BONE 2.5MM 12MM PRFL TI HAND MDLR XFIT SLFTAP ER SM","BOTH IP/OP","$126.00 ","$93.24 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$26.26 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"595000S","SUP","HCPCS C1713","","595000S  -  SCREW BONE OHS OCS ORTH HIP CMPR","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$44.55 ","$0.00 ","$20.63 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"596001S","SUP","HCPCS C1713","","596001S  -  SCREW BONE 3MM 32.2MM OMEGA 2 SS ORTH HIP CMPR STRL","BOTH IP/OP","$116.80 ","$86.43 ","$0.00 ","$130.63 ","$58.78 ","$0.00 ","$24.34 ","$0.00 ","$0.00 ","$22.87 ","$130.63 ","$0.00 ","$65.31 ","$103.46 ","$104.50 ","$0.00 ","$20.44 ","$0.00 ","$20.80 ","$0.00 "
"597002S","SUP","HCPCS C1713","","597002S  -  PLATE 130D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597003S","SUP","HCPCS C1713","","597003S  -  SCREW BONE 47MM OMEGA 3 130D STD BRL HIP 3 HOLE CMPR KEY","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597004S","SUP","HCPCS C1713","","597004S  -  PLATE 130D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597005S","SUP","HCPCS C1713","","597005S  -  PLATE 130D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597006S","SUP","HCPCS C1713","","597006S  -  PLATE 130D 111MM SS 6 HOLE STD BRL KEY OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597008S","SUP","HCPCS C1713","","597008S  -  PLATE 130D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597010S","SUP","HCPCS C1713","","597010S  -  PLATE 130D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597012S","SUP","HCPCS C1713","","597012S  -  PLATE 130D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597022S","SUP","HCPCS C1713","","597022S  -  PLATE 135D STD BRL 47MM SS SYS 2 HOLE KEY LP OMEGA3 CHS BONE","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597023S","SUP","HCPCS C1713","","597023S  -  PLATE 135D STD BRL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597024S","SUP","HCPCS C1713","","597024S  -  PLATE 130D STD BRL OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597025S","SUP","HCPCS C1713","","597025S  -  PLATE 135D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597026S","SUP","HCPCS C1713","","597026S  -  PLATE 135D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597028S","SUP","HCPCS C1713","","597028S  -  PLATE 135D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597030S","SUP","HCPCS C1713","","597030S  -  PLATE 135D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597032S","SUP","HCPCS C1713","","597032S  -  PLATE 135D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597042S","SUP","HCPCS C1713","","597042S  -  PLATE 140D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597043S","SUP","HCPCS C1713","","597043S  -  PLATE 140D STD BRL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597044S","SUP","HCPCS C1713","","597044S  -  PLATE 140D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597045S","SUP","HCPCS C1713","","597045S  -  PLATE 140D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597046S","SUP","HCPCS C1713","","597046S  -  PLATE 140D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597048S","SUP","HCPCS C1713","","597048S  -  PLATE 140D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597050S","SUP","HCPCS C1713","","597050S  -  PLATE 140D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597052S","SUP","HCPCS C1713","","597052S  -  PLATE 140D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597062S","SUP","HCPCS C1713","","597062S  -  PLATE 145D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597063S","SUP","HCPCS C1713","","597063S  -  PLATE 145D STD BRL 63MM SS 3 HOLE ANG KYLS CMPR OMEGA 3 BONE","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597064S","SUP","HCPCS C1713","","597064S  -  PLATE 145D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597065S","SUP","HCPCS C1713","","597065S  -  PLATE 145D STD BRL 95MM 5 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597066S","SUP","HCPCS C1713","","597066S  -  PLATE 145D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597068S","SUP","HCPCS C1713","","597068S  -  PLATE 145D STD BRL 143MM SS 8 HOLE ANG KYLS CMPR OMEGA 3","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597070S","SUP","HCPCS C1713","","597070S  -  PLATE 145D STD BRL 175MM SS 10 HOLE ANG KYLS CMPR OMEGA 3","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597072S","SUP","HCPCS C1713","","597072S  -  PLATE 145D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597082S","SUP","HCPCS C1713","","597082S  -  PLATE 150D STD BRL 47MM SS 2 HOLE ANG KYLS CMPR OMEGA 3 BONE","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597083S","SUP","HCPCS C1713","","597083S  -  PLATE 150D STD BRL 63MM SS 3 HOLE ANG KYLS CMPR OMEGA 3 BONE","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597084S","SUP","HCPCS C1713","","597084S  -  PLATE 150D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597085S","SUP","HCPCS C1713","","597085S  -  PLATE 150D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597086S","SUP","HCPCS C1713","","597086S  -  PLATE 150D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597088S","SUP","HCPCS C1713","","597088S  -  PLATE 150D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597090S","SUP","HCPCS C1713","","597090S  -  PLATE 150D STD BRL 175MM SS 10 HOLE ANG KYLS CMPR OMEGA 3","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597092S","SUP","HCPCS C1713","","597092S  -  PLATE 150D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597102S","SUP","HCPCS C1713","","597102S  -  PLATE 130D STD BRL 47MM SS 2 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597103S","SUP","HCPCS C1713","","597103S  -  PLATE 130D STD BRL SS 3 HOLE OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597104S","SUP","HCPCS C1713","","597104S  -  PLATE 135D STD BRL 32MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597105S","SUP","HCPCS C1713","","597105S  -  PLATE 130D STD BRL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597106S","SUP","HCPCS C1713","","597106S  -  PLATE 130D STD BRL 111MM SS 6 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597108S","SUP","HCPCS C1713","","597108S  -  PLATE 130D STD BRL 143MM SS 8 HOLE LP KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597110S","SUP","HCPCS C1713","","597110S  -  PLATE 130D STD BRL 10 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597112S","SUP","HCPCS C1713","","597112S  -  PLATE 130D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597122S","SUP","HCPCS C1713","","597122S  -  PLATE 135D STD BRL 47MM SS 2 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597123S","SUP","HCPCS C1713","","597123S  -  PLATE 135D 3 HOLE OMEGA 3 BONE KNEE STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597124S","SUP","HCPCS C1713","","597124S  -  PLATE 135D STD BRL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597125S","SUP","HCPCS C1713","","597125S  -  PLATE 135D 5 HOLE OMEGA 3 BONE STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597126S","SUP","HCPCS C1713","","597126S  -  PLATE STD BRL KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597128S","SUP","HCPCS C1713","","597128S  -  PLATE 8 HOLE OMEGA 3 BONE HIP STRL","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597130S","SUP","HCPCS C1713","","597130S  -  PLATE 135D STD BRL 175MM SS 10 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597132S","SUP","HCPCS C1713","","597132S  -  PLATE 135D STD BRL 135MM 12 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597142S","SUP","HCPCS C1713","","597142S  -  PLATE 140D STD BRL 47MM SS 2 HOLE ANG KYLS CMPR OMEGA 3 BONE","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597143S","SUP","HCPCS C1713","","597143S  -  PLATE 140D STD BRL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597144S","SUP","HCPCS C1713","","597144S  -  PLATE 140D STD BRL 79MM 4 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597145S","SUP","HCPCS C1713","","597145S  -  PLATE 140D STD BRL SS 5 HOLE OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597146S","SUP","HCPCS C1713","","597146S  -  PLATE 140D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597148S","SUP","HCPCS C1713","","597148S  -  PLATE 140D STD BRL 143MM 8 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
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"597164S","SUP","HCPCS C1713","","597164S  -  PLATE STD BRL 4 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597165S","SUP","HCPCS C1713","","597165S  -  PLATE 145D STD BRL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597166S","SUP","HCPCS C1713","","597166S  -  PLATE 145D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597168S","SUP","HCPCS C1713","","597168S  -  PLATE 145D STD BRL 143MM SS 8 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597170S","SUP","HCPCS C1713","","597170S  -  PLATE 145D STD BRL 175MM SS 10 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597172S","SUP","HCPCS C1713","","597172S  -  PLATE 145D STD BRL 207MM SS 12 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597182S","SUP","HCPCS C1713","","597182S  -  PLATE 150D STD BRL 47MM SS 2 HOLE KYLS OMEGA 3 BONE HIP STRL","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597183S","SUP","HCPCS C1713","","597183S  -  PLATE 150D STD BARRREL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597184S","SUP","HCPCS C1713","","597184S  -  PLATE 150D STD BARRREL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597185S","SUP","HCPCS C1713","","597185S  -  PLATE 150D STD BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597186S","SUP","HCPCS C1713","","597186S  -  PLATE 150D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$749.38 ","$554.54 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$156.19 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597188S","SUP","HCPCS C1713","","597188S  -  PLATE 150D STD BARRREL 143MM SS 8 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597190S","SUP","HCPCS C1713","","597190S  -  PLATE 150D STD BARRREL 175MM SS 10 HOLE KYLS OMEGA 3 BONE","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597192S","SUP","HCPCS C1713","","597192S  -  PLATE 150D STD BARRREL 207MM SS 12 HOLE KYLS OMEGA 3 BONE","BOTH IP/OP","$916.00 ","$677.84 ","$0.00 ","$948.75 ","$426.94 ","$0.00 ","$190.92 ","$0.00 ","$0.00 ","$166.12 ","$948.75 ","$0.00 ","$474.38 ","$751.41 ","$759.00 ","$0.00 ","$148.48 ","$0.00 ","$151.04 ","$0.00 "
"597202S","SUP","HCPCS C1713","","597202S  -  PLATE 130D SHRT BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597203S","SUP","HCPCS C1713","","597203S  -  PLATE 130D SHRT BRL SS 3 HOLE ANG KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
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"597213S","SUP","HCPCS C1713","","597213S  -  PLATE 135D SHRT BRL SS 3 HOLE ANG KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597214S","SUP","HCPCS C1713","","597214S  -  PLATE 135D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597215S","SUP","HCPCS C1713","","597215S  -  PLATE 135D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
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"597234S","SUP","HCPCS C1713","","597234S  -  PLATE 145D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
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"597244S","SUP","HCPCS C1713","","597244S  -  PLATE 150D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
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"597254S","SUP","HCPCS C1713","","597254S  -  PLATE 130D SHRT BRL KYLS BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597255S","SUP","HCPCS C1713","","597255S  -  PLATE 130D SHRT BRL 95MM SS 5 HOLE KYLS CMPR OMEGA 3 BONE","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597264S","SUP","HCPCS C1713","","597264S  -  PLATE 135D SHRT BRL 79MM 5 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597265S","SUP","HCPCS C1713","","597265S  -  PLATE 135D SHRT BRL 95MM SS 5 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597274S","SUP","HCPCS C1713","","597274S  -  PLATE 140D SHRT BRL SS 4 HOLE OMEGA 3 BONE HIP STRL","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597275S","SUP","HCPCS C1713","","597275S  -  PLATE 140D SHRT BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597284S","SUP","HCPCS C1713","","597284S  -  PLATE 145D SHRT BRL 79MM SS 4 HOLE KYLS LP OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597285S","SUP","HCPCS C1713","","597285S  -  PLATE 145D SHRT BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597294S","SUP","HCPCS C1713","","597294S  -  PLATE 150D SHRT BARRREL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597295S","SUP","HCPCS C1713","","597295S  -  PLATE 150D SHRT BARRREL 25MM SS 5 HOLE KYLS OMEGA 3 BONE HIP","BOTH IP/OP","$724.00 ","$535.76 ","$0.00 ","$749.38 ","$337.22 ","$0.00 ","$150.90 ","$0.00 ","$0.00 ","$131.21 ","$749.38 ","$0.00 ","$374.69 ","$593.51 ","$599.50 ","$0.00 ","$117.28 ","$0.00 ","$119.30 ","$0.00 "
"597404S","SUP","HCPCS C1713","","597404S  -  PLATE 135D 150MM SS 4 HOLE STAB OMEGA 3 BONE HIP STRL","BOTH IP/OP","$1,228.00 ","$908.72 ","$0.00 ","$1,271.88 ","$572.34 ","$0.00 ","$255.95 ","$0.00 ","$0.00 ","$222.70 ","$1,271.88 ","$0.00 ","$635.94 ","$1,007.33 ","$1,017.50 ","$0.00 ","$199.05 ","$0.00 ","$202.48 ","$0.00 "
"5A0002","SUP","HCPCS C1725","","5A0002  -  CATHETER ANGIO JR4 CRV 5FR 100CM STSR","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0007","SUP","HCPCS C1725","","5A0007  -  CATHETER ANGIOGRAPHIC 3DRCB CURVE 5FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0018","SUP","HCPCS C1725","","5A0018  -  CATHETER ANGIO AL1 CRV 5FR 100CM STSR","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0021","SUP","HCPCS C1725","","5A0021  -  CATHETER ANGIOGRAPHIC MPA1 CURVE 5FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0031","SUP","HCPCS C1725","","5A0031  -  CATHETER ANGIOGRAPHIC IM CURVE 5FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0070","SUP","HCPCS C1725","","5A0070  -  CATHETER ANGIOGRAPHIC PIGTAIL 145 CURVE 5FR 110CM 6 SIDEHOLE","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0084","SUP","HCPCS C1725","","5A0084  -  CATHETER ANGIO JL3.5 CRV 5FR 100CM STSR","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0085","SUP","HCPCS C1725","","5A0085  -  CATHETER ANGIOGRAPHIC JL4 CURVE 5FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5A0087","SUP","HCPCS C1725","","5A0087  -  CATHETER ANGIOGRAPHIC JL5 CURVE 5FR 100CM SITESEER","BOTH IP/OP","$21.88 ","$16.19 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$4.56 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"5B5136","SUP","Custom 25803010","","SOLUTION IV PERITONEAL","BOTH IP/OP","$123.75 ","$91.58 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.75 ","$0.00 ","$61.88 ","$98.01 ","$99.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"5MAXACE132","SUP","HCPCS C1887","","5MAXACE132  -  CATHETER REPERFUSION","BOTH IP/OP","$5,725.00 ","$4,236.50 ","$0.00 ","$6,175.00 ","$3,353.03 ","$0.00 ","$1,193.23 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"5MAXACE132KIT","SUP","HCPCS C1887","","5MAXACE132KIT  -  CATHETER REPERFUSION","BOTH IP/OP","$6,062.50 ","$4,486.25 ","$0.00 ","$6,062.50 ","$3,291.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,061.50 ","$6,062.50 ","$0.00 ","$3,031.25 ","$4,801.50 ","$4,850.00 ","$0.00 ","$948.78 ","$0.00 ","$965.15 ","$0.00 "
"6 LGT","SUP","Custom 27203010","","6 LGT  -  TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX","BOTH IP/OP","$143.01 ","$105.83 ","$0.00 ","$143.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$143.01 ","$0.00 ","$71.51 ","$113.26 ","$114.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60.116.521","SUP","HCPCS C1713","","60.116.521  -  PIN PUSH SCREW TYPE VAR ANG LOCKING GRAPHIC CASES NONSTRL","BOTH IP/OP","$113.25 ","$83.81 ","$0.00 ","$113.25 ","$50.96 ","$0.00 ","$23.60 ","$0.00 ","$0.00 ","$19.83 ","$113.25 ","$0.00 ","$56.63 ","$89.69 ","$90.60 ","$0.00 ","$17.72 ","$0.00 ","$18.03 ","$0.00 "
"60-00120","SUP","Custom 27203010","","60-00120  -  GUIDE DRILL 14.5CM 2 END","BOTH IP/OP","$646.25 ","$478.23 ","$0.00 ","$646.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$646.25 ","$0.00 ","$323.13 ","$511.83 ","$517.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000-215","SUP","HCPCS C1713","","6000-215  -  SUB BNGFT 40X15MM PLEXUR 15D BCMPS VOID FILR WDG RESORB","BOTH IP/OP","$1,370.00 ","$1,013.80 ","$0.00 ","$1,370.00 ","$616.50 ","$0.00 ","$285.54 ","$0.00 ","$0.00 ","$239.88 ","$1,370.00 ","$0.00 ","$685.00 ","$1,085.04 ","$1,096.00 ","$0.00 ","$214.41 ","$0.00 ","$218.10 ","$0.00 "
"6000BL","SUP","Custom 27803010","","6000BL  -  HOOK SPNL SPRL R90D LT OBLQ TI","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000BR","SUP","Custom 27803010","","6000BR  -  HOOK SPNL SPRL R90D RT OBLQ TI","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000LL","SUP","Custom 27803010","","6000LL  -  HOOK SPNL LG SPRL R90D TI LMR","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000LP","SUP","Custom 27803010","","6000LP  -  HOOK SPNL LG SPRL R90D TI PDCL","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000ME","SUP","Custom 27803010","","6000ME  -  HOOK SPNL MED SPRL R90D XTD TI LMR THOR","BOTH IP/OP","$1,745.55 ","$1,291.71 ","$0.00 ","$1,745.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,745.55 ","$0.00 ","$872.78 ","$1,382.48 ","$1,396.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000ML","SUP","Custom 27803010","","6000ML  -  HOOK SPNL MED SPRL R90D TI LMR","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000MW","SUP","Custom 27803010","","6000MW  -  HOOK SPNL MED SPRL R90D W TI LMR","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000SE","SUP","Custom 27803010","","6000SE  -  HOOK SPNL SM SPRL R90D XTD TI LMR","BOTH IP/OP","$1,745.55 ","$1,291.71 ","$0.00 ","$1,745.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,745.55 ","$0.00 ","$872.78 ","$1,382.48 ","$1,396.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000SL","SUP","Custom 27803010","","6000SL  -  HOOK SPNL SM SPRL R90D TI LMR","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000SP","SUP","Custom 27803010","","6000SP  -  HOOK SPNL SM SPRL R90D TI PDCL","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000SW","SUP","Custom 27803010","","6000SW  -  HOOK SPNL SM SPRL R90D W TI LMR","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6000TH","SUP","Custom 27803010","","6000TH  -  HOOK SPNL SPRL R90D TI LMR THOR","BOTH IP/OP","$1,662.43 ","$1,230.20 ","$0.00 ","$1,662.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,662.43 ","$0.00 ","$831.21 ","$1,316.64 ","$1,329.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2200","SUP","Custom 27803010","","6001-2200  -  HEAD FEMORAL +0MM C TAPER 22MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2205","SUP","Custom 27803010","","6001-2205  -  HEAD FEMORAL +5MM C TAPER 22MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2600","SUP","Custom 27803010","","6001-2600  -  HEAD FEMORAL +0MM C TAPER 26MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2605","SUP","Custom 27803010","","6001-2605  -  HEAD FEMORAL +5MM C TAPER 26MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2610","SUP","Custom 27803010","","6001-2610  -  HEAD FEMORAL +10MM C TAPER 26MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2800","SUP","Custom 27803010","","6001-2800  -  HEAD FEMORAL +0MM C TAPER 28MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2805","SUP","Custom 27803010","","6001-2805  -  HEAD FEMORAL +5MM C TAPER 28MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-2810","SUP","Custom 27803010","","6001-2810  -  HEAD FEMORAL +10MM C TAPER 28MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-3200","SUP","Custom 27803010","","6001-3200  -  HEAD FEMORAL +0MM C TAPER 32MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-3205","SUP","Custom 27803010","","6001-3205  -  HEAD FEMORAL +5MM C TAPER 32MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-3210","SUP","Custom 27803010","","6001-3210  -  HEAD FEMORAL +10MM C TAPER 32MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6001-3299","SUP","Custom 27803010","","6001-3299  -  HEAD FEMORAL -5MM C TAPER 32MM COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6003-003-090","SUP","HCPCS C1713","","6003-003-090  -  PIN FIX .125IN 3.54IN PRELOADED PINABALL NONSTRL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"6005LO","SUP","Custom 27803010","","6005LO  -  HOOK SPNL 5MM SPRL R90D LT OFST TI","BOTH IP/OP","$1,745.55 ","$1,291.71 ","$0.00 ","$1,745.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,745.55 ","$0.00 ","$872.78 ","$1,382.48 ","$1,396.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6005RO","SUP","Custom 27803010","","6005RO  -  HOOK SPNL 5MM SPRL R90D RT OFST TI","BOTH IP/OP","$1,745.55 ","$1,291.71 ","$0.00 ","$1,745.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,745.55 ","$0.00 ","$872.78 ","$1,382.48 ","$1,396.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-09504","SUP","Custom 27100030","","60-09504  -  DRILL TWST .9MM 46MM 4MM STRYK SHFT 1.2MM SCR","BOTH IP/OP","$555.00 ","$410.70 ","$0.00 ","$555.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.00 ","$0.00 ","$277.50 ","$439.56 ","$444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10115","SUP","Custom 27203010","","60-10115  -  BIT DRILL 83MM 1MM TWST STRL","BOTH IP/OP","$161.50 ","$119.51 ","$0.00 ","$163.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10122","SUP","Custom 27203010","","60-10122  -  BIT DRILL 90MM 1MM TWST STOP SHFT END 22MM STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10315","SUP","Custom 27203010","","60-10315  -  BIT DRILL 76MM 1MM TWST AO STRL","BOTH IP/OP","$163.63 ","$121.09 ","$0.00 ","$163.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10322","SUP","Custom 27203010","","60-10322  -  BIT DRL 22MM AO SHFT QCK 1.2MM SCR","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10415","SUP","Custom 27203010","","60-10415  -  DRILL DNTL 1MM 16MM BIT TWST STOP","BOTH IP/OP","$163.63 ","$121.09 ","$0.00 ","$163.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10422","SUP","Custom 27203010","","60-10422  -  BIT DRILL 73MM 1MM 22MM STOP TWST DNTL SHFT END STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10506","SUP","Custom 27100030","","60-10506  -  BIT DRILL TWIST 1MM 50MM 6MM STOP PROFYLE HAND STERILE SMALL","BOTH IP/OP","$224.18 ","$165.89 ","$0.00 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-10512","SUP","Custom 27100030","","60-10512  -  BIT DRILL 12MM STOP 1MM 54MM 12MM TWIST STOP STERILE","BOTH IP/OP","$224.18 ","$165.89 ","$0.00 ","$555.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$555.00 ","$0.00 ","$277.50 ","$439.56 ","$444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6010LO","SUP","Custom 27803010","","6010LO  -  HOOK SPNL 10MM SPRL R90D LT OFST TI","BOTH IP/OP","$1,745.55 ","$1,291.71 ","$0.00 ","$1,745.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,745.55 ","$0.00 ","$872.78 ","$1,382.48 ","$1,396.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6010RO","SUP","Custom 27803010","","6010RO  -  HOOK SPNL 10MM SPRL R90D RT OFST TI","BOTH IP/OP","$1,745.55 ","$1,291.71 ","$0.00 ","$1,745.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,745.55 ","$0.00 ","$872.78 ","$1,382.48 ","$1,396.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6012-0711","SUP","HCPCS C1776","","6012-0711  -  STEM FEMORAL 7 11MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-0713","SUP","HCPCS C1776","","6012-0713  -  STEM FEMORAL 7 13MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-0812","SUP","HCPCS C1776","","6012-0812  -  STEM FEMORAL 8 12MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-0814","SUP","HCPCS C1776","","6012-0814  -  STEM FEMORAL 8 14MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-0913","SUP","HCPCS C1776","","6012-0913  -  STEM FEMORAL 9 13MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-0915","SUP","HCPCS C1776","","6012-0915  -  STEM FEMORAL 9 15MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-1014","SUP","HCPCS C1776","","6012-1014  -  STEM FEMORAL 10 14MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-1016","SUP","HCPCS C1776","","6012-1016  -  STEM FEMORAL 10 16MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-1115","SUP","HCPCS C1776","","6012-1115  -  STEM FEMORAL 11 15MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-1117","SUP","HCPCS C1776","","6012-1117  -  STEM FEMORAL 11 17MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-1216","SUP","HCPCS C1776","","6012-1216  -  STEM FEMORAL 12 16MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6012-1218","SUP","HCPCS C1776","","6012-1218  -  STEM FEMORAL 12 18MM 155MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"601-251","SUP","HCPCS C1887","","MICROCATHETER RAPIDTRANSIT 150CM","BOTH IP/OP","$1,760.00 ","$1,302.40 ","$0.00 ","$1,760.00 ","$955.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.16 ","$1,760.00 ","$0.00 ","$880.00 ","$1,393.92 ","$1,408.00 ","$0.00 ","$275.44 ","$0.00 ","$280.19 ","$0.00 "
"601251X","SUP","HCPCS C1751","","601251X  -  MICROCATHETER CRBRVASC 2.3-2.8FR .021IN 150CM 50CM","BOTH IP/OP","$1,775.10 ","$1,313.57 ","$0.00 ","$1,775.10 ","$798.80 ","$0.00 ","$369.98 ","$0.00 ","$0.00 ","$310.81 ","$1,775.10 ","$0.00 ","$887.55 ","$1,405.88 ","$1,420.08 ","$0.00 ","$277.80 ","$0.00 ","$282.60 ","$0.00 "
"6013-0812","SUP","HCPCS C1776","","6013-0812  -  STEM FEMORAL 8 12MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-0814","SUP","HCPCS C1776","","6013-0814  -  STEM FEMORAL 8 14MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-0913","SUP","HCPCS C1776","","6013-0913  -  STEM FEMORAL 9 13MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-0915","SUP","HCPCS C1776","","6013-0915  -  STEM FEMORAL 9 15MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1014","SUP","HCPCS C1776","","6013-1014  -  STEM FEMORAL 10 14MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1016","SUP","HCPCS C1776","","6013-1016  -  STEM FEMORAL 10 16MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1115","SUP","HCPCS C1776","","6013-1115  -  STEM FEMORAL 11 15MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1117","SUP","HCPCS C1776","","6013-1117  -  STEM FEMORAL 11 17MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1216","SUP","HCPCS C1776","","6013-1216  -  STEM FEMORAL 12 16MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1218","SUP","HCPCS C1776","","6013-1218  -  STEM FEMORAL 12 18MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1317","SUP","HCPCS C1776","","6013-1317  -  STEM FEMORAL 13 17MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1319","SUP","HCPCS C1776","","6013-1319  -  STEM FEMORAL 13 19MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1418","SUP","HCPCS C1776","","6013-1418  -  STEM FEMORAL 14 18MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"6013-1420","SUP","HCPCS C1776","","6013-1420  -  STEM FEMORAL 14 20MM 205MM RSTOR TITANIUM HA HIP","BOTH IP/OP","$12,550.00 ","$9,287.00 ","$0.00 ","$12,550.00 ","$5,647.50 ","$0.00 ","$2,615.73 ","$0.00 ","$0.00 ","$2,197.40 ","$12,550.00 ","$0.00 ","$6,275.00 ","$9,939.60 ","$10,040.00 ","$0.00 ","$1,964.08 ","$0.00 ","$1,997.96 ","$0.00 "
"60-13506","SUP","Custom 27100030","","60-13506  -  BIT DRILL 6MM STOP 1.3MM 50MM 6MM TWIST STOP STERILE","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-13512","SUP","Custom 27100030","","60-13512  -  DRILL TWST 1.3MM 54MM STRL 12MM LEIBINGER UNV 2 12MM SCR","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-13570","SUP","Custom 27100030","","60-13570  -  BIT DRILL 12MM STOP 1.3MM 79MM TWIST STERILE","BOTH IP/OP","$242.15 ","$179.19 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-13712","SUP","Custom 27100030","","60-13712  -  BIT DRILL STERILE 12 MM SCREW","BOTH IP/OP","$272.60 ","$201.72 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-14008","SUP","Custom 27100030","","60-14008  -  BIT DRILL 1.4MM 8MM TWIST STERILE","BOTH IP/OP","$254.80 ","$188.55 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6014-0812L","SUP","HCPCS C1776","","6014-0812L  -  STEM FEM 255MM 12MM BW RSTOR HYDRXAPT 8 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-0812R","SUP","HCPCS C1776","","6014-0812R  -  STEM FEM 255MM 12MM RSTOR HYDRXAPT 8 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-0913L","SUP","HCPCS C1776","","6014-0913L  -  STEM FEM 255MM 13MM BW RSTOR HYDRXAPT 9 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-0913R","SUP","HCPCS C1776","","6014-0913R  -  STEM FEM 255MM 13MM BW RSTOR HYDRXAPT 9 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1014L","SUP","HCPCS C1776","","6014-1014L  -  STEM FEM 255MM 14MM BW RSTOR HYDRXAPT 10 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1014R","SUP","HCPCS C1776","","6014-1014R  -  STEM FEM 255MM 14MM BW RSTOR HYDRXAPT 10 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1115L","SUP","HCPCS C1776","","6014-1115L  -  STEM FEM 255MM 15MM BW RSTOR HYDRXAPT 11 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1115R","SUP","HCPCS C1776","","6014-1115R  -  STEM FEM 255MM 15MM BW RSTOR HYDRXAPT 11 RIGHT","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1216L","SUP","HCPCS C1776","","6014-1216L  -  STEM FEM 255MM 16MM BW RSTOR HA 12 LNG LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1216R","SUP","HCPCS C1776","","6014-1216R  -  STEM FEM 255MM 16MM BW RSTOR HYDRXAPT 12 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"60-14126","SUP","Custom 27203010","","60-14126  -  BIT DRILL 94MM 1.4MM TWST STOP SHFT END 27MM STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6014-1317L","SUP","HCPCS C1776","","6014-1317L  -  STEM FEM 255MM 17MM BW RSTOR HYDRXAPT 13 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1317R","SUP","HCPCS C1776","","6014-1317R  -  STEM FEM 255MM 17MM BW RSTOR HYDRXAPT 13 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1418L","SUP","HCPCS C1776","","6014-1418L  -  STEM FEM 255MM 18MM BW RSTOR HYDRXAPT 14 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6014-1418R","SUP","HCPCS C1776","","6014-1418R  -  STEM FEM 255MM 18MM BW RSTOR HYDRXAPT 14 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"60-14326","SUP","Custom 27203010","","60-14326  -  BIT DRILL 87MM 1.4MM TWST AO STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-14426","SUP","Custom 27203010","","60-14426  -  BIT DRILL 77MM 1.4MM 27MM STOP TWST DNTL SHFT END STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-15008","SUP","Custom 27100030","","60-15008  -  BIT DRILL 1.5MM 50MM 8MM TWIST STOP STERILE","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-15020","SUP","Custom 27100030","","60-15020  -  BIT DRILL TWIST 1.5MM 58MM 20MM STOP STERILE 20MM SCREW","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6015-0814L","SUP","HCPCS C1776","","6015-0814L  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT 8 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-0814R","SUP","HCPCS C1776","","6015-0814R  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT 8 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-0915L","SUP","HCPCS C1776","","6015-0915L  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT 9 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-0915R","SUP","HCPCS C1776","","6015-0915R  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT 9 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1016L","SUP","HCPCS C1776","","6015-1016L  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT 10 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1016R","SUP","HCPCS C1776","","6015-1016R  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT 10 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"60-15105","SUP","Custom 27100030","","60-15105  -  BIT DRILL 5MM STOP 1.5MM 50MM 5MM TWIST STERILE 5MM SCREW","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6015-1117L","SUP","HCPCS C1776","","6015-1117L  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT 11 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1117R","SUP","HCPCS C1776","","6015-1117R  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT 11 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1218L","SUP","HCPCS C1776","","6015-1218L  -  STEM FEM 205MM 18MM BW RSTOR HYDRXAPT 12 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1218R","SUP","HCPCS C1776","","6015-1218R  -  STEM FEM 205 18MM BW RSTOR HYDRXAPT 12 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1319L","SUP","HCPCS C1776","","6015-1319L  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT 13 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1319R","SUP","HCPCS C1776","","6015-1319R  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT 13 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1420L","SUP","HCPCS C1776","","6015-1420L  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT 14 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6015-1420R","SUP","HCPCS C1776","","6015-1420R  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT 14 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"60-15920","SUP","Custom 27100030","","60-15920  -  BIT DRILL 20MM STOP 1.5MM 107MM TWIST STERILE","BOTH IP/OP","$334.28 ","$247.37 ","$0.00 ","$762.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-15998","SUP","Custom 27203010","","60-15998  -  DRILL TWST 1.5MM 19MM 8MM","BOTH IP/OP","$827.50 ","$612.35 ","$0.00 ","$827.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$827.50 ","$0.00 ","$413.75 ","$655.38 ","$662.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16005","SUP","Custom 27203010","","60-16005  -  BIT DRILL 50MM 1.6MM 5MM STOP TWST 5MM STRL","BOTH IP/OP","$532.50 ","$394.05 ","$0.00 ","$268.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$268.13 ","$0.00 ","$134.06 ","$212.36 ","$214.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16007","SUP","Custom 27203010","","60-16007  -  DRILL TWST 1.6MM 50MM STRL 7MM STP","BOTH IP/OP","$570.00 ","$421.80 ","$0.00 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$570.00 ","$0.00 ","$285.00 ","$451.44 ","$456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16035","SUP","Custom 27100030","","60-16035  -  BIT DRILL 1.6MM 115MM TWIST NONSTRL 20MM SCREW","BOTH IP/OP","$642.50 ","$475.45 ","$0.00 ","$642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$642.50 ","$0.00 ","$321.25 ","$508.86 ","$514.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16050","SUP","Custom 27100030","","60-16050  -  BIT DRILL 1.6MM 125MM PILOT SHAFT END STERILE 50MM SCREW","BOTH IP/OP","$307.55 ","$227.59 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16407","SUP","Custom 27100030","","60-16407  -  BIT DRL 1.6MM 50MM NS 7MM DNTL SHFT END 2/2.3MM SCR","BOTH IP/OP","$255.85 ","$189.33 ","$0.00 ","$592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$592.50 ","$0.00 ","$296.25 ","$469.26 ","$474.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16435","SUP","Custom 27100030","","60-16435  -  BIT DRL 1.6MM 115MM NS 20MM DNTL SHFT END 2/2.3MM SCR","BOTH IP/OP","$296.43 ","$219.36 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16526","SUP","Custom 27203010","","60-16526  -  BIT DRILL TWIST 1.6MM 58MM 20MM STOP LEIBINGER HAND STERILE","BOTH IP/OP","$249.38 ","$184.54 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16535","SUP","Custom 27100030","","60-16535  -  BIT DRILL TWIST 1.6MM 85MM 26MM STOP STERILE 20MM SCREW","BOTH IP/OP","$258.33 ","$191.16 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16908","SUP","Custom 27100030","","60-16908  -  BIT DRILL 90D 8MM STOP 1.6MM 19MM 8MM DENTAL END STERILE 8MM","BOTH IP/OP","$238.75 ","$176.68 ","$0.00 ","$507.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-16918","SUP","Custom 27100030","","60-16918  -  BIT DRL 1.6MM 29MM NS 18MM DNTL SHFT END 2/2.3MM SCR","BOTH IP/OP","$238.75 ","$176.68 ","$0.00 ","$507.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6017-0425A","SUP","HCPCS C1776","","6017-0425A  -  STEM FEMORAL 4 25MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-0525A","SUP","HCPCS C1776","","6017-0525A  -  STEM FEMORAL 5 25MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-0625A","SUP","HCPCS C1776","","6017-0625A  -  STEM FEMORAL 6 25MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-0730A","SUP","HCPCS C1776","","6017-0730A  -  STEM FEMORAL 7 30MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-0830A","SUP","HCPCS C1776","","6017-0830A  -  STEM FEMORAL 8 30MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-0935A","SUP","HCPCS C1776","","6017-0935A  -  STEM FEMORAL 9 35MM C TAPER OMNIFIT HA HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-1035A","SUP","HCPCS C1776","","6017-1035A  -  STEM FEMORAL 10 35MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-1140A","SUP","HCPCS C1776","","6017-1140A  -  STEM FEMORAL 11 40MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-1240A","SUP","HCPCS C1776","","6017-1240A  -  STEM FEMORAL 12 40MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-1340A","SUP","HCPCS C1776","","6017-1340A  -  STEM FEMORAL 13 40MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6017-1440A","SUP","HCPCS C1776","","6017-1440A  -  STEM FEMORAL 14 40MM C TAPER OMNIFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6018-0814","SUP","HCPCS C1776","","6018-0814  -  STEM FEMORAL 1.5 14MM 205MM RSTOR HYDRXAPT CALCAR HIP","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"6018-0915","SUP","HCPCS C1776","","6018-0915  -  STEM FEMORAL 9 15MM 205MM REPLACEMENT RESECTION LEVEL SYSTEM","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"6018-1016","SUP","HCPCS C1776","","6018-1016  -  STEM FEMORAL 10 16MM 205MM REPLACEMENT RESECTION LEVEL","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"6018-1117","SUP","HCPCS C1776","","6018-1117  -  STEM FEMORAL 11 17MM 205MM REVISION RSTOR HYDRXAPT CALCAR","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"6018-1218","SUP","HCPCS C1776","","6018-1218  -  STEM FEMORAL 12 18MM 205MM RSTOR HYDRXAPT CALCAR HIP","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"6018-1319","SUP","HCPCS C1776","","6018-1319  -  STEM FEMORAL 13 19MM 205MM REVISION RSTOR HYDRXAPT CALCAR","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"6018-1420","SUP","HCPCS C1776","","6018-1420  -  STEM FEMORAL 14 20MM 205MM REVISION RSTOR HYDRXAPT CALCAR","BOTH IP/OP","$15,140.00 ","$11,203.60 ","$0.00 ","$15,140.00 ","$6,813.00 ","$0.00 ","$3,155.55 ","$0.00 ","$0.00 ","$2,650.89 ","$15,140.00 ","$0.00 ","$7,570.00 ","$11,990.88 ","$12,112.00 ","$0.00 ","$2,369.41 ","$0.00 ","$2,410.29 ","$0.00 "
"60-19035","SUP","Custom 27100030","","60-19035  -  BIT DRILL TWIST 1.9MM 115MM 35MM SHAFT END STOP STERILE","BOTH IP/OP","$322.43 ","$238.60 ","$0.00 ","$717.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$717.50 ","$0.00 ","$358.75 ","$568.26 ","$574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6019-0814","SUP","HCPCS C1776","","6019-0814  -  STEM FEM 205MM 14MM RSTOR HYDRXAPT 3 CLCR HIP","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"6019-0915","SUP","HCPCS C1776","","6019-0915  -  STEM FEM RSTOR HYDRXAPT 3 CLCR","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"6019-1016","SUP","HCPCS C1776","","6019-1016  -  STEM FEM 205MM 16MM RSTOR HYDRXAPT 3 CLCR HIP","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"6019-1117","SUP","HCPCS C1776","","6019-1117  -  STEM FEM 205MM 17MM REV RSTOR HYDRXAPT 11 CLCR HIP","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"6019-1218","SUP","HCPCS C1776","","6019-1218  -  STEM FEM 205MM 18MM REV RSTOR HYDRXAPT 12 CLCR HIP","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"60-19126","SUP","Custom 27203010","","60-19126  -  DRILL TWST 1.9MM 27MM STRYK END","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6019-1319","SUP","HCPCS C1776","","6019-1319  -  STEM FEM 205MM 19MM REV RSTOR HYDRXAPT 13 CLCR HIP","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"60-19140","SUP","Custom 27203010","","60-19140  -  BIT DRILL 108MM 1.9MM VARIAX TWST SHFT END","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6019-1420","SUP","HCPCS C1776","","6019-1420  -  STEM FEM 205MM 20MM REV RSTOR HYDRXAPT 14 CLCR HIP","BOTH IP/OP","$13,979.88 ","$10,345.11 ","$0.00 ","$13,979.88 ","$6,290.94 ","$0.00 ","$2,913.76 ","$0.00 ","$0.00 ","$2,447.76 ","$13,979.88 ","$0.00 ","$6,989.94 ","$11,072.06 ","$11,183.90 ","$0.00 ","$2,187.85 ","$0.00 ","$2,225.60 ","$0.00 "
"60-19326","SUP","Custom 27203010","","60-19326  -  BIT DRILL 87MM 1.9MM 27MM STOP TWST AO SHFT END STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19340","SUP","Custom 27203010","","60-19340  -  BIT DRILL 105MM 1.9MM VARIAX DISTAL AO SHFT END RAD NONSTRL","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19426","SUP","Custom 27203010","","60-19426  -  BIT DRILL 77MM 1.9MM TWST DNTL SHFT END DISP","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19435","SUP","Custom 27100030","","60-19435  -  DRILL TWIST 1.9MM 115MM 35MM STOP STERILE 2.3MM SCREW","BOTH IP/OP","$335.40 ","$248.20 ","$0.00 ","$765.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$765.00 ","$0.00 ","$382.50 ","$605.88 ","$612.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19440","SUP","Custom 27203010","","60-19440  -  BIT DRILL 91MM 1.9MM 41MM STOP TWST DNTL SHFT END STRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$185.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19526","SUP","Custom 27203010","","60-19526  -  BIT DRILL 1.9MM 58MM SHAFT END STERILE 20MM SCREW","BOTH IP/OP","$321.25 ","$237.73 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19535","SUP","Custom 27100030","","60-19535  -  BIT DRILL 1.9MM 85MM SHAFT END STERILE 20MM SCREW","BOTH IP/OP","$245.85 ","$181.93 ","$0.00 ","$552.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$552.50 ","$0.00 ","$276.25 ","$437.58 ","$442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19908","SUP","Custom 27100030","","60-19908  -  BIT DRILL 90D 8MM STOP 1.9MM 19MM DENTAL END STERILE 8MM","BOTH IP/OP","$238.75 ","$176.68 ","$0.00 ","$507.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-19918","SUP","Custom 27100030","","60-19918  -  BIT DRILL 90D 18MM STOP 1.9MM 29MM DENTAL END STERILE 18MM","BOTH IP/OP","$238.75 ","$176.68 ","$0.00 ","$507.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$507.50 ","$0.00 ","$253.75 ","$401.94 ","$406.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6020-0030","SUP","HCPCS C1776","","6020-0030  -  STEM FEMORAL 132D 0 33MM OFFST 86MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"60-20012","SUP","Custom 27100030","","60-20012  -  BIT DRILL TWIST 2MM 62MM 13MM REPOSITION PIN STOP STERILE","BOTH IP/OP","$670.00 ","$495.80 ","$0.00 ","$670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.00 ","$0.00 ","$335.00 ","$530.64 ","$536.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6020-0130","SUP","HCPCS C1776","","6020-0130  -  STEM FEMORAL 132D 1 34MM OFFST 110MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-0230","SUP","HCPCS C1776","","6020-0230  -  STEM FEMORAL 130D 2 35MM OFFST 115MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-0335","SUP","HCPCS C1776","","6020-0335  -  STEM FEMORAL 132D 3 39MM OFFST 120MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-0435","SUP","HCPCS C1776","","6020-0435  -  STEM FEMORAL 132D 4 40MM OFFST 125MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"60-20050","SUP","Custom 27100030","","60-20050  -  BIT DRL 2MM 125MM NS 50MM STRYK SHFT END 2MM LG SCR","BOTH IP/OP","$368.75 ","$272.88 ","$0.00 ","$785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$785.00 ","$0.00 ","$392.50 ","$621.72 ","$628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6020-0537","SUP","HCPCS C1776","","6020-0537  -  STEM FEMORAL 132D 5 44MM OFFST 130MM 37MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-0637","SUP","HCPCS C1776","","6020-0637  -  STEM FEMORAL 132D 6 45MM OFFST 135MM 37MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-0740","SUP","HCPCS C1776","","6020-0740  -  STEM FEMORAL 132D 7 48MM OFFST 140MM 40MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-0840","SUP","HCPCS C1776","","6020-0840  -  STEM FEMORAL 132D 8 49MM OFFST 145MM 40MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"60-20185","SUP","Custom 27203010","","60-20185  -  BIT DRILL 100MM 2MM 40MM STOP TWST DNTL SHFT END STRL","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6020-2530","SUP","HCPCS C1776","","6020-2530  -  STEM FEMORAL 132D 2.5 36MM OFFST 118MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6020-3535","SUP","HCPCS C1776","","6020-3535  -  STEM FEMORAL 132D 3.5 39MM OFFST 124MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"60-20385","SUP","Custom 27203010","","60-20385  -  DRILL TWST 2MM 105MM STRL 40MM AO SHFT END STP DIST VARIAX","BOTH IP/OP","$166.38 ","$123.12 ","$0.00 ","$166.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.38 ","$0.00 ","$83.19 ","$131.77 ","$133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6020-4535","SUP","HCPCS C1776","","6020-4535  -  STEM FEMORAL 132D 4.5 41MM OFFST 129MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"60-20485","SUP","Custom 27203010","","60-20485  -  BIT DRILL 100MM 2MM 40MM STOP TWST DNTL SHFT END STRL","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6020-5537","SUP","HCPCS C1776","","6020-5537  -  STEM FEMORAL 132D 5.5 45MM OFFST 133MM 37MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0030","SUP","HCPCS C1776","","6021-0030  -  STEM FEMORAL 127D 0 37MM OFFST 86MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0130","SUP","HCPCS C1776","","6021-0130  -  STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0230","SUP","HCPCS C1776","","6021-0230  -  STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0335","SUP","HCPCS C1776","","6021-0335  -  STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0435","SUP","HCPCS C1776","","6021-0435  -  STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0537","SUP","HCPCS C1776","","6021-0537  -  STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0637","SUP","HCPCS C1776","","6021-0637  -  STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0740","SUP","HCPCS C1776","","6021-0740  -  STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-0840","SUP","HCPCS C1776","","6021-0840  -  STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-2530","SUP","HCPCS C1776","","6021-2530  -  STEM FEMORAL 127D 2.5 40MM OFFST 118MM 30MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-3535","SUP","HCPCS C1776","","6021-3535  -  STEM FEMORAL 127D 3.5 43MM OFFST 124MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-4535","SUP","HCPCS C1776","","6021-4535  -  STEM FEMORAL 127D 4.5 45MM OFFST 129MM 35MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6021-5537","SUP","HCPCS C1776","","6021-5537  -  STEM FEMORAL 127D 5.5 49MM OFFST 133MM 37MM CEMENTLESS NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"60-23141","SUP","Custom 27203010","","60-23141  -  DRILL TWST 2.3MM","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-23341","SUP","Custom 27203010","","60-23341  -  DRILL TWST 2.3MM VARIAX DISTAL AO SHFT END RAD STRL","BOTH IP/OP","$168.30 ","$124.54 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-23441","SUP","Custom 27203010","","60-23441  -  DRILL TWST 2.3MM DNTL SHFT END","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-25126","SUP","Custom 27203010","","60-25126  -  BIT DRILL 94MM 2.5MM 26MM STOP TWST STRL","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-25326","SUP","Custom 27203010","","60-25326  -  BIT DRILL 87MM 2.5MM PRFL HAND MDLR AO SHFT END 26MM SM FRAG","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-25426","SUP","Custom 27203010","","60-25426  -  DRILL TWST 25MM 27MM WKG LN","BOTH IP/OP","$159.50 ","$118.03 ","$0.00 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.50 ","$0.00 ","$79.75 ","$126.32 ","$127.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"602640S","SUP","HCPCS C1713","","602640S  -  SCREW BN THRD 6.5MM 40MM STRL 20MM ASNS III CNN THRD TI HIP","BOTH IP/OP","$391.88 ","$289.99 ","$0.00 ","$604.00 ","$271.80 ","$0.00 ","$81.68 ","$0.00 ","$0.00 ","$105.76 ","$604.00 ","$0.00 ","$302.00 ","$478.37 ","$483.20 ","$0.00 ","$94.53 ","$0.00 ","$96.16 ","$0.00 "
"6033-0425","SUP","HCPCS C1776","","6033-0425  -  STEM FEMORAL 4 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-0525","SUP","HCPCS C1776","","6033-0525  -  STEM FEMORAL 5 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-0625","SUP","HCPCS C1776","","6033-0625  -  STEM FEMORAL 6 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-0730","SUP","HCPCS C1776","","6033-0730  -  STEM FEMORAL 7 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-0830","SUP","HCPCS C1776","","6033-0830  -  STEM FEMORAL 8 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-0935","SUP","HCPCS C1776","","6033-0935  -  STEM FEMORAL 9 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-1035","SUP","HCPCS C1776","","6033-1035  -  STEM FEMORAL 10 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-1140","SUP","HCPCS C1776","","6033-1140  -  STEM FEMORAL 11 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-1240","SUP","HCPCS C1776","","6033-1240  -  STEM FEMORAL 12 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6033-1340","SUP","HCPCS C1776","","6033-1340  -  STEM FEMORAL 13 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-0425","SUP","HCPCS C1776","","6034-0425  -  STEM FEMORAL 4 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-0525","SUP","HCPCS C1776","","6034-0525  -  STEM FEMORAL 5 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-0625","SUP","HCPCS C1776","","6034-0625  -  STEM FEMORAL 6 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-0730","SUP","HCPCS C1776","","6034-0730  -  STEM FEMORAL 7 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-0830","SUP","HCPCS C1776","","6034-0830  -  STEM FEMORAL 8 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-0935","SUP","HCPCS C1776","","6034-0935  -  STEM FEMORAL 9 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-1035","SUP","HCPCS C1776","","6034-1035  -  STEM FEMORAL 10 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-1140","SUP","HCPCS C1776","","6034-1140  -  STEM FEMORAL 11 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-1240","SUP","HCPCS C1776","","6034-1240  -  STEM FEMORAL 12 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6034-1340","SUP","HCPCS C1776","","6034-1340  -  STEM FEMORAL 13 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6041-1140","SUP","HCPCS C1776","","6041-1140  -  STEM FEM 40MM OMFT HYDRXAPT 11 HIP","BOTH IP/OP","$5,592.00 ","$4,138.08 ","$0.00 ","$5,592.00 ","$2,516.40 ","$0.00 ","$1,165.51 ","$0.00 ","$0.00 ","$979.11 ","$5,592.00 ","$0.00 ","$2,796.00 ","$4,428.86 ","$4,473.60 ","$0.00 ","$875.15 ","$0.00 ","$890.25 ","$0.00 "
"6041-1240","SUP","HCPCS C1776","","6041-1240  -  STEM FEM 40MM 12MM MRS TPR OSTNC HYDRXAPT HIP","BOTH IP/OP","$5,592.00 ","$4,138.08 ","$0.00 ","$5,592.00 ","$2,516.40 ","$0.00 ","$1,165.51 ","$0.00 ","$0.00 ","$979.11 ","$5,592.00 ","$0.00 ","$2,796.00 ","$4,428.86 ","$4,473.60 ","$0.00 ","$875.15 ","$0.00 ","$890.25 ","$0.00 "
"6046-0625","SUP","HCPCS C1776","","6046-0625  -  STEM FEM OMFLX HYDRXAPT 6 HIP","BOTH IP/OP","$6,546.00 ","$4,844.04 ","$0.00 ","$6,546.00 ","$2,945.70 ","$0.00 ","$1,364.35 ","$0.00 ","$0.00 ","$1,146.15 ","$6,546.00 ","$0.00 ","$3,273.00 ","$5,184.43 ","$5,236.80 ","$0.00 ","$1,024.45 ","$0.00 ","$1,042.12 ","$0.00 "
"6046-0830","SUP","HCPCS C1776","","6046-0830  -  STEM FEM OMFLX HYDRXAPT 8 HIP","BOTH IP/OP","$6,546.00 ","$4,844.04 ","$0.00 ","$6,546.00 ","$2,945.70 ","$0.00 ","$1,364.35 ","$0.00 ","$0.00 ","$1,146.15 ","$6,546.00 ","$0.00 ","$3,273.00 ","$5,184.43 ","$5,236.80 ","$0.00 ","$1,024.45 ","$0.00 ","$1,042.12 ","$0.00 "
"6046-1440","SUP","HCPCS C1776","","6046-1440  -  STEM FEM OMFLX HYDRXAPT 14 HIP","BOTH IP/OP","$6,546.00 ","$4,844.04 ","$0.00 ","$6,546.00 ","$2,945.70 ","$0.00 ","$1,364.35 ","$0.00 ","$0.00 ","$1,146.15 ","$6,546.00 ","$0.00 ","$3,273.00 ","$5,184.43 ","$5,236.80 ","$0.00 ","$1,024.45 ","$0.00 ","$1,042.12 ","$0.00 "
"6048-58","SUP","Custom 27203010","","6048-58  -  KIT STYLET BLUNT STR .014IN 58CM LEAD KNOB GREEN","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6050-0530","SUP","HCPCS C1776","","6050-0530  -  STEM FEMORAL 5 30MM HEAD NECK OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6050-0735","SUP","HCPCS C1776","","6050-0735  -  IMPLANT KN 69 68.9MM ANT/POSTERIORX70.1MM MEDI STRL IB2MKS","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6050-0745","SUP","HCPCS C1776","","6050-0745  -  STEM FEMORAL 7 45MM CEMENTED HEAD/NECK OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6050-0935","SUP","HCPCS C1776","","6050-0935  -  STEM FEMORAL 9 C TAPER 12MM 160MM 35MM OMNIFIT HEAD NECK HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6050-0945","SUP","HCPCS C1776","","6050-0945  -  STEM FEMORAL 9 45MM 160MM CEMENTED HEAD/NECK OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6050-0955","SUP","HCPCS C1776","","6050-0955  -  STEM FEMORAL 55MM 55MM 9MM HEAD NECK OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6050-1135","SUP","HCPCS C1776","","6050-1135  -  STEM FEMORAL 11 CEMENT OMNIFIT HIP","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6051-0425A","SUP","HCPCS C1776","","6051-0425A  -  STEM FEM 100MM 8.1MM CMNTLS SECFIT HYDRXAPT 4 25MM HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6051-0425S","SUP","HCPCS C1776","","6051-0425S  -  STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-0525A","SUP","HCPCS C1776","","6051-0525A  -  STEM FEM 110MM 8.9MM CMNTLS SECFIT HYDRXAPT 5 25MM HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-0525S","SUP","HCPCS C1776","","6051-0525S  -  STEM FEMORAL 132D 5 29MM OFFST 8.9MM 110MM 25MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-0625A","SUP","HCPCS C1776","","6051-0625A  -  STEM FEM CMNTLS CTPR CLRLS SECFIT HYDRXAPT 6 25MM HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-0625S","SUP","HCPCS C1776","","6051-0625S  -  STEM FEMORAL 132D 6 30MM OFFST 9.6MM 120MM 25MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-0730A","SUP","HCPCS C1776","","6051-0730A  -  STEM FEM 7 10.4MM 13CM 30MM SCRFT BS NK DIST TIP HA HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-0730S","SUP","HCPCS C1776","","6051-0730S  -  STEM FEMORAL 132D 7 35MM OFFST 10.4MM 130MM 30MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-0830A","SUP","HCPCS C1776","","6051-0830A  -  STEM FEM 140MM 11.2MM CMNTLS SECFIT HYDRXAPT 8 30MM HIP STRL","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-0830S","SUP","HCPCS C1776","","6051-0830S  -  STEM FEMORAL 132D 8 36MM OFFST 11.2MM 140MM 30MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-0935A","SUP","HCPCS C1776","","6051-0935A  -  STEM FEM 11.9MM SECFIT HYDRXAPT 9 35MM HIP STRL","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-0935S","SUP","HCPCS C1776","","6051-0935S  -  STEM FEMORAL 132D 9 40.8MM 11.9MM 15CM 35MM SECFIT MAX HA","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-1035A","SUP","HCPCS C1776","","6051-1035A  -  STEM FEM 160MM 12.7MM CMNTLS SECFIT HYDRXAPT 10 35MM HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-1035S","SUP","HCPCS C1776","","6051-1035S  -  STEM FEMORAL 132D 10 42MM OFFST 12.7MM 160MM 35MM NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-1140A","SUP","HCPCS C1776","","6051-1140A  -  STEM FEM 40MM SECFIT MXHYDRXAPT 11 40MM HIP STRL","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-1140S","SUP","HCPCS C1776","","6051-1140S  -  STEM FEMORAL 132D 11 46.5MM 13.5MM 17CM 40MM SECFIT MAX HA","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-1240A","SUP","HCPCS C1776","","6051-1240A  -  STEM FEM 170MM 14.7MM CMNTLS SECFIT HYDRXAPT 12 40MM HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6051-1240S","SUP","HCPCS C1776","","6051-1240S  -  STEM FEMORAL 132D 12 47MM OFFST 14.7MM 170MM 40MM NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-1340A","SUP","HCPCS C1776","","6051-1340A  -  STEM FEM 13 48.2MM OFST 16MM 17CM 40MM SCRFT HA HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6051-1340S","SUP","HCPCS C1776","","6051-1340S  -  STEM FEM 13 16MM 17CM 40MM SCRFT BS OFST HAP HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6051-1440A","SUP","HCPCS C1776","","6051-1440A  -  STEM FEM 170MM 17.2MM CMNTLS SECFIT HYDRXAPT 14 40MM HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6051-1440S","SUP","HCPCS C1776","","6051-1440S  -  STEM FEMORAL 132D 14 49MM OFFST 17.2MM 170MM 40MM NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-0625A","SUP","HCPCS C1776","","6052-0625A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 6 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-0625S","SUP","HCPCS C1776","","6052-0625S  -  STEM FEMORAL 127D 6 33MM OFFST 9.6MM 120MM 25MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-0730A","SUP","HCPCS C1776","","6052-0730A  -  STEM FEM 30MM SECFIT MXHYDRXAPT 7 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-0730S","SUP","HCPCS C1776","","6052-0730S  -  STEM FEMORAL 127D 7 39MM OFFST 10.4MM 130MM 30MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-0830A","SUP","HCPCS C1776","","6052-0830A  -  STEM FEM SECFIT HYDRXAPT 8 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-0830S","SUP","HCPCS C1776","","6052-0830S  -  STEM FEMORAL 127D 8 40MM OFFST 11.2MM 140MM 30MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-0935A","SUP","HCPCS C1776","","6052-0935A  -  STEM FEM SECFIT HYDRXAPT 127D 9 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-0935S","SUP","HCPCS C1776","","6052-0935S  -  STEM FEMORAL 127D 9 45MM OFFST 11.9MM 150MM 35MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-1035A","SUP","HCPCS C1776","","6052-1035A  -  STEM FEM SECFIT HYDRXAPT 127D 10 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-1035S","SUP","HCPCS C1776","","6052-1035S  -  STEM FEMORAL 127D 10 46MM OFFST 12.7MM 160MM 35MM NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-1140A","SUP","HCPCS C1776","","6052-1140A  -  STEM FEM SECFIT HYDRXAPT 127D 11 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-1140S","SUP","HCPCS C1776","","6052-1140S  -  STEM FEMORAL 127D 11 51MM OFFST 13.5MM 170MM 40MM NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-1240A","SUP","HCPCS C1776","","6052-1240A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 127D 12 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6052-1240S","SUP","HCPCS C1776","","6052-1240S  -  STEM FEMORAL 127D 12 52MM OFFST 14.7MM 170MM 40MM NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6052-1340A","SUP","HCPCS C1776","","6052-1340A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 127D 13 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6052-1340S","SUP","HCPCS C1776","","6052-1340S  -  STEM FEMORAL 127D 13 53MM OFFST 16MM 170MM 40MM NECK SECFIT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0509A","SUP","HCPCS C1776","","6054-0509A  -  STEM FEM 5 32MM OFST 9MM 110MM 25MM SCRFT + PRM HA HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6054-0509S","SUP","HCPCS C1776","","6054-0509S  -  STEM FEM 127D 5 32MM OFST 9MM 110MM 25MM SCRFT+ MX PLSH NK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0511A","SUP","HCPCS C1776","","6054-0511A  -  STEM FEM 5 32MM OFST 11MM 110MM 25MM SCRFT + PRM HA HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6054-0511S","SUP","HCPCS C1776","","6054-0511S  -  STEM FEM 5 11MM STRL SCRFT + HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0610A","SUP","HCPCS C1776","","6054-0610A  -  STEM FEM 10MM PRIM SECFIT PLUS HYDRXAPT 6 HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6054-0610S","SUP","HCPCS C1776","","6054-0610S  -  STEM FEMORAL 127D 6 33MM OFFST 10MM 120MM 25MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0612A","SUP","HCPCS C1776","","6054-0612A  -  STEM FEM 12MM CMNTLS PRIM SECFIT PLUS HYDRXAPT 6 HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6054-0612S","SUP","HCPCS C1776","","6054-0612S  -  STEM FEMORAL 127D 6 33MM OFFST 12MM 120MM 25MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0711A","SUP","HCPCS C1776","","6054-0711A  -  STEM FEM 11MM PRIM SECFIT MXHYDRXAPT 7 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-0711S","SUP","HCPCS C1776","","6054-0711S  -  STEM FEMORAL 127D 7 39MM OFFST 11MM 130MM 30MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0713A","SUP","HCPCS C1776","","6054-0713A  -  STEM FEM 13MM PRIM SECFIT PLUS HYDRXAPT 7 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-0713S","SUP","HCPCS C1776","","6054-0713S  -  STEM FEMORAL 127D 7 39MM OFFST 13MM 130MM 30MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0812A","SUP","HCPCS C1776","","6054-0812A  -  STEM FEM 12MM PRIM SECFIT PLUS HYDRXAPT 8 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-0812S","SUP","HCPCS C1776","","6054-0812S  -  STEM FEMORAL 127D 8 40MM OFFST 12MM 140MM 30MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0814A","SUP","HCPCS C1776","","6054-0814A  -  STEM FEM SECFIT PLUS 8 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-0814S","SUP","HCPCS C1776","","6054-0814S  -  STEM FEMORAL 127D 8 40MM OFFST 14MM 140MM 30MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0913A","SUP","HCPCS C1776","","6054-0913A  -  STEM FEM 13MM PRIM SECFIT MXHYDRXAPT 9 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-0913S","SUP","HCPCS C1776","","6054-0913S  -  STEM FEMORAL 127D 9 45MM OFFST 13MM 150MM 35MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-0915A","SUP","HCPCS C1776","","6054-0915A  -  STEM FEM PRIM CMNTLS SECFIT PLUS 9 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-0915S","SUP","HCPCS C1776","","6054-0915S  -  STEM FEMORAL 127D 9 45MM OFFST 15MM 150MM 35MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1014A","SUP","HCPCS C1776","","6054-1014A  -  STEM FEM 14MM PRIM SECFIT PLUS HYDRXAPT 10 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-1014S","SUP","HCPCS C1776","","6054-1014S  -  STEM FEMORAL 127D 10 46MM OFFST 14MM 160MM 35MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1016A","SUP","HCPCS C1776","","6054-1016A  -  STEM FEM 16MM PRIM SECFIT PLUS HYDRXAPT 10 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-1016S","SUP","HCPCS C1776","","6054-1016S  -  STEM FEMORAL 127D 10 46MM OFFST 16MM 160MM 35MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1115A","SUP","HCPCS C1776","","6054-1115A  -  STEM FEM 15MM PRIM SECFIT PLUS HYDRXAPT 11 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-1115S","SUP","HCPCS C1776","","6054-1115S  -  STEM FEMORAL 127D 11 51MM OFFST 15MM 170MM 40MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1117A","SUP","HCPCS C1776","","6054-1117A  -  STEM FEM 17MM PRIM SECFIT PLUS HYDRXAPT 11 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-1117S","SUP","HCPCS C1776","","6054-1117S  -  STEM FEMORAL 127D 11 51MM OFFST 17MM 170MM 40MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1216S","SUP","HCPCS C1776","","6054-1216S  -  STEM FEMORAL 127D 12 52MM OFFST 16MM 170MM 40MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1218A","SUP","HCPCS C1776","","6054-1218A  -  STEM FEM 18MM CMNTLS PRIM SECFIT PLUS HYDRXAPT 12 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6054-1218S","SUP","HCPCS C1776","","6054-1218S  -  STEM FEMORAL 127D 12 52MM OFFST 18MM 170MM 40MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1317S","SUP","HCPCS C1776","","6054-1317S  -  STEM FEMORAL 13 17MM PRIM SECFIT PLUS HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1319S","SUP","HCPCS C1776","","6054-1319S  -  STEM FEMORAL 127D 13 53MM OFFST 19MM 170MM 40MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1418S","SUP","HCPCS C1776","","6054-1418S  -  STEM FEMORAL 14 18MM CEMENTLESS PRIM SECFIT PLUS HYDRXAPT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-1420S","SUP","HCPCS C1776","","6054-1420S  -  STEM FEMORAL 127D 14 54MM OFFST 20MM 170MM 40MM POLISH NECK","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6054-58","SUP","HCPCS C1765","","6054-58  -  STYLET LEAD KT BALL TIP TPR","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$0.00 ","$0.00 "
"6057-0230D","SUP","HCPCS C1776","","6057-0230D  -  STEM FEMORAL 127D 2 39MM OFFST 124MM 30MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6057-0335D","SUP","HCPCS C1776","","6057-0335D  -  STEM FEMORAL 127D 3 43MM OFFST 131MM 35MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6057-0435D","SUP","HCPCS C1776","","6057-0435D  -  STEM FEMORAL 127D 4 46MM OFFST 137MM 35MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6057-0537D","SUP","HCPCS C1776","","6057-0537D  -  STEM FEMORAL 127D 5 48MM OFFST 145MM 37MM NECK CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6057-0637D","SUP","HCPCS C1776","","6057-0637D  -  STEM FEMORAL 127D 6 49MM OFFST 158MM 37MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6057-0740D","SUP","HCPCS C1776","","6057-0740D  -  STEM FEMORAL 127D 7 52MM OFFST 158MM 40MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6057-52","SUP","Custom 27203010","","6057-52  -  STYLET LEAD STR BALL .014IN 52CM KIT EXTENDED TAPER BLUE","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6057-58","SUP","HCPCS C1765","","6057-58  -  STYLET LEAD 58CM .014IN KT BALL TIP BLUE KNOB","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$0.00 ","$0.00 "
"6058-0230D","SUP","HCPCS C1776","","6058-0230D  -  STEM FEMORAL 132D 2 35MM OFFST 124MM 30MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6058-0335D","SUP","HCPCS C1776","","6058-0335D  -  STEM FEMORAL 132D 3 39MM OFFST 131MM 35MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6058-0435D","SUP","HCPCS C1776","","6058-0435D  -  STEM FEMORAL 132D 4 42MM OFFST 137MM 35MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6058-0537D","SUP","HCPCS C1776","","6058-0537D  -  STEM FEMORAL 132D 5 44MM OFFST 145MM 37MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6058-0637D","SUP","HCPCS C1776","","6058-0637D  -  STEM FEMORAL 132D 6 45MM OFFST 158MM 37MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6058-0740D","SUP","HCPCS C1776","","6058-0740D  -  STEM FEMORAL 132D 4 48MM OFFST 158MM 40MM CEMENTED NECK","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"606-004-103","SUP","HCPCS Q4130","","606-004-103  -  MATRIX TISS THK1MM SEMIOVAL 16X8CM STRL SURGIMEND PRS","BOTH IP/OP","$5,760.00 ","$4,262.40 ","$0.00 ","$7,520.00 ","$0.00 ","$0.00 ","$1,200.53 ","$0.00 ","$0.00 ","$0.00 ","$7,520.00 ","$0.00 ","$3,760.00 ","$5,955.84 ","$6,016.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-6085-200A","SUP","Custom 27203010","","60-6085-200A  -  RETRACTOR/ELEVATOR LAPSCP SM 32MM STRL LF VCARE 2 CUP LCK","BOTH IP/OP","$233.40 ","$172.72 ","$0.00 ","$233.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.40 ","$0.00 ","$116.70 ","$184.85 ","$186.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-6085-201A","SUP","Custom 27203010","","60-6085-201A  -  RETRACTOR/ELEVATOR LAPSCOP MEDIUM 34MM 2 CUP LOCK SCREW HOLE","BOTH IP/OP","$233.40 ","$172.72 ","$0.00 ","$233.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$233.40 ","$0.00 ","$116.70 ","$184.85 ","$186.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-6085-202","SUP","Custom 27203010","","60-6085-202  -  RETRACTOR/ELEVATOR LAPSCOP LARGE 37MM 2 CUP HOLE MANIPULATOR","BOTH IP/OP","$196.05 ","$145.08 ","$0.00 ","$198.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.99 ","$0.00 ","$99.50 ","$157.60 ","$159.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"606-151X","SUP","HCPCS C1729","","CATHETER INFUS .014IN STRG 2.3-1.9FR .0165IN 150CM 50CM MCTH","BOTH IP/OP","$1,747.50 ","$1,293.15 ","$0.00 ","$1,747.50 ","$948.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$305.97 ","$1,747.50 ","$0.00 ","$873.75 ","$1,384.02 ","$1,398.00 ","$0.00 ","$273.48 ","$0.00 ","$278.20 ","$0.00 "
"606-200-004","SUP","HCPCS C9360","","606-200-004  -  MATRIX TISSUE SURGIMEND BOVINE COLLAGEN THK2 MM RECTANGLE L1","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$4,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,140.00 ","$0.00 ","$2,070.00 ","$3,278.88 ","$3,312.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-660-01-04","SUP","HCPCS C1713","","60-660-01-04  -  PLATE BONE CSTM PROPHYLACTIC CRANIAL IRR","BOTH IP/OP","$17,487.50 ","$12,940.75 ","$0.00 ","$17,487.50 ","$7,869.38 ","$0.00 ","$3,644.83 ","$0.00 ","$0.00 ","$3,061.92 ","$17,487.50 ","$0.00 ","$8,743.75 ","$13,850.10 ","$13,990.00 ","$0.00 ","$2,736.79 ","$0.00 ","$2,784.01 ","$0.00 "
"606S255MX","SUP","HCPCS C1725","","606S255MX  -  MICROCATHETER CRBRVASC 90D 2.3-2.8FR .021IN 150CM 5CM PRWLR","BOTH IP/OP","$2,175.25 ","$1,609.69 ","$0.00 ","$2,027.30 ","$1,100.82 ","$0.00 ","$453.38 ","$0.00 ","$0.00 ","$354.96 ","$2,027.30 ","$0.00 ","$1,013.65 ","$1,605.62 ","$1,621.84 ","$0.00 ","$317.27 ","$0.00 ","$322.75 ","$0.00 "
"606-S255X","SUP","HCPCS C1729","","CATHETER INFUS 2.8-2.3FR .021IN 150CM 5CM MCTH DUAL MRKR","BOTH IP/OP","$1,965.00 ","$1,454.10 ","$0.00 ","$1,965.00 ","$1,067.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$344.06 ","$1,965.00 ","$0.00 ","$982.50 ","$1,556.28 ","$1,572.00 ","$0.00 ","$307.52 ","$0.00 ","$312.83 ","$0.00 "
"6070-0525A","SUP","Custom 27803010","","6070-0525A  -  STEM FEMORAL 132D 5 25MM PRIM OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6070-0625A","SUP","Custom 27803010","","6070-0625A  -  STEM FEMORAL 132D 6 30MM OFFST 120MM 25MM CEMENTED NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6070-0730A","SUP","Custom 27803010","","6070-0730A  -  STEM FEMORAL 132D 7 35MM OFFST 130MM 30MM CEMENTED NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6070-0830A","SUP","Custom 27803010","","6070-0830A  -  STEM FEMORAL 132D 8 36MM OFFST 140MM 30MM CEMENTED NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6070-0935A","SUP","Custom 27803010","","6070-0935A  -  STEM FEMORAL 132D 9 41MM OFFST 150MM 35MM CEMENTED NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6070-1035A","SUP","Custom 27803010","","6070-1035A  -  STEM FEMORAL 132D 10 35MM CEMENT OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6070-1140A","SUP","Custom 27803010","","6070-1140A  -  STEM FEMORAL 132D 11 46MM OFFST 170MM 40MM CEMENTED NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6072-0625","SUP","Custom 27803010","","6072-0625  -  STEM FEM CMNT ODC-FX 6 HIP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6072-0730","SUP","Custom 27803010","","6072-0730  -  STEM FEM CMNT ODC-FX 7 HIP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6072-0830","SUP","Custom 27803010","","6072-0830  -  STEM FEM CMNT ODC-FX 8 HIP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6072-0935","SUP","Custom 27803010","","6072-0935  -  STEM FEM CMNT ODC-FX 9 HIP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6072-1035","SUP","Custom 27803010","","6072-1035  -  STEM FEM CMNT OMFT 10 HIP","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-0525","SUP","Custom 27803010","","6073-0525  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-0625","SUP","Custom 27803010","","6073-0625  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-0730","SUP","Custom 27803010","","6073-0730  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-0830","SUP","Custom 27803010","","6073-0830  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-0935","SUP","Custom 27803010","","6073-0935  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-1035","SUP","Custom 27803010","","6073-1035  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6073-1140","SUP","Custom 27803010","","6073-1140  -  STEM FEM ODC HIP","BOTH IP/OP","$2,024.00 ","$1,497.76 ","$0.00 ","$2,024.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,024.00 ","$0.00 ","$1,012.00 ","$1,603.01 ","$1,619.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6076-0525A","SUP","Custom 27803010","","6076-0525A  -  STEM FEMORAL 127D 5 35MM 110MM 25MM CEMENT HFX OMNIFIT HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6076-0625A","SUP","Custom 27803010","","6076-0625A  -  STEM FEMORAL 127D 6 120MM 25MM CEMENT OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6076-0730A","SUP","Custom 27803010","","6076-0730A  -  STEM FEMORAL 7 OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6076-0830A","SUP","Custom 27803010","","6076-0830A  -  STEM FEMORAL 127D 8 135MM 30MM CEMENT OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6076-0935A","SUP","Custom 27803010","","6076-0935A  -  STEM FEMORAL 127D 9 140MM 35MM CEMENT OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6076-1035A","SUP","Custom 27803010","","6076-1035A  -  STEM FEMORAL 127D 10 145MM 35MM CEMENT OMNIFIT HFX HIP","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0130","SUP","Custom 27803010","","6077-0130  -  STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0230","SUP","Custom 27803010","","6077-0230  -  STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0335","SUP","Custom 27803010","","6077-0335  -  STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0435","SUP","Custom 27803010","","6077-0435  -  STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0537","SUP","Custom 27803010","","6077-0537  -  STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0637","SUP","Custom 27803010","","6077-0637  -  STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0740","SUP","Custom 27803010","","6077-0740  -  STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6077-0840","SUP","Custom 27803010","","6077-0840  -  STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6080-0530-200L","SUP","HCPCS C1776","","6080-0530-200L  -  STEM FEM OMFT LNG LEFT HDNK","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0530-200R","SUP","HCPCS C1776","","6080-0530-200R  -  STEM FEM 200MM 12MM HDNK OMFT 5 LNG 30MM RIGHT","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0735-200L","SUP","HCPCS C1776","","6080-0735-200L  -  STEM FEM 200MM 14.5MM HDNK PRTCL ADD SYS OMFT 7 LNG 35MM","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0735-200R","SUP","HCPCS C1776","","6080-0735-200R  -  STEM FEM 200MM 12.4MM CMNT HDNK OMFT 7 LNG 35MM RIGHT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0745-200L","SUP","HCPCS C1776","","6080-0745-200L  -  STEM FEM 200MM CMNT HDNK OMFT 12.4MM 7 LNG 45MM LEFT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0745-200R","SUP","HCPCS C1776","","6080-0745-200R  -  STEM FEM 200MM 14.5MM HDNK PRTCL ADD SYS OMFT 7 LNG 45MM","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0935-250L","SUP","HCPCS C1776","","6080-0935-250L  -  STEM FEM 250MM OMFT 9 LNG 35MM HDNK","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0935-250R","SUP","HCPCS C1776","","6080-0935-250R  -  STEM FEM 200MM 14MM CMNT HDNK OMFT 9 LNG 35MM RIGHT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0945-250L","SUP","HCPCS C1776","","6080-0945-250L  -  STEM FEM 250MM 14MM CMNT HDNK OMFT 9 LNG 45MM LEFT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6080-0945-250R","SUP","HCPCS C1776","","6080-0945-250R  -  STEM FEM 250MM 14MM CMNT HDNK OMFT 9 LNG 45MM RIGHT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"60-80317","SUP","Custom 27203010","","60-80317  -  CNTRSNK DRILL 47 AO SHFT END","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60-80323","SUP","Custom 27203010","","60-80323  -  CNTRSNK DRILL 48MM AO SHFT END STRL","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6082-52","SUP","Custom 27203010","","6082-52  -  STYLET LEAD .014IN 52CM KIT STR BALL TIP EXTENDED TAPER GRAY","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6082-65","SUP","Custom 27203010","","6082-65  -  KIT STY STRG XTD TPR .014IN 65CM GRY BALL TIP KNOB","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6088-0525-200L","SUP","HCPCS C1776","","6088-0525-200L  -  STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0525-200R","SUP","HCPCS C1776","","6088-0525-200R  -  STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0525-250L","SUP","HCPCS C1776","","6088-0525-250L  -  STEM FEMORAL 5 LONG 10.9MM 250MM 25MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0525-250R","SUP","HCPCS C1776","","6088-0525-250R  -  STEM FEMORAL 5 LONG 250MM CEMENTED REVISION OMNIFIT DISTAL","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0525-300L","SUP","HCPCS C1776","","6088-0525-300L  -  STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0525-300R","SUP","HCPCS C1776","","6088-0525-300R  -  STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0525-350L","SUP","HCPCS C1776","","6088-0525-350L  -  TRIAL SURG 350MM 10.9MM OMFT LNG LEFT STM CMNT IMPL 25MM","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-0525-350R","SUP","HCPCS C1776","","6088-0525-350R  -  STEM FEM 350MM 10.9MM CMNT OMFT 5 LNG 25MM RIGHT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-0730-200L","SUP","HCPCS C1776","","6088-0730-200L  -  STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0730-200R","SUP","HCPCS C1776","","6088-0730-200R  -  STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0730-250L","SUP","HCPCS C1776","","6088-0730-250L  -  STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0730-250R","SUP","HCPCS C1776","","6088-0730-250R  -  STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0730-300L","SUP","HCPCS C1776","","6088-0730-300L  -  STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0730-300R","SUP","HCPCS C1776","","6088-0730-300R  -  STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0730-350L","SUP","HCPCS C1776","","6088-0730-350L  -  STEM FEM 350MM 12.4MM CMNT OMFT 7 LNG 30MM LEFT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-0730-350R","SUP","HCPCS C1776","","6088-0730-350R  -  STEM FEM 350MM 12.4MM CMNT OMFT LNG 30MM HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-0935-200L","SUP","HCPCS C1776","","6088-0935-200L  -  STEM FEMORAL 9 LONG 14MM 200MM 35MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0935-200R","SUP","HCPCS C1776","","6088-0935-200R  -  STEM FEM 200MM 14MM REV CMNT NECK TRL OMFT 9 LNG 35MM HIP","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0935-250L","SUP","HCPCS C1776","","6088-0935-250L  -  STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT LEFT HIP","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0935-250R","SUP","HCPCS C1776","","6088-0935-250R  -  STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT HIP RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0935-300L","SUP","HCPCS C1776","","6088-0935-300L  -  STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT LEFT HIP","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0935-300R","SUP","HCPCS C1776","","6088-0935-300R  -  STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-0935-350L","SUP","HCPCS C1776","","6088-0935-350L  -  STEM FEM 350MM 14MM CMNT OMFT 9 LNG 35MM LEFT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-0935-350R","SUP","HCPCS C1776","","6088-0935-350R  -  STEM FEM 350MM 14MM CMNT OMFT 9 LNG 35MM RIGHT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-1140-200L","SUP","HCPCS C1776","","6088-1140-200L  -  STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-1140-200R","SUP","HCPCS C1776","","6088-1140-200R  -  STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-1140-250L","SUP","HCPCS C1776","","6088-1140-250L  -  STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-1140-250R","SUP","HCPCS C1776","","6088-1140-250R  -  STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-1140-300L","SUP","HCPCS C1776","","6088-1140-300L  -  STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT LEFT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-1140-300R","SUP","HCPCS C1776","","6088-1140-300R  -  STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT RIGHT","BOTH IP/OP","$11,872.50 ","$8,785.65 ","$0.00 ","$11,872.50 ","$5,342.63 ","$0.00 ","$2,474.53 ","$0.00 ","$0.00 ","$2,078.78 ","$11,872.50 ","$0.00 ","$5,936.25 ","$9,403.02 ","$9,498.00 ","$0.00 ","$1,858.05 ","$0.00 ","$1,890.10 ","$0.00 "
"6088-1140-350L","SUP","HCPCS C1776","","6088-1140-350L  -  STEM FEM 350MM CMNT OMFT 11 LNG 40MM HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"6088-1140-350R","SUP","HCPCS C1776","","6088-1140-350R  -  STEM FEM 350MM 15.5MM CMNT OMFT 11 LNG 40MM RIGHT HIP","BOTH IP/OP","$10,099.38 ","$7,473.54 ","$0.00 ","$10,099.38 ","$4,544.72 ","$0.00 ","$2,104.96 ","$0.00 ","$0.00 ","$1,768.32 ","$10,099.38 ","$0.00 ","$5,049.69 ","$7,998.71 ","$8,079.50 ","$0.00 ","$1,580.55 ","$0.00 ","$1,607.82 ","$0.00 "
"60-94120","SUP","HCPCS C1713","","60-94120  -  COUNTERSINK DRILL BICONCAVE WASHER","BOTH IP/OP","$435.68 ","$322.40 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$90.81 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"6097-0425","SUP","HCPCS C1776","","6097-0425  -  STEM FEMORAL 127D 4 33MM OFFST 8.1MM 100MM 25MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-0530","SUP","HCPCS C1776","","6097-0530  -  STEM FEMORAL 127D 5 39MM OFFST 8.9MM 110MM 30MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-0630","SUP","HCPCS C1776","","6097-0630  -  STEM FEMORAL 127D 6 40MM OFFST 9.6MM 120MM 30MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-0735","SUP","HCPCS C1776","","6097-0735  -  STEM FEMORAL 127D 7 45MM OFFST 10.4MM 130MM 35MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-0835","SUP","HCPCS C1776","","6097-0835  -  STEM FEMORAL 127D 8 46MM OFFST 11.3MM 135MM 35MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-0940","SUP","HCPCS C1776","","6097-0940  -  STEM FEMORAL 127D 9 51MM OFFST 12.6MM 140MM 40MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-1040","SUP","HCPCS C1776","","6097-1040  -  STEM FEMORAL 127D 10 52MM OFFST 13.8MM 145MM 40MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6097-1140","SUP","HCPCS C1776","","6097-1140  -  STEM FEMORAL 127D 11 53MM OFFST 14.8MM 150MM 40MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-0425","SUP","HCPCS C1776","","6098-0425  -  STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-0530","SUP","HCPCS C1776","","6098-0530  -  STEM FEMORAL 132D 5 35MM OFFST 8.9MM 110MM 30MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-0630","SUP","HCPCS C1776","","6098-0630  -  STEM FEMORAL 132D 6 36MM OFFST 9.6MM 120MM 30MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-0735","SUP","HCPCS C1776","","6098-0735  -  STEM FEMORAL 132D 7 41MM OFFST 10.4MM 130MM 35MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-0835","SUP","HCPCS C1776","","6098-0835  -  STEM FEMORAL 132D 8 42MM OFFST 11.3MM 135MM 35MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-0940","SUP","HCPCS C1776","","6098-0940  -  STEM FEMORAL 132D 9 46MM OFFST 12.6MM 140MM 40MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-1040","SUP","HCPCS C1776","","6098-1040  -  STEM FEMORAL 132D 10 47MM OFFST 13.8MM 145MM 40MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"6098-1140","SUP","HCPCS C1776","","6098-1140  -  STEM FEMORAL 132D 11 48MM OFFST 14.8MM 150MM 40MM CEMENTED","BOTH IP/OP","$4,317.50 ","$3,194.95 ","$0.00 ","$4,317.50 ","$1,942.88 ","$0.00 ","$899.87 ","$0.00 ","$0.00 ","$755.96 ","$4,317.50 ","$0.00 ","$2,158.75 ","$3,419.46 ","$3,454.00 ","$0.00 ","$675.69 ","$0.00 ","$687.35 ","$0.00 "
"60XLTCD","SUP","Custom 27203010","","60XLTCD  -  TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUF","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60XLTCP","SUP","HCPCS A7520","","60XLTCP  -  TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT CUF","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60XLTUD","SUP","Custom 27203010","","60XLTUD  -  TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUFLS","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"60XLTUP","SUP","Custom 27203010","","60XLTUP  -  TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61.231.017","SUP","HCPCS C1713","","61.231.017  -  GRAPHIC CASE FOR 4.5MM VA-LCP INSTRUMENT AND SCREW SET","BOTH IP/OP","$4,703.45 ","$3,480.55 ","$0.00 ","$4,566.45 ","$2,054.90 ","$0.00 ","$980.32 ","$0.00 ","$0.00 ","$799.55 ","$4,566.45 ","$0.00 ","$2,283.23 ","$3,616.63 ","$3,653.16 ","$0.00 ","$693.83 ","$0.00 ","$726.98 ","$0.00 "
"611.105.01S","SUP","Custom 27803010","","611.105.01S  -  CABLE ORTHOPEDIC 1.7MM 750MM TITANIUM CRIMP CERCLAGE COCR","BOTH IP/OP","$920.73 ","$681.34 ","$0.00 ","$893.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$893.90 ","$0.00 ","$446.95 ","$707.97 ","$715.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61114V","SUP","Custom 27203010","","61114V  -  CLIP INTNL LG SMTR VESOLOCK","BOTH IP/OP","$62.41 ","$46.18 ","$0.00 ","$62.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.41 ","$0.00 ","$31.20 ","$49.43 ","$49.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6-1221","SUP","Custom 27803010","","6-1221  -  CAGE SPNL 12MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2244","SUP","Custom 27803010","","61-2244  -  CUP ACETAB 44MM 22MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2248","SUP","Custom 27803010","","61-2248  -  CUP ACETAB 48MM 22MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2252","SUP","Custom 27803010","","61-2252  -  CUP ACETAB 52MM 22MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2256","SUP","Custom 27803010","","61-2256  -  CUP ACETAB 56MM 22MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6-1226","SUP","Custom 27803010","","6-1226  -  CAGE SPNL 12MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2261","SUP","Custom 27803010","","61-2261  -  CUP ACETAB 61MM 22MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2644","SUP","Custom 27803010","","61-2644  -  CUP ACETAB 44MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2646","SUP","Custom 27803010","","61-2646  -  CUP ACETAB 46MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2648","SUP","Custom 27803010","","61-2648  -  CUP ACETAB 48MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2652","SUP","Custom 27803010","","61-2652  -  CUP ACETAB 52MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2656","SUP","Custom 27803010","","61-2656  -  CUP ACETAB 56MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2658","SUP","Custom 27803010","","61-2658  -  CUP ACETAB 58MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2661","SUP","Custom 27803010","","61-2661  -  CUP ACETAB 61MM 26MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2844","SUP","Custom 27803010","","61-2844  -  CUP ACETAB 44MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2846","SUP","Custom 27803010","","61-2846  -  CUP ACETAB 46MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2848","SUP","Custom 27803010","","61-2848  -  CUP ACETAB 48MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2850","SUP","Custom 27803010","","61-2850  -  CUP ACETAB 50MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2852","SUP","Custom 27803010","","61-2852  -  CUP ACETAB 52MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2854","SUP","Custom 27803010","","61-2854  -  CUP ACETAB 54MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2856","SUP","Custom 27803010","","61-2856  -  CUP ACETAB 56MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2858","SUP","Custom 27803010","","61-2858  -  CUP ACETAB 58MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-2861","SUP","Custom 27803010","","61-2861  -  CUP ACETAB 61MM 28MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"613.03.01S","SUP","HCPCS C1713","","613.03.01S  -  CEMENT BONE NRN CRS FST ST 3ML PTTY STRL","BOTH IP/OP","$2,151.00 ","$1,591.74 ","$0.00 ","$2,151.00 ","$967.95 ","$0.00 ","$448.32 ","$0.00 ","$0.00 ","$376.62 ","$2,151.00 ","$0.00 ","$1,075.50 ","$1,703.59 ","$1,720.80 ","$0.00 ","$336.63 ","$0.00 ","$342.44 ","$0.00 "
"613.05.01S","SUP","HCPCS C1713","","613.05.01S  -  CEMENT BONE NRN CRS FST ST 5ML PTTY STRL","BOTH IP/OP","$3,532.50 ","$2,614.05 ","$0.00 ","$3,532.50 ","$1,589.63 ","$0.00 ","$736.26 ","$0.00 ","$0.00 ","$618.51 ","$3,532.50 ","$0.00 ","$1,766.25 ","$2,797.74 ","$2,826.00 ","$0.00 ","$552.84 ","$0.00 ","$562.37 ","$0.00 "
"613.10.01S","SUP","HCPCS C1713","","613.10.01S  -  CEMENT BONE NRN CRS FST ST 10ML PTTY STRL","BOTH IP/OP","$6,945.75 ","$5,139.86 ","$0.00 ","$6,945.75 ","$3,125.59 ","$0.00 ","$1,447.67 ","$0.00 ","$0.00 ","$1,216.15 ","$6,945.75 ","$0.00 ","$3,472.88 ","$5,501.03 ","$5,556.60 ","$0.00 ","$1,087.01 ","$0.00 ","$1,105.76 ","$0.00 "
"613.15.01S","SUP","HCPCS C1713","","613.15.01S  -  CEMENT BONE NRN CRS FST ST 15ML PTTY STRL","BOTH IP/OP","$10,194.75 ","$7,544.12 ","$0.00 ","$10,194.75 ","$4,587.64 ","$0.00 ","$2,124.84 ","$0.00 ","$0.00 ","$1,785.02 ","$10,194.75 ","$0.00 ","$5,097.38 ","$8,074.24 ","$8,155.80 ","$0.00 ","$1,595.48 ","$0.00 ","$1,623.00 ","$0.00 "
"61-3248","SUP","Custom 27803010","","61-3248  -  CUP ACETAB 48MM 32MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-3252","SUP","Custom 27803010","","61-3252  -  CUP ACETAB 52MM 32MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-3254","SUP","Custom 27803010","","61-3254  -  CUP ACETAB 54MM 32MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-3256","SUP","Custom 27803010","","61-3256  -  CUP ACETAB 56MM 32MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-3258","SUP","Custom 27803010","","61-3258  -  CUP ACETAB 58MM 32MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61-3261","SUP","Custom 27803010","","61-3261  -  CUP ACETAB 61MM 32MM CEMENTED UHMWPE HIP","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"614.03.01S","SUP","HCPCS C1713","","614.03.01S  -  CEMENT BONE NRN CRS 3ML ROTATORY MX STRL","BOTH IP/OP","$2,151.00 ","$1,591.74 ","$0.00 ","$2,151.00 ","$967.95 ","$0.00 ","$448.32 ","$0.00 ","$0.00 ","$376.62 ","$2,151.00 ","$0.00 ","$1,075.50 ","$1,703.59 ","$1,720.80 ","$0.00 ","$336.63 ","$0.00 ","$342.44 ","$0.00 "
"614.05.01S","SUP","HCPCS C1713","","614.05.01S  -  CEMENT BONE NRN CRS 5ML ROTATORY MX STRL","BOTH IP/OP","$3,532.50 ","$2,614.05 ","$0.00 ","$3,532.50 ","$1,589.63 ","$0.00 ","$736.26 ","$0.00 ","$0.00 ","$618.51 ","$3,532.50 ","$0.00 ","$1,766.25 ","$2,797.74 ","$2,826.00 ","$0.00 ","$552.84 ","$0.00 ","$562.37 ","$0.00 "
"614.10.01S","SUP","HCPCS C1713","","614.10.01S  -  CEMENT BONE NRN CRS 10ML ROTATORY MX STRL","BOTH IP/OP","$6,945.75 ","$5,139.86 ","$0.00 ","$6,945.75 ","$3,125.59 ","$0.00 ","$1,447.67 ","$0.00 ","$0.00 ","$1,216.15 ","$6,945.75 ","$0.00 ","$3,472.88 ","$5,501.03 ","$5,556.60 ","$0.00 ","$1,087.01 ","$0.00 ","$1,105.76 ","$0.00 "
"6-1426","SUP","Custom 27803010","","6-1426  -  CAGE SPNL 14MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"615-02","SUP","Custom 27203010","","615-02  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$267.75 ","$198.14 ","$0.00 ","$267.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6154-50-32","SUP","HCPCS C1776","","6154-50-32  -  LINER ACETAB TRLG STD 6.3MM 50/52/54MM 32MM TIV","BOTH IP/OP","$7,425.00 ","$5,494.50 ","$0.00 ","$7,425.00 ","$3,341.25 ","$0.00 ","$1,547.56 ","$0.00 ","$0.00 ","$1,300.06 ","$7,425.00 ","$0.00 ","$3,712.50 ","$5,880.60 ","$5,940.00 ","$0.00 ","$1,162.01 ","$0.00 ","$1,182.06 ","$0.00 "
"6-1626","SUP","Custom 27803010","","6-1626  -  CAGE SPNL 16MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"617-01","SUP","Custom 25003010","","ANTIBODY CLONE OC 125 LAB","BOTH IP/OP","$1,207.50 ","$893.55 ","$0.00 ","$1,207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,207.50 ","$0.00 ","$603.75 ","$956.34 ","$966.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"617-03","SUP","Custom 27203010","","617-03  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$274.13 ","$202.86 ","$0.00 ","$274.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$274.13 ","$0.00 ","$137.06 ","$217.11 ","$219.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"617-12","SUP","Custom 27203010","","617-12  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$267.75 ","$198.14 ","$0.00 ","$267.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.75 ","$0.00 ","$133.88 ","$212.06 ","$214.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6-1821","SUP","Custom 27803010","","6-1821  -  CAGE SPNL 18MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6-1826","SUP","Custom 27803010","","6-1826  -  CAGE SPNL 18MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF","BOTH IP/OP","$8,031.25 ","$5,943.13 ","$0.00 ","$8,031.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,031.25 ","$0.00 ","$4,015.63 ","$6,360.75 ","$6,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183-2-006","SUP","HCPCS C1762","","6183-2-006  -  SPACER ALGRF 6MM ALLOCRAFT C DBM ACDF","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-2-007","SUP","HCPCS C1762","","6183-2-007  -  SPACER ALGRF 7MM ALLOCRAFT C DBM ACDF","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-2-008","SUP","Custom 27803010","","6183-2-008  -  SPACER ALGRF 8MM ALLOCRAFT C DBM ACDF","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183-3-006","SUP","HCPCS C1762","","6183-3-006  -  GRAFT BONE ALLOCRAFT CERV 6MM","BOTH IP/OP","$2,625.68 ","$1,943.00 ","$0.00 ","$2,625.68 ","$0.00 ","$0.00 ","$547.26 ","$0.00 ","$0.00 ","$0.00 ","$2,625.68 ","$0.00 ","$1,312.84 ","$2,079.54 ","$2,100.54 ","$0.00 ","$410.92 ","$0.00 ","$0.00 ","$0.00 "
"6183-3-007","SUP","HCPCS C1762","","6183-3-007  -  GRAFT BONE ALLOCRAFT CERV 7MM","BOTH IP/OP","$2,625.68 ","$1,943.00 ","$0.00 ","$2,625.68 ","$0.00 ","$0.00 ","$547.26 ","$0.00 ","$0.00 ","$0.00 ","$2,625.68 ","$0.00 ","$1,312.84 ","$2,079.54 ","$2,100.54 ","$0.00 ","$410.92 ","$0.00 ","$0.00 ","$0.00 "
"6183-3-008","SUP","HCPCS C1762","","6183-3-008  -  RNGR SURG 8MM CERV BONE","BOTH IP/OP","$2,625.68 ","$1,943.00 ","$0.00 ","$2,625.68 ","$0.00 ","$0.00 ","$547.26 ","$0.00 ","$0.00 ","$0.00 ","$2,625.68 ","$0.00 ","$1,312.84 ","$2,079.54 ","$2,100.54 ","$0.00 ","$410.92 ","$0.00 ","$0.00 ","$0.00 "
"6183-3-010","SUP","HCPCS C1762","","6183-3-010  -  GRAFT BONE ALLOCRAFT DBM SPCR ANT CERV INTRBD FS C-RING 10MM","BOTH IP/OP","$2,625.68 ","$1,943.00 ","$0.00 ","$2,625.68 ","$0.00 ","$0.00 ","$547.26 ","$0.00 ","$0.00 ","$0.00 ","$2,625.68 ","$0.00 ","$1,312.84 ","$2,079.54 ","$2,100.54 ","$0.00 ","$410.92 ","$0.00 ","$0.00 ","$0.00 "
"6183-4-006","SUP","HCPCS C1762","","6183-4-006  -  GRAFT BONE ALLOCRAFT CERV 6MM","BOTH IP/OP","$3,534.58 ","$2,615.59 ","$0.00 ","$3,534.58 ","$0.00 ","$0.00 ","$736.69 ","$0.00 ","$0.00 ","$0.00 ","$3,534.58 ","$0.00 ","$1,767.29 ","$2,799.39 ","$2,827.66 ","$0.00 ","$553.16 ","$0.00 ","$0.00 ","$0.00 "
"6183-4-007","SUP","HCPCS C1762","","6183-4-007  -  GRAFT BONE ALLOCRAFT CERV 7MM","BOTH IP/OP","$3,534.58 ","$2,615.59 ","$0.00 ","$3,534.58 ","$0.00 ","$0.00 ","$736.69 ","$0.00 ","$0.00 ","$0.00 ","$3,534.58 ","$0.00 ","$1,767.29 ","$2,799.39 ","$2,827.66 ","$0.00 ","$553.16 ","$0.00 ","$0.00 ","$0.00 "
"6183-5-005","SUP","HCPCS C1762","","6183-5-005  -  GRAFT BONE 5MM LORDOTIC CERV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-5-006","SUP","HCPCS C1762","","6183-5-006  -  SPACER ALLOGRAFT 6MM ANTERIOR CERV INTERBODY FUSION LORDOTIC","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-5-007","SUP","Custom 27803010","","6183-5-007  -  SPACER ALLOGRAFT 7MM ANTERIOR CERV INTERBODY FUSION LORDOTIC","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183-5-008","SUP","Custom 27803010","","6183-5-008  -  SPACER ALGRF 8MM ALLOCRAFT CL DBM ACDF","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6183-5-009","SUP","HCPCS C1762","","6183-5-009  -  SPACER ALLOGRAFT 9MM ANTERIOR CERV INTERBODY FUSION LORDOTIC","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-6-007","SUP","HCPCS C1762","","6183-6-007  -  GRAFT BONE 7MM CERV SPN","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-7-005","SUP","HCPCS C1762","","6183-7-005  -  GRAFT BONE 14X11X5MM LORDOTIC CANCELLOUS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-7-006","SUP","HCPCS C1762","","6183-7-006  -  GRAFT BONE LORDOTIC 14X11X6MM ALLOCRAFT CANCELLOUS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-7-007","SUP","HCPCS C1762","","6183-7-007  -  GRAFT BONE LORDOTIC 14X11X7MM ALLOGRAFT ALLOCRAFT CANCELLOUS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-7-008","SUP","HCPCS C1762","","6183-7-008  -  GRAFT BONE 14X11X8MM LORDOTIC ALLOGRAFT CANCELLOUS CERV","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-7-009","SUP","HCPCS C1762","","6183-7-009  -  GRAFT BONE 14X11X9MM LORDOTIC CANCELLOUS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6183-7-010","SUP","HCPCS C1762","","6183-7-010  -  GRAFT BONE 14X11X10MM LORDOTIC CANCELLOUS","BOTH IP/OP","$6,675.00 ","$4,939.50 ","$0.00 ","$6,675.00 ","$0.00 ","$0.00 ","$1,391.24 ","$0.00 ","$0.00 ","$0.00 ","$6,675.00 ","$0.00 ","$3,337.50 ","$5,286.60 ","$5,340.00 ","$0.00 ","$1,044.64 ","$0.00 ","$0.00 ","$0.00 "
"6184-0-025","SUP","HCPCS C1713","","6184-0-025  -  CEMENT BONE BNSRC CALCIUM PHOS HYDRXAPT 2.5GM PST","BOTH IP/OP","$1,078.80 ","$798.31 ","$0.00 ","$1,078.80 ","$485.46 ","$0.00 ","$224.85 ","$0.00 ","$0.00 ","$188.89 ","$1,078.80 ","$0.00 ","$539.40 ","$854.41 ","$863.04 ","$0.00 ","$168.83 ","$0.00 ","$171.74 ","$0.00 "
"6184-0-050","SUP","HCPCS C1713","","6184-0-050  -  CEMENT BONE BNSRC CALCIUM PHOS HYDRXAPT 5GM PST","BOTH IP/OP","$1,815.83 ","$1,343.71 ","$0.00 ","$1,815.83 ","$817.12 ","$0.00 ","$378.46 ","$0.00 ","$0.00 ","$317.94 ","$1,815.83 ","$0.00 ","$907.91 ","$1,438.14 ","$1,452.66 ","$0.00 ","$284.18 ","$0.00 ","$289.08 ","$0.00 "
"6184-0-100","SUP","HCPCS C1713","","6184-0-100  -  CEMENT BONE BNSRC HYDRXAPT 10GM PST FILR STRL","BOTH IP/OP","$3,554.93 ","$2,630.65 ","$0.00 ","$3,554.93 ","$1,599.72 ","$0.00 ","$740.94 ","$0.00 ","$0.00 ","$622.44 ","$3,554.93 ","$0.00 ","$1,777.46 ","$2,815.50 ","$2,843.94 ","$0.00 ","$556.35 ","$0.00 ","$565.94 ","$0.00 "
"6184-0-250","SUP","HCPCS C1713","","6184-0-250  -  CEMENT BONE BNSRC HYDRXAPT 25GM PST FILR STRL","BOTH IP/OP","$7,616.70 ","$5,636.36 ","$0.00 ","$7,616.70 ","$3,427.52 ","$0.00 ","$1,587.51 ","$0.00 ","$0.00 ","$1,333.62 ","$7,616.70 ","$0.00 ","$3,808.35 ","$6,032.43 ","$6,093.36 ","$0.00 ","$1,192.01 ","$0.00 ","$1,212.58 ","$0.00 "
"6184-0-500","SUP","HCPCS C1713","","6184-0-500  -  CEMENT BONE BNSRC 50GM PST STRL","BOTH IP/OP","$12,682.88 ","$9,385.33 ","$0.00 ","$12,682.88 ","$5,707.29 ","$0.00 ","$2,643.43 ","$0.00 ","$0.00 ","$2,220.67 ","$12,682.88 ","$0.00 ","$6,341.44 ","$10,044.84 ","$10,146.30 ","$0.00 ","$1,984.87 ","$0.00 ","$2,019.11 ","$0.00 "
"6184-1-003","SUP","HCPCS C1713","","6184-1-003  -  CEMENT BONE BCMPT INJ OSTCNDC HYDROSET BONE SUB VOID FILR","BOTH IP/OP","$2,362.20 ","$1,748.03 ","$0.00 ","$2,362.20 ","$1,062.99 ","$0.00 ","$492.34 ","$0.00 ","$0.00 ","$413.60 ","$2,362.20 ","$0.00 ","$1,181.10 ","$1,870.86 ","$1,889.76 ","$0.00 ","$369.68 ","$0.00 ","$376.06 ","$0.00 "
"6184-1-005","SUP","HCPCS C1713","","6184-1-005  -  CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 5ML ORTH","BOTH IP/OP","$3,785.10 ","$2,800.97 ","$0.00 ","$3,785.10 ","$1,703.30 ","$0.00 ","$788.91 ","$0.00 ","$0.00 ","$662.74 ","$3,785.10 ","$0.00 ","$1,892.55 ","$2,997.80 ","$3,028.08 ","$0.00 ","$592.37 ","$0.00 ","$602.59 ","$0.00 "
"6184-1-010","SUP","HCPCS C1713","","6184-1-010  -  CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 10ML INJ","BOTH IP/OP","$7,286.55 ","$5,392.05 ","$0.00 ","$7,286.55 ","$3,278.95 ","$0.00 ","$1,518.70 ","$0.00 ","$0.00 ","$1,275.82 ","$7,286.55 ","$0.00 ","$3,643.28 ","$5,770.95 ","$5,829.24 ","$0.00 ","$1,140.35 ","$0.00 ","$1,160.02 ","$0.00 "
"6184-1-015","SUP","HCPCS C1713","","6184-1-015  -  CEMENT BONE INJ BCMPT STRL HYDROSET BONE SUB VOID FILR","BOTH IP/OP","$10,460.18 ","$7,740.53 ","$0.00 ","$10,460.18 ","$4,707.08 ","$0.00 ","$2,180.16 ","$0.00 ","$0.00 ","$1,831.49 ","$10,460.18 ","$0.00 ","$5,230.09 ","$8,284.46 ","$8,368.14 ","$0.00 ","$1,637.02 ","$0.00 ","$1,665.26 ","$0.00 "
"6184-5-100","SUP","HCPCS C1762","","6184-5-100  -  BONE STACK 5MM X 100 PELLETS","BOTH IP/OP","$1,274.10 ","$942.83 ","$0.00 ","$1,274.10 ","$0.00 ","$0.00 ","$265.55 ","$0.00 ","$0.00 ","$0.00 ","$1,274.10 ","$0.00 ","$637.05 ","$1,009.09 ","$1,019.28 ","$0.00 ","$199.40 ","$0.00 ","$0.00 ","$0.00 "
"6184-5-300","SUP","HCPCS C1762","","6184-5-300  -  BONE STACK 5MM X 300 PELLETS","BOTH IP/OP","$2,262.23 ","$1,674.05 ","$0.00 ","$2,262.23 ","$0.00 ","$0.00 ","$471.50 ","$0.00 ","$0.00 ","$0.00 ","$2,262.23 ","$0.00 ","$1,131.11 ","$1,791.69 ","$1,809.78 ","$0.00 ","$354.04 ","$0.00 ","$0.00 ","$0.00 "
"6184-9-220","SUP","HCPCS C1713","","6184-9-220  -  CEMENT BONE BONESAVE 4-6MM TCP HYDRXAPT 20ML GRNL","BOTH IP/OP","$3,073.65 ","$2,274.50 ","$0.00 ","$3,073.65 ","$1,383.14 ","$0.00 ","$640.63 ","$0.00 ","$0.00 ","$538.17 ","$3,073.65 ","$0.00 ","$1,536.83 ","$2,434.33 ","$2,458.92 ","$0.00 ","$481.03 ","$0.00 ","$489.33 ","$0.00 "
"6188-1-001","SUP","HCPCS C1713","","6188-1-001  -  CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$58.50 ","$0.00 ","$27.10 ","$0.00 ","$0.00 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"6188-1-010","SUP","HCPCS C1713","","6188-1-010  -  CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P STERILE","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$58.50 ","$0.00 ","$27.10 ","$0.00 ","$0.00 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"6191-1-001","SUP","HCPCS C1713","","6191-1-001  -  CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$76.50 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"6191-1-010","SUP","HCPCS C1713","","6191-1-010  -  CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P STERILE","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$76.50 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"6192-1-001","SUP","HCPCS C1713","","6192-1-001  -  CEMENT BONE FULL DOSE INDIVIDUAL SIMPLEX P SPEEDSET","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$76.50 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"6192-1-010","SUP","HCPCS C1713","","6192-1-010  -  CEMENT BONE SMPX P SPEEDSET FD FST SET STRL","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$76.50 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"6194-1-001","SUP","HCPCS C1713","","6194-1-001  -  CEMENT BN SMPX HVISC","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$76.50 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"6194-1-010","SUP","HCPCS C1713","","6194-1-010  -  CEMENT BN 20ML STRL SMPX HVISC 40GM","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$76.50 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"6195-1-001","SUP","HCPCS C1713","","6195-1-001  -  CEMENT BN SMPX HVISC GNTA 40GM","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$208.13 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"6195-1-010","SUP","HCPCS C1713","","6195-1-010  -  CEMENT BN 20ML STRL SMPX HVISC GNTA 40GM","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$208.13 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"6197-9-001","SUP","HCPCS C1713","","6197-9-001  -  CEMENT BONE SMPX P RADIOPQ FD TBR STRL","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$810.88 ","$364.89 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$141.98 ","$810.88 ","$0.00 ","$405.44 ","$642.22 ","$648.70 ","$0.00 ","$126.90 ","$0.00 ","$129.09 ","$0.00 "
"6197-9-010","SUP","HCPCS C1713","","6197-9-010  -  CEMENT BONE FULL DOSE RADIOPQ PREBLEND SIMPLEX P TOBRAMYCIN","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"61C-2242","SUP","Custom 27803010","","61C-2242  -  CUP ACETAB UHMWPE XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2244","SUP","Custom 27803010","","61C-2244  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2246","SUP","Custom 27803010","","61C-2246  -  CUP ACETAB UHMWPE XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2248","SUP","Custom 27803010","","61C-2248  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2250","SUP","Custom 27803010","","61C-2250  -  CUP ACETAB UHMWPE XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2252","SUP","Custom 27803010","","61C-2252  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2254","SUP","Custom 27803010","","61C-2254  -  CUP ACETAB UHMWPE XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2256","SUP","Custom 27803010","","61C-2256  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2258","SUP","Custom 27803010","","61C-2258  -  CUP ACETAB UHMWPE XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2261","SUP","Custom 27803010","","61C-2261  -  CUP ACETAB UHMWPE XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2642","SUP","Custom 27803010","","61C-2642  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2644","SUP","Custom 27803010","","61C-2644  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2646","SUP","Custom 27803010","","61C-2646  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2648","SUP","Custom 27803010","","61C-2648  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2650","SUP","Custom 27803010","","61C-2650  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2652","SUP","Custom 27803010","","61C-2652  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2654","SUP","Custom 27803010","","61C-2654  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2656","SUP","Custom 27803010","","61C-2656  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2658","SUP","Custom 27803010","","61C-2658  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2661","SUP","Custom 27803010","","61C-2661  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2844","SUP","Custom 27803010","","61C-2844  -  CUP ACETAB LOW HIP UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2846","SUP","Custom 27803010","","61C-2846  -  CUP ACETAB UHMWPE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2848","SUP","Custom 27803010","","61C-2848  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2850","SUP","Custom 27803010","","61C-2850  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2852","SUP","Custom 27803010","","61C-2852  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2854","SUP","Custom 27803010","","61C-2854  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2856","SUP","Custom 27803010","","61C-2856  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2858","SUP","Custom 27803010","","61C-2858  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C-2861","SUP","Custom 27803010","","61C-2861  -  CUP ACETAB ALPLY XFIRE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"61C3","SUP","Custom 27203010","","CONTROL SPHL RPR IMP RPR 1ML SERO","BOTH IP/OP","$51.20 ","$37.89 ","$0.00 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.20 ","$0.00 ","$25.60 ","$40.55 ","$40.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28D","SUP","Custom 27803010","","620-00-28D  -  INSERT ACETAB 28MM 0D D HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28E","SUP","Custom 27803010","","620-00-28E  -  INSERT ACETAB 28MM 0D E HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28F","SUP","Custom 27803010","","620-00-28F  -  INSERT ACETAB 28MM 0D F HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28G","SUP","Custom 27803010","","620-00-28G  -  INSERT ACETAB 28MM 0D G HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28H","SUP","Custom 27803010","","620-00-28H  -  INSERT ACETAB 28MM 0D H HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28I","SUP","Custom 27803010","","620-00-28I  -  INSERT ACETAB 28MM 0D 1 HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-00-28J","SUP","Custom 27803010","","620-00-28J  -  INSERT ACETAB 28MM 0D J HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-005","SUP","HCPCS C1713","","620-005  -  CEMENT BN 5ML STIMULAN RPD CURE KT","BOTH IP/OP","$2,425.00 ","$1,794.50 ","$0.00 ","$2,425.00 ","$1,091.25 ","$0.00 ","$505.43 ","$0.00 ","$0.00 ","$424.60 ","$2,425.00 ","$0.00 ","$1,212.50 ","$1,920.60 ","$1,940.00 ","$0.00 ","$379.51 ","$0.00 ","$386.06 ","$0.00 "
"620-010","SUP","HCPCS C9359","","620-010  -  FILLER BN VOID CA SLF","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00146","SUP","Custom 27100030","","62-00146  -  GUIDE DRILL 1.6MM LAG PILOT","BOTH IP/OP","$914.20 ","$676.51 ","$0.00 ","$1,822.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,822.50 ","$0.00 ","$911.25 ","$1,443.42 ","$1,458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00148","SUP","Custom 27100030","","62-00148  -  GUIDE DRILL 2MM LAG OVERDRILL","BOTH IP/OP","$998.50 ","$738.89 ","$0.00 ","$1,847.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,847.50 ","$0.00 ","$923.75 ","$1,463.22 ","$1,478.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-020","SUP","HCPCS C1713","","620-020  -  CEMENT BONE STIMULAN RPD CURE CALCIUM SLF 20ML KIT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"62-00231","SUP","Custom 27203010","","62-00231  -  GUIDE DRILL XS SRR CENTRIC","BOTH IP/OP","$163.63 ","$121.09 ","$0.00 ","$163.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00233","SUP","Custom 27203010","","62-00233  -  GUIDE DRILL SM SRR CENTRIC LEIBINGER","BOTH IP/OP","$163.63 ","$121.09 ","$0.00 ","$163.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00235","SUP","Custom 27203010","","62-00235  -  GUIDE MED LG DRILL SRR CENTRIC SURG","BOTH IP/OP","$163.63 ","$121.09 ","$0.00 ","$163.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00237","SUP","Custom 27203010","","62-00237  -  GUIDE MED DRILL ECNTRC SURG","BOTH IP/OP","$138.88 ","$102.77 ","$0.00 ","$138.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.88 ","$0.00 ","$69.44 ","$109.99 ","$111.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00239","SUP","Custom 27203010","","62-00239  -  GUIDE LG DRILL ECNTRC SURG","BOTH IP/OP","$138.88 ","$102.77 ","$0.00 ","$138.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.88 ","$0.00 ","$69.44 ","$109.99 ","$111.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00241","SUP","Custom 27203010","","62-00241  -  GUIDE DRILL 2.7MM ECNTRC","BOTH IP/OP","$82.50 ","$61.05 ","$0.00 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.50 ","$0.00 ","$41.25 ","$65.34 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00249","SUP","Custom 27203010","","62-00249  -  GUIDE DRILL 2.7MM SRR CENTRIC","BOTH IP/OP","$204.88 ","$151.61 ","$0.00 ","$204.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$204.88 ","$0.00 ","$102.44 ","$162.26 ","$163.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00254","SUP","Custom 27203010","","62-00254  -  GUIDE DRILL HNDL CENTRIC SURG","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00270","SUP","Custom 27203010","","62-00270  -  GUIDE DRILL REDX","BOTH IP/OP","$171.88 ","$127.19 ","$0.00 ","$171.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.88 ","$0.00 ","$85.94 ","$136.13 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-00605","SUP","Custom 27803010","","62-00605  -  SPACER SPNL HBRD MMF","BOTH IP/OP","$930.00 ","$688.20 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-10-28D","SUP","Custom 27803010","","620-10-28D  -  INSERT ACETAB 28MM 10D D HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-10-28E","SUP","Custom 27803010","","620-10-28E  -  INSERT ACETAB 28MM 10D E HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-10-28F","SUP","Custom 27803010","","620-10-28F  -  INSERT ACETAB 28MM 10D F HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-10-28G","SUP","Custom 27803010","","620-10-28G  -  INSERT ACETAB 10D HIP DUR S12","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-10-28H","SUP","Custom 27803010","","620-10-28H  -  INSERT ACETAB 28MM 10D H HIP PE TRDNT","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"620-10-28I","SUP","Custom 27803010","","620-10-28I  -  INSERT ACETAB 10D HIP CNSTRN ECNTRC POLY XFIRE OMFT S12","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-01245","SUP","Custom 27203010","","62-01245  -  GUIDE DRILL FEM 2.3 MM SCR","BOTH IP/OP","$534.88 ","$395.81 ","$0.00 ","$534.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$534.88 ","$0.00 ","$267.44 ","$423.62 ","$427.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-01246","SUP","Custom 27203010","","62-01246  -  GUIDE DRILL FEM 2.7 MM SCR","BOTH IP/OP","$534.88 ","$395.81 ","$0.00 ","$534.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$534.88 ","$0.00 ","$267.44 ","$423.62 ","$427.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-01250","SUP","Custom 27203010","","62-01250  -  GUIDE CENTRIC DRILL HNDL SURG","BOTH IP/OP","$484.00 ","$358.16 ","$0.00 ","$484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$484.00 ","$0.00 ","$242.00 ","$383.33 ","$387.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6201FAS","SUP","HCPCS C1760","","6201FAS  -  TOOL LEAD DELIVERY 15MM 22CM FLEXIBLE FASTAC","BOTH IP/OP","$935.00 ","$691.90 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$194.88 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6208-3-010","SUP","HCPCS C1713","","6208-3-010  -  PLUG BONE CMNT SDL 10MM IM","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"6208-3-016","SUP","HCPCS C1713","","6208-3-016  -  PLUG BONE CMNT SDL 16MM IM","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"621-00-22A","SUP","Custom 27803010","","621-00-22A  -  INSERT ACETAB 0D A 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22B","SUP","Custom 27803010","","621-00-22B  -  INSERT ACETAB 0D B 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22C","SUP","Custom 27803010","","621-00-22C  -  INSERT ACETAB 0D C 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22D","SUP","Custom 27803010","","621-00-22D  -  INSERT ACETAB 0D D 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22E","SUP","Custom 27803010","","621-00-22E  -  INSERT ACETAB 0D E 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22F","SUP","Custom 27803010","","621-00-22F  -  INSERT ACETAB 0D F 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22G","SUP","Custom 27803010","","621-00-22G  -  INSERT ACETAB 0D G 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22H","SUP","Custom 27803010","","621-00-22H  -  INSERT ACETAB 0D H 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22I","SUP","Custom 27803010","","621-00-22I  -  INSERT ACETAB 0D I 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-22J","SUP","Custom 27803010","","621-00-22J  -  INSERT ACETAB 0D J 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26C","SUP","Custom 27803010","","621-00-26C  -  INSERT ACETAB 0D C 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26D","SUP","Custom 27803010","","621-00-26D  -  INSERT ACETAB 0D D 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26E","SUP","Custom 27803010","","621-00-26E  -  INSERT ACETAB 0D E 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26F","SUP","Custom 27803010","","621-00-26F  -  INSERT ACETAB 0D F 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26G","SUP","Custom 27803010","","621-00-26G  -  INSERT ACETAB 0D G 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26H","SUP","Custom 27803010","","621-00-26H  -  INSERT ACETAB 0D H 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26I","SUP","Custom 27803010","","621-00-26I  -  INSERT ACETAB 0D I 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-26J","SUP","Custom 27803010","","621-00-26J  -  INSERT ACETAB 0D J 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28C","SUP","Custom 27803010","","621-00-28C  -  INSERT ACETAB 0D C 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28D","SUP","Custom 27803010","","621-00-28D  -  INSERT ACETAB 0D D 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28E","SUP","Custom 27803010","","621-00-28E  -  INSERT ACETAB 0D E 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28F","SUP","Custom 27803010","","621-00-28F  -  INSERT ACETAB 0D F 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28G","SUP","Custom 27803010","","621-00-28G  -  INSERT ACETAB 0D G 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28H","SUP","Custom 27803010","","621-00-28H  -  INSERT ACETAB 0D H 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28I","SUP","Custom 27803010","","621-00-28I  -  INSERT ACETAB 0D I 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-28J","SUP","Custom 27803010","","621-00-28J  -  INSERT ACETAB 0D J 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32D","SUP","Custom 27803010","","621-00-32D  -  INSERT ACETAB 0D D 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32E","SUP","Custom 27803010","","621-00-32E  -  INSERT ACETAB 0D E 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32F","SUP","Custom 27803010","","621-00-32F  -  INSERT ACETAB 0D F 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32G","SUP","Custom 27803010","","621-00-32G  -  INSERT ACETAB 0D G 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32H","SUP","Custom 27803010","","621-00-32H  -  INSERT ACETAB 0D H 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32I","SUP","Custom 27803010","","621-00-32I  -  INSERT ACETAB 0D I 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-32J","SUP","Custom 27803010","","621-00-32J  -  INSERT ACETAB 0D J 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-36E","SUP","Custom 27803010","","621-00-36E  -  INSERT ACETAB 0D E 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-36F","SUP","Custom 27803010","","621-00-36F  -  INSERT ACETAB 0D F 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-36G","SUP","Custom 27803010","","621-00-36G  -  INSERT ACETAB 0D G 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-36H","SUP","Custom 27803010","","621-00-36H  -  INSERT ACETAB 0D H 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-36I","SUP","Custom 27803010","","621-00-36I  -  INSERT ACETAB 0D I 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-00-36J","SUP","Custom 27803010","","621-00-36J  -  INSERT ACETAB 0D J 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6210-0-710","SUP","Custom 27203010","","6210-0-710  -  OSTEOTOME SURG 12MM 120MM FLEXIBLE GRAY STERILE","BOTH IP/OP","$1,422.50 ","$1,052.65 ","$0.00 ","$1,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,422.50 ","$0.00 ","$711.25 ","$1,126.62 ","$1,138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6210-0-740","SUP","Custom 27203010","","6210-0-740  -  OSTEOTOME SURG 12MMX93MM FLEXIBLE GRAY STERILE","BOTH IP/OP","$1,422.50 ","$1,052.65 ","$0.00 ","$1,422.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,422.50 ","$0.00 ","$711.25 ","$1,126.62 ","$1,138.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22A","SUP","Custom 27803010","","621-10-22A  -  INSERT ACETAB 10D A 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22B","SUP","Custom 27803010","","621-10-22B  -  INSERT ACETAB 10D B 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22C","SUP","Custom 27803010","","621-10-22C  -  INSERT ACETAB 10D C 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22D","SUP","Custom 27803010","","621-10-22D  -  INSERT ACETAB 10D D 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22E","SUP","Custom 27803010","","621-10-22E  -  INSERT ACETAB 10D E 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22F","SUP","Custom 27803010","","621-10-22F  -  INSERT ACETAB 10D F 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22G","SUP","Custom 27803010","","621-10-22G  -  INSERT ACETAB 10D G 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22H","SUP","Custom 27803010","","621-10-22H  -  INSERT ACETAB 10D H 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22I","SUP","Custom 27803010","","621-10-22I  -  INSERT ACETAB 10D I 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-22J","SUP","Custom 27803010","","621-10-22J  -  INSERT ACETAB 10D J 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26C","SUP","Custom 27803010","","621-10-26C  -  INSERT ACETAB 10D C 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26D","SUP","Custom 27803010","","621-10-26D  -  INSERT ACETAB 10D D 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26E","SUP","Custom 27803010","","621-10-26E  -  INSERT ACETAB 10D E 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26F","SUP","Custom 27803010","","621-10-26F  -  INSERT ACETAB 10D F 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26G","SUP","Custom 27803010","","621-10-26G  -  INSERT ACETAB 10D G 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26H","SUP","Custom 27803010","","621-10-26H  -  INSERT ACETAB 10D H 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26I","SUP","Custom 27803010","","621-10-26I  -  INSERT ACETAB 10D I 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-26J","SUP","Custom 27803010","","621-10-26J  -  INSERT ACETAB 10D J 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28C","SUP","Custom 27803010","","621-10-28C  -  INSERT ACETAB 10D C 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28D","SUP","Custom 27803010","","621-10-28D  -  INSERT ACETAB 10D D 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28E","SUP","Custom 27803010","","621-10-28E  -  INSERT ACETAB 10D E 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28F","SUP","Custom 27803010","","621-10-28F  -  INSERT ACETAB 10D F 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28G","SUP","Custom 27803010","","621-10-28G  -  INSERT ACETAB 10D G 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28H","SUP","Custom 27803010","","621-10-28H  -  INSERT ACETAB 10D H 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28I","SUP","Custom 27803010","","621-10-28I  -  INSERT ACETAB 10D I 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-28J","SUP","Custom 27803010","","621-10-28J  -  INSERT ACETAB 10D J 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-32D","SUP","Custom 27803010","","621-10-32D  -  INSERT ACETAB 10D D 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-32E","SUP","Custom 27803010","","621-10-32E  -  INSERT ACETAB 10D E 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-32F","SUP","Custom 27803010","","621-10-32F  -  INSERT ACETAB 10D F 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-32G","SUP","Custom 27803010","","621-10-32G  -  INSERT ACETAB 10D G 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-32H","SUP","HCPCS C1713","","621-10-32H  -  INSERT ACETAB 10D H 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$239.69 ","$0.00 ","$0.00 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"621-10-32I","SUP","Custom 27803010","","621-10-32I  -  INSERT ACETAB 10D I 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-32J","SUP","Custom 27803010","","621-10-32J  -  INSERT ACETAB 10D J 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-36E","SUP","Custom 27803010","","621-10-36E  -  INSERT ACETAB 10D E 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-36F","SUP","Custom 27803010","","621-10-36F  -  INSERT ACETAB 10D F 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-36G","SUP","Custom 27803010","","621-10-36G  -  INSERT ACETAB 10D G 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-36H","SUP","Custom 27803010","","621-10-36H  -  INSERT ACETAB 10D H 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-36I","SUP","Custom 27803010","","621-10-36I  -  INSERT ACETAB 10D I 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"621-10-36J","SUP","Custom 27803010","","621-10-36J  -  INSERT ACETAB 10D J 36MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-12002","SUP","Custom 27203010","","62-12002  -  BLADE XFIT DNTL SHFT END 1.2MM SCRDRVR","BOTH IP/OP","$361.63 ","$267.61 ","$0.00 ","$361.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.63 ","$0.00 ","$180.81 ","$286.41 ","$289.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-12333","SUP","Custom 27203010","","62-12333  -  BLADE 1.2MM XPIN SCRDRVR","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-12335","SUP","Custom 27203010","","62-12335  -  BLADE 1.2MM REM SCRDRVR","BOTH IP/OP","$309.70 ","$229.18 ","$0.00 ","$343.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.75 ","$0.00 ","$171.88 ","$272.25 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-12503","SUP","Custom 27803010","","62-12503  -  TAP SURG 1.2 MM SCR","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6215-5-001","SUP","HCPCS C1713","","6215-5-001  -  PLUG BN CMNT SM 18.5MM STRL IM CNL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"6215-5-011","SUP","HCPCS C1713","","6215-5-011  -  PLUG BN CMNT MED 25MM STRL IM CNL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"6215-5-021","SUP","HCPCS C1713","","6215-5-021  -  PLUG BN CMNT LG 30MM STRL IM CNL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"621573S","SUP","HCPCS C1713","","621573S  -  PLATE 81MM TI 3.5MM/4MM SCR 3 HOLE SM FRAG SET SHFT BONE FIB","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"621574S","SUP","HCPCS C1713","","621574S  -  PLATE 93MM TI 3.5MM/4MM SCR 4 HOLE SM FRAG SET SHFT BONE FIB","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"621575S","SUP","HCPCS C1713","","621575S  -  PLATE 105MM TI 3.5MM/4MM SCR 5 HOLE SM FRAG SET SHFT BONE","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"621576S","SUP","HCPCS C1713","","621576S  -  PLATE 117MM TI 3.5MM/4MM SCR 6 HOLE SM FRAG SET SHFT BONE","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"621577S","SUP","HCPCS C1713","","621577S  -  PLATE 129MM TI 3.5MM/4MM SCR 7 HOLE SM FRAG SET SHFT BONE","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"621578S","SUP","HCPCS C1713","","621578S  -  PLATE 141MM TI 3.5MM/4MM SCR 8 HOLE SM FRAG SET SHFT BONE","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"621579S","SUP","HCPCS C1713","","621579S  -  PLATE 153MM TI 3.5MM/4MM SCR 9 HOLE SM FRAG SET SHFT BONE","BOTH IP/OP","$284.00 ","$210.16 ","$0.00 ","$312.13 ","$140.46 ","$0.00 ","$59.19 ","$0.00 ","$0.00 ","$54.65 ","$312.13 ","$0.00 ","$156.06 ","$247.21 ","$249.70 ","$0.00 ","$48.85 ","$0.00 ","$49.69 ","$0.00 "
"62-17005","SUP","Custom 27203010","","62-17005  -  BLADE SCRDRVR 1.7MM XFT","BOTH IP/OP","$361.63 ","$267.61 ","$0.00 ","$361.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.63 ","$0.00 ","$180.81 ","$286.41 ","$289.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-17333","SUP","Custom 27203010","","62-17333  -  BLADE 1.7MM XPIN SCRDRVR","BOTH IP/OP","$240.63 ","$178.07 ","$0.00 ","$240.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.63 ","$0.00 ","$120.31 ","$190.58 ","$192.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-17335","SUP","Custom 27203010","","62-17335  -  BLADE 1.7MM REM SCRDRVR","BOTH IP/OP","$309.70 ","$229.18 ","$0.00 ","$343.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.75 ","$0.00 ","$171.88 ","$272.25 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-17503","SUP","Custom 27803010","","62-17503  -  TAP 1.7MM SURG MAXFACL","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-20125","SUP","Custom 27203010","","62-20125  -  CUTTER SURG PLT","BOTH IP/OP","$2,457.00 ","$1,818.18 ","$0.00 ","$2,420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,420.00 ","$0.00 ","$1,210.00 ","$1,916.64 ","$1,936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-21723","SUP","HCPCS C1713","","62-21723  -  IRON BNDRG PLT","BOTH IP/OP","$715.35 ","$529.36 ","$0.00 ","$728.75 ","$327.94 ","$0.00 ","$149.10 ","$0.00 ","$0.00 ","$127.60 ","$728.75 ","$0.00 ","$364.38 ","$577.17 ","$583.00 ","$0.00 ","$114.05 ","$0.00 ","$116.02 ","$0.00 "
"62-23005","SUP","Custom 27203010","","62-23005  -  BLADE 2.3MM XFIT DNTL SHFT END SCRDRVR","BOTH IP/OP","$361.63 ","$267.61 ","$0.00 ","$361.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.63 ","$0.00 ","$180.81 ","$286.41 ","$289.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-23333","SUP","Custom 27203010","","62-23333  -  BLADE 2.3MM XPIN SCRDRVR","BOTH IP/OP","$240.63 ","$178.07 ","$0.00 ","$240.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.63 ","$0.00 ","$120.31 ","$190.58 ","$192.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-23335","SUP","HCPCS C1713","","62-23335  -  SCREW REMOVAL BLADE 2.3 DENTAL","BOTH IP/OP","$309.70 ","$229.18 ","$0.00 ","$343.75 ","$154.69 ","$0.00 ","$64.55 ","$0.00 ","$0.00 ","$60.19 ","$343.75 ","$0.00 ","$171.88 ","$272.25 ","$275.00 ","$0.00 ","$53.80 ","$0.00 ","$54.73 ","$0.00 "
"62-23503","SUP","Custom 27803010","","62-23503  -  TAP SURG 2.3 MM SCR","BOTH IP/OP","$213.13 ","$157.72 ","$0.00 ","$213.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.13 ","$0.00 ","$106.56 ","$168.80 ","$170.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-27015","SUP","Custom 27203010","","62-27015  -  BLADE T7 SCRDRVR 2.3MM 2.7MM SCR","BOTH IP/OP","$501.88 ","$371.39 ","$0.00 ","$501.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.88 ","$0.00 ","$250.94 ","$397.49 ","$401.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6227DEF04","SUP","Custom 27203010","","6227DEF04  -  CATHETER GD 9.9FR 45CM STRL LF ATN PRVL LD DLV SYS DFLC CS","BOTH IP/OP","$1,242.50 ","$919.45 ","$0.00 ","$1,242.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,242.50 ","$0.00 ","$621.25 ","$984.06 ","$994.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22A","SUP","Custom 27803010","","623-00-22A  -  LINER ACETAB 0D A 22MM 7.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22B","SUP","Custom 27803010","","623-00-22B  -  LINER ACETAB 0D B 22MM 8.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22C","SUP","Custom 27803010","","623-00-22C  -  LINER ACETAB 0D C 22MM 9.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22D","SUP","Custom 27803010","","623-00-22D  -  LINER ACETAB 0D D 22MM 10.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22E","SUP","Custom 27803010","","623-00-22E  -  LINER ACETAB 0D E 22MM 12.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22F","SUP","Custom 27803010","","623-00-22F  -  LINER ACETAB 0D F 22MM 14.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22G","SUP","Custom 27803010","","623-00-22G  -  LINER ACETAB 0D G 22MM 16.3MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22H","SUP","Custom 27803010","","623-00-22H  -  LINER ACETAB 0D H 22MM 18.1MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22I","SUP","Custom 27803010","","623-00-22I  -  LINER ACETAB 0D I 22MM 19.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-22J","SUP","Custom 27803010","","623-00-22J  -  LINER ACETAB 0D J 22MM 21.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26C","SUP","Custom 27803010","","623-00-26C  -  LINER ACETAB 0D C 26MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26D","SUP","Custom 27803010","","623-00-26D  -  LINER ACETAB 0D D 26MM 8.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26E","SUP","Custom 27803010","","623-00-26E  -  LINER ACETAB 0D E 26MM 10.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26F","SUP","Custom 27803010","","623-00-26F  -  LINER ACETAB 0D F 26MM 12.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26G","SUP","Custom 27803010","","623-00-26G  -  LINER ACETAB 0D G 26MM 14.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26H","SUP","Custom 27803010","","623-00-26H  -  LINER ACETAB 0D H 26MM 16.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26I","SUP","Custom 27803010","","623-00-26I  -  LINER ACETAB 0D I 26MM 17.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-26J","SUP","Custom 27803010","","623-00-26J  -  LINER ACETAB 0D J 26MM 19.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28A","SUP","Custom 27803010","","623-00-28A  -  LINER ACETAB 0D A 28MM 4.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28B","SUP","Custom 27803010","","623-00-28B  -  LINER ACETAB 0D B 28MM 5.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28C","SUP","Custom 27803010","","623-00-28C  -  LINER ACETAB 0D C 28MM 6.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28D","SUP","Custom 27803010","","623-00-28D  -  LINER ACETAB 0D D 28MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28E","SUP","Custom 27803010","","623-00-28E  -  LINER ACETAB 0D E 28MM 9.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28F","SUP","Custom 27803010","","623-00-28F  -  LINER ACETAB 0D F 28MM 11.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28G","SUP","Custom 27803010","","623-00-28G  -  LINER ACETAB 0D G 28MM 13.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28H","SUP","Custom 27803010","","623-00-28H  -  LINER ACETAB 0D H 28MM 15.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28I","SUP","Custom 27803010","","623-00-28I  -  LINER ACETAB 0D I 28MM 16.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-28J","SUP","Custom 27803010","","623-00-28J  -  LINER ACETAB 0D J 28MM 18.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32B","SUP","Custom 27803010","","623-00-32B  -  LINER ACETAB 0D B 32MM 3.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32C","SUP","Custom 27803010","","623-00-32C  -  LINER ACETAB 0D C 32MM 4.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32D","SUP","Custom 27803010","","623-00-32D  -  LINER ACETAB 0D D 32MM 5.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32E","SUP","Custom 27803010","","623-00-32E  -  LINER ACETAB 0D E 32MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32F","SUP","Custom 27803010","","623-00-32F  -  LINER ACETAB 0D F 32MM 9.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32G","SUP","Custom 27803010","","623-00-32G  -  LINER ACETAB 0D G 32MM 11.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32H","SUP","Custom 27803010","","623-00-32H  -  LINER ACETAB 0D H 32MM 13.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32I","SUP","Custom 27803010","","623-00-32I  -  LINER ACETAB 0D I 32MM 14.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-32J","SUP","Custom 27803010","","623-00-32J  -  LINER ACETAB 0D J 32MM 16.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36D","SUP","Custom 27803010","","623-00-36D  -  LINER ACETAB 0D D 36MM 3.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36E","SUP","Custom 27803010","","623-00-36E  -  LINER ACETAB 0D E 36MM 5.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36F","SUP","Custom 27803010","","623-00-36F  -  LINER ACETAB 0D F 36MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36G","SUP","Custom 27803010","","623-00-36G  -  LINER ACETAB 0D G 36MM 9.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36H","SUP","Custom 27803010","","623-00-36H  -  LINER ACETAB 0D H 36MM 11.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36I","SUP","Custom 27803010","","623-00-36I  -  LINER ACETAB 0D I 36MM 12.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-36J","SUP","Custom 27803010","","623-00-36J  -  LINER ACETAB 0D J 36MM 14.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-40E","SUP","Custom 27803010","","623-00-40E  -  INSERT ACETAB 0D E 40MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-40F","SUP","Custom 27803010","","623-00-40F  -  LINER ACETAB 0D F 40MM 5.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-40G","SUP","Custom 27803010","","623-00-40G  -  LINER ACETAB 0D G 40MM 7.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-40H","SUP","Custom 27803010","","623-00-40H  -  LINER ACETAB 0D H 40MM 9.1MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-40I","SUP","Custom 27803010","","623-00-40I  -  LINER ACETAB 0D I 40MM 10.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-40J","SUP","Custom 27803010","","623-00-40J  -  LINER ACETAB 0D J 40MM 12.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-44F","SUP","Custom 27803010","","623-00-44F  -  LINER ACETAB 0D B F 44MM 3.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-44G","SUP","Custom 27803010","","623-00-44G  -  LINER ACETAB 0D G 44MM 5.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-44H","SUP","Custom 27803010","","623-00-44H  -  LINER ACETAB 0D H 44MM 7.1MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-44I","SUP","Custom 27803010","","623-00-44I  -  LINER ACETAB 0D I 44MM 8.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-00-44J","SUP","Custom 27803010","","623-00-44J  -  LINER ACETAB 0D J 44MM 10.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6230UNI","SUP","Custom 27203010","","6230UNI  -  SLITTER CATHETER UNIVERSAL UNIVERSAL II","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22A","SUP","Custom 27803010","","623-10-22A  -  LINER ACETAB 10D A 22MM 7.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22B","SUP","Custom 27803010","","623-10-22B  -  LINER ACETAB 10D B 22MM 8.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22C","SUP","Custom 27803010","","623-10-22C  -  LINER ACETAB 10D C 22MM 9.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22D","SUP","Custom 27803010","","623-10-22D  -  LINER ACETAB 10D D 22MM 10.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22E","SUP","Custom 27803010","","623-10-22E  -  LINER ACETAB 10D E 22MM 12.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22F","SUP","Custom 27803010","","623-10-22F  -  LINER ACETAB 10D F 22MM 14.8MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22G","SUP","Custom 27803010","","623-10-22G  -  LINER ACETAB 10D G 22MM 16.3MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22H","SUP","Custom 27803010","","623-10-22H  -  LINER ACETAB 10D H 22MM 18.1MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22I","SUP","Custom 27803010","","623-10-22I  -  LINER ACETAB 10D I 22MM 19.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-22J","SUP","Custom 27803010","","623-10-22J  -  LINER ACETAB 10D J 22MM 21.6MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26C","SUP","Custom 27803010","","623-10-26C  -  LINER ACETAB 10D C 26MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26D","SUP","Custom 27803010","","623-10-26D  -  LINER ACETAB 10D D 26MM 8.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26E","SUP","Custom 27803010","","623-10-26E  -  LINER ACETAB 10D E 26MM 10.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26F","SUP","Custom 27803010","","623-10-26F  -  LINER ACETAB 10D F 26MM 12.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26G","SUP","Custom 27803010","","623-10-26G  -  LINER ACETAB 10D G 26MM 14.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26H","SUP","Custom 27803010","","623-10-26H  -  LINER ACETAB 10D H 26MM 16.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26I","SUP","Custom 27803010","","623-10-26I  -  LINER ACETAB 10D I 26MM 17.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-26J","SUP","Custom 27803010","","623-10-26J  -  LINER ACETAB 10D J 26MM 19.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28C","SUP","Custom 27803010","","623-10-28C  -  LINER ACETAB 10D C 28MM 6.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28D","SUP","Custom 27803010","","623-10-28D  -  LINER ACETAB 10D D 28MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28E","SUP","Custom 27803010","","623-10-28E  -  LINER ACETAB 10D E 28MM 9.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28F","SUP","Custom 27803010","","623-10-28F  -  LINER ACETAB 10D F 28MM 11.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28G","SUP","Custom 27803010","","623-10-28G  -  LINER ACETAB 10D G 28MM 13.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28H","SUP","Custom 27803010","","623-10-28H  -  LINER ACETAB 10D H 28MM 15.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28I","SUP","Custom 27803010","","623-10-28I  -  LINER ACETAB 10D I 28MM 16.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-28J","SUP","Custom 27803010","","623-10-28J  -  LINER ACETAB 10D J 28MM 18.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32D","SUP","Custom 27803010","","623-10-32D  -  LINER ACETAB 10D D 32MM 5.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32E","SUP","Custom 27803010","","623-10-32E  -  INSERT ACETAB 10D E 32MM PRIM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32F","SUP","Custom 27803010","","623-10-32F  -  LINER ACETAB 10D F 32MM 9.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32G","SUP","Custom 27803010","","623-10-32G  -  LINER ACETAB 10D G 32MM 11.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32H","SUP","Custom 27803010","","623-10-32H  -  LINER ACETAB 10D H 32MM 13.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32I","SUP","Custom 27803010","","623-10-32I  -  LINER ACETAB 10D I 32MM 14.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-32J","SUP","Custom 27803010","","623-10-32J  -  LINER ACETAB 10D J 32MM 16.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-36E","SUP","Custom 27803010","","623-10-36E  -  INSERT ACETAB 10D E 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-36F","SUP","Custom 27803010","","623-10-36F  -  LINER ACETAB 10D F 36MM 7.9MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-36G","SUP","Custom 27803010","","623-10-36G  -  LINER ACETAB 10D G 36MM 9.4MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-36H","SUP","Custom 27803010","","623-10-36H  -  LINER ACETAB 10D H 36MM 11.2MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-36I","SUP","Custom 27803010","","623-10-36I  -  LINER ACETAB 10D I 36MM 12.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"623-10-36J","SUP","Custom 27803010","","623-10-36J  -  LINER ACETAB 10D J 36MM 14.7MM X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-32440","SUP","Custom 27803010","","62-32440  -  POSITIONER IMPL 3.2MM UNV REPOSITION PIN","BOTH IP/OP","$1,892.50 ","$1,400.45 ","$0.00 ","$1,892.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,892.50 ","$0.00 ","$946.25 ","$1,498.86 ","$1,514.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6232ADJ","SUP","Custom 27203010","","6232ADJ  -  SLITTER CATHETER ADJUSTABLE SHEATH","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"624.027S","SUP","Custom 27203010","","624.027S  -  KIT SURG PEDICLE ACCES SPN REVERE","BOTH IP/OP","$2,827.50 ","$2,092.35 ","$0.00 ","$2,827.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,827.50 ","$0.00 ","$1,413.75 ","$2,239.38 ","$2,262.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6248130D02","SUP","Custom 27203010","","6248130D02  -  CATHETER GD 130D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"624890D02","SUP","Custom 27203010","","624890D02  -  CATHETER GD 90D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-50201","SUP","Custom 27203010","","62-50201  -  PACK BTRY VARISPEED","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6250EH02","SUP","Custom 27203010","","6250EH02  -  CATHETER GD EH CRV 9FR 50CM STRL LF ATN CMND SUREVALVE 2 BRD","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6250MB202","SUP","Custom 27203010","","6250MB202  -  CATHETER GD MB2 CRV 9FR 45CM STRL LF ATN CMND SUREVALVE 2","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"625-0T-28D","SUP","Custom 27803010","","625-0T-28D  -  INSERT ACETAB D 28MM TRIDENT ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"625-0T-32E","SUP","Custom 27803010","","625-0T-32E  -  INSERT ACETAB E 32MM TRIDENT ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"625-0T-32F","SUP","Custom 27803010","","625-0T-32F  -  INSERT ACETAB F 32MM TRIDENT ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"625-0T-36G","SUP","Custom 27803010","","625-0T-36G  -  INSERT ACETAB G 36MM TRIDENT ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"625-0T-36H","SUP","Custom 27803010","","625-0T-36H  -  INSERT ACETAB H 36MM TRIDENT ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"625-0T-36I","SUP","Custom 27803010","","625-0T-36I  -  INSERT ACETAB I 36MM TRIDENT ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-51217","SUP","Custom 27203010","","62-51217  -  GUIDE DRILL 1.2MM 1.7MM STD","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-51723","SUP","Custom 27203010","","62-51723  -  GUIDE DRILL 1.7MM 2.3MM POLYAX LCK","BOTH IP/OP","$666.88 ","$493.49 ","$0.00 ","$666.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$666.88 ","$0.00 ","$333.44 ","$528.17 ","$533.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-52323","SUP","Custom 27203010","","62-52323  -  GUIDE DRILL 2.3MM CMPR","BOTH IP/OP","$735.63 ","$544.37 ","$0.00 ","$735.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.63 ","$0.00 ","$367.81 ","$582.62 ","$588.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"62-52325","SUP","Custom 27203010","","62-52325  -  GUIDE DRILL 2.3MM 2.5MM STD","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-080","SUP","Custom 27803010","","6259-8-080  -  CNTRLZR STM 8MM RLNC DISTAL FEM","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-090","SUP","Custom 27803010","","6259-8-090  -  CNTRLZR STM 9MM RLNC DISTAL FEM","BOTH IP/OP","$168.00 ","$124.32 ","$0.00 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$168.00 ","$0.00 ","$84.00 ","$133.06 ","$134.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-100","SUP","Custom 27803010","","6259-8-100  -  CENTRALIZER STEM 10MM RELIANCE HIP FEMUR FRAC PRODUCTS F R","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-110","SUP","HCPCS C1713","","6259-8-110  -  CENTRALIZER STEM 11MM PRIM RELIANCE HIP FEMUR","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"6259-8-120","SUP","Custom 27803010","","6259-8-120  -  CENTRALIZER STEM 12MM PRIM RELIANCE DISTAL FEMUR HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-130","SUP","HCPCS C1713","","6259-8-130  -  CENTRALIZER STEM 13MM PRIM RELIANCE HIP FEMUR","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"6259-8-140","SUP","HCPCS C1713","","6259-8-140  -  CENTRALIZER STEM 14MM RELIANCE HIP FEMUR","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"6259-8-150","SUP","HCPCS C1713","","6259-8-150  -  CENTRALIZER STEM 15MM RELIANCE HIP FEMUR","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"6259-8-160","SUP","Custom 27803010","","6259-8-160  -  CENTRALIZER STEM 16MM 16MM ACCESSORIES BONE PLUG CENTRALIZER","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-170","SUP","Custom 27803010","","6259-8-170  -  CENTRALIZER STEM 17MM 17MM BONE PLUGS ACCESSORIES HIP FRAC","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6259-8-180","SUP","Custom 27803010","","6259-8-180  -  CENTRALIZER STEM 18MM RELIANCE HIP FEMUR DISTAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"626-00-36C","SUP","HCPCS C1776","","626-00-36C  -  LINER ACTB C 36MM MDM COCR HIP 22.2MM FEM HD","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$1,056.38 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$411.03 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$367.38 ","$0.00 ","$373.72 ","$0.00 "
"626-00-38D","SUP","HCPCS C1776","","626-00-38D  -  LINER ACTB D 38MM MDLR 2 MBL COCR HIP","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$1,056.38 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$411.03 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$367.38 ","$0.00 ","$373.72 ","$0.00 "
"626-00-42E","SUP","HCPCS C1776","","626-00-42E  -  LINER ACTB E 42MM MDM 2 MBL MDLR COCR HIP","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$1,056.38 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$411.03 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$367.38 ","$0.00 ","$373.72 ","$0.00 "
"626-00-52H","SUP","HCPCS C1776","","626-00-52H  -  LINER ACTB H 52MM MDM COCR HIP 28MM FEM HD","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$1,056.38 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$411.03 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$367.38 ","$0.00 ","$373.72 ","$0.00 "
"626-00-54I","SUP","HCPCS C1776","","626-00-54I  -  LINER ACTB I 54MM MDM COCR HIP 28MM FEM HD","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$1,056.38 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$411.03 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$367.38 ","$0.00 ","$373.72 ","$0.00 "
"626-00-58J","SUP","HCPCS C1776","","626-00-58J  -  LINER ACTB J 58MM MDM COCR HIP 28MM FEM HD","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$1,056.38 ","$0.00 ","$489.28 ","$0.00 ","$0.00 ","$411.03 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$367.38 ","$0.00 ","$373.72 ","$0.00 "
"6260-1-212","SUP","HCPCS C1776","","6260-1-212  -  STEM FEM 237MM PS BW RSTOR TI 2/12 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-313","SUP","HCPCS C1776","","6260-1-313  -  STEM FEM 235MM PS BW RSTOR TI 3/13 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-414","SUP","HCPCS C1776","","6260-1-414  -  STEM FEM 234MM 14MM PS BW RSTOR TI 4 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-515","SUP","HCPCS C1776","","6260-1-515  -  STEM HUM 15MM 5MM MNBLCK RSTOR TI LNG LEFT T1","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-616","SUP","HCPCS C1776","","6260-1-616  -  STEM HUM 16MM 6MM MNBLCK RSTOR TI LNG LEFT T1","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-717","SUP","HCPCS C1776","","6260-1-717  -  STEM FEM 241MM 17MM PS BW RSTOR TI 7 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-719","SUP","HCPCS C1776","","6260-1-719  -  STEM FEM 251MM 19MM PS BW RSTOR TI 7 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-818","SUP","HCPCS C1776","","6260-1-818  -  STEM FEM 240MM 18MM PS BW RSTOR TI 8 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-820","SUP","HCPCS C1776","","6260-1-820  -  STEM FEM 251MM 20MM PS BW RSTOR TI 8 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-1-921","SUP","HCPCS C1776","","6260-1-921  -  STEM FEM 250MM 21MM PS BW RSTOR TI 9 LNG LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-212","SUP","HCPCS C1776","","6260-2-212  -  STEM HUM 12MM 2MM MNBLCK RSTOR TI LNG LEFT T1","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-313","SUP","HCPCS C1776","","6260-2-313  -  STEM FEM 235MM 13MM PS BW RSTOR TI LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-414","SUP","HCPCS C1776","","6260-2-414  -  STEM FEM 234MM PS BW RSTOR TI 4/14 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-515","SUP","HCPCS C1776","","6260-2-515  -  STEM FEM 233MM 15MM PS BW RSTOR TI 5 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-616","SUP","HCPCS C1776","","6260-2-616  -  STEM FEM 242MM 16MM PS BW RSTOR TI 6 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-717","SUP","HCPCS C1776","","6260-2-717  -  STEM FEM 241MM PS BW RSTOR TI 7/17 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-719","SUP","HCPCS C1776","","6260-2-719  -  STEM FEM 251MM 19MM PS BW RSTOR TI 7 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-818","SUP","HCPCS C1776","","6260-2-818  -  STEM FEM 240MM 18MM PS BW RSTOR TI 8 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-820","SUP","HCPCS C1776","","6260-2-820  -  STEM FEM 251MM 20MM PS BW RSTOR TI 8 LNG RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-2-921","SUP","HCPCS C1776","","6260-2-921  -  STEM HUM 21MM 9MM MNBLCK RSTOR TI LNG RIGHT T1","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6260-4-122","SUP","Custom 27803010","","6260-4-122  -  HEAD FEM +0MM 22.2MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-4-222","SUP","Custom 27803010","","6260-4-222  -  HEAD FEM +3MM 22.2MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-4-322","SUP","Custom 27803010","","6260-4-322  -  HEAD FEMORAL +8MM TAPER 22.2MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-026","SUP","Custom 27803010","","6260-5-026  -  HEAD FEMORAL -3MM TAPER 26MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-028","SUP","Custom 27803010","","6260-5-028  -  HEAD FEMORAL -4MM TAPER 28MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-032","SUP","Custom 27803010","","6260-5-032  -  HEAD FEMORAL -4MM TAPER 32MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-126","SUP","Custom 27803010","","6260-5-126  -  HEAD FEMORAL +0MM TAPER 26MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-128","SUP","Custom 27803010","","6260-5-128  -  HEAD FEMORAL +0MM TAPER 28MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-132","SUP","Custom 27803010","","6260-5-132  -  HEAD FEMORAL +0MM TAPER 32MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-226","SUP","Custom 27803010","","6260-5-226  -  HEAD FEMORAL +4MM TAPER 26MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-228","SUP","Custom 27803010","","6260-5-228  -  HEAD FEMORAL +4MM TAPER 28MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-232","SUP","Custom 27803010","","6260-5-232  -  HEAD FEMORAL +4MM TAPER 32MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-326","SUP","Custom 27803010","","6260-5-326  -  HEAD FEMORAL +8MM TAPER 26MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-328","SUP","Custom 27803010","","6260-5-328  -  HEAD FEMORAL +8MM TAPER 28MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-332","SUP","Custom 27803010","","6260-5-332  -  HEAD FEMORAL +8MM TAPER 32MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-426","SUP","Custom 27803010","","6260-5-426  -  HEAD FEMORAL +1MM TAPER 26MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-428","SUP","Custom 27803010","","6260-5-428  -  HEAD FEMORAL +12MM TAPER 28MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-432","SUP","Custom 27803010","","6260-5-432  -  HEAD FEMORAL +12MM TAPER 32MM V40 COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-5-628","SUP","Custom 27803010","","6260-5-628  -  HEAD FEMORAL +6MM TAPER 28MM V40 COCR HIP","BOTH IP/OP","$1,302.50 ","$963.85 ","$0.00 ","$1,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,302.50 ","$0.00 ","$651.25 ","$1,031.58 ","$1,042.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-6-111","SUP","HCPCS C1776","","6260-6-111  -  STEM FEMORAL 1 STR 11MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-113","SUP","HCPCS C1776","","6260-6-113  -  STEM FEMORAL 1 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-212","SUP","HCPCS C1776","","6260-6-212  -  STEM FEMORAL 2 STR 12MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-214","SUP","HCPCS C1776","","6260-6-214  -  STEM FEMORAL 2 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-313","SUP","HCPCS C1776","","6260-6-313  -  STEM FEMORAL 3 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-315","SUP","HCPCS C1776","","6260-6-315  -  STEM FEMORAL 3 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-414","SUP","HCPCS C1776","","6260-6-414  -  STEM FEMORAL 4 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-416","SUP","HCPCS C1776","","6260-6-416  -  STEM FEMORAL 4 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-515","SUP","HCPCS C1776","","6260-6-515  -  STEM FEMORAL 5 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-517","SUP","HCPCS C1776","","6260-6-517  -  STEM FEMORAL 5 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-616","SUP","HCPCS C1776","","6260-6-616  -  STEM FEMORAL 6 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-618","SUP","HCPCS C1776","","6260-6-618  -  STEM FEMORAL 6 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-717","SUP","HCPCS C1776","","6260-6-717  -  STEM FEMORAL 7 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-719","SUP","HCPCS C1776","","6260-6-719  -  STEM FEMORAL 7 STR 19MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-818","SUP","HCPCS C1776","","6260-6-818  -  STEM FEMORAL 8 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-820","SUP","HCPCS C1776","","6260-6-820  -  STEM FEMORAL 8 STR 20MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-6-921","SUP","HCPCS C1776","","6260-6-921  -  STEM FEMORAL 9 STR 21MM 165MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-036","SUP","Custom 27803010","","6260-8-036  -  HEAD FEM -4MM 36MM HIP COCR V40 LFIT","BOTH IP/OP","$2,035.00 ","$1,505.90 ","$0.00 ","$2,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,035.00 ","$0.00 ","$1,017.50 ","$1,611.72 ","$1,628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-8-111","SUP","HCPCS C1776","","6260-8-111  -  STEM FEMORAL 1 STR 11MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-113","SUP","HCPCS C1776","","6260-8-113  -  STEM FEMORAL 1 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-212","SUP","HCPCS C1776","","6260-8-212  -  STEM FEMORAL 2 STR 12MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-214","SUP","HCPCS C1776","","6260-8-214  -  STEM FEMORAL 2 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-236","SUP","Custom 27803010","","6260-8-236  -  HEAD FEM +4MM 36MM HIP COCR V40 LFIT","BOTH IP/OP","$2,035.00 ","$1,505.90 ","$0.00 ","$2,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,035.00 ","$0.00 ","$1,017.50 ","$1,611.72 ","$1,628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-8-313","SUP","HCPCS C1776","","6260-8-313  -  STEM FEMORAL 3 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-315","SUP","HCPCS C1776","","6260-8-315  -  STEM FEMORAL 3 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-336","SUP","Custom 27803010","","6260-8-336  -  HEAD FEM +8MM 36MM HIP COCR V40 LFIT","BOTH IP/OP","$2,035.00 ","$1,505.90 ","$0.00 ","$2,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,035.00 ","$0.00 ","$1,017.50 ","$1,611.72 ","$1,628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-8-414","SUP","HCPCS C1776","","6260-8-414  -  STEM FEMORAL 4 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-416","SUP","HCPCS C1776","","6260-8-416  -  STEM FEMORAL 4 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-515","SUP","HCPCS C1776","","6260-8-515  -  STEM FEMORAL 5 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-517","SUP","HCPCS C1776","","6260-8-517  -  STEM FEMORAL 5 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-616","SUP","HCPCS C1776","","6260-8-616  -  STEM FEMORAL 6 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-618","SUP","HCPCS C1776","","6260-8-618  -  STEM FEMORAL 6 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-717","SUP","HCPCS C1776","","6260-8-717  -  STEM FEMORAL 7 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-719","SUP","HCPCS C1776","","6260-8-719  -  STEM FEMORAL 7 STR 19MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-818","SUP","HCPCS C1776","","6260-8-818  -  STEM FEMORAL 8 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-820","SUP","HCPCS C1776","","6260-8-820  -  STEM FEMORAL 8 STR 20MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-8-921","SUP","HCPCS C1776","","6260-8-921  -  STEM FEMORAL 9 STR 21MM 203MM RSTOR TITANIUM PLASMA SPRAY","BOTH IP/OP","$13,152.50 ","$9,732.85 ","$0.00 ","$13,152.50 ","$5,918.63 ","$0.00 ","$2,741.31 ","$0.00 ","$0.00 ","$2,302.90 ","$13,152.50 ","$0.00 ","$6,576.25 ","$10,416.78 ","$10,522.00 ","$0.00 ","$2,058.37 ","$0.00 ","$2,093.88 ","$0.00 "
"6260-9-026","SUP","Custom 27803010","","6260-9-026  -  HEAD FEMORAL -3MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-028","SUP","Custom 27803010","","6260-9-028  -  HEAD FEM -4MM OFST TPR 28MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-032","SUP","Custom 27803010","","6260-9-032  -  HEAD FEM -4MM OFST 32MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-036","SUP","Custom 27803010","","6260-9-036  -  HEAD FEM -5MM OFST TPR 36MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-040","SUP","Custom 27803010","","6260-9-040  -  HEAD FEM -4MM OFST TPR 40MM V40 LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-044","SUP","Custom 27803010","","6260-9-044  -  HEAD FEM -4MM OFST TPR 44MM V40 LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-122","SUP","Custom 27803010","","6260-9-122  -  HEAD FEM +0MM OFST TPR 22MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-126","SUP","Custom 27803010","","6260-9-126  -  HEAD FEMORAL +0MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-128","SUP","Custom 27803010","","6260-9-128  -  HEAD FEM +0MM OFST 28MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-132","SUP","Custom 27803010","","6260-9-132  -  HEAD FEMORAL +0MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-136","SUP","Custom 27803010","","6260-9-136  -  HEAD FEMORAL +0MM OFFST TAPER 36MM PRIM ANATOMIC V40 LFIT","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-140","SUP","Custom 27803010","","6260-9-140  -  HEAD FEMORAL +0MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-144","SUP","Custom 27803010","","6260-9-144  -  HEAD FEM +0MM OFST TPR 44MM V40 LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-222","SUP","Custom 27803010","","6260-9-222  -  HEAD FEM +3MM OFST 22.2MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-226","SUP","Custom 27803010","","6260-9-226  -  HEAD FEMORAL +4MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-228","SUP","Custom 27803010","","6260-9-228  -  HEAD FEM +4MM OFST 28MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-232","SUP","Custom 27803010","","6260-9-232  -  HEAD FEM +4MM OFST TPR 32MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-236","SUP","Custom 27803010","","6260-9-236  -  HEAD FEM +5MM OFST TPR 36MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-240","SUP","Custom 27803010","","6260-9-240  -  HEAD FEMORAL +4MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-244","SUP","Custom 27803010","","6260-9-244  -  HEAD FEMORAL +4MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-322","SUP","Custom 27803010","","6260-9-322  -  HEAD FEM +8MM OFST TPR 22MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-326","SUP","Custom 27803010","","6260-9-326  -  HEAD FEMORAL +8MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-328","SUP","Custom 27803010","","6260-9-328  -  HEAD FEM +8MM OFST TPR 28MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-332","SUP","Custom 27803010","","6260-9-332  -  HEAD FEMORAL +8MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-336","SUP","Custom 27803010","","6260-9-336  -  HEAD FEM +10MM OFST TPR 36MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-340","SUP","Custom 27803010","","6260-9-340  -  HEAD FEM +8MM OFST TPR 40MM V40 LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-344","SUP","Custom 27803010","","6260-9-344  -  HEAD FEMORAL +8MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-426","SUP","Custom 27803010","","6260-9-426  -  HEAD FEMORAL +12MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-428","SUP","Custom 27803010","","6260-9-428  -  HEAD FEM +12MM OFST TPR 28MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-432","SUP","Custom 27803010","","6260-9-432  -  HEAD FEM +12MM OFST TPR 32MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-440","SUP","Custom 27803010","","6260-9-440  -  HEAD FEM +12MM OFST TPR 40MM V40 LFIT COCR HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-444","SUP","Custom 27803010","","6260-9-444  -  HEAD FEMORAL +12MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6260-9-628","SUP","Custom 27803010","","6260-9-628  -  HEAD FEMORAL +6MM 28MM V40 LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6261-0-001","SUP","HCPCS C1776","","6261-0-001  -  STEM FEM 9MM CMNTLS MRDN PERIAPT 00 HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6261-0-002","SUP","HCPCS C1776","","6261-0-002  -  STEM FEM 10MM CMNTLS MRDN PERIAPT HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6261-0-003","SUP","HCPCS C1776","","6261-0-003  -  STEM FEM 11MM CMNTLS MRDN PERIAPT 1 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-004","SUP","HCPCS C1776","","6261-0-004  -  STEM FEM 130MM 10MM CMNTLS MRDN PERIAPT 2 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-005","SUP","HCPCS C1776","","6261-0-005  -  STEM FEM 12MM CMNTLS MRDN PERIAPT 2 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-006","SUP","HCPCS C1776","","6261-0-006  -  STEM FEM 11MM CMNTLS MRDN PERIAPT 3 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-007","SUP","HCPCS C1776","","6261-0-007  -  STEM FEM 13MM MRDN PERIAPT 3 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-008","SUP","HCPCS C1776","","6261-0-008  -  STEM FEM 12MM CMNTLS MRDN PERIAPT 4 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-009","SUP","HCPCS C1776","","6261-0-009  -  STEM FEM 14MM CMNTLS MRDN PERIAPT 4 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-010","SUP","HCPCS C1776","","6261-0-010  -  STEM FEM 13MM CMNTLS MRDN PERIAPT 5 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-011","SUP","HCPCS C1776","","6261-0-011  -  STEM FEM 15MM CMNTLS MRDN PERIAPT 5 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-012","SUP","HCPCS C1776","","6261-0-012  -  STEM FEM 14MM CMNTLS MRDN PERIAPT 6 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-013","SUP","HCPCS C1776","","6261-0-013  -  STEM FEM 150MM 16MM MRDN PERIAPT 132D 6 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-014","SUP","HCPCS C1776","","6261-0-014  -  STEM FEM 15MM CMNTLS MRDN PERIAPT 7 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-015","SUP","HCPCS C1776","","6261-0-015  -  STEM FEM 17MM CMNTLS MRDN PERIAPT 7 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6261-0-016","SUP","HCPCS C1776","","6261-0-016  -  STEM FEM 16MM CMNTLS MRDN PERIAPT 8 HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6261-0-017","SUP","HCPCS C1776","","6261-0-017  -  STEM FEM 18MM CMNTLS MRDN PERIAPT 8 HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6261-0-018","SUP","HCPCS C1776","","6261-0-018  -  STEM FEM 19MM CMNTLS MRDN PERIAPT 9 HIP","BOTH IP/OP","$6,861.00 ","$5,077.14 ","$0.00 ","$6,861.00 ","$3,087.45 ","$0.00 ","$1,430.00 ","$0.00 ","$0.00 ","$1,201.31 ","$6,861.00 ","$0.00 ","$3,430.50 ","$5,433.91 ","$5,488.80 ","$0.00 ","$1,073.75 ","$0.00 ","$1,092.27 ","$0.00 "
"6265-0-010","SUP","HCPCS C1776","","6265-0-010  -  STEM FEM 13MM CMNTLS MRDN ST VIT POR 5 HIP","BOTH IP/OP","$6,538.00 ","$4,838.12 ","$0.00 ","$6,538.00 ","$2,942.10 ","$0.00 ","$1,362.68 ","$0.00 ","$0.00 ","$1,144.75 ","$6,538.00 ","$0.00 ","$3,269.00 ","$5,178.10 ","$5,230.40 ","$0.00 ","$1,023.20 ","$0.00 ","$1,040.85 ","$0.00 "
"6265-1-001","SUP","HCPCS C1776","","6265-1-001  -  STEM FEM 9MM MRDN TMZF 00 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6265-1-002","SUP","HCPCS C1776","","6265-1-002  -  STEM FEM 10MM CMNTLS MRDN TMZF 0 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6265-1-003","SUP","HCPCS C1776","","6265-1-003  -  STEM FEM 11MM MRDN TMZF 1 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-004","SUP","HCPCS C1776","","6265-1-004  -  STEM FEM 10MM MRDN TMZF 2 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-005","SUP","HCPCS C1776","","6265-1-005  -  STEM FEM 12MM MRDN TMZF 2 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-006","SUP","HCPCS C1776","","6265-1-006  -  STEM FEM 3-11MM","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-007","SUP","HCPCS C1776","","6265-1-007  -  STEM FEM 13MM MRDN TMZF 3 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-008","SUP","HCPCS C1776","","6265-1-008  -  STEM FEM 4-12MM","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-009","SUP","HCPCS C1776","","6265-1-009  -  STEM FEM 14MM MRDN TMZF 4 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-010","SUP","HCPCS C1776","","6265-1-010  -  STEM FEM 13MM MRDN TMZF 5 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-011","SUP","HCPCS C1776","","6265-1-011  -  STEM FEM 15MM CMNTLS MRDN TMZF 5 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-012","SUP","HCPCS C1776","","6265-1-012  -  STEM FEM 14MM MRDN TMZF 6 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-013","SUP","HCPCS C1776","","6265-1-013  -  STEM FEM 16MM MRDN TMZF 6 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-014","SUP","HCPCS C1776","","6265-1-014  -  STEM FEM 15MM CMNTLS MRDN TMZF 7 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-015","SUP","HCPCS C1776","","6265-1-015  -  STEM FEM 17MM CMNTLS MRDN TMZF 7 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"6265-1-016","SUP","HCPCS C1776","","6265-1-016  -  STEM FEM 16MM CMNTLS MRDN TMZF 8 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6265-1-017","SUP","HCPCS C1776","","6265-1-017  -  STEM FEM 18MM CMNTLS MRDN TMZF 8 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6265-1-018","SUP","HCPCS C1776","","6265-1-018  -  STEM FEM 19MM CMNTLS MRDN TMZF 9 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"6265-2-000","SUP","Custom 27803010","","6265-2-000  -  STEM FEMORAL 132D 0 10MM 115MM 31MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-001","SUP","Custom 27803010","","6265-2-001  -  STEM FEMORAL 132D 1 11MM 115MM 31MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-002","SUP","Custom 27803010","","6265-2-002  -  STEM FEMORAL 132D 2 12MM 130MM 32MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-003","SUP","Custom 27803010","","6265-2-003  -  STEM FEMORAL 132D 3 13MM 130MM 34MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-004","SUP","Custom 27803010","","6265-2-004  -  STEM FEMORAL 132D 4 14MM 140MM 35MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-005","SUP","Custom 27803010","","6265-2-005  -  STEM FEMORAL 5 15MM CEMENTED COLLARED PRESS FIT RELIANCE PF","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-006","SUP","Custom 27803010","","6265-2-006  -  STEM FEMORAL 132D 6 16MM 150MM 37MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-2-007","SUP","Custom 27803010","","6265-2-007  -  STEM FEMORAL 132D 7 17MM 150MM 39MM COLLAR PRESS FIT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-099","SUP","Custom 27803010","","6265-3-099  -  STEM FEM CMNT DFN PM 0 HIP","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-100","SUP","Custom 27803010","","6265-3-100  -  STEM FEM CMNT DFN PM 0 HIP","BOTH IP/OP","$4,488.00 ","$3,321.12 ","$0.00 ","$4,488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,488.00 ","$0.00 ","$2,244.00 ","$3,554.50 ","$3,590.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-101","SUP","Custom 27803010","","6265-3-101  -  STEM FEM 132D 1 34MM OFST 10MM 115MM 26MM CITN PUREFIX TMZF","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-102","SUP","Custom 27803010","","6265-3-102  -  STEM FEM CMNT DFN PM 2 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-103","SUP","Custom 27803010","","6265-3-103  -  STEM FEM CMNT DFN PM 3 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-104","SUP","Custom 27803010","","6265-3-104  -  STEM FEM CMNT DFN PM 4 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-105","SUP","Custom 27803010","","6265-3-105  -  STEM FEM CMNT DFN PM 5 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-106","SUP","Custom 27803010","","6265-3-106  -  STEM FEM CMNT DFN PM 6 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-107","SUP","Custom 27803010","","6265-3-107  -  STEM FEM CMNT DFN PM 7 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-111","SUP","Custom 27803010","","6265-3-111  -  STEM FEMORAL 132D 1 34MM OFFST 100MM 31MM BASE HEAD CEMENT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-112","SUP","Custom 27803010","","6265-3-112  -  STEM FEMORAL 132D 2 36MM OFFST 115MM 32MM BASE HEAD CEMENT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-113","SUP","Custom 27803010","","6265-3-113  -  STEM FEMORAL 132D 3 40MM OFFST 115MM 34MM BASE HEAD CEMENT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-114","SUP","Custom 27803010","","6265-3-114  -  STEM FEMORAL 132D 4 44MM OFFST 125MM 35MM BASE HEAD CEMENT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-3-115","SUP","Custom 27803010","","6265-3-115  -  STEM FEMORAL 132D 5 47MM OFFST 125MM 37MM BASE HEAD CEMENT","BOTH IP/OP","$2,877.50 ","$2,129.35 ","$0.00 ","$2,877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,877.50 ","$0.00 ","$1,438.75 ","$2,278.98 ","$2,302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-010","SUP","Custom 27803010","","6265-4-010  -  CNTRLZR STM 10MM DFN DISTAL FEM HIP TYPE AA TPR","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-011","SUP","Custom 27803010","","6265-4-011  -  CNTRLZR STM 11MM DFN DISTAL FEM HIP TYPE AA TPR","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-103","SUP","HCPCS C1776","","6265-4-103  -  STEM FEM DFN 3 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$1,855.35 ","$0.00 ","$859.34 ","$0.00 ","$0.00 ","$721.90 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$645.25 ","$0.00 ","$656.38 ","$0.00 "
"6265-4-105","SUP","HCPCS C1776","","6265-4-105  -  STEM FEM DFN 5 HIP","BOTH IP/OP","$4,123.00 ","$3,051.02 ","$0.00 ","$4,123.00 ","$1,855.35 ","$0.00 ","$859.34 ","$0.00 ","$0.00 ","$721.90 ","$4,123.00 ","$0.00 ","$2,061.50 ","$3,265.42 ","$3,298.40 ","$0.00 ","$645.25 ","$0.00 ","$656.38 ","$0.00 "
"6265-4-411","SUP","Custom 27803010","","6265-4-411  -  CNTRLZR STM 11MM DISTAL HIP TYPE A MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-412","SUP","Custom 27803010","","6265-4-412  -  CNTRLZR STM 12MM DISTAL HIP TYPE A MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-413","SUP","Custom 27803010","","6265-4-413  -  CNTRLZR STM 13MM DISTAL HIP TYPE A MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-414","SUP","Custom 27803010","","6265-4-414  -  CNTRLZR STM 14MM DISTAL MOD TYPE A","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-415","SUP","Custom 27803010","","6265-4-415  -  CNTRLZR STM 15MM DISTAL HIP TYPE A MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-416","SUP","Custom 27803010","","6265-4-416  -  CNTRLZR STM 16MM DFN DISTAL FEM HIP MOD TYPE A","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-417","SUP","Custom 27803010","","6265-4-417  -  CNTRLZR STM 17MM DFN DISTAL FEM HIP TYPE A MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-418","SUP","Custom 27803010","","6265-4-418  -  CNTRLZR STM 18MM DFN DISTAL FEM HIP MOD TYPE A","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-515","SUP","Custom 27803010","","6265-4-515  -  CNTRLZR STM 15MM DFN DISTAL FEM HIP TYPE B MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-516","SUP","Custom 27803010","","6265-4-516  -  CNTRLZR STM 16MM MODIFI DISTAL FEM TYPE B","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-517","SUP","Custom 27803010","","6265-4-517  -  CNTRLZR STM 17MM DFN DISTAL FEM HIP TYPE A MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-518","SUP","Custom 27803010","","6265-4-518  -  CNTRLZR STM 18MM DFN DISTAL FEM HIP TYPE B MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-519","SUP","Custom 27803010","","6265-4-519  -  CNTRLZR STM 19MM DFN DISTAL FEM HIP TYPE B MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-520","SUP","Custom 27803010","","6265-4-520  -  CONC CNTRF YLW FLTR COLLECT VL 0.5ML","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-521","SUP","Custom 27803010","","6265-4-521  -  CNTRLZR STM 21MM DFN DISTAL FEM HIP TYPE B MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-4-522","SUP","Custom 27803010","","6265-4-522  -  CNTRLZR STM 22MM DFN DISTAL FEM HIP TYPE B MOD","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6265-5-100","SUP","HCPCS C1776","","6265-5-100  -  STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-101","SUP","HCPCS C1776","","6265-5-101  -  STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-102","SUP","HCPCS C1776","","6265-5-102  -  STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-103","SUP","HCPCS C1776","","6265-5-103  -  STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-104","SUP","HCPCS C1776","","6265-5-104  -  STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-105","SUP","HCPCS C1776","","6265-5-105  -  STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-106","SUP","HCPCS C1776","","6265-5-106  -  STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-107","SUP","HCPCS C1776","","6265-5-107  -  STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-108","SUP","HCPCS C1776","","6265-5-108  -  STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-109","SUP","HCPCS C1776","","6265-5-109  -  STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-110","SUP","HCPCS C1776","","6265-5-110  -  STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-111","SUP","HCPCS C1776","","6265-5-111  -  STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-112","SUP","HCPCS C1776","","6265-5-112  -  STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-113","SUP","HCPCS C1776","","6265-5-113  -  STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-114","SUP","HCPCS C1776","","6265-5-114  -  STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-115","SUP","HCPCS C1776","","6265-5-115  -  STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-116","SUP","HCPCS C1776","","6265-5-116  -  STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-117","SUP","HCPCS C1776","","6265-5-117  -  STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-118","SUP","HCPCS C1776","","6265-5-118  -  STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5-119","SUP","HCPCS C1776","","6265-5-119  -  STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5200","SUP","HCPCS C1776","","6265-5200  -  STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5201","SUP","HCPCS C1776","","6265-5201  -  STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5202","SUP","HCPCS C1776","","6265-5202  -  STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT LEFT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5203","SUP","HCPCS C1776","","6265-5203  -  STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5204","SUP","HCPCS C1776","","6265-5204  -  STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5205","SUP","HCPCS C1776","","6265-5205  -  STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5206","SUP","HCPCS C1776","","6265-5206  -  STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT LEFT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5207","SUP","HCPCS C1776","","6265-5207  -  STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5208","SUP","HCPCS C1776","","6265-5208  -  STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5209","SUP","HCPCS C1776","","6265-5209  -  STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT LEFT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5210","SUP","HCPCS C1776","","6265-5210  -  STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5211","SUP","HCPCS C1776","","6265-5211  -  STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5212","SUP","HCPCS C1776","","6265-5212  -  STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5213","SUP","HCPCS C1776","","6265-5213  -  STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5214","SUP","HCPCS C1776","","6265-5214  -  STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5215","SUP","HCPCS C1776","","6265-5215  -  STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5216","SUP","HCPCS C1776","","6265-5216  -  STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5217","SUP","HCPCS C1776","","6265-5217  -  STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5218","SUP","HCPCS C1776","","6265-5218  -  STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"6265-5219","SUP","HCPCS C1776","","6265-5219  -  STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT RIGHT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"626631US","SUP","Custom 27803010","","626631US  -  KIT PRESSURE MONITR 14GA BASIC TRANSDUCER TUOHY NEEDLE","BOTH IP/OP","$2,043.98 ","$1,512.55 ","$0.00 ","$2,095.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,095.40 ","$0.00 ","$1,047.70 ","$1,659.56 ","$1,676.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6269-1-212","SUP","HCPCS C1776","","6269-1-212  -  STEM FEM 10IN 12MM BW RSTOR TI 2 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-1-414","SUP","HCPCS C1776","","6269-1-414  -  STEM FEM 10IN 14MM BW RSTOR TI 4 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-1-719","SUP","HCPCS C1776","","6269-1-719  -  STEM FEM 10IN 19MM BW RSTOR TI 7 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-1-818","SUP","HCPCS C1776","","6269-1-818  -  STEM FEM 10IN 18MM BW RSTOR TI 8 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-1-820","SUP","HCPCS C1776","","6269-1-820  -  STEM FEM 10IN 20MM BW RSTOR TI 8 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-1-921","SUP","HCPCS C1776","","6269-1-921  -  STEM FEM 10IN 21MM BW RSTOR TI 9 LEFT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-212","SUP","HCPCS C1776","","6269-2-212  -  STEM FEM 10IN 12MM BW RSTOR TI 2 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-313","SUP","HCPCS C1776","","6269-2-313  -  STEM FEM 10IN 13MM BW RSTOR TI 3 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-414","SUP","HCPCS C1776","","6269-2-414  -  STEM FEM 10IN 14MM BW RSTOR TI 4 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-515","SUP","HCPCS C1776","","6269-2-515  -  STEM FEM 10IN 15MM BW RSTOR TI 5 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-616","SUP","HCPCS C1776","","6269-2-616  -  STEM FEM 10IN 16MM BW RSTOR TI 6 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-717","SUP","HCPCS C1776","","6269-2-717  -  STEM FEM 10IN 17MM BW RSTOR TI 7 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-719","SUP","HCPCS C1776","","6269-2-719  -  STEM FEM 10IN 19MM BW RSTOR TI 7 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-818","SUP","HCPCS C1776","","6269-2-818  -  STEM FEM 10IN 18MM BW RSTOR TI 8 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-820","SUP","HCPCS C1776","","6269-2-820  -  STEM FEM 10IN 20MM BW RSTOR TI 8 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-2-921","SUP","HCPCS C1776","","6269-2-921  -  STEM FEM 10IN 21MM BW RSTOR TI 9 RIGHT HIP","BOTH IP/OP","$13,745.88 ","$10,171.95 ","$0.00 ","$13,745.88 ","$6,185.64 ","$0.00 ","$2,864.98 ","$0.00 ","$0.00 ","$2,406.79 ","$13,745.88 ","$0.00 ","$6,872.94 ","$10,886.74 ","$10,996.70 ","$0.00 ","$2,151.23 ","$0.00 ","$2,188.34 ","$0.00 "
"6269-3-111","SUP","HCPCS C1776","","6269-3-111  -  STEM FEM 8IN 11MM BW RSTOR TI 1 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-113","SUP","HCPCS C1776","","6269-3-113  -  STEM FEM 8IN 13MM BW RSTOR TI 1 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-212","SUP","HCPCS C1776","","6269-3-212  -  STEM FEM 8IN 12MM BW RSTOR TI 2 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-214","SUP","HCPCS C1776","","6269-3-214  -  STEM FEM 8IN 14MM BW RSTOR TI 2 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-313","SUP","HCPCS C1776","","6269-3-313  -  STEM FEM 8IN 13MM BW RSTOR TI 3 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-315","SUP","HCPCS C1776","","6269-3-315  -  STEM FEM 8IN 15MM BW RSTOR TI 3 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-414","SUP","HCPCS C1776","","6269-3-414  -  STEM FEM 8IN 14MM BW RSTOR TI 4 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-416","SUP","HCPCS C1776","","6269-3-416  -  STEM FEM 8IN 16MM BW RSTOR TI 4 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-515","SUP","HCPCS C1776","","6269-3-515  -  STEM FEM 8IN 15MM BW RSTOR TI 5 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-517","SUP","HCPCS C1776","","6269-3-517  -  STEM FEM 8IN 17MM BW RSTOR TI 5 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-616","SUP","HCPCS C1776","","6269-3-616  -  STEM FEM 8IN 16MM BW RSTOR TI 6 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-618","SUP","HCPCS C1776","","6269-3-618  -  STEM FEM 8IN 18MM BW RSTOR TI 6 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-717","SUP","HCPCS C1776","","6269-3-717  -  STEM FEM 8IN 17MM BW RSTOR TI 7 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-818","SUP","HCPCS C1776","","6269-3-818  -  STEM FEM 8IN 18MM BW RSTOR TI 8 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-3-820","SUP","HCPCS C1776","","6269-3-820  -  STEM FEM 8IN 20MM BW RSTOR TI 8 LEFT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-111","SUP","HCPCS C1776","","6269-4-111  -  STEM FEM 8IN 11MM BW RSTOR TI 1 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-113","SUP","HCPCS C1776","","6269-4-113  -  STEM FEM 8IN 13MM BW RSTOR TI 1 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-212","SUP","HCPCS C1776","","6269-4-212  -  STEM FEM 8IN 12MM BW RSTOR TI 2 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-214","SUP","HCPCS C1776","","6269-4-214  -  STEM FEM 8IN 14MM BW RSTOR TI 2 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-313","SUP","HCPCS C1776","","6269-4-313  -  STEM FEM 8IN 13MM BW RSTOR TI 3 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-315","SUP","HCPCS C1776","","6269-4-315  -  STEM FEM 8IN 15MM BW RSTOR TI 3 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-414","SUP","HCPCS C1776","","6269-4-414  -  STEM FEM 8IN 14MM BW PS RSTOR TI 4 RIGHT","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-416","SUP","HCPCS C1776","","6269-4-416  -  STEM FEM 8IN 16MM BW RSTOR TI 4 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-515","SUP","HCPCS C1776","","6269-4-515  -  STEM FEM 8IN 15MM BW RSTOR TI 5 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-517","SUP","HCPCS C1776","","6269-4-517  -  STEM FEM 8IN 17MM BW RSTOR TI 5 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-616","SUP","HCPCS C1776","","6269-4-616  -  STEM FEM 8IN 16MM BW RSTOR TI 6 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-618","SUP","HCPCS C1776","","6269-4-618  -  STEM FEM 8IN 18MM BW RSTOR TI 6 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-717","SUP","HCPCS C1776","","6269-4-717  -  STEM FEM 8IN 17MM BW RSTOR TI 7 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-719","SUP","HCPCS C1776","","6269-4-719  -  STEM FEM 8IN 19MM BW RSTOR TI 7 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-818","SUP","HCPCS C1776","","6269-4-818  -  STEM FEM 8IN 18MM BW RSTOR TI 8 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-820","SUP","HCPCS C1776","","6269-4-820  -  STEM FEM 8IN 20MM BW RSTOR TI 8 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6269-4-921","SUP","HCPCS C1776","","6269-4-921  -  STEM FEM 8IN 21MM BW RSTOR TI 9 RIGHT HIP","BOTH IP/OP","$13,281.13 ","$9,828.04 ","$0.00 ","$13,281.13 ","$5,976.51 ","$0.00 ","$2,768.12 ","$0.00 ","$0.00 ","$2,325.42 ","$13,281.13 ","$0.00 ","$6,640.56 ","$10,518.65 ","$10,624.90 ","$0.00 ","$2,078.50 ","$0.00 ","$2,114.36 ","$0.00 "
"6276-1-019","SUP","HCPCS C1776","","6276-1-019  -  BODY CONE +0MM STANDARD 19MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-021","SUP","HCPCS C1776","","6276-1-021  -  BODY CONE +0MM STANDARD 21MM MODULAR REVISION BOLT RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-023","SUP","HCPCS C1776","","6276-1-023  -  BODY CONE +0MM STANDARD 23MM 23MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-025","SUP","HCPCS C1776","","6276-1-025  -  BODY CONE +0MM STANDARD 25MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-027","SUP","HCPCS C1776","","6276-1-027  -  BODY CONE +0MM STANDARD 27MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-029","SUP","HCPCS C1776","","6276-1-029  -  BODY CONE +0MM STANDARD 29MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-031","SUP","HCPCS C1776","","6276-1-031  -  BODY CONE +0MM STANDARD 31MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-119","SUP","HCPCS C1776","","6276-1-119  -  BODY CONE +10MM 19MM MODULAR RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-121","SUP","HCPCS C1776","","6276-1-121  -  BODY CONE +10MM 21MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-123","SUP","HCPCS C1776","","6276-1-123  -  BODY CONE +10MM 23MM RSTR MDLR REV TI HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-125","SUP","HCPCS C1776","","6276-1-125  -  BODY CONE +10MM 25MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-127","SUP","HCPCS C1776","","6276-1-127  -  BODY CONE +10MM 27MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-129","SUP","HCPCS C1776","","6276-1-129  -  BODY CONE +10MM 29MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-131","SUP","HCPCS C1776","","6276-1-131  -  BODY CONE +10MM 31MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-219","SUP","HCPCS C1776","","6276-1-219  -  BODY CONE +20MM 19MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-221","SUP","HCPCS C1776","","6276-1-221  -  BODY CONE +20MM 21MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-223","SUP","HCPCS C1776","","6276-1-223  -  BODY CONE +20MM 23MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-225","SUP","HCPCS C1776","","6276-1-225  -  BODY CONE +20MM 25MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-227","SUP","HCPCS C1776","","6276-1-227  -  BODY CONE +20MM 27MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-229","SUP","HCPCS C1776","","6276-1-229  -  BODY CONE +20MM 29MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-231","SUP","HCPCS C1776","","6276-1-231  -  BODY CONE +20MM 31MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-319","SUP","HCPCS C1776","","6276-1-319  -  BODY CONE +30MM 19MM MODULAR RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-321","SUP","HCPCS C1776","","6276-1-321  -  BODY CONE +30MM 21MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-323","SUP","HCPCS C1776","","6276-1-323  -  BODY CONE +30MM 23MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-325","SUP","HCPCS C1776","","6276-1-325  -  BODY CONE +30MM 25MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-327","SUP","HCPCS C1776","","6276-1-327  -  BODY CONE +30MM 27MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-329","SUP","HCPCS C1776","","6276-1-329  -  BODY CONE +30MM 29MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-1-331","SUP","HCPCS C1776","","6276-1-331  -  BODY CONE +30MM 31MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-019","SUP","HCPCS C1776","","6276-2-019  -  BODY MILLED 19MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-021","SUP","HCPCS C1776","","6276-2-021  -  BODY MILLED 21MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-023","SUP","HCPCS C1776","","6276-2-023  -  BODY MILLED 23MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-025","SUP","HCPCS C1776","","6276-2-025  -  BODY MILLED 25MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-027","SUP","HCPCS C1776","","6276-2-027  -  BODY MILLED 27MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-029","SUP","HCPCS C1776","","6276-2-029  -  BODY MILLED 29MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-031","SUP","HCPCS C1776","","6276-2-031  -  BODY MILLED 31MM MODULAR SHALLOW RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-119","SUP","HCPCS C1776","","6276-2-119  -  BODY MILLED 19MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-121","SUP","HCPCS C1776","","6276-2-121  -  BODY MILLED 21MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-123","SUP","HCPCS C1776","","6276-2-123  -  BODY MILLED 23MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-125","SUP","HCPCS C1776","","6276-2-125  -  BODY MILLED 25MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-127","SUP","HCPCS C1776","","6276-2-127  -  BODY MILLED 27MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-129","SUP","HCPCS C1776","","6276-2-129  -  BODY MILLED 29MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-131","SUP","HCPCS C1776","","6276-2-131  -  BODY MILLED 31MM MODULAR DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-227","SUP","HCPCS C1776","","6276-2-227  -  BODY MILLED 27MM MODULAR EXTRA DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-229","SUP","HCPCS C1776","","6276-2-229  -  BODY MILLED 29MM MODULAR EXTRA DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-2-231","SUP","HCPCS C1776","","6276-2-231  -  BODY MILLED 31MM MODULAR EXTRA DEEP RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-001","SUP","HCPCS C1776","","6276-3-001  -  BODY BROACHED 1 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-002","SUP","HCPCS C1776","","6276-3-002  -  BODY BROACHED 2 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-003","SUP","HCPCS C1776","","6276-3-003  -  BODY BROACHED 3 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-004","SUP","HCPCS C1776","","6276-3-004  -  BODY BROACHED 4 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-005","SUP","HCPCS C1776","","6276-3-005  -  BODY BROACHED 5 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-006","SUP","HCPCS C1776","","6276-3-006  -  BODY BROACHED 6 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-007","SUP","HCPCS C1776","","6276-3-007  -  BODY BROACHED 7 REVISION MODULAR RSTOR HIP FEMUR","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-3-008","SUP","HCPCS C1776","","6276-3-008  -  BODY BROACHED 8 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL","BOTH IP/OP","$9,422.50 ","$6,972.65 ","$0.00 ","$9,422.50 ","$4,240.13 ","$0.00 ","$1,963.88 ","$0.00 ","$0.00 ","$1,649.80 ","$9,422.50 ","$0.00 ","$4,711.25 ","$7,462.62 ","$7,538.00 ","$0.00 ","$1,474.62 ","$0.00 ","$1,500.06 ","$0.00 "
"6276-4-119","SUP","HCPCS C1776","","6276-4-119  -  BODY CALCAR +10MM OFFST 19MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-121","SUP","HCPCS C1776","","6276-4-121  -  BODY CALCAR +10MM OFFST 21MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-123","SUP","HCPCS C1776","","6276-4-123  -  BODY CALCAR +10MM OFFST 23MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-125","SUP","HCPCS C1776","","6276-4-125  -  BODY CALCAR +10MM OFFST 25MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-127","SUP","HCPCS C1776","","6276-4-127  -  BODY CALCAR +10MM OFFST 27MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-129","SUP","HCPCS C1776","","6276-4-129  -  BODY CALCAR +10MM OFFST 29MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-131","SUP","HCPCS C1776","","6276-4-131  -  BODY CALCAR +10MM OFFST 31MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-219","SUP","HCPCS C1776","","6276-4-219  -  BODY CALCAR +20MM OFFST 19MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-221","SUP","HCPCS C1776","","6276-4-221  -  BODY CALCAR +20MM OFFST 21MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-223","SUP","HCPCS C1776","","6276-4-223  -  BODY CALCAR +20MM OFFST 23MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-225","SUP","HCPCS C1776","","6276-4-225  -  BODY CALCAR +20MM OFFST 25MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-227","SUP","HCPCS C1776","","6276-4-227  -  BODY CALCAR +20MM OFFST 27MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-229","SUP","HCPCS C1776","","6276-4-229  -  BODY CALCAR +20MM OFFST 29MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-231","SUP","HCPCS C1776","","6276-4-231  -  BODY CALCAR +20MM OFFST 31MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-319","SUP","HCPCS C1776","","6276-4-319  -  BODY CALCAR +30MM OFFST 19MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-321","SUP","HCPCS C1776","","6276-4-321  -  BODY CALCAR +30MM OFFST 21MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-323","SUP","HCPCS C1776","","6276-4-323  -  BODY CALCAR +30MM OFFST 23MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-325","SUP","HCPCS C1776","","6276-4-325  -  BODY CALCAR +30MM OFFST 25MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-327","SUP","HCPCS C1776","","6276-4-327  -  BODY CALCAR +30MM OFFST 27MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-329","SUP","HCPCS C1776","","6276-4-329  -  BODY CALCAR +30MM OFFST 29MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-4-331","SUP","HCPCS C1776","","6276-4-331  -  BODY CALCAR +30MM OFFST 31MM MODULAR RSTOR HIP","BOTH IP/OP","$9,827.50 ","$7,272.35 ","$0.00 ","$9,827.50 ","$4,422.38 ","$0.00 ","$2,048.30 ","$0.00 ","$0.00 ","$1,720.72 ","$9,827.50 ","$0.00 ","$4,913.75 ","$7,783.38 ","$7,862.00 ","$0.00 ","$1,538.00 ","$0.00 ","$1,564.54 ","$0.00 "
"6276-5-011","SUP","HCPCS C1776","","6276-5-011  -  STEM FEMORAL STR 11MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-012","SUP","HCPCS C1776","","6276-5-012  -  STEM FEMORAL STR 12MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-013","SUP","HCPCS C1776","","6276-5-013  -  STEM FEMORAL STR 13MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-014","SUP","HCPCS C1776","","6276-5-014  -  STEM FEMORAL STR 14MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-015","SUP","HCPCS C1776","","6276-5-015  -  STEM FEMORAL STR 15MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-016","SUP","HCPCS C1776","","6276-5-016  -  STEM FEMORAL STR 16MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-017","SUP","HCPCS C1776","","6276-5-017  -  STEM FEMORAL STR 17MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-018","SUP","HCPCS C1776","","6276-5-018  -  STEM FEMORAL STR 18MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-019","SUP","HCPCS C1776","","6276-5-019  -  STEM FEMORAL STR 19MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-020","SUP","HCPCS C1776","","6276-5-020  -  STEM FEMORAL STR 20MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-021","SUP","HCPCS C1776","","6276-5-021  -  STEM FEMORAL STR 21MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-022","SUP","HCPCS C1776","","6276-5-022  -  STEM FEMORAL STR 22MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-023","SUP","HCPCS C1776","","6276-5-023  -  STEM FEMORAL STR 23MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-024","SUP","HCPCS C1776","","6276-5-024  -  STEM FEMORAL STR 24MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-025","SUP","HCPCS C1776","","6276-5-025  -  STEM FEMORAL STR 25MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-026","SUP","HCPCS C1776","","6276-5-026  -  STEM FEMORAL STR 26MM 127MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-111","SUP","HCPCS C1776","","6276-5-111  -  STEM FEMORAL 11MM 167MM MODULAR STR PLASMA RSTOR DISTAL","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-112","SUP","HCPCS C1776","","6276-5-112  -  STEM FEMORAL STR 12MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-113","SUP","HCPCS C1776","","6276-5-113  -  STEM FEMORAL STR 13MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-114","SUP","HCPCS C1776","","6276-5-114  -  STEM FEMORAL STR 14MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-115","SUP","HCPCS C1776","","6276-5-115  -  STEM FEMORAL STR 15MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-116","SUP","HCPCS C1776","","6276-5-116  -  STEM FEMORAL STR 16MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-117","SUP","HCPCS C1776","","6276-5-117  -  STEM FEMORAL STR 17MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-118","SUP","HCPCS C1776","","6276-5-118  -  STEM FEMORAL STR 18MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-119","SUP","HCPCS C1776","","6276-5-119  -  STEM FEMORAL STR 19MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-120","SUP","HCPCS C1776","","6276-5-120  -  STEM FEMORAL STR 20MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-121","SUP","HCPCS C1776","","6276-5-121  -  STEM FEMORAL STR 21MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-122","SUP","HCPCS C1776","","6276-5-122  -  STEM FEMORAL STR 22MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-123","SUP","HCPCS C1776","","6276-5-123  -  STEM FEMORAL STR 23MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-124","SUP","HCPCS C1776","","6276-5-124  -  STEM FEMORAL STR 24MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-125","SUP","HCPCS C1776","","6276-5-125  -  STEM FEMORAL STR 25MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-126","SUP","HCPCS C1776","","6276-5-126  -  STEM FEMORAL STR 26MM 167MM MODULAR RSTOR HA POROUS PLASMA","BOTH IP/OP","$7,417.50 ","$5,488.95 ","$0.00 ","$7,417.50 ","$3,337.88 ","$0.00 ","$1,545.99 ","$0.00 ","$0.00 ","$1,298.74 ","$7,417.50 ","$0.00 ","$3,708.75 ","$5,874.66 ","$5,934.00 ","$0.00 ","$1,160.84 ","$0.00 ","$1,180.87 ","$0.00 "
"6276-5-211","SUP","HCPCS C1776","","6276-5-211  -  STEM FEMORAL BOWED 11MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-212","SUP","HCPCS C1776","","6276-5-212  -  STEM FEMORAL BOWED 12MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-213","SUP","HCPCS C1776","","6276-5-213  -  STEM FEMORAL BOWED 13MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-214","SUP","HCPCS C1776","","6276-5-214  -  STEM FEMORAL BOWED 14MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-215","SUP","HCPCS C1776","","6276-5-215  -  STEM FEMORAL BOWED 15MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-216","SUP","HCPCS C1776","","6276-5-216  -  STEM FEMORAL BOWED 16MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-217","SUP","HCPCS C1776","","6276-5-217  -  STEM FEMORAL BOWED 17MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-218","SUP","HCPCS C1776","","6276-5-218  -  STEM FEMORAL BOWED 18MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-219","SUP","HCPCS C1776","","6276-5-219  -  STEM FEMORAL BOWED 19MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-220","SUP","HCPCS C1776","","6276-5-220  -  STEM FEMORAL BOWED 20MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-221","SUP","HCPCS C1776","","6276-5-221  -  STEM FEMORAL BOWED 21MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-222","SUP","HCPCS C1776","","6276-5-222  -  STEM FEMORAL BOWED 22MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-223","SUP","HCPCS C1776","","6276-5-223  -  STEM FEMORAL BOWED 23MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-224","SUP","HCPCS C1776","","6276-5-224  -  STEM FEMORAL BOWED 24MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-225","SUP","HCPCS C1776","","6276-5-225  -  STEM FEMORAL BOWED 25MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-226","SUP","HCPCS C1776","","6276-5-226  -  STEM FEMORAL BOWED 26MM 167MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-411","SUP","HCPCS C1776","","6276-5-411  -  STEM FEMORAL BOWED 11MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-412","SUP","HCPCS C1776","","6276-5-412  -  STEM FEMORAL BOWED 12MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-413","SUP","HCPCS C1776","","6276-5-413  -  STEM FEMORAL BOWED 13MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-414","SUP","HCPCS C1776","","6276-5-414  -  STEM FEMORAL BOWED 14MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-415","SUP","HCPCS C1776","","6276-5-415  -  STEM FEMORAL BOWED 15MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-416","SUP","HCPCS C1776","","6276-5-416  -  STEM FEMORAL BOWED 16MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-417","SUP","HCPCS C1776","","6276-5-417  -  STEM FEMORAL BOWED 17MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-418","SUP","HCPCS C1776","","6276-5-418  -  STEM FEMORAL BOWED 18MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-419","SUP","HCPCS C1776","","6276-5-419  -  STEM FEMORAL BOWED 19MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-420","SUP","HCPCS C1776","","6276-5-420  -  STEM FEMORAL BOWED 20MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-421","SUP","HCPCS C1776","","6276-5-421  -  STEM FEMORAL BOWED 21MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-422","SUP","HCPCS C1776","","6276-5-422  -  STEM FEMORAL BOWED 22MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-423","SUP","HCPCS C1776","","6276-5-423  -  STEM FEMORAL BOWED 23MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-424","SUP","HCPCS C1776","","6276-5-424  -  STEM FEMORAL BOWED 24MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-425","SUP","HCPCS C1776","","6276-5-425  -  STEM FEMORAL BOWED 25MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-426","SUP","HCPCS C1776","","6276-5-426  -  STEM FEMORAL BOWED 26MM 217MM MODULAR PLASMA SPRAYED RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-511","SUP","HCPCS C1776","","6276-5-511  -  STEM FEMORAL 11MM 267MM BOWED PLASMA REVISION MODULAR RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-512","SUP","HCPCS C1776","","6276-5-512  -  STEM FEMORAL 12MM 267MM MODULAR BOWED PLASMA RSTOR DISTAL","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-513","SUP","HCPCS C1776","","6276-5-513  -  STEM FEMORAL 13MM 267MM BOWED PLASMA REVISION MODULAR RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-514","SUP","HCPCS C1776","","6276-5-514  -  STEM FEMORAL 14MM 267MM BOWED PLASMA REVISION MODULAR RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-515","SUP","HCPCS C1776","","6276-5-515  -  STEM FEMORAL 15MM 267MM BOWED PLASMA REVISION MODULAR RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-516","SUP","HCPCS C1776","","6276-5-516  -  STEM FEMORAL 16MM 267MM BOWED PLASMA REVISION MODULAR RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-517","SUP","HCPCS C1776","","6276-5-517  -  STEM FEMORAL 17MM 267MM BOWED PLASMA REVISION MODULAR RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-518","SUP","HCPCS C1776","","6276-5-518  -  STEM FEMORAL 18MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-519","SUP","HCPCS C1776","","6276-5-519  -  STEM FEMORAL 19MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-520","SUP","HCPCS C1776","","6276-5-520  -  STEM FEMORAL 20MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-521","SUP","HCPCS C1776","","6276-5-521  -  STEM FEMORAL 21MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-522","SUP","HCPCS C1776","","6276-5-522  -  STEM FEMORAL 22MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-523","SUP","HCPCS C1776","","6276-5-523  -  STEM FEMORAL 23MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-524","SUP","HCPCS C1776","","6276-5-524  -  STEM FEMORAL 24MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-525","SUP","HCPCS C1776","","6276-5-525  -  STEM FEMORAL 25MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-526","SUP","HCPCS C1776","","6276-5-526  -  STEM FEMORAL 26MM 267MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-611","SUP","HCPCS C1776","","6276-5-611  -  STEM FEMORAL 11MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-612","SUP","HCPCS C1776","","6276-5-612  -  STEM FEMORAL 12MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-613","SUP","HCPCS C1776","","6276-5-613  -  STEM FEMORAL 13MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-614","SUP","HCPCS C1776","","6276-5-614  -  STEM FEMORAL 14MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-615","SUP","HCPCS C1776","","6276-5-615  -  STEM FEMORAL 15MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-616","SUP","HCPCS C1776","","6276-5-616  -  STEM FEMORAL 16MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-617","SUP","HCPCS C1776","","6276-5-617  -  STEM FEMORAL 17MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-618","SUP","HCPCS C1776","","6276-5-618  -  STEM FEMORAL 18MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-619","SUP","HCPCS C1776","","6276-5-619  -  STEM FEMORAL 19MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-620","SUP","HCPCS C1776","","6276-5-620  -  STEM FEMORAL 20MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-621","SUP","HCPCS C1776","","6276-5-621  -  STEM FEMORAL 21MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-622","SUP","HCPCS C1776","","6276-5-622  -  STEM FEMORAL 22MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-623","SUP","HCPCS C1776","","6276-5-623  -  STEM FEMORAL 23MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-624","SUP","HCPCS C1776","","6276-5-624  -  STEM FEMORAL 24MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-625","SUP","HCPCS C1776","","6276-5-625  -  STEM FEMORAL 25MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-5-626","SUP","HCPCS C1776","","6276-5-626  -  STEM FEMORAL 26MM 317MM BOWED PLASMA MODULAR REVISION RSTOR","BOTH IP/OP","$8,420.00 ","$6,230.80 ","$0.00 ","$8,420.00 ","$3,789.00 ","$0.00 ","$1,754.94 ","$0.00 ","$0.00 ","$1,474.27 ","$8,420.00 ","$0.00 ","$4,210.00 ","$6,668.64 ","$6,736.00 ","$0.00 ","$1,317.73 ","$0.00 ","$1,340.46 ","$0.00 "
"6276-6-011","SUP","HCPCS C1776","","6276-6-011  -  STEM FEMORAL STR FLUTE 11MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-012","SUP","HCPCS C1776","","6276-6-012  -  STEM FEMORAL STR FLUTE 12MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-013","SUP","HCPCS C1776","","6276-6-013  -  STEM FEMORAL STR FLUTE 13MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-014","SUP","HCPCS C1776","","6276-6-014  -  STEM FEMORAL STR FLUTE 14MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-015","SUP","HCPCS C1776","","6276-6-015  -  STEM FEMORAL STR FLUTE 15MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-016","SUP","HCPCS C1776","","6276-6-016  -  STEM FEMORAL STR FLUTE 16MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-017","SUP","HCPCS C1776","","6276-6-017  -  STEM FEMORAL STR FLUTE 17MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-018","SUP","HCPCS C1776","","6276-6-018  -  STEM FEMORAL STR FLUTE 18MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-019","SUP","HCPCS C1776","","6276-6-019  -  STEM FEMORAL STR FLUTE 19MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-020","SUP","HCPCS C1776","","6276-6-020  -  STEM FEMORAL STR FLUTE 20MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-021","SUP","HCPCS C1776","","6276-6-021  -  STEM FEMORAL STR FLUTE 21MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-022","SUP","HCPCS C1776","","6276-6-022  -  STEM FEMORAL STR FLUTE 22MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-023","SUP","HCPCS C1776","","6276-6-023  -  STEM FEMORAL STR FLUTE 23MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-024","SUP","HCPCS C1776","","6276-6-024  -  STEM FEMORAL STR FLUTE 24MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-025","SUP","HCPCS C1776","","6276-6-025  -  STEM FEMORAL STR FLUTE 25MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-026","SUP","HCPCS C1776","","6276-6-026  -  STEM FEMORAL STR FLUTE 26MM 127MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-111","SUP","HCPCS C1776","","6276-6-111  -  STEM FEMORAL STR FLUTE 11MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-112","SUP","HCPCS C1776","","6276-6-112  -  STEM FEMORAL STR FLUTE 12MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-113","SUP","HCPCS C1776","","6276-6-113  -  STEM FEMORAL STR FLUTE 13MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-114","SUP","HCPCS C1776","","6276-6-114  -  STEM FEMORAL STR FLUTE 14MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-115","SUP","HCPCS C1776","","6276-6-115  -  STEM FEMORAL STR FLUTE 15MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-116","SUP","HCPCS C1776","","6276-6-116  -  STEM FEMORAL STR FLUTE 16MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-117","SUP","HCPCS C1776","","6276-6-117  -  STEM FEMORAL STR FLUTE 17MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-118","SUP","HCPCS C1776","","6276-6-118  -  STEM FEMORAL STR FLUTE 18MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-119","SUP","HCPCS C1776","","6276-6-119  -  STEM FEMORAL STR FLUTE 19MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-120","SUP","HCPCS C1776","","6276-6-120  -  STEM FEMORAL STR FLUTE 20MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-121","SUP","HCPCS C1776","","6276-6-121  -  STEM FEMORAL STR FLUTE 21MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-122","SUP","HCPCS C1776","","6276-6-122  -  STEM FEMORAL STR FLUTE 22MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-123","SUP","HCPCS C1776","","6276-6-123  -  STEM FEMORAL STR FLUTE 23MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-124","SUP","HCPCS C1776","","6276-6-124  -  STEM FEMORAL STR FLUTE 24MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-125","SUP","HCPCS C1776","","6276-6-125  -  STEM FEMORAL STR FLUTE 25MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-126","SUP","HCPCS C1776","","6276-6-126  -  STEM FEMORAL STR FLUTE 26MM 167MM MODULAR RSTOR HIP","BOTH IP/OP","$5,762.50 ","$4,264.25 ","$0.00 ","$5,762.50 ","$2,593.13 ","$0.00 ","$1,201.05 ","$0.00 ","$0.00 ","$1,008.97 ","$5,762.50 ","$0.00 ","$2,881.25 ","$4,563.90 ","$4,610.00 ","$0.00 ","$901.83 ","$0.00 ","$917.39 ","$0.00 "
"6276-6-211","SUP","HCPCS C1776","","6276-6-211  -  STEM FEMORAL 11MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-212","SUP","HCPCS C1776","","6276-6-212  -  STEM FEMORAL 12MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-213","SUP","HCPCS C1776","","6276-6-213  -  STEM FEMORAL 13MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-214","SUP","HCPCS C1776","","6276-6-214  -  STEM FEMORAL 14MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-215","SUP","HCPCS C1776","","6276-6-215  -  STEM FEMORAL 15MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-216","SUP","HCPCS C1776","","6276-6-216  -  STEM FEMORAL 16MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-217","SUP","HCPCS C1776","","6276-6-217  -  STEM FEMORAL 17MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-218","SUP","HCPCS C1776","","6276-6-218  -  STEM FEMORAL 18MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-219","SUP","HCPCS C1776","","6276-6-219  -  STEM FEMORAL 19MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-220","SUP","HCPCS C1776","","6276-6-220  -  STEM FEMORAL 20MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-221","SUP","HCPCS C1776","","6276-6-221  -  STEM FEMORAL 21MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-222","SUP","HCPCS C1776","","6276-6-222  -  STEM FEMORAL 22MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-223","SUP","HCPCS C1776","","6276-6-223  -  STEM FEMORAL 23MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-224","SUP","HCPCS C1776","","6276-6-224  -  STEM FEMORAL 24MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-225","SUP","HCPCS C1776","","6276-6-225  -  STEM FEMORAL 25MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-226","SUP","HCPCS C1776","","6276-6-226  -  STEM FEMORAL 26MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-411","SUP","HCPCS C1776","","6276-6-411  -  STEM FEMORAL 11MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-412","SUP","HCPCS C1776","","6276-6-412  -  STEM FEMORAL 12MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-413","SUP","HCPCS C1776","","6276-6-413  -  STEM FEMORAL 13MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-414","SUP","HCPCS C1776","","6276-6-414  -  STEM FEMORAL 14MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-415","SUP","HCPCS C1776","","6276-6-415  -  STEM FEMORAL 15MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-416","SUP","HCPCS C1776","","6276-6-416  -  STEM FEMORAL 16MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-417","SUP","HCPCS C1776","","6276-6-417  -  STEM FEMORAL 17MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-418","SUP","HCPCS C1776","","6276-6-418  -  STEM FEMORAL 18MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-419","SUP","HCPCS C1776","","6276-6-419  -  STEM FEMORAL 19MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-420","SUP","HCPCS C1776","","6276-6-420  -  STEM FEMORAL 20MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-421","SUP","HCPCS C1776","","6276-6-421  -  STEM FEMORAL 21MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-422","SUP","HCPCS C1776","","6276-6-422  -  STEM FEMORAL 22MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-423","SUP","HCPCS C1776","","6276-6-423  -  STEM FEMORAL 23MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-424","SUP","HCPCS C1776","","6276-6-424  -  STEM FEMORAL 24MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-425","SUP","HCPCS C1776","","6276-6-425  -  STEM FEMORAL 25MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-426","SUP","HCPCS C1776","","6276-6-426  -  STEM FEMORAL 26MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,760.00 ","$5,742.40 ","$0.00 ","$7,760.00 ","$3,492.00 ","$0.00 ","$1,617.38 ","$0.00 ","$0.00 ","$1,358.71 ","$7,760.00 ","$0.00 ","$3,880.00 ","$6,145.92 ","$6,208.00 ","$0.00 ","$1,214.44 ","$0.00 ","$1,235.39 ","$0.00 "
"6276-6-511","SUP","HCPCS C1776","","6276-6-511  -  STEM FEMORAL 11MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-512","SUP","HCPCS C1776","","6276-6-512  -  STEM FEMORAL 12MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-513","SUP","HCPCS C1776","","6276-6-513  -  STEM FEMORAL 13MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-514","SUP","HCPCS C1776","","6276-6-514  -  STEM FEMORAL 14MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-515","SUP","HCPCS C1776","","6276-6-515  -  STEM FEMORAL 15MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-516","SUP","HCPCS C1776","","6276-6-516  -  STEM FEMORAL 16MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-517","SUP","HCPCS C1776","","6276-6-517  -  STEM FEMORAL 17MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-518","SUP","HCPCS C1776","","6276-6-518  -  STEM FEMORAL 18MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-519","SUP","HCPCS C1776","","6276-6-519  -  STEM FEMORAL 19MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-520","SUP","HCPCS C1776","","6276-6-520  -  STEM FEMORAL 20MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-521","SUP","HCPCS C1776","","6276-6-521  -  STEM FEMORAL 21MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-522","SUP","HCPCS C1776","","6276-6-522  -  STEM FEMORAL 22MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-523","SUP","HCPCS C1776","","6276-6-523  -  STEM FEMORAL 23MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-524","SUP","HCPCS C1776","","6276-6-524  -  STEM FEMORAL 24MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-525","SUP","HCPCS C1776","","6276-6-525  -  STEM FEMORAL 25MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-526","SUP","HCPCS C1776","","6276-6-526  -  STEM FEMORAL 26MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-611","SUP","HCPCS C1776","","6276-6-611  -  STEM FEMORAL 11MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-612","SUP","HCPCS C1776","","6276-6-612  -  STEM FEMORAL 12MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-613","SUP","HCPCS C1776","","6276-6-613  -  STEM FEMORAL 13MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-614","SUP","HCPCS C1776","","6276-6-614  -  STEM FEMORAL 14MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-615","SUP","HCPCS C1776","","6276-6-615  -  STEM FEMORAL 15MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-616","SUP","HCPCS C1776","","6276-6-616  -  STEM FEMORAL 16MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-617","SUP","HCPCS C1776","","6276-6-617  -  STEM FEMORAL 17MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-618","SUP","HCPCS C1776","","6276-6-618  -  STEM FEMORAL 18MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-619","SUP","HCPCS C1776","","6276-6-619  -  STEM FEMORAL 19MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-620","SUP","HCPCS C1776","","6276-6-620  -  STEM FEMORAL 20MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-621","SUP","HCPCS C1776","","6276-6-621  -  STEM FEMORAL 21MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-622","SUP","HCPCS C1776","","6276-6-622  -  STEM FEMORAL 22MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-623","SUP","HCPCS C1776","","6276-6-623  -  STEM FEMORAL 23MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-624","SUP","HCPCS C1776","","6276-6-624  -  STEM FEMORAL 24MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-625","SUP","HCPCS C1776","","6276-6-625  -  STEM FEMORAL 25MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-6-626","SUP","HCPCS C1776","","6276-6-626  -  STEM FEMORAL 26MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-014","SUP","HCPCS C1776","","6276-7-014  -  STEM FEMORAL STR CONE 14MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-015","SUP","HCPCS C1776","","6276-7-015  -  STEM FEMORAL CONICAL 15MM 155MM MODULAR DISTAL HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-016","SUP","HCPCS C1776","","6276-7-016  -  STEM FEMORAL CONICAL 16MM 155MM MODULAR DISTAL HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-017","SUP","HCPCS C1776","","6276-7-017  -  STEM FEMORAL CONICAL 17MM 155MM MODULAR RSTOR HA DISTAL HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-018","SUP","HCPCS C1776","","6276-7-018  -  STEM FEMORAL STR CONE 18MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-019","SUP","HCPCS C1776","","6276-7-019  -  STEM FEMORAL CONICAL 19MM 155MM MODULAR RSTOR HA DISTAL HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-020","SUP","HCPCS C1776","","6276-7-020  -  STEM FEMORAL STR CONE 20MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-021","SUP","HCPCS C1776","","6276-7-021  -  STEM FEMORAL STR CONE 21MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-022","SUP","HCPCS C1776","","6276-7-022  -  STEM FEMORAL STR CONE 22MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-023","SUP","HCPCS C1776","","6276-7-023  -  STEM FEMORAL STR CONE 23MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-024","SUP","HCPCS C1776","","6276-7-024  -  STEM FEMORAL STR CONE 24MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-025","SUP","HCPCS C1776","","6276-7-025  -  STEM FEMORAL STR CONE 25MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-026","SUP","HCPCS C1776","","6276-7-026  -  STEM FEMORAL STR CONE 26MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-027","SUP","HCPCS C1776","","6276-7-027  -  STEM FEMORAL STR CONE 27MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-028","SUP","HCPCS C1776","","6276-7-028  -  STEM FEMORAL STR CONE 28MM 155MM MODULAR RSTOR HA HIP","BOTH IP/OP","$6,752.50 ","$4,996.85 ","$0.00 ","$6,752.50 ","$3,038.63 ","$0.00 ","$1,407.39 ","$0.00 ","$0.00 ","$1,182.31 ","$6,752.50 ","$0.00 ","$3,376.25 ","$5,347.98 ","$5,402.00 ","$0.00 ","$1,056.77 ","$0.00 ","$1,075.00 ","$0.00 "
"6276-7-114","SUP","HCPCS C1776","","6276-7-114  -  STEM FEMORAL STR CONE 14MM 195MM MODULAR RSTOR HA HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-115","SUP","HCPCS C1776","","6276-7-115  -  STEM FEMORAL STR CONE 15MM 195MM MODULAR RSTOR HA HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-116","SUP","HCPCS C1776","","6276-7-116  -  STEM FEMORAL CONE STR 16MM 195MM MODULAR RSTOR HA HIP DISTAL","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-117","SUP","HCPCS C1776","","6276-7-117  -  STEM FEMORAL STR CONE 17MM 195MM MODULAR RSTOR HA HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-118","SUP","HCPCS C1776","","6276-7-118  -  STEM FEMORAL STR CONE 18MM 195MM MODULAR RSTOR HA HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-119","SUP","HCPCS C1776","","6276-7-119  -  STEM FEMORAL STR CONE 19MM 195MM MODULAR RSTOR HA HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-120","SUP","HCPCS C1776","","6276-7-120  -  STEM FEMORAL STR CONE 20MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-121","SUP","HCPCS C1776","","6276-7-121  -  STEM FEMORAL STR CONE 21MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-122","SUP","HCPCS C1776","","6276-7-122  -  STEM FEMORAL STR CONE 22MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-123","SUP","HCPCS C1776","","6276-7-123  -  STEM FEMORAL STR CONE 23MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-124","SUP","HCPCS C1776","","6276-7-124  -  STEM FEMORAL STR CONE 24MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-125","SUP","HCPCS C1776","","6276-7-125  -  STEM FEMORAL STR CONE 25MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-126","SUP","HCPCS C1776","","6276-7-126  -  STEM FEMORAL STR CONE 26MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-127","SUP","HCPCS C1776","","6276-7-127  -  STEM FEMORAL STR CONE 27MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-128","SUP","HCPCS C1776","","6276-7-128  -  STEM FEMORAL STR CONE 28MM 195MM MODULAR RSTOR HIP","BOTH IP/OP","$7,150.00 ","$5,291.00 ","$0.00 ","$7,150.00 ","$3,217.50 ","$0.00 ","$1,490.24 ","$0.00 ","$0.00 ","$1,251.91 ","$7,150.00 ","$0.00 ","$3,575.00 ","$5,662.80 ","$5,720.00 ","$0.00 ","$1,118.98 ","$0.00 ","$1,138.28 ","$0.00 "
"6276-7-214","SUP","HCPCS C1776","","6276-7-214  -  STEM FEMORAL CONICAL 14MM 195MM MODULAR RSTOR DISTAL HIP","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-215","SUP","HCPCS C1776","","6276-7-215  -  STEM FEMORAL CONICAL 15MM 195MM BOWED MODULAR RSTOR HIP","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-216","SUP","HCPCS C1776","","6276-7-216  -  STEM FEMORAL BOW CONE 16MM 195MM MODULAR REVISION RSTOR","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-217","SUP","HCPCS C1776","","6276-7-217  -  STEM FEMORAL BOWED CONICAL 17MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-218","SUP","HCPCS C1776","","6276-7-218  -  STEM FEMORAL CONICAL 18MM 195MM BOWED MODULAR RSTOR HA HIP","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-219","SUP","HCPCS C1776","","6276-7-219  -  STEM FEMORAL BOWED CONICAL 19MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-220","SUP","HCPCS C1776","","6276-7-220  -  STEM FEMORAL CONICAL 20MM 195MM BOWED MODULAR RSTOR HIP","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-221","SUP","HCPCS C1776","","6276-7-221  -  STEM FEMORAL BOWED CONICAL 21MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-222","SUP","HCPCS C1776","","6276-7-222  -  STEM FEMORAL BOWED CONICAL 22MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-223","SUP","HCPCS C1776","","6276-7-223  -  STEM FEMORAL BOWED CONICAL 23MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-224","SUP","HCPCS C1776","","6276-7-224  -  STEM FEMORAL BOWED CONICAL 24MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-225","SUP","HCPCS C1776","","6276-7-225  -  STEM FEMORAL CONE 25MM 195MM MODULAR REVISION RSTOR HIP","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-226","SUP","HCPCS C1776","","6276-7-226  -  STEM FEMORAL BOWED CONICAL 26MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-227","SUP","HCPCS C1776","","6276-7-227  -  STEM FEMORAL BOWED CONICAL 27MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-228","SUP","HCPCS C1776","","6276-7-228  -  STEM FEMORAL BOWED CONICAL 28MM 195MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,547.50 ","$5,585.15 ","$0.00 ","$7,547.50 ","$3,396.38 ","$0.00 ","$1,573.09 ","$0.00 ","$0.00 ","$1,321.51 ","$7,547.50 ","$0.00 ","$3,773.75 ","$5,977.62 ","$6,038.00 ","$0.00 ","$1,181.18 ","$0.00 ","$1,201.56 ","$0.00 "
"6276-7-314","SUP","HCPCS C1776","","6276-7-314  -  STEM FEMORAL BOWED CONICAL 14MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-315","SUP","HCPCS C1776","","6276-7-315  -  STEM FEMORAL BOWED CONICAL 15MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-316","SUP","HCPCS C1776","","6276-7-316  -  STEM FEMORAL BOWED CONICAL 16MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-317","SUP","HCPCS C1776","","6276-7-317  -  STEM FEMORAL BOWED CONICAL 17MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-318","SUP","HCPCS C1776","","6276-7-318  -  STEM FEMORAL BOWED CONICAL 18MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-319","SUP","HCPCS C1776","","6276-7-319  -  STEM FEMORAL BOWED CONICAL 19MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-320","SUP","HCPCS C1776","","6276-7-320  -  STEM FEMORAL BOWED CONICAL 20MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-321","SUP","HCPCS C1776","","6276-7-321  -  STEM FEMORAL BOWED CONICAL 21MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-322","SUP","HCPCS C1776","","6276-7-322  -  STEM FEMORAL BOWED CONICAL 22MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-323","SUP","HCPCS C1776","","6276-7-323  -  STEM FEMORAL BOWED CONICAL 23MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-324","SUP","HCPCS C1776","","6276-7-324  -  STEM FEMORAL BOWED CONICAL 24MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-325","SUP","HCPCS C1776","","6276-7-325  -  STEM FEMORAL BOWED CONICAL 25MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-326","SUP","HCPCS C1776","","6276-7-326  -  STEM FEMORAL BOWED CONICAL 26MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-327","SUP","HCPCS C1776","","6276-7-327  -  STEM FEMORAL BOWED CONICAL 27MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-7-328","SUP","HCPCS C1776","","6276-7-328  -  STEM FEMORAL BOWED CONICAL 28MM 235MM MODULAR RSTOR DISTAL","BOTH IP/OP","$7,942.50 ","$5,877.45 ","$0.00 ","$7,942.50 ","$3,574.13 ","$0.00 ","$1,655.42 ","$0.00 ","$0.00 ","$1,390.67 ","$7,942.50 ","$0.00 ","$3,971.25 ","$6,290.46 ","$6,354.00 ","$0.00 ","$1,243.00 ","$0.00 ","$1,264.45 ","$0.00 "
"6276-8-213","SUP","HCPCS C1776","","6276-8-213  -  STEM FEMORAL 13MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-214","SUP","HCPCS C1776","","6276-8-214  -  STEM FEMORAL 14MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-215","SUP","HCPCS C1776","","6276-8-215  -  STEM FEMORAL 15MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-216","SUP","HCPCS C1776","","6276-8-216  -  STEM FEMORAL 16MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-217","SUP","HCPCS C1776","","6276-8-217  -  STEM FEMORAL 17MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-218","SUP","HCPCS C1776","","6276-8-218  -  STEM FEMORAL 18MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-219","SUP","HCPCS C1776","","6276-8-219  -  STEM FEMORAL 19MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-220","SUP","HCPCS C1776","","6276-8-220  -  STEM FEMORAL 20MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-221","SUP","HCPCS C1776","","6276-8-221  -  STEM FEMORAL 21MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-222","SUP","HCPCS C1776","","6276-8-222  -  STEM FEMORAL 22MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-223","SUP","HCPCS C1776","","6276-8-223  -  STEM FEMORAL 23MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-224","SUP","HCPCS C1776","","6276-8-224  -  STEM FEMORAL 24MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-225","SUP","HCPCS C1776","","6276-8-225  -  STEM FEMORAL 25MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-226","SUP","HCPCS C1776","","6276-8-226  -  STEM FEMORAL 26MM 167MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,260.00 ","$6,112.40 ","$0.00 ","$8,260.00 ","$3,717.00 ","$0.00 ","$1,721.59 ","$0.00 ","$0.00 ","$1,446.26 ","$8,260.00 ","$0.00 ","$4,130.00 ","$6,541.92 ","$6,608.00 ","$0.00 ","$1,292.69 ","$0.00 ","$1,314.99 ","$0.00 "
"6276-8-413","SUP","HCPCS C1776","","6276-8-413  -  STEM FEMORAL 13MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-414","SUP","HCPCS C1776","","6276-8-414  -  STEM FEMORAL 14MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-415","SUP","HCPCS C1776","","6276-8-415  -  STEM FEMORAL 15MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-416","SUP","HCPCS C1776","","6276-8-416  -  STEM FEMORAL 16MM 1217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-417","SUP","HCPCS C1776","","6276-8-417  -  STEM FEMORAL 17MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-418","SUP","HCPCS C1776","","6276-8-418  -  STEM FEMORAL 18MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-419","SUP","HCPCS C1776","","6276-8-419  -  STEM FEMORAL 19MM 1217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-420","SUP","HCPCS C1776","","6276-8-420  -  STEM FEMORAL 20MM 1217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-421","SUP","HCPCS C1776","","6276-8-421  -  STEM FEMORAL 21MM 1217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-422","SUP","HCPCS C1776","","6276-8-422  -  STEM FEMORAL 22MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-423","SUP","HCPCS C1776","","6276-8-423  -  STEM FEMORAL 23MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-424","SUP","HCPCS C1776","","6276-8-424  -  STEM FEMORAL 24MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-425","SUP","HCPCS C1776","","6276-8-425  -  STEM FEMORAL 25MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-426","SUP","HCPCS C1776","","6276-8-426  -  STEM FEMORAL 26MM 217MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$8,640.00 ","$6,393.60 ","$0.00 ","$8,640.00 ","$3,888.00 ","$0.00 ","$1,800.79 ","$0.00 ","$0.00 ","$1,512.79 ","$8,640.00 ","$0.00 ","$4,320.00 ","$6,842.88 ","$6,912.00 ","$0.00 ","$1,352.16 ","$0.00 ","$1,375.49 ","$0.00 "
"6276-8-513","SUP","HCPCS C1776","","6276-8-513  -  STEM FEMORAL 13MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-514","SUP","HCPCS C1776","","6276-8-514  -  STEM FEMORAL 14MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-515","SUP","HCPCS C1776","","6276-8-515  -  STEM FEMORAL 15MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-516","SUP","HCPCS C1776","","6276-8-516  -  STEM FEMORAL 16MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-517","SUP","HCPCS C1776","","6276-8-517  -  STEM FEMORAL 17MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-518","SUP","HCPCS C1776","","6276-8-518  -  STEM FEMORAL 18MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-519","SUP","HCPCS C1776","","6276-8-519  -  STEM FEMORAL 19MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-520","SUP","HCPCS C1776","","6276-8-520  -  STEM FEMORAL 20MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-521","SUP","HCPCS C1776","","6276-8-521  -  STEM FEMORAL 21MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-522","SUP","HCPCS C1776","","6276-8-522  -  STEM FEMORAL 22MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-523","SUP","HCPCS C1776","","6276-8-523  -  STEM FEMORAL 23MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-524","SUP","HCPCS C1776","","6276-8-524  -  STEM FEMORAL 24MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-525","SUP","HCPCS C1776","","6276-8-525  -  STEM FEMORAL 25MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-526","SUP","HCPCS C1776","","6276-8-526  -  STEM FEMORAL 26MM 267MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,027.50 ","$6,680.35 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,881.56 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"6276-8-613","SUP","HCPCS C1776","","6276-8-613  -  STEM FEMORAL 13MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-614","SUP","HCPCS C1776","","6276-8-614  -  STEM FEMORAL 14MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-615","SUP","HCPCS C1776","","6276-8-615  -  STEM FEMORAL 15MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-616","SUP","HCPCS C1776","","6276-8-616  -  STEM FEMORAL 16MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-617","SUP","HCPCS C1776","","6276-8-617  -  STEM FEMORAL 17MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-618","SUP","HCPCS C1776","","6276-8-618  -  STEM FEMORAL 18MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-619","SUP","HCPCS C1776","","6276-8-619  -  STEM FEMORAL 19MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-620","SUP","HCPCS C1776","","6276-8-620  -  STEM FEMORAL 20MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-621","SUP","HCPCS C1776","","6276-8-621  -  STEM FEMORAL 21MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-622","SUP","HCPCS C1776","","6276-8-622  -  STEM FEMORAL 22MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-623","SUP","HCPCS C1776","","6276-8-623  -  STEM FEMORAL 23MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-624","SUP","HCPCS C1776","","6276-8-624  -  STEM FEMORAL 24MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-625","SUP","HCPCS C1776","","6276-8-625  -  STEM FEMORAL 25MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6276-8-626","SUP","HCPCS C1776","","6276-8-626  -  STEM FEMORAL 26MM 317MM BOWED SLOTTED PLASMA HIP","BOTH IP/OP","$9,410.00 ","$6,963.40 ","$0.00 ","$9,410.00 ","$4,234.50 ","$0.00 ","$1,961.28 ","$0.00 ","$0.00 ","$1,647.62 ","$9,410.00 ","$0.00 ","$4,705.00 ","$7,452.72 ","$7,528.00 ","$0.00 ","$1,472.67 ","$0.00 ","$1,498.07 ","$0.00 "
"6280-0-036","SUP","Custom 27803010","","6280-0-036  -  HEAD FEM -3MM 36MM PCA OFST","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-126","SUP","Custom 27803010","","6280-0-126  -  HEAD FEMORAL STANDARD OFFST 26MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-128","SUP","Custom 27803010","","6280-0-128  -  HEAD FEM +0MM OFST 28MM STRL PCA VIT HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-132","SUP","Custom 27803010","","6280-0-132  -  HEAD FEM +0MM OFST 32MM STRL PCA VIT HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-136","SUP","Custom 27803010","","6280-0-136  -  HEAD FEM 36MM PCA","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-226","SUP","Custom 27803010","","6280-0-226  -  HEAD FEMORAL +5MM 26MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-228","SUP","Custom 27803010","","6280-0-228  -  HEAD FEM +5MM OFST 28MM STRL PCA VIT HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-232","SUP","Custom 27803010","","6280-0-232  -  HEAD FEM +5MM OFST 32MM STRL PCA VIT HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-236","SUP","Custom 27803010","","6280-0-236  -  HEAD FEM +5MM OFST 36MM STRL PCA VIT HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-326","SUP","Custom 27803010","","6280-0-326  -  HEAD FEMORAL +10MM 26MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-328","SUP","Custom 27803010","","6280-0-328  -  HEAD FEM +10MM OFST 28MM PCA HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-332","SUP","Custom 27803010","","6280-0-332  -  HEAD FEMORAL +10MM TAPER 32MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-336","SUP","Custom 27803010","","6280-0-336  -  HEAD FEM +10MM 36MM HIP OFFST PCA","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-436","SUP","Custom 27803010","","6280-0-436  -  HEAD FEM +15MM 36MM OFFST PCA","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-622","SUP","Custom 27803010","","6280-0-622  -  HEAD FEM +2MM OFST 22.2MM STRL PCA VIT HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-722","SUP","Custom 27803010","","6280-0-722  -  HEAD FEMORAL +5MM 22.2MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-0-822","SUP","Custom 27803010","","6280-0-822  -  HEAD FEMORAL +10MM 22MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6280-3-032","SUP","Custom 27803010","","6280-3-032  -  HEAD FEMORAL +3MM 32MM PCA VITALLIUM HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6290-7-012","SUP","HCPCS C1713","","6290-7-012  -  SCREW BONE 6.2MM 12MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-015","SUP","HCPCS C1713","","6290-7-015  -  SCREW BONE 6.2MM 15MM CANC SLFTAP HEX HEAD","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-020","SUP","HCPCS C1713","","6290-7-020  -  SCREW BONE 6.2MM 20MM CANC SLFTAP HEX HEAD","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-025","SUP","HCPCS C1713","","6290-7-025  -  SCREW BONE 6.2MM 25MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-030","SUP","HCPCS C1713","","6290-7-030  -  SCREW BONE 6.2MM 30MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-035","SUP","HCPCS C1713","","6290-7-035  -  SCREW BONE 6.2MM 35MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-040","SUP","HCPCS C1713","","6290-7-040  -  SCREW BONE 6.2MM 40MM CANC SLFTAP HEX HEAD","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-045","SUP","HCPCS C1713","","6290-7-045  -  SCREW BONE 6.2MM 45MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-050","SUP","HCPCS C1713","","6290-7-050  -  SCREW BONE 6.2MM 50MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-055","SUP","HCPCS C1713","","6290-7-055  -  SCREW BONE 6.2MM 55MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-060","SUP","HCPCS C1713","","6290-7-060  -  SCREW BONE 6.2MM 60MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-7-065","SUP","HCPCS C1713","","6290-7-065  -  SCREW BONE 6.2MM 65MM CANC SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6290-8-620","SUP","HCPCS C1713","","6290-8-620  -  WASHER 6.2MM SCR ORTH VIT","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"629210S","SUP","HCPCS C1713","","629210S  -  PLATE 176MM TI 10 SHFT HOLE LCK VARIAX BONE LEFT DISTAL LAT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629212S","SUP","HCPCS C1713","","629212S  -  PLATE 203MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT DISTAL LAT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629230S","SUP","HCPCS C1713","","629230S  -  PLATE 176MM TI 10 SHFT HOLE LCK VARIAX BONE RIGHT DISTAL LAT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629232S","SUP","HCPCS C1713","","629232S  -  PLATE 203MM TI 12 SHFT HOLE REDX CLMP SLFTAP BONE RL STRL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629250S","SUP","HCPCS C1713","","629250S  -  PLATE BN 173MM STRL VARIAX 10 HL TI HUM LT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629252S","SUP","HCPCS C1713","","629252S  -  PLATE BN 196MM STRL VARIAX 12 HL TI HUM LT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629254S","SUP","HCPCS C1713","","629254S  -  DISTAL POSTERIOR LATERAL PLATE  14 HOLE / LEFT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"629270S","SUP","HCPCS C1713","","629270S  -  PLATE BN 173MM STRL VARIAX 10 HL TI HUM RT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629272S","SUP","HCPCS C1713","","629272S  -  PLATE BN 196MM STRL VARIAX 12 HL TI HUM RT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629274S","SUP","HCPCS C1713","","629274S  -  PLATE BN 218MM STRL VARIAX 14 HL TI HUM RT P/L","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"629290S","SUP","HCPCS C1713","","629290S  -  PLATE 167MM TI 10 SHFT HOLE LCK XTD VARIAX BONE L/R MDL HUM","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629292S","SUP","HCPCS C1713","","629292S  -  PLATE 191MM TI 12 HOLE XTD VARIAX BONE MDL ELB STRL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629294S","SUP","HCPCS C1713","","629294S  -  PLATE 215MM TI 14 SHFT HOLE LCK XTD VARIAX BONE L/R MDL HUM","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"6293-0-000","SUP","Custom 27803010","","6293-0-000  -  HEAD FEM STD 32MM HIP PCA","BOTH IP/OP","$2,180.00 ","$1,613.20 ","$0.00 ","$2,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,180.00 ","$0.00 ","$1,090.00 ","$1,726.56 ","$1,744.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6293-0-005","SUP","Custom 27803010","","6293-0-005  -  HEAD FEM +5 32MM HIP PCA","BOTH IP/OP","$2,180.00 ","$1,613.20 ","$0.00 ","$2,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,180.00 ","$0.00 ","$1,090.00 ","$1,726.56 ","$1,744.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"629310S","SUP","HCPCS C1713","","629310S  -  PLATE 175MM TI 10 SHFT HOLE BONE LEFT POST MDL STRL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629312S","SUP","HCPCS C1713","","629312S  -  PLATE 199MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT POST MDL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629330S","SUP","HCPCS C1713","","629330S  -  PLATE 175MM TI 10 SHFT HOLE LCK VARIAX BONE RIGHT POST MDL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629332S","SUP","HCPCS C1713","","629332S  -  PLATE 199MM TI 12 HOLE LCK VARIAX BONE RIGHT POST MDL ELB","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629350S","SUP","HCPCS C1713","","629350S  -  PLATE BN 161MM NS VARIAX 10 HL TI OLCRN LT","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"629352S","SUP","HCPCS C1713","","629352S  -  PLATE 184MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT OLCRN ELB","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,021.25 ","$909.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$353.90 ","$2,021.25 ","$0.00 ","$1,010.63 ","$1,600.83 ","$1,617.00 ","$0.00 ","$316.33 ","$0.00 ","$321.78 ","$0.00 "
"629370S","SUP","HCPCS C1713","","629370S  -  PLATE 161MM TI 12 SHFT HOLE LCK VARIAX BONE RIGHT OLCRN ELB","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"629372S","SUP","HCPCS C1713","","629372S  -  PLATE 184MM TI 12 SHFT HOLE LCK VARIAX BONE RIGHT OLCRN ELB","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,021.25 ","$909.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$353.90 ","$2,021.25 ","$0.00 ","$1,010.63 ","$1,600.83 ","$1,617.00 ","$0.00 ","$316.33 ","$0.00 ","$321.78 ","$0.00 "
"629390S","SUP","HCPCS C1713","","629390S  -  PLATE 163MM TI 10 HOLE LCK VARIAX BONE MDL ELB STRL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,131.25 ","$959.06 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$373.16 ","$2,131.25 ","$0.00 ","$1,065.63 ","$1,687.95 ","$1,705.00 ","$0.00 ","$333.54 ","$0.00 ","$339.30 ","$0.00 "
"629392S","SUP","HCPCS C1713","","629392S  -  PLATE 187MM TI 12 SHFT HOLE LCK VARIAX BONE L/R DISTAL MDL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,241.25 ","$1,008.56 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$392.42 ","$2,241.25 ","$0.00 ","$1,120.63 ","$1,775.07 ","$1,793.00 ","$0.00 ","$350.76 ","$0.00 ","$356.81 ","$0.00 "
"629394S","SUP","HCPCS C1713","","629394S  -  PLATE 211MM TI 14 SHFT HOLE LCK VARIAX BONE L/R DISTAL MDL","BOTH IP/OP","$2,384.00 ","$1,764.16 ","$0.00 ","$2,406.25 ","$1,082.81 ","$0.00 ","$496.89 ","$0.00 ","$0.00 ","$421.32 ","$2,406.25 ","$0.00 ","$1,203.13 ","$1,905.75 ","$1,925.00 ","$0.00 ","$376.58 ","$0.00 ","$383.08 ","$0.00 "
"6299-2-403","SUP","Custom 27803010","","6299-2-403  -  INSERT ACETAB 0D NEUTRAL 40-43MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-2-469","SUP","Custom 27803010","","6299-2-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-2-525","SUP","Custom 27803010","","6299-2-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-2-581","SUP","Custom 27803010","","6299-2-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-3-469","SUP","Custom 27803010","","6299-3-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-3-525","SUP","Custom 27803010","","6299-3-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-3-581","SUP","Custom 27803010","","6299-3-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-3-647","SUP","Custom 27803010","","6299-3-647  -  INSERT ACETAB 0D NEUTRAL 64-67MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-4-469","SUP","Custom 27803010","","6299-4-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-4-525","SUP","Custom 27803010","","6299-4-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-4-581","SUP","Custom 27803010","","6299-4-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-4-647","SUP","Custom 27803010","","6299-4-647  -  INSERT ACETAB 0D NEUTRAL 64-67MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-5-403","SUP","Custom 27803010","","6299-5-403  -  INSERT ACETAB 10D 40-43MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-5-469","SUP","Custom 27803010","","6299-5-469  -  INSERT ACETAB 10D 46-49MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-5-525","SUP","Custom 27803010","","6299-5-525  -  INSERT ACETAB 10D 52-55MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-5-581","SUP","Custom 27803010","","6299-5-581  -  INSERT ACETAB 10D 58-61MM 26MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-6-469","SUP","Custom 27803010","","6299-6-469  -  INSERT ACETAB 10D 46-49MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-6-525","SUP","Custom 27803010","","6299-6-525  -  INSERT ACETAB 10D 52-55MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-6-581","SUP","Custom 27803010","","6299-6-581  -  INSERT ACETAB 10D 58-61MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-6-647","SUP","Custom 27803010","","6299-6-647  -  INSERT ACETAB 10D 64-67MM 28MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-7-469","SUP","Custom 27803010","","6299-7-469  -  INSERT ACETAB 10D 46-49MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-7-525","SUP","Custom 27803010","","6299-7-525  -  INSERT ACETAB 10D 52-55MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-7-581","SUP","Custom 27803010","","6299-7-581  -  INSERT ACETAB 10D 58-61MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-7-647","SUP","Custom 27803010","","6299-7-647  -  INSERT ACETAB 10D 64-67MM 32MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-8-403","SUP","Custom 27803010","","6299-8-403  -  INSERT ACETAB 10D 40-43MM 22MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-8-469","SUP","Custom 27803010","","6299-8-469  -  INSERT ACETAB 10D 46-49MM 22MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-8-525","SUP","Custom 27803010","","6299-8-525  -  INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-8-581","SUP","Custom 27803010","","6299-8-581  -  INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP","BOTH IP/OP","$2,117.50 ","$1,566.95 ","$0.00 ","$2,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,117.50 ","$0.00 ","$1,058.75 ","$1,677.06 ","$1,694.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-H-332","SUP","Custom 27803010","","6299-H-332  -  LINER ACETAB PCA 10D C 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6299-N-332","SUP","Custom 27803010","","6299-N-332  -  LINER ACETAB PCA NTRL 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-3-012","SUP","HCPCS C1713","","6302-3-012  -  SCREW BONE 6.5MM 12MM VTLK VIT PLUG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-014","SUP","HCPCS C1713","","6302-3-014  -  SCREW ACETAB 14MM 6.5MM VTLK VITALIUM PLUG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-016","SUP","HCPCS C1713","","6302-3-016  -  SCREW BONE 6.5MM 16MM VTLK VIT ACETUBULAR PLG VIT","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-018","SUP","HCPCS C1713","","6302-3-018  -  SCREW ACETAB 18MM 6.5MM VTLK VIT PLG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-020","SUP","HCPCS C1713","","6302-3-020  -  SCREW BONE 6.5MM 20MM VTLK VIT ACETAB SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-022","SUP","HCPCS C1713","","6302-3-022  -  SCREW ACETAB 22MM 6.5MM VTLK VIT PLUG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-024","SUP","HCPCS C1713","","6302-3-024  -  SCREW BONE 6.5MM 24MM VTLK VIT ACETAB SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-026","SUP","HCPCS C1713","","6302-3-026  -  SCREW BONE 6.5MM 26MM VTLK VIT SLFTAP","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-028","SUP","HCPCS C1713","","6302-3-028  -  SCREW BONE 6.8MM 28MM VTLK VIT PLG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
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"6302-3-040","SUP","HCPCS C1713","","6302-3-040  -  SCREW BONE 6.5MM 40MM VTLK VIT PLUG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-045","SUP","HCPCS C1713","","6302-3-045  -  SCREW ACETAB 45MM 6.5MM VTLK VIT PLUG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-3-050","SUP","HCPCS C1713","","6302-3-050  -  SCREW ACETAB 50MM 6.5MM VTLK VIT PLG","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-4-000","SUP","HCPCS C1713","","6302-4-000  -  PLUG DOME HL PRM RECON VIT APCL","BOTH IP/OP","$152.00 ","$112.48 ","$0.00 ","$152.00 ","$68.40 ","$0.00 ","$31.68 ","$0.00 ","$0.00 ","$26.61 ","$152.00 ","$0.00 ","$76.00 ","$120.38 ","$121.60 ","$0.00 ","$23.79 ","$0.00 ","$24.20 ","$0.00 "
"6302-5-000","SUP","Custom 27803010","","6302-5-000  -  INSERT ACETAB 22.2MM 0D P0 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-001","SUP","Custom 27803010","","6302-5-001  -  INSERT ACETAB 22.2MM P1 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-002","SUP","Custom 27803010","","6302-5-002  -  INSERT ACETAB 22.2MM P2 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-003","SUP","Custom 27803010","","6302-5-003  -  INSERT ACETAB 22.2MM P3 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-004","SUP","Custom 27803010","","6302-5-004  -  INSERT ACETAB 22.2MM P4 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-005","SUP","Custom 27803010","","6302-5-005  -  INSERT ACETAB 22.2MM P5 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-006","SUP","Custom 27803010","","6302-5-006  -  INSERT ACETAB 22.2MM P6 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-007","SUP","Custom 27803010","","6302-5-007  -  INSERT ACETAB 22.2MM P7 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-008","SUP","Custom 27803010","","6302-5-008  -  INSERT ACETAB 22.2MM P8 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-009","SUP","Custom 27803010","","6302-5-009  -  INSERT ACETAB 22.2MM P9 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-010","SUP","Custom 27803010","","6302-5-010  -  INSERT ACETAB 22.2MM 10D P0 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-011","SUP","Custom 27803010","","6302-5-011  -  INSERT ACETAB 22.2MM 10D P1 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-012","SUP","Custom 27803010","","6302-5-012  -  INSERT ACETAB 22.2MM 10D P2 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-013","SUP","Custom 27803010","","6302-5-013  -  INSERT ACETAB 22.2MM 10D P3 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-014","SUP","Custom 27803010","","6302-5-014  -  INSERT ACETAB 22.2MM 10D P4 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-015","SUP","Custom 27803010","","6302-5-015  -  INSERT ACETAB 22.2MM 10D P5 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-016","SUP","Custom 27803010","","6302-5-016  -  INSERT ACETAB 22.2MM 10D P6 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-017","SUP","Custom 27803010","","6302-5-017  -  INSERT ACETAB 22.2MM 10D P7 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-018","SUP","Custom 27803010","","6302-5-018  -  INSERT ACETAB 22.2MM 10D P8 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-019","SUP","Custom 27803010","","6302-5-019  -  INSERT ACETAB 22.2MM 10D P9 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-020","SUP","Custom 27803010","","6302-5-020  -  INSERT ACETAB 22.2MM 15D P0 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-021","SUP","Custom 27803010","","6302-5-021  -  INSERT ACETAB 22.2MM 15D P1 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-022","SUP","Custom 27803010","","6302-5-022  -  INSERT ACETAB 22.2MM 15D P2 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-023","SUP","Custom 27803010","","6302-5-023  -  INSERT ACETAB 22.2MM 15D P3 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-024","SUP","Custom 27803010","","6302-5-024  -  INSERT ACETAB 22.2MM 15D P4 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-025","SUP","Custom 27803010","","6302-5-025  -  INSERT ACETAB 22.2MM 15D P5 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-026","SUP","Custom 27803010","","6302-5-026  -  INSERT ACETAB 22.2MM 15D P6 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-027","SUP","Custom 27803010","","6302-5-027  -  INSERT ACETAB 22.2MM 15D P7 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-028","SUP","Custom 27803010","","6302-5-028  -  INSERT ACETAB 22.2MM 15D P8 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-029","SUP","Custom 27803010","","6302-5-029  -  INSERT ACETAB 22.2MM 15D P9 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-030","SUP","Custom 27803010","","6302-5-030  -  INSERT ACETAB 26MM P1 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-032","SUP","Custom 27803010","","6302-5-032  -  INSERT ACETAB 26MM P2 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-033","SUP","Custom 27803010","","6302-5-033  -  INSERT ACETAB 26MM P3 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-034","SUP","Custom 27803010","","6302-5-034  -  INSERT ACETAB 26MM P4 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-035","SUP","Custom 27803010","","6302-5-035  -  INSERT ACETAB 26MM P5 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-036","SUP","Custom 27803010","","6302-5-036  -  INSERT ACETAB 26MM P6 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-037","SUP","Custom 27803010","","6302-5-037  -  INSERT ACETAB 26MM P7 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-038","SUP","Custom 27803010","","6302-5-038  -  INSERT ACETAB 26MM P8 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-039","SUP","Custom 27803010","","6302-5-039  -  INSERT ACETAB 26MM P9 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-040","SUP","Custom 27803010","","6302-5-040  -  INSERT ACETAB 26MM 10D P1 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-042","SUP","Custom 27803010","","6302-5-042  -  INSERT ACETAB 26MM 10D P2 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-043","SUP","Custom 27803010","","6302-5-043  -  INSERT ACETAB 26MM 10D P3 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-044","SUP","Custom 27803010","","6302-5-044  -  INSERT ACETAB 26MM 10D P4 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-045","SUP","Custom 27803010","","6302-5-045  -  INSERT ACETAB 26MM 10D P5 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-046","SUP","Custom 27803010","","6302-5-046  -  INSERT ACETAB 26MM 10D P6 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-047","SUP","Custom 27803010","","6302-5-047  -  INSERT ACETAB 26MM 10D P7 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-048","SUP","Custom 27803010","","6302-5-048  -  INSERT ACETAB 26MM 10D P8 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-049","SUP","Custom 27803010","","6302-5-049  -  INSERT ACETAB 26MM 10D P9 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-050","SUP","Custom 27803010","","6302-5-050  -  INSERT ACETAB 26MM 15D P1 HIP DUR PE S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-052","SUP","Custom 27803010","","6302-5-052  -  INSERT ACETAB 26MM 15D P2 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-053","SUP","Custom 27803010","","6302-5-053  -  INSERT ACETAB 26MM 15D P3 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-054","SUP","Custom 27803010","","6302-5-054  -  INSERT ACETAB 26MM 15D P4 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-055","SUP","Custom 27803010","","6302-5-055  -  INSERT ACETAB 26MM 15D P5 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-056","SUP","Custom 27803010","","6302-5-056  -  INSERT ACETAB 26MM 15D P6 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-057","SUP","Custom 27803010","","6302-5-057  -  INSERT ACETAB 26MM 15D P7 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-058","SUP","Custom 27803010","","6302-5-058  -  INSERT ACETAB 26MM 15D P8 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-059","SUP","Custom 27803010","","6302-5-059  -  INSERT ACETAB 26MM 15D P9 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-062","SUP","Custom 27803010","","6302-5-062  -  INSERT ACETAB 28MM P2 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-063","SUP","Custom 27803010","","6302-5-063  -  INSERT ACETAB 28MM P3 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-064","SUP","Custom 27803010","","6302-5-064  -  INSERT ACETAB 28MM P4 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-065","SUP","Custom 27803010","","6302-5-065  -  INSERT ACETAB 28MM P5 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-066","SUP","Custom 27803010","","6302-5-066  -  INSERT ACETAB 28MM P6 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-067","SUP","Custom 27803010","","6302-5-067  -  INSERT ACETAB 28MM P7 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-068","SUP","Custom 27803010","","6302-5-068  -  INSERT ACETAB 28MM P8 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-069","SUP","Custom 27803010","","6302-5-069  -  INSERT ACETAB 28MM P9 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-072","SUP","Custom 27803010","","6302-5-072  -  INSERT ACETAB 28MM 10D P2 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-073","SUP","Custom 27803010","","6302-5-073  -  INSERT ACETAB 28MM 10D P3 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-074","SUP","Custom 27803010","","6302-5-074  -  INSERT ACETAB 28MM 10D P4 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-075","SUP","Custom 27803010","","6302-5-075  -  INSERT ACETAB 28MM 10D P5 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-076","SUP","Custom 27803010","","6302-5-076  -  INSERT ACETAB 28MM 10D P6 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-077","SUP","Custom 27803010","","6302-5-077  -  INSERT ACETAB 28MM 10D P7 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-078","SUP","Custom 27803010","","6302-5-078  -  INSERT ACETAB 28MM 10D P8 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-079","SUP","Custom 27803010","","6302-5-079  -  INSERT ACETAB 28MM 10D P9 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-082","SUP","Custom 27803010","","6302-5-082  -  INSERT ACETAB 15D P2 28MM SYSTEM 12 OSTEOLOCK DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-083","SUP","Custom 27803010","","6302-5-083  -  INSERT ACETAB 28MM 15D P3 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-084","SUP","Custom 27803010","","6302-5-084  -  INSERT ACETAB 28MM 15D P4 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-085","SUP","Custom 27803010","","6302-5-085  -  INSERT ACETAB 28MM 15D P5 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-086","SUP","Custom 27803010","","6302-5-086  -  INSERT ACETAB 28MM 15D P6 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-087","SUP","Custom 27803010","","6302-5-087  -  INSERT ACETAB 28MM 15D P7 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-088","SUP","Custom 27803010","","6302-5-088  -  INSERT ACETAB 28MM 15D P8 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-089","SUP","Custom 27803010","","6302-5-089  -  INSERT ACETAB 28MM 15D P9 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-093","SUP","Custom 27803010","","6302-5-093  -  INSERT ACETAB 15D P3 32MM SYSTEM 12 OSTEOLOCK DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-094","SUP","Custom 27803010","","6302-5-094  -  INSERT ACETAB 32MM P4 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-095","SUP","Custom 27803010","","6302-5-095  -  INSERT ACETAB 15D P5 32MM SYSTEM 12 OSTEOLOCK DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-096","SUP","Custom 27803010","","6302-5-096  -  INSERT ACETAB 15D P6 32MM SYSTEM 12 OSTEOLOCK DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-097","SUP","Custom 27803010","","6302-5-097  -  INSERT ACETAB 28MM P7 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-098","SUP","Custom 27803010","","6302-5-098  -  INSERT ACETAB 32MM P8 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-099","SUP","Custom 27803010","","6302-5-099  -  INSERT ACETAB 32MM P9 NTRL HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-103","SUP","Custom 27803010","","6302-5-103  -  INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-104","SUP","Custom 27803010","","6302-5-104  -  INSERT ACETAB 10D P4 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-105","SUP","Custom 27803010","","6302-5-105  -  INSERT ACETAB 10D P5 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-106","SUP","Custom 27803010","","6302-5-106  -  INSERT ACETAB 32MM 10D P6 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-107","SUP","Custom 27803010","","6302-5-107  -  INSERT ACETAB 10D P7 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-108","SUP","Custom 27803010","","6302-5-108  -  INSERT ACETAB 10D P8 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-109","SUP","Custom 27803010","","6302-5-109  -  INSERT ACETAB 10D P9 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-113","SUP","Custom 27803010","","6302-5-113  -  INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-114","SUP","Custom 27803010","","6302-5-114  -  INSERT ACETAB 15D P4 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-115","SUP","Custom 27803010","","6302-5-115  -  INSERT ACETAB 15D P5 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-116","SUP","Custom 27803010","","6302-5-116  -  INSERT ACETAB 15D P6 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-117","SUP","Custom 27803010","","6302-5-117  -  INSERT ACETAB 32MM 15D P7 HIP DUR S12","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-118","SUP","Custom 27803010","","6302-5-118  -  INSERT ACETAB 15D P8 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-5-119","SUP","Custom 27803010","","6302-5-119  -  INSERT ACETAB 15D P9 32MM SYSTEM 12 DUR HIP","BOTH IP/OP","$1,942.50 ","$1,437.45 ","$0.00 ","$1,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,942.50 ","$0.00 ","$971.25 ","$1,538.46 ","$1,554.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-007","SUP","Custom 27803010","","6302-6-007  -  INSERT ACETAB 10D P7 26MM SYSTEM 12 DUR HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-008","SUP","Custom 27803010","","6302-6-008  -  INSERT ACETAB 10D +4MM P8 26MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-009","SUP","Custom 27803010","","6302-6-009  -  INSERT ACETAB 10D +4MM P9 26MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-102","SUP","Custom 27803010","","6302-6-102  -  INSERT ACETAB 10D +4MM P2 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-103","SUP","Custom 27803010","","6302-6-103  -  INSERT ACETAB 10D +4MM P3 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-104","SUP","Custom 27803010","","6302-6-104  -  INSERT ACETAB 10D +4MM P4 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-105","SUP","Custom 27803010","","6302-6-105  -  INSERT ACETAB 10D +4MM P5 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-106","SUP","Custom 27803010","","6302-6-106  -  INSERT ACETAB 10D +4MM P6 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-107","SUP","Custom 27803010","","6302-6-107  -  INSERT ACETAB 10D +4MM P7 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-108","SUP","Custom 27803010","","6302-6-108  -  INSERT ACETAB 10D +4MM P8 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-109","SUP","Custom 27803010","","6302-6-109  -  INSERT ACETAB 10D +4MM P9 28MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-220","SUP","Custom 27803010","","6302-6-220  -  INSERT ACETAB 22.2MM 4MM P0 NTRL","BOTH IP/OP","$928.00 ","$686.72 ","$0.00 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.00 ","$0.00 ","$464.00 ","$734.98 ","$742.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-303","SUP","Custom 27803010","","6302-6-303  -  INSERT ACETAB 10D +4MM P3 32MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-304","SUP","Custom 27803010","","6302-6-304  -  INSERT ACETAB 10D +4MM P4 32MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-305","SUP","Custom 27803010","","6302-6-305  -  INSERT ACTB 10D P4 32MM S12 LATRILIZING RT","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-306","SUP","Custom 27803010","","6302-6-306  -  INSERT ACETAB 10D +4MM P6 32MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-307","SUP","Custom 27803010","","6302-6-307  -  INSERT ACETAB 10D +4MM P7 32MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-308","SUP","Custom 27803010","","6302-6-308  -  INSERT ACETAB 10D +4MM P8 32MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-6-309","SUP","Custom 27803010","","6302-6-309  -  INSERT ACETAB 10D +4MM P9 32MM SYSTEM 12 HIP","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-328","SUP","Custom 27803010","","6302-H-328  -  LINER ACETAB 10D 28MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-428","SUP","Custom 27803010","","6302-H-428  -  LINER ACETAB 10D 28MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-432","SUP","Custom 27803010","","6302-H-432  -  LINER ACETAB 10D 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-528","SUP","Custom 27803010","","6302-H-528  -  LINER ACETAB 10D 28MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-532","SUP","Custom 27803010","","6302-H-532  -  LINER ACETAB 10D 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-628","SUP","Custom 27803010","","6302-H-628  -  LINER ACETAB 10D 28MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-H-632","SUP","Custom 27803010","","6302-H-632  -  LINER ACETAB 10D 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-222","SUP","Custom 27803010","","6302-N-222  -  LINER ACETAB NTRL 22MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-328","SUP","Custom 27803010","","6302-N-328  -  LINER ACETAB TRDNT NTRL 28MM CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-426","SUP","Custom 27803010","","6302-N-426  -  LINER ACETAB NTRL 26MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-428","SUP","Custom 27803010","","6302-N-428  -  LINER ACETAB NTRL 28MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-432","SUP","Custom 27803010","","6302-N-432  -  LINER ACETAB NTRL 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-532","SUP","Custom 27803010","","6302-N-532  -  LINER ACETAB NTRL 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6302-N-632","SUP","Custom 27803010","","6302-N-632  -  LINER ACETAB NTRL 32MM HIP CNSTRN","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6309-2-240","SUP","HCPCS C1776","","6309-2-240  -  CUP ACTB 40MM 22MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-242","SUP","HCPCS C1776","","6309-2-242  -  CUP ACTB 42MM 22MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-244","SUP","HCPCS C1776","","6309-2-244  -  CUP ACTB 44MM 22MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-844","SUP","HCPCS C1776","","6309-2-844  -  CUP ACTB 44MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-846","SUP","HCPCS C1776","","6309-2-846  -  CUP ACTB 46MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-848","SUP","HCPCS C1776","","6309-2-848  -  CUP ACTB 48MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-850","SUP","HCPCS C1776","","6309-2-850  -  CUP ACTB 50MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-852","SUP","HCPCS C1776","","6309-2-852  -  CUP ACTB 52MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-854","SUP","HCPCS C1776","","6309-2-854  -  CUP ACTB 54MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-856","SUP","HCPCS C1776","","6309-2-856  -  CUP ACTB 56MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-858","SUP","HCPCS C1776","","6309-2-858  -  CUP ACTB 58MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-2-860","SUP","HCPCS C1776","","6309-2-860  -  CUP ACTB 60MM 28MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-248","SUP","HCPCS C1776","","6309-3-248  -  CUP ACTB 48MM 32MM EXTR RIMFIT X3 HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-250","SUP","HCPCS C1776","","6309-3-250  -  CUP ACTB 50MM 32MM EXTR RIMFIT X3 HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-252","SUP","HCPCS C1776","","6309-3-252  -  CUP ACTB 52MM 32MM EXTR X3 RIMFIT HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-254","SUP","HCPCS C1776","","6309-3-254  -  CUP ACTB 54MM 32MM EXTR X3 RIMFIT HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-256","SUP","HCPCS C1776","","6309-3-256  -  CUP ACTB 56MM 32MM EXTR X3 RIMFIT HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-258","SUP","HCPCS C1776","","6309-3-258  -  CUP ACTB 58MM 32MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-260","SUP","HCPCS C1776","","6309-3-260  -  CUP ACTB 60MM 32MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-652","SUP","HCPCS C1776","","6309-3-652  -  CUP ACTB 52MM 36MM EXTR RIMFIT X3 HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-654","SUP","HCPCS C1776","","6309-3-654  -  CUP ACTB 54MM 36MM EXTR X3 RIMFIT HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-656","SUP","HCPCS C1776","","6309-3-656  -  CUP ACTB 56MM 36MM EXTR RIMFIT X3 HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-658","SUP","HCPCS C1776","","6309-3-658  -  CUP ACTB 58MM 36MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-3-660","SUP","HCPCS C1776","","6309-3-660  -  CUP ACTB 60MM 36MM EXTR RIMFIT X3 HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-4-056","SUP","HCPCS C1776","","6309-4-056  -  CUP ACTB 56MM 40MM EXTR RIMFIT X3 HIP","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-4-058","SUP","HCPCS C1776","","6309-4-058  -  CUP ACTB 58MM 40MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"6309-4-060","SUP","HCPCS C1776","","6309-4-060  -  CUP ACTB 58MM 60MM STRL EXTR RIMFIT X3","BOTH IP/OP","$2,327.50 ","$1,722.35 ","$0.00 ","$2,327.50 ","$1,047.38 ","$0.00 ","$485.11 ","$0.00 ","$0.00 ","$407.53 ","$2,327.50 ","$0.00 ","$1,163.75 ","$1,843.38 ","$1,862.00 ","$0.00 ","$364.25 ","$0.00 ","$370.54 ","$0.00 "
"632.414S","SUP","Custom 27803010","","632.414S  -  PORT RTRCT BVL 22MM 40MM MRS","BOTH IP/OP","$897.50 ","$664.15 ","$0.00 ","$897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.50 ","$0.00 ","$448.75 ","$710.82 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.415S","SUP","Custom 27803010","","632.415S  -  PORT RTRCT BVL 22MM 50MM MRS","BOTH IP/OP","$897.50 ","$664.15 ","$0.00 ","$897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.50 ","$0.00 ","$448.75 ","$710.82 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.416S","SUP","Custom 27803010","","632.416S  -  22MM PORT, BEVELED, 60MM","BOTH IP/OP","$897.50 ","$664.15 ","$0.00 ","$897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.50 ","$0.00 ","$448.75 ","$710.82 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.417S","SUP","Custom 27803010","","632.417S  -  PORT RTRCT BVL 22MM 70MM MRS","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.418S","SUP","Custom 27803010","","632.418S  -  PORT RTRCT BVL 22MM 80MM MRS","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.419S","SUP","Custom 27803010","","632.419S  -  PORT RTRCT BVL 22MM 90MM MRS","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.420S","SUP","Custom 27803010","","632.420S  -  PORT RTRCT BVL 22MM 100MM MRS","BOTH IP/OP","$1,232.50 ","$912.05 ","$0.00 ","$1,232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.50 ","$0.00 ","$616.25 ","$976.14 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.421S","SUP","Custom 27803010","","632.421S  -  PORT RTRCT BVL 22MM 110MM MRS","BOTH IP/OP","$1,232.50 ","$912.05 ","$0.00 ","$1,232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.50 ","$0.00 ","$616.25 ","$976.14 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.422S","SUP","Custom 27803010","","632.422S  -  PORT RTRCT BVL 22MM 120MM MRS","BOTH IP/OP","$1,232.50 ","$912.05 ","$0.00 ","$1,232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.50 ","$0.00 ","$616.25 ","$976.14 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.424S","SUP","Custom 27803010","","632.424S  -  PORT RTRCT STRG 22MM 40MM MRS","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.425S","SUP","Custom 27803010","","632.425S  -  22MM PORT, STRAIGHT, 50MM","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.426S","SUP","Custom 27803010","","632.426S  -  22MM PORT, STRAIGHT, 60MM","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.427S","SUP","Custom 27803010","","632.427S  -  PORT RTRCT STRG 22MM 70MM","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.428S","SUP","Custom 27803010","","632.428S  -  PORT RTRCT STRG 22MM 80MM MRS","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.429S","SUP","Custom 27803010","","632.429S  -  PORT RTRCT STRG 22MM 90MM MRS","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.430S","SUP","Custom 27803010","","632.430S  -  PORT RTRCT STRG 22MM 100MM MRS","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.431S","SUP","Custom 27803010","","632.431S  -  PORT RTRCT STRG 22MM 110MM MRS","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.432S","SUP","Custom 27803010","","632.432S  -  PORT RTRCT STRG 22MM 120MM MRS","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.434S","SUP","Custom 27803010","","632.434S  -  PORT RTRCT BVL 19MM 40MM MRS","BOTH IP/OP","$897.50 ","$664.15 ","$0.00 ","$897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.50 ","$0.00 ","$448.75 ","$710.82 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.435S","SUP","Custom 27803010","","632.435S  -  PORT RTRCT BVL 19MM 50MM MRS","BOTH IP/OP","$897.50 ","$664.15 ","$0.00 ","$897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.50 ","$0.00 ","$448.75 ","$710.82 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.436S","SUP","Custom 27803010","","632.436S  -  PORT RTRCT BVL 19MM 60MM MRS","BOTH IP/OP","$897.50 ","$664.15 ","$0.00 ","$897.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.50 ","$0.00 ","$448.75 ","$710.82 ","$718.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.437S","SUP","Custom 27803010","","632.437S  -  PORT RTRCT BVL 19MM 70MM MRS","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.438S","SUP","Custom 27803010","","632.438S  -  PORT RTRCT BVL 19MM 80MM MRS","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.439S","SUP","Custom 27803010","","632.439S  -  19MM PORT, BEVELED, 90MM","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.440S","SUP","Custom 27803010","","632.440S  -  PORT RTRCT BVL 19MM 100MM MRS","BOTH IP/OP","$1,232.50 ","$912.05 ","$0.00 ","$1,232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.50 ","$0.00 ","$616.25 ","$976.14 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.441S","SUP","Custom 27803010","","632.441S  -  PORT RTRCT BVL 19MM 110MM MRS","BOTH IP/OP","$1,232.50 ","$912.05 ","$0.00 ","$1,232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.50 ","$0.00 ","$616.25 ","$976.14 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.442S","SUP","Custom 27803010","","632.442S  -  PORT RTRCT BVL 19MM 120MM MRS","BOTH IP/OP","$1,232.50 ","$912.05 ","$0.00 ","$1,232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,232.50 ","$0.00 ","$616.25 ","$976.14 ","$986.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.444S","SUP","Custom 27803010","","632.444S  -  PORT RTRCT STRG 19MM 40MM MRS","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.445S","SUP","Custom 27803010","","632.445S  -  PORT RTRCT STRG 19MM 50MM MRS","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.446S","SUP","Custom 27803010","","632.446S  -  PORT RTRCT STRG 19MM 60MM","BOTH IP/OP","$860.00 ","$636.40 ","$0.00 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$860.00 ","$0.00 ","$430.00 ","$681.12 ","$688.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.447S","SUP","Custom 27803010","","632.447S  -  PORT RTRCT STRG 19MM 70MM MRS","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.448S","SUP","Custom 27803010","","632.448S  -  PORT RTRCT STRG 19MM 80MM MRS","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.449S","SUP","Custom 27803010","","632.449S  -  PORT RTRCT STRG 19MM 90MM MRS","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.450S","SUP","Custom 27803010","","632.450S  -  PORT RTRCT STRG 19MM 100MM MRS","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.451S","SUP","Custom 27803010","","632.451S  -  PORT RTRCT STRG 19MM 110MM MRS","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.452S","SUP","Custom 27803010","","632.452S  -  PORT RTRCT STRG 19MM 120MM MRS","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.454S","SUP","Custom 27803010","","632.454S  -  PORT RTRCT BVL 26MM 40MM MRS","BOTH IP/OP","$1,197.50 ","$886.15 ","$0.00 ","$1,197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,197.50 ","$0.00 ","$598.75 ","$948.42 ","$958.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.455S","SUP","Custom 27803010","","632.455S  -  PORT RTRCT BVL 26MM 50MM MRS","BOTH IP/OP","$1,197.50 ","$886.15 ","$0.00 ","$1,197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,197.50 ","$0.00 ","$598.75 ","$948.42 ","$958.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.456S","SUP","Custom 27803010","","632.456S  -  PORT RTRCT BVL 26MM 60MM MRS","BOTH IP/OP","$1,197.50 ","$886.15 ","$0.00 ","$1,197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,197.50 ","$0.00 ","$598.75 ","$948.42 ","$958.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.457S","SUP","Custom 27803010","","632.457S  -  PORT RTRCT BVL 26MM 70MM MRS","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.458S","SUP","Custom 27803010","","632.458S  -  PORT RTRCT BVL 26MM 80MM MRS","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.459S","SUP","Custom 27803010","","632.459S  -  PORT RTRCT BVL 26MM 90MM MRS","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.460S","SUP","Custom 27803010","","632.460S  -  PORT RTRCT BVL 26MM 100MM MRS","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.461S","SUP","Custom 27803010","","632.461S  -  PORT RTRCT BVL 26MM 110MM MRS","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.462S","SUP","Custom 27803010","","632.462S  -  PORT RTRCT BVL 26MM 120MM MRS","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.464S","SUP","Custom 27803010","","632.464S  -  PORT RTRCT STRG 26MM 40MM MRS","BOTH IP/OP","$1,167.50 ","$863.95 ","$0.00 ","$1,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,167.50 ","$0.00 ","$583.75 ","$924.66 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.465S","SUP","Custom 27803010","","632.465S  -  PORT RTRCT STRG 26MM 50MM MRS","BOTH IP/OP","$1,167.50 ","$863.95 ","$0.00 ","$1,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,167.50 ","$0.00 ","$583.75 ","$924.66 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.466S","SUP","Custom 27803010","","632.466S  -  PORT RTRCT STRG 26MM 60MM MRS","BOTH IP/OP","$1,167.50 ","$863.95 ","$0.00 ","$1,167.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,167.50 ","$0.00 ","$583.75 ","$924.66 ","$934.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.467S","SUP","Custom 27803010","","632.467S  -  PORT RTRCT STRG 26MM 70MM MRS","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.468S","SUP","Custom 27803010","","632.468S  -  PORT RTRCT STRG 26MM 80MM STRL MRS SPNE","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.469S","SUP","Custom 27803010","","632.469S  -  PORT RTRCT STRG 26MM 90MM MRS","BOTH IP/OP","$1,307.50 ","$967.55 ","$0.00 ","$1,307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,307.50 ","$0.00 ","$653.75 ","$1,035.54 ","$1,046.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.470S","SUP","Custom 27803010","","632.470S  -  PORT RTRCT STRG 26MM 100MM MRS","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.471S","SUP","Custom 27803010","","632.471S  -  PORT RTRCT STRG 26MM 110MM MRS","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"632.472S","SUP","Custom 27803010","","632.472S  -  PORT RTRCT STRG 26MM 120MM MRS","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"633-350","SUP","HCPCS C1884","","COIL EMBL 6MM TRFL PSH CMPLX SHP","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"6352-5-062","SUP","Custom 27803010","","6352-5-062  -  INSERT ACETAB 0D P2 46/48MM 28MM LINER CONGRUENT ROBUST LOCK","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-063","SUP","Custom 27803010","","6352-5-063  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-064","SUP","Custom 27803010","","6352-5-064  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-065","SUP","Custom 27803010","","6352-5-065  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-065300","SUP","Custom 27803010","","6352-5-065300  -  INSERT ACETAB 28MM 0D XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-066","SUP","Custom 27803010","","6352-5-066  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-066300","SUP","Custom 27803010","","6352-5-066300  -  INSERT ACETAB 28MM 0D XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-072","SUP","Custom 27803010","","6352-5-072  -  INSERT ACETAB 0D P2 46/48MM 28MM 5MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-073","SUP","HCPCS C1776","","6352-5-073  -  INSERT ACTB 10D P3 50/52MM 28MM S12 LINR CNGR RBST LCK XFR","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$1,189.13 ","$0.00 ","$550.76 ","$0.00 ","$0.00 ","$462.68 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$413.55 ","$0.00 ","$420.69 ","$0.00 "
"6352-5-073300","SUP","Custom 27803010","","6352-5-073300  -  INSERT ACETAB 28MM 10D XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-074","SUP","HCPCS C1776","","6352-5-074  -  INSERT ACTB 10D P4 54/46MM 28MM S12 LINR CNGR RBST LCK XFR","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$1,189.13 ","$0.00 ","$550.76 ","$0.00 ","$0.00 ","$462.68 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$413.55 ","$0.00 ","$420.69 ","$0.00 "
"6352-5-074300","SUP","Custom 27803010","","6352-5-074300  -  INSERT ACETAB 28MM 10D HIP XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-075","SUP","Custom 27803010","","6352-5-075  -  INSERT ACETAB 10D P5 58/60MM 28MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-076","SUP","HCPCS C1776","","6352-5-076  -  INSERT ACTB 10D P6 62/64MM 28MM S12 LINR CNGR RBST LCK XFR","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$1,189.13 ","$0.00 ","$550.76 ","$0.00 ","$0.00 ","$462.68 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$413.55 ","$0.00 ","$420.69 ","$0.00 "
"6352-5-076300","SUP","Custom 27803010","","6352-5-076300  -  INSERT ACETAB 28MM 10D XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-093","SUP","Custom 27803010","","6352-5-093  -  INSERT ACETAB 0D P3 50/52MM 32MM LINER CONGRUENT ROBUST LOCK","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-094","SUP","Custom 27803010","","6352-5-094  -  INSERT ACETAB 0D P4 54/46MM 32MM LINER CONGRUENT ROBUST LOCK","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-095","SUP","Custom 27803010","","6352-5-095  -  INSERT ACETAB 0D P5 58/60MM 32MM 8MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-096","SUP","Custom 27803010","","6352-5-096  -  INSERT ACETAB 0D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-097","SUP","HCPCS C1776","","6352-5-097  -  INSERT ACTB 0D P7 32MM STRL S12 LINR CNGR RBST LCK XFR HIP","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$1,189.13 ","$0.00 ","$550.76 ","$0.00 ","$0.00 ","$462.68 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$413.55 ","$0.00 ","$420.69 ","$0.00 "
"6352-5-097300","SUP","Custom 27803010","","6352-5-097300  -  INSERT ACETAB 32MM 0D HIP XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-098","SUP","HCPCS C1776","","6352-5-098  -  INSERT ACTB 0D P8 70/72MM 32MM S12 LINR CNGR XFR HIP","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$1,189.13 ","$0.00 ","$550.76 ","$0.00 ","$0.00 ","$462.68 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$413.55 ","$0.00 ","$420.69 ","$0.00 "
"6352-5-098300","SUP","Custom 27803010","","6352-5-098300  -  INSERT ACETAB 32MM 0D P8 HIP XFIRE S12","BOTH IP/OP","$1,707.00 ","$1,263.18 ","$0.00 ","$1,707.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.00 ","$0.00 ","$853.50 ","$1,351.94 ","$1,365.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-103","SUP","Custom 27803010","","6352-5-103  -  INSERT ACETAB 10D P3 50/52MM 32MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-104","SUP","Custom 27803010","","6352-5-104  -  INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-105","SUP","Custom 27803010","","6352-5-105  -  INSERT ACETAB 10D P5 58/60MM 32MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-106","SUP","Custom 27803010","","6352-5-106  -  INSERT ACETAB 10D P6 62/64MM 32MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-107","SUP","Custom 27803010","","6352-5-107  -  INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6352-5-108","SUP","Custom 27803010","","6352-5-108  -  INSERT ACETAB 10D P8 70/72MM 32MM LINER CONGRUENT ROBUST","BOTH IP/OP","$2,642.50 ","$1,955.45 ","$0.00 ","$2,642.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,642.50 ","$0.00 ","$1,321.25 ","$2,092.86 ","$2,114.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-026","SUP","Custom 27803010","","6364-2-026  -  HEAD FEMORAL -3MM 26MM NECK V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-028","SUP","Custom 27803010","","6364-2-028  -  HEAD FEMORAL -4MM 28MM NECK V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-032","SUP","Custom 27803010","","6364-2-032  -  HEAD FEMORAL -4MM 32MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-036","SUP","Custom 27803010","","6364-2-036  -  HEAD FEMORAL -5MM 36MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-122","SUP","Custom 27803010","","6364-2-122  -  HEAD FEMORAL 0MM 22MM V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-126","SUP","Custom 27803010","","6364-2-126  -  HEAD FEMORAL 0MM 26MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-128","SUP","Custom 27803010","","6364-2-128  -  HEAD FEMORAL 0MM 28MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-132","SUP","Custom 27803010","","6364-2-132  -  HEAD FEMORAL 0MM 32MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-136","SUP","Custom 27803010","","6364-2-136  -  HEAD FEMORAL 0MM 36MM V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-226","SUP","Custom 27803010","","6364-2-226  -  HEAD FEMORAL +4MM 26MM NECK V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-228","SUP","Custom 27803010","","6364-2-228  -  HEAD FEMORAL +4MM 28MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-232","SUP","Custom 27803010","","6364-2-232  -  HEAD FEMORAL +4MM TAPER 32MM V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-236","SUP","Custom 27803010","","6364-2-236  -  HEAD FEMORAL +5MM 36MM TAPER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-322","SUP","Custom 27803010","","6364-2-322  -  HEAD FEMORAL +8MM 22MM V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-326","SUP","Custom 27803010","","6364-2-326  -  HEAD FEMORAL +8MM 26MM NECK V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-328","SUP","Custom 27803010","","6364-2-328  -  HEAD FEMORAL +8MM 28MM V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6364-2-332","SUP","Custom 27803010","","6364-2-332  -  HEAD FEMORAL +8MM 32MM EXETER V40 ORTHINOX HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6366-9-220","SUP","HCPCS C1776","","6366-9-220  -  GUIDE PIN ORTH HMRS AXIS","BOTH IP/OP","$2,030.00 ","$1,502.20 ","$0.00 ","$2,030.00 ","$913.50 ","$0.00 ","$423.10 ","$0.00 ","$0.00 ","$355.44 ","$2,030.00 ","$0.00 ","$1,015.00 ","$1,607.76 ","$1,624.00 ","$0.00 ","$317.70 ","$0.00 ","$323.18 ","$0.00 "
"640301S","SUP","HCPCS C1713","","640301S  -  SCREW BONE T2 STD CMPR STRL","BOTH IP/OP","$189.75 ","$140.42 ","$0.00 ","$189.75 ","$85.39 ","$0.00 ","$39.55 ","$0.00 ","$0.00 ","$33.22 ","$189.75 ","$0.00 ","$94.88 ","$150.28 ","$151.80 ","$0.00 ","$29.70 ","$0.00 ","$30.21 ","$0.00 "
"640302S","SUP","HCPCS C1713","","640302S  -  SCREW BONE T2 2 SPNL CMPR STRL","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$89.72 ","$0.00 ","$41.55 ","$0.00 ","$0.00 ","$34.91 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$31.20 ","$0.00 ","$31.74 ","$0.00 "
"640303S","SUP","HCPCS C1713","","640303S  -  SCREW BONE T2 3 SPNL CMPR STRL","BOTH IP/OP","$170.50 ","$126.17 ","$0.00 ","$170.50 ","$76.73 ","$0.00 ","$35.54 ","$0.00 ","$0.00 ","$29.85 ","$170.50 ","$0.00 ","$85.25 ","$135.04 ","$136.40 ","$0.00 ","$26.68 ","$0.00 ","$27.14 ","$0.00 "
"640304S","SUP","HCPCS C1713","","640304S  -  SCREW BONE T2 4 SPNL CMPR STRL","BOTH IP/OP","$170.50 ","$126.17 ","$0.00 ","$170.50 ","$76.73 ","$0.00 ","$35.54 ","$0.00 ","$0.00 ","$29.85 ","$170.50 ","$0.00 ","$85.25 ","$135.04 ","$136.40 ","$0.00 ","$26.68 ","$0.00 ","$27.14 ","$0.00 "
"640320S","SUP","HCPCS C1713","","640320S  -  WASHER SCR T2 ORTH STRL","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$27.23 ","$0.00 ","$12.61 ","$0.00 ","$0.00 ","$10.59 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$9.47 ","$0.00 ","$9.63 ","$0.00 "
"641-00-28C","SUP","Custom 27803010","","641-00-28C  -  INSERT ACETAB C 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28D","SUP","Custom 27803010","","641-00-28D  -  INSERT ACETAB D 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28E","SUP","Custom 27803010","","641-00-28E  -  INSERT ACETAB E 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28F","SUP","Custom 27803010","","641-00-28F  -  INSERT ACETAB F 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28G","SUP","Custom 27803010","","641-00-28G  -  INSERT ACETAB G 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28H","SUP","Custom 27803010","","641-00-28H  -  INSERT ACETAB H 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28I","SUP","Custom 27803010","","641-00-28I  -  INSERT ACETAB I 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-28J","SUP","Custom 27803010","","641-00-28J  -  INSERT ACETAB J 28MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-32E","SUP","Custom 27803010","","641-00-32E  -  INSERT ACETAB 0D E 32MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-32F","SUP","Custom 27803010","","641-00-32F  -  INSERT ACETAB F 32MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-32G","SUP","Custom 27803010","","641-00-32G  -  INSERT ACETAB G 32MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-32H","SUP","Custom 27803010","","641-00-32H  -  INSERT ACETAB H 32MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-32I","SUP","Custom 27803010","","641-00-32I  -  INSERT ACETAB I 32MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-32J","SUP","Custom 27803010","","641-00-32J  -  INSERT ACETAB J 32MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-36E","SUP","Custom 27803010","","641-00-36E  -  INSERT ACETAB E 36MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-36F","SUP","Custom 27803010","","641-00-36F  -  INSERT ACETAB F 36MM ELEVATED RIM TRIDENT X3 HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-36G","SUP","Custom 27803010","","641-00-36G  -  INSERT ACETAB G 36MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-36H","SUP","Custom 27803010","","641-00-36H  -  INSERT ACETAB H 36MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-36I","SUP","Custom 27803010","","641-00-36I  -  INSERT ACETAB I 36MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"641-00-36J","SUP","Custom 27803010","","641-00-36J  -  INSERT ACETAB J 36MM ELEVATED RIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"64122-06","SUP","Custom 27203010","","FIXATIVE B5 HISTOLGY","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6430-0-020","SUP","Custom 27803010","","6430-0-020  -  COMPONENT PATLR SMALL 20MM AVON KNEE","BOTH IP/OP","$2,170.00 ","$1,605.80 ","$0.00 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,170.00 ","$0.00 ","$1,085.00 ","$1,718.64 ","$1,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6430-0-030","SUP","Custom 27803010","","6430-0-030  -  COMPONENT PATLR MEDIUM 30MM AVON KNEE","BOTH IP/OP","$2,170.00 ","$1,605.80 ","$0.00 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,170.00 ","$0.00 ","$1,085.00 ","$1,718.64 ","$1,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6430-0-040","SUP","Custom 27803010","","6430-0-040  -  COMPONENT PATLR LARGE 40MM AVON KNEE","BOTH IP/OP","$2,170.00 ","$1,605.80 ","$0.00 ","$2,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,170.00 ","$0.00 ","$1,085.00 ","$1,718.64 ","$1,736.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6430-0-050","SUP","HCPCS C1776","","6430-0-050  -  COMPONENT FEMORAL XS 50MM AVON KNEE","BOTH IP/OP","$9,682.50 ","$7,165.05 ","$0.00 ","$9,682.50 ","$4,357.13 ","$0.00 ","$2,018.08 ","$0.00 ","$0.00 ","$1,695.33 ","$9,682.50 ","$0.00 ","$4,841.25 ","$7,668.54 ","$7,746.00 ","$0.00 ","$1,515.31 ","$0.00 ","$1,541.45 ","$0.00 "
"6430-0-100","SUP","HCPCS C1776","","6430-0-100  -  COMPONENT FEMORAL SMALL AVON KNEE","BOTH IP/OP","$9,682.50 ","$7,165.05 ","$0.00 ","$9,682.50 ","$4,357.13 ","$0.00 ","$2,018.08 ","$0.00 ","$0.00 ","$1,695.33 ","$9,682.50 ","$0.00 ","$4,841.25 ","$7,668.54 ","$7,746.00 ","$0.00 ","$1,515.31 ","$0.00 ","$1,541.45 ","$0.00 "
"6430-0-200","SUP","HCPCS C1776","","6430-0-200  -  COMPONENT FEMORAL MEDIUM AVON KNEE","BOTH IP/OP","$9,682.50 ","$7,165.05 ","$0.00 ","$9,682.50 ","$4,357.13 ","$0.00 ","$2,018.08 ","$0.00 ","$0.00 ","$1,695.33 ","$9,682.50 ","$0.00 ","$4,841.25 ","$7,668.54 ","$7,746.00 ","$0.00 ","$1,515.31 ","$0.00 ","$1,541.45 ","$0.00 "
"643-00-28C","SUP","Custom 27803010","","643-00-28C  -  INSERT ACETAB C 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28D","SUP","Custom 27803010","","643-00-28D  -  INSERT ACETAB D 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28E","SUP","Custom 27803010","","643-00-28E  -  INSERT ACETAB E 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28F","SUP","Custom 27803010","","643-00-28F  -  INSERT ACETAB F 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28G","SUP","Custom 27803010","","643-00-28G  -  INSERT ACETAB G 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28H","SUP","Custom 27803010","","643-00-28H  -  INSERT ACETAB H 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28I","SUP","Custom 27803010","","643-00-28I  -  INSERT ACETAB I 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-28J","SUP","Custom 27803010","","643-00-28J  -  INSERT ACETAB J 28MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6430-0-300","SUP","HCPCS C1776","","6430-0-300  -  COMPONENT FEMORAL LARGE AVON KNEE","BOTH IP/OP","$9,682.50 ","$7,165.05 ","$0.00 ","$9,682.50 ","$4,357.13 ","$0.00 ","$2,018.08 ","$0.00 ","$0.00 ","$1,695.33 ","$9,682.50 ","$0.00 ","$4,841.25 ","$7,668.54 ","$7,746.00 ","$0.00 ","$1,515.31 ","$0.00 ","$1,541.45 ","$0.00 "
"643-00-32E","SUP","Custom 27803010","","643-00-32E  -  INSERT ACETAB E 32MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-32F","SUP","Custom 27803010","","643-00-32F  -  INSERT ACETAB F 32MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-32G","SUP","Custom 27803010","","643-00-32G  -  INSERT ACETAB G 32MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-32H","SUP","Custom 27803010","","643-00-32H  -  INSERT ACETAB H 32MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-32I","SUP","Custom 27803010","","643-00-32I  -  INSERT ACETAB I 32MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-32J","SUP","Custom 27803010","","643-00-32J  -  INSERT ACETAB J 32MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,130.00 ","$2,316.20 ","$0.00 ","$3,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,130.00 ","$0.00 ","$1,565.00 ","$2,478.96 ","$2,504.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-36E","SUP","Custom 27803010","","643-00-36E  -  INSERT ACETAB E 36MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,345.00 ","$2,475.30 ","$0.00 ","$3,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-36F","SUP","Custom 27803010","","643-00-36F  -  INSERT ACETAB F 36MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,345.00 ","$2,475.30 ","$0.00 ","$3,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-36G","SUP","Custom 27803010","","643-00-36G  -  INSERT ACETAB G 36MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,345.00 ","$2,475.30 ","$0.00 ","$3,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-36H","SUP","Custom 27803010","","643-00-36H  -  INSERT ACETAB H 36MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,345.00 ","$2,475.30 ","$0.00 ","$3,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-36I","SUP","Custom 27803010","","643-00-36I  -  INSERT ACETAB I 36MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,345.00 ","$2,475.30 ","$0.00 ","$3,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"643-00-36J","SUP","Custom 27803010","","643-00-36J  -  INSERT ACETAB J 36MM ELEVATE RIM TRIDENT X3 HIP","BOTH IP/OP","$3,345.00 ","$2,475.30 ","$0.00 ","$3,345.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,345.00 ","$0.00 ","$1,672.50 ","$2,649.24 ","$2,676.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-0-808","SUP","Custom 27803010","","6471-0-808  -  INSERT TIB XS 8MM CNDYLR MDLR K-2","BOTH IP/OP","$2,192.13 ","$1,622.18 ","$0.00 ","$2,192.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,192.13 ","$0.00 ","$1,096.06 ","$1,736.17 ","$1,753.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-0-811","SUP","Custom 27803010","","6471-0-811  -  INSERT TIB XS 11MM CNDYLR MDLR K-2","BOTH IP/OP","$2,192.13 ","$1,622.18 ","$0.00 ","$2,192.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,192.13 ","$0.00 ","$1,096.06 ","$1,736.17 ","$1,753.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-0-813","SUP","Custom 27803010","","6471-0-813  -  INSERT TIB XS 13MM CNDYLR MDLR K-2","BOTH IP/OP","$2,192.13 ","$1,622.18 ","$0.00 ","$2,192.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,192.13 ","$0.00 ","$1,096.06 ","$1,736.17 ","$1,753.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-0-816","SUP","Custom 27803010","","6471-0-816  -  INSERT TIB XS 16MM CNDYLR MDLR K-2","BOTH IP/OP","$2,192.13 ","$1,622.18 ","$0.00 ","$2,192.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,192.13 ","$0.00 ","$1,096.06 ","$1,736.17 ","$1,753.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-1-808","SUP","Custom 27803010","","6471-1-808  -  INSERT TIB SM 8MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-1-811","SUP","Custom 27803010","","6471-1-811  -  INSERT TIB SM 11MM CNDYLR MDLR K-2","BOTH IP/OP","$2,283.13 ","$1,689.52 ","$0.00 ","$2,283.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,283.13 ","$0.00 ","$1,141.56 ","$1,808.24 ","$1,826.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-1-813","SUP","Custom 27803010","","6471-1-813  -  INSERT TIB SM 13MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-1-816","SUP","Custom 27803010","","6471-1-816  -  INSERT TIB SM 16MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-3-808","SUP","Custom 27803010","","6471-3-808  -  INSERT TIB MED 8MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-3-811","SUP","Custom 27803010","","6471-3-811  -  INSERT TIB MED 11MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-3-813","SUP","Custom 27803010","","6471-3-813  -  INSERT TIB MED 13MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-3-816","SUP","Custom 27803010","","6471-3-816  -  INSERT TIB MED 16MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-5-808","SUP","Custom 27803010","","6471-5-808  -  INSERT TIB LG 8MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-5-811","SUP","Custom 27803010","","6471-5-811  -  INSERT TIB LG 11MM CNDYLR MDLR K-2","BOTH IP/OP","$2,283.13 ","$1,689.52 ","$0.00 ","$2,283.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,283.13 ","$0.00 ","$1,141.56 ","$1,808.24 ","$1,826.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-5-813","SUP","Custom 27803010","","6471-5-813  -  INSERT TIB LG 13MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-5-816","SUP","Custom 27803010","","6471-5-816  -  INSERT TIB LG 16MM CNDYLR MDLR K-2","BOTH IP/OP","$1,509.63 ","$1,117.13 ","$0.00 ","$1,509.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,509.63 ","$0.00 ","$754.81 ","$1,195.63 ","$1,207.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-6-808","SUP","Custom 27803010","","6471-6-808  -  INSERT TIB XL 8MM CNDYLR KNEE MDLR K-2","BOTH IP/OP","$1,349.00 ","$998.26 ","$0.00 ","$1,349.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,349.00 ","$0.00 ","$674.50 ","$1,068.41 ","$1,079.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-6-811","SUP","Custom 27803010","","6471-6-811  -  INSERT TIB XL 11MM CNDYLR MDLR K-2","BOTH IP/OP","$2,192.13 ","$1,622.18 ","$0.00 ","$2,192.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,192.13 ","$0.00 ","$1,096.06 ","$1,736.17 ","$1,753.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-6-813","SUP","Custom 27803010","","6471-6-813  -  INSERT TIB XL 13MM CNDYLR MDLR K-2","BOTH IP/OP","$1,349.00 ","$998.26 ","$0.00 ","$1,349.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,349.00 ","$0.00 ","$674.50 ","$1,068.41 ","$1,079.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6471-6-816","SUP","Custom 27803010","","6471-6-816  -  INSERT TIB XL 16MM CNDYLR MDLR K-2","BOTH IP/OP","$1,116.00 ","$825.84 ","$0.00 ","$1,116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,116.00 ","$0.00 ","$558.00 ","$883.87 ","$892.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-0-808","SUP","Custom 27803010","","6472-0-808  -  INSERT TIB XS 8MM KNEE STAB MDLR","BOTH IP/OP","$1,398.00 ","$1,034.52 ","$0.00 ","$1,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.00 ","$0.00 ","$699.00 ","$1,107.22 ","$1,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-0-813","SUP","Custom 27803010","","6472-0-813  -  INSERT TIB XS 13MM KNEE STAB MDLR","BOTH IP/OP","$1,398.00 ","$1,034.52 ","$0.00 ","$1,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.00 ","$0.00 ","$699.00 ","$1,107.22 ","$1,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-0-816","SUP","Custom 27803010","","6472-0-816  -  INSERT TIB XS 16MM KNEE STAB MDLR","BOTH IP/OP","$1,398.00 ","$1,034.52 ","$0.00 ","$1,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.00 ","$0.00 ","$699.00 ","$1,107.22 ","$1,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-1-808","SUP","Custom 27803010","","6472-1-808  -  INSERT TIB SM 8MM KNEE STAB MDLR","BOTH IP/OP","$1,398.00 ","$1,034.52 ","$0.00 ","$1,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.00 ","$0.00 ","$699.00 ","$1,107.22 ","$1,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-1-816","SUP","Custom 27803010","","6472-1-816  -  INSERT TIB SM 16MM KNEE STAB MDLR","BOTH IP/OP","$1,398.00 ","$1,034.52 ","$0.00 ","$1,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.00 ","$0.00 ","$699.00 ","$1,107.22 ","$1,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-6-808","SUP","Custom 27803010","","6472-6-808  -  INSERT TIB XL 8MM KNEE STAB MDLR","BOTH IP/OP","$1,456.00 ","$1,077.44 ","$0.00 ","$1,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,456.00 ","$0.00 ","$728.00 ","$1,153.15 ","$1,164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-6-811","SUP","Custom 27803010","","6472-6-811  -  INSERT TIB XL 11MM KNEE STAB MDLR","BOTH IP/OP","$1,456.00 ","$1,077.44 ","$0.00 ","$1,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,456.00 ","$0.00 ","$728.00 ","$1,153.15 ","$1,164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-6-813","SUP","Custom 27803010","","6472-6-813  -  INSERT TIB XL 13MM KNEE STAB MDLR","BOTH IP/OP","$1,456.00 ","$1,077.44 ","$0.00 ","$1,456.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,456.00 ","$0.00 ","$728.00 ","$1,153.15 ","$1,164.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6472-6-816","SUP","Custom 27803010","","6472-6-816  -  INSERT TIB XL 16MM KNEE STAB MDLR","BOTH IP/OP","$1,398.00 ","$1,034.52 ","$0.00 ","$1,398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,398.00 ","$0.00 ","$699.00 ","$1,107.22 ","$1,118.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6475-3-933","SUP","HCPCS C1776","","6475-3-933  -  BEARING TIBIAL LONG COMPRESSION ROTATE HINGE MRS MRH KNEE","BOTH IP/OP","$5,895.00 ","$4,362.30 ","$0.00 ","$5,895.00 ","$2,652.75 ","$0.00 ","$1,228.67 ","$0.00 ","$0.00 ","$1,032.17 ","$5,895.00 ","$0.00 ","$2,947.50 ","$4,668.84 ","$4,716.00 ","$0.00 ","$922.57 ","$0.00 ","$938.48 ","$0.00 "
"6475-3-940","SUP","Custom 27803010","","6475-3-940  -  AXLE FEMORAL STANDARD ROTATE HINGE MRS KINEMATIC KNEE","BOTH IP/OP","$2,065.00 ","$1,528.10 ","$0.00 ","$2,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,065.00 ","$0.00 ","$1,032.50 ","$1,635.48 ","$1,652.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-100","SUP","Custom 27803010","","6476-0-100  -  WEDGE TIB 10MM KNMX PLUS XS FULL","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-110","SUP","Custom 27203010","","6476-0-110  -  TRIAL SURG BLK 10MM KNMX XS LL/RM HALF BLOCK WDG","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-120","SUP","Custom 27803010","","6476-0-120  -  WEDGE TIB 10MM KX+ XS LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-130","SUP","Custom 27803010","","6476-0-130  -  WEDGE TIB 5MM KX+ XS LL/RM BLOCK","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-140","SUP","Custom 27803010","","6476-0-140  -  WEDGE TIB 5MM KX+ XS LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-150","SUP","Custom 27803010","","6476-0-150  -  WEDGE TIB KX+ XS LL/RM FULL ANG","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-160","SUP","Custom 27803010","","6476-0-160  -  WEDGE TIB KX+ XS LEFT MDL RIGHT LAT FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-310","SUP","Custom 27803010","","6476-0-310  -  BSPLT TIB KNMX K2 XS MDLR","BOTH IP/OP","$2,274.00 ","$1,682.76 ","$0.00 ","$2,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,274.00 ","$0.00 ","$1,137.00 ","$1,801.01 ","$1,819.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-0-400","SUP","Custom 27803010","","6476-0-400  -  BSPLT TIB KMX+ 4 XS KNEE","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-100","SUP","Custom 27803010","","6476-1-100  -  WEDGE TIBIAL 10MM FULL BLOCK KINEMAX PLUS SMALL LEFT MEDIAL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-110","SUP","Custom 27803010","","6476-1-110  -  WEDGE TIB 10MM KX+ SM LL/RM BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-120","SUP","Custom 27803010","","6476-1-120  -  WEDGE TIB 10MM KX+ SM LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-130","SUP","Custom 27803010","","6476-1-130  -  WEDGE TIB 5MM KX+ SM LL/RM BLOCK","BOTH IP/OP","$673.00 ","$498.02 ","$0.00 ","$673.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$673.00 ","$0.00 ","$336.50 ","$533.02 ","$538.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-140","SUP","Custom 27803010","","6476-1-140  -  WEDGE TIB 5MM KX+ SM LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-150","SUP","Custom 27803010","","6476-1-150  -  WEDGE TIB KX+ SM LL/RM FULL ANG","BOTH IP/OP","$1,248.00 ","$923.52 ","$0.00 ","$1,248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,248.00 ","$0.00 ","$624.00 ","$988.42 ","$998.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-160","SUP","Custom 27803010","","6476-1-160  -  WEDGE TIB KX+ SM LEFT MDL RIGHT LAT FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-310","SUP","Custom 27803010","","6476-1-310  -  BSPLT TIB KNMX SM REG KNEE STM","BOTH IP/OP","$2,146.00 ","$1,588.04 ","$0.00 ","$2,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,146.00 ","$0.00 ","$1,073.00 ","$1,699.63 ","$1,716.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-1-400","SUP","Custom 27803010","","6476-1-400  -  BASEPLATE TIBIAL SMALL KINEMAX PLUS KNEE","BOTH IP/OP","$4,920.00 ","$3,640.80 ","$0.00 ","$4,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,920.00 ","$0.00 ","$2,460.00 ","$3,896.64 ","$3,936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-100","SUP","Custom 27803010","","6476-3-100  -  WEDGE TIB 10MM KNMX PLUS MED FULL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-110","SUP","Custom 27803010","","6476-3-110  -  WEDGE TIB 10MM KX+ MED LL/RM BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-120","SUP","Custom 27803010","","6476-3-120  -  WEDGE TIB 10MM KX+ MED LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-130","SUP","Custom 27803010","","6476-3-130  -  WEDGE TIB 5MM KX+ MED LL/RM BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-140","SUP","Custom 27803010","","6476-3-140  -  WEDGE TIB 5MM KX+ MED LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-150","SUP","Custom 27803010","","6476-3-150  -  WEDGE TIB KX+ MED LL/RM FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-160","SUP","Custom 27803010","","6476-3-160  -  WEDGE TIBIAL KINEMAX PLUS MEDIUM FULL ANGLE RIGHT MEDIAL","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-310","SUP","Custom 27803010","","6476-3-310  -  BSPLT TIB KNMX K2 MED KNEE MDLR","BOTH IP/OP","$2,146.00 ","$1,588.04 ","$0.00 ","$2,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,146.00 ","$0.00 ","$1,073.00 ","$1,699.63 ","$1,716.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-3-400","SUP","Custom 27803010","","6476-3-400  -  BSPLT TIB KMX+ MED KNEE ASMBLY","BOTH IP/OP","$2,996.00 ","$2,217.04 ","$0.00 ","$2,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,996.00 ","$0.00 ","$1,498.00 ","$2,372.83 ","$2,396.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-100","SUP","Custom 27803010","","6476-5-100  -  WEDGE TIB 10MM KNMX PLUS LG FULL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-110","SUP","Custom 27803010","","6476-5-110  -  WEDGE TIB 10MM KX+ LG LL/RM BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-120","SUP","Custom 27803010","","6476-5-120  -  WEDGE TIB 10MM KX+ LG LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$673.00 ","$498.02 ","$0.00 ","$673.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$673.00 ","$0.00 ","$336.50 ","$533.02 ","$538.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-130","SUP","Custom 27803010","","6476-5-130  -  WEDGE TIB 5MM KX+ LG LL/RM BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-140","SUP","Custom 27803010","","6476-5-140  -  WEDGE TIB 5MM KX+ LG LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-150","SUP","Custom 27803010","","6476-5-150  -  WEDGE TIB KX+ LG LL/RM FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-160","SUP","Custom 27803010","","6476-5-160  -  WEDGE TIB KX+ LG LEFT MDL RIGHT LAT FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-310","SUP","Custom 27803010","","6476-5-310  -  BSPLT TIB KNMX LG KNEE MODULLAR","BOTH IP/OP","$2,146.00 ","$1,588.04 ","$0.00 ","$2,146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,146.00 ","$0.00 ","$1,073.00 ","$1,699.63 ","$1,716.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-5-400","SUP","Custom 27803010","","6476-5-400  -  BSPLT TIB KMX+ LG KNEE ASMBLY","BOTH IP/OP","$2,996.00 ","$2,217.04 ","$0.00 ","$2,996.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,996.00 ","$0.00 ","$1,498.00 ","$2,372.83 ","$2,396.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-100","SUP","Custom 27803010","","6476-6-100  -  WEDGE TIB 10MM KNMX PLUS XL FULL","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-110","SUP","Custom 27803010","","6476-6-110  -  WEDGE TIB 10MM KX+ XL LL/RM BLOCK","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-120","SUP","Custom 27803010","","6476-6-120  -  WEDGE TIB 10MM KX+ XL LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-130","SUP","Custom 27803010","","6476-6-130  -  WEDGE TIB 5MM KX+ XL LL/RM BLOCK","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-140","SUP","Custom 27803010","","6476-6-140  -  WEDGE TIB 5MM KX+ XL LEFT MDL RIGHT LAT BLOCK","BOTH IP/OP","$776.00 ","$574.24 ","$0.00 ","$776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$776.00 ","$0.00 ","$388.00 ","$614.59 ","$620.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-150","SUP","Custom 27803010","","6476-6-150  -  WEDGE TIB KX+ XL LL/RM FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-160","SUP","Custom 27803010","","6476-6-160  -  WEDGE TIB KX+ XL LEFT MDL RIGHT LAT FULL ANG","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-310","SUP","Custom 27803010","","6476-6-310  -  BSPLT TIB KNMX XL KNEE MDLR","BOTH IP/OP","$2,274.00 ","$1,682.76 ","$0.00 ","$2,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,274.00 ","$0.00 ","$1,137.00 ","$1,801.01 ","$1,819.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-6-400","SUP","Custom 27803010","","6476-6-400  -  BSPLT TIB KMX+ XL ORTH ASMBLY","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-170","SUP","Custom 27803010","","6476-8-170  -  WEDGE TIB KMX+ FIX SCR","BOTH IP/OP","$103.00 ","$76.22 ","$0.00 ","$103.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.00 ","$0.00 ","$51.50 ","$81.58 ","$82.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-180","SUP","Custom 27803010","","6476-8-180  -  WEDGE TIB 15MM KNMX PLUS FIX PG","BOTH IP/OP","$218.00 ","$161.32 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$218.00 ","$0.00 ","$109.00 ","$172.66 ","$174.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-242","SUP","Custom 27803010","","6476-8-242  -  STEM FEM 40MM CMNT COCR XS FEM/TIB KNEE","BOTH IP/OP","$1,839.50 ","$1,361.23 ","$0.00 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,839.50 ","$0.00 ","$919.75 ","$1,456.88 ","$1,471.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-244","SUP","Custom 27803010","","6476-8-244  -  STEM FEM 80MM CMNT COCR XS TIB KNEE","BOTH IP/OP","$1,839.50 ","$1,361.23 ","$0.00 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,839.50 ","$0.00 ","$919.75 ","$1,456.88 ","$1,471.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-246","SUP","Custom 27803010","","6476-8-246  -  STEM FEM 155MM CMNT COCR XS TIB KNEE","BOTH IP/OP","$1,860.63 ","$1,376.87 ","$0.00 ","$1,860.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,860.63 ","$0.00 ","$930.31 ","$1,473.62 ","$1,488.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-250","SUP","Custom 27803010","","6476-8-250  -  EXTENSION STEM XS 40MM CEMENTED KINEMAX COCR KNEE FEMORAL","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-260","SUP","Custom 27803010","","6476-8-260  -  STEM FEMORAL 80MM CEMENT KINEMAX COCR KNEE","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-270","SUP","Custom 27803010","","6476-8-270  -  EXTENSION STEM XS 155MM CEMENTED KINEMAX COCR KNEE FEMORAL","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-315","SUP","Custom 27803010","","6476-8-315  -  WEDGE TIB KMX+ LG","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6476-8-320","SUP","Custom 27803010","","6476-8-320  -  WEDGE TIB KMX+ XL","BOTH IP/OP","$808.00 ","$597.92 ","$0.00 ","$808.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$808.00 ","$0.00 ","$404.00 ","$639.94 ","$646.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-020","SUP","Custom 27803010","","6478-6-020  -  INSERT TIB 20MM KNEE PEG KMX+","BOTH IP/OP","$446.00 ","$330.04 ","$0.00 ","$446.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.00 ","$0.00 ","$223.00 ","$353.23 ","$356.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-100","SUP","Custom 27803010","","6478-6-100  -  WEDGE TIB KNMX PLUS SM XS SS","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-110","SUP","Custom 27803010","","6478-6-110  -  WEDGE TIB SM KNEE SS MDLR PLUS KX","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-120","SUP","Custom 27803010","","6478-6-120  -  WEDGE TIB KNMX L+ MED KNEE SS WDG SUP STAB","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-395","SUP","Custom 27803010","","6478-6-395  -  EXTENSION STEM 10MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-396","SUP","Custom 27803010","","6478-6-396  -  EXTENSION STEM 11MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-397","SUP","Custom 27803010","","6478-6-397  -  EXTENSION STEM 12MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-398","SUP","Custom 27803010","","6478-6-398  -  TRIAL KNEE 13MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-399","SUP","Custom 27803010","","6478-6-399  -  EXTENSION STEM 14MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-400","SUP","Custom 27803010","","6478-6-400  -  TRIAL KNEE 15MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-405","SUP","Custom 27803010","","6478-6-405  -  EXTENSION STEM 16MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-410","SUP","Custom 27803010","","6478-6-410  -  EXTENSION STEM 17MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-415","SUP","Custom 27803010","","6478-6-415  -  EXTENSION STEM 18MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-420","SUP","Custom 27803010","","6478-6-420  -  EXTENSION STEM 19MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-425","SUP","Custom 27803010","","6478-6-425  -  EXTENSION STEM 21MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-430","SUP","Custom 27803010","","6478-6-430  -  EXTENSION STEM 23MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-435","SUP","Custom 27803010","","6478-6-435  -  EXTENSION STEM 10MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-436","SUP","Custom 27803010","","6478-6-436  -  EXTENSION STEM 11MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-437","SUP","Custom 27803010","","6478-6-437  -  TRIAL KNEE 12MM 155MM 1 AXIS PRESS FIT CEMENTED STEM EXTN","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-438","SUP","Custom 27803010","","6478-6-438  -  EXTENSION STEM 13MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-439","SUP","Custom 27803010","","6478-6-439  -  EXTENSION STEM 14MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-440","SUP","Custom 27803010","","6478-6-440  -  EXTENSION STEM 15MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-445","SUP","Custom 27803010","","6478-6-445  -  EXTENSION STEM 16MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-450","SUP","Custom 27803010","","6478-6-450  -  EXTENSION STEM 17MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-455","SUP","Custom 27803010","","6478-6-455  -  EXTENSION STEM 18MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-460","SUP","Custom 27803010","","6478-6-460  -  EXTENSION STEM 19MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-465","SUP","Custom 27803010","","6478-6-465  -  EXTENSION STEM 21MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-470","SUP","Custom 27803010","","6478-6-470  -  EXTENSION STEM 23MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO","BOTH IP/OP","$1,915.00 ","$1,417.10 ","$0.00 ","$1,915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,915.00 ","$0.00 ","$957.50 ","$1,516.68 ","$1,532.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-490","SUP","Custom 27803010","","6478-6-490  -  ADAPTER STEM 4MM OFFST JAM NUT SCORPIO KNEE","BOTH IP/OP","$2,220.00 ","$1,642.80 ","$0.00 ","$2,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,220.00 ","$0.00 ","$1,110.00 ","$1,758.24 ","$1,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-495","SUP","Custom 27803010","","6478-6-495  -  ADAPTER STM 6MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS","BOTH IP/OP","$2,220.00 ","$1,642.80 ","$0.00 ","$2,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,220.00 ","$0.00 ","$1,110.00 ","$1,758.24 ","$1,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-500","SUP","Custom 27803010","","6478-6-500  -  ADAPTER STM 8MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS","BOTH IP/OP","$2,220.00 ","$1,642.80 ","$0.00 ","$2,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,220.00 ","$0.00 ","$1,110.00 ","$1,758.24 ","$1,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-585","SUP","Custom 27803010","","6478-6-585  -  ADAPTER STM 2MM OFST SCRP JAM NUT FEM 1 AXIS KN SYS","BOTH IP/OP","$2,220.00 ","$1,642.80 ","$0.00 ","$2,220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,220.00 ","$0.00 ","$1,110.00 ","$1,758.24 ","$1,776.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-600","SUP","Custom 27803010","","6478-6-600  -  STEM TIBIAL FLUTE 10MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-605","SUP","Custom 27803010","","6478-6-605  -  STEM TIBIAL FLUTE 11MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-610","SUP","Custom 27803010","","6478-6-610  -  STEM TIBIAL FLUTE 12MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-615","SUP","Custom 27803010","","6478-6-615  -  STEM TIBIAL FLUTE 13MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-620","SUP","Custom 27803010","","6478-6-620  -  STEM TIBIAL FLUTE 14MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-625","SUP","Custom 27803010","","6478-6-625  -  STEM TIBIAL FLUTE 15MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-630","SUP","Custom 27803010","","6478-6-630  -  STEM TIBIAL FLUTE 16MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-635","SUP","Custom 27803010","","6478-6-635  -  STEM TIBIAL FLUTE 17MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-640","SUP","Custom 27803010","","6478-6-640  -  STEM TIBIAL FLUTE 18MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-645","SUP","Custom 27803010","","6478-6-645  -  STEM TIBIAL FLUTE 19MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-655","SUP","Custom 27803010","","6478-6-655  -  STEM TIBIAL FLUTE 21MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-665","SUP","Custom 27803010","","6478-6-665  -  STEM TIBIAL FLUTE 23MM 80MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-680","SUP","Custom 27803010","","6478-6-680  -  STEM TIBIAL FLUTE 10MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-685","SUP","Custom 27803010","","6478-6-685  -  STEM TIBIAL FLUTE 11MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-690","SUP","Custom 27803010","","6478-6-690  -  STEM TIBIAL FLUTE 12MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-695","SUP","Custom 27803010","","6478-6-695  -  STEM TIBIAL FLUTE 13MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-705","SUP","Custom 27803010","","6478-6-705  -  STEM TIBIAL FLUTE 14MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-710","SUP","Custom 27803010","","6478-6-710  -  STEM TIBIAL FLUTE 15MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-715","SUP","Custom 27803010","","6478-6-715  -  STEM TIBIAL FLUTE 16MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-720","SUP","Custom 27803010","","6478-6-720  -  STEM TIBIAL FLUTE 17MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-725","SUP","Custom 27803010","","6478-6-725  -  STEM TIBIAL FLUTE 18MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-730","SUP","Custom 27803010","","6478-6-730  -  STEM TIBIAL FLUTE 19MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-740","SUP","Custom 27803010","","6478-6-740  -  STEM TIBIAL FLUTE 21MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6478-6-750","SUP","Custom 27803010","","6478-6-750  -  STEM TIBIAL FLUTE 23MM 115MM GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$2,342.50 ","$1,733.45 ","$0.00 ","$2,342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,342.50 ","$0.00 ","$1,171.25 ","$1,855.26 ","$1,874.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-0-050","SUP","HCPCS C1776","","6479-0-050  -  CMPNT FEM XS CNDYLR KMX+ NPOR","BOTH IP/OP","$3,596.00 ","$2,661.04 ","$0.00 ","$3,596.00 ","$1,618.20 ","$0.00 ","$749.50 ","$0.00 ","$0.00 ","$629.63 ","$3,596.00 ","$0.00 ","$1,798.00 ","$2,848.03 ","$2,876.80 ","$0.00 ","$562.77 ","$0.00 ","$572.48 ","$0.00 "
"6479-0-100","SUP","HCPCS C1776","","6479-0-100  -  CMPNT FEM SM CNDYLR KMX+ NPOR","BOTH IP/OP","$3,467.00 ","$2,565.58 ","$0.00 ","$3,467.00 ","$1,560.15 ","$0.00 ","$722.61 ","$0.00 ","$0.00 ","$607.04 ","$3,467.00 ","$0.00 ","$1,733.50 ","$2,745.86 ","$2,773.60 ","$0.00 ","$542.59 ","$0.00 ","$551.95 ","$0.00 "
"6479-0-150","SUP","HCPCS C1776","","6479-0-150  -  CMPNT FEM MED CNDYLR KMX+ NPOR","BOTH IP/OP","$3,467.00 ","$2,565.58 ","$0.00 ","$3,467.00 ","$1,560.15 ","$0.00 ","$722.61 ","$0.00 ","$0.00 ","$607.04 ","$3,467.00 ","$0.00 ","$1,733.50 ","$2,745.86 ","$2,773.60 ","$0.00 ","$542.59 ","$0.00 ","$551.95 ","$0.00 "
"6479-0-200","SUP","HCPCS C1776","","6479-0-200  -  CMPNT FEM LG CNDYLR KMX+ NPOR","BOTH IP/OP","$3,467.00 ","$2,565.58 ","$0.00 ","$3,467.00 ","$1,560.15 ","$0.00 ","$722.61 ","$0.00 ","$0.00 ","$607.04 ","$3,467.00 ","$0.00 ","$1,733.50 ","$2,745.86 ","$2,773.60 ","$0.00 ","$542.59 ","$0.00 ","$551.95 ","$0.00 "
"6479-0-250","SUP","HCPCS C1776","","6479-0-250  -  CMPNT FEM XL CNDYLR KMX+ NPOR","BOTH IP/OP","$3,467.00 ","$2,565.58 ","$0.00 ","$3,467.00 ","$1,560.15 ","$0.00 ","$722.61 ","$0.00 ","$0.00 ","$607.04 ","$3,467.00 ","$0.00 ","$1,733.50 ","$2,745.86 ","$2,773.60 ","$0.00 ","$542.59 ","$0.00 ","$551.95 ","$0.00 "
"6479-0-300","SUP","HCPCS C1776","","6479-0-300  -  CMPNT FEM 2XL CNDYLR KMX+ NPOR","BOTH IP/OP","$3,596.00 ","$2,661.04 ","$0.00 ","$3,596.00 ","$1,618.20 ","$0.00 ","$749.50 ","$0.00 ","$0.00 ","$629.63 ","$3,596.00 ","$0.00 ","$1,798.00 ","$2,848.03 ","$2,876.80 ","$0.00 ","$562.77 ","$0.00 ","$572.48 ","$0.00 "
"6479-4-900","SUP","Custom 27803010","","6479-4-900  -  CMPNT PATLR SM KMX+ DUR","BOTH IP/OP","$1,133.00 ","$838.42 ","$0.00 ","$1,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,133.00 ","$0.00 ","$566.50 ","$897.34 ","$906.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-4-911","SUP","Custom 27803010","","6479-4-911  -  CMPNT PATLR MED KMX+ DUR","BOTH IP/OP","$1,133.00 ","$838.42 ","$0.00 ","$1,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,133.00 ","$0.00 ","$566.50 ","$897.34 ","$906.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-4-920","SUP","Custom 27803010","","6479-4-920  -  INSERT TIB LG PTLR DUR KX+","BOTH IP/OP","$1,133.00 ","$838.42 ","$0.00 ","$1,133.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,133.00 ","$0.00 ","$566.50 ","$897.34 ","$906.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-008","SUP","Custom 27803010","","6479-5-008  -  INSERT TIBIAL XS 65X41X8MM LATERAL STABILIZE CRUCIATE RETAIN","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-010","SUP","Custom 27803010","","6479-5-010  -  INSERT TIBIAL XS 65X41X10MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-012","SUP","Custom 27803010","","6479-5-012  -  INSERT TIBIAL XS 65X41X12MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-015","SUP","Custom 27803010","","6479-5-015  -  INSERT TIBIAL XS 65X41X15MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-018","SUP","Custom 27803010","","6479-5-018  -  INSERT TIBIAL XS 65X41X18MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-021","SUP","Custom 27803010","","6479-5-021  -  INSERT TIBIAL XS 21MM LATERAL STABILIZED CRUC RET KINEMAX","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-025","SUP","Custom 27803010","","6479-5-025  -  INSERT TIBIAL XS 65X41X25MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-108","SUP","Custom 27803010","","6479-5-108  -  INSERT TIBIAL SMALL 8MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-110","SUP","Custom 27803010","","6479-5-110  -  INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-112","SUP","Custom 27803010","","6479-5-112  -  INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-115","SUP","Custom 27803010","","6479-5-115  -  INSERT TIBIAL SMALL 15MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-118","SUP","Custom 27803010","","6479-5-118  -  INSERT TIBIAL SMALL 71X44X18MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-121","SUP","Custom 27803010","","6479-5-121  -  INSERT TIBIAL SMALL 21MM LATERAL STABILIZED CRUC RET KINEMAX","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-125","SUP","Custom 27803010","","6479-5-125  -  INSERT TIBIAL SMALL 71X44X25MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-208","SUP","Custom 27803010","","6479-5-208  -  INSERT TIBIAL MEDIUM 8MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-210","SUP","Custom 27803010","","6479-5-210  -  INSERT TIBIAL MEDIUM 76X48X10MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-212","SUP","Custom 27803010","","6479-5-212  -  INSERT TIBIAL MEDIUM 12MM LATERAL STABILIZED KINEMAX PLUS","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-215","SUP","Custom 27803010","","6479-5-215  -  INSERT TIBIAL MEDIUM 15MM LATERAL STABILIZED KINEMAX PLUS","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-218","SUP","Custom 27803010","","6479-5-218  -  INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-221","SUP","Custom 27803010","","6479-5-221  -  INSERT TIBIAL MEDIUM 76X48X21MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-225","SUP","Custom 27803010","","6479-5-225  -  INSERT TIBIAL MEDIUM 76X48X25MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-308","SUP","Custom 27803010","","6479-5-308  -  INSERT TIBIAL LARGE 8MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-310","SUP","Custom 27803010","","6479-5-310  -  INSERT TIBIAL LARGE 81X51X10MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-312","SUP","Custom 27803010","","6479-5-312  -  INSERT TIBIAL LARGE 12MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-315","SUP","Custom 27803010","","6479-5-315  -  INSERT TIBIAL LARGE 81X51X15MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-318","SUP","Custom 27803010","","6479-5-318  -  INSERT TIBIAL LARGE 81X51X18MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-321","SUP","Custom 27803010","","6479-5-321  -  INSERT TIBIAL LARGE 81X51X21MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-325","SUP","Custom 27803010","","6479-5-325  -  INSERT TIBIAL LARGE 81X51X25MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-408","SUP","Custom 27803010","","6479-5-408  -  INSERT TIBIAL XL 86X54X8MM LATERAL STABILIZE CRUCIATE RETAIN","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-410","SUP","Custom 27803010","","6479-5-410  -  INSERT TIBIAL XL 86X54X10MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-412","SUP","Custom 27803010","","6479-5-412  -  INSERT TIBIAL XL 86X54X12MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-415","SUP","Custom 27803010","","6479-5-415  -  INSERT TIBIAL XL 86X54X15MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-418","SUP","Custom 27803010","","6479-5-418  -  INSERT TIBIAL XL 86X54X18MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-421","SUP","Custom 27803010","","6479-5-421  -  INSERT TIBIAL XL 86X54X21MM LATERAL STABILIZE CRUCIATE","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-425","SUP","Custom 27803010","","6479-5-425  -  INSERT TIBIAL XL 25MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,265.00 ","$1,676.10 ","$0.00 ","$2,265.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,265.00 ","$0.00 ","$1,132.50 ","$1,793.88 ","$1,812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-508","SUP","Custom 27803010","","6479-5-508  -  INSERT TIBIAL XS 65X41X8MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-510","SUP","Custom 27803010","","6479-5-510  -  INSERT TIBIAL XS 65X41X10MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-512","SUP","Custom 27803010","","6479-5-512  -  INSERT TIBIAL XS 65X41X12MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-515","SUP","Custom 27803010","","6479-5-515  -  INSERT TIBIAL XS 65X41X15MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-518","SUP","Custom 27803010","","6479-5-518  -  INSERT TIBIAL XS 65X41X18MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-521","SUP","Custom 27803010","","6479-5-521  -  INSERT TIBIAL XS 65X41X21MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-525","SUP","Custom 27803010","","6479-5-525  -  INSERT TIBIAL XS 65X41X25MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-608","SUP","Custom 27803010","","6479-5-608  -  INSERT TIBIAL SMALL 70X45X8MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-610","SUP","Custom 27803010","","6479-5-610  -  INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-612","SUP","Custom 27803010","","6479-5-612  -  INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-615","SUP","Custom 27803010","","6479-5-615  -  INSERT TIBIAL SMALL 70X45X15MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-618","SUP","Custom 27803010","","6479-5-618  -  INSERT TIBIAL SMALL 70X45X18MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-621","SUP","Custom 27803010","","6479-5-621  -  INSERT TIBIAL SMALL 70X45X21MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-625","SUP","Custom 27803010","","6479-5-625  -  INSERT TIBIAL SMALL 70X45X25MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-708","SUP","Custom 27803010","","6479-5-708  -  INSERT TIBIAL MEDIUM 76X48X8MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-710","SUP","Custom 27803010","","6479-5-710  -  INSERT TIBIAL MEDIUM 76X48X10MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-712","SUP","Custom 27803010","","6479-5-712  -  INSERT TIBIAL MEDIUM 76X48X12MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-715","SUP","Custom 27803010","","6479-5-715  -  INSERT TIBIAL MEDIUM 76X48X15MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-718","SUP","Custom 27803010","","6479-5-718  -  INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-721","SUP","Custom 27803010","","6479-5-721  -  INSERT TIBIAL MEDIUM 76X48X21MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-725","SUP","Custom 27803010","","6479-5-725  -  INSERT TIBIAL MEDIUM 76X48X25MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-808","SUP","Custom 27803010","","6479-5-808  -  INSERT TIBIAL LARGE 81X51X8MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-810","SUP","Custom 27803010","","6479-5-810  -  INSERT TIBIAL LARGE 81X51X10MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-812","SUP","Custom 27803010","","6479-5-812  -  INSERT TIBIAL LARGE 81X51X12MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-815","SUP","Custom 27803010","","6479-5-815  -  INSERT TIBIAL LARGE 81X51X15MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-818","SUP","Custom 27803010","","6479-5-818  -  INSERT TIBIAL LARGE 81X51X18MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-821","SUP","Custom 27803010","","6479-5-821  -  INSERT TIBIAL LARGE 81X51X21MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-825","SUP","Custom 27803010","","6479-5-825  -  INSERT TIBIAL LARGE 81X51X25MM POSTERIOR STABILIZE KINEMAX","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-908","SUP","Custom 27803010","","6479-5-908  -  INSERT TIBIAL XL 86X54X8MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-910","SUP","Custom 27803010","","6479-5-910  -  INSERT TIBIAL XL 86X54X10MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-912","SUP","Custom 27803010","","6479-5-912  -  INSERT TIBIAL XL 86X54X12MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-915","SUP","Custom 27803010","","6479-5-915  -  INSERT TIBIAL XL 86X54X15MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-918","SUP","Custom 27803010","","6479-5-918  -  INSERT TIBIAL XL 86X54X18MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-921","SUP","Custom 27803010","","6479-5-921  -  INSERT TIBIAL XL 86X54X21MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6479-5-925","SUP","Custom 27803010","","6479-5-925  -  INSERT TIBIAL XL 86X54X25MM POSTERIOR STABILIZE KINEMAX PLUS","BOTH IP/OP","$2,347.50 ","$1,737.15 ","$0.00 ","$2,347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,347.50 ","$0.00 ","$1,173.75 ","$1,859.22 ","$1,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6480-0-050","SUP","HCPCS C1776","","6480-0-050  -  COMPONENT FEMORAL XS STABILIZE KINEMAX PLUS KNEE","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,787.50 ","$2,604.38 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$1,013.34 ","$5,787.50 ","$0.00 ","$2,893.75 ","$4,583.70 ","$4,630.00 ","$0.00 ","$905.74 ","$0.00 ","$921.37 ","$0.00 "
"6480-0-100","SUP","HCPCS C1776","","6480-0-100  -  COMPONENT FEMORAL SMALL STABILIZE KINEMAX PLUS KNEE","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,787.50 ","$2,604.38 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$1,013.34 ","$5,787.50 ","$0.00 ","$2,893.75 ","$4,583.70 ","$4,630.00 ","$0.00 ","$905.74 ","$0.00 ","$921.37 ","$0.00 "
"6480-0-150","SUP","HCPCS C1776","","6480-0-150  -  COMPONENT FEMORAL MEDIUM STABILIZE KINEMAX PLUS KNEE","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,787.50 ","$2,604.38 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$1,013.34 ","$5,787.50 ","$0.00 ","$2,893.75 ","$4,583.70 ","$4,630.00 ","$0.00 ","$905.74 ","$0.00 ","$921.37 ","$0.00 "
"6480-0-200","SUP","HCPCS C1776","","6480-0-200  -  COMPONENT FEMORAL LARGE STABILIZE KINEMAX PLUS KNEE","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,787.50 ","$2,604.38 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$1,013.34 ","$5,787.50 ","$0.00 ","$2,893.75 ","$4,583.70 ","$4,630.00 ","$0.00 ","$905.74 ","$0.00 ","$921.37 ","$0.00 "
"6480-0-250","SUP","HCPCS C1776","","6480-0-250  -  COMPONENT FEMORAL XL STABILIZE KINEMAX PLUS KNEE","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,787.50 ","$2,604.38 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$1,013.34 ","$5,787.50 ","$0.00 ","$2,893.75 ","$4,583.70 ","$4,630.00 ","$0.00 ","$905.74 ","$0.00 ","$921.37 ","$0.00 "
"6480-0-300","SUP","HCPCS C1776","","6480-0-300  -  COMPONENT FEMORAL 2XL STABILIZE KINEMAX PLUS KNEE","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,787.50 ","$2,604.38 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$1,013.34 ","$5,787.50 ","$0.00 ","$2,893.75 ","$4,583.70 ","$4,630.00 ","$0.00 ","$905.74 ","$0.00 ","$921.37 ","$0.00 "
"6481-1-100","SUP","HCPCS C1776","","6481-1-100  -  COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE KNEE LEFT","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-101","SUP","HCPCS C1776","","6481-1-101  -  COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-110","SUP","HCPCS C1776","","6481-1-110  -  COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-111","SUP","HCPCS C1776","","6481-1-111  -  COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-120","SUP","HCPCS C1776","","6481-1-120  -  COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-121","SUP","HCPCS C1776","","6481-1-121  -  COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-130","SUP","HCPCS C1776","","6481-1-130  -  COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-131","SUP","HCPCS C1776","","6481-1-131  -  COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-140","SUP","HCPCS C1776","","6481-1-140  -  COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-141","SUP","HCPCS C1776","","6481-1-141  -  COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$10,780.00 ","$7,977.20 ","$0.00 ","$10,780.00 ","$4,851.00 ","$0.00 ","$2,246.82 ","$0.00 ","$0.00 ","$1,887.49 ","$10,780.00 ","$0.00 ","$5,390.00 ","$8,537.76 ","$8,624.00 ","$0.00 ","$1,687.07 ","$0.00 ","$1,716.18 ","$0.00 "
"6481-1-200","SUP","Custom 27803010","","6481-1-200  -  BLOCK AUGMENTATION XS 10MM GMRS FEMORAL DISTAL","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$0.00 ","$1,455.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,455.00 ","$0.00 ","$727.50 ","$1,152.36 ","$1,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-1-210","SUP","Custom 27803010","","6481-1-210  -  BLOCK AUGMENTATION SMALL 10MM GMRS FEMORAL DISTAL","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$0.00 ","$1,455.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,455.00 ","$0.00 ","$727.50 ","$1,152.36 ","$1,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-1-220","SUP","Custom 27803010","","6481-1-220  -  BLOCK AUGMENTATION MEDIUM 10MM GMRS FEMORAL DISTAL","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$0.00 ","$1,455.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,455.00 ","$0.00 ","$727.50 ","$1,152.36 ","$1,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-1-230","SUP","Custom 27803010","","6481-1-230  -  BLOCK AUGMENTATION LARGE 10MM GMRS FEMORAL DISTAL","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$0.00 ","$1,455.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,455.00 ","$0.00 ","$727.50 ","$1,152.36 ","$1,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-1-240","SUP","Custom 27803010","","6481-1-240  -  BLOCK AUGMENTATION XL 10MM GMRS FEMORAL DISTAL","BOTH IP/OP","$1,455.00 ","$1,076.70 ","$0.00 ","$1,455.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,455.00 ","$0.00 ","$727.50 ","$1,152.36 ","$1,164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-2-100","SUP","HCPCS C1776","","6481-2-100  -  COMPONENT TIB XS-XL MNGR MDLR ROT HNG KN","BOTH IP/OP","$6,265.00 ","$4,636.10 ","$0.00 ","$6,265.00 ","$2,819.25 ","$0.00 ","$1,305.78 ","$0.00 ","$0.00 ","$1,096.95 ","$6,265.00 ","$0.00 ","$3,132.50 ","$4,961.88 ","$5,012.00 ","$0.00 ","$980.47 ","$0.00 ","$997.39 ","$0.00 "
"6481-2-101","SUP","HCPCS C1776","","6481-2-101  -  COMPONENT TIBIAL LARGE XL MOBILE ROTATE HINGE MRS KNEE","BOTH IP/OP","$6,265.00 ","$4,636.10 ","$0.00 ","$6,265.00 ","$2,819.25 ","$0.00 ","$1,305.78 ","$0.00 ","$0.00 ","$1,096.95 ","$6,265.00 ","$0.00 ","$3,132.50 ","$4,961.88 ","$5,012.00 ","$0.00 ","$980.47 ","$0.00 ","$997.39 ","$0.00 "
"6481-2-103","SUP","HCPCS C1776","","6481-2-103  -  COMPONENT TIBIAL XS LONG XL BEARING CROSSOVER MODULAR ROTATE","BOTH IP/OP","$6,265.00 ","$4,636.10 ","$0.00 ","$6,265.00 ","$2,819.25 ","$0.00 ","$1,305.78 ","$0.00 ","$0.00 ","$1,096.95 ","$6,265.00 ","$0.00 ","$3,132.50 ","$4,961.88 ","$5,012.00 ","$0.00 ","$980.47 ","$0.00 ","$997.39 ","$0.00 "
"6481-2-104","SUP","HCPCS C1776","","6481-2-104  -  COMPONENT TIBIAL XS XL SHORT BEARING CROSSOVER MODULAR","BOTH IP/OP","$6,265.00 ","$4,636.10 ","$0.00 ","$6,265.00 ","$2,819.25 ","$0.00 ","$1,305.78 ","$0.00 ","$0.00 ","$1,096.95 ","$6,265.00 ","$0.00 ","$3,132.50 ","$4,961.88 ","$5,012.00 ","$0.00 ","$980.47 ","$0.00 ","$997.39 ","$0.00 "
"6481-2-107","SUP","HCPCS C1776","","6481-2-107  -  COMPONENT TIBIAL BEARING GMRS ALL POLY PEDIATRIC KNEE","BOTH IP/OP","$5,752.50 ","$4,256.85 ","$0.00 ","$5,752.50 ","$2,588.63 ","$0.00 ","$1,198.96 ","$0.00 ","$0.00 ","$1,007.22 ","$5,752.50 ","$0.00 ","$2,876.25 ","$4,555.98 ","$4,602.00 ","$0.00 ","$900.27 ","$0.00 ","$915.80 ","$0.00 "
"6481-2-108","SUP","HCPCS C1776","","6481-2-108  -  COMPONENT TIBIAL BEARING CROSSOVER MODULAR ROTATE HINGE MRS","BOTH IP/OP","$6,265.00 ","$4,636.10 ","$0.00 ","$6,265.00 ","$2,819.25 ","$0.00 ","$1,305.78 ","$0.00 ","$0.00 ","$1,096.95 ","$6,265.00 ","$0.00 ","$3,132.50 ","$4,961.88 ","$5,012.00 ","$0.00 ","$980.47 ","$0.00 ","$997.39 ","$0.00 "
"6481-2-110","SUP","Custom 27803010","","6481-2-110  -  BUSHING FEMORAL MODULAR ROTATE HINGE KNEE","BOTH IP/OP","$617.50 ","$456.95 ","$0.00 ","$617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.50 ","$0.00 ","$308.75 ","$489.06 ","$494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-2-120","SUP","Custom 27803010","","6481-2-120  -  AXLE FEMORAL MODULAR ROTATE HINGE KNEE","BOTH IP/OP","$2,122.50 ","$1,570.65 ","$0.00 ","$2,122.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,122.50 ","$0.00 ","$1,061.25 ","$1,681.02 ","$1,698.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-2-130","SUP","Custom 27803010","","6481-2-130  -  INSERT BUMPER NEUTRAL MODULAR ROTATE HINGE GMRS KNEE","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-2-133","SUP","Custom 27803010","","6481-2-133  -  INSERT BUMPER 3D MODULAR ROTATE HINGE GMRS KNEE PROXIMAL","BOTH IP/OP","$1,272.50 ","$941.65 ","$0.00 ","$1,272.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,272.50 ","$0.00 ","$636.25 ","$1,007.82 ","$1,018.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-2-140","SUP","Custom 27203010","","6481-2-140  -  SLEEVE TIBIAL MODULAR ROTATE HINGE KNEE","BOTH IP/OP","$1,065.00 ","$788.10 ","$0.00 ","$1,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,065.00 ","$0.00 ","$532.50 ","$843.48 ","$852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-2-150","SUP","HCPCS C1776","","6481-2-150  -  COMPONENT FEMORAL PACK CROSSLINK GMRS POLYETHYLENE KNEE","BOTH IP/OP","$3,347.50 ","$2,477.15 ","$0.00 ","$3,347.50 ","$1,506.38 ","$0.00 ","$697.70 ","$0.00 ","$0.00 ","$586.12 ","$3,347.50 ","$0.00 ","$1,673.75 ","$2,651.22 ","$2,678.00 ","$0.00 ","$523.88 ","$0.00 ","$532.92 ","$0.00 "
"6481-3-110","SUP","HCPCS C1776","","6481-3-110  -  BASEPLATE TIB 1 SM MDLR ROT HNG KN","BOTH IP/OP","$6,730.00 ","$4,980.20 ","$0.00 ","$6,730.00 ","$3,028.50 ","$0.00 ","$1,402.70 ","$0.00 ","$0.00 ","$1,178.37 ","$6,730.00 ","$0.00 ","$3,365.00 ","$5,330.16 ","$5,384.00 ","$0.00 ","$1,053.25 ","$0.00 ","$1,071.42 ","$0.00 "
"6481-3-111","SUP","HCPCS C1776","","6481-3-111  -  BASEPLATE TIB 2 SM MDLR ROT HNG KN","BOTH IP/OP","$6,730.00 ","$4,980.20 ","$0.00 ","$6,730.00 ","$3,028.50 ","$0.00 ","$1,402.70 ","$0.00 ","$0.00 ","$1,178.37 ","$6,730.00 ","$0.00 ","$3,365.00 ","$5,330.16 ","$5,384.00 ","$0.00 ","$1,053.25 ","$0.00 ","$1,071.42 ","$0.00 "
"6481-3-112","SUP","HCPCS C1776","","6481-3-112  -  BASEPLATE TIB 2 MED MDLR ROT HNG KN","BOTH IP/OP","$6,730.00 ","$4,980.20 ","$0.00 ","$6,730.00 ","$3,028.50 ","$0.00 ","$1,402.70 ","$0.00 ","$0.00 ","$1,178.37 ","$6,730.00 ","$0.00 ","$3,365.00 ","$5,330.16 ","$5,384.00 ","$0.00 ","$1,053.25 ","$0.00 ","$1,071.42 ","$0.00 "
"6481-3-113","SUP","HCPCS C1776","","6481-3-113  -  BASEPLATE TIB 2 LG MDLR ROT HNG KN","BOTH IP/OP","$6,730.00 ","$4,980.20 ","$0.00 ","$6,730.00 ","$3,028.50 ","$0.00 ","$1,402.70 ","$0.00 ","$0.00 ","$1,178.37 ","$6,730.00 ","$0.00 ","$3,365.00 ","$5,330.16 ","$5,384.00 ","$0.00 ","$1,053.25 ","$0.00 ","$1,071.42 ","$0.00 "
"6481-3-210","SUP","Custom 27803010","","6481-3-210  -  INSERT TIBIAL THK10MM S1 S2 MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-213","SUP","Custom 27803010","","6481-3-213  -  INSERT TIBIAL THK13MM S1 S2 MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-216","SUP","Custom 27803010","","6481-3-216  -  INSERT TIBIAL THK16MM S1 S2 MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-220","SUP","Custom 27803010","","6481-3-220  -  INSERT TIBIAL THK20MM S1 S2 MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-224","SUP","Custom 27803010","","6481-3-224  -  INSERT TIBIAL THK24MM S1 S2 MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-310","SUP","Custom 27803010","","6481-3-310  -  INSERT TIBIAL MEDIUM LARGE M2 2 10MM BEARING MODULAR","BOTH IP/OP","$2,387.50 ","$1,766.75 ","$0.00 ","$2,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,387.50 ","$0.00 ","$1,193.75 ","$1,890.90 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-313","SUP","Custom 27803010","","6481-3-313  -  INSERT TIBIAL THK13MM M2 2 BEARING MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,387.50 ","$1,766.75 ","$0.00 ","$2,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,387.50 ","$0.00 ","$1,193.75 ","$1,890.90 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-316","SUP","Custom 27803010","","6481-3-316  -  INSERT TIBIAL THK16MM M2 2 BEARING MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,387.50 ","$1,766.75 ","$0.00 ","$2,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,387.50 ","$0.00 ","$1,193.75 ","$1,890.90 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-320","SUP","Custom 27803010","","6481-3-320  -  INSERT TIBIAL THK20MM M2 2 BEARING MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,387.50 ","$1,766.75 ","$0.00 ","$2,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,387.50 ","$0.00 ","$1,193.75 ","$1,890.90 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6481-3-324","SUP","Custom 27803010","","6481-3-324  -  INSERT TIBIAL THK24MM M2 2 BEARING MODULAR ROTATE HINGE GMRS","BOTH IP/OP","$2,387.50 ","$1,766.75 ","$0.00 ","$2,387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,387.50 ","$0.00 ","$1,193.75 ","$1,890.90 ","$1,910.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-0-020","SUP","HCPCS C1776","","6485-0-020  -  CMPNT FEM CNDYLR RIGHT MDLR ROT HNG MRS","BOTH IP/OP","$14,192.75 ","$10,502.64 ","$0.00 ","$14,192.75 ","$6,386.74 ","$0.00 ","$2,958.12 ","$0.00 ","$0.00 ","$2,485.04 ","$14,192.75 ","$0.00 ","$7,096.38 ","$11,240.66 ","$11,354.20 ","$0.00 ","$2,221.17 ","$0.00 ","$2,259.49 ","$0.00 "
"6485-0-025","SUP","HCPCS C1776","","6485-0-025  -  STEM FEM 75MM CNDYLR MRH MRS SM LEFT PRD","BOTH IP/OP","$14,192.75 ","$10,502.64 ","$0.00 ","$14,192.75 ","$6,386.74 ","$0.00 ","$2,958.12 ","$0.00 ","$0.00 ","$2,485.04 ","$14,192.75 ","$0.00 ","$7,096.38 ","$11,240.66 ","$11,354.20 ","$0.00 ","$2,221.17 ","$0.00 ","$2,259.49 ","$0.00 "
"6485-0-045","SUP","HCPCS C1776","","6485-0-045  -  CMPNT FEM SM 85MM LEFT CNDYLR MRS","BOTH IP/OP","$14,192.75 ","$10,502.64 ","$0.00 ","$14,192.75 ","$6,386.74 ","$0.00 ","$2,958.12 ","$0.00 ","$0.00 ","$2,485.04 ","$14,192.75 ","$0.00 ","$7,096.38 ","$11,240.66 ","$11,354.20 ","$0.00 ","$2,221.17 ","$0.00 ","$2,259.49 ","$0.00 "
"6485-0-050","SUP","HCPCS C1776","","6485-0-050  -  CMPNT FEM XS LEFT REV STAB KMX+","BOTH IP/OP","$5,216.00 ","$3,859.84 ","$0.00 ","$5,216.00 ","$2,347.20 ","$0.00 ","$1,087.14 ","$0.00 ","$0.00 ","$913.28 ","$5,216.00 ","$0.00 ","$2,608.00 ","$4,131.07 ","$4,172.80 ","$0.00 ","$816.30 ","$0.00 ","$830.39 ","$0.00 "
"6485-0-060","SUP","HCPCS C1776","","6485-0-060  -  CMPNT FEM XS RIGHT REV STAB KNMX PLUS","BOTH IP/OP","$5,189.00 ","$3,839.86 ","$0.00 ","$5,189.00 ","$2,335.05 ","$0.00 ","$1,081.52 ","$0.00 ","$0.00 ","$908.55 ","$5,189.00 ","$0.00 ","$2,594.50 ","$4,109.69 ","$4,151.20 ","$0.00 ","$812.08 ","$0.00 ","$826.09 ","$0.00 "
"6485-0-075","SUP","HCPCS C1776","","6485-0-075  -  CMPNT FEM SM 95MM RIGHT CNDYLR MRS","BOTH IP/OP","$10,856.63 ","$8,033.91 ","$0.00 ","$10,856.63 ","$4,885.48 ","$0.00 ","$2,262.79 ","$0.00 ","$0.00 ","$1,900.91 ","$10,856.63 ","$0.00 ","$5,428.31 ","$8,598.45 ","$8,685.30 ","$0.00 ","$1,699.06 ","$0.00 ","$1,728.37 ","$0.00 "
"6485-0-100","SUP","HCPCS C1776","","6485-0-100  -  CMPNT FEM SM LEFT REV STAB KMX+","BOTH IP/OP","$5,407.00 ","$4,001.18 ","$0.00 ","$5,407.00 ","$2,433.15 ","$0.00 ","$1,126.95 ","$0.00 ","$0.00 ","$946.72 ","$5,407.00 ","$0.00 ","$2,703.50 ","$4,282.34 ","$4,325.60 ","$0.00 ","$846.20 ","$0.00 ","$860.79 ","$0.00 "
"6485-0-110","SUP","HCPCS C1776","","6485-0-110  -  CMPNT FEM SM RIGHT REV STAB KMX+","BOTH IP/OP","$5,189.00 ","$3,839.86 ","$0.00 ","$5,189.00 ","$2,335.05 ","$0.00 ","$1,081.52 ","$0.00 ","$0.00 ","$908.55 ","$5,189.00 ","$0.00 ","$2,594.50 ","$4,109.69 ","$4,151.20 ","$0.00 ","$812.08 ","$0.00 ","$826.09 ","$0.00 "
"6485-0-150","SUP","HCPCS C1776","","6485-0-150  -  CMPNT FEM MED LEFT REV STAB KMX+","BOTH IP/OP","$5,407.00 ","$4,001.18 ","$0.00 ","$5,407.00 ","$2,433.15 ","$0.00 ","$1,126.95 ","$0.00 ","$0.00 ","$946.72 ","$5,407.00 ","$0.00 ","$2,703.50 ","$4,282.34 ","$4,325.60 ","$0.00 ","$846.20 ","$0.00 ","$860.79 ","$0.00 "
"6485-0-160","SUP","HCPCS C1776","","6485-0-160  -  CMPNT FEM MED RIGHT REV STAB KMX+","BOTH IP/OP","$5,407.00 ","$4,001.18 ","$0.00 ","$5,407.00 ","$2,433.15 ","$0.00 ","$1,126.95 ","$0.00 ","$0.00 ","$946.72 ","$5,407.00 ","$0.00 ","$2,703.50 ","$4,282.34 ","$4,325.60 ","$0.00 ","$846.20 ","$0.00 ","$860.79 ","$0.00 "
"6485-0-200","SUP","HCPCS C1776","","6485-0-200  -  CMPNT FEM LG LEFT REV STAB KMX+","BOTH IP/OP","$5,407.00 ","$4,001.18 ","$0.00 ","$5,407.00 ","$2,433.15 ","$0.00 ","$1,126.95 ","$0.00 ","$0.00 ","$946.72 ","$5,407.00 ","$0.00 ","$2,703.50 ","$4,282.34 ","$4,325.60 ","$0.00 ","$846.20 ","$0.00 ","$860.79 ","$0.00 "
"6485-0-210","SUP","HCPCS C1776","","6485-0-210  -  CMPNT FEM LG RIGHT REV STAB KMX+","BOTH IP/OP","$5,407.00 ","$4,001.18 ","$0.00 ","$5,407.00 ","$2,433.15 ","$0.00 ","$1,126.95 ","$0.00 ","$0.00 ","$946.72 ","$5,407.00 ","$0.00 ","$2,703.50 ","$4,282.34 ","$4,325.60 ","$0.00 ","$846.20 ","$0.00 ","$860.79 ","$0.00 "
"6485-0-250","SUP","HCPCS C1776","","6485-0-250  -  CMPNT FEM XL LEFT KNEE MDLR STABLILZED ASMBLY KMX+ LATEX","BOTH IP/OP","$5,407.00 ","$4,001.18 ","$0.00 ","$5,407.00 ","$2,433.15 ","$0.00 ","$1,126.95 ","$0.00 ","$0.00 ","$946.72 ","$5,407.00 ","$0.00 ","$2,703.50 ","$4,282.34 ","$4,325.60 ","$0.00 ","$846.20 ","$0.00 ","$860.79 ","$0.00 "
"6485-0-260","SUP","HCPCS C1776","","6485-0-260  -  CMPNT FEM XL RIGHT REV STAB KMX+","BOTH IP/OP","$4,552.00 ","$3,368.48 ","$0.00 ","$4,552.00 ","$2,048.40 ","$0.00 ","$948.75 ","$0.00 ","$0.00 ","$797.02 ","$4,552.00 ","$0.00 ","$2,276.00 ","$3,605.18 ","$3,641.60 ","$0.00 ","$712.39 ","$0.00 ","$724.68 ","$0.00 "
"6485-1-915","SUP","Custom 27803010","","6485-1-915  -  COMPONENT PATLR SMALL ROTATE HINGE KRH DUR","BOTH IP/OP","$1,705.00 ","$1,261.70 ","$0.00 ","$1,705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,705.00 ","$0.00 ","$852.50 ","$1,350.36 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-2-008","SUP","HCPCS C1776","","6485-2-008  -  INSERT TIBIAL XS 8MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-011","SUP","HCPCS C1776","","6485-2-011  -  INSERT TIBIAL XS 11MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-016","SUP","HCPCS C1776","","6485-2-016  -  INSERT TIBIAL XS 16MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-021","SUP","HCPCS C1776","","6485-2-021  -  INSERT TIBIAL XS 21MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-108","SUP","HCPCS C1776","","6485-2-108  -  INSERT TIBIAL SMALL 8MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-111","SUP","HCPCS C1776","","6485-2-111  -  INSERT TIBIAL SMALL 11MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-116","SUP","HCPCS C1776","","6485-2-116  -  INSERT TIBIAL SMALL 16MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-121","SUP","HCPCS C1776","","6485-2-121  -  INSERT TIBIAL SMALL 21MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-208","SUP","HCPCS C1776","","6485-2-208  -  INSERT TIBIAL MEDIUM 8MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-211","SUP","HCPCS C1776","","6485-2-211  -  COMPONENT TIBIAL MEDIUM 11MM ROTATING HINGE KRH ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-216","SUP","HCPCS C1776","","6485-2-216  -  INSERT TIBIAL MEDIUM 16MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-221","SUP","HCPCS C1776","","6485-2-221  -  INSERT TIBIAL MEDIUM 21MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-308","SUP","HCPCS C1776","","6485-2-308  -  INSERT TIBIAL LARGE 8MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-311","SUP","HCPCS C1776","","6485-2-311  -  INSERT TIBIAL LARGE 11MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-316","SUP","HCPCS C1776","","6485-2-316  -  INSERT TIBIAL LARGE 16MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-321","SUP","HCPCS C1776","","6485-2-321  -  INSERT TIBIAL LARGE 21MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-408","SUP","HCPCS C1776","","6485-2-408  -  INSERT TIBIAL XL 8MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-411","SUP","HCPCS C1776","","6485-2-411  -  INSERT TIBIAL XL 11MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-416","SUP","HCPCS C1776","","6485-2-416  -  INSERT TIBIAL XL 16MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-421","SUP","HCPCS C1776","","6485-2-421  -  INSERT TIBIAL XL 21MM GMRS ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-460","SUP","Custom 27803010","","6485-2-460  -  BUSHING FEMORAL STANDARD ROTATE HINGE KINEMATIC DUR","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-2-465","SUP","Custom 27803010","","6485-2-465  -  BUSHING FEMORAL SMALL ROTATE HINGE KINEMATIC DUR","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-2-508","SUP","HCPCS C1776","","6485-2-508  -  INSERT TIBIAL 3XS 8MM MRS POLYETHYLENE KNEE","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-511","SUP","HCPCS C1776","","6485-2-511  -  COMPONENT TIBIAL 3XS PT1 11MM MRS MRH KRH DUR","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-608","SUP","HCPCS C1776","","6485-2-608  -  INSERT TIBIAL 2XS 8MM MRS POLYETHYLENE KNEE","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-2-611","SUP","HCPCS C1776","","6485-2-611  -  COMPONENT TIBIAL 2XS PT2 11MM KRH ALL POLY","BOTH IP/OP","$3,142.50 ","$2,325.45 ","$0.00 ","$3,142.50 ","$1,414.13 ","$0.00 ","$654.98 ","$0.00 ","$0.00 ","$550.23 ","$3,142.50 ","$0.00 ","$1,571.25 ","$2,488.86 ","$2,514.00 ","$0.00 ","$491.80 ","$0.00 ","$500.29 ","$0.00 "
"6485-3-000","SUP","HCPCS C1776","","6485-3-000  -  STEM FEMORAL SMALL 10MM 102MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-008","SUP","HCPCS C1776","","6485-3-008  -  STEM FEMORAL SMALL 8MM 102MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-009","SUP","HCPCS C1776","","6485-3-009  -  STEM FEMORAL SMALL 9MM 102MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-010","SUP","HCPCS C1776","","6485-3-010  -  STEM FEMORAL SMALL 10MM 102MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-011","SUP","HCPCS C1776","","6485-3-011  -  STEM FEMORAL STANDARD STR 11MM 127MM CEMENTED BODY SECTION","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-013","SUP","HCPCS C1776","","6485-3-013  -  STEM FEMORAL STANDARD STR 13MM 127MM CEMENTED BODY SECTION","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-015","SUP","HCPCS C1776","","6485-3-015  -  STEM FEMORAL STANDARD 15MM 127MM MODULAR ROTATE HINGE MRS","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-017","SUP","HCPCS C1776","","6485-3-017  -  STEM FEMORAL 17MM 127MM CEMENTED BODY SECTION MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-018","SUP","HCPCS C1776","","6485-3-018  -  STEM FEMORAL SMALL 8MM 102MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-019","SUP","HCPCS C1776","","6485-3-019  -  STEM FEMORAL SMALL 9MM 102MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-111","SUP","HCPCS C1776","","6485-3-111  -  STEM FEMORAL 11MM 127MM MRS KNEE","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-113","SUP","HCPCS C1776","","6485-3-113  -  STEM FEMORAL STR 13MM 127MM CEMENTED BODY SECTION GMRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-115","SUP","HCPCS C1776","","6485-3-115  -  STEM FEMORAL STR 15MM 127MM CEMENTED BODY SECTION MRS KNEE","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-117","SUP","HCPCS C1776","","6485-3-117  -  STEM FEMORAL 17MM 127MM MRS KNEE","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-211","SUP","HCPCS C1776","","6485-3-211  -  STEM FEMORAL TAPER 11MM 127MM MRS HIP","BOTH IP/OP","$5,275.00 ","$3,903.50 ","$0.00 ","$5,275.00 ","$2,373.75 ","$0.00 ","$1,099.44 ","$0.00 ","$0.00 ","$923.61 ","$5,275.00 ","$0.00 ","$2,637.50 ","$4,177.80 ","$4,220.00 ","$0.00 ","$825.54 ","$0.00 ","$839.78 ","$0.00 "
"6485-3-213","SUP","HCPCS C1776","","6485-3-213  -  STEM FEMORAL TAPER 13MM 127MM MRS HIP","BOTH IP/OP","$5,275.00 ","$3,903.50 ","$0.00 ","$5,275.00 ","$2,373.75 ","$0.00 ","$1,099.44 ","$0.00 ","$0.00 ","$923.61 ","$5,275.00 ","$0.00 ","$2,637.50 ","$4,177.80 ","$4,220.00 ","$0.00 ","$825.54 ","$0.00 ","$839.78 ","$0.00 "
"6485-3-215","SUP","HCPCS C1776","","6485-3-215  -  STEM FEMORAL TAPER 15MM 127MM MRS HIP","BOTH IP/OP","$5,275.00 ","$3,903.50 ","$0.00 ","$5,275.00 ","$2,373.75 ","$0.00 ","$1,099.44 ","$0.00 ","$0.00 ","$923.61 ","$5,275.00 ","$0.00 ","$2,637.50 ","$4,177.80 ","$4,220.00 ","$0.00 ","$825.54 ","$0.00 ","$839.78 ","$0.00 "
"6485-3-217","SUP","HCPCS C1776","","6485-3-217  -  STEM FEMORAL TAPER 17MM 127MM MRS HIP","BOTH IP/OP","$5,275.00 ","$3,903.50 ","$0.00 ","$5,275.00 ","$2,373.75 ","$0.00 ","$1,099.44 ","$0.00 ","$0.00 ","$923.61 ","$5,275.00 ","$0.00 ","$2,637.50 ","$4,177.80 ","$4,220.00 ","$0.00 ","$825.54 ","$0.00 ","$839.78 ","$0.00 "
"6485-3-300","SUP","HCPCS C1776","","6485-3-300  -  STEM FEMORAL SMALL CURVE 10MM 102MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-308","SUP","HCPCS C1776","","6485-3-308  -  STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-309","SUP","HCPCS C1776","","6485-3-309  -  STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-310","SUP","HCPCS C1776","","6485-3-310  -  STEM FEMORAL SMALL CURVE 10MM 102MM MRS KNEE","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-311","SUP","HCPCS C1776","","6485-3-311  -  STEM FEMORAL 11MM 203MM MRS KNEE","BOTH IP/OP","$10,430.00 ","$7,718.20 ","$0.00 ","$10,430.00 ","$4,693.50 ","$0.00 ","$2,173.87 ","$0.00 ","$0.00 ","$1,826.21 ","$10,430.00 ","$0.00 ","$5,215.00 ","$8,260.56 ","$8,344.00 ","$0.00 ","$1,632.30 ","$0.00 ","$1,660.46 ","$0.00 "
"6485-3-313","SUP","HCPCS C1776","","6485-3-313  -  STEM FEMORAL LONG BOW 13MM 203MM CEMENTED BODY SECTION GMRS","BOTH IP/OP","$10,430.00 ","$7,718.20 ","$0.00 ","$10,430.00 ","$4,693.50 ","$0.00 ","$2,173.87 ","$0.00 ","$0.00 ","$1,826.21 ","$10,430.00 ","$0.00 ","$5,215.00 ","$8,260.56 ","$8,344.00 ","$0.00 ","$1,632.30 ","$0.00 ","$1,660.46 ","$0.00 "
"6485-3-315","SUP","HCPCS C1776","","6485-3-315  -  STEM FEMORAL LONG BOW 15MM 203MM CEMENTED BODY SECTION GMRS","BOTH IP/OP","$10,430.00 ","$7,718.20 ","$0.00 ","$10,430.00 ","$4,693.50 ","$0.00 ","$2,173.87 ","$0.00 ","$0.00 ","$1,826.21 ","$10,430.00 ","$0.00 ","$5,215.00 ","$8,260.56 ","$8,344.00 ","$0.00 ","$1,632.30 ","$0.00 ","$1,660.46 ","$0.00 "
"6485-3-317","SUP","HCPCS C1776","","6485-3-317  -  STEM FEMORAL 17MM 203MM MRS KNEE","BOTH IP/OP","$10,430.00 ","$7,718.20 ","$0.00 ","$10,430.00 ","$4,693.50 ","$0.00 ","$2,173.87 ","$0.00 ","$0.00 ","$1,826.21 ","$10,430.00 ","$0.00 ","$5,215.00 ","$8,260.56 ","$8,344.00 ","$0.00 ","$1,632.30 ","$0.00 ","$1,660.46 ","$0.00 "
"6485-3-318","SUP","HCPCS C1776","","6485-3-318  -  STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-319","SUP","HCPCS C1776","","6485-3-319  -  STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-611","SUP","HCPCS C1776","","6485-3-611  -  STEM FEMORAL LONG CURVE 11MM 203MM CEMENTED BODY SECTION","BOTH IP/OP","$8,115.00 ","$6,005.10 ","$0.00 ","$8,115.00 ","$3,651.75 ","$0.00 ","$1,691.37 ","$0.00 ","$0.00 ","$1,420.87 ","$8,115.00 ","$0.00 ","$4,057.50 ","$6,427.08 ","$6,492.00 ","$0.00 ","$1,270.00 ","$0.00 ","$1,291.91 ","$0.00 "
"6485-3-613","SUP","HCPCS C1776","","6485-3-613  -  STEM FEMORAL LONG CURVE 13MM 203MM CEMENT GMRS HIP DISTAL","BOTH IP/OP","$8,115.00 ","$6,005.10 ","$0.00 ","$8,115.00 ","$3,651.75 ","$0.00 ","$1,691.37 ","$0.00 ","$0.00 ","$1,420.87 ","$8,115.00 ","$0.00 ","$4,057.50 ","$6,427.08 ","$6,492.00 ","$0.00 ","$1,270.00 ","$0.00 ","$1,291.91 ","$0.00 "
"6485-3-615","SUP","HCPCS C1776","","6485-3-615  -  STEM FEMORAL LONG BOW CURVE 15MM 203MM CEMENTED BODY SECTION","BOTH IP/OP","$8,115.00 ","$6,005.10 ","$0.00 ","$8,115.00 ","$3,651.75 ","$0.00 ","$1,691.37 ","$0.00 ","$0.00 ","$1,420.87 ","$8,115.00 ","$0.00 ","$4,057.50 ","$6,427.08 ","$6,492.00 ","$0.00 ","$1,270.00 ","$0.00 ","$1,291.91 ","$0.00 "
"6485-3-617","SUP","HCPCS C1776","","6485-3-617  -  STEM FEMORAL LONG BOW 17MM 203MM CEMENTED BODY SECTION GMRS","BOTH IP/OP","$8,115.00 ","$6,005.10 ","$0.00 ","$8,115.00 ","$3,651.75 ","$0.00 ","$1,691.37 ","$0.00 ","$0.00 ","$1,420.87 ","$8,115.00 ","$0.00 ","$4,057.50 ","$6,427.08 ","$6,492.00 ","$0.00 ","$1,270.00 ","$0.00 ","$1,291.91 ","$0.00 "
"6485-3-711","SUP","HCPCS C1776","","6485-3-711  -  STEM FEMORAL CURVE 11MM 127MM MRS KNEE","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-713","SUP","HCPCS C1776","","6485-3-713  -  STEM FEMORAL CURVE 13MM 127MM MRS KNEE","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-715","SUP","HCPCS C1776","","6485-3-715  -  STEM FEMORAL CURVE 15MM 127MM MRS KNEE","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-717","SUP","HCPCS C1776","","6485-3-717  -  STEM FEMORAL CURVE 17MM 127MM MRS HIP","BOTH IP/OP","$7,977.50 ","$5,903.35 ","$0.00 ","$7,977.50 ","$3,589.88 ","$0.00 ","$1,662.71 ","$0.00 ","$0.00 ","$1,396.80 ","$7,977.50 ","$0.00 ","$3,988.75 ","$6,318.18 ","$6,382.00 ","$0.00 ","$1,248.48 ","$0.00 ","$1,270.02 ","$0.00 "
"6485-3-811","SUP","HCPCS C1776","","6485-3-811  -  STEM FEMORAL CURVE 11MM 127MM MRS KNEE","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-813","SUP","HCPCS C1776","","6485-3-813  -  STEM FEMORAL CURVE 13MM 127MM MRS KNEE","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-815","SUP","HCPCS C1776","","6485-3-815  -  STEM FEMORAL CURVE 15MM 127MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-817","SUP","HCPCS C1776","","6485-3-817  -  STEM FEMORAL CURVE 17MM 127MM MRS HIP","BOTH IP/OP","$5,780.00 ","$4,277.20 ","$0.00 ","$5,780.00 ","$2,601.00 ","$0.00 ","$1,204.70 ","$0.00 ","$0.00 ","$1,012.03 ","$5,780.00 ","$0.00 ","$2,890.00 ","$4,577.76 ","$4,624.00 ","$0.00 ","$904.57 ","$0.00 ","$920.18 ","$0.00 "
"6485-3-915","SUP","Custom 27803010","","6485-3-915  -  COMPONENT PATLR MEDIUM ROTATE HINGE KRH DUR","BOTH IP/OP","$1,705.00 ","$1,261.70 ","$0.00 ","$1,705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,705.00 ","$0.00 ","$852.50 ","$1,350.36 ","$1,364.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-100","SUP","Custom 27803010","","6485-4-100  -  COMPONENT FEMORAL STANDARD 10MM ROTATE HINGE BUMPER","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-111","SUP","Custom 27803010","","6485-4-111  -  INSERT TIBIAL SMALL 11MM MRS DUR METASUL KNEE ENCAPSULATE","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-113","SUP","Custom 27803010","","6485-4-113  -  INSERT TIBIAL SMALL 13MM MRS DUR METASUL KNEE ENCAPSULATE","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-116","SUP","Custom 27803010","","6485-4-116  -  INSERT TIBIAL SMALL 16MM MRS DUR KNEE ENCAP","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-121","SUP","Custom 27803010","","6485-4-121  -  INSERT TIBIAL SMALL 21MM MRS DUR KNEE ENCAP","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-125","SUP","Custom 27803010","","6485-4-125  -  INSERT TIBIAL 12.5MM BUMPER KRH DUR KNEE","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-145","SUP","Custom 27803010","","6485-4-145  -  INSERT TIBIAL 14.5MM 14.5MM BUMPER MRS MRH KRH DUR","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-160","SUP","Custom 27803010","","6485-4-160  -  INSERT TIBIAL 16MM BUMPER KRH DUR KNEE","BOTH IP/OP","$1,282.50 ","$949.05 ","$0.00 ","$1,282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,282.50 ","$0.00 ","$641.25 ","$1,015.74 ","$1,026.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-211","SUP","Custom 27803010","","6485-4-211  -  INSERT TIBIAL MEDIUM 11MM MRS DUR KNEE ENCAP","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-213","SUP","Custom 27803010","","6485-4-213  -  INSERT TIBIAL MEDIUM 13MM MRS DUR KNEE ENCAP","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-216","SUP","Custom 27803010","","6485-4-216  -  INSERT TIBIAL MEDIUM 16MM MRS DUR KNEE ENCAP","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-4-221","SUP","Custom 27803010","","6485-4-221  -  INSERT TIBIAL MEDIUM 21MM MRS DUR KNEE ENCAP","BOTH IP/OP","$3,120.00 ","$2,308.80 ","$0.00 ","$3,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,120.00 ","$0.00 ","$1,560.00 ","$2,471.04 ","$2,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-010","SUP","Custom 27803010","","6485-5-010  -  SPACER FEM 10MM KMX+ LCK SCR","BOTH IP/OP","$98.00 ","$72.52 ","$0.00 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$98.00 ","$0.00 ","$49.00 ","$77.62 ","$78.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-050","SUP","Custom 27803010","","6485-5-050  -  SPACER FEM 5MM KNMX XS LEFT DISTAL MDL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-051","SUP","Custom 27803010","","6485-5-051  -  SPACER FEM 10MM KNMX XS LEFT DISTAL MDL","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-052","SUP","Custom 27803010","","6485-5-052  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-053","SUP","Custom 27803010","","6485-5-053  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-060","SUP","Custom 27803010","","6485-5-060  -  SPACER FEM 5MM KNMX XS RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-061","SUP","Custom 27803010","","6485-5-061  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-062","SUP","Custom 27803010","","6485-5-062  -  SPACER FEM 10MM KMX+ MED XS DISTAL KNEE","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-063","SUP","Custom 27803010","","6485-5-063  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-100","SUP","Custom 27803010","","6485-5-100  -  SPACER FEM 5MM KNMX SM LEFT DISTAL MDL","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-101","SUP","Custom 27803010","","6485-5-101  -  SPACER FEM 10MM KMX+ SM LEFT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-102","SUP","Custom 27803010","","6485-5-102  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-103","SUP","Custom 27803010","","6485-5-103  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-110","SUP","Custom 27803010","","6485-5-110  -  SPACER FEM 5MM KNMX SM RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-111","SUP","Custom 27803010","","6485-5-111  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-112","SUP","Custom 27803010","","6485-5-112  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-113","SUP","Custom 27803010","","6485-5-113  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-150","SUP","Custom 27803010","","6485-5-150  -  SPACER FEM 5MM KMX+ MED LEFT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-151","SUP","Custom 27803010","","6485-5-151  -  SPACER FEM 10MM KNMX MED LEFT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-152","SUP","Custom 27803010","","6485-5-152  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-153","SUP","Custom 27803010","","6485-5-153  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-160","SUP","Custom 27803010","","6485-5-160  -  SPACER FEM 5MM KNMX MED RIGHT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-161","SUP","Custom 27803010","","6485-5-161  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-162","SUP","Custom 27803010","","6485-5-162  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-163","SUP","Custom 27803010","","6485-5-163  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-200","SUP","Custom 27803010","","6485-5-200  -  SPACER FEM 5MM KMX+ LG LEFT DISTAL MDL","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-201","SUP","Custom 27803010","","6485-5-201  -  SPACER FEM 10MM KMX+ LG LEFT DISTAL MDL","BOTH IP/OP","$572.00 ","$423.28 ","$0.00 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.00 ","$0.00 ","$286.00 ","$453.02 ","$457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-202","SUP","Custom 27803010","","6485-5-202  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-203","SUP","Custom 27803010","","6485-5-203  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-210","SUP","Custom 27803010","","6485-5-210  -  SPACER FEM 5MM KMX+ LG RIGHT DISTAL MDL","BOTH IP/OP","$572.00 ","$423.28 ","$0.00 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.00 ","$0.00 ","$286.00 ","$453.02 ","$457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-211","SUP","Custom 27803010","","6485-5-211  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-212","SUP","Custom 27803010","","6485-5-212  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-213","SUP","Custom 27803010","","6485-5-213  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-250","SUP","Custom 27803010","","6485-5-250  -  SPACER FEM 5MM KMX+ XL LEFT DISTAL MDL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-251","SUP","Custom 27803010","","6485-5-251  -  SPACER FEM 10MM KMX+ MED XL DISTAL KNEE","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-252","SUP","Custom 27803010","","6485-5-252  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-253","SUP","Custom 27803010","","6485-5-253  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-260","SUP","Custom 27803010","","6485-5-260  -  SPACER FEM 5MM KNMX 2XL RIGHT DISTAL MDL","BOTH IP/OP","$816.00 ","$603.84 ","$0.00 ","$816.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$816.00 ","$0.00 ","$408.00 ","$646.27 ","$652.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-261","SUP","Custom 27803010","","6485-5-261  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-262","SUP","Custom 27803010","","6485-5-262  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL","BOTH IP/OP","$687.00 ","$508.38 ","$0.00 ","$687.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.00 ","$0.00 ","$343.50 ","$544.10 ","$549.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-263","SUP","Custom 27803010","","6485-5-263  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL","BOTH IP/OP","$659.00 ","$487.66 ","$0.00 ","$659.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.00 ","$0.00 ","$329.50 ","$521.93 ","$527.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-5-915","SUP","Custom 27803010","","6485-5-915  -  CMPNT PATLR LG KNMTC","BOTH IP/OP","$1,639.63 ","$1,213.33 ","$0.00 ","$1,639.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,639.63 ","$0.00 ","$819.81 ","$1,298.59 ","$1,311.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6485-6-409","SUP","HCPCS C1776","","6485-6-409  -  STEM TIBIAL 9MM MRS KNEE","BOTH IP/OP","$7,905.00 ","$5,849.70 ","$0.00 ","$7,905.00 ","$3,557.25 ","$0.00 ","$1,647.60 ","$0.00 ","$0.00 ","$1,384.10 ","$7,905.00 ","$0.00 ","$3,952.50 ","$6,260.76 ","$6,324.00 ","$0.00 ","$1,237.13 ","$0.00 ","$1,258.48 ","$0.00 "
"6485-6-411","SUP","HCPCS C1776","","6485-6-411  -  STEM TIBIAL 11MM MRS KNEE","BOTH IP/OP","$7,905.00 ","$5,849.70 ","$0.00 ","$7,905.00 ","$3,557.25 ","$0.00 ","$1,647.60 ","$0.00 ","$0.00 ","$1,384.10 ","$7,905.00 ","$0.00 ","$3,952.50 ","$6,260.76 ","$6,324.00 ","$0.00 ","$1,237.13 ","$0.00 ","$1,258.48 ","$0.00 "
"6485-6-413","SUP","HCPCS C1776","","6485-6-413  -  STEM TIBIAL 13MM MRS KNEE","BOTH IP/OP","$7,905.00 ","$5,849.70 ","$0.00 ","$7,905.00 ","$3,557.25 ","$0.00 ","$1,647.60 ","$0.00 ","$0.00 ","$1,384.10 ","$7,905.00 ","$0.00 ","$3,952.50 ","$6,260.76 ","$6,324.00 ","$0.00 ","$1,237.13 ","$0.00 ","$1,258.48 ","$0.00 "
"6485-6-509","SUP","HCPCS C1776","","6485-6-509  -  STEM TIBIAL 9MM 127MM MRS KNEE","BOTH IP/OP","$5,722.50 ","$4,234.65 ","$0.00 ","$5,722.50 ","$2,575.13 ","$0.00 ","$1,192.71 ","$0.00 ","$0.00 ","$1,001.96 ","$5,722.50 ","$0.00 ","$2,861.25 ","$4,532.22 ","$4,578.00 ","$0.00 ","$895.57 ","$0.00 ","$911.02 ","$0.00 "
"6485-6-511","SUP","HCPCS C1776","","6485-6-511  -  STEM TIBIAL 11MM 127MM MRS KNEE","BOTH IP/OP","$5,722.50 ","$4,234.65 ","$0.00 ","$5,722.50 ","$2,575.13 ","$0.00 ","$1,192.71 ","$0.00 ","$0.00 ","$1,001.96 ","$5,722.50 ","$0.00 ","$2,861.25 ","$4,532.22 ","$4,578.00 ","$0.00 ","$895.57 ","$0.00 ","$911.02 ","$0.00 "
"6485-6-513","SUP","HCPCS C1776","","6485-6-513  -  STEM TIBIAL 13MM MRS KNEE","BOTH IP/OP","$5,722.50 ","$4,234.65 ","$0.00 ","$5,722.50 ","$2,575.13 ","$0.00 ","$1,192.71 ","$0.00 ","$0.00 ","$1,001.96 ","$5,722.50 ","$0.00 ","$2,861.25 ","$4,532.22 ","$4,578.00 ","$0.00 ","$895.57 ","$0.00 ","$911.02 ","$0.00 "
"6485-8-435","SUP","HCPCS C1776","","6485-8-435  -  COMPONENT TIBIAL SHORT BEARING MRS KNEE","BOTH IP/OP","$6,005.00 ","$4,443.70 ","$0.00 ","$6,005.00 ","$2,702.25 ","$0.00 ","$1,251.59 ","$0.00 ","$0.00 ","$1,051.43 ","$6,005.00 ","$0.00 ","$3,002.50 ","$4,755.96 ","$4,804.00 ","$0.00 ","$939.78 ","$0.00 ","$956.00 ","$0.00 "
"6485-8-450","SUP","HCPCS C1776","","6485-8-450  -  COMPONENT TIBIAL 3XS BEARING KRH KNEE","BOTH IP/OP","$6,122.50 ","$4,530.65 ","$0.00 ","$6,122.50 ","$2,755.13 ","$0.00 ","$1,276.08 ","$0.00 ","$0.00 ","$1,072.00 ","$6,122.50 ","$0.00 ","$3,061.25 ","$4,849.02 ","$4,898.00 ","$0.00 ","$958.17 ","$0.00 ","$974.70 ","$0.00 "
"6485-8-460","SUP","HCPCS C1895","","6485-8-460  -  AXLE FEMORAL SMALL ROTATE HINGE MODULE KINEMATIC KNEE","BOTH IP/OP","$2,182.50 ","$1,615.05 ","$0.00 ","$2,182.50 ","$982.13 ","$0.00 ","$454.89 ","$0.00 ","$0.00 ","$382.14 ","$2,182.50 ","$0.00 ","$1,091.25 ","$1,728.54 ","$1,746.00 ","$0.00 ","$341.56 ","$0.00 ","$347.45 ","$0.00 "
"6487-1-040","SUP","HCPCS C1776","","6487-1-040  -  BODY HUMERAL TAPER 40MM MALE TO FMALE MRS","BOTH IP/OP","$5,680.00 ","$4,203.20 ","$0.00 ","$5,680.00 ","$2,556.00 ","$0.00 ","$1,183.85 ","$0.00 ","$0.00 ","$994.52 ","$5,680.00 ","$0.00 ","$2,840.00 ","$4,498.56 ","$4,544.00 ","$0.00 ","$888.92 ","$0.00 ","$904.26 ","$0.00 "
"6487-1-060","SUP","HCPCS C1776","","6487-1-060  -  BODY HUMERAL TAPER 60MM MALE TO FMALE MRS","BOTH IP/OP","$5,680.00 ","$4,203.20 ","$0.00 ","$5,680.00 ","$2,556.00 ","$0.00 ","$1,183.85 ","$0.00 ","$0.00 ","$994.52 ","$5,680.00 ","$0.00 ","$2,840.00 ","$4,498.56 ","$4,544.00 ","$0.00 ","$888.92 ","$0.00 ","$904.26 ","$0.00 "
"6487-1-080","SUP","HCPCS C1776","","6487-1-080  -  BODY HUMERAL 80MM MALE/FMALE TAPERED MRS SHOULDER","BOTH IP/OP","$5,680.00 ","$4,203.20 ","$0.00 ","$5,680.00 ","$2,556.00 ","$0.00 ","$1,183.85 ","$0.00 ","$0.00 ","$994.52 ","$5,680.00 ","$0.00 ","$2,840.00 ","$4,498.56 ","$4,544.00 ","$0.00 ","$888.92 ","$0.00 ","$904.26 ","$0.00 "
"6487-1-100","SUP","HCPCS C1776","","6487-1-100  -  BODY HUMERAL TAPER 100MM MALE TO FMALE MRS","BOTH IP/OP","$5,680.00 ","$4,203.20 ","$0.00 ","$5,680.00 ","$2,556.00 ","$0.00 ","$1,183.85 ","$0.00 ","$0.00 ","$994.52 ","$5,680.00 ","$0.00 ","$2,840.00 ","$4,498.56 ","$4,544.00 ","$0.00 ","$888.92 ","$0.00 ","$904.26 ","$0.00 "
"6487-1-120","SUP","HCPCS C1776","","6487-1-120  -  BODY HUMERAL TAPER 120MM MALE TO FMALE MRS","BOTH IP/OP","$5,680.00 ","$4,203.20 ","$0.00 ","$5,680.00 ","$2,556.00 ","$0.00 ","$1,183.85 ","$0.00 ","$0.00 ","$994.52 ","$5,680.00 ","$0.00 ","$2,840.00 ","$4,498.56 ","$4,544.00 ","$0.00 ","$888.92 ","$0.00 ","$904.26 ","$0.00 "
"6487-1-140","SUP","HCPCS C1776","","6487-1-140  -  BODY HUMERAL TAPER 140MM MALE TO FMALE MRS","BOTH IP/OP","$5,680.00 ","$4,203.20 ","$0.00 ","$5,680.00 ","$2,556.00 ","$0.00 ","$1,183.85 ","$0.00 ","$0.00 ","$994.52 ","$5,680.00 ","$0.00 ","$2,840.00 ","$4,498.56 ","$4,544.00 ","$0.00 ","$888.92 ","$0.00 ","$904.26 ","$0.00 "
"6487-2-075","SUP","HCPCS C1776","","6487-2-075  -  STEM HUMERAL 7MM 75MM MRS MRH SHOULDER","BOTH IP/OP","$7,480.00 ","$5,535.20 ","$0.00 ","$7,480.00 ","$3,366.00 ","$0.00 ","$1,559.02 ","$0.00 ","$0.00 ","$1,309.69 ","$7,480.00 ","$0.00 ","$3,740.00 ","$5,924.16 ","$5,984.00 ","$0.00 ","$1,170.62 ","$0.00 ","$1,190.82 ","$0.00 "
"6487-2-115","SUP","HCPCS C1776","","6487-2-115  -  STEM HUMERAL 7MM 115MM MRS SHOULDER","BOTH IP/OP","$7,480.00 ","$5,535.20 ","$0.00 ","$7,480.00 ","$3,366.00 ","$0.00 ","$1,559.02 ","$0.00 ","$0.00 ","$1,309.69 ","$7,480.00 ","$0.00 ","$3,740.00 ","$5,924.16 ","$5,984.00 ","$0.00 ","$1,170.62 ","$0.00 ","$1,190.82 ","$0.00 "
"6487-3-075","SUP","HCPCS C1776","","6487-3-075  -  STEM HUMERAL 9MM 75MM MRS SHOULDER","BOTH IP/OP","$7,480.00 ","$5,535.20 ","$0.00 ","$7,480.00 ","$3,366.00 ","$0.00 ","$1,559.02 ","$0.00 ","$0.00 ","$1,309.69 ","$7,480.00 ","$0.00 ","$3,740.00 ","$5,924.16 ","$5,984.00 ","$0.00 ","$1,170.62 ","$0.00 ","$1,190.82 ","$0.00 "
"6487-3-115","SUP","HCPCS C1776","","6487-3-115  -  STEM HUMERAL 9MM 115MM MRS SHOULDER","BOTH IP/OP","$7,480.00 ","$5,535.20 ","$0.00 ","$7,480.00 ","$3,366.00 ","$0.00 ","$1,559.02 ","$0.00 ","$0.00 ","$1,309.69 ","$7,480.00 ","$0.00 ","$3,740.00 ","$5,924.16 ","$5,984.00 ","$0.00 ","$1,170.62 ","$0.00 ","$1,190.82 ","$0.00 "
"6487-4-075","SUP","HCPCS C1776","","6487-4-075  -  STEM HUMERAL 11MM 75MM MRS SHOULDER","BOTH IP/OP","$7,480.00 ","$5,535.20 ","$0.00 ","$7,480.00 ","$3,366.00 ","$0.00 ","$1,559.02 ","$0.00 ","$0.00 ","$1,309.69 ","$7,480.00 ","$0.00 ","$3,740.00 ","$5,924.16 ","$5,984.00 ","$0.00 ","$1,170.62 ","$0.00 ","$1,190.82 ","$0.00 "
"6487-4-115","SUP","HCPCS C1776","","6487-4-115  -  STEM HUMERAL 11MM 115MM MRS SHOULDER","BOTH IP/OP","$7,480.00 ","$5,535.20 ","$0.00 ","$7,480.00 ","$3,366.00 ","$0.00 ","$1,559.02 ","$0.00 ","$0.00 ","$1,309.69 ","$7,480.00 ","$0.00 ","$3,740.00 ","$5,924.16 ","$5,984.00 ","$0.00 ","$1,170.62 ","$0.00 ","$1,190.82 ","$0.00 "
"6487-5-010","SUP","HCPCS C1713","","6487-5-010  -  SCREW BONE INTERCALARY MRS HUMERUS","BOTH IP/OP","$932.50 ","$690.05 ","$0.00 ","$932.50 ","$419.63 ","$0.00 ","$194.36 ","$0.00 ","$0.00 ","$163.27 ","$932.50 ","$0.00 ","$466.25 ","$738.54 ","$746.00 ","$0.00 ","$145.94 ","$0.00 ","$148.45 ","$0.00 "
"6487-5-040","SUP","HCPCS C1776","","6487-5-040  -  HEAD HUM 40MM STRL MRS SHLDR PROX","BOTH IP/OP","$7,317.50 ","$5,414.95 ","$0.00 ","$7,317.50 ","$3,292.88 ","$0.00 ","$1,525.15 ","$0.00 ","$0.00 ","$1,281.24 ","$7,317.50 ","$0.00 ","$3,658.75 ","$5,795.46 ","$5,854.00 ","$0.00 ","$1,145.19 ","$0.00 ","$1,164.95 ","$0.00 "
"6487-5-044","SUP","HCPCS C1776","","6487-5-044  -  HEAD HUM 44MM STRL MRS SHLDR PROX","BOTH IP/OP","$7,317.50 ","$5,414.95 ","$0.00 ","$7,317.50 ","$3,292.88 ","$0.00 ","$1,525.15 ","$0.00 ","$0.00 ","$1,281.24 ","$7,317.50 ","$0.00 ","$3,658.75 ","$5,795.46 ","$5,854.00 ","$0.00 ","$1,145.19 ","$0.00 ","$1,164.95 ","$0.00 "
"6487-5-051","SUP","HCPCS C1776","","6487-5-051  -  STEM HUM 50MM BODY MRS 25MM SHLDR","BOTH IP/OP","$4,054.38 ","$3,000.24 ","$0.00 ","$4,054.38 ","$1,824.47 ","$0.00 ","$845.03 ","$0.00 ","$0.00 ","$709.89 ","$4,054.38 ","$0.00 ","$2,027.19 ","$3,211.07 ","$3,243.50 ","$0.00 ","$634.51 ","$0.00 ","$645.46 ","$0.00 "
"6487-5-075","SUP","HCPCS C1776","","6487-5-075  -  STEM HUMERAL 7MM 75MM MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-5-076","SUP","HCPCS C1776","","6487-5-076  -  STEM HUMERAL 75MM 25MM BODY MRS MRH SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-5-101","SUP","HCPCS C1776","","6487-5-101  -  STEM HUMERAL 100MM 25MM BODY MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-5-115","SUP","HCPCS C1776","","6487-5-115  -  STEM HUMERAL 7MM 115MM MRS","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-5-126","SUP","HCPCS C1776","","6487-5-126  -  STEM HUM 125MM BODY MRS 25MM SHLDR","BOTH IP/OP","$4,054.38 ","$3,000.24 ","$0.00 ","$4,054.38 ","$1,824.47 ","$0.00 ","$845.03 ","$0.00 ","$0.00 ","$709.89 ","$4,054.38 ","$0.00 ","$2,027.19 ","$3,211.07 ","$3,243.50 ","$0.00 ","$634.51 ","$0.00 ","$645.46 ","$0.00 "
"6487-6-051","SUP","HCPCS C1776","","6487-6-051  -  STEM HUM 50MM BODY MRS 50MM SHLDR","BOTH IP/OP","$4,054.38 ","$3,000.24 ","$0.00 ","$4,054.38 ","$1,824.47 ","$0.00 ","$845.03 ","$0.00 ","$0.00 ","$709.89 ","$4,054.38 ","$0.00 ","$2,027.19 ","$3,211.07 ","$3,243.50 ","$0.00 ","$634.51 ","$0.00 ","$645.46 ","$0.00 "
"6487-6-075","SUP","HCPCS C1776","","6487-6-075  -  STEM HUMERAL 9MM 75MM MRS","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-6-076","SUP","HCPCS C1776","","6487-6-076  -  STEM HUMERAL 50MM 75MM BODY MRS","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-6-101","SUP","HCPCS C1776","","6487-6-101  -  STEM HUMERAL 50MM 100MM BODY MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-6-115","SUP","HCPCS C1776","","6487-6-115  -  STEM HUMERAL 9MM 115MM MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-6-126","SUP","HCPCS C1776","","6487-6-126  -  STEM HUM 125MM BODY MRS 50MM SHLDR","BOTH IP/OP","$4,054.38 ","$3,000.24 ","$0.00 ","$4,054.38 ","$1,824.47 ","$0.00 ","$845.03 ","$0.00 ","$0.00 ","$709.89 ","$4,054.38 ","$0.00 ","$2,027.19 ","$3,211.07 ","$3,243.50 ","$0.00 ","$634.51 ","$0.00 ","$645.46 ","$0.00 "
"6487-7-051","SUP","HCPCS C1776","","6487-7-051  -  STEM HUM 50MM BODY MRS 75MM SHLDR","BOTH IP/OP","$4,054.38 ","$3,000.24 ","$0.00 ","$4,054.38 ","$1,824.47 ","$0.00 ","$845.03 ","$0.00 ","$0.00 ","$709.89 ","$4,054.38 ","$0.00 ","$2,027.19 ","$3,211.07 ","$3,243.50 ","$0.00 ","$634.51 ","$0.00 ","$645.46 ","$0.00 "
"6487-7-075","SUP","HCPCS C1776","","6487-7-075  -  STEM HUMERAL 11MM 75MM MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-7-076","SUP","HCPCS C1776","","6487-7-076  -  STEM HUMERAL 75MM 75MM BODY MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-7-101","SUP","HCPCS C1776","","6487-7-101  -  STEM HUMERAL 100MM 75MM BODY MRS MRH SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-7-115","SUP","HCPCS C1776","","6487-7-115  -  STEM HUMERAL 11MM 115MM BODY MRS SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-8-051","SUP","HCPCS C1776","","6487-8-051  -  STEM HUMERAL 100MM 50MM BODY MRS MRH SHOULDER","BOTH IP/OP","$5,420.00 ","$4,010.80 ","$0.00 ","$5,420.00 ","$2,439.00 ","$0.00 ","$1,129.66 ","$0.00 ","$0.00 ","$949.00 ","$5,420.00 ","$0.00 ","$2,710.00 ","$4,292.64 ","$4,336.00 ","$0.00 ","$848.23 ","$0.00 ","$862.86 ","$0.00 "
"6487-9-051","SUP","HCPCS C1776","","6487-9-051  -  CAP END 50MM MRS HUMERAL PROXIMAL","BOTH IP/OP","$2,635.00 ","$1,949.90 ","$0.00 ","$2,635.00 ","$1,185.75 ","$0.00 ","$549.20 ","$0.00 ","$0.00 ","$461.37 ","$2,635.00 ","$0.00 ","$1,317.50 ","$2,086.92 ","$2,108.00 ","$0.00 ","$412.38 ","$0.00 ","$419.49 ","$0.00 "
"6495-1-001","SUP","HCPCS C1776","","6495-1-001  -  COMPONENT FEMORAL STANDARD NEUTRAL GMRS COCR HIP","BOTH IP/OP","$10,355.00 ","$7,662.70 ","$0.00 ","$10,355.00 ","$4,659.75 ","$0.00 ","$2,158.24 ","$0.00 ","$0.00 ","$1,813.08 ","$10,355.00 ","$0.00 ","$5,177.50 ","$8,201.16 ","$8,284.00 ","$0.00 ","$1,620.56 ","$0.00 ","$1,648.52 ","$0.00 "
"6495-1-002","SUP","HCPCS C1776","","6495-1-002  -  COMPONENT FEMORAL NEUTRAL GMRS HIP TROCHANTER","BOTH IP/OP","$10,355.00 ","$7,662.70 ","$0.00 ","$10,355.00 ","$4,659.75 ","$0.00 ","$2,158.24 ","$0.00 ","$0.00 ","$1,813.08 ","$10,355.00 ","$0.00 ","$5,177.50 ","$8,201.16 ","$8,284.00 ","$0.00 ","$1,620.56 ","$0.00 ","$1,648.52 ","$0.00 "
"6495-1-101","SUP","HCPCS C1776","","6495-1-101  -  COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE LEFT","BOTH IP/OP","$10,355.00 ","$7,662.70 ","$0.00 ","$10,355.00 ","$4,659.75 ","$0.00 ","$2,158.24 ","$0.00 ","$0.00 ","$1,813.08 ","$10,355.00 ","$0.00 ","$5,177.50 ","$8,201.16 ","$8,284.00 ","$0.00 ","$1,620.56 ","$0.00 ","$1,648.52 ","$0.00 "
"6495-1-102","SUP","HCPCS C1776","","6495-1-102  -  COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE LEFT TROCHANTER","BOTH IP/OP","$10,355.00 ","$7,662.70 ","$0.00 ","$10,355.00 ","$4,659.75 ","$0.00 ","$2,158.24 ","$0.00 ","$0.00 ","$1,813.08 ","$10,355.00 ","$0.00 ","$5,177.50 ","$8,201.16 ","$8,284.00 ","$0.00 ","$1,620.56 ","$0.00 ","$1,648.52 ","$0.00 "
"6495-1-201","SUP","HCPCS C1776","","6495-1-201  -  COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE RIGHT","BOTH IP/OP","$10,355.00 ","$7,662.70 ","$0.00 ","$10,355.00 ","$4,659.75 ","$0.00 ","$2,158.24 ","$0.00 ","$0.00 ","$1,813.08 ","$10,355.00 ","$0.00 ","$5,177.50 ","$8,201.16 ","$8,284.00 ","$0.00 ","$1,620.56 ","$0.00 ","$1,648.52 ","$0.00 "
"6495-1-202","SUP","HCPCS C1776","","6495-1-202  -  COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE RIGHT TROCHANTER","BOTH IP/OP","$10,355.00 ","$7,662.70 ","$0.00 ","$10,355.00 ","$4,659.75 ","$0.00 ","$2,158.24 ","$0.00 ","$0.00 ","$1,813.08 ","$10,355.00 ","$0.00 ","$5,177.50 ","$8,201.16 ","$8,284.00 ","$0.00 ","$1,620.56 ","$0.00 ","$1,648.52 ","$0.00 "
"6495-2-010","SUP","HCPCS C1776","","6495-2-010  -  COMPONENT FEMORAL SMALL 65MM GMRS COCR KNEE LEFT","BOTH IP/OP","$14,922.50 ","$11,042.65 ","$0.00 ","$14,922.50 ","$6,715.13 ","$0.00 ","$3,110.22 ","$0.00 ","$0.00 ","$2,612.81 ","$14,922.50 ","$0.00 ","$7,461.25 ","$11,818.62 ","$11,938.00 ","$0.00 ","$2,335.37 ","$0.00 ","$2,375.66 ","$0.00 "
"6495-2-020","SUP","HCPCS C1776","","6495-2-020  -  COMPONENT FEMORAL SMALL 65MM GMRS DISTAL RIGHT","BOTH IP/OP","$14,922.50 ","$11,042.65 ","$0.00 ","$14,922.50 ","$6,715.13 ","$0.00 ","$3,110.22 ","$0.00 ","$0.00 ","$2,612.81 ","$14,922.50 ","$0.00 ","$7,461.25 ","$11,818.62 ","$11,938.00 ","$0.00 ","$2,335.37 ","$0.00 ","$2,375.66 ","$0.00 "
"6495-2-030","SUP","HCPCS C1776","","6495-2-030  -  COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE LEFT","BOTH IP/OP","$14,787.50 ","$10,942.75 ","$0.00 ","$14,787.50 ","$6,654.38 ","$0.00 ","$3,082.08 ","$0.00 ","$0.00 ","$2,589.17 ","$14,787.50 ","$0.00 ","$7,393.75 ","$11,711.70 ","$11,830.00 ","$0.00 ","$2,314.24 ","$0.00 ","$2,354.17 ","$0.00 "
"6495-2-040","SUP","HCPCS C1776","","6495-2-040  -  COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE RIGHT","BOTH IP/OP","$14,787.50 ","$10,942.75 ","$0.00 ","$14,787.50 ","$6,654.38 ","$0.00 ","$3,082.08 ","$0.00 ","$0.00 ","$2,589.17 ","$14,787.50 ","$0.00 ","$7,393.75 ","$11,711.70 ","$11,830.00 ","$0.00 ","$2,314.24 ","$0.00 ","$2,354.17 ","$0.00 "
"6495-2-105","SUP","Custom 27803010","","6495-2-105  -  BUSHING FEMORAL SMALL GMRS KNEE","BOTH IP/OP","$640.00 ","$473.60 ","$0.00 ","$640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$640.00 ","$0.00 ","$320.00 ","$506.88 ","$512.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-2-115","SUP","Custom 27803010","","6495-2-115  -  AXLE FEMORAL SMALL GMRS KNEE","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-3-010","SUP","Custom 27803010","","6495-3-010  -  INSERT TIBIAL SMALL 10MM GMRS PROXIMAL","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-3-013","SUP","Custom 27803010","","6495-3-013  -  INSERT TIBIAL SMALL 13MM GMRS PROXIMAL","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-3-016","SUP","Custom 27803010","","6495-3-016  -  INSERT TIBIAL SMALL 16MM GMRS PROXIMAL","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-3-020","SUP","Custom 27803010","","6495-3-020  -  INSERT TIBIAL SMALL 20MM GMRS PROXIMAL","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-3-024","SUP","Custom 27803010","","6495-3-024  -  INSERT TIBIAL SMALL 24MM GMRS PROXIMAL","BOTH IP/OP","$2,367.50 ","$1,751.95 ","$0.00 ","$2,367.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.50 ","$0.00 ","$1,183.75 ","$1,875.06 ","$1,894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6495-3-101","SUP","HCPCS C1776","","6495-3-101  -  COMPONENT TIBIAL SMALL GMRS PROXIMAL","BOTH IP/OP","$14,895.00 ","$11,022.30 ","$0.00 ","$14,895.00 ","$6,702.75 ","$0.00 ","$3,104.49 ","$0.00 ","$0.00 ","$2,608.00 ","$14,895.00 ","$0.00 ","$7,447.50 ","$11,796.84 ","$11,916.00 ","$0.00 ","$2,331.07 ","$0.00 ","$2,371.28 ","$0.00 "
"6495-3-102","SUP","HCPCS C1776","","6495-3-102  -  COMPONENT TIBIAL STANDARD GMRS PROXIMAL","BOTH IP/OP","$14,895.00 ","$11,022.30 ","$0.00 ","$14,895.00 ","$6,702.75 ","$0.00 ","$3,104.49 ","$0.00 ","$0.00 ","$2,608.00 ","$14,895.00 ","$0.00 ","$7,447.50 ","$11,796.84 ","$11,916.00 ","$0.00 ","$2,331.07 ","$0.00 ","$2,371.28 ","$0.00 "
"6495-3-601","SUP","HCPCS C1776","","6495-3-601  -  COMPONENT TIBIAL SMALL ROTATE GMRS TITANIUM KNEE PROXIMAL","BOTH IP/OP","$6,122.50 ","$4,530.65 ","$0.00 ","$6,122.50 ","$2,755.13 ","$0.00 ","$1,276.08 ","$0.00 ","$0.00 ","$1,072.00 ","$6,122.50 ","$0.00 ","$3,061.25 ","$4,849.02 ","$4,898.00 ","$0.00 ","$958.17 ","$0.00 ","$974.70 ","$0.00 "
"6495-5-011","SUP","HCPCS C1776","","6495-5-011  -  STEM FEMORAL STR FLUTE 11MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-012","SUP","HCPCS C1776","","6495-5-012  -  STEM FEMORAL STR FLUTE 12MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-013","SUP","HCPCS C1776","","6495-5-013  -  STEM FEMORAL STR FLUTE 13MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-014","SUP","HCPCS C1776","","6495-5-014  -  STEM FEMORAL STR FLUTE 14MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-015","SUP","HCPCS C1776","","6495-5-015  -  STEM FEMORAL STR FLUTE 15MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-016","SUP","HCPCS C1776","","6495-5-016  -  STEM FEMORAL STR FLUTE 16MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-017","SUP","HCPCS C1776","","6495-5-017  -  STEM FEMORAL STR FLUTE 17MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-018","SUP","HCPCS C1776","","6495-5-018  -  STEM FEMORAL STR FLUTE 18MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-019","SUP","HCPCS C1776","","6495-5-019  -  STEM FEMORAL STR FLUTE 19MM 125MM PRESSFIT GMRS COCR HIP","BOTH IP/OP","$9,450.00 ","$6,993.00 ","$0.00 ","$9,450.00 ","$4,252.50 ","$0.00 ","$1,969.62 ","$0.00 ","$0.00 ","$1,654.62 ","$9,450.00 ","$0.00 ","$4,725.00 ","$7,484.40 ","$7,560.00 ","$0.00 ","$1,478.93 ","$0.00 ","$1,504.44 ","$0.00 "
"6495-5-111","SUP","HCPCS C1776","","6495-5-111  -  STEM FEMORAL LONG BOW 11MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-112","SUP","HCPCS C1776","","6495-5-112  -  STEM FEMORAL LONG BOW 12MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-113","SUP","HCPCS C1776","","6495-5-113  -  STEM FEMORAL LONG BOW 13MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-114","SUP","HCPCS C1776","","6495-5-114  -  STEM FEMORAL LONG BOW 14MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-115","SUP","HCPCS C1776","","6495-5-115  -  STEM FEMORAL LONG BOW 15MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-116","SUP","HCPCS C1776","","6495-5-116  -  STEM FEMORAL LONG BOW 16MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-117","SUP","HCPCS C1776","","6495-5-117  -  STEM FEMORAL LONG BOW 17MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-118","SUP","HCPCS C1776","","6495-5-118  -  STEM FEMORAL LONG BOW 18MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-119","SUP","HCPCS C1776","","6495-5-119  -  STEM FEMORAL LONG BOW 19MM 200MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-211","SUP","HCPCS C1776","","6495-5-211  -  STEM FEMORAL BOW 11MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-212","SUP","HCPCS C1776","","6495-5-212  -  STEM FEMORAL BOW 12MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-213","SUP","HCPCS C1776","","6495-5-213  -  STEM FEMORAL BOW 13MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-214","SUP","HCPCS C1776","","6495-5-214  -  STEM FEMORAL BOW 14MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-215","SUP","HCPCS C1776","","6495-5-215  -  STEM FEMORAL BOW 15MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-216","SUP","HCPCS C1776","","6495-5-216  -  STEM FEMORAL BOW 16MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-217","SUP","HCPCS C1776","","6495-5-217  -  STEM FEMORAL BOW 17MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-218","SUP","HCPCS C1776","","6495-5-218  -  STEM FEMORAL BOW 18MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-5-219","SUP","HCPCS C1776","","6495-5-219  -  STEM FEMORAL BOW 19MM 150MM PRESSFIT GMRS HIP","BOTH IP/OP","$9,962.50 ","$7,372.25 ","$0.00 ","$9,962.50 ","$4,483.13 ","$0.00 ","$2,076.43 ","$0.00 ","$0.00 ","$1,744.35 ","$9,962.50 ","$0.00 ","$4,981.25 ","$7,890.30 ","$7,970.00 ","$0.00 ","$1,559.13 ","$0.00 ","$1,586.03 ","$0.00 "
"6495-6-008","SUP","HCPCS C1776","","6495-6-008  -  COMPONENT FEMORAL 80MM CONCTR GMRS KNEE LEFT","BOTH IP/OP","$9,002.50 ","$6,661.85 ","$0.00 ","$9,002.50 ","$4,051.13 ","$0.00 ","$1,876.35 ","$0.00 ","$0.00 ","$1,576.27 ","$9,002.50 ","$0.00 ","$4,501.25 ","$7,129.98 ","$7,202.00 ","$0.00 ","$1,408.89 ","$0.00 ","$1,433.20 ","$0.00 "
"6495-6-009","SUP","HCPCS C1776","","6495-6-009  -  COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE LEFT","BOTH IP/OP","$9,002.50 ","$6,661.85 ","$0.00 ","$9,002.50 ","$4,051.13 ","$0.00 ","$1,876.35 ","$0.00 ","$0.00 ","$1,576.27 ","$9,002.50 ","$0.00 ","$4,501.25 ","$7,129.98 ","$7,202.00 ","$0.00 ","$1,408.89 ","$0.00 ","$1,433.20 ","$0.00 "
"6495-6-018","SUP","HCPCS C1776","","6495-6-018  -  COMPONENT FEMORAL 80MM CONNECT PIECE GMRS TITANIUM HIP RIGHT","BOTH IP/OP","$9,087.50 ","$6,724.75 ","$0.00 ","$9,087.50 ","$4,089.38 ","$0.00 ","$1,894.06 ","$0.00 ","$0.00 ","$1,591.15 ","$9,087.50 ","$0.00 ","$4,543.75 ","$7,197.30 ","$7,270.00 ","$0.00 ","$1,422.19 ","$0.00 ","$1,446.73 ","$0.00 "
"6495-6-019","SUP","HCPCS C1776","","6495-6-019  -  COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE RIGHT","BOTH IP/OP","$9,087.50 ","$6,724.75 ","$0.00 ","$9,087.50 ","$4,089.38 ","$0.00 ","$1,894.06 ","$0.00 ","$0.00 ","$1,591.15 ","$9,087.50 ","$0.00 ","$4,543.75 ","$7,197.30 ","$7,270.00 ","$0.00 ","$1,422.19 ","$0.00 ","$1,446.73 ","$0.00 "
"6495-6-030","SUP","HCPCS C1776","","6495-6-030  -  EXTENSION FEMORAL 30MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-040","SUP","HCPCS C1776","","6495-6-040  -  EXTENSION FEMORAL 40MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-050","SUP","HCPCS C1776","","6495-6-050  -  EXTENSION FEMORAL 50MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-060","SUP","HCPCS C1776","","6495-6-060  -  EXTENSION FEMORAL 60MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-070","SUP","HCPCS C1776","","6495-6-070  -  EXTENSION FEMORAL 70MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-080","SUP","HCPCS C1776","","6495-6-080  -  EXTENSION FEMORAL 80MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-100","SUP","HCPCS C1776","","6495-6-100  -  EXTENSION FEMORAL 100MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-120","SUP","HCPCS C1776","","6495-6-120  -  EXTENSION FEMORAL 120MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-140","SUP","HCPCS C1776","","6495-6-140  -  EXTENSION FEMORAL 140MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-160","SUP","HCPCS C1776","","6495-6-160  -  EXTENSION STEM 160MM GMRS COCR KNEE FEMUR","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-180","SUP","HCPCS C1776","","6495-6-180  -  EXTENSION FEMORAL 180MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-200","SUP","HCPCS C1776","","6495-6-200  -  EXTENSION FEMORAL 200MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6495-6-220","SUP","HCPCS C1776","","6495-6-220  -  EXTENSION FEMORAL 220MM GMRS COCR KNEE DISTAL","BOTH IP/OP","$6,257.50 ","$4,630.55 ","$0.00 ","$6,257.50 ","$2,815.88 ","$0.00 ","$1,304.22 ","$0.00 ","$0.00 ","$1,095.64 ","$6,257.50 ","$0.00 ","$3,128.75 ","$4,955.94 ","$5,006.00 ","$0.00 ","$979.30 ","$0.00 ","$996.19 ","$0.00 "
"6500-000-009","SUP","Custom 27100030","","6500-000-009 -  MODEL ANTM CLRVW ADLT SKL","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65-0003-S","SUP","Custom 27803010","","65-0003-S  -  FILLER BN VOID 3ML CALLOS","BOTH IP/OP","$2,962.50 ","$2,192.25 ","$0.00 ","$2,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65-0005-S","SUP","Custom 27803010","","65-0005-S  -  SYSTEM BN CMNT 5ML CALLOS INJ","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65-0010-S","SUP","Custom 27803010","","65-0010-S  -  FILLER BN VOID 10ML CALLOS","BOTH IP/OP","$7,750.00 ","$5,735.00 ","$0.00 ","$7,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,750.00 ","$0.00 ","$3,875.00 ","$6,138.00 ","$6,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65-0099-S","SUP","Custom 27203010","","65-0099-S  -  KIT DLV INJ","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"650-1057","SUP","HCPCS C1776","","650-1057  -  HEAD FEM 36MM G7 BLX D OPTN HIP","BOTH IP/OP","$10,177.50 ","$7,531.35 ","$0.00 ","$10,177.50 ","$4,579.88 ","$0.00 ","$2,121.25 ","$0.00 ","$0.00 ","$1,782.00 ","$10,177.50 ","$0.00 ","$5,088.75 ","$8,060.58 ","$8,142.00 ","$0.00 ","$1,592.78 ","$0.00 ","$1,620.26 ","$0.00 "
"65-0105-S","SUP","Custom 27803010","","65-0105-S  -  FILLER BN VOID 5ML CALLOS","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"650-1066","SUP","HCPCS C1776","","650-1066  -  SLEEVE FEMORAL STANDARD TAPER TYPE 1 OPTION BIOLOX DELTA","BOTH IP/OP","$1,030.00 ","$762.20 ","$0.00 ","$1,030.00 ","$463.50 ","$0.00 ","$214.68 ","$0.00 ","$0.00 ","$180.34 ","$1,030.00 ","$0.00 ","$515.00 ","$815.76 ","$824.00 ","$0.00 ","$161.20 ","$0.00 ","$163.98 ","$0.00 "
"65-0110-S","SUP","Custom 27803010","","65-0110-S  -  FILLER BN VOID 10ML CALLOS","BOTH IP/OP","$7,750.00 ","$5,735.00 ","$0.00 ","$7,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,750.00 ","$0.00 ","$3,875.00 ","$6,138.00 ","$6,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65-018-E4S","SUP","Custom 27203010","","65-018-E4S  -  CATHETER INFS 4 4/3FR 65CM CLARIVEIN","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65-0199-S","SUP","Custom 27203010","","65-0199-S  -  SYSTEM BONE CMNT IMPCT KIT CALLOS","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6515-0814L","SUP","HCPCS C1776","","6515-0814L  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-0814R","SUP","HCPCS C1776","","6515-0814R  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-0915L","SUP","HCPCS C1776","","6515-0915L  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-0915R","SUP","HCPCS C1776","","6515-0915R  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1016L","SUP","HCPCS C1776","","6515-1016L  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1016R","SUP","HCPCS C1776","","6515-1016R  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1117L","SUP","HCPCS C1776","","6515-1117L  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1117R","SUP","HCPCS C1776","","6515-1117R  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1218L","SUP","HCPCS C1776","","6515-1218L  -  STEM REV 205MM 18MM RSTOR -5MM LEFT HIP HYDRXAPT BW","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1218R","SUP","HCPCS C1776","","6515-1218R  -  STEM FEM 205MM 18MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1319L","SUP","HCPCS C1776","","6515-1319L  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1319R","SUP","HCPCS C1776","","6515-1319R  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1420L","SUP","HCPCS C1776","","6515-1420L  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1420R","SUP","HCPCS C1776","","6515-1420R  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1422L","SUP","HCPCS C1776","","6515-1422L  -  STEM FEM 205MM 22MM BW RSTOR HYDRXAPT -5MM LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6515-1422R","SUP","HCPCS C1776","","6515-1422R  -  STEM FEM 205MM 22MM BW RSTOR HYDRXAPT -5MM RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-0814L","SUP","HCPCS C1776","","6516-0814L  -  STEM FEM 14MM 14MM RED NECK RSTOR HYDRXAPT -5MM 8 HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-0814R","SUP","HCPCS C1776","","6516-0814R  -  STEM FEM 255MM STR RED NECK RSTOR HYDRXAPT -5MM HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-0915L","SUP","HCPCS C1776","","6516-0915L  -  NECK FEM 15MM RSTOR LEFT HIP HYDRXAPT RED","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-0915R","SUP","HCPCS C1776","","6516-0915R  -  STEM FEM 15MM RED NECK RSTOR HYDRXAPT RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1016L","SUP","HCPCS C1776","","6516-1016L  -  STEM FEM 16MM RED NECK RSTOR HYDRXAPT LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1016R","SUP","HCPCS C1776","","6516-1016R  -  STEM FEM 16MM RED NECK RSTOR HYDRXAPT RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1117L","SUP","HCPCS C1776","","6516-1117L  -  STEM FEM 17MM 17MM NO DISTAL SLOT RED NECK SYS RSTOR","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1117R","SUP","HCPCS C1776","","6516-1117R  -  STEM FEM 17MM RED NECK RSTOR HYDRXAPT RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1218L","SUP","HCPCS C1776","","6516-1218L  -  STEM FEM 18MM RED RSTOR HYDRXAPT LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1218R","SUP","HCPCS C1776","","6516-1218R  -  STEM FEM 18MM 18MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT -5","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1319L","SUP","HCPCS C1776","","6516-1319L  -  STEM FEM 19MM RED NECK RSTOR HYDRXAPT LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1319R","SUP","HCPCS C1776","","6516-1319R  -  STEM FEM 19MM 19MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT 13","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1420L","SUP","HCPCS C1776","","6516-1420L  -  STEM FEM 20MM RED NECK RSTOR HYDRXAPT LEFT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1420R","SUP","HCPCS C1776","","6516-1420R  -  STEM FEM 20MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1422L","SUP","HCPCS C1776","","6516-1422L  -  STEM FEM 22MM 22MM NO DISTAL SLOT RED NECK SYS RSTOR","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6516-1422R","SUP","HCPCS C1776","","6516-1422R  -  STEM FEM 22MM RED NECK RSTOR HYDRXAPT RIGHT HIP","BOTH IP/OP","$12,943.13 ","$9,577.92 ","$0.00 ","$12,943.13 ","$5,824.41 ","$0.00 ","$2,697.67 ","$0.00 ","$0.00 ","$2,266.24 ","$12,943.13 ","$0.00 ","$6,471.56 ","$10,250.96 ","$10,354.50 ","$0.00 ","$2,025.60 ","$0.00 ","$2,060.55 ","$0.00 "
"6519-1-028","SUP","Custom 27803010","","6519-1-028  -  HEAD FEM +0MM UNV TPR 28MM STRL BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-1-032","SUP","Custom 27803010","","6519-1-032  -  HEAD FEM +0MM UNV TPR 32MM STRL BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-1-036","SUP","Custom 27803010","","6519-1-036  -  HEAD FEM +0MM UNV TPR 36MM STRL BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-1-040","SUP","Custom 27803010","","6519-1-040  -  HEAD FEM +0MM UNV TPR 40MM STRL BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-1-044","SUP","Custom 27803010","","6519-1-044  -  HEAD FEM +0MM UNV TPR 44MM STRL BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-T-025","SUP","Custom 27803010","","6519-T-025  -  SLEEVE ADAPTER -2.5MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-T-100","SUP","Custom 27803010","","6519-T-100  -  SLEEVE ADAPTER +0MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6519-T-204","SUP","Custom 27803010","","6519-T-204  -  SLEEVE ADAPTER +4MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6522-0509","SUP","HCPCS C1776","","6522-0509  -  STEM FEM 145MM 9MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$11,474.13 ","$8,490.86 ","$0.00 ","$11,474.13 ","$5,163.36 ","$0.00 ","$2,391.49 ","$0.00 ","$0.00 ","$2,009.03 ","$11,474.13 ","$0.00 ","$5,737.06 ","$9,087.51 ","$9,179.30 ","$0.00 ","$1,795.70 ","$0.00 ","$1,826.68 ","$0.00 "
"6522-0511","SUP","HCPCS C1776","","6522-0511  -  STEM FEM 145MM 11MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$11,474.13 ","$8,490.86 ","$0.00 ","$11,474.13 ","$5,163.36 ","$0.00 ","$2,391.49 ","$0.00 ","$0.00 ","$2,009.03 ","$11,474.13 ","$0.00 ","$5,737.06 ","$9,087.51 ","$9,179.30 ","$0.00 ","$1,795.70 ","$0.00 ","$1,826.68 ","$0.00 "
"6522-0610","SUP","HCPCS C1776","","6522-0610  -  STEM FEM 145MM 10MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$11,474.13 ","$8,490.86 ","$0.00 ","$11,474.13 ","$5,163.36 ","$0.00 ","$2,391.49 ","$0.00 ","$0.00 ","$2,009.03 ","$11,474.13 ","$0.00 ","$5,737.06 ","$9,087.51 ","$9,179.30 ","$0.00 ","$1,795.70 ","$0.00 ","$1,826.68 ","$0.00 "
"6522-0612","SUP","HCPCS C1776","","6522-0612  -  STEM FEM 145MM 12MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$11,474.13 ","$8,490.86 ","$0.00 ","$11,474.13 ","$5,163.36 ","$0.00 ","$2,391.49 ","$0.00 ","$0.00 ","$2,009.03 ","$11,474.13 ","$0.00 ","$5,737.06 ","$9,087.51 ","$9,179.30 ","$0.00 ","$1,795.70 ","$0.00 ","$1,826.68 ","$0.00 "
"6522-0711","SUP","HCPCS C1776","","6522-0711  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-0713","SUP","HCPCS C1776","","6522-0713  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-0812","SUP","HCPCS C1776","","6522-0812  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-0814","SUP","HCPCS C1776","","6522-0814  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-0913","SUP","HCPCS C1776","","6522-0913  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-0915","SUP","HCPCS C1776","","6522-0915  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-1014","SUP","HCPCS C1776","","6522-1014  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-1016","SUP","HCPCS C1776","","6522-1016  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-1115","SUP","HCPCS C1776","","6522-1115  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6522-1117","SUP","HCPCS C1776","","6522-1117  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$10,684.38 ","$7,906.44 ","$0.00 ","$10,684.38 ","$4,807.97 ","$0.00 ","$2,226.89 ","$0.00 ","$0.00 ","$1,870.75 ","$10,684.38 ","$0.00 ","$5,342.19 ","$8,462.03 ","$8,547.50 ","$0.00 ","$1,672.10 ","$0.00 ","$1,700.95 ","$0.00 "
"6523-0509","SUP","HCPCS C1776","","6523-0509  -  STEM FEM 175MM 9MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$12,150.13 ","$8,991.10 ","$0.00 ","$12,150.13 ","$5,467.56 ","$0.00 ","$2,532.39 ","$0.00 ","$0.00 ","$2,127.39 ","$12,150.13 ","$0.00 ","$6,075.06 ","$9,622.90 ","$9,720.10 ","$0.00 ","$1,901.49 ","$0.00 ","$1,934.30 ","$0.00 "
"6523-0511","SUP","HCPCS C1776","","6523-0511  -  STEM FEM 175MM 11MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$12,150.13 ","$8,991.10 ","$0.00 ","$12,150.13 ","$5,467.56 ","$0.00 ","$2,532.39 ","$0.00 ","$0.00 ","$2,127.39 ","$12,150.13 ","$0.00 ","$6,075.06 ","$9,622.90 ","$9,720.10 ","$0.00 ","$1,901.49 ","$0.00 ","$1,934.30 ","$0.00 "
"6523-0610","SUP","HCPCS C1776","","6523-0610  -  STEM FEM 175MM 10MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$12,150.13 ","$8,991.10 ","$0.00 ","$12,150.13 ","$5,467.56 ","$0.00 ","$2,532.39 ","$0.00 ","$0.00 ","$2,127.39 ","$12,150.13 ","$0.00 ","$6,075.06 ","$9,622.90 ","$9,720.10 ","$0.00 ","$1,901.49 ","$0.00 ","$1,934.30 ","$0.00 "
"6523-0612","SUP","HCPCS C1776","","6523-0612  -  STEM FEM 175MM 12MM CTPR RSTOR TI HYDRXAPT HIP","BOTH IP/OP","$12,150.13 ","$8,991.10 ","$0.00 ","$12,150.13 ","$5,467.56 ","$0.00 ","$2,532.39 ","$0.00 ","$0.00 ","$2,127.39 ","$12,150.13 ","$0.00 ","$6,075.06 ","$9,622.90 ","$9,720.10 ","$0.00 ","$1,901.49 ","$0.00 ","$1,934.30 ","$0.00 "
"6523-0711","SUP","HCPCS C1776","","6523-0711  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-0713","SUP","HCPCS C1776","","6523-0713  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-0812","SUP","HCPCS C1776","","6523-0812  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-0814","SUP","HCPCS C1776","","6523-0814  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-0913","SUP","HCPCS C1776","","6523-0913  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-0915","SUP","HCPCS C1776","","6523-0915  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-1014","SUP","HCPCS C1776","","6523-1014  -  STEM HUM 205MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-1016","SUP","HCPCS C1776","","6523-1016  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-1115","SUP","HCPCS C1776","","6523-1115  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6523-1117","SUP","HCPCS C1776","","6523-1117  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT","BOTH IP/OP","$11,313.25 ","$8,371.81 ","$0.00 ","$11,313.25 ","$5,090.96 ","$0.00 ","$2,357.96 ","$0.00 ","$0.00 ","$1,980.86 ","$11,313.25 ","$0.00 ","$5,656.63 ","$8,960.09 ","$9,050.60 ","$0.00 ","$1,770.52 ","$0.00 ","$1,801.07 ","$0.00 "
"6524-0511L","SUP","HCPCS C1776","","6524-0511L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0511R","SUP","HCPCS C1776","","6524-0511R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0612L","SUP","HCPCS C1776","","6524-0612L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0612R","SUP","HCPCS C1776","","6524-0612R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0713L","SUP","HCPCS C1776","","6524-0713L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$12,161.50 ","$8,999.51 ","$0.00 ","$12,161.50 ","$5,472.68 ","$0.00 ","$2,534.76 ","$0.00 ","$0.00 ","$2,129.38 ","$12,161.50 ","$0.00 ","$6,080.75 ","$9,631.91 ","$9,729.20 ","$0.00 ","$1,903.27 ","$0.00 ","$1,936.11 ","$0.00 "
"6524-0713R","SUP","HCPCS C1776","","6524-0713R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0814L","SUP","HCPCS C1776","","6524-0814L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0814R","SUP","HCPCS C1776","","6524-0814R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0915L","SUP","HCPCS C1776","","6524-0915L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-0915R","SUP","HCPCS C1776","","6524-0915R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-1016L","SUP","HCPCS C1776","","6524-1016L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-1016R","SUP","HCPCS C1776","","6524-1016R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-1117L","SUP","HCPCS C1776","","6524-1117L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6524-1117R","SUP","HCPCS C1776","","6524-1117R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT","BOTH IP/OP","$11,938.88 ","$8,834.77 ","$0.00 ","$11,938.88 ","$5,372.49 ","$0.00 ","$2,488.36 ","$0.00 ","$0.00 ","$2,090.40 ","$11,938.88 ","$0.00 ","$5,969.44 ","$9,455.59 ","$9,551.10 ","$0.00 ","$1,868.43 ","$0.00 ","$1,900.67 ","$0.00 "
"6528-0511","SUP","HCPCS C1776","","6528-0511  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-0612","SUP","HCPCS C1776","","6528-0612  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-0713","SUP","HCPCS C1776","","6528-0713  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-0814","SUP","HCPCS C1776","","6528-0814  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-0915","SUP","HCPCS C1776","","6528-0915  -  CMPNT FEM 175MM CLCR 2 RSTOR HYDRXAPT","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-1016","SUP","HCPCS C1776","","6528-1016  -  STEM FEM 145MM 15MM RSTOR HYDRXAPT 10/16 CLCR","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-1117","SUP","HCPCS C1776","","6528-1117  -  CMPNT FEM 11/17 175MM CLCR 2 RSTOR HYDRXAPT 15MM","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6528-1218","SUP","HCPCS C1776","","6528-1218  -  CMPNT FEM 12/18 175MM CLCR RSTOR HYDRXAPT 15MM","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-0511","SUP","HCPCS C1776","","6529-0511  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 5/11 CLCR 2","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-0612","SUP","HCPCS C1776","","6529-0612  -  CMPNT FEM 6/12 175MM CLCR 2 RSTOR HYDRXAPT 30MM","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-0713","SUP","HCPCS C1776","","6529-0713  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 7/13 CLCR 2","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-0814","SUP","HCPCS C1776","","6529-0814  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 8/14 CLCR","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-0915","SUP","HCPCS C1776","","6529-0915  -  CMPNT FEM 9/15 175MM CLCR 2 RSTOR HYDRXAPT 30MM","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-1016","SUP","HCPCS C1776","","6529-1016  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 10/16 CLCR 2","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6529-1117","SUP","HCPCS C1776","","6529-1117  -  CMPNT FEM 11/17 175MM CLCR 2 RSTOR HYDRXAPT 30MM","BOTH IP/OP","$12,689.63 ","$9,390.33 ","$0.00 ","$12,689.63 ","$5,710.33 ","$0.00 ","$2,644.84 ","$0.00 ","$0.00 ","$2,221.85 ","$12,689.63 ","$0.00 ","$6,344.81 ","$10,050.19 ","$10,151.70 ","$0.00 ","$1,985.93 ","$0.00 ","$2,020.19 ","$0.00 "
"6565-0-028","SUP","Custom 27803010","","6565-0-028  -  HEAD FEMORAL -2.7MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-032","SUP","Custom 27803010","","6565-0-032  -  HEAD FEMORAL -4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-036","SUP","Custom 27803010","","6565-0-036  -  HEAD FEMORAL -5MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-128","SUP","Custom 27803010","","6565-0-128  -  HEAD FEMORAL +0MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-132","SUP","Custom 27803010","","6565-0-132  -  HEAD FEM +0MM OFST TPR 32MM STRL V40 AL CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-136","SUP","Custom 27803010","","6565-0-136  -  HEAD FEMORAL +0MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-228","SUP","Custom 27803010","","6565-0-228  -  HEAD FEMORAL +4MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-232","SUP","Custom 27803010","","6565-0-232  -  HEAD FEMORAL +4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6565-0-236","SUP","Custom 27803010","","6565-0-236  -  HEAD FEM +5MM OFST TPR 36MM STRL V40 AL CERM HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65652-512","SUP","Custom 27203010","","CANISTER SCT 1L CURVE INTNL ON/OFF VLV XTD BKT HLDR REUSE LF","BOTH IP/OP","$64.00 ","$47.36 ","$0.00 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.00 ","$0.00 ","$32.00 ","$50.69 ","$51.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-028","SUP","Custom 27803010","","6570-0-028  -  HEAD FEM -4MM OFST TPR 28MM STRL V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-032","SUP","Custom 27803010","","6570-0-032  -  HEAD FEM -4MM OFST TPR 32MM STRL V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-036","SUP","Custom 27803010","","6570-0-036  -  HEAD FEM -5MM OFST TPR 36MM V40 ANTM BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-128","SUP","Custom 27803010","","6570-0-128  -  HEAD FEMORAL 0MM OFFST TAPER 28MM V40 BIOLOX DELTA HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-132","SUP","Custom 27803010","","6570-0-132  -  HEAD FEM +0MM OFST TPR 32MM V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-136","SUP","Custom 27803010","","6570-0-136  -  HEAD FEM +0MM OFST TPR 36MM V40 ANTM BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-228","SUP","Custom 27803010","","6570-0-228  -  HEAD FEM +4MM OFST TPR 28MM STRL V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-232","SUP","Custom 27803010","","6570-0-232  -  HEAD FEM +4MM OFST TPR 32MM STRL V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-236","SUP","Custom 27803010","","6570-0-236  -  HEAD FEM +5MM OFST TPR 36MM V40 ANTM BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-328","SUP","Custom 27803010","","6570-0-328  -  HEAD FEM -2.7MM OFST TPR 28MM STRL V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-436","SUP","Custom 27803010","","6570-0-436  -  HEAD FEM -2.5MM OFST TPR 36MM V40 ANTM BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-536","SUP","Custom 27803010","","6570-0-536  -  HEAD FEM +2.5MM OFST TPR 36MM V40 ANTM BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6570-0-736","SUP","Custom 27803010","","6570-0-736  -  HEAD FEM +7.5MM OFST TPR 36MM STRL V40 BLX D HIP","BOTH IP/OP","$1,725.00 ","$1,276.50 ","$0.00 ","$1,725.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,725.00 ","$0.00 ","$862.50 ","$1,366.20 ","$1,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2240","SUP","Custom 27803010","","65C-2240  -  CUP ACETAB 40MM 22MM 6.4MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2242","SUP","Custom 27803010","","65C-2242  -  CUP ACETAB 42MM 22MM 7.4MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2244","SUP","Custom 27803010","","65C-2244  -  CUP ACETAB 44MM 22MM 7.9MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2246","SUP","Custom 27803010","","65C-2246  -  CUP ACETAB 46MM 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2248","SUP","Custom 27803010","","65C-2248  -  CUP ACETAB 48MM 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2250","SUP","Custom 27803010","","65C-2250  -  CUP ACETAB 50MM 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2252","SUP","Custom 27803010","","65C-2252  -  CUP ACETAB 52MM 22MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2642","SUP","Custom 27803010","","65C-2642  -  CUP ACETAB 42MM 26MM 5.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2644","SUP","Custom 27803010","","65C-2644  -  CUP ACETAB 44MM 26MM 6.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2646","SUP","Custom 27803010","","65C-2646  -  CUP ACETAB 46MM 26MM 7.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2648","SUP","Custom 27803010","","65C-2648  -  CUP ACETAB 48MM 26MM 8MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2650","SUP","Custom 27803010","","65C-2650  -  CUP ACETAB 50MM 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2652","SUP","Custom 27803010","","65C-2652  -  CUP ACETAB 52MM 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2654","SUP","Custom 27803010","","65C-2654  -  CUP ACETAB 54MM 26MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2844","SUP","Custom 27803010","","65C-2844  -  CUP ACETAB 44MM 28MM 5.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2846","SUP","Custom 27803010","","65C-2846  -  CUP ACETAB 46MM 28MM 6.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2848","SUP","Custom 27803010","","65C-2848  -  CUP ACETAB 48MM 28MM 7.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2850","SUP","Custom 27803010","","65C-2850  -  CUP ACETAB 50MM 28MM 8MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2852","SUP","Custom 27803010","","65C-2852  -  CUP ACETAB 52MM 28MM 8.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2854","SUP","Custom 27803010","","65C-2854  -  CUP ACETAB 54MM 28MM 9.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2856","SUP","Custom 27803010","","65C-2856  -  CUP ACETAB 56MM 28MM 10.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2858","SUP","Custom 27803010","","65C-2858  -  CUP ACETAB 58MM 28MM 11.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2860","SUP","Custom 27803010","","65C-2860  -  CUP ACETAB 60MM 28MM 12.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2863","SUP","Custom 27803010","","65C-2863  -  CUP ACETAB 63MM 28MM 14MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-2866","SUP","Custom 27803010","","65C-2866  -  CUP ACETAB 66MM 28MM 15.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3248","SUP","Custom 27803010","","65C-3248  -  CUP ACETAB 48MM 32MM 5.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3250","SUP","Custom 27803010","","65C-3250  -  CUP ACETAB 50MM 32MM 6.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3252","SUP","Custom 27803010","","65C-3252  -  CUP ACETAB 52MM 32MM 7.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3254","SUP","Custom 27803010","","65C-3254  -  CUP ACETAB 54MM 32MM 8MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3256","SUP","Custom 27803010","","65C-3256  -  CUP ACETAB 56MM 32MM 8.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3258","SUP","Custom 27803010","","65C-3258  -  CUP ACETAB 58MM 32MM 9.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3260","SUP","Custom 27803010","","65C-3260  -  CUP ACETAB 60MM 32MM 10.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3263","SUP","Custom 27803010","","65C-3263  -  CUP ACETAB 63MM 32MM 12MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"65C-3266","SUP","Custom 27803010","","65C-3266  -  CUP ACETAB 66MM 32MM 13.5MM TRIDENT XFIRE HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28B","SUP","Custom 27803010","","661-00-28B  -  INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28C","SUP","Custom 27803010","","661-00-28C  -  INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28D","SUP","Custom 27803010","","661-00-28D  -  INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28E","SUP","Custom 27803010","","661-00-28E  -  INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28F","SUP","Custom 27803010","","661-00-28F  -  INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28G","SUP","Custom 27803010","","661-00-28G  -  INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28H","SUP","Custom 27803010","","661-00-28H  -  INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28I","SUP","Custom 27803010","","661-00-28I  -  INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-28J","SUP","Custom 27803010","","661-00-28J  -  INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32D","SUP","Custom 27803010","","661-00-32D  -  INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32E","SUP","Custom 27803010","","661-00-32E  -  INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32F","SUP","Custom 27803010","","661-00-32F  -  INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32G","SUP","Custom 27803010","","661-00-32G  -  INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32H","SUP","Custom 27803010","","661-00-32H  -  INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32I","SUP","Custom 27803010","","661-00-32I  -  INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-32J","SUP","Custom 27803010","","661-00-32J  -  INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-36E","SUP","Custom 27803010","","661-00-36E  -  INSERT ACETAB 0D E 36MM ECCENTRIC TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-36F","SUP","Custom 27803010","","661-00-36F  -  INSERT ACETAB 0D F 36MM ECCENTRIC TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-36G","SUP","Custom 27803010","","661-00-36G  -  INSERT ACETAB 0D G 36MM ECCENTRIC TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-36H","SUP","Custom 27803010","","661-00-36H  -  INSERT ACETAB 0D H 36MM ECCENTRIC TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-36I","SUP","Custom 27803010","","661-00-36I  -  INSERT ACETAB 0D I 36MM ECCENTRIC TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-00-36J","SUP","Custom 27803010","","661-00-36J  -  INSERT ACETAB 0D J 36MM ECCENTRIC TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28C","SUP","Custom 27803010","","661-10-28C  -  INSERT ACETAB 10D C ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28D","SUP","Custom 27803010","","661-10-28D  -  INSERT ACETAB 10D D ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28E","SUP","Custom 27803010","","661-10-28E  -  INSERT ACETAB 10D E ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28F","SUP","Custom 27803010","","661-10-28F  -  INSERT ACETAB 10D F ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28G","SUP","Custom 27803010","","661-10-28G  -  INSERT ACETAB 10D G ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28H","SUP","Custom 27803010","","661-10-28H  -  INSERT ACETAB 10D H ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28I","SUP","Custom 27803010","","661-10-28I  -  INSERT ACETAB 10D I ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-28J","SUP","Custom 27803010","","661-10-28J  -  INSERT ACETAB 10D J ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32D","SUP","Custom 27803010","","661-10-32D  -  INSERT ACETAB 10D D ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32E","SUP","Custom 27803010","","661-10-32E  -  INSERT ACETAB 10D E ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32F","SUP","Custom 27803010","","661-10-32F  -  INSERT ACETAB 10D F ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32G","SUP","Custom 27803010","","661-10-32G  -  INSERT ACETAB 10D G ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32H","SUP","Custom 27803010","","661-10-32H  -  INSERT ACETAB 10D H ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32I","SUP","Custom 27803010","","661-10-32I  -  INSERT ACETAB 10D I ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-32J","SUP","Custom 27803010","","661-10-32J  -  INSERT ACETAB 10D J ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-36E","SUP","Custom 27803010","","661-10-36E  -  INSERT ACETAB 10D E ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-36F","SUP","Custom 27803010","","661-10-36F  -  INSERT ACETAB 10D F ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-36G","SUP","Custom 27803010","","661-10-36G  -  INSERT ACETAB 10D G ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-36H","SUP","Custom 27803010","","661-10-36H  -  INSERT ACETAB 10D H ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-36I","SUP","Custom 27803010","","661-10-36I  -  INSERT ACETAB 10D I ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"661-10-36J","SUP","Custom 27803010","","661-10-36J  -  INSERT ACETAB 10D J ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-0-010","SUP","HCPCS C1776","","6630-0-010  -  CMPNT FEM 2XS LEFT KNEE BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-015","SUP","HCPCS C1776","","6630-0-015  -  CMPNT FEM 1 2XS LEFT KNEE NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-020","SUP","HCPCS C1776","","6630-0-020  -  CMPNT FEM 2XS RIGHT BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-025","SUP","HCPCS C1776","","6630-0-025  -  CMPNT FEM 1 2XS RIGHT KNEE NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-110","SUP","HCPCS C1776","","6630-0-110  -  CMPNT FEM XS LEFT BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-115","SUP","HCPCS C1776","","6630-0-115  -  CMPNT FEM 2 XS LEFT KNEE NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-120","SUP","HCPCS C1776","","6630-0-120  -  CMPNT FEM XS RIGHT BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-125","SUP","HCPCS C1776","","6630-0-125  -  CMPNT FEM XS STD RIGHT KNEE NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-210","SUP","HCPCS C1776","","6630-0-210  -  CMPNT FEM SM LEFT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-215","SUP","HCPCS C1776","","6630-0-215  -  CMPNT FEM SM LEFT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"6630-0-220","SUP","HCPCS C1776","","6630-0-220  -  CMPNT FEM SM RIGHT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-225","SUP","HCPCS C1776","","6630-0-225  -  CMPNT FEM SM RIGHT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"663-00-28B","SUP","Custom 27803010","","663-00-28B  -  INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28C","SUP","Custom 27803010","","663-00-28C  -  INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28D","SUP","Custom 27803010","","663-00-28D  -  INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28E","SUP","Custom 27803010","","663-00-28E  -  INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28F","SUP","Custom 27803010","","663-00-28F  -  INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28G","SUP","Custom 27803010","","663-00-28G  -  INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28H","SUP","Custom 27803010","","663-00-28H  -  INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28I","SUP","Custom 27803010","","663-00-28I  -  INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-28J","SUP","Custom 27803010","","663-00-28J  -  INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-0-310","SUP","HCPCS C1776","","6630-0-310  -  CMPNT FEM MED LEFT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-315","SUP","HCPCS C1776","","6630-0-315  -  CMPNT FEM MED LEFT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"6630-0-320","SUP","HCPCS C1776","","6630-0-320  -  CMPNT FEM MED RIGHT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-325","SUP","HCPCS C1776","","6630-0-325  -  CMPNT FEM MED RIGHT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"663-00-32D","SUP","Custom 27803010","","663-00-32D  -  INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-32E","SUP","Custom 27803010","","663-00-32E  -  INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-32F","SUP","Custom 27803010","","663-00-32F  -  INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-32G","SUP","Custom 27803010","","663-00-32G  -  INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-32H","SUP","Custom 27803010","","663-00-32H  -  INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-32I","SUP","Custom 27803010","","663-00-32I  -  INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-32J","SUP","Custom 27803010","","663-00-32J  -  INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-36E","SUP","Custom 27803010","","663-00-36E  -  INSERT ACETAB 0D E ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$3,830.00 ","$2,834.20 ","$0.00 ","$3,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,830.00 ","$0.00 ","$1,915.00 ","$3,033.36 ","$3,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-36F","SUP","Custom 27803010","","663-00-36F  -  INSERT ACETAB 0D F ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$3,830.00 ","$2,834.20 ","$0.00 ","$3,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,830.00 ","$0.00 ","$1,915.00 ","$3,033.36 ","$3,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-36G","SUP","Custom 27803010","","663-00-36G  -  INSERT ACETAB 0D G ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$3,830.00 ","$2,834.20 ","$0.00 ","$3,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,830.00 ","$0.00 ","$1,915.00 ","$3,033.36 ","$3,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-36H","SUP","Custom 27803010","","663-00-36H  -  INSERT ACETAB 0D H ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$3,830.00 ","$2,834.20 ","$0.00 ","$3,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,830.00 ","$0.00 ","$1,915.00 ","$3,033.36 ","$3,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-36I","SUP","Custom 27803010","","663-00-36I  -  INSERT ACETAB 0D I ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$3,830.00 ","$2,834.20 ","$0.00 ","$3,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,830.00 ","$0.00 ","$1,915.00 ","$3,033.36 ","$3,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-00-36J","SUP","Custom 27803010","","663-00-36J  -  INSERT ACETAB 0D J ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$3,830.00 ","$2,834.20 ","$0.00 ","$3,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,830.00 ","$0.00 ","$1,915.00 ","$3,033.36 ","$3,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-0-410","SUP","HCPCS C1776","","6630-0-410  -  CMPNT FEM MED LG LEFT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-415","SUP","HCPCS C1776","","6630-0-415  -  CMPNT FEM MED LG LEFT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"6630-0-420","SUP","HCPCS C1776","","6630-0-420  -  CMPNT FEM MED LG RIGHT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-425","SUP","HCPCS C1776","","6630-0-425  -  CMPNT FEM MED LG RIGHT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"6630-0-510","SUP","HCPCS C1776","","6630-0-510  -  CMPNT FEM LG LEFT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-515","SUP","HCPCS C1776","","6630-0-515  -  CMPNT FEM LG LEFT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"6630-0-520","SUP","HCPCS C1776","","6630-0-520  -  CMPNT FEM LG RIGHT BEADED DRCN","BOTH IP/OP","$4,385.00 ","$3,244.90 ","$0.00 ","$4,385.00 ","$1,973.25 ","$0.00 ","$913.94 ","$0.00 ","$0.00 ","$767.78 ","$4,385.00 ","$0.00 ","$2,192.50 ","$3,472.92 ","$3,508.00 ","$0.00 ","$686.25 ","$0.00 ","$698.09 ","$0.00 "
"6630-0-525","SUP","HCPCS C1776","","6630-0-525  -  CMPNT FEM LG RIGHT NBD DRCN","BOTH IP/OP","$3,464.00 ","$2,563.36 ","$0.00 ","$3,464.00 ","$1,558.80 ","$0.00 ","$721.98 ","$0.00 ","$0.00 ","$606.52 ","$3,464.00 ","$0.00 ","$1,732.00 ","$2,743.49 ","$2,771.20 ","$0.00 ","$542.12 ","$0.00 ","$551.47 ","$0.00 "
"6630-0-610","SUP","HCPCS C1776","","6630-0-610  -  CMPNT FEM XL LEFT BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-615","SUP","HCPCS C1776","","6630-0-615  -  CMPNT FEM 1 XL LEFT NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-620","SUP","HCPCS C1776","","6630-0-620  -  CMPNT FEM XL RIGHT BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-625","SUP","HCPCS C1776","","6630-0-625  -  CMPNT FEM 1 XL RIGHT NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-710","SUP","HCPCS C1776","","6630-0-710  -  CMPNT FEM 2XL STD LEFT KNEE BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-715","SUP","HCPCS C1776","","6630-0-715  -  CMPNT FEM 2XL LEFT NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-0-720","SUP","HCPCS C1776","","6630-0-720  -  CMPNT FEM 2XL RIGHT BEADED DRCN","BOTH IP/OP","$4,464.00 ","$3,303.36 ","$0.00 ","$4,464.00 ","$2,008.80 ","$0.00 ","$930.41 ","$0.00 ","$0.00 ","$781.61 ","$4,464.00 ","$0.00 ","$2,232.00 ","$3,535.49 ","$3,571.20 ","$0.00 ","$698.62 ","$0.00 ","$710.67 ","$0.00 "
"6630-0-725","SUP","HCPCS C1776","","6630-0-725  -  CMPNT FEM 2XL RIGHT NBD DRCN","BOTH IP/OP","$3,525.00 ","$2,608.50 ","$0.00 ","$3,525.00 ","$1,586.25 ","$0.00 ","$734.70 ","$0.00 ","$0.00 ","$617.20 ","$3,525.00 ","$0.00 ","$1,762.50 ","$2,791.80 ","$2,820.00 ","$0.00 ","$551.66 ","$0.00 ","$561.18 ","$0.00 "
"6630-6-105","SUP","Custom 27803010","","6630-6-105  -  WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-110","SUP","Custom 27803010","","6630-6-110  -  WEDGE TIBIAL S1 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-125","SUP","Custom 27803010","","6630-6-125  -  WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-130","SUP","Custom 27803010","","6630-6-130  -  WEDGE TIBIAL S1 FLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-150","SUP","Custom 27803010","","6630-6-150  -  WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-155","SUP","Custom 27803010","","6630-6-155  -  WEDGE TIBIAL S2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-170","SUP","Custom 27803010","","6630-6-170  -  WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-175","SUP","Custom 27803010","","6630-6-175  -  WEDGE TIBIAL S2 FLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-205","SUP","Custom 27803010","","6630-6-205  -  WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-210","SUP","Custom 27803010","","6630-6-210  -  WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-225","SUP","Custom 27803010","","6630-6-225  -  WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-230","SUP","Custom 27803010","","6630-6-230  -  WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-250","SUP","Custom 27803010","","6630-6-250  -  WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-255","SUP","Custom 27803010","","6630-6-255  -  WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-270","SUP","Custom 27803010","","6630-6-270  -  WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-275","SUP","Custom 27803010","","6630-6-275  -  WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-305","SUP","Custom 27803010","","6630-6-305  -  WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-310","SUP","Custom 27803010","","6630-6-310  -  WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-325","SUP","Custom 27803010","","6630-6-325  -  WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-330","SUP","Custom 27803010","","6630-6-330  -  WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-350","SUP","Custom 27803010","","6630-6-350  -  WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-355","SUP","Custom 27803010","","6630-6-355  -  WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-370","SUP","Custom 27803010","","6630-6-370  -  WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-375","SUP","Custom 27803010","","6630-6-375  -  WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-405","SUP","Custom 27803010","","6630-6-405  -  WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-410","SUP","Custom 27803010","","6630-6-410  -  WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-425","SUP","Custom 27803010","","6630-6-425  -  WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-430","SUP","Custom 27803010","","6630-6-430  -  WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-450","SUP","Custom 27803010","","6630-6-450  -  WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-455","SUP","Custom 27803010","","6630-6-455  -  WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE RIGHT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-470","SUP","Custom 27803010","","6630-6-470  -  WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-475","SUP","Custom 27803010","","6630-6-475  -  WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE LEFT","BOTH IP/OP","$1,885.00 ","$1,394.90 ","$0.00 ","$1,885.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,885.00 ","$0.00 ","$942.50 ","$1,492.92 ","$1,508.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-510","SUP","Custom 27803010","","6630-6-510  -  WEDGE TIBIAL S1 FULL FLAT 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-515","SUP","Custom 27803010","","6630-6-515  -  WEDGE TIBIAL S2 FULL 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-520","SUP","Custom 27803010","","6630-6-520  -  WEDGE TIBIAL M1 FULL 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-525","SUP","Custom 27803010","","6630-6-525  -  WEDGE TIBIAL M2 FULL FLAT 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-530","SUP","Custom 27803010","","6630-6-530  -  WEDGE TIBIAL 1 FULL FLAT 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-535","SUP","Custom 27803010","","6630-6-535  -  WEDGE TIBIAL 2 FULL FLAT 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-545","SUP","Custom 27803010","","6630-6-545  -  WEDGE TIBIAL X1 FULL 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-6-550","SUP","Custom 27803010","","6630-6-550  -  WEDGE TIBIAL X2 FULL 10MM REVISION DURACON KNEE","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6630-8-005","SUP","HCPCS C1776","","6630-8-005  -  CMPNT FEM 2XS LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-010","SUP","HCPCS C1776","","6630-8-010  -  CMPNT FEM 2XS RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-015","SUP","HCPCS C1776","","6630-8-015  -  CMPNT FEM XS LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-020","SUP","HCPCS C1776","","6630-8-020  -  CMPNT FEM XS RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-025","SUP","HCPCS C1776","","6630-8-025  -  CMPNT FEM SM LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-030","SUP","HCPCS C1776","","6630-8-030  -  CMPNT FEM SM RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-035","SUP","HCPCS C1776","","6630-8-035  -  CMPNT FEM MED LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-040","SUP","HCPCS C1776","","6630-8-040  -  CMPNT FEM MED RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-045","SUP","HCPCS C1776","","6630-8-045  -  CMPNT FEM MED LG LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-050","SUP","HCPCS C1776","","6630-8-050  -  CMPNT FEM MED LG RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-055","SUP","HCPCS C1776","","6630-8-055  -  CMPNT FEM LG LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-060","SUP","HCPCS C1776","","6630-8-060  -  BSPLT TIB DRCN LG FEM RIGHT BEADED PERIAPT 28MM","BOTH IP/OP","$5,167.00 ","$3,823.58 ","$0.00 ","$5,167.00 ","$2,325.15 ","$0.00 ","$1,076.93 ","$0.00 ","$0.00 ","$904.70 ","$5,167.00 ","$0.00 ","$2,583.50 ","$4,092.26 ","$4,133.60 ","$0.00 ","$808.64 ","$0.00 ","$822.59 ","$0.00 "
"6630-8-065","SUP","HCPCS C1776","","6630-8-065  -  CMPNT FEM XL LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-070","SUP","HCPCS C1776","","6630-8-070  -  CMPNT FEM XL RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-075","SUP","HCPCS C1776","","6630-8-075  -  CMPNT FEM 2XL LEFT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"6630-8-080","SUP","HCPCS C1776","","6630-8-080  -  CMPNT FEM 2XL RIGHT KNEE BEADED DRCN PERIAPT","BOTH IP/OP","$5,209.00 ","$3,854.66 ","$0.00 ","$5,209.00 ","$2,344.05 ","$0.00 ","$1,085.69 ","$0.00 ","$0.00 ","$912.05 ","$5,209.00 ","$0.00 ","$2,604.50 ","$4,125.53 ","$4,167.20 ","$0.00 ","$815.21 ","$0.00 ","$829.27 ","$0.00 "
"663-10-28C","SUP","Custom 27803010","","663-10-28C  -  INSERT ACETAB 10D C ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28D","SUP","Custom 27803010","","663-10-28D  -  INSERT ACETAB 10D D ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28E","SUP","Custom 27803010","","663-10-28E  -  INSERT ACETAB 10D E ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28F","SUP","Custom 27803010","","663-10-28F  -  INSERT ACETAB 10D F ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28G","SUP","Custom 27803010","","663-10-28G  -  INSERT ACETAB 10D G ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28H","SUP","Custom 27803010","","663-10-28H  -  INSERT ACETAB 10D H ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28I","SUP","Custom 27803010","","663-10-28I  -  INSERT ACETAB 10D I ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-28J","SUP","Custom 27803010","","663-10-28J  -  INSERT ACETAB 10D J ECCENTRIC 28MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32D","SUP","Custom 27803010","","663-10-32D  -  INSERT ACETAB 10D D ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32E","SUP","Custom 27803010","","663-10-32E  -  INSERT ACETAB 10D E ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32F","SUP","Custom 27803010","","663-10-32F  -  INSERT ACETAB 10D F ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32G","SUP","Custom 27803010","","663-10-32G  -  INSERT ACETAB 10D G ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32H","SUP","Custom 27803010","","663-10-32H  -  INSERT ACETAB 10D H ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32I","SUP","Custom 27803010","","663-10-32I  -  INSERT ACETAB 10D I ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-32J","SUP","Custom 27803010","","663-10-32J  -  INSERT ACETAB 10D J ECCENTRIC 32MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-36E","SUP","Custom 27803010","","663-10-36E  -  INSERT ACETAB 10D E ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-36F","SUP","Custom 27803010","","663-10-36F  -  INSERT ACETAB 10D F ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-36G","SUP","Custom 27803010","","663-10-36G  -  INSERT ACETAB 10D G ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-36H","SUP","Custom 27803010","","663-10-36H  -  INSERT ACETAB 10D H ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-36I","SUP","Custom 27803010","","663-10-36I  -  INSERT ACETAB 10D I ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"663-10-36J","SUP","Custom 27803010","","663-10-36J  -  INSERT ACETAB 10D J ECCENTRIC 36MM TRIDENT X3 HIP","BOTH IP/OP","$1,440.00 ","$1,065.60 ","$0.00 ","$1,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,440.00 ","$0.00 ","$720.00 ","$1,140.48 ","$1,152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-0-208","SUP","Custom 27803010","","6632-0-208  -  STAB SURG XS DRCN POR CMNT MONO FEM LEFT","BOTH IP/OP","$5,490.00 ","$4,062.60 ","$0.00 ","$5,490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,490.00 ","$0.00 ","$2,745.00 ","$4,348.08 ","$4,392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-0-210","SUP","HCPCS C1776","","6632-0-210  -  CMPNT FEM SM LEFT KNEE BEADED STAB MDLR DRCN","BOTH IP/OP","$7,057.38 ","$5,222.46 ","$0.00 ","$7,057.38 ","$3,175.82 ","$0.00 ","$1,470.93 ","$0.00 ","$0.00 ","$1,235.69 ","$7,057.38 ","$0.00 ","$3,528.69 ","$5,589.44 ","$5,645.90 ","$0.00 ","$1,104.48 ","$0.00 ","$1,123.53 ","$0.00 "
"6632-0-215","SUP","HCPCS C1776","","6632-0-215  -  CMPNT FEM SM LEFT MDLR NBD ASYM DRCN NONSTRL","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-218","SUP","HCPCS C1776","","6632-0-218  -  CMPNT FEM XS RIGHT KNEE CMNT MONO STAB DRCN POR","BOTH IP/OP","$5,490.00 ","$4,062.60 ","$0.00 ","$5,490.00 ","$2,470.50 ","$0.00 ","$1,144.25 ","$0.00 ","$0.00 ","$961.26 ","$5,490.00 ","$0.00 ","$2,745.00 ","$4,348.08 ","$4,392.00 ","$0.00 ","$859.19 ","$0.00 ","$874.01 ","$0.00 "
"6632-0-220","SUP","HCPCS C1776","","6632-0-220  -  CMPNT FEM SM RIGHT KNEE CRUC RET MDLR BEADED ASMBLY DRCN","BOTH IP/OP","$7,057.38 ","$5,222.46 ","$0.00 ","$7,057.38 ","$3,175.82 ","$0.00 ","$1,470.93 ","$0.00 ","$0.00 ","$1,235.69 ","$7,057.38 ","$0.00 ","$3,528.69 ","$5,589.44 ","$5,645.90 ","$0.00 ","$1,104.48 ","$0.00 ","$1,123.53 ","$0.00 "
"6632-0-225","SUP","HCPCS C1776","","6632-0-225  -  CMPNT FEM SM RIGHT KNEE CRUC RET MDLR NBD ASMBLY DRCN","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-310","SUP","HCPCS C1776","","6632-0-310  -  CMPNT FEM MED LEFT KNEE CRUC RET MDLR BEADED ASMBLY DRCN","BOTH IP/OP","$7,057.38 ","$5,222.46 ","$0.00 ","$7,057.38 ","$3,175.82 ","$0.00 ","$1,470.93 ","$0.00 ","$0.00 ","$1,235.69 ","$7,057.38 ","$0.00 ","$3,528.69 ","$5,589.44 ","$5,645.90 ","$0.00 ","$1,104.48 ","$0.00 ","$1,123.53 ","$0.00 "
"6632-0-315","SUP","HCPCS C1776","","6632-0-315  -  CMPNT FEM MED LEFT MDLR NBD ASYM DRCN NONSTRL","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-317","SUP","HCPCS C1776","","6632-0-317  -  CMPNT FEM MED NTRL LEFT KNEE CRUC RET NBD MDLR STAB ASMBLY","BOTH IP/OP","$3,314.00 ","$2,452.36 ","$0.00 ","$3,314.00 ","$1,491.30 ","$0.00 ","$690.72 ","$0.00 ","$0.00 ","$580.25 ","$3,314.00 ","$0.00 ","$1,657.00 ","$2,624.69 ","$2,651.20 ","$0.00 ","$518.64 ","$0.00 ","$527.59 ","$0.00 "
"6632-0-325","SUP","HCPCS C1776","","6632-0-325  -  STEM FEM NBD ASY DRCN MED RIGHT NONSTRL","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-327","SUP","HCPCS C1776","","6632-0-327  -  CMPNT FEM MED NTRL RIGHT KNEE CRUC RET NBD MDLR STAB ASMBLY","BOTH IP/OP","$3,314.00 ","$2,452.36 ","$0.00 ","$3,314.00 ","$1,491.30 ","$0.00 ","$690.72 ","$0.00 ","$0.00 ","$580.25 ","$3,314.00 ","$0.00 ","$1,657.00 ","$2,624.69 ","$2,651.20 ","$0.00 ","$518.64 ","$0.00 ","$527.59 ","$0.00 "
"6632-0-410","SUP","HCPCS C1776","","6632-0-410  -  CMPNT FEM MED LG LEFT KNEE CRUC RET MDLR BEADED ASMBLY DRCN","BOTH IP/OP","$7,057.38 ","$5,222.46 ","$0.00 ","$7,057.38 ","$3,175.82 ","$0.00 ","$1,470.93 ","$0.00 ","$0.00 ","$1,235.69 ","$7,057.38 ","$0.00 ","$3,528.69 ","$5,589.44 ","$5,645.90 ","$0.00 ","$1,104.48 ","$0.00 ","$1,123.53 ","$0.00 "
"6632-0-415","SUP","HCPCS C1776","","6632-0-415  -  CMPNT FEM MED LG LEFT KNEE CRUC RET MDLR NBD ASMBLY DRCN","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-425","SUP","HCPCS C1776","","6632-0-425  -  CMPNT FEM MED LG RIGHT MDLR NBD ASMBLY DRCN","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-515","SUP","HCPCS C1776","","6632-0-515  -  CMPNT FEM LG LEFT KNEE NBD ASMBLY MDLR DRCN NPOR","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-525","SUP","HCPCS C1776","","6632-0-525  -  CMPNT FEM LG RIGHT NBD MDLR ASMBLY DRCN","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-610","SUP","HCPCS C1776","","6632-0-610  -  CMPNT FEM XL LEFT BEADED MDLR ASMBLY DRCN","BOTH IP/OP","$7,192.25 ","$5,322.27 ","$0.00 ","$7,192.25 ","$3,236.51 ","$0.00 ","$1,499.04 ","$0.00 ","$0.00 ","$1,259.31 ","$7,192.25 ","$0.00 ","$3,596.13 ","$5,696.26 ","$5,753.80 ","$0.00 ","$1,125.59 ","$0.00 ","$1,145.01 ","$0.00 "
"6632-0-615","SUP","HCPCS C1776","","6632-0-615  -  CMPNT FEM XL LEFT MDLR NBD ASMBLY DRCN","BOTH IP/OP","$3,499.00 ","$2,589.26 ","$0.00 ","$3,499.00 ","$1,574.55 ","$0.00 ","$729.28 ","$0.00 ","$0.00 ","$612.65 ","$3,499.00 ","$0.00 ","$1,749.50 ","$2,771.21 ","$2,799.20 ","$0.00 ","$547.59 ","$0.00 ","$557.04 ","$0.00 "
"6632-0-620","SUP","HCPCS C1776","","6632-0-620  -  CMPNT FEM XL RIGHT BEADED MDLR ASMBLY DRCN","BOTH IP/OP","$7,192.25 ","$5,322.27 ","$0.00 ","$7,192.25 ","$3,236.51 ","$0.00 ","$1,499.04 ","$0.00 ","$0.00 ","$1,259.31 ","$7,192.25 ","$0.00 ","$3,596.13 ","$5,696.26 ","$5,753.80 ","$0.00 ","$1,125.59 ","$0.00 ","$1,145.01 ","$0.00 "
"6632-0-625","SUP","HCPCS C1776","","6632-0-625  -  CMPNT FEM XL RIGHT KNEE CRUC RET NBD MDLR DRCN","BOTH IP/OP","$3,499.00 ","$2,589.26 ","$0.00 ","$3,499.00 ","$1,574.55 ","$0.00 ","$729.28 ","$0.00 ","$0.00 ","$612.65 ","$3,499.00 ","$0.00 ","$1,749.50 ","$2,771.21 ","$2,799.20 ","$0.00 ","$547.59 ","$0.00 ","$557.04 ","$0.00 "
"6632-0-710","SUP","HCPCS C1776","","6632-0-710  -  CMPNT FEM 2XL LEFT KNEE CRUC RET BEADED MDLR DRCN","BOTH IP/OP","$7,192.25 ","$5,322.27 ","$0.00 ","$7,192.25 ","$3,236.51 ","$0.00 ","$1,499.04 ","$0.00 ","$0.00 ","$1,259.31 ","$7,192.25 ","$0.00 ","$3,596.13 ","$5,696.26 ","$5,753.80 ","$0.00 ","$1,125.59 ","$0.00 ","$1,145.01 ","$0.00 "
"6632-0-715","SUP","HCPCS C1776","","6632-0-715  -  CMPNT FEM 2XL LEFT KNEE NBD ASMBLY MDLR DRCN NPOR","BOTH IP/OP","$3,499.00 ","$2,589.26 ","$0.00 ","$3,499.00 ","$1,574.55 ","$0.00 ","$729.28 ","$0.00 ","$0.00 ","$612.65 ","$3,499.00 ","$0.00 ","$1,749.50 ","$2,771.21 ","$2,799.20 ","$0.00 ","$547.59 ","$0.00 ","$557.04 ","$0.00 "
"6632-0-720","SUP","HCPCS C1776","","6632-0-720  -  CMPNT FEM 2XL RIGHT BEADED MDLR ASMBLY DRCN","BOTH IP/OP","$7,192.25 ","$5,322.27 ","$0.00 ","$7,192.25 ","$3,236.51 ","$0.00 ","$1,499.04 ","$0.00 ","$0.00 ","$1,259.31 ","$7,192.25 ","$0.00 ","$3,596.13 ","$5,696.26 ","$5,753.80 ","$0.00 ","$1,125.59 ","$0.00 ","$1,145.01 ","$0.00 "
"6632-0-725","SUP","HCPCS C1776","","6632-0-725  -  CMPNT FEM 2XL RIGHT KNEE NBD ASMBLY MDLR DRCN NPOR","BOTH IP/OP","$3,499.00 ","$2,589.26 ","$0.00 ","$3,499.00 ","$1,574.55 ","$0.00 ","$729.28 ","$0.00 ","$0.00 ","$612.65 ","$3,499.00 ","$0.00 ","$1,749.50 ","$2,771.21 ","$2,799.20 ","$0.00 ","$547.59 ","$0.00 ","$557.04 ","$0.00 "
"6632-0-750","SUP","HCPCS C1713","","6632-0-750  -  PEG FIX FEM MDLR REPL","BOTH IP/OP","$524.00 ","$387.76 ","$0.00 ","$524.00 ","$235.80 ","$0.00 ","$109.21 ","$0.00 ","$0.00 ","$91.75 ","$524.00 ","$0.00 ","$262.00 ","$415.01 ","$419.20 ","$0.00 ","$82.01 ","$0.00 ","$83.42 ","$0.00 "
"6632-0-810","SUP","HCPCS C1776","","6632-0-810  -  CMPNT FEM SM LEFT MNLTH STAB DRCN","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-811","SUP","HCPCS C1776","","6632-0-811  -  CMPNT FEM SM LEFT KNEE CMNT MNLTH STAB DRCN VIT","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-815","SUP","HCPCS C1776","","6632-0-815  -  CMPNT FEM SM RIGHT MNLTH STAB DRCN VIT","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-820","SUP","HCPCS C1776","","6632-0-820  -  CMPNT FEM MED LEFT MONOLITHIX STAB DRCN","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-821","SUP","HCPCS C1776","","6632-0-821  -  CMPNT FEM MED LEFT KNEE CMNT MNLTH STAB DRCN VIT","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-825","SUP","HCPCS C1776","","6632-0-825  -  COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-826","SUP","HCPCS C1776","","6632-0-826  -  COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-830","SUP","HCPCS C1776","","6632-0-830  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-831","SUP","HCPCS C1776","","6632-0-831  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-835","SUP","HCPCS C1776","","6632-0-835  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-836","SUP","HCPCS C1776","","6632-0-836  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT","BOTH IP/OP","$3,437.00 ","$2,543.38 ","$0.00 ","$3,437.00 ","$1,546.65 ","$0.00 ","$716.36 ","$0.00 ","$0.00 ","$601.79 ","$3,437.00 ","$0.00 ","$1,718.50 ","$2,722.10 ","$2,749.60 ","$0.00 ","$537.89 ","$0.00 ","$547.17 ","$0.00 "
"6632-0-840","SUP","HCPCS C1776","","6632-0-840  -  CMPNT FEM LG LEFT MNLTH STAB DRCN VIT","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-845","SUP","HCPCS C1776","","6632-0-845  -  CMPNT FEM LG RIGHT MNLTH STAB DRCN","BOTH IP/OP","$3,869.00 ","$2,863.06 ","$0.00 ","$3,869.00 ","$1,741.05 ","$0.00 ","$806.40 ","$0.00 ","$0.00 ","$677.43 ","$3,869.00 ","$0.00 ","$1,934.50 ","$3,064.25 ","$3,095.20 ","$0.00 ","$605.50 ","$0.00 ","$615.94 ","$0.00 "
"6632-0-855","SUP","HCPCS C1776","","6632-0-855  -  STAB FEM DRCN XL RIGHT MONO","BOTH IP/OP","$3,941.00 ","$2,916.34 ","$0.00 ","$3,941.00 ","$1,773.45 ","$0.00 ","$821.40 ","$0.00 ","$0.00 ","$690.04 ","$3,941.00 ","$0.00 ","$1,970.50 ","$3,121.27 ","$3,152.80 ","$0.00 ","$616.77 ","$0.00 ","$627.41 ","$0.00 "
"6632-0-860","SUP","HCPCS C1776","","6632-0-860  -  CMPNT FEM 2XL LEFT MNLTH STAB DRCN BLK","BOTH IP/OP","$3,941.00 ","$2,916.34 ","$0.00 ","$3,941.00 ","$1,773.45 ","$0.00 ","$821.40 ","$0.00 ","$0.00 ","$690.04 ","$3,941.00 ","$0.00 ","$1,970.50 ","$3,121.27 ","$3,152.80 ","$0.00 ","$616.77 ","$0.00 ","$627.41 ","$0.00 "
"6632-0-865","SUP","HCPCS C1776","","6632-0-865  -  CMPNT FEM 2XL RIGHT MNLTH STAB DRCN","BOTH IP/OP","$3,941.00 ","$2,916.34 ","$0.00 ","$3,941.00 ","$1,773.45 ","$0.00 ","$821.40 ","$0.00 ","$0.00 ","$690.04 ","$3,941.00 ","$0.00 ","$1,970.50 ","$3,121.27 ","$3,152.80 ","$0.00 ","$616.77 ","$0.00 ","$627.41 ","$0.00 "
"6632-3-301","SUP","HCPCS C1776","","6632-3-301  -  BSPLT TIB DRCN XS1 BEADED CRCIFRM NPOR","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$1,300.95 ","$0.00 ","$602.56 ","$0.00 ","$0.00 ","$506.19 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$452.44 ","$0.00 ","$460.25 ","$0.00 "
"6632-3-303","SUP","HCPCS C1776","","6632-3-303  -  BSPLT TIB DRCN 2 XS KNEE CRCIFRM BEADED POR","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$1,300.95 ","$0.00 ","$602.56 ","$0.00 ","$0.00 ","$506.19 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$452.44 ","$0.00 ","$460.25 ","$0.00 "
"6632-3-305","SUP","HCPCS C1776","","6632-3-305  -  BSPLT TIB DRCN 1 SM CRCIFRM BSPLT POR","BOTH IP/OP","$2,838.00 ","$2,100.12 ","$0.00 ","$2,838.00 ","$1,277.10 ","$0.00 ","$591.51 ","$0.00 ","$0.00 ","$496.91 ","$2,838.00 ","$0.00 ","$1,419.00 ","$2,247.70 ","$2,270.40 ","$0.00 ","$444.15 ","$0.00 ","$451.81 ","$0.00 "
"6632-3-310","SUP","HCPCS C1776","","6632-3-310  -  BSPLT TIB DRCN 2 SM KNEE BEADED CRCIFRM POR","BOTH IP/OP","$2,838.00 ","$2,100.12 ","$0.00 ","$2,838.00 ","$1,277.10 ","$0.00 ","$591.51 ","$0.00 ","$0.00 ","$496.91 ","$2,838.00 ","$0.00 ","$1,419.00 ","$2,247.70 ","$2,270.40 ","$0.00 ","$444.15 ","$0.00 ","$451.81 ","$0.00 "
"6632-3-315","SUP","HCPCS C1776","","6632-3-315  -  BSPLT TIB DRCN 1 MED KNEE BEADED CRCIFRM POR","BOTH IP/OP","$2,838.00 ","$2,100.12 ","$0.00 ","$2,838.00 ","$1,277.10 ","$0.00 ","$591.51 ","$0.00 ","$0.00 ","$496.91 ","$2,838.00 ","$0.00 ","$1,419.00 ","$2,247.70 ","$2,270.40 ","$0.00 ","$444.15 ","$0.00 ","$451.81 ","$0.00 "
"6632-3-320","SUP","HCPCS C1776","","6632-3-320  -  BSPLT TIB DRCN 2 MED KNEE CRCIFRM POR","BOTH IP/OP","$2,838.00 ","$2,100.12 ","$0.00 ","$2,838.00 ","$1,277.10 ","$0.00 ","$591.51 ","$0.00 ","$0.00 ","$496.91 ","$2,838.00 ","$0.00 ","$1,419.00 ","$2,247.70 ","$2,270.40 ","$0.00 ","$444.15 ","$0.00 ","$451.81 ","$0.00 "
"6632-3-325","SUP","HCPCS C1776","","6632-3-325  -  BSPLT TIB DRCN 1 LG KNEE BEADED CRCIFRM POR","BOTH IP/OP","$2,838.00 ","$2,100.12 ","$0.00 ","$2,838.00 ","$1,277.10 ","$0.00 ","$591.51 ","$0.00 ","$0.00 ","$496.91 ","$2,838.00 ","$0.00 ","$1,419.00 ","$2,247.70 ","$2,270.40 ","$0.00 ","$444.15 ","$0.00 ","$451.81 ","$0.00 "
"6632-3-330","SUP","HCPCS C1776","","6632-3-330  -  BSPLT TIB DRCN 2 LG KNEE BEADED CRCIFRM POR","BOTH IP/OP","$2,838.00 ","$2,100.12 ","$0.00 ","$2,838.00 ","$1,277.10 ","$0.00 ","$591.51 ","$0.00 ","$0.00 ","$496.91 ","$2,838.00 ","$0.00 ","$1,419.00 ","$2,247.70 ","$2,270.40 ","$0.00 ","$444.15 ","$0.00 ","$451.81 ","$0.00 "
"6632-3-335","SUP","HCPCS C1776","","6632-3-335  -  BSPLT TIB DRCN 1 XL KNEE BEADED CRCIFRM POR","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$1,300.95 ","$0.00 ","$602.56 ","$0.00 ","$0.00 ","$506.19 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$452.44 ","$0.00 ","$460.25 ","$0.00 "
"6632-3-340","SUP","HCPCS C1776","","6632-3-340  -  BSPLT TIB DRCN 2 XL KNEE BEADED CRCIFRM POR","BOTH IP/OP","$2,891.00 ","$2,139.34 ","$0.00 ","$2,891.00 ","$1,300.95 ","$0.00 ","$602.56 ","$0.00 ","$0.00 ","$506.19 ","$2,891.00 ","$0.00 ","$1,445.50 ","$2,289.67 ","$2,312.80 ","$0.00 ","$452.44 ","$0.00 ","$460.25 ","$0.00 "
"6632-3-401","SUP","HCPCS C1776","","6632-3-401  -  BSPLT TIB DRCN 1 XS NBD CRCIFRM","BOTH IP/OP","$1,918.00 ","$1,419.32 ","$0.00 ","$1,918.00 ","$863.10 ","$0.00 ","$399.76 ","$0.00 ","$0.00 ","$335.83 ","$1,918.00 ","$0.00 ","$959.00 ","$1,519.06 ","$1,534.40 ","$0.00 ","$300.17 ","$0.00 ","$305.35 ","$0.00 "
"6632-3-403","SUP","HCPCS C1776","","6632-3-403  -  BSPLT TIB DRCN 2 XS NBD CRCIFRM","BOTH IP/OP","$2,149.00 ","$1,590.26 ","$0.00 ","$2,149.00 ","$967.05 ","$0.00 ","$447.91 ","$0.00 ","$0.00 ","$376.27 ","$2,149.00 ","$0.00 ","$1,074.50 ","$1,702.01 ","$1,719.20 ","$0.00 ","$336.32 ","$0.00 ","$342.12 ","$0.00 "
"6632-3-405","SUP","HCPCS C1776","","6632-3-405  -  BSPLT TIB DRCN S1 NBD CRCIFRM NPOR","BOTH IP/OP","$2,167.00 ","$1,603.58 ","$0.00 ","$2,167.00 ","$975.15 ","$0.00 ","$451.66 ","$0.00 ","$0.00 ","$379.42 ","$2,167.00 ","$0.00 ","$1,083.50 ","$1,716.26 ","$1,733.60 ","$0.00 ","$339.14 ","$0.00 ","$344.99 ","$0.00 "
"6632-3-410","SUP","HCPCS C1776","","6632-3-410  -  BSPLT TIB DRCN S2 NBD CRCIFRM NPOR","BOTH IP/OP","$2,167.00 ","$1,603.58 ","$0.00 ","$2,167.00 ","$975.15 ","$0.00 ","$451.66 ","$0.00 ","$0.00 ","$379.42 ","$2,167.00 ","$0.00 ","$1,083.50 ","$1,716.26 ","$1,733.60 ","$0.00 ","$339.14 ","$0.00 ","$344.99 ","$0.00 "
"6632-3-415","SUP","HCPCS C1776","","6632-3-415  -  BSPLT TIB DRCN M1 NBD CRCIFRM NPOR","BOTH IP/OP","$2,131.00 ","$1,576.94 ","$0.00 ","$2,131.00 ","$958.95 ","$0.00 ","$444.15 ","$0.00 ","$0.00 ","$373.12 ","$2,131.00 ","$0.00 ","$1,065.50 ","$1,687.75 ","$1,704.80 ","$0.00 ","$333.50 ","$0.00 ","$339.26 ","$0.00 "
"6632-3-420","SUP","HCPCS C1776","","6632-3-420  -  BSPLT TIB DRCN M2 NBD CRCIFRM NPOR","BOTH IP/OP","$2,131.00 ","$1,576.94 ","$0.00 ","$2,131.00 ","$958.95 ","$0.00 ","$444.15 ","$0.00 ","$0.00 ","$373.12 ","$2,131.00 ","$0.00 ","$1,065.50 ","$1,687.75 ","$1,704.80 ","$0.00 ","$333.50 ","$0.00 ","$339.26 ","$0.00 "
"6632-3-425","SUP","HCPCS C1776","","6632-3-425  -  BSPLT TIB DRCN 1 NBD CRCIFRM NPOR","BOTH IP/OP","$2,131.00 ","$1,576.94 ","$0.00 ","$2,131.00 ","$958.95 ","$0.00 ","$444.15 ","$0.00 ","$0.00 ","$373.12 ","$2,131.00 ","$0.00 ","$1,065.50 ","$1,687.75 ","$1,704.80 ","$0.00 ","$333.50 ","$0.00 ","$339.26 ","$0.00 "
"6632-3-430","SUP","HCPCS C1776","","6632-3-430  -  BSPLT TIB DRCN 2 NBD CRCIFRM NPOR","BOTH IP/OP","$2,131.00 ","$1,576.94 ","$0.00 ","$2,131.00 ","$958.95 ","$0.00 ","$444.15 ","$0.00 ","$0.00 ","$373.12 ","$2,131.00 ","$0.00 ","$1,065.50 ","$1,687.75 ","$1,704.80 ","$0.00 ","$333.50 ","$0.00 ","$339.26 ","$0.00 "
"6632-3-435","SUP","HCPCS C1776","","6632-3-435  -  BSPLT TIB DRCN X1 NBD CRCIFRM NPOR","BOTH IP/OP","$2,167.00 ","$1,603.58 ","$0.00 ","$2,167.00 ","$975.15 ","$0.00 ","$451.66 ","$0.00 ","$0.00 ","$379.42 ","$2,167.00 ","$0.00 ","$1,083.50 ","$1,716.26 ","$1,733.60 ","$0.00 ","$339.14 ","$0.00 ","$344.99 ","$0.00 "
"6632-3-440","SUP","HCPCS C1776","","6632-3-440  -  BSPLT TIB DRCN 2 XL KNEE NBD CRCIFRM NPOR","BOTH IP/OP","$2,167.00 ","$1,603.58 ","$0.00 ","$2,167.00 ","$975.15 ","$0.00 ","$451.66 ","$0.00 ","$0.00 ","$379.42 ","$2,167.00 ","$0.00 ","$1,083.50 ","$1,716.26 ","$1,733.60 ","$0.00 ","$339.14 ","$0.00 ","$344.99 ","$0.00 "
"6632-3-505","SUP","HCPCS C1776","","6632-3-505  -  BSPLT TIB DRCN 1 SM KNEE BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,355.00 ","$2,482.70 ","$0.00 ","$3,355.00 ","$1,509.75 ","$0.00 ","$699.27 ","$0.00 ","$0.00 ","$587.43 ","$3,355.00 ","$0.00 ","$1,677.50 ","$2,657.16 ","$2,684.00 ","$0.00 ","$525.06 ","$0.00 ","$534.12 ","$0.00 "
"6632-3-510","SUP","HCPCS C1776","","6632-3-510  -  BSPLT TIB DRCN S2 BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,355.00 ","$2,482.70 ","$0.00 ","$3,355.00 ","$1,509.75 ","$0.00 ","$699.27 ","$0.00 ","$0.00 ","$587.43 ","$3,355.00 ","$0.00 ","$1,677.50 ","$2,657.16 ","$2,684.00 ","$0.00 ","$525.06 ","$0.00 ","$534.12 ","$0.00 "
"6632-3-515","SUP","HCPCS C1776","","6632-3-515  -  BSPLT TIB DRCN M1 BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,339.00 ","$2,470.86 ","$0.00 ","$3,339.00 ","$1,502.55 ","$0.00 ","$695.93 ","$0.00 ","$0.00 ","$584.63 ","$3,339.00 ","$0.00 ","$1,669.50 ","$2,644.49 ","$2,671.20 ","$0.00 ","$522.55 ","$0.00 ","$531.57 ","$0.00 "
"6632-3-520","SUP","HCPCS C1776","","6632-3-520  -  BSPLT TIB DRCN M2 BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,339.00 ","$2,470.86 ","$0.00 ","$3,339.00 ","$1,502.55 ","$0.00 ","$695.93 ","$0.00 ","$0.00 ","$584.63 ","$3,339.00 ","$0.00 ","$1,669.50 ","$2,644.49 ","$2,671.20 ","$0.00 ","$522.55 ","$0.00 ","$531.57 ","$0.00 "
"6632-3-525","SUP","HCPCS C1776","","6632-3-525  -  BSPLT TIB DRCN 1 LG KNEE BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,339.00 ","$2,470.86 ","$0.00 ","$3,339.00 ","$1,502.55 ","$0.00 ","$695.93 ","$0.00 ","$0.00 ","$584.63 ","$3,339.00 ","$0.00 ","$1,669.50 ","$2,644.49 ","$2,671.20 ","$0.00 ","$522.55 ","$0.00 ","$531.57 ","$0.00 "
"6632-3-530","SUP","HCPCS C1776","","6632-3-530  -  BSPLT TIB DRCN 2 LG KNEE BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,339.00 ","$2,470.86 ","$0.00 ","$3,339.00 ","$1,502.55 ","$0.00 ","$695.93 ","$0.00 ","$0.00 ","$584.63 ","$3,339.00 ","$0.00 ","$1,669.50 ","$2,644.49 ","$2,671.20 ","$0.00 ","$522.55 ","$0.00 ","$531.57 ","$0.00 "
"6632-3-535","SUP","HCPCS C1776","","6632-3-535  -  BSPLT TIB DRCN 1 XL KNEE BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,355.00 ","$2,482.70 ","$0.00 ","$3,355.00 ","$1,509.75 ","$0.00 ","$699.27 ","$0.00 ","$0.00 ","$587.43 ","$3,355.00 ","$0.00 ","$1,677.50 ","$2,657.16 ","$2,684.00 ","$0.00 ","$525.06 ","$0.00 ","$534.12 ","$0.00 "
"6632-3-540","SUP","HCPCS C1776","","6632-3-540  -  BSPLT TIB DRCN 2 XL KNEE BEADED CRCIFRM PERIAPT","BOTH IP/OP","$3,355.00 ","$2,482.70 ","$0.00 ","$3,355.00 ","$1,509.75 ","$0.00 ","$699.27 ","$0.00 ","$0.00 ","$587.43 ","$3,355.00 ","$0.00 ","$1,677.50 ","$2,657.16 ","$2,684.00 ","$0.00 ","$525.06 ","$0.00 ","$534.12 ","$0.00 "
"6632-3-603","SUP","HCPCS C1776","","6632-3-603  -  BSPLT TIB DRCN 1 MED UNV KNEE NBD CRCIFRM NPOR","BOTH IP/OP","$2,169.00 ","$1,605.06 ","$0.00 ","$2,169.00 ","$976.05 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$379.77 ","$2,169.00 ","$0.00 ","$1,084.50 ","$1,717.85 ","$1,735.20 ","$0.00 ","$339.45 ","$0.00 ","$345.30 ","$0.00 "
"6632-3-605","SUP","HCPCS C1776","","6632-3-605  -  BSPLT TIB DRCN S1 UNV NBD CRCIFRM NPOR","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"6632-3-610","SUP","HCPCS C1776","","6632-3-610  -  BSPLT TIB DRCN S2 NBD CRCIFRM NPOR","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"6632-3-615","SUP","HCPCS C1776","","6632-3-615  -  BSPLT TIB M1 NPOR HWMDC","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"6632-3-620","SUP","HCPCS C1776","","6632-3-620  -  BSPLT TIB DRCN 2 MED UNV KNEE NBD CRCIFRM NPOR","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"6632-3-625","SUP","HCPCS C1776","","6632-3-625  -  BSPLT TIB DRCN 1 NBD CRCIFRM NPOR","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"6632-3-630","SUP","HCPCS C1776","","6632-3-630  -  BSPLT TIB DRCN 2 LG UNV KNEE NBD CRCIFRM NPOR","BOTH IP/OP","$2,130.00 ","$1,576.20 ","$0.00 ","$2,130.00 ","$958.50 ","$0.00 ","$443.95 ","$0.00 ","$0.00 ","$372.95 ","$2,130.00 ","$0.00 ","$1,065.00 ","$1,686.96 ","$1,704.00 ","$0.00 ","$333.35 ","$0.00 ","$339.10 ","$0.00 "
"6632-3-635","SUP","HCPCS C1776","","6632-3-635  -  BSPLT TIB DRCN 1 XL UNV KNEE NBD CRCIFRM NPOR","BOTH IP/OP","$2,169.00 ","$1,605.06 ","$0.00 ","$2,169.00 ","$976.05 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$379.77 ","$2,169.00 ","$0.00 ","$1,084.50 ","$1,717.85 ","$1,735.20 ","$0.00 ","$339.45 ","$0.00 ","$345.30 ","$0.00 "
"6632-3-640","SUP","HCPCS C1776","","6632-3-640  -  BSPLT TIB DRCN X2 NBD CRCIFRM NPOR","BOTH IP/OP","$2,169.00 ","$1,605.06 ","$0.00 ","$2,169.00 ","$976.05 ","$0.00 ","$452.07 ","$0.00 ","$0.00 ","$379.77 ","$2,169.00 ","$0.00 ","$1,084.50 ","$1,717.85 ","$1,735.20 ","$0.00 ","$339.45 ","$0.00 ","$345.30 ","$0.00 "
"6632-3-701","SUP","HCPCS C1776","","6632-3-701  -  BSPLT TIB DRCN XS1 UNV KNEE BEADED POR 62X37MM","BOTH IP/OP","$2,919.00 ","$2,160.06 ","$0.00 ","$2,919.00 ","$1,313.55 ","$0.00 ","$608.39 ","$0.00 ","$0.00 ","$511.09 ","$2,919.00 ","$0.00 ","$1,459.50 ","$2,311.85 ","$2,335.20 ","$0.00 ","$456.82 ","$0.00 ","$464.70 ","$0.00 "
"6632-3-703","SUP","HCPCS C1776","","6632-3-703  -  BSPLT TIB DRCN XS2 UNV KNEE BEADED POR 64X39MM","BOTH IP/OP","$2,919.00 ","$2,160.06 ","$0.00 ","$2,919.00 ","$1,313.55 ","$0.00 ","$608.39 ","$0.00 ","$0.00 ","$511.09 ","$2,919.00 ","$0.00 ","$1,459.50 ","$2,311.85 ","$2,335.20 ","$0.00 ","$456.82 ","$0.00 ","$464.70 ","$0.00 "
"6632-3-705","SUP","HCPCS C1776","","6632-3-705  -  BSPLT TIB DRCN S1 UNV KNEE BEADED POR 67X42MM","BOTH IP/OP","$2,865.00 ","$2,120.10 ","$0.00 ","$2,865.00 ","$1,289.25 ","$0.00 ","$597.14 ","$0.00 ","$0.00 ","$501.64 ","$2,865.00 ","$0.00 ","$1,432.50 ","$2,269.08 ","$2,292.00 ","$0.00 ","$448.37 ","$0.00 ","$456.11 ","$0.00 "
"6632-3-710","SUP","HCPCS C1776","","6632-3-710  -  BSPLT TIB DRCN S2 UNV KNEE BEADED POR 69X45MM","BOTH IP/OP","$2,865.00 ","$2,120.10 ","$0.00 ","$2,865.00 ","$1,289.25 ","$0.00 ","$597.14 ","$0.00 ","$0.00 ","$501.64 ","$2,865.00 ","$0.00 ","$1,432.50 ","$2,269.08 ","$2,292.00 ","$0.00 ","$448.37 ","$0.00 ","$456.11 ","$0.00 "
"6632-3-715","SUP","HCPCS C1776","","6632-3-715  -  BSPLT TIB DRCN M1 UNV KNEE BEADED POR 72X48MM","BOTH IP/OP","$2,865.00 ","$2,120.10 ","$0.00 ","$2,865.00 ","$1,289.25 ","$0.00 ","$597.14 ","$0.00 ","$0.00 ","$501.64 ","$2,865.00 ","$0.00 ","$1,432.50 ","$2,269.08 ","$2,292.00 ","$0.00 ","$448.37 ","$0.00 ","$456.11 ","$0.00 "
"6632-3-720","SUP","HCPCS C1776","","6632-3-720  -  BSPLT TIB DRCN M2 BEADED CRCIFRM NPOR","BOTH IP/OP","$2,865.00 ","$2,120.10 ","$0.00 ","$2,865.00 ","$1,289.25 ","$0.00 ","$597.14 ","$0.00 ","$0.00 ","$501.64 ","$2,865.00 ","$0.00 ","$1,432.50 ","$2,269.08 ","$2,292.00 ","$0.00 ","$448.37 ","$0.00 ","$456.11 ","$0.00 "
"6632-3-725","SUP","HCPCS C1776","","6632-3-725  -  BSPLT TIB DRCN UNV KNEE SCR POR 77X53MM HWMDC X 1","BOTH IP/OP","$2,865.00 ","$2,120.10 ","$0.00 ","$2,865.00 ","$1,289.25 ","$0.00 ","$597.14 ","$0.00 ","$0.00 ","$501.64 ","$2,865.00 ","$0.00 ","$1,432.50 ","$2,269.08 ","$2,292.00 ","$0.00 ","$448.37 ","$0.00 ","$456.11 ","$0.00 "
"6632-3-730","SUP","HCPCS C1776","","6632-3-730  -  BSPLT TIB DRCN X2 UNV KNEE SCR FIX POR 79X55MM","BOTH IP/OP","$2,865.00 ","$2,120.10 ","$0.00 ","$2,865.00 ","$1,289.25 ","$0.00 ","$597.14 ","$0.00 ","$0.00 ","$501.64 ","$2,865.00 ","$0.00 ","$1,432.50 ","$2,269.08 ","$2,292.00 ","$0.00 ","$448.37 ","$0.00 ","$456.11 ","$0.00 "
"6632-3-735","SUP","HCPCS C1776","","6632-3-735  -  BSPLT TIB DRCN X1 UNV KNEE BEADED POR 82X58MM","BOTH IP/OP","$2,919.00 ","$2,160.06 ","$0.00 ","$2,919.00 ","$1,313.55 ","$0.00 ","$608.39 ","$0.00 ","$0.00 ","$511.09 ","$2,919.00 ","$0.00 ","$1,459.50 ","$2,311.85 ","$2,335.20 ","$0.00 ","$456.82 ","$0.00 ","$464.70 ","$0.00 "
"6632-3-740","SUP","HCPCS C1776","","6632-3-740  -  BSPLT TIB DRCN X2 UNV KNEE SCR FIX POR 85X60MM","BOTH IP/OP","$2,919.00 ","$2,160.06 ","$0.00 ","$2,919.00 ","$1,313.55 ","$0.00 ","$608.39 ","$0.00 ","$0.00 ","$511.09 ","$2,919.00 ","$0.00 ","$1,459.50 ","$2,311.85 ","$2,335.20 ","$0.00 ","$456.82 ","$0.00 ","$464.70 ","$0.00 "
"6632-5-080","SUP","Custom 27803010","","6632-5-080  -  SPACER FEM 5MM LEFT MDL KNEE","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-085","SUP","Custom 27803010","","6632-5-085  -  SPACER FEM 5MM RIGHT MDL KNEE","BOTH IP/OP","$1,794.00 ","$1,327.56 ","$0.00 ","$1,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,794.00 ","$0.00 ","$897.00 ","$1,420.85 ","$1,435.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-090","SUP","Custom 27803010","","6632-5-090  -  SPACER FEM 5MM DRCN XS LEFT DISTAL LAT","BOTH IP/OP","$1,737.13 ","$1,285.48 ","$0.00 ","$1,737.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,737.13 ","$0.00 ","$868.56 ","$1,375.81 ","$1,389.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-100","SUP","Custom 27803010","","6632-5-100  -  SPACER FEM 5MM DRCN SM LEFT DISTAL MDL VIT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-105","SUP","Custom 27803010","","6632-5-105  -  SPACER FEM 5MM DRCN SM RIGHT DISTAL MDL","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-110","SUP","Custom 27803010","","6632-5-110  -  SPACER FEM 5MM DRCN SM LEFT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-115","SUP","Custom 27803010","","6632-5-115  -  SPACER FEM 5MM DRCN SM RIGHT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-120","SUP","Custom 27803010","","6632-5-120  -  SPACER FEM 5MM DRCN MED LEFT DISTAL MDL","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-125","SUP","Custom 27803010","","6632-5-125  -  SPACER FEM 5MM DRCN MED RIGHT DISTAL MDL","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-130","SUP","Custom 27803010","","6632-5-130  -  SPACER FEM 5MM DRCN MED LEFT DISTAL LAT VIT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-135","SUP","Custom 27803010","","6632-5-135  -  SPACER FEM 5MM DRCN MED RIGHT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-140","SUP","Custom 27803010","","6632-5-140  -  SPACER FEM 5MM DRCN MED LG LEFT DISTAL MDL VIT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-145","SUP","Custom 27803010","","6632-5-145  -  SPACER FEM 5MM DRCN MED LG RIGHT DISTAL MDL VIT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-150","SUP","Custom 27803010","","6632-5-150  -  SPACER FEM 5MM DRCN MED LG LEFT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-155","SUP","Custom 27803010","","6632-5-155  -  SPACER FEM 5MM DRCN MED LG RIGHT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-160","SUP","Custom 27803010","","6632-5-160  -  SPACER FEM 5MM DRCN LG LEFT DISTAL MDL","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-165","SUP","Custom 27803010","","6632-5-165  -  SPACER FEM 5MM DRCN LG RIGHT DISTAL MDL","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-170","SUP","Custom 27803010","","6632-5-170  -  SPACER FEM 5MM DRCN LG LEFT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-175","SUP","Custom 27803010","","6632-5-175  -  SPACER FEM 5MM DRCN LG RIGHT DISTAL LAT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-180","SUP","Custom 27803010","","6632-5-180  -  SPACER FEM 5MM DRCN XL LEFT DISTAL MDL VIT","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-185","SUP","Custom 27803010","","6632-5-185  -  SPACER FEM 5MM DRCN XL RIGHT DISTAL MDL VIT","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-190","SUP","Custom 27803010","","6632-5-190  -  SPACER FEM 5MM DRCN XL LEFT DISTAL LAT","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-195","SUP","Custom 27803010","","6632-5-195  -  SPACER FEM 5MM DRCN XL RIGHT DISTAL LAT VIT","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-450","SUP","Custom 27803010","","6632-5-450  -  STABILIZER SRG S/MED ML DRCN MDLR KN","BOTH IP/OP","$414.00 ","$306.36 ","$0.00 ","$414.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$414.00 ","$0.00 ","$207.00 ","$327.89 ","$331.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-5-600","SUP","HCPCS C1713","","6632-5-600  -  SCREW BONE 5MM DRCN VIT DISTAL FEM LCK SMPL","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$54.00 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"6632-6-100","SUP","Custom 27803010","","6632-6-100  -  SPACER FEM SM 10MM DRCN KN LT MDL","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-105","SUP","Custom 27803010","","6632-6-105  -  SPACER FEM 10MM DRCN SM RIGHT MDL DP VIT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-110","SUP","Custom 27803010","","6632-6-110  -  SPACER FEM 10MM DRCN SM L/L DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-115","SUP","Custom 27803010","","6632-6-115  -  SPACER FEM 10MM DRCN SM RIGHT LAT DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-120","SUP","Custom 27803010","","6632-6-120  -  SPACER FEM 10MM DRCN MED LEFT MDL DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-125","SUP","Custom 27803010","","6632-6-125  -  SPACER FEM 10MM DRCN MED RIGHT MDL DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-130","SUP","Custom 27803010","","6632-6-130  -  SPACER FEM 10MM DRCN MED L/L DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-135","SUP","Custom 27803010","","6632-6-135  -  SPACER FEM 10MM DRCN MED RIGHT LAT DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-140","SUP","Custom 27803010","","6632-6-140  -  SPACER FEM 10MM DRCN MED LG LEFT MDL DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-145","SUP","Custom 27803010","","6632-6-145  -  SPACER FEM 10MM DRCN MED LG RIGHT MDL DP VIT","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-150","SUP","Custom 27803010","","6632-6-150  -  SPACER FEM 10MM DRCN MED LG L/L DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-155","SUP","Custom 27803010","","6632-6-155  -  SPACER FEM 10MM DRCN MED LG RIGHT LAT DP VIT SPCR STAB","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-160","SUP","Custom 27803010","","6632-6-160  -  SPACER FEM 10MM DRCN LG LEFT MDL DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-165","SUP","Custom 27803010","","6632-6-165  -  SPACER FEM 10MM DRCN LG RIGHT MDL DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-170","SUP","Custom 27803010","","6632-6-170  -  SPACER FEM 10MM DRCN LG L/L DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-175","SUP","Custom 27803010","","6632-6-175  -  SPACER FEM 10MM DRCN LG RIGHT LAT DP","BOTH IP/OP","$1,865.50 ","$1,380.47 ","$0.00 ","$1,865.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,865.50 ","$0.00 ","$932.75 ","$1,477.48 ","$1,492.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-180","SUP","Custom 27803010","","6632-6-180  -  SPACER FEM 10MM DRCN XL LEFT MDL DP","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-185","SUP","Custom 27803010","","6632-6-185  -  SPACER FEM 10MM DRCN XL RIGHT MDL DP","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-190","SUP","Custom 27803010","","6632-6-190  -  SPACER FEM 10MM DRCN XL L/L DP","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-195","SUP","Custom 27803010","","6632-6-195  -  SPACER FEM 10MM DRCN XL RIGHT LAT DP","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-410","SUP","Custom 27803010","","6632-6-410  -  SPACER FEM 10MM DRCN SM POST","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-415","SUP","Custom 27803010","","6632-6-415  -  SPACER FEM 5MM DRCN SM POST","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-420","SUP","Custom 27803010","","6632-6-420  -  SPACER FEM 10MM DRCN MED POST","BOTH IP/OP","$1,581.13 ","$1,170.04 ","$0.00 ","$1,581.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,581.13 ","$0.00 ","$790.56 ","$1,252.25 ","$1,264.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-425","SUP","Custom 27803010","","6632-6-425  -  SPACER FEM 5MM DRCN MED POST","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-430","SUP","Custom 27803010","","6632-6-430  -  SPACER FEM 10MM DRCN MED LG POST","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-435","SUP","Custom 27803010","","6632-6-435  -  SPACER FEM 5MM DRCN MED LG POST VIT FULL","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-440","SUP","Custom 27803010","","6632-6-440  -  SPACER FEM 10MM DRCN LG POST","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-445","SUP","Custom 27803010","","6632-6-445  -  SPACER FEM 5MM DRCN LG POST","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-450","SUP","Custom 27803010","","6632-6-450  -  SPACER FEM 10MM DRCN XL POST","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-455","SUP","Custom 27803010","","6632-6-455  -  SPACER FEM 5MM DRCN XL POST VIT FULL","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-460","SUP","Custom 27803010","","6632-6-460  -  SPACER FEM 10MM DRCN 2XL POST FULL","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-465","SUP","Custom 27803010","","6632-6-465  -  SPACER FEM 5MM DRCN 2XL POST FULL","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-600","SUP","HCPCS C1713","","6632-6-600  -  SCREW BONE 10MM 10MM DRCN DISTAL FEM LCK","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$54.00 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"6632-6-705","SUP","Custom 27803010","","6632-6-705  -  SPACER FEM 5MM DRCN XS POST HALF","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-710","SUP","Custom 27803010","","6632-6-710  -  SPACER FEM 10MM DRCN SM POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-715","SUP","Custom 27803010","","6632-6-715  -  SPACER FEM 5MM DRCN SM POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-720","SUP","Custom 27803010","","6632-6-720  -  SPACER FEM 10MM DRCN MED POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-725","SUP","Custom 27803010","","6632-6-725  -  SPACER FEM 5MM DRCN MED POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-730","SUP","Custom 27803010","","6632-6-730  -  SPACER FEM 10MM DRCN MED LG POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-735","SUP","Custom 27803010","","6632-6-735  -  SPACER FEM 5MM DRCN MED LG POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-740","SUP","Custom 27803010","","6632-6-740  -  SPACER FEM 10MM DRCN LG POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-745","SUP","Custom 27803010","","6632-6-745  -  SPACER FEM 5MM DRCN LG POST HALF","BOTH IP/OP","$1,868.75 ","$1,382.88 ","$0.00 ","$1,868.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,868.75 ","$0.00 ","$934.38 ","$1,480.05 ","$1,495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-750","SUP","Custom 27803010","","6632-6-750  -  SPACER FEM 10MM DRCN XL POST HALF","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-755","SUP","Custom 27803010","","6632-6-755  -  SPACER FEM XL HLF 5MM DRCN KN POST","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-760","SUP","Custom 27803010","","6632-6-760  -  SPACER FEM 10MM DRCN 2XL POST KNEE HALF","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-6-765","SUP","Custom 27803010","","6632-6-765  -  SPACER FEM 5MM DRCN XL POST HALF","BOTH IP/OP","$1,961.38 ","$1,451.42 ","$0.00 ","$1,961.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,961.38 ","$0.00 ","$980.69 ","$1,553.41 ","$1,569.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6632-8-800","SUP","HCPCS C1776","","6632-8-800  -  CMPNT FEM XS LEFT TOT STAB","BOTH IP/OP","$10,811.13 ","$8,000.24 ","$0.00 ","$10,811.13 ","$4,865.01 ","$0.00 ","$2,253.31 ","$0.00 ","$0.00 ","$1,892.94 ","$10,811.13 ","$0.00 ","$5,405.56 ","$8,562.41 ","$8,648.90 ","$0.00 ","$1,691.94 ","$0.00 ","$1,721.13 ","$0.00 "
"6632-8-805","SUP","HCPCS C1776","","6632-8-805  -  CMPNT FEM XS RIGHT KNEE TOT STAB DRCN","BOTH IP/OP","$10,811.13 ","$8,000.24 ","$0.00 ","$10,811.13 ","$4,865.01 ","$0.00 ","$2,253.31 ","$0.00 ","$0.00 ","$1,892.94 ","$10,811.13 ","$0.00 ","$5,405.56 ","$8,562.41 ","$8,648.90 ","$0.00 ","$1,691.94 ","$0.00 ","$1,721.13 ","$0.00 "
"6632-8-810","SUP","HCPCS C1776","","6632-8-810  -  CMPNT FEM SM LEFT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-815","SUP","HCPCS C1776","","6632-8-815  -  CMPNT FEM SM RIGHT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-820","SUP","HCPCS C1776","","6632-8-820  -  CMPNT FEM MED LEFT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-825","SUP","HCPCS C1776","","6632-8-825  -  CMPNT FEM MED RIGHT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-830","SUP","HCPCS C1776","","6632-8-830  -  CMPNT FEM MED LG LEFT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-835","SUP","HCPCS C1776","","6632-8-835  -  CMPNT FEM MED LG RIGHT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-840","SUP","HCPCS C1776","","6632-8-840  -  CMPNT FEM LG LEFT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-845","SUP","HCPCS C1776","","6632-8-845  -  CMPNT FEM LG RIGHT TOT STAB","BOTH IP/OP","$10,619.38 ","$7,858.34 ","$0.00 ","$10,619.38 ","$4,778.72 ","$0.00 ","$2,213.34 ","$0.00 ","$0.00 ","$1,859.37 ","$10,619.38 ","$0.00 ","$5,309.69 ","$8,410.55 ","$8,495.50 ","$0.00 ","$1,661.93 ","$0.00 ","$1,690.60 ","$0.00 "
"6632-8-850","SUP","HCPCS C1776","","6632-8-850  -  CMPNT FEM XL LEFT TOT STAB","BOTH IP/OP","$10,811.13 ","$8,000.24 ","$0.00 ","$10,811.13 ","$4,865.01 ","$0.00 ","$2,253.31 ","$0.00 ","$0.00 ","$1,892.94 ","$10,811.13 ","$0.00 ","$5,405.56 ","$8,562.41 ","$8,648.90 ","$0.00 ","$1,691.94 ","$0.00 ","$1,721.13 ","$0.00 "
"6632-8-855","SUP","HCPCS C1776","","6632-8-855  -  CMPNT FEM XL RIGHT TOT STAB","BOTH IP/OP","$10,811.13 ","$8,000.24 ","$0.00 ","$10,811.13 ","$4,865.01 ","$0.00 ","$2,253.31 ","$0.00 ","$0.00 ","$1,892.94 ","$10,811.13 ","$0.00 ","$5,405.56 ","$8,562.41 ","$8,648.90 ","$0.00 ","$1,691.94 ","$0.00 ","$1,721.13 ","$0.00 "
"6634-0-330","SUP","Custom 27803010","","6634-0-330  -  CMPNT FEM UNV SM LEFT MDL RIGHT LAT DRCN","BOTH IP/OP","$1,856.00 ","$1,373.44 ","$0.00 ","$1,856.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,856.00 ","$0.00 ","$928.00 ","$1,469.95 ","$1,484.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6637-0-009","SUP","HCPCS C1776","","6637-0-009  -  INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-011","SUP","HCPCS C1776","","6637-0-011  -  INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-013","SUP","HCPCS C1776","","6637-0-013  -  INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-016","SUP","HCPCS C1776","","6637-0-016  -  INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-019","SUP","HCPCS C1776","","6637-0-019  -  INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-022","SUP","HCPCS C1776","","6637-0-022  -  INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-025","SUP","HCPCS C1776","","6637-0-025  -  INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-028","SUP","HCPCS C1776","","6637-0-028  -  INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-031","SUP","HCPCS C1776","","6637-0-031  -  INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-109","SUP","HCPCS C1776","","6637-0-109  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-111","SUP","HCPCS C1776","","6637-0-111  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-113","SUP","HCPCS C1776","","6637-0-113  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-116","SUP","HCPCS C1776","","6637-0-116  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-119","SUP","HCPCS C1776","","6637-0-119  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-122","SUP","HCPCS C1776","","6637-0-122  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-125","SUP","HCPCS C1776","","6637-0-125  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-128","SUP","HCPCS C1776","","6637-0-128  -  INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-131","SUP","HCPCS C1776","","6637-0-131  -  INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-209","SUP","HCPCS C1776","","6637-0-209  -  INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-211","SUP","HCPCS C1776","","6637-0-211  -  INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-213","SUP","HCPCS C1776","","6637-0-213  -  INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-216","SUP","HCPCS C1776","","6637-0-216  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-219","SUP","HCPCS C1776","","6637-0-219  -  INSERT TIBIAL LARGE 19MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-222","SUP","HCPCS C1776","","6637-0-222  -  INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-225","SUP","HCPCS C1776","","6637-0-225  -  INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-228","SUP","HCPCS C1776","","6637-0-228  -  INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-231","SUP","HCPCS C1776","","6637-0-231  -  INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-309","SUP","HCPCS C1776","","6637-0-309  -  INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-311","SUP","HCPCS C1776","","6637-0-311  -  INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-313","SUP","HCPCS C1776","","6637-0-313  -  INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-316","SUP","HCPCS C1776","","6637-0-316  -  INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-319","SUP","HCPCS C1776","","6637-0-319  -  INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-322","SUP","HCPCS C1776","","6637-0-322  -  INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-325","SUP","HCPCS C1776","","6637-0-325  -  INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-328","SUP","HCPCS C1776","","6637-0-328  -  INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-331","SUP","HCPCS C1776","","6637-0-331  -  INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-609","SUP","HCPCS C1776","","6637-0-609  -  INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-611","SUP","HCPCS C1776","","6637-0-611  -  INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-613","SUP","HCPCS C1776","","6637-0-613  -  INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-616","SUP","HCPCS C1776","","6637-0-616  -  INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-619","SUP","HCPCS C1776","","6637-0-619  -  INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-622","SUP","HCPCS C1776","","6637-0-622  -  INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-625","SUP","HCPCS C1776","","6637-0-625  -  INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-628","SUP","HCPCS C1776","","6637-0-628  -  INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-631","SUP","HCPCS C1776","","6637-0-631  -  INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-709","SUP","HCPCS C1776","","6637-0-709  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-711","SUP","HCPCS C1776","","6637-0-711  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-713","SUP","HCPCS C1776","","6637-0-713  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-716","SUP","HCPCS C1776","","6637-0-716  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-719","SUP","HCPCS C1776","","6637-0-719  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-722","SUP","HCPCS C1776","","6637-0-722  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-725","SUP","HCPCS C1776","","6637-0-725  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-728","SUP","HCPCS C1776","","6637-0-728  -  INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-731","SUP","HCPCS C1776","","6637-0-731  -  INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-809","SUP","HCPCS C1776","","6637-0-809  -  INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-811","SUP","HCPCS C1776","","6637-0-811  -  INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-813","SUP","HCPCS C1776","","6637-0-813  -  INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-816","SUP","HCPCS C1776","","6637-0-816  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-819","SUP","HCPCS C1776","","6637-0-819  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-822","SUP","HCPCS C1776","","6637-0-822  -  INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-825","SUP","HCPCS C1776","","6637-0-825  -  INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-828","SUP","HCPCS C1776","","6637-0-828  -  INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-831","SUP","HCPCS C1776","","6637-0-831  -  INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-909","SUP","HCPCS C1776","","6637-0-909  -  INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-911","SUP","HCPCS C1776","","6637-0-911  -  INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-913","SUP","HCPCS C1776","","6637-0-913  -  INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-916","SUP","HCPCS C1776","","6637-0-916  -  INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-919","SUP","HCPCS C1776","","6637-0-919  -  INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-922","SUP","HCPCS C1776","","6637-0-922  -  INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-925","SUP","HCPCS C1776","","6637-0-925  -  INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-928","SUP","HCPCS C1776","","6637-0-928  -  INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-0-931","SUP","HCPCS C1776","","6637-0-931  -  INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE RIGHT","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-009","SUP","HCPCS C1776","","6637-4-009  -  INSERT TIBIAL SMALL NEUTRAL 9MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-011","SUP","HCPCS C1776","","6637-4-011  -  INSERT TIBIAL SMALL NEUTRAL 11MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-013","SUP","HCPCS C1776","","6637-4-013  -  INSERT TIBIAL SMALL NEUTRAL 13MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-016","SUP","HCPCS C1776","","6637-4-016  -  INSERT TIBIAL SMALL NEUTRAL 16MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-019","SUP","HCPCS C1776","","6637-4-019  -  INSERT TIBIAL SMALL NEUTRAL 19MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-022","SUP","HCPCS C1776","","6637-4-022  -  INSERT TIBIAL SMALL NEUTRAL 22MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-025","SUP","HCPCS C1776","","6637-4-025  -  INSERT TIBIAL SMALL NEUTRAL 25MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-028","SUP","HCPCS C1776","","6637-4-028  -  INSERT TIBIAL SMALL NEUTRAL 28MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-031","SUP","HCPCS C1776","","6637-4-031  -  INSERT TIBIAL SMALL NEUTRAL 31MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-109","SUP","HCPCS C1776","","6637-4-109  -  INSERT TIBIAL MEDIUM NEUTRAL 9MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-111","SUP","HCPCS C1776","","6637-4-111  -  INSERT TIBIAL MEDIUM NEUTRAL 11MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-113","SUP","HCPCS C1776","","6637-4-113  -  INSERT TIBIAL MEDIUM NEUTRAL 13MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-116","SUP","HCPCS C1776","","6637-4-116  -  INSERT TIBIAL MEDIUM NEUTRAL 16MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-119","SUP","HCPCS C1776","","6637-4-119  -  INSERT TIBIAL MEDIUM NEUTRAL 19MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-122","SUP","HCPCS C1776","","6637-4-122  -  INSERT TIBIAL MEDIUM NEUTRAL 22MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-125","SUP","HCPCS C1776","","6637-4-125  -  INSERT TIBIAL MEDIUM NEUTRAL 25MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-128","SUP","HCPCS C1776","","6637-4-128  -  INSERT TIBIAL MEDIUM NEUTRAL 28MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-131","SUP","HCPCS C1776","","6637-4-131  -  INSERT TIBIAL MEDIUM NEUTRAL 31MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-209","SUP","HCPCS C1776","","6637-4-209  -  INSERT TIBIAL LARGE NEUTRAL 9MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-211","SUP","HCPCS C1776","","6637-4-211  -  INSERT TIBIAL LARGE NEUTRAL 11MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-213","SUP","HCPCS C1776","","6637-4-213  -  INSERT TIBIAL LARGE NEUTRAL 13MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-216","SUP","HCPCS C1776","","6637-4-216  -  INSERT TIBIAL LARGE NEUTRAL 16MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-219","SUP","HCPCS C1776","","6637-4-219  -  INSERT TIBIAL LARGE NEUTRAL 19MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-222","SUP","HCPCS C1776","","6637-4-222  -  INSERT TIBIAL LARGE NEUTRAL 22MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-225","SUP","HCPCS C1776","","6637-4-225  -  INSERT TIBIAL LARGE NEUTRAL 25MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-228","SUP","HCPCS C1776","","6637-4-228  -  INSERT TIBIAL LARGE NEUTRAL 28MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-231","SUP","HCPCS C1776","","6637-4-231  -  INSERT TIBIAL LARGE NEUTRAL 31MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-309","SUP","HCPCS C1776","","6637-4-309  -  INSERT TIBIAL XL NEUTRAL 9MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-311","SUP","HCPCS C1776","","6637-4-311  -  INSERT TIBIAL XL NEUTRAL 11MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-313","SUP","HCPCS C1776","","6637-4-313  -  INSERT TIBIAL XL NEUTRAL 13MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-316","SUP","HCPCS C1776","","6637-4-316  -  INSERT TIBIAL XL NEUTRAL 16MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-319","SUP","HCPCS C1776","","6637-4-319  -  INSERT TIBIAL XL NEUTRAL 19MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-322","SUP","HCPCS C1776","","6637-4-322  -  INSERT TIBIAL XL NEUTRAL 22MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-325","SUP","HCPCS C1776","","6637-4-325  -  INSERT TIBIAL XL NEUTRAL 25MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-328","SUP","HCPCS C1776","","6637-4-328  -  INSERT TIBIAL XL NEUTRAL 28MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6637-4-331","SUP","HCPCS C1776","","6637-4-331  -  INSERT TIBIAL XL NEUTRAL 31MM REVISION PCA DURACON KNEE","BOTH IP/OP","$5,517.50 ","$4,082.95 ","$0.00 ","$5,517.50 ","$2,482.88 ","$0.00 ","$1,149.98 ","$0.00 ","$0.00 ","$966.07 ","$5,517.50 ","$0.00 ","$2,758.75 ","$4,369.86 ","$4,414.00 ","$0.00 ","$863.49 ","$0.00 ","$878.39 ","$0.00 "
"6642-1-009","SUP","Custom 27803010","","6642-1-009  -  INSERT TIB XS 9MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-011","SUP","Custom 27803010","","6642-1-011  -  INSERT TIB XS 11MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-013","SUP","Custom 27803010","","6642-1-013  -  INSERT TIB XS 13MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-016","SUP","Custom 27803010","","6642-1-016  -  INSERT TIB XS 16MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-109","SUP","Custom 27803010","","6642-1-109  -  INSERT TIB SM 9MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-111","SUP","Custom 27803010","","6642-1-111  -  INSERT TIB SM 11MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-113","SUP","Custom 27803010","","6642-1-113  -  INSERT TIB SM 13MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-116","SUP","Custom 27803010","","6642-1-116  -  INSERT TIB SM 16MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-119","SUP","Custom 27803010","","6642-1-119  -  INSERT TIB SM 19MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-209","SUP","Custom 27803010","","6642-1-209  -  INSERT TIB MED 9MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-211","SUP","Custom 27803010","","6642-1-211  -  INSERT TIB MED 11MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-213","SUP","Custom 27803010","","6642-1-213  -  INSERT TIB MED 13MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-216","SUP","Custom 27803010","","6642-1-216  -  INSERT TIB MED 16MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-219","SUP","Custom 27803010","","6642-1-219  -  INSERT TIB MED 19MM CNDYLR KNEE DUR CNDYLR STAB DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-309","SUP","Custom 27803010","","6642-1-309  -  INSERT TIB LG 9MM CNDYLR DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-311","SUP","Custom 27803010","","6642-1-311  -  INSERT TIB LG 11MM CNDYLR DUR","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-313","SUP","Custom 27803010","","6642-1-313  -  INSERT TIB LG 13MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-316","SUP","Custom 27803010","","6642-1-316  -  INSERT TIB LG 16MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-319","SUP","Custom 27803010","","6642-1-319  -  INSERT TIB LG 19MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,191.00 ","$881.34 ","$0.00 ","$1,191.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,191.00 ","$0.00 ","$595.50 ","$943.27 ","$952.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-409","SUP","Custom 27803010","","6642-1-409  -  INSERT TIB XL 9MM CNDYLR DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-411","SUP","Custom 27803010","","6642-1-411  -  INSERT TIB XL 11MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-413","SUP","Custom 27803010","","6642-1-413  -  INSERT TIB XL 13MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-416","SUP","Custom 27803010","","6642-1-416  -  INSERT TIB XL 16MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-419","SUP","Custom 27803010","","6642-1-419  -  INSERT TIB XL 19MM CNDYLR KNEE DUR DRCN","BOTH IP/OP","$1,214.00 ","$898.36 ","$0.00 ","$1,214.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,214.00 ","$0.00 ","$607.00 ","$961.49 ","$971.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-509","SUP","Custom 27803010","","6642-1-509  -  INSERT TIBIAL XS 9MM ANTERIOR/POSTERIOR LIPPED DURACON DUR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-511","SUP","Custom 27803010","","6642-1-511  -  INSERT TIBIAL XS 11MM ANTERIOR/POSTERIOR LIPPED DURACON DUR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-513","SUP","Custom 27803010","","6642-1-513  -  INSERT TIBIAL XS 13MM ANTERIOR/POSTERIOR LIPPED DURACON DUR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-516","SUP","Custom 27803010","","6642-1-516  -  INSERT TIBIAL XS 16MM ANTERIOR/POSTERIOR LIPPED DURACON DUR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-609","SUP","Custom 27803010","","6642-1-609  -  INSERT TIBIAL SMALL 9MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-611","SUP","Custom 27803010","","6642-1-611  -  INSERT TIBIAL SMALL 11MM LIPPED REVISION RECONSTRUCTION","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-613","SUP","Custom 27803010","","6642-1-613  -  INSERT TIBIAL SMALL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-616","SUP","Custom 27803010","","6642-1-616  -  INSERT TIBIAL SMALL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-619","SUP","Custom 27803010","","6642-1-619  -  INSERT TIBIAL SMALL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-622","SUP","Custom 27803010","","6642-1-622  -  INSERT TIBIAL SMALL 22MM LIP DURACON DUR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-625","SUP","Custom 27803010","","6642-1-625  -  INSERT TIBIAL SMALL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-709","SUP","Custom 27803010","","6642-1-709  -  INSERT TIBIAL MEDIUM 9MM LIPPED DURACON DUR ANTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-711","SUP","Custom 27803010","","6642-1-711  -  INSERT TIBIAL MEDIUM 11MM DURACON DUR ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-713","SUP","Custom 27803010","","6642-1-713  -  INSERT TIBIAL MEDIUM 13MM DURACON DUR ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-716","SUP","Custom 27803010","","6642-1-716  -  INSERT TIBIAL MEDIUM 16MM LIPPED REVISION RECONSTRUCTION","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-719","SUP","Custom 27803010","","6642-1-719  -  INSERT TIBIAL MEDIUM 19MM DURACON DUR ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-722","SUP","Custom 27803010","","6642-1-722  -  INSERT TIBIAL MEDIUM 22MM DURACON DUR KNEE ANTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-725","SUP","Custom 27803010","","6642-1-725  -  INSERT TIBIAL MEDIUM 25MM DURACON DUR KNEE ANTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-809","SUP","Custom 27803010","","6642-1-809  -  INSERT TIBIAL LARGE 9MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-811","SUP","Custom 27803010","","6642-1-811  -  INSERT TIBIAL LARGE 11MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-813","SUP","Custom 27803010","","6642-1-813  -  INSERT TIBIAL LARGE 13MM LIPPED REVISION RECONSTRUCTION","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-816","SUP","Custom 27803010","","6642-1-816  -  INSERT TIBIAL LARGE 16MM LIPPED REVISION RECONSTRUCTION","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-819","SUP","Custom 27803010","","6642-1-819  -  INSERT TIBIAL LARGE 19MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-822","SUP","Custom 27803010","","6642-1-822  -  INSERT TIBIAL LARGE 22MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-825","SUP","Custom 27803010","","6642-1-825  -  INSERT TIBIAL LARGE 25MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-909","SUP","Custom 27803010","","6642-1-909  -  INSERT TIBIAL XL 9MM LIPPED REVISION RECONSTRUCTION DURACON","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-911","SUP","Custom 27803010","","6642-1-911  -  INSERT TIBIAL XL 11MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-913","SUP","Custom 27803010","","6642-1-913  -  INSERT TIBIAL XL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-916","SUP","Custom 27803010","","6642-1-916  -  INSERT TIBIAL XL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-919","SUP","Custom 27803010","","6642-1-919  -  INSERT TIBIAL XL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-922","SUP","Custom 27803010","","6642-1-922  -  INSERT TIBIAL XL 22MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-1-925","SUP","Custom 27803010","","6642-1-925  -  INSERT TIBIAL XL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR","BOTH IP/OP","$1,917.50 ","$1,418.95 ","$0.00 ","$1,917.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,917.50 ","$0.00 ","$958.75 ","$1,518.66 ","$1,534.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-040","SUP","Custom 27803010","","6642-2-040  -  COMPONENT PATLR XS 29MM HDPE RESIN KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-050","SUP","Custom 27803010","","6642-2-050  -  COMPONENT PATLR SMALL 32MM HDPE RESIN KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-100","SUP","Custom 27803010","","6642-2-100  -  COMPONENT PATLR MEDIUM 35MM HDPE RESIN KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-140","SUP","Custom 27803010","","6642-2-140  -  CMPNT PATLR 33MM MTLBLK DRCN DUR","BOTH IP/OP","$1,316.00 ","$973.84 ","$0.00 ","$1,316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,316.00 ","$0.00 ","$658.00 ","$1,042.27 ","$1,052.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-145","SUP","Custom 27803010","","6642-2-145  -  CMPNT PATLR 33MM DRCN","BOTH IP/OP","$1,571.00 ","$1,162.54 ","$0.00 ","$1,571.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,571.00 ","$0.00 ","$785.50 ","$1,244.23 ","$1,256.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-150","SUP","Custom 27803010","","6642-2-150  -  COMPONENT PATLR LARGE 11MM DURACON DUR ALL POLY KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-200","SUP","Custom 27803010","","6642-2-200  -  COMPONENT PATLR XL 11MM DURACON DUR ALL POLY KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-300","SUP","Custom 27803010","","6642-2-300  -  CMPNT PATLR SM MTLBLK DRCN DUR","BOTH IP/OP","$1,316.00 ","$973.84 ","$0.00 ","$1,316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,316.00 ","$0.00 ","$658.00 ","$1,042.27 ","$1,052.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-350","SUP","Custom 27803010","","6642-2-350  -  CMPNT PATLR MED MTLBLK DRCN DUR","BOTH IP/OP","$1,316.00 ","$973.84 ","$0.00 ","$1,316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,316.00 ","$0.00 ","$658.00 ","$1,042.27 ","$1,052.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-400","SUP","Custom 27803010","","6642-2-400  -  CMPNT PATLR LG ASYM MTLBLK DRCN DUR","BOTH IP/OP","$1,316.00 ","$973.84 ","$0.00 ","$1,316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,316.00 ","$0.00 ","$658.00 ","$1,042.27 ","$1,052.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-600","SUP","Custom 27803010","","6642-2-600  -  INSERT TIBIAL 8MM 27MM SYMMETRIC DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-610","SUP","Custom 27803010","","6642-2-610  -  INSERT TIBIAL 8MM 29MM SYMMETRIC DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-620","SUP","Custom 27803010","","6642-2-620  -  COMPONENT PATLR 31MM 9MM SYMMETRIC DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-626","SUP","Custom 27203010","","6642-2-626  -  TRIAL SURG 25MM 10MM INSET DURACON DUR PATELLA","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-627","SUP","Custom 27803010","","6642-2-627  -  COMPONENT PATLR 27MM 10MM SYMMETRIC DURACON DUR KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-629","SUP","Custom 27803010","","6642-2-629  -  COMPONENT PATLR 29MM 10MM INSET DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-630","SUP","Custom 27803010","","6642-2-630  -  INSERT TIBIAL 9MM 33MM SYMMETRIC DURACON DUR KNEE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-631","SUP","Custom 27803010","","6642-2-631  -  COMPONENT PATLR 31MM 10MM SYMMETRIC DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-633","SUP","Custom 27803010","","6642-2-633  -  COMPONENT PATLR 33MM 10MM INSET DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-640","SUP","Custom 27803010","","6642-2-640  -  COMPONENT PATLR 36MM 10MM SYMMETRIC DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-645","SUP","Custom 27803010","","6642-2-645  -  INSERT TIBIAL 11MM 39MM SYMMETRIC DURACON DUR","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-700","SUP","Custom 27803010","","6642-2-700  -  CMPNT PATLR SM CNVR DRCN DUR","BOTH IP/OP","$1,634.00 ","$1,209.16 ","$0.00 ","$1,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,634.00 ","$0.00 ","$817.00 ","$1,294.13 ","$1,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-705","SUP","Custom 27803010","","6642-2-705  -  CMPNT PATLR MED CNVR DRCN DUR","BOTH IP/OP","$1,634.00 ","$1,209.16 ","$0.00 ","$1,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,634.00 ","$0.00 ","$817.00 ","$1,294.13 ","$1,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-710","SUP","Custom 27803010","","6642-2-710  -  CMPNT PATLR LG CNVX DRCN DUR","BOTH IP/OP","$1,634.00 ","$1,209.16 ","$0.00 ","$1,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,634.00 ","$0.00 ","$817.00 ","$1,294.13 ","$1,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-715","SUP","Custom 27803010","","6642-2-715  -  CMPNT PATLR XL CNVX DRCN DUR UHMWPE","BOTH IP/OP","$1,634.00 ","$1,209.16 ","$0.00 ","$1,634.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,634.00 ","$0.00 ","$817.00 ","$1,294.13 ","$1,307.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-720","SUP","Custom 27803010","","6642-2-720  -  INSERT TIB SM 20MM KNEE DUR CNVX DRCN 7MM","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$677.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.00 ","$0.00 ","$338.50 ","$536.18 ","$541.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-725","SUP","Custom 27803010","","6642-2-725  -  INSERT TIB MED 25MM KNEE DUR CNVX DRCN 7MM","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$677.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.00 ","$0.00 ","$338.50 ","$536.18 ","$541.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-730","SUP","Custom 27803010","","6642-2-730  -  INSERT TIB LG 30MM KNEE DUR CNVX DRCN 7MM","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$677.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.00 ","$0.00 ","$338.50 ","$536.18 ","$541.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-735","SUP","Custom 27803010","","6642-2-735  -  INSERT TIB XL 35MM KNEE DUR CNVX DRCN 7MM","BOTH IP/OP","$677.00 ","$500.98 ","$0.00 ","$677.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$677.00 ","$0.00 ","$338.50 ","$536.18 ","$541.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-740","SUP","Custom 27803010","","6642-2-740  -  CMPNT PATLR SM DRCN","BOTH IP/OP","$1,768.00 ","$1,308.32 ","$0.00 ","$1,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,768.00 ","$0.00 ","$884.00 ","$1,400.26 ","$1,414.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-745","SUP","Custom 27803010","","6642-2-745  -  CMPNT PATLR MED DRCN","BOTH IP/OP","$1,842.00 ","$1,363.08 ","$0.00 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,842.00 ","$0.00 ","$921.00 ","$1,458.86 ","$1,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-750","SUP","Custom 27803010","","6642-2-750  -  CMPNT PATLR ASYM DUR","BOTH IP/OP","$1,842.00 ","$1,363.08 ","$0.00 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,842.00 ","$0.00 ","$921.00 ","$1,458.86 ","$1,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-2-755","SUP","Custom 27803010","","6642-2-755  -  CMPNT PATLR XL DRCN","BOTH IP/OP","$1,842.00 ","$1,363.08 ","$0.00 ","$1,842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,842.00 ","$0.00 ","$921.00 ","$1,458.86 ","$1,473.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-5-111","SUP","HCPCS C1776","","6642-5-111  -  INSERT TIBIAL SMALL 11MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-113","SUP","HCPCS C1776","","6642-5-113  -  INSERT TIBIAL SMALL 13MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-116","SUP","HCPCS C1776","","6642-5-116  -  INSERT TIBIAL SMALL 16MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-119","SUP","HCPCS C1776","","6642-5-119  -  INSERT TIBIAL SMALL 19MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-122","SUP","HCPCS C1776","","6642-5-122  -  INSERT TIBIAL SMALL 22MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-125","SUP","HCPCS C1776","","6642-5-125  -  INSERT TIBIAL SMALL 25MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-128","SUP","HCPCS C1776","","6642-5-128  -  INSERT TIBIAL SMALL 28MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-131","SUP","HCPCS C1776","","6642-5-131  -  INSERT TIBIAL SMALL 31MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-211","SUP","HCPCS C1776","","6642-5-211  -  INSERT TIBIAL MEDIUM 11MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-213","SUP","HCPCS C1776","","6642-5-213  -  INSERT TIBIAL MEDIUM 13MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-216","SUP","HCPCS C1776","","6642-5-216  -  INSERT TIBIAL MEDIUM 16MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-219","SUP","HCPCS C1776","","6642-5-219  -  INSERT TIBIAL MEDIUM 19MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-222","SUP","HCPCS C1776","","6642-5-222  -  INSERT TIBIAL MEDIUM 22MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-225","SUP","HCPCS C1776","","6642-5-225  -  INSERT TIBIAL MEDIUM 25MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-228","SUP","HCPCS C1776","","6642-5-228  -  INSERT TIBIAL MEDIUM 28MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-231","SUP","HCPCS C1776","","6642-5-231  -  INSERT TIBIAL MEDIUM 31MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-311","SUP","HCPCS C1776","","6642-5-311  -  INSERT TIBIAL LARGE 11MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-313","SUP","HCPCS C1776","","6642-5-313  -  INSERT TIBIAL LARGE 13MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-316","SUP","HCPCS C1776","","6642-5-316  -  INSERT TIBIAL LARGE 16MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-319","SUP","HCPCS C1776","","6642-5-319  -  INSERT TIBIAL LARGE 19MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-322","SUP","HCPCS C1776","","6642-5-322  -  INSERT TIBIAL LARGE 22MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-325","SUP","HCPCS C1776","","6642-5-325  -  INSERT TIBIAL LARGE 25MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-328","SUP","HCPCS C1776","","6642-5-328  -  INSERT TIBIAL LARGE 28MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-331","SUP","HCPCS C1776","","6642-5-331  -  INSERT TIBIAL LARGE 31MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-411","SUP","HCPCS C1776","","6642-5-411  -  INSERT TIBIAL XL 11MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-413","SUP","HCPCS C1776","","6642-5-413  -  INSERT TIBIAL XL 13MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-416","SUP","HCPCS C1776","","6642-5-416  -  INSERT TIBIAL XL 16MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-419","SUP","HCPCS C1776","","6642-5-419  -  INSERT TIBIAL XL 19MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-422","SUP","HCPCS C1776","","6642-5-422  -  INSERT TIBIAL XL 22MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-425","SUP","HCPCS C1776","","6642-5-425  -  INSERT TIBIAL XL 25MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-428","SUP","HCPCS C1776","","6642-5-428  -  INSERT TIBIAL XL 28MM TOT STABILIZED DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-5-431","SUP","HCPCS C1776","","6642-5-431  -  INSERT TIBIAL XL 31MM TOT STABILIZE DURACON DUR KNEE","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"6642-9-009","SUP","Custom 27803010","","6642-9-009  -  INSERT TIB XS STD 9MM KNEE DUR DRCN","BOTH IP/OP","$2,075.13 ","$1,535.60 ","$0.00 ","$2,075.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,075.13 ","$0.00 ","$1,037.56 ","$1,643.50 ","$1,660.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-011","SUP","HCPCS C1776","","6642-9-011  -  INSERT TIB XS STD 11MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-013","SUP","HCPCS C1776","","6642-9-013  -  INSERT TIB XS STD 13MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-016","SUP","HCPCS C1776","","6642-9-016  -  INSERT TIB XS STD 16MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-019","SUP","HCPCS C1776","","6642-9-019  -  INSERT TIB XS STD 19MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-109","SUP","HCPCS C1776","","6642-9-109  -  INSERT TIB STD SM 9MM KNEE DUR TOT STAB DRCN OTHR","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-111","SUP","HCPCS C1776","","6642-9-111  -  INSERT TIB SM STD 11MM KNEE DUR TOT STAB DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-113","SUP","HCPCS C1776","","6642-9-113  -  INSERT TIB SM STD 13MM KNEE DUR TOT STAB DRCN OTHR","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-116","SUP","HCPCS C1776","","6642-9-116  -  INSERT TIB SM STD 16MM KNEE DUR TOT STAB DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-119","SUP","HCPCS C1776","","6642-9-119  -  INSERT TIB STD SM 19MM KNEE DUR TOT STAB DRCN OTHR","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-209","SUP","HCPCS C1776","","6642-9-209  -  INSERT TIB STD MED 9MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-211","SUP","HCPCS C1776","","6642-9-211  -  INSERT TIB MED 11MM KNEE DUR STD DRCN 11MM","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-213","SUP","HCPCS C1776","","6642-9-213  -  INSERT TIB MED 13MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-216","SUP","HCPCS C1776","","6642-9-216  -  INSERT TIB STD MED 16MM KNEE DUR OTHR INS DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-219","SUP","HCPCS C1776","","6642-9-219  -  INSERT TIB STD 19MM KNEE DUR DRCN 4 016","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-309","SUP","HCPCS C1776","","6642-9-309  -  INSERT TIB STD 9MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-311","SUP","HCPCS C1776","","6642-9-311  -  INSERT TIB STD 11MM LEG DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-313","SUP","HCPCS C1776","","6642-9-313  -  INSERT TIB LG 13MM KNEE COCR CNDYLR STAB LIP DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-316","SUP","HCPCS C1776","","6642-9-316  -  INSERT TIB STD LG 16MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-319","SUP","HCPCS C1776","","6642-9-319  -  INSERT TIB STD 19MM KNEE DUR DRCN","BOTH IP/OP","$5,026.13 ","$3,719.34 ","$0.00 ","$5,026.13 ","$2,261.76 ","$0.00 ","$1,047.57 ","$0.00 ","$0.00 ","$880.03 ","$5,026.13 ","$0.00 ","$2,513.06 ","$3,980.69 ","$4,020.90 ","$0.00 ","$786.59 ","$0.00 ","$800.16 ","$0.00 "
"6642-9-609","SUP","Custom 27803010","","6642-9-609  -  INSERT TIBIAL SMALL 9MM CONSTRAIN DURACON DUR KNEE OTHER","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-611","SUP","Custom 27803010","","6642-9-611  -  INSERT TIBIAL SMALL 11MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-613","SUP","Custom 27803010","","6642-9-613  -  INSERT TIBIAL SMALL 13MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-616","SUP","Custom 27803010","","6642-9-616  -  INSERT TIBIAL SMALL 16MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-619","SUP","Custom 27803010","","6642-9-619  -  INSERT TIBIAL SMALL 19MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-622","SUP","Custom 27803010","","6642-9-622  -  INSERT TIBIAL SMALL 22MM CONSTRAIN DURACON DUR KNEE OTHER","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-625","SUP","Custom 27803010","","6642-9-625  -  INSERT TIBIAL SMALL 25MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-709","SUP","Custom 27803010","","6642-9-709  -  INSERT TIBIAL MEDIUM 9MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-711","SUP","HCPCS C1776","","6642-9-711  -  INSERT TIBIAL MEDIUM 11MM CONSTRAIN DURACON DUR KNEE OTHER","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$2,286.00 ","$0.00 ","$1,058.80 ","$0.00 ","$0.00 ","$889.47 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$795.02 ","$0.00 ","$808.74 ","$0.00 "
"6642-9-713","SUP","Custom 27803010","","6642-9-713  -  INSERT TIBIAL MEDIUM 13MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-716","SUP","Custom 27803010","","6642-9-716  -  INSERT TIBIAL MEDIUM 16MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-719","SUP","Custom 27803010","","6642-9-719  -  INSERT TIBIAL MEDIUM 19MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-722","SUP","Custom 27803010","","6642-9-722  -  INSERT TIBIAL MEDIUM 22MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-725","SUP","Custom 27803010","","6642-9-725  -  INSERT TIBIAL MEDIUM 25MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-809","SUP","Custom 27803010","","6642-9-809  -  INSERT TIBIAL LARGE 9MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-811","SUP","Custom 27803010","","6642-9-811  -  INSERT TIBIAL LARGE 11MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-813","SUP","Custom 27803010","","6642-9-813  -  INSERT TIBIAL LARGE 13MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-816","SUP","Custom 27803010","","6642-9-816  -  INSERT TIBIAL LARGE 16MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-819","SUP","Custom 27803010","","6642-9-819  -  INSERT TIBIAL LARGE 19MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-822","SUP","Custom 27803010","","6642-9-822  -  INSERT TIBIAL LARGE 22MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6642-9-825","SUP","Custom 27803010","","6642-9-825  -  INSERT TIBIAL LARGE 25MM CONSTRAIN DURACON DUR KNEE","BOTH IP/OP","$5,080.00 ","$3,759.20 ","$0.00 ","$5,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,080.00 ","$0.00 ","$2,540.00 ","$4,023.36 ","$4,064.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6647-1-018","SUP","HCPCS C1776","","6647-1-018  -  CMPNT FEM CMPR WCHT 18MM","BOTH IP/OP","$7,213.38 ","$5,337.90 ","$0.00 ","$7,213.38 ","$3,246.02 ","$0.00 ","$1,503.45 ","$0.00 ","$0.00 ","$1,263.00 ","$7,213.38 ","$0.00 ","$3,606.69 ","$5,713.00 ","$5,770.70 ","$0.00 ","$1,128.89 ","$0.00 ","$1,148.37 ","$0.00 "
"6647-2-012","SUP","HCPCS C1713","","6647-2-012  -  NAIL 12MM HUM TIB WCHT IM","BOTH IP/OP","$5,000.13 ","$3,700.10 ","$0.00 ","$5,000.13 ","$2,250.06 ","$0.00 ","$1,042.15 ","$0.00 ","$0.00 ","$875.48 ","$5,000.13 ","$0.00 ","$2,500.06 ","$3,960.10 ","$4,000.10 ","$0.00 ","$782.52 ","$0.00 ","$796.02 ","$0.00 "
"6647-3-000","SUP","HCPCS C1713","","6647-3-000  -  SCREW BONE WCHT FULTHD KNEE CMPR FSN NAIL","BOTH IP/OP","$3,519.75 ","$2,604.62 ","$0.00 ","$3,519.75 ","$1,583.89 ","$0.00 ","$733.60 ","$0.00 ","$0.00 ","$616.28 ","$3,519.75 ","$0.00 ","$1,759.88 ","$2,787.64 ","$2,815.80 ","$0.00 ","$550.84 ","$0.00 ","$560.34 ","$0.00 "
"6647-3-125","SUP","HCPCS C1713","","6647-3-125  -  SCREW BONE 6MM 25MM WCHT FULTHD ORTH SLFTAP","BOTH IP/OP","$494.00 ","$365.56 ","$0.00 ","$494.00 ","$222.30 ","$0.00 ","$102.96 ","$0.00 ","$0.00 ","$86.50 ","$494.00 ","$0.00 ","$247.00 ","$391.25 ","$395.20 ","$0.00 ","$77.31 ","$0.00 ","$78.64 ","$0.00 "
"6647-3-130","SUP","HCPCS C1713","","6647-3-130  -  SCREW BONE 6MM 30MM WCHT FULTHD KNEE CMPR FSN NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"6647-3-135","SUP","HCPCS C1713","","6647-3-135  -  SCREW BONE 6MM 35MM WCHT FULTHRD IM NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"6647-3-140","SUP","HCPCS C1713","","6647-3-140  -  SCREW BONE 6MM 40MM WCHT FULTHD KNEE CMPR FSN NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"6647-3-145","SUP","HCPCS C1713","","6647-3-145  -  SCREW BONE 6MM 45MM WCHT FULTHD KNEE CMPR FSN NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"6647-3-150","SUP","HCPCS C1713","","6647-3-150  -  SCREW BONE 6MM 50MM WCHT FULTHD KNEE CMPR FSN NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"6647-3-155","SUP","HCPCS C1713","","6647-3-155  -  SCREW BONE 6MM 55MM WCHT FULTHD KNEE FSN NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"6647-3-160","SUP","HCPCS C1713","","6647-3-160  -  SCREW BONE 6MM 60MM WCHT FULTHD KNEE FSN NAIL","BOTH IP/OP","$500.50 ","$370.37 ","$0.00 ","$500.50 ","$225.23 ","$0.00 ","$104.32 ","$0.00 ","$0.00 ","$87.63 ","$500.50 ","$0.00 ","$250.25 ","$396.40 ","$400.40 ","$0.00 ","$78.33 ","$0.00 ","$79.68 ","$0.00 "
"670000B","SUP","HCPCS C1713","","670000B  -  SCREW BONE 6.5MM 30MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670001B","SUP","HCPCS C1713","","670001B  -  SCREW BONE 6.5MM 35MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670002B","SUP","HCPCS C1713","","670002B  -  SCREW BONE 6.5MM 40MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670003B","SUP","HCPCS C1713","","670003B  -  SCREW BONE 6.5MM 45MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670004B","SUP","HCPCS C1713","","670004B  -  SCREW BONE 6.5MM 50MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670005B","SUP","HCPCS C1713","","670005B  -  SCREW BONE 7.5MM 35MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670006B","SUP","HCPCS C1713","","670006B  -  SCREW BONE 7.5MM 40MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670007B","SUP","HCPCS C1713","","670007B  -  SCREW BONE 7.5MM 45MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670008B","SUP","HCPCS C1713","","670008B  -  SCREW BONE 7.5MM 50MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670009B","SUP","HCPCS C1713","","670009B  -  SCREW BONE 7.5MM 55MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670010B","SUP","HCPCS C1713","","670010B  -  SCREW BONE 7.5MM 60MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670015B","SUP","HCPCS C1713","","670015B  -  SCREW BONE 6.5MM 55MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670016B","SUP","HCPCS C1713","","670016B  -  SCREW BONE 6.5MM 60MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670017B","SUP","HCPCS C1713","","670017B  -  SCREW BONE 7.5MM 30MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670-044-00","SUP","HCPCS C1887","","CATHETER GUID AL 1ST TIP SHP 6FR .070IN 100CM PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"670061B","SUP","HCPCS C1713","","670061B  -  SCREW BONE 5.5MM 30MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670062B","SUP","HCPCS C1713","","670062B  -  SCREW BONE 5.5MM 35MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670063B","SUP","HCPCS C1713","","670063B  -  SCREW BONE 5.5MM 40MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670070B","SUP","HCPCS C1713","","670070B  -  SCREW BONE 6.5MM 30MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670071B","SUP","HCPCS C1713","","670071B  -  SCREW BONE 6.5MM 35MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670072B","SUP","HCPCS C1713","","670072B  -  SCREW BONE 6.5MM 40MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670073B","SUP","HCPCS C1713","","670073B  -  SCREW BONE 6.5MM 45MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670074B","SUP","HCPCS C1713","","670074B  -  SCREW BONE 6.5MM 50MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670075B","SUP","HCPCS C1713","","670075B  -  SCREW BONE 6.5MM 55MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670076B","SUP","HCPCS C1713","","670076B  -  SCREW BONE 6.5MM 60MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670080B","SUP","HCPCS C1713","","670080B  -  SCREW BONE 7.5MM 30MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670081B","SUP","HCPCS C1713","","670081B  -  SCREW BONE 7.5MM 35MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670082B","SUP","HCPCS C1713","","670082B  -  SCREW BONE 7.5MM 40MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670083B","SUP","HCPCS C1713","","670083B  -  SCREW BONE 7.5MM 45MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670084B","SUP","HCPCS C1713","","670084B  -  SCREW BONE 7.5MM 50MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670086B","SUP","HCPCS C1713","","670086B  -  SCREW BONE 7.5MM 55MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670087B","SUP","HCPCS C1713","","670087B  -  SCREW BONE 7.5MM 60MM OPUS LNG SPNL HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670-090-00","SUP","HCPCS C1887","","CATHETER GUID JR4ST CURVE 6FR .070IN 100CM PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"670110B","SUP","HCPCS C1713","","670110B  -  SCREW BONE 9MM 30MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670111B","SUP","HCPCS C1713","","670111B  -  SCREW BONE 9MM 35MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670112B","SUP","HCPCS C1713","","670112B  -  SCREW BONE 9MM 40MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670113B","SUP","HCPCS C1713","","670113B  -  SCREW BONE 9MM 45MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670114B","SUP","HCPCS C1713","","670114B  -  SCREW BONE 9MM 50MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670115B","SUP","HCPCS C1713","","670115B  -  SCREW BONE 9MM 55MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670116B","SUP","HCPCS C1713","","670116B  -  SCREW BONE 9MM 60MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670212B","SUP","HCPCS C1713","","670212B  -  SCREW BONE 5.5MM 30MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670213B","SUP","HCPCS C1713","","670213B  -  SCREW BONE 5.5MM 35MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670214B","SUP","HCPCS C1713","","670214B  -  SCREW BONE 5.5MM 40MM OPUS SPNL CYLND","BOTH IP/OP","$1,556.83 ","$1,152.05 ","$0.00 ","$1,556.83 ","$700.57 ","$0.00 ","$324.48 ","$0.00 ","$0.00 ","$272.59 ","$1,556.83 ","$0.00 ","$778.41 ","$1,233.01 ","$1,245.46 ","$0.00 ","$243.64 ","$0.00 ","$247.85 ","$0.00 "
"670215B","SUP","HCPCS C1713","","670215B  -  SCREW BONE 5.5MM 45MM OPUS THOR SPN","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670223C","SUP","HCPCS C1713","","670223C  -  PLATE SHRT 3 HOLE OPUS BONE SPNL","BOTH IP/OP","$2,772.18 ","$2,051.41 ","$0.00 ","$2,772.18 ","$1,247.48 ","$0.00 ","$577.79 ","$0.00 ","$0.00 ","$485.39 ","$2,772.18 ","$0.00 ","$1,386.09 ","$2,195.57 ","$2,217.74 ","$0.00 ","$433.85 ","$0.00 ","$441.33 ","$0.00 "
"670-26090","SUP","HCPCS C1887","","CATHETER GUID STRG ENVOY 6FR .90CM","BOTH IP/OP","$785.00 ","$580.90 ","$0.00 ","$785.00 ","$426.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.45 ","$785.00 ","$0.00 ","$392.50 ","$621.72 ","$628.00 ","$0.00 ","$122.85 ","$0.00 ","$124.97 ","$0.00 "
"670300B","SUP","HCPCS C1713","","670300B  -  SCREW BONE 6.5MM 30MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670301B","SUP","HCPCS C1713","","670301B  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670302B","SUP","HCPCS C1713","","670302B  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670303B","SUP","HCPCS C1713","","670303B  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670304B","SUP","HCPCS C1713","","670304B  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670305B","SUP","HCPCS C1713","","670305B  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6703-1-018","SUP","Custom 27203010","","6703-1-018  -  WIRE SUT .032IN VIT 6 PER TUBE","BOTH IP/OP","$50.38 ","$37.28 ","$0.00 ","$50.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.38 ","$0.00 ","$25.19 ","$39.90 ","$40.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"670310B","SUP","HCPCS C1713","","670310B  -  SCREW BONE 7.5MM 30MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670311B","SUP","HCPCS C1713","","670311B  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670312B","SUP","HCPCS C1713","","670312B  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670313B","SUP","HCPCS C1713","","670313B  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670314B","SUP","HCPCS C1713","","670314B  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670315B","SUP","HCPCS C1713","","670315B  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670316B","SUP","HCPCS C1713","","670316B  -  SCREW BONE 7.5MM 60MM OPUS SPNL LNG TOP CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6703-2-120","SUP","Custom 27203010","","6703-2-120  -  WIRE SUT .032IN VIT","BOTH IP/OP","$217.75 ","$161.14 ","$0.00 ","$217.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$217.75 ","$0.00 ","$108.88 ","$172.46 ","$174.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"670370B","SUP","HCPCS C1713","","670370B  -  SCREW BONE 6.5MM 30MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670371B","SUP","HCPCS C1713","","670371B  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670372B","SUP","HCPCS C1713","","670372B  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670373B","SUP","HCPCS C1713","","670373B  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670374B","SUP","HCPCS C1713","","670374B  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670375B","SUP","HCPCS C1713","","670375B  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670376B","SUP","HCPCS C1713","","670376B  -  SCREW BONE 6.5MM 60MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670380B","SUP","HCPCS C1713","","670380B  -  SCREW BONE 7.5MM 30MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670381B","SUP","HCPCS C1713","","670381B  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670382B","SUP","HCPCS C1713","","670382B  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670383B","SUP","HCPCS C1713","","670383B  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670384B","SUP","HCPCS C1713","","670384B  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670385B","SUP","HCPCS C1713","","670385B  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"670386B","SUP","HCPCS C1713","","670386B  -  SCREW BONE 7.5MM 60MM OPUS SPNL LNG TOP LNG HEX CYLND","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"6704-0-110","SUP","HCPCS C1713","","6704-0-110  -  CABLE ORTHOPEDIC 2 1.6MM HOMOGENOUS GRIP DALL-MILES","BOTH IP/OP","$2,022.50 ","$1,496.65 ","$0.00 ","$2,022.50 ","$910.13 ","$0.00 ","$421.54 ","$0.00 ","$0.00 ","$354.12 ","$2,022.50 ","$0.00 ","$1,011.25 ","$1,601.82 ","$1,618.00 ","$0.00 ","$316.52 ","$0.00 ","$321.98 ","$0.00 "
"6704-0-210","SUP","HCPCS C1713","","6704-0-210  -  CABLE ORTHOPEDIC 2 2MM HOMOGENOUS GRIP DALL-MILES VITALLIUM","BOTH IP/OP","$2,022.50 ","$1,496.65 ","$0.00 ","$2,022.50 ","$910.13 ","$0.00 ","$421.54 ","$0.00 ","$0.00 ","$354.12 ","$2,022.50 ","$0.00 ","$1,011.25 ","$1,601.82 ","$1,618.00 ","$0.00 ","$316.52 ","$0.00 ","$321.98 ","$0.00 "
"6704-0-310","SUP","HCPCS C1713","","6704-0-310  -  CABLE ORTHOPEDIC 2 LARGE 2MM 22MM GRIP DALL-MILES VITALLIUM","BOTH IP/OP","$2,022.50 ","$1,496.65 ","$0.00 ","$2,022.50 ","$910.13 ","$0.00 ","$421.54 ","$0.00 ","$0.00 ","$354.12 ","$2,022.50 ","$0.00 ","$1,011.25 ","$1,601.82 ","$1,618.00 ","$0.00 ","$316.52 ","$0.00 ","$321.98 ","$0.00 "
"6704-0-410","SUP","HCPCS C1713","","6704-0-410  -  CABLE ORTHOPEDIC 1.6MM SET SLEEVE DALL-MILES VITALLIUM HIP","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$310.50 ","$0.00 ","$143.81 ","$0.00 ","$0.00 ","$120.81 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$107.99 ","$0.00 ","$109.85 ","$0.00 "
"6704-0-420","SUP","HCPCS C1713","","6704-0-420  -  CABLE ORTHOPEDIC 1.6MM SET SLEEVE BEADED DALL-MILES","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$333.00 ","$0.00 ","$154.23 ","$0.00 ","$0.00 ","$129.57 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$115.81 ","$0.00 ","$117.81 ","$0.00 "
"6704-0-510","SUP","Custom 27803010","","6704-0-510  -  CABLE ORTHOPEDIC 2 2MM HOMOGENOUS DALL-MILES VITALLIUM HIP","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6704-0-520","SUP","HCPCS C1713","","6704-0-520  -  CABLE ORTHOPEDIC 2MM SET SLEEVE BEAD DALL-MILES VITALLIUM","BOTH IP/OP","$740.00 ","$547.60 ","$0.00 ","$740.00 ","$333.00 ","$0.00 ","$154.23 ","$0.00 ","$0.00 ","$129.57 ","$740.00 ","$0.00 ","$370.00 ","$586.08 ","$592.00 ","$0.00 ","$115.81 ","$0.00 ","$117.81 ","$0.00 "
"6704-1-018","SUP","Custom 27203010","","6704-1-018  -  WIRE SUT .04IN 18IN DLMLS VIT 6 PER TUBE","BOTH IP/OP","$48.75 ","$36.08 ","$0.00 ","$48.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.75 ","$0.00 ","$24.38 ","$38.61 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6704-2-120","SUP","Custom 27203010","","6704-2-120  -  WIRE FX .04IN SUT VIT","BOTH IP/OP","$253.50 ","$187.59 ","$0.00 ","$253.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$253.50 ","$0.00 ","$126.75 ","$200.77 ","$202.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6704-3-070","SUP","HCPCS C1713","","6704-3-070  -  GRIP CBL 2MM SM DLMLS 2 CBL VIT HIP TROCH","BOTH IP/OP","$2,552.50 ","$1,888.85 ","$0.00 ","$2,552.50 ","$1,148.63 ","$0.00 ","$532.00 ","$0.00 ","$0.00 ","$446.92 ","$2,552.50 ","$0.00 ","$1,276.25 ","$2,021.58 ","$2,042.00 ","$0.00 ","$399.47 ","$0.00 ","$406.36 ","$0.00 "
"6704-3-080","SUP","HCPCS C1713","","6704-3-080  -  GRIP CABLE 2MM MEDIUM 2MM DALL-MILES VITALLIUM HIP","BOTH IP/OP","$2,552.50 ","$1,888.85 ","$0.00 ","$2,552.50 ","$1,148.63 ","$0.00 ","$532.00 ","$0.00 ","$0.00 ","$446.92 ","$2,552.50 ","$0.00 ","$1,276.25 ","$2,021.58 ","$2,042.00 ","$0.00 ","$399.47 ","$0.00 ","$406.36 ","$0.00 "
"6704-3-081","SUP","HCPCS C1713","","6704-3-081  -  PLATE BONE 2MM MEDIUM 100MM 2 CABLE GRIP DALL-MILES","BOTH IP/OP","$2,552.50 ","$1,888.85 ","$0.00 ","$2,552.50 ","$1,148.63 ","$0.00 ","$532.00 ","$0.00 ","$0.00 ","$446.92 ","$2,552.50 ","$0.00 ","$1,276.25 ","$2,021.58 ","$2,042.00 ","$0.00 ","$399.47 ","$0.00 ","$406.36 ","$0.00 "
"6704-3-082","SUP","HCPCS C1713","","6704-3-082  -  PLATE BN 2MM MED 150MM DLMLS 2 CBL GRP VIT HIP TROCH","BOTH IP/OP","$3,325.00 ","$2,460.50 ","$0.00 ","$3,325.00 ","$1,496.25 ","$0.00 ","$693.01 ","$0.00 ","$0.00 ","$582.18 ","$3,325.00 ","$0.00 ","$1,662.50 ","$2,633.40 ","$2,660.00 ","$0.00 ","$520.36 ","$0.00 ","$529.34 ","$0.00 "
"6704-3-083","SUP","HCPCS C1713","","6704-3-083  -  PLATE BN 2MM MED 200MM DLMLS 2 CBL GRP VIT HIP TROCH","BOTH IP/OP","$4,115.00 ","$3,045.10 ","$0.00 ","$4,115.00 ","$1,851.75 ","$0.00 ","$857.67 ","$0.00 ","$0.00 ","$720.50 ","$4,115.00 ","$0.00 ","$2,057.50 ","$3,259.08 ","$3,292.00 ","$0.00 ","$644.00 ","$0.00 ","$655.11 ","$0.00 "
"6704-3-090","SUP","HCPCS C1713","","6704-3-090  -  GRIP CABLE 2MM LARGE DALL-MILES VITALLIUM HIP","BOTH IP/OP","$2,552.50 ","$1,888.85 ","$0.00 ","$2,552.50 ","$1,148.63 ","$0.00 ","$532.00 ","$0.00 ","$0.00 ","$446.92 ","$2,552.50 ","$0.00 ","$1,276.25 ","$2,021.58 ","$2,042.00 ","$0.00 ","$399.47 ","$0.00 ","$406.36 ","$0.00 "
"6704-3-091","SUP","HCPCS C1713","","6704-3-091  -  PLATE BN 2MM LG 110MM DLMLS 2 CBL GRP VIT HIP TROCH","BOTH IP/OP","$2,552.50 ","$1,888.85 ","$0.00 ","$2,552.50 ","$1,148.63 ","$0.00 ","$532.00 ","$0.00 ","$0.00 ","$446.92 ","$2,552.50 ","$0.00 ","$1,276.25 ","$2,021.58 ","$2,042.00 ","$0.00 ","$399.47 ","$0.00 ","$406.36 ","$0.00 "
"6704-3-092","SUP","HCPCS C1713","","6704-3-092  -  PLATE BONE 2MM LARGE 160MM 2 CABLE GRIP DALL-MILES VITALLIUM","BOTH IP/OP","$3,325.00 ","$2,460.50 ","$0.00 ","$3,325.00 ","$1,496.25 ","$0.00 ","$693.01 ","$0.00 ","$0.00 ","$582.18 ","$3,325.00 ","$0.00 ","$1,662.50 ","$2,633.40 ","$2,660.00 ","$0.00 ","$520.36 ","$0.00 ","$529.34 ","$0.00 "
"6704-3-093","SUP","HCPCS C1713","","6704-3-093  -  PLATE BONE 2MM LARGE 210MM 2 CABLE GRIP DALL-MILES VITALLIUM","BOTH IP/OP","$4,115.00 ","$3,045.10 ","$0.00 ","$4,115.00 ","$1,851.75 ","$0.00 ","$857.67 ","$0.00 ","$0.00 ","$720.50 ","$4,115.00 ","$0.00 ","$2,057.50 ","$3,259.08 ","$3,292.00 ","$0.00 ","$644.00 ","$0.00 ","$655.11 ","$0.00 "
"6704-3-120","SUP","HCPCS C1713","","6704-3-120  -  WIRE FX .046IN HVY GA VIT","BOTH IP/OP","$253.50 ","$187.59 ","$0.00 ","$253.50 ","$114.08 ","$0.00 ","$52.84 ","$0.00 ","$0.00 ","$44.39 ","$253.50 ","$0.00 ","$126.75 ","$200.77 ","$202.80 ","$0.00 ","$39.67 ","$0.00 ","$40.36 ","$0.00 "
"6704-4-016","SUP","HCPCS C1713","","6704-4-016  -  SLEEVE CABLE SMALL 1.6MM CRIMP DALL-MILES VITALLIUM HIP","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"6704-4-020","SUP","HCPCS C1713","","6704-4-020  -  SLEEVE CABLE MEDIUM 2MM GRIP CRIMP DALL-MILES VITALLIUM HIP","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"6704-5-016","SUP","HCPCS C1713","","6704-5-016  -  GRIP CABLE SMALL 1.6MM HOLE DALL-MILES VITALLIUM HIP STERILE","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$537.75 ","$0.00 ","$249.07 ","$0.00 ","$0.00 ","$209.23 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$187.02 ","$0.00 ","$190.24 ","$0.00 "
"6704-6-020","SUP","HCPCS C1713","","6704-6-020  -  GRIP CABLE MEDIUM 2MM HOLE DALL-MILES VITALLIUM HIP STERILE","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$537.75 ","$0.00 ","$249.07 ","$0.00 ","$0.00 ","$209.23 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$187.02 ","$0.00 ","$190.24 ","$0.00 "
"6704-6-110","SUP","HCPCS C1713","","6704-6-110  -  BUTTON FIX GROOVE LOCK DALL-MILES VITALLIUM HIP","BOTH IP/OP","$647.50 ","$479.15 ","$0.00 ","$647.50 ","$291.38 ","$0.00 ","$134.96 ","$0.00 ","$0.00 ","$113.37 ","$647.50 ","$0.00 ","$323.75 ","$512.82 ","$518.00 ","$0.00 ","$101.33 ","$0.00 ","$103.08 ","$0.00 "
"6704-7-020","SUP","Custom 27803010","","6704-7-020  -  GRIP CABLE LARGE 2MM DALL-MILES VITALLIUM HIP STERILE","BOTH IP/OP","$1,195.00 ","$884.30 ","$0.00 ","$1,195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,195.00 ","$0.00 ","$597.50 ","$946.44 ","$956.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6704-8-030","SUP","HCPCS C1713","","6704-8-030  -  CABLE ORTHOPEDIC MINI SLEEVE DALL-MILES VITALLIUM HIP","BOTH IP/OP","$555.00 ","$410.70 ","$0.00 ","$555.00 ","$249.75 ","$0.00 ","$115.68 ","$0.00 ","$0.00 ","$97.18 ","$555.00 ","$0.00 ","$277.50 ","$439.56 ","$444.00 ","$0.00 ","$86.86 ","$0.00 ","$88.36 ","$0.00 "
"6704-8-236","SUP","HCPCS C1713","","6704-8-236  -  CABLE ORTHOPEDIC 1.6MM 750MM GRIP DALL-MILES VITALLIUM HIP","BOTH IP/OP","$622.50 ","$460.65 ","$0.00 ","$622.50 ","$280.13 ","$0.00 ","$129.74 ","$0.00 ","$0.00 ","$108.99 ","$622.50 ","$0.00 ","$311.25 ","$493.02 ","$498.00 ","$0.00 ","$97.42 ","$0.00 ","$99.10 ","$0.00 "
"6704-8-240","SUP","HCPCS C1713","","6704-8-240  -  CABLE ORTHOPEDIC 2MM 750MM GRIP DALL-MILES VITALLIUM HIP","BOTH IP/OP","$622.50 ","$460.65 ","$0.00 ","$622.50 ","$280.13 ","$0.00 ","$129.74 ","$0.00 ","$0.00 ","$108.99 ","$622.50 ","$0.00 ","$311.25 ","$493.02 ","$498.00 ","$0.00 ","$97.42 ","$0.00 ","$99.10 ","$0.00 "
"6707920P2","SUP","HCPCS C1713","","6707920P2  -  IMPLANT SPNL 4D 20X7X9MM LF CRNT LI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6707926P2","SUP","HCPCS C1713","","6707926P2  -  IMPLANT SPNL 4D 26X7X9MM LF CRNT LI","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708520P2","SUP","HCPCS C1713","","6708520P2  -  CAGE SPNL 15D LG TPR 20X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708820P2","SUP","HCPCS C1713","","6708820P2  -  CAGE SPNL 8D LG TPR 20X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708920P2","SUP","HCPCS C1713","","6708920P2  -  CAGE SPNL 4D LG IMPCT 20X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708926P2","SUP","HCPCS C1713","","6708926P2  -  CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6708932P2","SUP","HCPCS C1713","","6708932P2  -  CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709920P2","SUP","HCPCS C1713","","6709920P2  -  CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709926P2","SUP","HCPCS C1713","","6709926P2  -  CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6709932P2","SUP","HCPCS C1713","","6709932P2  -  CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710520P2","SUP","HCPCS C1713","","6710520P2  -  CAGE SPNL 15D LG TPR 20X10X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710820P2","SUP","HCPCS C1713","","6710820P2  -  CAGE SPNL 8D LG TPR 20X10X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710920P2","SUP","HCPCS C1713","","6710920P2  -  CAGE SPNL 4D LG IMPCT 20X10X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710926P2","SUP","HCPCS C1713","","6710926P2  -  CAGE SPNL 4D LG IMPCT 26X10X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6710932P2","SUP","HCPCS C1713","","6710932P2  -  CAGE SPNL 4D LG IMPCT 32X10X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711920P2","SUP","HCPCS C1713","","6711920P2  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711926P2","SUP","HCPCS C1713","","6711926P2  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6711932P2","SUP","HCPCS C1713","","6711932P2  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712520P2","SUP","HCPCS C1713","","6712520P2  -  CAGE SPNL 15D LG TPR 20X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712820P2","SUP","HCPCS C1713","","6712820P2  -  CAGE SPNL 8D LG TPR 20X12X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712920P2","SUP","HCPCS C1713","","6712920P2  -  CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712926P2","SUP","HCPCS C1713","","6712926P2  -  CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6712932P2","SUP","HCPCS C1713","","6712932P2  -  CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713920P2","SUP","HCPCS C1713","","6713920P2  -  CAGE SPNL 4D LG IMPCT LRDTC 20X13X9MM NS LF CRNT PEEK","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713926P2","SUP","HCPCS C1713","","6713926P2  -  CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6713932P2","SUP","HCPCS C1713","","6713932P2  -  CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714820P2","SUP","HCPCS C1713","","6714820P2  -  CAGE SPNL 8D LG TPR 20X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714920P2","SUP","HCPCS C1713","","6714920P2  -  CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714926P2","SUP","HCPCS C1713","","6714926P2  -  CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6714932P2","SUP","HCPCS C1713","","6714932P2  -  CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT PEEK-OPTM","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6715920P2","SUP","HCPCS C1713","","6715920P2  -  CAGE SPNL 4D LG IMPCT 20X9X15MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6715926P2","SUP","HCPCS C1713","","6715926P2  -  CAGE SPNL 4D LG IMPCT 26X9X15MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6716920P2","SUP","HCPCS C1713","","6716920P2  -  CAGE SPNL 4D LG IMPCT 20X9X16MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6716926P2","SUP","HCPCS C1713","","6716926P2  -  CAGE SPNL 4D LG IMPCT 26X9X16MM NS LF CRNT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"6720-0027","SUP","HCPCS C1776","","6720-0027  -  STEM FEM 132D 0 28MM STD OFST 93MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0127","SUP","HCPCS C1776","","6720-0127  -  STEM FEM 132D 1 29MM STD OFST 96MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0230","SUP","HCPCS C1776","","6720-0230  -  STEM FEM 132D 2 33MM STD OFST 99MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0330","SUP","HCPCS C1776","","6720-0330  -  STEM FEM 132D 3 35MM STD OFST 102MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0435","SUP","HCPCS C1776","","6720-0435  -  STEM FEM 132D 4 38MM STD OFST 105MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0535","SUP","HCPCS C1776","","6720-0535  -  STEM FEM 132D 5 40MM STD OFST 108MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0635","SUP","HCPCS C1776","","6720-0635  -  STEM FEM 132D 6 41MM STD OFST 111MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0737","SUP","HCPCS C1776","","6720-0737  -  STEM FEM 132D 7 46MM STD OFST 114MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0837","SUP","HCPCS C1776","","6720-0837  -  STEM FEM 132D 8 47MM STD OFST 117MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-0937","SUP","HCPCS C1776","","6720-0937  -  STEM FEM 132D 9 49MM STD OFST 120MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-1040","SUP","HCPCS C1776","","6720-1040  -  STEM FEM 132D 10 51MM STD OFST 123MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6720-1140","SUP","HCPCS C1776","","6720-1140  -  STEM FEM 132D 11 53MM STD OFST 126MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-0027","SUP","HCPCS C1776","","6721-0027  -  STEM FEM 127D 0 32MM HI OFST 93MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-0330","SUP","HCPCS C1776","","6721-0330  -  STEM FEM ACLD II 3 127D","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-0435","SUP","HCPCS C1713","","6721-0435  -  STEM FEM ACLD II 4 127D","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-0535","SUP","HCPCS C1713","","6721-0535  -  STEM FEM ACLD II 5 127D","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-0635","SUP","HCPCS C1776","","6721-0635  -  STEM FEM 127D 6 TPR 111MM STRL 35MM ACLD MDLR HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-0837","SUP","HCPCS C1776","","6721-0837  -  STEM FEM 127D 8 TPR 117MM STRL 37MM ACLD II MDLR HIP","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6721-1140","SUP","HCPCS C1776","","6721-1140  -  STEM FEM 127D 11 58MM HI OFST 126MM STRL ACLD II V40 PRFT","BOTH IP/OP","$5,357.50 ","$3,964.55 ","$0.00 ","$5,357.50 ","$2,410.88 ","$0.00 ","$1,116.64 ","$0.00 ","$0.00 ","$938.06 ","$5,357.50 ","$0.00 ","$2,678.75 ","$4,243.14 ","$4,286.00 ","$0.00 ","$838.45 ","$0.00 ","$852.91 ","$0.00 "
"6728-1-609","SUP","HCPCS C1776","","6728-1-609  -  INSERT TIBIAL SMALL 9MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-611","SUP","HCPCS C1776","","6728-1-611  -  INSERT TIBIAL SMALL 11MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-613","SUP","HCPCS C1776","","6728-1-613  -  INSERT TIBIAL SMALL 13MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-616","SUP","HCPCS C1776","","6728-1-616  -  INSERT TIBIAL SMALL 16MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-619","SUP","HCPCS C1776","","6728-1-619  -  INSERT TIBIAL SMALL 19MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-622","SUP","HCPCS C1776","","6728-1-622  -  INSERT TIBIAL SMALL 22MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-625","SUP","HCPCS C1776","","6728-1-625  -  INSERT TIBIAL SMALL 25MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-709","SUP","HCPCS C1776","","6728-1-709  -  INSERT TIBIAL SMALL 9MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-711","SUP","HCPCS C1776","","6728-1-711  -  INSERT TIBIAL SMALL 11MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-713","SUP","HCPCS C1776","","6728-1-713  -  INSERT TIBIAL SMALL 13MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-716","SUP","HCPCS C1776","","6728-1-716  -  INSERT TIBIAL SMALL 16MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-719","SUP","HCPCS C1776","","6728-1-719  -  INSERT TIBIAL SMALL 19MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-722","SUP","HCPCS C1776","","6728-1-722  -  INSERT TIBIAL SMALL 22MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-725","SUP","HCPCS C1776","","6728-1-725  -  INSERT TIBIAL SMALL 25MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-1-940","SUP","Custom 27803010","","6728-1-940  -  COMPONENT PATLR SMALL PRIM REVISION CUP PCA KNEE","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6728-2-609","SUP","HCPCS C1776","","6728-2-609  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-611","SUP","HCPCS C1776","","6728-2-611  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-613","SUP","HCPCS C1776","","6728-2-613  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-616","SUP","HCPCS C1776","","6728-2-616  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-619","SUP","HCPCS C1776","","6728-2-619  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-622","SUP","HCPCS C1776","","6728-2-622  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-625","SUP","HCPCS C1776","","6728-2-625  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-709","SUP","HCPCS C1776","","6728-2-709  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-711","SUP","HCPCS C1776","","6728-2-711  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-713","SUP","HCPCS C1776","","6728-2-713  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-716","SUP","HCPCS C1776","","6728-2-716  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-719","SUP","HCPCS C1776","","6728-2-719  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-722","SUP","HCPCS C1776","","6728-2-722  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-725","SUP","HCPCS C1776","","6728-2-725  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-2-940","SUP","HCPCS C1776","","6728-2-940  -  COMPONENT PATLR MEDIUM PRIM REVISION CUP PCA KNEE","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$1,633.50 ","$0.00 ","$756.58 ","$0.00 ","$0.00 ","$635.58 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$568.10 ","$0.00 ","$577.90 ","$0.00 "
"6728-4-609","SUP","HCPCS C1776","","6728-4-609  -  INSERT TIBIAL LARGE 9MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-611","SUP","HCPCS C1776","","6728-4-611  -  INSERT TIBIAL LARGE 11MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-613","SUP","HCPCS C1776","","6728-4-613  -  INSERT TIBIAL LARGE 13MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-616","SUP","HCPCS C1776","","6728-4-616  -  INSERT TIBIAL LARGE 16MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-619","SUP","HCPCS C1776","","6728-4-619  -  INSERT TIBIAL LARGE 19MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-622","SUP","HCPCS C1776","","6728-4-622  -  INSERT TIBIAL LARGE 22MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-625","SUP","HCPCS C1776","","6728-4-625  -  INSERT TIBIAL LARGE 25MM REVISION PCA KNEE LEFT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-709","SUP","HCPCS C1776","","6728-4-709  -  INSERT TIBIAL LARGE 9MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-711","SUP","HCPCS C1776","","6728-4-711  -  INSERT TIBIAL LARGE 11MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-713","SUP","HCPCS C1776","","6728-4-713  -  INSERT TIBIAL LARGE 13MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-716","SUP","HCPCS C1776","","6728-4-716  -  INSERT TIBIAL LARGE 16MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-719","SUP","HCPCS C1776","","6728-4-719  -  INSERT TIBIAL LARGE 19MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-722","SUP","HCPCS C1776","","6728-4-722  -  INSERT TIBIAL LARGE 22MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-725","SUP","HCPCS C1776","","6728-4-725  -  INSERT TIBIAL LARGE 25MM REVISION PCA KNEE RIGHT","BOTH IP/OP","$5,410.00 ","$4,003.40 ","$0.00 ","$5,410.00 ","$2,434.50 ","$0.00 ","$1,127.58 ","$0.00 ","$0.00 ","$947.25 ","$5,410.00 ","$0.00 ","$2,705.00 ","$4,284.72 ","$4,328.00 ","$0.00 ","$846.67 ","$0.00 ","$861.27 ","$0.00 "
"6728-4-940","SUP","Custom 27803010","","6728-4-940  -  COMPONENT PATLR LARGE PRIM REVISION PCA","BOTH IP/OP","$3,630.00 ","$2,686.20 ","$0.00 ","$3,630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,630.00 ","$0.00 ","$1,815.00 ","$2,874.96 ","$2,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-109","SUP","Custom 27803010","","6742-1-109  -  INSERT TIBIAL SMALL 9MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-111","SUP","Custom 27803010","","6742-1-111  -  INSERT TIBIAL SMALL 11MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-113","SUP","Custom 27803010","","6742-1-113  -  INSERT TIBIAL SMALL 13MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-116","SUP","Custom 27803010","","6742-1-116  -  INSERT TIBIAL SMALL 16MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-119","SUP","Custom 27803010","","6742-1-119  -  INSERT TIBIAL SMALL 19MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-122","SUP","Custom 27803010","","6742-1-122  -  INSERT TIBIAL SMALL 22MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-125","SUP","Custom 27803010","","6742-1-125  -  INSERT TIBIAL SMALL 25MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-209","SUP","Custom 27803010","","6742-1-209  -  INSERT TIBIAL MEDIUM 9MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-211","SUP","Custom 27803010","","6742-1-211  -  INSERT TIBIAL MEDIUM 11MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-213","SUP","Custom 27803010","","6742-1-213  -  INSERT TIBIAL MEDIUM 13MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-216","SUP","Custom 27803010","","6742-1-216  -  INSERT TIBIAL MEDIUM 16MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-219","SUP","Custom 27803010","","6742-1-219  -  INSERT TIBIAL MEDIUM 19MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-222","SUP","Custom 27803010","","6742-1-222  -  INSERT TIBIAL MEDIUM 12MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-225","SUP","Custom 27803010","","6742-1-225  -  INSERT TIBIAL MEDIUM 25MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-309","SUP","Custom 27803010","","6742-1-309  -  INSERT TIBIAL LARGE 9MM POSTERIOR STABILIZE LIPPED DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-311","SUP","Custom 27803010","","6742-1-311  -  INSERT TIBIAL LARGE 11MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-313","SUP","Custom 27803010","","6742-1-313  -  INSERT TIBIAL LARGE 13MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-316","SUP","Custom 27803010","","6742-1-316  -  INSERT TIBIAL LARGE 16MM POSTERIOR STABILIZE LIP DURACON DUR","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-319","SUP","Custom 27803010","","6742-1-319  -  INSERT TIBIAL LARGE 19MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-322","SUP","Custom 27803010","","6742-1-322  -  INSERT TIBIAL LARGE 22MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-325","SUP","Custom 27803010","","6742-1-325  -  INSERT TIBIAL LARGE 25MM POSTERIOR STABILIZE LIP DURACON","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-409","SUP","Custom 27803010","","6742-1-409  -  INSERT TIBIAL XL 9MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-411","SUP","Custom 27803010","","6742-1-411  -  INSERT TIBIAL XL 11MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-413","SUP","Custom 27803010","","6742-1-413  -  INSERT TIBIAL XL 13MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-416","SUP","Custom 27803010","","6742-1-416  -  INSERT TIBIAL XL 16MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-419","SUP","Custom 27803010","","6742-1-419  -  INSERT TIBIAL XL 19MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-422","SUP","Custom 27803010","","6742-1-422  -  INSERT TIBIAL XL 22MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-1-425","SUP","Custom 27803010","","6742-1-425  -  INSERT TIBIAL XL 25MM POSTERIOR STABILIZE LIP DURACON KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-009","SUP","Custom 27803010","","6742-4-009  -  INSERT TIBIAL XS 9MM STABILIZE LIP DURACON DUR KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-011","SUP","Custom 27803010","","6742-4-011  -  INSERT TIBIAL XS 11MM STABILIZE LIP DURACON DUR KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-013","SUP","Custom 27803010","","6742-4-013  -  INSERT TIBIAL XS 13MM STABILIZE LIP DURACON DUR KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-016","SUP","Custom 27803010","","6742-4-016  -  INSERT TIBIAL XS 16MM STABILIZE LIP DURACON DUR KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-109","SUP","Custom 27803010","","6742-4-109  -  INSERT TIBIAL SMALL 9MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-111","SUP","Custom 27803010","","6742-4-111  -  INSERT TIBIAL SMALL 11MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-113","SUP","Custom 27803010","","6742-4-113  -  INSERT TIBIAL SMALL 13MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-116","SUP","Custom 27803010","","6742-4-116  -  INSERT TIBIAL SMALL 16MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-119","SUP","Custom 27803010","","6742-4-119  -  INSERT TIBIAL SMALL 19MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-122","SUP","Custom 27803010","","6742-4-122  -  INSERT TIBIAL SMALL 22MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-125","SUP","Custom 27803010","","6742-4-125  -  INSERT TIBIAL SMALL 25MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-209","SUP","Custom 27803010","","6742-4-209  -  INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$2,230.00 ","$1,650.20 ","$0.00 ","$2,230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,230.00 ","$0.00 ","$1,115.00 ","$1,766.16 ","$1,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-209X","SUP","Custom 27803010","","6742-4-209X  -  INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-211","SUP","Custom 27803010","","6742-4-211  -  INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-211X","SUP","Custom 27803010","","6742-4-211X  -  INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-213","SUP","Custom 27803010","","6742-4-213  -  INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-213X","SUP","Custom 27803010","","6742-4-213X  -  INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-216","SUP","Custom 27803010","","6742-4-216  -  INSERT TIBIAL MEDIUM 16MM STABILIZE DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-219","SUP","Custom 27803010","","6742-4-219  -  INSERT TIBIAL MEDIUM 19MM STABILIZE DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-222","SUP","Custom 27803010","","6742-4-222  -  INSERT TIBIAL MEDIUM 22MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-225","SUP","Custom 27803010","","6742-4-225  -  INSERT TIBIAL MEDIUM 25MM STABILIZE DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-309","SUP","Custom 27803010","","6742-4-309  -  INSERT TIBIAL LARGE 9MM STABILIZE DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-309X","SUP","Custom 27803010","","6742-4-309X  -  INSERT TIBIAL LARGE 9MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-311","SUP","Custom 27803010","","6742-4-311  -  INSERT TIBIAL LARGE 11MM STABILIZE DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-311X","SUP","Custom 27803010","","6742-4-311X  -  INSERT TIBIAL LARGE 11MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-313","SUP","Custom 27803010","","6742-4-313  -  INSERT TIBIAL LARGE 13MM STABILIZE DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-313X","SUP","Custom 27803010","","6742-4-313X  -  INSERT TIBIAL LARGE 13MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-316","SUP","Custom 27803010","","6742-4-316  -  INSERT TIBIAL LARGE 16MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-319","SUP","Custom 27803010","","6742-4-319  -  INSERT TIBIAL LARGE 19MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-322","SUP","Custom 27803010","","6742-4-322  -  INSERT TIBIAL LARGE 22MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-325","SUP","Custom 27803010","","6742-4-325  -  INSERT TIBIAL LARGE 25MM STABILIZE LIP DURACON DUR KNEE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-409","SUP","Custom 27803010","","6742-4-409  -  INSERT TIBIAL XL 9MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-409X","SUP","Custom 27803010","","6742-4-409X  -  INSERT TIBIAL XL 9MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-411","SUP","Custom 27803010","","6742-4-411  -  INSERT TIBIAL XL 11MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-411X","SUP","Custom 27803010","","6742-4-411X  -  INSERT TIBIAL XL 11MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-413","SUP","Custom 27803010","","6742-4-413  -  INSERT TIBIAL XL 13MM STABILIZE DURACON KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-413X","SUP","Custom 27803010","","6742-4-413X  -  INSERT TIBIAL XL 13MM STABILIZE DURACON X3 KNEE CONDYLE","BOTH IP/OP","$5,025.00 ","$3,718.50 ","$0.00 ","$5,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,025.00 ","$0.00 ","$2,512.50 ","$3,979.80 ","$4,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-416","SUP","Custom 27803010","","6742-4-416  -  INSERT TIBIAL XL 16MM CNDYLR STABILIZED DURACON RIGHT","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-419","SUP","Custom 27803010","","6742-4-419  -  INSERT TIBIAL XL 19MM CNDYLR STABILIZED DURACON RIGHT","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-422","SUP","Custom 27803010","","6742-4-422  -  INSERT TIBIAL XL 22MM STABILIZE LIP DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6742-4-425","SUP","Custom 27803010","","6742-4-425  -  INSERT TIBIAL XL 25MM STABILIZE LIP DURACON DUR KNEE CONDYLE","BOTH IP/OP","$3,055.00 ","$2,260.70 ","$0.00 ","$3,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,055.00 ","$0.00 ","$1,527.50 ","$2,419.56 ","$2,444.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-111","SUP","Custom 27803010","","6752-5-111  -  INSERT TIB SM 11MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-113","SUP","Custom 27803010","","6752-5-113  -  INSERT TIB SM 13MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-116","SUP","Custom 27803010","","6752-5-116  -  INSERT TIB SM 16MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-119","SUP","Custom 27803010","","6752-5-119  -  INSERT TIB SM 19MM KNEE PS CNSTRN","BOTH IP/OP","$1,412.00 ","$1,044.88 ","$0.00 ","$1,412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.00 ","$0.00 ","$706.00 ","$1,118.30 ","$1,129.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-122","SUP","Custom 27803010","","6752-5-122  -  INSERT TIB SM 22MM KNEE PS CNSTRN","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-125","SUP","Custom 27803010","","6752-5-125  -  INSERT TIB SM 25MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,381.00 ","$1,021.94 ","$0.00 ","$1,381.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,381.00 ","$0.00 ","$690.50 ","$1,093.75 ","$1,104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-128","SUP","Custom 27803010","","6752-5-128  -  INSERT TIB SM 28MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-131","SUP","Custom 27803010","","6752-5-131  -  INSERT TIB SM 31MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-211","SUP","Custom 27803010","","6752-5-211  -  INSERT TIB MED 11MM KNEE PS CNSTRN","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-213","SUP","Custom 27803010","","6752-5-213  -  INSERT TIB MED 13MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-216","SUP","Custom 27803010","","6752-5-216  -  INSERT TIB MED 16MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-219","SUP","Custom 27803010","","6752-5-219  -  INSERT TIB MED 19MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-222","SUP","Custom 27803010","","6752-5-222  -  INSERT TIB MED 22MM KNEE PS CNSTRN","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-225","SUP","Custom 27803010","","6752-5-225  -  INSERT TIB MED 25MM KNEE PS CNSTRN","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-228","SUP","Custom 27803010","","6752-5-228  -  INSERT TIB MED 28MM KNEE PS CNSTRN","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-231","SUP","Custom 27803010","","6752-5-231  -  INSERT TIB MED 31MM KNEE PS CNSTRN","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-311","SUP","Custom 27803010","","6752-5-311  -  INSERT TIB LG 11MM KNEE PS CNSTRN","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-313","SUP","Custom 27803010","","6752-5-313  -  INSERT TIB LG 13MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-316","SUP","Custom 27803010","","6752-5-316  -  INSERT TIB LG 16MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-319","SUP","Custom 27803010","","6752-5-319  -  INSERT TIB LG 19MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,412.00 ","$1,044.88 ","$0.00 ","$1,412.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.00 ","$0.00 ","$706.00 ","$1,118.30 ","$1,129.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-322","SUP","Custom 27803010","","6752-5-322  -  INSERT TIB LG 22MM KNEE PS CNSTRN","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-325","SUP","Custom 27803010","","6752-5-325  -  INSERT TIB LG 25MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-328","SUP","Custom 27803010","","6752-5-328  -  INSERT TIB LG 28MM KNEE PS CNSTRN","BOTH IP/OP","$1,381.00 ","$1,021.94 ","$0.00 ","$1,381.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,381.00 ","$0.00 ","$690.50 ","$1,093.75 ","$1,104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-331","SUP","Custom 27803010","","6752-5-331  -  INSERT TIB LG 31MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,381.00 ","$1,021.94 ","$0.00 ","$1,381.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,381.00 ","$0.00 ","$690.50 ","$1,093.75 ","$1,104.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-411","SUP","Custom 27803010","","6752-5-411  -  INSERT TIB XL 11MM KNEE PS CNSTRN","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-413","SUP","Custom 27803010","","6752-5-413  -  INSERT TIB XL 13MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-416","SUP","Custom 27803010","","6752-5-416  -  INSERT TIB XL 16MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-419","SUP","Custom 27803010","","6752-5-419  -  INSERT TIB XL 19MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,763.00 ","$1,304.62 ","$0.00 ","$1,763.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,763.00 ","$0.00 ","$881.50 ","$1,396.30 ","$1,410.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-422","SUP","Custom 27803010","","6752-5-422  -  INSERT TIB XL 22MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6752-5-425","SUP","Custom 27803010","","6752-5-425  -  INSERT TIB XL 25MM KNEE PS CNSTRN MRS","BOTH IP/OP","$1,439.00 ","$1,064.86 ","$0.00 ","$1,439.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,439.00 ","$0.00 ","$719.50 ","$1,139.69 ","$1,151.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"67525P","SUP","HCPCS C1713","","67525P  -  SCREW BN 6.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67525S","SUP","HCPCS C1713","","67525S  -  SCREW BN STD 6.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67530P","SUP","HCPCS C1713","","67530P  -  SCREW BN 6.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67530S","SUP","HCPCS C1713","","67530S  -  SCREW BN STD 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67535P","SUP","HCPCS C1713","","67535P  -  SCREW BN 6.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67535S","SUP","HCPCS C1713","","67535S  -  SCREW BN STD 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67540P","SUP","HCPCS C1713","","67540P  -  SCREW BN 6.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67540S","SUP","HCPCS C1713","","67540S  -  SCREW BN STD 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67545P","SUP","HCPCS C1713","","67545P  -  SCREW BN 6.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67545S","SUP","HCPCS C1713","","67545S  -  SCREW BN STD 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67550P","SUP","HCPCS C1713","","67550P  -  SCREW BN 6.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67550S","SUP","HCPCS C1713","","67550S  -  SCREW BN STD 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67555P","SUP","HCPCS C1713","","67555P  -  SCREW BN 6.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67555S","SUP","HCPCS C1713","","67555S  -  SCREW BN STD 6.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67560P","SUP","HCPCS C1713","","67560P  -  SCREW BN 6.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67560S","SUP","HCPCS C1713","","67560S  -  SCREW BN STD 6.75MM 60MM SPRL R90D LCK SPNE THORLMBR","BOTH IP/OP","$2,228.53 ","$1,649.11 ","$0.00 ","$2,228.53 ","$1,002.84 ","$0.00 ","$464.48 ","$0.00 ","$0.00 ","$390.20 ","$2,228.53 ","$0.00 ","$1,114.26 ","$1,765.00 ","$1,782.82 ","$0.00 ","$348.76 ","$0.00 ","$354.78 ","$0.00 "
"67565P","SUP","HCPCS C1713","","67565P  -  SCREW BN 6.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"67565S","SUP","HCPCS C1713","","67565S  -  SCREW BN STD 6.75MM 65MM SPRL R90D LCK SPNE THORLMBR","BOTH IP/OP","$1,233.33 ","$912.66 ","$0.00 ","$1,233.33 ","$555.00 ","$0.00 ","$257.06 ","$0.00 ","$0.00 ","$215.95 ","$1,233.33 ","$0.00 ","$616.66 ","$976.80 ","$986.66 ","$0.00 ","$193.02 ","$0.00 ","$196.35 ","$0.00 "
"68-1405","SUP","Custom 27203010","","FORCEPS SURG DBKY 5MM ATRM CURVE 330 MD","BOTH IP/OP","$1,507.50 ","$1,115.55 ","$0.00 ","$1,507.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,507.50 ","$0.00 ","$753.75 ","$1,193.94 ","$1,206.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"68-1415","SUP","Custom 27203010","","FORCEPS SURG CLN 30MM 10MM JAW 330","BOTH IP/OP","$1,530.00 ","$1,132.20 ","$0.00 ","$1,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,530.00 ","$0.00 ","$765.00 ","$1,211.76 ","$1,224.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-22D","SUP","Custom 27803010","","690-00-22D  -  INSERT ACETAB 0D D 40MM 36MM 22MM 5.6MM CONSTRAIN RING LOCK","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-22E","SUP","Custom 27803010","","690-00-22E  -  INSERT ACETAB 0D E 44MM 36MM 22MM 7.5MM CONSTRAIN LOCK RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-28F","SUP","Custom 27803010","","690-00-28F  -  INSERT ACETAB 0D F 42MM 28MM CONSTRAIN TRIDENT UHMWPE HIP","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-28G","SUP","Custom 27803010","","690-00-28G  -  INSERT ACETAB 0D G 51.5MM 42MM 28MM 5.6MM CONSTRAIN LOCK","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-32H","SUP","Custom 27803010","","690-00-32H  -  INSERT ACETAB 0D H 55MM 46MM 32MM 7.8MM CONSTRAIN LOCK RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-32I","SUP","Custom 27803010","","690-00-32I  -  INSERT ACETAB 0D I 58MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-00-32J","SUP","Custom 27803010","","690-00-32J  -  INSERT ACETAB 0D J 62MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6900PTFX","SUP","Custom 27203010","","6900PTFX  -  SIZER VLV 29MM CRP-ED PRIMNT PLUS 33MM PRICRD HRT PRICRD","BOTH IP/OP","$20,695.00 ","$15,314.30 ","$0.00 ","$20,695.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,695.00 ","$0.00 ","$10,347.50 ","$16,390.44 ","$16,556.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6900PTFX 29","SUP","Custom 27803010","","6900PTFX 29  -  VALVE MTRL 29MM C-E PRM+ BPRTH THERMAFIX TRICENTRIX HLDR","BOTH IP/OP","$18,487.50 ","$13,680.75 ","$0.00 ","$18,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,487.50 ","$0.00 ","$9,243.75 ","$14,642.10 ","$14,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-22E","SUP","Custom 27803010","","690-10-22E  -  INSERT ACETAB 10D E 22MM CONSTRAIN TRIDENT HIP","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-22F","SUP","Custom 27803010","","690-10-22F  -  INSERT ACETAB 10D H 48.4MM 36MM 22MM 9.9MM CONSTRAIN BIPOL","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-28G","SUP","Custom 27803010","","690-10-28G  -  INSERT ACETAB 10D G 51.5MM 42MM 28MM 8.4MM CONSTRAIN BIPOL","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-28H","SUP","Custom 27803010","","690-10-28H  -  INSERT ACETAB 10D H 55MM 42MM 28MM 10.2MM CONSTRAIN BIPOL","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-28I","SUP","Custom 27803010","","690-10-28I  -  INSERT ACETAB 10D I 58MM 42MM 28MM 11.6MM CONSTRAIN RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-28J","SUP","Custom 27803010","","690-10-28J  -  INSERT ACETAB 10D J 62MM 42MM 28MM 13.7MM CONSTRAIN RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"690-10-28K","SUP","Custom 27803010","","690-10-28K  -  INSERT ACETAB 10D K 42MM 28MM CONSTRAIN BIPOL SPLIT RING","BOTH IP/OP","$6,590.00 ","$4,876.60 ","$0.00 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,590.00 ","$0.00 ","$3,295.00 ","$5,219.28 ","$5,272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-2244","SUP","Custom 27803010","","69-2244  -  INSERT ACETAB 0D 44MM 36MM 22MM 7.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-2246","SUP","Custom 27803010","","69-2246  -  INSERT ACETAB 0D 46MM 36MM 22MM 8.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-2248","SUP","Custom 27803010","","69-2248  -  INSERT ACETAB 0D 48MM 36MM 22MM CONSTRAIN BIPOL SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-2850","SUP","Custom 27803010","","69-2850  -  INSERT ACETAB 0D 50MM 42MM 28MM 7.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-2852","SUP","Custom 27803010","","69-2852  -  INSERT ACETAB 0D 52MM 42MM 28MM 8.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-2854","SUP","Custom 27803010","","69-2854  -  INSERT ACETAB 0D 54MM 42MM 28MM 9.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-3256","SUP","Custom 27803010","","69-3256  -  INSERT ACETAB 0D 56MM 46MM 32MM 8.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-3258","SUP","Custom 27803010","","69-3258  -  INSERT ACETAB 0D 58MM 46MM 32MM 9.3MM CONSTRAIN SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"69-3260","SUP","Custom 27803010","","69-3260  -  INSERT ACETAB 0D 60MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING","BOTH IP/OP","$6,797.50 ","$5,030.15 ","$0.00 ","$6,797.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,797.50 ","$0.00 ","$3,398.75 ","$5,383.62 ","$5,438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-380","SUP","Custom 27803010","","6936-0-380  -  HEAD FEM 105MM 38MM THMPSN REG HIP ENDOPRSTH FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-400","SUP","Custom 27803010","","6936-0-400  -  HEAD FEM 105MM 40MM THMPSN REG HIP FENST FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-410","SUP","Custom 27803010","","6936-0-410  -  HEAD FEM 41MM HIP ENDOPRSTH UNPLR ZML MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-420","SUP","Custom 27803010","","6936-0-420  -  HEAD FEM 42MM THMPSN HIP ENDOPRSTH FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-430","SUP","Custom 27803010","","6936-0-430  -  STEM FEM 105MM 43MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-440","SUP","Custom 27803010","","6936-0-440  -  HEAD FEM 44MM THMPSN HIP ENDOPRSTH FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-450","SUP","Custom 27803010","","6936-0-450  -  HEAD FEM 105MM 45MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-460","SUP","Custom 27803010","","6936-0-460  -  HEAD FEM 46MM MOORE ODC OMFT RLNC UHR UNTRX HIP ENDOPRSTH FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-470","SUP","Custom 27803010","","6936-0-470  -  HEAD FEM 47MM THMPSN HIP ENDOPRSTH FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-480","SUP","Custom 27803010","","6936-0-480  -  HEAD FEM REG 48MM HIP ENDOPRSTH FRAC PRD FR. THMPSN","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-490","SUP","Custom 27803010","","6936-0-490  -  HEAD FEM 105MM 49MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-500","SUP","Custom 27803010","","6936-0-500  -  STEM FEM 105MM 50MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-510","SUP","Custom 27803010","","6936-0-510  -  STEM FEM 105MM 51MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-520","SUP","Custom 27803010","","6936-0-520  -  HEAD FEM 105MM 52MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-530","SUP","Custom 27803010","","6936-0-530  -  STEM FEM 105MM 53MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-540","SUP","Custom 27803010","","6936-0-540  -  HEAD FEM 105MM 54MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-550","SUP","Custom 27803010","","6936-0-550  -  STEM FEM 105MM 55MM FENST MOORE ODC OMFT RLNC UHR UNPLR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6936-0-570","SUP","Custom 27803010","","6936-0-570  -  HEAD FEM 57MM THMPSN FEM HIP ENDOPRSTH FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-380","SUP","Custom 27803010","","6939-0-380  -  STEM FEM 130MM 38MM CVD FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-400","SUP","Custom 27803010","","6939-0-400  -  STEM FEM 130MM 40MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-410","SUP","Custom 27803010","","6939-0-410  -  STEM FEM 130MM 41MM CVD FENST ENDOPRSTH A-MVIT HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-420","SUP","Custom 27803010","","6939-0-420  -  STEM FEM 130MM 42MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-430","SUP","Custom 27803010","","6939-0-430  -  STEM FEM 43MM CVD FENST ENDOPRSTH MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-440","SUP","Custom 27803010","","6939-0-440  -  STEM FEM 130MM 44MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-450","SUP","Custom 27803010","","6939-0-450  -  STEM FEM 140MM 45MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-460","SUP","Custom 27803010","","6939-0-460  -  STEM FEM 140MM 46MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-470","SUP","Custom 27803010","","6939-0-470  -  STEM FEM 140MM 47MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-480","SUP","Custom 27803010","","6939-0-480  -  STEM FEM 140MM 48MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-490","SUP","Custom 27803010","","6939-0-490  -  STEM FEM 140MM 49MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-500","SUP","Custom 27803010","","6939-0-500  -  STEM FEM 150MM 50MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-510","SUP","Custom 27803010","","6939-0-510  -  STEM FEM 150MM 51MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-520","SUP","Custom 27803010","","6939-0-520  -  STEM FEM 150MM 52MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-530","SUP","Custom 27803010","","6939-0-530  -  STEM FEM 53MM CVD FENST ENDOPRSTH MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-540","SUP","Custom 27803010","","6939-0-540  -  STEM FEM 150MM 54MM CVD FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-550","SUP","Custom 27803010","","6939-0-550  -  HEAD FEM 150MM 55MM A-M FEM HIP FENST CURVE FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-560","SUP","Custom 27803010","","6939-0-560  -  HEAD FEM 56MM HIP FENST CVD MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-570","SUP","Custom 27803010","","6939-0-570  -  STEM FEM 150MM 57MM CVD FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-600","SUP","Custom 27803010","","6939-0-600  -  STEM FEM 60MM 60MM CVD FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-0-630","SUP","Custom 27803010","","6939-0-630  -  STEM FEM 150MM 63MM CVD FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-380","SUP","Custom 27803010","","6939-1-380  -  STEM FEM 135MM 38MM CVD FENST NAR A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-400","SUP","Custom 27803010","","6939-1-400  -  STEM FEM 40MM 40MM CVD FENST ENDOPRSTH A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-410","SUP","Custom 27803010","","6939-1-410  -  STEM FEM 135MM 41MM CVD FENST ENDOPRSTH A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-420","SUP","Custom 27803010","","6939-1-420  -  STEM FEM 135MM 42MM CVD FENST NAR A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-430","SUP","Custom 27803010","","6939-1-430  -  STEM FEM 135MM 43MM CVD FENST NAR A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-440","SUP","Custom 27803010","","6939-1-440  -  STEM FEM 135MM 44MM CVD FENST NAR A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-450","SUP","Custom 27803010","","6939-1-450  -  STEM FEM 135MM 45MM CVD FENST A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-460","SUP","Custom 27803010","","6939-1-460  -  STEM FEM 135MM 46MM CVD FENST A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-470","SUP","Custom 27803010","","6939-1-470  -  STEM FEM 47MM CVD FENST ENDOPRSTH MOORE NAR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-480","SUP","Custom 27803010","","6939-1-480  -  STEM FEM 135MM 48MM CVD FENST A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-490","SUP","Custom 27803010","","6939-1-490  -  STEM FEM 135MM 49MM CVD FENST A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-500","SUP","Custom 27803010","","6939-1-500  -  STEM FEM 135MM 50MM CVD FENST A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-1-510","SUP","Custom 27803010","","6939-1-510  -  STEM FEM 135MM 51MM CVD FENST A-M NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-400","SUP","Custom 27803010","","6939-5-400  -  STEM FEM 40MM MOORE HIP ENDOPRSTH CVD SLD FRAC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-410","SUP","Custom 27803010","","6939-5-410  -  STEM FEM 41MM ENDOPRSTH CVD SLD FRAC MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-420","SUP","Custom 27803010","","6939-5-420  -  STEM FEM 42MM ENDOPRSTH CVD SLD FRAC MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-430","SUP","Custom 27803010","","6939-5-430  -  STEM FEM 43MM SLD CVD MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-440","SUP","Custom 27803010","","6939-5-440  -  STEM FEM 44MM SLD CVD MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-450","SUP","Custom 27803010","","6939-5-450  -  STEM FEM 45MM SLD CVD MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-460","SUP","Custom 27803010","","6939-5-460  -  STEM FEM 46MM CVD SLD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-470","SUP","Custom 27803010","","6939-5-470  -  STEM FEM 47MM ENDOPRSTH CVD SLD FRAC MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-480","SUP","Custom 27803010","","6939-5-480  -  STEM FEM 48MM CVD SLD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-490","SUP","Custom 27803010","","6939-5-490  -  STEM FEM 49MM ENDOPRSTH CVD SLD FRAC MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-500","SUP","Custom 27803010","","6939-5-500  -  STEM FEM 50MM CVD SLD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-510","SUP","Custom 27803010","","6939-5-510  -  STEM FEM 51MM ENDOPRSTH CVD SLD FRAC MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-520","SUP","Custom 27803010","","6939-5-520  -  STEM FEM 52MM ENDOPRSTH MDLR CVD SLD MOORE HIP FRAC PRD","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-530","SUP","Custom 27803010","","6939-5-530  -  STEM FEM 53MM CVD SLD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-540","SUP","Custom 27803010","","6939-5-540  -  STEM FEM 54MM CVD SLD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-550","SUP","Custom 27803010","","6939-5-550  -  STEM FEM 55MM SLD CVD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6939-5-570","SUP","Custom 27803010","","6939-5-570  -  STEM FEM 57MM SLD CVD MOORE HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-380","SUP","Custom 27803010","","6940-0-380  -  STEM FEM 165MM 38MM STR FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-400","SUP","Custom 27803010","","6940-0-400  -  STEM FEM 165MM 40MM STR FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-410","SUP","Custom 27803010","","6940-0-410  -  HEAD UNPLR 165MM 41MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-420","SUP","Custom 27803010","","6940-0-420  -  HEAD FEM 42MM MOORE FEM HIP FENST STR FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-430","SUP","Custom 27803010","","6940-0-430  -  HEAD FEM 43MM A-M FEM HIP STR FENST FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-440","SUP","Custom 27803010","","6940-0-440  -  STEM FEM 165MM 44MM FENST ENDOPRSTH STR MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-450","SUP","Custom 27803010","","6940-0-450  -  HEAD FEM 165MM 45MM MOORE ODC OMFT RLNC UHR UNTRX HIP STR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-460","SUP","Custom 27803010","","6940-0-460  -  HEAD FEM 165MM 46MM A-M HIP FENST FR STRL","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-470","SUP","Custom 27803010","","6940-0-470  -  HEAD FEM 165MM 43MM MOORE ODC OMFT RLNC UHR UNTRX HIP FENST","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-480","SUP","Custom 27803010","","6940-0-480  -  HEAD FEM 48MM 48MM MOORE FEM HIP PENESTRATED FR STRL","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-490","SUP","Custom 27803010","","6940-0-490  -  HEAD FEM 165MM 49MM A-M FEM HIP STR FENST FR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-500","SUP","Custom 27803010","","6940-0-500  -  STEM FEM 190MM 50MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-510","SUP","Custom 27803010","","6940-0-510  -  STEM FEM 190MM 51MM STR FENST ENDOPRSTH A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-520","SUP","Custom 27803010","","6940-0-520  -  HEAD UNPLR 190MM 52MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-530","SUP","Custom 27803010","","6940-0-530  -  HEAD UNPLR 190MM 53MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-540","SUP","Custom 27803010","","6940-0-540  -  HEAD UNPLR 54MM 54MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-550","SUP","Custom 27803010","","6940-0-550  -  HEAD FEM 190MM 55MM A-M HIP FENST FR STRL","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-570","SUP","Custom 27803010","","6940-0-570  -  HEAD FEM 190MM 57MM A-M HIP FENST STR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-600","SUP","Custom 27803010","","6940-0-600  -  STEM FEM 190MM 60MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-0-630","SUP","Custom 27803010","","6940-0-630  -  STEM FEM 190MM 63MM STR FENST A-M HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-380","SUP","Custom 27803010","","6940-1-380  -  STEM FEM 38MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-400","SUP","Custom 27803010","","6940-1-400  -  STEM FEM 40MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-410","SUP","Custom 27803010","","6940-1-410  -  STEM FEM 41MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-420","SUP","Custom 27803010","","6940-1-420  -  STEM FEM 42MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-430","SUP","Custom 27803010","","6940-1-430  -  STEM FEM 43MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-440","SUP","Custom 27803010","","6940-1-440  -  STEM FEM 44MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-450","SUP","Custom 27803010","","6940-1-450  -  STEM FEM 45MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-460","SUP","Custom 27803010","","6940-1-460  -  STEM FEM 46MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-470","SUP","Custom 27803010","","6940-1-470  -  STEM FEM 47MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-480","SUP","Custom 27803010","","6940-1-480  -  STEM FEM 48MM STR FENST ENDOPRSTH MOORE NAR HIP","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-490","SUP","Custom 27803010","","6940-1-490  -  STEM FEM 49MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-500","SUP","Custom 27803010","","6940-1-500  -  STEM FEM 50MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-1-510","SUP","Custom 27803010","","6940-1-510  -  STEM FEM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-380","SUP","Custom 27803010","","6940-2-380  -  STEM FEM 300MM 38MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-400","SUP","Custom 27803010","","6940-2-400  -  STEM FEM 300MM 40MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-410","SUP","Custom 27803010","","6940-2-410  -  STEM FEM 300MM 41MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-420","SUP","Custom 27803010","","6940-2-420  -  STEM FEM 300MM 42MM STR FENST ENDOPRSTH A-M ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-450","SUP","Custom 27803010","","6940-2-450  -  STEM FEM 300MM 45MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-460","SUP","Custom 27803010","","6940-2-460  -  STEM FEM 300MM 46MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-470","SUP","Custom 27803010","","6940-2-470  -  STEM FEM 300MM 47MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-480","SUP","Custom 27803010","","6940-2-480  -  STEM FEM 300MM 48MM STR FENST ENDOPRSTH A-M ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-490","SUP","Custom 27803010","","6940-2-490  -  STEM FEM 300MM 49MM STR FENST ENDOPRSTH MOORE","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-500","SUP","Custom 27803010","","6940-2-500  -  STEM FEM 300MM 50MM STR FENST ENDOPRSTH MOORE","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-510","SUP","Custom 27803010","","6940-2-510  -  STEM FEM 300MM 51MM STR FENST ENDOPRSTH MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-520","SUP","Custom 27803010","","6940-2-520  -  STEM FEM 300MM 52MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-540","SUP","Custom 27803010","","6940-2-540  -  STEM FEM 300MM 54MM ENDOPRSTH STR FENST FRAC MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-550","SUP","Custom 27803010","","6940-2-550  -  STEM FEM 300MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-600","SUP","Custom 27803010","","6940-2-600  -  STEM FEM 300MM 60MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-2-630","SUP","Custom 27803010","","6940-2-630  -  STEM FEM 300MM 63MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-400","SUP","Custom 27803010","","6940-5-400  -  HEAD FEM 40MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-410","SUP","Custom 27803010","","6940-5-410  -  HEAD FEM 41MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-420","SUP","Custom 27803010","","6940-5-420  -  HEAD FEM 42MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-430","SUP","Custom 27803010","","6940-5-430  -  HEAD FEM 43MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-440","SUP","Custom 27803010","","6940-5-440  -  HEAD FEM 44MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-460","SUP","Custom 27803010","","6940-5-460  -  HEAD FEM 46MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-470","SUP","Custom 27803010","","6940-5-470  -  STEM FEM 47MM SLD ENDOPRSTH A-M STRL","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-490","SUP","Custom 27803010","","6940-5-490  -  HEAD FEM 49MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-500","SUP","Custom 27803010","","6940-5-500  -  HEAD FEM 50MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-510","SUP","Custom 27803010","","6940-5-510  -  HEAD FEM 51MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-520","SUP","Custom 27803010","","6940-5-520  -  HEAD FEM 52MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-530","SUP","Custom 27803010","","6940-5-530  -  STEM FEM 53MM SLD ENDOPRSTH A-M STRL","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-540","SUP","Custom 27803010","","6940-5-540  -  HEAD FEM 54MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-550","SUP","Custom 27803010","","6940-5-550  -  HEAD FEM 55MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-570","SUP","Custom 27803010","","6940-5-570  -  HEAD FEM 57MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-600","SUP","Custom 27803010","","6940-5-600  -  HEAD FEM 60MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-5-630","SUP","Custom 27803010","","6940-5-630  -  HEAD FEM 63MM HIP SLD STR MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-410","SUP","Custom 27803010","","6940-6-410  -  STEM FEM 41MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-420","SUP","Custom 27803010","","6940-6-420  -  STEM FEM 42MM STR SLD ENDOPRSTH MOORE","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-440","SUP","Custom 27803010","","6940-6-440  -  STEM FEM 44MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-450","SUP","Custom 27803010","","6940-6-450  -  STEM FEM 45MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-460","SUP","Custom 27803010","","6940-6-460  -  STEM FEM 46MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-470","SUP","Custom 27803010","","6940-6-470  -  STEM FEM 47MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-480","SUP","Custom 27803010","","6940-6-480  -  STEM FEM 48MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-6-490","SUP","Custom 27803010","","6940-6-490  -  STEM FEM 49MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR","BOTH IP/OP","$1,257.00 ","$930.18 ","$0.00 ","$1,257.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.00 ","$0.00 ","$628.50 ","$995.54 ","$1,005.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-380","SUP","Custom 27803010","","6940-8-380  -  STEM FEM 200MM 38MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-400","SUP","Custom 27803010","","6940-8-400  -  STEM FEM 200MM 40MM STR FENST ENDOPRSTH MOORE","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-410","SUP","Custom 27803010","","6940-8-410  -  STEM FEM 200MM 41MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-420","SUP","Custom 27803010","","6940-8-420  -  STEM FEM 200MM 42MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-430","SUP","Custom 27803010","","6940-8-430  -  STEM FEM 200MM 43MM ENDOPRSTH A-M HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-440","SUP","Custom 27803010","","6940-8-440  -  STEM FEM 200MM 44MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-450","SUP","Custom 27803010","","6940-8-450  -  STEM FEM 200MM 45MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-460","SUP","Custom 27803010","","6940-8-460  -  STEM FEM 200MM 46MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-470","SUP","Custom 27803010","","6940-8-470  -  STEM FEM 200MM 47MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-500","SUP","Custom 27803010","","6940-8-500  -  STEM FEM 200MM 50MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-510","SUP","Custom 27803010","","6940-8-510  -  STEM FEM 200MM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-530","SUP","Custom 27803010","","6940-8-530  -  STEM FEM 200MM 53MM STR FENST A-M HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-540","SUP","Custom 27803010","","6940-8-540  -  STEM FEM 200MM 54MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-550","SUP","Custom 27803010","","6940-8-550  -  STEM FEM 200MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-570","SUP","Custom 27803010","","6940-8-570  -  STEM FEM 200MM 57MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-600","SUP","Custom 27803010","","6940-8-600  -  STEM FEM 200MM 60MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-8-630","SUP","Custom 27803010","","6940-8-630  -  STEM FEM 200MM 63MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-380","SUP","Custom 27803010","","6940-9-380  -  STEM FEM 225MM 38MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-410","SUP","Custom 27803010","","6940-9-410  -  STEM FEM 225MM 41MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-440","SUP","Custom 27803010","","6940-9-440  -  STEM FEM 225MM 44MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-460","SUP","Custom 27803010","","6940-9-460  -  STEM FEM 225MM 46MM STR FENST ASTN-MOORE HIP","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-480","SUP","Custom 27803010","","6940-9-480  -  STEM FEM 225MM 48MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-490","SUP","Custom 27803010","","6940-9-490  -  STEM FEM 225MM 49MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-510","SUP","Custom 27803010","","6940-9-510  -  STEM FEM 225MM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-520","SUP","Custom 27803010","","6940-9-520  -  STEM FEM 225MM 52MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-530","SUP","Custom 27803010","","6940-9-530  -  STEM FEM 225MM 53MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-550","SUP","Custom 27803010","","6940-9-550  -  STEM FEM 225MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-570","SUP","Custom 27803010","","6940-9-570  -  STEM FEM 225MM 57MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6940-9-630","SUP","Custom 27803010","","6940-9-630  -  STEM FEM 225MM 63MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT","BOTH IP/OP","$1,544.00 ","$1,142.56 ","$0.00 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,544.00 ","$0.00 ","$772.00 ","$1,222.85 ","$1,235.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-038","SUP","Custom 27803010","","6942-5-038  -  HEAD UNPLR 38MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-040","SUP","Custom 27803010","","6942-5-040  -  HEAD UNPLR 40MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-041","SUP","Custom 27803010","","6942-5-041  -  HEAD UNPLR 41MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-042","SUP","Custom 27803010","","6942-5-042  -  HEAD UNPLR 42MM UNTRX FEM HIP MDLR ENDOPRSTH FR STRL","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-043","SUP","Custom 27803010","","6942-5-043  -  HEAD UNIPOLAR 43MM MODULAR THOMPSON MOORE ODC OMNIFIT HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-044","SUP","Custom 27803010","","6942-5-044  -  HEAD UNPLR 44MM UNTRX HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-045","SUP","Custom 27803010","","6942-5-045  -  HEAD UNPLR 45MM UNTRX FEM HIP MDLR ENDOPRSTH FR","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-046","SUP","Custom 27803010","","6942-5-046  -  HEAD UNPLR 46MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-047","SUP","Custom 27803010","","6942-5-047  -  HEAD UNIPOLAR 47MM MODULAR UNITRAX HIP FEMORAL EXETER V40","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-048","SUP","Custom 27803010","","6942-5-048  -  HEAD UNPLR 48MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-049","SUP","Custom 27803010","","6942-5-049  -  HEAD UNPLR 49MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-050","SUP","Custom 27803010","","6942-5-050  -  HEAD UNPLR 50MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-051","SUP","Custom 27803010","","6942-5-051  -  HEAD UNPLR 51MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-052","SUP","Custom 27803010","","6942-5-052  -  HEAD UNPLR 52MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-053","SUP","Custom 27803010","","6942-5-053  -  HEAD UNPLR 53MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-054","SUP","Custom 27803010","","6942-5-054  -  HEAD UNPLR 54MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-055","SUP","Custom 27803010","","6942-5-055  -  HEAD UNPLR 55MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-056","SUP","Custom 27803010","","6942-5-056  -  HEAD UNPLR 56MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-057","SUP","Custom 27803010","","6942-5-057  -  HEAD UNPLR 57MM UNTRX FEM HIP MDLR ENDOPRSTH","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-058","SUP","Custom 27803010","","6942-5-058  -  HEAD UNPLR 58MM STRL UNTRX MDLR EPRSTH HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-060","SUP","Custom 27803010","","6942-5-060  -  HEAD UNPLR 60MM UNTRX FEM HIP MDLR ENDOPRSTH","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-061","SUP","Custom 27803010","","6942-5-061  -  HEAD UNIPOLAR 61MM MODULAR UNITRAX HIP FEMORAL EXETER V40","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-5-063","SUP","Custom 27803010","","6942-5-063  -  HEAD UNPLR 63MM UNTRX FEM HIP MDLR ENDOPRSTH","BOTH IP/OP","$548.00 ","$405.52 ","$0.00 ","$548.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$548.00 ","$0.00 ","$274.00 ","$434.02 ","$438.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-010","SUP","Custom 27803010","","6942-6-010  -  SLEEVE CENTERING U PCA +0MM FEM HIP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-020","SUP","Custom 27803010","","6942-6-020  -  SLEEVE CENTERING +5MM UNITRAX PCA HIP FEMUR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-030","SUP","Custom 27803010","","6942-6-030  -  SLEEVE CENTERING +10MM UNITRAX PCA HIP FEMUR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-050","SUP","Custom 27803010","","6942-6-050  -  SLEEVE CENTERING -4MM UNITRAX PCA HIP FEMUR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-060","SUP","Custom 27803010","","6942-6-060  -  SLEEVE CENTERING -4MM UNIPOLAR UNITRAX V40 HIP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-065","SUP","Custom 27803010","","6942-6-065  -  SLEEVE CENTERING +0MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-070","SUP","Custom 27803010","","6942-6-070  -  SLEEVE CENTERING +4MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-075","SUP","Custom 27803010","","6942-6-075  -  SLEEVE CENTERING +8MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-6-080","SUP","Custom 27803010","","6942-6-080  -  SLEEVE CENTERING +12MM UNIPOLAR UNITRAX V40 HIP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-7-060","SUP","Custom 27803010","","6942-7-060  -  SLEEVE CENTERING -3MM C TAPER UNITRAX HIP FEMUR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-7-065","SUP","Custom 27803010","","6942-7-065  -  SLEEVE CENTERING +0MM C TAPER UNITRAX HIP FEMUR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-7-075","SUP","Custom 27803010","","6942-7-075  -  SLEEVE CENTERING UNTRX +5MM HIP CTPR NECK","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$226.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.00 ","$0.00 ","$113.00 ","$178.99 ","$180.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-7-080","SUP","Custom 27803010","","6942-7-080  -  SLEEVE CENTERING UNTRX 7.5MM CTPR","BOTH IP/OP","$226.00 ","$167.24 ","$0.00 ","$226.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.00 ","$0.00 ","$113.00 ","$178.99 ","$180.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6942-7-085","SUP","Custom 27203010","","6942-7-085  -  SLEEVE ADJ UNTRX +10MM FEM HIP CTPR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$226.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.00 ","$0.00 ","$113.00 ","$178.99 ","$180.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6951-0-036","SUP","Custom 27803010","","6951-0-036  -  SHELL ACETAB 44MM 40MM HIP VIT","BOTH IP/OP","$1,326.00 ","$981.24 ","$0.00 ","$1,326.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.00 ","$0.00 ","$663.00 ","$1,050.19 ","$1,060.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6951-0-040","SUP","Custom 27803010","","6951-0-040  -  SHELL ACETAB 48MM 44MM HIP","BOTH IP/OP","$1,326.00 ","$981.24 ","$0.00 ","$1,326.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.00 ","$0.00 ","$663.00 ","$1,050.19 ","$1,060.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6951-0-045","SUP","Custom 27803010","","6951-0-045  -  SHELL ACETAB 53MM 49MM HIP","BOTH IP/OP","$1,326.00 ","$981.24 ","$0.00 ","$1,326.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.00 ","$0.00 ","$663.00 ","$1,050.19 ","$1,060.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6951-0-050","SUP","Custom 27803010","","6951-0-050  -  SHELL ACETAB 58MM 54MM HIP PRTRS","BOTH IP/OP","$1,326.00 ","$981.24 ","$0.00 ","$1,326.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.00 ","$0.00 ","$663.00 ","$1,050.19 ","$1,060.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6951-0-054","SUP","Custom 27803010","","6951-0-054  -  SHELL ACETAB 62MM 58MM HIP VIT","BOTH IP/OP","$1,326.00 ","$981.24 ","$0.00 ","$1,326.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,326.00 ","$0.00 ","$663.00 ","$1,050.19 ","$1,060.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6955975L","SUP","HCPCS C1713","","6955975L  -  HOOK SPNL 4.5MM NS VRTX MX LT OFST TI LMN RECON SYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6955975R","SUP","HCPCS C1713","","6955975R  -  HOOK SPNL 4.5MM NS VRTX MX RT OFST TI LMN RECON SYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6955977L","SUP","HCPCS C1713","","6955977L  -  HOOK SPNL 6MM NS VRTX MX LT OFST TI LMN RECON SYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6955977R","SUP","HCPCS C1713","","6955977R  -  HOOK SPNL 6MM NS VRTX MX RT OFST TI LMN RECON SYS","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"6958718PT","SUP","HCPCS C1713","","6958718PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958720PT","SUP","HCPCS C1713","","6958720PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958722PT","SUP","HCPCS C1713","","6958722PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958724PT","SUP","HCPCS C1713","","6958724PT  -  SCREW BN P/T 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958726PT","SUP","HCPCS C1713","","6958726PT  -  SCREW BN P/T 3.5MM 26MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958728PT","SUP","HCPCS C1713","","6958728PT  -  SCREW BN P/T 3.5MM 28MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958730PT","SUP","HCPCS C1713","","6958730PT  -  SCREW BN P/T 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958732PT","SUP","HCPCS C1713","","6958732PT  -  SCREW BN P/T 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958734PT","SUP","HCPCS C1713","","6958734PT  -  SCREW BN P/T 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958736PT","SUP","HCPCS C1713","","6958736PT  -  SCREW BN P/T 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958738PT","SUP","HCPCS C1713","","6958738PT  -  SCREW BN P/T 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958740PT","SUP","HCPCS C1713","","6958740PT  -  SCREW BN P/T 3.5MM 40MM GRN NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958742PT","SUP","HCPCS C1713","","6958742PT  -  SCREW BN P/T 3.5MM 42MM VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958744PT","SUP","HCPCS C1713","","6958744PT  -  SCREW BN P/T 3.5MM 44MM VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958746PT","SUP","HCPCS C1713","","6958746PT  -  SCREW BN P/T 3.5MM 46MM VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958748PT","SUP","HCPCS C1713","","6958748PT  -  SCREW BN P/T 3.5MM 48MM VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958750PT","SUP","HCPCS C1713","","6958750PT  -  SCREW BN P/T 3.5MM 50MM VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958752PT","SUP","HCPCS C1713","","6958752PT  -  SCREW BN P/T 3.5MM 52MM VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958818PT","SUP","HCPCS C1713","","6958818PT  -  SCREW BN P/T 4MM 18MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958820PT","SUP","HCPCS C1713","","6958820PT  -  SCREW BN P/T 4MM 20MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958822PT","SUP","HCPCS C1713","","6958822PT  -  SCREW BN P/T 4MM 22MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958824PT","SUP","HCPCS C1713","","6958824PT  -  SCREW BN P/T 4MM 24MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958826PT","SUP","HCPCS C1713","","6958826PT  -  SCREW BN P/T 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958828PT","SUP","HCPCS C1713","","6958828PT  -  SCREW BN P/T 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958830PT","SUP","HCPCS C1713","","6958830PT  -  SCREW BN P/T 4MM 30MM AU 15MM VRTX MX TI SPNE OCPTL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958832PT","SUP","HCPCS C1713","","6958832PT  -  SCREW BN P/T 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958834PT","SUP","HCPCS C1713","","6958834PT  -  SCREW BN P/T 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958836PT","SUP","HCPCS C1713","","6958836PT  -  SCREW BN P/T 4MM 36MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958838PT","SUP","HCPCS C1713","","6958838PT  -  SCREW BN P/T 4MM 38MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958840PT","SUP","HCPCS C1713","","6958840PT  -  SCREW BN P/T 4MM 40MM AU NS VRTX MX MA TI SPNE THOR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958842PT","SUP","HCPCS C1713","","6958842PT  -  SCREW BN P/T 4MM 42MM AU VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958844PT","SUP","HCPCS C1713","","6958844PT  -  SCREW BN P/T 4MM 44MM AU VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958846PT","SUP","HCPCS C1713","","6958846PT  -  SCREW BN P/T 4MM 46MM AU VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958848PT","SUP","HCPCS C1713","","6958848PT  -  SCREW BN P/T 4MM 48MM AU VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958850PT","SUP","HCPCS C1713","","6958850PT  -  SCREW BN P/T 4MM 50MM AU VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6958852PT","SUP","HCPCS C1713","","6958852PT  -  SCREW BN P/T 4MM 52MM AU VRTX MX MA TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"6959420PT","SUP","HCPCS C1713","","6959420PT  -  SCREW BN P/T 4MM 20MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959422PT","SUP","HCPCS C1713","","6959422PT  -  SCREW BN P/T 4MM 22MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959424PT","SUP","HCPCS C1713","","6959424PT  -  SCREW BN P/T 4MM 24MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959426PT","SUP","HCPCS C1713","","6959426PT  -  SCREW BN P/T 4MM 26MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959428PT","SUP","HCPCS C1713","","6959428PT  -  SCREW BN P/T 4MM 28MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959430PT","SUP","HCPCS C1713","","6959430PT  -  SCREW BN P/T 4MM 30MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959432PT","SUP","HCPCS C1713","","6959432PT  -  SCREW BN P/T 4MM 32MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959434PT","SUP","HCPCS C1713","","6959434PT  -  SCREW BN P/T 4MM 34MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959436PT","SUP","HCPCS C1713","","6959436PT  -  SCREW BN P/T 4MM 36MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959438PT","SUP","HCPCS C1713","","6959438PT  -  SCREW BN P/T 4MM 38MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6959440PT","SUP","HCPCS C1713","","6959440PT  -  SCREW BN P/T 4MM 40MM MA CNN TI SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"6971250CK","SUP","HCPCS C1713","","6971250CK  -  DISC INTVRTB 5MM 12MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971270CK","SUP","HCPCS C1713","","6971270CK  -  DISC INTVRTB 7MM 12MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971450CK","SUP","HCPCS C1713","","6971450CK  -  DISC INTVRTB 5MM 14MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971470CK","SUP","HCPCS C1713","","6971470CK  -  DISC INTVRTB 7MM 14MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971480CK","SUP","HCPCS C1713","","6971480CK  -  DISC INTVRTB 8MM 14MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971650CK","SUP","HCPCS C1713","","6971650CK  -  DISC INTVRTB 5MM 16MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971670CK","SUP","HCPCS C1713","","6971670CK  -  DISC INTVRTB 7MM 16MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971680CK","SUP","HCPCS C1713","","6971680CK  -  DISC INTVRTB 8MM 16MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971870CK","SUP","HCPCS C1713","","6971870CK  -  DISC INTVRTB 7MM 18MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"6971880CK","SUP","HCPCS C1713","","6971880CK  -  DISC INTVRTB 8MM 18MM SPNE CRV","BOTH IP/OP","$10,200.00 ","$7,548.00 ","$0.00 ","$10,200.00 ","$4,590.00 ","$0.00 ","$2,125.94 ","$0.00 ","$0.00 ","$1,785.94 ","$10,200.00 ","$0.00 ","$5,100.00 ","$8,078.40 ","$8,160.00 ","$0.00 ","$1,596.30 ","$0.00 ","$1,623.84 ","$0.00 "
"698.600S","SUP","Custom 27803010","","698.600S  -  MARS 3V DISPOSABLE KIT","BOTH IP/OP","$7,440.00 ","$5,505.60 ","$0.00 ","$7,440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,440.00 ","$0.00 ","$3,720.00 ","$5,892.48 ","$5,952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6980-5-030","SUP","Custom 27803010","","6980-5-030  -  SRFC ARTC 30MM 1STP DISTAL KNEE","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6980-5-035","SUP","HCPCS C1713","","6980-5-035  -  STAPLE BONE DISTAL IMPL 35MM DISTAL KNEE 1STP","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$817.65 ","$0.00 ","$378.71 ","$0.00 ","$0.00 ","$318.14 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$284.36 ","$0.00 ","$289.27 ","$0.00 "
"6980-5-040","SUP","HCPCS C1713","","6980-5-040  -  STAPLE BONE 40MM DISTAL TIB 1STP","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$817.65 ","$0.00 ","$378.71 ","$0.00 ","$0.00 ","$318.14 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$284.36 ","$0.00 ","$289.27 ","$0.00 "
"6980-5-045","SUP","Custom 27803010","","6980-5-045  -  SRFC ARTC 45MM 1STP DISTAL","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6980-5-050","SUP","HCPCS C1713","","6980-5-050  -  STAPLE BONE 50MM DISTAL 1STP","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$817.65 ","$0.00 ","$378.71 ","$0.00 ","$0.00 ","$318.14 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$284.36 ","$0.00 ","$289.27 ","$0.00 "
"6980-5-055","SUP","HCPCS C1713","","6980-5-055  -  STAPLE BONE 55MM DISTAL TIB 1STP","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$817.65 ","$0.00 ","$378.71 ","$0.00 ","$0.00 ","$318.14 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$284.36 ","$0.00 ","$289.27 ","$0.00 "
"6980-5-060","SUP","HCPCS C1713","","6980-5-060  -  STAPLE BONE 60MM DISTAL FIRSTSTEP","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$817.65 ","$0.00 ","$378.71 ","$0.00 ","$0.00 ","$318.14 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$284.36 ","$0.00 ","$289.27 ","$0.00 "
"6980-5-065","SUP","HCPCS C1713","","6980-5-065  -  STAPLE BONE 65MM DISTAL KNEE FIRSTSTEP","BOTH IP/OP","$1,817.00 ","$1,344.58 ","$0.00 ","$1,817.00 ","$817.65 ","$0.00 ","$378.71 ","$0.00 ","$0.00 ","$318.14 ","$1,817.00 ","$0.00 ","$908.50 ","$1,439.06 ","$1,453.60 ","$0.00 ","$284.36 ","$0.00 ","$289.27 ","$0.00 "
"6981-5-060","SUP","HCPCS C1713","","6981-5-060  -  STAPLE BONE 60X15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-5-065","SUP","HCPCS C1713","","6981-5-065  -  STAPLE BONE 65X15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-5-070","SUP","HCPCS C1713","","6981-5-070  -  STAPLE BONE 70X15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-5-075","SUP","HCPCS C1713","","6981-5-075  -  STAPLE BONE 75 MMX 15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-5-080","SUP","HCPCS C1713","","6981-5-080  -  STAPLE BONE 80X15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-5-085","SUP","HCPCS C1713","","6981-5-085  -  STAPLE BONE 85X15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-5-090","SUP","HCPCS C1713","","6981-5-090  -  STAPLE BONE 90X15MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-6-060","SUP","HCPCS C1713","","6981-6-060  -  STAPLE BONE 60X10MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-6-065","SUP","HCPCS C1713","","6981-6-065  -  STAPLE BONE 65X10MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-6-070","SUP","HCPCS C1713","","6981-6-070  -  STAPLE BONE 70X10MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-6-075","SUP","Custom 27803010","","6981-6-075  -  SRFC ARTC 75X10MM 1STP PROX","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6981-6-080","SUP","HCPCS C1713","","6981-6-080  -  STAPLE BONE 80X10MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-6-085","SUP","HCPCS C1713","","6981-6-085  -  STAPLE BONE 85X10MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-6-090","SUP","HCPCS C1713","","6981-6-090  -  STAPLE BONE 90X10MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-060","SUP","HCPCS C1713","","6981-7-060  -  STAPLE BONE 60MMX5MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-065","SUP","HCPCS C1713","","6981-7-065  -  STAPLE BONE 65X5MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-070","SUP","HCPCS C1713","","6981-7-070  -  STAPLE BONE 70MMX5MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-075","SUP","HCPCS C1713","","6981-7-075  -  STAPLE BONE 75MMX5MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-080","SUP","HCPCS C1713","","6981-7-080  -  STAPLE BONE 80MMX5MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-085","SUP","HCPCS C1713","","6981-7-085  -  STAPLE BONE 85X5MM PROX KNEE 1STP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6981-7-090","SUP","HCPCS C1713","","6981-7-090  -  STAPLE BONE 90X5MM PROX FIRSTSTEP","BOTH IP/OP","$1,137.00 ","$841.38 ","$0.00 ","$1,137.00 ","$511.65 ","$0.00 ","$236.98 ","$0.00 ","$0.00 ","$199.08 ","$1,137.00 ","$0.00 ","$568.50 ","$900.50 ","$909.60 ","$0.00 ","$177.94 ","$0.00 ","$181.01 ","$0.00 "
"6985M","SUP","Custom 27203010","","KIT EXTENDER LEAD","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6A0001","SUP","HCPCS C1725","","CATHETER 6FR JR 3.5","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$47.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"6A0014","SUP","HCPCS C1725","","CATHETER ANGIO JR6 CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0019","SUP","HCPCS C1725","","CATHETER ANGIO AR2 CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A002","SUP","HCPCS C1725","","CATHETER 6FR JR4","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$19.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"6A0021","SUP","HCPCS C1725","","CATHETER ANGIO AL2 CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0024","SUP","HCPCS C1725","","CATHETER ANGIO 6FR 100CM 2 SH STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A003","SUP","HCPCS C1725","","CATHETER 6FR JR5","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0033","SUP","HCPCS C1725","","CATHETER ANGIO IMA CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0034","SUP","HCPCS C1725","","CATHETER ANGIO LCB CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0080","SUP","HCPCS C1725","","CATHETER ANGIO JL3.5 CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0083","SUP","HCPCS C1725","","CATHETER ANGIO JL5 CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6A0085","SUP","HCPCS C1725","","CATHETER ANGIO JL4 CURVE 6FR 100CM STSR","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"6DCFN","SUP","Custom 27203010","","6DCFN  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR","BOTH IP/OP","$83.74 ","$61.97 ","$0.00 ","$83.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.74 ","$0.00 ","$41.87 ","$66.32 ","$66.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6DCFS","SUP","Custom 27203010","","6DCFS  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR","BOTH IP/OP","$104.53 ","$77.35 ","$0.00 ","$89.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.90 ","$0.00 ","$44.95 ","$71.20 ","$71.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6DCT","SUP","Custom 27203010","","6DCT  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN","BOTH IP/OP","$117.10 ","$86.65 ","$0.00 ","$95.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.08 ","$0.00 ","$47.54 ","$75.30 ","$76.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6DFEN","SUP","Custom 27203010","","6DFEN  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN","BOTH IP/OP","$99.43 ","$73.58 ","$0.00 ","$100.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.92 ","$0.00 ","$50.46 ","$79.93 ","$80.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6E1322","SUP","Custom 25803010","","SOLUTION IV 0.9% NA CHLOR 250ML AVIVA LF","BOTH IP/OP","$7.70 ","$5.70 ","$0.00 ","$7.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.70 ","$0.00 ","$3.85 ","$6.10 ","$6.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6L215","SUP","Custom 27203010","","BELT 5 THK7/16IN 101IN B TYPE WRP 21/32IN","BOTH IP/OP","$81.35 ","$60.20 ","$0.00 ","$81.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.35 ","$0.00 ","$40.68 ","$64.43 ","$65.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6LGT","SUP","Custom 27203010","","6LGT  -  TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX","BOTH IP/OP","$114.73 ","$84.90 ","$0.00 ","$119.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$119.98 ","$0.00 ","$59.99 ","$92.23 ","$95.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6LGT","SUP","Custom 27203010","","TUBE 6.4MM UNCUF LRNTMY SHLY TRCH 6","BOTH IP/OP","$114.73 ","$84.90 ","$0.00 ","$119.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$119.98 ","$0.00 ","$59.99 ","$95.02 ","$95.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6M02A","SUP","Custom 27203010","","6M02A  -  SUTURE NONABSORBABLE CV-6 TTC-9 30IN 2 ARM MONOFILAMENT","BOTH IP/OP","$73.33 ","$54.26 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"6SCT","SUP","Custom 27203010","","6SCT  -  TUBE TRCH 6 8.3MM 6MM 67MM LF SHLY CUF SGL CNN RND TIP OBT","BOTH IP/OP","$71.38 ","$52.82 ","$0.00 ","$72.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.45 ","$0.00 ","$36.22 ","$57.38 ","$57.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70-0007","SUP","HCPCS C1713","","70-0007  -  PLATE BN 5 HL 1ST TARSOMETATARSAL","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0008","SUP","HCPCS C1713","","70-0008  -  PLATE BN 4 HL 1ST TARSOMETATARSAL","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0009","SUP","HCPCS C1713","","70-0009  -  PLATE BN 4 HL 2ND AND 3RD TARSOMETATARSAL","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0010","SUP","HCPCS C1713","","70-0010  -  PLATE BN LCK LT PROX MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0011","SUP","HCPCS C1713","","70-0011  -  PLATE BN LCK RT PROX MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0012","SUP","HCPCS C1713","","70-0012  -  PLATE BN LCK FSN LT DRSL 1ST MTP","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0013","SUP","HCPCS C1713","","70-0013  -  PLATE BN LCK FSN RT DRSL 1ST MTP","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0018","SUP","HCPCS C1713","","70-0018  -  PLATE BN REV LCK FSN LT 1ST MTP","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0019","SUP","HCPCS C1713","","70-0019  -  PLATE BN REV LCK FSN RT 1ST MTP","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"70-0022","SUP","HCPCS C1713","","70-0022  -  PLATE SM TI LCK BONE LEFT CALC NONSTRL","BOTH IP/OP","$3,520.00 ","$2,604.80 ","$0.00 ","$3,520.00 ","$1,584.00 ","$0.00 ","$733.66 ","$0.00 ","$0.00 ","$616.32 ","$3,520.00 ","$0.00 ","$1,760.00 ","$2,787.84 ","$2,816.00 ","$0.00 ","$550.88 ","$0.00 ","$560.38 ","$0.00 "
"70-0023","SUP","HCPCS C1713","","70-0023  -  PLATE SM LCK BONE RIGHT CALC","BOTH IP/OP","$3,520.00 ","$2,604.80 ","$0.00 ","$3,520.00 ","$1,584.00 ","$0.00 ","$733.66 ","$0.00 ","$0.00 ","$616.32 ","$3,520.00 ","$0.00 ","$1,760.00 ","$2,787.84 ","$2,816.00 ","$0.00 ","$550.88 ","$0.00 ","$560.38 ","$0.00 "
"70-0024","SUP","HCPCS C1713","","70-0024  -  PLATE MED BONE LEFT CALC","BOTH IP/OP","$3,520.00 ","$2,604.80 ","$0.00 ","$3,520.00 ","$1,584.00 ","$0.00 ","$733.66 ","$0.00 ","$0.00 ","$616.32 ","$3,520.00 ","$0.00 ","$1,760.00 ","$2,787.84 ","$2,816.00 ","$0.00 ","$550.88 ","$0.00 ","$560.38 ","$0.00 "
"70-0025","SUP","HCPCS C1713","","70-0025  -  PLATE BONE RIGHT CALC","BOTH IP/OP","$3,520.00 ","$2,604.80 ","$0.00 ","$3,520.00 ","$1,584.00 ","$0.00 ","$733.66 ","$0.00 ","$0.00 ","$616.32 ","$3,520.00 ","$0.00 ","$1,760.00 ","$2,787.84 ","$2,816.00 ","$0.00 ","$550.88 ","$0.00 ","$560.38 ","$0.00 "
"70-0026","SUP","HCPCS C1713","","70-0026  -  PLATE LG LCK BONE LEFT CALC NONSTRL","BOTH IP/OP","$3,520.00 ","$2,604.80 ","$0.00 ","$3,520.00 ","$1,584.00 ","$0.00 ","$733.66 ","$0.00 ","$0.00 ","$616.32 ","$3,520.00 ","$0.00 ","$1,760.00 ","$2,787.84 ","$2,816.00 ","$0.00 ","$550.88 ","$0.00 ","$560.38 ","$0.00 "
"70-0027","SUP","HCPCS C1713","","70-0027  -  PLATE LG LCK BONE CALC RIGHT","BOTH IP/OP","$3,520.00 ","$2,604.80 ","$0.00 ","$3,520.00 ","$1,584.00 ","$0.00 ","$733.66 ","$0.00 ","$0.00 ","$616.32 ","$3,520.00 ","$0.00 ","$1,760.00 ","$2,787.84 ","$2,816.00 ","$0.00 ","$550.88 ","$0.00 ","$560.38 ","$0.00 "
"70-0036","SUP","HCPCS C1713","","70-0036  -  PLATE BN MPJ 5 HL CMB FSN LCK LT 1ST MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0037","SUP","HCPCS C1713","","70-0037  -  PLATE 5 HOLE PRIM BONE RIGHT MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"700-04-42A","SUP","HCPCS C1776","","700-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-44B","SUP","HCPCS C1776","","700-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-46C","SUP","HCPCS C1776","","700-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-48D","SUP","HCPCS C1776","","700-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"70-0045","SUP","HCPCS C1713","","70-0045  -  PLATE BN STD NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"700-04-50D","SUP","HCPCS C1776","","700-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-52E","SUP","HCPCS C1776","","700-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-54E","SUP","HCPCS C1776","","700-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-56F","SUP","HCPCS C1776","","700-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-58F","SUP","HCPCS C1776","","700-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"70-0046","SUP","HCPCS C1713","","70-0046  -  PLATE BN STD RT DIST VOLR ULN","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"700-04-60G","SUP","HCPCS C1776","","700-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-62G","SUP","HCPCS C1776","","700-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-64H","SUP","HCPCS C1776","","700-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"700-04-66H","SUP","HCPCS C1776","","700-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II SB TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"70-0047","SUP","HCPCS C1713","","70-0047  -  PLATE BN LNG LG DIST ULN","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0048","SUP","HCPCS C1713","","70-0048  -  PLATE BN LNG NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0049","SUP","HCPCS C1713","","70-0049  -  PLATE 8 HOLE LCK BONE 1ST TARSOMETATARSAL","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-005","SUP","HCPCS C1713","","70-005  -  PLATE STD ACLC BONE DORSAL DISTAL RADL","BOTH IP/OP","$2,362.50 ","$1,748.25 ","$0.00 ","$2,362.50 ","$1,063.13 ","$0.00 ","$492.40 ","$0.00 ","$0.00 ","$413.65 ","$2,362.50 ","$0.00 ","$1,181.25 ","$1,871.10 ","$1,890.00 ","$0.00 ","$369.73 ","$0.00 ","$376.11 ","$0.00 "
"70-0050","SUP","HCPCS C1713","","70-0050  -  PLATE 7 HOLE LCK BONE 1ST TARSOMETATARSAL","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0051","SUP","HCPCS C1713","","70-0051  -  PLATE 7 HOLE LCK BONE SEC 3RD TARSOMETATARSAL","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0052","SUP","HCPCS C1713","","70-0052  -  PLATE MPJ LOW PROFILE 4 DEGREE L","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0053","SUP","HCPCS C1713","","70-0053  -  PLATE MPJ LOW PROFILE 4 DEGREE R","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0055","SUP","HCPCS C1713","","70-0055  -  PLATE STD TI ACLC BONE LEFT DISTAL DORSAL RADL STRL","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0056","SUP","HCPCS C1713","","70-0056  -  PLATE BN STD ACLC TI RT DRSL","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0057","SUP","HCPCS C1713","","70-0057  -  PLATE BN NAR NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0058","SUP","HCPCS C1713","","70-0058  -  PLATE BN NAR ACLC RT DRSL","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0063","SUP","HCPCS C1713","","70-0063  -  PLATE BN STD STRL ACLC XTD","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0064","SUP","HCPCS C1713","","70-0064  -  PLATE NAR TI ACLC BONE LEFT DISTAL VOLR ULN","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"70-0066","SUP","HCPCS C1713","","70-0066  -  PLATE 80MM 6 HOLE MIDSHAFT ACUMED BONE VOLR RADL STRL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0067","SUP","HCPCS C1713","","70-0067  -  PLATE TI 8 HOLE MIDSHAFT BONE VOLR RADL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0068","SUP","HCPCS C1713","","70-0068  -  PLATE 10 HOLE MIDSHAFT ACUMED BONE VOLR RADL STRL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0069","SUP","HCPCS C1713","","70-0069  -  PLATE 160MM 12 HOLE MIDSHAFT BONE VOLR RADL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0070","SUP","HCPCS C1713","","70-0070  -  PLATE BN 80MM NS 6 HL MIDSHAFT LOPRFL ULNA","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0071","SUP","HCPCS C1713","","70-0071  -  PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL ULNA","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0072","SUP","HCPCS C1713","","70-0072  -  PLATE TI 10 HOLE BONE ULN","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0073","SUP","HCPCS C1713","","70-0073  -  PLATE 12 HOLE MIDSHAFT BONE ULN","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0074","SUP","HCPCS C1713","","70-0074  -  PLATE 6 HOLE MIDSHAFT BONE ULN","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0075","SUP","HCPCS C1713","","70-0075  -  PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL RDS DORSOLATERAL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0076","SUP","HCPCS C1713","","70-0076  -  PLATE 10 HOLE BONE DORSOLATERAL RADL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0077","SUP","HCPCS C1713","","70-0077  -  PLATE 12 HOLE BONE DORSOLATERAL RADL","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0078","SUP","HCPCS C1713","","70-0078  -  PLATE MPJ PETIETE 4 DEGREE L","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0079","SUP","HCPCS C1713","","70-0079  -  PLATE MPJ PETIETE 4 DEGREE R","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0097","SUP","HCPCS C1713","","70-0097  -  PLATE BN STD CRVTR 31MM NS 3 HL LCK RADL HD","BOTH IP/OP","$2,652.50 ","$1,962.85 ","$0.00 ","$2,652.50 ","$1,193.63 ","$0.00 ","$552.85 ","$0.00 ","$0.00 ","$464.43 ","$2,652.50 ","$0.00 ","$1,326.25 ","$2,100.78 ","$2,122.00 ","$0.00 ","$415.12 ","$0.00 ","$422.28 ","$0.00 "
"70-0098","SUP","HCPCS C1713","","70-0098  -  PLATE BN 5 HLE/HD LCK RDS","BOTH IP/OP","$2,652.50 ","$1,962.85 ","$0.00 ","$2,652.50 ","$1,193.63 ","$0.00 ","$552.85 ","$0.00 ","$0.00 ","$464.43 ","$2,652.50 ","$0.00 ","$1,326.25 ","$2,100.78 ","$2,122.00 ","$0.00 ","$415.12 ","$0.00 ","$422.28 ","$0.00 "
"70-0099","SUP","HCPCS C1713","","70-0099  -  PLATE BN SM CRV 3 HL LCK RDS HD","BOTH IP/OP","$2,652.50 ","$1,962.85 ","$0.00 ","$2,652.50 ","$1,193.63 ","$0.00 ","$552.85 ","$0.00 ","$0.00 ","$464.43 ","$2,652.50 ","$0.00 ","$1,326.25 ","$2,100.78 ","$2,122.00 ","$0.00 ","$415.12 ","$0.00 ","$422.28 ","$0.00 "
"7000AC","SUP","Custom 27803010","","7000AC  -  CLAMP SPNL SPRL R90D","BOTH IP/OP","$1,615.25 ","$1,195.29 ","$0.00 ","$1,615.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.25 ","$0.00 ","$807.63 ","$1,279.28 ","$1,292.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7000OC","SUP","Custom 27803010","","7000OC  -  CLIP FX SPRL R90D OFST CRNL","BOTH IP/OP","$2,147.68 ","$1,589.28 ","$0.00 ","$2,147.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,147.68 ","$0.00 ","$1,073.84 ","$1,700.96 ","$1,718.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7000SOL","SUP","HCPCS C1713","","7000SOL  -  SCREW BN LG SPRL R90D OFST TI THORLMBR SPNE","BOTH IP/OP","$1,534.38 ","$1,135.44 ","$0.00 ","$1,534.38 ","$690.47 ","$0.00 ","$319.80 ","$0.00 ","$0.00 ","$268.66 ","$1,534.38 ","$0.00 ","$767.19 ","$1,215.23 ","$1,227.50 ","$0.00 ","$240.13 ","$0.00 ","$244.27 ","$0.00 "
"7000SOS","SUP","HCPCS C1713","","7000SOS  -  SCREW BN SHRT SPRL R90D OFST TI THORLMBR SPNE","BOTH IP/OP","$1,534.38 ","$1,135.44 ","$0.00 ","$1,534.38 ","$690.47 ","$0.00 ","$319.80 ","$0.00 ","$0.00 ","$268.66 ","$1,534.38 ","$0.00 ","$767.19 ","$1,215.23 ","$1,227.50 ","$0.00 ","$240.13 ","$0.00 ","$244.27 ","$0.00 "
"70-0100","SUP","HCPCS C1713","","70-0100  -  PLATE SM 5 HOLE LCK CRVTR BONE RADL HEAD STRL","BOTH IP/OP","$2,652.50 ","$1,962.85 ","$0.00 ","$2,652.50 ","$1,193.63 ","$0.00 ","$552.85 ","$0.00 ","$0.00 ","$464.43 ","$2,652.50 ","$0.00 ","$1,326.25 ","$2,100.78 ","$2,122.00 ","$0.00 ","$415.12 ","$0.00 ","$422.28 ","$0.00 "
"70-0109","SUP","HCPCS C1713","","70-0109  -  PLATE BONE LEFT TIB MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0110","SUP","HCPCS C1713","","70-0110  -  PLATE BONE RIGHT TIB MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0111","SUP","HCPCS C1713","","70-0111  -  PLATE BN 12 HL LCK LT DIST 3.5 MM SCR","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0112","SUP","HCPCS C1713","","70-0112  -  PLATE BN 12 HL LCK LT DIST 3.5 MM SCR","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0116","SUP","HCPCS C1713","","70-0116  -  PLATE BN 9 HL LCK LT DIST 3.5 MM SCR","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0117","SUP","HCPCS C1713","","70-0117  -  PLATE BN DIST CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0118","SUP","HCPCS C1713","","70-0118  -  PLATE BN 8 HL LAT ANT","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0119","SUP","HCPCS C1713","","70-0119  -  PLATE BN 8 HL LCK ANT MDL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0120","SUP","HCPCS C1713","","70-0120  -  PLATE BN 6 HL LCK ANT MDL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0121","SUP","HCPCS C1713","","70-0121  -  PLATE BN 10 HL ANT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0122","SUP","HCPCS C1713","","70-0122  -  PLATE BN 6 HL LCK ANT LAT","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0123","SUP","HCPCS C1713","","70-0123  -  PLATE BN 16 HL LCK RT DIST 2.3 MM SCR","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0124","SUP","HCPCS C1713","","70-0124  -  PLATE BN 101X11MM NS 16 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0125","SUP","HCPCS C1713","","70-0125  -  PLATE BN 13 HL LCK RT DIST 2.3 MM SCR","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0126","SUP","HCPCS C1713","","70-0126  -  PLATE BN 68X11MM NS 13 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0141","SUP","HCPCS C1713","","70-0141  -  PLATE 4D BONE LEFT MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0142","SUP","HCPCS C1713","","70-0142  -  PLATE 4D BONE RIGHT MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0143","SUP","HCPCS C1713","","70-0143  -  PLATE REV BONE LEFT MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0144","SUP","HCPCS C1713","","70-0144  -  PLATE REV BONE RIGHT MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0145","SUP","HCPCS C1713","","70-0145  -  PLATE 5 HOLE BONE FIB","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0147","SUP","HCPCS C1713","","70-0147  -  PLATE 7 HOLE LCK BONE LAT FIB","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0149","SUP","HCPCS C1713","","70-0149  -  PLATE 9 HOLE LP LCK BONE LAT FIB ANKL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0151","SUP","HCPCS C1713","","70-0151  -  PLATE 11 HOLE LCK LP TYPE 2 ANODIZE FNSH BONE LAT FIB ANKL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0153","SUP","HCPCS C1713","","70-0153  -  PLATE 13 HOLE LCK LP BONE LAT FIB ANKL NONSTRL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0169","SUP","HCPCS C1713","","70-0169  -  PLATE BN STD 9 HL LCK LAT FIB","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0171","SUP","HCPCS C1713","","70-0171  -  PLATE 11 HOLE LCK BONE LAT FIB ANKL NONSTRL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0173","SUP","HCPCS C1713","","70-0173  -  PLATE 13 HOLE LCK BONE LAT FIB ANKL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0227","SUP","HCPCS C1713","","70-0227  -  PLATE 7 HOLE LCK LP BONE MDL TIB NONSTRL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0229","SUP","HCPCS C1713","","70-0229  -  PLATE 9 HOLE BONE MDL TIB","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0245","SUP","HCPCS C1713","","70-0245  -  PLATE 5 HOLE LCK LP BONE ANT TIB NONSTRL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0247","SUP","HCPCS C1713","","70-0247  -  PLATE 7 HOLE LCK LP BONE ANT TIB NONSTRL","BOTH IP/OP","$3,222.50 ","$2,384.65 ","$0.00 ","$3,222.50 ","$1,450.13 ","$0.00 ","$671.65 ","$0.00 ","$0.00 ","$564.23 ","$3,222.50 ","$0.00 ","$1,611.25 ","$2,552.22 ","$2,578.00 ","$0.00 ","$504.32 ","$0.00 ","$513.02 ","$0.00 "
"70-0286","SUP","HCPCS C1713","","70-0286  -  PLATE BN 8 HL STRG LOPRFL CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0287","SUP","HCPCS C1713","","70-0287  -  PLATE BN 8 HL LOPRFL STRG RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0288","SUP","HCPCS C1713","","70-0288  -  PLATE BN LNG 8 HL LOPRFL LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0289","SUP","HCPCS C1713","","70-0289  -  PLATE BN LNG 8 HL LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0290","SUP","HCPCS C1713","","70-0290  -  PLATE BN 8 HL LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0291","SUP","HCPCS C1713","","70-0291  -  PLATE BN MED 8 HL LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0292","SUP","HCPCS C1713","","70-0292  -  PLATE BN SM 8 HL LOPRFL LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0293","SUP","HCPCS C1713","","70-0293  -  PLATE BN SM 8 HL LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0294","SUP","HCPCS C1713","","70-0294  -  PLATE BN LG 121X11MM NS 10 HL LCK MIDSHAFT LOPRFL TI CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0295","SUP","HCPCS C1713","","70-0295  -  PLATE BN 10 HL LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0296","SUP","HCPCS C1713","","70-0296  -  PLATE BN 6 HL LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0297","SUP","HCPCS C1713","","70-0297  -  PLATE BN NAR 6 HL LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0298","SUP","HCPCS C1713","","70-0298  -  PLATE BN 8 HL STRG LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0299","SUP","HCPCS C1713","","70-0299  -  PLATE BN NAR 8 HL LOPRFL STRG RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0300","SUP","HCPCS C1713","","70-0300  -  PLATE BN 8 HL LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0301","SUP","HCPCS C1713","","70-0301  -  PLATE BN NAR 8 HL LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0302","SUP","HCPCS C1713","","70-0302  -  PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN LT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0303","SUP","HCPCS C1713","","70-0303  -  PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN RT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0304","SUP","HCPCS C1713","","70-0304  -  PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN LT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0305","SUP","HCPCS C1713","","70-0305  -  PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN RT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0306","SUP","HCPCS C1713","","70-0306  -  PLATE BN STD 110MM NS 7 HL LOPRFL DIST TPR LMT CNTCT OLCRN","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0307","SUP","HCPCS C1713","","70-0307  -  PLATE BN STD 110MM NS 7 HL LOPRFL OLCRN RT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0308","SUP","HCPCS C1713","","70-0308  -  PLATE BN STD 150MM NS 11 HL LOPRFL OLCRN LT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0309","SUP","HCPCS C1713","","70-0309  -  PLATE STD 11 HOLE BONE RIGHT OLCRN","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0310","SUP","HCPCS C1713","","70-0310  -  PLATE 15 HOLE BONE CLVCL","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0311","SUP","HCPCS C1713","","70-0311  -  PLATE STD 190MM 15 HOLE PRECONTOURED LP TAP-LOC TCH ANTM","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0312","SUP","HCPCS C1713","","70-0312  -  PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN LT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0313","SUP","HCPCS C1713","","70-0313  -  PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN RT","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0314","SUP","HCPCS C1713","","70-0314  -  PLATE 9 HOLE EXTN BONE OLCRN","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0315","SUP","HCPCS C1713","","70-0315  -  PLATE 9 HOLE XTD BONE OLCRN","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0316","SUP","HCPCS C1713","","70-0316  -  PLATE NAR 85MM 5 HOLE BONE LEFT OLCRN","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0317","SUP","HCPCS C1713","","70-0317  -  PLATE NAR 85MM 5 HOLE OPTN DISTAL TPR DSGN LMT CNTCT PR BONE","BOTH IP/OP","$3,137.50 ","$2,321.75 ","$0.00 ","$3,137.50 ","$1,411.88 ","$0.00 ","$653.93 ","$0.00 ","$0.00 ","$549.35 ","$3,137.50 ","$0.00 ","$1,568.75 ","$2,484.90 ","$2,510.00 ","$0.00 ","$491.02 ","$0.00 ","$499.49 ","$0.00 "
"70-0319","SUP","HCPCS C1713","","70-0319  -  PLATE BN J LOPRFL LT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0320","SUP","HCPCS C1713","","70-0320  -  PLATE BN J LOPRFL RT CLVCL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"70-0323","SUP","HCPCS C1713","","70-0323  -  PLATE EXTN OSTMY BONE LEFT","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0324","SUP","HCPCS C1713","","70-0324  -  PLATE EXTN OSTMY BONE RIGHT","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0329","SUP","HCPCS C1713","","70-0329  -  PLATE BN 4D PET LCK MTP LT","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0330","SUP","HCPCS C1713","","70-0330  -  PLATE BN 4D PET MPJ LCK RT MTP","BOTH IP/OP","$1,280.00 ","$947.20 ","$0.00 ","$1,280.00 ","$576.00 ","$0.00 ","$266.78 ","$0.00 ","$0.00 ","$224.12 ","$1,280.00 ","$0.00 ","$640.00 ","$1,013.76 ","$1,024.00 ","$0.00 ","$200.32 ","$0.00 ","$203.78 ","$0.00 "
"70-0331","SUP","HCPCS C1713","","70-0331  -  PLATE BONE RADL STYLOID","BOTH IP/OP","$2,315.00 ","$1,713.10 ","$0.00 ","$2,315.00 ","$1,041.75 ","$0.00 ","$482.50 ","$0.00 ","$0.00 ","$405.34 ","$2,315.00 ","$0.00 ","$1,157.50 ","$1,833.48 ","$1,852.00 ","$0.00 ","$362.30 ","$0.00 ","$368.55 ","$0.00 "
"70-0334","SUP","HCPCS C1713","","70-0334  -  PLATE BN NS ACLC 2 SUT RDS LUNATE VOLR DIST","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0335","SUP","HCPCS C1713","","70-0335  -  PLATE BN BTRS NS ACLC 2 RIM RDS RT DIST DRSL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0336","SUP","HCPCS C1713","","70-0336  -  PLATE FRAC SYS BTRS RIM BONE LEFT DISTAL DORSAL RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0337","SUP","HCPCS C1713","","70-0337  -  PLATE FRAC SYS BTRS RIM BONE RIGHT DISTAL DORSAL LUNATE RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0338","SUP","HCPCS C1713","","70-0338  -  PLATE BONE LEFT DORSAL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0350","SUP","HCPCS C1713","","70-0350  -  PLATE BN STD 49X24MM NS ACLC 2 VA RDS LT VOLR DIST 2.3MM SCR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0351","SUP","HCPCS C1713","","70-0351  -  PLATE BN STD 49X24MM NS ACLC 2 VA RDS RT VOLR DIST 2.3MM SCR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0352","SUP","HCPCS C1713","","70-0352  -  PLATE LNG NAR ACLC 2 BONE PROX DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0353","SUP","HCPCS C1713","","70-0353  -  PLATE ACLC BONE RIGHT DISTAL VOLR PROX","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0354","SUP","HCPCS C1713","","70-0354  -  PLATE BN ACLC 2 W LT PROX","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0355","SUP","HCPCS C1713","","70-0355  -  PLATE BN W ACLC 2 RT PROX DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0356","SUP","HCPCS C1713","","70-0356  -  PLATE BN STD SLVR NS ACLC 2 LT DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0357","SUP","HCPCS C1713","","70-0357  -  PLATE BN STD REG ACLC 2 RT VOLR DIST RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0358","SUP","HCPCS C1713","","70-0358  -  PLATE BN NAR STRL ACLC 2 LT DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0359","SUP","HCPCS C1713","","70-0359  -  PLATE BN NAR STRL ACLC 2 RT DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0360","SUP","HCPCS C1713","","70-0360  -  PLATE BN W STRL ACLC 2 LT DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0361","SUP","HCPCS C1713","","70-0361  -  PLATE BN W ACLC 2 RT VOLR DIST RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0364","SUP","HCPCS C1713","","70-0364  -  PLATE NTRL ACLC 2 BONE PROX DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0365","SUP","HCPCS C1713","","70-0365  -  PLATE LNG EXTN ACLC 2 BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0366","SUP","HCPCS C1713","","70-0366  -  PLATE LNG EXTN ACLC 2 BONE RIGHT DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0368","SUP","HCPCS C1713","","70-0368  -  PLATE BN LNG STD ACLC 2 LT DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0369","SUP","HCPCS C1713","","70-0369  -  PLATE LNG STD ACLC 2 BONE RIGHT DISTAL RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0370","SUP","HCPCS C1713","","70-0370  -  PLATE LNG NAR ACLC 2 BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0371","SUP","HCPCS C1713","","70-0371  -  PLATE LNG NAR 65MM OPTM DSGN ACLC 2 BONE RIGHT DISTAL VOLR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0372","SUP","HCPCS C1713","","70-0372  -  PLATE BN LNG STD ACLC 2 LT PROX DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0373","SUP","HCPCS C1713","","70-0373  -  PLATE BN LNG STD ACLC 2 RT PROX DIST VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0374","SUP","HCPCS C1713","","70-0374  -  PLATE 5 HOLE BONE LEFT DISTAL POSTLAT HUM","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0375","SUP","HCPCS C1713","","70-0375  -  PLATE 78MM 5 HOLE BONE RIGHT P/L HUM","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0376","SUP","HCPCS C1713","","70-0376  -  PLATE 103MM 7 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0377","SUP","HCPCS C1713","","70-0377  -  PLATE 7 HOLE BONE RIGHT DISTAL POSTLAT HUM","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0378","SUP","HCPCS C1713","","70-0378  -  PLATE 152MM 11 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0379","SUP","HCPCS C1713","","70-0379  -  PLATE 152MM 11 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0380","SUP","HCPCS C1713","","70-0380  -  PLATE 203MM 15 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0381","SUP","HCPCS C1713","","70-0381  -  PLATE 203MM 15 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL","BOTH IP/OP","$3,437.50 ","$2,543.75 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$716.46 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"70-0382","SUP","HCPCS C1713","","70-0382  -  PLATE NAR LNG ACLC 2 BONE LEFT PROX DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0383","SUP","HCPCS C1713","","70-0383  -  PLATE LNG NAR ACLC 2 BONE LEFT PROX DISTAL VOLR RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70-0386","SUP","HCPCS C1713","","70-0386  -  PLATE MED BONE LEFT ANT CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0387","SUP","HCPCS C1713","","70-0387  -  PLATE MED BONE RIGHT ANT CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0388","SUP","HCPCS C1713","","70-0388  -  PLATE BONE LEFT ANT CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0389","SUP","HCPCS C1713","","70-0389  -  PLATE LG BONE RIGHT ANT CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0394","SUP","HCPCS C1713","","70-0394  -  PLATE LG 5 HOLE TUBE BONE POST CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0395","SUP","HCPCS C1713","","70-0395  -  PLATE 5 HOLE BONE RIGHT POST CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0396","SUP","HCPCS C1713","","70-0396  -  PLATE 6 HOLE BONE LEFT POST CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0397","SUP","HCPCS C1713","","70-0397  -  PLATE 6 HOLE BONE RIGHT POST CALC","BOTH IP/OP","$3,052.50 ","$2,258.85 ","$0.00 ","$3,052.50 ","$1,373.63 ","$0.00 ","$636.22 ","$0.00 ","$0.00 ","$534.47 ","$3,052.50 ","$0.00 ","$1,526.25 ","$2,417.58 ","$2,442.00 ","$0.00 ","$477.72 ","$0.00 ","$485.96 ","$0.00 "
"70-0400","SUP","HCPCS C1713","","70-0400  -  PLATE 8 HOLE BONE LEFT CALC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"70-0401","SUP","HCPCS C1713","","70-0401  -  PLATE MED 8 HOLE COMBO BONE RIGHT CALC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"70-0404","SUP","HCPCS C1713","","70-0404  -  PLATE 8 HOLE COMBO BONE LEFT CLVCL","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"70-0405","SUP","HCPCS C1713","","70-0405  -  PLATE 8 HOLE BONE RL NONSTRL","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"70-0406","SUP","HCPCS C1713","","70-0406  -  PLATE 4 HOLE COMBO BONE LEFT CALC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"70-0407","SUP","HCPCS C1713","","70-0407  -  PLATE LG 9 HOLE COMBO BONE RIGHT CALC","BOTH IP/OP","$3,250.00 ","$2,405.00 ","$0.00 ","$3,250.00 ","$1,462.50 ","$0.00 ","$677.38 ","$0.00 ","$0.00 ","$569.05 ","$3,250.00 ","$0.00 ","$1,625.00 ","$2,574.00 ","$2,600.00 ","$0.00 ","$508.63 ","$0.00 ","$517.40 ","$0.00 "
"7005-08003","SUP","HCPCS C1713","","7005-08003  -  PLATE BN T .8MM NS LOPRFL TI HND","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$614.25 ","$0.00 ","$284.50 ","$0.00 ","$0.00 ","$239.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$213.62 ","$0.00 ","$217.31 ","$0.00 "
"7005-08006","SUP","HCPCS C1713","","7005-08006  -  PLATE BN .8MM NS 6 HL CMPR TI HND","BOTH IP/OP","$1,185.00 ","$876.90 ","$0.00 ","$1,185.00 ","$533.25 ","$0.00 ","$246.98 ","$0.00 ","$0.00 ","$207.48 ","$1,185.00 ","$0.00 ","$592.50 ","$938.52 ","$948.00 ","$0.00 ","$185.45 ","$0.00 ","$188.65 ","$0.00 "
"7005-13005","SUP","HCPCS C1713","","7005-13005  -  PLATE BN NS ROT CRRT HND 1.3 MM SCR","BOTH IP/OP","$945.00 ","$699.30 ","$0.00 ","$945.00 ","$425.25 ","$0.00 ","$196.96 ","$0.00 ","$0.00 ","$165.46 ","$945.00 ","$0.00 ","$472.50 ","$748.44 ","$756.00 ","$0.00 ","$147.89 ","$0.00 ","$150.44 ","$0.00 "
"7005-13006","SUP","HCPCS C1713","","7005-13006  -  PLATE BONE 6 HOLE COMPRESSION HAND NONSTRL 1.3 MM SCREW","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$614.25 ","$0.00 ","$284.50 ","$0.00 ","$0.00 ","$239.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$213.62 ","$0.00 ","$217.31 ","$0.00 "
"70-1050","SUP","Custom 27203010","","ELECTRODE 3010B SER ANALY","BOTH IP/OP","$2,600.00 ","$1,924.00 ","$0.00 ","$2,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,600.00 ","$0.00 ","$1,300.00 ","$2,059.20 ","$2,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7014-5927","SUP","HCPCS L8613","","7014-5927  -  PISTON OSS .6MM 4.25MM SMRT RECON OVR CRMP NTNL FLRPLAS","BOTH IP/OP","$752.40 ","$556.78 ","$0.00 ","$752.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.40 ","$0.00 ","$376.20 ","$595.90 ","$601.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7014-5928","SUP","HCPCS L8613","","7014-5928  -  PISTON OSS .6MM 4.5MM SMRT NTNL FLRPLAS EAR STPS","BOTH IP/OP","$752.40 ","$556.78 ","$0.00 ","$752.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$752.40 ","$0.00 ","$376.20 ","$595.90 ","$601.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7016RR","SUP","Custom 27803010","","7016RR  -  CONNECTOR ROD 16MM SPRL R90D 2 SD TI THORLMBR SPNE","BOTH IP/OP","$2,075.80 ","$1,536.09 ","$0.00 ","$2,075.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,075.80 ","$0.00 ","$1,037.90 ","$1,644.03 ","$1,660.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"702-04-42A","SUP","HCPCS C1776","","702-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-44B","SUP","HCPCS C1776","","702-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-46C","SUP","HCPCS C1776","","702-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-48D","SUP","HCPCS C1776","","702-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-50D","SUP","HCPCS C1776","","702-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-52E","SUP","HCPCS C1776","","702-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-54E","SUP","HCPCS C1776","","702-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-56F","SUP","HCPCS C1776","","702-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-58F","SUP","HCPCS C1776","","702-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-60G","SUP","HCPCS C1776","","702-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-62G","SUP","HCPCS C1776","","702-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-64H","SUP","HCPCS C1776","","702-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-04-66H","SUP","HCPCS C1776","","702-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"702-11-42A","SUP","HCPCS C1776","","702-11-42A  -  SHELL ACTB A 42MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-44B","SUP","HCPCS C1776","","702-11-44B  -  SHELL ACTB B 44MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-46C","SUP","HCPCS C1776","","702-11-46C  -  SHELL ACTB C 46MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-48D","SUP","HCPCS C1776","","702-11-48D  -  SHELL ACTB D 48MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-50D","SUP","HCPCS C1776","","702-11-50D  -  SHELL ACTB D 50MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-52E","SUP","HCPCS C1776","","702-11-52E  -  SHELL ACTB E 52MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-54E","SUP","HCPCS C1776","","702-11-54E  -  SHELL ACTB E 54MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-56F","SUP","HCPCS C1776","","702-11-56F  -  SHELL ACTB F 56MM TRDNT II CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-58F","SUP","HCPCS C1776","","702-11-58F  -  SHELL ACTB F 58MM STRL TRDNT II CLSTR 5 HL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-60G","SUP","HCPCS C1776","","702-11-60G  -  SHELL ACTB G 60MM STRL TRDNT II CLSTR 5 HL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-62G","SUP","HCPCS C1776","","702-11-62G  -  SHELL ACTB G 62MM STRL TRDNT II CLSTR 5 HL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-64H","SUP","HCPCS C1776","","702-11-64H  -  SHELL ACTB H 64MM STRL TRDNT II CLSTR 5 HL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702-11-66H","SUP","HCPCS C1776","","702-11-66H  -  SHELL ACTB H 66MM STRL TRDNT II CLSTR 5 HL HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"702301-5","SUP","HCPCS C1713","","702301-5  -  SCREW BN ALTA CNCT ORTH","BOTH IP/OP","$185.63 ","$137.37 ","$0.00 ","$185.63 ","$83.53 ","$0.00 ","$38.69 ","$0.00 ","$0.00 ","$32.50 ","$185.63 ","$0.00 ","$92.81 ","$147.02 ","$148.50 ","$0.00 ","$29.05 ","$0.00 ","$29.55 ","$0.00 "
"702336S","SUP","HCPCS C1769","","702336S  -  GWIRE ORTH 100MM 3MM SS BALL TIP STRL","BOTH IP/OP","$259.88 ","$192.31 ","$0.00 ","$259.88 ","$141.11 ","$0.00 ","$54.16 ","$0.00 ","$0.00 ","$45.50 ","$259.88 ","$0.00 ","$129.94 ","$205.82 ","$207.90 ","$0.00 ","$40.67 ","$0.00 ","$41.37 ","$0.00 "
"702341-2","SUP","Custom 27203010","","702341-2  -  SLEEVE PRTC REPL","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"702460S","SUP","HCPCS C1769","","702460S  -  GWIRE ORTH 150MM 2MM ASNS 3 FEM HIP THRD 5MM NONSTRL DISP","BOTH IP/OP","$124.10 ","$91.83 ","$0.00 ","$163.63 ","$88.85 ","$0.00 ","$25.87 ","$0.00 ","$0.00 ","$28.65 ","$163.63 ","$0.00 ","$81.81 ","$129.59 ","$130.90 ","$0.00 ","$25.61 ","$0.00 ","$26.05 ","$0.00 "
"702627S","SUP","HCPCS C1769","","702627S  -  GWIRE ORTH 300MM 3.2MM CLBRT FIT STRL","BOTH IP/OP","$281.88 ","$208.59 ","$0.00 ","$281.88 ","$153.06 ","$0.00 ","$58.75 ","$0.00 ","$0.00 ","$49.35 ","$281.88 ","$0.00 ","$140.94 ","$223.25 ","$225.50 ","$0.00 ","$44.11 ","$0.00 ","$44.87 ","$0.00 "
"702716-2","SUP","HCPCS C1713","","702716-2  -  SCREW BONE 4MM AXSOS HUM AIM BLOCK LCK PLT SYS","BOTH IP/OP","$94.88 ","$70.21 ","$0.00 ","$94.88 ","$42.69 ","$0.00 ","$19.77 ","$0.00 ","$0.00 ","$16.61 ","$94.88 ","$0.00 ","$47.44 ","$75.14 ","$75.90 ","$0.00 ","$14.85 ","$0.00 ","$15.10 ","$0.00 "
"702718-2","SUP","HCPCS C1713","","702718-2  -  SCREW BN SET SPR AIM BLCK FEM DIST","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$44.55 ","$0.00 ","$20.63 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"702720-2","SUP","HCPCS C1713","","702720-2  -  SCREW BONE 4MM AXSOS TIB AIM BLOCK LCK PLT SYS","BOTH IP/OP","$193.88 ","$143.47 ","$0.00 ","$193.88 ","$87.24 ","$0.00 ","$40.41 ","$0.00 ","$0.00 ","$33.95 ","$193.88 ","$0.00 ","$96.94 ","$153.55 ","$155.10 ","$0.00 ","$30.34 ","$0.00 ","$30.86 ","$0.00 "
"702858-1","SUP","Custom 27803010","","702858-1  -  DRIVER SRG 4MM VARIAX RING HD LCK","BOTH IP/OP","$570.63 ","$422.27 ","$0.00 ","$570.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$570.63 ","$0.00 ","$285.31 ","$451.94 ","$456.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"702970-2","SUP","Custom 27803010","","702970-2  -  SCREW BONE AXSOS SPR SET HUM AIM BLOCK LCK PALTE SYS","BOTH IP/OP","$199.38 ","$147.54 ","$0.00 ","$199.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.38 ","$0.00 ","$99.69 ","$157.91 ","$159.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70-3003L","SUP","HCPCS C1776","","70-3003L  -  CMPNT FEM 3 LEFT KNEE CMNT CRUC RET BASIC SCRP","BOTH IP/OP","$3,074.00 ","$2,274.76 ","$0.00 ","$3,074.00 ","$1,383.30 ","$0.00 ","$640.70 ","$0.00 ","$0.00 ","$538.23 ","$3,074.00 ","$0.00 ","$1,537.00 ","$2,434.61 ","$2,459.20 ","$0.00 ","$481.08 ","$0.00 ","$489.38 ","$0.00 "
"70-3003R","SUP","HCPCS C1776","","70-3003R  -  CMPNT FEM 3 RIGHT KNEE CMNT CRUC RET BASIC SCRP","BOTH IP/OP","$3,074.00 ","$2,274.76 ","$0.00 ","$3,074.00 ","$1,383.30 ","$0.00 ","$640.70 ","$0.00 ","$0.00 ","$538.23 ","$3,074.00 ","$0.00 ","$1,537.00 ","$2,434.61 ","$2,459.20 ","$0.00 ","$481.08 ","$0.00 ","$489.38 ","$0.00 "
"70-3004L","SUP","HCPCS C1776","","70-3004L  -  CMPNT FEM 4 LEFT KNEE CMNT CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3004R","SUP","HCPCS C1776","","70-3004R  -  CMPNT FEM 4 RIGHT KNEE CMNT CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3005L","SUP","HCPCS C1776","","70-3005L  -  CMPNT FEM 5 LEFT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3005R","SUP","HCPCS C1776","","70-3005R  -  CMPNT FEM 5 RIGHT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3006L","SUP","HCPCS C1776","","70-3006L  -  CMPNT FEM 6 LEFT KNEE CMNT CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3006R","SUP","HCPCS C1776","","70-3006R  -  CMPNT FEM 6 RIGHT KNEE CMNT CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3007L","SUP","HCPCS C1776","","70-3007L  -  CMPNT FEM 7 LEFT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3007R","SUP","HCPCS C1776","","70-3007R  -  CMPNT FEM 7 RIGHT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3009L","SUP","HCPCS C1776","","70-3009L  -  CMPNT FEM 9 LEFT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3009R","SUP","HCPCS C1776","","70-3009R  -  CMPNT FEM 9 RIGHT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3011L","SUP","HCPCS C1776","","70-3011L  -  CMPNT FEM 11 LEFT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3011R","SUP","HCPCS C1776","","70-3011R  -  CMPNT FEM 11 RIGHT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,029.00 ","$2,241.46 ","$0.00 ","$3,029.00 ","$1,363.05 ","$0.00 ","$631.32 ","$0.00 ","$0.00 ","$530.35 ","$3,029.00 ","$0.00 ","$1,514.50 ","$2,398.97 ","$2,423.20 ","$0.00 ","$474.04 ","$0.00 ","$482.22 ","$0.00 "
"70-3013L","SUP","HCPCS C1776","","70-3013L  -  CMPNT FEM 13 LEFT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,074.00 ","$2,274.76 ","$0.00 ","$3,074.00 ","$1,383.30 ","$0.00 ","$640.70 ","$0.00 ","$0.00 ","$538.23 ","$3,074.00 ","$0.00 ","$1,537.00 ","$2,434.61 ","$2,459.20 ","$0.00 ","$481.08 ","$0.00 ","$489.38 ","$0.00 "
"70-3013R","SUP","HCPCS C1776","","70-3013R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET BASIC SCRP","BOTH IP/OP","$3,074.00 ","$2,274.76 ","$0.00 ","$3,074.00 ","$1,383.30 ","$0.00 ","$640.70 ","$0.00 ","$0.00 ","$538.23 ","$3,074.00 ","$0.00 ","$1,537.00 ","$2,434.61 ","$2,459.20 ","$0.00 ","$481.08 ","$0.00 ","$489.38 ","$0.00 "
"7030-6515","SUP","HCPCS C1713","","7030-6515  -  SCREW BN 6.5MM 15MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6520","SUP","HCPCS C1713","","7030-6520  -  SCREW BN 6.5MM 20MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6525","SUP","HCPCS C1713","","7030-6525  -  SCREW BN 6.5MM 25MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6530","SUP","HCPCS C1713","","7030-6530  -  SCREW BN 6.5MM 30MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6535","SUP","HCPCS C1713","","7030-6535  -  SCREW BN 6.5MM 35MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6540","SUP","HCPCS C1713","","7030-6540  -  SCREW BN 6.5MM 40MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6545","SUP","HCPCS C1713","","7030-6545  -  SCREW BN 6.5MM 45MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6550","SUP","HCPCS C1713","","7030-6550  -  SCREW BN 6.5MM 50MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6555","SUP","HCPCS C1713","","7030-6555  -  SCREW BN 6.5MM 55MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7030-6560","SUP","HCPCS C1713","","7030-6560  -  SCREW BN 6.5MM 60MM STRL TRDNT II LOPRFL HEX","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"703165-20","SUP","Custom 27203010","","703165-20  -  SLEEVE DRILL ANT FEM RTN","BOTH IP/OP","$559.63 ","$414.13 ","$0.00 ","$559.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$559.63 ","$0.00 ","$279.81 ","$443.23 ","$447.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70-3191","SUP","Custom 27203010","","ELECTRODE ANALY SLVR CHLOR REF WIRE 3010B SER","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70-3849","SUP","Custom 27203010","","CONTROL BLOOD LEAD LVL 1 HMTL","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70-3850","SUP","Custom 27203010","","CONTROL BLOOD LEAD LVL 2 HMTL","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70-3851","SUP","Custom 27203010","","CONTROL CHM HI","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"704001-1","SUP","Custom 27203010","","704001-1  -  IMPCTR SURG OMEGA HIP HEAD","BOTH IP/OP","$371.25 ","$274.73 ","$0.00 ","$371.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$371.25 ","$0.00 ","$185.63 ","$294.03 ","$297.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"704005-10","SUP","Custom 27203010","","704005-10  -  REAMER SURG DRILL COMBO","BOTH IP/OP","$701.25 ","$518.93 ","$0.00 ","$701.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$701.25 ","$0.00 ","$350.63 ","$555.39 ","$561.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"704011S","SUP","HCPCS C1713","","704011S  -  PIN SURG GUIDE","BOTH IP/OP","$75.63 ","$55.97 ","$0.00 ","$75.63 ","$34.03 ","$0.00 ","$15.76 ","$0.00 ","$0.00 ","$13.24 ","$75.63 ","$0.00 ","$37.81 ","$59.90 ","$60.50 ","$0.00 ","$11.84 ","$0.00 ","$12.04 ","$0.00 "
"704012S","SUP","HCPCS C1769","","704012S  -  GWIRE ORTH 230MM 2.8MM THRD TIP QC","BOTH IP/OP","$226.88 ","$167.89 ","$0.00 ","$226.88 ","$123.19 ","$0.00 ","$47.29 ","$0.00 ","$0.00 ","$39.72 ","$226.88 ","$0.00 ","$113.44 ","$179.69 ","$181.50 ","$0.00 ","$35.51 ","$0.00 ","$36.12 ","$0.00 "
"70-4103L","SUP","HCPCS C1776","","70-4103L  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4103R","SUP","HCPCS C1776","","70-4103R  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4104L","SUP","HCPCS C1776","","70-4104L  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4104R","SUP","HCPCS C1776","","70-4104R  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4105L","SUP","HCPCS C1776","","70-4105L  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4105R","SUP","HCPCS C1776","","70-4105R  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4106L","SUP","HCPCS C1776","","70-4106L  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4106R","SUP","HCPCS C1776","","70-4106R  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4107L","SUP","HCPCS C1776","","70-4107L  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4107R","SUP","HCPCS C1776","","70-4107R  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4109L","SUP","HCPCS C1776","","70-4109L  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4109R","SUP","HCPCS C1776","","70-4109R  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4111L","SUP","HCPCS C1776","","70-4111L  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4111R","SUP","HCPCS C1776","","70-4111R  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4113L","SUP","HCPCS C1776","","70-4113L  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-4113R","SUP","HCPCS C1776","","70-4113R  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"70-5003L","SUP","HCPCS C1776","","70-5003L  -  CMPNT FEM 3 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$0.00 ","$4,906.00 ","$2,207.70 ","$0.00 ","$1,022.53 ","$0.00 ","$0.00 ","$859.00 ","$4,906.00 ","$0.00 ","$2,453.00 ","$3,885.55 ","$3,924.80 ","$0.00 ","$767.79 ","$0.00 ","$781.04 ","$0.00 "
"70-5003R","SUP","HCPCS C1776","","70-5003R  -  CMPNT FEM 3 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$0.00 ","$4,906.00 ","$2,207.70 ","$0.00 ","$1,022.53 ","$0.00 ","$0.00 ","$859.00 ","$4,906.00 ","$0.00 ","$2,453.00 ","$3,885.55 ","$3,924.80 ","$0.00 ","$767.79 ","$0.00 ","$781.04 ","$0.00 "
"70-5004L","SUP","HCPCS C1776","","70-5004L  -  CMPNT FEM 4 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5004R","SUP","HCPCS C1776","","70-5004R  -  CMPNT FEM 4 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5005L","SUP","HCPCS C1776","","70-5005L  -  CMPNT FEM 5 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5005R","SUP","HCPCS C1776","","70-5005R  -  CMPNT FEM 5 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5006L","SUP","HCPCS C1776","","70-5006L  -  CMPNT FEM 6 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5006R","SUP","HCPCS C1776","","70-5006R  -  CMPNT FEM 6 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5007L","SUP","HCPCS C1776","","70-5007L  -  CMPNT FEM 7 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5007R","SUP","HCPCS C1776","","70-5007R  -  CMPNT FEM 7 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5009L","SUP","HCPCS C1776","","70-5009L  -  CMPNT FEM 9 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5009R","SUP","HCPCS C1776","","70-5009R  -  CMPNT FEM 9 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5011L","SUP","HCPCS C1776","","70-5011L  -  CMPNT FEM 11 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5011R","SUP","HCPCS C1776","","70-5011R  -  CMPNT FEM 11 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,777.00 ","$3,534.98 ","$0.00 ","$4,777.00 ","$2,149.65 ","$0.00 ","$995.65 ","$0.00 ","$0.00 ","$836.41 ","$4,777.00 ","$0.00 ","$2,388.50 ","$3,783.38 ","$3,821.60 ","$0.00 ","$747.60 ","$0.00 ","$760.50 ","$0.00 "
"70-5013L","SUP","HCPCS C1776","","70-5013L  -  CMPNT FEM 13 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$0.00 ","$4,906.00 ","$2,207.70 ","$0.00 ","$1,022.53 ","$0.00 ","$0.00 ","$859.00 ","$4,906.00 ","$0.00 ","$2,453.00 ","$3,885.55 ","$3,924.80 ","$0.00 ","$767.79 ","$0.00 ","$781.04 ","$0.00 "
"70-5013R","SUP","HCPCS C1776","","70-5013R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET MCSTRCT NON LFIT SCRP","BOTH IP/OP","$4,906.00 ","$3,630.44 ","$0.00 ","$4,906.00 ","$2,207.70 ","$0.00 ","$1,022.53 ","$0.00 ","$0.00 ","$859.00 ","$4,906.00 ","$0.00 ","$2,453.00 ","$3,885.55 ","$3,924.80 ","$0.00 ","$767.79 ","$0.00 ","$781.04 ","$0.00 "
"70-5103L","SUP","HCPCS C1776","","70-5103L  -  CMPNT FEM 3 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,647.00 ","$3,438.78 ","$0.00 ","$4,647.00 ","$2,091.15 ","$0.00 ","$968.55 ","$0.00 ","$0.00 ","$813.65 ","$4,647.00 ","$0.00 ","$2,323.50 ","$3,680.42 ","$3,717.60 ","$0.00 ","$727.26 ","$0.00 ","$739.80 ","$0.00 "
"70-5103R","SUP","HCPCS C1776","","70-5103R  -  CMPNT FEM 3 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,647.00 ","$3,438.78 ","$0.00 ","$4,647.00 ","$2,091.15 ","$0.00 ","$968.55 ","$0.00 ","$0.00 ","$813.65 ","$4,647.00 ","$0.00 ","$2,323.50 ","$3,680.42 ","$3,717.60 ","$0.00 ","$727.26 ","$0.00 ","$739.80 ","$0.00 "
"70-5104L","SUP","HCPCS C1776","","70-5104L  -  CMPNT FEM 4 LEFT KNEE CRUC RET MCSTRCT LFIT SCRP","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5104R","SUP","HCPCS C1776","","70-5104R  -  CMPNT FEM 4 RIGHT KNEE CRUC RET MCSTRCT LFIT SCRP","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5105L","SUP","HCPCS C1776","","70-5105L  -  CMPNT FEM 5 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5105R","SUP","HCPCS C1776","","70-5105R  -  CMPNT FEM 5 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5106L","SUP","HCPCS C1776","","70-5106L  -  CMPNT FEM 6 LEFT KNEE CRUC RET MCSTRCT LFIT SCRP","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5106R","SUP","HCPCS C1776","","70-5106R  -  CMPNT FEM 6 RIGHT KNEE CRUC RET MCSTRCT LFIT SCRP","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5107L","SUP","HCPCS C1776","","70-5107L  -  CMPNT FEM 7 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5107R","SUP","HCPCS C1776","","70-5107R  -  CMPNT FEM 7 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5109L","SUP","HCPCS C1776","","70-5109L  -  CMPNT FEM 9 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5109R","SUP","HCPCS C1776","","70-5109R  -  CMPNT FEM 9 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5111L","SUP","HCPCS C1776","","70-5111L  -  CMPNT FEM 11 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5111R","SUP","HCPCS C1776","","70-5111R  -  CMPNT FEM 11 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,565.00 ","$3,378.10 ","$0.00 ","$4,565.00 ","$2,054.25 ","$0.00 ","$951.46 ","$0.00 ","$0.00 ","$799.29 ","$4,565.00 ","$0.00 ","$2,282.50 ","$3,615.48 ","$3,652.00 ","$0.00 ","$714.42 ","$0.00 ","$726.75 ","$0.00 "
"70-5113L","SUP","HCPCS C1776","","70-5113L  -  CMPNT FEM 13 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,647.00 ","$3,438.78 ","$0.00 ","$4,647.00 ","$2,091.15 ","$0.00 ","$968.55 ","$0.00 ","$0.00 ","$813.65 ","$4,647.00 ","$0.00 ","$2,323.50 ","$3,680.42 ","$3,717.60 ","$0.00 ","$727.26 ","$0.00 ","$739.80 ","$0.00 "
"70-5113R","SUP","HCPCS C1776","","70-5113R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT","BOTH IP/OP","$4,647.00 ","$3,438.78 ","$0.00 ","$4,647.00 ","$2,091.15 ","$0.00 ","$968.55 ","$0.00 ","$0.00 ","$813.65 ","$4,647.00 ","$0.00 ","$2,323.50 ","$3,680.42 ","$3,717.60 ","$0.00 ","$727.26 ","$0.00 ","$739.80 ","$0.00 "
"70-5203L","SUP","HCPCS C1776","","70-5203L  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5203R","SUP","HCPCS C1776","","70-5203R  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5205L","SUP","HCPCS C1776","","70-5205L  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5205R","SUP","HCPCS C1776","","70-5205R  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5207L","SUP","HCPCS C1776","","70-5207L  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5207R","SUP","HCPCS C1776","","70-5207R  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5209L","SUP","HCPCS C1776","","70-5209L  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5209R","SUP","HCPCS C1776","","70-5209R  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5211L","SUP","HCPCS C1776","","70-5211L  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5211R","SUP","HCPCS C1776","","70-5211R  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5213L","SUP","HCPCS C1776","","70-5213L  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"70-5213R","SUP","HCPCS C1776","","70-5213R  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"7060-0000","SUP","HCPCS C1713","","7060-0000  -  PLUG DOME HL HEX STRL LF TRDNT II DISP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"7066-24","SUP","Custom 27203010","","SPLINT ORTH UNV 24IN KNEE SUP PRFR FOAM","BOTH IP/OP","$44.23 ","$32.73 ","$0.00 ","$66.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.85 ","$0.00 ","$33.43 ","$52.95 ","$53.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"709-04-42A","SUP","HCPCS C1776","","709-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II 8 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-44B","SUP","HCPCS C1776","","709-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II 8 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-46C","SUP","HCPCS C1776","","709-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II 8 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-48D","SUP","HCPCS C1776","","709-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II 9 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-50D","SUP","HCPCS C1776","","709-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II 9 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-52E","SUP","HCPCS C1776","","709-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II 11 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-54E","SUP","HCPCS C1776","","709-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II 11 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-56F","SUP","HCPCS C1776","","709-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-58F","SUP","HCPCS C1776","","709-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-60G","SUP","HCPCS C1776","","709-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-62G","SUP","HCPCS C1776","","709-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-64H","SUP","HCPCS C1776","","709-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-66H","SUP","HCPCS C1776","","709-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-68I","SUP","HCPCS C1776","","709-04-68I  -  SHELL ACTB I 68MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-70I","SUP","HCPCS C1776","","709-04-70I  -  SHELL ACTB I 70MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"709-04-72J","SUP","HCPCS C1776","","709-04-72J  -  SHELL ACTB J 72MM STRL TRDNT II 13 HL TRITANIUM HIP","BOTH IP/OP","$6,782.50 ","$5,019.05 ","$0.00 ","$6,782.50 ","$3,052.13 ","$0.00 ","$1,413.64 ","$0.00 ","$0.00 ","$1,187.56 ","$6,782.50 ","$0.00 ","$3,391.25 ","$5,371.74 ","$5,426.00 ","$0.00 ","$1,061.46 ","$0.00 ","$1,079.77 ","$0.00 "
"70-DO55","SUP","HCPCS C1713","","70-DO55  -  PLATE STD BONE LEFT DISTAL RADL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"70XLTCD","SUP","Custom 27203010","","70XLTCD  -  TUBE TRCH 39MM 49MM 12.3MM 7MM 100MM STRL LF 12MM SHLY XLT","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"70XLTUP","SUP","Custom 27203010","","70XLTUP  -  TUBE TRCH 39MM 34MM 12.3MM 7MM 100MM STRL LF 27MM SHLY XLT","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"710.000.98S","SUP","HCPCS C1763","","710.000.98S  -  SUBSTITUTE BNGFT XS VOID FILR GRANULES CHRONOS BTCP .5ML","BOTH IP/OP","$216.25 ","$160.03 ","$0.00 ","$216.25 ","$97.31 ","$0.00 ","$45.07 ","$0.00 ","$0.00 ","$37.86 ","$216.25 ","$0.00 ","$108.13 ","$171.27 ","$173.00 ","$0.00 ","$33.84 ","$0.00 ","$34.43 ","$0.00 "
"710.001.98S","SUP","HCPCS C1763","","710.001.98S  -  SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS","BOTH IP/OP","$216.25 ","$160.03 ","$0.00 ","$216.25 ","$97.31 ","$0.00 ","$45.07 ","$0.00 ","$0.00 ","$37.86 ","$216.25 ","$0.00 ","$108.13 ","$171.27 ","$173.00 ","$0.00 ","$33.84 ","$0.00 ","$34.43 ","$0.00 "
"710.002.98S","SUP","HCPCS C1713","","710.002.98S  -  CEMENT BONE .7-1.4MM/1CC GRANULES BETA-TRICALCIUM PHOSPHATE","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"710.003.98S","SUP","HCPCS C1763","","710.003.98S  -  SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS","BOTH IP/OP","$887.50 ","$656.75 ","$0.00 ","$887.50 ","$399.38 ","$0.00 ","$184.98 ","$0.00 ","$0.00 ","$155.39 ","$887.50 ","$0.00 ","$443.75 ","$702.90 ","$710.00 ","$0.00 ","$138.89 ","$0.00 ","$141.29 ","$0.00 "
"710.011.98S","SUP","HCPCS C1763","","710.011.98S  -  SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS","BOTH IP/OP","$887.50 ","$656.75 ","$0.00 ","$887.50 ","$399.38 ","$0.00 ","$184.98 ","$0.00 ","$0.00 ","$155.39 ","$887.50 ","$0.00 ","$443.75 ","$702.90 ","$710.00 ","$0.00 ","$138.89 ","$0.00 ","$141.29 ","$0.00 "
"710.014.98S","SUP","HCPCS C1763","","710.014.98S  -  SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS","BOTH IP/OP","$1,242.50 ","$919.45 ","$0.00 ","$1,242.50 ","$559.13 ","$0.00 ","$258.97 ","$0.00 ","$0.00 ","$217.55 ","$1,242.50 ","$0.00 ","$621.25 ","$984.06 ","$994.00 ","$0.00 ","$194.45 ","$0.00 ","$197.81 ","$0.00 "
"710.019.97S","SUP","HCPCS C1713","","710.019.97S  -  SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID","BOTH IP/OP","$1,849.95 ","$1,368.96 ","$0.00 ","$1,796.08 ","$808.23 ","$0.00 ","$385.58 ","$0.00 ","$0.00 ","$314.48 ","$1,796.08 ","$0.00 ","$898.04 ","$1,422.50 ","$1,436.86 ","$0.00 ","$272.90 ","$0.00 ","$285.94 ","$0.00 "
"710.021.97S","SUP","HCPCS C1713","","710.021.97S  -  SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID","BOTH IP/OP","$2,641.65 ","$1,954.82 ","$0.00 ","$2,564.70 ","$1,154.12 ","$0.00 ","$550.59 ","$0.00 ","$0.00 ","$449.06 ","$2,564.70 ","$0.00 ","$1,282.35 ","$2,031.24 ","$2,051.76 ","$0.00 ","$389.69 ","$0.00 ","$408.30 ","$0.00 "
"710.042.98S","SUP","HCPCS C1763","","710.042.98S  -  SUBSTITUTE BNGFT 10X5X5MM VOID FILR BLOCK CHRONOS BTCP","BOTH IP/OP","$672.50 ","$497.65 ","$0.00 ","$672.50 ","$302.63 ","$0.00 ","$140.17 ","$0.00 ","$0.00 ","$117.75 ","$672.50 ","$0.00 ","$336.25 ","$532.62 ","$538.00 ","$0.00 ","$105.25 ","$0.00 ","$107.06 ","$0.00 "
"710.045.97S","SUP","HCPCS C1763","","710.045.97S  -  SUBSTITUTE BNGFT 12.5X12.5X10MM VOID FILR BLOCK","BOTH IP/OP","$924.98 ","$684.49 ","$0.00 ","$898.03 ","$404.11 ","$0.00 ","$192.79 ","$0.00 ","$0.00 ","$157.24 ","$898.03 ","$0.00 ","$449.01 ","$711.24 ","$718.42 ","$0.00 ","$136.45 ","$0.00 ","$142.97 ","$0.00 "
"710.047.97S","SUP","HCPCS C1763","","710.047.97S  -  SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK OSTEOCONDUCTIVE","BOTH IP/OP","$1,818.13 ","$1,345.42 ","$0.00 ","$1,765.18 ","$794.33 ","$0.00 ","$378.94 ","$0.00 ","$0.00 ","$309.07 ","$1,765.18 ","$0.00 ","$882.59 ","$1,398.02 ","$1,412.14 ","$0.00 ","$268.20 ","$0.00 ","$281.02 ","$0.00 "
"710.047.98S","SUP","HCPCS C1763","","710.047.98S  -  SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK CHRONOS BETA","BOTH IP/OP","$2,355.00 ","$1,742.70 ","$0.00 ","$2,355.00 ","$1,059.75 ","$0.00 ","$490.84 ","$0.00 ","$0.00 ","$412.34 ","$2,355.00 ","$0.00 ","$1,177.50 ","$1,865.16 ","$1,884.00 ","$0.00 ","$368.56 ","$0.00 ","$374.92 ","$0.00 "
"710.050.97S","SUP","HCPCS C1763","","710.050.97S  -  SUBSTITUTE BNGFT 10D RECTANGLE 25X20X6.5MM VOID FILR WEDGE","BOTH IP/OP","$1,838.00 ","$1,360.12 ","$0.00 ","$1,784.48 ","$803.01 ","$0.00 ","$383.09 ","$0.00 ","$0.00 ","$312.45 ","$1,784.48 ","$0.00 ","$892.24 ","$1,413.31 ","$1,427.58 ","$0.00 ","$271.14 ","$0.00 ","$284.09 ","$0.00 "
"710.050.98S","SUP","HCPCS C1713","","710.050.98S  -  SUBSTITUTE BNGFT 10D RECTANGLE 25X20MM WEDGE CHRONOS BTCP","BOTH IP/OP","$2,380.00 ","$1,761.20 ","$0.00 ","$2,380.00 ","$1,071.00 ","$0.00 ","$496.05 ","$0.00 ","$0.00 ","$416.72 ","$2,380.00 ","$0.00 ","$1,190.00 ","$1,884.96 ","$1,904.00 ","$0.00 ","$372.47 ","$0.00 ","$378.90 ","$0.00 "
"710.051.97S","SUP","HCPCS C1763","","710.051.97S  -  SUBSTITUTE BNGFT 14D RECTANGLE 25X20X8MM VOID FILR WEDGE","BOTH IP/OP","$1,937.48 ","$1,433.74 ","$0.00 ","$1,881.05 ","$846.47 ","$0.00 ","$403.82 ","$0.00 ","$0.00 ","$329.36 ","$1,881.05 ","$0.00 ","$940.53 ","$1,489.79 ","$1,504.84 ","$0.00 ","$285.81 ","$0.00 ","$299.46 ","$0.00 "
"710.052.97S","SUP","HCPCS C1763","","710.052.97S  -  SUBSTITUTE BNGFT 18D RECTANGULAR 25X20X10MM VOID FILR WEDGE","BOTH IP/OP","$2,058.80 ","$1,523.51 ","$0.00 ","$1,998.85 ","$899.48 ","$0.00 ","$429.11 ","$0.00 ","$0.00 ","$349.98 ","$1,998.85 ","$0.00 ","$999.43 ","$1,583.09 ","$1,599.08 ","$0.00 ","$303.71 ","$0.00 ","$318.22 ","$0.00 "
"710.053.97S","SUP","HCPCS C1763","","710.053.97S  -  SUBSTITUTE BNGFT 22D RECTANGLE 25X20X12MM VOID FILR WEDGE","BOTH IP/OP","$2,170.20 ","$1,605.95 ","$0.00 ","$2,107.00 ","$948.15 ","$0.00 ","$452.32 ","$0.00 ","$0.00 ","$368.92 ","$2,107.00 ","$0.00 ","$1,053.50 ","$1,668.74 ","$1,685.60 ","$0.00 ","$320.14 ","$0.00 ","$335.43 ","$0.00 "
"710.057.97S","SUP","HCPCS C1763","","710.057.97S  -  SUBSTITUTE BNGFT 7D SEMICIRCLE 35X25X7MM VOID FILR WEDGE","BOTH IP/OP","$2,170.20 ","$1,605.95 ","$0.00 ","$2,107.00 ","$948.15 ","$0.00 ","$452.32 ","$0.00 ","$0.00 ","$368.92 ","$2,107.00 ","$0.00 ","$1,053.50 ","$1,668.74 ","$1,685.60 ","$0.00 ","$320.14 ","$0.00 ","$335.43 ","$0.00 "
"710.057.98S","SUP","HCPCS C1763","","710.057.98S  -  SUBSTITUTE BNGFT 7D VOID FILR WEDGE SEMICIRCULAR CHRONOS","BOTH IP/OP","$2,810.00 ","$2,079.40 ","$0.00 ","$2,810.00 ","$1,264.50 ","$0.00 ","$585.67 ","$0.00 ","$0.00 ","$492.01 ","$2,810.00 ","$0.00 ","$1,405.00 ","$2,225.52 ","$2,248.00 ","$0.00 ","$439.77 ","$0.00 ","$447.35 ","$0.00 "
"710.060.97S","SUP","HCPCS C1763","","710.060.97S  -  SUBSTITUTE BNGFT 10D VOID FILR WEDGE ANGLED SEMICIRCULAR","BOTH IP/OP","$2,245.80 ","$1,661.89 ","$0.00 ","$2,180.38 ","$981.17 ","$0.00 ","$468.08 ","$0.00 ","$0.00 ","$381.77 ","$2,180.38 ","$0.00 ","$1,090.19 ","$1,726.86 ","$1,744.30 ","$0.00 ","$331.29 ","$0.00 ","$347.12 ","$0.00 "
"710.063.97S","SUP","HCPCS C1763","","710.063.97S  -  SUBSTITUTE BNGFT 13D SEMICIRCLE 35X25X13MM WEDGE","BOTH IP/OP","$2,355.20 ","$1,742.85 ","$0.00 ","$2,286.60 ","$1,028.97 ","$0.00 ","$490.88 ","$0.00 ","$0.00 ","$400.37 ","$2,286.60 ","$0.00 ","$1,143.30 ","$1,810.99 ","$1,829.28 ","$0.00 ","$347.43 ","$0.00 ","$364.03 ","$0.00 "
"71063108S","SUP","HCPCS C1713","","71063108S  -  PIN HLF 3MM 10MM JTX TI NTRD","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$190.80 ","$0.00 ","$88.37 ","$0.00 ","$0.00 ","$74.24 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$66.36 ","$0.00 ","$67.50 ","$0.00 "
"71063158S","SUP","HCPCS C1713","","71063158S  -  PIN HLF 3MM 15MM JTX TI NTRD","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$190.80 ","$0.00 ","$88.37 ","$0.00 ","$0.00 ","$74.24 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$66.36 ","$0.00 ","$67.50 ","$0.00 "
"71063208S","SUP","HCPCS C1713","","71063208S  -  PIN HLF 3MM 20MM JTX TI NTRD","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$190.80 ","$0.00 ","$88.37 ","$0.00 ","$0.00 ","$74.24 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$66.36 ","$0.00 ","$67.50 ","$0.00 "
"71063258S","SUP","HCPCS C1713","","71063258S  -  PIN HLF 3MM 25MM JTX TI NTRD","BOTH IP/OP","$424.00 ","$313.76 ","$0.00 ","$424.00 ","$190.80 ","$0.00 ","$88.37 ","$0.00 ","$0.00 ","$74.24 ","$424.00 ","$0.00 ","$212.00 ","$335.81 ","$339.20 ","$0.00 ","$66.36 ","$0.00 ","$67.50 ","$0.00 "
"71064158S","SUP","HCPCS C1713","","71064158S  -  PIN HLF 4MM 15MM JTX TI NTRD","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$456.00 ","$205.20 ","$0.00 ","$95.04 ","$0.00 ","$0.00 ","$79.84 ","$456.00 ","$0.00 ","$228.00 ","$361.15 ","$364.80 ","$0.00 ","$71.36 ","$0.00 ","$72.60 ","$0.00 "
"71064208S","SUP","HCPCS C1713","","71064208S  -  PIN HLF 4MM 20MM JTX TI NTRD","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$456.00 ","$205.20 ","$0.00 ","$95.04 ","$0.00 ","$0.00 ","$79.84 ","$456.00 ","$0.00 ","$228.00 ","$361.15 ","$364.80 ","$0.00 ","$71.36 ","$0.00 ","$72.60 ","$0.00 "
"71064258S","SUP","HCPCS C1713","","71064258S  -  PIN HLF 4MM 25MM JTX TI NTRD","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$456.00 ","$205.20 ","$0.00 ","$95.04 ","$0.00 ","$0.00 ","$79.84 ","$456.00 ","$0.00 ","$228.00 ","$361.15 ","$364.80 ","$0.00 ","$71.36 ","$0.00 ","$72.60 ","$0.00 "
"71064308S","SUP","HCPCS C1713","","71064308S  -  PIN HLF 4MM 30MM JTX TI NTRD","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$456.00 ","$205.20 ","$0.00 ","$95.04 ","$0.00 ","$0.00 ","$79.84 ","$456.00 ","$0.00 ","$228.00 ","$361.15 ","$364.80 ","$0.00 ","$71.36 ","$0.00 ","$72.60 ","$0.00 "
"71064358S","SUP","HCPCS C1713","","71064358S  -  PIN HLF 4MM 35MM JTX TI NTRD","BOTH IP/OP","$456.00 ","$337.44 ","$0.00 ","$456.00 ","$205.20 ","$0.00 ","$95.04 ","$0.00 ","$0.00 ","$79.84 ","$456.00 ","$0.00 ","$228.00 ","$361.15 ","$364.80 ","$0.00 ","$71.36 ","$0.00 ","$72.60 ","$0.00 "
"7106-5300","SUP","HCPCS C1713","","7106-5300  -  PIN HLF SHRT 5MM 30MM ORTH","BOTH IP/OP","$608.00 ","$449.92 ","$0.00 ","$608.00 ","$273.60 ","$0.00 ","$126.72 ","$0.00 ","$0.00 ","$106.46 ","$608.00 ","$0.00 ","$304.00 ","$481.54 ","$486.40 ","$0.00 ","$95.15 ","$0.00 ","$96.79 ","$0.00 "
"71065304S","SUP","HCPCS C1713","","71065304S  -  PIN HLF XSH 5MM 30MM STRL JTX TI NTRD","BOTH IP/OP","$584.00 ","$432.16 ","$0.00 ","$584.00 ","$262.80 ","$0.00 ","$121.72 ","$0.00 ","$0.00 ","$102.25 ","$584.00 ","$0.00 ","$292.00 ","$462.53 ","$467.20 ","$0.00 ","$91.40 ","$0.00 ","$92.97 ","$0.00 "
"71065308S","SUP","HCPCS C1713","","71065308S  -  PIN HLF SHRT 5MM 30MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065309S","SUP","HCPCS C1713","","71065309S  -  PIN HLF LNG 5MM 30MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065354S","SUP","HCPCS C1713","","71065354S  -  PIN HLF XSH 5MM 35MM STRL JTX TI NTRD","BOTH IP/OP","$556.00 ","$411.44 ","$0.00 ","$556.00 ","$250.20 ","$0.00 ","$115.88 ","$0.00 ","$0.00 ","$97.35 ","$556.00 ","$0.00 ","$278.00 ","$440.35 ","$444.80 ","$0.00 ","$87.01 ","$0.00 ","$88.52 ","$0.00 "
"71065358S","SUP","HCPCS C1713","","71065358S  -  PIN HLF SHRT 5MM 35MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065359S","SUP","HCPCS C1713","","71065359S  -  PIN HLF LNG 5MM 35MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065404S","SUP","HCPCS C1713","","71065404S  -  PIN HLF XSH 5MM 40MM STRL JTX TI NTRD","BOTH IP/OP","$584.00 ","$432.16 ","$0.00 ","$584.00 ","$262.80 ","$0.00 ","$121.72 ","$0.00 ","$0.00 ","$102.25 ","$584.00 ","$0.00 ","$292.00 ","$462.53 ","$467.20 ","$0.00 ","$91.40 ","$0.00 ","$92.97 ","$0.00 "
"71065407S","SUP","HCPCS C1713","","71065407S  -  PIN HLF XSH 1.6MM 40MM STRL JTX CNN TI NTRD","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$790.00 ","$355.50 ","$0.00 ","$164.66 ","$0.00 ","$0.00 ","$138.32 ","$790.00 ","$0.00 ","$395.00 ","$625.68 ","$632.00 ","$0.00 ","$123.64 ","$0.00 ","$125.77 ","$0.00 "
"71065408S","SUP","HCPCS C1713","","71065408S  -  PIN HLF SHRT 5MM 40MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065409S","SUP","HCPCS C1713","","71065409S  -  PIN HLF LNG 5MM 40MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065454S","SUP","HCPCS C1713","","71065454S  -  PIN HLF XSH 5MM 45MM STRL JTX TI NTRD","BOTH IP/OP","$556.00 ","$411.44 ","$0.00 ","$556.00 ","$250.20 ","$0.00 ","$115.88 ","$0.00 ","$0.00 ","$97.35 ","$556.00 ","$0.00 ","$278.00 ","$440.35 ","$444.80 ","$0.00 ","$87.01 ","$0.00 ","$88.52 ","$0.00 "
"71065458S","SUP","HCPCS C1713","","71065458S  -  PIN HLF SHRT 5MM 45MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065459S","SUP","HCPCS C1713","","71065459S  -  PIN HLF LNG 5MM 45MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
"71065507S","SUP","HCPCS C1713","","71065507S  -  PIN HLF 5MM 50MM STRL JTX TRC TI NTRD","BOTH IP/OP","$1,132.00 ","$837.68 ","$0.00 ","$1,132.00 ","$509.40 ","$0.00 ","$235.94 ","$0.00 ","$0.00 ","$198.20 ","$1,132.00 ","$0.00 ","$566.00 ","$896.54 ","$905.60 ","$0.00 ","$177.16 ","$0.00 ","$180.21 ","$0.00 "
"71065508S","SUP","HCPCS C1713","","71065508S  -  PIN HLF SHRT 5MM 50MM STRL JTX TI NTRD","BOTH IP/OP","$618.00 ","$457.32 ","$0.00 ","$618.00 ","$278.10 ","$0.00 ","$128.81 ","$0.00 ","$0.00 ","$108.21 ","$618.00 ","$0.00 ","$309.00 ","$489.46 ","$494.40 ","$0.00 ","$96.72 ","$0.00 ","$98.39 ","$0.00 "
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"71149555M","SUP","HCPCS C1713","","71149555M  -  SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149714M","SUP","HCPCS C1713","","71149714M  -  SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149716M","SUP","HCPCS C1713","","71149716M  -  SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149718M","SUP","HCPCS C1713","","71149718M  -  SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149720M","SUP","HCPCS C1713","","71149720M  -  SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149722M","SUP","HCPCS C1713","","71149722M  -  SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149724M","SUP","HCPCS C1713","","71149724M  -  SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149726M","SUP","HCPCS C1713","","71149726M  -  SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149728M","SUP","HCPCS C1713","","71149728M  -  SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149730M","SUP","HCPCS C1713","","71149730M  -  SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149732M","SUP","HCPCS C1713","","71149732M  -  SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149734M","SUP","HCPCS C1713","","71149734M  -  SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149736M","SUP","HCPCS C1713","","71149736M  -  SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149738M","SUP","HCPCS C1713","","71149738M  -  SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149740M","SUP","HCPCS C1713","","71149740M  -  SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149742M","SUP","HCPCS C1713","","71149742M  -  SCREW BN 4.5MM 42MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149744M","SUP","HCPCS C1713","","71149744M  -  SCREW BN 4.5MM 44MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149746M","SUP","HCPCS C1713","","71149746M  -  SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149748M","SUP","HCPCS C1713","","71149748M  -  SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149750M","SUP","HCPCS C1713","","71149750M  -  SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149752M","SUP","HCPCS C1713","","71149752M  -  SCREW BN 4.5MM 52MM TC100 ST CORT","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149754M","SUP","HCPCS C1713","","71149754M  -  SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149756M","SUP","HCPCS C1713","","71149756M  -  SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149758M","SUP","HCPCS C1713","","71149758M  -  SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149760M","SUP","HCPCS C1713","","71149760M  -  SCREW BN 4.5MM 60MM TC100 ST CORT","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149762M","SUP","HCPCS C1713","","71149762M  -  SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149764M","SUP","HCPCS C1713","","71149764M  -  SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149766M","SUP","HCPCS C1713","","71149766M  -  SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149768M","SUP","HCPCS C1713","","71149768M  -  SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149770M","SUP","HCPCS C1713","","71149770M  -  SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$101.20 ","$74.89 ","$0.00 ","$101.20 ","$45.54 ","$0.00 ","$21.09 ","$0.00 ","$0.00 ","$17.72 ","$101.20 ","$0.00 ","$50.60 ","$80.15 ","$80.96 ","$0.00 ","$15.84 ","$0.00 ","$16.11 ","$0.00 "
"71149772M","SUP","HCPCS C1713","","71149772M  -  SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$167.20 ","$123.73 ","$0.00 ","$167.20 ","$75.24 ","$0.00 ","$34.85 ","$0.00 ","$0.00 ","$29.28 ","$167.20 ","$0.00 ","$83.60 ","$132.42 ","$133.76 ","$0.00 ","$26.17 ","$0.00 ","$26.62 ","$0.00 "
"71149776M","SUP","HCPCS C1713","","71149776M  -  SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$167.20 ","$123.73 ","$0.00 ","$167.20 ","$75.24 ","$0.00 ","$34.85 ","$0.00 ","$0.00 ","$29.28 ","$167.20 ","$0.00 ","$83.60 ","$132.42 ","$133.76 ","$0.00 ","$26.17 ","$0.00 ","$26.62 ","$0.00 "
"71149780M","SUP","HCPCS C1713","","71149780M  -  SCREW BN 4.5MM 8MM 80MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$47.25 ","$0.00 ","$21.88 ","$0.00 ","$0.00 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"71149785M","SUP","HCPCS C1713","","71149785M  -  SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS","BOTH IP/OP","$167.20 ","$123.73 ","$0.00 ","$167.20 ","$75.24 ","$0.00 ","$34.85 ","$0.00 ","$0.00 ","$29.28 ","$167.20 ","$0.00 ","$83.60 ","$132.42 ","$133.76 ","$0.00 ","$26.17 ","$0.00 ","$26.62 ","$0.00 "
"71149790M","SUP","HCPCS C1713","","71149790M  -  SCREW BN 4.5MM 8MM 90MM TC100 ST HEX SCKT SS METACARPUS","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$47.25 ","$0.00 ","$21.88 ","$0.00 ","$0.00 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"7115-0003","SUP","HCPCS C1776","","7115-0003  -  COMPONENT TIBIAL TRAY 3 STANDARD CEMENT SCORPIO KNEE 7000","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0004","SUP","HCPCS C1776","","7115-0004  -  COMPONENT TIBIAL TRAY STANDARD SERIES 7000","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0005","SUP","HCPCS C1776","","7115-0005  -  COMPONENT TIBIAL TRAY 5 1 AXIS PRIM POSTERIOR STABILIZED","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0006","SUP","HCPCS C1776","","7115-0006  -  COMPONENT TIBIAL TRAY STANDARD 1 AXIS PRIM POSTERIOR","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0007","SUP","HCPCS C1776","","7115-0007  -  COMPONENT TIBIAL TRAY 7 1 AXIS PRIM POSTERIOR STABILIZE","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0009","SUP","HCPCS C1776","","7115-0009  -  COMPONENT TIBIAL TRAY 9 1 AXIS PRIM POSTERIOR STABILIZED","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0011","SUP","HCPCS C1776","","7115-0011  -  COMPONENT TIBIAL TRAY 11 1 AXIS PRIM POSTERIOR STABILIZED","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7115-0013","SUP","HCPCS C1776","","7115-0013  -  COMPONENT TIBIAL TRAY 13 STANDARD 1 AXIS PRIM POSTERIOR","BOTH IP/OP","$2,330.00 ","$1,724.20 ","$0.00 ","$2,330.00 ","$1,048.50 ","$0.00 ","$485.63 ","$0.00 ","$0.00 ","$407.96 ","$2,330.00 ","$0.00 ","$1,165.00 ","$1,845.36 ","$1,864.00 ","$0.00 ","$364.65 ","$0.00 ","$370.94 ","$0.00 "
"7120/60","SUP","HCPCS C1895","","7120/60  -  LEAD PCNG 7FR 60CM DURATA TRUE BP ACTFX 2 COIL STRD","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7120/65","SUP","HCPCS C1895","","7120/65  -  LEAD PACING 7FR 65CM 2 COIL DF-4 CONCTR TRUE BIPOL","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7120/75","SUP","HCPCS C1895","","7120/75  -  DURATA+++PMM#:87533","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"7120Q/52","SUP","HCPCS C1895","","7120Q/52  -  LEAD DEFIBRILLATOR 17CM 7FR 52CM 2 COIL DF-4 CONCTR TRUE","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7120Q/58","SUP","HCPCS C1895","","7120Q/58  -  LEAD ICD 7FR 58CM DURATA OPTIM DF4 CNCT 2 COIL BP","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7120Q/65","SUP","HCPCS C1895","","7120Q/65  -  LEAD PACING 7FR 65CM 2 COIL DF-4 TRUE BIPOL ACTIVE FIX","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7121/60","SUP","HCPCS C1895","","7121/60  -  LEAD DFBR 7FR 60CM 21CM DURATA 2 COIL IS-1 CNCT TRUE BP","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7121/65","SUP","HCPCS C1895","","7121/65  -  LEAD PCNG 7FR 65CM DURATA 2 COIL ACTFX IMPL CARDVRT DFBR","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"71-2100","SUP","Custom 27011340","","71-2100  -  ADPR SCT MTL DISS","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7121Q/52","SUP","HCPCS C1895","","7121Q/52  -  LEAD PACING 21CM SPACE 7FR 52CM 2 COIL TRUE BIPOL","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7121Q/58","SUP","HCPCS C1895","","7121Q/58  -  LEAD PACING 21CM SPACE 7FR 58CM 2 COIL TRUE BIPOL","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7121Q/65","SUP","HCPCS C1895","","7121Q/65  -  LEAD PCNG 7FR 65CM DURATA DF4 CNCT TRUE BP ACTFX IMPL","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7122/60","SUP","HCPCS C1895","","7122/60  -  LEAD DFBR 7FR 60CM DURATA 1 COIL DF1 IS-1 CNCT TRUE BP SNS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7122/65","SUP","HCPCS C1895","","7122/65  -  LEAD PACING 7FR 65CM 1 COIL TRUE BIPOL CARDIOVERTER","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"71222010M","SUP","HCPCS C1713","","71222010M  -  SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222012M","SUP","HCPCS C1713","","71222012M  -  SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222016M","SUP","HCPCS C1713","","71222016M  -  SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222018M","SUP","HCPCS C1713","","71222018M  -  SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222020M","SUP","HCPCS C1713","","71222020M  -  SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222022M","SUP","HCPCS C1713","","71222022M  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222024M","SUP","HCPCS C1713","","71222024M  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222026M","SUP","HCPCS C1713","","71222026M  -  SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222028M","SUP","HCPCS C1713","","71222028M  -  SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222030M","SUP","HCPCS C1713","","71222030M  -  SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222032M","SUP","HCPCS C1713","","71222032M  -  SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222034M","SUP","HCPCS C1713","","71222034M  -  SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222036M","SUP","HCPCS C1713","","71222036M  -  SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222038M","SUP","HCPCS C1713","","71222038M  -  SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222040M","SUP","HCPCS C1713","","71222040M  -  SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71222045M","SUP","HCPCS C1713","","71222045M  -  SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71223010M","SUP","HCPCS C1713","","71223010M  -  SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223012M","SUP","HCPCS C1713","","71223012M  -  SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223014M","SUP","HCPCS C1713","","71223014M  -  SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223016M","SUP","HCPCS C1713","","71223016M  -  SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223018M","SUP","HCPCS C1713","","71223018M  -  SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223020M","SUP","HCPCS C1713","","71223020M  -  SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223024M","SUP","HCPCS C1713","","71223024M  -  SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223026M","SUP","HCPCS C1713","","71223026M  -  SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223028M","SUP","HCPCS C1713","","71223028M  -  SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223030M","SUP","HCPCS C1713","","71223030M  -  SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223032M","SUP","HCPCS C1713","","71223032M  -  SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223035M","SUP","HCPCS C1713","","71223035M  -  SCREW BN SM FT 4MM 6MM 35MM TC100 SS CANC","BOTH IP/OP","$72.40 ","$53.58 ","$0.00 ","$72.40 ","$32.58 ","$0.00 ","$15.09 ","$0.00 ","$0.00 ","$12.68 ","$72.40 ","$0.00 ","$36.20 ","$57.34 ","$57.92 ","$0.00 ","$11.33 ","$0.00 ","$11.53 ","$0.00 "
"71223036M","SUP","HCPCS C1713","","71223036M  -  SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223040M","SUP","HCPCS C1713","","71223040M  -  SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223045M","SUP","HCPCS C1713","","71223045M  -  SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223050M","SUP","HCPCS C1713","","71223050M  -  SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223055M","SUP","HCPCS C1713","","71223055M  -  SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223060M","SUP","HCPCS C1713","","71223060M  -  SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$82.80 ","$61.27 ","$0.00 ","$82.80 ","$37.26 ","$0.00 ","$17.26 ","$0.00 ","$0.00 ","$14.50 ","$82.80 ","$0.00 ","$41.40 ","$65.58 ","$66.24 ","$0.00 ","$12.96 ","$0.00 ","$13.18 ","$0.00 "
"71223210M","SUP","HCPCS C1713","","71223210M  -  SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223212M","SUP","HCPCS C1713","","71223212M  -  SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223214M","SUP","HCPCS C1713","","71223214M  -  SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223216M","SUP","HCPCS C1713","","71223216M  -  SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223218M","SUP","HCPCS C1713","","71223218M  -  SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223220M","SUP","HCPCS C1713","","71223220M  -  SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223222M","SUP","HCPCS C1713","","71223222M  -  SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223224M","SUP","HCPCS C1713","","71223224M  -  SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223226M","SUP","HCPCS C1713","","71223226M  -  SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223228M","SUP","HCPCS C1713","","71223228M  -  SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223230M","SUP","HCPCS C1713","","71223230M  -  SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223235M","SUP","HCPCS C1713","","71223235M  -  SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223240M","SUP","HCPCS C1713","","71223240M  -  SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223245M","SUP","HCPCS C1713","","71223245M  -  SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71223250M","SUP","HCPCS C1713","","71223250M  -  SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS","BOTH IP/OP","$80.80 ","$59.79 ","$0.00 ","$80.80 ","$36.36 ","$0.00 ","$16.84 ","$0.00 ","$0.00 ","$14.15 ","$80.80 ","$0.00 ","$40.40 ","$63.99 ","$64.64 ","$0.00 ","$12.65 ","$0.00 ","$12.86 ","$0.00 "
"71225026M","SUP","HCPCS C1713","","71225026M  -  SCREW BN 4.5MM 8MM 26MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225028M","SUP","HCPCS C1713","","71225028M  -  SCREW BN 4.5MM 8MM 28MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225030M","SUP","HCPCS C1713","","71225030M  -  SCREW BN 4.5MM 8MM 30MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225032M","SUP","HCPCS C1713","","71225032M  -  SCREW BN 4.5MM 8MM 32MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225034M","SUP","HCPCS C1713","","71225034M  -  SCREW BN 4.5MM 8MM 34MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225036M","SUP","HCPCS C1713","","71225036M  -  SCREW BN 4.5MM 8MM 36MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225038M","SUP","HCPCS C1713","","71225038M  -  SCREW BN 4.5MM 8MM 38MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225040M","SUP","HCPCS C1713","","71225040M  -  SCREW BN 4.5MM 8MM 40MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225042M","SUP","HCPCS C1713","","71225042M  -  SCREW BN 4.5MM 8MM 42MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225044M","SUP","HCPCS C1713","","71225044M  -  SCREW BN 4.5MM 8MM 44MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71225046M","SUP","HCPCS C1713","","71225046M  -  SCREW BN 4.5MM 8MM 46MM TC100 SS CORT LG FRAG SYS","BOTH IP/OP","$76.80 ","$56.83 ","$0.00 ","$76.80 ","$34.56 ","$0.00 ","$16.01 ","$0.00 ","$0.00 ","$13.45 ","$76.80 ","$0.00 ","$38.40 ","$60.83 ","$61.44 ","$0.00 ","$12.02 ","$0.00 ","$12.23 ","$0.00 "
"71226030M","SUP","HCPCS C1713","","71226030M  -  SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226035M","SUP","HCPCS C1713","","71226035M  -  SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226040M","SUP","HCPCS C1713","","71226040M  -  SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226045M","SUP","HCPCS C1713","","71226045M  -  SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226055M","SUP","HCPCS C1713","","71226055M  -  SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226060M","SUP","HCPCS C1713","","71226060M  -  SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226065M","SUP","HCPCS C1713","","71226065M  -  SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226070M","SUP","HCPCS C1713","","71226070M  -  SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226075M","SUP","HCPCS C1713","","71226075M  -  SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71226080M","SUP","HCPCS C1713","","71226080M  -  SCREW BN P/T 6.5MM 80MM 16MM TC100 CANC","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71229075M","SUP","HCPCS C1713","","71229075M  -  SCREW BN FT 6.5MM 8MM 75MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"71229080M","SUP","HCPCS C1713","","71229080M  -  SCREW BN FT 6.5MM 8MM 80MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$180.80 ","$133.79 ","$0.00 ","$180.80 ","$81.36 ","$0.00 ","$37.68 ","$0.00 ","$0.00 ","$31.66 ","$180.80 ","$0.00 ","$90.40 ","$143.19 ","$144.64 ","$0.00 ","$28.30 ","$0.00 ","$28.78 ","$0.00 "
"71229085M","SUP","HCPCS C1713","","71229085M  -  SCREW BN FT 6.5MM 8MM 85MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$180.80 ","$133.79 ","$0.00 ","$180.80 ","$81.36 ","$0.00 ","$37.68 ","$0.00 ","$0.00 ","$31.66 ","$180.80 ","$0.00 ","$90.40 ","$143.19 ","$144.64 ","$0.00 ","$28.30 ","$0.00 ","$28.78 ","$0.00 "
"71229090M","SUP","HCPCS C1713","","71229090M  -  SCREW BN FT 6.5MM 8MM 90MM TC100 SS CANC LG FRAG SYS","BOTH IP/OP","$164.80 ","$121.95 ","$0.00 ","$164.80 ","$74.16 ","$0.00 ","$34.35 ","$0.00 ","$0.00 ","$28.86 ","$164.80 ","$0.00 ","$82.40 ","$130.52 ","$131.84 ","$0.00 ","$25.79 ","$0.00 ","$26.24 ","$0.00 "
"7122Q/52","SUP","HCPCS C1777","","7122Q/52  -  LEAD PCNG 11MM SPC 6.8FR 58CM DURATA 1 COIL TRUE BP ACTFX","BOTH IP/OP","$8,775.00 ","$6,493.50 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,828.93 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7122Q/58","SUP","HCPCS C1777","","7122Q/58  -  LEAD PCNG 58CM 6.8FR 11MM SPC ECRDL 1 COIL DFBR ACT FIX TRUE","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"7122Q/65","SUP","HCPCS C1777","","7122Q/65  -  LEAD PACING 11MM SPACING 6.8FR 65CM TRUE BIPOL ACTIVE FIX","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7125-0003","SUP","HCPCS C1776","","7125-0003  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0004","SUP","HCPCS C1776","","7125-0004  -  COMPONENT TIBIAL TRAY STANDARD 4MM MICROSTRUCTURED SERIES","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0005","SUP","HCPCS C1776","","7125-0005  -  COMPONENT TIBIAL TRAY 5 STANDARD 66X44MM 30MM STEM WAFFLE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0006","SUP","HCPCS C1776","","7125-0006  -  COMPONENT TIBIAL TRAY 6 STANDARD MICROSTRUCTURED CEMENTED","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0007","SUP","HCPCS C1776","","7125-0007  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0009","SUP","HCPCS C1776","","7125-0009  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0011","SUP","HCPCS C1776","","7125-0011  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7125-0013","SUP","HCPCS C1776","","7125-0013  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7130/60","SUP","HCPCS C1895","","7130/60  -  LEAD DFBR 6.8FR 60CM STRL LF 17MM DURATA DISP","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7130/65","SUP","HCPCS C1895","","7130/65  -  DURATA+++PMM#:96295","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"71-3003L","SUP","HCPCS C1776","","71-3003L  -  CMPNT FEM 3 LEFT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,176.00 ","$2,350.24 ","$0.00 ","$3,176.00 ","$1,429.20 ","$0.00 ","$661.96 ","$0.00 ","$0.00 ","$556.09 ","$3,176.00 ","$0.00 ","$1,588.00 ","$2,515.39 ","$2,540.80 ","$0.00 ","$497.04 ","$0.00 ","$505.62 ","$0.00 "
"71-3003R","SUP","HCPCS C1776","","71-3003R  -  CMPNT FEM 3 RIGHT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,176.00 ","$2,350.24 ","$0.00 ","$3,176.00 ","$1,429.20 ","$0.00 ","$661.96 ","$0.00 ","$0.00 ","$556.09 ","$3,176.00 ","$0.00 ","$1,588.00 ","$2,515.39 ","$2,540.80 ","$0.00 ","$497.04 ","$0.00 ","$505.62 ","$0.00 "
"71-3005L","SUP","HCPCS C1776","","71-3005L  -  CMPNT FEM 5 LEFT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3005R","SUP","HCPCS C1776","","71-3005R  -  CMPNT FEM 5 RIGHT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3007L","SUP","HCPCS C1776","","71-3007L  -  CMPNT FEM 7 LEFT KNEE PS CMNT BASIC SCRP NPOR","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3007R","SUP","HCPCS C1776","","71-3007R  -  CMPNT FEM 7 RIGHT KNEE PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3009L","SUP","HCPCS C1776","","71-3009L  -  CMPNT FEM 9 LEFT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3009R","SUP","HCPCS C1776","","71-3009R  -  CMPNT FEM 9 RIGHT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3011L","SUP","HCPCS C1776","","71-3011L  -  CMPNT FEM 11 LEFT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3011R","SUP","HCPCS C1776","","71-3011R  -  CMPNT FEM 11 RIGHT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,110.00 ","$2,301.40 ","$0.00 ","$3,110.00 ","$1,399.50 ","$0.00 ","$648.20 ","$0.00 ","$0.00 ","$544.54 ","$3,110.00 ","$0.00 ","$1,555.00 ","$2,463.12 ","$2,488.00 ","$0.00 ","$486.72 ","$0.00 ","$495.11 ","$0.00 "
"71-3013L","SUP","HCPCS C1776","","71-3013L  -  CMPNT FEM 13 LEFT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,176.00 ","$2,350.24 ","$0.00 ","$3,176.00 ","$1,429.20 ","$0.00 ","$661.96 ","$0.00 ","$0.00 ","$556.09 ","$3,176.00 ","$0.00 ","$1,588.00 ","$2,515.39 ","$2,540.80 ","$0.00 ","$497.04 ","$0.00 ","$505.62 ","$0.00 "
"71-3013R","SUP","HCPCS C1776","","71-3013R  -  CMPNT FEM 13 RIGHT KNEE CMNT PS BASIC SCRP","BOTH IP/OP","$3,176.00 ","$2,350.24 ","$0.00 ","$3,176.00 ","$1,429.20 ","$0.00 ","$661.96 ","$0.00 ","$0.00 ","$556.09 ","$3,176.00 ","$0.00 ","$1,588.00 ","$2,515.39 ","$2,540.80 ","$0.00 ","$497.04 ","$0.00 ","$505.62 ","$0.00 "
"7131/60","SUP","HCPCS C1895","","7131/60  -  LEAD DFBR 60CM STRL LF 21CM DURATA DISP","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"7131/65","SUP","HCPCS C1895","","7131/65  -  LEAD PACING 21MM SPACE 6.8FR 65CM 2 COIL INTEGRATE BIPOL","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"71-4103L","SUP","HCPCS C1776","","71-4103L  -  CMPNT FEM 3 LEFT KNEE PS WFL POST SCRP LFIT","BOTH IP/OP","$3,657.00 ","$2,706.18 ","$0.00 ","$3,657.00 ","$1,645.65 ","$0.00 ","$762.21 ","$0.00 ","$0.00 ","$640.31 ","$3,657.00 ","$0.00 ","$1,828.50 ","$2,896.34 ","$2,925.60 ","$0.00 ","$572.32 ","$0.00 ","$582.19 ","$0.00 "
"71-4103R","SUP","HCPCS C1776","","71-4103R  -  CMPNT FEM 3 RIGHT KNEE PS WFL POST SCRP LFIT","BOTH IP/OP","$3,657.00 ","$2,706.18 ","$0.00 ","$3,657.00 ","$1,645.65 ","$0.00 ","$762.21 ","$0.00 ","$0.00 ","$640.31 ","$3,657.00 ","$0.00 ","$1,828.50 ","$2,896.34 ","$2,925.60 ","$0.00 ","$572.32 ","$0.00 ","$582.19 ","$0.00 "
"71-4104L","SUP","HCPCS C1776","","71-4104L  -  CMPNT FEM PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4104R","SUP","HCPCS C1776","","71-4104R  -  CMPNT FEM PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4105L","SUP","HCPCS C1776","","71-4105L  -  CMPNT FEM 5 LEFT PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4105R","SUP","HCPCS C1776","","71-4105R  -  CMPNT FEM 5 RIGHT PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4106L","SUP","HCPCS C1776","","71-4106L  -  CMPNT FEM PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4106R","SUP","HCPCS C1776","","71-4106R  -  CMPNT FEM 6 RIGHT PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4107L","SUP","HCPCS C1776","","71-4107L  -  COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN LT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4107R","SUP","HCPCS C1776","","71-4107R  -  COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN RT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4109L","SUP","HCPCS C1776","","71-4109L  -  CMPNT FEM 9 LEFT PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4109R","SUP","HCPCS C1776","","71-4109R  -  CMPNT FEM 9 RIGHT PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4111L","SUP","HCPCS C1776","","71-4111L  -  CMPNT FEM 11 LEFT PS WFL SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4111R","SUP","HCPCS C1776","","71-4111R  -  CMPNT FEM 11 RIGHT WFL PS SCRP LFIT","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"71-4113L","SUP","HCPCS C1776","","71-4113L  -  CMPNT FEM 13 LEFT PS WFL SCRP LFIT","BOTH IP/OP","$3,657.00 ","$2,706.18 ","$0.00 ","$3,657.00 ","$1,645.65 ","$0.00 ","$762.21 ","$0.00 ","$0.00 ","$640.31 ","$3,657.00 ","$0.00 ","$1,828.50 ","$2,896.34 ","$2,925.60 ","$0.00 ","$572.32 ","$0.00 ","$582.19 ","$0.00 "
"71-4113R","SUP","HCPCS C1776","","71-4113R  -  CMPNT FEM 13 RIGHT KNEE PS WFL POST SCRP LFIT","BOTH IP/OP","$3,657.00 ","$2,706.18 ","$0.00 ","$3,657.00 ","$1,645.65 ","$0.00 ","$762.21 ","$0.00 ","$0.00 ","$640.31 ","$3,657.00 ","$0.00 ","$1,828.50 ","$2,896.34 ","$2,925.60 ","$0.00 ","$572.32 ","$0.00 ","$582.19 ","$0.00 "
"7145-0003","SUP","HCPCS C1776","","7145-0003  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7145-0005","SUP","HCPCS C1776","","7145-0005  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7145-0007","SUP","HCPCS C1776","","7145-0007  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7145-0009","SUP","HCPCS C1776","","7145-0009  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7145-0011","SUP","HCPCS C1776","","7145-0011  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"7145-0013","SUP","HCPCS C1776","","7145-0013  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4503L","SUP","HCPCS C1776","","71-4503L  -  COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4503R","SUP","HCPCS C1776","","71-4503R  -  COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4504L","SUP","HCPCS C1776","","71-4504L  -  COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4504R","SUP","HCPCS C1776","","71-4504R  -  COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4505L","SUP","HCPCS C1776","","71-4505L  -  COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4505R","SUP","HCPCS C1776","","71-4505R  -  COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4506L","SUP","HCPCS C1776","","71-4506L  -  COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4506R","SUP","HCPCS C1776","","71-4506R  -  COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4507L","SUP","HCPCS C1776","","71-4507L  -  COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4507R","SUP","HCPCS C1776","","71-4507R  -  COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4509L","SUP","HCPCS C1776","","71-4509L  -  COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4509R","SUP","HCPCS C1776","","71-4509R  -  COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4511L","SUP","HCPCS C1776","","71-4511L  -  COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4511R","SUP","HCPCS C1776","","71-4511R  -  COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4513L","SUP","HCPCS C1776","","71-4513L  -  COMPONENT FEMORAL 13 81X58MM CEMENTED POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-4513R","SUP","HCPCS C1776","","71-4513R  -  COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"71-5003L","SUP","HCPCS C1776","","71-5003L  -  CMPNT FEM 3 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,199.00 ","$3,847.26 ","$0.00 ","$5,199.00 ","$2,339.55 ","$0.00 ","$1,083.60 ","$0.00 ","$0.00 ","$910.30 ","$5,199.00 ","$0.00 ","$2,599.50 ","$4,117.61 ","$4,159.20 ","$0.00 ","$813.64 ","$0.00 ","$827.68 ","$0.00 "
"71-5003R","SUP","HCPCS C1776","","71-5003R  -  CMPNT FEM 3 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,199.00 ","$3,847.26 ","$0.00 ","$5,199.00 ","$2,339.55 ","$0.00 ","$1,083.60 ","$0.00 ","$0.00 ","$910.30 ","$5,199.00 ","$0.00 ","$2,599.50 ","$4,117.61 ","$4,159.20 ","$0.00 ","$813.64 ","$0.00 ","$827.68 ","$0.00 "
"71-5004L","SUP","HCPCS C1776","","71-5004L  -  CMPNT FEM 4 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5004R","SUP","HCPCS C1776","","71-5004R  -  CMPNT FEM 4 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5005L","SUP","HCPCS C1776","","71-5005L  -  CMPNT FEM 5 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5005R","SUP","HCPCS C1776","","71-5005R  -  CMPNT FEM 5 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5006L","SUP","HCPCS C1776","","71-5006L  -  CMPNT FEM 6 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5006R","SUP","HCPCS C1776","","71-5006R  -  CMPNT FEM 6 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5007L","SUP","HCPCS C1776","","71-5007L  -  CMPNT FEM 7 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5007R","SUP","HCPCS C1776","","71-5007R  -  CMPNT FEM 7 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5009L","SUP","HCPCS C1776","","71-5009L  -  CMPNT FEM 9 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5009R","SUP","HCPCS C1776","","71-5009R  -  CMPNT FEM 9 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5011L","SUP","HCPCS C1776","","71-5011L  -  CMPNT FEM 11 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5011R","SUP","HCPCS C1776","","71-5011R  -  CMPNT FEM 11 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,096.00 ","$3,771.04 ","$0.00 ","$5,096.00 ","$2,293.20 ","$0.00 ","$1,062.13 ","$0.00 ","$0.00 ","$892.27 ","$5,096.00 ","$0.00 ","$2,548.00 ","$4,036.03 ","$4,076.80 ","$0.00 ","$797.52 ","$0.00 ","$811.28 ","$0.00 "
"71-5013L","SUP","HCPCS C1776","","71-5013L  -  CMPNT FEM 13 LEFT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,199.00 ","$3,847.26 ","$0.00 ","$5,199.00 ","$2,339.55 ","$0.00 ","$1,083.60 ","$0.00 ","$0.00 ","$910.30 ","$5,199.00 ","$0.00 ","$2,599.50 ","$4,117.61 ","$4,159.20 ","$0.00 ","$813.64 ","$0.00 ","$827.68 ","$0.00 "
"71-5013R","SUP","HCPCS C1776","","71-5013R  -  CMPNT FEM 13 RIGHT KNEE PS MCSTRCT NON LFIT SCRP","BOTH IP/OP","$5,199.00 ","$3,847.26 ","$0.00 ","$5,199.00 ","$2,339.55 ","$0.00 ","$1,083.60 ","$0.00 ","$0.00 ","$910.30 ","$5,199.00 ","$0.00 ","$2,599.50 ","$4,117.61 ","$4,159.20 ","$0.00 ","$813.64 ","$0.00 ","$827.68 ","$0.00 "
"71-5103L","SUP","HCPCS C1776","","71-5103L  -  CMPNT FEM 3 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,839.00 ","$3,580.86 ","$0.00 ","$4,839.00 ","$2,177.55 ","$0.00 ","$1,008.57 ","$0.00 ","$0.00 ","$847.27 ","$4,839.00 ","$0.00 ","$2,419.50 ","$3,832.49 ","$3,871.20 ","$0.00 ","$757.30 ","$0.00 ","$770.37 ","$0.00 "
"71-5103R","SUP","HCPCS C1776","","71-5103R  -  CMPNT FEM 3 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,839.00 ","$3,580.86 ","$0.00 ","$4,839.00 ","$2,177.55 ","$0.00 ","$1,008.57 ","$0.00 ","$0.00 ","$847.27 ","$4,839.00 ","$0.00 ","$2,419.50 ","$3,832.49 ","$3,871.20 ","$0.00 ","$757.30 ","$0.00 ","$770.37 ","$0.00 "
"71-5104L","SUP","HCPCS C1776","","71-5104L  -  CMPNT FEM LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5104R","SUP","HCPCS C1776","","71-5104R  -  CMPNT FEM 4 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5105L","SUP","HCPCS C1776","","71-5105L  -  CMPNT FEM 5 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5105R","SUP","HCPCS C1776","","71-5105R  -  CMPNT FEM 5 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5106L","SUP","HCPCS C1776","","71-5106L  -  CMPNT FEM 6 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5106R","SUP","HCPCS C1776","","71-5106R  -  CMPNT FEM 6 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5107L","SUP","HCPCS C1776","","71-5107L  -  CMPNT FEM 7 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5107R","SUP","HCPCS C1776","","71-5107R  -  CMPNT FEM 7 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5109L","SUP","HCPCS C1776","","71-5109L  -  CMPNT FEM 9 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5109R","SUP","HCPCS C1776","","71-5109R  -  CMPNT FEM 9 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5111L","SUP","HCPCS C1776","","71-5111L  -  CMPNT FEM 11 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5111R","SUP","HCPCS C1776","","71-5111R  -  CMPNT FEM 11 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$2,151.00 ","$0.00 ","$996.27 ","$0.00 ","$0.00 ","$836.94 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$748.07 ","$0.00 ","$760.98 ","$0.00 "
"71-5113L","SUP","HCPCS C1776","","71-5113L  -  CMPNT FEM 13 LEFT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,839.00 ","$3,580.86 ","$0.00 ","$4,839.00 ","$2,177.55 ","$0.00 ","$1,008.57 ","$0.00 ","$0.00 ","$847.27 ","$4,839.00 ","$0.00 ","$2,419.50 ","$3,832.49 ","$3,871.20 ","$0.00 ","$757.30 ","$0.00 ","$770.37 ","$0.00 "
"71-5113R","SUP","HCPCS C1776","","71-5113R  -  CMPNT FEM 13 RIGHT KNEE PS MCSTRCT SCRP LFIT","BOTH IP/OP","$4,839.00 ","$3,580.86 ","$0.00 ","$4,839.00 ","$2,177.55 ","$0.00 ","$1,008.57 ","$0.00 ","$0.00 ","$847.27 ","$4,839.00 ","$0.00 ","$2,419.50 ","$3,832.49 ","$3,871.20 ","$0.00 ","$757.30 ","$0.00 ","$770.37 ","$0.00 "
"71511V","SUP","Custom 27203010","","71511V  -  CLIP INTNL REMOVER MED LARGE - LARGE  STRAIGHT 11IN��","BOTH IP/OP","$412.48 ","$305.24 ","$0.00 ","$412.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.48 ","$0.00 ","$206.24 ","$326.68 ","$329.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71512V","SUP","Custom 27203010","","71512V  -  APPLIER MED LARGE  CURVED 11IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71517V","SUP","Custom 27203010","","71517V  -  APPLIER MED LARGE  70 DEGREE 11IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71-5203L","SUP","HCPCS C1776","","71-5203L  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5203R","SUP","HCPCS C1776","","71-5203R  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5205L","SUP","HCPCS C1776","","71-5205L  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5205R","SUP","HCPCS C1776","","71-5205R  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5207L","SUP","HCPCS C1776","","71-5207L  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5207R","SUP","HCPCS C1776","","71-5207R  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5209L","SUP","HCPCS C1776","","71-5209L  -  COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5209R","SUP","HCPCS C1776","","71-5209R  -  COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5211L","SUP","HCPCS C1776","","71-5211L  -  COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5211R","SUP","HCPCS C1776","","71-5211R  -  COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5213L","SUP","HCPCS C1776","","71-5213L  -  COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71-5213R","SUP","HCPCS C1776","","71-5213R  -  COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM","BOTH IP/OP","$4,505.00 ","$3,333.70 ","$0.00 ","$4,505.00 ","$2,027.25 ","$0.00 ","$938.95 ","$0.00 ","$0.00 ","$788.79 ","$4,505.00 ","$0.00 ","$2,252.50 ","$3,567.96 ","$3,604.00 ","$0.00 ","$705.03 ","$0.00 ","$717.20 ","$0.00 "
"71582V","SUP","Custom 27203010","","71582V  -  APPLIER MED LARGE  CURVED 8IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71587V","SUP","Custom 27203010","","71587V  -  APPLIER MED LARGE  70 DEGREE 8IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7160-20","SUP","Custom 27203010","","7160-20  -  KIT PEG 20FR 4X4IN SPONGE FEED TUBE EXTERNAL RETENTION RING","BOTH IP/OP","$225.15 ","$166.61 ","$0.00 ","$228.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$228.53 ","$0.00 ","$114.26 ","$181.00 ","$182.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71612V","SUP","Custom 27203010","","71612V  -  APPLIER LARGE  CURVED 11IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71617V","SUP","Custom 27203010","","71617V  -  APPLIER LARGE  70 DEGREE 11IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71682510L","SUP","HCPCS C1713","","71682510L  -  NAIL IM 125D STD 10MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71682510R","SUP","HCPCS C1713","","71682510R  -  NAIL IM 125D STD 10MM 19.5CM IMHS CP SS HIP RT","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71682512L","SUP","HCPCS C1713","","71682512L  -  NAIL IM 125D STD 12MM 19.5CM IMHS CP SS HIP LT","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71682512R","SUP","HCPCS C1713","","71682512R  -  NAIL IM 125D STD 12MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71682514L","SUP","HCPCS C1713","","71682514L  -  NAIL IM 125D STD 14MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71682514R","SUP","HCPCS C1713","","71682514R  -  NAIL IM 125D STD 14MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71682516L","SUP","HCPCS C1713","","71682516L  -  NAIL IM 125D STD 16MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71682516R","SUP","HCPCS C1713","","71682516R  -  NAIL IM 125D STD 16MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71682532L","SUP","HCPCS C1713","","71682532L  -  NAIL IM 125D LNG 10MM 32CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682532R","SUP","HCPCS C1713","","71682532R  -  NAIL IM 125D LNG 10MM 32CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682534L","SUP","HCPCS C1713","","71682534L  -  NAIL IM 125D LNG 10MM 34CM IMHS CP SS FEM LT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682534R","SUP","HCPCS C1713","","71682534R  -  NAIL IM 125D LNG 10MM 34CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682536L","SUP","HCPCS C1713","","71682536L  -  NAIL IM 125D LNG 10MM 36CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682536R","SUP","HCPCS C1713","","71682536R  -  NAIL IM 125D LNG 10MM 36CM IMHS CP SS RT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682538L","SUP","HCPCS C1713","","71682538L  -  NAIL IM 125D LNG 10MM 38CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682538R","SUP","HCPCS C1713","","71682538R  -  NAIL IM 125D LNG 10MM 38CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682540L","SUP","HCPCS C1713","","71682540L  -  NAIL IM 125D LNG 10MM 40CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682540R","SUP","HCPCS C1713","","71682540R  -  NAIL IM 125D LNG 10MM 40CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682542L","SUP","HCPCS C1713","","71682542L  -  NAIL IM 125D LNG 10MM 42CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682542R","SUP","HCPCS C1713","","71682542R  -  NAIL IM 125D LNG 10MM 42CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682544L","SUP","HCPCS C1713","","71682544L  -  NAIL IM 125D LNG 10MM 44CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682544R","SUP","HCPCS C1713","","71682544R  -  NAIL IM 125D LNG 10MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682632L","SUP","HCPCS C1713","","71682632L  -  NAIL IM 125D LNG 12MM 32CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682632R","SUP","HCPCS C1713","","71682632R  -  NAIL IM 125D LNG 12MM 32CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682634L","SUP","HCPCS C1713","","71682634L  -  NAIL IM 125D 12MM 34CM IMHS SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682634R","SUP","HCPCS C1713","","71682634R  -  NAIL IM 125D LNG 12MM 34CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682636L","SUP","HCPCS C1713","","71682636L  -  NAIL IM 125D LNG 12MM 36CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682636R","SUP","HCPCS C1713","","71682636R  -  NAIL IM 125D LNG 12MM 36CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682638L","SUP","HCPCS C1713","","71682638L  -  NAIL IM 125D LNG 12MM 38CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682638R","SUP","HCPCS C1713","","71682638R  -  NAIL IM 125D LNG 12MM 38CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682640L","SUP","HCPCS C1713","","71682640L  -  NAIL IM 125D LNG 12MM 40CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682640R","SUP","HCPCS C1713","","71682640R  -  NAIL IM 125D LNG 12MM 40CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682642L","SUP","HCPCS C1713","","71682642L  -  NAIL IM 125D LNG 12MM 42CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682642R","SUP","HCPCS C1713","","71682642R  -  NAIL IM 125D LNG 12MM 42CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682644L","SUP","HCPCS C1713","","71682644L  -  NAIL IM 125D LNG 12MM 44CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682644R","SUP","HCPCS C1713","","71682644R  -  NAIL IM 125D LNG 12MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682734R","SUP","HCPCS C1713","","71682734R  -  NAIL IM 125D 14MM 34CM IMHS CP SS RT HIP","BOTH IP/OP","$6,269.38 ","$4,639.34 ","$0.00 ","$6,269.38 ","$2,821.22 ","$0.00 ","$1,306.69 ","$0.00 ","$0.00 ","$1,097.72 ","$6,269.38 ","$0.00 ","$3,134.69 ","$4,965.35 ","$5,015.50 ","$0.00 ","$981.16 ","$0.00 ","$998.08 ","$0.00 "
"71682736L","SUP","HCPCS C1713","","71682736L  -  NAIL IM 125D 14MM 36CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71682744L","SUP","HCPCS C1713","","71682744L  -  NAIL IM 125D 14MM 44CM IMHS CP SS LT HIP","BOTH IP/OP","$6,269.38 ","$4,639.34 ","$0.00 ","$6,269.38 ","$2,821.22 ","$0.00 ","$1,306.69 ","$0.00 ","$0.00 ","$1,097.72 ","$6,269.38 ","$0.00 ","$3,134.69 ","$4,965.35 ","$5,015.50 ","$0.00 ","$981.16 ","$0.00 ","$998.08 ","$0.00 "
"71682744R","SUP","HCPCS C1713","","71682744R  -  NAIL IM 125D 14MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,269.38 ","$4,639.34 ","$0.00 ","$6,269.38 ","$2,821.22 ","$0.00 ","$1,306.69 ","$0.00 ","$0.00 ","$1,097.72 ","$6,269.38 ","$0.00 ","$3,134.69 ","$4,965.35 ","$5,015.50 ","$0.00 ","$981.16 ","$0.00 ","$998.08 ","$0.00 "
"71682V","SUP","Custom 27203010","","71682V  -  APPLIER LARGE  CURVED 8IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71683010L","SUP","HCPCS C1713","","71683010L  -  NAIL IM 130D 10MM 19.5CM IMHS CP SS HIP LT","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71683012L","SUP","HCPCS C1713","","71683012L  -  NAIL IM 130D 12MM 19.5CM IMHS SS LT HIP","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71683012R","SUP","HCPCS C1713","","71683012R  -  NAIL IM 130D STD 12MM 19.5CM IMHS SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683014L","SUP","HCPCS C1713","","71683014L  -  NAIL IM 130D 14MM 19.5CM IMHS SS LT HIP","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71683014R","SUP","HCPCS C1713","","71683014R  -  NAIL IM 130D STD 14MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683016L","SUP","HCPCS C1713","","71683016L  -  NAIL IM 130D STD 16MM 19.5CM IMHS CP SS HIP LT","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683016R","SUP","HCPCS C1713","","71683016R  -  NAIL IM 130D STD 16MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683032L","SUP","HCPCS C1713","","71683032L  -  NAIL IM 130D LNG 10MM 32CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683032R","SUP","HCPCS C1713","","71683032R  -  NAIL IM 130D LNG 10MM 32CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683034L","SUP","HCPCS C1713","","71683034L  -  NAIL IM 130D LNG 10MM 34CM IMHS CP SS LT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683034R","SUP","HCPCS C1713","","71683034R  -  NAIL IM 130D LNG 10MM 34CM IMHS CP SS RT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683036L","SUP","HCPCS C1713","","71683036L  -  NAIL IM 130D LNG 10MM 36CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683036R","SUP","HCPCS C1713","","71683036R  -  NAIL IM 130D LNG 10MM 36CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683038L","SUP","HCPCS C1713","","71683038L  -  NAIL IM 130D LNG 10MM 38CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683038R","SUP","HCPCS C1713","","71683038R  -  NAIL IM 130D LNG 10MM 38CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683040L","SUP","HCPCS C1713","","71683040L  -  NAIL IM 130D LNG 10MM 40CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683040R","SUP","HCPCS C1713","","71683040R  -  NAIL IM 130D 10MM 40CM IMHS SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683042L","SUP","HCPCS C1713","","71683042L  -  NAIL IM 130D LNG 10MM 42CM IMHS CP SS HIP LT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683042R","SUP","HCPCS C1713","","71683042R  -  NAIL IM 130D LNG 10MM 42CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683044L","SUP","HCPCS C1713","","71683044L  -  NAIL IM 130D LNG 10MM 44CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683044R","SUP","HCPCS C1713","","71683044R  -  NAIL IM 130D LNG 10MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683132L","SUP","HCPCS C1713","","71683132L  -  NAIL IM 130D LNG 12MM 32CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683132R","SUP","HCPCS C1713","","71683132R  -  NAIL IM 130D LNG 12MM 32CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683134L","SUP","HCPCS C1713","","71683134L  -  NAIL IM 130D LNG 12MM 34CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683134R","SUP","HCPCS C1713","","71683134R  -  NAIL IM 130D 12MM 34CM IMHS CP SS RT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683136L","SUP","HCPCS C1713","","71683136L  -  NAIL IM 130D 12MM 36CM IMHS SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683136R","SUP","HCPCS C1713","","71683136R  -  NAIL IM 130D LNG 12MM 36CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683138L","SUP","HCPCS C1713","","71683138L  -  NAIL IM 130D LNG 12MM 38CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683138R","SUP","HCPCS C1713","","71683138R  -  NAIL IM 130D LNG 12MM 38CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683140L","SUP","HCPCS C1713","","71683140L  -  NAIL IM 130D LNG 12MM 40CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683140R","SUP","HCPCS C1713","","71683140R  -  NAIL IM 130D LNG 12MM 40CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683142L","SUP","HCPCS C1713","","71683142L  -  NAIL IM 130D LNG 12MM 42CM IMHS CP SS HIP LT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683142R","SUP","HCPCS C1713","","71683142R  -  NAIL IM 130D LNG 12MM 42CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683144L","SUP","HCPCS C1713","","71683144L  -  NAIL IM 130D LNG 12MM 44CM IMHS CP SS HIP LT","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683144R","SUP","HCPCS C1713","","71683144R  -  NAIL IM 130D LNG 12MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683510L","SUP","HCPCS C1713","","71683510L  -  NAIL IM 135D STD 10MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71683510R","SUP","HCPCS C1713","","71683510R  -  NAIL IM 135D STD 10MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71683512L","SUP","HCPCS C1713","","71683512L  -  NAIL IM 135D STD 12MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,329.38 ","$2,463.74 ","$0.00 ","$3,329.38 ","$1,498.22 ","$0.00 ","$693.92 ","$0.00 ","$0.00 ","$582.95 ","$3,329.38 ","$0.00 ","$1,664.69 ","$2,636.87 ","$2,663.50 ","$0.00 ","$521.05 ","$0.00 ","$530.04 ","$0.00 "
"71683512R","SUP","HCPCS C1713","","71683512R  -  NAIL IM 135D STD 12MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683514L","SUP","HCPCS C1713","","71683514L  -  NAIL IM 135D STD 14MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683514R","SUP","HCPCS C1713","","71683514R  -  NAIL IM 135D STD 14MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683516L","SUP","HCPCS C1713","","71683516L  -  NAIL IM 135D 16MM 19.5CM IMHS CP SS LT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683516R","SUP","HCPCS C1713","","71683516R  -  NAIL IM 135D 16MM 19.5CM IMHS CP SS RT HIP","BOTH IP/OP","$3,342.50 ","$2,473.45 ","$0.00 ","$3,342.50 ","$1,504.13 ","$0.00 ","$696.66 ","$0.00 ","$0.00 ","$585.25 ","$3,342.50 ","$0.00 ","$1,671.25 ","$2,647.26 ","$2,674.00 ","$0.00 ","$523.10 ","$0.00 ","$532.13 ","$0.00 "
"71683532L","SUP","HCPCS C1713","","71683532L  -  NAIL IM 135D LNG 10MM 32CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683532R","SUP","HCPCS C1713","","71683532R  -  NAIL IM 135D LNG 10MM 32CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683534L","SUP","HCPCS C1713","","71683534L  -  NAIL IM 135D LNG 10MM 34CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683534R","SUP","HCPCS C1713","","71683534R  -  NAIL IM 135D LNG 10MM 34CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683536L","SUP","HCPCS C1713","","71683536L  -  NAIL IM 135D LNG 10MM 36CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683536R","SUP","HCPCS C1713","","71683536R  -  NAIL IM 135D LNG 10MM 36CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683538L","SUP","HCPCS C1713","","71683538L  -  NAIL IM 135D LNG 10MM 38CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683538R","SUP","HCPCS C1713","","71683538R  -  NAIL IM 135D LNG 10MM 38CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683540L","SUP","HCPCS C1713","","71683540L  -  NAIL IM 135D LNG 10MM 40CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683540R","SUP","HCPCS C1713","","71683540R  -  NAIL IM 135D LNG 10MM 40CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683542L","SUP","HCPCS C1713","","71683542L  -  NAIL IM 135D LNG 10MM 42CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683542R","SUP","HCPCS C1713","","71683542R  -  NAIL IM 135D LNG 10MM 42CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683544L","SUP","HCPCS C1713","","71683544L  -  NAIL IM 135D LNG 10MM 44CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683544R","SUP","HCPCS C1713","","71683544R  -  NAIL IM 135D LNG 10MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683632L","SUP","HCPCS C1713","","71683632L  -  NAIL IM 135D LNG 12MM 32CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683632R","SUP","HCPCS C1713","","71683632R  -  NAIL IM 135D 12MM 32CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683634L","SUP","HCPCS C1713","","71683634L  -  NAIL IM 135D LNG 12MM 34CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683634R","SUP","HCPCS C1713","","71683634R  -  NAIL IM 135D LNG 12MM 34CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683636L","SUP","HCPCS C1713","","71683636L  -  NAIL IM 135D LNG 12MM 36CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683636R","SUP","HCPCS C1713","","71683636R  -  NAIL IM 135D LNG 12MM 36CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683638L","SUP","HCPCS C1713","","71683638L  -  NAIL IM 135D LNG 12MM 38CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683638R","SUP","HCPCS C1713","","71683638R  -  NAIL IM 135D LNG 12MM 38CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683640L","SUP","HCPCS C1713","","71683640L  -  NAIL IM 135D LNG 12MM 40CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683640R","SUP","HCPCS C1713","","71683640R  -  NAIL IM 135D LNG 12MM 40CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683642L","SUP","HCPCS C1713","","71683642L  -  NAIL IM 135D LNG 12MM 42CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683642R","SUP","HCPCS C1713","","71683642R  -  NAIL IM 135D LNG 12MM 42CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683644L","SUP","HCPCS C1713","","71683644L  -  NAIL IM 135D LNG 12MM 44CM IMHS CP SS LT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71683644R","SUP","HCPCS C1713","","71683644R  -  NAIL IM 135D LNG 12MM 44CM IMHS CP SS RT HIP","BOTH IP/OP","$6,671.88 ","$4,937.19 ","$0.00 ","$6,671.88 ","$3,002.34 ","$0.00 ","$1,390.59 ","$0.00 ","$0.00 ","$1,168.19 ","$6,671.88 ","$0.00 ","$3,335.94 ","$5,284.13 ","$5,337.50 ","$0.00 ","$1,044.15 ","$0.00 ","$1,062.16 ","$0.00 "
"71687V","SUP","Custom 27203010","","71687V  -  APPLIER LARGE  70 DEGREE 8IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71701016L","SUP","HCPCS C1713","","71701016L  -  NAIL IM 12-10MM 16CM LIME TRGN FSN RND XSECT DC SLOT TI","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701016R","SUP","HCPCS C1713","","71701016R  -  NAIL IM 10MM 16CM TRGN FSN TI RT HINDFOOT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701020L","SUP","HCPCS C1713","","71701020L  -  NAIL INTRAMEDULLARY 10MM 20CM FUSION TRIGEN LEFT HINDFOOT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701020R","SUP","HCPCS C1713","","71701020R  -  NAIL IM 12-10MM 20CM ROSE TRGN FSN RND XSECT DC SLOT TI","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701025L","SUP","HCPCS C1713","","71701025L  -  NAIL IM 10MM 25CM TRGN TI LT HINDFOOT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701025R","SUP","HCPCS C1713","","71701025R  -  NAIL IM 10MM 25CM TRGN FSN TI RT HINDFOOT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701116R","SUP","HCPCS C1713","","71701116R  -  NAIL INTRAMEDULLARY 11.5MM 16CM FUSION TRIGEN RIGHT HINDFOOT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701120L","SUP","HCPCS C1713","","71701120L  -  NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM LEFT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701120R","SUP","HCPCS C1713","","71701120R  -  NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM RIGHT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701125L","SUP","HCPCS C1713","","71701125L  -  NAIL IM 11.5MM 25CM TRGN TI HINDFOOT LT","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"71701125R","SUP","HCPCS C1713","","71701125R  -  TRIGIN HINDFOOT FUSION NAIL (R) 11.5x25CM","BOTH IP/OP","$5,613.75 ","$4,154.18 ","$0.00 ","$5,613.75 ","$2,526.19 ","$0.00 ","$1,170.05 ","$0.00 ","$0.00 ","$982.92 ","$5,613.75 ","$0.00 ","$2,806.88 ","$4,446.09 ","$4,491.00 ","$0.00 ","$878.55 ","$0.00 ","$893.71 ","$0.00 "
"7170-20","SUP","Custom 27203010","","7170-20  -  KIT PG 20FR MIC PUSH","BOTH IP/OP","$229.50 ","$169.83 ","$0.00 ","$229.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$229.50 ","$0.00 ","$114.75 ","$181.76 ","$183.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7170-24","SUP","Custom 27203010","","7170-24  -  KIT PG 24FR 12ML STRL LF MC SLK PUSH RADOPQ MED PORT SIL","BOTH IP/OP","$229.50 ","$169.83 ","$0.00 ","$229.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$229.50 ","$0.00 ","$114.75 ","$181.76 ","$183.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7170Q/52","SUP","HCPCS C1895","","7170Q/52  -  DURATA SJ4 - PASSIVE","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"7170Q/58","SUP","HCPCS C1895","","7170Q/58  -  LEAD PACING 7FR 58CM 17CM TRUE BIPOL ACTIVE FIX 2 COIL","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7170Q/65","SUP","HCPCS C1895","","7170Q/65  -  LEAD DFBR 17CM 65CM DURATA TINE FX 2 COIL DF4 CNCT TRUE BP","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"71711V","SUP","Custom 27203010","","71711V  -  CLIP INTNL REMOVER LARGE - XLARGE  STRAIGHT 11IN��","BOTH IP/OP","$412.48 ","$305.24 ","$0.00 ","$412.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.48 ","$0.00 ","$206.24 ","$326.68 ","$329.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71712V","SUP","Custom 27203010","","71712V  -  APPLIER XLARGE  CURVED 11IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71717V","SUP","Custom 27203010","","71717V  -  APPLIER XLARGE  70 DEGREE 11IN��","BOTH IP/OP","$378.73 ","$280.26 ","$0.00 ","$378.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.73 ","$0.00 ","$189.36 ","$299.95 ","$302.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7171Q/52","SUP","HCPCS C1895","","7171Q/52  -  DURATA SJ4 - PASSIVE","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"7171Q/58","SUP","HCPCS C1895","","7171Q/58  -  LEAD DFBR 7FR 58CM 21CM DURATA 2 COIL DF4 CNCT TRUE BP ACTFX","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7171Q/65","SUP","HCPCS C1895","","7171Q/65  -  LEAD DFBR 65CM DURATA 2 COIL TRUE BP TINE FX DF4 CNCT OPTIM","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"7180025A","SUP","HCPCS C1713","","7180025A  -  END CAP SPNL 18MM 20-25MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180027A","SUP","HCPCS C1713","","7180027A  -  END CAP SPNL 18MM 21-27MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180033A","SUP","HCPCS C1713","","7180033A  -  END CAP SPNL 18MM 24-33MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180041A","SUP","HCPCS C1713","","7180041A  -  END CAP SPNL 18MM 28-41MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180055A","SUP","HCPCS C1713","","7180055A  -  END CAP SPNL 18MM 35-55MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180067A","SUP","HCPCS C1713","","7180067A  -  END CAP SPNL 18MM 41-67MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180079A","SUP","HCPCS C1713","","7180079A  -  END CAP SPNL 18MM 47-79MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7180-20","SUP","Custom 27203010","","7180-20  -  KIT PG 20FR 4X4IN 12ML STRL LF SECUR-LOK MIC SPNG FDTB XTRN","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$312.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$0.00 ","$156.30 ","$247.58 ","$250.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7180-24","SUP","Custom 27203010","","7180-24  -  KIT PG 24FR 12ML STRL LF MC SLK PUL RADOPQ MED PORT SIL DISP","BOTH IP/OP","$231.75 ","$171.50 ","$0.00 ","$312.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.60 ","$0.00 ","$156.30 ","$247.58 ","$250.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71A003","SUP","Custom 27804086","","71A003  -  GRAFT BONE SMALL 40-65MM CORTICAL SEGMENT","BOTH IP/OP","$1,617.50 ","$1,196.95 ","$0.00 ","$1,617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,617.50 ","$0.00 ","$808.75 ","$1,281.06 ","$1,294.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"71A004","SUP","Custom 27804086","","71A004  -  GRAFT BONE LARGE 66-99MM CORTICAL SEGMENT","BOTH IP/OP","$1,707.50 ","$1,263.55 ","$0.00 ","$1,707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,707.50 ","$0.00 ","$853.75 ","$1,352.34 ","$1,366.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"720088-01","SUP","HCPCS C1771","","720088-01  -  SLING UROLOGICAL ADVANCE MALE","BOTH IP/OP","$14,150.00 ","$10,471.00 ","$0.00 ","$14,150.00 ","$6,367.50 ","$0.00 ","$2,949.21 ","$0.00 ","$0.00 ","$2,477.55 ","$14,150.00 ","$0.00 ","$7,075.00 ","$11,206.80 ","$11,320.00 ","$0.00 ","$2,214.48 ","$0.00 ","$2,252.68 ","$0.00 "
"720185-01","SUP","HCPCS C1813","","720185-01  -  PROSTHESIS PENILE PRECONNECT INFLATABLE RESERVOIR AMS 700 MS","BOTH IP/OP","$4,672.50 ","$3,457.65 ","$0.00 ","$4,672.50 ","$2,102.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,672.50 ","$0.00 ","$2,336.25 ","$3,700.62 ","$3,738.00 ","$0.00 ","$0.00 ","$0.00 ","$743.86 ","$0.00 "
"72-12-0308","SUP","Custom 27803010","","72-12-0308  -  INSERT TIBIAL 3 8MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0310","SUP","Custom 27803010","","72-12-0310  -  INSERT TIBIAL 3 10MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0312","SUP","Custom 27803010","","72-12-0312  -  INSERT TIBIAL 3 12MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0315","SUP","Custom 27803010","","72-12-0315  -  INSERT TIBIAL 3 15MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0318","SUP","Custom 27803010","","72-12-0318  -  INSERT TIBIAL 3 18MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0321","SUP","Custom 27803010","","72-12-0321  -  INSERT TIBIAL 3 21MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0324","SUP","Custom 27803010","","72-12-0324  -  INSERT TIBIAL 3 24MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0508","SUP","Custom 27803010","","72-12-0508  -  INSERT TIBIAL 5 8MM CRUC RET SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0510","SUP","Custom 27803010","","72-12-0510  -  INSERT TIBIAL 5 10MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0512","SUP","Custom 27803010","","72-12-0512  -  INSERT TIBIAL 5 12MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0515","SUP","Custom 27803010","","72-12-0515  -  INSERT TIBIAL 5 15MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0518","SUP","Custom 27803010","","72-12-0518  -  INSERT TIBIAL 5 18MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0521","SUP","Custom 27803010","","72-12-0521  -  INSERT TIBIAL 5 21MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0524","SUP","Custom 27803010","","72-12-0524  -  INSERT TIBIAL 5 24MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0708","SUP","Custom 27803010","","72-12-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0710","SUP","Custom 27803010","","72-12-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0712","SUP","Custom 27803010","","72-12-0712  -  INSERT TIBIAL 7 12MM CRUC RET SCORPIO N2/VAC KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0715","SUP","Custom 27803010","","72-12-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO N2/VAC KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0718","SUP","Custom 27803010","","72-12-0718  -  INSERT TIBIAL 7 18MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0721","SUP","Custom 27803010","","72-12-0721  -  INSERT TIBIAL 7 21MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0724","SUP","Custom 27803010","","72-12-0724  -  INSERT TIBIAL 7 24MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0908","SUP","Custom 27803010","","72-12-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0910","SUP","Custom 27803010","","72-12-0910  -  INSERT TIBIAL 9 10MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0912","SUP","Custom 27803010","","72-12-0912  -  INSERT TIBIAL 9 12MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0915","SUP","Custom 27803010","","72-12-0915  -  INSERT TIBIAL 9 15MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0918","SUP","Custom 27803010","","72-12-0918  -  INSERT TIBIAL 9 18MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0921","SUP","Custom 27803010","","72-12-0921  -  INSERT TIBIAL 9 21MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-0924","SUP","Custom 27803010","","72-12-0924  -  INSERT TIBIAL 9 24MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1108","SUP","Custom 27803010","","72-12-1108  -  INSERT TIBIAL 11 8MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1110","SUP","Custom 27803010","","72-12-1110  -  INSERT TIBIAL 11 10MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1112","SUP","Custom 27803010","","72-12-1112  -  INSERT TIBIAL 11 12MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1115","SUP","Custom 27803010","","72-12-1115  -  INSERT TIBIAL 11 15MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1118","SUP","Custom 27803010","","72-12-1118  -  INSERT TIBIAL 11 18MM CRUC RET SCORPIO POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1121","SUP","Custom 27803010","","72-12-1121  -  INSERT TIBIAL 11 21MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-12-1124","SUP","Custom 27803010","","72-12-1124  -  INSERT TIBIAL 11 24MM CRUC RET HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0308","SUP","Custom 27803010","","72-13-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0310","SUP","Custom 27803010","","72-13-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0312","SUP","Custom 27803010","","72-13-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0315","SUP","Custom 27803010","","72-13-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0318","SUP","Custom 27803010","","72-13-0318  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0321","SUP","Custom 27803010","","72-13-0321  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0324","SUP","Custom 27803010","","72-13-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0508","SUP","Custom 27803010","","72-13-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0510","SUP","Custom 27803010","","72-13-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0512","SUP","Custom 27803010","","72-13-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0515","SUP","Custom 27803010","","72-13-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0518","SUP","Custom 27803010","","72-13-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0521","SUP","Custom 27803010","","72-13-0521  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0524","SUP","Custom 27803010","","72-13-0524  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0708","SUP","Custom 27803010","","72-13-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0710","SUP","Custom 27803010","","72-13-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0712","SUP","Custom 27803010","","72-13-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0715","SUP","Custom 27803010","","72-13-0715  -  INSERT TIBIAL POSTERIOR STABILIZE SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0718","SUP","Custom 27803010","","72-13-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0721","SUP","Custom 27803010","","72-13-0721  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0724","SUP","Custom 27803010","","72-13-0724  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0908","SUP","Custom 27803010","","72-13-0908  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0910","SUP","Custom 27803010","","72-13-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0912","SUP","Custom 27803010","","72-13-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0915","SUP","Custom 27803010","","72-13-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0918","SUP","Custom 27803010","","72-13-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0921","SUP","Custom 27803010","","72-13-0921  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-0924","SUP","Custom 27803010","","72-13-0924  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1108","SUP","Custom 27803010","","72-13-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1110","SUP","Custom 27803010","","72-13-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1112","SUP","Custom 27803010","","72-13-1112  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1115","SUP","Custom 27803010","","72-13-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1118","SUP","Custom 27803010","","72-13-1118  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1121","SUP","Custom 27803010","","72-13-1121  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-13-1124","SUP","Custom 27803010","","72-13-1124  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0308","SUP","Custom 27803010","","72-15-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0310","SUP","Custom 27803010","","72-15-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0312","SUP","Custom 27803010","","72-15-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0315","SUP","Custom 27803010","","72-15-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0318","SUP","Custom 27803010","","72-15-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0321","SUP","Custom 27803010","","72-15-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0324","SUP","Custom 27803010","","72-15-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0508","SUP","Custom 27803010","","72-15-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0510","SUP","Custom 27803010","","72-15-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0512","SUP","Custom 27803010","","72-15-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0515","SUP","Custom 27803010","","72-15-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0518","SUP","Custom 27803010","","72-15-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0521","SUP","Custom 27803010","","72-15-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0524","SUP","Custom 27803010","","72-15-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0708","SUP","Custom 27803010","","72-15-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0710","SUP","Custom 27803010","","72-15-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0712","SUP","Custom 27803010","","72-15-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0715","SUP","Custom 27803010","","72-15-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0718","SUP","Custom 27803010","","72-15-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0721","SUP","Custom 27803010","","72-15-0721  -  INSERT TIBIAL POSTERIOR STABILIZED HYPER EXTN SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0724","SUP","Custom 27803010","","72-15-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0908","SUP","Custom 27803010","","72-15-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0910","SUP","Custom 27803010","","72-15-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0912","SUP","Custom 27803010","","72-15-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0915","SUP","Custom 27803010","","72-15-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0918","SUP","Custom 27803010","","72-15-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0921","SUP","Custom 27803010","","72-15-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-0924","SUP","Custom 27803010","","72-15-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1108","SUP","Custom 27803010","","72-15-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1110","SUP","Custom 27803010","","72-15-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1112","SUP","Custom 27803010","","72-15-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1115","SUP","Custom 27803010","","72-15-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1118","SUP","Custom 27803010","","72-15-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1121","SUP","Custom 27803010","","72-15-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-15-1124","SUP","Custom 27803010","","72-15-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZED HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0308","SUP","Custom 27803010","","72-16-0308  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0310","SUP","Custom 27803010","","72-16-0310  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0312","SUP","Custom 27803010","","72-16-0312  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0315","SUP","Custom 27803010","","72-16-0315  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0318","SUP","Custom 27803010","","72-16-0318  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0321","SUP","Custom 27803010","","72-16-0321  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0324","SUP","Custom 27803010","","72-16-0324  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0508","SUP","Custom 27803010","","72-16-0508  -  INSERT TIBIAL 5 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0510","SUP","Custom 27803010","","72-16-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0512","SUP","Custom 27803010","","72-16-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0515","SUP","Custom 27803010","","72-16-0515  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0518","SUP","Custom 27803010","","72-16-0518  -  INSERT TIBIAL 5 18MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0521","SUP","Custom 27803010","","72-16-0521  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0524","SUP","Custom 27803010","","72-16-0524  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0708","SUP","Custom 27803010","","72-16-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0710","SUP","Custom 27803010","","72-16-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0712","SUP","Custom 27803010","","72-16-0712  -  INSERT TIBIAL 7 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0715","SUP","Custom 27803010","","72-16-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0718","SUP","Custom 27803010","","72-16-0718  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0721","SUP","Custom 27803010","","72-16-0721  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0724","SUP","Custom 27803010","","72-16-0724  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0908","SUP","Custom 27803010","","72-16-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0910","SUP","Custom 27803010","","72-16-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0912","SUP","Custom 27803010","","72-16-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0915","SUP","Custom 27803010","","72-16-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0918","SUP","Custom 27803010","","72-16-0918  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0921","SUP","Custom 27803010","","72-16-0921  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0924","SUP","Custom 27803010","","72-16-0924  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-0924300","SUP","Custom 27803010","","72-16-0924300  -  INSERT TIB CRUC RET HPR EXTN SCRPFLX","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1108","SUP","Custom 27803010","","72-16-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1110","SUP","Custom 27803010","","72-16-1110  -  INSERT TIBIAL 11 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1112","SUP","Custom 27803010","","72-16-1112  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1115","SUP","Custom 27803010","","72-16-1115  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1118","SUP","Custom 27803010","","72-16-1118  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1121","SUP","Custom 27803010","","72-16-1121  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-16-1124","SUP","Custom 27803010","","72-16-1124  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7220025A","SUP","HCPCS C1713","","7220025A  -  END CAP SPNL 22MM 20-25MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220027A","SUP","HCPCS C1713","","7220027A  -  END CAP SPNL 22MM 21-27MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220033A","SUP","HCPCS C1713","","7220033A  -  END CAP SPNL 22MM 24-33MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220041A","SUP","HCPCS C1713","","7220041A  -  END CAP SPNL 22MM 28-41MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220055A","SUP","HCPCS C1713","","7220055A  -  END CAP SPNL 22MM 35-55MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220067A","SUP","HCPCS C1713","","7220067A  -  END CAP SPNL 22MM 41-67MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220079A","SUP","HCPCS C1713","","7220079A  -  END CAP SPNL 22MM 47-79MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"7220121A","SUP","HCPCS C1713","","7220121A  -  END CAP SPNL 22MM 68-121MM NS X-COR 2 ATLCK TI","BOTH IP/OP","$13,962.50 ","$10,332.25 ","$0.00 ","$13,962.50 ","$6,283.13 ","$0.00 ","$2,910.13 ","$0.00 ","$0.00 ","$2,444.72 ","$13,962.50 ","$0.00 ","$6,981.25 ","$11,058.30 ","$11,170.00 ","$0.00 ","$2,185.13 ","$0.00 ","$2,222.83 ","$0.00 "
"72-2049","SUP","Custom 27203010","","72-2049  -  DRILL SURG 1.5MM 5MM STOP HIGH SPEED MANDIB IQ","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-2055","SUP","Custom 27203010","","72-2055  -  DRILL SURG 1.5MM 22MM STOP MANDIB","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0308","SUP","Custom 27803010","","72-25-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0310","SUP","Custom 27803010","","72-25-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0312","SUP","HCPCS C1776","","72-25-0312  -  INSERT TIB 3 12MM SCRPFLX POST STAB PE KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"72-25-0315","SUP","HCPCS C1776","","72-25-0315  -  INSERT TIB 3 15MM SCRPFLX POST STAB X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"72-25-0318","SUP","HCPCS C1776","","72-25-0318  -  INSERT TIB 3 18MM SCRPFLX POST STAB X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"72-25-0321","SUP","HCPCS C1776","","72-25-0321  -  INSERT TIB 3 21MM SCRPFLX POST STAB X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"72-25-0324","SUP","HCPCS C1776","","72-25-0324  -  INSERT TIB 3 24MM SCRPFLX POST STAB X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"72-25-0508","SUP","Custom 27803010","","72-25-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0510","SUP","Custom 27803010","","72-25-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0512","SUP","Custom 27803010","","72-25-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0515","SUP","Custom 27803010","","72-25-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0518","SUP","HCPCS C1776","","72-25-0518  -  INSERT TIB SCRPFLX POST STAB X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"72-25-0521","SUP","Custom 27803010","","72-25-0521  -  INSERT TIB 5 21MM SCRP SFLX POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0524","SUP","Custom 27803010","","72-25-0524  -  INSERT TIB 5 24MM SCRPFLX POST STAB X3 ARTC KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0708","SUP","Custom 27803010","","72-25-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0710","SUP","Custom 27803010","","72-25-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0712","SUP","Custom 27803010","","72-25-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0715","SUP","Custom 27803010","","72-25-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0718","SUP","Custom 27803010","","72-25-0718  -  INSERT TIBIAL POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0721","SUP","Custom 27803010","","72-25-0721  -  INSERT TIB 7 21MM SCRP SFLX POST STAB KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0724","SUP","Custom 27803010","","72-25-0724  -  INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0908","SUP","Custom 27803010","","72-25-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 RIGHT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0910","SUP","Custom 27803010","","72-25-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0912","SUP","Custom 27803010","","72-25-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0915","SUP","Custom 27803010","","72-25-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0918","SUP","Custom 27803010","","72-25-0918  -  INSERT TIB 9 18MM SCRPFLX POST STAB X3 ARTC","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0921","SUP","Custom 27803010","","72-25-0921  -  INSERT TIB 9 21MM SCRPFLX POST STAB X3 ARTC KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-0924","SUP","Custom 27803010","","72-25-0924  -  INSERT TIB 9 24MM STRL SCRPFLX POST STAB X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1108","SUP","Custom 27803010","","72-25-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO SUPERFLEX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1110","SUP","Custom 27803010","","72-25-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1112","SUP","Custom 27803010","","72-25-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1115","SUP","Custom 27803010","","72-25-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1118","SUP","Custom 27803010","","72-25-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCRPFLX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1121","SUP","Custom 27803010","","72-25-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCRPFLX X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-25-1124","SUP","Custom 27803010","","72-25-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0308","SUP","Custom 27803010","","72-26-0308  -  INSERT TIBIAL 3 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0310","SUP","Custom 27803010","","72-26-0310  -  INSERT TIBIAL 3 10MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0312","SUP","Custom 27803010","","72-26-0312  -  INSERT TIBIAL 3 12MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0315","SUP","Custom 27803010","","72-26-0315  -  INSERT TIBIAL 3 15MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0318","SUP","Custom 27803010","","72-26-0318  -  INSERT TIBIAL 3 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0321","SUP","Custom 27803010","","72-26-0321  -  INSERT TIBIAL 3 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0324","SUP","Custom 27803010","","72-26-0324  -  INSERT TIBIAL 3 24MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0508","SUP","Custom 27803010","","72-26-0508  -  INSERT TIBIAL 5 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0510","SUP","Custom 27803010","","72-26-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0512","SUP","Custom 27803010","","72-26-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCRPFLX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0515","SUP","Custom 27803010","","72-26-0515  -  INSERT TIB 5 15MM STRL SCRPFLX CR X3 KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0518","SUP","Custom 27803010","","72-26-0518  -  INSERT TIBIAL 5 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0521","SUP","Custom 27803010","","72-26-0521  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0524","SUP","Custom 27803010","","72-26-0524  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0708","SUP","Custom 27803010","","72-26-0708  -  INSERT TIBIAL 7 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0710","SUP","Custom 27803010","","72-26-0710  -  INSERT TIBIAL 7 10MM CRUC RET POSTERIOR STABILIZED SCRPFLX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0712","SUP","Custom 27803010","","72-26-0712  -  INSERT TIBIAL 7 12MM CRUC RET POSTERIOR STABILIZED SCRPFLX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0715","SUP","Custom 27803010","","72-26-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0718","SUP","Custom 27803010","","72-26-0718  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0721","SUP","Custom 27803010","","72-26-0721  -  INSERT TIBIAL 7 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0724","SUP","Custom 27803010","","72-26-0724  -  INSERT TIBIAL 7 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0908","SUP","Custom 27803010","","72-26-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0910","SUP","Custom 27803010","","72-26-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0912","SUP","Custom 27803010","","72-26-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCORPIO SUPERFLEX POLYETHYLENE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0915","SUP","Custom 27803010","","72-26-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0918","SUP","Custom 27803010","","72-26-0918  -  INSERT TIBIAL 9 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0921","SUP","Custom 27803010","","72-26-0921  -  INSERT TIBIAL 9 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-0924","SUP","Custom 27803010","","72-26-0924  -  INSERT TIBIAL 9 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1108","SUP","Custom 27803010","","72-26-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1110","SUP","Custom 27803010","","72-26-1110  -  INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1112","SUP","Custom 27803010","","72-26-1112  -  INSERT TIBIAL 11 12MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1115","SUP","Custom 27803010","","72-26-1115  -  INSERT TIBIAL CRUC RET SCRPFLX","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1118","SUP","Custom 27803010","","72-26-1118  -  INSERT TIBIAL 11 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1121","SUP","Custom 27803010","","72-26-1121  -  INSERT TIBIAL 11 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-26-1124","SUP","Custom 27803010","","72-26-1124  -  INSERT TIBIAL 11 24MM CRUC RET SCORPIO SUPERFLEX KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72402408N","SUP","HCPCS C1713","","72402408N  -  SCREW BONE 2.4MM 3.8MM 8MM EVOS MINI SS CORT ST T7","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$53.44 ","$0.00 ","$24.75 ","$0.00 ","$0.00 ","$20.79 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$18.58 ","$0.00 ","$18.91 ","$0.00 "
"72402409N","SUP","HCPCS C1713","","72402409N  -  SCREW BONE 2.4MM 3.8MM 9MM EVOS MINI SS CORT ST T7","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$53.44 ","$0.00 ","$24.75 ","$0.00 ","$0.00 ","$20.79 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$18.58 ","$0.00 ","$18.91 ","$0.00 "
"72402410N","SUP","HCPCS C1713","","72402410N  -  SCREW BONE 2.4MM 3.8MM 10MM EVOS MINI SS CORTEX T7","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$53.44 ","$0.00 ","$24.75 ","$0.00 ","$0.00 ","$20.79 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$18.58 ","$0.00 ","$18.91 ","$0.00 "
"72402420N","SUP","HCPCS C1713","","72402420N  -  SCREW BONE 2.4MM 3.8MM 20MM EVOS SS 1.6MM SM BONE","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$53.44 ","$0.00 ","$24.75 ","$0.00 ","$0.00 ","$20.79 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$18.58 ","$0.00 ","$18.91 ","$0.00 "
"72-4-0310","SUP","Custom 27203010","","72-4-0310  -  TRIAL SURG 3 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0312","SUP","Custom 27203010","","72-4-0312  -  TRIAL SURG 3 12MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0314","SUP","Custom 27203010","","72-4-0314  -  TRIAL SURG 3 14MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0316","SUP","Custom 27203010","","72-4-0316  -  TRIAL SURG 3 16MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0318","SUP","Custom 27203010","","72-4-0318  -  INSERT TIBIAL 3 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0321","SUP","Custom 27203010","","72-4-0321  -  TRIAL SURG 3 21MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0324","SUP","HCPCS C1776","","72-4-0324  -  INSERT TIBIAL 3 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0510","SUP","Custom 27203010","","72-4-0510  -  TRIAL SURG 5 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0512","SUP","Custom 27203010","","72-4-0512  -  INSERT TIBIAL 5 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0514","SUP","HCPCS C1776","","72-4-0514  -  INSERT TIBIAL 5 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0516","SUP","HCPCS C1776","","72-4-0516  -  INSERT TIBIAL 5 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0518","SUP","HCPCS C1776","","72-4-0518  -  INSERT TIBIAL 5 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0521","SUP","HCPCS C1776","","72-4-0521  -  INSERT TIBIAL 5 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0524","SUP","Custom 27203010","","72-4-0524  -  TRIAL SURG 5 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0710","SUP","HCPCS C1776","","72-4-0710  -  INSERT TIBIAL 7 10MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0712","SUP","HCPCS C1776","","72-4-0712  -  INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0714","SUP","HCPCS C1776","","72-4-0714  -  INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0716","SUP","HCPCS C1776","","72-4-0716  -  INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0718","SUP","HCPCS C1776","","72-4-0718  -  INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0721","SUP","HCPCS C1776","","72-4-0721  -  INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0724","SUP","HCPCS C1776","","72-4-0724  -  INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0910","SUP","Custom 27203010","","72-4-0910  -  TRIAL SURG 9 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-0912","SUP","HCPCS C1776","","72-4-0912  -  INSERT TIBIAL 9 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0914","SUP","HCPCS C1776","","72-4-0914  -  INSERT TIBIAL 9 14MM CONSTRAINED TOT STABILIZED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0916","SUP","HCPCS C1776","","72-4-0916  -  INSERT TIBIAL 9 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0918","SUP","HCPCS C1776","","72-4-0918  -  INSERT TIBIAL 9 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0921","SUP","HCPCS C1776","","72-4-0921  -  INSERT TIBIAL 9 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-0924","SUP","Custom 27203010","","72-4-0924  -  TRIAL SURG 9 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-4-1110","SUP","HCPCS C1776","","72-4-1110  -  INSERT TIBIAL 11 10MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1112","SUP","HCPCS C1776","","72-4-1112  -  INSERT TIBIAL 11 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1114","SUP","HCPCS C1776","","72-4-1114  -  INSERT TIBIAL 11 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1116","SUP","HCPCS C1776","","72-4-1116  -  INSERT TIBIAL 11 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1118","SUP","HCPCS C1776","","72-4-1118  -  INSERT TIBIAL 11 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1121","SUP","HCPCS C1776","","72-4-1121  -  INSERT TIBIAL 11 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1124","SUP","HCPCS C1776","","72-4-1124  -  INSERT TIBIAL 11 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72412410N","SUP","HCPCS C1713","","72412410N  -  SCREW BONE 2.4MM 3.8MM 10MM EVOS SS LNG BONE SM","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$172.13 ","$0.00 ","$79.72 ","$0.00 ","$0.00 ","$66.97 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$59.86 ","$0.00 ","$60.89 ","$0.00 "
"72-4-1910","SUP","HCPCS C1776","","72-4-1910  -  INSERT TIBIAL 19 10MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1912","SUP","HCPCS C1776","","72-4-1912  -  INSERT TIBIAL 19 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1914","SUP","HCPCS C1776","","72-4-1914  -  INSERT TIBIAL 19 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1916","SUP","HCPCS C1776","","72-4-1916  -  INSERT TIBIAL 19 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1918","SUP","HCPCS C1776","","72-4-1918  -  INSERT TIBIAL 19 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1921","SUP","HCPCS C1776","","72-4-1921  -  INSERT TIBIAL 19 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-1924","SUP","HCPCS C1776","","72-4-1924  -  INSERT TIBIAL 19 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5710","SUP","HCPCS C1776","","72-4-5710  -  INSERT TIBIAL 7 10MM TOT STABILIZE SCORPIO POLYETHYLENE KNEE","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5712","SUP","HCPCS C1776","","72-4-5712  -  INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5714","SUP","HCPCS C1776","","72-4-5714  -  INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5716","SUP","HCPCS C1776","","72-4-5716  -  INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5718","SUP","HCPCS C1776","","72-4-5718  -  INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5721","SUP","HCPCS C1776","","72-4-5721  -  INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-5724","SUP","HCPCS C1776","","72-4-5724  -  INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-7512","SUP","HCPCS C1776","","72-4-7512  -  INSERT TIBIAL 7F/5T 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-7514","SUP","HCPCS C1776","","72-4-7514  -  INSERT TIBIAL 7F/5T 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-7516","SUP","HCPCS C1776","","72-4-7516  -  INSERT TIBIAL 7F/5T 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-7518","SUP","HCPCS C1776","","72-4-7518  -  INSERT TIBIAL 7F/5T 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-7521","SUP","HCPCS C1776","","72-4-7521  -  INSERT TIBIAL 7F/5T 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-7524","SUP","HCPCS C1776","","72-4-7524  -  INSERT TIBIAL 7F/5T 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9110","SUP","HCPCS C1776","","72-4-9110  -  INSERT TIBIAL 9F/11T 10MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9112","SUP","HCPCS C1776","","72-4-9112  -  INSERT TIBIAL 9F/11T 12MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9114","SUP","HCPCS C1776","","72-4-9114  -  INSERT TIBIAL 9F/11T 14MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9116","SUP","HCPCS C1776","","72-4-9116  -  INSERT TIBIAL 9F/11T 16MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9118","SUP","HCPCS C1776","","72-4-9118  -  INSERT TIBIAL 9F/11T 18MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9121","SUP","HCPCS C1776","","72-4-9121  -  INSERT TIBIAL 9F/11T 21MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-4-9124","SUP","HCPCS C1776","","72-4-9124  -  INSERT TIBIAL 9F/11T 24MM CONSTRAIN TOT STABILIZE SCORPIO","BOTH IP/OP","$3,492.50 ","$2,584.45 ","$0.00 ","$3,492.50 ","$1,571.63 ","$0.00 ","$727.92 ","$0.00 ","$0.00 ","$611.51 ","$3,492.50 ","$0.00 ","$1,746.25 ","$2,766.06 ","$2,794.00 ","$0.00 ","$546.58 ","$0.00 ","$556.01 ","$0.00 "
"72-5-0508","SUP","Custom 27803010","","72-5-0508  -  INSERT TIB 5 8MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0510","SUP","Custom 27803010","","72-5-0510  -  INSERT TIB 5 10MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0512","SUP","Custom 27803010","","72-5-0512  -  INSERT TIB 5 12MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0515","SUP","Custom 27803010","","72-5-0515  -  INSERT TIB 5 15MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0518","SUP","Custom 27803010","","72-5-0518  -  INSERT TIB 5 18MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0521","SUP","Custom 27803010","","72-5-0521  -  INSERT TIB 5 21MM KNEE PS SCRP SFLX","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0524","SUP","Custom 27803010","","72-5-0524  -  INSERT TIB 5 44X66X24MM SCRPFLX 1 AXIS PS PE KN","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0708","SUP","Custom 27803010","","72-5-0708  -  INSERT TIB 7 8MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0710","SUP","Custom 27803010","","72-5-0710  -  INSERT TIB KNEE PS SCRPFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0712","SUP","Custom 27803010","","72-5-0712  -  INSERT TIB 7 12MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0715","SUP","Custom 27803010","","72-5-0715  -  INSERT TIB 7 15MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0718","SUP","Custom 27803010","","72-5-0718  -  INSERT TIB 7 18MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0721","SUP","Custom 27803010","","72-5-0721  -  INSERT TIB 7 21MM SCRP SFLX POST STAB KN","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0724","SUP","Custom 27803010","","72-5-0724  -  INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0908","SUP","HCPCS C1776","","72-5-0908  -  CMPNT TIB 8MM SCRP 9 KNEE PE PS","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$868.50 ","$0.00 ","$402.26 ","$0.00 ","$0.00 ","$337.93 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$302.05 ","$0.00 ","$307.26 ","$0.00 "
"72-5-0910","SUP","Custom 27803010","","72-5-0910  -  INSERT TIB 9 10MM RIGHT KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0912","SUP","Custom 27803010","","72-5-0912  -  INSERT TIB 9 12MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0915","SUP","Custom 27803010","","72-5-0915  -  INSERT TIB 9 15MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0918","SUP","Custom 27803010","","72-5-0918  -  INSERT TIB 9 18MM SCRP SFLX POST STAB ARTC KN","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0921","SUP","Custom 27803010","","72-5-0921  -  INSERT TIB 9 21MM SCRP SFLX POST STAB ARTC KN","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-0924","SUP","Custom 27803010","","72-5-0924  -  INSERT TIB 9 24MM SCRP SFLX POST STAB KN","BOTH IP/OP","$2,013.00 ","$1,489.62 ","$0.00 ","$2,013.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,013.00 ","$0.00 ","$1,006.50 ","$1,594.30 ","$1,610.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-5-1110","SUP","Custom 27803010","","72-5-1110  -  INSERT TIB 11 10MM KNEE PS SCRP SFLX","BOTH IP/OP","$1,930.00 ","$1,428.20 ","$0.00 ","$1,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,930.00 ","$0.00 ","$965.00 ","$1,528.56 ","$1,544.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-6-0515","SUP","Custom 27803010","","72-6-0515  -  INSERT TIB 5 15MM SCRP SFLX CRCTE RTN KN","BOTH IP/OP","$1,922.00 ","$1,422.28 ","$0.00 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,922.00 ","$0.00 ","$961.00 ","$1,522.22 ","$1,537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-6-0708","SUP","Custom 27803010","","72-6-0708  -  INSERT TIB 7 8MM KNEE CRUC RET SCRP SFLX","BOTH IP/OP","$1,922.00 ","$1,422.28 ","$0.00 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,922.00 ","$0.00 ","$961.00 ","$1,522.22 ","$1,537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-6-0710","SUP","Custom 27803010","","72-6-0710  -  INSERT TIB KNEE CRUC RET SCRP SFLX","BOTH IP/OP","$1,922.00 ","$1,422.28 ","$0.00 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,922.00 ","$0.00 ","$961.00 ","$1,522.22 ","$1,537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-6-0908","SUP","Custom 27803010","","72-6-0908  -  INSERT TIB 9 8MM KNEE CRUC RET SCRP SFLX","BOTH IP/OP","$1,922.00 ","$1,422.28 ","$0.00 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,922.00 ","$0.00 ","$961.00 ","$1,522.22 ","$1,537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72-6-1110","SUP","Custom 27803010","","72-6-1110  -  INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN","BOTH IP/OP","$1,922.00 ","$1,422.28 ","$0.00 ","$1,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,922.00 ","$0.00 ","$961.00 ","$1,522.22 ","$1,537.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72821012S","SUP","HCPCS C1713","","72821012S  -  PLATE BN 20X11MM STRL VLP LT MDL LAT TALUS 2.5MM SCR","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"72821013S","SUP","HCPCS C1713","","72821013S  -  PLATE BN 20X11MM STRL VLP RT MDL LAT TALUS 2.5MM SCR","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"72821014S","SUP","HCPCS C1713","","72821014S  -  PLATE BN 22X16MM STRL VLP 3 HL L/L TALUS 2.5MM SCR","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"72821015S","SUP","HCPCS C1713","","72821015S  -  PLATE BN 22X16MM STRL VLP 3 HL RL TALUS 2.5MM SCR","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"72821016S","SUP","HCPCS C1713","","72821016S  -  PLATE BN 25X16MM STRL VLP 4 HL L/L TALUS 2.5MM SCR","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$0.00 ","$2,275.00 ","$1,023.75 ","$0.00 ","$474.17 ","$0.00 ","$0.00 ","$398.33 ","$2,275.00 ","$0.00 ","$1,137.50 ","$1,801.80 ","$1,820.00 ","$0.00 ","$356.04 ","$0.00 ","$362.18 ","$0.00 "
"72821017S","SUP","HCPCS C1713","","72821017S  -  PLATE BN 25X16MM STRL VLP 4 HL RL TALUS FT 2.5MM SCR","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$0.00 ","$2,275.00 ","$1,023.75 ","$0.00 ","$474.17 ","$0.00 ","$0.00 ","$398.33 ","$2,275.00 ","$0.00 ","$1,137.50 ","$1,801.80 ","$1,820.00 ","$0.00 ","$356.04 ","$0.00 ","$362.18 ","$0.00 "
"72821018S","SUP","HCPCS C1713","","72821018S  -  PLATE BN SM 55MM STRL VLP LT CALCANEUS FT 2.7MM SCR PERC","BOTH IP/OP","$2,306.25 ","$1,706.63 ","$0.00 ","$2,306.25 ","$1,037.81 ","$0.00 ","$480.68 ","$0.00 ","$0.00 ","$403.81 ","$2,306.25 ","$0.00 ","$1,153.13 ","$1,826.55 ","$1,845.00 ","$0.00 ","$360.93 ","$0.00 ","$367.16 ","$0.00 "
"72821019S","SUP","HCPCS C1713","","72821019S  -  PLATE BN SM 55MM STRL VLP RT CALCANEUS 2.7MM SCR PERC","BOTH IP/OP","$2,306.25 ","$1,706.63 ","$0.00 ","$2,306.25 ","$1,037.81 ","$0.00 ","$480.68 ","$0.00 ","$0.00 ","$403.81 ","$2,306.25 ","$0.00 ","$1,153.13 ","$1,826.55 ","$1,845.00 ","$0.00 ","$360.93 ","$0.00 ","$367.16 ","$0.00 "
"72821020S","SUP","HCPCS C1713","","72821020S  -  PLATE BN LG 62 STRL VLP LT CALCANEUS FT 2.7MM SCR PERC","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"72821021S","SUP","HCPCS C1713","","72821021S  -  PLATE BN LG 62 STRL VLP RT CALCANEUS FT 2.7MM SCR PERC","BOTH IP/OP","$2,512.50 ","$1,859.25 ","$0.00 ","$2,512.50 ","$1,130.63 ","$0.00 ","$523.67 ","$0.00 ","$0.00 ","$439.92 ","$2,512.50 ","$0.00 ","$1,256.25 ","$1,989.90 ","$2,010.00 ","$0.00 ","$393.21 ","$0.00 ","$399.99 ","$0.00 "
"72821022S","SUP","HCPCS C1713","","72821022S  -  PLATE BN 67MM STRL 3 HL FSN PRM RT ANT ANKL 3.5MM SCR","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"72821023S","SUP","HCPCS C1713","","72821023S  -  PLATE BN 67MM STRL 3 HL FSN PRM LT ANT ANKL 3.5MM SCR","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"72821024S","SUP","HCPCS C1713","","72821024S  -  PLATE BN 92MM STRL 5 HL FSN PRM RT ANT ANKL 3.5MM SCR","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"72821025S","SUP","HCPCS C1713","","72821025S  -  PLATE BN 92MM STRL 5 HL FSN PRM LT ANT ANKL 3.5MM SCR","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"72821026S","SUP","HCPCS C1713","","72821026S  -  PLATE BN 79MM STRL 3 HL FSN UTL RT ANKL HINDFOOT 3.5MM SCR","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"72821027S","SUP","HCPCS C1713","","72821027S  -  PLATE BN 79MM STRL 3 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR","BOTH IP/OP","$2,575.00 ","$1,905.50 ","$0.00 ","$2,575.00 ","$1,158.75 ","$0.00 ","$536.69 ","$0.00 ","$0.00 ","$450.86 ","$2,575.00 ","$0.00 ","$1,287.50 ","$2,039.40 ","$2,060.00 ","$0.00 ","$402.99 ","$0.00 ","$409.94 ","$0.00 "
"72821028S","SUP","HCPCS C1713","","72821028S  -  PLATE BN 5 FSN UTL RT ANKL HINDFOOT 3.5MM SCR","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"72821029S","SUP","HCPCS C1713","","72821029S  -  PLATE BN 79MM STRL 5 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"72821030S","SUP","HCPCS C1713","","72821030S  -  PLATE BN 120MM STRL PRLC FSN RL TIB TALOCALCANEUS ANKL 4.5MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"72821031S","SUP","HCPCS C1713","","72821031S  -  PLATE BN 120MM STRL PRLC FSN L/L TIB TALOCALCANEUS ANKL 4.5","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"72821034S","SUP","HCPCS C1713","","72821034S  -  PLATE BN 80MMX3.8-5.3MM STRL PRLC FSN RT POST ANKL 3.5MM SCR","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"72821035S","SUP","HCPCS C1713","","72821035S  -  PLATE BN 80MM STRL PRLC FSN LT POST ANKL 3.5MM SCR SM FRAG","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"72821036S","SUP","HCPCS C1713","","72821036S  -  PLATE BONE MEDIUM 58MM VLP LEFT CALCANEUS FT STERILE 2.7MM","BOTH IP/OP","$2,400.00 ","$1,776.00 ","$0.00 ","$2,400.00 ","$1,080.00 ","$0.00 ","$500.22 ","$0.00 ","$0.00 ","$420.22 ","$2,400.00 ","$0.00 ","$1,200.00 ","$1,900.80 ","$1,920.00 ","$0.00 ","$375.60 ","$0.00 ","$382.08 ","$0.00 "
"72821037S","SUP","HCPCS C1713","","72821037S  -  PLATE BN MED 58MM STRL VLP RT CALCANEUS FT 2.7MM SCR PERC","BOTH IP/OP","$2,400.00 ","$1,776.00 ","$0.00 ","$2,400.00 ","$1,080.00 ","$0.00 ","$500.22 ","$0.00 ","$0.00 ","$420.22 ","$2,400.00 ","$0.00 ","$1,200.00 ","$1,900.80 ","$1,920.00 ","$0.00 ","$375.60 ","$0.00 ","$382.08 ","$0.00 "
"72821040S","SUP","HCPCS C1713","","72821040S  -  PLATE BN 20X17MM STRL VLP LT MDL LAT TALUS TIB 2.5MM SCR","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$0.00 ","$2,275.00 ","$1,023.75 ","$0.00 ","$474.17 ","$0.00 ","$0.00 ","$398.33 ","$2,275.00 ","$0.00 ","$1,137.50 ","$1,801.80 ","$1,820.00 ","$0.00 ","$356.04 ","$0.00 ","$362.18 ","$0.00 "
"72821041S","SUP","HCPCS C1713","","72821041S  -  PLATE BN 20X17MM STRL VLP RT DIST MDL TALUS 2.5MM SCR","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$0.00 ","$2,275.00 ","$1,023.75 ","$0.00 ","$474.17 ","$0.00 ","$0.00 ","$398.33 ","$2,275.00 ","$0.00 ","$1,137.50 ","$1,801.80 ","$1,820.00 ","$0.00 ","$356.04 ","$0.00 ","$362.18 ","$0.00 "
"72821042S","SUP","HCPCS C1713","","72821042S  -  PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL RT ANT","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"72821043S","SUP","HCPCS C1713","","72821043S  -  PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL LT ANT","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"72821044S","SUP","HCPCS C1713","","72821044S  -  PLATE BN 92MM STRL ANCHORAGE 5 HL PRM FSN CMPR RT ANT","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"72821045S","SUP","HCPCS C1713","","72821045S  -  PLATE BN 92MM STRL PRLC 5 HL FSN PRM CMPR SLOT ANKL LT 3.5MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"72821046S","SUP","HCPCS C1713","","72821046S  -  PLATE BN 5 FSN UTL CMPR RT ANKL HINDFOOT 3.5MM SCR","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
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"72823232S","SUP","HCPCS C1713","","72823232S  -  SCREW BN 4MM 32MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
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"72823238S","SUP","HCPCS C1713","","72823238S  -  SCREW BN FT 4MM 38MM STRL VLP FT OSTEOPENIA","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
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"72823244S","SUP","HCPCS C1713","","72823244S  -  SCREW BN FT 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
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"72823248S","SUP","HCPCS C1713","","72823248S  -  SCREW BN FT LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823250S","SUP","HCPCS C1713","","72823250S  -  SCREW BN FT LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823326S","SUP","HCPCS C1713","","72823326S  -  SCREW BN 4MM 26MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823328S","SUP","HCPCS C1713","","72823328S  -  SCREW BN 4MM 28MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
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"72823332S","SUP","HCPCS C1713","","72823332S  -  SCREW BN 4MM 32MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
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"72823336S","SUP","HCPCS C1713","","72823336S  -  SCREW BN 4MM 36MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823338S","SUP","HCPCS C1713","","72823338S  -  SCREW BN P/T 4MM 5MM 38MMX2.5MM STRL 14MM VLP FOREFOOT","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823340S","SUP","HCPCS C1713","","72823340S  -  SCREW BN P/T 4MM 5MM 40MMX2.5MM STRL 14MM VLP FOREFOOT","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823342S","SUP","HCPCS C1713","","72823342S  -  SCREW BN P/T LOPRFL 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823344S","SUP","HCPCS C1713","","72823344S  -  SCREW BN P/T LOPRFL 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
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"72823350S","SUP","HCPCS C1713","","72823350S  -  SCREW BN P/T LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"72823406S","SUP","HCPCS C1713","","72823406S  -  SCREW BN 4MM 6MM STRL VLP LCK FT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823408S","SUP","HCPCS C1713","","72823408S  -  SCREW BN 4MM 8MM STRL VLP LCK FT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823410S","SUP","HCPCS C1713","","72823410S  -  SCREW BN 4MM 10MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823412S","SUP","HCPCS C1713","","72823412S  -  SCREW BN 4MM 12MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823414S","SUP","HCPCS C1713","","72823414S  -  SCREW BN 4MM 14MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823416S","SUP","HCPCS C1713","","72823416S  -  SCREW BN 4MM 16MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823418S","SUP","HCPCS C1713","","72823418S  -  SCREW BN 4MM 18MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823420S","SUP","HCPCS C1713","","72823420S  -  SCREW BN 4MM 20MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823422S","SUP","HCPCS C1713","","72823422S  -  SCREW BN 4MM 22MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823424S","SUP","HCPCS C1713","","72823424S  -  SCREW BN 4MM 24MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823426S","SUP","HCPCS C1713","","72823426S  -  SCREW BN 4MM 26MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823428S","SUP","HCPCS C1713","","72823428S  -  SCREW BN 4MM 28MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823430S","SUP","HCPCS C1713","","72823430S  -  SCREW BN 4MM 30MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823432S","SUP","HCPCS C1713","","72823432S  -  SCREW BN 4MM 32MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
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"72823440S","SUP","HCPCS C1713","","72823440S  -  SCREW BN 4MM 40MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823442S","SUP","HCPCS C1713","","72823442S  -  SCREW BN 4MM 4.9MM 42MM STRL VLP LCK FT OSTEOPENIA PERC","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823444S","SUP","HCPCS C1713","","72823444S  -  SCREW BN LOPRFL 4MM 4.9MM 44MM STRL VLP LCK FT OSTEOPENIA","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
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"72823510S","SUP","HCPCS C1713","","72823510S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823512S","SUP","HCPCS C1713","","72823512S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823514S","SUP","HCPCS C1713","","72823514S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823516S","SUP","HCPCS C1713","","72823516S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823518S","SUP","HCPCS C1713","","72823518S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823520S","SUP","HCPCS C1713","","72823520S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823522S","SUP","HCPCS C1713","","72823522S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823524S","SUP","HCPCS C1713","","72823524S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823526S","SUP","HCPCS C1713","","72823526S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823528S","SUP","HCPCS C1713","","72823528S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823530S","SUP","HCPCS C1713","","72823530S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823532S","SUP","HCPCS C1713","","72823532S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 32MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823534S","SUP","HCPCS C1713","","72823534S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 34MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823536S","SUP","HCPCS C1713","","72823536S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823538S","SUP","HCPCS C1713","","72823538S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823540S","SUP","HCPCS C1713","","72823540S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823542S","SUP","HCPCS C1713","","72823542S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823544S","SUP","HCPCS C1713","","72823544S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823546S","SUP","HCPCS C1713","","72823546S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823548S","SUP","HCPCS C1713","","72823548S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 48MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823550S","SUP","HCPCS C1713","","72823550S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823555S","SUP","HCPCS C1713","","72823555S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72823560S","SUP","HCPCS C1713","","72823560S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM STRL VLP LCK LOPRFL","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"72824001S","SUP","HCPCS C1713","","72824001S  -  PLATE BN T STRL VLP LCK VA FT 2.7MM SCR","BOTH IP/OP","$1,262.50 ","$934.25 ","$0.00 ","$1,262.50 ","$568.13 ","$0.00 ","$263.14 ","$0.00 ","$0.00 ","$221.05 ","$1,262.50 ","$0.00 ","$631.25 ","$999.90 ","$1,010.00 ","$0.00 ","$197.58 ","$0.00 ","$200.99 ","$0.00 "
"72824002S","SUP","HCPCS C1713","","72824002S  -  PLATE BN L STRL PRLC VLP SS LT MTP FOREFOOT MIDFOOT 2.7MM","BOTH IP/OP","$1,021.25 ","$755.73 ","$0.00 ","$1,021.25 ","$459.56 ","$0.00 ","$212.85 ","$0.00 ","$0.00 ","$178.81 ","$1,021.25 ","$0.00 ","$510.63 ","$808.83 ","$817.00 ","$0.00 ","$159.83 ","$0.00 ","$162.58 ","$0.00 "
"72824003S","SUP","HCPCS C1713","","72824003S  -  PLATE BN L STRL PRLC VLP SS RT MTP FOREFOOT MIDFOOT 2.7MM","BOTH IP/OP","$1,021.25 ","$755.73 ","$0.00 ","$1,021.25 ","$459.56 ","$0.00 ","$212.85 ","$0.00 ","$0.00 ","$178.81 ","$1,021.25 ","$0.00 ","$510.63 ","$808.83 ","$817.00 ","$0.00 ","$159.83 ","$0.00 ","$162.58 ","$0.00 "
"72824004S","SUP","HCPCS C1713","","72824004S  -  PLATE BN H STRL PRLC VLP 5 HL SS FOREFOOT MIDFOOT 2.7MM SCR","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824005S","SUP","HCPCS C1713","","72824005S  -  PLATE BN STRL PRLC VLP H 8 HL 2.7 MM SCR","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"72824006S","SUP","HCPCS C1713","","72824006S  -  PLATE BN .25 TBLR STRL PRLC VLP 3 HL SS FOREFOOT MIDFOOT 2.7","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$435.94 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"72824007S","SUP","HCPCS C1713","","72824007S  -  PLATE BN STRL PRLC VLP 4 HL QT TBLR MTP 2.7 MM SCR","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$435.94 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"72824008S","SUP","HCPCS C1713","","72824008S  -  PLATE BN .25 TBLR 39.8X8X1.5MM STRL VLP 5 HL FOREFOOT","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$435.94 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"72824009S","SUP","HCPCS C1713","","72824009S  -  PLATE BN STRL PRLC VLP 6 HL QT TBLR MTP 2.7 MM SCR","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$435.94 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"72824010S","SUP","HCPCS C1713","","72824010S  -  PLATE BN STRL PRLC VLP 7 HL QT TBLR MTP 2.7 MM SCR","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$435.94 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"72824011S","SUP","HCPCS C1713","","72824011S  -  PLATE BN .25 TBLR STRL PRLC VLP 8 HL SS FOREFOOT MIDFOOT 2.7","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$435.94 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"72824012S","SUP","HCPCS C1713","","72824012S  -  PLATE BN .25 TBLR STRL PRLC VLP 3 HL CMPR SS FOREFOOT","BOTH IP/OP","$1,518.75 ","$1,123.88 ","$0.00 ","$1,518.75 ","$683.44 ","$0.00 ","$316.55 ","$0.00 ","$0.00 ","$265.92 ","$1,518.75 ","$0.00 ","$759.38 ","$1,202.85 ","$1,215.00 ","$0.00 ","$237.68 ","$0.00 ","$241.79 ","$0.00 "
"72824013S","SUP","HCPCS C1713","","72824013S  -  PLATE BN STRL PRLC VLP 5 HL QT TBLR CMPR 2.7 MM SCR","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$759.38 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"72824014S","SUP","HCPCS C1713","","72824014S  -  PLATE BN .25 TBLR STRL PRLC VLP 7 HL CMPR SS FOREFOOT","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824015S","SUP","HCPCS C1713","","72824015S  -  PLATE BN STRL PRLC VLP PRM SS LT MTP FOREFOOT MIDFOOT 2.7 MM","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824016S","SUP","HCPCS C1713","","72824016S  -  PLATE BN 53.1MMX1.27MM STRL 11MM VLP PRM RT MTP FOREFOOT","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824017S","SUP","HCPCS C1713","","72824017S  -  PLATE BN STRL PRLC VLP REV LT MTP 2.7 MM SCR","BOTH IP/OP","$2,262.50 ","$1,674.25 ","$0.00 ","$2,262.50 ","$1,018.13 ","$0.00 ","$471.56 ","$0.00 ","$0.00 ","$396.15 ","$2,262.50 ","$0.00 ","$1,131.25 ","$1,791.90 ","$1,810.00 ","$0.00 ","$354.08 ","$0.00 ","$360.19 ","$0.00 "
"72824018S","SUP","HCPCS C1713","","72824018S  -  PLATE BN STRL PRLC VLP REV SS RT MTP FOREFOOT MIDFOOT 2.7 MM","BOTH IP/OP","$2,262.50 ","$1,674.25 ","$0.00 ","$2,262.50 ","$1,018.13 ","$0.00 ","$471.56 ","$0.00 ","$0.00 ","$396.15 ","$2,262.50 ","$0.00 ","$1,131.25 ","$1,791.90 ","$1,810.00 ","$0.00 ","$354.08 ","$0.00 ","$360.19 ","$0.00 "
"72824019S","SUP","HCPCS C1713","","72824019S  -  PLATE BN SHRT STRL VLP FSN LCK VA TARSOMETATARSAL FT 2.7MM","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824020S","SUP","HCPCS C1713","","72824020S  -  PLATE BN LNG STRL PRLC VLP FSN TARSOMETATARSAL 2.7MM SCR","BOTH IP/OP","$2,143.75 ","$1,586.38 ","$0.00 ","$2,143.75 ","$964.69 ","$0.00 ","$446.81 ","$0.00 ","$0.00 ","$375.35 ","$2,143.75 ","$0.00 ","$1,071.88 ","$1,697.85 ","$1,715.00 ","$0.00 ","$335.50 ","$0.00 ","$341.29 ","$0.00 "
"72824021S","SUP","HCPCS C1713","","72824021S  -  PLATE BN 18.1X7.1X1.5MM STRL VLP BRBL FOREFOOT MIDFOOT 2.7MM","BOTH IP/OP","$1,193.75 ","$883.38 ","$0.00 ","$1,193.75 ","$537.19 ","$0.00 ","$248.81 ","$0.00 ","$0.00 ","$209.02 ","$1,193.75 ","$0.00 ","$596.88 ","$945.45 ","$955.00 ","$0.00 ","$186.82 ","$0.00 ","$190.05 ","$0.00 "
"72824022S","SUP","HCPCS C1713","","72824022S  -  PLATE BN SM 24X18X1.5MM STRL VLP UTL FOREFOOT MIDFOOT 2.7MM","BOTH IP/OP","$2,012.50 ","$1,489.25 ","$0.00 ","$2,012.50 ","$905.63 ","$0.00 ","$419.46 ","$0.00 ","$0.00 ","$352.37 ","$2,012.50 ","$0.00 ","$1,006.25 ","$1,593.90 ","$1,610.00 ","$0.00 ","$314.96 ","$0.00 ","$320.39 ","$0.00 "
"72824023S","SUP","HCPCS C1713","","72824023S  -  PLATE BN MED STRL PRLC VLP UTL MTP 2.7MM SCR","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"72824024S","SUP","HCPCS C1713","","72824024S  -  PLATE BN LG STRL PRLC VLP UTL SS FOREFOOT MIDFOOT 2.7MM SCR","BOTH IP/OP","$2,262.50 ","$1,674.25 ","$0.00 ","$2,262.50 ","$1,018.13 ","$0.00 ","$471.56 ","$0.00 ","$0.00 ","$396.15 ","$2,262.50 ","$0.00 ","$1,131.25 ","$1,791.90 ","$1,810.00 ","$0.00 ","$354.08 ","$0.00 ","$360.19 ","$0.00 "
"72824025S","SUP","HCPCS C1713","","72824025S  -  PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR CMPR MTP 3.5 MM SCR","BOTH IP/OP","$1,518.75 ","$1,123.88 ","$0.00 ","$1,518.75 ","$683.44 ","$0.00 ","$316.55 ","$0.00 ","$0.00 ","$265.92 ","$1,518.75 ","$0.00 ","$759.38 ","$1,202.85 ","$1,215.00 ","$0.00 ","$237.68 ","$0.00 ","$241.79 ","$0.00 "
"72824026S","SUP","HCPCS C1713","","72824026S  -  PLATE BN STRL PRLC VLP 5 HL 1/3 TBLR CMPR 3.5 MM SCR","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$759.38 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"72824027S","SUP","HCPCS C1713","","72824027S  -  PLATE BN STRL PRLC VLP 7 HL 1/3 TBLR CMPR 3.5 MM SCR","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824028S","SUP","HCPCS C1713","","72824028S  -  PLATE BN SM STRL PRLC VLP LT CALCANEUS 3.5MM SCR","BOTH IP/OP","$2,018.75 ","$1,493.88 ","$0.00 ","$2,018.75 ","$908.44 ","$0.00 ","$420.76 ","$0.00 ","$0.00 ","$353.47 ","$2,018.75 ","$0.00 ","$1,009.38 ","$1,598.85 ","$1,615.00 ","$0.00 ","$315.93 ","$0.00 ","$321.39 ","$0.00 "
"72824029S","SUP","HCPCS C1713","","72824029S  -  PLATE BN SM STRL PRLC VLP VA LCK RT CALCANEUS 3.5MM SCR","BOTH IP/OP","$2,018.75 ","$1,493.88 ","$0.00 ","$2,018.75 ","$908.44 ","$0.00 ","$420.76 ","$0.00 ","$0.00 ","$353.47 ","$2,018.75 ","$0.00 ","$1,009.38 ","$1,598.85 ","$1,615.00 ","$0.00 ","$315.93 ","$0.00 ","$321.39 ","$0.00 "
"72824030S","SUP","HCPCS C1713","","72824030S  -  PLATE BN LG STRL PRLC VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$939.38 ","$0.00 ","$435.09 ","$0.00 ","$0.00 ","$365.50 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$326.69 ","$0.00 ","$332.33 ","$0.00 "
"72824031S","SUP","HCPCS C1713","","72824031S  -  PLATE BN LG STRL PRLC VLP VA LCK SS RT CALCANEUS 3.5MM SCR","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$939.38 ","$0.00 ","$435.09 ","$0.00 ","$0.00 ","$365.50 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$326.69 ","$0.00 ","$332.33 ","$0.00 "
"72824032S","SUP","HCPCS C1713","","72824032S  -  PLATE BN STRL PRLC VLP FSN MTP 3.5 MM SCR","BOTH IP/OP","$2,012.50 ","$1,489.25 ","$0.00 ","$2,012.50 ","$905.63 ","$0.00 ","$419.46 ","$0.00 ","$0.00 ","$352.37 ","$2,012.50 ","$0.00 ","$1,006.25 ","$1,593.90 ","$1,610.00 ","$0.00 ","$314.96 ","$0.00 ","$320.39 ","$0.00 "
"72824033S","SUP","HCPCS C1713","","72824033S  -  PLATE BN LNG STRL PRLC VLP FSN 3.5MM SCR","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"72824034S","SUP","HCPCS C1713","","72824034S  -  PLATE BN STRL PRLC VLP CLMN FSN 3.5 MM SCR","BOTH IP/OP","$2,993.75 ","$2,215.38 ","$0.00 ","$2,993.75 ","$1,347.19 ","$0.00 ","$623.97 ","$0.00 ","$0.00 ","$524.18 ","$2,993.75 ","$0.00 ","$1,496.88 ","$2,371.05 ","$2,395.00 ","$0.00 ","$468.52 ","$0.00 ","$476.61 ","$0.00 "
"72824035S","SUP","HCPCS C1713","","72824035S  -  PLATE BN STRL VLP 6 HL MLT FRAG MIDFOOT HINDFOOT 3.5 MM SCR","BOTH IP/OP","$1,775.00 ","$1,313.50 ","$0.00 ","$1,775.00 ","$798.75 ","$0.00 ","$369.95 ","$0.00 ","$0.00 ","$310.79 ","$1,775.00 ","$0.00 ","$887.50 ","$1,405.80 ","$1,420.00 ","$0.00 ","$277.79 ","$0.00 ","$282.58 ","$0.00 "
"72824036S","SUP","HCPCS C1713","","72824036S  -  PLATE BN STRL PRLC VLP 10 HL MLT FRAG MTP 3.5 MM SCR","BOTH IP/OP","$2,443.75 ","$1,808.38 ","$0.00 ","$2,443.75 ","$1,099.69 ","$0.00 ","$509.34 ","$0.00 ","$0.00 ","$427.88 ","$2,443.75 ","$0.00 ","$1,221.88 ","$1,935.45 ","$1,955.00 ","$0.00 ","$382.45 ","$0.00 ","$389.05 ","$0.00 "
"72824037S","SUP","HCPCS C1713","","72824037S  -  PLATE BN STRL PRLC VLP 14 HL MLT FRAG VARAIBLE ANG MIDFOOT","BOTH IP/OP","$2,925.00 ","$2,164.50 ","$0.00 ","$2,925.00 ","$1,316.25 ","$0.00 ","$609.64 ","$0.00 ","$0.00 ","$512.14 ","$2,925.00 ","$0.00 ","$1,462.50 ","$2,316.60 ","$2,340.00 ","$0.00 ","$457.76 ","$0.00 ","$465.66 ","$0.00 "
"72824038S","SUP","HCPCS C1713","","72824038S  -  PLATE BN VLP 4 HL MULTIFRAGMENT MIDFOOT HINDFOOT 3.5 MM SCR","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$759.38 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"72824039S","SUP","HCPCS C1713","","72824039S  -  PLATE BN MED STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM","BOTH IP/OP","$2,225.00 ","$1,646.50 ","$0.00 ","$2,225.00 ","$1,001.25 ","$0.00 ","$463.75 ","$0.00 ","$0.00 ","$389.58 ","$2,225.00 ","$0.00 ","$1,112.50 ","$1,762.20 ","$1,780.00 ","$0.00 ","$348.21 ","$0.00 ","$354.22 ","$0.00 "
"72824040S","SUP","HCPCS C1713","","72824040S  -  PLATE BN MED STRL VLP RT CALCANEUS MIDFOOT HINDFOOT 3.5MM","BOTH IP/OP","$2,225.00 ","$1,646.50 ","$0.00 ","$2,225.00 ","$1,001.25 ","$0.00 ","$463.75 ","$0.00 ","$0.00 ","$389.58 ","$2,225.00 ","$0.00 ","$1,112.50 ","$1,762.20 ","$1,780.00 ","$0.00 ","$348.21 ","$0.00 ","$354.22 ","$0.00 "
"72824041S","SUP","HCPCS C1713","","72824041S  -  PLATE BN XL STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM SCR","BOTH IP/OP","$2,331.25 ","$1,725.13 ","$0.00 ","$2,331.25 ","$1,049.06 ","$0.00 ","$485.89 ","$0.00 ","$0.00 ","$408.18 ","$2,331.25 ","$0.00 ","$1,165.63 ","$1,846.35 ","$1,865.00 ","$0.00 ","$364.84 ","$0.00 ","$371.14 ","$0.00 "
"72824042S","SUP","HCPCS C1713","","72824042S  -  PLATE BN XL RT CALC 3.5MM SCR","BOTH IP/OP","$2,331.25 ","$1,725.13 ","$0.00 ","$2,331.25 ","$1,049.06 ","$0.00 ","$485.89 ","$0.00 ","$0.00 ","$408.18 ","$2,331.25 ","$0.00 ","$1,165.63 ","$1,846.35 ","$1,865.00 ","$0.00 ","$364.84 ","$0.00 ","$371.14 ","$0.00 "
"7291-0108","SUP","Custom 27803010","","7291-0108  -  INSERT TIB 1 8MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0110","SUP","Custom 27803010","","7291-0110  -  INSERT TIB 1 10MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0115","SUP","Custom 27803010","","7291-0115  -  INSERT TIB 1 15MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0118","SUP","Custom 27803010","","7291-0118  -  INSERT TIB 1 18MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0121","SUP","Custom 27803010","","7291-0121  -  INSERT TIB 1 21MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0124","SUP","Custom 27803010","","7291-0124  -  INSERT TIB 1 24MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0308","SUP","Custom 27803010","","7291-0308  -  INSERT TIB 3 8MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0310","SUP","Custom 27803010","","7291-0310  -  INSERT TIB 3 10MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0312","SUP","Custom 27803010","","7291-0312  -  INSERT TIB 3 12MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0315","SUP","Custom 27803010","","7291-0315  -  INSERT TIB 3 15MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0318","SUP","Custom 27803010","","7291-0318  -  INSERT TIB 3 18MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0321","SUP","Custom 27803010","","7291-0321  -  INSERT TIB 3 21MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0324","SUP","Custom 27803010","","7291-0324  -  INSERT TIB 3 24MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0512","SUP","Custom 27803010","","7291-0512  -  INSERT TIB 5 12MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0515","SUP","Custom 27803010","","7291-0515  -  INSERT TIB 5 15MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0518","SUP","Custom 27803010","","7291-0518  -  INSERT TIB 5 18MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0521","SUP","Custom 27803010","","7291-0521  -  INSERT TIB 5 21MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0524","SUP","Custom 27803010","","7291-0524  -  INSERT TIB 5 24MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0708","SUP","Custom 27803010","","7291-0708  -  INSERT TIB 7 8MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0710","SUP","Custom 27803010","","7291-0710  -  INSERT TIB 7 10MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0712","SUP","Custom 27803010","","7291-0712  -  INSERT TIB 7 12MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0718","SUP","Custom 27803010","","7291-0718  -  INSERT TIB 7 18MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0721","SUP","Custom 27803010","","7291-0721  -  INSERT TIB 7 21MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0724","SUP","Custom 27803010","","7291-0724  -  INSERT TIB 7 24MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0908","SUP","Custom 27803010","","7291-0908  -  INSERT TIB 9 8MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,298.00 ","$960.52 ","$0.00 ","$1,298.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,298.00 ","$0.00 ","$649.00 ","$1,028.02 ","$1,038.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0910","SUP","Custom 27803010","","7291-0910  -  INSERT TIB 9 10MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0915","SUP","Custom 27803010","","7291-0915  -  INSERT TIB 9 15MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0918","SUP","Custom 27803010","","7291-0918  -  INSERT TIB 9 18MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0921","SUP","Custom 27803010","","7291-0921  -  INSERT TIB 9 21MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,299.00 ","$961.26 ","$0.00 ","$1,299.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,299.00 ","$0.00 ","$649.50 ","$1,028.81 ","$1,039.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7291-0924","SUP","Custom 27803010","","7291-0924  -  INSERT TIB 9 24MM KNEE PS BRNG SER 1","BOTH IP/OP","$1,246.00 ","$922.04 ","$0.00 ","$1,246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,246.00 ","$0.00 ","$623.00 ","$986.83 ","$996.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72A002","SUP","Custom 27804086","","72A002  -  GRAFT BONE SMALL 100-125MM FREEZE DRIED SHAFT CORTICAL","BOTH IP/OP","$1,760.00 ","$1,302.40 ","$0.00 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,760.00 ","$0.00 ","$880.00 ","$1,393.92 ","$1,408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"72B006","SUP","HCPCS C1762","","72B006  -  GRAFT BONE LARGE 126MM FROZEN SHAFT CORTICAL","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$0.00 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$0.00 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$0.00 ","$0.00 "
"730032ADP","SUP","Custom 27803010","","730032ADP  -  GRAFT CV 42MM 32MM 15CM 32MM GLWV VSLV WVN GELTN AOR ROOT","BOTH IP/OP","$6,437.50 ","$4,763.75 ","$0.00 ","$6,437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,437.50 ","$0.00 ","$3,218.75 ","$5,098.50 ","$5,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7300TFX25MM","SUP","Custom 27803010","","7300TFX25MM  -  VALVE MTRL 25MM CRP-ED PRIMNT MAGNA BPRTH EASE HRT","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7300TFX29MM","SUP","Custom 27803010","","7300TFX29MM  -  VALVE MTRL 29MM CRP-ED PRIMNT MG HRT PRICRD EASE","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7300TFX31MM","SUP","Custom 27803010","","7300TFX31MM  -  VALVE MITRAL 31MM BIOPROSTHESIS EASE CARPENTIER-EDWARDS","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7300TFX33MM","SUP","Custom 27803010","","7300TFX33MM  -  VALVE MTRL 33MM CRP-ED PRIMNT MG EASE PRICRD HRT","BOTH IP/OP","$22,275.00 ","$16,483.50 ","$0.00 ","$22,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22,275.00 ","$0.00 ","$11,137.50 ","$17,641.80 ","$17,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-0110","SUP","Custom 27803010","","73-0110  -  COMPONENT PATLR 11 10MM MEDIALIZED DOME SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-020S","SUP","HCPCS C1713","","73-020S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 20MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-025S","SUP","HCPCS C1713","","73-025S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 25MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-030S","SUP","HCPCS C1713","","73-030S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 30MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-035S","SUP","HCPCS C1713","","73-035S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 35MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-040S","SUP","HCPCS C1713","","73-040S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 40MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-045S","SUP","HCPCS C1713","","73-045S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 45MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-050S","SUP","HCPCS C1713","","73-050S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 50MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-0510","SUP","Custom 27803010","","73-0510  -  COMPONENT PATLR 5 1.5MM OFFST 32/35MM 5MM 5MMX10MM MEDIALIZE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-055S","SUP","HCPCS C1713","","73-055S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 55MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-060S","SUP","HCPCS C1713","","73-060S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 60MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-065S","SUP","HCPCS C1713","","73-065S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 65MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-070S","SUP","HCPCS C1713","","73-070S  -  SCREW  CANNULATED FULLY THREADED 7.3MM X 70MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-0710","SUP","Custom 27803010","","73-0710  -  COMPONENT PATLR 7 1.5MM OFFST 34/38MM 5MM 5MMX10MM MEDIALIZE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-075S","SUP","HCPCS C1713","","73-075S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 75MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-080S","SUP","HCPCS C1713","","73-080S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 80MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-085S","SUP","HCPCS C1713","","73-085S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 85MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-090S","SUP","HCPCS C1713","","73-090S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 90MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-0910","SUP","Custom 27803010","","73-0910  -  COMPONENT PATLR 7 1.5MM OFFST 36/41MM 5MM 5MMX10MM MEDIALIZE","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-095S","SUP","HCPCS C1713","","73-095S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 95MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-100S","SUP","HCPCS C1713","","73-100S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 100MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-105S","SUP","HCPCS C1713","","73-105S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 105MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-110S","SUP","HCPCS C1713","","73-110S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 110MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-115S","SUP","HCPCS C1713","","73-115S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 115MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-120S","SUP","HCPCS C1713","","73-120S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 120MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-125S","SUP","HCPCS C1713","","73-125S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 125MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-130S","SUP","HCPCS C1713","","73-130S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 130MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16030S","SUP","HCPCS C1713","","73-16030S  -  SCREW 7.3MM X 30MM CANNULATED SCREW 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16035S","SUP","HCPCS C1713","","73-16035S  -  SCREW 7.3MM X 35MM CANNULATED SCREW 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16040S","SUP","HCPCS C1713","","73-16040S  -  SCREW CANNULATED 7.3MM X 40MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16045S","SUP","HCPCS C1713","","73-16045S  -  SCREW CANNULATED 7.3MM X 45MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16050S","SUP","HCPCS C1713","","73-16050S  -  SCREW CANNULATED 7.3MM X 50MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16055S","SUP","HCPCS C1713","","73-16055S  -  SCREW CANNULATED 7.3MM X 55MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16060S","SUP","HCPCS C1713","","73-16060S  -  SCREW CANNULATED 7.3MM X 60MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16065S","SUP","HCPCS C1713","","73-16065S  -  SCREW CANNULATED 7.3MM X 65MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16070S","SUP","HCPCS C1713","","73-16070S  -  SCREW CANNULATED 7.3MM X 70MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16075S","SUP","HCPCS C1713","","73-16075S  -  SCREW CANNULATED 7.3MM X 75MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16080S","SUP","HCPCS C1713","","73-16080S  -  SCREW CANNULATED 7.3MM X 80MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16085S","SUP","HCPCS C1713","","73-16085S  -  SCREW CANNULATED 7.3MM X 85MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16090S","SUP","HCPCS C1713","","73-16090S  -  SCREW CANNULATED 7.3MM X 90MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16095S","SUP","HCPCS C1713","","73-16095S  -  SCREW CANNULATED 7.3MM X 95MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16100S","SUP","HCPCS C1713","","73-16100S  -  SCREW CANNULATED 7.3MM X 100MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16105S","SUP","HCPCS C1713","","73-16105S  -  SCREW CANNULATED 7.3MM X 105MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16110S","SUP","HCPCS C1713","","73-16110S  -  SCREW CANNULATED 7.3MM X 110MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16115S","SUP","HCPCS C1713","","73-16115S  -  SCREW CANNULATED 7.3MM X 115MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16120S","SUP","HCPCS C1713","","73-16120S  -  SCREW CANNULATED 7.3MM X 120MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16125S","SUP","HCPCS C1713","","73-16125S  -  SCREW CANNULATED 7.3MM X 125MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16130S","SUP","HCPCS C1713","","73-16130S  -  SCREW CANNULATED 7.3MM X 130MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16135S","SUP","HCPCS C1713","","73-16135S  -  SCREW CANNULATED 7.3MM X 135MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16140S","SUP","HCPCS C1713","","73-16140S  -  SCREW CANNULATED 7.3MM X 140MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16145S","SUP","HCPCS C1713","","73-16145S  -  SCREW CANNULATED 7.3MM X 145MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-16150S","SUP","HCPCS C1713","","73-16150S  -  SCREW CANNULATED 7.3MM X 150MM 16MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-1952","SUP","HCPCS C1713","","73-1952  -  PLATE BN STERNALOCK BLU 8 HL STRG STRNM","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$1,153.13 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$448.67 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$401.03 ","$0.00 ","$407.95 ","$0.00 "
"73-20-0110","SUP","Custom 27803010","","73-20-0110  -  COMPONENT PATLR 1 10MM MEDIALIZED DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-0510","SUP","Custom 27803010","","73-20-0510  -  COMPONENT PATLR 5 10MM MEDIALIZED DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-0710","SUP","Custom 27803010","","73-20-0710  -  COMPONENT PATLR 7 MEDIALIZE DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-0910","SUP","Custom 27803010","","73-20-0910  -  COMPONENT PATLR 9 10MM MEDIALIZED DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-2110","SUP","Custom 27803010","","73-20-2110  -  COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-2510","SUP","Custom 27803010","","73-20-2510  -  COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-2710","SUP","Custom 27803010","","73-20-2710  -  COMPONENT PATLR 7 10MM CONCENTRIC DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-2910","SUP","Custom 27803010","","73-20-2910  -  COMPONENT PATLR 9 10MM CONCENTRIC DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-3110","SUP","Custom 27803010","","73-20-3110  -  COMPONENT PATLR 11 10MM UNIVERSAL DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-3308","SUP","Custom 27803010","","73-20-3308  -  COMPONENT PATLR UNIVERSAL DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-3508","SUP","Custom 27803010","","73-20-3508  -  COMPONENT PATLR 5 8MM UNIVERSAL DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-3708","SUP","Custom 27803010","","73-20-3708  -  COMPONENT PATLR 7 8MM UNIVERSAL DOME SCORPIO X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-3710","SUP","Custom 27803010","","73-20-3710  -  COMPONENT PTLR 7 UNV DOME 34MM 10MM STRL SCRP X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-3910","SUP","Custom 27803010","","73-20-3910  -  COMPONENT PTLR 9 UNV DOME 36MM 10MM STRL SCRP X3","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-4026","SUP","Custom 27803010","","73-20-4026  -  COMPONENT PATLR 26MM RECESSED SCORPIO X3","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-4028","SUP","Custom 27803010","","73-20-4028  -  COMPONENT PATLR 28MM SCORPIO X3","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-4030","SUP","Custom 27803010","","73-20-4030  -  COMPONENT PATLR 30MM RECESSED SCORPIO X3","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-4032","SUP","Custom 27803010","","73-20-4032  -  COMPONENT PATLR 32MM RECESSED SCORPIO X3","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-5030","SUP","Custom 27803010","","73-20-5030  -  CMPNT PATLR 30MM SCRP X3","BOTH IP/OP","$1,205.00 ","$891.70 ","$0.00 ","$1,205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,205.00 ","$0.00 ","$602.50 ","$954.36 ","$964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-20-5032","SUP","Custom 27803010","","73-20-5032  -  CMPNT PATLR 32MM INSET SCRP X3","BOTH IP/OP","$1,205.00 ","$891.70 ","$0.00 ","$1,205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,205.00 ","$0.00 ","$602.50 ","$954.36 ","$964.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-2110","SUP","Custom 27803010","","73-2110  -  COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-2408","SUP","HCPCS C1713","","73-2408  -  SCREW BN 2.4MM 8MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2410","SUP","HCPCS C1713","","73-2410  -  SCREW BN 2.4MM 10MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2412","SUP","HCPCS C1713","","73-2412  -  SCREW BN 2.4MM 12MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2414","SUP","HCPCS C1713","","73-2414  -  SCREW BN 2.4MM 14MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2416","SUP","HCPCS C1713","","73-2416  -  SCREW BN 2.4MM 16MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2418","SUP","HCPCS C1713","","73-2418  -  SCREW BN 2.4MM 18MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2420","SUP","HCPCS C1713","","73-2420  -  SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2510","SUP","Custom 27803010","","73-2510  -  COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-2610","SUP","Custom 27803010","","73-2610  -  INSERT TIB 6 10MM PATLR N2 VAC INSET SCRP 26MM","BOTH IP/OP","$851.00 ","$629.74 ","$0.00 ","$851.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$851.00 ","$0.00 ","$425.50 ","$673.99 ","$680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-2622","SUP","HCPCS C1713","","73-2622  -  PLATE BN SQ STERNALOCK BLU 4 HL STRNM","BOTH IP/OP","$1,537.50 ","$1,137.75 ","$0.00 ","$1,537.50 ","$691.88 ","$0.00 ","$320.45 ","$0.00 ","$0.00 ","$269.20 ","$1,537.50 ","$0.00 ","$768.75 ","$1,217.70 ","$1,230.00 ","$0.00 ","$240.62 ","$0.00 ","$244.77 ","$0.00 "
"73-2623","SUP","HCPCS C1713","","73-2623  -  PLATE BN STERNALOCK BLU 8 HL STRNM","BOTH IP/OP","$2,077.50 ","$1,537.35 ","$0.00 ","$2,077.50 ","$934.88 ","$0.00 ","$433.00 ","$0.00 ","$0.00 ","$363.75 ","$2,077.50 ","$0.00 ","$1,038.75 ","$1,645.38 ","$1,662.00 ","$0.00 ","$325.13 ","$0.00 ","$330.74 ","$0.00 "
"73-2632","SUP","HCPCS C1713","","73-2632  -  PLATE BN NAR STERNALOCK BLU 12 HL STRNM 2.4MM SCR","BOTH IP/OP","$2,175.00 ","$1,609.50 ","$0.00 ","$2,175.00 ","$978.75 ","$0.00 ","$453.32 ","$0.00 ","$0.00 ","$380.83 ","$2,175.00 ","$0.00 ","$1,087.50 ","$1,722.60 ","$1,740.00 ","$0.00 ","$340.39 ","$0.00 ","$346.26 ","$0.00 "
"73-2634","SUP","HCPCS C1713","","73-2634  -  PLATE BN W STERNALOCK BLU 12 HL STRNM 2.4MM SCR","BOTH IP/OP","$2,175.00 ","$1,609.50 ","$0.00 ","$2,175.00 ","$978.75 ","$0.00 ","$453.32 ","$0.00 ","$0.00 ","$380.83 ","$2,175.00 ","$0.00 ","$1,087.50 ","$1,722.60 ","$1,740.00 ","$0.00 ","$340.39 ","$0.00 ","$346.26 ","$0.00 "
"73-2636","SUP","HCPCS C1713","","73-2636  -  PLATE BN STRG STERNALOCK BLU 4 HL STRNM 2.4MM SCR","BOTH IP/OP","$1,537.50 ","$1,137.75 ","$0.00 ","$1,537.50 ","$691.88 ","$0.00 ","$320.45 ","$0.00 ","$0.00 ","$269.20 ","$1,537.50 ","$0.00 ","$768.75 ","$1,217.70 ","$1,230.00 ","$0.00 ","$240.62 ","$0.00 ","$244.77 ","$0.00 "
"73-2643","SUP","HCPCS C1713","","73-2643  -  PLATE BN 100D L STERNALOCK BLU 4 HL STRNM","BOTH IP/OP","$1,537.50 ","$1,137.75 ","$0.00 ","$1,537.50 ","$691.88 ","$0.00 ","$320.45 ","$0.00 ","$0.00 ","$269.20 ","$1,537.50 ","$0.00 ","$768.75 ","$1,217.70 ","$1,230.00 ","$0.00 ","$240.62 ","$0.00 ","$244.77 ","$0.00 "
"73-2645","SUP","HCPCS C1713","","73-2645  -  PLATE BN JL STERNALOCK BLU 8 HL STRNM PRM CLSR SYS","BOTH IP/OP","$1,945.00 ","$1,439.30 ","$0.00 ","$1,945.00 ","$875.25 ","$0.00 ","$405.39 ","$0.00 ","$0.00 ","$340.55 ","$1,945.00 ","$0.00 ","$972.50 ","$1,540.44 ","$1,556.00 ","$0.00 ","$304.39 ","$0.00 ","$309.64 ","$0.00 "
"73-2708","SUP","HCPCS C1713","","73-2708  -  SCREW BN 2.7MM 8MM MAG STERNALOCK BLU SLF DRL LCK STRNM CANC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2710","SUP","HCPCS C1713","","73-2710  -  COMPONENT PTLR 7 CONC DOME 34/38MM 10MM SCRP N2/VAC","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2712","SUP","HCPCS C1713","","73-2712  -  SCREW BN 2.7MM 12MM MAG STERNALOCK BLU SLF DRL LCK STRNM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2714","SUP","HCPCS C1713","","73-2714  -  SCREW BN 2.7MM 14MM MAG STERNALOCK BLU SLF DRL LCK STRNM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2716","SUP","HCPCS C1713","","73-2716  -  SCREW BN 2.7MM 16MM MAG STERNALOCK BLU SLF DRL LCK STRNM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2718","SUP","HCPCS C1713","","73-2718  -  SCREW BN 2.7MM 18MM MAG STERNALOCK BLU SLF DRL LCK STRNM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2720","SUP","HCPCS C1713","","73-2720  -  SCREW BN 2.7MM 20MM MAG STERNALOCK BLU SLF DRL LCK STRNM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"73-2810","SUP","Custom 27803010","","73-2810  -  CMPNT PATLR 8 10MM 28MM INSET SCRP","BOTH IP/OP","$851.00 ","$629.74 ","$0.00 ","$851.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$851.00 ","$0.00 ","$425.50 ","$673.99 ","$680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73281488/8ARM","SUP","HCPCS C1768","","73281488/8ARM  -  GRAFT CARDIOVASCULAR PLEXUS 28MM 14X8X8","BOTH IP/OP","$6,612.50 ","$4,893.25 ","$0.00 ","$6,612.50 ","$2,975.63 ","$0.00 ","$1,378.21 ","$0.00 ","$0.00 ","$1,157.80 ","$6,612.50 ","$0.00 ","$3,306.25 ","$5,237.10 ","$5,290.00 ","$0.00 ","$1,034.86 ","$0.00 ","$1,052.71 ","$0.00 "
"73-2910","SUP","Custom 27803010","","73-2910  -  COMPONENT PATLR 9 CONCENTRIC DOME 10MM SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-3010","SUP","Custom 27803010","","73-3010  -  CMPNT PATLR INSET SCRP","BOTH IP/OP","$851.00 ","$629.74 ","$0.00 ","$851.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$851.00 ","$0.00 ","$425.50 ","$673.99 ","$680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73301488/8ARM","SUP","HCPCS C1768","","73301488/8ARM  -  4 BRANCH TOTAL ARC GRAFT 30MM","BOTH IP/OP","$6,612.50 ","$4,893.25 ","$0.00 ","$6,612.50 ","$2,975.63 ","$0.00 ","$1,378.21 ","$0.00 ","$0.00 ","$1,157.80 ","$6,612.50 ","$0.00 ","$3,306.25 ","$5,237.10 ","$5,290.00 ","$0.00 ","$1,034.86 ","$0.00 ","$1,052.71 ","$0.00 "
"73-3110","SUP","Custom 27803010","","73-3110  -  COMPONENT PATLR 11MM 10MM UNIVERSAL DOME SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-32045S","SUP","HCPCS C1713","","73-32045S  -  SCREW CANNULATED 7.3MM X 45MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32050S","SUP","HCPCS C1713","","73-32050S  -  SCREW CANNULATED 7.3MM X 50MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32055S","SUP","HCPCS C1713","","73-32055S  -  SCREW CANNULATED 7.3MM X 55MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32060S","SUP","HCPCS C1713","","73-32060S  -  SCREW CANNULATED 7.3MM X 60MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32065S","SUP","HCPCS C1713","","73-32065S  -  SCREW CANNULATED 7.3MM X 65MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32070S","SUP","HCPCS C1713","","73-32070S  -  SCREW CANNULATED 7.3MM X 70MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32075S","SUP","HCPCS C1713","","73-32075S  -  SCREW CANNULATED 7.3MM X 75MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32080S","SUP","HCPCS C1713","","73-32080S  -  SCREW CANNULATED 7.3MM X 80MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32085S","SUP","HCPCS C1713","","73-32085S  -  SCREW CANNULATED 7.3MM X 85MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32090S","SUP","HCPCS C1713","","73-32090S  -  SCREW CANNULATED 7.3MM X 90MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32095S","SUP","HCPCS C1713","","73-32095S  -  SCREW CANNULATED 7.3MM X 95MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-3210","SUP","Custom 27803010","","73-3210  -  CMPNT PATLR 2 10MM 32MM INSET SCRP","BOTH IP/OP","$851.00 ","$629.74 ","$0.00 ","$851.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$851.00 ","$0.00 ","$425.50 ","$673.99 ","$680.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-32100S","SUP","HCPCS C1713","","73-32100S  -  SCREW CANNULATED 7.3MM X 100MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32105S","SUP","HCPCS C1713","","73-32105S  -  SCREW CANNULATED 7.3MM X 105MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32110S","SUP","HCPCS C1713","","73-32110S  -  SCREW CANNULATED 7.3MM X 110MM 32MM THREAD","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32115S","SUP","HCPCS C1713","","73-32115S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 115MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32120S","SUP","HCPCS C1713","","73-32120S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 120MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32125S","SUP","HCPCS C1713","","73-32125S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 125MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32130S","SUP","HCPCS C1713","","73-32130S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 130MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32135S","SUP","HCPCS C1713","","73-32135S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 135MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32140S","SUP","HCPCS C1713","","73-32140S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 140MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32145S","SUP","HCPCS C1713","","73-32145S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 145MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-32150S","SUP","HCPCS C1713","","73-32150S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 150MM","BOTH IP/OP","$235.00 ","$173.90 ","$0.00 ","$235.00 ","$105.75 ","$0.00 ","$48.98 ","$0.00 ","$0.00 ","$41.15 ","$235.00 ","$0.00 ","$117.50 ","$186.12 ","$188.00 ","$0.00 ","$36.78 ","$0.00 ","$37.41 ","$0.00 "
"73-3308","SUP","Custom 27803010","","73-3308  -  COMPONENT PATLR 3 8MM UNIVERSAL DOME SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-3508","SUP","Custom 27803010","","73-3508  -  COMPONENT PATLR 5 32MM 5MM 8MM 4MM UNIVERSAL DOME PEGGED","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-3708","SUP","Custom 27803010","","73-3708  -  COMPONENT PATLR 7 8MM 8MM UNIVERSAL DOME SCORPIO N2/VAC","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-3710","SUP","Custom 27803010","","73-3710  -  COMPONENT PTLR 7 UNV DOME 34MM 10MM SCRP PG N2/VAC 1 AXIS KN","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"73-3910","SUP","Custom 27803010","","73-3910  -  COMPONENT PTLR 5 UNV DOME 36MM 10MM SCRP PG N2/VAC 1 AXIS KN","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"734024/8","SUP","HCPCS C1768","","734024/8  -  GRAFT CARDIO 8MM 24MM 8MM 40CM 15CM ANTE-FLO VASCUTEK","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$1,451.25 ","$0.00 ","$672.17 ","$0.00 ","$0.00 ","$564.67 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$504.71 ","$0.00 ","$513.42 ","$0.00 "
"734026/8","SUP","HCPCS C1768","","734026/8  -  GRAFT CARDIO 8MM 26MM 8MM 40CM 15CM PERFUSION SIDE BRANCH","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"734028/8","SUP","HCPCS C1768","","734028/8  -  GRAFT CARDIO 40CM 28MM 8MM AORTIC ARCH WVN SIDE BRCH GLWV","BOTH IP/OP","$3,862.50 ","$2,858.25 ","$0.00 ","$1,338.75 ","$602.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$234.40 ","$1,338.75 ","$0.00 ","$669.38 ","$1,060.29 ","$1,071.00 ","$0.00 ","$209.51 ","$0.00 ","$213.13 ","$0.00 "
"734030/8","SUP","HCPCS C1768","","734030/8  -  GRAFT CARDIO 30MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"734032/8","SUP","HCPCS C1768","","734032/8  -  GRAFT CARDIO 32MM 8MM 40CM 15CM PERFUSION SIDE BRANCH GRAFT","BOTH IP/OP","$4,050.00 ","$2,997.00 ","$0.00 ","$4,050.00 ","$1,822.50 ","$0.00 ","$844.12 ","$0.00 ","$0.00 ","$709.12 ","$4,050.00 ","$0.00 ","$2,025.00 ","$3,207.60 ","$3,240.00 ","$0.00 ","$633.83 ","$0.00 ","$644.76 ","$0.00 "
"734034/8","SUP","HCPCS C1768","","734034/8  -  GRAFT CARDIO 34MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE","BOTH IP/OP","$3,387.50 ","$2,506.75 ","$0.00 ","$3,387.50 ","$1,524.38 ","$0.00 ","$706.04 ","$0.00 ","$0.00 ","$593.12 ","$3,387.50 ","$0.00 ","$1,693.75 ","$2,682.90 ","$2,710.00 ","$0.00 ","$530.14 ","$0.00 ","$539.29 ","$0.00 "
"74-2-0510","SUP","Custom 27803010","","74-2-0510  -  INSERT TIB 5 10MM KNEE ALPLY CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-0512","SUP","Custom 27803010","","74-2-0512  -  INSERT TIB 5 12MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-0515","SUP","HCPCS C1776","","74-2-0515  -  CMPNT TIB 15MM SCRP 5 KNEE ALPLY CRUC RET","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$643.95 ","$0.00 ","$298.26 ","$0.00 ","$0.00 ","$250.56 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$223.95 ","$0.00 ","$227.82 ","$0.00 "
"74-2-0710","SUP","Custom 27803010","","74-2-0710  -  INSERT TIB 7 10MM KNEE PE N2 VAC CRUC RET STY SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-0712","SUP","Custom 27803010","","74-2-0712  -  INSERT TIB 7 12MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-0715","SUP","Custom 27803010","","74-2-0715  -  INSERT TIB 7 15MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-0910","SUP","HCPCS C1776","","74-2-0910  -  CMPNT TIB 10MM SCRP 9 KNEE ALPLY CRUC RET","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$643.95 ","$0.00 ","$298.26 ","$0.00 ","$0.00 ","$250.56 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$223.95 ","$0.00 ","$227.82 ","$0.00 "
"74-2-0912","SUP","Custom 27803010","","74-2-0912  -  INSERT TIB 9 12MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-0915","SUP","Custom 27803010","","74-2-0915  -  INSERT TIB 9 15MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-1110","SUP","Custom 27803010","","74-2-1110  -  INSERT TIB 11 10MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-1112","SUP","Custom 27803010","","74-2-1112  -  INSERT TIB 11 12MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74-2-1115","SUP","Custom 27803010","","74-2-1115  -  INSERT TIB 11 15MM KNEE ALPLY N2 VAC CRUC RET SCRP","BOTH IP/OP","$1,431.00 ","$1,058.94 ","$0.00 ","$1,431.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,431.00 ","$0.00 ","$715.50 ","$1,133.35 ","$1,144.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"742-11-42A","SUP","HCPCS C1776","","742-11-42A  -  SHELL ACTB A 42MM STRL TRDNT II PSL 3 HL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-44B","SUP","HCPCS C1776","","742-11-44B  -  SHELL ACTB B 44MM STRL TRDNT II PSL 3 HL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-46C","SUP","HCPCS C1776","","742-11-46C  -  SHELL ACTB C 46MM STRL TRDNT II PSL 3 HL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-48D","SUP","HCPCS C1776","","742-11-48D  -  SHELL ACTB D 48MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-50D","SUP","HCPCS C1776","","742-11-50D  -  SHELL ACTB D 50MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-52E","SUP","HCPCS C1776","","742-11-52E  -  SHELL ACTB E 52MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-54E","SUP","HCPCS C1776","","742-11-54E  -  SHELL ACTB E 54MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-56F","SUP","HCPCS C1776","","742-11-56F  -  SHELL ACTB F 56MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-58F","SUP","HCPCS C1776","","742-11-58F  -  SHELL ACTB F 58MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-60G","SUP","HCPCS C1776","","742-11-60G  -  SHELL ACTB G 60MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-62G","SUP","HCPCS C1776","","742-11-62G  -  SHELL ACTB G 62MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-64H","SUP","HCPCS C1776","","742-11-64H  -  SHELL ACTB H 64MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"742-11-66H","SUP","HCPCS C1776","","742-11-66H  -  SHELL ACTB H 66MM STRL TRDNT II PSL CH HA HIP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"74-3-0510","SUP","HCPCS C1776","","74-3-0510  -  CMPNT TIB 10MM 5 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0512","SUP","HCPCS C1776","","74-3-0512  -  CMPNT TIB 12MM 5 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0515","SUP","HCPCS C1776","","74-3-0515  -  CMPNT TIB 15MM 5 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0710","SUP","HCPCS C1776","","74-3-0710  -  CMPNT TIB 10MM 7 KNEE ALPLY PS STY","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0712","SUP","HCPCS C1776","","74-3-0712  -  CMPNT TIB 12MM 7 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0715","SUP","HCPCS C1776","","74-3-0715  -  CMPNT TIB 15MM 7 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0910","SUP","HCPCS C1776","","74-3-0910  -  CMPNT TIB 10MM 9 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0912","SUP","HCPCS C1776","","74-3-0912  -  CMPNT TIB 12MM 9 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-0915","SUP","HCPCS C1776","","74-3-0915  -  CMPNT TIB 15MM 9 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-1110","SUP","HCPCS C1776","","74-3-1110  -  CMPNT TIB 10MM 11 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-1112","SUP","HCPCS C1776","","74-3-1112  -  CMPNT TIB 12MM 11 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74-3-1115","SUP","HCPCS C1776","","74-3-1115  -  CMPNT TIB 15MM 11 KNEE ALPLY PS","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$661.50 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"74402006N","SUP","HCPCS C1713","","74402006N  -  SCREW BN T6 2MM 1.4MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402007N","SUP","HCPCS C1713","","74402007N  -  SCREW BN T6 2MM 1.4MM 7MM NS VLP MN-MOD ST TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402008N","SUP","HCPCS C1713","","74402008N  -  SCREW BN T6 2MM 1.4MM 8MM NS VLP MN-MOD ST DRV MECH TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402009N","SUP","HCPCS C1713","","74402009N  -  SCREW BN T6 2MM 1.4MM 9MM NS VLP MN-MOD ST TI OSTEOPENIA","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402010N","SUP","HCPCS C1713","","74402010N  -  SCREW BN T6 2MM 1.4MM 10MM NS VLP MN-MOD ST TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402011N","SUP","HCPCS C1713","","74402011N  -  SCREW BN T6 2MM 1.4MM 11MM NS VLP MN-MOD ST TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
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"74402413N","SUP","HCPCS C1713","","74402413N  -  SCREW BN T7 2.4MM 1.7MM 13MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
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"74402415N","SUP","HCPCS C1713","","74402415N  -  SCREW BN 2.4MM 1.7MM 15MM GRN NS VLP MN-MOD T7 DRVR ST TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402416N","SUP","HCPCS C1713","","74402416N  -  SCREW BN T7 2.4MM 1.7MM 16MM GRN NS VLP ST LOPRFL HD TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402418N","SUP","HCPCS C1713","","74402418N  -  SCREW BN T7 2.4MM 1.7MM 18MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402420N","SUP","HCPCS C1713","","74402420N  -  SCREW BN T7 2.4MM 1.7MM 20MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402422N","SUP","HCPCS C1713","","74402422N  -  SCREW BN T7 2.4MM 1.7MM 22MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402424N","SUP","HCPCS C1713","","74402424N  -  SCREW BN T7 2.4MM 1.7MM 24MM GRN NS VLP ST LOPRFL HD TI CORT","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
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"74402430N","SUP","HCPCS C1713","","74402430N  -  SCREW BN T7 2.4MM 1.7MM 30MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402432N","SUP","HCPCS C1713","","74402432N  -  SCREW BN T7 2.4MM 1.7MM 32MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402434N","SUP","HCPCS C1713","","74402434N  -  SCREW BN T7 2.4MM 1.7MM 34MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402436N","SUP","HCPCS C1713","","74402436N  -  SCREW BN T7 2.4MM 1.7MM 36MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402438N","SUP","HCPCS C1713","","74402438N  -  SCREW BN T7 2.4MM 1.7MM 38MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402440N","SUP","HCPCS C1713","","74402440N  -  SCREW BN T7 2.4MM 1.7MM 40MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402442N","SUP","HCPCS C1713","","74402442N  -  SCREW BN T7 2.4MM 1.7MM 42MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402444N","SUP","HCPCS C1713","","74402444N  -  SCREW BN T7 2.4MM 1.7MM 44MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74402446N","SUP","HCPCS C1713","","74402446N  -  SCREW BN T7 2.4MM 1.7MM 46MM GRN NS VLP ST LO HD PRFL TI","BOTH IP/OP","$112.48 ","$83.24 ","$0.00 ","$112.48 ","$50.61 ","$0.00 ","$23.44 ","$0.00 ","$0.00 ","$19.69 ","$112.48 ","$0.00 ","$56.24 ","$89.08 ","$89.98 ","$0.00 ","$17.60 ","$0.00 ","$17.91 ","$0.00 "
"74412006N","SUP","HCPCS C1713","","74412006N  -  SCREW BN T6 2MM 1.4MM 6MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
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"74412008N","SUP","HCPCS C1713","","74412008N  -  SCREW BN 2MM 8MM NS VLP LCK ST T6 DRVR TI SM BN","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412009N","SUP","HCPCS C1713","","74412009N  -  SCREW BN T6 2MM 1.4MM 9MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
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"74412013N","SUP","HCPCS C1713","","74412013N  -  SCREW BN T6 2MM 1.4MM 13MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412014N","SUP","HCPCS C1713","","74412014N  -  SCREW BN 2MM 14MM NS VLP LCK ST T6 DRVR TI SM BN","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412016N","SUP","HCPCS C1713","","74412016N  -  SCREW BN T6 2MM 1.4MM 16MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412018N","SUP","HCPCS C1713","","74412018N  -  SCREW BN T6 2MM 1.4MM 18MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412020N","SUP","HCPCS C1713","","74412020N  -  SCREW BN T6 2MM 1.4MM 20MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412022N","SUP","HCPCS C1713","","74412022N  -  SCREW BN T6 2MM 1.4MM 22MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412024N","SUP","HCPCS C1713","","74412024N  -  SCREW BN T6 2MM 1.4MM 24MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412026N","SUP","HCPCS C1713","","74412026N  -  SCREW BN T6 2MM 1.4MM 26MM PUR NS VLP LCK ST LO HD PRFL TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412028N","SUP","HCPCS C1713","","74412028N  -  SCREW BN T6 2MM 1.4MM 28MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412030N","SUP","HCPCS C1713","","74412030N  -  SCREW BN T6 2MM 1.4MM 30MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412032N","SUP","HCPCS C1713","","74412032N  -  SCREW BN T6 2MM 1.4MM 32MM PUR NS VLP LCK ST LO HD PRFL TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412034N","SUP","HCPCS C1713","","74412034N  -  SCREW BN T6 2MM 1.4MM 34MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412036N","SUP","HCPCS C1713","","74412036N  -  SCREW BN T6 2MM 1.4MM 36MM PUR NS VLP LCK ST LOPRFL HD TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412406N","SUP","HCPCS C1713","","74412406N  -  SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST LCK TI CORT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412407N","SUP","HCPCS C1713","","74412407N  -  SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412408N","SUP","HCPCS C1713","","74412408N  -  SCREW BN T7 2.4MM 8MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412409N","SUP","HCPCS C1713","","74412409N  -  SCREW BN T7 2.4MM 1.7MM 9MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412410N","SUP","HCPCS C1713","","74412410N  -  SCREW BN T7 2.4MM 10MM NS VLP MN-MOD ST LCK LOPRFL HD TI FT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412411N","SUP","HCPCS C1713","","74412411N  -  SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412412N","SUP","HCPCS C1713","","74412412N  -  SCREW BN T7 2.4MM 1.7MM 12MM NS VLP ST LCK TI CORT MN-MOD SM","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412413N","SUP","HCPCS C1713","","74412413N  -  SCREW BN T7 2.4MM 1.7MM 13MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412414N","SUP","HCPCS C1713","","74412414N  -  SCREW BN T7 2.4MM 1.7MM 14MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412415N","SUP","HCPCS C1713","","74412415N  -  SCREW BN T7 2.4MM 1.7MM 15MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412416N","SUP","HCPCS C1713","","74412416N  -  SCREW BN 2.4MM 1.7MM 16MM GRN NS VLP MN-MOD T7 DRVR ST LCK","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412418N","SUP","HCPCS C1713","","74412418N  -  SCREW BN T7 2.4MM 18MM NS VLP ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412420N","SUP","HCPCS C1713","","74412420N  -  SCREW BN T7 2.4MM 1.7MM 20MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412422N","SUP","HCPCS C1713","","74412422N  -  SCREW BN T7 2.4MM 22MM GRN NS VLP ST DRVR TI FT SM BN PLT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412424N","SUP","HCPCS C1713","","74412424N  -  SCREW BN T7 2.4MM 24MM GRN NS VLP ST DRVR TI FT SM BN PLT","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412426N","SUP","HCPCS C1713","","74412426N  -  SCREW BN T7 2.4MM 1.7MM 26MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412428N","SUP","HCPCS C1713","","74412428N  -  SCREW BN T7 2.4MM 1.7MM 28MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412430N","SUP","HCPCS C1713","","74412430N  -  SCREW BN T7 2.4MM 1.7MM 30MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412432N","SUP","HCPCS C1713","","74412432N  -  SCREW BN T7 2.4MM 1.7MM 32MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412434N","SUP","HCPCS C1713","","74412434N  -  SCREW BN T7 2.4MM 1.7MM 34MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412436N","SUP","HCPCS C1713","","74412436N  -  SCREW BN T7 2.4MM 1.7MM 36MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412438N","SUP","HCPCS C1713","","74412438N  -  SCREW BN T7 2.4MM 1.7MM 38MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412440N","SUP","HCPCS C1713","","74412440N  -  SCREW BN T7 2.4MM 1.7MM 40MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412442N","SUP","HCPCS C1713","","74412442N  -  SCREW BN T7 2.4MM 1.7MM 42MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412444N","SUP","HCPCS C1713","","74412444N  -  SCREW BN T7 2.4MM 1.7MM 44MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"74412446N","SUP","HCPCS C1713","","74412446N  -  SCREW BN T7 2.4MM 1.7MM 46MM NS VLP MN-MOD ST LCK TI","BOTH IP/OP","$237.88 ","$176.03 ","$0.00 ","$237.88 ","$107.04 ","$0.00 ","$49.58 ","$0.00 ","$0.00 ","$41.65 ","$237.88 ","$0.00 ","$118.94 ","$188.40 ","$190.30 ","$0.00 ","$37.23 ","$0.00 ","$37.87 ","$0.00 "
"746F8","SUP","HCPCS C1751","","746F8  -  CATHETER PA STD 8FR 110CM SG C VIP TD","BOTH IP/OP","$1,006.70 ","$744.96 ","$0.00 ","$1,006.70 ","$453.02 ","$0.00 ","$209.82 ","$0.00 ","$0.00 ","$176.27 ","$1,006.70 ","$0.00 ","$503.35 ","$797.31 ","$805.36 ","$0.00 ","$157.55 ","$0.00 ","$160.27 ","$0.00 "
"746HF8","SUP","Custom 27203010","","746HF8  -  CATHETER ART LN 8FR 110CM SG C VIP 7 LUM CCO AMC THRMBSH","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"74703-02","SUP","Custom 27203010","","74703-02  -  TUBING PACK","BOTH IP/OP","$636.25 ","$470.83 ","$0.00 ","$636.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$636.25 ","$0.00 ","$318.13 ","$503.91 ","$509.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0108","SUP","Custom 27803010","","7492-0108  -  BRNG INS PS TIB","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0110","SUP","Custom 27803010","","7492-0110  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0112","SUP","Custom 27803010","","7492-0112  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0115","SUP","Custom 27803010","","7492-0115  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0118","SUP","Custom 27803010","","7492-0118  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0121","SUP","Custom 27803010","","7492-0121  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0124","SUP","Custom 27803010","","7492-0124  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0308","SUP","Custom 27803010","","7492-0308  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0310","SUP","Custom 27803010","","7492-0310  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0312","SUP","Custom 27803010","","7492-0312  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0315","SUP","Custom 27803010","","7492-0315  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0318","SUP","Custom 27803010","","7492-0318  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0321","SUP","Custom 27803010","","7492-0321  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0324","SUP","Custom 27803010","","7492-0324  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0508","SUP","Custom 27803010","","7492-0508  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0510","SUP","Custom 27803010","","7492-0510  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0512","SUP","Custom 27803010","","7492-0512  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0515","SUP","Custom 27803010","","7492-0515  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0518","SUP","Custom 27803010","","7492-0518  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0521","SUP","Custom 27803010","","7492-0521  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0524","SUP","Custom 27803010","","7492-0524  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0708","SUP","Custom 27803010","","7492-0708  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0710","SUP","Custom 27803010","","7492-0710  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0712","SUP","Custom 27803010","","7492-0712  -  INSERT TIB 7 12MM KNEE BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0715","SUP","Custom 27803010","","7492-0715  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0718","SUP","Custom 27803010","","7492-0718  -  INSERT TIB KNEE PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0721","SUP","Custom 27803010","","7492-0721  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0724","SUP","Custom 27803010","","7492-0724  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0908","SUP","Custom 27803010","","7492-0908  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,347.00 ","$996.78 ","$0.00 ","$1,347.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,347.00 ","$0.00 ","$673.50 ","$1,066.82 ","$1,077.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0910","SUP","Custom 27803010","","7492-0910  -  INSERT TIB 9 KNEE 10MM","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0912","SUP","Custom 27803010","","7492-0912  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0915","SUP","Custom 27803010","","7492-0915  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0918","SUP","Custom 27803010","","7492-0918  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0921","SUP","Custom 27803010","","7492-0921  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7492-0924","SUP","Custom 27803010","","7492-0924  -  INSERT TIB PS 2 BRNG","BOTH IP/OP","$1,293.00 ","$956.82 ","$0.00 ","$1,293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,293.00 ","$0.00 ","$646.50 ","$1,024.06 ","$1,034.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0108","SUP","Custom 27803010","","7493-0108  -  INSERT TIBIAL 1 8MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0110","SUP","Custom 27803010","","7493-0110  -  INSERT TIBIAL 1 10MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0112","SUP","Custom 27803010","","7493-0112  -  INSERT TIBIAL 1 12MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0115","SUP","Custom 27803010","","7493-0115  -  INSERT TIBIAL 1 15MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0118","SUP","Custom 27803010","","7493-0118  -  INSERT TIBIAL 1 18MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0121","SUP","Custom 27803010","","7493-0121  -  INSERT TIBIAL 1 21MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0124","SUP","Custom 27803010","","7493-0124  -  INSERT TIBIAL 1 24MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0308","SUP","Custom 27803010","","7493-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0310","SUP","Custom 27803010","","7493-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0312","SUP","Custom 27803010","","7493-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0315","SUP","Custom 27803010","","7493-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0318","SUP","Custom 27803010","","7493-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0321","SUP","Custom 27803010","","7493-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0324","SUP","Custom 27803010","","7493-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0508","SUP","Custom 27803010","","7493-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0510","SUP","Custom 27803010","","7493-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0512","SUP","Custom 27803010","","7493-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0515","SUP","Custom 27803010","","7493-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0518","SUP","Custom 27803010","","7493-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0521","SUP","Custom 27803010","","7493-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0524","SUP","Custom 27803010","","7493-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0708","SUP","Custom 27803010","","7493-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0710","SUP","Custom 27803010","","7493-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0712","SUP","Custom 27803010","","7493-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0715","SUP","Custom 27803010","","7493-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0718","SUP","Custom 27803010","","7493-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0721","SUP","Custom 27803010","","7493-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0724","SUP","Custom 27803010","","7493-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0908","SUP","Custom 27803010","","7493-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0910","SUP","Custom 27803010","","7493-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0912","SUP","Custom 27803010","","7493-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0915","SUP","Custom 27803010","","7493-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0918","SUP","Custom 27803010","","7493-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0921","SUP","Custom 27803010","","7493-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7493-0924","SUP","Custom 27803010","","7493-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING KNEE S7000","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0305","SUP","Custom 27803010","","75-1-0305  -  BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0310","SUP","Custom 27803010","","75-1-0310  -  BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0315","SUP","Custom 27803010","","75-1-0315  -  BLOCK AUGMENTATION 3 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0405","SUP","Custom 27803010","","75-1-0405  -  BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0410","SUP","Custom 27803010","","75-1-0410  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0415","SUP","Custom 27803010","","75-1-0415  -  BLOCK AUGMENTATION 4 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0505","SUP","Custom 27803010","","75-1-0505  -  BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0510","SUP","Custom 27803010","","75-1-0510  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0515","SUP","Custom 27803010","","75-1-0515  -  BLOCK AUGMENTATION 5 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0605","SUP","Custom 27803010","","75-1-0605  -  BLOCK AUGMENTATION 6 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0610","SUP","Custom 27803010","","75-1-0610  -  BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0615","SUP","Custom 27803010","","75-1-0615  -  BLOCK AUGMENTATION 6 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0705","SUP","Custom 27803010","","75-1-0705  -  BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0710","SUP","Custom 27803010","","75-1-0710  -  BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0715","SUP","Custom 27803010","","75-1-0715  -  BLOCK AUGMENTATION 7 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0905","SUP","Custom 27803010","","75-1-0905  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0910","SUP","Custom 27803010","","75-1-0910  -  BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-0915","SUP","Custom 27803010","","75-1-0915  -  BLOCK AUGMENTATION 9 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-1105","SUP","Custom 27803010","","75-1-1105  -  BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-1110","SUP","Custom 27803010","","75-1-1110  -  BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-1115","SUP","Custom 27803010","","75-1-1115  -  BLOCK AUGMENTATION 11 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-1305","SUP","Custom 27803010","","75-1-1305  -  BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-1310","SUP","Custom 27803010","","75-1-1310  -  BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-1-1315","SUP","Custom 27803010","","75-1-1315  -  BLOCK AUGMENTATION 13 15MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0305","SUP","Custom 27803010","","75-2-0305  -  BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0310","SUP","Custom 27803010","","75-2-0310  -  BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0405","SUP","Custom 27803010","","75-2-0405  -  BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0410","SUP","Custom 27803010","","75-2-0410  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0505","SUP","Custom 27803010","","75-2-0505  -  BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0510","SUP","Custom 27803010","","75-2-0510  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0605","SUP","Custom 27803010","","75-2-0605  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0610","SUP","Custom 27803010","","75-2-0610  -  BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0705","SUP","Custom 27803010","","75-2-0705  -  BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0710","SUP","Custom 27803010","","75-2-0710  -  BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0905","SUP","Custom 27803010","","75-2-0905  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-0910","SUP","Custom 27803010","","75-2-0910  -  BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-1105","SUP","Custom 27803010","","75-2-1105  -  BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-1110","SUP","Custom 27803010","","75-2-1110  -  BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-1305","SUP","Custom 27803010","","75-2-1305  -  BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-2-1310","SUP","Custom 27803010","","75-2-1310  -  BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,292.50 ","$1,696.45 ","$0.00 ","$2,292.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,292.50 ","$0.00 ","$1,146.25 ","$1,815.66 ","$1,834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0305","SUP","Custom 27803010","","75-3-0305  -  BLOCK AUGMENTATION 3 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0310","SUP","Custom 27803010","","75-3-0310  -  BLOCK AUGMENTATION 3 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0405","SUP","Custom 27203010","","75-3-0405  -  TRIAL KN 4 5MM SCRP AUG HLF BLCK TIB LT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0410","SUP","Custom 27203010","","75-3-0410  -  TRIAL KN 4 10MM SCRP AUG HLF BLCK TIB LT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0505","SUP","Custom 27803010","","75-3-0505  -  BLOCK AUGMENTATION 5 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0510","SUP","Custom 27203010","","75-3-0510  -  BLOCK AUGMENTATION 5 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0605","SUP","Custom 27803010","","75-3-0605  -  BLOCK AUGMENTATION 6 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0610","SUP","Custom 27203010","","75-3-0610  -  TRIAL KN 6 10MM SCRP AUG HLF BLCK TIB LT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0705","SUP","Custom 27803010","","75-3-0705  -  BLOCK AUGMENTATION 7 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0710","SUP","Custom 27203010","","75-3-0710  -  BLOCK AUGMENTATION 7 10MM TOT STABILIZED HALF SCORPIO KNEE","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0905","SUP","Custom 27803010","","75-3-0905  -  BLOCK AUGMENTATION 9 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-0910","SUP","Custom 27803010","","75-3-0910  -  BLOCK AUGMENTATION 9 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-1105","SUP","Custom 27803010","","75-3-1105  -  BLOCK AUGMENTATION 11 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-1110","SUP","Custom 27203010","","75-3-1110  -  BLOCK AUGMENTATION 11 HALF 10MM 1 AXIS CRUC RET POSTERIOR","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-1305","SUP","Custom 27803010","","75-3-1305  -  BLOCK AUGMENTATION 13 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-3-1310","SUP","Custom 27803010","","75-3-1310  -  BLOCK AUGMENTATION 13 HALF 10MM 1 AXIS CRUC RET POSTERIOR","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-0310","SUP","Custom 27803010","","75-4-0310  -  BLOCK AUGMENTATION 3 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-0410","SUP","Custom 27803010","","75-4-0410  -  BLOCK AUGMENTATION 4 10MM FULL SCORPIO TIBIA","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-0510","SUP","Custom 27803010","","75-4-0510  -  BLOCK AUGMENTATION 5 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-0610","SUP","Custom 27803010","","75-4-0610  -  BLOCK AUGMENTATION 6 10MM FULL SCORPIO TIBIA","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-0710","SUP","Custom 27803010","","75-4-0710  -  BLOCK AUGMENTATION 7 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-0910","SUP","Custom 27803010","","75-4-0910  -  BLOCK AUGMENTATION 9 FULL 5MM 1 AXIS CRUC RET POSTERIOR TOT","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-1110","SUP","Custom 27803010","","75-4-1110  -  BLOCK AUGMENTATION 11 10MM FULL TOT STABILIZED SCORPIO FEMUR","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-4-1310","SUP","Custom 27803010","","75-4-1310  -  BLOCK AUGMENTATION 13 10MM FULL TOT STABILIZED SCORPIO FEMUR","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-0305","SUP","Custom 27803010","","75-5-0305  -  BLOCK AUGMENTATION 5D FULL WEDGE 3MM CRUCIATE RETAIN TOT","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-0405","SUP","Custom 27803010","","75-5-0405  -  TRIAL SURG 4.5D FULL WEDGE","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-0505","SUP","Custom 27803010","","75-5-0505  -  WEDGE TIBIAL 5D FULL 5 TOT STABILIZE SCORPIO KNEE","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-0605","SUP","Custom 27203010","","75-5-0605  -  TRIAL SURG FULL WEDGE 6.5D","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-0705","SUP","Custom 27803010","","75-5-0705  -  WEDGE TIBIAL 5D FULL 7 10MM TOT STABILIZE SCORPIO KNEE","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-0905","SUP","Custom 27803010","","75-5-0905  -  BLOCK AUGMENTATION 5D FULL WEDGE 9MM CRUCIATE RETAIN TOT","BOTH IP/OP","$3,585.00 ","$2,652.90 ","$0.00 ","$3,585.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,585.00 ","$0.00 ","$1,792.50 ","$2,839.32 ","$2,868.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-1105","SUP","Custom 27803010","","75-5-1105  -  WEDGE TIB 11MM SCRP 5D KNEE TOT STAB FULL","BOTH IP/OP","$3,445.00 ","$2,549.30 ","$0.00 ","$3,445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,445.00 ","$0.00 ","$1,722.50 ","$2,728.44 ","$2,756.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75-5-1305","SUP","Custom 27803010","","75-5-1305  -  WEDGE TIB 13MM SCRP 5D KNEE TOT STAB FULL","BOTH IP/OP","$3,615.63 ","$2,675.57 ","$0.00 ","$3,615.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,615.63 ","$0.00 ","$1,807.81 ","$2,863.58 ","$2,892.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75AC50","SUP","Custom 27203010","","75AC50  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$303.88 ","$224.87 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.88 ","$0.00 ","$151.94 ","$240.67 ","$243.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75AC60","SUP","Custom 27203010","","75AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$303.88 ","$224.87 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.88 ","$0.00 ","$151.94 ","$240.67 ","$243.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA05","SUP","Custom 27203010","","75BA05  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA05L","SUP","Custom 27203010","","75BA05L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA06DL","SUP","Custom 27203010","","75BA06DL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA08DL","SUP","Custom 27203010","","75BA08DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10","SUP","Custom 27203010","","75BA10  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10D","SUP","Custom 27203010","","75BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10DC","SUP","Custom 27203010","","75BA10DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10DCL","SUP","Custom 27203010","","75BA10DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10DL","SUP","Custom 27203010","","75BA10DL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10DLF","SUP","Custom 27203010","","75BA10DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA10L","SUP","Custom 27203010","","75BA10L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA12DL","SUP","Custom 27203010","","75BA12DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15","SUP","Custom 27203010","","75BA15  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15D","SUP","Custom 27203010","","75BA15D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15DC","SUP","Custom 27203010","","75BA15DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15DCL","SUP","Custom 27203010","","75BA15DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15DL","SUP","Custom 27203010","","75BA15DL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15DLF","SUP","Custom 27203010","","75BA15DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA15L","SUP","Custom 27203010","","75BA15L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20","SUP","Custom 27203010","","75BA20  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20D","SUP","Custom 27203010","","75BA20D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20DC","SUP","Custom 27203010","","75BA20DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20DCL","SUP","Custom 27203010","","75BA20DCL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20DF","SUP","Custom 27203010","","75BA20DF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20DL","SUP","Custom 27203010","","75BA20DL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20DLF","SUP","Custom 27203010","","75BA20DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20F","SUP","Custom 27203010","","75BA20F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20L","SUP","Custom 27203010","","75BA20L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA20LF","SUP","Custom 27203010","","75BA20LF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25","SUP","Custom 27203010","","75BA25  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25D","SUP","Custom 27203010","","75BA25D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25DC","SUP","Custom 27203010","","75BA25DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25DCL","SUP","Custom 27203010","","75BA25DCL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25DL","SUP","Custom 27203010","","75BA25DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25DLF","SUP","Custom 27203010","","75BA25DLF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25F","SUP","Custom 27203010","","75BA25F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25L","SUP","Custom 27203010","","75BA25L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA25LF","SUP","Custom 27203010","","75BA25LF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30","SUP","Custom 27203010","","75BA30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30D","SUP","Custom 27203010","","75BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30DC","SUP","Custom 27203010","","75BA30DC  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30DCL","SUP","Custom 27203010","","75BA30DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30DF","SUP","Custom 27203010","","75BA30DF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30DL","SUP","Custom 27203010","","75BA30DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30DLF","SUP","Custom 27203010","","75BA30DLF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30F","SUP","Custom 27203010","","75BA30F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30L","SUP","Custom 27203010","","75BA30L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA30LF","SUP","Custom 27203010","","75BA30LF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35","SUP","Custom 27203010","","75BA35  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35D","SUP","Custom 27203010","","75BA35D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35DCL","SUP","Custom 27203010","","75BA35DCL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35DL","SUP","Custom 27203010","","75BA35DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35F","SUP","Custom 27203010","","75BA35F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35L","SUP","Custom 27203010","","75BA35L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA35LF","SUP","Custom 27203010","","75BA35LF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40","SUP","Custom 27203010","","75BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40D","SUP","Custom 27203010","","75BA40D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40DC","SUP","Custom 27203010","","75BA40DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40DF","SUP","Custom 27203010","","75BA40DF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40DL","SUP","Custom 27203010","","75BA40DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40DX","SUP","Custom 27203010","","75BA40DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40F","SUP","Custom 27203010","","75BA40F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA40L","SUP","Custom 27203010","","75BA40L  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA50","SUP","Custom 27203010","","75BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA50D","SUP","Custom 27203010","","75BA50D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA50DC","SUP","Custom 27203010","","75BA50DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA50DF","SUP","Custom 27203010","","75BA50DF  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA50DX","SUP","Custom 27203010","","75BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA50F","SUP","Custom 27203010","","75BA50F  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA60","SUP","Custom 27203010","","75BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA60D","SUP","Custom 27203010","","75BA60D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA60DC","SUP","Custom 27203010","","75BA60DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA60DX","SUP","Custom 27203010","","75BA60DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA60F","SUP","Custom 27203010","","75BA60F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA70","SUP","Custom 27203010","","75BA70  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA80","SUP","Custom 27203010","","75BA80  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$293.25 ","$217.01 ","$0.00 ","$293.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$293.25 ","$0.00 ","$146.63 ","$232.25 ","$234.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA80D","SUP","Custom 27203010","","75BA80D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$316.63 ","$234.31 ","$0.00 ","$316.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.63 ","$0.00 ","$158.31 ","$250.77 ","$253.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75BA80DC","SUP","Custom 27203010","","75BA80DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75CY65DX","SUP","Custom 27203010","","75CY65DX  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75MH22","SUP","Custom 27203010","","75MH22  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$303.88 ","$224.87 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.88 ","$0.00 ","$151.94 ","$240.67 ","$243.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75MH22D","SUP","Custom 27203010","","75MH22D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75MH30","SUP","Custom 27203010","","75MH30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$303.88 ","$224.87 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.88 ","$0.00 ","$151.94 ","$240.67 ","$243.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75MH30D","SUP","Custom 27203010","","75MH30D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"75OV40","SUP","Custom 27203010","","75OV40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$303.88 ","$224.87 ","$0.00 ","$303.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.88 ","$0.00 ","$151.94 ","$240.67 ","$243.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76-0007","SUP","HCPCS C1713","","76-0007  -  SCREW BN 2.4MM 10MM RIBFIX BLU LCK TI STRNM","BOTH IP/OP","$615.00 ","$455.10 ","$0.00 ","$615.00 ","$276.75 ","$0.00 ","$128.18 ","$0.00 ","$0.00 ","$107.68 ","$615.00 ","$0.00 ","$307.50 ","$487.08 ","$492.00 ","$0.00 ","$96.25 ","$0.00 ","$97.91 ","$0.00 "
"76-0010","SUP","HCPCS C1713","","76-0010  -  SCREW BN 2.4MM 12MM RIBFIX BLU DRL LCK STRNM SCAPULA","BOTH IP/OP","$605.00 ","$447.70 ","$0.00 ","$605.00 ","$272.25 ","$0.00 ","$126.10 ","$0.00 ","$0.00 ","$105.93 ","$605.00 ","$0.00 ","$302.50 ","$479.16 ","$484.00 ","$0.00 ","$94.68 ","$0.00 ","$96.32 ","$0.00 "
"7602-20M","SUP","HCPCS C1725","","7602-20M  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR .052IN 100CM SIZING","BOTH IP/OP","$226.28 ","$167.45 ","$0.00 ","$226.28 ","$122.87 ","$0.00 ","$47.16 ","$0.00 ","$0.00 ","$39.62 ","$226.28 ","$0.00 ","$113.14 ","$179.21 ","$181.02 ","$0.00 ","$35.41 ","$0.00 ","$36.02 ","$0.00 "
"7602-2M65","SUP","HCPCS C1725","","7602-2M65  -  CATH ANGIO .035IN PGTL CURVE 5FR .052IN 65CM 10 SDPRT 2 BAND","BOTH IP/OP","$69.13 ","$51.16 ","$0.00 ","$69.13 ","$37.53 ","$0.00 ","$14.41 ","$0.00 ","$0.00 ","$12.10 ","$69.13 ","$0.00 ","$34.56 ","$54.75 ","$55.30 ","$0.00 ","$10.82 ","$0.00 ","$11.00 ","$0.00 "
"7602-51","SUP","HCPCS C1725","","7602-51  -  CATHETER ANGIO PGTL CRV 5FR 90CM STRL PRFM 10 SH RADOPQ BRD","BOTH IP/OP","$29.65 ","$21.94 ","$0.00 ","$29.65 ","$16.10 ","$0.00 ","$6.18 ","$0.00 ","$0.00 ","$5.19 ","$29.65 ","$0.00 ","$14.83 ","$23.48 ","$23.72 ","$0.00 ","$4.64 ","$0.00 ","$4.72 ","$0.00 "
"76-2001","SUP","HCPCS C1713","","76-2001  -  SCREW BN 2.4MM 34MM X DRV","BOTH IP/OP","$1,127.50 ","$834.35 ","$0.00 ","$1,127.50 ","$507.38 ","$0.00 ","$235.00 ","$0.00 ","$0.00 ","$197.42 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$176.45 ","$0.00 ","$179.50 ","$0.00 "
"76-2408","SUP","HCPCS C1713","","76-2408  -  SCREW BN 2.4MM 8MM RIBFIX BLU SLF DRL LCK RB","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2410","SUP","HCPCS C1713","","76-2410  -  SCREW BN 2.4MM 10MM RIBFIX BLU ST LCK","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2412","SUP","HCPCS C1713","","76-2412  -  Screw S/d-lk 2.4x12mm","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2414","SUP","HCPCS C1713","","76-2414  -  SCREW BN 2.4MM 14MM RIBFIX BLU ST LCK TI THOR","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2416","SUP","HCPCS C1713","","76-2416  -  SCREW BN 2.4MM 16MM RIBFIX BLU SLF DRL LCK RB","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2601","SUP","HCPCS C1713","","76-2601  -  PLATE BN STRG NS RIBFIX BLU 8 HL TI RB","BOTH IP/OP","$2,497.50 ","$1,848.15 ","$0.00 ","$2,497.50 ","$1,123.88 ","$0.00 ","$520.54 ","$0.00 ","$0.00 ","$437.29 ","$2,497.50 ","$0.00 ","$1,248.75 ","$1,978.02 ","$1,998.00 ","$0.00 ","$390.86 ","$0.00 ","$397.60 ","$0.00 "
"76-2602","SUP","HCPCS C1713","","76-2602  -  SCREW BN PREBNT 2.4MM 14MM SLF DRL LCK TI RB","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"76-2603","SUP","HCPCS C1713","","76-2603  -  PLATE BN PREBNT NS RIBFIX BLU 16 HL TI RB","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"76-2708","SUP","HCPCS C1713","","76-2708  -  SCREW BN 2.7MM 8MM ER TI RB","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2710","SUP","HCPCS C1713","","76-2710  -  SCREW BN 2.7MM 10MM ER TI RB","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2712","SUP","HCPCS C1713","","76-2712  -  SCREW BN 2.7MM 12MM ER RB","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-2714","SUP","HCPCS C1713","","76-2714  -  SCREW BN 2.7MM 14MM ER RB","BOTH IP/OP","$367.50 ","$271.95 ","$0.00 ","$367.50 ","$165.38 ","$0.00 ","$76.60 ","$0.00 ","$0.00 ","$64.35 ","$367.50 ","$0.00 ","$183.75 ","$291.06 ","$294.00 ","$0.00 ","$57.51 ","$0.00 ","$58.51 ","$0.00 "
"76-4003L","SUP","HCPCS C1776","","76-4003L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$10,226.13 ","$7,567.34 ","$0.00 ","$10,226.13 ","$4,601.76 ","$0.00 ","$2,131.38 ","$0.00 ","$0.00 ","$1,790.51 ","$10,226.13 ","$0.00 ","$5,113.06 ","$8,099.09 ","$8,180.90 ","$0.00 ","$1,600.39 ","$0.00 ","$1,628.00 ","$0.00 "
"76-4003R","SUP","HCPCS C1776","","76-4003R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$10,226.13 ","$7,567.34 ","$0.00 ","$10,226.13 ","$4,601.76 ","$0.00 ","$2,131.38 ","$0.00 ","$0.00 ","$1,790.51 ","$10,226.13 ","$0.00 ","$5,113.06 ","$8,099.09 ","$8,180.90 ","$0.00 ","$1,600.39 ","$0.00 ","$1,628.00 ","$0.00 "
"76-4004L","SUP","HCPCS C1776","","76-4004L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$10,226.13 ","$7,567.34 ","$0.00 ","$10,226.13 ","$4,601.76 ","$0.00 ","$2,131.38 ","$0.00 ","$0.00 ","$1,790.51 ","$10,226.13 ","$0.00 ","$5,113.06 ","$8,099.09 ","$8,180.90 ","$0.00 ","$1,600.39 ","$0.00 ","$1,628.00 ","$0.00 "
"76-4004R","SUP","HCPCS C1776","","76-4004R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$10,226.13 ","$7,567.34 ","$0.00 ","$10,226.13 ","$4,601.76 ","$0.00 ","$2,131.38 ","$0.00 ","$0.00 ","$1,790.51 ","$10,226.13 ","$0.00 ","$5,113.06 ","$8,099.09 ","$8,180.90 ","$0.00 ","$1,600.39 ","$0.00 ","$1,628.00 ","$0.00 "
"76-4005L","SUP","HCPCS C1776","","76-4005L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4005R","SUP","HCPCS C1776","","76-4005R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4006L","SUP","HCPCS C1776","","76-4006L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$10,226.13 ","$7,567.34 ","$0.00 ","$10,226.13 ","$4,601.76 ","$0.00 ","$2,131.38 ","$0.00 ","$0.00 ","$1,790.51 ","$10,226.13 ","$0.00 ","$5,113.06 ","$8,099.09 ","$8,180.90 ","$0.00 ","$1,600.39 ","$0.00 ","$1,628.00 ","$0.00 "
"76-4006R","SUP","HCPCS C1776","","76-4006R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$10,226.13 ","$7,567.34 ","$0.00 ","$10,226.13 ","$4,601.76 ","$0.00 ","$2,131.38 ","$0.00 ","$0.00 ","$1,790.51 ","$10,226.13 ","$0.00 ","$5,113.06 ","$8,099.09 ","$8,180.90 ","$0.00 ","$1,600.39 ","$0.00 ","$1,628.00 ","$0.00 "
"76-4007L","SUP","HCPCS C1776","","76-4007L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4007R","SUP","HCPCS C1776","","76-4007R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4009L","SUP","HCPCS C1776","","76-4009L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4009R","SUP","HCPCS C1776","","76-4009R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4011L","SUP","HCPCS C1776","","76-4011L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4011R","SUP","HCPCS C1776","","76-4011R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$9,995.38 ","$7,396.58 ","$0.00 ","$9,995.38 ","$4,497.92 ","$0.00 ","$2,083.29 ","$0.00 ","$0.00 ","$1,750.11 ","$9,995.38 ","$0.00 ","$4,997.69 ","$7,916.34 ","$7,996.30 ","$0.00 ","$1,564.28 ","$0.00 ","$1,591.26 ","$0.00 "
"76-4013L","SUP","HCPCS C1776","","76-4013L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$8,567.00 ","$6,339.58 ","$0.00 ","$8,567.00 ","$3,855.15 ","$0.00 ","$1,785.58 ","$0.00 ","$0.00 ","$1,500.01 ","$8,567.00 ","$0.00 ","$4,283.50 ","$6,785.06 ","$6,853.60 ","$0.00 ","$1,340.74 ","$0.00 ","$1,363.87 ","$0.00 "
"76-4013R","SUP","HCPCS C1776","","76-4013R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP","BOTH IP/OP","$8,567.00 ","$6,339.58 ","$0.00 ","$8,567.00 ","$3,855.15 ","$0.00 ","$1,785.58 ","$0.00 ","$0.00 ","$1,500.01 ","$8,567.00 ","$0.00 ","$4,283.50 ","$6,785.06 ","$6,853.60 ","$0.00 ","$1,340.74 ","$0.00 ","$1,363.87 ","$0.00 "
"76-4103L","SUP","HCPCS C1776","","76-4103L  -  COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4103R","SUP","HCPCS C1776","","76-4103R  -  COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4105L","SUP","HCPCS C1776","","76-4105L  -  COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4105R","SUP","HCPCS C1776","","76-4105R  -  COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4107L","SUP","HCPCS C1776","","76-4107L  -  COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4107R","SUP","HCPCS C1776","","76-4107R  -  COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4109L","SUP","HCPCS C1776","","76-4109L  -  COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4109R","SUP","HCPCS C1776","","76-4109R  -  COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4111L","SUP","HCPCS C1776","","76-4111L  -  COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4111R","SUP","HCPCS C1776","","76-4111R  -  COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4113L","SUP","HCPCS C1776","","76-4113L  -  COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"76-4113R","SUP","HCPCS C1776","","76-4113R  -  COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION","BOTH IP/OP","$12,130.00 ","$8,976.20 ","$0.00 ","$12,130.00 ","$5,458.50 ","$0.00 ","$2,528.20 ","$0.00 ","$0.00 ","$2,123.87 ","$12,130.00 ","$0.00 ","$6,065.00 ","$9,606.96 ","$9,704.00 ","$0.00 ","$1,898.35 ","$0.00 ","$1,931.10 ","$0.00 "
"7650-2038A","SUP","Custom 27203010","","7650-2038A  -  PIN FIX FLUTE SQUARE 1/8IN 3.5IN STAINLESS STEEL KNEE","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76791-MX","SUP","HCPCS C1725","","THERMOMETER SYSTEM DIAG INTEGRATED 767","BOTH IP/OP","$2,070.45 ","$1,532.13 ","$0.00 ","$2,070.45 ","$1,124.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.52 ","$2,070.45 ","$0.00 ","$1,035.23 ","$1,639.80 ","$1,656.36 ","$0.00 ","$324.03 ","$0.00 ","$329.62 ","$0.00 "
"7679922P","SUP","Custom 27203010","","7679922P  -  REAMER SRG 3.15MM STRL PCM MRC SPNE","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7679925P","SUP","Custom 27203010","","7679925P  -  REAMER SRG 3.5MM STRL PCM ANS SPNE","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7679926P","SUP","Custom 27203010","","7679926P  -  REAMER SRG 3.5MM STRL PCM MRL SPNE","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7679927P","SUP","Custom 27203010","","7679927P  -  REAMER SRG 3.5MM STRL PCM HXL SPNE","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7679930P","SUP","Custom 27203010","","7679930P  -  REAMER SRG 3.5MM STRL PCM JC SPNE","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7679934P","SUP","Custom 27203010","","7679934P  -  REAMER SRG 3.5MM STRL PCM TSPE SPNE","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"768G","SUP","Custom 27203010","","768G  -  SUTURE NONABSORBABLE 7-0 G-6 18IN 2 ARM BRAID NEEDLE","BOTH IP/OP","$32.63 ","$24.15 ","$0.00 ","$33.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.12 ","$0.00 ","$16.56 ","$26.23 ","$26.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"76-9102","SUP","HCPCS C1713","","76-9102  -  SCREW BN 2.7MM 8MM ER LCK RB","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$83.25 ","$0.00 ","$38.56 ","$0.00 ","$0.00 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$28.95 ","$0.00 ","$29.45 ","$0.00 "
"76-9103","SUP","HCPCS C1713","","76-9103  -  PLATE BN 16 HL TMPLT RB","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$83.25 ","$0.00 ","$38.56 ","$0.00 ","$0.00 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$28.95 ","$0.00 ","$29.45 ","$0.00 "
"76-9104","SUP","HCPCS C1713","","76-9104  -  TEMPLATE SZ 16 HL PLT","BOTH IP/OP","$185.00 ","$136.90 ","$0.00 ","$185.00 ","$83.25 ","$0.00 ","$38.56 ","$0.00 ","$0.00 ","$32.39 ","$185.00 ","$0.00 ","$92.50 ","$146.52 ","$148.00 ","$0.00 ","$28.95 ","$0.00 ","$29.45 ","$0.00 "
"769G","SUP","Custom 27203010","","769G  -  SUTURE NABSB 6-0 G-6 18IN BLK PRMHND MICROPOINT 2 ARM BRD","BOTH IP/OP","$32.39 ","$23.97 ","$0.00 ","$32.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.87 ","$0.00 ","$16.44 ","$26.03 ","$26.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77-1003","SUP","HCPCS C1776","","77-1003  -  CMPNT TIBTRY 3MM KNEE LP SCRP","BOTH IP/OP","$2,308.00 ","$1,707.92 ","$0.00 ","$2,308.00 ","$1,038.60 ","$0.00 ","$481.04 ","$0.00 ","$0.00 ","$404.11 ","$2,308.00 ","$0.00 ","$1,154.00 ","$1,827.94 ","$1,846.40 ","$0.00 ","$361.20 ","$0.00 ","$367.43 ","$0.00 "
"77-1004","SUP","HCPCS C1776","","77-1004  -  CMPNT TIBTRY 4MM KNEE LP SCRP","BOTH IP/OP","$2,308.00 ","$1,707.92 ","$0.00 ","$2,308.00 ","$1,038.60 ","$0.00 ","$481.04 ","$0.00 ","$0.00 ","$404.11 ","$2,308.00 ","$0.00 ","$1,154.00 ","$1,827.94 ","$1,846.40 ","$0.00 ","$361.20 ","$0.00 ","$367.43 ","$0.00 "
"77-1006","SUP","HCPCS C1776","","77-1006  -  CMPNT TIBTRY 6MM KNEE LP SCRP","BOTH IP/OP","$2,308.00 ","$1,707.92 ","$0.00 ","$2,308.00 ","$1,038.60 ","$0.00 ","$481.04 ","$0.00 ","$0.00 ","$404.11 ","$2,308.00 ","$0.00 ","$1,154.00 ","$1,827.94 ","$1,846.40 ","$0.00 ","$361.20 ","$0.00 ","$367.43 ","$0.00 "
"77-1007","SUP","HCPCS C1776","","77-1007  -  CMPNT TIBTRY 7MM KNEE LP SCRP","BOTH IP/OP","$2,308.00 ","$1,707.92 ","$0.00 ","$2,308.00 ","$1,038.60 ","$0.00 ","$481.04 ","$0.00 ","$0.00 ","$404.11 ","$2,308.00 ","$0.00 ","$1,154.00 ","$1,827.94 ","$1,846.40 ","$0.00 ","$361.20 ","$0.00 ","$367.43 ","$0.00 "
"77-1009","SUP","HCPCS C1776","","77-1009  -  CMPNT TIB 9MM SCRP KNEE LP","BOTH IP/OP","$2,308.00 ","$1,707.92 ","$0.00 ","$2,308.00 ","$1,038.60 ","$0.00 ","$481.04 ","$0.00 ","$0.00 ","$404.11 ","$2,308.00 ","$0.00 ","$1,154.00 ","$1,827.94 ","$1,846.40 ","$0.00 ","$361.20 ","$0.00 ","$367.43 ","$0.00 "
"7717G","SUP","Custom 27203010","","7717G  -  SUTURE NONABSORBABLE 9-0 TG140-8 12IN 2 ARM MONOFILAMENT","BOTH IP/OP","$33.76 ","$24.98 ","$0.00 ","$34.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.27 ","$0.00 ","$17.14 ","$27.14 ","$27.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7731G","SUP","Custom 27203010","","7731G  -  SUTURE NABSB 5-0 S-24 18IN BLK ETH SBLC 2 ARM MFL","BOTH IP/OP","$33.98 ","$25.15 ","$0.00 ","$34.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.49 ","$0.00 ","$17.24 ","$27.32 ","$27.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"77-4003","SUP","HCPCS C1776","","77-4003  -  TRAY TIBIAL 3 40/61MM 35MM 1 AXIS TOT STABILIZE STEM END CAP","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4004","SUP","HCPCS C1776","","77-4004  -  TRAY TIBIAL 4 TOT STABILIZE MODULAR SCORPIO KNEE","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4005","SUP","HCPCS C1776","","77-4005  -  TRAY TIBIAL 5 44/66MM 35MM 1 AXIS TOT STABILIZE STEM END CAP","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4006","SUP","HCPCS C1776","","77-4006  -  TRAY TIBIAL 6 TOT STABILIZE MODULAR SCORPIO KNEE","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4007","SUP","HCPCS C1776","","77-4007  -  TRAY TIBIAL 7 47/71MM 37MM 1 AXIS TOT STABILIZE STEM END CAP","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4009","SUP","HCPCS C1776","","77-4009  -  TRAY TIBIAL 9 51/77MM 37MM 1 AXIS TOT STABILIZE STEM END CAP","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4011","SUP","HCPCS C1776","","77-4011  -  TRAY TIBIAL 11 54/82MM 43MM 1 AXIS TOT STABILIZE STEM END","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"77-4013","SUP","HCPCS C1776","","77-4013  -  TRAY TIBIAL 13 58/88MM 43MM 1 AXIS TOT STABILIZE STEM END","BOTH IP/OP","$5,837.50 ","$4,319.75 ","$0.00 ","$5,837.50 ","$2,626.88 ","$0.00 ","$1,216.68 ","$0.00 ","$0.00 ","$1,022.10 ","$5,837.50 ","$0.00 ","$2,918.75 ","$4,623.30 ","$4,670.00 ","$0.00 ","$913.57 ","$0.00 ","$929.33 ","$0.00 "
"7751710EP","SUP","HCPCS C1713","","7751710EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751712EP","SUP","HCPCS C1713","","7751712EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751714EP","SUP","HCPCS C1713","","7751714EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751716EP","SUP","HCPCS C1713","","7751716EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751718EP","SUP","HCPCS C1713","","7751718EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751720EP","SUP","HCPCS C1713","","7751720EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751722EP","SUP","HCPCS C1713","","7751722EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751724EP","SUP","HCPCS C1713","","7751724EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751724PT","SUP","HCPCS C1713","","7751724PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751726PT","SUP","HCPCS C1713","","7751726PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751728PT","SUP","HCPCS C1713","","7751728PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751730PT","SUP","HCPCS C1713","","7751730PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751732PT","SUP","HCPCS C1713","","7751732PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751734PT","SUP","HCPCS C1713","","7751734PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751810EP","SUP","HCPCS C1713","","7751810EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751812EP","SUP","HCPCS C1713","","7751812EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751814EP","SUP","HCPCS C1713","","7751814EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751816EP","SUP","HCPCS C1713","","7751816EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751818EP","SUP","HCPCS C1713","","7751818EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751820EP","SUP","HCPCS C1713","","7751820EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751822EP","SUP","HCPCS C1713","","7751822EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751824EP","SUP","HCPCS C1713","","7751824EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751824PT","SUP","HCPCS C1713","","7751824PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751826EP","SUP","HCPCS C1713","","7751826EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751826PT","SUP","HCPCS C1713","","7751826PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751828EP","SUP","HCPCS C1713","","7751828EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751828PT","SUP","HCPCS C1713","","7751828PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751830EP","SUP","HCPCS C1713","","7751830EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751830PT","SUP","HCPCS C1713","","7751830PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751832EP","SUP","HCPCS C1713","","7751832EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751832PT","SUP","HCPCS C1713","","7751832PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751834EP","SUP","HCPCS C1713","","7751834EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751834PT","SUP","HCPCS C1713","","7751834PT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751924EP","SUP","HCPCS C1713","","7751924EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751926EP","SUP","HCPCS C1713","","7751926EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751928EP","SUP","HCPCS C1713","","7751928EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751930EP","SUP","HCPCS C1713","","7751930EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751932EP","SUP","HCPCS C1713","","7751932EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"7751934EP","SUP","HCPCS C1713","","7751934EP  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$983.68 ","$727.92 ","$0.00 ","$983.68 ","$442.65 ","$0.00 ","$205.02 ","$0.00 ","$0.00 ","$172.23 ","$983.68 ","$0.00 ","$491.84 ","$779.07 ","$786.94 ","$0.00 ","$153.95 ","$0.00 ","$156.60 ","$0.00 "
"77525P","SUP","HCPCS C1713","","77525P  -  SCREW BN 7.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77525S","SUP","HCPCS C1713","","77525S  -  SCREW BN STD 7.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77530P","SUP","HCPCS C1713","","77530P  -  SCREW BN 7.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77530S","SUP","HCPCS C1713","","77530S  -  SCREW BN STD 7.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77535P","SUP","HCPCS C1713","","77535P  -  SCREW BN 7.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77535S","SUP","HCPCS C1713","","77535S  -  SCREW BN STD 7.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77540P","SUP","HCPCS C1713","","77540P  -  SCREW BN 7.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77540S","SUP","HCPCS C1713","","77540S  -  SCREW BN STD 7.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77545P","SUP","HCPCS C1713","","77545P  -  SCREW BN 7.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77545S","SUP","HCPCS C1713","","77545S  -  SCREW BN STD 7.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77550P","SUP","HCPCS C1713","","77550P  -  SCREW BN 7.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77550S","SUP","HCPCS C1713","","77550S  -  SCREW BN STD 7.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77555P","SUP","HCPCS C1713","","77555P  -  SCREW BN 7.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77555S","SUP","HCPCS C1713","","77555S  -  SCREW BN STD 7.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"7756073L","SUP","HCPCS C1713","","7756073L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7756073R","SUP","HCPCS C1713","","7756073R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7756074L","SUP","HCPCS C1713","","7756074L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"7756074R","SUP","HCPCS C1713","","7756074R  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"77560P","SUP","HCPCS C1713","","77560P  -  SCREW BN 7.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77560S","SUP","HCPCS C1713","","77560S  -  SCREW BN STD 7.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77565P","SUP","HCPCS C1713","","77565P  -  SCREW BN 7.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$1,621.98 ","$1,200.27 ","$0.00 ","$1,621.98 ","$729.89 ","$0.00 ","$338.06 ","$0.00 ","$0.00 ","$283.99 ","$1,621.98 ","$0.00 ","$810.99 ","$1,284.61 ","$1,297.58 ","$0.00 ","$253.84 ","$0.00 ","$258.22 ","$0.00 "
"77565S","SUP","HCPCS C1713","","77565S  -  SCREW BN STD 7.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,233.33 ","$912.66 ","$0.00 ","$1,233.33 ","$555.00 ","$0.00 ","$257.06 ","$0.00 ","$0.00 ","$215.95 ","$1,233.33 ","$0.00 ","$616.66 ","$976.80 ","$986.66 ","$0.00 ","$193.02 ","$0.00 ","$196.35 ","$0.00 "
"77570P","SUP","HCPCS C1713","","77570P  -  SCREW BN 7.75MM 70MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77580P","SUP","HCPCS C1713","","77580P  -  SCREW BN 7.75MM 80MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"77590P","SUP","HCPCS C1713","","77590P  -  SCREW BN 7.75MM 90MM SPRL R90D MULTIANGLE TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"778-014-00","SUP","HCPCS C1887","","CATHETER GUID JL4ST CURVE 7FR .078IN 100CM PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"778-081-00","SUP","HCPCS C1887","","CATHETER GUID JR3.5 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"778-181-00","SUP","HCPCS C1887","","CATHETER GUID LCB CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE","BOTH IP/OP","$139.93 ","$103.55 ","$0.00 ","$139.93 ","$75.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.50 ","$139.93 ","$0.00 ","$69.96 ","$110.82 ","$111.94 ","$0.00 ","$21.90 ","$0.00 ","$22.28 ","$0.00 "
"78-10030","SUP","HCPCS C1713","","78-10030  -  IMPLANT CRNL LG KT CSTM","BOTH IP/OP","$30,104.35 ","$22,277.22 ","$0.00 ","$43,877.50 ","$19,744.88 ","$0.00 ","$6,274.50 ","$0.00 ","$0.00 ","$7,682.60 ","$43,877.50 ","$0.00 ","$21,938.75 ","$34,750.98 ","$35,102.00 ","$0.00 ","$6,866.83 ","$0.00 ","$6,985.30 ","$0.00 "
"7850-1-000","SUP","HCPCS C1776","","7850-1-000  -  STEM FEM HIPSTAR 135D 0 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-1-001","SUP","HCPCS C1776","","7850-1-001  -  STEM FEM HIPSTAR 135D 1 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-1-002","SUP","HCPCS C1776","","7850-1-002  -  STEM FEM HIPSTAR 135D 2 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-003","SUP","HCPCS C1776","","7850-1-003  -  STEM FEM HIPSTAR TMZF 135D 3 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-004","SUP","HCPCS C1776","","7850-1-004  -  STEM FEM HIPSTAR HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-005","SUP","HCPCS C1776","","7850-1-005  -  STEM FEM HIPSTAR TMZF 135D 5 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-006","SUP","HCPCS C1776","","7850-1-006  -  STEM FEM HIPSTAR 135D 6 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-007","SUP","HCPCS C1776","","7850-1-007  -  STEM FEM HIPSTAR 135D 7 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-008","SUP","HCPCS C1776","","7850-1-008  -  STEM FEM HIPSTAR 135D 8 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-009","SUP","HCPCS C1776","","7850-1-009  -  STEM FEM HIPSTAR 135D 9 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-010","SUP","HCPCS C1776","","7850-1-010  -  STEM FEM HIPSTAR 135D 10 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-1-011","SUP","HCPCS C1776","","7850-1-011  -  STEM FEM HIPSTAR 135D 11 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-1-012","SUP","HCPCS C1776","","7850-1-012  -  STEM FEM HIPSTAR 135D 12 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-5-000","SUP","HCPCS C1776","","7850-5-000  -  STEM FEM HIPSTAR 127D 0 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-5-001","SUP","HCPCS C1776","","7850-5-001  -  STEM FEM HIPSTAR 127D 1 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-5-002","SUP","HCPCS C1776","","7850-5-002  -  STEM FEM HIPSTAR 127D 2 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-003","SUP","HCPCS C1776","","7850-5-003  -  STEM FEM HIPSTAR 127D 3 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-004","SUP","HCPCS C1776","","7850-5-004  -  STEM FEM HIPSTAR 127D 4 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-005","SUP","HCPCS C1776","","7850-5-005  -  STEM FEM HIPSTAR 127D 5 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-006","SUP","HCPCS C1776","","7850-5-006  -  STEM FEM HIPSTAR 127D 6 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-007","SUP","HCPCS C1776","","7850-5-007  -  STEM FEM HIPSTAR 127D 7 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-008","SUP","HCPCS C1776","","7850-5-008  -  STEM FEM HIPSTAR 127D 8 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-009","SUP","HCPCS C1776","","7850-5-009  -  STEM FEM HIPSTAR 127D 9 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-010","SUP","HCPCS C1776","","7850-5-010  -  STEM FEM HIPSTAR 127D 10 HIP","BOTH IP/OP","$6,328.00 ","$4,682.72 ","$0.00 ","$6,328.00 ","$2,847.60 ","$0.00 ","$1,318.91 ","$0.00 ","$0.00 ","$1,107.98 ","$6,328.00 ","$0.00 ","$3,164.00 ","$5,011.78 ","$5,062.40 ","$0.00 ","$990.33 ","$0.00 ","$1,007.42 ","$0.00 "
"7850-5-011","SUP","HCPCS C1776","","7850-5-011  -  STEM FEM HIPSTAR 127D 11 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7850-5-012","SUP","HCPCS C1776","","7850-5-012  -  STEM FEM HIPSTAR 127D 12 HIP","BOTH IP/OP","$6,665.00 ","$4,932.10 ","$0.00 ","$6,665.00 ","$2,999.25 ","$0.00 ","$1,389.15 ","$0.00 ","$0.00 ","$1,166.99 ","$6,665.00 ","$0.00 ","$3,332.50 ","$5,278.68 ","$5,332.00 ","$0.00 ","$1,043.07 ","$0.00 ","$1,061.07 ","$0.00 "
"7925011S","SUP","HCPCS C1713","","7925011S  -  CABLE SPINAL 2 LOOP 2 CRIMP TITANIUM STERILE","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$0.00 ","$2,325.00 ","$1,046.25 ","$0.00 ","$484.59 ","$0.00 ","$0.00 ","$407.09 ","$2,325.00 ","$0.00 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$0.00 ","$363.86 ","$0.00 ","$370.14 ","$0.00 "
"79-43903","SUP","HCPCS C1713","","79-43903  -  CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE","BOTH IP/OP","$2,314.78 ","$1,712.94 ","$0.00 ","$3,357.50 ","$1,510.88 ","$0.00 ","$482.46 ","$0.00 ","$0.00 ","$587.87 ","$3,357.50 ","$0.00 ","$1,678.75 ","$2,659.14 ","$2,686.00 ","$0.00 ","$525.45 ","$0.00 ","$534.51 ","$0.00 "
"79-43905","SUP","HCPCS C1713","","79-43905  -  CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE","BOTH IP/OP","$3,817.23 ","$2,824.75 ","$0.00 ","$3,817.23 ","$1,717.75 ","$0.00 ","$795.61 ","$0.00 ","$0.00 ","$668.37 ","$3,817.23 ","$0.00 ","$1,908.62 ","$3,023.25 ","$3,053.79 ","$0.00 ","$597.40 ","$0.00 ","$607.70 ","$0.00 "
"79-43910","SUP","HCPCS C1713","","79-43910  -  CEMENT BN 10CC STRL LF HYDROSET INJ OSTCNDC CA PHOS VOID FIL","BOTH IP/OP","$7,335.12 ","$5,427.99 ","$0.00 ","$7,335.12 ","$3,300.80 ","$0.00 ","$1,528.82 ","$0.00 ","$0.00 ","$1,284.32 ","$7,335.12 ","$0.00 ","$3,667.56 ","$5,809.42 ","$5,868.10 ","$0.00 ","$1,147.95 ","$0.00 ","$1,167.75 ","$0.00 "
"79-43915","SUP","HCPCS C1713","","79-43915  -  CEMENT BONE INJECTABLE OSTEOCONDUCTIVE HYDROSET CALCIUM","BOTH IP/OP","$10,553.66 ","$7,809.71 ","$0.00 ","$10,553.66 ","$4,749.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,847.86 ","$10,553.66 ","$0.00 ","$5,276.83 ","$8,358.50 ","$8,442.93 ","$0.00 ","$1,651.65 ","$0.00 ","$1,680.14 ","$0.00 "
"79-45903","SUP","HCPCS C1713","","79-45903  -  DIRECT INJECT 3CC","BOTH IP/OP","$3,840.00 ","$2,841.60 ","$0.00 ","$3,840.00 ","$1,728.00 ","$0.00 ","$800.35 ","$0.00 ","$0.00 ","$672.35 ","$3,840.00 ","$0.00 ","$1,920.00 ","$3,041.28 ","$3,072.00 ","$0.00 ","$600.96 ","$0.00 ","$611.33 ","$0.00 "
"79-45905","SUP","HCPCS C1713","","79-45905  -  DIRECT INJECT 5CC","BOTH IP/OP","$6,010.00 ","$4,447.40 ","$0.00 ","$6,010.00 ","$2,704.50 ","$0.00 ","$1,252.63 ","$0.00 ","$0.00 ","$1,052.30 ","$6,010.00 ","$0.00 ","$3,005.00 ","$4,759.92 ","$4,808.00 ","$0.00 ","$940.57 ","$0.00 ","$956.79 ","$0.00 "
"79-45910","SUP","HCPCS C1713","","79-45910  -  DIRECT INJECT 10CC","BOTH IP/OP","$9,277.75 ","$6,865.54 ","$0.00 ","$11,437.50 ","$5,146.88 ","$0.00 ","$1,933.72 ","$0.00 ","$0.00 ","$2,002.61 ","$11,437.50 ","$0.00 ","$5,718.75 ","$9,058.50 ","$9,150.00 ","$0.00 ","$1,789.97 ","$0.00 ","$1,820.85 ","$0.00 "
"794G","SUP","Custom 27203010","","794G  -  SUTURE ABSORBABLE 6-0 G-6 18IN 2 ARM MONOFILAMENT CHROMIC","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$44.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.15 ","$0.00 ","$22.08 ","$34.97 ","$35.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-80017","SUP","Custom 27203010","","SPLINT ORTH LG 16IN KNEE SUP","BOTH IP/OP","$31.53 ","$23.33 ","$0.00 ","$31.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.53 ","$0.00 ","$15.76 ","$24.97 ","$25.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-83203","SUP","HCPCS L0172","","79-83203  -  COLLAR CERV SMALL 10-20IN 2IN CHIN REST COMFORT PAD","BOTH IP/OP","$86.65 ","$64.12 ","$0.00 ","$112.86 ","$45.85 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$17.84 ","$101.88 ","$0.00 ","$50.94 ","$80.69 ","$81.50 ","$61.13 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"79-83205","SUP","HCPCS L0172","","79-83205  -  COLLAR CERV MEDIUM 10-20IN 2.5IN CHIN REST PAD TRACHEAL OPEN","BOTH IP/OP","$101.88 ","$75.39 ","$0.00 ","$112.86 ","$45.85 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$17.84 ","$101.88 ","$0.00 ","$50.94 ","$80.69 ","$81.50 ","$61.13 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"79-83207","SUP","HCPCS L0172","","79-83207  -  COLLAR CERV LARGE 10-20IN 3IN CHIN REST PAD TRACHEAL OPEN","BOTH IP/OP","$101.88 ","$75.39 ","$0.00 ","$112.86 ","$45.85 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$17.84 ","$101.88 ","$0.00 ","$50.94 ","$80.69 ","$81.50 ","$61.13 ","$107.46 ","$0.00 ","$109.67 ","$0.00 "
"79-83208","SUP","Custom 27203010","","COLLAR CERV ADLT STOUT 14-24INX1.75IN MI J CHIN REST TRCH","BOTH IP/OP","$108.68 ","$80.42 ","$0.00 ","$108.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.68 ","$0.00 ","$54.34 ","$86.07 ","$86.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-94000","SUP","Custom 27203010","","BRACE ORTH SM UNV PS FOAM KNEERANGER","BOTH IP/OP","$139.65 ","$103.34 ","$0.00 ","$139.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.65 ","$0.00 ","$69.83 ","$110.60 ","$111.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-94001","SUP","Custom 27203010","","BRACE ORTH LG UNV PS FOAM KNEERANGER","BOTH IP/OP","$139.65 ","$103.34 ","$0.00 ","$139.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.65 ","$0.00 ","$69.83 ","$110.60 ","$111.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-95413","SUP","Custom 27203010","","BRACE WLK SM AIR RCKR SOLE MAXTRAX BLK STD HT","BOTH IP/OP","$93.15 ","$68.93 ","$0.00 ","$93.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.15 ","$0.00 ","$46.58 ","$73.77 ","$74.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-96018","SUP","Custom 27203010","","IMMOBILIZER ORTH UNV 18IN 36IN KNEE BSC ELAST ML STAY CNTCT","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-97957","SUP","Custom 27203010","","BRACE HUMERAL FX LARGE","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"79-98600","SUP","Custom 27203010","","CORD TRC 100YD SPL NYL","BOTH IP/OP","$53.43 ","$39.54 ","$0.00 ","$53.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.43 ","$0.00 ","$26.71 ","$42.32 ","$42.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7AC60-MN","SUP","Custom 27203010","","7AC60-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA05","SUP","Custom 27203010","","7BA05  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA05L-MN","SUP","Custom 27203010","","7BA05L-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA05-MN","SUP","Custom 27203010","","7BA05-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA06DL-MN","SUP","Custom 27203010","","7BA06DL-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA06D-MN","SUP","Custom 27203010","","7BA06D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA10","SUP","Custom 27203010","","7BA10  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA10C-MN","SUP","Custom 27203010","","7BA10C-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA10D","SUP","Custom 27203010","","7BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA10-MN","SUP","Custom 27203010","","7BA10-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA15","SUP","Custom 27203010","","7BA15  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA15D","SUP","Custom 27203010","","7BA15D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA15DL-MN","SUP","Custom 27203010","","7BA15DL-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA15D-MN","SUP","Custom 27203010","","7BA15D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA15-MN","SUP","Custom 27203010","","7BA15-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA20","SUP","Custom 27203010","","7BA20  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA20C-MN","SUP","Custom 27203010","","7BA20C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA20D","SUP","Custom 27203010","","7BA20D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA20DC-MN","SUP","Custom 27203010","","7BA20DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA20DL-MN","SUP","Custom 27203010","","7BA20DL-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA20-MN","SUP","Custom 27203010","","7BA20-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA25","SUP","Custom 27203010","","7BA25  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA25D","SUP","Custom 27203010","","7BA25D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA25D-MN","SUP","Custom 27203010","","7BA25D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA25-MN","SUP","Custom 27203010","","7BA25-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30","SUP","Custom 27203010","","7BA30  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$299.63 ","$221.73 ","$0.00 ","$299.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.63 ","$0.00 ","$149.81 ","$237.31 ","$239.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30C-MN","SUP","Custom 27203010","","7BA30C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30D","SUP","Custom 27203010","","7BA30D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30DC-MN","SUP","Custom 27203010","","7BA30DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30DL-MN","SUP","Custom 27203010","","7BA30DL-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30L-MN","SUP","Custom 27203010","","7BA30L-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA30-MN","SUP","Custom 27203010","","7BA30-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA40C-MN","SUP","Custom 27203010","","7BA40C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA40D","SUP","Custom 27203010","","7BA40D  -  TOOL DISSECTING BALL 4MM 7CM DIAMOND MIDAS REX LEGEND","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA40DC-MN","SUP","Custom 27203010","","7BA40DC-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA40F-MN","SUP","Custom 27203010","","7BA40F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA40-MN","SUP","Custom 27203010","","7BA40-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA50C-MN","SUP","Custom 27203010","","7BA50C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA50DC-MN","SUP","Custom 27203010","","7BA50DC-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA50F-MN","SUP","Custom 27203010","","7BA50F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA50-MN","SUP","Custom 27203010","","7BA50-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA60C-MN","SUP","Custom 27203010","","7BA60C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA60D","SUP","Custom 27203010","","7BA60D  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA60DC-MN","SUP","Custom 27203010","","7BA60DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$325.13 ","$240.60 ","$0.00 ","$325.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.13 ","$0.00 ","$162.56 ","$257.50 ","$260.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA60D-MN","SUP","Custom 27203010","","7BA60D-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA60F-MN","SUP","Custom 27203010","","7BA60F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA60-MN","SUP","Custom 27203010","","7BA60-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA70C-MN","SUP","Custom 27203010","","7BA70C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA70D-MN","SUP","Custom 27203010","","7BA70D-MN  -  TOOL DISS MIDAS REX LEGEND MEDNEXT BALL L7 CM OD7 MM STERILE","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA70-MN","SUP","Custom 27203010","","7BA70-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$299.63 ","$221.73 ","$0.00 ","$299.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.63 ","$0.00 ","$149.81 ","$237.31 ","$239.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA80C-MN","SUP","Custom 27203010","","7BA80C-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$306.00 ","$226.44 ","$0.00 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.00 ","$0.00 ","$153.00 ","$242.35 ","$244.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA80D-MN","SUP","Custom 27203010","","7BA80D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7BA80-MN","SUP","Custom 27203010","","7BA80-MN  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$297.50 ","$220.15 ","$0.00 ","$297.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$297.50 ","$0.00 ","$148.75 ","$235.62 ","$238.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"7SCT","SUP","Custom 27203010","","7SCT  -  TUBE TRACHEOSTOMY 9.6MM 7MM 80MM 1 CANNU CUFF LOW PRESSURE","BOTH IP/OP","$71.38 ","$52.82 ","$0.00 ","$72.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.45 ","$0.00 ","$36.22 ","$57.38 ","$57.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"800.604.02S","SUP","HCPCS C1713","","800.604.02S  -  SCREW BONE 4MM 1.5MM CORT CRNMXF RESORB STRL","BOTH IP/OP","$373.50 ","$276.39 ","$0.00 ","$373.50 ","$168.08 ","$0.00 ","$77.85 ","$0.00 ","$0.00 ","$65.40 ","$373.50 ","$0.00 ","$186.75 ","$295.81 ","$298.80 ","$0.00 ","$58.45 ","$0.00 ","$59.46 ","$0.00 "
"80-0055","SUP","Custom 27203010","","80-0055  -  DRILL SURG CANN","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0056","SUP","Custom 27203010","","80-0056  -  BIT DRL 5.5MM ACTRK2","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0100","SUP","Custom 27203010","","80-0100  -  DRILL SRG MIC LNG ACTRK2","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"800-1003A","SUP","Custom 27203010","","800-1003A  -  KIT CNTRF 30ML GPS III 1 PLTL CONC DISP","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8001021-3","SUP","HCPCS C1781","","8001021-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,962.25 ","$2,192.07 ","$0.00 ","$2,962.25 ","$1,333.01 ","$0.00 ","$617.41 ","$0.00 ","$0.00 ","$518.67 ","$2,962.25 ","$0.00 ","$1,481.13 ","$2,346.10 ","$2,369.80 ","$0.00 ","$463.59 ","$0.00 ","$471.59 ","$0.00 "
"8001021-6","SUP","HCPCS C1781","","8001021-6  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,962.25 ","$2,192.07 ","$0.00 ","$2,962.25 ","$1,333.01 ","$0.00 ","$617.41 ","$0.00 ","$0.00 ","$518.67 ","$2,962.25 ","$0.00 ","$1,481.13 ","$2,346.10 ","$2,369.80 ","$0.00 ","$463.59 ","$0.00 ","$471.59 ","$0.00 "
"80-0148","SUP","HCPCS C1713","","80-0148  -  SCREW BN 3MM 2 TRK TAP DRL CLVCL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$192.38 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$74.85 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$66.90 ","$0.00 ","$68.06 ","$0.00 "
"80-0149","SUP","Custom 27203010","","80-0149  -  SCREW BN 3.8MM 2 TRK TAP DRL CLVCL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0150","SUP","HCPCS C1769","","80-0150  -  GUIDE STD T ACLC SURG LEFT DORSAL","BOTH IP/OP","$2,960.00 ","$2,190.40 ","$0.00 ","$2,960.00 ","$1,607.28 ","$0.00 ","$616.94 ","$0.00 ","$0.00 ","$518.27 ","$2,960.00 ","$0.00 ","$1,480.00 ","$2,344.32 ","$2,368.00 ","$0.00 ","$463.24 ","$0.00 ","$471.23 ","$0.00 "
"8001511-3","SUP","HCPCS C1781","","8001511-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,188.75 ","$1,619.68 ","$0.00 ","$2,188.75 ","$984.94 ","$0.00 ","$456.19 ","$0.00 ","$0.00 ","$383.23 ","$2,188.75 ","$0.00 ","$1,094.38 ","$1,733.49 ","$1,751.00 ","$0.00 ","$342.54 ","$0.00 ","$348.45 ","$0.00 "
"8001511-6","SUP","HCPCS C1781","","8001511-6  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,188.75 ","$1,619.68 ","$0.00 ","$2,188.75 ","$984.94 ","$0.00 ","$456.19 ","$0.00 ","$0.00 ","$383.23 ","$2,188.75 ","$0.00 ","$1,094.38 ","$1,733.49 ","$1,751.00 ","$0.00 ","$342.54 ","$0.00 ","$348.45 ","$0.00 "
"8001521-3","SUP","HCPCS C1781","","8001521-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,768.88 ","$2,048.97 ","$0.00 ","$2,768.88 ","$1,245.99 ","$0.00 ","$577.10 ","$0.00 ","$0.00 ","$484.81 ","$2,768.88 ","$0.00 ","$1,384.44 ","$2,192.95 ","$2,215.10 ","$0.00 ","$433.33 ","$0.00 ","$440.80 ","$0.00 "
"8001521-6","SUP","HCPCS C1781","","8001521-6  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,881.50 ","$2,132.31 ","$0.00 ","$2,881.50 ","$1,296.68 ","$0.00 ","$600.58 ","$0.00 ","$0.00 ","$504.53 ","$2,881.50 ","$0.00 ","$1,440.75 ","$2,282.15 ","$2,305.20 ","$0.00 ","$450.95 ","$0.00 ","$458.73 ","$0.00 "
"8001523-6","SUP","HCPCS C1781","","8001523-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,881.50 ","$2,132.31 ","$0.00 ","$2,881.50 ","$1,296.68 ","$0.00 ","$600.58 ","$0.00 ","$0.00 ","$504.53 ","$2,881.50 ","$0.00 ","$1,440.75 ","$2,282.15 ","$2,305.20 ","$0.00 ","$450.95 ","$0.00 ","$458.73 ","$0.00 "
"8001531-6","SUP","HCPCS C1781","","8001531-6  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,740.88 ","$3,508.25 ","$0.00 ","$4,740.88 ","$2,133.39 ","$0.00 ","$988.12 ","$0.00 ","$0.00 ","$830.09 ","$4,740.88 ","$0.00 ","$2,370.44 ","$3,754.78 ","$3,792.70 ","$0.00 ","$741.95 ","$0.00 ","$754.75 ","$0.00 "
"8001533-6","SUP","HCPCS C1781","","8001533-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,836.50 ","$3,579.01 ","$0.00 ","$4,836.50 ","$2,176.43 ","$0.00 ","$1,008.05 ","$0.00 ","$0.00 ","$846.83 ","$4,836.50 ","$0.00 ","$2,418.25 ","$3,830.51 ","$3,869.20 ","$0.00 ","$756.91 ","$0.00 ","$769.97 ","$0.00 "
"80-018","SUP","Custom 27203010","","80-018  -  BIT DRILL 2MM HEAD","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0180","SUP","Custom 27203010","","80-0180  -  TIP SCRDRVR 1.5MM SLD HEX AO CONNECT DRVR NONSTRL","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0205","SUP","Custom 27203010","","80-0205  -  TRPHN ACTRK6/7 SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0206","SUP","Custom 27203010","","80-0206  -  TRPHN ACTRK+ SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0207","SUP","Custom 27203010","","80-0207  -  TRPHN ACTRK 4/5 SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0208","SUP","Custom 27203010","","80-0208  -  TRPHN 20+ MM STD ACTRK SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0209","SUP","Custom 27203010","","80-0209  -  TRPHN 0-20MM STD ACTRK SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0210","SUP","Custom 27203010","","80-0210  -  TRPHN MINI ACTRK SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0211","SUP","Custom 27203010","","80-0211  -  TRPHN STD ACTRK2 SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0212","SUP","Custom 27203010","","80-0212  -  TRPHN MINI ACTRK2 SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0213","SUP","Custom 27203010","","80-0213  -  TRPHN MIC ACTRK2 SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0214","SUP","Custom 27203010","","80-0214  -  TRPHN ACTRK2 SURG 5.5 MM SCR","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0216","SUP","Custom 27203010","","80-0216  -  TRPHN ACTRK2 BRKN SURG 3.5 MM CMPR SCR","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0217","SUP","Custom 27203010","","80-0217  -  TRPHN ACTRK2 BRKN SURG 2.7 MM CMPR SCR","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8002221-6","SUP","HCPCS C1781","","8002221-6  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,828.38 ","$2,093.00 ","$0.00 ","$2,828.38 ","$1,272.77 ","$0.00 ","$589.50 ","$0.00 ","$0.00 ","$495.23 ","$2,828.38 ","$0.00 ","$1,414.19 ","$2,240.08 ","$2,262.70 ","$0.00 ","$442.64 ","$0.00 ","$450.28 ","$0.00 "
"8002231-6","SUP","HCPCS C1781","","8002231-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$4,798.25 ","$3,550.71 ","$0.00 ","$4,798.25 ","$2,159.21 ","$0.00 ","$1,000.08 ","$0.00 ","$0.00 ","$840.14 ","$4,798.25 ","$0.00 ","$2,399.13 ","$3,800.21 ","$3,838.60 ","$0.00 ","$750.93 ","$0.00 ","$763.88 ","$0.00 "
"8002233-6","SUP","HCPCS C1781","","8002233-6  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$4,798.25 ","$3,550.71 ","$0.00 ","$4,798.25 ","$2,159.21 ","$0.00 ","$1,000.08 ","$0.00 ","$0.00 ","$840.14 ","$4,798.25 ","$0.00 ","$2,399.13 ","$3,800.21 ","$3,838.60 ","$0.00 ","$750.93 ","$0.00 ","$763.88 ","$0.00 "
"80-0248","SUP","HCPCS C1713","","80-0248  -  PLATE SM TACK BONE","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$61.88 ","$0.00 ","$28.66 ","$0.00 ","$0.00 ","$24.08 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$21.52 ","$0.00 ","$21.89 ","$0.00 "
"80-0297","SUP","Custom 27203010","","80-0297  -  BIT DRILL 4.6MM 3.1MM ACTRK DNS","BOTH IP/OP","$805.00 ","$595.70 ","$0.00 ","$805.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$805.00 ","$0.00 ","$402.50 ","$637.56 ","$644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0298","SUP","Custom 27203010","","80-0298  -  DRILL SURG ACTRK+ CANN DNS QRLSE","BOTH IP/OP","$805.00 ","$595.70 ","$0.00 ","$805.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$805.00 ","$0.00 ","$402.50 ","$637.56 ","$644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0302","SUP","Custom 27203010","","80-0302  -  BIT DRILL 2.5MM HEX TIP FLXB","BOTH IP/OP","$1,152.50 ","$852.85 ","$0.00 ","$1,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,152.50 ","$0.00 ","$576.25 ","$912.78 ","$922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0318","SUP","Custom 27203010","","80-0318  -  BIT DRL 2MM NS ACLC 2 SURGIBIT QRLSE 2.7MM SCR","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"800-3510","SUP","Custom 27203010","","STRIP UA ATNMX 9 PRMTR REAGENT","BOTH IP/OP","$86.13 ","$63.74 ","$0.00 ","$86.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.13 ","$0.00 ","$43.06 ","$68.21 ","$68.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0362","SUP","Custom 27203010","","80-0362  -  TAP BN 2.3MM","BOTH IP/OP","$285.00 ","$210.90 ","$0.00 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$285.00 ","$0.00 ","$142.50 ","$225.72 ","$228.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0386","SUP","Custom 27203010","","80-0386  -  DRILL SURG QRLSE 2MM","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0387","SUP","Custom 27203010","","80-0387  -  DRILL SRG 2.8MM QRLSE 3.5MM SCR","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0399","SUP","Custom 27203010","","80-0399  -  DRILL SURG 1.5MM ACTRK LEFT HND","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0400","SUP","Custom 27203010","","80-0400  -  DRILL SURG 2MM ACTRK LEFT HND SCR REM","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0401","SUP","Custom 27203010","","80-0401  -  DRILL SURG 2.5MM ACTRK LEFT HND SCR REM","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0402","SUP","Custom 27203010","","80-0402  -  DRILL SURG 3MM ACTRK LEFT HND SCR REM","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0403","SUP","Custom 27203010","","80-0403  -  DRILL SURG 3.5MM ACTRK LEFT HND SCR REM","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0404","SUP","Custom 27203010","","80-0404  -  DRILL SURG 4MM ACTRK LEFT HND SCR REM","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0411","SUP","Custom 27803010","","80-0411  -  PIN TNSNBND SNAPPER","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0413","SUP","HCPCS C1769","","80-0413  -  WIRE FX .062IN KRSH","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$20.36 ","$0.00 ","$7.82 ","$0.00 ","$0.00 ","$6.57 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$5.87 ","$0.00 ","$5.97 ","$0.00 "
"80-0465","SUP","Custom 27203010","","80-0465  -  DRILL SRG CNN OLCRN","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0477","SUP","Custom 27203010","","80-0477  -  DRILL SURG 40-65MM ACTRK6/7 CANN QRLSE DNS","BOTH IP/OP","$805.00 ","$595.70 ","$0.00 ","$805.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$805.00 ","$0.00 ","$402.50 ","$637.56 ","$644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0478","SUP","Custom 27203010","","80-0478  -  DRILL SURG 70-85MM ACTRK6/7 CANN QRLSE DNS","BOTH IP/OP","$902.50 ","$667.85 ","$0.00 ","$902.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$902.50 ","$0.00 ","$451.25 ","$714.78 ","$722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0479","SUP","Custom 27203010","","80-0479  -  DRILL SURG 90-120MM ACTRK6/7 CANN QRLSE DNS","BOTH IP/OP","$1,127.50 ","$834.35 ","$0.00 ","$1,127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0569","SUP","Custom 27203010","","80-0569  -  REAMER SURG 16MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0570","SUP","Custom 27203010","","80-0570  -  REAMER SURG 16MM CNVX MTP FRFT MIDFT PLT SYS NONSTRL","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0571","SUP","Custom 27203010","","80-0571  -  REAMER SURG 18MM MALE SET FT","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0572","SUP","Custom 27203010","","80-0572  -  REAMER SURG 18MM FMALE SET FT","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0573","SUP","Custom 27203010","","80-0573  -  REAMER SURG 20MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0574","SUP","Custom 27203010","","80-0574  -  REAMER SURG 74MM STNLS STELL CNCV SM BONE","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0575","SUP","Custom 27203010","","80-0575  -  REAMER SURG 76MM SS CNVX SM BONE","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0576","SUP","Custom 27203010","","80-0576  -  REAMER SURG 75MM SS CNCV SM BONE","BOTH IP/OP","$1,360.00 ","$1,006.40 ","$0.00 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,360.00 ","$0.00 ","$680.00 ","$1,077.12 ","$1,088.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0583","SUP","Custom 27203010","","80-0583  -  DRIVER 1.5MM ACTRK QRLSE SLD HEX TIP SURG","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0598","SUP","Custom 27203010","","80-0598  -  XTRT SURG EZOUT QRLSE 1.5MM","BOTH IP/OP","$307.50 ","$227.55 ","$0.00 ","$307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0599","SUP","Custom 27203010","","80-0599  -  XTRT SURG ACTRK QRLSE EZOUT 2MM","BOTH IP/OP","$307.50 ","$227.55 ","$0.00 ","$307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0600","SUP","Custom 27203010","","80-0600  -  XTRT SURG EZOUT QRLSE 2.5MM","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0601","SUP","Custom 27203010","","80-0601  -  TOOL REM 3MM ACTRK SCR EASYOUT","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0602","SUP","Custom 27203010","","80-0602  -  TOOL REM 3.5MM ACTRK SCR EASYOUT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$430.00 ","$0.00 ","$215.00 ","$340.56 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0603","SUP","Custom 27203010","","80-0603  -  TOOL REM 4MM ACTRK SCR EASYOUT","BOTH IP/OP","$490.00 ","$362.60 ","$0.00 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.00 ","$0.00 ","$245.00 ","$388.08 ","$392.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0605","SUP","Custom 27203010","","80-0605  -  DRIVER ACTRK HEX TIP IMPCT XTRT 3MM SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0606","SUP","Custom 27203010","","80-0606  -  DRIVER ACTRK HEX TIP IMPCT SCR XTRT 4MM SURG","BOTH IP/OP","$842.50 ","$623.45 ","$0.00 ","$842.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$842.50 ","$0.00 ","$421.25 ","$667.26 ","$674.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0610","SUP","Custom 27203010","","80-0610  -  TIP SCRDRVR ACTRK REM SHFT QRLSE","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0611","SUP","Custom 27203010","","80-0611  -  WRENCH SURG SCR REM TIP ACTRK","BOTH IP/OP","$1,837.50 ","$1,359.75 ","$0.00 ","$1,837.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,837.50 ","$0.00 ","$918.75 ","$1,455.30 ","$1,470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0612","SUP","Custom 27203010","","80-0612  -  TIP SCRDRVR ACTRK MIC REM","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0613","SUP","Custom 27203010","","80-0613  -  TOOL REM ACTRK MINI TIP","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0614","SUP","Custom 27203010","","80-0614  -  TOOL REM ACTRK STD TIP","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0615","SUP","Custom 27203010","","80-0615  -  TOOL REM ACTRK LG TIP","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0616","SUP","Custom 27203010","","80-0616  -  TOOL REM ACTRK XL TIP","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0625","SUP","Custom 27203010","","80-0625  -  TAP BONE 2.7MM HEXALOBE SCR","BOTH IP/OP","$307.50 ","$227.55 ","$0.00 ","$307.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$307.50 ","$0.00 ","$153.75 ","$243.54 ","$246.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0626","SUP","Custom 27203010","","80-0626  -  TAP BN INS CORONOID DISP 3MM NLCKG SCR","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0627","SUP","Custom 27203010","","80-0627  -  DRILL SURG QRLSE 2.3MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0628","SUP","Custom 27203010","","80-0628  -  GUIDE DRILL 2MM 2.3MM NAR","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0632","SUP","Custom 27203010","","80-0632  -  DRIVER 2MM QRLSE SLD HEX TIP SURG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0633","SUP","Custom 27203010","","80-0633  -  DRIVER 3MM ACTRK QRLSE SLD HEX TIP SURG","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0634","SUP","Custom 27203010","","80-0634  -  DRIVER 3.5MM ACTRK QRLSE SLD HEX TIP SURG","BOTH IP/OP","$597.50 ","$442.15 ","$0.00 ","$597.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$597.50 ","$0.00 ","$298.75 ","$473.22 ","$478.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0635","SUP","Custom 27203010","","80-0635  -  DRIVER 4MM ACTRK QRLSE SLD HEX TIP SURG","BOTH IP/OP","$657.50 ","$486.55 ","$0.00 ","$657.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$657.50 ","$0.00 ","$328.75 ","$520.74 ","$526.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0636","SUP","Custom 27203010","","80-0636  -  DRIVER ACTRK QRLSE CRCIFRM TIP SURG","BOTH IP/OP","$767.50 ","$567.95 ","$0.00 ","$767.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$767.50 ","$0.00 ","$383.75 ","$607.86 ","$614.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0642","SUP","Custom 27203010","","80-0642  -  ROD XTRNFX 2.8IN DRL FIB","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0659","SUP","Custom 27203010","","80-0659  -  TAP SRG DIST ELB 3 MM SCR","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0661","SUP","Custom 27203010","","80-0661  -  TAP SRG NS HUM DIST 3.5 MM SCR","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0663","SUP","Custom 27203010","","80-0663  -  HANDLE DRVR MED RCHT","BOTH IP/OP","$2,275.00 ","$1,683.50 ","$0.00 ","$2,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,275.00 ","$0.00 ","$1,137.50 ","$1,801.80 ","$1,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0664","SUP","Custom 27203010","","80-0664  -  PROBE SURG 2.3MM DEPTH","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0688","SUP","Custom 27203010","","80-0688  -  WIRE FIX .054IN KWIRE GUIDE REUSE","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0724","SUP","Custom 27203010","","80-0724  -  BIT DRILL 2.5MM FRAG-LOC SURG","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0728","SUP","Custom 27203010","","80-0728  -  DRIVER 1.5MM HEX TIP LCK GRV 2.3MM SURG","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0758","SUP","Custom 27203010","","80-0758  -  GUIDEWIRE ORTHOPEDIC 24IN THREADED INSTR UCSS","BOTH IP/OP","$805.00 ","$595.70 ","$0.00 ","$805.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$805.00 ","$0.00 ","$402.50 ","$637.56 ","$644.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0759","SUP","Custom 27203010","","80-0759  -  DRIVER SRG T8 MN STICKFIT HEXALOBE QC DRL REUSE","BOTH IP/OP","$707.50 ","$523.55 ","$0.00 ","$707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.50 ","$0.00 ","$353.75 ","$560.34 ","$566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0760","SUP","Custom 27203010","","80-0760  -  DRIVER SRG T15 HEXALOBE SCR STK FIR","BOTH IP/OP","$707.50 ","$523.55 ","$0.00 ","$707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.50 ","$0.00 ","$353.75 ","$560.34 ","$566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0772","SUP","HCPCS C1713","","80-0772  -  SCREW BN 3MM 2 TRK STP DRL CLVCL","BOTH IP/OP","$547.50 ","$405.15 ","$0.00 ","$547.50 ","$246.38 ","$0.00 ","$114.11 ","$0.00 ","$0.00 ","$95.86 ","$547.50 ","$0.00 ","$273.75 ","$433.62 ","$438.00 ","$0.00 ","$85.68 ","$0.00 ","$87.16 ","$0.00 "
"80-0773","SUP","Custom 27203010","","80-0773  -  SCREW BN 3.8MM 2 TRK STP DRL CLVCL","BOTH IP/OP","$547.50 ","$405.15 ","$0.00 ","$547.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$547.50 ","$0.00 ","$273.75 ","$433.62 ","$438.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0774","SUP","Custom 27203010","","80-0774  -  REAMER SURG 3MM THDL","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0775","SUP","Custom 27203010","","80-0775  -  REAMER SURG 3.8MM THDL DL TRK CLVCL SCR SYS","BOTH IP/OP","$1,287.50 ","$952.75 ","$0.00 ","$1,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.50 ","$0.00 ","$643.75 ","$1,019.70 ","$1,030.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0783","SUP","Custom 27203010","","80-0783  -  SCREW BN 3MM 2 TRK TAP CLVCL","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-0838","SUP","HCPCS C1713","","80-0838  -  SCREW BONE .75IN 3/32IN BLNK","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$6.75 ","$0.00 ","$3.13 ","$0.00 ","$0.00 ","$2.63 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$2.35 ","$0.00 ","$2.39 ","$0.00 "
"801 325 100","SUP","Custom 27203010","","SERACLONE ANTI-A 10X10ML","BOTH IP/OP","$894.38 ","$661.84 ","$0.00 ","$894.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$894.38 ","$0.00 ","$447.19 ","$708.35 ","$715.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"801 350 100","SUP","Custom 27203010","","SERACLONE ANTI-B 10X10ML","BOTH IP/OP","$894.38 ","$661.84 ","$0.00 ","$894.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$894.38 ","$0.00 ","$447.19 ","$708.35 ","$715.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80129-201","SUP","HCPCS C1874","","80129-201  -  STENT ESPH 16FR 18MM 67CM 70MM ALIMAXX-ES FULL CVR PROX SUT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-202","SUP","HCPCS C1874","","80129-202  -  STENT ESPH 18MM 22FR 100CM ALIMAXX-E REM COVERED RADOPQ MTL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-203","SUP","HCPCS C1874","","80129-203  -  STENT ESPH 22FR 18MM 120CM ALIMAXX-E REM COVERED MTL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-204","SUP","HCPCS C1874","","80129-204  -  STENT ESPH 22MM 22FR 70CM ALIMAXX-E REM COVERED RADOPQ MTL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-205","SUP","HCPCS C1874","","80129-205  -  STENT ESPH 22FR 100CM ALIMAXX-E SYS MTL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-206","SUP","HCPCS C1874","","80129-206  -  STENT ESPH 22FR 120CM ALIMAXX-E SLF XPD MTL DISP","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-207","SUP","HCPCS C1874","","80129-207  -  STENT ESPH 12MM 70CM ALIMAXX-ES FLLY COVERED","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-208","SUP","HCPCS C1874","","80129-208  -  STENT ESPH 22MM 100CM ALIMAXX-ES PU CVR ANTIMIGRATION STRUT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-209","SUP","HCPCS C1874","","80129-209  -  STENT ESPH GMTR 12MM 16FR 120MM NS 62CM ALIMAXX-ES FLLY","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-210","SUP","HCPCS C1874","","80129-210  -  STENT ESPH 14MM 70CM ALIMAXX-ES FLLY COVERED","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-211","SUP","HCPCS C1874","","80129-211  -  STENT ESPH 14MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-212","SUP","HCPCS C1874","","80129-212  -  STENT ESPH 14MM 16FR 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-213","SUP","HCPCS C1874","","80129-213  -  STENT ESPH GMTR 16MM 70CM ALIMAXX-ES FLLY COVERED PU CVR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-214","SUP","HCPCS C1874","","80129-214  -  STENT ESPH 16MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-215","SUP","HCPCS C1874","","80129-215  -  STENT ESPH 16MM 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR PU","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"80129-406","SUP","HCPCS C1769","","80129-406  -  GUIDEWIRE ENDSCP STR .035IN 260CM SUPER STIFF FLEXIBILITY","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"80-1759","SUP","HCPCS C1713","","80-1759  -  TACK FX .04IN PLT","BOTH IP/OP","$322.50 ","$238.65 ","$0.00 ","$322.50 ","$145.13 ","$0.00 ","$67.22 ","$0.00 ","$0.00 ","$56.47 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$50.47 ","$0.00 ","$51.34 ","$0.00 "
"80-1794","SUP","Custom 27203010","","80-1794  -  DRILL SRG 1.1MM 3.5IN QRLSE STD AO 1.5MM SCR","BOTH IP/OP","$742.50 ","$549.45 ","$0.00 ","$742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$742.50 ","$0.00 ","$371.25 ","$588.06 ","$594.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-1796","SUP","Custom 27203010","","80-1796  -  DRILL SURG 2MM 3.5IN QUICK RELEASE STANDARD AO SURGIBIT","BOTH IP/OP","$742.50 ","$549.45 ","$0.00 ","$742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$742.50 ","$0.00 ","$371.25 ","$588.06 ","$594.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80-1797","SUP","Custom 27203010","","80-1797  -  DRILL SURG 3.5IN CUT INSERTION SURGIBIT MINI 2IN REUSABLE","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"802 042 100","SUP","Custom 27203010","","SERACLONE ANTI-D 10X10ML","BOTH IP/OP","$928.13 ","$686.82 ","$0.00 ","$928.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$928.13 ","$0.00 ","$464.06 ","$735.08 ","$742.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"802 336 100","SUP","Custom 27203010","","SERACLONE ANTI-E 1X5ML","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$265.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$265.50 ","$0.00 ","$132.75 ","$210.28 ","$212.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8023 A","SUP","Custom 27803010","","8023 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8023 B","SUP","Custom 27803010","","8023 B  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$213.75 ","$158.18 ","$0.00 ","$213.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$213.75 ","$0.00 ","$106.88 ","$169.29 ","$171.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"803.605.02S","SUP","HCPCS C1713","","803.605.02S  -  SCREW BONE 1.5MM 5MM CORT RESORB STRL","BOTH IP/OP","$361.03 ","$267.16 ","$0.00 ","$361.03 ","$162.46 ","$0.00 ","$75.25 ","$0.00 ","$0.00 ","$63.21 ","$361.03 ","$0.00 ","$180.51 ","$285.94 ","$288.82 ","$0.00 ","$56.50 ","$0.00 ","$57.48 ","$0.00 "
"804 175 100","SUP","Custom 27203010","","AHG ANTI-LGG 10 X 10 ML","BOTH IP/OP","$463.50 ","$342.99 ","$0.00 ","$463.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$463.50 ","$0.00 ","$231.75 ","$367.09 ","$370.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"804.006.02S","SUP","HCPCS C1713","","804.006.02S  -  SCREW BONE 2MM 6MM CORT RESORB MESH STRL","BOTH IP/OP","$361.03 ","$267.16 ","$0.00 ","$361.03 ","$162.46 ","$0.00 ","$75.25 ","$0.00 ","$0.00 ","$63.21 ","$361.03 ","$0.00 ","$180.51 ","$285.94 ","$288.82 ","$0.00 ","$56.50 ","$0.00 ","$57.48 ","$0.00 "
"80-4403L","SUP","HCPCS C1776","","80-4403L  -  COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN POST PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4403R","SUP","HCPCS C1776","","80-4403R  -  COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4404L","SUP","HCPCS C1776","","80-4404L  -  COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4404R","SUP","HCPCS C1776","","80-4404R  -  COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4405L","SUP","HCPCS C1776","","80-4405L  -  COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4405R","SUP","HCPCS C1776","","80-4405R  -  COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4406L","SUP","HCPCS C1776","","80-4406L  -  COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4406R","SUP","HCPCS C1776","","80-4406R  -  COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4407L","SUP","HCPCS C1776","","80-4407L  -  COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4407R","SUP","HCPCS C1776","","80-4407R  -  COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4408L","SUP","HCPCS C1776","","80-4408L  -  COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4408R","SUP","HCPCS C1776","","80-4408R  -  COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4409L","SUP","HCPCS C1776","","80-4409L  -  COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4409R","SUP","HCPCS C1776","","80-4409R  -  COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4411L","SUP","HCPCS C1776","","80-4411L  -  COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4411R","SUP","HCPCS C1776","","80-4411R  -  COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4413L","SUP","HCPCS C1776","","80-4413L  -  COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"80-4413R","SUP","HCPCS C1776","","80-4413R  -  COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"805.603.02S","SUP","HCPCS C1713","","805.603.02S  -  SCREW BN 1.5MM 3MM STRL CRNMXF CORT 2 PK","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"805.604.02S","SUP","HCPCS C1713","","805.604.02S  -  SCREW BONE RPD RESORB 4MM 1.5MM CORT CRNMXF STRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"805.605.02S","SUP","HCPCS C1713","","805.605.02S  -  SCREW BN 1.5MM 5MM STRL CRNMXF CORT 2 PK","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"805.606.02S","SUP","HCPCS C1713","","805.606.02S  -  SCREW BN 1.5MM 6MM STRL CRNMXF CORT 2 PK","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"805.608.02S","SUP","HCPCS C1713","","805.608.02S  -  SCREW BONE 8MM 1.5MM CORT CRNMXF RPD RESORB STRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"805.614.02S","SUP","HCPCS C1713","","805.614.02S  -  TACK FX 1.5MM 4MM STRL RAPIDSORB RSRB CRNMXF","BOTH IP/OP","$373.50 ","$276.39 ","$0.00 ","$373.50 ","$168.08 ","$0.00 ","$77.85 ","$0.00 ","$0.00 ","$65.40 ","$373.50 ","$0.00 ","$186.75 ","$295.81 ","$298.80 ","$0.00 ","$58.45 ","$0.00 ","$59.46 ","$0.00 "
"806.004.02S","SUP","HCPCS C1713","","806.004.02S  -  SCREW BONE 4MM 2MM CORT CRNMXF RPD RESORB STRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"806.006.02S","SUP","HCPCS C1713","","806.006.02S  -  SCREW BN 2MM 6MM STRL CRNMXF CORT 2 PK","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"806.008.02S","SUP","HCPCS C1713","","806.008.02S  -  SCREW BN 2MM 8MM STRL CRNMXF CORT 2 PK","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"806.044.02S","SUP","HCPCS C1713","","806.044.02S  -  SCREW BONE 4MM 2.5MM CORT CRNMXF RPD RESORB ER STRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"806.046.02S","SUP","HCPCS C1713","","806.046.02S  -  SCREW BONE 6MM 2.5MM CORT CRNMXF RPD RESORB ER STRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"806.048.02S","SUP","HCPCS C1713","","806.048.02S  -  SCREW BONE 8MM 2.5MM CORT CRNMXF RPD RESORB ER STRL","BOTH IP/OP","$393.75 ","$291.38 ","$0.00 ","$393.75 ","$177.19 ","$0.00 ","$82.07 ","$0.00 ","$0.00 ","$68.94 ","$393.75 ","$0.00 ","$196.88 ","$311.85 ","$315.00 ","$0.00 ","$61.62 ","$0.00 ","$62.69 ","$0.00 "
"808 052 100","SUP","Custom 27203010","","SERACLONE ANTI-S 1 X 2 MLL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"808 188 100","SUP","Custom 27203010","","SERACLONE ANTI-FYA 1 X 2 ML","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"808 403 100","SUP","Custom 27203010","","SERACLONE ANTI-LEA 1X2ML","BOTH IP/OP","$590.63 ","$437.07 ","$0.00 ","$590.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$590.63 ","$0.00 ","$295.31 ","$467.78 ","$472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"808 410 100","SUP","Custom 27203010","","SERACLONE ANTI-M 1X 2 ML","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"808 415 100","SUP","Custom 27203010","","SERACLONE ANTI-N 1 X 2 ML","BOTH IP/OP","$236.25 ","$174.83 ","$0.00 ","$236.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$236.25 ","$0.00 ","$118.13 ","$187.11 ","$189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"808-002","SUP","HCPCS C1713","","808-002  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"808-083","SUP","HCPCS C1713","","808-083  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"808-105","SUP","HCPCS C1713","","808-105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"808-190","SUP","HCPCS C1713","","808-190  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"808-524","SUP","HCPCS C1713","","808-524  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,670.00 ","$1,975.80 ","$0.00 ","$2,670.00 ","$1,201.50 ","$0.00 ","$556.49 ","$0.00 ","$0.00 ","$467.50 ","$2,670.00 ","$0.00 ","$1,335.00 ","$2,114.64 ","$2,136.00 ","$0.00 ","$417.86 ","$0.00 ","$425.06 ","$0.00 "
"809-DBL","SUP","HCPCS C1713","","809-DBL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$97.05 ","$71.82 ","$0.00 ","$97.05 ","$43.67 ","$0.00 ","$20.23 ","$0.00 ","$0.00 ","$16.99 ","$97.05 ","$0.00 ","$48.53 ","$76.86 ","$77.64 ","$0.00 ","$15.19 ","$0.00 ","$15.45 ","$0.00 "
"80CR000022","SUP","Custom 27203010","","REAGENT TRIS BUFF SAL PH 8 COAG","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80XLTCD","SUP","Custom 27203010","","80XLTCD  -  TUBE TRCH 40MM 50MM 13.3MM 8MM 105MM STRL LF 15MM SHLY XLT","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"80XLTCP","SUP","Custom 27203010","","80XLTCP  -  TUBE TRCH 40MM 35MM 13.3MM 8MM 105MM STRL LF 30MM SHLY XLT","BOTH IP/OP","$159.65 ","$118.14 ","$0.00 ","$162.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.05 ","$0.00 ","$81.02 ","$128.34 ","$129.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"810041B","SUP","HCPCS C1781","","810041B  -  MESH TRANSVAGINAL 45X1.1CM TAPE TVT PROLENE BLUE","BOTH IP/OP","$1,955.10 ","$1,446.77 ","$0.00 ","$1,955.10 ","$879.80 ","$0.00 ","$407.49 ","$0.00 ","$0.00 ","$342.32 ","$1,955.10 ","$0.00 ","$977.55 ","$1,548.44 ","$1,564.08 ","$0.00 ","$305.97 ","$0.00 ","$311.25 ","$0.00 "
"810-200","SUP","HCPCS C1713","","810-200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-201","SUP","HCPCS C1713","","810-201  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-202","SUP","HCPCS C1713","","810-202  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-203","SUP","HCPCS C1713","","810-203  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-205","SUP","HCPCS C1713","","810-205  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-206","SUP","HCPCS C1713","","810-206  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-207","SUP","HCPCS C1713","","810-207  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-208","SUP","HCPCS C1713","","810-208  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-221","SUP","HCPCS C1713","","810-221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-222","SUP","HCPCS C1713","","810-222  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8103.0201S","SUP","HCPCS C1713","","8103.0201S  -  SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 1ML","BOTH IP/OP","$570.00 ","$421.80 ","$0.00 ","$570.00 ","$256.50 ","$0.00 ","$118.80 ","$0.00 ","$0.00 ","$99.80 ","$570.00 ","$0.00 ","$285.00 ","$451.44 ","$456.00 ","$0.00 ","$89.21 ","$0.00 ","$90.74 ","$0.00 "
"8103.0203S","SUP","HCPCS C1713","","8103.0203S  -  SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 3ML","BOTH IP/OP","$1,485.00 ","$1,098.90 ","$0.00 ","$1,485.00 ","$668.25 ","$0.00 ","$309.51 ","$0.00 ","$0.00 ","$260.01 ","$1,485.00 ","$0.00 ","$742.50 ","$1,176.12 ","$1,188.00 ","$0.00 ","$232.40 ","$0.00 ","$236.41 ","$0.00 "
"810-300","SUP","HCPCS C1713","","810-300  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-301","SUP","HCPCS C1713","","810-301  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-302","SUP","HCPCS C1713","","810-302  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-303","SUP","HCPCS C1713","","810-303  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-304","SUP","HCPCS C1713","","810-304  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-305","SUP","HCPCS C1713","","810-305  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-306","SUP","HCPCS C1713","","810-306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-307","SUP","HCPCS C1713","","810-307  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-308","SUP","HCPCS C1713","","810-308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-321","SUP","HCPCS C1713","","810-321  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-322","SUP","HCPCS C1713","","810-322  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-323","SUP","HCPCS C1713","","810-323  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-400","SUP","HCPCS C1713","","810-400  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-401","SUP","HCPCS C1713","","810-401  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-402","SUP","HCPCS C1713","","810-402  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-403","SUP","HCPCS C1713","","810-403  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-404","SUP","HCPCS C1713","","810-404  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-405","SUP","HCPCS C1713","","810-405  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-406","SUP","HCPCS C1713","","810-406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-407","SUP","HCPCS C1713","","810-407  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-408","SUP","HCPCS C1713","","810-408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-421","SUP","HCPCS C1713","","810-421  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-422","SUP","HCPCS C1713","","810-422  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-423","SUP","HCPCS C1713","","810-423  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-450","SUP","HCPCS C1713","","810-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"810-451","SUP","HCPCS C1713","","810-451  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8104528M","SUP","HCPCS C1713","","8104528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104530M","SUP","HCPCS C1713","","8104530M  -  PLATE BN 30-34MM X10 XLNK TI SPNE 4.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104534M","SUP","HCPCS C1713","","8104534M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104541M","SUP","HCPCS C1713","","8104541M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8104555M","SUP","HCPCS C1713","","8104555M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"810-A20-1350","SUP","Custom 27203010","","SCISSORS 4.75IN CRB EDG WIRE CTR SURG LTX","BOTH IP/OP","$105.33 ","$77.94 ","$0.00 ","$105.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.33 ","$0.00 ","$52.66 ","$83.42 ","$84.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"811-300","SUP","HCPCS C1713","","811-300  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-301","SUP","HCPCS C1713","","811-301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-302","SUP","HCPCS C1713","","811-302  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-303","SUP","HCPCS C1713","","811-303  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-304","SUP","HCPCS C1713","","811-304  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-305","SUP","HCPCS C1713","","811-305  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-306","SUP","HCPCS C1713","","811-306  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-307","SUP","HCPCS C1713","","811-307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-308","SUP","HCPCS C1713","","811-308  -  PLATE BN 1.5IN STRL XLNK CD HZN LOPRFL TI SPNE 5.5MM ROD","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-313","SUP","Custom 27803010","","811-313  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"811-321","SUP","HCPCS C1713","","811-321  -  PLATE BN 1.55-1.75IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-322","SUP","HCPCS C1713","","811-322  -  PLATE BN 1.75-2.15IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-323","SUP","HCPCS C1713","","811-323  -  PLATE BN 2.15-2.95IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-324","SUP","HCPCS C1713","","811-324  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-400","SUP","HCPCS C1713","","811-400  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-401","SUP","HCPCS C1713","","811-401  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-402","SUP","HCPCS C1713","","811-402  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-403","SUP","HCPCS C1713","","811-403  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-404","SUP","HCPCS C1713","","811-404  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-405","SUP","HCPCS C1713","","811-405  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-406","SUP","HCPCS C1713","","811-406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-407","SUP","HCPCS C1713","","811-407  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-408","SUP","HCPCS C1713","","811-408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-421","SUP","HCPCS C1713","","811-421  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-422","SUP","HCPCS C1713","","811-422  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-423","SUP","HCPCS C1713","","811-423  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-450","SUP","HCPCS C1713","","811-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"811-451","SUP","HCPCS C1713","","811-451  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8114528M","SUP","HCPCS C1713","","8114528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114530M","SUP","HCPCS C1713","","8114530M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114534M","SUP","HCPCS C1713","","8114534M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114541M","SUP","HCPCS C1713","","8114541M  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"8114555M","SUP","HCPCS C1713","","8114555M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-500","SUP","HCPCS C1713","","811-500  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-501","SUP","HCPCS C1713","","811-501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"811-DBL","SUP","HCPCS C1713","","811-DBL  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"813-DBL","SUP","HCPCS C1713","","813-DBL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$97.75 ","$72.34 ","$0.00 ","$97.75 ","$43.99 ","$0.00 ","$20.37 ","$0.00 ","$0.00 ","$17.12 ","$97.75 ","$0.00 ","$48.88 ","$77.42 ","$78.20 ","$0.00 ","$15.30 ","$0.00 ","$15.56 ","$0.00 "
"81-4403L","SUP","HCPCS C1776","","81-4403L  -  COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4403R","SUP","HCPCS C1776","","81-4403R  -  COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4404L","SUP","HCPCS C1776","","81-4404L  -  COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4404R","SUP","HCPCS C1776","","81-4404R  -  COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4405L","SUP","HCPCS C1776","","81-4405L  -  COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4405R","SUP","HCPCS C1776","","81-4405R  -  COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4406L","SUP","HCPCS C1776","","81-4406L  -  COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4406R","SUP","HCPCS C1776","","81-4406R  -  COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4407L","SUP","HCPCS C1776","","81-4407L  -  COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4407R","SUP","HCPCS C1776","","81-4407R  -  COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4408L","SUP","HCPCS C1776","","81-4408L  -  COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4408R","SUP","HCPCS C1776","","81-4408R  -  COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4409L","SUP","HCPCS C1776","","81-4409L  -  COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4409R","SUP","HCPCS C1776","","81-4409R  -  COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4411L","SUP","HCPCS C1776","","81-4411L  -  COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4411R","SUP","HCPCS C1776","","81-4411R  -  COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4413L","SUP","HCPCS C1776","","81-4413L  -  COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81-4413R","SUP","HCPCS C1776","","81-4413R  -  COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"81500V","SUP","Custom 27203010","","81500V  -  APPLIER ENDOSCOPIC MED LARGE  STRAIGHT 13IN��","BOTH IP/OP","$2,373.73 ","$1,756.56 ","$0.00 ","$2,373.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,373.73 ","$0.00 ","$1,186.86 ","$1,879.99 ","$1,898.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"815-013","SUP","HCPCS C1713","","815-013  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$475.50 ","$351.87 ","$0.00 ","$475.50 ","$213.98 ","$0.00 ","$99.11 ","$0.00 ","$0.00 ","$83.26 ","$475.50 ","$0.00 ","$237.75 ","$376.60 ","$380.40 ","$0.00 ","$74.42 ","$0.00 ","$75.70 ","$0.00 "
"815-015","SUP","HCPCS C1713","","815-015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$475.50 ","$351.87 ","$0.00 ","$475.50 ","$213.98 ","$0.00 ","$99.11 ","$0.00 ","$0.00 ","$83.26 ","$475.50 ","$0.00 ","$237.75 ","$376.60 ","$380.40 ","$0.00 ","$74.42 ","$0.00 ","$75.70 ","$0.00 "
"815-017","SUP","HCPCS C1713","","815-017  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$475.50 ","$351.87 ","$0.00 ","$475.50 ","$213.98 ","$0.00 ","$99.11 ","$0.00 ","$0.00 ","$83.26 ","$475.50 ","$0.00 ","$237.75 ","$376.60 ","$380.40 ","$0.00 ","$74.42 ","$0.00 ","$75.70 ","$0.00 "
"81501V","SUP","Custom 27203010","","81501V  -  CLIP INTNL ENDO REMOVER MED LARGE - LARGE  STRAIGHT 13IN��","BOTH IP/OP","$2,164.98 ","$1,602.09 ","$0.00 ","$2,164.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,164.98 ","$0.00 ","$1,082.49 ","$1,714.66 ","$1,731.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"816-013","SUP","HCPCS C1713","","816-013  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$247.05 ","$0.00 ","$114.43 ","$0.00 ","$0.00 ","$96.13 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$85.92 ","$0.00 ","$87.40 ","$0.00 "
"816-015","SUP","HCPCS C1713","","816-015  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$247.05 ","$0.00 ","$114.43 ","$0.00 ","$0.00 ","$96.13 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$85.92 ","$0.00 ","$87.40 ","$0.00 "
"816-017","SUP","HCPCS C1713","","816-017  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$549.00 ","$406.26 ","$0.00 ","$549.00 ","$247.05 ","$0.00 ","$114.43 ","$0.00 ","$0.00 ","$96.13 ","$549.00 ","$0.00 ","$274.50 ","$434.81 ","$439.20 ","$0.00 ","$85.92 ","$0.00 ","$87.40 ","$0.00 "
"81602V","SUP","Custom 27203010","","81602V  -  APPLIER ENDOSCOPIC LARGE  CURVED 13IN��","BOTH IP/OP","$2,373.73 ","$1,756.56 ","$0.00 ","$2,373.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,373.73 ","$0.00 ","$1,186.86 ","$1,879.99 ","$1,898.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8161-35-026","SUP","HCPCS C1713","","8161-35-026  -  SCREW 3.5X26MM CORTICAL LOCKING","BOTH IP/OP","$402.50 ","$297.85 ","$0.00 ","$402.50 ","$181.13 ","$0.00 ","$83.89 ","$0.00 ","$0.00 ","$70.47 ","$402.50 ","$0.00 ","$201.25 ","$318.78 ","$322.00 ","$0.00 ","$62.99 ","$0.00 ","$64.08 ","$0.00 "
"8161-35-044","SUP","HCPCS C1713","","8161-35-044  -  SCREW BONE 3.5MM 44MM CORT LCK","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$146.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"81701V","SUP","Custom 27203010","","81701V  -  CLIP INTNL ENDO REMOVER�LARGE - XLARGE  STRAIGHT 13IN��","BOTH IP/OP","$2,249.98 ","$1,664.99 ","$0.00 ","$2,249.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,249.98 ","$0.00 ","$1,124.99 ","$1,781.98 ","$1,799.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81702V","SUP","Custom 27203010","","81702V  -  APPLIER ENDOSCOPIC XLARGE  CURVED 13IN��","BOTH IP/OP","$2,548.73 ","$1,886.06 ","$0.00 ","$2,548.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,548.73 ","$0.00 ","$1,274.36 ","$2,018.59 ","$2,038.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"81B001","SUP","HCPCS C1776","","81B001  -  GRAFT SFT TIS FRZDR ANT TIB TNDN","BOTH IP/OP","$5,032.50 ","$3,724.05 ","$0.00 ","$5,032.50 ","$2,264.63 ","$0.00 ","$1,048.90 ","$0.00 ","$0.00 ","$881.15 ","$5,032.50 ","$0.00 ","$2,516.25 ","$3,985.74 ","$4,026.00 ","$0.00 ","$787.59 ","$0.00 ","$801.17 ","$0.00 "
"81B005","SUP","HCPCS C1776","","81B005  -  GRAFT BN GRCLS SEMITENDINOSUS","BOTH IP/OP","$5,045.00 ","$3,733.30 ","$0.00 ","$5,045.00 ","$2,270.25 ","$0.00 ","$1,051.50 ","$0.00 ","$0.00 ","$883.34 ","$5,045.00 ","$0.00 ","$2,522.50 ","$3,995.64 ","$4,036.00 ","$0.00 ","$789.54 ","$0.00 ","$803.16 ","$0.00 "
"820-050","SUP","HCPCS C1713","","820-050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$553.50 ","$409.59 ","$0.00 ","$553.50 ","$249.08 ","$0.00 ","$115.36 ","$0.00 ","$0.00 ","$96.91 ","$553.50 ","$0.00 ","$276.75 ","$438.37 ","$442.80 ","$0.00 ","$86.62 ","$0.00 ","$88.12 ","$0.00 "
"82091-01","SUP","HCPCS C1876","","82091-01  -  STENT VASCULAR TAPER 8-6MM 30MM SELF EXPANDABLE ERGONOMIC","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$1,856.25 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$722.25 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$645.56 ","$0.00 ","$656.70 ","$0.00 "
"82-1750","SUP","HCPCS C1729","","82-1750  -  BACTISEAL CLEAR EVD CATHETER ANTIBIOTIC IMPREGNATED CATHETER","BOTH IP/OP","$386.40 ","$285.94 ","$0.00 ","$386.40 ","$209.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.66 ","$386.40 ","$0.00 ","$193.20 ","$306.03 ","$309.12 ","$0.00 ","$60.47 ","$0.00 ","$61.51 ","$0.00 "
"82-2-0308","SUP","Custom 27803010","","82-2-0308  -  INSERT TIBIAL 3 8MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0310","SUP","Custom 27803010","","82-2-0310  -  INSERT TIBIAL 3 10MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0312","SUP","Custom 27803010","","82-2-0312  -  INSERT TIBIAL 3 12MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0315","SUP","Custom 27803010","","82-2-0315  -  INSERT TIBIAL 3 15MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0318","SUP","Custom 27803010","","82-2-0318  -  INSERT TIBIAL 3 18MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0321","SUP","Custom 27803010","","82-2-0321  -  INSERT TIBIAL 3 21MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0324","SUP","Custom 27803010","","82-2-0324  -  INSERT TIBIAL 3 24MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0508","SUP","Custom 27803010","","82-2-0508  -  INSERT TIBIAL 5 8MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0510","SUP","Custom 27803010","","82-2-0510  -  INSERT TIBIAL 5 10MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0512","SUP","Custom 27803010","","82-2-0512  -  INSERT TIBIAL 5 12MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0515","SUP","Custom 27803010","","82-2-0515  -  INSERT TIBIAL 5 15MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0518","SUP","Custom 27803010","","82-2-0518  -  INSERT TIBIAL 5 18MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0521","SUP","Custom 27803010","","82-2-0521  -  INSERT TIBIAL 5 21MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0524","SUP","Custom 27803010","","82-2-0524  -  INSERT TIBIAL 5 24MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0708","SUP","Custom 27803010","","82-2-0708  -  INSERT TIBIAL 7 BEARING NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0710","SUP","Custom 27803010","","82-2-0710  -  INSERT TIBIAL 7 10MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0712","SUP","Custom 27803010","","82-2-0712  -  INSERT TIBIAL 7 12MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0715","SUP","Custom 27803010","","82-2-0715  -  INSERT TIBIAL 7 15MM SCORPIO NRG CR ANKLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0718","SUP","Custom 27803010","","82-2-0718  -  INSERT TIBIAL 7 18MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0721","SUP","Custom 27803010","","82-2-0721  -  INSERT TIBIAL 7 21MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0724","SUP","Custom 27803010","","82-2-0724  -  INSERT TIBIAL 7 24MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0908","SUP","Custom 27803010","","82-2-0908  -  INSERT TIBIAL 9 8MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0910","SUP","Custom 27803010","","82-2-0910  -  INSERT TIBIAL 9 10MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0912","SUP","Custom 27803010","","82-2-0912  -  INSERT TIBIAL 9 12MM SCORPIO NRG CR ANKLE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0915","SUP","Custom 27803010","","82-2-0915  -  INSERT TIBIAL 9 15MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0918","SUP","Custom 27803010","","82-2-0918  -  INSERT TIBIAL 9 18MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0921","SUP","Custom 27803010","","82-2-0921  -  INSERT TIBIAL 9 21MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-0924","SUP","Custom 27803010","","82-2-0924  -  INSERT TIBIAL 9 24MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1108","SUP","Custom 27803010","","82-2-1108  -  INSERT TIBIAL 11 8MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1110","SUP","Custom 27803010","","82-2-1110  -  INSERT TIBIAL 11 10MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1112","SUP","Custom 27803010","","82-2-1112  -  INSERT TIBIAL 11 12MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1115","SUP","Custom 27803010","","82-2-1115  -  INSERT TIBIAL 11 15MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1118","SUP","Custom 27803010","","82-2-1118  -  INSERT TIBIAL 11 18MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1121","SUP","Custom 27803010","","82-2-1121  -  INSERT TIBIAL 11 21MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-2-1124","SUP","Custom 27803010","","82-2-1124  -  INSERT TIBIAL 11 24MM CRUC RET BEARING SCORPIO NRG KNEE","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"822-230","SUP","HCPCS C1713","","822-230  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"822-235","SUP","HCPCS C1713","","822-235  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,209.00 ","$894.66 ","$0.00 ","$1,209.00 ","$544.05 ","$0.00 ","$251.99 ","$0.00 ","$0.00 ","$211.69 ","$1,209.00 ","$0.00 ","$604.50 ","$957.53 ","$967.20 ","$0.00 ","$189.21 ","$0.00 ","$192.47 ","$0.00 "
"82-3-0308","SUP","Custom 27803010","","82-3-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0310","SUP","Custom 27803010","","82-3-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0312","SUP","Custom 27803010","","82-3-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0315","SUP","Custom 27803010","","82-3-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0318","SUP","Custom 27803010","","82-3-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0321","SUP","Custom 27803010","","82-3-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0324","SUP","Custom 27803010","","82-3-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0508","SUP","Custom 27803010","","82-3-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0510","SUP","Custom 27803010","","82-3-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0512","SUP","Custom 27803010","","82-3-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0515","SUP","Custom 27803010","","82-3-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0518","SUP","Custom 27803010","","82-3-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0521","SUP","Custom 27803010","","82-3-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0524","SUP","Custom 27803010","","82-3-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0708","SUP","Custom 27803010","","82-3-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0710","SUP","Custom 27803010","","82-3-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0712","SUP","Custom 27803010","","82-3-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0715","SUP","Custom 27803010","","82-3-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0718","SUP","Custom 27803010","","82-3-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0721","SUP","Custom 27803010","","82-3-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0724","SUP","Custom 27803010","","82-3-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0908","SUP","Custom 27803010","","82-3-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0910","SUP","Custom 27803010","","82-3-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0912","SUP","Custom 27803010","","82-3-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0915","SUP","Custom 27803010","","82-3-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0918","SUP","Custom 27803010","","82-3-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0921","SUP","Custom 27803010","","82-3-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-0924","SUP","Custom 27803010","","82-3-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1108","SUP","Custom 27803010","","82-3-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1110","SUP","Custom 27803010","","82-3-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE BEARING SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1112","SUP","Custom 27803010","","82-3-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE BEARING SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1115","SUP","Custom 27803010","","82-3-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE BEARING SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1118","SUP","Custom 27803010","","82-3-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE BEARING SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1121","SUP","Custom 27803010","","82-3-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE BEARING SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3-1124","SUP","Custom 27803010","","82-3-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE BEARING SCORPIO","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-3164","SUP","Custom 27803010","","82-3164  -  VALVE SHNT REG STRL STRT2 CSF PRGM FLW CNTRL BALL SPRG MECH","BOTH IP/OP","$9,839.45 ","$7,281.19 ","$0.00 ","$9,839.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,839.45 ","$0.00 ","$4,919.73 ","$7,792.84 ","$7,871.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"824-005","SUP","HCPCS C1713","","824-005  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"824-007","SUP","Custom 27803010","","824-007  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"824-027","SUP","HCPCS C1713","","824-027  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"824-028","SUP","HCPCS C1713","","824-028  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"824-040","SUP","HCPCS C1713","","824-040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"824-041","SUP","HCPCS C1713","","824-041  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"824-042","SUP","HCPCS C1713","","824-042  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"82-50200","SUP","Custom 27203010","","ELECTRODE EMG NM RSPN PT SMLTR CBL 15FT 8250200","BOTH IP/OP","$1,802.50 ","$1,333.85 ","$0.00 ","$1,802.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,802.50 ","$0.00 ","$901.25 ","$1,427.58 ","$1,442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-50600","SUP","Custom 27203010","","ELECTRODE EMG NM RSPN PT SMLTR CBL 15FT 8250600","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-5472","SUP","Custom 27803010","","82-5472  -  VALVE SHNT REG STRL DLT CSF 1 LVL","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-5474","SUP","Custom 27803010","","82-5474  -  VALVE SHNT REG 40X16.5MM STRL LF 13MM DLT PS MDCL CSF PRFRM","BOTH IP/OP","$3,617.13 ","$2,676.68 ","$0.00 ","$3,617.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,617.13 ","$0.00 ","$1,808.56 ","$2,864.77 ","$2,893.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-011","SUP","Custom 27203010","","826-011  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$828.50 ","$613.09 ","$0.00 ","$828.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$828.50 ","$0.00 ","$414.25 ","$656.17 ","$662.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-012","SUP","Custom 27203010","","826-012  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$828.50 ","$613.09 ","$0.00 ","$828.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$828.50 ","$0.00 ","$414.25 ","$656.17 ","$662.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-013","SUP","Custom 27203010","","826-013  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$828.50 ","$613.09 ","$0.00 ","$828.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$828.50 ","$0.00 ","$414.25 ","$656.17 ","$662.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-016","SUP","Custom 27803010","","826-016  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$388.50 ","$287.49 ","$0.00 ","$388.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$388.50 ","$0.00 ","$194.25 ","$307.69 ","$310.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0308","SUP","Custom 27803010","","82-6-0308  -  INSERT TIBIAL 3 8MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0310","SUP","Custom 27803010","","82-6-0310  -  INSERT TIBIAL 3 10MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0312","SUP","Custom 27803010","","82-6-0312  -  INSERT TIBIAL 3 12MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0314","SUP","Custom 27803010","","82-6-0314  -  INSERT TIBIAL 3 14MM CRUC RET SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0315","SUP","Custom 27803010","","82-6-0315  -  INSERT TIBIAL 3 15MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0318","SUP","Custom 27803010","","82-6-0318  -  INSERT TIBIAL 3 18MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0321","SUP","Custom 27803010","","82-6-0321  -  INSERT TIBIAL 3 21MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0324","SUP","Custom 27803010","","82-6-0324  -  INSERT TIBIAL 3 24MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0508","SUP","Custom 27803010","","82-6-0508  -  INSERT TIBIAL 5 8MM KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0510","SUP","Custom 27803010","","82-6-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0512","SUP","Custom 27803010","","82-6-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0515","SUP","Custom 27803010","","82-6-0515  -  INSERT TIBIAL 5 15MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0518","SUP","Custom 27803010","","82-6-0518  -  INSERT TIBIAL 5 18MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0521","SUP","Custom 27803010","","82-6-0521  -  INSERT TIBIAL 5 21MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0524","SUP","Custom 27803010","","82-6-0524  -  INSERT TIBIAL 5 24MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0708","SUP","Custom 27803010","","82-6-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0710","SUP","Custom 27803010","","82-6-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0712","SUP","Custom 27803010","","82-6-0712  -  INSERT TIBIAL X3 POLYETHYLENE KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0715","SUP","Custom 27803010","","82-6-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0718","SUP","Custom 27803010","","82-6-0718  -  INSERT TIBIAL 7 18MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0721","SUP","Custom 27803010","","82-6-0721  -  INSERT TIBIAL 7 21MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0724","SUP","Custom 27803010","","82-6-0724  -  INSERT TIBIAL 7 24MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0908","SUP","Custom 27803010","","82-6-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0910","SUP","Custom 27803010","","82-6-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0912","SUP","Custom 27803010","","82-6-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0914","SUP","Custom 27803010","","82-6-0914  -  INSERT TIBIAL 9 14MM CRUC RET SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0915","SUP","Custom 27803010","","82-6-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0916","SUP","Custom 27803010","","82-6-0916  -  INSERT TIBIAL 9 16MM CRUC RET SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0918","SUP","Custom 27803010","","82-6-0918  -  INSERT TIBIAL 9 18MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0921","SUP","Custom 27803010","","82-6-0921  -  INSERT TIBIAL 9 21MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-0924","SUP","Custom 27803010","","82-6-0924  -  INSERT TIBIAL 9 24MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1108","SUP","Custom 27803010","","82-6-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1110","SUP","Custom 27803010","","82-6-1110  -  INSERT TIBIAL 11 10MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1112","SUP","Custom 27803010","","82-6-1112  -  INSERT TIBIAL 11 12MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1114","SUP","Custom 27803010","","82-6-1114  -  INSERT TIBIAL 11 14MM CRUC RET SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1115","SUP","Custom 27803010","","82-6-1115  -  INSERT TIBIAL 11 15MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1116","SUP","Custom 27803010","","82-6-1116  -  INSERT TIBIAL 11 16MM CRUC RET SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1118","SUP","Custom 27803010","","82-6-1118  -  INSERT TIBIAL CRUC RET SCORPIO X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1121","SUP","Custom 27803010","","82-6-1121  -  INSERT TIBIAL 11 21MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6-1124","SUP","Custom 27803010","","82-6-1124  -  INSERT TIBIAL 11 24MM CRUC RET SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-212","SUP","Custom 27203010","","826-212  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,004.75 ","$743.52 ","$0.00 ","$1,004.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.75 ","$0.00 ","$502.38 ","$795.76 ","$803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-213","SUP","Custom 27203010","","826-213  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,004.75 ","$743.52 ","$0.00 ","$1,004.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.75 ","$0.00 ","$502.38 ","$795.76 ","$803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-216","SUP","Custom 27803010","","826-216  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$495.00 ","$366.30 ","$0.00 ","$495.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$495.00 ","$0.00 ","$247.50 ","$392.04 ","$396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-217","SUP","HCPCS C1713","","826-217  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$178.50 ","$132.09 ","$0.00 ","$178.50 ","$80.33 ","$0.00 ","$37.20 ","$0.00 ","$0.00 ","$31.25 ","$178.50 ","$0.00 ","$89.25 ","$141.37 ","$142.80 ","$0.00 ","$27.94 ","$0.00 ","$28.42 ","$0.00 "
"826-219","SUP","Custom 27203010","","826-219  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,004.75 ","$743.52 ","$0.00 ","$1,004.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.75 ","$0.00 ","$502.38 ","$795.76 ","$803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826-320","SUP","Custom 27203010","","826-320  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,004.75 ","$743.52 ","$0.00 ","$1,004.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.75 ","$0.00 ","$502.38 ","$795.76 ","$803.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"826614 - USE 19994800","SUP","Custom 27803010","","826614 - USE 19994800  -  KIT CRANIOTOMY CRANIAL ACCES CODMAN","BOTH IP/OP","$721.63 ","$534.01 ","$0.00 ","$721.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$721.63 ","$0.00 ","$360.81 ","$571.53 ","$577.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6638","SUP","Custom 27803010","","82-6638  -  KIT PRSS MONITR MCSNSR .7MM SBDRL INPRENCH SKL BOLT","BOTH IP/OP","$1,947.50 ","$1,441.15 ","$0.00 ","$1,947.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,947.50 ","$0.00 ","$973.75 ","$1,542.42 ","$1,558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-6653","SUP","Custom 27803010","","82-6653  -  KIT PRESSURE MONITR 38CM TRANSDUCER CATHETER TUNNELING","BOTH IP/OP","$2,027.50 ","$1,500.35 ","$0.00 ","$2,027.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,027.50 ","$0.00 ","$1,013.75 ","$1,605.78 ","$1,622.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0308","SUP","Custom 27803010","","82-7-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0310","SUP","Custom 27803010","","82-7-0310  -  INSERT TIBIAL 3 10MM","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0312","SUP","Custom 27803010","","82-7-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0314","SUP","Custom 27803010","","82-7-0314  -  INSERT TIBIAL 3 14MM POSTERIOR STABILIZING SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0315","SUP","Custom 27803010","","82-7-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0316","SUP","Custom 27803010","","82-7-0316  -  INSERT TIBIAL 3 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0318","SUP","Custom 27803010","","82-7-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0321","SUP","Custom 27803010","","82-7-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0324","SUP","Custom 27803010","","82-7-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0508","SUP","Custom 27803010","","82-7-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0510","SUP","Custom 27803010","","82-7-0510  -  INSERT TIBIAL 5 10MM","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0512","SUP","Custom 27803010","","82-7-0512  -  INSERT TIBIAL 5 12MM","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0514","SUP","Custom 27803010","","82-7-0514  -  INSERT TIBIAL 5 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0515","SUP","Custom 27803010","","82-7-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0516","SUP","Custom 27803010","","82-7-0516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0518","SUP","Custom 27803010","","82-7-0518  -  INSERT TIBIAL 3 18MM","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0521","SUP","Custom 27803010","","82-7-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0524","SUP","Custom 27803010","","82-7-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0708","SUP","Custom 27803010","","82-7-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0710","SUP","Custom 27803010","","82-7-0710  -  INSERT TIBIAL 7 10MM","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0712","SUP","Custom 27803010","","82-7-0712  -  INSERT TIBIAL 7 12MM SCORPIO KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0714","SUP","Custom 27803010","","82-7-0714  -  INSERT TIBIAL 7 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0715","SUP","Custom 27803010","","82-7-0715  -  INSERT TIBIAL 7 15MM SCORPIO KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0716","SUP","Custom 27803010","","82-7-0716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0718","SUP","Custom 27803010","","82-7-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0721","SUP","Custom 27803010","","82-7-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0724","SUP","Custom 27803010","","82-7-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0908","SUP","Custom 27803010","","82-7-0908  -  INSERT TIBIAL 9 8MM KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0910","SUP","Custom 27803010","","82-7-0910  -  INSERT TIBIAL 10MM KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0912","SUP","Custom 27803010","","82-7-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0914","SUP","Custom 27803010","","82-7-0914  -  INSERT TIBIAL 9 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0915","SUP","Custom 27803010","","82-7-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0916","SUP","Custom 27803010","","82-7-0916  -  INSERT TIBIAL 9 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0918","SUP","Custom 27803010","","82-7-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0921","SUP","Custom 27803010","","82-7-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-0924","SUP","Custom 27803010","","82-7-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1108","SUP","Custom 27803010","","82-7-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1110","SUP","Custom 27803010","","82-7-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCORPIO NRG X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1112","SUP","Custom 27803010","","82-7-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCORPIO NRG X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1114","SUP","Custom 27803010","","82-7-1114  -  INSERT TIBIAL 11 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1115","SUP","Custom 27803010","","82-7-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCORPIO NRG X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1116","SUP","Custom 27803010","","82-7-1116  -  INSERT TIBIAL 11 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1118","SUP","Custom 27803010","","82-7-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCORPIO NRG X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1121","SUP","Custom 27803010","","82-7-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCORPIO NRG X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"82-7-1124","SUP","Custom 27803010","","82-7-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCORPIO NRG X3","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"827-160","SUP","HCPCS C1713","","827-160  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$129.00 ","$95.46 ","$0.00 ","$129.00 ","$58.05 ","$0.00 ","$26.89 ","$0.00 ","$0.00 ","$22.59 ","$129.00 ","$0.00 ","$64.50 ","$102.17 ","$103.20 ","$0.00 ","$20.19 ","$0.00 ","$20.54 ","$0.00 "
"828-083","SUP","HCPCS C1713","","828-083  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"828-090","SUP","HCPCS C1713","","828-090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"828-105","SUP","HCPCS C1713","","828-105  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"828-107","SUP","HCPCS C1713","","828-107  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"828-135C","SUP","Custom 27803010","","828-135C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,314.30 ","$972.58 ","$0.00 ","$1,314.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.30 ","$0.00 ","$657.15 ","$1,040.93 ","$1,051.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-136C","SUP","Custom 27803010","","828-136C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,314.30 ","$972.58 ","$0.00 ","$1,314.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.30 ","$0.00 ","$657.15 ","$1,040.93 ","$1,051.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-137C","SUP","Custom 27803010","","828-137C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,314.30 ","$972.58 ","$0.00 ","$1,314.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.30 ","$0.00 ","$657.15 ","$1,040.93 ","$1,051.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-145","SUP","HCPCS C1713","","828-145  -  SCREW BONE TSRH TI SPNL LCK FLSH BRK 6.35 MM ROD","BOTH IP/OP","$482.65 ","$357.16 ","$0.00 ","$482.65 ","$217.19 ","$0.00 ","$100.60 ","$0.00 ","$0.00 ","$84.51 ","$482.65 ","$0.00 ","$241.33 ","$382.26 ","$386.12 ","$0.00 ","$75.53 ","$0.00 ","$76.84 ","$0.00 "
"828-190","SUP","HCPCS C1713","","828-190  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"828-191C","SUP","Custom 27803010","","828-191C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,314.30 ","$972.58 ","$0.00 ","$1,314.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.30 ","$0.00 ","$657.15 ","$1,040.93 ","$1,051.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-193","SUP","Custom 27803010","","828-193  -  BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT VA","BOTH IP/OP","$2,361.80 ","$1,747.73 ","$0.00 ","$2,361.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,361.80 ","$0.00 ","$1,180.90 ","$1,870.55 ","$1,889.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-193C","SUP","HCPCS C1713","","828-193C  -  BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT CONNCTR","BOTH IP/OP","$1,314.30 ","$972.58 ","$0.00 ","$1,314.30 ","$591.44 ","$0.00 ","$273.93 ","$0.00 ","$0.00 ","$230.12 ","$1,314.30 ","$0.00 ","$657.15 ","$1,040.93 ","$1,051.44 ","$0.00 ","$205.69 ","$0.00 ","$209.24 ","$0.00 "
"828-349C","SUP","Custom 27803010","","828-349C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,314.30 ","$972.58 ","$0.00 ","$1,314.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,314.30 ","$0.00 ","$657.15 ","$1,040.93 ","$1,051.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-780","SUP","HCPCS C1713","","828-780  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-785","SUP","HCPCS C1713","","828-785  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-790","SUP","HCPCS C1713","","828-790  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-795","SUP","HCPCS C1713","","828-795  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828800PL","SUP","Custom 27803010","","828800PL  -  VALVE SHUNT INLINE CERTAS","BOTH IP/OP","$11,722.83 ","$8,674.89 ","$0.00 ","$11,400.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,400.58 ","$0.00 ","$5,700.29 ","$9,029.26 ","$9,120.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"828-830","SUP","HCPCS C1713","","828-830  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-835","SUP","HCPCS C1713","","828-835  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-840","SUP","HCPCS C1713","","828-840  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-845","SUP","HCPCS C1713","","828-845  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-850","SUP","HCPCS C1713","","828-850  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-855","SUP","HCPCS C1713","","828-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-860","SUP","HCPCS C1713","","828-860  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-930","SUP","HCPCS C1713","","828-930  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-935","SUP","HCPCS C1713","","828-935  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-940","SUP","HCPCS C1713","","828-940  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-945","SUP","HCPCS C1713","","828-945  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"828-950","SUP","HCPCS C1713","","828-950  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,194.50 ","$1,623.93 ","$0.00 ","$2,194.50 ","$987.53 ","$0.00 ","$457.39 ","$0.00 ","$0.00 ","$384.24 ","$2,194.50 ","$0.00 ","$1,097.25 ","$1,738.04 ","$1,755.60 ","$0.00 ","$343.44 ","$0.00 ","$349.36 ","$0.00 "
"830-031","SUP","HCPCS C1713","","830-031  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-033","SUP","HCPCS C1713","","830-033  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-035","SUP","HCPCS C1713","","830-035  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-037","SUP","HCPCS C1713","","830-037  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-039","SUP","HCPCS C1713","","830-039  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-041","SUP","HCPCS C1713","","830-041  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-043","SUP","HCPCS C1713","","830-043  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-045","SUP","HCPCS C1713","","830-045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-050","SUP","HCPCS C1713","","830-050  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-051","SUP","HCPCS C1713","","830-051  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8300KITB19A","SUP","Custom 27803010","","8300KITB19A  -  VALVE AOR 19MM STRL LF EDWRD INTUITY ELT","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8300KITB21A","SUP","Custom 27803010","","8300KITB21A  -  VALVE AOR 21MM STRL LF EDWRD INTUITY ELT","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8300KITB23A","SUP","Custom 27803010","","8300KITB23A  -  VALVE AOR 23MM STRL LF EDWRD INTUITY ELT","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8300KITB25A","SUP","Custom 27803010","","8300KITB25A  -  VALVE AOR 25MM STRL LF EDWRD INTUITY ELT","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8300KITB27A","SUP","Custom 27803010","","8300KITB27A  -  VALVE AOR 27MM STRL LF EDWRD INTUITY ELT","BOTH IP/OP","$30,000.00 ","$22,200.00 ","$0.00 ","$30,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,000.00 ","$0.00 ","$15,000.00 ","$23,760.00 ","$24,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8304H","SUP","Custom 27203010","","8304H  -  SUTURE NABSB 7-0 BV-1 24IN BLU PR VSBLCK 2 ARM MFL","BOTH IP/OP","$46.76 ","$34.60 ","$0.00 ","$47.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.46 ","$0.00 ","$23.73 ","$37.59 ","$37.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"830-529","SUP","HCPCS C1713","","830-529  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-531","SUP","HCPCS C1713","","830-531  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-533","SUP","HCPCS C1713","","830-533  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-535","SUP","HCPCS C1713","","830-535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-537","SUP","HCPCS C1713","","830-537  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-539","SUP","HCPCS C1713","","830-539  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-541","SUP","HCPCS C1713","","830-541  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-550","SUP","HCPCS C1713","","830-550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"830-551","SUP","HCPCS C1713","","830-551  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"8305H","SUP","Custom 27203010","","8305H  -  SUTURE NONABSORBABLE 6-0 BV-1 24IN 2 ARM MONOFILAMENT FIRM","BOTH IP/OP","$46.66 ","$34.53 ","$0.00 ","$47.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.36 ","$0.00 ","$23.68 ","$37.51 ","$37.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"83545309H","SUP","HCPCS C1713","","83545309H  -  SCREW BN OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83545359H","SUP","HCPCS C1713","","83545359H  -  SCREW BN OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83545409H","SUP","HCPCS C1713","","83545409H  -  SCREW BN 4.5MM 40MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83545459H","SUP","HCPCS C1713","","83545459H  -  SCREW BN 4.5MM 45MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83545509H","SUP","HCPCS C1713","","83545509H  -  SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83545559H","SUP","HCPCS C1713","","83545559H  -  SCREW BN 4.5MM 55MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83545609H","SUP","HCPCS C1713","","83545609H  -  SCREW BN 4.5MM 60MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555309H","SUP","HCPCS C1713","","83555309H  -  SCREW BN 5.5MM 30MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555359H","SUP","HCPCS C1713","","83555359H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555409H","SUP","HCPCS C1713","","83555409H  -  SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555459H","SUP","HCPCS C1713","","83555459H  -  SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555509H","SUP","HCPCS C1713","","83555509H  -  SCREW BN 5.5MM 50MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555559H","SUP","HCPCS C1713","","83555559H  -  SCREW BN 5.5MM 55MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83555609H","SUP","HCPCS C1713","","83555609H  -  SCREW BN 5.5MM 60MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565309H","SUP","HCPCS C1713","","83565309H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565359H","SUP","HCPCS C1713","","83565359H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565409H","SUP","HCPCS C1713","","83565409H  -  SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565459H","SUP","HCPCS C1713","","83565459H  -  SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565509H","SUP","HCPCS C1713","","83565509H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565559H","SUP","HCPCS C1713","","83565559H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83565609H","SUP","HCPCS C1713","","83565609H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575309H","SUP","HCPCS C1713","","83575309H  -  SCREW BN 7.5MM 30MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575359H","SUP","HCPCS C1713","","83575359H  -  SCREW BN 7.5MM 35MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575409H","SUP","HCPCS C1713","","83575409H  -  SCREW BN 7.5MM 40MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575459H","SUP","HCPCS C1713","","83575459H  -  SCREW BN 7.5MM 45MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575509H","SUP","HCPCS C1713","","83575509H  -  SCREW BN 7.5MM 50MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575559H","SUP","HCPCS C1713","","83575559H  -  SCREW BN 7.5MM 55MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83575609H","SUP","HCPCS C1713","","83575609H  -  SCREW BN 7.5MM 60MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585309H","SUP","HCPCS C1713","","83585309H  -  SCREW BN 8.5MM 30MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585359H","SUP","HCPCS C1713","","83585359H  -  SCREW BN 8.5MM 35MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585409H","SUP","HCPCS C1713","","83585409H  -  SCREW BN 8.5MM 40MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585459H","SUP","HCPCS C1713","","83585459H  -  SCREW BN 8.5MM 45MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585509H","SUP","HCPCS C1713","","83585509H  -  SCREW BN 8.5MM 50MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585559H","SUP","HCPCS C1713","","83585559H  -  SCREW BN 8.5MM 55MM OSTEOGRIP TSRH HA SPNE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"83585609H","SUP","HCPCS C1713","","83585609H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"837-125","SUP","HCPCS C1713","","837-125  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"837-135","SUP","HCPCS C1713","","837-135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"837-230","SUP","HCPCS C1713","","837-230  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-235","SUP","HCPCS C1713","","837-235  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-240","SUP","HCPCS C1713","","837-240  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-245","SUP","HCPCS C1713","","837-245  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-250","SUP","HCPCS C1713","","837-250  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-330","SUP","HCPCS C1713","","837-330  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-335","SUP","HCPCS C1713","","837-335  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-340","SUP","HCPCS C1713","","837-340  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-345","SUP","HCPCS C1713","","837-345  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-350","SUP","HCPCS C1713","","837-350  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-355","SUP","HCPCS C1713","","837-355  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-430","SUP","HCPCS C1713","","837-430  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-435","SUP","HCPCS C1713","","837-435  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-440","SUP","HCPCS C1713","","837-440  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-445","SUP","HCPCS C1713","","837-445  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-450","SUP","HCPCS C1713","","837-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-455","SUP","HCPCS C1713","","837-455  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-460","SUP","HCPCS C1713","","837-460  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"837-530","SUP","HCPCS C1713","","837-530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-535","SUP","HCPCS C1713","","837-535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-540","SUP","HCPCS C1713","","837-540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-545","SUP","HCPCS C1713","","837-545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-550","SUP","HCPCS C1713","","837-550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-630","SUP","HCPCS C1713","","837-630  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-635","SUP","HCPCS C1713","","837-635  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-640","SUP","HCPCS C1713","","837-640  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-645","SUP","HCPCS C1713","","837-645  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-650","SUP","HCPCS C1713","","837-650  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-655","SUP","HCPCS C1713","","837-655  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-730","SUP","HCPCS C1713","","837-730  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-735","SUP","HCPCS C1713","","837-735  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-740","SUP","HCPCS C1713","","837-740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-745","SUP","HCPCS C1713","","837-745  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-750","SUP","HCPCS C1713","","837-750  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-755","SUP","HCPCS C1713","","837-755  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-760","SUP","HCPCS C1713","","837-760  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-835","SUP","HCPCS C1713","","837-835  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"837-845","SUP","HCPCS C1713","","837-845  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$984.00 ","$728.16 ","$0.00 ","$984.00 ","$442.80 ","$0.00 ","$205.09 ","$0.00 ","$0.00 ","$172.29 ","$984.00 ","$0.00 ","$492.00 ","$779.33 ","$787.20 ","$0.00 ","$154.00 ","$0.00 ","$156.65 ","$0.00 "
"8379120C","SUP","Custom 27803010","","8379120C  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8379121C","SUP","Custom 27803010","","8379121C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,165.65 ","$1,602.58 ","$0.00 ","$2,165.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.65 ","$0.00 ","$1,082.83 ","$1,715.19 ","$1,732.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"838-012","SUP","HCPCS C1713","","838-012  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"838-855","SUP","HCPCS C1713","","838-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"8400-0611","SUP","HCPCS Q4107","","8400-0611  -  TISSUE SYNTH CALCIUM SLF 5ML OSTST RESORB MINI BEAD KIT FST","BOTH IP/OP","$1,637.50 ","$1,211.75 ","$0.00 ","$1,637.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,637.50 ","$0.00 ","$818.75 ","$1,296.90 ","$1,310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84133HT","SUP","HCPCS C1713","","84133HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"84154T","SUP","Custom 27803010","","84154T  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,200.50 ","$1,628.37 ","$0.00 ","$2,200.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.50 ","$0.00 ","$1,100.25 ","$1,742.80 ","$1,760.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84161HT","SUP","HCPCS C1713","","84161HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"84181H","SUP","Custom 27803010","","84181H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,991.25 ","$1,473.53 ","$0.00 ","$1,991.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,991.25 ","$0.00 ","$995.63 ","$1,577.07 ","$1,593.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84193H","SUP","HCPCS C1713","","84193H  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"84193HT","SUP","HCPCS C1713","","84193HT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"8450107030D","SUP","Custom 27203010","","8450107030D  -  BIT DRILL 3MM 13CM MATCH HEAD DIAMOND","BOTH IP/OP","$466.35 ","$345.10 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$466.35 ","$0.00 ","$233.18 ","$369.35 ","$373.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"845-011","SUP","HCPCS C1713","","845-011  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"84505H","SUP","Custom 27803010","","84505H  -  CONNECTOR ROD 5.5/5.5MM DMN SPNE","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84505HT","SUP","Custom 27803010","","84505HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84505LH","SUP","Custom 27803010","","84505LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84505QH","SUP","Custom 27803010","","84505QH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84506H","SUP","Custom 27803010","","84506H  -  CONNECTOR ROD 5.5/6.35MM CD HZN DMN SS SPNE","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84506HT","SUP","Custom 27803010","","84506HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84507H","SUP","Custom 27803010","","84507H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,052.75 ","$1,519.04 ","$0.00 ","$2,052.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,052.75 ","$0.00 ","$1,026.38 ","$1,625.78 ","$1,642.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84507HT","SUP","Custom 27803010","","84507HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84509H","SUP","Custom 27803010","","84509H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84509HT","SUP","Custom 27803010","","84509HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84510H","SUP","Custom 27803010","","84510H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84510HT","SUP","Custom 27803010","","84510HT  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"84511H","SUP","Custom 27803010","","84511H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"848-011","SUP","HCPCS C1713","","848-011  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"848-012","SUP","HCPCS C1713","","848-012  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"848-520","SUP","HCPCS C1713","","848-520  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-523","SUP","HCPCS C1713","","848-523  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-525","SUP","HCPCS C1713","","848-525  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-528","SUP","HCPCS C1713","","848-528  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-530","SUP","HCPCS C1713","","848-530  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-533","SUP","HCPCS C1713","","848-533  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-535","SUP","HCPCS C1713","","848-535  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-538","SUP","HCPCS C1713","","848-538  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-540","SUP","HCPCS C1713","","848-540  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-543","SUP","HCPCS C1713","","848-543  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-545","SUP","HCPCS C1713","","848-545  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-548","SUP","HCPCS C1713","","848-548  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-550","SUP","HCPCS C1713","","848-550  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-553","SUP","HCPCS C1713","","848-553  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-555","SUP","HCPCS C1713","","848-555  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-625","SUP","HCPCS C1713","","848-625  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-630","SUP","HCPCS C1713","","848-630  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-635","SUP","HCPCS C1713","","848-635  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-640","SUP","HCPCS C1713","","848-640  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-645","SUP","HCPCS C1713","","848-645  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-725","SUP","HCPCS C1713","","848-725  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-730","SUP","HCPCS C1713","","848-730  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-735","SUP","HCPCS C1713","","848-735  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-740","SUP","HCPCS C1713","","848-740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-745","SUP","HCPCS C1713","","848-745  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$2,352.00 ","$1,740.48 ","$0.00 ","$2,352.00 ","$1,058.40 ","$0.00 ","$490.22 ","$0.00 ","$0.00 ","$411.82 ","$2,352.00 ","$0.00 ","$1,176.00 ","$1,862.78 ","$1,881.60 ","$0.00 ","$368.09 ","$0.00 ","$374.44 ","$0.00 "
"848-855","SUP","HCPCS C1713","","848-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"851.002.01S","SUP","HCPCS C1713","","851.002.01S  -  PLATE BONE CRNMXF 2 HOLE STR RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$315.00 ","$233.10 ","$0.00 ","$315.00 ","$141.75 ","$0.00 ","$65.65 ","$0.00 ","$0.00 ","$55.15 ","$315.00 ","$0.00 ","$157.50 ","$249.48 ","$252.00 ","$0.00 ","$49.30 ","$0.00 ","$50.15 ","$0.00 "
"851.004.01S","SUP","HCPCS C1713","","851.004.01S  -  PLATE BONE CRNMXF 4 HOLE STR RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$461.25 ","$207.56 ","$0.00 ","$96.14 ","$0.00 ","$0.00 ","$80.76 ","$461.25 ","$0.00 ","$230.63 ","$365.31 ","$369.00 ","$0.00 ","$72.19 ","$0.00 ","$73.43 ","$0.00 "
"851.008.01S","SUP","HCPCS C1713","","851.008.01S  -  PLATE BONE CRNMXF 8 HOLE ADP RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"851.009.01S","SUP","HCPCS C1713","","851.009.01S  -  PLATE 1.5 MM SCR 8 HOLE SCLP ADP SCLP RPD RESORB BONE STRL","BOTH IP/OP","$517.50 ","$382.95 ","$0.00 ","$517.50 ","$232.88 ","$0.00 ","$107.86 ","$0.00 ","$0.00 ","$90.61 ","$517.50 ","$0.00 ","$258.75 ","$409.86 ","$414.00 ","$0.00 ","$80.99 ","$0.00 ","$82.39 ","$0.00 "
"851.020.01S","SUP","HCPCS C1713","","851.020.01S  -  PLATE BONE CRNMXF 20 HOLE ADP RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$753.75 ","$557.78 ","$0.00 ","$753.75 ","$339.19 ","$0.00 ","$157.10 ","$0.00 ","$0.00 ","$131.98 ","$753.75 ","$0.00 ","$376.88 ","$596.97 ","$603.00 ","$0.00 ","$117.96 ","$0.00 ","$120.00 ","$0.00 "
"851.021.01S","SUP","HCPCS C1713","","851.021.01S  -  PLATE 1.5 MM SCR 20 HOLE SCLP ADP SCLP RPD RESORB BONE STRL","BOTH IP/OP","$753.75 ","$557.78 ","$0.00 ","$753.75 ","$339.19 ","$0.00 ","$157.10 ","$0.00 ","$0.00 ","$131.98 ","$753.75 ","$0.00 ","$376.88 ","$596.97 ","$603.00 ","$0.00 ","$117.96 ","$0.00 ","$120.00 ","$0.00 "
"851.110.01S","SUP","HCPCS C1713","","851.110.01S  -  PLATE BONE ORBTL RIM 10 HOLE RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"851.320.01S","SUP","HCPCS C1713","","851.320.01S  -  PLATE BONE CRNMXF 10 HOLE 2 Y RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"851.343.01S","SUP","HCPCS C1713","","851.343.01S  -  PLATE BONE CRNMXF 4X3X3 HOLE Y RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"851.344.01S","SUP","HCPCS C1713","","851.344.01S  -  1.5MM RAPID RESORB T-PLATE 2 X 3 HOLES-STERILE","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"851.420.01S","SUP","HCPCS C1713","","851.420.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$1,226.25 ","$907.43 ","$0.00 ","$1,226.25 ","$551.81 ","$0.00 ","$255.58 ","$0.00 ","$0.00 ","$214.71 ","$1,226.25 ","$0.00 ","$613.13 ","$971.19 ","$981.00 ","$0.00 ","$191.91 ","$0.00 ","$195.22 ","$0.00 "
"851.421.01S","SUP","HCPCS C1713","","851.421.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$1,518.75 ","$1,123.88 ","$0.00 ","$1,518.75 ","$683.44 ","$0.00 ","$316.55 ","$0.00 ","$0.00 ","$265.92 ","$1,518.75 ","$0.00 ","$759.38 ","$1,202.85 ","$1,215.00 ","$0.00 ","$237.68 ","$0.00 ","$241.79 ","$0.00 "
"851.424.01S","SUP","HCPCS C1713","","851.424.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT SCLP RPD RESORB 1.5 MM SCR","BOTH IP/OP","$1,228.50 ","$909.09 ","$0.00 ","$1,228.50 ","$552.83 ","$0.00 ","$256.05 ","$0.00 ","$0.00 ","$215.10 ","$1,228.50 ","$0.00 ","$614.25 ","$972.97 ","$982.80 ","$0.00 ","$192.26 ","$0.00 ","$195.58 ","$0.00 "
"851.425.01S","SUP","HCPCS C1713","","851.425.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT SCLP RPD RESORB 1.5 MM SCR","BOTH IP/OP","$1,518.75 ","$1,123.88 ","$0.00 ","$1,518.75 ","$683.44 ","$0.00 ","$316.55 ","$0.00 ","$0.00 ","$265.92 ","$1,518.75 ","$0.00 ","$759.38 ","$1,202.85 ","$1,215.00 ","$0.00 ","$237.68 ","$0.00 ","$241.79 ","$0.00 "
"851.436.01S","SUP","HCPCS C1713","","851.436.01S  -  PLATE 1.5 MM SCR 2X36 HOLE STRUT SCLP RPD RESORB BONE STRL","BOTH IP/OP","$3,026.25 ","$2,239.43 ","$0.00 ","$3,026.25 ","$1,361.81 ","$0.00 ","$630.75 ","$0.00 ","$0.00 ","$529.87 ","$3,026.25 ","$0.00 ","$1,513.13 ","$2,396.79 ","$2,421.00 ","$0.00 ","$473.61 ","$0.00 ","$481.78 ","$0.00 "
"851.500.01S","SUP","HCPCS C1713","","851.500.01S  -  1.5MM RAPID RESORB BOX PLATE 4 HOLES-STERILE","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"851.506.01S","SUP","Custom 27803010","","851.506.01S  -  COVER BUR HOLE CRNMXF 8 HOLE RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851.508.01S","SUP","Custom 27803010","","851.508.01S  -  COVER BUR HOLE CRNMXF 10 HOLE RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"851.510.01S","SUP","HCPCS C1713","","851.510.01S  -  PLATE BONE 50X50X.5MM CRNMXF MESH RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$3,060.00 ","$2,264.40 ","$0.00 ","$3,060.00 ","$1,377.00 ","$0.00 ","$637.78 ","$0.00 ","$0.00 ","$535.78 ","$3,060.00 ","$0.00 ","$1,530.00 ","$2,423.52 ","$2,448.00 ","$0.00 ","$478.89 ","$0.00 ","$487.15 ","$0.00 "
"851.512.01S","SUP","HCPCS C1713","","851.512.01S  -  PLATE BONE 100X100X.5MM CRNMXF MESH RPD RESORB 1.5MM SCR","BOTH IP/OP","$6,525.00 ","$4,828.50 ","$0.00 ","$6,525.00 ","$2,936.25 ","$0.00 ","$1,359.97 ","$0.00 ","$0.00 ","$1,142.48 ","$6,525.00 ","$0.00 ","$3,262.50 ","$5,167.80 ","$5,220.00 ","$0.00 ","$1,021.16 ","$0.00 ","$1,038.78 ","$0.00 "
"851.520.01S","SUP","HCPCS C1713","","851.520.01S  -  PLATE BONE 50X50X.8MM CRNMXF MESH RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$3,195.00 ","$2,364.30 ","$0.00 ","$3,195.00 ","$1,437.75 ","$0.00 ","$665.92 ","$0.00 ","$0.00 ","$559.42 ","$3,195.00 ","$0.00 ","$1,597.50 ","$2,530.44 ","$2,556.00 ","$0.00 ","$500.02 ","$0.00 ","$508.64 ","$0.00 "
"851.521.01S","SUP","HCPCS C1713","","851.521.01S  -  PLATE BONE 100X100X.8MM CRNMXF MESH RPD RESORB 1.5MM SCR","BOTH IP/OP","$7,278.75 ","$5,386.28 ","$0.00 ","$7,278.75 ","$3,275.44 ","$0.00 ","$1,517.07 ","$0.00 ","$0.00 ","$1,274.45 ","$7,278.75 ","$0.00 ","$3,639.38 ","$5,764.77 ","$5,823.00 ","$0.00 ","$1,139.12 ","$0.00 ","$1,158.78 ","$0.00 "
"851.532.01S","SUP","HCPCS C1713","","851.532.01S  -  PLATE BONE 50X50X.5MM CRNMXF SHT RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$2,256.75 ","$1,670.00 ","$0.00 ","$2,256.75 ","$1,015.54 ","$0.00 ","$470.36 ","$0.00 ","$0.00 ","$395.14 ","$2,256.75 ","$0.00 ","$1,128.38 ","$1,787.35 ","$1,805.40 ","$0.00 ","$353.18 ","$0.00 ","$359.27 ","$0.00 "
"851.534.01S","SUP","HCPCS C1713","","851.534.01S  -  PLATE BONE 50X50X.8MM CRNMXF SHT RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$2,351.25 ","$1,739.93 ","$0.00 ","$2,351.25 ","$1,058.06 ","$0.00 ","$490.06 ","$0.00 ","$0.00 ","$411.69 ","$2,351.25 ","$0.00 ","$1,175.63 ","$1,862.19 ","$1,881.00 ","$0.00 ","$367.97 ","$0.00 ","$374.32 ","$0.00 "
"851.540.01S","SUP","HCPCS C1713","","851.540.01S  -  PLATE BONE TRNS 24X24MM THK.5MM ORBTL FLR RPD REABSORBABLE","BOTH IP/OP","$1,890.00 ","$1,398.60 ","$0.00 ","$1,890.00 ","$850.50 ","$0.00 ","$393.92 ","$0.00 ","$0.00 ","$330.92 ","$1,890.00 ","$0.00 ","$945.00 ","$1,496.88 ","$1,512.00 ","$0.00 ","$295.79 ","$0.00 ","$300.89 ","$0.00 "
"851.541.01S","SUP","HCPCS C1713","","851.541.01S  -  PLATE BONE 30MM MED ORBTL FLR RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$1,968.75 ","$1,456.88 ","$0.00 ","$1,968.75 ","$885.94 ","$0.00 ","$410.34 ","$0.00 ","$0.00 ","$344.71 ","$1,968.75 ","$0.00 ","$984.38 ","$1,559.25 ","$1,575.00 ","$0.00 ","$308.11 ","$0.00 ","$313.43 ","$0.00 "
"851.542.01S","SUP","HCPCS C1713","","851.542.01S  -  PLATE BONE 35MM LG ORBTL FLR RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"851.604.01S","SUP","HCPCS C1713","","851.604.01S  -  PLATE BONE CRNMXF 4 HOLE X RPD RESORB 1.5 MM SCR STRL","BOTH IP/OP","$663.75 ","$491.18 ","$0.00 ","$663.75 ","$298.69 ","$0.00 ","$138.34 ","$0.00 ","$0.00 ","$116.22 ","$663.75 ","$0.00 ","$331.88 ","$525.69 ","$531.00 ","$0.00 ","$103.88 ","$0.00 ","$105.67 ","$0.00 "
"851.605.01S","SUP","HCPCS C1713","","851.605.01S  -  1.5MM RAPID RESORB X-PLATE 8 HOLES-STERILE","BOTH IP/OP","$663.75 ","$491.18 ","$0.00 ","$663.75 ","$298.69 ","$0.00 ","$138.34 ","$0.00 ","$0.00 ","$116.22 ","$663.75 ","$0.00 ","$331.88 ","$525.69 ","$531.00 ","$0.00 ","$103.88 ","$0.00 ","$105.67 ","$0.00 "
"851.611.01S","SUP","HCPCS C1713","","851.611.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/50X50X0.25MM THK-STERILE","BOTH IP/OP","$3,352.50 ","$2,480.85 ","$0.00 ","$3,352.50 ","$1,508.63 ","$0.00 ","$698.74 ","$0.00 ","$0.00 ","$587.00 ","$3,352.50 ","$0.00 ","$1,676.25 ","$2,655.18 ","$2,682.00 ","$0.00 ","$524.67 ","$0.00 ","$533.72 ","$0.00 "
"851.612.01S","SUP","HCPCS C1713","","851.612.01S  -  MESH CRNL 100X100X.25MM STRL RAPIDSORB CNTR RSRB RPD 1.5MM","BOTH IP/OP","$7,222.50 ","$5,344.65 ","$0.00 ","$7,222.50 ","$3,250.13 ","$0.00 ","$1,505.35 ","$0.00 ","$0.00 ","$1,264.60 ","$7,222.50 ","$0.00 ","$3,611.25 ","$5,720.22 ","$5,778.00 ","$0.00 ","$1,130.32 ","$0.00 ","$1,149.82 ","$0.00 "
"851.621.01S","SUP","HCPCS C1713","","851.621.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/50X50X0.5MM THK-STERILE","BOTH IP/OP","$3,352.50 ","$2,480.85 ","$0.00 ","$3,352.50 ","$1,508.63 ","$0.00 ","$698.74 ","$0.00 ","$0.00 ","$587.00 ","$3,352.50 ","$0.00 ","$1,676.25 ","$2,655.18 ","$2,682.00 ","$0.00 ","$524.67 ","$0.00 ","$533.72 ","$0.00 "
"851.622.01S","SUP","HCPCS C1713","","851.622.01S  -  PLATE 100X100X.50MM 1.5MM SCR CONTUR MESH RPD RESORB BONE","BOTH IP/OP","$7,222.50 ","$5,344.65 ","$0.00 ","$7,222.50 ","$3,250.13 ","$0.00 ","$1,505.35 ","$0.00 ","$0.00 ","$1,264.60 ","$7,222.50 ","$0.00 ","$3,611.25 ","$5,720.22 ","$5,778.00 ","$0.00 ","$1,130.32 ","$0.00 ","$1,149.82 ","$0.00 "
"851.623.01S","SUP","HCPCS C1713","","851.623.01S  -  PLATE 150X150X.5MM 1.5MM SCR CONTUR MESH RPD RESORB BONE","BOTH IP/OP","$12,172.50 ","$9,007.65 ","$0.00 ","$12,172.50 ","$5,477.63 ","$0.00 ","$2,537.05 ","$0.00 ","$0.00 ","$2,131.31 ","$12,172.50 ","$0.00 ","$6,086.25 ","$9,640.62 ","$9,738.00 ","$0.00 ","$1,905.00 ","$0.00 ","$1,937.86 ","$0.00 "
"851.633.01S","SUP","HCPCS C1713","","851.633.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/150X150X0.8MM THK-STERIL","BOTH IP/OP","$12,375.00 ","$9,157.50 ","$0.00 ","$12,375.00 ","$5,568.75 ","$0.00 ","$2,579.26 ","$0.00 ","$0.00 ","$2,166.76 ","$12,375.00 ","$0.00 ","$6,187.50 ","$9,801.00 ","$9,900.00 ","$0.00 ","$1,936.69 ","$0.00 ","$1,970.10 ","$0.00 "
"851.651.01S","SUP","HCPCS C1713","","851.651.01S  -  PLATE BONE .5MM CRNMXF CONTUR MESH RPD RESORB 1.5MM SCR STRL","BOTH IP/OP","$3,352.50 ","$2,480.85 ","$0.00 ","$3,352.50 ","$1,508.63 ","$0.00 ","$698.74 ","$0.00 ","$0.00 ","$587.00 ","$3,352.50 ","$0.00 ","$1,676.25 ","$2,655.18 ","$2,682.00 ","$0.00 ","$524.67 ","$0.00 ","$533.72 ","$0.00 "
"851.652.01S","SUP","HCPCS C1713","","851.652.01S  -  PLATE BONE .5MM 100MM CRNMXF CONTUR MESH RPD RESORB 1.5MM","BOTH IP/OP","$7,222.50 ","$5,344.65 ","$0.00 ","$7,222.50 ","$3,250.13 ","$0.00 ","$1,505.35 ","$0.00 ","$0.00 ","$1,264.60 ","$7,222.50 ","$0.00 ","$3,611.25 ","$5,720.22 ","$5,778.00 ","$0.00 ","$1,130.32 ","$0.00 ","$1,149.82 ","$0.00 "
"851.661.01S","SUP","HCPCS C1713","","851.661.01S  -  PLATE BONE .8MM 50MM CRNMXF CONTUR MESH RPD RESORB 1.5MM SCR","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"851.662.01S","SUP","HCPCS C1713","","851.662.01S  -  PLATE .8MM 1.5MM SCR CONTUR MESH RESORB RGD BONE 100MM","BOTH IP/OP","$7,605.00 ","$5,627.70 ","$0.00 ","$7,605.00 ","$3,422.25 ","$0.00 ","$1,585.07 ","$0.00 ","$0.00 ","$1,331.57 ","$7,605.00 ","$0.00 ","$3,802.50 ","$6,023.16 ","$6,084.00 ","$0.00 ","$1,190.18 ","$0.00 ","$1,210.72 ","$0.00 "
"851.680.01S","SUP","HCPCS C1713","","851.680.01S  -  1.5MM RAPID RESORB SELLAR FLR PL 7MMX25MM/0.5MM THK-STERILE","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$288.56 ","$0.00 ","$133.65 ","$0.00 ","$0.00 ","$112.28 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$100.36 ","$0.00 ","$102.09 ","$0.00 "
"851.681.01S","SUP","HCPCS C1713","","851.681.01S  -  1.5MM RAPID RESORB SELLAR FLR PL 7MMX25MM/0.8MM THK-STERILE","BOTH IP/OP","$641.25 ","$474.53 ","$0.00 ","$641.25 ","$288.56 ","$0.00 ","$133.65 ","$0.00 ","$0.00 ","$112.28 ","$641.25 ","$0.00 ","$320.63 ","$507.87 ","$513.00 ","$0.00 ","$100.36 ","$0.00 ","$102.09 ","$0.00 "
"851.689.01S","SUP","HCPCS C1713","","851.689.01S  -  1.5MM RAPID RESORB ORBTL FL PL W/BENDING TEMPLATE/24MM-STER","BOTH IP/OP","$1,901.25 ","$1,406.93 ","$0.00 ","$1,901.25 ","$855.56 ","$0.00 ","$396.27 ","$0.00 ","$0.00 ","$332.89 ","$1,901.25 ","$0.00 ","$950.63 ","$1,505.79 ","$1,521.00 ","$0.00 ","$297.55 ","$0.00 ","$302.68 ","$0.00 "
"851.690.01S","SUP","HCPCS C1713","","851.690.01S  -  PLATE BONE 30X30MM ORBTL FLR RPD RESORB BNDRG TMPLT 1.5MM","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$891.00 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"851.691.01S","SUP","HCPCS C1713","","851.691.01S  -  PLATE 35X35MM 1.5MM SCR BNDRG TMPLT RPD RESORB BONE ORBTL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"851.711.01S","SUP","HCPCS C1713","","851.711.01S  -  PLATE BONE 50X50X.5MM CRNMXF STR ROW MESH RPD RESORB 1.5MM","BOTH IP/OP","$3,060.00 ","$2,264.40 ","$0.00 ","$3,060.00 ","$1,377.00 ","$0.00 ","$637.78 ","$0.00 ","$0.00 ","$535.78 ","$3,060.00 ","$0.00 ","$1,530.00 ","$2,423.52 ","$2,448.00 ","$0.00 ","$478.89 ","$0.00 ","$487.15 ","$0.00 "
"851.711.97S","SUP","HCPCS C1713","","851.711.97S  -  PLATE BONE 50X50X.5MM STR ROW MESH RAPID RESORB POLY","BOTH IP/OP","$2,846.53 ","$2,106.43 ","$0.00 ","$2,763.63 ","$1,243.63 ","$0.00 ","$593.29 ","$0.00 ","$0.00 ","$483.89 ","$2,763.63 ","$0.00 ","$1,381.81 ","$2,188.79 ","$2,210.90 ","$0.00 ","$419.91 ","$0.00 ","$439.97 ","$0.00 "
"851.712.01S","SUP","HCPCS C1713","","851.712.01S  -  PLATE BONE 100X100X.5MM CRNMXF STR ROW MESH RPD RESORB 1.5MM","BOTH IP/OP","$6,525.00 ","$4,828.50 ","$0.00 ","$6,525.00 ","$2,936.25 ","$0.00 ","$1,359.97 ","$0.00 ","$0.00 ","$1,142.48 ","$6,525.00 ","$0.00 ","$3,262.50 ","$5,167.80 ","$5,220.00 ","$0.00 ","$1,021.16 ","$0.00 ","$1,038.78 ","$0.00 "
"851.712.97S","SUP","HCPCS C1713","","851.712.97S  -  PLATE BONE 100MM RESORB STR ROW MESH ORTHOPEDIC NONSTRL 1MM","BOTH IP/OP","$6,071.00 ","$4,492.54 ","$0.00 ","$5,894.18 ","$2,652.38 ","$0.00 ","$1,265.35 ","$0.00 ","$0.00 ","$1,032.02 ","$5,894.18 ","$0.00 ","$2,947.09 ","$4,668.19 ","$4,715.34 ","$0.00 ","$895.57 ","$0.00 ","$938.35 ","$0.00 "
"851.721.01S","SUP","HCPCS C1713","","851.721.01S  -  PLATE BONE 50X50X.8MM CRNMXF STR ROW MESH RPD RESORB 1.5MM","BOTH IP/OP","$3,240.00 ","$2,397.60 ","$0.00 ","$3,240.00 ","$1,458.00 ","$0.00 ","$675.30 ","$0.00 ","$0.00 ","$567.30 ","$3,240.00 ","$0.00 ","$1,620.00 ","$2,566.08 ","$2,592.00 ","$0.00 ","$507.06 ","$0.00 ","$515.81 ","$0.00 "
"851.722.01S","SUP","HCPCS C1713","","851.722.01S  -  PLATE BONE 100X100X.8MM CRNMXF STR ROW MESH RPD RESORB 1.5MM","BOTH IP/OP","$7,200.00 ","$5,328.00 ","$0.00 ","$7,200.00 ","$3,240.00 ","$0.00 ","$1,500.66 ","$0.00 ","$0.00 ","$1,260.66 ","$7,200.00 ","$0.00 ","$3,600.00 ","$5,702.40 ","$5,760.00 ","$0.00 ","$1,126.80 ","$0.00 ","$1,146.24 ","$0.00 "
"851.724.01S","SUP","HCPCS C1713","","851.724.01S  -  1.5MM RAPID RESORB STRAIGHT ROW MESH/75X75X0.8MM THK-STER","BOTH IP/OP","$4,657.50 ","$3,446.55 ","$0.00 ","$4,657.50 ","$2,095.88 ","$0.00 ","$970.74 ","$0.00 ","$0.00 ","$815.49 ","$4,657.50 ","$0.00 ","$2,328.75 ","$3,688.74 ","$3,726.00 ","$0.00 ","$728.90 ","$0.00 ","$741.47 ","$0.00 "
"851.801.01S","SUP","Custom 27803010","","851.801.01S  -  CLAMP TUBE 18MM CRANIAL FLP RPD RESORB STRL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"852.002.01S","SUP","HCPCS C1713","","852.002.01S  -  PLATE BONE CRNMXF 2 HOLE STR RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$326.25 ","$241.43 ","$0.00 ","$326.25 ","$146.81 ","$0.00 ","$68.00 ","$0.00 ","$0.00 ","$57.12 ","$326.25 ","$0.00 ","$163.13 ","$258.39 ","$261.00 ","$0.00 ","$51.06 ","$0.00 ","$51.94 ","$0.00 "
"852.004.01S","SUP","HCPCS C1713","","852.004.01S  -  PLATE BONE CRNMXF 4 HOLE STR RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$483.75 ","$357.98 ","$0.00 ","$483.75 ","$217.69 ","$0.00 ","$100.83 ","$0.00 ","$0.00 ","$84.70 ","$483.75 ","$0.00 ","$241.88 ","$383.13 ","$387.00 ","$0.00 ","$75.71 ","$0.00 ","$77.01 ","$0.00 "
"852.008.01S","SUP","HCPCS C1713","","852.008.01S  -  PLATE BONE CRNMXF 8 HOLE ADP RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$540.00 ","$399.60 ","$0.00 ","$540.00 ","$243.00 ","$0.00 ","$112.55 ","$0.00 ","$0.00 ","$94.55 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$84.51 ","$0.00 ","$85.97 ","$0.00 "
"852.020.01S","SUP","HCPCS C1713","","852.020.01S  -  PLATE BONE 2MM 20 HOLE ADP RPD RESORB STRL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"852.110.01S","SUP","HCPCS C1713","","852.110.01S  -  PLATE BONE ORBTL RIM 10 HOLE RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"852.263.01S","SUP","HCPCS C1713","","852.263.01S  -  PLATE BONE CRNMXF 6X4 HOLE L LEFT OBLQ RPD RESORB 2 MM SCR","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"852.264.01S","SUP","HCPCS C1713","","852.264.01S  -  PLATE BONE CRNMXF 6X4 HOLE L RIGHT OBLQ RPD RESORB 2 MM SCR","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"852.343.01S","SUP","HCPCS C1713","","852.343.01S  -  PLATE BONE CRNMXF 4X3X3 HOLE RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$313.88 ","$0.00 ","$145.38 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"852.420.01S","SUP","HCPCS C1713","","852.420.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$1,293.75 ","$957.38 ","$0.00 ","$1,293.75 ","$582.19 ","$0.00 ","$269.65 ","$0.00 ","$0.00 ","$226.53 ","$1,293.75 ","$0.00 ","$646.88 ","$1,024.65 ","$1,035.00 ","$0.00 ","$202.47 ","$0.00 ","$205.97 ","$0.00 "
"852.421.01S","SUP","HCPCS C1713","","852.421.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT RPD RESORB 2 MM SCR STRL","BOTH IP/OP","$1,597.50 ","$1,182.15 ","$0.00 ","$1,597.50 ","$718.88 ","$0.00 ","$332.96 ","$0.00 ","$0.00 ","$279.71 ","$1,597.50 ","$0.00 ","$798.75 ","$1,265.22 ","$1,278.00 ","$0.00 ","$250.01 ","$0.00 ","$254.32 ","$0.00 "
"852.520.01S","SUP","HCPCS C1713","","852.520.01S  -  PLATE BONE 48X48X1.2MM CRNMXF MESH RPD RESORB 2MM SCR STRL","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"852.521.01S","SUP","HCPCS C1713","","852.521.01S  -  PLATE BONE 78X78X1.2MM CRNMXF MESH RPD RESORB 2MM SCR STRL","BOTH IP/OP","$5,445.00 ","$4,029.30 ","$0.00 ","$5,445.00 ","$2,450.25 ","$0.00 ","$1,134.87 ","$0.00 ","$0.00 ","$953.38 ","$5,445.00 ","$0.00 ","$2,722.50 ","$4,312.44 ","$4,356.00 ","$0.00 ","$852.14 ","$0.00 ","$866.84 ","$0.00 "
"852.641.01S","SUP","HCPCS C1713","","852.641.01S  -  PLATE BONE 1.2MM 50MM CRNMXF CONTUR MESH RPD RESORB 2MM SCR","BOTH IP/OP","$3,802.50 ","$2,813.85 ","$0.00 ","$3,802.50 ","$1,711.13 ","$0.00 ","$792.54 ","$0.00 ","$0.00 ","$665.79 ","$3,802.50 ","$0.00 ","$1,901.25 ","$3,011.58 ","$3,042.00 ","$0.00 ","$595.09 ","$0.00 ","$605.36 ","$0.00 "
"852-000","SUP","Custom 27203010","","KIT NOW LGNL URN AG MCBLTST 22 TST","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"853008LH","SUP","HCPCS C1713","","853008LH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853008LW","SUP","HCPCS C1713","","853008LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853008WM","SUP","HCPCS C1713","","853008WM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-010","SUP","HCPCS C1713","","853-010  -  PLATE 10MM TI MLT HOLE OPN DOOR PCUT INTRINSIC STAB CLR CD","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853010LH","SUP","HCPCS C1713","","853010LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853010LW","SUP","HCPCS C1713","","853010LW  -  PLATE BN W MTH 10MM CENTERPIECE LAT HL OPN DOOR CLR CD TI","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853010WM","SUP","HCPCS C1713","","853010WM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-012","SUP","HCPCS C1713","","853-012  -  PLATE 12MM TI MLT HOLE OPN DOOR PCUT INTRINSIC STAB CLR CD","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853012LH","SUP","HCPCS C1713","","853012LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853012WM","SUP","HCPCS C1713","","853012WM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-014","SUP","HCPCS C1713","","853-014  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853014LH","SUP","HCPCS C1713","","853014LH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853014LW","SUP","HCPCS C1713","","853014LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853014WM","SUP","HCPCS C1713","","853014WM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-016","SUP","HCPCS C1713","","853-016  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853016LH","SUP","HCPCS C1713","","853016LH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853016LW","SUP","HCPCS C1713","","853016LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853016WM","SUP","HCPCS C1713","","853016WM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-018","SUP","HCPCS C1713","","853-018  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853018LH","SUP","HCPCS C1713","","853018LH  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853018LW","SUP","HCPCS C1713","","853018LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853018WM","SUP","HCPCS C1713","","853018WM  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-107","SUP","HCPCS C1713","","853-107  -  PLATE 7MM TI BONE SPNL","BOTH IP/OP","$1,657.50 ","$1,226.55 ","$0.00 ","$1,657.50 ","$745.88 ","$0.00 ","$345.46 ","$0.00 ","$0.00 ","$290.21 ","$1,657.50 ","$0.00 ","$828.75 ","$1,312.74 ","$1,326.00 ","$0.00 ","$259.40 ","$0.00 ","$263.87 ","$0.00 "
"853408LH","SUP","HCPCS C1713","","853408LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-410","SUP","HCPCS C1713","","853-410  -  PLATE BN 10MM NS CENTERPIECE GFT SPNE","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853410LH","SUP","HCPCS C1713","","853410LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-412","SUP","HCPCS C1713","","853-412  -  PLATE BN 12MM NS CENTERPIECE GFT SPNE","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853412LH","SUP","HCPCS C1713","","853412LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-414","SUP","HCPCS C1713","","853-414  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853414LH","SUP","HCPCS C1713","","853414LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-416","SUP","HCPCS C1713","","853-416  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853416LH","SUP","HCPCS C1713","","853416LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$492.08 ","$0.00 ","$227.91 ","$0.00 ","$0.00 ","$191.46 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$171.13 ","$0.00 ","$174.09 ","$0.00 "
"853-418","SUP","Custom 27803010","","853-418  -  PLATE 18MM TI BONE SPNL","BOTH IP/OP","$1,093.50 ","$809.19 ","$0.00 ","$1,093.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,093.50 ","$0.00 ","$546.75 ","$866.05 ","$874.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"853-465","SUP","HCPCS C1713","","853-465  -  SCREW BONE 2.6MM 5MM CENTERPIECE TI SPNL SLFTAP CLR CD","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-467","SUP","HCPCS C1713","","853-467  -  BONE SCREW 853-467 2.6 X 7MM","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-469","SUP","HCPCS C1713","","853-469  -  BONE SCREW 853-469 2.6 X 9MM","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-471","SUP","HCPCS C1713","","853-471  -  BONE SCREW 853-471 2.6 X 11MM","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-505","SUP","HCPCS C1713","","853-505  -  SCREW BONE 3MM 5MM CENTERPIECE TI SPNL SLFTAP CLR CD","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-507","SUP","HCPCS C1713","","853-507  -  BONE SCREW 853-507 3.0 X 7MM","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-509","SUP","HCPCS C1713","","853-509  -  BONE SCREW 853-509 3.0 X 9MM","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-511","SUP","HCPCS C1713","","853-511  -  BONE SCREW 853-511 3.0 X 11MM","BOTH IP/OP","$171.00 ","$126.54 ","$0.00 ","$171.00 ","$76.95 ","$0.00 ","$35.64 ","$0.00 ","$0.00 ","$29.94 ","$171.00 ","$0.00 ","$85.50 ","$135.43 ","$136.80 ","$0.00 ","$26.76 ","$0.00 ","$27.22 ","$0.00 "
"853-602","SUP","Custom 27203010","","853-602  -  INSTRUMENT 853-602 TRI FLAT DRILL BIT","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8550012L","SUP","HCPCS C1713","","8550012L  -  ROD 8550012L 5.5MM TI HEX END LINED ROD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"855-011","SUP","HCPCS C1713","","855-011  -  ROD 855-011 5.5 MM HEX-END ROD L20 TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"855011L100","SUP","HCPCS C1713","","855011L100  -  ROD 855011L100 TSRH 5.5X100MM TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"855-012","SUP","HCPCS C1713","","855-012  -  ROD 855-012 TITANIUM ROD CP GRADE IV","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"85-62010","SUP","Custom 27203010","","85-62010  -  STM HNDHLD LCTR VRSTIM3 NRV STD SBDRM","BOTH IP/OP","$113.00 ","$83.62 ","$0.00 ","$113.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.00 ","$0.00 ","$56.50 ","$89.50 ","$90.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"858-002","SUP","HCPCS C1713","","858-002  -  HOOK 858-002 5.5 SMALL PEDICLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-010","SUP","HCPCS C1713","","858-010  -  HOOK 858-010 5.5 SMALL WIDE BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-020","SUP","HCPCS C1713","","858-020  -  HOOK 858-020 5.5 SMALL NARROW BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-024","SUP","HCPCS C1713","","858-024  -  HOOK 858-024 5.5 SMALL ANGLED BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-030","SUP","HCPCS C1713","","858-030  -  HOOK 858-030 5.5 SMALL EXTENDED BODY","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-052","SUP","HCPCS C1713","","858-052  -  HOOK 858-052 5.5 SMALL NARROW BLADE RMPD","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-102","SUP","HCPCS C1713","","858-102  -  HOOK 858-102 5.5 PEDICLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-110","SUP","HCPCS C1713","","858-110  -  HOOK 858-110 5.5 WIDE BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-112","SUP","HCPCS C1713","","858-112  -  HOOK 858-112 5.5 WIDE BLADE SMALL GRVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-120","SUP","HCPCS C1713","","858-120  -  HOOK 858-120 5.5 NARROW BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-122","SUP","HCPCS C1713","","858-122  -  HOOK 858-122 NARROW BLADE SMALL GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-124","SUP","HCPCS C1713","","858-124  -  HOOK 858-124 5.5 ANGLED BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-130","SUP","HCPCS C1713","","858-130  -  HOOK 858-130 5.5 EXTENDED BODY","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-140","SUP","HCPCS C1713","","858-140  -  HOOK 858-140 5.5 RIGHT OFFSET","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-142","SUP","HCPCS C1713","","858-142  -  HOOK 858-142 5.5 LEFT OFFSET","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-150","SUP","HCPCS C1713","","858-150  -  HOOK 858-150 5.5 STANDARD BLADE RAMPED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-152","SUP","HCPCS C1713","","858-152  -  HOOK 858-152 5.5 NARROW BLADE RAMPED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-160","SUP","HCPCS C1713","","858-160  -  HOOK 858-160 5.5 RIGHT ANGLED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-162","SUP","HCPCS C1713","","858-162  -  HOOK 858-162 5.5 LEFT ANGLED","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-202","SUP","HCPCS C1713","","858-202  -  HOOK 858-202 5.5 LARGE PEDICLE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-218","SUP","HCPCS C1713","","858-218  -  HOOK 858-218 LARGE GROOVE WIDE BLADE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-220","SUP","HCPCS C1713","","858-220  -  HOOK 858-220 5.5 LARGE GROOVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-230","SUP","HCPCS C1713","","858-230  -  HOOK 858-230 5.5 EXTD BODY LARGE GRVE","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"858-425","SUP","HCPCS C1713","","858-425  -  SCREW 858-425 CDH FIXED ANGLE 4.5 X 25","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-430","SUP","HCPCS C1713","","858-430  -  SCREW 858-430 CDH FIXED ANGLE 4.5 X 30","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-435","SUP","HCPCS C1713","","858-435  -  SCREW 858-435 CDH FIXED ANGLE 4.5 X 35","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-440","SUP","HCPCS C1713","","858-440  -  SCREW 858-440 CDH FIXED ANGLE 4.5 X 40","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-525","SUP","HCPCS C1713","","858-525  -  SCREW 858-525 CDH FIXED ANGLE 5.5 X 25","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-530","SUP","HCPCS C1713","","858-530  -  SCREW 858-530 CDH FIXED ANGLE 5.5 X 30","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-535","SUP","HCPCS C1713","","858-535  -  SCREW 858-535 CDH FIXED ANGLE 5.5 X 35","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-540","SUP","HCPCS C1713","","858-540  -  SCREW 858-540 CDH FIXED ANGLE 5.5 X 40","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-545","SUP","HCPCS C1713","","858-545  -  SCREW 858-545 CDH FIXED ANGLE 5.5 X 45","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-550","SUP","HCPCS C1713","","858-550  -  SCREW 858-550 CDH FIXED ANGLE 5.5 X 50","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-555","SUP","HCPCS C1713","","858-555  -  SCREW BONE 5.5MM 55MM TI SPNL FIXANG","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-630","SUP","HCPCS C1713","","858-630  -  SCREW 858-630 CDH FIXED ANGLE 6.5 X 30","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-635","SUP","HCPCS C1713","","858-635  -  SCREW 858-635 CDH FIXED ANGLE 6.5 X 35","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-640","SUP","HCPCS C1713","","858-640  -  SCREW 858-640 CDH FIXED ANGLE 6.5 X 40","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-645","SUP","HCPCS C1713","","858-645  -  SCREW 858-645 CDH FIXED ANGLE 6.5 X 45","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-650","SUP","HCPCS C1713","","858-650  -  SCREW 858-650 CDH FIXED ANGLE 6.5 X 50","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-655","SUP","HCPCS C1713","","858-655  -  SCREW 858-655 CDH FIXED ANGLE 6.5 X 55","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-730","SUP","HCPCS C1713","","858-730  -  SCREW 858-730 CDH FIXED ANGLE 7.5 X 30","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-735","SUP","HCPCS C1713","","858-735  -  SCREW 858-735 CDH FIXED ANGLE 7.5 X 35","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-740","SUP","HCPCS C1713","","858-740  -  SCREW 858-740 CDH FIXED ANGLE 7.5 X 40","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-745","SUP","HCPCS C1713","","858-745  -  SCREW 858-745 CDH FIXED ANGLE 7.5 X 45","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-750","SUP","HCPCS C1713","","858-750  -  SCREW 858-750 CDH FIXED ANGLE 7.5 X 50","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-755","SUP","HCPCS C1713","","858-755  -  SCREW 858-755 CDH FIXED ANGLE 7.5 X 55","BOTH IP/OP","$1,659.00 ","$1,227.66 ","$0.00 ","$1,659.00 ","$746.55 ","$0.00 ","$345.78 ","$0.00 ","$0.00 ","$290.48 ","$1,659.00 ","$0.00 ","$829.50 ","$1,313.93 ","$1,327.20 ","$0.00 ","$259.63 ","$0.00 ","$264.11 ","$0.00 "
"858-855","SUP","HCPCS C1713","","858-855  -  SCREW SET 8.5MM 55MM HZNM8 BRK OFF SS SPNE 5.5MM ROD","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"859-002","SUP","HCPCS C1713","","859-002  -  HOOK 859-002 5.5 SMALL PEDICLE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"85900P","SUP","HCPCS C1725","","85900P  -  CATHETER ULTRASOUND 20MHZ STANDARD TAPER 5FR 20MM 150CM","BOTH IP/OP","$1,812.50 ","$1,341.25 ","$0.00 ","$1,812.50 ","$984.19 ","$0.00 ","$377.77 ","$0.00 ","$0.00 ","$317.35 ","$1,812.50 ","$0.00 ","$906.25 ","$1,435.50 ","$1,450.00 ","$0.00 ","$283.66 ","$0.00 ","$288.55 ","$0.00 "
"859-010","SUP","HCPCS C1713","","859-010  -  HOOK 859-010 5.5 SMALL WIDE BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-012","SUP","HCPCS C1713","","859-012  -  HOOK 859-012 SV WIDE BLADE SM GROOVE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-020","SUP","HCPCS C1713","","859-020  -  HOOK 859-020 5.5 SM NARROW BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-024","SUP","HCPCS C1713","","859-024  -  HOOK 859-024 5.5 SM ANGLED BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-030","SUP","HCPCS C1713","","859-030  -  HOOK 859-030 5.5 SM EXTEND BODY TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-052","SUP","HCPCS C1713","","859-052  -  HOOK 859-052 5.5 SM NRW BLD RAMPED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-102","SUP","HCPCS C1713","","859-102  -  HOOK 859-102 5.5 PEDICLE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-110","SUP","HCPCS C1713","","859-110  -  HOOK 859-110 5.5 WIDE BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-112","SUP","HCPCS C1713","","859-112  -  HOOK 859-112 5.5 WIDE BLADE SM GROOVE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-120","SUP","HCPCS C1713","","859-120  -  HOOK 859-120 5.5 NARROW BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-122","SUP","HCPCS C1713","","859-122  -  HOOK 859-122 NARROW BLADE SM GROOVE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-124","SUP","HCPCS C1713","","859-124  -  HOOK 859-124 5.5 ANGLED BLADE TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-130","SUP","HCPCS C1713","","859-130  -  HOOK 859-130 5.5 EXTENDED BOBY TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-140","SUP","HCPCS C1713","","859-140  -  HOOK 859-140 5.5 RIGHT OFFSET TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-142","SUP","HCPCS C1713","","859-142  -  HOOK 859-142 5.5 LEFT OFFSET TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-150","SUP","HCPCS C1713","","859-150  -  HOOK 859-150 5.5 STNDRD BLADE RPD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-152","SUP","HCPCS C1713","","859-152  -  HOOK 859-152 5.5 NARROW BLADE RPD TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-160","SUP","HCPCS C1713","","859-160  -  HOOK 859-160 5.5 RIGHT ANGLED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-162","SUP","HCPCS C1713","","859-162  -  HOOK 859-162 5.5 LEFT ANGLED TI","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"859-425","SUP","HCPCS C1713","","859-425  -  SCREW 859-425 CDH FIXED ANGLE 4.5 X25 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-430","SUP","HCPCS C1713","","859-430  -  SCREW 859-430 CDH FIXED ANGLE 4.5 X30 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-435","SUP","HCPCS C1713","","859-435  -  SCREW 859-435 CDH FIXED ANGLE 4.5 X35 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-440","SUP","HCPCS C1713","","859-440  -  SCREW 859-440 CDH FIXED ANGLE 4.5 X40 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-445","SUP","HCPCS C1713","","859-445  -  SCREW 859-445 CDH FIXED ANGLE 4.5 X45 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-450","SUP","HCPCS C1713","","859-450  -  SCREW 859-450 CDH FIXED ANGLE 4.5 X50 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-525","SUP","HCPCS C1713","","859-525  -  SCREW 859-525  5.5 FIXED ANGLE 5.5X25 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-530","SUP","HCPCS C1713","","859-530  -  SCREW 859-530  5.5 FIXED ANGLE 5.5X30 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-535","SUP","HCPCS C1713","","859-535  -  SCREW 859-535  5.5 FIXED ANGLE 5.5X35 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-540","SUP","HCPCS C1713","","859-540  -  SCREW 859-540  5.5 FIXED ANGLE 5.5X40 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-545","SUP","HCPCS C1713","","859-545  -  SCREW 859-545  5.5 FIXED ANGLE 5.5X45 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-550","SUP","HCPCS C1713","","859-550  -  SCREW 859-550  5.5 FIXED ANGLE 5.5X50 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-555","SUP","HCPCS C1713","","859-555  -  SCREW 859-555  5.5 FIXED ANGLE 5.5X55 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-630","SUP","HCPCS C1713","","859-630  -  SCREW 859-630  5.5 FIXED ANGLE 6.5X30 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-635","SUP","HCPCS C1713","","859-635  -  SCREW 859-635  5.5 FIXED ANGLE 6.5X35 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-640","SUP","HCPCS C1713","","859-640  -  SCREW 859-640  5.5 FIXED ANGLE 6.5X40 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-645","SUP","HCPCS C1713","","859-645  -  SCREW 859-645  5.5 FIXED ANGLE 6.5X45 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-650","SUP","HCPCS C1713","","859-650  -  SCREW 859-650  5.5 FIXED ANGLE 6.5X50 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-655","SUP","HCPCS C1713","","859-655  -  SCREW 859-655  5.5 FIXED ANGLE 6.5X55 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-730","SUP","HCPCS C1713","","859-730  -  SCREW 859-730  5.5 FIXED ANGLE 7.5X30 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-735","SUP","HCPCS C1713","","859-735  -  SCREW 859-735  5.5 FIXED ANGLE 7.5X35 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-740","SUP","HCPCS C1713","","859-740  -  SCREW 859-740  5.5 FIXED ANGLE 7.5X40 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-745","SUP","HCPCS C1713","","859-745  -  SCREW 859-745  5.5 FIXED ANGLE 7.5X45 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-750","SUP","HCPCS C1713","","859-750  -  SCREW 859-750  5.5 FIXED ANGLE 7.5X50 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-755","SUP","HCPCS C1713","","859-755  -  SCREW 859-755  5.5 FIXED ANGLE 7.5X55 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"859-760","SUP","HCPCS C1713","","859-760  -  SCREW 859-760  5.5 FIXED ANGLE 7.5X60 TI","BOTH IP/OP","$1,893.00 ","$1,400.82 ","$0.00 ","$1,893.00 ","$851.85 ","$0.00 ","$394.55 ","$0.00 ","$0.00 ","$331.45 ","$1,893.00 ","$0.00 ","$946.50 ","$1,499.26 ","$1,514.40 ","$0.00 ","$296.25 ","$0.00 ","$301.37 ","$0.00 "
"86-100","SUP","HCPCS C1713","","86-100  -  PLATE BN V NS LF TRITIUM STRNL DISP","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"86-200","SUP","HCPCS C1713","","86-200  -  PLATE BN TRITIUM 8 HL 1 CBL STRNL","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"86-27-08","SUP","HCPCS C1713","","86-27-08  -  SCREW BN 2.7MM 8MM NS TRITIUM STRNL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-27-10","SUP","HCPCS C1713","","86-27-10  -  SCREW BN 2.7MM 10MM NS TRITIUM STRNL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-27-12","SUP","HCPCS C1713","","86-27-12  -  SCREW BN 12MM NS LF TRITIUM STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-27-14","SUP","HCPCS C1713","","86-27-14  -  SCREW BN 14MM NS LF TRITIUM STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-27-16","SUP","HCPCS C1713","","86-27-16  -  SCREW BN 16MM NS TRITIUM STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-300","SUP","HCPCS C1713","","86-300  -  PLATE BN NS TRITIUM 2 CBL STRNL","BOTH IP/OP","$1,845.00 ","$1,365.30 ","$0.00 ","$1,845.00 ","$830.25 ","$0.00 ","$384.54 ","$0.00 ","$0.00 ","$323.04 ","$1,845.00 ","$0.00 ","$922.50 ","$1,461.24 ","$1,476.00 ","$0.00 ","$288.74 ","$0.00 ","$293.72 ","$0.00 "
"86-30-08","SUP","HCPCS C1713","","86-30-08  -  SCREW BN NS TRITIUM RSC STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-30-10","SUP","HCPCS C1713","","86-30-10  -  SCREW BN 3MM 10MM NS LF RSC TRITIUM STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-30-12","SUP","HCPCS C1713","","86-30-12  -  SCREW BN 3MM 12MM NS LF RSC TRITIUM STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-30-14","SUP","HCPCS C1713","","86-30-14  -  SCREW BN 3MM 14MM NS LF RSC TRITIUM STRNL CBL PLT SYS","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-30-16","SUP","HCPCS C1713","","86-30-16  -  SCREW BN NS TRITIUM RSC STRNL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"86-350-S","SUP","HCPCS C1713","","86-350-S  -  DEVICE FX STRL LF TRITIUM 4 HL 2 CBL PLT SHRP NDL STRNL","BOTH IP/OP","$1,882.50 ","$1,393.05 ","$0.00 ","$1,882.50 ","$847.13 ","$0.00 ","$392.36 ","$0.00 ","$0.00 ","$329.61 ","$1,882.50 ","$0.00 ","$941.25 ","$1,490.94 ","$1,506.00 ","$0.00 ","$294.61 ","$0.00 ","$299.69 ","$0.00 "
"86-400","SUP","HCPCS C1713","","86-400  -  PLATE BN TRITIUM 5 HL 1 CBL STRNL","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"86-500","SUP","HCPCS C1713","","86-500  -  PLATE BN TRITIUM 4 HL 1 CBL STRNL","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"86-600","SUP","HCPCS C1713","","86-600  -  PLATE BN NS TRITIUM CBL STRNL RB","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"86-700","SUP","HCPCS C1713","","86-700  -  PLATE LADDER TRITIUM SCP 14 HL PRECONTOUR STRNM STRNL CBL","BOTH IP/OP","$1,797.50 ","$1,330.15 ","$0.00 ","$1,797.50 ","$808.88 ","$0.00 ","$374.64 ","$0.00 ","$0.00 ","$314.73 ","$1,797.50 ","$0.00 ","$898.75 ","$1,423.62 ","$1,438.00 ","$0.00 ","$281.31 ","$0.00 ","$286.16 ","$0.00 "
"868-011","SUP","HCPCS C1713","","868-011  -  ROD 868-011 LEG 5.5 DIA HEX END SS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"868-021","SUP","HCPCS C1713","","868-021  -  ROD 868-021 LEG 5.5 DIA LINED HEX END SS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"869-011","SUP","HCPCS C1713","","869-011  -  ROD 869-011 LEG 5.5 DIA HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"869-012","SUP","HCPCS C1713","","869-012  -  ROD 869-012 LEG 5.5 DIA HEX END TI","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"869-013","SUP","HCPCS C1713","","869-013  -  ROD SPNL 50MM 5.5MM CD HZN LGC STD TI HEX END IV CP GRAD","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"869-014","SUP","HCPCS C1713","","869-014  -  CP 2 ROD - 5.5MM DIA L=500MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"869-021","SUP","HCPCS C1713","","869-021  -  SCREW BONE 5.5MM 210MM CD HZN LGC TI PDCL MULTIAX STRL 5.5MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"869-022","SUP","HCPCS C1713","","869-022  -  ROD SPNL 50CM 5.5MM CD HZN LGC LNG TI IV HEX END LN CAP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"8696G","SUP","Custom 27203010","","8696G  -  SUTURE NABSB 7-0 P1 18IN BLU PRLN MFL","BOTH IP/OP","$16.63 ","$12.31 ","$0.00 ","$16.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.63 ","$0.00 ","$8.32 ","$13.17 ","$13.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-000865-01","SUP","Custom 27203010","","8700-000865-01  -  PACK SRG 6FT IVTM COOL LINE SRT UP DISP","BOTH IP/OP","$6,725.10 ","$4,976.57 ","$0.00 ","$6,725.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,725.10 ","$0.00 ","$3,362.55 ","$5,326.28 ","$5,380.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-000866-01","SUP","Custom 27203010","","8700-000866-01  -  PACK SRG 6FT IVTM ICY SRT UP DISP","BOTH IP/OP","$9,639.60 ","$7,133.30 ","$0.00 ","$9,639.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,639.60 ","$0.00 ","$4,819.80 ","$7,634.56 ","$7,711.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-000867-01","SUP","Custom 27203010","","8700-000867-01  -  PACK SRG 6FT IVTM QUATTRO SRT UP DISP","BOTH IP/OP","$10,579.20 ","$7,828.61 ","$0.00 ","$10,579.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,579.20 ","$0.00 ","$5,289.60 ","$8,378.73 ","$8,463.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-0654-01","SUP","HCPCS C1751","","8700-0654-01  -  CATH CEN VEN 9.3FR 22CM 58MM ODS","BOTH IP/OP","$1,226.70 ","$907.76 ","$0.00 ","$1,226.70 ","$552.02 ","$0.00 ","$255.67 ","$0.00 ","$0.00 ","$214.79 ","$1,226.70 ","$0.00 ","$613.35 ","$971.55 ","$981.36 ","$0.00 ","$191.98 ","$0.00 ","$195.29 ","$0.00 "
"8700-0657-01","SUP","HCPCS C1751","","8700-0657-01  -  CATHETER CEN VEN .032IN 9.3FR 38CM 75CM 3 INFUS LUMEN EXTN","BOTH IP/OP","$1,955.33 ","$1,446.94 ","$0.00 ","$1,955.33 ","$879.90 ","$0.00 ","$407.54 ","$0.00 ","$0.00 ","$342.36 ","$1,955.33 ","$0.00 ","$977.66 ","$1,548.62 ","$1,564.26 ","$0.00 ","$306.01 ","$0.00 ","$311.29 ","$0.00 "
"8700-0660-01","SUP","HCPCS C1752","","8700-0660-01  -  KIT 45CM 9.3FR TRIP CATH QT","BOTH IP/OP","$2,190.23 ","$1,620.77 ","$0.00 ","$2,190.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,190.23 ","$0.00 ","$1,095.11 ","$1,734.66 ","$1,752.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-0781-01","SUP","Custom 27203010","","8700-0781-01  -  CATHETER CV 9.3FR 22CM STRL LF CL LN HEAT EXCH KT","BOTH IP/OP","$1,287.60 ","$952.82 ","$0.00 ","$1,287.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,287.60 ","$0.00 ","$643.80 ","$1,019.78 ","$1,030.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-0782-01","SUP","Custom 27203010","","8700-0782-01  -  KIT CATH 9.3FR 38CM ICY CV","BOTH IP/OP","$2,053.20 ","$1,519.37 ","$0.00 ","$2,053.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,053.20 ","$0.00 ","$1,026.60 ","$1,626.13 ","$1,642.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-0783-01","SUP","Custom 27203010","","8700-0783-01  -  KIT CATH 9.3FR 45CM QUATTRO HEAT EXCH 3 LUM LL APPLAUSE HEP","BOTH IP/OP","$2,298.98 ","$1,701.25 ","$0.00 ","$2,298.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,298.98 ","$0.00 ","$1,149.49 ","$1,820.79 ","$1,839.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-0784-01","SUP","Custom 27203010","","8700-0784-01  -  KIT IV CLGRD 3K SRT","BOTH IP/OP","$454.58 ","$336.39 ","$0.00 ","$454.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$454.58 ","$0.00 ","$227.29 ","$360.03 ","$363.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8700-0785-01","SUP","Custom 27203010","","8700-0785-01  -  TUBING XTN 9FT","BOTH IP/OP","$511.13 ","$378.24 ","$0.00 ","$511.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$511.13 ","$0.00 ","$255.56 ","$404.81 ","$408.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8709H","SUP","Custom 27203010","","8709H  -  SUTURE NONABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT","BOTH IP/OP","$34.09 ","$25.23 ","$0.00 ","$34.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.09 ","$0.00 ","$17.04 ","$27.00 ","$27.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"873-004","SUP","HCPCS C1769","","873-004  -  GWIRE ORTH 24IN UCSS THRD INSTR","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"873-011","SUP","HCPCS C1769","","873-011  -  GWIRE ORTH 24IN UCSS NTHRD INSTR DISP","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"873-030","SUP","HCPCS C1713","","873-030  -  BONE SCREW 873-030 4.0 CANN CORT L 30MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-032","SUP","HCPCS C1713","","873-032  -  BONE SCREW 873-032 4.0 CANN CORT L 32MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-034","SUP","HCPCS C1713","","873-034  -  BONE SCREW 873-034 4.0 CANN CORT L 34MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-036","SUP","HCPCS C1713","","873-036  -  BONE SCREW 873-036 4.0 CANN CORT L 36MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-038","SUP","HCPCS C1713","","873-038  -  BONE SCREW 873-038 4.0 CANN CORT L 38MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-040","SUP","HCPCS C1713","","873-040  -  SCREW BONE 4MM 40MM UCSS TI CORT CANN","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-042","SUP","HCPCS C1713","","873-042  -  SCREW BONE 4MM 42MM UCSS TI CORT CANN","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-044","SUP","HCPCS C1713","","873-044  -  BONE SCREW 873-044 4.0 CANN CORT L 44MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-046","SUP","HCPCS C1713","","873-046  -  BONE SCREW 873-046 4.0 CANN CORT L 46MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-048","SUP","HCPCS C1713","","873-048  -  BONE SCREW 873-048 4.0 CANN CORT L 48MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-050","SUP","HCPCS C1713","","873-050  -  BONE SCREW 873-050 4.0 CANN CORT L 50MM","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-136","SUP","HCPCS C1713","","873-136  -  SCREW BN P/T 4MM 36MM UCSS LG CNN TI SPNE CORT","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-138","SUP","HCPCS C1713","","873-138  -  BONE SCREW 873-138 4.0 CAN CORT LAG L 38","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-140","SUP","HCPCS C1713","","873-140  -  BONE SCREW 873-140 4.0 CAN CORT LAG L 40","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-142","SUP","HCPCS C1713","","873-142  -  BONE SCREW 873-142 4.0 CAN CORT LAG L 42","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-144","SUP","HCPCS C1713","","873-144  -  BONE SCREW 873-144 4.0 CAN CORT LAG L 44","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-146","SUP","HCPCS C1713","","873-146  -  BONE SCREW 873-146 4.0 CAN CORT LAG L 46","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-148","SUP","HCPCS C1713","","873-148  -  BONE SCREW 873-148 4.0 CAN CORT LAG L 48","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"873-150","SUP","HCPCS C1713","","873-150  -  BONE SCREW 873-150 4.0 CAN CORT LAG L 50","BOTH IP/OP","$1,381.50 ","$1,022.31 ","$0.00 ","$1,381.50 ","$621.68 ","$0.00 ","$287.94 ","$0.00 ","$0.00 ","$241.89 ","$1,381.50 ","$0.00 ","$690.75 ","$1,094.15 ","$1,105.20 ","$0.00 ","$216.20 ","$0.00 ","$219.93 ","$0.00 "
"8747H","SUP","Custom 27203010","","8747H  -  SUTURE NONABSORBABLE 7-0 BV175-8 24IN 2 ARM MONOFILAMENT","BOTH IP/OP","$72.38 ","$53.56 ","$0.00 ","$72.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.38 ","$0.00 ","$36.19 ","$57.32 ","$57.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"87525S","SUP","HCPCS C1713","","87525S  -  SCREW BN STD 8.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$1,233.33 ","$912.66 ","$0.00 ","$1,233.33 ","$555.00 ","$0.00 ","$257.06 ","$0.00 ","$0.00 ","$215.95 ","$1,233.33 ","$0.00 ","$616.66 ","$976.80 ","$986.66 ","$0.00 ","$193.02 ","$0.00 ","$196.35 ","$0.00 "
"87530S","SUP","HCPCS C1713","","87530S  -  SCREW BN STD 8.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"87535S","SUP","HCPCS C1713","","87535S  -  SCREW BN STD 8.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"87540S","SUP","HCPCS C1713","","87540S  -  SCREW BN STD 8.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"87545S","SUP","HCPCS C1713","","87545S  -  SCREW BN STD 8.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"87550S","SUP","HCPCS C1713","","87550S  -  SCREW BN STD 8.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"87555S","SUP","HCPCS C1713","","87555S  -  SCREW BN STD 8.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"876-010","SUP","HCPCS C1713","","876-010  -  SCREW 876-010 ATLANTIS CAN FAS 4.0X10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-011","SUP","HCPCS C1713","","876-011  -  SCREW 876-011 ATLANTIS CAN FAS 4.0X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-012","SUP","HCPCS C1713","","876-012  -  SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-013","SUP","HCPCS C1713","","876-013  -  SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-014","SUP","HCPCS C1713","","876-014  -  SCREW BN 4MM 14MM GRY STRL ATLNTS FX ANG TI SPNE CANC CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-015","SUP","HCPCS C1713","","876-015  -  SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-016","SUP","HCPCS C1713","","876-016  -  SCREW BN 4MM 16MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-017","SUP","HCPCS C1713","","876-017  -  SCREW BN 4MM 17MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-018","SUP","HCPCS C1713","","876-018  -  SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-019","SUP","HCPCS C1713","","876-019  -  SCREW 876-019 ATLANTIS CAN FAS 4.0X19MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-020","SUP","HCPCS C1713","","876-020  -  SCREW 876-020 ATLANTIS CAN FAS 4.0X20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-021","SUP","HCPCS C1713","","876-021  -  SCREW 876-021 ATLANTIS CAN FAS 4.0X21MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-053","SUP","HCPCS C1713","","876-053  -  SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-055","SUP","HCPCS C1713","","876-055  -  SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-057","SUP","HCPCS C1713","","876-057  -  SCREW BN 4.5MM 17MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-119","SUP","HCPCS C1713","","876-119  -  PLATE 876-119 19MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"876-121","SUP","HCPCS C1713","","876-121  -  PLATE 876-121 21MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"876-123","SUP","HCPCS C1713","","876-123  -  PLATE 876-123 23MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"876-125","SUP","HCPCS C1713","","876-125  -  PLATE 876-125 25MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"876-127","SUP","HCPCS C1713","","876-127  -  PLATE 876-127 27.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"876-130","SUP","HCPCS C1713","","876-130  -  PLATE 876-130 30MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-132","SUP","HCPCS C1713","","876-132  -  PLATE 876-132 32.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-135","SUP","HCPCS C1713","","876-135  -  PLATE 876-135 35MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-137","SUP","HCPCS C1713","","876-137  -  PLATE 876-137 37.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-140","SUP","HCPCS C1713","","876-140  -  PLATE 876-140 40MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-142","SUP","HCPCS C1713","","876-142  -  PLATE BN 42.5MM STRL ATLNTS LCK LOPRFL TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-145","SUP","HCPCS C1713","","876-145  -  PLATE 876-145 45MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-147","SUP","HCPCS C1713","","876-147  -  PLATE 876-147 47.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-150","SUP","HCPCS C1713","","876-150  -  PLATE 876-150 50MM ANTERIOR CERVICAL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"876-152","SUP","HCPCS C1713","","876-152  -  PLATE 876-152 52.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"876-155","SUP","HCPCS C1713","","876-155  -  PLATE 876-155 55MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"876-157","SUP","HCPCS C1713","","876-157  -  PLATE 876-157 57.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"876-160","SUP","HCPCS C1713","","876-160  -  PLATE 876-160 60MM ANTERIOR CERVICAL","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"876-162","SUP","HCPCS C1713","","876-162  -  PLATE 876-162 62.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-165","SUP","HCPCS C1713","","876-165  -  PLATE 876-165 65MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-167","SUP","HCPCS C1713","","876-167  -  PLATE 876-167 67.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-170","SUP","HCPCS C1713","","876-170  -  PLATE 876-170 70MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-172","SUP","HCPCS C1713","","876-172  -  PLATE 876-172 72.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-175","SUP","HCPCS C1713","","876-175  -  PLATE 876-175 75MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-177","SUP","HCPCS C1713","","876-177  -  PLATE 876-177 77.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-180","SUP","HCPCS C1713","","876-180  -  PLATE 876-180 80MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-182","SUP","HCPCS C1713","","876-182  -  PLATE 876-182 82.5MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-185","SUP","HCPCS C1713","","876-185  -  PLATE 876-185 85MM ANTERIOR CERVICAL","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"876-187","SUP","HCPCS C1713","","876-187  -  PLATE 876-187 87.5MM ANTERIOR CERVICAL","BOTH IP/OP","$4,135.50 ","$3,060.27 ","$0.00 ","$4,135.50 ","$1,860.98 ","$0.00 ","$861.94 ","$0.00 ","$0.00 ","$724.09 ","$4,135.50 ","$0.00 ","$2,067.75 ","$3,275.32 ","$3,308.40 ","$0.00 ","$647.21 ","$0.00 ","$658.37 ","$0.00 "
"876-190","SUP","HCPCS C1713","","876-190  -  PLATE 876-190 90MM ANTERIOR CERVICAL","BOTH IP/OP","$4,135.50 ","$3,060.27 ","$0.00 ","$4,135.50 ","$1,860.98 ","$0.00 ","$861.94 ","$0.00 ","$0.00 ","$724.09 ","$4,135.50 ","$0.00 ","$2,067.75 ","$3,275.32 ","$3,308.40 ","$0.00 ","$647.21 ","$0.00 ","$658.37 ","$0.00 "
"876-195","SUP","HCPCS C1713","","876-195  -  PLATE 876-195 95MM ANTERIOR CERVICAL","BOTH IP/OP","$4,135.50 ","$3,060.27 ","$0.00 ","$4,135.50 ","$1,860.98 ","$0.00 ","$861.94 ","$0.00 ","$0.00 ","$724.09 ","$4,135.50 ","$0.00 ","$2,067.75 ","$3,275.32 ","$3,308.40 ","$0.00 ","$647.21 ","$0.00 ","$658.37 ","$0.00 "
"876-200","SUP","HCPCS C1713","","876-200  -  PLATE 876-200 100MM ANTERIOR CERVICAL","BOTH IP/OP","$4,135.50 ","$3,060.27 ","$0.00 ","$4,135.50 ","$1,860.98 ","$0.00 ","$861.94 ","$0.00 ","$0.00 ","$724.09 ","$4,135.50 ","$0.00 ","$2,067.75 ","$3,275.32 ","$3,308.40 ","$0.00 ","$647.21 ","$0.00 ","$658.37 ","$0.00 "
"876-205","SUP","HCPCS C1713","","876-205  -  PLATE 876-205 105MM ANTERIOR CERVICAL","BOTH IP/OP","$4,135.50 ","$3,060.27 ","$0.00 ","$4,135.50 ","$1,860.98 ","$0.00 ","$861.94 ","$0.00 ","$0.00 ","$724.09 ","$4,135.50 ","$0.00 ","$2,067.75 ","$3,275.32 ","$3,308.40 ","$0.00 ","$647.21 ","$0.00 ","$658.37 ","$0.00 "
"876-210","SUP","HCPCS C1713","","876-210  -  PLATE 876-210 110MM ANTERIOR CERVICAL","BOTH IP/OP","$4,135.50 ","$3,060.27 ","$0.00 ","$4,135.50 ","$1,860.98 ","$0.00 ","$861.94 ","$0.00 ","$0.00 ","$724.09 ","$4,135.50 ","$0.00 ","$2,067.75 ","$3,275.32 ","$3,308.40 ","$0.00 ","$647.21 ","$0.00 ","$658.37 ","$0.00 "
"8762H","SUP","Custom 27203010","","8762H  -  SUTURE NABSB 3-0 SH-1 30IN BLU PRLN 2 ARM MFL","BOTH IP/OP","$554.42 ","$410.27 ","$0.00 ","$554.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$554.42 ","$0.00 ","$277.21 ","$439.10 ","$443.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"876-310","SUP","HCPCS C1713","","876-310  -  SCREW 876-310 VAS CANCELLOUS 4.0X10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-311","SUP","HCPCS C1713","","876-311  -  SCREW 876-311 VAS CANCELLOUS 4.0X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-312","SUP","HCPCS C1713","","876-312  -  SCREW BN 4MM 12MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-313","SUP","HCPCS C1713","","876-313  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-314","SUP","HCPCS C1713","","876-314  -  SCREW BN 4MM 14MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-315","SUP","HCPCS C1713","","876-315  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-316","SUP","HCPCS C1713","","876-316  -  SCREW BN 4MM 16MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-317","SUP","HCPCS C1713","","876-317  -  SCREW BN 4MM 17MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-318","SUP","HCPCS C1713","","876-318  -  SCREW BN 4MM 18MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-319","SUP","HCPCS C1713","","876-319  -  SCREW 876-319 VAS CANCELLOUS 4.0X19MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-320","SUP","HCPCS C1713","","876-320  -  SCREW 876-320 VAS CANCELLOUS 4.0X20MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-321","SUP","HCPCS C1713","","876-321  -  SCREW 876-321 VAS CANCELLOUS 4.0X21MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-353","SUP","HCPCS C1713","","876-353  -  SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-355","SUP","HCPCS C1713","","876-355  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-357","SUP","HCPCS C1713","","876-357  -  SCREW BN 4.5MM 17MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-404","SUP","HCPCS C1713","","876-404  -  PIN HLD ATLNTS ANT CERV SPN PLT INSTR TI STRL","BOTH IP/OP","$219.00 ","$162.06 ","$0.00 ","$219.00 ","$98.55 ","$0.00 ","$45.65 ","$0.00 ","$0.00 ","$38.35 ","$219.00 ","$0.00 ","$109.50 ","$173.45 ","$175.20 ","$0.00 ","$34.27 ","$0.00 ","$34.86 ","$0.00 "
"876-443","SUP","Custom 27203010","","876-443  -  BIT DRILL 13MM ATLNTS SPNL 3 FLAT STRL DISP","BOTH IP/OP","$760.00 ","$562.40 ","$0.00 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$760.00 ","$0.00 ","$380.00 ","$601.92 ","$608.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"876-455","SUP","Custom 27203010","","876-455  -  BIT DRILL 5MM ATLNTS 3 FLAT ADJ STRL DISP","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"876-612","SUP","HCPCS C1713","","876-612  -  SCREW BN 4MM 12MM STRL ATLNTS VA SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-613","SUP","HCPCS C1713","","876-613  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-614","SUP","HCPCS C1713","","876-614  -  SCREW BN 4MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-615","SUP","HCPCS C1713","","876-615  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-643","SUP","HCPCS C1713","","876-643  -  SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-644","SUP","HCPCS C1713","","876-644  -  SCREW BN 4.5MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-645","SUP","HCPCS C1713","","876-645  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-710","SUP","HCPCS C1713","","876-710  -  SCREW 876-710 FA SELF TAPPING 4.0X10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-711","SUP","HCPCS C1713","","876-711  -  SCREW 876-711 FA SELF TAPPING 4.0X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-712","SUP","HCPCS C1713","","876-712  -  SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-713","SUP","HCPCS C1713","","876-713  -  SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-714","SUP","HCPCS C1713","","876-714  -  SCREW BONE 4MM 14MM ATLNTS TI CANC ANT CERV SPN FAVORED ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-715","SUP","HCPCS C1713","","876-715  -  SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-716","SUP","HCPCS C1713","","876-716  -  SCREW BONE 4MM 16MM ATLNTS TI CANC ANT CERV SPNE SLFTAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-717","SUP","HCPCS C1713","","876-717  -  SCREW BONE 4MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP FIX","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-718","SUP","HCPCS C1713","","876-718  -  SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-753","SUP","HCPCS C1713","","876-753  -  SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-755","SUP","HCPCS C1713","","876-755  -  SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-757","SUP","HCPCS C1713","","876-757  -  SCREW BONE 4.5MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-810","SUP","HCPCS C1713","","876-810  -  SCREW 876-810 VA SELF TAPPING 4.0X10MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-811","SUP","HCPCS C1713","","876-811  -  SCREW 876-811 VA SELF TAPPING 4.0X11MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-812","SUP","HCPCS C1713","","876-812  -  SCREW BN 4MM 12MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-813","SUP","HCPCS C1713","","876-813  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-814","SUP","HCPCS C1713","","876-814  -  SCREW BONE 4MM 14MM ATLNTS TI SPNL CANC VAR ANG SLFTAP STRL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-815","SUP","HCPCS C1713","","876-815  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-816","SUP","HCPCS C1713","","876-816  -  SCREW BONE 4MM 16MM ATLNTS TI SPNL CANC VAR ANG SLFTAP STRL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-817","SUP","HCPCS C1713","","876-817  -  SCREW BONE 4MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-818","SUP","HCPCS C1713","","876-818  -  SCREW BN 4MM 18MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-853","SUP","HCPCS C1713","","876-853  -  SCREW BONE 4.5MM 13MM ATLNTS TI ANT CERV SPN SLFTAP VAR ANG","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-855","SUP","HCPCS C1713","","876-855  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA ST TI SPNE CRV CANC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-857","SUP","HCPCS C1713","","876-857  -  SCREW BONE 4.5MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"876-943","SUP","Custom 27203010","","876-943  -  INSTRUMENT 876-943 ATL NONSTRL 3M DRLBIT","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"876-955","SUP","Custom 27203010","","876-955  -  INSTRUMENT 876-955 ATL NONSTRL ADJ DRLBT","BOTH IP/OP","$501.00 ","$370.74 ","$0.00 ","$501.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$501.00 ","$0.00 ","$250.50 ","$396.79 ","$400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8800500A","SUP","HCPCS C1713","","8800500A  -  SCREW BN 10.5MM 100MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800510A","SUP","HCPCS C1713","","8800510A  -  SCREW BN 10.5MM 110MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800520A","SUP","HCPCS C1713","","8800520A  -  SCREW BN 10.5MM 120MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800525A","SUP","HCPCS C1713","","8800525A  -  SCREW BN 10.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800530A","SUP","HCPCS C1713","","8800530A  -  SCREW BN 10.5MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800535A","SUP","HCPCS C1713","","8800535A  -  SCREW BN 10.5MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800540A","SUP","HCPCS C1713","","8800540A  -  SCREW BN 10.5MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800545A","SUP","HCPCS C1713","","8800545A  -  SCREW BN 10.5MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800550A","SUP","HCPCS C1713","","8800550A  -  SCREW BN 10.5MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800555A","SUP","HCPCS C1713","","8800555A  -  SCREW BN 10.5MM 55MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800560A","SUP","HCPCS C1713","","8800560A  -  SCREW BN 10.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800570A","SUP","HCPCS C1713","","8800570A  -  SCREW BN 10.5MM 70MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800580A","SUP","HCPCS C1713","","8800580A  -  SCREW BN 10.5MM 80MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8800590A","SUP","HCPCS C1713","","8800590A  -  SCREW BN 10.5MM 90MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804525A","SUP","HCPCS C1713","","8804525A  -  SCREW BN 4.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804530A","SUP","HCPCS C1713","","8804530A  -  SCREW BN 4.5MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804535A","SUP","HCPCS C1713","","8804535A  -  SCREW BN 4.5MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804540A","SUP","HCPCS C1713","","8804540A  -  SCREW BN 4.5MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804545A","SUP","HCPCS C1713","","8804545A  -  SCREW BN 4.5MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804550A","SUP","HCPCS C1713","","8804550A  -  SCREW BN 4.5MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804555A","SUP","HCPCS C1713","","8804555A  -  SCREW BN 4.5MM 55MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8804560A","SUP","HCPCS C1713","","8804560A  -  SCREW BN 4.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805025A","SUP","HCPCS C1713","","8805025A  -  SCREW BN 5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805030A","SUP","HCPCS C1713","","8805030A  -  SCREW BN 5MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805035A","SUP","HCPCS C1713","","8805035A  -  SCREW BN 5MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805040A","SUP","HCPCS C1713","","8805040A  -  SCREW BN 5MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805045A","SUP","HCPCS C1713","","8805045A  -  SCREW BN 5MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805050A","SUP","HCPCS C1713","","8805050A  -  SCREW BN 5MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805055A","SUP","HCPCS C1713","","8805055A  -  SCREW BN 5MM 55MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805060A","SUP","HCPCS C1713","","8805060A  -  SCREW BN 5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805525A","SUP","HCPCS C1713","","8805525A  -  SCREW BN 5.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805530A","SUP","HCPCS C1713","","8805530A  -  SCREW BN 5.5MM 30MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805535A","SUP","HCPCS C1713","","8805535A  -  SCREW BN 5.5MM 35MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805540A","SUP","HCPCS C1713","","8805540A  -  SCREW BONE 40MM POLYAX PRECEPT 5.5MM SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805545A","SUP","HCPCS C1713","","8805545A  -  SCREW BONE 45MM POLYAX PRECEPT 5.5MM SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805550A","SUP","HCPCS C1713","","8805550A  -  SCREW BONE 50MM POLYAX PRECEPT 5.5MM SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805555A","SUP","HCPCS C1713","","8805555A  -  SCREW BN 5.5MM 55MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8805560A","SUP","HCPCS C1713","","8805560A  -  SCREW BN 5.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806025A","SUP","HCPCS C1713","","8806025A  -  SCREW BN 6MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806030A","SUP","HCPCS C1713","","8806030A  -  SCREW BN 6MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806035A","SUP","HCPCS C1713","","8806035A  -  SCREW BN 6MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806040A","SUP","HCPCS C1713","","8806040A  -  SCREW BN 6MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806045A","SUP","HCPCS C1713","","8806045A  -  SCREW BN 6MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806050A","SUP","HCPCS C1713","","8806050A  -  SCREW BN 6MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806055A","SUP","HCPCS C1713","","8806055A  -  SCREW BN 6MM 55MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806060A","SUP","HCPCS C1713","","8806060A  -  SCREW BN 6MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806500A","SUP","HCPCS C1713","","8806500A  -  SCREW BN 6.5MM 100MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806510A","SUP","HCPCS C1713","","8806510A  -  SCREW BN 6.5MM 110MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806520A","SUP","HCPCS C1713","","8806520A  -  SCREW BN 6.5MM 120MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806525A","SUP","HCPCS C1713","","8806525A  -  SCREW BN 6.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806530A","SUP","HCPCS C1713","","8806530A  -  SCREW BN 6.5MM 30MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806535A","SUP","HCPCS C1713","","8806535A  -  SCREW BN 6.5MM 35MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806540A","SUP","HCPCS C1713","","8806540A  -  SCREW BN 6.5MM 40MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806545A","SUP","HCPCS C1713","","8806545A  -  SCREW BONE 6.5MM 45MM POLYAX PRECEPT SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806550A","SUP","HCPCS C1713","","8806550A  -  SCREW BONE 50MM 6.5MM SPN MAS","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806555A","SUP","HCPCS C1713","","8806555A  -  SCREW BN 6.5MM 55MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806560A","SUP","HCPCS C1713","","8806560A  -  SCREW BN 6.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806570A","SUP","HCPCS C1713","","8806570A  -  SCREW BN 6.5MM 70MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806580A","SUP","HCPCS C1713","","8806580A  -  SCREW BN 6.5MM 80MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8806590A","SUP","HCPCS C1713","","8806590A  -  SCREW BN 6.5MM 90MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807000A","SUP","HCPCS C1713","","8807000A  -  SCREW BN 7MM 100MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807010A","SUP","HCPCS C1713","","8807010A  -  SCREW BN 7MM 110MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807020A","SUP","HCPCS C1713","","8807020A  -  SCREW BN 7MM 120MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807025A","SUP","HCPCS C1713","","8807025A  -  SCREW BN 7MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807030A","SUP","HCPCS C1713","","8807030A  -  SCREW BN 7MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807035A","SUP","HCPCS C1713","","8807035A  -  SCREW BN 7MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807040A","SUP","HCPCS C1713","","8807040A  -  SCREW BN 7MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807045A","SUP","HCPCS C1713","","8807045A  -  SCREW BN 7MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807050A","SUP","HCPCS C1713","","8807050A  -  SCREW BN 7MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807060A","SUP","HCPCS C1713","","8807060A  -  SCREW BN 7MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807070A","SUP","HCPCS C1713","","8807070A  -  SCREW BN 7MM 70MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807080A","SUP","HCPCS C1713","","8807080A  -  SCREW BN 7MM 80MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807090A","SUP","HCPCS C1713","","8807090A  -  SCREW BN 7MM 90MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807500A","SUP","HCPCS C1713","","8807500A  -  SCREW BN 7.5MM 100MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807510A","SUP","HCPCS C1713","","8807510A  -  SCREW BN 7.5MM 110MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807520A","SUP","HCPCS C1713","","8807520A  -  SCREW BN 7.5MM 120MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807525A","SUP","HCPCS C1713","","8807525A  -  SCREW BN 7.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807530A","SUP","HCPCS C1713","","8807530A  -  SCREW BN 7.5MM 30MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807535A","SUP","HCPCS C1713","","8807535A  -  SCREW BN 7.5MM 35MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807540A","SUP","HCPCS C1713","","8807540A  -  SCREW BN 7.5MM 40MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807545A","SUP","HCPCS C1713","","8807545A  -  SCREW BN 7.5MM 45MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807550A","SUP","HCPCS C1713","","8807550A  -  SCREW BN 7.5MM 50MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807555A","SUP","HCPCS C1713","","8807555A  -  SCREW BN 7.5MM 55MM NS PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807560A","SUP","HCPCS C1713","","8807560A  -  SCREW BN 7.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807570A","SUP","HCPCS C1713","","8807570A  -  SCREW BN 7.5MM 70MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807580A","SUP","HCPCS C1713","","8807580A  -  SCREW BN 7.5MM 80MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8807590A","SUP","HCPCS C1713","","8807590A  -  SCREW BN 7.5MM 90MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808500A","SUP","HCPCS C1713","","8808500A  -  SCREW BN 8.5MM 100MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808510A","SUP","HCPCS C1713","","8808510A  -  SCREW BN 8.5MM 110MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808520A","SUP","HCPCS C1713","","8808520A  -  SCREW BN 8.5MM 120MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808525A","SUP","HCPCS C1713","","8808525A  -  SCREW BN 8.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808530A","SUP","HCPCS C1713","","8808530A  -  SCREW BN 8.5MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808535A","SUP","HCPCS C1713","","8808535A  -  SCREW BN 8.5MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808540A","SUP","HCPCS C1713","","8808540A  -  SCREW BN 8.5MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808545A","SUP","HCPCS C1713","","8808545A  -  SCREW BN 8.5MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808550A","SUP","HCPCS C1713","","8808550A  -  SCREW BN 8.5MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808555A","SUP","HCPCS C1713","","8808555A  -  SCREW BN 8.5MM 55MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808560A","SUP","HCPCS C1713","","8808560A  -  SCREW BN 8.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808570A","SUP","HCPCS C1713","","8808570A  -  SCREW BN 8.5MM 70MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808580A","SUP","HCPCS C1713","","8808580A  -  SCREW BN 8.5MM 80MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8808590A","SUP","HCPCS C1713","","8808590A  -  SCREW BN 8.5MM 90MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809500A","SUP","HCPCS C1713","","8809500A  -  SCREW BN 9.5MM 100MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809510A","SUP","HCPCS C1713","","8809510A  -  SCREW BN 9.5MM 110MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809520A","SUP","HCPCS C1713","","8809520A  -  SCREW BN 9.5MM 120MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809525A","SUP","HCPCS C1713","","8809525A  -  SCREW BN 9.5MM 25MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809530A","SUP","HCPCS C1713","","8809530A  -  SCREW BN 9.5MM 30MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809535A","SUP","HCPCS C1713","","8809535A  -  SCREW BN 9.5MM 35MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809540A","SUP","HCPCS C1713","","8809540A  -  SCREW BN 9.5MM 40MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809545A","SUP","HCPCS C1713","","8809545A  -  SCREW BN 9.5MM 45MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809550A","SUP","HCPCS C1713","","8809550A  -  SCREW BN 9.5MM 50MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809555A","SUP","HCPCS C1713","","8809555A  -  SCREW BN 9.5MM 55MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809560A","SUP","HCPCS C1713","","8809560A  -  SCREW BN 9.5MM 60MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809570A","SUP","HCPCS C1713","","8809570A  -  SCREW BN 9.5MM 70MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809580A","SUP","HCPCS C1713","","8809580A  -  SCREW BN 9.5MM 80MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8809590A","SUP","HCPCS C1713","","8809590A  -  SCREW BN 9.5MM 90MM PRCPT PA SPNE","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"8829-01","SUP","Custom 27203010","","8829-01  -  PADDING CAST 36X21X.25IN ORTHOPEDIC LATEX FREE WHITE FELT","BOTH IP/OP","$17.45 ","$12.91 ","$0.00 ","$17.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.71 ","$0.00 ","$8.86 ","$14.03 ","$14.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"88-571042","SUP","HCPCS C1725","","88-571042  -  CATH DRAIN 28FR 20IN ARG 6 EYLT RIGHT ANG THRMSNS DEPTH MARK","BOTH IP/OP","$182.39 ","$134.97 ","$0.00 ","$182.39 ","$99.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.94 ","$182.39 ","$0.00 ","$91.20 ","$144.45 ","$145.91 ","$0.00 ","$28.54 ","$0.00 ","$29.04 ","$0.00 "
"8872H","SUP","Custom 27203010","","8872H  -  SUTURE NONABSORBABLE 3-0 RB-1 30IN MONOFILAMENT PROLENE BLUE","BOTH IP/OP","$337.65 ","$249.86 ","$0.00 ","$342.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.72 ","$0.00 ","$171.36 ","$271.43 ","$274.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8888146044P","SUP","HCPCS C1750","","8888146044P  -  KIT CATHETER 61CM 44CM SYMMETRICAL TIP PALINDROME PRECISION","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$1,144.77 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$1,144.77 ","$400.00 ","$0.00 ","$226.21 ","$0.00 ","$79.60 ","$0.00 "
"8900-2065","SUP","Custom 27203010","","ELECTRODE DFBR PED MULFUNC PAD PDPDZ","BOTH IP/OP","$75.75 ","$56.06 ","$0.00 ","$75.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.75 ","$0.00 ","$37.88 ","$59.99 ","$60.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8900-4003","SUP","Custom 27203010","","8900-4003  -  ELECTRODE DEFIBRILLATOR RECTANGULAR 24IN MULTIFUNCTION CLOSE","BOTH IP/OP","$72.85 ","$53.91 ","$0.00 ","$72.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.85 ","$0.00 ","$36.42 ","$57.70 ","$58.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-120","SUP","Custom 27803010","","890-120  -  CAGE SPNL 20MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-125","SUP","Custom 27803010","","890-125  -  CAGE SPNL 25MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-140","SUP","Custom 27803010","","890-140  -  CAGE SPNL 20MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-143","SUP","Custom 27803010","","890-143  -  CAGE SPNL 23MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-146","SUP","Custom 27803010","","890-146  -  CAGE SPNL 26MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-149","SUP","Custom 27803010","","890-149  -  CAGE SPNL 29MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-160","SUP","Custom 27803010","","890-160  -  CAGE SPNL 20MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-163","SUP","Custom 27803010","","890-163  -  CAGE SPNL 23MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-166","SUP","Custom 27803010","","890-166  -  CAGE SPNL 26MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-169","SUP","Custom 27803010","","890-169  -  CAGE SPNL 29MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-180","SUP","Custom 27803010","","890-180  -  CAGE SPNL 20MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-183","SUP","Custom 27803010","","890-183  -  CAGE SPNL 23MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-186","SUP","Custom 27803010","","890-186  -  CAGE SPNL 26MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-189","SUP","Custom 27803010","","890-189  -  CAGE SPNL 29MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-200","SUP","Custom 27803010","","890-200  -  CAGE SPNL 20MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-203","SUP","Custom 27803010","","890-203  -  CAGE SPNL 23MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-206","SUP","Custom 27803010","","890-206  -  CAGE SPNL 26MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-209","SUP","Custom 27803010","","890-209  -  CAGE SPNL 29MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-220","SUP","Custom 27803010","","890-220  -  CAGE SPNL 20MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-223","SUP","Custom 27803010","","890-223  -  CAGE SPNL 23MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-226","SUP","Custom 27803010","","890-226  -  CAGE SPNL 26MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-229","SUP","Custom 27803010","","890-229  -  CAGE SPNL 29MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-240","SUP","Custom 27803010","","890-240  -  CAGE SPNL 24MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-243","SUP","Custom 27803010","","890-243  -  CAGE SPNL 24MMX23MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-244","SUP","HCPCS C1713","","890-244  -  BONE 890-244 PRESS PLUG 12MM","BOTH IP/OP","$541.50 ","$400.71 ","$0.00 ","$541.50 ","$243.68 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$94.81 ","$541.50 ","$0.00 ","$270.75 ","$428.87 ","$433.20 ","$0.00 ","$84.74 ","$0.00 ","$86.21 ","$0.00 "
"890-246","SUP","Custom 27803010","","890-246  -  CAGE SPNL 26MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-249","SUP","Custom 27803010","","890-249  -  CAGE SPNL 29MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"890-444","SUP","HCPCS C1713","","890-444  -  BONE 890-444 PRESS PLUG 14MM","BOTH IP/OP","$541.50 ","$400.71 ","$0.00 ","$541.50 ","$243.68 ","$0.00 ","$112.86 ","$0.00 ","$0.00 ","$94.81 ","$541.50 ","$0.00 ","$270.75 ","$428.87 ","$433.20 ","$0.00 ","$84.74 ","$0.00 ","$86.21 ","$0.00 "
"890-999","SUP","HCPCS C1713","","890-999  -  SCREW 890-999 LATERAL EXT. REPLACEMENT","BOTH IP/OP","$42.00 ","$31.08 ","$0.00 ","$42.00 ","$18.90 ","$0.00 ","$8.75 ","$0.00 ","$0.00 ","$7.35 ","$42.00 ","$0.00 ","$21.00 ","$33.26 ","$33.60 ","$0.00 ","$6.57 ","$0.00 ","$6.69 ","$0.00 "
"89104EH","SUP","HCPCS C1713","","89104EH  -  SCREW 89104EH  BREAK OFF SET  T25","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"89104EHT","SUP","HCPCS C1713","","89104EHT  -  SET SCR CD HZN M10 BRKOF TI SPNE PDCL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"89-2505","SUP","Custom 27203010","","89-2505  -  KIT SRG OB EMS","BOTH IP/OP","$19.18 ","$14.19 ","$0.00 ","$19.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.18 ","$0.00 ","$9.59 ","$15.19 ","$15.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941420P","SUP","Custom 27803010","","8941420P  -  CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941423P","SUP","Custom 27803010","","8941423P  -  CAGE SPNL 14MM 23X17.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941620P","SUP","Custom 27803010","","8941620P  -  CAGE SPNL 16MM 20X19MM LTCG PEEK-OPTM LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941623P","SUP","Custom 27803010","","8941623P  -  CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941626P","SUP","Custom 27803010","","8941626P  -  CAGE SPNL 16MM 26X20MM LTCG PEEK-OPTM LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941823P","SUP","Custom 27803010","","8941823P  -  CAGE SPNL 18MM 23X21.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8941826P","SUP","Custom 27803010","","8941826P  -  CAGE SPNL 18MM 26X22MM LTCG PEEK-OPTM LMBR TPR FSN DEV","BOTH IP/OP","$7,865.00 ","$5,820.10 ","$0.00 ","$7,865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,865.00 ","$0.00 ","$3,932.50 ","$6,229.08 ","$6,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"89690E","SUP","Custom 27203010","","89690E  -  INSTRUMENT 89690E IMP HLDR CURVD REDUCD","BOTH IP/OP","$2,295.00 ","$1,698.30 ","$0.00 ","$2,295.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,295.00 ","$0.00 ","$1,147.50 ","$1,817.64 ","$1,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8AC50","SUP","Custom 27203010","","8AC50  -  TOOL LEGEND 8CM 5MM AC","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8AC60","SUP","Custom 27203010","","8AC60  -  TOOL LEGEND 8CM 6MM AC","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8DCFN","SUP","Custom 27203010","","8DCFN  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR","BOTH IP/OP","$83.74 ","$61.97 ","$0.00 ","$83.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.74 ","$0.00 ","$41.87 ","$66.32 ","$66.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8DCFS","SUP","Custom 27203010","","8DCFS  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR","BOTH IP/OP","$88.58 ","$65.55 ","$0.00 ","$89.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.90 ","$0.00 ","$44.95 ","$71.20 ","$71.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8DCT","SUP","Custom 27203010","","8DCT  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN","BOTH IP/OP","$117.10 ","$86.65 ","$0.00 ","$95.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.08 ","$0.00 ","$47.54 ","$75.30 ","$76.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8DFEN","SUP","Custom 27203010","","8DFEN  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN","BOTH IP/OP","$99.43 ","$73.58 ","$0.00 ","$100.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.92 ","$0.00 ","$50.46 ","$79.93 ","$80.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8LGT","SUP","Custom 27203010","","8LGT  -  TUBE TRACHEOSTOMY 8 12.6MM 15MM 7.6MM 50MM CUFFLESS","BOTH IP/OP","$114.73 ","$84.90 ","$0.00 ","$116.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.45 ","$0.00 ","$58.22 ","$92.23 ","$93.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8LGT","SUP","Custom 27203010","","TUBE 50MM 7.6MM UNCUF LRNTMY SHLY TRCH 8 STRL LF DISP","BOTH IP/OP","$114.73 ","$84.90 ","$0.00 ","$116.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.45 ","$0.00 ","$58.22 ","$95.02 ","$93.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8MH22D","SUP","Custom 27203010","","8MH22D  -  TOOL LEGEND 8CM 1.7 MH DIAM","BOTH IP/OP","$295.38 ","$218.58 ","$0.00 ","$295.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$295.38 ","$0.00 ","$147.69 ","$233.94 ","$236.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8SCT","SUP","Custom 27203010","","8SCT  -  TUBE TRACHEOSTOMY 8 10.9MM 8MM 89MM 1 CANNU CUFF SMOOTH","BOTH IP/OP","$71.38 ","$52.82 ","$0.00 ","$72.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.45 ","$0.00 ","$36.22 ","$57.38 ","$57.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TA17","SUP","Custom 27203010","","8TA17  -  TOOL LEGEND 8CM 1.7MM TA","BOTH IP/OP","$265.63 ","$196.57 ","$0.00 ","$265.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$265.63 ","$0.00 ","$132.81 ","$210.38 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD084","SUP","Custom 27203010","","8TD084  -  TOOL LEGND 8CM 8MM 4MM DEPTH TWST","BOTH IP/OP","$388.88 ","$287.77 ","$0.00 ","$388.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$388.88 ","$0.00 ","$194.44 ","$307.99 ","$311.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD104","SUP","Custom 27203010","","8TD104  -  TOOL LEGEND 8CM 1MM 4MM DEPTH TD","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD114","SUP","Custom 27203010","","8TD114  -  TOOL LEGEND 8CM 1.1MM 4MM TD","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD116","SUP","Custom 27203010","","8TD116  -  TOOL LEGEND 8CM 1.1MM 6MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD124","SUP","Custom 27203010","","8TD124  -  TOOL LEGEND 8CM 1.2MM 4MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD126","SUP","Custom 27203010","","8TD126  -  TOOL LEGEND 8CM 1.2MM 6MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD134","SUP","Custom 27203010","","8TD134  -  TOOL LEGEND 8CM 1.3MM 4MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD136","SUP","Custom 27203010","","8TD136  -  TOOL LEGEND 8CM 1.3MM 6MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD154","SUP","Custom 27203010","","8TD154  -  TOOL LEGEND 8CM 1.5MM 4MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD156","SUP","Custom 27203010","","8TD156  -  TOOL LEGEND 8CM 1.5MM 6MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD158","SUP","Custom 27203010","","8TD158  -  TOOL LEGEND 8CM 1.5MM 8MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD174","SUP","Custom 27203010","","8TD174  -  TOOL LEGEND 8CM 1.7MM 4MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD176","SUP","Custom 27203010","","8TD176  -  TOOL LEGEND 8CM 1.7MM 6MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD178","SUP","Custom 27203010","","8TD178  -  TOOL LEGEND 8CM 1.7MM 8MM DEPTH","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD204","SUP","Custom 27203010","","8TD204  -  TOOL LEGEND 8CM 2MM 4MM DEPTH TD","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD206","SUP","Custom 27203010","","8TD206  -  TOOL LEGEND 8CM 2MM 6 MM DEPTH TD","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"8TD208","SUP","Custom 27203010","","8TD208  -  TOOL LEGEND 8CM 2MM 8MM DEPTH TD","BOTH IP/OP","$240.13 ","$177.70 ","$0.00 ","$240.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.13 ","$0.00 ","$120.06 ","$190.18 ","$192.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9001G","SUP","Custom 27203010","","9001G  -  SUTURE NONABSORBABLE 10-0 CS160-6 6IN 2 ARM MONOFILAMENT","BOTH IP/OP","$48.64 ","$35.99 ","$0.00 ","$48.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.64 ","$0.00 ","$24.32 ","$38.52 ","$38.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9001-VC-005","SUP","Custom 27203010","","9001-VC-005  -  NEEDLE BAND PRC WRST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9003 B","SUP","Custom 27803010","","9003 B  -  KIT 9003 B INTL ONLY SHUNT CONT SM ME","BOTH IP/OP","$859.75 ","$636.22 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.75 ","$0.00 ","$429.88 ","$680.92 ","$687.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900-601","SUP","HCPCS C1769","","900-601  -  GWIRE ORTH 150MM 1.6MM DRILL TIP NONSTRL","BOTH IP/OP","$108.65 ","$80.40 ","$0.00 ","$108.65 ","$59.00 ","$0.00 ","$22.65 ","$0.00 ","$0.00 ","$19.02 ","$108.65 ","$0.00 ","$54.33 ","$86.05 ","$86.92 ","$0.00 ","$17.00 ","$0.00 ","$17.30 ","$0.00 "
"9007 H","SUP","Custom 27803010","","9007 H  -  CATH 9007 H C/P STD W/CLOS PRESS-HIGH","BOTH IP/OP","$605.63 ","$448.17 ","$0.00 ","$605.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.63 ","$0.00 ","$302.81 ","$479.66 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9007 L","SUP","Custom 27803010","","9007 L  -  CATH 9007 L C/P STD W/CLOS PRESS-LOW","BOTH IP/OP","$605.63 ","$448.17 ","$0.00 ","$605.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.63 ","$0.00 ","$302.81 ","$479.66 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9007 M","SUP","Custom 27803010","","9007 M  -  CATH 9007 M C/P STD W/CLOS PRESS-MED","BOTH IP/OP","$605.63 ","$448.17 ","$0.00 ","$605.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$605.63 ","$0.00 ","$302.81 ","$479.66 ","$484.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9009 B-H","SUP","Custom 27803010","","9009 B-H  -  SHUNT 9009 B-H ASSY SM HI W/PERT OPN-90","BOTH IP/OP","$2,657.63 ","$1,966.65 ","$0.00 ","$2,657.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,657.63 ","$0.00 ","$1,328.81 ","$2,104.84 ","$2,126.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9009 B-L","SUP","Custom 27803010","","9009 B-L  -  SHUNT 9009 B-L ASSY SM LO W/PERT OPN-90","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9009 B-M","SUP","Custom 27803010","","9009 B-M  -  SHNT 9009 B-M ASSY SM MED W/PERT OPN-90","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"900MR869","SUP","Custom 27203010","","PROBE DUAL ARWY THRMTR 90D 60IN MR850 HMDF","BOTH IP/OP","$334.38 ","$247.44 ","$0.00 ","$334.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$334.38 ","$0.00 ","$167.19 ","$264.83 ","$267.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"901-118","SUP","Custom 27803010","","901-118  -  SHUNT NS INTRO PRTNL","BOTH IP/OP","$127.00 ","$93.98 ","$0.00 ","$127.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.00 ","$0.00 ","$63.50 ","$100.58 ","$101.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"90129-203","SUP","HCPCS C1874","","90129-203  -  STENT TRCHBR LOPRFL 18MM 22FR 56MM NS AERO OTW FULL CVR FLXB","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-204","SUP","HCPCS C1874","","90129-204  -  STENT TRCHBR GMTR 16MM 22FR 40MM NS 61CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-206","SUP","HCPCS C1874","","90129-206  -  STENT TRCHBR LOPRFL 16MM 22FR 56MM NS AERO OTW FULL CVR FLXB","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-207","SUP","HCPCS C1874","","90129-207  -  STENT TRCHBR GMTR 10MM 16FR 20MM NS 63CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-209","SUP","HCPCS C1874","","90129-209  -  STENT TRCHBR GMTR 10MM 16FR 40MM NS 61CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-210","SUP","HCPCS C1874","","90129-210  -  STENT TRCHBR 12MM 16FR 20MM 63CM AERO FLLY CVR ANTIMIGRATION","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-211","SUP","HCPCS C1874","","90129-211  -  STENT TRCHBR GMTR 12MM 16FR 30MM NS 62CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-213","SUP","HCPCS C1874","","90129-213  -  STENT TRCHBR GMTR 14MM 16FR 20MM NS 63CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-214","SUP","HCPCS C1874","","90129-214  -  STENT TRCHBR GMTR 14MM 16FR 30MM NS 62CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-215","SUP","HCPCS C1874","","90129-215  -  STENT TRCHBR GMTR 14MM 16FR 40MM NS 61CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-216","SUP","HCPCS C1874","","90129-216  -  STENT TRCHBR GMTR 20MM 22FR 40MM NS 61CM AERO OTW FLLY CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-217","SUP","HCPCS C1874","","90129-217  -  STENT TRCHBR 20MM 60MM AERO OTW FLLY COVERED","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-218","SUP","HCPCS C1874","","90129-218  -  STENT TRCH 20MM 80MM AERO FLLY COVERED","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"90129-301","SUP","HCPCS C1874","","90129-301  -  STENT TRCHBR 18MM 40MM AERO DV FLLY COVERED DRCT VIS SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-302","SUP","HCPCS C1874","","90129-302  -  STENT TRCHBR 18MM 60MM AERO DV FLLY COVERED DRCT VIS SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-303","SUP","HCPCS C1874","","90129-303  -  STENT TRCHBR 18MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-304","SUP","HCPCS C1874","","90129-304  -  STENT TRCHBR 16MM 30MM 40MM 39MM AERO OTW DRCT VIS NOVEL","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-305","SUP","HCPCS C1874","","90129-305  -  STENT TRCHBR 16MM 60MM AERO FLLY COVERED PURSE STNG DRCT VIS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-306","SUP","HCPCS C1874","","90129-306  -  STENT TRCHBR 16MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-310","SUP","HCPCS C1874","","90129-310  -  STENT TRCHBR 12MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-311","SUP","HCPCS C1874","","90129-311  -  STENT TRCHBR GMTR LOPRFL 12MM 28FR 30MM 40CM AERO FULL CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-312","SUP","HCPCS C1874","","90129-312  -  STENT TRCHBR GMTR LOPRFL 28FR 12MM 40MM 39CM AERO FULL CVR","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-313","SUP","HCPCS C1874","","90129-313  -  STENT TRCHBR 14MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-314","SUP","HCPCS C1874","","90129-314  -  STENT TRCHBR 14MM 30MM AERO DV FLLY COVERED DRCT VIS SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-315","SUP","HCPCS C1874","","90129-315  -  STENT TRCHBR 14MM 40MM AERO FLLY COVERED PURSE STNG DRCT VIS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-316","SUP","HCPCS C1874","","90129-316  -  STENT TRCHBR 20MM 40MM AERO DV FLLY COVERED DRCT VIS SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-317","SUP","HCPCS C1874","","90129-317  -  STENT TRCHBR 20MM 60MM AERO DV FLLY COVERED DRCT VIS SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-318","SUP","HCPCS C1874","","90129-318  -  STENT TRCHBR 20MM 80MM AERO DV FLLY COVERED DRCT VIS SYS","BOTH IP/OP","$5,750.00 ","$4,255.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,198.44 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"90129-501","SUP","HCPCS C1874","","90129-501  -  SIZER SRG AEROSIZER STNT MSR DEV","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"9013 A","SUP","Custom 27803010","","9013 A  -  RESERVOIR 9013 A VENT 12MM CONVT IC 50MM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9013 B","SUP","Custom 27803010","","9013 B  -  RESERVOIR 9013 B VENT 12MM CONVT IC 60MM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9013 F","SUP","Custom 27803010","","9013 F  -  RESERVOIR 9013 F VENT 12MM CONVT IC 7CM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9013 G","SUP","Custom 27803010","","9013 G  -  RESERVOIR 9013 G VENT 12MM CONVT IC 8CM","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"903016A","SUP","HCPCS C1729","","903016A  -  TRAY CATH BDX IC CMP CR 16FR 350ML FOLEY URMTR ANTIINFECTIVE","BOTH IP/OP","$24.95 ","$18.46 ","$0.00 ","$24.95 ","$13.55 ","$0.00 ","$5.20 ","$0.00 ","$0.00 ","$4.37 ","$24.95 ","$0.00 ","$12.48 ","$19.76 ","$19.96 ","$0.00 ","$3.91 ","$0.00 ","$3.97 ","$0.00 "
"903018A","SUP","HCPCS C1729","","TRAY CATH LBRCTH 18FR 350ML FOLEY URMTR","BOTH IP/OP","$41.48 ","$30.70 ","$0.00 ","$41.48 ","$22.52 ","$0.00 ","$8.64 ","$0.00 ","$0.00 ","$7.26 ","$41.48 ","$0.00 ","$20.74 ","$32.85 ","$33.18 ","$0.00 ","$6.49 ","$0.00 ","$6.60 ","$0.00 "
"9032G","SUP","Custom 27203010","","9032G  -  SUTURE NONABSORBABLE 10-0 CS175-8 12IN 2 ARM MONOFILAMENT","BOTH IP/OP","$42.97 ","$31.80 ","$0.00 ","$43.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.61 ","$0.00 ","$21.81 ","$34.54 ","$34.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9040 R","SUP","Custom 27803010","","9040 R  -  KIT 9040 R SHUNT CSF BH MED SML CATHS","BOTH IP/OP","$859.75 ","$636.22 ","$0.00 ","$859.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$859.75 ","$0.00 ","$429.88 ","$680.92 ","$687.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9042 A","SUP","HCPCS C1894","","9042 A  -  VAD 9042 A 12MM CONVT 50MM-INTRODUCER","BOTH IP/OP","$1,223.13 ","$905.12 ","$0.00 ","$1,223.13 ","$664.16 ","$0.00 ","$254.93 ","$0.00 ","$0.00 ","$214.16 ","$1,223.13 ","$0.00 ","$611.56 ","$968.72 ","$978.50 ","$0.00 ","$191.42 ","$0.00 ","$194.72 ","$0.00 "
"9042 B","SUP","HCPCS C1894","","9042 B  -  VAD 9042 B 12MM CONVT 60MM-INTRODUCER","BOTH IP/OP","$1,223.13 ","$905.12 ","$0.00 ","$1,223.13 ","$664.16 ","$0.00 ","$254.93 ","$0.00 ","$0.00 ","$214.16 ","$1,223.13 ","$0.00 ","$611.56 ","$968.72 ","$978.50 ","$0.00 ","$191.42 ","$0.00 ","$194.72 ","$0.00 "
"9042 D","SUP","HCPCS C1894","","9042 D  -  VAD 9042 D 12MM CONVT 40MM-INTRODUCER","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$568.72 ","$0.00 ","$218.30 ","$0.00 ","$0.00 ","$183.39 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$163.91 ","$0.00 ","$166.74 ","$0.00 "
"9042 G","SUP","HCPCS C1894","","9042 G  -  VAD 9042 G 12MM CONVT 35MM-INTRODUCER","BOTH IP/OP","$1,047.38 ","$775.06 ","$0.00 ","$1,047.38 ","$568.72 ","$0.00 ","$218.30 ","$0.00 ","$0.00 ","$183.39 ","$1,047.38 ","$0.00 ","$523.69 ","$829.52 ","$837.90 ","$0.00 ","$163.91 ","$0.00 ","$166.74 ","$0.00 "
"9046 B-H","SUP","Custom 27803010","","9046 B-H  -  SHUNT 9046 B-H ASSY REG HIGH PERIT 90CM","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9046 B-L","SUP","Custom 27803010","","9046 B-L  -  SHUNT 9046 B-L ASSY REG LOW PERIT-90CM","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9046 B-M","SUP","Custom 27803010","","9046 B-M  -  SHUNT 9046 B-M ASSY REG MED PERIT-90CM","BOTH IP/OP","$2,498.50 ","$1,848.89 ","$0.00 ","$2,498.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,498.50 ","$0.00 ","$1,249.25 ","$1,978.81 ","$1,998.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-101","SUP","HCPCS C1781","","905-101  -  MESH 905-101  PYRM 10MM X 100MM ROUND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-103","SUP","HCPCS C1781","","905-103  -  CAGE SPNL RND 10MM 30MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-107","SUP","HCPCS C1781","","905-107  -  MESH 905-107  PYRM 10MM X 70MM ROUND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-108","SUP","HCPCS C1781","","905-108  -  CAGE SPNL RND 10MM 8MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-110","SUP","HCPCS C1781","","905-110  -  CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-112","SUP","HCPCS C1781","","905-112  -  CAGE SPNL RND 10MM 12MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-115","SUP","HCPCS C1781","","905-115  -  CAGE SPNL RND 10MM 15MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-133","SUP","HCPCS C1781","","905-133  -  CAGE SPNL RND 13MM 30MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-137","SUP","HCPCS C1781","","905-137  -  MESH 905-137  PYRM 13MM X 70MM ROUND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-139","SUP","HCPCS C1781","","905-139  -  CAGE SPNL RND 13MM 9MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-161","SUP","HCPCS C1781","","905-161  -  CAGE SPNL RND 16MM 10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-163","SUP","HCPCS C1781","","905-163  -  CAGE SPNL RND 16MM 30MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-166","SUP","HCPCS C1781","","905-166  -  MESH 905-166  PYRM 16MM X 60MM ROUND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-194","SUP","Custom 27803010","","905-194  -  CAGE SPNL RND 19MM 40MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-199","SUP","HCPCS C1781","","905-199  -  CAGE SPNL RND 19MM 90MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-251","SUP","HCPCS C1781","","905-251  -  MESH 905-251  PYRM 25MM X 100MM ROUND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-255","SUP","HCPCS C1781","","905-255  -  MESH 905-255  PYRM 25MM ROUND X 10X15HGT","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-256","SUP","Custom 27803010","","905-256  -  CAGE SPNL 60MMX25MM PRMSH TI RND MESH","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-299","SUP","HCPCS C1781","","905-299  -  MESH 905-299  PYRM 19MM X ROUND END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"905-308","SUP","HCPCS C1781","","905-308  -  CAGE SPNL RND 13MM 8MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-309","SUP","HCPCS C1781","","905-309  -  MESH 905-309  PYRM 25MM X 100MM ROUND","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-310","SUP","HCPCS C1781","","905-310  -  CAGE SPNL RND 13MM 10MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-311","SUP","HCPCS C1781","","905-311  -  MESH 905-311  PYRM  13MM X 11MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-312","SUP","HCPCS C1781","","905-312  -  MESH 905-312  PYRM  13MM X 12MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-313","SUP","HCPCS C1781","","905-313  -  MESH 905-313  PYRM  13MM X 13MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-320","SUP","HCPCS C1781","","905-320  -  MESH 905-320  PYRM  13MM X 20MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-399","SUP","HCPCS C1781","","905-399  -  MESH 905-399  PYRM 25MM ROUND END CAP","BOTH IP/OP","$858.00 ","$634.92 ","$0.00 ","$858.00 ","$386.10 ","$0.00 ","$178.83 ","$0.00 ","$0.00 ","$150.23 ","$858.00 ","$0.00 ","$429.00 ","$679.54 ","$686.40 ","$0.00 ","$134.28 ","$0.00 ","$136.59 ","$0.00 "
"905-401","SUP","HCPCS C1781","","905-401  -  MESH SRG OVOID 14X10X10MM PRMSH","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-403","SUP","HCPCS C1781","","905-403  -  CAGE SPNL OVOID 14X10X30MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-407","SUP","HCPCS C1781","","905-407  -  MESH 905-407  PYRM 10X14X70 OVOID","BOTH IP/OP","$12,604.58 ","$9,327.39 ","$0.00 ","$12,604.58 ","$5,672.06 ","$0.00 ","$2,627.11 ","$0.00 ","$0.00 ","$2,206.96 ","$12,604.58 ","$0.00 ","$6,302.29 ","$9,982.83 ","$10,083.66 ","$0.00 ","$1,972.62 ","$0.00 ","$2,006.65 ","$0.00 "
"905-408","SUP","HCPCS C1781","","905-408  -  CAGE SPNL OVOID 14X10X8MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-409","SUP","HCPCS C1781","","905-409  -  MESH 905-409  PYRM  10 X 14 OVOID X 9MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-411","SUP","HCPCS C1781","","905-411  -  MESH 905-411  PYRM  10 X 14 OVOID X 11MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-412","SUP","HCPCS C1781","","905-412  -  MESH 905-412  PYRM  10 X 14 OVOID X 12MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-415","SUP","HCPCS C1781","","905-415  -  MESH 905-415  PYRM  10 X 14 OVOID X 15MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-501","SUP","HCPCS C1781","","905-501  -  MESH 905-501  PYRM 13 X17 X 10 OVOID","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-508","SUP","HCPCS C1781","","905-508  -  MESH 905-508  PYRM  13 X 17 OVOID X 8MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-509","SUP","HCPCS C1781","","905-509  -  MESH 905-509  PYRM  13 X 17 OVOID X 9MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-511","SUP","HCPCS C1781","","905-511  -  MESH 905-511  PYRM  13 X 17 OVOID X 11MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-512","SUP","HCPCS C1781","","905-512  -  MESH 905-512  PYRM  13 X 17 OVOID X 12MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-515","SUP","HCPCS C1781","","905-515  -  MESH 905-515  PYRM  13 X 17 OVOID X 15MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-520","SUP","HCPCS C1781","","905-520  -  MESH 905-520  PYRM  13 X 17 OVOID X 20MM","BOTH IP/OP","$7,138.60 ","$5,282.56 ","$0.00 ","$7,138.60 ","$3,212.37 ","$0.00 ","$1,487.86 ","$0.00 ","$0.00 ","$1,249.91 ","$7,138.60 ","$0.00 ","$3,569.30 ","$5,653.77 ","$5,710.88 ","$0.00 ","$1,117.19 ","$0.00 ","$1,136.47 ","$0.00 "
"905-608","SUP","HCPCS C1781","","905-608  -  MESH 905-608  PYRM  16MM X 8MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-609","SUP","HCPCS C1781","","905-609  -  MESH 905-609  PYRM  16MM X 9MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-611","SUP","HCPCS C1781","","905-611  -  MESH 905-611  PYRM  16MM X 11MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-612","SUP","HCPCS C1781","","905-612  -  MESH 905-612  PYRM  16MM X 12MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-615","SUP","HCPCS C1781","","905-615  -  MESH 905-615  PYRM  16MM X 15MM ROUND","BOTH IP/OP","$3,513.85 ","$2,600.25 ","$0.00 ","$3,513.85 ","$1,581.23 ","$0.00 ","$732.37 ","$0.00 ","$0.00 ","$615.25 ","$3,513.85 ","$0.00 ","$1,756.93 ","$2,782.97 ","$2,811.08 ","$0.00 ","$549.92 ","$0.00 ","$559.40 ","$0.00 "
"905-800","SUP","HCPCS C1781","","905-800  -  MESH 905-800  PYRM END RING SET SCRW","BOTH IP/OP","$81.25 ","$60.13 ","$0.00 ","$81.25 ","$36.56 ","$0.00 ","$16.93 ","$0.00 ","$0.00 ","$14.23 ","$81.25 ","$0.00 ","$40.63 ","$64.35 ","$65.00 ","$0.00 ","$12.72 ","$0.00 ","$12.94 ","$0.00 "
"905-810","SUP","Custom 27203010","","905-810  -  INSTRUMENT 905-810 MESH HOLDER STRAIGHT","BOTH IP/OP","$1,486.50 ","$1,100.01 ","$0.00 ","$1,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,486.50 ","$0.00 ","$743.25 ","$1,177.31 ","$1,189.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-815","SUP","Custom 27203010","","905-815  -  INSTRUMENT 905-815 MESH HOLDER SMALL","BOTH IP/OP","$1,486.50 ","$1,100.01 ","$0.00 ","$1,486.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,486.50 ","$0.00 ","$743.25 ","$1,177.31 ","$1,189.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-820","SUP","Custom 27203010","","905-820  -  INSTRUMENT 905-820 MESH ACTOR STRAIGHT","BOTH IP/OP","$1,461.00 ","$1,081.14 ","$0.00 ","$1,461.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,461.00 ","$0.00 ","$730.50 ","$1,157.11 ","$1,168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-825","SUP","Custom 27203010","","905-825  -  INSTRUMENT 905-825 ANGLED MESH IMPACTOR","BOTH IP/OP","$1,461.00 ","$1,081.14 ","$0.00 ","$1,461.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,461.00 ","$0.00 ","$730.50 ","$1,157.11 ","$1,168.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-830","SUP","Custom 27203010","","905-830  -  INSTRUMENT 905-830 MESH TRIMMER","BOTH IP/OP","$2,518.50 ","$1,863.69 ","$0.00 ","$2,518.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,518.50 ","$0.00 ","$1,259.25 ","$1,994.65 ","$2,014.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-880","SUP","Custom 27203010","","905-880  -  INSTRUMENT 905-880 END RING DRVR","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"905-901","SUP","HCPCS C1781","","905-901  -  MESH 905-901  PYRM 13MM X 130MM CURVED","BOTH IP/OP","$16,827.60 ","$12,452.42 ","$0.00 ","$16,827.60 ","$7,572.42 ","$0.00 ","$3,507.29 ","$0.00 ","$0.00 ","$2,946.38 ","$16,827.60 ","$0.00 ","$8,413.80 ","$13,327.46 ","$13,462.08 ","$0.00 ","$2,633.52 ","$0.00 ","$2,678.95 ","$0.00 "
"905-902","SUP","HCPCS C1781","","905-902  -  MESH 905-902  PYRM 10X14 OVOIDX130MM CRV","BOTH IP/OP","$16,827.60 ","$12,452.42 ","$0.00 ","$16,827.60 ","$7,572.42 ","$0.00 ","$3,507.29 ","$0.00 ","$0.00 ","$2,946.38 ","$16,827.60 ","$0.00 ","$8,413.80 ","$13,327.46 ","$13,462.08 ","$0.00 ","$2,633.52 ","$0.00 ","$2,678.95 ","$0.00 "
"905-903","SUP","HCPCS C1781","","905-903  -  CAGE SPNL ANG 19MM 150MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$16,827.60 ","$12,452.42 ","$0.00 ","$16,827.60 ","$7,572.42 ","$0.00 ","$3,507.29 ","$0.00 ","$0.00 ","$2,946.38 ","$16,827.60 ","$0.00 ","$8,413.80 ","$13,327.46 ","$13,462.08 ","$0.00 ","$2,633.52 ","$0.00 ","$2,678.95 ","$0.00 "
"905-904","SUP","HCPCS C1781","","905-904  -  CAGE SPNL ANG 25MM 150MM PRMSH MESH TI LMBR INTRBD FS","BOTH IP/OP","$16,827.60 ","$12,452.42 ","$0.00 ","$16,827.60 ","$7,572.42 ","$0.00 ","$3,507.29 ","$0.00 ","$0.00 ","$2,946.38 ","$16,827.60 ","$0.00 ","$8,413.80 ","$13,327.46 ","$13,462.08 ","$0.00 ","$2,633.52 ","$0.00 ","$2,678.95 ","$0.00 "
"907-1080011","SUP","Custom 27203010","","BRACE ORTH BGE 10.5IN SM RT WRST SPRT 11425-55","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"909-145","SUP","Custom 27203010","","909-145  -  PIN 14MM DSTRCT","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9091G","SUP","Custom 27203010","","9091G  -  SUTURE NABSB 10-0 CTC-6L 4IN BLU PRLN HMSL ULT 2 ARM MFL","BOTH IP/OP","$73.45 ","$54.35 ","$0.00 ","$74.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.55 ","$0.00 ","$37.27 ","$59.04 ","$59.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91-1504","SUP","HCPCS C1713","","91-1504  -  SCREW BONE 1.5MM 4MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1505","SUP","HCPCS C1713","","91-1505  -  SCREW BONE 1.5MM 5MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1506","SUP","HCPCS C1713","","91-1506  -  SCREW BONE 1.5MM 6MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1507","SUP","HCPCS C1713","","91-1507  -  SCREW BONE 1.5MM 7MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1508","SUP","HCPCS C1713","","91-1508  -  SCREW TI 8MM 1.5MM MANDIB XDR HTORQ BONE CD","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$63.00 ","$0.00 ","$29.18 ","$0.00 ","$0.00 ","$24.51 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$21.91 ","$0.00 ","$22.29 ","$0.00 "
"91-1509","SUP","HCPCS C1713","","91-1509  -  SCREW BONE 1.5MM 9MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1511","SUP","HCPCS C1713","","91-1511  -  SCREW BONE 1.5MM 11MM HIGH TORQUE CROSS DRIVE TITANIUM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1513","SUP","HCPCS C1713","","91-1513  -  SCREW BONE 1.5MM 13MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1515","SUP","HCPCS C1713","","91-1515  -  SCREW BONE 1.5MM 15MM HIGH TORQUE CROSS DRIVE TITANIUM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"91-1805","SUP","HCPCS C1713","","91-1805  -  SCREW BONE 1.8MM 5MM EMERGENCY SELF TAP HIGH TORQUE CROSS","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$110.25 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"91-1807","SUP","HCPCS C1713","","91-1807  -  SCREW BONE 1.8MM 7MM EMERGENCY HIGH TORQUE CROSS DRIVE","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$110.25 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"91-1809","SUP","HCPCS C1713","","91-1809  -  SCREW TI 9MM 1.8MM MANDIB ER XDR HTORQ BONE CD","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$63.00 ","$0.00 ","$29.18 ","$0.00 ","$0.00 ","$24.51 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$21.91 ","$0.00 ","$22.29 ","$0.00 "
"91500V","SUP","Custom 27203010","","91500V  -  APPLIER ENDOSCOPIC MED LARGE  STRAIGHT 18IN��","BOTH IP/OP","$2,773.73 ","$2,052.56 ","$0.00 ","$2,773.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,773.73 ","$0.00 ","$1,386.86 ","$2,196.79 ","$2,218.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91501V","SUP","Custom 27203010","","91501V  -  CLIP INTNL ENDO REMOVER MED LARGE - LARGE  STRAIGHT 18IN��","BOTH IP/OP","$2,249.98 ","$1,664.99 ","$0.00 ","$2,249.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,249.98 ","$0.00 ","$1,124.99 ","$1,781.98 ","$1,799.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"915-3100","SUP","Custom 27803010","","915-3100  -  PIN FIX HEAT CONTOURING PEN LACTOSORB STERILE","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91-5607","SUP","HCPCS C1713","","91-5607  -  SCREW BONE 2MM 7MM SELF DRILL TRAUMAONE LORENZ BLUE MANDIB","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$195.75 ","$0.00 ","$90.66 ","$0.00 ","$0.00 ","$76.17 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$68.08 ","$0.00 ","$69.25 ","$0.00 "
"91-5609","SUP","HCPCS C1713","","91-5609  -  SCREW BONE 2MM 9MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$195.75 ","$0.00 ","$90.66 ","$0.00 ","$0.00 ","$76.17 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$68.08 ","$0.00 ","$69.25 ","$0.00 "
"91-5611","SUP","HCPCS C1713","","91-5611  -  SCREW BONE 2MM 11MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB","BOTH IP/OP","$435.00 ","$321.90 ","$0.00 ","$435.00 ","$195.75 ","$0.00 ","$90.66 ","$0.00 ","$0.00 ","$76.17 ","$435.00 ","$0.00 ","$217.50 ","$344.52 ","$348.00 ","$0.00 ","$68.08 ","$0.00 ","$69.25 ","$0.00 "
"91-5707","SUP","HCPCS C1713","","91-5707  -  SCREW BONE 2MM 7MM SELF DRILL TEMPORARY ANCHOR CROSS DRIVE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"91602V","SUP","Custom 27203010","","91602V  -  APPLIER ENDOSCOPIC LARGE  CURVED 18IN��","BOTH IP/OP","$2,773.73 ","$2,052.56 ","$0.00 ","$2,773.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,773.73 ","$0.00 ","$1,386.86 ","$2,196.79 ","$2,218.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91-6103","SUP","HCPCS C1713","","91-6103  -  SCREW BONE 1.5MM 3.5MM SELF DRILL HIGH TORQUE CROSS DRIVE","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$110.25 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"91-6104","SUP","HCPCS C1713","","91-6104  -  SCREW BONE 1.5MM 4MM SELF DRILL HIGH TORQUE CROSS DRIVE","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$110.25 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"91-6105","SUP","HCPCS C1713","","91-6105  -  SCREW BONE 1.5MM 5MM SELF DRILL HIGH TORQUE CROSS DRIVE","BOTH IP/OP","$245.00 ","$181.30 ","$0.00 ","$245.00 ","$110.25 ","$0.00 ","$51.06 ","$0.00 ","$0.00 ","$42.90 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$38.34 ","$0.00 ","$39.00 ","$0.00 "
"91-6106","SUP","HCPCS C1713","","91-6106  -  SCREW BN 1.5MM 6MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"91-6107","SUP","HCPCS C1713","","91-6107  -  SCREW BN 1.5MM 7MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$68.63 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"91-6703","SUP","HCPCS C1713","","91-6703  -  SCREW BONE 1.5MM 3.5MM SELF DRILL CROSS DRIVE THINFLAP","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$117.00 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$45.52 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$40.69 ","$0.00 ","$41.39 ","$0.00 "
"91-6704","SUP","HCPCS C1713","","91-6704  -  SCREW BONE 1.5MM 4MM SELF DRILL CROSS DRIVE THINFLAP","BOTH IP/OP","$260.00 ","$192.40 ","$0.00 ","$260.00 ","$117.00 ","$0.00 ","$54.19 ","$0.00 ","$0.00 ","$45.52 ","$260.00 ","$0.00 ","$130.00 ","$205.92 ","$208.00 ","$0.00 ","$40.69 ","$0.00 ","$41.39 ","$0.00 "
"91701V","SUP","Custom 27203010","","91701V  -  CLIP INTNL ENDO REMOVER LARGE - XLARGE  STRAIGHT 18IN��","BOTH IP/OP","$2,364.98 ","$1,750.09 ","$0.00 ","$2,364.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,364.98 ","$0.00 ","$1,182.49 ","$1,873.06 ","$1,891.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"91702V","SUP","Custom 27203010","","91702V  -  APPLIER ENDOSCOPIC XLARGE  CURVED 18IN��","BOTH IP/OP","$2,773.73 ","$2,052.56 ","$0.00 ","$2,773.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,773.73 ","$0.00 ","$1,386.86 ","$2,196.79 ","$2,218.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-00646","SUP","HCPCS C1713","","92-00646  -  PLATE BONE 90X90MM MESH PREFORMED TITANIUM","BOTH IP/OP","$17,716.88 ","$13,110.49 ","$0.00 ","$24,750.00 ","$11,137.50 ","$0.00 ","$3,692.64 ","$0.00 ","$0.00 ","$4,333.53 ","$24,750.00 ","$0.00 ","$12,375.00 ","$19,602.00 ","$19,800.00 ","$0.00 ","$3,873.38 ","$0.00 ","$3,940.20 ","$0.00 "
"92-00647","SUP","HCPCS C1713","","92-00647  -  PLATE BONE 190X140MM MESH PREFORMED TITANIUM","BOTH IP/OP","$68,617.50 ","$50,776.95 ","$0.00 ","$68,617.50 ","$30,877.88 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$68,617.50 ","$0.00 ","$34,308.75 ","$54,345.06 ","$54,894.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"92-03210","SUP","HCPCS C1713","","92-03210  -  PLATE BN NS UNV NEURO II 2 HL LOPRFL TAB","BOTH IP/OP","$227.50 ","$168.35 ","$0.00 ","$540.00 ","$243.00 ","$0.00 ","$47.42 ","$0.00 ","$0.00 ","$94.55 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$84.51 ","$0.00 ","$85.97 ","$0.00 "
"92-03510","SUP","Custom 27803010","","92-03510  -  COVER BURR HOLE 10MM LP CRANIUM 3MM SCREW","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$1,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,052.50 ","$0.00 ","$526.25 ","$833.58 ","$842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-03514","SUP","Custom 27803010","","92-03514  -  COVER BURR HOLE LP 14MM CRANIUM 3MM SCREW","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$1,052.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,052.50 ","$0.00 ","$526.25 ","$833.58 ","$842.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-03608","SUP","HCPCS C1713","","92-03608  -  PLATE BONE 2Y MICRO LP 8MM 6 HOLE BAR CRANIUM","BOTH IP/OP","$639.00 ","$472.86 ","$0.00 ","$1,170.00 ","$526.50 ","$0.00 ","$133.18 ","$0.00 ","$0.00 ","$204.86 ","$1,170.00 ","$0.00 ","$585.00 ","$926.64 ","$936.00 ","$0.00 ","$183.11 ","$0.00 ","$186.26 ","$0.00 "
"92-05228","SUP","HCPCS C1713","","92-05228  -  PLATE BONE LARGE LP BOX TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$498.18 ","$368.65 ","$0.00 ","$945.00 ","$425.25 ","$0.00 ","$103.83 ","$0.00 ","$0.00 ","$165.46 ","$945.00 ","$0.00 ","$472.50 ","$748.44 ","$756.00 ","$0.00 ","$147.89 ","$0.00 ","$150.44 ","$0.00 "
"92-07211","SUP","Custom 27203010","","92-07211  -  SLEEVE LAPSCP TWN FX BLDE","BOTH IP/OP","$525.25 ","$388.69 ","$0.00 ","$525.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.25 ","$0.00 ","$262.63 ","$416.00 ","$420.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-07230","SUP","Custom 27203010","","92-07230  -  BIT DRILL 200MM 3.4MM CANN","BOTH IP/OP","$463.25 ","$342.81 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-10504","SUP","HCPCS C1713","","92-10504  -  PLATE BN MN 4 HL TI 1.25MM","BOTH IP/OP","$1,857.50 ","$1,374.55 ","$0.00 ","$1,857.50 ","$835.88 ","$0.00 ","$387.15 ","$0.00 ","$0.00 ","$325.23 ","$1,857.50 ","$0.00 ","$928.75 ","$1,471.14 ","$1,486.00 ","$0.00 ","$290.70 ","$0.00 ","$295.71 ","$0.00 "
"92-10505","SUP","HCPCS C1713","","92-10505  -  PLATE BONE MINI 1.5MM 4 HOLE BAR TITANIUM MAXFACL","BOTH IP/OP","$1,374.23 ","$1,016.93 ","$0.00 ","$2,100.00 ","$945.00 ","$0.00 ","$286.42 ","$0.00 ","$0.00 ","$367.69 ","$2,100.00 ","$0.00 ","$1,050.00 ","$1,663.20 ","$1,680.00 ","$0.00 ","$328.65 ","$0.00 ","$334.32 ","$0.00 "
"92-10506","SUP","HCPCS C1713","","92-10506  -  PLATE BONE MINI 6 HOLE CUSTOM MAXFACL","BOTH IP/OP","$2,555.00 ","$1,890.70 ","$0.00 ","$2,555.00 ","$1,149.75 ","$0.00 ","$532.53 ","$0.00 ","$0.00 ","$447.36 ","$2,555.00 ","$0.00 ","$1,277.50 ","$2,023.56 ","$2,044.00 ","$0.00 ","$399.86 ","$0.00 ","$406.76 ","$0.00 "
"92-10507","SUP","HCPCS C1713","","92-10507  -  PLATE BONE 2MM 6 HOLE BARMAND LOCK CRANIOMAXILLOFACIAL","BOTH IP/OP","$1,702.73 ","$1,260.02 ","$0.00 ","$2,675.00 ","$1,203.75 ","$0.00 ","$354.89 ","$0.00 ","$0.00 ","$468.37 ","$2,675.00 ","$0.00 ","$1,337.50 ","$2,118.60 ","$2,140.00 ","$0.00 ","$418.64 ","$0.00 ","$425.86 ","$0.00 "
"92-10516","SUP","HCPCS C1713","","92-10516  -  PLATE BN 1.5MM MN 16 HL MXLFCL","BOTH IP/OP","$2,850.00 ","$2,109.00 ","$0.00 ","$2,850.00 ","$1,282.50 ","$0.00 ","$594.01 ","$0.00 ","$0.00 ","$499.01 ","$2,850.00 ","$0.00 ","$1,425.00 ","$2,257.20 ","$2,280.00 ","$0.00 ","$446.03 ","$0.00 ","$453.72 ","$0.00 "
"92-10562","SUP","HCPCS C1713","","92-10562  -  PLATE BN STRUT TROCH","BOTH IP/OP","$2,850.00 ","$2,109.00 ","$0.00 ","$2,850.00 ","$1,282.50 ","$0.00 ","$594.01 ","$0.00 ","$0.00 ","$499.01 ","$2,850.00 ","$0.00 ","$1,425.00 ","$2,257.20 ","$2,280.00 ","$0.00 ","$446.03 ","$0.00 ","$453.72 ","$0.00 "
"92-15514","SUP","HCPCS C1713","","92-15514  -  PLATE BONE 2MM STR FRAC","BOTH IP/OP","$3,907.50 ","$2,891.55 ","$0.00 ","$3,907.50 ","$1,758.38 ","$0.00 ","$814.42 ","$0.00 ","$0.00 ","$684.17 ","$3,907.50 ","$0.00 ","$1,953.75 ","$3,094.74 ","$3,126.00 ","$0.00 ","$611.52 ","$0.00 ","$622.07 ","$0.00 "
"92-15904","SUP","HCPCS C1713","","92-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL TITANIUM CRANIOMAXILLOFACIAL","BOTH IP/OP","$100.95 ","$74.70 ","$0.00 ","$100.95 ","$45.43 ","$0.00 ","$21.04 ","$0.00 ","$0.00 ","$17.68 ","$100.95 ","$0.00 ","$50.48 ","$79.95 ","$80.76 ","$0.00 ","$15.80 ","$0.00 ","$16.07 ","$0.00 "
"92-15905","SUP","HCPCS C1713","","92-15905  -  SCREW BONE 5MM 1.5MM MAXFACL TI SLFDRILL XPIN","BOTH IP/OP","$100.95 ","$74.70 ","$0.00 ","$100.95 ","$45.43 ","$0.00 ","$21.04 ","$0.00 ","$0.00 ","$17.68 ","$100.95 ","$0.00 ","$50.48 ","$79.95 ","$80.76 ","$0.00 ","$15.80 ","$0.00 ","$16.07 ","$0.00 "
"92-15920","SUP","HCPCS C1713","","92-15920  -  PLATE BONE 20MM HEMI RECONSTRUCTION TITANIUM MANDIB","BOTH IP/OP","$10,292.50 ","$7,616.45 ","$0.00 ","$10,292.50 ","$4,631.63 ","$0.00 ","$2,145.21 ","$0.00 ","$0.00 ","$1,802.13 ","$10,292.50 ","$0.00 ","$5,146.25 ","$8,151.66 ","$8,234.00 ","$0.00 ","$1,610.78 ","$0.00 ","$1,638.57 ","$0.00 "
"92-15922","SUP","HCPCS C1713","","92-15922  -  PLATE BONE 22MM HEMI RECONSTRUCTION TITANIUM MANDIB","BOTH IP/OP","$10,292.50 ","$7,616.45 ","$0.00 ","$10,292.50 ","$4,631.63 ","$0.00 ","$2,145.21 ","$0.00 ","$0.00 ","$1,802.13 ","$10,292.50 ","$0.00 ","$5,146.25 ","$8,151.66 ","$8,234.00 ","$0.00 ","$1,610.78 ","$0.00 ","$1,638.57 ","$0.00 "
"92-16035","SUP","Custom 27100030","","92-16035  -  BIT DRILL 1.6MM 35MM 7MM TWIST STOP","BOTH IP/OP","$468.58 ","$346.75 ","$0.00 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-16135","SUP","Custom 27203010","","92-16135  -  DRILL SRG 1.6MM 115MM NS LF 35MM CLR CD DISP","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-17126","SUP","Custom 27203010","","92-17126  -  BIT DRL TWST","BOTH IP/OP","$160.65 ","$118.88 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-19035","SUP","Custom 27100030","","92-19035  -  BIT DRILL 1.9MM 35MM TWIST","BOTH IP/OP","$736.88 ","$545.29 ","$0.00 ","$1,002.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,002.50 ","$0.00 ","$501.25 ","$793.98 ","$802.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-23126","SUP","Custom 27203010","","92-23126  -  BIT DRL 23MM","BOTH IP/OP","$160.65 ","$118.88 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-25290","SUP","HCPCS C1713","","92-25290  -  PLATE STD LNG BONE RIGHT DORSAL RADL","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$893.75 ","$402.19 ","$0.00 ","$186.28 ","$0.00 ","$0.00 ","$156.49 ","$893.75 ","$0.00 ","$446.88 ","$707.85 ","$715.00 ","$0.00 ","$139.87 ","$0.00 ","$142.29 ","$0.00 "
"92-25291","SUP","HCPCS C1713","","92-25291  -  PLATE STD LNG BONE LEFT DORSAL RADL","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$893.75 ","$402.19 ","$0.00 ","$186.28 ","$0.00 ","$0.00 ","$156.49 ","$893.75 ","$0.00 ","$446.88 ","$707.85 ","$715.00 ","$0.00 ","$139.87 ","$0.00 ","$142.29 ","$0.00 "
"92-25292","SUP","HCPCS C1713","","92-25292  -  PLATE LNG W BONE RIGHT DORSAL RADL","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$893.75 ","$402.19 ","$0.00 ","$186.28 ","$0.00 ","$0.00 ","$156.49 ","$893.75 ","$0.00 ","$446.88 ","$707.85 ","$715.00 ","$0.00 ","$139.87 ","$0.00 ","$142.29 ","$0.00 "
"92-25293","SUP","HCPCS C1713","","92-25293  -  PLATE LNG W BONE LEFT DORSAL RADL","BOTH IP/OP","$893.75 ","$661.38 ","$0.00 ","$893.75 ","$402.19 ","$0.00 ","$186.28 ","$0.00 ","$0.00 ","$156.49 ","$893.75 ","$0.00 ","$446.88 ","$707.85 ","$715.00 ","$0.00 ","$139.87 ","$0.00 ","$142.29 ","$0.00 "
"92-25395","SUP","HCPCS C1713","","92-25395  -  PLATE NAR XLNG BONE VOLR RADL","BOTH IP/OP","$1,216.88 ","$900.49 ","$0.00 ","$1,216.88 ","$547.59 ","$0.00 ","$253.63 ","$0.00 ","$0.00 ","$213.07 ","$1,216.88 ","$0.00 ","$608.44 ","$963.77 ","$973.50 ","$0.00 ","$190.44 ","$0.00 ","$193.73 ","$0.00 "
"92-25397","SUP","HCPCS C1713","","92-25397  -  PLATE STD XLNG BONE VOLR RADL","BOTH IP/OP","$1,216.88 ","$900.49 ","$0.00 ","$1,216.88 ","$547.59 ","$0.00 ","$253.63 ","$0.00 ","$0.00 ","$213.07 ","$1,216.88 ","$0.00 ","$608.44 ","$963.77 ","$973.50 ","$0.00 ","$190.44 ","$0.00 ","$193.73 ","$0.00 "
"92-25399","SUP","HCPCS C1713","","92-25399  -  PLATE W XLNG BONE VOLR RADL","BOTH IP/OP","$1,216.88 ","$900.49 ","$0.00 ","$1,216.88 ","$547.59 ","$0.00 ","$253.63 ","$0.00 ","$0.00 ","$213.07 ","$1,216.88 ","$0.00 ","$608.44 ","$963.77 ","$973.50 ","$0.00 ","$190.44 ","$0.00 ","$193.73 ","$0.00 "
"92-25403","SUP","HCPCS C1713","","92-25403  -  PLATE BN SHRT T","BOTH IP/OP","$1,271.00 ","$940.54 ","$0.00 ","$1,124.75 ","$506.14 ","$0.00 ","$264.91 ","$0.00 ","$0.00 ","$196.93 ","$1,124.75 ","$0.00 ","$562.38 ","$890.80 ","$899.80 ","$0.00 ","$176.02 ","$0.00 ","$179.06 ","$0.00 "
"92-25405","SUP","HCPCS C1713","","92-25405  -  PLATE LNG 7 HOLE T CLMN BONE ULN","BOTH IP/OP","$1,271.00 ","$940.54 ","$0.00 ","$1,124.75 ","$506.14 ","$0.00 ","$264.91 ","$0.00 ","$0.00 ","$196.93 ","$1,124.75 ","$0.00 ","$562.38 ","$890.80 ","$899.80 ","$0.00 ","$176.02 ","$0.00 ","$179.06 ","$0.00 "
"92-27007","SUP","Custom 27203010","","92-27007  -  HOLDER INSTR SHFT PLT","BOTH IP/OP","$434.50 ","$321.53 ","$0.00 ","$434.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$434.50 ","$0.00 ","$217.25 ","$344.12 ","$347.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-40281","SUP","HCPCS C1713","","92-40281  -  WIRE FX 1.4MM 160MM KRSH STP","BOTH IP/OP","$41.25 ","$30.53 ","$0.00 ","$41.25 ","$18.56 ","$0.00 ","$8.60 ","$0.00 ","$0.00 ","$7.22 ","$41.25 ","$0.00 ","$20.63 ","$32.67 ","$33.00 ","$0.00 ","$6.46 ","$0.00 ","$6.57 ","$0.00 "
"92-40283","SUP","HCPCS C1713","","92-40283  -  WIRE FX .062IN 160MM KRSH","BOTH IP/OP","$48.13 ","$35.62 ","$0.00 ","$48.13 ","$21.66 ","$0.00 ","$10.03 ","$0.00 ","$0.00 ","$8.43 ","$48.13 ","$0.00 ","$24.06 ","$38.12 ","$38.50 ","$0.00 ","$7.53 ","$0.00 ","$7.66 ","$0.00 "
"92-53514","SUP","Custom 27803010","","92-53514  -  COVER BURR HOLE 14MM LP","BOTH IP/OP","$520.05 ","$384.84 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-55005","SUP","HCPCS C1713","","92-55005  -  PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL LEFT","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"92-55007","SUP","HCPCS C1713","","92-55007  -  PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL RIGHT","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"92-55011","SUP","HCPCS C1713","","92-55011  -  PLATE BN 2.5MM 11 HL MNDB","BOTH IP/OP","$7,835.00 ","$5,797.90 ","$0.00 ","$7,835.00 ","$3,525.75 ","$0.00 ","$1,633.01 ","$0.00 ","$0.00 ","$1,371.85 ","$7,835.00 ","$0.00 ","$3,917.50 ","$6,205.32 ","$6,268.00 ","$0.00 ","$1,226.18 ","$0.00 ","$1,247.33 ","$0.00 "
"92-55066","SUP","HCPCS C1713","","92-55066  -  PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL RIGHT","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$239.69 ","$0.00 ","$0.00 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"92-55067","SUP","HCPCS C1713","","92-55067  -  PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL LEFT","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$517.50 ","$0.00 ","$239.69 ","$0.00 ","$0.00 ","$201.36 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$179.98 ","$0.00 ","$183.08 ","$0.00 "
"92-55159","SUP","HCPCS C1713","","92-55159  -  PLATE BN 2MM 11 HL CRNMXF","BOTH IP/OP","$6,960.00 ","$5,150.40 ","$0.00 ","$6,960.00 ","$3,132.00 ","$0.00 ","$1,450.64 ","$0.00 ","$0.00 ","$1,218.64 ","$6,960.00 ","$0.00 ","$3,480.00 ","$5,512.32 ","$5,568.00 ","$0.00 ","$1,089.24 ","$0.00 ","$1,108.03 ","$0.00 "
"92-55161","SUP","HCPCS C1713","","92-55161  -  PLATE BONE 2MM 17 HOLE PRIM RECONSTRUCTION TEMPLATE MANDIB","BOTH IP/OP","$8,477.50 ","$6,273.35 ","$0.00 ","$8,477.50 ","$3,814.88 ","$0.00 ","$1,766.92 ","$0.00 ","$0.00 ","$1,484.34 ","$8,477.50 ","$0.00 ","$4,238.75 ","$6,714.18 ","$6,782.00 ","$0.00 ","$1,326.73 ","$0.00 ","$1,349.62 ","$0.00 "
"92-55506","SUP","HCPCS C1713","","92-55506  -  PLATE BONE 4 HOLE PREBENT TITANIUM LEFT MAXFACL","BOTH IP/OP","$1,082.50 ","$801.05 ","$0.00 ","$1,082.50 ","$487.13 ","$0.00 ","$225.62 ","$0.00 ","$0.00 ","$189.54 ","$1,082.50 ","$0.00 ","$541.25 ","$857.34 ","$866.00 ","$0.00 ","$169.41 ","$0.00 ","$172.33 ","$0.00 "
"92-55922","SUP","HCPCS C1713","","92-55922  -  PLATE BN 2MM HEMI PRM LT 2","BOTH IP/OP","$6,475.00 ","$4,791.50 ","$0.00 ","$6,475.00 ","$2,913.75 ","$0.00 ","$1,349.55 ","$0.00 ","$0.00 ","$1,133.72 ","$6,475.00 ","$0.00 ","$3,237.50 ","$5,128.20 ","$5,180.00 ","$0.00 ","$1,013.34 ","$0.00 ","$1,030.82 ","$0.00 "
"92-57262","SUP","HCPCS C1713","","92-57262  -  PLATE BN FX 1.7 MM SCR","BOTH IP/OP","$584.38 ","$432.44 ","$0.00 ","$584.38 ","$262.97 ","$0.00 ","$121.80 ","$0.00 ","$0.00 ","$102.32 ","$584.38 ","$0.00 ","$292.19 ","$462.83 ","$467.50 ","$0.00 ","$91.45 ","$0.00 ","$93.03 ","$0.00 "
"92-60090","SUP","Custom 27203010","","92-60090  -  TWIST DRILL DIA.0.9X66MM TWIST LENGTH 22MM AO SHAFT","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-60130","SUP","Custom 27203010","","92-60130  -  TWIST DRILL DIA.1.3X66MM TWIST LENGTH 22MM AO SHAFT","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-60165","SUP","Custom 27100030","","92-60165  -  BIT DRILL 35MM COLOR CODED","BOTH IP/OP","$406.70 ","$300.96 ","$0.00 ","$775.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-60170","SUP","Custom 27203010","","92-60170  -  DRILL TWST 1.7MM 66MM","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-60190","SUP","Custom 27203010","","92-60190  -  TWIST DRILL DIA.1.9X82MM TWIST LENGTH 39MM AO SHAFT","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-60199","SUP","Custom 27100030","","92-60199  -  DRILL TWIST 1.9MM STOP 35MM 115MM","BOTH IP/OP","$491.18 ","$363.47 ","$0.00 ","$877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-60230","SUP","Custom 27203010","","92-60230  -  DRILL TWST 2.3MM 82MM","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-62254","SUP","Custom 27203010","","92-62254  -  GUIDE DRL 1.2MM 1.7MM FUSED","BOTH IP/OP","$1,175.63 ","$869.97 ","$0.00 ","$1,175.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,175.63 ","$0.00 ","$587.81 ","$931.10 ","$940.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-62255","SUP","Custom 27203010","","92-62255  -  GUIDE DRL 2.3MM LG FUSED CMPR","BOTH IP/OP","$1,117.88 ","$827.23 ","$0.00 ","$1,117.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,117.88 ","$0.00 ","$558.94 ","$885.36 ","$894.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-62256","SUP","Custom 27203010","","92-62256  -  GUIDE DRL 2.3MM 2.5MM FUSED CENTRIC","BOTH IP/OP","$1,227.88 ","$908.63 ","$0.00 ","$1,227.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,227.88 ","$0.00 ","$613.94 ","$972.48 ","$982.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"92-62270","SUP","Custom 27803010","","92-62270  -  TAP FOR 2.7MM SCREW","BOTH IP/OP","$570.63 ","$422.27 ","$0.00 ","$570.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$570.63 ","$0.00 ","$285.31 ","$451.94 ","$456.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"931HF75","SUP","HCPCS C1887","","CATHETER ART 7.5FR 110CM 5 LUM TD SG HEP","BOTH IP/OP","$210.25 ","$155.59 ","$0.00 ","$210.25 ","$114.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.81 ","$210.25 ","$0.00 ","$105.13 ","$166.52 ","$168.20 ","$0.00 ","$32.90 ","$0.00 ","$33.47 ","$0.00 "
"93-9268","SUP","HCPCS C1762","","93-9268  -  GRAFT SKIN 8X6CM DEHYDRATED GAMA IRRADIATED AXIS TUTOPLAST","BOTH IP/OP","$3,847.50 ","$2,847.15 ","$0.00 ","$3,847.50 ","$0.00 ","$0.00 ","$801.92 ","$0.00 ","$0.00 ","$0.00 ","$3,847.50 ","$0.00 ","$1,923.75 ","$3,047.22 ","$3,078.00 ","$0.00 ","$602.13 ","$0.00 ","$0.00 ","$0.00 "
"94107CE","SUP","HCPCS C1713","","94107CE  -  CROSSLINK 94107CE DTT4 FOR COMPRESS L60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"94107DE","SUP","HCPCS C1713","","94107DE  -  CROSSLINK 94107DE DTT4 FOR DISTRACT L60","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"94-202","SUP","Custom 27203010","","REAGENT LUPOTEK DETECTIN ANALY","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9450002E","SUP","Custom 27203010","","9450002E  -  DISPOSABLE 9450002E ELECTRO LOWIMPED22MM","BOTH IP/OP","$669.00 ","$495.06 ","$0.00 ","$669.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$669.00 ","$0.00 ","$334.50 ","$529.85 ","$535.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DMA1002","SUP","Custom 27203010","","945DMA1002  -  ELECTRODE 945DMA1002 AD GOLDFOIL EAR CAN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DMA1004","SUP","Custom 27203010","","945DMA1004  -  ELECTRODE 945DMA1004 PED GOLDFOIL EARCAN","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DME1001","SUP","Custom 27203010","","945DME1001  -  ELECTRODE 945DME1001 1.2M CORKSCREW","BOTH IP/OP","$82.50 ","$61.05 ","$0.00 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.50 ","$0.00 ","$41.25 ","$65.34 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DME1004","SUP","Custom 27203010","","945DME1004  -  ELECTRODE 945DME1004 3.5X5CM 2M SING GR","BOTH IP/OP","$25.50 ","$18.87 ","$0.00 ","$25.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.50 ","$0.00 ","$12.75 ","$20.20 ","$20.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DME2002","SUP","Custom 27203010","","945DME2002  -  ELECTRODE 945DME2002 48IN 1.2M CORKSCREW","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE1115","SUP","Custom 27203010","","945DSE1115  -  ELECTRODE 945DSE1115 1.5X2CM 1.5M SINGLE","BOTH IP/OP","$12.00 ","$8.88 ","$0.00 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.00 ","$0.00 ","$6.00 ","$9.50 ","$9.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE1125","SUP","Custom 27203010","","945DSE1125  -  ELECTRODE 945DSE1125 1.5X2CM 2.5M SINGLE","BOTH IP/OP","$18.00 ","$13.32 ","$0.00 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.00 ","$0.00 ","$9.00 ","$14.26 ","$14.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE2115","SUP","Custom 27203010","","945DSE2115  -  ELECTRODE 945DSE2115 2X2.7CM 1.5M SINGLE","BOTH IP/OP","$12.00 ","$8.88 ","$0.00 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.00 ","$0.00 ","$6.00 ","$9.50 ","$9.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE2125","SUP","Custom 27203010","","945DSE2125  -  ELECTRODE 945DSE2125 2X2.7CM 2.5M SINGLE","BOTH IP/OP","$15.00 ","$11.10 ","$0.00 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.00 ","$0.00 ","$7.50 ","$11.88 ","$12.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE3115","SUP","Custom 27203010","","945DSE3115  -  ELECTRODE 945DSE3115 1.5X2CM 1.5M DUAL","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$43.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.50 ","$0.00 ","$21.75 ","$34.45 ","$34.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE3125","SUP","Custom 27203010","","945DSE3125  -  ELECTRODE 945DSE3125 1.5X2CM 2.5M DUAL","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE4115","SUP","Custom 27203010","","945DSE4115  -  ELECTRODE 945DSE4115 2X2.7CM 1.5M DUAL","BOTH IP/OP","$43.50 ","$32.19 ","$0.00 ","$43.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.50 ","$0.00 ","$21.75 ","$34.45 ","$34.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSE4125","SUP","Custom 27203010","","945DSE4125  -  ELECTRODE 945DSE4125 2X2.7CM 2.5M DUAL","BOTH IP/OP","$63.00 ","$46.62 ","$0.00 ","$63.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$63.00 ","$0.00 ","$31.50 ","$49.90 ","$50.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSN1260","SUP","Custom 27203010","","945DSN1260  -  ELECTRODE 945DSN1260 13MM 27G 1.5M SING","BOTH IP/OP","$22.50 ","$16.65 ","$0.00 ","$22.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.50 ","$0.00 ","$11.25 ","$17.82 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSN1299","SUP","Custom 27203010","","945DSN1299  -  ELECTRODE 945DSN1299 13MM 27G 2.5M SING","BOTH IP/OP","$22.50 ","$16.65 ","$0.00 ","$22.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.50 ","$0.00 ","$11.25 ","$17.82 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSN2260","SUP","Custom 27203010","","945DSN2260  -  ELECTRODE 945DSN2260 13MM 27G 1.5M DUAL","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSN2280","SUP","Custom 27203010","","945DSN2280  -  ELECTRODE 945DSN2280 13MM 27G 2.0M DUAL","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DSN2299","SUP","Custom 27203010","","945DSN2299  -  ELECTRODE 945DSN2299 13MM 27G 2.5M DUAL","BOTH IP/OP","$61.50 ","$45.51 ","$0.00 ","$61.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.50 ","$0.00 ","$30.75 ","$48.71 ","$49.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DTE0001","SUP","HCPCS C1898","","945DTE0001  -  LEAD 945DTE0001 0.6M RED CLIP","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$20.25 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"945DTE0002","SUP","HCPCS C1898","","945DTE0002  -  LEAD 945DTE0002 0.6 GREEN CLIP","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$20.25 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"945DTE0003","SUP","HCPCS C1898","","945DTE0003  -  LEAD 945DTE0003 0.6M BLACK CLIP","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$20.25 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"945DTE1002","SUP","Custom 27203010","","945DTE1002  -  ELECTRODE 945DTE1002 1.27X1.9CMPREGELTAB","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945DTE1003","SUP","Custom 27203010","","945DTE1003  -  ELECTRODE 945DTE1003 2.54X2.54CMPRETAB","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945MEP1001","SUP","Custom 27203010","","945MEP1001  -  ELECTRODE 945MEP1001 KEYED CORKSCREW","BOTH IP/OP","$624.00 ","$461.76 ","$0.00 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$624.00 ","$0.00 ","$312.00 ","$494.21 ","$499.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945NRE1003","SUP","Custom 27203010","","945NRE1003  -  ELECTRODE 945NRE1003 SD NEEDLE RECORDING","BOTH IP/OP","$891.00 ","$659.34 ","$0.00 ","$891.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$891.00 ","$0.00 ","$445.50 ","$705.67 ","$712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945NRE1004","SUP","Custom 27203010","","945NRE1004  -  ELECTRODE 945NRE1004 NEEDLE WITH RING","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945POC1002","SUP","HCPCS C1713","","945POC1002  -  CLIP 945POC1002 SD PULSE OX","BOTH IP/OP","$223.50 ","$165.39 ","$0.00 ","$223.50 ","$100.58 ","$0.00 ","$46.58 ","$0.00 ","$0.00 ","$39.13 ","$223.50 ","$0.00 ","$111.75 ","$177.01 ","$178.80 ","$0.00 ","$34.98 ","$0.00 ","$35.58 ","$0.00 "
"945PXC2002","SUP","HCPCS C1713","","945PXC2002  -  CLIP 945PXC2002 1MLEAD PULSEOX FING/TOE","BOTH IP/OP","$82.50 ","$61.05 ","$0.00 ","$82.50 ","$37.13 ","$0.00 ","$17.20 ","$0.00 ","$0.00 ","$14.45 ","$82.50 ","$0.00 ","$41.25 ","$65.34 ","$66.00 ","$0.00 ","$12.91 ","$0.00 ","$13.13 ","$0.00 "
"945RMA1016","SUP","Custom 27203010","","945RMA1016  -  TUBE 945RMA1016 REPLACEMENT","BOTH IP/OP","$22.50 ","$16.65 ","$0.00 ","$22.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.50 ","$0.00 ","$11.25 ","$17.82 ","$18.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945RMA1019","SUP","Custom 27203010","","945RMA1019  -  ELECTRODE 945RMA1019 10-7.5MMLARYNGEAL","BOTH IP/OP","$289.50 ","$214.23 ","$0.00 ","$289.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.50 ","$0.00 ","$144.75 ","$229.28 ","$231.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945RMA1019S","SUP","Custom 27203010","","945RMA1019S  -  ELECTRODE 945RMA1019S 7-6MM LARYNGEAL","BOTH IP/OP","$289.50 ","$214.23 ","$0.00 ","$289.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.50 ","$0.00 ","$144.75 ","$229.28 ","$231.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945RMA1019SP","SUP","Custom 27203010","","945RMA1019SP  -  ELECTRODE 945RMA1019SP 5.5-2MMLARYNGEAL","BOTH IP/OP","$289.50 ","$214.23 ","$0.00 ","$289.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.50 ","$0.00 ","$144.75 ","$229.28 ","$231.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945RMA2029","SUP","Custom 27203010","","945RMA2029  -  ELECTRODE 945RMA2029 LARGE LARYNGEAL","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945RMA2029SP","SUP","Custom 27203010","","945RMA2029SP  -  ELECTRODE 945RMA2029SP MEDIUM LARYNGEAL","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"945SRE1002","SUP","Custom 27203010","","945SRE1002  -  ELECTRODE 945SRE1002 SD SURFACERECORDING","BOTH IP/OP","$891.00 ","$659.34 ","$0.00 ","$891.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$891.00 ","$0.00 ","$445.50 ","$705.67 ","$712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9461-217","SUP","Custom 27203010","","TUBING BP RECT SCR CONNCTR LF 12FT PED ADLT GRY EGL 3K DASH","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95-1318BIO","SUP","Custom 27203010","","BAG 18X13IN BHZR LOGO SPGRD SPEC","BOTH IP/OP","$0.40 ","$0.30 ","$0.00 ","$0.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.40 ","$0.00 ","$0.20 ","$0.32 ","$0.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"95-201","SUP","Custom 27203010","","REAGENT LUPOTEK CORRECTIN ANALY","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9529-","SUP","Custom 27203010","","9529-  -  SLEEVE CMPR MED KN LGTH 21- IN NS LF KDL SCD EXP ADJ CRCMF","BOTH IP/OP","$34.45 ","$25.49 ","$0.00 ","$27.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.49 ","$27.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96004-N","SUP","Custom 27203010","","PACIFIER NBN SIL STH 1 PC DSGN LF NTR","BOTH IP/OP","$2.58 ","$1.91 ","$0.00 ","$2.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.58 ","$0.00 ","$1.29 ","$2.04 ","$2.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96505H","SUP","Custom 27803010","","96505H  -  CONNECTOR ROD 6.35/6.35MM DMN SPNE","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96505HT","SUP","Custom 27803010","","96505HT  -  CONNECTOR 96505HT DOM DIA 6.35-6.35 TI","BOTH IP/OP","$1,831.18 ","$1,355.07 ","$0.00 ","$1,831.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,831.18 ","$0.00 ","$915.59 ","$1,450.29 ","$1,464.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96507H","SUP","Custom 27803010","","96507H  -  CONNECTOR 96507H CDH DOMINO 6.35-7MM","BOTH IP/OP","$1,796.58 ","$1,329.47 ","$0.00 ","$1,796.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,796.58 ","$0.00 ","$898.29 ","$1,422.89 ","$1,437.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96509H","SUP","Custom 27803010","","96509H  -  CONNECTOR 96509H AXIAL 6.35- 6.35","BOTH IP/OP","$2,118.45 ","$1,567.65 ","$0.00 ","$2,118.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,118.45 ","$0.00 ","$1,059.23 ","$1,677.81 ","$1,694.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96509HT","SUP","Custom 27803010","","96509HT  -  CONNECTOR 96509HT AXIAL 6.35- 6.35TI","BOTH IP/OP","$2,346.10 ","$1,736.11 ","$0.00 ","$2,346.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,346.10 ","$0.00 ","$1,173.05 ","$1,858.11 ","$1,876.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"968-021","SUP","HCPCS C1713","","968-021  -  ROD 968-021    WITH LINE SS","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"96880-021","SUP","Custom 27803010","","96880-021  -  CANNULA PRFSN 60CM 21FR FEM PERC VN ADLT 3/8IN 1","BOTH IP/OP","$986.86 ","$730.28 ","$0.00 ","$1,060.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,060.00 ","$0.00 ","$530.00 ","$839.52 ","$848.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"96880-025","SUP","Custom 27203010","","96880-025  -  CANNULA PERFUSION 3/8IN 25FR 60CM 1 PIECE KINK RESISTANT","BOTH IP/OP","$986.86 ","$730.28 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"969-012","SUP","HCPCS C1713","","969-012  -  ROD 969-012 SEA FOAM GREEN CP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"969-022","SUP","HCPCS C1713","","969-022  -  ROD 969-022 SEA FOAM GREEN CP W/LINE","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"976-119","SUP","HCPCS C1713","","976-119  -  PLATE BN 19MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"976-121","SUP","HCPCS C1713","","976-121  -  PLATE 21MM TI LCK ATL VS BONE ANT CERV SPNE STRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"976-123","SUP","HCPCS C1713","","976-123  -  PLATE 23MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"976-125","SUP","HCPCS C1713","","976-125  -  PLATE 25MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"976-127","SUP","HCPCS C1713","","976-127  -  PLATE 27.5MM TI ATLNTS BONE ANT CERV SPN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"976-130","SUP","HCPCS C1713","","976-130  -  PLATE BN 30MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"976-132","SUP","HCPCS C1713","","976-132  -  PLATE BN 32.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-135","SUP","HCPCS C1713","","976-135  -  PLATE BN 35MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-137","SUP","HCPCS C1713","","976-137  -  PLATE BN 37.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-140","SUP","HCPCS C1713","","976-140  -  PLATE BN 40MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-142","SUP","HCPCS C1713","","976-142  -  PLATE 42.5MM TI ALLOY LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-145","SUP","HCPCS C1713","","976-145  -  PLATE 45MM TI ATLNTS BONE ANT CERV SPN","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-147","SUP","HCPCS C1713","","976-147  -  PLATE BN 47.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-150","SUP","HCPCS C1713","","976-150  -  PLATE BN 50MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"976-152","SUP","HCPCS C1713","","976-152  -  PLATE BN 52.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-155","SUP","HCPCS C1713","","976-155  -  PLATE BN 55MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-157","SUP","HCPCS C1713","","976-157  -  PLATE BN 57.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-160","SUP","HCPCS C1713","","976-160  -  PLATE BN 60MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-162","SUP","HCPCS C1713","","976-162  -  PLATE BN 62.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-165","SUP","HCPCS C1713","","976-165  -  PLATE BN 65MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-167","SUP","HCPCS C1713","","976-167  -  PLATE BN 67.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-170","SUP","HCPCS C1713","","976-170  -  PLATE BN 70MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-172","SUP","HCPCS C1713","","976-172  -  PLATE BN 72.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"976-175","SUP","HCPCS C1713","","976-175  -  PLATE BN 75MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"976-177","SUP","HCPCS C1713","","976-177  -  PLATE BN 77.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"976-180","SUP","HCPCS C1713","","976-180  -  PLATE BN 80MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"976-182","SUP","HCPCS C1713","","976-182  -  PLATE BN 82.5MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"976-185","SUP","HCPCS C1713","","976-185  -  PLATE BN 85MM STRL ATL VS LCK TI SPNE CRV ANT","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"976-187","SUP","HCPCS C1713","","976-187  -  PLATE 87.5MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$4,278.00 ","$3,165.72 ","$0.00 ","$4,278.00 ","$1,925.10 ","$0.00 ","$891.64 ","$0.00 ","$0.00 ","$749.04 ","$4,278.00 ","$0.00 ","$2,139.00 ","$3,388.18 ","$3,422.40 ","$0.00 ","$669.51 ","$0.00 ","$681.06 ","$0.00 "
"976-190","SUP","HCPCS C1713","","976-190  -  PLATE 90MM TI ATL VS BONE ANT CERV SPN","BOTH IP/OP","$4,278.00 ","$3,165.72 ","$0.00 ","$4,278.00 ","$1,925.10 ","$0.00 ","$891.64 ","$0.00 ","$0.00 ","$749.04 ","$4,278.00 ","$0.00 ","$2,139.00 ","$3,388.18 ","$3,422.40 ","$0.00 ","$669.51 ","$0.00 ","$681.06 ","$0.00 "
"976-195","SUP","HCPCS C1713","","976-195  -  PLATE 95MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$4,278.00 ","$3,165.72 ","$0.00 ","$4,278.00 ","$1,925.10 ","$0.00 ","$891.64 ","$0.00 ","$0.00 ","$749.04 ","$4,278.00 ","$0.00 ","$2,139.00 ","$3,388.18 ","$3,422.40 ","$0.00 ","$669.51 ","$0.00 ","$681.06 ","$0.00 "
"976-200","SUP","HCPCS C1713","","976-200  -  PLATE 100MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$4,278.00 ","$3,165.72 ","$0.00 ","$4,278.00 ","$1,925.10 ","$0.00 ","$891.64 ","$0.00 ","$0.00 ","$749.04 ","$4,278.00 ","$0.00 ","$2,139.00 ","$3,388.18 ","$3,422.40 ","$0.00 ","$669.51 ","$0.00 ","$681.06 ","$0.00 "
"976-205","SUP","HCPCS C1713","","976-205  -  PLATE 105MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$4,278.00 ","$3,165.72 ","$0.00 ","$4,278.00 ","$1,925.10 ","$0.00 ","$891.64 ","$0.00 ","$0.00 ","$749.04 ","$4,278.00 ","$0.00 ","$2,139.00 ","$3,388.18 ","$3,422.40 ","$0.00 ","$669.51 ","$0.00 ","$681.06 ","$0.00 "
"976-210","SUP","HCPCS C1713","","976-210  -  PLATE 110MM TI LCK ATL VS BONE ANT CERV SPN STRL","BOTH IP/OP","$4,278.00 ","$3,165.72 ","$0.00 ","$4,278.00 ","$1,925.10 ","$0.00 ","$891.64 ","$0.00 ","$0.00 ","$749.04 ","$4,278.00 ","$0.00 ","$2,139.00 ","$3,388.18 ","$3,422.40 ","$0.00 ","$669.51 ","$0.00 ","$681.06 ","$0.00 "
"976-612","SUP","HCPCS C1713","","976-612  -  SCREW BN 4MM 12MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"976-613","SUP","HCPCS C1713","","976-613  -  SCREW BN 4MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"976-614","SUP","HCPCS C1713","","976-614  -  SCREW BN 4MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"976-615","SUP","HCPCS C1713","","976-615  -  SCREW BN 4MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"976-643","SUP","HCPCS C1713","","976-643  -  SCREW BN 4.5MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"976-644","SUP","HCPCS C1713","","976-644  -  SCREW BN 4.5MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"976-645","SUP","HCPCS C1713","","976-645  -  SCREW BN 4.5MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"9789-","SUP","Custom 27203010","","9789-  -  SLEEVE CMPR LG KN LGTH 26- IN NS LF KDL SCD EXP ADJ CRCMF","BOTH IP/OP","$45.05 ","$33.34 ","$0.00 ","$35.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.57 ","$35.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"995FR19","SUP","Custom 27803010","","995FR19  -  FREESTYLE ROOT VALVE 19 MM","BOTH IP/OP","$15,330.00 ","$11,344.20 ","$0.00 ","$15,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,330.00 ","$0.00 ","$7,665.00 ","$12,141.36 ","$12,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"995FR21","SUP","Custom 27803010","","995FR21  -  FREESTYLE ROOT VALVE 21 MM","BOTH IP/OP","$15,330.00 ","$11,344.20 ","$0.00 ","$15,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,330.00 ","$0.00 ","$7,665.00 ","$12,141.36 ","$12,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"995FR23","SUP","Custom 27803010","","995FR23  -  FREESTYLE ROOT VALVE 23 MM","BOTH IP/OP","$15,330.00 ","$11,344.20 ","$0.00 ","$15,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,330.00 ","$0.00 ","$7,665.00 ","$12,141.36 ","$12,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"995FR25","SUP","Custom 27803010","","995FR25  -  FREESTYLE ROOT VALVE 25 MM","BOTH IP/OP","$15,330.00 ","$11,344.20 ","$0.00 ","$15,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,330.00 ","$0.00 ","$7,665.00 ","$12,141.36 ","$12,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"995FR29","SUP","Custom 27803010","","995FR29  -  FREESTYLE ROOT VALVE 29 MM","BOTH IP/OP","$15,330.00 ","$11,344.20 ","$0.00 ","$15,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,330.00 ","$0.00 ","$7,665.00 ","$12,141.36 ","$12,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"99-7284","SUP","HCPCS C1713","","99-7284  -  SCREW BONE 1.5MM 4MM SELF DRILL CENTRE-DRIVE TITANIUM MANDIB","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$63.00 ","$0.00 ","$29.18 ","$0.00 ","$0.00 ","$24.51 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$21.91 ","$0.00 ","$22.29 ","$0.00 "
"999-LG","SUP","HCPCS L3702","","999-LG  -  SPLINT ORTH LG BCKL VLCR CLSR PVC KODEL POST ELB","BOTH IP/OP","$66.03 ","$48.86 ","$0.00 ","$208.54 ","$29.71 ","$198.92 ","$208.54 ","$0.00 ","$0.00 ","$11.56 ","$66.03 ","$0.00 ","$33.01 ","$52.30 ","$52.82 ","$39.62 ","$198.56 ","$0.00 ","$202.65 ","$0.00 "
"999-MED","SUP","HCPCS L3702","","999-MED  -  SPLINT ORTH MED BCKL VLCR CLSR PVC KODEL POST ELB","BOTH IP/OP","$66.03 ","$48.86 ","$0.00 ","$208.54 ","$29.71 ","$198.92 ","$208.54 ","$0.00 ","$0.00 ","$11.56 ","$66.03 ","$0.00 ","$33.01 ","$52.30 ","$52.82 ","$39.62 ","$198.56 ","$0.00 ","$202.65 ","$0.00 "
"9AC50","SUP","Custom 27203010","","9AC50  -  TOOL LEGEND 9CM 5MM AC","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9AC60","SUP","Custom 27203010","","9AC60  -  TOOL LEGEND 9CM 6MM AC","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9AC75","SUP","Custom 27203010","","9AC75  -  TOOL LEGEND 9CM 7.5MM AC","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9AC90","SUP","Custom 27203010","","9AC90  -  TOOL LEGEND 9CM 9MM AC","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA30","SUP","Custom 27203010","","9BA30  -  TOOL LEGEND 9CM 3MM BA","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA30D","SUP","Custom 27203010","","9BA30D  -  TOOL LEGEND 9CM 3MM BA DIAM","BOTH IP/OP","$380.38 ","$281.48 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.38 ","$0.00 ","$190.19 ","$301.26 ","$304.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA30DC","SUP","Custom 27203010","","9BA30DC  -  TOOL LEGEND 9CM 3MM BA DIAM CRS","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA40","SUP","Custom 27203010","","9BA40  -  TOOL LEGEND 9CM 4MM BA FLUTED","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA40D","SUP","Custom 27203010","","9BA40D  -  TOOL LEGEND 9CM 4MM BA DIAM","BOTH IP/OP","$380.38 ","$281.48 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.38 ","$0.00 ","$190.19 ","$301.26 ","$304.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA40DC","SUP","Custom 27203010","","9BA40DC  -  TOOL LEGEND 9CM 4MM BA DIAM CRS","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA40DX","SUP","Custom 27203010","","9BA40DX  -  TOOL LEGEND 9CM 4MM DIAM X CRS","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA50DC","SUP","Custom 27203010","","9BA50DC  -  TOOL LEGEND 9CM 5MM BA DIAM CRS","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA50DX","SUP","Custom 27203010","","9BA50DX  -  TOOL LEGEND 9CM 5MM DIAM X CRS","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA60DC","SUP","Custom 27203010","","9BA60DC  -  TOOL LEGEND 9CM 6MM BA DIAM CRS","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA60DX","SUP","Custom 27203010","","9BA60DX  -  TOOL LEGEND 9CM 6MM DIAM X CRS","BOTH IP/OP","$378.25 ","$279.91 ","$0.00 ","$378.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$378.25 ","$0.00 ","$189.13 ","$299.57 ","$302.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA75D","SUP","Custom 27203010","","9BA75D  -  TOOL LEGEND 9CM 7.5MM BA DIAM","BOTH IP/OP","$380.38 ","$281.48 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.38 ","$0.00 ","$190.19 ","$301.26 ","$304.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9BA90","SUP","Custom 27203010","","9BA90  -  TOOL LEGEND 9CM 9MM BA","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9CY50","SUP","Custom 27203010","","9CY50  -  TOOL LEGEND 9CM 5MM CY","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9CY60","SUP","Custom 27203010","","9CY60  -  TOOL LEGEND 9CM 6MM CY","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9CY75","SUP","Custom 27203010","","9CY75  -  TOOL LEGEND 9CM 7.5MM CY","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9HM100","SUP","Custom 27203010","","9HM100  -  TOOL LEGEND 9CM 10MM HOLE MAKER","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9HM126","SUP","Custom 27203010","","9HM126  -  TOOL LEGEND 9CM 12.6MM HOLE MAKER","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9HM95","SUP","Custom 27203010","","9HM95  -  TOOL LEGEND 9CM 9.5MM HOLE MAKER","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9HS108","SUP","Custom 27203010","","9HS108  -  TOOL LEGEND 9CM 10.8MM ID HS","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9HS135","SUP","Custom 27203010","","9HS135  -  TOOL LEGEND 9CM 13.5MM ID HS","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9MH30DC","SUP","Custom 27203010","","9MH30DC  -  TOOL LEGEND 9CM 3MM MH DIAM CRS","BOTH IP/OP","$367.63 ","$272.05 ","$0.00 ","$367.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$367.63 ","$0.00 ","$183.81 ","$291.16 ","$294.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9OV55","SUP","Custom 27203010","","9OV55  -  TOOL LEGEND 9CM 5.5MM OVAL","BOTH IP/OP","$323.00 ","$239.02 ","$0.00 ","$323.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$323.00 ","$0.00 ","$161.50 ","$255.82 ","$258.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9SCT","SUP","Custom 27203010","","9SCT  -  TUBE TRACHEOSTOMY 12.1MM 9MM 99MM 1 CANNU CUFF LATEX FREE","BOTH IP/OP","$71.38 ","$52.82 ","$0.00 ","$72.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.45 ","$0.00 ","$36.22 ","$57.38 ","$57.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"9TA30","SUP","Custom 27203010","","9TA30  -  TOOL LEGEND 9CM 3MM TA","BOTH IP/OP","$337.88 ","$250.03 ","$0.00 ","$337.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.88 ","$0.00 ","$168.94 ","$267.60 ","$270.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A0082","SUP","Custom 25003010","","ANTIBODY VWF 8 RBT IGG ANHMN 2ML LAB","BOTH IP/OP","$708.10 ","$523.99 ","$0.00 ","$708.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$708.10 ","$0.00 ","$354.05 ","$560.82 ","$566.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A1-0014","SUP","HCPCS C1713","","A1-0014  -  SCREW BONE 14MM ACUTWIST","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"A1-0016","SUP","HCPCS C1713","","A1-0016  -  SCREW BONE 16MM ACUTWIST","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"A1-0020","SUP","HCPCS C1713","","A1-0020  -  SCREW BONE 20MM ACUTWIST","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"A1-0022","SUP","HCPCS C1713","","A1-0022  -  SCREW BONE 22MM ACUTWIST","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"A10230592","SUP","Custom 27803010","","A10230592  -  VALVE AORTIC 21MM EP SUP THV","BOTH IP/OP","$23,350.00 ","$17,279.00 ","$0.00 ","$23,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,350.00 ","$0.00 ","$11,675.00 ","$18,493.20 ","$18,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A10235766","SUP","Custom 27803010","","A10235766  -  VALVE MTRL 25MM 23MM EP 3 PIG LEAFLETS STNT LINX AC TCH LP","BOTH IP/OP","$23,350.00 ","$17,279.00 ","$0.00 ","$23,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,350.00 ","$0.00 ","$11,675.00 ","$18,493.20 ","$18,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A1072","SUP","Custom 27203010","","A1072  -  PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP","BOTH IP/OP","$27.27 ","$20.18 ","$0.00 ","$27.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.27 ","$0.00 ","$13.64 ","$21.60 ","$21.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A-1083","SUP","HCPCS C1713","","A-1083  -  PIN SKULL 13MM RED O RING SECURE FIT RIGID FIX MAYFIELD","BOTH IP/OP","$102.50 ","$75.85 ","$0.00 ","$102.50 ","$46.13 ","$0.00 ","$21.36 ","$0.00 ","$0.00 ","$17.95 ","$102.50 ","$0.00 ","$51.25 ","$81.18 ","$82.00 ","$0.00 ","$16.04 ","$0.00 ","$16.32 ","$0.00 "
"A14208","SUP","Custom 27203010","","REAGENT FOL ACCES SYN 100 TST ANALY","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A16793","SUP","Custom 27203010","","REAGENT ANALY UNCL DSL WSH BUFF 10L 800 SER","BOTH IP/OP","$77.50 ","$57.35 ","$0.00 ","$77.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.50 ","$0.00 ","$38.75 ","$61.38 ","$62.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A16953","SUP","Custom 27203010","","CALIBRATOR INTC PTH UNICEL IMMUN","BOTH IP/OP","$382.50 ","$283.05 ","$0.00 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$382.50 ","$0.00 ","$191.25 ","$302.94 ","$306.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A16972","SUP","Custom 27203010","","REAGENT INTC PTH ACCES 100 TST ANALY NEO","BOTH IP/OP","$690.00 ","$510.60 ","$0.00 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$690.00 ","$0.00 ","$345.00 ","$546.48 ","$552.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A16P4","SUP","Custom 27203010","","CHEMICAL LAB ACTN POLY BTL 4L HST GRAD","BOTH IP/OP","$196.40 ","$145.34 ","$0.00 ","$196.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.40 ","$0.00 ","$98.20 ","$155.55 ","$157.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A16S-4","SUP","Custom 27203010","","CHEMICAL LAB ACTN SAFETIN 4L HST GRAD","BOTH IP/OP","$264.35 ","$195.62 ","$0.00 ","$264.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.35 ","$0.00 ","$132.18 ","$209.37 ","$211.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A18/20","SUP","Custom 27203010","","NEEDLE BIOP 18GA 20CM ACHV COAX AUTO PRGM SFT TIS DISP","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A1815","SUP","Custom 27203010","","NEEDLE BIOP 18GA 15CM ACHV COAX AUTO PRGM SFT TIS DISP","BOTH IP/OP","$92.50 ","$68.45 ","$0.00 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.00 ","$0.00 ","$54.00 ","$85.54 ","$86.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A189","SUP","Custom 27203010","","NEEDLE BIOP 18GA 9CM ACHV COAX AUTO PRGM SFT TIS DISP","BOTH IP/OP","$106.95 ","$79.14 ","$0.00 ","$106.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.95 ","$0.00 ","$53.48 ","$84.70 ","$85.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A19611","SUP","Custom 27203010","","REAGENT LI SYN INFNT 18ML 130 TST ANALY","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A200S","SUP","Custom 27203010","","REAGENT SHTH FLUID A MLTLY BTL ANALY","BOTH IP/OP","$107.53 ","$79.57 ","$0.00 ","$107.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.53 ","$0.00 ","$53.76 ","$85.16 ","$86.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A2015-020","SUP","HCPCS C1725","","A2015-020  -  CATHETER BLNDIL 1.5MM 150CM 20MM ARMADA FLXB MRKR STREAMLINE","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$115.39 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"A2020","SUP","Custom 27203010","","NEEDLE BIOP 20GA 20CM ACHV COAX AUTO PRGM SFT TIS DISP","BOTH IP/OP","$116.03 ","$85.86 ","$0.00 ","$116.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$116.03 ","$0.00 ","$58.01 ","$91.90 ","$92.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A2020-200","SUP","HCPCS C1725","","A2020-200  -  CATHETER BLNDIL 2MM 150CM 200MM ARMADA FLXB MRKR STREAMLINE","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$115.39 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"A2030-080","SUP","HCPCS C1725","","A2030-080  -  CATHETER BLNDIL 3MM 150CM 80MM ARMADA FLXB MRKR STREAMLINE","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$115.39 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"A21101","SUP","Custom 27203010","","REAGENT ANA 2 A MLTLY ANALY","BOTH IP/OP","$3,008.98 ","$2,226.65 ","$0.00 ","$3,008.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,008.98 ","$0.00 ","$1,504.49 ","$2,383.11 ","$2,407.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A2552 25","SUP","Custom 27203010","","TRAY EPDRL NRV BLCK A2552 25","BOTH IP/OP","$37.33 ","$27.62 ","$0.00 ","$37.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.33 ","$0.00 ","$18.66 ","$29.57 ","$29.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A-3434","SUP","Custom 27203010","","A-3434  -  BIT DRILL 86MM AO SHAFT TWIST STOP 30MM 1.6MM 2MM SCREW","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$290.00 ","$0.00 ","$145.00 ","$229.68 ","$232.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A3524","SUP","Custom 25003010","","ANTIBODY TDT RBT PLYCLN .5ML LAB","BOTH IP/OP","$3,400.00 ","$2,516.00 ","$0.00 ","$3,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,400.00 ","$0.00 ","$1,700.00 ","$2,692.80 ","$2,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A368LL","SUP","HCPCS L1930","","A368LL  -  SPLINT ORTHOPEDIC 9-10.5 LARGE 20.5IN 7.75IN POSTERIOR LEAF","BOTH IP/OP","$74.98 ","$55.49 ","$0.00 ","$74.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.98 ","$0.00 ","$37.49 ","$59.38 ","$59.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A368LM","SUP","HCPCS L1930","","A368LM  -  SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF","BOTH IP/OP","$74.98 ","$55.49 ","$0.00 ","$74.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.98 ","$0.00 ","$37.49 ","$59.38 ","$59.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A368LX","SUP","HCPCS L1930","","A368LX  -  SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF","BOTH IP/OP","$80.58 ","$59.63 ","$0.00 ","$80.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.58 ","$0.00 ","$40.29 ","$63.82 ","$64.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A368RL","SUP","HCPCS L1930","","A368RL  -  SPLINT ORTHOPEDIC 9-11 LARGE 20.5IN 7.75IN POSTERIOR LEAF","BOTH IP/OP","$74.98 ","$55.49 ","$0.00 ","$74.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.98 ","$0.00 ","$37.49 ","$59.38 ","$59.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A368RM","SUP","HCPCS L1930","","A368RM  -  SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF","BOTH IP/OP","$74.98 ","$55.49 ","$0.00 ","$74.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.98 ","$0.00 ","$37.49 ","$59.38 ","$59.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A368RX","SUP","HCPCS L1930","","A368RX  -  SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF","BOTH IP/OP","$80.58 ","$59.63 ","$0.00 ","$80.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.58 ","$0.00 ","$40.29 ","$63.82 ","$64.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A38-212","SUP","Custom 27203010","","CHEMICAL GLAC ACETCID 2.5L GLS BTL ACS GRAD LAB","BOTH IP/OP","$267.70 ","$198.10 ","$0.00 ","$267.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$267.70 ","$0.00 ","$133.85 ","$212.02 ","$214.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A390014","SUP","HCPCS C1713","","A390014  -  WASHER ORTH 8MM 4MM","BOTH IP/OP","$35.70 ","$26.42 ","$0.00 ","$35.70 ","$16.07 ","$0.00 ","$7.44 ","$0.00 ","$0.00 ","$6.25 ","$35.70 ","$0.00 ","$17.85 ","$28.27 ","$28.56 ","$0.00 ","$5.59 ","$0.00 ","$5.68 ","$0.00 "
"A3SR01","SUP","HCPCS C1786","","A3SR01  -  PACEMAKER CRD ADVISA SR MR SURESCAN 1 CHMBR UNPLR","BOTH IP/OP","$7,595.00 ","$5,620.30 ","$0.00 ","$7,750.00 ","$0.00 ","$0.00 ","$1,582.99 ","$0.00 ","$0.00 ","$0.00 ","$7,750.00 ","$0.00 ","$3,875.00 ","$6,138.00 ","$6,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A-4300.01","SUP","HCPCS C1713","","A-4300.01  -  PLATE BN STRG 18MMX.6MM APTUS 4 HL FX TI HND 1.2/1.5MM SCR","BOTH IP/OP","$580.13 ","$429.30 ","$0.00 ","$580.13 ","$261.06 ","$0.00 ","$120.91 ","$0.00 ","$0.00 ","$101.58 ","$580.13 ","$0.00 ","$290.06 ","$459.46 ","$464.10 ","$0.00 ","$90.79 ","$0.00 ","$92.36 ","$0.00 "
"A-4300.03","SUP","HCPCS C1713","","A-4300.03  -  PLATE 6 HOLE BONE","BOTH IP/OP","$580.13 ","$429.30 ","$0.00 ","$580.13 ","$261.06 ","$0.00 ","$120.91 ","$0.00 ","$0.00 ","$101.58 ","$580.13 ","$0.00 ","$290.06 ","$459.46 ","$464.10 ","$0.00 ","$90.79 ","$0.00 ","$92.36 ","$0.00 "
"A-4300.04","SUP","HCPCS C1713","","A-4300.04  -  PLATE 1.5MM 16 HOLE STR BONE 1.2MM","BOTH IP/OP","$784.88 ","$580.81 ","$0.00 ","$784.88 ","$353.19 ","$0.00 ","$163.59 ","$0.00 ","$0.00 ","$137.43 ","$784.88 ","$0.00 ","$392.44 ","$621.62 ","$627.90 ","$0.00 ","$122.83 ","$0.00 ","$124.95 ","$0.00 "
"A-4300.05","SUP","HCPCS C1713","","A-4300.05  -  PLATE BN CRV 69MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR","BOTH IP/OP","$784.88 ","$580.81 ","$0.00 ","$784.88 ","$353.19 ","$0.00 ","$163.59 ","$0.00 ","$0.00 ","$137.43 ","$784.88 ","$0.00 ","$392.44 ","$621.62 ","$627.90 ","$0.00 ","$122.83 ","$0.00 ","$124.95 ","$0.00 "
"A-4300.06","SUP","HCPCS C1713","","A-4300.06  -  PLATE BN OFST 51MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR","BOTH IP/OP","$784.88 ","$580.81 ","$0.00 ","$784.88 ","$353.19 ","$0.00 ","$163.59 ","$0.00 ","$0.00 ","$137.43 ","$784.88 ","$0.00 ","$392.44 ","$621.62 ","$627.90 ","$0.00 ","$122.83 ","$0.00 ","$124.95 ","$0.00 "
"A-4300.10","SUP","HCPCS C1713","","A-4300.10  -  PLATE BN T 27MMX.6MM APTUS 2X5 HL FX TI HND 1.2/1.5MM SCR","BOTH IP/OP","$690.38 ","$510.88 ","$0.00 ","$690.38 ","$310.67 ","$0.00 ","$143.89 ","$0.00 ","$0.00 ","$120.88 ","$690.38 ","$0.00 ","$345.19 ","$546.78 ","$552.30 ","$0.00 ","$108.04 ","$0.00 ","$109.91 ","$0.00 "
"A-4300.11","SUP","HCPCS C1713","","A-4300.11  -  PLATE T 27X10X.6MM TI 1.2-1.5MM SCR 3X5 HOLE FIX APTUS BONE","BOTH IP/OP","$690.38 ","$510.88 ","$0.00 ","$690.38 ","$310.67 ","$0.00 ","$143.89 ","$0.00 ","$0.00 ","$120.88 ","$690.38 ","$0.00 ","$345.19 ","$546.78 ","$552.30 ","$0.00 ","$108.04 ","$0.00 ","$109.91 ","$0.00 "
"A-4300.13","SUP","HCPCS C1713","","A-4300.13  -  PLATE BN 1.2MM 1.5MM Y 2.4 HL","BOTH IP/OP","$690.38 ","$510.88 ","$0.00 ","$690.38 ","$310.67 ","$0.00 ","$143.89 ","$0.00 ","$0.00 ","$120.88 ","$690.38 ","$0.00 ","$345.19 ","$546.78 ","$552.30 ","$0.00 ","$108.04 ","$0.00 ","$109.91 ","$0.00 "
"A-4300.20","SUP","HCPCS C1713","","A-4300.20  -  PLATE BN 1.2MM 1.5MM L 2-3 HL LT","BOTH IP/OP","$690.38 ","$510.88 ","$0.00 ","$690.38 ","$310.67 ","$0.00 ","$143.89 ","$0.00 ","$0.00 ","$120.88 ","$690.38 ","$0.00 ","$345.19 ","$546.78 ","$552.30 ","$0.00 ","$108.04 ","$0.00 ","$109.91 ","$0.00 "
"A-4300.21","SUP","HCPCS C1713","","A-4300.21  -  PLATE BN L RT 18MMX.6MM APTUS 2X3 HL FX TI HND 1.2/1.5MM SCR","BOTH IP/OP","$690.38 ","$510.88 ","$0.00 ","$690.38 ","$310.67 ","$0.00 ","$143.89 ","$0.00 ","$0.00 ","$120.88 ","$690.38 ","$0.00 ","$345.19 ","$546.78 ","$552.30 ","$0.00 ","$108.04 ","$0.00 ","$109.91 ","$0.00 "
"A-4300.50","SUP","HCPCS C1713","","A-4300.50  -  PLATE BN RECT 9MMX.6MM APTUS 2X2 HL GRID FX TI HND 1.2/1.5MM","BOTH IP/OP","$711.38 ","$526.42 ","$0.00 ","$711.38 ","$320.12 ","$0.00 ","$148.27 ","$0.00 ","$0.00 ","$124.56 ","$711.38 ","$0.00 ","$355.69 ","$563.41 ","$569.10 ","$0.00 ","$111.33 ","$0.00 ","$113.25 ","$0.00 "
"A-4300.51","SUP","HCPCS C1713","","A-4300.51  -  PLATE 1.2 MM 1.5 MM SCR LEAN MESH BONE","BOTH IP/OP","$711.38 ","$526.42 ","$0.00 ","$711.38 ","$320.12 ","$0.00 ","$148.27 ","$0.00 ","$0.00 ","$124.56 ","$711.38 ","$0.00 ","$355.69 ","$563.41 ","$569.10 ","$0.00 ","$111.33 ","$0.00 ","$113.25 ","$0.00 "
"A-4300.54","SUP","HCPCS C1713","","A-4300.54  -  PLATE 1.2-1.5 MM SCR MESH TRP 2X2 HOLE BONE","BOTH IP/OP","$711.38 ","$526.42 ","$0.00 ","$711.38 ","$320.12 ","$0.00 ","$148.27 ","$0.00 ","$0.00 ","$124.56 ","$711.38 ","$0.00 ","$355.69 ","$563.41 ","$569.10 ","$0.00 ","$111.33 ","$0.00 ","$113.25 ","$0.00 "
"A-4300.55","SUP","HCPCS C1713","","A-4300.55  -  PLATE BN RECT 15MMX.6MM APTUS 3X2 HL GRID FX TI HND 1.2/1.5","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"A-4300.56","SUP","HCPCS C1713","","A-4300.56  -  PLATE BN TRPZD","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"A-4300.58","SUP","HCPCS C1713","","A-4300.58  -  PLATE 1.2-1.5 MM SCR MESH TRP 3X2 HOLE BONE LEFT","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"A-4300.59","SUP","HCPCS C1713","","A-4300.59  -  PLATE BN TRPZD RT 17MMX.6MM APTUS 3X2 HL GRID FX TI HND","BOTH IP/OP","$771.75 ","$571.10 ","$0.00 ","$771.75 ","$347.29 ","$0.00 ","$160.85 ","$0.00 ","$0.00 ","$135.13 ","$771.75 ","$0.00 ","$385.88 ","$611.23 ","$617.40 ","$0.00 ","$120.78 ","$0.00 ","$122.86 ","$0.00 "
"A-4300.60","SUP","HCPCS C1713","","A-4300.60  -  PLATE BN ANG LT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND","BOTH IP/OP","$800.63 ","$592.47 ","$0.00 ","$800.63 ","$360.28 ","$0.00 ","$166.87 ","$0.00 ","$0.00 ","$140.18 ","$800.63 ","$0.00 ","$400.31 ","$634.10 ","$640.50 ","$0.00 ","$125.30 ","$0.00 ","$127.46 ","$0.00 "
"A-4300.61","SUP","HCPCS C1713","","A-4300.61  -  PLATE BN ANG RT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND","BOTH IP/OP","$800.63 ","$592.47 ","$0.00 ","$800.63 ","$360.28 ","$0.00 ","$166.87 ","$0.00 ","$0.00 ","$140.18 ","$800.63 ","$0.00 ","$400.31 ","$634.10 ","$640.50 ","$0.00 ","$125.30 ","$0.00 ","$127.46 ","$0.00 "
"A-4300.62","SUP","HCPCS C1713","","A-4300.62  -  PLATE BN TRPZD 21MMX.6MM APTUS 4X2 HL GRID FX TI HND 1.2/1.5","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$363.83 ","$0.00 ","$168.51 ","$0.00 ","$0.00 ","$141.56 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$126.53 ","$0.00 ","$128.71 ","$0.00 "
"A-4300.64","SUP","HCPCS C1713","","A-4300.64  -  PLATE BN ANG LT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$363.83 ","$0.00 ","$168.51 ","$0.00 ","$0.00 ","$141.56 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$126.53 ","$0.00 ","$128.71 ","$0.00 "
"A-4300.65","SUP","HCPCS C1713","","A-4300.65  -  PLATE BN ANG RT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$363.83 ","$0.00 ","$168.51 ","$0.00 ","$0.00 ","$141.56 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$126.53 ","$0.00 ","$128.71 ","$0.00 "
"A-4300.66","SUP","HCPCS C1713","","A-4300.66  -  PLATE BN ANG LT 27MMX.6MM APTUS 5X2 HL GRID FX TI HND","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$363.83 ","$0.00 ","$168.51 ","$0.00 ","$0.00 ","$141.56 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$126.53 ","$0.00 ","$128.71 ","$0.00 "
"A-4300.67","SUP","HCPCS C1713","","A-4300.67  -  PLATE BN TRPZD 33MMX.6MM APTUS 6X2 HL GRID FX TI HND 1.2/1.5","BOTH IP/OP","$808.50 ","$598.29 ","$0.00 ","$808.50 ","$363.83 ","$0.00 ","$168.51 ","$0.00 ","$0.00 ","$141.56 ","$808.50 ","$0.00 ","$404.25 ","$640.33 ","$646.80 ","$0.00 ","$126.53 ","$0.00 ","$128.71 ","$0.00 "
"A43102","SUP","Custom 27804086","","A43102  -  FILLER BN VOID 1ML GRFTN ALGRF PTTY JR DBM","BOTH IP/OP","$540.00 ","$399.60 ","$0.00 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$540.00 ","$0.00 ","$270.00 ","$427.68 ","$432.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A43103","SUP","Custom 27804086","","A43103  -  GRAFT BN 2.5ML GRFTN PTTY JR DBM","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,190.00 ","$0.00 ","$595.00 ","$942.48 ","$952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A433F-1GAL","SUP","Custom 27203010","","CHEMICAL METHNL 1GL F STY POLY BTL HST GRAD LAB","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A433P4","SUP","Custom 27203010","","CHEMICAL METHNL 4L POLY BTL HST GRAD LAB","BOTH IP/OP","$67.45 ","$49.91 ","$0.00 ","$67.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.45 ","$0.00 ","$33.73 ","$53.42 ","$53.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A-4340.11","SUP","HCPCS C1713","","A-4340.11  -  PLATE BN T OFST 35X10X.6MM APTUS 3X8 HL 2 HK CMPR TI HND","BOTH IP/OP","$879.38 ","$650.74 ","$0.00 ","$879.38 ","$395.72 ","$0.00 ","$183.28 ","$0.00 ","$0.00 ","$153.97 ","$879.38 ","$0.00 ","$439.69 ","$696.47 ","$703.50 ","$0.00 ","$137.62 ","$0.00 ","$140.00 ","$0.00 "
"A-4340.12","SUP","HCPCS C1713","","A-4340.12  -  PLATE BN T OFST 35X13X.6MM APTUS 4X8 HL CMPR TI HND 1.2/1.5","BOTH IP/OP","$879.38 ","$650.74 ","$0.00 ","$879.38 ","$395.72 ","$0.00 ","$183.28 ","$0.00 ","$0.00 ","$153.97 ","$879.38 ","$0.00 ","$439.69 ","$696.47 ","$703.50 ","$0.00 ","$137.62 ","$0.00 ","$140.00 ","$0.00 "
"A-4340.30","SUP","HCPCS C1713","","A-4340.30  -  PLATE 30MM 1.5MM SCR 4X8 HOLE GRID ANG CMPR BONE TRPZD","BOTH IP/OP","$950.25 ","$703.19 ","$0.00 ","$950.25 ","$427.61 ","$0.00 ","$198.06 ","$0.00 ","$0.00 ","$166.38 ","$950.25 ","$0.00 ","$475.13 ","$752.60 ","$760.20 ","$0.00 ","$148.71 ","$0.00 ","$151.28 ","$0.00 "
"A-4340.31","SUP","HCPCS C1713","","A-4340.31  -  PLATE 5 HOLE CMPR PIN BONE RIGHT","BOTH IP/OP","$950.25 ","$703.19 ","$0.00 ","$950.25 ","$427.61 ","$0.00 ","$198.06 ","$0.00 ","$0.00 ","$166.38 ","$950.25 ","$0.00 ","$475.13 ","$752.60 ","$760.20 ","$0.00 ","$148.71 ","$0.00 ","$151.28 ","$0.00 "
"A-4340.32","SUP","HCPCS C1713","","A-4340.32  -  PLATE BN .6MM APTUS 1 HL 2 HK CMPR TI HND 1.2/1.5MM SCR","BOTH IP/OP","$879.38 ","$650.74 ","$0.00 ","$879.38 ","$395.72 ","$0.00 ","$183.28 ","$0.00 ","$0.00 ","$153.97 ","$879.38 ","$0.00 ","$439.69 ","$696.47 ","$703.50 ","$0.00 ","$137.62 ","$0.00 ","$140.00 ","$0.00 "
"A-4350.01","SUP","HCPCS C1713","","A-4350.01  -  PLATE STR 19MMX.8MM TI 1.5MM SCR 4 HOLE APTUS TRLK BONE","BOTH IP/OP","$1,141.88 ","$844.99 ","$0.00 ","$1,141.88 ","$513.84 ","$0.00 ","$238.00 ","$0.00 ","$0.00 ","$199.93 ","$1,141.88 ","$0.00 ","$570.94 ","$904.37 ","$913.50 ","$0.00 ","$178.70 ","$0.00 ","$181.79 ","$0.00 "
"A-4350.14","SUP","HCPCS C1713","","A-4350.14  -  PLATE T 25X11X.8MM TI 1.5MM SCR 8 HOLE APTUS TRLK BONE","BOTH IP/OP","$1,218.00 ","$901.32 ","$0.00 ","$1,218.00 ","$548.10 ","$0.00 ","$253.86 ","$0.00 ","$0.00 ","$213.26 ","$1,218.00 ","$0.00 ","$609.00 ","$964.66 ","$974.40 ","$0.00 ","$190.62 ","$0.00 ","$193.91 ","$0.00 "
"A-4350.23","SUP","HCPCS C1713","","A-4350.23  -  PLATE 23X9X.8MM TI 1.5MM SCR 6 HOLE ROT APTUS TRLK BONE","BOTH IP/OP","$1,241.63 ","$918.81 ","$0.00 ","$1,241.63 ","$558.73 ","$0.00 ","$258.79 ","$0.00 ","$0.00 ","$217.40 ","$1,241.63 ","$0.00 ","$620.81 ","$983.37 ","$993.30 ","$0.00 ","$194.31 ","$0.00 ","$197.67 ","$0.00 "
"A-4350.41","SUP","HCPCS C1713","","A-4350.41  -  PLATE T 24X11X.8MM TI 1.5MM SCR 9 HOLE 2 ROW APTUS TRLK BONE","BOTH IP/OP","$1,262.63 ","$934.35 ","$0.00 ","$1,262.63 ","$568.18 ","$0.00 ","$263.16 ","$0.00 ","$0.00 ","$221.08 ","$1,262.63 ","$0.00 ","$631.31 ","$1,000.00 ","$1,010.10 ","$0.00 ","$197.60 ","$0.00 ","$201.01 ","$0.00 "
"A-4350.50","SUP","HCPCS C1713","","A-4350.50  -  PLATE RECT 9MMX.8MM TI 1.5MM SCR 4 HOLE GRID APTUS TRLK BONE","BOTH IP/OP","$1,372.88 ","$1,015.93 ","$0.00 ","$1,372.88 ","$617.79 ","$0.00 ","$286.14 ","$0.00 ","$0.00 ","$240.38 ","$1,372.88 ","$0.00 ","$686.44 ","$1,087.32 ","$1,098.30 ","$0.00 ","$214.85 ","$0.00 ","$218.56 ","$0.00 "
"A-4350.56","SUP","HCPCS C1713","","A-4350.56  -  PLATE TRPZD 15MMX.8MM TI 1.5MM SCR 6X2 HOLE GRID APTUS TRLK","BOTH IP/OP","$1,420.13 ","$1,050.90 ","$0.00 ","$1,420.13 ","$639.06 ","$0.00 ","$295.99 ","$0.00 ","$0.00 ","$248.65 ","$1,420.13 ","$0.00 ","$710.06 ","$1,124.74 ","$1,136.10 ","$0.00 ","$222.25 ","$0.00 ","$226.08 ","$0.00 "
"A-4350.62","SUP","HCPCS C1713","","A-4350.62  -  PLATE TRPZD 21MMX.8MM TI 1.5MM SCR 4X2 HOLE GRID APTUS TRLK","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"A-4350.66","SUP","HCPCS C1713","","A-4350.66  -  PLATE TRPZD 27MMX.8MM TI 1.5MM SCR 5X2 HOLE GRID APTUS TRLK","BOTH IP/OP","$1,530.38 ","$1,132.48 ","$0.00 ","$1,530.38 ","$688.67 ","$0.00 ","$318.97 ","$0.00 ","$0.00 ","$267.96 ","$1,530.38 ","$0.00 ","$765.19 ","$1,212.06 ","$1,224.30 ","$0.00 ","$239.50 ","$0.00 ","$243.64 ","$0.00 "
"A-4350.80","SUP","HCPCS C1713","","A-4350.80  -  PLATE SCPHD 17MMX.8MM TI 1.5MM SCR 6 HOLE APTUS TRLK BONE","BOTH IP/OP","$1,496.25 ","$1,107.23 ","$0.00 ","$1,496.25 ","$673.31 ","$0.00 ","$311.86 ","$0.00 ","$0.00 ","$261.98 ","$1,496.25 ","$0.00 ","$748.13 ","$1,185.03 ","$1,197.00 ","$0.00 ","$234.16 ","$0.00 ","$238.20 ","$0.00 "
"A4502","SUP","Custom 25003010","","ANTIBODY CD117 PLYCLN RBT ANHMN .2 1ML LAB","BOTH IP/OP","$1,399.23 ","$1,035.43 ","$0.00 ","$1,399.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,399.23 ","$0.00 ","$699.61 ","$1,108.19 ","$1,119.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A45-10020","SUP","HCPCS C1713","","A45-10020  -  SCREW BONE 4.5/3.5MM 100MM 20MM DNFX SS CORT TPR","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"A-4645.01","SUP","HCPCS C1713","","A-4645.01  -  PLATE BN STRG 29MMX1.3MM APTUS 4 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$816.38 ","$604.12 ","$0.00 ","$816.38 ","$367.37 ","$0.00 ","$170.15 ","$0.00 ","$0.00 ","$142.94 ","$816.38 ","$0.00 ","$408.19 ","$646.57 ","$653.10 ","$0.00 ","$127.76 ","$0.00 ","$129.97 ","$0.00 "
"A-4645.02","SUP","HCPCS C1713","","A-4645.02  -  PLATE BN STRG 36MMX1.3MM APTUS 5 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$816.38 ","$604.12 ","$0.00 ","$816.38 ","$367.37 ","$0.00 ","$170.15 ","$0.00 ","$0.00 ","$142.94 ","$816.38 ","$0.00 ","$408.19 ","$646.57 ","$653.10 ","$0.00 ","$127.76 ","$0.00 ","$129.97 ","$0.00 "
"A-4645.03","SUP","HCPCS C1713","","A-4645.03  -  PLATE BN STRG 42MMX1.3MM APTUS 6 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$816.38 ","$604.12 ","$0.00 ","$816.38 ","$367.37 ","$0.00 ","$170.15 ","$0.00 ","$0.00 ","$142.94 ","$816.38 ","$0.00 ","$408.19 ","$646.57 ","$653.10 ","$0.00 ","$127.76 ","$0.00 ","$129.97 ","$0.00 "
"A-4645.08","SUP","HCPCS C1713","","A-4645.08  -  PLATE STR 2-2.3MM SCR 8 HOLE 4 CRNR FSN CMPR APTUS BONE","BOTH IP/OP","$918.75 ","$679.88 ","$0.00 ","$918.75 ","$413.44 ","$0.00 ","$191.49 ","$0.00 ","$0.00 ","$160.87 ","$918.75 ","$0.00 ","$459.38 ","$727.65 ","$735.00 ","$0.00 ","$143.78 ","$0.00 ","$146.27 ","$0.00 "
"A-4645.10","SUP","HCPCS C1713","","A-4645.10  -  PLATE BN T 35MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$737.63 ","$545.85 ","$0.00 ","$737.63 ","$331.93 ","$0.00 ","$153.74 ","$0.00 ","$0.00 ","$129.15 ","$737.63 ","$0.00 ","$368.81 ","$584.20 ","$590.10 ","$0.00 ","$115.44 ","$0.00 ","$117.43 ","$0.00 "
"A-4645.16","SUP","HCPCS C1713","","A-4645.16  -  PLATE BN T 60MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$997.50 ","$738.15 ","$0.00 ","$997.50 ","$448.88 ","$0.00 ","$207.90 ","$0.00 ","$0.00 ","$174.65 ","$997.50 ","$0.00 ","$498.75 ","$790.02 ","$798.00 ","$0.00 ","$156.11 ","$0.00 ","$158.80 ","$0.00 "
"A-4645.20","SUP","HCPCS C1713","","A-4645.20  -  PLATE BN L LT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$737.63 ","$545.85 ","$0.00 ","$737.63 ","$331.93 ","$0.00 ","$153.74 ","$0.00 ","$0.00 ","$129.15 ","$737.63 ","$0.00 ","$368.81 ","$584.20 ","$590.10 ","$0.00 ","$115.44 ","$0.00 ","$117.43 ","$0.00 "
"A-4645.21","SUP","HCPCS C1713","","A-4645.21  -  PLATE BN L RT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$737.63 ","$545.85 ","$0.00 ","$737.63 ","$331.93 ","$0.00 ","$153.74 ","$0.00 ","$0.00 ","$129.15 ","$737.63 ","$0.00 ","$368.81 ","$584.20 ","$590.10 ","$0.00 ","$115.44 ","$0.00 ","$117.43 ","$0.00 "
"A-4645.22","SUP","HCPCS C1713","","A-4645.22  -  PLATE BN L LT 63MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM","BOTH IP/OP","$997.50 ","$738.15 ","$0.00 ","$997.50 ","$448.88 ","$0.00 ","$207.90 ","$0.00 ","$0.00 ","$174.65 ","$997.50 ","$0.00 ","$498.75 ","$790.02 ","$798.00 ","$0.00 ","$156.11 ","$0.00 ","$158.80 ","$0.00 "
"A-4645.23","SUP","HCPCS C1713","","A-4645.23  -  PLATE RIGHT ANG 63MMX1.3MM 2-2.3MM SCR 2X8 HOLE CMPR BAR","BOTH IP/OP","$997.50 ","$738.15 ","$0.00 ","$997.50 ","$448.88 ","$0.00 ","$207.90 ","$0.00 ","$0.00 ","$174.65 ","$997.50 ","$0.00 ","$498.75 ","$790.02 ","$798.00 ","$0.00 ","$156.11 ","$0.00 ","$158.80 ","$0.00 "
"A-4650.03","SUP","HCPCS C1713","","A-4650.03  -  PLATE BN STRG 33MMX1MM APTUS TRLK 6 HL TI HND 2/2.3MM SCR","BOTH IP/OP","$1,186.50 ","$878.01 ","$0.00 ","$1,186.50 ","$533.93 ","$0.00 ","$247.30 ","$0.00 ","$0.00 ","$207.75 ","$1,186.50 ","$0.00 ","$593.25 ","$939.71 ","$949.20 ","$0.00 ","$185.69 ","$0.00 ","$188.89 ","$0.00 "
"A-4650.10","SUP","HCPCS C1713","","A-4650.10  -  PLATE BN T 29MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR","BOTH IP/OP","$1,228.50 ","$909.09 ","$0.00 ","$1,228.50 ","$552.83 ","$0.00 ","$256.05 ","$0.00 ","$0.00 ","$215.10 ","$1,228.50 ","$0.00 ","$614.25 ","$972.97 ","$982.80 ","$0.00 ","$192.26 ","$0.00 ","$195.58 ","$0.00 "
"A-4650.11","SUP","HCPCS C1713","","A-4650.11  -  PLATE BN T 29X13X1MM APTUS TRLK 3X4 HL TI HND 2/2.3MM SCR","BOTH IP/OP","$1,286.25 ","$951.83 ","$0.00 ","$1,286.25 ","$578.81 ","$0.00 ","$268.09 ","$0.00 ","$0.00 ","$225.21 ","$1,286.25 ","$0.00 ","$643.13 ","$1,018.71 ","$1,029.00 ","$0.00 ","$201.30 ","$0.00 ","$204.77 ","$0.00 "
"A-4650.13","SUP","HCPCS C1713","","A-4650.13  -  PLATE BN Y 35MMX1MM APTUS TRLK 2X5 HL TI HND 2/2.3MM SCR","BOTH IP/OP","$1,265.25 ","$936.29 ","$0.00 ","$1,265.25 ","$569.36 ","$0.00 ","$263.71 ","$0.00 ","$0.00 ","$221.54 ","$1,265.25 ","$0.00 ","$632.63 ","$1,002.08 ","$1,012.20 ","$0.00 ","$198.01 ","$0.00 ","$201.43 ","$0.00 "
"A-4650.20","SUP","HCPCS C1713","","A-4650.20  -  PLATE 20MM 2MM SCR 4 HOLE L LCK GRID CMPR BONE TRPZD","BOTH IP/OP","$1,218.00 ","$901.32 ","$0.00 ","$1,218.00 ","$548.10 ","$0.00 ","$253.86 ","$0.00 ","$0.00 ","$213.26 ","$1,218.00 ","$0.00 ","$609.00 ","$964.66 ","$974.40 ","$0.00 ","$190.62 ","$0.00 ","$193.91 ","$0.00 "
"A-4650.21","SUP","HCPCS C1713","","A-4650.21  -  PLATE BN L RT 32MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR","BOTH IP/OP","$1,218.00 ","$901.32 ","$0.00 ","$1,218.00 ","$548.10 ","$0.00 ","$253.86 ","$0.00 ","$0.00 ","$213.26 ","$1,218.00 ","$0.00 ","$609.00 ","$964.66 ","$974.40 ","$0.00 ","$190.62 ","$0.00 ","$193.91 ","$0.00 "
"A-4650.51","SUP","HCPCS C1713","","A-4650.51  -  PLATE BN RECT 13MMX1MM APTUS TRLK 2X2 HL GRID TI HND 2/2.3MM","BOTH IP/OP","$1,428.00 ","$1,056.72 ","$0.00 ","$1,428.00 ","$642.60 ","$0.00 ","$297.63 ","$0.00 ","$0.00 ","$250.03 ","$1,428.00 ","$0.00 ","$714.00 ","$1,130.98 ","$1,142.40 ","$0.00 ","$223.48 ","$0.00 ","$227.34 ","$0.00 "
"A-4650.56","SUP","HCPCS C1713","","A-4650.56  -  PLATE 56MM 2MM SCR 6 HOLE LCK GRID CMPR BONE TRPZD","BOTH IP/OP","$1,475.25 ","$1,091.69 ","$0.00 ","$1,475.25 ","$663.86 ","$0.00 ","$307.48 ","$0.00 ","$0.00 ","$258.30 ","$1,475.25 ","$0.00 ","$737.63 ","$1,168.40 ","$1,180.20 ","$0.00 ","$230.88 ","$0.00 ","$234.86 ","$0.00 "
"A-4650.58","SUP","HCPCS C1713","","A-4650.58  -  PLATE 2 MM 2.3 MM SCR 3X2 HOLE LCK GRID BONE TRPZD LEFT","BOTH IP/OP","$1,556.63 ","$1,151.91 ","$0.00 ","$1,556.63 ","$700.48 ","$0.00 ","$324.44 ","$0.00 ","$0.00 ","$272.55 ","$1,556.63 ","$0.00 ","$778.31 ","$1,232.85 ","$1,245.30 ","$0.00 ","$243.61 ","$0.00 ","$247.81 ","$0.00 "
"A-4650.59","SUP","HCPCS C1713","","A-4650.59  -  PLATE BN TRPZD RT 23MMX1MM APTUS TRLK 3X2 HL GRID TI HND","BOTH IP/OP","$1,556.63 ","$1,151.91 ","$0.00 ","$1,556.63 ","$700.48 ","$0.00 ","$324.44 ","$0.00 ","$0.00 ","$272.55 ","$1,556.63 ","$0.00 ","$778.31 ","$1,232.85 ","$1,245.30 ","$0.00 ","$243.61 ","$0.00 ","$247.81 ","$0.00 "
"A-4650.62","SUP","HCPCS C1713","","A-4650.62  -  PLATE BN TRPZD 29MMX1MM APTUS TRLK 4X2 HL GRID TI HND 2/2.3","BOTH IP/OP","$1,556.63 ","$1,151.91 ","$0.00 ","$1,556.63 ","$700.48 ","$0.00 ","$324.44 ","$0.00 ","$0.00 ","$272.55 ","$1,556.63 ","$0.00 ","$778.31 ","$1,232.85 ","$1,245.30 ","$0.00 ","$243.61 ","$0.00 ","$247.81 ","$0.00 "
"A-4650.67","SUP","HCPCS C1713","","A-4650.67  -  PLATE BN TRPZD 45MMX1MM APTUS TRLK 6X2 HL GRID TI HND 2/2.3","BOTH IP/OP","$1,622.25 ","$1,200.47 ","$0.00 ","$1,622.25 ","$730.01 ","$0.00 ","$338.12 ","$0.00 ","$0.00 ","$284.04 ","$1,622.25 ","$0.00 ","$811.13 ","$1,284.82 ","$1,297.80 ","$0.00 ","$253.88 ","$0.00 ","$258.26 ","$0.00 "
"A-4655.01","SUP","HCPCS C1713","","A-4655.01  -  PLATE STR 27MMX1.3MM TI 2-2.3MM SCR 4 HOLE LCK GRID APTUS","BOTH IP/OP","$1,572.50 ","$1,163.65 ","$0.00 ","$1,572.50 ","$707.63 ","$0.00 ","$327.75 ","$0.00 ","$0.00 ","$275.33 ","$1,572.50 ","$0.00 ","$786.25 ","$1,245.42 ","$1,258.00 ","$0.00 ","$246.10 ","$0.00 ","$250.34 ","$0.00 "
"A-4655.02","SUP","HCPCS C1713","","A-4655.02  -  PLATE STR 32MMX1.3MM TI 2-2.3MM SCR 5 HOLE LCK GRID APTUS","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"A-4655.03","SUP","HCPCS C1713","","A-4655.03  -  PLATE STR 38MMX1.3MM TI 2-2.3MM SCR 6 HOLE LCK GRID APTUS","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"A-4655.08","SUP","HCPCS C1713","","A-4655.08  -  PLATE 1.3MM 2MM 2.3MM SCR 8 HOLE LCK CVD BONE TRPZD","BOTH IP/OP","$1,922.50 ","$1,422.65 ","$0.00 ","$1,922.50 ","$865.13 ","$0.00 ","$400.70 ","$0.00 ","$0.00 ","$336.61 ","$1,922.50 ","$0.00 ","$961.25 ","$1,522.62 ","$1,538.00 ","$0.00 ","$300.87 ","$0.00 ","$306.06 ","$0.00 "
"A-4655.10","SUP","HCPCS C1713","","A-4655.10  -  PLATE 1.3MM 2MM 2.3MM SCR 2-4 HOLE T LCK BONE TRPZD","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"A-4655.16","SUP","HCPCS C1713","","A-4655.16  -  PLATE T 56MMX1.3MM TI 2-2.3MM SCR 2X8 HOLE LCK GRID APTUS","BOTH IP/OP","$1,922.50 ","$1,422.65 ","$0.00 ","$1,922.50 ","$865.13 ","$0.00 ","$400.70 ","$0.00 ","$0.00 ","$336.61 ","$1,922.50 ","$0.00 ","$961.25 ","$1,522.62 ","$1,538.00 ","$0.00 ","$300.87 ","$0.00 ","$306.06 ","$0.00 "
"A-4655.20","SUP","HCPCS C1713","","A-4655.20  -  PLATE L LEFT ANG 35MMX1.3MM TI 2-2.3MM SCR 2X6 HOLE LCK GRID","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"A-4655.21","SUP","HCPCS C1713","","A-4655.21  -  PLATE L RIGHT ANG 35MMX1.3MM TI 2-2.3MM SCR 4 HOLE LCK GRID","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"A-4655.22","SUP","HCPCS C1713","","A-4655.22  -  PLATE L LEFT ANG 58MMX1.3MM TI 2-2.3MM SCR 2X8 HOLE LCK GRID","BOTH IP/OP","$1,922.50 ","$1,422.65 ","$0.00 ","$1,922.50 ","$865.13 ","$0.00 ","$400.70 ","$0.00 ","$0.00 ","$336.61 ","$1,922.50 ","$0.00 ","$961.25 ","$1,522.62 ","$1,538.00 ","$0.00 ","$300.87 ","$0.00 ","$306.06 ","$0.00 "
"A-4655.23","SUP","HCPCS C1713","","A-4655.23  -  PLATE L RIGHT ANG 58MMX1.3MM TI 2-2.3MM SCR 10 HOLE LCK GRID","BOTH IP/OP","$1,922.50 ","$1,422.65 ","$0.00 ","$1,922.50 ","$865.13 ","$0.00 ","$400.70 ","$0.00 ","$0.00 ","$336.61 ","$1,922.50 ","$0.00 ","$961.25 ","$1,522.62 ","$1,538.00 ","$0.00 ","$300.87 ","$0.00 ","$306.06 ","$0.00 "
"A-4655.51","SUP","HCPCS C1713","","A-4655.51  -  PLATE 1.3MM 2MM 2.3MM SCR 2X2 HOLE LCK GRID SQ BONE TRPZD","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"A-4655.56","SUP","HCPCS C1713","","A-4655.56  -  PLATE 3X2 HOLE MESH LCK TRP BONE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"A-4655.62","SUP","HCPCS C1713","","A-4655.62  -  PLATE 1.3MM 2MM 2.3MM SCR 4X2 HOLE T LCK GRID BONE TRPZD","BOTH IP/OP","$1,970.00 ","$1,457.80 ","$0.00 ","$1,970.00 ","$886.50 ","$0.00 ","$410.60 ","$0.00 ","$0.00 ","$344.93 ","$1,970.00 ","$0.00 ","$985.00 ","$1,560.24 ","$1,576.00 ","$0.00 ","$308.31 ","$0.00 ","$313.62 ","$0.00 "
"A-4655.66","SUP","HCPCS C1713","","A-4655.66  -  PLATE TRPZD 42MMX1.3MM TI 2-2.3MM SCR 5X2 HOLE LCK GRID","BOTH IP/OP","$2,057.50 ","$1,522.55 ","$0.00 ","$2,057.50 ","$925.88 ","$0.00 ","$428.83 ","$0.00 ","$0.00 ","$360.25 ","$2,057.50 ","$0.00 ","$1,028.75 ","$1,629.54 ","$1,646.00 ","$0.00 ","$322.00 ","$0.00 ","$327.55 ","$0.00 "
"A-5040.21/1","SUP","Custom 27203010","","A-5040.21/1  -  WIRE FX 1.2MM 150MM NS KRSH APTUS TROC TIP SS","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"A-5100.04/1","SUP","HCPCS C1713","","A-5100.04/1  -  SCREW 4MM 1.2MM 4MM HEAD CORT BONE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.05/1","SUP","HCPCS C1713","","A-5100.05/1  -  SCREW BONE 1.2MM 5MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.06/1","SUP","HCPCS C1713","","A-5100.06/1  -  SCREW BONE 1.2MM 6MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.07/1","SUP","HCPCS C1713","","A-5100.07/1  -  SCREW BONE 1.2MM 7MM APTUS TI 4MM HEAD CORTEX HAND HEXADRIVE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.08/1","SUP","HCPCS C1713","","A-5100.08/1  -  SCREW BONE 1.2MM 08MM CORT HD4 1-PKG","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.09/1","SUP","HCPCS C1713","","A-5100.09/1  -  SCREW BONE 1.2MM 9MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.10/1","SUP","HCPCS C1713","","A-5100.10/1  -  SCREW BONE 10MM 1.2MM 4MM HEAD CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.12/1","SUP","HCPCS C1713","","A-5100.12/1  -  SCREW BONE 1.2MM 12MM 4MM HEAD CORTEX HAND HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.14/1","SUP","HCPCS C1713","","A-5100.14/1  -  SCREW BONE 1.2MM 14MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5100.16/1","SUP","HCPCS C1713","","A-5100.16/1  -  SCREW BONE 1.2MM 16MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.04/1","SUP","HCPCS C1713","","A-5200.04/1  -  SCREW BONE 1.5MM 4MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.05/1","SUP","HCPCS C1713","","A-5200.05/1  -  SCREW BONE 1.5MM 5MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.06","SUP","HCPCS C1713","","A-5200.06  -  SCREW BONE 6MM 1.5MM CORTICAL","BOTH IP/OP","$218.50 ","$161.69 ","$0.00 ","$218.50 ","$98.33 ","$0.00 ","$45.54 ","$0.00 ","$0.00 ","$38.26 ","$218.50 ","$0.00 ","$109.25 ","$173.05 ","$174.80 ","$0.00 ","$34.20 ","$0.00 ","$34.79 ","$0.00 "
"A-5200.06/1","SUP","HCPCS C1713","","A-5200.06/1  -  SCREW BONE 1.5MM 6MM APTUS TI HAND CORT HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.07/1","SUP","HCPCS C1713","","A-5200.07/1  -  SCREW BONE 1.5MM 7MM APTUS TI HAND CORT HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.08","SUP","HCPCS C1713","","A-5200.08  -  SCREW BONE 8MM HEXADRIVE 4 APTUS TITANIUM 1.5MM CORTICAL","BOTH IP/OP","$218.50 ","$161.69 ","$0.00 ","$218.50 ","$98.33 ","$0.00 ","$45.54 ","$0.00 ","$0.00 ","$38.26 ","$218.50 ","$0.00 ","$109.25 ","$173.05 ","$174.80 ","$0.00 ","$34.20 ","$0.00 ","$34.79 ","$0.00 "
"A-5200.08/1","SUP","HCPCS C1713","","A-5200.08/1  -  SCREW BONE 1.5MM 8MM APTUS TI CORTEX HAND GRN","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.09/1","SUP","HCPCS C1713","","A-5200.09/1  -  SCREW BONE 1.5MM 9MM APTUS TI HAND CORT HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.10","SUP","HCPCS C1713","","A-5200.10  -  SCREW BONE 10MM WASHER TWIST DRILL HEXADRIVE 4 APTUS GREEN","BOTH IP/OP","$218.50 ","$161.69 ","$0.00 ","$218.50 ","$98.33 ","$0.00 ","$45.54 ","$0.00 ","$0.00 ","$38.26 ","$218.50 ","$0.00 ","$109.25 ","$173.05 ","$174.80 ","$0.00 ","$34.20 ","$0.00 ","$34.79 ","$0.00 "
"A-5200.10/1","SUP","HCPCS C1713","","A-5200.10/1  -  SCREW BONE 1.5MM 10MM APTUS TI HAND CORT HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.11/1","SUP","HCPCS C1713","","A-5200.11/1  -  SCREW BONE 1.5MM 11MM APTUS TI 4MM HEAD CORTEX ELB HAND","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.12/1","SUP","HCPCS C1713","","A-5200.12/1  -  SCREW BONE 1.5MM 12MM APTUS TI 4MM HEAD CORTEX HAND 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.13/1","SUP","HCPCS C1713","","A-5200.13/1  -  SCREW BONE 1.5MM 13MM APTUS TI 4MM HEAD CORTEX ELB HAND","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.14/1","SUP","HCPCS C1713","","A-5200.14/1  -  SCREW BONE 1.5MM 14MM APTUS TI HAND CORT HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.15/1","SUP","HCPCS C1713","","A-5200.15/1  -  SCREW BONE 1.5MM 15MM APTUS TI CORTEX HAND HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.16/1","SUP","HCPCS C1713","","A-5200.16/1  -  SCREW BN 1.5MM 16MM 4 HNDL CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.17/1","SUP","HCPCS C1713","","A-5200.17/1  -  SCREW BN 1.5MM 17MM 4 HNDL CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.18/1","SUP","HCPCS C1713","","A-5200.18/1  -  SCREW BONE 1.5MM 18MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.19/1","SUP","HCPCS C1713","","A-5200.19/1  -  SCREW BONE 1.5MM 19MM APTUS CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.20/1","SUP","HCPCS C1713","","A-5200.20/1  -  SCREW BONE 1.5MM 20MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.21/1","SUP","HCPCS C1713","","A-5200.21/1  -  SCREW BONE 1.5MM 21MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.22/1","SUP","HCPCS C1713","","A-5200.22/1  -  SCREW BONE 1.5MM 22MM APTUS CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.23/1","SUP","HCPCS C1713","","A-5200.23/1  -  SCREW BN 1.5MM 23MM APTUS CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5200.24/1","SUP","HCPCS C1713","","A-5200.24/1  -  SCREW BONE 1.5MM 24MM APTUS TI CORTEX HAND HEXADRIVE 4","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5250.04/1","SUP","HCPCS C1713","","A-5250.04/1  -  SCREW BONE 1.5MM 4MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.05/1","SUP","HCPCS C1713","","A-5250.05/1  -  SCREW BONE 1.5MM 5MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.06/1","SUP","HCPCS C1713","","A-5250.06/1  -  SCREW BONE 1.5MM 6MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.07","SUP","HCPCS C1713","","A-5250.07  -  SCREW BONE 7MM 2 THREADED HEXADRIVE 4 OPTIMAL SELF RETAINING","BOTH IP/OP","$218.50 ","$161.69 ","$0.00 ","$218.50 ","$98.33 ","$0.00 ","$45.54 ","$0.00 ","$0.00 ","$38.26 ","$218.50 ","$0.00 ","$109.25 ","$173.05 ","$174.80 ","$0.00 ","$34.20 ","$0.00 ","$34.79 ","$0.00 "
"A-5250.07/1","SUP","HCPCS C1713","","A-5250.07/1  -  SCREW BONE 1.5MM 7MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.08","SUP","HCPCS C1713","","A-5250.08  -  SCREW BONE 8MM 2 THREAD HEXADRIVE 4 ATRAUMATIC TIP LOCKING","BOTH IP/OP","$305.00 ","$225.70 ","$0.00 ","$305.00 ","$137.25 ","$0.00 ","$63.57 ","$0.00 ","$0.00 ","$53.40 ","$305.00 ","$0.00 ","$152.50 ","$241.56 ","$244.00 ","$0.00 ","$47.73 ","$0.00 ","$48.56 ","$0.00 "
"A-5250.08/1","SUP","HCPCS C1713","","A-5250.08/1  -  SCREW BONE 1.5MM 8MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.09/1","SUP","HCPCS C1713","","A-5250.09/1  -  SCREW BONE 1.5MM 9MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.10/1","SUP","HCPCS C1713","","A-5250.10/1  -  SCREW BONE 1.5MM 10MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.11/1","SUP","HCPCS C1713","","A-5250.11/1  -  SCREW BONE 1.5MM 11MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.12/1","SUP","HCPCS C1713","","A-5250.12/1  -  SCREW BONE 1.5MM 12MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250.13/1","SUP","HCPCS C1713","","A-5250.13/1  -  SCREW BONE 1.5MM 13MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5250-11","SUP","HCPCS C1713","","A-5250-11  -  SCREW BONE 11MM LOCK 1.5MM CORTICAL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"A-5300.06/1","SUP","HCPCS C1713","","A-5300.06/1  -  SCREW BONE 1.8MM 6MM CORT 4 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5300.10/1","SUP","HCPCS C1713","","A-5300.10/1  -  SCREW BONE 1.8MM 10MM APTUS TI 4MM HEAD CORTEX HAND ER","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.04/1","SUP","HCPCS C1713","","A-5400.04/1  -  SCREW BONE 2MM 4MM APTUS TI CORTEX HAND HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.05","SUP","HCPCS C1713","","A-5400.05  -  SCREW BONE 5MM 6MM HEAD 2MM CORTICAL","BOTH IP/OP","$437.00 ","$323.38 ","$0.00 ","$437.00 ","$196.65 ","$0.00 ","$91.08 ","$0.00 ","$0.00 ","$76.52 ","$437.00 ","$0.00 ","$218.50 ","$346.10 ","$349.60 ","$0.00 ","$68.39 ","$0.00 ","$69.57 ","$0.00 "
"A-5400.05/1","SUP","HCPCS C1713","","A-5400.05/1  -  SCREW BONE 2MM 5MM APTUS TI CORTEX HAND HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.06/1","SUP","HCPCS C1713","","A-5400.06/1  -  SCREW BONE 2MM 6MM APTUS TI CORTEX HAND HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.07/1","SUP","HCPCS C1713","","A-5400.07/1  -  SCREW BONE 2MM 7MM APTUS TI TPR HAND WRST CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.08","SUP","HCPCS C1713","","A-5400.08  -  SCREW BONE 8MM SLFTAP SELF RETAINING ATRAUMATIC TIP","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.08/1","SUP","HCPCS C1713","","A-5400.08/1  -  SCREW BONE 2MM 8MM APTUS TI TPR HAND ELB WRST CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.09/1","SUP","HCPCS C1713","","A-5400.09/1  -  SCREW BONE 2MM 9MM APTUS TI 6MM HEAD CORTEX HAND LCK BLUE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.10/1","SUP","HCPCS C1713","","A-5400.10/1  -  SCREW BONE 2MM 10MM APTUS TI 6MM HEAD CORTEX WRST ELB HAND","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.11","SUP","HCPCS C1713","","A-5400.11  -  SCREW BONE 11MM SLFTAP SELF RETAINING ATRAUMATIC TIP","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.11/1","SUP","HCPCS C1713","","A-5400.11/1  -  SCREW BONE 2MM 11MM APTUS TI CORTEX WRST ELB HAND FT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.12","SUP","HCPCS C1713","","A-5400.12  -  SCREW BONE 12MM 6MM HEAD 2MM CORTICAL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.12/1","SUP","HCPCS C1713","","A-5400.12/1  -  SCREW BONE 2MM 12MM APTUS TI TPR HAND ELB WRST CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.13","SUP","HCPCS C1713","","A-5400.13  -  SCREW BONE 13MM 2MM CORTICAL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.13/1","SUP","HCPCS C1713","","A-5400.13/1  -  SCREW BONE 2MM 13MM APTUS TI TPR HAND WRST CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.14","SUP","HCPCS C1713","","A-5400.14  -  SCREW BONE 14MM SLFTAP SELF RETAINING ATRAUMATIC TIP","BOTH IP/OP","$218.50 ","$161.69 ","$0.00 ","$218.50 ","$98.33 ","$0.00 ","$45.54 ","$0.00 ","$0.00 ","$38.26 ","$218.50 ","$0.00 ","$109.25 ","$173.05 ","$174.80 ","$0.00 ","$34.20 ","$0.00 ","$34.79 ","$0.00 "
"A-5400.14/1","SUP","HCPCS C1713","","A-5400.14/1  -  SCREW BONE 2MM 14MM APTUS TI CORTEX HAND HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.15/1","SUP","HCPCS C1713","","A-5400.15/1  -  SCREW BONE 2MM 15MM APTUS TI CORTEX HAND BLUE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.16/1","SUP","HCPCS C1713","","A-5400.16/1  -  SCREW BONE 2MM 16MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.17","SUP","HCPCS C1713","","A-5400.17  -  SCREW BONE 17MM APTUS BLUE TITANIUM 2MM HAND CORTICAL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.17/1","SUP","HCPCS C1713","","A-5400.17/1  -  SCREW BONE 2MM 17MM APTUS TI CORTEX HAND BLUE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.18/1","SUP","HCPCS C1713","","A-5400.18/1  -  SCREW BONE 2MM 18MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.19/1","SUP","HCPCS C1713","","A-5400.19/1  -  SCREW BONE 2MM 19MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.20","SUP","HCPCS C1713","","A-5400.20  -  SCREW BONE 20MM 6MM HEAD 2MM CORTICAL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.20/1","SUP","HCPCS C1713","","A-5400.20/1  -  SCREW BONE 2MM 20MM APTUS TRLK TI MIDFT HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.21/1","SUP","HCPCS C1713","","A-5400.21/1  -  SCREW BONE 2MM 21MM APTUS TI CORTEX HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.22/1","SUP","HCPCS C1713","","A-5400.22/1  -  SCREW BONE 2MM 22MM APTUS TI CORTEX HEXADRIVE 6","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.23/1","SUP","HCPCS C1713","","A-5400.23/1  -  SCREW BONE 2MM 23MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5400.24/1","SUP","HCPCS C1713","","A-5400.24/1  -  SCREW BONE 2MM 24MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5450.06/1","SUP","HCPCS C1713","","A-5450.06/1  -  SCREW BONE 2MM 6MM APTUS TRLK TI FT HAND ELB WRST CORT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.07/1","SUP","HCPCS C1713","","A-5450.07/1  -  SCREW BONE 2MM 7MM APTUS TRLK TI FT HAND WRST CORT HEXADRIVE","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.08/1","SUP","HCPCS C1713","","A-5450.08/1  -  SCREW BONE 2MM 8MM APTUS TRLK TI FT HAND ELB WRST CORT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.09","SUP","HCPCS C1713","","A-5450.09  -  SCREW BONE 9MM LOCK APTUS BLUE TITANIUM 2MM HAND CORTICAL","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.09/1","SUP","HCPCS C1713","","A-5450.09/1  -  SCREW BONE 2MM 9MM APTUS TI 6MM CORTEX WRST 2 THRD TRLK","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.10","SUP","HCPCS C1713","","A-5450.10  -  SCREW BONE 10MM TRILOCK LOCKING TECHNOLOGY SLFTAP VAR ANG","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.10/1","SUP","HCPCS C1713","","A-5450.10/1  -  SCREW BONE 2MM 10MM APTUS TI 6MM HEAD WRST ELB HAND FT 2","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.11","SUP","HCPCS C1713","","A-5450.11  -  SCREW BONE 11MM LOCKING HEXADRIVE 6 APTUS TRILOCK BLUE","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.11/1","SUP","HCPCS C1713","","A-5450.11/1  -  SCREW BONE 2MM 11MM APTUS TRLK TI FT HAND WRST CORT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.12","SUP","HCPCS C1713","","A-5450.12  -  SCREW BONE 12MM TRILOCK LOCKING TECHNOLOGY SLFTAP VAR ANG","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.12/1","SUP","HCPCS C1713","","A-5450.12/1  -  SCREW BONE 2MM 12MM APTUS TRLK TI CORTEX FRFT MIDFT LCK","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.13/1","SUP","HCPCS C1713","","A-5450.13/1  -  SCREW BONE 2MM 13MM APTUS TI 6MM HEAD CORTEX WRST ELB HAND","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.14/1","SUP","HCPCS C1713","","A-5450.14/1  -  SCREW BONE 2MM 14MM APTUS TI 6MM HEAD CORTEX HAND LCK BLUE","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.16","SUP","HCPCS C1713","","A-5450.16  -  SCREW BONE 16MM LOCKING HEXAGONAL DRIVE 2MM","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"A-5450.16/1","SUP","HCPCS C1713","","A-5450.16/1  -  SCREW BONE 2MM 16MM APTUS TRLK TI MIDFT HEXADRIVE 6","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.18/1","SUP","HCPCS C1713","","A-5450.18/1  -  SCREW BONE 2MM 18MM APTUS TRLK TI FT HAND ELB WRST CORT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5450.20/1","SUP","HCPCS C1713","","A-5450.20/1  -  SCREW BONE 2MM 20MM APTUS TI 6MM HEAD WRST ELB HAND FT 2","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$151.88 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"A-5500.05/1","SUP","HCPCS C1713","","A-5500.05/1  -  SCREW 5MM 2.3MM 6MM HEAD CORT BONE","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.06/1","SUP","HCPCS C1713","","A-5500.06/1  -  SCREW BONE 2.3MM 6MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.07/1","SUP","HCPCS C1713","","A-5500.07/1  -  SCREW BONE 2.3MM 7MM APTUS CORT","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.08/1","SUP","HCPCS C1713","","A-5500.08/1  -  SCREW BONE 2.3MM 8MM APTUS TI TPR ATRM CORTEX WRST ELB HAND","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.09/1","SUP","HCPCS C1713","","A-5500.09/1  -  SCREW BONE 2.3MM 9MM APTUS TI TPR FT HAND CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.10/1","SUP","HCPCS C1713","","A-5500.10/1  -  SCREW BONE 2.3MM 10MM APTUS TI TPR FT HAND ELB WRST CORT 2","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.11/1","SUP","HCPCS C1713","","A-5500.11/1  -  SCREW BONE 2.3MM 11MM APTUS TI CORTEX HAND BROWN","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.12/1","SUP","HCPCS C1713","","A-5500.12/1  -  SCREW BONE 2.3MM 12MM APTUS TI TPR ATRM CORTEX WRST ELB HAND","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.13/1","SUP","HCPCS C1713","","A-5500.13/1  -  SCREW BONE 2.3MM 13MM APTUS TI TPR FT HAND CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.14/1","SUP","HCPCS C1713","","A-5500.14/1  -  SCREW BONE 2.3MM 14MM APTUS TI TPR ATRM CORTEX WRST ELB HAND","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.15/1","SUP","HCPCS C1713","","A-5500.15/1  -  SCREW BONE 2.3MM 15MM APTUS TI TPR FT HAND CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.16/1","SUP","HCPCS C1713","","A-5500.16/1  -  SCREW BONE 2.3MM 16MM APTUS TI TPR FT HAND ELB WRST CORT 2","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.17/1","SUP","HCPCS C1713","","A-5500.17/1  -  SCREW BONE 2.3MM 17MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.18/1","SUP","HCPCS C1713","","A-5500.18/1  -  SCREW BONE 2.3MM 18MM APTUS TI TPR FT HAND CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.19/1","SUP","HCPCS C1713","","A-5500.19/1  -  SCREW BONE 2.3MM 19MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.20/1","SUP","HCPCS C1713","","A-5500.20/1  -  SCREW BONE 2.3MM 20MM APTUS TI TPR FT HAND CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.21/1","SUP","HCPCS C1713","","A-5500.21/1  -  SCREW BONE 2.3MM 21MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.22/1","SUP","HCPCS C1713","","A-5500.22/1  -  SCREW BONE 2.3MM 22MM CORT 6 HNDL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.23/1","SUP","HCPCS C1713","","A-5500.23/1  -  SCREW BONE 2.3MM 23MM APTUS TI CORT HAND BROWN","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A-5500.24/1","SUP","HCPCS C1713","","A-5500.24/1  -  SCREW BONE 2.3MM 24MM APTUS TI TPR FT HAND CORT 2 THRD","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$94.50 ","$0.00 ","$43.77 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"A60-15030","SUP","HCPCS C1713","","A60-15030  -  SCREW BONE 6/5MM 150MM 30MM VSN 6MM SHNK CORT ANKL THRD TPR","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"AAE21","SUP","Custom 27203010","","AAE21  -  DST SERIES EEA 21  BX /3","BOTH IP/OP","$2,445.20 ","$1,809.45 ","$0.00 ","$2,445.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,445.20 ","$0.00 ","$1,222.60 ","$1,936.60 ","$1,956.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1000","SUP","Custom 27203010","","ABS-1000  -  SYSTEM BN CMNT 3ML DLV MX ABS","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1000-L","SUP","Custom 27203010","","ABS-1000-L  -  SYSTEM BN CMNT LG MX DLV APL","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1000-S","SUP","Custom 27203010","","ABS-1000-S  -  SYSTEM BN CMNT STRL ARTHX DLV MX SM APL","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1001","SUP","Custom 27203010","","ABS-1001  -  NEEDLE EPDRL TUO OBT","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1002","SUP","Custom 27203010","","ABS-1002  -  NEEDLE EPDRL STRG TUO OBT","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$140.00 ","$0.00 ","$70.00 ","$110.88 ","$112.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-10020","SUP","Custom 27203010","","ABS-10020  -  CENTRIFUGE BNCHTP 110V ACP HETTICH ROTOFIX 32 SWNG OUT RTR","BOTH IP/OP","$10,750.00 ","$7,955.00 ","$0.00 ","$10,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,750.00 ","$0.00 ","$5,375.00 ","$8,514.00 ","$8,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-10023","SUP","HCPCS C1713","","ABS-10023  -  CAP CNTRF ACP HETTICH REPL BCKT ABS-10023","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"ABS-1003","SUP","Custom 27203010","","ABS-1003  -  SYSTEM BN CMNT FNL","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-10050","SUP","Custom 27203010","","ABS-10050  -  APPLICATOR SRG XLNG BLNT BVL 10CM VISCOGEL EZ TO FIL HVISC","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-10051","SUP","Custom 27203010","","ABS-10051  -  APPLICATOR SRG XLNG BLNT BVL 3CM VSC SPRY EZ TO FIL LVISC MX","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS10055","SUP","Custom 27203010","","ABS10055  -  KIT SRG STRL TULIP GEMS CELLFRIENDLY SUPERLUERLOK ADIPOSE","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1007-BC","SUP","HCPCS C1762","","ABS-1007-BC  -  MATRIX TISS .75CC BIOCARTILAGE","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$0.00 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$0.00 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1010-BC","SUP","HCPCS C1762","","ABS-1010-BC  -  FILLER BN VOID 1CC BIOCARTILAGE","BOTH IP/OP","$2,450.00 ","$1,813.00 ","$0.00 ","$2,450.00 ","$0.00 ","$0.00 ","$510.64 ","$0.00 ","$0.00 ","$0.00 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1102-19","SUP","HCPCS L8699","","ABS-1102-19  -  GRAFT BN 19X12MM CARTIFORM","BOTH IP/OP","$15,625.00 ","$11,562.50 ","$0.00 ","$15,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,625.00 ","$0.00 ","$7,812.50 ","$12,375.00 ","$12,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-1102-25","SUP","HCPCS L8699","","ABS-1102-25  -  GRAFT BN 25X20MM CARTIFORM","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-20000","SUP","Custom 27203010","","ABS-20000  -  NEEDLE SPNL 17GA 14.63CM 1.27CM 8 HL FENESTRATE HUB","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-2001-01","SUP","HCPCS C1713","","ABS-2001-01  -  FILLER BN VOID 1CC STIMUBLAST PTTY","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"ABS-2001-02","SUP","HCPCS C1713","","ABS-2001-02  -  FILLER BN VOID 2.5CC STIMUBLAST PTTY","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$495.00 ","$0.00 ","$229.27 ","$0.00 ","$0.00 ","$192.60 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$172.15 ","$0.00 ","$175.12 ","$0.00 "
"ABS-2001-05","SUP","HCPCS C1713","","ABS-2001-05  -  FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED DBM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"ABS-2002-05","SUP","HCPCS C1713","","ABS-2002-05  -  FILLER BN VOID 5CC NS STIMUBLAST ARTHX GEL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"ABS-2002-10","SUP","HCPCS C1713","","ABS-2002-10  -  FILLER BN VOID 10ML STIMUBLAST GEL RVRS PHS MED DBM","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"ABS-2003-05","SUP","HCPCS C1713","","ABS-2003-05  -  FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED CANC DBM","BOTH IP/OP","$2,050.00 ","$1,517.00 ","$0.00 ","$2,050.00 ","$922.50 ","$0.00 ","$427.27 ","$0.00 ","$0.00 ","$358.94 ","$2,050.00 ","$0.00 ","$1,025.00 ","$1,623.60 ","$1,640.00 ","$0.00 ","$320.83 ","$0.00 ","$326.36 ","$0.00 "
"ABS-2003-10","SUP","HCPCS C1713","","ABS-2003-10  -  FILLER BN VOID 10ML STIMUBLAST PTTY RVRS PHS MED CANC DBM","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"ABS-2004-01","SUP","HCPCS C1713","","ABS-2004-01  -  FILLER BN VOID 1ML STIMUBLAST PTTY RVRS PHS MED CANC DBM","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"ABS-2004-03","SUP","HCPCS C1713","","ABS-2004-03  -  FILLER BN VOID 3ML STIMUBLAST PST RVRS PHS MED CANC DBM","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"ABS-2004-08","SUP","HCPCS C1713","","ABS-2004-08  -  FILLER BN VOID 8ML STIMUBLAST PST RVRS PHS MED CANC DBM","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"ABS-2009-02","SUP","HCPCS L8699","","ABS-2009-02  -  GRAFT BN 2.5CC ARTHROCELL","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-2009-05","SUP","HCPCS L8699","","ABS-2009-05  -  GRAFT BN 5CC ARTHROCELL","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-21000","SUP","Custom 27203010","","ABS-21000  -  NEEDLE EPDRL 17GA 6IN TUO DLV","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-30001S","SUP","HCPCS L8699","","ABS-30001S  -  GRAFT SFT TIS THK 5X5CM STRL HDRT RTU REINF DRML XCLR MTRX","BOTH IP/OP","$4,125.00 ","$3,052.50 ","$0.00 ","$4,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,125.00 ","$0.00 ","$2,062.50 ","$3,267.00 ","$3,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-30002S","SUP","HCPCS L8699","","ABS-30002S  -  GRAFT SFT TIS THK 8X6CM STRL HDRT RTU REINF DRML XCLR MTRX","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4003","SUP","Custom 27203010","","ABS-4003  -  DRESSING WND 3X3IN JUMPSTART ANMC","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4004","SUP","Custom 27203010","","ABS-4004  -  DRESSING WND 4X4IN JUMPSTART ANMC","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4005","SUP","Custom 27203010","","ABS-4005  -  DRESSING WND 1.5IN 8IN JUMPSTART ANMC","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4008","SUP","Custom 27203010","","ABS-4008  -  DRESSING WND 8X8IN JUMPSTART ANMC","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4012","SUP","Custom 27203010","","ABS-4012  -  DRESSING WND 12X12IN JUMPSTART 1 LYR DOT MTRX PTRN ANMC LSR","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4025","SUP","Custom 27203010","","ABS-4025  -  DRESSING WND 2X5IN JUMPSTART ANMC","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4053","SUP","Custom 27203010","","ABS-4053  -  DRESSING WND 4X4IN 2X2IN JUMPSTART COMP ADH BRDR PD ANMC","BOTH IP/OP","$82.50 ","$61.05 ","$0.00 ","$82.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.50 ","$0.00 ","$41.25 ","$65.34 ","$66.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4054","SUP","Custom 27203010","","ABS-4054  -  DRESSING WND 2.5IN 1IN JUMPSTART COMP ADH BRDR PD ANMC","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4056","SUP","Custom 27203010","","ABS-4056  -  DRESSING WND 4IN 2IN JUMPSTART COMP ADH BRDR PD ANMC","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-022","SUP","HCPCS L8699","","ABS-4100-022  -  MATRIX TISS THN 2X2CM ARTHX AMNION","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-023","SUP","HCPCS L8699","","ABS-4100-023  -  MATRIX TISS THN 3X2CM ARTHX AMNION","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-033","SUP","HCPCS L8699","","ABS-4100-033  -  MATRIX TISS THN 3X3CM AMNION","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-044","SUP","HCPCS L8699","","ABS-4100-044  -  MATRIX TISS THN 4X4CM ARTHX AMNION","BOTH IP/OP","$5,562.50 ","$4,116.25 ","$0.00 ","$5,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,562.50 ","$0.00 ","$2,781.25 ","$4,405.50 ","$4,450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-046","SUP","HCPCS L8699","","ABS-4100-046  -  MATRIX TISS THN 6X4CM ALGRF AMNION","BOTH IP/OP","$7,562.50 ","$5,596.25 ","$0.00 ","$7,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,562.50 ","$0.00 ","$3,781.25 ","$5,989.50 ","$6,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-048","SUP","HCPCS L8699","","ABS-4100-048  -  MATRIX TISS THN 8X4CM ARTHX AMNION","BOTH IP/OP","$9,312.50 ","$6,891.25 ","$0.00 ","$9,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,312.50 ","$0.00 ","$4,656.25 ","$7,375.50 ","$7,450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-077","SUP","HCPCS L8699","","ABS-4100-077  -  MATRIX TISS THN 7X7CM ARTHX AMNION","BOTH IP/OP","$12,312.50 ","$9,111.25 ","$0.00 ","$12,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,312.50 ","$0.00 ","$6,156.25 ","$9,751.50 ","$9,850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4100-212","SUP","HCPCS L8699","","ABS-4100-212  -  MATRIX TISS THN 12X2CM ARTHX AMNION","BOTH IP/OP","$7,562.50 ","$5,596.25 ","$0.00 ","$7,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,562.50 ","$0.00 ","$3,781.25 ","$5,989.50 ","$6,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4200-022","SUP","HCPCS L8699","","ABS-4200-022  -  MATRIX TISS THK 2X2CM ALGRF AMNION","BOTH IP/OP","$2,956.25 ","$2,187.63 ","$0.00 ","$2,956.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,956.25 ","$0.00 ","$1,478.13 ","$2,341.35 ","$2,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4200-023","SUP","HCPCS L8699","","ABS-4200-023  -  MATRIX TISS THK 8X3CM ARTHX AMNION","BOTH IP/OP","$4,250.00 ","$3,145.00 ","$0.00 ","$4,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,250.00 ","$0.00 ","$2,125.00 ","$3,366.00 ","$3,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4200-033","SUP","HCPCS L8699","","ABS-4200-033  -  MATRIX TISS THK 3X3CM ALGRF AMNION","BOTH IP/OP","$6,125.00 ","$4,532.50 ","$0.00 ","$6,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4200-034","SUP","HCPCS L8699","","ABS-4200-034  -  MATRIX TISS THK 4X3CM ARTHX AMNION","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,000.00 ","$0.00 ","$3,500.00 ","$5,544.00 ","$5,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4200-036","SUP","HCPCS L8699","","ABS-4200-036  -  MATRIX TISS THK 4X3CM AMNION","BOTH IP/OP","$9,250.00 ","$6,845.00 ","$0.00 ","$9,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,250.00 ","$0.00 ","$4,625.00 ","$7,326.00 ","$7,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4200-038","SUP","HCPCS L8699","","ABS-4200-038  -  MATRIX TISS THK 8X3CM ARTHX AMNION","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,000.00 ","$0.00 ","$5,500.00 ","$8,712.00 ","$8,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4300-050","SUP","HCPCS L8699","","ABS-4300-050  -  MATRIX TISS .5CC ARTHX ALGRF FLW AMNION","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4300-100","SUP","HCPCS L8699","","ABS-4300-100  -  MATRIX TISS 1CC ARTHX AMNION FLW","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABS-4300-200","SUP","HCPCS L8699","","ABS-4300-200  -  MATRIX TISS 2CC ARTHX AMNION FLW","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABSTACK15","SUP","Custom 27203010","","ABSTACK15  -  DEVICE FIX 5MM 15 TACK RATCHET HANDLE PISTOL GRIP NO SHARP","BOTH IP/OP","$627.03 ","$464.00 ","$0.00 ","$627.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$627.03 ","$0.00 ","$313.51 ","$496.61 ","$501.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ABSTACK30","SUP","Custom 27203010","","ABSTACK30  -  DEVICE FIX 5MM 30 TACK RATCHET HANDLE PISTOL GRIP NO SHARP","BOTH IP/OP","$2,104.35 ","$1,557.22 ","$0.00 ","$1,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AC003","SUP","Custom 27203010","","AC003  -  SET SPNL ADPR BRMR HL MYFLD","BOTH IP/OP","$2,077.78 ","$1,537.56 ","$0.00 ","$2,077.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,077.78 ","$0.00 ","$1,038.89 ","$1,645.60 ","$1,662.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AC018","SUP","HCPCS C1713","","AC018  -  PIN BRMR HL SKL STRL","BOTH IP/OP","$116.25 ","$86.03 ","$0.00 ","$116.25 ","$52.31 ","$0.00 ","$24.23 ","$0.00 ","$0.00 ","$20.35 ","$116.25 ","$0.00 ","$58.13 ","$92.07 ","$93.00 ","$0.00 ","$18.19 ","$0.00 ","$18.51 ","$0.00 "
"AC020","SUP","HCPCS C1713","","AC020  -  PIN BRMR HL SKL STRL","BOTH IP/OP","$100.50 ","$74.37 ","$0.00 ","$100.50 ","$45.23 ","$0.00 ","$20.95 ","$0.00 ","$0.00 ","$17.60 ","$100.50 ","$0.00 ","$50.25 ","$79.60 ","$80.40 ","$0.00 ","$15.73 ","$0.00 ","$16.00 ","$0.00 "
"AC3930A","SUP","Custom 27203010","","AC3930A  -  CATHETER ANGEL","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ACH140","SUP","HCPCS C1760","","ACH140  -  DEVICE CLOSURE STANDARD 40MM EXCLUSION SYSTEM ATRICLIP","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"ACTR10","SUP","Custom 27803010","","ACTR10  -  RING CPSLR TNSN THK.15MM 10-12.3MM STRL REFORM PMMA","BOTH IP/OP","$492.53 ","$364.47 ","$0.00 ","$492.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$492.53 ","$0.00 ","$246.26 ","$390.08 ","$394.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ACTR11","SUP","Custom 27803010","","ACTR11  -  RING CPSLR FX THK.17MM 11-13MM STRL REFORM PMMA","BOTH IP/OP","$492.53 ","$364.47 ","$0.00 ","$492.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$492.53 ","$0.00 ","$246.26 ","$390.08 ","$394.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ACTR12","SUP","Custom 27803010","","ACTR12  -  RING CPSLR TNSN THK.2MM 12-14.5MM STRL REFORM PMMA","BOTH IP/OP","$492.53 ","$364.47 ","$0.00 ","$492.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$492.53 ","$0.00 ","$246.26 ","$390.08 ","$394.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ACU0T0.300","SUP","HCPCS V2632","","ACU0T0.300  -  LENS IOL +30 DIOP STRL LF ACRSF ULTRASERT 1 PC FLD UV BLU","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"ACX2200","SUP","Custom 27203010","","NEUTRALIZER SOL GLUTEX 2 GLUT AND OPA","BOTH IP/OP","$13.03 ","$9.64 ","$0.00 ","$13.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.03 ","$0.00 ","$6.51 ","$10.32 ","$10.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AD03","SUP","Custom 27203010","","AD03  -  CHUCK DRL 1000 RPM MDSRX LGN JCB PRFR DRVR","BOTH IP/OP","$7,528.10 ","$5,570.79 ","$0.00 ","$7,528.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,528.10 ","$0.00 ","$3,764.05 ","$5,962.26 ","$6,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AD-5230","SUP","HCPCS V2790","","AD-5230  -  GRAFT HUM TIS 3X2CM AMBIODRY2 AMNIO MEMBR DHDR STRL DISP","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"ADAPTADRK2","SUP","HCPCS C2619","","ADAPTADRK2  -  PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER","BOTH IP/OP","$8,355.00 ","$6,182.70 ","$0.00 ","$8,525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,525.00 ","$0.00 ","$4,262.50 ","$6,751.80 ","$6,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADAPTALGDRK2","SUP","HCPCS C2619","","ADAPTALGDRK2  -  KIT PCMKR LG ADAPTA 2 CHMBR 2 LD","BOTH IP/OP","$8,355.00 ","$6,182.70 ","$0.00 ","$8,525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,525.00 ","$0.00 ","$4,262.50 ","$6,751.80 ","$6,820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADAPTASRK2","SUP","HCPCS C2619","","ADAPTASRK2  -  PACEMAKER CARDIAC IMPLTABLE 1 CHAMBER RATE RESPONSIVE","BOTH IP/OP","$6,382.50 ","$4,723.05 ","$0.00 ","$6,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,512.50 ","$0.00 ","$3,256.25 ","$5,157.90 ","$5,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADDR01","SUP","HCPCS C1785","","ADDR01  -  PACEMAKER CRD 12.1CC ADAPTA DR 2 CHMBR IS-1 CNCT GNTR 27.1GM","BOTH IP/OP","$6,370.00 ","$4,713.80 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,327.67 ","$0.00 ","$0.00 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"ADDRL1","SUP","HCPCS C2619","","ADDRL1  -  PACEMAKER CARDIAC THK7.5MM 45.4X52.3MM 2 CHAMBER UNIPOLAR","BOTH IP/OP","$6,370.00 ","$4,713.80 ","$0.00 ","$6,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADDRS1","SUP","Custom 27203010","","ADDRS1  -  PACEMAKER CARDIAC THK7.5MM 42.9X44.7MM 2 CHAMBER UNIPOLAR","BOTH IP/OP","$6,370.00 ","$4,713.80 ","$0.00 ","$6,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADP215790C","SUP","Custom 27011340","","ADP215790C  -  KIT SURG PED","BOTH IP/OP","$29.73 ","$22.00 ","$0.00 ","$29.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.73 ","$0.00 ","$14.86 ","$23.55 ","$23.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADS201844","SUP","Custom 27203010","","ADS201844  -  SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 10ML","BOTH IP/OP","$339.22 ","$251.02 ","$0.00 ","$766.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$620.62 ","$0.00 ","$310.31 ","$766.85 ","$496.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ADS201845","SUP","Custom 27203010","","ADS201845  -  SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 5ML","BOTH IP/OP","$620.62 ","$459.26 ","$0.00 ","$968.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$968.25 ","$0.00 ","$484.13 ","$491.53 ","$774.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AF02","SUP","Custom 27203010","","AF02  -  ATTCH TL FT MDSRX LGN 2.4MM F2","BOTH IP/OP","$2,133.10 ","$1,578.49 ","$0.00 ","$2,133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,133.10 ","$0.00 ","$1,066.55 ","$1,689.42 ","$1,706.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AF101","SUP","Custom 27011340","","AF101  -  HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX","BOTH IP/OP","$2,812.50 ","$2,081.25 ","$0.00 ","$2,812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,812.50 ","$0.00 ","$1,406.25 ","$2,227.50 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AF-101","SUP","Custom 27203010","","AF-101  -  HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX","BOTH IP/OP","$3,002.13 ","$2,221.58 ","$0.00 ","$3,002.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,002.13 ","$0.00 ","$1,501.06 ","$2,377.69 ","$2,401.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AF102","SUP","Custom 27011340","","AF102  -  HALTER TRC 30-44IN BREMER AIRFLO LG HDNK VST HALO","BOTH IP/OP","$2,812.50 ","$2,081.25 ","$0.00 ","$2,812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,812.50 ","$0.00 ","$1,406.25 ","$2,227.50 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AF-1230","SUP","HCPCS V2790","","AF-1230  -  GRAFT SFT TIS THN 3X2CM OPQ AMBIODRY5 LTWT AMNIO MEMBR","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$759.38 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"AFLEX100","SUP","HCPCS Q4125","","AFLEX100  -  GRAFT SFT TIS THK1.5MM 35X35MM STRL ARTHROFLEX FLEXIGRAFT","BOTH IP/OP","$5,942.50 ","$4,397.45 ","$0.00 ","$5,682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,682.50 ","$0.00 ","$2,841.25 ","$4,500.54 ","$4,546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX101","SUP","HCPCS Q4125","","AFLEX101  -  GRAFT SFT TIS THK1.5MM 40X70MM STRL MATRACELL ARTHROFLEX","BOTH IP/OP","$7,065.00 ","$5,228.10 ","$0.00 ","$6,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,755.00 ","$0.00 ","$3,377.50 ","$5,349.96 ","$5,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX103","SUP","HCPCS Q4125","","AFLEX103  -  GRAFT SFT TIS THK1.5MM 90X50MM STRL MATRACELL ARTHROFLEX","BOTH IP/OP","$9,502.50 ","$7,031.85 ","$0.00 ","$9,177.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,177.50 ","$0.00 ","$4,588.75 ","$7,268.58 ","$7,342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX150","SUP","HCPCS Q4125","","AFLEX150  -  GRAFT SFT TIS THK1.5MM 140X15MM STRL MATRACELL ARTHROFLEX","BOTH IP/OP","$5,360.00 ","$3,966.40 ","$0.00 ","$5,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,100.00 ","$0.00 ","$2,550.00 ","$4,039.20 ","$4,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX200","SUP","HCPCS Q4125","","AFLEX200  -  GRAFT SFT TIS THK2MM 35X35MM STRL MATRACELL ARTHROFLEX","BOTH IP/OP","$7,932.50 ","$5,870.05 ","$0.00 ","$7,662.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,662.50 ","$0.00 ","$3,831.25 ","$6,068.70 ","$6,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX201","SUP","HCPCS Q4125","","AFLEX201  -  GRAFT SFT TIS THK2MM 70X40MM STRL MATRACELL ARTHROFLEX","BOTH IP/OP","$9,505.00 ","$7,033.70 ","$0.00 ","$9,270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX301","SUP","HCPCS Q4125","","AFLEX301  -  GRAFT SFT TIS THK3MM 70X40MM DECELLULARIZE DERM","BOTH IP/OP","$9,965.00 ","$7,374.10 ","$0.00 ","$9,722.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,722.50 ","$0.00 ","$4,861.25 ","$7,700.22 ","$7,778.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX400","SUP","HCPCS Q4125","","AFLEX400  -  GRAFT SFT TIS 40X40X1MM DECELLUARIZE DERM","BOTH IP/OP","$5,495.00 ","$4,066.30 ","$0.00 ","$5,227.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,227.50 ","$0.00 ","$2,613.75 ","$4,140.18 ","$4,182.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX401","SUP","HCPCS Q4125","","AFLEX401  -  GRAFT SFT TIS 70X40X1MM DECELLULARIZE DERM","BOTH IP/OP","$6,700.00 ","$4,958.00 ","$0.00 ","$6,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,375.00 ","$0.00 ","$3,187.50 ","$5,049.00 ","$5,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AFLEX500","SUP","HCPCS Q4125","","AFLEX500  -  GRAFT SFT TIS THK.5MM 40X30MM DECELLULARIZE DERM","BOTH IP/OP","$3,107.50 ","$2,299.55 ","$0.00 ","$2,942.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,942.50 ","$0.00 ","$1,471.25 ","$2,330.46 ","$2,354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AG0340","SUP","HCPCS C1763","","AG0340  -  PROTECTOR NERVE 3.5MM 40MM REINFORCED WRAP AXOGUARD PIG","BOTH IP/OP","$5,787.50 ","$4,282.75 ","$0.00 ","$5,350.00 ","$2,407.50 ","$0.00 ","$1,206.26 ","$0.00 ","$0.00 ","$936.74 ","$5,350.00 ","$0.00 ","$2,675.00 ","$4,237.20 ","$4,280.00 ","$0.00 ","$837.28 ","$0.00 ","$851.72 ","$0.00 "
"AG0740","SUP","HCPCS C1763","","AG0740  -  PROTECTOR TISSUE 7MM 40MM AXOGUARD PIG EXTRACELLULAR MATRIX","BOTH IP/OP","$5,935.00 ","$4,391.90 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,237.00 ","$0.00 ","$0.00 ","$941.12 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$855.70 ","$0.00 "
"AG1040","SUP","HCPCS C1763","","AG1040  -  PROTECTOR NERVE 10MM 40MM MULTILAMINAR AXOGUARD","BOTH IP/OP","$5,935.00 ","$4,391.90 ","$0.00 ","$5,487.50 ","$2,469.38 ","$0.00 ","$1,237.00 ","$0.00 ","$0.00 ","$960.82 ","$5,487.50 ","$0.00 ","$2,743.75 ","$4,346.10 ","$4,390.00 ","$0.00 ","$858.79 ","$0.00 ","$873.61 ","$0.00 "
"AG-2015","SUP","HCPCS V2790","","AG-2015  -  GRAFT SOFT TISSUE B THK50-100UM 2X1.5IN ALLOGRAFT","BOTH IP/OP","$1,722.50 ","$1,274.65 ","$0.00 ","$1,675.00 ","$753.75 ","$0.00 ","$359.01 ","$0.00 ","$0.00 ","$293.28 ","$1,675.00 ","$0.00 ","$837.50 ","$1,326.60 ","$1,340.00 ","$0.00 ","$262.14 ","$0.00 ","$266.66 ","$0.00 "
"AGX215","SUP","HCPCS C1763","","AGX215  -  CONNECTOR NERVE 2MM 15MM COAPTATION AID AXOGUARD PIG","BOTH IP/OP","$3,730.00 ","$2,760.20 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$777.43 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$571.13 ","$0.00 "
"AGX310","SUP","HCPCS C1763","","AGX310  -  CONNECTOR NERVE 3MM 10MM COAPTATION AID AXOGUARD PIG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AGX415","SUP","HCPCS C1763","","AGX415  -  CONNECTOR NERVE 4MM 15MM COAPTATION AID AXOGUARD PIG","BOTH IP/OP","$3,730.00 ","$2,760.20 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$777.43 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$571.13 ","$0.00 "
"AGX515","SUP","HCPCS C1763","","AGX515  -  CONNECTOR NERVE 5MM 15MM COAPTATION AID AXOGUARD PIG","BOTH IP/OP","$3,730.00 ","$2,760.20 ","$0.00 ","$3,450.00 ","$1,552.50 ","$0.00 ","$777.43 ","$0.00 ","$0.00 ","$604.07 ","$3,450.00 ","$0.00 ","$1,725.00 ","$2,732.40 ","$2,760.00 ","$0.00 ","$539.93 ","$0.00 ","$571.13 ","$0.00 "
"AI-0010-S","SUP","HCPCS C1713","","AI-0010-S  -  SCREW BONE 10MM ACUTWIST ACTRK CALC CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0012-S","SUP","HCPCS C1713","","AI-0012-S  -  SCREW BONE 12MM ACUTWIST SS CALC CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0014-S","SUP","HCPCS C1713","","AI-0014-S  -  SCREW BONE 14MM ACUTWIST SS FT HAND CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0016","SUP","HCPCS C1713","","AI-0016  -  SCREW BONE 16MM ACUTWIST TI ORTH CMPR NONSTRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0016-S","SUP","HCPCS C1713","","AI-0016-S  -  SCREW BONE 16MM ACUTWIST ACTRK CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0018-S","SUP","HCPCS C1713","","AI-0018-S  -  SCREW BONE 18MM ACUTWIST ACTRK CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0020","SUP","HCPCS C1713","","AI-0020  -  SCREW BONE 20MM ACUTWIST","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0020-S","SUP","HCPCS C1713","","AI-0020-S  -  SCREW BONE 20MM ACUTWIST SS FT HAND CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0022-S","SUP","HCPCS C1713","","AI-0022-S  -  SCREW BONE 22MM ACUTWIST ACTRK TI FULTHD HAND FT CMPR HDLS","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0024","SUP","HCPCS C1713","","AI-0024  -  SCREW BONE 24MM ACUTWIST TI ORTH NONSTRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0024-S","SUP","HCPCS C1713","","AI-0024-S  -  SCREW BONE 24MM ACUTWIST ACTRK TI ORTH CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0026","SUP","HCPCS C1713","","AI-0026  -  SCREW BONE 26MM ACTRK ACUTWIST CMPR NONSTRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0026-S","SUP","HCPCS C1713","","AI-0026-S  -  SCREW BONE 26MM ACUTWIST ACTRK ORTH CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0028-S","SUP","HCPCS C1713","","AI-0028-S  -  SCREW BONE 28MM ACUTWIST ACTRK FT HAND CMPR STRL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-0030-S","SUP","HCPCS C1713","","AI-0030-S  -  SCREW BONE 30MM ACUTWIST ACTRK PERIART WRST ANKL HAND FT","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AI-07127","SUP","HCPCS C1725","","CATHETER ANGIO 7FR 110CM 2 LUM WDG PRSS PED","BOTH IP/OP","$113.68 ","$84.12 ","$0.00 ","$113.68 ","$61.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.90 ","$113.68 ","$0.00 ","$56.84 ","$90.03 ","$90.94 ","$0.00 ","$17.79 ","$0.00 ","$18.10 ","$0.00 "
"AI-EX20","SUP","HCPCS C1713","","AI-EX20  -  SCREW BONE ACTRK ACUTWIST CMPNT XTRT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AI-NG30","SUP","HCPCS C1713","","AI-NG30  -  SCREW BONE 30MM ACTRK ACUTWIST TI ORTH TAP NONSTRL","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"AK-01000","SUP","Custom 27203010","","AK-01000  -  KIT THORACENTESIS 8FR 22GA 7.5IN 1.5IN 3 WAY STOPCOCK","BOTH IP/OP","$140.00 ","$103.60 ","$0.00 ","$218.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$133.98 ","$0.00 ","$66.99 ","$218.12 ","$107.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AK-04212","SUP","HCPCS C1751","","AK-04212  -  KIT CATHETER .032IN 16GA 18GA 20CM 2.5IN CATHETER GWIRE","BOTH IP/OP","$41.70 ","$30.86 ","$0.00 ","$41.70 ","$22.65 ","$0.00 ","$8.69 ","$0.00 ","$0.00 ","$7.30 ","$41.70 ","$0.00 ","$20.85 ","$33.03 ","$33.36 ","$0.00 ","$6.53 ","$0.00 ","$6.64 ","$0.00 "
"AK-09000","SUP","HCPCS C1729","","AK-09000  -  KIT PERITONEAL LAVAGE .035IN 8FR 18GA 9.25IN 17.75IN","BOTH IP/OP","$58.02 ","$42.93 ","$0.00 ","$85.17 ","$46.25 ","$0.00 ","$12.09 ","$0.00 ","$0.00 ","$14.91 ","$85.17 ","$0.00 ","$42.58 ","$67.45 ","$68.13 ","$0.00 ","$13.33 ","$0.00 ","$13.56 ","$0.00 "
"AK-09601","SUP","HCPCS C1894","","INTRODUCER SHTH 6FR 10CM INTGR HMSTS VLV SDPRT TISS DILAT","BOTH IP/OP","$78.75 ","$58.28 ","$0.00 ","$78.75 ","$42.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.79 ","$78.75 ","$0.00 ","$39.38 ","$62.37 ","$63.00 ","$0.00 ","$12.32 ","$0.00 ","$12.54 ","$0.00 "
"AK-15703-ASP","SUP","Custom 27203010","","TRAY CATH 7FR 8IN CEN VEN A-H BL FLX 3 LUM RADIOPQ SPRG","BOTH IP/OP","$131.08 ","$97.00 ","$0.00 ","$131.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.08 ","$0.00 ","$65.54 ","$103.82 ","$104.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AK-16553","SUP","HCPCS C1769","","KIT PED 5 1/8IN 5.5FR .018IN 3 LUM RADIOPQ SPRG GUIDEWIRE","BOTH IP/OP","$126.85 ","$93.87 ","$0.00 ","$126.85 ","$68.88 ","$0.00 ","$26.44 ","$0.00 ","$0.00 ","$22.21 ","$126.85 ","$0.00 ","$63.43 ","$100.47 ","$101.48 ","$0.00 ","$19.85 ","$0.00 ","$20.19 ","$0.00 "
"AK-16702","SUP","HCPCS C1769","","KIT 8IN 7FR .032IN 2 LUM RADIOPQ SPRG GUIDEWIRE INTROD NDL","BOTH IP/OP","$95.50 ","$70.67 ","$0.00 ","$95.50 ","$51.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.72 ","$95.50 ","$0.00 ","$47.75 ","$75.64 ","$76.40 ","$0.00 ","$14.95 ","$0.00 ","$15.20 ","$0.00 "
"AK-22702","SUP","HCPCS C1729","","KIT CATH 6 5/16IN 7FR BLUFLTP ARWG+A BL .025IN CEN VEN PU 2","BOTH IP/OP","$130.25 ","$96.39 ","$0.00 ","$130.25 ","$70.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.81 ","$130.25 ","$0.00 ","$65.13 ","$103.16 ","$104.20 ","$0.00 ","$20.38 ","$0.00 ","$20.74 ","$0.00 "
"AK-24703-A","SUP","HCPCS C1729","","CATHETER KIT  CENTRAL VENOUS ARROWGUARD 7FR X 12IN MULTI LUM","BOTH IP/OP","$960.00 ","$710.40 ","$0.00 ","$960.00 ","$521.28 ","$0.00 ","$200.09 ","$0.00 ","$0.00 ","$168.09 ","$960.00 ","$0.00 ","$480.00 ","$760.32 ","$768.00 ","$0.00 ","$150.24 ","$0.00 ","$152.83 ","$0.00 "
"AK-42854-SK","SUP","HCPCS C1769","","KIT 6IN 8.5FR .032IN 4 LUM RADIOPQ SPRG GUIDEWIRE INTROD NDL","BOTH IP/OP","$194.61 ","$144.01 ","$0.00 ","$194.61 ","$105.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.07 ","$194.61 ","$0.00 ","$97.31 ","$154.13 ","$155.69 ","$0.00 ","$30.46 ","$0.00 ","$30.98 ","$0.00 "
"AM-0025S","SUP","HCPCS C1713","","AM-0025S  -  SCREW BONE 4/5MM 25MM ACTRK FIXAT STRL","BOTH IP/OP","$769.78 ","$569.64 ","$0.00 ","$769.78 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.78 ","$769.78 ","$0.00 ","$384.89 ","$609.67 ","$615.82 ","$0.00 ","$120.47 ","$0.00 ","$122.55 ","$0.00 "
"AM-0025-S","SUP","HCPCS C1713","","AM-0025-S  -  SCREW BONE 4/5MM 25MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AM-0030S","SUP","HCPCS C1713","","AM-0030S  -  SCREW BONE 4/5MM 30MM ACTRK FIXAT STRL","BOTH IP/OP","$769.78 ","$569.64 ","$0.00 ","$769.78 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.78 ","$769.78 ","$0.00 ","$384.89 ","$609.67 ","$615.82 ","$0.00 ","$120.47 ","$0.00 ","$122.55 ","$0.00 "
"AM-0030-S","SUP","HCPCS C1713","","AM-0030-S  -  SCREW BONE 4/5MM 30MM ACTRK TI FULTHD HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AM-0035S","SUP","HCPCS C1713","","AM-0035S  -  SCREW BONE 35MM ACTRK 4/5 ACUMED FIXAT STRL","BOTH IP/OP","$769.78 ","$569.64 ","$0.00 ","$769.78 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.78 ","$769.78 ","$0.00 ","$384.89 ","$609.67 ","$615.82 ","$0.00 ","$120.47 ","$0.00 ","$122.55 ","$0.00 "
"AM-0035-S","SUP","HCPCS C1713","","AM-0035-S  -  SCREW BONE 4/5MM 35MM ACTRK TI FULTHD HINDFOOT ANKL SLFTAP","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AM-0040S","SUP","HCPCS C1713","","AM-0040S  -  SCREW BONE 40MM ACTRK 4/5 ACUMED FIXAT STRL","BOTH IP/OP","$769.78 ","$569.64 ","$0.00 ","$769.78 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.78 ","$769.78 ","$0.00 ","$384.89 ","$609.67 ","$615.82 ","$0.00 ","$120.47 ","$0.00 ","$122.55 ","$0.00 "
"AM-0040-S","SUP","HCPCS C1713","","AM-0040-S  -  SCREW BONE 4MM 5MM 40MM ACTRK TI FULTHD ORTH FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AM-0045S","SUP","HCPCS C1713","","AM-0045S  -  SCREW BONE 4/5MM 45MM ACTRK FIXAT STRL","BOTH IP/OP","$769.78 ","$569.64 ","$0.00 ","$769.78 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.78 ","$769.78 ","$0.00 ","$384.89 ","$609.67 ","$615.82 ","$0.00 ","$120.47 ","$0.00 ","$122.55 ","$0.00 "
"AM-0045-S","SUP","HCPCS C1713","","AM-0045-S  -  SCREW BN FT 4-5MM 45MM STRL ACTRK ST CNN CMPR HDLS TPR TI","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AM-0050S","SUP","HCPCS C1713","","AM-0050S  -  SCREW BONE 4/5MM 50MM ACTRK FIXAT STRL","BOTH IP/OP","$769.78 ","$569.64 ","$0.00 ","$769.78 ","$346.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.78 ","$769.78 ","$0.00 ","$384.89 ","$609.67 ","$615.82 ","$0.00 ","$120.47 ","$0.00 ","$122.55 ","$0.00 "
"AM-0050-S","SUP","HCPCS C1713","","AM-0050-S  -  SCREW BONE 4/5MM 50MM ACTRK TI FULTHD HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AM2184","SUP","Custom 27203010","","STRIP UA URSTX GLUC PRTN REAGENT","BOTH IP/OP","$48.45 ","$35.85 ","$0.00 ","$48.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.45 ","$0.00 ","$24.23 ","$38.37 ","$38.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AM2190","SUP","Custom 27203010","","STRIP UA HEMASTIX URN BLOOD REAGENT","BOTH IP/OP","$37.98 ","$28.11 ","$0.00 ","$37.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.98 ","$0.00 ","$18.99 ","$30.08 ","$30.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AM-5010","SUP","Custom 27203010","","AM-5010  -  BIT DRILL 4MM 5MM ACTRK STD CANN NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AM-5014","SUP","Custom 27203010","","AM-5014  -  DRILL SRG 4/5MM ACTRK DNS CNN BN","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AMP 225 210 152","SUP","HCPCS C1725","","AMP 225 210 152  -  CATHETER BLNDIL 2-2.5MM 150CM 210MM AM DP OTW LOPRFL TPR BRD","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$536.21 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AM-TA25","SUP","HCPCS C1713","","AM-TA25  -  SCREW BONE 25MM ACTRK 4/5 FT ANKL TPR NONSTRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AN04318","SUP","HCPCS C1769","","INTRODUCER CATH 18GA 2.5IN SPRG GUIDEWIRE","BOTH IP/OP","$5.38 ","$3.98 ","$0.00 ","$5.38 ","$2.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.94 ","$5.38 ","$0.00 ","$2.69 ","$4.26 ","$4.30 ","$0.00 ","$0.84 ","$0.00 ","$0.86 ","$0.00 "
"AP-0035-S","SUP","HCPCS C1713","","AP-0035-S  -  SCREW BONE 5/6.5MM 35MM ACTRK+ TI ORTH FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0040-S","SUP","HCPCS C1713","","AP-0040-S  -  SCREW BONE 5/6.5MM 40MM ACTRK+ TI HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0045-S","SUP","HCPCS C1713","","AP-0045-S  -  SCREW BONE 5/6.5MM 45MM ACTRK+ TI ORTH CANN STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0050-S","SUP","HCPCS C1713","","AP-0050-S  -  SCREW BONE 5/6.5MM 50MM ACTRK+ TI HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0055-S","SUP","HCPCS C1713","","AP-0055-S  -  SCREW BONE 5/6.5MM 55MM ACTRK+ TI ORTH FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0060-S","SUP","HCPCS C1713","","AP-0060-S  -  SCREW BONE 5/6.5MM 60MM ACTRK+ TI HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0065-S","SUP","HCPCS C1713","","AP-0065-S  -  SCREW BONE 5/6.5MM 65MM ACTRK+ TI HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0070-S","SUP","HCPCS C1713","","AP-0070-S  -  SCREW BONE 5/6.5MM 70MM ACMD/TRK PLUS TI ORTH FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0075-S","SUP","HCPCS C1713","","AP-0075-S  -  SCREW BONE 5/6.5MM 75MM ACMD/TRK PLUS TI ORTH FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-0080-S","SUP","HCPCS C1713","","AP-0080-S  -  SCREW BONE 5/6.5MM 80MM ACTRK+ TI HINDFOOT ANKL FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-010","SUP","Custom 27203010","","AP-010  -  BIT DRILL CANN","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-0100","SUP","Custom 27203010","","AP-0100  -  DRILL SURG TAPER CANN ACUTRAK PLUS TITANIUM","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-0104","SUP","Custom 27203010","","AP-0104  -  DRILL SRG ACTRK+ DNS BN","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-0110","SUP","Custom 27203010","","AP-0110  -  BIT DRL NS ACTRK+ CNN GRV SPNE","BOTH IP/OP","$785.00 ","$580.90 ","$0.00 ","$785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$785.00 ","$0.00 ","$392.50 ","$621.72 ","$628.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67008","SUP","Custom 27203010","","AP-67008  -  DEVICE REM 4MM SCR","BOTH IP/OP","$747.50 ","$553.15 ","$0.00 ","$747.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$747.50 ","$0.00 ","$373.75 ","$592.02 ","$598.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67011","SUP","Custom 27203010","","AP-67011  -  DRILL SURG SM 40-120MM CANN ACTRK 6-7MM STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67012","SUP","Custom 27203010","","AP-67012  -  DRILL SURG MED 70-85MM CANN DNS ACTRK 6-7MM STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67013","SUP","Custom 27203010","","AP-67013  -  DRILL SURG LG 90-120MM CANN ACTRK 6-7MM NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67014","SUP","Custom 27203010","","AP-67014  -  BIT DRILL 40-65MM 6MM 7MM ACTRK SM CANN DNS STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67015","SUP","Custom 27203010","","AP-67015  -  DRILL HAND RED 70-85MM ACTRK MED CANN DNS 6/7 SCR SYS STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67016","SUP","Custom 27203010","","AP-67016  -  DRILL SURG REG 40-120MM CANN ACTRK 6-7MM STRL YLW ACUTRACK","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AP-67100-S","SUP","HCPCS C1713","","AP-67100-S  -  SCREW BONE 6-7MM 100MM ACTRK TI SM BONE NONSTRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-67105-S","SUP","HCPCS C1713","","AP-67105-S  -  SCREW BONE 6-7MM 105MM ACTRK FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-67110-S","SUP","HCPCS C1713","","AP-67110-S  -  SCREW BONE 6-7MM 110MM ACTRK FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-67115-S","SUP","HCPCS C1713","","AP-67115-S  -  SCREW BONE 6/7MM 115MM ACTRK FIX","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-67120-S","SUP","HCPCS C1713","","AP-67120-S  -  SCREW BONE 6/7MM 120MM ACTRK FIX","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6740-S","SUP","HCPCS C1713","","AP-6740-S  -  SCREW BONE 6/7MM 40MM ACTRK TI FULTHD ORTH SLFTAP CANN STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6745-S","SUP","HCPCS C1713","","AP-6745-S  -  SCREW BONE 6/7MM 45MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6750-S","SUP","HCPCS C1713","","AP-6750-S  -  SCREW BONE 6/7MM 50MM ACTRK TI UPR XTRMT FRFT FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6755-S","SUP","HCPCS C1713","","AP-6755-S  -  SCREW BONE 6/7MM 55MM ACTRK TI UPR XTRMT FRFT FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6760-S","SUP","HCPCS C1713","","AP-6760-S  -  SCREW BONE 6/7MM 60MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6765-S","SUP","HCPCS C1713","","AP-6765-S  -  SCREW BONE 6/7MM 65MM ACTRK TI ORTH FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6770-S","SUP","HCPCS C1713","","AP-6770-S  -  SCREW BONE 6/7MM 70MM ACTRK TI ORTH FIX STRL 6 7 SCR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6775-S","SUP","HCPCS C1713","","AP-6775-S  -  SCREW BONE 6/7MM 75MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6780-S","SUP","HCPCS C1713","","AP-6780-S  -  SCREW BN .094IN 6/7MM 4MM 80MM STRL ACTRK FX TI","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6785-S","SUP","HCPCS C1713","","AP-6785-S  -  SCREW BONE 6/7MM 85MM ACTRK TI UPR XTRMT FRFT FIX STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6790-S","SUP","HCPCS C1713","","AP-6790-S  -  SCREW BONE 6-7MM 90MM ACTRK TI SM BONE STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AP-6795-S","SUP","HCPCS C1713","","AP-6795-S  -  SCREW BONE 6/7MM 95MM ACTRK TI ORTH STRL","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AQL-110","SUP","HCPCS C1713","","AQL-110  -  SET TBG AQUILEX FL CNTRL INFL","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$912.50 ","$410.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.77 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$142.81 ","$0.00 ","$145.27 ","$0.00 "
"AQL-111","SUP","Custom 27203010","","AQL-111  -  SET TBG AQUILEX FL CNTRL OFLW","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-005-AC00","SUP","Custom 27203010","","AR-005-AC00  -  CLAMP XTRNFX IBALANCE ANKL UNCNDL KN ARTHOPLASTY","BOTH IP/OP","$1,700.00 ","$1,258.00 ","$0.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,700.00 ","$0.00 ","$850.00 ","$1,346.40 ","$1,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1000","SUP","Custom 27203010","","AR-1000  -  PASSER SUT TRANSOSSEOUS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1006","SUP","HCPCS C1713","","AR-1006  -  STAPLE BN SPK 20X6MM STRL COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"AR-1006M","SUP","HCPCS C1713","","AR-1006M  -  STAPLE BN 20X6MM STRL COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"AR-1006MNS","SUP","Custom 27803010","","AR-1006MNS  -  STAPLE BN 20X6MM NS COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1006NS","SUP","Custom 27803010","","AR-1006NS  -  STAPLE BN SPK 20X6MM NS COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1008","SUP","HCPCS C1713","","AR-1008  -  STAPLE BN SPK 20X8MM STRL LOPRFL LGMNT COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"AR-1008NS","SUP","Custom 27803010","","AR-1008NS  -  STAPLE BN SPK 20X8MM NS COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1011","SUP","HCPCS C1713","","AR-1011  -  STAPLE BN SPK 20X11MM STRL COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"AR-1011NS","SUP","Custom 27803010","","AR-1011NS  -  STAPLE BN SPK LOPRFL 20X11MM NS COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1016","SUP","HCPCS C1713","","AR-1016  -  STAPLE BN SPK 20X16MM STRL COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$88.88 ","$0.00 ","$41.16 ","$0.00 ","$0.00 ","$34.58 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$30.91 ","$0.00 ","$31.44 ","$0.00 "
"AR-1016NS","SUP","Custom 27803010","","AR-1016NS  -  STAPLE BN SPK LOPRFL 20X16MM NS COCR ACL PCL","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1201.7D","SUP","Custom 27203010","","AR-1201.7D  -  BIT DRL SM LOPRFL 1.7MM 20X25IN AMERPAK FRM 100 AO CNCT PLT","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1201-7DC","SUP","Custom 27203010","","AR-1201-7DC  -  BIT DRL 1.7MM CNN AO CNCT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1202-3D","SUP","Custom 27203010","","AR-1202-3D  -  BIT DRL 2.3MM SM FRAG SCR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-12040","SUP","Custom 27203010","","AR-12040  -  PUNCH ARTHRO 3.5MM STR SER 1 DSGN WIDEBITER 3.4MM","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-100","SUP","Custom 27203010","","AR-1204AF-100  -  CUTTER ASCP 10MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-105","SUP","Custom 27203010","","AR-1204AF-105  -  CUTTER ARTHRO RTRGRD LP 10.5MM DRILL PIN FEMORAL SOCKET","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-110","SUP","Custom 27203010","","AR-1204AF-110  -  CUTTER ARTHRO RTRGRD LP 11MM DRILL PIN FEMORAL SOCKET","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-115","SUP","Custom 27203010","","AR-1204AF-115  -  CUTTER ASCP 11.5MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-120","SUP","Custom 27203010","","AR-1204AF-120  -  CUTTER ASCP 12MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN RMR","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-125","SUP","Custom 27203010","","AR-1204AF-125  -  CUTTER ASCP RTRGD LOPRFL 12.5MM BLU STRL LF FLIPCUTTER II","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-130","SUP","Custom 27203010","","AR-1204AF-130  -  CUTTER ASCP RTRGD LOPRFL 13MM BLU STRL LF FLIPCUTTER II DRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-50","SUP","Custom 27203010","","AR-1204AF-50  -  CUTTER ASCP RTRGD LOPRFL 5MM BLU STRL LF FLIPCUTTER II DRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-55","SUP","Custom 27203010","","AR-1204AF-55  -  CUTTER ASCP 5MM FLIPCUTTER II","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-60","SUP","Custom 27203010","","AR-1204AF-60  -  CUTTER ASCP RTRGD LOPRFL 6MM BLU STRL LF FLIPCUTTER II DRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-65","SUP","Custom 27203010","","AR-1204AF-65  -  CUTTER ASCP RTRGD LOPRFL 6.5MM BLU STRL LF FLIPCUTTER II DRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-70","SUP","Custom 27203010","","AR-1204AF-70  -  CUTTER ASCP RTRGD LOPRFL 7MM BLU STRL LF FLIPCUTTER II DRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-75","SUP","Custom 27203010","","AR-1204AF-75  -  CUTTER ASCP RTRGD 7.5MM BLU STRL LF FLIPCUTTER II DRL PIN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-80","SUP","Custom 27203010","","AR-1204AF-80  -  CUTTER ASCP 8MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-85","SUP","Custom 27203010","","AR-1204AF-85  -  CUTTER ASCP 8.5MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-90","SUP","Custom 27203010","","AR-1204AF-90  -  CUTTER ASCP RTRGD 9MM BLU STRL LF FLIPCUTTER II DRL PIN FEM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AF-95","SUP","Custom 27203010","","AR-1204AF-95  -  CUTTER ASCP RTRGD LOPRFL 9.5MM BLU STRL LF FLIPCUTTER II DRL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-105","SUP","Custom 27203010","","AR-1204AS-105  -  CUTTER ASCP SHRT 10.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-110","SUP","Custom 27203010","","AR-1204AS-110  -  CUTTER ASCP SHRT 11MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-120","SUP","Custom 27203010","","AR-1204AS-120  -  CUTTER ASCP SHRT 12MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-50","SUP","Custom 27203010","","AR-1204AS-50  -  CUTTER ASCP SHRT 5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-55","SUP","Custom 27203010","","AR-1204AS-55  -  CUTTER ASCP SHRT 5.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-60","SUP","Custom 27203010","","AR-1204AS-60  -  CUTTER ASCP SHRT 6MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-65","SUP","Custom 27203010","","AR-1204AS-65  -  CUTTER ASCP SHRT 6.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-70","SUP","Custom 27203010","","AR-1204AS-70  -  CUTTER ASCP SHRT 7MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-75","SUP","Custom 27203010","","AR-1204AS-75  -  CUTTER ASCP SHRT 7.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-80","SUP","Custom 27203010","","AR-1204AS-80  -  CUTTER ASCP SHRT 8MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-85","SUP","Custom 27203010","","AR-1204AS-85  -  CUTTER ASCP SHRT 8.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-90","SUP","Custom 27203010","","AR-1204AS-90  -  CUTTER ARTHRO ANTM SCKT FLIPCUTTER II SHRT KNEE 9","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204AS-95","SUP","Custom 27203010","","AR-1204AS-95  -  CUTTER ASCP SHRT 9.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204D","SUP","Custom 27203010","","AR-1204D  -  DRILL SURG BIT SCREW BIO-TENODESIS 4MM","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-055S","SUP","Custom 27203010","","AR-1204R-055S  -  CUTTER ASCP 5.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-05S","SUP","Custom 27203010","","AR-1204R-05S  -  CUTTER ASCP 5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-065S","SUP","Custom 27203010","","AR-1204R-065S  -  CUTTER ASCP 6.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-06S","SUP","Custom 27203010","","AR-1204R-06S  -  CUTTER ASCP 6MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-075S","SUP","Custom 27203010","","AR-1204R-075S  -  CUTTER ASCP 7.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-07S","SUP","Custom 27203010","","AR-1204R-07S  -  CUTTER ASCP 7MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-08S","SUP","Custom 27203010","","AR-1204R-08S  -  CUTTER ASCP 8MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-095S","SUP","Custom 27203010","","AR-1204R-095S  -  CUTTER ASCP 9.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-09S","SUP","Custom 27203010","","AR-1204R-09S  -  CUTTER ASCP 9MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-105S","SUP","Custom 27203010","","AR-1204R-105S  -  CUTTER ASCP 10.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1204R-12S","SUP","Custom 27203010","","AR-1204R-12S  -  CUTTER ASCP 12MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-100","SUP","Custom 27203010","","AR-1218-100  -  DRILL SURG FULL THICK 10MM CALIBRATE DEPTH MARK CANN ACL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-105","SUP","Custom 27203010","","AR-1218-105  -  DRILL SRG 10.5MM STRL CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-115","SUP","Custom 27203010","","AR-1218-115  -  DRILL SRG 11.5MM STRL CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-120","SUP","Custom 27203010","","AR-1218-120  -  DRILL SRG 12MM STRL CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-150","SUP","Custom 27203010","","AR-1218-150  -  DRILL SRG 15MM STRL CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-40","SUP","Custom 27203010","","AR-1218-40  -  DRILL SRG FULL THK 4MM STRL CLBRT D MRK CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-50","SUP","Custom 27203010","","AR-1218-50  -  DRILL SRG FULL THK 5MM STRL CLBRT D MRK CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-55","SUP","Custom 27203010","","AR-1218-55  -  DRILL SRG CNN 5.5 MM SCR","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-60","SUP","Custom 27203010","","AR-1218-60  -  DRILL SRG FULL THK 6MM STRL CLBRT D MRK CNN ACL HAZ","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-65","SUP","Custom 27203010","","AR-1218-65  -  DRILL SRG 6.5MM STRL CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-70","SUP","Custom 27203010","","AR-1218-70  -  DRILL SRG 7MM STRL CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-75","SUP","Custom 27203010","","AR-1218-75  -  DRILL SURG 7.5MM CANN STERILE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-80","SUP","Custom 27203010","","AR-1218-80  -  DRILL SRG FULL THK 8MM STRL CLBRT D MRK CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-90","SUP","Custom 27203010","","AR-1218-90  -  DRILL SURG FULL THICK 9MM CALIBRATE DEPTH MARK CANN ACL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1218-95","SUP","Custom 27203010","","AR-1218-95  -  DRILL SURG FULL THK CLBRT DEPTH MARK CANN ACL 9.5","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1220S","SUP","Custom 27203010","","AR-1220S  -  REAMER SRG 7MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1222S","SUP","Custom 27203010","","AR-1222S  -  REAMER SRG 8MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1223S","SUP","Custom 27203010","","AR-1223S  -  REAMER SRG 9MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1224S","SUP","Custom 27203010","","AR-1224S  -  REAMER SRG 10MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1226S","SUP","Custom 27203010","","AR-1226S  -  REAMER SRG 11MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1227S","SUP","Custom 27203010","","AR-1227S  -  REAMER SRG 12MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1229S","SUP","Custom 27203010","","AR-1229S  -  REAMER SRG 13MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1231S","SUP","Custom 27203010","","AR-1231S  -  REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1246-1","SUP","Custom 27203010","","AR-1246-1  -  GUIDE DRL OFST 3MM","BOTH IP/OP","$780.00 ","$577.20 ","$0.00 ","$780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$780.00 ","$0.00 ","$390.00 ","$617.76 ","$624.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1250","SUP","Custom 27203010","","AR-1250  -  DRILL SRG 25-30MM 2MM 12IN STRL SEMIFIX D MRK NTNL TIB DISP","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1250F","SUP","Custom 27203010","","AR-1250F  -  GUIDE PIN ORTH 3.5MM 30CM STRL PREDRILL ACL DISP FLIPCUTTER","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1250L","SUP","Custom 27203010","","AR-1250L  -  GUIDE PIN ORTH 2.4MM 30CM STRL PREDRILL ACL DISP","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1250LT","SUP","Custom 27203010","","AR-1250LT  -  DRILL SRG 2.4MM STP 3MM SUT TK","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1250LTC","SUP","Custom 27203010","","AR-1250LTC  -  DRILL SRG 3MM STP 3MM SUT TK HRD BN","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1252","SUP","Custom 27203010","","AR-1252  -  DRILL SRG THK SPD 3MM SUT TK","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1254","SUP","Custom 27203010","","AR-1254  -  GUIDE PIN ORTH 25/30MM 2MM STRL D MRK NTNL 6MM SCR","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1256","SUP","Custom 27203010","","AR-1256  -  DRILL SRG SHRT SPD STRL BSUT TK NDL DISP SUT TK","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1257","SUP","Custom 27203010","","AR-1257  -  DRILL SRG SPD STRL BSUT TK DISP 3MM SUT TK","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1259","SUP","Custom 27203010","","AR-1259  -  PASSER SUT RETROPASSER NTNL ASCP","BOTH IP/OP","$310.00 ","$229.40 ","$0.00 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$310.00 ","$0.00 ","$155.00 ","$245.52 ","$248.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1267","SUP","HCPCS C1713","","AR-1267  -  CAP PCTV POPLITEUM PCL","BOTH IP/OP","$840.00 ","$621.60 ","$0.00 ","$840.00 ","$378.00 ","$0.00 ","$175.08 ","$0.00 ","$0.00 ","$147.08 ","$840.00 ","$0.00 ","$420.00 ","$665.28 ","$672.00 ","$0.00 ","$131.46 ","$0.00 ","$133.73 ","$0.00 "
"AR-1270","SUP","Custom 27203010","","AR-1270  -  GUIDE DRL LNG NS RETROBUTTON D","BOTH IP/OP","$872.50 ","$645.65 ","$0.00 ","$872.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$872.50 ","$0.00 ","$436.25 ","$691.02 ","$698.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1288-100","SUP","HCPCS C1713","","AR-1288-100  -  SYSTEM FX SHRT 10MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-105","SUP","HCPCS C1713","","AR-1288-105  -  SYSTEM FX SHRT 10.5MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-110","SUP","HCPCS C1713","","AR-1288-110  -  SYSTEM FX 11MM TGHTRP RT SHRT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-70","SUP","HCPCS C1713","","AR-1288-70  -  SYSTEM FX SHRT 7MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-75","SUP","HCPCS C1713","","AR-1288-75  -  SYSTEM FX SHRT 7.5MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-80","SUP","HCPCS C1713","","AR-1288-80  -  SYSTEM FX SHRT 8MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-85","SUP","HCPCS C1713","","AR-1288-85  -  SYSTEM FX SHRT 8.5MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-90","SUP","HCPCS C1713","","AR-1288-90  -  SYSTEM FX SHRT 9MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288-95","SUP","HCPCS C1713","","AR-1288-95  -  SYSTEM FX SHRT 9.5MM TGHTRP RT FLIPCUTTER II 2 LD","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-1288BTB-100","SUP","HCPCS C1713","","AR-1288BTB-100  -  KIT FX 10MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-110","SUP","HCPCS C1713","","AR-1288BTB-110  -  KIT FX 11MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-70","SUP","HCPCS C1713","","AR-1288BTB-70  -  KIT FX 7MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-75","SUP","HCPCS C1713","","AR-1288BTB-75  -  KIT FX 7.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-80","SUP","HCPCS C1713","","AR-1288BTB-80  -  KIT FX 8MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-85","SUP","HCPCS C1713","","AR-1288BTB-85  -  KIT FX 8.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-90","SUP","HCPCS C1713","","AR-1288BTB-90  -  SYSTEM FX 9MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1288BTB-95","SUP","HCPCS C1713","","AR-1288BTB-95  -  SYSTEM FX 9.5MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$866.25 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"AR-1291-4","SUP","Custom 27203010","","AR-1291-4  -  NEEDLE SUT STRL GFT PREP DISP","BOTH IP/OP","$925.00 ","$684.50 ","$0.00 ","$925.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$925.00 ","$0.00 ","$462.50 ","$732.60 ","$740.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1297","SUP","Custom 27203010","","AR-1297  -  GUIDE PIN ORTH BALL 1.7MM ACL","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1297L","SUP","Custom 27203010","","AR-1297L  -  GUIDE PIN ORTH 2.4MM 50CM STRL SUT EYE ACL DISP PCL REPR","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-12990N","SUP","Custom 27203010","","AR-12990N  -  NEEDLE SUT SCRPN KN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13100-05.0","SUP","HCPCS C1713","","AR-13100-05.0  -  PLATE BN 5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-07.5","SUP","HCPCS C1713","","AR-13100-07.5  -  PLATE BN 7.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-09.0","SUP","HCPCS C1713","","AR-13100-09.0  -  PLATE BN 9MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-10.0","SUP","HCPCS C1713","","AR-13100-10.0  -  PLATE BN 10MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-11.0","SUP","HCPCS C1713","","AR-13100-11.0  -  PLATE BN 11MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-12.5","SUP","HCPCS C1713","","AR-13100-12.5  -  PLATE BN 12.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-15.0","SUP","HCPCS C1713","","AR-13100-15.0  -  PLATE BN 15MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100-17.5","SUP","HCPCS C1713","","AR-13100-17.5  -  PLATE BN 17.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13100T-05.0","SUP","HCPCS C1713","","AR-13100T-05.0  -  PLATE BN 5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-07.5","SUP","HCPCS C1713","","AR-13100T-07.5  -  PLATE BN 7.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-09.0","SUP","HCPCS C1713","","AR-13100T-09.0  -  PLATE BN 9MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-10.0","SUP","HCPCS C1713","","AR-13100T-10.0  -  PLATE BN 10MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-11.0","SUP","HCPCS C1713","","AR-13100T-11.0  -  PLATE BN 11MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-12.5","SUP","HCPCS C1713","","AR-13100T-12.5  -  PLATE BN 12.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-15.0","SUP","HCPCS C1713","","AR-13100T-15.0  -  PLATE BN 15MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13100T-17.5","SUP","HCPCS C1713","","AR-13100T-17.5  -  PLATE BN 17.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-13120G-2","SUP","Custom 27203010","","AR-13120G-2  -  GUIDE DRL MN LOPRFL D 2.4MM SCR","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13120T-10","SUP","HCPCS C1713","","AR-13120T-10  -  SCREW BN 1.5MM FT HEX 2.3MM 10MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-10C","SUP","HCPCS C1713","","AR-13120T-10C  -  SCREW BN 1.5MM P/T HEX 2.3MM 10MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-10S","SUP","HCPCS C1713","","AR-13120T-10S  -  SCREW BN 2.3MM 10MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-11","SUP","HCPCS C1713","","AR-13120T-11  -  SCREW BN 1.5MM HEX FT 2.3MM 11MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-11S","SUP","HCPCS C1713","","AR-13120T-11S  -  SCREW BN 2.3MM 11MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-12","SUP","HCPCS C1713","","AR-13120T-12  -  SCREW BN 1.5MM FT HEX 2.3MM 12MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-12C","SUP","HCPCS C1713","","AR-13120T-12C  -  SCREW BN 1.5MM P/T HEX 2.3MM 12MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-12S","SUP","HCPCS C1713","","AR-13120T-12S  -  SCREW BN 2.3MM 12MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-13","SUP","HCPCS C1713","","AR-13120T-13  -  SCREW BN 1.5MM HEX FT 2.3MM 13MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-13S","SUP","HCPCS C1713","","AR-13120T-13S  -  SCREW BN 2.3MM 13MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-14","SUP","HCPCS C1713","","AR-13120T-14  -  SCREW BN 1.5MM FT HEX 2.3MM 14MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-14C","SUP","HCPCS C1713","","AR-13120T-14C  -  SCREW BN 1.5MM P/T HEX 2.3MM 14MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-14S","SUP","HCPCS C1713","","AR-13120T-14S  -  SCREW BN 2.3MM 14MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-15","SUP","HCPCS C1713","","AR-13120T-15  -  SCREW BN 1.5MM HEX FT 2.3MM 15MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-15S","SUP","HCPCS C1713","","AR-13120T-15S  -  SCREW BN 2.3MM 15MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-16","SUP","HCPCS C1713","","AR-13120T-16  -  SCREW BN 1.5MM FT HEX 2.3MM 16MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-16C","SUP","HCPCS C1713","","AR-13120T-16C  -  SCREW BN 1.5MM P/T HEX 2.3MM 16MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-16S","SUP","HCPCS C1713","","AR-13120T-16S  -  SCREW BN 2.3MM 16MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-17","SUP","HCPCS C1713","","AR-13120T-17  -  SCREW BN 1.5MM HEX FT 2.3MM 17MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-17S","SUP","HCPCS C1713","","AR-13120T-17S  -  SCREW BN 2.3MM 17MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-18","SUP","HCPCS C1713","","AR-13120T-18  -  SCREW BN 1.5MM FT HEX 2.3MM 18MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-18C","SUP","HCPCS C1713","","AR-13120T-18C  -  SCREW BN 1.5MM P/T HEX 2.3MM 18MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-18S","SUP","HCPCS C1713","","AR-13120T-18S  -  SCREW BN 2.3MM 18MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-19","SUP","HCPCS C1713","","AR-13120T-19  -  SCREW BN 1.5MM HEX FT 2.3MM 19MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-19S","SUP","HCPCS C1713","","AR-13120T-19S  -  SCREW BN 2.3MM 19MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-20","SUP","HCPCS C1713","","AR-13120T-20  -  SCREW BN 1.5MM FT HEX 2.3MM 20MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-20C","SUP","HCPCS C1713","","AR-13120T-20C  -  SCREW BN 1.5MM P/T HEX 2.3MM 20MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-20S","SUP","HCPCS C1713","","AR-13120T-20S  -  SCREW BN 2.3MM 20MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-21","SUP","HCPCS C1713","","AR-13120T-21  -  SCREW BN 1.5MM HEX FT 2.3MM 21MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-21S","SUP","HCPCS C1713","","AR-13120T-21S  -  SCREW BN 2.3MM 21MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-22","SUP","HCPCS C1713","","AR-13120T-22  -  SCREW BN 1.5MM FT HEX 2.3MM 22MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-22C","SUP","HCPCS C1713","","AR-13120T-22C  -  SCREW BN 1.5MM P/T HEX 2.3MM 22MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-22S","SUP","HCPCS C1713","","AR-13120T-22S  -  SCREW BN 2.3MM 22MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-23","SUP","HCPCS C1713","","AR-13120T-23  -  SCREW BN 1.5MM HEX FT 2.3MM 23MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-23S","SUP","HCPCS C1713","","AR-13120T-23S  -  SCREW BN 2.3MM 23MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-24","SUP","HCPCS C1713","","AR-13120T-24  -  SCREW BN 1.5MM FT HEX 2.3MM 24MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-24C","SUP","HCPCS C1713","","AR-13120T-24C  -  SCREW BN 1.5MM P/T HEX 2.3MM 24MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-24S","SUP","HCPCS C1713","","AR-13120T-24S  -  SCREW BN 2.3MM 24MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-25","SUP","HCPCS C1713","","AR-13120T-25  -  SCREW BN 1.5MM HEX FT 2.3MM 25MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-25S","SUP","HCPCS C1713","","AR-13120T-25S  -  SCREW BN 2.3MM 25MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-26","SUP","HCPCS C1713","","AR-13120T-26  -  SCREW BN 1.5MM FT HEX 2.3MM 26MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-26C","SUP","HCPCS C1713","","AR-13120T-26C  -  SCREW BN 1.5MM P/T HEX 2.3MM 26MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-26S","SUP","HCPCS C1713","","AR-13120T-26S  -  SCREW BN 2.3MM 26MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-27","SUP","HCPCS C1713","","AR-13120T-27  -  SCREW BN 1.5MM HEX FT 2.3MM 27MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-27S","SUP","HCPCS C1713","","AR-13120T-27S  -  SCREW BN 2.3MM 27MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-28","SUP","HCPCS C1713","","AR-13120T-28  -  SCREW BN 1.5MM FT HEX 2.3MM 28MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-28C","SUP","HCPCS C1713","","AR-13120T-28C  -  SCREW BN 1.5MM P/T HEX 2.3MM 28MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-28S","SUP","HCPCS C1713","","AR-13120T-28S  -  SCREW BN 2.3MM 28MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-29","SUP","HCPCS C1713","","AR-13120T-29  -  SCREW BN 1.5MM HEX FT 2.3MM 29MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-29S","SUP","HCPCS C1713","","AR-13120T-29S  -  SCREW BN 2.3MM 29MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-30","SUP","HCPCS C1713","","AR-13120T-30  -  SCREW BN 1.5MM FT HEX 2.3MM 30MM STRL LOPRFL SCR SLF DRL ST","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13120T-30C","SUP","HCPCS C1713","","AR-13120T-30C  -  SCREW BN 1.5MM P/T HEX 2.3MM 30MM STRL LOPRFL SCR LG CNN ST","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-13120T-30S","SUP","HCPCS C1713","","AR-13120T-30S  -  SCREW BN 2.3MM 30MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13123-08","SUP","HCPCS C1713","","AR-13123-08  -  SCREW BN 2.3MM 8MM SS CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-10","SUP","HCPCS C1713","","AR-13123-10  -  SCREW BN 2.3MM 10MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-12","SUP","HCPCS C1713","","AR-13123-12  -  SCREW BN 2.3MM 12MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-14","SUP","HCPCS C1713","","AR-13123-14  -  SCREW BN 2.3MM 14MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-16","SUP","HCPCS C1713","","AR-13123-16  -  SCREW BN 2.3MM 16MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-18","SUP","HCPCS C1713","","AR-13123-18  -  SCREW BN 2.3MM 18MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-20","SUP","HCPCS C1713","","AR-13123-20  -  SCREW BN 2.3MM 20MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-22","SUP","HCPCS C1713","","AR-13123-22  -  SCREW BN 2.3MM 22MM STRL LOPRFL SCR SLD SS SM BN CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-13123-24","SUP","HCPCS C1713","","AR-13123-24  -  SCREW BN 2.3MM 24MM SS CORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"AR-1318FT","SUP","HCPCS C1713","","AR-1318FT  -  ANCHOR SUTURE 2-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 17.9","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1318FT-40","SUP","HCPCS C1713","","AR-1318FT-40  -  ANCHOR SUTURE 4-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 12.3","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$1,020.00 ","$459.00 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$178.59 ","$1,020.00 ","$0.00 ","$510.00 ","$807.84 ","$816.00 ","$0.00 ","$159.63 ","$0.00 ","$162.38 ","$0.00 "
"AR-1319FT","SUP","HCPCS C1713","","AR-1319FT  -  ANCHOR SUTURE 2-0 3/8 CIR MINI FULTHD TAPER 2.7MM 7MM 17.9MM","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-13200-03.0","SUP","HCPCS C1713","","AR-13200-03.0  -  PLATE BN 3MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-03.0S","SUP","HCPCS C1713","","AR-13200-03.0S  -  PLATE BN 3MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-05.0","SUP","HCPCS C1713","","AR-13200-05.0  -  PLATE BN 5MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-05.0S","SUP","HCPCS C1713","","AR-13200-05.0S  -  PLATE BN 5MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-06.0","SUP","HCPCS C1713","","AR-13200-06.0  -  PLATE BN 6MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-06.0S","SUP","HCPCS C1713","","AR-13200-06.0S  -  PLATE BN 6MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-07.5","SUP","HCPCS C1713","","AR-13200-07.5  -  PLATE BN 7.5MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-07.5S","SUP","HCPCS C1713","","AR-13200-07.5S  -  PLATE BN 7.5MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-09.0","SUP","HCPCS C1713","","AR-13200-09.0  -  PLATE BN 9MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-09.0S","SUP","HCPCS C1713","","AR-13200-09.0S  -  PLATE BN 9MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-10.0","SUP","HCPCS C1713","","AR-13200-10.0  -  PLATE BN 10MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-10.0S","SUP","HCPCS C1713","","AR-13200-10.0S  -  PLATE BN 10MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-11.0","SUP","HCPCS C1713","","AR-13200-11.0  -  PLATE BN 11MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-11.0S","SUP","HCPCS C1713","","AR-13200-11.0S  -  PLATE BN 11MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-12.5","SUP","HCPCS C1713","","AR-13200-12.5  -  PLATE BN 12.5MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-12.5S","SUP","HCPCS C1713","","AR-13200-12.5S  -  PLATE BN 12.5MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-13.5","SUP","HCPCS C1713","","AR-13200-13.5  -  PLATE BN 13.5MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-13.5S","SUP","HCPCS C1713","","AR-13200-13.5S  -  PLATE BN 13.5MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-15.0","SUP","HCPCS C1713","","AR-13200-15.0  -  PLATE BN 15MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-15.0S","SUP","HCPCS C1713","","AR-13200-15.0S  -  PLATE BN 15MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-16.0","SUP","HCPCS C1713","","AR-13200-16.0  -  PLATE BN 16MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-16.0S","SUP","HCPCS C1713","","AR-13200-16.0S  -  PLATE BN 16MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200-17.5","SUP","HCPCS C1713","","AR-13200-17.5  -  PLATE BN 17.5MM STRL SS TIB OPN WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200-17.5S","SUP","HCPCS C1713","","AR-13200-17.5S  -  PLATE BN 17.5MM STRL ARTHX TIB OPN WDG OSTM","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$155.25 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"AR-13200D-05","SUP","HCPCS C1713","","AR-13200D-05  -  PLATE BN LOPRFL 5MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200D-06","SUP","HCPCS C1713","","AR-13200D-06  -  PLATE BN LOPRFL 6MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200D-07","SUP","HCPCS C1713","","AR-13200D-07  -  PLATE BN LOPRFL 7MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200D-08","SUP","HCPCS C1713","","AR-13200D-08  -  PLATE BN LOPRFL 8MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200D-09","SUP","HCPCS C1713","","AR-13200D-09  -  PLATE BN LOPRFL 9MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200D-10","SUP","HCPCS C1713","","AR-13200D-10  -  PLATE BN LOPRFL 10MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200DC","SUP","HCPCS C1713","","AR-13200DC  -  PLATE BN LOPRFL SS TIB DIST 3.5/4MM SCR CLS WDG OSTM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200M","SUP","HCPCS C1713","","AR-13200M  -  PLATE BN L FLT TI METATARSUS 2.4MM SCR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-025L","SUP","HCPCS C1713","","AR-13200M-025L  -  PLATE BN L LOPRFL 2.5MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-025R","SUP","HCPCS C1713","","AR-13200M-025R  -  PLATE BN L LOPRFL 2.5MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-02L","SUP","HCPCS C1713","","AR-13200M-02L  -  PLATE BN L LOPRFL 2MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-02R","SUP","HCPCS C1713","","AR-13200M-02R  -  PLATE BN L LOPRFL 2MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-035L","SUP","HCPCS C1713","","AR-13200M-035L  -  PLATE BN L LOPRFL 3.5MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-035R","SUP","HCPCS C1713","","AR-13200M-035R  -  PLATE BN L LOPRFL 3.5MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-03L","SUP","HCPCS C1713","","AR-13200M-03L  -  PLATE BN L LOPRFL 3MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-03R","SUP","HCPCS C1713","","AR-13200M-03R  -  PLATE BN L LOPRFL 3MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-045L","SUP","HCPCS C1713","","AR-13200M-045L  -  PLATE BN L LOPRFL 4.5MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-045R","SUP","HCPCS C1713","","AR-13200M-045R  -  PLATE BN L LOPRFL 4.5MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-04L","SUP","HCPCS C1713","","AR-13200M-04L  -  PLATE BN L LOPRFL 4MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-04R","SUP","HCPCS C1713","","AR-13200M-04R  -  PLATE BN L LOPRFL 4MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-055L","SUP","HCPCS C1713","","AR-13200M-055L  -  PLATE BN L LOPRFL 5.5MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-055R","SUP","HCPCS C1713","","AR-13200M-055R  -  PLATE BN L LOPRFL 5.5MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-05L","SUP","HCPCS C1713","","AR-13200M-05L  -  PLATE BN L LOPRFL 5MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-05R","SUP","HCPCS C1713","","AR-13200M-05R  -  PLATE BN L LOPRFL 5MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-065L","SUP","HCPCS C1713","","AR-13200M-065L  -  PLATE BN L LOPRFL 6.5MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-065R","SUP","HCPCS C1713","","AR-13200M-065R  -  PLATE BN L LOPRFL 6.5MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-06L","SUP","HCPCS C1713","","AR-13200M-06L  -  PLATE BN L LOPRFL 6MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-06R","SUP","HCPCS C1713","","AR-13200M-06R  -  PLATE BN L LOPRFL 6MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-075L","SUP","HCPCS C1713","","AR-13200M-075L  -  PLATE BN 32219095 7.5MM NS ARTHX LOPRFL OPN WDG TI","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-13200M-075R","SUP","HCPCS C1713","","AR-13200M-075R  -  PLATE BN 7.5MM NS ARTHX LOPRFL OPN WDG TI METATARSUS RT","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-13200M-07L","SUP","HCPCS C1713","","AR-13200M-07L  -  PLATE BN L LOPRFL 7MM TI METATARSUS LT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200M-07R","SUP","HCPCS C1713","","AR-13200M-07R  -  PLATE BN L LOPRFL 7MM TI METATARSUS RT 2.4MM SCR OPN WDG","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-13200PA-05.0","SUP","HCPCS C1713","","AR-13200PA-05.0  -  PLATE BN 5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-06.0","SUP","HCPCS C1713","","AR-13200PA-06.0  -  PLATE BN 6MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-07.5","SUP","HCPCS C1713","","AR-13200PA-07.5  -  PLATE BN 7.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-09.0","SUP","HCPCS C1713","","AR-13200PA-09.0  -  PLATE BN 9MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-10.0","SUP","HCPCS C1713","","AR-13200PA-10.0  -  PLATE BN 10MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-11.0","SUP","HCPCS C1713","","AR-13200PA-11.0  -  PLATE BN 11MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-12.5","SUP","HCPCS C1713","","AR-13200PA-12.5  -  PLATE BN 12.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-13.5","SUP","HCPCS C1713","","AR-13200PA-13.5  -  PLATE BN 13.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-15.0","SUP","HCPCS C1713","","AR-13200PA-15.0  -  PLATE BN 15MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-16.0","SUP","HCPCS C1713","","AR-13200PA-16.0  -  PLATE BN 16MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200PA-17.5","SUP","HCPCS C1713","","AR-13200PA-17.5  -  PLATE BN 17.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-13200ST-05.0","SUP","HCPCS C1713","","AR-13200ST-05.0  -  PLATE BN LOPRFL 5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-07.5","SUP","HCPCS C1713","","AR-13200ST-07.5  -  PLATE BN LOPRFL 7.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-09.0","SUP","HCPCS C1713","","AR-13200ST-09.0  -  PLATE BN LOPRFL 9MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-10.0","SUP","HCPCS C1713","","AR-13200ST-10.0  -  PLATE BN LOPRFL 10MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-11.0","SUP","HCPCS C1713","","AR-13200ST-11.0  -  PLATE BN LOPRFL 11MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-12.5","SUP","HCPCS C1713","","AR-13200ST-12.5  -  PLATE BN LOPRFL 12.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-15.0","SUP","HCPCS C1713","","AR-13200ST-15.0  -  PLATE BN LOPRFL 15MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200ST-17.5","SUP","HCPCS C1713","","AR-13200ST-17.5  -  PLATE BN LOPRFL 17.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-05.0","SUP","HCPCS C1713","","AR-13200T-05.0  -  PLATE BN LOPRFL 5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-07.5","SUP","HCPCS C1713","","AR-13200T-07.5  -  PLATE BN LOPRFL 7.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-09.0","SUP","HCPCS C1713","","AR-13200T-09.0  -  PLATE BN LOPRFL 9MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-10.0","SUP","HCPCS C1713","","AR-13200T-10.0  -  PLATE BN 10MM LOPRFL TI TIB 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-11.0","SUP","HCPCS C1713","","AR-13200T-11.0  -  PLATE BN LOPRFL 11MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-12.5","SUP","HCPCS C1713","","AR-13200T-12.5  -  PLATE BN LOPRFL 12.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-15.0","SUP","HCPCS C1713","","AR-13200T-15.0  -  PLATE BN LOPRFL 15MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-13200T-17.5","SUP","HCPCS C1713","","AR-13200T-17.5  -  PLATE BN LOPRFL 17.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"AR-1320BCNF","SUP","HCPCS C1713","","AR-1320BCNF  -  ANCHOR SUT MIC NS DISP","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-1320BCNF-40","SUP","HCPCS C1713","","AR-1320BCNF-40  -  ANCHOR SUT 4-0 MIC 2 TPR 2.4MM 6.5MM NS SUT TK FBRWR BCMPS","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-1320DSC","SUP","Custom 27203010","","AR-1320DSC  -  KIT INST MIC 1.8MM 2MM STRL SUT TK BIT DRL GD PNCH SHLDR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13215","SUP","HCPCS C1713","","AR-13215  -  PLATE BN 30MM STRL 2 HL SPRT KN OSTM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-13217","SUP","Custom 27203010","","AR-13217  -  KIT INST CUT BLCK PIN DISP T3 AMZ","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13220","SUP","Custom 27203010","","AR-13220  -  DRILL BIT CNTRSNK 2.3MM AO CNCT","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13220C","SUP","Custom 27203010","","AR-13220C  -  DRILL BIT CNTRSNK 2.3MM AO CNCT CNN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13220DG","SUP","Custom 27203010","","AR-13220DG  -  GUIDE DRL LOPRFL PLT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1322-752SF","SUP","HCPCS C1713","","AR-1322-752SF  -  ANCHOR SUT 2-0 SM 2.4MM 7.5MM STRL FSTK2 FWR BABSR HNDL","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$208.13 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"AR-1322BCNF","SUP","HCPCS C1713","","AR-1322BCNF  -  ANCHOR SUT 2-0 MIC STRG FWD TPR 2.4MM 8.5MM LF BSUT TK FBRWR","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-1322D-18","SUP","Custom 27203010","","AR-1322D-18  -  DRILL SRG MN 1.8MM SUT TK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1322D-20","SUP","Custom 27203010","","AR-1322D-20  -  DRILL SRG MN 2MM SUT TK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1322DSC","SUP","Custom 27203010","","AR-1322DSC  -  KIT ESCP INST 2-0 MN 2.4MM 8.5MM STRL LF BSUT TK ANCH DRLBT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1322SXF","SUP","HCPCS C1713","","AR-1322SXF  -  ANCHOR SUT 2 2.4MM 11.7MM STRL FSTK FWR BRD CNN INSRTR ST TI","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-1324B","SUP","HCPCS C1713","","AR-1324B  -  ANCHOR SUT 2 3MM 14MM STRL BFSTK TVDK BRD EYLT HNDL INSRTR","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-1324BF","SUP","HCPCS C1713","","AR-1324BF  -  ANCHOR SUT 2 3MM 14MM STRL BFSTK FWR BRD EYLT HNDL INSRTR","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$275.63 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"AR-1324BF-2","SUP","HCPCS C1713","","AR-1324BF-2  -  ANCHOR SUT 2 3MM 11MM STRL BFSTK FWR BRD EYLT HNDL INSRTR","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$135.48 ","$0.00 ","$0.00 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"AR-1324D","SUP","Custom 27203010","","AR-1324D  -  DRILL SRG SPR 2.8MM FSTK II CNN TI SHLDR","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1324HF","SUP","HCPCS C1713","","AR-1324HF  -  ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR HNDL TI KN","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$202.50 ","$0.00 ","$93.79 ","$0.00 ","$0.00 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"AR-1324SF","SUP","HCPCS C1713","","AR-1324SF  -  ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR CNN INSRTR TI","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-13280-35","SUP","HCPCS C1713","","AR-13280-35  -  SCREW BN 6.5MM 35MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-40","SUP","HCPCS C1713","","AR-13280-40  -  SCREW BN 6.5MM 40MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-45","SUP","HCPCS C1713","","AR-13280-45  -  SCREW BN 6.5MM 45MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-50","SUP","HCPCS C1713","","AR-13280-50  -  SCREW BN 6.5MM 50MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-55","SUP","HCPCS C1713","","AR-13280-55  -  SCREW BN 6.5MM 55MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-60","SUP","HCPCS C1713","","AR-13280-60  -  SCREW BN 6.5MM 60MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-65","SUP","HCPCS C1713","","AR-13280-65  -  SCREW BN 6.5MM 65MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13280-70","SUP","HCPCS C1713","","AR-13280-70  -  SCREW BN 6.5MM 70MM TI TIB CANC OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13303-2.4","SUP","Custom 27203010","","AR-13303-2.4  -  GUIDE PIN ORTH 2.4MM BRKWY FEM OSTM","BOTH IP/OP","$92.50 ","$68.45 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.50 ","$0.00 ","$46.25 ","$73.26 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13303-3.0","SUP","Custom 27203010","","AR-13303-3.0  -  GUIDE PIN ORTH 3MM BRKWY FEM OSTM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13319","SUP","Custom 27203010","","AR-13319  -  DRILL SRG HTO TI SCR","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13320","SUP","Custom 27203010","","AR-13320  -  GUIDE DRL OPN WDG OSTM HTO PLT","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13321","SUP","Custom 27203010","","AR-13321  -  GUIDE DRL OPN WDG OSTM HTO TI PLT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13370-2","SUP","HCPCS C1713","","AR-13370-2  -  FILLER BN VOID 30X10MM STRL OPTM PORE DIA RGD FX DEV TRM WDG","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-13370-3","SUP","HCPCS C1713","","AR-13370-3  -  FILLER BN VOID 35X12MM STRL OPTM PORE DIA RGD FX DEV TRM WDG","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-13370-4","SUP","HCPCS C1713","","AR-13370-4  -  FILLER BN VOID 35X15MM STRL OPTM PORE DIA RGD FX DEV TRM WDG","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-13372-1","SUP","HCPCS C1713","","AR-13372-1  -  FILLER BN VOID 75D THK7MM TRPZD 25X8MM OSFERION","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13372-2","SUP","HCPCS C1713","","AR-13372-2  -  FILLER BN VOID 75D THK7MM TRPZD 25X9MM OSFERION","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13372-3","SUP","HCPCS C1713","","AR-13372-3  -  FILLER BN VOID 75D THK7MM TRPZD 25X10MM OSFERION","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13380-26","SUP","HCPCS C1713","","AR-13380-26  -  SCREW BN 4.5MM 26MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-28","SUP","HCPCS C1713","","AR-13380-28  -  SCREW BN 4.5MM 28MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-30","SUP","HCPCS C1713","","AR-13380-30  -  SCREW BN 4.5MM 30MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-32","SUP","HCPCS C1713","","AR-13380-32  -  SCREW BN 4.5MM 32MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-34","SUP","HCPCS C1713","","AR-13380-34  -  SCREW BN 4.5MM 34MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-36","SUP","HCPCS C1713","","AR-13380-36  -  SCREW BN 4.5MM 36MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-38","SUP","HCPCS C1713","","AR-13380-38  -  SCREW BN 4.5MM 38MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-40","SUP","HCPCS C1713","","AR-13380-40  -  SCREW BN 4.5MM 40MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-42","SUP","HCPCS C1713","","AR-13380-42  -  SCREW BN 4.5MM 42MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-44","SUP","HCPCS C1713","","AR-13380-44  -  SCREW BN 4.5MM 44MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-46","SUP","HCPCS C1713","","AR-13380-46  -  SCREW BN 4.5MM 46MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-48","SUP","HCPCS C1713","","AR-13380-48  -  SCREW BN 4.5MM 48MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-50","SUP","HCPCS C1713","","AR-13380-50  -  SCREW BN 4.5MM 50MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-52","SUP","HCPCS C1713","","AR-13380-52  -  SCREW BN 4.5MM 52MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-54","SUP","HCPCS C1713","","AR-13380-54  -  SCREW BN 4.5MM 54MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-56","SUP","HCPCS C1713","","AR-13380-56  -  SCREW BN 4.5MM 56MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-58","SUP","HCPCS C1713","","AR-13380-58  -  SCREW BN 4.5MM 58MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13380-60","SUP","HCPCS C1713","","AR-13380-60  -  SCREW BN 4.5MM 60MM TI TIB CORT OPN WDG OSTM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-13400L-05","SUP","Custom 27803010","","AR-13400L-05  -  WEDGE TIB 5D LG IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-06","SUP","Custom 27803010","","AR-13400L-06  -  WEDGE TIB 6D 7D LG XL IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-07","SUP","Custom 27803010","","AR-13400L-07  -  WEDGE TIB 6D 7D LG XL IBALANCE PEEK KN HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-08","SUP","Custom 27803010","","AR-13400L-08  -  WEDGE TIB 7D 8D LG XL IBALANCE KN HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-09","SUP","Custom 27803010","","AR-13400L-09  -  WEDGE TIB 8D 9D LG XL IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-10","SUP","Custom 27803010","","AR-13400L-10  -  WEDGE TIB 9D 10D LG XL IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-11","SUP","Custom 27803010","","AR-13400L-11  -  WEDGE TIB 10D 11D LG XL IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-12","SUP","Custom 27803010","","AR-13400L-12  -  WEDGE TIB 11D 12D LG XL IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-13","SUP","Custom 27803010","","AR-13400L-13  -  WEDGE TIB 12D 13D LG XL IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-14","SUP","Custom 27803010","","AR-13400L-14  -  WEDGE TIB 13D 14D LG XL IBALANCE PEEK HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400L-15","SUP","Custom 27803010","","AR-13400L-15  -  WEDGE TIB 15D LG IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-05","SUP","Custom 27803010","","AR-13400M-05  -  WEDGE TIB 5D 6D S/MED IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-06","SUP","Custom 27803010","","AR-13400M-06  -  WEDGE TIB 6D MED IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-07","SUP","Custom 27803010","","AR-13400M-07  -  WEDGE TIB 7D 8D S/MED IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-08","SUP","Custom 27803010","","AR-13400M-08  -  WEDGE TIB 8D 9D S/MED IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-09","SUP","Custom 27803010","","AR-13400M-09  -  WEDGE TIB 9D 10D S/MED IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-10","SUP","Custom 27803010","","AR-13400M-10  -  WEDGE TIB 10D 11D S/MED IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-11","SUP","Custom 27803010","","AR-13400M-11  -  WEDGE TIB 13D 11D S/MED IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-12","SUP","Custom 27803010","","AR-13400M-12  -  WEDGE TIB 12D 14D S/MED IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-13","SUP","Custom 27803010","","AR-13400M-13  -  WEDGE TIB 15D 13D S/MED IBALANCE KN HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-14","SUP","Custom 27803010","","AR-13400M-14  -  WEDGE TIB 14D MED IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400M-15","SUP","Custom 27803010","","AR-13400M-15  -  WEDGE TIB 15D MED IBALANCE HTO","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13400S-12","SUP","Custom 27803010","","AR-13400S-12  -  WEDGE TIB 12D SM IBALANCE PEEK KN HTO PLT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13401-20","SUP","HCPCS C1713","","AR-13401-20  -  ANCHOR SUT 6.5MM 20MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13401-22","SUP","HCPCS C1713","","AR-13401-22  -  ANCHOR SUT 6.5MM 22MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13401-24","SUP","HCPCS C1713","","AR-13401-24  -  ANCHOR SUT 6.5MM 24MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13401-26","SUP","HCPCS C1713","","AR-13401-26  -  ANCHOR SUT 6.5MM 26MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13401-28","SUP","HCPCS C1713","","AR-13401-28  -  ANCHOR SUT 6.5MM 28MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13401-30","SUP","HCPCS C1713","","AR-13401-30  -  ANCHOR SUT 6.5MM 30MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13401-32","SUP","HCPCS C1713","","AR-13401-32  -  ANCHOR SUT 6.5MM 32MM IBALANCE CANC HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-24","SUP","HCPCS C1713","","AR-13402-24  -  ANCHOR SUT 4.5MM 24MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-26","SUP","HCPCS C1713","","AR-13402-26  -  ANCHOR SUT 4.5MM 26MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-28","SUP","HCPCS C1713","","AR-13402-28  -  ANCHOR SUT 4.5MM 28MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-30","SUP","HCPCS C1713","","AR-13402-30  -  ANCHOR SUT 4.5MM 30MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-32","SUP","HCPCS C1713","","AR-13402-32  -  ANCHOR SUT 4.5MM 32MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-34","SUP","HCPCS C1713","","AR-13402-34  -  ANCHOR SUT 4.5MM 34MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-36","SUP","HCPCS C1713","","AR-13402-36  -  ANCHOR SUT 4.5MM 36MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-38","SUP","HCPCS C1713","","AR-13402-38  -  ANCHOR SUT 4.5MM 38MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-40","SUP","HCPCS C1713","","AR-13402-40  -  ANCHOR SUT 4.5MM 40MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-42","SUP","HCPCS C1713","","AR-13402-42  -  ANCHOR SUT 4.5MM 42MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-44","SUP","HCPCS C1713","","AR-13402-44  -  ANCHOR SUT 4.5MM 44MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-46","SUP","HCPCS C1713","","AR-13402-46  -  ANCHOR SUT 4.5MM 46MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-48","SUP","HCPCS C1713","","AR-13402-48  -  ANCHOR SUT 4.5MM 48MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-50","SUP","HCPCS C1713","","AR-13402-50  -  ANCHOR SUT 4.5MM 50MM IBALANCE CORT HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13402-52","SUP","HCPCS C1713","","AR-13402-52  -  ANCHOR SUT 4.5MM 52MM IBALANCE HTO","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-13413","SUP","HCPCS C1713","","AR-13413  -  WASHER ORTH FSTN LCK","BOTH IP/OP","$177.45 ","$131.31 ","$0.00 ","$177.45 ","$79.85 ","$0.00 ","$36.99 ","$0.00 ","$0.00 ","$31.07 ","$177.45 ","$0.00 ","$88.73 ","$140.54 ","$141.96 ","$0.00 ","$27.77 ","$0.00 ","$28.25 ","$0.00 "
"AR-13417L","SUP","Custom 27203010","","AR-13417L  -  GUIDE DRL LG FREECUT KYHL HTO IBALANCE","BOTH IP/OP","$2,697.50 ","$1,996.15 ","$0.00 ","$2,697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,697.50 ","$0.00 ","$1,348.75 ","$2,136.42 ","$2,158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13417M","SUP","Custom 27203010","","AR-13417M  -  GUIDE DRL MED FREECUT KYHL HTO IBALANCE","BOTH IP/OP","$2,697.50 ","$1,996.15 ","$0.00 ","$2,697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,697.50 ","$0.00 ","$1,348.75 ","$2,136.42 ","$2,158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13433","SUP","Custom 27203010","","AR-13433  -  GUIDE DRL IBALANCE ANCH HTO","BOTH IP/OP","$632.40 ","$467.98 ","$0.00 ","$632.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.40 ","$0.00 ","$316.20 ","$500.86 ","$505.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349","SUP","Custom 27803010","","AR-1349  -  WASHER 14MM SPK LP ORTH TI CANC SCR STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349L","SUP","Custom 27803010","","AR-1349L  -  WASHER ORTH 18MM STRL SPK LOPRFL TI CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349LM","SUP","Custom 27803010","","AR-1349LM  -  WASHER ORTH 18MM STRL SUT TI ACL DISP CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349LMNS","SUP","Custom 27803010","","AR-1349LMNS  -  WASHER ORTH LOPRFL 18MM NS SUT TI ACL PCL CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349LNS","SUP","Custom 27803010","","AR-1349LNS  -  WASHER 18MM ACL PCL SPK LP ORTH TI CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349M","SUP","Custom 27803010","","AR-1349M  -  WASHER ORTH 14MM STRL TI CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349MNS","SUP","Custom 27803010","","AR-1349MNS  -  WASHER 14MM ACL PCL SUTURE LP ORTH TI CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1349NS","SUP","Custom 27803010","","AR-1349NS  -  WASHER ORTH SPK LOPRFL 14MM NS TI ACL PCL CANC SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1351","SUP","HCPCS C1713","","AR-1351  -  PIN FX 3MM 40MM STRL TRNFX SLF CUT ST TI ACL","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$395.00 ","$177.75 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$69.16 ","$395.00 ","$0.00 ","$197.50 ","$312.84 ","$316.00 ","$0.00 ","$61.82 ","$0.00 ","$62.88 ","$0.00 "
"AR-1351B","SUP","HCPCS C1713","","AR-1351B  -  IMPLANT FX 5MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT","BOTH IP/OP","$722.50 ","$534.65 ","$0.00 ","$722.50 ","$325.13 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$126.50 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$113.07 ","$0.00 ","$115.02 ","$0.00 "
"AR-1351BK-CP","SUP","HCPCS C1713","","AR-1351BK-CP  -  SET IMPL 40MM BTRNSF PK ACL","BOTH IP/OP","$1,102.50 ","$815.85 ","$0.00 ","$1,102.50 ","$496.13 ","$0.00 ","$229.79 ","$0.00 ","$0.00 ","$193.04 ","$1,102.50 ","$0.00 ","$551.25 ","$873.18 ","$882.00 ","$0.00 ","$172.54 ","$0.00 ","$175.52 ","$0.00 "
"AR-1351BT","SUP","HCPCS C1713","","AR-1351BT  -  IMPLANT FX 3MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT","BOTH IP/OP","$722.50 ","$534.65 ","$0.00 ","$722.50 ","$325.13 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$126.50 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$113.07 ","$0.00 ","$115.02 ","$0.00 "
"AR-1351C-01","SUP","HCPCS C1713","","AR-1351C-01  -  SCREW INTFR 5MM 40MM STRL TRNFX STRNG BCMPS KN","BOTH IP/OP","$997.50 ","$738.15 ","$0.00 ","$997.50 ","$448.88 ","$0.00 ","$207.90 ","$0.00 ","$0.00 ","$174.65 ","$997.50 ","$0.00 ","$498.75 ","$790.02 ","$798.00 ","$0.00 ","$156.11 ","$0.00 ","$158.80 ","$0.00 "
"AR-1351C-02","SUP","HCPCS C1713","","AR-1351C-02  -  SCREW INTFR 5MM 50MM STRL TRNFX STRNG BCMPS KN","BOTH IP/OP","$997.50 ","$738.15 ","$0.00 ","$997.50 ","$448.88 ","$0.00 ","$207.90 ","$0.00 ","$0.00 ","$174.65 ","$997.50 ","$0.00 ","$498.75 ","$790.02 ","$798.00 ","$0.00 ","$156.11 ","$0.00 ","$158.80 ","$0.00 "
"AR-1351K-CP","SUP","HCPCS C1713","","AR-1351K-CP  -  SET IMPL 40MM TRNFX2 PK ACL","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$348.75 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"AR-1351L","SUP","HCPCS C1713","","AR-1351L  -  IMPLANT FX 3MM 50MM STRL TRNFX SLF CUT ST TI ACL","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$395.00 ","$177.75 ","$0.00 ","$82.33 ","$0.00 ","$0.00 ","$69.16 ","$395.00 ","$0.00 ","$197.50 ","$312.84 ","$316.00 ","$0.00 ","$61.82 ","$0.00 ","$62.88 ","$0.00 "
"AR-1351LB","SUP","HCPCS C1713","","AR-1351LB  -  IMPLANT FX 5MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT","BOTH IP/OP","$722.50 ","$534.65 ","$0.00 ","$722.50 ","$325.13 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$126.50 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$113.07 ","$0.00 ","$115.02 ","$0.00 "
"AR-1351LBK-CP","SUP","HCPCS C1713","","AR-1351LBK-CP  -  SET IMPL 50MM BTRNSF PK ACL","BOTH IP/OP","$1,102.50 ","$815.85 ","$0.00 ","$1,102.50 ","$496.13 ","$0.00 ","$229.79 ","$0.00 ","$0.00 ","$193.04 ","$1,102.50 ","$0.00 ","$551.25 ","$873.18 ","$882.00 ","$0.00 ","$172.54 ","$0.00 ","$175.52 ","$0.00 "
"AR-1351LBT","SUP","HCPCS C1713","","AR-1351LBT  -  IMPLANT FX 3MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT","BOTH IP/OP","$722.50 ","$534.65 ","$0.00 ","$722.50 ","$325.13 ","$0.00 ","$150.59 ","$0.00 ","$0.00 ","$126.50 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$113.07 ","$0.00 ","$115.02 ","$0.00 "
"AR-1351LK-CP","SUP","HCPCS C1713","","AR-1351LK-CP  -  SET IMPL 50MM TRNFX PK ACL","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$348.75 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"AR-1355","SUP","HCPCS C1713","","AR-1355  -  SCREW BONE GROOVE LP 6.5MM 25MM DEPTH MARK STEP DRILL","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1355D","SUP","Custom 27203010","","AR-1355D  -  DRILL SRG 25MM LSR D MRK STP KN LOPRFL CANC SCR","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1355NS","SUP","HCPCS C1713","","AR-1355NS  -  SCREW BN LOPRFL 6.5MM 25MM NS SMTH SHNK TI ACL PCL CANC","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1356","SUP","HCPCS C1713","","AR-1356  -  SCREW BN GRV LOPRFL 6.5MM 30MM STRL D MRK STP DRL TI ACL/PCL","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1356NS","SUP","HCPCS C1713","","AR-1356NS  -  SCREW BN LOPRFL 6.5MM 30MM NS SMTH SHNK TI ACL PCL CANC","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1357","SUP","HCPCS C1713","","AR-1357  -  SCREW BN GRV LOPRFL 6.5MM 35MM STRL D MRK STP DRL TI ACL/PCL","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1357B","SUP","HCPCS C1713","","AR-1357B  -  POST FX 6.25MM 35MM STRL BPST WSHR POLY L LAC ACD ACL DISP","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"AR-1357NS","SUP","HCPCS C1713","","AR-1357NS  -  SCREW BN LOPRFL 6.5MM 35MM NS SMTH SHNK TI ACL PCL CANC","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1358","SUP","HCPCS C1713","","AR-1358  -  SCREW BN GRV LOPRFL 6.5MM 40MM STRL D MRK STP DRL TI ACL/PCL","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1358NS","SUP","HCPCS C1713","","AR-1358NS  -  SCREW BN LOPRFL 6.5MM 40MM NS SMTH SHNK TI ACL PCL CANC","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$100.13 ","$0.00 ","$46.37 ","$0.00 ","$0.00 ","$38.96 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$34.82 ","$0.00 ","$35.42 ","$0.00 "
"AR-1360B","SUP","HCPCS C1713","","AR-1360B  -  SCREW INTFR 6MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1360C","SUP","HCPCS C1713","","AR-1360C  -  SCREW INTFR 6MM 23MM STRL CNN RDC HD BCMPS ACL PCL","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1360C-CP","SUP","HCPCS C1713","","AR-1360C-CP  -  SET IMPL 4.5MM 6MM CNN DRL GDPN INTFR SCR RMR TMPLT MPFL PK","BOTH IP/OP","$3,717.50 ","$2,750.95 ","$0.00 ","$3,717.50 ","$1,672.88 ","$0.00 ","$774.82 ","$0.00 ","$0.00 ","$650.90 ","$3,717.50 ","$0.00 ","$1,858.75 ","$2,944.26 ","$2,974.00 ","$0.00 ","$581.79 ","$0.00 ","$591.83 ","$0.00 "
"AR-1360CST-CP","SUP","HCPCS C1713","","AR-1360CST-CP  -  SET IMPL 1.1MM 3.5IN CNN CLS EYLT DRL PIN RMR TMPLT MPFL PK","BOTH IP/OP","$4,217.50 ","$3,120.95 ","$0.00 ","$4,217.50 ","$1,897.88 ","$0.00 ","$879.03 ","$0.00 ","$0.00 ","$738.45 ","$4,217.50 ","$0.00 ","$2,108.75 ","$3,340.26 ","$3,374.00 ","$0.00 ","$660.04 ","$0.00 ","$671.43 ","$0.00 "
"AR-1360E","SUP","HCPCS C1713","","AR-1360E  -  SCREW INTFR 6MM 20MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1360P","SUP","HCPCS C1713","","AR-1360P  -  SCREW INTFR 6MM 23MM STRL THRD PTRN PEEK-OPTM ACL PCL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-1363","SUP","HCPCS C1713","","AR-1363  -  SCREW INTFR 3MM 40MM STRL TRNFX SLF CUT ST TI ACL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"AR-1363L","SUP","HCPCS C1713","","AR-1363L  -  SCREW INTFR 3MM 50MM STRL TRNFX SLF CUT ST TI ACL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"AR-1365-25","SUP","HCPCS C1713","","AR-1365-25  -  POST FIX LP 4.5MM 25MM SELF TAP THREAD TITANIUM KNEE","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"AR-1365-275","SUP","Custom 27203010","","AR-1365-275  -  POST FX LOPRFL 4.5MM 27.5MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-30","SUP","Custom 27203010","","AR-1365-30  -  POST FX LOPRFL 4.5MM 30MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-325","SUP","Custom 27203010","","AR-1365-325  -  POST FX LOPRFL 4.5MM 32.5MM ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-375","SUP","Custom 27203010","","AR-1365-375  -  POST FX LOPRFL 4.5MM 37.5MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-40","SUP","Custom 27203010","","AR-1365-40  -  POST FX LOPRFL 4.5MM 40MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-425","SUP","Custom 27203010","","AR-1365-425  -  POST FX LOPRFL 4.5MM 42.5MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-45","SUP","Custom 27203010","","AR-1365-45  -  POST FX LOPRFL 4.5MM 45MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-475","SUP","Custom 27203010","","AR-1365-475  -  POST FX LOPRFL 4.5MM 47.5MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-50","SUP","Custom 27203010","","AR-1365-50  -  POST FX LOPRFL 4.5MM 50MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-525","SUP","Custom 27203010","","AR-1365-525  -  POST FX LOPRFL 4.5MM 52.5MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-55","SUP","Custom 27203010","","AR-1365-55  -  POST FX LOPRFL 4.5MM 55MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-575","SUP","Custom 27203010","","AR-1365-575  -  POST FX LOPRFL 4.5MM 57.5MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365-60","SUP","Custom 27203010","","AR-1365-60  -  POST FX LOPRFL 4.5MM 60MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-25","SUP","Custom 27203010","","AR-1365NS-25  -  POST FX LOPRFL 4.5MM 25MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-275","SUP","Custom 27203010","","AR-1365NS-275  -  POST FX LOPRFL 4.5MM 27.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-30","SUP","Custom 27203010","","AR-1365NS-30  -  POST FX LOPRFL 4.5MM 30MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-325","SUP","Custom 27203010","","AR-1365NS-325  -  POST FX LOPRFL 4.5MM 32.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-35","SUP","Custom 27203010","","AR-1365NS-35  -  POST FX LOPRFL 4.5MM 35MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-375","SUP","Custom 27203010","","AR-1365NS-375  -  POST FX LOPRFL 4.5MM 37.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-40","SUP","Custom 27203010","","AR-1365NS-40  -  POST FX LOPRFL 4.5MM 40MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-425","SUP","Custom 27203010","","AR-1365NS-425  -  POST FX LOPRFL 4.5MM 42.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-45","SUP","Custom 27203010","","AR-1365NS-45  -  POST FX LOPRFL 4.5MM 45MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-475","SUP","Custom 27203010","","AR-1365NS-475  -  POST FX LOPRFL 4.5MM 47.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-50","SUP","Custom 27203010","","AR-1365NS-50  -  POST FX LOPRFL 4.5MM 50MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-525","SUP","Custom 27203010","","AR-1365NS-525  -  POST FX LOPRFL 4.5MM 52.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-55","SUP","Custom 27203010","","AR-1365NS-55  -  POST FX LOPRFL 4.5MM 55MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-575","SUP","Custom 27203010","","AR-1365NS-575  -  POST FX LOPRFL 4.5MM 57.5MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1365NS-60","SUP","Custom 27203010","","AR-1365NS-60  -  POST FX LOPRFL 4.5MM 60MM NS TI ACL PCL BCORT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-30","SUP","Custom 27203010","","AR-1366-30  -  POST FX LOPRFL 6.5MM 30MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-32","SUP","Custom 27203010","","AR-1366-32  -  POST FX LOPRFL 6.5MM 32MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-34","SUP","Custom 27203010","","AR-1366-34  -  POST FX LOPRFL 6.5MM 34MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-36","SUP","Custom 27203010","","AR-1366-36  -  POST FX LOPRFL 6.5MM 36MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-38","SUP","Custom 27203010","","AR-1366-38  -  POST FX LOPRFL 6.5MM 38MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-40","SUP","Custom 27203010","","AR-1366-40  -  POST FX LOPRFL 6.5MM 40MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-42","SUP","Custom 27203010","","AR-1366-42  -  POST FX LOPRFL 6.5MM 42MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-44","SUP","Custom 27203010","","AR-1366-44  -  POST FX LOPRFL 6.5MM 44MM ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-46","SUP","Custom 27203010","","AR-1366-46  -  POST FX LOPRFL 6.5MM 46MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-48","SUP","Custom 27203010","","AR-1366-48  -  POST FX LOPRFL 6.5MM 48MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-50","SUP","Custom 27203010","","AR-1366-50  -  POST FX LOPRFL 6.5MM 50MM ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366-52","SUP","Custom 27203010","","AR-1366-52  -  POST FX LOPRFL 6.5MM 52MM STRL ST THRD TI KN BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-30","SUP","Custom 27203010","","AR-1366NS-30  -  POST FX LOPRFL 6.5MM 30MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-32","SUP","Custom 27203010","","AR-1366NS-32  -  POST FX LOPRFL 6.5MM 32MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-34","SUP","Custom 27203010","","AR-1366NS-34  -  POST FX LOPRFL 6.5MM 34MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-36","SUP","Custom 27203010","","AR-1366NS-36  -  POST FX LOPRFL 6.5MM 36MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-38","SUP","Custom 27203010","","AR-1366NS-38  -  POST FX LOPRFL 6.5MM 38MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-40","SUP","Custom 27203010","","AR-1366NS-40  -  POST FX LOPRFL 6.5MM 40MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-42","SUP","Custom 27203010","","AR-1366NS-42  -  POST FX LOPRFL 6.5MM 42MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-44","SUP","Custom 27203010","","AR-1366NS-44  -  POST FX LOPRFL 6.5MM 44MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-46","SUP","Custom 27203010","","AR-1366NS-46  -  POST FX LOPRFL 6.5MM 46MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-48","SUP","Custom 27203010","","AR-1366NS-48  -  POST FX LOPRFL 6.5MM 48MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1366NS-50","SUP","Custom 27203010","","AR-1366NS-50  -  POST FX LOPRFL 6.5MM 50MM NS TI ACL PCL BCORT","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1367D","SUP","Custom 27203010","","AR-1367D  -  BIT DRL 4.8MM 6.5MM POST","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1370","SUP","HCPCS C1713","","AR-1370  -  SCREW, CANNULATED INTERFERENCE","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1370B","SUP","HCPCS C1713","","AR-1370B  -  SCREW INTFR 7MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1370C","SUP","HCPCS C1713","","AR-1370C  -  SCREW INTERFERENCE 7MM 23MM CANN REDUCE HEAD BIOCOMPOSITE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1370E","SUP","HCPCS C1713","","AR-1370E  -  SCREW INTFR 7MM 20MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1370H-25","SUP","HCPCS C1713","","AR-1370H-25  -  SCREW INTFR BLNT RND 7MM 25MM STRL CNN SFT TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1370H-30","SUP","HCPCS C1713","","AR-1370H-30  -  SCREW INTFR BLNT RND 7MM 30MM STRL CNN SFT TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1370P","SUP","HCPCS C1713","","AR-1370P  -  SCREW INTFR 7MM 23MM STRL PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-1370T","SUP","HCPCS C1713","","AR-1370T  -  SCREW INTFR FT RND 7MM 20MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1370TB","SUP","HCPCS C1713","","AR-1370TB  -  SCREW INTFR FT 7MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1370TC","SUP","HCPCS C1713","","AR-1370TC  -  SCREW INTFR FT STP TPR 7MM 28MM STRL CNN FULL SEAT RDC HD","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1371","SUP","HCPCS C1713","","AR-1371  -  SCREW INTFR 7MM 25MM STRL CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13710-03.0","SUP","HCPCS C1713","","AR-13710-03.0  -  PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-05.0","SUP","HCPCS C1713","","AR-13710-05.0  -  PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-07.5","SUP","HCPCS C1713","","AR-13710-07.5  -  PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-09.0","SUP","HCPCS C1713","","AR-13710-09.0  -  PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-10.0","SUP","HCPCS C1713","","AR-13710-10.0  -  PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-11.0","SUP","HCPCS C1713","","AR-13710-11.0  -  PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-12.5","SUP","HCPCS C1713","","AR-13710-12.5  -  PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-15.0","SUP","HCPCS C1713","","AR-13710-15.0  -  PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13710-17.5","SUP","HCPCS C1713","","AR-13710-17.5  -  PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-03.0","SUP","HCPCS C1713","","AR-13715-03.0  -  PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-05.0","SUP","HCPCS C1713","","AR-13715-05.0  -  PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-07.5","SUP","HCPCS C1713","","AR-13715-07.5  -  PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-09.0","SUP","HCPCS C1713","","AR-13715-09.0  -  PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-10.0","SUP","HCPCS C1713","","AR-13715-10.0  -  PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-11.0","SUP","HCPCS C1713","","AR-13715-11.0  -  PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-12.5","SUP","HCPCS C1713","","AR-13715-12.5  -  PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-15.0","SUP","HCPCS C1713","","AR-13715-15.0  -  PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13715-17.5","SUP","HCPCS C1713","","AR-13715-17.5  -  PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-1371E","SUP","HCPCS C1713","","AR-1371E  -  SCREW INTFR 7MM 25MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1371T","SUP","HCPCS C1713","","AR-1371T  -  SCREW INTFR FT RND 7MM 25MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1372","SUP","HCPCS C1713","","AR-1372  -  SCREW INTFR 7MM 30MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13720-05.0","SUP","HCPCS C1713","","AR-13720-05.0  -  PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-07.5","SUP","HCPCS C1713","","AR-13720-07.5  -  PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-09.0","SUP","HCPCS C1713","","AR-13720-09.0  -  PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-10.0","SUP","HCPCS C1713","","AR-13720-10.0  -  PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-11.0","SUP","HCPCS C1713","","AR-13720-11.0  -  PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-12.5","SUP","HCPCS C1713","","AR-13720-12.5  -  PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-15.0","SUP","HCPCS C1713","","AR-13720-15.0  -  PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13720-17.5","SUP","HCPCS C1713","","AR-13720-17.5  -  PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-05.0","SUP","HCPCS C1713","","AR-13725-05.0  -  PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-07.5","SUP","HCPCS C1713","","AR-13725-07.5  -  PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-09.0","SUP","HCPCS C1713","","AR-13725-09.0  -  PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-10.0","SUP","HCPCS C1713","","AR-13725-10.0  -  PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-11.0","SUP","HCPCS C1713","","AR-13725-11.0  -  PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-12.5","SUP","HCPCS C1713","","AR-13725-12.5  -  PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-15.0","SUP","HCPCS C1713","","AR-13725-15.0  -  PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13725-17.5","SUP","HCPCS C1713","","AR-13725-17.5  -  PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-1372E","SUP","HCPCS C1713","","AR-1372E  -  SCREW INTFR 7MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1372T","SUP","HCPCS C1713","","AR-1372T  -  SCREW INTFR FT RND 7MM 30MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13730-01","SUP","HCPCS C1713","","AR-13730-01  -  PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13730-02","SUP","HCPCS C1713","","AR-13730-02  -  PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13730-03","SUP","HCPCS C1713","","AR-13730-03  -  PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13735-01","SUP","HCPCS C1713","","AR-13735-01  -  PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13735-02","SUP","HCPCS C1713","","AR-13735-02  -  PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-13735-03","SUP","HCPCS C1713","","AR-13735-03  -  PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-1375E","SUP","HCPCS C1713","","AR-1375E  -  SCREW INTFR 7MM 15MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1380","SUP","HCPCS C1713","","AR-1380  -  SCREW INTFR 8MM 20MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1380B","SUP","HCPCS C1713","","AR-1380B  -  SCREW INTFR 8MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1380E","SUP","HCPCS C1713","","AR-1380E  -  SCREW INTERFERENCE 8MM 20MM CANN SHEATH TITANIUM ACL PCL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1380H-25","SUP","HCPCS C1713","","AR-1380H-25  -  SCREW INTFR BLNT RND 8MM 25MM STRL CNN SFT TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1380H-30","SUP","HCPCS C1713","","AR-1380H-30  -  SCREW INTFR BLNT RND 8MM 30MM STRL CNN SFT TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1380H-35","SUP","HCPCS C1713","","AR-1380H-35  -  SCREW INTFR BLNT RND 8MM 35MM STRL CNN SFT TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1380HLU-25","SUP","HCPCS C1713","","AR-1380HLU-25  -  SCREW SOFT CANN LFT HAND THD 8X25MM TI","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1380P","SUP","HCPCS C1713","","AR-1380P  -  SCREW INTFR 8MM 23MM STRL PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-1380T","SUP","HCPCS C1713","","AR-1380T  -  SCREW INTFR FT RND 8MM 20MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1380TB","SUP","HCPCS C1713","","AR-1380TB  -  SCREW INTFR FT 8MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1380TC","SUP","HCPCS C1713","","AR-1380TC  -  SCREW INTFR BLNT FT STP TPR 8MM 28MM STRL CNN FULL SEAT RDC","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1381","SUP","HCPCS C1713","","AR-1381  -  SCREW INTFR 8MM 25MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1381T","SUP","HCPCS C1713","","AR-1381T  -  SCREW INTFR FT RND 8MM 25MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1382","SUP","HCPCS C1713","","AR-1382  -  SCREW INTFR 8MM 30MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1382T","SUP","HCPCS C1713","","AR-1382T  -  SCREW INTFR FT RND 8MM 30MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1390","SUP","HCPCS C1713","","AR-1390  -  SCREW INTFR 9MM 20MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1390B","SUP","HCPCS C1713","","AR-1390B  -  SCREW INTFR 9MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1390E","SUP","HCPCS C1713","","AR-1390E  -  SCREW INTFR 20MM 9MM KNEE CANN SHTH STRL DISP","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1390H-35","SUP","HCPCS C1713","","AR-1390H-35  -  SCREW INTFR BLNT RND 9MM 35MM STRL CNN SFT TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1390P","SUP","HCPCS C1713","","AR-1390P  -  SCREW INTFR 9MM 23MM STRL PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-1390T","SUP","HCPCS C1713","","AR-1390T  -  SCREW INTFR FT RND 9MM 20MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1390TB","SUP","HCPCS C1713","","AR-1390TB  -  SCREW INTFR FT 9MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1390TC","SUP","HCPCS C1713","","AR-1390TC  -  SCREW INTERFERENCE BLUNT FULTHD STEP TAPER 9MM 28MM CANN","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1391","SUP","HCPCS C1713","","AR-1391  -  SCREW INTFR 9MM 25MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1391E","SUP","HCPCS C1713","","AR-1391E  -  SCREW INTFR 9MM 25MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1391T","SUP","HCPCS C1713","","AR-1391T  -  SCREW INTFR FT RND 9MM 25MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1392","SUP","HCPCS C1713","","AR-1392  -  SCREW INTFR RND 9MM 30MM STRL CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1392E","SUP","HCPCS C1713","","AR-1392E  -  SCREW INTFR 9MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1392T","SUP","HCPCS C1713","","AR-1392T  -  SCREW INTFR FT RND 9MM 30MM STRL CNN RECON TI ACL PCL ACPT 2","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-13991N","SUP","Custom 27203010","","AR-13991N  -  NEEDLE SUTURE SCORPION SUREFIRE ROTATOR CUFF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-13995N","SUP","Custom 27203010","","AR-13995N  -  NEEDLE SUT MF SCRPN","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1400","SUP","HCPCS C1713","","AR-1400  -  SCREW INTFR 10MM 20MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-14003","SUP","HCPCS C1713","","AR-14003  -  PLATE BN STRL SUTUREPLATE 3 HL HUM","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-14005","SUP","HCPCS C1713","","AR-14005  -  PLATE BN STRL SUTUREPLATE 5 HL HUM","BOTH IP/OP","$3,987.50 ","$2,950.75 ","$0.00 ","$3,987.50 ","$1,794.38 ","$0.00 ","$831.09 ","$0.00 ","$0.00 ","$698.18 ","$3,987.50 ","$0.00 ","$1,993.75 ","$3,158.10 ","$3,190.00 ","$0.00 ","$624.04 ","$0.00 ","$634.81 ","$0.00 "
"AR-1400B","SUP","HCPCS C1713","","AR-1400B  -  SCREW INTFR 10MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1400H-25","SUP","HCPCS C1713","","AR-1400H-25  -  SCREW INTFR BLNT RND 10MM 25MM STRL CNN SFT TI ACL PCL ACPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1400H-30","SUP","HCPCS C1713","","AR-1400H-30  -  SCREW INTFR BLNT RND 10MM 30MM STRL CNN SFT TI ACL PCL ACPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1400H-35","SUP","HCPCS C1713","","AR-1400H-35  -  SCREW INTFR BLNT RND 10MM 35MM STRL CNN SFT TI ACL PCL ACPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1400P","SUP","HCPCS C1713","","AR-1400P  -  SCREW INTFR 10MM 23MM STRL PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-1400T","SUP","HCPCS C1713","","AR-1400T  -  SCREW INTFR FT RND 10MM 28MM STRL CNN RECON TI ACL PCL ACPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1400TB","SUP","HCPCS C1713","","AR-1400TB  -  SCREW INTFR FT 10MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1400TC","SUP","HCPCS C1713","","AR-1400TC  -  SCREW INTFR BLNT FT STP TPR 10MM 28MM STRL CNN FULL SEAT RDC","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1401","SUP","HCPCS C1713","","AR-1401  -  SCREW INTFR 10MM 25MM STRL CNN TI ACL PCL DISP","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-14012","SUP","Custom 27203010","","AR-14012  -  GUIDE DRL 2.5MM SUTUREPLATE THRD","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1401T","SUP","HCPCS C1713","","AR-1401T  -  SCREW INTFR FT RND 10MM 25MM STRL CNN RECON TI ACL PCL ACPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1402","SUP","HCPCS C1713","","AR-1402  -  SCREW INTFR 10MM 30MM STRL BIOINTF CNN TI ACL PCL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-14029","SUP","Custom 27203010","","AR-14029  -  GUIDE DRL 2.5MM","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1402T","SUP","HCPCS C1713","","AR-1402T  -  SCREW INTFR FT RND 10MM 30MM STRL CNN RECON TI ACL PCL ACPT","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-1403TB","SUP","HCPCS C1713","","AR-1403TB  -  SCREW INTFR FT 11MM 28MM STRL BIOINTF CNN BLNT POLY L LAC","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1403TC","SUP","HCPCS C1713","","AR-1403TC  -  SCREW INTFR FT STP TPR 11MM 28MM STRL CNN SEAT RDC HD BLNT","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1404TB","SUP","HCPCS C1713","","AR-1404TB  -  SCREW INTFR FT 12MM 28MM STRL BIOINTF CNN BLNT POLY L LAC","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-1405LP","SUP","Custom 27203010","","AR-1405LP  -  REAMER SRG LOPRFL 5MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1405LP-50","SUP","Custom 27203010","","AR-1405LP-50  -  REAMER SURG LP 5.5MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1406LP","SUP","Custom 27203010","","AR-1406LP  -  REAMER SRG LOPRFL 6MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1406LP-50","SUP","Custom 27203010","","AR-1406LP-50  -  REAMER SRG LOPRFL 6.5MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1407LP","SUP","Custom 27203010","","AR-1407LP  -  REAMER SURG LP 7MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1407LP-50","SUP","Custom 27203010","","AR-1407LP-50  -  REAMER SURG LP 7.5MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1408LP","SUP","Custom 27203010","","AR-1408LP  -  REAMER SURG LP 8MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1408LP-50","SUP","Custom 27203010","","AR-1408LP-50  -  REAMER SURG LP 8.5MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1408LPF","SUP","Custom 27203010","","AR-1408LPF  -  REAMER SRG LOPRFL 8MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1408LPF-50","SUP","Custom 27203010","","AR-1408LPF-50  -  REAMER SRG LOPRFL 8.5MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1409LP","SUP","Custom 27203010","","AR-1409LP  -  REAMER SURG LP 9MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1409LP-50","SUP","Custom 27203010","","AR-1409LP-50  -  REAMER SURG LP 9.5MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1409LPF","SUP","Custom 27203010","","AR-1409LPF  -  REAMER SRG LOPRFL 9MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1409LPF-50","SUP","Custom 27203010","","AR-1409LPF-50  -  REAMER SRG LOPRFL 9.5MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1410LP","SUP","Custom 27203010","","AR-1410LP  -  REAMER SURG LP 10MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1410LP-50","SUP","Custom 27203010","","AR-1410LP-50  -  REAMER SURG LP 10.5MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1410LPF","SUP","Custom 27203010","","AR-1410LPF  -  REAMER SRG LOPRFL 10MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1410LPF-50","SUP","Custom 27203010","","AR-1410LPF-50  -  REAMER SRG LOPRFL 10.5MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-14116","SUP","HCPCS C1713","","AR-14116  -  SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14116NL","SUP","HCPCS C1713","","AR-14116NL  -  SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14118","SUP","HCPCS C1713","","AR-14118  -  SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14118NL","SUP","HCPCS C1713","","AR-14118NL  -  SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-1411LP","SUP","Custom 27203010","","AR-1411LP  -  REAMER SURG LP 11MM CANN ACL STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1411LP-50","SUP","Custom 27203010","","AR-1411LP-50  -  REAMER SRG LOPRFL 11.5MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1411LPF","SUP","Custom 27203010","","AR-1411LPF  -  REAMER SRG LOPRFL 11MM LOW PROFILE","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-14120","SUP","HCPCS C1713","","AR-14120  -  SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14120NL","SUP","HCPCS C1713","","AR-14120NL  -  SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14122","SUP","HCPCS C1713","","AR-14122  -  SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14122NL","SUP","HCPCS C1713","","AR-14122NL  -  SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14124","SUP","HCPCS C1713","","AR-14124  -  SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14124NL","SUP","HCPCS C1713","","AR-14124NL  -  SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14126","SUP","HCPCS C1713","","AR-14126  -  SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14126NL","SUP","HCPCS C1713","","AR-14126NL  -  SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14128","SUP","HCPCS C1713","","AR-14128  -  SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14128NL","SUP","HCPCS C1713","","AR-14128NL  -  SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-1412LP","SUP","Custom 27203010","","AR-1412LP  -  REAMER SRG LOPRFL 12MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1412LP-50","SUP","Custom 27203010","","AR-1412LP-50  -  REAMER SRG LOPRFL 12.5MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-14130","SUP","HCPCS C1713","","AR-14130  -  SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14130NL","SUP","HCPCS C1713","","AR-14130NL  -  SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14132","SUP","HCPCS C1713","","AR-14132  -  SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14132NL","SUP","HCPCS C1713","","AR-14132NL  -  SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14134","SUP","HCPCS C1713","","AR-14134  -  SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14134NL","SUP","HCPCS C1713","","AR-14134NL  -  SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14136","SUP","HCPCS C1713","","AR-14136  -  SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14136NL","SUP","HCPCS C1713","","AR-14136NL  -  SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14138","SUP","HCPCS C1713","","AR-14138  -  SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14138NL","SUP","HCPCS C1713","","AR-14138NL  -  SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-1413LP","SUP","Custom 27203010","","AR-1413LP  -  REAMER SRG LOPRFL 13MM STRL CNN ACL DISP","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-14140","SUP","HCPCS C1713","","AR-14140  -  SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14140NL","SUP","HCPCS C1713","","AR-14140NL  -  SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14145","SUP","HCPCS C1713","","AR-14145  -  SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14145NL","SUP","HCPCS C1713","","AR-14145NL  -  SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14150","SUP","HCPCS C1713","","AR-14150  -  SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE LCK TI SHLDR CORT","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14150NL","SUP","HCPCS C1713","","AR-14150NL  -  SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE TI SHLDR CORT ARTHPL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-14224","SUP","HCPCS C1713","","AR-14224  -  SCREW BN LOPRFL 4MM 24MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14226","SUP","HCPCS C1713","","AR-14226  -  SCREW BN LOPRFL 4MM 26MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14228","SUP","HCPCS C1713","","AR-14228  -  SCREW BN LOPRFL 4MM 28MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14230","SUP","HCPCS C1713","","AR-14230  -  SCREW BN LOPRFL 4MM 30MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14232","SUP","HCPCS C1713","","AR-14232  -  SCREW BN LOPRFL 4MM 32MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14234","SUP","HCPCS C1713","","AR-14234  -  SCREW BN LOPRFL 4MM 34MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14236","SUP","HCPCS C1713","","AR-14236  -  SCREW BN LOPRFL 4MM 36MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14238","SUP","HCPCS C1713","","AR-14238  -  SCREW BN LOPRFL 4MM 38MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14240","SUP","HCPCS C1713","","AR-14240  -  SCREW BN LOPRFL 4MM 40MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14242","SUP","HCPCS C1713","","AR-14242  -  SCREW BN LOPRFL 4MM 42MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14244","SUP","HCPCS C1713","","AR-14244  -  SCREW BN LOPRFL 4MM 44MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14246","SUP","HCPCS C1713","","AR-14246  -  SCREW BN LOPRFL 4MM 46MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14248","SUP","HCPCS C1713","","AR-14248  -  SCREW BN LOPRFL 4MM 48MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14250","SUP","HCPCS C1713","","AR-14250  -  SCREW BN 4MM 50MM SUTUREPLATE LCK HUM CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14252","SUP","HCPCS C1713","","AR-14252  -  SCREW BN LOPRFL 4MM 52MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14254","SUP","HCPCS C1713","","AR-14254  -  SCREW BN LOPRFL 4MM 54MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-14256","SUP","HCPCS C1713","","AR-14256  -  SCREW BN LOPRFL 4MM 56MM SUTUREPLATE LCK TI SHLDR CANC","BOTH IP/OP","$280.00 ","$207.20 ","$0.00 ","$280.00 ","$126.00 ","$0.00 ","$58.36 ","$0.00 ","$0.00 ","$49.03 ","$280.00 ","$0.00 ","$140.00 ","$221.76 ","$224.00 ","$0.00 ","$43.82 ","$0.00 ","$44.58 ","$0.00 "
"AR-1450","SUP","Custom 27203010","","AR-1450  -  REAMER SRG 6MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1451","SUP","Custom 27203010","","AR-1451  -  REAMER SURG 6.5MM PILOT HEAD STERILE","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1452","SUP","Custom 27203010","","AR-1452  -  REAMER SRG 7MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1453","SUP","Custom 27203010","","AR-1453  -  REAMER SRG 7.5MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1454","SUP","Custom 27203010","","AR-1454  -  REAMER SRG 8MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1455","SUP","Custom 27203010","","AR-1455  -  REAMER SRG 8.5MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1456","SUP","Custom 27203010","","AR-1456  -  REAMER SRG 9MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1457","SUP","Custom 27203010","","AR-1457  -  REAMER SRG 9.5MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1458","SUP","Custom 27203010","","AR-1458  -  REAMER SRG 10MM STRL PILT HD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1502","SUP","Custom 27203010","","AR-1502  -  INSERT PSTN CSHN FM LG HLDR","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1510FL","SUP","Custom 27203010","","AR-1510FL  -  GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM LT","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1510FLS","SUP","Custom 27203010","","AR-1510FLS  -  GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM LT ACL","BOTH IP/OP","$2,433.75 ","$1,800.98 ","$0.00 ","$2,433.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.75 ","$0.00 ","$1,216.88 ","$1,927.53 ","$1,947.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1510FPL","SUP","Custom 27203010","","AR-1510FPL  -  GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM LT ACL","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1510FPR","SUP","Custom 27203010","","AR-1510FPR  -  GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM RT ACL","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1510FR","SUP","Custom 27203010","","AR-1510FR  -  GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM RT","BOTH IP/OP","$1,365.00 ","$1,010.10 ","$0.00 ","$1,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,365.00 ","$0.00 ","$682.50 ","$1,081.08 ","$1,092.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1510FRS","SUP","Custom 27203010","","AR-1510FRS  -  GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM RT ACL","BOTH IP/OP","$2,433.75 ","$1,800.98 ","$0.00 ","$2,433.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,433.75 ","$0.00 ","$1,216.88 ","$1,927.53 ","$1,947.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1530BC","SUP","HCPCS C1713","","AR-1530BC  -  SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR BCMPS SFT TIS","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-1530C-25","SUP","Custom 27203010","","AR-1530C-25  -  BIT DRL 2.5MM CNN","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1530DS","SUP","Custom 27203010","","AR-1530DS  -  KIT INST 2-0 .041IN 2.5MM BTNDS FWR NDL CNN DRL SUT PASS WRE","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1530P-CP","SUP","HCPCS C1713","","AR-1530P-CP  -  SYSTEM IMPL STRL INTERNALBRACE PEEK FOREFOOT","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"AR-1530PS","SUP","HCPCS C1713","","AR-1530PS  -  SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR VNT PEEK-OPTM","BOTH IP/OP","$912.50 ","$675.25 ","$0.00 ","$912.50 ","$410.63 ","$0.00 ","$190.19 ","$0.00 ","$0.00 ","$159.77 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$142.81 ","$0.00 ","$145.27 ","$0.00 "
"AR-1540B","SUP","HCPCS C1713","","AR-1540B  -  SCREW INTFR 4MM 10MM STRL BTNDS RECON POLY L LAC ACD ACL PCL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1540BC","SUP","HCPCS C1713","","AR-1540BC  -  SCREW INTFR 4MM 10MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1540CDS","SUP","HCPCS C1713","","AR-1540CDS  -  SCREW INTFR 4MM 10MM TENODESIS SCR DISP DRVR PK BCMPS","BOTH IP/OP","$4,812.50 ","$3,561.25 ","$0.00 ","$4,812.50 ","$2,165.63 ","$0.00 ","$1,003.05 ","$0.00 ","$0.00 ","$842.63 ","$4,812.50 ","$0.00 ","$2,406.25 ","$3,811.50 ","$3,850.00 ","$0.00 ","$753.16 ","$0.00 ","$766.15 ","$0.00 "
"AR-1540PS","SUP","HCPCS C1713","","AR-1540PS  -  SCREW INTFR 4MM 10MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1547BC","SUP","HCPCS C1713","","AR-1547BC  -  SCREW INTFR 4.75MM 15MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1547CDS","SUP","HCPCS C1713","","AR-1547CDS  -  SCREW INTFR 4.75MM 15MM TENODESIS SCR DISP DRVR PK BCMPS","BOTH IP/OP","$4,812.50 ","$3,561.25 ","$0.00 ","$4,812.50 ","$2,165.63 ","$0.00 ","$1,003.05 ","$0.00 ","$0.00 ","$842.63 ","$4,812.50 ","$0.00 ","$2,406.25 ","$3,811.50 ","$3,850.00 ","$0.00 ","$753.16 ","$0.00 ","$766.15 ","$0.00 "
"AR-1547PS","SUP","HCPCS C1713","","AR-1547PS  -  SCREW INTFR 4.75MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1555BC","SUP","HCPCS C1713","","AR-1555BC  -  SCREW INTFR 5.5MM 15MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1555CDS-1","SUP","HCPCS C1713","","AR-1555CDS-1  -  SCREW BN 5.5MM 15MM STRL ARTHX DISP DRVR BCMPS TENODESIS","BOTH IP/OP","$962.50 ","$712.25 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$200.61 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"AR-1555PS","SUP","HCPCS C1713","","AR-1555PS  -  SCREW INTFR 5.5MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1562BC","SUP","HCPCS C1713","","AR-1562BC  -  SCREW INTFR 6.25MM 15MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1562CDS","SUP","HCPCS C1713","","AR-1562CDS  -  SCREW INTFR 6.25MM 15MM TENODESIS SCR DISP DRVR PK BCMPS","BOTH IP/OP","$4,812.50 ","$3,561.25 ","$0.00 ","$4,812.50 ","$2,165.63 ","$0.00 ","$1,003.05 ","$0.00 ","$0.00 ","$842.63 ","$4,812.50 ","$0.00 ","$2,406.25 ","$3,811.50 ","$3,850.00 ","$0.00 ","$753.16 ","$0.00 ","$766.15 ","$0.00 "
"AR-1562PS","SUP","HCPCS C1713","","AR-1562PS  -  SCREW INTFR 6.25MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1570BC","SUP","HCPCS C1713","","AR-1570BC  -  SCREW INTFR 7MM 23MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1570PS","SUP","HCPCS C1713","","AR-1570PS  -  SCREW INTFR 7MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1580BC","SUP","HCPCS C1713","","AR-1580BC  -  SCREW INTFR 8MM 23MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1580PS","SUP","HCPCS C1713","","AR-1580PS  -  SCREW INTFR 8MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1586FR-07","SUP","HCPCS C1713","","AR-1586FR-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586FR-08","SUP","HCPCS C1713","","AR-1586FR-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586FR-09","SUP","HCPCS C1713","","AR-1586FR-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586FR-10","SUP","HCPCS C1713","","AR-1586FR-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586FRB-07","SUP","HCPCS C1713","","AR-1586FRB-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586FRB-08","SUP","HCPCS C1713","","AR-1586FRB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586FRB-09","SUP","HCPCS C1713","","AR-1586FRB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586FRB-10","SUP","HCPCS C1713","","AR-1586FRB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586LB-08","SUP","HCPCS C1713","","AR-1586LB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586LB-09","SUP","HCPCS C1713","","AR-1586LB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586LB-10","SUP","HCPCS C1713","","AR-1586LB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586R-08","SUP","HCPCS C1713","","AR-1586R-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586R-09","SUP","HCPCS C1713","","AR-1586R-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586R-10","SUP","HCPCS C1713","","AR-1586R-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1586RB-06","SUP","HCPCS C1713","","AR-1586RB-06  -  SCREW INTFR 6MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586RB-07","SUP","HCPCS C1713","","AR-1586RB-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586RB-08","SUP","HCPCS C1713","","AR-1586RB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD POLY L","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586RB-09","SUP","HCPCS C1713","","AR-1586RB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586RB-10","SUP","HCPCS C1713","","AR-1586RB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1586RC-07","SUP","HCPCS C1713","","AR-1586RC-07  -  SCREW INTFR 20MM 7MM STRL RETROSCREW RVRS THRD DSGN BCMPS","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1586RC-08","SUP","HCPCS C1713","","AR-1586RC-08  -  SCREW INTFR 20MM 8MM STRL RETROSCREW RVRS THRD DSGN BCMPS","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1586RC-09","SUP","HCPCS C1713","","AR-1586RC-09  -  SCREW INTFR 20MM 9MM STRL RETROSCREW RVRS THRD DSGN BCMPS","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1586RC-10","SUP","HCPCS C1713","","AR-1586RC-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW ACL RVRS THRD DSGN","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1587S","SUP","Custom 27203010","","AR-1587S  -  KIT INST STRL ALL INSD ACL DISP","BOTH IP/OP","$1,182.50 ","$875.05 ","$0.00 ","$1,182.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,182.50 ","$0.00 ","$591.25 ","$936.54 ","$946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1588-15","SUP","HCPCS C1763","","AR-1588-15  -  BUTTON FX 12MM STRL 15MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-25","SUP","HCPCS C1763","","AR-1588-25  -  BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-25BT","SUP","HCPCS C1763","","AR-1588-25BT  -  BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1588-30BT","SUP","HCPCS C1763","","AR-1588-30BT  -  BUTTON FX 12MM STRL 30MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1588-35","SUP","HCPCS C1763","","AR-1588-35  -  BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-35BT","SUP","HCPCS C1763","","AR-1588-35BT  -  BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1588-40","SUP","HCPCS C1763","","AR-1588-40  -  BUTTON FX 12MM STRL 40MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-45","SUP","HCPCS C1763","","AR-1588-45  -  BUTTON FX 12MM STRL 45MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-50","SUP","HCPCS C1763","","AR-1588-50  -  BUTTON FX 12MM STRL 50MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-55","SUP","HCPCS C1763","","AR-1588-55  -  BUTTON FX 12MM STRL 55MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-55BT","SUP","HCPCS C1763","","AR-1588-55BT  -  BUTTON BTB RETROBUTTON, 12MM X 55MM LOOP","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1588-60","SUP","HCPCS C1763","","AR-1588-60  -  BUTTON FX 12MM STRL 60MM RETROBUTTON LOOP SLF FLP TI UHMWPE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1588-60BT","SUP","HCPCS C1763","","AR-1588-60BT  -  BUTTON BTB 12MM RETROBUTTON, 60MM LOOP","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1588BTB","SUP","HCPCS C1713","","AR-1588BTB  -  DEVICE FIX SMALL 10MM 4 POINT LOCK ADJUSTABLE LOOP DRILL","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-1588BTB-J","SUP","HCPCS C1713","","AR-1588BTB-J  -  DEVICE FX TGHTRP DEPLOYING SUT","BOTH IP/OP","$1,112.50 ","$823.25 ","$0.00 ","$1,112.50 ","$500.63 ","$0.00 ","$231.87 ","$0.00 ","$0.00 ","$194.79 ","$1,112.50 ","$0.00 ","$556.25 ","$881.10 ","$890.00 ","$0.00 ","$174.11 ","$0.00 ","$177.11 ","$0.00 "
"AR-1588RT","SUP","HCPCS C1713","","AR-1588RT  -  KIT ENDSCP INSTR LATEX FREE TIGHTROPE TITANIUM UHMWPE ACL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"AR-1588RT-07","SUP","Custom 27203010","","AR-1588RT-07  -  KIT ASCP FX 8MM LF TGHTRP FLIPCUTTER II TIB RT ACL","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1588RT-13","SUP","Custom 27203010","","AR-1588RT-13  -  KIT ASCP FX 11MM LF TGHTRP FLIPCUTTER II TIB RT ACL","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1588RT-18","SUP","Custom 27203010","","AR-1588RT-18  -  KIT ASCP FX 9MM LF TGHTRP FLIPCUTTER II TIB RT ACL","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1588RT-J","SUP","HCPCS C1713","","AR-1588RT-J  -  DEVICE FX TGHTRP 2 LD PASS SUT ACL RT","BOTH IP/OP","$925.00 ","$684.50 ","$0.00 ","$925.00 ","$416.25 ","$0.00 ","$192.79 ","$0.00 ","$0.00 ","$161.96 ","$925.00 ","$0.00 ","$462.50 ","$732.60 ","$740.00 ","$0.00 ","$144.76 ","$0.00 ","$147.26 ","$0.00 "
"AR-1588RTS","SUP","HCPCS C1713","","AR-1588RTS  -  KIT ARTHRO FIX DELIVERY SYSTEM DRILL PIN TIGHTROPE ACL RIGHT","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"AR-1588T","SUP","Custom 27203010","","AR-1588T  -  KIT ASCP FX STRL TGHTRP REPR ACL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1588TB","SUP","HCPCS C1763","","AR-1588TB  -  BUTTON FX 12MM 8MM TGHTRP ATCH SLOT ACL","BOTH IP/OP","$357.50 ","$264.55 ","$0.00 ","$357.50 ","$160.88 ","$0.00 ","$74.51 ","$0.00 ","$0.00 ","$62.60 ","$357.50 ","$0.00 ","$178.75 ","$283.14 ","$286.00 ","$0.00 ","$55.95 ","$0.00 ","$56.91 ","$0.00 "
"AR-1588TB-1","SUP","HCPCS C1763","","AR-1588TB-1  -  BUTTON FIXATION TIGHTROPE ROUND OD14 MM ACL ATTACHABLE","BOTH IP/OP","$535.00 ","$395.90 ","$0.00 ","$535.00 ","$240.75 ","$0.00 ","$111.51 ","$0.00 ","$0.00 ","$93.67 ","$535.00 ","$0.00 ","$267.50 ","$423.72 ","$428.00 ","$0.00 ","$83.73 ","$0.00 ","$85.17 ","$0.00 "
"AR-1588TB-2","SUP","HCPCS C1763","","AR-1588TB-2  -  BUTTON FX OBLNG 13MMXW 3.4MM TGHTRP ATCH SLOT ACL","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$226.13 ","$0.00 ","$104.73 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"AR-1588TB-3","SUP","HCPCS C1763","","AR-1588TB-3  -  BUTTON FX RND CNCV 11MM TGHTRP ATCH","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$252.00 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"AR-1588TB-4","SUP","HCPCS C1763","","AR-1588TB-4  -  BUTTON FX RND CNCV 14MM TGHTRP ATCH","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$252.00 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"AR-1588TB-5","SUP","HCPCS C1763","","AR-1588TB-5  -  BUTTON FX RND 20MM 9MM TGHTRP COLR ABS","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$252.00 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"AR-1588TDB-7","SUP","HCPCS C1713","","AR-1588TDB-7  -  DEVICE FX 7MM TGHTRP DLV SYS ACL DISP","BOTH IP/OP","$1,162.50 ","$860.25 ","$0.00 ","$1,162.50 ","$523.13 ","$0.00 ","$242.29 ","$0.00 ","$0.00 ","$203.54 ","$1,162.50 ","$0.00 ","$581.25 ","$920.70 ","$930.00 ","$0.00 ","$181.93 ","$0.00 ","$185.07 ","$0.00 "
"AR-1588TDB-7S","SUP","HCPCS C1713","","AR-1588TDB-7S  -  DEVICE FX TGHTRP DLV SYS ACL","BOTH IP/OP","$1,475.00 ","$1,091.50 ","$0.00 ","$1,475.00 ","$663.75 ","$0.00 ","$307.43 ","$0.00 ","$0.00 ","$258.26 ","$1,475.00 ","$0.00 ","$737.50 ","$1,168.20 ","$1,180.00 ","$0.00 ","$230.84 ","$0.00 ","$234.82 ","$0.00 "
"AR-1588TN","SUP","HCPCS C1713","","AR-1588TN  -  DEVICE TGHTRP ACL UHMWPE ATCH","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"AR-1588TN-1","SUP","HCPCS C1713","","AR-1588TN-1  -  DEVICE FX TGHTRP ATCH OPN UHMWPE ACL","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-1588TP","SUP","Custom 27203010","","AR-1588TP  -  KIT ASCP FX TGHTRP PCL","BOTH IP/OP","$872.50 ","$645.65 ","$0.00 ","$872.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$872.50 ","$0.00 ","$436.25 ","$691.02 ","$698.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1589-15","SUP","HCPCS C1763","","AR-1589-15  -  BUTTON FX LNG 15MM STRL 15MM RETROBUTTON LOOP SLF FLP TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1589-20","SUP","HCPCS C1763","","AR-1589-20  -  BUTTON FX LNG 15MM STRL 20MM RETROBUTTON LOOP SLF FLP TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1589-25","SUP","HCPCS C1763","","AR-1589-25  -  BUTTON FX LNG 15MM STRL 25MM RETROBUTTON LOOP SLF FLP TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1589-30","SUP","HCPCS C1763","","AR-1589-30  -  BUTTON FX LNG 15MM STRL 30MM RETROBUTTON LOOP SLF FLP TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1589-35","SUP","HCPCS C1763","","AR-1589-35  -  BUTTON FX LNG 15MM STRL 35MM RETROBUTTON LOOP SLF FLP TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1589-40","SUP","HCPCS C1763","","AR-1589-40  -  BUTTON FX LNG 15MM STRL 40MM RETROBUTTON LOOP SLF FLP TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-1589RT","SUP","HCPCS C1763","","AR-1589RT  -  BUTTON SUT LG 20X5MM TGHTRP XTD FTPRNT","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-1590BC","SUP","HCPCS C1713","","AR-1590BC  -  SCREW INTFR 9MM 23MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1590PS","SUP","HCPCS C1713","","AR-1590PS  -  SCREW INTFR 9MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1592","SUP","HCPCS C1763","","AR-1592  -  BUTTON FX XL 11MM 20MM STRL RETROBUTTON ASYM LOOP RECON STF","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$298.13 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"AR-1593","SUP","Custom 27203010","","AR-1593  -  SYSTEM FX ACL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1595","SUP","HCPCS C1763","","AR-1595  -  PIN DRILL RETROBUTTON KNEE ACL STERILE DISPOSABLE","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-1595TC","SUP","HCPCS C1763","","AR-1595TC  -  PIN DRL 4MM STRL RETROBUTTON TGHTRP CLS EYLT KN ACL DISP","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-1605S","SUP","HCPCS C1713","","AR-1605S  -  HOOK SCR STOR WLMNT 2 HK 2 BOLT DRL","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$47.50 ","$21.38 ","$0.00 ","$9.90 ","$0.00 ","$0.00 ","$8.32 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$7.43 ","$0.00 ","$7.56 ","$0.00 "
"AR-1606","SUP","Custom 27203010","","AR-1606  -  DEVICE PSTN STRL CBN STAR SLV LAT TRC ROT STRAP FM FRARM","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1606C","SUP","Custom 27203010","","AR-1606C  -  DEVICE PSTN STRL CBN STAR SLV CMPCT LAT TRC ROT STRAP SFT FM","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1606LV","SUP","Custom 27203010","","AR-1606LV  -  DEVICE PSTN XLNG STRL STAR SLV VLCR FM ARM DISP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1606SV","SUP","Custom 27203010","","AR-1606SV  -  DEVICE PSTN SM STRL STAR SLV VLCR LMB DISP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1606V","SUP","Custom 27203010","","AR-1606V  -  DEVICE POSITIONING TRACTION SLING STAR SLEEVE VELCRO FOAM","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1627-06","SUP","Custom 27203010","","AR-1627-06  -  KIT PSTN UNV HD STRL DISP","BOTH IP/OP","$49.75 ","$36.82 ","$0.00 ","$49.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.75 ","$0.00 ","$24.88 ","$39.40 ","$39.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1627-11","SUP","Custom 27203010","","AR-1627-11  -  CLAMP OP TBL CLRK RAIL","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1644","SUP","Custom 27203010","","AR-1644  -  KIT POSITIONING BEACH CHAIR DRAPE HOLDER LIGHTWEIGHT TRIMANO","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1648","SUP","Custom 27203010","","AR-1648  -  COVER PSTN STRL TRIMANO DRP","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1650-07","SUP","Custom 27203010","","AR-1650-07  -  CLAMP OP TBL CLRK RAIL SHLDR SPNS SYS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1655PS","SUP","HCPCS C1713","","AR-1655PS  -  SCREW INTFR 5.5MM 8MM STRL BTNDS RECON PEEK-OPTM ACL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1655PS-10","SUP","HCPCS C1713","","AR-1655PS-10  -  SCREW INTFR 5.5MM 10MM STRL BTNDS RECON PEEK-OPTM ACL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1655PS-12","SUP","HCPCS C1713","","AR-1655PS-12  -  SCREW INTFR 5.5MM 12MM STRL BTNDS RECON PEEK-OPTM ACL","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1662B","SUP","HCPCS C1713","","AR-1662B  -  ANCHOR SUT 6.25MM 19.1MM SWIVELOCK BICEPS TENODESIS SYS","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$427.50 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$166.34 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$148.68 ","$0.00 ","$151.24 ","$0.00 "
"AR-1662BC","SUP","HCPCS C1713","","AR-1662BC  -  ANCHOR SUT 6.25MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT","BOTH IP/OP","$1,025.00 ","$758.50 ","$0.00 ","$1,025.00 ","$461.25 ","$0.00 ","$213.64 ","$0.00 ","$0.00 ","$179.47 ","$1,025.00 ","$0.00 ","$512.50 ","$811.80 ","$820.00 ","$0.00 ","$160.41 ","$0.00 ","$163.18 ","$0.00 "
"AR-1662BC-7","SUP","HCPCS C1713","","AR-1662BC-7  -  ANCHOR SUT SWVLK TENO BIO-COMP 7X 19.5MM","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-1662BC-8","SUP","HCPCS C1713","","AR-1662BC-8  -  ANCHOR SUTURE 8MM 19.5MM FORK EYELET SWIVELOCK TENODESIS","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,555.00 ","$699.75 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$272.27 ","$1,555.00 ","$0.00 ","$777.50 ","$1,231.56 ","$1,244.00 ","$0.00 ","$243.36 ","$0.00 ","$247.56 ","$0.00 "
"AR-1662BC-9","SUP","HCPCS C1713","","AR-1662BC-9  -  ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-1662BCC-7","SUP","HCPCS C1713","","AR-1662BCC-7  -  ANCHOR SUT 7MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-1662BCC-8","SUP","HCPCS C1713","","AR-1662BCC-8  -  ANCHOR SUT 8MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-1662BCC-9","SUP","HCPCS C1713","","AR-1662BCC-9  -  ANCHOR SUT 9MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-1662PSL-7","SUP","HCPCS C1713","","AR-1662PSL-7  -  ANCHOR SUT 7MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK","BOTH IP/OP","$1,012.50 ","$749.25 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$211.03 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"AR-1662PSL-8","SUP","HCPCS C1713","","AR-1662PSL-8  -  ANCHOR SUT 8MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK","BOTH IP/OP","$1,012.50 ","$749.25 ","$0.00 ","$1,447.50 ","$651.38 ","$0.00 ","$211.03 ","$0.00 ","$0.00 ","$253.45 ","$1,447.50 ","$0.00 ","$723.75 ","$1,146.42 ","$1,158.00 ","$0.00 ","$226.53 ","$0.00 ","$230.44 ","$0.00 "
"AR-1662PSL-9","SUP","HCPCS C1713","","AR-1662PSL-9  -  ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK","BOTH IP/OP","$1,012.50 ","$749.25 ","$0.00 ","$1,012.50 ","$455.63 ","$0.00 ","$211.03 ","$0.00 ","$0.00 ","$177.28 ","$1,012.50 ","$0.00 ","$506.25 ","$801.90 ","$810.00 ","$0.00 ","$158.46 ","$0.00 ","$161.19 ","$0.00 "
"AR-1670BC","SUP","HCPCS C1713","","AR-1670BC  -  SCREW INTFR 7MM 10MM STRL TENODESIS BCMPS ACL","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1670PS","SUP","HCPCS C1713","","AR-1670PS  -  SCREW INTFR 7MM 10MM STRL TENODESIS PEEK-OPTM ACL","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1675BC-CP","SUP","HCPCS C1713","","AR-1675BC-CP  -  SET IMPL BCMPS SCRDRVR RECON SYS","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-1676DS","SUP","Custom 27203010","","AR-1676DS  -  KIT INSTR BIOABSORBABLE BIO-TENODESIS STERILE DISPOSABLE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1676-DS","SUP","HCPCS C1713","","KIT ARTHRO FIXAT BTNDS BABSR STRL DISP","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-1677BC-CP","SUP","HCPCS C1713","","AR-1677BC-CP  -  SET IMPL 4MM CNN DRL GDPN RLR SCR TNDN SHTL CMC LGMNT RECON","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-1678-01","SUP","Custom 27203010","","AR-1678-01  -  GUIDE DRL LF TTH FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1678-02","SUP","Custom 27203010","","AR-1678-02  -  BIT DRL 3.5MM SWIVELOCK","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1678-05","SUP","Custom 27203010","","AR-1678-05  -  BIT DRL 3.5MM SWIVELOCK","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1678-CP","SUP","HCPCS C1713","","AR-1678-CP  -  SET IMPL 3.5MM INTERNALBRACE SWIVELOCK FIBERTAPE 2 2 NDL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"AR-1680B","SUP","HCPCS C1713","","AR-1680B  -  SCREW BABSR 12MM 8MM BTNDS ACL PLLA RECON STRL DISP","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1680PS","SUP","HCPCS C1713","","AR-1680PS  -  TENODESIS SCREW 8X12MM","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1688-CP","SUP","Custom 27203010","","AR-1688-CP  -  KIT ASCP FX INTERNALBRACE FIBERTAPE CLGN LGMNT AUG REPR","BOTH IP/OP","$2,687.50 ","$1,988.75 ","$0.00 ","$2,687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,687.50 ","$0.00 ","$1,343.75 ","$2,128.50 ","$2,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-16991N","SUP","Custom 27203010","","AR-16991N  -  NEEDLE SUT RND GRV LOPRFL SCRPN FBRWR 1 PRTL SMTH JAW MN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-16992N","SUP","Custom 27203010","","AR-16992N  -  NEEDLE SUT SCRPN CAPSULECLOSE","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1713-03","SUP","Custom 27203010","","AR-1713-03  -  CLAMP BDRL DSTRCT SET STRL ANKL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1801","SUP","Custom 27203010","","AR-1801  -  GUIDE DRL OFST 7MM AU FEM ACL TRNTB DISP 7-8MM HL","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1802D","SUP","Custom 27203010","","AR-1802D  -  CANNULA ASCP 9-12MM STRL TNL SIL TIB DISP","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1803","SUP","Custom 27203010","","AR-1803  -  GUIDE DRL OFST 5MM RD FEM ACL TRNTB DISP 7-8MM HL","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1804","SUP","Custom 27203010","","AR-1804  -  GUIDE DRL OFST 6MM GRN FEM ACL TRNTB DISP 8-9MM HL","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1805","SUP","Custom 27203010","","AR-1805  -  GUIDE DRL OFST 8MM BLU FEM ACL TRNTB DISP 12-13MM HL","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1806","SUP","Custom 27203010","","AR-1806  -  GUIDE DRL OFST 4MM PUR FEM ACL TRNTB DISP 6-7MM HL","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1822","SUP","Custom 27203010","","AR-1822  -  BIT DRL LNG 2MM STRL D STP GFT HRVT","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1861","SUP","Custom 27203010","","AR-1861  -  CANNULA ASCP 11MM GFT PASS","BOTH IP/OP","$732.50 ","$542.05 ","$0.00 ","$732.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$732.50 ","$0.00 ","$366.25 ","$580.14 ","$586.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1875","SUP","Custom 27203010","","AR-1875  -  GUIDE DRL ADAPTEUR C RING ACL","BOTH IP/OP","$3,545.00 ","$2,623.30 ","$0.00 ","$3,545.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,545.00 ","$0.00 ","$1,772.50 ","$2,807.64 ","$2,836.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1897S","SUP","Custom 27203010","","AR-1897S  -  KIT INST HALL SW BLDE ACL DISP TRNTB","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-18985","SUP","HCPCS C1713","","AR-18985  -  KIT INST ACL TRNTB DISP","BOTH IP/OP","$520.00 ","$384.80 ","$0.00 ","$520.00 ","$234.00 ","$0.00 ","$108.38 ","$0.00 ","$0.00 ","$91.05 ","$520.00 ","$0.00 ","$260.00 ","$411.84 ","$416.00 ","$0.00 ","$81.38 ","$0.00 ","$82.78 ","$0.00 "
"AR-1902SF","SUP","HCPCS C1713","","AR-1902SF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR2 FWR 2 EYLT ST TI ROTR CUF","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$241.88 ","$0.00 ","$112.03 ","$0.00 ","$0.00 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"AR-1907H-3.5","SUP","Custom 27203010","","AR-1907H-3.5  -  GUIDE DRL 3.5MM ANCH CNN TROC SDL HIP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1911","SUP","Custom 27203010","","AR-1911  -  DRILL SRG SPD 1 STP 3.5MM PUSHLOCK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1912","SUP","Custom 27203010","","AR-1912  -  DRILL SRG LG 1 STP 3.5MM PUSHLOCK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1913","SUP","Custom 27203010","","AR-1913  -  BIT DRL 3.5MM BCMPS PUSHLOCK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1915FT-2","SUP","HCPCS C1713","","AR-1915FT-2  -  ANCHOR SUT 1 2.3MM .5 CRC 2 DMD PT FT 3.5MM 2.5MM 26.5MM","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1915S","SUP","HCPCS C1713","","AR-1915S  -  ANCHOR SUT 2 3.5MM 12MM STRL CRKSCR BABSR ST TI ROTR CUF","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$202.50 ","$0.00 ","$93.79 ","$0.00 ","$0.00 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"AR-1915SF","SUP","HCPCS C1713","","AR-1915SF  -  ANCHOR SUT 2 3.5MM 12MM STRL CSCR FWR ST SUT EYLT TI ROTR","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-1915SNF","SUP","HCPCS C1713","","AR-1915SNF  -  ANCHOR SUTURE 2.3MM 0 SHORT .5 CIR 2 DIAMOND POINT 3.5MM","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"AR-1920BF","SUP","HCPCS C1713","","AR-1920BF  -  BIOCRKSCRW SUTR ANCH 5MM W/2 #2 FW","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$135.48 ","$0.00 ","$0.00 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"AR-1920BFT","SUP","HCPCS C1713","","AR-1920BFT  -  ANCHOR SUT 2 5MM 17.9MM STRL BCSCR TGRL BABSR BRD HNDL","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"AR-1920BNF","SUP","HCPCS C1713","","AR-1920BNF  -  ANCHOR SUT 2 3/8 CRC 5MM 26MM STRL 17.9MM BCSCR FWR BABSR","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"AR-1920NSF","SUP","HCPCS C1713","","AR-1920NSF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR BRD NDL ROTR CUF DISP","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$241.88 ","$0.00 ","$112.03 ","$0.00 ","$0.00 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"AR-1920S","SUP","HCPCS C1713","","AR-1920S  -  ANCHOR SUT 2 5MM 15.5MM STRL CRKSCR BRD HNDL INSRTR TI ROTR","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$202.50 ","$0.00 ","$93.79 ","$0.00 ","$0.00 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"AR-1920SF","SUP","HCPCS C1713","","AR-1920SF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR HNDL INSRTR TI ROTR","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-1920SNF","SUP","HCPCS C1713","","AR-1920SNF  -  ANCHOR SUT 2 5MM 15MM STRL CSCR FWR BABSR HNDL INSRTR NDL","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"AR-1922BC","SUP","HCPCS C1713","","AR-1922BC  -  ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK BCMPS DISP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-1922BCM","SUP","HCPCS C1713","","AR-1922BCM  -  ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH BCMPS DISP","BOTH IP/OP","$1,037.50 ","$767.75 ","$0.00 ","$1,037.50 ","$466.88 ","$0.00 ","$216.24 ","$0.00 ","$0.00 ","$181.66 ","$1,037.50 ","$0.00 ","$518.75 ","$821.70 ","$830.00 ","$0.00 ","$162.37 ","$0.00 ","$165.17 ","$0.00 "
"AR-1922BM","SUP","HCPCS C1713","","AR-1922BM  -  ANCHOR SUT 4.5MM 28MM STRL BIO-PUSHLOCK SLF PNCH DISP","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$438.75 ","$0.00 ","$203.21 ","$0.00 ","$0.00 ","$170.71 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$152.59 ","$0.00 ","$155.22 ","$0.00 "
"AR-1922PS","SUP","HCPCS C1713","","AR-1922PS  -  ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK PEEK SHLDR DISP","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-1922PSM","SUP","HCPCS C1713","","AR-1922PSM  -  ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH PEEK DISP","BOTH IP/OP","$975.00 ","$721.50 ","$0.00 ","$975.00 ","$438.75 ","$0.00 ","$203.21 ","$0.00 ","$0.00 ","$170.71 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$152.59 ","$0.00 ","$155.22 ","$0.00 "
"AR-1923BC","SUP","HCPCS C1713","","AR-1923BC  -  ANCHOR SUTURE 2.9MM 15.5MM PUSHLOCK BIOCOMPOSITE STERILE","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-1923BCH","SUP","HCPCS C1713","","AR-1923BCH  -  ANCHOR SUT PUSHLOCK BCMPS HIP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-1923BNF","SUP","HCPCS C1713","","AR-1923BNF  -  ANCHOR SUT 3/8 CRC DMD 3.7MM 17.9MM STRL 22.2MM BCSCR FWR","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$135.48 ","$0.00 ","$0.00 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"AR-1923D","SUP","Custom 27203010","","AR-1923D  -  DRILL SRG 2.9 MM PUSHLOCK HRD BN","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923DH","SUP","Custom 27203010","","AR-1923DH  -  DRILL SRG HIP 2.9 MM PUSHLOCK","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923DHS","SUP","Custom 27203010","","AR-1923DHS  -  KIT INST 2.9MM DISP 2.9MM PUSHLOCK","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923DHT","SUP","Custom 27203010","","AR-1923DHT  -  DRILL SRG HIP HRD BN 2.9 MM PUSHLOCK","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923DS","SUP","HCPCS C1713","","AR-1923DS  -  KIT INSTR 2.9MM DRILL SPEAR METAL STERILE DISPOSABLE 2.9MM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-1923D-ST","SUP","Custom 27203010","","AR-1923D-ST  -  DRILL SRG STRL 2.9 MM PUSHLOCK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923DT","SUP","Custom 27203010","","AR-1923DT  -  DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923DT-ST","SUP","Custom 27203010","","AR-1923DT-ST  -  DRILL SRG STRL 2.9 MM PUSHLOCK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923MC","SUP","Custom 27203010","","AR-1923MC  -  CANNULA ASCP FT 2.9MM 4.5MM PUSHLOCK CRKSCR MTL REUSE","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923MCS","SUP","Custom 27203010","","AR-1923MCS  -  CANNULA ASCP 2.9MM 4.5MM PUSHLOCK CRKSCR SET MTL REUSE","BOTH IP/OP","$1,412.50 ","$1,045.25 ","$0.00 ","$1,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,412.50 ","$0.00 ","$706.25 ","$1,118.70 ","$1,130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923PHS","SUP","HCPCS C1713","","AR-1923PHS  -  ANCHOR SUT 2.9MM 15.5MM STRL PUSHLOCK PEEK HIP DISP","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-1923PK","SUP","Custom 27203010","","AR-1923PK  -  KIT ENDSCP INSTR 1.1MM 17GA 2.9MM CANNU DRILL NEEDLE PORTAL","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1923SD","SUP","Custom 27203010","","AR-1923SD  -  DRILL SRG SPD STRL 2.9MM PUSHLOCK","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1925BF","SUP","HCPCS C1713","","AR-1925BF  -  ANCHOR SUT 2 FT 6.5MM 17.9MM STRL BCSCR 2 BABSR ROTR CUF","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$292.50 ","$0.00 ","$135.48 ","$0.00 ","$0.00 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"AR-1925BNF","SUP","HCPCS C1713","","AR-1925BNF  -  ANCHOR SUT 2 6.5MM 17.9MM STRL BCSCR FWR 2 BRD BABSR MLD","BOTH IP/OP","$675.00 ","$499.50 ","$0.00 ","$675.00 ","$303.75 ","$0.00 ","$140.69 ","$0.00 ","$0.00 ","$118.19 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$105.64 ","$0.00 ","$107.46 ","$0.00 "
"AR-1925SF","SUP","HCPCS C1713","","AR-1925SF  -  ANCHOR SUT 2 6.5MM 15.5MM STRL CSCR FWR 2 BABSR HNDL INSRTR","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-1926BC","SUP","HCPCS C1713","","AR-1926BC  -  ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK BCMPS DISP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-1926BH","SUP","HCPCS C1713","","AR-1926BH  -  ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-1926DHS","SUP","Custom 27203010","","AR-1926DHS  -  KIT INST DISP 3.5MM PUSHLOCK","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1926DS-2","SUP","Custom 27203010","","AR-1926DS-2  -  KIT INST OFST DRL GD 3.5MM PUSHLOCK","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1926MC","SUP","Custom 27203010","","AR-1926MC  -  CANNULA ASCP PUSHLOCK MTL","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1926PHS","SUP","HCPCS C1713","","AR-1926PHS  -  ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-1926PS","SUP","HCPCS C1713","","AR-1926PS  -  ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK PEEK ROTR CUF DISP","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-1927BCF","SUP","HCPCS C1713","","AR-1927BCF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR TIGERWIRE 2 DRV","BOTH IP/OP","$4,062.50 ","$3,006.25 ","$0.00 ","$4,062.50 ","$1,828.13 ","$0.00 ","$846.73 ","$0.00 ","$0.00 ","$711.31 ","$4,062.50 ","$0.00 ","$2,031.25 ","$3,217.50 ","$3,250.00 ","$0.00 ","$635.78 ","$0.00 ","$646.75 ","$0.00 "
"AR-1927BCF-3","SUP","HCPCS C1713","","AR-1927BCF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 BCMPS DISP","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$382.50 ","$0.00 ","$177.16 ","$0.00 ","$0.00 ","$148.83 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$133.03 ","$0.00 ","$135.32 ","$0.00 "
"AR-1927BCF-45","SUP","HCPCS C1713","","AR-1927BCF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR FWR 2 BCMPS DISP","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-1927BCF-65","SUP","HCPCS C1713","","AR-1927BCF-65  -  ANCHOR SUT 2 FT 6.5MM 14.7MM STRL CSCR FWR 2 VNT BCMPS DISP","BOTH IP/OP","$837.50 ","$619.75 ","$0.00 ","$837.50 ","$376.88 ","$0.00 ","$174.56 ","$0.00 ","$0.00 ","$146.64 ","$837.50 ","$0.00 ","$418.75 ","$663.30 ","$670.00 ","$0.00 ","$131.07 ","$0.00 ","$133.33 ","$0.00 "
"AR-1927BCFT","SUP","HCPCS C1713","","AR-1927BCFT  -  ANCHOR SUTURE 2 SQUARE FULTHD 5.5MM 14.7MM DRIVE MECHANISM","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1927BCFT-45","SUP","HCPCS C1713","","AR-1927BCFT-45  -  ANCHOR SUT 2 SQ FT 4.5MM 14.7MM STRL CRKSCR TGTL DRV MECH","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$388.13 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"AR-1927BCNF","SUP","HCPCS C1713","","AR-1927BCNF  -  ANCHOR SUTURE 2 FULTHD 5.5MM 14.7MM 2 4 NEEDLE CORKSCREW","BOTH IP/OP","$837.50 ","$619.75 ","$0.00 ","$1,197.50 ","$538.88 ","$0.00 ","$174.56 ","$0.00 ","$0.00 ","$209.67 ","$1,197.50 ","$0.00 ","$598.75 ","$948.42 ","$958.00 ","$0.00 ","$187.41 ","$0.00 ","$190.64 ","$0.00 "
"AR-1927BCNF-45","SUP","HCPCS C1713","","AR-1927BCNF-45  -  ANCHOR SUT 4.5MM BCMPS CRKSCR FT NDL","BOTH IP/OP","$837.50 ","$619.75 ","$0.00 ","$837.50 ","$376.88 ","$0.00 ","$174.56 ","$0.00 ","$0.00 ","$146.64 ","$837.50 ","$0.00 ","$418.75 ","$663.30 ","$670.00 ","$0.00 ","$131.07 ","$0.00 ","$133.33 ","$0.00 "
"AR-1927BCT","SUP","HCPCS C1713","","AR-1927BCT  -  ANCHOR SUT FT 1.3MM 5.5MM 14.7MM BLK BLU WHT CRKSCR","BOTH IP/OP","$4,437.50 ","$3,283.75 ","$0.00 ","$4,437.50 ","$1,996.88 ","$0.00 ","$924.89 ","$0.00 ","$0.00 ","$776.97 ","$4,437.50 ","$0.00 ","$2,218.75 ","$3,514.50 ","$3,550.00 ","$0.00 ","$694.47 ","$0.00 ","$706.45 ","$0.00 "
"AR-1927BF","SUP","HCPCS C1713","","AR-1927BF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1927BF-3","SUP","HCPCS C1713","","AR-1927BF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 3 PLAY BABSR VNT","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"AR-1927BF-45","SUP","HCPCS C1713","","AR-1927BF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR FWR 2 POLY L LACTD CO","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1927BF-65","SUP","HCPCS C1713","","AR-1927BF-65  -  ANCHOR SUT 2 FT 6.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-1927BFC","SUP","HCPCS C1713","","AR-1927BFC  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR FIBERCHAIN BABSR","BOTH IP/OP","$787.50 ","$582.75 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$164.13 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"AR-1927BFS","SUP","HCPCS C1713","","AR-1927BFS  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR SCRPN BABSR NDL DISP","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-1927BFT-45","SUP","HCPCS C1713","","AR-1927BFT-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR TGRL POLY L LACTD CO D","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1927BNF","SUP","HCPCS C1713","","AR-1927BNF  -  ANCHOR SUT 2 .5 CRC FT 5.5MM 14.7MM STRL 26MM BCSCR FWR 2 4","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-1927BNF-45","SUP","HCPCS C1713","","AR-1927BNF-45  -  ANCHOR SUT 2 .5 CRC FT 4.5MM 14MM STRL 26MM BCSCR FWR 2 4","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-1927PBS","SUP","HCPCS C1713","","AR-1927PBS  -  PUNCH ARTHRO STERILE DISPOSABLE 5.5 CORKSCREW FULTHD","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-1927PNF","SUP","HCPCS C1713","","AR-1927PNF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 BRD 4 NDL PEEK","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-1927PNF-45","SUP","HCPCS C1713","","AR-1927PNF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM BLU W/B STRL CSCR FWR 2 BRD 4 NDL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$502.50 ","$226.13 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"AR-1927PSF","SUP","HCPCS C1713","","AR-1927PSF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 PEEK DISP","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-1927PSF-3","SUP","HCPCS C1713","","AR-1927PSF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 PEEK SHLDR DISP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"AR-1927PSF-45","SUP","HCPCS C1713","","AR-1927PSF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM BLK BLU WHT STRL CSCR FWR 2 PEEK","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$820.00 ","$369.00 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$143.58 ","$820.00 ","$0.00 ","$410.00 ","$649.44 ","$656.00 ","$0.00 ","$128.33 ","$0.00 ","$130.54 ","$0.00 "
"AR-1927PSF-65","SUP","HCPCS C1713","","AR-1927PSF-65  -  ANCHOR SUT 2 FT 6.5MM STRL CSCR FWR 2 PEEK DISP","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-1928SF","SUP","HCPCS C1713","","AR-1928SF  -  ANCHOR SUT 2 FT 5.5MM 15MM STRL CSCR2 FWR","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"AR-1928SF-2","SUP","HCPCS C1713","","AR-1928SF-2  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR TI DISP","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"AR-1928SF-3","SUP","HCPCS C1713","","AR-1928SF-3  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR 3 TI DISP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$275.63 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"AR-1928SF-45","SUP","HCPCS C1713","","AR-1928SF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR2 FWR 2 TI DISP","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"AR-1928SFT-2","SUP","HCPCS C1713","","AR-1928SFT-2  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CRKSCR II TGTL TI","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-1928SNF","SUP","HCPCS C1713","","AR-1928SNF  -  ANCHOR SUT 2 5.5MM 26MM STRL CSCR FWR TI ROTR CUF DISP","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$286.88 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$111.62 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$99.77 ","$0.00 ","$101.49 ","$0.00 "
"AR1928SNF-2","SUP","HCPCS C1713","","AR1928SNF-2  -  ANCHOR SUT 5.5MM 2 .5 CRC FT DMD CSCR2 FWR ROTR CUF 2 KNT","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$286.88 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$111.62 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$99.77 ","$0.00 ","$101.49 ","$0.00 "
"AR-1928SNF-2","SUP","HCPCS C1713","","AR-1928SNF-2  -  ANCHOR SUTURE 2 .5 CIR FULTHD DIAMOND 5.5MM 16MM 26MM 2 KNOT","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$286.88 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$111.62 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$99.77 ","$0.00 ","$101.49 ","$0.00 "
"AR-1929SF-3","SUP","HCPCS C1713","","AR-1929SF-3  -  SUTURE ANCHOR, CORKSCREW FT III","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$275.63 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"AR-1931S","SUP","Custom 27203010","","AR-1931S  -  REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934-20DS","SUP","Custom 27203010","","AR-1934-20DS  -  KIT INST 2MM SUT TK ANCH DRL SPR TROC DISP","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934-24DS","SUP","Custom 27203010","","AR-1934-24DS  -  KIT ESCP INST 2.4MM BSUT TK ANCH SPR STP DRL DISP ASCP","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934BCF","SUP","HCPCS C1713","","AR-1934BCF  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK FBRWR BCMPS DISP","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1934BCF-2","SUP","HCPCS C1713","","AR-1934BCF-2  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TIGERWIRE FBRWR BCMPS","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"AR-1934BCF-20","SUP","HCPCS C1713","","AR-1934BCF-20  -  ANCHOR SUT 1 MN 2MM 12MM STRL SUT TK FBRWR BCMPS","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1934BCF-24","SUP","HCPCS C1713","","AR-1934BCF-24  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP","BOTH IP/OP","$762.50 ","$564.25 ","$0.00 ","$762.50 ","$343.13 ","$0.00 ","$158.92 ","$0.00 ","$0.00 ","$133.51 ","$762.50 ","$0.00 ","$381.25 ","$603.90 ","$610.00 ","$0.00 ","$119.33 ","$0.00 ","$121.39 ","$0.00 "
"AR-1934BCF-24-2","SUP","HCPCS C1713","","AR-1934BCF-24-2  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"AR-1934BCFT","SUP","HCPCS C1713","","AR-1934BCFT  -  ANCHOR SUTURE 2 3MM 14.5MM SUTURETAK TIGERTAIL BIOCOMPOSITE","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-1934BCFT-2","SUP","HCPCS C1713","","AR-1934BCFT-2  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TGTL BCMPS DISP","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$382.50 ","$0.00 ","$177.16 ","$0.00 ","$0.00 ","$148.83 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$133.03 ","$0.00 ","$135.32 ","$0.00 "
"AR-1934BF","SUP","HCPCS C1713","","AR-1934BF  -  ANCHOR SUT 2 3MM 14.5MM STRL BSUT TK FBRWR BABSR PUSH IN","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$275.63 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"AR-1934BFT","SUP","HCPCS C1713","","AR-1934BFT  -  ANCHOR SUTURE 3MM 2 BSUT TK TGTL ROTR CUF BABSR ARTHRO 14MM","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$298.13 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"AR-1934D-20","SUP","Custom 27203010","","AR-1934D-20  -  DRILL SRG 2 MM SUT TK","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934D-20-1","SUP","Custom 27203010","","AR-1934D-20-1  -  DRILL SRG 2 MM SUT TK HRD BN","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934D-24","SUP","Custom 27203010","","AR-1934D-24  -  DRILL SRG STP DISP 2.4MM SUT TK","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934D-24-1","SUP","Custom 27203010","","AR-1934D-24-1  -  DRILL SRG 2.6MM 2.4MM SUT TK","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934D-24-2","SUP","Custom 27203010","","AR-1934D-24-2  -  DRILL SRG 2.6MM 2.4MM SUT TK","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934DHS-2","SUP","Custom 27203010","","AR-1934DHS-2  -  KIT INST HIP DISP 3MM SUT TK","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934DS-2","SUP","Custom 27203010","","AR-1934DS-2  -  KIT INST STRL GD SPR STP DRL TROC DISP 3MM SUT TK","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934PF-20","SUP","HCPCS C1713","","AR-1934PF-20  -  ANCHOR SUT 1 2MM 12MM STRL SUT TK FBRWR PEEK","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-1934PF-24","SUP","HCPCS C1713","","AR-1934PF-24  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR PEEK","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-1934PI","SUP","Custom 27203010","","AR-1934PI  -  KIT INS 1.1MM 17GA 2.4MM BSUT TK DRL NDL PERC INS PRTL DIL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934PI-20","SUP","Custom 27203010","","AR-1934PI-20  -  KIT INS 1.1MM 17GA 2MM SUT TK DRL PRTL DIL SPR SPNL NDL WRE","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934PI-30","SUP","Custom 27203010","","AR-1934PI-30  -  KIT INSERTION 1.1MM 17GA 3MM STEP DRILL PORTAL DILAT SPEAR","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934PRK","SUP","Custom 27203010","","AR-1934PRK  -  KIT ASCP FX 2.4MM 4.5MM SUT TK SWIVELOCK SPR NDL GW DIL","BOTH IP/OP","$2,962.50 ","$2,192.25 ","$0.00 ","$2,962.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1934PS","SUP","HCPCS C1713","","AR-1934PS  -  ANCHOR SUT 2 3MM 12.4MM BSUT TK FBRWR PEEK","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-1934PS-2","SUP","HCPCS C1713","","AR-1934PS-2  -  ANCHOR SUT 2 3MM 12.2MM SUT TK FBRWR PEEK ROTR CUF","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$286.88 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$111.62 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$99.77 ","$0.00 ","$101.49 ","$0.00 "
"AR-1938BC","SUP","HCPCS C1713","","AR-1938BC  -  ANCHOR SUT 2 3MM 12.7MM SUT TK FBRWR KNTLS BCMPS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-1938D","SUP","Custom 27203010","","AR-1938D  -  DRILL SRG 2.6MM 3MM SUT TK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1938PS","SUP","HCPCS C1713","","AR-1938PS  -  ANCHOR SUT 2 3MM 12.7MM KNTLS SUT TK FBRWR PEEK","BOTH IP/OP","$962.50 ","$712.25 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$200.61 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"AR-1938PS-PL","SUP","HCPCS C1713","","AR-1938PS-PL  -  SUTRE ANCH PEEK S-TAK KNOTLESS 3X12.7M","BOTH IP/OP","$962.50 ","$712.25 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$200.61 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"AR-1949H-2.4","SUP","Custom 27203010","","AR-1949H-2.4  -  GUIDE DRL 2.4MM ANCH CNN SDL TROC HIP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1949H-3.0","SUP","Custom 27203010","","AR-1949H-3.0  -  GUIDE DRL 3MM ANCH CNN SDL TROC HIP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1965","SUP","Custom 27203010","","AR-1965  -  GUIDE DRL ALGTR MNSCL ALGRF","BOTH IP/OP","$5,120.00 ","$3,788.80 ","$0.00 ","$5,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,120.00 ","$0.00 ","$2,560.00 ","$4,055.04 ","$4,096.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1965G","SUP","Custom 27203010","","AR-1965G  -  GUIDE DRL DVTL TIB","BOTH IP/OP","$7,250.00 ","$5,365.00 ","$0.00 ","$7,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,250.00 ","$0.00 ","$3,625.00 ","$5,742.00 ","$5,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1966DS","SUP","Custom 27203010","","AR-1966DS  -  KIT INST ALGRF DISP","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1967A","SUP","Custom 27203010","","AR-1967A  -  CLAMP SRG ADJ SFT TIS","BOTH IP/OP","$1,510.00 ","$1,117.40 ","$0.00 ","$1,510.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,510.00 ","$0.00 ","$755.00 ","$1,195.92 ","$1,208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1967F","SUP","Custom 27203010","","AR-1967F  -  CLAMP SRG FX SFT TIS","BOTH IP/OP","$1,510.00 ","$1,117.40 ","$0.00 ","$1,510.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,510.00 ","$0.00 ","$755.00 ","$1,195.92 ","$1,208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1974","SUP","Custom 27203010","","AR-1974  -  DRILL SRG 5MM ACL 3MM PIN TRNFX","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1974L","SUP","Custom 27203010","","AR-1974L  -  DRILL SRG LNG 5MM STRL 2MM GDPN TRNFX2","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1975","SUP","Custom 27203010","","AR-1975  -  GUIDE DRL ACL RECON TIB TRNFX2","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-05S","SUP","Custom 27203010","","AR-1980-05S  -  SET GFT HRVT 6MM 5MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-06S","SUP","Custom 27203010","","AR-1980-06S  -  SET GFT HRVT 7MM 6MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-07S","SUP","Custom 27203010","","AR-1980-07S  -  SET GFT HRVT 8MM 7MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-08S","SUP","Custom 27203010","","AR-1980-08S  -  SET GFT HRVT 9MM 8MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-09S","SUP","Custom 27203010","","AR-1980-09S  -  SET GFT HRVT 10MM 9MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-10S","SUP","Custom 27203010","","AR-1980-10S  -  SET GFT HRVT 11MM 10MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1980-12SU","SUP","Custom 27203010","","AR-1980-12SU  -  SET GFT HRVT 12MM 11MM STRL OATS COLR PIN TUBE ACL DISP","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1981-04S","SUP","Custom 27203010","","AR-1981-04S  -  SET GFT HRVT 4.75MM STRL OATS ALGN ROD COR XTRDR DLV TUBE","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1981-06H","SUP","Custom 27203010","","AR-1981-06H  -  SET GFT HRVT 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1981-06S","SUP","Custom 27203010","","AR-1981-06S  -  SET GFT HRVT 7MM 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1981-08H","SUP","Custom 27203010","","AR-1981-08H  -  SET GFT HRVT 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1981-08S","SUP","Custom 27203010","","AR-1981-08S  -  SET GFT HRVT 9MM 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1981-10H","SUP","Custom 27203010","","AR-1981-10H  -  SET GFT HRVT 10MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1982-08S","SUP","Custom 27203010","","AR-1982-08S  -  SET GFT HRVT RTRGD 8MM STRL OATS DISP","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1982-10S","SUP","Custom 27203010","","AR-1982-10S  -  SET GFT HRVT RTRGD 10MM STRL OATS DISP","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-1983","SUP","HCPCS C1713","","AR-1983  -  CAP PCTV OATS CRTLG ACL","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$348.75 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"AR-1991","SUP","HCPCS C1713","","AR-1991  -  CALIBRATOR PIN OATS","BOTH IP/OP","$327.50 ","$242.35 ","$0.00 ","$327.50 ","$147.38 ","$0.00 ","$68.26 ","$0.00 ","$0.00 ","$57.34 ","$327.50 ","$0.00 ","$163.75 ","$259.38 ","$262.00 ","$0.00 ","$51.25 ","$0.00 ","$52.14 ","$0.00 "
"AR-2236B","SUP","HCPCS C1763","","AR-2236B  -  BUTTON FX 6.5MM 1MM TISSUEBUTTON HNDL INSRTR PRELD POLY L","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"AR-2238B","SUP","HCPCS C1763","","AR-2238B  -  BUTTON FX 8MM 1MM STRL TISSUEBUTTON BABSR POLY L LAC ACD SFT","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"AR-2240B","SUP","HCPCS C1763","","AR-2240B  -  BUTTON FX 5MM 10MM STRL TISSUEBUTTON POLY L LAC ACD ROTR CUF","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"AR-2253L","SUP","Custom 27203010","","AR-2253L  -  GUIDE DRL ARM LT ACJT ACJT RECON SYS","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2253R","SUP","Custom 27203010","","AR-2253R  -  GUIDE DRL ARM RT ACJT ACJT RECON SYS","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2255CG","SUP","Custom 27203010","","AR-2255CG  -  GUIDE DRL CNST ACJT","BOTH IP/OP","$4,912.50 ","$3,635.25 ","$0.00 ","$4,912.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,912.50 ","$0.00 ","$2,456.25 ","$3,890.70 ","$3,930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2257-01","SUP","HCPCS C1763","","AR-2257-01  -  BUTTON FX CLVCL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"AR-2257-02","SUP","HCPCS C1763","","AR-2257-02  -  BUTTON FX CORACOID","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"AR-2257D-24","SUP","Custom 27203010","","AR-2257D-24  -  DRILL SRG 2.4MM CNN ACML REPR","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2257D-30","SUP","Custom 27203010","","AR-2257D-30  -  DRILL SRG 3MM CNN AC REPR","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2258-03","SUP","Custom 27803010","","AR-2258-03  -  WASHER ORTH CLVCL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2260","SUP","Custom 27203010","","AR-2260  -  KIT ASCP FX STRL BTN DRL PIN INSRTR SCR","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2261","SUP","HCPCS C1763","","AR-2261  -  BUTTON SUT 12MM STRL BICEPS","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-2263","SUP","HCPCS C1763","","AR-2263  -  PIN DRL 3.2MM STRL BISCEPSBUTTON DIST DISP","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-2264","SUP","HCPCS C1713","","AR-2264  -  DEVICE FX STRL TGHTRP TWN TAIL ACJT","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-2266","SUP","HCPCS C1763","","AR-2266  -  BUTTON FX 2.6MM 10.9MM TI SHLDR PECTORALIS MN OPN REPR","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-2267","SUP","HCPCS C1763","","AR-2267  -  BUTTON FX LF INSRTR LG EYLT PECTORALIS","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-2270","SUP","HCPCS C1763","","AR-2270  -  BUTTON FX DOG BN","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"AR-2271","SUP","Custom 27203010","","AR-2271  -  KIT ASCP FX 2MM 3MM TIGERTAPE SUTLSO 2 DOG BN BTN CNN DRL","BOTH IP/OP","$2,812.50 ","$2,081.25 ","$0.00 ","$2,812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,812.50 ","$0.00 ","$1,406.25 ","$2,227.50 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2273","SUP","Custom 27203010","","AR-2273  -  GUIDE DRL ACJT ACJT RECON SYS","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2274","SUP","Custom 27203010","","AR-2274  -  CANNULA ESCP 4.7MM SLOT","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2280","SUP","HCPCS C1763","","AR-2280  -  BUTTON INSERTER/SUTURE KIT","BOTH IP/OP","$1,975.00 ","$1,461.50 ","$0.00 ","$1,975.00 ","$888.75 ","$0.00 ","$411.64 ","$0.00 ","$0.00 ","$345.81 ","$1,975.00 ","$0.00 ","$987.50 ","$1,564.20 ","$1,580.00 ","$0.00 ","$309.09 ","$0.00 ","$314.42 ","$0.00 "
"AR-2281","SUP","HCPCS C1763","","AR-2281  -  12MM BUTTON/SUTURE CONSTRUCT","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-2290","SUP","HCPCS C1713","","AR-2290  -  SET IMPLANT PROXIMAL TENODESIS BUTTON FIBERLOOP DRILL PIN","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,687.50 ","$759.38 ","$0.00 ","$351.72 ","$0.00 ","$0.00 ","$295.47 ","$1,687.50 ","$0.00 ","$843.75 ","$1,336.50 ","$1,350.00 ","$0.00 ","$264.09 ","$0.00 ","$268.65 ","$0.00 "
"AR-2291","SUP","HCPCS C1763","","AR-2291  -  BUTTON FX 0 BICEPS PROX TENODESIS","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-2323BCC","SUP","HCPCS C1713","","AR-2323BCC  -  ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET VENT SWIVELOCK C","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2323BCM","SUP","HCPCS C1713","","AR-2323BCM  -  ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SP SLF PNCH VNT BCMPS","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$472.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$183.85 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$164.33 ","$0.00 ","$167.16 ","$0.00 "
"AR-2323BCT-2","SUP","HCPCS C1713","","AR-2323BCT-2  -  ANCHOR SUT 2 5.5MM 22MM BLK BLU WHT FIBERTAK SWIVELOCK C","BOTH IP/OP","$5,312.50 ","$3,931.25 ","$0.00 ","$5,312.50 ","$2,390.63 ","$0.00 ","$1,107.26 ","$0.00 ","$0.00 ","$930.18 ","$5,312.50 ","$0.00 ","$2,656.25 ","$4,207.50 ","$4,250.00 ","$0.00 ","$831.41 ","$0.00 ","$845.75 ","$0.00 "
"AR-2323BSL","SUP","HCPCS C1713","","AR-2323BSL  -  ANCHOR SUT 5.5MM 20MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-2323BSLC","SUP","HCPCS C1713","","AR-2323BSLC  -  ANCHOR SUT 5.5MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-2323BSLM","SUP","HCPCS C1713","","AR-2323BSLM  -  ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2323PSL","SUP","HCPCS C1713","","AR-2323PSL  -  ANCHOR SUT 5.5MM 20MM SWIVELOCK PEEK","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-2323PSLC","SUP","HCPCS C1713","","AR-2323PSLC  -  ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET SWIVELOCK C","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$1,340.00 ","$603.00 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$234.62 ","$1,340.00 ","$0.00 ","$670.00 ","$1,061.28 ","$1,072.00 ","$0.00 ","$209.71 ","$0.00 ","$213.33 ","$0.00 "
"AR-2323PSLC-2","SUP","HCPCS C1713","","AR-2323PSLC-2  -  ANCHOR SUT 5.5MM STRL LF ARTHX SWIVELOCK 2 LD PEEK","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-2323PSLM","SUP","HCPCS C1713","","AR-2323PSLM  -  ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH DISP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2323SLM","SUP","HCPCS C1713","","AR-2323SLM  -  ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SLF PNCH DISP","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"AR-2324BCC","SUP","HCPCS C1713","","AR-2324BCC  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2324BCC-2","SUP","HCPCS C1713","","AR-2324BCC-2  -  ANCHOR SUT 4.75MM STRL SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP","BOTH IP/OP","$1,042.50 ","$771.45 ","$0.00 ","$1,042.50 ","$469.13 ","$0.00 ","$217.28 ","$0.00 ","$0.00 ","$182.53 ","$1,042.50 ","$0.00 ","$521.25 ","$825.66 ","$834.00 ","$0.00 ","$163.15 ","$0.00 ","$165.97 ","$0.00 "
"AR-2324BCC-CP","SUP","HCPCS C1713","","AR-2324BCC-CP  -  SET IMPL FULL 4.75MM 19.1MM SWIVELOCK C CLS EYLT VNT KN","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$1,153.13 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$448.67 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$401.03 ","$0.00 ","$407.95 ","$0.00 "
"AR-2324BCCS","SUP","HCPCS C1713","","AR-2324BCCS  -  SYSTEM ENDSCP FIX 4.75MM NEEDLE MULTIFIRE SCORPION SWIVELOCK","BOTH IP/OP","$1,600.00 ","$1,184.00 ","$0.00 ","$1,600.00 ","$720.00 ","$0.00 ","$333.48 ","$0.00 ","$0.00 ","$280.15 ","$1,600.00 ","$0.00 ","$800.00 ","$1,267.20 ","$1,280.00 ","$0.00 ","$250.40 ","$0.00 ","$254.72 ","$0.00 "
"AR-2324BCCT","SUP","HCPCS C1713","","AR-2324BCCT  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET TAPE LOOP VENT","BOTH IP/OP","$1,175.00 ","$869.50 ","$0.00 ","$1,607.50 ","$723.38 ","$0.00 ","$244.90 ","$0.00 ","$0.00 ","$281.46 ","$1,607.50 ","$0.00 ","$803.75 ","$1,273.14 ","$1,286.00 ","$0.00 ","$251.57 ","$0.00 ","$255.91 ","$0.00 "
"AR-2324BCCTT","SUP","HCPCS C1713","","AR-2324BCCTT  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C","BOTH IP/OP","$1,175.00 ","$869.50 ","$0.00 ","$1,350.00 ","$607.50 ","$0.00 ","$244.90 ","$0.00 ","$0.00 ","$236.37 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$211.28 ","$0.00 ","$214.92 ","$0.00 "
"AR-2324BCM","SUP","HCPCS C1713","","AR-2324BCM  -  ANCHOR SUTURE 4.75MM 24.5MM SELF PUNCH VENT SWIVELOCK","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,430.00 ","$643.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$250.38 ","$1,430.00 ","$0.00 ","$715.00 ","$1,132.56 ","$1,144.00 ","$0.00 ","$223.80 ","$0.00 ","$227.66 ","$0.00 "
"AR-2324BCT-2","SUP","HCPCS C1713","","AR-2324BCT-2  -  ANCHOR SUT 2 4.75MM 22MM BLK BLU WHT SWIVELOCK C FIBERTAK","BOTH IP/OP","$5,312.50 ","$3,931.25 ","$0.00 ","$5,312.50 ","$2,390.63 ","$0.00 ","$1,107.26 ","$0.00 ","$0.00 ","$930.18 ","$5,312.50 ","$0.00 ","$2,656.25 ","$4,207.50 ","$4,250.00 ","$0.00 ","$831.41 ","$0.00 ","$845.75 ","$0.00 "
"AR-2324BSL","SUP","HCPCS C1713","","AR-2324BSL  -  ANCHOR SUT 4.75MM 20MM STRL BIO-SWIVELOCK DISP","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-2324BSLC","SUP","HCPCS C1713","","AR-2324BSLC  -  ANCHOR SUT 4.75MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-2324PCT","SUP","HCPCS C1713","","AR-2324PCT  -  ANCHOR SUT 4.75MM 19.1MM BLU STRL SWIVELOCK C FIBERTAPE CLS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-2324PCTT","SUP","HCPCS C1713","","AR-2324PCTT  -  ANCHOR SUT 4.75MM 19.1MM B/W STRL SWIVELOCK C TIGERTAPE CLS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-2324PSLC","SUP","HCPCS C1713","","AR-2324PSLC  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK PEEK","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$1,340.00 ","$603.00 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$234.62 ","$1,340.00 ","$0.00 ","$670.00 ","$1,061.28 ","$1,072.00 ","$0.00 ","$209.71 ","$0.00 ","$213.33 ","$0.00 "
"AR-2324PSLC-2","SUP","HCPCS C1713","","AR-2324PSLC-2  -  ANCHOR SUT 4.75MM STRL LF ARTHX SWIVELOCK 2 LD PEEK","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-2324PSLM","SUP","HCPCS C1713","","AR-2324PSLM  -  ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT PEEK","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2324SLM","SUP","HCPCS C1713","","AR-2324SLM  -  ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT TI DISP","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"AR-2325BCC","SUP","HCPCS C1713","","AR-2325BCC  -  BIO-COMP SWVLK 3.5X 15.8MM","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2325D","SUP","Custom 27203010","","AR-2325D  -  DRILL SRG 3.5 MM SWIVELLOCK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2325D-ST","SUP","Custom 27203010","","AR-2325D-ST  -  DRILL SRG STRL 3.5 MM LABRAL SWIVELOCK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2325PSLC","SUP","HCPCS C1713","","AR-2325PSLC  -  ANCHOR SUT 3.5MM 14.8MM SWIVELOCK VNT PEEK-OPTM","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"AR-2374","SUP","Custom 27203010","","AR-2374  -  5.1MM CANNULATED REAMER WITH STOP","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2511","SUP","Custom 27203010","","AR-2511  -  GUIDE DRL SHLDR PERC REUSE PNG SYS","BOTH IP/OP","$1,937.50 ","$1,433.75 ","$0.00 ","$1,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,937.50 ","$0.00 ","$968.75 ","$1,534.50 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2512","SUP","Custom 27203010","","AR-2512  -  GUIDE DRL PRLL SHLDR PERC REUSE PNG SYS","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2528","SUP","Custom 27203010","","AR-2528  -  DRILL SRG 3.2MM CNN SHLDR PERC DISP PNG SYS","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2600SBS-6","SUP","HCPCS C1713","","AR-2600SBS-6  -  SYSTEM FX 4.75MM BLK BLU WHT SPEEDBRIDGE SWIVELOCK FIBERTAPE","BOTH IP/OP","$4,000.00 ","$2,960.00 ","$0.00 ","$4,000.00 ","$1,800.00 ","$0.00 ","$833.70 ","$0.00 ","$0.00 ","$700.37 ","$4,000.00 ","$0.00 ","$2,000.00 ","$3,168.00 ","$3,200.00 ","$0.00 ","$626.00 ","$0.00 ","$636.80 ","$0.00 "
"AR-2622DL","SUP","HCPCS C1713","","AR-2622DL  -  PLATE BN 22MM CLVCL LT DIST","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2622DR","SUP","HCPCS C1713","","AR-2622DR  -  PLATE BN 22D STRL ARTHX CLVCL RT DIST","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2650CL","SUP","HCPCS C1713","","AR-2650CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2650CR","SUP","HCPCS C1713","","AR-2650CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2651CL","SUP","HCPCS C1713","","AR-2651CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2651CR","SUP","HCPCS C1713","","AR-2651CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2652CL","SUP","HCPCS C1713","","AR-2652CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2652CR","SUP","HCPCS C1713","","AR-2652CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2653CL","SUP","HCPCS C1713","","AR-2653CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2653CR","SUP","HCPCS C1713","","AR-2653CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2654CL","SUP","HCPCS C1713","","AR-2654CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2654CR","SUP","HCPCS C1713","","AR-2654CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2655CL","SUP","HCPCS C1713","","AR-2655CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2655CR","SUP","HCPCS C1713","","AR-2655CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2656DL","SUP","HCPCS C1713","","AR-2656DL  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2656DR","SUP","HCPCS C1713","","AR-2656DR  -  PLATE BN SHRT PRECONTOUR LOPRFL LCK CMPR HL SS CLVCL RT DIST","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2657DL","SUP","HCPCS C1713","","AR-2657DL  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2657DR","SUP","HCPCS C1713","","AR-2657DR  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2658","SUP","HCPCS C1713","","AR-2658  -  BUTTON FX CMPR SLOT PLT SEAT FLSH SS CLVCL DIST","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$393.75 ","$0.00 ","$182.37 ","$0.00 ","$0.00 ","$153.21 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$136.94 ","$0.00 ","$139.30 ","$0.00 "
"AR-2664L","SUP","Custom 27203010","","AR-2664L  -  GUIDE DRL PLT SCR CLVCL LT DIST","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2664R","SUP","Custom 27203010","","AR-2664R  -  GUIDE DRL PLT SCR CLVCL RT DIST","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2665-10H","SUP","HCPCS C1713","","AR-2665-10H  -  SCREW BN HEXALOBE 2.5MM 10MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-12H","SUP","HCPCS C1713","","AR-2665-12H  -  SCREW BN HEXALOBE 2.5MM 12MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-14H","SUP","HCPCS C1713","","AR-2665-14H  -  SCREW BN HEXALOBE 2.5MM 14MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-16H","SUP","HCPCS C1713","","AR-2665-16H  -  SCREW BN HEXALOBE 2.5MM 16MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-18H","SUP","HCPCS C1713","","AR-2665-18H  -  SCREW BN HEXALOBE 2.5MM 18MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-20H","SUP","HCPCS C1713","","AR-2665-20H  -  SCREW BN HEXALOBE 2.5MM 20MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-22H","SUP","HCPCS C1713","","AR-2665-22H  -  SCREW BN HEXALOBE 2.5MM 22MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2665-24H","SUP","HCPCS C1713","","AR-2665-24H  -  SCREW BN HEXALOBE 2.5MM 24MM HRBRT 2 PTCH SS ELB SHLDR SM","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-2668","SUP","Custom 27203010","","AR-2668  -  GUIDE DRL LCK SLV 2.7 MM SCR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2669","SUP","Custom 27203010","","AR-2669  -  GUIDE DRL LCK DIST 2.7 MM SCR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2680ST","SUP","HCPCS C1713","","AR-2680ST  -  PLATE BN PRECONTOUR FX 7 HL SS CLVCL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2685DR-10","SUP","HCPCS C1713","","AR-2685DR-10  -  PLATE BN 10 HL LOPRFL PRECONTOUR CMPR SLOT SS CLVCL RT DIST","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-2810-20","SUP","Custom 27203010","","AR-2810-20  -  PARTIAL ECLIPSE HUMERAL REAMER","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810-25","SUP","Custom 27203010","","AR-2810-25  -  PARTIAL ECLIPSE HUMERAL REAMER","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810F-18-5","SUP","Custom 27203010","","AR-2810F-18-5  -  PARTIAL ECLIPSE GLENOID REAMER","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810F-20-5","SUP","Custom 27203010","","AR-2810F-20-5  -  PARTIAL ECLIPSE GLENOID REAMER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810F-22-5","SUP","Custom 27203010","","AR-2810F-22-5  -  PARTIAL ECLIPSE GLENOID REAMER","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810R-20-5","SUP","Custom 27203010","","AR-2810R-20-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810R-25-5","SUP","Custom 27203010","","AR-2810R-25-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2810R-30-5","SUP","Custom 27203010","","AR-2810R-30-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2820","SUP","Custom 27203010","","AR-2820  -  GUIDE DRL PRT ECLPS STEMLESS SHLDR ARTHPL","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2922BC","SUP","HCPCS C1713","","AR-2922BC  -  ANCHOR SUT 2.4MM 11.3MM PUSHLOCK BCMPS 1 FBRWR 2 FIBERLINK","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-2922D-24-1","SUP","Custom 27203010","","AR-2922D-24-1  -  DRILL SRG 2.4 MM PUSHLOCK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2922PS","SUP","HCPCS C1713","","AR-2922PS  -  ANCHOR SUT 2.4MM 14MM STRL PUSHLOCK CNN EYLT HNDL INSRTR","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-2923BC","SUP","HCPCS C1713","","AR-2923BC  -  ANCHOR SUTURE SHORT 2.9MM 12.5MM CANN EYELET HANDLE INSERTER","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,430.00 ","$643.50 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$250.38 ","$1,430.00 ","$0.00 ","$715.00 ","$1,132.56 ","$1,144.00 ","$0.00 ","$223.80 ","$0.00 ","$227.66 ","$0.00 "
"AR-2923BCH","SUP","HCPCS C1713","","AR-2923BCH  -  SUTR ANCH HIP BIO-COMP P-LCK 2.9X12.5MM","BOTH IP/OP","$1,050.00 ","$777.00 ","$0.00 ","$1,050.00 ","$472.50 ","$0.00 ","$218.85 ","$0.00 ","$0.00 ","$183.85 ","$1,050.00 ","$0.00 ","$525.00 ","$831.60 ","$840.00 ","$0.00 ","$164.33 ","$0.00 ","$167.16 ","$0.00 "
"AR-2923D","SUP","Custom 27203010","","AR-2923D  -  DRILL SRG BCMPS 2.9 MM SHRT PUSHLOCK","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2923DHT","SUP","Custom 27203010","","AR-2923DHT  -  DRILL SRG HIP SHRT 2.9 MM PUSHLOCK HRD BN","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2923D-ST","SUP","Custom 27203010","","AR-2923D-ST  -  DRILL SRG STRL ELB SHLDR 2.9 MM SHRT PUSHLOCK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2923DT","SUP","Custom 27203010","","AR-2923DT  -  DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2923DT-ST","SUP","Custom 27203010","","AR-2923DT-ST  -  DRILL SRG STRL 2.9 MM SHRT PUSHLOCK HRD BN","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2923PHS","SUP","HCPCS C1713","","AR-2923PHS  -  ANCHOR SUT SHRT 2.9MM 12.5MM PUSHLOCK PEEK HIP","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$427.50 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$166.34 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$148.68 ","$0.00 ","$151.24 ","$0.00 "
"AR-2923PS","SUP","HCPCS C1713","","AR-2923PS  -  ANCHOR SUT SHRT 2.9MM 12.5MM STRL PUSHLOCK CNN PEEK","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-2950SC","SUP","Custom 27203010","","AR-2950SC  -  CLAMP SRG GRAFTPRO SFT TIS","BOTH IP/OP","$1,492.50 ","$1,104.45 ","$0.00 ","$1,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,492.50 ","$0.00 ","$746.25 ","$1,182.06 ","$1,194.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-2962","SUP","Custom 27203010","","AR-2962  -  GUIDE DRL DVTL ALGRF MNSCS","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3400H-4.5","SUP","Custom 27203010","","AR-3400H-4.5  -  CANNULA ASCP HIP LGTH TPR 4.5MM BLNT FENESTRATE QCK CNCT LCK","BOTH IP/OP","$869.55 ","$643.47 ","$0.00 ","$869.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$869.55 ","$0.00 ","$434.78 ","$688.68 ","$695.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3400H-5.0","SUP","Custom 27203010","","AR-3400H-5.0  -  CANNULA ASCP HIP LGTH TPR 5MM BLNT FENESTRATE QCK CNCT LCK","BOTH IP/OP","$869.55 ","$643.47 ","$0.00 ","$869.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$869.55 ","$0.00 ","$434.78 ","$688.68 ","$695.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3400H-5.5","SUP","Custom 27203010","","AR-3400H-5.5  -  CANNULA ASCP HIP LGTH TPR 5.5MM BLNT FENESTRATE QCK CNCT LCK","BOTH IP/OP","$869.55 ","$643.47 ","$0.00 ","$869.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$869.55 ","$0.00 ","$434.78 ","$688.68 ","$695.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3400H-6.5","SUP","Custom 27203010","","AR-3400H-6.5  -  CANNULA ASCP HIP LGTH TPR 6.5MM BLNT FENESTRATE QCK CNCT LCK","BOTH IP/OP","$869.55 ","$643.47 ","$0.00 ","$869.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$869.55 ","$0.00 ","$434.78 ","$688.68 ","$695.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3490HQC","SUP","Custom 27203010","","AR-3490HQC  -  CANNULA ASCP STD HIP LGTH HUB QCK CNCT","BOTH IP/OP","$670.73 ","$496.34 ","$0.00 ","$670.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$670.73 ","$0.00 ","$335.36 ","$531.22 ","$536.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3600-2","SUP","HCPCS C1713","","AR-3600-2  -  ANCHOR SUT 2 FIBERTAK FBRWR CLS EYLT","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$382.50 ","$0.00 ","$177.16 ","$0.00 ","$0.00 ","$148.83 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$133.03 ","$0.00 ","$135.32 ","$0.00 "
"AR-3600D-1","SUP","Custom 27203010","","AR-3600D-1  -  DRILL SRG 1.6MM FIBERTAK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3600DS","SUP","HCPCS C1713","","AR-3600DS  -  ANCHOR SUT STRL LF ARTHX FIBERTAK DRL SPR OBT DISP","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$585.00 ","$0.00 ","$270.95 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"AR-3600ND-3","SUP","Custom 27203010","","AR-3600ND-3  -  DRILL SRG 1.7MM FLXB FIBERTAK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-3601","SUP","HCPCS C1713","","AR-3601  -  KNOTLESS FIBERTAK SUTURE ANCHOR, 1.5MM","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-3602-2","SUP","HCPCS C1713","","AR-3602-2  -  ANCHOR SUT 1.3MM BLU WHT FIBERTAK SUTURETAPE 2 LD","BOTH IP/OP","$925.00 ","$684.50 ","$0.00 ","$925.00 ","$416.25 ","$0.00 ","$192.79 ","$0.00 ","$0.00 ","$161.96 ","$925.00 ","$0.00 ","$462.50 ","$732.60 ","$740.00 ","$0.00 ","$144.76 ","$0.00 ","$147.26 ","$0.00 "
"AR-3603-2","SUP","HCPCS C1713","","AR-3603-2  -  ANCHOR SUT 2 FIBERTAK TGTL 2 LD","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$382.50 ","$0.00 ","$177.16 ","$0.00 ","$0.00 ","$148.83 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$133.03 ","$0.00 ","$135.32 ","$0.00 "
"AR-3651T","SUP","HCPCS C1713","","AR-3651T  -  ANCHOR SUT 2 BLK GRN/WHT FIBERTAK TGTL LABRALTAPE 2 ROW","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"AR-3651TT","SUP","HCPCS C1713","","AR-3651TT  -  ANCHOR SUT 2 BLK BLU WHT FIBERTAK TGTL LABRALTAPE 2 ROW","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"AR-4007JS","SUP","Custom 27203010","","AR-4007JS  -  SET GFT PREP MNS DRT JSTK","BOTH IP/OP","$1,300.00 ","$962.00 ","$0.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4008","SUP","Custom 27203010","","AR-4008  -  PROBE ASCP STRL MNS DRT MSR DISP","BOTH IP/OP","$117.50 ","$86.95 ","$0.00 ","$117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.50 ","$0.00 ","$58.75 ","$93.06 ","$94.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4045","SUP","Custom 27203010","","AR-4045  -  CANNULA ASCP STRL MNS DRT OBT DISP","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065-45L","SUP","Custom 27203010","","AR-4065-45L  -  PASSER SUT 45D CRV LT STRL CRKSCR SUTLSO DISP ASCP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065-45R","SUP","Custom 27203010","","AR-4065-45R  -  PASSER SUT 45D RT CRV STRL CRKSCR SUTLSO DISP ASCP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065-90S","SUP","Custom 27203010","","AR-4065-90S  -  PASSER SUT 90D 2.3MM STRL SUTLSO NTNL ELB SHLDR DISP ASCP","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065-90W","SUP","Custom 27203010","","AR-4065-90W  -  PASSER SUT 90D 2.3MM STRL SUTLSO WRE LOOP NTNL ELB SHLDR","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065B","SUP","Custom 27203010","","AR-4065B  -  PASSER SUT UNV BNA 2.3MM STRL SUTLSO ROTR CUF NTNL DISP ASCP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065H","SUP","HCPCS C1713","","AR-4065H  -  ANCHOR SUT 45D LASSO HIP","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-4065S","SUP","Custom 27203010","","AR-4065S  -  PASSER SUT 45D CRV STRL SUTLSO NTNL DISP ASCP","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4065W","SUP","Custom 27203010","","AR-4065W  -  PASSER SUT 45D 2.3MM STRL SUTLSO WRE LOOP NTNL DISP ASCP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-05SD","SUP","Custom 27203010","","AR-4068-05SD  -  PASSER SUT 1.8MM 3.8MM STRL SUTLSO SD WIRELOOP NTNL ASCP","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-25TL","SUP","Custom 27203010","","AR-4068-25TL  -  PASSER SUTURE 25D TIGHT LEFT CURVE 1.8MM 3.8MM SUTURELASSO","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-25TLF","SUP","Custom 27203010","","AR-4068-25TLF  -  PASSER SUT 25D TIGHT LT CRV 1.8MM 3.8MM STRL SUTLSO SD","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-25TR","SUP","Custom 27203010","","AR-4068-25TR  -  PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD THB","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-25TRF","SUP","Custom 27203010","","AR-4068-25TRF  -  PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD","BOTH IP/OP","$445.00 ","$329.30 ","$0.00 ","$445.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$445.00 ","$0.00 ","$222.50 ","$352.44 ","$356.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-30","SUP","Custom 27203010","","AR-4068-30  -  PASSER SUT 30D STRG 1.8MM 3.8MM STRL SUTLSO SD THB PD NTNL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-45L","SUP","Custom 27203010","","AR-4068-45L  -  PASSER SUTURE 45D LEFT CURVE 1.8MM 3.8MM THUMB PAD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-45LH","SUP","Custom 27203010","","AR-4068-45LH  -  PASSER SUT 45D LT CRV STRL SUTLSO DISP HIP ASCP","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-45R","SUP","Custom 27203010","","AR-4068-45R  -  PASSER SUTURE 45D RIGHT CURVE 1.8MM 3.8MM THUMB PAD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-45RH","SUP","Custom 27203010","","AR-4068-45RH  -  PASSER SUT 45D RT CRV STRL SUTLSO DISP HIP ASCP","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-90","SUP","Custom 27203010","","AR-4068-90  -  PASSER SUTURE 90D UP STR 1.8MM 3.8MM THUMB PAD SUTURELASSO","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-90H","SUP","Custom 27203010","","AR-4068-90H  -  PASSER SUT 90D STRG STRL SUTLSO DISP HIP ASCP","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-90L","SUP","Custom 27203010","","AR-4068-90L  -  PASSER SUTURE 90D LEFT CURVE 1.8MM 3.8MM THUMB PAD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068-90R","SUP","Custom 27203010","","AR-4068-90R  -  PASSER SUTURE 90D RIGHT CURVE 1.8MM 3.8MM THUMB PAD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068C","SUP","Custom 27203010","","AR-4068C  -  PASSER SUTURE SMALL CRESCENT 1.8MM 3.8MM THUMB PAD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4068CH","SUP","Custom 27203010","","AR-4068CH  -  PASSER SUT CRSNT STRL SUTLSO DISP HIP ASCP","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4070-01","SUP","Custom 27203010","","AR-4070-01  -  PROBE ASCP 60D 220MM MSR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4070-70S","SUP","Custom 27203010","","AR-4070-70S  -  PROBE ASCP 70D STRL MSR MP KN DISP","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$395.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$395.00 ","$0.00 ","$197.50 ","$312.84 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4151B","SUP","HCPCS C1713","","AR-4151B  -  PIN DRL 1.5MM 100MM STRL TRMIT DISP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-4151DS","SUP","HCPCS C1713","","AR-4151DS  -  KIT INST 1.5MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-4152B","SUP","HCPCS C1713","","AR-4152B  -  PIN DRL 2MM 100MM STRL TRMIT DISP","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"AR-4152DS","SUP","HCPCS C1713","","AR-4152DS  -  KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-4152MS","SUP","HCPCS C1713","","AR-4152MS  -  PIN DRL 2MM 100MM STRL TRMIT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"AR-4154P-3010","SUP","HCPCS C1713","","AR-4154P-3010  -  KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART RDLCNT INSRTR DRL","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-4154PS-3000","SUP","HCPCS C1713","","AR-4154PS-3000  -  KIT TRMA FX STRG 2.5MM 30MM STRL PIP DART INSRTR DRL GW TROC","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-4154PS-3010","SUP","HCPCS C1713","","AR-4154PS-3010  -  KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART INSRTR DRL GW BRB","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-4155P-3010","SUP","HCPCS C1713","","AR-4155P-3010  -  KIT TRMA FX 10D 3MM 30MM STRL PIP DART RDLCNT INSRTR DRL GW","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-4155PS-3010","SUP","HCPCS C1713","","AR-4155PS-3010  -  KIT TRMA FX 10D 3MM 30MM STRL PIP DART INSRTR DRL GW TROC","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-4156DS","SUP","HCPCS C1713","","AR-4156DS  -  KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"AR-4160-20","SUP","Custom 27203010","","AR-4160-20  -  BIT DRL 2MM TRMIT","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-24","SUP","Custom 27203010","","AR-4160-24  -  BIT DRL 2.4MM TRMIT","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-25","SUP","Custom 27203010","","AR-4160-25  -  BIT DRL 2.5MM TRMIT","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-26","SUP","Custom 27203010","","AR-4160-26  -  BIT DRL 2.6MM TRMIT","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-27","SUP","Custom 27203010","","AR-4160-27  -  BIT DRL 2.7MM TRMIT","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-34","SUP","Custom 27203010","","AR-4160-34  -  BIT DRL 3.4MM TRMIT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-35","SUP","Custom 27203010","","AR-4160-35  -  BIT DRL 3.5MM TRMIT","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-40","SUP","Custom 27203010","","AR-4160-40  -  BIT DRL 4MM TRMIT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4160-45","SUP","Custom 27203010","","AR-4160-45  -  BIT DRL 4.5MM TRMIT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4161","SUP","Custom 27203010","","AR-4161  -  DRILL BIT CNTRSNK 2.7MM TRMIT","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4161B","SUP","HCPCS C1713","","AR-4161B  -  SCREW INTFR HEX 2.7MM 30MM STRL TRMIT CNN POLY L LAC ACD ACL","BOTH IP/OP","$482.50 ","$357.05 ","$0.00 ","$482.50 ","$217.13 ","$0.00 ","$100.57 ","$0.00 ","$0.00 ","$84.48 ","$482.50 ","$0.00 ","$241.25 ","$382.14 ","$386.00 ","$0.00 ","$75.51 ","$0.00 ","$76.81 ","$0.00 "
"AR-4161G","SUP","Custom 27203010","","AR-4161G  -  GUIDE DRL 2MM 2.7MM TRMIT","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4162B","SUP","HCPCS C1713","","AR-4162B  -  SCREW INTFR HEX 3.5MM 40MM STRL TRMIT CNN POLY L LAC ACD ACL","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"AR-4163","SUP","Custom 27203010","","AR-4163  -  DRILL BIT CNTRSNK 4MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4163B","SUP","HCPCS C1713","","AR-4163B  -  SCREW INTFR HEX 4MM 50MM STRL TRMIT CNN POLY L LAC ACD ACL","BOTH IP/OP","$525.00 ","$388.50 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$109.42 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"AR-4163G","SUP","Custom 27203010","","AR-4163G  -  GUIDE DRL 2.4MM 4MM TRMIT","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4164","SUP","Custom 27203010","","AR-4164  -  DRILL BIT CNTRSNK 4.5MM","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4164B","SUP","HCPCS C1713","","AR-4164B  -  SCREW INTFR FT HEX 4.5MM 60MM STRL TRMIT CNN POLY L LAC ACD","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$348.75 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"AR-4164G","SUP","Custom 27203010","","AR-4164G  -  GUIDE DRL 3.4MM 4.5MM TRMIT","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4207-12","SUP","Custom 27203010","","AR-4207-12  -  COMPONENT SUBTALAR CNCV 7MM 12MM STRL PROSTOP BABSR TI POLY","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$2,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4208-14","SUP","Custom 27203010","","AR-4208-14  -  COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP BABSR TI POLY","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$2,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4208B-14","SUP","Custom 27203010","","AR-4208B-14  -  COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP + BABSR TI","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4209-14","SUP","Custom 27203010","","AR-4209-14  -  COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP BABSR TI POLY","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$2,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4209B-14","SUP","Custom 27203010","","AR-4209B-14  -  COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP + BABSR TI","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4210-14","SUP","Custom 27203010","","AR-4210-14  -  COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP BABSR TI POLY","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$2,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4210B-14","SUP","Custom 27203010","","AR-4210B-14  -  COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP + BABSR TI","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4211-16","SUP","Custom 27203010","","AR-4211-16  -  COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP BABSR TI POLY","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$2,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4211B-16","SUP","Custom 27203010","","AR-4211B-16  -  COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP + BABSR TI","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4212-16","SUP","Custom 27203010","","AR-4212-16  -  COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP BABSR TI POLY","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$2,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4212B-16","SUP","Custom 27203010","","AR-4212B-16  -  COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP + BABSR TI","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4502","SUP","HCPCS C1713","","AR-4502  -  NEEDLE SUT 2-0 CRV SPEEDCINCH FBRWR PEEK","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-4515","SUP","Custom 27203010","","AR-4515  -  CUTTER SUTURE REMOVAL KNOT PUSHER MENISCAL CINCH STERILE","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-4520","SUP","Custom 27203010","","AR-4520  -  CUTTER SUT REM TGHTRP RECON SUT ACL ASCP","BOTH IP/OP","$395.00 ","$292.30 ","$0.00 ","$395.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$395.00 ","$0.00 ","$197.50 ","$312.84 ","$316.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5010AB","SUP","HCPCS C1713","","AR-5010AB  -  SCREW INTFR 50D 10MM 17MM STRL BCRTCL BCK END FLSH POLY L","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-5010BB","SUP","HCPCS C1713","","AR-5010BB  -  SCREW INTFR 10MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-5011AB","SUP","HCPCS C1713","","AR-5011AB  -  SCREW INTFR 50D 11MM 17MM STRL BCRTCL BCK END FLSH POLY L","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-501-TBA0","SUP","HCPCS C1713","","AR-501-TBA0  -  BEARING TIB 1 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBA1","SUP","HCPCS C1713","","AR-501-TBA1  -  BEARING TIB 1 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBA2","SUP","HCPCS C1713","","AR-501-TBA2  -  BEARING TIB 1 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBA4","SUP","HCPCS C1713","","AR-501-TBA4  -  BEARING TIB 1 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBA8","SUP","HCPCS C1713","","AR-501-TBA8  -  BEARING TIB 1 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBA9","SUP","HCPCS C1713","","AR-501-TBA9  -  BEARING TIB 1 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBB0","SUP","HCPCS C1713","","AR-501-TBB0  -  BEARING TIB 2 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBB1","SUP","HCPCS C1713","","AR-501-TBB1  -  BEARING TIB 2 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBB2","SUP","HCPCS C1713","","AR-501-TBB2  -  BEARING TIB 2 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBB4","SUP","HCPCS C1713","","AR-501-TBB4  -  BEARING TIB 2 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBB8","SUP","HCPCS C1713","","AR-501-TBB8  -  BEARING TIB 2 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBB9","SUP","HCPCS C1713","","AR-501-TBB9  -  BEARING TIB 2 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBC0","SUP","HCPCS C1713","","AR-501-TBC0  -  BEARING TIB 3 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBC1","SUP","HCPCS C1713","","AR-501-TBC1  -  BEARING TIB 3 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBC2","SUP","HCPCS C1713","","AR-501-TBC2  -  BEARING TIB 3 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBC4","SUP","HCPCS C1713","","AR-501-TBC4  -  BEARING TIB 3 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBC8","SUP","HCPCS C1713","","AR-501-TBC8  -  BEARING TIB 3 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBC9","SUP","HCPCS C1713","","AR-501-TBC9  -  BEARING TIB 3 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBD0","SUP","HCPCS C1713","","AR-501-TBD0  -  BEARING TIB 4 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBD1","SUP","HCPCS C1713","","AR-501-TBD1  -  BEARING TIB 4 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBD2","SUP","HCPCS C1713","","AR-501-TBD2  -  BEARING TIB 4 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBD4","SUP","HCPCS C1713","","AR-501-TBD4  -  BEARING TIB 4 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBD8","SUP","HCPCS C1713","","AR-501-TBD8  -  BEARING TIB 4 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBD9","SUP","HCPCS C1713","","AR-501-TBD9  -  BEARING TIB D 9MM UNCMP","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBE0","SUP","HCPCS C1713","","AR-501-TBE0  -  BEARING TIB 5 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBE1","SUP","HCPCS C1713","","AR-501-TBE1  -  BEARING TIB 5 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBE2","SUP","HCPCS C1713","","AR-501-TBE2  -  BEARING TIB 5 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBE4","SUP","HCPCS C1713","","AR-501-TBE4  -  BEARING TIB 5 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBE8","SUP","HCPCS C1713","","AR-501-TBE8  -  BEARING TIB 5 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBE9","SUP","HCPCS C1713","","AR-501-TBE9  -  BEARING TIB 5 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBF0","SUP","HCPCS C1713","","AR-501-TBF0  -  BEARING TIB 6 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBF1","SUP","HCPCS C1713","","AR-501-TBF1  -  BEARING TIB 6 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBF2","SUP","HCPCS C1713","","AR-501-TBF2  -  BEARING TIB 6 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBF4","SUP","HCPCS C1713","","AR-501-TBF4  -  BEARING TIB 6 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBF8","SUP","HCPCS C1713","","AR-501-TBF8  -  BEARING TIB 6 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TBF9","SUP","HCPCS C1713","","AR-501-TBF9  -  BEARING TIB 6 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-501-TTLA","SUP","Custom 27203010","","AR-501-TTLA  -  TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTLB","SUP","Custom 27203010","","AR-501-TTLB  -  TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTLC","SUP","Custom 27203010","","AR-501-TTLC  -  TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTLD","SUP","HCPCS C1776","","AR-501-TTLD  -  COMPONENT TIBTRY D UNCMP LT","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"AR-501-TTLE","SUP","Custom 27203010","","AR-501-TTLE  -  TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTLF","SUP","Custom 27203010","","AR-501-TTLF  -  TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTRA","SUP","Custom 27203010","","AR-501-TTRA  -  TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTRB","SUP","Custom 27203010","","AR-501-TTRB  -  TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTRC","SUP","Custom 27203010","","AR-501-TTRC  -  TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTRD","SUP","Custom 27203010","","AR-501-TTRD  -  TRAY TIB 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTRE","SUP","Custom 27203010","","AR-501-TTRE  -  TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-TTRF","SUP","Custom 27203010","","AR-501-TTRF  -  TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-501-UFLA","SUP","HCPCS C1776","","AR-501-UFLA  -  COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFLB","SUP","HCPCS C1776","","AR-501-UFLB  -  COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFLC","SUP","HCPCS C1776","","AR-501-UFLC  -  COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFLD","SUP","HCPCS C1776","","AR-501-UFLD  -  COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFLE","SUP","HCPCS C1776","","AR-501-UFLE  -  COMPONENT FEM E KN LT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFLF","SUP","HCPCS C1776","","AR-501-UFLF  -  COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFRA","SUP","HCPCS C1776","","AR-501-UFRA  -  COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFRB","SUP","HCPCS C1776","","AR-501-UFRB  -  COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFRC","SUP","HCPCS C1776","","AR-501-UFRC  -  COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFRD","SUP","HCPCS C1776","","AR-501-UFRD  -  COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFRE","SUP","HCPCS C1776","","AR-501-UFRE  -  COMPONENT FEM 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-501-UFRF","SUP","HCPCS C1776","","AR-501-UFRF  -  COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-502-1L","SUP","HCPCS C1776","","AR-502-1L  -  COMPONENT FEM 1 IBALANCE PTLFEM LT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-1R","SUP","HCPCS C1776","","AR-502-1R  -  COMPONENT FEM 1 IBALANCE PTLFEM RT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-2L","SUP","HCPCS C1776","","AR-502-2L  -  COMPONENT FEM 2 IBALANCE PTLFEM LT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-2R","SUP","HCPCS C1776","","AR-502-2R  -  COMPONENT FEM 2 IBALANCE PTLFEM RT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-3L","SUP","HCPCS C1776","","AR-502-3L  -  COMPONENT FEM 3 IBALANCE PTLFEM LT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-3R","SUP","HCPCS C1776","","AR-502-3R  -  COMPONENT FEM 3 IBALANCE PTLFEM RT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-4L","SUP","HCPCS C1776","","AR-502-4L  -  COMPONENT FEM 4 IBALANCE PTLFEM LT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-502-4R","SUP","HCPCS C1776","","AR-502-4R  -  COMPONENT FEM 4 IBALANCE PTLFEM RT","BOTH IP/OP","$11,900.00 ","$8,806.00 ","$0.00 ","$11,900.00 ","$5,355.00 ","$0.00 ","$2,480.26 ","$0.00 ","$0.00 ","$2,083.59 ","$11,900.00 ","$0.00 ","$5,950.00 ","$9,424.80 ","$9,520.00 ","$0.00 ","$1,862.35 ","$0.00 ","$1,894.48 ","$0.00 "
"AR-5024TDA","SUP","Custom 27203010","","AR-5024TDA  -  BIT DRL CMPR SCR TPR ASCP","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5024TDP","SUP","Custom 27203010","","AR-5024TDP  -  BIT DRL CMPR SCR TPR PERC","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025B-16","SUP","HCPCS C1713","","AR-5025B-16  -  SCREW INTFR TPR 3-3.7MM 16MM STRL BIO-CMPR SCR CNN SLF CMPR","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5025B-18","SUP","HCPCS C1713","","AR-5025B-18  -  SCREW INTFR TPR 3-3.7MM 18MM STRL BIO-CMPR SCR CNN SLF CMPR","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5025B-20","SUP","HCPCS C1713","","AR-5025B-20  -  SCREW INTFR TPR 2.7-3.7MM 20MM STRL BIO-CMPR SCR CNN SLF","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5025B-22","SUP","HCPCS C1713","","AR-5025B-22  -  SCREW INTFR TPR 3-3.7MM 22MM STRL BIO-CMPR SCR CNN SLF CMPR","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5025B-24","SUP","HCPCS C1713","","AR-5025B-24  -  SCREW INTFR TPR 3-3.7MM 24MM STRL BIO-CMPR SCR CNN SLF CMPR","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5025B-26","SUP","HCPCS C1713","","AR-5025B-26  -  SCREW INTFR TPR 3-3.7MM 26MM STRL BIO-CMPR SCR CNN SLF CMPR","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5025ETDC-26","SUP","Custom 27203010","","AR-5025ETDC-26  -  BIT DRL 26MM CNN BIO-CMPR SCR","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TD","SUP","Custom 27203010","","AR-5025TD  -  BIT DRL 2.7MM 20MM CNN BIO-CMPR SCR","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TDC","SUP","Custom 27203010","","AR-5025TDC  -  BIT DRL CNN BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TDC-16","SUP","Custom 27203010","","AR-5025TDC-16  -  BIT DRL 16MM CNN BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TDC-18","SUP","Custom 27203010","","AR-5025TDC-18  -  BIT DRL 18MM CNN BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TDC-22","SUP","Custom 27203010","","AR-5025TDC-22  -  BIT DRL 22MM CNN BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TDC-24","SUP","Custom 27203010","","AR-5025TDC-24  -  BIT DRL 24MM CNN BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5025TDC-26","SUP","Custom 27203010","","AR-5025TDC-26  -  BIT DRL 26MM CNN BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026B-16","SUP","HCPCS C1713","","AR-5026B-16  -  SCREW INTFR TPR 3.5-4.4MM 16MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-18","SUP","HCPCS C1713","","AR-5026B-18  -  SCREW INTFR TPR 3.5-4.5MM 18MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-20","SUP","HCPCS C1713","","AR-5026B-20  -  SCREW INTFR TPR 3.5-4.6MM 20MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-22","SUP","HCPCS C1713","","AR-5026B-22  -  SCREW INTFR TPR 3.5-4.7MM 22MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-24","SUP","HCPCS C1713","","AR-5026B-24  -  SCREW INTFR TPR 3.5-4.8MM 24MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-26","SUP","HCPCS C1713","","AR-5026B-26  -  SCREW INTFR TPR 3.5-4.9MM 26MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-28","SUP","HCPCS C1713","","AR-5026B-28  -  SCREW INTFR TPR 3.5-5-5MM 28MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-30","SUP","HCPCS C1713","","AR-5026B-30  -  SCREW INTFR TPR 3.5-5.1MM 30MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026B-32","SUP","HCPCS C1713","","AR-5026B-32  -  SCREW INTFR TPR 3.5-3.5MM 32MM BIO-CMPR SCR CNN SLF CMPR STP","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$444.38 ","$0.00 ","$205.82 ","$0.00 ","$0.00 ","$172.90 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$154.54 ","$0.00 ","$157.21 ","$0.00 "
"AR-5026G","SUP","Custom 27203010","","AR-5026G  -  GUIDE DRL 20MM C RING DRVR BIO-CMPR SCR","BOTH IP/OP","$1,900.00 ","$1,406.00 ","$0.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,900.00 ","$0.00 ","$950.00 ","$1,504.80 ","$1,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-16","SUP","Custom 27203010","","AR-5026TDC-16  -  BIT DRL TPR 3.5MM 16MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-18","SUP","Custom 27203010","","AR-5026TDC-18  -  BIT DRL TPR 3.5MM 18MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-20","SUP","Custom 27203010","","AR-5026TDC-20  -  BIT DRL TPR 3.5MM 20MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-22","SUP","Custom 27203010","","AR-5026TDC-22  -  BIT DRL TPR 3.5MM 22MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-24","SUP","Custom 27203010","","AR-5026TDC-24  -  BIT DRL TPR 3.5MM 24MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-26","SUP","Custom 27203010","","AR-5026TDC-26  -  BIT DRL TPR 3.5MM 26MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-28","SUP","Custom 27203010","","AR-5026TDC-28  -  BIT DRL TPR 3.5MM 28MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-30","SUP","Custom 27203010","","AR-5026TDC-30  -  BIT DRL TPR 3.5MM 30MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5026TDC-32","SUP","Custom 27203010","","AR-5026TDC-32  -  BIT DRL TPR 3.5MM 32MM BIO-CMPR SCR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5028B-08","SUP","HCPCS C1713","","AR-5028B-08  -  SCREW INTFR DLT TPR 8MM 28MM STRL 6.5MM BIOINTF POLY L LAC","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5028B-09","SUP","HCPCS C1713","","AR-5028B-09  -  SCREW INTFR DLT TPR 9MM 28MM STRL 7.5MM BIOINTF POLY L LAC","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5028B-10","SUP","HCPCS C1713","","AR-5028B-10  -  SCREW INTFR DLT TPR 10MM 28MM STRL 8.5MM BIOINTF POLY L LAC","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5028B-11","SUP","HCPCS C1713","","AR-5028B-11  -  SCREW INTFR DLT TPR 11MM 28MM STRL 9.5MM BIOINTF POLY L LAC","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5028C-08","SUP","HCPCS C1713","","AR-5028C-08  -  SCREW INTFR DLT TPR 8MM 28MM STRL BCMPS SHLDR","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-5028C-10","SUP","HCPCS C1713","","AR-5028C-10  -  SCREW INTERFERENCE DELTA TAPER 10MM 28MM BIOCOMPOSITE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-5028C-11","SUP","HCPCS C1713","","AR-5028C-11  -  SCREW INTERFERENCE DELTA TAPER 11MM 28MM BIOCOMPOSITE","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-5028P-07","SUP","HCPCS C1713","","AR-5028P-07  -  SCREW INTFR DLT TPR 7MM 28MM STRL RECON SHTH THRD PTRN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5028P-08","SUP","HCPCS C1713","","AR-5028P-08  -  ROUND DELTA TAPERED INTERFERENCE SCREW","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5028P-09","SUP","HCPCS C1713","","AR-5028P-09  -  SCREW INTFR DLT TPR 9MM 28MM STRL RECON SHTH THRD PTRN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5028P-10","SUP","HCPCS C1713","","AR-5028P-10  -  SCREW INTFR DLT TPR 10MM 28MM STRL RECON SHTH THRD PTRN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5028P-11","SUP","HCPCS C1713","","AR-5028P-11  -  SCREW INTFR DLT TPR 11MM 28MM STRL RECON SHTH THRD PTRN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5028P-12","SUP","HCPCS C1713","","AR-5028P-12  -  SCREW INTFR DLT TPR 12MM 28MM STRL RECON SHTH THRD PTRN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5035P-09","SUP","HCPCS C1713","","AR-5035P-09  -  SCREW INTFR DLT TPR 9MM 35MM STRL CNN DRVR RECON PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5035P-10","SUP","HCPCS C1713","","AR-5035P-10  -  SCREW INTFR DLT TPR 10MM 35MM STRL CNN DRVR RECON PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5035P-11","SUP","HCPCS C1713","","AR-5035P-11  -  SCREW INTFR DLT TPR 11MM 35MM STRL CNN DRVR RECON PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5035P-12","SUP","HCPCS C1713","","AR-5035P-12  -  SCREW INTFR DLT TPR 12MM 35MM STRL CNN DRVR RECON PEEK-OPTM","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-5035TB-09","SUP","HCPCS C1713","","AR-5035TB-09  -  SCREW INTFR DLT TPR 7.5-9MM 35MM STRL BIOINTF CNN POLY L LAC","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5035TB-10","SUP","HCPCS C1713","","AR-5035TB-10  -  SCREW INTFR DLT TPR 8.5-10MM 35MM STRL BIOINTF CNN POLY L","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5035TB-11","SUP","HCPCS C1713","","AR-5035TB-11  -  SCREW INTFR DLT TPR 9.5-11MM 35MM STRL BIOINTF CNN POLY L","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5035TB-12","SUP","HCPCS C1713","","AR-5035TB-12  -  SCREW INTFR DLT TPR 10.5-12MM 35MM STRL BIOINTF CNN POLY L","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"AR-5035TC-09","SUP","HCPCS C1713","","AR-5035TC-09  -  SCREW INTFR DLT 9MM 35MM STRL CNN BCMPS ACL","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-5035TC-10","SUP","HCPCS C1713","","AR-5035TC-10  -  SCREW INTFR DLT 10MM 35MM STRL CNN BCMPS ACL","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-5035TC-12","SUP","HCPCS C1713","","AR-5035TC-12  -  SCREW INTFR BCMPS 35MM 12MM DLT ACL CANN STRL","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-503-A1008","SUP","HCPCS C1776","","AR-503-A1008  -  CR PLUS TIBIAL BEARING, SIZE 10, 8MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1009","SUP","HCPCS C1776","","AR-503-A1009  -  CR PLUS TIBIAL BEARING, SIZE 10, 9MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1010","SUP","HCPCS C1776","","AR-503-A1010  -  CR PLUS TIBIAL BEARING, SIZE 10, 10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1011","SUP","HCPCS C1776","","AR-503-A1011  -  CR PLUS TIBIAL BEARING, SIZE 10, 11MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1012","SUP","HCPCS C1776","","AR-503-A1012  -  CR PLUS TIBIAL BEARING, SIZE 10, 12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1013","SUP","HCPCS C1776","","AR-503-A1013  -  CR PLUS TIBIAL BEARING, SIZE 10, 13MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1014","SUP","HCPCS C1776","","AR-503-A1014  -  CR PLUS TIBIAL BEARING, SIZE 10, 14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1016","SUP","HCPCS C1776","","AR-503-A1016  -  CR PLUS TIBIAL BEARING, SIZE 10, 16MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A1018","SUP","HCPCS C1776","","AR-503-A1018  -  CR PLUS TIBIAL BEARING, SIZE 10, 18MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A908","SUP","HCPCS C1776","","AR-503-A908  -  CR PLUS TIBIAL BEARING, SIZE 9, 8MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A909","SUP","HCPCS C1776","","AR-503-A909  -  CR PLUS TIBIAL BEARING, SIZE 9, 9MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A910","SUP","HCPCS C1776","","AR-503-A910  -  CR PLUS TIBIAL BEARING, SIZE 9, 10MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A911","SUP","HCPCS C1776","","AR-503-A911  -  CR PLUS TIBIAL BEARING, SIZE 9, 11MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A912","SUP","HCPCS C1776","","AR-503-A912  -  CR PLUS TIBIAL BEARING, SIZE 9, 12MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A913","SUP","HCPCS C1776","","AR-503-A913  -  CR PLUS TIBIAL BEARING, SIZE 9, 13MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A914","SUP","HCPCS C1776","","AR-503-A914  -  CR PLUS TIBIAL BEARING, SIZE 9, 14MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A916","SUP","HCPCS C1776","","AR-503-A916  -  CR PLUS TIBIAL BEARING, SIZE 9, 16MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-A918","SUP","HCPCS C1776","","AR-503-A918  -  CR PLUS TIBIAL BEARING, SIZE 9, 18MM","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"AR-503-PSRA","SUP","HCPCS C1776","","AR-503-PSRA  -  COMPONENT FEM IBALANCE CMNT POST STAB KN RT","BOTH IP/OP","$7,750.00 ","$5,735.00 ","$0.00 ","$7,750.00 ","$3,487.50 ","$0.00 ","$1,615.29 ","$0.00 ","$0.00 ","$1,356.96 ","$7,750.00 ","$0.00 ","$3,875.00 ","$6,138.00 ","$6,200.00 ","$0.00 ","$1,212.88 ","$0.00 ","$1,233.80 ","$0.00 "
"AR-504-PSA8","SUP","HCPCS C1776","","AR-504-PSA8  -  COMPONENT PTLR DOME 27MM 8MM IBALANCE","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"AR-504-PSB8","SUP","HCPCS C1776","","AR-504-PSB8  -  COMPONENT PTLR DOME 30MM 8MM IBALANCE","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"AR-504-PSE0","SUP","HCPCS C1776","","AR-504-PSE0  -  COMPONENT PTLR THK10MM 3 DOME 40MM IBALANCE 3 PG","BOTH IP/OP","$2,187.50 ","$1,618.75 ","$0.00 ","$2,187.50 ","$984.38 ","$0.00 ","$455.93 ","$0.00 ","$0.00 ","$383.01 ","$2,187.50 ","$0.00 ","$1,093.75 ","$1,732.50 ","$1,750.00 ","$0.00 ","$342.34 ","$0.00 ","$348.25 ","$0.00 "
"AR-5050-05","SUP","Custom 27203010","","AR-5050-05  -  CLAMP SRG 2X SM WEBER LNG THROW PTLR FX SYS","BOTH IP/OP","$442.50 ","$327.45 ","$0.00 ","$442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$442.50 ","$0.00 ","$221.25 ","$350.46 ","$354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5050-07","SUP","Custom 27203010","","AR-5050-07  -  GUIDE DRL 2MM 1.6MM","BOTH IP/OP","$1,117.50 ","$826.95 ","$0.00 ","$1,117.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,117.50 ","$0.00 ","$558.75 ","$885.06 ","$894.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5050-11","SUP","Custom 27203010","","AR-5050-11  -  GUIDE DRL PRLL PTLR FX","BOTH IP/OP","$1,402.50 ","$1,037.85 ","$0.00 ","$1,402.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,402.50 ","$0.00 ","$701.25 ","$1,110.78 ","$1,122.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5050K-2","SUP","Custom 27203010","","AR-5050K-2  -  CANNULA ASCP 7MM 7CM STRL OBT THRD SHLDR DISP","BOTH IP/OP","$97.50 ","$72.15 ","$0.00 ","$97.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.50 ","$0.00 ","$48.75 ","$77.22 ","$78.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5051-24","SUP","HCPCS C1713","","AR-5051-24  -  SCREW BN 4MM 24MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-26","SUP","HCPCS C1713","","AR-5051-26  -  SCREW BN 4MM 26MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-28","SUP","HCPCS C1713","","AR-5051-28  -  SCREW BN 4MM 28MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-30","SUP","HCPCS C1713","","AR-5051-30  -  SCREW BN 4MM 30MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-32","SUP","HCPCS C1713","","AR-5051-32  -  SCREW BN 4MM 32MM BLNT TIP CNN LG","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-34","SUP","HCPCS C1713","","AR-5051-34  -  SCREW BN 4MM 34MM BLNT TIP CNN LG","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-36","SUP","HCPCS C1713","","AR-5051-36  -  SCREW BN 4MM 36MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-38","SUP","HCPCS C1713","","AR-5051-38  -  SCREW BN 4MM 38MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-40","SUP","HCPCS C1713","","AR-5051-40  -  SCREW BN 4MM 40MM BLNT TIP CNN LG","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-42","SUP","HCPCS C1713","","AR-5051-42  -  SCREW BN 4MM 42MM BLNT TIP CNN LG","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-44","SUP","HCPCS C1713","","AR-5051-44  -  SCREW BN 4MM 44MM CNN BLNT LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-46","SUP","HCPCS C1713","","AR-5051-46  -  SCREW BN 4MM 46MM CNN BLNT LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-48","SUP","HCPCS C1713","","AR-5051-48  -  SCREW BN 4MM 48MM CNN BLNT TIP LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-50","SUP","HCPCS C1713","","AR-5051-50  -  SCREW BN 4MM 50MM CNN LOPRFL BLNT TIP","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-55","SUP","HCPCS C1713","","AR-5051-55  -  SCREW BN 4MM 55MM CNN BLNT LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5051-60","SUP","HCPCS C1713","","AR-5051-60  -  SCREW BN 4MM 60MM CNN BLNT LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-5068-25TL","SUP","Custom 27203010","","AR-5068-25TL  -  PASSER SUT 25D SUTLSO SD CRV LT SHFT TIGHT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-25TR","SUP","Custom 27203010","","AR-5068-25TR  -  PASSER SUT 25D SUTLSO SD CRV RT SHFT TIGHT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-30","SUP","Custom 27203010","","AR-5068-30  -  PASSER SUT 30D SUTLSO SD STRG SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-45L","SUP","Custom 27203010","","AR-5068-45L  -  PASSER SUT 45D SUTLSO SD CRV LT SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-45R","SUP","Custom 27203010","","AR-5068-45R  -  PASSER SUT 45D SUTLSO SD CRV RT SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-90","SUP","Custom 27203010","","AR-5068-90  -  PASSER SUT 90D SUTLSO SD STRG SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-90L","SUP","Custom 27203010","","AR-5068-90L  -  PASSER SUT 90D SUTLSO SD CRV LT SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-90R","SUP","Custom 27203010","","AR-5068-90R  -  PASSER SUT 90D SUTLSO SD CRV RT SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068-90T","SUP","Custom 27203010","","AR-5068-90T  -  PASSER SUT 90D 2 SUTLSO SD SHFT STRG RT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068C","SUP","Custom 27203010","","AR-5068C  -  PASSER SUT SUTLSO SD CRSNT SHFT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5068H","SUP","Custom 27203010","","AR-5068H  -  PASSER SUT SUTLSO HNDL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5080AB","SUP","HCPCS C1713","","AR-5080AB  -  SCREW INTFR 50D 8MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-5080BB","SUP","HCPCS C1713","","AR-5080BB  -  SCREW INTFR 8MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-5090AB","SUP","HCPCS C1713","","AR-5090AB  -  SCREW INTFR 50D 9MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-5090BB","SUP","HCPCS C1713","","AR-5090BB  -  SCREW INTFR 9MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"AR-513-10100","SUP","HCPCS C1776","","AR-513-10100  -  EXTENSION STM 10MM 100MM IBALANCE SCR TIB","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-513-1050","SUP","HCPCS C1776","","AR-513-1050  -  STEM XTN 10MM 50MM IBALANCE TKA SCR TIB","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-513-12100","SUP","HCPCS C1776","","AR-513-12100  -  EXTENSION STM 12MM 100MM IBALANCE SCR TIB","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-513-1250","SUP","HCPCS C1776","","AR-513-1250  -  COMPONENT FEM 12MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-513-14100","SUP","HCPCS C1776","","AR-513-14100  -  EXTENSION STM 14MM 100MM IBALANCE SCR TIB","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-513-1450","SUP","HCPCS C1776","","AR-513-1450  -  COMPONENT FEM 14MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-513-RL1010","SUP","HCPCS C1713","","AR-513-RL1010  -  AUGMENT TIB 10 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL105","SUP","HCPCS C1713","","AR-513-RL105  -  AUGMENT TIB 10 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL110","SUP","HCPCS C1713","","AR-513-RL110  -  AUGMENT TIB 1 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL15","SUP","HCPCS C1713","","AR-513-RL15  -  AUGMENT TIB 1 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL210","SUP","HCPCS C1713","","AR-513-RL210  -  AUGMENT TIB 2 10MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL25","SUP","HCPCS C1713","","AR-513-RL25  -  AUGMENT TIB 2 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL310","SUP","HCPCS C1713","","AR-513-RL310  -  AUGMENT TIB 3 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL35","SUP","HCPCS C1713","","AR-513-RL35  -  AUGMENT TIB 3 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL410","SUP","HCPCS C1713","","AR-513-RL410  -  AUGMENT TIB 4 10MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL45","SUP","HCPCS C1713","","AR-513-RL45  -  AUGMENT TIB 4 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL510","SUP","HCPCS C1713","","AR-513-RL510  -  AUGMENT TIB 5 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL55","SUP","HCPCS C1713","","AR-513-RL55  -  AUGMENT TIB 5 5MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL610","SUP","HCPCS C1713","","AR-513-RL610  -  AUGMENT TIB 6 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL65","SUP","HCPCS C1713","","AR-513-RL65  -  AUGMENT TIB 5 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL710","SUP","HCPCS C1713","","AR-513-RL710  -  AUGMENT TIB 7 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL75","SUP","HCPCS C1713","","AR-513-RL75  -  AUGMENT TIB 7 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL810","SUP","HCPCS C1713","","AR-513-RL810  -  AUGMENT TIB 8 10MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL85","SUP","HCPCS C1713","","AR-513-RL85  -  AUGMENT TIB 8 5MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL910","SUP","HCPCS C1713","","AR-513-RL910  -  AUGMENT TIB 9 10MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RL95","SUP","HCPCS C1713","","AR-513-RL95  -  AUGMENT TIB 9 5MM IBALANCE SCR RL/LM TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM1010","SUP","HCPCS C1713","","AR-513-RM1010  -  AUGMENT TIB 10 10MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM105","SUP","HCPCS C1713","","AR-513-RM105  -  AUGMENT TIB 10 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM110","SUP","HCPCS C1713","","AR-513-RM110  -  AUGMENT TIB 1 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM15","SUP","HCPCS C1713","","AR-513-RM15  -  AUGMENT TIB 1 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM210","SUP","HCPCS C1713","","AR-513-RM210  -  AUGMENT TIB 2 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM25","SUP","HCPCS C1713","","AR-513-RM25  -  AUGMENT TIB 2 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM310","SUP","HCPCS C1713","","AR-513-RM310  -  AUGMENT TIB 3 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM35","SUP","HCPCS C1713","","AR-513-RM35  -  AUGMENT TIB 3 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM410","SUP","HCPCS C1713","","AR-513-RM410  -  AUGMENT TIB 4 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM45","SUP","HCPCS C1713","","AR-513-RM45  -  AUGMENT TIB 4 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM510","SUP","HCPCS C1713","","AR-513-RM510  -  AUGMENT TIB 5 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM55","SUP","HCPCS C1713","","AR-513-RM55  -  AUGMENT TIB 5 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM610","SUP","HCPCS C1713","","AR-513-RM610  -  AUGMENT TIB 6 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM65","SUP","HCPCS C1713","","AR-513-RM65  -  AUGMENT TIB 6 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM710","SUP","HCPCS C1713","","AR-513-RM710  -  AUGMENT TIB 7 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM75","SUP","HCPCS C1713","","AR-513-RM75  -  AUGMENT TIB 7 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM810","SUP","HCPCS C1713","","AR-513-RM810  -  AUGMENT TIB 8 10MM IBALANCE SCR LT MDL RL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM85","SUP","HCPCS C1713","","AR-513-RM85  -  AUGMENT TIB 8 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM910","SUP","HCPCS C1713","","AR-513-RM910  -  AUGMENT TIB 9 10MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-RM95","SUP","HCPCS C1713","","AR-513-RM95  -  AUGMENT TIB 9 5MM IBALANCE SCR RMLL TKA","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"AR-513-T1","SUP","HCPCS C1713","","AR-513-T1  -  COMPONENT TIBTRY 1 STRL IBALANCE ARTHX MDLR T/K ARTHPL","BOTH IP/OP","$6,175.00 ","$4,569.50 ","$0.00 ","$6,175.00 ","$2,778.75 ","$0.00 ","$1,287.02 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"AR-513-T2","SUP","HCPCS C1713","","AR-513-T2  -  COMPONENT TIBTRY 2 STRL IBALANCE ARTHX MDLR T/K ARTHPL","BOTH IP/OP","$6,175.00 ","$4,569.50 ","$0.00 ","$6,175.00 ","$2,778.75 ","$0.00 ","$1,287.02 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"AR-513-T5","SUP","HCPCS C1713","","AR-513-T5  -  COMPONENT TIBTRY 5 STRL IBALANCE ARTHX MDLR T/K ARTHPL","BOTH IP/OP","$6,175.00 ","$4,569.50 ","$0.00 ","$6,175.00 ","$2,778.75 ","$0.00 ","$1,287.02 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"AR-513-T7","SUP","HCPCS C1713","","AR-513-T7  -  COMPONENT TIBTRY 7 STRL IBALANCE ARTHX MDLR T/K ARTHPL","BOTH IP/OP","$6,175.00 ","$4,569.50 ","$0.00 ","$6,175.00 ","$2,778.75 ","$0.00 ","$1,287.02 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"AR-513-T8","SUP","HCPCS C1713","","AR-513-T8  -  COMPONENT TIBTRY 8 STRL IBALANCE ARTHX MDLR T/K ARTHPL","BOTH IP/OP","$6,175.00 ","$4,569.50 ","$0.00 ","$6,175.00 ","$2,778.75 ","$0.00 ","$1,287.02 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"AR-513-T9","SUP","HCPCS C1713","","AR-513-T9  -  COMPONENT TIBTRY 9 STRL IBALANCE ARTHX MDLR T/K ARTHPL","BOTH IP/OP","$6,175.00 ","$4,569.50 ","$0.00 ","$6,175.00 ","$2,778.75 ","$0.00 ","$1,287.02 ","$0.00 ","$0.00 ","$1,081.19 ","$6,175.00 ","$0.00 ","$3,087.50 ","$4,890.60 ","$4,940.00 ","$0.00 ","$966.39 ","$0.00 ","$983.06 ","$0.00 "
"AR-513-TL10","SUP","HCPCS C1713","","AR-513-TL10  -  AUGMENT TIB 10MM LCK SCR","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"AR-513-TL5","SUP","HCPCS C1713","","AR-513-TL5  -  AUGMENT TIB 5MM LCK SCR KN","BOTH IP/OP","$167.50 ","$123.95 ","$0.00 ","$167.50 ","$75.38 ","$0.00 ","$34.91 ","$0.00 ","$0.00 ","$29.33 ","$167.50 ","$0.00 ","$83.75 ","$132.66 ","$134.00 ","$0.00 ","$26.21 ","$0.00 ","$26.67 ","$0.00 "
"AR-516-5R","SUP","HCPCS C1776","","AR-516-5R  -  COMPONENT FEM 5 IBALANCE CMNT POST STAB KN RT T/K ARTHPL","BOTH IP/OP","$7,750.00 ","$5,735.00 ","$0.00 ","$7,750.00 ","$3,487.50 ","$0.00 ","$1,615.29 ","$0.00 ","$0.00 ","$1,356.96 ","$7,750.00 ","$0.00 ","$3,875.00 ","$6,138.00 ","$6,200.00 ","$0.00 ","$1,212.88 ","$0.00 ","$1,233.80 ","$0.00 "
"AR-523-B1008","SUP","HCPCS C1776","","AR-523-B1008  -  PS TIBIAL BEARING, SIZE 10, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1009","SUP","HCPCS C1776","","AR-523-B1009  -  PS TIBIAL BEARING, SIZE 10, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1010","SUP","HCPCS C1776","","AR-523-B1010  -  PS TIBIAL BEARING, SIZE 10, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1011","SUP","HCPCS C1776","","AR-523-B1011  -  PS TIBIAL BEARING, SIZE 10, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1012","SUP","HCPCS C1776","","AR-523-B1012  -  PS TIBIAL BEARING, SIZE 10, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1013","SUP","HCPCS C1776","","AR-523-B1013  -  PS TIBIAL BEARING, SIZE 10, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1014","SUP","HCPCS C1776","","AR-523-B1014  -  PS TIBIAL BEARING, SIZE 10, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1016","SUP","HCPCS C1776","","AR-523-B1016  -  PS TIBIAL BEARING, SIZE 10, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1018","SUP","HCPCS C1776","","AR-523-B1018  -  PS TIBIAL BEARING, SIZE 10, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B1020","SUP","HCPCS C1776","","AR-523-B1020  -  PS TIBIAL BEARING, SIZE 10, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B108","SUP","HCPCS C1776","","AR-523-B108  -  PS TIBIAL BEARING, SIZE 1, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B109","SUP","HCPCS C1776","","AR-523-B109  -  PS TIBIAL BEARING, SIZE 1, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B110","SUP","HCPCS C1776","","AR-523-B110  -  PS TIBIAL BEARING, SIZE 1, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B111","SUP","HCPCS C1776","","AR-523-B111  -  PS TIBIAL BEARING, SIZE 1, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B112","SUP","HCPCS C1776","","AR-523-B112  -  PS TIBIAL BEARING, SIZE 1, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B113","SUP","HCPCS C1776","","AR-523-B113  -  PS TIBIAL BEARING, SIZE 1, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B114","SUP","HCPCS C1776","","AR-523-B114  -  PS TIBIAL BEARING, SIZE 1, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B116","SUP","HCPCS C1776","","AR-523-B116  -  PS TIBIAL BEARING, SIZE 1, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B118","SUP","HCPCS C1776","","AR-523-B118  -  PS TIBIAL BEARING, SIZE 1, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B120","SUP","HCPCS C1776","","AR-523-B120  -  PS TIBIAL BEARING, SIZE 1, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B208","SUP","HCPCS C1776","","AR-523-B208  -  PS TIBIAL BEARING, SIZE 2, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B209","SUP","HCPCS C1776","","AR-523-B209  -  PS TIBIAL BEARING, SIZE 2, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B210","SUP","HCPCS C1776","","AR-523-B210  -  PS TIBIAL BEARING, SIZE 2, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B211","SUP","HCPCS C1776","","AR-523-B211  -  PS TIBIAL BEARING, SIZE 2, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B212","SUP","HCPCS C1776","","AR-523-B212  -  PS TIBIAL BEARING, SIZE 2, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B213","SUP","HCPCS C1776","","AR-523-B213  -  PS TIBIAL BEARING, SIZE 2, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B214","SUP","HCPCS C1776","","AR-523-B214  -  PS TIBIAL BEARING, SIZE 2, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B216","SUP","HCPCS C1776","","AR-523-B216  -  PS TIBIAL BEARING, SIZE 2, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B218","SUP","HCPCS C1776","","AR-523-B218  -  PS TIBIAL BEARING, SIZE 2, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B220","SUP","HCPCS C1776","","AR-523-B220  -  PS TIBIAL BEARING, SIZE 2, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B308","SUP","HCPCS C1776","","AR-523-B308  -  PS TIBIAL BEARING, SIZE 3, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B309","SUP","HCPCS C1776","","AR-523-B309  -  PS TIBIAL BEARING, SIZE 3, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B310","SUP","HCPCS C1776","","AR-523-B310  -  PS TIBIAL BEARING, SIZE 3, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B311","SUP","HCPCS C1776","","AR-523-B311  -  PS TIBIAL BEARING, SIZE 3, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B312","SUP","HCPCS C1776","","AR-523-B312  -  PS TIBIAL BEARING, SIZE 3, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B313","SUP","HCPCS C1776","","AR-523-B313  -  PS TIBIAL BEARING, SIZE 3, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B314","SUP","HCPCS C1776","","AR-523-B314  -  PS TIBIAL BEARING, SIZE 3, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B316","SUP","HCPCS C1776","","AR-523-B316  -  PS TIBIAL BEARING, SIZE 3, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B318","SUP","HCPCS C1776","","AR-523-B318  -  PS TIBIAL BEARING, SIZE 3, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B320","SUP","HCPCS C1776","","AR-523-B320  -  PS TIBIAL BEARING, SIZE 3, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B408","SUP","HCPCS C1776","","AR-523-B408  -  PS TIBIAL BEARING, SIZE 4, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B409","SUP","HCPCS C1776","","AR-523-B409  -  PS TIBIAL BEARING, SIZE 4, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B410","SUP","HCPCS C1776","","AR-523-B410  -  PS TIBIAL BEARING, SIZE 4, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B411","SUP","HCPCS C1776","","AR-523-B411  -  PS TIBIAL BEARING, SIZE 4, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B412","SUP","HCPCS C1776","","AR-523-B412  -  PS TIBIAL BEARING, SIZE 4, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B413","SUP","HCPCS C1776","","AR-523-B413  -  PS TIBIAL BEARING, SIZE 4, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B414","SUP","HCPCS C1776","","AR-523-B414  -  PS TIBIAL BEARING, SIZE 4, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B416","SUP","HCPCS C1776","","AR-523-B416  -  PS TIBIAL BEARING, SIZE 4, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B418","SUP","HCPCS C1776","","AR-523-B418  -  PS TIBIAL BEARING, SIZE 4, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B420","SUP","HCPCS C1776","","AR-523-B420  -  PS TIBIAL BEARING, SIZE 4, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B508","SUP","HCPCS C1776","","AR-523-B508  -  PS TIBIAL BEARING, SIZE 5, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B509","SUP","HCPCS C1776","","AR-523-B509  -  PS TIBIAL BEARING, SIZE 5, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B510","SUP","HCPCS C1776","","AR-523-B510  -  PS TIBIAL BEARING, SIZE 5, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B511","SUP","HCPCS C1776","","AR-523-B511  -  PS TIBIAL BEARING, SIZE 5, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B512","SUP","HCPCS C1776","","AR-523-B512  -  PS TIBIAL BEARING, SIZE 5, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B513","SUP","HCPCS C1776","","AR-523-B513  -  PS TIBIAL BEARING, SIZE 5, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B514","SUP","HCPCS C1776","","AR-523-B514  -  PS TIBIAL BEARING, SIZE 5, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B516","SUP","HCPCS C1776","","AR-523-B516  -  PS TIBIAL BEARING, SIZE 5, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B518","SUP","HCPCS C1776","","AR-523-B518  -  PS TIBIAL BEARING, SIZE 5, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B520","SUP","HCPCS C1776","","AR-523-B520  -  PS TIBIAL BEARING, SIZE 5, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B608","SUP","HCPCS C1776","","AR-523-B608  -  PS TIBIAL BEARING, SIZE 6, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B609","SUP","HCPCS C1776","","AR-523-B609  -  PS TIBIAL BEARING, SIZE 6, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B610","SUP","HCPCS C1776","","AR-523-B610  -  PS TIBIAL BEARING, SIZE 6, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B611","SUP","HCPCS C1776","","AR-523-B611  -  PS TIBIAL BEARING, SIZE 6, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B612","SUP","HCPCS C1776","","AR-523-B612  -  PS TIBIAL BEARING, SIZE 6, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B613","SUP","HCPCS C1776","","AR-523-B613  -  PS TIBIAL BEARING, SIZE 6, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B614","SUP","HCPCS C1776","","AR-523-B614  -  PS TIBIAL BEARING, SIZE 6, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B616","SUP","HCPCS C1776","","AR-523-B616  -  PS TIBIAL BEARING, SIZE 6, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B618","SUP","HCPCS C1776","","AR-523-B618  -  PS TIBIAL BEARING, SIZE 6, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B620","SUP","HCPCS C1776","","AR-523-B620  -  PS TIBIAL BEARING, SIZE 6, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B708","SUP","HCPCS C1776","","AR-523-B708  -  PS TIBIAL BEARING, SIZE 7, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B709","SUP","HCPCS C1776","","AR-523-B709  -  PS TIBIAL BEARING, SIZE 7, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B710","SUP","HCPCS C1776","","AR-523-B710  -  PS TIBIAL BEARING, SIZE 7, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B711","SUP","HCPCS C1776","","AR-523-B711  -  PS TIBIAL BEARING, SIZE 7, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B712","SUP","HCPCS C1776","","AR-523-B712  -  PS TIBIAL BEARING, SIZE 7, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B713","SUP","HCPCS C1776","","AR-523-B713  -  PS TIBIAL BEARING, SIZE 7, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B714","SUP","HCPCS C1776","","AR-523-B714  -  PS TIBIAL BEARING, SIZE 7, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B716","SUP","HCPCS C1776","","AR-523-B716  -  PS TIBIAL BEARING, SIZE 7, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B718","SUP","HCPCS C1776","","AR-523-B718  -  PS TIBIAL BEARING, SIZE 7, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B720","SUP","HCPCS C1776","","AR-523-B720  -  PS TIBIAL BEARING, SIZE 7, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B808","SUP","HCPCS C1776","","AR-523-B808  -  PS TIBIAL BEARING, SIZE 8, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B809","SUP","HCPCS C1776","","AR-523-B809  -  PS TIBIAL BEARING, SIZE 8, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B810","SUP","HCPCS C1776","","AR-523-B810  -  PS TIBIAL BEARING, SIZE 8, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B811","SUP","HCPCS C1776","","AR-523-B811  -  PS TIBIAL BEARING, SIZE 8, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B812","SUP","HCPCS C1776","","AR-523-B812  -  PS TIBIAL BEARING, SIZE 8, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B813","SUP","HCPCS C1776","","AR-523-B813  -  PS TIBIAL BEARING, SIZE 8, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B814","SUP","HCPCS C1776","","AR-523-B814  -  PS TIBIAL BEARING, SIZE 8, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B816","SUP","HCPCS C1776","","AR-523-B816  -  PS TIBIAL BEARING, SIZE 8, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B818","SUP","HCPCS C1776","","AR-523-B818  -  PS TIBIAL BEARING, SIZE 8, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B820","SUP","HCPCS C1776","","AR-523-B820  -  PS TIBIAL BEARING, SIZE 8, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B908","SUP","HCPCS C1776","","AR-523-B908  -  PS TIBIAL BEARING, SIZE 9, 8MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B909","SUP","HCPCS C1776","","AR-523-B909  -  PS TIBIAL BEARING, SIZE 9, 9MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B910","SUP","HCPCS C1776","","AR-523-B910  -  PS TIBIAL BEARING, SIZE 9, 10MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B911","SUP","HCPCS C1776","","AR-523-B911  -  PS TIBIAL BEARING, SIZE 9, 11MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B912","SUP","HCPCS C1776","","AR-523-B912  -  PS TIBIAL BEARING, SIZE 9, 12MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B913","SUP","HCPCS C1776","","AR-523-B913  -  PS TIBIAL BEARING, SIZE 9, 13MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B914","SUP","HCPCS C1776","","AR-523-B914  -  PS TIBIAL BEARING, SIZE 9, 14MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B916","SUP","HCPCS C1776","","AR-523-B916  -  PS TIBIAL BEARING, SIZE 9, 16MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B918","SUP","HCPCS C1776","","AR-523-B918  -  PS TIBIAL BEARING, SIZE 9, 18MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-523-B920","SUP","HCPCS C1776","","AR-523-B920  -  PS TIBIAL BEARING, SIZE 9, 20MM, VIT E","BOTH IP/OP","$5,085.00 ","$3,762.90 ","$0.00 ","$5,085.00 ","$2,288.25 ","$0.00 ","$1,059.84 ","$0.00 ","$0.00 ","$890.34 ","$5,085.00 ","$0.00 ","$2,542.50 ","$4,027.32 ","$4,068.00 ","$0.00 ","$795.80 ","$0.00 ","$809.53 ","$0.00 "
"AR-524-PS328","SUP","HCPCS C1713","","AR-524-PS328  -  DOME PTLR 32MM 8MM STRL LF ARTHX VIT E KN","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$1,335.38 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$519.59 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$472.43 ","$0.00 "
"AR-524-PSA8","SUP","HCPCS C1713","","AR-524-PSA8  -  DOME PTLR 27MM 8MM STRL LF ARTHX VIT E KN","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$1,335.38 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$519.59 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$472.43 ","$0.00 "
"AR-524-PSB8","SUP","HCPCS C1713","","AR-524-PSB8  -  DOME PTLR 30MM 8MM STRL LF ARTHX VIT E KN","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$1,335.38 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$519.59 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$472.43 ","$0.00 "
"AR-524-PSC9","SUP","HCPCS C1713","","AR-524-PSC9  -  DOME PTLR 34MM 9MM STRL LF ARTHX VIT E","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$1,335.38 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$519.59 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$472.43 ","$0.00 "
"AR-524-PSD0","SUP","HCPCS C1713","","AR-524-PSD0  -  DOME PTLR 37MM 10MM STRL LF ARTHX VIT E","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$1,335.38 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$519.59 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$472.43 ","$0.00 "
"AR-524-PSE0","SUP","HCPCS C1713","","AR-524-PSE0  -  DOME PTLR 40MM 10MM STRL LF ARTHX VIT E KN","BOTH IP/OP","$2,967.50 ","$2,195.95 ","$0.00 ","$2,967.50 ","$1,335.38 ","$0.00 ","$618.50 ","$0.00 ","$0.00 ","$519.59 ","$2,967.50 ","$0.00 ","$1,483.75 ","$2,350.26 ","$2,374.00 ","$0.00 ","$464.41 ","$0.00 ","$472.43 ","$0.00 "
"AR-5503","SUP","Custom 27203010","","AR-5503  -  GUIDE DRL PIN PRLL","BOTH IP/OP","$1,390.30 ","$1,028.82 ","$0.00 ","$1,390.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,390.30 ","$0.00 ","$695.15 ","$1,101.12 ","$1,112.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5511-CP","SUP","HCPCS C1713","","AR-5511-CP  -  KIT ARTHRO FIX INTERNALBRACE FIBERTAPE SWIVELOCK","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-5600-01","SUP","Custom 27203010","","AR-5600-01  -  GUIDE DRL OFST CRDL FISH MTH 4MM CHONDROGUARD NOVEL TIP XTN","BOTH IP/OP","$1,497.50 ","$1,108.15 ","$0.00 ","$1,497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,497.50 ","$0.00 ","$748.75 ","$1,186.02 ","$1,198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-5600-02","SUP","Custom 27203010","","AR-5600-02  -  GUIDE DRL OFST CRDL FISH MTH 6MM CHONDROGUARD NOVEL TIP XTN","BOTH IP/OP","$1,497.50 ","$1,108.15 ","$0.00 ","$1,497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,497.50 ","$0.00 ","$748.75 ","$1,186.02 ","$1,198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-601-BBS0","SUP","Custom 27203010","","AR-601-BBS0  -  BIT DRL 2.7MM TRMIT CNN SLF CMPR THRD PTCH","BOTH IP/OP","$850.00 ","$629.00 ","$0.00 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-601-SB06","SUP","Custom 27203010","","AR-601-SB06  -  INSERT TIB 6MM IBALANCE SPCR BLCK KN UNCNDL","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-601-SB07","SUP","Custom 27203010","","AR-601-SB07  -  INSERT TIB 7MM IBALANCE SPCR BLCK KN UNCNDL","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-601-SB08","SUP","Custom 27203010","","AR-601-SB08  -  INSERT TIB 8MM IBALANCE SPCR BLCK KN UNCNDL","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-601-SB09","SUP","Custom 27203010","","AR-601-SB09  -  INSERT TIB 9MM IBALANCE SPCR BLCK KN UNCNDL","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-601-SB10","SUP","Custom 27203010","","AR-601-SB10  -  INSERT TIB 10MM IBALANCE SPCR BLCK KN UNCNDL","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-602-44","SUP","Custom 27203010","","AR-602-44  -  GUIDE DRL 27MM IBALANCE PTLR","BOTH IP/OP","$617.50 ","$456.95 ","$0.00 ","$617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.50 ","$0.00 ","$308.75 ","$489.06 ","$494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-602-45","SUP","Custom 27203010","","AR-602-45  -  GUIDE DRL 30MM IBALANCE PTLR","BOTH IP/OP","$617.50 ","$456.95 ","$0.00 ","$617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.50 ","$0.00 ","$308.75 ","$489.06 ","$494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-602-46","SUP","Custom 27203010","","AR-602-46  -  GUIDE DRL 34MM IBALANCE PTLR","BOTH IP/OP","$617.50 ","$456.95 ","$0.00 ","$617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.50 ","$0.00 ","$308.75 ","$489.06 ","$494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-602-47","SUP","Custom 27203010","","AR-602-47  -  GUIDE DRL 37MM IBALANCE PTLR","BOTH IP/OP","$617.50 ","$456.95 ","$0.00 ","$617.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$617.50 ","$0.00 ","$308.75 ","$489.06 ","$494.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-602-49","SUP","Custom 27203010","","AR-602-49  -  GUIDE DRL IBALANCE CMBN PTLR","BOTH IP/OP","$915.00 ","$677.10 ","$0.00 ","$915.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$915.00 ","$0.00 ","$457.50 ","$724.68 ","$732.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-603-85","SUP","Custom 27203010","","AR-603-85  -  CLAMP SRG IBALANCE CMNT TMPLT PTLR","BOTH IP/OP","$3,712.50 ","$2,747.25 ","$0.00 ","$3,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,712.50 ","$0.00 ","$1,856.25 ","$2,940.30 ","$2,970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-25TL","SUP","Custom 27203010","","AR-6068-25TL  -  PASSER SUTURE 25D SMALL TIGHT LEFT CURVE 8.25MM CANNU","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-25TR","SUP","Custom 27203010","","AR-6068-25TR  -  PASSER SUT 25D SM TIGHT RT CRV 8.25MM STRL QUICKPASS SUTLSO","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-30","SUP","Custom 27203010","","AR-6068-30  -  PASSER SUT 30D SM STRG 7MM STRL QUICKPASS SUTLSO CNN ERG","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-45L","SUP","Custom 27203010","","AR-6068-45L  -  PASSER SUT 45D SM LT CRV 7MM STRL QUICKPASS SUTLSO CNN ERG","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-45R","SUP","Custom 27203010","","AR-6068-45R  -  PASSER SUT 45D CRV QUICKPASS SUTLSO RT","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-90","SUP","Custom 27203010","","AR-6068-90  -  PASSER SUTURE 90D SMALL STR 7MM CANNU ERGONOMIC HANDLE","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-90L","SUP","Custom 27203010","","AR-6068-90L  -  PASSER SUT 90D SM LT CRV 8.25MM STRL QUICKPASS SUTLSO CNN","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-90R","SUP","Custom 27203010","","AR-6068-90R  -  PASSER SUT 90D SM RT CRV 8.25MM STRL QUICKPASS SUTLSO CNN","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6068-90T","SUP","Custom 27203010","","AR-6068-90T  -  PASSER SUT 90D SM TC 7MM STRL QUICKPASS SUTLSO CNN ERG HNDL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6069-45L","SUP","Custom 27203010","","AR-6069-45L  -  PASSER SUT 45D 1 LT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6069-45R","SUP","Custom 27203010","","AR-6069-45R  -  PASSER SUT 45D 1 RT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6069-90","SUP","Custom 27203010","","AR-6069-90  -  PASSER SUT 90D STRG CRV SUTLSO REELPASS","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6506","SUP","Custom 27203010","","AR-6506  -  CANNULA ASCP OPN","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6507","SUP","Custom 27203010","","AR-6507  -  CANNULA ASCP BLNT OPN","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6507-01","SUP","Custom 27203010","","AR-6507-01  -  CANNULA ASCP TPR OPN SHRP PLYCRB","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6507-02","SUP","Custom 27203010","","AR-6507-02  -  CANNULA ASCP BLNT OPN SHRP PLYCRB","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6507-03","SUP","Custom 27203010","","AR-6507-03  -  CANNULA ASCP TPR DTCH HNDL OPN MTL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6507-04","SUP","Custom 27203010","","AR-6507-04  -  CANNULA ASCP BLNT DTCH HNDL OPN MTL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6520-15","SUP","Custom 27203010","","AR-6520-15  -  STICK SWH LNG ACR CNN DTCH HNDL HIP","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6520-16","SUP","Custom 27203010","","AR-6520-16  -  STICK SWH LNG 3.5MM 15IN CNN","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6521","SUP","Custom 27203010","","AR-6521  -  NEEDLE ESCP STRL PIN REPL DISP PRTL DILATION SET ASCP","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6523","SUP","Custom 27203010","","AR-6523  -  NEEDLE ESCP BLNT STRL DISP PRTL DILATION SET ASCP","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6526S","SUP","Custom 27203010","","AR-6526S  -  KIT ENDSCP INSTR MSTR 1.5MM 14GA GWIRE KNF BLADE","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6527S","SUP","Custom 27203010","","AR-6527S  -  KIT ESCP INST CRV BNA 14GA 1.5MM 35ML BLDE KNF PIN SYR NTNL","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6528-07","SUP","Custom 27203010","","AR-6528-07  -  PROBE ASCP 220MM NAV-X RND ABLT MNPLR STRBL COAG HIP","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6529-07","SUP","Custom 27203010","","AR-6529-07  -  POST OP TBL PERI HDS","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6530","SUP","Custom 27203010","","AR-6530  -  CANNU ARTHRO 7CM THRD TWST IN STRL DISP 8.25MM","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6530N","SUP","Custom 27203010","","AR-6530N  -  CANNU ARTHRO 7CM NTCH TWST IN STRL DISP 8.25MM","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6532","SUP","Custom 27203010","","AR-6532  -  CANNULA ASCP 5.5MM 9CM STRL OBT THRD SHLDR DISP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6535","SUP","Custom 27203010","","AR-6535  -  CANNULA ARTHRO 6MM 7CM OBTURATOR THREAD TWIST-IN TRANSLUCENT","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6535TD","SUP","Custom 27203010","","AR-6535TD  -  CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6545","SUP","Custom 27203010","","AR-6545  -  CANNULA ASCP 6MM 9CM TRNLU STRL TWST-IN OBT THRD SHLDR DISP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6548","SUP","Custom 27203010","","AR-6548  -  CANNULA ARTHRO LP OBTURATOR THREAD PUSHLOCK SHOULDER STERILE","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6550TD","SUP","Custom 27203010","","AR-6550TD  -  CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6551L","SUP","Custom 27203010","","AR-6551L  -  CANNULA ASCP SM 6MM 7.75CM","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6560","SUP","Custom 27203010","","AR-6560  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING RTNT","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6560F","SUP","Custom 27203010","","AR-6560F  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING FLXB","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6562","SUP","Custom 27203010","","AR-6562  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL SMTH","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6564","SUP","Custom 27203010","","AR-6564  -  CANNULA ASCP P/T BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6565","SUP","Custom 27203010","","AR-6565  -  CANNULA ASCP 6MM 9CM STRL SHOHN LNGTDNL SLOT OBT SHLDR DISP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6566","SUP","Custom 27203010","","AR-6566  -  CANNULA ASCP P/T 8.25MM 7CM TRNLU STRL FLXB OBT THRD ROTR","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6568","SUP","Custom 27203010","","AR-6568  -  CANNULA ASCP SHRT P/T 5.75MM 5CM TRNLU CRYS","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6570","SUP","Custom 27203010","","AR-6570  -  CANNULA ARTHRO 7MM 7CM OBTURATOR TWIST-IN TRANSLUCENT","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6570F","SUP","Custom 27203010","","AR-6570F  -  CANNULA ASCP 7MM 7CM TRNLU STRL TWST-IN FLXB OBT SHLDR DISP","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6570TD","SUP","Custom 27203010","","AR-6570TD  -  CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6570TDNV","SUP","Custom 27203010","","AR-6570TDNV  -  CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT NO VLV","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6572","SUP","Custom 27203010","","AR-6572  -  CANNULA ARTHRO LP 8.25MM 9CM SELF RETAINING SYSTEM GEMINI SR","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6575-09","SUP","Custom 27203010","","AR-6575-09  -  CANNULA ASCP P/T 8.25MM 9CM TRNLU STRL OBT DISP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6575-11","SUP","Custom 27203010","","AR-6575-11  -  CANNULA ASCP P/T 8.25MM 11CM TRNLU STRL OBT DISP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6576S-C","SUP","Custom 27203010","","AR-6576S-C  -  SYSTEM ESCP XL ASCP C MNT HIP","BOTH IP/OP","$69,755.00 ","$51,618.70 ","$0.00 ","$68,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68,530.00 ","$0.00 ","$34,265.00 ","$54,275.76 ","$54,824.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6576S-E","SUP","Custom 27203010","","AR-6576S-E  -  SYSTEM ESCP XL ASCP EYE PC HIP","BOTH IP/OP","$62,280.00 ","$46,087.20 ","$0.00 ","$61,055.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61,055.00 ","$0.00 ","$30,527.50 ","$48,355.56 ","$48,844.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6577-09","SUP","Custom 27203010","","AR-6577-09  -  CANNULA ARTHRO PTHRD 7MM 9CM HIP STERILE","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6577-11","SUP","Custom 27203010","","AR-6577-11  -  CANNULA ASCP P/T 7MM 11CM STRL HIP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6580","SUP","Custom 27203010","","AR-6580  -  CANNULA ASCP 3.75MM 3 DAM","BOTH IP/OP","$343.75 ","$254.38 ","$0.00 ","$343.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$343.75 ","$0.00 ","$171.88 ","$272.25 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6590","SUP","Custom 27203010","","AR-6590  -  CANNULA ASCP TRMIT CSTM HIP","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6590DT","SUP","Custom 27203010","","AR-6590DT  -  CANNULA ASCP TRMIT DTCH OBT","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6590ST","SUP","Custom 27203010","","AR-6590ST  -  STICK SWH 4MM TRMIT CNN CNN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592","SUP","Custom 27203010","","AR-6592  -  CANNULA BTN CRV LOPRFL STRL LF PSPRT 1 PC MLD 2 DAM DSGN 2","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-06-20","SUP","Custom 27203010","","AR-6592-06-20  -  CANNULA BTN CRV LOPRFL 6MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-06-30","SUP","Custom 27203010","","AR-6592-06-30  -  CANNULA BTN CRV LOPRFL 6MM 3CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-06-40","SUP","Custom 27203010","","AR-6592-06-40  -  CANNULA BTN CRV LOPRFL 6MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-06-50","SUP","Custom 27203010","","AR-6592-06-50  -  CANNULA BTN CRV LOPRFL 6MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-08-20","SUP","Custom 27203010","","AR-6592-08-20  -  CANNULA BTN CRV LOPRFL 8MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-08-40","SUP","Custom 27203010","","AR-6592-08-40  -  CANNULA BTN CRV LOPRFL 8MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-08-50","SUP","Custom 27203010","","AR-6592-08-50  -  CANNULA BTN CRV LOPRFL 8MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-08-60","SUP","Custom 27203010","","AR-6592-08-60  -  CANNULA BTN CRV LOPRFL 8MM 6CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-08-90","SUP","Custom 27203010","","AR-6592-08-90  -  CANNULA BTN CRV LOPRFL 9MM 9CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-10-20","SUP","Custom 27203010","","AR-6592-10-20  -  CANNULA BTN CRV LOPRFL 10MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-10-30","SUP","Custom 27203010","","AR-6592-10-30  -  CANNU 3CM 10MM CANNU BTN PSPRT DISP STRL","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-10-40","SUP","Custom 27203010","","AR-6592-10-40  -  CANNULA BUTTON CURVE LP 10MM 4CM 1 PIECE MOLD 2 DAM DESIGN 2","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6592-10-50","SUP","Custom 27203010","","AR-6592-10-50  -  CANNULA BUTTON CURVE LP 10MM 5CM 1 PIECE MOLD 2 DAM DESIGN 2","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.00 ","$0.00 ","$57.50 ","$91.08 ","$92.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-6955","SUP","HCPCS C1713","","AR-6955  -  SET IMPL 2.7MM TRMIT TNL INSTRUMENTATION SET","BOTH IP/OP","$4,917.50 ","$3,638.95 ","$0.00 ","$4,917.50 ","$2,212.88 ","$0.00 ","$1,024.93 ","$0.00 ","$0.00 ","$861.01 ","$4,917.50 ","$0.00 ","$2,458.75 ","$3,894.66 ","$3,934.00 ","$0.00 ","$769.59 ","$0.00 ","$782.87 ","$0.00 "
"AR-7000-03","SUP","Custom 27203010","","AR-7000-03  -  GUIDE DRL 4MM PRLL","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-04","SUP","Custom 27203010","","AR-7000-04  -  GUIDE DRL 6MM PRLL","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-05","SUP","Custom 27203010","","AR-7000-05  -  GUIDE DRL 8MM PRLL","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-07","SUP","Custom 27203010","","AR-7000-07  -  GUIDE DRL CORACOID","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-14","SUP","Custom 27203010","","AR-7000-14  -  DRILL SURG MINI .066IN 2.75MM CANN OPEN REPAIR","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-15","SUP","Custom 27803010","","AR-7000-15  -  WASHER ORTHOPEDIC CANN SELF COMPRESS THREAD PITCH TITANIUM","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-16","SUP","Custom 27203010","","AR-7000-16  -  GUIDE DRL PRLL","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-17","SUP","Custom 27203010","","AR-7000-17  -  GUIDE DRL SHLW CORACOID","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-18T","SUP","Custom 27803010","","AR-7000-18T  -  WASHER ESCP 2 CRV FBRWR NDL SUT TI ASCP","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7000-26","SUP","HCPCS C1713","","AR-7000-26  -  SCREW BN P/T 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-26FT","SUP","HCPCS C1713","","AR-7000-26FT  -  SCREW BN FT 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-28","SUP","HCPCS C1713","","AR-7000-28  -  SCREW BN P/T 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-28FT","SUP","HCPCS C1713","","AR-7000-28FT  -  SCREW BN FT 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-30","SUP","HCPCS C1713","","AR-7000-30  -  SCREW BN P/T 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-30FT","SUP","HCPCS C1713","","AR-7000-30FT  -  SCREW BN FT 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-32","SUP","HCPCS C1713","","AR-7000-32  -  SCREW BONE PTHRD 3.75MM 32MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-32FT","SUP","HCPCS C1713","","AR-7000-32FT  -  SCREW BN FT 3.75MM 32MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-34","SUP","HCPCS C1713","","AR-7000-34  -  SCREW BN P/T 3.75MM 34MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-34FT","SUP","HCPCS C1713","","AR-7000-34FT  -  SCREW BONE 3.75MM 34MM TI FULTHD SHLDR GLND SLF","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-36","SUP","HCPCS C1713","","AR-7000-36  -  SCREW BONE PTHRD 3.75MM 36MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-36FT","SUP","HCPCS C1713","","AR-7000-36FT  -  SCREW BN FT 3.75MM 36MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-38","SUP","HCPCS C1713","","AR-7000-38  -  SCREW BN P/T 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-38FT","SUP","HCPCS C1713","","AR-7000-38FT  -  SCREW BN FT 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-40","SUP","HCPCS C1713","","AR-7000-40  -  SCREW BONE PTHRD 3.75MM 40MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-40FT","SUP","HCPCS C1713","","AR-7000-40FT  -  SCREW BN FT 3.75MM 40MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-42","SUP","HCPCS C1713","","AR-7000-42  -  SCREW BONE PTHRD 3.75MM 42MM SELF DRILL SELF TAP CANN","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7000-42FT","SUP","HCPCS C1713","","AR-7000-42FT  -  SCREW BN FT 3.75MM 42MM SLF DRL ST CNN TI SHLDR GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-7199","SUP","Custom 27203010","","AR-7199  -  DEVICE PSTN BLU WHT FINGERSHIELD LT OPN TIP MRKR PCTV RADOPQ","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7200","SUP","Custom 27803010","","AR-7200  -  SUTURE NABSB 2 T-5 38IN BLU FBRWR MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7200B","SUP","Custom 27803010","","AR-7200B  -  SUTURE NABSB 2 TPR 38IN FBRWR BRD TIE MS LWR KNT PRFL NDL","BOTH IP/OP","$97.50 ","$72.15 ","$0.00 ","$97.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.50 ","$0.00 ","$48.75 ","$77.22 ","$78.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7201","SUP","Custom 27803010","","AR-7201  -  SUTURE NABSB 2 .5 CRC STRG DMD PT RVRS CUT 38IN BLK BLU WHT","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7202","SUP","Custom 27803010","","AR-7202  -  SUTURE NABSB 2 C-13 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7203","SUP","Custom 27203010","","AR-7203  -  SUTURE NABSB 2 38IN B/W TIGERWIRE BRD","BOTH IP/OP","$57.50 ","$42.55 ","$0.00 ","$57.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.50 ","$0.00 ","$28.75 ","$45.54 ","$46.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7204","SUP","Custom 27803010","","AR-7204  -  SUTURE NABSB 2 STRG 26IN GRN 10MM FBRWR BRD MS CLS LOOP LWR","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7205","SUP","Custom 27803010","","AR-7205  -  SUTURE NABSB 2 T-5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7205T","SUP","Custom 27203010","","AR-7205T  -  SUTURE NABSB 2 T-5 38IN B/W FVR TGRWR 2 ARM BRD TIE MS LWR","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7206","SUP","Custom 27803010","","AR-7206  -  SUTURE NABSB 2 T-8 38IN BLU FBRWR 2 ARM BRD MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7207","SUP","Custom 27803010","","AR-7207  -  SUTURE NABSB 2 38IN BLU 10MM FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7208","SUP","Custom 27803010","","AR-7208  -  SUTURE NABSB 2 T-5 38IN BLK BLU WHT FBRWR BRD TIE MS LWR KNT","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7209","SUP","Custom 27803010","","AR-7209  -  SUTURE NABSB 2 50IN 12IN FBSTK FBRWR 1 END STIFFEN","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7209T","SUP","HCPCS C1713","","AR-7209T  -  SUTURE NONABSORBABLE 2 50IN 12IN 1 END STIFFEN MONOFILAMENT","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"AR-7210","SUP","Custom 27803010","","AR-7210  -  SUTURE NABSB 5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7211","SUP","Custom 27203010","","AR-7211  -  SUTURE NABSB 5 CCS-1 38IN BLU FBRWR MS LWR KNT PRFL","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7212","SUP","Custom 27803010","","AR-7212  -  SUTURE NABSB 5 .5 CRC 38IN BLK BLU WHT 48MM FBRWR CNV CUT","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7213","SUP","Custom 27803010","","AR-7213  -  SUTURE NONABSORBABLE 5 T-5 CCS-1 38IN 48MM BRAID TIES","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7216","SUP","Custom 27803010","","AR-7216  -  SUTURE NABSB 1 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7217","SUP","Custom 27803010","","AR-7217  -  SUTURE NABSB 2 .5 CRC RVRS CUT 38IN BLK BLU WHT 36.6MM FBRWR","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7220","SUP","Custom 27203010","","AR-7220  -  SUTURE NABSB 2-0 T-13 18IN BLU FBRWR MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$48.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.75 ","$0.00 ","$24.38 ","$38.61 ","$39.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7221","SUP","Custom 27803010","","AR-7221  -  FIBERWIRE, BRAIDED PB 2-0 SUTURE, BLUE","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7222","SUP","Custom 27803010","","AR-7222  -  SUTURE NABSB 2-0 50IN BLU 12IN FBRWR FBSTK 1 END STIFFEN BRD","BOTH IP/OP","$105.00 ","$77.70 ","$0.00 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7223SM","SUP","Custom 27803010","","AR-7223SM  -  SUTURE NABSB 2-0 SM STRL FBRWR BRD SWEDGE LO KNT PRFL MNSCS","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$206.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.25 ","$0.00 ","$103.13 ","$163.35 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7227-01","SUP","Custom 27803010","","AR-7227-01  -  SUTURE NABSB 3-0 T-43 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7227-02","SUP","Custom 27803010","","AR-7227-02  -  SUTURE NABSB 3-0 C-22 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7228","SUP","Custom 27803010","","AR-7228  -  SUTURE NABSB 4-0 DE-10 18IN BLU FBRWR BRD TIE MS LWR KNT","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7229-12","SUP","Custom 27203010","","AR-7229-12  -  SUTURE NABSB 4-0 T-13 12IN BLU FIBERLOOP MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7229-20","SUP","Custom 27203010","","AR-7229-20  -  SUTURE NABSB 4-0 3/8 CRC 10IN BLU 17.9MM FIBERLOOP TPR NDL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7230-01","SUP","Custom 27803010","","AR-7230-01  -  SUTURE NABSB 4-0 T-12 18IN BLU FBRWR MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7230-02","SUP","Custom 27803010","","AR-7230-02  -  SUTURE NABSB 4-0 C-17 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7232-01","SUP","Custom 27203010","","AR-7232-01  -  SUTURE NABSB 2-0 D-17 60IN BLU FIBERLOOP 2 ARM MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7232-02","SUP","Custom 27203010","","AR-7232-02  -  SUTURE NABSB 2-0 D-14 24IN BLU FIBERLOOP 2 ARM MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7232-03","SUP","Custom 27203010","","AR-7232-03  -  SUTURE NABSB 2-0 SD-2 13IN BLU FIBERLOOP 2 ARM MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7232-05","SUP","Custom 27203010","","AR-7232-05  -  SUTURE NABSB 2-0 3/8 CRC TPR PNT 14IN 17.9MM FIBERLOOP LOOP","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7233","SUP","Custom 27803010","","AR-7233  -  SUTURE NABSB 2 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7234","SUP","Custom 27203010","","AR-7234  -  SUTURE NONABSORBABLE 2 7MM STR 20IN 76MM BRAID MULTISTRAND","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7234-01","SUP","Custom 27203010","","AR-7234-01  -  SUTURE NABSB 2 7MM STRG 20IN WHT 76MM FIBERLOOP BRD MS NDL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7234B","SUP","Custom 27203010","","AR-7234B  -  SUTURE NABSB 2 STRG 20IN BLU 76MM FIBERLOOP BRD MS NDL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7234C","SUP","Custom 27203010","","AR-7234C  -  SUTURE NONABSORBABLE 2 .5 CIR CURVE 20IN BRAID MULTISTRAND","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$161.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.25 ","$0.00 ","$80.63 ","$127.71 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7234T","SUP","Custom 27203010","","AR-7234T  -  SUTURE NONABSORBABLE 2 STR 20IN 3IN BRAID MULTISTRAND NEEDLE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$161.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$161.25 ","$0.00 ","$80.63 ","$127.71 ","$129.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7235","SUP","Custom 27203010","","AR-7235  -  SUTURE NONABSORBABLE 2 26IN 1.5IN BRAID TIES MULTISTRAND","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7235T","SUP","Custom 27203010","","AR-7235T  -  SUTURE NABSB 2 26IN B/W TIGERLINK FBRWR CLS LOOP","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7237","SUP","Custom 27803010","","AR-7237  -  SUTURE NABSB 2 TPR 54IN BLU 36INX2MM FIBERTAPE FBRWR BRD","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7237-17LN","SUP","Custom 27803010","","AR-7237-17LN  -  SUTURE NABSB 2MM STRG 17IN BLU FIBERTAPE BRD","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7237-17N","SUP","Custom 27803010","","AR-7237-17N  -  SUTURE NABSB 2 .5 CRC TPR 17IN BLU 26.5MM FIBERTAPE FBRWR","BOTH IP/OP","$190.00 ","$140.60 ","$0.00 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7237-7","SUP","Custom 27803010","","AR-7237-7  -  SUTURE NONABSORBABLE 2 TAPER 7INX2MM BRAID FIBERTAPE","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7237-7T","SUP","Custom 27203010","","AR-7237-7T  -  SUTURE NABSB 2 TPR 7INX2MM B/W TIGERTAPE TIGERWIRE BRD","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7240","SUP","Custom 27803010","","AR-7240  -  SUTURE NONABSORBABLE 2 38IN BRAID 2 STRAND LOWER KNOT","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7242","SUP","Custom 27203010","","AR-7242  -  SUTURE NABSB 2-0 T-5 18IN BLU TIGERTAPE FBRWR BRD TIE MS","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7246","SUP","Custom 27803010","","AR-7246  -  SUTURE NABSB 2 STRG DMD 38IN BLU 26.5MM FBRWR 1 END NDL","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$80.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.00 ","$0.00 ","$40.00 ","$63.36 ","$64.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7246-02","SUP","Custom 27803010","","AR-7246-02  -  SUTURE NABSB 2 STRG DMD 38IN BLU 64MM FBRWR 1 END 2 NDL","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7248","SUP","Custom 27803010","","AR-7248  -  SUTURE NABSB 4-0 T-22 18IN WHT FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7249-12","SUP","Custom 27203010","","AR-7249-12  -  SUTURE NABSB 4-0 T-22 6IN WHT FIBERLOOP MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7249-20","SUP","Custom 27203010","","AR-7249-20  -  SUTURE NABSB 4-0 T-22 10IN WHT FIBERLOOP MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7250","SUP","Custom 27803010","","AR-7250  -  SUTURE NABSB 0 T-4 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7251","SUP","Custom 27803010","","AR-7251  -  SUTURE NABSB 0 D-10 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7253","SUP","Custom 27203010","","AR-7253  -  SUTURE NABSB 0 7MM STRG 13IN BLU 76MM FIBERLOOP BRD MS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7253T","SUP","Custom 27203010","","AR-7253T  -  SUTURE NABSB 0 7MM STRG 13IN B/W 76MM FIBERLOOP TIGERLOOP","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7254","SUP","Custom 27803010","","AR-7254  -  SUTURE NABSB 0 FBRWR","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7255","SUP","Custom 27803010","","AR-7255  -  SUTURE NABSB 0 38IN WHT FBRWR LWR KNT PRFL SMTH TIE ABL SUP","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7258","SUP","Custom 27203010","","AR-7258  -  SUTURE NABSB 0 36IN BLU 1.5IN FIBERLINK LOOP","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$0.00 ","$1,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,950.00 ","$0.00 ","$975.00 ","$1,544.40 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7258T","SUP","Custom 27203010","","AR-7258T  -  SUTURE NABSB 0 36IN 1.5IN TIGERLINK LOOP","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$0.00 ","$1,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,950.00 ","$0.00 ","$975.00 ","$1,544.40 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7264","SUP","Custom 27803010","","AR-7264  -  SUTURE NABSB 2 FIBERTAG SPEEDWHIP FIBERLOOP","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7270","SUP","Custom 27803010","","AR-7270  -  SUTURE NABSB 2 10 LNG LOOP 7MM FBRWR FIBERCHAIN BRD","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7272","SUP","Custom 27803010","","AR-7272  -  FIBERWIRE CL WHITE BLUE 38IN","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7272T","SUP","Custom 27203010","","AR-7272T  -  TIGERWIRE CL WHITE BLACK 38IN W  NDL","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7275","SUP","Custom 27803010","","AR-7275  -  SUTURE NONABSORBABLE 2 2MM 8IN 24IN FIBERTAPE FIBERWIRE BLUE","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7275T","SUP","Custom 27203010","","AR-7275T  -  SUTURE NONABSORBABLE 2 2MM 8IN 24IN TIGERTAPE TIGERWIRE BLUE","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7276","SUP","Custom 27203010","","AR-7276  -  SUTURE NABSB 1.5MM 36IN WHT LABRALTAPE","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7276T","SUP","Custom 27203010","","AR-7276T  -  SUTURE NONABSORBABLE 1.5MM 36IN LABRALTAPE BLACK WHITE","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7280","SUP","Custom 27203010","","AR-7280  -  NEEDLE SUT C-13 .5 CRC RVRS CUT 36.6MM LOOP NTNL","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$47.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7281","SUP","Custom 27203010","","AR-7281  -  NEEDLE SUT T-5 .5 CRC TPR 26.5MM BTNDS LOOP NTNL DISP","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$47.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7282","SUP","Custom 27203010","","AR-7282  -  PASSER SUT 1 FBRWR LOOP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7284","SUP","Custom 27203010","","AR-7284  -  SUTURE NABSB 2 FIBERLOOP SWAGE STRG NDL","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$0.00 ","$1,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,950.00 ","$0.00 ","$975.00 ","$1,544.40 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7300DS","SUP","Custom 27203010","","AR-7300DS  -  BLADE SHVR 3MM 7CM STRL COOLCUT ASCP DSCT S JNT DISP","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7300OBT","SUP","Custom 27203010","","AR-7300OBT  -  BURR SHVR 10 FLUT OVL3MM S JNT","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7324PSL","SUP","HCPCS C1713","","AR-7324PSL  -  ANCHOR SUT SWIVELOCK TENODESIS PEEK","BOTH IP/OP","$1,087.50 ","$804.75 ","$0.00 ","$1,087.50 ","$489.38 ","$0.00 ","$226.66 ","$0.00 ","$0.00 ","$190.41 ","$1,087.50 ","$0.00 ","$543.75 ","$861.30 ","$870.00 ","$0.00 ","$170.19 ","$0.00 ","$173.13 ","$0.00 "
"AR-7400TD","SUP","Custom 27203010","","AR-7400TD  -  BLADE SHVR 4MM 7CM TORPEDO COOLCUT OVIOD OUTR WDW SMTH CUT","BOTH IP/OP","$252.50 ","$186.85 ","$0.00 ","$252.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$252.50 ","$0.00 ","$126.25 ","$199.98 ","$202.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7500","SUP","Custom 27203010","","AR-7500  -  SUTURE NABSB 1.3MM 36IN WHT BLU STRL SUTURETAPE .5 CRC TPR","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7710","SUP","Custom 27203010","","AR-7710  -  BIT DRL 5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7710-4.5","SUP","Custom 27203010","","AR-7710-4.5  -  BIT DRL 4.5MM HUM TNL ULN COLLATERAL LGMNT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7710-5.0","SUP","Custom 27203010","","AR-7710-5.0  -  BIT DRL 5MM HUM TNL ULN COLLATERAL LGMNT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7711","SUP","Custom 27203010","","AR-7711  -  BIT DRL 4.5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7715-4.5","SUP","Custom 27203010","","AR-7715-4.5  -  KIT INST 2 MIC CRV 6IN STRL TIGERLOOP FIBERLOOP SUTLSO NDL","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7720-2.0","SUP","Custom 27203010","","AR-7720-2.0  -  DRILL SRG 2MM RECON ELB HUM ULN COLLATERAL LGMNT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7720-2.7","SUP","Custom 27203010","","AR-7720-2.7  -  DRILL SRG 2.7MM HUM","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7720-3.2","SUP","Custom 27203010","","AR-7720-3.2  -  DRILL SRG 3.2MM HUM","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7720-3.5","SUP","Custom 27203010","","AR-7720-3.5  -  DRILL SRG 3.5MM RECON ELB HUM ULN COLLATERAL LGMNT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7720-4.0","SUP","Custom 27203010","","AR-7720-4.0  -  DRILL SRG 4MM RECON ELB HUM ULN COLLATERAL LGMNT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7750-3.5","SUP","Custom 27203010","","AR-7750-3.5  -  GUIDE DRL V 3.5MM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7750-55","SUP","Custom 27203010","","AR-7750-55  -  GUIDE DRL 55D V ULNA","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7750-55M","SUP","Custom 27203010","","AR-7750-55M  -  GUIDE DRL 55D V PRT ULNA","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7752","SUP","Custom 27203010","","AR-7752  -  GUIDE DRL 3.5MM","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-7755","SUP","Custom 27203010","","AR-7755  -  GUIDE DRL OFST 7MM ULNA","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8003-10","SUP","HCPCS C1713","","AR-8003-10  -  STAPLE BN 10X10MM CMPR SS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-8003-15","SUP","HCPCS C1713","","AR-8003-15  -  STAPLE BN 15X10MM CMPR SS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-8004-10","SUP","HCPCS C1713","","AR-8004-10  -  STAPLE BN 10X15MM CMPR SS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-8004-15","SUP","HCPCS C1713","","AR-8004-15  -  STAPLE BN 15X15MM CMPR SS DISP","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-8005-20","SUP","HCPCS C1713","","AR-8005-20  -  STAPLE BN 20X20MM CMPR SS DISP","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-8005D-20","SUP","Custom 27203010","","AR-8005D-20  -  BIT DRL 2MM 120MM CNN","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8005D-30","SUP","Custom 27203010","","AR-8005D-30  -  BIT DRL 3MM 120MM CNN","BOTH IP/OP","$347.50 ","$257.15 ","$0.00 ","$347.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$347.50 ","$0.00 ","$173.75 ","$275.22 ","$278.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8006-20","SUP","HCPCS C1713","","AR-8006-20  -  PLATE BN 20MM 2 CMPR 2 HL SS FT/ANKL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8006-25","SUP","HCPCS C1713","","AR-8006-25  -  PLATE BN 25MM 2 CMPR 2 HL SS FT/ANKL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8006-30","SUP","HCPCS C1713","","AR-8006-30  -  PLATE BN 30MM 2 CMPR 2 HL SS FT/ANKL","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8006C","SUP","Custom 27203010","","AR-8006C  -  BIT DRL 2.4MM TRMIT CNN SLF CMPR THRD PTCH","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8006S","SUP","Custom 27203010","","AR-8006S  -  BIT DRL 2.5MM LAPIDUS CNN SLF CMPR THRD PTCH MIDFOOT","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8006T","SUP","HCPCS C1713","","AR-8006T  -  PLATE BN TRL 2 HL 2 CMPR","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-8007-20","SUP","HCPCS C1713","","AR-8007-20  -  PLATE BN 20MM 2 CMPR 3 HL SS FT/ANKL","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"AR-8007-25","SUP","HCPCS C1713","","AR-8007-25  -  PLATE BN 25MM 2 CMPR 3 HL SS FT/ANKL","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"AR-8007-30","SUP","HCPCS C1713","","AR-8007-30  -  PLATE BN 30MM 2 CMPR 3 HL SS FT/ANKL","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"AR-8007C-1","SUP","HCPCS C1713","","AR-8007C-1  -  CASE INST 2 CMPR","BOTH IP/OP","$4,737.50 ","$3,505.75 ","$0.00 ","$4,737.50 ","$2,131.88 ","$0.00 ","$987.41 ","$0.00 ","$0.00 ","$829.50 ","$4,737.50 ","$0.00 ","$2,368.75 ","$3,752.10 ","$3,790.00 ","$0.00 ","$741.42 ","$0.00 ","$754.21 ","$0.00 "
"AR-8007T","SUP","HCPCS C1713","","AR-8007T  -  TRIAL TRMA 3 HL 2 CMPR PLT","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"AR-8008-20","SUP","HCPCS C1713","","AR-8008-20  -  PLATE BN STRG 20MM 2 CMPR 4 HL SS FT/ANKL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-8008-25","SUP","HCPCS C1713","","AR-8008-25  -  PLATE BN STRG 25MM 2 CMPR 4 HL SS FT/ANKL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-8008-30","SUP","HCPCS C1713","","AR-8008-30  -  PLATE BN STRG 30MM 2 CMPR 4 HL SS FT/ANKL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-8009-20","SUP","HCPCS C1713","","AR-8009-20  -  PLATE BN SQ 20MM 2 CMPR 4 HL SS FT/ANKL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-8009-25","SUP","HCPCS C1713","","AR-8009-25  -  PLATE BN SQ 25MM 2 CMPR 4 HL SS FT/ANKL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-8009-30","SUP","HCPCS C1713","","AR-8009-30  -  PLATE BN SQ 30MM 2 CMPR 4 HL SS FT/ANKL","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-8400CSS","SUP","Custom 27203010","","AR-8400CSS  -  BURR SHVR 6 FLUT 4MM 13CM STRL CLRCT COOLCUT SLAP","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8400EX","SUP","Custom 27203010","","AR-8400EX  -  BLADE SHVR 4MM 13CM STRL EXCLBR COOLCUT DISP","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8400OBE","SUP","Custom 27203010","","AR-8400OBE  -  BURR SHVR 8 FLUT OVL 4MM 13CM STRL COOLCUT DISP","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8500BC","SUP","Custom 27203010","","AR-8500BC  -  CUTTER BN CUT 5MM 13CM STRL COOLCUT DISP","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8500EX","SUP","Custom 27203010","","AR-8500EX  -  BLADE SHVR 5MM 13CM STRL EXCLBR COOLCUT DISP","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8500OBE","SUP","Custom 27203010","","AR-8500OBE  -  BURR SHVR 8 FLUT OVL 5MM 13CM STRL COOLCUT DISP","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8545-16","SUP","HCPCS C1713","","AR-8545-16  -  SCREW BN LOPRFL 4.5MM 16MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-18","SUP","HCPCS C1713","","AR-8545-18  -  SCREW BN LOPRFL 4.5MM 18MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-20","SUP","HCPCS C1713","","AR-8545-20  -  SCREW BN LOPRFL 4.5MM 20MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-22","SUP","HCPCS C1713","","AR-8545-22  -  SCREW BN LOPRFL 4.5MM 22MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-24","SUP","HCPCS C1713","","AR-8545-24  -  SCREW BN LOPRFL 4.5MM 24MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-26","SUP","HCPCS C1713","","AR-8545-26  -  SCREW BN LOPRFL 4.5MM 26MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-28","SUP","HCPCS C1713","","AR-8545-28  -  SCREW BN LOPRFL 4.5MM 28MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-30","SUP","HCPCS C1713","","AR-8545-30  -  SCREW BN LOPRFL 4.5MM 30MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-32","SUP","HCPCS C1713","","AR-8545-32  -  SCREW BN LOPRFL 4.5MM 32MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-34","SUP","HCPCS C1713","","AR-8545-34  -  SCREW BN LOPRFL 4.5MM 34MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-36","SUP","HCPCS C1713","","AR-8545-36  -  SCREW BN LOPRFL 4.5MM 36MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-38","SUP","HCPCS C1713","","AR-8545-38  -  SCREW BN LOPRFL 4.5MM 38MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-40","SUP","HCPCS C1713","","AR-8545-40  -  SCREW BN LOPRFL 4.5MM 40MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-42","SUP","HCPCS C1713","","AR-8545-42  -  SCREW BN 4.5MM 42MM NS ARTHX LOPRFL TI","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-45","SUP","HCPCS C1713","","AR-8545-45  -  SCREW BN LOPRFL 4.5MM 45MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-48","SUP","HCPCS C1713","","AR-8545-48  -  SCREW BN 4.5MM 48MM LOPRFL TI","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-50","SUP","HCPCS C1713","","AR-8545-50  -  SCREW BN LOPRFL 4.5MM 50MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-55","SUP","HCPCS C1713","","AR-8545-55  -  SCREW BN LOPRFL 4.5MM 55MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-60","SUP","HCPCS C1713","","AR-8545-60  -  SCREW BN LOPRFL 4.5MM 60MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545-65","SUP","HCPCS C1713","","AR-8545-65  -  SCREW BN LOPRFL 4.5MM 65MM ANKL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"AR-8545L-16","SUP","HCPCS C1713","","AR-8545L-16  -  SCREW BN LOPRFL 4.5MM 16MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-18","SUP","HCPCS C1713","","AR-8545L-18  -  SCREW BN LOPRFL 4.5MM 18MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-20","SUP","HCPCS C1713","","AR-8545L-20  -  SCREW BN LOPRFL 4.5MM 20MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-22","SUP","HCPCS C1713","","AR-8545L-22  -  SCREW BN LOPRFL 4.5MM 22MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-24","SUP","HCPCS C1713","","AR-8545L-24  -  SCREW BN LOPRFL 4.5MM 24MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-26","SUP","HCPCS C1713","","AR-8545L-26  -  SCREW BN LOPRFL 4.5MM 26MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-28","SUP","HCPCS C1713","","AR-8545L-28  -  SCREW BN LOPRFL 4.5MM 28MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-30","SUP","HCPCS C1713","","AR-8545L-30  -  SCREW BN LOPRFL 4.5MM 30MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-32","SUP","HCPCS C1713","","AR-8545L-32  -  SCREW BN LOPRFL 4.5MM 32MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-34","SUP","HCPCS C1713","","AR-8545L-34  -  SCREW BN LOPRFL 4.5MM 34MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-36","SUP","HCPCS C1713","","AR-8545L-36  -  SCREW BN LOPRFL 4.5MM 36MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-38","SUP","HCPCS C1713","","AR-8545L-38  -  SCREW BN LOPRFL 4.5MM 38MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-40","SUP","HCPCS C1713","","AR-8545L-40  -  SCREW BN LOPRFL 4.5MM 40MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-44","SUP","HCPCS C1713","","AR-8545L-44  -  SCREW BN 4.5MM 44MM NS ARTHX LCK LOPRFL TI","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-50","SUP","HCPCS C1713","","AR-8545L-50  -  SCREW BN LOPRFL 4.5MM 50MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-50S","SUP","HCPCS C1713","","AR-8545L-50S  -  SCREW BN 4.5MM 50MM STRL ARTHX LOPRFL LCK","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-52","SUP","HCPCS C1713","","AR-8545L-52  -  SCREW BN 4.5MM 52MM LOPRFL LCK","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-54","SUP","HCPCS C1713","","AR-8545L-54  -  SCREW BN 4.5MM 54MM LOPRFL LCK","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8545L-55","SUP","HCPCS C1713","","AR-8545L-55  -  SCREW BN LOPRFL 4.5MM 55MM LCK ANKL","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
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"AR-8625-34","SUP","HCPCS C1713","","AR-8625-34  -  HEADLESS COMPR SCRW 2.5X 34 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
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"AR-8630-12","SUP","HCPCS C1713","","AR-8630-12  -  HEDLESS COMPR SCRW,3.0X 12 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-14","SUP","HCPCS C1713","","AR-8630-14  -  HEDLESS COMPR SCRW,3.0X 14 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-16","SUP","HCPCS C1713","","AR-8630-16  -  HEDLESS COMPR SCRW,3.0X 16 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-18","SUP","HCPCS C1713","","AR-8630-18  -  HEDLESS COMPR SCRW,3.0X 18 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-20","SUP","HCPCS C1713","","AR-8630-20  -  HEDLESS COMPR SCRW,3.0X 20 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-22","SUP","HCPCS C1713","","AR-8630-22  -  HEDLESS COMPR SCRW,3.0X 22 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-24","SUP","HCPCS C1713","","AR-8630-24  -  SCREW BN 3MM 24MM NS ARTHX CMPR CNN HDLS","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-26","SUP","HCPCS C1713","","AR-8630-26  -  HEDLESS COMPR SCRW,3.0X 26 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-28","SUP","HCPCS C1713","","AR-8630-28  -  HEDLESS COMPR SCRW,3.0X 28 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-30","SUP","HCPCS C1713","","AR-8630-30  -  HEDLESS COMPR SCRW,3.0X 30 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-32","SUP","HCPCS C1713","","AR-8630-32  -  HEDLESS COMPR SCRW,3.0X 32 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-34","SUP","HCPCS C1713","","AR-8630-34  -  HEDLESS COMPR SCRW,3.0X 34 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8630-36","SUP","HCPCS C1713","","AR-8630-36  -  HEDLESS COMPR SCRW,3.0X 36 MMCANN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8643-14","SUP","HCPCS C1713","","AR-8643-14  -  HEDLESS COMPR SCRW,4.3X 14 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-16","SUP","HCPCS C1713","","AR-8643-16  -  HEDLESS COMPR SCRW,4.3X 16 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-18","SUP","HCPCS C1713","","AR-8643-18  -  HEDLESS COMPR SCRW,4.3X 18 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-20","SUP","HCPCS C1713","","AR-8643-20  -  HEDLESS COMPR SCRW,4.3X 20 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-22","SUP","HCPCS C1713","","AR-8643-22  -  HEDLESS COMPR SCRW,4.3X 22 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-24","SUP","HCPCS C1713","","AR-8643-24  -  HEDLESS COMPR SCRW,4.3X 24 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-26","SUP","HCPCS C1713","","AR-8643-26  -  HEDLESS COMPR SCRW,4.3X 26 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-28","SUP","HCPCS C1713","","AR-8643-28  -  HEDLESS COMPR SCRW,4.3X 28 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-30","SUP","HCPCS C1713","","AR-8643-30  -  HEDLESS COMPR SCRW,4.3X 30 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-32","SUP","HCPCS C1713","","AR-8643-32  -  HEDLESS COMPR SCRW,4.3X 32 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-34","SUP","HCPCS C1713","","AR-8643-34  -  HEDLESS COMPR SCRW,4.3X 34 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-36","SUP","HCPCS C1713","","AR-8643-36  -  HEDLESS COMPR SCRW,4.3X 36 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-38","SUP","HCPCS C1713","","AR-8643-38  -  HEDLESS COMPR SCRW,4.3X 38 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-40","SUP","HCPCS C1713","","AR-8643-40  -  HEDLESS COMPR SCRW,4.3X 40 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-42","SUP","HCPCS C1713","","AR-8643-42  -  HEDLESS COMPR SCRW,4.3X 42 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-44","SUP","HCPCS C1713","","AR-8643-44  -  HEDLESS COMPR SCRW,4.3X 44 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-46","SUP","HCPCS C1713","","AR-8643-46  -  HEDLESS COMPR SCRW,4.3X 46 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-48","SUP","HCPCS C1713","","AR-8643-48  -  HEDLESS COMPR SCRW,4.3X 48 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-50","SUP","HCPCS C1713","","AR-8643-50  -  HEDLESS COMPR SCRW,4.3X 50 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-55","SUP","HCPCS C1713","","AR-8643-55  -  HEDLESS COMPR SCRW,4.3X 55 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-60","SUP","HCPCS C1713","","AR-8643-60  -  HEDLESS COMPR SCRW,4.3X 60 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-65","SUP","HCPCS C1713","","AR-8643-65  -  HEDLESS COMPR SCRW,4.3X 65 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-70","SUP","HCPCS C1713","","AR-8643-70  -  HEDLESS COMPR SCRW,4.3X 70 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-75","SUP","HCPCS C1713","","AR-8643-75  -  HEDLESS COMPR SCRW,4.3X 75 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8643-80","SUP","HCPCS C1713","","AR-8643-80  -  HEDLESS COMPR SCRW,4.3X 80 MMCANN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8655-13","SUP","Custom 27203010","","AR-8655-13  -  GUIDE DRL ANKL","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8656G","SUP","Custom 27203010","","AR-8656G  -  GUIDE DRL GPS TRGT","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8656G-04","SUP","Custom 27203010","","AR-8656G-04  -  CANNULA ASCP GPS 1.1/1.6/2.4 MM","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8665-100","SUP","HCPCS C1713","","AR-8665-100  -  HEDLESS COMPR SCRW 6.5X 100 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-105","SUP","HCPCS C1713","","AR-8665-105  -  HEDLESS COMPR SCRW 6.5X 105 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-110","SUP","HCPCS C1713","","AR-8665-110  -  HEDLESS COMPR SCRW 6.5X 110MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-115","SUP","HCPCS C1713","","AR-8665-115  -  HEDLESS COMPR SCRW 6.5X 115 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-120","SUP","HCPCS C1713","","AR-8665-120  -  HEDLESS COMPR SCRW 6.5X 120 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-18100","SUP","HCPCS C1713","","AR-8665-18100  -  SCREW BN ST 6.5MM 100MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-18105","SUP","HCPCS C1713","","AR-8665-18105  -  SCREW BN ST 6.5MM 105MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-18110","SUP","HCPCS C1713","","AR-8665-18110  -  SCREW BN ST 6.5MM 110MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-18115","SUP","HCPCS C1713","","AR-8665-18115  -  SCREW BN ST 6.5MM 115MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-18120","SUP","HCPCS C1713","","AR-8665-18120  -  SCREW BN ST 6.5MM 120MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1830","SUP","HCPCS C1713","","AR-8665-1830  -  SCREW BN ST 6.5MM 30MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1835","SUP","HCPCS C1713","","AR-8665-1835  -  SCREW BN ST 6.5MM 35MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1850","SUP","HCPCS C1713","","AR-8665-1850  -  SCREW BN P/T 6.5MM 50MM CMPR HDLS","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1855","SUP","HCPCS C1713","","AR-8665-1855  -  SCREW BN ST 6.5MM 55MM CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1860","SUP","HCPCS C1713","","AR-8665-1860  -  SCREW BN ST 6.5MM 60MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1865","SUP","HCPCS C1713","","AR-8665-1865  -  SCREW BN ST 6.5MM 65MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1880","SUP","HCPCS C1713","","AR-8665-1880  -  SCREW BN P/T 6.5MM 80MM CMPR HDLS","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1885","SUP","HCPCS C1713","","AR-8665-1885  -  SCREW BN P/T 6.5MM 85MM CMPR HDLS","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1890","SUP","HCPCS C1713","","AR-8665-1890  -  SCREW BN ST 6.5MM 90MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-1895","SUP","HCPCS C1713","","AR-8665-1895  -  SCREW BN ST 6.5MM 95MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-28100","SUP","HCPCS C1713","","AR-8665-28100  -  SCREW BN L/T 6.5MM 100MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-28105","SUP","HCPCS C1713","","AR-8665-28105  -  SCREW BN L/T 6.5MM 105MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-28110","SUP","HCPCS C1713","","AR-8665-28110  -  SCREW BN L/T 6.5MM 110MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-28115","SUP","HCPCS C1713","","AR-8665-28115  -  SCREW BN L/T 6.5MM 115MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-28120","SUP","HCPCS C1713","","AR-8665-28120  -  SCREW BN L/T 6.5MM 120MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2860","SUP","HCPCS C1713","","AR-8665-2860  -  SCREW BN L/T 6.5MM 60MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2865","SUP","HCPCS C1713","","AR-8665-2865  -  SCREW BN L/T 6.5MM 65MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2870","SUP","HCPCS C1713","","AR-8665-2870  -  SCREW BN L/T 6.5MM 70MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2875","SUP","HCPCS C1713","","AR-8665-2875  -  SCREW BN L/T 6.5MM 75MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2880","SUP","HCPCS C1713","","AR-8665-2880  -  SCREW BN L/T 6.5MM 80MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2885","SUP","HCPCS C1713","","AR-8665-2885  -  SCREW BN L/T 6.5MM 85MM NS ARTHX CMPR HDLS","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2890","SUP","HCPCS C1713","","AR-8665-2890  -  SCREW BN L/T 6.5MM 90MM CMPR CNN HDLS VTRN","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-2895","SUP","HCPCS C1713","","AR-8665-2895  -  SCREW BN L/T 6.5MM 95MM NS ARTHX CMPR HDLS","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$646.88 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"AR-8665-30","SUP","HCPCS C1713","","AR-8665-30  -  HEDLESS COMPR SCRW 6.5X 30 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-35","SUP","HCPCS C1713","","AR-8665-35  -  HEDLESS COMPR SCRW 6.5X 35 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-40","SUP","HCPCS C1713","","AR-8665-40  -  HEDLESS COMPR SCRW 6.5X 40 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-45","SUP","HCPCS C1713","","AR-8665-45  -  HEDLESS COMPR SCRW 6.5X 45 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-50","SUP","HCPCS C1713","","AR-8665-50  -  HEDLESS COMPR SCRW 6.5X 50 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-55","SUP","HCPCS C1713","","AR-8665-55  -  HEDLESS COMPR SCRW 6.5X 55 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-60","SUP","HCPCS C1713","","AR-8665-60  -  HEDLESS COMPR SCRW 6.5X 60 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-65","SUP","HCPCS C1713","","AR-8665-65  -  HEDLESS COMPR SCRW 6.5X 65 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-70","SUP","HCPCS C1713","","AR-8665-70  -  HEDLESS COMPR SCRW 6.5X 70 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-75","SUP","HCPCS C1713","","AR-8665-75  -  HEDLESS COMPR SCRW 6.5X 75 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-80","SUP","HCPCS C1713","","AR-8665-80  -  SCREW BN 6.5MM 80MM NS ARTHX CMPR CNN HDLS","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-85","SUP","HCPCS C1713","","AR-8665-85  -  HEDLESS COMPR SCRW 6.5X 85 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-90","SUP","HCPCS C1713","","AR-8665-90  -  SCREW BN 6.5MM 90MM NS ARTHX CMPR CNN HDLS","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8665-95","SUP","HCPCS C1713","","AR-8665-95  -  HEDLESS COMPR SCRW 6.5X 95 MMCANN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8690DS","SUP","HCPCS C1713","","AR-8690DS  -  SYSTEM FX CPR MN SCRPN DX","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"AR-8692DS","SUP","Custom 27203010","","AR-8692DS  -  SYSTEM FX CPR VPR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8701","SUP","Custom 27203010","","AR-8701  -  PASSER SUTURE MICRO SMALL CURVE BENT 1.25MM 6IN BRAID EASIER","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8703","SUP","Custom 27203010","","AR-8703  -  PASSER SUTLSO MIC STR SUTURE STRL DISP","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8704","SUP","Custom 27203010","","AR-8704  -  PASSER SUT 70D MIC SHRT BNT 3ANG STRL SUTLSO FIBROCARTILAGE","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8708","SUP","HCPCS C1713","","AR-8708  -  STAPLE BN SM 8MM SUT SS","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8708S","SUP","HCPCS C1713","","AR-8708S  -  STAPLE BN SM QFIX","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$2,531.25 ","$0.00 ","$1,172.39 ","$0.00 ","$0.00 ","$984.89 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$880.31 ","$0.00 ","$895.50 ","$0.00 "
"AR-8710","SUP","HCPCS C1713","","AR-8710  -  STAPLE BN SM 10MM QFIX SS","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8714","SUP","HCPCS C1713","","AR-8714  -  PLATE BN LOPRFL 12MM PLAPLE SS DIAPHYSIS","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"AR-8715","SUP","HCPCS C1713","","AR-8715  -  PLATE BN LOPRFL 15MM PLAPLE SS SM BN 2.3MM CORT SCR","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"AR-8716","SUP","HCPCS C1713","","AR-8716  -  PLATE BN LOPRFL 20MM PLAPLE SS SM BN 2.3MM CORT SCR","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$962.50 ","$433.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$168.53 ","$962.50 ","$0.00 ","$481.25 ","$762.30 ","$770.00 ","$0.00 ","$150.63 ","$0.00 ","$153.23 ","$0.00 "
"AR-8720-08PT","SUP","HCPCS C1713","","AR-8720-08PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 8MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-10PT","SUP","HCPCS C1713","","AR-8720-10PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 10MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-12PT","SUP","HCPCS C1713","","AR-8720-12PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 12MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-14PT","SUP","HCPCS C1713","","AR-8720-14PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 14MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-16PT","SUP","HCPCS C1713","","AR-8720-16PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 16MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-18PT","SUP","HCPCS C1713","","AR-8720-18PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 18MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-20PT","SUP","HCPCS C1713","","AR-8720-20PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 20MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-22PT","SUP","HCPCS C1713","","AR-8720-22PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 22MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-24PT","SUP","HCPCS C1713","","AR-8720-24PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 24MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-26PT","SUP","HCPCS C1713","","AR-8720-26PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 26MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-28PT","SUP","HCPCS C1713","","AR-8720-28PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 28MM QFIX SLF DRL ST CNN","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8720-30PT","SUP","HCPCS C1713","","AR-8720-30PT  -  SCREW BN P/T 2MM 30MM QFIX CNN TI","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724-08","SUP","HCPCS C1713","","AR-8724-08  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-08PT","SUP","HCPCS C1713","","AR-8724-08PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-10","SUP","HCPCS C1713","","AR-8724-10  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-10PT","SUP","HCPCS C1713","","AR-8724-10PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-12","SUP","HCPCS C1713","","AR-8724-12  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-12PT","SUP","HCPCS C1713","","AR-8724-12PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-14","SUP","HCPCS C1713","","AR-8724-14  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-14PT","SUP","HCPCS C1713","","AR-8724-14PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-16","SUP","HCPCS C1713","","AR-8724-16  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-16PT","SUP","HCPCS C1713","","AR-8724-16PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-18PT","SUP","HCPCS C1713","","AR-8724-18PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 18MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-20","SUP","HCPCS C1713","","AR-8724-20  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-20PT","SUP","HCPCS C1713","","AR-8724-20PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-22","SUP","HCPCS C1713","","AR-8724-22  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-22PT","SUP","HCPCS C1713","","AR-8724-22PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-24PT","SUP","HCPCS C1713","","AR-8724-24PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 24MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-26PT","SUP","HCPCS C1713","","AR-8724-26PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 26MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-28","SUP","HCPCS C1713","","AR-8724-28  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-28PT","SUP","HCPCS C1713","","AR-8724-28PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-30","SUP","HCPCS C1713","","AR-8724-30  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-30PT","SUP","HCPCS C1713","","AR-8724-30PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-32","SUP","HCPCS C1713","","AR-8724-32  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-32PT","SUP","HCPCS C1713","","AR-8724-32PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-34","SUP","HCPCS C1713","","AR-8724-34  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-34PT","SUP","HCPCS C1713","","AR-8724-34PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-36","SUP","HCPCS C1713","","AR-8724-36  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 36MM QFIX SLF DRL ST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-36PT","SUP","HCPCS C1713","","AR-8724-36PT  -  SCREW BN P/T 2.4MM 36MM QFIX CNN TI","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$163.13 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"AR-8724-38","SUP","HCPCS C1713","","AR-8724-38  -  SCREW BN 2.4MM 38MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724-40","SUP","HCPCS C1713","","AR-8724-40  -  SCREW BN 2.4MM 40MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8724GV","SUP","Custom 27203010","","AR-8724GV  -  GUIDE DRL 2.4MM VA","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,037.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.50 ","$0.00 ","$518.75 ","$821.70 ","$830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8724L-08","SUP","HCPCS C1713","","AR-8724L-08  -  SCREW BN 2.4MM 8MM LCK LOPRFL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-10","SUP","HCPCS C1713","","AR-8724L-10  -  SCREW BN T8 FT HEXALOBE 2.4MM 10MM SLF DRL SLD LCK TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-12","SUP","HCPCS C1713","","AR-8724L-12  -  SCREW BN T8 FT HEXALOBE 2.4MM 12MM SLF DRL SLD LCK TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-14","SUP","HCPCS C1713","","AR-8724L-14  -  SCREW BN T8 FT HEXALOBE 2.4MM 14MM SLF DRL SLD LCK TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-16","SUP","HCPCS C1713","","AR-8724L-16  -  SCREW BN T8 FT HEXALOBE 2.4MM 16MM SLF DRL SLD LCK TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-18","SUP","HCPCS C1713","","AR-8724L-18  -  SCREW BN T8 FT HEXALOBE 2.4MM 18MM SLF DRL SLD LCK TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-20","SUP","HCPCS C1713","","AR-8724L-20  -  SCREW BN T8 FT HEXALOBE 2.4MM 20MM SLF DRL SLD LCK TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-22","SUP","HCPCS C1713","","AR-8724L-22  -  SCREW BN LOPRFL 2.4MM 22MM LCK ST SLD TI FT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-24","SUP","HCPCS C1713","","AR-8724L-24  -  SCREW BN LOPRFL 2.4MM 24MM LCK ST SLD TI FT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-26","SUP","HCPCS C1713","","AR-8724L-26  -  SCREW BN 2.4MM 26MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-28","SUP","HCPCS C1713","","AR-8724L-28  -  SCREW BN 2.4MM 28MM LOPRFL LCK TI","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-30","SUP","HCPCS C1713","","AR-8724L-30  -  SCREW BN 2.4MM 30MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-32","SUP","HCPCS C1713","","AR-8724L-32  -  SCREW BN 2.4MM 32MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-34","SUP","HCPCS C1713","","AR-8724L-34  -  SCREW BN T8 FT HEXALOBE 2.4MM 34MM LCK SLF DRL SLD TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-36","SUP","HCPCS C1713","","AR-8724L-36  -  SCREW BN T8 FT HEXALOBE 2.4MM 36MM LCK SLF DRL SLD TI SM BN","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-38","SUP","HCPCS C1713","","AR-8724L-38  -  SCREW BN 2.4MM 38MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724L-40","SUP","HCPCS C1713","","AR-8724L-40  -  SCREW BN 2.4MM 40MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8724V-08","SUP","HCPCS C1713","","AR-8724V-08  -  SCREW BN LOPRFL 2.4MM 8MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-10","SUP","HCPCS C1713","","AR-8724V-10  -  SCREW BN LOPRFL 2.4MM 10MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-12","SUP","HCPCS C1713","","AR-8724V-12  -  SCREW BN LOPRFL 2.4MM 12MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-14","SUP","HCPCS C1713","","AR-8724V-14  -  SCREW BN LOPRFL 2.4MM 14MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-16","SUP","HCPCS C1713","","AR-8724V-16  -  SCREW BN LOPRFL 2.4MM 16MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-18","SUP","HCPCS C1713","","AR-8724V-18  -  SCREW BN LOPRFL 2.4MM 18MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-20","SUP","HCPCS C1713","","AR-8724V-20  -  SCREW BN LOPRFL 2.4MM 20MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-22","SUP","HCPCS C1713","","AR-8724V-22  -  SCREW BN LOPRFL 2.4MM 22MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-24","SUP","HCPCS C1713","","AR-8724V-24  -  SCREW BN LOPRFL 2.4MM 24MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-26","SUP","HCPCS C1713","","AR-8724V-26  -  SCREW BN LOPRFL 2.4MM 26MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-28","SUP","HCPCS C1713","","AR-8724V-28  -  SCREW BN LOPRFL 2.4MM 28MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-30","SUP","HCPCS C1713","","AR-8724V-30  -  SCREW BN LOPRFL 2.4MM 30MM VA ST SLD LCK TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-32","SUP","HCPCS C1713","","AR-8724V-32  -  SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-34","SUP","HCPCS C1713","","AR-8724V-34  -  SCREW BN LOPRFL 2.4MM 34MM LCK ST SLD VA TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-36","SUP","HCPCS C1713","","AR-8724V-36  -  SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-38","SUP","HCPCS C1713","","AR-8724V-38  -  SCREW BN LOPRFL 2.4MM 38MM LCK ST SLD VA TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724V-40","SUP","HCPCS C1713","","AR-8724V-40  -  SCREW BN LOPRFL 2.4MM 40MM LCK ST SLD VA TI FT HND ANKL WRST","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8724W","SUP","HCPCS C1713","","AR-8724W  -  WASHER ORTH 6MM TI 2/2.4MM QFIX SCR","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8725-08H","SUP","HCPCS C1713","","AR-8725-08H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 8MM QFIX SLF DRL ST CNN CMPR","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-09H","SUP","HCPCS C1713","","AR-8725-09H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 9MM QFIX SLF DRL ST CNN CMPR","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-10H","SUP","HCPCS C1713","","AR-8725-10H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 10MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-11H","SUP","HCPCS C1713","","AR-8725-11H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 11MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-12H","SUP","HCPCS C1713","","AR-8725-12H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 12MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-13H","SUP","HCPCS C1713","","AR-8725-13H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 13MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-14H","SUP","HCPCS C1713","","AR-8725-14H  -  SCREW BN 1.5MM MIC FT 2.5MM 14MM QFIX SLF DRL ST CNN CMPR TI","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-16H","SUP","HCPCS C1713","","AR-8725-16H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 16MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-18H","SUP","HCPCS C1713","","AR-8725-18H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 18MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-20H","SUP","HCPCS C1713","","AR-8725-20H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 20MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-22H","SUP","HCPCS C1713","","AR-8725-22H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 22MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-24H","SUP","HCPCS C1713","","AR-8725-24H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 24MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-26H","SUP","HCPCS C1713","","AR-8725-26H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 26MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-28H","SUP","HCPCS C1713","","AR-8725-28H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 28MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8725-30H","SUP","HCPCS C1713","","AR-8725-30H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 30MM QFIX SLF DRL ST CNN","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8730-10PT","SUP","HCPCS C1713","","AR-8730-10PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 10MM QFIX SLF DRL ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"AR-8730-12H","SUP","HCPCS C1713","","AR-8730-12H  -  SCREW BN MN FT 3.6MM 12MM QFIX CNN CMPR TI FT/ANKL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8730-12PT","SUP","HCPCS C1713","","AR-8730-12PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 12MM QFIX SLF DRL ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"AR-8730-14H","SUP","HCPCS C1713","","AR-8730-14H  -  SCREW BN MN FT 3.6MM 14MM QFIX CNN CMPR TI FT/ANKL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8730-14PT","SUP","HCPCS C1713","","AR-8730-14PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 14MM QFIX SLF DRL ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"AR-8730-16H","SUP","HCPCS C1713","","AR-8730-16H  -  SCREW BN MN FT 3.6MM 16MM QFIX CNN CMPR TI FT/ANKL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8730-16PT","SUP","HCPCS C1713","","AR-8730-16PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 16MM QFIX SLF DRL ST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"AR-8730-18H","SUP","HCPCS C1713","","AR-8730-18H  -  SCREW BN MN FT 3.6MM 18MM QFIX CNN CMPR TI FT/ANKL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
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"AR-8740-18H","SUP","HCPCS C1713","","AR-8740-18H  -  SCREW BN STD FT 4.6MM 18MM QFIX CNN CMPR TI ANKL/FT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-18PTS","SUP","HCPCS C1713","","AR-8740-18PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 18MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-20H","SUP","HCPCS C1713","","AR-8740-20H  -  SCREW BN STD FT 4.6MM 20MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-20PTS","SUP","HCPCS C1713","","AR-8740-20PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 20MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-22H","SUP","HCPCS C1713","","AR-8740-22H  -  SCREW BN STD FT 4MM 22MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-22PTS","SUP","HCPCS C1713","","AR-8740-22PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 22MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-24H","SUP","HCPCS C1713","","AR-8740-24H  -  SCREW BN STD FT 4.6MM 24MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-24PTS","SUP","HCPCS C1713","","AR-8740-24PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 24MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-26H","SUP","HCPCS C1713","","AR-8740-26H  -  SCREW BN STD FT 4.6MM 26MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-26PTS","SUP","HCPCS C1713","","AR-8740-26PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 26MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-28H","SUP","HCPCS C1713","","AR-8740-28H  -  SCREW BN STD FT 4.6MM 28MM QFIX CNN CMPR TI ANKL/FT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-28PTS","SUP","HCPCS C1713","","AR-8740-28PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 28MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-30H","SUP","HCPCS C1713","","AR-8740-30H  -  SCREW BN STD FT 4MM 30MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-30PTL","SUP","HCPCS C1713","","AR-8740-30PTL  -  SCREW BN LNG P/T LOPRFL 4MM 30MM SLF DRL ST CNN TI SHLDR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-30PTS","SUP","HCPCS C1713","","AR-8740-30PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 30MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-32H","SUP","HCPCS C1713","","AR-8740-32H  -  SCREW BN STD FT 4.6MM 32MM QFIX CNN CMPR TI ANKL/FT","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-32PTL","SUP","HCPCS C1713","","AR-8740-32PTL  -  SCREW BN LNG P/T LOPRFL 4MM 32MM SLF DRL ST CNN TI SHLDR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-32PTS","SUP","HCPCS C1713","","AR-8740-32PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 32MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-34H","SUP","HCPCS C1713","","AR-8740-34H  -  SCREW BN STD FT 4MM 34MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-34PTL","SUP","HCPCS C1713","","AR-8740-34PTL  -  SCREW BN LNG P/T LOPRFL 4MM 34MM SLF DRL ST CNN TI SHLDR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-34PTS","SUP","HCPCS C1713","","AR-8740-34PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 34MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-36H","SUP","HCPCS C1713","","AR-8740-36H  -  SCREW BN STD FT 4MM 36MM CNN CMPR VAR STP PTCH TI FT/ANKL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-36PTL","SUP","HCPCS C1713","","AR-8740-36PTL  -  SCREW BN LNG P/T LOPRFL 4MM 36MM SLF DRL ST CNN TI SHLDR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-36PTS","SUP","HCPCS C1713","","AR-8740-36PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 36MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-38H","SUP","HCPCS C1713","","AR-8740-38H  -  SCREW BN STD FT 4MM 38MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-38PTL","SUP","HCPCS C1713","","AR-8740-38PTL  -  SCREW BN LNG P/T LOPRFL 4MM 38MM SLF DRL ST CNN TI SHLDR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-38PTS","SUP","HCPCS C1713","","AR-8740-38PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 38MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-40H","SUP","HCPCS C1713","","AR-8740-40H  -  SCREW BN STD FT 4MM 40MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-40PTS","SUP","HCPCS C1713","","AR-8740-40PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 40MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-42H","SUP","HCPCS C1713","","AR-8740-42H  -  SCREW BN STD FT 4.6MM 42MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-42PTS","SUP","HCPCS C1713","","AR-8740-42PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 42MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-44H","SUP","HCPCS C1713","","AR-8740-44H  -  SCREW BN STD FT 4.6MM 44MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-44PTS","SUP","HCPCS C1713","","AR-8740-44PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 44MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-46H","SUP","HCPCS C1713","","AR-8740-46H  -  SCREW BN STD FT 4.6MM 46MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-46PTS","SUP","HCPCS C1713","","AR-8740-46PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 46MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-48H","SUP","HCPCS C1713","","AR-8740-48H  -  SCREW BN STD FT 4.6MM 48MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-48PTS","SUP","HCPCS C1713","","AR-8740-48PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 48MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-50H","SUP","HCPCS C1713","","AR-8740-50H  -  SCREW BN STD FT 4.6MM 50MM CNN CMPR VAR STP PTCH TI FT HND","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8740-50PTS","SUP","HCPCS C1713","","AR-8740-50PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 50MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-52PTLS","SUP","HCPCS C1713","","AR-8740-52PTLS  -  SCREW BN P/T 4MM 52MM STRL ARTHX LOPRFL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-52PTS","SUP","HCPCS C1713","","AR-8740-52PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 52MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-54PTS","SUP","HCPCS C1713","","AR-8740-54PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 54MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-56PTS","SUP","HCPCS C1713","","AR-8740-56PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 56MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-58PTS","SUP","HCPCS C1713","","AR-8740-58PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 58MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740-60PTS","SUP","HCPCS C1713","","AR-8740-60PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 60MM QFIX BCMPT","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8740W","SUP","HCPCS C1713","","AR-8740W  -  WASHER ORTH 7MM TI 4MM QFIX SCR","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8801","SUP","Custom 27203010","","AR-8801  -  SHEATH ASCP GD SLOT","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8825B","SUP","HCPCS C1713","","AR-8825B  -  ANCHOR SUT MN 2.5MM 8MM STRL BIO-PUSHLOCK","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-8825CP","SUP","Custom 27203010","","AR-8825CP  -  KIT INST 3ANG FIBROCARTILAGE CMPLX DISP","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8825P","SUP","HCPCS C1713","","AR-8825P  -  ANCHOR SUT MN 2.5MM 8MM STRL PUSHLOCK PEEK","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"AR-8826G","SUP","Custom 27203010","","AR-8826G  -  GUIDE DRL C RING GFT ANCH","BOTH IP/OP","$7,187.50 ","$5,318.75 ","$0.00 ","$7,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,187.50 ","$0.00 ","$3,593.75 ","$5,692.50 ","$5,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8827-10","SUP","HCPCS C1713","","AR-8827-10  -  SCREW BN 2.7MM 10MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-12","SUP","HCPCS C1713","","AR-8827-12  -  SCREW BN 2.7MM 12MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-14","SUP","HCPCS C1713","","AR-8827-14  -  SCREW BN 2.7MM 14MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-16","SUP","HCPCS C1713","","AR-8827-16  -  SCREW BN 2.7MM 16MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-18","SUP","HCPCS C1713","","AR-8827-18  -  SCREW BN 2.7MM 18MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-20","SUP","HCPCS C1713","","AR-8827-20  -  SCREW BN 2.7MM 20MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-22","SUP","HCPCS C1713","","AR-8827-22  -  SCREW BN 2.7MM 22MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-24","SUP","HCPCS C1713","","AR-8827-24  -  SCREW BN 2.7MM 24MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-26","SUP","HCPCS C1713","","AR-8827-26  -  SCREW BN 2.7MM 26MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-28","SUP","HCPCS C1713","","AR-8827-28  -  SCREW BN 2.7MM 28MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-30","SUP","HCPCS C1713","","AR-8827-30  -  SCREW BN 2.7MM 30MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-32","SUP","HCPCS C1713","","AR-8827-32  -  SCREW BN 2.7MM 32MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-34","SUP","HCPCS C1713","","AR-8827-34  -  SCREW BN 2.7MM 34MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-36","SUP","HCPCS C1713","","AR-8827-36  -  SCREW BN 2.7MM 36MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-38","SUP","HCPCS C1713","","AR-8827-38  -  SCREW BN 2.7MM 38MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-40","SUP","HCPCS C1713","","AR-8827-40  -  SCREW BN 2.7MM 40MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-42","SUP","HCPCS C1713","","AR-8827-42  -  SCREW BN 2.7MM 42MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-44","SUP","HCPCS C1713","","AR-8827-44  -  SCREW BN 2.7MM 44MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-46","SUP","HCPCS C1713","","AR-8827-46  -  SCREW BN 2.7MM 46MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-48","SUP","HCPCS C1713","","AR-8827-48  -  SCREW BN 2.7MM 48MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-50","SUP","HCPCS C1713","","AR-8827-50  -  SCREW BN 2.7MM 50MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-52","SUP","HCPCS C1713","","AR-8827-52  -  SCREW BN 2.7MM 52MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-54","SUP","HCPCS C1713","","AR-8827-54  -  SCREW BN 2.7MM 54MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-56","SUP","HCPCS C1713","","AR-8827-56  -  SCREW BN 2.7MM 56MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-58","SUP","HCPCS C1713","","AR-8827-58  -  SCREW BN 2.7MM 56MM NONLOCK LOPRFL ANKL CORT FX MGMT SYS","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827-60","SUP","HCPCS C1713","","AR-8827-60  -  SCREW BN 2.7MM 60MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"AR-8827D-01","SUP","Custom 27203010","","AR-8827D-01  -  BIT DRL 2.7MM 2.7/3MM SCR ANKL FX MGMT SYS","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8827D-02","SUP","Custom 27203010","","AR-8827D-02  -  GUIDE DRL 2.7MM 2MM","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8827L-08","SUP","HCPCS C1713","","AR-8827L-08  -  SCREW BN T10 HEXALOBE FT 2.7MM 8MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-10","SUP","HCPCS C1713","","AR-8827L-10  -  SCREW BN FT T10 HEXALOBE 2.7MM 10MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-12","SUP","HCPCS C1713","","AR-8827L-12  -  SCREW BN FT T10 HEXALOBE 2.7MM 12MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-14","SUP","HCPCS C1713","","AR-8827L-14  -  SCREW BN FT T10 HEXALOBE 2.7MM 14MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-16","SUP","HCPCS C1713","","AR-8827L-16  -  SCREW BN FT T10 HEXALOBE 2.7MM 16MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-18","SUP","HCPCS C1713","","AR-8827L-18  -  SCREW BN FT T10 HEXALOBE 2.7MM 18MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-20","SUP","HCPCS C1713","","AR-8827L-20  -  SCREW BN FT T10 HEXALOBE 2.7MM 20MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-22","SUP","HCPCS C1713","","AR-8827L-22  -  SCREW BN FT T10 HEXALOBE 2.7MM 22MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-24","SUP","HCPCS C1713","","AR-8827L-24  -  SCREW BN FT T10 HEXALOBE 2.7MM 24MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-26","SUP","HCPCS C1713","","AR-8827L-26  -  SCREW BN FT T10 HEXALOBE 2.7MM 26MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-28","SUP","HCPCS C1713","","AR-8827L-28  -  SCREW BN T10 HEXALOBE FT 2.7MM 28MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-30","SUP","HCPCS C1713","","AR-8827L-30  -  SCREW BN 2.7MM 30MM LOPRFL LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-34","SUP","HCPCS C1713","","AR-8827L-34  -  SCREW BN 2.7MM 34MM NS LF LPR ARTHX LCK SS","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-36","SUP","HCPCS C1713","","AR-8827L-36  -  SCREW BN 2.7MM 36MM NS LF LPR ARTHX LCK SS","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-38","SUP","HCPCS C1713","","AR-8827L-38  -  SCREW BN 2.7MM 38MM NS LF LPR ARTHX LCK SS","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-40","SUP","HCPCS C1713","","AR-8827L-40  -  SCREW BN 2.7MM 40MM NS LF LPR ARTHX LCK SS","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-42","SUP","HCPCS C1713","","AR-8827L-42  -  SCREW BN 2.7MM 42MM STRL LOPRFL SCR LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-44","SUP","HCPCS C1713","","AR-8827L-44  -  SCREW BN 2.7MM 44MM LOPRFL SCR LCK","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-46","SUP","HCPCS C1713","","AR-8827L-46  -  SCREW BN 2.7MM 46MM STRL LOPRFL SCR LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-48","SUP","HCPCS C1713","","AR-8827L-48  -  SCREW BN 2.7MM 48MM STRL LOPRFL SCR LCK","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-50","SUP","HCPCS C1713","","AR-8827L-50  -  SCREW BN 2.7MM 50MM LOPRFL SCR LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-52","SUP","HCPCS C1713","","AR-8827L-52  -  SCREW BN 2.7MM 52MM LOPRFL SCR LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-54","SUP","HCPCS C1713","","AR-8827L-54  -  SCREW BN 2.7MM 54MM ARTHX LOPRFL SCR LCK","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-56","SUP","HCPCS C1713","","AR-8827L-56  -  SCREW BN 2.7MM 56MM LOPRFL SCR LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-58","SUP","HCPCS C1713","","AR-8827L-58  -  SCREW BN 2.7MM 58MM ARTHX LOPRFL SCR LCK","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8827L-60","SUP","HCPCS C1713","","AR-8827L-60  -  SCREW BN 2.7MM 60MM LOPRFL SCR LCK ANKL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8830-10","SUP","HCPCS C1713","","AR-8830-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-12","SUP","HCPCS C1713","","AR-8830-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-14","SUP","HCPCS C1713","","AR-8830-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-16","SUP","HCPCS C1713","","AR-8830-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-18","SUP","HCPCS C1713","","AR-8830-18  -  SCREW BN FT T10 HEXALOBE 3MM 18MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-20","SUP","HCPCS C1713","","AR-8830-20  -  SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-22","SUP","HCPCS C1713","","AR-8830-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-24","SUP","HCPCS C1713","","AR-8830-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-26","SUP","HCPCS C1713","","AR-8830-26  -  SCREW BN FT T10 HEXALOBE 3MM 26MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-28","SUP","HCPCS C1713","","AR-8830-28  -  SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8830-30","SUP","HCPCS C1713","","AR-8830-30  -  SCREW BN FT T10 HEXALOBE 3MM 30MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-08","SUP","HCPCS C1713","","AR-8835-08  -  SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-08S","SUP","HCPCS C1713","","AR-8835-08S  -  SCREW BN 3.5MM 8MM STRL ARTHX LOPRFL CORT","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-10","SUP","HCPCS C1713","","AR-8835-10  -  SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-12","SUP","HCPCS C1713","","AR-8835-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-14","SUP","HCPCS C1713","","AR-8835-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-16","SUP","HCPCS C1713","","AR-8835-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-18","SUP","HCPCS C1713","","AR-8835-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-20","SUP","HCPCS C1713","","AR-8835-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-22","SUP","HCPCS C1713","","AR-8835-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-24","SUP","HCPCS C1713","","AR-8835-24  -  SCREW BN T15 FT HEXALOBE 3.5MM 24MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-26","SUP","HCPCS C1713","","AR-8835-26  -  SCREW BN T15 FT HEXALOBE 3.5MM 26MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-28","SUP","HCPCS C1713","","AR-8835-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-30","SUP","HCPCS C1713","","AR-8835-30  -  SCREW BN T15 HEXALOBE FT 3.5MM 30MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-32","SUP","HCPCS C1713","","AR-8835-32  -  SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-34","SUP","HCPCS C1713","","AR-8835-34  -  SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-35","SUP","HCPCS C1713","","AR-8835-35  -  SCREW BN T15 FT HEXALOBE 3.5MM 35MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-36","SUP","HCPCS C1713","","AR-8835-36  -  SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-38","SUP","HCPCS C1713","","AR-8835-38  -  SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-40","SUP","HCPCS C1713","","AR-8835-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-42","SUP","HCPCS C1713","","AR-8835-42  -  SCREW BN T15 HEXALOBE FT 3.5MM 42MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-44","SUP","HCPCS C1713","","AR-8835-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-45","SUP","HCPCS C1713","","AR-8835-45  -  SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-46","SUP","HCPCS C1713","","AR-8835-46  -  SCREW BN T15 HEXALOBE FT 3.5MM 46MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-48","SUP","HCPCS C1713","","AR-8835-48  -  SCREW BN T15 HEXALOBE FT 3.5MM 48MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-50","SUP","HCPCS C1713","","AR-8835-50  -  SCREW BN T15 FT HEXALOBE 3.5MM 50MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-55","SUP","HCPCS C1713","","AR-8835-55  -  SCREW BN T15 FT HEXALOBE 3.5MM 55MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-60","SUP","HCPCS C1713","","AR-8835-60  -  SCREW BN T15 FT HEXALOBE 3.5MM 60MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-65","SUP","HCPCS C1713","","AR-8835-65  -  SCREW BN HEXALOBE FT 3.5MM 65MM LOPRFL SCR T15 SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-70","SUP","HCPCS C1713","","AR-8835-70  -  SCREW BN HEXALOBE FT 3.5MM 70MM LOPRFL SCR T15 SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-75","SUP","HCPCS C1713","","AR-8835-75  -  SCREW BN HEXALOBE FT 3.5MM 75MM LOPRFL SCR T15 SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835-80","SUP","HCPCS C1713","","AR-8835-80  -  SCREW BN 3.5MM 80MM ARTHX LOPRFL SCR CORT","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8835L-08","SUP","HCPCS C1713","","AR-8835L-08  -  SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-10","SUP","HCPCS C1713","","AR-8835L-10  -  SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-12","SUP","HCPCS C1713","","AR-8835L-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-14","SUP","HCPCS C1713","","AR-8835L-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-16","SUP","HCPCS C1713","","AR-8835L-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-18","SUP","HCPCS C1713","","AR-8835L-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-20","SUP","HCPCS C1713","","AR-8835L-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-22","SUP","HCPCS C1713","","AR-8835L-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-24","SUP","HCPCS C1713","","AR-8835L-24  -  SCREW BN T15 HEXALOBE FT 3.5MM 24MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-26","SUP","HCPCS C1713","","AR-8835L-26  -  SCREW BN T15 HEXALOBE FT 3.5MM 26MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-28","SUP","HCPCS C1713","","AR-8835L-28  -  SCREW BN T15 HEXALOBE FT 3.5MM 28MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-30","SUP","HCPCS C1713","","AR-8835L-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-32","SUP","HCPCS C1713","","AR-8835L-32  -  SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-34","SUP","HCPCS C1713","","AR-8835L-34  -  SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-36","SUP","HCPCS C1713","","AR-8835L-36  -  SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-38","SUP","HCPCS C1713","","AR-8835L-38  -  SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-40","SUP","HCPCS C1713","","AR-8835L-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-42","SUP","HCPCS C1713","","AR-8835L-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-44","SUP","HCPCS C1713","","AR-8835L-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-45","SUP","HCPCS C1713","","AR-8835L-45  -  SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-46","SUP","HCPCS C1713","","AR-8835L-46  -  SCREW BN T15 FT HEXALOBE 3.5MM 46MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-48","SUP","HCPCS C1713","","AR-8835L-48  -  SCREW BN T15 FT HEXALOBE 3.5MM 48MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8835L-50","SUP","HCPCS C1713","","AR-8835L-50  -  SCREW BN T15 HEXALOBE FT 3.5MM 50MM LOPRFL SCR LCK MDLR SLF","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8840-10","SUP","HCPCS C1713","","AR-8840-10  -  SCREW BN T15 FT HEXALOBE 4MM 10MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-10S","SUP","HCPCS C1713","","AR-8840-10S  -  SCREW BN 4MM 10MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-12","SUP","HCPCS C1713","","AR-8840-12  -  SCREW BN T15 FT HEXALOBE 4MM 12MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-12S","SUP","HCPCS C1713","","AR-8840-12S  -  SCREW BN 4MM 12MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-14","SUP","HCPCS C1713","","AR-8840-14  -  SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-16","SUP","HCPCS C1713","","AR-8840-16  -  SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-16S","SUP","HCPCS C1713","","AR-8840-16S  -  SCREW BN 4MM 16MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-18","SUP","HCPCS C1713","","AR-8840-18  -  SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-18S","SUP","HCPCS C1713","","AR-8840-18S  -  SCREW BN 4MM 18MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-20","SUP","HCPCS C1713","","AR-8840-20  -  SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-20S","SUP","HCPCS C1713","","AR-8840-20S  -  SCREW BN 4MM 20MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-22","SUP","HCPCS C1713","","AR-8840-22  -  SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-22S","SUP","HCPCS C1713","","AR-8840-22S  -  SCREW BN 4MM 22MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-24","SUP","HCPCS C1713","","AR-8840-24  -  SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-26","SUP","HCPCS C1713","","AR-8840-26  -  SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-26S","SUP","HCPCS C1713","","AR-8840-26S  -  SCREW BN 4MM 26MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-28","SUP","HCPCS C1713","","AR-8840-28  -  SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-28S","SUP","HCPCS C1713","","AR-8840-28S  -  SCREW BN 4MM 28MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-30","SUP","HCPCS C1713","","AR-8840-30  -  SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-32","SUP","HCPCS C1713","","AR-8840-32  -  SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-32S","SUP","HCPCS C1713","","AR-8840-32S  -  SCREW BN 4MM 32MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-34","SUP","HCPCS C1713","","AR-8840-34  -  SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-34S","SUP","HCPCS C1713","","AR-8840-34S  -  SCREW BN 4MM 34MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-36","SUP","HCPCS C1713","","AR-8840-36  -  SCREW BN T15 HEXALOBE FT 4MM 36MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-36S","SUP","HCPCS C1713","","AR-8840-36S  -  SCREW BN 4MM 36MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-38","SUP","HCPCS C1713","","AR-8840-38  -  SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-38S","SUP","HCPCS C1713","","AR-8840-38S  -  SCREW BN 4MM 38MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-40","SUP","HCPCS C1713","","AR-8840-40  -  SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-40S","SUP","HCPCS C1713","","AR-8840-40S  -  SCREW BN 4MM 40MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-42","SUP","HCPCS C1713","","AR-8840-42  -  SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-44","SUP","HCPCS C1713","","AR-8840-44  -  SCREW BN T15 HEXALOBE FT 4MM 44MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-45","SUP","HCPCS C1713","","AR-8840-45  -  SCREW BN T15 FT HEXALOBE 4MM 45MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-46","SUP","HCPCS C1713","","AR-8840-46  -  SCREW BN T15 HEXALOBE FT 4MM 46MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-48","SUP","HCPCS C1713","","AR-8840-48  -  SCREW BN T15 HEXALOBE FT 4MM 48MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-50","SUP","HCPCS C1713","","AR-8840-50  -  SCREW BN T15 HEXALOBE FT 4MM 50MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-50S","SUP","HCPCS C1713","","AR-8840-50S  -  SCREW BN 4MM 50MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-55","SUP","HCPCS C1713","","AR-8840-55  -  SCREW BN T15 FT HEXALOBE 4MM 55MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-55S","SUP","HCPCS C1713","","AR-8840-55S  -  SCREW BN 4MM 55MM STRL ARTHX LOPRFL CANC","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840-60","SUP","HCPCS C1713","","AR-8840-60  -  SCREW BN T15 HEXALOBE FT 4MM 60MM LOPRFL SCR MDLR SLF DRL","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840C-30","SUP","HCPCS C1713","","AR-8840C-30  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-32","SUP","HCPCS C1713","","AR-8840C-32  -  SCREW BN ST 4MM 32MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-34","SUP","HCPCS C1713","","AR-8840C-34  -  SCREW BN ST 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-35","SUP","HCPCS C1713","","AR-8840C-35  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR MDLR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-36","SUP","HCPCS C1713","","AR-8840C-36  -  SCREW BN ST 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-38","SUP","HCPCS C1713","","AR-8840C-38  -  SCREW BN ST 4MM 38MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-40","SUP","HCPCS C1713","","AR-8840C-40  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-42","SUP","HCPCS C1713","","AR-8840C-42  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-44","SUP","HCPCS C1713","","AR-8840C-44  -  SCREW BN ST 4MM 44MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-45","SUP","HCPCS C1713","","AR-8840C-45  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR MDLR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-46","SUP","HCPCS C1713","","AR-8840C-46  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-48","SUP","HCPCS C1713","","AR-8840C-48  -  SCREW BN ST 4MM 48MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-50","SUP","HCPCS C1713","","AR-8840C-50  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-55","SUP","HCPCS C1713","","AR-8840C-55  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR MDLR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840C-60","SUP","HCPCS C1713","","AR-8840C-60  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR MDLR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-30","SUP","HCPCS C1713","","AR-8840CL-30  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-32","SUP","HCPCS C1713","","AR-8840CL-32  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 32MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-34","SUP","HCPCS C1713","","AR-8840CL-34  -  SCREW BN L/T 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-35","SUP","HCPCS C1713","","AR-8840CL-35  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-36","SUP","HCPCS C1713","","AR-8840CL-36  -  SCREW BN L/T 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-38","SUP","HCPCS C1713","","AR-8840CL-38  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-40","SUP","HCPCS C1713","","AR-8840CL-40  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-42","SUP","HCPCS C1713","","AR-8840CL-42  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR MDLR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-44","SUP","HCPCS C1713","","AR-8840CL-44  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 44MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-45","SUP","HCPCS C1713","","AR-8840CL-45  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-46","SUP","HCPCS C1713","","AR-8840CL-46  -  SCREW BN L/T 4MM 46MM LOPRFL SCR CNN SS ANKL FX MGMT SYS","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-48","SUP","HCPCS C1713","","AR-8840CL-48  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-50","SUP","HCPCS C1713","","AR-8840CL-50  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-55","SUP","HCPCS C1713","","AR-8840CL-55  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840CL-60","SUP","HCPCS C1713","","AR-8840CL-60  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR SLF","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"AR-8840P-30","SUP","HCPCS C1713","","AR-8840P-30  -  SCREW BN ST 4MM 30MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-32","SUP","HCPCS C1713","","AR-8840P-32  -  SCREW BN ST 4MM 32MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-34","SUP","HCPCS C1713","","AR-8840P-34  -  SCREW BN ST 4MM 34MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-36","SUP","HCPCS C1713","","AR-8840P-36  -  SCREW BN ST 4MM 36MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-38","SUP","HCPCS C1713","","AR-8840P-38  -  SCREW BN ST 4MM 38MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-40","SUP","HCPCS C1713","","AR-8840P-40  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-42","SUP","HCPCS C1713","","AR-8840P-42  -  SCREW BN ST 4MM 42MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-44","SUP","HCPCS C1713","","AR-8840P-44  -  SCREW BN ST 4MM 44MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-46","SUP","HCPCS C1713","","AR-8840P-46  -  SCREW BN ST 4MM 46MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-48","SUP","HCPCS C1713","","AR-8840P-48  -  SCREW BN ST 4MM 48MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-50","SUP","HCPCS C1713","","AR-8840P-50  -  SCREW BN ST 4MM 50MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-55","SUP","HCPCS C1713","","AR-8840P-55  -  SCREW BN ST 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840P-60","SUP","HCPCS C1713","","AR-8840P-60  -  SCREW BN ST 4MM 60MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-30","SUP","HCPCS C1713","","AR-8840PL-30  -  SCREW BN L/T 4MM 30MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-32","SUP","HCPCS C1713","","AR-8840PL-32  -  SCREW BN L/T 4MM 32MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-34","SUP","HCPCS C1713","","AR-8840PL-34  -  SCREW BN L/T 4MM 34MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-36","SUP","HCPCS C1713","","AR-8840PL-36  -  SCREW BN L/T 4MM 36MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-38","SUP","HCPCS C1713","","AR-8840PL-38  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR MDLR","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-40","SUP","HCPCS C1713","","AR-8840PL-40  -  SCREW BN L/T 4MM 40MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-42","SUP","HCPCS C1713","","AR-8840PL-42  -  SCREW BN L/T 4MM 42MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-44","SUP","HCPCS C1713","","AR-8840PL-44  -  SCREW BN L/T 4MM 44MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-46","SUP","HCPCS C1713","","AR-8840PL-46  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR MDLR","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-48","SUP","HCPCS C1713","","AR-8840PL-48  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR MDLR","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-50","SUP","HCPCS C1713","","AR-8840PL-50  -  SCREW BN L/T 4MM 50MM LOPRFL SS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-55","SUP","HCPCS C1713","","AR-8840PL-55  -  SCREW BN L/T 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8840PL-60","SUP","HCPCS C1713","","AR-8840PL-60  -  SCREW BN L/T 4MM 60MM LOPRFL SCR SS ANKL FX MGMT SYS","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8870W","SUP","HCPCS C1713","","AR-8870W  -  WASHER ORTH 7MM","BOTH IP/OP","$80.25 ","$59.39 ","$0.00 ","$80.25 ","$36.11 ","$0.00 ","$16.73 ","$0.00 ","$0.00 ","$14.05 ","$80.25 ","$0.00 ","$40.13 ","$63.56 ","$64.20 ","$0.00 ","$12.56 ","$0.00 ","$12.78 ","$0.00 "
"AR-8911DC","SUP","Custom 27203010","","AR-8911DC  -  BIT DRL CNN MN TGHTRP","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8911DS","SUP","HCPCS C1713","","AR-8911DS  -  KIT ESCP INST .45IN MN RND 2.7MM 1.6MM STRL TGHTRP BTN CNN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8911G-05","SUP","Custom 27203010","","AR-8911G-05  -  GUIDE DRL KRSH WRE MN TGHTRP","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8912DS","SUP","HCPCS C1713","","AR-8912DS  -  KIT ESCP INST MN FT STRL TGHTRP BCSCR CNN DRLBT CUP BTN DRVR","BOTH IP/OP","$1,700.00 ","$1,258.00 ","$0.00 ","$1,700.00 ","$765.00 ","$0.00 ","$354.32 ","$0.00 ","$0.00 ","$297.66 ","$1,700.00 ","$0.00 ","$850.00 ","$1,346.40 ","$1,360.00 ","$0.00 ","$266.05 ","$0.00 ","$270.64 ","$0.00 "
"AR-8913DS","SUP","HCPCS C1713","","AR-8913DS  -  BUTTON FX MN TGHTRP INSRTR","BOTH IP/OP","$1,512.50 ","$1,119.25 ","$0.00 ","$1,512.50 ","$680.63 ","$0.00 ","$315.24 ","$0.00 ","$0.00 ","$264.83 ","$1,512.50 ","$0.00 ","$756.25 ","$1,197.90 ","$1,210.00 ","$0.00 ","$236.71 ","$0.00 ","$240.79 ","$0.00 "
"AR-8914P","SUP","HCPCS C1713","","AR-8914P  -  PLATE BN MN TGHTRP BTRS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916-05","SUP","Custom 27203010","","AR-8916-05  -  GUIDE DRL 1.7MM 2.5MM","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-06","SUP","Custom 27203010","","AR-8916-06  -  BIT DRL 2.5MM CLBRT GRAD 3.5MM LCK CORT SCR","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-07","SUP","Custom 27203010","","AR-8916-07  -  GUIDE DRL 3.5MM 30MM THRD WRST PLT SYS","BOTH IP/OP","$720.00 ","$532.80 ","$0.00 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$720.00 ","$0.00 ","$360.00 ","$570.24 ","$576.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-09","SUP","Custom 27203010","","AR-8916-09  -  GUIDE DRL 2.4MM AIM WRST PLT SYS","BOTH IP/OP","$790.00 ","$584.60 ","$0.00 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$790.00 ","$0.00 ","$395.00 ","$625.68 ","$632.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-16","SUP","HCPCS C1713","","AR-8916-16  -  SCREW BN ATCH RDS RT DIST VOLR","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-8916-17","SUP","HCPCS C1713","","AR-8916-17  -  SCREW BN ATCH RDS LT DIST VOLR","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-8916-21","SUP","Custom 27203010","","AR-8916-21  -  GUIDE DRL 2.4MM VAL DRP WRST PLT SYS","BOTH IP/OP","$610.00 ","$451.40 ","$0.00 ","$610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$610.00 ","$0.00 ","$305.00 ","$483.12 ","$488.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-23","SUP","Custom 27203010","","AR-8916-23  -  GUIDE DRL 2.5MM 1.7MM","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-26","SUP","Custom 27203010","","AR-8916-26  -  GUIDE DRL PRLL Y 1.7MM PLT PERIPROSTHETIC","BOTH IP/OP","$950.00 ","$703.00 ","$0.00 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.00 ","$0.00 ","$475.00 ","$752.40 ","$760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916-28","SUP","Custom 27203010","","AR-8916-28  -  BIT DRL SHRT 1.7MM GRAD 2.4MM VA LCK CORT SCR","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8916CX24-18","SUP","HCPCS C1713","","AR-8916CX24-18  -  SCREW BN 2.4MM CORT","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8916DNL-04","SUP","HCPCS C1713","","AR-8916DNL-04  -  PLATE BN NAR 4 HL RDS LT DIST DRSL","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"AR-8916DNR-04","SUP","HCPCS C1713","","AR-8916DNR-04  -  PLATE BN NAR 4 HL RDS RT DIST DRSL","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"AR-8916DSL-04","SUP","HCPCS C1713","","AR-8916DSL-04  -  PLATE BN 4 HL RDS LT DIST DRSL","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"AR-8916DSR-04","SUP","HCPCS C1713","","AR-8916DSR-04  -  PLATE BN STD 4 HL RDS RT DRSL DIST","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"AR-8916FS","SUP","HCPCS C1713","","AR-8916FS  -  MODULE INST FRAG SPC SYS","BOTH IP/OP","$5,662.50 ","$4,190.25 ","$0.00 ","$5,662.50 ","$2,548.13 ","$0.00 ","$1,180.21 ","$0.00 ","$0.00 ","$991.46 ","$5,662.50 ","$0.00 ","$2,831.25 ","$4,484.70 ","$4,530.00 ","$0.00 ","$886.18 ","$0.00 ","$901.47 ","$0.00 "
"AR-8916RSTY-05","SUP","HCPCS C1713","","AR-8916RSTY-05  -  PLATE BN 5 HL WRST RDS 2.4 MM SCR STYLOID","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8916SPN","SUP","HCPCS C1713","","AR-8916SPN  -  PLATE BN 9 HL SPAN TI WRST","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"AR-8916VH-04","SUP","HCPCS C1713","","AR-8916VH-04  -  PLATE BN 4 HL HK RDS VOLR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8916VH-06","SUP","HCPCS C1713","","AR-8916VH-06  -  PLATE BN 6 HL HK TI WRST VOLR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8916VNC-08","SUP","HCPCS C1713","","AR-8916VNC-08  -  SCREW BN P/T LOPRFL 2.4MM 8MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-10","SUP","HCPCS C1713","","AR-8916VNC-10  -  SCREW BN P/T LOPRFL 2.4MM 10MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-12","SUP","HCPCS C1713","","AR-8916VNC-12  -  SCREW BN P/T LOPRFL 2.4MM 12MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-14","SUP","HCPCS C1713","","AR-8916VNC-14  -  SCREW BN P/T LOPRFL 2.4MM 14MM AU VA LCK SMTH TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-16","SUP","HCPCS C1713","","AR-8916VNC-16  -  SCREW BN P/T LOPRFL 2.4MM 16MM AU VA LCK SMTH TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-18","SUP","HCPCS C1713","","AR-8916VNC-18  -  SCREW BN P/T LOPRFL 2.4MM 18MM AU VA LCK SMTH TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-20","SUP","HCPCS C1713","","AR-8916VNC-20  -  SCREW BN P/T LOPRFL 2.4MM 20MM AU VA LCK SMTH TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-22","SUP","HCPCS C1713","","AR-8916VNC-22  -  SCREW BN P/T LOPRFL 2.4MM 22MM AU VA LCK SMTH TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-24","SUP","HCPCS C1713","","AR-8916VNC-24  -  SCREW BN P/T LOPRFL 2.4MM 24MM AU VA LCK SMTH TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-26","SUP","HCPCS C1713","","AR-8916VNC-26  -  SCREW BN P/T LOPRFL 2.4MM 26MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-28","SUP","HCPCS C1713","","AR-8916VNC-28  -  SCREW BN P/T LOPRFL 2.4MM 28MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-30","SUP","HCPCS C1713","","AR-8916VNC-30  -  SCREW BN P/T LOPRFL 2.4MM 30MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-32","SUP","HCPCS C1713","","AR-8916VNC-32  -  SCREW BN P/T LOPRFL 2.4MM 32MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNC-34","SUP","HCPCS C1713","","AR-8916VNC-34  -  SCREW BN P/T LOPRFL 2.4MM 34MM AU LCK SMTH VA TI RDS CORT","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8916VNL-03","SUP","HCPCS C1713","","AR-8916VNL-03  -  PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VNL-05","SUP","HCPCS C1713","","AR-8916VNL-05  -  PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VNL-07","SUP","HCPCS C1713","","AR-8916VNL-07  -  PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VNR-03","SUP","HCPCS C1713","","AR-8916VNR-03  -  PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VNR-05","SUP","HCPCS C1713","","AR-8916VNR-05  -  PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VNR-07","SUP","HCPCS C1713","","AR-8916VNR-07  -  PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSL-03","SUP","HCPCS C1713","","AR-8916VSL-03  -  PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSL-05","SUP","HCPCS C1713","","AR-8916VSL-05  -  PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSL-07","SUP","HCPCS C1713","","AR-8916VSL-07  -  PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSL-09","SUP","HCPCS C1713","","AR-8916VSL-09  -  PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSR-03","SUP","HCPCS C1713","","AR-8916VSR-03  -  PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSR-05","SUP","HCPCS C1713","","AR-8916VSR-05  -  PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSR-07","SUP","HCPCS C1713","","AR-8916VSR-07  -  PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VSR-09","SUP","HCPCS C1713","","AR-8916VSR-09  -  PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWL-03","SUP","HCPCS C1713","","AR-8916VWL-03  -  PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWL-05","SUP","HCPCS C1713","","AR-8916VWL-05  -  PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWL-07","SUP","HCPCS C1713","","AR-8916VWL-07  -  PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWL-09","SUP","HCPCS C1713","","AR-8916VWL-09  -  PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWR-03","SUP","HCPCS C1713","","AR-8916VWR-03  -  PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWR-05","SUP","HCPCS C1713","","AR-8916VWR-05  -  PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWR-07","SUP","HCPCS C1713","","AR-8916VWR-07  -  PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8916VWR-09","SUP","HCPCS C1713","","AR-8916VWR-09  -  PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8917DS","SUP","HCPCS C1713","","AR-8917DS  -  KIT ESCP INST MN FT 3.5MM STRL TGHTRP DRL GW HNDL INSRTR","BOTH IP/OP","$1,575.00 ","$1,165.50 ","$0.00 ","$1,575.00 ","$708.75 ","$0.00 ","$328.27 ","$0.00 ","$0.00 ","$275.77 ","$1,575.00 ","$0.00 ","$787.50 ","$1,247.40 ","$1,260.00 ","$0.00 ","$246.49 ","$0.00 ","$250.74 ","$0.00 "
"AR-8919DS","SUP","Custom 27203010","","AR-8919DS  -  KIT ASCP FX MN 1.1MM TGHTRP KRSH BTN ANCH SUT CMC","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8920","SUP","HCPCS C1763","","AR-8920  -  BUTTON SUT 3.5MM STRL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"AR-8920CDS","SUP","Custom 27203010","","AR-8920CDS  -  KIT ESCP INST STRL TGHTRP CNN FLXB TI DISP SYNDESMOSIS REPR","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8920DC","SUP","Custom 27203010","","AR-8920DC  -  BIT DRL 3.5MM CNN","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8921CDS","SUP","HCPCS C1769","","AR-8921CDS  -  TIGHTROPE AR-8921CDS","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$712.69 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8922","SUP","HCPCS C1763","","AR-8922  -  BUTTON SUT 12MM STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"AR-8923BC","SUP","HCPCS C1713","","AR-8923BC  -  ANCHOR SUT SHRT MED 2.9MM 2.3MM 12.5MM STRL PUSHLOCK BCMPS","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-8923DSC","SUP","Custom 27203010","","AR-8923DSC  -  KIT INST SHRT DRLBT DRL GD DISP 2.9/12.5MM BCMPS PUSHLOCK","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8926SS","SUP","Custom 27203010","","AR-8926SS  -  KIT ESCP INST STRL TGHTRP CNN SS SYNDESMOSIS REPR ASCP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8926T","SUP","Custom 27203010","","AR-8926T  -  KIT ESCP INST STRL TGHTRP SUT TI DESMOSIS REPR ASCP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8927BC","SUP","HCPCS C1713","","AR-8927BC  -  ANCHOR SUT 1 LG FT TPR 3.4MM 15MM CSCR FWR TIGERWIRE BRD NDL","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$365.63 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$142.26 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$127.16 ","$0.00 ","$129.35 ","$0.00 "
"AR-8927BCNF-CP","SUP","HCPCS C1713","","AR-8927BCNF-CP  -  SET IMPL STRL LF ARTHX SUTUREBRIDGE BCMPS DISP AHLS PK","BOTH IP/OP","$3,987.50 ","$2,950.75 ","$0.00 ","$3,987.50 ","$1,794.38 ","$0.00 ","$831.09 ","$0.00 ","$0.00 ","$698.18 ","$3,987.50 ","$0.00 ","$1,993.75 ","$3,158.10 ","$3,190.00 ","$0.00 ","$624.04 ","$0.00 ","$634.81 ","$0.00 "
"AR-8927BNF","SUP","HCPCS C1713","","AR-8927BNF  -  ANCHOR SUT 1 LG FT TPR 5.5MM 15MM BCSCR FWR BRD NDL POLY L","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8927BNF-CP","SUP","HCPCS C1713","","AR-8927BNF-CP  -  SET IMPL LG TPR SUTUREBRIDGE ANCH DRL GD NDL PNCH TAP AHLS","BOTH IP/OP","$3,100.00 ","$2,294.00 ","$0.00 ","$3,100.00 ","$1,395.00 ","$0.00 ","$646.12 ","$0.00 ","$0.00 ","$542.79 ","$3,100.00 ","$0.00 ","$1,550.00 ","$2,455.20 ","$2,480.00 ","$0.00 ","$485.15 ","$0.00 ","$493.52 ","$0.00 "
"AR-8927DSC","SUP","Custom 27203010","","AR-8927DSC  -  KIT INST DISP 4.5/14MM BCMPS CRKSCR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$502.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8927P-CP","SUP","HCPCS C1713","","AR-8927P-CP  -  SET IMPL SUTUREBRIDGE DRL GD PNCH PUSHLOCK TAP PEEK AHLS PK","BOTH IP/OP","$3,100.00 ","$2,294.00 ","$0.00 ","$3,100.00 ","$1,395.00 ","$0.00 ","$646.12 ","$0.00 ","$0.00 ","$542.79 ","$3,100.00 ","$0.00 ","$1,550.00 ","$2,455.20 ","$2,480.00 ","$0.00 ","$485.15 ","$0.00 ","$493.52 ","$0.00 "
"AR-8928BC-CP","SUP","HCPCS C1713","","AR-8928BC-CP  -  SET IMPL SUTUREBRIDGE ANCH DRILL GUIDE PNCH TAP","BOTH IP/OP","$4,350.00 ","$3,219.00 ","$0.00 ","$4,350.00 ","$1,957.50 ","$0.00 ","$906.65 ","$0.00 ","$0.00 ","$761.65 ","$4,350.00 ","$0.00 ","$2,175.00 ","$3,445.20 ","$3,480.00 ","$0.00 ","$680.78 ","$0.00 ","$692.52 ","$0.00 "
"AR-8928BCJ-CP","SUP","HCPCS C1713","","AR-8928BCJ-CP  -  SYSTEM FX STRL SPEEDBRIDGE JUMPSTART BCMPS AHLS","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$2,244.38 ","$0.00 ","$1,039.52 ","$0.00 ","$0.00 ","$873.27 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$780.54 ","$0.00 ","$794.01 ","$0.00 "
"AR-8928P-CP","SUP","HCPCS C1713","","AR-8928P-CP  -  SET IMPL SUTUREBRIDGE ANCH DRL GD PNCH TAP PEEK AHLS PK","BOTH IP/OP","$4,350.00 ","$3,219.00 ","$0.00 ","$4,350.00 ","$1,957.50 ","$0.00 ","$906.65 ","$0.00 ","$0.00 ","$761.65 ","$4,350.00 ","$0.00 ","$2,175.00 ","$3,445.20 ","$3,480.00 ","$0.00 ","$680.78 ","$0.00 ","$692.52 ","$0.00 "
"AR-8928PJ-CP","SUP","HCPCS C1713","","AR-8928PJ-CP  -  SYSTEM IMPL STRL ARTHX SPEEDBRIDGE JUMPSTART AHLS","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$2,244.38 ","$0.00 ","$1,039.52 ","$0.00 ","$0.00 ","$873.27 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$780.54 ","$0.00 ","$794.01 ","$0.00 "
"AR-8930-10","SUP","HCPCS C1713","","AR-8930-10  -  SCREW BN FT 2MM 10MM SLVR QFIX 3 PR SLF DRL ST SNPOF SLD TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8930-11","SUP","HCPCS C1713","","AR-8930-11  -  SCREW BN FT 2MM 11MM MAG QFIX 3 PR SLF DRL ST SNPOF SLD TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8930-12","SUP","HCPCS C1713","","AR-8930-12  -  SCREW BN FT 2MM 12MM BLU QFIX 3 PR SLF DRL ST SNPOF SLD TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8930-13","SUP","HCPCS C1713","","AR-8930-13  -  SCREW BN FT 2MM 13MM GRN QFIX 3 PR SLF DRL ST SNPOF SLD TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8930-14","SUP","HCPCS C1713","","AR-8930-14  -  SCREW BN FT 2MM 14MM PUR QFIX 3 PR SLF DRL ST SNPOF SLD TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8930D-13","SUP","Custom 27203010","","AR-8930D-13  -  BIT DRL 1.3MM 2MM QFIX SCR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8930MC","SUP","Custom 27203010","","AR-8930MC  -  CLAMP SRG QFIX WEIL OSTM","BOTH IP/OP","$3,987.50 ","$2,950.75 ","$0.00 ","$3,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8930MCS","SUP","Custom 27203010","","AR-8930MCS  -  CLAMP SRG QFIX INST SET","BOTH IP/OP","$4,737.50 ","$3,505.75 ","$0.00 ","$4,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,737.50 ","$0.00 ","$2,368.75 ","$3,752.10 ","$3,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8931-13","SUP","HCPCS C1713","","AR-8931-13  -  SCREW BN FT 3MM 13MM YLW QFIX 3 PR SLF DRL SNPOF TI FT HND","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8931-15","SUP","HCPCS C1713","","AR-8931-15  -  SCREW BN FT 3MM 15MM LGHT BLU QFIX 3 PR SLF DRL SNPOF TI FT","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8931-17","SUP","HCPCS C1713","","AR-8931-17  -  SCREW BN FT 3MM 17MM AQ QFIX 3 PR SLF DRL SNPOF TI FT HND","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8931-17S","SUP","HCPCS C1713","","AR-8931-17S  -  SCREW BN 3MM 17MM STRL ARTHX QFIX","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8931-19","SUP","HCPCS C1713","","AR-8931-19  -  SCREW BN FT 3MM 19MM BRNZ QFIX 3 PR SLF DRL SNPOF TI FT HND","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8933-10","SUP","HCPCS C1713","","AR-8933-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-10PT","SUP","HCPCS C1713","","AR-8933-10PT  -  SCREW BN 2.5MM HEX P/T 3MM 10MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-12","SUP","HCPCS C1713","","AR-8933-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-12PT","SUP","HCPCS C1713","","AR-8933-12PT  -  SCREW BN 2.5MM P/T HEX 3MM 12MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-14","SUP","HCPCS C1713","","AR-8933-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-14PT","SUP","HCPCS C1713","","AR-8933-14PT  -  SCREW BN 2.5MM P/T HEX 3MM 14MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-16","SUP","HCPCS C1713","","AR-8933-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-16PT","SUP","HCPCS C1713","","AR-8933-16PT  -  SCREW BN 2.5MM P/T HEX 3MM 16MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-18","SUP","HCPCS C1713","","AR-8933-18  -  SCREW BN T10 HEXALOBE FT 3MM 18MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-18PT","SUP","HCPCS C1713","","AR-8933-18PT  -  SCREW BN 2.5MM P/T HEX 3MM 18MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-18PTS","SUP","HCPCS C1713","","AR-8933-18PTS  -  SCREW BN P/T 3MM 18MM STRL ARTHX LOPRFL SCR CNN TI","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8933-20","SUP","HCPCS C1713","","AR-8933-20  -  SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-20C","SUP","Custom 27203010","","AR-8933-20C  -  BIT DRL 2MM CNN AO","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8933-20PT","SUP","HCPCS C1713","","AR-8933-20PT  -  SCREW BN 2.5MM P/T HEX 3MM 20MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-20PTS","SUP","HCPCS C1713","","AR-8933-20PTS  -  SCREW BN P/T 3MM 20MM STRL ARTHX LOPRFL SCR CNN TI","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8933-22","SUP","HCPCS C1713","","AR-8933-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-22PT","SUP","HCPCS C1713","","AR-8933-22PT  -  SCREW BN 2.5MM P/T HEX 3MM 22MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-24","SUP","HCPCS C1713","","AR-8933-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-24PT","SUP","HCPCS C1713","","AR-8933-24PT  -  SCREW BN 2.5MM P/T HEX 3MM 24MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-26","SUP","HCPCS C1713","","AR-8933-26  -  SCREW BN T10 HEXALOBE FT 3MM 26MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-26PT","SUP","HCPCS C1713","","AR-8933-26PT  -  SCREW BN 2.5MM P/T HEX 3MM 26MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-28","SUP","HCPCS C1713","","AR-8933-28  -  SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-28PT","SUP","HCPCS C1713","","AR-8933-28PT  -  SCREW BN 2.5MM P/T HEX 3MM 28MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-30","SUP","HCPCS C1713","","AR-8933-30  -  SCREW BN T10 HEXALOBE FT 3MM 30MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-30C","SUP","Custom 27203010","","AR-8933-30C  -  BIT DRL 3MM CNN","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8933-30PT","SUP","HCPCS C1713","","AR-8933-30PT  -  SCREW BN 2.5MM P/T HEX 3MM 30MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-30PTS","SUP","HCPCS C1713","","AR-8933-30PTS  -  SCREW BN P/T 3MM 30MM STRL ARTHX LOPRFL SCR CNN TI","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$39.38 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"AR-8933-32PT","SUP","HCPCS C1713","","AR-8933-32PT  -  SCREW BN 2.5MM P/T HEX 3MM 32MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-34","SUP","HCPCS C1713","","AR-8933-34  -  SCREW BN T10 HEXALOBE FT 3MM 34MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-34PT","SUP","HCPCS C1713","","AR-8933-34PT  -  SCREW BN 2.5MM HEX P/T 3MM 34MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-36","SUP","HCPCS C1713","","AR-8933-36  -  SCREW BN T10 HEXALOBE FT 3MM 36MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-36PT","SUP","HCPCS C1713","","AR-8933-36PT  -  SCREW BN 2.5MM P/T HEX 3MM 36MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-38","SUP","HCPCS C1713","","AR-8933-38  -  SCREW BN T10 HEXALOBE FT 3MM 38MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-38PT","SUP","HCPCS C1713","","AR-8933-38PT  -  SCREW BN 2.5MM P/T HEX 3MM 38MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933-40","SUP","HCPCS C1713","","AR-8933-40  -  SCREW BN T10 HEXALOBE FT 3MM 40MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$57.32 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933-40PT","SUP","HCPCS C1713","","AR-8933-40PT  -  SCREW BN 2.5MM P/T HEX 3MM 40MM LOPRFL SCR SLF DRL ST CNN TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8933G","SUP","Custom 27203010","","AR-8933G  -  GUIDE DRL LOPRFL 1.1-2MM","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8933GV","SUP","Custom 27203010","","AR-8933GV  -  GUIDE DRL 3MM VA","BOTH IP/OP","$1,037.50 ","$767.75 ","$0.00 ","$1,037.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.50 ","$0.00 ","$518.75 ","$821.70 ","$830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8933L-10","SUP","HCPCS C1713","","AR-8933L-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-12","SUP","HCPCS C1713","","AR-8933L-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-14","SUP","HCPCS C1713","","AR-8933L-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-16","SUP","HCPCS C1713","","AR-8933L-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-18","SUP","HCPCS C1713","","AR-8933L-18  -  SCREW BN T10 HEXALOBE FT 3MM 18MM SLF DRL SLD LCK LOPRFL TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-20","SUP","HCPCS C1713","","AR-8933L-20  -  SCREW BN FT T10 3MM 20MM SLF DRL SLD LCK LOPRFL TI FOREFOOT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-22","SUP","HCPCS C1713","","AR-8933L-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-24","SUP","HCPCS C1713","","AR-8933L-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-26","SUP","HCPCS C1713","","AR-8933L-26  -  SCREW BN T10 HEXALOBE FT 3MM 26MM LCK SLF DRL SLD TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-28","SUP","HCPCS C1713","","AR-8933L-28  -  SCREW BN 3MM 28MM LCK LOPRFL TI FT HND ANKL WRST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-30","SUP","HCPCS C1713","","AR-8933L-30  -  SCREW BN 3MM 30MM LCK LOPRFL TI FT HND ANKL WRST","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-32","SUP","HCPCS C1713","","AR-8933L-32  -  SCREW BN 3MM 32MM LCK TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-36","SUP","HCPCS C1713","","AR-8933L-36  -  SCREW BN 3MM 36MM LOPRFL LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-38","SUP","HCPCS C1713","","AR-8933L-38  -  SCREW BN 3MM 38MM LCK TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933L-40","SUP","HCPCS C1713","","AR-8933L-40  -  SCREW BN 3MM 40MM LCK TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$275.00 ","$123.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"AR-8933V-10","SUP","HCPCS C1713","","AR-8933V-10  -  SCREW BN 3MM 10MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-12","SUP","HCPCS C1713","","AR-8933V-12  -  SCREW BN 3MM 12MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-14","SUP","HCPCS C1713","","AR-8933V-14  -  SCREW BN 3MM 14MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-16","SUP","HCPCS C1713","","AR-8933V-16  -  SCREW BN 3MM 16MM VA LCK TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-18","SUP","HCPCS C1713","","AR-8933V-18  -  SCREW BN 3MM 18MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-20","SUP","HCPCS C1713","","AR-8933V-20  -  SCREW BN 3MM 20MM VA LCK TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-22","SUP","HCPCS C1713","","AR-8933V-22  -  SCREW BN 3MM 22MM VA LCK TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-24","SUP","HCPCS C1713","","AR-8933V-24  -  SCREW BN 3MM 24MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-26","SUP","HCPCS C1713","","AR-8933V-26  -  SCREW BN 3MM 26MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-28","SUP","HCPCS C1713","","AR-8933V-28  -  SCREW BN 3MM 28MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-30","SUP","HCPCS C1713","","AR-8933V-30  -  SCREW BN 3MM 30MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-32","SUP","HCPCS C1713","","AR-8933V-32  -  SCREW BN 3MM 32MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-34","SUP","HCPCS C1713","","AR-8933V-34  -  SCREW BN 3MM 34MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-36","SUP","HCPCS C1713","","AR-8933V-36  -  SCREW BN 3MM 36MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-38","SUP","HCPCS C1713","","AR-8933V-38  -  SCREW BN 3MM 38MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8933V-40","SUP","HCPCS C1713","","AR-8933V-40  -  SCREW BN 3MM 40MM LCK VA TI FT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"AR-8934BCNF","SUP","HCPCS C1713","","AR-8934BCNF  -  ANCHOR SUTURE 1 .5 CIR 2 DIAMOND 26.2MM NEEDLE SUTURETAK","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$1,162.50 ","$523.13 ","$0.00 ","$169.35 ","$0.00 ","$0.00 ","$203.54 ","$1,162.50 ","$0.00 ","$581.25 ","$920.70 ","$930.00 ","$0.00 ","$181.93 ","$0.00 ","$185.07 ","$0.00 "
"AR-8934BCNF-00","SUP","HCPCS C1713","","AR-8934BCNF-00  -  ANCHOR SUT 0 .5 CRC 4 DMD 22.2MM SUT TK FBRWR NDL BCMPS S","BOTH IP/OP","$4,062.50 ","$3,006.25 ","$0.00 ","$4,062.50 ","$1,828.13 ","$0.00 ","$846.73 ","$0.00 ","$0.00 ","$711.31 ","$4,062.50 ","$0.00 ","$2,031.25 ","$3,217.50 ","$3,250.00 ","$0.00 ","$635.78 ","$0.00 ","$646.75 ","$0.00 "
"AR-8934DSC","SUP","Custom 27203010","","AR-8934DSC  -  KIT INSTR 2.4MM DRILL GUIDE STEP DRILL DISPOSABLE SMALL","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8935-10","SUP","HCPCS C1713","","AR-8935-10  -  SCREW BN T15 HEXALOBE FT 3.5MM 10MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-11","SUP","HCPCS C1713","","AR-8935-11  -  SCREW BN T15 HEXALOBE FT 3.5MM 11MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-12","SUP","HCPCS C1713","","AR-8935-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-13","SUP","HCPCS C1713","","AR-8935-13  -  SCREW BN T15 FT HEXALOBE 3.5MM 13MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-14","SUP","HCPCS C1713","","AR-8935-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-16","SUP","HCPCS C1713","","AR-8935-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-18","SUP","HCPCS C1713","","AR-8935-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-20","SUP","HCPCS C1713","","AR-8935-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-22","SUP","HCPCS C1713","","AR-8935-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-28","SUP","HCPCS C1713","","AR-8935-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-30","SUP","HCPCS C1713","","AR-8935-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-34","SUP","HCPCS C1713","","AR-8935-34  -  SCREW BN T15 FT HEXALOBE 3.5MM 34MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-36","SUP","HCPCS C1713","","AR-8935-36  -  SCREW BN T15 FT HEXALOBE 3.5MM 36MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-38","SUP","HCPCS C1713","","AR-8935-38  -  SCREW BN T15 FT HEXALOBE 3.5MM 38MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-40","SUP","HCPCS C1713","","AR-8935-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-42","SUP","HCPCS C1713","","AR-8935-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-44","SUP","HCPCS C1713","","AR-8935-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-46","SUP","HCPCS C1713","","AR-8935-46  -  SCREW BN 3.5MM 46MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-48","SUP","HCPCS C1713","","AR-8935-48  -  SCREW BN 3.5MM 48MM LOPRFL TI CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-50","SUP","HCPCS C1713","","AR-8935-50  -  SCREW BN 3.5MM 50MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-52","SUP","HCPCS C1713","","AR-8935-52  -  SCREW BN 3.5MM 52MM LOPRFL TI CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-54","SUP","HCPCS C1713","","AR-8935-54  -  SCREW BN 3.5MM 54MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-56","SUP","HCPCS C1713","","AR-8935-56  -  SCREW BN 3.5MM 56MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-58","SUP","HCPCS C1713","","AR-8935-58  -  SCREW BN 3.5MM 58MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935-60","SUP","HCPCS C1713","","AR-8935-60  -  SCREW BN 3.5MM 60MM LOPRFL TI FT/ANKL CORT","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8935G","SUP","Custom 27203010","","AR-8935G  -  GUIDE DRL 3.5MM 4MM","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8935GV","SUP","Custom 27203010","","AR-8935GV  -  GUIDE DRL 3.5MM VA","BOTH IP/OP","$1,037.50 ","$767.75 ","$0.00 ","$1,037.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,037.50 ","$0.00 ","$518.75 ","$821.70 ","$830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8935GVN","SUP","Custom 27203010","","AR-8935GVN  -  GUIDE DRL 3.5MM LCK VA","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8935L-10","SUP","HCPCS C1713","","AR-8935L-10  -  SCREW BN 3.5MM 10MM LOPRFL LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-12","SUP","HCPCS C1713","","AR-8935L-12  -  SCREW BN 3.5MM 12MM LCK LOPRFL TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-14","SUP","HCPCS C1713","","AR-8935L-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-16","SUP","HCPCS C1713","","AR-8935L-16  -  SCREW BN 3.5MM 16MM LCK TI MIDFOOT CORT","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-20","SUP","HCPCS C1713","","AR-8935L-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-22","SUP","HCPCS C1713","","AR-8935L-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-24","SUP","HCPCS C1713","","AR-8935L-24  -  SCREW BN T15 FT HEXALOBE 3.5MM 24MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-26","SUP","HCPCS C1713","","AR-8935L-26  -  SCREW BN T15 FT HEXALOBE 3.5MM 26MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-28","SUP","HCPCS C1713","","AR-8935L-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-30","SUP","HCPCS C1713","","AR-8935L-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-32","SUP","HCPCS C1713","","AR-8935L-32  -  SCREW BN T15 FT HEXALOBE 3.5MM 32MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-34","SUP","HCPCS C1713","","AR-8935L-34  -  SCREW BN T15 FT HEXALOBE 3.5MM 34MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-36","SUP","HCPCS C1713","","AR-8935L-36  -  SCREW BN T15 FT HEXALOBE 3.5MM 36MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-38","SUP","HCPCS C1713","","AR-8935L-38  -  SCREW BN T15 FT HEXALOBE 3.5MM 38MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-40","SUP","HCPCS C1713","","AR-8935L-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-42","SUP","HCPCS C1713","","AR-8935L-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-44","SUP","HCPCS C1713","","AR-8935L-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM SLF DRL SLD LCK TI","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-46","SUP","HCPCS C1713","","AR-8935L-46  -  SCREW BN 3.5MM 46MM LCK LOPRFL TI HND ANKL LNG BN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-48","SUP","HCPCS C1713","","AR-8935L-48  -  SCREW BN 3.5MM 48MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-50","SUP","HCPCS C1713","","AR-8935L-50  -  SCREW BN 3.5MM 50MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-52","SUP","HCPCS C1713","","AR-8935L-52  -  SCREW BN 3.5MM 52MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-54","SUP","HCPCS C1713","","AR-8935L-54  -  SCREW BN 3.5MM 54MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-56","SUP","HCPCS C1713","","AR-8935L-56  -  SCREW BN 3.5MM 56MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-58","SUP","HCPCS C1713","","AR-8935L-58  -  SCREW BN 3.5MM 58MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8935L-60","SUP","HCPCS C1713","","AR-8935L-60  -  SCREW BN 3.5MM 60MM LCK LOPRFL TI FT/ANKL","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"AR-8936BC-CP","SUP","HCPCS C1713","","AR-8936BC-CP  -  KIT ESCP INST CNN STP DRL DRL GD OBT BROSTROM ASCP","BOTH IP/OP","$3,625.00 ","$2,682.50 ","$0.00 ","$3,625.00 ","$1,631.25 ","$0.00 ","$755.54 ","$0.00 ","$0.00 ","$634.71 ","$3,625.00 ","$0.00 ","$1,812.50 ","$2,871.00 ","$2,900.00 ","$0.00 ","$567.31 ","$0.00 ","$577.10 ","$0.00 "
"AR-8938P","SUP","HCPCS C1713","","AR-8938P  -  KIT INST RD YLW 2 EYLT CNVR LCK DRVR SMPL SNP SUT LDR PEEK","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$219.38 ","$0.00 ","$101.61 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"AR-8940-14","SUP","HCPCS C1713","","AR-8940-14  -  SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-16","SUP","HCPCS C1713","","AR-8940-16  -  SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-16S","SUP","HCPCS C1713","","AR-8940-16S  -  SCREW BN 4MM 16MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-18","SUP","HCPCS C1713","","AR-8940-18  -  SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-18S","SUP","HCPCS C1713","","AR-8940-18S  -  SCREW BN 4MM 18MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-20","SUP","HCPCS C1713","","AR-8940-20  -  SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-20S","SUP","HCPCS C1713","","AR-8940-20S  -  SCREW BN 4MM 20MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-22","SUP","HCPCS C1713","","AR-8940-22  -  SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-22S","SUP","HCPCS C1713","","AR-8940-22S  -  SCREW BN 4MM 22MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-24","SUP","HCPCS C1713","","AR-8940-24  -  SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-26","SUP","HCPCS C1713","","AR-8940-26  -  SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-28","SUP","HCPCS C1713","","AR-8940-28  -  SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-28S","SUP","HCPCS C1713","","AR-8940-28S  -  SCREW BN 4MM 28MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-30","SUP","HCPCS C1713","","AR-8940-30  -  SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-30S","SUP","HCPCS C1713","","AR-8940-30S  -  SCREW BN 4MM 30MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-32","SUP","HCPCS C1713","","AR-8940-32  -  SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-32S","SUP","HCPCS C1713","","AR-8940-32S  -  SCREW BN 4MM 32MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-34","SUP","HCPCS C1713","","AR-8940-34  -  SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-36","SUP","HCPCS C1713","","AR-8940-36  -  SCREW BN T15 FT HEXALOBE 4MM 36MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-38","SUP","HCPCS C1713","","AR-8940-38  -  SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-40","SUP","HCPCS C1713","","AR-8940-40  -  SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-40S","SUP","HCPCS C1713","","AR-8940-40S  -  SCREW BN 4MM 40MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-42","SUP","HCPCS C1713","","AR-8940-42  -  SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-42S","SUP","HCPCS C1713","","AR-8940-42S  -  SCREW BN 4MM 42MM STRL ARTHX LOPRFL SCR TI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-8940-44","SUP","HCPCS C1713","","AR-8940-44  -  SCREW BN T15 FT HEXALOBE 4MM 44MM LOPRFL SCR SLF DRL SLD TI","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-46","SUP","HCPCS C1713","","AR-8940-46  -  SCREW BN 4MM 46MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-48","SUP","HCPCS C1713","","AR-8940-48  -  SCREW BN 4MM 48MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-50","SUP","HCPCS C1713","","AR-8940-50  -  SCREW BN 4MM 50MM LOPRFL TI HND ANKL LNG BN","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-52","SUP","HCPCS C1713","","AR-8940-52  -  SCREW BN 4MM 52MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-54","SUP","HCPCS C1713","","AR-8940-54  -  SCREW BN 4MM 54MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-56","SUP","HCPCS C1713","","AR-8940-56  -  SCREW BN 4MM 56MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-58","SUP","HCPCS C1713","","AR-8940-58  -  SCREW BN 4MM 58MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8940-60","SUP","HCPCS C1713","","AR-8940-60  -  SCREW BN 4MM 60MM LOPRFL TI FT/ANKL CANC","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-8941-6","SUP","HCPCS C1769","","AR-8941-6  -  WIRE FIX .062IN .062IN 6IN KWIRE","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$20.84 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"AR-8941-7","SUP","HCPCS C1769","","AR-8941-7  -  WIRE FIX .062IN .062IN 7IN KWIRE","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$20.84 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"AR-8941G","SUP","Custom 27203010","","AR-8941G  -  GUIDE DRL 3.5/4 MM MTL SCR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8941GL","SUP","Custom 27203010","","AR-8941GL  -  GUIDE DRL D LCK","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8941L","SUP","HCPCS C1713","","AR-8941L  -  PLATE BN LNG LOPRFL FT/ANKL LAPIDUS LISFRANC","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8941PLS","SUP","HCPCS C1713","","AR-8941PLS  -  PLATE BN SHRT LOPRFL PRECONTOUR TI PLNTR LT LAPIDUS","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8941PR","SUP","HCPCS C1713","","AR-8941PR  -  PLATE BN PLNTR RT LAPIDUS","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8941PRS","SUP","HCPCS C1713","","AR-8941PRS  -  PLATE BN SHRT PLNTR RT LAPIDUS","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8942-02","SUP","Custom 27203010","","AR-8942-02  -  BIT DRL WDG 1.7MM EVANS DISP","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8942-03","SUP","Custom 27203010","","AR-8942-03  -  GUIDE DRL 1.7MM EVANS WDG","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8942L-06","SUP","HCPCS C1713","","AR-8942L-06  -  PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8942L-08","SUP","HCPCS C1713","","AR-8942L-08  -  PLATE BN H WDG LOPRFL 36X16X8MM TI MIDFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8942L-10","SUP","HCPCS C1713","","AR-8942L-10  -  PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8942L-L","SUP","HCPCS C1713","","AR-8942L-L  -  PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-8942L-M","SUP","HCPCS C1713","","AR-8942L-M  -  PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-8942L-S","SUP","HCPCS C1713","","AR-8942L-S  -  PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-8942R-06","SUP","HCPCS C1713","","AR-8942R-06  -  PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8942R-08","SUP","HCPCS C1713","","AR-8942R-08  -  PLATE BN H WDG LOPRFL 34X16X8MM TI MIDFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8942R-10","SUP","HCPCS C1713","","AR-8942R-10  -  PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8942R-L","SUP","HCPCS C1713","","AR-8942R-L  -  PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-8942R-M","SUP","HCPCS C1713","","AR-8942R-M  -  PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-8942R-S","SUP","HCPCS C1713","","AR-8942R-S  -  PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-8943-02","SUP","Custom 27203010","","AR-8943-02  -  BIT DRL 2.6MM 160MM CNN 4MM LPS P/T SCR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-03","SUP","Custom 27203010","","AR-8943-03  -  GUIDE DRL 1.35-2.6MM 4MM LPS P/T SCR","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-05","SUP","Custom 27203010","","AR-8943-05  -  DRILL BIT CNTRSNK 4MM QFIX CNN 4MM LPS P/T SCR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-13","SUP","Custom 27203010","","AR-8943-13  -  BIT DRL 2.5MM CLBRT GRAD","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-14","SUP","Custom 27203010","","AR-8943-14  -  GUIDE DRL 3.5MM 2.5MM 3.5MM CORT 4MM CANC SCR LCK","BOTH IP/OP","$1,687.50 ","$1,248.75 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-16","SUP","Custom 27203010","","AR-8943-16  -  BIT DRL 2MM CLBRT GRAD 2.7/3MM SCR","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-17","SUP","Custom 27203010","","AR-8943-17  -  GUIDE DRL LOPRFL 2.7MM THRD 2.7/3MM SCR","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-24","SUP","Custom 27203010","","AR-8943-24  -  CLAMP SRG WEBER","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-26","SUP","Custom 27203010","","AR-8943-26  -  GUIDE DRL LOPRFL 3.5MM THRD","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-30","SUP","Custom 27203010","","AR-8943-30  -  BIT DRL 2.5MM 110MM ANKL 3.5MM CORT 4MM CANC SCR LCK","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-31","SUP","Custom 27203010","","AR-8943-31  -  GUIDE DRL 3MM 2MM ANKL 2.7/3MM SCR","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-36","SUP","Custom 27203010","","AR-8943-36  -  BIT DRL 3MM ANKL 2.7/3MM SCR","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-37","SUP","HCPCS C1713","","AR-8943-37  -  SCREW BN REPL ATCH ANKL FX MGMT","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"AR-8943-40","SUP","Custom 27203010","","AR-8943-40  -  BIT DRL 2MM CNN","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-41","SUP","Custom 27203010","","AR-8943-41  -  GUIDE DRL 2.6MM 1.35MM PRLL 4MM LPS P/T SCR","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-43","SUP","Custom 27203010","","AR-8943-43  -  GUIDE DRL 3.5MM BIT FX LCK VA FT/ANKL 3.5MM CORT 4MM CANC","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943-44","SUP","Custom 27203010","","AR-8943-44  -  CLAMP SRG SYNDESMOSIS","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8943BL-04","SUP","HCPCS C1713","","AR-8943BL-04  -  PLATE BN LOPRFL 4 HL LCK MDLR SS FIB LT DIST","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-8943BL-05","SUP","HCPCS C1713","","AR-8943BL-05  -  PLATE BN LOPRFL 5 HL LCK MDLR SS FIB LT DIST","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8943BL-06","SUP","HCPCS C1713","","AR-8943BL-06  -  PLATE BN LOPRFL 6 HL LCK MDLR SS FIB LT DIST","BOTH IP/OP","$1,812.50 ","$1,341.25 ","$0.00 ","$1,812.50 ","$815.63 ","$0.00 ","$377.77 ","$0.00 ","$0.00 ","$317.35 ","$1,812.50 ","$0.00 ","$906.25 ","$1,435.50 ","$1,450.00 ","$0.00 ","$283.66 ","$0.00 ","$288.55 ","$0.00 "
"AR-8943BL-08","SUP","HCPCS C1713","","AR-8943BL-08  -  PLATE BN LOPRFL 8 HL LCK MDLR SS FIB LT DIST","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8943BLS-10","SUP","HCPCS C1713","","AR-8943BLS-10  -  PLATE BN STRL 10 HL LCK FIB LT DIST","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"AR-8943BLS-12","SUP","HCPCS C1713","","AR-8943BLS-12  -  PLATE BN STRL 12 HL LCK FIB LT DIST","BOTH IP/OP","$2,150.00 ","$1,591.00 ","$0.00 ","$2,150.00 ","$967.50 ","$0.00 ","$448.11 ","$0.00 ","$0.00 ","$376.45 ","$2,150.00 ","$0.00 ","$1,075.00 ","$1,702.80 ","$1,720.00 ","$0.00 ","$336.48 ","$0.00 ","$342.28 ","$0.00 "
"AR-8943BLS-14","SUP","HCPCS C1713","","AR-8943BLS-14  -  PLATE BN STRL 14 HL LCK FIB LT DIST","BOTH IP/OP","$2,175.00 ","$1,609.50 ","$0.00 ","$2,175.00 ","$978.75 ","$0.00 ","$453.32 ","$0.00 ","$0.00 ","$380.83 ","$2,175.00 ","$0.00 ","$1,087.50 ","$1,722.60 ","$1,740.00 ","$0.00 ","$340.39 ","$0.00 ","$346.26 ","$0.00 "
"AR-8943BR-04","SUP","HCPCS C1713","","AR-8943BR-04  -  PLATE BN LOPRFL 4 HL LCK MDLR SS ANKL RT FIB","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-8943BR-05","SUP","HCPCS C1713","","AR-8943BR-05  -  PLATE BN LOPRFL 5 HL LCK MDLR SS ANKL RT FIB","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"AR-8943BR-06","SUP","HCPCS C1713","","AR-8943BR-06  -  PLATE BN LOPRFL 6 HL LCK MDLR SS ANKL RT FIB","BOTH IP/OP","$1,812.50 ","$1,341.25 ","$0.00 ","$1,812.50 ","$815.63 ","$0.00 ","$377.77 ","$0.00 ","$0.00 ","$317.35 ","$1,812.50 ","$0.00 ","$906.25 ","$1,435.50 ","$1,450.00 ","$0.00 ","$283.66 ","$0.00 ","$288.55 ","$0.00 "
"AR-8943BR-08","SUP","HCPCS C1713","","AR-8943BR-08  -  PLATE BN LOPRFL 8 HL LCK MDLR SS ANKL RT FIB","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8943BRS-10","SUP","HCPCS C1713","","AR-8943BRS-10  -  PLATE BN STRL 10 HL LCK FIB RT DIST","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"AR-8943BRS-12","SUP","HCPCS C1713","","AR-8943BRS-12  -  PLATE BN STRL 12 HL LCK FIB RT DIST","BOTH IP/OP","$2,150.00 ","$1,591.00 ","$0.00 ","$2,150.00 ","$967.50 ","$0.00 ","$448.11 ","$0.00 ","$0.00 ","$376.45 ","$2,150.00 ","$0.00 ","$1,075.00 ","$1,702.80 ","$1,720.00 ","$0.00 ","$336.48 ","$0.00 ","$342.28 ","$0.00 "
"AR-8943BRS-14","SUP","HCPCS C1713","","AR-8943BRS-14  -  PLATE BN STRL 12 HL LCK FIB RT DIST","BOTH IP/OP","$2,175.00 ","$1,609.50 ","$0.00 ","$2,175.00 ","$978.75 ","$0.00 ","$453.32 ","$0.00 ","$0.00 ","$380.83 ","$2,175.00 ","$0.00 ","$1,087.50 ","$1,722.60 ","$1,740.00 ","$0.00 ","$340.39 ","$0.00 ","$346.26 ","$0.00 "
"AR-8943C-04","SUP","HCPCS C1713","","AR-8943C-04  -  PLATE BN STRG 55MM 4 HL LCK SS ANKL","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"AR-8943C-06","SUP","HCPCS C1713","","AR-8943C-06  -  PLATE BN STRG 80MM 6 HL LCK SS ANKL","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$534.38 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$207.92 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$185.84 ","$0.00 ","$189.05 ","$0.00 "
"AR-8943C-07","SUP","HCPCS C1713","","AR-8943C-07  -  PLATE BN STRG 93MM 7 HL LCK SS ANKL","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-8943C-08","SUP","HCPCS C1713","","AR-8943C-08  -  PLATE BN STRG 106MM 8 HL LCK SS ANKL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-8943C-10","SUP","HCPCS C1713","","AR-8943C-10  -  PLATE BN STRG 131MM 10 HL LCK SS ANKL","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-8943C-12","SUP","HCPCS C1713","","AR-8943C-12  -  PLATE BN STRG 156MM 12 HL LCK SS ANKL","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8943H-03","SUP","HCPCS C1713","","AR-8943H-03  -  PLATE BN 61MM 3 HL HK LCK SS ANKL MLLE MDL","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"AR-8943H-05","SUP","HCPCS C1713","","AR-8943H-05  -  PLATE BN 79MM 5 HL HK LCK SS FT/ANKL MDL","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"AR-8943H-07","SUP","HCPCS C1713","","AR-8943H-07  -  PLATE BN 97MM 7 HL HK LCK SS FT/ANKL MDL","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"AR-8943I","SUP","HCPCS C1713","","AR-8943I  -  SET IMPL ANKL FX SYS","BOTH IP/OP","$112,500.00 ","$83,250.00 ","$0.00 ","$112,500.00 ","$50,625.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$112,500.00 ","$0.00 ","$56,250.00 ","$89,100.00 ","$90,000.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"AR-8943T-04","SUP","HCPCS C1713","","AR-8943T-04  -  PLATE BN 1/3 TUBE 47MM 4 HL LCK SS ANKL","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-8943T-05","SUP","HCPCS C1713","","AR-8943T-05  -  PLATE BN 1/3 TUBE 59MM 5 HL LCK SS ANKL","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-8943T-06","SUP","HCPCS C1713","","AR-8943T-06  -  PLATE BN 1/3 TUBE 72MM 6 HL LCK SS ANKL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-8943T-07","SUP","HCPCS C1713","","AR-8943T-07  -  PLATE BN 1/3 TUBE 85MM 7 HL LCK SS ANKL","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$286.88 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$111.62 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$99.77 ","$0.00 ","$101.49 ","$0.00 "
"AR-8943T-08","SUP","HCPCS C1713","","AR-8943T-08  -  PLATE BN 1/3 TUBE 98MM 8 HL LCK SS ANKL","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$298.13 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"AR-8943T-10","SUP","HCPCS C1713","","AR-8943T-10  -  PLATE BN 1/3 TUBE 123MM 10 HL LCK SS ANKL","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"AR-8943T-12","SUP","HCPCS C1713","","AR-8943T-12  -  PLATE BN 1/3 TUBE 148MM 12 HL LCK SS ANKL","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"AR-8943TH-03","SUP","HCPCS C1713","","AR-8943TH-03  -  PLATE BN 72MM 3 HL AVULSION HK LCK SS ANKL LAT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"AR-8943TH-05","SUP","HCPCS C1713","","AR-8943TH-05  -  PLATE BN 98MM 5 HL AVULSION HK LCK SS ANKL LAT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"AR-8943TH-07","SUP","HCPCS C1713","","AR-8943TH-07  -  PLATE BN 123MM 7 HL AVULSION HK LCK SS ANKL LAT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"AR-8944-10S","SUP","HCPCS C1713","","AR-8944-10S  -  PLATE BN 10D STD LOPRFL MTP VLGS","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8944-22","SUP","Custom 27203010","","AR-8944-22  -  BIT DRL 2MM AO CNCT LCK 3MM SCR","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8944C-10S","SUP","HCPCS C1713","","AR-8944C-10S  -  PLATE BN 10D STD DFLXN MTP VLGS","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8944CL-L","SUP","HCPCS C1713","","AR-8944CL-L  -  PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944CL-P","SUP","HCPCS C1713","","AR-8944CL-P  -  PLATE BN SHRT CNTR FSN MOD TI FOREFOOT 1ST MTP LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944CL-S","SUP","HCPCS C1713","","AR-8944CL-S  -  PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944CR-L","SUP","HCPCS C1713","","AR-8944CR-L  -  PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944CR-P","SUP","HCPCS C1713","","AR-8944CR-P  -  PLATE BN SHRT CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944CR-S","SUP","HCPCS C1713","","AR-8944CR-S  -  PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944-L","SUP","HCPCS C1713","","AR-8944-L  -  PLATE BN LNG STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8944-P","SUP","HCPCS C1713","","AR-8944-P  -  PLATE BN SHRT STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8945-20FT","SUP","HCPCS C1713","","AR-8945-20FT  -  SCREW BN .062IN 3.5MM FT HEX LOPRFL 4.5MM 20MM SLF DRL ST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-20PT","SUP","HCPCS C1713","","AR-8945-20PT  -  SCREW BN .062IN 3.5MM 1/3 FT HEX LOPRFL 4.5MM 20MM SLF DRL","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-22FT","SUP","HCPCS C1713","","AR-8945-22FT  -  SCREW BN FT HEX 4.5MM 22MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-22PT","SUP","HCPCS C1713","","AR-8945-22PT  -  SCREW BN P/T LOPRFL 4.5MM 22MM CNN TI MLR CORT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-24FT","SUP","HCPCS C1713","","AR-8945-24FT  -  SCREW BN FT HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-24PT","SUP","HCPCS C1713","","AR-8945-24PT  -  SCREW BN P/T HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-26FT","SUP","HCPCS C1713","","AR-8945-26FT  -  SCREW BN FT HEX 4.5MM 26MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-26PT","SUP","HCPCS C1713","","AR-8945-26PT  -  SCREW BN P/T LOPRFL 4.5MM 26MM CNN TI MLR CORT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-28FT","SUP","HCPCS C1713","","AR-8945-28FT  -  SCREW BN FT HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-28PT","SUP","HCPCS C1713","","AR-8945-28PT  -  SCREW BN P/T HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-30C","SUP","Custom 27203010","","AR-8945-30C  -  BIT DRL MN 3MM 120MM CNN 4.5MM SCR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8945-30FT","SUP","HCPCS C1713","","AR-8945-30FT  -  SCREW BN FT HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-30PT","SUP","HCPCS C1713","","AR-8945-30PT  -  SCREW BN P/T HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-32FT","SUP","HCPCS C1713","","AR-8945-32FT  -  SCREW BN FT HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-32PT","SUP","HCPCS C1713","","AR-8945-32PT  -  SCREW BN P/T HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-34FT","SUP","HCPCS C1713","","AR-8945-34FT  -  SCREW BN FT HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-34PT","SUP","HCPCS C1713","","AR-8945-34PT  -  SCREW BN P/T HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-35FT","SUP","HCPCS C1713","","AR-8945-35FT  -  SCREW BN FT HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-35PT","SUP","HCPCS C1713","","AR-8945-35PT  -  SCREW BN P/T HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-36FT","SUP","HCPCS C1713","","AR-8945-36FT  -  SCREW BN FT HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-36PT","SUP","HCPCS C1713","","AR-8945-36PT  -  SCREW BN P/T HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-38FT","SUP","HCPCS C1713","","AR-8945-38FT  -  SCREW BN FT HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-38PT","SUP","HCPCS C1713","","AR-8945-38PT  -  SCREW BN P/T HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-40FT","SUP","HCPCS C1713","","AR-8945-40FT  -  SCREW BN FT HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-40PT","SUP","HCPCS C1713","","AR-8945-40PT  -  SCREW BN P/T HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-45C","SUP","Custom 27203010","","AR-8945-45C  -  BIT DRL 4.5MM HDSN CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8945-45FT","SUP","HCPCS C1713","","AR-8945-45FT  -  SCREW BN FT HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-45PT","SUP","HCPCS C1713","","AR-8945-45PT  -  SCREW BN P/T HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-50FT","SUP","HCPCS C1713","","AR-8945-50FT  -  SCREW BN FT HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-50PT","SUP","HCPCS C1713","","AR-8945-50PT  -  SCREW BN P/T HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-55FT","SUP","HCPCS C1713","","AR-8945-55FT  -  SCREW BN FT HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-55PT","SUP","HCPCS C1713","","AR-8945-55PT  -  SCREW BN P/T HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-60FT","SUP","HCPCS C1713","","AR-8945-60FT  -  SCREW BN FT HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-60PT","SUP","HCPCS C1713","","AR-8945-60PT  -  SCREW BN P/T HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-65FT","SUP","HCPCS C1713","","AR-8945-65FT  -  SCREW BN FT HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-65PT","SUP","HCPCS C1713","","AR-8945-65PT  -  SCREW BN P/T HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-70FT","SUP","HCPCS C1713","","AR-8945-70FT  -  SCREW BN FT HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-70PT","SUP","HCPCS C1713","","AR-8945-70PT  -  SCREW BN P/T HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-75FT","SUP","HCPCS C1713","","AR-8945-75FT  -  SCREW BN FT HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-75PT","SUP","HCPCS C1713","","AR-8945-75PT  -  SCREW BN P/T HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-80FT","SUP","HCPCS C1713","","AR-8945-80FT  -  SCREW BN FT HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945-80PT","SUP","HCPCS C1713","","AR-8945-80PT  -  SCREW BN P/T HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8945CS","SUP","Custom 27203010","","AR-8945CS  -  DRILL BIT CNTRSNK CNN FX HNDL 4.5/6 MM","BOTH IP/OP","$550.00 ","$407.00 ","$0.00 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$550.00 ","$0.00 ","$275.00 ","$435.60 ","$440.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8945CSF","SUP","Custom 27203010","","AR-8945CSF  -  COUNTERSINK DRL CNN 4.5 MM SCR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8945W","SUP","HCPCS C1713","","AR-8945W  -  WASHER ORTH 10MM CNN TI","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"AR-8947DS","SUP","HCPCS C1713","","AR-8947DS  -  PLATE BN BTRS TGHTRP IMPL DLV ANKL SYNDESMOSIS","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$1,153.13 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$448.67 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$401.03 ","$0.00 ","$407.95 ","$0.00 "
"AR-8948-00","SUP","HCPCS C1713","","AR-8948-00  -  PLATE BN FLT LOPRFL TI CTTN FT/ANKL 2.4MM SCR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8948-02","SUP","HCPCS C1713","","AR-8948-02  -  PLATE BN LOPRFL 2MM TI CTTN FT/ANKL 2.4MM SCR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8948-06","SUP","HCPCS C1713","","AR-8948-06  -  PLATE BN LOPRFL 6MM TI CTTN FT/ANKL 2.4MM SCR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8948-08","SUP","HCPCS C1713","","AR-8948-08  -  PLATE BN LOPRFL 8MM TI CTTN FT/ANKL 2.4MM SCR","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-8949-050","SUP","HCPCS C1713","","AR-8949-050  -  PLATE BN 5MM STP CALCANEUS","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,450.00 ","$1,102.50 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$428.98 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$390.04 ","$0.00 "
"AR-8949-075","SUP","HCPCS C1713","","AR-8949-075  -  PLATE BN 7.5MM STP CALCANEUS","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,450.00 ","$1,102.50 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$428.98 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$390.04 ","$0.00 "
"AR-8949-100","SUP","HCPCS C1713","","AR-8949-100  -  PLATE BN 10MM STP CALCANEUS","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,450.00 ","$1,102.50 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$428.98 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$390.04 ","$0.00 "
"AR-8949DG","SUP","Custom 27203010","","AR-8949DG  -  GUIDE DRL CMPR HL","BOTH IP/OP","$1,200.00 ","$888.00 ","$0.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,200.00 ","$0.00 ","$600.00 ","$950.40 ","$960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8949S","SUP","HCPCS C1713","","AR-8949S  -  PLATE BN 5MM 7.5MM 10MM STP CALCANEUS","BOTH IP/OP","$5,625.00 ","$4,162.50 ","$0.00 ","$5,625.00 ","$2,531.25 ","$0.00 ","$1,172.39 ","$0.00 ","$0.00 ","$984.89 ","$5,625.00 ","$0.00 ","$2,812.50 ","$4,455.00 ","$4,500.00 ","$0.00 ","$880.31 ","$0.00 ","$895.50 ","$0.00 "
"AR-8950-01","SUP","Custom 27203010","","AR-8950-01  -  COUNTERSINK DRL 2.4MM","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950-02","SUP","Custom 27203010","","AR-8950-02  -  COUNTERSINK DRL 3MM","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950-03","SUP","Custom 27203010","","AR-8950-03  -  COUNTERSINK DRL 3.5 4 MM SCR","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950-05","SUP","Custom 27203010","","AR-8950-05  -  BIT DRL 3MM","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950-08","SUP","Custom 27203010","","AR-8950-08  -  GUIDE DRL BNT 2.4MM LCK","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950-09","SUP","Custom 27203010","","AR-8950-09  -  GUIDE DRL BNT 3MM LCK","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950C-14","SUP","Custom 27203010","","AR-8950C-14  -  INSERT TRY CMPRH FT SYS","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8950JD-1","SUP","HCPCS C1713","","AR-8950JD-1  -  DISTRACTOR SRG MN 16MM TRC SCR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8950JD-2","SUP","HCPCS C1713","","AR-8950JD-2  -  SCREW DSTRCT 20MM MN JNT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8950S-V1","SUP","HCPCS C1713","","AR-8950S-V1  -  SET SCR VA CMPRH FT SYS","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"AR-8951LL","SUP","HCPCS C1713","","AR-8951LL  -  PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC LT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8951LR","SUP","HCPCS C1713","","AR-8951LR  -  PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC RT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8951ML","SUP","HCPCS C1713","","AR-8951ML  -  PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC LT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8951MR","SUP","HCPCS C1713","","AR-8951MR  -  PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC RT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8951SL","SUP","HCPCS C1713","","AR-8951SL  -  PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC LT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8951SR","SUP","HCPCS C1713","","AR-8951SR  -  PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC RT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952MC-LL","SUP","HCPCS C1713","","AR-8952MC-LL  -  PLATE BN LG LOPRFL CLMN FT LT MDL 3.5MM SCR","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8952MC-LR","SUP","HCPCS C1713","","AR-8952MC-LR  -  PLATE BN LG LOPRFL CLMN FT RT MDL 3.5MM SCR","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8952MC-ML","SUP","HCPCS C1713","","AR-8952MC-ML  -  PLATE BN MED LOPRFL CLMN FT LT MDL 3.5MM SCR","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8952MC-MR","SUP","HCPCS C1713","","AR-8952MC-MR  -  PLATE BN MED LOPRFL CLMN FT RT MDL 3.5MM SCR","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8952MC-SL","SUP","HCPCS C1713","","AR-8952MC-SL  -  PLATE BN SM LOPRFL CLMN FT LT MDL 3.5MM SCR","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8952MC-SR","SUP","HCPCS C1713","","AR-8952MC-SR  -  PLATE BN SM LOPRFL CLMN FT RT MDL 3.5MM SCR","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"AR-8952ML-05L","SUP","HCPCS C1713","","AR-8952ML-05L  -  PLATE BN 5 HL TI WRST LT 2.4 MM SCR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8952ML-05R","SUP","HCPCS C1713","","AR-8952ML-05R  -  PLATE BN L 2 HLE/HD 5 HL SHFT TI RT 2.4MM SCR","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8952MS-04","SUP","HCPCS C1713","","AR-8952MS-04  -  PLATE BN STRG LOPRFL 2.4MM 4 HL FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MS-05","SUP","HCPCS C1713","","AR-8952MS-05  -  PLATE BN STRG LOPRFL 2.4MM 5 HL FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MS-06","SUP","HCPCS C1713","","AR-8952MS-06  -  PLATE BN STRG LOPRFL 2.4MM 6 HL FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MS-07","SUP","HCPCS C1713","","AR-8952MS-07  -  PLATE BN STRG LOPRFL 2.4MM 7 HL FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MS-08","SUP","HCPCS C1713","","AR-8952MS-08  -  PLATE BN STRG 8 HL LOPRFL 2.4MM SCR","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-03","SUP","HCPCS C1713","","AR-8952MT-03  -  PLATE BN T 3 HL LOPRFL 2.4MM SCR","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-04","SUP","HCPCS C1713","","AR-8952MT-04  -  PLATE BN T LOPRFL 4 HL FT 2.4MM SCR","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-05","SUP","HCPCS C1713","","AR-8952MT-05  -  PLATE BN T LOPRFL 2.4MM 5 HL FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-06","SUP","HCPCS C1713","","AR-8952MT-06  -  PLATE BN T LOPRFL 2.4MM 6 HL FT","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-07","SUP","HCPCS C1713","","AR-8952MT-07  -  PLATE BN T 2.4MM 7 HL LOPRFL","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-08","SUP","HCPCS C1713","","AR-8952MT-08  -  PLATE BN T 8 HL LOPRFL 2.4MM SCR","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952MT-09","SUP","HCPCS C1713","","AR-8952MT-09  -  PLATE BN T LOPRFL 9 HL 2.4MM SCR","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8952TS-02","SUP","HCPCS C1713","","AR-8952TS-02  -  PLATE BN STRG LOPRFL 2 HL TI FT 3MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952TS-04","SUP","HCPCS C1713","","AR-8952TS-04  -  PLATE BN STRG 3MM LOPRFL 4 HL TI","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952TS-05","SUP","HCPCS C1713","","AR-8952TS-05  -  PLATE BN STRG 5 HL LOPRFL TI 3MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952TT-03","SUP","HCPCS C1713","","AR-8952TT-03  -  PLATE BN T LOPRFL 3MM 3 HL TI FT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952TT-04","SUP","HCPCS C1713","","AR-8952TT-04  -  PLATE BN T 4 HL LOPRFL TI 3MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952XL","SUP","HCPCS C1713","","AR-8952XL  -  PLATE BN LG X 2 HL TI FT 3MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952XM","SUP","HCPCS C1713","","AR-8952XM  -  PLATE BN MED X TI 3MM SCR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8952XP","SUP","HCPCS C1713","","AR-8952XP  -  PLATE BN SM X TI 2.4MM SCR","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-8953-00","SUP","HCPCS C1713","","AR-8953-00  -  PLATE BN FLT LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG OSTM","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-02","SUP","HCPCS C1713","","AR-8953-02  -  PLATE BN LOPRFL 2MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-025","SUP","HCPCS C1713","","AR-8953-025  -  PLATE BN LOPRFL 2.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-03","SUP","HCPCS C1713","","AR-8953-03  -  PLATE BN LOPRFL 3MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-035","SUP","HCPCS C1713","","AR-8953-035  -  PLATE BN LOPRFL 3.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-04","SUP","HCPCS C1713","","AR-8953-04  -  PLATE BN 4MM LCK POW LOPRFL TI FT/ANKL PROX 3MM SCR OPN WDG","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-045","SUP","HCPCS C1713","","AR-8953-045  -  PLATE BN LOPRFL 4.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-05","SUP","HCPCS C1713","","AR-8953-05  -  PLATE BN LOPRFL 5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-055","SUP","HCPCS C1713","","AR-8953-055  -  PLATE BN LOPRFL 5.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-06","SUP","HCPCS C1713","","AR-8953-06  -  PLATE BN LOPRFL 6MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-065","SUP","HCPCS C1713","","AR-8953-065  -  PLATE BN LOPRFL 6.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8953-07","SUP","HCPCS C1713","","AR-8953-07  -  PLATE BN LOPRFL 7MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"AR-8954-07","SUP","Custom 27203010","","AR-8954-07  -  GUIDE DRL BNT 3.5MM LCK","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8954ML-L","SUP","HCPCS C1713","","AR-8954ML-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954ML-S","SUP","HCPCS C1713","","AR-8954ML-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954MR-L","SUP","HCPCS C1713","","AR-8954MR-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954MR-S","SUP","HCPCS C1713","","AR-8954MR-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954MT","SUP","HCPCS C1713","","AR-8954MT  -  PLATE BN T LOPRFL 4 HL FT 3.5MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PL-L","SUP","HCPCS C1713","","AR-8954PL-L  -  PLATE BN LG PRIMTR CALC FX LT","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PL-M","SUP","HCPCS C1713","","AR-8954PL-M  -  PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PL-S","SUP","HCPCS C1713","","AR-8954PL-S  -  PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PL-XS","SUP","HCPCS C1713","","AR-8954PL-XS  -  PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PR-L","SUP","HCPCS C1713","","AR-8954PR-L  -  PLATE BN LG LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PR-M","SUP","HCPCS C1713","","AR-8954PR-M  -  PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PR-S","SUP","HCPCS C1713","","AR-8954PR-S  -  PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954PR-XS","SUP","HCPCS C1713","","AR-8954PR-XS  -  PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954YL-L","SUP","HCPCS C1713","","AR-8954YL-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954YL-S","SUP","HCPCS C1713","","AR-8954YL-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954YR-L","SUP","HCPCS C1713","","AR-8954YR-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8954YR-S","SUP","HCPCS C1713","","AR-8954YR-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD","BOTH IP/OP","$2,737.50 ","$2,025.75 ","$0.00 ","$2,737.50 ","$1,231.88 ","$0.00 ","$570.56 ","$0.00 ","$0.00 ","$479.31 ","$2,737.50 ","$0.00 ","$1,368.75 ","$2,168.10 ","$2,190.00 ","$0.00 ","$428.42 ","$0.00 ","$435.81 ","$0.00 "
"AR-8955-60PT","SUP","HCPCS C1713","","AR-8955-60PT  -  SCREW BN 3.5MM P/T HEX 5.5MM 60MM LOPRFL SCR SLF DRL SLD LG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"AR-8955-65PT","SUP","HCPCS C1713","","AR-8955-65PT  -  SCREW BN 3.5MM P/T HEX 5.5MM 65MM LOPRFL SCR SLF DRL SLD LG","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"AR-8955G","SUP","Custom 27203010","","AR-8955G  -  GUIDE DRL LOPRFL 4MM 1.6MM 4.5MM SCR","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8955T","SUP","HCPCS C1713","","AR-8955T  -  SCREW BN LOPRFL 5.5MM TAP JNS FX","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"AR-8956-01","SUP","HCPCS C1713","","AR-8956-01  -  PLATE BN UNV HK METATARSUS FIFTH MTRSL FX SYS","BOTH IP/OP","$2,312.50 ","$1,711.25 ","$0.00 ","$2,312.50 ","$1,040.63 ","$0.00 ","$481.98 ","$0.00 ","$0.00 ","$404.90 ","$2,312.50 ","$0.00 ","$1,156.25 ","$1,831.50 ","$1,850.00 ","$0.00 ","$361.91 ","$0.00 ","$368.15 ","$0.00 "
"AR-8956-08","SUP","HCPCS C1713","","AR-8956-08  -  PLATE BN HK TAMP METATARSUS FIFTH MTRSL FX SYS","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"AR-8956L-02","SUP","HCPCS C1713","","AR-8956L-02  -  PLATE BN LNG HK METATARSUS LT FIFTH MTRSL FX SYS","BOTH IP/OP","$3,187.50 ","$2,358.75 ","$0.00 ","$3,187.50 ","$1,434.38 ","$0.00 ","$664.35 ","$0.00 ","$0.00 ","$558.11 ","$3,187.50 ","$0.00 ","$1,593.75 ","$2,524.50 ","$2,550.00 ","$0.00 ","$498.84 ","$0.00 ","$507.45 ","$0.00 "
"AR-8956R-03","SUP","HCPCS C1713","","AR-8956R-03  -  PLATE BN LNG 7 HL HK LOPRFL 5TH MTRSL RT 2.4MM SCR","BOTH IP/OP","$3,187.50 ","$2,358.75 ","$0.00 ","$3,187.50 ","$1,434.38 ","$0.00 ","$664.35 ","$0.00 ","$0.00 ","$558.11 ","$3,187.50 ","$0.00 ","$1,593.75 ","$2,524.50 ","$2,550.00 ","$0.00 ","$498.84 ","$0.00 ","$507.45 ","$0.00 "
"AR-8958-01","SUP","HCPCS C1713","","AR-8958-01  -  PLATE BN TGHTRP 2 HL SS SYNDESMOSIS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8958-01S","SUP","HCPCS C1713","","AR-8958-01S  -  PLATE BN STRL TGHTRP 2 HL SS SYNDESMOSIS","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"AR-8958-02","SUP","HCPCS C1713","","AR-8958-02  -  PLATE BN TGHTRP 2 HL TI SYNDESMOSIS","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8958-02S","SUP","HCPCS C1713","","AR-8958-02S  -  PLATE BN STRL TGHTRP 2 HL TI SYNDESMOSIS","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"AR-8958TDS","SUP","HCPCS C1713","","AR-8958TDS  -  SYSTEM FX TGHTRP BB-TAK 2","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-8963-05","SUP","Custom 27203010","","AR-8963-05  -  BIT DRL LNG 2MM CLBRT TIB DIST","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8963-08","SUP","Custom 27203010","","AR-8963-08  -  GUIDE DRL 2.7MM 10-60MM THRD","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8963A-03","SUP","HCPCS C1713","","AR-8963A-03  -  PLATE BN 62MM 3 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7","BOTH IP/OP","$2,312.50 ","$1,711.25 ","$0.00 ","$2,312.50 ","$1,040.63 ","$0.00 ","$481.98 ","$0.00 ","$0.00 ","$404.90 ","$2,312.50 ","$0.00 ","$1,156.25 ","$1,831.50 ","$1,850.00 ","$0.00 ","$361.91 ","$0.00 ","$368.15 ","$0.00 "
"AR-8963A-05","SUP","HCPCS C1713","","AR-8963A-05  -  PLATE BN 84MM 5 HL TIB DIST ANT","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"AR-8963A-07","SUP","HCPCS C1713","","AR-8963A-07  -  PLATE BN 107MM 7 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7","BOTH IP/OP","$2,450.00 ","$1,813.00 ","$0.00 ","$2,450.00 ","$1,102.50 ","$0.00 ","$510.64 ","$0.00 ","$0.00 ","$428.98 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$390.04 ","$0.00 "
"AR-8963A-09","SUP","HCPCS C1713","","AR-8963A-09  -  PLATE BN 130MM 9 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-8963AL-04","SUP","HCPCS C1713","","AR-8963AL-04  -  PLATE BN CNTR 66MM 4 HL TPR TIP LOPRFL TIB LT DIST ALAT 2.7","BOTH IP/OP","$4,550.00 ","$3,367.00 ","$0.00 ","$4,550.00 ","$2,047.50 ","$0.00 ","$948.33 ","$0.00 ","$0.00 ","$796.67 ","$4,550.00 ","$0.00 ","$2,275.00 ","$3,603.60 ","$3,640.00 ","$0.00 ","$712.08 ","$0.00 ","$724.36 ","$0.00 "
"AR-8963AL-06","SUP","HCPCS C1713","","AR-8963AL-06  -  PLATE BN OBLNG 91MM 6 HL TPR TIP LOPRFL TIB LT DIST ALAT","BOTH IP/OP","$4,600.00 ","$3,404.00 ","$0.00 ","$4,600.00 ","$2,070.00 ","$0.00 ","$958.76 ","$0.00 ","$0.00 ","$805.42 ","$4,600.00 ","$0.00 ","$2,300.00 ","$3,643.20 ","$3,680.00 ","$0.00 ","$719.90 ","$0.00 ","$732.32 ","$0.00 "
"AR-8963AL-08","SUP","HCPCS C1713","","AR-8963AL-08  -  PLATE BN 117MM 8 HL TIB LT DIST ALAT","BOTH IP/OP","$4,650.00 ","$3,441.00 ","$0.00 ","$4,650.00 ","$2,092.50 ","$0.00 ","$969.18 ","$0.00 ","$0.00 ","$814.18 ","$4,650.00 ","$0.00 ","$2,325.00 ","$3,682.80 ","$3,720.00 ","$0.00 ","$727.73 ","$0.00 ","$740.28 ","$0.00 "
"AR-8963AL-10","SUP","HCPCS C1713","","AR-8963AL-10  -  PLATE BN 142MM 10 HL TIB LT DIST ALAT","BOTH IP/OP","$4,700.00 ","$3,478.00 ","$0.00 ","$4,700.00 ","$2,115.00 ","$0.00 ","$979.60 ","$0.00 ","$0.00 ","$822.93 ","$4,700.00 ","$0.00 ","$2,350.00 ","$3,722.40 ","$3,760.00 ","$0.00 ","$735.55 ","$0.00 ","$748.24 ","$0.00 "
"AR-8963AL-12","SUP","HCPCS C1713","","AR-8963AL-12  -  PLATE BN 168MM 12 HL TIB LT DIST ALAT","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"AR-8963AL-14","SUP","HCPCS C1713","","AR-8963AL-14  -  PLATE BN 193MM 14 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST","BOTH IP/OP","$4,800.00 ","$3,552.00 ","$0.00 ","$4,800.00 ","$2,160.00 ","$0.00 ","$1,000.44 ","$0.00 ","$0.00 ","$840.44 ","$4,800.00 ","$0.00 ","$2,400.00 ","$3,801.60 ","$3,840.00 ","$0.00 ","$751.20 ","$0.00 ","$764.16 ","$0.00 "
"AR-8963AL-16","SUP","HCPCS C1713","","AR-8963AL-16  -  PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST","BOTH IP/OP","$4,850.00 ","$3,589.00 ","$0.00 ","$4,850.00 ","$2,182.50 ","$0.00 ","$1,010.86 ","$0.00 ","$0.00 ","$849.20 ","$4,850.00 ","$0.00 ","$2,425.00 ","$3,841.20 ","$3,880.00 ","$0.00 ","$759.03 ","$0.00 ","$772.12 ","$0.00 "
"AR-8963AL-18","SUP","HCPCS C1713","","AR-8963AL-18  -  PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB LT","BOTH IP/OP","$4,900.00 ","$3,626.00 ","$0.00 ","$4,900.00 ","$2,205.00 ","$0.00 ","$1,021.28 ","$0.00 ","$0.00 ","$857.95 ","$4,900.00 ","$0.00 ","$2,450.00 ","$3,880.80 ","$3,920.00 ","$0.00 ","$766.85 ","$0.00 ","$780.08 ","$0.00 "
"AR-8963APLL-04","SUP","HCPCS C1713","","AR-8963APLL-04  -  PLATE BN 75MM 4 HL TPR TIP LOPRFL FIB LT DIST P/L 2.7MM LCK","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"AR-8963APLL-06","SUP","HCPCS C1713","","AR-8963APLL-06  -  PLATE BN 126MM ANTM 6 HL SS FIB LT DIST P/L","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-8963APLL-08","SUP","HCPCS C1713","","AR-8963APLL-08  -  PLATE BN 151MM 8 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"AR-8963APLL-10","SUP","HCPCS C1713","","AR-8963APLL-10  -  PLATE BN 10 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-8963APLR-04","SUP","HCPCS C1713","","AR-8963APLR-04  -  PLATE BN 75MM JUMPSTART 4 HL FIB RT DIST P/L","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"AR-8963APLR-06","SUP","HCPCS C1713","","AR-8963APLR-06  -  PLATE BN LOPRFL SS FIB RT P/L DIST","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$599.22 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"AR-8963APLR-08","SUP","HCPCS C1713","","AR-8963APLR-08  -  PLATE BN 151MM 8 HL FIB RT DIST P/L","BOTH IP/OP","$3,000.00 ","$2,220.00 ","$0.00 ","$3,000.00 ","$1,350.00 ","$0.00 ","$625.28 ","$0.00 ","$0.00 ","$525.28 ","$3,000.00 ","$0.00 ","$1,500.00 ","$2,376.00 ","$2,400.00 ","$0.00 ","$469.50 ","$0.00 ","$477.60 ","$0.00 "
"AR-8963APLR-10","SUP","HCPCS C1713","","AR-8963APLR-10  -  PLATE BN 10 HL FIB RT DIST P/L","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-8963AR-04","SUP","HCPCS C1713","","AR-8963AR-04  -  PLATE BN BTRS 66MM 4 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST","BOTH IP/OP","$4,550.00 ","$3,367.00 ","$0.00 ","$4,550.00 ","$2,047.50 ","$0.00 ","$948.33 ","$0.00 ","$0.00 ","$796.67 ","$4,550.00 ","$0.00 ","$2,275.00 ","$3,603.60 ","$3,640.00 ","$0.00 ","$712.08 ","$0.00 ","$724.36 ","$0.00 "
"AR-8963AR-06","SUP","HCPCS C1713","","AR-8963AR-06  -  PLATE BN BTRS 91MM 6 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST","BOTH IP/OP","$4,600.00 ","$3,404.00 ","$0.00 ","$4,600.00 ","$2,070.00 ","$0.00 ","$958.76 ","$0.00 ","$0.00 ","$805.42 ","$4,600.00 ","$0.00 ","$2,300.00 ","$3,643.20 ","$3,680.00 ","$0.00 ","$719.90 ","$0.00 ","$732.32 ","$0.00 "
"AR-8963AR-08","SUP","HCPCS C1713","","AR-8963AR-08  -  PLATE BN 117MM 8 HL TIB RT DIST ALAT","BOTH IP/OP","$4,650.00 ","$3,441.00 ","$0.00 ","$4,650.00 ","$2,092.50 ","$0.00 ","$969.18 ","$0.00 ","$0.00 ","$814.18 ","$4,650.00 ","$0.00 ","$2,325.00 ","$3,682.80 ","$3,720.00 ","$0.00 ","$727.73 ","$0.00 ","$740.28 ","$0.00 "
"AR-8963AR-10","SUP","HCPCS C1713","","AR-8963AR-10  -  PLATE BN 142MM 10 HL TIB RT DIST ALAT","BOTH IP/OP","$4,700.00 ","$3,478.00 ","$0.00 ","$4,700.00 ","$2,115.00 ","$0.00 ","$979.60 ","$0.00 ","$0.00 ","$822.93 ","$4,700.00 ","$0.00 ","$2,350.00 ","$3,722.40 ","$3,760.00 ","$0.00 ","$735.55 ","$0.00 ","$748.24 ","$0.00 "
"AR-8963AR-14","SUP","HCPCS C1713","","AR-8963AR-14  -  PLATE BN 193MM 14 HL TIB RT DIST ALAT","BOTH IP/OP","$4,800.00 ","$3,552.00 ","$0.00 ","$4,800.00 ","$2,160.00 ","$0.00 ","$1,000.44 ","$0.00 ","$0.00 ","$840.44 ","$4,800.00 ","$0.00 ","$2,400.00 ","$3,801.60 ","$3,840.00 ","$0.00 ","$751.20 ","$0.00 ","$764.16 ","$0.00 "
"AR-8963AR-16","SUP","HCPCS C1713","","AR-8963AR-16  -  PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST","BOTH IP/OP","$4,850.00 ","$3,589.00 ","$0.00 ","$4,850.00 ","$2,182.50 ","$0.00 ","$1,010.86 ","$0.00 ","$0.00 ","$849.20 ","$4,850.00 ","$0.00 ","$2,425.00 ","$3,841.20 ","$3,880.00 ","$0.00 ","$759.03 ","$0.00 ","$772.12 ","$0.00 "
"AR-8963AR-18","SUP","HCPCS C1713","","AR-8963AR-18  -  PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB RT","BOTH IP/OP","$4,900.00 ","$3,626.00 ","$0.00 ","$4,900.00 ","$2,205.00 ","$0.00 ","$1,021.28 ","$0.00 ","$0.00 ","$857.95 ","$4,900.00 ","$0.00 ","$2,450.00 ","$3,880.80 ","$3,920.00 ","$0.00 ","$766.85 ","$0.00 ","$780.08 ","$0.00 "
"AR-8963ML-04","SUP","HCPCS C1713","","AR-8963ML-04  -  PLATE BN 103MM 4 HL TIB LT DIST MDL","BOTH IP/OP","$4,300.00 ","$3,182.00 ","$0.00 ","$4,300.00 ","$1,935.00 ","$0.00 ","$896.23 ","$0.00 ","$0.00 ","$752.90 ","$4,300.00 ","$0.00 ","$2,150.00 ","$3,405.60 ","$3,440.00 ","$0.00 ","$672.95 ","$0.00 ","$684.56 ","$0.00 "
"AR-8963ML-06","SUP","HCPCS C1713","","AR-8963ML-06  -  PLATE BN 128MM 6 HL TIB LT DIST MDL","BOTH IP/OP","$4,350.00 ","$3,219.00 ","$0.00 ","$4,350.00 ","$1,957.50 ","$0.00 ","$906.65 ","$0.00 ","$0.00 ","$761.65 ","$4,350.00 ","$0.00 ","$2,175.00 ","$3,445.20 ","$3,480.00 ","$0.00 ","$680.78 ","$0.00 ","$692.52 ","$0.00 "
"AR-8963ML-10","SUP","HCPCS C1713","","AR-8963ML-10  -  PLATE BN 179MM 10 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL","BOTH IP/OP","$4,450.00 ","$3,293.00 ","$0.00 ","$4,450.00 ","$2,002.50 ","$0.00 ","$927.49 ","$0.00 ","$0.00 ","$779.16 ","$4,450.00 ","$0.00 ","$2,225.00 ","$3,524.40 ","$3,560.00 ","$0.00 ","$696.43 ","$0.00 ","$708.44 ","$0.00 "
"AR-8963ML-14","SUP","HCPCS C1713","","AR-8963ML-14  -  PLATE BN 230MM 14 HL TIB LT DIST MDL","BOTH IP/OP","$4,550.00 ","$3,367.00 ","$0.00 ","$4,550.00 ","$2,047.50 ","$0.00 ","$948.33 ","$0.00 ","$0.00 ","$796.67 ","$4,550.00 ","$0.00 ","$2,275.00 ","$3,603.60 ","$3,640.00 ","$0.00 ","$712.08 ","$0.00 ","$724.36 ","$0.00 "
"AR-8963ML-16","SUP","HCPCS C1713","","AR-8963ML-16  -  PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL","BOTH IP/OP","$4,600.00 ","$3,404.00 ","$0.00 ","$4,600.00 ","$2,070.00 ","$0.00 ","$958.76 ","$0.00 ","$0.00 ","$805.42 ","$4,600.00 ","$0.00 ","$2,300.00 ","$3,643.20 ","$3,680.00 ","$0.00 ","$719.90 ","$0.00 ","$732.32 ","$0.00 "
"AR-8963MR-04","SUP","HCPCS C1713","","AR-8963MR-04  -  PLATE BN 4 HL LOPRFL SS TIB RT DIST MDL 2.7 MM SCR","BOTH IP/OP","$4,300.00 ","$3,182.00 ","$0.00 ","$4,300.00 ","$1,935.00 ","$0.00 ","$896.23 ","$0.00 ","$0.00 ","$752.90 ","$4,300.00 ","$0.00 ","$2,150.00 ","$3,405.60 ","$3,440.00 ","$0.00 ","$672.95 ","$0.00 ","$684.56 ","$0.00 "
"AR-8963MR-06","SUP","HCPCS C1713","","AR-8963MR-06  -  PLATE BN CNTR 128MM 6 HL TPR TIP LOPRFL TIB RT DIST MDL 2.7","BOTH IP/OP","$4,350.00 ","$3,219.00 ","$0.00 ","$4,350.00 ","$1,957.50 ","$0.00 ","$906.65 ","$0.00 ","$0.00 ","$761.65 ","$4,350.00 ","$0.00 ","$2,175.00 ","$3,445.20 ","$3,480.00 ","$0.00 ","$680.78 ","$0.00 ","$692.52 ","$0.00 "
"AR-8963MR-08","SUP","HCPCS C1713","","AR-8963MR-08  -  PLATE BN 154MM 8 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL","BOTH IP/OP","$4,400.00 ","$3,256.00 ","$0.00 ","$4,400.00 ","$1,980.00 ","$0.00 ","$917.07 ","$0.00 ","$0.00 ","$770.40 ","$4,400.00 ","$0.00 ","$2,200.00 ","$3,484.80 ","$3,520.00 ","$0.00 ","$688.60 ","$0.00 ","$700.48 ","$0.00 "
"AR-8963MR-10","SUP","HCPCS C1713","","AR-8963MR-10  -  PLATE BN CNTR 179MM 10 HL LOPRFL TPR TIP TIB RT DIST MDL","BOTH IP/OP","$4,450.00 ","$3,293.00 ","$0.00 ","$4,450.00 ","$2,002.50 ","$0.00 ","$927.49 ","$0.00 ","$0.00 ","$779.16 ","$4,450.00 ","$0.00 ","$2,225.00 ","$3,524.40 ","$3,560.00 ","$0.00 ","$696.43 ","$0.00 ","$708.44 ","$0.00 "
"AR-8963MR-12","SUP","HCPCS C1713","","AR-8963MR-12  -  PLATE BN 204MM 12 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"AR-8963MR-14","SUP","HCPCS C1713","","AR-8963MR-14  -  PLATE BN 230MM 14 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL","BOTH IP/OP","$4,550.00 ","$3,367.00 ","$0.00 ","$4,550.00 ","$2,047.50 ","$0.00 ","$948.33 ","$0.00 ","$0.00 ","$796.67 ","$4,550.00 ","$0.00 ","$2,275.00 ","$3,603.60 ","$3,640.00 ","$0.00 ","$712.08 ","$0.00 ","$724.36 ","$0.00 "
"AR-8963MR-16","SUP","HCPCS C1713","","AR-8963MR-16  -  PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL","BOTH IP/OP","$4,600.00 ","$3,404.00 ","$0.00 ","$4,600.00 ","$2,070.00 ","$0.00 ","$958.76 ","$0.00 ","$0.00 ","$805.42 ","$4,600.00 ","$0.00 ","$2,300.00 ","$3,643.20 ","$3,680.00 ","$0.00 ","$719.90 ","$0.00 ","$732.32 ","$0.00 "
"AR-8963P-03","SUP","HCPCS C1713","","AR-8963P-03  -  PLATE BN 57MM ARTHX 3 HL TIB DP","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"AR-8963P-05","SUP","HCPCS C1713","","AR-8963P-05  -  PLATE BN 77MM 5 HL TIB DP","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"AR-8963P-07","SUP","HCPCS C1713","","AR-8963P-07  -  PLATE BN 7 HL TIB DP","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"AR-8963P-09","SUP","HCPCS C1713","","AR-8963P-09  -  PLATE BN 118MM 9 HL TIB DP","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-8963PLL-04","SUP","HCPCS C1713","","AR-8963PLL-04  -  PLATE BN 75MM 4 HL FIB DIST P/L","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"AR-8963PLL-05","SUP","HCPCS C1713","","AR-8963PLL-05  -  PLATE BN STD 88MM 5 HL TPR TIP FIB DIST P/L 2.7MM LCK","BOTH IP/OP","$2,050.00 ","$1,517.00 ","$0.00 ","$2,050.00 ","$922.50 ","$0.00 ","$427.27 ","$0.00 ","$0.00 ","$358.94 ","$2,050.00 ","$0.00 ","$1,025.00 ","$1,623.60 ","$1,640.00 ","$0.00 ","$320.83 ","$0.00 ","$326.36 ","$0.00 "
"AR-8963PLL-06","SUP","HCPCS C1713","","AR-8963PLL-06  -  PLATE BN 100MM 6 HL TPR TIP CUT OUT SCLP FIB DIST P/L","BOTH IP/OP","$2,100.00 ","$1,554.00 ","$0.00 ","$2,100.00 ","$945.00 ","$0.00 ","$437.69 ","$0.00 ","$0.00 ","$367.69 ","$2,100.00 ","$0.00 ","$1,050.00 ","$1,663.20 ","$1,680.00 ","$0.00 ","$328.65 ","$0.00 ","$334.32 ","$0.00 "
"AR-8963PLL-08","SUP","HCPCS C1713","","AR-8963PLL-08  -  PLATE BN STD 126MM 8 HL TPR TIP FIB DIST P/L 2.7MM LCK","BOTH IP/OP","$2,150.00 ","$1,591.00 ","$0.00 ","$2,150.00 ","$967.50 ","$0.00 ","$448.11 ","$0.00 ","$0.00 ","$376.45 ","$2,150.00 ","$0.00 ","$1,075.00 ","$1,702.80 ","$1,720.00 ","$0.00 ","$336.48 ","$0.00 ","$342.28 ","$0.00 "
"AR-8963RM-02","SUP","HCPCS C1713","","AR-8963RM-02  -  PLATE BN STRG 16MM 2 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8963RM-03","SUP","HCPCS C1713","","AR-8963RM-03  -  PLATE BN STRG 16MM 3 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-8963RM-04","SUP","HCPCS C1713","","AR-8963RM-04  -  PLATE BN STRG 16MM 4 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$320.63 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"AR-8963RM-05","SUP","HCPCS C1713","","AR-8963RM-05  -  PLATE BN STRG 40MM 5 HL 2.7MM SCR","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"AR-8964-01","SUP","HCPCS C1713","","AR-8964-01  -  SCREW BN 4MM 125MM SCHNZ","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8964-02","SUP","HCPCS C1713","","AR-8964-02  -  SCREW BN 4MM 125MM SCHNZ","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8964-03","SUP","HCPCS C1713","","AR-8964-03  -  SCREW BN 5MM 175MM SCHNZ","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8964-04","SUP","HCPCS C1713","","AR-8964-04  -  SCREW BN 5MM 200MM SCHNZ","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8964-05","SUP","HCPCS C1713","","AR-8964-05  -  PIN FX 6MM 225MM TRNFX","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"AR-8964-06","SUP","HCPCS C1713","","AR-8964-06  -  PIN FX 6MM 300MM TRNFX","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"AR-8964-07","SUP","Custom 27203010","","AR-8964-07  -  CLAMP XTRNFX LG CMBN","BOTH IP/OP","$1,240.00 ","$917.60 ","$0.00 ","$1,240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,240.00 ","$0.00 ","$620.00 ","$982.08 ","$992.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8964-08","SUP","Custom 27203010","","AR-8964-08  -  CLAMP XTRNFX LG MLPN","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8964-09","SUP","Custom 27203010","","AR-8964-09  -  CLAMP XTRNFX LG MLPN ROD ATCH","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8964-10","SUP","Custom 27203010","","AR-8964-10  -  BIT DRL 3.5MM 195MM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8964-22","SUP","HCPCS C1713","","AR-8964-22  -  CAP END NS LF ARTHX SCR","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$562.50 ","$0.00 ","$260.53 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"AR-8964-24","SUP","HCPCS C1713","","AR-8964-24  -  SCREW BN 5MM 250MM SCHNZ","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$140.63 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"AR-8964R-100","SUP","HCPCS C1713","","AR-8964R-100  -  ROD XTRNFX 11MM 100MM ARTHROFX RDLCNT LTWT CFBR","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"AR-8964R-150","SUP","HCPCS C1713","","AR-8964R-150  -  ROD XTRNFX 11MM 150MM CFBR","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"AR-8964R-200","SUP","HCPCS C1713","","AR-8964R-200  -  ROD XTRNFX 11MM 200MM ARTHROFX CFBR","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"AR-8964R-250","SUP","HCPCS C1713","","AR-8964R-250  -  ROD XTRNFX 11MM 250MM CFBR","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$190.13 ","$0.00 ","$88.06 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"AR-8964R-300","SUP","HCPCS C1713","","AR-8964R-300  -  ROD XTRNFX 11MM 300MM CFBR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"AR-8964R-350","SUP","HCPCS C1713","","AR-8964R-350  -  ROD XTRNFX 11MM 350MM CFBR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"AR-8964R-400","SUP","HCPCS C1713","","AR-8964R-400  -  ROD XTRNFX 11MM 400MM CFBR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-8964R-450","SUP","HCPCS C1713","","AR-8964R-450  -  ROD XTRNFX 11MM 450MM CFBR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-8964R-500","SUP","HCPCS C1713","","AR-8964R-500  -  ROD XTRNFX 11MM 500MM ARTHROFX RDLCNT LTWT CFBR","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8964S","SUP","Custom 27203010","","AR-8964S  -  SYSTEM XTRNFX ARTHROFX","BOTH IP/OP","$35,000.00 ","$25,900.00 ","$0.00 ","$35,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35,000.00 ","$0.00 ","$17,500.00 ","$27,720.00 ","$28,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8967-100FT","SUP","HCPCS C1713","","AR-8967-100FT  -  SCREW BN FT 6.7MM 100MM LOPRFL SCR SLF DRL ST CNN MTL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-105FT","SUP","HCPCS C1713","","AR-8967-105FT  -  SCREW BN FT 6.7MM 105MM LOPRFL SCR SLF DRL ST CNN MTL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-110FT","SUP","HCPCS C1713","","AR-8967-110FT  -  SCREW BN FT 6.7MM 110MM LOPRFL SCR SLF DRL ST CNN MTL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-115FT","SUP","HCPCS C1713","","AR-8967-115FT  -  SCREW BN FT 6.7MM 115MM LOPRFL SCR SLF DRL ST CNN MTL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-120FT","SUP","HCPCS C1713","","AR-8967-120FT  -  SCREW BN FT 6.7MM 120MM LOPRFL SCR SLF DRL ST CNN MTL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-18100","SUP","HCPCS C1713","","AR-8967-18100  -  SCREW BN LOPRFL 6.7MM 100MM 18MM CNN TI FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-18105","SUP","HCPCS C1713","","AR-8967-18105  -  SCREW BN LOPRFL 6.7MM 105MM 18MM CNN TI FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-18110","SUP","HCPCS C1713","","AR-8967-18110  -  SCREW BN LOPRFL 6.7MM 110MM 18MM CNN TI FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-18115","SUP","HCPCS C1713","","AR-8967-18115  -  SCREW BN LOPRFL 6.7MM 115MM 18MM CNN TI FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-18120","SUP","HCPCS C1713","","AR-8967-18120  -  SCREW BN LOPRFL 6.7MM 120MM 18MM CNN TI FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1840","SUP","HCPCS C1713","","AR-8967-1840  -  SCREW BN 3.5MM HEX 6.7MM 40MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1845","SUP","HCPCS C1713","","AR-8967-1845  -  SCREW BN 3.5MM HEX 6.7MM 45MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1850","SUP","HCPCS C1713","","AR-8967-1850  -  SCREW BN 3.5MM HEX 6.7MM 50MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1855","SUP","HCPCS C1713","","AR-8967-1855  -  SCREW BN 3.5MM HEX 6.7MM 55MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1860","SUP","HCPCS C1713","","AR-8967-1860  -  SCREW BN 3.5MM HEX 6.7MM 60MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1865","SUP","HCPCS C1713","","AR-8967-1865  -  SCREW BN 3.5MM HEX 6.7MM 65MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1865S","SUP","HCPCS C1713","","AR-8967-1865S  -  SCREW BN P/T 6.7MM 65MM STRL ARTHX LOPRFL SCR CNN TI","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1870","SUP","HCPCS C1713","","AR-8967-1870  -  SCREW BN 3.5MM HEX 6.7MM 70MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1875","SUP","HCPCS C1713","","AR-8967-1875  -  SCREW BN 3.5MM HEX 6.7MM 75MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1880","SUP","HCPCS C1713","","AR-8967-1880  -  SCREW BN 3.5MM HEX 6.7MM 80MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1880S","SUP","HCPCS C1713","","AR-8967-1880S  -  SCREW BN P/T 6.7MM 80MM STRL ARTHX LOPRFL SCR CNN TI","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1885","SUP","HCPCS C1713","","AR-8967-1885  -  SCREW BN 3.5MM HEX 6.7MM 85MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1890","SUP","HCPCS C1713","","AR-8967-1890  -  SCREW BN 3.5MM HEX 6.7MM 90MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1890S","SUP","HCPCS C1713","","AR-8967-1890S  -  SCREW BN P/T 6.7MM 90MM STRL ARTHX LOPRFL SCR CNN TI","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-1895","SUP","HCPCS C1713","","AR-8967-1895  -  SCREW BN 3.5MM HEX 6.7MM 95MM 18MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-28100","SUP","HCPCS C1713","","AR-8967-28100  -  SCREW BN 3.5MM HEX 6.7MM 100MM 18MM LOPRFL SCR SLF DRL ST","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-28105","SUP","HCPCS C1713","","AR-8967-28105  -  SCREW BN 3.5MM HEX 6.7MM 105MM 18MM LOPRFL SCR SLF DRL ST","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-28110","SUP","HCPCS C1713","","AR-8967-28110  -  SCREW BN 3.5MM HEX 6.7MM 110MM 18MM LOPRFL SCR SLF DRL ST","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-28115","SUP","HCPCS C1713","","AR-8967-28115  -  SCREW BN 3.5MM HEX 6.7MM 115MM 18MM LOPRFL SCR SLF DRL ST","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-28120","SUP","HCPCS C1713","","AR-8967-28120  -  SCREW BN 3.5MM HEX 6.7MM 120MM 18MM LOPRFL SCR SLF DRL ST","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2840","SUP","HCPCS C1713","","AR-8967-2840  -  SCREW BN 3.5MM HEX 6.7MM 40MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2845","SUP","HCPCS C1713","","AR-8967-2845  -  SCREW BN 3.5MM HEX 6.7MM 45MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2850","SUP","HCPCS C1713","","AR-8967-2850  -  SCREW BN 3.5MM HEX 6.7MM 50MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2855","SUP","HCPCS C1713","","AR-8967-2855  -  SCREW BN 3.5MM HEX 6.7MM 55MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2860","SUP","HCPCS C1713","","AR-8967-2860  -  SCREW BN 3.5MM HEX 6.7MM 60MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2865","SUP","HCPCS C1713","","AR-8967-2865  -  SCREW BN 3.5MM HEX 6.7MM 65MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2870","SUP","HCPCS C1713","","AR-8967-2870  -  SCREW BN 3.5MM HEX 6.7MM 70MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2875","SUP","HCPCS C1713","","AR-8967-2875  -  SCREW BN 3.5MM HEX 6.7MM 75MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2880","SUP","HCPCS C1713","","AR-8967-2880  -  SCREW BN 3.5MM HEX 6.7MM 80MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2885","SUP","HCPCS C1713","","AR-8967-2885  -  SCREW BN 3.5MM HEX 6.7MM 85MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2890","SUP","HCPCS C1713","","AR-8967-2890  -  SCREW BN 3.5MM HEX 6.7MM 90MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-2895","SUP","HCPCS C1713","","AR-8967-2895  -  SCREW BN 3.5MM HEX 6.7MM 95MM 28MM LOPRFL SCR SLF DRL ST CNN","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-40C","SUP","Custom 27203010","","AR-8967-40C  -  BIT DRL 4MM 120MM CNN 6.7MM SCR","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8967-40FT","SUP","HCPCS C1713","","AR-8967-40FT  -  SCREW BN FT 6.7MM 40MM LOPRFL SCR CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-45FT","SUP","HCPCS C1713","","AR-8967-45FT  -  SCREW BN FT 6.7MM 45MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-50FT","SUP","HCPCS C1713","","AR-8967-50FT  -  SCREW BN FT 6.7MM 50MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-55FT","SUP","HCPCS C1713","","AR-8967-55FT  -  SCREW BN FT 6.7MM 55MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-60FT","SUP","HCPCS C1713","","AR-8967-60FT  -  SCREW BN FT 6.7MM 60MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-65FT","SUP","HCPCS C1713","","AR-8967-65FT  -  SCREW BN FT 6.7MM 65MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-67C","SUP","Custom 27203010","","AR-8967-67C  -  BIT DRL MN 6.7MM HDSN CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8967-70FT","SUP","HCPCS C1713","","AR-8967-70FT  -  SCREW BN FT 6.7MM 70MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-75FT","SUP","HCPCS C1713","","AR-8967-75FT  -  SCREW BN FT 6.7MM 75MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-80FT","SUP","HCPCS C1713","","AR-8967-80FT  -  SCREW BN FT 6.7MM 80MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-85FT","SUP","HCPCS C1713","","AR-8967-85FT  -  SCREW BN FT 6.7MM 85MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-90FT","SUP","HCPCS C1713","","AR-8967-90FT  -  SCREW BN FT 6.7MM 90MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967-95FT","SUP","HCPCS C1713","","AR-8967-95FT  -  SCREW BN FT 6.7MM 95MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-8967C","SUP","HCPCS C1713","","AR-8967C  -  SCREW BN LOPRFL 7MM PLT INS SM BN","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"AR-8967CSF","SUP","Custom 27203010","","AR-8967CSF  -  COUNTERSINK DRL CNN 6.7 MM SCR","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8967G","SUP","Custom 27203010","","AR-8967G  -  GUIDE DRL 6.7MM 4MM CNN","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8967S","SUP","HCPCS C1713","","AR-8967S  -  MODULE INST 6.7 MM TENODESIS LOPRFL SCR","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"AR-8967W","SUP","HCPCS C1713","","AR-8967W  -  WASHER ORTH 13MM TI","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$90.00 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"AR-8970-01","SUP","Custom 27203010","","AR-8970-01  -  GUIDE DRL 4.5 MM LCK SCR","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970-02","SUP","Custom 27203010","","AR-8970-02  -  GUIDE DRL 3 4.5 MM SCR","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970-30","SUP","Custom 27203010","","AR-8970-30  -  BIT DRL 3MM CLBRT","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970-30C","SUP","Custom 27203010","","AR-8970-30C  -  BIT DRL 3MM CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970-40C","SUP","Custom 27203010","","AR-8970-40C  -  BIT DRL 4MM CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970-45","SUP","Custom 27203010","","AR-8970-45  -  BIT DRL 4.5MM","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970-55","SUP","Custom 27203010","","AR-8970-55  -  BIT DRL 5.5MM","BOTH IP/OP","$197.50 ","$146.15 ","$0.00 ","$197.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.50 ","$0.00 ","$98.75 ","$156.42 ","$158.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8970AL","SUP","HCPCS C1713","","AR-8970AL  -  PLATE BN ANKL LT ANT","BOTH IP/OP","$5,187.50 ","$3,838.75 ","$0.00 ","$5,187.50 ","$2,334.38 ","$0.00 ","$1,081.20 ","$0.00 ","$0.00 ","$908.29 ","$5,187.50 ","$0.00 ","$2,593.75 ","$4,108.50 ","$4,150.00 ","$0.00 ","$811.84 ","$0.00 ","$825.85 ","$0.00 "
"AR-8970AR","SUP","HCPCS C1713","","AR-8970AR  -  PLATE BN ANKL RT ANT","BOTH IP/OP","$5,187.50 ","$3,838.75 ","$0.00 ","$5,187.50 ","$2,334.38 ","$0.00 ","$1,081.20 ","$0.00 ","$0.00 ","$908.29 ","$5,187.50 ","$0.00 ","$2,593.75 ","$4,108.50 ","$4,150.00 ","$0.00 ","$811.84 ","$0.00 ","$825.85 ","$0.00 "
"AR-8970PL","SUP","HCPCS C1713","","AR-8970PL  -  PLATE BN ANKL LT TIBIOTALOCALCANEAL POST","BOTH IP/OP","$5,687.50 ","$4,208.75 ","$0.00 ","$5,687.50 ","$2,559.38 ","$0.00 ","$1,185.42 ","$0.00 ","$0.00 ","$995.84 ","$5,687.50 ","$0.00 ","$2,843.75 ","$4,504.50 ","$4,550.00 ","$0.00 ","$890.09 ","$0.00 ","$905.45 ","$0.00 "
"AR-8970PR","SUP","HCPCS C1713","","AR-8970PR  -  PLATE BN ANKL RT POST TIBIOTALOCALCANEAL","BOTH IP/OP","$5,687.50 ","$4,208.75 ","$0.00 ","$5,687.50 ","$2,559.38 ","$0.00 ","$1,185.42 ","$0.00 ","$0.00 ","$995.84 ","$5,687.50 ","$0.00 ","$2,843.75 ","$4,504.50 ","$4,550.00 ","$0.00 ","$890.09 ","$0.00 ","$905.45 ","$0.00 "
"AR-8970S","SUP","HCPCS C1713","","AR-8970S  -  SCREW BN ANKL FSN PLT SYS","BOTH IP/OP","$36,250.00 ","$26,825.00 ","$0.00 ","$36,250.00 ","$16,312.50 ","$0.00 ","$7,555.41 ","$0.00 ","$0.00 ","$6,347.09 ","$36,250.00 ","$0.00 ","$18,125.00 ","$28,710.00 ","$29,000.00 ","$0.00 ","$5,673.13 ","$0.00 ","$5,771.00 ","$0.00 "
"AR-8970TT","SUP","HCPCS C1713","","AR-8970TT  -  PLATE BN FSN ANKL TIBIOTALAR LAT","BOTH IP/OP","$5,187.50 ","$3,838.75 ","$0.00 ","$5,187.50 ","$2,334.38 ","$0.00 ","$1,081.20 ","$0.00 ","$0.00 ","$908.29 ","$5,187.50 ","$0.00 ","$2,593.75 ","$4,108.50 ","$4,150.00 ","$0.00 ","$811.84 ","$0.00 ","$825.85 ","$0.00 "
"AR-8970TTC","SUP","HCPCS C1713","","AR-8970TTC  -  PLATE BN FSN ANKL LAT TIBIOTALOCALCANEAL","BOTH IP/OP","$5,437.50 ","$4,023.75 ","$0.00 ","$5,437.50 ","$2,446.88 ","$0.00 ","$1,133.31 ","$0.00 ","$0.00 ","$952.06 ","$5,437.50 ","$0.00 ","$2,718.75 ","$4,306.50 ","$4,350.00 ","$0.00 ","$850.97 ","$0.00 ","$865.65 ","$0.00 "
"AR-8978DS","SUP","Custom 27203010","","AR-8978DS  -  KIT ASCP FX 3.5MM 8.5MM STRL ARTHX DX SWIVELOCK SL","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8978P","SUP","HCPCS C1713","","AR-8978P  -  ANCHOR SUT 3.5MM STRL DX SWIVELOCK SL8.5MM FRK EYLT","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AR-8981-06S","SUP","Custom 27203010","","AR-8981-06S  -  SET GFT HRVT 6MM STRL OATS DISP S JNT","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8981-08S","SUP","Custom 27203010","","AR-8981-08S  -  SET GFT HRVT 8MM STRL OATS DISP S JNT","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8981-10S","SUP","Custom 27203010","","AR-8981-10S  -  SET GFT HRVT 10MM STRL OATS DISP S JNT","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-8999N","SUP","Custom 27203010","","AR-8999N  -  NEEDLE SUT MN SCRPN DX","BOTH IP/OP","$4,937.50 ","$3,653.75 ","$0.00 ","$4,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,937.50 ","$0.00 ","$2,468.75 ","$3,910.50 ","$3,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9045-40PT","SUP","HCPCS C1713","","AR-9045-40PT  -  SCREW BN P/T LOPRFL 4.5MM 40MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9045-45PT","SUP","HCPCS C1713","","AR-9045-45PT  -  SCREW BN P/T 4.5MM 45MM LOPRFL HD ST TI METATARSUS","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9045-50PT","SUP","HCPCS C1713","","AR-9045-50PT  -  SCREW BN P/T LOPRFL 4.5MM 50MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9045-55PT","SUP","HCPCS C1713","","AR-9045-55PT  -  SCREW BN P/T LOPRFL 4.5MM 55MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9045-60PT","SUP","HCPCS C1713","","AR-9045-60PT  -  SCREW BN P/T LOPRFL 4.5MM 60MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9045-65PT","SUP","HCPCS C1713","","AR-9045-65PT  -  SCREW BN P/T LOPRFL 4.5MM 65MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9055-40PT","SUP","HCPCS C1713","","AR-9055-40PT  -  SCREW BN P/T LOPRFL 5.5MM 40MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9055-45PT","SUP","HCPCS C1713","","AR-9055-45PT  -  SCREW BN P/T 5.5MM 45MM SOLINULLD LOPRFL ST TI METATARSUS","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9055-50PT","SUP","HCPCS C1713","","AR-9055-50PT  -  SCREW BN P/T LOPRFL 5.5MM 50MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9055-55PT","SUP","HCPCS C1713","","AR-9055-55PT  -  SCREW BN P/T 5.5MM 55MM LOPRFL HD ST TI METATARSUS","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9055-60PT","SUP","HCPCS C1713","","AR-9055-60PT  -  SCREW BN P/T LOPRFL 5.5MM 60MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9055-65PT","SUP","HCPCS C1713","","AR-9055-65PT  -  SCREW BN P/T LOPRFL 5.5MM 65MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9060-40PT","SUP","HCPCS C1713","","AR-9060-40PT  -  SCREW BN P/T LOPRFL 6MM 40MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9060-45PT","SUP","HCPCS C1713","","AR-9060-45PT  -  SCREW BN P/T LOPRFL 6MM 45MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9060-50PT","SUP","HCPCS C1713","","AR-9060-50PT  -  SCREW BN P/T LOPRFL 6MM 50MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9060-55PT","SUP","HCPCS C1713","","AR-9060-55PT  -  SCREW BN P/T LOPRFL 6MM 55MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9060-60PT","SUP","HCPCS C1713","","AR-9060-60PT  -  SCREW BN P/T LOPRFL 6MM 60MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9060-65PT","SUP","HCPCS C1713","","AR-9060-65PT  -  SCREW BN P/T LOPRFL 6MM 65MM SLD TI METATARSUS JNS FX","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"AR-9100-05P","SUP","HCPCS C1776","","AR-9100-05P  -  STEM HUM 5MM 105MM STRL","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-05S","SUP","HCPCS C1776","","AR-9100-05S  -  STEM HUM 132.5D 5MM 60MM UNIVERS APX","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-06P","SUP","HCPCS C1776","","AR-9100-06P  -  STEM HUM 6MM 115MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-06S","SUP","HCPCS C1776","","AR-9100-06S  -  STEM HUM RECT 6MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-07","SUP","HCPCS C1776","","AR-9100-07  -  STEM HUM 7MM UNIVERS SHLDR","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$2,694.38 ","$0.00 ","$1,247.94 ","$0.00 ","$0.00 ","$1,048.36 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$937.04 ","$0.00 ","$953.21 ","$0.00 "
"AR-9100-07P","SUP","HCPCS C1776","","AR-9100-07P  -  STEM HUM 7MM 140MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-07S","SUP","HCPCS C1776","","AR-9100-07S  -  STEM HUM RECT 7MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-08","SUP","HCPCS C1776","","AR-9100-08  -  STEM HUM 8MM UNIVERS SHLDR","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$2,694.38 ","$0.00 ","$1,247.94 ","$0.00 ","$0.00 ","$1,048.36 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$937.04 ","$0.00 ","$953.21 ","$0.00 "
"AR-9100-08F","SUP","HCPCS C1776","","AR-9100-08F  -  STEM HUM 8MM 158MM STRL UNIVERS ADJ HT SHLDR","BOTH IP/OP","$6,812.50 ","$5,041.25 ","$0.00 ","$6,812.50 ","$3,065.63 ","$0.00 ","$1,419.90 ","$0.00 ","$0.00 ","$1,192.81 ","$6,812.50 ","$0.00 ","$3,406.25 ","$5,395.50 ","$5,450.00 ","$0.00 ","$1,066.16 ","$0.00 ","$1,084.55 ","$0.00 "
"AR-9100-08P","SUP","HCPCS C1776","","AR-9100-08P  -  STEM HUM 8MM 143MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-08S","SUP","HCPCS C1776","","AR-9100-08S  -  STEM HUM RECT 8MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-09","SUP","HCPCS C1776","","AR-9100-09  -  STEM HUM 9MM UNIVERS SHLDR","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$2,694.38 ","$0.00 ","$1,247.94 ","$0.00 ","$0.00 ","$1,048.36 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$937.04 ","$0.00 ","$953.21 ","$0.00 "
"AR-9100-09F","SUP","HCPCS C1776","","AR-9100-09F  -  STEM HUM 9MM 173MM STRL UNIVERS ADJ HT SHLDR","BOTH IP/OP","$6,812.50 ","$5,041.25 ","$0.00 ","$6,812.50 ","$3,065.63 ","$0.00 ","$1,419.90 ","$0.00 ","$0.00 ","$1,192.81 ","$6,812.50 ","$0.00 ","$3,406.25 ","$5,395.50 ","$5,450.00 ","$0.00 ","$1,066.16 ","$0.00 ","$1,084.55 ","$0.00 "
"AR-9100-09P","SUP","HCPCS C1776","","AR-9100-09P  -  STEM HUM 9MM 146MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-09S","SUP","HCPCS C1776","","AR-9100-09S  -  STEM HUM RECT 9MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-10F","SUP","HCPCS C1776","","AR-9100-10F  -  STEM HUM 10MM 180MM STRL UNIVERS ADJ HT FX SHLDR","BOTH IP/OP","$6,812.50 ","$5,041.25 ","$0.00 ","$6,812.50 ","$3,065.63 ","$0.00 ","$1,419.90 ","$0.00 ","$0.00 ","$1,192.81 ","$6,812.50 ","$0.00 ","$3,406.25 ","$5,395.50 ","$5,450.00 ","$0.00 ","$1,066.16 ","$0.00 ","$1,084.55 ","$0.00 "
"AR-9100-10P","SUP","HCPCS C1776","","AR-9100-10P  -  STEM HUM 10MM 148MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-10S","SUP","HCPCS C1776","","AR-9100-10S  -  STEM HUM RECT 10MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-11","SUP","HCPCS C1776","","AR-9100-11  -  STEM HUM 11MM UNIVERS SHLDR","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$2,694.38 ","$0.00 ","$1,247.94 ","$0.00 ","$0.00 ","$1,048.36 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$937.04 ","$0.00 ","$953.21 ","$0.00 "
"AR-9100-11F","SUP","HCPCS C1776","","AR-9100-11F  -  STEM HUM 11MM 187MM STRL UNIVERS ADJ HT SHLDR","BOTH IP/OP","$6,812.50 ","$5,041.25 ","$0.00 ","$6,812.50 ","$3,065.63 ","$0.00 ","$1,419.90 ","$0.00 ","$0.00 ","$1,192.81 ","$6,812.50 ","$0.00 ","$3,406.25 ","$5,395.50 ","$5,450.00 ","$0.00 ","$1,066.16 ","$0.00 ","$1,084.55 ","$0.00 "
"AR-9100-11P","SUP","HCPCS C1776","","AR-9100-11P  -  STEM HUM 11MM 151MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-11S","SUP","HCPCS C1776","","AR-9100-11S  -  STEM HUM RECT 11MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-12","SUP","HCPCS C1776","","AR-9100-12  -  STEM HUM 12MM UNIVERS SHLDR","BOTH IP/OP","$5,987.50 ","$4,430.75 ","$0.00 ","$5,987.50 ","$2,694.38 ","$0.00 ","$1,247.94 ","$0.00 ","$0.00 ","$1,048.36 ","$5,987.50 ","$0.00 ","$2,993.75 ","$4,742.10 ","$4,790.00 ","$0.00 ","$937.04 ","$0.00 ","$953.21 ","$0.00 "
"AR-9100-12F","SUP","HCPCS C1776","","AR-9100-12F  -  STEM HUM 12MM 195MM STRL UNIVERS ADJ HT SHLDR","BOTH IP/OP","$6,812.50 ","$5,041.25 ","$0.00 ","$6,812.50 ","$3,065.63 ","$0.00 ","$1,419.90 ","$0.00 ","$0.00 ","$1,192.81 ","$6,812.50 ","$0.00 ","$3,406.25 ","$5,395.50 ","$5,450.00 ","$0.00 ","$1,066.16 ","$0.00 ","$1,084.55 ","$0.00 "
"AR-9100-12P","SUP","HCPCS C1776","","AR-9100-12P  -  STEM HUM 12MM 151MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-12S","SUP","HCPCS C1776","","AR-9100-12S  -  STEM HUM RECT 12MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-13F","SUP","HCPCS C1776","","AR-9100-13F  -  STEM HUM 13MM 204MM STRL UNIVERS ADJ HT SHLDR FX","BOTH IP/OP","$6,812.50 ","$5,041.25 ","$0.00 ","$6,812.50 ","$3,065.63 ","$0.00 ","$1,419.90 ","$0.00 ","$0.00 ","$1,192.81 ","$6,812.50 ","$0.00 ","$3,406.25 ","$5,395.50 ","$5,450.00 ","$0.00 ","$1,066.16 ","$0.00 ","$1,084.55 ","$0.00 "
"AR-9100-13P","SUP","HCPCS C1776","","AR-9100-13P  -  STEM HUM 13MM UNIVERS SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-13S","SUP","HCPCS C1776","","AR-9100-13S  -  STEM HUM RECT 13MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-14P","SUP","HCPCS C1776","","AR-9100-14P  -  STEM HUM 14MM 151MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-14S","SUP","HCPCS C1776","","AR-9100-14S  -  STEM HUM RECT 14MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-15P","SUP","HCPCS C1776","","AR-9100-15P  -  STEM HUM 15MM 151MM STRL UNIVERS II SHLDR","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9100-15S","SUP","HCPCS C1776","","AR-9100-15S  -  STEM HUM RECT 15MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL","BOTH IP/OP","$10,437.50 ","$7,723.75 ","$0.00 ","$10,437.50 ","$4,696.88 ","$0.00 ","$2,175.44 ","$0.00 ","$0.00 ","$1,827.52 ","$10,437.50 ","$0.00 ","$5,218.75 ","$8,266.50 ","$8,350.00 ","$0.00 ","$1,633.47 ","$0.00 ","$1,661.65 ","$0.00 "
"AR-9100-21","SUP","Custom 27203010","","AR-9100-21  -  KIT ASCP FX UNV TRUNNION","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9100-22","SUP","HCPCS C1776","","AR-9100-22  -  COMPONENT GLND 3 USP UNIVERS REPL TRUNION KT","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-9100-24","SUP","HCPCS C1776","","AR-9100-24  -  COMPONENT GLND 5 USP UNIVERS REPL TRUNION KT","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"AR-9104-01","SUP","HCPCS C1776","","AR-9104-01  -  COMPONENT GLND SM STRL UNIVERS II CMNT KEEL PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9104-02","SUP","HCPCS C1776","","AR-9104-02  -  COMPONENT GLND MED STRL UNIVERS II CMNT KEEL PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9104-03","SUP","HCPCS C1776","","AR-9104-03  -  COMPONENT GLND LG STRL UNIVERS II CMNT KEEL PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9104-04","SUP","HCPCS C1776","","AR-9104-04  -  COMPONENT GLND XL STRL UNIVERS II CMNT KEEL PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9105-01","SUP","HCPCS C1776","","AR-9105-01  -  COMPONENT GLND SM STRL UNIVERS II CMNT PG PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9105-02","SUP","HCPCS C1776","","AR-9105-02  -  COMPONENT GLND MED STRL UNIVERS II CMNT PG PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9105-03","SUP","HCPCS C1776","","AR-9105-03  -  COMPONENT GLND LG STRL UNIVERS II CMNT PG PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9105-04","SUP","HCPCS C1776","","AR-9105-04  -  COMPONENT GLND XL STRL UNIVERS II CMNT PG PE SHLDR","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9106-01","SUP","HCPCS C1713","","AR-9106-01  -  COMPONENT GLND SM STRL LF UNIVERS VAULTLOCK DISP","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9106-02","SUP","HCPCS C1776","","AR-9106-02  -  COMPONENT GLND MED STRL ARTHX UNIVERS VAULTLOCK","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9106-04","SUP","HCPCS C1776","","AR-9106-04  -  COMPONENT GLND XL STRL ARTHX UNIVERS VAULTLOCK","BOTH IP/OP","$3,937.50 ","$2,913.75 ","$0.00 ","$3,937.50 ","$1,771.88 ","$0.00 ","$820.67 ","$0.00 ","$0.00 ","$689.42 ","$3,937.50 ","$0.00 ","$1,968.75 ","$3,118.50 ","$3,150.00 ","$0.00 ","$616.22 ","$0.00 ","$626.85 ","$0.00 "
"AR-9120-01","SUP","HCPCS C1713","","AR-9120-01  -  BASEPLATE GLND SM UNV SHLDR","BOTH IP/OP","$4,287.50 ","$3,172.75 ","$0.00 ","$4,287.50 ","$1,929.38 ","$0.00 ","$893.62 ","$0.00 ","$0.00 ","$750.71 ","$4,287.50 ","$0.00 ","$2,143.75 ","$3,395.70 ","$3,430.00 ","$0.00 ","$670.99 ","$0.00 ","$682.57 ","$0.00 "
"AR-9125-1","SUP","Custom 27203010","","AR-9125-1  -  GUIDE DRL -10D 5D SM GLND","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9125-10","SUP","Custom 27203010","","AR-9125-10  -  GUIDE DRL -20D 15D 0D SM GLND","BOTH IP/OP","$1,787.50 ","$1,322.75 ","$0.00 ","$1,787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,787.50 ","$0.00 ","$893.75 ","$1,415.70 ","$1,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9125-2","SUP","Custom 27203010","","AR-9125-2  -  GUIDE DRL -10D 5D MED GLND","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9125-20","SUP","Custom 27203010","","AR-9125-20  -  GUIDE DRL -20D 15D 0D MED GLND","BOTH IP/OP","$1,787.50 ","$1,322.75 ","$0.00 ","$1,787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,787.50 ","$0.00 ","$893.75 ","$1,415.70 ","$1,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9125-3","SUP","Custom 27203010","","AR-9125-3  -  GUIDE DRL -10D 5D LG GLND","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9125-30","SUP","Custom 27203010","","AR-9125-30  -  GUIDE DRL -20D 15D 0D LG GLND","BOTH IP/OP","$1,787.50 ","$1,322.75 ","$0.00 ","$1,787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,787.50 ","$0.00 ","$893.75 ","$1,415.70 ","$1,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9140-14","SUP","HCPCS C1776","","AR-9140-14  -  HEAD HUM 40MM 14MM UNIVERS 3D MTL SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9140-17P","SUP","HCPCS C1776","","AR-9140-17P  -  HEAD HUM 40MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9142-17CA","SUP","HCPCS C1776","","AR-9142-17CA  -  UNIVERS CA HUMERAL HEAD,  42/17","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9142-17P","SUP","HCPCS C1776","","AR-9142-17P  -  HEAD HUM 42MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9143-15","SUP","HCPCS C1776","","AR-9143-15  -  HEAD HUM 43MM 15MM SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9143-15F","SUP","HCPCS C1776","","AR-9143-15F  -  HEAD HUM 43MM 15MM SHLDR","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-9144-17CA","SUP","HCPCS C1776","","AR-9144-17CA  -  UNIVERS CA HUMERAL HEAD, 44/17","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9144-17P","SUP","HCPCS C1776","","AR-9144-17P  -  HEAD HUM 44MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9144-19CA","SUP","HCPCS C1776","","AR-9144-19CA  -  UNIVERS CA HUMERAL HEAD, 44/19","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9144-19P","SUP","HCPCS C1776","","AR-9144-19P  -  HEAD HUM 44MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9145-15","SUP","HCPCS C1776","","AR-9145-15  -  HEAD HUM 45MM 15MM MTL SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9145-24","SUP","HCPCS C1713","","AR-9145-24  -  SCREW BN 18D 4.5MM 24MM UNIVERS REVERS LCK VA SHLDR GLND","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-24NL","SUP","HCPCS C1713","","AR-9145-24NL  -  SCREW BN 4.5MM 24MM UNIVERS REVERS NONLOCK PERI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-30","SUP","HCPCS C1713","","AR-9145-30  -  SCREW BONE 4.5MM 30MM UNIVERS REVERS 18D SHLDR","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-30NL","SUP","HCPCS C1713","","AR-9145-30NL  -  PERIPHERAL SCREW,  NL, UNI REV, 4.5X30MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-36","SUP","HCPCS C1713","","AR-9145-36  -  SCREW BONE 4.5MM 36MM UNIVERS REVERS 18D SHLDR","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-36NL","SUP","HCPCS C1713","","AR-9145-36NL  -  SCREW BN 4.5MM 36MM UNIVERS REVERS NONLOCK PERI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-42","SUP","HCPCS C1713","","AR-9145-42  -  SCREW BN 18D 4.5MM 42MM UNIVERS REVERS LCK VA SHLDR GLND","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-42NL","SUP","HCPCS C1713","","AR-9145-42NL  -  SCREW BN 4.5MM 42MM UNIVERS REVERS NONLOCK PERI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-48","SUP","HCPCS C1713","","AR-9145-48  -  SCREW BN 18D 4.5MM 48MM UNIVERS REVERS LCK VA SHLDR GLND","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145-48NL","SUP","HCPCS C1713","","AR-9145-48NL  -  SCREW BN 4.5MM 48MM UNIVERS REVERS NONLOCK PERI","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$135.00 ","$0.00 ","$62.53 ","$0.00 ","$0.00 ","$52.53 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$46.95 ","$0.00 ","$47.76 ","$0.00 "
"AR-9145DG","SUP","Custom 27203010","","AR-9145DG  -  GUIDE DRL 45MM UNIVERS REVERS GLND","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9146-17","SUP","HCPCS C1776","","AR-9146-17  -  HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9146-17F","SUP","HCPCS C1776","","AR-9146-17F  -  HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-9146-18CA","SUP","HCPCS C1776","","AR-9146-18CA  -  UNIVERS CA HUMERAL HEAD, 46/18","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9146-18P","SUP","HCPCS C1776","","AR-9146-18P  -  HEAD HUM 46MM 18MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9146-20CA","SUP","HCPCS C1776","","AR-9146-20CA  -  UNIVERS CA HUMERAL HEAD, 46/20","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9146-20P","SUP","HCPCS C1776","","AR-9146-20P  -  HEAD HUM 46MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9148-17","SUP","HCPCS C1776","","AR-9148-17  -  HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9148-17F","SUP","HCPCS C1776","","AR-9148-17F  -  HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-9148-18","SUP","HCPCS C1776","","AR-9148-18  -  HEAD HUM 3D","BOTH IP/OP","$2,987.50 ","$2,210.75 ","$0.00 ","$2,987.50 ","$1,344.38 ","$0.00 ","$622.67 ","$0.00 ","$0.00 ","$523.09 ","$2,987.50 ","$0.00 ","$1,493.75 ","$2,366.10 ","$2,390.00 ","$0.00 ","$467.54 ","$0.00 ","$475.61 ","$0.00 "
"AR-9148-19CA","SUP","HCPCS C1776","","AR-9148-19CA  -  UNIVERS CA HUMERAL HEAD, 48/19","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9148-19P","SUP","HCPCS C1776","","AR-9148-19P  -  HEAD HUM 48MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9148-21CA","SUP","HCPCS C1776","","AR-9148-21CA  -  UNIVERS CA HUMERAL HEAD, 48/21","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9148-21P","SUP","HCPCS C1776","","AR-9148-21P  -  HEAD HUM 48MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9150-19","SUP","HCPCS C1776","","AR-9150-19  -  HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9150-19CA","SUP","HCPCS C1776","","AR-9150-19CA  -  UNIVERS CA HUMERAL HEAD, 50/19","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9150-19F","SUP","HCPCS C1776","","AR-9150-19F  -  HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-9150-19P","SUP","HCPCS C1776","","AR-9150-19P  -  HEAD HUM 50MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9150-21CA","SUP","HCPCS C1776","","AR-9150-21CA  -  UNIVERS CA HUMERAL HEAD, 50/21","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9150-21P","SUP","HCPCS C1776","","AR-9150-21P  -  HEAD HUM 50MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9151-22","SUP","HCPCS C1776","","AR-9151-22  -  HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9151-22F","SUP","HCPCS C1776","","AR-9151-22F  -  HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ANTM REFIXATION","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-9152-20CA","SUP","HCPCS C1776","","AR-9152-20CA  -  UNIVERS CA HUMERAL HEAD, 52/20","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9152-20P","SUP","HCPCS C1776","","AR-9152-20P  -  HEAD HUM 52MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9152-22CA","SUP","HCPCS C1776","","AR-9152-22CA  -  UNIVERS CA HUMERAL HEAD, 52/22","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9152-22P","SUP","HCPCS C1776","","AR-9152-22P  -  HEAD HUM 52MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9153-19","SUP","HCPCS C1776","","AR-9153-19  -  HEAD HUM 53MM 19MM UNIVERS 3D SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9153-19F","SUP","HCPCS C1776","","AR-9153-19F  -  HEAD HUM 53MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"AR-9153-23","SUP","HCPCS C1776","","AR-9153-23  -  HEAD HUM 53MM 23MM UNIVERS 3D SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9154-21CA","SUP","HCPCS C1776","","AR-9154-21CA  -  UNIVERS CA HUMERAL HEAD, 54/21","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9154-21P","SUP","HCPCS C1776","","AR-9154-21P  -  HEAD HUM 54MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9154-23CA","SUP","HCPCS C1776","","AR-9154-23CA  -  UNIVERS CA HUMERAL HEAD, 54/23","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9154-23P","SUP","HCPCS C1776","","AR-9154-23P  -  HEAD HUM 54MM 23MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9156-22CA","SUP","HCPCS C1776","","AR-9156-22CA  -  HEAD HUM 56MM 22MM UNIVERS CA","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9156-22P","SUP","HCPCS C1776","","AR-9156-22P  -  HEAD HUM 56MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9156-24CA","SUP","HCPCS C1776","","AR-9156-24CA  -  HEAD HUM 56MM 24MM UNIVERS CA","BOTH IP/OP","$5,875.00 ","$4,347.50 ","$0.00 ","$5,875.00 ","$2,643.75 ","$0.00 ","$1,224.50 ","$0.00 ","$0.00 ","$1,028.67 ","$5,875.00 ","$0.00 ","$2,937.50 ","$4,653.00 ","$4,700.00 ","$0.00 ","$919.44 ","$0.00 ","$935.30 ","$0.00 "
"AR-9156-24P","SUP","HCPCS C1776","","AR-9156-24P  -  HEAD HUM 56MM 24MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"AR-9165-15","SUP","HCPCS C1713","","AR-9165-15  -  SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-15NL","SUP","HCPCS C1713","","AR-9165-15NL  -  SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR NONLOC","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-20","SUP","HCPCS C1713","","AR-9165-20  -  SCREW BN 6.5MM 20MM UNIVERS REVERS VA SHLDR GLND CNTR","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-20NL","SUP","HCPCS C1713","","AR-9165-20NL  -  SCREW BONE 6.5MM 20MM UNIVERS REVERS","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-25","SUP","HCPCS C1713","","AR-9165-25  -  SCREW BN 6.5MM 25MM UNIVERS REVERS VA SHLDR GLND CNTR","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-25NL","SUP","HCPCS C1713","","AR-9165-25NL  -  SCREW BN 6.5MM 25MM UNIVERS REVERS CNTR NONLOCK","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-30NL","SUP","HCPCS C1713","","AR-9165-30NL  -  SCREW BN 6.5MM 30MM UNIVERS REVERS CNTR NONLOCK","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165-35NL","SUP","HCPCS C1713","","AR-9165-35NL  -  SCREW BN 6.5MM 35MM UNIVERS REVERS CNTR NONLOCK","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$191.25 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"AR-9165DDG","SUP","HCPCS C1713","","AR-9165DDG  -  SCREW BN UNIVERS REVERS CNTR UNV BSPLT IMPCTR","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"AR-9202-16","SUP","HCPCS C1776","","AR-9202-16  -  CONNECTOR XTRNFX UNIVERS 3D TRL HD","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$258.75 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"AR-9204-02","SUP","HCPCS C1776","","AR-9204-02  -  STEM HUM UNIVERS XTRT SHLDR SHLDR FX","BOTH IP/OP","$2,100.00 ","$1,554.00 ","$0.00 ","$2,100.00 ","$945.00 ","$0.00 ","$437.69 ","$0.00 ","$0.00 ","$367.69 ","$2,100.00 ","$0.00 ","$1,050.00 ","$1,663.20 ","$1,680.00 ","$0.00 ","$328.65 ","$0.00 ","$334.32 ","$0.00 "
"AR-9207S","SUP","HCPCS C1776","","AR-9207S  -  SET SPNL UNIVERS II STRL","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"AR-9215-1-01","SUP","Custom 27203010","","AR-9215-1-01  -  GUIDE DRL 6.5IN HNDL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-1-02","SUP","Custom 27203010","","AR-9215-1-02  -  GUIDE DRL LNG UNIVERS II HNDL GLND","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-2","SUP","Custom 27203010","","AR-9215-2  -  GUIDE DRL 1 SM GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-3","SUP","Custom 27203010","","AR-9215-3  -  GUIDE DRL 2 SM KEEL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-4","SUP","Custom 27203010","","AR-9215-4  -  GUIDE DRL 1 MED KEEL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-5","SUP","Custom 27203010","","AR-9215-5  -  GUIDE DRL 2 MED KEEL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-6","SUP","Custom 27203010","","AR-9215-6  -  GUIDE DRL 1 LG KEEL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-7","SUP","Custom 27203010","","AR-9215-7  -  GUIDE DRL 2 LG KEEL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-8","SUP","Custom 27203010","","AR-9215-8  -  GUIDE DRL 1 XL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9215-9","SUP","Custom 27203010","","AR-9215-9  -  GUIDE DRL 2 XL KEEL GLND","BOTH IP/OP","$875.00 ","$647.50 ","$0.00 ","$875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$875.00 ","$0.00 ","$437.50 ","$693.00 ","$700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9216-1","SUP","Custom 27203010","","AR-9216-1  -  GUIDE DRL 6MM UNIVERS II GLND","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$812.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$812.50 ","$0.00 ","$406.25 ","$643.50 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9216-2","SUP","Custom 27203010","","AR-9216-2  -  GUIDE DRL UNIVERS II GLV PRTC GLND","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9216-4","SUP","Custom 27203010","","AR-9216-4  -  GUIDE DRL UNIVERS II GLV PRTC GLND","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-01","SUP","Custom 27203010","","AR-9231-01  -  GUIDE DRL 2 SM UNIVERS II PG GLND","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-01PP","SUP","Custom 27203010","","AR-9231-01PP  -  GUIDE DRL SM UNIVERS VAULTLOCK GLND","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-02","SUP","Custom 27203010","","AR-9231-02  -  GUIDE DRL 2 MED UNIVERS II PG GLND","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-02PP","SUP","Custom 27203010","","AR-9231-02PP  -  GUIDE DRL MED UNIVERS VAULTLOCK GLND","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-03","SUP","Custom 27203010","","AR-9231-03  -  GUIDE DRL 2 LG UNIVERS II PG GLND","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-03PP","SUP","Custom 27203010","","AR-9231-03PP  -  GUIDE DRL LG UNIVERS VAULTLOCK GLND","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-04","SUP","Custom 27203010","","AR-9231-04  -  GUIDE DRL 2 XL UNIVERS II PG GLND","BOTH IP/OP","$1,250.00 ","$925.00 ","$0.00 ","$1,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9231-04PP","SUP","Custom 27203010","","AR-9231-04PP  -  GUIDE DRL XL UNIVERS VAULTLOCK GLND","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9500-170","SUP","HCPCS C1776","","AR-9500-170  -  JOINT TOE 17MM STRL ANATOEMIC PILT PNCH COCR PHALANX","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-9500-185","SUP","HCPCS C1776","","AR-9500-185  -  JOINT TOE 18.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-9500-200","SUP","HCPCS C1776","","AR-9500-200  -  JOINT TOE 20MM STRL ANATOEMIC PILT PNCH COCR PHALANX","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-9500-215","SUP","HCPCS C1776","","AR-9500-215  -  JOINT TOE 21.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-9500-230","SUP","HCPCS C1776","","AR-9500-230  -  JOINT TOE 23MM STRL ANATOEMIC PILT PNCH COCR PHALANX","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-9500T-170","SUP","HCPCS C1776","","AR-9500T-170  -  TRIAL ANKL 17MM ANATOEMIC PHALANX","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-9500T-185","SUP","HCPCS C1776","","AR-9500T-185  -  TRIAL ANKL 18.5MM ANATOEMIC PHALANX","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-9500T-200","SUP","HCPCS C1776","","AR-9500T-200  -  TRIAL ANKL 20MM ANATOEMIC PHALANX","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-9500T-215","SUP","HCPCS C1776","","AR-9500T-215  -  TRIAL ANKL 21.5MM ANATOEMIC PHALANX","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-9500T-230","SUP","HCPCS C1776","","AR-9500T-230  -  TRIAL ANKL 23MM ANATOEMIC PHALANX","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"AR-9501-05-135CPC","SUP","HCPCS C1776","","AR-9501-05-135CPC  -  STEM HUM 135D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9501-05-155CPC","SUP","HCPCS C1776","","AR-9501-05-155CPC  -  STEM HUM 155D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX","BOTH IP/OP","$9,187.50 ","$6,798.75 ","$0.00 ","$9,187.50 ","$4,134.38 ","$0.00 ","$1,914.90 ","$0.00 ","$0.00 ","$1,608.66 ","$9,187.50 ","$0.00 ","$4,593.75 ","$7,276.50 ","$7,350.00 ","$0.00 ","$1,437.84 ","$0.00 ","$1,462.65 ","$0.00 "
"AR-9501-06CPC","SUP","HCPCS C1776","","AR-9501-06CPC  -  STEM HUM 6 111MM STRL UNIVERS REVERS COR SET PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-06RCPC","SUP","HCPCS C1776","","AR-9501-06RCPC  -  STEM HUM 6 LNG 150MM STRL UNIVERS REVERS PROX FIL REV CA","BOTH IP/OP","$7,437.50 ","$5,503.75 ","$0.00 ","$7,437.50 ","$3,346.88 ","$0.00 ","$1,550.16 ","$0.00 ","$0.00 ","$1,302.25 ","$7,437.50 ","$0.00 ","$3,718.75 ","$5,890.50 ","$5,950.00 ","$0.00 ","$1,163.97 ","$0.00 ","$1,184.05 ","$0.00 "
"AR-9501-07CPC","SUP","HCPCS C1776","","AR-9501-07CPC  -  STEM HUM 115MM CORE SET PROX FIL UNIVERS REVERS","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-08CPC","SUP","HCPCS C1776","","AR-9501-08CPC  -  STEM HUM 8 119MM STRL UNIVERS REVERS COR SET PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-09CPC","SUP","HCPCS C1776","","AR-9501-09CPC  -  STEM HUM 9 123MM STRL UNIVERS REVERS COR SET PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-09RCPC","SUP","HCPCS C1776","","AR-9501-09RCPC  -  STEM HUM 9 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA","BOTH IP/OP","$7,437.50 ","$5,503.75 ","$0.00 ","$7,437.50 ","$3,346.88 ","$0.00 ","$1,550.16 ","$0.00 ","$0.00 ","$1,302.25 ","$7,437.50 ","$0.00 ","$3,718.75 ","$5,890.50 ","$5,950.00 ","$0.00 ","$1,163.97 ","$0.00 ","$1,184.05 ","$0.00 "
"AR-9501-10CPC","SUP","HCPCS C1776","","AR-9501-10CPC  -  STEM HUM 10 127MM STRL UNIVERS REVERS COR SET PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-11CPC","SUP","HCPCS C1776","","AR-9501-11CPC  -  STEM HUM 11 131MM STRL UNIVERS REVERS COR SET PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-12CPC","SUP","HCPCS C1776","","AR-9501-12CPC  -  STEM HUM 12 135MM STRL UNIVERS REVERS COR SET PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-12RCPC","SUP","HCPCS C1776","","AR-9501-12RCPC  -  STEM HUM 12 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA","BOTH IP/OP","$7,437.50 ","$5,503.75 ","$0.00 ","$7,437.50 ","$3,346.88 ","$0.00 ","$1,550.16 ","$0.00 ","$0.00 ","$1,302.25 ","$7,437.50 ","$0.00 ","$3,718.75 ","$5,890.50 ","$5,950.00 ","$0.00 ","$1,163.97 ","$0.00 ","$1,184.05 ","$0.00 "
"AR-9501-13CPC","SUP","HCPCS C1776","","AR-9501-13CPC  -  STEM HUM 13 139MM STRL UNIVERS REVERS SET SPL PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-14CPC","SUP","HCPCS C1776","","AR-9501-14CPC  -  STEM HUM 14 143MM STRL UNIVERS REVERS SET SPL PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9501-15CPC","SUP","HCPCS C1776","","AR-9501-15CPC  -  STEM HUM 15 146MM STRL UNIVERS REVERS SET SPL PROX FIL CA","BOTH IP/OP","$6,212.50 ","$4,597.25 ","$0.00 ","$6,212.50 ","$2,795.63 ","$0.00 ","$1,294.84 ","$0.00 ","$0.00 ","$1,087.76 ","$6,212.50 ","$0.00 ","$3,106.25 ","$4,920.30 ","$4,970.00 ","$0.00 ","$972.26 ","$0.00 ","$989.03 ","$0.00 "
"AR-9502-36ARCA","SUP","HCPCS C1776","","AR-9502-36ARCA  -  ADAPTER HD 36MM STRL ARTHX RVRS CUF ARTHROPATHY","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$0.00 ","$0.00 ","$941.12 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$855.70 ","$0.00 "
"AR-9502-36CPC","SUP","Custom 27803010","","AR-9502-36CPC  -  CUP HUM NTRL 36MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-36LCPC","SUP","Custom 27803010","","AR-9502-36LCPC  -  CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR LT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-36RCPC","SUP","Custom 27803010","","AR-9502-36RCPC  -  CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR RT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-39ARCA","SUP","HCPCS C1776","","AR-9502-39ARCA  -  ADAPTER HD 39MM STRL ARTHX RVRS","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$0.00 ","$0.00 ","$941.12 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$855.70 ","$0.00 "
"AR-9502-39CPC","SUP","Custom 27803010","","AR-9502-39CPC  -  CUP HUM NTRL 39MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-39LCPC","SUP","Custom 27803010","","AR-9502-39LCPC  -  CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR LT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-39RCPC","SUP","Custom 27803010","","AR-9502-39RCPC  -  CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR RT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-42ARCA","SUP","HCPCS C1776","","AR-9502-42ARCA  -  ADAPTER HD 42MM STRL ARTHX RVRS","BOTH IP/OP","$5,375.00 ","$3,977.50 ","$0.00 ","$5,375.00 ","$2,418.75 ","$0.00 ","$1,120.28 ","$0.00 ","$0.00 ","$941.12 ","$5,375.00 ","$0.00 ","$2,687.50 ","$4,257.00 ","$4,300.00 ","$0.00 ","$841.19 ","$0.00 ","$855.70 ","$0.00 "
"AR-9502-42CPC","SUP","Custom 27803010","","AR-9502-42CPC  -  CUP HUM NTRL 42MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-42LCPC","SUP","Custom 27803010","","AR-9502-42LCPC  -  CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR LT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502-42RCPC","SUP","Custom 27803010","","AR-9502-42RCPC  -  CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR RT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502F-36CPC","SUP","HCPCS C1776","","AR-9502F-36CPC  -  CUP HUM 36MM STRL LF ARTHX UNIVERS REVERS SUT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$2,008.13 ","$0.00 ","$930.10 ","$0.00 ","$0.00 ","$781.35 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$698.38 ","$0.00 ","$710.43 ","$0.00 "
"AR-9502F-36LCPC","SUP","Custom 27803010","","AR-9502F-36LCPC  -  CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR LT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502F-36RCPC","SUP","Custom 27803010","","AR-9502F-36RCPC  -  CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR RT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502F-39LCPC","SUP","Custom 27803010","","AR-9502F-39LCPC  -  CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR LT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502F-39RCPC","SUP","Custom 27803010","","AR-9502F-39RCPC  -  CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR RT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9502F-42RCPC","SUP","Custom 27803010","","AR-9502F-42RCPC  -  CUP HUM +2 42MM UNIVERS REVERS SUT SHLDR RT","BOTH IP/OP","$4,462.50 ","$3,302.25 ","$0.00 ","$4,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,462.50 ","$0.00 ","$2,231.25 ","$3,534.30 ","$3,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9503L-03","SUP","HCPCS C1776","","AR-9503L-03  -  INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503L-03C","SUP","HCPCS C1776","","AR-9503L-03C  -  INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503L-06","SUP","HCPCS C1776","","AR-9503L-06  -  INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503L-06C","SUP","HCPCS C1776","","AR-9503L-06C  -  INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503M-03","SUP","HCPCS C1776","","AR-9503M-03  -  INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503M-03C","SUP","HCPCS C1776","","AR-9503M-03C  -  INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503M-06","SUP","HCPCS C1776","","AR-9503M-06  -  INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503M-06C","SUP","HCPCS C1776","","AR-9503M-06C  -  INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503S-03","SUP","HCPCS C1776","","AR-9503S-03  -  INSERT HUM 36MM UNIVERS REVERS +3MM SM SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503S-03C","SUP","HCPCS C1776","","AR-9503S-03C  -  INSERT HUM +3MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503S-06","SUP","HCPCS C1776","","AR-9503S-06  -  INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS SHLDR ARTHPL","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9503S-06C","SUP","HCPCS C1776","","AR-9503S-06C  -  INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR","BOTH IP/OP","$2,537.50 ","$1,877.75 ","$0.00 ","$2,537.50 ","$1,141.88 ","$0.00 ","$528.88 ","$0.00 ","$0.00 ","$444.30 ","$2,537.50 ","$0.00 ","$1,268.75 ","$2,009.70 ","$2,030.00 ","$0.00 ","$397.12 ","$0.00 ","$403.97 ","$0.00 "
"AR-9504L","SUP","HCPCS C1776","","AR-9504L  -  HEAD GLND LG UNV 42MM STRL UNIVERS REVERS GLENOSPHERE VA CA","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504L-04","SUP","HCPCS C1776","","AR-9504L-04  -  HEAD GLND +4MM LG UNV LAT OFST 42MM STRL UNIVERS REVERS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504M","SUP","HCPCS C1776","","AR-9504M  -  HEAD GLND MED UNV 39MM STRL UNIVERS REVERS GLENOSPHERE VA CA","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504M-02","SUP","HCPCS C1776","","AR-9504M-02  -  HEAD GLND +2.5MM MED UNV INFR OFST 42MM STRL UNIVERS REVERS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504M-04","SUP","HCPCS C1776","","AR-9504M-04  -  HEAD GLND +4MM MED UNV LAT OFST 39MM STRL UNIVERS REVERS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504S","SUP","HCPCS C1776","","AR-9504S  -  HEAD GLND SM UNV 36MM STRL UNIVERS REVERS GLENOSPHERE VA CA","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504S-02","SUP","HCPCS C1776","","AR-9504S-02  -  HEAD GLND +2.5MM SM UNV INFR OFST 36MM STRL UNIVERS REVERS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504S-04","SUP","HCPCS C1776","","AR-9504S-04  -  HEAD GLND 36MM UNIVERS REVERS +4MM SM UNV LAT","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9504S-INF","SUP","HCPCS C1776","","AR-9504S-INF  -  HEAD GLND +2.5MM INFR OFST 36MM STRL UNIVERS REVERS","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"AR-9505-06","SUP","HCPCS C1776","","AR-9505-06  -  SPACER HUM +6MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9505-09","SUP","HCPCS C1776","","AR-9505-09  -  SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9505-12","SUP","HCPCS C1776","","AR-9505-12  -  SPACER HUM +12MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9505-15","SUP","HCPCS C1776","","AR-9505-15  -  SPACER HUM +15MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9510-06","SUP","HCPCS C1776","","AR-9510-06  -  RASP SRG 6 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-07","SUP","HCPCS C1776","","AR-9510-07  -  RASP SRG 7 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-08","SUP","HCPCS C1776","","AR-9510-08  -  RASP SRG 8 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-09","SUP","HCPCS C1776","","AR-9510-09  -  RASP SRG 9 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-09R","SUP","HCPCS C1776","","AR-9510-09R  -  RASP SRG 9 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,612.50 ","$2,673.25 ","$0.00 ","$3,612.50 ","$1,625.63 ","$0.00 ","$752.94 ","$0.00 ","$0.00 ","$632.52 ","$3,612.50 ","$0.00 ","$1,806.25 ","$2,861.10 ","$2,890.00 ","$0.00 ","$565.36 ","$0.00 ","$575.11 ","$0.00 "
"AR-9510-10","SUP","HCPCS C1776","","AR-9510-10  -  RASP SRG 10 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-11","SUP","HCPCS C1776","","AR-9510-11  -  RASP SRG 11 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-12","SUP","HCPCS C1776","","AR-9510-12  -  RASP SRG 12 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-12R","SUP","HCPCS C1776","","AR-9510-12R  -  RASP SRG 12 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR","BOTH IP/OP","$3,612.50 ","$2,673.25 ","$0.00 ","$3,612.50 ","$1,625.63 ","$0.00 ","$752.94 ","$0.00 ","$0.00 ","$632.52 ","$3,612.50 ","$0.00 ","$1,806.25 ","$2,861.10 ","$2,890.00 ","$0.00 ","$565.36 ","$0.00 ","$575.11 ","$0.00 "
"AR-9510-13","SUP","HCPCS C1776","","AR-9510-13  -  RASP SRG 13 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,262.50 ","$2,414.25 ","$0.00 ","$3,262.50 ","$1,468.13 ","$0.00 ","$679.99 ","$0.00 ","$0.00 ","$571.24 ","$3,262.50 ","$0.00 ","$1,631.25 ","$2,583.90 ","$2,610.00 ","$0.00 ","$510.58 ","$0.00 ","$519.39 ","$0.00 "
"AR-9510-14","SUP","HCPCS C1776","","AR-9510-14  -  RASP SRG 14 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,412.50 ","$2,525.25 ","$0.00 ","$3,412.50 ","$1,535.63 ","$0.00 ","$711.25 ","$0.00 ","$0.00 ","$597.50 ","$3,412.50 ","$0.00 ","$1,706.25 ","$2,702.70 ","$2,730.00 ","$0.00 ","$534.06 ","$0.00 ","$543.27 ","$0.00 "
"AR-9510-15","SUP","HCPCS C1776","","AR-9510-15  -  RASP SRG 15 UNIVERS REVERS STM TRL SHLDR ARTHPL","BOTH IP/OP","$3,412.50 ","$2,525.25 ","$0.00 ","$3,412.50 ","$1,535.63 ","$0.00 ","$711.25 ","$0.00 ","$0.00 ","$597.50 ","$3,412.50 ","$0.00 ","$1,706.25 ","$2,702.70 ","$2,730.00 ","$0.00 ","$534.06 ","$0.00 ","$543.27 ","$0.00 "
"AR-9550-06","SUP","HCPCS C1776","","AR-9550-06  -  SPACER HUM +6MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9550-09","SUP","HCPCS C1776","","AR-9550-09  -  SPACER HUM +9MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9550-12","SUP","HCPCS C1776","","AR-9550-12  -  SPACER HUM +12MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9550-15","SUP","HCPCS C1776","","AR-9550-15  -  SPACER HUM +15MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9555-06","SUP","HCPCS C1776","","AR-9555-06  -  SPACER HUM 36MM UNIVERS REVERS +6MM SHLDR TI","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9555-09","SUP","HCPCS C1776","","AR-9555-09  -  SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9555-12","SUP","HCPCS C1776","","AR-9555-12  -  SPACER HUM +12MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9555-15","SUP","HCPCS C1776","","AR-9555-15  -  SPACER HUM +15MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$551.25 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"AR-9703A-90","SUP","Custom 27203010","","AR-9703A-90  -  PROBE ESURG 90D LOPRFL 3MM STRL OPES ASPIRATE ABLT DISP","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9704A-90","SUP","Custom 27203010","","AR-9704A-90  -  PROBE ESURG 90D LOPRFL 4MM STRL OPES ASPIRATE ABLT DISP","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9705-90","SUP","Custom 27203010","","AR-9705-90  -  PROBE ESURG 90D LOPRFL STRL OPES ABLT TTHBRSH DISP","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9705A-90","SUP","Custom 27203010","","AR-9705A-90  -  PROBE ESURG 90D LOPRFL STRL OPES ASPIRATE ABLT TTHBRSH DISP","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9802M-45","SUP","Custom 27203010","","AR-9802M-45  -  ELECTRODE ESURG 45D STRL COOLCUT ABLATOR MNSCTM","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9802M-90","SUP","Custom 27203010","","AR-9802M-90  -  ELECTRODE ESURG 90D COOLCUT ABLATOR MNSCTM","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9803-30","SUP","Custom 27203010","","AR-9803-30  -  PROBE ESURG 30D 3MM STRL COOLCUT ABLT RF WND","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9803-50","SUP","Custom 27203010","","AR-9803-50  -  ELECTRODE ESURG 50D 3MM COOLCUT 50 ABLATOR 50NA","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9803-90","SUP","Custom 27203010","","AR-9803-90  -  PROBE ESURG 90D 3MM STRL COOLCUT ABLT RF WND","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9803A-30","SUP","Custom 27203010","","AR-9803A-30  -  PROBE ESURG 30D 3MM STRL COOLCUT ASPIRATE ABLT RF WND","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9803A-50","SUP","Custom 27203010","","AR-9803A-50  -  PROBE ESURG 50D 3MM STRL COOLCUT ASPIRATE ABLT RF WND","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9803A-90","SUP","Custom 27203010","","AR-9803A-90  -  PROBE ESURG 3MM COOLCUT 90D ASPIRATE ABLT RF WND","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9808","SUP","Custom 27203010","","AR-9808  -  ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9808-45","SUP","Custom 27203010","","AR-9808-45  -  ELECTRODE ESURG 45D COOLCUT BALL ASCP","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9808SJ","SUP","Custom 27203010","","AR-9808SJ  -  ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9808SJ-45","SUP","Custom 27203010","","AR-9808SJ-45  -  ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9809SJ-45","SUP","Custom 27203010","","AR-9809SJ-45  -  ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9809SJ-90","SUP","Custom 27203010","","AR-9809SJ-90  -  ELECTRODE ESURG 90D BALL STRL COOLCUT ABLT RF WND S JNT","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9811","SUP","Custom 27203010","","AR-9811  -  PROBE ESURG 90D APLO RF ML PRT","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-992","SUP","Custom 27203010","","AR-992  -  KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AR-9943BL-04","SUP","HCPCS C1713","","AR-9943BL-04  -  PLATE BN 4 HL LCK TI FIB LT DIST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-9943BL-05","SUP","HCPCS C1713","","AR-9943BL-05  -  PLATE BN 5 HL LCK TI FIB LT DIST","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"AR-9943BL-06","SUP","HCPCS C1713","","AR-9943BL-06  -  PLATE BN 6 HL LCK TI FIB LT DIST","BOTH IP/OP","$1,937.50 ","$1,433.75 ","$0.00 ","$1,937.50 ","$871.88 ","$0.00 ","$403.82 ","$0.00 ","$0.00 ","$339.24 ","$1,937.50 ","$0.00 ","$968.75 ","$1,534.50 ","$1,550.00 ","$0.00 ","$303.22 ","$0.00 ","$308.45 ","$0.00 "
"AR-9943BL-08","SUP","HCPCS C1713","","AR-9943BL-08  -  PLATE BN ARTHX 8 HL LCK TI FIB LT DIST","BOTH IP/OP","$2,112.50 ","$1,563.25 ","$0.00 ","$2,112.50 ","$950.63 ","$0.00 ","$440.30 ","$0.00 ","$0.00 ","$369.88 ","$2,112.50 ","$0.00 ","$1,056.25 ","$1,673.10 ","$1,690.00 ","$0.00 ","$330.61 ","$0.00 ","$336.31 ","$0.00 "
"AR-9943BL-10","SUP","HCPCS C1713","","AR-9943BL-10  -  PLATE BN ARTHX 10 HL LCK TI FIB LT DIST","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$0.00 ","$2,325.00 ","$1,046.25 ","$0.00 ","$484.59 ","$0.00 ","$0.00 ","$407.09 ","$2,325.00 ","$0.00 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$0.00 ","$363.86 ","$0.00 ","$370.14 ","$0.00 "
"AR-9943BL-12","SUP","HCPCS C1713","","AR-9943BL-12  -  PLATE BN ARTHX 12 HL LCK TI FIB LT DIST","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$1,057.50 ","$0.00 ","$489.80 ","$0.00 ","$0.00 ","$411.47 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$367.78 ","$0.00 ","$374.12 ","$0.00 "
"AR-9943BL-14","SUP","HCPCS C1713","","AR-9943BL-14  -  PLATE BN ARTHX 14 HL LCK TI FIB LT DIST","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"AR-9943BR-04","SUP","HCPCS C1713","","AR-9943BR-04  -  PLATE BN 4 HL LCK TI FIB DIST","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$312.64 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"AR-9943BR-06","SUP","HCPCS C1713","","AR-9943BR-06  -  PLATE BN 6 HL LCK TI FIB RT DIST","BOTH IP/OP","$1,937.50 ","$1,433.75 ","$0.00 ","$1,937.50 ","$871.88 ","$0.00 ","$403.82 ","$0.00 ","$0.00 ","$339.24 ","$1,937.50 ","$0.00 ","$968.75 ","$1,534.50 ","$1,550.00 ","$0.00 ","$303.22 ","$0.00 ","$308.45 ","$0.00 "
"AR-9943BR-08","SUP","HCPCS C1713","","AR-9943BR-08  -  PLATE BN ARTHX 8 HL LCK TI FIB RT DIST","BOTH IP/OP","$2,112.50 ","$1,563.25 ","$0.00 ","$2,112.50 ","$950.63 ","$0.00 ","$440.30 ","$0.00 ","$0.00 ","$369.88 ","$2,112.50 ","$0.00 ","$1,056.25 ","$1,673.10 ","$1,690.00 ","$0.00 ","$330.61 ","$0.00 ","$336.31 ","$0.00 "
"AR-9943BR-10","SUP","HCPCS C1713","","AR-9943BR-10  -  PLATE BN ARTHX 10 HL LCK TI FIB RT DIST","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$0.00 ","$2,325.00 ","$1,046.25 ","$0.00 ","$484.59 ","$0.00 ","$0.00 ","$407.09 ","$2,325.00 ","$0.00 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$0.00 ","$363.86 ","$0.00 ","$370.14 ","$0.00 "
"AR-9943BR-12","SUP","HCPCS C1713","","AR-9943BR-12  -  PLATE BN NS ARTHX 12 HL LCK TI FIB RT DIST","BOTH IP/OP","$2,350.00 ","$1,739.00 ","$0.00 ","$2,350.00 ","$1,057.50 ","$0.00 ","$489.80 ","$0.00 ","$0.00 ","$411.47 ","$2,350.00 ","$0.00 ","$1,175.00 ","$1,861.20 ","$1,880.00 ","$0.00 ","$367.78 ","$0.00 ","$374.12 ","$0.00 "
"AR-9943BR-14","SUP","HCPCS C1713","","AR-9943BR-14  -  PLATE BN ARTHX 14 HL LCK TI FIB RT DIST","BOTH IP/OP","$2,375.00 ","$1,757.50 ","$0.00 ","$2,375.00 ","$1,068.75 ","$0.00 ","$495.01 ","$0.00 ","$0.00 ","$415.84 ","$2,375.00 ","$0.00 ","$1,187.50 ","$1,881.00 ","$1,900.00 ","$0.00 ","$371.69 ","$0.00 ","$378.10 ","$0.00 "
"AR-9943C-04","SUP","HCPCS C1713","","AR-9943C-04  -  PLATE BN STRG 4 HL LCK TI","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"AR-9943C-06","SUP","HCPCS C1713","","AR-9943C-06  -  PLATE BN STRG 6 HL LCK TI","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$534.38 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$207.92 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$185.84 ","$0.00 ","$189.05 ","$0.00 "
"AR-9943C-07","SUP","HCPCS C1713","","AR-9943C-07  -  PLATE BN STRG 7 HL LCK TI","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$273.56 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"AR-9943C-08","SUP","HCPCS C1713","","AR-9943C-08  -  PLATE BN STRG 8 HL LCK TI ANKL","BOTH IP/OP","$1,375.00 ","$1,017.50 ","$0.00 ","$1,375.00 ","$618.75 ","$0.00 ","$286.58 ","$0.00 ","$0.00 ","$240.75 ","$1,375.00 ","$0.00 ","$687.50 ","$1,089.00 ","$1,100.00 ","$0.00 ","$215.19 ","$0.00 ","$218.90 ","$0.00 "
"AR-9943C-10","SUP","HCPCS C1713","","AR-9943C-10  -  PLATE BN STRG 10 HL LCK TI","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"AR-9943C-12","SUP","HCPCS C1713","","AR-9943C-12  -  PLATE BN STRG 12 HL LCK TI","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$362.14 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"AR-9943T-04","SUP","HCPCS C1713","","AR-9943T-04  -  PLATE BN 1/3 TBLR 4 HL LCK TI","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"AR-9943T-05","SUP","HCPCS C1713","","AR-9943T-05  -  PLATE BN 1/3 TBLR 5 HL LCK TI","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"AR-9943T-06","SUP","HCPCS C1713","","AR-9943T-06  -  PLATE BN 1/3 TUBE 6 HL LCK TI","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$270.00 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AR-9943T-07","SUP","HCPCS C1713","","AR-9943T-07  -  PLATE BN 3 TBLR 7 HL LCK TI","BOTH IP/OP","$637.50 ","$471.75 ","$0.00 ","$637.50 ","$286.88 ","$0.00 ","$132.87 ","$0.00 ","$0.00 ","$111.62 ","$637.50 ","$0.00 ","$318.75 ","$504.90 ","$510.00 ","$0.00 ","$99.77 ","$0.00 ","$101.49 ","$0.00 "
"AR-9943T-08","SUP","HCPCS C1713","","AR-9943T-08  -  PLATE BN 1/3 TBLR 8 HL LCK TI","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$298.13 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"AR-9943T-10","SUP","HCPCS C1713","","AR-9943T-10  -  PLATE BN 1/3 TBLR 10 HL LCK TI ANKL","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"AR-9943T-12","SUP","HCPCS C1713","","AR-9943T-12  -  PLATE BN 1/3 TBLR 12 HL LCK TI","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"AS09","SUP","Custom 27203010","","AS09  -  ATTACHMENT TL STRG 3.2MM 9CM MDSRX LGN LG BORE","BOTH IP/OP","$2,133.10 ","$1,578.49 ","$0.00 ","$2,133.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,133.10 ","$0.00 ","$1,066.55 ","$1,689.42 ","$1,706.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AS10","SUP","Custom 27203010","","AS10  -  ATTCH TL 10CM STR SM BORE MDSRX LGN 2.4MM","BOTH IP/OP","$1,823.93 ","$1,349.71 ","$0.00 ","$1,823.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,823.93 ","$0.00 ","$911.96 ","$1,444.55 ","$1,459.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AS74180-06","SUP","Custom 27203010","","AS74180-06  -  PACK VITRECTOMY 23GA","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT-0225-S","SUP","HCPCS C1713","","AT-0225-S  -  SCREW BONE 22.5MM ACTRK STD","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$775.00 ","$348.75 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$135.70 ","$775.00 ","$0.00 ","$387.50 ","$613.80 ","$620.00 ","$0.00 ","$121.29 ","$0.00 ","$123.38 ","$0.00 "
"AT-1032","SUP","Custom 27203010","","AT-1032  -  BIT DRILL ACTRK CANN","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT-1125-S","SUP","HCPCS C1713","","AT-1125-S  -  SCREW BONE 3.3-4.6MM 12.5MM ACTRK TI STD FULTHD ORTH SLFTAP","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1150-S","SUP","HCPCS C1713","","AT-1150-S  -  SCREW BN STD 15MM","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1175-S","SUP","HCPCS C1713","","AT-1175-S  -  SCREW BN STD 3.3-4.6MM 17.5MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1200-S","SUP","HCPCS C1713","","AT-1200-S  -  SCREW BN STD 3.3-4.6MM 20MM STRL ACTRK SLF CUT CNN VAR PTCH","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1225-S","SUP","HCPCS C1713","","AT-1225-S  -  SCREW BN STD 3.3-4.6MM 22.5MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1250-S","SUP","HCPCS C1713","","AT-1250-S  -  SCREW BN STD 3.3-4.6MM 25MM STRL ACTRK SLF CUT CNN VAR PTCH","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1275-S","SUP","HCPCS C1713","","AT-1275-S  -  SCREW BN STD 3.3-4.6MM 27.5MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT-1300-S","SUP","HCPCS C1713","","AT-1300-S  -  SCREW BN STD 3.3-4.6MM 30MM STRL ACTRK SLF CUT CNN VAR PTCH","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AT2-1509","SUP","Custom 27203010","","AT2-1509  -  BIT DRL 2 MIC ACUTRAL","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2-2515","SUP","Custom 27203010","","AT2-2515  -  BIT DRL STD ACTRK2","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2-3500","SUP","HCPCS C1769","","AT2-3500  -  GUIDEWIRE ORTH .035IN PRLL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$325.80 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"AT2-4500","SUP","HCPCS C1769","","AT2-4500  -  GWIRE ORTH .045IN PRLL","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$304.08 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"AT2-520-S","SUP","HCPCS C1713","","AT2-520-S  -  SCREW BONE 20MM ACTRK2 STD STRL","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$221.45 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AT2-5400","SUP","HCPCS C1769","","AT2-5400  -  GWIRE ORTH .054IN PRLL","BOTH IP/OP","$560.00 ","$414.40 ","$0.00 ","$560.00 ","$304.08 ","$0.00 ","$116.72 ","$0.00 ","$0.00 ","$98.05 ","$560.00 ","$0.00 ","$280.00 ","$443.52 ","$448.00 ","$0.00 ","$87.64 ","$0.00 ","$89.15 ","$0.00 "
"AT2-C08-S","SUP","HCPCS C1713","","AT2-C08-S  -  SCREW BN MIC 8MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C09-S","SUP","HCPCS C1713","","AT2-C09-S  -  SCREW BN MIC 9MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C10-S","SUP","HCPCS C1713","","AT2-C10-S  -  SCREW BN MIC 10MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C11-S","SUP","HCPCS C1713","","AT2-C11-S  -  SCREW BONE 2MM 11MM ACTRK TI MIC FULTHD ORTH SLFTAP CANN","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C12-S","SUP","HCPCS C1713","","AT2-C12-S  -  SCREW BN MIC 12MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C13-S","SUP","HCPCS C1713","","AT2-C13-S  -  SCREW BONE 2MM 13MM ACTRK2 TI MIC FULTHD ORTH SLFTAP CANN","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C14-S","SUP","HCPCS C1713","","AT2-C14-S  -  SCREW BN MIC 14MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C16-S","SUP","HCPCS C1713","","AT2-C16-S  -  SCREW BN MIC 16MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C18-S","SUP","HCPCS C1713","","AT2-C18-S  -  SCREW BN MIC 18MM FUSHIA","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-C20-S","SUP","HCPCS C1713","","AT2-C20-S  -  SCREW BN MIC FT 2.5-2.8MM 20MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2L1813","SUP","Custom 27203010","","AT2L1813  -  BIT DRILL ACTRK2 MINI","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2-L2515","SUP","HCPCS C1713","","AT2-L2515  -  BIT DRL LNG ACTRK2","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$255.38 ","$0.00 ","$118.28 ","$0.00 ","$0.00 ","$99.36 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$88.81 ","$0.00 ","$90.35 ","$0.00 "
"AT2-M16-S","SUP","HCPCS C1713","","AT2-M16-S  -  SCREW BN MN FT 3.5-3.6MM 16MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2M-1813","SUP","Custom 27203010","","AT2M-1813  -  BIT DRILL 2MM ACTRK2 MINI PRFL 3.5-4MM SCR NONSTRL","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2-M18-S","SUP","HCPCS C1713","","AT2-M18-S  -  SCREW BN MN 18MM STRL ACTRK2 TI ORTH","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-M20-S","SUP","HCPCS C1713","","AT2-M20-S  -  SCREW BN MN 20MM STRL ACTRK2 TI ORTH","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-M22-S","SUP","HCPCS C1713","","AT2-M22-S  -  SCREW BN MN FT 3.5-3.6MM 22MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-M24-S","SUP","HCPCS C1713","","AT2-M24-S  -  SCREW BN MN 24MM STRL ACTRK2 TI ORTH","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2M-26S","SUP","HCPCS C1713","","AT2M-26S  -  SCREW BONE 26MM ACTRK2 MINI STRL","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AT2-M26-S","SUP","HCPCS C1713","","AT2-M26-S  -  SCREW BN MN FT 3.5-3.6MM 26MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2M-28S","SUP","HCPCS C1713","","AT2M-28S  -  SCREW BONE 28MM ACTRK2 MINI STRL","BOTH IP/OP","$1,062.50 ","$786.25 ","$0.00 ","$1,062.50 ","$478.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.04 ","$1,062.50 ","$0.00 ","$531.25 ","$841.50 ","$850.00 ","$0.00 ","$166.28 ","$0.00 ","$169.15 ","$0.00 "
"AT2-M28-S","SUP","HCPCS C1713","","AT2-M28-S  -  SCREW BN MN FT 3.5-3.6MM 28MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-M30-S","SUP","HCPCS C1713","","AT2-M30-S  -  SCREW 30.0MM MINI ACUTRAK 2 BONE","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2M-L1813","SUP","Custom 27203010","","AT2M-L1813  -  BIT DRL MN","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2-ML1813","SUP","Custom 27203010","","BIT DRILL ACTRK2 MINI LNG INSTR","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$467.50 ","$0.00 ","$233.75 ","$370.26 ","$374.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2ML1816","SUP","Custom 27203010","","AT2ML1816  -  BIT DRILL","BOTH IP/OP","$567.50 ","$419.95 ","$0.00 ","$567.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$567.50 ","$0.00 ","$283.75 ","$449.46 ","$454.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT2-S16-S","SUP","HCPCS C1713","","AT2-S16-S  -  SCREW BN STD 2MM 16MM ACTRK2","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S18-S","SUP","HCPCS C1713","","AT2-S18-S  -  SCREW BN STD FT 4-4.1MM 18MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S20-S","SUP","HCPCS C1713","","AT2-S20-S  -  SCREW BN STD FT 4-4.1MM 20MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S22-S","SUP","HCPCS C1713","","AT2-S22-S  -  SCREW BN STD FT 4-4.1MM 22MM STRL ACTRK2 SLF CUT CNN VAR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S24-S","SUP","HCPCS C1713","","AT2-S24-S  -  SCREW BN 24MM STRL","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S26-S","SUP","HCPCS C1713","","AT2-S26-S  -  SCREW BN STD FT 4-4.1MM 26MM STRL ACTRK2 SLFCT CNN CMPR HEX","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S28-S","SUP","HCPCS C1713","","AT2-S28-S  -  SCREW BN STD 2MM 28MM ACTRK2","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S30-S","SUP","HCPCS C1713","","AT2-S30-S  -  SCREW BONE 2MM 30MM ACTRK2 TI STD HINDFOOT ANKL SLFTAP CANN","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S32-S","SUP","HCPCS C1713","","AT2-S32-S  -  SCREW BONE 2MM 32MM ACTRK2 TI STD FT HAND SLFTAP CANN CMPR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT2-S34-S","SUP","HCPCS C1713","","AT2-S34-S  -  SCREW BONE 2MM 34MM ACTRK2 TI STD FT HAND SLFTAP CANN CMPR","BOTH IP/OP","$1,160.00 ","$858.40 ","$0.00 ","$1,160.00 ","$522.00 ","$0.00 ","$241.77 ","$0.00 ","$0.00 ","$203.11 ","$1,160.00 ","$0.00 ","$580.00 ","$918.72 ","$928.00 ","$0.00 ","$181.54 ","$0.00 ","$184.67 ","$0.00 "
"AT-7032","SUP","Custom 27203010","","AT-7032  -  BIT DRL STD TPR 2.5MM 4.7MM STRL ACTRK CNN TI","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AT-7044","SUP","Custom 27203010","","AT-7044  -  BIT DRILL ACTRK STD BONE CANN DNS STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATF-024","SUP","Custom 27203010","","ATF-024  -  DRILL SRG 24MM ACTRK FSN","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATF-032","SUP","Custom 27203010","","ATF-032  -  BIT DRILL 32MM ACTRK FSN STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATF-037","SUP","Custom 27203010","","ATF-037  -  BIT DRILL 37MM ACTRK FSN STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATF-140-S","SUP","HCPCS C1713","","ATF-140-S  -  SCREW BN 14MM ACTRK FSN","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-160-S","SUP","HCPCS C1713","","ATF-160-S  -  SCREW BN 16MM ACTRK FSN","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-180-S","SUP","HCPCS C1713","","ATF-180-S  -  SCREW BN 18MM ACTRK FSN","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-200-S","SUP","HCPCS C1713","","ATF-200-S  -  SCREW BN 20MM ACTRK FSN","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-220-S","SUP","HCPCS C1713","","ATF-220-S  -  SCREW BN 22MM ACTRK FSN","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-240-S","SUP","HCPCS C1713","","ATF-240-S  -  SCREW BN FT 2-2.5MM 24MM STRL ACTRK SLF CUT CNN FSN HDLS TI","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-270-S","SUP","HCPCS C1713","","ATF-270-S  -  SCREW BN FT 2.8-3.5MM 27MM STRL ACTRK SLF CUT CNN FSN HDLS","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-320-S","SUP","HCPCS C1713","","ATF-320-S  -  SCREW BONE 32MM ACTRK TI HAND FT STRL","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$364.50 ","$0.00 ","$168.82 ","$0.00 ","$0.00 ","$141.82 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$126.77 ","$0.00 ","$128.95 ","$0.00 "
"ATF-370-S","SUP","Custom 27803010","","ATF-370-S  -  FUSION DEVICE 37.0MM ACUTRAK","BOTH IP/OP","$810.00 ","$599.40 ","$0.00 ","$810.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$810.00 ","$0.00 ","$405.00 ","$641.52 ","$648.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATM-008-S","SUP","HCPCS C1713","","ATM-008-S  -  SCREW BN 8MM ACTRK","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-078","SUP","Custom 27203010","","ATM-078  -  BIT DRILL MN ACTRK SHRT CANN STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATM-099","SUP","Custom 27203010","","ATM-099  -  BIT DRILL ACTRK LNG CANN TIP TPR STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ATM-100-S","SUP","HCPCS C1713","","ATM-100-S  -  SCREW BN MN 10MM ACTRK FX","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-120-S","SUP","HCPCS C1713","","ATM-120-S  -  SCREW BN MN FT 2.8-3.6MM 12MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-140-S","SUP","HCPCS C1713","","ATM-140-S  -  SCREW BN MN FT 2.8-3.6MM 14MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-160-S","SUP","HCPCS C1713","","ATM-160-S  -  SCREW BN MN FT 2.8-3.6MM 16MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-180-S","SUP","HCPCS C1713","","ATM-180-S  -  SCREW BN MN FT 2.8-3.6MM 18MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-200-S","SUP","HCPCS C1713","","ATM-200-S  -  SCREW BN MN FT 2.8-3.6MM 20MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-220-S","SUP","HCPCS C1713","","ATM-220-S  -  SCREW BN MN FT 2.8-3.6MM 22MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-240-S","SUP","HCPCS C1713","","ATM-240-S  -  SCREW BN MN 24MM ACTRK FX","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"ATM-260-S","SUP","HCPCS C1713","","ATM-260-S  -  SCREW BN MN FT 2.8-3.6MM 26MM STRL ACTRK SLF CUT CNN VAR","BOTH IP/OP","$940.00 ","$695.60 ","$0.00 ","$940.00 ","$423.00 ","$0.00 ","$195.92 ","$0.00 ","$0.00 ","$164.59 ","$940.00 ","$0.00 ","$470.00 ","$744.48 ","$752.00 ","$0.00 ","$147.11 ","$0.00 ","$149.65 ","$0.00 "
"AU00T0","SUP","HCPCS V2632","","AU00T0  -  LENS IOL 0D PLANAR 6MM 30MM ACRSF IQ STABLEFORCE ULTRASERT","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$241.88 ","$0.00 ","$112.03 ","$0.00 ","$0.00 ","$94.11 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$84.12 ","$0.00 ","$85.57 ","$0.00 "
"AVM851","SUP","Custom 27803010","","AVM851  -  CLIP INTNL SM STRL LF FLSH SFLN UPR JAW SIL TI FLLPN TUBE","BOTH IP/OP","$223.95 ","$165.72 ","$0.00 ","$223.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$223.95 ","$0.00 ","$111.98 ","$177.37 ","$179.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AVSM10060","SUP","HCPCS C2625","","AVSM10060  -  STENT VASCULAR COVERA COVERED 10MM X 60MM 80CM DELIVERY STR","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"AW-04018","SUP","HCPCS C1769","","GUIDEWIRE VASC .018IN 25CM STRG SFTP SPRG","BOTH IP/OP","$15.50 ","$11.47 ","$0.00 ","$15.50 ","$8.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.71 ","$15.50 ","$0.00 ","$7.75 ","$12.28 ","$12.40 ","$0.00 ","$2.43 ","$0.00 ","$2.47 ","$0.00 "
"AW04432","SUP","HCPCS C1769","","GUIDEWIRE VASC .032IN 60CM JTP STRG SFTP DUAL END SPRG ARW","BOTH IP/OP","$23.50 ","$17.39 ","$0.00 ","$23.50 ","$12.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.11 ","$23.50 ","$0.00 ","$11.75 ","$18.61 ","$18.80 ","$0.00 ","$3.68 ","$0.00 ","$3.74 ","$0.00 "
"AW-04432","SUP","HCPCS C1769","","GUIDEWIRE VASC .032IN 60CM JTP STRG SFTP DUAL END SPRG ARW","BOTH IP/OP","$58.75 ","$43.48 ","$0.00 ","$58.75 ","$31.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.29 ","$58.75 ","$0.00 ","$29.38 ","$46.53 ","$47.00 ","$0.00 ","$9.19 ","$0.00 ","$9.35 ","$0.00 "
"AW-14735","SUP","HCPCS C1769","","GUIDEWIRE VASC .35IN 65CM SPRG JTP 2 END STRG ARW ADV SS","BOTH IP/OP","$40.15 ","$29.71 ","$0.00 ","$23.60 ","$12.81 ","$0.00 ","$8.37 ","$0.00 ","$0.00 ","$4.13 ","$23.60 ","$0.00 ","$11.80 ","$18.69 ","$18.88 ","$0.00 ","$3.69 ","$0.00 ","$3.76 ","$0.00 "
"AX100","SUP","Custom 27203010","","CALIBRATOR A MLTLY 5ML IMMUN","BOTH IP/OP","$1,452.78 ","$1,075.06 ","$0.00 ","$1,452.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,452.78 ","$0.00 ","$726.39 ","$1,150.60 ","$1,162.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"AX9001","SUP","Custom 27203010","","REAGENT A MLTLY DLY MNTN ANALY","BOTH IP/OP","$460.95 ","$341.10 ","$0.00 ","$460.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.95 ","$0.00 ","$230.48 ","$365.07 ","$368.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B000-0185","SUP","HCPCS C1713","","B000-0185  -  RESTRICTOR CEMENT SMALL UNIVERSAL 18.5MM REVISION PLUG HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B000-0200","SUP","HCPCS C1713","","B000-0200  -  PLUG BONE CMNT MED UNV 20MM","BOTH IP/OP","$188.00 ","$139.12 ","$0.00 ","$188.00 ","$84.60 ","$0.00 ","$39.18 ","$0.00 ","$0.00 ","$32.92 ","$188.00 ","$0.00 ","$94.00 ","$148.90 ","$150.40 ","$0.00 ","$29.42 ","$0.00 ","$29.93 ","$0.00 "
"B000-0240","SUP","HCPCS C1713","","B000-0240  -  RSTRC CMNT MED UNV 24MM HIP REV","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$183.00 ","$82.35 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$32.04 ","$183.00 ","$0.00 ","$91.50 ","$144.94 ","$146.40 ","$0.00 ","$28.64 ","$0.00 ","$29.13 ","$0.00 "
"B000-0300","SUP","HCPCS C1713","","B000-0300  -  RESTRICTOR CEMENT XL UNIVERSAL 30MM REVISION HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B000-1185","SUP","HCPCS C1713","","B000-1185  -  RESTRICTOR CEMENT SMALL UNIVERSAL DISPOSABLE INSERTER DISTAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B000-1240","SUP","HCPCS C1713","","B000-1240  -  RESTRICTOR CEMENT MEDIUM UNIVERSAL DISPOSABLE INSERTER","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B000-1300","SUP","HCPCS C1713","","B000-1300  -  RESTRICTOR CEMENT UNIVERSAL DISPOSABLE INSERTER","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B001-0110","SUP","HCPCS C1713","","B001-0110  -  PLUG BONE CEMENT 1 11MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B002-0125","SUP","HCPCS C1713","","B002-0125  -  PLUG BONE CEMENT 2 12.5MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B003-0140","SUP","HCPCS C1713","","B003-0140  -  PLUG BONE CEMENT 3 17.5MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B004-0155","SUP","HCPCS C1713","","B004-0155  -  PLUG BONE CEMENT 4 23MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B005-0170","SUP","HCPCS C1713","","B005-0170  -  PLUG BONE CEMENT 5 17MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B006-0185","SUP","HCPCS C1713","","B006-0185  -  PLUG BONE CEMENT 6 18MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B007-0200","SUP","HCPCS C1713","","B007-0200  -  PLUG BONE CEMENT 7 20MM UHMWPE HIP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B008-0215","SUP","HCPCS C1713","","B008-0215  -  PLUG BONE CEMENT 8 21.5MM  UHMWPE","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$50.63 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"B1000729BL","SUP","Custom 27203010","","CASSETTE TISS BLUE SHDN EMBD DISP","BOTH IP/OP","$288.18 ","$213.25 ","$0.00 ","$288.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$288.18 ","$0.00 ","$144.09 ","$228.24 ","$230.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1000729DRD","SUP","Custom 27203010","","CASSETTE TISS ANTM PTH 2","BOTH IP/OP","$328.35 ","$242.98 ","$0.00 ","$328.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$328.35 ","$0.00 ","$164.18 ","$260.05 ","$262.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1000729OR","SUP","Custom 27203010","","CASSETTE TISS ORNG SHDN EMBD 2 DISP","BOTH IP/OP","$262.25 ","$194.07 ","$0.00 ","$262.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.25 ","$0.00 ","$131.13 ","$207.70 ","$209.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1000729PK","SUP","Custom 27203010","","CASSETTE TISS PNK SHDN EMBD DISP","BOTH IP/OP","$326.50 ","$241.61 ","$0.00 ","$326.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$326.50 ","$0.00 ","$163.25 ","$258.59 ","$261.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1000729WH","SUP","Custom 27203010","","CASSETTE TISS/BIOP WHT EMBD SM SLOT ACTL PLMR","BOTH IP/OP","$262.25 ","$194.07 ","$0.00 ","$262.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.25 ","$0.00 ","$131.13 ","$207.70 ","$209.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B10-27A-00","SUP","Custom 27803010","","B10-27A-00  -  VALVE AORTIC 17MM 27MM BIOCOR PIG STNT LP FLEXFIT STENT","BOTH IP/OP","$19,200.00 ","$14,208.00 ","$0.00 ","$19,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,200.00 ","$0.00 ","$9,600.00 ","$15,206.40 ","$15,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1036-1","SUP","Custom 27203010","","KIT PR RTCLN RVIR EIA DIR AG DTCT MICROTITRATION VIR TST 48","BOTH IP/OP","$789.23 ","$584.03 ","$0.00 ","$789.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$789.23 ","$0.00 ","$394.61 ","$625.07 ","$631.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1046-23","SUP","Custom 27203010","","KIT IMMUN TST GNGN 2 N GC 24 TST","BOTH IP/OP","$181.90 ","$134.61 ","$0.00 ","$181.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$181.90 ","$0.00 ","$90.95 ","$144.06 ","$145.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1055-16A","SUP","Custom 27203010","","REAGENT MYCL CALCOFLUOR WHT DRPR .5ML","BOTH IP/OP","$135.93 ","$100.59 ","$0.00 ","$135.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.93 ","$0.00 ","$67.96 ","$107.66 ","$108.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1055-4","SUP","Custom 27203010","","REAGENT MCBL INDOPHENOL OXDS DRPR CRUSHABLE AMPULE BBL .5ML","BOTH IP/OP","$1.28 ","$0.95 ","$0.00 ","$1.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.28 ","$0.00 ","$0.64 ","$1.01 ","$1.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B1076-1B","SUP","Custom 25003010","","DISK NITROCEFIN B LCTMS DTCT BBL ID","BOTH IP/OP","$125.60 ","$92.94 ","$0.00 ","$125.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$125.60 ","$0.00 ","$62.80 ","$99.48 ","$100.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B12LT","SUP","Custom 27203010","","B12LT  -  TROCAR LAPSCOP 12MM 100MM STABILITY SLEEVE OPTICAL TIP","BOTH IP/OP","$475.45 ","$351.83 ","$0.00 ","$475.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$475.45 ","$0.00 ","$237.73 ","$376.56 ","$380.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B12XT","SUP","Custom 27203010","","B12XT  -  TROCAR LAPSCOP 12MM 150MM STABILITY SLEEVE OPTICAL OBTURATOR","BOTH IP/OP","$536.91 ","$397.31 ","$0.00 ","$536.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$536.91 ","$0.00 ","$268.45 ","$425.23 ","$429.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"B56030","SUP","Custom 27203010","","KIT DRCGN EZ RSV CNTRL REAGENT TUBE TIP VIR TST 30 TST","BOTH IP/OP","$355.50 ","$263.07 ","$0.00 ","$355.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.50 ","$0.00 ","$177.75 ","$281.56 ","$284.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"B5STF","SUP","Custom 27203010","","B5STF  -  TROCAR LAPSCP STD 5MM STRL LF VERSAONE FX CNN BLDE DISP","BOTH IP/OP","$72.88 ","$53.93 ","$0.00 ","$73.97 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.97 ","$0.00 ","$36.98 ","$58.58 ","$59.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B5XT","SUP","Custom 27203010","","B5XT  -  TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE XCEL ENDOPATH","BOTH IP/OP","$405.73 ","$300.24 ","$0.00 ","$405.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.73 ","$0.00 ","$202.86 ","$321.34 ","$324.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B6940-20","SUP","Custom 27203010","","CONTROL RPR BBL MACV CRD 1.5ML IMMUN","BOTH IP/OP","$46.10 ","$34.11 ","$0.00 ","$46.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.10 ","$0.00 ","$23.05 ","$36.51 ","$36.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B6940-21","SUP","Custom 27203010","","DEVICE DISPENSTIRS RPR CRD IMMUN TST","BOTH IP/OP","$79.23 ","$58.63 ","$0.00 ","$79.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.23 ","$0.00 ","$39.61 ","$62.75 ","$63.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B6940-4","SUP","Custom 27203010","","KIT MACV RPR QUAL SPOT CRD SERTST 10 TST","BOTH IP/OP","$243.75 ","$180.38 ","$0.00 ","$243.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.75 ","$0.00 ","$121.88 ","$193.05 ","$195.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B6944-19","SUP","Custom 27203010","","KIT DRCGN RSV LAT FLW CLIA WVD VIR TST 30 TST","BOTH IP/OP","$994.50 ","$735.93 ","$0.00 ","$994.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$994.50 ","$0.00 ","$497.25 ","$787.64 ","$795.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"B9990800","SUP","Custom 27203010","","REAGENT CYTO RD CYRCH COLLECT FLUID ALC BS 3.8L","BOTH IP/OP","$278.58 ","$206.15 ","$0.00 ","$278.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$278.58 ","$0.00 ","$139.29 ","$220.64 ","$222.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BA22-40/I13-40","SUP","Custom 27803010","","BA22-40/I13-40  -  GRAFT STNT 2 BRCH 22MM 13MM 40MM STRL LF 40MM AFX STRATA","BOTH IP/OP","$28,950.00 ","$21,423.00 ","$0.00 ","$28,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,950.00 ","$0.00 ","$14,475.00 ","$22,928.40 ","$23,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BA22-60/I13-40","SUP","Custom 27803010","","BA22-60/I13-40  -  GRAFT STNT BFUR 22-13MM 17FR 60MM 40MM AFX ACTIVESEAL STRATA","BOTH IP/OP","$28,025.00 ","$20,738.50 ","$0.00 ","$28,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,025.00 ","$0.00 ","$14,012.50 ","$22,195.80 ","$22,420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BA22-70/I16-30","SUP","Custom 27803010","","BA22-70/I16-30  -  GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL 30MM AFX LMB XTN PTFE","BOTH IP/OP","$28,950.00 ","$21,423.00 ","$0.00 ","$28,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,950.00 ","$0.00 ","$14,475.00 ","$22,928.40 ","$23,160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BA25-70/I16-30","SUP","Custom 27803010","","BA25-70/I16-30  -  GRAFT STENT 70MM SELF EXPANDABLE MAIN BODY POLYPRO SUTURE","BOTH IP/OP","$28,025.00 ","$20,738.50 ","$0.00 ","$28,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,025.00 ","$0.00 ","$14,012.50 ","$22,195.80 ","$22,420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BA25-80/I16-40","SUP","Custom 27803010","","BA25-80/I16-40  -  GRAFT STENT 80MM SELF EXPAND MAIN BODY AFX ACTIVESEAL STRATA","BOTH IP/OP","$28,025.00 ","$20,738.50 ","$0.00 ","$28,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,025.00 ","$0.00 ","$14,012.50 ","$22,195.80 ","$22,420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BA28-70/I16-30","SUP","Custom 27803010","","BA28-70/I16-30  -  GRAFT STNT BFUR 28-16MM 17FR 70MM 30MM AFX ACTIVESEAL STRATA","BOTH IP/OP","$28,237.50 ","$20,895.75 ","$0.00 ","$28,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,237.50 ","$0.00 ","$14,118.75 ","$22,364.10 ","$22,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"BCK9015","SUP","Custom 27804086","","BCK9015  -  SYSTEM BONE CMNT 15CM DLV NDL HNDL KT 11GA STRL AVTX","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"BG-8040","SUP","Custom 27203010","","BG-8040  -  ADPR TBG HDSN FIT","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BG-8043","SUP","Custom 27203010","","BG-8043  -  HANDLE RCHT T BNGFT","BOTH IP/OP","$2,287.50 ","$1,692.75 ","$0.00 ","$2,287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,287.50 ","$0.00 ","$1,143.75 ","$1,811.70 ","$1,830.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BG-8044","SUP","Custom 27203010","","BG-8044  -  ADPR CHK JCB","BOTH IP/OP","$572.50 ","$423.65 ","$0.00 ","$572.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.50 ","$0.00 ","$286.25 ","$453.42 ","$458.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BG-8060","SUP","Custom 27203010","","BG-8060  -  EXTRACTOR SRG G S GFT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BG-8064","SUP","Custom 27203010","","BG-8064  -  EXTRACTOR SRG 6MM G S","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BG-8080","SUP","Custom 27203010","","BG-8080  -  PUNCH SRG GFT TROC","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BI-2030","SUP","Custom 27203010","","BI-2030  -  CIRCUIT BREATHING 9X8X3IN TRANSPORT TEST CAP PORTABLE","BOTH IP/OP","$73.61 ","$54.47 ","$0.00 ","$73.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.61 ","$0.00 ","$36.80 ","$58.30 ","$58.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BK406","SUP","Custom 27203010","","BK406  -  PROTECTOR STUMP ROOKE BKA","BOTH IP/OP","$622.50 ","$460.65 ","$0.00 ","$622.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$622.50 ","$0.00 ","$311.25 ","$493.02 ","$498.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BL5115-2","SUP","Custom 27203010","","BL5115-2  -  PACK SRG STD NS LF ADP FLUIDICS DISP","BOTH IP/OP","$160.00 ","$118.40 ","$0.00 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.00 ","$0.00 ","$80.00 ","$126.72 ","$128.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BM200","SUP","Custom 27203010","","BM200  -  BONE MILL BM200 LEGEND PNEU DISPOSABLE","BOTH IP/OP","$627.75 ","$464.54 ","$0.00 ","$627.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$627.75 ","$0.00 ","$313.88 ","$497.18 ","$502.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BMW2021","SUP","HCPCS Q4108","","BMW2021  -  DRESSING BIO 2X2IN STRL LF INTGR BL MX BVN CLGN GAG","BOTH IP/OP","$5,171.98 ","$3,827.27 ","$0.00 ","$5,877.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,877.25 ","$0.00 ","$2,938.63 ","$4,654.78 ","$4,701.80 ","$0.00 ","$39.86 ","$0.00 ","$0.00 ","$0.00 "
"BMW8101","SUP","HCPCS Q4104","","BMW8101  -  DRESSING BIOLOGICAL 10X8IN ADHERENT BILAYER MATRIX FLEXIBLE","BOTH IP/OP","$23,893.18 ","$17,680.95 ","$0.00 ","$27,151.33 ","$12,218.10 ","$0.00 ","$4,979.93 ","$0.00 ","$0.00 ","$0.00 ","$27,151.33 ","$0.00 ","$13,575.66 ","$21,503.85 ","$21,721.06 ","$0.00 ","$0.00 ","$0.00 ","$4,322.49 ","$0.00 "
"BP10405","SUP","Custom 27803010","","BP10405  -  BP SUTURABLE GRAFT 4CM X 5CM","BOTH IP/OP","$850.28 ","$629.21 ","$0.00 ","$978.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$978.25 ","$0.00 ","$489.13 ","$774.77 ","$782.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BP10608","SUP","Custom 27803010","","BP10608  -  BP SUTURABLE GRAFT 6CM X 8CM","BOTH IP/OP","$1,097.98 ","$812.51 ","$0.00 ","$1,264.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,264.90 ","$0.00 ","$632.45 ","$1,001.80 ","$1,011.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BP10812","SUP","Custom 27803010","","BP10812  -  BP SUTURABLE GRAFT 8CM X 12CM","BOTH IP/OP","$1,811.00 ","$1,340.14 ","$0.00 ","$2,083.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,083.90 ","$0.00 ","$1,041.95 ","$1,650.45 ","$1,667.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BP11216","SUP","Custom 27803010","","BP11216  -  GRAFT SFT TIS 12X16CM STRL TTPLST RSRB SUTURABLE","BOTH IP/OP","$3,613.63 ","$2,674.09 ","$0.00 ","$3,884.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,884.80 ","$0.00 ","$1,942.40 ","$3,076.76 ","$3,107.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BRC000410-00","SUP","HCPCS C1725","","BRC000410-00  -  CATHETER BLNOCC 4MM 10MM ASCNT CMPT SYS MCIOL NRVSC ANRSM","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,582.85 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"BRC000415-00","SUP","HCPCS C1725","","BRC000415-00  -  CATHETER BLNOCC 4MM 15MM ASCNT REMODEL","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,582.85 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"BRS000609-00","SUP","HCPCS C1725","","BRS000609-00  -  CATHETER BLNOCC 6MM 9MM ASCNT REMODEL","BOTH IP/OP","$2,915.00 ","$2,157.10 ","$0.00 ","$2,915.00 ","$1,582.85 ","$0.00 ","$607.56 ","$0.00 ","$0.00 ","$510.39 ","$2,915.00 ","$0.00 ","$1,457.50 ","$2,308.68 ","$2,332.00 ","$0.00 ","$456.20 ","$0.00 ","$464.07 ","$0.00 "
"BSCLX351304100","SUP","Custom 27203010","","BSCLX351304100  -  CATHETER BLNDIL 4MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351304120","SUP","Custom 27203010","","BSCLX351304120  -  CATHETER BLNDIL 4MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351304150","SUP","Custom 27203010","","BSCLX351304150  -  CATHETER BLNDIL 4MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130440","SUP","Custom 27203010","","BSCLX35130440  -  CATHETER BLNDIL 4MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130460","SUP","Custom 27203010","","BSCLX35130460  -  CATHETER BLNDIL 4MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130480","SUP","Custom 27203010","","BSCLX35130480  -  CATHETER BLNDIL 4MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351305100","SUP","Custom 27203010","","BSCLX351305100  -  CATHETER BLNDIL 5MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351305120","SUP","Custom 27203010","","BSCLX351305120  -  CATHETER BLNDIL 5MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351305150","SUP","Custom 27203010","","BSCLX351305150  -  CATHETER BLNDIL 5MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130540","SUP","Custom 27203010","","BSCLX35130540  -  CATHETER BLNDIL 5MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130560","SUP","Custom 27203010","","BSCLX35130560  -  CATHETER BLNDIL 5MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130580","SUP","Custom 27203010","","BSCLX35130580  -  CATHETER BLNDIL 5MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351306100","SUP","Custom 27203010","","BSCLX351306100  -  CATHETER BLNDIL 6MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351306120","SUP","Custom 27203010","","BSCLX351306120  -  CATHETER BALDILAT 6FR 6MM 130CM 120MM PCLTXL","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX351306150","SUP","Custom 27203010","","BSCLX351306150  -  CATHETER BLNDIL 6MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130640","SUP","Custom 27203010","","BSCLX35130640  -  CATHETER BLNDIL 6MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130660","SUP","Custom 27203010","","BSCLX35130660  -  CATHETER BLNDIL 6MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BSCLX35130680","SUP","Custom 27203010","","BSCLX35130680  -  CATHETER BLNDIL 6MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BTC-100","SUP","HCPCS C1758","","CATHETER URET BT-CATH TEMPONADE","BOTH IP/OP","$290.00 ","$214.60 ","$0.00 ","$266.75 ","$144.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.71 ","$266.75 ","$0.00 ","$133.38 ","$211.27 ","$213.40 ","$0.00 ","$41.75 ","$0.00 ","$42.47 ","$0.00 "
"BTE1000","SUP","Custom 27803010","","BTE1000  -  EXPANDER TISSUE P8-10.2CM RECTANGLE 17X8CM REMOTE PORT","BOTH IP/OP","$1,337.50 ","$989.75 ","$0.00 ","$1,337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.50 ","$0.00 ","$668.75 ","$1,059.30 ","$1,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BTE750","SUP","Custom 27803010","","BTE750  -  EXPANDER TISSUE P7-9CM RECTANGLE 15X7.5CM REMOTE PORT SMOOTH","BOTH IP/OP","$1,337.50 ","$989.75 ","$0.00 ","$1,337.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,337.50 ","$0.00 ","$668.75 ","$1,059.30 ","$1,070.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BW012","SUP","Custom 27803010","","BW012  -  WAX BN STRL LF OSTENE HMST AGNT ALK OXD 2.5GM DISP","BOTH IP/OP","$192.05 ","$142.12 ","$0.00 ","$192.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.05 ","$0.00 ","$96.03 ","$152.10 ","$153.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BW-012","SUP","Custom 27203010","","OSTENE-A WATER-SOLUBLE BONE HEMOSTASIS MATERIALS","BOTH IP/OP","$165.63 ","$122.57 ","$0.00 ","$165.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$165.63 ","$0.00 ","$82.81 ","$131.18 ","$132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BX00711052","SUP","Custom 27203010","","BX00711052  -  NET SPEC RTRVL 230CM 2.5MM RTHNT STD STRNG REINF NT X SCR","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BX-1000","SUP","Custom 27203010","","BX-1000  -  KIT ASCP ARTHROBOX","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"BXA073901A","SUP","HCPCS C1874","","BXA073901A  -  STENT EPRSTH .035IN 7MM 11MM 7FR 39MM 80CM GORE VBHN BLN","BOTH IP/OP","$8,935.00 ","$6,611.90 ","$0.00 ","$8,760.00 ","$3,942.00 ","$0.00 ","$1,862.28 ","$0.00 ","$0.00 ","$1,533.81 ","$8,760.00 ","$0.00 ","$4,380.00 ","$6,937.92 ","$7,008.00 ","$0.00 ","$1,370.94 ","$0.00 ","$1,394.59 ","$0.00 "
"BXA075901A","SUP","HCPCS C1874","","BXA075901A  -  STENT EPRSTH .035IN 7MM 11MM 7FR 59MM 80CM GORE VBHN BLN","BOTH IP/OP","$8,935.00 ","$6,611.90 ","$0.00 ","$8,760.00 ","$3,942.00 ","$0.00 ","$1,862.28 ","$0.00 ","$0.00 ","$1,533.81 ","$8,760.00 ","$0.00 ","$4,380.00 ","$6,937.92 ","$7,008.00 ","$0.00 ","$1,370.94 ","$0.00 ","$1,394.59 ","$0.00 "
"BXA082901A","SUP","HCPCS C1874","","BXA082901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 29MM 80CM GORE VBHN BLN","BOTH IP/OP","$8,935.00 ","$6,611.90 ","$0.00 ","$8,760.00 ","$3,942.00 ","$0.00 ","$1,862.28 ","$0.00 ","$0.00 ","$1,533.81 ","$8,760.00 ","$0.00 ","$4,380.00 ","$6,937.92 ","$7,008.00 ","$0.00 ","$1,370.94 ","$0.00 ","$1,394.59 ","$0.00 "
"BXA083901A","SUP","HCPCS C1874","","BXA083901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 39MM 80CM GORE VBHN BLN","BOTH IP/OP","$8,935.00 ","$6,611.90 ","$0.00 ","$8,760.00 ","$3,942.00 ","$0.00 ","$1,862.28 ","$0.00 ","$0.00 ","$1,533.81 ","$8,760.00 ","$0.00 ","$4,380.00 ","$6,937.92 ","$7,008.00 ","$0.00 ","$1,370.94 ","$0.00 ","$1,394.59 ","$0.00 "
"BXA085901A","SUP","HCPCS C1874","","BXA085901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 59MM 80CM GORE VBHN BLN","BOTH IP/OP","$8,935.00 ","$6,611.90 ","$0.00 ","$8,760.00 ","$3,942.00 ","$0.00 ","$1,862.28 ","$0.00 ","$0.00 ","$1,533.81 ","$8,760.00 ","$0.00 ","$4,380.00 ","$6,937.92 ","$7,008.00 ","$0.00 ","$1,370.94 ","$0.00 ","$1,394.59 ","$0.00 "
"C021D","SUP","Custom 27203010","","C021D  -  SUTURE NONABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8","BOTH IP/OP","$285.50 ","$211.27 ","$0.00 ","$289.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.78 ","$0.00 ","$144.89 ","$229.51 ","$231.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C-028","SUP","HCPCS C1713","","C-028  -  GUARD PIN YLW .028IN PINCAP .028IN POST SURG KWR STNM PIN","BOTH IP/OP","$4.58 ","$3.39 ","$0.00 ","$4.58 ","$2.06 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$0.80 ","$4.58 ","$0.00 ","$2.29 ","$3.63 ","$3.67 ","$0.00 ","$0.72 ","$0.00 ","$0.73 ","$0.00 "
"C-045","SUP","HCPCS C1713","","C-045  -  CAP PCTV PINCAP STRL WHT .045IN 1.1MM .045IN","BOTH IP/OP","$4.58 ","$3.39 ","$0.00 ","$4.58 ","$2.06 ","$0.00 ","$0.96 ","$0.00 ","$0.00 ","$0.80 ","$4.58 ","$0.00 ","$2.29 ","$3.63 ","$3.67 ","$0.00 ","$0.72 ","$0.00 ","$0.73 ","$0.00 "
"C-062","SUP","HCPCS C1713","","C-062  -  CAP PCTV .062IN KWR PINCAP STRL POST SURG KWR STNM PIN GRN","BOTH IP/OP","$2.75 ","$2.04 ","$0.00 ","$2.75 ","$1.24 ","$0.00 ","$0.57 ","$0.00 ","$0.00 ","$0.48 ","$2.75 ","$0.00 ","$1.38 ","$2.18 ","$2.20 ","$0.00 ","$0.43 ","$0.00 ","$0.44 ","$0.00 "
"C-078","SUP","HCPCS C1713","","C-078  -  GUARD PIN PNK .078IN .035IN KWR STNM STRL","BOTH IP/OP","$5.00 ","$3.70 ","$0.00 ","$5.00 ","$2.25 ","$0.00 ","$1.04 ","$0.00 ","$0.00 ","$0.88 ","$5.00 ","$0.00 ","$2.50 ","$3.96 ","$4.00 ","$0.00 ","$0.78 ","$0.00 ","$0.80 ","$0.00 "
"C0L-3140","SUP","HCPCS C1713","","C0L-3140  -  SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"C0L-3160","SUP","HCPCS C1713","","C0L-3160  -  SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"C141","SUP","HCPCS C1713","","C141  -  COVER PIN .141IN KWR","BOTH IP/OP","$5.00 ","$3.70 ","$0.00 ","$5.00 ","$2.25 ","$0.00 ","$1.04 ","$0.00 ","$0.00 ","$0.88 ","$5.00 ","$0.00 ","$2.50 ","$3.96 ","$4.00 ","$0.00 ","$0.78 ","$0.00 ","$0.80 ","$0.00 "
"C156","SUP","HCPCS C1713","","C156  -  COVER PIN .156IN KWR","BOTH IP/OP","$5.00 ","$3.70 ","$0.00 ","$5.00 ","$2.25 ","$0.00 ","$1.04 ","$0.00 ","$0.00 ","$0.88 ","$5.00 ","$0.00 ","$2.50 ","$3.96 ","$4.00 ","$0.00 ","$0.78 ","$0.00 ","$0.80 ","$0.00 "
"C1712","SUP","HCPCS C1713","","C1712  -  SCREW BONE 1.7MM 12MM CANN LBLU","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"C1713","SUP","HCPCS C1713","","C1713  -  SCREW BONE 13MM CANN LIGHT BLUE 1.7MM","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"C1714","SUP","HCPCS C1713","","C1714  -  SCREW BONE 9MM CANN COMPRESSION LIGHT BLUE 1.7MM ORTHOPEDIC","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$787.50 ","$354.38 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$137.88 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$123.24 ","$0.00 ","$125.37 ","$0.00 "
"C2314","SUP","HCPCS C1713","","C2314  -  SCREW BONE L14 MM OD2.3 MM ORTHOPEDIC LOCK BLUE","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2316","SUP","HCPCS C1713","","C2316  -  SCREW BN 2.3MM 16MM BLU CNN CMPR","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2318","SUP","HCPCS C1713","","C2318  -  CANNULATED SCREW 2.3MM, 18MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2320","SUP","HCPCS C1713","","C2320  -  SCREW BONE 20MM LOCK BLUE 2.3MM ORTHOPEDIC","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2322","SUP","HCPCS C1713","","C2322  -  SCREW BONE 22MM CANN COMPRESSION BLUE 2.3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2324","SUP","HCPCS C1713","","C2324  -  SCREW BN 2.3MM 24MM BLU CNN CMPR","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2326","SUP","HCPCS C1713","","C2326  -  SCREW BONE 26MM CANN COMPRESSION BLUE 2.3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2328","SUP","HCPCS C1713","","C2328  -  SCREW BONE 28MM CANN COMPRESSION BLUE 2.3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C2TR01","SUP","HCPCS C2621","","C2TR01  -  PACEMAKER CARDIAC THK6MM 57X59MM 2 CHAMBER RATE RESPONSIVE","BOTH IP/OP","$14,700.00 ","$10,878.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C3.5-20","SUP","HCPCS C1713","","C3.5-20  -  SCREW BONE 20MM CANN ORANGE 3.5MM ORTHOPEDIC","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3018","SUP","HCPCS C1713","","C3018  -  SCREW BONE 18MM CANN COMPRESSION YELLOW 3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3020","SUP","HCPCS C1713","","C3020  -  SCREW BONE 20MM CANN COMPRESSION YELLOW 3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3022","SUP","HCPCS C1713","","C3022  -  SCREW BONE 22MM CANN YELLOW 3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3024","SUP","HCPCS C1713","","C3024  -  SCREW BONE 24MM COMPRESSION 3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3026","SUP","HCPCS C1713","","C3026  -  SCREW BONE 26MM CANN COMPRESSION YELLOW 3MM","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3524","SUP","HCPCS C1713","","C3524  -  SCREW BONE 24MM CANN COMPRESSION ORANGE 3.5MM ORTHOPEDIC","BOTH IP/OP","$775.00 ","$573.50 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$161.53 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"C3RL01-B:US","SUP","HCPCS Q4100","","C3RL01-B:US  -  DEVICE CELL HRVT RECELL ATLGS","BOTH IP/OP","$16,687.50 ","$12,348.75 ","$0.00 ","$16,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C4120","SUP","Custom 27203010","","C4120  -  CARTRIDGE GRSPR 5MM 38CM STRL 20MM D DR ATRM DISP","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C4319-5B","SUP","Custom 27203010","","C4319-5B  -  ADPR SCT 15MM 15MM BLUE SWVL TRCHCR CLOSE SCT SYS TRCHCR","BOTH IP/OP","$86.68 ","$64.14 ","$0.00 ","$86.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$86.68 ","$0.00 ","$43.34 ","$68.65 ","$69.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C4330","SUP","Custom 27203010","","CHEMICAL LAB XYLN CLR AGNT POLY BTL 1GL HST GRAD","BOTH IP/OP","$35.93 ","$26.59 ","$0.00 ","$35.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.93 ","$0.00 ","$17.96 ","$28.46 ","$28.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C46145","SUP","Custom 27203010","","C46145  -  CUSA CURVED EXTENDED STD TIPS 8/BX","BOTH IP/OP","$1,219.38 ","$902.34 ","$0.00 ","$1,219.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,219.38 ","$0.00 ","$609.69 ","$965.75 ","$975.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C514D","SUP","Custom 27203010","","C514D  -  SUTURE NONABSORBABLE 4-0 SH 18IN CONTROL RELEASE BRAID 8","BOTH IP/OP","$30.13 ","$22.30 ","$0.00 ","$30.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.13 ","$0.00 ","$15.07 ","$23.86 ","$24.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C554D","SUP","Custom 27203010","","C554D  -  SUTURE NRLN 4-0 RB1 18IN BRAID CR MPK BLK NABSB","BOTH IP/OP","$35.34 ","$26.15 ","$0.00 ","$35.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.34 ","$0.00 ","$17.67 ","$27.99 ","$28.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C584D","SUP","Custom 27203010","","C584D  -  SUTURE NABSB 4-0 TF 18IN BLK NRLN CR BRD 8 STRN NYL 6 6","BOTH IP/OP","$39.86 ","$29.50 ","$0.00 ","$40.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.46 ","$0.00 ","$20.23 ","$32.04 ","$32.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8402","SUP","Custom 27203010","","C8402  -  RETRACTOR SURG MEDIUM RING ATRAUMATIC SELF RETAIN WOUND","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8403","SUP","Custom 27203010","","C8403  -  RETRACTOR SURG LARGE RIGID RETRACTION RING ALEXIS O 9-14CM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8404","SUP","Custom 27203010","","C8404  -  RETRACTOR SURG XL 11-17CM WOUND LATEX FREE ALEXIS 11-17CM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8584","SUP","Custom 27203010","","C8584  -  BIT DRILL 9IN TAPERED HEAD TUNNEL DEPTH ECCENTRIC MONOFLUTED","BOTH IP/OP","$1,751.00 ","$1,295.74 ","$0.00 ","$1,751.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,751.00 ","$0.00 ","$875.50 ","$1,386.79 ","$1,400.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8XX2","SUP","Custom 27203010","","C8XX2  -  PORT HND ACC 120MM LF ALEXIS GLPRT WND RTRCTR LAPSCP MRK PEN","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8XX2NONCE","SUP","Custom 27203010","","PORT HND ACCES GLPRT ALEXIS O RTRCTR LAPSCOP","BOTH IP/OP","$1,264.65 ","$935.84 ","$0.00 ","$1,264.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,264.65 ","$0.00 ","$632.33 ","$1,001.60 ","$1,011.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C8XXX2N","SUP","Custom 27203010","","C8XXX2N  -  GELPORT","BOTH IP/OP","$1,264.65 ","$935.84 ","$0.00 ","$1,264.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,264.65 ","$0.00 ","$632.33 ","$1,001.60 ","$1,011.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C-99999-13","SUP","Custom 27203010","","CAP TUBE BLK PHNL SCR ON RBR LINR DISP","BOTH IP/OP","$0.25 ","$0.19 ","$0.00 ","$0.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.25 ","$0.00 ","$0.13 ","$0.20 ","$0.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CA0304","SUP","Custom 27803010","","CA0304  -  GRAFT SFT TISSUE AVIVE HUMAN UMBILICAL CORD MEMBRANE 3CMX4CM","BOTH IP/OP","$6,000.00 ","$4,440.00 ","$0.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,000.00 ","$0.00 ","$3,000.00 ","$4,752.00 ","$4,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CA2011","SUP","HCPCS C1894","","DEVICE BIOP 11CM 20GA ACHV SFT TIS COAX AUTO INTROD THNWL","BOTH IP/OP","$149.10 ","$110.33 ","$0.00 ","$149.10 ","$80.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.11 ","$149.10 ","$0.00 ","$74.55 ","$118.09 ","$119.28 ","$0.00 ","$23.33 ","$0.00 ","$23.74 ","$0.00 "
"CA-4120","SUP","HCPCS C1713","","CA-4120  -  SCREW BN 4MM 12MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4140","SUP","HCPCS C1713","","CA-4140  -  SCREW BN 4MM 14MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4160","SUP","HCPCS C1713","","CA-4160  -  SCREW BN 4MM 16MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4180","SUP","HCPCS C1713","","CA-4180  -  SCREW BN 4MM 18MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4200","SUP","HCPCS C1713","","CA-4200  -  SCREW BN 4MM 20MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4220","SUP","HCPCS C1713","","CA-4220  -  SCREW BN 4MM 22MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4225","SUP","HCPCS C1713","","CA-4225  -  SCREW BONE 4MM 22.5MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4240","SUP","HCPCS C1713","","CA-4240  -  SCREW BN 4MM 24MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4250","SUP","HCPCS C1713","","CA-4250  -  SCREW BONE 4MM 25MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4260","SUP","HCPCS C1713","","CA-4260  -  SCREW BN 4MM 26MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4275","SUP","HCPCS C1713","","CA-4275  -  SCREW BONE 4MM 27.5MM CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4280","SUP","HCPCS C1713","","CA-4280  -  SCREW BN 4MM 28MM CNN","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4300","SUP","HCPCS C1713","","CA-4300  -  SCREW BN 4MM 30MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4340","SUP","HCPCS C1713","","CA-4340  -  SCREW BONE 4MM 34MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4350","SUP","HCPCS C1713","","CA-4350  -  SCREW BONE 4MM 35MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4400","SUP","HCPCS C1713","","CA-4400  -  SCREW BONE 4MM 40MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4450","SUP","HCPCS C1713","","CA-4450  -  SCREW BONE 4MM 45MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4500","SUP","HCPCS C1713","","CA-4500  -  SCREW BONE 4MM 50MM TI CANC NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4550","SUP","HCPCS C1713","","CA-4550  -  SCREW BN 4MM 55MM CNN","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CA-4600","SUP","HCPCS C1713","","CA-4600  -  SCREW BN 4MM 60MM NS HEX TI CANC","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CAB3.8-12","SUP","HCPCS C1713","","CAB3.8-12  -  SCREW BONE 3.8MM 12MM CANCELLOUS","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"CAB3.8-16","SUP","HCPCS C1713","","CAB3.8-16  -  SCREW BONE 3.8MM 16MM CANCELLOUS","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"CAB3.8-20","SUP","HCPCS C1713","","CAB3.8-20  -  SCREW BONE 3.8MM 20MM CANCELLOUS ANKLE FIX SYSTEM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"CAB3.8-24","SUP","HCPCS C1713","","CAB3.8-24  -  SCREW BN 3.8MM 24MM CANC ANKL FX SYS","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"CAB3.8-26","SUP","HCPCS C1713","","CAB3.8-26  -  SCREW BONE 3.8MM 26MM CANCELLOUS ANKLE FIX SYSTEM","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"CA-PHB25","SUP","HCPCS C1713","","CA-PHB25  -  SCREW BONE 4.5MM 25MM TI ORTH LCK BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB275","SUP","HCPCS C1713","","CA-PHB275  -  SCREW BONE 27.5MM CANC PROX HUM BTRS","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB30","SUP","HCPCS C1713","","CA-PHB30  -  SCREW BONE 4.5MM 30MM TI ORTH LCK BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB325","SUP","HCPCS C1713","","CA-PHB325  -  SCREW BONE 4.5MM 32.5MM TI ORTH LCK BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB35","SUP","HCPCS C1713","","CA-PHB35  -  SCREW BONE 4.5MM 35MM TI ORTH LCK BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB375","SUP","HCPCS C1713","","CA-PHB375  -  SCREW BONE 4.5MM 37.5MM TI CANC LCK BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB40","SUP","HCPCS C1713","","CA-PHB40  -  SCREW BN 4.5MM 40MM NS CORT","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB45","SUP","HCPCS C1713","","CA-PHB45  -  SCREW BN 4.5MM 45MM LCK","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB50","SUP","HCPCS C1713","","CA-PHB50  -  SCREW BONE 4.5MM 50MM TI PROX HUM BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CA-PHB55","SUP","HCPCS C1713","","CA-PHB55  -  SCREW BONE 4.5MM 55MM TI PROX HUM PLT BTRS NONSTRL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$180.00 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"CAR500","SUP","Custom 27203010","","CARTRIDGE HMDIAL DISP CAR-500","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CAT00241","SUP","Custom 27203010","","CAT00241  -  KIT ARTHRO 17GA HIP NTNL PRTL ENTRY 2 SPNL NDL SYR","BOTH IP/OP","$822.50 ","$608.65 ","$0.00 ","$822.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.50 ","$0.00 ","$411.25 ","$651.42 ","$658.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA10","SUP","Custom 27203010","","CB09BA10  -  CURVEDBUR CB09BA10 09CMX1MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA10D","SUP","Custom 27203010","","CB09BA10D  -  CURVEDBUR CB09BA10D 09CMX1MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA20","SUP","Custom 27203010","","CB09BA20  -  CURVEDBUR CB09BA20 09CMX2MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA20D","SUP","Custom 27203010","","CB09BA20D  -  CURVEDBUR CB09BA20D 09CMX2MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA30","SUP","Custom 27203010","","CB09BA30  -  CURVEDBUR CB09BA30 09CMX3MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA30D","SUP","Custom 27203010","","CB09BA30D  -  CURVEDBUR CB09BA30D 09CMX1MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA40","SUP","Custom 27203010","","CB09BA40  -  CURVEDBUR CB09BA40 09CMX4MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB09BA40D","SUP","Custom 27203010","","CB09BA40D  -  CURVEDBUR CB09BA40D 09CMX4MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA10","SUP","Custom 27203010","","CB11BA10  -  CURVEDBUR CB11BA10 11CMX1MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA10D","SUP","Custom 27203010","","CB11BA10D  -  CURVEDBUR CB11BA10D 11CMX1MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA20","SUP","Custom 27203010","","CB11BA20  -  CURVEDBUR CB11BA20 11CMX2MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA20D","SUP","Custom 27203010","","CB11BA20D  -  CURVEDBUR CB11BA20D 11CMX2MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA30","SUP","Custom 27203010","","CB11BA30  -  CURVEDBUR CB11BA30 11CMX3MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA30D","SUP","Custom 27203010","","CB11BA30D  -  CURVEDBUR CB11BA30D 11CMX1MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA40","SUP","Custom 27203010","","CB11BA40  -  CURVEDBUR CB11BA40 11CMX4MM BALL","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CB11BA40D","SUP","Custom 27203010","","CB11BA40D  -  CURVEDBUR CB11BA40D 11CMX4MM BALL DIAMND","BOTH IP/OP","$711.00 ","$526.14 ","$0.00 ","$711.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$711.00 ","$0.00 ","$355.50 ","$563.11 ","$568.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CBO33010","SUP","HCPCS C1726","","CBO33010  -  CATHETER BLNDIL 3MM 10MM ANGPLSTY","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"CC-2300","SUP","Custom 27203010","","CC-2300  -  CONNECTOR DIALYSIS TITANIUM 2 PART FLEX-NECK CATHETER STERIL","BOTH IP/OP","$377.50 ","$279.35 ","$0.00 ","$377.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C-CAE-14.0-100-DLT-EF","SUP","HCPCS C1729","","CATHETER ARWYEX 14FR 100CM 2 LUM ENDOTRAC TUBE XFRM RPFT","BOTH IP/OP","$114.05 ","$84.40 ","$0.00 ","$114.05 ","$61.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.97 ","$114.05 ","$0.00 ","$57.03 ","$90.33 ","$91.24 ","$0.00 ","$17.85 ","$0.00 ","$18.16 ","$0.00 "
"CCH1910","SUP","Custom 27203010","","COAXIAL INTRODUCER NEEDLE 19GA 10CM","BOTH IP/OP","$33.75 ","$24.98 ","$0.00 ","$33.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.75 ","$0.00 ","$16.88 ","$26.73 ","$27.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CD1231-40","SUP","HCPCS C1722","","CD1231-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X73MM 1 CHAMBER IS-1","BOTH IP/OP","$32,250.00 ","$23,865.00 ","$0.00 ","$32,250.00 ","$14,512.50 ","$0.00 ","$6,721.71 ","$0.00 ","$0.00 ","$5,646.72 ","$32,250.00 ","$0.00 ","$16,125.00 ","$25,542.00 ","$25,800.00 ","$0.00 ","$5,047.13 ","$0.00 ","$5,134.20 ","$0.00 "
"CD1231-40Q","SUP","HCPCS C1722","","CD1231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 1 CHAMBER DF-4 RF","BOTH IP/OP","$32,250.00 ","$23,865.00 ","$0.00 ","$32,250.00 ","$14,512.50 ","$0.00 ","$6,721.71 ","$0.00 ","$0.00 ","$5,646.72 ","$32,250.00 ","$0.00 ","$16,125.00 ","$25,542.00 ","$25,800.00 ","$0.00 ","$5,047.13 ","$0.00 ","$5,134.20 ","$0.00 "
"CD2231-40","SUP","HCPCS C1721","","CD2231-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1","BOTH IP/OP","$33,075.00 ","$24,475.50 ","$0.00 ","$33,075.00 ","$14,883.75 ","$0.00 ","$6,893.66 ","$0.00 ","$0.00 ","$5,791.17 ","$33,075.00 ","$0.00 ","$16,537.50 ","$26,195.40 ","$26,460.00 ","$0.00 ","$5,176.24 ","$0.00 ","$5,265.54 ","$0.00 "
"CD2231-40Q","SUP","HCPCS C1721","","CD2231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 2 CHAMBER 2DF-4","BOTH IP/OP","$33,075.00 ","$24,475.50 ","$0.00 ","$33,075.00 ","$14,883.75 ","$0.00 ","$6,893.66 ","$0.00 ","$0.00 ","$5,791.17 ","$33,075.00 ","$0.00 ","$16,537.50 ","$26,195.40 ","$26,460.00 ","$0.00 ","$5,176.24 ","$0.00 ","$5,265.54 ","$0.00 "
"CD2257-40","SUP","HCPCS C1721","","CD2257-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1","BOTH IP/OP","$33,075.00 ","$24,475.50 ","$0.00 ","$33,075.00 ","$14,883.75 ","$0.00 ","$6,893.66 ","$0.00 ","$0.00 ","$5,791.17 ","$33,075.00 ","$0.00 ","$16,537.50 ","$26,195.40 ","$26,460.00 ","$0.00 ","$5,176.24 ","$0.00 ","$5,265.54 ","$0.00 "
"CD2257-40Q","SUP","HCPCS C1721","","CD2257-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 40X71MM 35CC STRL LF FORTIFY","BOTH IP/OP","$33,075.00 ","$24,475.50 ","$0.00 ","$33,075.00 ","$14,883.75 ","$0.00 ","$6,893.66 ","$0.00 ","$0.00 ","$5,791.17 ","$33,075.00 ","$0.00 ","$16,537.50 ","$26,195.40 ","$26,460.00 ","$0.00 ","$5,176.24 ","$0.00 ","$5,265.54 ","$0.00 "
"CD2311-36","SUP","HCPCS C1721","","CD2311-36  -  DEFIBRILLATOR CARDIAC THK12MM 36J 51X69MM 1 CHAMBER 1IS-1 1","BOTH IP/OP","$33,075.00 ","$24,475.50 ","$0.00 ","$33,075.00 ","$14,883.75 ","$0.00 ","$6,893.66 ","$0.00 ","$0.00 ","$5,791.17 ","$33,075.00 ","$0.00 ","$16,537.50 ","$26,195.40 ","$26,460.00 ","$0.00 ","$5,176.24 ","$0.00 ","$5,265.54 ","$0.00 "
"CD2311-36Q","SUP","HCPCS C1721","","CD2311-36Q  -  DEFIBRILLATOR CRD THK12MM 36J 51X70MM 31ML ELLIPSE 2 CHMBR 1","BOTH IP/OP","$33,075.00 ","$24,475.50 ","$0.00 ","$33,075.00 ","$14,883.75 ","$0.00 ","$6,893.66 ","$0.00 ","$0.00 ","$5,791.17 ","$33,075.00 ","$0.00 ","$16,537.50 ","$26,195.40 ","$26,460.00 ","$0.00 ","$5,176.24 ","$0.00 ","$5,265.54 ","$0.00 "
"CD3231-40","SUP","HCPCS C1721","","CD3231-40  -  DEFIBRILLATOR CRD THK14MM 2.5V 40X79MM 36ML UNIFY CRT-D QHR","BOTH IP/OP","$45,500.00 ","$33,670.00 ","$0.00 ","$45,500.00 ","$20,475.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$7,966.69 ","$45,500.00 ","$0.00 ","$22,750.00 ","$36,036.00 ","$36,400.00 ","$0.00 ","$7,120.75 ","$0.00 ","$7,243.60 ","$0.00 "
"CD3231-40Q","SUP","HCPCS C1721","","CD3231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 2.5V 500OHM 60 PPM 40X73MM 2","BOTH IP/OP","$39,825.00 ","$29,470.50 ","$0.00 ","$39,825.00 ","$17,921.25 ","$0.00 ","$8,300.53 ","$0.00 ","$0.00 ","$6,973.04 ","$39,825.00 ","$0.00 ","$19,912.50 ","$31,541.40 ","$31,860.00 ","$0.00 ","$6,232.61 ","$0.00 ","$6,340.14 ","$0.00 "
"CD3257-40","SUP","HCPCS C1882","","CD3257-40  -  DEFIBRILLATOR CRD THK14MM 40J 40X79MM 36CC UNIFY ASR CRT-D 2","BOTH IP/OP","$39,825.00 ","$29,470.50 ","$0.00 ","$39,825.00 ","$17,921.25 ","$0.00 ","$8,300.53 ","$0.00 ","$0.00 ","$6,973.04 ","$39,825.00 ","$0.00 ","$19,912.50 ","$31,541.40 ","$31,860.00 ","$0.00 ","$6,232.61 ","$0.00 ","$6,340.14 ","$0.00 "
"CD3257-40Q","SUP","HCPCS C1882","","CD3257-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 40X73MM 36CC UNIFY ASR","BOTH IP/OP","$39,825.00 ","$29,470.50 ","$0.00 ","$39,825.00 ","$17,921.25 ","$0.00 ","$8,300.53 ","$0.00 ","$0.00 ","$6,973.04 ","$39,825.00 ","$0.00 ","$19,912.50 ","$31,541.40 ","$31,860.00 ","$0.00 ","$6,232.61 ","$0.00 ","$6,340.14 ","$0.00 "
"CD3265-40","SUP","HCPCS C1882","","CD3265-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 41X83MM 2 CHAMBER 1IS-1 1","BOTH IP/OP","$42,750.00 ","$31,635.00 ","$0.00 ","$42,750.00 ","$19,237.50 ","$0.00 ","$8,910.17 ","$0.00 ","$0.00 ","$7,485.18 ","$42,750.00 ","$0.00 ","$21,375.00 ","$33,858.00 ","$34,200.00 ","$0.00 ","$6,690.38 ","$0.00 ","$6,805.80 ","$0.00 "
"CD3265-40Q","SUP","HCPCS C1882","","CD3265-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 41X76MM 38CC QD ASR","BOTH IP/OP","$42,750.00 ","$31,635.00 ","$0.00 ","$42,750.00 ","$19,237.50 ","$0.00 ","$8,910.17 ","$0.00 ","$0.00 ","$7,485.18 ","$42,750.00 ","$0.00 ","$21,375.00 ","$33,858.00 ","$34,200.00 ","$0.00 ","$6,690.38 ","$0.00 ","$6,805.80 ","$0.00 "
"CDSLM57","SUP","Custom 27803010","","CDSLM57  -  PATCH DURAL 7X5IN LATEX FREE DURAMATRIX-ONLAY","BOTH IP/OP","$4,337.03 ","$3,209.40 ","$0.00 ","$6,065.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,065.00 ","$0.00 ","$3,032.50 ","$4,803.48 ","$4,852.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CDSM33","SUP","Custom 27803010","","CDSM33  -  PATCH DURA 3X3IN DRMTRX IMPL FLXB STRNG CLGN MTRX","BOTH IP/OP","$1,731.00 ","$1,280.94 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CF7-3-60","SUP","HCPCS C1888","","CF7-3-60  -  CATHETER INTERVENTIONAL .025IN 7FR 60CM 3CM RADIOFREQUENCY","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CFF03","SUP","Custom 27203010","","CFF03  -  TROCAR LAPSCP 5MM 100MM LF KII FIOS ADV FX SLV RPD INSFL 1ST","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CFF71","SUP","Custom 27203010","","CFF71  -  TROCAR LAPSCP 12MM 150MM LF KII FIOS 1ST ENTRY ADV FX SLV","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CG409","SUP","HCPCS C1725","","CG409  -  CATHETER ANGIO CBR 2 CRV 4FR .041IN 65CM 15CM GLDCATH GLD","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG415","SUP","HCPCS C1725","","CG415  -  CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 65CM 15CM 2 BRAID","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG416","SUP","HCPCS C1887","","CG416  -  CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 100CM 15CM 2 BRAID","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG502","SUP","HCPCS C1725","","CG502  -  CATHETER ANGIO CBR 2 CRV 5FR .047IN 65CM 25CM GLDCATH GLD","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG506","SUP","HCPCS C1725","","CG506  -  CATHETER ANGIO STRG TPR 5FR .047IN 100CM GLDCATH GLD TCH BRD","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG507","SUP","HCPCS C1725","","CG507  -  CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 65CM 25CM 1 BRAID","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG508","SUP","HCPCS C1725","","CG508  -  CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 100CM 25CM 1 BRAID","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG511","SUP","HCPCS C1725","","CG511  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR .047IN 100CM 1","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG513","SUP","HCPCS C1725","","CG513  -  CATHETER ANGIO HDHNTR 1 CRV 5FR .047IN 100CM 25CM GLDCATH","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CG514","SUP","HCPCS C1725","","CG514  -  CATHETER ANGIO BNTSN 1 CRV 5FR .047IN 100CM 25CM GLDCATH GLD","BOTH IP/OP","$132.95 ","$98.38 ","$0.00 ","$121.38 ","$65.91 ","$0.00 ","$27.71 ","$0.00 ","$0.00 ","$21.25 ","$121.38 ","$0.00 ","$60.69 ","$96.13 ","$97.10 ","$0.00 ","$19.00 ","$0.00 ","$19.32 ","$0.00 "
"CL-07735","SUP","HCPCS C1894","","INTRODUCER SHTH 7FR 8FR 13.75IN INTGR HMSTS VLV SDPRT","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$149.00 ","$80.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.09 ","$149.00 ","$0.00 ","$74.50 ","$118.01 ","$119.20 ","$0.00 ","$23.32 ","$0.00 ","$23.72 ","$0.00 "
"CL-07765","SUP","HCPCS C1894","","INTRODUCER SHTH 7FR 65CM INTGR HMSTS VLV SDPRT TISS DILAT 3W","BOTH IP/OP","$233.45 ","$172.75 ","$0.00 ","$233.45 ","$126.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.88 ","$233.45 ","$0.00 ","$116.73 ","$184.89 ","$186.76 ","$0.00 ","$36.53 ","$0.00 ","$37.17 ","$0.00 "
"CM105C","SUP","Custom 25003010","","ANTIBODY CK 5 CK 6 CLONE CK5/6.007 MS IGG1 1ML LAB","BOTH IP/OP","$1,257.50 ","$930.55 ","$0.00 ","$1,257.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,257.50 ","$0.00 ","$628.75 ","$995.94 ","$1,006.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CM1520","SUP","HCPCS Q4116","","CM1520  -  MATRIX TISS THK.4-1.6MM MED CNTR 19.3X9.6CM ALDRM SLCT ALGRF","BOTH IP/OP","$9,007.50 ","$6,665.55 ","$0.00 ","$13,972.50 ","$6,287.63 ","$0.00 ","$1,877.39 ","$0.00 ","$0.00 ","$2,446.47 ","$13,972.50 ","$0.00 ","$6,986.25 ","$11,066.22 ","$11,178.00 ","$0.00 ","$2,186.70 ","$0.00 ","$2,224.42 ","$0.00 "
"CM630147S","SUP","HCPCS C1713","","CM630147S  -  NAIL 11MM 32CM HIP RIGHT GAMMA3 IM 130D LNG STRL","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM640047S","SUP","HCPCS C1713","","CM640047S  -  NAIL 11MM 32CM LEFT HIP GAMA IM 130D LNG STRL","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM640048S","SUP","HCPCS C1713","","CM640048S  -  NAIL 11MM 28CM LEFT HIP GAMA IM 130D LNG","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM640060S","SUP","HCPCS C1713","","CM640060S  -  NAIL 11MM 300MM HIP LEFT GAMMA3 IM 135D LNG","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM640106S","SUP","HCPCS C1713","","CM640106S  -  NAIL 11MM 32CM LEFT ORTH GAMA IM 135D LNG STRL","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM640113S","SUP","HCPCS C1713","","CM640113S  -  NAIL 11MM 30CM HIP LEFT FEM GAMMA3 IM 130D LNG TI STRL","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM644004S","SUP","HCPCS C1713","","CM644004S  -  NAIL 11MM 28CM LEFT HIP GAMA IM 135D LNG","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM645050S","SUP","HCPCS C1713","","CM645050S  -  NAIL RIGHT GAMA IM LNG","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM645051S","SUP","HCPCS C1713","","CM645051S  -  NAIL 11MM 280MM HIP RIGHT GAMMA3 IM 135D LNG","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM645059S","SUP","HCPCS C1713","","CM645059S  -  NAIL 11MM 30CM RIGHT ORTH GAMA IM 135D LNG STRL","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM645092S","SUP","HCPCS C1713","","CM645092S  -  NAIL RIGHT GAMA IM LNG","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CM645107S","SUP","HCPCS C1713","","CM645107S  -  NAIL 11MM 30CM HIP RIGHT FEM GAMMA3 IM 130D LNG TI STRL","BOTH IP/OP","$1,947.00 ","$1,440.78 ","$0.00 ","$1,947.00 ","$876.15 ","$0.00 ","$405.80 ","$0.00 ","$0.00 ","$340.90 ","$1,947.00 ","$0.00 ","$973.50 ","$1,542.02 ","$1,557.60 ","$0.00 ","$304.71 ","$0.00 ","$309.96 ","$0.00 "
"CMRM6122","SUP","Custom 27503206","","CMRM6122  -  ENVELOPE DFBR MED 2.5X2.75IN AIGISRX PCMKR ANBCTRL KNTD DISP","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CMRM6133","SUP","Custom 27503206","","CMRM6133  -  ENVELOPE DFBR 3.35X3IN AIGISRX RSRB MINOCYCLINE RFMPN PP","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CMW-18-190","SUP","HCPCS C1769","","CMW-18-190  -  GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH","BOTH IP/OP","$167.03 ","$123.60 ","$0.00 ","$167.03 ","$90.69 ","$0.00 ","$34.81 ","$0.00 ","$0.00 ","$29.24 ","$167.03 ","$0.00 ","$83.51 ","$132.29 ","$133.62 ","$0.00 ","$26.14 ","$0.00 ","$26.59 ","$0.00 "
"CO201037","SUP","HCPCS C1760","","CO201037  -  CLIP SURG HEMOSTATIC TEMPORARY NEUROLOGICAL RANEY PLST SCALP","BOTH IP/OP","$42.14 ","$31.18 ","$0.00 ","$42.14 ","$18.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.38 ","$42.14 ","$0.00 ","$21.07 ","$33.37 ","$33.72 ","$0.00 ","$6.60 ","$0.00 ","$6.71 ","$0.00 "
"CO-2324","SUP","HCPCS C1713","","CO-2324  -  SCREW BONE 2.3MM 24MM TI CORT NONSTRL","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"CO-2326","SUP","HCPCS C1713","","CO-2326  -  SCREW BONE 2.3MM 26MM TI CORT NONSTRL","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"CO261230","SUP","Custom 27203010","","CO261230  -  KIT CRANIOTOMY","BOTH IP/OP","$1,025.00 ","$758.50 ","$0.00 ","$1,025.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.00 ","$0.00 ","$512.50 ","$811.80 ","$820.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-2706","SUP","HCPCS C1713","","CO-2706  -  SCREW BONE 2MM 7MM 6MM CORT DORSAL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2708","SUP","HCPCS C1713","","CO-2708  -  SCREW BN 2.7MM 8MM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2710","SUP","HCPCS C1713","","CO-2710  -  SCREW BN 2.7MM 10MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2712","SUP","HCPCS C1713","","CO-2712  -  SCREW BN 2.7MM 12MM NS CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2714","SUP","HCPCS C1713","","CO-2714  -  SCREW BN 2.7MM 14MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2716","SUP","HCPCS C1713","","CO-2716  -  SCREW BN 2.7MM 16MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2718","SUP","HCPCS C1713","","CO-2718  -  SCREW BN 2.7MM 18MM NS CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2720","SUP","HCPCS C1713","","CO-2720  -  SCREW BN 2.7MM 20MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2722","SUP","HCPCS C1713","","CO-2722  -  SCREW BN 2.7MM 22MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-27225","SUP","HCPCS C1713","","CO-27225  -  SCREW BONE 2.7MM 22.5MM TI CORT ELB NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2724","SUP","HCPCS C1713","","CO-2724  -  SCREW BN 2.7MM 24MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2725","SUP","HCPCS C1713","","CO-2725  -  SCREW BN 2.7MM 25MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2726","SUP","HCPCS C1713","","CO-2726  -  SCREW BN 2.7MM 26MM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-27275","SUP","HCPCS C1713","","CO-27275  -  SCREW BONE 2.7MM 27.5MM TI CORT ELB NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2728","SUP","HCPCS C1713","","CO-2728  -  SCREW BN 2.7MM 28MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2730","SUP","HCPCS C1713","","CO-2730  -  SCREW BN 2.7MM 30MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2732","SUP","HCPCS C1713","","CO-2732  -  SCREW BN 2.7MM 32MM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2734","SUP","HCPCS C1713","","CO-2734  -  SCREW BN 2.7MM 34MM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2735","SUP","HCPCS C1713","","CO-2735  -  SCREW BONE 2.7MM 35MM TI CORT ELB NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2736","SUP","HCPCS C1713","","CO-2736  -  SCREW BN 2.7MM 36MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-27375","SUP","HCPCS C1713","","CO-27375  -  SCREW BONE 2.7MM 37.5MM CORT NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2738","SUP","HCPCS C1713","","CO-2738  -  SCREW BN 2.7MM 38MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2740","SUP","HCPCS C1713","","CO-2740  -  SCREW BN 2.7MM 40MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2745","SUP","HCPCS C1713","","CO-2745  -  SCREW BONE 2.7MM 45MM TI CORT NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2750","SUP","HCPCS C1713","","CO-2750  -  SCREW BN 2.7MM 50MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2755","SUP","HCPCS C1713","","CO-2755  -  SCREW BN 2.7MM 55MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2760","SUP","HCPCS C1713","","CO-2760  -  SCREW BN 2.7MM 60MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-2765","SUP","HCPCS C1713","","CO-2765  -  SCREW BONE 2.7MM 65MM TI CORT ORTH LCK NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3060","SUP","HCPCS C1713","","CO-3060  -  SCREW BONE 3.5MM 6MM CORT NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3080","SUP","HCPCS C1713","","CO-3080  -  SCREW BN 3.5MM 8MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3100","SUP","HCPCS C1713","","CO-3100  -  SCREW BN 3.5MM 10MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3110","SUP","HCPCS C1713","","CO-3110  -  SCREW BN 3.5MM 10MM NS NLCKG CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3120","SUP","HCPCS C1713","","CO-3120  -  SCREW BN 3.5MM 12MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3140","SUP","HCPCS C1713","","CO-3140  -  SCREW BN 3.5MM 14MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3150-S","SUP","HCPCS C1713","","CO-3150-S  -  SCREW BONE 3.5MM 15MM ACUMED TI CORT WR HND STRL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"CO-3160","SUP","HCPCS C1713","","CO-3160  -  SCREW BN 3.5MM 16MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3175-S","SUP","HCPCS C1713","","CO-3175-S  -  SCREW BONE 3.5MM 17.5MM ACUMED TI CORT WR HND STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"CO-3180","SUP","HCPCS C1713","","CO-3180  -  SCREW BN 3.5MM 18MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3200","SUP","HCPCS C1713","","CO-3200  -  SCREW BN 3.5MM 20MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3200-S","SUP","HCPCS C1713","","CO-3200-S  -  SCREW BONE 3.5MM 20MM CORT STRL","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"CO-3220","SUP","HCPCS C1713","","CO-3220  -  SCREW BN 3.5MM 22MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3225","SUP","HCPCS C1713","","CO-3225  -  SCREW BN 3.5MM 22.5MM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3240","SUP","HCPCS C1713","","CO-3240  -  SCREW BN 3.5MM 24MM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3250","SUP","HCPCS C1713","","CO-3250  -  SCREW BONE 3.5MM 25MM TI CORT NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3250-S","SUP","HCPCS C1713","","CO-3250-S  -  SCREW BONE L25 MM OD3.5 MM CORTICAL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3260","SUP","HCPCS C1713","","CO-3260  -  SCREW BN 3.5MM 26MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3275","SUP","HCPCS C1713","","CO-3275  -  SCREW BONE 3.5MM 27.5MM TI CORT ELB NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3280","SUP","HCPCS C1713","","CO-3280  -  SCREW BN 3.5MM 28MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO3300","SUP","HCPCS C1713","","CO3300  -  SCREW BONE 3.5MM 30MM TI CORT ORTH STRL","BOTH IP/OP","$135.85 ","$100.53 ","$0.00 ","$135.85 ","$61.13 ","$0.00 ","$28.31 ","$0.00 ","$0.00 ","$23.79 ","$135.85 ","$0.00 ","$67.93 ","$107.59 ","$108.68 ","$0.00 ","$21.26 ","$0.00 ","$21.63 ","$0.00 "
"CO-3300","SUP","HCPCS C1713","","CO-3300  -  SCREW BN 3.5MM 30MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3300-S","SUP","HCPCS C1713","","CO-3300-S  -  SCREW BONE 3.5MM 30MM ACUMED TI CORT WR HND STRL","BOTH IP/OP","$165.00 ","$122.10 ","$0.00 ","$165.00 ","$74.25 ","$0.00 ","$34.39 ","$0.00 ","$0.00 ","$28.89 ","$165.00 ","$0.00 ","$82.50 ","$130.68 ","$132.00 ","$0.00 ","$25.82 ","$0.00 ","$26.27 ","$0.00 "
"CO-3320","SUP","HCPCS C1713","","CO-3320  -  SCREW BN 3.5MM 32MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3325","SUP","HCPCS C1713","","CO-3325  -  SCREW BN 3.5MM 32.5MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3340","SUP","HCPCS C1713","","CO-3340  -  SCREW BONE 3.5MM 34MM TI CORT CLVCL SHLDR ANKL FT LCK","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3350","SUP","HCPCS C1713","","CO-3350  -  SCREW BONE 3.5MM 35MM TI CORT ELB NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3360","SUP","HCPCS C1713","","CO-3360  -  SCREW BN 3.5MM 36MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3375","SUP","HCPCS C1713","","CO-3375  -  SCREW BONE 3.5MM 37.5MM TI CORT NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3380","SUP","HCPCS C1713","","CO-3380  -  SCREW BN 3.5MM 38MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3400","SUP","HCPCS C1713","","CO-3400  -  SCREW BN 3.5MM 40MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3450","SUP","HCPCS C1713","","CO-3450  -  SCREW BN 3.5MM 45MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3500","SUP","HCPCS C1713","","CO-3500  -  SCREW BONE 3.5MM 50MM TI CORT FIB NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3550","SUP","HCPCS C1713","","CO-3550  -  SCREW BN 3.5MM 55MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3600","SUP","HCPCS C1713","","CO-3600  -  SCREW BN 3.5MM 60MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-3650","SUP","HCPCS C1713","","CO-3650  -  SCREW BN 3.5MM 65MM NS TI CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO431022","SUP","HCPCS C1713","","CO431022  -  PLATE BONE 150X150MM MESH TITANIUM CRANFCL","BOTH IP/OP","$2,950.00 ","$2,183.00 ","$0.00 ","$2,950.00 ","$1,327.50 ","$0.00 ","$614.85 ","$0.00 ","$0.00 ","$516.52 ","$2,950.00 ","$0.00 ","$1,475.00 ","$2,336.40 ","$2,360.00 ","$0.00 ","$461.68 ","$0.00 ","$469.64 ","$0.00 "
"CO431050","SUP","HCPCS C1713","","KIT CRANIOPLASTY 2 BAG POWDER 2 VIAL LIQUID 2 MATRIX BAG","BOTH IP/OP","$2,879.26 ","$2,130.65 ","$0.00 ","$2,879.26 ","$1,295.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$504.13 ","$2,879.26 ","$0.00 ","$1,439.63 ","$2,280.37 ","$2,303.41 ","$0.00 ","$450.60 ","$0.00 ","$458.38 ","$0.00 "
"CODA-2-10.0-35-120-32","SUP","HCPCS C2628","","CODA-2-10.0-35-120-32  -  CATH BALDILAT .035IN 10FR OD 32MM 120CM BALLON VASC PROS","BOTH IP/OP","$1,042.50 ","$771.45 ","$0.00 ","$1,042.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,042.50 ","$0.00 ","$521.25 ","$825.66 ","$834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CODA-2-10.0-35-120-40","SUP","HCPCS C2628","","CODA-2-10.0-35-120-40  -  CATH BALDILAT .035IN 10FR 40MM 120CM CODA 40ML","BOTH IP/OP","$1,042.50 ","$771.45 ","$0.00 ","$1,042.50 ","$0.00 ","$0.00 ","$217.28 ","$0.00 ","$0.00 ","$0.00 ","$1,042.50 ","$0.00 ","$521.25 ","$825.66 ","$834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-F2106","SUP","HCPCS C1713","","CO-F2106  -  SCREW BONE 2.1MM 6MM TI CORT WR HND CRCIFRM RECESS NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2108","SUP","HCPCS C1713","","CO-F2108  -  SCREW BN 2.1MM 8MM NLCKG TI","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2110","SUP","HCPCS C1713","","CO-F2110  -  SCREW BN 2.1MM 10MM NLCKG TI","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2112","SUP","HCPCS C1713","","CO-F2112  -  SCREW BN 2.1MM 12MM NLCKG TI","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2114","SUP","HCPCS C1713","","CO-F2114  -  SCREW BONE 2.1MM 14MM TI WR HND CRCIFRM NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2116","SUP","HCPCS C1713","","CO-F2116  -  SCREW BN 2.1MM 16MM NLCKG TI","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2118","SUP","HCPCS C1713","","CO-F2118  -  SCREW BONE 2.1MM 18MM TI CORT LCK NONSTRL MDLR HAND SYS","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2120","SUP","HCPCS C1713","","CO-F2120  -  SCREW BONE 2.1MM 20MM CORT NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2122","SUP","HCPCS C1713","","CO-F2122  -  SCREW BONE 2.1MM 22MM TI ORTH NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2124","SUP","HCPCS C1713","","CO-F2124  -  SCREW BONE 2.1MM 24MM TI CORT CRCIFRM RECESS NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2126","SUP","HCPCS C1713","","CO-F2126  -  SCREW BONE 2.1MM 26MM TI CORT CRCIFRM RECESS NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2128","SUP","HCPCS C1713","","CO-F2128  -  SCREW BONE 2.1MM 28MM TI CORT CRCIFRM RECESS NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2706","SUP","HCPCS C1713","","CO-F2706  -  SCREW BN 2.7MM 6MM NS CRFRM TI CORT MDLR HND SYS","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2708","SUP","HCPCS C1713","","CO-F2708  -  SCREW BN 2.7MM 8MM NS CRFRM TI CORT MDLR HND SYS","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2710","SUP","HCPCS C1713","","CO-F2710  -  SCREW BN 2.7MM 10MM NS CRFRM TI CORT MDLR HND SYS","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2712","SUP","HCPCS C1713","","CO-F2712  -  SCREW BN 2.7MM 12MM NS CRFRM TI CORT MDLR HND SYS","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2714","SUP","HCPCS C1713","","CO-F2714  -  SCREW BN 2.7MM 14MM CRFRM CORT","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2716","SUP","HCPCS C1713","","CO-F2716  -  SCREW BONE 2.7MM 16MM TI ORTH CRCIFRM NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2718","SUP","HCPCS C1713","","CO-F2718  -  SCREW BONE 2.7MM 18MM TI CORT LCK NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2720","SUP","HCPCS C1713","","CO-F2720  -  SCREW BONE 2.7MM 20MM TI CORT LCK NSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2722","SUP","HCPCS C1713","","CO-F2722  -  SCREW BONE 2.7MM 22MM TI CORT LCK NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2724","SUP","HCPCS C1713","","CO-F2724  -  SCREW BONE 2.7MM 24MM TI CORT LCK NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2726","SUP","HCPCS C1713","","CO-F2726  -  SCREW BONE 2.7MM 26MM ACUMED TI RADL ELB CRCIFRM STRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-F2728","SUP","HCPCS C1713","","CO-F2728  -  SCREW BONE 2.7MM 28MM TI CORT CRCIFRM NONSTRL","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$81.00 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"CO-FA2736","SUP","HCPCS C1713","","CO-FA2736  -  SCREW BONE 2.7MM 36MM TAP-LOC ACUMED CORT ELB STRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"CO-FA3545","SUP","HCPCS C1713","","CO-FA3545  -  SCREW BONE 3.5MM 45MM TAP-LOC ACUMED ELB STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"CO-FA3555","SUP","HCPCS C1713","","CO-FA3555  -  SCREW BONE 3.5MM 55MM TAP-LOC ACUMED ELB STRL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"COL-2080","SUP","HCPCS C1713","","COL-2080  -  SCREW BN 2.7MM 8MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2100","SUP","HCPCS C1713","","COL-2100  -  SCREW BONE 2.7MM 10MM TI CORT ELB LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2120","SUP","HCPCS C1713","","COL-2120  -  SCREW BN 2.7MM 12MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2140","SUP","HCPCS C1713","","COL-2140  -  SCREW BN 2.7MM 14MM NS LCK HEX TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2160","SUP","HCPCS C1713","","COL-2160  -  SCREW BN 2.7MM 16MM NS LCK HEX TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2180","SUP","HCPCS C1713","","COL-2180  -  SCREW BN 2.7MM 18MM NS LCK HEX TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2200","SUP","HCPCS C1713","","COL-2200  -  SCREW BN 2.7MM 20MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2220","SUP","HCPCS C1713","","COL-2220  -  SCREW BN 2.7MM 22MM NS LCK HEX TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2240","SUP","HCPCS C1713","","COL-2240  -  SCREW BONE 2.7MM 24MM TI CORT ELB LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2250","SUP","HCPCS C1713","","COL-2250  -  SCREW BONE 2.7MM 25MM CORT SCAPULAR LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2260","SUP","HCPCS C1713","","COL-2260  -  SCREW BONE 2.7MM 26MM TI CORT ELB LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2280","SUP","HCPCS C1713","","COL-2280  -  SCREW BONE 2.7MM 28MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2300","SUP","HCPCS C1713","","COL-2300  -  SCREW BONE 2.7MM 30MM CORT LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2320","SUP","HCPCS C1713","","COL-2320  -  SCREW BONE 2.7MM 32MM CORT LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2340","SUP","HCPCS C1713","","COL-2340  -  SCREW BONE 2.7MM 34MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2360","SUP","HCPCS C1713","","COL-2360  -  SCREW BONE 2.7MM 36MM CORT LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2380","SUP","HCPCS C1713","","COL-2380  -  SCREW BONE 2.7MM 38MM TI FULTHD CORT LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2400","SUP","HCPCS C1713","","COL-2400  -  SCREW BONE 2.7MM 40MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2450","SUP","HCPCS C1713","","COL-2450  -  SCREW BONE 2.7MM 45MM CORT SCAPULAR LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2500","SUP","HCPCS C1713","","COL-2500  -  SCREW BONE 2.7MM 50MM CORT SCAPULAR LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2550","SUP","HCPCS C1713","","COL-2550  -  SCREW BONE 2.7MM 55MM CORT SCAPULAR LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2600","SUP","HCPCS C1713","","COL-2600  -  SCREW BN 2.7MM 60MM NS LCK HEX TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2650","SUP","HCPCS C1713","","COL-2650  -  SCREW BONE 2.7MM 65MM CORT SCAPULAR LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2718","SUP","HCPCS C1713","","COL-2718  -  SCREW BONE 2.7MM 18MM CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2720","SUP","HCPCS C1713","","COL-2720  -  SCREW BONE 2.7MM 20MM CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-2722","SUP","HCPCS C1713","","COL-2722  -  SCREW BONE 2.7MM 22MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3060","SUP","HCPCS C1713","","COL-3060  -  SCREW BONE 3.5MM 6MM CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3080","SUP","HCPCS C1713","","COL-3080  -  SCREW BONE 3.5MM 8MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3100","SUP","HCPCS C1713","","COL-3100  -  SCREW BONE 3.5MM 10MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3120","SUP","HCPCS C1713","","COL-3120  -  SCREW BONE 3.5MM 12MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"CO-L3120","SUP","HCPCS C1713","","CO-L3120  -  SCREW BONE 3.5MM 12MM CORT LCK NSTRL","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"COL-3140","SUP","HCPCS C1713","","COL-3140  -  SCREW BONE 3.5MM 14MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"CO-L3140","SUP","HCPCS C1713","","CO-L3140  -  SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"COL-3160","SUP","HCPCS C1713","","COL-3160  -  SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3180","SUP","HCPCS C1713","","COL-3180  -  SCREW BONE 3.5MM 18MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"CO-L3180","SUP","HCPCS C1713","","CO-L3180  -  SCREW BONE 3.5MM 18MM ACLC ACUMED CORT ORTH LCK STRL","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"COL-3200","SUP","HCPCS C1713","","COL-3200  -  SCREW BONE 3.5MM 20MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3220","SUP","HCPCS C1713","","COL-3220  -  SCREW BONE 3.5MM 22MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3225","SUP","HCPCS C1713","","COL-3225  -  SCREW BONE 3.5MM 22.5MM CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3240","SUP","HCPCS C1713","","COL-3240  -  SCREW BONE 3.5MM 24MM ACUMED TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3250","SUP","HCPCS C1713","","COL-3250  -  SCREW BONE 3.5MM 25MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3260","SUP","HCPCS C1713","","COL-3260  -  SCREW BONE 3.5MM 26MM ACUMED TI DISTAL RADL CORT CLVCL WR","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3275","SUP","HCPCS C1713","","COL-3275  -  SCREW BONE 3.5MM 27.5MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3280","SUP","HCPCS C1713","","COL-3280  -  SCREW BONE 3.5MM 28MM TI DISTAL RADL CORT CLVCL WR HND LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3300","SUP","HCPCS C1713","","COL-3300  -  SCREW BN 3.5MM 30MM NS TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3320","SUP","HCPCS C1713","","COL-3320  -  SCREW BN 3.5MM 32MM NS LCK TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3340","SUP","HCPCS C1713","","COL-3340  -  SCREW BONE 3.5MM 34MM TI CORT LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3360","SUP","HCPCS C1713","","COL-3360  -  SCREW BN 3.5MM 36MM NS LCK TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3380","SUP","HCPCS C1713","","COL-3380  -  SCREW BN 3.5MM 38MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3400","SUP","HCPCS C1713","","COL-3400  -  SCREW BN 3.5MM 40MM NS LCK TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3450","SUP","HCPCS C1713","","COL-3450  -  SCREW BN 3.5MM 45MM NS LCK TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3500","SUP","HCPCS C1713","","COL-3500  -  SCREW BN 3.5MM 50MM NS LCK TI CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3550","SUP","HCPCS C1713","","COL-3550  -  SCREW BN 3.5MM 55MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3600","SUP","HCPCS C1713","","COL-3600  -  SCREW BN 3.5MM 60MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COL-3650","SUP","HCPCS C1713","","COL-3650  -  SCREW BN 3.5MM 65MM LCK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"COLS-35080-TS","SUP","HCPCS C1713","","COLS-35080-TS  -  SCREW BN 3.5MM 8MM LCK TI RDS CORT DIST","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35090-TS","SUP","HCPCS C1713","","COLS-35090-TS  -  SCREW BN 3.5MM 9MM LCK TI RDS CORT DIST","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35100-TS","SUP","HCPCS C1713","","COLS-35100-TS  -  SCREW BN 3.5MM 10MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35110-TS","SUP","HCPCS C1713","","COLS-35110-TS  -  SCREW BN 3.5MM 11MM BRNZ NS GEMINUS LCK TI CORT VOLR DIST","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"COLS-35120-TS","SUP","HCPCS C1713","","COLS-35120-TS  -  SCREW BN 3.5MM 12MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35130-TS","SUP","HCPCS C1713","","COLS-35130-TS  -  SCREW BN 3.5MM 13MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35140-TS","SUP","HCPCS C1713","","COLS-35140-TS  -  SCREW BN 3.5MM 14MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35150-TS","SUP","HCPCS C1713","","COLS-35150-TS  -  SCREW BN 3.5MM 15MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35160-TS","SUP","HCPCS C1713","","COLS-35160-TS  -  SCREW BN 3.5MM 16MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"COLS-35180-TS","SUP","HCPCS C1713","","COLS-35180-TS  -  SCREW BN 3.5MM 18MM NS GEMINUS LCK TI DIST CORT VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"CO-N2308","SUP","HCPCS C1713","","CO-N2308  -  SCREW BN 2.3MM 8MM NONTOGGLING","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2310","SUP","HCPCS C1713","","CO-N2310  -  SCREW BN 2.3MM 10MM NONTOGGLING CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2312","SUP","HCPCS C1713","","CO-N2312  -  SCREW BN 2.3MM 12MM NLCKG","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2314","SUP","HCPCS C1713","","CO-N2314  -  SCREW BN 2.3MM 14MM SLVR NS NONTOGGLE HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2316","SUP","HCPCS C1713","","CO-N2316  -  SCREW BN 2.3MM 16MM SLVR NS NONTOGGLE HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2318","SUP","HCPCS C1713","","CO-N2318  -  SCREW BN 2.3MM 18MM SLVR NS NONTOGGLE HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2320","SUP","HCPCS C1713","","CO-N2320  -  SCREW BN 2.3MM 20MM SLVR NS NONTOGGLE HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2322","SUP","HCPCS C1713","","CO-N2322  -  SCREW BN 2.3MM 22MM SLVR NS NONTOGGLE HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2324","SUP","HCPCS C1713","","CO-N2324  -  SCREW BONE 2.3MM 24MM ACLC ACUMED TI DISTAL RADL WR HND","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CON-2326","SUP","HCPCS C1713","","CON-2326  -  SCREW BONE 2.3MM 26MM ACLC ACUMED DISTAL RADL WR HND","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"CO-N2326","SUP","HCPCS C1713","","CO-N2326  -  SCREW BONE 2.3MM 26MM ACLC ACUMED TI THRD DISTAL RADL WR HND","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2328","SUP","HCPCS C1713","","CO-N2328  -  SCREW 2.3MM X 28MM NON-TOGGLING CORTICAL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2330","SUP","HCPCS C1713","","CO-N2330  -  SCREW BONE 2.3MM 30MM ACLC ACUMED TI THRD DISTAL RADL WR HND","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2332","SUP","HCPCS C1713","","CO-N2332  -  SCREW BN 2.3MM 32MM STRL NONTOGGLING CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2334","SUP","HCPCS C1713","","CO-N2334  -  SCREW BONE 2.3MM 34MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2336","SUP","HCPCS C1713","","CO-N2336  -  SCREW BONE 2.3MM 36MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2338","SUP","HCPCS C1713","","CO-N2338  -  SCREW BONE 2.3MM 38MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2340","SUP","HCPCS C1713","","CO-N2340  -  SCREW BONE 2.3MM 40MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2342","SUP","HCPCS C1713","","CO-N2342  -  SCREW BONE 2.3MM 42MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2344","SUP","HCPCS C1713","","CO-N2344  -  SCREW BONE 2.3MM 44MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-N2346","SUP","HCPCS C1713","","CO-N2346  -  SCREW BONE 2.3MM 46MM ACLC 2 DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CONSULTAMMAM","SUP","HCPCS C2621","","CONSULTAMMAM  -  CONSULTA CRT-D ADVANCED SYSTEM","BOTH IP/OP","$60,500.00 ","$44,770.00 ","$0.00 ","$60,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60,500.00 ","$0.00 ","$30,250.00 ","$47,916.00 ","$48,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2112","SUP","HCPCS C1713","","CO-S2112  -  SCREW BONE 2.1MM 12MM CORT LP STRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"CO-S2114","SUP","HCPCS C1713","","CO-S2114  -  SCREW BONE 2.1MM 14MM CORT LP STRL","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"CO-S2308","SUP","Custom 27803010","","CO-S2308  -  PEG FIX 2.3MM 8MM CORT LCK ACUMED STRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2310","SUP","HCPCS C1713","","CO-S2310  -  PEG FX 2.3MM 10MM LCK SMTH","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-S2312","SUP","Custom 27203010","","CO-S2312  -  PEG FIX 2.3MM 12MM CORT LCK STRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2314","SUP","Custom 27803010","","CO-S2314  -  PEG 2.3MM 14MM CORT LCK TI NONSTRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2316","SUP","Custom 27803010","","CO-S2316  -  PEG FX 2.3MM 16MM SMTH LCK CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2318","SUP","Custom 27803010","","CO-S2318  -  PEG 2.3MM 18MM DISTAL RADL WR HND LCK SMTH TI NONSTRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2320","SUP","Custom 27803010","","CO-S2320  -  PEG BONE 20MM 2.3MM CORT SMTH LCK STRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2322","SUP","Custom 27803010","","CO-S2322  -  PEG BONE 22MM 2.3MM ACLC CORT SMTH LCK","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2324","SUP","Custom 27803010","","CO-S2324  -  PEG 2.3MM 24MM DISTAL RADL WR HND LCK SMTH TI ACUMED STRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2326","SUP","Custom 27803010","","CO-S2326  -  PEG 2.3MM 26MM WR HND LCK SMTH TI ACUMED STRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CO-S2328","SUP","HCPCS C1713","","CO-S2328  -  PEG FX 2.3MM 28MM SMTH LCK CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-S2714","SUP","HCPCS C1713","","CO-S2714  -  SCREW BONE 2.7MM 14MM CORT LP STRL","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$65.25 ","$0.00 ","$30.22 ","$0.00 ","$0.00 ","$25.39 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$22.69 ","$0.00 ","$23.08 ","$0.00 "
"CO-T2308","SUP","HCPCS C1713","","CO-T2308  -  SCREW BN FT 2.3MM 8MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2310","SUP","HCPCS C1713","","CO-T2310  -  SCREW BN FT 2.3MM 10MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2312","SUP","HCPCS C1713","","CO-T2312  -  SCREW BN FT 2.3MM 12MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"COT-2314","SUP","HCPCS C1713","","COT-2314  -  SCREW BONE 2.3MM 14MM CORT LCK NSTRL","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"CO-T2314","SUP","HCPCS C1713","","CO-T2314  -  SCREW BN FT 2.3MM 14MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2316","SUP","HCPCS C1713","","CO-T2316  -  SCREW BN FT 2.3MM 16MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2318","SUP","HCPCS C1713","","CO-T2318  -  SCREW BN FT 2.3MM 18MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2320","SUP","HCPCS C1713","","CO-T2320  -  SCREW BN FT 2.3MM 20MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2322","SUP","HCPCS C1713","","CO-T2322  -  SCREW BN FT 2.3MM 22MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2324","SUP","HCPCS C1713","","CO-T2324  -  SCREW BN FT 2.3MM 24MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2326","SUP","HCPCS C1713","","CO-T2326  -  SCREW BN FT 2.3MM 26MM AU NS LCK HEX TI CORT","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2328","SUP","HCPCS C1713","","CO-T2328  -  SCREW BONE 2.3MM 28MM ACUMED TI THRD DISTAL RADL CORT WR HND","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2330","SUP","HCPCS C1713","","CO-T2330  -  SCREW CORTICAL LOCK 2.3MM X 30MM","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2332","SUP","HCPCS C1713","","CO-T2332  -  SCREW BONE 2.3MM 32MM ACLC 2 FULTHD DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2334","SUP","HCPCS C1713","","CO-T2334  -  SCREW BONE 2.3MM 34MM CORT LCK","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2336","SUP","HCPCS C1713","","CO-T2336  -  SCREW BONE 2.3MM 36MM CORT LCK","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2338","SUP","HCPCS C1713","","CO-T2338  -  SCREW BONE 2.3MM 38MM ACLC 2 FULTHD DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2340","SUP","HCPCS C1713","","CO-T2340  -  SCREW BONE 2.3MM 24MM TI CORT ELB LCK NONSTRL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2342","SUP","HCPCS C1713","","CO-T2342  -  SCREW BONE 2.3MM 42MM ACLC 2 FULTHD DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2344","SUP","HCPCS C1713","","CO-T2344  -  SCREW BONE 2.3MM 44MM ACLC 2 FULTHD DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CO-T2346","SUP","HCPCS C1713","","CO-T2346  -  SCREW BONE 2.3MM 46MM ACLC 2 FULTHD DISTAL VOLR CORT RADL","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$99.00 ","$0.00 ","$45.85 ","$0.00 ","$0.00 ","$38.52 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$34.43 ","$0.00 ","$35.02 ","$0.00 "
"CP320340","SUP","HCPCS C1713","","CP320340  -  CUSTOM KNEE ARTHRODESIS NAIL 11.5X880MM","BOTH IP/OP","$16,225.00 ","$12,006.50 ","$0.00 ","$16,225.00 ","$7,301.25 ","$0.00 ","$3,381.70 ","$0.00 ","$0.00 ","$2,840.87 ","$16,225.00 ","$0.00 ","$8,112.50 ","$12,850.20 ","$12,980.00 ","$0.00 ","$2,539.21 ","$0.00 ","$2,583.02 ","$0.00 "
"CP326963","SUP","HCPCS C1713","","CP326963  -  ASNIS SCREW 8.0 X 160MM","BOTH IP/OP","$1,097.25 ","$811.97 ","$0.00 ","$1,097.25 ","$493.76 ","$0.00 ","$228.69 ","$0.00 ","$0.00 ","$192.12 ","$1,097.25 ","$0.00 ","$548.63 ","$869.02 ","$877.80 ","$0.00 ","$171.72 ","$0.00 ","$174.68 ","$0.00 "
"CP326981","SUP","HCPCS C1713","","CP326981  -  ASNIS SCREW 8.0 X 180MM","BOTH IP/OP","$1,097.25 ","$811.97 ","$0.00 ","$1,097.25 ","$493.76 ","$0.00 ","$228.69 ","$0.00 ","$0.00 ","$192.12 ","$1,097.25 ","$0.00 ","$548.63 ","$869.02 ","$877.80 ","$0.00 ","$171.72 ","$0.00 ","$174.68 ","$0.00 "
"CP390009","SUP","HCPCS C1713","","CP390009  -  WASHER 26MM","BOTH IP/OP","$140.25 ","$103.79 ","$0.00 ","$140.25 ","$63.11 ","$0.00 ","$29.23 ","$0.00 ","$0.00 ","$24.56 ","$140.25 ","$0.00 ","$70.13 ","$111.08 ","$112.20 ","$0.00 ","$21.95 ","$0.00 ","$22.33 ","$0.00 "
"CP425737","SUP","HCPCS C1713","","CP425737  -  CUSTOM CLAVICLE PLATE","BOTH IP/OP","$4,400.00 ","$3,256.00 ","$0.00 ","$4,400.00 ","$1,980.00 ","$0.00 ","$917.07 ","$0.00 ","$0.00 ","$770.40 ","$4,400.00 ","$0.00 ","$2,200.00 ","$3,484.80 ","$3,520.00 ","$0.00 ","$688.60 ","$0.00 ","$700.48 ","$0.00 "
"CP427181","SUP","HCPCS C1713","","CP427181  -  AXSOS CUSTOM-MADE DEVICE_ HUMERUS PLATE 8-HOLES","BOTH IP/OP","$4,812.50 ","$3,561.25 ","$0.00 ","$4,812.50 ","$2,165.63 ","$0.00 ","$1,003.05 ","$0.00 ","$0.00 ","$842.63 ","$4,812.50 ","$0.00 ","$2,406.25 ","$3,811.50 ","$3,850.00 ","$0.00 ","$753.16 ","$0.00 ","$766.15 ","$0.00 "
"CP427182","SUP","HCPCS C1713","","CP427182  -  AXSOS CUSTOM-MADE DEVICE - HUMERUS PLATE 6 HOLES","BOTH IP/OP","$9,625.00 ","$7,122.50 ","$0.00 ","$9,625.00 ","$4,331.25 ","$0.00 ","$2,006.09 ","$0.00 ","$0.00 ","$1,685.26 ","$9,625.00 ","$0.00 ","$4,812.50 ","$7,623.00 ","$7,700.00 ","$0.00 ","$1,506.31 ","$0.00 ","$1,532.30 ","$0.00 "
"CP461006","SUP","Custom 27803010","","CP461006  -  TRIAL SURG 4CM OSS DPHSL IMPL","BOTH IP/OP","$2,500,000.00 ","$1,850,000.00 ","$0.00 ","$2,500,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,500,000.00 ","$0.00 ","$1,250,000.00 ","$1,980,000.00 ","$2,000,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP5080-2-112","SUP","Custom 27203010","","CP5080-2-112  -  APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 12MM","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP5080-2-120","SUP","Custom 27203010","","CP5080-2-120  -  APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 20MM","BOTH IP/OP","$220.00 ","$162.80 ","$0.00 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$220.00 ","$0.00 ","$110.00 ","$174.24 ","$176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP5080-2-212","SUP","Custom 27203010","","CP5080-2-212  -  CUSTOM-MADE DEVICE APEX DIA 2MM 100 X 12MM","BOTH IP/OP","$364.38 ","$269.64 ","$0.00 ","$364.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$364.38 ","$0.00 ","$182.19 ","$288.59 ","$291.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP5080-2-220","SUP","Custom 27203010","","CP5080-2-220  -  CUSTOM-MADE DEVICE APEX DIA 2MM 100 X 20MM","BOTH IP/OP","$364.38 ","$269.64 ","$0.00 ","$364.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$364.38 ","$0.00 ","$182.19 ","$288.59 ","$291.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP5150-2-864","SUP","Custom 27803010","","CP5150-2-864  -  MONOTUBE TRIAX DIA 20 X 640MM","BOTH IP/OP","$3,118.50 ","$2,307.69 ","$0.00 ","$3,118.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,118.50 ","$0.00 ","$1,559.25 ","$2,469.85 ","$2,494.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP606155","SUP","Custom 27803010","","CP606155  -  ASNIS III DIA 6.5 X 155MM - CUSTOM MADE DEVICE","BOTH IP/OP","$1,080.75 ","$799.76 ","$0.00 ","$1,080.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,080.75 ","$0.00 ","$540.38 ","$855.95 ","$864.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP606160","SUP","Custom 27803010","","CP606160  -  ASNIS III DIA 6.5 X 160MM - CUSTOM MADE DEVICE","BOTH IP/OP","$1,080.75 ","$799.76 ","$0.00 ","$1,080.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,080.75 ","$0.00 ","$540.38 ","$855.95 ","$864.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CP910","SUP","HCPCS L8614","","CP910  -  PROCESSOR SOUND EARHOOK INDICATOR LIGHT RECHARGABLE BATTERY","BOTH IP/OP","$23,250.00 ","$17,205.00 ","$0.00 ","$23,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,250.00 ","$0.00 ","$11,625.00 ","$18,414.00 ","$18,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CPO-6","SUP","Custom 27011340","","CPO-6  -  CATHETER SURG 6FR PNEUMO COLPOTOMY LATEX FREE COLPO-PNEUMO","BOTH IP/OP","$109.68 ","$81.16 ","$0.00 ","$109.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.68 ","$0.00 ","$54.84 ","$86.87 ","$87.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C-PTISY-100-HC-PERC8","SUP","HCPCS C1769","","C-PTISY-100-HC-PERC8  -  INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT","BOTH IP/OP","$905.05 ","$669.74 ","$0.00 ","$905.05 ","$491.44 ","$0.00 ","$188.64 ","$0.00 ","$0.00 ","$158.47 ","$905.05 ","$0.00 ","$452.53 ","$716.80 ","$724.04 ","$0.00 ","$141.64 ","$0.00 ","$144.08 ","$0.00 "
"CQ75102","SUP","HCPCS C1725","","CQ75102  -  CATHETER BLNDIL 10MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$359.74 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"CQ75104","SUP","HCPCS C1725","","CQ75104  -  CATHETER BLNDIL 10MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ75122","SUP","HCPCS C1725","","CQ75122  -  CATHETER BLNDIL 12MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ75124","SUP","HCPCS C1725","","CQ75124  -  CATHETER BLNDIL 12MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ7552","SUP","HCPCS C1725","","CQ7552  -  CATHETER BLNDIL 5MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ7554","SUP","HCPCS C1725","","CQ7554  -  CATHETER BLNDIL 5MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ7562","SUP","HCPCS C1725","","CQ7562  -  CATHETER BLNDIL 6MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$359.74 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"CQ7564","SUP","HCPCS C1725","","CQ7564  -  CATHETER BLNDIL 6MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ7572","SUP","HCPCS C1725","","CQ7572  -  CATHETER BLNDIL 7MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$359.74 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"CQ7574","SUP","HCPCS C1725","","CQ7574  -  CATHETER BLNDIL 7MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$662.50 ","$490.25 ","$0.00 ","$662.50 ","$359.74 ","$0.00 ","$138.08 ","$0.00 ","$0.00 ","$116.00 ","$662.50 ","$0.00 ","$331.25 ","$524.70 ","$530.00 ","$0.00 ","$103.68 ","$0.00 ","$105.47 ","$0.00 "
"CQ7582","SUP","HCPCS C1725","","CQ7582  -  CATHETER BLNDIL 8MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CQ7584","SUP","HCPCS C1725","","CQ7584  -  CATHETER BLNDIL 8MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$251.14 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"CR5BU0.100","SUP","HCPCS V2632","","CR5BU0.100  -  LENS IOL +10 DIOP 13.5MM 7MM PSTCHBR BICNVX 1 PC PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.105","SUP","HCPCS V2632","","CR5BU0.105  -  LENS IOL +10.5 DIOP 13.5MM 7MM PSTCHBR BICNVX 1 PC PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.110","SUP","HCPCS V2632","","CR5BU0.110  -  LENS INTRAOCULAR PMMA 11.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.115","SUP","HCPCS V2632","","CR5BU0.115  -  LENS INTRAOCULAR PMMA 11.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.120","SUP","HCPCS V2632","","CR5BU0.120  -  LENS INTRAOCULAR PMMA 12.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.125","SUP","HCPCS V2632","","CR5BU0.125  -  LENS INTRAOCULAR PMMA 12.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.130","SUP","HCPCS V2632","","CR5BU0.130  -  LENS INTRAOCULAR PMMA 13.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.135","SUP","HCPCS V2632","","CR5BU0.135  -  LENS INTRAOCULAR PMMA 13.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.140","SUP","HCPCS V2632","","CR5BU0.140  -  LENS INTRAOCULAR PMMA 14.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.145","SUP","HCPCS V2632","","CR5BU0.145  -  LENS INTRAOCULAR PMMA 14.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.150","SUP","HCPCS V2632","","CR5BU0.150  -  LENS INTRAOCULAR PMMA 15.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.155","SUP","HCPCS V2632","","CR5BU0.155  -  LENS INTRAOCULAR PMMA 15.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.160","SUP","HCPCS V2632","","CR5BU0.160  -  LENS INTRAOCULAR PMMA 16.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.165","SUP","HCPCS V2632","","CR5BU0.165  -  LENS INTRAOCULAR PMMA 16.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.170","SUP","HCPCS V2632","","CR5BU0.170  -  LENS INTRAOCULAR PMMA 17.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.175","SUP","HCPCS V2632","","CR5BU0.175  -  LENS INTRAOCULAR PMMA 17.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.180","SUP","HCPCS V2632","","CR5BU0.180  -  LENS INTRAOCULAR PMMA 18.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.185","SUP","HCPCS V2632","","CR5BU0.185  -  LENS INTRAOCULAR PMMA 18.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.190","SUP","HCPCS V2632","","CR5BU0.190  -  LENS INTRAOCULAR PMMA 19.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.195","SUP","HCPCS V2632","","CR5BU0.195  -  LENS INTRAOCULAR PMMA 19.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.200","SUP","HCPCS V2632","","CR5BU0.200  -  LENS INTRAOCULAR PMMA 20.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.205","SUP","HCPCS V2632","","CR5BU0.205  -  LENS INTRAOCULAR PMMA 20.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.210","SUP","HCPCS V2632","","CR5BU0.210  -  LENS INTRAOCULAR PMMA 21.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.215","SUP","HCPCS V2632","","CR5BU0.215  -  LENS INTRAOCULAR PMMA 21.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.220","SUP","HCPCS V2632","","CR5BU0.220  -  LENS INTRAOCULAR PMMA 22.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.225","SUP","HCPCS V2632","","CR5BU0.225  -  LENS INTRAOCULAR PMMA 22.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.230","SUP","HCPCS V2632","","CR5BU0.230  -  LENS INTRAOCULAR PMMA 23.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.235","SUP","HCPCS V2632","","CR5BU0.235  -  LENS INTRAOCULAR PMMA 23.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.240","SUP","HCPCS V2632","","CR5BU0.240  -  LENS INTRAOCULAR PMMA 24.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.245","SUP","HCPCS V2632","","CR5BU0.245  -  LENS INTRAOCULAR PMMA 24.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.250","SUP","HCPCS V2632","","CR5BU0.250  -  LENS INTRAOCULAR PMMA 25.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.255","SUP","HCPCS V2632","","CR5BU0.255  -  LENS INTRAOCULAR PMMA 25.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.260","SUP","HCPCS V2632","","CR5BU0.260  -  LENS INTRAOCULAR PMMA 26.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.265","SUP","HCPCS V2632","","CR5BU0.265  -  LENS INTRAOCULAR PMMA 26.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.270","SUP","HCPCS V2632","","CR5BU0.270  -  LENS INTRAOCULAR PMMA 27.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.275","SUP","HCPCS V2632","","CR5BU0.275  -  LENS INTRAOCULAR PMMA 27.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.280","SUP","HCPCS V2632","","CR5BU0.280  -  LENS INTRAOCULAR PMMA 28.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.285","SUP","HCPCS V2632","","CR5BU0.285  -  LENS INTRAOCULAR PMMA 28.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.290","SUP","HCPCS V2632","","CR5BU0.290  -  LENS INTRAOCULAR PMMA 29.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.295","SUP","HCPCS V2632","","CR5BU0.295  -  LENS INTRAOCULAR PMMA 29.5 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR5BU0.300","SUP","HCPCS V2632","","CR5BU0.300  -  LENS INTRAOCULAR PMMA 30.0 DIOPTER L13.5 MM OD7 MM","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.040","SUP","HCPCS V2632","","CR70BU.040  -  LENS IOL 10 D +4 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.045","SUP","HCPCS V2632","","CR70BU.045  -  LENS IOL 10 D +4.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.050","SUP","HCPCS V2632","","CR70BU.050  -  LENS IOL 10 D +5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.055","SUP","HCPCS V2632","","CR70BU.055  -  LENS IOL 10 D +5.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.060","SUP","HCPCS V2632","","CR70BU.060  -  LENS IOL 10 D +6 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.065","SUP","HCPCS V2632","","CR70BU.065  -  LENS IOL 10 D +6.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.070","SUP","HCPCS V2632","","CR70BU.070  -  LENS IOL 10 D +7 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.075","SUP","HCPCS V2632","","CR70BU.075  -  LENS IOL 10 D +7.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.080","SUP","HCPCS V2632","","CR70BU.080  -  LENS IOL 10 D +8 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.085","SUP","HCPCS V2632","","CR70BU.085  -  LENS IOL 10 D +8.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.090","SUP","HCPCS V2632","","CR70BU.090  -  LENS IOL 10 D +9 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.095","SUP","HCPCS V2632","","CR70BU.095  -  LENS IOL 10 D +9.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.100","SUP","HCPCS V2632","","CR70BU.100  -  LENS IOL 10 D +10 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.105","SUP","HCPCS V2632","","CR70BU.105  -  LENS IOL 10 D +10.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.110","SUP","HCPCS V2632","","CR70BU.110  -  LENS IOL 10 D +11 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.115","SUP","HCPCS V2632","","CR70BU.115  -  LENS IOL 10 D +11.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.120","SUP","HCPCS V2632","","CR70BU.120  -  LENS IOL 10 D +12 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.125","SUP","HCPCS V2632","","CR70BU.125  -  LENS IOL 10 D +12.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.130","SUP","HCPCS V2632","","CR70BU.130  -  LENS IOL 10 D +13 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.135","SUP","HCPCS V2632","","CR70BU.135  -  LENS IOL 10 D +13.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.140","SUP","HCPCS V2632","","CR70BU.140  -  LENS IOL 10 D +14 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.145","SUP","HCPCS V2632","","CR70BU.145  -  LENS IOL 10 D +14.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.150","SUP","HCPCS V2632","","CR70BU.150  -  LENS IOL 10 D +15 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.155","SUP","HCPCS V2632","","CR70BU.155  -  LENS IOL 10 D +15.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.160","SUP","HCPCS V2632","","CR70BU.160  -  LENS IOL 10 D +16 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.165","SUP","HCPCS V2632","","CR70BU.165  -  LENS IOL 10 D +16.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.170","SUP","HCPCS V2632","","CR70BU.170  -  LENS IOL 10 D +17 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.175","SUP","HCPCS V2632","","CR70BU.175  -  LENS IOL 10 D +17.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.180","SUP","HCPCS V2632","","CR70BU.180  -  LENS IOL 10 D +18 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.185","SUP","HCPCS V2632","","CR70BU.185  -  LENS IOL 10 D +18.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.190","SUP","HCPCS V2632","","CR70BU.190  -  LENS IOL 10 D +19 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.195","SUP","HCPCS V2632","","CR70BU.195  -  LENS IOL 10 D +19.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.200","SUP","HCPCS V2632","","CR70BU.200  -  LENS IOL 10 D +20 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.205","SUP","HCPCS V2632","","CR70BU.205  -  LENS IOL 10 D +20.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.210","SUP","HCPCS V2632","","CR70BU.210  -  LENS IOL 10 D +21 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.215","SUP","HCPCS V2632","","CR70BU.215  -  LENS IOL 10 D +21.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.220","SUP","HCPCS V2632","","CR70BU.220  -  LENS IOL 10 D +22 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.225","SUP","HCPCS V2632","","CR70BU.225  -  LENS IOL 10 D +22.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.230","SUP","HCPCS V2632","","CR70BU.230  -  LENS IOL 10 D +23 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.235","SUP","HCPCS V2632","","CR70BU.235  -  LENS IOL 10 D +23.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.240","SUP","HCPCS V2632","","CR70BU.240  -  LENS IOL 10 D +24 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.245","SUP","HCPCS V2632","","CR70BU.245  -  LENS IOL 10 D +24.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.250","SUP","HCPCS V2632","","CR70BU.250  -  LENS IOL 10 D +25 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.255","SUP","HCPCS V2632","","CR70BU.255  -  LENS IOL 10 D +25.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.260","SUP","HCPCS V2632","","CR70BU.260  -  LENS IOL 10 D +26 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.265","SUP","HCPCS V2632","","CR70BU.265  -  LENS IOL 10 D +26.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.270","SUP","HCPCS V2632","","CR70BU.270  -  LENS IOL 10 D +27 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.275","SUP","HCPCS V2632","","CR70BU.275  -  LENS IOL 10 D +27.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.280","SUP","HCPCS V2632","","CR70BU.280  -  LENS IOL 10 D +28 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.285","SUP","HCPCS V2632","","CR70BU.285  -  LENS IOL 10 D +28.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.290","SUP","HCPCS V2632","","CR70BU.290  -  LENS IOL 10 D +29 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.295","SUP","HCPCS V2632","","CR70BU.295  -  LENS IOL 10 D +29.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CR70BU.300","SUP","HCPCS V2632","","CR70BU.300  -  LENS IOL 10 D +30 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CS-01701","SUP","HCPCS C1726","","CS-01701  -  KIT CHLGM 4FR 10FR 60CM 1.25ML 21.4CM 2 LUM 3W STPCK CATH","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"CS-12","SUP","HCPCS C1713","","CS-12  -  SCREW BONE 3.5MM 12MM DVR TI DISTAL RADL VOLR CORT","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"CS-16","SUP","HCPCS C1713","","CS-16  -  SCREW BONE 3.5MM 16MM DVR TI DISTAL RADL VOLR CORT","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"CS-18","SUP","HCPCS C1713","","CS-18  -  SCREW BONE 3.5MM 18MM DVR TI DISTAL RADL VOLR CORT","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"CS220-ICC","SUP","Custom 27203010","","DRESSING NADH VAC GFM FOAM ABD","BOTH IP/OP","$801.14 ","$592.84 ","$0.00 ","$801.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$801.14 ","$0.00 ","$400.57 ","$634.50 ","$640.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CS-362","SUP","Custom 27203010","","CS-362  -  CATHETER DIALYSIS FLEX-NECK ADULT SMALL L62 CM W6-14 CM OD5.","BOTH IP/OP","$222.50 ","$164.65 ","$0.00 ","$222.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$222.50 ","$0.00 ","$111.25 ","$176.22 ","$178.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CS40G","SUP","Custom 27203010","","CS40G  -  STAPLER INTERNAL CURVE 40MMX4.7MM 2MM 6 FIRING 4 ROW LINEAR","BOTH IP/OP","$1,625.51 ","$1,202.88 ","$0.00 ","$1,625.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,625.51 ","$0.00 ","$812.75 ","$1,287.40 ","$1,300.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CSOFT6","SUP","Custom 27203010","","CSOFT6  -  CLIP SURG FGRTY SFJW 6MM SPRG ATRM OCL STRL","BOTH IP/OP","$33.23 ","$24.59 ","$0.00 ","$322.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.50 ","$0.00 ","$161.25 ","$255.42 ","$258.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CSP243","SUP","Custom 27203010","","PACK HAEMONETICS BASIC HI","BOTH IP/OP","$170.00 ","$125.80 ","$0.00 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CTI-512N","SUP","Custom 27203010","","CTI-512N  -  DEVICE CLOSURE 5MM 10/12MM SUTURE PASSER CARTER-THOMASON","BOTH IP/OP","$278.10 ","$205.79 ","$0.00 ","$278.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$278.10 ","$0.00 ","$139.05 ","$220.26 ","$222.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C-TP-1507","SUP","Custom 27803010","","C-TP-1507  -  DEVICE CLSR ANG TIGERPAW SYS II 7 CNCT UNQ FSTNR ZERO BLD","BOTH IP/OP","$3,375.00 ","$2,497.50 ","$0.00 ","$3,375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,375.00 ","$0.00 ","$1,687.50 ","$2,673.00 ","$2,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"C-TP-1509","SUP","Custom 27803010","","C-TP-1509  -  DEVICE CLSR ANG TIGERPAW SYS II 9 CNCT UNQ FSTNR ZERO BLD","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CTP200-FLS","SUP","Custom 27203010","","SYRINGE INJEC 60IN VSTRN CT LP TBG QKFL TUBE FRN LD 200ML","BOTH IP/OP","$865.00 ","$640.10 ","$0.00 ","$865.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$865.00 ","$0.00 ","$432.50 ","$685.08 ","$692.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CTR11R","SUP","Custom 27803010","","CTR11R  -  RING TENSION FORTIFEYE PMMA 13 MM 11 MM CAPSULAR RIGHT PRELO","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CUSTOM IMPLANT","SUP","HCPCS C1763","","CUSTOM IMPLANT  -  TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL","BOTH IP/OP","$12,000.00 ","$8,880.00 ","$0.00 ","$12,000.00 ","$5,400.00 ","$0.00 ","$2,501.10 ","$0.00 ","$0.00 ","$2,101.10 ","$12,000.00 ","$0.00 ","$6,000.00 ","$9,504.00 ","$9,600.00 ","$0.00 ","$1,878.00 ","$0.00 ","$1,910.40 ","$0.00 "
"CX30D","SUP","Custom 27203010","","CX30D  -  SUTURE NABSB 1 CTX 18IN GRN EBND CR BRD 8 STRN","BOTH IP/OP","$355.28 ","$262.91 ","$0.00 ","$360.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$360.61 ","$0.00 ","$180.30 ","$285.60 ","$288.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CX41D","SUP","Custom 27203010","","CX41D  -  SUTURE NONABSORBABLE 0 MO-7 18IN CONTROL RELEASE BRAID 8","BOTH IP/OP","$35.29 ","$26.11 ","$0.00 ","$35.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.82 ","$0.00 ","$17.91 ","$28.37 ","$28.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"CXI-4.0-35-150-P-NS-0","SUP","HCPCS C1887","","CXI-4.0-35-150-P-NS-0  -  CATH GUID .035IN 4FR 150CM SPRT STR TIP LP RADIOPQ BRAID SS","BOTH IP/OP","$422.50 ","$312.65 ","$0.00 ","$422.50 ","$229.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.98 ","$422.50 ","$0.00 ","$211.25 ","$334.62 ","$338.00 ","$0.00 ","$66.12 ","$0.00 ","$67.26 ","$0.00 "
"CXS08300","SUP","HCPCS C1874","","CXS08300  -  STENT CORON 3MM 8MM 137CM .014IN OTW SLF XPD RAPEX RAPTORAIL","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$0.00 ","$0.00 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"CZ70BD.100","SUP","HCPCS V2632","","CZ70BD.100  -  LENS IOL +10 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.105","SUP","HCPCS V2632","","CZ70BD.105  -  LENS IOL +10.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.110","SUP","HCPCS V2632","","CZ70BD.110  -  LENS IOL +11 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.115","SUP","HCPCS V2632","","CZ70BD.115  -  LENS IOL +11.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.120","SUP","HCPCS V2632","","CZ70BD.120  -  LENS IOL +12 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.125","SUP","HCPCS V2632","","CZ70BD.125  -  LENS IOL +12.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.130","SUP","HCPCS V2632","","CZ70BD.130  -  LENS IOL +13 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.135","SUP","HCPCS V2632","","CZ70BD.135  -  LENS IOL +13.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.140","SUP","HCPCS V2632","","CZ70BD.140  -  LENS IOL +14 DIOP 12.5MM 7MM PSTCHBR BICNVX EYLT 1 PC PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.145","SUP","HCPCS V2632","","CZ70BD.145  -  LENS IOL +14.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.150","SUP","HCPCS V2632","","CZ70BD.150  -  LENS IOL +15 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.155","SUP","HCPCS V2632","","CZ70BD.155  -  LENS IOL +15.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.160","SUP","HCPCS V2632","","CZ70BD.160  -  LENS IOL +16 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.165","SUP","HCPCS V2632","","CZ70BD.165  -  LENS IOL +16.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.170","SUP","HCPCS V2632","","CZ70BD.170  -  LENS IOL +17 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.175","SUP","HCPCS V2632","","CZ70BD.175  -  LENS IOL +17.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.180","SUP","HCPCS V2632","","CZ70BD.180  -  LENS IOL 5 D +18 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.185","SUP","HCPCS V2632","","CZ70BD.185  -  LENS IOL +18.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.190","SUP","HCPCS V2632","","CZ70BD.190  -  LENS IOL +19 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.195","SUP","HCPCS V2632","","CZ70BD.195  -  LENS IOL +19.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.200","SUP","HCPCS V2632","","CZ70BD.200  -  LENS IOL 5 D +20 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$56.25 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"CZ70BD.205","SUP","HCPCS V2632","","CZ70BD.205  -  LENS IOL +20.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.210","SUP","HCPCS V2632","","CZ70BD.210  -  LENS IOL +21 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.215","SUP","HCPCS V2632","","CZ70BD.215  -  LENS IOL +21.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.220","SUP","HCPCS V2632","","CZ70BD.220  -  LENS IOL 5 D +22 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.225","SUP","HCPCS V2632","","CZ70BD.225  -  LENS IOL +22.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.230","SUP","HCPCS V2632","","CZ70BD.230  -  LEN INTRAOCULAR CZ70BD 23.0D","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.235","SUP","HCPCS V2632","","CZ70BD.235  -  LENS IOL 5 D +23.5 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.240","SUP","HCPCS V2632","","CZ70BD.240  -  LENS IOL +24 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.245","SUP","HCPCS V2632","","CZ70BD.245  -  LENS IOL +24.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.250","SUP","HCPCS V2632","","CZ70BD.250  -  LENS IOL 5 D +25 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.255","SUP","HCPCS V2632","","CZ70BD.255  -  LENS IOL +25.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.260","SUP","HCPCS V2632","","CZ70BD.260  -  LENS IOL +26 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.265","SUP","HCPCS V2632","","CZ70BD.265  -  LENS IOL +26.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.270","SUP","HCPCS V2632","","CZ70BD.270  -  LENS IOL +27 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.275","SUP","HCPCS V2632","","CZ70BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.280","SUP","HCPCS V2632","","CZ70BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.285","SUP","HCPCS V2632","","CZ70BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.290","SUP","HCPCS V2632","","CZ70BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.295","SUP","HCPCS V2632","","CZ70BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"CZ70BD.300","SUP","HCPCS V2632","","CZ70BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"D204DRM","SUP","HCPCS C1721","","D204DRM  -  ICD D204DRM SECURA DR DF4 US","BOTH IP/OP","$38,750.00 ","$28,675.00 ","$0.00 ","$38,750.00 ","$17,437.50 ","$0.00 ","$8,076.47 ","$0.00 ","$0.00 ","$6,784.82 ","$38,750.00 ","$0.00 ","$19,375.00 ","$30,690.00 ","$31,000.00 ","$0.00 ","$6,064.38 ","$0.00 ","$6,169.00 ","$0.00 "
"D204TRM","SUP","HCPCS C2621","","D204TRM  -  DEFIBRILLATOR CARDIAC THK15MM 51X66MM 2 CHAMBER 2IS-1 1DF-4","BOTH IP/OP","$69,920.00 ","$51,740.80 ","$0.00 ","$69,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69,920.00 ","$0.00 ","$34,960.00 ","$55,376.64 ","$55,936.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D204VRM","SUP","HCPCS C1721","","D204VRM  -  ICD D204VRM SECURA VR DF4 US","BOTH IP/OP","$33,750.00 ","$24,975.00 ","$0.00 ","$33,750.00 ","$15,187.50 ","$0.00 ","$7,034.34 ","$0.00 ","$0.00 ","$5,909.36 ","$33,750.00 ","$0.00 ","$16,875.00 ","$26,730.00 ","$27,000.00 ","$0.00 ","$5,281.88 ","$0.00 ","$5,373.00 ","$0.00 "
"D224DRG","SUP","HCPCS C1721","","D224DRG  -  ICD D224DRG SECURA DR","BOTH IP/OP","$38,750.00 ","$28,675.00 ","$0.00 ","$38,750.00 ","$17,437.50 ","$0.00 ","$8,076.47 ","$0.00 ","$0.00 ","$6,784.82 ","$38,750.00 ","$0.00 ","$19,375.00 ","$30,690.00 ","$31,000.00 ","$0.00 ","$6,064.38 ","$0.00 ","$6,169.00 ","$0.00 "
"D224TRK","SUP","HCPCS C1882","","D224TRK  -  DEFIBRILLATOR CARDIAC THK.59IN 2.01X2.72IN IMPLTABLE","BOTH IP/OP","$69,920.00 ","$51,740.80 ","$0.00 ","$69,920.00 ","$31,464.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$69,920.00 ","$0.00 ","$34,960.00 ","$55,376.64 ","$55,936.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"D25L","SUP","Custom 27203010","","SENSOR ADLT NC OXSNSR 2 36IN OXM PLS ADH STRAP CBL DISP","BOTH IP/OP","$38.43 ","$28.44 ","$0.00 ","$38.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.43 ","$0.00 ","$19.21 ","$30.44 ","$30.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D284DRG","SUP","HCPCS C1721","","D284DRG  -  DEFIBRILLATOR CARD MXMO 2 IMPLTABLE 2 CHMBR DR MODL","BOTH IP/OP","$38,750.00 ","$28,675.00 ","$0.00 ","$38,750.00 ","$17,437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,784.82 ","$38,750.00 ","$0.00 ","$19,375.00 ","$30,690.00 ","$31,000.00 ","$0.00 ","$6,064.38 ","$0.00 ","$6,169.00 ","$0.00 "
"D284VRC","SUP","HCPCS C1721","","D284VRC  -  DEFIBRILLATOR CARD MXMO 2 IMPLTABLE 1 CHMBR VR MODL","BOTH IP/OP","$32,500.00 ","$24,050.00 ","$0.00 ","$32,500.00 ","$14,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,690.49 ","$32,500.00 ","$0.00 ","$16,250.00 ","$25,740.00 ","$26,000.00 ","$0.00 ","$5,086.25 ","$0.00 ","$5,174.00 ","$0.00 "
"D-2871-600","SUP","Custom 27203010","","FILTER INCBTR OHMD","BOTH IP/OP","$27.68 ","$20.48 ","$0.00 ","$27.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.68 ","$0.00 ","$13.84 ","$21.92 ","$22.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D300","SUP","Custom 27203010","","SYSTEM BLOOD WRM ADM SET NRMTH LVL 1 DISP 1000ML/MIN STRL LF","BOTH IP/OP","$269.20 ","$199.21 ","$0.00 ","$269.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.20 ","$0.00 ","$134.60 ","$213.21 ","$215.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D334DRG","SUP","HCPCS C1721","","D334DRG  -  ICD D334DRG PROTECTA DR IS-1/DF-1 US","BOTH IP/OP","$38,750.00 ","$28,675.00 ","$0.00 ","$38,750.00 ","$17,437.50 ","$0.00 ","$8,076.47 ","$0.00 ","$0.00 ","$6,784.82 ","$38,750.00 ","$0.00 ","$19,375.00 ","$30,690.00 ","$31,000.00 ","$0.00 ","$6,064.38 ","$0.00 ","$6,169.00 ","$0.00 "
"D334DRM","SUP","HCPCS C1721","","D334DRM  -  ICD D334DRM PROTECTA DR DF4 US","BOTH IP/OP","$38,750.00 ","$28,675.00 ","$0.00 ","$38,750.00 ","$17,437.50 ","$0.00 ","$8,076.47 ","$0.00 ","$0.00 ","$6,784.82 ","$38,750.00 ","$0.00 ","$19,375.00 ","$30,690.00 ","$31,000.00 ","$0.00 ","$6,064.38 ","$0.00 ","$6,169.00 ","$0.00 "
"D334TRG","SUP","HCPCS C1721","","D334TRG  -  CRT-D D334TRG PROTECTA IS-1/DF-1 US","BOTH IP/OP","$45,500.00 ","$33,670.00 ","$0.00 ","$45,500.00 ","$20,475.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$7,966.69 ","$45,500.00 ","$0.00 ","$22,750.00 ","$36,036.00 ","$36,400.00 ","$0.00 ","$7,120.75 ","$0.00 ","$7,243.60 ","$0.00 "
"D334TRM","SUP","HCPCS C1721","","D334TRM  -  CRT-D D334TRM PROTECTA DF4 US","BOTH IP/OP","$45,500.00 ","$33,670.00 ","$0.00 ","$45,500.00 ","$20,475.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$7,966.69 ","$45,500.00 ","$0.00 ","$22,750.00 ","$36,036.00 ","$36,400.00 ","$0.00 ","$7,120.75 ","$0.00 ","$7,243.60 ","$0.00 "
"D4295","SUP","Custom 27203010","","D4295  -  SUTURE PRLN 4-0 TF 36IN MFL CSTM BLUE NABSB","BOTH IP/OP","$120.03 ","$88.82 ","$0.00 ","$120.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$120.03 ","$0.00 ","$60.01 ","$95.06 ","$96.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D5961","SUP","Custom 27203010","","D5961  -  SUTURE ABSORBABLE 2 BP-1 27IN BRAID COATED CUSTOM VICRYL","BOTH IP/OP","$375.79 ","$278.08 ","$0.00 ","$357.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$357.60 ","$0.00 ","$178.80 ","$283.22 ","$286.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D7933","SUP","Custom 27203010","","D7933  -  SUTURE ABS 4-0 SH 36IN VIOL PDS2 2 ARM MFL","BOTH IP/OP","$97.96 ","$72.49 ","$0.00 ","$97.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.96 ","$0.00 ","$48.98 ","$77.58 ","$78.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D900VP8HS","SUP","Custom 27203010","","PROBE DPLR 2.9X5.5IN MN DPL 8 MHZ MINI","BOTH IP/OP","$1,846.28 ","$1,366.25 ","$0.00 ","$1,280.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,280.83 ","$0.00 ","$640.41 ","$1,014.42 ","$1,024.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D9311","SUP","Custom 27203010","","D9311  -  KIT SUTURE 3-0 EBND EXC CSTM D SPCL","BOTH IP/OP","$179.13 ","$132.56 ","$0.00 ","$94.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"D98100H","SUP","Custom 27203010","","D98100H  -  PROBE PCNG 135CM 2.4FR CHND TRNLMN 5 PCNG PCPRT CATH","BOTH IP/OP","$481.83 ","$356.55 ","$0.00 ","$481.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$481.83 ","$0.00 ","$240.91 ","$381.61 ","$385.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DB2.5","SUP","Custom 27203010","","BIT DRILL 2.5MM FAST STRL DISP","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DB-2.5","SUP","Custom 27203010","","DB-2.5  -  BIT DRILL 2.5MM STRL DISP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DCE-110","SUP","Custom 27203010","","ELECTRODE ESURG 23MM 15MM CLTZ LG CNZTN DISP","BOTH IP/OP","$52.25 ","$38.67 ","$0.00 ","$52.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DCE-115","SUP","Custom 27203010","","ELECTRODE ESURG 18X11MM CLTZ MED CNZTN CNTOUR","BOTH IP/OP","$52.25 ","$38.67 ","$0.00 ","$52.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.25 ","$0.00 ","$26.13 ","$41.38 ","$41.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100210-20","SUP","Custom 27803010","","DFS100210-20  -  COIL EMBL 2MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100250-20","SUP","Custom 27803010","","DFS100250-20  -  COIL EMBL 2.5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100310-20","SUP","Custom 27803010","","DFS100310-20  -  MICROCOIL PLATINUM DELTAPAQ 3MMX10CM","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100406-20","SUP","Custom 27803010","","DFS100406-20  -  COIL EMBL 4MM 6CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100408-20","SUP","Custom 27803010","","DFS100408-20  -  COIL EMBL 4MM 8CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100410-20","SUP","Custom 27803010","","DFS100410-20  -  COIL EMBL 4MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100510-20","SUP","Custom 27803010","","DFS100510-20  -  COIL EMBL 5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DFS100515-20","SUP","Custom 27803010","","DFS100515-20  -  COIL EMBL 5MM 15CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH","BOTH IP/OP","$2,294.25 ","$1,697.75 ","$0.00 ","$2,294.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,294.25 ","$0.00 ","$1,147.13 ","$1,817.05 ","$1,835.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DIN1515X","SUP","Custom 27203010","","NEEDLE IO 3/8-1 7/8IN 15GA BN MRW LNCT PNT ADJ FLNG STY","BOTH IP/OP","$31.73 ","$23.48 ","$0.00 ","$31.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.73 ","$0.00 ","$15.86 ","$25.13 ","$25.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DJ4008X","SUP","Custom 27203010","","DJ4008X  -  NEEDLE BIOP STANDARD TAPER 8GA 4IN LIGHTWEIGHT HANDLE DISTAL","BOTH IP/OP","$55.13 ","$40.80 ","$0.00 ","$55.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.96 ","$0.00 ","$27.98 ","$34.71 ","$44.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DJ4011X","SUP","Custom 27203010","","NEEDLE BIOP 11GA 4IN JMSHD STD HNDL TPR DISTAL TIP BN MRW","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$53.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.85 ","$0.00 ","$26.93 ","$42.65 ","$43.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DJ6011X","SUP","Custom 27203010","","DJ6011X  -  NEEDLE BIOP 11GA 6IN TAPER DISTAL SHARP BEVEL TIP ADAPTER","BOTH IP/OP","$39.36 ","$29.13 ","$0.00 ","$39.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.36 ","$0.00 ","$19.68 ","$31.17 ","$31.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DL900F","SUP","HCPCS C1880","","DL900F  -  FILTER EMBOLIZATION DELIVERY KIT DENALI NITINOL FEMORAL VENA","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$1,687.50 ","$0.00 ","$781.59 ","$0.00 ","$0.00 ","$656.60 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$586.88 ","$0.00 ","$597.00 ","$0.00 "
"DLP-B11","SUP","Custom 27203010","","ELECTRODE ESURG TN 11CM LETZ SF-T-GA UTAHLOOP RND LOOP SHAFT","BOTH IP/OP","$35.63 ","$26.37 ","$0.00 ","$35.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.63 ","$0.00 ","$17.81 ","$28.22 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DLS-7083-01S","SUP","Custom 27203010","","DLS-7083-01S  -  NEEDLE BN CMNT 8GA 10CM STRL DLV","BOTH IP/OP","$151.18 ","$111.87 ","$0.00 ","$146.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$146.78 ","$0.00 ","$73.39 ","$116.25 ","$117.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DLS-7083-05S","SUP","Custom 27203010","","DLS-7083-05S  -  NEEDLE BONE CEMENT 8GA 10CM DELIVERY NORIAN SRS STERILE","BOTH IP/OP","$114.38 ","$84.64 ","$0.00 ","$114.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$114.38 ","$0.00 ","$57.19 ","$90.59 ","$91.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DLS-7103-01S","SUP","Custom 27804086","","DLS-7103-01S  -  SYSTEM BONE CEMENT 10GA 10CM DELIVERY NEEDLE NORIAN SRS","BOTH IP/OP","$151.18 ","$111.87 ","$0.00 ","$146.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$146.78 ","$0.00 ","$73.39 ","$116.25 ","$117.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DLS-7103-05S","SUP","Custom 27203010","","DLS-7103-05S  -  NEEDLE BONE CEMENT 10GA 10CM NORIAN SRS STERILE DISPOSABLE","BOTH IP/OP","$606.70 ","$448.96 ","$0.00 ","$589.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$589.03 ","$0.00 ","$294.51 ","$466.51 ","$471.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DNX12","SUP","HCPCS A4364","","DNX12  -  ADH SKNCLS 2 OCTYL CYNCRLT DRMBND ADV EZ TO USE APL TOP .7ML","BOTH IP/OP","$49.98 ","$36.99 ","$0.00 ","$49.98 ","$27.14 ","$0.00 ","$10.42 ","$0.00 ","$0.00 ","$8.75 ","$49.98 ","$0.00 ","$24.99 ","$39.58 ","$39.98 ","$0.00 ","$7.82 ","$0.00 ","$7.96 ","$0.00 "
"DPL 100151-20","SUP","Custom 27803010","","DPL 100151-20  -  COIL EMBL 1MM 1.5CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL 100152-20","SUP","Custom 27803010","","DPL 100152-20  -  COIL EMBL 1.5MM 2CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL 100153-20","SUP","Custom 27803010","","DPL 100153-20  -  COIL EMBL MIC 1.5MM 3CM DELTAPLUSH","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL 100202-20","SUP","Custom 27803010","","DPL 100202-20  -  COIL EMBL 2MM 2CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL 100203-20","SUP","Custom 27803010","","DPL 100203-20  -  COIL EMBL 2MM 3CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL 100204-20","SUP","Custom 27803010","","DPL 100204-20  -  COIL EMBL 2MM 4CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL 100206-20","SUP","Custom 27803010","","DPL 100206-20  -  COIL EMBL 2MM 6CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DPL10020120","SUP","Custom 27803010","","DPL10020120  -  COIL EMBL 2MM 1CM DELTAPLUSH PLTN","BOTH IP/OP","$2,544.60 ","$1,883.00 ","$0.00 ","$2,544.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,544.60 ","$0.00 ","$1,272.30 ","$2,015.32 ","$2,035.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRB1015","SUP","Custom 27203010","","DRB1015  -  BIT DRILL 10MM BUD NONSTRL","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRB1115","SUP","Custom 27203010","","DRB1115  -  DRILL SURG 11MM IMPL FIX BUD STRL","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL BIT","SUP","HCPCS C1713","","DRILL BIT  -  DRILL BIT 2.4MM QUICK COUPLING W/65MM STOP","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$208.13 ","$0.00 ","$96.40 ","$0.00 ","$0.00 ","$80.98 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$72.38 ","$0.00 ","$73.63 ","$0.00 "
"DRILL-1.6CL","SUP","Custom 27203010","","DRILL-1.6CL  -  BIT DRILL TWISTED 1.6MM","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-1.75L","SUP","Custom 27203010","","DRILL-1.75L  -  BIT DRL 1.75IN TWST","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.00","SUP","Custom 27203010","","DRILL-2.00  -  DRILL TWIST REGULAR 2MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.00CL","SUP","Custom 27203010","","DRILL-2.00CL  -  BIT DRILL CANN TWIST LONG 3.2MM 2MM","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.00L","SUP","Custom 27203010","","DRILL-2.00L  -  DRILL TWIST LONG 2MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.1/110C","SUP","Custom 27203010","","DRILL-2.1/110C  -  DRILL SRG 2.1MM 110MM CNN TI","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.1CL","SUP","Custom 27203010","","DRILL-2.1CL  -  BIT DRILL SMALL HEADLESS SCREWS 2.1MM","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.3","SUP","Custom 27203010","","DRILL-2.3  -  BIT DRL 2.3MM STRL","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.3/080","SUP","Custom 27203010","","DRILL-2.3/080  -  DRILL SRG 2.3MM 80MM NS LF REUSE","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.30","SUP","Custom 27203010","","DRILL-2.30  -  BIT DRILL TWIST 2.3MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.30L","SUP","Custom 27203010","","DRILL-2.30L  -  BIT DRILL LONG TWIST 2.3MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-2.4CL","SUP","Custom 27203010","","DRILL-2.4CL  -  BIT DRILL 2.4MM GS","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRILL-3.20L","SUP","Custom 27203010","","DRILL-3.20L  -  DRILL TWIST NONCANNULATED 3.2MM","BOTH IP/OP","$300.00 ","$222.00 ","$0.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$300.00 ","$0.00 ","$150.00 ","$237.60 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRLL-PLS-20","SUP","HCPCS C1713","","DRLL-PLS-20  -  DRILL SRG 2MM 40MM GEMINUS CNN PA LCK SCR","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"DRLL-SSC-20040","SUP","Custom 27203010","","DRLL-SSC-20040  -  DRILL SURG 2MM 40MM SOLID SIDE CUT GEMINUS NONSTRL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRLL-SSC-23040","SUP","Custom 27203010","","DRLL-SSC-23040  -  DRILL, 2.3MM X 40MM","BOTH IP/OP","$2,755.00 ","$2,038.70 ","$0.00 ","$2,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,755.00 ","$0.00 ","$1,377.50 ","$2,181.96 ","$2,204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRLL-SSC-25040","SUP","Custom 27203010","","DRLL-SSC-25040  -  DRILL SURG 2.5MM 40MM SOLID SIDE CUT GEMINUS NONSTRL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRM600","SUP","Custom 27203010","","HEMOCYTOMETER SPERM CNT 2 CHMBR SLD COVERLIP GRID ETCH CLVU","BOTH IP/OP","$399.20 ","$295.41 ","$0.00 ","$399.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$399.20 ","$0.00 ","$199.60 ","$316.17 ","$319.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRV22508UX","SUP","HCPCS C1874","","STENT CORON 2.25MM 8MM RAPEX MDRVR DRV22508UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV22512UX","SUP","HCPCS C1874","","STENT CORON 2.25MM 12MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV22514UX","SUP","HCPCS C1874","","STENT CORON 2.25MM 14MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV22518UX","SUP","HCPCS C1874","","STENT CORON 2.25MM 18MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV22524UX","SUP","HCPCS C1874","","STENT CORON 2.25MM 24MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV25008UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 8MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV25012UX","SUP","HCPCS C1874","","STENT CORON 2.25MM 8MM RAPEX MDRVR DRV25012UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV25014UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 14MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV25018UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 18MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV25024UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 24MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV27508UX","SUP","HCPCS C1874","","STENT CORON 2.75MM 8MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV27512UX","SUP","HCPCS C1874","","STENT CORON 2.75MM 12MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV27514UX","SUP","HCPCS C1874","","STENT CORON 2.75MM 14MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV27518UX","SUP","HCPCS C1874","","STENT CORON 2.75MM 18MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV27524UX","SUP","HCPCS C1874","","STENT CORON 2.75MM 24MM RAPEX MDRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV30012UX","SUP","HCPCS C1874","","STENT CORON 3MM 12MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV30015UX","SUP","HCPCS C1874","","STENT CORON 3MM 15MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV30018UX","SUP","HCPCS C1874","","STENT CORON 3MM 18MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV30024UX","SUP","HCPCS C1874","","STENT CORON 3MM 24MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV30030UX","SUP","HCPCS C1874","","STENT CORON 3MM 30MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV35009UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 9MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV35012UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 12MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV35015UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 15MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV35018UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 18MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV35024UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 24MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV35030UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 30MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV40009UX","SUP","HCPCS C1874","","STENT CORON 4MM 9MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV40012UX","SUP","HCPCS C1874","","STENT CORON 4MM 12MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV40015UX","SUP","HCPCS C1874","","STENT CORON 4MM 15MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV40018UX","SUP","HCPCS C1874","","STENT CORON 4MM 18MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV40024UX","SUP","HCPCS C1874","","STENT CORON 4MM 24MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRV40030UX","SUP","HCPCS C1874","","STENT CORON 4MM 30MM RAPEX DRVR","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"DRVR-AOS-PLS","SUP","Custom 27203010","","DRVR-AOS-PLS  -  DRIVER SRG GEMINUS PA LCK SCR AO CNCT DISP","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRVR-AOS-S20","SUP","Custom 27203010","","DRVR-AOS-S20  -  DRIVER SRG 2MM NS GEMINUS SQ TIP AO CNCT DISP","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DRVR-UQC-T10","SUP","Custom 27203010","","DRVR-UQC-T10  -  DRIVER SRG 2MM NS GEMINUS T10 UNV QCK CNCT DISP","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DS100A-1","SUP","Custom 27203010","","SENSOR ADLT DRSNSR 24IN FNGR OXM CLIP DGT MEM CHP NSTRL","BOTH IP/OP","$210.63 ","$155.87 ","$0.00 ","$210.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.63 ","$0.00 ","$105.31 ","$166.82 ","$168.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DS2A003","SUP","Custom 27203010","","DS2A003  -  SLITTER CATH UNV CPS ERG DSGN ACPT 4-6FR LD","BOTH IP/OP","$80.00 ","$59.20 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DS2C002","SUP","HCPCS C1893","","DS2C002  -  CATHETER GD 115D 9FR 47CM CPS DRCT SL II DRCT-TO-TRGT BRD","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$1,250.00 ","$678.75 ","$0.00 ","$93.79 ","$0.00 ","$0.00 ","$218.87 ","$1,250.00 ","$0.00 ","$625.00 ","$990.00 ","$1,000.00 ","$0.00 ","$195.63 ","$0.00 ","$199.00 ","$0.00 "
"DS2N021/59","SUP","HCPCS C1893","","DS2N021/59  -  CATHETER GD ACUTE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N021/65","SUP","HCPCS C1887","","DS2N021/65  -  CATHETER GD ACUTE CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N022/59","SUP","HCPCS C1887","","DS2N022/59  -  CPS AIM SL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N022/65","SUP","HCPCS C1887","","DS2N022/65  -  CATHETER GD 90D 7FR 65CM CPS AIM SL DRCT-TO-TRGT SLITTABLE","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N023/59","SUP","HCPCS C1887","","DS2N023/59  -  CATHETER GD OBTUSE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N023/65","SUP","HCPCS C1887","","DS2N023/65  -  CPS AIM SL","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N024/65","SUP","HCPCS C1887","","DS2N024/65  -  CATHETER GD CSL CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DS2N025/65","SUP","HCPCS C1887","","DS2N025/65  -  CATHETER GD ASII CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"DSF1833","SUP","HCPCS C1894","","DSF1833  -  SHEATH INTRO 18FR 6.7MM 6MM 33CM GORE DRYSEAL FLX HDRPH","BOTH IP/OP","$1,657.50 ","$1,226.55 ","$0.00 ","$1,510.00 ","$819.93 ","$0.00 ","$345.46 ","$0.00 ","$0.00 ","$264.39 ","$1,510.00 ","$0.00 ","$755.00 ","$1,195.92 ","$1,208.00 ","$0.00 ","$236.32 ","$0.00 ","$240.39 ","$0.00 "
"DSL1228","SUP","HCPCS C1894","","DSL1228  -  SHEATH INTRO 12FR 5MM 4.1MM 28CM DRYSEAL DIL VLV INFL SYR","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"DSL1628","SUP","HCPCS C1894","","DSL1628  -  SHEATH INTRO 16FR 6.2MM 5.3MM 28CM DRYSEAL DIL VLV INFL SYR","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"DSL2628","SUP","HCPCS C1894","","DSL2628  -  SHEATH INTROD 28CM DRYSEAL DILAT VALVE INFLAT SYRINGE","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$468.34 ","$0.00 ","$179.77 ","$0.00 ","$0.00 ","$151.02 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$134.98 ","$0.00 ","$137.31 ","$0.00 "
"DUET4535A","SUP","Custom 27203010","","DUET4535A  -  RELOAD STPLR 45MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS","BOTH IP/OP","$1,718.23 ","$1,271.49 ","$0.00 ","$1,718.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,718.23 ","$0.00 ","$859.11 ","$1,360.84 ","$1,374.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUET4548A","SUP","Custom 27203010","","DUET4548A  -  RELOAD STPLR 45MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP","BOTH IP/OP","$1,909.14 ","$1,412.76 ","$0.00 ","$1,909.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,909.14 ","$0.00 ","$954.57 ","$1,512.04 ","$1,527.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUET6035A","SUP","Custom 27203010","","DUET6035A  -  RELOAD STPLR 60MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS","BOTH IP/OP","$1,867.59 ","$1,382.02 ","$0.00 ","$1,867.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,867.59 ","$0.00 ","$933.80 ","$1,479.13 ","$1,494.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUET6048A","SUP","Custom 27203010","","DUET6048A  -  RELOAD STPLR 60MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP","BOTH IP/OP","$11,205.54 ","$8,292.10 ","$0.00 ","$11,205.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,205.54 ","$0.00 ","$5,602.77 ","$8,874.79 ","$8,964.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUR1000D","SUP","Custom 27011340","","DUR1000D  -  LASER FIBER_ 1000 MICRON","BOTH IP/OP","$2,794.28 ","$2,067.77 ","$0.00 ","$2,794.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,794.28 ","$0.00 ","$1,397.14 ","$2,213.07 ","$2,235.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUR270D","SUP","Custom 27011340","","DUR270D  -  LASER FIBER_ 270 MICRON","BOTH IP/OP","$1,266.67 ","$937.34 ","$0.00 ","$1,266.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,266.67 ","$0.00 ","$633.33 ","$1,003.20 ","$1,013.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUR400D","SUP","Custom 27011340","","DUR400D  -  LASER FIBER_ 400 MICRON","BOTH IP/OP","$1,266.67 ","$937.34 ","$0.00 ","$1,266.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,266.67 ","$0.00 ","$633.33 ","$1,003.20 ","$1,013.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUR400DBX","SUP","Custom 27011340","","DUR400DBX  -  FIBER LSR 400UM STRL DUR HO DISP LTHTRP","BOTH IP/OP","$1,074.28 ","$794.97 ","$0.00 ","$1,074.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,074.28 ","$0.00 ","$537.14 ","$850.83 ","$859.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUR600D","SUP","Custom 27011340","","DUR600D  -  LASER FIBER_ 600 MICRON","BOTH IP/OP","$1,475.00 ","$1,091.50 ","$0.00 ","$1,475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,475.00 ","$0.00 ","$737.50 ","$1,168.20 ","$1,180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DUR600DBX","SUP","Custom 27011340","","DUR600DBX  -  FIBER LSR 600UM STRL DUR HO DISP LTHTRP","BOTH IP/OP","$1,254.17 ","$928.09 ","$0.00 ","$1,254.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,254.17 ","$0.00 ","$627.08 ","$993.30 ","$1,003.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DVR-AXXL","SUP","HCPCS C1713","","DVR-AXXL  -  PLATE X XTD DVR BONE LEFT DISTAL VOLR RADL STRL","BOTH IP/OP","$3,865.00 ","$2,860.10 ","$0.00 ","$3,865.00 ","$1,739.25 ","$0.00 ","$805.56 ","$0.00 ","$0.00 ","$676.73 ","$3,865.00 ","$0.00 ","$1,932.50 ","$3,061.08 ","$3,092.00 ","$0.00 ","$604.87 ","$0.00 ","$615.31 ","$0.00 "
"DWB172","SUP","HCPCS C1776","","DWB172  -  STEM HUM 130MM 9MM BONE GRW AQLS CMNT 25IN NECK FRAC","BOTH IP/OP","$10,685.00 ","$7,906.90 ","$0.00 ","$10,685.00 ","$4,808.25 ","$0.00 ","$2,227.02 ","$0.00 ","$0.00 ","$1,870.86 ","$10,685.00 ","$0.00 ","$5,342.50 ","$8,462.52 ","$8,548.00 ","$0.00 ","$1,672.20 ","$0.00 ","$1,701.05 ","$0.00 "
"DWB173","SUP","HCPCS C1776","","DWB173  -  HEAD HUM 130MM 12MM SHLDR FRAC AQLS COCR 130D","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"DWB243","SUP","HCPCS C1776","","DWB243  -  HEAD HUM CALOTTE HUMERALE","BOTH IP/OP","$4,215.00 ","$3,119.10 ","$0.00 ","$4,215.00 ","$1,896.75 ","$0.00 ","$878.51 ","$0.00 ","$0.00 ","$738.01 ","$4,215.00 ","$0.00 ","$2,107.50 ","$3,338.28 ","$3,372.00 ","$0.00 ","$659.65 ","$0.00 ","$671.03 ","$0.00 "
"DWB252","SUP","HCPCS C1776","","DWB252  -  HEAD HUM 52MM 19MM AQLS CMNT PVRS TI SHLDR","BOTH IP/OP","$17,125.00 ","$12,672.50 ","$0.00 ","$17,125.00 ","$7,706.25 ","$0.00 ","$3,569.28 ","$0.00 ","$0.00 ","$2,998.45 ","$17,125.00 ","$0.00 ","$8,562.50 ","$13,563.00 ","$13,700.00 ","$0.00 ","$2,680.06 ","$0.00 ","$2,726.30 ","$0.00 "
"DWB253","SUP","HCPCS C1776","","DWB253  -  HEAD HUM 23MM 52MM SHLDR CMNT PVRS AQLS TI","BOTH IP/OP","$10,685.00 ","$7,906.90 ","$0.00 ","$10,685.00 ","$4,808.25 ","$0.00 ","$2,227.02 ","$0.00 ","$0.00 ","$1,870.86 ","$10,685.00 ","$0.00 ","$5,342.50 ","$8,462.52 ","$8,548.00 ","$0.00 ","$1,672.20 ","$0.00 ","$1,701.05 ","$0.00 "
"DWD020","SUP","HCPCS C1713","","DWD020  -  SCREW BSPLT 20MM 4.5MM AQLS GLND TI LOCK MLDIR ST","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"DWD023","SUP","HCPCS C1713","","DWD023  -  SCREW BSPLT 23MM 4.5MM AQLS GLND TI LOCK MLDIR ST","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"DWD029","SUP","HCPCS C1713","","DWD029  -  SCREW BSPLT 29MM 4.5MM AQLS GLND TI LOCK MLDIR ST","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"DWD055","SUP","Custom 27203010","","DWD055  -  BIT DRL 3MM STRL DISP","BOTH IP/OP","$342.50 ","$253.45 ","$0.00 ","$342.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$342.50 ","$0.00 ","$171.25 ","$271.26 ","$274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DWD180","SUP","HCPCS C1776","","DWD180  -  SPHERE GLND 36MM AQLS CRCO RVRS CNTR 25MM BSPLT","BOTH IP/OP","$8,312.50 ","$6,151.25 ","$0.00 ","$8,312.50 ","$3,740.63 ","$0.00 ","$1,732.53 ","$0.00 ","$0.00 ","$1,455.45 ","$8,312.50 ","$0.00 ","$4,156.25 ","$6,583.50 ","$6,650.00 ","$0.00 ","$1,300.91 ","$0.00 ","$1,323.35 ","$0.00 "
"DWD860","SUP","HCPCS C1776","","DWD860  -  INSERT HUM 36MM AQLS 6MM SHLDR LAT PVRS ADPR FRAC","BOTH IP/OP","$4,507.50 ","$3,335.55 ","$0.00 ","$4,507.50 ","$2,028.38 ","$0.00 ","$939.48 ","$0.00 ","$0.00 ","$789.23 ","$4,507.50 ","$0.00 ","$2,253.75 ","$3,569.94 ","$3,606.00 ","$0.00 ","$705.42 ","$0.00 ","$717.59 ","$0.00 "
"DWD861","SUP","HCPCS C1776","","DWD861  -  INSERT HUM 36MM AQLS +9MM LAT RVRS ADPR FRAC PRIM","BOTH IP/OP","$4,507.50 ","$3,335.55 ","$0.00 ","$4,507.50 ","$2,028.38 ","$0.00 ","$939.48 ","$0.00 ","$0.00 ","$789.23 ","$4,507.50 ","$0.00 ","$2,253.75 ","$3,569.94 ","$3,606.00 ","$0.00 ","$705.42 ","$0.00 ","$717.59 ","$0.00 "
"DWD901","SUP","HCPCS C1776","","DWD901  -  STEM HUM 130MM 7MM PVRS FRAC AQLS SHLDR","BOTH IP/OP","$13,975.00 ","$10,341.50 ","$0.00 ","$13,975.00 ","$6,288.75 ","$0.00 ","$2,912.74 ","$0.00 ","$0.00 ","$2,446.91 ","$13,975.00 ","$0.00 ","$6,987.50 ","$11,068.20 ","$11,180.00 ","$0.00 ","$2,187.09 ","$0.00 ","$2,224.82 ","$0.00 "
"DX-22-100","SUP","Custom 27203010","","DX-22-100  -  SYSTEM SPNL FX DTRAX","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"DYND13522","SUP","HCPCS A4351","","DYND13522  -  CATHETER URTH RBNSN 22FR 16IN SMTH TIP 2 OVL EYE RADIOPQ FNL","BOTH IP/OP","$1.65 ","$1.22 ","$0.00 ","$2.07 ","$0.00 ","$0.00 ","$0.34 ","$0.00 ","$0.00 ","$0.00 ","$2.07 ","$0.00 ","$1.03 ","$1.64 ","$1.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E05021","SUP","Custom 27203010","","E05021  -  ADAPTER ESURG UNV STRL VLAB MNPLR FTSWTCH DISP ACPT 3.2- MM","BOTH IP/OP","$97.83 ","$72.39 ","$0.00 ","$97.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$97.83 ","$0.00 ","$48.91 ","$77.48 ","$78.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E0570","SUP","Custom 27203010","","RETRACTOR STRG NRV ROOT SURG","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-21A-00","SUP","Custom 27803010","","E100-21A-00  -  VALVE AORTIC 21MM EP","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-23A-00","SUP","Custom 27803010","","E100-23A-00  -  VALVE AOR 23MM 21MM 15MM EP LINX BPRTH STNT SW CUF PLSTR SUP","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-25A-00","SUP","Custom 27803010","","E100-25A-00  -  VALVE AORTIC 25MM EP","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-25M-00","SUP","Custom 27803010","","E100-25M-00  -  VALVE MTRL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR LOPRFL","BOTH IP/OP","$23,350.00 ","$17,279.00 ","$0.00 ","$23,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,350.00 ","$0.00 ","$11,675.00 ","$18,493.20 ","$18,680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-27A-00","SUP","Custom 27803010","","E100-27A-00  -  VALVE AOR 27MM 25MM 17MM EP LINX BPRTH STNT SW CUF PLSTR SUP","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-27M-00","SUP","Custom 27803010","","E100-27M-00  -  VALVE MTRL LOPRFL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR","BOTH IP/OP","$15,500.00 ","$11,470.00 ","$0.00 ","$15,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,500.00 ","$0.00 ","$7,750.00 ","$12,276.00 ","$12,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-29A-00","SUP","Custom 27803010","","E100-29A-00  -  VALVE AORTIC 29MM EP THV","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-29M-00","SUP","Custom 27803010","","E100-29M-00  -  VALVE MTRL 29MM 27MM 19MM LF 10MM EP LINX BIOCOR FLEXFIT","BOTH IP/OP","$15,500.00 ","$11,470.00 ","$0.00 ","$15,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,500.00 ","$0.00 ","$7,750.00 ","$12,276.00 ","$12,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-31M-00","SUP","Custom 27803010","","E100-31M-00  -  VALVE MTRL 31MM 29MM 20MM STRL LF EP FLEXFIT BPRTH STNT HLDR","BOTH IP/OP","$15,500.00 ","$11,470.00 ","$0.00 ","$15,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,500.00 ","$0.00 ","$7,750.00 ","$12,276.00 ","$12,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E100-33M-00","SUP","Custom 27803010","","E100-33M-00  -  VALVE MTRL 33MM 41MM 31MM 20MM STRL EP FLEXFIT BPRTH STNT","BOTH IP/OP","$15,500.00 ","$11,470.00 ","$0.00 ","$15,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,500.00 ","$0.00 ","$7,750.00 ","$12,276.00 ","$12,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E1457","SUP","Custom 27203010","","E1457  -  ELECTRODE ELECTROSURGICAL 45D 178MM NEEDLE SLEEVE","BOTH IP/OP","$282.50 ","$209.05 ","$0.00 ","$282.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$282.50 ","$0.00 ","$141.25 ","$223.74 ","$226.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E2505-10FR","SUP","Custom 27203010","","E2505-10FR  -  COAG SCT 6IN 10FR LECTROVAC FTSWTCH ACT SHFT STRL DISP","BOTH IP/OP","$19.33 ","$14.30 ","$0.00 ","$19.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.33 ","$0.00 ","$9.66 ","$15.31 ","$15.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E2530-6","SUP","Custom 27203010","","E2530-6  -  ELECTRODE ELECTROSURGICAL 6IN HANDSET COAGULATION FLEXIBLE","BOTH IP/OP","$649.00 ","$480.26 ","$0.00 ","$649.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$649.00 ","$0.00 ","$324.50 ","$514.01 ","$519.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E-3F","SUP","Custom 27203010","","PROBE LTHTRP 120CM 3FR ELHDR STRL AEH2 3","BOTH IP/OP","$446.68 ","$330.54 ","$0.00 ","$446.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$446.68 ","$0.00 ","$223.34 ","$353.77 ","$357.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E5211-6K","SUP","Custom 27203010","","E5211-6K  -  BIT DRILL 7.4MM 150MM","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E5211-6L","SUP","Custom 27203010","","E5211-6L  -  BIT DRILL 7.4MM 200MM","BOTH IP/OP","$291.50 ","$215.71 ","$0.00 ","$291.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$291.50 ","$0.00 ","$145.75 ","$230.87 ","$233.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"E-70-0045","SUP","HCPCS C1713","","E-70-0045  -  PLATE ACUMED BONE LEFT DISTAL ULN","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"EA100","SUP","Custom 27203010","","EA100  -  INSTRUMENT TRAY EA100 LEGEND EHS STYLUS","BOTH IP/OP","$1,258.00 ","$930.92 ","$0.00 ","$1,258.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,258.00 ","$0.00 ","$629.00 ","$996.34 ","$1,006.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EAW2827","SUP","Custom 27203010","","REGULATOR FLOW 1 DISS OXYGEN CYLINDER","BOTH IP/OP","$240.00 ","$177.60 ","$0.00 ","$240.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.00 ","$0.00 ","$120.00 ","$190.08 ","$192.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EB0101","SUP","Custom 27203010","","EB0101  -  RSTRC CMNT LTD 8-15MM ELB","BOTH IP/OP","$420.00 ","$310.80 ","$0.00 ","$420.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$420.00 ","$0.00 ","$210.00 ","$332.64 ","$336.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EB2S103","SUP","HCPCS C1884","","EB2S103  -  PARTICLES EMBL 100-300UM 2ML YLW BDBL MCSPH CMPR PVA","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"EB2S305","SUP","Custom 27803010","","EB2S305  -  PARTICLES EMBL 300-500UM 2ML BLU BDBL CMPR MCSPH PVA","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EB2S507","SUP","HCPCS C1884","","EB2S507  -  PARTICLES EMBL 500-700UM 2ML RD BDBL CMPR PRECISELY CLBRT","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"EB2S709","SUP","HCPCS C1884","","EB2S709  -  PARTICLES EMBL 700-900UM 2ML GRN BDBL CMPR PRECISELY CLBRT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"EB2S912","SUP","HCPCS C1884","","EB2S912  -  PARTICLES EMBL 900-1200UM 2ML PUR BDBL CMPR PRECISELY CLBRT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"ECATCH15","SUP","Custom 27203010","","ECATCH15  -  POUCH SPEC RTRVL 15MM 34.5CM LF 29.5CM E-CTCH II FLXB ERG","BOTH IP/OP","$283.90 ","$210.09 ","$0.00 ","$283.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$283.90 ","$0.00 ","$141.95 ","$224.85 ","$227.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ECH060040A","SUP","HCPCS C1768","","ECH060040A  -  GRAFT VASCULAR 6CM 40CM 3 LAYER ACUSEAL PTFE","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$1,451.25 ","$0.00 ","$672.17 ","$0.00 ","$0.00 ","$564.67 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$504.71 ","$0.00 ","$513.42 ","$0.00 "
"ECH470045A","SUP","HCPCS C1768","","ECH470045A  -  GRAFT VASCULAR 4-7MM 45CM TAPER GORE ACUSEAL STERILE","BOTH IP/OP","$3,700.00 ","$2,738.00 ","$0.00 ","$3,700.00 ","$1,665.00 ","$0.00 ","$771.17 ","$0.00 ","$0.00 ","$647.84 ","$3,700.00 ","$0.00 ","$1,850.00 ","$2,930.40 ","$2,960.00 ","$0.00 ","$579.05 ","$0.00 ","$589.04 ","$0.00 "
"ECHO-1-22","SUP","Custom 27203102","","SHEATH BLUE 22G (STIFFER)","BOTH IP/OP","$669.30 ","$495.28 ","$0.00 ","$669.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$669.30 ","$0.00 ","$334.65 ","$530.09 ","$535.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ECHO--19","SUP","Custom 27203105","","NEEDLE 19G","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ECHO-19-CB","SUP","Custom 27203106","","CYTOLOGY BRUSH (ECHO-19)","BOTH IP/OP","$20.13 ","$14.90 ","$0.00 ","$20.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.13 ","$0.00 ","$10.06 ","$15.94 ","$16.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ECHO-20-CPN","SUP","Custom 27203104","","CELIAC PLEXUS NEUROLYSIS NEEDLE 20G","BOTH IP/OP","$272.58 ","$201.71 ","$0.00 ","$272.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.58 ","$0.00 ","$136.29 ","$215.88 ","$218.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ECHO-25","SUP","Custom 27203590","","NEEDLE BX 25G","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ECHO-3-22","SUP","Custom 27203103","","GREEN SPRING COIL SHEATH 22G","BOTH IP/OP","$669.30 ","$495.28 ","$0.00 ","$669.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$669.30 ","$0.00 ","$334.65 ","$530.09 ","$535.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EDI-3180","SUP","Custom 27203010","","PAD DFBR PADPRO RDTRNS ADLT 2516 LF","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EDI-3183","SUP","Custom 27203010","","PAD DFBR PADPRO RDTRNS INF 2603 LF","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EEA2835","SUP","Custom 27203010","","EEA2835  -  STAPLER INTERNAL 3.5MM CIRCULAR 28MM 22CM SHAFT LARGE","BOTH IP/OP","$746.73 ","$552.58 ","$0.00 ","$746.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$746.73 ","$0.00 ","$373.36 ","$591.41 ","$597.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EGIA60CTAMT","SUP","Custom 27203010","","EGIA60CTAMT  -  RELOAD STPLR 60MM PUR STRL LF ARTC CRV TIP INTRO MED THKTIS","BOTH IP/OP","$4,321.80 ","$3,198.13 ","$0.00 ","$4,321.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,321.80 ","$0.00 ","$2,160.90 ","$3,422.87 ","$3,457.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EGIARADXT","SUP","Custom 27203010","","EGIARADXT  -  RELOAD STPLR 15MM BLK STRL LF EGIA RADL TI X THKTIS DISP","BOTH IP/OP","$6,411.75 ","$4,744.70 ","$0.00 ","$6,411.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,411.75 ","$0.00 ","$3,205.88 ","$5,078.11 ","$5,129.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EL21L","SUP","Custom 27203010","","EL21L  -  SUTURE ABSORBABLE 0 3.9MM 21IN BRAID COATED LIGATE LOOP","BOTH IP/OP","$54.25 ","$40.15 ","$0.00 ","$55.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.06 ","$0.00 ","$27.53 ","$43.61 ","$44.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ELAFIXP2P744","SUP","HCPCS C1893","","ELAFIXP2P744  -  LEAD PCNG ELAPASS PSV FX ART VNTRC","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$610.88 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAFIXP2P752","SUP","HCPCS C1893","","ELAFIXP2P752  -  LEAD PCNG 52CM SCR IN BP ATRERY","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$610.88 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAFIXP2P758","SUP","HCPCS C1893","","ELAFIXP2P758  -  LEAD SRG 10MM 7FR 58CM SCR IN IS 1","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$610.88 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAFIXS2J748","SUP","HCPCS C1898","","ELAFIXS2J748  -  LEAD PCNG JTP ATR","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAFIXS2J752","SUP","HCPCS C1898","","ELAFIXS2J752  -  LEAD PCNG JTP ATR","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAPASSP752","SUP","HCPCS C1898","","ELAPASSP752  -  LEAD PCNG ELAPASS TN VNTRC","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAPASSP758","SUP","HCPCS C1898","","ELAPASSP758  -  LEAD PCNG 58CM BP STRG VNTRC","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAPASSPJ744","SUP","HCPCS C1898","","ELAPASSPJ744  -  LEAD PCNG 7FR 44CM ELAPASS P BP ATR","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"ELAPASSPJ752","SUP","HCPCS C1898","","ELAPASSPJ752  -  LEAD PACING J 52CM BIPOL PREFORMED TINED LOW VOLTAGE ELAPASS","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$234.48 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"EMP-FBX1000HS","SUP","Custom 27203010","","EMP-FBX1000HS  -  LASER SURGICAL 1000 MH FIBER SINGLE USE","BOTH IP/OP","$1,937.50 ","$1,433.75 ","$0.00 ","$2,026.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,026.14 ","$0.00 ","$1,013.07 ","$1,604.70 ","$1,620.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EMP-FBX272HS-C","SUP","Custom 27203010","","EMP-FBX272HS-C  -  LASER SURGICAL 272 MH FIBER SINGLE USE, COMPATIBLE","BOTH IP/OP","$725.95 ","$537.20 ","$0.00 ","$640.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$640.62 ","$0.00 ","$320.31 ","$507.37 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EMP-FBX365HS","SUP","Custom 27203010","","EMP-FBX365HS  -  LASER SURGICAL 365 MH FIBER SINGLE USE","BOTH IP/OP","$874.75 ","$647.32 ","$0.00 ","$640.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$640.62 ","$0.00 ","$320.31 ","$507.37 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EMP-FBX550HS","SUP","Custom 27203010","","EMP-FBX550HS  -  LASER SURGICAL 550 MH FIBER SINGLE USE","BOTH IP/OP","$1,070.50 ","$792.17 ","$0.00 ","$1,084.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,084.68 ","$0.00 ","$542.34 ","$859.07 ","$867.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EN2006015-C","SUP","HCPCS C1757","","EN2006015-C  -  SNARE VASC STD 9-15MM 6FR 120CM 100CM ENSNR 3 PREFRM LOOP","BOTH IP/OP","$827.50 ","$612.35 ","$0.00 ","$827.50 ","$0.00 ","$0.00 ","$172.47 ","$0.00 ","$0.00 ","$0.00 ","$827.50 ","$0.00 ","$413.75 ","$655.38 ","$662.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EN2007030","SUP","Custom 27203010","","EN2007030  -  SNARE VASC STD 18-30MM 7FR 120CM 100CM ENSNR 3 INTERLACE","BOTH IP/OP","$827.50 ","$612.35 ","$0.00 ","$827.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$827.50 ","$0.00 ","$413.75 ","$655.38 ","$662.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EN2007045","SUP","Custom 27203010","","EN2007045  -  SNARE VASCULAR 120CM 3 PREFORM LOOP WIRE KINK RESISTANT","BOTH IP/OP","$1,100.00 ","$814.00 ","$0.00 ","$1,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,100.00 ","$0.00 ","$550.00 ","$871.20 ","$880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ENBD-7","SUP","HCPCS C1725","","CATHETER DRAIN 7FR 250CM 5 SDPRT LCK PGTL ENDSCP BIL NSL","BOTH IP/OP","$286.15 ","$211.75 ","$0.00 ","$286.15 ","$155.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.10 ","$286.15 ","$0.00 ","$143.08 ","$226.63 ","$228.92 ","$0.00 ","$44.78 ","$0.00 ","$45.56 ","$0.00 "
"ENDO-014","SUP","HCPCS C1769","","ENDO-014  -  GUIDEWIRE ENDOVASCULAR L260 CM OD.014 IN ANCILLARY","BOTH IP/OP","$450.00 ","$333.00 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$93.79 ","$0.00 ","$0.00 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"ENF402300","SUP","HCPCS C1874","","ENF402300  -  STENT VASCULAR 4.5MM 22MM W/O DISTAL TIP ENTERPRISE NITINOL","BOTH IP/OP","$14,899.20 ","$11,025.41 ","$0.00 ","$14,899.20 ","$6,704.64 ","$0.00 ","$3,105.37 ","$0.00 ","$0.00 ","$2,608.73 ","$14,899.20 ","$0.00 ","$7,449.60 ","$11,800.17 ","$11,919.36 ","$0.00 ","$2,331.72 ","$0.00 ","$2,371.95 ","$0.00 "
"ENF402312","SUP","HCPCS C1874","","ENF402312  -  STENT VASC 4.5MM 22MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS","BOTH IP/OP","$14,899.20 ","$11,025.41 ","$0.00 ","$14,899.20 ","$6,704.64 ","$0.00 ","$3,105.37 ","$0.00 ","$0.00 ","$2,608.73 ","$14,899.20 ","$0.00 ","$7,449.60 ","$11,800.17 ","$11,919.36 ","$0.00 ","$2,331.72 ","$0.00 ","$2,371.95 ","$0.00 "
"ENF403000","SUP","HCPCS C1874","","ENF403000  -  STENT VASCULAR 4.5MM 28MM W/O DISTAL TIP ENTERPRISE NITINOL","BOTH IP/OP","$14,899.20 ","$11,025.41 ","$0.00 ","$14,899.20 ","$6,704.64 ","$0.00 ","$3,105.37 ","$0.00 ","$0.00 ","$2,608.73 ","$14,899.20 ","$0.00 ","$7,449.60 ","$11,800.17 ","$11,919.36 ","$0.00 ","$2,331.72 ","$0.00 ","$2,371.95 ","$0.00 "
"ENF403012","SUP","HCPCS C1874","","ENF403012  -  STENT VASC 4.5MM 28MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS","BOTH IP/OP","$14,899.20 ","$11,025.41 ","$0.00 ","$14,899.20 ","$6,704.64 ","$0.00 ","$3,105.37 ","$0.00 ","$0.00 ","$2,608.73 ","$14,899.20 ","$0.00 ","$7,449.60 ","$11,800.17 ","$11,919.36 ","$0.00 ","$2,331.72 ","$0.00 ","$2,371.95 ","$0.00 "
"ENF403900","SUP","HCPCS C1874","","ENF403900  -  STENT VASCULAR 4.5MM 37MM W/O DISTAL TIP ENTERPRISE NITINOL","BOTH IP/OP","$14,899.20 ","$11,025.41 ","$0.00 ","$14,899.20 ","$6,704.64 ","$0.00 ","$3,105.37 ","$0.00 ","$0.00 ","$2,608.73 ","$14,899.20 ","$0.00 ","$7,449.60 ","$11,800.17 ","$11,919.36 ","$0.00 ","$2,331.72 ","$0.00 ","$2,371.95 ","$0.00 "
"ENF403912","SUP","HCPCS C1874","","ENF403912  -  STENT VASC 4.5MM 37MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS","BOTH IP/OP","$14,899.20 ","$11,025.41 ","$0.00 ","$14,899.20 ","$6,704.64 ","$0.00 ","$3,105.37 ","$0.00 ","$0.00 ","$2,608.73 ","$14,899.20 ","$0.00 ","$7,449.60 ","$11,800.17 ","$11,919.36 ","$0.00 ","$2,331.72 ","$0.00 ","$2,371.95 ","$0.00 "
"ENSP25008UX","SUP","HCPCS C1874","","STENT CORON 8MM 25MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP25012UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 12MM DRUG ELUDING ENDVR SPRNT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP25014UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 14MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP25018UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 18MM DRUG ELUDING ENDVR SPRNT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP25024UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 24MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP25030UX","SUP","HCPCS C1874","","STENT CORON 2.5MM 30MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP30009UX","SUP","HCPCS C1874","","STENT CORON 3MM 9MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP30012UX","SUP","HCPCS C1874","","STENT CORON 3MM 12MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP30015UX","SUP","HCPCS C1874","","STENT CORON 3MM 15MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP30018UX","SUP","HCPCS C1874","","STENT CORON 3MM 18MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP30024UX","SUP","HCPCS C1874","","STENT CORON 3MM 24MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP30030UX","SUP","HCPCS C1874","","STENT CORON 3MM 30MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP35009UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 9MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP35012UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 12MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP35015UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 15MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP35018UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 18MM DRUG ELUDING ENDVR SPRNT","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP35024UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 24MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ENSP35030UX","SUP","HCPCS C1874","","STENT CORON 3.5MM 30MM DRUG ELUDING ENDVR","BOTH IP/OP","$4,312.50 ","$3,191.25 ","$0.00 ","$4,312.50 ","$1,940.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$755.08 ","$4,312.50 ","$0.00 ","$2,156.25 ","$3,415.50 ","$3,450.00 ","$0.00 ","$674.91 ","$0.00 ","$686.55 ","$0.00 "
"ER7232A","SUP","HCPCS C2628","","ER7232A  -  ER-REBOA CATHETER","BOTH IP/OP","$5,437.50 ","$4,023.75 ","$0.00 ","$5,437.50 ","$0.00 ","$0.00 ","$1,133.31 ","$0.00 ","$0.00 ","$0.00 ","$5,437.50 ","$0.00 ","$2,718.75 ","$4,306.50 ","$4,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ES3352","SUP","HCPCS C1729","","CATHETER INTRAVENOUS PROTECTIV ACUVANCE 16G X 2IN SAFETY STR","BOTH IP/OP","$4.10 ","$3.03 ","$0.00 ","$4.10 ","$2.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.72 ","$4.10 ","$0.00 ","$2.05 ","$3.25 ","$3.28 ","$0.00 ","$0.64 ","$0.00 ","$0.65 ","$0.00 "
"ESCDH33","SUP","Custom 27203010","","ESCDH33  -  STAPLER INTNL CRV CRC 33MM 5.5MM STRL LF 1-2.5MM PRX LNR CTR","BOTH IP/OP","$3,588.47 ","$2,655.47 ","$0.00 ","$3,588.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,588.47 ","$0.00 ","$1,794.24 ","$2,842.07 ","$2,870.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESEJ10G","SUP","Custom 27203010","","ESEJ10G  -  SUTURE ABSORBABLE 0 18IN BRAID TIES COATED VICRYL ENDOLOOP","BOTH IP/OP","$376.17 ","$278.37 ","$0.00 ","$376.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$376.17 ","$0.00 ","$188.09 ","$297.93 ","$300.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP100-21-00","SUP","Custom 27803010","","ESP100-21-00  -  VALVE AORTIC 21MM EP SUP THV","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP100-23-00","SUP","Custom 27803010","","ESP100-23-00  -  VALVE AOR 23MM 16MM EP FLEXFIT BPRTH STNT SCLP INFL EDG HLDR","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP100-25-00","SUP","Custom 27803010","","ESP100-25-00  -  VALVE AORTIC 25MM EP SUP THV","BOTH IP/OP","$19,700.00 ","$14,578.00 ","$0.00 ","$19,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19,700.00 ","$0.00 ","$9,850.00 ","$15,602.40 ","$15,760.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP100-27-00","SUP","Custom 27803010","","ESP100-27-00  -  VALVE AORTIC 27MM EP SUP THV","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP1955","SUP","Custom 27011340","","ESP1955  -  SPLINTS YELLOW JACKET","BOTH IP/OP","$65.63 ","$48.57 ","$0.00 ","$65.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.63 ","$0.00 ","$32.81 ","$51.98 ","$52.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP3075","SUP","Custom 27203010","","ESP3075  -  KIT SPLINT NEOPRENE DURABLE NONABSORBENT EASY FRACTURE MANAG","BOTH IP/OP","$437.38 ","$323.66 ","$0.00 ","$437.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.38 ","$0.00 ","$218.69 ","$346.40 ","$349.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP-3100","SUP","Custom 27203010","","SPLINT TRACTION 4 LEG ADULT","BOTH IP/OP","$412.38 ","$305.16 ","$0.00 ","$412.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.38 ","$0.00 ","$206.19 ","$326.60 ","$329.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP3101","SUP","Custom 27203010","","SPLINT TRACTION 3 LEG PEDIATRIC","BOTH IP/OP","$412.38 ","$305.16 ","$0.00 ","$412.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.38 ","$0.00 ","$206.19 ","$326.60 ","$329.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESP-3119","SUP","Custom 27203010","","SPLINT TRACTION SINGLE SAGER FORM III","BOTH IP/OP","$686.25 ","$507.83 ","$0.00 ","$686.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$686.25 ","$0.00 ","$343.13 ","$543.51 ","$549.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ESU-501","SUP","Custom 27203010","","FILTER SMKEVC PK FINESSE","BOTH IP/OP","$83.13 ","$61.52 ","$0.00 ","$83.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.13 ","$0.00 ","$41.56 ","$65.84 ","$66.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ETBF3216C166E","SUP","Custom 27803010","","ETBF3216C166E  -  GRAFT STNT 2 BRCH 32-16MM 20FR 166MM ENDURANT II DLV SYS C","BOTH IP/OP","$24,937.50 ","$18,453.75 ","$0.00 ","$24,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24,937.50 ","$0.00 ","$12,468.75 ","$19,750.50 ","$19,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ETDPP6","SUP","Custom 27203010","","ETDPP6  -  ADHESIVE SKNCLS 2 OCTYL CYNCRLT DRMBND VL TOP LQ HVISC PRPN","BOTH IP/OP","$64.42 ","$47.67 ","$0.00 ","$64.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.42 ","$0.00 ","$32.21 ","$51.02 ","$51.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ETLW1616C82E","SUP","Custom 27803010","","ETLW1616C82E  -  GRAFT STNT 16-16MM 14FR 82MM ENDURANT II DLV SYS C DIST","BOTH IP/OP","$11,187.50 ","$8,278.75 ","$0.00 ","$11,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11,187.50 ","$0.00 ","$5,593.75 ","$8,860.50 ","$8,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ETLW1620C156E","SUP","Custom 27803010","","ETLW1620C156E  -  GRAFT STNT 16-20MM 16FR 156MM ENDURANT II DLV SYS C DIST","BOTH IP/OP","$16,000.00 ","$11,840.00 ","$0.00 ","$16,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,000.00 ","$0.00 ","$8,000.00 ","$12,672.00 ","$12,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ETLW1628C93E","SUP","HCPCS C2625","","ETLW1628C93E  -  GRAFT STNT 16-28MM 16FR 93MM ENDURANT II DLV SYS C DIST","BOTH IP/OP","$12,312.50 ","$9,111.25 ","$0.00 ","$12,312.50 ","$5,540.63 ","$0.00 ","$2,566.23 ","$0.00 ","$0.00 ","$2,155.82 ","$12,312.50 ","$0.00 ","$6,156.25 ","$9,751.50 ","$9,850.00 ","$0.00 ","$1,926.91 ","$0.00 ","$1,960.15 ","$0.00 "
"ETVKMM","SUP","HCPCS C1781","","ETVKMM  -  MESH SURG 6X6IN ABS KNTD WVN VCL PLGC 910","BOTH IP/OP","$791.30 ","$585.56 ","$0.00 ","$791.30 ","$356.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$138.55 ","$791.30 ","$0.00 ","$395.65 ","$626.71 ","$633.04 ","$0.00 ","$123.84 ","$0.00 ","$125.97 ","$0.00 "
"EUSCFS-070026-14-13","SUP","HCPCS C1768","","EUSCFS-070026-14-13  -  SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM","BOTH IP/OP","$297.06 ","$219.82 ","$0.00 ","$297.06 ","$133.68 ","$0.00 ","$61.92 ","$0.00 ","$0.00 ","$52.01 ","$297.06 ","$0.00 ","$148.53 ","$235.27 ","$237.65 ","$0.00 ","$46.49 ","$0.00 ","$47.29 ","$0.00 "
"EUSN-19-QC","SUP","Custom 27203105","","NEEDLE BX 19G","BOTH IP/OP","$359.88 ","$266.31 ","$0.00 ","$359.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$359.88 ","$0.00 ","$179.94 ","$285.02 ","$287.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EX70410","SUP","HCPCS A4364","","EX70410  -  ADHESIVE SKNCLS 1ML EXOFIN","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$5.21 ","$1.36 ","$0.00 ","$5.21 ","$0.00 ","$0.00 ","$0.44 ","$2.50 ","$0.00 ","$1.25 ","$1.98 ","$2.00 ","$0.00 ","$0.39 ","$0.00 ","$0.40 ","$0.00 "
"EXPORTAP","SUP","HCPCS C1757","","EXPORTAP  -  CATHETER THROMBECTOMY FULL WALL 6FR .07IN 140CM BRAID","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$0.00 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$0.00 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EZ15-15-15","SUP","HCPCS C1713","","EZ15-15-15  -  STAPLE BONE 2MM 15X15X1.8-1.3MM MONOCORTICAL SUPERELASTIC LP","BOTH IP/OP","$3,208.50 ","$2,374.29 ","$0.00 ","$3,092.70 ","$1,391.72 ","$0.00 ","$668.73 ","$0.00 ","$0.00 ","$541.51 ","$3,092.70 ","$0.00 ","$1,546.35 ","$2,449.42 ","$2,474.16 ","$0.00 ","$484.01 ","$0.00 ","$492.36 ","$0.00 "
"EZF21TA","SUP","Custom 27203010","","EZF21TA  -  CANNULA PERFUSION 3/8IN 21FR 14.8IN CURVE TIP SUTURE FLANGE","BOTH IP/OP","$110.68 ","$81.90 ","$0.00 ","$110.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.68 ","$0.00 ","$55.34 ","$87.66 ","$88.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"EZS24TA","SUP","Custom 27203010","","EZS24TA  -  CANNULA PERFUSION 3/8IN STR 24FR 14IN AUTO DILATE TIP SUTURE","BOTH IP/OP","$93.30 ","$69.04 ","$0.00 ","$93.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.30 ","$0.00 ","$46.65 ","$73.89 ","$74.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"F1/8TA15S","SUP","Custom 27203010","","F1/8TA15S  -  TOOL LEGEND 8 CM 1.5MM SPIRAL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"F1006","SUP","HCPCS C1768","","F1006  -  GRAFT VASC 10CM 6MM IMPR CBFL PTFE PERI BYPS FLX","BOTH IP/OP","$891.48 ","$659.70 ","$0.00 ","$891.48 ","$401.16 ","$0.00 ","$185.81 ","$0.00 ","$0.00 ","$156.09 ","$891.48 ","$0.00 ","$445.74 ","$706.05 ","$713.18 ","$0.00 ","$139.52 ","$0.00 ","$141.92 ","$0.00 "
"F1010","SUP","HCPCS C1768","","F1010  -  GRAFT VASC 10CM 10MM IMPR CBFL PTFE PERI BYPS FLX","BOTH IP/OP","$891.48 ","$659.70 ","$0.00 ","$891.48 ","$401.16 ","$0.00 ","$185.81 ","$0.00 ","$0.00 ","$156.09 ","$891.48 ","$0.00 ","$445.74 ","$706.05 ","$713.18 ","$0.00 ","$139.52 ","$0.00 ","$141.92 ","$0.00 "
"F2/8TA23S","SUP","Custom 27203010","","F2/8TA23S  -  TOOL LEGEND 8CM 2.3MM SPIRAL","BOTH IP/OP","$269.88 ","$199.71 ","$0.00 ","$269.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$269.88 ","$0.00 ","$134.94 ","$213.74 ","$215.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"F-30","SUP","Custom 27203010","","FILTER TRNSF GAS VNT REPL LKCYT RBC 40UM","BOTH IP/OP","$51.75 ","$38.30 ","$0.00 ","$51.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.75 ","$0.00 ","$25.88 ","$40.99 ","$41.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"F6008","SUP","HCPCS C1768","","F6008  -  GRAFT VASC 60CM 8MM IMPR CBFL PTFE PERI BYPS FLX","BOTH IP/OP","$2,160.88 ","$1,599.05 ","$0.00 ","$2,160.88 ","$972.39 ","$0.00 ","$450.38 ","$0.00 ","$0.00 ","$378.35 ","$2,160.88 ","$0.00 ","$1,080.44 ","$1,711.42 ","$1,728.70 ","$0.00 ","$338.18 ","$0.00 ","$344.01 ","$0.00 "
"F7006","SUP","HCPCS C1768","","F7006  -  GRAFT VASC 70CM 6MM IMPR CBFL PTFE PERI BYPS FLX","BOTH IP/OP","$2,570.28 ","$1,902.01 ","$0.00 ","$2,570.28 ","$1,156.62 ","$0.00 ","$535.71 ","$0.00 ","$0.00 ","$450.03 ","$2,570.28 ","$0.00 ","$1,285.14 ","$2,035.66 ","$2,056.22 ","$0.00 ","$402.25 ","$0.00 ","$409.19 ","$0.00 "
"F7008","SUP","HCPCS C1768","","F7008  -  GRAFT VASC STRG 8MM 70CM IMPRA FLX SM BEAD EPTFE","BOTH IP/OP","$2,570.28 ","$1,902.01 ","$0.00 ","$2,570.28 ","$1,156.62 ","$0.00 ","$535.71 ","$0.00 ","$0.00 ","$450.03 ","$2,570.28 ","$0.00 ","$1,285.14 ","$2,035.66 ","$2,056.22 ","$0.00 ","$402.25 ","$0.00 ","$409.19 ","$0.00 "
"FA-0140","SUP","HCPCS C1713","","FA-0140  -  SCREW BN 3.5MM 14MM CNN XTRMT","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$253.13 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"FA-0160","SUP","HCPCS C1713","","FA-0160  -  SCREW BN 3.5MM 16MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0180","SUP","HCPCS C1713","","FA-0180  -  SCREW BN 3.5MM 18MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0200","SUP","HCPCS C1713","","FA-0200  -  SCREW BN 3.5MM 20MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0220","SUP","HCPCS C1713","","FA-0220  -  SCREW BN 3.5MM 22MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0240","SUP","HCPCS C1713","","FA-0240  -  SCREW BN 3.5MM 24MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0260","SUP","HCPCS C1713","","FA-0260  -  SCREW BN 3.5MM 26MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0280","SUP","HCPCS C1713","","FA-0280  -  SCREW BN 3.5MM 28MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0300","SUP","HCPCS C1713","","FA-0300  -  SCREW BN 3.5MM 30MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0320","SUP","HCPCS C1713","","FA-0320  -  SCREW BN 3.5MM 32MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0340","SUP","HCPCS C1713","","FA-0340  -  SCREW BN 3.5MM 34MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0360","SUP","HCPCS C1713","","FA-0360  -  SCREW BN 3.5MM 36MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0380","SUP","HCPCS C1713","","FA-0380  -  SCREW BN 3.5MM 38MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-0400","SUP","HCPCS C1713","","FA-0400  -  SCREW BN 3.5MM 40MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-04020","SUP","Custom 27203010","","FA-04020  -  KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ","BOTH IP/OP","$34.40 ","$25.46 ","$0.00 ","$57.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.04 ","$0.00 ","$28.52 ","$45.18 ","$45.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FA-0420","SUP","HCPCS C1713","","FA-0420  -  SCREW BN 3.5MM 42MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4014","SUP","HCPCS C1713","","FA-4014  -  SCREW BN 4MM 14MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4016","SUP","HCPCS C1713","","FA-4016  -  SCREW BN 4MM 16MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4018","SUP","HCPCS C1713","","FA-4018  -  SCREW BN 4MM 18MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4020","SUP","HCPCS C1713","","FA-4020  -  SCREW BN 4MM 20MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4022","SUP","HCPCS C1713","","FA-4022  -  SCREW BN 4MM 22MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4024","SUP","HCPCS C1713","","FA-4024  -  SCREW BN 4MM 24MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4026","SUP","HCPCS C1713","","FA-4026  -  SCREW BN 4MM 26MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4028","SUP","HCPCS C1713","","FA-4028  -  SCREW BN 4MM 28MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4030","SUP","HCPCS C1713","","FA-4030  -  SCREW BN 4MM 30MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4032","SUP","HCPCS C1713","","FA-4032  -  SCREW BN 4MM 32MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4034","SUP","HCPCS C1713","","FA-4034  -  SCREW BN 4MM 34MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4036","SUP","HCPCS C1713","","FA-4036  -  SCREW BN 4MM 36MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4038","SUP","HCPCS C1713","","FA-4038  -  SCREW BN 4MM 38MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4040","SUP","HCPCS C1713","","FA-4040  -  SCREW BN 4MM 40MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-4042","SUP","HCPCS C1713","","FA-4042  -  SCREW BN 4MM 42MM CNN XTRMT","BOTH IP/OP","$492.50 ","$364.45 ","$0.00 ","$492.50 ","$221.63 ","$0.00 ","$102.65 ","$0.00 ","$0.00 ","$86.23 ","$492.50 ","$0.00 ","$246.25 ","$390.06 ","$394.00 ","$0.00 ","$77.08 ","$0.00 ","$78.41 ","$0.00 "
"FA-55150-1030","SUP","HCPCS C2628","","FA-55150-1030  -  CATH INFUS MIC 2.8FR 3.2FR .027IN 150CM 10CM MARKSMAN","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,625.00 ","$0.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$0.00 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FA-88810-20","SUP","Custom 27203010","","FA-88810-20  -  DEVICE RTRVL 2MM ALGTR NRVSC FB ATRM DSGN SF RELS","BOTH IP/OP","$6,562.50 ","$4,856.25 ","$0.00 ","$6,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,562.50 ","$0.00 ","$3,281.25 ","$5,197.50 ","$5,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FA-88810-30","SUP","Custom 27203010","","FA-88810-30  -  ALLIGATOR RETRIEVAL-30","BOTH IP/OP","$6,562.50 ","$4,856.25 ","$0.00 ","$6,562.50 ","$0.00 ","$0.00 ","$1,367.79 ","$0.00 ","$0.00 ","$0.00 ","$6,562.50 ","$0.00 ","$3,281.25 ","$5,197.50 ","$5,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FA-88810-40","SUP","Custom 27203010","","FA-88810-40  -  DEVICE RTRVL ALGTR 4MM FB ATRM DSGN SF RELS","BOTH IP/OP","$6,562.50 ","$4,856.25 ","$0.00 ","$6,562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,562.50 ","$0.00 ","$3,281.25 ","$5,197.50 ","$5,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FA-88810-50","SUP","HCPCS C1773","","FA-88810-50  -  DEVICE SPEC RTRVL ALGTR 5MM NRVSC 4 INTLCK PLTN JAW","BOTH IP/OP","$6,562.50 ","$4,856.25 ","$0.00 ","$6,562.50 ","$3,563.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,149.04 ","$6,562.50 ","$0.00 ","$3,281.25 ","$5,197.50 ","$5,250.00 ","$0.00 ","$1,027.03 ","$0.00 ","$1,044.75 ","$0.00 "
"FA-9020","SUP","HCPCS C1713","","FA-9020  -  DRILL SRG XTRMT 3.5 MM SCR","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$159.75 ","$0.00 ","$73.99 ","$0.00 ","$0.00 ","$62.16 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$55.56 ","$0.00 ","$56.52 ","$0.00 "
"FA-CO2736","SUP","HCPCS C1713","","FA-CO2736  -  SCREW BONE 2.7MM 36MM TAP-LOC ACUMED TI ELB TAP STRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO2738","SUP","HCPCS C1713","","FA-CO2738  -  SCREW BONE 2.7MM 38MM TI CORT TAP NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO2740","SUP","HCPCS C1713","","FA-CO2740  -  SCREW BONE 2.7MM 40MM ACUMED TI CORT TAP NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO2745","SUP","HCPCS C1713","","FA-CO2745  -  SCREW BONE 2.7MM 45MM TI ELB LCK TAP STRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO2750","SUP","HCPCS C1713","","FA-CO2750  -  SCREW BONE 2.7MM 50MM TAP-LOC TI CORT ELB LCK NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO2755","SUP","HCPCS C1713","","FA-CO2755  -  SCREW BONE 2.7MM 55MM TAP-LOC ACUMED TI ELB TAP STRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO2760","SUP","HCPCS C1713","","FA-CO2760  -  SCREW BONE 2.7MM 60MM TAP-LOC ACUMED TI ELB TPR STRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3536","SUP","HCPCS C1713","","FA-CO3536  -  SCREW BONE 3.5MM 36MM TAP-LOC TI CORT LCK TAP NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3538","SUP","HCPCS C1713","","FA-CO3538  -  SCREW BN 3.5MM 38MM TAP LCK","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3540","SUP","HCPCS C1713","","FA-CO3540  -  SCREW BONE 3.5MM 40MM TAP-LOC TI ELB LCK TAP NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3545","SUP","HCPCS C1713","","FA-CO3545  -  SCREW BONE 3.5MM 45MM TI CORT LCK TAP NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3550","SUP","HCPCS C1713","","FA-CO3550  -  SCREW BN 3.5MM 50MM NS TPRLK CORT","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3555","SUP","HCPCS C1713","","FA-CO3555  -  SCREW BN 3.5MM 55MM NS LCK TAP TI ELB PLT SYS","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FA-CO3560","SUP","HCPCS C1713","","FA-CO3560  -  SCREW BN 3.5MM 60MM NS LCK TAP TI ELB PLT SYS","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$104.63 ","$0.00 ","$48.46 ","$0.00 ","$0.00 ","$40.71 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$36.39 ","$0.00 ","$37.01 ","$0.00 "
"FBRC","SUP","HCPCS C1884","","FBRC  -  SYSTEM REM .035IN 10FR 75CM RCVR CN WRE BSKT RADOPQ PEBAX","BOTH IP/OP","$1,593.45 ","$1,179.15 ","$0.00 ","$1,593.45 ","$717.05 ","$0.00 ","$332.11 ","$0.00 ","$0.00 ","$279.00 ","$1,593.45 ","$0.00 ","$796.72 ","$1,262.01 ","$1,274.76 ","$0.00 ","$249.37 ","$0.00 ","$253.68 ","$0.00 "
"FCROF2005","SUP","Custom 27203010","","FILTER 20.5UM","BOTH IP/OP","$31.58 ","$23.37 ","$0.00 ","$31.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.58 ","$0.00 ","$15.79 ","$25.01 ","$25.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FD-410LR","SUP","Custom 27203010","","FD-410LR  -  FORCEPS MNPLR 2.75MM 2.8MM 165X5MM STRL COAGRASPER HMSTS","BOTH IP/OP","$463.53 ","$343.01 ","$0.00 ","$463.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$463.53 ","$0.00 ","$231.76 ","$367.12 ","$370.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FD-411UR","SUP","Custom 27203010","","FD-411UR  -  FORCEPS MNPLR 2.75MM 3.2MM 230X4MM STRL COAGRASPER HMSTS","BOTH IP/OP","$588.85 ","$435.75 ","$0.00 ","$588.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$588.85 ","$0.00 ","$294.43 ","$466.37 ","$471.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FD-412LR","SUP","Custom 27203010","","FD-412LR  -  FORCEPS ESCP 2.8MM 2.75MM 165CM COAGRASPER HMST GRSPR MNPLR","BOTH IP/OP","$463.53 ","$343.01 ","$0.00 ","$463.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$463.53 ","$0.00 ","$231.76 ","$367.12 ","$370.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FDB2.0","SUP","Custom 27203010","","BIT DRILL 2MM STRL DISP DB20","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FE660K","SUP","Custom 27803010","","FE660K  -  CLIP ANEURYSM STANDARD 10.3MM OPENING 5MM 12MM STR FENST","BOTH IP/OP","$1,013.59 ","$750.06 ","$0.00 ","$920.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$920.95 ","$0.00 ","$460.48 ","$729.39 ","$736.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FE664K","SUP","Custom 27803010","","FE664K  -  CLIP ANEURYSM 5.5MM OPEN STANDARD 5MM 10/6.4MM PERMANENT","BOTH IP/OP","$1,013.59 ","$750.06 ","$0.00 ","$920.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$920.95 ","$0.00 ","$460.48 ","$729.39 ","$736.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FE776K","SUP","Custom 27803010","","FE776K  -  CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD DOWN FENST","BOTH IP/OP","$1,013.59 ","$750.06 ","$0.00 ","$920.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$920.95 ","$0.00 ","$460.48 ","$729.39 ","$736.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FE779K","SUP","Custom 27803010","","FE779K  -  CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD UP FENST","BOTH IP/OP","$1,013.59 ","$750.06 ","$0.00 ","$920.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$920.95 ","$0.00 ","$460.48 ","$729.39 ","$736.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FEM08040","SUP","HCPCS C1876","","FEM08040  -  GRAFT STNT 8MM 9FR 40MM 80CM FLN + 2 LYR KINK RST INR CATH","BOTH IP/OP","$7,857.50 ","$5,814.55 ","$0.00 ","$7,857.50 ","$3,535.88 ","$0.00 ","$1,637.70 ","$0.00 ","$0.00 ","$1,375.79 ","$7,857.50 ","$0.00 ","$3,928.75 ","$6,223.14 ","$6,286.00 ","$0.00 ","$1,229.70 ","$0.00 ","$1,250.91 ","$0.00 "
"FEMII016AS","SUP","Custom 27203010","","FEMII016AS  -  FEM-FLEX II CANNULA 16 FR","BOTH IP/OP","$592.30 ","$438.30 ","$0.00 ","$592.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$592.30 ","$0.00 ","$296.15 ","$469.10 ","$473.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FEMII018AS","SUP","Custom 27203010","","FEMII018AS  -  FEM-FLEX II CANNULA 18 FR","BOTH IP/OP","$592.30 ","$438.30 ","$0.00 ","$592.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$592.30 ","$0.00 ","$296.15 ","$469.10 ","$473.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FEMII020AS","SUP","Custom 27203010","","FEMII020AS  -  FEM-FLEX II CANNULA 20 FR","BOTH IP/OP","$592.30 ","$438.30 ","$0.00 ","$592.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$592.30 ","$0.00 ","$296.15 ","$469.10 ","$473.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FG-0201","SUP","Custom 27203010","","FG-0201  -  DEVICE TISS REM 3.6MM SYMPHION RESCT","BOTH IP/OP","$4,120.00 ","$3,048.80 ","$0.00 ","$4,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,120.00 ","$0.00 ","$2,060.00 ","$3,263.04 ","$3,296.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FG-0202","SUP","Custom 27203010","","FG-0202  -  TISSUE REMOVAL SYSTEM FLUID MANAGEMENT ACCESSORIES","BOTH IP/OP","$1,284.93 ","$950.85 ","$0.00 ","$1,284.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,284.93 ","$0.00 ","$642.46 ","$1,017.66 ","$1,027.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FG-44NR-1","SUP","Custom 27203010","","FG-44NR-1  -  FORCEP SPEC RTRVL 180CM 2.8MM BRNCHL FB ROT ALGTR JAW RAT","BOTH IP/OP","$1,163.58 ","$861.05 ","$0.00 ","$1,163.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,163.58 ","$0.00 ","$581.79 ","$921.56 ","$930.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FGL07560","SUP","HCPCS L8699","","FGL07560  -  GRAFT SFT TIS 7.5MM 60MM FLEXIGRAFT GRAFTLINK ALGRF FRZN","BOTH IP/OP","$6,160.00 ","$4,558.40 ","$0.00 ","$6,040.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,040.00 ","$0.00 ","$3,020.00 ","$4,783.68 ","$4,832.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FLT08040","SUP","HCPCS C1768","","STENT TRACHEOBRONCHIAL FLUENCY 8MM X 40MM SELF EXPANDING COV","BOTH IP/OP","$5,737.50 ","$4,245.75 ","$0.00 ","$5,737.50 ","$2,581.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,004.59 ","$5,737.50 ","$0.00 ","$2,868.75 ","$4,544.10 ","$4,590.00 ","$0.00 ","$897.92 ","$0.00 ","$913.41 ","$0.00 "
"FP-07.24.0","SUP","HCPCS C1713","","FP-07.24.0  -  CAGE SPNL 24MMX7MM FUSE 0D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-08.24.0","SUP","HCPCS C1713","","FP-08.24.0  -  CAGE SPNL 24MMX8MM FUSE 0D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-09.24.4","SUP","HCPCS C1713","","FP-09.24.4  -  CAGE SPNL 24MMX9MM FUSE 4D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-09.24.8","SUP","HCPCS C1713","","FP-09.24.8  -  CAGE SPNL 24MMX9MM FUSE 8D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-10.24.4","SUP","HCPCS C1713","","FP-10.24.4  -  CAGE SPNL 24MMX10MM FUSE 4D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-10.24.8","SUP","HCPCS C1713","","FP-10.24.8  -  CAGE SPNL 24MMX10MM FUSE 8D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-11.24.4","SUP","HCPCS C1713","","FP-11.24.4  -  CAGE SPNL 24MMX11MM FUSE 4D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-11.24.8","SUP","HCPCS C1713","","FP-11.24.8  -  CAGE SPNL 24MMX11MM FUSE 8D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-12.24.4","SUP","HCPCS C1713","","FP-12.24.4  -  CAGE SPNL 24MMX12MM FUSE 4D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-12.24.8","SUP","HCPCS C1713","","FP-12.24.8  -  CAGE SPNL 24MMX12MM FUSE 8D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-13.24.4","SUP","HCPCS C1713","","FP-13.24.4  -  CAGE SPNL 24MMX13MM FUSE 4D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-13.24.8","SUP","HCPCS C1713","","FP-13.24.8  -  CAGE SPNL 24MMX13MM FUSE 8D PLIF","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$3,375.00 ","$0.00 ","$1,563.19 ","$0.00 ","$0.00 ","$1,313.19 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$1,173.75 ","$0.00 ","$1,194.00 ","$0.00 "
"FP-14","SUP","HCPCS C1713","","FP-14  -  PEG FIX 2.5MM 14MM FULTHD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"FP-16","SUP","HCPCS C1713","","FP-16  -  PEG FIX 2.5MM 16MM FULTHD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"FP-20","SUP","HCPCS C1713","","FP-20  -  PEG FIX 2.5MM 20MM FULTHD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"FP-26","SUP","HCPCS C1713","","FP-26  -  PEG FIX 2.5MM 26MM FULTHD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"FP-7","SUP","HCPCS C1783","","FP-7  -  DRAIN GLAUCOMA THK.9MM BLUNT TAPER .635MM .305MM 16X13MM 25","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"FR995-27","SUP","Custom 27803010","","FR995-27  -  VALVE AOR 27MM 34MM STRL 3MM FRSTL BPRTH PRCN ROOT","BOTH IP/OP","$23,125.00 ","$17,112.50 ","$0.00 ","$23,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23,125.00 ","$0.00 ","$11,562.50 ","$18,315.00 ","$18,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FR995-29","SUP","Custom 27803010","","FR995-29  -  FREESTYLE ROOT VALVE 29 MM","BOTH IP/OP","$15,330.00 ","$11,344.20 ","$0.00 ","$15,330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,330.00 ","$0.00 ","$7,665.00 ","$12,141.36 ","$12,264.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FS0808","SUP","HCPCS C1781","","FS0808  -  GRAFT SNTH TISS 8X8CM BIO-A BABSR REINF SCFLD TISS","BOTH IP/OP","$1,022.50 ","$756.65 ","$0.00 ","$1,022.50 ","$460.13 ","$0.00 ","$213.11 ","$0.00 ","$0.00 ","$179.03 ","$1,022.50 ","$0.00 ","$511.25 ","$809.82 ","$818.00 ","$0.00 ","$160.02 ","$0.00 ","$162.78 ","$0.00 "
"FS0915","SUP","HCPCS C1781","","FS0915  -  GRAFT SNTH TISS 15X9CM GORE BIO-A BABSR SCFLD","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$821.25 ","$0.00 ","$380.38 ","$0.00 ","$0.00 ","$319.54 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$285.61 ","$0.00 ","$290.54 ","$0.00 "
"FS1030","SUP","HCPCS C1781","","FS1030  -  MESH SRG 30X10CM BIO-ASNTH BABSR REINF SCFLD TRM TISS","BOTH IP/OP","$5,027.50 ","$3,720.35 ","$0.00 ","$5,027.50 ","$2,262.38 ","$0.00 ","$1,047.86 ","$0.00 ","$0.00 ","$880.28 ","$5,027.50 ","$0.00 ","$2,513.75 ","$3,981.78 ","$4,022.00 ","$0.00 ","$786.80 ","$0.00 ","$800.38 ","$0.00 "
"FS2020","SUP","HCPCS C1781","","FS2020  -  GRAFT SNTH TISS 20X20CM BIO-A BABSR REINF SCFLD TISS","BOTH IP/OP","$6,712.50 ","$4,967.25 ","$0.00 ","$6,712.50 ","$3,020.63 ","$0.00 ","$1,399.05 ","$0.00 ","$0.00 ","$1,175.31 ","$6,712.50 ","$0.00 ","$3,356.25 ","$5,316.30 ","$5,370.00 ","$0.00 ","$1,050.51 ","$0.00 ","$1,068.63 ","$0.00 "
"FS2030","SUP","HCPCS C1781","","FS2030  -  MESH SRG 30X20CM BIO-A BABSR REINF SCFLD TISS","BOTH IP/OP","$10,080.00 ","$7,459.20 ","$0.00 ","$10,080.00 ","$4,536.00 ","$0.00 ","$2,100.92 ","$0.00 ","$0.00 ","$1,764.93 ","$10,080.00 ","$0.00 ","$5,040.00 ","$7,983.36 ","$8,064.00 ","$0.00 ","$1,577.52 ","$0.00 ","$1,604.74 ","$0.00 "
"FSR100201-20","SUP","Custom 27803010","","FSR100201-20  -  COIL EMBL HLCL 2MM 1CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,165.95 ","$1,602.80 ","$0.00 ","$2,165.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,165.95 ","$0.00 ","$1,082.98 ","$1,715.43 ","$1,732.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100202-20","SUP","Custom 27803010","","FSR100202-20  -  COIL EMBL HLCL 2MM 2CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,195.23 ","$1,624.47 ","$0.00 ","$2,195.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,195.23 ","$0.00 ","$1,097.61 ","$1,738.62 ","$1,756.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100203-20","SUP","Custom 27803010","","FSR100203-20  -  COIL EMBL HLCL 2MM 3CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,224.50 ","$1,646.13 ","$0.00 ","$2,224.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,224.50 ","$0.00 ","$1,112.25 ","$1,761.80 ","$1,779.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100204-20","SUP","Custom 27803010","","FSR100204-20  -  COIL EMBL HLCL 2MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,224.50 ","$1,646.13 ","$0.00 ","$2,224.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,224.50 ","$0.00 ","$1,112.25 ","$1,761.80 ","$1,779.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100206-20","SUP","Custom 27803010","","FSR100206-20  -  COIL EMBL HLCL 2MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,253.78 ","$1,667.80 ","$0.00 ","$2,253.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,253.78 ","$0.00 ","$1,126.89 ","$1,784.99 ","$1,803.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100208-20","SUP","Custom 27803010","","FSR100208-20  -  COIL EMBL HLX 2MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP","BOTH IP/OP","$2,283.05 ","$1,689.46 ","$0.00 ","$2,283.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,283.05 ","$0.00 ","$1,141.53 ","$1,808.18 ","$1,826.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100252-20","SUP","Custom 27803010","","FSR100252-20  -  COIL EMBL HLX 2.5MM 2CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP","BOTH IP/OP","$2,195.23 ","$1,624.47 ","$0.00 ","$2,195.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,195.23 ","$0.00 ","$1,097.61 ","$1,738.62 ","$1,756.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100254-20","SUP","Custom 27803010","","FSR100254-20  -  COIL EMBL HLCL 2.5MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,224.50 ","$1,646.13 ","$0.00 ","$2,224.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,224.50 ","$0.00 ","$1,112.25 ","$1,761.80 ","$1,779.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100256-20","SUP","Custom 27803010","","FSR100256-20  -  COIL EMBL HLCL 2.5MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,253.78 ","$1,667.80 ","$0.00 ","$2,253.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,253.78 ","$0.00 ","$1,126.89 ","$1,784.99 ","$1,803.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100258-20","SUP","Custom 27803010","","FSR100258-20  -  COIL EMBL 2.5MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP DTCH","BOTH IP/OP","$2,283.05 ","$1,689.46 ","$0.00 ","$2,283.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,283.05 ","$0.00 ","$1,141.53 ","$1,808.18 ","$1,826.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100306-20","SUP","Custom 27803010","","FSR100306-20  -  COIL EMBL HLCL 3MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,253.78 ","$1,667.80 ","$0.00 ","$2,253.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,253.78 ","$0.00 ","$1,126.89 ","$1,784.99 ","$1,803.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100308-20","SUP","Custom 27803010","","FSR100308-20  -  COIL EMBL 3MM 8CM ULTIPAQ 10 MCIOL HLCL LOOP DTCH SFT STRCH","BOTH IP/OP","$2,283.05 ","$1,689.46 ","$0.00 ","$2,283.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,283.05 ","$0.00 ","$1,141.53 ","$1,808.18 ","$1,826.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100406-20","SUP","Custom 27803010","","FSR100406-20  -  COIL EMBL HLCL 4MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,253.78 ","$1,667.80 ","$0.00 ","$2,253.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,253.78 ","$0.00 ","$1,126.89 ","$1,784.99 ","$1,803.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FSR100408-20","SUP","Custom 27803010","","FSR100408-20  -  COIL EMBL HLCL 4MM 8CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH","BOTH IP/OP","$2,283.05 ","$1,689.46 ","$0.00 ","$2,283.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,283.05 ","$0.00 ","$1,141.53 ","$1,808.18 ","$1,826.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-1100","SUP","Custom 27203010","","FT-1100  -  TROCAR SURGICAL FALLER DIALYSIS CATHETER","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12100","SUP","Custom 27803010","","FT-12100  -  CORONARY SHUNT 1.00 MM","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT12125","SUP","Custom 27803010","","FT12125  -  SHUNT CARDIO BULB TAPER 1.25MM 18MM RADIOPQ FLEXIBLE","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12125","SUP","Custom 27803010","","FT-12125  -  CORONARY SHUNT 1.25 MM","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12150","SUP","Custom 27803010","","FT-12150  -  CORONARY SHUNT 1.50 MM","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12175","SUP","Custom 27803010","","FT-12175  -  CORONARY SHUNT 1.75 MM","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12200","SUP","Custom 27803010","","FT-12200  -  CORONARY SHUNT 2.00 MM","BOTH IP/OP","$184.60 ","$136.60 ","$0.00 ","$184.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$184.60 ","$0.00 ","$92.30 ","$146.20 ","$147.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12225","SUP","Custom 27803010","","FT-12225  -  CORONARY SHUNT 2.25 MM","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT12250","SUP","Custom 27803010","","FT12250  -  SHUNT CARDIO 2.5MM 18MM FLO-THRU INTRALUMINAL","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT-12250","SUP","Custom 27803010","","FT-12250  -  CORONARY SHUNT 2.20 MM","BOTH IP/OP","$174.00 ","$128.76 ","$0.00 ","$174.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$174.00 ","$0.00 ","$87.00 ","$137.81 ","$139.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT180T","SUP","Custom 27803010","","FT180T  -  CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR TEMPORARY NARROW","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT190T","SUP","Custom 27803010","","FT190T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW TEMPORARY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT220T","SUP","Custom 27803010","","FT220T  -  CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR TEMPORARY LATEX","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT222T","SUP","Custom 27803010","","FT222T  -  CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT224T","SUP","Custom 27803010","","FT224T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM CVD TEMPORARY LATEX FREE","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT250T","SUP","Custom 27803010","","FT250T  -  CLIP ANEURYSM 7MM OPEN STANDARD 9MM TEMPORARY SPRING","BOTH IP/OP","$975.25 ","$721.69 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT252T","SUP","Custom 27803010","","FT252T  -  CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM CVD SLIGHTLY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT254T","SUP","Custom 27803010","","FT254T  -  CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD TEMPORARY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT280T","SUP","Custom 27803010","","FT280T  -  CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM TEMPORARY MRI","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT290T","SUP","Custom 27803010","","FT290T  -  CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR TEMPORARY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT620T","SUP","Custom 27803010","","FT620T  -  CLIP ANEURYSM STANDARD 9.6MM OPENING 3.5MM 12MM STR FENST","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT623T","SUP","Custom 27803010","","FT623T  -  CLIP ANEURYSM 7.8MM OPENING STANDARD 10.6MM PERMANENT MRI","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT640T","SUP","Custom 27803010","","FT640T  -  CLIP ANEURYSM STANDARD 7.9MM OPENING 5MM 6MM STR FENST","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT680T","SUP","Custom 27803010","","FT680T  -  CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR NARROW PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT690T","SUP","Custom 27803010","","FT690T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT700T","SUP","Custom 27803010","","FT700T  -  CLIP ANEURYSM MINI 3.5MM OPENING 3MM SLIGHTLY CVD PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT710T","SUP","Custom 27803010","","FT710T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR PERMANENT LATEX FREE","BOTH IP/OP","$975.25 ","$721.69 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT712T","SUP","Custom 27803010","","FT712T  -  CLIP ANEURYSM MINI 3.8MM OPENING 4.7MM CVD SLIGHTLY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT714T","SUP","Custom 27803010","","FT714T  -  CLIP ANEURYSM MINI 3.5MM OPENING 3.9MM SLIGHTLY CVD","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT720T","SUP","Custom 27803010","","FT720T  -  CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR PERMANENT LATEX","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT722T","SUP","Custom 27803010","","FT722T  -  CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT724T","SUP","Custom 27803010","","FT724T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM CVD PERMANENT LATEX FREE","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT726T","SUP","Custom 27803010","","FT726T  -  CLIP ANEURYSM MINI 4MM OPENING 5.2MM SLIGHTLY CVD PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT727T","SUP","Custom 27803010","","FT727T  -  CLIP ANEURYSM MINI 7MM OPENING 4MM BAYONET PERMANENT LATEX","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT728D","SUP","Custom 27803010","","FT728D  -  CLIP ANEURYSM MINI 5.7MM OPENING 7MM BAYONET PERMANENT LATEX","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT740T","SUP","Custom 27803010","","FT740T  -  CLIP ANEURYSM 6.2MM OPENING STANDARD 7MM PERMANENT MRI","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT742T","SUP","Custom 27803010","","FT742T  -  CLIP ANEURYSM STANDARD 6MM OPENING 6.5MM SLIGHTLY CVD","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT744T","SUP","Custom 27803010","","FT744T  -  CLIP ANEURYSM STANDARD 5.5MM OPENING 5.4MM CVD PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT746T","SUP","Custom 27803010","","FT746T  -  CLIP ANEURYSM STANDARD 5.7MM OPENING 7MM LATERAL ANGLED","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT747T","SUP","Custom 27803010","","FT747T  -  CLIP ANEURYSM 7MM OPENING STANDARD 8.6MM PERMANENT MRI","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT750T","SUP","Custom 27803010","","FT750T  -  CLIP ANEURYSM STANDARD 7MM OPENING 9MM STR PERMANENT LATEX","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT752T","SUP","Custom 27803010","","FT752T  -  CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM SLIGHTLY CVD","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT754T","SUP","Custom 27803010","","FT754T  -  CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT760T","SUP","Custom 27803010","","FT760T  -  CLIP ANEURYSM STANDARD 7.8MM OPENING 11MM STR PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT762T","SUP","Custom 27803010","","FT762T  -  CLIP ANEURYSM 7.5MM OPENING STANDARD 10.2MM PERMANENT MRI","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT780D","SUP","Custom 27803010","","FT780D  -  CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM PERMANENT MRI","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT782T","SUP","Custom 27803010","","FT782T  -  CLIP ANEURYSM STANDARD 8.7MM OPENING 13.7MM PERMANENT CVD","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT786T","SUP","Custom 27803010","","FT786T  -  CLIP ANEURYSM STANDARD 9.8MM OPENING 15.3MM CVD SLIGHTLY","BOTH IP/OP","$975.25 ","$721.69 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT790D","SUP","Custom 27803010","","FT790D  -  CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR PERMANENT","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT806T","SUP","Custom 27803010","","FT806T  -  CLIP ANEURYSM MINI 4.5MM OPENING 7MM ANGLED FORWARD","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT810T","SUP","Custom 27803010","","FT810T  -  CLIP ANEURYSM STANDARD 6.5MM OPENING 9MM ANGLED FORWARD","BOTH IP/OP","$1,084.23 ","$802.33 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FT820T","SUP","Custom 27803010","","FT820T  -  CLIP ANEURYSM STANDARD 4.5MM OPENING 7MM ANGLED RIGHT","BOTH IP/OP","$975.25 ","$721.69 ","$0.00 ","$975.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$975.25 ","$0.00 ","$487.63 ","$772.40 ","$780.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FTL10040","SUP","HCPCS C1876","","FTL10040  -  STENT TRCHBR 10MM 9FR 40MM STRL 117CM FLN + PUZZLE GFT","BOTH IP/OP","$7,482.50 ","$5,537.05 ","$0.00 ","$7,482.50 ","$3,367.13 ","$0.00 ","$1,559.54 ","$0.00 ","$0.00 ","$1,310.13 ","$7,482.50 ","$0.00 ","$3,741.25 ","$5,926.14 ","$5,986.00 ","$0.00 ","$1,171.01 ","$0.00 ","$1,191.21 ","$0.00 "
"FTM06040","SUP","HCPCS C1876","","FTM06040  -  STENT TRCHBR 6MM 40MM 80CM .035IN SLF XPD DLV SYS FLN PLUS","BOTH IP/OP","$7,482.50 ","$5,537.05 ","$0.00 ","$7,482.50 ","$3,367.13 ","$0.00 ","$1,559.54 ","$0.00 ","$0.00 ","$1,310.13 ","$7,482.50 ","$0.00 ","$3,741.25 ","$5,926.14 ","$5,986.00 ","$0.00 ","$1,171.01 ","$0.00 ","$1,191.21 ","$0.00 "
"FX-4001-S","SUP","Custom 27203010","","FX-4001-S  -  KIT XTRNFX STRL STABLELOC LTWT RDLCNT WRST","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FX-4004-S","SUP","Custom 27203010","","FX-4004-S  -  PIN FIX 3.2MM SLFDRILL 30MM ORTH STABLELOC STRL","BOTH IP/OP","$707.50 ","$523.55 ","$0.00 ","$707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.50 ","$0.00 ","$353.75 ","$560.34 ","$566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"FX-4054-S","SUP","Custom 27203010","","FX-4054-S  -  PIN FIX 2.7MM SLFDRILL 25MM","BOTH IP/OP","$707.50 ","$523.55 ","$0.00 ","$707.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$707.50 ","$0.00 ","$353.75 ","$560.34 ","$566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G00130","SUP","HCPCS C1725","","G00130  -  CATH ANGIO .035IN 5FR 65CM STR FLXB PE","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"G00164","SUP","Custom 27203010","","G00164  -  STOPCOCK IV .95IN CLR STRL 1 WY F TO M LL ROT ADPR LP PLS","BOTH IP/OP","$14.38 ","$10.64 ","$0.00 ","$14.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.38 ","$0.00 ","$7.19 ","$11.39 ","$11.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G00165","SUP","HCPCS C1770","","G00165  -  COIL EMBL 5CM 5MM 3.2 LOOP FBR OCL SPRG .035IN SS A/V STRL","BOTH IP/OP","$65.89 ","$48.76 ","$0.00 ","$65.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.89 ","$0.00 ","$32.94 ","$52.18 ","$52.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G00314","SUP","HCPCS C1769","","G00314  -  GUIDEWIRE VASC 3MM .038IN 100CM STRL SFTJ JTP HVYDTY CRV","BOTH IP/OP","$25.50 ","$18.87 ","$0.00 ","$25.50 ","$13.85 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.50 ","$0.00 ","$12.75 ","$20.20 ","$20.40 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"G00321","SUP","HCPCS C1769","","G00321  -  GUIDEWIRE VASC STRG .038IN 145CM LNDRQS RING TRQ SS PTFE","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G00331","SUP","HCPCS C1769","","G00331  -  SET STNT .035IN 2 PGTL CRV 4.7FR 28CM STRL PSTNR GW SFLX","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G00511","SUP","HCPCS C1769","","G00511  -  GUIDEWIRE VASCULAR CURVE TAPER .035IN 145CM 3CM FLEXIBLE TIP","BOTH IP/OP","$36.87 ","$27.28 ","$0.00 ","$35.63 ","$19.34 ","$0.00 ","$7.69 ","$0.00 ","$0.00 ","$6.24 ","$35.63 ","$0.00 ","$17.81 ","$28.22 ","$28.50 ","$0.00 ","$5.58 ","$0.00 ","$5.67 ","$0.00 "
"G00529","SUP","HCPCS C1769","","G00529  -  GUIDEWIRE VASCULAR CURVE TAPER .035IN 80CM 3CM FLEXIBLE TIP","BOTH IP/OP","$33.10 ","$24.49 ","$0.00 ","$31.98 ","$17.36 ","$0.00 ","$6.90 ","$0.00 ","$0.00 ","$5.60 ","$31.98 ","$0.00 ","$15.99 ","$25.33 ","$25.58 ","$0.00 ","$5.00 ","$0.00 ","$5.09 ","$0.00 "
"G00593","SUP","HCPCS C1769","","G00593  -  GUIDEWIRE VASCULAR STR TAPER .018IN 50CM FLEXIBLE TIP FIX","BOTH IP/OP","$32.03 ","$23.70 ","$0.00 ","$30.95 ","$16.81 ","$0.00 ","$6.68 ","$0.00 ","$0.00 ","$5.42 ","$30.95 ","$0.00 ","$15.48 ","$24.51 ","$24.76 ","$0.00 ","$4.84 ","$0.00 ","$4.93 ","$0.00 "
"G00631","SUP","HCPCS C1769","","G00631  -  GUIDEWIRE VASC STRG .038IN 145CM FX COR SS","BOTH IP/OP","$45.70 ","$33.82 ","$0.00 ","$45.70 ","$24.82 ","$0.00 ","$9.53 ","$0.00 ","$0.00 ","$8.00 ","$45.70 ","$0.00 ","$22.85 ","$36.19 ","$36.56 ","$0.00 ","$7.15 ","$0.00 ","$7.28 ","$0.00 "
"G00666","SUP","HCPCS C1769","","G00666  -  GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ 2 FLX TP XSTIF SS","BOTH IP/OP","$52.55 ","$38.89 ","$0.00 ","$52.55 ","$28.53 ","$0.00 ","$10.95 ","$0.00 ","$0.00 ","$9.20 ","$52.55 ","$0.00 ","$26.28 ","$41.62 ","$42.04 ","$0.00 ","$8.22 ","$0.00 ","$8.37 ","$0.00 "
"G00683","SUP","HCPCS C1769","","G00683  -  GUIDEWIRE VASC STRG TPR .028IN 145CM STRL FX COR SS PTFE","BOTH IP/OP","$43.38 ","$32.10 ","$0.00 ","$43.38 ","$23.55 ","$0.00 ","$9.04 ","$0.00 ","$0.00 ","$7.59 ","$43.38 ","$0.00 ","$21.69 ","$34.36 ","$34.70 ","$0.00 ","$6.79 ","$0.00 ","$6.91 ","$0.00 "
"G00691","SUP","HCPCS C1769","","G00691  -  GWIRE VASC .035IN 145CM 20CM STR FLEXIBILE TIP FLPY BNTSN LG","BOTH IP/OP","$49.97 ","$36.98 ","$0.00 ","$48.75 ","$26.47 ","$0.00 ","$10.41 ","$0.00 ","$0.00 ","$8.54 ","$48.75 ","$0.00 ","$24.38 ","$38.61 ","$39.00 ","$0.00 ","$7.63 ","$0.00 ","$7.76 ","$0.00 "
"G00693","SUP","HCPCS C1769","","G00693  -  GUIDEWIRE VASCULAR STR BENTSON CURVE .038IN 145CM 20CM","BOTH IP/OP","$61.88 ","$45.79 ","$0.00 ","$61.88 ","$33.60 ","$0.00 ","$12.90 ","$0.00 ","$0.00 ","$10.83 ","$61.88 ","$0.00 ","$30.94 ","$49.01 ","$49.50 ","$0.00 ","$9.68 ","$0.00 ","$9.85 ","$0.00 "
"G00785","SUP","HCPCS C1769","","G00785  -  GUIDEWIRE VASC .045IN 145CM STRL STRG TPR FXCR SS PTFE DISP","BOTH IP/OP","$44.10 ","$32.63 ","$0.00 ","$44.10 ","$23.95 ","$0.00 ","$9.19 ","$0.00 ","$0.00 ","$7.72 ","$44.10 ","$0.00 ","$22.05 ","$34.93 ","$35.28 ","$0.00 ","$6.90 ","$0.00 ","$7.02 ","$0.00 "
"G00852","SUP","Custom 27203010","","G00852  -  NEEDLE BIOP 22GA 10CM CHIBA STERILE DISPOSABLE ASPIRAT","BOTH IP/OP","$26.58 ","$19.67 ","$0.00 ","$26.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.58 ","$0.00 ","$13.29 ","$21.05 ","$21.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01035","SUP","Custom 27203010","","COIL 38-2-3 EMBOLIZATION  MWCE","BOTH IP/OP","$145.00 ","$107.30 ","$0.00 ","$145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.00 ","$0.00 ","$72.50 ","$114.84 ","$116.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01095","SUP","HCPCS C1769","","G01095  -  GWIRE VASC 6CM .035IN 200CM 20CM BNTSN STR ATRM TIP LG DIA","BOTH IP/OP","$52.53 ","$38.87 ","$0.00 ","$51.25 ","$27.83 ","$0.00 ","$10.95 ","$0.00 ","$0.00 ","$8.97 ","$51.25 ","$0.00 ","$25.63 ","$40.59 ","$41.00 ","$0.00 ","$8.02 ","$0.00 ","$8.16 ","$0.00 "
"G01184","SUP","HCPCS C1770","","G01184  -  COIL EMBL 4CM 3MM 4.3 LOOP .038IN SS VASC STRL DISP","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01185","SUP","HCPCS C1770","","G01185  -  COIL EMBL .038IN 5MM 5CM STRL 3.2 LOOP SS VASC","BOTH IP/OP","$65.89 ","$48.76 ","$0.00 ","$65.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.89 ","$0.00 ","$32.94 ","$52.18 ","$52.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G011LF","SUP","Custom 27203010","","GUIDE PRB 11GA MAMTM BRST BIOP LORAD FSCHR STRL DISP","BOTH IP/OP","$18.38 ","$13.60 ","$0.00 ","$18.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.38 ","$0.00 ","$9.19 ","$14.56 ","$14.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01212","SUP","HCPCS C1892","","G01212  -  DILATOR SURG STANDARD 16FR 20CM RADIOPQ VESSEL STERILE","BOTH IP/OP","$19.91 ","$14.73 ","$0.00 ","$18.35 ","$9.96 ","$0.00 ","$4.15 ","$0.00 ","$0.00 ","$3.21 ","$18.35 ","$0.00 ","$9.18 ","$14.53 ","$14.68 ","$0.00 ","$2.87 ","$0.00 ","$2.92 ","$0.00 "
"G01232","SUP","HCPCS C1770","","G01232  -  COIL EMBOLIZATION 15MM 8CM 1.7 LOOP LOAD CARTRIDGE STAINLESS","BOTH IP/OP","$65.89 ","$48.76 ","$0.00 ","$65.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.89 ","$0.00 ","$32.94 ","$52.18 ","$52.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01261","SUP","HCPCS C1769","","G01261  -  GUIDEWIRE VASCULAR J ROSEN CURVE .035IN 145CM 1.5CM HEAVY","BOTH IP/OP","$36.93 ","$27.33 ","$0.00 ","$35.00 ","$19.01 ","$0.00 ","$7.70 ","$0.00 ","$0.00 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"G01292","SUP","HCPCS C1770","","G01292  -  COIL EMBL .038IN 10MM 5CM STRL 1.6 LOOP SS VASC","BOTH IP/OP","$65.89 ","$48.76 ","$0.00 ","$65.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.89 ","$0.00 ","$32.94 ","$52.18 ","$52.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01371","SUP","HCPCS C1769","","G01371  -  GUIDEWIRE VASC .038IN 145CM AMPTZ MOV COR TPR STRG PTFE","BOTH IP/OP","$45.70 ","$33.82 ","$0.00 ","$45.70 ","$24.82 ","$0.00 ","$9.53 ","$0.00 ","$0.00 ","$8.00 ","$45.70 ","$0.00 ","$22.85 ","$36.19 ","$36.56 ","$0.00 ","$7.15 ","$0.00 ","$7.28 ","$0.00 "
"G01384","SUP","HCPCS C1725","","G01384  -  CATHETER BLNDIL 80CM 4.5CM V ANDL TPR TIP ILC FEM POPLT ART","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$32.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.51 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$9.39 ","$0.00 ","$9.55 ","$0.00 "
"G01471","SUP","Custom 27203010","","G01471  -  DILATOR VASCULAR STANDARD 20FR 20CM RADIOPQ STERILE","BOTH IP/OP","$36.95 ","$27.34 ","$0.00 ","$34.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.05 ","$0.00 ","$17.03 ","$26.97 ","$27.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01472","SUP","Custom 27203010","","G01472  -  DILATOR VASCULAR .038IN 22FR 20CM RADIOPQ GWIRE STERILE","BOTH IP/OP","$36.95 ","$27.34 ","$0.00 ","$34.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.05 ","$0.00 ","$17.03 ","$26.97 ","$27.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01616","SUP","HCPCS C1769","","G01616  -  GUIDEWIRE VASC .038IN 260CM BNTSN STRG FXCR SS PTFE CRBRL","BOTH IP/OP","$121.25 ","$89.73 ","$0.00 ","$121.25 ","$65.84 ","$0.00 ","$25.27 ","$0.00 ","$0.00 ","$21.23 ","$121.25 ","$0.00 ","$60.63 ","$96.03 ","$97.00 ","$0.00 ","$18.98 ","$0.00 ","$19.30 ","$0.00 "
"G01618","SUP","Custom 27203010","","G01618  -  NEEDLE PROCEDURE 21GA 7CM 1 PART ENTRY THIN WALL","BOTH IP/OP","$8.23 ","$6.09 ","$0.00 ","$8.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.23 ","$0.00 ","$4.11 ","$6.52 ","$6.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G01729","SUP","HCPCS C1769","","G01729  -  GUIDEWIRE VASC STD STRG .035IN 145CM 3CM 2 FLXB SS PTFE","BOTH IP/OP","$39.33 ","$29.10 ","$0.00 ","$39.33 ","$21.35 ","$0.00 ","$8.20 ","$0.00 ","$0.00 ","$6.89 ","$39.33 ","$0.00 ","$19.66 ","$31.15 ","$31.46 ","$0.00 ","$6.15 ","$0.00 ","$6.26 ","$0.00 "
"G01884","SUP","Custom 27203010","","G01884  -  DILATOR VASCULAR .038IN STANDARD 24FR 20CM STANDARD RADIOPQ","BOTH IP/OP","$36.95 ","$27.34 ","$0.00 ","$34.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.05 ","$0.00 ","$17.03 ","$26.97 ","$27.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G02295","SUP","HCPCS C1769","","G02295  -  CATHETER URET UNV 4FR 70CM RTNR WDG","BOTH IP/OP","$4.30 ","$3.18 ","$0.00 ","$4.30 ","$2.34 ","$0.00 ","$0.90 ","$0.00 ","$0.00 ","$0.75 ","$4.30 ","$0.00 ","$2.15 ","$3.41 ","$3.44 ","$0.00 ","$0.67 ","$0.00 ","$0.68 ","$0.00 "
"G02760","SUP","HCPCS C1770","","G02760  -  COIL EMBL 4CM 3MM 4.3 LOOP .035IN SS STRL DISP","BOTH IP/OP","$65.89 ","$48.76 ","$0.00 ","$65.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.89 ","$0.00 ","$32.94 ","$52.18 ","$52.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G03031","SUP","HCPCS C1769","","G03031  -  GUIDEWIRE VASCULAR STR FLOPPY TAPER .038IN 145CM FLEXIBLE","BOTH IP/OP","$64.58 ","$47.79 ","$0.00 ","$64.58 ","$35.06 ","$0.00 ","$13.46 ","$0.00 ","$0.00 ","$11.31 ","$64.58 ","$0.00 ","$32.29 ","$51.15 ","$51.66 ","$0.00 ","$10.11 ","$0.00 ","$10.28 ","$0.00 "
"G03037","SUP","HCPCS C1769","","G03037  -  GUIDEWIRE VASC .038IN 100CM STRL STRG TPR FXCR SS PTFE DISP","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$29.87 ","$0.00 ","$11.46 ","$0.00 ","$0.00 ","$9.63 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$8.61 ","$0.00 ","$8.76 ","$0.00 "
"G03095","SUP","HCPCS C1769","","G03095  -  GUIDEWIRE VASCULAR 3CM STR TAPER .035IN 145CM 7CM FLEXIBLE","BOTH IP/OP","$67.16 ","$49.70 ","$0.00 ","$64.58 ","$35.06 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$11.31 ","$64.58 ","$0.00 ","$32.29 ","$51.15 ","$51.66 ","$0.00 ","$10.11 ","$0.00 ","$10.28 ","$0.00 "
"G03211","SUP","HCPCS C1769","","G03211  -  GUIDEWIRE VASC .038IN 145CM STRL STRG MOV COR SS PTFE DISP","BOTH IP/OP","$51.93 ","$38.43 ","$0.00 ","$51.93 ","$28.20 ","$0.00 ","$10.82 ","$0.00 ","$0.00 ","$9.09 ","$51.93 ","$0.00 ","$25.96 ","$41.13 ","$41.54 ","$0.00 ","$8.13 ","$0.00 ","$8.27 ","$0.00 "
"G03301","SUP","HCPCS C1729","","G03301  -  SET DRAIN 29CM 9FR PTFE THOR 20 SDPRT 1 WY STPCK CATH NDL","BOTH IP/OP","$458.70 ","$339.44 ","$0.00 ","$383.65 ","$208.32 ","$0.00 ","$95.60 ","$0.00 ","$0.00 ","$67.17 ","$383.65 ","$0.00 ","$191.83 ","$303.85 ","$306.92 ","$0.00 ","$60.04 ","$0.00 ","$61.08 ","$0.00 "
"G03445","SUP","HCPCS C1769","","G03445  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM 2 FLX TP FXCR","BOTH IP/OP","$55.00 ","$40.70 ","$0.00 ","$55.00 ","$29.87 ","$0.00 ","$11.46 ","$0.00 ","$0.00 ","$9.63 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$8.61 ","$0.00 ","$8.76 ","$0.00 "
"G03522","SUP","HCPCS C1769","","G03522  -  GUIDEWIRE VASC STRG TPR .035IN 145CM STRL AMPTZ MOV COR SS","BOTH IP/OP","$50.10 ","$37.07 ","$0.00 ","$50.10 ","$27.20 ","$0.00 ","$10.44 ","$0.00 ","$0.00 ","$8.77 ","$50.10 ","$0.00 ","$25.05 ","$39.68 ","$40.08 ","$0.00 ","$7.84 ","$0.00 ","$7.98 ","$0.00 "
"G03562","SUP","HCPCS C1769","","G03562  -  GUIDEWIRE VASCULAR STR .035IN 260CM EXTRA STIFF SHAFT COIL","BOTH IP/OP","$70.20 ","$51.95 ","$0.00 ","$67.50 ","$36.65 ","$0.00 ","$14.63 ","$0.00 ","$0.00 ","$11.82 ","$67.50 ","$0.00 ","$33.75 ","$53.46 ","$54.00 ","$0.00 ","$10.56 ","$0.00 ","$10.75 ","$0.00 "
"G03579","SUP","HCPCS C1769","","G03579  -  GUIDEWIRE VASCULAR STR .038IN 300CM EXTRA STIFF SHAFT","BOTH IP/OP","$67.50 ","$49.95 ","$0.00 ","$67.50 ","$36.65 ","$0.00 ","$14.07 ","$0.00 ","$0.00 ","$11.82 ","$67.50 ","$0.00 ","$33.75 ","$53.46 ","$54.00 ","$0.00 ","$10.56 ","$0.00 ","$10.75 ","$0.00 "
"G03831","SUP","HCPCS C2628","","G03831  -  CATHETER BLNDIL 32MM 120CM CODA PU ACPT .035IN GW 12FR INTRO","BOTH IP/OP","$1,042.50 ","$771.45 ","$0.00 ","$1,042.50 ","$0.00 ","$0.00 ","$217.28 ","$0.00 ","$0.00 ","$0.00 ","$1,042.50 ","$0.00 ","$521.25 ","$825.66 ","$834.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G04001","SUP","HCPCS C1769","","G04001  -  GUIDEWIRE VASCULAR STR .035IN 300CM FLEXIBLE TIP EXTRA STIFF","BOTH IP/OP","$105.30 ","$77.92 ","$0.00 ","$101.25 ","$54.98 ","$0.00 ","$21.95 ","$0.00 ","$0.00 ","$17.73 ","$101.25 ","$0.00 ","$50.63 ","$80.19 ","$81.00 ","$0.00 ","$15.85 ","$0.00 ","$16.12 ","$0.00 "
"G04044","SUP","HCPCS C1770","","G04044  -  COIL EMBL 2CM 3MM 2.1 LOOP .035IN SS STRL DISP","BOTH IP/OP","$65.89 ","$48.76 ","$0.00 ","$65.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.89 ","$0.00 ","$32.94 ","$52.18 ","$52.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G04096","SUP","HCPCS C1892","","G04096  -  INTRODUCER SHEATH LARGE 22FR 13CM 20CM GWIRE DILAT PEEL-AWAY","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G04267","SUP","HCPCS C1894","","G04267  -  SET ACC NEFF PERC","BOTH IP/OP","$208.90 ","$154.59 ","$0.00 ","$204.80 ","$111.21 ","$0.00 ","$43.54 ","$0.00 ","$0.00 ","$35.86 ","$204.80 ","$0.00 ","$102.40 ","$162.20 ","$163.84 ","$0.00 ","$32.05 ","$0.00 ","$32.60 ","$0.00 "
"G04636","SUP","HCPCS C1894","","G04636  -  INTROD SHTH 4FR 10CM 40CM COAX CATH MPNCH SS .018IN","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$0.00 ","$0.00 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"G05021","SUP","Custom 27203010","","G05021  -  COIL EMBOLIZATION .035IN X 10MM X 5CM SPRING METAL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G05060","SUP","HCPCS C1725","","G05060  -  CATH ANGIO .035IN STD PGTL CURVE 4FR 70CM 10 SDPRT HFLO NYL","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$6.77 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"G05183","SUP","HCPCS C1769","","G05183  -  GUIDEWIRE VASCULAR ANGLED .018IN 60CM 7CM SOFT COPE MANDRIL","BOTH IP/OP","$97.83 ","$72.39 ","$0.00 ","$94.53 ","$51.33 ","$0.00 ","$20.39 ","$0.00 ","$0.00 ","$16.55 ","$94.53 ","$0.00 ","$47.26 ","$74.87 ","$75.62 ","$0.00 ","$14.79 ","$0.00 ","$15.05 ","$0.00 "
"G05189","SUP","HCPCS C1725","","G05189  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 70CM SIZING 10","BOTH IP/OP","$57.75 ","$42.74 ","$0.00 ","$55.00 ","$29.87 ","$0.00 ","$12.04 ","$0.00 ","$0.00 ","$9.63 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$8.61 ","$0.00 ","$8.76 ","$0.00 "
"G05641","SUP","Custom 27203010","","G05641  -  ADAPTER TUBING MALE LUER LOCK LOCK TO TUOHY BORST STOPCOCK","BOTH IP/OP","$25.20 ","$18.65 ","$0.00 ","$25.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.20 ","$0.00 ","$12.60 ","$19.96 ","$20.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G05839","SUP","Custom 27203010","","G05839  -  SET JJNSTM 80CM 16.5FR 24FR CR-ALZT-CNS 2 LUM 2 CATH SDPRT","BOTH IP/OP","$825.80 ","$611.09 ","$0.00 ","$825.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.80 ","$0.00 ","$412.90 ","$654.03 ","$660.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G06299","SUP","Custom 27203010","","G06299  -  ADAPTER CATHETER 9FR LARGE BORE SIDE ARM ROTATING MALE INFUS","BOTH IP/OP","$53.00 ","$39.22 ","$0.00 ","$50.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G06444","SUP","HCPCS C1892","","G06444  -  SET INTROD 18FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G06445","SUP","HCPCS C1892","","G06445  -  INTRODUCER SHEATH LARGE 20FR 13CM 20CM PEEL-AWAY","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G06446","SUP","HCPCS C1892","","G06446  -  INTRODUCER SHEATH .038IN LARGE 24FR 13CM 20CM PEEL-AWAY","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G06447","SUP","HCPCS C1892","","G06447  -  INTRODUCER SHEATH .038IN LARGE 26FR 13CM 20CM W/O GWIRE","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G06451","SUP","HCPCS C1880","","G06451  -  SYSTEM EMBOLIZATION .038IN 11FR 12FR 40CM EMERGENCY CHRONIC","BOTH IP/OP","$4,010.63 ","$2,967.87 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$835.91 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"G06452","SUP","HCPCS C1880","","G06452  -  FILTER EMBOLIZATION .038IN 40MM 11FR 75CM CATHETER GWIRE","BOTH IP/OP","$4,010.63 ","$2,967.87 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$835.91 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"G06491","SUP","HCPCS C1892","","G06491  -  SET INTROD .038IN 11FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G06492","SUP","HCPCS C1892","","G06492  -  SET INTROD .038IN 12FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE","BOTH IP/OP","$114.85 ","$84.99 ","$0.00 ","$113.15 ","$61.44 ","$0.00 ","$23.94 ","$0.00 ","$0.00 ","$19.81 ","$113.15 ","$0.00 ","$56.58 ","$89.61 ","$90.52 ","$0.00 ","$17.71 ","$0.00 ","$18.01 ","$0.00 "
"G06541","SUP","HCPCS C1894","","G06541  -  SET INTERVENTIONAL 9FR 16GA 38.5CM 50.5CM INTROD SHEATH","BOTH IP/OP","$1,215.25 ","$899.29 ","$0.00 ","$1,215.25 ","$659.88 ","$0.00 ","$253.29 ","$0.00 ","$0.00 ","$212.78 ","$1,215.25 ","$0.00 ","$607.63 ","$962.48 ","$972.20 ","$0.00 ","$190.19 ","$0.00 ","$193.47 ","$0.00 "
"G06929","SUP","Custom 27203010","","G06929  -  SET INTERVENTIONAL .038IN 10FR 40CM 62.5CM CATHETER CANNU","BOTH IP/OP","$1,101.30 ","$814.96 ","$0.00 ","$1,101.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,101.30 ","$0.00 ","$550.65 ","$872.23 ","$881.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G07090","SUP","HCPCS C1729","","G07090  -  TRAY DRAIN 14FR 41CM 4 SIDEPORT RADIOPQ ENTRY NEEDLE SCALPEL","BOTH IP/OP","$424.90 ","$314.43 ","$0.00 ","$377.98 ","$205.24 ","$0.00 ","$88.56 ","$0.00 ","$0.00 ","$66.18 ","$377.98 ","$0.00 ","$188.99 ","$299.36 ","$302.38 ","$0.00 ","$59.15 ","$0.00 ","$60.17 ","$0.00 "
"G07429","SUP","HCPCS C1894","","G07429  -  SET INTROD 6FR 13CM 20CM SIDEARM FITTING SIDE CONNECT LINE","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$27.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"G07465","SUP","HCPCS C1894","","G07465  -  INTRODUCER SHEATH 9FR 30CM SMALL VALVE ASMBLY RADIOPQ BAND","BOTH IP/OP","$177.63 ","$131.45 ","$0.00 ","$175.00 ","$95.03 ","$0.00 ","$37.02 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"G07914","SUP","HCPCS C1769","","G07914  -  GUIDEWIRE VASCULAR TAPER .035IN 145CM RADIOPQ FLOPPY TIP","BOTH IP/OP","$97.50 ","$72.15 ","$0.00 ","$93.75 ","$50.91 ","$0.00 ","$20.32 ","$0.00 ","$0.00 ","$16.41 ","$93.75 ","$0.00 ","$46.88 ","$74.25 ","$75.00 ","$0.00 ","$14.67 ","$0.00 ","$14.93 ","$0.00 "
"G07937","SUP","HCPCS C1769","","G07937  -  GUIDEWIRE VASCULAR ANGLE TAPER .035IN 180CM 9CM RADIOPQ","BOTH IP/OP","$97.50 ","$72.15 ","$0.00 ","$93.75 ","$50.91 ","$0.00 ","$20.32 ","$0.00 ","$0.00 ","$16.41 ","$93.75 ","$0.00 ","$46.88 ","$74.25 ","$75.00 ","$0.00 ","$14.67 ","$0.00 ","$14.93 ","$0.00 "
"G08113","SUP","Custom 27203010","","G08113  -  CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP HYDROPHILIC OD18","BOTH IP/OP","$313.20 ","$231.77 ","$0.00 ","$313.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$313.20 ","$0.00 ","$156.60 ","$248.05 ","$250.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G08259","SUP","Custom 27203010","","G08259  -  COIL EMBOLIZATION .018IN 6-2MM 7CM SOFT MICROCOIL TORNADO","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G08261","SUP","HCPCS C1770","","G08261  -  COIL EMBL 2CM 3-2MM TRND MCIOL MLFRM SFT .018IN PLTN","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G08283","SUP","Custom 27203010","","G08283  -  SET BIOP 60CM 18GA 7FR Q COR CHK FLO VLV ADPR HVDTY FRNG","BOTH IP/OP","$1,075.00 ","$795.50 ","$0.00 ","$1,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,075.00 ","$0.00 ","$537.50 ","$851.40 ","$860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G08417","SUP","HCPCS C1729","","G08417  -  SET GSTRM 14FR 1 LUM 6 SDPRT CATH GWIRE NDL LOOP W-O 30CM","BOTH IP/OP","$301.63 ","$223.21 ","$0.00 ","$301.63 ","$163.78 ","$0.00 ","$62.87 ","$0.00 ","$0.00 ","$52.81 ","$301.63 ","$0.00 ","$150.81 ","$238.89 ","$241.30 ","$0.00 ","$47.20 ","$0.00 ","$48.02 ","$0.00 "
"G08421","SUP","HCPCS C1725","","G08421  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM TORCON NB","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G08422","SUP","HCPCS C1725","","G08422  -  CATHETER ANGIOGRAPHIC ANGLE SIMMONS 2 CURVE 5FR 100CM","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G08427","SUP","HCPCS C1769","","G08427  -  GUIDEWIRE VASCULAR ANGLE TAPER .018IN 60CM SOFT TIP COPE","BOTH IP/OP","$119.34 ","$88.31 ","$0.00 ","$115.30 ","$62.61 ","$0.00 ","$24.87 ","$0.00 ","$0.00 ","$20.19 ","$115.30 ","$0.00 ","$57.65 ","$91.32 ","$92.24 ","$0.00 ","$18.04 ","$0.00 ","$18.36 ","$0.00 "
"G08441","SUP","HCPCS C1725","","G08441  -  CATHETER ANGIOGRAPHIC C1 CURVE ANGLE 5FR 65CM MULTPUR TORCON","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G08442","SUP","HCPCS C1725","","G08442  -  CATH ANGIO .035IN C2 CURVE 5FR 65CM VSCR ANG MULTPUR NYL SS","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$6.77 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"G08471","SUP","HCPCS C1725","","G08471  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM TORCON NB","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G08515","SUP","HCPCS C1725","","G08515  -  CATH ANGIO .035IN NEFF CURVE 5FR 80CM 8 SDPRT NYL SS TRNB AD","BOTH IP/OP","$40.55 ","$30.01 ","$0.00 ","$40.55 ","$22.02 ","$0.00 ","$8.45 ","$0.00 ","$0.00 ","$7.10 ","$40.55 ","$0.00 ","$20.28 ","$32.12 ","$32.44 ","$0.00 ","$6.35 ","$0.00 ","$6.46 ","$0.00 "
"G08581","SUP","HCPCS C1884","","G08581  -  CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$28.13 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G08597","SUP","HCPCS C1725","","G08597  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM TORCON NB","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G08686","SUP","HCPCS C1894","","G08686  -  SET INTRO 10FR 3.3MM 30CM STRL 41CM CKFL DISP ACPT .038IN GW","BOTH IP/OP","$111.80 ","$82.73 ","$0.00 ","$107.50 ","$58.37 ","$0.00 ","$23.30 ","$0.00 ","$0.00 ","$18.82 ","$107.50 ","$0.00 ","$53.75 ","$85.14 ","$86.00 ","$0.00 ","$16.82 ","$0.00 ","$17.11 ","$0.00 "
"G08699","SUP","Custom 27203010","","G08699  -  CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G08777","SUP","HCPCS C1769","","G08777  -  GUIDEWIRE VASCULAR ANGLE SPRING COIL .014IN 180CM HEAVY DUTY","BOTH IP/OP","$282.30 ","$208.90 ","$0.00 ","$278.13 ","$151.02 ","$0.00 ","$58.84 ","$0.00 ","$0.00 ","$48.70 ","$278.13 ","$0.00 ","$139.06 ","$220.28 ","$222.50 ","$0.00 ","$43.53 ","$0.00 ","$44.28 ","$0.00 "
"G08801","SUP","HCPCS C1769","","G08801  -  GUIDEWIRE VASCULAR TAPER FLOPPY ANGLE SPRING COIL .014IN 300","BOTH IP/OP","$310.85 ","$230.03 ","$0.00 ","$306.25 ","$166.29 ","$0.00 ","$64.79 ","$0.00 ","$0.00 ","$53.62 ","$306.25 ","$0.00 ","$153.13 ","$242.55 ","$245.00 ","$0.00 ","$47.93 ","$0.00 ","$48.76 ","$0.00 "
"G08943","SUP","HCPCS C1725","","G08943  -  CATH ANGIO .038IN 7FR 100CM PULM 4 SDPRT MONT1 TIP GW FLXB","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$6.77 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"G08957","SUP","HCPCS C1894","","G08957  -  SET INTROD .038IN 14FR 30CM 41CM RADIOPQ DILAT SIDEARM FIT","BOTH IP/OP","$330.20 ","$244.35 ","$0.00 ","$317.50 ","$172.40 ","$0.00 ","$68.82 ","$0.00 ","$0.00 ","$55.59 ","$317.50 ","$0.00 ","$158.75 ","$251.46 ","$254.00 ","$0.00 ","$49.69 ","$0.00 ","$50.55 ","$0.00 "
"G09215","SUP","HCPCS C1770","","G09215  -  COIL EMBOLIZATION .018IN 8-4MM 9.5CM MICROCOIL SOFT SPACED","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G09409","SUP","HCPCS C1725","","G09409  -  CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"G09411","SUP","HCPCS C1725","","G09411  -  CATH ANGIO .035IN 5FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$6.77 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"G09469","SUP","HCPCS C1725","","G09469  -  CATHETER ANGIOGRAPHIC ANGLE KMP CURVE TAPER 5FR 65CM LP","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G09479","SUP","HCPCS C1894","","G09479  -  INTRODUCER CATHETER .038IN 7FR 40CM BALKIN UP AND OVER","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"G09497","SUP","HCPCS C1729","","G09497  -  CATHETER DRAIN 8.5FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC","BOTH IP/OP","$253.65 ","$187.70 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$52.87 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09498","SUP","HCPCS C1729","","G09498  -  CATHETER DRAIN 10.2FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC","BOTH IP/OP","$253.65 ","$187.70 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$52.87 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09499","SUP","HCPCS C1729","","G09499  -  CATHETER DRAIN 12FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC","BOTH IP/OP","$253.65 ","$187.70 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$52.87 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09500","SUP","HCPCS C1729","","G09500  -  CATHETER DRAIN 14FR 40CM 8CM 32 SIDEPORT LOCK MECHANISM","BOTH IP/OP","$253.65 ","$187.70 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$52.87 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09501","SUP","HCPCS C1729","","G09501  -  CATHETER DRAIN 8.5FR 25CM 6 SIDEPORT TROCAR MULTPUR RADIOPQ","BOTH IP/OP","$254.90 ","$188.63 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$53.13 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09502","SUP","HCPCS C1729","","G09502  -  CATHETER DRAIN 10.2FR 25CM 6 SIDEPORT LOCK LOOP RADIOPQ BAND","BOTH IP/OP","$254.90 ","$188.63 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$53.13 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09503","SUP","HCPCS C1729","","G09503  -  CATHETER DRAIN .038IN 12FR 25CM 6 SIDEPORT MAC LOC LOCKING","BOTH IP/OP","$254.90 ","$188.63 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$53.13 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09504","SUP","HCPCS C1729","","G09504  -  CATHETER DRAIN .038IN 14FR 25CM 6 SIDEPORT MAC-LOC LOCKING","BOTH IP/OP","$254.90 ","$188.63 ","$0.00 ","$249.90 ","$135.70 ","$0.00 ","$53.13 ","$0.00 ","$0.00 ","$43.76 ","$249.90 ","$0.00 ","$124.95 ","$197.92 ","$199.92 ","$0.00 ","$39.11 ","$0.00 ","$39.78 ","$0.00 "
"G09607","SUP","HCPCS C1769","","G09607  -  GUIDEWIRE VASCULAR .035IN 145CM ANGLE SHORT TAPER FLEXIBLE","BOTH IP/OP","$97.50 ","$72.15 ","$0.00 ","$93.75 ","$50.91 ","$0.00 ","$20.32 ","$0.00 ","$0.00 ","$16.41 ","$93.75 ","$0.00 ","$46.88 ","$74.25 ","$75.00 ","$0.00 ","$14.67 ","$0.00 ","$14.93 ","$0.00 "
"G09691","SUP","HCPCS C1892","","G09691  -  INTRODUCER SHEATH .038IN LARGE 16FR 30CM 42CM RADIOPQ BAND","BOTH IP/OP","$328.61 ","$243.17 ","$0.00 ","$317.50 ","$172.40 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$55.59 ","$317.50 ","$0.00 ","$158.75 ","$251.46 ","$254.00 ","$0.00 ","$49.69 ","$0.00 ","$50.55 ","$0.00 "
"G09751","SUP","HCPCS C1725","","G09751  -  CATHETER ANGIOGRAPHIC KMP CURVE 5FR 40CM TORCON NB ADVANTAGE","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G09954","SUP","HCPCS C1769","","G09954  -  GUIDEWIRE VASCULAR STR .035IN 145CM FLEXIBLE TIP ULTRA-STIFF","BOTH IP/OP","$67.16 ","$49.70 ","$0.00 ","$64.58 ","$35.06 ","$0.00 ","$14.00 ","$0.00 ","$0.00 ","$11.31 ","$64.58 ","$0.00 ","$32.29 ","$51.15 ","$51.66 ","$0.00 ","$10.11 ","$0.00 ","$10.28 ","$0.00 "
"G09956","SUP","HCPCS C1769","","G09956  -  GUIDEWIRE VASCULAR STR .035IN 180CM FLEXIBLE TIP ULTRA-STIFF","BOTH IP/OP","$89.70 ","$66.38 ","$0.00 ","$86.25 ","$46.83 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$15.10 ","$86.25 ","$0.00 ","$43.13 ","$68.31 ","$69.00 ","$0.00 ","$13.50 ","$0.00 ","$13.73 ","$0.00 "
"G10205","SUP","Custom 27203010","","G10205  -  DILATOR VASCULAR .025IN 4FR 20CM DECREASED FRICTION RADIOPQ","BOTH IP/OP","$26.75 ","$19.80 ","$0.00 ","$26.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.75 ","$0.00 ","$13.38 ","$21.19 ","$21.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10210","SUP","Custom 27203010","","G10210  -  TRAY PERICARDIOCENTESIS PIGTAIL CURVE 8.3FR 18GA 40CM 15CM 6","BOTH IP/OP","$473.75 ","$350.58 ","$0.00 ","$473.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$473.75 ","$0.00 ","$236.88 ","$375.21 ","$379.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10292","SUP","HCPCS C1758","","G10292  -  DILATOR VASCULAR 12FR 20CM RADIOPQ HYDPHI STERILE DISPOSABLE","BOTH IP/OP","$29.03 ","$21.48 ","$0.00 ","$26.75 ","$14.53 ","$0.00 ","$6.05 ","$0.00 ","$0.00 ","$4.68 ","$26.75 ","$0.00 ","$13.38 ","$21.19 ","$21.40 ","$0.00 ","$4.19 ","$0.00 ","$4.26 ","$0.00 "
"G10383","SUP","HCPCS C1894","","G10383  -  INTRODUCER SHEATH 6FR 40CM OVER CONTRALATERAL RADIOPQ BAND","BOTH IP/OP","$194.06 ","$143.60 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$40.45 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G10405","SUP","HCPCS C1894","","G10405  -  INTROD SHTH 7FR 40CM BLK U-O CNTRLT DSGN RADIOPQ BAND W/O","BOTH IP/OP","$154.70 ","$114.48 ","$0.00 ","$154.70 ","$84.00 ","$0.00 ","$32.24 ","$0.00 ","$0.00 ","$27.09 ","$154.70 ","$0.00 ","$77.35 ","$122.52 ","$123.76 ","$0.00 ","$24.21 ","$0.00 ","$24.63 ","$0.00 "
"G10414","SUP","HCPCS C1770","","G10414  -  COIL EMBOLIZATION .035IN STANDARD SMALL 4-3MM 2.6CM TORNADO","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10415","SUP","HCPCS C1770","","G10415  -  COIL EMBOLIZATION .035IN STANDARD SMALL 5-3MM 4.1CM SOFT","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10417","SUP","HCPCS C1770","","G10417  -  COIL EMBOLIZATION 7-3MM 8CM TORNADO PLATINUM ARTERIOVENOUS","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10455","SUP","HCPCS C1725","","G10455  -  CATHETER ANGIOGRAPHIC MPA CURVE 5FR 65CM TORCON NB ADVANTAGE","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$55.00 ","$29.87 ","$0.00 ","$12.51 ","$0.00 ","$0.00 ","$9.63 ","$55.00 ","$0.00 ","$27.50 ","$43.56 ","$44.00 ","$0.00 ","$8.61 ","$0.00 ","$8.76 ","$0.00 "
"G10460","SUP","HCPCS C1894","","G10460  -  SET ACCES 15CM 6FR 22GA 4FR NEFF .018IN PERC HYDPHI CHBA NDL","BOTH IP/OP","$249.38 ","$184.54 ","$0.00 ","$249.38 ","$135.41 ","$0.00 ","$51.98 ","$0.00 ","$0.00 ","$43.66 ","$249.38 ","$0.00 ","$124.69 ","$197.51 ","$199.50 ","$0.00 ","$39.03 ","$0.00 ","$39.70 ","$0.00 "
"G10554","SUP","Custom 27203010","","G10554  -  SET INTUBATION .038IN 3MM 14FR 70CM 110CM RTRGRD RADIOPQ","BOTH IP/OP","$383.33 ","$283.66 ","$0.00 ","$316.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$316.25 ","$0.00 ","$158.13 ","$250.47 ","$253.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10722","SUP","Custom 27203010","","G10722  -  NEEDLE INTRAOSSEOUS 15.5GA 3CM 2 OPPOSE SIDEPORT INFUS","BOTH IP/OP","$111.25 ","$82.33 ","$0.00 ","$111.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.25 ","$0.00 ","$55.63 ","$88.11 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G10992","SUP","Custom 27203010","","G10992  -  CATH IU DISP HSG","BOTH IP/OP","$299.49 ","$221.62 ","$0.00 ","$299.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.49 ","$0.00 ","$149.74 ","$237.20 ","$239.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G11017","SUP","HCPCS C1894","","G11017  -  INTROD CATH 40CM 8FR .038IN CHK-FLO PRFRMR BLK U-O CNTRLT","BOTH IP/OP","$337.50 ","$249.75 ","$0.00 ","$337.50 ","$183.26 ","$0.00 ","$70.34 ","$0.00 ","$0.00 ","$59.09 ","$337.50 ","$0.00 ","$168.75 ","$267.30 ","$270.00 ","$0.00 ","$52.82 ","$0.00 ","$53.73 ","$0.00 "
"G11189","SUP","HCPCS C1892","","G11189 - CATHETER ANGIOGRAPHIC VISCERAL 1 CURVE 5FR 80CM TORCON NB","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$46.88 ","$25.45 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"G11240","SUP","HCPCS C1894","","G11240  -  SET INTROD .038IN 11FR 70CM RADIOPQ BAND CHK-FLO PERFORMER","BOTH IP/OP","$247.00 ","$182.78 ","$0.00 ","$237.50 ","$128.96 ","$0.00 ","$51.48 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"G11667","SUP","HCPCS C1769","","G11667  -  GUIDEWIRE VASC CRV .035IN 260CM STRL 2MM RDRR PC THE FIRM","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$93.75 ","$50.91 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$16.41 ","$93.75 ","$0.00 ","$46.88 ","$74.25 ","$75.00 ","$0.00 ","$14.67 ","$0.00 ","$14.93 ","$0.00 "
"G11672","SUP","HCPCS C1894","","G11672  -  INTRODUCER SHEATH .038IN LARGE 18FR 30CM 42CM RADIOPQ BAND","BOTH IP/OP","$328.61 ","$243.17 ","$0.00 ","$317.50 ","$172.40 ","$0.00 ","$68.49 ","$0.00 ","$0.00 ","$55.59 ","$317.50 ","$0.00 ","$158.75 ","$251.46 ","$254.00 ","$0.00 ","$49.69 ","$0.00 ","$50.55 ","$0.00 "
"G11916","SUP","HCPCS C1884","","G11916  -  CATHETER ANGIO PGTL CRV 5FR 100CM AUROUS 10 SDPRT RADOPQ SZ","BOTH IP/OP","$343.13 ","$253.92 ","$0.00 ","$343.13 ","$154.41 ","$0.00 ","$71.52 ","$0.00 ","$0.00 ","$60.08 ","$343.13 ","$0.00 ","$171.56 ","$271.76 ","$274.50 ","$0.00 ","$53.70 ","$0.00 ","$54.63 ","$0.00 "
"G12016","SUP","HCPCS C1769","","G12016  -  GUIDEWIRE VASC .018IN 8FR 6.5FR 20CM STRL 15CM JEFFREY SET","BOTH IP/OP","$324.31 ","$239.99 ","$0.00 ","$317.95 ","$172.65 ","$0.00 ","$67.59 ","$0.00 ","$0.00 ","$55.67 ","$317.95 ","$0.00 ","$158.98 ","$251.82 ","$254.36 ","$0.00 ","$49.76 ","$0.00 ","$50.62 ","$0.00 "
"G12082","SUP","HCPCS C1884","","G12082  -  CATHETER ANGIO VTK CRBRL CRV 5FR 125CM SCTH BTP BRD RADOPQ","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"G12168","SUP","HCPCS C1884","","G12168  -  CATH ANGIO .038IN VERT CURVE 5FR 125CM RADIOPQ LUB SRFC","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$55.13 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"G12170","SUP","HCPCS C1725","","G12170  -  CATHETER ANGIOGRAPHIC .038IN VERT CURVE 5FR 125CM LP RADIOPQ","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G12179","SUP","Custom 27203010","","G12179  -  CATH ANGIO .038IN TEGT CURVE 5FR 65CM HYDPHI SCTH BTP","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G12266","SUP","HCPCS C1894","","G12266  -  SHEATH GUID 6FR 2.2MM 90CM CHK-FLO VALVE SOFT TIP RADIOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G12423","SUP","HCPCS C1894","","G12423  -  SET INTROD .018IN 6FR 20CM 13CM ACCES NEEDLE PLATINUM TIP","BOTH IP/OP","$104.50 ","$77.33 ","$0.00 ","$95.00 ","$51.59 ","$0.00 ","$21.78 ","$0.00 ","$0.00 ","$16.63 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$14.87 ","$0.00 ","$15.12 ","$0.00 "
"G12513","SUP","Custom 27203010","","G12513  -  TRAY TRCH 24-28FR CGL BRHN STD HYDPHI SHLY PERC TUBE DILAT","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$838.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$838.43 ","$0.00 ","$419.21 ","$664.04 ","$670.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G12560","SUP","HCPCS C1894","","G12560  -  SET INTROD 10CM 4FR MPNCH PSH+ .018IN GWIRE PLTN TIP CATH 40","BOTH IP/OP","$122.93 ","$90.97 ","$0.00 ","$122.93 ","$66.75 ","$0.00 ","$25.62 ","$0.00 ","$0.00 ","$21.52 ","$122.93 ","$0.00 ","$61.46 ","$97.36 ","$98.34 ","$0.00 ","$19.24 ","$0.00 ","$19.57 ","$0.00 "
"G12565","SUP","HCPCS C1894","","G12565  -  TRAY TRCH 8FR STRL SHLY CGL BLU RHINO JTP NDL GD CATH RADOPQ","BOTH IP/OP","$1,096.10 ","$811.11 ","$0.00 ","$1,631.40 ","$885.85 ","$0.00 ","$228.45 ","$0.00 ","$0.00 ","$285.65 ","$1,631.40 ","$0.00 ","$815.70 ","$1,292.07 ","$1,305.12 ","$0.00 ","$255.31 ","$0.00 ","$259.72 ","$0.00 "
"G12580","SUP","HCPCS C1763","","G12580  -  GRAFT SFT TIS 10X7CM 4 SHT FRZDR SIS ES PIG ACLR CLGN MTRX","BOTH IP/OP","$2,262.50 ","$1,674.25 ","$0.00 ","$2,262.50 ","$1,018.13 ","$0.00 ","$471.56 ","$0.00 ","$0.00 ","$396.15 ","$2,262.50 ","$0.00 ","$1,131.25 ","$1,791.90 ","$1,810.00 ","$0.00 ","$354.08 ","$0.00 ","$360.19 ","$0.00 "
"G12831","SUP","HCPCS C1894","","G12831  -  INTRODUCER SHEATH 25CM DILAT NONTAPER CLOSE CHK-FLO XL AQ 41","BOTH IP/OP","$847.50 ","$627.15 ","$0.00 ","$847.50 ","$460.19 ","$0.00 ","$176.64 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$132.63 ","$0.00 ","$134.92 ","$0.00 "
"G12835","SUP","HCPCS C1894","","G12835  -  INTRODUCER CATHETER 7FR 2.5MM 90CM TUOHY BORST SIDEARM DILAT","BOTH IP/OP","$390.71 ","$289.13 ","$0.00 ","$377.50 ","$204.98 ","$0.00 ","$81.43 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"G12847","SUP","HCPCS C1763","","G12847  -  GUIDEWIRE ESCP STRG .038IN 145CM 2 FLX TP","BOTH IP/OP","$872.83 ","$645.89 ","$0.00 ","$872.83 ","$392.77 ","$0.00 ","$181.92 ","$0.00 ","$0.00 ","$152.82 ","$872.83 ","$0.00 ","$436.41 ","$691.28 ","$698.26 ","$0.00 ","$136.60 ","$0.00 ","$138.95 ","$0.00 "
"G12848","SUP","HCPCS C1763","","G12848  -  GRAFT SFT TIS 10X7CM SURGISIS 1 LYR SHT PEEL OPN DRY PRCN","BOTH IP/OP","$2,391.50 ","$1,769.71 ","$0.00 ","$2,391.50 ","$1,076.18 ","$0.00 ","$498.45 ","$0.00 ","$0.00 ","$418.73 ","$2,391.50 ","$0.00 ","$1,195.75 ","$1,894.07 ","$1,913.20 ","$0.00 ","$374.27 ","$0.00 ","$380.73 ","$0.00 "
"G13032","SUP","HCPCS C1894","","G13032  -  INTRODUCER CATHETER .038IN 10IN 30CM LARGE VALVE ASMBLY","BOTH IP/OP","$192.85 ","$142.71 ","$0.00 ","$190.00 ","$103.17 ","$0.00 ","$40.19 ","$0.00 ","$0.00 ","$33.27 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$29.74 ","$0.00 ","$30.25 ","$0.00 "
"G13033","SUP","HCPCS C1894","","G13033  -  INTRODUCER SHEATH .038IN 10FR 80CM LARGE VALVE ASMBLY","BOTH IP/OP","$268.98 ","$199.05 ","$0.00 ","$265.00 ","$143.90 ","$0.00 ","$56.06 ","$0.00 ","$0.00 ","$46.40 ","$265.00 ","$0.00 ","$132.50 ","$209.88 ","$212.00 ","$0.00 ","$41.47 ","$0.00 ","$42.19 ","$0.00 "
"G13081","SUP","HCPCS C1894","","G13081  -  INTRODUCER CATHETER .035IN 10FR 38.5CM CHK FLO VALVE RADIOPQ","BOTH IP/OP","$214.23 ","$158.53 ","$0.00 ","$214.23 ","$116.32 ","$0.00 ","$44.65 ","$0.00 ","$0.00 ","$37.51 ","$214.23 ","$0.00 ","$107.11 ","$169.67 ","$171.38 ","$0.00 ","$33.53 ","$0.00 ","$34.10 ","$0.00 "
"G13116","SUP","HCPCS C1763","","G13116  -  GRAFT SFT TIS 20X7CM SURGISIS BIODESIGN 4 PLY SHT PRCN ACLR","BOTH IP/OP","$1,309.23 ","$968.83 ","$0.00 ","$1,309.23 ","$589.15 ","$0.00 ","$272.88 ","$0.00 ","$0.00 ","$229.23 ","$1,309.23 ","$0.00 ","$654.61 ","$1,036.91 ","$1,047.38 ","$0.00 ","$204.89 ","$0.00 ","$208.43 ","$0.00 "
"G13166","SUP","HCPCS C1769","","G13166  -  TRAY TRCH STRL SHLY CGL BLU RHINO PERC DISP","BOTH IP/OP","$1,096.10 ","$811.11 ","$0.00 ","$1,757.72 ","$954.44 ","$0.00 ","$228.45 ","$0.00 ","$0.00 ","$307.76 ","$1,757.72 ","$0.00 ","$878.86 ","$1,392.11 ","$1,406.18 ","$0.00 ","$275.08 ","$0.00 ","$279.83 ","$0.00 "
"G13287","SUP","HCPCS C1773","","G13287  -  SET RETRIEVAL 6.3FR 11FR 80CM 60CM LOOP CATHETER GUNTHER","BOTH IP/OP","$879.37 ","$650.73 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$183.28 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"G13338","SUP","HCPCS C1894","","G13338  -  INTRODUCER SHEATH 7FR .1IN 80CM TUOHY BORST SIDEARM RADIOPQ","BOTH IP/OP","$390.71 ","$289.13 ","$0.00 ","$377.50 ","$204.98 ","$0.00 ","$81.43 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"G13389","SUP","HCPCS C1876","","G13389  -  STENT VASC 6MM 40MM 80CM .035IN SLF XPD DLV SYS ZL NTNL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"G13398","SUP","HCPCS C1876","","G13398  -  STENT VASC 8MM 30MM 80CM SLF XPD DLV SYS ZL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"G13399","SUP","HCPCS C1876","","G13399  -  STENT BIL 9MM 7FR 40MM 80CM .035IN SLF XPD PRELD DLV SYS ZL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"G13400","SUP","HCPCS C1876","","G13400  -  STENT BIL 8MM 6CM 80CM .035IN SLF XPD PRELD DLV SYS ZL NTNL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"G13404","SUP","HCPCS C1876","","G13404  -  STENT VASC 9MM 40MM 80CM SLF XPD DLV SYS ZL","BOTH IP/OP","$2.50 ","$1.85 ","$0.00 ","$2.50 ","$1.13 ","$0.00 ","$0.52 ","$0.00 ","$0.00 ","$0.44 ","$2.50 ","$0.00 ","$1.25 ","$1.98 ","$2.00 ","$0.00 ","$0.39 ","$0.00 ","$0.40 ","$0.00 "
"G13539","SUP","HCPCS C1894","","G13539  -  INTRODUCER SHEATH .038IN 6FR .087IN 80CM GWIRE FLEXOR","BOTH IP/OP","$390.71 ","$289.13 ","$0.00 ","$377.50 ","$204.98 ","$0.00 ","$81.43 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"G13559","SUP","HCPCS C1725","","G13559  -  CATH ANGIO .038IN CHG-A CURVE 5FR 80CM VSCR NYL SS TRNB AD","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$47.51 ","$0.00 ","$18.24 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"G13561","SUP","HCPCS C1725","","G13561  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 80CM TORCON NB","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.55 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"G13793","SUP","Custom 27203010","","G13793  -  CATHETER ANGIOGRAPHIC 65CM MULTPUR TORCON NB ADVANTAGE","BOTH IP/OP","$65.00 ","$48.10 ","$0.00 ","$65.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G13806","SUP","HCPCS C1763","","G13806  -  GRAFT SFT TIS 7X4CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN","BOTH IP/OP","$1,870.33 ","$1,384.04 ","$0.00 ","$1,870.33 ","$841.65 ","$0.00 ","$389.82 ","$0.00 ","$0.00 ","$327.48 ","$1,870.33 ","$0.00 ","$935.16 ","$1,481.30 ","$1,496.26 ","$0.00 ","$292.71 ","$0.00 ","$297.76 ","$0.00 "
"G13807","SUP","HCPCS C1763","","G13807  -  GRAFT SFT TIS 10X7CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN","BOTH IP/OP","$897.75 ","$664.34 ","$0.00 ","$897.75 ","$403.99 ","$0.00 ","$187.11 ","$0.00 ","$0.00 ","$157.19 ","$897.75 ","$0.00 ","$448.88 ","$711.02 ","$718.20 ","$0.00 ","$140.50 ","$0.00 ","$142.92 ","$0.00 "
"G13808","SUP","HCPCS C1763","","G13808  -  GRAFT SFT TIS 3.5X5CM SURGISIS BIODESIGN 4 PLY PRCN ACLR","BOTH IP/OP","$993.60 ","$735.26 ","$0.00 ","$993.60 ","$447.12 ","$0.00 ","$207.09 ","$0.00 ","$0.00 ","$173.97 ","$993.60 ","$0.00 ","$496.80 ","$786.93 ","$794.88 ","$0.00 ","$155.50 ","$0.00 ","$158.18 ","$0.00 "
"G13816","SUP","HCPCS C1769","","G13816  -  GUIDEWIRE ENDSCP STR STANDARD .035IN 480CM PURPLE STERILE","BOTH IP/OP","$192.50 ","$142.45 ","$0.00 ","$192.50 ","$104.53 ","$0.00 ","$40.12 ","$0.00 ","$0.00 ","$33.71 ","$192.50 ","$0.00 ","$96.25 ","$152.46 ","$154.00 ","$0.00 ","$30.13 ","$0.00 ","$30.65 ","$0.00 "
"G14014","SUP","HCPCS C1758","","G14014  -  GRAFT SFT TIS 2X3CM SURGISIS BIODESIGN FRZDR PRCN ACLR CLGN","BOTH IP/OP","$276.25 ","$204.43 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$57.58 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G14015","SUP","HCPCS C1758","","G14015  -  CATHETER URET 3FR 70CM FLXTP CLS END RT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14016","SUP","HCPCS C1758","","G14016  -  CATHETER URET 4FR 70CM LF FLXTP CLS END FLX TP RT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14017","SUP","HCPCS C1758","","G14017  -  CATHETER URET 5FR 70CM LF FLXTP CLS END RT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14018","SUP","HCPCS C1758","","G14018  -  CATHETER URET 6FR 70CM LF FLXTP CLS END FLX TP RT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14019","SUP","HCPCS C1758","","G14019  -  CATHETER URET 7FR 70CM FLXTP CLS END RT","BOTH IP/OP","$31.77 ","$23.51 ","$0.00 ","$31.77 ","$17.25 ","$0.00 ","$6.62 ","$0.00 ","$0.00 ","$5.56 ","$31.77 ","$0.00 ","$15.89 ","$25.16 ","$25.42 ","$0.00 ","$4.97 ","$0.00 ","$5.06 ","$0.00 "
"G14022","SUP","HCPCS C1758","","G14022  -  CATHETER URET 8FR 70CM LF FLXTP CLS END FLX TP RT","BOTH IP/OP","$31.77 ","$23.51 ","$0.00 ","$31.77 ","$17.25 ","$0.00 ","$6.62 ","$0.00 ","$0.00 ","$5.56 ","$31.77 ","$0.00 ","$15.89 ","$25.16 ","$25.42 ","$0.00 ","$4.97 ","$0.00 ","$5.06 ","$0.00 "
"G14023","SUP","HCPCS C1758","","G14023  -  CATHETER URET 3FR 70CM FLXTP CLS END FLX TP LT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14024","SUP","HCPCS C1758","","G14024  -  CATHETER URET 4FR 70CM FLXTP CLS END FLX TP LT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14025","SUP","HCPCS C1758","","G14025  -  CATHETER URET 5FR 70CM LF FLXTP CLS END FLX TP LT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14026","SUP","HCPCS C1758","","G14026  -  CATHETER URET 6FR 70CM FLXTP CLS END LT","BOTH IP/OP","$31.77 ","$23.51 ","$0.00 ","$31.77 ","$17.25 ","$0.00 ","$6.62 ","$0.00 ","$0.00 ","$5.56 ","$31.77 ","$0.00 ","$15.89 ","$25.16 ","$25.42 ","$0.00 ","$4.97 ","$0.00 ","$5.06 ","$0.00 "
"G14027","SUP","HCPCS C1758","","G14027  -  CATHETER URET 7FR 70CM FLXTP CLS END LT","BOTH IP/OP","$31.77 ","$23.51 ","$0.00 ","$31.77 ","$17.25 ","$0.00 ","$6.62 ","$0.00 ","$0.00 ","$5.56 ","$31.77 ","$0.00 ","$15.89 ","$25.16 ","$25.42 ","$0.00 ","$4.97 ","$0.00 ","$5.06 ","$0.00 "
"G14034","SUP","HCPCS C1758","","G14034  -  CATHETER URET 8FR 70CM WHSTLTP RT","BOTH IP/OP","$2.78 ","$2.06 ","$0.00 ","$2.78 ","$1.51 ","$0.00 ","$0.58 ","$0.00 ","$0.00 ","$0.49 ","$2.78 ","$0.00 ","$1.39 ","$2.20 ","$2.23 ","$0.00 ","$0.44 ","$0.00 ","$0.44 ","$0.00 "
"G14035","SUP","HCPCS C1758","","G14035  -  CATHETER URET 9FR 70CM WHSTLTP RT","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14040","SUP","HCPCS C1758","","G14040  -  CATHETER URET 6FR 70CM WHSTLTP LT","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$14.60 ","$0.00 ","$5.60 ","$0.00 ","$0.00 ","$4.71 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.51 ","$0.00 ","$4.21 ","$0.00 ","$4.28 ","$0.00 "
"G14041","SUP","HCPCS C1758","","G14041  -  CATHETER URET WHSTL 7FR 70CM LT","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$14.60 ","$0.00 ","$5.60 ","$0.00 ","$0.00 ","$4.71 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.51 ","$0.00 ","$4.21 ","$0.00 ","$4.28 ","$0.00 "
"G14046","SUP","HCPCS C1758","","G14046  -  CATHETER URET 6FR 70CM RND TIP LT","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$14.60 ","$0.00 ","$5.60 ","$0.00 ","$0.00 ","$4.71 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.51 ","$0.00 ","$4.21 ","$0.00 ","$4.28 ","$0.00 "
"G14047","SUP","HCPCS C1758","","G14047  -  CATHETER URET 7FR 70CM RND TIP LT","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$14.60 ","$0.00 ","$5.60 ","$0.00 ","$0.00 ","$4.71 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.51 ","$0.00 ","$4.21 ","$0.00 ","$4.28 ","$0.00 "
"G14048","SUP","HCPCS C1758","","G14048  -  CATHETER URET 8FR 70CM RND TIP LT","BOTH IP/OP","$2.78 ","$2.06 ","$0.00 ","$2.78 ","$1.51 ","$0.00 ","$0.58 ","$0.00 ","$0.00 ","$0.49 ","$2.78 ","$0.00 ","$1.39 ","$2.20 ","$2.23 ","$0.00 ","$0.44 ","$0.00 ","$0.44 ","$0.00 "
"G14049","SUP","HCPCS C1758","","G14049  -  CATHETER URET 9FR 70CM RND TIP LT","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14050","SUP","HCPCS C1758","","G14050  -  CATHETER URET 10FR 70CM RND TIP LT","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$14.60 ","$0.00 ","$5.60 ","$0.00 ","$0.00 ","$4.71 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.51 ","$0.00 ","$4.21 ","$0.00 ","$4.28 ","$0.00 "
"G14053","SUP","HCPCS C1758","","G14053  -  CATHETER URET RND 5FR 70CM STY NTCH PORT LT","BOTH IP/OP","$26.88 ","$19.89 ","$0.00 ","$26.88 ","$14.60 ","$0.00 ","$5.60 ","$0.00 ","$0.00 ","$4.71 ","$26.88 ","$0.00 ","$13.44 ","$21.29 ","$21.51 ","$0.00 ","$4.21 ","$0.00 ","$4.28 ","$0.00 "
"G14054","SUP","HCPCS C1758","","G14054  -  CATHETER URET RND 6FR 70CM STY NTCH PORT LT","BOTH IP/OP","$2.78 ","$2.06 ","$0.00 ","$2.78 ","$1.51 ","$0.00 ","$0.58 ","$0.00 ","$0.00 ","$0.49 ","$2.78 ","$0.00 ","$1.39 ","$2.20 ","$2.23 ","$0.00 ","$0.44 ","$0.00 ","$0.44 ","$0.00 "
"G14055","SUP","HCPCS C1758","","G14055  -  CATHETER URET 7FR 70CM RND TIP RT","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14056","SUP","HCPCS C1758","","G14056  -  CATHETER URET PGTL CRV 4.7FR 45CM DRETLER MTLNTH","BOTH IP/OP","$276.25 ","$204.43 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$57.58 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G14057","SUP","HCPCS C1758","","G14057  -  CATHETER URET RND 8FR 70CM STY NTCH PORT RT","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14099","SUP","HCPCS C2627","","G14099  -  CATH SPBC STAMEY 14FR 25CM OBT CONNCTNG TUBE STPCK PERC STRL","BOTH IP/OP","$95.63 ","$70.77 ","$0.00 ","$95.63 ","$51.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.74 ","$95.63 ","$0.00 ","$47.81 ","$75.74 ","$76.50 ","$0.00 ","$14.97 ","$0.00 ","$15.22 ","$0.00 "
"G14120","SUP","HCPCS C1729","","G14120  -  TUBE CONNCTNG STANDARD 14FR 50CM MALE LUER LOCK LOCK LOCK","BOTH IP/OP","$40.70 ","$30.12 ","$0.00 ","$40.70 ","$22.10 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$7.13 ","$40.70 ","$0.00 ","$20.35 ","$32.23 ","$32.56 ","$0.00 ","$6.37 ","$0.00 ","$6.48 ","$0.00 "
"G14121","SUP","HCPCS C1729","","G14121  -  TUBE CNCT 14FR 30CM T-B 2 F LL Y 1 DRN BG CNCT ADPR","BOTH IP/OP","$40.70 ","$30.12 ","$0.00 ","$40.70 ","$22.10 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$7.13 ","$40.70 ","$0.00 ","$20.35 ","$32.23 ","$32.56 ","$0.00 ","$6.37 ","$0.00 ","$6.48 ","$0.00 "
"G14127","SUP","HCPCS C1773","","G14127  -  STOPCOCK IV 3W 2 F TO 1 M LL PLS PERC","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$216.36 ","$0.00 ","$83.05 ","$0.00 ","$0.00 ","$69.77 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$62.36 ","$0.00 ","$63.43 ","$0.00 "
"G14133","SUP","HCPCS C2627","","G14133  -  DISK RTNT 14FR PERC","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14134","SUP","HCPCS C2627","","G14134  -  DILATOR URTH 6FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14135","SUP","HCPCS C2627","","G14135  -  DILATOR URTH 7FR 20CM STRL PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14136","SUP","HCPCS C2627","","G14136  -  DILATOR URTH 7FR 20CM STRL PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14137","SUP","HCPCS C2627","","G14137  -  DILATOR URTH 9FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14138","SUP","HCPCS C2627","","G14138  -  DILATOR URTH 10FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14139","SUP","HCPCS C2627","","G14139  -  DILATOR URTH 12FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14140","SUP","HCPCS C2627","","G14140  -  DILATOR URTH 14FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14141","SUP","HCPCS C2627","","G14141  -  DILATOR URTH 16FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14143","SUP","HCPCS C1758","","G14143  -  DILATOR URTH 18FR 20CM STRL PE FSCA","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14144","SUP","HCPCS C1758","","G14144  -  SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW PU RT","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14145","SUP","HCPCS C1758","","G14145  -  SET CATH PGTL CRV 5FR .38IN 70CM STRL 145CM SDPRT GW RT","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14146","SUP","HCPCS C1758","","G14146  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14147","SUP","HCPCS C1758","","G14147  -  SET CATH PGTL CRV 7FR .045IN 70CM STRL 145CM SDPRT GW RT","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14148","SUP","HCPCS C1758","","G14148  -  SET CATH .025IN PGTL CRV 4FR 70CM 145CM SDPRT GW LFRIC SRFC","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14149","SUP","HCPCS C1758","","G14149  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14150","SUP","HCPCS C1758","","G14150  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW LFRIC SRFC","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14151","SUP","HCPCS C1758","","G14151  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW LFRIC SRFC","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14152","SUP","HCPCS C1758","","G14152  -  SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW ALONG","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14153","SUP","HCPCS C1758","","G14153  -  SET CATH .038IN PGTL CRV 6FR 70CM STRL 145CM SDPRT GW ALONG","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14155","SUP","HCPCS C1758","","G14155  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14156","SUP","HCPCS C1758","","G14156  -  SET CATH .038IN PGTL CRV 5FR 70CM STRL 145CM SDPRT GW ALONG","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14157","SUP","HCPCS C1758","","G14157  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW ALONG SHFT","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14158","SUP","HCPCS C1758","","G14158  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT","BOTH IP/OP","$108.45 ","$80.25 ","$0.00 ","$108.45 ","$58.89 ","$0.00 ","$22.60 ","$0.00 ","$0.00 ","$18.99 ","$108.45 ","$0.00 ","$54.23 ","$85.89 ","$86.76 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"G14173","SUP","HCPCS C2627","","G14173  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW ALONG SHFT","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14174","SUP","HCPCS C2627","","G14174  -  DILATOR URTH 24FR 20CM PE FSCA","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14175","SUP","HCPCS C2627","","G14175  -  DILATOR URTH 20FR 20CM STRL PE FSCA DISP","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14177","SUP","HCPCS C2627","","G14177  -  DILATOR URTH 22FR 20CM STRL PE FSCA DISP","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G14178","SUP","Custom 27203010","","G14178  -  DILATOR URTH 5FR 20CM STRL PE FSCA DISP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14185","SUP","HCPCS C1769","","G14185  -  SHEATH ACC 12FR 13CM LF FLXR PRLL RPD RELS WKG CHNL LFRIC","BOTH IP/OP","$510.95 ","$378.10 ","$0.00 ","$510.95 ","$277.45 ","$0.00 ","$106.49 ","$0.00 ","$0.00 ","$89.46 ","$510.95 ","$0.00 ","$255.48 ","$404.67 ","$408.76 ","$0.00 ","$79.96 ","$0.00 ","$81.34 ","$0.00 "
"G14186","SUP","HCPCS C2627","","G14186  -  STYLET NPHSTM 14FR FLXB","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14187","SUP","HCPCS C2627","","G14187  -  DILATOR URTH 8FR 37CM STRL PE FSCA DISP","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14188","SUP","HCPCS C2627","","G14188  -  DILATOR URTH 10FR 37CM STRL PE FSCA DISP","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14189","SUP","HCPCS C2627","","G14189  -  DILATOR URTH 12FR 37CM STRL PE FSCA DISP","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14190","SUP","HCPCS C2627","","G14190  -  DILATOR URTH 14FR 37CM STRL PE FSCA DISP","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14191","SUP","HCPCS C2627","","G14191  -  DILATOR URTH 16FR 37CM PE FSCA","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14192","SUP","HCPCS C2627","","G14192  -  DILATOR URTH 20FR 37CM PE FSCA","BOTH IP/OP","$63.25 ","$46.81 ","$0.00 ","$63.25 ","$34.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.07 ","$63.25 ","$0.00 ","$31.63 ","$50.09 ","$50.60 ","$0.00 ","$9.90 ","$0.00 ","$10.07 ","$0.00 "
"G14193","SUP","HCPCS C2627","","G14193  -  DILATOR URTH 22FR 37CM STRL DISP","BOTH IP/OP","$72.73 ","$53.82 ","$0.00 ","$72.73 ","$39.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.73 ","$72.73 ","$0.00 ","$36.36 ","$57.60 ","$58.18 ","$0.00 ","$11.38 ","$0.00 ","$11.58 ","$0.00 "
"G14194","SUP","HCPCS C2627","","G14194  -  DILATOR URTH 24FR 37CM STRL DISP","BOTH IP/OP","$75.28 ","$55.71 ","$0.00 ","$75.28 ","$40.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.18 ","$75.28 ","$0.00 ","$37.64 ","$59.62 ","$60.22 ","$0.00 ","$11.78 ","$0.00 ","$11.98 ","$0.00 "
"G14195","SUP","HCPCS C2627","","G14195  -  DILATOR URTH 8FR 37CM SDPRT PE FSCA","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14196","SUP","HCPCS C2627","","G14196  -  DILATOR URTH 10FR 37CM STRL SDPRT DISP","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14197","SUP","HCPCS C2627","","G14197  -  DILATOR URTH 12FR 37CM SDPRT PE FSCA","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14198","SUP","HCPCS C2627","","G14198  -  DILATOR URTH 14FR 37CM STRL SDPRT DISP","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14199","SUP","HCPCS C2627","","G14199  -  DILATOR URTH 16FR 37CM SDPRT PE FSCA","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14200","SUP","HCPCS C2627","","G14200  -  DILATOR URTH 18FR 37CM STRL SDPRT DISP","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14201","SUP","HCPCS C2627","","G14201  -  DILATOR URTH 20FR 37CM STRL SDPRT DISP","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14202","SUP","HCPCS C2627","","G14202  -  DILATOR URTH 22FR 37CM STRL SDPRT DISP","BOTH IP/OP","$65.45 ","$48.43 ","$0.00 ","$65.45 ","$35.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.46 ","$65.45 ","$0.00 ","$32.73 ","$51.84 ","$52.36 ","$0.00 ","$10.24 ","$0.00 ","$10.42 ","$0.00 "
"G14211","SUP","HCPCS C1773","","G14211  -  DILATOR URTH 24FR 37CM STRL SDPRT DISP","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$216.36 ","$0.00 ","$83.05 ","$0.00 ","$0.00 ","$69.77 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$62.36 ","$0.00 ","$63.43 ","$0.00 "
"G14214","SUP","HCPCS C2627","","G14214  -  FORCEPS GRSP 5FR 20MM 60CM 3 PR","BOTH IP/OP","$510.95 ","$378.10 ","$0.00 ","$510.95 ","$277.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.46 ","$510.95 ","$0.00 ","$255.48 ","$404.67 ","$408.76 ","$0.00 ","$79.96 ","$0.00 ","$81.34 ","$0.00 "
"G14220","SUP","Custom 27203010","","G14220  -  NEEDLE ENDSCP 35CM 23GA 8MM URTH CSCP INJEC PRC WMS","BOTH IP/OP","$47.30 ","$35.00 ","$0.00 ","$47.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.30 ","$0.00 ","$23.65 ","$37.46 ","$37.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14231","SUP","HCPCS C1769","","G14231  -  TUBE DRN STD 14FR 30CM STRL LF 1 WY STPCK CNCT DISP","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","$18.35 ","$0.00 ","$7.04 ","$0.00 ","$0.00 ","$5.92 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$5.29 ","$0.00 ","$5.38 ","$0.00 "
"G14254","SUP","Custom 27203010","","G14254  -  PUNCH SRG 14FR 3MM NS FL CATH TIP REUSE CUT .118IN RND HL","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14255","SUP","Custom 27203010","","G14255  -  NEEDLE PRC 22GA 20CM SKNY CHBA TIP PERC NPHSTM","BOTH IP/OP","$35.75 ","$26.46 ","$0.00 ","$35.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.75 ","$0.00 ","$17.88 ","$28.31 ","$28.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14256","SUP","Custom 27203010","","G14256  -  NEEDLE PRC STD 18GA 20CM ECHTP 2 PRT TROC DISP NPHSTM","BOTH IP/OP","$35.75 ","$26.46 ","$0.00 ","$35.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.75 ","$0.00 ","$17.88 ","$28.31 ","$28.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14257","SUP","Custom 27203010","","G14257  -  NEEDLE PRC 18GA 11CM MTPLK PERC","BOTH IP/OP","$74.65 ","$55.24 ","$0.00 ","$74.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$74.65 ","$0.00 ","$37.33 ","$59.12 ","$59.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14259","SUP","Custom 27203010","","G14259  -  NEEDLE PRC STD 18GA 25CM 2 PRT TROC DISP","BOTH IP/OP","$95.70 ","$70.82 ","$0.00 ","$95.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.70 ","$0.00 ","$47.85 ","$75.79 ","$76.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14260","SUP","HCPCS C1769","","G14260  -  NEEDLE BX STD 18GA 25CM TFE SHTH TROC STY RNL","BOTH IP/OP","$91.25 ","$67.53 ","$0.00 ","$91.25 ","$49.55 ","$0.00 ","$19.02 ","$0.00 ","$0.00 ","$15.98 ","$91.25 ","$0.00 ","$45.63 ","$72.27 ","$73.00 ","$0.00 ","$14.28 ","$0.00 ","$14.53 ","$0.00 "
"G14261","SUP","HCPCS C1726","","G14261  -  GUIDEWIRE URO STD .038IN 80CM STRL LF 3MM SFTJ FX COR STRG","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$179.19 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"G14263","SUP","Custom 27203010","","G14263  -  DILATOR URTH 18FR 37CM STRL DISP","BOTH IP/OP","$525.20 ","$388.65 ","$0.00 ","$525.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$525.20 ","$0.00 ","$262.60 ","$415.96 ","$420.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14270","SUP","HCPCS C1894","","G14270  -  SET NDL 18-22GA 14-22CM MTPLK COAX PERC","BOTH IP/OP","$128.70 ","$95.24 ","$0.00 ","$128.70 ","$69.88 ","$0.00 ","$26.82 ","$0.00 ","$0.00 ","$22.53 ","$128.70 ","$0.00 ","$64.35 ","$101.93 ","$102.96 ","$0.00 ","$20.14 ","$0.00 ","$20.49 ","$0.00 "
"G14275","SUP","HCPCS C2627","","G14275  -  TUBE CNCT STD 14FR 135CM M LL DRN BG","BOTH IP/OP","$578.13 ","$427.82 ","$0.00 ","$578.13 ","$313.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$101.23 ","$578.13 ","$0.00 ","$289.06 ","$457.88 ","$462.50 ","$0.00 ","$90.48 ","$0.00 ","$92.04 ","$0.00 "
"G14276","SUP","Custom 27203010","","G14276  -  SET DIL 26-36FR 37CM STRL PE FSCA DISP","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14277","SUP","Custom 27203010","","G14277  -  DILATOR URTH 26FR 37CM PE FSCA","BOTH IP/OP","$90.20 ","$66.75 ","$0.00 ","$90.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.20 ","$0.00 ","$45.10 ","$71.44 ","$72.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14278","SUP","Custom 27203010","","G14278  -  DILATOR URTH 28FR 37CM STRL PE FSCA DISP","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14279","SUP","Custom 27203010","","G14279  -  DILATOR URTH 30FR 37CM STRL DISP","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14280","SUP","Custom 27203010","","G14280  -  DILATOR URTH 32FR 37CM PE FSCA","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14281","SUP","Custom 27203010","","G14281  -  DILATOR URTH 34FR 37CM PE FSCA","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14282","SUP","HCPCS C1729","","G14282  -  DILATOR URTH 36FR 37CM PE FSCA","BOTH IP/OP","$404.80 ","$299.55 ","$0.00 ","$404.80 ","$219.81 ","$0.00 ","$84.37 ","$0.00 ","$0.00 ","$70.88 ","$404.80 ","$0.00 ","$202.40 ","$320.60 ","$323.84 ","$0.00 ","$63.35 ","$0.00 ","$64.44 ","$0.00 "
"G14283","SUP","HCPCS C1729","","G14283  -  SET NPHSTM STD 10FR 19.5CM LTX COPE LOOP NDL GW CATH CNN DIL","BOTH IP/OP","$188.10 ","$139.19 ","$0.00 ","$188.10 ","$102.14 ","$0.00 ","$39.20 ","$0.00 ","$0.00 ","$32.93 ","$188.10 ","$0.00 ","$94.05 ","$148.98 ","$150.48 ","$0.00 ","$29.44 ","$0.00 ","$29.95 ","$0.00 "
"G14284","SUP","HCPCS C1894","","G14284  -  SET NPHSTM 10FR 18GA 19.5CM STRL LTX 35CM CK RADOPQ CATH CNN","BOTH IP/OP","$216.70 ","$160.36 ","$0.00 ","$216.70 ","$117.67 ","$0.00 ","$45.17 ","$0.00 ","$0.00 ","$37.94 ","$216.70 ","$0.00 ","$108.35 ","$171.63 ","$173.36 ","$0.00 ","$33.91 ","$0.00 ","$34.50 ","$0.00 "
"G14285","SUP","HCPCS C1769","","G14285  -  SET NPHSTM 6-16FR 20CM COPE LOOP NDL GW CATH CNN DIL PERC","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","$18.35 ","$0.00 ","$7.04 ","$0.00 ","$0.00 ","$5.92 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$5.29 ","$0.00 ","$5.38 ","$0.00 "
"G14287","SUP","Custom 27203010","","G14287  -  GUIDEWIRE VASC 39CM STD STRG .038IN 80CM STRL 1CM FXCR FLX","BOTH IP/OP","$50.60 ","$37.44 ","$0.00 ","$50.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.60 ","$0.00 ","$25.30 ","$40.08 ","$40.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14297","SUP","HCPCS C1769","","G14297  -  ADAPTER INST 3-6FR 1 WY STPCK SDARM Y FIT M LL","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$179.19 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"G14298","SUP","HCPCS C2627","","G14298  -  SET DIL 6-18FR 60CM PE URETER","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14299","SUP","HCPCS C2627","","G14299  -  DILATOR URET 8FR 60CM STRL PE DISP","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14300","SUP","HCPCS C2627","","G14300  -  DILATOR URET 9FR 60CM STRL PE DISP","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14301","SUP","HCPCS C2627","","G14301  -  DILATOR URET 10FR 60CM STRL PE","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14302","SUP","HCPCS C2627","","G14302  -  DILATOR URET 12FR 60CM STRL PE","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14303","SUP","HCPCS C2627","","G14303  -  DILATOR URET 14FR 60CM STRL PE","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14304","SUP","HCPCS C2627","","G14304  -  DILATOR URET 16FR 60CM STRL PE","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14305","SUP","HCPCS C1726","","G14305  -  DILATOR URET 16FR 60CM PE FSCA","BOTH IP/OP","$51.15 ","$37.85 ","$0.00 ","$51.15 ","$27.77 ","$0.00 ","$10.66 ","$0.00 ","$0.00 ","$8.96 ","$51.15 ","$0.00 ","$25.58 ","$40.51 ","$40.92 ","$0.00 ","$8.00 ","$0.00 ","$8.14 ","$0.00 "
"G14306","SUP","HCPCS C1894","","G14306  -  CATHETER BLNDIL 8FR 84CM STRL AMPTZ GD RNL","BOTH IP/OP","$86.90 ","$64.31 ","$0.00 ","$86.90 ","$47.19 ","$0.00 ","$18.11 ","$0.00 ","$0.00 ","$15.22 ","$86.90 ","$0.00 ","$43.45 ","$68.82 ","$69.52 ","$0.00 ","$13.60 ","$0.00 ","$13.83 ","$0.00 "
"G14307","SUP","HCPCS C1769","","G14307  -  SET INTRO .038IN 50CM 12FR 5FR 100CM STRL 22CM GW RADOPQ","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$21.11 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$6.08 ","$0.00 ","$6.19 ","$0.00 "
"G14309","SUP","HCPCS C1769","","G14309  -  GUIDEWIRE ESCP STD CDE .038IN 145CM FXCR","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","$18.35 ","$0.00 ","$7.04 ","$0.00 ","$0.00 ","$5.92 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$5.29 ","$0.00 ","$5.38 ","$0.00 "
"G14311","SUP","HCPCS C1892","","G14311  -  GUIDEWIRE VASC STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$77.65 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$25.04 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$22.38 ","$0.00 ","$22.77 ","$0.00 "
"G14320","SUP","HCPCS C1758","","G14320  -  SET INTRO STD 9FR 65CM 60CM PLWY SHTH GW URET","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$191.14 ","$0.00 ","$73.37 ","$0.00 ","$0.00 ","$61.63 ","$352.00 ","$0.00 ","$176.00 ","$278.78 ","$281.60 ","$0.00 ","$55.09 ","$0.00 ","$56.04 ","$0.00 "
"G14323","SUP","HCPCS C1769","","G14323  -  DILATOR URET 7FR 6MM 65CM 4CM BLN CATH","BOTH IP/OP","$37.40 ","$27.68 ","$0.00 ","$37.40 ","$20.31 ","$0.00 ","$7.80 ","$0.00 ","$0.00 ","$6.55 ","$37.40 ","$0.00 ","$18.70 ","$29.62 ","$29.92 ","$0.00 ","$5.85 ","$0.00 ","$5.95 ","$0.00 "
"G14326","SUP","HCPCS C1769","","G14326  -  GUIDEWIRE URO .038IN 145CM 3CM FX COR STRG FLX TP HVDTY SS","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$21.11 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$6.08 ","$0.00 ","$6.19 ","$0.00 "
"G14328","SUP","Custom 27203010","","G14328  -  GUIDEWIRE VASC STD .038IN 100CM FXCR SS","BOTH IP/OP","$572.00 ","$423.28 ","$0.00 ","$572.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$572.00 ","$0.00 ","$286.00 ","$453.02 ","$457.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14335","SUP","HCPCS C1773","","G14335  -  SET NPHSTM 7FR 82CM STRL LAWSON RTRGD GW PNCT PERC DISP","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$216.36 ","$0.00 ","$83.05 ","$0.00 ","$0.00 ","$69.77 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$62.36 ","$0.00 ","$63.43 ","$0.00 "
"G14337","SUP","HCPCS C2628","","G14337  -  FORCEPS GRSP 4.5FR 65CM 15MM 3WR COAX SHTH","BOTH IP/OP","$319.00 ","$236.06 ","$0.00 ","$319.00 ","$0.00 ","$0.00 ","$66.49 ","$0.00 ","$0.00 ","$0.00 ","$319.00 ","$0.00 ","$159.50 ","$252.65 ","$255.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14343","SUP","HCPCS C1729","","G14343  -  CATHETER BLNOCC 6FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP","BOTH IP/OP","$363.00 ","$268.62 ","$0.00 ","$363.00 ","$197.11 ","$0.00 ","$75.66 ","$0.00 ","$0.00 ","$63.56 ","$363.00 ","$0.00 ","$181.50 ","$287.50 ","$290.40 ","$0.00 ","$56.81 ","$0.00 ","$57.79 ","$0.00 "
"G14344","SUP","HCPCS C1758","","G14344  -  CATHETER NPHSTM 17FR 12MM 25CM 15CM KAYE TMPND BLN RADOPQ","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$179.19 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"G14363","SUP","HCPCS C2617","","G14363  -  DILATOR SRG 7FR 6MM 65CM STRL 10CM BLN CATH RADOPQ PINVISE","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G14364","SUP","HCPCS C2617","","G14364  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 8CM GRN STRL 70","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G14365","SUP","HCPCS C2617","","G14365  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 10CM GRN STRL 70","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G14366","SUP","HCPCS C2617","","G14366  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 12CM GRN STRL 70","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G14367","SUP","HCPCS C2617","","G14367  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 14CM GRN STRL 70","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G14405","SUP","HCPCS C1892","","G14405  -  SET STNT .035IN 50CM SM 2 PGTL CRV 5FR 16CM GRN STRL 70CM","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$77.65 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$25.04 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$22.38 ","$0.00 ","$22.77 ","$0.00 "
"G14408","SUP","HCPCS C1758","","G14408  -  SET INTRO 14FR 60CM 65CM PLWY CATH 2 KNOB GW SHTH URET","BOTH IP/OP","$60.38 ","$44.68 ","$0.00 ","$60.38 ","$32.78 ","$0.00 ","$12.58 ","$0.00 ","$0.00 ","$10.57 ","$60.38 ","$0.00 ","$30.19 ","$47.82 ","$48.30 ","$0.00 ","$9.45 ","$0.00 ","$9.61 ","$0.00 "
"G14420","SUP","HCPCS C2627","","G14420  -  TUBE CNCT LG 24FR 30CM LF M LL TO BG DRN","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14421","SUP","HCPCS C2627","","G14421  -  DILATOR URET 6FR 60CM STRL LFRIC SRFC PE DISP","BOTH IP/OP","$165.73 ","$122.64 ","$0.00 ","$165.73 ","$89.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.02 ","$165.73 ","$0.00 ","$82.86 ","$131.26 ","$132.58 ","$0.00 ","$25.94 ","$0.00 ","$26.38 ","$0.00 "
"G14422","SUP","HCPCS C1758","","G14422  -  SET NPHSTM 5FR 75CM 15CM KAYE TMPND BLN CATH STY STNT PERC","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$352.00 ","$191.14 ","$0.00 ","$73.37 ","$0.00 ","$0.00 ","$61.63 ","$352.00 ","$0.00 ","$176.00 ","$278.78 ","$281.60 ","$0.00 ","$55.09 ","$0.00 ","$56.04 ","$0.00 "
"G14423","SUP","HCPCS C1729","","G14423  -  DILATOR URET .038IN 5FR 5MM 65CM STRL 4CM INFL BLN RADOPQ","BOTH IP/OP","$466.40 ","$345.14 ","$0.00 ","$466.40 ","$253.26 ","$0.00 ","$97.21 ","$0.00 ","$0.00 ","$81.66 ","$466.40 ","$0.00 ","$233.20 ","$369.39 ","$373.12 ","$0.00 ","$72.99 ","$0.00 ","$74.25 ","$0.00 "
"G14426","SUP","HCPCS C1892","","G14426  -  SET NPHSTM 17FR 12MM 25CM 10ML STRL LF 15CM KAYE TMPND BLN","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$77.65 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$25.04 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$22.38 ","$0.00 ","$22.77 ","$0.00 "
"G14427","SUP","HCPCS C1892","","G14427  -  SET INTRO STD 12FR 65CM 60CM PLWY GW 2 KNOB URET","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$77.65 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$25.04 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$22.38 ","$0.00 ","$22.77 ","$0.00 "
"G14428","SUP","HCPCS C1892","","G14428  -  SET INTRO STD 11FR 65CM 60CM PLWY GW 2 KNOB URET","BOTH IP/OP","$143.00 ","$105.82 ","$0.00 ","$143.00 ","$77.65 ","$0.00 ","$29.80 ","$0.00 ","$0.00 ","$25.04 ","$143.00 ","$0.00 ","$71.50 ","$113.26 ","$114.40 ","$0.00 ","$22.38 ","$0.00 ","$22.77 ","$0.00 "
"G14431","SUP","HCPCS C1729","","G14431  -  CATHETER URET .025IN 4FR 70CM STRL OP-EN PVC DISP","BOTH IP/OP","$18.59 ","$13.76 ","$0.00 ","$18.59 ","$10.09 ","$0.00 ","$3.87 ","$0.00 ","$0.00 ","$3.25 ","$18.59 ","$0.00 ","$9.30 ","$14.72 ","$14.87 ","$0.00 ","$2.91 ","$0.00 ","$2.96 ","$0.00 "
"G14432","SUP","HCPCS C1892","","G14432  -  SET NPHSTM 7-18FR 20-30CM STRL MLCT CATH STNT STY RTNT DISK","BOTH IP/OP","$164.45 ","$121.69 ","$0.00 ","$164.45 ","$89.30 ","$0.00 ","$34.28 ","$0.00 ","$0.00 ","$28.79 ","$164.45 ","$0.00 ","$82.23 ","$130.24 ","$131.56 ","$0.00 ","$25.74 ","$0.00 ","$26.18 ","$0.00 "
"G14433","SUP","HCPCS C1892","","G14433  -  SET INTRO .038IN STD STRG 16FR 65CM 60CM PLWY 2 KNOB GW SHTH","BOTH IP/OP","$164.45 ","$121.69 ","$0.00 ","$164.45 ","$89.30 ","$0.00 ","$34.28 ","$0.00 ","$0.00 ","$28.79 ","$164.45 ","$0.00 ","$82.23 ","$130.24 ","$131.56 ","$0.00 ","$25.74 ","$0.00 ","$26.18 ","$0.00 "
"G14434","SUP","HCPCS C2627","","G14434  -  SET INTRO STD 18FR 65CM 60CM PLWY GW SHTH 2 KNOB URET","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G14437","SUP","HCPCS C1729","","G14437  -  DILATOR URET 11FR 60CM SET PE","BOTH IP/OP","$185.90 ","$137.57 ","$0.00 ","$185.90 ","$100.94 ","$0.00 ","$38.75 ","$0.00 ","$0.00 ","$32.55 ","$185.90 ","$0.00 ","$92.95 ","$147.23 ","$148.72 ","$0.00 ","$29.09 ","$0.00 ","$29.60 ","$0.00 "
"G14440","SUP","HCPCS C1892","","G14440  -  SET NPHSTM 22FR 35CM MLCT CATH STY RTNT DISK CNCT TUBE PU","BOTH IP/OP","$118.80 ","$87.91 ","$0.00 ","$118.80 ","$64.51 ","$0.00 ","$24.76 ","$0.00 ","$0.00 ","$20.80 ","$118.80 ","$0.00 ","$59.40 ","$94.09 ","$95.04 ","$0.00 ","$18.59 ","$0.00 ","$18.91 ","$0.00 "
"G14441","SUP","HCPCS C1892","","G14441  -  SET INTRO STD 9FR 37CM 32CM PLWY 2 KNOB SHTH GW","BOTH IP/OP","$118.80 ","$87.91 ","$0.00 ","$118.80 ","$64.51 ","$0.00 ","$24.76 ","$0.00 ","$0.00 ","$20.80 ","$118.80 ","$0.00 ","$59.40 ","$94.09 ","$95.04 ","$0.00 ","$18.59 ","$0.00 ","$18.91 ","$0.00 "
"G14442","SUP","HCPCS C1892","","G14442  -  SET INTRO STD 10FR 37CM 32CM PLWY GW 2 KNOB SHTH URET","BOTH IP/OP","$118.80 ","$87.91 ","$0.00 ","$118.80 ","$64.51 ","$0.00 ","$24.76 ","$0.00 ","$0.00 ","$20.80 ","$118.80 ","$0.00 ","$59.40 ","$94.09 ","$95.04 ","$0.00 ","$18.59 ","$0.00 ","$18.91 ","$0.00 "
"G14443","SUP","HCPCS C1892","","G14443  -  SET INTRO STD 12FR 37CM 32CM PLWY 2 KNOB SHTH GW URETER","BOTH IP/OP","$118.80 ","$87.91 ","$0.00 ","$118.80 ","$64.51 ","$0.00 ","$24.76 ","$0.00 ","$0.00 ","$20.80 ","$118.80 ","$0.00 ","$59.40 ","$94.09 ","$95.04 ","$0.00 ","$18.59 ","$0.00 ","$18.91 ","$0.00 "
"G14444","SUP","HCPCS C1892","","G14444  -  SET INTRO STD 14FR 37CM 32CM PLWY 2 KNOB SHTH GW","BOTH IP/OP","$118.80 ","$87.91 ","$0.00 ","$118.80 ","$64.51 ","$0.00 ","$24.76 ","$0.00 ","$0.00 ","$20.80 ","$118.80 ","$0.00 ","$59.40 ","$94.09 ","$95.04 ","$0.00 ","$18.59 ","$0.00 ","$18.91 ","$0.00 "
"G14445","SUP","HCPCS C1892","","G14445  -  SET INTRO STD 16FR 37CM 32CM PLWY GW 2 KNOB SHTH URET","BOTH IP/OP","$118.80 ","$87.91 ","$0.00 ","$118.80 ","$64.51 ","$0.00 ","$24.76 ","$0.00 ","$0.00 ","$20.80 ","$118.80 ","$0.00 ","$59.40 ","$94.09 ","$95.04 ","$0.00 ","$18.59 ","$0.00 ","$18.91 ","$0.00 "
"G14454","SUP","HCPCS C1729","","G14454  -  LINE INJ 7FR 30CM CNRST STD FIT","BOTH IP/OP","$185.90 ","$137.57 ","$0.00 ","$185.90 ","$100.94 ","$0.00 ","$38.75 ","$0.00 ","$0.00 ","$32.55 ","$185.90 ","$0.00 ","$92.95 ","$147.23 ","$148.72 ","$0.00 ","$29.09 ","$0.00 ","$29.60 ","$0.00 "
"G14457","SUP","Custom 27203010","","G14457  -  CATHETER URET .038IN 8FR 70CM STRL OP-EN DISP","BOTH IP/OP","$11.01 ","$8.15 ","$0.00 ","$11.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.01 ","$0.00 ","$5.50 ","$8.72 ","$8.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14461","SUP","Custom 27203010","","G14461  -  NEEDLE PRC STD 18GA 15CM ECHTP TROC STY SHTH PTFE RNL","BOTH IP/OP","$35.75 ","$26.46 ","$0.00 ","$35.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.75 ","$0.00 ","$17.88 ","$28.31 ","$28.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14463","SUP","HCPCS C1758","","G14463  -  NEEDLE PRC 18GA 15CM STRL ECHTP 2 PRT TROC DISP NPHSTM","BOTH IP/OP","$404.80 ","$299.55 ","$0.00 ","$404.80 ","$219.81 ","$0.00 ","$84.37 ","$0.00 ","$0.00 ","$70.88 ","$404.80 ","$0.00 ","$202.40 ","$320.60 ","$323.84 ","$0.00 ","$63.35 ","$0.00 ","$64.44 ","$0.00 "
"G14485","SUP","HCPCS C1726","","G14485  -  ADAPTER CATH F LL TO LG FIT","BOTH IP/OP","$510.95 ","$378.10 ","$0.00 ","$510.95 ","$277.45 ","$0.00 ","$106.49 ","$0.00 ","$0.00 ","$89.46 ","$510.95 ","$0.00 ","$255.48 ","$404.67 ","$408.76 ","$0.00 ","$79.96 ","$0.00 ","$81.34 ","$0.00 "
"G14500","SUP","Custom 27203010","","G14500  -  STYLET NPHSTM 8.5FR FLXB MLCT CATH REM","BOTH IP/OP","$147.40 ","$109.08 ","$0.00 ","$147.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.40 ","$0.00 ","$73.70 ","$116.74 ","$117.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14501","SUP","HCPCS C1729","","G14501  -  APPROXIMATOR SRG WILLSCHER SET VASC","BOTH IP/OP","$185.90 ","$137.57 ","$0.00 ","$185.90 ","$100.94 ","$0.00 ","$38.75 ","$0.00 ","$0.00 ","$32.55 ","$185.90 ","$0.00 ","$92.95 ","$147.23 ","$148.72 ","$0.00 ","$29.09 ","$0.00 ","$29.60 ","$0.00 "
"G14504","SUP","HCPCS C1726","","G14504  -  SET NPHSTM 5FR 20CM MLCT CATH LL STY RTNT DISK CNCT TUBE PU","BOTH IP/OP","$587.60 ","$434.82 ","$0.00 ","$587.60 ","$319.07 ","$0.00 ","$122.47 ","$0.00 ","$0.00 ","$102.88 ","$587.60 ","$0.00 ","$293.80 ","$465.38 ","$470.08 ","$0.00 ","$91.96 ","$0.00 ","$93.55 ","$0.00 "
"G14508","SUP","HCPCS C1729","","G14508  -  SET DIL 6-30FR 30CM 19CM AMPTZ MOD RADOPQ SHTH RNL","BOTH IP/OP","$363.00 ","$268.62 ","$0.00 ","$363.00 ","$197.11 ","$0.00 ","$75.66 ","$0.00 ","$0.00 ","$63.56 ","$363.00 ","$0.00 ","$181.50 ","$287.50 ","$290.40 ","$0.00 ","$56.81 ","$0.00 ","$57.79 ","$0.00 "
"G14510","SUP","HCPCS C1729","","G14510  -  SET NPHSTM PGTL CRV 6FR 7CM STRL 3 DIL 2 NDL CATH CNCT TUBE","BOTH IP/OP","$185.90 ","$137.57 ","$0.00 ","$185.90 ","$100.94 ","$0.00 ","$38.75 ","$0.00 ","$0.00 ","$32.55 ","$185.90 ","$0.00 ","$92.95 ","$147.23 ","$148.72 ","$0.00 ","$29.09 ","$0.00 ","$29.60 ","$0.00 "
"G14511","SUP","HCPCS C1758","","G14511  -  SET NPHSTM 7FR 20CM MLCT CATH STNT LL RTNT DISK PU","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14513","SUP","HCPCS C2625","","G14513  -  CATHETER URET 10FR 70CM OP-EN ACPT .038IN GW","BOTH IP/OP","$123.00 ","$91.02 ","$0.00 ","$123.00 ","$55.35 ","$0.00 ","$25.64 ","$0.00 ","$0.00 ","$21.54 ","$123.00 ","$0.00 ","$61.50 ","$97.42 ","$98.40 ","$0.00 ","$19.25 ","$0.00 ","$19.58 ","$0.00 "
"G14514","SUP","HCPCS C2625","","G14514  -  SET STNT .025IN PGTL CRV STRG 3.7FR 125CM BLU STRL 145CM","BOTH IP/OP","$141.45 ","$104.67 ","$0.00 ","$141.45 ","$63.65 ","$0.00 ","$29.48 ","$0.00 ","$0.00 ","$24.77 ","$141.45 ","$0.00 ","$70.73 ","$112.03 ","$113.16 ","$0.00 ","$22.14 ","$0.00 ","$22.52 ","$0.00 "
"G14515","SUP","HCPCS C2628","","G14515  -  SET STNT .035IN PGTL CRV STRG 4.7FR 125CM BLU STRL 145CM","BOTH IP/OP","$319.00 ","$236.06 ","$0.00 ","$319.00 ","$0.00 ","$0.00 ","$66.49 ","$0.00 ","$0.00 ","$0.00 ","$319.00 ","$0.00 ","$159.50 ","$252.65 ","$255.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14519","SUP","Custom 27203010","","G14519  -  PROBE LTHTRP 1MM 605MM LMA STONEBREAKER PNEUM KT DISP","BOTH IP/OP","$15.62 ","$11.56 ","$0.00 ","$15.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.62 ","$0.00 ","$7.81 ","$12.37 ","$12.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14521","SUP","HCPCS C1758","","G14521  -  SET DRN 300ML NS PCH 1 CNCT","BOTH IP/OP","$276.25 ","$204.43 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$57.58 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G14526","SUP","HCPCS C1729","","G14526  -  STYLET NPHSTM 5FR FLXB 10FR MLCT CATH REM","BOTH IP/OP","$185.90 ","$137.57 ","$0.00 ","$185.90 ","$100.94 ","$0.00 ","$38.75 ","$0.00 ","$0.00 ","$32.55 ","$185.90 ","$0.00 ","$92.95 ","$147.23 ","$148.72 ","$0.00 ","$29.09 ","$0.00 ","$29.60 ","$0.00 "
"G14544","SUP","HCPCS C1769","","G14544  -  DEVICE SPEC RTRVL 5FR 5MM 65CM 4CM RTNR 4WR OCL STON BLN","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","$18.35 ","$0.00 ","$7.04 ","$0.00 ","$0.00 ","$5.92 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$5.29 ","$0.00 ","$5.38 ","$0.00 "
"G14547","SUP","Custom 27203010","","G14547  -  GUIDEWIRE URO STD STRG .035IN 145CM STRL 3CM FLX TP FX COR","BOTH IP/OP","$604.00 ","$446.96 ","$0.00 ","$604.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$604.00 ","$0.00 ","$302.00 ","$478.37 ","$483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14551","SUP","HCPCS C1769","","G14551  -  EXTRACTOR STON 5FR 6MM 65CM 4CM RTNR 4WR HLCL BLNDIL FLFRM","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$21.11 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$6.08 ","$0.00 ","$6.19 ","$0.00 "
"G14554","SUP","HCPCS C1769","","G14554  -  GUIDEWIRE ESCP STD .028IN 145CM LD EXTR RDRR PC FXCR DFLC","BOTH IP/OP","$33.80 ","$25.01 ","$0.00 ","$33.80 ","$18.35 ","$0.00 ","$7.04 ","$0.00 ","$0.00 ","$5.92 ","$33.80 ","$0.00 ","$16.90 ","$26.77 ","$27.04 ","$0.00 ","$5.29 ","$0.00 ","$5.38 ","$0.00 "
"G14565","SUP","HCPCS C2627","","G14565  -  GUIDEWIRE ESCP STD STRG .038IN 145CM STRL 1CM FXCR FLX TP SS","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$56.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.16 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$16.23 ","$0.00 ","$16.51 ","$0.00 "
"G14566","SUP","HCPCS C2627","","G14566  -  DILATOR URTH 6FR 37CM SET PTFE FSCA","BOTH IP/OP","$90.20 ","$66.75 ","$0.00 ","$90.20 ","$48.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.79 ","$90.20 ","$0.00 ","$45.10 ","$71.44 ","$72.16 ","$0.00 ","$14.12 ","$0.00 ","$14.36 ","$0.00 "
"G14567","SUP","HCPCS C2627","","G14567  -  DILATOR URTH 8FR 37CM SET PTFE FSCA","BOTH IP/OP","$90.20 ","$66.75 ","$0.00 ","$90.20 ","$48.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.79 ","$90.20 ","$0.00 ","$45.10 ","$71.44 ","$72.16 ","$0.00 ","$14.12 ","$0.00 ","$14.36 ","$0.00 "
"G14568","SUP","HCPCS C2627","","G14568  -  DILATOR URTH 10FR 37CM SET TFE FSCA","BOTH IP/OP","$90.20 ","$66.75 ","$0.00 ","$90.20 ","$48.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.79 ","$90.20 ","$0.00 ","$45.10 ","$71.44 ","$72.16 ","$0.00 ","$14.12 ","$0.00 ","$14.36 ","$0.00 "
"G14569","SUP","HCPCS C2627","","G14569  -  DILATOR URTH 12FR 37CM PTFE FSCA","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$56.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.16 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$16.23 ","$0.00 ","$16.51 ","$0.00 "
"G14570","SUP","HCPCS C2627","","G14570  -  DILATOR URTH 14FR 37CM SET TFE FSCA","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$56.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.16 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$16.23 ","$0.00 ","$16.51 ","$0.00 "
"G14571","SUP","HCPCS C2627","","G14571  -  DILATOR URTH 16FR 37CM SET PTFE FSCA","BOTH IP/OP","$103.73 ","$76.76 ","$0.00 ","$103.73 ","$56.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.16 ","$103.73 ","$0.00 ","$51.86 ","$82.15 ","$82.98 ","$0.00 ","$16.23 ","$0.00 ","$16.51 ","$0.00 "
"G14572","SUP","HCPCS C2627","","G14572  -  DILATOR URTH 18FR 37CM SET PTFE FSCA","BOTH IP/OP","$721.05 ","$533.58 ","$0.00 ","$721.05 ","$391.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$126.25 ","$721.05 ","$0.00 ","$360.53 ","$571.07 ","$576.84 ","$0.00 ","$112.84 ","$0.00 ","$114.79 ","$0.00 "
"G14574","SUP","HCPCS C1769","","G14574  -  DILATOR URET 6-18FR 37CM SET PTFE FSCA","BOTH IP/OP","$638.00 ","$472.12 ","$0.00 ","$638.00 ","$346.43 ","$0.00 ","$132.98 ","$0.00 ","$0.00 ","$111.71 ","$638.00 ","$0.00 ","$319.00 ","$505.30 ","$510.40 ","$0.00 ","$99.85 ","$0.00 ","$101.57 ","$0.00 "
"G14575","SUP","HCPCS C2627","","G14575  -  DILATOR URET 6-18FR 60CM SET GW LFRIC SRFC PTFE FSCA","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G14576","SUP","HCPCS C2627","","G14576  -  DILATOR URET 6FR 60CM SET PTFE DISP","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G14577","SUP","HCPCS C2627","","G14577  -  DILATOR URET 8FR 60CM SET PTFE FSCA","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G14578","SUP","HCPCS C2627","","G14578  -  DILATOR URET 10FR 60CM SET PTFE DISP","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G14579","SUP","HCPCS C2627","","G14579  -  DILATOR URET 12FR 60CM SET PTFE DISP","BOTH IP/OP","$113.85 ","$84.25 ","$0.00 ","$113.85 ","$61.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.93 ","$113.85 ","$0.00 ","$56.93 ","$90.17 ","$91.08 ","$0.00 ","$17.82 ","$0.00 ","$18.12 ","$0.00 "
"G14580","SUP","HCPCS C2627","","G14580  -  DILATOR URET 14FR 60CM SET PTFE FSCA","BOTH IP/OP","$113.85 ","$84.25 ","$0.00 ","$113.85 ","$61.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.93 ","$113.85 ","$0.00 ","$56.93 ","$90.17 ","$91.08 ","$0.00 ","$17.82 ","$0.00 ","$18.12 ","$0.00 "
"G14581","SUP","HCPCS C2627","","G14581  -  DILATOR URET 16FR 60CM SET TFE FSCA","BOTH IP/OP","$113.85 ","$84.25 ","$0.00 ","$113.85 ","$61.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.93 ","$113.85 ","$0.00 ","$56.93 ","$90.17 ","$91.08 ","$0.00 ","$17.82 ","$0.00 ","$18.12 ","$0.00 "
"G14587","SUP","HCPCS C1758","","G14587  -  DILATOR URET 18FR 60CM SET PTFE FSCA","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$15.13 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G14589","SUP","HCPCS C1769","","G14589  -  CATHETER URET 20D .035IN TPR STRG 6FR 70CM 145CM GW","BOTH IP/OP","$52.08 ","$38.54 ","$0.00 ","$52.08 ","$28.28 ","$0.00 ","$10.85 ","$0.00 ","$0.00 ","$9.12 ","$52.08 ","$0.00 ","$26.04 ","$41.25 ","$41.66 ","$0.00 ","$8.15 ","$0.00 ","$8.29 ","$0.00 "
"G14590","SUP","HCPCS C1769","","G14590  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 15CM BNTSN FLX TP FX","BOTH IP/OP","$52.08 ","$38.54 ","$0.00 ","$52.08 ","$28.28 ","$0.00 ","$10.85 ","$0.00 ","$0.00 ","$9.12 ","$52.08 ","$0.00 ","$26.04 ","$41.25 ","$41.66 ","$0.00 ","$8.15 ","$0.00 ","$8.29 ","$0.00 "
"G14592","SUP","HCPCS C1758","","G14592  -  GUIDEWIRE VASC .035IN 145CM STRL 15CM BNTSN BNTSN FLX TP","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$14.93 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"G14593","SUP","HCPCS C1758","","G14593  -  CATHETER URET 4FR 70CM RND TIP STY LT","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$14.93 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"G14595","SUP","HCPCS C1773","","G14595  -  CATHETER URET 5FR 70CM RND TIP STY LT","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$216.36 ","$0.00 ","$83.05 ","$0.00 ","$0.00 ","$69.77 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$62.36 ","$0.00 ","$63.43 ","$0.00 "
"G14596","SUP","HCPCS C1773","","G14596  -  FORCEPS SPEC RTRVL 3.2FR 10MM 65CM STRL 3WR GRSP COAX SHTH","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$216.36 ","$0.00 ","$83.05 ","$0.00 ","$0.00 ","$69.77 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$62.36 ","$0.00 ","$63.43 ","$0.00 "
"G14597","SUP","HCPCS C1758","","G14597  -  FORCEPS ESCP 14MM 3.5FR 65CM STRL GRSP","BOTH IP/OP","$83.50 ","$61.79 ","$0.00 ","$83.50 ","$45.34 ","$0.00 ","$17.40 ","$0.00 ","$0.00 ","$14.62 ","$83.50 ","$0.00 ","$41.75 ","$66.13 ","$66.80 ","$0.00 ","$13.07 ","$0.00 ","$13.29 ","$0.00 "
"G14598","SUP","HCPCS C1758","","G14598  -  CATHETER URET 20D .028IN TPR STRG 4FR 70CM 145CM GW","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$15.13 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G14599","SUP","HCPCS C1758","","G14599  -  CATHETER URET 20D .035IN 5FR 70CM FLXB ANG TIP TPR END GW","BOTH IP/OP","$83.50 ","$61.79 ","$0.00 ","$83.50 ","$45.34 ","$0.00 ","$17.40 ","$0.00 ","$0.00 ","$14.62 ","$83.50 ","$0.00 ","$41.75 ","$66.13 ","$66.80 ","$0.00 ","$13.07 ","$0.00 ","$13.29 ","$0.00 "
"G14600","SUP","HCPCS C1758","","G14600  -  CATHETER URET 20D .028IN BVL STRG 4FR 70CM 145CM GW","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$15.13 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G14606","SUP","HCPCS C2617","","G14606  -  CATHETER URET 20D .035IN 5FR 70CM 145CM ANG TIP BVL END GW","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14608","SUP","HCPCS C1758","","G14608  -  SET STNT .025IN 50CM SM 2 PGTL CRV STRG 3.7FR 26CM GRN STRL","BOTH IP/OP","$330.00 ","$244.20 ","$0.00 ","$330.00 ","$179.19 ","$0.00 ","$68.78 ","$0.00 ","$0.00 ","$57.78 ","$330.00 ","$0.00 ","$165.00 ","$261.36 ","$264.00 ","$0.00 ","$51.65 ","$0.00 ","$52.54 ","$0.00 "
"G14619","SUP","HCPCS C1769","","G14619  -  TROCAR SRG STD 18GA 11CM DISP","BOTH IP/OP","$52.08 ","$38.54 ","$0.00 ","$52.08 ","$28.28 ","$0.00 ","$10.85 ","$0.00 ","$0.00 ","$9.12 ","$52.08 ","$0.00 ","$26.04 ","$41.25 ","$41.66 ","$0.00 ","$8.15 ","$0.00 ","$8.29 ","$0.00 "
"G14631","SUP","HCPCS C1769","","G14631  -  GUIDEWIRE ESCP .038IN 145CM STRL CNS BNTSN MOV COR SS PTFE","BOTH IP/OP","$71.38 ","$52.82 ","$0.00 ","$71.38 ","$38.76 ","$0.00 ","$14.88 ","$0.00 ","$0.00 ","$12.50 ","$71.38 ","$0.00 ","$35.69 ","$56.53 ","$57.10 ","$0.00 ","$11.17 ","$0.00 ","$11.36 ","$0.00 "
"G14639","SUP","HCPCS C2617","","G14639  -  GUIDEWIRE VASC STRG .038IN 145CM AMPTZ FLXB FXCR","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14650","SUP","HCPCS C2627","","G14650  -  SET NPHSTM .038IN 22GA 18GA 80CM 20CM SFTJ 2 NDL ENTRY GW","BOTH IP/OP","$306.13 ","$226.54 ","$0.00 ","$306.13 ","$166.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.60 ","$306.13 ","$0.00 ","$153.06 ","$242.45 ","$244.90 ","$0.00 ","$47.91 ","$0.00 ","$48.74 ","$0.00 "
"G14658","SUP","HCPCS C1769","","G14658  -  SET NPHSTM 300ML STRL 2 CNCT DRN PCH SFT ELC BELT REED VLV","BOTH IP/OP","$465.53 ","$344.49 ","$0.00 ","$465.53 ","$252.78 ","$0.00 ","$97.03 ","$0.00 ","$0.00 ","$81.51 ","$465.53 ","$0.00 ","$232.76 ","$368.70 ","$372.42 ","$0.00 ","$72.85 ","$0.00 ","$74.11 ","$0.00 "
"G14659","SUP","HCPCS C1758","","G14659  -  SET NPHSTM 8.2FR 19.5CM LTX COPE LOOP CATH NDL GW STPCK","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G14663","SUP","HCPCS C1758","","G14663  -  CATHETER URETERAL 4.8FR 8FR 70CM CONE TIP","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14665","SUP","HCPCS C1758","","G14665  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G14667","SUP","HCPCS C1758","","G14667  -  CATHETER URETERAL CONE 7FR 12FR 70CM","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14669","SUP","HCPCS C1758","","G14669  -  CATHETER URET 6FR 10FR 70CM CONE TIP","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14671","SUP","HCPCS C1758","","G14671  -  CATHETER URET 8FR 14FR 70CM CONE TIP","BOTH IP/OP","$3.29 ","$2.43 ","$0.00 ","$3.29 ","$1.79 ","$0.00 ","$0.69 ","$0.00 ","$0.00 ","$0.58 ","$3.29 ","$0.00 ","$1.65 ","$2.61 ","$2.63 ","$0.00 ","$0.51 ","$0.00 ","$0.52 ","$0.00 "
"G14674","SUP","HCPCS C1773","","G14674  -  CATHETER URET 5FR 70CM ANG TIP TPR END MOD","BOTH IP/OP","$313.45 ","$231.95 ","$0.00 ","$313.45 ","$170.20 ","$0.00 ","$65.33 ","$0.00 ","$0.00 ","$54.88 ","$313.45 ","$0.00 ","$156.73 ","$248.25 ","$250.76 ","$0.00 ","$49.05 ","$0.00 ","$49.90 ","$0.00 "
"G14676","SUP","Custom 27203010","","G14676  -  FORCEPS GRASPING 10MM 3.2FR 115MM COAXIAL SHEATH HANDLE","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14677","SUP","HCPCS C1773","","G14677  -  RETRIEVER SRG 3FR 115CM STRL FLTWR LOOP URET","BOTH IP/OP","$398.45 ","$294.85 ","$0.00 ","$398.45 ","$216.36 ","$0.00 ","$83.05 ","$0.00 ","$0.00 ","$69.77 ","$398.45 ","$0.00 ","$199.23 ","$315.57 ","$318.76 ","$0.00 ","$62.36 ","$0.00 ","$63.43 ","$0.00 "
"G14681","SUP","Custom 27203010","","G14681  -  SYRINGE ASP 5ML VAC","BOTH IP/OP","$604.00 ","$446.96 ","$0.00 ","$604.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$604.00 ","$0.00 ","$302.00 ","$478.37 ","$483.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14685","SUP","HCPCS C1769","","G14685  -  DEVICE SPEC RTRVL 5CM 5MM 5FR 4CM 65CM RTNR 3WR STON HLCL","BOTH IP/OP","$52.08 ","$38.54 ","$0.00 ","$52.08 ","$28.28 ","$0.00 ","$10.85 ","$0.00 ","$0.00 ","$9.12 ","$52.08 ","$0.00 ","$26.04 ","$41.25 ","$41.66 ","$0.00 ","$8.15 ","$0.00 ","$8.29 ","$0.00 "
"G14686","SUP","HCPCS C1758","","G14686  -  GUIDEWIRE VASC .035IN 145CM CNS BNTSN MOV COR DSGN FLXB","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$14.93 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"G14687","SUP","HCPCS C1758","","G14687  -  CATHETER URET 4FR 70CM RND TIP STY RT","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$14.93 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"G14688","SUP","HCPCS C1894","","G14688  -  CATHETER URET 5FR 70CM RND TIP STY LT","BOTH IP/OP","$86.90 ","$64.31 ","$0.00 ","$86.90 ","$47.19 ","$0.00 ","$18.11 ","$0.00 ","$0.00 ","$15.22 ","$86.90 ","$0.00 ","$43.45 ","$68.82 ","$69.52 ","$0.00 ","$13.60 ","$0.00 ","$13.83 ","$0.00 "
"G14693","SUP","HCPCS C1769","","G14693  -  STRAINER SPEC NS STON DISP","BOTH IP/OP","$1.40 ","$1.04 ","$0.00 ","$1.40 ","$0.76 ","$0.00 ","$0.29 ","$0.00 ","$0.00 ","$0.25 ","$1.40 ","$0.00 ","$0.70 ","$1.11 ","$1.12 ","$0.00 ","$0.22 ","$0.00 ","$0.22 ","$0.00 "
"G14694","SUP","HCPCS C1729","","G14694  -  GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ FLX TP XSTIF SS","BOTH IP/OP","$188.10 ","$139.19 ","$0.00 ","$188.10 ","$102.14 ","$0.00 ","$39.20 ","$0.00 ","$0.00 ","$32.93 ","$188.10 ","$0.00 ","$94.05 ","$148.98 ","$150.48 ","$0.00 ","$29.44 ","$0.00 ","$29.95 ","$0.00 "
"G14700","SUP","HCPCS C2617","","G14700  -  CATHETER NPHSTM 8.2FR 19.5CM STRL LTX COPE LOOP CNN PERC","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14705","SUP","HCPCS C1729","","G14705  -  SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 14CM GRN STRL 70CM","BOTH IP/OP","$188.10 ","$139.19 ","$0.00 ","$188.10 ","$102.14 ","$0.00 ","$39.20 ","$0.00 ","$0.00 ","$32.93 ","$188.10 ","$0.00 ","$94.05 ","$148.98 ","$150.48 ","$0.00 ","$29.44 ","$0.00 ","$29.95 ","$0.00 "
"G14706","SUP","HCPCS C1758","","G14706  -  SET NPHSTM 12FR 19.5CM CK CNN GW COPE TY LOOP","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G14714","SUP","HCPCS C1729","","G14714  -  CATHETER URET 6FR 70CM ANG TIP TPR END","BOTH IP/OP","$404.80 ","$299.55 ","$0.00 ","$404.80 ","$219.81 ","$0.00 ","$84.37 ","$0.00 ","$0.00 ","$70.88 ","$404.80 ","$0.00 ","$202.40 ","$320.60 ","$323.84 ","$0.00 ","$63.35 ","$0.00 ","$64.44 ","$0.00 "
"G14717","SUP","HCPCS C1758","","G14717  -  SET NPHSTM THNWL 12FR 21GA 19.5CM STRL 15CM COPE LOOP 1 WY","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$15.53 ","$0.00 ","$5.96 ","$0.00 ","$0.00 ","$5.01 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$4.48 ","$0.00 ","$4.55 ","$0.00 "
"G14731","SUP","HCPCS C1769","","G14731  -  CATHETER URET 4.8FR 8FR 70CM CONE TIP OP-EN","BOTH IP/OP","$3.38 ","$2.50 ","$0.00 ","$3.38 ","$1.84 ","$0.00 ","$0.70 ","$0.00 ","$0.00 ","$0.59 ","$3.38 ","$0.00 ","$1.69 ","$2.68 ","$2.70 ","$0.00 ","$0.53 ","$0.00 ","$0.54 ","$0.00 "
"G14732","SUP","Custom 27203010","","G14732  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL LF 3CM FX COR FLX","BOTH IP/OP","$61.25 ","$45.33 ","$0.00 ","$61.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.25 ","$0.00 ","$30.63 ","$48.51 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14738","SUP","HCPCS C1758","","G14738  -  ADAPTER CATH Y 3-6FR M LL SDARM T-B","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14742","SUP","HCPCS C2617","","G14742  -  FILIFORM URTH 7FR 10IN MLBL TIP THRD","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14744","SUP","Custom 27203010","","G14744  -  SET STNT .035IN 70CM SM 2 PGTL CRV STRG 3.7FR 24CM GRN STRL","BOTH IP/OP","$366.85 ","$271.47 ","$0.00 ","$366.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.85 ","$0.00 ","$183.43 ","$290.55 ","$293.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14748","SUP","Custom 27203010","","G14748  -  ADAPTER CATHETER 3-6FR FOLEY SIDEARM TUOHY-BORST STERILE","BOTH IP/OP","$50.60 ","$37.44 ","$0.00 ","$50.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.60 ","$0.00 ","$25.30 ","$40.08 ","$40.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14772","SUP","HCPCS C1729","","G14772  -  DISK RTNT 12FR STAB INDWL PERC CATH TIE","BOTH IP/OP","$185.90 ","$137.57 ","$0.00 ","$185.90 ","$100.94 ","$0.00 ","$38.75 ","$0.00 ","$0.00 ","$32.55 ","$185.90 ","$0.00 ","$92.95 ","$147.23 ","$148.72 ","$0.00 ","$29.09 ","$0.00 ","$29.60 ","$0.00 "
"G14779","SUP","HCPCS C2625","","G14779  -  SET NPHSTM 7-12FR 30CM 20CM MLCT CATH STNT LL CNCT TUBE STY","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$139.40 ","$62.73 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$24.41 ","$139.40 ","$0.00 ","$69.70 ","$110.40 ","$111.52 ","$0.00 ","$21.82 ","$0.00 ","$22.19 ","$0.00 "
"G14780","SUP","HCPCS C2617","","G14780  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$139.40 ","$62.73 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$24.41 ","$139.40 ","$0.00 ","$69.70 ","$110.40 ","$111.52 ","$0.00 ","$21.82 ","$0.00 ","$22.19 ","$0.00 "
"G14782","SUP","HCPCS C1769","","G14782  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH","BOTH IP/OP","$404.80 ","$299.55 ","$0.00 ","$404.80 ","$219.81 ","$0.00 ","$84.37 ","$0.00 ","$0.00 ","$70.88 ","$404.80 ","$0.00 ","$202.40 ","$320.60 ","$323.84 ","$0.00 ","$63.35 ","$0.00 ","$64.44 ","$0.00 "
"G14787","SUP","HCPCS C2617","","G14787  -  DILATOR URET 7FR 6MM 65CM 4CM SET BLN RADOPQ GW","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14788","SUP","HCPCS C2617","","G14788  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 16CM STRL 145CM","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14789","SUP","HCPCS C2617","","G14789  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 26CM STRL","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14790","SUP","HCPCS C2617","","G14790  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 24CM STRL","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14791","SUP","HCPCS C2628","","G14791  -  CATHETER BLNOCC 5.3FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP","BOTH IP/OP","$319.00 ","$236.06 ","$0.00 ","$319.00 ","$0.00 ","$0.00 ","$66.49 ","$0.00 ","$0.00 ","$0.00 ","$319.00 ","$0.00 ","$159.50 ","$252.65 ","$255.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14794","SUP","HCPCS C2617","","G14794  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 22CM STRL","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14796","SUP","HCPCS C2627","","G14796  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 8CM STRL 145CM","BOTH IP/OP","$36.70 ","$27.16 ","$0.00 ","$36.70 ","$19.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.43 ","$36.70 ","$0.00 ","$18.35 ","$29.07 ","$29.36 ","$0.00 ","$5.74 ","$0.00 ","$5.84 ","$0.00 "
"G14798","SUP","HCPCS C1758","","G14798  -  DILATOR URTH 11FR 20CM PE FSCA","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$15.53 ","$0.00 ","$5.96 ","$0.00 ","$0.00 ","$5.01 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$4.48 ","$0.00 ","$4.55 ","$0.00 "
"G14799","SUP","HCPCS C2617","","G14799  -  CATHETER URET 5FR 110CM FLXTP CLS END RT","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14803","SUP","HCPCS C1758","","G14803  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 18CM STRL 145CM","BOTH IP/OP","$123.83 ","$91.63 ","$0.00 ","$123.83 ","$67.24 ","$0.00 ","$25.81 ","$0.00 ","$0.00 ","$21.68 ","$123.83 ","$0.00 ","$61.91 ","$98.07 ","$99.06 ","$0.00 ","$19.38 ","$0.00 ","$19.71 ","$0.00 "
"G14804","SUP","HCPCS C1758","","G14804  -  CATHETER URET .045IN PGTL CRV 8FR 70CM SDPRT GW RT","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14808","SUP","HCPCS C1758","","G14808  -  CATHETER URET .038IN 5FR 115CM OP-EN GW MOD","BOTH IP/OP","$276.25 ","$204.43 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$57.58 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G14809","SUP","HCPCS C1758","","G14809  -  CATHETER URET STD 6FR 70CM FLXTP OP-EN FLX TP ACPT .038IN GW","BOTH IP/OP","$27.63 ","$20.45 ","$0.00 ","$27.63 ","$15.00 ","$0.00 ","$5.76 ","$0.00 ","$0.00 ","$4.84 ","$27.63 ","$0.00 ","$13.81 ","$21.88 ","$22.10 ","$0.00 ","$4.32 ","$0.00 ","$4.40 ","$0.00 "
"G14822","SUP","HCPCS C2625","","G14822  -  CATHETER URET 3FR 70CM OP-EN ACPT .018IN GW","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$139.40 ","$62.73 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$24.41 ","$139.40 ","$0.00 ","$69.70 ","$110.40 ","$111.52 ","$0.00 ","$21.82 ","$0.00 ","$22.19 ","$0.00 "
"G14823","SUP","HCPCS C2625","","G14823  -  SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$139.40 ","$62.73 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$24.41 ","$139.40 ","$0.00 ","$69.70 ","$110.40 ","$111.52 ","$0.00 ","$21.82 ","$0.00 ","$22.19 ","$0.00 "
"G14832","SUP","HCPCS C2617","","G14832  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 12CM STRL CP","BOTH IP/OP","$253.25 ","$187.41 ","$0.00 ","$253.25 ","$113.96 ","$0.00 ","$52.78 ","$0.00 ","$0.00 ","$44.34 ","$253.25 ","$0.00 ","$126.63 ","$200.57 ","$202.60 ","$0.00 ","$39.63 ","$0.00 ","$40.32 ","$0.00 "
"G14834","SUP","HCPCS C2617","","G14834  -  SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14836","SUP","HCPCS C2625","","G14836  -  SET STNT SM 2 PGTL CRV 3.7FR AST LGTH STRL CATH RADOPQ PSTNR","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14837","SUP","HCPCS C2625","","G14837  -  SET STNT .038IN 3CM 40CM 70CM 6FR 22-32CM STRL 145CM KWART","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14840","SUP","HCPCS C2617","","G14840  -  SET STNT .038IN 3CM 40CM 70CM .038IN 7FR 22-32CM STRL 145CM","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14843","SUP","HCPCS C2617","","G14843  -  SET STNT .018IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CP MDRL","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14844","SUP","HCPCS C2625","","G14844  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 26CM STRL 145","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14854","SUP","HCPCS C2617","","G14854  -  SET STNT .038IN 8.2FR 22-32CM STRL KWART RETRO-INJ STNT","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14857","SUP","HCPCS C1758","","G14857  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 24CM STRL 145","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14859","SUP","HCPCS C2627","","G14859  -  CATHETER URET .038IN 5FR 95CM OP-EN GW MOD","BOTH IP/OP","$66.43 ","$49.16 ","$0.00 ","$66.43 ","$36.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.63 ","$66.43 ","$0.00 ","$33.21 ","$52.61 ","$53.14 ","$0.00 ","$10.40 ","$0.00 ","$10.57 ","$0.00 "
"G14861","SUP","HCPCS C2627","","G14861  -  DILATOR URTH 26FR 20CM PE FSCA","BOTH IP/OP","$66.43 ","$49.16 ","$0.00 ","$66.43 ","$36.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.63 ","$66.43 ","$0.00 ","$33.21 ","$52.61 ","$53.14 ","$0.00 ","$10.40 ","$0.00 ","$10.57 ","$0.00 "
"G14865","SUP","HCPCS C2617","","G14865  -  DILATOR URTH 30FR 20CM PE FSCA","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14866","SUP","HCPCS C2617","","G14866  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 16CM STRL CP MDRL","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14867","SUP","HCPCS C2617","","G14867  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 14CM STRL CP MDRL","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14870","SUP","HCPCS C1758","","G14870  -  SET STNT .018IN SM 2 PGTL CRV 6FR 4FR 12CM STRL CP MDRL","BOTH IP/OP","$36.70 ","$27.16 ","$0.00 ","$36.70 ","$19.93 ","$0.00 ","$7.65 ","$0.00 ","$0.00 ","$6.43 ","$36.70 ","$0.00 ","$18.35 ","$29.07 ","$29.36 ","$0.00 ","$5.74 ","$0.00 ","$5.84 ","$0.00 "
"G14873","SUP","HCPCS C1758","","G14873  -  CATHETER URET 3.8FR 70CM LSR","BOTH IP/OP","$276.25 ","$204.43 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$57.58 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G14885","SUP","HCPCS C2625","","G14885  -  SET STNT 3CM 6FR 22CM STRL 145CM KWART RETRO-INJ RADOPQ","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G14886","SUP","HCPCS C2625","","G14886  -  CATHETER URET 5FR 70CM SPRL TIP SDPRT ACC ACPT .038IN GW","BOTH IP/OP","$26.14 ","$19.34 ","$0.00 ","$26.14 ","$11.76 ","$0.00 ","$5.45 ","$0.00 ","$0.00 ","$4.58 ","$26.14 ","$0.00 ","$13.07 ","$20.70 ","$20.91 ","$0.00 ","$4.09 ","$0.00 ","$4.16 ","$0.00 "
"G14887","SUP","HCPCS C2625","","G14887  -  SET STNT .038IN 2 PGTL CRV 6FR 26CM STRL KWART RETRO-INJ","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14890","SUP","HCPCS C1758","","G14890  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 6FR 24CM STRL 145","BOTH IP/OP","$36.70 ","$27.16 ","$0.00 ","$36.70 ","$19.93 ","$0.00 ","$7.65 ","$0.00 ","$0.00 ","$6.43 ","$36.70 ","$0.00 ","$18.35 ","$29.07 ","$29.36 ","$0.00 ","$5.74 ","$0.00 ","$5.84 ","$0.00 "
"G14891","SUP","HCPCS C2627","","G14891  -  SET CATH 16FR 25CM SET SPBC STM MLCT","BOTH IP/OP","$95.63 ","$70.77 ","$0.00 ","$95.63 ","$51.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.74 ","$95.63 ","$0.00 ","$47.81 ","$75.74 ","$76.50 ","$0.00 ","$14.97 ","$0.00 ","$15.22 ","$0.00 "
"G14893","SUP","HCPCS C1894","","G14893  -  CATHETER URET 3FR 70CM LSR ACPT .010IN GW","BOTH IP/OP","$451.00 ","$333.74 ","$0.00 ","$451.00 ","$244.89 ","$0.00 ","$94.00 ","$0.00 ","$0.00 ","$78.97 ","$451.00 ","$0.00 ","$225.50 ","$357.19 ","$360.80 ","$0.00 ","$70.58 ","$0.00 ","$71.80 ","$0.00 "
"G14897","SUP","HCPCS C2617","","G14897  -  DILATOR URTH RING 8-26FR 50CM LTX RADOPQ PTFE TRQ GW RADOPQ","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14898","SUP","HCPCS C2617","","G14898  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 22CM STRL 145CM","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14900","SUP","Custom 27203010","","G14900  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 14CM STRL CP","BOTH IP/OP","$26.58 ","$19.67 ","$0.00 ","$26.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.58 ","$0.00 ","$13.29 ","$21.05 ","$21.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14905","SUP","HCPCS C2625","","G14905  -  DEVICE SCR 16FR STRL RTNT DISK SIL DISP ACPT 16FR","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14906","SUP","HCPCS C2617","","G14906  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 10CM STRL RADOPQ","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14910","SUP","HCPCS C2625","","G14910  -  SET STNT .038IN 2 PGTL CRV 6FR 28CM STRL KWART RETRO-INJ","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14911","SUP","HCPCS C2625","","G14911  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 26CM STRL 145","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14912","SUP","HCPCS C2625","","G14912  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV 7FR 24CM STRL 145CM","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14916","SUP","HCPCS C2625","","G14916  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 28CM STRL 145","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14917","SUP","HCPCS C1729","","G14917  -  SET STNT .038IN 3CM 40CM 70CM STRG 4.7FR 22-32CM STRL 145CM","BOTH IP/OP","$404.80 ","$299.55 ","$0.00 ","$404.80 ","$219.81 ","$0.00 ","$84.37 ","$0.00 ","$0.00 ","$70.88 ","$404.80 ","$0.00 ","$202.40 ","$320.60 ","$323.84 ","$0.00 ","$63.35 ","$0.00 ","$64.44 ","$0.00 "
"G14919","SUP","Custom 27203010","","G14919  -  SET NPHSTM .038IN THNWL CRV 14FR 19.5CM STRL 30CM COPE LOOP","BOTH IP/OP","$185.60 ","$137.34 ","$0.00 ","$185.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$185.60 ","$0.00 ","$92.80 ","$147.00 ","$148.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G14920","SUP","HCPCS C2627","","G14920  -  BRUSH CYTO 3.2FR 115CM BX SET STRG TIP OCL URET","BOTH IP/OP","$144.10 ","$106.63 ","$0.00 ","$144.10 ","$78.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.23 ","$144.10 ","$0.00 ","$72.05 ","$114.13 ","$115.28 ","$0.00 ","$22.55 ","$0.00 ","$22.94 ","$0.00 "
"G14921","SUP","HCPCS C1773","","G14921  -  GUIDEWIRE ESCP .035IN 145CM 3CM FLX TP STD BD SS URET","BOTH IP/OP","$664.55 ","$491.77 ","$0.00 ","$664.55 ","$360.85 ","$0.00 ","$138.51 ","$0.00 ","$0.00 ","$116.36 ","$664.55 ","$0.00 ","$332.28 ","$526.32 ","$531.64 ","$0.00 ","$104.00 ","$0.00 ","$105.80 ","$0.00 "
"G14922","SUP","HCPCS C1773","","G14922  -  SET CATH 16FR 14FR 22CM 3CC LTX 30CM RTNR BLN NDL OBT CNCT","BOTH IP/OP","$664.55 ","$491.77 ","$0.00 ","$664.55 ","$360.85 ","$0.00 ","$138.51 ","$0.00 ","$0.00 ","$116.36 ","$664.55 ","$0.00 ","$332.28 ","$526.32 ","$531.64 ","$0.00 ","$104.00 ","$0.00 ","$105.80 ","$0.00 "
"G14925","SUP","HCPCS C1758","","G14925  -  FORCEPS SPEC RTRVL 3.3FR 115CM STRL 1 JAW STON FLXB SHFT","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G14935","SUP","HCPCS C1773","","G14935  -  CATHETER URET STD 8FR 70CM PLLK OP-EN FLX TP ACPT .038IN GW","BOTH IP/OP","$664.55 ","$491.77 ","$0.00 ","$664.55 ","$360.85 ","$0.00 ","$138.51 ","$0.00 ","$0.00 ","$116.36 ","$664.55 ","$0.00 ","$332.28 ","$526.32 ","$531.64 ","$0.00 ","$104.00 ","$0.00 ","$105.80 ","$0.00 "
"G14936","SUP","HCPCS C1773","","G14936  -  FORCEPS SPEC RTRVL 3.3FR 65CM STRL LF ALGTR TTH FLXB SHFT","BOTH IP/OP","$764.25 ","$565.55 ","$0.00 ","$764.25 ","$414.99 ","$0.00 ","$159.29 ","$0.00 ","$0.00 ","$133.81 ","$764.25 ","$0.00 ","$382.13 ","$605.29 ","$611.40 ","$0.00 ","$119.61 ","$0.00 ","$121.67 ","$0.00 "
"G14938","SUP","HCPCS C1758","","G14938  -  FORCEPS SPEC RTRVL 3.3FR 65CM 1 JAW RAT TTH URO","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$15.53 ","$0.00 ","$5.96 ","$0.00 ","$0.00 ","$5.01 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$4.48 ","$0.00 ","$4.55 ","$0.00 "
"G14941","SUP","HCPCS C1758","","G14941  -  CATHETER URET .038IN 5FR 70CM PLLK OP-EN GW MOD FLX TP","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$15.53 ","$0.00 ","$5.96 ","$0.00 ","$0.00 ","$5.01 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$4.48 ","$0.00 ","$4.55 ","$0.00 "
"G14943","SUP","HCPCS C2617","","G14943  -  CATHETER URET SPRL 6FR 70CM LG SDPRT ACPT .038IN GW","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14951","SUP","HCPCS C2617","","G14951  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 22CM STRL 145CM","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G14952","SUP","HCPCS C1758","","G14952  -  SET STNT .018IN SM 2 PGTL CRV CDE 7FR 4FR 12CM STRL CP MDRL","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G14955","SUP","HCPCS C2625","","G14955  -  CATHETER URET 5FR 70CM WHSTLTP MOD","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G14975","SUP","HCPCS C1769","","G14975  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 24CM STRL","BOTH IP/OP","$69.98 ","$51.79 ","$0.00 ","$69.98 ","$38.00 ","$0.00 ","$14.58 ","$0.00 ","$0.00 ","$12.25 ","$69.98 ","$0.00 ","$34.99 ","$55.42 ","$55.98 ","$0.00 ","$10.95 ","$0.00 ","$11.14 ","$0.00 "
"G14980","SUP","HCPCS C1758","","G14980  -  GUIDEWIRE URO .035IN 145CM 8CM AMPTZ STRG FLX TP SS","BOTH IP/OP","$109.48 ","$81.02 ","$0.00 ","$109.48 ","$59.44 ","$0.00 ","$22.82 ","$0.00 ","$0.00 ","$19.17 ","$109.48 ","$0.00 ","$54.74 ","$86.71 ","$87.58 ","$0.00 ","$17.13 ","$0.00 ","$17.43 ","$0.00 "
"G14991","SUP","HCPCS C2617","","G14991  -  SET CATH .038IN PGTL CRV 7FR 90CM STRL 145CM PSTNR SDPRT GW","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G14992","SUP","HCPCS C2617","","G14992  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 28CM STRL 145CM","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15000","SUP","HCPCS C2617","","G15000  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 20CM STRL 145CM","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15003","SUP","HCPCS C2617","","G15003  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 8CM STRL CP MDRL","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15015","SUP","HCPCS C2625","","G15015  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 10CM STRL CP MDRL","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G15016","SUP","HCPCS C2625","","G15016  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 8.2FR 24CM STRL","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G15020","SUP","HCPCS C1758","","G15020  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 26CM STRL","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$6.65 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G15030","SUP","Custom 27203010","","G15030  -  CATHETER URET 3FR 115CM LSR FBR HNDL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15034","SUP","HCPCS C1729","","G15034  -  ADAPTER CATH 14FR 15CM GOLDBERG FL DRN BG URET","BOTH IP/OP","$155.60 ","$115.14 ","$0.00 ","$155.60 ","$84.49 ","$0.00 ","$32.43 ","$0.00 ","$0.00 ","$27.24 ","$155.60 ","$0.00 ","$77.80 ","$123.24 ","$124.48 ","$0.00 ","$24.35 ","$0.00 ","$24.77 ","$0.00 "
"G15035","SUP","HCPCS C1729","","G15035  -  SET NPHSTM PGTL CRV 8.2FR 15CM 5CM MOD CATH STNT CNCT TUBE","BOTH IP/OP","$155.60 ","$115.14 ","$0.00 ","$155.60 ","$84.49 ","$0.00 ","$32.43 ","$0.00 ","$0.00 ","$27.24 ","$155.60 ","$0.00 ","$77.80 ","$123.24 ","$124.48 ","$0.00 ","$24.35 ","$0.00 ","$24.77 ","$0.00 "
"G15037","SUP","HCPCS C1758","","G15037  -  SET NPHSTM PGTL CRV 8.2FR 15CM 7CM MOD CATH STNT CNCT TUBE","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G15038","SUP","HCPCS C2617","","G15038  -  CATHETER URET .038IN 5FR 115CM PLLK OP-EN GW MOD FLX TP","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15040","SUP","HCPCS C1758","","G15040  -  SET STNT .038IN 2 PGTL CRV CDE 7FR 10CM STRL RADOPQ GW SFLX","BOTH IP/OP","$276.25 ","$204.43 ","$0.00 ","$276.25 ","$150.00 ","$0.00 ","$57.58 ","$0.00 ","$0.00 ","$48.37 ","$276.25 ","$0.00 ","$138.13 ","$218.79 ","$221.00 ","$0.00 ","$43.23 ","$0.00 ","$43.98 ","$0.00 "
"G15042","SUP","HCPCS C2617","","G15042  -  CATHETER URET STD 4FR 70CM LF FLXTP PLCK OP-EN ACPT .028IN","BOTH IP/OP","$6.66 ","$4.93 ","$0.00 ","$6.66 ","$3.00 ","$0.00 ","$1.39 ","$0.00 ","$0.00 ","$1.17 ","$6.66 ","$0.00 ","$3.33 ","$5.27 ","$5.33 ","$0.00 ","$1.04 ","$0.00 ","$1.06 ","$0.00 "
"G15045","SUP","Custom 27203010","","G15045  -  STENT URTH 10FR 30CM STRL FRLT KLG SUT BLB SIL DISP","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15047","SUP","HCPCS C2617","","G15047  -  SET BX 3.2FR 115CM BRSH DFLC RADOPQ URET","BOTH IP/OP","$66.63 ","$49.31 ","$0.00 ","$66.63 ","$29.98 ","$0.00 ","$13.89 ","$0.00 ","$0.00 ","$11.67 ","$66.63 ","$0.00 ","$33.31 ","$52.77 ","$53.30 ","$0.00 ","$10.43 ","$0.00 ","$10.61 ","$0.00 "
"G15049","SUP","HCPCS C2617","","G15049  -  STENT URTH 8FR 30CM STRL FRLT KLG SIL DISP HYPOSPADIAS","BOTH IP/OP","$66.63 ","$49.31 ","$0.00 ","$66.63 ","$29.98 ","$0.00 ","$13.89 ","$0.00 ","$0.00 ","$11.67 ","$66.63 ","$0.00 ","$33.31 ","$52.77 ","$53.30 ","$0.00 ","$10.43 ","$0.00 ","$10.61 ","$0.00 "
"G15050","SUP","HCPCS C2617","","G15050  -  STENT URTH 8FR 12CM STRL ZAONTZ DISP HYPOSPADIAS EPISPADIAS","BOTH IP/OP","$66.63 ","$49.31 ","$0.00 ","$66.63 ","$29.98 ","$0.00 ","$13.89 ","$0.00 ","$0.00 ","$11.67 ","$66.63 ","$0.00 ","$33.31 ","$52.77 ","$53.30 ","$0.00 ","$10.43 ","$0.00 ","$10.61 ","$0.00 "
"G15054","SUP","Custom 27203010","","G15054  -  FORCEPS ENDSCP 3.3FR 115CM FLEXIBLE OVAL BIOP CUP TISSUE","BOTH IP/OP","$781.00 ","$577.94 ","$0.00 ","$781.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$781.00 ","$0.00 ","$390.50 ","$618.55 ","$624.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15056","SUP","Custom 27203010","","G15056  -  STENT URTH 10FR 12CM STRL ZAONTZ DISP HYPOSPADIAS OR","BOTH IP/OP","$45.55 ","$33.71 ","$0.00 ","$45.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.55 ","$0.00 ","$22.78 ","$36.08 ","$36.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15061","SUP","HCPCS C1726","","G15061  -  CARRIER SUT 30D 16CM PEREYRA RAZ LGT REUSE","BOTH IP/OP","$385.00 ","$284.90 ","$0.00 ","$385.00 ","$209.06 ","$0.00 ","$80.24 ","$0.00 ","$0.00 ","$67.41 ","$385.00 ","$0.00 ","$192.50 ","$304.92 ","$308.00 ","$0.00 ","$60.25 ","$0.00 ","$61.29 ","$0.00 "
"G15062","SUP","HCPCS C1726","","G15062  -  CATHETER URTH 7FR 30CM STRL M DISP","BOTH IP/OP","$442.75 ","$327.64 ","$0.00 ","$442.75 ","$240.41 ","$0.00 ","$92.28 ","$0.00 ","$0.00 ","$77.52 ","$442.75 ","$0.00 ","$221.38 ","$350.66 ","$354.20 ","$0.00 ","$69.29 ","$0.00 ","$70.49 ","$0.00 "
"G15067","SUP","HCPCS C1769","","G15067  -  CATHETER BLNDIL SET F URET","BOTH IP/OP","$37.40 ","$27.68 ","$0.00 ","$37.40 ","$20.31 ","$0.00 ","$7.80 ","$0.00 ","$0.00 ","$6.55 ","$37.40 ","$0.00 ","$18.70 ","$29.62 ","$29.92 ","$0.00 ","$5.85 ","$0.00 ","$5.95 ","$0.00 "
"G15070","SUP","HCPCS C2627","","G15070  -  GUIDEWIRE ESCP STRG STD .038IN 80CM STRL 3CM FLX TP FXCR SS","BOTH IP/OP","$144.10 ","$106.63 ","$0.00 ","$144.10 ","$78.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.23 ","$144.10 ","$0.00 ","$72.05 ","$114.13 ","$115.28 ","$0.00 ","$22.55 ","$0.00 ","$22.94 ","$0.00 "
"G15076","SUP","HCPCS C2617","","G15076  -  SET CATH 10FR 22CM 3ML STRL LTX 30CM RTNR BLN SS NDL OBT","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15077","SUP","HCPCS C2617","","G15077  -  SET DRN 8FR 6-10FR 30CM 20CM CATH DIL LOOP","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15079","SUP","HCPCS C1892","","G15079  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 8CM STRL RADOPQ","BOTH IP/OP","$103.53 ","$76.61 ","$0.00 ","$103.53 ","$56.21 ","$0.00 ","$21.58 ","$0.00 ","$0.00 ","$18.13 ","$103.53 ","$0.00 ","$51.76 ","$82.00 ","$82.82 ","$0.00 ","$16.20 ","$0.00 ","$16.48 ","$0.00 "
"G15088","SUP","HCPCS C2627","","G15088  -  CATHETER URO 8FR 8.5FR 88CM 30CM CK SET GW 810 STNT PLC","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$22.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.32 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$6.54 ","$0.00 ","$6.65 ","$0.00 "
"G15089","SUP","HCPCS C2627","","G15089  -  DILATOR URET 7FR 60CM SET PE","BOTH IP/OP","$187.00 ","$138.38 ","$0.00 ","$187.00 ","$101.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.74 ","$187.00 ","$0.00 ","$93.50 ","$148.10 ","$149.60 ","$0.00 ","$29.27 ","$0.00 ","$29.77 ","$0.00 "
"G15093","SUP","HCPCS C2617","","G15093  -  CATHETER SPBC 16FR 12CM OB PLWY ACC INTRO SET GW TROC NDL","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15108","SUP","Custom 27203010","","G15108  -  SET STNT .018IN 2 PGTL CRV CDE 7FR 16CM STRL RADOPQ PSTNR GW","BOTH IP/OP","$75.90 ","$56.17 ","$0.00 ","$75.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.90 ","$0.00 ","$37.95 ","$60.11 ","$60.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15109","SUP","Custom 27203010","","G15109  -  DILATOR URTH 8FR 35.5CM DIST TIP","BOTH IP/OP","$75.90 ","$56.17 ","$0.00 ","$75.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.90 ","$0.00 ","$37.95 ","$60.11 ","$60.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15116","SUP","HCPCS C1758","","G15116  -  CATHETER URET 4FR 70CM WHSTLTP MOD","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G15120","SUP","HCPCS C2617","","G15120  -  CATHETER URET 4FR 115CM FLXTP CLS END RT","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15121","SUP","HCPCS C1758","","G15121  -  SET STNT .038IN 2 PGTL CRV 7FR 24CM BLK STRL 145CM RADOPQ","BOTH IP/OP","$83.50 ","$61.79 ","$0.00 ","$83.50 ","$45.34 ","$0.00 ","$17.40 ","$0.00 ","$0.00 ","$14.62 ","$83.50 ","$0.00 ","$41.75 ","$66.13 ","$66.80 ","$0.00 ","$13.07 ","$0.00 ","$13.29 ","$0.00 "
"G15123","SUP","HCPCS C2617","","G15123  -  CATHETER URET 20D .035IN 7FR 70CM 145CM ANG TIP TPR END GW","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15124","SUP","HCPCS C2617","","G15124  -  SET STNT .038IN 2 PGTL CRV FLFRM 7FR 22CM BLK STRL 145CM","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15125","SUP","HCPCS C2617","","G15125  -  SET STNT .038IN 2 PGTL CRV 7FR 26CM BLK STRL 145CM RADOPQ","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15126","SUP","HCPCS C2617","","G15126  -  SET STNT .038IN 2 PGTL CRV 7FR 28CM BLK STRL 145CM RADOPQ","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15127","SUP","HCPCS C2617","","G15127  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 30CM BLK STRL 145","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15128","SUP","HCPCS C2617","","G15128  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 22CM BLK STRL","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15129","SUP","HCPCS C2617","","G15129  -  SET STNT .038IN 2 PGTL CRV 8.5FR 24CM BLK STRL 145CM RADOPQ","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15130","SUP","HCPCS C2617","","G15130  -  SET STNT .038IN 2 PGTL CRV 8.5FR 28CM BLK STRL 145CM RADOPQ","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15133","SUP","Custom 27203010","","G15133  -  SET NPHSTM 500ML STRL 1 CNCT DRN PCH SFT ELC BELT REED VLV","BOTH IP/OP","$71.25 ","$52.73 ","$0.00 ","$71.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.25 ","$0.00 ","$35.63 ","$56.43 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15134","SUP","Custom 27203010","","G15134  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 26CM BLK STRL","BOTH IP/OP","$71.25 ","$52.73 ","$0.00 ","$71.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.25 ","$0.00 ","$35.63 ","$56.43 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15136","SUP","Custom 27203010","","G15136  -  SET NPHSTM 500ML STRL DRN PCH SFT ELC BELT REED VLV MECH","BOTH IP/OP","$71.25 ","$52.73 ","$0.00 ","$71.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.25 ","$0.00 ","$35.63 ","$56.43 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15137","SUP","Custom 27203010","","G15137  -  SET NPHSTM 500ML NS CK 1 CNCT DRN PCH SFT ELC BELT DISP","BOTH IP/OP","$71.25 ","$52.73 ","$0.00 ","$71.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$71.25 ","$0.00 ","$35.63 ","$56.43 ","$57.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15138","SUP","HCPCS C2617","","G15138  -  SET NPHSTM 500ML NS 2 CNCT DRN PCH SFT ELC BELT REED VLV","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15144","SUP","HCPCS C2617","","G15144  -  SET STNT .018IN SM 2 PGTL CRV 7FR 14CM STRL RADOPQ PSTNR GW","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15145","SUP","HCPCS C2617","","G15145  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 22CM BLK STRL 145CM","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15146","SUP","HCPCS C2617","","G15146  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 24CM BLK STRL 145CM","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15147","SUP","HCPCS C2617","","G15147  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 26CM BLK STRL 145CM","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15148","SUP","HCPCS C2617","","G15148  -  SET STNT .038IN 2 PGTL CRV 6FR 28CM BLK STRL 145CM RADOPQ","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15149","SUP","HCPCS C2627","","G15149  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 30CM BLK STRL 145","BOTH IP/OP","$137.90 ","$102.05 ","$0.00 ","$137.90 ","$74.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.15 ","$137.90 ","$0.00 ","$68.95 ","$109.22 ","$110.32 ","$0.00 ","$21.58 ","$0.00 ","$21.95 ","$0.00 "
"G15150","SUP","HCPCS C2617","","G15150  -  SET CATH LOOP 14FR 23CM BLU SFLX 1 WY STPCK NDL OBT CNCT","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15167","SUP","Custom 27203010","","G15167  -  DILATOR URTH 6-10FR MEATUS","BOTH IP/OP","$35.43 ","$26.22 ","$0.00 ","$35.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.43 ","$0.00 ","$17.71 ","$28.06 ","$28.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15168","SUP","HCPCS C2625","","G15168  -  CATHETER URO 8-14FR SPRT SFT LOPRFL NKNK CRV PERC","BOTH IP/OP","$141.45 ","$104.67 ","$0.00 ","$141.45 ","$63.65 ","$0.00 ","$29.48 ","$0.00 ","$0.00 ","$24.77 ","$141.45 ","$0.00 ","$70.73 ","$112.03 ","$113.16 ","$0.00 ","$22.14 ","$0.00 ","$22.52 ","$0.00 "
"G15170","SUP","Custom 27203010","","G15170  -  SET NPHSTM PGTL CRV 8.2FR 125CM DRETLER STNT GW","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15172","SUP","HCPCS C1758","","G15172  -  CATHETER URTH 22-24FR RTNR FL TRC TEMP TRC","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G15193","SUP","HCPCS C2617","","G15193  -  CATHETER URET 3FR 70CM RND TIP STY RT","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15195","SUP","HCPCS C1758","","G15195  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 20CM BLK STRL 145","BOTH IP/OP","$31.90 ","$23.61 ","$0.00 ","$31.90 ","$17.32 ","$0.00 ","$6.65 ","$0.00 ","$0.00 ","$5.59 ","$31.90 ","$0.00 ","$15.95 ","$25.26 ","$25.52 ","$0.00 ","$4.99 ","$0.00 ","$5.08 ","$0.00 "
"G15196","SUP","HCPCS C2627","","G15196  -  CATHETER URET 2FR 115CM LSR ADPR","BOTH IP/OP","$256.80 ","$190.03 ","$0.00 ","$256.80 ","$139.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.96 ","$256.80 ","$0.00 ","$128.40 ","$203.39 ","$205.44 ","$0.00 ","$40.19 ","$0.00 ","$40.88 ","$0.00 "
"G15211","SUP","HCPCS C1773","","G15211  -  FOLLOWER URTH 10FR 35.5CM PHLPS DIL DIST TIP THRD WO SDPRT","BOTH IP/OP","$664.55 ","$491.77 ","$0.00 ","$664.55 ","$360.85 ","$0.00 ","$138.51 ","$0.00 ","$0.00 ","$116.36 ","$664.55 ","$0.00 ","$332.28 ","$526.32 ","$531.64 ","$0.00 ","$104.00 ","$0.00 ","$105.80 ","$0.00 "
"G15214","SUP","HCPCS C1729","","G15214  -  FORCEPS SPEC RTRVL 3.3FR 115CM MS TTH FLXB SHFT","BOTH IP/OP","$188.10 ","$139.19 ","$0.00 ","$188.10 ","$102.14 ","$0.00 ","$39.20 ","$0.00 ","$0.00 ","$32.93 ","$188.10 ","$0.00 ","$94.05 ","$148.98 ","$150.48 ","$0.00 ","$29.44 ","$0.00 ","$29.95 ","$0.00 "
"G15216","SUP","HCPCS C1758","","G15216  -  SET NPHSTM 14FR 19.5CM STRL LTX CK CATH CNN COPE LOOP NTR","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G15219","SUP","Custom 27203010","","G15219  -  CATHETER URET .038IN 5FR 70CM OP-EN MOD","BOTH IP/OP","$25.30 ","$18.72 ","$0.00 ","$25.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.30 ","$0.00 ","$12.65 ","$20.04 ","$20.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15221","SUP","HCPCS C1892","","G15221  -  ADAPTER CATH 7-10FR T-B M LL LD TM","BOTH IP/OP","$136.63 ","$101.11 ","$0.00 ","$136.63 ","$74.19 ","$0.00 ","$28.48 ","$0.00 ","$0.00 ","$23.92 ","$136.63 ","$0.00 ","$68.31 ","$108.21 ","$109.30 ","$0.00 ","$21.38 ","$0.00 ","$21.75 ","$0.00 "
"G15223","SUP","HCPCS C2625","","G15223  -  SET INTRO STD 20FR 37CM 32CM PLWY 2 KNOB SHTH GW","BOTH IP/OP","$160.30 ","$118.62 ","$0.00 ","$160.30 ","$72.14 ","$0.00 ","$33.41 ","$0.00 ","$0.00 ","$28.07 ","$160.30 ","$0.00 ","$80.15 ","$126.96 ","$128.24 ","$0.00 ","$25.09 ","$0.00 ","$25.52 ","$0.00 "
"G15224","SUP","HCPCS C2625","","G15224  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR","BOTH IP/OP","$160.30 ","$118.62 ","$0.00 ","$160.30 ","$72.14 ","$0.00 ","$33.41 ","$0.00 ","$0.00 ","$28.07 ","$160.30 ","$0.00 ","$80.15 ","$126.96 ","$128.24 ","$0.00 ","$25.09 ","$0.00 ","$25.52 ","$0.00 "
"G15225","SUP","HCPCS C1769","","G15225  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR","BOTH IP/OP","$38.88 ","$28.77 ","$0.00 ","$38.88 ","$21.11 ","$0.00 ","$8.10 ","$0.00 ","$0.00 ","$6.81 ","$38.88 ","$0.00 ","$19.44 ","$30.79 ","$31.10 ","$0.00 ","$6.08 ","$0.00 ","$6.19 ","$0.00 "
"G15227","SUP","HCPCS C2625","","G15227  -  SET STNT 3CM 2 PGTL CRV 7FR 22CM STRL 145CM KWART RETRO-INJ","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G15230","SUP","Custom 27203010","","G15230  -  FORCEP SPEC RTRVL 65CM 5.2FR 1 JAW ALGTR TOOTH FLXB SHFT","BOTH IP/OP","$646.00 ","$478.04 ","$0.00 ","$646.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$646.00 ","$0.00 ","$323.00 ","$511.63 ","$516.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15233","SUP","HCPCS C2617","","G15233  -  GUIDEWIRE ESCP STD .035IN 145CM FXCR SS","BOTH IP/OP","$66.63 ","$49.31 ","$0.00 ","$66.63 ","$29.98 ","$0.00 ","$13.89 ","$0.00 ","$0.00 ","$11.67 ","$66.63 ","$0.00 ","$33.31 ","$52.77 ","$53.30 ","$0.00 ","$10.43 ","$0.00 ","$10.61 ","$0.00 "
"G15240","SUP","HCPCS C1729","","G15240  -  TUBE CNCT 10FR 30CM M LL DRN BG","BOTH IP/OP","$150.55 ","$111.41 ","$0.00 ","$150.55 ","$81.75 ","$0.00 ","$31.38 ","$0.00 ","$0.00 ","$26.36 ","$150.55 ","$0.00 ","$75.28 ","$119.24 ","$120.44 ","$0.00 ","$23.56 ","$0.00 ","$23.97 ","$0.00 "
"G15248","SUP","HCPCS C1769","","G15248  -  SET NPHSTM 10FR 19.5CM COPE LOOP CATH CNN GW","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$0.00 ","$0.00 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"G15252","SUP","HCPCS C1769","","G15252  -  GUIDEWIRE VASC STD STRG .028IN 145CM STRL 3CM FXCR FLX TP SS","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$0.00 ","$0.00 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"G15256","SUP","HCPCS C1769","","G15256  -  GUIDEWIRE VASC STD STRG .035IN 145CM STRL 3CM FX COR FLX TP","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$0.00 ","$0.00 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"G15261","SUP","HCPCS C2627","","G15261  -  CUFF CONTINENCE 10ML NS TEMP INTOP CAP SYR SIL M REUSE","BOTH IP/OP","$144.10 ","$106.63 ","$0.00 ","$144.10 ","$78.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.23 ","$144.10 ","$0.00 ","$72.05 ","$114.13 ","$115.28 ","$0.00 ","$22.55 ","$0.00 ","$22.94 ","$0.00 "
"G15262","SUP","Custom 27203010","","G15262  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS","BOTH IP/OP","$177.10 ","$131.05 ","$0.00 ","$177.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$177.10 ","$0.00 ","$88.55 ","$140.26 ","$141.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15276","SUP","Custom 27203010","","G15276  -  ADAPTER CATH 2 M LL","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15279","SUP","Custom 27203010","","G15279  -  NEEDLE ESCP 25GA 5FR 35CM 8MM WMS CSCP","BOTH IP/OP","$46.83 ","$34.65 ","$0.00 ","$46.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.83 ","$0.00 ","$23.41 ","$37.09 ","$37.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15280","SUP","HCPCS C1769","","G15280  -  NEEDLE ESCP 14FR 20CM HATTER ASP CSCP FLXB","BOTH IP/OP","$51.00 ","$37.74 ","$0.00 ","$51.00 ","$27.69 ","$0.00 ","$10.63 ","$0.00 ","$0.00 ","$8.93 ","$51.00 ","$0.00 ","$25.50 ","$40.39 ","$40.80 ","$0.00 ","$7.98 ","$0.00 ","$8.12 ","$0.00 "
"G15284","SUP","HCPCS C1758","","G15284  -  GUIDEWIRE VASC STD .035IN 145CM STRL MOV COR SS SLIP-COAT","BOTH IP/OP","$40.70 ","$30.12 ","$0.00 ","$40.70 ","$22.10 ","$0.00 ","$8.48 ","$0.00 ","$0.00 ","$7.13 ","$40.70 ","$0.00 ","$20.35 ","$32.23 ","$32.56 ","$0.00 ","$6.37 ","$0.00 ","$6.48 ","$0.00 "
"G15290","SUP","Custom 27203010","","G15290  -  CATHETER ESCP 2FR 3CM SILBER ASP","BOTH IP/OP","$37.40 ","$27.68 ","$0.00 ","$37.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.40 ","$0.00 ","$18.70 ","$29.62 ","$29.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15291","SUP","Custom 27203010","","G15291  -  NEEDLE PRC 22GA 20CM STRL SKNY ECHTP CHBA TIP PERC US IMG","BOTH IP/OP","$41.80 ","$30.93 ","$0.00 ","$41.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$41.80 ","$0.00 ","$20.90 ","$33.11 ","$33.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15292","SUP","Custom 27203010","","G15292  -  NEEDLE PRC TROC 18GA 20CM STRL ECHTP 2 PRT DISP US IMG","BOTH IP/OP","$93.50 ","$69.19 ","$0.00 ","$93.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.50 ","$0.00 ","$46.75 ","$74.05 ","$74.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15293","SUP","Custom 27203010","","G15293  -  NEEDLE PRC 18GA 22GA 14-22CM MTPLK ECHTP COAX PERC","BOTH IP/OP","$79.70 ","$58.98 ","$0.00 ","$79.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$79.70 ","$0.00 ","$39.85 ","$63.12 ","$63.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15296","SUP","Custom 27203010","","G15296  -  NEEDLE TROC STD 18GA 25CM ECHTP 2 PRT DISP","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15299","SUP","HCPCS C1758","","G15299  -  NEEDLE ESCP 23GA 3.7FR 35CM WMS CSCP","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$16.13 ","$0.00 ","$6.19 ","$0.00 ","$0.00 ","$5.20 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$4.65 ","$0.00 ","$4.73 ","$0.00 "
"G15300","SUP","HCPCS C1758","","G15300  -  ADAPTER ESCP ANG STRL LF SCHOBORG LSR FBR CATH URET DISP","BOTH IP/OP","$83.50 ","$61.79 ","$0.00 ","$83.50 ","$45.34 ","$0.00 ","$17.40 ","$0.00 ","$0.00 ","$14.62 ","$83.50 ","$0.00 ","$41.75 ","$66.13 ","$66.80 ","$0.00 ","$13.07 ","$0.00 ","$13.29 ","$0.00 "
"G15301","SUP","HCPCS C1758","","G15301  -  CATHETER URET 40D .035IN TPR STRG 5FR 70CM 145CM SF GW NYL","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$15.13 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G15302","SUP","HCPCS C1758","","G15302  -  CATHETER URET 40D .035IN TPR 6FR 70CM 145CM GW","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$15.13 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G15397","SUP","HCPCS C2617","","G15397  -  CATHETER URET 40D .035IN 5FR 70CM 145CM FLXB ANG TIP BVL END","BOTH IP/OP","$215.55 ","$159.51 ","$0.00 ","$215.55 ","$97.00 ","$0.00 ","$44.93 ","$0.00 ","$0.00 ","$37.74 ","$215.55 ","$0.00 ","$107.78 ","$170.72 ","$172.44 ","$0.00 ","$33.73 ","$0.00 ","$34.32 ","$0.00 "
"G15422","SUP","Custom 27203010","","G15422  -  FORCEP SPEC RTRVL 65CM 5.2FR 2 JAW ALGTR TOOTH","BOTH IP/OP","$675.28 ","$499.71 ","$0.00 ","$656.00 ","$0.00 ","$0.00 ","$140.74 ","$0.00 ","$0.00 ","$0.00 ","$656.00 ","$0.00 ","$328.00 ","$519.55 ","$524.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15424","SUP","HCPCS C1758","","G15424  -  STENT URET 2 PGTL CRV 4.7FR 8CM STRL SFLX PED DISP ACPT .035","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G15425","SUP","HCPCS C1758","","G15425  -  CATHETER URET .018IN 3FR 70CM OP-EN GW MOD","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G15429","SUP","HCPCS C1726","","G15429  -  CATHETER URET .025IN 4FR 70CM OP-EN GW MOD","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"G15434","SUP","HCPCS C1726","","G15434  -  DEVICE SUT 10D 17CM PEREYRA LGT CR REUSE","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"G15435","SUP","HCPCS C1726","","G15435  -  CATHETER URDY 7FR 38CM STRL 2 LUM URETER DISP","BOTH IP/OP","$54.23 ","$40.13 ","$0.00 ","$54.23 ","$29.44 ","$0.00 ","$11.30 ","$0.00 ","$0.00 ","$9.49 ","$54.23 ","$0.00 ","$27.11 ","$42.95 ","$43.38 ","$0.00 ","$8.49 ","$0.00 ","$8.63 ","$0.00 "
"G15443","SUP","HCPCS C2617","","G15443  -  CATHETER URDY 7.4FR 30CM 3 LUM","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15444","SUP","HCPCS C2617","","G15444  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 20CM BLK STRL","BOTH IP/OP","$287.00 ","$212.38 ","$0.00 ","$287.00 ","$129.15 ","$0.00 ","$59.82 ","$0.00 ","$0.00 ","$50.25 ","$287.00 ","$0.00 ","$143.50 ","$227.30 ","$229.60 ","$0.00 ","$44.92 ","$0.00 ","$45.69 ","$0.00 "
"G15469","SUP","HCPCS C1769","","G15469  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 20CM BLK STRL 145","BOTH IP/OP","$207.90 ","$153.85 ","$0.00 ","$207.90 ","$112.89 ","$0.00 ","$43.33 ","$0.00 ","$0.00 ","$36.40 ","$207.90 ","$0.00 ","$103.95 ","$164.66 ","$166.32 ","$0.00 ","$32.54 ","$0.00 ","$33.10 ","$0.00 "
"G15473","SUP","HCPCS C2625","","G15473  -  SET INTRO .035IN STRG 8-14FR 18GA 14CM STRL 10CM SP TUBE NDL","BOTH IP/OP","$160.30 ","$118.62 ","$0.00 ","$160.30 ","$72.14 ","$0.00 ","$33.41 ","$0.00 ","$0.00 ","$28.07 ","$160.30 ","$0.00 ","$80.15 ","$126.96 ","$128.24 ","$0.00 ","$25.09 ","$0.00 ","$25.52 ","$0.00 "
"G15475","SUP","Custom 27203010","","G15475  -  SET STNT .038IN 5MM PGTL CRV 8.2FR 75CM STRL 100CM BNDR CATH","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15476","SUP","Custom 27203010","","G15476  -  ADAPTER CATH 9FR STRL CKFL SDARM STPCK F LL PEEL OPN DISP","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15495","SUP","HCPCS C2625","","G15495  -  SET STNT 3CM 145CM STRL KWART RETRO-INJ INSRTR TETH RELS SLV","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G15500","SUP","HCPCS C1758","","G15500  -  ADAPTER CATH 9FR STRL CKFL SLF SL F LL DISP","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G15513","SUP","Custom 27203010","","G15513  -  CATHETER URET 4FR 70CM SPRL TIP ACC LG SDPRT ACPT .028IN GW","BOTH IP/OP","$115.13 ","$85.20 ","$0.00 ","$115.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.13 ","$0.00 ","$57.56 ","$91.18 ","$92.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15514","SUP","HCPCS C2617","","G15514  -  NEEDLE PRC 18GA 25CM ECHTP TROC STY SHTH TFE RNL","BOTH IP/OP","$215.55 ","$159.51 ","$0.00 ","$215.55 ","$97.00 ","$0.00 ","$44.93 ","$0.00 ","$0.00 ","$37.74 ","$215.55 ","$0.00 ","$107.78 ","$170.72 ","$172.44 ","$0.00 ","$33.73 ","$0.00 ","$34.32 ","$0.00 "
"G15530","SUP","HCPCS C1769","","G15530  -  STENT URET 2 PGTL CRV 7FR 20CM STRL SFLX DISP ACPT .038IN GW","BOTH IP/OP","$58.65 ","$43.40 ","$0.00 ","$58.65 ","$31.85 ","$0.00 ","$12.22 ","$0.00 ","$0.00 ","$10.27 ","$58.65 ","$0.00 ","$29.33 ","$46.45 ","$46.92 ","$0.00 ","$9.18 ","$0.00 ","$9.34 ","$0.00 "
"G15532","SUP","HCPCS C2617","","G15532  -  GUIDEWIRE ESCP STD .028IN 145CM FXCR HDRPH","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G15540","SUP","HCPCS C1726","","G15540  -  SET STNT .025IN 3.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR","BOTH IP/OP","$97.18 ","$71.91 ","$0.00 ","$97.18 ","$52.77 ","$0.00 ","$20.25 ","$0.00 ","$0.00 ","$17.01 ","$97.18 ","$0.00 ","$48.59 ","$76.97 ","$77.74 ","$0.00 ","$15.21 ","$0.00 ","$15.47 ","$0.00 "
"G15579","SUP","HCPCS C1758","","G15579  -  CATHETER URDY 7.4FR 30CM 3 LUM BLN","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G15600","SUP","HCPCS C1769","","G15600  -  CATHETER URET .028IN 4FR 115CM FLXTP OP-EN GW MOD FLX TP","BOTH IP/OP","$58.65 ","$43.40 ","$0.00 ","$58.65 ","$31.85 ","$0.00 ","$12.22 ","$0.00 ","$0.00 ","$10.27 ","$58.65 ","$0.00 ","$29.33 ","$46.45 ","$46.92 ","$0.00 ","$9.18 ","$0.00 ","$9.34 ","$0.00 "
"G15602","SUP","HCPCS C1769","","G15602  -  GUIDEWIRE ESCP STD .035IN 145CM FXCR HDRPH","BOTH IP/OP","$58.65 ","$43.40 ","$0.00 ","$58.65 ","$31.85 ","$0.00 ","$12.22 ","$0.00 ","$0.00 ","$10.27 ","$58.65 ","$0.00 ","$29.33 ","$46.45 ","$46.92 ","$0.00 ","$9.18 ","$0.00 ","$9.34 ","$0.00 "
"G15603","SUP","HCPCS C1726","","G15603  -  GUIDEWIRE URO BNTSN CRV STRG .035IN 145CM STRL 15CM FXCR FLX","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"G15606","SUP","HCPCS C2617","","G15606  -  CATHETER URDY 10FR 39CM 2 LUM","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15607","SUP","HCPCS C2617","","G15607  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 8CM GRY STRL CATH","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15608","SUP","HCPCS C2617","","G15608  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 10CM GRY STRL CATH","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15610","SUP","HCPCS C2617","","G15610  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 12CM GRY STRL CATH","BOTH IP/OP","$215.55 ","$159.51 ","$0.00 ","$215.55 ","$97.00 ","$0.00 ","$44.93 ","$0.00 ","$0.00 ","$37.74 ","$215.55 ","$0.00 ","$107.78 ","$170.72 ","$172.44 ","$0.00 ","$33.73 ","$0.00 ","$34.32 ","$0.00 "
"G15621","SUP","Custom 27203010","","G15621  -  STENT URET 2 PGTL CRV 4.7FR 10CM STRL SFLX PED DISP ACPT","BOTH IP/OP","$48.08 ","$35.58 ","$0.00 ","$48.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.08 ","$0.00 ","$24.04 ","$38.08 ","$38.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15624","SUP","HCPCS C2617","","G15624  -  NEEDLE PRC STD 18GA 11CM ECHTP 2 PRT TROC DISP","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G15632","SUP","HCPCS C2627","","G15632  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 7FR 6CM STRL RADOPQ GW","BOTH IP/OP","$258.05 ","$190.96 ","$0.00 ","$258.05 ","$140.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.18 ","$258.05 ","$0.00 ","$129.03 ","$204.38 ","$206.44 ","$0.00 ","$40.38 ","$0.00 ","$41.08 ","$0.00 "
"G15636","SUP","HCPCS C1758","","G15636  -  SET DIL 6-12FR 60CM WO GW PE HDRPH URET","BOTH IP/OP","$47.30 ","$35.00 ","$0.00 ","$47.30 ","$25.68 ","$0.00 ","$9.86 ","$0.00 ","$0.00 ","$8.28 ","$47.30 ","$0.00 ","$23.65 ","$37.46 ","$37.84 ","$0.00 ","$7.40 ","$0.00 ","$7.53 ","$0.00 "
"G15637","SUP","HCPCS C1758","","G15637  -  CATHETER URET 5FR 70CM ECHTP OP-EN ACPT .038IN GW","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$54.40 ","$29.54 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$9.53 ","$54.40 ","$0.00 ","$27.20 ","$43.08 ","$43.52 ","$0.00 ","$8.51 ","$0.00 ","$8.66 ","$0.00 "
"G15638","SUP","HCPCS C1758","","G15638  -  CATHETER URET .038IN 6FR 70CM ECHTP OP-EN GW","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$54.40 ","$29.54 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$9.53 ","$54.40 ","$0.00 ","$27.20 ","$43.08 ","$43.52 ","$0.00 ","$8.51 ","$0.00 ","$8.66 ","$0.00 "
"G15639","SUP","HCPCS C1758","","G15639  -  CATHETER URET .038IN 7FR 70CM ECHTP OP-EN GW","BOTH IP/OP","$54.40 ","$40.26 ","$0.00 ","$54.40 ","$29.54 ","$0.00 ","$11.34 ","$0.00 ","$0.00 ","$9.53 ","$54.40 ","$0.00 ","$27.20 ","$43.08 ","$43.52 ","$0.00 ","$8.51 ","$0.00 ","$8.66 ","$0.00 "
"G15650","SUP","Custom 27203010","","G15650  -  CATHETER URET .038IN 8FR 70CM ECHTP OP-EN GW","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15670","SUP","HCPCS C1758","","G15670  -  ADAPTER CATH UNV 9FR STRL CKFL F LL DISP","BOTH IP/OP","$150.68 ","$111.50 ","$0.00 ","$150.68 ","$81.82 ","$0.00 ","$31.40 ","$0.00 ","$0.00 ","$26.38 ","$150.68 ","$0.00 ","$75.34 ","$119.34 ","$120.54 ","$0.00 ","$23.58 ","$0.00 ","$23.99 ","$0.00 "
"G15731","SUP","HCPCS C1769","","G15731  -  GUIDEWIRE VASC .032IN 145CM AMPTZ MOV COR STRG TPR","BOTH IP/OP","$69.98 ","$51.79 ","$0.00 ","$69.98 ","$38.00 ","$0.00 ","$14.58 ","$0.00 ","$0.00 ","$12.25 ","$69.98 ","$0.00 ","$34.99 ","$55.42 ","$55.98 ","$0.00 ","$10.95 ","$0.00 ","$11.14 ","$0.00 "
"G15732","SUP","HCPCS C1769","","G15732  -  CATHETER URET .045IN PGTL CRV 8FR 70CM 145CM SDPRT SHFT GW","BOTH IP/OP","$69.98 ","$51.79 ","$0.00 ","$69.98 ","$38.00 ","$0.00 ","$14.58 ","$0.00 ","$0.00 ","$12.25 ","$69.98 ","$0.00 ","$34.99 ","$55.42 ","$55.98 ","$0.00 ","$10.95 ","$0.00 ","$11.14 ","$0.00 "
"G15733","SUP","HCPCS C1892","","G15733  -  GUIDEWIRE VASC .038IN 145CM LF 3CM AMPTZ 2 FLXB STF SS","BOTH IP/OP","$136.63 ","$101.11 ","$0.00 ","$136.63 ","$74.19 ","$0.00 ","$28.48 ","$0.00 ","$0.00 ","$23.92 ","$136.63 ","$0.00 ","$68.31 ","$108.21 ","$109.30 ","$0.00 ","$21.38 ","$0.00 ","$21.75 ","$0.00 "
"G15739","SUP","HCPCS C1726","","G15739  -  POUCH SPEC RTRVL 5X2IN YLW LAPSAC SRG REM MORCELLATION INTGR","BOTH IP/OP","$54.23 ","$40.13 ","$0.00 ","$54.23 ","$29.44 ","$0.00 ","$11.30 ","$0.00 ","$0.00 ","$9.49 ","$54.23 ","$0.00 ","$27.11 ","$42.95 ","$43.38 ","$0.00 ","$8.49 ","$0.00 ","$8.63 ","$0.00 "
"G15753","SUP","HCPCS C2627","","G15753  -  TUBE CNCT 14FR 11CM M LL DRN BG T-B ADPR","BOTH IP/OP","$72.73 ","$53.82 ","$0.00 ","$72.73 ","$39.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.73 ","$72.73 ","$0.00 ","$36.36 ","$57.60 ","$58.18 ","$0.00 ","$11.38 ","$0.00 ","$11.58 ","$0.00 "
"G15764","SUP","HCPCS C2627","","G15764  -  DILATOR URTH 6FR 37CM PE FSCA","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$16.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.20 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$4.65 ","$0.00 ","$4.73 ","$0.00 "
"G15766","SUP","Custom 27203010","","G15766  -  CATHETER URDY 4FR 60CM PRSS BLDR","BOTH IP/OP","$70.40 ","$52.10 ","$0.00 ","$70.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$70.40 ","$0.00 ","$35.20 ","$55.76 ","$56.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15771","SUP","Custom 27203010","","G15771  -  CATHETER URDY 12FR 36CM STRL LTX 5CM PRSS BLN SIL RCTL DISP","BOTH IP/OP","$626.88 ","$463.89 ","$0.00 ","$626.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$626.88 ","$0.00 ","$313.44 ","$496.49 ","$501.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15789","SUP","HCPCS C1729","","G15789  -  INTRODUCER ESCP 25.5CM 5X8IN LAPSAC LGR ACC PORT HNDL SS AL","BOTH IP/OP","$465.53 ","$344.49 ","$0.00 ","$465.53 ","$252.78 ","$0.00 ","$97.03 ","$0.00 ","$0.00 ","$81.51 ","$465.53 ","$0.00 ","$232.76 ","$368.70 ","$372.42 ","$0.00 ","$72.85 ","$0.00 ","$74.11 ","$0.00 "
"G15792","SUP","HCPCS C1758","","G15792  -  SET NPHSTM 12FR 30CM STRL LTX 20CM COPE LOOP NDL GW DIL CNCT","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G15803","SUP","HCPCS C1758","","G15803  -  CATHETER URET .038IN 5FR 120CM FLXTP OP-EN GW MOD","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G15821","SUP","HCPCS C1758","","G15821  -  CATHETER URET 9FR 15CM WHSTLTP MOD LT","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G15859","SUP","HCPCS C1758","","G15859  -  CATHETER URET 3FR 125CM RND TIP STY LT","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G15864","SUP","Custom 27203010","","G15864  -  CATHETER URET 4FR 90CM WHSTLTP MOD RT","BOTH IP/OP","$69.58 ","$51.49 ","$0.00 ","$69.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.58 ","$0.00 ","$34.79 ","$55.11 ","$55.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G15871","SUP","HCPCS C1758","","G15871  -  NEEDLE INJ 20GA 5FR 35CM 7MM WMS CSCP","BOTH IP/OP","$100.25 ","$74.19 ","$0.00 ","$100.25 ","$54.44 ","$0.00 ","$20.89 ","$0.00 ","$0.00 ","$17.55 ","$100.25 ","$0.00 ","$50.13 ","$79.40 ","$80.20 ","$0.00 ","$15.69 ","$0.00 ","$15.96 ","$0.00 "
"G15873","SUP","HCPCS C1726","","G15873  -  CATHETER URET PGTL CRV 8.2FR 56CM SFLX","BOTH IP/OP","$49.10 ","$36.33 ","$0.00 ","$49.10 ","$26.66 ","$0.00 ","$10.23 ","$0.00 ","$0.00 ","$8.60 ","$49.10 ","$0.00 ","$24.55 ","$38.89 ","$39.28 ","$0.00 ","$7.68 ","$0.00 ","$7.82 ","$0.00 "
"G15875","SUP","HCPCS C2625","","G15875  -  CATHETER URDY 7.4FR 30CM 3 LUM","BOTH IP/OP","$259.33 ","$191.90 ","$0.00 ","$259.33 ","$116.70 ","$0.00 ","$54.05 ","$0.00 ","$0.00 ","$45.41 ","$259.33 ","$0.00 ","$129.66 ","$205.39 ","$207.46 ","$0.00 ","$40.58 ","$0.00 ","$41.28 ","$0.00 "
"G15876","SUP","HCPCS C2625","","G15876  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH","BOTH IP/OP","$225.50 ","$166.87 ","$0.00 ","$225.50 ","$101.48 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$39.48 ","$225.50 ","$0.00 ","$112.75 ","$178.60 ","$180.40 ","$0.00 ","$35.29 ","$0.00 ","$35.90 ","$0.00 "
"G15877","SUP","HCPCS C2625","","G15877  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH","BOTH IP/OP","$259.33 ","$191.90 ","$0.00 ","$259.33 ","$116.70 ","$0.00 ","$54.05 ","$0.00 ","$0.00 ","$45.41 ","$259.33 ","$0.00 ","$129.66 ","$205.39 ","$207.46 ","$0.00 ","$40.58 ","$0.00 ","$41.28 ","$0.00 "
"G15878","SUP","HCPCS C2625","","G15878  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH","BOTH IP/OP","$225.50 ","$166.87 ","$0.00 ","$225.50 ","$101.48 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$39.48 ","$225.50 ","$0.00 ","$112.75 ","$178.60 ","$180.40 ","$0.00 ","$35.29 ","$0.00 ","$35.90 ","$0.00 "
"G15885","SUP","HCPCS C1758","","G15885  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH","BOTH IP/OP","$36.30 ","$26.86 ","$0.00 ","$36.30 ","$19.71 ","$0.00 ","$7.57 ","$0.00 ","$0.00 ","$6.36 ","$36.30 ","$0.00 ","$18.15 ","$28.75 ","$29.04 ","$0.00 ","$5.68 ","$0.00 ","$5.78 ","$0.00 "
"G15889","SUP","HCPCS C1758","","G15889  -  CATHETER URET 3FR 70CM STF STY PED","BOTH IP/OP","$39.95 ","$29.56 ","$0.00 ","$39.95 ","$21.69 ","$0.00 ","$8.33 ","$0.00 ","$0.00 ","$6.99 ","$39.95 ","$0.00 ","$19.98 ","$31.64 ","$31.96 ","$0.00 ","$6.25 ","$0.00 ","$6.36 ","$0.00 "
"G15899","SUP","HCPCS C1726","","G15899  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"G15924","SUP","HCPCS C2617","","G15924  -  POUCH DRN 300ML STRL SFT ELC BELT REED VLV MECH REUSE","BOTH IP/OP","$76.63 ","$56.71 ","$0.00 ","$76.63 ","$34.48 ","$0.00 ","$15.97 ","$0.00 ","$0.00 ","$13.42 ","$76.63 ","$0.00 ","$38.31 ","$60.69 ","$61.30 ","$0.00 ","$11.99 ","$0.00 ","$12.20 ","$0.00 "
"G15925","SUP","HCPCS C1729","","G15925  -  STENT URTH 8FR 40CM STRL FRLT KLG CNTR BLB SIL DISP","BOTH IP/OP","$404.80 ","$299.55 ","$0.00 ","$404.80 ","$219.81 ","$0.00 ","$84.37 ","$0.00 ","$0.00 ","$70.88 ","$404.80 ","$0.00 ","$202.40 ","$320.60 ","$323.84 ","$0.00 ","$63.35 ","$0.00 ","$64.44 ","$0.00 "
"G15929","SUP","HCPCS C2617","","G15929  -  SET NPHSTM 10FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G15934","SUP","HCPCS C1769","","G15934  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 14CM STRL CP MDRL","BOTH IP/OP","$58.65 ","$43.40 ","$0.00 ","$58.65 ","$31.85 ","$0.00 ","$12.22 ","$0.00 ","$0.00 ","$10.27 ","$58.65 ","$0.00 ","$29.33 ","$46.45 ","$46.92 ","$0.00 ","$9.18 ","$0.00 ","$9.34 ","$0.00 "
"G15935","SUP","HCPCS C1769","","G15935  -  GUIDEWIRE ESCP STD STRG .025IN 145CM 3CM FLX TP FXCR SS","BOTH IP/OP","$52.08 ","$38.54 ","$0.00 ","$52.08 ","$28.28 ","$0.00 ","$10.85 ","$0.00 ","$0.00 ","$9.12 ","$52.08 ","$0.00 ","$26.04 ","$41.25 ","$41.66 ","$0.00 ","$8.15 ","$0.00 ","$8.29 ","$0.00 "
"G16019","SUP","HCPCS C2617","","G16019  -  TUBE CNCT 14FR 30CM STRL 2 DRN PCH","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G16020","SUP","HCPCS C2617","","G16020  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 10CM STRL CATH","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G16021","SUP","HCPCS C2617","","G16021  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 14CM STRL CATH","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G16035","SUP","HCPCS C2617","","G16035  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CATH","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G16040","SUP","HCPCS C2617","","G16040  -  SET STNT .038IN SM 2 PGTL CRV 7FR 4FR 12CM STRL CATH RADOPQ","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G16112","SUP","Custom 27203010","","G16112  -  SET STNT .038IN SM 2 PGTL CRV 6FR 4FR 14CM STRL CATH RADOPQ","BOTH IP/OP","$69.58 ","$51.49 ","$0.00 ","$69.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.58 ","$0.00 ","$34.79 ","$55.11 ","$55.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16116","SUP","HCPCS C1726","","G16116  -  NEEDLE INJ 23GA 5FR 45CM 8MM WMS CSCP","BOTH IP/OP","$587.60 ","$434.82 ","$0.00 ","$587.60 ","$319.07 ","$0.00 ","$122.47 ","$0.00 ","$0.00 ","$102.88 ","$587.60 ","$0.00 ","$293.80 ","$465.38 ","$470.08 ","$0.00 ","$91.96 ","$0.00 ","$93.55 ","$0.00 "
"G16120","SUP","HCPCS C2627","","G16120  -  SET DIL 6-30FR 30CM 16CM AMPTZ MOD RADOPQ SHTH RNL","BOTH IP/OP","$215.05 ","$159.14 ","$0.00 ","$215.05 ","$116.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.65 ","$215.05 ","$0.00 ","$107.53 ","$170.32 ","$172.04 ","$0.00 ","$33.66 ","$0.00 ","$34.24 ","$0.00 "
"G16121","SUP","HCPCS C1769","","G16121  -  INTRODUCER NPHSTM 18FR 12CM OB PLWY ACC SET GW TROC NDL SPBC","BOTH IP/OP","$215.05 ","$159.14 ","$0.00 ","$215.05 ","$116.77 ","$0.00 ","$44.82 ","$0.00 ","$0.00 ","$37.65 ","$215.05 ","$0.00 ","$107.53 ","$170.32 ","$172.04 ","$0.00 ","$33.66 ","$0.00 ","$34.24 ","$0.00 "
"G16122","SUP","HCPCS C1769","","G16122  -  SET CATH TROC 20FR 12CM OB PLWY INTRO NDL GW SPBC","BOTH IP/OP","$215.05 ","$159.14 ","$0.00 ","$215.05 ","$116.77 ","$0.00 ","$44.82 ","$0.00 ","$0.00 ","$37.65 ","$215.05 ","$0.00 ","$107.53 ","$170.32 ","$172.04 ","$0.00 ","$33.66 ","$0.00 ","$34.24 ","$0.00 "
"G16123","SUP","HCPCS C1769","","G16123  -  INTRODUCER NPHSTM 22FR 12CM PLWY ACC SET GW TROC NDL","BOTH IP/OP","$215.05 ","$159.14 ","$0.00 ","$215.05 ","$116.77 ","$0.00 ","$44.82 ","$0.00 ","$0.00 ","$37.65 ","$215.05 ","$0.00 ","$107.53 ","$170.32 ","$172.04 ","$0.00 ","$33.66 ","$0.00 ","$34.24 ","$0.00 "
"G16187","SUP","HCPCS C2625","","G16187  -  POUCH DRN STRL BELT PLS ADJ REUSE","BOTH IP/OP","$160.30 ","$118.62 ","$0.00 ","$160.30 ","$72.14 ","$0.00 ","$33.41 ","$0.00 ","$0.00 ","$28.07 ","$160.30 ","$0.00 ","$80.15 ","$126.96 ","$128.24 ","$0.00 ","$25.09 ","$0.00 ","$25.52 ","$0.00 "
"G16198","SUP","HCPCS C2627","","G16198  -  CATHETER URET .038IN 5FR 120CM OP-EN GW MOD","BOTH IP/OP","$165.73 ","$122.64 ","$0.00 ","$165.73 ","$89.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.02 ","$165.73 ","$0.00 ","$82.86 ","$131.26 ","$132.58 ","$0.00 ","$25.94 ","$0.00 ","$26.38 ","$0.00 "
"G16226","SUP","HCPCS C2617","","G16226  -  SET CATH 10FR 22CM RTNR BLN SPBC","BOTH IP/OP","$317.75 ","$235.14 ","$0.00 ","$317.75 ","$142.99 ","$0.00 ","$66.23 ","$0.00 ","$0.00 ","$55.64 ","$317.75 ","$0.00 ","$158.88 ","$251.66 ","$254.20 ","$0.00 ","$49.73 ","$0.00 ","$50.59 ","$0.00 "
"G16227","SUP","HCPCS C2617","","G16227  -  SET STNT 5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT","BOTH IP/OP","$317.75 ","$235.14 ","$0.00 ","$317.75 ","$142.99 ","$0.00 ","$66.23 ","$0.00 ","$0.00 ","$55.64 ","$317.75 ","$0.00 ","$158.88 ","$251.66 ","$254.20 ","$0.00 ","$49.73 ","$0.00 ","$50.59 ","$0.00 "
"G16228","SUP","HCPCS C2617","","G16228  -  SET STNT .028IN 6FR 8-20CM GRN STRL 145CM GRN CATH MTLNTH","BOTH IP/OP","$365.43 ","$270.42 ","$0.00 ","$365.43 ","$164.44 ","$0.00 ","$76.16 ","$0.00 ","$0.00 ","$63.98 ","$365.43 ","$0.00 ","$182.71 ","$289.42 ","$292.34 ","$0.00 ","$57.19 ","$0.00 ","$58.18 ","$0.00 "
"G16229","SUP","HCPCS C2617","","G16229  -  SET STNT 6FR 22-32CM GRN GW CATH PSTNR RNL TRNSPLNT","BOTH IP/OP","$317.75 ","$235.14 ","$0.00 ","$317.75 ","$142.99 ","$0.00 ","$66.23 ","$0.00 ","$0.00 ","$55.64 ","$317.75 ","$0.00 ","$158.88 ","$251.66 ","$254.20 ","$0.00 ","$49.73 ","$0.00 ","$50.59 ","$0.00 "
"G16230","SUP","HCPCS C2617","","G16230  -  SET STNT 7FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT","BOTH IP/OP","$317.75 ","$235.14 ","$0.00 ","$317.75 ","$142.99 ","$0.00 ","$66.23 ","$0.00 ","$0.00 ","$55.64 ","$317.75 ","$0.00 ","$158.88 ","$251.66 ","$254.20 ","$0.00 ","$49.73 ","$0.00 ","$50.59 ","$0.00 "
"G16658","SUP","HCPCS C1769","","G16658  -  SET STNT 8.5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT","BOTH IP/OP","$465.53 ","$344.49 ","$0.00 ","$465.53 ","$252.78 ","$0.00 ","$97.03 ","$0.00 ","$0.00 ","$81.51 ","$465.53 ","$0.00 ","$232.76 ","$368.70 ","$372.42 ","$0.00 ","$72.85 ","$0.00 ","$74.11 ","$0.00 "
"G16672","SUP","Custom 27203010","","G16672  -  SET NPHSTM 12FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK","BOTH IP/OP","$482.33 ","$356.92 ","$0.00 ","$482.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$482.33 ","$0.00 ","$241.16 ","$382.01 ","$385.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16684","SUP","Custom 27203010","","G16684  -  EXTRACTOR STON FLT 3FR 115CM 4WR BSKT LSR PLMD","BOTH IP/OP","$60.50 ","$44.77 ","$0.00 ","$60.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.50 ","$0.00 ","$30.25 ","$47.92 ","$48.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16695","SUP","Custom 27203010","","G16695  -  NEEDLE INJ 23GA 3.7FR 35CM 8MM WMS CSCP","BOTH IP/OP","$73.15 ","$54.13 ","$0.00 ","$73.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.15 ","$0.00 ","$36.58 ","$57.93 ","$58.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16696","SUP","HCPCS C2627","","G16696  -  CATHETER PRSS 12FR 36CM 2CM BLN SIL RCTL","BOTH IP/OP","$166.10 ","$122.91 ","$0.00 ","$166.10 ","$90.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.08 ","$166.10 ","$0.00 ","$83.05 ","$131.55 ","$132.88 ","$0.00 ","$25.99 ","$0.00 ","$26.44 ","$0.00 "
"G16699","SUP","HCPCS C2627","","G16699  -  SET CATH TROC 8FR 54CM STRL DRN ADPR SPBC CYSTOSTOMY","BOTH IP/OP","$166.10 ","$122.91 ","$0.00 ","$166.10 ","$90.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.08 ","$166.10 ","$0.00 ","$83.05 ","$131.55 ","$132.88 ","$0.00 ","$25.99 ","$0.00 ","$26.44 ","$0.00 "
"G16702","SUP","HCPCS C1773","","G16702  -  SET CATH LOPRFL STD 10FR 54CM STRL TROC STY PLS DRN ADPR","BOTH IP/OP","$397.80 ","$294.37 ","$0.00 ","$397.80 ","$216.01 ","$0.00 ","$82.91 ","$0.00 ","$0.00 ","$69.65 ","$397.80 ","$0.00 ","$198.90 ","$315.06 ","$318.24 ","$0.00 ","$62.26 ","$0.00 ","$63.33 ","$0.00 "
"G16705","SUP","HCPCS C1726","","G16705  -  FORCEPS SPEC RTRVL 2.5FR 10MM 115CM COAX SHTH GRSP","BOTH IP/OP","$98.20 ","$72.67 ","$0.00 ","$98.20 ","$53.32 ","$0.00 ","$20.47 ","$0.00 ","$0.00 ","$17.19 ","$98.20 ","$0.00 ","$49.10 ","$77.77 ","$78.56 ","$0.00 ","$15.37 ","$0.00 ","$15.63 ","$0.00 "
"G16708","SUP","HCPCS C1758","","G16708  -  CATHETER URDY 7FR 43CM STRL 2 LUM LOOP URETHRA DISP","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$15.53 ","$0.00 ","$5.96 ","$0.00 ","$0.00 ","$5.01 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$4.48 ","$0.00 ","$4.55 ","$0.00 "
"G16731","SUP","HCPCS C2617","","G16731  -  CATHETER URET .038IN 6FR 10CM FLXTP OP-EN GW MOD","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G16740","SUP","HCPCS C2627","","G16740  -  SET CATH 12FR 16GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE","BOTH IP/OP","$166.10 ","$122.91 ","$0.00 ","$166.10 ","$90.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.08 ","$166.10 ","$0.00 ","$83.05 ","$131.55 ","$132.88 ","$0.00 ","$25.99 ","$0.00 ","$26.44 ","$0.00 "
"G16758","SUP","HCPCS C2617","","G16758  -  SET STNT .038IN CDE 3FR 4FR 8-12CM STRL CATH RADOPQ MTLNTH","BOTH IP/OP","$66.63 ","$49.31 ","$0.00 ","$66.63 ","$29.98 ","$0.00 ","$13.89 ","$0.00 ","$0.00 ","$11.67 ","$66.63 ","$0.00 ","$33.31 ","$52.77 ","$53.30 ","$0.00 ","$10.43 ","$0.00 ","$10.61 ","$0.00 "
"G16775","SUP","Custom 27203010","","G16775  -  STENT URTH 6FR 12CM STRL ZAONTZ PS DRN DISP HYPOSPADIAS","BOTH IP/OP","$78.10 ","$57.79 ","$0.00 ","$78.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.10 ","$0.00 ","$39.05 ","$61.86 ","$62.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16780","SUP","HCPCS C1726","","G16780  -  NEEDLE ESCP 4.5MM 18GA 10CM INCISING RNL FSCA","BOTH IP/OP","$49.10 ","$36.33 ","$0.00 ","$49.10 ","$26.66 ","$0.00 ","$10.23 ","$0.00 ","$0.00 ","$8.60 ","$49.10 ","$0.00 ","$24.55 ","$38.89 ","$39.28 ","$0.00 ","$7.68 ","$0.00 ","$7.82 ","$0.00 "
"G16783","SUP","HCPCS C1758","","G16783  -  CATHETER URDY 7FR 30CM 2 LUM","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G16784","SUP","HCPCS C1758","","G16784  -  CATHETER URET 4FR 110CM RND TIP RT","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G16791","SUP","HCPCS C2627","","G16791  -  CATHETER URET 3FR 70CM RND TIP STY PORT LT","BOTH IP/OP","$50.60 ","$37.44 ","$0.00 ","$50.60 ","$27.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.86 ","$50.60 ","$0.00 ","$25.30 ","$40.08 ","$40.48 ","$0.00 ","$7.92 ","$0.00 ","$8.06 ","$0.00 "
"G16792","SUP","HCPCS C1758","","G16792  -  CATHETER SPBC 8FR 54CM CYSTOSTOMY SFT LOPRFL","BOTH IP/OP","$35.43 ","$26.22 ","$0.00 ","$35.43 ","$19.24 ","$0.00 ","$7.38 ","$0.00 ","$0.00 ","$6.20 ","$35.43 ","$0.00 ","$17.71 ","$28.06 ","$28.34 ","$0.00 ","$5.54 ","$0.00 ","$5.64 ","$0.00 "
"G16816","SUP","HCPCS C1729","","G16816  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD","BOTH IP/OP","$216.33 ","$160.08 ","$0.00 ","$216.33 ","$117.46 ","$0.00 ","$45.09 ","$0.00 ","$0.00 ","$37.88 ","$216.33 ","$0.00 ","$108.16 ","$171.33 ","$173.06 ","$0.00 ","$33.85 ","$0.00 ","$34.44 ","$0.00 "
"G16817","SUP","HCPCS C2625","","G16817  -  SET NPHSTM 12FR 40CM COPE LOOP MOD NDL GW CNN DIL","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$139.40 ","$62.73 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$24.41 ","$139.40 ","$0.00 ","$69.70 ","$110.40 ","$111.52 ","$0.00 ","$21.82 ","$0.00 ","$22.19 ","$0.00 "
"G16818","SUP","HCPCS C2625","","G16818  -  SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ","BOTH IP/OP","$139.40 ","$103.16 ","$0.00 ","$139.40 ","$62.73 ","$0.00 ","$29.05 ","$0.00 ","$0.00 ","$24.41 ","$139.40 ","$0.00 ","$69.70 ","$110.40 ","$111.52 ","$0.00 ","$21.82 ","$0.00 ","$22.19 ","$0.00 "
"G16820","SUP","HCPCS C2617","","G16820  -  SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G16821","SUP","HCPCS C2617","","G16821  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 16CM STRL CP MDRL CATH","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G16876","SUP","HCPCS C1769","","G16876  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 20CM STRL CP MDRL CATH","BOTH IP/OP","$39.33 ","$29.10 ","$0.00 ","$39.33 ","$21.35 ","$0.00 ","$8.20 ","$0.00 ","$0.00 ","$6.89 ","$39.33 ","$0.00 ","$19.66 ","$31.15 ","$31.46 ","$0.00 ","$6.15 ","$0.00 ","$6.26 ","$0.00 "
"G16880","SUP","HCPCS C2617","","G16880  -  GUIDEWIRE ESCP 70CM STD STRG .038IN 145CM STRL 3CM FXCR FLX","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G16881","SUP","HCPCS C2617","","G16881  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 22CM STRL CP MDRL CATH","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G16890","SUP","HCPCS C1758","","G16890  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 24CM STRL CP MDRL CATH","BOTH IP/OP","$182.45 ","$135.01 ","$0.00 ","$182.45 ","$99.07 ","$0.00 ","$38.03 ","$0.00 ","$0.00 ","$31.95 ","$182.45 ","$0.00 ","$91.23 ","$144.50 ","$145.96 ","$0.00 ","$28.55 ","$0.00 ","$29.05 ","$0.00 "
"G16893","SUP","HCPCS C1726","","G16893  -  SET CATH 7.5FR 25CM DEWAN URDY NDL SF WRE PLWY SHTH DIL SPBC","BOTH IP/OP","$510.95 ","$378.10 ","$0.00 ","$510.95 ","$277.45 ","$0.00 ","$106.49 ","$0.00 ","$0.00 ","$89.46 ","$510.95 ","$0.00 ","$255.48 ","$404.67 ","$408.76 ","$0.00 ","$79.96 ","$0.00 ","$81.34 ","$0.00 "
"G16919","SUP","HCPCS C2627","","G16919  -  SYSTEM IRR URTSCP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16920","SUP","HCPCS C2627","","G16920  -  CATHETER SPBC 8FR 20CM STRL MLCT SIL DISP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16921","SUP","HCPCS C2627","","G16921  -  CATHETER SPBC 10FR 20CM MLCT WNG SFT SIL","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16922","SUP","HCPCS C2627","","G16922  -  CATHETER SPBC 12FR 20CM STRL MLCT SIL DISP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16923","SUP","HCPCS C2627","","G16923  -  CATHETER SPBC 14FR 25CM STRL MLCT WNG SIL DISP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16924","SUP","HCPCS C2627","","G16924  -  CATHETER SPBC 16FR 25CM STRL MLCT WNG SIL DISP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16925","SUP","HCPCS C2627","","G16925  -  CATHETER SPBC 18FR 25CM MLCT WNG SFT SIL","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16926","SUP","HCPCS C2627","","G16926  -  CATHETER SPBC 20FR 25CM STRL MLCT WNG SIL DISP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16927","SUP","HCPCS C2627","","G16927  -  CATHETER SPBC 22FR 25CM STRL MLCT WNG SIL DISP","BOTH IP/OP","$205.38 ","$151.98 ","$0.00 ","$205.38 ","$111.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.96 ","$205.38 ","$0.00 ","$102.69 ","$162.66 ","$164.30 ","$0.00 ","$32.14 ","$0.00 ","$32.70 ","$0.00 "
"G16938","SUP","HCPCS C2625","","G16938  -  CATHETER SPBC 24FR 25CM STRL MLCT WNG SFT SIL","BOTH IP/OP","$160.30 ","$118.62 ","$0.00 ","$160.30 ","$72.14 ","$0.00 ","$33.41 ","$0.00 ","$0.00 ","$28.07 ","$160.30 ","$0.00 ","$80.15 ","$126.96 ","$128.24 ","$0.00 ","$25.09 ","$0.00 ","$25.52 ","$0.00 "
"G16939","SUP","Custom 27203010","","G16939  -  SET STNT .038IN 5MM PGTL CRV TPR 7FR 75CM STRL 100CM BNDR","BOTH IP/OP","$266.20 ","$196.99 ","$0.00 ","$266.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$266.20 ","$0.00 ","$133.10 ","$210.83 ","$212.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16940","SUP","Custom 27203010","","G16940  -  SET NPHSTM 16.8CM NDL GW PERC","BOTH IP/OP","$306.13 ","$226.54 ","$0.00 ","$306.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.13 ","$0.00 ","$153.06 ","$242.45 ","$244.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G16987","SUP","HCPCS C1726","","G16987  -  SET NPHSTM NDL SHTH PERC","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"G16989","SUP","HCPCS C1758","","G16989  -  CATHETER URDY 7.4FR 30CM 3 LUM CDE OVL PORT BLN","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G16992","SUP","HCPCS C2625","","G16992  -  CATHETER URET .038IN 5FR 70CM OP-EN GW","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G16993","SUP","HCPCS C2625","","G16993  -  SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100CM BNDR CATH","BOTH IP/OP","$379.25 ","$280.65 ","$0.00 ","$379.25 ","$170.66 ","$0.00 ","$79.05 ","$0.00 ","$0.00 ","$66.40 ","$379.25 ","$0.00 ","$189.63 ","$300.37 ","$303.40 ","$0.00 ","$59.35 ","$0.00 ","$60.38 ","$0.00 "
"G16994","SUP","HCPCS C2625","","G16994  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH","BOTH IP/OP","$379.25 ","$280.65 ","$0.00 ","$379.25 ","$170.66 ","$0.00 ","$79.05 ","$0.00 ","$0.00 ","$66.40 ","$379.25 ","$0.00 ","$189.63 ","$300.37 ","$303.40 ","$0.00 ","$59.35 ","$0.00 ","$60.38 ","$0.00 "
"G16995","SUP","HCPCS C2625","","G16995  -  SET STENT .038IN 5MM PIGTAIL CURVE 8.2FR 75CM 100CM CATHETER","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G16996","SUP","HCPCS C2625","","G16996  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G16997","SUP","HCPCS C2625","","G16997  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G17013","SUP","HCPCS C1758","","G17013  -  CATHETER URET .05IN 10FR 50CM STRL LF 2 INJ LUM TPR TIP","BOTH IP/OP","$79.20 ","$58.61 ","$0.00 ","$79.20 ","$43.01 ","$0.00 ","$16.51 ","$0.00 ","$0.00 ","$13.87 ","$79.20 ","$0.00 ","$39.60 ","$62.73 ","$63.36 ","$0.00 ","$12.39 ","$0.00 ","$12.61 ","$0.00 "
"G17018","SUP","Custom 27203010","","G17018  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM STRL 100CM BNDR CATH","BOTH IP/OP","$89.10 ","$65.93 ","$0.00 ","$89.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.10 ","$0.00 ","$44.55 ","$70.57 ","$71.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17043","SUP","HCPCS C1726","","G17043  -  TUBE CNCT 5FR 10CM M TO F LL MOD","BOTH IP/OP","$73.60 ","$54.46 ","$0.00 ","$73.60 ","$39.96 ","$0.00 ","$15.34 ","$0.00 ","$0.00 ","$12.89 ","$73.60 ","$0.00 ","$36.80 ","$58.29 ","$58.88 ","$0.00 ","$11.52 ","$0.00 ","$11.72 ","$0.00 "
"G17051","SUP","HCPCS C1758","","G17051  -  CATHETER URDY 7FR 38CM CLR JSPH 2 LUM NRDOP","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$15.53 ","$0.00 ","$5.96 ","$0.00 ","$0.00 ","$5.01 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$4.48 ","$0.00 ","$4.55 ","$0.00 "
"G17083","SUP","HCPCS C1758","","G17083  -  ADAPTER CATH STD TLR LL SYR","BOTH IP/OP","$56.10 ","$41.51 ","$0.00 ","$56.10 ","$30.46 ","$0.00 ","$11.69 ","$0.00 ","$0.00 ","$9.82 ","$56.10 ","$0.00 ","$28.05 ","$44.43 ","$44.88 ","$0.00 ","$8.78 ","$0.00 ","$8.93 ","$0.00 "
"G17104","SUP","Custom 27203010","","G17104  -  CATHETER URET .028IN 4FR 70CM FLXTP OP-EN GW MOD","BOTH IP/OP","$306.13 ","$226.54 ","$0.00 ","$306.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$306.13 ","$0.00 ","$153.06 ","$242.45 ","$244.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17111","SUP","Custom 27203010","","G17111  -  CATH URTH 6FR 25CM 2W FOLEY CLOSE END RND SIL 1.5ML","BOTH IP/OP","$48.76 ","$36.08 ","$0.00 ","$48.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.76 ","$0.00 ","$24.38 ","$38.62 ","$39.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17128","SUP","HCPCS C1769","","G17128  -  SET NPHSTM 6-12FR NDL GW DIL PERC","BOTH IP/OP","$248.30 ","$183.74 ","$0.00 ","$248.30 ","$134.83 ","$0.00 ","$51.75 ","$0.00 ","$0.00 ","$43.48 ","$248.30 ","$0.00 ","$124.15 ","$196.65 ","$198.64 ","$0.00 ","$38.86 ","$0.00 ","$39.53 ","$0.00 "
"G17130","SUP","HCPCS C2617","","G17130  -  SET STNT .038IN 2 PGTL CRV 6FR 10CM STRL CATH RADOPQ PSTNR","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17131","SUP","HCPCS C2617","","G17131  -  SET STNT 2 PGTL CRV 7-14FR 30CM 13CM RELS SLV PSTNR ULTHNE","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17132","SUP","HCPCS C2617","","G17132  -  SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 28CM RADOPQ","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17133","SUP","HCPCS C2617","","G17133  -  SET STNT BCNTP 7-14FR 26CM STRL 13CM RELS SLV PSTNR ULTHNE","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17135","SUP","HCPCS C2617","","G17135  -  SET STNT 2 PGTL CRV 7-14FR 24CM 13CM RELS SLV PSTNR ULTHNE","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17136","SUP","HCPCS C2617","","G17136  -  SET STNT 2 PGTL CRV 7-14FR 22CM 13CM RELS SLV PSTNR ULTHNE","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17138","SUP","HCPCS C2617","","G17138  -  SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 20CM RADOPQ","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17139","SUP","HCPCS C2617","","G17139  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 30CM RADOPQ","BOTH IP/OP","$271.63 ","$201.01 ","$0.00 ","$271.63 ","$122.23 ","$0.00 ","$56.61 ","$0.00 ","$0.00 ","$47.56 ","$271.63 ","$0.00 ","$135.81 ","$215.13 ","$217.30 ","$0.00 ","$42.51 ","$0.00 ","$43.24 ","$0.00 "
"G17140","SUP","HCPCS C2617","","G17140  -  STENT URET THNWL PGTL CRV 7-14FR 26CM STRL LF RTRMX+ PSTNR","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17141","SUP","HCPCS C2617","","G17141  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 28CM RADOPQ","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17142","SUP","HCPCS C2617","","G17142  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 24CM RADOPQ","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17143","SUP","HCPCS C2617","","G17143  -  SET STNT 2 PGTL CRV 6-9.5FR 22CM 13CM RELS SLV PSTNR ULTHNE","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17144","SUP","HCPCS C2617","","G17144  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 20CM RADOPQ","BOTH IP/OP","$312.38 ","$231.16 ","$0.00 ","$312.38 ","$140.57 ","$0.00 ","$65.11 ","$0.00 ","$0.00 ","$54.69 ","$312.38 ","$0.00 ","$156.19 ","$247.40 ","$249.90 ","$0.00 ","$48.89 ","$0.00 ","$49.73 ","$0.00 "
"G17145","SUP","HCPCS C1758","","G17145  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 18CM RADOPQ","BOTH IP/OP","$85.80 ","$63.49 ","$0.00 ","$85.80 ","$46.59 ","$0.00 ","$17.88 ","$0.00 ","$0.00 ","$15.02 ","$85.80 ","$0.00 ","$42.90 ","$67.95 ","$68.64 ","$0.00 ","$13.43 ","$0.00 ","$13.66 ","$0.00 "
"G17150","SUP","HCPCS C2625","","G17150  -  CATHETER URET .04IN 6/10FR 50CM LF FLXTP 2 LUM GW AQ","BOTH IP/OP","$292.13 ","$216.18 ","$0.00 ","$292.13 ","$131.46 ","$0.00 ","$60.89 ","$0.00 ","$0.00 ","$51.15 ","$292.13 ","$0.00 ","$146.06 ","$231.37 ","$233.70 ","$0.00 ","$45.72 ","$0.00 ","$46.51 ","$0.00 "
"G17151","SUP","HCPCS C2625","","G17151  -  SET STNT .038IN 3CM STRG 4.7FR 22-32CM STRL 145CM KWART","BOTH IP/OP","$292.13 ","$216.18 ","$0.00 ","$292.13 ","$131.46 ","$0.00 ","$60.89 ","$0.00 ","$0.00 ","$51.15 ","$292.13 ","$0.00 ","$146.06 ","$231.37 ","$233.70 ","$0.00 ","$45.72 ","$0.00 ","$46.51 ","$0.00 "
"G17152","SUP","HCPCS C2625","","G17152  -  SET STNT .038IN 3CM STRG 6FR 22-32CM STRL 145CM KWART","BOTH IP/OP","$292.13 ","$216.18 ","$0.00 ","$292.13 ","$131.46 ","$0.00 ","$60.89 ","$0.00 ","$0.00 ","$51.15 ","$292.13 ","$0.00 ","$146.06 ","$231.37 ","$233.70 ","$0.00 ","$45.72 ","$0.00 ","$46.51 ","$0.00 "
"G17153","SUP","HCPCS C2625","","G17153  -  SET STNT 7FR 22-32CM KWART RETRO-INJ SFLX MTLNTH RELS SLV GW","BOTH IP/OP","$292.13 ","$216.18 ","$0.00 ","$292.13 ","$131.46 ","$0.00 ","$60.89 ","$0.00 ","$0.00 ","$51.15 ","$292.13 ","$0.00 ","$146.06 ","$231.37 ","$233.70 ","$0.00 ","$45.72 ","$0.00 ","$46.51 ","$0.00 "
"G17155","SUP","HCPCS C2627","","G17155  -  SET STNT .038IN 3CM STRG 8.2FR 22-32CM STRL 145CM KWART","BOTH IP/OP","$444.40 ","$328.86 ","$0.00 ","$444.40 ","$241.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.81 ","$444.40 ","$0.00 ","$222.20 ","$351.96 ","$355.52 ","$0.00 ","$69.55 ","$0.00 ","$70.75 ","$0.00 "
"G17156","SUP","HCPCS C1769","","G17156  -  SET NPHSTM 8.5FR 25CM STRL 2 GW CNN DIL MCLC CATH ULTHNE","BOTH IP/OP","$444.40 ","$328.86 ","$0.00 ","$444.40 ","$241.31 ","$0.00 ","$92.62 ","$0.00 ","$0.00 ","$77.81 ","$444.40 ","$0.00 ","$222.20 ","$351.96 ","$355.52 ","$0.00 ","$69.55 ","$0.00 ","$70.75 ","$0.00 "
"G17157","SUP","HCPCS C2627","","G17157  -  SET NPHSTM 10.2FR 25CM STRL MCLC 2 GW CNN DIL CNCT TUBE","BOTH IP/OP","$511.05 ","$378.18 ","$0.00 ","$511.05 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.48 ","$511.05 ","$0.00 ","$255.53 ","$404.75 ","$408.84 ","$0.00 ","$79.98 ","$0.00 ","$81.36 ","$0.00 "
"G17158","SUP","HCPCS C2627","","G17158  -  SET NPHSTM 12FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP","BOTH IP/OP","$511.05 ","$378.18 ","$0.00 ","$511.05 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$89.48 ","$511.05 ","$0.00 ","$255.53 ","$404.75 ","$408.84 ","$0.00 ","$79.98 ","$0.00 ","$81.36 ","$0.00 "
"G17160","SUP","HCPCS C1758","","G17160  -  SET NPHSTM 14FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G17185","SUP","HCPCS C2625","","G17185  -  DRAIN INCS .25IN 12IN STRL LF PNRS SIL DISP OPN WND","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G17186","SUP","HCPCS C2625","","G17186  -  SET STNT 8.2FR 75CM BNDR SFLX OP-EN DVRSN URETER","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G17214","SUP","HCPCS C1769","","G17214  -  CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W FL CLS END RND TIP","BOTH IP/OP","$8.59 ","$6.36 ","$0.00 ","$8.59 ","$4.67 ","$0.00 ","$1.79 ","$0.00 ","$0.00 ","$1.50 ","$8.59 ","$0.00 ","$4.30 ","$6.80 ","$6.88 ","$0.00 ","$1.34 ","$0.00 ","$1.37 ","$0.00 "
"G17230","SUP","HCPCS C1726","","G17230  -  SET CATH .021IN 6FR 25CM 1ML UNIVERSA 2W FL OP-EN GW SIL PED","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$24.44 ","$0.00 ","$9.38 ","$0.00 ","$0.00 ","$7.88 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$7.04 ","$0.00 ","$7.16 ","$0.00 "
"G17237","SUP","HCPCS C1758","","G17237  -  CATHETER URDY 7FR 38CM 2 LUM CDE","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G17239","SUP","HCPCS C1729","","G17239  -  CATHETER URET 5FR 110CM RND TIP RT","BOTH IP/OP","$311.20 ","$230.29 ","$0.00 ","$311.20 ","$168.98 ","$0.00 ","$64.86 ","$0.00 ","$0.00 ","$54.49 ","$311.20 ","$0.00 ","$155.60 ","$246.47 ","$248.96 ","$0.00 ","$48.70 ","$0.00 ","$49.54 ","$0.00 "
"G17252","SUP","HCPCS C1726","","G17252  -  CATHETER XTRN 1.3IN NS NADH CNDM SIL M REUSE","BOTH IP/OP","$51.15 ","$37.85 ","$0.00 ","$51.15 ","$27.77 ","$0.00 ","$10.66 ","$0.00 ","$0.00 ","$8.96 ","$51.15 ","$0.00 ","$25.58 ","$40.51 ","$40.92 ","$0.00 ","$8.00 ","$0.00 ","$8.14 ","$0.00 "
"G17262","SUP","HCPCS C1758","","G17262  -  TUBING URDY INF ST VNT","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G17306","SUP","HCPCS C2617","","G17306  -  ADAPTER CATH TLR LL SYR PED","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G17310","SUP","HCPCS C1769","","G17310  -  SET STNT .025IN 3.7FR 8-30CM STRL CATH RADOPQ MTLNTH PSTNR","BOTH IP/OP","$396.00 ","$293.04 ","$0.00 ","$396.00 ","$215.03 ","$0.00 ","$82.54 ","$0.00 ","$0.00 ","$69.34 ","$396.00 ","$0.00 ","$198.00 ","$313.63 ","$316.80 ","$0.00 ","$61.97 ","$0.00 ","$63.04 ","$0.00 "
"G17318","SUP","HCPCS C1726","","G17318  -  SET DIL 6-18FR 60CM AQ PE URET","BOTH IP/OP","$48.08 ","$35.58 ","$0.00 ","$48.08 ","$26.10 ","$0.00 ","$10.02 ","$0.00 ","$0.00 ","$8.42 ","$48.08 ","$0.00 ","$24.04 ","$38.08 ","$38.46 ","$0.00 ","$7.52 ","$0.00 ","$7.65 ","$0.00 "
"G17320","SUP","HCPCS C1726","","G17320  -  CATHETER SUPRAPUBIC 14FR 22CM 30CM SET NEEDLE OBTURATOR","BOTH IP/OP","$144.10 ","$106.63 ","$0.00 ","$144.10 ","$78.25 ","$0.00 ","$30.03 ","$0.00 ","$0.00 ","$25.23 ","$144.10 ","$0.00 ","$72.05 ","$114.13 ","$115.28 ","$0.00 ","$22.55 ","$0.00 ","$22.94 ","$0.00 "
"G17322","SUP","HCPCS C1726","","G17322  -  CATHETER URDY 5FR 30CM 2 LUM","BOTH IP/OP","$657.80 ","$486.77 ","$0.00 ","$657.80 ","$357.19 ","$0.00 ","$137.10 ","$0.00 ","$0.00 ","$115.18 ","$657.80 ","$0.00 ","$328.90 ","$520.98 ","$526.24 ","$0.00 ","$102.95 ","$0.00 ","$104.72 ","$0.00 "
"G17323","SUP","HCPCS C1758","","G17323  -  SET DIL 6-30FR 30CM 16CM AMPTZ RADOPQ SHTH HDRPH RNL","BOTH IP/OP","$97.18 ","$71.91 ","$0.00 ","$97.18 ","$52.77 ","$0.00 ","$20.25 ","$0.00 ","$0.00 ","$17.01 ","$97.18 ","$0.00 ","$48.59 ","$76.97 ","$77.74 ","$0.00 ","$15.21 ","$0.00 ","$15.47 ","$0.00 "
"G17330","SUP","HCPCS C1758","","G17330  -  CATHETER URET .05IN 6/10FR .04IN 50CM STRL LF FLXTP 2 LUM AQ","BOTH IP/OP","$103.33 ","$76.46 ","$0.00 ","$103.33 ","$56.11 ","$0.00 ","$21.54 ","$0.00 ","$0.00 ","$18.09 ","$103.33 ","$0.00 ","$51.66 ","$81.84 ","$82.66 ","$0.00 ","$16.17 ","$0.00 ","$16.45 ","$0.00 "
"G17354","SUP","HCPCS C2627","","G17354  -  CATHETER URTH 16FR 34CM 5ML UNIVERSA 2W FL OP-EN SIL","BOTH IP/OP","$4.85 ","$3.59 ","$0.00 ","$4.85 ","$2.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.85 ","$4.85 ","$0.00 ","$2.43 ","$3.84 ","$3.88 ","$0.00 ","$0.76 ","$0.00 ","$0.77 ","$0.00 "
"G17355","SUP","HCPCS C2627","","G17355  -  DILATOR URET 8FR 60CM PE HDRPH","BOTH IP/OP","$58.20 ","$43.07 ","$0.00 ","$58.20 ","$31.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$58.20 ","$0.00 ","$29.10 ","$46.09 ","$46.56 ","$0.00 ","$9.11 ","$0.00 ","$9.27 ","$0.00 "
"G17477","SUP","HCPCS C2627","","G17477  -  STOPCOCK CSCP SAN ANTONIO MOD FIT","BOTH IP/OP","$58.20 ","$43.07 ","$0.00 ","$58.20 ","$31.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$58.20 ","$0.00 ","$29.10 ","$46.09 ","$46.56 ","$0.00 ","$9.11 ","$0.00 ","$9.27 ","$0.00 "
"G17515","SUP","HCPCS C2627","","G17515  -  CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W OP-EN BLN FL SIL DOD","BOTH IP/OP","$15.92 ","$11.78 ","$0.00 ","$15.92 ","$8.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.79 ","$15.92 ","$0.00 ","$7.96 ","$12.61 ","$12.74 ","$0.00 ","$2.49 ","$0.00 ","$2.53 ","$0.00 "
"G17520","SUP","Custom 27203010","","G17520  -  CATHETER SPBC 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR PUL","BOTH IP/OP","$302.83 ","$224.09 ","$0.00 ","$302.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.83 ","$0.00 ","$151.41 ","$239.84 ","$242.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17521","SUP","HCPCS C1758","","G17521  -  EXTRACTOR STON 4.5FR 2CM 65CM STRL NCRCL TPLS UNDX HNDL WRE","BOTH IP/OP","$100.25 ","$74.19 ","$0.00 ","$100.25 ","$54.44 ","$0.00 ","$20.89 ","$0.00 ","$0.00 ","$17.55 ","$100.25 ","$0.00 ","$50.13 ","$79.40 ","$80.20 ","$0.00 ","$15.69 ","$0.00 ","$15.96 ","$0.00 "
"G17539","SUP","HCPCS C1769","","G17539  -  CATHETER URET .038IN PGTL CRV 6FR 70CM SDPRT GW","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G17540","SUP","HCPCS C1769","","G17540  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 3CM RDRR PC STD BD","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G17541","SUP","HCPCS C1769","","G17541  -  GUIDEWIRE VASC ANG STD .035IN 145CM 3CM RDRR PC TRQ CNTRL","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G17542","SUP","HCPCS C1769","","G17542  -  GUIDEWIRE VASC ANG .038IN 145CM STRL 3CM RDRR PC STD BD NTNL","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G17558","SUP","Custom 27203010","","G17558  -  CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP","BOTH IP/OP","$243.48 ","$180.18 ","$0.00 ","$246.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$246.02 ","$0.00 ","$123.01 ","$194.85 ","$196.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17560","SUP","HCPCS C1758","","G17560  -  POSITIONER STNT 6FR 50CM RADOPQ URET","BOTH IP/OP","$111.00 ","$82.14 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$23.14 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"G17571","SUP","HCPCS C2625","","G17571  -  CATHETER URET .03IN 4FR 70CM SFLX OP-EN GW","BOTH IP/OP","$141.45 ","$104.67 ","$0.00 ","$141.45 ","$63.65 ","$0.00 ","$29.48 ","$0.00 ","$0.00 ","$24.77 ","$141.45 ","$0.00 ","$70.73 ","$112.03 ","$113.16 ","$0.00 ","$22.14 ","$0.00 ","$22.52 ","$0.00 "
"G17578","SUP","HCPCS C2627","","G17578  -  CATHETER URET .05IN 5/10FR .04IN 50CM FLXTP 2 LUM AQ","BOTH IP/OP","$58.20 ","$43.07 ","$0.00 ","$58.20 ","$31.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.19 ","$58.20 ","$0.00 ","$29.10 ","$46.09 ","$46.56 ","$0.00 ","$9.11 ","$0.00 ","$9.27 ","$0.00 "
"G17601","SUP","HCPCS C1892","","G17601  -  DILATOR URET 14FR 60CM PE HDRPH","BOTH IP/OP","$164.45 ","$121.69 ","$0.00 ","$164.45 ","$89.30 ","$0.00 ","$34.28 ","$0.00 ","$0.00 ","$28.79 ","$164.45 ","$0.00 ","$82.23 ","$130.24 ","$131.56 ","$0.00 ","$25.74 ","$0.00 ","$26.18 ","$0.00 "
"G17618","SUP","Custom 27203010","","G17618  -  INTRODUCER NPHSTM 14FR 65CM 60CM PLWY PERC","BOTH IP/OP","$390.50 ","$288.97 ","$0.00 ","$390.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$390.50 ","$0.00 ","$195.25 ","$309.28 ","$312.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17627","SUP","Custom 27203010","","G17627  -  NEEDLE BRCHTX 18GA 20CM ECHTP SET","BOTH IP/OP","$462.20 ","$342.03 ","$0.00 ","$462.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.20 ","$0.00 ","$231.10 ","$366.06 ","$369.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17639","SUP","HCPCS C2625","","G17639  -  DILATOR URET LNG TPR 6-12FR 60CM STRL LFRIC SRFC AQ","BOTH IP/OP","$141.45 ","$104.67 ","$0.00 ","$141.45 ","$63.65 ","$0.00 ","$29.48 ","$0.00 ","$0.00 ","$24.77 ","$141.45 ","$0.00 ","$70.73 ","$112.03 ","$113.16 ","$0.00 ","$22.14 ","$0.00 ","$22.52 ","$0.00 "
"G17648","SUP","HCPCS C2617","","G17648  -  POSITIONER STNT 4FR 25CM","BOTH IP/OP","$76.63 ","$56.71 ","$0.00 ","$76.63 ","$34.48 ","$0.00 ","$15.97 ","$0.00 ","$0.00 ","$13.42 ","$76.63 ","$0.00 ","$38.31 ","$60.69 ","$61.30 ","$0.00 ","$11.99 ","$0.00 ","$12.20 ","$0.00 "
"G17666","SUP","HCPCS C2617","","G17666  -  STENT URTH 8FR 24FR 30CM STRL FRLT KLG SDPRT SUT BLB DISP","BOTH IP/OP","$117.88 ","$87.23 ","$0.00 ","$117.88 ","$53.04 ","$0.00 ","$24.57 ","$0.00 ","$0.00 ","$20.64 ","$117.88 ","$0.00 ","$58.94 ","$93.36 ","$94.30 ","$0.00 ","$18.45 ","$0.00 ","$18.77 ","$0.00 "
"G17667","SUP","HCPCS C2617","","G17667  -  SET STNT 6FR 50CM STRL KL DPR URETHRA DISP","BOTH IP/OP","$92.25 ","$68.27 ","$0.00 ","$92.25 ","$41.51 ","$0.00 ","$19.23 ","$0.00 ","$0.00 ","$16.15 ","$92.25 ","$0.00 ","$46.13 ","$73.06 ","$73.80 ","$0.00 ","$14.44 ","$0.00 ","$14.69 ","$0.00 "
"G17668","SUP","HCPCS C2617","","G17668  -  STENT URTH 6FR 50CM KL DPR","BOTH IP/OP","$102.50 ","$75.85 ","$0.00 ","$102.50 ","$46.13 ","$0.00 ","$21.36 ","$0.00 ","$0.00 ","$17.95 ","$102.50 ","$0.00 ","$51.25 ","$81.18 ","$82.00 ","$0.00 ","$16.04 ","$0.00 ","$16.32 ","$0.00 "
"G17669","SUP","HCPCS C2617","","G17669  -  SET STNT 8FR 50CM STRL KL DPR URETHRA DISP","BOTH IP/OP","$92.25 ","$68.27 ","$0.00 ","$92.25 ","$41.51 ","$0.00 ","$19.23 ","$0.00 ","$0.00 ","$16.15 ","$92.25 ","$0.00 ","$46.13 ","$73.06 ","$73.80 ","$0.00 ","$14.44 ","$0.00 ","$14.69 ","$0.00 "
"G17671","SUP","HCPCS C2617","","G17671  -  STENT URTH 8FR 50CM STRL KL DPR DISP","BOTH IP/OP","$300.60 ","$222.44 ","$0.00 ","$300.60 ","$135.27 ","$0.00 ","$62.65 ","$0.00 ","$0.00 ","$52.63 ","$300.60 ","$0.00 ","$150.30 ","$238.08 ","$240.48 ","$0.00 ","$47.04 ","$0.00 ","$47.86 ","$0.00 "
"G17676","SUP","HCPCS C2617","","G17676  -  SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 6CM STRL RADOPQ","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G17793","SUP","HCPCS C2617","","G17793  -  POSITIONER STNT 5FR 50CM","BOTH IP/OP","$288.80 ","$213.71 ","$0.00 ","$288.80 ","$129.96 ","$0.00 ","$60.19 ","$0.00 ","$0.00 ","$50.57 ","$288.80 ","$0.00 ","$144.40 ","$228.73 ","$231.04 ","$0.00 ","$45.20 ","$0.00 ","$45.98 ","$0.00 "
"G17794","SUP","HCPCS C2627","","G17794  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 4CM STRL CP MDRL CATH","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G17795","SUP","HCPCS C1726","","G17795  -  DILATOR URTH 6-12FR 30CM LNG TPR FSCA","BOTH IP/OP","$72.60 ","$53.72 ","$0.00 ","$72.60 ","$39.42 ","$0.00 ","$15.13 ","$0.00 ","$0.00 ","$12.71 ","$72.60 ","$0.00 ","$36.30 ","$57.50 ","$58.08 ","$0.00 ","$11.36 ","$0.00 ","$11.56 ","$0.00 "
"G17797","SUP","HCPCS C1758","","G17797  -  DILATOR URTH LNG TPR 18FR 30CM AQ","BOTH IP/OP","$42.90 ","$31.75 ","$0.00 ","$42.90 ","$23.29 ","$0.00 ","$8.94 ","$0.00 ","$0.00 ","$7.51 ","$42.90 ","$0.00 ","$21.45 ","$33.98 ","$34.32 ","$0.00 ","$6.71 ","$0.00 ","$6.83 ","$0.00 "
"G17819","SUP","HCPCS C1758","","G17819  -  DEVICE TRQ STRL OLCOTT DISP ACPT .014-.045IN GW RDRR","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G17842","SUP","HCPCS C1726","","G17842  -  CATHETER URET .040IN 7FR 70CM SFLX OP-EN GW","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$143.35 ","$0.00 ","$55.02 ","$0.00 ","$0.00 ","$46.22 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$41.32 ","$0.00 ","$42.03 ","$0.00 "
"G17843","SUP","HCPCS C1726","","G17843  -  CATHETER URTH 9FR 8.7MM 29CM 18CM CDE BLN","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$143.35 ","$0.00 ","$55.02 ","$0.00 ","$0.00 ","$46.22 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$41.32 ","$0.00 ","$42.03 ","$0.00 "
"G17844","SUP","HCPCS C1726","","G17844  -  CATHETER URTH FLFRM 9FR 8.7MM 29CM 18CM BLN","BOTH IP/OP","$264.00 ","$195.36 ","$0.00 ","$264.00 ","$143.35 ","$0.00 ","$55.02 ","$0.00 ","$0.00 ","$46.22 ","$264.00 ","$0.00 ","$132.00 ","$209.09 ","$211.20 ","$0.00 ","$41.32 ","$0.00 ","$42.03 ","$0.00 "
"G17852","SUP","HCPCS C2617","","G17852  -  CATHETER URTH 7FR 8.7MM 29CM 18CM OPN TIP BLN","BOTH IP/OP","$251.13 ","$185.84 ","$0.00 ","$251.13 ","$113.01 ","$0.00 ","$52.34 ","$0.00 ","$0.00 ","$43.97 ","$251.13 ","$0.00 ","$125.56 ","$198.89 ","$200.90 ","$0.00 ","$39.30 ","$0.00 ","$39.98 ","$0.00 "
"G17866","SUP","HCPCS C1769","","G17866  -  SET STNT .035IN 4.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR","BOTH IP/OP","$107.85 ","$79.81 ","$0.00 ","$107.85 ","$58.56 ","$0.00 ","$22.48 ","$0.00 ","$0.00 ","$18.88 ","$107.85 ","$0.00 ","$53.93 ","$85.42 ","$86.28 ","$0.00 ","$16.88 ","$0.00 ","$17.17 ","$0.00 "
"G17898","SUP","HCPCS C1769","","G17898  -  KIT PRC 11FR MNPRC ENTRY PED PERC","BOTH IP/OP","$108.75 ","$80.48 ","$0.00 ","$108.75 ","$59.05 ","$0.00 ","$22.67 ","$0.00 ","$0.00 ","$19.04 ","$108.75 ","$0.00 ","$54.38 ","$86.13 ","$87.00 ","$0.00 ","$17.02 ","$0.00 ","$17.31 ","$0.00 "
"G17913","SUP","HCPCS C1758","","G17913  -  FILIFORM URTH 18FR 12.5IN INTGR","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$27.50 ","$14.93 ","$0.00 ","$5.73 ","$0.00 ","$0.00 ","$4.82 ","$27.50 ","$0.00 ","$13.75 ","$21.78 ","$22.00 ","$0.00 ","$4.30 ","$0.00 ","$4.38 ","$0.00 "
"G17915","SUP","HCPCS C1758","","G17915  -  CATHETER URET .038IN 7FR 15CM FLXTP OP-EN GW MOD","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G17940","SUP","Custom 27203010","","G17940  -  SET DRN 200ML NS BG PED DISP","BOTH IP/OP","$478.13 ","$353.82 ","$0.00 ","$478.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$478.13 ","$0.00 ","$239.06 ","$378.68 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17941","SUP","Custom 27203010","","G17941  -  EXTRACTOR STON 3.2FR 115CM 5CM NFORCE DWR 3WR BSKT HLCL OCL","BOTH IP/OP","$478.13 ","$353.82 ","$0.00 ","$478.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$478.13 ","$0.00 ","$239.06 ","$378.68 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G17948","SUP","HCPCS C1726","","G17948  -  EXTRACTOR SRG 3.2FR 115CM 7CM NFORCE HLCL STON SET NTNL URO","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17949","SUP","HCPCS C1726","","G17949  -  DILATOR URTH 12FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17950","SUP","HCPCS C1726","","G17950  -  DILATOR URTH 14FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17951","SUP","HCPCS C1892","","G17951  -  DILATOR URET 16FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17952","SUP","HCPCS C1892","","G17952  -  DILATOR URTH 18FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17953","SUP","HCPCS C1726","","G17953  -  DILATOR URET 20FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17954","SUP","HCPCS C1726","","G17954  -  DILATOR URET 22FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17955","SUP","HCPCS C1726","","G17955  -  DILATOR SRG 24FR 30CM AMPTZ NPHSTM TRACT DILATION","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17956","SUP","HCPCS C1726","","G17956  -  DILATOR URET 26FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17957","SUP","HCPCS C1726","","G17957  -  DILATOR URET 28FR 30CM AMPTZ RNL","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$32.25 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$10.40 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"G17963","SUP","HCPCS C1894","","G17963  -  DILATOR URTH 30FR 30CM AMPTZ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17964","SUP","HCPCS C1892","","G17964  -  SHEATH DIL 22FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$61.60 ","$45.58 ","$0.00 ","$61.60 ","$33.45 ","$0.00 ","$12.84 ","$0.00 ","$0.00 ","$10.79 ","$61.60 ","$0.00 ","$30.80 ","$48.79 ","$49.28 ","$0.00 ","$9.64 ","$0.00 ","$9.81 ","$0.00 "
"G17965","SUP","HCPCS C1894","","G17965  -  SHEATH ACC 24FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$61.60 ","$45.58 ","$0.00 ","$61.60 ","$33.45 ","$0.00 ","$12.84 ","$0.00 ","$0.00 ","$10.79 ","$61.60 ","$0.00 ","$30.80 ","$48.79 ","$49.28 ","$0.00 ","$9.64 ","$0.00 ","$9.81 ","$0.00 "
"G17966","SUP","HCPCS C1894","","G17966  -  SHEATH DIL 26FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$61.60 ","$45.58 ","$0.00 ","$61.60 ","$33.45 ","$0.00 ","$12.84 ","$0.00 ","$0.00 ","$10.79 ","$61.60 ","$0.00 ","$30.80 ","$48.79 ","$49.28 ","$0.00 ","$9.64 ","$0.00 ","$9.81 ","$0.00 "
"G17967","SUP","HCPCS C1894","","G17967  -  SHEATH DIL 28FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$61.60 ","$45.58 ","$0.00 ","$61.60 ","$33.45 ","$0.00 ","$12.84 ","$0.00 ","$0.00 ","$10.79 ","$61.60 ","$0.00 ","$30.80 ","$48.79 ","$49.28 ","$0.00 ","$9.64 ","$0.00 ","$9.81 ","$0.00 "
"G17968","SUP","HCPCS C1894","","G17968  -  SHEATH DIL 30FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17969","SUP","HCPCS C1894","","G17969  -  SHEATH DIL 24FR 20CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17970","SUP","HCPCS C1894","","G17970  -  SHEATH DIL 26FR 20CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17971","SUP","HCPCS C1894","","G17971  -  SHEATH DIL 28FR 20CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17973","SUP","HCPCS C1894","","G17973  -  SHEATH DIL 30FR 20CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17975","SUP","HCPCS C1894","","G17975  -  SHEATH DIL 30FR 19CM AMPTZ OPQ RNL","BOTH IP/OP","$61.60 ","$45.58 ","$0.00 ","$61.60 ","$33.45 ","$0.00 ","$12.84 ","$0.00 ","$0.00 ","$10.79 ","$61.60 ","$0.00 ","$30.80 ","$48.79 ","$49.28 ","$0.00 ","$9.64 ","$0.00 ","$9.81 ","$0.00 "
"G17976","SUP","HCPCS C1894","","G17976  -  SHEATH DIL 28FR 30CM OPQ AMPTZ RNL","BOTH IP/OP","$61.60 ","$45.58 ","$0.00 ","$61.60 ","$33.45 ","$0.00 ","$12.84 ","$0.00 ","$0.00 ","$10.79 ","$61.60 ","$0.00 ","$30.80 ","$48.79 ","$49.28 ","$0.00 ","$9.64 ","$0.00 ","$9.81 ","$0.00 "
"G17980","SUP","HCPCS C1894","","G17980  -  SHEATH DIL 30FR 30CM AMPTZ OPQ","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17981","SUP","HCPCS C1894","","G17981  -  SHEATH DIL 30FR 24CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17982","SUP","HCPCS C1894","","G17982  -  SHEATH DIL 12FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17983","SUP","HCPCS C1894","","G17983  -  SHEATH DIL 14FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17984","SUP","HCPCS C1894","","G17984  -  SHEATH DIL 16FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17985","SUP","HCPCS C1894","","G17985  -  SHEATH DIL 18FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17986","SUP","HCPCS C1894","","G17986  -  SHEATH DIL 20FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17997","SUP","HCPCS C1894","","G17997  -  SHEATH DIL 30FR 25CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17998","SUP","HCPCS C1894","","G17998  -  SHEATH DIL 30FR 22CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G17999","SUP","HCPCS C1894","","G17999  -  SHEATH DIL 32FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$70.85 ","$52.43 ","$0.00 ","$70.85 ","$38.47 ","$0.00 ","$14.77 ","$0.00 ","$0.00 ","$12.41 ","$70.85 ","$0.00 ","$35.43 ","$56.11 ","$56.68 ","$0.00 ","$11.09 ","$0.00 ","$11.28 ","$0.00 "
"G18001","SUP","HCPCS C1892","","G18001  -  SHEATH DIL 34FR 16CM AMPTZ OPQ RNL","BOTH IP/OP","$80.85 ","$59.83 ","$0.00 ","$80.85 ","$43.90 ","$0.00 ","$16.85 ","$0.00 ","$0.00 ","$14.16 ","$80.85 ","$0.00 ","$40.43 ","$64.03 ","$64.68 ","$0.00 ","$12.65 ","$0.00 ","$12.87 ","$0.00 "
"G18002","SUP","HCPCS C1894","","G18002  -  INTRODUCER NPHSTM 24FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$80.85 ","$59.83 ","$0.00 ","$80.85 ","$43.90 ","$0.00 ","$16.85 ","$0.00 ","$0.00 ","$14.16 ","$80.85 ","$0.00 ","$40.43 ","$64.03 ","$64.68 ","$0.00 ","$12.65 ","$0.00 ","$12.87 ","$0.00 "
"G18003","SUP","HCPCS C1892","","G18003  -  INTRODUCER NPHSTM 26FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$80.85 ","$59.83 ","$0.00 ","$80.85 ","$43.90 ","$0.00 ","$16.85 ","$0.00 ","$0.00 ","$14.16 ","$80.85 ","$0.00 ","$40.43 ","$64.03 ","$64.68 ","$0.00 ","$12.65 ","$0.00 ","$12.87 ","$0.00 "
"G18004","SUP","HCPCS C1894","","G18004  -  INTRODUCER NPHSTM 28FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$80.85 ","$59.83 ","$0.00 ","$80.85 ","$43.90 ","$0.00 ","$16.85 ","$0.00 ","$0.00 ","$14.16 ","$80.85 ","$0.00 ","$40.43 ","$64.03 ","$64.68 ","$0.00 ","$12.65 ","$0.00 ","$12.87 ","$0.00 "
"G18005","SUP","HCPCS C1892","","G18005  -  INTRODUCER NPHSTM 30FR 16CM 30CM AMPTZ DIL SHTH RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18006","SUP","HCPCS C1892","","G18006  -  INTRODUCER NPHSTM 28FR 20CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18007","SUP","HCPCS C1892","","G18007  -  INTRODUCER NPHSTM 30FR 20CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18008","SUP","HCPCS C1892","","G18008  -  INTRODUCER NPHSTM 22FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18009","SUP","HCPCS C1892","","G18009  -  INTRODUCER NPHSTM 24FR 24CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18010","SUP","HCPCS C1892","","G18010  -  INTRODUCER NPHSTM 26FR 24CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18011","SUP","HCPCS C1892","","G18011  -  INTRODUCER NPHSTM 28FR 24CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18012","SUP","HCPCS C1892","","G18012  -  INTRODUCER NPHSTM 30FR 24CM 30CM AMPTZ DIL SHTH RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18013","SUP","HCPCS C1892","","G18013  -  INTRODUCER NPHSTM 16FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18014","SUP","HCPCS C1892","","G18014  -  INTRODUCER NPHSTM 18FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18015","SUP","HCPCS C1892","","G18015  -  INTRODUCER NPHSTM 20FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18016","SUP","HCPCS C1892","","G18016  -  INTRODUCER NPHSTM 28FR 30CM 40CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18017","SUP","HCPCS C1892","","G18017  -  INTRODUCER NPHSTM 30FR 25CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18018","SUP","HCPCS C1892","","G18018  -  INTRODUCER NPHSTM 30FR 28CM 32CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18019","SUP","HCPCS C1892","","G18019  -  INTRODUCER NPHSTM 30FR 30CM 40CM AMPTZ DIL RNL","BOTH IP/OP","$80.85 ","$59.83 ","$0.00 ","$80.85 ","$43.90 ","$0.00 ","$16.85 ","$0.00 ","$0.00 ","$14.16 ","$80.85 ","$0.00 ","$40.43 ","$64.03 ","$64.68 ","$0.00 ","$12.65 ","$0.00 ","$12.87 ","$0.00 "
"G18020","SUP","HCPCS C1892","","G18020  -  INTRODUCER NPHSTM 32FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$80.85 ","$59.83 ","$0.00 ","$80.85 ","$43.90 ","$0.00 ","$16.85 ","$0.00 ","$0.00 ","$14.16 ","$80.85 ","$0.00 ","$40.43 ","$64.03 ","$64.68 ","$0.00 ","$12.65 ","$0.00 ","$12.87 ","$0.00 "
"G18021","SUP","HCPCS C1892","","G18021  -  INTRODUCER NPHSTM 34FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18063","SUP","HCPCS C1892","","G18063  -  INTRODUCER NPHSTM 36FR 16CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$103.53 ","$76.61 ","$0.00 ","$103.53 ","$56.21 ","$0.00 ","$21.58 ","$0.00 ","$0.00 ","$18.13 ","$103.53 ","$0.00 ","$51.76 ","$82.00 ","$82.82 ","$0.00 ","$16.20 ","$0.00 ","$16.48 ","$0.00 "
"G18067","SUP","HCPCS C1726","","G18067  -  SET INTRO 8FR 10FR 70CM 30CM DSLT HFMN SHTH CATH RADOPQ BAND","BOTH IP/OP","$58.83 ","$43.53 ","$0.00 ","$58.83 ","$31.94 ","$0.00 ","$12.26 ","$0.00 ","$0.00 ","$10.30 ","$58.83 ","$0.00 ","$29.41 ","$46.59 ","$47.06 ","$0.00 ","$9.21 ","$0.00 ","$9.36 ","$0.00 "
"G18070","SUP","HCPCS C2625","","G18070  -  CATHETER GD .038IN 5FR 100CM AMPTZ RADOPQ TFE SHTH RNL","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G18127","SUP","HCPCS C2617","","G18127  -  SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G18131","SUP","HCPCS C2617","","G18131  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100MM BNDR 2 CATH","BOTH IP/OP","$235.75 ","$174.46 ","$0.00 ","$235.75 ","$106.09 ","$0.00 ","$49.14 ","$0.00 ","$0.00 ","$41.28 ","$235.75 ","$0.00 ","$117.88 ","$186.71 ","$188.60 ","$0.00 ","$36.89 ","$0.00 ","$37.53 ","$0.00 "
"G18140","SUP","HCPCS C2617","","G18140  -  SET STNT .038IN 2 PGTL CRV 6-10FR 13CM STRL 26CM RADOPQ","BOTH IP/OP","$155.40 ","$115.00 ","$0.00 ","$155.40 ","$69.93 ","$0.00 ","$32.39 ","$0.00 ","$0.00 ","$27.21 ","$155.40 ","$0.00 ","$77.70 ","$123.08 ","$124.32 ","$0.00 ","$24.32 ","$0.00 ","$24.74 ","$0.00 "
"G18142","SUP","HCPCS C1769","","G18142  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT SHFT GW MOD","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18143","SUP","HCPCS C1769","","G18143  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 7CM RDRR PC STD BD","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18144","SUP","HCPCS C1769","","G18144  -  GUIDEWIRE VASC ANG STD .035IN 145CM STRL 7CM RDRR PC STF BD","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18145","SUP","HCPCS C1769","","G18145  -  GUIDEWIRE VASC STRG STD .038IN 145CM STRL 7CM RDRR PC STF BD","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18153","SUP","HCPCS C1769","","G18153  -  GUIDEWIRE VASC STD ANG .038IN 145CM STRL 7CM RDRR PC NTNL","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18154","SUP","HCPCS C1769","","G18154  -  GUIDEWIRE VASC STRG .035IN 145CM 8CM RDRR PC STF BD LFRIC","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18155","SUP","HCPCS C1769","","G18155  -  GUIDEWIRE VASC .035IN 145CM STRL 8CM RDRR PC STF BD ANG TIP","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18156","SUP","HCPCS C1769","","G18156  -  GUIDEWIRE VASC STRG .038IN 145CM 8CM RDRR PC 1 TO 1 TRQ","BOTH IP/OP","$94.58 ","$69.99 ","$0.00 ","$94.58 ","$51.35 ","$0.00 ","$19.71 ","$0.00 ","$0.00 ","$16.56 ","$94.58 ","$0.00 ","$47.29 ","$74.91 ","$75.66 ","$0.00 ","$14.80 ","$0.00 ","$15.06 ","$0.00 "
"G18162","SUP","HCPCS C2617","","G18162  -  GUIDEWIRE URO STRG .038IN 145CM STRL 5CM AMPTZ FLX TP FX COR","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$14.81 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G18189","SUP","HCPCS C2627","","G18189  -  SET STNT 4FR 12-18CM STRL SALLE CATH MTLNTH PSTNR CNCT GW","BOTH IP/OP","$198.63 ","$146.99 ","$0.00 ","$198.63 ","$107.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.78 ","$198.63 ","$0.00 ","$99.31 ","$157.31 ","$158.90 ","$0.00 ","$31.08 ","$0.00 ","$31.62 ","$0.00 "
"G18191","SUP","Custom 27203010","","G18191  -  SET CATH 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR SPBC","BOTH IP/OP","$462.20 ","$342.03 ","$0.00 ","$462.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.20 ","$0.00 ","$231.10 ","$366.06 ","$369.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18193","SUP","Custom 27203010","","G18193  -  EXTRACTOR STON HLX 3FR 1CM 115CM NCRCL FLXB SHTH NTNL MEM","BOTH IP/OP","$302.83 ","$224.09 ","$0.00 ","$302.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.83 ","$0.00 ","$151.41 ","$239.84 ","$242.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18201","SUP","HCPCS C1892","","G18201  -  CATHETER XTRN 1.53IN NS NADH CNDM SIL M DISP","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18622","SUP","HCPCS C2617","","G18622  -  INTRODUCER NPHSTM 30FR 22CM 30CM AMPTZ DIL RNL","BOTH IP/OP","$285.83 ","$211.51 ","$0.00 ","$285.83 ","$128.62 ","$0.00 ","$59.57 ","$0.00 ","$0.00 ","$50.05 ","$285.83 ","$0.00 ","$142.91 ","$226.38 ","$228.66 ","$0.00 ","$44.73 ","$0.00 ","$45.50 ","$0.00 "
"G18624","SUP","HCPCS C2625","","G18624  -  SET STNT .038IN 2 PGTL CRV 7FR 20CM BLU STRL CATH RADOPQ","BOTH IP/OP","$271.13 ","$200.64 ","$0.00 ","$271.13 ","$122.01 ","$0.00 ","$56.51 ","$0.00 ","$0.00 ","$47.47 ","$271.13 ","$0.00 ","$135.56 ","$214.73 ","$216.90 ","$0.00 ","$42.43 ","$0.00 ","$43.16 ","$0.00 "
"G18629","SUP","HCPCS C1769","","G18629  -  SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100MM BNDR 2","BOTH IP/OP","$107.85 ","$79.81 ","$0.00 ","$107.85 ","$58.56 ","$0.00 ","$22.48 ","$0.00 ","$0.00 ","$18.88 ","$107.85 ","$0.00 ","$53.93 ","$85.42 ","$86.28 ","$0.00 ","$16.88 ","$0.00 ","$17.17 ","$0.00 "
"G18639","SUP","HCPCS C2617","","G18639  -  GUIDEWIRE ESCP STRG .035IN 145CM STRL 3CM RDRR PC 1-1 TRQ","BOTH IP/OP","$285.83 ","$211.51 ","$0.00 ","$285.83 ","$128.62 ","$0.00 ","$59.57 ","$0.00 ","$0.00 ","$50.05 ","$285.83 ","$0.00 ","$142.91 ","$226.38 ","$228.66 ","$0.00 ","$44.73 ","$0.00 ","$45.50 ","$0.00 "
"G18671","SUP","Custom 27203010","","G18671  -  SET STNT .038IN 2 PGTL CRV 7FR 24CM BLU STRL CATH RADOPQ","BOTH IP/OP","$84.70 ","$62.68 ","$0.00 ","$84.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.70 ","$0.00 ","$42.35 ","$67.08 ","$67.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18702","SUP","Custom 27203010","","G18702  -  NEEDLE BRCHTX 18GA 20CM ECHTP LOC","BOTH IP/OP","$94.60 ","$70.00 ","$0.00 ","$94.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.60 ","$0.00 ","$47.30 ","$74.92 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18705","SUP","Custom 27203010","","G18705  -  NEEDLE BX 14GA 15CM STRL Q COR 1 HNDCNTL LTWT SFT TIS DISP","BOTH IP/OP","$94.60 ","$70.00 ","$0.00 ","$94.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.60 ","$0.00 ","$47.30 ","$74.92 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18707","SUP","Custom 27203010","","G18707  -  NEEDLE BX 18GA 15CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP","BOTH IP/OP","$94.60 ","$70.00 ","$0.00 ","$94.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$94.60 ","$0.00 ","$47.30 ","$74.92 ","$75.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18725","SUP","HCPCS C1892","","G18725  -  NEEDLE BX 18GA 20CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$50.49 ","$0.00 ","$19.38 ","$0.00 ","$0.00 ","$16.28 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$14.55 ","$0.00 ","$14.80 ","$0.00 "
"G18758","SUP","HCPCS C1758","","G18758  -  INTRODUCER NPHSTM 26FR 20CM 32CM AMPTZ DIL RNL","BOTH IP/OP","$39.95 ","$29.56 ","$0.00 ","$39.95 ","$21.69 ","$0.00 ","$8.33 ","$0.00 ","$0.00 ","$6.99 ","$39.95 ","$0.00 ","$19.98 ","$31.64 ","$31.96 ","$0.00 ","$6.25 ","$0.00 ","$6.36 ","$0.00 "
"G18777","SUP","Custom 27203010","","G18777  -  CATHETER URET .038IN 5FR 85CM FLXTP OP-EN GW MOD","BOTH IP/OP","$462.20 ","$342.03 ","$0.00 ","$462.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.20 ","$0.00 ","$231.10 ","$366.06 ","$369.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18778","SUP","Custom 27203010","","G18778  -  EXTRACTOR STON 2.2FR 2CM 115CM NCRCL TPLS MOD BSKT NTNL","BOTH IP/OP","$462.20 ","$342.03 ","$0.00 ","$462.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.20 ","$0.00 ","$231.10 ","$366.06 ","$369.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18790","SUP","HCPCS C1758","","G18790  -  EXTRACTOR STON 2.2FR 1CM 115CM STRL NCRCL NTNL URO DISP","BOTH IP/OP","$32.90 ","$24.35 ","$0.00 ","$32.90 ","$17.86 ","$0.00 ","$6.86 ","$0.00 ","$0.00 ","$5.76 ","$32.90 ","$0.00 ","$16.45 ","$26.06 ","$26.32 ","$0.00 ","$5.15 ","$0.00 ","$5.24 ","$0.00 "
"G18792","SUP","HCPCS C1769","","G18792  -  CATHETER URET .038IN 5FR 110CM FLXTP OP-EN GW MOD","BOTH IP/OP","$108.38 ","$80.20 ","$0.00 ","$108.38 ","$58.85 ","$0.00 ","$22.59 ","$0.00 ","$0.00 ","$18.98 ","$108.38 ","$0.00 ","$54.19 ","$85.84 ","$86.70 ","$0.00 ","$16.96 ","$0.00 ","$17.25 ","$0.00 "
"G18803","SUP","HCPCS C1892","","G18803  -  GUIDEWIRE URO .035IN 145CM STRL RDRR PC 2 FLX TP AQ DISP","BOTH IP/OP","$164.45 ","$121.69 ","$0.00 ","$164.45 ","$89.30 ","$0.00 ","$34.28 ","$0.00 ","$0.00 ","$28.79 ","$164.45 ","$0.00 ","$82.23 ","$130.24 ","$131.56 ","$0.00 ","$25.74 ","$0.00 ","$26.18 ","$0.00 "
"G18813","SUP","Custom 27203010","","G18813  -  INTRODUCER NPHSTM 12FR 65CM 60CM PLWY 2 KNOB","BOTH IP/OP","$59.40 ","$43.96 ","$0.00 ","$59.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.40 ","$0.00 ","$29.70 ","$47.04 ","$47.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18827","SUP","HCPCS C2627","","G18827  -  ADAPTER CATH 6FR STRL T-B SDARM URET DISP","BOTH IP/OP","$102.50 ","$75.85 ","$0.00 ","$102.50 ","$55.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.95 ","$102.50 ","$0.00 ","$51.25 ","$81.18 ","$82.00 ","$0.00 ","$16.04 ","$0.00 ","$16.32 ","$0.00 "
"G18845","SUP","HCPCS C1758","","G18845  -  STENT URTH 6FR 50CM STRL 26CM KL DPR INK MRK DISP","BOTH IP/OP","$85.80 ","$63.49 ","$0.00 ","$85.80 ","$46.59 ","$0.00 ","$17.88 ","$0.00 ","$0.00 ","$15.02 ","$85.80 ","$0.00 ","$42.90 ","$67.95 ","$68.64 ","$0.00 ","$13.43 ","$0.00 ","$13.66 ","$0.00 "
"G18876","SUP","HCPCS C1758","","G18876  -  CATHETER URET STD 6/10FR 24CM FLXTP 2 LUM ACC HDRPH","BOTH IP/OP","$27.83 ","$20.59 ","$0.00 ","$27.83 ","$15.11 ","$0.00 ","$5.80 ","$0.00 ","$0.00 ","$4.87 ","$27.83 ","$0.00 ","$13.91 ","$22.04 ","$22.26 ","$0.00 ","$4.35 ","$0.00 ","$4.43 ","$0.00 "
"G18882","SUP","Custom 27203010","","G18882  -  GRASPER ENDSCP 3.2FR 10MM 115CM 3 PRONG DELTA WIRE STAINLESS","BOTH IP/OP","$472.83 ","$349.89 ","$0.00 ","$472.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$472.83 ","$0.00 ","$236.41 ","$374.48 ","$378.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G18883","SUP","HCPCS C1758","","G18883  -  CATHETER URET 5FR 100CM RND TIP LT","BOTH IP/OP","$49.35 ","$36.52 ","$0.00 ","$49.35 ","$26.80 ","$0.00 ","$10.29 ","$0.00 ","$0.00 ","$8.64 ","$49.35 ","$0.00 ","$24.68 ","$39.09 ","$39.48 ","$0.00 ","$7.72 ","$0.00 ","$7.86 ","$0.00 "
"G18884","SUP","HCPCS C1758","","G18884  -  CATHETER URET .05IN 7.1FR 40CM SFLX NTPR TIP LSR","BOTH IP/OP","$104.35 ","$77.22 ","$0.00 ","$104.35 ","$56.66 ","$0.00 ","$21.75 ","$0.00 ","$0.00 ","$18.27 ","$104.35 ","$0.00 ","$52.18 ","$82.65 ","$83.48 ","$0.00 ","$16.33 ","$0.00 ","$16.61 ","$0.00 "
"G18909","SUP","HCPCS C1758","","G18909  -  CATHETER URET PGTL CRV 8.2FR 56CM SFLX HDRPH","BOTH IP/OP","$31.63 ","$23.41 ","$0.00 ","$31.63 ","$17.17 ","$0.00 ","$6.59 ","$0.00 ","$0.00 ","$5.54 ","$31.63 ","$0.00 ","$15.81 ","$25.05 ","$25.30 ","$0.00 ","$4.95 ","$0.00 ","$5.03 ","$0.00 "
"G18996","SUP","HCPCS C1758","","G18996  -  CATHETER URET 3FR 100CM RND TIP STY LT","BOTH IP/OP","$104.35 ","$77.22 ","$0.00 ","$104.35 ","$56.66 ","$0.00 ","$21.75 ","$0.00 ","$0.00 ","$18.27 ","$104.35 ","$0.00 ","$52.18 ","$82.65 ","$83.48 ","$0.00 ","$16.33 ","$0.00 ","$16.61 ","$0.00 "
"G18997","SUP","HCPCS C1758","","G18997  -  CATHETER URET PGTL CRV 10FR 56CM SFLX HDRPH","BOTH IP/OP","$119.20 ","$88.21 ","$0.00 ","$119.20 ","$64.73 ","$0.00 ","$24.84 ","$0.00 ","$0.00 ","$20.87 ","$119.20 ","$0.00 ","$59.60 ","$94.41 ","$95.36 ","$0.00 ","$18.65 ","$0.00 ","$18.98 ","$0.00 "
"G19002","SUP","HCPCS C1758","","G19002  -  CATHETER URET PGTL CRV 7FR 56CM SFLX HDRPH","BOTH IP/OP","$53.13 ","$39.32 ","$0.00 ","$53.13 ","$28.85 ","$0.00 ","$11.07 ","$0.00 ","$0.00 ","$9.30 ","$53.13 ","$0.00 ","$26.56 ","$42.08 ","$42.50 ","$0.00 ","$8.31 ","$0.00 ","$8.46 ","$0.00 "
"G19030","SUP","Custom 27203010","","G19030  -  CATHETER URET .038IN 7FR 70CM OP-EN GW MOD","BOTH IP/OP","$43.00 ","$31.82 ","$0.00 ","$43.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G19032","SUP","Custom 27203010","","G19032  -  NEEDLE ESCP 18GA 20CM SKNY ECHTP CHBA TIP","BOTH IP/OP","$29.70 ","$21.98 ","$0.00 ","$29.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.70 ","$0.00 ","$14.85 ","$23.52 ","$23.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G19055","SUP","HCPCS C1758","","G19055  -  ADAPTER CATH 9FR CKFL 3W STPCK SDARM SLF SL","BOTH IP/OP","$53.13 ","$39.32 ","$0.00 ","$53.13 ","$28.85 ","$0.00 ","$11.07 ","$0.00 ","$0.00 ","$9.30 ","$53.13 ","$0.00 ","$26.56 ","$42.08 ","$42.50 ","$0.00 ","$8.31 ","$0.00 ","$8.46 ","$0.00 "
"G19069","SUP","HCPCS C2617","","G19069  -  CATHETER URET .038IN 7FR 70CM OP-EN GW MOD","BOTH IP/OP","$261.38 ","$193.42 ","$0.00 ","$261.38 ","$117.62 ","$0.00 ","$54.48 ","$0.00 ","$0.00 ","$45.76 ","$261.38 ","$0.00 ","$130.69 ","$207.01 ","$209.10 ","$0.00 ","$40.91 ","$0.00 ","$41.61 ","$0.00 "
"G19072","SUP","Custom 27203010","","G19072  -  SET STNT 5FR 8-20CM STRL GRN CATH RADOPQ MTLNTH PSTNR","BOTH IP/OP","$478.13 ","$353.82 ","$0.00 ","$478.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$478.13 ","$0.00 ","$239.06 ","$378.68 ","$382.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G19073","SUP","Custom 27203010","","G19073  -  EXTRACTOR STON 2.2FR 115CM 5CM NFORCE 3WR HLCL OCL NTNL","BOTH IP/OP","$549.85 ","$406.89 ","$0.00 ","$549.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$549.85 ","$0.00 ","$274.93 ","$435.48 ","$439.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G19089","SUP","HCPCS C1729","","G19089  -  SET NPHSTM ECHTP NDL GW DIL PERC","BOTH IP/OP","$417.45 ","$308.91 ","$0.00 ","$417.45 ","$226.68 ","$0.00 ","$87.01 ","$0.00 ","$0.00 ","$73.09 ","$417.45 ","$0.00 ","$208.73 ","$330.62 ","$333.96 ","$0.00 ","$65.33 ","$0.00 ","$66.46 ","$0.00 "
"G19097","SUP","HCPCS C1894","","G19097  -  SET NPHSTM PGTL CRV 6FR 7CM ECHTP NDL GW CATH DIL CNCT TUBE","BOTH IP/OP","$254.28 ","$188.17 ","$0.00 ","$254.28 ","$138.07 ","$0.00 ","$53.00 ","$0.00 ","$0.00 ","$44.52 ","$254.28 ","$0.00 ","$127.14 ","$201.39 ","$203.42 ","$0.00 ","$39.79 ","$0.00 ","$40.48 ","$0.00 "
"G19098","SUP","HCPCS C1769","","G19098  -  SET NPHSTM COPE LOOP ECHTP NDL GW CATH CNN PERC","BOTH IP/OP","$465.53 ","$344.49 ","$0.00 ","$465.53 ","$252.78 ","$0.00 ","$97.03 ","$0.00 ","$0.00 ","$81.51 ","$465.53 ","$0.00 ","$232.76 ","$368.70 ","$372.42 ","$0.00 ","$72.85 ","$0.00 ","$74.11 ","$0.00 "
"G19110","SUP","Custom 27203010","","G19110  -  SET NPHSTM 10FR 19.5CM LTX COPE LOOP ECHTP NDL STPCK CNN","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G19111","SUP","Custom 27203010","","G19111  -  EXTRACTOR STON 3ANG 2.4FR 1CM 115CM STRL NCR DWR TPLS BSKT","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G19119","SUP","HCPCS C1758","","G19119  -  EXTRACTOR STON 2.4FR 2CM 115CM NCR DWR TPLS MOD BSKT NTNL","BOTH IP/OP","$225.50 ","$166.87 ","$0.00 ","$225.50 ","$122.45 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$39.48 ","$225.50 ","$0.00 ","$112.75 ","$178.60 ","$180.40 ","$0.00 ","$35.29 ","$0.00 ","$35.90 ","$0.00 "
"G19168","SUP","HCPCS C1894","","G19168  -  SHEATH ACCES 12FR 35CM DILATION CONTIN WORKING CHANNEL","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19169","SUP","HCPCS C1894","","G19169  -  SET STNT ANTGRD 2 PGTL CRV 6FR 50CM GRN STRL 32CM SEIDMON","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19172","SUP","HCPCS C1894","","G19172  -  SHEATH ACCES 12FR DILATION CONTIN WKG CHNL FLXR","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19173","SUP","HCPCS C1894","","G19173  -  SHEATH ACC 12FR 55CM STRL LTX FLXR DILATION CNT WRK CHNL","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19174","SUP","HCPCS C1894","","G19174  -  SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19175","SUP","HCPCS C1894","","G19175  -  SHEATH ACC 12FR 20CM STRL LTX FLXR DILATION CNT WRK CHNL","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19176","SUP","HCPCS C1894","","G19176  -  SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19177","SUP","HCPCS C1894","","G19177  -  SHEATH ACC FNL 9.5FR 55CM STRL FLXR WKG CHNL LFRIC SRFC DIL","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G19191","SUP","Custom 27203010","","G19191  -  NEEDLE ENDSCP 22GA 25CM SKINNY NEEDLE CHIBA ECHOTIP","BOTH IP/OP","$28.60 ","$21.16 ","$0.00 ","$28.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.60 ","$0.00 ","$14.30 ","$22.65 ","$22.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G21363","SUP","Custom 27203010","","G21363  -  PROBE DPLR IMPLTABLE FLW 20MHZ STRL CKSWTZ","BOTH IP/OP","$1,240.00 ","$917.60 ","$0.00 ","$1,006.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,006.38 ","$0.00 ","$503.19 ","$797.05 ","$805.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G21421","SUP","HCPCS C1729","","G21421  -  CATHETER ENDSCP 7FR 250CM 5 SIDEPORT LATEX FREE BILIARY","BOTH IP/OP","$207.50 ","$153.55 ","$0.00 ","$207.50 ","$112.67 ","$0.00 ","$43.25 ","$0.00 ","$0.00 ","$36.33 ","$207.50 ","$0.00 ","$103.75 ","$164.34 ","$166.00 ","$0.00 ","$32.47 ","$0.00 ","$33.03 ","$0.00 "
"G21509","SUP","HCPCS C2617","","G21509  -  STENT PANCREATIC 7FR 15CM DRAIN OBSTRUCTED POSITIONING","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$79.88 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$31.08 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$27.78 ","$0.00 ","$28.26 ","$0.00 "
"G21586","SUP","HCPCS C1729","","G21586  -  SET DRAIN PUR 250CM 7FR .035IN PGTL CURVE NSBIL 5 SDPRT CATH","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$190.05 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"G21962","SUP","HCPCS C1769","","G21962  -  GUIDEWIRE ENDSCP 250CM PROGRESSIVELY FLEXIBLE TIP","BOTH IP/OP","$415.00 ","$307.10 ","$0.00 ","$415.00 ","$225.35 ","$0.00 ","$86.50 ","$0.00 ","$0.00 ","$72.66 ","$415.00 ","$0.00 ","$207.50 ","$328.68 ","$332.00 ","$0.00 ","$64.95 ","$0.00 ","$66.07 ","$0.00 "
"G21978","SUP","HCPCS C1769","","G21978  -  GUIDEWIRE ENDSCP 360CM SAVARY-GILLIARD NONSTRL REUSABLE","BOTH IP/OP","$480.00 ","$355.20 ","$0.00 ","$480.00 ","$260.64 ","$0.00 ","$100.04 ","$0.00 ","$0.00 ","$84.04 ","$480.00 ","$0.00 ","$240.00 ","$380.16 ","$384.00 ","$0.00 ","$75.12 ","$0.00 ","$76.42 ","$0.00 "
"G22102","SUP","HCPCS C2617","","G22102  -  STENT PANCREATIC 5FR 153CM DRAIN OBSTRUCTED POSITIONING","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$79.88 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$31.08 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$27.78 ","$0.00 ","$28.26 ","$0.00 "
"G22139","SUP","HCPCS C1769","","G22139  -  GUIDEWIRE ENDSCP 200CM FLEXIBLE TIP SAVARY-GILLIARD","BOTH IP/OP","$345.00 ","$255.30 ","$0.00 ","$345.00 ","$187.34 ","$0.00 ","$71.91 ","$0.00 ","$0.00 ","$60.41 ","$345.00 ","$0.00 ","$172.50 ","$273.24 ","$276.00 ","$0.00 ","$53.99 ","$0.00 ","$54.92 ","$0.00 "
"G22409","SUP","Custom 27203010","","G22409  -  BRUSH CYTOLOGY 5FR 2MM 180CM GASTROSCOPE GREEN","BOTH IP/OP","$46.25 ","$34.23 ","$0.00 ","$46.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.25 ","$0.00 ","$23.13 ","$36.63 ","$37.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23239","SUP","HCPCS C2617","","G23239  -  LASER SRG 115V 20AMP RHPSD H-30","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23240","SUP","HCPCS C2617","","G23240  -  SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23241","SUP","HCPCS C2617","","G23241  -  STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23242","SUP","HCPCS C2617","","G23242  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23243","SUP","HCPCS C2617","","G23243  -  STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23244","SUP","HCPCS C2617","","G23244  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23312","SUP","HCPCS C2617","","G23312  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23313","SUP","HCPCS C2617","","G23313  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23314","SUP","HCPCS C2617","","G23314  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23315","SUP","HCPCS C2617","","G23315  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23316","SUP","HCPCS C2617","","G23316  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23317","SUP","HCPCS C2617","","G23317  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23318","SUP","HCPCS C2617","","G23318  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23319","SUP","HCPCS C2617","","G23319  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23320","SUP","HCPCS C2617","","G23320  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23326","SUP","HCPCS C2617","","G23326  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23327","SUP","HCPCS C2617","","G23327  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23328","SUP","HCPCS C2617","","G23328  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23329","SUP","HCPCS C2617","","G23329  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23330","SUP","HCPCS C2617","","G23330  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23331","SUP","HCPCS C2617","","G23331  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23332","SUP","HCPCS C2617","","G23332  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23333","SUP","HCPCS C2617","","G23333  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23334","SUP","HCPCS C2617","","G23334  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23335","SUP","HCPCS C2617","","G23335  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23336","SUP","HCPCS C2617","","G23336  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23337","SUP","HCPCS C2617","","G23337  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23338","SUP","HCPCS C2617","","G23338  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23339","SUP","HCPCS C2617","","G23339  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23340","SUP","HCPCS C2617","","G23340  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23341","SUP","HCPCS C2617","","G23341  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23342","SUP","HCPCS C2617","","G23342  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23343","SUP","HCPCS C2617","","G23343  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23344","SUP","HCPCS C2617","","G23344  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23345","SUP","HCPCS C2617","","G23345  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23346","SUP","HCPCS C2617","","G23346  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23347","SUP","HCPCS C2617","","G23347  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23348","SUP","HCPCS C2617","","G23348  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23349","SUP","HCPCS C2617","","G23349  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23350","SUP","HCPCS C2617","","G23350  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23351","SUP","HCPCS C2617","","G23351  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23352","SUP","HCPCS C2617","","G23352  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23353","SUP","HCPCS C2617","","G23353  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23354","SUP","HCPCS C2617","","G23354  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23355","SUP","HCPCS C2617","","G23355  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23356","SUP","HCPCS C2617","","G23356  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23357","SUP","HCPCS C2617","","G23357  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23358","SUP","HCPCS C2617","","G23358  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23359","SUP","HCPCS C2617","","G23359  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23360","SUP","HCPCS C2617","","G23360  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23361","SUP","HCPCS C2617","","G23361  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23362","SUP","HCPCS C2617","","G23362  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23363","SUP","HCPCS C2617","","G23363  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23365","SUP","HCPCS C2617","","G23365  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23366","SUP","HCPCS C2617","","G23366  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23367","SUP","HCPCS C2617","","G23367  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23368","SUP","HCPCS C2617","","G23368  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23369","SUP","HCPCS C2617","","G23369  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23370","SUP","HCPCS C2617","","G23370  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23371","SUP","HCPCS C2617","","G23371  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23372","SUP","HCPCS C2617","","G23372  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23373","SUP","HCPCS C2617","","G23373  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23374","SUP","HCPCS C2617","","G23374  -  SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23376","SUP","HCPCS C2617","","G23376  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23377","SUP","HCPCS C2617","","G23377  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23378","SUP","HCPCS C2617","","G23378  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23379","SUP","HCPCS C2617","","G23379  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23380","SUP","HCPCS C2617","","G23380  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23381","SUP","HCPCS C2617","","G23381  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23382","SUP","HCPCS C2617","","G23382  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD PSTNR","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23383","SUP","HCPCS C2617","","G23383  -  STENT URET 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23384","SUP","HCPCS C2617","","G23384  -  STENT URET 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23385","SUP","HCPCS C2617","","G23385  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD PSTNR","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23386","SUP","HCPCS C2617","","G23386  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23387","SUP","HCPCS C2617","","G23387  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23388","SUP","HCPCS C2617","","G23388  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23389","SUP","HCPCS C2617","","G23389  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23390","SUP","HCPCS C2617","","G23390  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23391","SUP","HCPCS C2617","","G23391  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23392","SUP","HCPCS C2617","","G23392  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23395","SUP","HCPCS C2617","","G23395  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23396","SUP","HCPCS C2617","","G23396  -  STENT URET 5FR 20CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23397","SUP","HCPCS C2617","","G23397  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23398","SUP","HCPCS C2617","","G23398  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23399","SUP","HCPCS C2617","","G23399  -  STENT URET 5FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23400","SUP","HCPCS C2617","","G23400  -  STENT URET 5FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23401","SUP","HCPCS C2617","","G23401  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23402","SUP","HCPCS C2617","","G23402  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23404","SUP","HCPCS C2617","","G23404  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23405","SUP","HCPCS C2617","","G23405  -  STENT URET 6FR 22CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23406","SUP","HCPCS C2617","","G23406  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23407","SUP","HCPCS C2617","","G23407  -  STENT URET 6FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23408","SUP","HCPCS C2617","","G23408  -  STENT URET 6FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23411","SUP","HCPCS C2617","","G23411  -  STENT URET 6FR 30CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23412","SUP","HCPCS C2617","","G23412  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23413","SUP","HCPCS C2617","","G23413  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23415","SUP","HCPCS C2617","","G23415  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23416","SUP","HCPCS C2617","","G23416  -  STENT URET 7FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23417","SUP","HCPCS C2617","","G23417  -  STENT URET 7FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23418","SUP","HCPCS C2617","","G23418  -  STENT URET 7FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23419","SUP","HCPCS C2617","","G23419  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23420","SUP","HCPCS C2617","","G23420  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23421","SUP","HCPCS C2617","","G23421  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23422","SUP","HCPCS C2617","","G23422  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23423","SUP","HCPCS C2617","","G23423  -  STENT URET 8FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23424","SUP","HCPCS C2617","","G23424  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23425","SUP","HCPCS C2617","","G23425  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23428","SUP","HCPCS C2617","","G23428  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23429","SUP","HCPCS C2617","","G23429  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23430","SUP","HCPCS C2617","","G23430  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23431","SUP","HCPCS C2617","","G23431  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23432","SUP","HCPCS C2617","","G23432  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23433","SUP","HCPCS C2617","","G23433  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23434","SUP","HCPCS C2617","","G23434  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23435","SUP","HCPCS C2617","","G23435  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23436","SUP","HCPCS C2617","","G23436  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23437","SUP","HCPCS C2617","","G23437  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23438","SUP","HCPCS C2617","","G23438  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23439","SUP","HCPCS C2617","","G23439  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23440","SUP","HCPCS C2617","","G23440  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23441","SUP","HCPCS C2617","","G23441  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23442","SUP","HCPCS C2617","","G23442  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23443","SUP","HCPCS C2617","","G23443  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23444","SUP","HCPCS C2617","","G23444  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23445","SUP","HCPCS C2617","","G23445  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23446","SUP","HCPCS C2617","","G23446  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23447","SUP","HCPCS C2617","","G23447  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23448","SUP","HCPCS C2617","","G23448  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23449","SUP","HCPCS C2617","","G23449  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23450","SUP","HCPCS C2617","","G23450  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23451","SUP","HCPCS C2617","","G23451  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23452","SUP","HCPCS C2617","","G23452  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23453","SUP","HCPCS C2617","","G23453  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23454","SUP","HCPCS C2617","","G23454  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23455","SUP","HCPCS C2617","","G23455  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23456","SUP","HCPCS C2617","","G23456  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23457","SUP","HCPCS C2617","","G23457  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23458","SUP","HCPCS C2617","","G23458  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23459","SUP","HCPCS C2617","","G23459  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23460","SUP","HCPCS C2617","","G23460  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23461","SUP","HCPCS C2617","","G23461  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23462","SUP","HCPCS C2617","","G23462  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23463","SUP","HCPCS C2617","","G23463  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23464","SUP","HCPCS C2617","","G23464  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23465","SUP","HCPCS C2617","","G23465  -  SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23466","SUP","HCPCS C2617","","G23466  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23467","SUP","HCPCS C2617","","G23467  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23468","SUP","HCPCS C2617","","G23468  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23469","SUP","HCPCS C2617","","G23469  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23470","SUP","HCPCS C2617","","G23470  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23471","SUP","HCPCS C2617","","G23471  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23472","SUP","HCPCS C2617","","G23472  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23473","SUP","HCPCS C2617","","G23473  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23474","SUP","HCPCS C2617","","G23474  -  SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23475","SUP","HCPCS C2617","","G23475  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23476","SUP","HCPCS C2617","","G23476  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23477","SUP","HCPCS C2617","","G23477  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23478","SUP","HCPCS C2617","","G23478  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23479","SUP","HCPCS C2617","","G23479  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23480","SUP","HCPCS C2617","","G23480  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23481","SUP","HCPCS C2617","","G23481  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23482","SUP","HCPCS C2617","","G23482  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$148.75 ","$110.08 ","$0.00 ","$148.75 ","$66.94 ","$0.00 ","$31.00 ","$0.00 ","$0.00 ","$26.04 ","$148.75 ","$0.00 ","$74.38 ","$117.81 ","$119.00 ","$0.00 ","$23.28 ","$0.00 ","$23.68 ","$0.00 "
"G23483","SUP","HCPCS C2617","","G23483  -  SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23484","SUP","HCPCS C2617","","G23484  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23485","SUP","HCPCS C2617","","G23485  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23486","SUP","HCPCS C2617","","G23486  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23487","SUP","HCPCS C2617","","G23487  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23488","SUP","HCPCS C2617","","G23488  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23489","SUP","HCPCS C2617","","G23489  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23490","SUP","HCPCS C2617","","G23490  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23491","SUP","HCPCS C2617","","G23491  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23492","SUP","HCPCS C2617","","G23492  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23493","SUP","HCPCS C2617","","G23493  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23494","SUP","HCPCS C2617","","G23494  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23495","SUP","HCPCS C2617","","G23495  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23496","SUP","HCPCS C2617","","G23496  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23497","SUP","HCPCS C2617","","G23497  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23498","SUP","HCPCS C2617","","G23498  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23499","SUP","HCPCS C2617","","G23499  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23500","SUP","HCPCS C2617","","G23500  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23501","SUP","HCPCS C2617","","G23501  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23502","SUP","HCPCS C2617","","G23502  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23503","SUP","HCPCS C2617","","G23503  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23504","SUP","HCPCS C2617","","G23504  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23505","SUP","HCPCS C2617","","G23505  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23506","SUP","HCPCS C2617","","G23506  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23507","SUP","HCPCS C2617","","G23507  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23508","SUP","HCPCS C2617","","G23508  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23509","SUP","HCPCS C2617","","G23509  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23510","SUP","HCPCS C2617","","G23510  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23511","SUP","HCPCS C2617","","G23511  -  SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$137.05 ","$101.42 ","$0.00 ","$137.05 ","$61.67 ","$0.00 ","$28.56 ","$0.00 ","$0.00 ","$24.00 ","$137.05 ","$0.00 ","$68.53 ","$108.54 ","$109.64 ","$0.00 ","$21.45 ","$0.00 ","$21.82 ","$0.00 "
"G23512","SUP","HCPCS C2617","","G23512  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA RADOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G23523","SUP","Custom 27803010","","G23523  -  COIL EMBOLIZATION 3MM 7CM 7.4 LOOP NESTER PLATINUM SYNTH","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23552","SUP","Custom 27203010","","G23552  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23553","SUP","Custom 27203010","","G23553  -  FIBER LSR 20W 365UM RD STRL SMARTSYNC CNCT HO DISP RHPSD","BOTH IP/OP","$2,367.30 ","$1,751.80 ","$0.00 ","$2,367.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.30 ","$0.00 ","$1,183.65 ","$1,874.90 ","$1,893.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23665","SUP","Custom 27203010","","G23665  -  LASER SRG 230V 10AMP RHPSD H-30 HL-30B","BOTH IP/OP","$2,231.25 ","$1,651.13 ","$0.00 ","$2,231.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,231.25 ","$0.00 ","$1,115.63 ","$1,767.15 ","$1,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23666","SUP","Custom 27203010","","G23666  -  FIBER LSR 940UM CK HO","BOTH IP/OP","$1,168.75 ","$864.88 ","$0.00 ","$1,168.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,168.75 ","$0.00 ","$584.38 ","$925.65 ","$935.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23667","SUP","Custom 27203010","","G23667  -  FIBER LSR 550UM CK HO","BOTH IP/OP","$1,009.38 ","$746.94 ","$0.00 ","$1,009.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,009.38 ","$0.00 ","$504.69 ","$799.43 ","$807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23668","SUP","Custom 27203010","","G23668  -  FIBER LSR 365UM CK HO","BOTH IP/OP","$1,593.75 ","$1,179.38 ","$0.00 ","$1,593.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,593.75 ","$0.00 ","$796.88 ","$1,262.25 ","$1,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23731","SUP","Custom 27203010","","G23731  -  FIBER LSR 273UM CK HO","BOTH IP/OP","$2,921.25 ","$2,161.73 ","$0.00 ","$2,921.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,921.25 ","$0.00 ","$1,460.63 ","$2,313.63 ","$2,337.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23733","SUP","Custom 27203010","","G23733  -  FIBER LSR 150UM CK HO","BOTH IP/OP","$849.10 ","$628.33 ","$0.00 ","$849.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$849.10 ","$0.00 ","$424.55 ","$672.49 ","$679.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23734","SUP","Custom 27203010","","G23734  -  FIBER LSR 200UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30","BOTH IP/OP","$953.25 ","$705.41 ","$0.00 ","$953.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$953.25 ","$0.00 ","$476.63 ","$754.97 ","$762.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G23735","SUP","Custom 27203010","","G23735  -  FIBER LSR 550UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30","BOTH IP/OP","$1,578.50 ","$1,168.09 ","$0.00 ","$1,578.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,578.50 ","$0.00 ","$789.25 ","$1,250.17 ","$1,262.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G24129","SUP","HCPCS C1769","","G24129  -  SET INTRO .018IN .087IN 5.5CM GW SUBMANDIBULAR SLVA DCT","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$210.41 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"G24132","SUP","HCPCS C1769","","G24132  -  SET INTRO .018IN .074IN 5.5CM GW SUBMANDIBULAR SLVA DCT","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$210.41 ","$0.00 ","$80.76 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"G24889","SUP","HCPCS C1874","","G24889  -  STENT VASCULAR 60MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"G24890","SUP","HCPCS C1874","","G24890  -  STENT VASCULAR 80MM DRUG ELUTING SELF EXPANDING GWIRE ZILVER","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G24894","SUP","HCPCS C1874","","G24894  -  STENT VASCULAR 60MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"G24895","SUP","HCPCS C1874","","G24895  -  STENT VASC .035IN 7MM 6FR 80MM 125CM ZL PTX DRG ELUT SLF XPD","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G24935","SUP","HCPCS C1874","","G24935  -  STENT VASCULAR 100MM DRUG ELUTING OTW SELF EXPAND ZILVER PTX","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G24937","SUP","HCPCS C1874","","G24937  -  STENT VASCULAR 100MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G25292","SUP","Custom 27203010","","G25292  -  SYSTEM LTHTRP UNV 11.6FR 5FR 38CM STRL LITHASSIST TUO 2 LUM","BOTH IP/OP","$2,666.15 ","$1,972.95 ","$0.00 ","$2,666.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,666.15 ","$0.00 ","$1,333.08 ","$2,111.59 ","$2,132.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25293","SUP","Custom 27203010","","G25293  -  FIBER LSR CK HO DISP","BOTH IP/OP","$802.58 ","$593.91 ","$0.00 ","$802.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$802.58 ","$0.00 ","$401.29 ","$635.64 ","$642.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25294","SUP","Custom 27203010","","G25294  -  FIBER LSR 200UM CK HO DISP","BOTH IP/OP","$659.25 ","$487.85 ","$0.00 ","$659.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.25 ","$0.00 ","$329.63 ","$522.13 ","$527.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25295","SUP","Custom 27203010","","G25295  -  FIBER LSR HO HO DISP","BOTH IP/OP","$659.25 ","$487.85 ","$0.00 ","$659.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$659.25 ","$0.00 ","$329.63 ","$522.13 ","$527.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25296","SUP","Custom 27203010","","G25296  -  FIBER LSR 365UM RD SMARTSYNC HO DISP STD SMA CNCT","BOTH IP/OP","$857.93 ","$634.87 ","$0.00 ","$857.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$857.93 ","$0.00 ","$428.96 ","$679.48 ","$686.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25297","SUP","Custom 27203010","","G25297  -  FIBER LSR 550UM CK HO DISP","BOTH IP/OP","$1,420.65 ","$1,051.28 ","$0.00 ","$1,420.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,420.65 ","$0.00 ","$710.33 ","$1,125.15 ","$1,136.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25298","SUP","Custom 27203010","","G25298  -  FIBER LSR 940UM RD SMARTSYNC HO DISP STD SMA CNCT","BOTH IP/OP","$531.25 ","$393.13 ","$0.00 ","$531.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$531.25 ","$0.00 ","$265.63 ","$420.75 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25299","SUP","Custom 27203010","","G25299  -  FIBER LSR 273UM CK MU HO","BOTH IP/OP","$1,009.38 ","$746.94 ","$0.00 ","$1,009.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,009.38 ","$0.00 ","$504.69 ","$799.43 ","$807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25300","SUP","Custom 27203010","","G25300  -  FIBER LSR 365UM CK MU HO","BOTH IP/OP","$1,168.75 ","$864.88 ","$0.00 ","$1,168.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,168.75 ","$0.00 ","$584.38 ","$925.65 ","$935.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25301","SUP","Custom 27203010","","G25301  -  FIBER LSR 550UM CK MU HO","BOTH IP/OP","$2,231.25 ","$1,651.13 ","$0.00 ","$2,231.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,231.25 ","$0.00 ","$1,115.63 ","$1,767.15 ","$1,785.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25507","SUP","Custom 27203010","","G25507  -  NEEDLE ENDSCP 0-8CM 19GA 5.2FR 138-140CM SFT TIS US SHTH Q","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25668","SUP","Custom 27203010","","G25668  -  LGTR 15MM SHORTSHOT SA HMRHD 4 BAND NONSTRL DISP ENDSCP","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G25981","SUP","HCPCS C1894","","G25981  -  BUNDLE FO 150CM VUEOPTIC","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$95.57 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"G26124","SUP","Custom 27203010","","G26124  -  INTRODUCER SPBC 10FR 14FR 17CM 20CM 1STP DRN CATH DIL TROC","BOTH IP/OP","$536.58 ","$397.07 ","$0.00 ","$536.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$536.58 ","$0.00 ","$268.29 ","$424.97 ","$429.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G26574","SUP","HCPCS C1726","","G26574  -  SET SPINAL MICROCOMPRESSION BROWN 4FR TRIGEMINAL GANGLION","BOTH IP/OP","$1,027.00 ","$759.98 ","$0.00 ","$1,027.00 ","$557.66 ","$0.00 ","$214.05 ","$0.00 ","$0.00 ","$179.82 ","$1,027.00 ","$0.00 ","$513.50 ","$813.38 ","$821.60 ","$0.00 ","$160.73 ","$0.00 ","$163.50 ","$0.00 "
"G26642","SUP","HCPCS C1894","","G26642  -  EXTRACTOR STON 5CM 7FR 6MM 65CM 4CM RTNR 3WR HLCL BLN","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$95.57 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"G26648","SUP","HCPCS C1894","","G26648  -  INTRODUCER SPBC 10FR 16FR 17CM 20CM 1STP DRN CATH DIL TROC","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$95.57 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"G26655","SUP","HCPCS C1894","","G26655  -  INTRODUCER SPBC 12FR 18FR 17CM 20CM 1STP DRN CATH DIL TROC","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$95.57 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"G26666","SUP","HCPCS C1894","","G26666  -  INTRODUCER SPBC 16FR 20- FR 17CM 20CM PLWY 1 STP DIL TROC","BOTH IP/OP","$176.00 ","$130.24 ","$0.00 ","$176.00 ","$95.57 ","$0.00 ","$36.68 ","$0.00 ","$0.00 ","$30.82 ","$176.00 ","$0.00 ","$88.00 ","$139.39 ","$140.80 ","$0.00 ","$27.54 ","$0.00 ","$28.02 ","$0.00 "
"G26891","SUP","HCPCS C1725","","G26891  -  CATHETER BLNDIL 4MM 80CM STRL 2CM ATB ADV 2 LUM XPD RADOPQ","BOTH IP/OP","$277.75 ","$205.54 ","$0.00 ","$275.00 ","$149.33 ","$0.00 ","$57.89 ","$0.00 ","$0.00 ","$48.15 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$43.04 ","$0.00 ","$43.78 ","$0.00 "
"G26908","SUP","HCPCS C1726","","G26908  -  SET ENDSCP INSTR BILE DUCT ADPR CATH STON XTRT XPLR STRL","BOTH IP/OP","$1,980.00 ","$1,465.20 ","$0.00 ","$1,980.00 ","$1,075.14 ","$0.00 ","$412.68 ","$0.00 ","$0.00 ","$346.68 ","$1,980.00 ","$0.00 ","$990.00 ","$1,568.16 ","$1,584.00 ","$0.00 ","$309.87 ","$0.00 ","$315.22 ","$0.00 "
"G26957","SUP","HCPCS C1769","","G26957  -  GUIDEWIRE VASCULAR 10MM RAD .035IN 110CM REUTER TIP","BOTH IP/OP","$215.63 ","$159.57 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$44.94 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G26973","SUP","HCPCS C1725","","G26973  -  CATH ANGIO 5FR .35IN 90CM VSCR SUP VIS GRADUAL TRNS OF","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$17.65 ","$0.00 ","$6.77 ","$0.00 ","$0.00 ","$5.69 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$5.09 ","$0.00 ","$5.17 ","$0.00 "
"G26986","SUP","HCPCS C1770","","G26986  -  COIL EMBOLIZATION .018IN 10MM 14CM 4.5 LOOP SOFT RADIOPACITY","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G26989","SUP","HCPCS C1770","","G26989  -  COIL EMBOLIZATION .018IN 6MM 14CM 7.4 LOOP SOFT RADIOPACITY","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G26990","SUP","HCPCS C1770","","G26990  -  COIL EMBOLIZATION .018IN 8MM 14CM 5.6 LOOP SOFT RADIOPACITY","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G26991","SUP","Custom 27203010","","G26991  -  COIL EMBOLIZATION .035IN 10MM 14CM 4.5 LOOP SOFT NESTER","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G26994","SUP","Custom 27803010","","G26994  -  COIL EMBOLIZATION .035IN 7.4 LOOP 6MM 14CM SOFT CATHETER","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G26995","SUP","HCPCS C1770","","G26995  -  COIL EMBOLIZATION .035IN 5.6 LOOPS 8MM 14CM SOFT CATHETER","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G27035","SUP","HCPCS C1769","","G27035  -  GUIDEWIRE VASCULAR STR .035IN 260CM FLEXIBLE TIP STIFF SHAFT","BOTH IP/OP","$89.70 ","$66.38 ","$0.00 ","$86.25 ","$46.83 ","$0.00 ","$18.70 ","$0.00 ","$0.00 ","$15.10 ","$86.25 ","$0.00 ","$43.13 ","$68.31 ","$69.00 ","$0.00 ","$13.50 ","$0.00 ","$13.73 ","$0.00 "
"G27047","SUP","Custom 27203010","","G27047  -  CATH JJNSTM 80CM 16.5FR CR-ALZT-CNS 2 LUM REPL STRL DISP","BOTH IP/OP","$180.35 ","$133.46 ","$0.00 ","$180.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.35 ","$0.00 ","$90.18 ","$142.84 ","$144.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G27059","SUP","HCPCS C2617","","G27059  -  INTRODUCER SPBC 18FR 22FR 17CM 20CM 1STP DRN CATH DIL TROC","BOTH IP/OP","$253.45 ","$187.55 ","$0.00 ","$253.45 ","$114.05 ","$0.00 ","$52.83 ","$0.00 ","$0.00 ","$44.38 ","$253.45 ","$0.00 ","$126.73 ","$200.73 ","$202.76 ","$0.00 ","$39.66 ","$0.00 ","$40.35 ","$0.00 "
"G27061","SUP","HCPCS C1729","","G27061  -  SET STNT 2 PGTL CRV 8.2FR 40CM RADOPQ PSTNR SFLX URETER","BOTH IP/OP","$150.55 ","$111.41 ","$0.00 ","$150.55 ","$81.75 ","$0.00 ","$31.38 ","$0.00 ","$0.00 ","$26.36 ","$150.55 ","$0.00 ","$75.28 ","$119.24 ","$120.44 ","$0.00 ","$23.56 ","$0.00 ","$23.97 ","$0.00 "
"G27063","SUP","HCPCS C2617","","G27063  -  SET NPHSTM 12FR 30CM COPE LOOP MOD NDL GW CNN DIL","BOTH IP/OP","$365.43 ","$270.42 ","$0.00 ","$365.43 ","$164.44 ","$0.00 ","$76.16 ","$0.00 ","$0.00 ","$63.98 ","$365.43 ","$0.00 ","$182.71 ","$289.42 ","$292.34 ","$0.00 ","$57.19 ","$0.00 ","$58.18 ","$0.00 "
"G27161","SUP","HCPCS C2617","","G27161  -  STENT PANCREATIC 5FR 14CM DRAIN OBSTRUCTED POSITIONING","BOTH IP/OP","$177.50 ","$131.35 ","$0.00 ","$177.50 ","$79.88 ","$0.00 ","$37.00 ","$0.00 ","$0.00 ","$31.08 ","$177.50 ","$0.00 ","$88.75 ","$140.58 ","$142.00 ","$0.00 ","$27.78 ","$0.00 ","$28.26 ","$0.00 "
"G27234","SUP","Custom 27203010","","G27234  -  DEVICE STNT RTRVL 4.5FR 65CM NSNARE FLXB NTNL WRE CNSTRCT","BOTH IP/OP","$289.10 ","$213.93 ","$0.00 ","$289.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.10 ","$0.00 ","$144.55 ","$228.97 ","$231.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G27887","SUP","HCPCS C1769","","G27887  -  GUIDEWIRE VASC STRG .028IN 145CM FX COR SS","BOTH IP/OP","$64.83 ","$47.97 ","$0.00 ","$64.83 ","$35.20 ","$0.00 ","$13.51 ","$0.00 ","$0.00 ","$11.35 ","$64.83 ","$0.00 ","$32.41 ","$51.35 ","$51.86 ","$0.00 ","$10.15 ","$0.00 ","$10.32 ","$0.00 "
"G28999","SUP","HCPCS C1894","","G28999  -  INTRODUCER CATHETER 25CM SET CHK-FLO 20FR","BOTH IP/OP","$847.50 ","$627.15 ","$0.00 ","$847.50 ","$460.19 ","$0.00 ","$176.64 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$132.63 ","$0.00 ","$134.92 ","$0.00 "
"G29965","SUP","HCPCS C1769","","GUIDE WIRE .035IN X 80CM X 10CM REFLECTOR REUTER TIP DEFLECT","BOTH IP/OP","$161.00 ","$119.14 ","$0.00 ","$161.00 ","$87.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.19 ","$161.00 ","$0.00 ","$80.50 ","$127.51 ","$128.80 ","$0.00 ","$25.20 ","$0.00 ","$25.63 ","$0.00 "
"G29982","SUP","HCPCS C1894","","G29982  -  SHEATH GUID .018/.038IN ANL1 CURVE 6FR .087IN 45CM RADIOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G29983","SUP","HCPCS C1894","","G29983  -  SHEATH GUID .018/.038IN ANL2 CURVE 6FR .087IN 45CM RADIOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G29985","SUP","HCPCS C1894","","G29985  -  SHEATH GUID ANL1 CURVE 7FR .100IN 45CM UNIQUELY FABRICATED","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G29986","SUP","HCPCS C1894","","G29986  -  SHEATH GUID .018/.038IN ANL2 CURVE 7FR .1IN 45CM RADIOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G29989","SUP","HCPCS C1894","","G29989  -  SHEATH GUID .018-.038IN ANL2 CURVE 6FR .087IN 90CM RADIOPQ","BOTH IP/OP","$392.60 ","$290.52 ","$0.00 ","$377.50 ","$204.98 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"G30117","SUP","HCPCS C1894","","G30117  -  INTRODUCER SHEATH .018 .038IN ANL2 CURVE 5FR .074IN 45CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G30357","SUP","HCPCS C1726","","G30357  -  POUCH DRN 300ML NS ELC BELT ADJ 1 CNCT 2 TUBE REED VLV MECH","BOTH IP/OP","$618.80 ","$457.91 ","$0.00 ","$618.80 ","$336.01 ","$0.00 ","$128.97 ","$0.00 ","$0.00 ","$108.35 ","$618.80 ","$0.00 ","$309.40 ","$490.09 ","$495.04 ","$0.00 ","$96.84 ","$0.00 ","$98.51 ","$0.00 "
"G30358","SUP","HCPCS C1726","","G30358  -  EXTRACTOR SRG 12FR 38CM STRL PRC NC STON TPLS ATRM NTNL DISP","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G30360","SUP","HCPCS C1773","","G30360  -  CATHETER NPHSTM 10MM 15CM CLR ULTRX TRNS TPR BLN RADOPQ STRP","BOTH IP/OP","$419.70 ","$310.58 ","$0.00 ","$419.70 ","$227.90 ","$0.00 ","$87.48 ","$0.00 ","$0.00 ","$73.49 ","$419.70 ","$0.00 ","$209.85 ","$332.40 ","$335.76 ","$0.00 ","$65.68 ","$0.00 ","$66.82 ","$0.00 "
"G30361","SUP","HCPCS C1773","","G30361  -  FORCEPS SPEC RTRVL 15MM 3.2FR 115CM STRL CPTR 3 PR STON FB","BOTH IP/OP","$419.70 ","$310.58 ","$0.00 ","$419.70 ","$227.90 ","$0.00 ","$87.48 ","$0.00 ","$0.00 ","$73.49 ","$419.70 ","$0.00 ","$209.85 ","$332.40 ","$335.76 ","$0.00 ","$65.68 ","$0.00 ","$66.82 ","$0.00 "
"G30362","SUP","HCPCS C1773","","G30362  -  GRASPER ESCP 2.8FR 15MM 115CM CPTR 3 PR OPN WD MICROTHROW","BOTH IP/OP","$419.70 ","$310.58 ","$0.00 ","$419.70 ","$227.90 ","$0.00 ","$87.48 ","$0.00 ","$0.00 ","$73.49 ","$419.70 ","$0.00 ","$209.85 ","$332.40 ","$335.76 ","$0.00 ","$65.68 ","$0.00 ","$66.82 ","$0.00 "
"G30364","SUP","HCPCS C1726","","G30364  -  CATHETER NEPHROSTOMY 20 ATM 10MM 15CM INFLATE BALLOON SHEATH","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G30365","SUP","HCPCS C1726","","G30365  -  SET NEPHROSTOMY 10MM 15CM CATHETER RADIOPQ BALLOON SHEATH","BOTH IP/OP","$618.80 ","$457.91 ","$0.00 ","$618.80 ","$336.01 ","$0.00 ","$128.97 ","$0.00 ","$0.00 ","$108.35 ","$618.80 ","$0.00 ","$309.40 ","$490.09 ","$495.04 ","$0.00 ","$96.84 ","$0.00 ","$98.51 ","$0.00 "
"G30375","SUP","HCPCS C1773","","G30375  -  FORCEPS SPEC RTRVL 15MM 3.2FR 90CM STRL CPTR 3 PR STON FB","BOTH IP/OP","$482.65 ","$357.16 ","$0.00 ","$482.65 ","$262.08 ","$0.00 ","$100.60 ","$0.00 ","$0.00 ","$84.51 ","$482.65 ","$0.00 ","$241.33 ","$382.26 ","$386.12 ","$0.00 ","$75.53 ","$0.00 ","$76.84 ","$0.00 "
"G30389","SUP","HCPCS C1894","","G30389  -  SHEATH ACCES 14FR 35CM DILATION CONTIN WORKING CHANNEL","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G30390","SUP","HCPCS C1894","","G30390  -  FORCEPS SPEC RTRVL 15MM 2.8FR 115CM STRL CPTR 3 PR STON FB","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G30391","SUP","HCPCS C1894","","G30391  -  SHEATH ACC 14FR 55CM STRL FLXR DILATION CNT WRK CHNL AQ URET","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G30393","SUP","HCPCS C1894","","G30393  -  SHEATH ACC 14FR 20CM FLXR DILATION CNT WKG CHNL URET","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G30403","SUP","HCPCS C2627","","G30403  -  SHEATH ACC 14FR 28CM FLXR DILATION CNT WKG CHNL LFRIC SM","BOTH IP/OP","$166.10 ","$122.91 ","$0.00 ","$166.10 ","$90.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.08 ","$166.10 ","$0.00 ","$83.05 ","$131.55 ","$132.88 ","$0.00 ","$25.99 ","$0.00 ","$26.44 ","$0.00 "
"G30404","SUP","HCPCS C2627","","G30404  -  SET CATH 8.5FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC","BOTH IP/OP","$166.10 ","$122.91 ","$0.00 ","$166.10 ","$90.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.08 ","$166.10 ","$0.00 ","$83.05 ","$131.55 ","$132.88 ","$0.00 ","$25.99 ","$0.00 ","$26.44 ","$0.00 "
"G30405","SUP","HCPCS C2627","","G30405  -  SET CATH 12FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC","BOTH IP/OP","$166.10 ","$122.91 ","$0.00 ","$166.10 ","$90.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.08 ","$166.10 ","$0.00 ","$83.05 ","$131.55 ","$132.88 ","$0.00 ","$25.99 ","$0.00 ","$26.44 ","$0.00 "
"G30470","SUP","HCPCS C1769","","G30470  -  SET CATH 14FR 25CM MCLC NDL OBT CNN CNCT TUBE LCK LOOP","BOTH IP/OP","$595.83 ","$440.91 ","$0.00 ","$595.83 ","$323.53 ","$0.00 ","$124.18 ","$0.00 ","$0.00 ","$104.32 ","$595.83 ","$0.00 ","$297.91 ","$471.90 ","$476.66 ","$0.00 ","$93.25 ","$0.00 ","$94.86 ","$0.00 "
"G30471","SUP","HCPCS C1769","","G30471  -  GUIDEWIRE VASCULAR .038IN 150CM 3CM STIFF ANGLED TIP CORE","BOTH IP/OP","$119.17 ","$88.19 ","$0.00 ","$119.17 ","$64.71 ","$0.00 ","$24.84 ","$0.00 ","$0.00 ","$20.86 ","$119.17 ","$0.00 ","$59.58 ","$94.38 ","$95.33 ","$0.00 ","$18.65 ","$0.00 ","$18.97 ","$0.00 "
"G30472","SUP","HCPCS C1769","","G30472  -  GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ","BOTH IP/OP","$75.84 ","$56.12 ","$0.00 ","$75.84 ","$41.18 ","$0.00 ","$15.81 ","$0.00 ","$0.00 ","$13.28 ","$75.84 ","$0.00 ","$37.92 ","$60.07 ","$60.67 ","$0.00 ","$11.87 ","$0.00 ","$12.07 ","$0.00 "
"G30473","SUP","HCPCS C1769","","G30473  -  GUIDEWIRE VASCULAR STANDARD STR TAPER .038IN 150CM 3CM ONE","BOTH IP/OP","$74.80 ","$55.35 ","$0.00 ","$74.80 ","$40.61 ","$0.00 ","$15.59 ","$0.00 ","$0.00 ","$13.10 ","$74.80 ","$0.00 ","$37.40 ","$59.24 ","$59.84 ","$0.00 ","$11.71 ","$0.00 ","$11.91 ","$0.00 "
"G30474","SUP","HCPCS C1769","","G30474  -  GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ","BOTH IP/OP","$119.17 ","$88.19 ","$0.00 ","$119.17 ","$64.71 ","$0.00 ","$24.84 ","$0.00 ","$0.00 ","$20.86 ","$119.17 ","$0.00 ","$59.58 ","$94.38 ","$95.33 ","$0.00 ","$18.65 ","$0.00 ","$18.97 ","$0.00 "
"G30475","SUP","HCPCS C1769","","G30475  -  GUIDEWIRE VASCULAR ANGLE TAPER .035IN 150CM 3CM 1TO 1 TORQUE","BOTH IP/OP","$119.17 ","$88.19 ","$0.00 ","$119.17 ","$64.71 ","$0.00 ","$24.84 ","$0.00 ","$0.00 ","$20.86 ","$119.17 ","$0.00 ","$59.58 ","$94.38 ","$95.33 ","$0.00 ","$18.65 ","$0.00 ","$18.97 ","$0.00 "
"G30476","SUP","HCPCS C1769","","G30476  -  GUIDEWIRE VASCULAR STANDARD STR TAPER .035IN 150CM 3CM 1TO 1","BOTH IP/OP","$74.80 ","$55.35 ","$0.00 ","$74.80 ","$40.61 ","$0.00 ","$15.59 ","$0.00 ","$0.00 ","$13.10 ","$74.80 ","$0.00 ","$37.40 ","$59.24 ","$59.84 ","$0.00 ","$11.71 ","$0.00 ","$11.91 ","$0.00 "
"G30477","SUP","HCPCS C1769","","G30477  -  GUIDEWIRE VASC STRG TPR .035IN 150CM 3CM HIWIRE STF BD 1 TO","BOTH IP/OP","$119.17 ","$88.19 ","$0.00 ","$119.17 ","$64.71 ","$0.00 ","$24.84 ","$0.00 ","$0.00 ","$20.86 ","$119.17 ","$0.00 ","$59.58 ","$94.38 ","$95.33 ","$0.00 ","$18.65 ","$0.00 ","$18.97 ","$0.00 "
"G30478","SUP","HCPCS C1769","","G30478  -  GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD STRG","BOTH IP/OP","$119.17 ","$88.19 ","$0.00 ","$119.17 ","$64.71 ","$0.00 ","$24.84 ","$0.00 ","$0.00 ","$20.86 ","$119.17 ","$0.00 ","$59.58 ","$94.38 ","$95.33 ","$0.00 ","$18.65 ","$0.00 ","$18.97 ","$0.00 "
"G30479","SUP","HCPCS C1769","","G30479  -  GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD ANG","BOTH IP/OP","$75.84 ","$56.12 ","$0.00 ","$75.84 ","$41.18 ","$0.00 ","$15.81 ","$0.00 ","$0.00 ","$13.28 ","$75.84 ","$0.00 ","$37.92 ","$60.07 ","$60.67 ","$0.00 ","$11.87 ","$0.00 ","$12.07 ","$0.00 "
"G30480","SUP","HCPCS C1769","","G30480  -  GUIDEWIRE VASC ANG TPR .025IN 150CM STRL 3CM HIWIRE STD BD","BOTH IP/OP","$75.84 ","$56.12 ","$0.00 ","$75.84 ","$41.18 ","$0.00 ","$15.81 ","$0.00 ","$0.00 ","$13.28 ","$75.84 ","$0.00 ","$37.92 ","$60.07 ","$60.67 ","$0.00 ","$11.87 ","$0.00 ","$12.07 ","$0.00 "
"G30481","SUP","HCPCS C1769","","G30481  -  GUIDEWIRE VASCULAR STANDARD ANGLE TAPER .035IN 150CM 3CM 1TO","BOTH IP/OP","$379.18 ","$280.59 ","$0.00 ","$379.18 ","$205.89 ","$0.00 ","$79.03 ","$0.00 ","$0.00 ","$66.39 ","$379.18 ","$0.00 ","$189.59 ","$300.31 ","$303.34 ","$0.00 ","$59.34 ","$0.00 ","$60.36 ","$0.00 "
"G31027","SUP","Custom 27203010","","G31027  -  DEVICE SPHR 20ML EZTRD ERGONOMICAL QRLSE LOCK LVR INFLAT 30","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G31138","SUP","HCPCS C1894","","G31138  -  INTRODUCER SHEATH .038IN 6FR .087IN 90CM TUOHY BORST SIDEARM","BOTH IP/OP","$401.06 ","$296.78 ","$0.00 ","$387.50 ","$210.41 ","$0.00 ","$83.59 ","$0.00 ","$0.00 ","$67.85 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$60.64 ","$0.00 ","$61.69 ","$0.00 "
"G31215","SUP","Custom 27203010","","G31215  -  CATH ANGIO .035IN PGTL 5FR 70CM SZ 10 SDPRT RADIOPQ MRKR NYL","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G31216","SUP","HCPCS C1884","","G31216  -  CATH ANGIO .035IN PGTL 5FR 100CM SZ 10 SDPRT RADIOPQ MRKR","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"G31221","SUP","HCPCS C1884","","G31221  -  CATH ANGIO .035IN VCF CURVE 5FR 100CM 10 SDPRT RADIOPQ MRKR","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"G31518","SUP","Custom 27203010","","G31518  -  NEEDLE ENDSCP 22GA 5.2FR 8- CM ULTRASOUND BALL TIP ADJUST","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G31519","SUP","Custom 27203010","","G31519  -  NEEDLE ENDSCP 25GA 5.2FR 0-8CM ULTRASOUND CNTOUR HANDLE","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G31520","SUP","Custom 27203010","","G31520  -  NEEDLE ENDSCP 19GA 5.2-4.2FR 0-8CM ULTRASOUND CNTOUR HANDLE","BOTH IP/OP","$730.00 ","$540.20 ","$0.00 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$730.00 ","$0.00 ","$365.00 ","$578.16 ","$584.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G31550","SUP","HCPCS C1894","","G31550  -  CATHETER PSH .035IN 5FR STRL LF FSN GW BIL DCT DISP ESCP","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$97.74 ","$0.00 ","$37.52 ","$0.00 ","$0.00 ","$31.52 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$28.17 ","$0.00 ","$28.66 ","$0.00 "
"G31551","SUP","Custom 27203010","","G31551  -  CATHETER ENDSCP 7FR 3.2MM 170CM DOME TIP FUSION PURPLE","BOTH IP/OP","$180.00 ","$133.20 ","$0.00 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$180.00 ","$0.00 ","$90.00 ","$142.56 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32011","SUP","HCPCS C1876","","G32011  -  STENT BIL 6MM 6FR 30MM 80CM SLF XPD FLXB FLXR INTROD GOLD","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"G32233","SUP","HCPCS C1894","","G32233  -  INTRODUCER SHEATH .038IN LONG 10FR 40CM LARGE VALVE ASMBLY","BOTH IP/OP","$192.85 ","$142.71 ","$0.00 ","$190.00 ","$103.17 ","$0.00 ","$40.19 ","$0.00 ","$0.00 ","$33.27 ","$190.00 ","$0.00 ","$95.00 ","$150.48 ","$152.00 ","$0.00 ","$29.74 ","$0.00 ","$30.25 ","$0.00 "
"G32500","SUP","HCPCS C1874","","G32500  -  GRAFT EVAS 2 BRCH 12MM 106MM STRL 28MM H&L-B 1-SHOT ZNTH","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32501","SUP","HCPCS C1874","","G32501  -  GRAFT EVAS 2 BRCH 12MM 7.7MM 20FR 121MM 28MM ZNTH H&L-B","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32502","SUP","HCPCS C1874","","G32502  -  GRAFT EVAS 24MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32503","SUP","HCPCS C1874","","G32503  -  GRAFT EVAS 26MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32504","SUP","HCPCS C1874","","G32504  -  GRAFT EVAS 28MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32505","SUP","HCPCS C1874","","G32505  -  GRAFT EVAS 30MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32506","SUP","HCPCS C1874","","G32506  -  GRAFT EVAS 32MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32507","SUP","HCPCS C1874","","G32507  -  GRAFT EVAS 24MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32508","SUP","HCPCS C1874","","G32508  -  GRAFT EVAS 26MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32509","SUP","HCPCS C1874","","G32509  -  GRAFT EVAS 28MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32510","SUP","HCPCS C1874","","G32510  -  GRAFT EVAS 30MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32511","SUP","HCPCS C1874","","G32511  -  GRAFT EVAS 32MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32512","SUP","HCPCS C1874","","G32512  -  GRAFT EVAS 24MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32513","SUP","HCPCS C1874","","G32513  -  GRAFT EVAS 26MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32514","SUP","HCPCS C1874","","G32514  -  GRAFT EVAS 28MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32515","SUP","HCPCS C1874","","G32515  -  GRAFT EVAS 30MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32516","SUP","HCPCS C1874","","G32516  -  GRAFT EVAS 32MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32517","SUP","HCPCS C1874","","G32517  -  GRAFT EVAS 24MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32518","SUP","HCPCS C1874","","G32518  -  GRAFT EVAS 26MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32519","SUP","HCPCS C1874","","G32519  -  GRAFT EVAS 28MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32520","SUP","HCPCS C1874","","G32520  -  GRAFT EVAS 30MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32521","SUP","HCPCS C1874","","G32521  -  GRAFT EVAS 32MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32522","SUP","HCPCS C1874","","G32522  -  GRAFT EVAS 34MM 7.7MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32523","SUP","HCPCS C1874","","G32523  -  GRAFT EVAS 36MM 8.5MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32524","SUP","HCPCS C1874","","G32524  -  GRAFT EVAS 34MM 7.7MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32525","SUP","HCPCS C1874","","G32525  -  GRAFT EVAS 36MM 8.5MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32526","SUP","HCPCS C1874","","G32526  -  GRAFT EVAS 34MM 7.7MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32527","SUP","HCPCS C1874","","G32527  -  GRAFT EVAS 36MM 8.5MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32528","SUP","HCPCS C1874","","G32528  -  GRAFT EVAS 34MM 7.7MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32529","SUP","HCPCS C1874","","G32529  -  GRAFT EVAS 36MM 8.5MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32530","SUP","HCPCS C1874","","G32530  -  GRAFT EVAS 24MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32531","SUP","HCPCS C1874","","G32531  -  GRAFT EVAS 26MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32532","SUP","HCPCS C1874","","G32532  -  GRAFT EVAS 20FR 94MM 28MM ZNTH VSCR FEN PROX BFUR BD AAA","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32533","SUP","HCPCS C1874","","G32533  -  GRAFT EVAS 30MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32534","SUP","HCPCS C1874","","G32534  -  GRAFT EVAS 32MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32535","SUP","HCPCS C1874","","G32535  -  GRAFT EVAS 24MM 7.7MM 20FR 109MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32536","SUP","HCPCS C1874","","G32536  -  GRAFT EVAS 26MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32537","SUP","HCPCS C1874","","G32537  -  GRAFT EVAS 28MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32538","SUP","HCPCS C1874","","G32538  -  GRAFT EVAS 30MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32539","SUP","HCPCS C1874","","G32539  -  GRAFT EVAS 32MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32540","SUP","HCPCS C1874","","G32540  -  GRAFT EVAS 24MM 7.7MM 20FR 124MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32541","SUP","HCPCS C1874","","G32541  -  GRAFT EVAS 12FR 124MM 91MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32542","SUP","HCPCS C1874","","G32542  -  GRAFT EVAS 2FR 124MM 28MM ZNTH FEN PROX BD AAA","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32543","SUP","HCPCS C1874","","G32543  -  GRAFT EVAS 30MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32544","SUP","HCPCS C1874","","G32544  -  GRAFT EVAS 32MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32545","SUP","HCPCS C1874","","G32545  -  GRAFT EVAS 34MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32546","SUP","HCPCS C1874","","G32546  -  GRAFT EVAS 36MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32547","SUP","HCPCS C1874","","G32547  -  GRAFT EVAS 34MM 20FR 122MM STRL H L-B 1-SHOT ZNTH 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32548","SUP","HCPCS C1874","","G32548  -  GRAFT EVAS 36MM 8.5MM 22FR 122MM ZNTH H&L-B 1-SHOT 2 PROX","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32549","SUP","HCPCS C1874","","G32549  -  GRAFT EVAS 34MM 137MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32550","SUP","HCPCS C1874","","G32550  -  GRAFT EVAS 36MM 137MM STRL ZNTH H&L-B 1-SHOT 2 PROX INTNL","BOTH IP/OP","$27,500.00 ","$20,350.00 ","$0.00 ","$27,500.00 ","$12,375.00 ","$0.00 ","$5,731.69 ","$0.00 ","$0.00 ","$4,815.03 ","$27,500.00 ","$0.00 ","$13,750.00 ","$21,780.00 ","$22,000.00 ","$0.00 ","$4,303.75 ","$0.00 ","$4,378.00 ","$0.00 "
"G32551","SUP","HCPCS C1874","","G32551  -  GRAFT EVAS 12FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32552","SUP","HCPCS C1874","","G32552  -  GRAFT EVAS 16FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32553","SUP","HCPCS C1874","","G32553  -  GRAFT EVAS 20FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32554","SUP","HCPCS C1874","","G32554  -  GRAFT EVAS 12FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32555","SUP","HCPCS C1874","","G32555  -  GRAFT EVAS 16FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32556","SUP","HCPCS C1874","","G32556  -  GRAFT EVAS 20FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32557","SUP","HCPCS C1874","","G32557  -  GRAFT EVAS 16FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32558","SUP","HCPCS C1874","","G32558  -  GRAFT EVAS 20FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32559","SUP","HCPCS C1874","","G32559  -  GRAFT EVAS 16FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32560","SUP","HCPCS C1874","","G32560  -  GRAFT EVAS 20FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32561","SUP","HCPCS C1874","","G32561  -  GRAFT EVAS 12FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32562","SUP","HCPCS C1874","","G32562  -  GRAFT EVAS 16FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32563","SUP","HCPCS C1874","","G32563  -  GRAFT EVAS 20FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32564","SUP","HCPCS C1874","","G32564  -  GRAFT EVAS 24FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32565","SUP","HCPCS C1874","","G32565  -  GRAFT EVAS 12FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32566","SUP","HCPCS C1874","","G32566  -  GRAFT EVAS 16FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32567","SUP","HCPCS C1874","","G32567  -  GRAFT EVAS 20FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32568","SUP","HCPCS C1874","","G32568  -  GRAFT EVAS 24FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32569","SUP","HCPCS C1874","","G32569  -  GRAFT EVAS 12FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32570","SUP","HCPCS C1874","","G32570  -  GRAFT EVAS 16FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32571","SUP","HCPCS C1874","","G32571  -  GRAFT EVAS 2 BRCH 20FR 106MM 45MM ZNTH H&L-B 1-SHOT VSCR FEN","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32572","SUP","HCPCS C1874","","G32572  -  GRAFT EVAS 24FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32573","SUP","HCPCS C1874","","G32573  -  GRAFT EVAS 12FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32574","SUP","HCPCS C1874","","G32574  -  GRAFT EVAS 16FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32575","SUP","HCPCS C1874","","G32575  -  GRAFT EVAS 20FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32576","SUP","HCPCS C1874","","G32576  -  GRAFT EVAS 24FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32577","SUP","HCPCS C1874","","G32577  -  GRAFT EVAS 12FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32578","SUP","HCPCS C1874","","G32578  -  GRAFT EVAS 2 BRCH 20MM 8.1MM 20FR 76MM STRL 62MM ZNTH DIST","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32579","SUP","HCPCS C1874","","G32579  -  GRAFT EVAS 24FR 76MM 62MM ZNTH 1-SHOT 2 BRCH VSCR FENESTRATE","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32580","SUP","HCPCS C1874","","G32580  -  GRAFT EVAS 12FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32581","SUP","HCPCS C1874","","G32581  -  GRAFT EVAS 16FR 91MM 62MM ZNTH FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32582","SUP","HCPCS C1874","","G32582  -  GRAFT EVAS 20FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32583","SUP","HCPCS C1874","","G32583  -  GRAFT EVAS 24FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32584","SUP","HCPCS C1874","","G32584  -  GRAFT EVAS 12FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32585","SUP","HCPCS C1874","","G32585  -  GRAFT EVAS 16FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32586","SUP","HCPCS C1874","","G32586  -  GRAFT EVAS 20FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32587","SUP","HCPCS C1874","","G32587  -  GRAFT EVAS 24FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32588","SUP","HCPCS C1874","","G32588  -  GRAFT EVAS 12FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32589","SUP","HCPCS C1874","","G32589  -  GRAFT EVAS 16FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32590","SUP","HCPCS C1874","","G32590  -  GRAFT EVAS 20FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32591","SUP","HCPCS C1874","","G32591  -  GRAFT EVAS 24FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32592","SUP","HCPCS C1874","","G32592  -  GRAFT EVAS 16FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$4,171.50 ","$0.00 ","$1,932.10 ","$0.00 ","$0.00 ","$1,623.10 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$1,450.76 ","$0.00 ","$1,475.78 ","$0.00 "
"G32701","SUP","Custom 27203010","","G32701  -  GUIDEWIRE VASC TPR STRG .025IN 150CM 3CM HIWIRE 1 TO 1 TRQ","BOTH IP/OP","$103.07 ","$76.27 ","$0.00 ","$103.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$103.07 ","$0.00 ","$51.53 ","$81.63 ","$82.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32702","SUP","Custom 27203010","","G32702  -  EXTRACTOR STON 2.4FR 1CM 115CM STRL NCOMPASS NCRCL 16 4WR","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32724","SUP","Custom 27203010","","G32724  -  EXTRACTOR STON 7MM 2.8FR 145MM NTRAP UMRL DSGN ENTRAPMENT","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32727","SUP","Custom 27203010","","G32727  -  CATHETER URTH 26FR 34CM UNIVERSA 2W FL CLS END RND TIP SIL","BOTH IP/OP","$33.94 ","$25.12 ","$0.00 ","$33.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.94 ","$0.00 ","$16.97 ","$26.88 ","$27.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32730","SUP","Custom 27203010","","G32730  -  EXTRACTOR STON HLX 3FR 3.2FR 115CM STRL CPTR 4WR OCL BSKT","BOTH IP/OP","$473.25 ","$350.21 ","$0.00 ","$473.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$473.25 ","$0.00 ","$236.63 ","$374.81 ","$378.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32733","SUP","Custom 27203010","","G32733  -  EXTRACTOR STONE 3FR 3.2FR 115CM 3 WIRE HELICAL OCCLUSIVE","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32734","SUP","Custom 27203010","","G32734  -  EXTRACTOR STON 3FR 3.2FR 115CM 5CM ATLS WR 4WR FLFRM BSKT","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32739","SUP","Custom 27203010","","G32739  -  EXTRACTOR STON 1.1FR 1.7FR 115CM STRL ATLS WR 4WR OCL BSKT","BOTH IP/OP","$281.55 ","$208.35 ","$0.00 ","$281.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.55 ","$0.00 ","$140.78 ","$222.99 ","$225.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32740","SUP","Custom 27203010","","G32740  -  EXTRACTOR STON 4.5FR 65CM CPTR 4WR OCL BSKT SHTH SS","BOTH IP/OP","$281.55 ","$208.35 ","$0.00 ","$281.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.55 ","$0.00 ","$140.78 ","$222.99 ","$225.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32742","SUP","Custom 27203010","","G32742  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT SHTH","BOTH IP/OP","$281.55 ","$208.35 ","$0.00 ","$281.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.55 ","$0.00 ","$140.78 ","$222.99 ","$225.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32746","SUP","Custom 27203010","","G32746  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 5WR HLCL FLFRM BSKT SHTH","BOTH IP/OP","$281.55 ","$208.35 ","$0.00 ","$281.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.55 ","$0.00 ","$140.78 ","$222.99 ","$225.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32749","SUP","Custom 27203010","","G32749  -  EXTRACTOR STON HLX 4.5FR 65CM CPTR 4WR HLCL OCL BSKT SHTH SS","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32750","SUP","Custom 27203010","","G32750  -  EXTRACTOR STON HLCL 3FR 3.2FR 115CM STRL CPTR 5WR OCL SHTH","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32756","SUP","Custom 27203010","","G32756  -  EXTRACTOR STON 3FR 3.2FR 115CM 5CM CPTR 4WR HLCL FLFRM BSKT","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32757","SUP","Custom 27203010","","G32757  -  EXTRACTOR STON 2.5FR 115CM CPTR 4WR HLCL OCL URO SS","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32773","SUP","HCPCS C2625","","G32773  -  CATHETER URTH 26FR 34CM UNIVERSA 2W FL OP-EN OPN TIP SIL","BOTH IP/OP","$17.08 ","$12.64 ","$0.00 ","$17.08 ","$7.69 ","$0.00 ","$3.56 ","$0.00 ","$0.00 ","$2.99 ","$17.08 ","$0.00 ","$8.54 ","$13.53 ","$13.67 ","$0.00 ","$2.67 ","$0.00 ","$2.72 ","$0.00 "
"G32774","SUP","HCPCS C2625","","G32774  -  SET NPHSTM 4FR .025IN 12-18CM 145CM SALLE SFLX GW STY SS PU","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$92.25 ","$0.00 ","$42.73 ","$0.00 ","$0.00 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"G32779","SUP","Custom 27203010","","G32779  -  EXTRACTOR STONE 1.7FR 115CM 3 WIRE HELICAL OCCLUSIVE BASKET","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32781","SUP","Custom 27203010","","G32781  -  SET STNT .038IN 4.7FR 12-18CM STRL 145CM SALLE INTOP GW STY","BOTH IP/OP","$281.55 ","$208.35 ","$0.00 ","$281.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.55 ","$0.00 ","$140.78 ","$222.99 ","$225.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32784","SUP","Custom 27203010","","G32784  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 6WR HLCL OCL BSKT SHTH SS","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32786","SUP","Custom 27203010","","G32786  -  EXTRACTOR STON 5CM 3.2FR 3FR 115CM CPTR 3WR HLCL FLFRM SS","BOTH IP/OP","$281.55 ","$208.35 ","$0.00 ","$281.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$281.55 ","$0.00 ","$140.78 ","$222.99 ","$225.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32788","SUP","Custom 27203010","","G32788  -  EXTRACTOR STON HLX 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32789","SUP","HCPCS C1726","","G32789  -  SET DILAT 8-20FR 37CM SIDEPORT LOW FRICTION SLIPPERY SURFACE","BOTH IP/OP","$451.00 ","$333.74 ","$0.00 ","$451.00 ","$244.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.97 ","$451.00 ","$0.00 ","$225.50 ","$357.19 ","$360.80 ","$0.00 ","$70.58 ","$0.00 ","$71.80 ","$0.00 "
"G32824","SUP","Custom 27203010","","G32824  -  EXTRACTOR STONE 3.2FR 3FR 115CM 4 WIRE SHEATH TIP OCCLUSIVE","BOTH IP/OP","$407.30 ","$301.40 ","$0.00 ","$407.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$407.30 ","$0.00 ","$203.65 ","$322.58 ","$325.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32831","SUP","HCPCS C1758","","G32831  -  CATH URET .038IN 5FR 6MM 4CM TPR TIP PLTN BAND GWIRE","BOTH IP/OP","$433.88 ","$321.07 ","$0.00 ","$433.88 ","$235.59 ","$0.00 ","$90.43 ","$0.00 ","$0.00 ","$75.97 ","$433.88 ","$0.00 ","$216.94 ","$343.63 ","$347.10 ","$0.00 ","$67.90 ","$0.00 ","$69.07 ","$0.00 "
"G32833","SUP","HCPCS C1758","","G32833  -  CATH URET .038IN 5FR 6MM 10CM TPR TIP PLTN BAND GWIRE","BOTH IP/OP","$433.88 ","$321.07 ","$0.00 ","$433.88 ","$235.59 ","$0.00 ","$90.43 ","$0.00 ","$0.00 ","$75.97 ","$433.88 ","$0.00 ","$216.94 ","$343.63 ","$347.10 ","$0.00 ","$67.90 ","$0.00 ","$69.07 ","$0.00 "
"G32840","SUP","HCPCS C1758","","G32840  -  SET CATH ASCND BALDILAT INFLAT DEV TPR TIP PLTN BAND GWIRE 5","BOTH IP/OP","$511.88 ","$378.79 ","$0.00 ","$511.88 ","$277.95 ","$0.00 ","$106.69 ","$0.00 ","$0.00 ","$89.63 ","$511.88 ","$0.00 ","$255.94 ","$405.41 ","$409.50 ","$0.00 ","$80.11 ","$0.00 ","$81.49 ","$0.00 "
"G32842","SUP","HCPCS C1758","","G32842  -  SET CATH ASCND BALDILAT INFLAT DEV TPR TIP PLTN BAND GWIRE 5","BOTH IP/OP","$511.88 ","$378.79 ","$0.00 ","$511.88 ","$277.95 ","$0.00 ","$106.69 ","$0.00 ","$0.00 ","$89.63 ","$511.88 ","$0.00 ","$255.94 ","$405.41 ","$409.50 ","$0.00 ","$80.11 ","$0.00 ","$81.49 ","$0.00 "
"G32852","SUP","HCPCS C1894","","G32852  -  EXTRACTOR STON 2.5FR 2.8FR 115CM CPTR 4WR OCL BSKT SHTH SS","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G32853","SUP","HCPCS C1894","","G32853  -  SHEATH ACC 12FR 13CM FLXR DILATION CNT WRK CHNL PRTC PED","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G32855","SUP","HCPCS C2627","","G32855  -  SHEATH ACC 9.5FR 13CM FLXR DILATION CNT WKG CHNL PRTC PED","BOTH IP/OP","$223.98 ","$165.75 ","$0.00 ","$223.98 ","$121.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.22 ","$223.98 ","$0.00 ","$111.99 ","$177.39 ","$179.18 ","$0.00 ","$35.05 ","$0.00 ","$35.66 ","$0.00 "
"G32862","SUP","Custom 27203010","","G32862  -  STENT URET 8.5FR 65CM WHT STRL PATERSON-FORRESTER DISP URN","BOTH IP/OP","$289.10 ","$213.93 ","$0.00 ","$289.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$289.10 ","$0.00 ","$144.55 ","$228.97 ","$231.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G32863","SUP","Custom 27203010","","G32863  -  EXTRACTOR STON 10FR 2CM 38CM PRC NC BSKT RPD ATRM TPLS NTNL","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G33016","SUP","HCPCS C1880","","G33016  -  SYSTEM EMBOLIC PROTECTION 30MM 8.5FR 50MM 65CM DILAT COAXIAL","BOTH IP/OP","$3,050.00 ","$2,257.00 ","$0.00 ","$3,050.00 ","$1,372.50 ","$0.00 ","$635.70 ","$0.00 ","$0.00 ","$534.03 ","$3,050.00 ","$0.00 ","$1,525.00 ","$2,415.60 ","$2,440.00 ","$0.00 ","$477.33 ","$0.00 ","$485.56 ","$0.00 "
"G33017","SUP","HCPCS C1880","","G33017  -  FILTER EMBOLIZATION 30MM 8.5FR 50MM 65CM 3 WAY STOPCOCK","BOTH IP/OP","$3,050.00 ","$2,257.00 ","$0.00 ","$3,050.00 ","$1,372.50 ","$0.00 ","$635.70 ","$0.00 ","$0.00 ","$534.03 ","$3,050.00 ","$0.00 ","$1,525.00 ","$2,415.60 ","$2,440.00 ","$0.00 ","$477.33 ","$0.00 ","$485.56 ","$0.00 "
"G34038","SUP","Custom 27203010","","G34038  -  BRUSH CYTO 1MM 5MM SHFT US CYSTIC ECHOBRUSH ECHTP STRL DISP","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G34176","SUP","HCPCS C2625","","G34176  -  EXTRACTOR STON 1.5CM 2.4FR 115CM 1.5CM NCOMPASS 4/16 WRE MOD","BOTH IP/OP","$2,245.75 ","$1,661.86 ","$0.00 ","$2,245.75 ","$1,010.59 ","$0.00 ","$468.07 ","$0.00 ","$0.00 ","$393.21 ","$2,245.75 ","$0.00 ","$1,122.88 ","$1,778.63 ","$1,796.60 ","$0.00 ","$351.46 ","$0.00 ","$357.52 ","$0.00 "
"G34309","SUP","HCPCS C1880","","G34309  -  FILTER EMBL 65CM 30MM 7FR 49MM STRL 71CM CELECT NAVALIGN","BOTH IP/OP","$3,522.38 ","$2,606.56 ","$0.00 ","$2,312.50 ","$1,040.63 ","$0.00 ","$734.15 ","$0.00 ","$0.00 ","$404.90 ","$2,312.50 ","$0.00 ","$1,156.25 ","$1,831.50 ","$1,850.00 ","$0.00 ","$361.91 ","$0.00 ","$368.15 ","$0.00 "
"G34311","SUP","Custom 27203010","","G34311  -  STENT URET 6FR 30CM RSNCE PSTN MTL ADLT URETER","BOTH IP/OP","$45.00 ","$33.30 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G34502","SUP","HCPCS C1880","","G34502  -  FILTER EMBOLIZATION 65CM 30MM 7FR 49MM 79CM RADIOPQ PRELOAD","BOTH IP/OP","$3,522.38 ","$2,606.56 ","$0.00 ","$2,312.50 ","$1,040.63 ","$0.00 ","$734.15 ","$0.00 ","$0.00 ","$404.90 ","$2,312.50 ","$0.00 ","$1,156.25 ","$1,831.50 ","$1,850.00 ","$0.00 ","$361.91 ","$0.00 ","$368.15 ","$0.00 "
"G34870","SUP","HCPCS C1894","","G34870  -  ADAPTER L/S NS VUELITE ACMI SCP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G34871","SUP","HCPCS C1894","","G34871  -  SHEATH ACC 10.7FR 13CM RPD RELS PRLL FLXR CNT CHNL URETER","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G34872","SUP","HCPCS C1894","","G34872  -  SHEATH ACC 10.7FR 20CM RPD RELS PRLL FLXR CNT CHNL URETER","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G34873","SUP","HCPCS C1894","","G34873  -  SHEATH ACC 10.7FR 28CM RPD RELS PRLL FLXR CNT CHNL URETER","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G34874","SUP","HCPCS C1894","","G34874  -  SHEATH ACC 10.7FR 35CM RPD RELS PRLL FLXR CNT CHNL URETER","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G34875","SUP","HCPCS C1894","","G34875  -  SHEATH ACC 10.7FR 45CM RPD RELS PRLL FLXR CNT CHNL URETER","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G34876","SUP","HCPCS C1894","","G34876  -  SHEATH ACC 10.7FR 55CM RPD RELS PRLL FLXR CNT CHNL URETER","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G34877","SUP","HCPCS C1894","","G34877  -  SHEATH ACC 10.7FR 13CM FLXR DILATION CNT WRK CHNL URETER","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G34878","SUP","HCPCS C1894","","G34878  -  SHEATH ACCES SM TPR FNL 10.7FR DILAT LOCK HUB FLXB","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G34879","SUP","HCPCS C1894","","G34879  -  SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G34880","SUP","HCPCS C1894","","G34880  -  SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G34881","SUP","HCPCS C1894","","G34881  -  SHEATH ACC 10.7FR 20CM FLXR DILATION CNT WRK CHNL URETER","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G34931","SUP","Custom 27203010","","G34931  -  SHEATH ACC 10.7FR 55CM FLXR DILATION CNT WRK CHNL URETER","BOTH IP/OP","$462.50 ","$342.25 ","$0.00 ","$462.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$462.50 ","$0.00 ","$231.25 ","$366.30 ","$370.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G35129","SUP","Custom 27203010","","G35129  -  LIGATOR ENDSCP MINI HEXAGON 9.5-13MM 5FR 2.8MM 6 BAND SNARE","BOTH IP/OP","$795.00 ","$588.30 ","$0.00 ","$795.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$795.00 ","$0.00 ","$397.50 ","$629.64 ","$636.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G36022","SUP","HCPCS C1876","","G36022  -  STENT BILIARY .035IN 5MM 6FR 80MM 125CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G36226","SUP","HCPCS C1763","","G36226  -  GRAFT SFT TIS 9.5X.6CM ANAL FSTL PLUS SIS AFP PIG STRL DISP","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"G36229","SUP","HCPCS C1876","","G36229  -  STENT BIL 12MM 6FR 40MM 80CM .035IN SLF XPD FLXB FLXR INTROD","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G36231","SUP","HCPCS C1876","","G36231  -  STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD FLXB FLXR INTROD","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G36239","SUP","HCPCS C1876","","G36239  -  STENT BIL 12MM 40MM STRL 125CM ZL 635 FLXR SLF XPD RADOPQ","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G36240","SUP","HCPCS C1876","","G36240  -  STENT BIL .035IN 12MM 6FR 60MM STRL 125CM ZL 635 SLF XPD","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G36245","SUP","HCPCS C1876","","G36245  -  STENT BIL 14MM 6FR 60MM 125CM .035IN SLF XPD FLXB FLXR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G36321","SUP","Custom 27803010","","G36321  -  CATH ANGIO SLIP-CATH HYDROPHILIC .038 IN 160 D TIGHT CURVE","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G36333","SUP","HCPCS C1894","","G36333  -  SET INTROD .018IN 5FR 21GA 10CM 40CM COAXIAL CATHETER GWIRE","BOTH IP/OP","$101.50 ","$75.11 ","$0.00 ","$100.00 ","$54.30 ","$0.00 ","$21.16 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"G36359","SUP","HCPCS C1725","","G36359  -  CATH ANGIO .035IN VTK CURVE 5.5FR 125CM SHTH GWIRE RADIOPQ","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$105.89 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"G36360","SUP","HCPCS C1725","","G36360  -  CATH ANGIO .035IN SIM2 CURVE 5.5FR 125CM SHTH GWIRE RADIOPQ","BOTH IP/OP","$195.00 ","$144.30 ","$0.00 ","$195.00 ","$105.89 ","$0.00 ","$40.64 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"G36405","SUP","HCPCS C1770","","G36405  -  COIL EMBOLIZATION .035IN 5MM 5CM 3.1 LOOP MREYE PLATINUM","BOTH IP/OP","$264.07 ","$195.41 ","$0.00 ","$250.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.30 ","$0.00 ","$125.15 ","$198.24 ","$200.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G38463","SUP","HCPCS C1874","","G38463  -  STENT VASCULAR 6MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"G38479","SUP","HCPCS C1874","","G38479  -  STENT VASCULAR 6MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"G38480","SUP","HCPCS C1874","","G38480  -  STENT VASCULAR 6MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G38481","SUP","HCPCS C1874","","G38481  -  STENT VASCULAR 125CM 6FR 80MM 100MM OTW ZILVER PTX","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G38482","SUP","HCPCS C1874","","G38482  -  STENT VASCULAR 6MM 120MM 125CM DRUG ELUTE OTW DELIVERY","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$2,244.38 ","$0.00 ","$1,039.52 ","$0.00 ","$0.00 ","$873.27 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$780.54 ","$0.00 ","$794.01 ","$0.00 "
"G38486","SUP","HCPCS C1874","","G38486  -  STENT VASCULAR 7MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM","BOTH IP/OP","$2,937.50 ","$2,173.75 ","$0.00 ","$2,937.50 ","$1,321.88 ","$0.00 ","$612.25 ","$0.00 ","$0.00 ","$514.33 ","$2,937.50 ","$0.00 ","$1,468.75 ","$2,326.50 ","$2,350.00 ","$0.00 ","$459.72 ","$0.00 ","$467.65 ","$0.00 "
"G38487","SUP","HCPCS C1874","","G38487  -  STENT VASCULAR 7MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM","BOTH IP/OP","$3,737.50 ","$2,765.75 ","$0.00 ","$3,737.50 ","$1,681.88 ","$0.00 ","$778.99 ","$0.00 ","$0.00 ","$654.41 ","$3,737.50 ","$0.00 ","$1,868.75 ","$2,960.10 ","$2,990.00 ","$0.00 ","$584.92 ","$0.00 ","$595.01 ","$0.00 "
"G38488","SUP","HCPCS C1874","","G38488  -  STENT VASCULAR 7MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G38489","SUP","HCPCS C1874","","G38489  -  STENT VASCULAR 7MM 100MM 125CM DRUG ELUTE OTW DELIVERY","BOTH IP/OP","$4,487.50 ","$3,320.75 ","$0.00 ","$4,487.50 ","$2,019.38 ","$0.00 ","$935.31 ","$0.00 ","$0.00 ","$785.73 ","$4,487.50 ","$0.00 ","$2,243.75 ","$3,554.10 ","$3,590.00 ","$0.00 ","$702.29 ","$0.00 ","$714.41 ","$0.00 "
"G38490","SUP","HCPCS C1874","","G38490  -  STENT VASCULAR 7MM 120MM 125CM DRUG ELUTE OTW DELIVERY","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$2,244.38 ","$0.00 ","$1,039.52 ","$0.00 ","$0.00 ","$873.27 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$780.54 ","$0.00 ","$794.01 ","$0.00 "
"G38532","SUP","HCPCS C1874","","G38532  -  STENT VASCULAR 8MM 120MM 125CM OTW DRUG ELUTE DELIVERY","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$2,244.38 ","$0.00 ","$1,039.52 ","$0.00 ","$0.00 ","$873.27 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$780.54 ","$0.00 ","$794.01 ","$0.00 "
"G38589","SUP","Custom 27803010","","G38589  -  GRAFT EVAS 2 BRCH 20MM 7.7MM 20FR 109MM 45MM ZNTH FENESTRATE","BOTH IP/OP","$9,270.00 ","$6,859.80 ","$0.00 ","$9,270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,270.00 ","$0.00 ","$4,635.00 ","$7,341.84 ","$7,416.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G42409","SUP","Custom 27803010","","G42409  -  COIL EMBOLIZATION .035IN 4MM 3CM 2.4 LOOP MREYE PLATINUM","BOTH IP/OP","$264.07 ","$195.41 ","$0.00 ","$250.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.30 ","$0.00 ","$125.15 ","$198.24 ","$200.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G42410","SUP","HCPCS C1770","","G42410  -  COIL EMBOLIZATION 5MM 3CM 1.9 LOOP STAINLESS STEEL SYNTH","BOTH IP/OP","$264.07 ","$195.41 ","$0.00 ","$250.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.30 ","$0.00 ","$125.15 ","$198.24 ","$200.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G42419","SUP","HCPCS C1770","","G42419  -  COIL EMBOLIZATION .035IN 3MM 5CM 5.3 LOOP STAINLESS STEEL","BOTH IP/OP","$264.07 ","$195.41 ","$0.00 ","$250.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.30 ","$0.00 ","$125.15 ","$198.24 ","$200.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G42423","SUP","HCPCS C1770","","G42423  -  COIL EMBOLIZATION .035IN 8MM 5CM 2 LOOP MREYE PLATINUM","BOTH IP/OP","$264.07 ","$195.41 ","$0.00 ","$250.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$250.30 ","$0.00 ","$125.15 ","$198.24 ","$200.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G43821","SUP","HCPCS C1876","","G43821  -  STENT VASCULAR .035IN 6MM 6FR 40MM 125CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43823","SUP","HCPCS C1876","","G43823  -  STENT VASCULAR 6MM 6FR 80MM 125CM SELF EXPAND INTROD OTW","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43831","SUP","HCPCS C1876","","G43831  -  STENT VASC 8MM 6FR 40MM 125CM .035IN SLF EXPANDABLE DLV SYS","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G43833","SUP","HCPCS C1876","","G43833  -  STENT VASC 8MM 6FR 80MM 125CM .035IN SLF XPD FLXB FLXR","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G43845","SUP","HCPCS C1877","","G43845  -  STENT VASC 6MM 6FR 30MM 80CM .035IN SLF XPD FLXB FLXR INTROD","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G43846","SUP","HCPCS C1876","","G43846  -  STENT VASCULAR 6MM 40MM 80CM SELF EXPAND OTW INTROD RADIOPQ","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43850","SUP","HCPCS C1876","","G43850  -  STENT VASC 7MM 6FR 30MM 80CM .035IN SLF XPD FLXB FLXR INTROD","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G43851","SUP","HCPCS C1876","","G43851  -  STENT VASCULAR 7MM 6FR 40MM 80CM SELF EXPAND FLEXIBLE SLOT","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43855","SUP","HCPCS C1876","","G43855  -  STENT VASCULAR .035IN 8MM 6FR 30MM 80CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43856","SUP","HCPCS C1876","","G43856  -  STENT VASCULAR .035IN 8MM 6FR 40MM 80CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43857","SUP","HCPCS C1876","","G43857  -  STENT VASCULAR .035IN 8MM 6FR 60MM 80CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43861","SUP","HCPCS C1876","","G43861  -  STENT VASCULAR 9MM 6FR 40MM 80CM SELF EXPAND INTROD OTW","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43863","SUP","HCPCS C1876","","G43863  -  STENT VASC 9MM 6FR 80MM 80CM .035IN SLF XPD FLXB FLXR INTROD","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G43865","SUP","HCPCS C1876","","G43865  -  STENT VASCULAR .035IN 10MM 6FR 30MM 80CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43866","SUP","HCPCS C1876","","G43866  -  STENT VASCULAR .035IN 10MM 6FR 40MM 80CM SELF EXPANDING","BOTH IP/OP","$2,283.75 ","$1,689.98 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$475.99 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"G43868","SUP","HCPCS C1876","","G43868  -  STENT VASC 10MM 6FR 80MM 80CM .035IN SLF EXPANDABLE DLV SYS","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G43870","SUP","HCPCS C1894","","G43870  -  SET INTROD 40CM 5FR MPNCH .018IN NTNL GWIRE 10CM VLNK STRL","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$69.00 ","$37.47 ","$0.00 ","$14.38 ","$0.00 ","$0.00 ","$12.08 ","$69.00 ","$0.00 ","$34.50 ","$54.65 ","$55.20 ","$0.00 ","$10.80 ","$0.00 ","$10.98 ","$0.00 "
"G44153","SUP","HCPCS C1894","","G44153  -  SHEATH GUID .018-.038IN ANL0 CURVE 5FR .074IN 45CM INTROD","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G44154","SUP","HCPCS C1894","","G44154  -  SHEATH GUID .018-.038IN ANL0 CURVE 6FR .087IN 45CM INTROD","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G44155","SUP","HCPCS C1894","","G44155  -  SHEATH GUID .018/.038IN ANL0 CURVE 7FR .1IN 45CM INTROD","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G44846","SUP","HCPCS C1769","","G44846  -  GUIDEWIRE URO STRG .035IN 150CM 3CM MTN HBRD FLXB","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"G44848","SUP","HCPCS C1769","","G44848  -  GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB STRG TIP","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"G44849","SUP","HCPCS C1769","","G44849  -  GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB STRG TIP","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"G44855","SUP","HCPCS C1769","","G44855  -  GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB ANG TIP","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"G45208","SUP","HCPCS C1769","","G45208  -  GUIDEWIRE VASCULAR CURVE .035IN 260CM 2 END FLEXIBLE TIP","BOTH IP/OP","$1,432.50 ","$1,060.05 ","$0.00 ","$1,432.50 ","$777.85 ","$0.00 ","$298.57 ","$0.00 ","$0.00 ","$250.82 ","$1,432.50 ","$0.00 ","$716.25 ","$1,134.54 ","$1,146.00 ","$0.00 ","$224.19 ","$0.00 ","$228.05 ","$0.00 "
"G45352","SUP","HCPCS C1769","","G45352  -  GUIDEWIRE VASC STRG .035IN 300CM 4CM LNDRQS XSTF FLX TP PTFE","BOTH IP/OP","$1,169.05 ","$865.10 ","$0.00 ","$1,169.05 ","$634.79 ","$0.00 ","$243.66 ","$0.00 ","$0.00 ","$204.69 ","$1,169.05 ","$0.00 ","$584.53 ","$925.89 ","$935.24 ","$0.00 ","$182.96 ","$0.00 ","$186.11 ","$0.00 "
"G46023","SUP","HCPCS C1726","","G46023  -  GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB ANG TIP","BOTH IP/OP","$103.87 ","$76.86 ","$0.00 ","$103.87 ","$56.40 ","$0.00 ","$21.65 ","$0.00 ","$0.00 ","$18.19 ","$103.87 ","$0.00 ","$51.94 ","$82.27 ","$83.10 ","$0.00 ","$16.26 ","$0.00 ","$16.54 ","$0.00 "
"G46024","SUP","HCPCS C1726","","G46024  -  CATHETER NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR","BOTH IP/OP","$618.80 ","$457.91 ","$0.00 ","$618.80 ","$336.01 ","$0.00 ","$128.97 ","$0.00 ","$0.00 ","$108.35 ","$618.80 ","$0.00 ","$309.40 ","$490.09 ","$495.04 ","$0.00 ","$96.84 ","$0.00 ","$98.51 ","$0.00 "
"G46027","SUP","Custom 27203010","","G46027  -  SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46028","SUP","HCPCS C1894","","G46028  -  EXTRACTOR STON 1.7FR 1CM 115CM NCOMPASS 4/16 WRE BSKT MOD","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46029","SUP","HCPCS C1894","","G46029  -  SHEATH ACC 3FR 9.5FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46030","SUP","HCPCS C2627","","G46030  -  SHEATH ACC 3FR 12FR 13CM FLXR 2 CNT WRK CHNL 2 LUM DILATION","BOTH IP/OP","$117.15 ","$86.69 ","$0.00 ","$117.15 ","$63.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.51 ","$117.15 ","$0.00 ","$58.58 ","$92.78 ","$93.72 ","$0.00 ","$18.33 ","$0.00 ","$18.65 ","$0.00 "
"G46031","SUP","HCPCS C2627","","G46031  -  SHEATH ACC 18FR 17CM CLR AMPTZ RADOPQ STRP RNL","BOTH IP/OP","$117.15 ","$86.69 ","$0.00 ","$117.15 ","$63.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.51 ","$117.15 ","$0.00 ","$58.58 ","$92.78 ","$93.72 ","$0.00 ","$18.33 ","$0.00 ","$18.65 ","$0.00 "
"G46032","SUP","HCPCS C2627","","G46032  -  SHEATH ACC 24FR 17CM CLR AMPTZ RADOPQ STRP RNL","BOTH IP/OP","$117.15 ","$86.69 ","$0.00 ","$117.15 ","$63.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20.51 ","$117.15 ","$0.00 ","$58.58 ","$92.78 ","$93.72 ","$0.00 ","$18.33 ","$0.00 ","$18.65 ","$0.00 "
"G46033","SUP","HCPCS C1726","","G46033  -  SHEATH ACC 30FR 17CM CLR AMPTZ RADOPQ STRP RNL","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G46034","SUP","HCPCS C1726","","G46034  -  CATHETER NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G46035","SUP","HCPCS C1726","","G46035  -  CATHETER NPHSTM 8MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G46036","SUP","HCPCS C1726","","G46036  -  CATHETER NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR","BOTH IP/OP","$618.80 ","$457.91 ","$0.00 ","$618.80 ","$336.01 ","$0.00 ","$128.97 ","$0.00 ","$0.00 ","$108.35 ","$618.80 ","$0.00 ","$309.40 ","$490.09 ","$495.04 ","$0.00 ","$96.84 ","$0.00 ","$98.51 ","$0.00 "
"G46037","SUP","HCPCS C1726","","G46037  -  SET NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ STRP","BOTH IP/OP","$618.80 ","$457.91 ","$0.00 ","$618.80 ","$336.01 ","$0.00 ","$128.97 ","$0.00 ","$0.00 ","$108.35 ","$618.80 ","$0.00 ","$309.40 ","$490.09 ","$495.04 ","$0.00 ","$96.84 ","$0.00 ","$98.51 ","$0.00 "
"G46038","SUP","HCPCS C1726","","G46038  -  SET NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ","BOTH IP/OP","$618.80 ","$457.91 ","$0.00 ","$618.80 ","$336.01 ","$0.00 ","$128.97 ","$0.00 ","$0.00 ","$108.35 ","$618.80 ","$0.00 ","$309.40 ","$490.09 ","$495.04 ","$0.00 ","$96.84 ","$0.00 ","$98.51 ","$0.00 "
"G46041","SUP","HCPCS C1726","","G46041  -  CATHETER NPHSTM 10MM 15CM ULTRX","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G46042","SUP","HCPCS C1726","","G46042  -  CATHETER NPHSTM 6MM 15CM ULTRX","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G46043","SUP","HCPCS C1726","","G46043  -  EXTRACTOR STON 2.2FR 11MM 115CM STRL NGAGE NTNL URETER","BOTH IP/OP","$519.35 ","$384.32 ","$0.00 ","$519.35 ","$282.01 ","$0.00 ","$108.25 ","$0.00 ","$0.00 ","$90.93 ","$519.35 ","$0.00 ","$259.68 ","$411.33 ","$415.48 ","$0.00 ","$81.28 ","$0.00 ","$82.68 ","$0.00 "
"G46044","SUP","Custom 27203010","","G46044  -  SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ","BOTH IP/OP","$814.00 ","$602.36 ","$0.00 ","$814.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$814.00 ","$0.00 ","$407.00 ","$644.69 ","$651.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46071","SUP","Custom 27203010","","G46071  -  DEVICE BX BX KNDY REUSE","BOTH IP/OP","$814.00 ","$602.36 ","$0.00 ","$814.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$814.00 ","$0.00 ","$407.00 ","$644.69 ","$651.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46072","SUP","HCPCS C1894","","G46072  -  NEEDLE BX 18GA 25CM STRL HUB ECHGN TIP SMPL NTCH DISP","BOTH IP/OP","$20.35 ","$15.06 ","$0.00 ","$20.35 ","$11.05 ","$0.00 ","$4.24 ","$0.00 ","$0.00 ","$3.56 ","$20.35 ","$0.00 ","$10.18 ","$16.12 ","$16.28 ","$0.00 ","$3.18 ","$0.00 ","$3.24 ","$0.00 "
"G46073","SUP","HCPCS C1894","","G46073  -  SHEATH ACC 3FR 9.5FR 13CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46074","SUP","HCPCS C1894","","G46074  -  SHEATH ACC 3FR 9.5FR 20CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46075","SUP","HCPCS C1894","","G46075  -  SHEATH ACC 3FR 9.5FR 28CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46076","SUP","HCPCS C1894","","G46076  -  SHEATH ACC 3FR 9.5FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46077","SUP","HCPCS C1894","","G46077  -  SHEATH ACC 3FR 9.5FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46078","SUP","HCPCS C1894","","G46078  -  SHEATH ACC 3FR 12FR 20CM FLXR 2 CNT WRK CHNL 2 LUM DILATION","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46079","SUP","HCPCS C1894","","G46079  -  SHEATH ACC 3FR 12FR 28CM FLXR 2 CNT WRK CHNL 2 LUM DILATION","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46080","SUP","HCPCS C1894","","G46080  -  SHEATH ACC 3FR 12FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46081","SUP","HCPCS C1894","","G46081  -  SHEATH ACC 3FR 12FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM","BOTH IP/OP","$407.00 ","$301.18 ","$0.00 ","$407.00 ","$221.00 ","$0.00 ","$84.83 ","$0.00 ","$0.00 ","$71.26 ","$407.00 ","$0.00 ","$203.50 ","$322.34 ","$325.60 ","$0.00 ","$63.70 ","$0.00 ","$64.79 ","$0.00 "
"G46137","SUP","HCPCS C1769","","G46137  -  SHEATH ACC 3FR 12FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION","BOTH IP/OP","$669.38 ","$495.34 ","$0.00 ","$669.38 ","$363.47 ","$0.00 ","$139.51 ","$0.00 ","$0.00 ","$117.20 ","$669.38 ","$0.00 ","$334.69 ","$530.15 ","$535.50 ","$0.00 ","$104.76 ","$0.00 ","$106.56 ","$0.00 "
"G46138","SUP","HCPCS C1769","","G46138  -  GUIDEWIRE ESCP ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1","BOTH IP/OP","$133.88 ","$99.07 ","$0.00 ","$133.88 ","$72.69 ","$0.00 ","$27.90 ","$0.00 ","$0.00 ","$23.44 ","$133.88 ","$0.00 ","$66.94 ","$106.03 ","$107.10 ","$0.00 ","$20.95 ","$0.00 ","$21.31 ","$0.00 "
"G46139","SUP","HCPCS C1769","","G46139  -  GUIDEWIRE ESCP ANG .035IN 150CM STRL 3CM BIWIRE 1TO 1 TRQ","BOTH IP/OP","$133.88 ","$99.07 ","$0.00 ","$133.88 ","$72.69 ","$0.00 ","$27.90 ","$0.00 ","$0.00 ","$23.44 ","$133.88 ","$0.00 ","$66.94 ","$106.03 ","$107.10 ","$0.00 ","$20.95 ","$0.00 ","$21.31 ","$0.00 "
"G46140","SUP","HCPCS C1769","","G46140  -  GUIDEWIRE VASC STRG ANG TPR .025IN 150CM 3CM BIWIRE 1TO 1","BOTH IP/OP","$111.38 ","$82.42 ","$0.00 ","$111.38 ","$60.48 ","$0.00 ","$23.21 ","$0.00 ","$0.00 ","$19.50 ","$111.38 ","$0.00 ","$55.69 ","$88.21 ","$89.10 ","$0.00 ","$17.43 ","$0.00 ","$17.73 ","$0.00 "
"G46141","SUP","HCPCS C1769","","G46141  -  GUIDEWIRE URO ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1","BOTH IP/OP","$111.38 ","$82.42 ","$0.00 ","$111.38 ","$60.48 ","$0.00 ","$23.21 ","$0.00 ","$0.00 ","$19.50 ","$111.38 ","$0.00 ","$55.69 ","$88.21 ","$89.10 ","$0.00 ","$17.43 ","$0.00 ","$17.73 ","$0.00 "
"G46142","SUP","HCPCS C1769","","G46142  -  GUIDEWIRE VASC STD STRG .035IN 150CM 3CM BIWIRE 1TO 1 TRQ","BOTH IP/OP","$111.38 ","$82.42 ","$0.00 ","$111.38 ","$60.48 ","$0.00 ","$23.21 ","$0.00 ","$0.00 ","$19.50 ","$111.38 ","$0.00 ","$55.69 ","$88.21 ","$89.10 ","$0.00 ","$17.43 ","$0.00 ","$17.73 ","$0.00 "
"G46167","SUP","HCPCS C1894","","G46167  -  SHEATH ACCES 9.5FR CONTIN WKG CHNL FLXB SCP","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G46168","SUP","HCPCS C1894","","G46168  -  SHEATH ACCES 12FR CONTIN WOR CHNL TPR DILAT LOCK","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G46169","SUP","HCPCS C1894","","G46169  -  GUIDEWIRE URO ANG STRG TPR .025IN 150CM 3CM BIWIRE STD BD","BOTH IP/OP","$308.00 ","$227.92 ","$0.00 ","$308.00 ","$167.24 ","$0.00 ","$64.19 ","$0.00 ","$0.00 ","$53.93 ","$308.00 ","$0.00 ","$154.00 ","$243.94 ","$246.40 ","$0.00 ","$48.20 ","$0.00 ","$49.03 ","$0.00 "
"G46199","SUP","Custom 27203010","","G46199  -  RETRIEVER STNT 2.4FR 115CM NSNARE FLXB NTNL","BOTH IP/OP","$796.88 ","$589.69 ","$0.00 ","$796.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$796.88 ","$0.00 ","$398.44 ","$631.13 ","$637.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46200","SUP","Custom 27203010","","G46200  -  ELECTRODE ESURG .014IN 27FR CUT LOOP FIT 27FR STRZ 1 STM","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46202","SUP","Custom 27203010","","G46202  -  KNIFE ESCP STRL COLLINGS DISP FIT 24/27FR 1 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46203","SUP","Custom 27203010","","G46203  -  ELECTRODE ESURG 3MM RLLR BRL FIT 24/26/28FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46204","SUP","Custom 27203010","","G46204  -  ELECTRODE ESURG .014IN CUT LOOP GW FIT 24FR STRZ 2 STM RSSCP","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46205","SUP","Custom 27203010","","G46205  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR ACMI USA/ELT RSSCP","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46206","SUP","Custom 27203010","","G46206  -  EXTRACTOR STONE 1.5FR 1CM 115CM 4 WIRE TIPLESS BASKET","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46209","SUP","Custom 27203010","","G46209  -  KNIFE ESCP COLLINGS FIT 24/26/28 FR ACMI USA/ELT RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46210","SUP","Custom 27203010","","G46210  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46211","SUP","Custom 27203010","","G46211  -  ELECTRODE ESURG .015IN CUT LOOP GW FIT 24FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46212","SUP","Custom 27203010","","G46212  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 26FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46213","SUP","Custom 27203010","","G46213  -  ELECTRODE ESURG .015IN CUT LOOP GW FIT 26FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46214","SUP","Custom 27203010","","G46214  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 28FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46215","SUP","Custom 27203010","","G46215  -  ELECTRODE ESURG .015IN LOOP GW URO FIT 28FR ACMI USA/ELT","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46216","SUP","Custom 27203010","","G46216  -  ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR ACMI USA/ELT RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46217","SUP","Custom 27203010","","G46217  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46218","SUP","Custom 27203010","","G46218  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46219","SUP","Custom 27203010","","G46219  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46220","SUP","Custom 27203010","","G46220  -  ELECTRODE MNPLR .014IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46221","SUP","Custom 27203010","","G46221  -  ELECTRODE ESURG .012IN LOOP GW URO FIT 27FR STRZ SGL STM","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46222","SUP","Custom 27203010","","G46222  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 1 STM RSSCP","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46223","SUP","Custom 27203010","","G46223  -  ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 1 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46224","SUP","Custom 27203010","","G46224  -  ELECTRODE MNPLR 3MM CK RLLR BALL DISP FIT 24/27FR STRZ 1 STM","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46225","SUP","Custom 27203010","","G46225  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 1 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46226","SUP","Custom 27203010","","G46226  -  ELECTRODE ESURG 3MM RLLR BRL FIT 24/27FR STRZ 1 STM RSSCP","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46228","SUP","Custom 27203010","","G46228  -  KNIFE ESCP COLLINGS 24/26/28 FR RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46229","SUP","Custom 27203010","","G46229  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 24FR OL OES RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46230","SUP","Custom 27203010","","G46230  -  ELECTRODE ESURG 30D 24FR .012IN CUT LOOP WRE OL OES RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46231","SUP","Custom 27203010","","G46231  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 26FR OL OES RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46232","SUP","Custom 27203010","","G46232  -  ELECTRODE ESURG 30D .012IN 26FR LOOP CUT WRE FIT 26FR OL OES","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46233","SUP","Custom 27203010","","G46233  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46234","SUP","Custom 27203010","","G46234  -  ELECTRODE ESURG 30D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46235","SUP","Custom 27203010","","G46235  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR OL OES RSSCP","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46236","SUP","Custom 27203010","","G46236  -  ELECTRODE ESURG PRFR RESCT COAG FIT 26 FR OL OES RSSCP","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46237","SUP","Custom 27203010","","G46237  -  ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR OL OES RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46238","SUP","Custom 27203010","","G46238  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR OL OES RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46239","SUP","Custom 27203010","","G46239  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR OL OES RSSCP","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46240","SUP","Custom 27203010","","G46240  -  ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/26/28FR","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46241","SUP","Custom 27203010","","G46241  -  ELECTRODE ESURG .014IN CUT LOOP GW FIT 27FR STRZ 2 STM","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46242","SUP","Custom 27203010","","G46242  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 2 STM RSSCP","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46243","SUP","Custom 27203010","","G46243  -  ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 2 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46244","SUP","Custom 27203010","","G46244  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46245","SUP","Custom 27203010","","G46245  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP","BOTH IP/OP","$159.38 ","$117.94 ","$0.00 ","$159.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.38 ","$0.00 ","$79.69 ","$126.23 ","$127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46246","SUP","Custom 27203010","","G46246  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP","BOTH IP/OP","$308.13 ","$228.02 ","$0.00 ","$308.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$308.13 ","$0.00 ","$154.06 ","$244.04 ","$246.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46247","SUP","Custom 27203010","","G46247  -  ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/27FR","BOTH IP/OP","$350.63 ","$259.47 ","$0.00 ","$350.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.63 ","$0.00 ","$175.31 ","$277.70 ","$280.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G46612","SUP","HCPCS C1763","","G46612  -  GRAFT SFT TIS 13X8CM PLVC FLR INS SIS ES PIG ACLR CLGN MTRX","BOTH IP/OP","$2,487.50 ","$1,840.75 ","$0.00 ","$2,487.50 ","$1,119.38 ","$0.00 ","$518.46 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"G47325","SUP","HCPCS C1770","","G47325  -  COIL EMBL 10MM 14CM NST MCIOL PLTN .018IN CATH","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47329","SUP","HCPCS C1770","","G47329  -  COIL EMBL 6MM 14CM NST MCIOL PLTN .018IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47330","SUP","HCPCS C1770","","G47330  -  COIL EMBL 8MM 14CM NST MCIOL PLTN .018IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47338","SUP","HCPCS Q4107","","G47338  -  COIL EMBL 3MM 7CM NST MCIOL PLTN .018IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47339","SUP","Custom 27805113","","G47339  -  COIL EMBL 4MM 7CM NST MCIOL PLTN .018IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47345","SUP","HCPCS C1770","","G47345  -  COIL EMBL 10MM 14CM NST MCIOL PLTN .035IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47354","SUP","Custom 27803010","","G47354  -  COIL EMBL 6MM 14CM NST MCIOL PLTN .035IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47355","SUP","HCPCS C1770","","G47355  -  COIL EMBL 8MM 14CM NST MCIOL PLTN .035IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47365","SUP","Custom 27803010","","G47365  -  COIL EMBL 10MM 7CM NST MCIOL PLTN .035IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47371","SUP","Custom 27803010","","G47371  -  COIL EMBL 3MM 7IN NST PLTN ACPT .035IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47372","SUP","Custom 27803010","","G47372  -  COIL EMBL 4MM 7CM NST MCIOL PLTN .035IN CATH","BOTH IP/OP","$278.73 ","$206.26 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47416","SUP","HCPCS C1770","","G47416  -  COIL EMBL 3-2MM TRND MCIOL PLTN .018IN CATH","BOTH IP/OP","$275.33 ","$203.74 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47419","SUP","HCPCS C1770","","G47419  -  COIL EMBL 6-2MM TRND MCIOL PLTN .018IN CATH","BOTH IP/OP","$290.47 ","$214.95 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47421","SUP","HCPCS C1770","","G47421  -  COIL EMBL 8-4MM 9.5CM TRND MCL PRELD CRTDG PLTN SNTH FBR","BOTH IP/OP","$290.47 ","$214.95 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47519","SUP","HCPCS C1770","","G47519  -  COIL EMBL 4-3MM TRND PLTN .035IN CATH","BOTH IP/OP","$290.47 ","$214.95 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47520","SUP","HCPCS C1770","","G47520  -  COIL EMBL 5-3MM TRND PLTN .035IN CATH","BOTH IP/OP","$290.47 ","$214.95 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47522","SUP","HCPCS C1770","","G47522  -  COIL EMBL 7-3MM TRND PLTN .035IN CATH","BOTH IP/OP","$290.47 ","$214.95 ","$0.00 ","$275.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47654","SUP","HCPCS C1763","","G47654  -  DILATOR URTH 26FR 37CM S-CRV SDPRT HDRPH","BOTH IP/OP","$985.03 ","$728.92 ","$0.00 ","$985.03 ","$443.26 ","$0.00 ","$205.30 ","$0.00 ","$0.00 ","$172.47 ","$985.03 ","$0.00 ","$492.51 ","$780.14 ","$788.02 ","$0.00 ","$154.16 ","$0.00 ","$156.82 ","$0.00 "
"G47655","SUP","HCPCS C1763","","G47655  -  GRAFT SFT TIS STD SURGISIS BIODESIGN STRTH FLXB RST TO INFCT","BOTH IP/OP","$1,457.50 ","$1,078.55 ","$0.00 ","$1,457.50 ","$655.88 ","$0.00 ","$303.78 ","$0.00 ","$0.00 ","$255.20 ","$1,457.50 ","$0.00 ","$728.75 ","$1,154.34 ","$1,166.00 ","$0.00 ","$228.10 ","$0.00 ","$232.03 ","$0.00 "
"G47700","SUP","HCPCS C1892","","G47700  -  INTRODUCER SHEATH .035IN ANL1 CURVE 11.4FR 10FR 45CM HIGH","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$44.19 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"G47701","SUP","HCPCS C1892","","G47701  -  INTRODUCER SHEATH .035IN ANL1 CURVE 13.4FR 12FR 45CM HIGH","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$44.19 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"G47732","SUP","HCPCS C1769","","G47732  -  GUIDEWIRE VASCULAR .014IN 135CM SHAPEABLE TIP KINK","BOTH IP/OP","$167.03 ","$123.60 ","$0.00 ","$167.03 ","$90.69 ","$0.00 ","$34.81 ","$0.00 ","$0.00 ","$29.24 ","$167.03 ","$0.00 ","$83.51 ","$132.29 ","$133.62 ","$0.00 ","$26.14 ","$0.00 ","$26.59 ","$0.00 "
"G47733","SUP","HCPCS C1769","","G47733  -  GUIDEWIRE VASC .014IN 190CM APRCH SHP TIP KINK RST MNVBL LNR","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$204.00 ","$110.77 ","$0.00 ","$42.52 ","$0.00 ","$0.00 ","$35.72 ","$204.00 ","$0.00 ","$102.00 ","$161.57 ","$163.20 ","$0.00 ","$31.93 ","$0.00 ","$32.48 ","$0.00 "
"G47734","SUP","HCPCS C1769","","G47734  -  GUIDEWIRE VASC .014IN 300CM APRCH SHP TIP KINK RST MNVBL LNR","BOTH IP/OP","$204.00 ","$150.96 ","$0.00 ","$204.00 ","$110.77 ","$0.00 ","$42.52 ","$0.00 ","$0.00 ","$35.72 ","$204.00 ","$0.00 ","$102.00 ","$161.57 ","$163.20 ","$0.00 ","$31.93 ","$0.00 ","$32.48 ","$0.00 "
"G47804","SUP","HCPCS C1729","","G47804  -  GRAFT SFT TIS LG SURGISIS BIODESIGN STRTH FLXB RST TO INFCT","BOTH IP/OP","$244.20 ","$180.71 ","$0.00 ","$244.20 ","$132.60 ","$0.00 ","$50.90 ","$0.00 ","$0.00 ","$42.76 ","$244.20 ","$0.00 ","$122.10 ","$193.41 ","$195.36 ","$0.00 ","$38.22 ","$0.00 ","$38.88 ","$0.00 "
"G47805","SUP","HCPCS C1729","","G47805  -  SET CATH CRC NPHSTM SPBC","BOTH IP/OP","$244.20 ","$180.71 ","$0.00 ","$244.20 ","$132.60 ","$0.00 ","$50.90 ","$0.00 ","$0.00 ","$42.76 ","$244.20 ","$0.00 ","$122.10 ","$193.41 ","$195.36 ","$0.00 ","$38.22 ","$0.00 ","$38.88 ","$0.00 "
"G47806","SUP","HCPCS C1729","","G47806  -  SET CATH CRC NPHSTM SPBC","BOTH IP/OP","$244.20 ","$180.71 ","$0.00 ","$244.20 ","$132.60 ","$0.00 ","$50.90 ","$0.00 ","$0.00 ","$42.76 ","$244.20 ","$0.00 ","$122.10 ","$193.41 ","$195.36 ","$0.00 ","$38.22 ","$0.00 ","$38.88 ","$0.00 "
"G47833","SUP","HCPCS C1769","","G47833  -  TRAY CENTRAL LINE INSERTION WITH BIOPATCH","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$378.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.13 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$109.16 ","$0.00 ","$111.04 ","$0.00 "
"G47858","SUP","Custom 27203010","","G47858  -  SET CATH CRC NPHSTM SPBC","BOTH IP/OP","$1,034.00 ","$765.16 ","$0.00 ","$1,034.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,034.00 ","$0.00 ","$517.00 ","$818.93 ","$827.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47859","SUP","Custom 27203010","","G47859  -  NEEDLE BX 18GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN","BOTH IP/OP","$51.70 ","$38.26 ","$0.00 ","$51.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$51.70 ","$0.00 ","$25.85 ","$40.95 ","$41.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47868","SUP","HCPCS C1770","","G47868  -  COIL EMBL MREYE STRT KIT VRSTL MCIOL PLTN STRL DISP","BOTH IP/OP","$8,750.00 ","$6,475.00 ","$0.00 ","$8,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,750.00 ","$0.00 ","$4,375.00 ","$6,930.00 ","$7,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G47942","SUP","HCPCS C1894","","G47942  -  SET INTROD .018IN 4FR 21GA 40CM 10CM SILHOUETTE","BOTH IP/OP","$106.58 ","$78.87 ","$0.00 ","$105.00 ","$57.02 ","$0.00 ","$22.21 ","$0.00 ","$0.00 ","$18.38 ","$105.00 ","$0.00 ","$52.50 ","$83.16 ","$84.00 ","$0.00 ","$16.43 ","$0.00 ","$16.72 ","$0.00 "
"G48003","SUP","HCPCS C1894","","G48003  -  SET INTROD .018IN 4FR 40CM 10CM TRANSITIONLESS STIFFENED","BOTH IP/OP","$172.55 ","$127.69 ","$0.00 ","$170.00 ","$92.31 ","$0.00 ","$35.96 ","$0.00 ","$0.00 ","$29.77 ","$170.00 ","$0.00 ","$85.00 ","$134.64 ","$136.00 ","$0.00 ","$26.61 ","$0.00 ","$27.06 ","$0.00 "
"G48007","SUP","HCPCS C1894","","G48007  -  INTRODUCER SHTH 5FR 10CM 40CM TRNSTLS STF MPNCH NTNL .018IN","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$47.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.32 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$13.69 ","$0.00 ","$13.93 ","$0.00 "
"G48008","SUP","HCPCS C1894","","G48008  -  SET INTROD .018IN 5FR 21GA 40CM 10CM COAXIAL CATHETER GWIRE","BOTH IP/OP","$175.09 ","$129.57 ","$0.00 ","$172.50 ","$93.67 ","$0.00 ","$36.49 ","$0.00 ","$0.00 ","$30.20 ","$172.50 ","$0.00 ","$86.25 ","$136.62 ","$138.00 ","$0.00 ","$27.00 ","$0.00 ","$27.46 ","$0.00 "
"G48031","SUP","HCPCS C1876","","G48031  -  STENT ESOPHAGEAL 20MM 25MM 10CM 8MM PARTIALLY COVERED","BOTH IP/OP","$4,705.00 ","$3,481.70 ","$0.00 ","$4,705.00 ","$2,117.25 ","$0.00 ","$980.64 ","$0.00 ","$0.00 ","$823.81 ","$4,705.00 ","$0.00 ","$2,352.50 ","$3,726.36 ","$3,764.00 ","$0.00 ","$736.33 ","$0.00 ","$749.04 ","$0.00 "
"G48186","SUP","HCPCS C1894","","G48186  -  SHEATH GUID .018-.035IN ANL0 CURVE 4FR 1.5IN 45CM RADIOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$195.00 ","$105.89 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$34.14 ","$195.00 ","$0.00 ","$97.50 ","$154.44 ","$156.00 ","$0.00 ","$30.52 ","$0.00 ","$31.04 ","$0.00 "
"G48188","SUP","HCPCS C1894","","G48188  -  SHEATH GUID .018/.035IN ANL0 CURVE 4FR .059IN 90CM RADIOPQ","BOTH IP/OP","$392.60 ","$290.52 ","$0.00 ","$377.50 ","$204.98 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"G48189","SUP","HCPCS C1894","","G48189  -  SHEATH GUID ANL0 CURVE STR 5FR .074IN 90CM CHK-FLO VALVE","BOTH IP/OP","$392.60 ","$290.52 ","$0.00 ","$377.50 ","$204.98 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$66.10 ","$377.50 ","$0.00 ","$188.75 ","$298.98 ","$302.00 ","$0.00 ","$59.08 ","$0.00 ","$60.10 ","$0.00 "
"G48240","SUP","Custom 27203010","","G48240  -  FORCEPS BIOP 2.4FR 115CM 1 BITE COLLECT BACKLOAD BIGOPSY","BOTH IP/OP","$880.00 ","$651.20 ","$0.00 ","$880.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$880.00 ","$0.00 ","$440.00 ","$696.96 ","$704.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48294","SUP","Custom 27203010","","G48294  -  EXTRACTOR STONE 1.7FR 8MM 115CM PATENTED NGAGE NITINOL","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48295","SUP","Custom 27203010","","G48295  -  NEEDLE BX 20GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN","BOTH IP/OP","$25.77 ","$19.07 ","$0.00 ","$25.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.77 ","$0.00 ","$12.88 ","$20.41 ","$20.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48296","SUP","Custom 27203010","","G48296  -  SET NPHSTM 10MM 30FR 15CM CLR 17CM ULTRX RADOPQ STRP BLN","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48297","SUP","Custom 27203010","","G48297  -  EXTRACTOR STONE 2.2FR 8MM 115CM NGAGE NITINOL KIDNEY URETER","BOTH IP/OP","$515.33 ","$381.34 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$515.33 ","$0.00 ","$257.66 ","$408.14 ","$412.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48373","SUP","HCPCS C1880","","G48373  -  FILTER EMBOLIZATION 30MM 8.5FR 48MM 65CM 3 WAY STOPCOCK","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$573.17 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"G48402","SUP","HCPCS C1874","","G48402  -  GRAFT EVAS 2 BRCH 22MM 18FR 82MM STRL Z-TRK ZNTH FLX SLF","BOTH IP/OP","$21,145.00 ","$15,647.30 ","$0.00 ","$21,145.00 ","$9,515.25 ","$0.00 ","$4,407.15 ","$0.00 ","$0.00 ","$3,702.32 ","$21,145.00 ","$0.00 ","$10,572.50 ","$16,746.84 ","$16,916.00 ","$0.00 ","$3,309.19 ","$0.00 ","$3,366.28 ","$0.00 "
"G48422","SUP","HCPCS C1874","","G48422  -  GRAFT EVAS BFUR 30MM 7.7MM 20FR 82MM ZNTH FLX Z-TRK SLF XPD","BOTH IP/OP","$21,145.00 ","$15,647.30 ","$0.00 ","$21,145.00 ","$9,515.25 ","$0.00 ","$4,407.15 ","$0.00 ","$0.00 ","$3,702.32 ","$21,145.00 ","$0.00 ","$10,572.50 ","$16,746.84 ","$16,916.00 ","$0.00 ","$3,309.19 ","$0.00 ","$3,366.28 ","$0.00 "
"G48424","SUP","Custom 27803010","","G48424  -  GRAFT EVAS 2 BRCH 30MM 20FR 111MM ZNTH FLX Z-TRK SLF","BOTH IP/OP","$21,145.00 ","$15,647.30 ","$0.00 ","$21,145.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,145.00 ","$0.00 ","$10,572.50 ","$16,746.84 ","$16,916.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48429","SUP","HCPCS C1874","","G48429  -  GRAFT EVAS 2 BRCH 32MM 20FR 111MM ZNTH FLX Z-TRK SLF","BOTH IP/OP","$21,145.00 ","$15,647.30 ","$0.00 ","$21,145.00 ","$9,515.25 ","$0.00 ","$4,407.15 ","$0.00 ","$0.00 ","$3,702.32 ","$21,145.00 ","$0.00 ","$10,572.50 ","$16,746.84 ","$16,916.00 ","$0.00 ","$3,309.19 ","$0.00 ","$3,366.28 ","$0.00 "
"G48431","SUP","HCPCS C1874","","G48431  -  GRAFT EVAS BFUR 32MM 20FR 140MM ZNTH FLX Z-TRK SLF XPD WVN","BOTH IP/OP","$21,145.00 ","$15,647.30 ","$0.00 ","$21,145.00 ","$9,515.25 ","$0.00 ","$4,407.15 ","$0.00 ","$0.00 ","$3,702.32 ","$21,145.00 ","$0.00 ","$10,572.50 ","$16,746.84 ","$16,916.00 ","$0.00 ","$3,309.19 ","$0.00 ","$3,366.28 ","$0.00 "
"G48522","SUP","Custom 27203010","","G48522  -  EXTRACTOR STON 1.7FR 11MM 115CM NGAGE NTNL KNDY URETER","BOTH IP/OP","$1,615.00 ","$1,195.10 ","$0.00 ","$1,615.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,615.00 ","$0.00 ","$807.50 ","$1,279.08 ","$1,292.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48526","SUP","Custom 27203010","","G48526  -  FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE STD SMA","BOTH IP/OP","$2,329.80 ","$1,724.05 ","$0.00 ","$2,329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,329.80 ","$0.00 ","$1,164.90 ","$1,845.20 ","$1,863.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48611","SUP","Custom 27203010","","G48611  -  FIBER LSR 273UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT","BOTH IP/OP","$538.33 ","$398.36 ","$0.00 ","$538.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$538.33 ","$0.00 ","$269.17 ","$426.36 ","$430.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48612","SUP","Custom 27203010","","G48612  -  FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE CNVGNT","BOTH IP/OP","$4,735.50 ","$3,504.27 ","$0.00 ","$4,735.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,735.50 ","$0.00 ","$2,367.75 ","$3,750.52 ","$3,788.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48613","SUP","Custom 27203010","","G48613  -  FIBER LSR 940UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA","BOTH IP/OP","$336.46 ","$248.98 ","$0.00 ","$336.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.46 ","$0.00 ","$168.23 ","$266.48 ","$269.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48614","SUP","Custom 27203010","","G48614  -  FIBER LSR 365UM BLU OPTILITE FLT TIP CNCT HO REUSE CNVGNT","BOTH IP/OP","$2,367.30 ","$1,751.80 ","$0.00 ","$2,367.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,367.30 ","$0.00 ","$1,183.65 ","$1,874.90 ","$1,893.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48615","SUP","Custom 27203010","","G48615  -  FIBER LSR 273UM RD OPTILITE FLT TIP CNCT HO DISP CNVGNT LSR","BOTH IP/OP","$389.58 ","$288.29 ","$0.00 ","$389.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$389.58 ","$0.00 ","$194.79 ","$308.55 ","$311.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48616","SUP","Custom 27203010","","G48616  -  FIBER LSR 550UM VIOL OPTILITE FLT TIP CNCT HO REUSE CNVGNT","BOTH IP/OP","$2,152.50 ","$1,592.85 ","$0.00 ","$2,152.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,152.50 ","$0.00 ","$1,076.25 ","$1,704.78 ","$1,722.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48617","SUP","Custom 27203010","","G48617  -  FIBER LSR 365UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS","BOTH IP/OP","$743.75 ","$550.38 ","$0.00 ","$743.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$743.75 ","$0.00 ","$371.88 ","$589.05 ","$595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48618","SUP","Custom 27203010","","G48618  -  FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE CNVGNT","BOTH IP/OP","$1,009.38 ","$746.94 ","$0.00 ","$1,009.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,009.38 ","$0.00 ","$504.69 ","$799.43 ","$807.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48619","SUP","Custom 27203010","","G48619  -  FIBER LSR 365UM FLT BLU OPTILITE FLXB CNCT HO REUSE STD SMA","BOTH IP/OP","$1,168.75 ","$864.88 ","$0.00 ","$1,168.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,168.75 ","$0.00 ","$584.38 ","$925.65 ","$935.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48620","SUP","Custom 27203010","","G48620  -  FIBER LSR 550UM RD OPTILITE FLT TIP CNCT HO REUSE STD SMA","BOTH IP/OP","$2,859.75 ","$2,116.22 ","$0.00 ","$2,859.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,859.75 ","$0.00 ","$1,429.88 ","$2,264.92 ","$2,287.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48621","SUP","Custom 27203010","","G48621  -  FIBER LSR 550UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS","BOTH IP/OP","$743.75 ","$550.38 ","$0.00 ","$743.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$743.75 ","$0.00 ","$371.88 ","$589.05 ","$595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48622","SUP","Custom 27203010","","G48622  -  FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE STD SMA","BOTH IP/OP","$4,735.50 ","$3,504.27 ","$0.00 ","$4,735.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,735.50 ","$0.00 ","$2,367.75 ","$3,750.52 ","$3,788.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48623","SUP","Custom 27203010","","G48623  -  FIBER LSR 940UM FLT 940UM RD OPTILITE RD CNCT HO DISP CNVGNT","BOTH IP/OP","$891.75 ","$659.90 ","$0.00 ","$891.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$891.75 ","$0.00 ","$445.88 ","$706.27 ","$713.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48624","SUP","Custom 27203010","","G48624  -  FIBER LSR 273UM BLK OPTILITE FLT TIP CNCT HO DISP TRMDN LSR","BOTH IP/OP","$973.75 ","$720.58 ","$0.00 ","$973.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$973.75 ","$0.00 ","$486.88 ","$771.21 ","$779.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48625","SUP","Custom 27203010","","G48625  -  FIBER LSR 150UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA","BOTH IP/OP","$891.75 ","$659.90 ","$0.00 ","$891.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$891.75 ","$0.00 ","$445.88 ","$706.27 ","$713.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48626","SUP","Custom 27203010","","G48626  -  FIBER LSR 200UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA","BOTH IP/OP","$717.50 ","$530.95 ","$0.00 ","$717.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$717.50 ","$0.00 ","$358.75 ","$568.26 ","$574.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G48627","SUP","Custom 27203010","","G48627  -  FIBER LSR FLT 365UM BLK OPTILITE CNCT EXTREMELY FLXB HO DISP","BOTH IP/OP","$953.25 ","$705.41 ","$0.00 ","$953.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$953.25 ","$0.00 ","$476.63 ","$754.97 ","$762.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G49044","SUP","HCPCS C1894","","G49044  -  INTRODUCER SHEATH .035IN ANL1 CURVE 8.8FR 7FR 110CM GUIDE","BOTH IP/OP","$502.50 ","$371.85 ","$0.00 ","$502.50 ","$272.86 ","$0.00 ","$104.73 ","$0.00 ","$0.00 ","$87.98 ","$502.50 ","$0.00 ","$251.25 ","$397.98 ","$402.00 ","$0.00 ","$78.64 ","$0.00 ","$80.00 ","$0.00 "
"G49099","SUP","HCPCS C1894","","G49099  -  SHEATH GUID .018/.038IN ANL0 CURVE 8FR .113IN 45CM RADIOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49100","SUP","HCPCS C1894","","G49100  -  INTRODUCER CATHETER .018/.038IN ANL1 CURVE 8FR .113IN 45CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49257","SUP","Custom 27203010","","G49257  -  NEEDLE ESCP 20GA 6FR 8- CM STRL ECHTP ULT US CONE TIP SH CLC","BOTH IP/OP","$697.50 ","$516.15 ","$0.00 ","$697.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$697.50 ","$0.00 ","$348.75 ","$552.42 ","$558.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G49333","SUP","HCPCS C1877","","G49333  -  STENT VASC 10MM 5FR 80MM 125CM .018IN SLF XPD FLXB FLXR","BOTH IP/OP","$3,062.50 ","$2,266.25 ","$0.00 ","$3,062.50 ","$1,378.13 ","$0.00 ","$638.30 ","$0.00 ","$0.00 ","$536.22 ","$3,062.50 ","$0.00 ","$1,531.25 ","$2,425.50 ","$2,450.00 ","$0.00 ","$479.28 ","$0.00 ","$487.55 ","$0.00 "
"G49472","SUP","HCPCS C1892","","G49472  -  SET INTROD .018IN LONG 5FR 70CM 30CM COAXIAL CATHETER PEEL","BOTH IP/OP","$151.93 ","$112.43 ","$0.00 ","$147.50 ","$80.09 ","$0.00 ","$31.66 ","$0.00 ","$0.00 ","$25.83 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$23.08 ","$0.00 ","$23.48 ","$0.00 "
"G49473","SUP","HCPCS C1894","","G49473  -  SET INTROD .018IN LONG 5FR 21GA 100CM 45CM NEEDLE WIRE GUIDE","BOTH IP/OP","$151.93 ","$112.43 ","$0.00 ","$147.50 ","$80.09 ","$0.00 ","$31.66 ","$0.00 ","$0.00 ","$25.83 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$23.08 ","$0.00 ","$23.48 ","$0.00 "
"G49620","SUP","Custom 27203010","","G49620  -  FIBER LSR 550UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT","BOTH IP/OP","$154.07 ","$114.01 ","$0.00 ","$154.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$154.07 ","$0.00 ","$77.03 ","$122.02 ","$123.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G49762","SUP","HCPCS C2617","","G49762  -  MICROSCOPE SRG NS INSP FO SAFE EFCT CMPLT","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49862","SUP","HCPCS C2617","","G49862  -  SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49863","SUP","HCPCS C2617","","G49863  -  SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49864","SUP","HCPCS C2617","","G49864  -  SET STNT .038IN 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49865","SUP","HCPCS C2617","","G49865  -  SET STNT .038IN 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49866","SUP","HCPCS C2617","","G49866  -  SET STNT .038IN 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49867","SUP","HCPCS C2617","","G49867  -  SET STNT .038IN 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49868","SUP","HCPCS C2617","","G49868  -  SET STNT .038IN 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49869","SUP","HCPCS C2617","","G49869  -  SET STNT .038IN 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49870","SUP","HCPCS C2617","","G49870  -  SET STNT .038IN 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49871","SUP","HCPCS C2617","","G49871  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49872","SUP","HCPCS C2617","","G49872  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49873","SUP","HCPCS C2617","","G49873  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49874","SUP","HCPCS C2617","","G49874  -  SET STENT .038IN 3CM 2 PIGTAIL CURVE 6FR 26CM 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49875","SUP","HCPCS C2617","","G49875  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49876","SUP","HCPCS C2617","","G49876  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49877","SUP","HCPCS C2617","","G49877  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49878","SUP","HCPCS C2617","","G49878  -  SET STNT 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49879","SUP","HCPCS C2617","","G49879  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49880","SUP","HCPCS C2617","","G49880  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49881","SUP","HCPCS C2617","","G49881  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49882","SUP","HCPCS C2617","","G49882  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49883","SUP","HCPCS C2617","","G49883  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49884","SUP","HCPCS C2617","","G49884  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49885","SUP","HCPCS C2617","","G49885  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49886","SUP","HCPCS C2617","","G49886  -  SET STNT 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49887","SUP","HCPCS C2617","","G49887  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49888","SUP","HCPCS C2617","","G49888  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49889","SUP","HCPCS C2617","","G49889  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49890","SUP","HCPCS C2617","","G49890  -  SET STNT 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA FIRM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49891","SUP","HCPCS C2617","","G49891  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49892","SUP","HCPCS C2617","","G49892  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49893","SUP","HCPCS C2617","","G49893  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49894","SUP","HCPCS C2617","","G49894  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49895","SUP","HCPCS C2625","","G49895  -  SET STENT 2 PIGTAIL CURVE 5FR 20CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49896","SUP","HCPCS C2625","","G49896  -  SET STENT 2 PIGTAIL CURVE 5FR 22CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49897","SUP","HCPCS C2625","","G49897  -  SET STENT 2 PIGTAIL CURVE 5FR 24CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49898","SUP","HCPCS C2625","","G49898  -  SET STENT 2 PIGTAIL CURVE 5FR 26CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49899","SUP","HCPCS C2625","","G49899  -  SET STENT 2 PIGTAIL CURVE 5FR 28CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49900","SUP","HCPCS C2617","","G49900  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49901","SUP","HCPCS C2617","","G49901  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49902","SUP","HCPCS C2617","","G49902  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49903","SUP","HCPCS C2625","","G49903  -  SET STENT 2 PIGTAIL CURVE 6FR 20CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49904","SUP","HCPCS C2625","","G49904  -  SET STENT 2 PIGTAIL CURVE 6FR 22CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49906","SUP","HCPCS C2625","","G49906  -  STENT URETERAL 6FR 26CM POSITIONER BRAID TETHER STRAIGHTENER","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49907","SUP","HCPCS C2625","","G49907  -  STENT URETERAL 6FR 28CM POSITIONER SET BRAID TETHER RADIOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49908","SUP","HCPCS C2617","","G49908  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49909","SUP","HCPCS C2617","","G49909  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49910","SUP","HCPCS C2617","","G49910  -  STENT URET 6FR 22-32CM UNIVERSA PSTNR SET BRD TETH RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49911","SUP","HCPCS C2617","","G49911  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49912","SUP","HCPCS C2625","","G49912  -  SET STENT 2 PIGTAIL CURVE 7FR 22CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49913","SUP","HCPCS C2625","","G49913  -  SET STENT PIGTAIL 7FR 24CM RADIOPQ TIP STRAIGHTENER","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49914","SUP","HCPCS C2625","","G49914  -  SET STENT PIGTAIL 7FR 26CM RADIOPQ TIP STRAIGHTENER","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49915","SUP","HCPCS C2625","","G49915  -  SET STENT 2 PIGTAIL CURVE 7FR 28CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49916","SUP","HCPCS C2617","","G49916  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49917","SUP","HCPCS C2617","","G49917  -  STENT URET 2 PGTL CRV 7FR 30CM UNIVERSA FIRM GRAD MRK RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49918","SUP","HCPCS C2617","","G49918  -  SET STNT PGTL 7FR 22-32CM STRL UNIVERSA RADOPQ TIP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49919","SUP","HCPCS C2617","","G49919  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49920","SUP","HCPCS C2625","","G49920  -  SET STENT 2 PIGTAIL CURVE 8FR 22CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49921","SUP","HCPCS C2625","","G49921  -  SET STENT 2 PIGTAIL CURVE 8FR 24CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49922","SUP","HCPCS C2625","","G49922  -  SET STENT 2 PIGTAIL CURVE 8FR 26CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49923","SUP","HCPCS C2625","","G49923  -  SET STENT 2 PIGTAIL CURVE 8FR 28CM RADIOPQ GRADUATE MARK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49924","SUP","HCPCS C2617","","G49924  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49925","SUP","HCPCS C2617","","G49925  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49931","SUP","HCPCS C2617","","G49931  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49932","SUP","HCPCS C2617","","G49932  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49933","SUP","HCPCS C2617","","G49933  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49934","SUP","HCPCS C2617","","G49934  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49935","SUP","HCPCS C2617","","G49935  -  SET STNT .038IN 2 PGTL CRV 3CM 5FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49936","SUP","HCPCS C2617","","G49936  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49937","SUP","HCPCS C2617","","G49937  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49938","SUP","HCPCS C2617","","G49938  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49939","SUP","HCPCS C2617","","G49939  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49940","SUP","HCPCS C2617","","G49940  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49941","SUP","HCPCS C2617","","G49941  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49942","SUP","HCPCS C2617","","G49942  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49943","SUP","HCPCS C2617","","G49943  -  SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49944","SUP","HCPCS C2617","","G49944  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49945","SUP","HCPCS C2617","","G49945  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49946","SUP","HCPCS C2617","","G49946  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49947","SUP","HCPCS C2617","","G49947  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49948","SUP","HCPCS C2617","","G49948  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49949","SUP","HCPCS C2617","","G49949  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49950","SUP","HCPCS C2617","","G49950  -  SET STNT 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA SFT","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49951","SUP","HCPCS C2617","","G49951  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49952","SUP","HCPCS C2617","","G49952  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49953","SUP","HCPCS C2617","","G49953  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49954","SUP","HCPCS C2617","","G49954  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49955","SUP","HCPCS C2617","","G49955  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49956","SUP","HCPCS C2617","","G49956  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49957","SUP","HCPCS C2617","","G49957  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49958","SUP","HCPCS C2617","","G49958  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49959","SUP","HCPCS C2617","","G49959  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49960","SUP","HCPCS C2617","","G49960  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49961","SUP","HCPCS C2617","","G49961  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G49962","SUP","HCPCS C2617","","G49962  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49963","SUP","HCPCS C2617","","G49963  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49964","SUP","HCPCS C2617","","G49964  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49965","SUP","HCPCS C2617","","G49965  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49966","SUP","HCPCS C2617","","G49966  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49967","SUP","HCPCS C2617","","G49967  -  SET STNT 2 PGTL CRV 5FR 26CM UNIVERSA SFT GRAD MRK RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49968","SUP","HCPCS C2617","","G49968  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49969","SUP","HCPCS C2617","","G49969  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49970","SUP","HCPCS C2617","","G49970  -  STENT URET 2 PGTL CRV 5FR 30CM UNIVERSA SFT GRAD MRK RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49971","SUP","HCPCS C2617","","G49971  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49972","SUP","HCPCS C2617","","G49972  -  SET STNT PGTL 6FR 20CM STRL UNIVERSA RADOPQ TIP PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49973","SUP","HCPCS C2617","","G49973  -  SET STNT PGTL 6FR 22CM STRL UNIVERSA RADOPQ TIP PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49974","SUP","HCPCS C2617","","G49974  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49975","SUP","HCPCS C2617","","G49975  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ PSTNR BRD","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49976","SUP","HCPCS C2617","","G49976  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49977","SUP","HCPCS C2617","","G49977  -  STENT URET 2 PGTL CRV 6FR 30CM UNIVERSA SFT GRAD MRK RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49978","SUP","HCPCS C2617","","G49978  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49979","SUP","HCPCS C2617","","G49979  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49980","SUP","HCPCS C2617","","G49980  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49981","SUP","HCPCS C2617","","G49981  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49982","SUP","HCPCS C2617","","G49982  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49983","SUP","HCPCS C2617","","G49983  -  SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49984","SUP","HCPCS C2617","","G49984  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49985","SUP","HCPCS C2617","","G49985  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49986","SUP","HCPCS C2617","","G49986  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49987","SUP","HCPCS C2617","","G49987  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49988","SUP","HCPCS C2617","","G49988  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49989","SUP","HCPCS C2617","","G49989  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49990","SUP","HCPCS C2617","","G49990  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49991","SUP","HCPCS C2617","","G49991  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49992","SUP","HCPCS C2617","","G49992  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G49993","SUP","HCPCS C2617","","G49993  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G50001","SUP","HCPCS C1887","","G50001  -  CATHETER GUID .018IN 2.6FR 150CM DEPTH MARKER RADIOPQ","BOTH IP/OP","$545.56 ","$403.71 ","$0.00 ","$487.50 ","$264.71 ","$0.00 ","$113.71 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"G50003","SUP","HCPCS C1887","","G50003  -  CATHETER GUID 2.6FR 150CM BRAID KINK RESISTANT RADIOPQ","BOTH IP/OP","$545.56 ","$403.71 ","$0.00 ","$487.50 ","$264.71 ","$0.00 ","$113.71 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"G50010","SUP","Custom 27203010","","G50010  -  FIBER LSR 550UM NS STRP TL","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G50122","SUP","HCPCS C1876","","G50122  -  STENT BIL 6MM 6FR 140MM 80CM .035IN SLF EXPANDABLE DLV SYS","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"G50131","SUP","HCPCS C1876","","G50131  -  STENT BIL 7MM 6FR 140MM 80CM .035IN SLF EXPANDABLE DLV SYS","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"G50168","SUP","HCPCS C1876","","G50168  -  STENT BIL 7MM 6FR 100MM 125CM .035IN SLF EXPANDABLE DLV SYS","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"G50171","SUP","HCPCS C1876","","G50171  -  STENT BIL 8MM 6FR 100MM 125CM .035IN SLF EXPANDABLE DLV SYS","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"G50214","SUP","Custom 27203010","","G50214  -  GLASSES SF NS HO LSR","BOTH IP/OP","$95.70 ","$70.82 ","$0.00 ","$95.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.70 ","$0.00 ","$47.85 ","$75.79 ","$76.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G50319","SUP","HCPCS C1725","","G50319  -  CATHETER BLNDIL 2MM 170CM STRL LF 20CM ADV LOPRFL KINK RST","BOTH IP/OP","$1,351.50 ","$1,000.11 ","$0.00 ","$1,351.50 ","$733.86 ","$0.00 ","$281.69 ","$0.00 ","$0.00 ","$236.64 ","$1,351.50 ","$0.00 ","$675.75 ","$1,070.39 ","$1,081.20 ","$0.00 ","$211.51 ","$0.00 ","$215.16 ","$0.00 "
"G50333","SUP","HCPCS C1725","","G50333  -  CATHETER BLNDIL 3MM 170CM STRL LF 20CM ADV LOPRFL KINK RST","BOTH IP/OP","$1,351.50 ","$1,000.11 ","$0.00 ","$1,351.50 ","$733.86 ","$0.00 ","$281.69 ","$0.00 ","$0.00 ","$236.64 ","$1,351.50 ","$0.00 ","$675.75 ","$1,070.39 ","$1,081.20 ","$0.00 ","$211.51 ","$0.00 ","$215.16 ","$0.00 "
"G50337","SUP","HCPCS C1725","","G50337  -  CATHETER BLNDIL 4MM 170CM STRL LF 8CM ADV LOPRFL KINK RST","BOTH IP/OP","$1,351.50 ","$1,000.11 ","$0.00 ","$1,351.50 ","$733.86 ","$0.00 ","$281.69 ","$0.00 ","$0.00 ","$236.64 ","$1,351.50 ","$0.00 ","$675.75 ","$1,070.39 ","$1,081.20 ","$0.00 ","$211.51 ","$0.00 ","$215.16 ","$0.00 "
"G50686","SUP","HCPCS C1880","","G50686  -  SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 75CM GWIRE","BOTH IP/OP","$3,953.13 ","$2,925.32 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$823.93 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"G50687","SUP","HCPCS C1880","","G50687  -  SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 45CM GWIRE","BOTH IP/OP","$3,953.13 ","$2,925.32 ","$0.00 ","$3,437.50 ","$1,546.88 ","$0.00 ","$823.93 ","$0.00 ","$0.00 ","$601.88 ","$3,437.50 ","$0.00 ","$1,718.75 ","$2,722.50 ","$2,750.00 ","$0.00 ","$537.97 ","$0.00 ","$547.25 ","$0.00 "
"G50784","SUP","HCPCS C1769","","G50784  -  GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS","BOTH IP/OP","$416.88 ","$308.49 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$86.89 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50785","SUP","HCPCS C1769","","G50785  -  GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS","BOTH IP/OP","$416.88 ","$308.49 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$86.89 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50788","SUP","HCPCS C1769","","G50788  -  GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS","BOTH IP/OP","$423.13 ","$313.12 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$88.19 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50789","SUP","HCPCS C1769","","G50789  -  GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS","BOTH IP/OP","$423.13 ","$313.12 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$88.19 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50791","SUP","HCPCS C1769","","G50791  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 12GM TIP LOAD APPROACH","BOTH IP/OP","$423.13 ","$313.12 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$88.19 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50792","SUP","HCPCS C1769","","G50792  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 18GM TIP LOAD APPROACH","BOTH IP/OP","$423.13 ","$313.12 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$88.19 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50793","SUP","HCPCS C1769","","G50793  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 25GM TIP LOAD APPROACH","BOTH IP/OP","$423.13 ","$313.12 ","$0.00 ","$416.88 ","$226.36 ","$0.00 ","$88.19 ","$0.00 ","$0.00 ","$72.99 ","$416.88 ","$0.00 ","$208.44 ","$330.17 ","$333.50 ","$0.00 ","$65.24 ","$0.00 ","$66.37 ","$0.00 "
"G50972","SUP","HCPCS C1894","","G50972  -  NEEDLE PRC SHTH TFE","BOTH IP/OP","$5,118.75 ","$3,787.88 ","$0.00 ","$5,118.75 ","$2,779.48 ","$0.00 ","$1,066.88 ","$0.00 ","$0.00 ","$896.25 ","$5,118.75 ","$0.00 ","$2,559.38 ","$4,054.05 ","$4,095.00 ","$0.00 ","$801.08 ","$0.00 ","$814.91 ","$0.00 "
"G50973","SUP","HCPCS C1894","","G50973  -  SHEATH ACC FLXR DFLC VSN URETER","BOTH IP/OP","$1,023.75 ","$757.58 ","$0.00 ","$1,023.75 ","$555.90 ","$0.00 ","$213.38 ","$0.00 ","$0.00 ","$179.25 ","$1,023.75 ","$0.00 ","$511.88 ","$810.81 ","$819.00 ","$0.00 ","$160.22 ","$0.00 ","$162.98 ","$0.00 "
"G50974","SUP","HCPCS C1894","","G50974  -  SHEATH ACC 180D FLXR DFLC VSN URETER","BOTH IP/OP","$1,023.75 ","$757.58 ","$0.00 ","$1,023.75 ","$555.90 ","$0.00 ","$213.38 ","$0.00 ","$0.00 ","$179.25 ","$1,023.75 ","$0.00 ","$511.88 ","$810.81 ","$819.00 ","$0.00 ","$160.22 ","$0.00 ","$162.98 ","$0.00 "
"G51183","SUP","HCPCS C1874","","G51183  -  STENT ESOPHAGEAL 23MM 18MM 12CM 2 LASSO LOOP CONTROL RELEASE","BOTH IP/OP","$4,705.00 ","$3,481.70 ","$0.00 ","$4,705.00 ","$2,117.25 ","$0.00 ","$980.64 ","$0.00 ","$0.00 ","$823.81 ","$4,705.00 ","$0.00 ","$2,352.50 ","$3,726.36 ","$3,764.00 ","$0.00 ","$736.33 ","$0.00 ","$749.04 ","$0.00 "
"G51574","SUP","HCPCS C1887","","G51574  -  CATHETER GUID .014IN 3-1.9FR 150CM SUPPORT CORSSCATH","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$196.84 ","$0.00 ","$75.55 ","$0.00 ","$0.00 ","$63.47 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$56.73 ","$0.00 ","$57.71 ","$0.00 "
"G51954","SUP","HCPCS C1769","","G51954  -  GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH","BOTH IP/OP","$167.03 ","$123.60 ","$0.00 ","$167.03 ","$90.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.24 ","$167.03 ","$0.00 ","$83.51 ","$132.29 ","$133.62 ","$0.00 ","$26.14 ","$0.00 ","$26.59 ","$0.00 "
"G51956","SUP","HCPCS C1769","","G51956  -  GUIDEWIRE VASCULAR MICRO .018IN 300CM SHAPEABLE TIP APPROACH","BOTH IP/OP","$218.68 ","$161.82 ","$0.00 ","$218.68 ","$118.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.29 ","$218.68 ","$0.00 ","$109.34 ","$173.19 ","$174.94 ","$0.00 ","$34.22 ","$0.00 ","$34.81 ","$0.00 "
"G52226","SUP","HCPCS C1874","","G52226  -  STENT ESOPHAGEAL 25MM 20MM 12CM CONTROLLED RELEASE FULLY","BOTH IP/OP","$4,705.00 ","$3,481.70 ","$0.00 ","$4,705.00 ","$2,117.25 ","$0.00 ","$980.64 ","$0.00 ","$0.00 ","$823.81 ","$4,705.00 ","$0.00 ","$2,352.50 ","$3,726.36 ","$3,764.00 ","$0.00 ","$736.33 ","$0.00 ","$749.04 ","$0.00 "
"G52247","SUP","HCPCS C1725","","G52247  -  CATHETER BLNDIL 3MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52249","SUP","HCPCS C1725","","G52249  -  CATHETER BLNDIL 3MM 135CM STRL LF 12CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52253","SUP","HCPCS C1725","","G52253  -  CATHETER BLNDIL 4MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52260","SUP","HCPCS C1725","","G52260  -  CATHETER BLNDIL 5MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52263","SUP","HCPCS C1725","","G52263  -  CATHETER BLNDIL 5MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52267","SUP","HCPCS C1725","","G52267  -  CATHETER BLNDIL 6MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52270","SUP","HCPCS C1725","","G52270  -  CATHETER BLNDIL 6MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52274","SUP","HCPCS C1725","","G52274  -  CATHETER BLNDIL 7MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52277","SUP","HCPCS C1725","","G52277  -  CATHETER BLNDIL 7MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL","BOTH IP/OP","$600.00 ","$444.00 ","$0.00 ","$600.00 ","$325.80 ","$0.00 ","$125.06 ","$0.00 ","$0.00 ","$105.06 ","$600.00 ","$0.00 ","$300.00 ","$475.20 ","$480.00 ","$0.00 ","$93.90 ","$0.00 ","$95.52 ","$0.00 "
"G52349","SUP","HCPCS C1725","","G52349  -  CATHETER BLNDIL 6MM 80CM STRL LF 12CM ADV 2 LUM LOPRFL","BOTH IP/OP","$612.00 ","$452.88 ","$0.00 ","$612.00 ","$332.32 ","$0.00 ","$127.56 ","$0.00 ","$0.00 ","$107.16 ","$612.00 ","$0.00 ","$306.00 ","$484.70 ","$489.60 ","$0.00 ","$95.78 ","$0.00 ","$97.43 ","$0.00 "
"G52542","SUP","HCPCS C1887","","G52542  -  CATHETER GUID .035IN 4FR 135CM SUPPORT STR TIP LP RADIOPQ","BOTH IP/OP","$494.81 ","$366.16 ","$0.00 ","$487.50 ","$264.71 ","$0.00 ","$103.13 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"G52543","SUP","HCPCS C1887","","G52543  -  CATHETER SPRT DAV CRV 4FR 135CM STRL CXI RADOPQ BRD LOPRFL","BOTH IP/OP","$494.81 ","$366.16 ","$0.00 ","$487.50 ","$264.71 ","$0.00 ","$103.13 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"G52545","SUP","HCPCS C1887","","G52545  -  CATHETER GUID .035IN 4FR 150CM SUPPORT ANGLED TIP LP RADIOPQ","BOTH IP/OP","$494.81 ","$366.16 ","$0.00 ","$487.50 ","$264.71 ","$0.00 ","$103.13 ","$0.00 ","$0.00 ","$85.36 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$76.29 ","$0.00 ","$77.61 ","$0.00 "
"G52599","SUP","Custom 27203010","","G52599  -  SHEATH ACC VUE FLXR DFLC UT ESCP SYS","BOTH IP/OP","$64.13 ","$47.46 ","$0.00 ","$64.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$64.13 ","$0.00 ","$32.06 ","$50.79 ","$51.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52603","SUP","Custom 27203010","","G52603  -  CARTRIDGE CO2 LITHOTRIPTER PNEUMATIC KIT LMA STONEBREAKER","BOTH IP/OP","$35.63 ","$26.37 ","$0.00 ","$35.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.63 ","$0.00 ","$17.81 ","$28.22 ","$28.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52605","SUP","Custom 27203010","","G52605  -  CATHETER URTH 10FR 25CM 3ML UNIVERSA 2W OP-EN BLN FL SIL DOD","BOTH IP/OP","$192.19 ","$142.22 ","$0.00 ","$192.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.19 ","$0.00 ","$96.09 ","$152.21 ","$153.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52606","SUP","Custom 27203010","","G52606  -  PROBE LITHOTRIPTER 1.6MM 500MM PNEUMATIC KIT LMA","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$461.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$461.25 ","$0.00 ","$230.63 ","$365.31 ","$369.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52607","SUP","Custom 27203010","","G52607  -  PROBE LITHOTRIPTER 1MM 500MM PNEUMATIC KIT LMA STONEBREAKER","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$461.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$461.25 ","$0.00 ","$230.63 ","$365.31 ","$369.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52608","SUP","Custom 27203010","","G52608  -  PROBE LITHOTRIPTER 2MM 425MM PNEUMATIC KIT STONEBREAKER","BOTH IP/OP","$461.25 ","$341.33 ","$0.00 ","$461.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$461.25 ","$0.00 ","$230.63 ","$365.31 ","$369.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52609","SUP","Custom 27203010","","G52609  -  LITHOTRIPTER SRG LMA STONEBREAKER XHST LN STRL PRB CAP PORT","BOTH IP/OP","$2,306.25 ","$1,706.63 ","$0.00 ","$2,306.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,306.25 ","$0.00 ","$1,153.13 ","$1,826.55 ","$1,845.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52736","SUP","HCPCS Q4107","","G52736  -  COIL EMBOLIZATION 7CM 3MM NESTER 7.4 LOOP SOFT ENHANCED RADI","BOTH IP/OP","$249.30 ","$184.48 ","$0.00 ","$249.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$249.30 ","$0.00 ","$124.65 ","$197.45 ","$199.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52737","SUP","Custom 27805113","","G52737  -  COIL EMBOLIZATION .018IN 4MM 7CM 5.6 LOOP SOFT ENHANCED","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52742","SUP","Custom 27803010","","G52742  -  COIL EMBOLIZATION .035IN 4MM 7CM 5.6 LOOP SOFT ENHANCED","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52745","SUP","Custom 27803010","","G52745  -  COIL EMBOLIZATION .035IN 10MM 7CM 2.2 LOOP SOFT ENHANCED","BOTH IP/OP","$264.20 ","$195.51 ","$0.00 ","$264.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$264.20 ","$0.00 ","$132.10 ","$209.25 ","$211.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52753","SUP","Custom 27803010","","G52753  -  COIL EMBOLIZATION .035IN 18MM 14CM 2.5 LOOP SOFT ENHANCED","BOTH IP/OP","$303.83 ","$224.83 ","$0.00 ","$303.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.83 ","$0.00 ","$151.91 ","$240.63 ","$243.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52754","SUP","Custom 27803010","","G52754  -  COIL EMBOLIZATION .035IN 20MM 14CM 2.2 LOOP SOFT ENHANCED","BOTH IP/OP","$303.83 ","$224.83 ","$0.00 ","$303.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$303.83 ","$0.00 ","$151.91 ","$240.63 ","$243.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52756","SUP","Custom 27803010","","G52756  -  COIL EMBOLIZATION .035IN 20MM 20CM 3.2 LOOP SOFT ENHANCED","BOTH IP/OP","$325.28 ","$240.71 ","$0.00 ","$325.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$325.28 ","$0.00 ","$162.64 ","$257.62 ","$260.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G52909","SUP","HCPCS C1880","","G52909  -  FILTER EMBOLIZATION 30MM 7FR 48MM 65CM NAVALIGN DELIVERY","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"G52914","SUP","HCPCS C1880","","G52914  -  SYSTEM EMBL PRTC 30MM 7FR 48MM 65CM CELECT NAVALIGN DLV","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,569.38 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"G53030","SUP","HCPCS C1758","","G53030  -  PROBE LTHTRP 1.6MM 605MM LMA STONEBREAKER PNEUM KT DISP","BOTH IP/OP","$63.75 ","$47.18 ","$0.00 ","$63.75 ","$34.62 ","$0.00 ","$13.29 ","$0.00 ","$0.00 ","$11.16 ","$63.75 ","$0.00 ","$31.88 ","$50.49 ","$51.00 ","$0.00 ","$9.98 ","$0.00 ","$10.15 ","$0.00 "
"G53145","SUP","HCPCS C2617","","G53145  -  CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL RND BLDR SIL","BOTH IP/OP","$20.25 ","$14.99 ","$0.00 ","$20.25 ","$9.11 ","$0.00 ","$4.22 ","$0.00 ","$0.00 ","$3.55 ","$20.25 ","$0.00 ","$10.13 ","$16.04 ","$16.20 ","$0.00 ","$3.17 ","$0.00 ","$3.22 ","$0.00 "
"G53146","SUP","HCPCS C2617","","G53146  -  SET STNT .038IN 3CM PGTL CRV 5FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53179","SUP","HCPCS C1769","","G53179  -  TRAY TRACHEOSTOMY 2 CANNU TUBE SHILEY CUFFED PLIANT TIP","BOTH IP/OP","$1,142.50 ","$845.45 ","$0.00 ","$1,218.95 ","$661.89 ","$0.00 ","$238.13 ","$0.00 ","$0.00 ","$213.43 ","$1,218.95 ","$0.00 ","$609.48 ","$965.41 ","$975.16 ","$0.00 ","$190.77 ","$0.00 ","$194.06 ","$0.00 "
"G53211","SUP","HCPCS C1769","","G53211  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ SFT","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53235","SUP","HCPCS C1758","","G53235  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 2W FL RND TIP CLS END","BOTH IP/OP","$26.56 ","$19.65 ","$0.00 ","$26.56 ","$14.42 ","$0.00 ","$5.54 ","$0.00 ","$0.00 ","$4.65 ","$26.56 ","$0.00 ","$13.28 ","$21.04 ","$21.25 ","$0.00 ","$4.16 ","$0.00 ","$4.23 ","$0.00 "
"G53236","SUP","HCPCS C1758","","G53236  -  CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53237","SUP","HCPCS C1758","","G53237  -  CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53238","SUP","HCPCS C1758","","G53238  -  CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53240","SUP","HCPCS C1758","","G53240  -  CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53241","SUP","HCPCS C1758","","G53241  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53242","SUP","HCPCS C1758","","G53242  -  CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53243","SUP","HCPCS C1758","","G53243  -  CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53244","SUP","HCPCS C1758","","G53244  -  CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53245","SUP","HCPCS C1758","","G53245  -  CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53246","SUP","HCPCS C1758","","G53246  -  CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL","BOTH IP/OP","$31.88 ","$23.59 ","$0.00 ","$31.88 ","$17.31 ","$0.00 ","$6.64 ","$0.00 ","$0.00 ","$5.58 ","$31.88 ","$0.00 ","$15.94 ","$25.25 ","$25.50 ","$0.00 ","$4.99 ","$0.00 ","$5.07 ","$0.00 "
"G53421","SUP","HCPCS C1874","","G53421  -  GRAFT EVAS BFUR 30MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$13,605.75 ","$0.00 ","$6,301.73 ","$0.00 ","$0.00 ","$5,293.91 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$4,731.78 ","$0.00 ","$4,813.41 ","$0.00 "
"G53422","SUP","Custom 27803010","","G53422  -  GRAFT EVAS BFUR 30MM 20FR 140MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53423","SUP","Custom 27803010","","G53423  -  GRAFT EVAS 30MM 20FR 200MM ZNTH TX2 DIST CMPNT PRFRM Z TRK +","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53424","SUP","Custom 27803010","","G53424  -  GRAFT EVAS BFUR 32MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + PROX","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53426","SUP","HCPCS C1874","","G53426  -  GRAFT EVAS 2 BRCH 32MM 20FR 200MM ZNTH TX2 PROX PRFRM Z-TRK","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$13,605.75 ","$0.00 ","$6,301.73 ","$0.00 ","$0.00 ","$5,293.91 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$4,731.78 ","$0.00 ","$4,813.41 ","$0.00 "
"G53427","SUP","HCPCS C1874","","G53427  -  GRAFT EVAS 2 BRCH CYL 34MM 20FR 127MM STRL PRFRM Z-TRK +","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$13,605.75 ","$0.00 ","$6,301.73 ","$0.00 ","$0.00 ","$5,293.91 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$4,731.78 ","$0.00 ","$4,813.41 ","$0.00 "
"G53428","SUP","Custom 27803010","","G53428  -  GRAFT EVAS BFUR 34MM 20FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53429","SUP","Custom 27803010","","G53429  -  GRAFT EVAS BFUR 34MM 20FR 202MM ZNTH TX2 PRFRM Z-TRK + PROX","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53430","SUP","Custom 27803010","","G53430  -  GRAFT EVAS BFUR 36MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53433","SUP","HCPCS C1874","","G53433  -  GRAFT EVAS 2 BRCH 38MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$13,605.75 ","$0.00 ","$6,301.73 ","$0.00 ","$0.00 ","$5,293.91 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$4,731.78 ","$0.00 ","$4,813.41 ","$0.00 "
"G53434","SUP","Custom 27803010","","G53434  -  GRAFT EVAS BFUR 38MM 22FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53435","SUP","Custom 27803010","","G53435  -  GRAFT EVAS BFUR 38MM 22FR 202MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53436","SUP","Custom 27803010","","G53436  -  GRAFT EVAS BFUR 40MM 22FR 135MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53440","SUP","Custom 27803010","","G53440  -  GRAFT EVAS BFUR 42MM 22FR 162MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53441","SUP","Custom 27803010","","G53441  -  GRAFT EVAS BFUR 42MM 22FR 216MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53442","SUP","Custom 27803010","","G53442  -  GRAFT EVAS BFUR 32MM 20FR 160MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53446","SUP","Custom 27803010","","G53446  -  GRAFT EVAS BFUR 36MM 22FR 157MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53449","SUP","HCPCS C1874","","G53449  -  GRAFT EVAS CYL TPR 38-34MM 8.5MM 22FR 202MM STRL PRFRM Z-TRK","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$13,605.75 ","$0.00 ","$6,301.73 ","$0.00 ","$0.00 ","$5,293.91 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$4,731.78 ","$0.00 ","$4,813.41 ","$0.00 "
"G53450","SUP","Custom 27803010","","G53450  -  GRAFT EVAS 40MM 22FR 158MM ZNTH TX2 PROX TPR CMPNT PRFRM","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53454","SUP","Custom 27803010","","G53454  -  GRAFT EVAS 28MM 20FR 80MM ZNTH TX2 TBE CMPNT PROX XTN PRFRM","BOTH IP/OP","$12,996.03 ","$9,617.06 ","$0.00 ","$12,996.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,996.03 ","$0.00 ","$6,498.01 ","$10,292.86 ","$10,396.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53455","SUP","Custom 27803010","","G53455  -  GRAFT EVAS BFUR 30MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + PROX","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53456","SUP","Custom 27803010","","G53456  -  GRAFT EVAS BFUR 32MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53457","SUP","Custom 27803010","","G53457  -  GRAFT EVAS 34MM 20FR 77MM ZNTH TX2 DIST XTN TBE CMPNT PRFRM","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53458","SUP","Custom 27803010","","G53458  -  GRAFT EVAS 36MM 22FR 77MM ZNTH TX2 PROX XTN Z-TRK + TAA","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53459","SUP","Custom 27803010","","G53459  -  GRAFT EVAS 38MM 22FR 77MM ZNTH TX2 PROX XTN PRFRM Z TRK +","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53460","SUP","Custom 27803010","","G53460  -  GRAFT EVAS BFUR 40MM 22FR 81MM ZNTH TX2 PRFRM Z-TRK + SLF","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53461","SUP","Custom 27803010","","G53461  -  GRAFT EVAS 42MM 22FR 81MM ZNTH TX2 PROX XTN PRFRM Z-TRK +","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53463","SUP","HCPCS C1874","","G53463  -  GRAFT EVAS 30MM 7.7MM 20FR 80MM STRL ZNTH TX2 PRFRM ESBE","BOTH IP/OP","$12,995.00 ","$9,616.30 ","$0.00 ","$12,995.00 ","$5,847.75 ","$0.00 ","$2,708.48 ","$0.00 ","$0.00 ","$2,275.32 ","$12,995.00 ","$0.00 ","$6,497.50 ","$10,292.04 ","$10,396.00 ","$0.00 ","$2,033.72 ","$0.00 ","$2,068.80 ","$0.00 "
"G53486","SUP","Custom 27803010","","G53486  -  GRAFT EVAS 42MM 22FR 144MM ZNTH TX2 PRFRM Z TRK + INTRO SYS","BOTH IP/OP","$16,442.50 ","$12,167.45 ","$0.00 ","$16,442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16,442.50 ","$0.00 ","$8,221.25 ","$13,022.46 ","$13,154.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G53556","SUP","HCPCS C1769","","G53556  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL","BOTH IP/OP","$6.76 ","$5.00 ","$0.00 ","$6.76 ","$3.67 ","$0.00 ","$1.41 ","$0.00 ","$0.00 ","$1.18 ","$6.76 ","$0.00 ","$3.38 ","$5.35 ","$5.41 ","$0.00 ","$1.06 ","$0.00 ","$1.08 ","$0.00 "
"G53557","SUP","HCPCS C1769","","G53557  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB STF","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53558","SUP","HCPCS C1769","","G53558  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB STF","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53559","SUP","HCPCS C1769","","G53559  -  GUIDEWIRE ESCP STRG .025IN 145CM STRL 5CM AMPTZ XSTF FXCR","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53560","SUP","HCPCS C1769","","G53560  -  CATHETER NPHSTM 8MM 15CM ULTRX","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53561","SUP","HCPCS C1769","","G53561  -  GUIDEWIRE ESCP .035IN STRG 145CM 5CM AMPTZ FLX TP FXCR XSTF","BOTH IP/OP","$88.13 ","$65.22 ","$0.00 ","$88.13 ","$47.85 ","$0.00 ","$18.37 ","$0.00 ","$0.00 ","$15.43 ","$88.13 ","$0.00 ","$44.06 ","$69.80 ","$70.50 ","$0.00 ","$13.79 ","$0.00 ","$14.03 ","$0.00 "
"G53562","SUP","HCPCS C1769","","G53562  -  GUIDEWIRE ESCP STRG .035IN 260CM STRL 5CM AMPTZ XSTF FXCR","BOTH IP/OP","$88.13 ","$65.22 ","$0.00 ","$88.13 ","$47.85 ","$0.00 ","$18.37 ","$0.00 ","$0.00 ","$15.43 ","$88.13 ","$0.00 ","$44.06 ","$69.80 ","$70.50 ","$0.00 ","$13.79 ","$0.00 ","$14.03 ","$0.00 "
"G53563","SUP","HCPCS C1769","","G53563  -  GUIDEWIRE ESCP STRG .038IN 260CM STRL 5CM AMPTZ XSTF FXCR","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53564","SUP","HCPCS C1769","","G53564  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLX TP","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53566","SUP","HCPCS C1769","","G53566  -  GUIDEWIRE URO STRG .038IN 145CM 5CM AMPTZ 2 FLX TP FX COR","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53567","SUP","HCPCS C1769","","G53567  -  GUIDEWIRE VASC STRG .035IN 145CM 5CM AMPTZ 2 FLX TP FXCR ULT","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53568","SUP","HCPCS C1769","","G53568  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB ULT STF","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53569","SUP","HCPCS C1769","","G53569  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLXB ULT","BOTH IP/OP","$67.58 ","$50.01 ","$0.00 ","$67.58 ","$36.69 ","$0.00 ","$14.08 ","$0.00 ","$0.00 ","$11.83 ","$67.58 ","$0.00 ","$33.79 ","$53.52 ","$54.06 ","$0.00 ","$10.58 ","$0.00 ","$10.76 ","$0.00 "
"G53672","SUP","HCPCS C2617","","G53672  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB ULT","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53674","SUP","HCPCS C2617","","G53674  -  SET STNT .038IN 3CM PGTL CRV 5FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53675","SUP","HCPCS C2617","","G53675  -  SET STNT .038IN 3CM PGTL CRV 5FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53676","SUP","HCPCS C2617","","G53676  -  SET STNT 3CM PGTL CRV 5FR 22CM STRL 145CM UNIVERSA RADOPQ","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53677","SUP","HCPCS C2617","","G53677  -  SET STNT .038IN 3CM PGTL CRV 5FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53678","SUP","HCPCS C2617","","G53678  -  SET STNT .038IN 3CM PGTL CRV 5FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53680","SUP","HCPCS C2617","","G53680  -  SET STNT .038IN 3CM PGTL CRV 5FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53681","SUP","HCPCS C2617","","G53681  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53682","SUP","HCPCS C2617","","G53682  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53683","SUP","HCPCS C2617","","G53683  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53684","SUP","HCPCS C2617","","G53684  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53685","SUP","HCPCS C2617","","G53685  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53686","SUP","HCPCS C2617","","G53686  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53687","SUP","HCPCS C2617","","G53687  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53688","SUP","HCPCS C2617","","G53688  -  SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53689","SUP","HCPCS C2617","","G53689  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA PSTNR","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53690","SUP","HCPCS C2617","","G53690  -  SET STNT 2 PGTL CRV 6FR 18CM UNIVERSA SFT GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53691","SUP","HCPCS C2617","","G53691  -  SET STNT PGTL CRV 6FR 20CM UNIVERSA SFT GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53692","SUP","HCPCS C2617","","G53692  -  SET STNT 2 PGTL CRV 6FR 22CM UNIVERSA SFT GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53693","SUP","HCPCS C2617","","G53693  -  SET STNT .038IN 3CM PGTL CRV 6FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53694","SUP","HCPCS C2617","","G53694  -  SET STNT .038IN 3CM PGTL CRV 6FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53695","SUP","HCPCS C2617","","G53695  -  SET STNT PGTL CRV 6FR 28CM UNIVERSA GW SFT GRAD MRK","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53696","SUP","HCPCS C2617","","G53696  -  SET STNT .038IN 3CM PGTL CRV 6FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53697","SUP","HCPCS C2617","","G53697  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53698","SUP","HCPCS C2617","","G53698  -  SET STNT 6FR 22CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53699","SUP","HCPCS C2617","","G53699  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53700","SUP","HCPCS C2617","","G53700  -  SET STNT 6FR 26CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53701","SUP","HCPCS C2617","","G53701  -  SET STNT 6FR 24CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53702","SUP","HCPCS C2617","","G53702  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53703","SUP","HCPCS C2617","","G53703  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53704","SUP","HCPCS C2617","","G53704  -  SET STNT .038IN 3CM PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53706","SUP","HCPCS C2617","","G53706  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53707","SUP","HCPCS C2617","","G53707  -  SET STNT 3CM PGTL CRV 7FR 22-32CM STRL LF 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53708","SUP","HCPCS C2617","","G53708  -  SET STNT .038IN 3CM PGTL CRV 7FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53709","SUP","HCPCS C2617","","G53709  -  SET STNT .038IN 3CM PGTL CRV 7FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53710","SUP","HCPCS C2617","","G53710  -  SET STNT .038IN 3CM PGTL CRV 7FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53711","SUP","HCPCS C2617","","G53711  -  SET STNT .038IN 3CM PGTL CRV 7FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53712","SUP","HCPCS C2617","","G53712  -  SET STNT .038IN 3CM PGTL CRV 7FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53713","SUP","HCPCS C2617","","G53713  -  SET STNT .038IN 3CM PGTL CRV 7FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53714","SUP","HCPCS C2617","","G53714  -  SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53715","SUP","HCPCS C2617","","G53715  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53716","SUP","HCPCS C2617","","G53716  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53717","SUP","HCPCS C2617","","G53717  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53718","SUP","HCPCS C2617","","G53718  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53719","SUP","HCPCS C2617","","G53719  -  SET STNT 2 PGTL CRV 7FR 26CM STRL LF UNIVERSA RADOPQ SFT","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53720","SUP","HCPCS C2617","","G53720  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53721","SUP","HCPCS C2617","","G53721  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53722","SUP","HCPCS C2617","","G53722  -  SET STNT .038IN 3CM PGTL CRV 8FR 22-32CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53723","SUP","HCPCS C2617","","G53723  -  SET STNT .038IN 3CM PGTL CRV 8FR 18CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53724","SUP","HCPCS C2617","","G53724  -  SET STNT .038IN 3CM PGTL CRV 8FR 20CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53725","SUP","HCPCS C2617","","G53725  -  SET STNT .038IN 3CM PGTL CRV 8FR 22CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53726","SUP","HCPCS C2617","","G53726  -  SET STNT .038IN 3CM PGTL CRV 8FR 24CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53727","SUP","HCPCS C2617","","G53727  -  SET STNT .038IN 3CM PGTL CRV 8FR 26CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53728","SUP","HCPCS C2617","","G53728  -  SET STNT .038IN 3CM PGTL CRV 8FR 28CM STRL 145CM UNIVERSA","BOTH IP/OP","$202.50 ","$149.85 ","$0.00 ","$202.50 ","$91.13 ","$0.00 ","$42.21 ","$0.00 ","$0.00 ","$35.46 ","$202.50 ","$0.00 ","$101.25 ","$160.38 ","$162.00 ","$0.00 ","$31.69 ","$0.00 ","$32.24 ","$0.00 "
"G53729","SUP","HCPCS C2617","","G53729  -  SET STNT .038IN 3CM PGTL CRV 8FR 30CM STRL 145CM UNIVERSA","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53731","SUP","HCPCS C2617","","G53731  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53732","SUP","HCPCS C2617","","G53732  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53734","SUP","HCPCS C2617","","G53734  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53735","SUP","HCPCS C2617","","G53735  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53736","SUP","HCPCS C2617","","G53736  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G53737","SUP","HCPCS C2617","","G53737  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$84.38 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G54613","SUP","HCPCS C1763","","G54613  -  GRAFT SOFT TISSUE .4CM SET PLUG BUTTON BIODESIGN SURGISIS","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G54614","SUP","HCPCS C1763","","G54614  -  GRAFT ENDOVASCULAR .7CM SET PLUG BUTTON BIODESIGN SURGISIS","BOTH IP/OP","$2,612.50 ","$1,933.25 ","$0.00 ","$2,612.50 ","$1,175.63 ","$0.00 ","$544.51 ","$0.00 ","$0.00 ","$457.43 ","$2,612.50 ","$0.00 ","$1,306.25 ","$2,069.10 ","$2,090.00 ","$0.00 ","$408.86 ","$0.00 ","$415.91 ","$0.00 "
"G55230","SUP","HCPCS C1874","","G55230  -  GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 39MM STRL ZNTH SPRLZ Z-TRK","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$3,470.63 ","$0.00 ","$1,607.48 ","$0.00 ","$0.00 ","$1,350.40 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$1,207.01 ","$0.00 ","$1,227.83 ","$0.00 "
"G55231","SUP","HCPCS C1874","","G55231  -  GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 56MM STRL ZNTH SPRLZ Z-TRK","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$3,470.63 ","$0.00 ","$1,607.48 ","$0.00 ","$0.00 ","$1,350.40 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$1,207.01 ","$0.00 ","$1,227.83 ","$0.00 "
"G55236","SUP","HCPCS C1874","","G55236  -  GRAFT EVAS 2 BRCH 16MM 14FR 39MM SPRLZ ZNTH Z-TRK SLF XPD LG","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$3,470.63 ","$0.00 ","$1,607.48 ","$0.00 ","$0.00 ","$1,350.40 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$1,207.01 ","$0.00 ","$1,227.83 ","$0.00 "
"G55237","SUP","HCPCS C1874","","G55237  -  GRAFT EVAS BFUR 16MM 5.4MM 14FR 56MM ZNTH SPRLZ ANCLRY","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$3,470.63 ","$0.00 ","$1,607.48 ","$0.00 ","$0.00 ","$1,350.40 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$1,207.01 ","$0.00 ","$1,227.83 ","$0.00 "
"G55242","SUP","HCPCS C1874","","G55242  -  GRAFT EVAS 2 BRCH 20MM 6MM 16FR 74MM ZNTH SPRLZ ILC LG","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$3,470.63 ","$0.00 ","$1,607.48 ","$0.00 ","$0.00 ","$1,350.40 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$1,207.01 ","$0.00 ","$1,227.83 ","$0.00 "
"G55243","SUP","Custom 27803010","","G55243  -  GRAFT EVAS 2 BRCH 20MM 16FR 90MM SPRLZ ZNTH Z-TRK SLF XPD LG","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G55245","SUP","Custom 27803010","","G55245  -  GRAFT EVAS 24MM 6MM 5.3MM 56MM 71CM ZNTH SPRLZ ILC LG CAPTOR","BOTH IP/OP","$9,412.50 ","$6,965.25 ","$0.00 ","$9,412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,412.50 ","$0.00 ","$4,706.25 ","$7,454.70 ","$7,530.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G55246","SUP","Custom 27803010","","G55246  -  GRAFT EVAS BFUR 24MM 16FR 74MM ZNTH SPRLZ Z-TRK SLF XPD WVN","BOTH IP/OP","$7,712.50 ","$5,707.25 ","$0.00 ","$7,712.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,712.50 ","$0.00 ","$3,856.25 ","$6,108.30 ","$6,170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G55247","SUP","HCPCS C1874","","G55247  -  GRAFT EVAS 24MM 6MM 16FR 90MM ZNTH SPRLZ ANCLRY CNTRLT/IPSL","BOTH IP/OP","$385.63 ","$285.37 ","$0.00 ","$385.63 ","$173.53 ","$0.00 ","$80.37 ","$0.00 ","$0.00 ","$67.52 ","$385.63 ","$0.00 ","$192.81 ","$305.42 ","$308.50 ","$0.00 ","$60.35 ","$0.00 ","$61.39 ","$0.00 "
"G55800","SUP","HCPCS C1729","","G55800  -  SET DRN 14FR 6-16FR 30CM 20CM UNIVERSA ECHTP SFTJ LOOP CATH","BOTH IP/OP","$350.68 ","$259.50 ","$0.00 ","$350.68 ","$190.42 ","$0.00 ","$73.09 ","$0.00 ","$0.00 ","$61.40 ","$350.68 ","$0.00 ","$175.34 ","$277.74 ","$280.54 ","$0.00 ","$54.88 ","$0.00 ","$55.83 ","$0.00 "
"G55801","SUP","HCPCS C1729","","G55801  -  SET DRN 6FR 5-8FR 15CM 20CM CATH DIL LOOP","BOTH IP/OP","$350.68 ","$259.50 ","$0.00 ","$350.68 ","$190.42 ","$0.00 ","$73.09 ","$0.00 ","$0.00 ","$61.40 ","$350.68 ","$0.00 ","$175.34 ","$277.74 ","$280.54 ","$0.00 ","$54.88 ","$0.00 ","$55.83 ","$0.00 "
"G55802","SUP","HCPCS C1729","","G55802  -  SHIELD SPLSH ELLIPSE 9X12IN LTX BRR RBR","BOTH IP/OP","$350.68 ","$259.50 ","$0.00 ","$350.68 ","$190.42 ","$0.00 ","$73.09 ","$0.00 ","$0.00 ","$61.40 ","$350.68 ","$0.00 ","$175.34 ","$277.74 ","$280.54 ","$0.00 ","$54.88 ","$0.00 ","$55.83 ","$0.00 "
"G55803","SUP","HCPCS C1729","","G55803  -  SET DRN 12FR 6-14FR 30CM 20CM UNIVERSA DIL LOOP CATH INTRO","BOTH IP/OP","$350.68 ","$259.50 ","$0.00 ","$350.68 ","$190.42 ","$0.00 ","$73.09 ","$0.00 ","$0.00 ","$61.40 ","$350.68 ","$0.00 ","$175.34 ","$277.74 ","$280.54 ","$0.00 ","$54.88 ","$0.00 ","$55.83 ","$0.00 "
"G55804","SUP","HCPCS C1729","","G55804  -  SET DRN 10FR 6-12FR 30CM 20CM CATH DIL LOOP","BOTH IP/OP","$350.68 ","$259.50 ","$0.00 ","$350.68 ","$190.42 ","$0.00 ","$73.09 ","$0.00 ","$0.00 ","$61.40 ","$350.68 ","$0.00 ","$175.34 ","$277.74 ","$280.54 ","$0.00 ","$54.88 ","$0.00 ","$55.83 ","$0.00 "
"G55821","SUP","HCPCS C2627","","G55821  -  SET CATH 14FR 15GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G55822","SUP","HCPCS C2627","","G55822  -  CATHETER SPBC 12FR 14FR 22CM 3CC STRL LTX 30CM RTNR SET NDL","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G55823","SUP","HCPCS C2627","","G55823  -  SET CATH 10FR 18GA 30CM UNIVERSA MLCT DRN SPBC","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G55824","SUP","HCPCS C2627","","G55824  -  SET CATH 12FR 54CM TROC STY DRN ADPR SPBC CYSTOSTOMY","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G55825","SUP","HCPCS C1729","","G55825  -  INSERTER SRG 1.91IN STRL DISP ACPT 3.1FR","BOTH IP/OP","$3.96 ","$2.93 ","$0.00 ","$3.96 ","$2.15 ","$0.00 ","$0.83 ","$0.00 ","$0.00 ","$0.69 ","$3.96 ","$0.00 ","$1.98 ","$3.14 ","$3.17 ","$0.00 ","$0.62 ","$0.00 ","$0.63 ","$0.00 "
"G56219","SUP","HCPCS C1894","","G56219  -  INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL0 CURVE STR TIP","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56220","SUP","HCPCS C1894","","G56220  -  INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL0 CURVE STR TIP","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56221","SUP","HCPCS C1894","","G56221  -  INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL0 CURVE STR TIP","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56222","SUP","HCPCS C1894","","G56222  -  INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL0 CURVE STR TIP","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56224","SUP","HCPCS C1894","","G56224  -  INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL1 CURVE MULTPUR","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56225","SUP","HCPCS C1894","","G56225  -  INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL1 CURVE MULTPUR","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56226","SUP","HCPCS C1894","","G56226  -  INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL1 CURVE MULTPUR","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56227","SUP","HCPCS C1894","","G56227  -  INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL1 CURVE MULTPUR","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56228","SUP","HCPCS C1894","","G56228  -  INTRODUCER SHEATH .035IN 8FR .113IN 70CM ANL1 CURVE MULTPUR","BOTH IP/OP","$238.50 ","$176.49 ","$0.00 ","$225.00 ","$122.18 ","$0.00 ","$49.71 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"G56277","SUP","HCPCS C1751","","G56277  -  TRAY CATHETER CEN VEN STERILE","BOTH IP/OP","$463.00 ","$342.62 ","$0.00 ","$462.99 ","$251.40 ","$0.00 ","$96.50 ","$0.00 ","$0.00 ","$81.07 ","$462.99 ","$0.00 ","$231.50 ","$366.69 ","$370.39 ","$0.00 ","$72.46 ","$0.00 ","$73.71 ","$0.00 "
"G56278","SUP","HCPCS C1892","","G56278  -  INTRODUCER SHEATH .035IN 10FR .134IN 45CM ANL0 CURVE STR TIP","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$44.19 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"G56279","SUP","HCPCS C1892","","G56279  -  INTRODUCER SHEATH .035IN 12FR .162IN 45CM ANL0 CURVE STR TIP","BOTH IP/OP","$212.00 ","$156.88 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$44.19 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"G56334","SUP","HCPCS C1729","","G56334  -  CATHETER DRN 16FR 15GA 30CM UNIVERSA MLCT NDL","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$20.63 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G56335","SUP","HCPCS C1729","","G56335  -  CATHETER DRN 8FR 19GA 15CM UNIVERSA MLCT NDL","BOTH IP/OP","$99.00 ","$73.26 ","$0.00 ","$99.00 ","$53.76 ","$0.00 ","$20.63 ","$0.00 ","$0.00 ","$17.33 ","$99.00 ","$0.00 ","$49.50 ","$78.41 ","$79.20 ","$0.00 ","$15.49 ","$0.00 ","$15.76 ","$0.00 "
"G56401","SUP","Custom 27203010","","G56401  -  CATHETER DRN 10FR 18GA 15CM UNIVERSA MLCT NDL","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"G56428","SUP","HCPCS C1894","","G56428  -  EXTRACTOR STON STD 10FR 1.5CM 38CM PERC NGAGE BSKT NTNL SS","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56429","SUP","HCPCS C1894","","G56429  -  SHEATH ESCP 9.5FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56430","SUP","HCPCS C1894","","G56430  -  SHEATH ESCP 9.5FR 28CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56431","SUP","HCPCS C1894","","G56431  -  SHEATH ESCP 9.5FR 35CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56432","SUP","HCPCS C1894","","G56432  -  SHEATH ESCP 9.5FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56433","SUP","HCPCS C1894","","G56433  -  SHEATH ESCP 9.5FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56434","SUP","HCPCS C1894","","G56434  -  SHEATH ESCP 12FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56435","SUP","HCPCS C1894","","G56435  -  SHEATH ACC 12FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56436","SUP","HCPCS C1894","","G56436  -  SHEATH ACC 12FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56438","SUP","HCPCS C1894","","G56438  -  SHEATH ESCP 12FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56439","SUP","HCPCS C1894","","G56439  -  SHEATH ESCP 12FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56440","SUP","HCPCS C1894","","G56440  -  SHEATH ESCP 14FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56441","SUP","HCPCS C1894","","G56441  -  SHEATH ACC 14FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56442","SUP","HCPCS C1894","","G56442  -  SHEATH ACC 14FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56443","SUP","HCPCS C1894","","G56443  -  SHEATH ESCP 14FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56445","SUP","HCPCS C1894","","G56445  -  SHEATH ESCP 14FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56446","SUP","HCPCS C1894","","G56446  -  SHEATH ESCP 9.5FR 13CM STRL PRLL FLXR DIL HDRPH URETER DISP","BOTH IP/OP","$325.00 ","$240.50 ","$0.00 ","$325.00 ","$176.48 ","$0.00 ","$67.74 ","$0.00 ","$0.00 ","$56.90 ","$325.00 ","$0.00 ","$162.50 ","$257.40 ","$260.00 ","$0.00 ","$50.86 ","$0.00 ","$51.74 ","$0.00 "
"G56537","SUP","Custom 27203010","","G56537  -  TRAY SURG 14FR 18GA 29CM 5CM 19 SIDEPORT CATHETER ECHOGENIC","BOTH IP/OP","$450.38 ","$333.28 ","$0.00 ","$829.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$829.98 ","$0.00 ","$414.99 ","$657.34 ","$663.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GA3501","SUP","HCPCS C1769","","GA3501  -  GUIDEWIRE VASC ANG .035IN 180CM 25CM GLDWR ADV PTFE NTNL","BOTH IP/OP","$400.00 ","$296.00 ","$0.00 ","$400.00 ","$217.20 ","$0.00 ","$83.37 ","$0.00 ","$0.00 ","$70.04 ","$400.00 ","$0.00 ","$200.00 ","$316.80 ","$320.00 ","$0.00 ","$62.60 ","$0.00 ","$63.68 ","$0.00 "
"GA3502","SUP","HCPCS C1769","","GA3502  -  GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEWIRE","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$450.00 ","$244.35 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$78.79 ","$450.00 ","$0.00 ","$225.00 ","$356.40 ","$360.00 ","$0.00 ","$70.43 ","$0.00 ","$71.64 ","$0.00 "
"GD-1115-100","SUP","Custom 27203010","","GD-1115-100  -  CANNULA ASCP 10CM OSTEOPRECISION VNT","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM1521","SUP","Custom 27203010","","GEM1521  -  CLIP HEMOSTATIC 30 CARTRIDGE SUPERFINE GEM BLUE TITANIUM","BOTH IP/OP","$29.17 ","$21.59 ","$0.00 ","$29.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.17 ","$0.00 ","$14.58 ","$23.10 ","$23.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM2431","SUP","Custom 27203010","","GEM2431  -  CLIP INTNL MIC GM CRTDG TI HMST","BOTH IP/OP","$25.83 ","$19.11 ","$0.00 ","$25.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.83 ","$0.00 ","$12.92 ","$20.46 ","$20.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM2751","SUP","Custom 27803010","","GEM2751  -  COUPLER ANSTM 1.5MM STRL GM MCVSC ANSTM DISP","BOTH IP/OP","$645.83 ","$477.91 ","$0.00 ","$645.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$645.83 ","$0.00 ","$322.92 ","$511.50 ","$516.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM2752","SUP","Custom 27803010","","GEM2752  -  COUPLER ANSTM 20MHZ 2MM STRL LF GM RING PIN US DPLR SS DISP","BOTH IP/OP","$770.83 ","$570.41 ","$0.00 ","$747.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$747.92 ","$0.00 ","$373.96 ","$592.35 ","$598.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM2753","SUP","Custom 27803010","","GEM2753  -  COUPLER ANSTM 20MHZ 2.5MM STRL LF GM RING PIN US DPLR SS","BOTH IP/OP","$770.83 ","$570.41 ","$0.00 ","$747.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$747.92 ","$0.00 ","$373.96 ","$592.35 ","$598.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM2754","SUP","Custom 27803010","","GEM2754  -  COUPLER ANSTM 3MM STRL GM MCVSC DISP","BOTH IP/OP","$770.83 ","$570.41 ","$0.00 ","$747.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$747.92 ","$0.00 ","$373.96 ","$592.35 ","$598.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEM2756","SUP","Custom 27803010","","GEM2756  -  COUPLER ANSTM 4MM STRL GM MCVSC ANSTM DISP","BOTH IP/OP","$770.83 ","$570.41 ","$0.00 ","$747.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$747.92 ","$0.00 ","$373.96 ","$592.35 ","$598.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GEZ6200US7B","SUP","HCPCS C1757","","GEZ6200US7B  -  CATHETER THROMBECTOMY 7FR .08IN 145CM ASPIRAT FULL-WALL","BOTH IP/OP","$1,425.00 ","$1,054.50 ","$0.00 ","$1,425.00 ","$0.00 ","$0.00 ","$297.01 ","$0.00 ","$0.00 ","$0.00 ","$1,425.00 ","$0.00 ","$712.50 ","$1,128.60 ","$1,140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GFS-10A","SUP","Custom 27203010","","GFS-10A  -  PASSER SUT STRL LF GAB/FRAT GD ORG VLV IMPL","BOTH IP/OP","$950.18 ","$703.13 ","$0.00 ","$950.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$950.18 ","$0.00 ","$475.09 ","$752.54 ","$760.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GFS-1A","SUP","Custom 27203010","","GFS-1A  -  PASSER SUTURE GUIDE ORGANIZER LATEX FREE GABBAY-FRATER VALVE","BOTH IP/OP","$403.53 ","$298.61 ","$0.00 ","$403.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$403.53 ","$0.00 ","$201.76 ","$319.60 ","$322.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GH-05501","SUP","HCPCS C1729","","KIT EPDRL 9.84CM 17GA CATH","BOTH IP/OP","$90.80 ","$67.19 ","$0.00 ","$90.80 ","$49.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15.90 ","$90.80 ","$0.00 ","$45.40 ","$71.91 ","$72.64 ","$0.00 ","$14.21 ","$0.00 ","$14.46 ","$0.00 "
"GIA10038L","SUP","Custom 27203010","","GIA10038L  -  RELOAD STPLR 100MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR","BOTH IP/OP","$268.10 ","$198.39 ","$0.00 ","$272.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$272.12 ","$0.00 ","$136.06 ","$215.52 ","$217.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA10038S","SUP","Custom 27203010","","GIA10038S  -  STAPLER INTERNAL 100MMX3.8MM 1.5MM 2 STAGGER ROW STAPLE LOAD","BOTH IP/OP","$514.53 ","$380.75 ","$0.00 ","$522.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$522.24 ","$0.00 ","$261.12 ","$413.61 ","$417.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA10048L","SUP","Custom 27203010","","GIA10048L  -  RELOAD STPLR 100MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR","BOTH IP/OP","$268.10 ","$198.39 ","$0.00 ","$275.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.04 ","$0.00 ","$137.52 ","$217.83 ","$220.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA10048S","SUP","Custom 27203010","","GIA10048S  -  STAPLER INTERNAL 104MMX4.8MM 2MM 2 STAGGER ROW STAPLE LOAD","BOTH IP/OP","$564.67 ","$417.86 ","$0.00 ","$564.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$564.67 ","$0.00 ","$282.34 ","$447.22 ","$451.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA6025L","SUP","Custom 27203010","","GIA6025L  -  RELOAD STPLR 60MMX2.5MM WHT STRL LF 1MM DST GIA 4 ROW LNR","BOTH IP/OP","$128.02 ","$94.73 ","$0.00 ","$128.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$128.02 ","$0.00 ","$64.01 ","$101.39 ","$102.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA6038L","SUP","Custom 27203010","","GIA6038L  -  RELOAD STPLR 60MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR","BOTH IP/OP","$117.10 ","$86.65 ","$0.00 ","$118.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.86 ","$0.00 ","$59.43 ","$94.14 ","$95.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA6038S","SUP","Custom 27203010","","GIA6038S  -  STAPLER INTERNAL TEARDROP 60MMX3.8MM 1.5MM 4 ROW 2 STAGGER","BOTH IP/OP","$222.80 ","$164.87 ","$0.00 ","$226.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$226.14 ","$0.00 ","$113.07 ","$179.10 ","$180.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA6048L","SUP","Custom 27203010","","GIA6048L  -  RELOAD STPLR 60MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR","BOTH IP/OP","$115.40 ","$85.40 ","$0.00 ","$117.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.13 ","$0.00 ","$58.57 ","$92.77 ","$93.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA6048S","SUP","Custom 27203010","","GIA6048S  -  STAPLER INTERNAL TEARDROP 60MMX4.8MM 2MM 4 ROW 2 STAGGER","BOTH IP/OP","$228.58 ","$169.15 ","$0.00 ","$228.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$228.58 ","$0.00 ","$114.29 ","$181.04 ","$182.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA8038L","SUP","Custom 27203010","","GIA8038L  -  RELOAD STPLR 80MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR","BOTH IP/OP","$171.20 ","$126.69 ","$0.00 ","$173.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.77 ","$0.00 ","$86.88 ","$137.63 ","$139.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA8038S","SUP","Custom 27203010","","GIA8038S  -  STAPLER INTERNAL TEARDROP 80MMX3.8MM 1.5MM 4 ROW 2 STAGGER","BOTH IP/OP","$328.33 ","$242.96 ","$0.00 ","$333.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.25 ","$0.00 ","$166.63 ","$263.93 ","$266.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA8048L","SUP","Custom 27203010","","GIA8048L  -  RELOAD STPLR 80MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR","BOTH IP/OP","$171.20 ","$126.69 ","$0.00 ","$173.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$173.77 ","$0.00 ","$86.88 ","$137.63 ","$139.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GIA8048S","SUP","Custom 27203010","","GIA8048S  -  STAPLER INTERNAL TEARDROP 80MMX4.8MM 2MM 4 ROW 2 STAGGER","BOTH IP/OP","$336.83 ","$249.25 ","$0.00 ","$336.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$336.83 ","$0.00 ","$168.41 ","$266.77 ","$269.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GJ44","SUP","HCPCS Q4107","","GJ44  -  GRAFT SKIN 4CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER","BOTH IP/OP","$4,302.50 ","$3,183.85 ","$0.00 ","$4,302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,302.50 ","$0.00 ","$2,151.25 ","$3,407.58 ","$3,442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GJ48","SUP","HCPCS Q4107","","GJ48  -  GRAFT SKIN 8CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER","BOTH IP/OP","$7,570.20 ","$5,601.95 ","$0.00 ","$7,570.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,570.20 ","$0.00 ","$3,785.10 ","$5,995.60 ","$6,056.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GJX","SUP","HCPCS Q4113","","GJX  -  GRAFT SKN 2ML GTJKT XPRESS SFT TIS SCFLD FLW ACLR DRML MTRX","BOTH IP/OP","$4,840.00 ","$3,581.60 ","$0.00 ","$4,840.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,840.00 ","$0.00 ","$2,420.00 ","$3,833.28 ","$3,872.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GLU-50122","SUP","HCPCS A6196","","GLU-50122  -  DRESSING WND 12X5IN STRL LF GLUCAN II B GLUCAN CLGN DISP","BOTH IP/OP","$170.71 ","$126.33 ","$0.00 ","$170.71 ","$92.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.89 ","$170.71 ","$0.00 ","$85.35 ","$135.20 ","$136.57 ","$0.00 ","$26.72 ","$0.00 ","$27.18 ","$0.00 "
"GM1253-1720","SUP","Custom 27203010","","GM1253-1720  -  SET 3 NEEDLES W/MARKER 1.2X5MM","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GM1601","SUP","HCPCS C1769","","GM1601  -  GWIRE VASC 45D .016IN 180CM 2MM ANG FLX TP TRQ DEV GLDWR GL","BOTH IP/OP","$725.00 ","$536.50 ","$0.00 ","$725.00 ","$393.68 ","$0.00 ","$151.11 ","$0.00 ","$0.00 ","$126.94 ","$725.00 ","$0.00 ","$362.50 ","$574.20 ","$580.00 ","$0.00 ","$113.46 ","$0.00 ","$115.42 ","$0.00 "
"GMN-DSP-160","SUP","HCPCS C1713","","GMN-DSP-160  -  PLATE DORSAL SPANNING, SHORT","BOTH IP/OP","$2,990.00 ","$2,212.60 ","$0.00 ","$2,990.00 ","$1,345.50 ","$0.00 ","$623.19 ","$0.00 ","$0.00 ","$523.53 ","$2,990.00 ","$0.00 ","$1,495.00 ","$2,368.08 ","$2,392.00 ","$0.00 ","$467.94 ","$0.00 ","$476.01 ","$0.00 "
"GMN-DSP-210","SUP","HCPCS C1713","","GMN-DSP-210  -  PLATE DORSAL SPANNING","BOTH IP/OP","$2,990.00 ","$2,212.60 ","$0.00 ","$2,990.00 ","$1,345.50 ","$0.00 ","$623.19 ","$0.00 ","$0.00 ","$523.53 ","$2,990.00 ","$0.00 ","$1,495.00 ","$2,368.08 ","$2,392.00 ","$0.00 ","$467.94 ","$0.00 ","$476.01 ","$0.00 "
"GMN-HP","SUP","HCPCS C1713","","GMN-HP  -  PLATE BN GEMINUS HK VOLR","BOTH IP/OP","$990.00 ","$732.60 ","$0.00 ","$990.00 ","$445.50 ","$0.00 ","$206.34 ","$0.00 ","$0.00 ","$173.34 ","$990.00 ","$0.00 ","$495.00 ","$784.08 ","$792.00 ","$0.00 ","$154.94 ","$0.00 ","$157.61 ","$0.00 "
"GMN-HP-SCRW","SUP","HCPCS C1713","","GMN-HP-SCRW  -  PLATE BN GEMINUS HK SCR VOLR","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"GMN-LTN-3HL","SUP","HCPCS C1713","","GMN-LTN-3HL  -  PLATE BN NAR NS GEMINUS 3 HL TI LT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-LTN-4HL","SUP","HCPCS C1713","","GMN-LTN-4HL  -  PLATE BN NAR NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-LTS-3HL","SUP","HCPCS C1713","","GMN-LTS-3HL  -  PLATE BN STD NS GEMINUS 3 HL TI RDS LT VOLR DIST","BOTH IP/OP","$2,237.50 ","$1,655.75 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$466.35 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"GMN-LTS-4HL","SUP","HCPCS C1713","","GMN-LTS-4HL  -  PLATE BN STD NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-LTS-7HL","SUP","HCPCS C1713","","GMN-LTS-7HL  -  PLATE BN STD NS GEMINUS 7 HL TI LT DIST VOLR RDS FOSSA","BOTH IP/OP","$2,190.00 ","$1,620.60 ","$0.00 ","$2,190.00 ","$985.50 ","$0.00 ","$456.45 ","$0.00 ","$0.00 ","$383.45 ","$2,190.00 ","$0.00 ","$1,095.00 ","$1,734.48 ","$1,752.00 ","$0.00 ","$342.74 ","$0.00 ","$348.65 ","$0.00 "
"GMN-LTW-4HL","SUP","HCPCS C1713","","GMN-LTW-4HL  -  PLATE BN W NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-RTN-3HL","SUP","HCPCS C1713","","GMN-RTN-3HL  -  PLATE BN NAR NS GEMINUS 3 HL TI RT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-RTN-4HL","SUP","HCPCS C1713","","GMN-RTN-4HL  -  PLATE BN NAR NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-RTS-3HL","SUP","HCPCS C1713","","GMN-RTS-3HL  -  PLATE BN STD NS GEMINUS 3 HL TI RT DIST VOLR RDS","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-RTS-4HL","SUP","HCPCS C1713","","GMN-RTS-4HL  -  PLATE BN STD NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GMN-RTS-7HL","SUP","HCPCS C1713","","GMN-RTS-7HL  -  PLATE BN STD NS GEMINUS 7 HL TI RDS RT FOSSA DIST","BOTH IP/OP","$2,190.00 ","$1,620.60 ","$0.00 ","$2,190.00 ","$985.50 ","$0.00 ","$456.45 ","$0.00 ","$0.00 ","$383.45 ","$2,190.00 ","$0.00 ","$1,095.00 ","$1,734.48 ","$1,752.00 ","$0.00 ","$342.74 ","$0.00 ","$348.65 ","$0.00 "
"GMN-RTW-4HL","SUP","HCPCS C1713","","GMN-RTW-4HL  -  PLATE BN W NS GEMINUS 4 HL TI RDS RT DIST FOSSA","BOTH IP/OP","$1,990.00 ","$1,472.60 ","$0.00 ","$1,990.00 ","$895.50 ","$0.00 ","$414.77 ","$0.00 ","$0.00 ","$348.43 ","$1,990.00 ","$0.00 ","$995.00 ","$1,576.08 ","$1,592.00 ","$0.00 ","$311.44 ","$0.00 ","$316.81 ","$0.00 "
"GN1000","SUP","Custom 27803010","","GN1000  -  KIT SNR 10MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GN1500","SUP","Custom 27203010","","GN1500  -  KIT VASC 120CM 15MM 6FR AGN NTNL GOLD TUNG LOOP CATH NTNL","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GN2500","SUP","Custom 27803010","","GN2500  -  KIT SNR 25MM 6FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GN500","SUP","Custom 27803010","","GN500  -  KIT SNR 5MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ","BOTH IP/OP","$747.25 ","$552.97 ","$0.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$675.00 ","$0.00 ","$337.50 ","$534.60 ","$540.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GOLD-18","SUP","HCPCS L8610","","GOLD-18  -  WEIGHT EYELID 3 SUTURE HOLE SUTUREGROOVE GOLD 1.8GM STERILE","BOTH IP/OP","$800.00 ","$592.00 ","$0.00 ","$800.00 ","$360.00 ","$0.00 ","$166.74 ","$0.00 ","$0.00 ","$140.07 ","$800.00 ","$0.00 ","$400.00 ","$633.60 ","$640.00 ","$0.00 ","$125.20 ","$0.00 ","$127.36 ","$0.00 "
"GPSL","SUP","HCPCS C1781","","GPSL  -  MESH SURG GYNMSH 6X4IN PLVC NABSB SFT KNTD LTWT STRL POLYPRO","BOTH IP/OP","$847.00 ","$626.78 ","$0.00 ","$847.00 ","$381.15 ","$0.00 ","$176.54 ","$0.00 ","$0.00 ","$148.30 ","$847.00 ","$0.00 ","$423.50 ","$670.82 ","$677.60 ","$0.00 ","$132.56 ","$0.00 ","$134.84 ","$0.00 "
"GPSXL3","SUP","HCPCS C1781","","GPSXL3  -  MESH SURG 25X25CM SOFT KNIT NONABSORBABLE GYNECARE GYNEMESH","BOTH IP/OP","$4,367.00 ","$3,231.58 ","$0.00 ","$4,367.00 ","$1,965.15 ","$0.00 ","$910.19 ","$0.00 ","$0.00 ","$764.63 ","$4,367.00 ","$0.00 ","$2,183.50 ","$3,458.66 ","$3,493.60 ","$0.00 ","$683.44 ","$0.00 ","$695.23 ","$0.00 "
"GR1807","SUP","HCPCS C1769","","GR1807  -  GUIDEWIRE VASCULAR ANGLE .018IN 260CM 3CM GLIDEWIRE HYDPHI","BOTH IP/OP","$1,010.63 ","$747.87 ","$0.00 ","$975.00 ","$529.43 ","$0.00 ","$210.64 ","$0.00 ","$0.00 ","$170.71 ","$975.00 ","$0.00 ","$487.50 ","$772.20 ","$780.00 ","$0.00 ","$152.59 ","$0.00 ","$155.22 ","$0.00 "
"GR3501","SUP","HCPCS C1769","","GR3501  -  GUIDEWIRE VASC STRG .035IN 150CM 3CM GLDWR STF SHFT HDRPH","BOTH IP/OP","$80.45 ","$59.53 ","$0.00 ","$72.50 ","$39.37 ","$0.00 ","$16.77 ","$0.00 ","$0.00 ","$12.69 ","$72.50 ","$0.00 ","$36.25 ","$57.42 ","$58.00 ","$0.00 ","$11.35 ","$0.00 ","$11.54 ","$0.00 "
"GR3503","SUP","HCPCS C1769","","GR3503  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 180CM 3CM JACKET CORE","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$99.25 ","$53.89 ","$0.00 ","$22.51 ","$0.00 ","$0.00 ","$17.38 ","$99.25 ","$0.00 ","$49.63 ","$78.61 ","$79.40 ","$0.00 ","$15.53 ","$0.00 ","$15.80 ","$0.00 "
"GR3504","SUP","HCPCS C1769","","GR3504  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM JACKET CORE","BOTH IP/OP","$120.75 ","$89.36 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$25.17 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"GR3508","SUP","HCPCS C1769","","GR3508  -  GUIDEWIRE VASCULAR ANGLE STANDARD .035IN 180CM 3CM JACKET","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$99.25 ","$53.89 ","$0.00 ","$22.51 ","$0.00 ","$0.00 ","$17.38 ","$99.25 ","$0.00 ","$49.63 ","$78.61 ","$79.40 ","$0.00 ","$15.53 ","$0.00 ","$15.80 ","$0.00 "
"GR3509","SUP","HCPCS C1769","","GUIDEWIRE VASC .035IN 260CM 3CM ANG FLX TP STD GLDWR GR3509","BOTH IP/OP","$120.75 ","$89.36 ","$0.00 ","$118.60 ","$64.40 ","$0.00 ","$25.17 ","$0.00 ","$0.00 ","$20.77 ","$118.60 ","$0.00 ","$59.30 ","$93.93 ","$94.88 ","$0.00 ","$18.56 ","$0.00 ","$18.88 ","$0.00 "
"GR3807","SUP","HCPCS C1769","","GR3807  -  GUIDEWIRE VASCULAR ANGLED .038IN 150CM 8CM GLIDEWIRE HYDPHI","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$81.75 ","$44.39 ","$0.00 ","$18.55 ","$0.00 ","$0.00 ","$14.31 ","$81.75 ","$0.00 ","$40.88 ","$64.75 ","$65.40 ","$0.00 ","$12.79 ","$0.00 ","$13.01 ","$0.00 "
"GR3808","SUP","HCPCS C1769","","GR3808  -  GUIDEWIRE VASCULAR ANGLED .038IN 180CM 3CM GLIDEWIRE HYDPHI","BOTH IP/OP","$108.00 ","$79.92 ","$0.00 ","$99.25 ","$53.89 ","$0.00 ","$22.51 ","$0.00 ","$0.00 ","$17.38 ","$99.25 ","$0.00 ","$49.63 ","$78.61 ","$79.40 ","$0.00 ","$15.53 ","$0.00 ","$15.80 ","$0.00 "
"GR3809","SUP","HCPCS C1769","","GR3809  -  GUIDEWIRE VASCULAR ANGLED .038IN 260CM 3CM GLIDEWIRE HYDPHI","BOTH IP/OP","$120.75 ","$89.36 ","$0.00 ","$111.00 ","$60.27 ","$0.00 ","$25.17 ","$0.00 ","$0.00 ","$19.44 ","$111.00 ","$0.00 ","$55.50 ","$87.91 ","$88.80 ","$0.00 ","$17.37 ","$0.00 ","$17.67 ","$0.00 "
"GR74089-02","SUP","Custom 27203010","","GR74089-02  -  BAG TISS CLSR 7.5CM DRAIN WL DFCT 7.5CM SILO STRL DISP SIL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GRAD0026-06","SUP","HCPCS C1751","","GRAD0026-06  -  TRAY SRG STRL PICC CTH LB RAD","BOTH IP/OP","$88.91 ","$65.79 ","$0.00 ","$88.91 ","$48.28 ","$0.00 ","$18.53 ","$0.00 ","$0.00 ","$15.57 ","$88.91 ","$0.00 ","$44.46 ","$70.42 ","$71.13 ","$0.00 ","$13.92 ","$0.00 ","$14.16 ","$0.00 "
"GRAD0027-05","SUP","Custom 27203010","","GRAD0027-05  -  TRAY SRG STRL VNS ACC CTH LB RAD","BOTH IP/OP","$117.73 ","$87.12 ","$0.00 ","$117.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.73 ","$0.00 ","$58.87 ","$93.24 ","$94.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GRAD0058-03","SUP","Custom 27203010","","GRAD0058-03  -  TRAY NEURO ANGIO","BOTH IP/OP","$131.43 ","$97.26 ","$0.00 ","$131.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.43 ","$0.00 ","$65.71 ","$104.09 ","$105.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GRAD0059-03","SUP","Custom 27203010","","GRAD0059-03  -  TRAY BX STRL LF AVID TRUCUSTOM DISP","BOTH IP/OP","$52.27 ","$38.68 ","$0.00 ","$52.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52.27 ","$0.00 ","$26.14 ","$41.40 ","$41.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GS3503","SUP","HCPCS C1769","","GS3503  -  GUIDEWIRE VASCULAR STR .035IN 180CM 3CM STIFF SHAFT","BOTH IP/OP","$116.75 ","$86.40 ","$0.00 ","$116.75 ","$63.40 ","$0.00 ","$24.33 ","$0.00 ","$0.00 ","$20.44 ","$116.75 ","$0.00 ","$58.38 ","$92.47 ","$93.40 ","$0.00 ","$18.27 ","$0.00 ","$18.59 ","$0.00 "
"GS3504","SUP","HCPCS C1769","","GS3504  -  GUIDEWIRE VASCULAR STR .035IN 260CM 3CM STIFF SHAFT FLEXIBLE","BOTH IP/OP","$135.58 ","$100.33 ","$0.00 ","$124.63 ","$67.67 ","$0.00 ","$28.26 ","$0.00 ","$0.00 ","$21.82 ","$124.63 ","$0.00 ","$62.31 ","$98.71 ","$99.70 ","$0.00 ","$19.50 ","$0.00 ","$19.84 ","$0.00 "
"GS3506","SUP","HCPCS C1769","","GS3506  -  GUIDEWIRE VASCULAR ANGLE .035IN 150CM 3CM FLEXIBLE TIP STIFF","BOTH IP/OP","$122.85 ","$90.91 ","$0.00 ","$112.88 ","$61.29 ","$0.00 ","$25.61 ","$0.00 ","$0.00 ","$19.76 ","$112.88 ","$0.00 ","$56.44 ","$89.40 ","$90.30 ","$0.00 ","$17.66 ","$0.00 ","$17.97 ","$0.00 "
"GS3508","SUP","HCPCS C1769","","GS3508  -  GUIDEWIRE VASCULAR ANGLE .035IN 180CM 3CM STIFF SHAFT","BOTH IP/OP","$127.18 ","$94.11 ","$0.00 ","$116.75 ","$63.40 ","$0.00 ","$26.51 ","$0.00 ","$0.00 ","$20.44 ","$116.75 ","$0.00 ","$58.38 ","$92.47 ","$93.40 ","$0.00 ","$18.27 ","$0.00 ","$18.59 ","$0.00 "
"GS3509","SUP","HCPCS C1769","","GS3509  -  GUIDEWIRE VASCULAR ANGLE .035IN 260CM 3CM STIFF SHAFT","BOTH IP/OP","$135.58 ","$100.33 ","$0.00 ","$124.63 ","$67.67 ","$0.00 ","$28.26 ","$0.00 ","$0.00 ","$21.82 ","$124.63 ","$0.00 ","$62.31 ","$98.71 ","$99.70 ","$0.00 ","$19.50 ","$0.00 ","$19.84 ","$0.00 "
"GS3807","SUP","HCPCS C1769","","GS3807  -  GUIDEWIRE VASCULAR ANGLE .038IN 180CM 3CM STIFF SHAFT","BOTH IP/OP","$127.18 ","$94.11 ","$0.00 ","$116.75 ","$63.40 ","$0.00 ","$26.51 ","$0.00 ","$0.00 ","$20.44 ","$116.75 ","$0.00 ","$58.38 ","$92.47 ","$93.40 ","$0.00 ","$18.27 ","$0.00 ","$18.59 ","$0.00 "
"GSLM-14","SUP","HCPCS L8610","","GSLM-14  -  WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.4GM STERILE","BOTH IP/OP","$700.00 ","$518.00 ","$0.00 ","$700.00 ","$315.00 ","$0.00 ","$145.90 ","$0.00 ","$0.00 ","$122.56 ","$700.00 ","$0.00 ","$350.00 ","$554.40 ","$560.00 ","$0.00 ","$109.55 ","$0.00 ","$111.44 ","$0.00 "
"GSLM-16","SUP","HCPCS L8610","","GSLM-16  -  WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.6GM STERILE","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$750.00 ","$337.50 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$131.32 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$117.38 ","$0.00 ","$119.40 ","$0.00 "
"GST45B","SUP","Custom 27203010","","GST45B  -  RELOAD STPLR 45MMX3.6MM BLU STRL LF 1.5MM ECHLN EPTH ECHLN","BOTH IP/OP","$877.84 ","$649.60 ","$0.00 ","$891.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$891.00 ","$0.00 ","$445.50 ","$705.67 ","$712.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GST45G","SUP","Custom 27203010","","GST45G  -  RELOAD STPLR 45MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX","BOTH IP/OP","$877.84 ","$649.60 ","$0.00 ","$10,534.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,534.03 ","$0.00 ","$5,267.01 ","$8,342.95 ","$8,427.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GST45W","SUP","Custom 27203010","","GST45W  -  RELOAD STPLR 45MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX","BOTH IP/OP","$877.84 ","$649.60 ","$0.00 ","$877.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$877.84 ","$0.00 ","$438.92 ","$695.25 ","$702.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GST60G","SUP","Custom 27203010","","GST60G  -  RELOAD STPLR 60MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX","BOTH IP/OP","$949.21 ","$702.42 ","$0.00 ","$949.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$949.21 ","$0.00 ","$474.60 ","$751.77 ","$759.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GST60W","SUP","Custom 27203010","","GST60W  -  RELOAD STPLR 60MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX","BOTH IP/OP","$949.21 ","$702.42 ","$0.00 ","$949.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$949.21 ","$0.00 ","$474.60 ","$751.77 ","$759.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GTK14","SUP","Custom 27203010","","GTK14  -  SYSTEM XTRT 14CM ALEXIS KII SPEC CNTN BG BLN BLNT TPGRD","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GTK17","SUP","Custom 27203010","","GTK17  -  SYSTEM XTRT 12X100MM 6500ML ALEXIS BLN BLNT TIP CNTN","BOTH IP/OP","$812.50 ","$601.25 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GYN-0480","SUP","Custom 27203010","","KIT SRPTH PK LAB CYTO 480 TST","BOTH IP/OP","$7,380.00 ","$5,461.20 ","$0.00 ","$7,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,380.00 ","$0.00 ","$3,690.00 ","$5,844.96 ","$5,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"GYN-0500-B","SUP","Custom 27203010","","BRUSH CYTO BLUE BRM HNDL","BOTH IP/OP","$10.90 ","$8.07 ","$0.00 ","$10.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.90 ","$0.00 ","$5.45 ","$8.63 ","$8.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H1058","SUP","Custom 27203010","","MASK O2 PED NREB","BOTH IP/OP","$8.00 ","$5.92 ","$0.00 ","$8.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.00 ","$0.00 ","$4.00 ","$6.34 ","$6.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H312-4","SUP","Custom 27203010","","CHEMICAL LAB 3% H2O2 AMBR GLS BTL 4L","BOTH IP/OP","$460.25 ","$340.59 ","$0.00 ","$460.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$460.25 ","$0.00 ","$230.13 ","$364.52 ","$368.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H470045A","SUP","HCPCS C1768","","H470045A  -  GRAFT VASCULAR STANDARD WALL TAPER 4-7MM 45CM STRETCH COATED","BOTH IP/OP","$3,147.50 ","$2,329.15 ","$0.00 ","$3,147.50 ","$1,416.38 ","$0.00 ","$656.02 ","$0.00 ","$0.00 ","$551.10 ","$3,147.50 ","$0.00 ","$1,573.75 ","$2,492.82 ","$2,518.00 ","$0.00 ","$492.58 ","$0.00 ","$501.08 ","$0.00 "
"H74912100012","SUP","HCPCS C1769","","H74912100012  -  GUIDEWIRE VASCULAR STR FLOPPY SPRING COIL .014IN 300CM","BOTH IP/OP","$159.25 ","$117.85 ","$0.00 ","$159.25 ","$86.47 ","$0.00 ","$33.19 ","$0.00 ","$0.00 ","$27.88 ","$159.25 ","$0.00 ","$79.63 ","$126.13 ","$127.40 ","$0.00 ","$24.92 ","$0.00 ","$25.35 ","$0.00 "
"H74912118012","SUP","HCPCS C1769","","H74912118012  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 3CM MODERATE","BOTH IP/OP","$796.25 ","$589.23 ","$0.00 ","$796.25 ","$432.36 ","$0.00 ","$165.96 ","$0.00 ","$0.00 ","$139.42 ","$796.25 ","$0.00 ","$398.13 ","$630.63 ","$637.00 ","$0.00 ","$124.61 ","$0.00 ","$126.76 ","$0.00 "
"H74912119012","SUP","HCPCS C1769","","H74912119012  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM EXTRA","BOTH IP/OP","$159.25 ","$117.85 ","$0.00 ","$159.25 ","$86.47 ","$0.00 ","$33.19 ","$0.00 ","$0.00 ","$27.88 ","$159.25 ","$0.00 ","$79.63 ","$126.13 ","$127.40 ","$0.00 ","$24.92 ","$0.00 ","$25.35 ","$0.00 "
"H74912154012","SUP","HCPCS C1769","","H74912154012  -  GUIDEWIRE VASCULAR STR FLOPPY INTERMEDIATE .014IN 300CM 35CM","BOTH IP/OP","$159.25 ","$117.85 ","$0.00 ","$159.25 ","$86.47 ","$0.00 ","$33.19 ","$0.00 ","$0.00 ","$27.88 ","$159.25 ","$0.00 ","$79.63 ","$126.13 ","$127.40 ","$0.00 ","$24.92 ","$0.00 ","$25.35 ","$0.00 "
"H74912155012","SUP","HCPCS C1769","","H74912155012  -  GUIDEWIRE VASCULAR STR .014IN 300CM EXTRA SUPPORT","BOTH IP/OP","$159.25 ","$117.85 ","$0.00 ","$159.25 ","$86.47 ","$0.00 ","$33.19 ","$0.00 ","$0.00 ","$27.88 ","$159.25 ","$0.00 ","$79.63 ","$126.13 ","$127.40 ","$0.00 ","$24.92 ","$0.00 ","$25.35 ","$0.00 "
"H74914090100","SUP","HCPCS C1876","","H74914090100  -  STENT EPRSTH 14MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"H74916060100","SUP","HCPCS C1876","","H74916060100  -  STENT EPRSTH 16MM 60MM 100MM VICI VNS STNT CATH NTNL ACPT","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$2,250.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$875.46 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$782.50 ","$0.00 ","$796.00 ","$0.00 "
"H74916090100","SUP","HCPCS C1876","","H74916090100  -  STENT EPRSTH 16MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"H74917521","SUP","HCPCS C1769","","H74917521  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 5CM SUPER","BOTH IP/OP","$477.75 ","$353.54 ","$0.00 ","$477.75 ","$259.42 ","$0.00 ","$99.58 ","$0.00 ","$0.00 ","$83.65 ","$477.75 ","$0.00 ","$238.88 ","$378.38 ","$382.20 ","$0.00 ","$74.77 ","$0.00 ","$76.06 ","$0.00 "
"H749201001900","SUP","HCPCS C1884","","H749201001900  -  SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM","BOTH IP/OP","$3,001.25 ","$2,220.93 ","$0.00 ","$3,001.25 ","$1,350.56 ","$0.00 ","$625.54 ","$0.00 ","$0.00 ","$525.49 ","$3,001.25 ","$0.00 ","$1,500.63 ","$2,376.99 ","$2,401.00 ","$0.00 ","$469.70 ","$0.00 ","$477.80 ","$0.00 "
"H749201003000","SUP","HCPCS C1884","","H749201003000  -  SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM","BOTH IP/OP","$3,001.25 ","$2,220.93 ","$0.00 ","$3,001.25 ","$1,350.56 ","$0.00 ","$625.54 ","$0.00 ","$0.00 ","$525.49 ","$3,001.25 ","$0.00 ","$1,500.63 ","$2,376.99 ","$2,401.00 ","$0.00 ","$469.70 ","$0.00 ","$477.80 ","$0.00 "
"H7492062009150","SUP","HCPCS C1726","","H7492062009150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 9MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062009200","SUP","HCPCS C1726","","H7492062009200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 9MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062009250","SUP","HCPCS C1726","","H7492062009250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 9MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062009300","SUP","HCPCS C1726","","H7492062009300  -  CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 9MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062009350","SUP","HCPCS C1726","","H7492062009350  -  CATH BALDILAT .014IN 3.5MM 135CM 9MM CORON OTW TRK TIP MAV","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062015150","SUP","HCPCS C1726","","H7492062015150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 15MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062015200","SUP","HCPCS C1726","","H7492062015200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 15MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062015250","SUP","HCPCS C1726","","H7492062015250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 15MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062015270","SUP","HCPCS C1726","","H7492062015270  -  CATH BALDILAT .014IN 2.75MM 135CM 15MM CORON OTW TRK TIP MAV","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062015300","SUP","HCPCS C1726","","H7492062015300  -  CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 15MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062015350","SUP","HCPCS C1726","","H7492062015350  -  CATH BALDILAT .014IN 3.2-2.7FR 3.5MM 135CM 15MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062020150","SUP","HCPCS C1726","","H7492062020150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 20MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062020200","SUP","HCPCS C1726","","H7492062020200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 20MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062020250","SUP","HCPCS C1726","","H7492062020250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 20MM PTCA OTW TRK","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7492062020300","SUP","HCPCS C1726","","H7492062020300  -  CATH BALDILAT .014IN 3MM 135CM 20MM CORON OTW TRK TIP MAV","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H749364560","SUP","HCPCS C1753","","H749364560  -  CATHETER ULTRASOUND 95CM OTW ATLANTIS PV 15MHZ 8FR","BOTH IP/OP","$1,925.00 ","$1,424.50 ","$0.00 ","$1,925.00 ","$1,045.28 ","$0.00 ","$401.22 ","$0.00 ","$0.00 ","$337.05 ","$1,925.00 ","$0.00 ","$962.50 ","$1,524.60 ","$1,540.00 ","$0.00 ","$301.26 ","$0.00 ","$306.46 ","$0.00 "
"H74937911415150","SUP","HCPCS C1877","","H74937911415150  -  STENT BILIARY 4MM 15MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911415900","SUP","HCPCS C1877","","H74937911415900  -  STENT BILIARY 4MM 15MM 90CM PREMOUNT BALLOON EXPAND CATHETER","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911515150","SUP","HCPCS C1877","","H74937911515150  -  STENT BILIARY 5MM 15MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911515900","SUP","HCPCS C2617","","H74937911515900  -  STENT BILIARY SMALL 5MM 15MM 90CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911614150","SUP","HCPCS C1877","","H74937911614150  -  STENT BILIARY 6MM 14MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911614900","SUP","HCPCS C2617","","H74937911614900  -  STENT BILIARY SMALL 6MM 16MM 90CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911715150","SUP","HCPCS C1877","","H74937911715150  -  STENT BILIARY 7MM 15MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937911715900","SUP","HCPCS C1877","","H74937911715900  -  STENT BILIARY SMALL 7MM 15MM 90CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912419150","SUP","HCPCS C1877","","H74937912419150  -  STENT BILIARY 4MM 19MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912419900","SUP","HCPCS C1877","","H74937912419900  -  STENT BILIARY 4MM 19MM 90CM PREMOUNTED BALLOON EXPANDING","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912519150","SUP","HCPCS C1877","","H74937912519150  -  STENT BILIARY 5MM 19MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912519900","SUP","HCPCS C2617","","H74937912519900  -  STENT BILIARY SMALL 5MM 19MM 90CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912618150","SUP","HCPCS C1877","","H74937912618150  -  STENT BILIARY 6MM 18MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912618900","SUP","HCPCS C2617","","H74937912618900  -  STENT BILIARY SMALL 6MM 18MM 90CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912719150","SUP","HCPCS C1877","","H74937912719150  -  STENT BILIARY 7MM 19MM 150CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74937912719900","SUP","HCPCS C1877","","H74937912719900  -  STENT BILIARY SMALL 7MM 19MM 90CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H7493791540200","SUP","HCPCS C1725","","H7493791540200  -  CATHETER BALDILAT 4MM 90CM 2CM SV RAPEX ULSF SV ANGIOPLST","BOTH IP/OP","$1,162.50 ","$860.25 ","$0.00 ","$1,162.50 ","$631.24 ","$0.00 ","$242.29 ","$0.00 ","$0.00 ","$203.54 ","$1,162.50 ","$0.00 ","$581.25 ","$920.70 ","$930.00 ","$0.00 ","$181.93 ","$0.00 ","$185.07 ","$0.00 "
"H7493791550200","SUP","HCPCS C1726","","H7493791550200  -  CATHETER BLNDIL 3.1FR 5MM 90CM 2CM ULSF SV PTA RX NONLASER","BOTH IP/OP","$1,055.00 ","$780.70 ","$0.00 ","$1,055.00 ","$572.87 ","$0.00 ","$219.89 ","$0.00 ","$0.00 ","$184.72 ","$1,055.00 ","$0.00 ","$527.50 ","$835.56 ","$844.00 ","$0.00 ","$165.11 ","$0.00 ","$167.96 ","$0.00 "
"H74938046102070","SUP","HCPCS C1877","","H74938046102070  -  STENT BILIARY 30MM 10MM 25MM 75CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046104070","SUP","HCPCS C1877","","H74938046104070  -  STENT BILIARY 40MM 10MM 37MM 75CM OTW PREMOUNT CATHETER","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046106070","SUP","HCPCS C1877","","H74938046106070  -  STENT BILIARY 60MM 10MM 57MM 75CM OTW PREMOUNT CATHETER","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046520750","SUP","HCPCS C1877","","H74938046520750  -  STENT BILIARY 5MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"H74938046530750","SUP","HCPCS C1877","","H74938046530750  -  STENT BILIARY 30MM 5MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046540750","SUP","HCPCS C1877","","H74938046540750  -  STENT BILIARY 5MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"H74938046560750","SUP","HCPCS C1877","","H74938046560750  -  STENT BILIARY 5MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046620750","SUP","HCPCS C1877","","H74938046620750  -  STENT BILIARY 6MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046630750","SUP","HCPCS C1877","","H74938046630750  -  STENT BILIARY 6MM 30MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046640750","SUP","HCPCS C1877","","H74938046640750  -  STENT BILIARY 40MM 6MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046660750","SUP","HCPCS C1877","","H74938046660750  -  STENT BILIARY 60MM 6MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046720750","SUP","HCPCS C1877","","H74938046720750  -  STENT BILIARY 7MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046730750","SUP","HCPCS C1877","","H74938046730750  -  STENT BILIARY 30MM 7MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046740750","SUP","HCPCS C1877","","H74938046740750  -  STENT BILIARY 40MM 7MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046760750","SUP","HCPCS C1877","","H74938046760750  -  STENT BILIARY 60MM 7MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046820750","SUP","HCPCS C1877","","H74938046820750  -  STENT BILIARY 8MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046830750","SUP","HCPCS C1877","","H74938046830750  -  STENT BILIARY 8MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046840750","SUP","HCPCS C1877","","H74938046840750  -  STENT BILIARY 40MM 8MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046860750","SUP","HCPCS C1877","","H74938046860750  -  STENT BILIARY 60MM 8MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046920750","SUP","HCPCS C1877","","H74938046920750  -  STENT BILIARY 30MM 9MM 25MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046940750","SUP","HCPCS C1877","","H74938046940750  -  STENT BILIARY 40MM 9MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938046960750","SUP","HCPCS C1877","","H74938046960750  -  STENT BILIARY 60MM 9MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047120130","SUP","HCPCS C1877","","H74938047120130  -  STENT BILIARY 30MM 10MM 25MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047140130","SUP","HCPCS C1877","","H74938047140130  -  STENT BILIARY 10MM 7FR 37MM 135CM BALLOON EXPANDABLE","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$67.50 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"H74938047160130","SUP","HCPCS C1877","","H74938047160130  -  STENT BILIARY 10MM 7FR 57MM 135CM BALLOON EXPANDABLE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047520130","SUP","HCPCS C1877","","H74938047520130  -  STENT BILIARY .035IN 5MM 17MM 75CM CATHETER BALLOON INFLAT","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047530130","SUP","HCPCS C1877","","H74938047530130  -  STENT BILIARY 5MM 27MM 135CM OTW BALLOON EXPAND PREMOUNT","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047540130","SUP","HCPCS C1877","","H74938047540130  -  STENT BILIARY 5MM 40MM 135CM OTW BALLOON EXPAND PREMOUNT","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047560130","SUP","HCPCS C1877","","H74938047560130  -  STENT BILIARY 5MM 6FR 60MM 135CM BALLOON EXPANDING","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047620130","SUP","HCPCS C1877","","H74938047620130  -  STENT BILIARY 6MM 6FR 17MM 135CM PREMOUNTED BALLOON EXPRESS","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047630130","SUP","HCPCS C1877","","H74938047630130  -  STENT BILIARY 30MM 6MM 27MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047640130","SUP","HCPCS C1877","","H74938047640130  -  STENT BILIARY 40MM 6MM 37MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047660130","SUP","HCPCS C1877","","H74938047660130  -  STENT BILIARY 9MM 6MM 57MM 135CM PREMOUNT BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047720130","SUP","HCPCS C1877","","H74938047720130  -  STENT BILIARY 20MM 7MM 17MM 135CM OTW BALLOON EXPAND","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047730130","SUP","HCPCS C1877","","H74938047730130  -  STENT BILIARY 30MM 7MM 27MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047740130","SUP","HCPCS C1877","","H74938047740130  -  STENT BILIARY 9MM 7MM 6FR 37MM 135CM BALLOON EXPANDABLE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047760130","SUP","HCPCS C1877","","H74938047760130  -  STENT BILIARY 9MM 7MM 6FR 57MM 135CM BALLOON EXPANDABLE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047820130","SUP","HCPCS C1877","","H74938047820130  -  STENT BILIARY 8MM 6FR 17MM 135CM BALLOON EXPANDABLE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047830130","SUP","HCPCS C1877","","H74938047830130  -  STENT BILIARY 30MM 8MM 27MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047840130","SUP","HCPCS C1877","","H74938047840130  -  STENT BILIARY 8MM 37MM 135CM BALLOON EXPAND PREMOUNT EXPRESS","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047860130","SUP","HCPCS C1877","","H74938047860130  -  STENT BILIARY 8MM 7IN 57MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047920130","SUP","HCPCS C1877","","H74938047920130  -  STENT BILIARY 30MM 9MM 25MM 135CM OTW PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047940130","SUP","HCPCS C1877","","H74938047940130  -  STENT BILIARY 9MM 7FR 37MM 135CM BALLOON EXPANDABLE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74938047960130","SUP","HCPCS C1877","","H74938047960130  -  STENT BILIARY 11MM 9MM 7FR 57MM 135CM PREMOUNT BALLOON","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H7493808012200","SUP","HCPCS C1726","","H7493808012200  -  CATH BALDILAT .014IN 2MM 12MM PCTA RAPEX LP TPR TIP Q M","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808012250","SUP","HCPCS C1726","","H7493808012250  -  CATH BALDILAT 1.8-2.7FR 2.5MM 135CM 12MM PTCA RAPEX LP TPR","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808012300","SUP","HCPCS C1726","","H7493808012300  -  CATH BALDILAT 3MM 135CM 12MM PCTA RAPEX LP TPR TIP Q M","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808012350","SUP","HCPCS C1726","","H7493808012350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 12MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808012400","SUP","HCPCS C1726","","H7493808012400  -  CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 12MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808012450","SUP","HCPCS C1726","","H7493808012450  -  CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 12MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H749380801250","SUP","HCPCS C1726","","H749380801250  -  CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 12MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808015250","SUP","HCPCS C1726","","H7493808015250  -  CATH BALDILAT .014IN 2.5MM 15MM PTCA RAPEX Q M","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808015300","SUP","HCPCS C1726","","H7493808015300  -  CATH BALDILAT 3MM 135CM 15MM CORON PCTA RAPEX LP TPR TIP Q M","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808015350","SUP","HCPCS C1726","","H7493808015350  -  CATH BALDILAT .014IN 3.5MM 15MM PTCA RAPEX Q M","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808015400","SUP","HCPCS C1726","","H7493808015400  -  CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 15MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808015450","SUP","HCPCS C1726","","H7493808015450  -  CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 15MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808015500","SUP","HCPCS C1726","","H7493808015500  -  CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 15MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808020250","SUP","HCPCS C1726","","H7493808020250  -  CATH BALDILAT .014IN 1.8-2.7FR 2.5MM 135CM 20MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808020300","SUP","HCPCS C1726","","H7493808020300  -  CATH BALDILAT .014IN 1.8-2.7FR 3MM 135CM 20MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808020350","SUP","HCPCS C1726","","H7493808020350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 20MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493808020400","SUP","HCPCS C1726","","H7493808020400  -  CATH BALDILAT .014IN 2-2.7FR 4MM 135CM 20MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892809200","SUP","HCPCS C1726","","H7493892809200  -  CATHETER BLNDIL 2MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR","BOTH IP/OP","$269.50 ","$199.43 ","$0.00 ","$269.50 ","$146.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.19 ","$269.50 ","$0.00 ","$134.75 ","$213.44 ","$215.60 ","$0.00 ","$42.18 ","$0.00 ","$42.90 ","$0.00 "
"H7493892809250","SUP","HCPCS C1725","","H7493892809250  -  CATHETER BLNDIL 2.5MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR","BOTH IP/OP","$269.50 ","$199.43 ","$0.00 ","$269.50 ","$146.34 ","$0.00 ","$56.17 ","$0.00 ","$0.00 ","$47.19 ","$269.50 ","$0.00 ","$134.75 ","$213.44 ","$215.60 ","$0.00 ","$42.18 ","$0.00 ","$42.90 ","$0.00 "
"H7493892809300","SUP","HCPCS C1725","","H7493892809300  -  CATHETER BLNDIL 3MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR","BOTH IP/OP","$269.50 ","$199.43 ","$0.00 ","$269.50 ","$146.34 ","$0.00 ","$56.17 ","$0.00 ","$0.00 ","$47.19 ","$269.50 ","$0.00 ","$134.75 ","$213.44 ","$215.60 ","$0.00 ","$42.18 ","$0.00 ","$42.90 ","$0.00 "
"H7493892809350","SUP","HCPCS C1726","","H7493892809350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 9MM PTCA RAPEX LP","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892815150","SUP","HCPCS C1726","","H7493892815150  -  CATH BALDILAT .014IN 1.8-2.6-2.3FR 1.5MM 135CM 15MM PTCA","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892815200","SUP","HCPCS C1726","","H7493892815200  -  CATHETER BLNDIL 2MM 142CM 15MM MAVERICK2 MNRL TRAKTIP TPR","BOTH IP/OP","$269.50 ","$199.43 ","$0.00 ","$269.50 ","$146.34 ","$0.00 ","$56.17 ","$0.00 ","$0.00 ","$47.19 ","$269.50 ","$0.00 ","$134.75 ","$213.44 ","$215.60 ","$0.00 ","$42.18 ","$0.00 ","$42.90 ","$0.00 "
"H7493892815250","SUP","HCPCS C1726","","H7493892815250  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 15MM PTCA","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892815300","SUP","HCPCS C1726","","H7493892815300  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 15MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892815350","SUP","HCPCS C1726","","H7493892815350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 15MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892820200","SUP","HCPCS C1726","","H7493892820200  -  CATH BALDILAT .014IN 1.8-2.6-2.3FR 2MM 135CM 20MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892820250","SUP","HCPCS C1726","","H7493892820250  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 20MM PTCA","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493892820300","SUP","HCPCS C1726","","H7493892820300  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 20MM PTCA RAPEX","BOTH IP/OP","$612.50 ","$453.25 ","$0.00 ","$612.50 ","$332.59 ","$0.00 ","$127.66 ","$0.00 ","$0.00 ","$107.24 ","$612.50 ","$0.00 ","$306.25 ","$485.10 ","$490.00 ","$0.00 ","$95.86 ","$0.00 ","$97.51 ","$0.00 "
"H7493894812010","SUP","HCPCS C1876","","H7493894812010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 10","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894812070","SUP","HCPCS C1876","","H7493894812070  -  STENT BILIARY 21MM SELF EXPANDING NONCOATED NONCOVERED","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894814010","SUP","HCPCS C1876","","H7493894814010  -  STENT BILIARY 40MM SELF EXPANDING SENTINOL NITINOL 135CM 10","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894814070","SUP","HCPCS C1876","","H7493894814070  -  STENT BILIARY 41MM SELF EXPANDING SHEATH CATHETER SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894816010","SUP","HCPCS C1876","","H7493894816010  -  STENT BILIARY 59MM SELF EXPANDABLE SENTINOL NITINOL 135CM 10","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894818010","SUP","HCPCS C1876","","H7493894818010  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 135CM 10","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894852010","SUP","HCPCS C1876","","H7493894852010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 5MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894852070","SUP","HCPCS C1876","","H7493894852070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 5MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894854010","SUP","HCPCS C1876","","H7493894854010  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894854070","SUP","HCPCS C1876","","H7493894854070  -  STENT BILIARY 40MM SELF EXPANDING NONCOATED NONCOVERED","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894856010","SUP","HCPCS C1876","","H7493894856010  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894856070","SUP","HCPCS C1876","","H7493894856070  -  STENT BILIARY 60MM SELF EXPANDING NONCOATED NONCOVERED","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894862010","SUP","HCPCS C1876","","H7493894862010  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 135CM 6MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894862070","SUP","HCPCS C1876","","H7493894862070  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894864010","SUP","HCPCS C1876","","H7493894864010  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894864070","SUP","HCPCS C1876","","H7493894864070  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894866010","SUP","HCPCS C1876","","H7493894866010  -  STENT BILIARY 59MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894866070","SUP","HCPCS C1876","","H7493894866070  -  STENT BILIARY 59MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894868010","SUP","HCPCS C1876","","H7493894868010  -  STENT BILIARY 79MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894868070","SUP","HCPCS C1876","","H7493894868070  -  STENT BILIARY 79MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894872010","SUP","HCPCS C1876","","H7493894872010  -  STENT BILIARY 1350MM SELF EXPANDING CATHETER DELIVERY SYSTEM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894872070","SUP","HCPCS C1876","","H7493894872070  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894874010","SUP","HCPCS C1876","","H7493894874010  -  STENT BILIARY 39MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894874070","SUP","HCPCS C1876","","H7493894874070  -  STENT BILIARY 39MM SELF EXPANDABLE SENTINOL NITINOL 75CM 7MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894876010","SUP","HCPCS C1876","","H7493894876010  -  STENT BILIARY 59MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894876070","SUP","HCPCS C1876","","H7493894876070  -  STENT BILIARY 59MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894878010","SUP","HCPCS C1876","","H7493894878010  -  STENT BILIARY 78MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894878070","SUP","HCPCS C1876","","H7493894878070  -  STENT BILIARY 78MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894882010","SUP","HCPCS C1876","","H7493894882010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 8MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894882070","SUP","HCPCS C1876","","H7493894882070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 8MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894884010","SUP","HCPCS C1876","","H7493894884010  -  STENT BILIARY 42MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894884070","SUP","HCPCS C1876","","H7493894884070  -  STENT BILIARY 42MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894886010","SUP","HCPCS C1876","","H7493894886010  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894886070","SUP","HCPCS C1876","","H7493894886070  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894888010","SUP","HCPCS C1876","","H7493894888010  -  STENT BILIARY 81MM SELF EXPANDING DELIVERY SYSTEM SENTINOL","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894892010","SUP","HCPCS C1876","","H7493894892010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894892070","SUP","HCPCS C1876","","H7493894892070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894894010","SUP","HCPCS C1876","","H7493894894010  -  STENT BILIARY 42MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894894070","SUP","HCPCS C1876","","H7493894894070  -  STENT BILIARY 750MM SELF EXPANDING CATHETER DELIVERY SYSTEM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894896010","SUP","HCPCS C1876","","H7493894896010  -  STENT BILIARY 60MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894896070","SUP","HCPCS C1876","","H7493894896070  -  STENT BILIARY 60MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894898010","SUP","HCPCS C1876","","H7493894898010  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493894898070","SUP","HCPCS C1876","","H7493894898070  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM","BOTH IP/OP","$2,437.50 ","$1,803.75 ","$0.00 ","$2,437.50 ","$1,096.88 ","$0.00 ","$508.04 ","$0.00 ","$0.00 ","$426.79 ","$2,437.50 ","$0.00 ","$1,218.75 ","$1,930.50 ","$1,950.00 ","$0.00 ","$381.47 ","$0.00 ","$388.05 ","$0.00 "
"H7493897008250","SUP","HCPCS C2617","","H7493897008250  -  STENT CORON 2.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897008300","SUP","HCPCS C2617","","H7493897008300  -  STENT CORON 3MM 8MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$0.00 ","$0.00 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"H7493897008350","SUP","HCPCS C2617","","H7493897008350  -  STENT CORON 3.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897012250","SUP","HCPCS C2617","","H7493897012250  -  STENT CORON 2.50MM 12MM XPR TAXUS XPR2 MNRL PCLTXL ELUT RX","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897012300","SUP","HCPCS C2617","","H7493897012300  -  STENT CORON 3MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897012350","SUP","HCPCS C2617","","H7493897012350  -  STENT CORON 3.5MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897016250","SUP","HCPCS C2617","","H7493897016250  -  STENT CORON 2.5MM 16MM SYS ART TAXUS XPR2 MNRL 8.8% PCLTXL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897016300","SUP","HCPCS C2617","","H7493897016300  -  STENT CORONARY ARTERY EXPRESS 2 TAXUS 3 X 16MM 8.8% PACLITAX","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897016350","SUP","HCPCS C2617","","H7493897016350  -  STENT CORON 3.5MM 16MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897020250","SUP","HCPCS C2617","","H7493897020250  -  STENT CORON 2.5MM 20MM TAXUS XPR2 MNRL 8.8% PCLTXL ELUT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897020300","SUP","HCPCS C2617","","H7493897020300  -  STENT CORON 3MM 20MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897020350","SUP","HCPCS C2617","","H7493897020350  -  STENT CORON 3.5MM 20MM RAPEX BLN XPD XPR RX PCLTXL ELUT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897028300","SUP","HCPCS C2617","","H7493897028300  -  STENT CORON 3MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897028350","SUP","HCPCS C2617","","H7493897028350  -  STENT CORON 3.5MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%","BOTH IP/OP","$6,500.00 ","$4,810.00 ","$0.00 ","$6,500.00 ","$2,925.00 ","$0.00 ","$1,354.76 ","$0.00 ","$0.00 ","$1,138.10 ","$6,500.00 ","$0.00 ","$3,250.00 ","$5,148.00 ","$5,200.00 ","$0.00 ","$1,017.25 ","$0.00 ","$1,034.80 ","$0.00 "
"H7493897032300","SUP","HCPCS C2617","","H7493897032300  -  STENT CORON 3MM 32MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H7493897032350","SUP","HCPCS C2617","","H7493897032350  -  STENT CORON 3.5MM 32MM RAPEX BLN XPD XPR RX PCLTXL ELUT","BOTH IP/OP","$6,250.00 ","$4,625.00 ","$0.00 ","$6,250.00 ","$2,812.50 ","$0.00 ","$1,302.66 ","$0.00 ","$0.00 ","$1,094.33 ","$6,250.00 ","$0.00 ","$3,125.00 ","$4,950.00 ","$5,000.00 ","$0.00 ","$978.13 ","$0.00 ","$995.00 ","$0.00 "
"H74939031302010","SUP","HCPCS C1725","","H74939031302010  -  CATHETER BLNDIL 3MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031303010","SUP","HCPCS C1725","","H74939031303010  -  CATHETER BLNDIL 3MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031304010","SUP","HCPCS C1725","","H74939031304010  -  CATHETER BLNDIL 3MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031306010","SUP","HCPCS C1725","","H74939031306010  -  CATHETER BLNDIL 3MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031352010","SUP","HCPCS C1725","","H74939031352010  -  CATHETER BLNDIL 3.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031353010","SUP","HCPCS C1725","","H74939031353010  -  CATHETER BLNDIL 3.5MM 135CM 30MM STRLG MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031354010","SUP","HCPCS C1725","","H74939031354010  -  CATHETER BLNDIL 3.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031401080","SUP","HCPCS C1725","","H74939031401080  -  CATHETER BLNDIL 4MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031401580","SUP","HCPCS C1725","","H74939031401580  -  CATHETER BLNDIL 4MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031402010","SUP","HCPCS C1725","","H74939031402010  -  CATHETER BLNDIL 4MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031402080","SUP","HCPCS C1725","","H74939031402080  -  CATHETER BLNDIL 4MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031403010","SUP","HCPCS C1725","","H74939031403010  -  CATHETER BLNDIL 4MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031403080","SUP","HCPCS C1725","","H74939031403080  -  CATHETER BLNDIL 4MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031404010","SUP","HCPCS C1725","","H74939031404010  -  CATHETER BLNDIL 4MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031404080","SUP","HCPCS C1725","","H74939031404080  -  CATHETER BLNDIL 4MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031406010","SUP","HCPCS C1725","","H74939031406010  -  CATHETER BLNDIL 4MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031451580","SUP","HCPCS C1725","","H74939031451580  -  CATHETER BLNDIL 4.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031452010","SUP","HCPCS C1725","","H74939031452010  -  CATHETER BLNDIL 4.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031452080","SUP","HCPCS C1725","","H74939031452080  -  CATHETER BLNDIL 4.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031453010","SUP","HCPCS C1725","","H74939031453010  -  CATHETER BLNDIL 4.5MM 135CM 30MM STRLG MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031453080","SUP","HCPCS C1725","","H74939031453080  -  CATHETER BLNDIL 4.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031454010","SUP","HCPCS C1725","","H74939031454010  -  CATHETER BLNDIL 4.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031454080","SUP","HCPCS C1725","","H74939031454080  -  CATHETER BLNDIL 4.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031501080","SUP","HCPCS C1725","","H74939031501080  -  CATHETER BLNDIL 5MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031501580","SUP","HCPCS C1725","","H74939031501580  -  CATHETER BLNDIL 5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031502010","SUP","HCPCS C1725","","H74939031502010  -  CATHETER BLNDIL 5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031502080","SUP","HCPCS C1725","","H74939031502080  -  CATHETER BLNDIL 5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031503010","SUP","HCPCS C1725","","H74939031503010  -  CATHETER BLNDIL 5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031503080","SUP","HCPCS C1725","","H74939031503080  -  CATHETER BLNDIL 5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031504010","SUP","HCPCS C1725","","H74939031504010  -  CATHETER BLNDIL 5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031504080","SUP","HCPCS C1725","","H74939031504080  -  CATHETER BLNDIL 5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031506010","SUP","HCPCS C1725","","H74939031506010  -  CATHETER BLNDIL 5MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031551580","SUP","HCPCS C1725","","H74939031551580  -  CATHETER BLNDIL 5.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031552010","SUP","HCPCS C1725","","H74939031552010  -  CATHETER BLNDIL 5.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031552080","SUP","HCPCS C1725","","H74939031552080  -  CATHETER BLNDIL 5.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031553010","SUP","HCPCS C1725","","H74939031553010  -  CATHETER BLNDIL 5.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031553080","SUP","HCPCS C1725","","H74939031553080  -  CATHETER BLNDIL 5.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031554010","SUP","HCPCS C1725","","H74939031554010  -  CATHETER BLNDIL 5.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031554080","SUP","HCPCS C1725","","H74939031554080  -  CATHETER BLNDIL 5.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031601080","SUP","HCPCS C1725","","H74939031601080  -  CATHETER BLNDIL 6MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031601580","SUP","HCPCS C1725","","H74939031601580  -  CATHETER BLNDIL 6MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031602010","SUP","HCPCS C1725","","H74939031602010  -  CATHETER BLNDIL 6MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031602080","SUP","HCPCS C1725","","H74939031602080  -  CATHETER BLNDIL 6MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031603010","SUP","HCPCS C1725","","H74939031603010  -  CATHETER BLNDIL 6MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031603080","SUP","HCPCS C1725","","H74939031603080  -  CATHETER BLNDIL 6MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031604010","SUP","HCPCS C1725","","H74939031604010  -  CATHETER BLNDIL 6MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031604080","SUP","HCPCS C1725","","H74939031604080  -  CATHETER BLNDIL 6MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031606010","SUP","HCPCS C1725","","H74939031606010  -  CATHETER BLNDIL 6MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031651580","SUP","HCPCS C1725","","H74939031651580  -  CATHETER BLNDIL 6.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031652010","SUP","HCPCS C1725","","H74939031652010  -  CATHETER BLNDIL 6.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031652080","SUP","HCPCS C1725","","H74939031652080  -  CATHETER BLNDIL 6.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031653010","SUP","HCPCS C1725","","H74939031653010  -  CATHETER BLNDIL 6.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031653080","SUP","HCPCS C1725","","H74939031653080  -  CATHETER BLNDIL 6.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031654010","SUP","HCPCS C1725","","H74939031654010  -  CATHETER BLNDIL 6.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031654080","SUP","HCPCS C1725","","H74939031654080  -  CATHETER BLNDIL 6.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031701080","SUP","HCPCS C1725","","H74939031701080  -  CATHETER BLNDIL 7MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031701580","SUP","HCPCS C1725","","H74939031701580  -  CATHETER BLNDIL 7MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031702010","SUP","HCPCS C1725","","H74939031702010  -  CATHETER BLNDIL 7MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031702080","SUP","HCPCS C1725","","H74939031702080  -  CATHETER BLNDIL 7MM 80CM 20MM STRLG MNRL RX INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031703010","SUP","HCPCS C1725","","H74939031703010  -  CATHETER BLNDIL 7MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031703080","SUP","HCPCS C1725","","H74939031703080  -  CATHETER BLNDIL 7MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031704010","SUP","HCPCS C1725","","H74939031704010  -  CATHETER BLNDIL 7MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031704080","SUP","HCPCS C1725","","H74939031704080  -  CATHETER BLNDIL 7MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031706010","SUP","HCPCS C1725","","H74939031706010  -  CATHETER BLNDIL 7MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031801080","SUP","HCPCS C1725","","H74939031801080  -  CATHETER BLNDIL 8MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031801580","SUP","HCPCS C1725","","H74939031801580  -  CATHETER BLNDIL 8MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031802010","SUP","HCPCS C1725","","H74939031802010  -  CATHETER BLNDIL 8MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031802080","SUP","HCPCS C1725","","H74939031802080  -  CATHETER BLNDIL 8MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031803010","SUP","HCPCS C1725","","H74939031803010  -  CATHETER BLNDIL 8MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031803080","SUP","HCPCS C1725","","H74939031803080  -  CATHETER BLNDIL 8MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031804010","SUP","HCPCS C1725","","H74939031804010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031804080","SUP","HCPCS C1725","","H74939031804080  -  CATHETER BLNDIL 8MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939031806010","SUP","HCPCS C1725","","H74939031806010  -  CATHETER BLNDIL 8MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032102010","SUP","HCPCS C1753","","H74939032102010  -  CATHETER BLNDIL 10MM 135CM 20MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032102080","SUP","HCPCS C1753","","H74939032102080  -  CATHETER BLNDIL 10MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032103010","SUP","HCPCS C1753","","H74939032103010  -  CATHETER BLNDIL 10MM 135CM 30MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032103080","SUP","HCPCS C1753","","H74939032103080  -  CATHETER BLNDIL 10MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032104010","SUP","HCPCS C1753","","H74939032104010  -  CATHETER BLNDIL 10MM 135CM 40MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032104080","SUP","HCPCS C1753","","H74939032104080  -  CATHETER BLNDIL 10MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032106010","SUP","HCPCS C1753","","H74939032106010  -  CATHETER BLNDIL 10MM 135CM 60MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032106080","SUP","HCPCS C1753","","H74939032106080  -  CATHETER BLNDIL 10MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032108010","SUP","HCPCS C1753","","H74939032108010  -  CATHETER BLNDIL 10MM 135CM 80MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032108080","SUP","HCPCS C1753","","H74939032108080  -  CATHETER BLNDIL 10MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032401010","SUP","HCPCS C1753","","H74939032401010  -  CATHETER BLNDIL 4MM 135CM 100MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032401080","SUP","HCPCS C1753","","H74939032401080  -  CATHETER BLNDIL 4MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032402010","SUP","HCPCS C1726","","H74939032402010  -  CATHETER BLNDIL 4MM 135CM 20MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032402040","SUP","HCPCS C1753","","H74939032402040  -  CATHETER BLNDIL 4MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032402080","SUP","HCPCS C1753","","H74939032402080  -  CATHETER BLNDIL 4MM 80CM 20MM STRLG OTW INFL PORT LOPRFL TPR","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032403010","SUP","HCPCS C1753","","H74939032403010  -  CATHETER BLNDIL 4MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032403080","SUP","HCPCS C1753","","H74939032403080  -  CATHETER BLNDIL 4MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032404010","SUP","HCPCS C1726","","H74939032404010  -  CATHETER BLNDIL 4MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032404040","SUP","HCPCS C1753","","H74939032404040  -  CATHETER BLNDIL 4MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032404080","SUP","HCPCS C1753","","H74939032404080  -  CATHETER BLNDIL 4MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032406010","SUP","HCPCS C1753","","H74939032406010  -  CATHETER BLNDIL 4MM 135CM 60MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032406080","SUP","HCPCS C1753","","H74939032406080  -  CATHETER BLNDIL 4MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032408010","SUP","HCPCS C1753","","H74939032408010  -  CATHETER BLNDIL 4MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032408080","SUP","HCPCS C1753","","H74939032408080  -  CATHETER BLNDIL 4MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032501010","SUP","HCPCS C1753","","H74939032501010  -  CATHETER BLNDIL 5MM 135CM 100MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032501080","SUP","HCPCS C1726","","H74939032501080  -  CATHETER BLNDIL 5MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032501510","SUP","HCPCS C1725","","H74939032501510  -  CATHETER BLNDIL 5MM 150CM 150MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032502010","SUP","HCPCS C1753","","H74939032502010  -  CATHETER BLNDIL 5MM 135CM 20MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032502040","SUP","HCPCS C1753","","H74939032502040  -  CATHETER BLNDIL 5MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032502080","SUP","HCPCS C1726","","H74939032502080  -  CATHETER BLNDIL 5MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032502110","SUP","HCPCS C1725","","H74939032502110  -  CATHETER BLNDIL 5MM 150CM 200MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032503010","SUP","HCPCS C1753","","H74939032503010  -  CATHETER BLNDIL 5MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032503080","SUP","HCPCS C1753","","H74939032503080  -  CATHETER BLNDIL 5MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032504010","SUP","HCPCS C1726","","H74939032504010  -  CATHETER BLNDIL 5MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032504040","SUP","HCPCS C1753","","H74939032504040  -  CATHETER BLNDIL 5MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032504080","SUP","HCPCS C1726","","H74939032504080  -  CATHETER BLNDIL 5MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032506010","SUP","HCPCS C1753","","H74939032506010  -  CATHETER BLNDIL 5MM 135CM 60MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032506080","SUP","HCPCS C1726","","H74939032506080  -  CATHETER BLNDIL 5MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032508010","SUP","HCPCS C1753","","H74939032508010  -  CATHETER BLNDIL 5MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032508080","SUP","HCPCS C1726","","H74939032508080  -  CATHETER BLNDIL 5MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032601010","SUP","HCPCS C1753","","H74939032601010  -  CATHETER BLNDIL 6MM 135CM 100MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032601080","SUP","HCPCS C1753","","H74939032601080  -  CATHETER BLNDIL 6MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032601510","SUP","HCPCS C1725","","H74939032601510  -  CATHETER BLNDIL 6MM 150CM 150MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032602010","SUP","HCPCS C1726","","H74939032602010  -  CATHETER BLNDIL 6MM 135CM 20MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032602040","SUP","HCPCS C1753","","H74939032602040  -  CATHETER BLNDIL 6MM 40CM 20MM STRLG OTW INFL PORT LOPRFL TPR","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032602080","SUP","HCPCS C1726","","H74939032602080  -  CATHETER BLNDIL 6MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032602210","SUP","HCPCS C1725","","H74939032602210  -  CATHETER BLNDIL 6MM 150CM 220MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032603010","SUP","HCPCS C1753","","H74939032603010  -  CATHETER BLNDIL 6MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032603080","SUP","HCPCS C1753","","H74939032603080  -  CATHETER BLNDIL 6MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032604010","SUP","HCPCS C1726","","H74939032604010  -  CATHETER BLNDIL 6MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032604040","SUP","HCPCS C1753","","H74939032604040  -  CATHETER BLNDIL 6MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032604080","SUP","HCPCS C1726","","H74939032604080  -  CATHETER BLNDIL 6MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032606010","SUP","HCPCS C1726","","H74939032606010  -  CATHETER BLNDIL 6MM 135CM 60MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032606080","SUP","HCPCS C1726","","H74939032606080  -  CATHETER BLNDIL 6MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032608010","SUP","HCPCS C1726","","H74939032608010  -  CATHETER BLNDIL 6MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032608080","SUP","HCPCS C1753","","H74939032608080  -  CATHETER BLNDIL 6MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032701010","SUP","HCPCS C1753","","H74939032701010  -  CATHETER BLNDIL 7MM 135CM 100MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032701080","SUP","HCPCS C1753","","H74939032701080  -  CATHETER BLNDIL 7MM 80CM 100MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032701210","SUP","HCPCS C1725","","H74939032701210  -  CATHETER BLNDIL 7MM 150CM 120MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032701510","SUP","HCPCS C1725","","H74939032701510  -  CATHETER BLNDIL 7MM 150CM 150MM STRLG OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032702010","SUP","HCPCS C1726","","H74939032702010  -  CATHETER BLNDIL 7MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032702040","SUP","HCPCS C1753","","H74939032702040  -  CATHETER BLNDIL 7MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032702080","SUP","HCPCS C1726","","H74939032702080  -  CATHETER BLNDIL 7MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032702110","SUP","HCPCS C1725","","H74939032702110  -  CATHETER BLNDIL 7MM 150CM 200MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032702210","SUP","HCPCS C1725","","H74939032702210  -  CATHETER BLNDIL 7MM 150CM 220MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032703010","SUP","HCPCS C1753","","H74939032703010  -  CATHETER BLNDIL 7MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032703080","SUP","HCPCS C1753","","H74939032703080  -  CATHETER BLNDIL 7MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032704010","SUP","HCPCS C1726","","H74939032704010  -  CATHETER BLNDIL 7MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032704040","SUP","HCPCS C1753","","H74939032704040  -  CATHETER BLNDIL 7MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032704080","SUP","HCPCS C1726","","H74939032704080  -  CATHETER BLNDIL 7MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032706010","SUP","HCPCS C1726","","H74939032706010  -  CATHETER BLNDIL 7MM 135CM 60MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032706080","SUP","HCPCS C1726","","H74939032706080  -  CATHETER BLNDIL 7MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032708010","SUP","HCPCS C1753","","H74939032708010  -  CATHETER BLNDIL 7MM 135CM 80MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032708080","SUP","HCPCS C1726","","H74939032708080  -  CATHETER BLNDIL 7MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032802010","SUP","HCPCS C1726","","H74939032802010  -  CATHETER BLNDIL 8MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032802040","SUP","HCPCS C1753","","H74939032802040  -  CATHETER BLNDIL 8MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032802080","SUP","HCPCS C1726","","H74939032802080  -  CATHETER BLNDIL 8MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032803010","SUP","HCPCS C1753","","H74939032803010  -  CATHETER BLNDIL 8MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032803080","SUP","HCPCS C1753","","H74939032803080  -  CATHETER BLNDIL 8MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032804010","SUP","HCPCS C1726","","H74939032804010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032804040","SUP","HCPCS C1753","","H74939032804040  -  CATHETER BLNDIL 8MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032804080","SUP","HCPCS C1726","","H74939032804080  -  CATHETER BLNDIL 8MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032806010","SUP","HCPCS C1726","","H74939032806010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032806080","SUP","HCPCS C1726","","H74939032806080  -  CATHETER BLNDIL 8MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$81.45 ","$0.00 ","$31.26 ","$0.00 ","$0.00 ","$26.26 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$23.48 ","$0.00 ","$23.88 ","$0.00 "
"H74939032808010","SUP","HCPCS C1726","","H74939032808010  -  CATHETER BLNDIL 8MM 135CM 80MM STRLG OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032808080","SUP","HCPCS C1753","","H74939032808080  -  CATHETER BLNDIL 8MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032902010","SUP","HCPCS C1753","","H74939032902010  -  CATHETER BLNDIL 9MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032902080","SUP","HCPCS C1753","","H74939032902080  -  CATHETER BLNDIL 9MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032903010","SUP","HCPCS C1753","","H74939032903010  -  CATHETER BLNDIL 9MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032903080","SUP","HCPCS C1753","","H74939032903080  -  CATHETER BLNDIL 9MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032904010","SUP","HCPCS C1726","","H74939032904010  -  CATHETER BLNDIL 9MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032904080","SUP","HCPCS C1726","","H74939032904080  -  CATHETER BLNDIL 9MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032906010","SUP","HCPCS C1753","","H74939032906010  -  CATHETER BLNDIL 9MM 135CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032906080","SUP","HCPCS C1753","","H74939032906080  -  CATHETER BLNDIL 9MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032908010","SUP","HCPCS C1753","","H74939032908010  -  CATHETER BLNDIL 9MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939032908080","SUP","HCPCS C1753","","H74939032908080  -  CATHETER BLNDIL 9MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134152010","SUP","HCPCS C1726","","H74939134152010  -  CATHETER BLNDIL 1.5MM 142CM 20MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134202010","SUP","HCPCS C1726","","H74939134202010  -  CATHETER BLNDIL 2MM 142CM 20MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134203010","SUP","HCPCS C1753","","H74939134203010  -  CATHETER BLNDIL 2MM 143CM 30MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134204010","SUP","HCPCS C1726","","H74939134204010  -  CATHETER BLNDIL 2MM 144CM 40MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134252010","SUP","HCPCS C1753","","H74939134252010  -  CATHETER BLNDIL 2.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134253010","SUP","HCPCS C1753","","H74939134253010  -  CATHETER BLNDIL 2.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134254010","SUP","HCPCS C1726","","H74939134254010  -  CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134302010","SUP","HCPCS C1726","","H74939134302010  -  CATHETER BLNDIL 3MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134303010","SUP","HCPCS C1753","","H74939134303010  -  CATHETER BLNDIL 3MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134304010","SUP","HCPCS C1726","","H74939134304010  -  CATHETER BLNDIL 3MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134352010","SUP","HCPCS C1753","","H74939134352010  -  CATHETER BLNDIL 3.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134353010","SUP","HCPCS C1753","","H74939134353010  -  CATHETER BLNDIL 3.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134354010","SUP","HCPCS C1753","","H74939134354010  -  CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134402010","SUP","HCPCS C1726","","H74939134402010  -  CATHETER BLNDIL 4MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134403010","SUP","HCPCS C1753","","H74939134403010  -  CATHETER BLNDIL 4MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939134404010","SUP","HCPCS C1726","","H74939134404010  -  CATHETER BLNDIL 4MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135152010","SUP","HCPCS C1753","","H74939135152010  -  CATHETER BLNDIL 1.5MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135202010","SUP","HCPCS C1753","","H74939135202010  -  CATHETER BLNDIL 2MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135203010","SUP","HCPCS C1753","","H74939135203010  -  CATHETER BLNDIL 2MM 144CM 30MM CYTE ES MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135204010","SUP","HCPCS C1753","","H74939135204010  -  CATHETER BLNDIL 2MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135252010","SUP","HCPCS C1753","","H74939135252010  -  CATHETER BLNDIL 2.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135253010","SUP","HCPCS C1753","","H74939135253010  -  CATHETER BLNDIL 2.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135254010","SUP","HCPCS C1753","","H74939135254010  -  CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135302010","SUP","HCPCS C1753","","H74939135302010  -  CATHETER BLNDIL 3MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135303010","SUP","HCPCS C1753","","H74939135303010  -  CATHETER BLNDIL 3MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135304010","SUP","HCPCS C1753","","H74939135304010  -  CATHETER BLNDIL 3MM 146CM 40MM CYTE ES MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135352010","SUP","HCPCS C1753","","H74939135352010  -  CATHETER BLNDIL 3.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135353010","SUP","HCPCS C1753","","H74939135353010  -  CATHETER BLNDIL 3.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135354010","SUP","HCPCS C1753","","H74939135354010  -  CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135402010","SUP","HCPCS C1753","","H74939135402010  -  CATHETER BLNDIL 4MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135403010","SUP","HCPCS C1753","","H74939135403010  -  CATHETER BLNDIL 4MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939135404010","SUP","HCPCS C1753","","H74939135404010  -  CATHETER BLNDIL 4MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147201010","SUP","HCPCS C1725","","H74939147201010  -  CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147201090","SUP","HCPCS C1725","","H74939147201090  -  CATHETER BLNDIL 2MM 90CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147201210","SUP","HCPCS C1725","","H74939147201210  -  CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147201290","SUP","HCPCS C1725","","H74939147201290  -  CATHETER BLNDIL 2MM 90CM 120MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147201510","SUP","HCPCS C1725","","H74939147201510  -  CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147201590","SUP","HCPCS C1725","","H74939147201590  -  CATHETER BLNDIL 2MM 90CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147208010","SUP","HCPCS C1725","","H74939147208010  -  CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147208090","SUP","HCPCS C1725","","H74939147208090  -  CATHETER BLNDIL 2MM 90CM 80MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147251010","SUP","HCPCS C1725","","H74939147251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW TPR TIP","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147251090","SUP","HCPCS C1725","","H74939147251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147251210","SUP","HCPCS C1725","","H74939147251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL MNRL TPR TIP","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147251290","SUP","HCPCS C1725","","H74939147251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147251510","SUP","HCPCS C1725","","H74939147251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL MNRL TPR TIP","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147251590","SUP","HCPCS C1725","","H74939147251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147258010","SUP","HCPCS C1725","","H74939147258010  -  CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL MNRL TPR TIP","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147258090","SUP","HCPCS C1725","","H74939147258090  -  CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147301010","SUP","HCPCS C1725","","H74939147301010  -  CATHETER BLNDIL 3MM 150CM 100MM STRLG SL MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147301090","SUP","HCPCS C1725","","H74939147301090  -  CATHETER BLNDIL 3MM 90CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147301210","SUP","HCPCS C1725","","H74939147301210  -  CATHETER BLNDIL 3MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147301290","SUP","HCPCS C1725","","H74939147301290  -  CATHETER BLNDIL 3MM 90CM 120MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147301510","SUP","HCPCS C1725","","H74939147301510  -  CATHETER BLNDIL 3MM 150CM 150MM STRLG SL MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147301590","SUP","HCPCS C1725","","H74939147301590  -  CATHETER BLNDIL 3MM 90CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147308010","SUP","HCPCS C1725","","H74939147308010  -  CATHETER BLNDIL 3MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147308090","SUP","HCPCS C1725","","H74939147308090  -  CATHETER BLNDIL 3MM 90CM 80MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147351010","SUP","HCPCS C1725","","H74939147351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147351090","SUP","HCPCS C1725","","H74939147351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147351210","SUP","HCPCS C1725","","H74939147351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147351290","SUP","HCPCS C1725","","H74939147351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147351510","SUP","HCPCS C1725","","H74939147351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147351590","SUP","HCPCS C1725","","H74939147351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147358010","SUP","HCPCS C1725","","H74939147358010  -  CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147358090","SUP","HCPCS C1725","","H74939147358090  -  CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147401010","SUP","HCPCS C1725","","H74939147401010  -  CATHETER BLNDIL 4MM 150CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147401090","SUP","HCPCS C1725","","H74939147401090  -  CATHETER BLNDIL 4MM 90CM 100MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147401210","SUP","HCPCS C1725","","H74939147401210  -  CATHETER BLNDIL 4MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147401290","SUP","HCPCS C1725","","H74939147401290  -  CATHETER BLNDIL 4MM 90CM 120MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147401510","SUP","HCPCS C1725","","H74939147401510  -  CATHETER BLNDIL 4MM 150CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147401590","SUP","HCPCS C1725","","H74939147401590  -  CATHETER BLNDIL 4MM 90CM 150MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147408010","SUP","HCPCS C1725","","H74939147408010  -  CATHETER BLNDIL 4MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939147408090","SUP","HCPCS C1725","","H74939147408090  -  CATHETER BLNDIL 4MM 90CM 80MM STRLG SL MNRL RX INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148201010","SUP","HCPCS C1726","","H74939148201010  -  CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148201090","SUP","HCPCS C1753","","H74939148201090  -  CATHETER BLNDIL 2MM 100CM 90MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148201210","SUP","HCPCS C1726","","H74939148201210  -  CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148201290","SUP","HCPCS C1725","","H74939148201290  -  CATHETER BLNDIL 2MM 90CM 120MM STRLG SL OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148201510","SUP","HCPCS C1726","","H74939148201510  -  CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148201590","SUP","HCPCS C1725","","H74939148201590  -  CATHETER BLNDIL 2MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148208010","SUP","HCPCS C1726","","H74939148208010  -  CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148208090","SUP","HCPCS C1753","","H74939148208090  -  CATHETER BLNDIL 2MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148251010","SUP","HCPCS C1753","","H74939148251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148251090","SUP","HCPCS C1753","","H74939148251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148251210","SUP","HCPCS C1725","","H74939148251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148251290","SUP","HCPCS C1725","","H74939148251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148251510","SUP","HCPCS C1725","","H74939148251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148251590","SUP","HCPCS C1725","","H74939148251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148258010","SUP","HCPCS C1753","","H74939148258010  -  CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148258090","SUP","HCPCS C1753","","H74939148258090  -  CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148301010","SUP","HCPCS C1726","","H74939148301010  -  CATHETER BLNDIL 3MM 150CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148301090","SUP","HCPCS C1753","","H74939148301090  -  CATHETER BLNDIL 3MM 90CM 100MM STRLG SL OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148301210","SUP","HCPCS C1726","","H74939148301210  -  CATHETER BLNDIL 3MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148301290","SUP","HCPCS C1725","","H74939148301290  -  CATHETER BLNDIL 3MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148301510","SUP","HCPCS C1726","","H74939148301510  -  CATHETER BLNDIL 3MM 150CM 150MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148301590","SUP","HCPCS C1725","","H74939148301590  -  CATHETER BLNDIL 3MM 90CM 150MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148308010","SUP","HCPCS C1726","","H74939148308010  -  CATHETER BLNDIL 3MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148308090","SUP","HCPCS C1753","","H74939148308090  -  CATHETER BLNDIL 3MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148351010","SUP","HCPCS C1753","","H74939148351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148351090","SUP","HCPCS C1753","","H74939148351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148351210","SUP","HCPCS C1725","","H74939148351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148351290","SUP","HCPCS C1725","","H74939148351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148351510","SUP","HCPCS C1725","","H74939148351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148351590","SUP","HCPCS C1725","","H74939148351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148358010","SUP","HCPCS C1753","","H74939148358010  -  CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148358090","SUP","HCPCS C1753","","H74939148358090  -  CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148401010","SUP","HCPCS C1753","","H74939148401010  -  CATHETER BLNDIL 4MM 150CM 100MM STRLG SL OTW INFL PORT","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148401210","SUP","HCPCS C1725","","H74939148401210  -  CATHETER BLNDIL 4MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148401290","SUP","HCPCS C1725","","H74939148401290  -  CATHETER BLNDIL 4MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148401510","SUP","HCPCS C1726","","H74939148401510  -  CATHETER BLNDIL 4MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148401590","SUP","HCPCS C1725","","H74939148401590  -  CATHETER BLNDIL 4MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939148408010","SUP","HCPCS C1726","","H74939148408010  -  CATHETER BLNDIL 4MM 150CM 80MM STRLG SL OTW INFL PORT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939171030210","SUP","HCPCS C1753","","H74939171030210  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030240","SUP","HCPCS C1753","","H74939171030240  -  CATHETER BLNDIL 3MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030270","SUP","HCPCS C1753","","H74939171030270  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030310","SUP","HCPCS C1753","","H74939171030310  -  CATHETER BALDILAT .035IN 5FR 3MM 135CM 30MM PTA LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030340","SUP","HCPCS C1753","","H74939171030340  -  CATHETER BLNDIL 3MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030370","SUP","HCPCS C1753","","H74939171030370  -  CATHETER BLNDIL 3MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030410","SUP","HCPCS C1753","","H74939171030410  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030440","SUP","HCPCS C1753","","H74939171030440  -  CATHETER BLNDIL 3MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030470","SUP","HCPCS C1753","","H74939171030470  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030610","SUP","HCPCS C1753","","H74939171030610  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030640","SUP","HCPCS C1753","","H74939171030640  -  CATHETER BLNDIL 3MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030670","SUP","HCPCS C1753","","H74939171030670  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030810","SUP","HCPCS C1753","","H74939171030810  -  CATHETER BLNDIL 3MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030840","SUP","HCPCS C1753","","H74939171030840  -  CATHETER BLNDIL 3MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171030870","SUP","HCPCS C1753","","H74939171030870  -  CATHETER BLNDIL 3MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031010","SUP","HCPCS C1753","","H74939171031010  -  CATHETER BALDILAT .035IN 3MM 135CM 100MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031040","SUP","HCPCS C1753","","H74939171031040  -  CATHETER BLNDIL 3MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031070","SUP","HCPCS C1753","","H74939171031070  -  CATHETER BLNDIL 3MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031210","SUP","HCPCS C1753","","H74939171031210  -  CATHETER BLNDIL 3MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031270","SUP","HCPCS C1753","","H74939171031270  -  CATHETER BLNDIL 3MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031510","SUP","HCPCS C1753","","H74939171031510  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 150MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031570","SUP","HCPCS C1753","","H74939171031570  -  CATHETER BLNDIL 3MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031810","SUP","HCPCS C1753","","H74939171031810  -  CATHETER BALDILAT .035IN 5FR 3MM 135CM 180MM PTA LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171031870","SUP","HCPCS C1753","","H74939171031870  -  CATHETER BLNDIL 3MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171032010","SUP","HCPCS C1753","","H74939171032010  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 200MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171032070","SUP","HCPCS C1753","","H74939171032070  -  CATHETER BLNDIL 3MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040210","SUP","HCPCS C1725","","H74939171040210  -  CATHETER BALDILAT .035IN 4MM 135CM 20MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040240","SUP","HCPCS C1753","","H74939171040240  -  CATHETER BLNDIL 4MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040270","SUP","HCPCS C1726","","H74939171040270  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040310","SUP","HCPCS C1753","","H74939171040310  -  CATHETER BALDILAT 4MM 135CM 30MM HIGH PRESSURE LP INFLAT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040340","SUP","HCPCS C1753","","H74939171040340  -  CATHETER BLNDIL 4MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040370","SUP","HCPCS C1753","","H74939171040370  -  CATHETER BLNDIL 4MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040410","SUP","HCPCS C1726","","H74939171040410  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040440","SUP","HCPCS C1753","","H74939171040440  -  CATHETER BLNDIL 4MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040470","SUP","HCPCS C1726","","H74939171040470  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040610","SUP","HCPCS C1753","","H74939171040610  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040640","SUP","HCPCS C1753","","H74939171040640  -  CATHETER BLNDIL 4MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040670","SUP","HCPCS C1753","","H74939171040670  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040810","SUP","HCPCS C1753","","H74939171040810  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 80MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040840","SUP","HCPCS C1753","","H74939171040840  -  CATHETER BLNDIL 4MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171040870","SUP","HCPCS C1753","","H74939171040870  -  CATHETER BLNDIL 4MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041010","SUP","HCPCS C1753","","H74939171041010  -  CATHETER BALDILAT .035IN 4MM 135CM 100MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041040","SUP","HCPCS C1753","","H74939171041040  -  CATHETER BLNDIL 4MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041070","SUP","HCPCS C1753","","H74939171041070  -  CATHETER BLNDIL 4MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041210","SUP","HCPCS C1726","","H74939171041210  -  CATHETER BLNDIL 4MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041270","SUP","HCPCS C1753","","H74939171041270  -  CATHETER BLNDIL 4MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041510","SUP","HCPCS C1753","","H74939171041510  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 150MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041570","SUP","HCPCS C1753","","H74939171041570  -  CATHETER BLNDIL 4MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041810","SUP","HCPCS C1753","","H74939171041810  -  CATHETER BLNDIL 4MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171041870","SUP","HCPCS C1753","","H74939171041870  -  CATHETER BLNDIL 4MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171042010","SUP","HCPCS C1725","","H74939171042010  -  CATHETER BALDILAT .035IN 4MM 135CM 200MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171042070","SUP","HCPCS C1753","","H74939171042070  -  CATHETER BLNDIL 4MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050210","SUP","HCPCS C1726","","H74939171050210  -  CATHETER BALDILAT .035IN 5MM 135CM 20MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050240","SUP","HCPCS C1753","","H74939171050240  -  CATHETER BLNDIL 5MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050270","SUP","HCPCS C1725","","H74939171050270  -  CATHETER BALDILAT LP 5.3FR 5MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050310","SUP","HCPCS C1753","","H74939171050310  -  CATHETER BALDILAT LP 5FR 5MM 135CM 30MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050340","SUP","HCPCS C1753","","H74939171050340  -  CATHETER BLNDIL 5MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050370","SUP","HCPCS C1753","","H74939171050370  -  CATHETER BLNDIL 5MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050410","SUP","HCPCS C1726","","H74939171050410  -  CATHETER BALDILAT 5FR 5MM 135CM 40MM HIGH PRESSURE LP INFLAT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050440","SUP","HCPCS C1726","","H74939171050440  -  CATHETER BLNDIL 5MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050470","SUP","HCPCS C1726","","H74939171050470  -  CATHETER BALDILAT .035IN 5MM 75CM 40MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050610","SUP","HCPCS C1753","","H74939171050610  -  CATHETER BALDILAT .035IN 5MM 135CM 60MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050640","SUP","HCPCS C1753","","H74939171050640  -  CATHETER BLNDIL 5MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050670","SUP","HCPCS C1753","","H74939171050670  -  CATHETER BALDILAT .035IN 5MM 75CM 60MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050810","SUP","HCPCS C1753","","H74939171050810  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 80MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050840","SUP","HCPCS C1753","","H74939171050840  -  CATHETER BLNDIL 5MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171050870","SUP","HCPCS C1753","","H74939171050870  -  CATHETER BLNDIL 5MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051010","SUP","HCPCS C1725","","H74939171051010  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 100MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051040","SUP","HCPCS C1753","","H74939171051040  -  CATHETER BLNDIL 5MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051070","SUP","HCPCS C1753","","H74939171051070  -  CATHETER BLNDIL 5MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051210","SUP","HCPCS C1753","","H74939171051210  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 120MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051240","SUP","HCPCS C1753","","H74939171051240  -  CATHETER BLNDIL 5MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051270","SUP","HCPCS C1753","","H74939171051270  -  CATHETER BLNDIL 5MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051510","SUP","HCPCS C1726","","H74939171051510  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 150MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051570","SUP","HCPCS C1753","","H74939171051570  -  CATHETER BLNDIL 5MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051810","SUP","HCPCS C1753","","H74939171051810  -  CATHETER BLNDIL 5MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171051870","SUP","HCPCS C1753","","H74939171051870  -  CATHETER BLNDIL 5MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171052010","SUP","HCPCS C1726","","H74939171052010  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 200MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171052070","SUP","HCPCS C1753","","H74939171052070  -  CATHETER BLNDIL 5MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060210","SUP","HCPCS C1726","","H74939171060210  -  CATHETER BALDILAT .035IN 6MM 135CM 20MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060240","SUP","HCPCS C1753","","H74939171060240  -  CATHETER BLNDIL 6MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060270","SUP","HCPCS C1726","","H74939171060270  -  CATHETER BALDILAT .035IN 6MM 75CM 20MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060310","SUP","HCPCS C1753","","H74939171060310  -  CATHETER BLNDIL 6MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060340","SUP","HCPCS C1753","","H74939171060340  -  CATHETER BLNDIL 6MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060370","SUP","HCPCS C1753","","H74939171060370  -  CATHETER BLNDIL 6MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060410","SUP","HCPCS C1726","","H74939171060410  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060440","SUP","HCPCS C1726","","H74939171060440  -  CATHETER BLNDIL 6MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060470","SUP","HCPCS C1726","","H74939171060470  -  CATHETER BALDILAT 6MM 75CM 40MM HIGH PRESSURE LP INFLAT PORT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060610","SUP","HCPCS C1753","","H74939171060610  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060640","SUP","HCPCS C1753","","H74939171060640  -  CATHETER BLNDIL 6MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060670","SUP","HCPCS C1753","","H74939171060670  -  CATHETER BALDILAT .035IN 6MM 75CM 60MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060810","SUP","HCPCS C1753","","H74939171060810  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 80MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060840","SUP","HCPCS C1753","","H74939171060840  -  CATHETER BLNDIL 6MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171060870","SUP","HCPCS C1753","","H74939171060870  -  CATHETER BALDILAT .035IN 6MM 75CM 80MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061010","SUP","HCPCS C1726","","H74939171061010  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 100MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061040","SUP","HCPCS C1753","","H74939171061040  -  CATHETER BLNDIL 6MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061070","SUP","HCPCS C1726","","H74939171061070  -  CATHETER BALDILAT LP 5.3FR 6MM 75CM 100MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061210","SUP","HCPCS C1753","","H74939171061210  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 120MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061240","SUP","HCPCS C1753","","H74939171061240  -  CATHETER BLNDIL 6MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061270","SUP","HCPCS C1753","","H74939171061270  -  CATHETER BLNDIL 6MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061510","SUP","HCPCS C1726","","H74939171061510  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 150MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061570","SUP","HCPCS C1753","","H74939171061570  -  CATHETER BLNDIL 6MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061810","SUP","HCPCS C1753","","H74939171061810  -  CATHETER BLNDIL 6MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171061870","SUP","HCPCS C1753","","H74939171061870  -  CATHETER BLNDIL 6MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171062010","SUP","HCPCS C1726","","H74939171062010  -  CATHETER BALDILAT 6MM 135CM 200MM HIGH PRESSURE LP INFLAT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171062070","SUP","HCPCS C1753","","H74939171062070  -  CATHETER BLNDIL 6MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070210","SUP","HCPCS C1753","","H74939171070210  -  CATHETER BALDILAT .035IN 7MM 135CM 20MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070240","SUP","HCPCS C1753","","H74939171070240  -  CATHETER BLNDIL 7MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070270","SUP","HCPCS C1726","","H74939171070270  -  CATHETER BALDILAT LP 5.3FR 7MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070310","SUP","HCPCS C1753","","H74939171070310  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 30MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070340","SUP","HCPCS C1753","","H74939171070340  -  CATHETER BLNDIL 7MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070370","SUP","HCPCS C1753","","H74939171070370  -  CATHETER BLNDIL 7MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070410","SUP","HCPCS C1726","","H74939171070410  -  CATHETER BALDILAT .035IN 7MM 135CM 40MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070440","SUP","HCPCS C1726","","H74939171070440  -  CATHETER BLNDIL 7MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070470","SUP","HCPCS C1726","","H74939171070470  -  CATHETER BALDILAT .035IN 7MM 75CM 40MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070610","SUP","HCPCS C1753","","H74939171070610  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070640","SUP","HCPCS C1753","","H74939171070640  -  CATHETER BLNDIL 7MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070670","SUP","HCPCS C1753","","H74939171070670  -  CATHETER BALDILAT .035IN 7MM 75CM 60MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070810","SUP","HCPCS C1753","","H74939171070810  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 80MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070840","SUP","HCPCS C1753","","H74939171070840  -  CATHETER BLNDIL 7MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171070870","SUP","HCPCS C1753","","H74939171070870  -  CATHETER BLNDIL 7MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071010","SUP","HCPCS C1725","","H74939171071010  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 100MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071040","SUP","HCPCS C1753","","H74939171071040  -  CATHETER BLNDIL 7MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071070","SUP","HCPCS C1753","","H74939171071070  -  CATHETER BLNDIL 7MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071210","SUP","HCPCS C1753","","H74939171071210  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 120MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071270","SUP","HCPCS C1753","","H74939171071270  -  CATHETER BLNDIL 7MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071510","SUP","HCPCS C1753","","H74939171071510  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 150MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071570","SUP","HCPCS C1753","","H74939171071570  -  CATHETER BLNDIL 7MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071810","SUP","HCPCS C1753","","H74939171071810  -  CATHETER BLNDIL 7MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171071870","SUP","HCPCS C1753","","H74939171071870  -  CATHETER BLNDIL 7MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171072010","SUP","HCPCS C1753","","H74939171072010  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 200MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171072070","SUP","HCPCS C1753","","H74939171072070  -  CATHETER BLNDIL 7MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080210","SUP","HCPCS C1753","","H74939171080210  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080240","SUP","HCPCS C1753","","H74939171080240  -  CATHETER BLNDIL 8MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080270","SUP","HCPCS C1725","","H74939171080270  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080310","SUP","HCPCS C1753","","H74939171080310  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 30MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080340","SUP","HCPCS C1753","","H74939171080340  -  CATHETER BLNDIL 8MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080370","SUP","HCPCS C1753","","H74939171080370  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 30MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080410","SUP","HCPCS C1726","","H74939171080410  -  CATHETER BALDILAT 8MM 135CM 40MM HIGH PRESSURE LP INFLAT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080440","SUP","HCPCS C1726","","H74939171080440  -  CATHETER BLNDIL 8MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080470","SUP","HCPCS C1726","","H74939171080470  -  CATHETER BALDILAT .035IN 8MM 75CM 40MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080610","SUP","HCPCS C1753","","H74939171080610  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 60MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080640","SUP","HCPCS C1753","","H74939171080640  -  CATHETER BLNDIL 8MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080670","SUP","HCPCS C1753","","H74939171080670  -  CATHETER BALDILAT .035IN 8MM 75CM 60MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080810","SUP","HCPCS C1753","","H74939171080810  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 80MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080840","SUP","HCPCS C1753","","H74939171080840  -  CATHETER BLNDIL 8MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171080870","SUP","HCPCS C1725","","H74939171080870  -  CATHETER BALDILAT .035IN 8MM 75CM 80MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081010","SUP","HCPCS C1726","","H74939171081010  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 100MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081040","SUP","HCPCS C1753","","H74939171081040  -  CATHETER BLNDIL 8MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081070","SUP","HCPCS C1726","","H74939171081070  -  CATHETER BLNDIL 8MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081210","SUP","HCPCS C1753","","H74939171081210  -  CATHETER BLNDIL 8MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081270","SUP","HCPCS C1753","","H74939171081270  -  CATHETER BLNDIL 8MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081510","SUP","HCPCS C1753","","H74939171081510  -  CATHETER BLNDIL 8MM 135CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081570","SUP","HCPCS C1753","","H74939171081570  -  CATHETER BLNDIL 8MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081810","SUP","HCPCS C1753","","H74939171081810  -  CATHETER BALDILAT .035IN 5FR 8MM 135CM 180MM PTA LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171081870","SUP","HCPCS C1753","","H74939171081870  -  CATHETER BLNDIL 8MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171082010","SUP","HCPCS C1753","","H74939171082010  -  CATHETER BALDILAT .035IN 5FR 8MM 135CM 200MM PTA LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171082070","SUP","HCPCS C1753","","H74939171082070  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 200MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171086070","SUP","HCPCS C1725","","H74939171086070  -  MUSTANG 8X 60, 75","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"H74939171090210","SUP","HCPCS C1753","","H74939171090210  -  CATHETER BALDILAT 18 ATM LP TAPER 5.8FR 9MM 135CM 20MM 2","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090240","SUP","HCPCS C1753","","H74939171090240  -  CATHETER BLNDIL 9MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090270","SUP","HCPCS C1753","","H74939171090270  -  CATHETER BALDILAT LP 5.3FR 9MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090310","SUP","HCPCS C1753","","H74939171090310  -  CATHETER BLNDIL 9MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090340","SUP","HCPCS C1753","","H74939171090340  -  CATHETER BLNDIL 9MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090370","SUP","HCPCS C1753","","H74939171090370  -  CATHETER BLNDIL 9MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090410","SUP","HCPCS C1753","","H74939171090410  -  CATHETER BALDILAT LP 5.8FR 9MM 135CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090440","SUP","HCPCS C1753","","H74939171090440  -  CATHETER BLNDIL 9MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090470","SUP","HCPCS C1725","","H74939171090470  -  CATHETER BALDILAT .035IN 9MM 75CM 40MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090610","SUP","HCPCS C1753","","H74939171090610  -  CATHETER BLNDIL 9MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090640","SUP","HCPCS C1753","","H74939171090640  -  CATHETER BLNDIL 9MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090670","SUP","HCPCS C1726","","H74939171090670  -  CATHETER BLNDIL 9MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090810","SUP","HCPCS C1753","","H74939171090810  -  CATHETER BLNDIL 9MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090840","SUP","HCPCS C1753","","H74939171090840  -  CATHETER BLNDIL 9MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171090870","SUP","HCPCS C1753","","H74939171090870  -  CATHETER BLNDIL 9MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100210","SUP","HCPCS C1753","","H74939171100210  -  CATHETER BALDILAT LP 5.8FR 10MM 135CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100240","SUP","HCPCS C1753","","H74939171100240  -  CATHETER BLNDIL 10MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100270","SUP","HCPCS C1726","","H74939171100270  -  CATHETER BALDILAT 10MM 75CM 20MM HIGH PRESSURE LP INFLAT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100310","SUP","HCPCS C1753","","H74939171100310  -  CATHETER BLNDIL 10MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100340","SUP","HCPCS C1753","","H74939171100340  -  CATHETER BLNDIL 10MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100370","SUP","HCPCS C1753","","H74939171100370  -  CATHETER BALDILAT LP 5.8FR 10MM 75CM 30MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100410","SUP","HCPCS C1753","","H74939171100410  -  CATHETER BALDILAT LP 5.8FR 10MM 135CM 40MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100440","SUP","HCPCS C1753","","H74939171100440  -  CATHETER BLNDIL 10MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100470","SUP","HCPCS C1726","","H74939171100470  -  CATHETER BALDILAT 10MM 75CM 40MM HIGH PRESSURE LP MUSTANG","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100610","SUP","HCPCS C1753","","H74939171100610  -  CATHETER BLNDIL 10MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100640","SUP","HCPCS C1753","","H74939171100640  -  CATHETER BLNDIL 10MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100670","SUP","HCPCS C1725","","H74939171100670  -  CATHETER BALDILAT 5.8FR 10MM 75CM 60MM HIGH PRESSURE LP","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100810","SUP","HCPCS C1753","","H74939171100810  -  CATHETER BLNDIL 10MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100840","SUP","HCPCS C1753","","H74939171100840  -  CATHETER BLNDIL 10MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171100870","SUP","HCPCS C1753","","H74939171100870  -  CATHETER BALDILAT LP 5.8FR 10MM 75CM 80MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120210","SUP","HCPCS C1753","","H74939171120210  -  CATHETER BALDILAT LP 5.8FR 12MM 135CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120240","SUP","HCPCS C1753","","H74939171120240  -  CATHETER BLNDIL 12MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120270","SUP","HCPCS C1753","","H74939171120270  -  CATHETER BALDILAT LP 5.8FR 12MM 75CM 20MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120310","SUP","HCPCS C1753","","H74939171120310  -  CATHETER BLNDIL 12MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120340","SUP","HCPCS C1753","","H74939171120340  -  CATHETER BLNDIL 12MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120370","SUP","HCPCS C1753","","H74939171120370  -  CATHETER BALDILAT LP 5.8FR 12MM 75CM 30MM HIGH PRESSURE","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120410","SUP","HCPCS C1753","","H74939171120410  -  CATHETER BLNDIL 12MM 135CM 40MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120440","SUP","HCPCS C1753","","H74939171120440  -  CATHETER BLNDIL 12MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120470","SUP","HCPCS C1726","","H74939171120470  -  CATHETER BALDILAT 12MM 75CM 40MM HIGH PRESSURE LP MUSTANG","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120610","SUP","HCPCS C1753","","H74939171120610  -  CATHETER BLNDIL 12MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120640","SUP","HCPCS C1753","","H74939171120640  -  CATHETER BLNDIL 12MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120670","SUP","HCPCS C1753","","H74939171120670  -  CATHETER BLNDIL 12MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120810","SUP","HCPCS C1753","","H74939171120810  -  CATHETER BLNDIL 12MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120840","SUP","HCPCS C1753","","H74939171120840  -  CATHETER BLNDIL 12MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939171120870","SUP","HCPCS C1753","","H74939171120870  -  CATHETER BLNDIL 12MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT","BOTH IP/OP","$430.00 ","$318.20 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$89.62 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"H74939185150410","SUP","HCPCS C1725","","H74939185150410  -  CATHETER BLNDIL 1.5MM 150CM 40MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185201210","SUP","HCPCS C1725","","H74939185201210  -  CATHETER BLNDIL 2MM 150CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185201290","SUP","HCPCS C1725","","H74939185201290  -  CATHETER BLNDIL 2MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185201510","SUP","HCPCS C1725","","H74939185201510  -  CATHETER BLNDIL 2MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185201590","SUP","HCPCS C1725","","H74939185201590  -  CATHETER BLNDIL 2MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185251210","SUP","HCPCS C1725","","H74939185251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185251290","SUP","HCPCS C1725","","H74939185251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185251510","SUP","HCPCS C1725","","H74939185251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185251590","SUP","HCPCS C1725","","H74939185251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185301210","SUP","HCPCS C1725","","H74939185301210  -  CATHETER BLNDIL 3MM 150CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185301290","SUP","HCPCS C1725","","H74939185301290  -  CATHETER BLNDIL 3MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185301510","SUP","HCPCS C1725","","H74939185301510  -  CATHETER BLNDIL 3MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185301590","SUP","HCPCS C1725","","H74939185301590  -  CATHETER BLNDIL 3MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185351210","SUP","HCPCS C1725","","H74939185351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185351290","SUP","HCPCS C1725","","H74939185351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185351510","SUP","HCPCS C1725","","H74939185351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185351590","SUP","HCPCS C1725","","H74939185351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185401210","SUP","HCPCS C1725","","H74939185401210  -  CATHETER BLNDIL 4MM 150CM 120MM CYTE MNRL RX ULT LOPRFL","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185401290","SUP","HCPCS C1725","","H74939185401290  -  CATHETER BLNDIL 4MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185401510","SUP","HCPCS C1725","","H74939185401510  -  CATHETER BLNDIL 4MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939185401590","SUP","HCPCS C1725","","H74939185401590  -  CATHETER BLNDIL 4MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186150410","SUP","HCPCS C1726","","H74939186150410  -  CATHETER BLNDIL 1.5MM 150CM 40MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186150490","SUP","HCPCS C1753","","H74939186150490  -  CATHETER BLNDIL 1.5MM 90CM 40MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186200610","SUP","HCPCS C1753","","H74939186200610  -  CATHETER BLNDIL 2MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186200690","SUP","HCPCS C1753","","H74939186200690  -  CATHETER BLNDIL 2MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186200810","SUP","HCPCS C1753","","H74939186200810  -  CATHETER BLNDIL 2MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186200890","SUP","HCPCS C1753","","H74939186200890  -  CATHETER BLNDIL 2MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186201010","SUP","HCPCS C1726","","H74939186201010  -  CATHETER BLNDIL 2MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186201090","SUP","HCPCS C1753","","H74939186201090  -  CATHETER BLNDIL 2MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186201210","SUP","HCPCS C1726","","H74939186201210  -  CATHETER BLNDIL 2MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186201290","SUP","HCPCS C1753","","H74939186201290  -  CATHETER BLNDIL 2MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186201510","SUP","HCPCS C1726","","H74939186201510  -  CATHETER BLNDIL 2MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186201590","SUP","HCPCS C1753","","H74939186201590  -  CATHETER BLNDIL 2MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186202210","SUP","HCPCS C1726","","H74939186202210  -  CATHETER BLNDIL 2MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
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"H74939186401510","SUP","HCPCS C1753","","H74939186401510  -  CATHETER BLNDIL 4MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186401590","SUP","HCPCS C1753","","H74939186401590  -  CATHETER BLNDIL 4MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186402210","SUP","HCPCS C1726","","H74939186402210  -  CATHETER BLNDIL 4MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939186402290","SUP","HCPCS C1753","","H74939186402290  -  CATHETER BLNDIL 4MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX","BOTH IP/OP","$417.50 ","$308.95 ","$0.00 ","$417.50 ","$226.70 ","$0.00 ","$87.02 ","$0.00 ","$0.00 ","$73.10 ","$417.50 ","$0.00 ","$208.75 ","$330.66 ","$334.00 ","$0.00 ","$65.34 ","$0.00 ","$66.47 ","$0.00 "
"H74939200061020","SUP","HCPCS C1876","","H74939200061020  -  STENT VASCULAR .035IN 6MM 100MM 120CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200061070","SUP","HCPCS C1876","","H74939200061070  -  STENT VASCULAR 6MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200061220","SUP","HCPCS C1876","","H74939200061220  -  STENT VASCULAR 6MM 120MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200061270","SUP","HCPCS C1876","","H74939200061270  -  STENT VASCULAR .035IN 6MM 120MM 75CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200062020","SUP","HCPCS C1876","","H74939200062020  -  STENT VASCULAR 6MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200062070","SUP","HCPCS C1876","","H74939200062070  -  STENT VASCULAR 6MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200063020","SUP","HCPCS C1876","","H74939200063020  -  STENT VASCULAR 6MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200063070","SUP","HCPCS C1876","","H74939200063070  -  STENT VASCULAR 6MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200064020","SUP","HCPCS C1876","","H74939200064020  -  STENT VASCULAR 6MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200064070","SUP","HCPCS C1876","","H74939200064070  -  STENT VASCULAR .035IN 6MM 40MM 75CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200065020","SUP","HCPCS C1876","","H74939200065020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 6MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200065070","SUP","HCPCS C1876","","H74939200065070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 6MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200066020","SUP","HCPCS C1876","","H74939200066020  -  STENT VASCULAR .035IN 6MM 60MM 120CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200066070","SUP","HCPCS C1876","","H74939200066070  -  STENT VASCULAR 6MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200067020","SUP","HCPCS C1876","","H74939200067020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 6MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200067070","SUP","HCPCS C1876","","H74939200067070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 6MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200068020","SUP","HCPCS C1876","","H74939200068020  -  STENT VASCULAR 6MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200068070","SUP","HCPCS C1876","","H74939200068070  -  STENT VASCULAR 6MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200071020","SUP","HCPCS C1876","","H74939200071020  -  STENT VASCULAR .035IN 7MM 100MM 120CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200071070","SUP","HCPCS C1876","","H74939200071070  -  STENT VASCULAR 7MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200071220","SUP","HCPCS C1876","","H74939200071220  -  STENT VASCULAR 7MM 120MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200071270","SUP","HCPCS C1876","","H74939200071270  -  STENT VASCULAR 7MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200072020","SUP","HCPCS C1876","","H74939200072020  -  STENT VASCULAR 7MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200072070","SUP","HCPCS C1876","","H74939200072070  -  STENT VASCULAR 7MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200073020","SUP","HCPCS C1876","","H74939200073020  -  STENT VASCULAR 7MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200073070","SUP","HCPCS C1876","","H74939200073070  -  STENT VASCULAR .035IN 7MM 30MM 75CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200074020","SUP","HCPCS C1876","","H74939200074020  -  STENT VASCULAR .035IN 7MM 40MM 120CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200074070","SUP","HCPCS C1876","","H74939200074070  -  STENT VASCULAR .035IN 7MM 40MM 75CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200075020","SUP","HCPCS C1876","","H74939200075020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 7MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200075070","SUP","HCPCS C1876","","H74939200075070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 7MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200076020","SUP","HCPCS C1876","","H74939200076020  -  STENT VASCULAR 7MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200076070","SUP","HCPCS C1876","","H74939200076070  -  STENT VASCULAR 7MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200077020","SUP","HCPCS C1876","","H74939200077020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 7MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200077070","SUP","HCPCS C1876","","H74939200077070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 7MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200078020","SUP","HCPCS C1876","","H74939200078020  -  STENT VASCULAR 7MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200078070","SUP","HCPCS C1876","","H74939200078070  -  STENT VASCULAR 7MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200081020","SUP","HCPCS C1876","","H74939200081020  -  STENT VASCULAR 8MM 100MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200081070","SUP","HCPCS C1876","","H74939200081070  -  STENT VASCULAR 8MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200081220","SUP","HCPCS C1876","","H74939200081220  -  STENT VASCULAR .035IN 8MM 120MM 120CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200081270","SUP","HCPCS C1876","","H74939200081270  -  STENT VASCULAR 8MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200082020","SUP","HCPCS C1876","","H74939200082020  -  STENT VASCULAR 8MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200082070","SUP","HCPCS C1876","","H74939200082070  -  STENT VASCULAR 8MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIUM","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200083020","SUP","HCPCS C1876","","H74939200083020  -  STENT VASCULAR 8MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200083070","SUP","HCPCS C1876","","H74939200083070  -  STENT VASCULAR .035IN 8MM 30MM 75CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200084020","SUP","HCPCS C1876","","H74939200084020  -  STENT VASCULAR 8MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200085020","SUP","HCPCS C1876","","H74939200085020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 8MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200085070","SUP","HCPCS C1876","","H74939200085070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 8MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200086020","SUP","HCPCS C1876","","H74939200086020  -  STENT VASCULAR 8MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200086070","SUP","HCPCS C1876","","H74939200086070  -  STENT VASCULAR 8MM 6FR 60MM 75CM SELF EXPAND SHEATH EPIC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200087020","SUP","HCPCS C1876","","H74939200087020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 8MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200087070","SUP","HCPCS C1876","","H74939200087070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 8MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200088020","SUP","HCPCS C1876","","H74939200088020  -  STENT VASCULAR 8MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200088070","SUP","HCPCS C1876","","H74939200088070  -  STENT VASCULAR 8MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200091020","SUP","HCPCS C1876","","H74939200091020  -  STENT VASCULAR .035IN 8MM 100MM 120CM SELF EXPAND OTW GWIRE","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200091070","SUP","HCPCS C1876","","H74939200091070  -  STENT VASCULAR 9MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200092020","SUP","HCPCS C1876","","H74939200092020  -  STENT VASCULAR 9MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200092070","SUP","HCPCS C1876","","H74939200092070  -  STENT VASCULAR 9MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200093020","SUP","HCPCS C1876","","H74939200093020  -  STENT VASCULAR 9MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200093070","SUP","HCPCS C1876","","H74939200093070  -  STENT VASCULAR 9MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200094020","SUP","HCPCS C1876","","H74939200094020  -  STENT VASCULAR 9MM 40MM 120CM SELF EXPAND EPIC METAL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200094070","SUP","HCPCS C1876","","H74939200094070  -  STENT VASCULAR 9MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIUM","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200095020","SUP","HCPCS C1876","","H74939200095020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 9MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200095070","SUP","HCPCS C1876","","H74939200095070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 9MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200096020","SUP","HCPCS C1876","","H74939200096020  -  STENT VASCULAR 9MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200096070","SUP","HCPCS C1876","","H74939200096070  -  STENT VASCULAR 9MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIUM","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200097020","SUP","HCPCS C1876","","H74939200097020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 9MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200097070","SUP","HCPCS C1876","","H74939200097070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 9MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200098020","SUP","HCPCS C1876","","H74939200098020  -  STENT VASCULAR 9MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200098070","SUP","HCPCS C1876","","H74939200098070  -  STENT VASCULAR 9MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200101020","SUP","HCPCS C1876","","H74939200101020  -  STENT VASCULAR 9MM 100MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200101070","SUP","HCPCS C1876","","H74939200101070  -  STENT VASCULAR 10MM 100MM 75CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200102020","SUP","HCPCS C1876","","H74939200102020  -  STENT VASCULAR 10MM 20MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200102070","SUP","HCPCS C1876","","H74939200102070  -  STENT VASCULAR 10MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200103020","SUP","HCPCS C1876","","H74939200103020  -  STENT VASCULAR 10MM 30MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200103070","SUP","HCPCS C1876","","H74939200103070  -  STENT VASCULAR 10MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200104020","SUP","HCPCS C1876","","H74939200104020  -  STENT VASCULAR 10MM 40MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200104070","SUP","HCPCS C1876","","H74939200104070  -  STENT VASCULAR 10MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200105020","SUP","HCPCS C1876","","H74939200105020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 10MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200105070","SUP","HCPCS C1876","","H74939200105070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 10MM ILIAC","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200106020","SUP","HCPCS C1876","","H74939200106020  -  STENT VASCULAR 10MM 60MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200106070","SUP","HCPCS C1876","","H74939200106070  -  STENT VASCULAR 10MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200107020","SUP","HCPCS C1876","","H74939200107020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 10MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200107070","SUP","HCPCS C1876","","H74939200107070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 10MM ILIUM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200108020","SUP","HCPCS C1876","","H74939200108020  -  STENT VASCULAR 10MM 80MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200108070","SUP","HCPCS C1876","","H74939200108070  -  STENT VASCULAR 10MM 80MM 75CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200123020","SUP","HCPCS C1876","","H74939200123020  -  STENT VASCULAR 12MM 30MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200123070","SUP","HCPCS C1876","","H74939200123070  -  STENT VASCULAR 12MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200124020","SUP","HCPCS C1876","","H74939200124020  -  STENT VASCULAR 12MM 40MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200124070","SUP","HCPCS C1876","","H74939200124070  -  STENT VASCULAR 12MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200125020","SUP","HCPCS C1876","","H74939200125020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 12MM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200125070","SUP","HCPCS C1876","","H74939200125070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 12MM ILIUM","BOTH IP/OP","$2,500.00 ","$1,850.00 ","$0.00 ","$2,500.00 ","$1,125.00 ","$0.00 ","$521.06 ","$0.00 ","$0.00 ","$437.73 ","$2,500.00 ","$0.00 ","$1,250.00 ","$1,980.00 ","$2,000.00 ","$0.00 ","$391.25 ","$0.00 ","$398.00 ","$0.00 "
"H74939200126020","SUP","HCPCS C1876","","H74939200126020  -  STENT VASCULAR 12MM 60MM 120CM SELF EXPAND EPIC NITINOL","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939200126070","SUP","HCPCS C1876","","H74939200126070  -  STENT VASCULAR 12MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC","BOTH IP/OP","$1,462.50 ","$1,082.25 ","$0.00 ","$1,462.50 ","$658.13 ","$0.00 ","$304.82 ","$0.00 ","$0.00 ","$256.07 ","$1,462.50 ","$0.00 ","$731.25 ","$1,158.30 ","$1,170.00 ","$0.00 ","$228.88 ","$0.00 ","$232.83 ","$0.00 "
"H74939206030210","SUP","HCPCS C1753","","H74939206030210  -  CATHETER BLNDIL 3MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206030270","SUP","HCPCS C1753","","H74939206030270  -  CATHETER BLNDIL 3MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206030370","SUP","HCPCS C1753","","H74939206030370  -  CATHETER BLNDIL 3MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206030410","SUP","HCPCS C1753","","H74939206030410  -  CATHETER BLNDIL 3MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206030470","SUP","HCPCS C1753","","H74939206030470  -  CATHETER BLNDIL 3MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206030670","SUP","HCPCS C1753","","H74939206030670  -  CATHETER BLNDIL 3MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206030810","SUP","HCPCS C1753","","H74939206030810  -  CATHETER BLNDIL 3MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206031010","SUP","HCPCS C1753","","H74939206031010  -  CATHETER BLNDIL 3MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206031210","SUP","HCPCS C1753","","H74939206031210  -  CATHETER BLNDIL 3MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206031510","SUP","HCPCS C1753","","H74939206031510  -  CATHETER BLNDIL 3MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206031810","SUP","HCPCS C1753","","H74939206031810  -  CATHETER BLNDIL 3MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206032010","SUP","HCPCS C1753","","H74939206032010  -  CATHETER BLNDIL 3MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040210","SUP","HCPCS C1753","","H74939206040210  -  CATHETER BLNDIL 4MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040270","SUP","HCPCS C1753","","H74939206040270  -  CATHETER BLNDIL 4MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040370","SUP","HCPCS C1753","","H74939206040370  -  CATHETER BLNDIL 4MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040410","SUP","HCPCS C1753","","H74939206040410  -  CATHETER BLNDIL 4MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040470","SUP","HCPCS C1753","","H74939206040470  -  CATHETER BLNDIL 4MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040610","SUP","HCPCS C1753","","H74939206040610  -  CATHETER BLNDIL 4MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040670","SUP","HCPCS C1753","","H74939206040670  -  CATHETER BLNDIL 4MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040810","SUP","HCPCS C1753","","H74939206040810  -  CATHETER BLNDIL 4MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206040870","SUP","HCPCS C1753","","H74939206040870  -  CATHETER BLNDIL 4MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206041010","SUP","HCPCS C1753","","H74939206041010  -  CATHETER BLNDIL 4MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206041070","SUP","HCPCS C1753","","H74939206041070  -  CATHETER BLNDIL 4MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206041210","SUP","HCPCS C1753","","H74939206041210  -  CATHETER BLNDIL 4MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206041510","SUP","HCPCS C1753","","H74939206041510  -  CATHETER BLNDIL 4MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206041810","SUP","HCPCS C1753","","H74939206041810  -  CATHETER BLNDIL 4MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206042010","SUP","HCPCS C1753","","H74939206042010  -  CATHETER BLNDIL 4MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050210","SUP","HCPCS C1753","","H74939206050210  -  CATHETER BLNDIL 5MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050270","SUP","HCPCS C1753","","H74939206050270  -  CATHETER BLNDIL 5MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050370","SUP","HCPCS C1753","","H74939206050370  -  CATHETER BLNDIL 5MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050410","SUP","HCPCS C1753","","H74939206050410  -  CATHETER BLNDIL 5MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050470","SUP","HCPCS C1753","","H74939206050470  -  CATHETER BLNDIL 5MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050610","SUP","HCPCS C1753","","H74939206050610  -  CATHETER BLNDIL 5MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050670","SUP","HCPCS C1753","","H74939206050670  -  CATHETER BLNDIL 5MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050810","SUP","HCPCS C1753","","H74939206050810  -  CATHETER BLNDIL 5MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206050870","SUP","HCPCS C1753","","H74939206050870  -  CATHETER BLNDIL 5MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206051010","SUP","HCPCS C1753","","H74939206051010  -  CATHETER BLNDIL 5MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206051070","SUP","HCPCS C1753","","H74939206051070  -  CATHETER BLNDIL 5MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206051210","SUP","HCPCS C1753","","H74939206051210  -  CATHETER BLNDIL 5MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206051510","SUP","HCPCS C1753","","H74939206051510  -  CATHETER BLNDIL 5MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206051810","SUP","HCPCS C1753","","H74939206051810  -  CATHETER BLNDIL 5MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206052010","SUP","HCPCS C1753","","H74939206052010  -  CATHETER BLNDIL 5MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060210","SUP","HCPCS C1753","","H74939206060210  -  CATHETER BLNDIL 6MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060270","SUP","HCPCS C1753","","H74939206060270  -  CATHETER BLNDIL 6MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060370","SUP","HCPCS C1753","","H74939206060370  -  CATHETER BLNDIL 6MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060410","SUP","HCPCS C1753","","H74939206060410  -  CATHETER BLNDIL 6MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060470","SUP","HCPCS C1753","","H74939206060470  -  CATHETER BLNDIL 6MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060610","SUP","HCPCS C1753","","H74939206060610  -  CATHETER BLNDIL 6MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060670","SUP","HCPCS C1753","","H74939206060670  -  CATHETER BLNDIL 6MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060810","SUP","HCPCS C1753","","H74939206060810  -  CATHETER BLNDIL 6MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206060870","SUP","HCPCS C1753","","H74939206060870  -  CATHETER BLNDIL 6MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206061010","SUP","HCPCS C1753","","H74939206061010  -  CATHETER BLNDIL 6MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206061070","SUP","HCPCS C1753","","H74939206061070  -  CATHETER BLNDIL 6MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206061210","SUP","HCPCS C1753","","H74939206061210  -  CATHETER BLNDIL 6MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206061510","SUP","HCPCS C1753","","H74939206061510  -  CATHETER BLNDIL 6MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206061810","SUP","HCPCS C1753","","H74939206061810  -  CATHETER BLNDIL 6MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206062010","SUP","HCPCS C1753","","H74939206062010  -  CATHETER BLNDIL 6MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070210","SUP","HCPCS C1753","","H74939206070210  -  CATHETER BLNDIL 7MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070270","SUP","HCPCS C1753","","H74939206070270  -  CATHETER BLNDIL 7MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070370","SUP","HCPCS C1753","","H74939206070370  -  CATHETER BLNDIL 7MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070410","SUP","HCPCS C1753","","H74939206070410  -  CATHETER BLNDIL 7MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070470","SUP","HCPCS C1753","","H74939206070470  -  CATHETER BLNDIL 7MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070610","SUP","HCPCS C1753","","H74939206070610  -  BALLOON CATHETER CHARGER 7.0 x60, 135cm","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070670","SUP","HCPCS C1753","","H74939206070670  -  CATHETER BLNDIL 7MM 75CM 60MM CHRGR OTW 2 LUM TPR TIP LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070810","SUP","HCPCS C1753","","H74939206070810  -  CATHETER BLNDIL 7MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206070870","SUP","HCPCS C1753","","H74939206070870  -  CATHETER BLNDIL 7MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206071010","SUP","HCPCS C1753","","H74939206071010  -  CATHETER BLNDIL 7MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206071070","SUP","HCPCS C1753","","H74939206071070  -  CATHETER BLNDIL 7MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206071210","SUP","HCPCS C1753","","H74939206071210  -  CATHETER BLNDIL 7MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206071510","SUP","HCPCS C1753","","H74939206071510  -  CATHETER BLNDIL 7MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206071810","SUP","HCPCS C1753","","H74939206071810  -  CATHETER BLNDIL 7MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206072010","SUP","HCPCS C1753","","H74939206072010  -  CATHETER BLNDIL 7MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080210","SUP","HCPCS C1753","","H74939206080210  -  CATHETER BLNDIL 8MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080270","SUP","HCPCS C1753","","H74939206080270  -  CATHETER BLNDIL 8MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080370","SUP","HCPCS C1753","","H74939206080370  -  CATHETER BLNDIL 8MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080410","SUP","HCPCS C1753","","H74939206080410  -  CATHETER BLNDIL 8MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080470","SUP","HCPCS C1753","","H74939206080470  -  CATHETER BLNDIL 8MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080670","SUP","HCPCS C1753","","H74939206080670  -  CATHETER BLNDIL 8MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080810","SUP","HCPCS C1753","","H74939206080810  -  CATHETER BLNDIL 8MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206080870","SUP","HCPCS C1753","","H74939206080870  -  CATHETER BLNDIL 8MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206081010","SUP","HCPCS C1753","","H74939206081010  -  CATHETER BLNDIL 8MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206081070","SUP","HCPCS C1753","","H74939206081070  -  CATHETER BLNDIL 8MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206081210","SUP","HCPCS C1753","","H74939206081210  -  CATHETER BLNDIL 8MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206081510","SUP","HCPCS C1753","","H74939206081510  -  CATHETER BLNDIL 8MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206081810","SUP","HCPCS C1753","","H74939206081810  -  CATHETER BLNDIL 8MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206082010","SUP","HCPCS C1753","","H74939206082010  -  CATHETER BLNDIL 8MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090210","SUP","HCPCS C1753","","H74939206090210  -  CATHETER BLNDIL 9MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090270","SUP","HCPCS C1753","","H74939206090270  -  CATHETER BLNDIL 9MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090370","SUP","HCPCS C1753","","H74939206090370  -  CATHETER BLNDIL 9MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090410","SUP","HCPCS C1753","","H74939206090410  -  CATHETER BLNDIL 9MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090470","SUP","HCPCS C1753","","H74939206090470  -  CATHETER BLNDIL 9MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090670","SUP","HCPCS C1753","","H74939206090670  -  CATHETER BLNDIL 9MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206090870","SUP","HCPCS C1753","","H74939206090870  -  CATHETER BLNDIL 9MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100210","SUP","HCPCS C1753","","H74939206100210  -  CATHETER BLNDIL 10MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100270","SUP","HCPCS C1753","","H74939206100270  -  CATHETER BLNDIL 10MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100370","SUP","HCPCS C1753","","H74939206100370  -  CATHETER BLNDIL 10MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100410","SUP","HCPCS C1753","","H74939206100410  -  CATHETER BLNDIL 10MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100470","SUP","HCPCS C1753","","H74939206100470  -  CATHETER BLNDIL 10MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100670","SUP","HCPCS C1753","","H74939206100670  -  CATHETER BLNDIL 10MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206100870","SUP","HCPCS C1753","","H74939206100870  -  CATHETER BLNDIL 10MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120210","SUP","HCPCS C1753","","H74939206120210  -  CATHETER BLNDIL 12MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120270","SUP","HCPCS C1753","","H74939206120270  -  CATHETER BLNDIL 12MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120370","SUP","HCPCS C1753","","H74939206120370  -  CATHETER BLNDIL 12MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120410","SUP","HCPCS C1753","","H74939206120410  -  CATHETER BLNDIL 12MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120470","SUP","HCPCS C1753","","H74939206120470  -  CATHETER BLNDIL 12MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120670","SUP","HCPCS C1753","","H74939206120670  -  CATHETER BLNDIL 12MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939206120870","SUP","HCPCS C1753","","H74939206120870  -  CATHETER BLNDIL 12MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$108.60 ","$0.00 ","$41.69 ","$0.00 ","$0.00 ","$35.02 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$31.30 ","$0.00 ","$31.84 ","$0.00 "
"H74939208001601","SUP","HCPCS C1769","","H74939208001601  -  WIRE CATHETER .017IN .018IN 165CM 300CM SHAPABLE DISTAL TIP","BOTH IP/OP","$205.80 ","$152.29 ","$0.00 ","$205.80 ","$111.75 ","$0.00 ","$42.89 ","$0.00 ","$0.00 ","$36.03 ","$205.80 ","$0.00 ","$102.90 ","$162.99 ","$164.64 ","$0.00 ","$32.21 ","$0.00 ","$32.76 ","$0.00 "
"H74939208181650","SUP","HCPCS C2628","","H74939208181650  -  CATHETER ATHERECTOMY .017IN .018IN 165CM SHAPABLE DISTAL TIP","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H74939212014131","SUP","HCPCS C1887","","H74939212014131  -  CATHETER SPRT 15MM SPC 3.4FR 135CM CLR PUR RUBICON 14 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939212014151","SUP","HCPCS C1887","","H74939212014151  -  CATHETER GUID .018IN 150CM RADIOPQ ULTRA LP ROBUST BALLOON","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939216718210","SUP","HCPCS C1769","","H74939216718210  -  GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 182CM 8CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216718220","SUP","HCPCS C1769","","H74939216718220  -  GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 182CM 8CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216730010","SUP","HCPCS C1769","","H74939216730010  -  GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216730020","SUP","HCPCS C1769","","H74939216730020  -  GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 300CM 8CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216918210","SUP","HCPCS C1769","","H74939216918210  -  GUIDEWIRE VASCULAR STR LONG TAPER .014IN 182CM 11CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216918220","SUP","HCPCS C1769","","H74939216918220  -  GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 182CM 11CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216930010","SUP","HCPCS C1769","","H74939216930010  -  GUIDEWIRE VASCULAR STR LONG TAPER .014IN 300CM 11CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939216930020","SUP","HCPCS C1769","","H74939216930020  -  GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 300CM 11CM ROBUST","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"H74939239018091","SUP","HCPCS C1887","","H74939239018091  -  CATHETER SPRT 15MM SPC 4FR 90CM CLR PUR RUBICON 18 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939239018131","SUP","HCPCS C1887","","H74939239018131  -  CATHETER SPRT 15MM SPC 4FR 135CM CLR PUR RUBICON 18 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939239018151","SUP","HCPCS C1887","","H74939239018151  -  CATHETER SPRT 15MM SPC 4FR 150CM CLR PUR RUBICON 18 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939240035061","SUP","HCPCS C1887","","H74939240035061  -  CATHETER SPRT 50MM SPC 5.1FR 65CM CLR PUR RUBICON 35 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939240035091","SUP","HCPCS C1887","","H74939240035091  -  CATHETER SPRT 50MM SPC 5.1FR 90CM CLR PUR RUBICON 35 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939240035131","SUP","HCPCS C1887","","H74939240035131  -  CATHETER SPRT 50MM SPC 5.1FR 135CM CLR PUR RUBICON 35 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H74939240035151","SUP","HCPCS C1887","","H74939240035151  -  CATHETER SPRT 50MM SPC 5.1FR 150CM CLR PUR RUBICON 35 RADOPQ","BOTH IP/OP","$1,470.00 ","$1,087.80 ","$0.00 ","$1,470.00 ","$798.21 ","$0.00 ","$306.38 ","$0.00 ","$0.00 ","$257.39 ","$1,470.00 ","$0.00 ","$735.00 ","$1,164.24 ","$1,176.00 ","$0.00 ","$230.06 ","$0.00 ","$234.02 ","$0.00 "
"H749501001500","SUP","Custom 27203010","","H749501001500  -  SHEATH RTRVL 150CM 4FR F EZ .014IN BNTP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H749CBO3200100","SUP","HCPCS C1726","","H749CBO3200100  -  CATHETER BLNDIL 2MM 137CM 10MM F CBLN OTW INFL PORT GW PORT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$1,086.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"H749CBO3200150","SUP","HCPCS C1726","","H749CBO3200150  -  CATHETER BLNDIL 2MM 137CM 15MM F CBLN OTW INFL PORT GW PORT","BOTH IP/OP","$1,715.00 ","$1,269.10 ","$0.00 ","$1,715.00 ","$931.25 ","$0.00 ","$357.45 ","$0.00 ","$0.00 ","$300.28 ","$1,715.00 ","$0.00 ","$857.50 ","$1,358.28 ","$1,372.00 ","$0.00 ","$268.40 ","$0.00 ","$273.03 ","$0.00 "
"H749CBO3250100","SUP","HCPCS C1726","","H749CBO3250100  -  CATHETER BLNDIL 2.5MM 137CM 10MM F CBLN OTW INFL PORT GW","BOTH IP/OP","$1,715.00 ","$1,269.10 ","$0.00 ","$1,715.00 ","$931.25 ","$0.00 ","$357.45 ","$0.00 ","$0.00 ","$300.28 ","$1,715.00 ","$0.00 ","$857.50 ","$1,358.28 ","$1,372.00 ","$0.00 ","$268.40 ","$0.00 ","$273.03 ","$0.00 "
"H749CBO3250150","SUP","HCPCS C1726","","H749CBO3250150  -  CATHETER BLNDIL 2.5MM 137CM 15MM F CBLN OTW INFL PORT GW","BOTH IP/OP","$1,715.00 ","$1,269.10 ","$0.00 ","$1,715.00 ","$931.25 ","$0.00 ","$357.45 ","$0.00 ","$0.00 ","$300.28 ","$1,715.00 ","$0.00 ","$857.50 ","$1,358.28 ","$1,372.00 ","$0.00 ","$268.40 ","$0.00 ","$273.03 ","$0.00 "
"H7587-58","SUP","Custom 27203010","","REAGENT B-OHB R1 R2 50ML ANALY","BOTH IP/OP","$854.13 ","$632.06 ","$0.00 ","$854.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$854.13 ","$0.00 ","$427.06 ","$676.47 ","$683.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H7587-CTL","SUP","Custom 27203010","","CONTROL CHM 5ML SET B-OHB","BOTH IP/OP","$723.00 ","$535.02 ","$0.00 ","$723.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$723.00 ","$0.00 ","$361.50 ","$572.62 ","$578.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H787107140145","SUP","HCPCS C1713","","H787107140145  -  CATHETER ANGIO ANG KMP CRV 4FR 65CM SFVU RADOPQ SLCT HTORQ","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$15.75 ","$0.00 ","$7.29 ","$0.00 ","$0.00 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"H787107322055","SUP","HCPCS C1887","","H787107322055  -  CATHETER ANGIO OM CRV 5FR 100CM SFVU RADOPQ FLSH HTORQ SHFT","BOTH IP/OP","$35.00 ","$25.90 ","$0.00 ","$35.00 ","$19.01 ","$0.00 ","$7.29 ","$0.00 ","$0.00 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"H965100510","SUP","HCPCS C1887","","H965100510  -  CATHETER GD STRG 7FR 90CM STRL GDR SFTP XF 2X2 RND BRD X","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"H965251850","SUP","Custom 27203010","","H965251850  -  CANNULA PRFSN ANGIOVAC DIL FNL TIP RADOPQ COIL REINF DISP","BOTH IP/OP","$28,750.00 ","$21,275.00 ","$0.00 ","$28,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,750.00 ","$0.00 ","$14,375.00 ","$22,770.00 ","$23,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965251860","SUP","Custom 27203010","","H965251860  -  CANNULA PRFSN 20D ANGIOVAC DIL FNL TIP RADOPQ COIL REINF","BOTH IP/OP","$28,750.00 ","$21,275.00 ","$0.00 ","$28,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28,750.00 ","$0.00 ","$14,375.00 ","$22,770.00 ","$23,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965251870","SUP","Custom 27203010","","H965251870  -  SYSTEM PRFSN ANGIOVAC CRCT PMP HD BBL TRP","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965251880","SUP","Custom 27203010","","H965251880  -  SYSTEM PRFSN ANGIOVAC CRCT BBL TRP","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965251900","SUP","Custom 27203010","","H965251900  -  CANNULA PRFSN ANGIOVAC STRG DIL CRCT BBL TRP COIL REINF DISP","BOTH IP/OP","$32,500.00 ","$24,050.00 ","$0.00 ","$32,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,500.00 ","$0.00 ","$16,250.00 ","$25,740.00 ","$26,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965251910","SUP","Custom 27203010","","H965251910  -  CANNULA PRFSN 20D ANGIOVAC DIL CRCT PMP HD BBL TRP DISP","BOTH IP/OP","$32,500.00 ","$24,050.00 ","$0.00 ","$32,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32,500.00 ","$0.00 ","$16,250.00 ","$25,740.00 ","$26,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965251990","SUP","Custom 27203010","","H965251990  -  SYSTEM PRFSN ANGIOVAC CRCT","BOTH IP/OP","$3,750.00 ","$2,775.00 ","$0.00 ","$3,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,750.00 ","$0.00 ","$1,875.00 ","$2,970.00 ","$3,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965402100","SUP","HCPCS C1877","","H965402100  -  STENT ENDOPRSTH 100CM 12MM 20MM 75CM UNCONSTRAIN FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965402110","SUP","HCPCS C1877","","H965402110  -  STENT ENDOPRSTH 12MM 8FR 40MM 100CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965402120","SUP","HCPCS C2617","","H965402120  -  STENT ENDOPRSTH 100CM 12MM 8FR 60MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965402130","SUP","HCPCS C2617","","H965402130  -  STENT ENDOPRSTH 100CM 12MM 8FR 90MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403100","SUP","HCPCS C1877","","H965403100  -  STENT ENDOPRSTH 100CM 14MM 20MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403110","SUP","HCPCS C1877","","H965403110  -  STENT ENDOPRSTH 100CM 14MM 40MM 75CM UNCONSTRAIN FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403120","SUP","HCPCS C1877","","H965403120  -  STENT ENDOPRSTH 100CM 14MM 9FR 60MM 75CM CATHETER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403130","SUP","HCPCS C1877","","H965403130  -  STENT ENDOPRSTH 100CM 14MM 9FR 90MM 75CM CATHETER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403300","SUP","HCPCS C1877","","H965403300  -  STENT ENDOPRSTH 160CM 16MM 9FR 20MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403310","SUP","HCPCS C1877","","H965403310  -  STENT ENDOPRSTH 100CM 16MM 9FR 40MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403320","SUP","HCPCS C1877","","H965403320  -  STENT ENDOPRSTH 100CM 16MM 9FR 60MM 75CM CATHETER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965403330","SUP","HCPCS C2617","","H965403330  -  STENT ENDOPRSTH 100CM 16MM 9FR 90MM 75CM CATHETER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404110","SUP","HCPCS C1877","","H965404110  -  STENT ENDOPRSTH 100CM 18MM 10FR 40MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404120","SUP","HCPCS C1877","","H965404120  -  STENT ENDOPRSTH 100CM 18MM 10FR 60MM 75CM CATHETER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404130","SUP","HCPCS C1877","","H965404130  -  STENT ENDOPRSTH 100CM 18MM 10FR 90MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404300","SUP","HCPCS C1877","","H965404300  -  STENT ENDOPRSTH 100CM 20MM 10FR 40MM 75CM CATHETER","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404310","SUP","HCPCS C1877","","H965404310  -  STENT ENDOPRSTH 100CM 20MM 10FR 55MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404320","SUP","HCPCS C1877","","H965404320  -  STENT ENDOPRSTH 100CM 20MM 10FR 80MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404500","SUP","HCPCS C1877","","H965404500  -  STENT ENDOPRSTH 100CM 22MM 10FR 35MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404510","SUP","HCPCS C1877","","H965404510  -  STENT ENDOPRSTH 100CM 22MM 10FR 45MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965404520","SUP","HCPCS C1877","","H965404520  -  STENT ENDOPRSTH 100CM 22MM 10FR 70MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965405100","SUP","HCPCS C1877","","H965405100  -  STENT ENDOPRSTH 100CM 24MM 11FR 35MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965405110","SUP","HCPCS C1877","","H965405110  -  STENT ENDOPRSTH 100CM 24MM 12FR 45MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965405120","SUP","HCPCS C1877","","H965405120  -  STENT ENDOPRSTH 100CM 24MM 11FR 70MM 75CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965412000","SUP","HCPCS C1877","","H965412000  -  STENT ENDOPRSTH 160CM 12MM 9FR 20MM 135CM FLEXIBLE DELIVERY","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965412010","SUP","HCPCS C1877","","H965412010  -  STENT ENDOPRSTH 160CM 12MM 8FR 40MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965412020","SUP","HCPCS C1877","","H965412020  -  STENT ENDOPRSTH 160CM 12MM 8FR 60MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965412030","SUP","HCPCS C1877","","H965412030  -  STENT ENDOPRSTH 160CM 12MM 8FR 90MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"H965700150021","SUP","Custom 27203010","","H965700150021  -  STOPCOCK ANGIO 200 PSI NAMIC 3W ROT M COLR RT PORT PRTC","BOTH IP/OP","$2.32 ","$1.72 ","$0.00 ","$2.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.32 ","$0.00 ","$1.16 ","$1.84 ","$1.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965700150151","SUP","Custom 27203010","","H965700150151  -  STOPCOCK ANGIO 200 PSI NAMIC 1 WY ROT M COLR PORT PRTC","BOTH IP/OP","$2.16 ","$1.60 ","$0.00 ","$2.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.16 ","$0.00 ","$1.08 ","$1.58 ","$1.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965914000211","SUP","Custom 27203010","","H965914000211  -  ADAPTER ANGIO 200 PSI 5/16IN 28 THRD ORG Y .1IN STRL NAMIC","BOTH IP/OP","$16.05 ","$11.88 ","$0.00 ","$16.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$16.05 ","$0.00 ","$8.03 ","$12.71 ","$12.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"H965SCH306011","SUP","HCPCS C1769","","H965SCH306011  -  GUIDEWIRE VASCULAR C .035IN 300CM 10CM FLEXIBLE MEIER WIRE","BOTH IP/OP","$391.15 ","$289.45 ","$0.00 ","$391.15 ","$212.39 ","$0.00 ","$81.53 ","$0.00 ","$0.00 ","$68.49 ","$391.15 ","$0.00 ","$195.58 ","$309.79 ","$312.92 ","$0.00 ","$61.21 ","$0.00 ","$62.27 ","$0.00 "
"HARH36","SUP","Custom 27203010","","HARH36  -  SHEARS ESURG CRV 5MM 36CM STRL LF HRMN A +7 ADV HMSTS 3","BOTH IP/OP","$756.33 ","$559.68 ","$0.00 ","$9,211.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$9,211.20 ","$0.00 ","$4,605.60 ","$7,295.27 ","$7,368.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HC0002","SUP","Custom 27203010","","HEMOSTASE MPH 5G 5-PACK","BOTH IP/OP","$669.50 ","$495.43 ","$0.00 ","$669.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$669.50 ","$0.00 ","$334.75 ","$530.24 ","$535.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HC7001GAL","SUP","Custom 27203010","","REAGENT XYLN HSTPRP 1GL SLVT HISTOLGY","BOTH IP/OP","$58.70 ","$43.44 ","$0.00 ","$58.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.70 ","$0.00 ","$29.35 ","$46.49 ","$46.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HCA-5125","SUP","HCPCS C1713","","HCA-5125  -  SCREW BONE 5MM 25MM TI CANC LCK NONSTRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5127","SUP","HCPCS C1713","","HCA-5127  -  SCREW BONE 5MM 27.5MM CANC","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5130","SUP","HCPCS C1713","","HCA-5130  -  SCREW BONE 5MM 30MM TI CANC NONSTRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5132","SUP","HCPCS C1713","","HCA-5132  -  SCREW BONE 5MM 32.5MM TI CANC NONSTRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5135","SUP","HCPCS C1713","","HCA-5135  -  SCREW BN 5MM 35MM NLCKG ORTH","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5137","SUP","HCPCS C1713","","HCA-5137  -  SCREW BONE 5MM 37.5MM PLRS TI CANC HUM LCK NONSTRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5140","SUP","HCPCS C1713","","HCA-5140  -  SCREW BN 5MM 40MM CANC","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5145","SUP","HCPCS C1713","","HCA-5145  -  SCREW BONE 5MM 45MM CANC","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5150","SUP","HCPCS C1713","","HCA-5150  -  SCREW BONE 5MM 50MM TI CANC NONSTRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-5155","SUP","HCPCS C1713","","HCA-5155  -  SCREW BN 5MM 55MM CANC","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5200-S","SUP","HCPCS C1713","","HCA5200-S  -  SCREW BONE 5MM 20MM PLRS TI CANC HUM STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5250-S","SUP","HCPCS C1713","","HCA5250-S  -  SCREW BONE 5MM 25MM PLRS TI CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5275-S","SUP","HCPCS C1713","","HCA5275-S  -  SCREW BONE 5MM 27.5MM PLRS RADL ULN HUM FIB CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5300-S","SUP","HCPCS C1713","","HCA5300-S  -  SCREW BONE 5MM 30MM PLRS TI CANC HUM STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5325-S","SUP","HCPCS C1713","","HCA5325-S  -  SCREW BONE 5MM 32.5MM CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5350-S","SUP","HCPCS C1713","","HCA5350-S  -  SCREW BONE 5MM 35MM PLRS TI CANC HUM LCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5375-S","SUP","HCPCS C1713","","HCA5375-S  -  SCREW BONE 5MM 37.5MM PLRS RADL ULN HUM FIB CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5400-S","SUP","HCPCS C1713","","HCA5400-S  -  SCREW BONE 5MM 40MM PLRS TI CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5425-S","SUP","HCPCS C1713","","HCA5425-S  -  SCREW BONE 5MM 42.5MM PLRS RADL ULN HUM FIB CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5450-S","SUP","HCPCS C1713","","HCA5450-S  -  SCREW BONE 5MM 45MM PLRS TI CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5500-S","SUP","HCPCS C1713","","HCA5500-S  -  SCREW BONE 5MM 50MM PLRS TI CANC STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA5550-S","SUP","HCPCS C1713","","HCA5550-S  -  SCREW BONE 5MM 50MM PLRS TI CANC HUM LCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-L5325-S","SUP","HCPCS C1713","","HCA-L5325-S  -  SCREW BN 5.3MM 25MM STRL PLRS LCK TI CANC HUM","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-L5330-S","SUP","HCPCS C1713","","HCA-L5330-S  -  SCREW BONE 5.3MM 30MM PLRS TI ORTH LCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-L5335-S","SUP","HCPCS C1713","","HCA-L5335-S  -  SCREW BONE 5.3MM 35MM TI CANC LCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-L5340-S","SUP","HCPCS C1713","","HCA-L5340-S  -  SCREW BONE 5.3MM 40MM PLRS TI ORTH LCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCA-L5345-S","SUP","HCPCS C1713","","HCA-L5345-S  -  SCREW BN 5.3MM 45MM STRL LCK TI CANC","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCLP-27100-TS","SUP","HCPCS C1713","","HCLP-27100-TS  -  PEG FX 2.7MM 10MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27120-TS","SUP","HCPCS C1713","","HCLP-27120-TS  -  PEG FX 2.7MM 12MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27140-TS","SUP","HCPCS C1713","","HCLP-27140-TS  -  PEG FX 2.7MM 14MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27160-TS","SUP","HCPCS C1713","","HCLP-27160-TS  -  PEG FIX 2.7MM 16MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"HCLP-27180-TS","SUP","HCPCS C1713","","HCLP-27180-TS  -  PEG FX 2.7MM 18MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27190-TS","SUP","HCPCS C1713","","HCLP-27190-TS  -  PEG FX 2.7MM 19MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27200-TS","SUP","HCPCS C1713","","HCLP-27200-TS  -  PEG FIX 2.7MM 20MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"HCLP-27210-TS","SUP","HCPCS C1713","","HCLP-27210-TS  -  PEG FX 2.7MM 21MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27220-TS","SUP","HCPCS C1713","","HCLP-27220-TS  -  PEG FX 2.7MM 22MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27230-TS","SUP","HCPCS C1713","","HCLP-27230-TS  -  PEG FX 2.7MM 23MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27240-TS","SUP","HCPCS C1713","","HCLP-27240-TS  -  PEG FX 2.7MM 24MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27260-TS","SUP","HCPCS C1713","","HCLP-27260-TS  -  PEG FX 2.7MM 26MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27280-TS","SUP","HCPCS C1713","","HCLP-27280-TS  -  PEG FX 2.7MM 28MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27300-TS","SUP","HCPCS C1713","","HCLP-27300-TS  -  PEG FX 2.7MM 30MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCLP-27320-TS","SUP","HCPCS C1713","","HCLP-27320-TS  -  PEG FX 2.7MM 32MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"HCO-3150-S","SUP","HCPCS C1713","","HCO-3150-S  -  SCREW BONE 3.5MM 15MM CORT","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3175-S","SUP","HCPCS C1713","","HCO3175-S  -  SCREW BONE 3.5MM 17.5MM PLRS TI CORT SHLDR STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3200-S","SUP","HCPCS C1713","","HCO3200-S  -  SCREW BONE 3.5MM 20MM PLRS TI CORT HUM INTLCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3225-S","SUP","HCPCS C1713","","HCO3225-S  -  SCREW BN 3.5MM 22.5MM STRL CORT","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3250-S","SUP","HCPCS C1713","","HCO3250-S  -  SCREW BONE 3.5MM 25MM PLRS TI CORT HUM SHLDR STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3275-S","SUP","HCPCS C1713","","HCO3275-S  -  SCREW BONE 3.5MM 27.5MM PLRS CORT HUM SHLDR STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3300-S","SUP","HCPCS C1713","","HCO3300-S  -  SCREW BONE 3.5MM 30MM PLRS TI CORT HUM INTLCK STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3325-S","SUP","HCPCS C1713","","HCO3325-S  -  SCREW BONE 3.5MM 32.5MM PLRS TI CORT HUM STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3350-S","SUP","HCPCS C1713","","HCO3350-S  -  SCREW BONE 3.5MM 35MM ACUMED TI CORT SHLDR STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3375-S","SUP","HCPCS C1713","","HCO3375-S  -  SCREW BONE 3.5MM 37.5MM TI CORT STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3400-S","SUP","HCPCS C1713","","HCO3400-S  -  SCREW BONE 3.5MM 40MM PLRS TI CORT HUM STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3450-S","SUP","HCPCS C1713","","HCO3450-S  -  SCREW BONE 3.5MM 45MM PLRS TI CORT STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3500-S","SUP","HCPCS C1713","","HCO3500-S  -  SCREW BONE 3.5MM 50MM PLRS TI CORT HUM SHLDR STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO3550-S","SUP","HCPCS C1713","","HCO3550-S  -  SCREW BONE 3.5MM 55MM PLRS TI CORT HUM STRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HCO35WA","SUP","Custom 27803010","","HCO35WA  -  WASHER ORTH 3.5MM NS PLRS TI CORT SCR","BOTH IP/OP","$92.50 ","$68.45 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.50 ","$0.00 ","$46.25 ","$73.26 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HCO3600-S","SUP","HCPCS C1713","","HCO3600-S  -  SCREW BONE 3.5MM 60MM PLRS TI CORT NONSTRL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HD-1500","SUP","Custom 27203010","","HD-1500  -  DRIVER HEX SLD 1.5MM SURG","BOTH IP/OP","$301.88 ","$223.39 ","$0.00 ","$301.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$301.88 ","$0.00 ","$150.94 ","$239.09 ","$241.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-1509","SUP","Custom 27203010","","HD-1509  -  DRIVER CANN HEX ASMBLY 1.5MM SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-2000","SUP","Custom 27203010","","HD-2000  -  DRIVER 2MM SLD SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-2011","SUP","Custom 27203010","","HD-2011  -  DRIVER SRG 2MM HEX CNN","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-2500","SUP","Custom 27203010","","HD-2500  -  DRIVER SURG 2.5MM HEX SLD ASMBLY 2.5MM","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-2515","SUP","Custom 27203010","","HD-2515  -  SCRDRVR 2.5MM CANN HEX 2.5MM SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-2516","SUP","Custom 27203010","","HD-2516  -  DRIVER CANN HEX ASMBLY 2.5MM SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-3016","SUP","Custom 27203010","","HD-3016  -  DRIVER CANN ASMBLY 3MM SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-3500","SUP","Custom 27203010","","HD-3500  -  SCRDRVR SLD ASMBLY 3.5MM SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HD-3725","SUP","Custom 27203010","","HD-3725  -  DRIVER PLRS CANN HDSN FIT 3MM SURG NONSTRL","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HDF-1500","SUP","Custom 27203010","","HDF-1500  -  DRIVER 1.5MM ACTRK FSN SLD 1.5MM SURG MINI SCR","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HDL-2000","SUP","Custom 27203010","","HDL-2000  -  SCREWDRIVER SRG 2MM SLD","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HDL-2500","SUP","Custom 27203010","","HDL-2500  -  SCRDRVR 2.5MM HEX SLD SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HDM-1500","SUP","Custom 27203010","","HDM-1500  -  DRIVER 1.5MM SLD SURG","BOTH IP/OP","$682.50 ","$505.05 ","$0.00 ","$682.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$682.50 ","$0.00 ","$341.25 ","$540.54 ","$546.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL180620-20","SUP","Custom 27803010","","HEL180620-20  -  COIL EMBL HLCL 6MM 20CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS","BOTH IP/OP","$1,268.93 ","$939.01 ","$0.00 ","$1,268.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,268.93 ","$0.00 ","$634.46 ","$1,004.99 ","$1,015.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL180730-20","SUP","Custom 27803010","","HEL180730-20  -  COIL EMBL HLCL 7MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS","BOTH IP/OP","$1,358.30 ","$1,005.14 ","$0.00 ","$1,358.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,358.30 ","$0.00 ","$679.15 ","$1,075.77 ","$1,086.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL180830-20","SUP","Custom 27803010","","HEL180830-20  -  COIL EMBL HLCL 8MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS","BOTH IP/OP","$1,358.30 ","$1,005.14 ","$0.00 ","$1,358.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,358.30 ","$0.00 ","$679.15 ","$1,075.77 ","$1,086.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL18093020","SUP","Custom 27803010","","HEL18093020  -  COIL EMBL HLCL 9MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS","BOTH IP/OP","$1,358.30 ","$1,005.14 ","$0.00 ","$1,358.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,358.30 ","$0.00 ","$679.15 ","$1,075.77 ","$1,086.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL181030-20","SUP","Custom 27803010","","HEL181030-20  -  COIL EMBL HLCL 10MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS","BOTH IP/OP","$1,358.30 ","$1,005.14 ","$0.00 ","$1,358.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,358.30 ","$0.00 ","$679.15 ","$1,075.77 ","$1,086.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL181230-20","SUP","Custom 27803010","","HEL181230-20  -  COIL EMBL 12MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS","BOTH IP/OP","$1,429.78 ","$1,058.04 ","$0.00 ","$1,429.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,429.78 ","$0.00 ","$714.89 ","$1,132.39 ","$1,143.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL181430-20","SUP","Custom 27803010","","HEL181430-20  -  COIL EMBL 14MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS","BOTH IP/OP","$1,429.78 ","$1,058.04 ","$0.00 ","$1,429.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,429.78 ","$0.00 ","$714.89 ","$1,132.39 ","$1,143.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL181630-20","SUP","Custom 27803010","","HEL181630-20  -  COIL EMBL 16MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS","BOTH IP/OP","$1,268.93 ","$939.01 ","$0.00 ","$1,268.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,268.93 ","$0.00 ","$634.46 ","$1,004.99 ","$1,015.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL181830-20","SUP","Custom 27803010","","HEL181830-20  -  COIL EMBL 18MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS","BOTH IP/OP","$1,501.28 ","$1,110.95 ","$0.00 ","$1,501.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,501.28 ","$0.00 ","$750.64 ","$1,189.01 ","$1,201.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEL182030-20","SUP","Custom 27803010","","HEL182030-20  -  COIL EMBL 20MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS","BOTH IP/OP","$1,501.28 ","$1,110.95 ","$0.00 ","$1,501.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,501.28 ","$0.00 ","$750.64 ","$1,189.01 ","$1,201.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HERO 1003","SUP","Custom 27203010","","HERO 1003  -  KIT HEMODIALYSIS 16FR Y 10FR 12FR DELIVERY STYLET DILAT","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HEX2.7-12","SUP","HCPCS C1713","","HEX2.7-12  -  SCREW BN 2.7MM 12MM SS CORT TRIMED CLVCL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX2.7-14","SUP","HCPCS C1713","","HEX2.7-14  -  SCREW BN 2.7MM 14MM SS CORT TRIMED CLVCL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-08","SUP","HCPCS C1713","","HEX3.2-08  -  SCREW BONE 3.2MM 8MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-10","SUP","HCPCS C1713","","HEX3.2-10  -  SCREW BN 3.2MM 10MM HEX CORT ANKL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-11","SUP","HCPCS C1713","","HEX3.2-11  -  SCREW BONE 3.2MM 11MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-12","SUP","HCPCS C1713","","HEX3.2-12  -  SCREW BN 3.2MM 12MM HEX CORT ANKL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-13","SUP","HCPCS C1713","","HEX3.2-13  -  SCREW BN 3.2MM 13MM HEX CORT ANKL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-14","SUP","HCPCS C1713","","HEX3.2-14  -  SCREW BN 3.2MM 14MM HEX CORT ANKL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-15","SUP","HCPCS C1713","","HEX3.2-15  -  SCREW BONE 3.2MM 15MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-16","SUP","HCPCS C1713","","HEX3.2-16  -  SCREW BN 3.2MM 16MM HEX CORT ANKL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-18","SUP","HCPCS C1713","","HEX3.2-18  -  SCREW BN 3.2MM 18MM HEX CORT ANKL FX SYS","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-20","SUP","HCPCS C1713","","HEX3.2-20  -  SCREW BONE 3.2MM 20MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-22","SUP","HCPCS C1713","","HEX3.2-22  -  SCREW BONE 3.2MM 22MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-24","SUP","HCPCS C1713","","HEX3.2-24  -  SCREW BONE 3.2MM 24MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-26","SUP","HCPCS C1713","","HEX3.2-26  -  SCREW BONE 3.2MM 26MM HEXAGONAL HEAD CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-28","SUP","HCPCS C1713","","HEX3.2-28  -  SCREW BONE 3.2MM 28MM HEXAGON CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HEX3.2-30","SUP","HCPCS C1713","","HEX3.2-30  -  SCREW BN 3.2MM 30MM HEX CORT","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"HF0200DSSM","SUP","Custom 27011340","","HF0200DSSM  -  FIBER LSR 270UM HO 1 WL STRL DISP","BOTH IP/OP","$1,074.28 ","$794.97 ","$0.00 ","$1,074.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,074.28 ","$0.00 ","$537.14 ","$850.83 ","$859.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HH0710","SUP","HCPCS C1781","","HH0710  -  MESH SRG 10X7CM GORE BIO-ASNTH REINF TISS HIATAL HRN REPR","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"HIC135","SUP","HCPCS C1729","","EMBOCATHETER INFUSION SEGWAY","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"HLFDBX0270C","SUP","Custom 27203010","","HLFDBX0270C  -  LASER SRG 270MH DISP","BOTH IP/OP","$710.67 ","$525.90 ","$0.00 ","$710.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.67 ","$0.00 ","$355.33 ","$562.85 ","$568.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HLFDBX0400C","SUP","Custom 27203010","","HLFDBX0400C  -  LASER SRG 400MH DISP","BOTH IP/OP","$848.67 ","$628.02 ","$0.00 ","$848.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$848.67 ","$0.00 ","$424.33 ","$672.15 ","$678.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HLFDBX0600C","SUP","Custom 27011340","","HLFDBX0600C  -  FIBER LSR 600UM STRL DUR HO DISP LTHTRP","BOTH IP/OP","$848.67 ","$628.02 ","$0.00 ","$848.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$848.67 ","$0.00 ","$424.33 ","$672.15 ","$678.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HLFDBX1000C","SUP","Custom 27203010","","HLFDBX1000C  -  LASER SURGICAL 1000 MH DISPOSABLE","BOTH IP/OP","$2,193.09 ","$1,622.89 ","$0.00 ","$1,911.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,911.60 ","$0.00 ","$955.80 ","$1,513.99 ","$1,529.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HLS1007M","SUP","HCPCS C1894","","HLS1007M  -  INTRODUCER SHTH 7FR 13CM 20CM SFSHTH HMSTS VLV TRAW SDPRT","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$70.59 ","$0.00 ","$27.10 ","$0.00 ","$0.00 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"HLS10095M","SUP","HCPCS C1894","","HLS10095M  -  INTRODUCER SHEATH 9.5FR 13CM 20CM HEMOSTASIS VALVE TEAR AWAY","BOTH IP/OP","$146.25 ","$108.23 ","$0.00 ","$146.25 ","$79.41 ","$0.00 ","$30.48 ","$0.00 ","$0.00 ","$25.61 ","$146.25 ","$0.00 ","$73.13 ","$115.83 ","$117.00 ","$0.00 ","$22.89 ","$0.00 ","$23.28 ","$0.00 "
"HLS1009M","SUP","HCPCS C1894","","HLS1009M  -  INTRODUCER LEAD 13CM 9FR SFSHTH HMSTS VLV TRAW SDPRT 20CM","BOTH IP/OP","$650.00 ","$481.00 ","$0.00 ","$650.00 ","$352.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.81 ","$650.00 ","$0.00 ","$325.00 ","$514.80 ","$520.00 ","$0.00 ","$101.73 ","$0.00 ","$103.48 ","$0.00 "
"HLS10105M","SUP","HCPCS C1894","","HLS10105M  -  INTRODUCER SHEATH 10.5FR 13CM 20CM HEMOSTASIS VALVE TEAR","BOTH IP/OP","$130.00 ","$96.20 ","$0.00 ","$130.00 ","$70.59 ","$0.00 ","$27.10 ","$0.00 ","$0.00 ","$22.76 ","$130.00 ","$0.00 ","$65.00 ","$102.96 ","$104.00 ","$0.00 ","$20.35 ","$0.00 ","$20.70 ","$0.00 "
"HLS2509M","SUP","HCPCS C1894","","HLS2509M  -  INTRODUCER LEAD LONG 9FR 25CM 31.5CM HEMOSTASIS VALVE TEAR","BOTH IP/OP","$146.00 ","$108.04 ","$0.00 ","$146.00 ","$79.28 ","$0.00 ","$30.43 ","$0.00 ","$0.00 ","$25.56 ","$146.00 ","$0.00 ","$73.00 ","$115.63 ","$116.80 ","$0.00 ","$22.85 ","$0.00 ","$23.24 ","$0.00 "
"HN1200","SUP","HCPCS C1776","","HN1200  -  SLEEVE CENTERING 38.1IN 9MM 12.7IN IMHS CP SET SCR IM HIP","BOTH IP/OP","$831.25 ","$615.13 ","$0.00 ","$831.25 ","$374.06 ","$0.00 ","$173.25 ","$0.00 ","$0.00 ","$145.55 ","$831.25 ","$0.00 ","$415.63 ","$658.35 ","$665.00 ","$0.00 ","$130.09 ","$0.00 ","$132.34 ","$0.00 "
"HN1202","SUP","HCPCS C1713","","HN1202  -  SCREW SET IMHS CENTERING SLV HIP","BOTH IP/OP","$533.75 ","$394.98 ","$0.00 ","$533.75 ","$240.19 ","$0.00 ","$111.25 ","$0.00 ","$0.00 ","$93.46 ","$533.75 ","$0.00 ","$266.88 ","$422.73 ","$427.00 ","$0.00 ","$83.53 ","$0.00 ","$84.97 ","$0.00 "
"HNR4.0-35-70-P-10S-0","SUP","HCPCS C1725","","HNR4.0-35-70-P-10S-0  -  CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN","BOTH IP/OP","$46.88 ","$34.69 ","$0.00 ","$46.88 ","$25.45 ","$0.00 ","$9.77 ","$0.00 ","$0.00 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"HOOK-L4","SUP","HCPCS C1713","","HOOK-L4  -  PLATE BONE 4 HOLE HOOK LEFT ELBOW","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"HOOK-R6","SUP","HCPCS C1713","","HOOK-R6  -  PLATE BONE 6 HOLE HOOK ORTHOPEDIC","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$416.85 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"HP01","SUP","HCPCS C1781","","HP01  -  PLUG SURG BIOABSORBABLE BIO-A HERN REPAIR","BOTH IP/OP","$1,260.00 ","$932.40 ","$0.00 ","$1,260.00 ","$567.00 ","$0.00 ","$262.62 ","$0.00 ","$0.00 ","$220.62 ","$1,260.00 ","$0.00 ","$630.00 ","$997.92 ","$1,008.00 ","$0.00 ","$197.19 ","$0.00 ","$200.59 ","$0.00 "
"HP-2515","SUP","Custom 27203010","","HP-2515  -  DRIVER 2.5MM PWR TIP CANN SURG","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HP3000","SUP","Custom 27203010","","HP3000  -  POSITIONER SRG STRFSH EVO MULTIAPPENDAGE SIL SCT CUP LOPRFL","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HP-3016","SUP","Custom 27203010","","HP-3016  -  DRIVER CANN PWR TIP 3MM SURG OPTN INST","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HPC-0015","SUP","Custom 27203010","","HPC-0015  -  DRIVER 1.5MM SM HEX TIP SHFT 1.5MM SURG STRL DISP","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HPC-0025","SUP","Custom 27203010","","HPC-0025  -  DRIVER 2.5MM QRLSE 2.5MM SURG","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HPC-0035","SUP","Custom 27203010","","HPC-0035  -  DRIVER HEX QRLSE 3.5MM SURG","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HR-0001-S","SUP","HCPCS C1713","","HR-0001-S  -  CAP END ORTH SCR ASMBLY IM NAIL STRL PLRS","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$171.00 ","$0.00 ","$79.20 ","$0.00 ","$0.00 ","$66.53 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$59.47 ","$0.00 ","$60.50 ","$0.00 "
"HR-0024-S","SUP","HCPCS C1713","","HR-0024-S  -  CAP END 4MM STRL PLRS SCR ASMB","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"HR-0028-S","SUP","HCPCS C1713","","HR-0028-S  -  CAP END 8MM STRL PLRS SCR ASMB","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"HR-0050-S","SUP","HCPCS C1713","","HR-0050-S  -  CAP END PLRS SCR ASMB INS DEV","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"HR-0054-S","SUP","HCPCS C1713","","HR-0054-S  -  CAP END 4MM STRL PLRS SCR ASMB","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"HR-0058-S","SUP","HCPCS C1713","","HR-0058-S  -  CAP END 8MM STRL PLRS SCR ASMB","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$340.88 ","$0.00 ","$157.88 ","$0.00 ","$0.00 ","$132.63 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$118.55 ","$0.00 ","$120.59 ","$0.00 "
"HR-0105","SUP","Custom 27203010","","HR-0105  -  BIT DRILL 2.7MM PLRS TAP","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HR-0820-S","SUP","HCPCS C1713","","HR-0820-S  -  ROD ORTH 200MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HR-0822-S","SUP","HCPCS C1713","","HR-0822-S  -  ROD ORTH 220MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HR-0824-S","SUP","HCPCS C1713","","HR-0824-S  -  ROD ORTH 240MM 8MM PLRS PLUS HUM TI IM IMPL STRL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HR-0826-S","SUP","HCPCS C1713","","HR-0826-S  -  ROD ORTH 260MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HR-0828-S","SUP","HCPCS C1713","","HR-0828-S  -  ROD ORTH 280MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HR-3106","SUP","Custom 27203010","","HR-3106  -  DRILL SRG WITNESS HL CLRNC","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HR-3107","SUP","Custom 27203010","","HR-3107  -  TAP SRG 3.5 MM SCR","BOTH IP/OP","$930.00 ","$688.20 ","$0.00 ","$930.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$930.00 ","$0.00 ","$465.00 ","$736.56 ","$744.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HR-4D1055-S","SUP","HCPCS C1713","","HR-4D1055-S  -  ROD XTRNFX 2-4D 5.5MM 150MM STRL 10MM ANT POST","BOTH IP/OP","$3,817.50 ","$2,824.95 ","$0.00 ","$3,817.50 ","$1,717.88 ","$0.00 ","$795.66 ","$0.00 ","$0.00 ","$668.41 ","$3,817.50 ","$0.00 ","$1,908.75 ","$3,023.46 ","$3,054.00 ","$0.00 ","$597.44 ","$0.00 ","$607.75 ","$0.00 "
"HRA-1055-S","SUP","HCPCS C1713","","HRA-1055-S  -  ROD XTRNFX 2-4D STD 5.5MM 150MM STRL 10MM","BOTH IP/OP","$5,422.50 ","$4,012.65 ","$0.00 ","$5,422.50 ","$2,440.13 ","$0.00 ","$1,130.18 ","$0.00 ","$0.00 ","$949.44 ","$5,422.50 ","$0.00 ","$2,711.25 ","$4,294.62 ","$4,338.00 ","$0.00 ","$848.62 ","$0.00 ","$863.26 ","$0.00 "
"HR-D105","SUP","Custom 27203010","","HR-D105  -  BIT DRILL 35MM .109MM PLRS LNG TAP STRL","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HRH-0820-S","SUP","HCPCS C1713","","HRH-0820-S  -  ROD XTRNFX 8MM 200MM STRL PLRS + SPCL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HRH-0822-S","SUP","HCPCS C1713","","HRH-0822-S  -  ROD XTRNFX 8MM 220MM PLRS + HUM PROX","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HRH-0824-S","SUP","HCPCS C1713","","HRH-0824-S  -  ROD XTRNFX 8MM 240MM PLRS + SPCL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HRH-0826-S","SUP","HCPCS C1713","","HRH-0826-S  -  ROD XTRNFX 8MM 260MM STRL PLRS + SPCL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HRH-0828-S","SUP","HCPCS C1713","","HRH-0828-S  -  ROD XTRNFX 8MM 280MM NS PLRS + SPCL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HR-L1115-S","SUP","HCPCS C1713","","HR-L1115-S  -  NAIL 11MM 15CM HUM PLRS IM LCK TI STRL","BOTH IP/OP","$4,107.50 ","$3,039.55 ","$0.00 ","$4,107.50 ","$1,848.38 ","$0.00 ","$856.11 ","$0.00 ","$0.00 ","$719.19 ","$4,107.50 ","$0.00 ","$2,053.75 ","$3,253.14 ","$3,286.00 ","$0.00 ","$642.82 ","$0.00 ","$653.91 ","$0.00 "
"HRSD105","SUP","Custom 27203010","","HRSD105  -  BIT DRILL 2.8MM PLRS SHRT TAP STRL","BOTH IP/OP","$95.00 ","$70.30 ","$0.00 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$95.00 ","$0.00 ","$47.50 ","$75.24 ","$76.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HR-WC50-S","SUP","Custom 27203010","","HR-WC50-S  -  WASHER XTRNFX 5MM STRL CIRC CLEATED FIB","BOTH IP/OP","$132.50 ","$98.05 ","$0.00 ","$132.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$132.50 ","$0.00 ","$66.25 ","$104.94 ","$106.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HS007","SUP","Custom 27011340","","HS007  -  SPRT ORTH HALO SSTRC TLSO 14","BOTH IP/OP","$1,860.55 ","$1,376.81 ","$0.00 ","$1,860.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,860.55 ","$0.00 ","$930.28 ","$1,473.56 ","$1,488.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HS765-010","SUP","HCPCS C1713","","SPACER MDI OPTHLR HLD CHMBR HNDHLD","BOTH IP/OP","$13.30 ","$9.84 ","$0.00 ","$13.30 ","$5.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.33 ","$13.30 ","$0.00 ","$6.65 ","$10.53 ","$10.64 ","$0.00 ","$2.08 ","$0.00 ","$2.12 ","$0.00 "
"HS80010-010","SUP","HCPCS C1713","","SPACER MDI OPTCH ADV VLV HLD CHMBR HNDHLD RPD BRTHG ALRM WO","BOTH IP/OP","$8.55 ","$6.33 ","$0.00 ","$8.55 ","$3.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.50 ","$8.55 ","$0.00 ","$4.28 ","$6.77 ","$6.84 ","$0.00 ","$1.34 ","$0.00 ","$1.36 ","$0.00 "
"HSK-3038","SUP","Custom 27203010","","HSK-3038  -  SYSTEM PROX SL 3.8MM HRTSTR III DLV DEV LDR AOR CTR","BOTH IP/OP","$1,650.00 ","$1,221.00 ","$0.00 ","$1,650.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,650.00 ","$0.00 ","$825.00 ","$1,306.80 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT036","SUP","Custom 27011340","","HT036  -  HALTER TRC LG HLCRWN VST XTRNFXTR ADLT HDNK","BOTH IP/OP","$1,492.50 ","$1,104.45 ","$0.00 ","$1,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,492.50 ","$0.00 ","$746.25 ","$1,182.06 ","$1,194.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT036HI","SUP","Custom 27011340","","HT036HI  -  SET HLCRWN PIN LG SKL TRC","BOTH IP/OP","$1,492.50 ","$1,104.45 ","$0.00 ","$1,492.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,492.50 ","$0.00 ","$746.25 ","$1,182.06 ","$1,194.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT064050A","SUP","HCPCS C1768","","HT064050A  -  GRAFT VASCULAR THIN WALL 6MM 50CM 40CM REMOVABLE RING","BOTH IP/OP","$4,527.50 ","$3,350.35 ","$0.00 ","$4,527.50 ","$2,037.38 ","$0.00 ","$943.64 ","$0.00 ","$0.00 ","$792.73 ","$4,527.50 ","$0.00 ","$2,263.75 ","$3,585.78 ","$3,622.00 ","$0.00 ","$708.55 ","$0.00 ","$720.78 ","$0.00 "
"HT067090A","SUP","HCPCS C1768","","HT067090A  -  GRAFT VASCULAR THIN WALL 6MM 90CM 70CM REMOVABLE RING","BOTH IP/OP","$7,437.50 ","$5,503.75 ","$0.00 ","$7,437.50 ","$3,346.88 ","$0.00 ","$1,550.16 ","$0.00 ","$0.00 ","$1,302.25 ","$7,437.50 ","$0.00 ","$3,718.75 ","$5,890.50 ","$5,950.00 ","$0.00 ","$1,163.97 ","$0.00 ","$1,184.05 ","$0.00 "
"HT084050A","SUP","HCPCS C1768","","HT084050A  -  GRAFT VASCULAR THIN WALL 8MM 50CM 40CM REMOVABLE RING","BOTH IP/OP","$4,527.50 ","$3,350.35 ","$0.00 ","$4,527.50 ","$2,037.38 ","$0.00 ","$943.64 ","$0.00 ","$0.00 ","$792.73 ","$4,527.50 ","$0.00 ","$2,263.75 ","$3,585.78 ","$3,622.00 ","$0.00 ","$708.55 ","$0.00 ","$720.78 ","$0.00 "
"HT087090A","SUP","HCPCS C1768","","HT087090A  -  GRAFT VASCULAR THINWALL 8MM 90CM 70CM REMOVABLE RING STRETCH","BOTH IP/OP","$7,437.50 ","$5,503.75 ","$0.00 ","$7,437.50 ","$3,346.88 ","$0.00 ","$1,550.16 ","$0.00 ","$0.00 ","$1,302.25 ","$7,437.50 ","$0.00 ","$3,718.75 ","$5,890.50 ","$5,950.00 ","$0.00 ","$1,163.97 ","$0.00 ","$1,184.05 ","$0.00 "
"HT-0915","SUP","Custom 27203010","","HT-0915  -  DRIVER SRG 1.5MM HEX","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT-1120","SUP","Custom 27203010","","HT-1120  -  DRIVER SRG 2MM HEX","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT-1725","SUP","Custom 27203010","","HT-1725  -  DRIVER SRG 2.5MM HEX","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT-2502","SUP","Custom 27203010","","HT-2502  -  TIP SCRDRVR 6IN 2.5MM QRLSE SLD","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT-3010","SUP","HCPCS C1713","","HT-3010  -  SCREW BN ACUTRAC DRVR CNN TIP","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$211.50 ","$0.00 ","$97.96 ","$0.00 ","$0.00 ","$82.29 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$73.56 ","$0.00 ","$74.82 ","$0.00 "
"HT-3012","SUP","Custom 27203010","","HT-3012  -  TIP SCRDRVR 3MM QRLSE SLD HEX","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT-4000","SUP","Custom 27203010","","HT-4000  -  DRIVER SRG 4MM CNN","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HT-4001","SUP","Custom 27203010","","HT-4001  -  TIP SCRDRVR 4MM SLD HEX","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"HW-0034","SUP","HCPCS C1713","","HW-0034  -  SCREW BN .25IN 8-32IN DRL HNDL SET","BOTH IP/OP","$2.50 ","$1.85 ","$0.00 ","$2.50 ","$1.13 ","$0.00 ","$0.52 ","$0.00 ","$0.00 ","$0.44 ","$2.50 ","$0.00 ","$1.25 ","$1.98 ","$2.00 ","$0.00 ","$0.39 ","$0.00 ","$0.40 ","$0.00 "
"I20","SUP","Custom 27203010","","SENSOR INF OXSNR 2 OXM ADH","BOTH IP/OP","$30.80 ","$22.79 ","$0.00 ","$30.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.80 ","$0.00 ","$15.40 ","$24.39 ","$24.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"I20-13/C70F","SUP","Custom 27803010","","I20-13/C70F  -  GRAFT STNT STRG 20-13MM 17FR 70MM AFX ACTIVESEAL STRATA SLF","BOTH IP/OP","$8,237.50 ","$6,095.75 ","$0.00 ","$8,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,237.50 ","$0.00 ","$4,118.75 ","$6,524.10 ","$6,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"I20-13/C88F","SUP","Custom 27803010","","I20-13/C88F  -  GRAFT STNT STRG 20-13MM 17FR 88MM AFX ACTIVESEAL STRATA SLF","BOTH IP/OP","$8,187.50 ","$6,058.75 ","$0.00 ","$8,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,187.50 ","$0.00 ","$4,093.75 ","$6,484.50 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"I20-13/C88F SA","SUP","Custom 27803010","","I20-13/C88F SA  -  GRAFT STNT 20-13MM 88MM STRL LF AFX STRATA ILC LMB AAA","BOTH IP/OP","$8,187.50 ","$6,058.75 ","$0.00 ","$8,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,187.50 ","$0.00 ","$4,093.75 ","$6,484.50 ","$6,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"I20-20/C55F","SUP","Custom 27803010","","I20-20/C55F  -  GRAFT STNT STRG 20MM 17FR 55MM AFX ACTIVESEAL STRATA SLF","BOTH IP/OP","$6,700.00 ","$4,958.00 ","$0.00 ","$6,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,700.00 ","$0.00 ","$3,350.00 ","$5,306.40 ","$5,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IAB05830-LWS","SUP","HCPCS C1714","","IAB05830-LWS  -  CATH IAB .025IN 8FR 25.3IN 6IN GWIRE NYL PU CARDIOTHANE 2","BOTH IP/OP","$3,451.70 ","$2,554.26 ","$0.00 ","$3,451.70 ","$1,874.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$604.37 ","$3,451.70 ","$0.00 ","$1,725.85 ","$2,733.75 ","$2,761.36 ","$0.00 ","$540.19 ","$0.00 ","$549.51 ","$0.00 "
"IAB-05830-LWS","SUP","Custom 27203010","","CATHETER IAB 8FR FIBEROPTIX 30ML LF","BOTH IP/OP","$2,560.00 ","$1,894.40 ","$0.00 ","$2,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,560.00 ","$0.00 ","$1,280.00 ","$2,027.52 ","$2,048.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IAB-05840-LWS","SUP","HCPCS C1714","","IAB-05840-LWS  -  CATH IAB .025IN 8FR 27.3IN 6IN GWIRE NYL PU CARDIOTHANE 2","BOTH IP/OP","$3,451.70 ","$2,554.26 ","$0.00 ","$3,451.70 ","$1,874.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$604.37 ","$3,451.70 ","$0.00 ","$1,725.85 ","$2,733.75 ","$2,761.36 ","$0.00 ","$540.19 ","$0.00 ","$549.51 ","$0.00 "
"IAB-06830-LWS","SUP","HCPCS C1725","","CATHETER IAB 7.5FR FIBEROPTIX FLXB 30ML LF","BOTH IP/OP","$2,087.50 ","$1,544.75 ","$0.00 ","$2,087.50 ","$1,133.51 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.50 ","$2,087.50 ","$0.00 ","$1,043.75 ","$1,653.30 ","$1,670.00 ","$0.00 ","$326.69 ","$0.00 ","$332.33 ","$0.00 "
"IAS5-120LP","SUP","Custom 27203010","","IAS5-120LP  -  PORT ACC 5MM 120MM AIRSEAL 2 WL CNN LOPRFL OBT BLDLS OPTC","BOTH IP/OP","$291.67 ","$215.84 ","$0.00 ","$291.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$291.67 ","$0.00 ","$145.83 ","$231.00 ","$233.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IBI-85641","SUP","Custom 27203010","","IBI-85641  -  CABLE CATH 8FT STRL LF REUSE","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IBI-85931","SUP","Custom 27203010","","IBI-85931  -  CABLE CATH 150CM INQ 24 PIN CNCT DX","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IBI-87008","SUP","HCPCS C1731","","IBI-87008  -  CATHETER EP 4MM SPC 7FR 20MM 110CM INQ AFOCUS II 20 ELTRD MP","BOTH IP/OP","$3,800.00 ","$2,812.00 ","$0.00 ","$3,800.00 ","$2,063.40 ","$0.00 ","$792.02 ","$0.00 ","$0.00 ","$665.35 ","$3,800.00 ","$0.00 ","$1,900.00 ","$3,009.60 ","$3,040.00 ","$0.00 ","$594.70 ","$0.00 ","$604.96 ","$0.00 "
"ICV1102","SUP","HCPCS C1785","","ICV1102  -  PACEMAKER CRD REPLY 2 CHMBR","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"ICV1102 SYSTEM","SUP","HCPCS C1785","","ICV1102 SYSTEM  -  REPLY DR V2  SYSTEM","BOTH IP/OP","$12,500.00 ","$9,250.00 ","$0.00 ","$12,500.00 ","$5,625.00 ","$0.00 ","$2,605.31 ","$0.00 ","$0.00 ","$2,188.65 ","$12,500.00 ","$0.00 ","$6,250.00 ","$9,900.00 ","$10,000.00 ","$0.00 ","$1,956.25 ","$0.00 ","$1,990.00 ","$0.00 "
"ICV1116","SUP","HCPCS C1786","","ICV1116  -  PACEMAKER CRD ESPRT DR","BOTH IP/OP","$9,125.00 ","$6,752.50 ","$0.00 ","$9,125.00 ","$0.00 ","$0.00 ","$1,901.88 ","$0.00 ","$0.00 ","$0.00 ","$9,125.00 ","$0.00 ","$4,562.50 ","$7,227.00 ","$7,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ICV1116 SYSTEM","SUP","HCPCS C1785","","ICV1116 SYSTEM  -  ESPRIT DR SYSTEM","BOTH IP/OP","$11,610.00 ","$8,591.40 ","$0.00 ","$11,610.00 ","$5,224.50 ","$0.00 ","$2,419.81 ","$0.00 ","$0.00 ","$2,032.82 ","$11,610.00 ","$0.00 ","$5,805.00 ","$9,195.12 ","$9,288.00 ","$0.00 ","$1,816.97 ","$0.00 ","$1,848.31 ","$0.00 "
"ICV1122","SUP","HCPCS C1786","","ICV1122  -  PACEMAKER CRD REPLY 1 CHMBR","BOTH IP/OP","$8,250.00 ","$6,105.00 ","$0.00 ","$8,250.00 ","$0.00 ","$0.00 ","$1,719.51 ","$0.00 ","$0.00 ","$0.00 ","$8,250.00 ","$0.00 ","$4,125.00 ","$6,534.00 ","$6,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ICV1122 SYSTEM","SUP","HCPCS C1786","","ICV1122 SYSTEM  -  REPLY SR V2 SYSTEM","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,500.00 ","$0.00 ","$0.00 ","$1,980.04 ","$0.00 ","$0.00 ","$0.00 ","$9,500.00 ","$0.00 ","$4,750.00 ","$7,524.00 ","$7,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ICV1127","SUP","HCPCS C1786","","ICV1127  -  PACEMAKER CRD ESPRT SR","BOTH IP/OP","$6,962.50 ","$5,152.25 ","$0.00 ","$6,962.50 ","$0.00 ","$0.00 ","$1,451.16 ","$0.00 ","$0.00 ","$0.00 ","$6,962.50 ","$0.00 ","$3,481.25 ","$5,514.30 ","$5,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ICV1127 SYSTEM","SUP","HCPCS C1786","","ICV1127 SYSTEM  -  ESPRIT SR SYSTEM","BOTH IP/OP","$8,205.00 ","$6,071.70 ","$0.00 ","$8,205.00 ","$0.00 ","$0.00 ","$1,710.13 ","$0.00 ","$0.00 ","$0.00 ","$8,205.00 ","$0.00 ","$4,102.50 ","$6,498.36 ","$6,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ICV1179","SUP","HCPCS C1882","","ICV1179  -  DEFIBRILLATOR CRD PARADYM CRT ICD","BOTH IP/OP","$44,412.50 ","$32,865.25 ","$0.00 ","$44,412.50 ","$19,985.63 ","$0.00 ","$9,256.68 ","$0.00 ","$0.00 ","$7,776.27 ","$44,412.50 ","$0.00 ","$22,206.25 ","$35,174.70 ","$35,530.00 ","$0.00 ","$6,950.56 ","$0.00 ","$7,070.47 ","$0.00 "
"ICV1179 SYSTEM","SUP","HCPCS C1882","","ICV1179 SYSTEM  -  PARADYM CRT-D 8750 SYSTEM","BOTH IP/OP","$58,187.50 ","$43,058.75 ","$0.00 ","$58,187.50 ","$26,184.38 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$58,187.50 ","$0.00 ","$29,093.75 ","$46,084.50 ","$46,550.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"ICV1199","SUP","HCPCS C1722","","ICV1199  -  DEFIBRILLATOR CRD PARADYM VR ICD","BOTH IP/OP","$36,575.00 ","$27,065.50 ","$0.00 ","$36,575.00 ","$16,458.75 ","$0.00 ","$7,623.14 ","$0.00 ","$0.00 ","$6,403.99 ","$36,575.00 ","$0.00 ","$18,287.50 ","$28,967.40 ","$29,260.00 ","$0.00 ","$5,723.99 ","$0.00 ","$5,822.74 ","$0.00 "
"ICV1200","SUP","HCPCS C1721","","ICV1200  -  DEFIBRILLATOR CRD PARADYM DR ICD","BOTH IP/OP","$42,512.50 ","$31,459.25 ","$0.00 ","$42,512.50 ","$19,130.63 ","$0.00 ","$8,860.67 ","$0.00 ","$0.00 ","$7,443.60 ","$42,512.50 ","$0.00 ","$21,256.25 ","$33,669.90 ","$34,010.00 ","$0.00 ","$6,653.21 ","$0.00 ","$6,767.99 ","$0.00 "
"ICV1258","SUP","HCPCS C1785","","ICV1258  -  REPLY DR","BOTH IP/OP","$9,125.00 ","$6,752.50 ","$0.00 ","$9,125.00 ","$4,106.25 ","$0.00 ","$1,901.88 ","$0.00 ","$0.00 ","$1,597.71 ","$9,125.00 ","$0.00 ","$4,562.50 ","$7,227.00 ","$7,300.00 ","$0.00 ","$1,428.06 ","$0.00 ","$1,452.70 ","$0.00 "
"ICV1258 SYSTEM","SUP","HCPCS C1785","","ICV1258 SYSTEM  -  REPLY DR SYSTEM","BOTH IP/OP","$11,610.00 ","$8,591.40 ","$0.00 ","$11,610.00 ","$5,224.50 ","$0.00 ","$2,419.81 ","$0.00 ","$0.00 ","$2,032.82 ","$11,610.00 ","$0.00 ","$5,805.00 ","$9,195.12 ","$9,288.00 ","$0.00 ","$1,816.97 ","$0.00 ","$1,848.31 ","$0.00 "
"ID-1-5","SUP","Custom 27203010","","ID-1-5  -  ACTU PNEUM LRS AXIUM 3D DTCH HLCL","BOTH IP/OP","$57.75 ","$42.74 ","$0.00 ","$134.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$134.50 ","$0.00 ","$67.25 ","$106.52 ","$107.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ID3305","SUP","Custom 27803010","","ID3305  -  GRAFT SOFT TISSUE 3X3IN PATCH RESORB SUTURABLE DURAGEN","BOTH IP/OP","$2,068.76 ","$1,530.88 ","$0.00 ","$2,255.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,255.70 ","$0.00 ","$1,127.85 ","$1,786.51 ","$1,804.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IJ27U","SUP","HCPCS C1898","","IJ27U  -  LEAD PACING 58CM ACTIVE FIX ISOLINE","BOTH IP/OP","$10,000.00 ","$7,400.00 ","$0.00 ","$10,000.00 ","$4,500.00 ","$0.00 ","$2,084.25 ","$0.00 ","$0.00 ","$1,750.92 ","$10,000.00 ","$0.00 ","$5,000.00 ","$7,920.00 ","$8,000.00 ","$0.00 ","$1,565.00 ","$0.00 ","$1,592.00 ","$0.00 "
"IM3ST","SUP","Custom 27803010","","IM3ST  -  BRAIN TISSUE MONITERING KIT","BOTH IP/OP","$3,115.00 ","$2,305.10 ","$0.00 ","$3,115.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.00 ","$0.00 ","$1,557.50 ","$2,467.08 ","$2,492.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"INS5010","SUP","HCPCS C1729","","INS5010  -  CATHETER DRN 1.5MM .7MM 80CM STRL LF HRMTC TUO CLS TIP LL","BOTH IP/OP","$635.93 ","$470.59 ","$0.00 ","$568.05 ","$308.45 ","$0.00 ","$132.54 ","$0.00 ","$0.00 ","$99.46 ","$568.05 ","$0.00 ","$284.03 ","$449.90 ","$454.44 ","$0.00 ","$88.90 ","$0.00 ","$90.43 ","$0.00 "
"INS8401","SUP","Custom 27803010","","INS8401  -  SYSTEM DRN 35CM 700ML BLU STRL LF BE2 MNTR TRNDCR ATCH VNTRC","BOTH IP/OP","$763.85 ","$565.25 ","$0.00 ","$980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$980.00 ","$0.00 ","$490.00 ","$776.16 ","$784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"INS-8420","SUP","Custom 27803010","","INS-8420  -  KIT XTRN DRN 1.9MM VNTRC","BOTH IP/OP","$361.25 ","$267.33 ","$0.00 ","$361.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.25 ","$0.00 ","$180.63 ","$286.11 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"INS8700","SUP","Custom 27011340","","INS8700  -  BAG XTRN DRN 700ML EDS 3 CSF CLT","BOTH IP/OP","$824.38 ","$610.04 ","$0.00 ","$787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$787.50 ","$0.00 ","$393.75 ","$623.70 ","$630.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"INSHITHRZN","SUP","Custom 27803010","","INSHITHRZN  -  KIT CRNTMY 25GA 5/8IN STRL RZR NDL DRP","BOTH IP/OP","$700.60 ","$518.44 ","$0.00 ","$700.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$700.60 ","$0.00 ","$350.30 ","$554.88 ","$560.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"INT-105-19","SUP","HCPCS C1894","","INT-105-19  -  INTRODUCER SHTH 16FR 15CM PTFE","BOTH IP/OP","$52.50 ","$38.85 ","$0.00 ","$52.50 ","$28.51 ","$0.00 ","$10.94 ","$0.00 ","$0.00 ","$9.19 ","$52.50 ","$0.00 ","$26.25 ","$41.58 ","$42.00 ","$0.00 ","$8.22 ","$0.00 ","$8.36 ","$0.00 "
"INT-105-45","SUP","HCPCS C1894","","INT-105-45  -  INTRODUCER TEAR AWAY 120F X 30CM","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$26.05 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"INT22508UX","SUP","HCPCS C1876","","STENT METAL BARE INT22508UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT22512UX","SUP","HCPCS C1876","","INT22512UX  -  SYSTEM COR STNT 2.25MM 12MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT22514UX","SUP","HCPCS C1876","","STENT METAL BARE INT22514UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT22518UX","SUP","HCPCS C1876","","STENT METAL BARE INT22518UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT22522UX","SUP","HCPCS C1874","","INT22522UX  -  SYSTEM COR STNT 2.25MM 22MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT22526UX","SUP","HCPCS C1874","","INT22526UX  -  SYSTEM COR STNT 2.25MM 26MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"INT25008UX","SUP","HCPCS C1877","","INT25008UX  -  SYSTEM COR STNT 2.5MM 8MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT25012UX","SUP","HCPCS C1874","","INT25012UX  -  SYSTEM COR STNT 2.5MM 12MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT25014UX","SUP","HCPCS C1874","","INT25014UX  -  SYSTEM COR STNT 2.5MM 14MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT25018UX","SUP","HCPCS C1876","","STENT METAL BARE INT25018UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT25022UX","SUP","HCPCS C1874","","INT25022UX  -  SYSTEM COR STNT 2.5MM 22MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"INT25026UX","SUP","HCPCS C1874","","INT25026UX  -  SYSTEM COR STNT 2.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT27508UX","SUP","HCPCS C1874","","INT27508UX  -  SYSTEM COR STNT 2.75MM 8MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT27512UX","SUP","HCPCS C1874","","INT27512UX  -  SYSTEM COR STNT 2.75MM 12MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT27514UX","SUP","HCPCS C1874","","INT27514UX  -  SYSTEM COR STNT 2.75MM 14MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT27518UX","SUP","HCPCS C1874","","INT27518UX  -  SYSTEM COR STNT 2.75MM 18MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"INT27526UX","SUP","HCPCS C1876","","INT27526UX  -  STENT CORON 2.75MM 26MM 1 STRN RAPEX SINUSOID OPTM","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT30009UX","SUP","HCPCS C1876","","INT30009UX  -  SYSTEM COR STNT 3MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT30012UX","SUP","HCPCS C1874","","INT30012UX  -  SYSTEM COR STNT 3MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT30018UX","SUP","HCPCS C1874","","INT30018UX  -  SYSTEM COR STNT 3MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT30022UX","SUP","HCPCS C1874","","INT30022UX  -  SYSTEM COR STNT 3MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT30026UX","SUP","HCPCS C1874","","INT30026UX  -  SYSTEM COR STNT 3MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$338.69 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"INT30030UX","SUP","HCPCS C1876","","STENT METAL BARE INT30030UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT35009UX","SUP","HCPCS C1876","","STENT METAL BARE INT35009UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT35012UX","SUP","HCPCS C1876","","STENT METAL BARE INT35012UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT35015UX","SUP","HCPCS C1876","","STENT METAL BARE INT35015UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT35018UX","SUP","HCPCS C1876","","STENT METAL BARE INT35018UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT35022UX","SUP","HCPCS C1876","","STENT METAL BARE INT35022UX","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.18 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$313.00 ","$0.00 ","$318.40 ","$0.00 "
"INT35026UX","SUP","HCPCS C1874","","INT35026UX  -  SYSTEM COR STNT 3.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT35030UX","SUP","HCPCS C1874","","INT35030UX  -  SYSTEM COR STNT 3.5MM 30MM INTGR MICROTRAC RX 1 STRN INTGR","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40009UX","SUP","HCPCS C1874","","INT40009UX  -  SYSTEM COR STNT 4MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40012UX","SUP","HCPCS C1876","","INT40012UX  -  SYSTEM COR STNT 4MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40015UX","SUP","HCPCS C1874","","INT40015UX  -  SYSTEM COR STNT 4MM 15MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40018UX","SUP","HCPCS C1874","","INT40018UX  -  SYSTEM COR STNT 4MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40022UX","SUP","HCPCS C1874","","INT40022UX  -  SYSTEM COR STNT 4MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40026UX","SUP","HCPCS C1874","","INT40026UX  -  SYSTEM COR STNT 4MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"INT40030UX","SUP","HCPCS C1874","","INT40030UX  -  SYSTEM COR STNT 4MM 30MM INTGR MICROTRAC RX 1 STRN INTGR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$787.50 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"IPC-5000E","SUP","Custom 27203010","","IPC-5000E  -  CATHETER PRESSURE 3.5MM 5MM 82CM 2CM SENSOR TIP EXTERNAL","BOTH IP/OP","$56.88 ","$42.09 ","$0.00 ","$57.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.73 ","$0.00 ","$28.86 ","$45.72 ","$46.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRC115","SUP","Custom 27203010","","IRC115  -  CONSOLE LEGEND EHS IRRIGATION","BOTH IP/OP","$4,710.00 ","$3,485.40 ","$0.00 ","$4,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,710.00 ","$0.00 ","$2,355.00 ","$3,730.32 ","$3,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRC230","SUP","Custom 27203010","","IRC230  -  CONSOLE LEGEND IRRIGATION EHS EU","BOTH IP/OP","$4,710.00 ","$3,485.40 ","$0.00 ","$4,710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,710.00 ","$0.00 ","$2,355.00 ","$3,730.32 ","$3,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRC400","SUP","Custom 27203010","","IRC400  -  CABLE SIGNAL IRRIGATION SYSTEM","BOTH IP/OP","$254.00 ","$187.96 ","$0.00 ","$254.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$254.00 ","$0.00 ","$127.00 ","$201.17 ","$203.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRC500","SUP","Custom 27203010","","IRC500  -  IV POLE IRC500  EHS IRRIGATION SYSTEM","BOTH IP/OP","$218.00 ","$161.32 ","$0.00 ","$218.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$218.00 ","$0.00 ","$109.00 ","$172.66 ","$174.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRD200","SUP","Custom 27203010","","IRD200  -  DISPOSABLE IRD200 IRRIGATION CONTROL","BOTH IP/OP","$162.00 ","$119.88 ","$0.00 ","$162.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.00 ","$0.00 ","$81.00 ","$128.30 ","$129.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRD250","SUP","Custom 27203010","","IRD250  -  DISPOSABLE IRD250 IRRIGATION TUBING SET","BOTH IP/OP","$200.00 ","$148.00 ","$0.00 ","$200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.00 ","$0.00 ","$100.00 ","$158.40 ","$160.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRD300","SUP","Custom 27203010","","IRD300  -  TUBING IRRIGATION MIDAS REX LEGEND EHS DISPOSABLE","BOTH IP/OP","$196.40 ","$145.34 ","$0.00 ","$196.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.40 ","$0.00 ","$98.20 ","$155.55 ","$157.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IRD350","SUP","Custom 27203010","","IRD350  -  TUBING IRRIGATION BURR TRANSNASAL","BOTH IP/OP","$322.00 ","$238.28 ","$0.00 ","$322.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$322.00 ","$0.00 ","$161.00 ","$255.02 ","$257.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"IST2","SUP","Custom 27203010","","IST2  -  INDIGO SYSTEM, ASPIRATION TUBING","BOTH IP/OP","$912.50 ","$675.25 ","$0.00 ","$912.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J3053-20","SUP","Custom 27203010","","INDICATOR ANAER GSPK DISP","BOTH IP/OP","$90.98 ","$67.33 ","$0.00 ","$90.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.98 ","$0.00 ","$45.49 ","$72.06 ","$72.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J3053-21","SUP","Custom 27203010","","INDICATOR ANAER DRY STRP GSPK","BOTH IP/OP","$107.10 ","$79.25 ","$0.00 ","$107.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.10 ","$0.00 ","$53.55 ","$84.82 ","$85.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J408G","SUP","Custom 27203010","","J408G  -  SUTURE VCL 8-0 5-130-4 9IN BRAID COAT VIOL ABS","BOTH IP/OP","$48.93 ","$36.21 ","$0.00 ","$48.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.93 ","$0.00 ","$24.47 ","$38.75 ","$39.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J494H","SUP","Custom 27203010","","J494H  -  SUTURE ABSORBABLE 4-0 P-3 18IN BRAID COATED VICRYL MULTIPASS","BOTH IP/OP","$411.38 ","$304.42 ","$0.00 ","$417.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$417.55 ","$0.00 ","$208.77 ","$330.70 ","$334.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J546G","SUP","Custom 27203010","","J546G  -  SUTURE ABS 7-0 TG140-8 18IN VIOL VC MCRPT 2 ARM BRD COAT","BOTH IP/OP","$35.56 ","$26.31 ","$0.00 ","$36.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.09 ","$0.00 ","$18.05 ","$28.58 ","$28.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J548G","SUP","Custom 27203010","","J548G  -  SUTURE ABSORBABLE 8-0 TG140-8 12IN 2 ARM BRAID COATED VICRYL","BOTH IP/OP","$36.05 ","$26.68 ","$0.00 ","$36.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.59 ","$0.00 ","$18.30 ","$28.98 ","$29.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J555G","SUP","Custom 27203010","","J555G  -  SUTURE ABS 6-0 S-29 18IN VIOL VC SBRLC 2 ARM BRD COAT","BOTH IP/OP","$37.20 ","$27.53 ","$0.00 ","$37.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.76 ","$0.00 ","$18.88 ","$29.91 ","$30.21 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J570G","SUP","Custom 27203010","","J570G  -  SUTURE ABSORBABLE 6-0 S-14 18IN 2 ARM BRAID COATED VICRYL","BOTH IP/OP","$37.29 ","$27.59 ","$0.00 ","$37.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.85 ","$0.00 ","$18.92 ","$29.98 ","$30.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J6054-0610","SUP","HCPCS C1776","","J6054-0610  -  SYSTEM THR SCRFT+ 6-10","BOTH IP/OP","$7,204.00 ","$5,330.96 ","$0.00 ","$7,204.00 ","$3,241.80 ","$0.00 ","$1,501.49 ","$0.00 ","$0.00 ","$1,261.36 ","$7,204.00 ","$0.00 ","$3,602.00 ","$5,705.57 ","$5,763.20 ","$0.00 ","$1,127.43 ","$0.00 ","$1,146.88 ","$0.00 "
"J6054-0711","SUP","HCPCS C1776","","J6054-0711  -  STEM FEM 130MM 11MM PRIM SECFIT PLUS HYDRXAPT 7 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-0713","SUP","HCPCS C1776","","J6054-0713  -  STEM FEM 130MM 13MM PRIM SECFIT PLUS HYDRXAPT 7 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-0812","SUP","HCPCS C1776","","J6054-0812  -  STEM FEM 130MM 12MM PRIM SECFIT PLUS HYDRXAPT 8 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-0814","SUP","HCPCS C1776","","J6054-0814  -  STEM FEM 130MM 14MM PRIM SECFIT PLUS HYDRXAPT 8 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-0913","SUP","HCPCS C1776","","J6054-0913  -  STEM FEM 130MM 13MM PRIM SECFIT PLUS HYDRXAPT 9 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-0915","SUP","HCPCS C1776","","J6054-0915  -  STEM FEM 130MM 15MM PRIM SECFIT PLUS HYDRXAPT 9 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-1014","SUP","HCPCS C1776","","J6054-1014  -  STEM FEM 130MM 14MM PRIM SECFIT PLUS HYDRXAPT 10 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-1016","SUP","HCPCS C1776","","J6054-1016  -  STEM FEM 130MM 16MM PRIM SECFIT PLUS HYDRXAPT 10 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-1115","SUP","HCPCS C1776","","J6054-1115  -  STEM FEM 170MM 15MM PRIM SECFIT PLUS HYDRXAPT 11 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-1117","SUP","HCPCS C1776","","J6054-1117  -  STEM FEM 170MM 17MM PRIM SECFIT PLUS HYDRXAPT 11 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J6054-1216","SUP","HCPCS C1776","","J6054-1216  -  STEM FEM 170MM 16MM PRIM SECFIT PLUS HYDRXAPT 12 HIP","BOTH IP/OP","$6,865.00 ","$5,080.10 ","$0.00 ","$6,865.00 ","$3,089.25 ","$0.00 ","$1,430.84 ","$0.00 ","$0.00 ","$1,202.01 ","$6,865.00 ","$0.00 ","$3,432.50 ","$5,437.08 ","$5,492.00 ","$0.00 ","$1,074.37 ","$0.00 ","$1,092.91 ","$0.00 "
"J634H","SUP","Custom 27203010","","J634H  -  SUTURE ABS VIOL 18IN VCL 3-0 TIE BRAID COAT","BOTH IP/OP","$5.29 ","$3.91 ","$0.00 ","$5.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.29 ","$0.00 ","$2.65 ","$4.19 ","$4.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J671G","SUP","Custom 27203010","","J671G  -  SUTURE ABSORBABLE 5-0 S-14 18IN 2 ARM BRAID COATED VICRYL","BOTH IP/OP","$31.41 ","$23.24 ","$0.00 ","$31.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.41 ","$0.00 ","$15.71 ","$24.88 ","$25.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J726D","SUP","Custom 27203010","","J726D  -  SUTURE VCL 2-0 CT2 8-18IN CR BRAID COAT VIOL ABS","BOTH IP/OP","$47.20 ","$34.93 ","$0.00 ","$47.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.20 ","$0.00 ","$23.60 ","$37.38 ","$37.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J727D","SUP","Custom 27203010","","J727D  -  SUTURE ABSORBABLE 0 CT-2 8-18IN TAPER POINT BRAID 8 STRAND","BOTH IP/OP","$29.89 ","$22.12 ","$0.00 ","$30.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.34 ","$0.00 ","$15.17 ","$24.03 ","$24.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J739D","SUP","Custom 27203010","","J739D  -  SUTURE ABSORBABLE 2-0 CT-1 18IN CONTROL RELEASE BRAIDED 8","BOTH IP/OP","$29.86 ","$22.10 ","$0.00 ","$30.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.30 ","$0.00 ","$15.15 ","$24.00 ","$24.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J740D","SUP","Custom 27203010","","J740D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$29.96 ","$22.17 ","$0.00 ","$30.41 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.41 ","$0.00 ","$15.20 ","$24.08 ","$24.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J741D","SUP","Custom 27203010","","J741D  -  SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$361.24 ","$267.32 ","$0.00 ","$361.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.24 ","$0.00 ","$180.62 ","$286.10 ","$288.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J754T CR","SUP","Custom 27203010","","J754T CR  -  NEEDLE 0 VICRYL 18 OS-6","BOTH IP/OP","$465.23 ","$344.27 ","$0.00 ","$465.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$465.23 ","$0.00 ","$232.61 ","$368.46 ","$372.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J761D","SUP","Custom 27203010","","J761D  -  SUTURE ABSORBABLE 3-0 CP-2 18IN CONTROL RELEASE BRAID 8","BOTH IP/OP","$37.30 ","$27.60 ","$0.00 ","$37.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.86 ","$0.00 ","$18.93 ","$29.99 ","$30.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J762D","SUP","Custom 27203010","","J762D  -  SUTURE ABSORBABLE 2-0 CP-2 18IN CONTROL RELEASE BRAID 8","BOTH IP/OP","$37.49 ","$27.74 ","$0.00 ","$36.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.98 ","$0.00 ","$18.49 ","$29.29 ","$29.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J764D","SUP","Custom 27203010","","J764D  -  SUTURE ABSORBABLE 0 CTX 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$29.82 ","$22.07 ","$0.00 ","$30.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.27 ","$0.00 ","$15.14 ","$23.97 ","$24.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J765D","SUP","Custom 27203010","","J765D  -  SUTURE ABSORBABLE 1 CTX 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$29.82 ","$22.07 ","$0.00 ","$30.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.27 ","$0.00 ","$15.14 ","$23.97 ","$24.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J774D","SUP","Custom 27203010","","J774D  -  SUTURE ABS 3-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT","BOTH IP/OP","$29.45 ","$21.79 ","$0.00 ","$29.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.89 ","$0.00 ","$14.94 ","$23.67 ","$23.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J775D","SUP","Custom 27203010","","J775D  -  SUTURE ABS 2-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT","BOTH IP/OP","$28.82 ","$21.33 ","$0.00 ","$29.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.26 ","$0.00 ","$14.63 ","$23.17 ","$23.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J790D","SUP","Custom 27203010","","J790D  -  SUTURE ABSORBABLE 3-0 X-1 18IN CONTROL RELEASE BRAID 8","BOTH IP/OP","$43.68 ","$32.32 ","$0.00 ","$44.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$44.34 ","$0.00 ","$22.17 ","$35.12 ","$35.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J840D","SUP","Custom 27203010","","J840D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$30.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.47 ","$0.00 ","$15.24 ","$24.13 ","$24.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J841D","SUP","Custom 27203010","","J841D  -  SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$29.80 ","$22.05 ","$0.00 ","$30.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.24 ","$0.00 ","$15.12 ","$23.95 ","$24.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J841D CR","SUP","Custom 27203010","","J841D CR  -  NEEDLE 1VICRYL 18 CT1","BOTH IP/OP","$355.23 ","$262.87 ","$0.00 ","$355.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.23 ","$0.00 ","$177.61 ","$281.34 ","$284.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"J864D","SUP","Custom 27203010","","J864D  -  SUTURE ABS 3-0 SH 18IN UD VCL CR BRD 8 STRN COAT","BOTH IP/OP","$361.08 ","$267.20 ","$0.00 ","$366.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.49 ","$0.00 ","$183.25 ","$290.26 ","$293.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-DLVT35L","SUP","Custom 27203010","","JA-DLVT35L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 35 FR LEFT SIDED","BOTH IP/OP","$442.50 ","$327.45 ","$0.00 ","$442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$442.50 ","$0.00 ","$221.25 ","$350.46 ","$354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-DLVT37L","SUP","Custom 27203010","","JA-DLVT37L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 37 FR LEFT SIDED","BOTH IP/OP","$442.50 ","$327.45 ","$0.00 ","$442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$442.50 ","$0.00 ","$221.25 ","$350.46 ","$354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-DLVT39L","SUP","Custom 27203010","","JA-DLVT39L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 39 FR LEFT SIDED","BOTH IP/OP","$442.50 ","$327.45 ","$0.00 ","$442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$442.50 ","$0.00 ","$221.25 ","$350.46 ","$354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-DLVT41L","SUP","Custom 27203010","","JA-DLVT41L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 41 FR LEFT SIDED","BOTH IP/OP","$442.50 ","$327.45 ","$0.00 ","$442.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$442.50 ","$0.00 ","$221.25 ","$350.46 ","$354.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-TVT70100","SUP","Custom 27203010","","JA-TVT70100  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.0MM","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-TVT75105","SUP","Custom 27203010","","JA-TVT75105  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.5MM","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JA-TVT80110","SUP","Custom 27203010","","JA-TVT80110  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 8.0MM","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JB840","SUP","Custom 27203010","","JB840  -  SUTURE ABS 0 CTB-1 18IN UD VCL ETHGRD CR BRD 8 STRN COAT","BOTH IP/OP","$37.53 ","$27.77 ","$0.00 ","$38.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$38.09 ","$0.00 ","$19.04 ","$30.17 ","$30.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JCDS-1618-EDS-HC","SUP","Custom 27203010","","SET DILATOR 16 AND 18 FR","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JCDS-2022-EDS-HC","SUP","Custom 27203010","","SET DILATOR 20 AND 22 FR","BOTH IP/OP","$427.50 ","$316.35 ","$0.00 ","$427.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$427.50 ","$0.00 ","$213.75 ","$338.58 ","$342.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JEM 330","SUP","HCPCS A7521","","JEM 330  -  TUBE ENDOTRAC 3MM CHGR SMTH RND TIP PE LATEX FREE DISP 3MM","BOTH IP/OP","$23.75 ","$17.58 ","$0.00 ","$23.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.75 ","$0.00 ","$11.88 ","$18.81 ","$19.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JEM 365","SUP","HCPCS A7520","","JEM 365  -  CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM","BOTH IP/OP","$26.15 ","$19.35 ","$0.00 ","$26.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.15 ","$0.00 ","$13.08 ","$20.71 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JEM 400","SUP","Custom 27203010","","JEM 400  -  CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM","BOTH IP/OP","$27.50 ","$20.35 ","$0.00 ","$26.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$26.15 ","$0.00 ","$13.08 ","$20.71 ","$20.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JEM370","SUP","Custom 27203010","","JEM370  -  CATHETER ARWYEX SMPL RPD TCHQ PE DISP 7MM","BOTH IP/OP","$22.55 ","$16.69 ","$0.00 ","$22.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.55 ","$0.00 ","$11.28 ","$17.86 ","$18.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JJ1952","SUP","Custom 27203010","","JJ1952  -  HEMOSTAT ABSORBABLE 8X4IN ORIGINAL FLEXIBLE SHEER WEAVE","BOTH IP/OP","$147.91 ","$109.45 ","$0.00 ","$147.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.91 ","$0.00 ","$73.95 ","$117.14 ","$118.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JJ4055","SUP","HCPCS C1729","","CATHETER IV 18GA 1.25IN RADIOPQ GRN JELCO TFLN STRL LF","BOTH IP/OP","$327.60 ","$242.42 ","$0.00 ","$327.60 ","$177.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$57.36 ","$327.60 ","$0.00 ","$163.80 ","$259.46 ","$262.08 ","$0.00 ","$51.27 ","$0.00 ","$52.15 ","$0.00 "
"J-NCS-504070","SUP","HCPCS C1887","","J-NCS-504070  -  CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP","BOTH IP/OP","$246.25 ","$182.23 ","$0.00 ","$246.25 ","$133.71 ","$0.00 ","$51.32 ","$0.00 ","$0.00 ","$43.12 ","$246.25 ","$0.00 ","$123.13 ","$195.03 ","$197.00 ","$0.00 ","$38.54 ","$0.00 ","$39.20 ","$0.00 "
"JP-2230","SUP","Custom 27203010","","JP-2230  -  DRAIN INCS 19FR JP SIL RND HBLS CHNL STRL LATEX","BOTH IP/OP","$40.63 ","$30.07 ","$0.00 ","$40.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.63 ","$0.00 ","$20.31 ","$34.10 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JP-HUF071","SUP","Custom 27203010","","JP-HUF071  -  DRAIN INCISION 20CMX7MM 10FR FULL DUCT TROCAR LATEX FREE","BOTH IP/OP","$55.14 ","$40.80 ","$0.00 ","$55.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$55.14 ","$0.00 ","$27.57 ","$43.67 ","$44.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"JW31U","SUP","HCPCS C1898","","JW31U  -  LEAD PCNG OTW LT VNTRC SIN","BOTH IP/OP","$4,750.00 ","$3,515.00 ","$0.00 ","$4,750.00 ","$2,137.50 ","$0.00 ","$990.02 ","$0.00 ","$0.00 ","$831.69 ","$4,750.00 ","$0.00 ","$2,375.00 ","$3,762.00 ","$3,800.00 ","$0.00 ","$743.38 ","$0.00 ","$756.20 ","$0.00 "
"K0675","SUP","Custom 27203010","","REAGENT RBT MS AB LSAB 2 110ML UNV SYS HRP CNJG IMMUN","BOTH IP/OP","$1,382.93 ","$1,023.37 ","$0.00 ","$1,382.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,382.93 ","$0.00 ","$691.46 ","$1,095.28 ","$1,106.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K20-2154","SUP","Custom 27203010","","K20-2154  -  BLADE OPTH 7MM CRNL SS TRPHN HNDL STRL DISP","BOTH IP/OP","$92.50 ","$68.45 ","$0.00 ","$92.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.50 ","$0.00 ","$46.25 ","$73.26 ","$74.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K3468","SUP","Custom 27203010","","REAGENT DAB PLUS 110ML LQ CHRMGN 1100 TST IMMUN","BOTH IP/OP","$366.93 ","$271.53 ","$0.00 ","$366.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.93 ","$0.00 ","$183.46 ","$290.61 ","$293.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K4061","SUP","Custom 27203010","","REAGENT HRP ENVSN PLUS 11ML RBT MS DUAL LNK 1100 TST IMMUN","BOTH IP/OP","$4,024.85 ","$2,978.39 ","$0.00 ","$4,024.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,024.85 ","$0.00 ","$2,012.43 ","$3,187.68 ","$3,219.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K5204","SUP","Custom 27203010","","KIT IMMUN TST HERCEPTEST SLD REAGENT HER 2 35 TST","BOTH IP/OP","$3,781.18 ","$2,798.07 ","$0.00 ","$3,781.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,781.18 ","$0.00 ","$1,890.59 ","$2,994.69 ","$3,024.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K581H","SUP","Custom 27203010","","K581H  -  SUTURE NONABSORBABLE 4-0 BB 24IN 2 ARM BRAID PERMA-HAND","BOTH IP/OP","$391.58 ","$289.77 ","$0.00 ","$397.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$397.45 ","$0.00 ","$198.72 ","$314.78 ","$317.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K8-6180","SUP","Custom 27203010","","K8-6180  -  SPHERE EYE 18MM PLST SLD CLR","BOTH IP/OP","$62.78 ","$46.46 ","$0.00 ","$35.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"K8-6200","SUP","HCPCS L8610","","K8-6200  -  SPHERE EYE 20MM PLST SLD CLR","BOTH IP/OP","$62.78 ","$46.46 ","$0.00 ","$62.78 ","$28.25 ","$0.00 ","$13.08 ","$0.00 ","$0.00 ","$10.99 ","$62.78 ","$0.00 ","$31.39 ","$49.72 ","$50.22 ","$0.00 ","$9.82 ","$0.00 ","$9.99 ","$0.00 "
"K8-6220","SUP","HCPCS L8610","","K8-6220  -  SPHERE EYE 22MM PLST SLD CLR","BOTH IP/OP","$62.78 ","$46.46 ","$0.00 ","$67.50 ","$30.38 ","$0.00 ","$13.08 ","$0.00 ","$0.00 ","$11.82 ","$67.50 ","$0.00 ","$33.75 ","$53.46 ","$54.00 ","$0.00 ","$10.56 ","$0.00 ","$10.75 ","$0.00 "
"K8-6330","SUP","HCPCS L8610","","K8-6330  -  CNFRMR OPTH LG UNV PLST CLR","BOTH IP/OP","$62.78 ","$46.46 ","$0.00 ","$35.00 ","$15.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.13 ","$35.00 ","$0.00 ","$17.50 ","$27.72 ","$28.00 ","$0.00 ","$5.48 ","$0.00 ","$5.57 ","$0.00 "
"KC9529","SUP","Custom 27203010","","KC9529  -  SLEEVES KNEE MEDIUM LENGTH","BOTH IP/OP","$73.60 ","$54.46 ","$0.00 ","$73.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.60 ","$0.00 ","$36.80 ","$58.29 ","$58.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KCFW-6.0-35-70-RB-HFANL1-HC","SUP","HCPCS C1894","","KCFW-6.0-35-70-RB-HFANL1-HC  -  INTROD SHTH 6FR .087IN 70CM ANL1 CURVE MULTPUR TIP ANSEL","BOTH IP/OP","$210.00 ","$155.40 ","$0.00 ","$210.00 ","$114.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36.77 ","$210.00 ","$0.00 ","$105.00 ","$166.32 ","$168.00 ","$0.00 ","$32.87 ","$0.00 ","$33.43 ","$0.00 "
"KC-RUMI-35","SUP","HCPCS C1713","","KC-RUMI-35  -  MANIPULATOR ESCP 3.5CM STRL LF KOH-EFCT RUMI II K CP EZ LD","BOTH IP/OP","$223.26 ","$165.21 ","$0.00 ","$223.26 ","$100.47 ","$0.00 ","$46.53 ","$0.00 ","$0.00 ","$39.09 ","$223.26 ","$0.00 ","$111.63 ","$176.82 ","$178.61 ","$0.00 ","$34.94 ","$0.00 ","$35.54 ","$0.00 "
"KLIPPEN","SUP","HCPCS C1879","","KLIPPEN  -  MARKER","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KLTSD403","SUP","Custom 27203010","","AIRWAY ESPH 3 KLT-D SCT MGMT PORT","BOTH IP/OP","$80.58 ","$59.63 ","$0.00 ","$80.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.58 ","$0.00 ","$40.29 ","$63.82 ","$64.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KLTSD424","SUP","Custom 27203010","","KLTSD424 - AIRWAY ESPH 4 KLT-D SCT MGMT PORT","BOTH IP/OP","$90.67 ","$67.10 ","$0.00 ","$80.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$80.58 ","$0.00 ","$40.29 ","$63.82 ","$64.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KLTSD425","SUP","Custom 27203010","","KLTSD425 - AIRWAY ESPH 5 KLT-D SCT MGMT PORT","BOTH IP/OP","$85.44 ","$63.23 ","$0.00 ","$77.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.85 ","$0.00 ","$38.93 ","$61.66 ","$62.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KM172-14-54","SUP","Custom 27203010","","KM172-14-54  -  WIRE .054IN 4IN KWIRE SS SMTH TROCAR PNT 1 END ORTH NONSTRL","BOTH IP/OP","$5.70 ","$4.22 ","$0.00 ","$5.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.70 ","$0.00 ","$2.85 ","$4.51 ","$4.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KT1835C","SUP","HCPCS C1753","","KT1835C  -  KIT CATH ER-REBOA","BOTH IP/OP","$467.50 ","$345.95 ","$0.00 ","$375.00 ","$203.63 ","$0.00 ","$97.44 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"KW-062","SUP","HCPCS C1769","","KW-062  -  WIRE FIX .062IN KWIRE SS","BOTH IP/OP","$181.25 ","$134.13 ","$0.00 ","$181.25 ","$98.42 ","$0.00 ","$37.78 ","$0.00 ","$0.00 ","$31.74 ","$181.25 ","$0.00 ","$90.63 ","$143.55 ","$145.00 ","$0.00 ","$28.37 ","$0.00 ","$28.86 ","$0.00 "
"KW062SS","SUP","HCPCS C1769","","KW062SS  -  WIRE FIX 1.6MM KWIRE SS","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$33.94 ","$0.00 ","$13.03 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"KWIR-STD-09152","SUP","Custom 27203010","","KWIR-STD-09152  -  WIRE FX STD .9MM 152MM KRSH TIP SS","BOTH IP/OP","$60.00 ","$44.40 ","$0.00 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.00 ","$0.00 ","$30.00 ","$47.52 ","$48.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"KWIR-STD-15127","SUP","HCPCS C1713","","KWIR-STD-15127  -  WIRE FX 1.5MM 127MM KRSH STD TIP SS","BOTH IP/OP","$70.00 ","$51.80 ","$0.00 ","$70.00 ","$31.50 ","$0.00 ","$14.59 ","$0.00 ","$0.00 ","$12.26 ","$70.00 ","$0.00 ","$35.00 ","$55.44 ","$56.00 ","$0.00 ","$10.96 ","$0.00 ","$11.14 ","$0.00 "
"L270309B","SUP","Custom 27203010","","KIT BBL RPR CRD SERTST 3ML","BOTH IP/OP","$131.50 ","$97.31 ","$0.00 ","$131.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.50 ","$0.00 ","$65.75 ","$104.15 ","$105.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"L3030","SUP","HCPCS C1713","","L3030  -  PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$405.00 ","$0.00 ","$187.58 ","$0.00 ","$0.00 ","$157.58 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$140.85 ","$0.00 ","$143.28 ","$0.00 "
"L-70","SUP","Custom 27203010","","SYSTEM BLOOD WRM ADM SET INJEC PORT LVL 1 HTLN DISP STRL LF","BOTH IP/OP","$31.10 ","$23.01 ","$0.00 ","$31.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.10 ","$0.00 ","$15.55 ","$24.63 ","$24.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LA6EBU30","SUP","HCPCS C1887","","CATHETER GUID EBU3 CURVE 6FR 100CM CORON LNCHR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"LA6EBU40","SUP","HCPCS C1887","","CATHETER GUID EBU4 CURVE 6FR 100CM LNCHR","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"LAG3.2-24","SUP","HCPCS C1713","","LAG3.2-24  -  SCREW BN 3.2MM 24MM LG CORT","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LAG3.2-26","SUP","HCPCS C1713","","LAG3.2-26  -  SCREW BN 3.2MM 26MM LG CORT","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LAG-4300","SUP","HCPCS C1713","","LAG-4300  -  SCREW BONE 30MM MLR LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-4350","SUP","HCPCS C1713","","LAG-4350  -  SCREW BONE 35MM MLR LAG NONSTRL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-4400","SUP","HCPCS C1713","","LAG-4400  -  SCREW BONE 40MM MLR LAG STRL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-4450","SUP","HCPCS C1713","","LAG-4450  -  SCREW BONE 45MM MLR LAG NONSTRL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-4500","SUP","HCPCS C1713","","LAG-4500  -  SCREW BONE 4MM 50MM TI MLR LAG NONSTRL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5036","SUP","HCPCS C1713","","LAG-5036  -  SCREW BONE 36MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5038","SUP","HCPCS C1713","","LAG-5038  -  SCREW BONE 38MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5040","SUP","HCPCS C1713","","LAG-5040  -  SCREW BONE 40MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5042","SUP","HCPCS C1713","","LAG-5042  -  SCREW BONE 42MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5044","SUP","HCPCS C1713","","LAG-5044  -  SCREW BONE 44MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5046","SUP","HCPCS C1713","","LAG-5046  -  SCREW BONE 46MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5048","SUP","HCPCS C1713","","LAG-5048  -  SCREW BONE 48MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5050","SUP","HCPCS C1713","","LAG-5050  -  SCREW BONE 50MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5052","SUP","HCPCS C1713","","LAG-5052  -  SCREW BONE 52MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5054","SUP","HCPCS C1713","","LAG-5054  -  SCREW BONE 54MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5056","SUP","HCPCS C1713","","LAG-5056  -  SCREW BONE 56MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5058","SUP","HCPCS C1713","","LAG-5058  -  SCREW BONE 58MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5060","SUP","HCPCS C1713","","LAG-5060  -  SCREW BONE 60MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5062","SUP","HCPCS C1713","","LAG-5062  -  SCREW BONE 62MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5064","SUP","HCPCS C1713","","LAG-5064  -  SCREW BONE 64MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5066","SUP","HCPCS C1713","","LAG-5066  -  SCREW BONE 66MM ANKL SYNDESMOSIS LAG NONSTRL","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5068","SUP","HCPCS C1713","","LAG-5068  -  SCREW BONE 68MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5070","SUP","HCPCS C1713","","LAG-5070  -  SCREW BONE 70MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5072","SUP","HCPCS C1713","","LAG-5072  -  SCREW BONE 72MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LAG-5074","SUP","HCPCS C1713","","LAG-5074  -  SCREW BONE 74MM UPR/LWR XTRMT SYNDESMOSIS LAG","BOTH IP/OP","$460.00 ","$340.40 ","$0.00 ","$460.00 ","$207.00 ","$0.00 ","$95.88 ","$0.00 ","$0.00 ","$80.54 ","$460.00 ","$0.00 ","$230.00 ","$364.32 ","$368.00 ","$0.00 ","$71.99 ","$0.00 ","$73.23 ","$0.00 "
"LC3006","SUP","Custom 27203010","","LC3006  -  KIT SRG STRL LF SPY PAQ DISP","BOTH IP/OP","$1,374.25 ","$1,016.95 ","$0.00 ","$1,374.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,374.25 ","$0.00 ","$687.13 ","$1,088.41 ","$1,099.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LCB002","SUP","Custom 27203010","","KIT INDCTR VRF MONITR STRP MEDIA VL LF","BOTH IP/OP","$6.83 ","$5.05 ","$0.00 ","$6.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.83 ","$0.00 ","$3.41 ","$5.41 ","$5.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LCBS2.7-10","SUP","HCPCS C1713","","LCBS2.7-10  -  SCREW BN 2.7MM 10MM LCK SS CORT TRIMED CLVCL FX SYS","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS2.7-16","SUP","HCPCS C1713","","LCBS2.7-16  -  SCREW BN 2.7MM 16MM LCK SS CORT TRIMED CLVCL FX SYS","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS3.2-08","SUP","HCPCS C1713","","LCBS3.2-08  -  SCREW BONE 3.2MM 8MM FRARM ELB CORT LOCK","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS3.2-12","SUP","HCPCS C1713","","LCBS3.2-12  -  SCREW BONE 3.2MM 12MM LOCK FOREARM ELBOW CORTICAL","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS3.2-14","SUP","HCPCS C1713","","LCBS3.2-14  -  SCREW BONE 3.2MM 14MM LOCK OLECRANON HOOK PLATE FOREARM","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS3.2-16","SUP","HCPCS C1713","","LCBS3.2-16  -  SCREW BONE 3.2MM 16MM LOCK FOREARM ELBOW CORTICAL","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS3.2-18","SUP","HCPCS C1713","","LCBS3.2-18  -  SCREW BONE 3.2MM 18MM LOCK FOREARM ELBOW CORTICAL","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS3.2-22","SUP","HCPCS C1713","","LCBS3.2-22  -  SCREW BONE 3.2MM 22MM LOCK FOREARM ELBOW CORTICAL","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LCBS32-24","SUP","HCPCS C1713","","LCBS32-24  -  SCREW BONE 24MM LOCK 3.2MM FOREARM ELBOW CORTICAL","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"LCC008","SUP","Custom 27203010","","STRIP INDCTR CHM MONITR VRF S1 PRC","BOTH IP/OP","$4.40 ","$3.26 ","$0.00 ","$4.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.40 ","$0.00 ","$2.20 ","$3.48 ","$3.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LF1737","SUP","Custom 27203010","","LF1737  -  SEALER/DIVIDER LAPSCP 350D 5MM 37CM LGSR MD 1 STP SL MLFNC","BOTH IP/OP","$1,318.35 ","$975.58 ","$0.00 ","$1,318.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,318.35 ","$0.00 ","$659.18 ","$1,044.13 ","$1,054.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LF4318","SUP","Custom 27203010","","LF4318  -  SEALER/DIVIDER BP 180D 34MM LG 13.5MM 7.1IN STRL LF 36MM","BOTH IP/OP","$8,795.55 ","$6,508.71 ","$0.00 ","$8,795.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,795.55 ","$0.00 ","$4,397.78 ","$6,966.08 ","$7,036.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LF4418","SUP","Custom 27203010","","LF4418  -  SEALER/DIVIDER BP 14D 180D 34MM 13.5MM 18CM STRL LF 36MM","BOTH IP/OP","$1,465.93 ","$1,084.79 ","$0.00 ","$1,465.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,465.93 ","$0.00 ","$732.96 ","$1,161.02 ","$1,172.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LFC002","SUP","Custom 27203010","","LFC002  -  TIP APL LIQUIBAND ADH TISS FLW CNTRL","BOTH IP/OP","$92.98 ","$68.81 ","$0.00 ","$92.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$92.98 ","$0.00 ","$46.49 ","$73.64 ","$74.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LHEX3.2-12","SUP","HCPCS C1713","","LHEX3.2-12  -  SCREW BN 3.2MM 12MM LCK SS CORT TRIMED CLVCL FX SYS","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"LIG101","SUP","Custom 27203010","","LIQUIMMUNE IMMUNOASSAY LV 1 6X5ML","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LIG-101","SUP","Custom 27203010","","CONTROL IMAS MAS LIQUIMMUNE LVL 1 LQ 5ML IMMUN","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LIG202","SUP","Custom 27203010","","LIQUIMMUNE IMMUNOASSAY LV 2 6X5ML","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LIG-202","SUP","Custom 27203010","","CONTROL MLANLT 3-PNT LIQUIMMUNE LVL 2 ASY 5ML IMMUN","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LIG303","SUP","Custom 27203010","","LIQUIMMUNE IMMUNOASSAY LV 3 6X5ML","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LIG-303","SUP","Custom 27203010","","CONTROL IMAS MAS LIQUIMMUNE LVL 3 LQ 5ML IMMUN","BOTH IP/OP","$150.00 ","$111.00 ","$0.00 ","$150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$150.00 ","$0.00 ","$75.00 ","$118.80 ","$120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LL0004","SUP","Custom 27203010","","LL0004  -  SET TBG 250 MILLIBAR STRL LTX 1 LUM INFL 2 OFLW DISP","BOTH IP/OP","$362.50 ","$268.25 ","$0.00 ","$362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$362.50 ","$0.00 ","$181.25 ","$287.10 ","$290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LN205","SUP","Custom 27203010","","LN205  -  RESERVOIR CARDIOTOMY 3L UNFILTERED","BOTH IP/OP","$77.00 ","$56.98 ","$0.00 ","$77.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$77.00 ","$0.00 ","$38.50 ","$60.98 ","$61.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LPG1510","SUP","HCPCS C1781","","LPG1510  -  MESH SURG 15X10CM SELF FIXATE FLAT SHEET LATEX FREE PROGRIP","BOTH IP/OP","$886.40 ","$655.94 ","$0.00 ","$1,048.25 ","$471.71 ","$0.00 ","$184.75 ","$0.00 ","$0.00 ","$183.54 ","$1,048.25 ","$0.00 ","$524.13 ","$830.21 ","$838.60 ","$0.00 ","$164.05 ","$0.00 ","$166.88 ","$0.00 "
"LPP11","SUP","Custom 27803010","","LPP11  -  EXPANDER TISSUE P5CM 11X9CM TEXTURED LP PLUS LATERAL EXTN","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LPP12","SUP","HCPCS C1789","","LPP12  -  EXPANDER TISSUE P5.2CM 9.8X12CM TEXTURED LOW POLE PLUS","BOTH IP/OP","$3,025.00 ","$2,238.50 ","$0.00 ","$3,025.00 ","$1,361.25 ","$0.00 ","$630.49 ","$0.00 ","$0.00 ","$529.65 ","$3,025.00 ","$0.00 ","$1,512.50 ","$2,395.80 ","$2,420.00 ","$0.00 ","$473.41 ","$0.00 ","$481.58 ","$0.00 "
"LPP13","SUP","HCPCS C1789","","LPP13  -  XPD TISS 380-450ML TXTR LP PLUS LAT EXTN MID HT DERMASPAN","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"LPP14","SUP","HCPCS C1789","","LPP14  -  EXPANDER TISSUE P6CM 14X11.2CM TEXTURED LP PLUS LATERAL EXTN","BOTH IP/OP","$3,025.00 ","$2,238.50 ","$0.00 ","$3,025.00 ","$1,361.25 ","$0.00 ","$630.49 ","$0.00 ","$0.00 ","$529.65 ","$3,025.00 ","$0.00 ","$1,512.50 ","$2,395.80 ","$2,420.00 ","$0.00 ","$473.41 ","$0.00 ","$481.58 ","$0.00 "
"LPP15","SUP","HCPCS C1789","","LPP15  -  EXPANDER TISS P6.4-7.9CM MID HT 15X11.5CM 500-600CC","BOTH IP/OP","$3,025.00 ","$2,238.50 ","$0.00 ","$3,025.00 ","$1,361.25 ","$0.00 ","$630.49 ","$0.00 ","$0.00 ","$529.65 ","$3,025.00 ","$0.00 ","$1,512.50 ","$2,395.80 ","$2,420.00 ","$0.00 ","$473.41 ","$0.00 ","$481.58 ","$0.00 "
"LPP16","SUP","HCPCS C1789","","LPP16  -  EXPANDER TISS P6.6-8.2CM MID HT 16X12CM 580-690CC DERMASPAN","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"LQB001","SUP","Custom 27203010","","LQB001  -  LIQUIBAND SKIN ADHESIVE DOME TIP","BOTH IP/OP","$127.22 ","$94.14 ","$0.00 ","$127.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$127.22 ","$0.00 ","$63.61 ","$100.76 ","$101.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LS1500","SUP","Custom 27203010","","LS1500  -  SEALER/DIVIDER LAPSCP 179D 12MM 5MM 37CM STRL 18X2.6MM LGSR","BOTH IP/OP","$1,215.66 ","$899.59 ","$0.00 ","$1,215.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,215.66 ","$0.00 ","$607.83 ","$962.80 ","$972.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LS3111","SUP","Custom 27203010","","ELECTRODE ESURG LG XTD SNP IN RDG GR SRFC CORD","BOTH IP/OP","$102.05 ","$75.52 ","$0.00 ","$102.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$102.05 ","$0.00 ","$51.03 ","$80.82 ","$81.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LT200","SUP","HCPCS C1760","","LT200  -  CLIP MED 3.2MM INTNL LGCLP EX TI ENDSCP LIGAT STRL DISP LF","BOTH IP/OP","$30.60 ","$22.64 ","$0.00 ","$30.60 ","$13.77 ","$0.00 ","$6.38 ","$0.00 ","$0.00 ","$5.36 ","$30.60 ","$0.00 ","$15.30 ","$24.24 ","$24.48 ","$0.00 ","$4.79 ","$0.00 ","$4.87 ","$0.00 "
"LT400","SUP","HCPCS C1760","","LT400  -  CLIP LG 6.2MM INTNL LGCLP EX TI ENDSCP LIGAT STRL DISP LF","BOTH IP/OP","$56.10 ","$41.51 ","$0.00 ","$56.10 ","$25.25 ","$0.00 ","$11.69 ","$0.00 ","$0.00 ","$9.82 ","$56.10 ","$0.00 ","$28.05 ","$44.43 ","$44.88 ","$0.00 ","$8.78 ","$0.00 ","$8.93 ","$0.00 "
"LUB07030","SUP","HCPCS C2625","","LUB07030  -  STENT BIL 7MM 6FR 30MM 80CM .035IN CATH GWIRE E-LMNX","BOTH IP/OP","$3,883.20 ","$2,873.57 ","$0.00 ","$3,883.20 ","$1,747.44 ","$0.00 ","$809.36 ","$0.00 ","$0.00 ","$679.92 ","$3,883.20 ","$0.00 ","$1,941.60 ","$3,075.49 ","$3,106.56 ","$0.00 ","$607.72 ","$0.00 ","$618.21 ","$0.00 "
"LUB07040","SUP","HCPCS C2625","","LUB07040  -  STENT BIL .035IN 7MM 6FR 40MM 80CM LMNX SLF XPD DLV SYS NTNL","BOTH IP/OP","$3,883.19 ","$2,873.56 ","$0.00 ","$3,883.19 ","$1,747.44 ","$0.00 ","$809.35 ","$0.00 ","$0.00 ","$679.92 ","$3,883.19 ","$0.00 ","$1,941.60 ","$3,075.49 ","$3,106.55 ","$0.00 ","$607.72 ","$0.00 ","$618.20 ","$0.00 "
"LUB08030","SUP","HCPCS C2625","","LUB08030  -  STENT BIL .035IN 8MM 6FR 30MM 80CM LMNX SLF XPD DLV SYS NTNL","BOTH IP/OP","$3,883.19 ","$2,873.56 ","$0.00 ","$3,883.19 ","$1,747.44 ","$0.00 ","$809.35 ","$0.00 ","$0.00 ","$679.92 ","$3,883.19 ","$0.00 ","$1,941.60 ","$3,075.49 ","$3,106.55 ","$0.00 ","$607.72 ","$0.00 ","$618.20 ","$0.00 "
"LUB08060","SUP","HCPCS C2625","","LUB08060  -  STENT BIL .035IN 8MM 6FR 60MM 80CM LMNX SLF XPD DLV SYS NTNL","BOTH IP/OP","$3,883.19 ","$2,873.56 ","$0.00 ","$3,883.19 ","$1,747.44 ","$0.00 ","$809.35 ","$0.00 ","$0.00 ","$679.92 ","$3,883.19 ","$0.00 ","$1,941.60 ","$3,075.49 ","$3,106.55 ","$0.00 ","$607.72 ","$0.00 ","$618.20 ","$0.00 "
"LUB10040","SUP","HCPCS C2625","","LUB10040  -  STENT VASC .035IN 10MM 6FR 40MM 80CM E-LMNX SAFE PERFORMAXX","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$1,012.50 ","$0.00 ","$468.96 ","$0.00 ","$0.00 ","$393.96 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$352.13 ","$0.00 ","$358.20 ","$0.00 "
"LUB10060","SUP","HCPCS C2625","","LUB10060  -  STENT BIL 10MM 60MM 80CM PERFORMAXX GRP E-LMNX","BOTH IP/OP","$3,883.20 ","$2,873.57 ","$0.00 ","$3,883.20 ","$1,747.44 ","$0.00 ","$809.36 ","$0.00 ","$0.00 ","$679.92 ","$3,883.20 ","$0.00 ","$1,941.60 ","$3,075.49 ","$3,106.56 ","$0.00 ","$607.72 ","$0.00 ","$618.21 ","$0.00 "
"LUB12080","SUP","HCPCS C2625","","LUB12080  -  STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD DLV SYS LMNX","BOTH IP/OP","$4,686.61 ","$3,468.09 ","$0.00 ","$4,686.61 ","$2,108.97 ","$0.00 ","$976.81 ","$0.00 ","$0.00 ","$820.59 ","$4,686.61 ","$0.00 ","$2,343.30 ","$3,711.80 ","$3,749.29 ","$0.00 ","$733.45 ","$0.00 ","$746.11 ","$0.00 "
"LX10BD.100","SUP","HCPCS V2632","","LX10BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.105","SUP","HCPCS V2632","","LX10BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.110","SUP","HCPCS V2632","","LX10BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.115","SUP","HCPCS V2632","","LX10BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.120","SUP","HCPCS V2632","","LX10BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.125","SUP","HCPCS V2632","","LX10BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.130","SUP","HCPCS V2632","","LX10BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.135","SUP","HCPCS V2632","","LX10BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.140","SUP","HCPCS V2632","","LX10BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.145","SUP","HCPCS V2632","","LX10BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.150","SUP","HCPCS V2632","","LX10BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.155","SUP","HCPCS V2632","","LX10BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.160","SUP","HCPCS V2632","","LX10BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.165","SUP","HCPCS V2632","","LX10BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.170","SUP","HCPCS V2632","","LX10BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.175","SUP","HCPCS V2632","","LX10BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.180","SUP","HCPCS V2632","","LX10BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.185","SUP","HCPCS V2632","","LX10BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.190","SUP","HCPCS V2632","","LX10BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.195","SUP","HCPCS V2632","","LX10BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.200","SUP","HCPCS V2632","","LX10BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.205","SUP","HCPCS V2632","","LX10BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.210","SUP","HCPCS V2632","","LX10BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.215","SUP","HCPCS V2632","","LX10BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.220","SUP","HCPCS V2632","","LX10BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.225","SUP","HCPCS V2632","","LX10BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.230","SUP","HCPCS V2632","","LX10BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.235","SUP","HCPCS V2632","","LX10BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.240","SUP","HCPCS V2632","","LX10BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.245","SUP","HCPCS V2632","","LX10BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.250","SUP","HCPCS V2632","","LX10BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.255","SUP","HCPCS V2632","","LX10BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.260","SUP","HCPCS V2632","","LX10BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.265","SUP","HCPCS V2632","","LX10BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.270","SUP","HCPCS V2632","","LX10BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.275","SUP","HCPCS V2632","","LX10BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.280","SUP","HCPCS V2632","","LX10BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.285","SUP","HCPCS V2632","","LX10BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.290","SUP","HCPCS V2632","","LX10BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.295","SUP","HCPCS V2632","","LX10BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX10BD.300","SUP","HCPCS V2632","","LX10BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.100","SUP","HCPCS V2632","","LX90BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.105","SUP","HCPCS V2632","","LX90BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.110","SUP","HCPCS V2632","","LX90BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.115","SUP","HCPCS V2632","","LX90BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.120","SUP","HCPCS V2632","","LX90BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.125","SUP","HCPCS V2632","","LX90BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.130","SUP","HCPCS V2632","","LX90BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.135","SUP","HCPCS V2632","","LX90BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.140","SUP","HCPCS V2632","","LX90BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.145","SUP","HCPCS V2632","","LX90BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.150","SUP","HCPCS V2632","","LX90BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.155","SUP","HCPCS V2632","","LX90BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.160","SUP","HCPCS V2632","","LX90BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.165","SUP","HCPCS V2632","","LX90BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.170","SUP","HCPCS V2632","","LX90BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.175","SUP","HCPCS V2632","","LX90BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.180","SUP","HCPCS V2632","","LX90BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.185","SUP","HCPCS V2632","","LX90BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.190","SUP","HCPCS V2632","","LX90BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.195","SUP","HCPCS V2632","","LX90BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.200","SUP","HCPCS V2632","","LX90BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.205","SUP","HCPCS V2632","","LX90BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.210","SUP","HCPCS V2632","","LX90BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.215","SUP","HCPCS V2632","","LX90BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.220","SUP","HCPCS V2632","","LX90BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.225","SUP","HCPCS V2632","","LX90BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.230","SUP","HCPCS V2632","","LX90BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.235","SUP","HCPCS V2632","","LX90BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.240","SUP","HCPCS V2632","","LX90BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.245","SUP","HCPCS V2632","","LX90BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.250","SUP","HCPCS V2632","","LX90BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.255","SUP","HCPCS V2632","","LX90BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.260","SUP","HCPCS V2632","","LX90BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.265","SUP","HCPCS V2632","","LX90BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.270","SUP","HCPCS V2632","","LX90BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.275","SUP","HCPCS V2632","","LX90BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.280","SUP","HCPCS V2632","","LX90BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.285","SUP","HCPCS V2632","","LX90BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.290","SUP","HCPCS V2632","","LX90BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.295","SUP","HCPCS V2632","","LX90BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LX90BD.300","SUP","HCPCS V2632","","LX90BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"LXA19","SUP","Custom 27803010","","LXA19  -  VALVE AORTIC 19MM MITROFLOW BVN PRICRD","BOTH IP/OP","$12,500.00 ","$9,250.00 ","$0.00 ","$12,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,500.00 ","$0.00 ","$6,250.00 ","$9,900.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"LXA21","SUP","Custom 27803010","","LXA21  -  VALVE AORTIC 21MM MITROFLOW BVN PRICRD","BOTH IP/OP","$12,500.00 ","$9,250.00 ","$0.00 ","$12,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,500.00 ","$0.00 ","$6,250.00 ","$9,900.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001102200","SUP","HCPCS C1726","","M001102200  -  CATHETER BLNDIL 9FR 15MM 100CM 3CM LV ANGPLSTY","BOTH IP/OP","$998.00 ","$738.52 ","$0.00 ","$998.00 ","$541.91 ","$0.00 ","$208.01 ","$0.00 ","$0.00 ","$174.74 ","$998.00 ","$0.00 ","$499.00 ","$790.42 ","$798.40 ","$0.00 ","$156.19 ","$0.00 ","$158.88 ","$0.00 "
"M001102240","SUP","HCPCS C1726","","M001102240  -  CATHETER BLNDIL 9FR 20MM 100CM 3CM BLU MAX 20 OTW NC HI-PRS","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$373.31 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"M0011031020","SUP","HCPCS C1751","","M0011031020  -  CATHETER INFS .014-.016IN 3-2.7FR .021-.022IN 150CM 12CM","BOTH IP/OP","$1,225.00 ","$906.50 ","$0.00 ","$1,225.00 ","$665.18 ","$0.00 ","$255.32 ","$0.00 ","$0.00 ","$214.49 ","$1,225.00 ","$0.00 ","$612.50 ","$970.20 ","$980.00 ","$0.00 ","$191.71 ","$0.00 ","$195.02 ","$0.00 "
"M001125000","SUP","HCPCS C1753","","M001125000  -  CATHETER BLNDIL 4MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125010","SUP","HCPCS C1753","","M001125010  -  CATHETER BLNDIL 4MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125020","SUP","HCPCS C1753","","M001125020  -  CATHETER BLNDIL 4MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125030","SUP","HCPCS C1753","","M001125030  -  CATHETER BLNDIL 4MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125040","SUP","HCPCS C1753","","M001125040  -  CATHETER BLNDIL 4MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125050","SUP","HCPCS C1753","","M001125050  -  CATHETER BLNDIL 4MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125060","SUP","HCPCS C1753","","M001125060  -  CATHETER BLNDIL 4MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125070","SUP","HCPCS C1753","","M001125070  -  CATHETER BLNDIL 4MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125080","SUP","HCPCS C1753","","M001125080  -  CATHETER BLNDIL 4MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125090","SUP","HCPCS C1753","","M001125090  -  CATHETER BLNDIL 4MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125100","SUP","HCPCS C1753","","M001125100  -  CATHETER BLNDIL 4MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125110","SUP","HCPCS C1753","","M001125110  -  CATHETER BLNDIL 4MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"M001125120","SUP","HCPCS C1753","","M001125120  -  CATHETER BLNDIL 5MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125130","SUP","HCPCS C1753","","M001125130  -  CATHETER BLNDIL 5MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125140","SUP","HCPCS C1753","","M001125140  -  CATHETER BLNDIL 5MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125150","SUP","HCPCS C1753","","M001125150  -  CATHETER BLNDIL 5MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125160","SUP","HCPCS C1753","","M001125160  -  CATHETER BLNDIL 5MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125170","SUP","HCPCS C1753","","M001125170  -  CATHETER BLNDIL 5MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125180","SUP","HCPCS C1753","","M001125180  -  CATHETER BLNDIL 5MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125190","SUP","HCPCS C1753","","M001125190  -  CATHETER BLNDIL 5MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125200","SUP","HCPCS C1753","","M001125200  -  CATHETER BLNDIL 5MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125210","SUP","HCPCS C1753","","M001125210  -  CATHETER BLNDIL 5MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125220","SUP","HCPCS C1753","","M001125220  -  CATHETER BLNDIL 5MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125230","SUP","HCPCS C1753","","M001125230  -  CATHETER BLNDIL 5MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125240","SUP","HCPCS C1753","","M001125240  -  CATHETER BLNDIL 6MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125250","SUP","HCPCS C1753","","M001125250  -  CATHETER BLNDIL 6MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125260","SUP","HCPCS C1753","","M001125260  -  CATHETER BLNDIL 6MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125270","SUP","HCPCS C1753","","M001125270  -  CATHETER BLNDIL 6MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125280","SUP","HCPCS C1753","","M001125280  -  CATHETER BLNDIL 6MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125290","SUP","HCPCS C1753","","M001125290  -  CATHETER BLNDIL 6MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125300","SUP","HCPCS C1753","","M001125300  -  CATHETER BLNDIL 6MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125310","SUP","HCPCS C1753","","M001125310  -  CATHETER BLNDIL 6MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125320","SUP","HCPCS C1753","","M001125320  -  CATHETER BLNDIL 6MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125330","SUP","HCPCS C1753","","M001125330  -  CATHETER BLNDIL 6MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125340","SUP","HCPCS C1753","","M001125340  -  CATHETER BLNDIL 6MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125350","SUP","HCPCS C1753","","M001125350  -  CATHETER BLNDIL 6MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125360","SUP","HCPCS C1753","","M001125360  -  CATHETER BLNDIL 7MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125370","SUP","HCPCS C1753","","M001125370  -  CATHETER BLNDIL 7MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125380","SUP","HCPCS C1753","","M001125380  -  CATHETER BLNDIL 7MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125390","SUP","HCPCS C1753","","M001125390  -  CATHETER BLNDIL 7MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125400","SUP","HCPCS C1753","","M001125400  -  CATHETER BLNDIL 7MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125410","SUP","HCPCS C1753","","M001125410  -  CATHETER BLNDIL 7MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125420","SUP","HCPCS C1753","","M001125420  -  CATHETER BLNDIL 7MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125430","SUP","HCPCS C1753","","M001125430  -  CATHETER BLNDIL 7MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125440","SUP","HCPCS C1753","","M001125440  -  CATHETER BLNDIL 7MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125450","SUP","HCPCS C1753","","M001125450  -  CATHETER BLNDIL 7MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125460","SUP","HCPCS C1753","","M001125460  -  CATHETER BLNDIL 7MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125470","SUP","HCPCS C1753","","M001125470  -  CATHETER BLNDIL 7MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$447.98 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"M001125480","SUP","HCPCS C1753","","M001125480  -  CATHETER BLNDIL 8MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125490","SUP","HCPCS C1726","","M001125490  -  CATHETER BLNDIL 8MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125500","SUP","HCPCS C1753","","M001125500  -  CATHETER BLNDIL 8MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125510","SUP","HCPCS C1753","","M001125510  -  CATHETER BLNDIL 8MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125520","SUP","HCPCS C1753","","M001125520  -  CATHETER BLNDIL 8MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125530","SUP","HCPCS C1753","","M001125530  -  CATHETER BLNDIL 8MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125540","SUP","HCPCS C1753","","M001125540  -  CATHETER BLNDIL 8MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125550","SUP","HCPCS C1753","","M001125550  -  CATHETER BLNDIL 8MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125560","SUP","HCPCS C1753","","M001125560  -  CATHETER BLNDIL 8MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125580","SUP","HCPCS C1753","","M001125580  -  CATHETER BLNDIL 9MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125590","SUP","HCPCS C1753","","M001125590  -  CATHETER BLNDIL 9MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125600","SUP","HCPCS C1753","","M001125600  -  CATHETER BLNDIL 9MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125610","SUP","HCPCS C1753","","M001125610  -  CATHETER BLNDIL 9MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125620","SUP","HCPCS C1753","","M001125620  -  CATHETER BLNDIL 9MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125630","SUP","HCPCS C1753","","M001125630  -  CATHETER BLNDIL 9MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125640","SUP","HCPCS C1753","","M001125640  -  CATHETER BLNDIL 9MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125650","SUP","HCPCS C1753","","M001125650  -  CATHETER BLNDIL 9MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125660","SUP","HCPCS C1753","","M001125660  -  CATHETER BLNDIL 10MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125670","SUP","HCPCS C1753","","M001125670  -  CATHETER BLNDIL 10MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125680","SUP","HCPCS C1753","","M001125680  -  CATHETER BLNDIL 10MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125690","SUP","HCPCS C1753","","M001125690  -  CATHETER BLNDIL 10MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125700","SUP","HCPCS C1726","","M001125700  -  CATHETER BLNDIL 10MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125710","SUP","HCPCS C1753","","M001125710  -  CATHETER BLNDIL 10MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125720","SUP","HCPCS C1753","","M001125720  -  CATHETER BLNDIL 10MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125730","SUP","HCPCS C1753","","M001125730  -  CATHETER BLNDIL 10MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M001125740","SUP","HCPCS C1753","","M001125740  -  CATHETER BLNDIL 10MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI","BOTH IP/OP","$463.05 ","$342.66 ","$0.00 ","$463.05 ","$251.44 ","$0.00 ","$96.51 ","$0.00 ","$0.00 ","$81.08 ","$463.05 ","$0.00 ","$231.53 ","$366.74 ","$370.44 ","$0.00 ","$72.47 ","$0.00 ","$73.72 ","$0.00 "
"M0011341080","SUP","HCPCS C1751","","M0011341080  -  CATH INFUS .014-.016IN 3-2.5FR .022-.021IN 150CM 20CM MCTH 1","BOTH IP/OP","$1,437.50 ","$1,063.75 ","$0.00 ","$1,437.50 ","$780.56 ","$0.00 ","$299.61 ","$0.00 ","$0.00 ","$251.69 ","$1,437.50 ","$0.00 ","$718.75 ","$1,138.50 ","$1,150.00 ","$0.00 ","$224.97 ","$0.00 ","$228.85 ","$0.00 "
"M001145080","SUP","HCPCS C1753","","M001145080  -  CATHETER BLNDIL 12MM 75CM 20MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145090","SUP","HCPCS C1753","","M001145090  -  CATHETER BLNDIL 12MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145100","SUP","HCPCS C1726","","M001145100  -  CATHETER BLNDIL 12MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145110","SUP","HCPCS C1726","","M001145110  -  CATHETER BLNDIL 12MM 120CM 40MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145120","SUP","HCPCS C1753","","M001145120  -  CATHETER BLNDIL 14MM 75CM 20MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145130","SUP","HCPCS C1753","","M001145130  -  CATHETER BLNDIL 14MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145140","SUP","HCPCS C1753","","M001145140  -  CATHETER BLNDIL 14MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145150","SUP","HCPCS C1726","","M001145150  -  CATHETER BLNDIL 14MM 120CM 40MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145300","SUP","HCPCS C1753","","M001145300  -  CATHETER BLNDIL 12MM 75CM 60MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145320","SUP","HCPCS C1753","","M001145320  -  CATHETER BLNDIL 14MM 75CM 60MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145500","SUP","HCPCS C1753","","M001145500  -  CATHETER BLNDIL 16MM 75CM 20MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145510","SUP","HCPCS C1753","","M001145510  -  CATHETER BLNDIL 16MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145520","SUP","HCPCS C1753","","M001145520  -  CATHETER BLNDIL 16MM 75CM 40MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145530","SUP","HCPCS C1726","","M001145530  -  CATHETER BLNDIL 16MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145540","SUP","HCPCS C1753","","M001145540  -  CATHETER BLNDIL 16MM 75CM 60MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145550","SUP","HCPCS C1753","","M001145550  -  CATHETER BLNDIL 18MM 75CM 20MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145560","SUP","HCPCS C1753","","M001145560  -  CATHETER BLNDIL 18MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145570","SUP","HCPCS C1753","","M001145570  -  CATHETER BLNDIL 18MM 75CM 40MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145580","SUP","HCPCS C1726","","M001145580  -  CATHETER BLNDIL 18MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001145590","SUP","HCPCS C1753","","M001145590  -  CATHETER BLNDIL 18MM 75CM 60MM XXL QD-FOLD SCRCH RST HI","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$105.25 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"M001163980","SUP","HCPCS C1753","","M001163980  -  CATHETER BLNDIL 3MM 120CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164000","SUP","HCPCS C1753","","M001164000  -  CATHETER BLNDIL 3MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164010","SUP","HCPCS C1753","","M001164010  -  CATHETER BLNDIL 3MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164020","SUP","HCPCS C1753","","M001164020  -  CATHETER BLNDIL 3MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164030","SUP","HCPCS C1753","","M001164030  -  CATHETER BLNDIL 3MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164040","SUP","HCPCS C1753","","M001164040  -  CATHETER BLNDIL 3MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164050","SUP","HCPCS C1753","","M001164050  -  CATHETER BLNDIL 3MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164060","SUP","HCPCS C1753","","M001164060  -  CATHETER BLNDIL 3MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164070","SUP","HCPCS C1753","","M001164070  -  CATHETER BLNDIL 3MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164080","SUP","HCPCS C1753","","M001164080  -  CATHETER BLNDIL 3MM 40CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164090","SUP","HCPCS C1753","","M001164090  -  CATHETER BLNDIL 3MM 75CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164100","SUP","HCPCS C1753","","M001164100  -  CATHETER BLNDIL 3MM 120CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164110","SUP","HCPCS C1753","","M001164110  -  CATHETER BLNDIL 3MM 150CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164120","SUP","HCPCS C1753","","M001164120  -  CATHETER BLNDIL 4MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164130","SUP","HCPCS C1753","","M001164130  -  CATHETER BLNDIL 4MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164140","SUP","HCPCS C1753","","M001164140  -  CATHETER BLNDIL 4MM 120CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164150","SUP","HCPCS C1753","","M001164150  -  CATHETER BLNDIL 4MM 150CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164160","SUP","HCPCS C1753","","M001164160  -  CATHETER BLNDIL 4MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164170","SUP","HCPCS C1726","","M001164170  -  CATHETER BLNDIL 4MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164180","SUP","HCPCS C1726","","M001164180  -  CATHETER BLNDIL 4MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164190","SUP","HCPCS C1753","","M001164190  -  CATHETER BLNDIL 4MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164200","SUP","HCPCS C1753","","M001164200  -  CATHETER BLNDIL 4MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164210","SUP","HCPCS C1753","","M001164210  -  CATHETER BLNDIL 4MM 120CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164220","SUP","HCPCS C1753","","M001164220  -  CATHETER BLNDIL 4MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164230","SUP","HCPCS C1726","","M001164230  -  CATHETER BLNDIL 4MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164240","SUP","HCPCS C1726","","M001164240  -  CATHETER BLNDIL 4MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164250","SUP","HCPCS C1753","","M001164250  -  CATHETER BLNDIL 4MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164280","SUP","HCPCS C1753","","M001164280  -  CATHETER BLNDIL 4MM 40CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164290","SUP","HCPCS C1726","","M001164290  -  CATHETER BLNDIL 4MM 75CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164300","SUP","HCPCS C1726","","M001164300  -  CATH BALDILAT 5FR 4MM 120CM 10CM PERI PTA OTW TPR SHFT LP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164310","SUP","HCPCS C1753","","M001164310  -  CATHETER BLNDIL 4MM 150CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164320","SUP","HCPCS C1753","","M001164320  -  CATHETER BLNDIL 5MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164330","SUP","HCPCS C1753","","M001164330  -  CATHETER BLNDIL 5MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164340","SUP","HCPCS C1753","","M001164340  -  CATHETER BLNDIL 5MM 120CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164350","SUP","HCPCS C1753","","M001164350  -  CATHETER BLNDIL 5MM 150CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164360","SUP","HCPCS C1753","","M001164360  -  CATHETER BLNDIL 5MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164370","SUP","HCPCS C1753","","M001164370  -  CATHETER BLNDIL 5MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164380","SUP","HCPCS C1753","","M001164380  -  CATHETER BLNDIL 5MM 120CM 50MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164390","SUP","HCPCS C1753","","M001164390  -  CATHETER BLNDIL 5MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164400","SUP","HCPCS C1753","","M001164400  -  CATHETER BLNDIL 5MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164410","SUP","HCPCS C1753","","M001164410  -  CATHETER BLNDIL 5MM 120CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164420","SUP","HCPCS C1753","","M001164420  -  CATHETER BLNDIL 5MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164430","SUP","HCPCS C1753","","M001164430  -  CATHETER BLNDIL 5MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164440","SUP","HCPCS C1753","","M001164440  -  CATHETER BLNDIL 5MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164450","SUP","HCPCS C1753","","M001164450  -  CATHETER BLNDIL 5MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164480","SUP","HCPCS C1753","","M001164480  -  CATHETER BLNDIL 5MM 40CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164490","SUP","HCPCS C1726","","M001164490  -  CATHETER BLNDIL 5MM 75CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164500","SUP","HCPCS C1726","","M001164500  -  CATH BALDILAT 5FR 5MM 120CM 10CM PERI PTA OTW TPR SHFT LP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164510","SUP","HCPCS C1753","","M001164510  -  CATHETER BLNDIL 5MM 150CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164520","SUP","HCPCS C1753","","M001164520  -  CATHETER BLNDIL 6MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164530","SUP","HCPCS C1753","","M001164530  -  CATHETER BLNDIL 6MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164540","SUP","HCPCS C1753","","M001164540  -  CATHETER BLNDIL 6MM 120CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164550","SUP","HCPCS C1753","","M001164550  -  CATHETER BLNDIL 6MM 150CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164560","SUP","HCPCS C1753","","M001164560  -  CATHETER BLNDIL 6MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164570","SUP","HCPCS C1753","","M001164570  -  CATHETER BLNDIL 6MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164580","SUP","HCPCS C1753","","M001164580  -  CATHETER BLNDIL 6MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164590","SUP","HCPCS C1753","","M001164590  -  CATHETER BLNDIL 6MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164600","SUP","HCPCS C1753","","M001164600  -  CATHETER BLNDIL 6MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164610","SUP","HCPCS C1753","","M001164610  -  CATHETER BLNDIL 6MM 120CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164620","SUP","HCPCS C1753","","M001164620  -  CATHETER BLNDIL TPR 6MM 40CM 40MM U-T D OTW NC HDRPH PERI","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164630","SUP","HCPCS C1753","","M001164630  -  CATHETER BLNDIL 6MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164640","SUP","HCPCS C1753","","M001164640  -  CATHETER BLNDIL 6MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164650","SUP","HCPCS C1753","","M001164650  -  CATHETER BLNDIL 6MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164680","SUP","HCPCS C1753","","M001164680  -  CATHETER BLNDIL 6MM 40CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164690","SUP","HCPCS C1726","","M001164690  -  CATHETER BLNDIL TPR 6MM 75CM 100MM U-T D OTW NC HDRPH PERI","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164700","SUP","HCPCS C1726","","M001164700  -  CATHETER BLNDIL 6MM 120CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164710","SUP","HCPCS C1753","","M001164710  -  CATHETER BLNDIL 6MM 150CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164720","SUP","HCPCS C1753","","M001164720  -  CATHETER BLNDIL 7MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$509.93 ","$377.35 ","$0.00 ","$509.93 ","$276.89 ","$0.00 ","$106.28 ","$0.00 ","$0.00 ","$89.28 ","$509.93 ","$0.00 ","$254.96 ","$403.86 ","$407.94 ","$0.00 ","$79.80 ","$0.00 ","$81.18 ","$0.00 "
"M001164730","SUP","HCPCS C1753","","M001164730  -  CATHETER BLNDIL 7MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164740","SUP","HCPCS C1753","","M001164740  -  CATHETER BLNDIL 7MM 120CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164750","SUP","HCPCS C1753","","M001164750  -  CATHETER BLNDIL 7MM 150CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164760","SUP","HCPCS C1753","","M001164760  -  CATHETER BLNDIL 7MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164770","SUP","HCPCS C1753","","M001164770  -  CATHETER BLNDIL 7MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164780","SUP","HCPCS C1753","","M001164780  -  CATHETER BLNDIL 7MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164790","SUP","HCPCS C1753","","M001164790  -  CATHETER BLNDIL 7MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164800","SUP","HCPCS C1753","","M001164800  -  CATHETER BLNDIL 7MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164810","SUP","HCPCS C1753","","M001164810  -  CATHETER BLNDIL 7MM 120CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164820","SUP","HCPCS C1753","","M001164820  -  CATHETER BLNDIL TPR 7MM 40CM 40MM U-T D OTW NC HDRPH PERI","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164830","SUP","HCPCS C1753","","M001164830  -  CATHETER BLNDIL 7MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164840","SUP","HCPCS C1753","","M001164840  -  CATHETER BLNDIL 7MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164850","SUP","HCPCS C1753","","M001164850  -  CATHETER BLNDIL 7MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164880","SUP","HCPCS C1753","","M001164880  -  CATHETER BLNDIL 7MM 40CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164890","SUP","HCPCS C1753","","M001164890  -  CATHETER BLNDIL TPR 7MM 75CM 100MM U-T D OTW NC HDRPH PERI","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164900","SUP","HCPCS C1753","","M001164900  -  CATHETER BLNDIL 7MM 120CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164910","SUP","HCPCS C1753","","M001164910  -  CATHETER BLNDIL 7MM 150CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164920","SUP","HCPCS C1753","","M001164920  -  CATHETER BLNDIL 8MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164930","SUP","HCPCS C1753","","M001164930  -  CATHETER BLNDIL 8MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164940","SUP","HCPCS C1753","","M001164940  -  CATHETER BLNDIL 8MM 120CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164950","SUP","HCPCS C1753","","M001164950  -  CATHETER BLNDIL 8MM 150CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164960","SUP","HCPCS C1753","","M001164960  -  CATHETER BLNDIL 8MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164970","SUP","HCPCS C1753","","M001164970  -  CATHETER BLNDIL 8MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164980","SUP","HCPCS C1753","","M001164980  -  CATHETER BLNDIL 8MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001164990","SUP","HCPCS C1753","","M001164990  -  CATHETER BLNDIL 8MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165000","SUP","HCPCS C1753","","M001165000  -  CATHETER BLNDIL 8MM 40CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165010","SUP","HCPCS C1726","","M001165010  -  CATHETER BLNDIL 8MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165020","SUP","HCPCS C1753","","M001165020  -  CATHETER BLNDIL 8MM 120CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165030","SUP","HCPCS C1753","","M001165030  -  CATHETER BLNDIL 8MM 150CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165040","SUP","HCPCS C1753","","M001165040  -  CATHETER BLNDIL TPR 8MM 40CM 40MM U-T D OTW NC HDRPH PERI","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165050","SUP","HCPCS C1753","","M001165050  -  CATHETER BLNDIL 8MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165060","SUP","HCPCS C1753","","M001165060  -  CATHETER BLNDIL 8MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165070","SUP","HCPCS C1753","","M001165070  -  CATHETER BLNDIL 8MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165080","SUP","HCPCS C1753","","M001165080  -  CATHETER BLNDIL 8MM 40CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165090","SUP","HCPCS C1753","","M001165090  -  CATHETER BLNDIL 8MM 75CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165100","SUP","HCPCS C1753","","M001165100  -  CATHETER BLNDIL 8MM 120CM 80MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165110","SUP","HCPCS C1753","","M001165110  -  CATHETER BLNDIL 8MM 150CM 80MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165120","SUP","HCPCS C1753","","M001165120  -  CATHETER BLNDIL 9MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165130","SUP","HCPCS C1753","","M001165130  -  CATHETER BLNDIL 9MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165140","SUP","HCPCS C1753","","M001165140  -  CATHETER BLNDIL 9MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165150","SUP","HCPCS C1753","","M001165150  -  CATHETER BLNDIL 9MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165160","SUP","HCPCS C1753","","M001165160  -  CATHETER BLNDIL 9MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165170","SUP","HCPCS C1753","","M001165170  -  CATHETER BLNDIL 9MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165180","SUP","HCPCS C1753","","M001165180  -  CATHETER BLNDIL 9MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165190","SUP","HCPCS C1753","","M001165190  -  CATHETER BLNDIL 9MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165200","SUP","HCPCS C1753","","M001165200  -  CATHETER BLNDIL 10MM 40CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165210","SUP","HCPCS C1753","","M001165210  -  CATHETER BLNDIL 10MM 75CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165220","SUP","HCPCS C1753","","M001165220  -  CATHETER BLNDIL 10MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165230","SUP","HCPCS C1753","","M001165230  -  CATHETER BLNDIL 10MM 150CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165240","SUP","HCPCS C1753","","M001165240  -  CATHETER BLNDIL TPR 10MM 40CM 40MM U-T D OTW NC HDRPH PERI","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165250","SUP","HCPCS C1753","","M001165250  -  CATHETER BLNDIL 10MM 75CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165260","SUP","HCPCS C1753","","M001165260  -  CATHETER BLNDIL 10MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165270","SUP","HCPCS C1753","","M001165270  -  CATHETER BLNDIL 10MM 150CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165290","SUP","HCPCS C1726","","M001165290  -  CATHETER BLNDIL 12MM 75CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165300","SUP","HCPCS C1753","","M001165300  -  CATHETER BLNDIL 12MM 120CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165330","SUP","HCPCS C1753","","M001165330  -  CATHETER BLNDIL 12MM 75CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165340","SUP","HCPCS C1753","","M001165340  -  CATHETER BLNDIL 12MM 120CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165550","SUP","HCPCS C1753","","M001165550  -  CATHETER BLNDIL 4MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165560","SUP","HCPCS C1753","","M001165560  -  CATHETER BLNDIL 4MM 120CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165590","SUP","HCPCS C1753","","M001165590  -  CATHETER BLNDIL 5MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165600","SUP","HCPCS C1753","","M001165600  -  CATHETER BLNDIL 5MM 120CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165630","SUP","HCPCS C1753","","M001165630  -  CATHETER BLNDIL 6MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165640","SUP","HCPCS C1753","","M001165640  -  CATHETER BLNDIL 6MM 120CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165670","SUP","HCPCS C1753","","M001165670  -  CATHETER BLNDIL 7MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001165680","SUP","HCPCS C1753","","M001165680  -  CATHETER BLNDIL 7MM 120CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169410","SUP","HCPCS C1753","","M001169410  -  CATHETER BLNDIL 3MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169420","SUP","HCPCS C1753","","M001169420  -  CATHETER BLNDIL 3MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169430","SUP","HCPCS C1753","","M001169430  -  CATHETER BLNDIL 3MM 135CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169440","SUP","HCPCS C1753","","M001169440  -  CATHETER BLNDIL 4MM 135CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169450","SUP","HCPCS C1753","","M001169450  -  CATHETER BLNDIL 4MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169460","SUP","HCPCS C1753","","M001169460  -  CATHETER BLNDIL 4MM 135CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169470","SUP","HCPCS C1753","","M001169470  -  CATHETER BLNDIL 4MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169480","SUP","HCPCS C1753","","M001169480  -  CATHETER BLNDIL 4MM 135CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169490","SUP","HCPCS C1753","","M001169490  -  CATHETER BLNDIL 4MM 135CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169510","SUP","HCPCS C1753","","M001169510  -  CATHETER BLNDIL 5MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169520","SUP","HCPCS C1753","","M001169520  -  CATHETER BLNDIL 5MM 135CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169530","SUP","HCPCS C1753","","M001169530  -  CATHETER BLNDIL 5MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169540","SUP","HCPCS C1753","","M001169540  -  CATHETER BLNDIL 5MM 135CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169550","SUP","HCPCS C1753","","M001169550  -  CATHETER BLNDIL 5MM 135CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169570","SUP","HCPCS C1753","","M001169570  -  CATHETER BLNDIL 6MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169580","SUP","HCPCS C1753","","M001169580  -  CATHETER BLNDIL 6MM 135CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169590","SUP","HCPCS C1753","","M001169590  -  CATHETER BLNDIL 6MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169600","SUP","HCPCS C1753","","M001169600  -  CATHETER BLNDIL 6MM 135CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169610","SUP","HCPCS C1753","","M001169610  -  CATHETER BLNDIL 6MM 135CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169620","SUP","HCPCS C1753","","M001169620  -  CATHETER BLNDIL 7MM 135CM 15MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169630","SUP","HCPCS C1753","","M001169630  -  CATHETER BLNDIL 7MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169640","SUP","HCPCS C1753","","M001169640  -  CATHETER BLNDIL 7MM 135CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169650","SUP","HCPCS C1753","","M001169650  -  CATHETER BLNDIL 7MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169660","SUP","HCPCS C1753","","M001169660  -  CATHETER BLNDIL 7MM 135CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169670","SUP","HCPCS C1753","","M001169670  -  CATHETER BLNDIL 7MM 135CM 100MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169690","SUP","HCPCS C1753","","M001169690  -  CATHETER BLNDIL 8MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169700","SUP","HCPCS C1753","","M001169700  -  CATHETER BLNDIL 8MM 135CM 30MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169710","SUP","HCPCS C1753","","M001169710  -  CATHETER BLNDIL 8MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169720","SUP","HCPCS C1753","","M001169720  -  CATHETER BLNDIL 8MM 135CM 60MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169730","SUP","HCPCS C1753","","M001169730  -  CATHETER BLNDIL 8MM 135CM 80MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169740","SUP","HCPCS C1753","","M001169740  -  CATHETER BLNDIL 9MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169750","SUP","HCPCS C1753","","M001169750  -  CATHETER BLNDIL 9MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169760","SUP","HCPCS C1753","","M001169760  -  CATHETER BLNDIL 10MM 135CM 20MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001169770","SUP","HCPCS C1753","","M001169770  -  CATHETER BLNDIL 10MM 135CM 40MM U-T D OTW 2 LUM TPR TIP","BOTH IP/OP","$415.25 ","$307.29 ","$0.00 ","$415.25 ","$225.48 ","$0.00 ","$86.55 ","$0.00 ","$0.00 ","$72.71 ","$415.25 ","$0.00 ","$207.63 ","$328.88 ","$332.20 ","$0.00 ","$64.99 ","$0.00 ","$66.11 ","$0.00 "
"M001171020","SUP","Custom 27203010","","M001171020  -  CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 65CM 2 LUMEN","BOTH IP/OP","$471.45 ","$348.87 ","$0.00 ","$471.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$471.45 ","$0.00 ","$235.73 ","$373.39 ","$377.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001171030","SUP","HCPCS C2628","","M001171030  -  CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 100CM 2","BOTH IP/OP","$471.45 ","$348.87 ","$0.00 ","$471.45 ","$0.00 ","$0.00 ","$98.26 ","$0.00 ","$0.00 ","$0.00 ","$471.45 ","$0.00 ","$235.73 ","$373.39 ","$377.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001171050","SUP","HCPCS C1726","","M001171050  -  CATHETER BALLOON OCCLUSION 14FR 20MM 65CM 2 LUMEN RADIOPQ","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001171060","SUP","HCPCS C1726","","M001171060  -  CATHETER BALLOON OCCLUSION 14FR 20MM 100CM 2 LUMEN GWIRE","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001171070","SUP","HCPCS C1726","","M001171070  -  CATHETER BALLOON OCCLUSION 7FR 27MM 65CM 2 LUMEN RADIOPQ","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001171080","SUP","HCPCS C1726","","M001171080  -  CATH BLNOCC .038IN 7FR 27MM 100CM 2 LUM EQLZR 10ML","BOTH IP/OP","$575.93 ","$426.19 ","$0.00 ","$575.93 ","$312.73 ","$0.00 ","$120.04 ","$0.00 ","$0.00 ","$100.84 ","$575.93 ","$0.00 ","$287.96 ","$456.14 ","$460.74 ","$0.00 ","$90.13 ","$0.00 ","$91.69 ","$0.00 "
"M001171090","SUP","HCPCS C1726","","M001171090  -  CATHETER BALLOON OCCLUSION 7FR 33MM 65CM 2 LUMEN RADIOPQ","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001171100","SUP","HCPCS C1726","","M001171100  -  CATHETER BALLOON OCCLUSION 16FR 33MM 100CM 2 LUMEN RADIOPQ","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001171110","SUP","HCPCS C1726","","M001171110  -  CATHETER BALLOON OCCLUSION 7FR 40MM 65CM 2 LUMEN RADIOPQ","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001171120","SUP","HCPCS C1726","","M001171120  -  CATHETER BALLOON OCCLUSION 7FR 40MM 100CM 2 LUMEN RADIOPQ","BOTH IP/OP","$605.65 ","$448.18 ","$0.00 ","$605.65 ","$328.87 ","$0.00 ","$126.23 ","$0.00 ","$0.00 ","$106.04 ","$605.65 ","$0.00 ","$302.83 ","$479.67 ","$484.52 ","$0.00 ","$94.78 ","$0.00 ","$96.42 ","$0.00 "
"M001173010","SUP","HCPCS C2628","","M001173010  -  CATHETER BALLOON OCCLUSION 6FR 11.5MM 80CM 2 LUMEN RADIOPQ","BOTH IP/OP","$471.45 ","$348.87 ","$0.00 ","$471.45 ","$0.00 ","$0.00 ","$98.26 ","$0.00 ","$0.00 ","$0.00 ","$471.45 ","$0.00 ","$235.73 ","$373.39 ","$377.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001175000","SUP","Custom 27203010","","M001175000  -  CATHETER BLNOCC .035IN 5FR 8.5MM 65CM EQLZR 2 LUM","BOTH IP/OP","$551.13 ","$407.84 ","$0.00 ","$551.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$551.13 ","$0.00 ","$275.56 ","$436.49 ","$440.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001181250","SUP","HCPCS C1887","","M001181250  -  MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$210.09 ","$0.00 ","$0.00 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"M001181260","SUP","HCPCS C1887","","M001181260  -  MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$210.09 ","$0.00 ","$0.00 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"M001181270","SUP","HCPCS C1887","","M001181270  -  MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$573.00 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"M001181280","SUP","HCPCS C1887","","M001181280  -  MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$573.00 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"M001181310","SUP","HCPCS C1887","","M001181310  -  MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"M001181320","SUP","HCPCS C1887","","M001181320  -  MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$210.09 ","$0.00 ","$0.00 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"M001181330","SUP","HCPCS C1887","","M001181330  -  MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$573.00 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"M001181340","SUP","HCPCS C1887","","M001181340  -  MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$573.00 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"M001181370","SUP","HCPCS C1887","","M001181370  -  MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$210.09 ","$0.00 ","$0.00 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"M001181380","SUP","HCPCS C1887","","M001181380  -  MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,008.00 ","$745.92 ","$0.00 ","$1,008.00 ","$547.34 ","$0.00 ","$210.09 ","$0.00 ","$0.00 ","$176.49 ","$1,008.00 ","$0.00 ","$504.00 ","$798.34 ","$806.40 ","$0.00 ","$157.75 ","$0.00 ","$160.47 ","$0.00 "
"M001181390","SUP","HCPCS C1887","","M001181390  -  MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$573.00 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"M001181400","SUP","HCPCS C1887","","M001181400  -  MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ","BOTH IP/OP","$1,055.25 ","$780.89 ","$0.00 ","$1,055.25 ","$573.00 ","$0.00 ","$219.94 ","$0.00 ","$0.00 ","$184.77 ","$1,055.25 ","$0.00 ","$527.63 ","$835.76 ","$844.20 ","$0.00 ","$165.15 ","$0.00 ","$168.00 ","$0.00 "
"M001182590","SUP","HCPCS C1887","","M001182590  -  MICROCATHETER INFS 3-2.5FR 150CM RNGD RADOPQ BRD DIST TIP","BOTH IP/OP","$1,959.90 ","$1,450.33 ","$0.00 ","$1,662.50 ","$902.74 ","$0.00 ","$408.49 ","$0.00 ","$0.00 ","$291.09 ","$1,662.50 ","$0.00 ","$831.25 ","$1,316.70 ","$1,330.00 ","$0.00 ","$260.18 ","$0.00 ","$264.67 ","$0.00 "
"M001182830","SUP","HCPCS C1751","","M001182830  -  CATHETER INFUS MICRO 3-2.8FR .027IN 80CM 20CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182840","SUP","HCPCS C1751","","M001182840  -  CATHETER INFUS STR 20.8-30FR .027IN 105CM 10CM RENEGADE","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182850","SUP","HCPCS C1751","","M001182850  -  CATHETER INFUS MICRO 3-2.8FR .027IN 105CM 20CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182860","SUP","HCPCS C1751","","M001182860  -  CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 10CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182870","SUP","HCPCS C1751","","M001182870  -  CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 20CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182880","SUP","HCPCS C1751","","M001182880  -  CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 10CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182890","SUP","HCPCS C1751","","M001182890  -  CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 20CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182900","SUP","HCPCS C1751","","M001182900  -  CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 10CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182910","SUP","HCPCS C1751","","M001182910  -  CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 20CM KIT RADIOPQ","BOTH IP/OP","$899.60 ","$665.70 ","$0.00 ","$899.60 ","$488.48 ","$0.00 ","$187.50 ","$0.00 ","$0.00 ","$157.51 ","$899.60 ","$0.00 ","$449.80 ","$712.48 ","$719.68 ","$0.00 ","$140.79 ","$0.00 ","$143.22 ","$0.00 "
"M001182920","SUP","HCPCS C1887","","M001182920  -  CATHETER INFUS 105CM KIT MICROCATHETER RADIOPQ MARKER","BOTH IP/OP","$1,193.53 ","$883.21 ","$0.00 ","$1,193.53 ","$648.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.98 ","$1,193.53 ","$0.00 ","$596.76 ","$945.28 ","$954.82 ","$0.00 ","$186.79 ","$0.00 ","$190.01 ","$0.00 "
"M001182930","SUP","HCPCS C1887","","M001182930  -  CATHETER INFUS 105CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO","BOTH IP/OP","$1,193.53 ","$883.21 ","$0.00 ","$1,193.53 ","$648.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.98 ","$1,193.53 ","$0.00 ","$596.76 ","$945.28 ","$954.82 ","$0.00 ","$186.79 ","$0.00 ","$190.01 ","$0.00 "
"M001182940","SUP","HCPCS C1887","","M001182940  -  CATHETER INFUS 115CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO","BOTH IP/OP","$1,193.53 ","$883.21 ","$0.00 ","$1,193.53 ","$648.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.98 ","$1,193.53 ","$0.00 ","$596.76 ","$945.28 ","$954.82 ","$0.00 ","$186.79 ","$0.00 ","$190.01 ","$0.00 "
"M001182950","SUP","HCPCS C1887","","M001182950  -  CATHETER INFUS 115CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO","BOTH IP/OP","$1,193.53 ","$883.21 ","$0.00 ","$1,193.53 ","$648.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.98 ","$1,193.53 ","$0.00 ","$596.76 ","$945.28 ","$954.82 ","$0.00 ","$186.79 ","$0.00 ","$190.01 ","$0.00 "
"M001182960","SUP","HCPCS C1887","","M001182960  -  CATHETER INFUS 135CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO","BOTH IP/OP","$1,193.53 ","$883.21 ","$0.00 ","$1,193.53 ","$648.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.98 ","$1,193.53 ","$0.00 ","$596.76 ","$945.28 ","$954.82 ","$0.00 ","$186.79 ","$0.00 ","$190.01 ","$0.00 "
"M001182970","SUP","HCPCS C1887","","M001182970  -  CATHETER INFUS 135CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO","BOTH IP/OP","$1,193.53 ","$883.21 ","$0.00 ","$1,193.53 ","$648.08 ","$0.00 ","$248.76 ","$0.00 ","$0.00 ","$208.98 ","$1,193.53 ","$0.00 ","$596.76 ","$945.28 ","$954.82 ","$0.00 ","$186.79 ","$0.00 ","$190.01 ","$0.00 "
"M001184500","SUP","HCPCS C1887","","M001184500  -  GUIDEWIRE VASCULAR .016IN 105CM 10CM PRELOAD HI-FLO RENEGADE","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184510","SUP","HCPCS C1887","","M001184510  -  GUIDEWIRE VASCULAR .016IN 105CM 20CM PRELOAD HI-FLO RENEGADE","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184520","SUP","HCPCS C1887","","M001184520  -  GUIDEWIRE VASCULAR .016IN 115CM 10CM PRELOAD HI-FLO RENEGADE","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184530","SUP","HCPCS C1887","","M001184530  -  GUIDEWIRE VASCULAR .016IN 115CM 20CM PRELOAD HI-FLO RENEGADE","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184540","SUP","HCPCS C1887","","M001184540  -  CATHETER GUID 10CM MICRO 2.8-3FR 180CM 135CM KIT STEERABLE","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184550","SUP","HCPCS C1887","","M001184550  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184560","SUP","HCPCS C1887","","M001184560  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001184570","SUP","HCPCS C1887","","M001184570  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM","BOTH IP/OP","$1,540.00 ","$1,139.60 ","$0.00 ","$1,540.00 ","$836.22 ","$0.00 ","$320.97 ","$0.00 ","$0.00 ","$269.64 ","$1,540.00 ","$0.00 ","$770.00 ","$1,219.68 ","$1,232.00 ","$0.00 ","$241.01 ","$0.00 ","$245.17 ","$0.00 "
"M001196000","SUP","HCPCS C1887","","M001196000  -  CATHETER GD HS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196040","SUP","HCPCS C1887","","M001196040  -  CATHETER GD RE S 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196080","SUP","HCPCS C1887","","M001196080  -  CATHETER GD RE SS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196120","SUP","HCPCS C1887","","M001196120  -  CATHETER GD RE1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196160","SUP","HCPCS C1887","","M001196160  -  CATHETER GD C1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196200","SUP","HCPCS C1887","","M001196200  -  CATHETER GD C2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196230","SUP","HCPCS C1887","","M001196230  -  CATHETER GD MP CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196260","SUP","HCPCS C1887","","M001196260  -  CATHETER GD MP CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196300","SUP","HCPCS C1887","","M001196300  -  CATHETER GD MP2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196330","SUP","HCPCS C1887","","M001196330  -  CATHETER GD MP2 CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196380","SUP","HCPCS C1887","","M001196380  -  CATHETER GD 40D 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196450","SUP","HCPCS C1887","","M001196450  -  CATHETER GD ST CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196480","SUP","HCPCS C1887","","M001196480  -  CATHETER GD ST CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196530","SUP","HCPCS C1887","","M001196530  -  CATHETER GD XVR 1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196560","SUP","HCPCS C1887","","M001196560  -  CATHETER GD XVR 2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196620","SUP","HCPCS C1887","","M001196620  -  CATHETER GD LIMA CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196660","SUP","HCPCS C1887","","M001196660  -  CATHETER GD RDC CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196700","SUP","HCPCS C1887","","M001196700  -  CATHETER GD BATES 1 CRV 6FR 55CM STRL LF MACH1 LG LUM SH","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196800","SUP","HCPCS C1887","","M001196800  -  CATHETER GD BATES 2 CRV 6FR 55CM STRL LF MACH1 LG LUM SH","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001196960","SUP","HCPCS C1887","","M001196960  -  CATHETER GD RDC1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197000","SUP","HCPCS C1887","","M001197000  -  CATHETER GD HS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197040","SUP","HCPCS C1887","","M001197040  -  CATHETER GD RE S 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197080","SUP","HCPCS C1887","","M001197080  -  CATHETER GD RE SS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197120","SUP","HCPCS C1887","","M001197120  -  CATHETER GD RE L CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197160","SUP","HCPCS C1887","","M001197160  -  CATHETER GD C1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197200","SUP","HCPCS C1887","","M001197200  -  CATHETER GD C2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197230","SUP","HCPCS C1887","","M001197230  -  CATHETER GD MP CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197260","SUP","HCPCS C1887","","M001197260  -  CATHETER GD MP CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197300","SUP","HCPCS C1887","","M001197300  -  CATHETER GD MP2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197330","SUP","HCPCS C1887","","M001197330  -  CATHETER GD MP2 CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197380","SUP","HCPCS C1887","","M001197380  -  CATHETER GD 40D 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197450","SUP","HCPCS C1887","","M001197450  -  CATHETER GD ST CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197480","SUP","HCPCS C1887","","M001197480  -  CATHETER GD ST CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197530","SUP","HCPCS C1887","","M001197530  -  CATHETER GD XVR 1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197560","SUP","HCPCS C1887","","M001197560  -  CATHETER GD XVR 2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197620","SUP","HCPCS C1887","","M001197620  -  CATHETER GD LIMA CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197660","SUP","HCPCS C1887","","M001197660  -  CATHETER GD RDC CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197700","SUP","HCPCS C1887","","M001197700  -  CATHETER GD BATES 1 CRV 7FR 55CM STRL LF MACH1 LG LUM SH","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197800","SUP","HCPCS C1887","","M001197800  -  CATHETER GD BATES 2 CRV 7FR 55CM STRL LF MACH1 LG LUM SH","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001197960","SUP","HCPCS C1887","","M001197960  -  CATHETER GD RDC1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198000","SUP","HCPCS C1887","","M001198000  -  CATHETER GD HS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198040","SUP","HCPCS C1887","","M001198040  -  CATHETER GD RE S 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198080","SUP","HCPCS C1887","","M001198080  -  CATHETER GD RE SS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198120","SUP","HCPCS C1887","","M001198120  -  CATHETER GD RE L CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198160","SUP","HCPCS C1887","","M001198160  -  CATHETER GD C1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198200","SUP","HCPCS C1887","","M001198200  -  CATHETER GD C2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198230","SUP","HCPCS C1887","","M001198230  -  CATHETER GD MP CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198260","SUP","HCPCS C1887","","M001198260  -  CATHETER GD MP CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198300","SUP","HCPCS C1887","","M001198300  -  CATHETER GD MP2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198330","SUP","HCPCS C1887","","M001198330  -  CATHETER GD MP2 CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198380","SUP","HCPCS C1887","","M001198380  -  CATHETER GD 40D 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198450","SUP","HCPCS C1887","","M001198450  -  CATHETER GD ST CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198480","SUP","HCPCS C1887","","M001198480  -  CATHETER GD ST CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198530","SUP","HCPCS C1887","","M001198530  -  CATHETER GD XVR 1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198560","SUP","HCPCS C1887","","M001198560  -  CATHETER GD XVR 2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198620","SUP","HCPCS C1887","","M001198620  -  CATHETER GD LIMA CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198660","SUP","HCPCS C1887","","M001198660  -  CATHETER GD RDC CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198700","SUP","HCPCS C1887","","M001198700  -  CATHETER GD BATES 1 CRV 8FR 55CM STRL LF MACH1 LG LUM SH","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198800","SUP","HCPCS C1887","","M001198800  -  CATHETER GD BATES 2 CRV 8FR 55CM STRL LF MACH1 LG LUM SH","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001198960","SUP","HCPCS C1887","","M001198960  -  CATHETER GD RDC1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2","BOTH IP/OP","$214.50 ","$158.73 ","$0.00 ","$214.50 ","$116.47 ","$0.00 ","$44.71 ","$0.00 ","$0.00 ","$37.56 ","$214.50 ","$0.00 ","$107.25 ","$169.88 ","$171.60 ","$0.00 ","$33.57 ","$0.00 ","$34.15 ","$0.00 "
"M001206130","SUP","HCPCS C1892","","M001206130  -  INTRODUCER SHTH 11FR 30CM BNA PL PLWY COAX LCK TPR PE","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$73.31 ","$0.00 ","$28.14 ","$0.00 ","$0.00 ","$23.64 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$21.13 ","$0.00 ","$21.49 ","$0.00 "
"M001207020","SUP","HCPCS C1894","","M001207020  -  INTROD SHTH 6FR 4FR 20CM COAX DILAT JTP HVDTY FLPY XSTIF","BOTH IP/OP","$63.13 ","$46.72 ","$0.00 ","$233.13 ","$126.59 ","$0.00 ","$13.16 ","$0.00 ","$0.00 ","$40.82 ","$233.13 ","$0.00 ","$116.56 ","$184.64 ","$186.50 ","$0.00 ","$36.48 ","$0.00 ","$37.11 ","$0.00 "
"M001207030","SUP","HCPCS C1894","","M001207030  -  SYSTEM INTROD .018IN .038IN FLOPPY STR 6FR 4FR 60CM 145CM 2","BOTH IP/OP","$189.38 ","$140.14 ","$0.00 ","$189.38 ","$102.83 ","$0.00 ","$39.47 ","$0.00 ","$0.00 ","$33.16 ","$189.38 ","$0.00 ","$94.69 ","$149.99 ","$151.50 ","$0.00 ","$29.64 ","$0.00 ","$30.15 ","$0.00 "
"M001207040","SUP","HCPCS C1892","","M001207040  -  SYSTEM INTROD .038IN FLOPPY 6FR 4FR 60CM 20CM DILAT RADIOPQ","BOTH IP/OP","$151.88 ","$112.39 ","$0.00 ","$151.88 ","$82.47 ","$0.00 ","$31.65 ","$0.00 ","$0.00 ","$26.59 ","$151.88 ","$0.00 ","$75.94 ","$120.29 ","$121.50 ","$0.00 ","$23.77 ","$0.00 ","$24.18 ","$0.00 "
"M001207050","SUP","HCPCS C1894","","M001207050  -  SYSTEM INTROD 6FR ACCUSTICK II STERILE DISPOSABLE","BOTH IP/OP","$120.00 ","$88.80 ","$0.00 ","$120.00 ","$65.16 ","$0.00 ","$25.01 ","$0.00 ","$0.00 ","$21.01 ","$120.00 ","$0.00 ","$60.00 ","$95.04 ","$96.00 ","$0.00 ","$18.78 ","$0.00 ","$19.10 ","$0.00 "
"M001207111","SUP","HCPCS C1729","","M001207111  -  INTRODUCER SHEATH .018IN FLOPPY 60CM 6CM RADIOPQ GWIRE","BOTH IP/OP","$451.88 ","$334.39 ","$0.00 ","$451.88 ","$245.37 ","$0.00 ","$94.18 ","$0.00 ","$0.00 ","$79.12 ","$451.88 ","$0.00 ","$225.94 ","$357.89 ","$361.50 ","$0.00 ","$70.72 ","$0.00 ","$71.94 ","$0.00 "
"M001208500","SUP","Custom 27203010","","M001208500  -  SET GSTRM 18GA BVL NDL AFFIXATION DEV BR-MLR TFSTNR SET","BOTH IP/OP","$131.25 ","$97.13 ","$0.00 ","$131.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.25 ","$0.00 ","$65.63 ","$103.95 ","$105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001221000","SUP","HCPCS C1729","","M001221000  -  CATHETER DRAIN 8FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR","BOTH IP/OP","$189.38 ","$140.14 ","$0.00 ","$189.38 ","$102.83 ","$0.00 ","$39.47 ","$0.00 ","$0.00 ","$33.16 ","$189.38 ","$0.00 ","$94.69 ","$149.99 ","$151.50 ","$0.00 ","$29.64 ","$0.00 ","$30.15 ","$0.00 "
"M001221010","SUP","HCPCS C1729","","M001221010  -  CATHETER DRAIN 10FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR","BOTH IP/OP","$189.38 ","$140.14 ","$0.00 ","$189.38 ","$102.83 ","$0.00 ","$39.47 ","$0.00 ","$0.00 ","$33.16 ","$189.38 ","$0.00 ","$94.69 ","$149.99 ","$151.50 ","$0.00 ","$29.64 ","$0.00 ","$30.15 ","$0.00 "
"M001221020","SUP","HCPCS C2617","","M001221020  -  CATHETER DRAIN 12FR 30CM LOCK STIFFEN CANNU LATEX FREE","BOTH IP/OP","$189.38 ","$140.14 ","$0.00 ","$189.38 ","$85.22 ","$0.00 ","$39.47 ","$0.00 ","$0.00 ","$33.16 ","$189.38 ","$0.00 ","$94.69 ","$149.99 ","$151.50 ","$0.00 ","$29.64 ","$0.00 ","$30.15 ","$0.00 "
"M001221360","SUP","HCPCS C2617","","M001221360  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221370","SUP","HCPCS C2617","","M001221370  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221380","SUP","HCPCS C2617","","M001221380  -  STENT NEPHROURETERAL 2.66MM 26CM STIFFENING CANNU INTERNAL","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221390","SUP","HCPCS C2617","","M001221390  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221400","SUP","HCPCS C2617","","M001221400  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221410","SUP","HCPCS C2617","","M001221410  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221420","SUP","HCPCS C2617","","M001221420  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001221430","SUP","HCPCS C2617","","M001221430  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM","BOTH IP/OP","$245.63 ","$181.77 ","$0.00 ","$245.63 ","$110.53 ","$0.00 ","$51.19 ","$0.00 ","$0.00 ","$43.01 ","$245.63 ","$0.00 ","$122.81 ","$194.54 ","$196.50 ","$0.00 ","$38.44 ","$0.00 ","$39.10 ","$0.00 "
"M001225140","SUP","HCPCS C1729","","M001225140  -  SET NEPHROSTOMY PIGTAIL CURVE 8FR FIRM DUROMETER LOCK VTC","BOTH IP/OP","$176.25 ","$130.43 ","$0.00 ","$176.25 ","$95.70 ","$0.00 ","$36.73 ","$0.00 ","$0.00 ","$30.86 ","$176.25 ","$0.00 ","$88.13 ","$139.59 ","$141.00 ","$0.00 ","$27.58 ","$0.00 ","$28.06 ","$0.00 "
"M001225510","SUP","HCPCS C2617","","M001225510  -  STENT URET .038IN LG REG PGTL CRV 8FR 24CM DRMTR RADOPQ DRN","BOTH IP/OP","$313.50 ","$231.99 ","$0.00 ","$313.50 ","$141.08 ","$0.00 ","$65.34 ","$0.00 ","$0.00 ","$54.89 ","$313.50 ","$0.00 ","$156.75 ","$248.29 ","$250.80 ","$0.00 ","$49.06 ","$0.00 ","$49.91 ","$0.00 "
"M001225520","SUP","HCPCS C1768","","STENT URET 8FR 26CM REG DRMTR LG DRAIN HOLE PROX PGTL LCK","BOTH IP/OP","$303.28 ","$224.43 ","$0.00 ","$303.28 ","$136.47 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.10 ","$303.28 ","$0.00 ","$151.64 ","$240.20 ","$242.62 ","$0.00 ","$47.46 ","$0.00 ","$48.28 ","$0.00 "
"M001262160","SUP","Custom 27203010","","M001262160  -  NEEDLE ELECTROSURGICAL STANDARD UMBRELLA 5CM 15CM ARRAY TIP","BOTH IP/OP","$5,362.50 ","$3,968.25 ","$0.00 ","$5,362.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,362.50 ","$0.00 ","$2,681.25 ","$4,247.10 ","$4,290.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001271460","SUP","HCPCS C1729","","M001271460  -  CATHETER DRAIN LOOP 8FR 25CM QUICKSTICK FLEXIMA HYDPHI","BOTH IP/OP","$170.18 ","$125.93 ","$0.00 ","$170.18 ","$92.41 ","$0.00 ","$35.47 ","$0.00 ","$0.00 ","$29.80 ","$170.18 ","$0.00 ","$85.09 ","$134.78 ","$136.14 ","$0.00 ","$26.63 ","$0.00 ","$27.09 ","$0.00 "
"M001271470","SUP","HCPCS C1729","","M001271470  -  CATHETER DRAIN LOOP 10FR 25CM QUICKSTICK FLEXIMA HYDPHI","BOTH IP/OP","$170.18 ","$125.93 ","$0.00 ","$170.18 ","$92.41 ","$0.00 ","$35.47 ","$0.00 ","$0.00 ","$29.80 ","$170.18 ","$0.00 ","$85.09 ","$134.78 ","$136.14 ","$0.00 ","$26.63 ","$0.00 ","$27.09 ","$0.00 "
"M001271540","SUP","HCPCS C1729","","M001271540  -  CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271550","SUP","HCPCS C1729","","M001271550  -  CATHETER DRAIN 10FR 35CM METAL AND FLEXIBLE STIFFENING CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271560","SUP","HCPCS C1729","","M001271560  -  CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271570","SUP","HCPCS C1729","","M001271570  -  CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271580","SUP","HCPCS C1729","","M001271580  -  CATHETER DRAIN PIGTAIL CURVE 12FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271590","SUP","HCPCS C1729","","M001271590  -  CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271600","SUP","HCPCS C1729","","M001271600  -  CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271610","SUP","HCPCS C1729","","M001271610  -  CATHETER DRN PGTL CRV 12FR 35CM FLXB STF CNN LCK DRMTR SFT","BOTH IP/OP","$235.25 ","$174.09 ","$0.00 ","$235.25 ","$127.74 ","$0.00 ","$49.03 ","$0.00 ","$0.00 ","$41.19 ","$235.25 ","$0.00 ","$117.63 ","$186.32 ","$188.20 ","$0.00 ","$36.82 ","$0.00 ","$37.45 ","$0.00 "
"M001271620","SUP","HCPCS C1729","","M001271620  -  CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271630","SUP","HCPCS C1729","","M001271630  -  KIT DRAIN 8FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$186.79 ","$0.00 ","$71.70 ","$0.00 ","$0.00 ","$60.23 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$53.84 ","$0.00 ","$54.76 ","$0.00 "
"M001271640","SUP","HCPCS C1729","","M001271640  -  KIT DRAIN 10FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$186.79 ","$0.00 ","$71.70 ","$0.00 ","$0.00 ","$60.23 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$53.84 ","$0.00 ","$54.76 ","$0.00 "
"M001271650","SUP","HCPCS C1729","","M001271650  -  CATHETER DRAIN REGULAR PIGTAIL CURVE 8FR 35CM KIT LOCK","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$186.79 ","$0.00 ","$71.70 ","$0.00 ","$0.00 ","$60.23 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$53.84 ","$0.00 ","$54.76 ","$0.00 "
"M001271660","SUP","HCPCS C1729","","M001271660  -  KIT DRAIN REGULAR 10FR 35CM DUROMETER LARGE HOLE FLEXIMA","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$186.79 ","$0.00 ","$71.70 ","$0.00 ","$0.00 ","$60.23 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$53.84 ","$0.00 ","$54.76 ","$0.00 "
"M001271770","SUP","HCPCS C1729","","M001271770  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK DUROMETER","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271780","SUP","HCPCS C1729","","M001271780  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271790","SUP","HCPCS C1729","","M001271790  -  CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 8FR 25CM LOCK","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271800","SUP","HCPCS C1729","","M001271800  -  CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 10FR 25CM LOCK","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271810","SUP","HCPCS C1729","","M001271810  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK DUROMETER","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271820","SUP","Custom 27203010","","M001271820  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK DUROMETER","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001271830","SUP","HCPCS C1726","","M001271830  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271840","SUP","HCPCS C1729","","M001271840  -  CATHETER DRAIN 12FR 25CM RADIOPQ SOFT DUROMETER TEMP TIP","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271850","SUP","HCPCS C1729","","M001271850  -  CATHETER NPHSTM PGTL CRV 14FR 25CM LCK SFT DRMTR FLXM PU","BOTH IP/OP","$190.30 ","$140.82 ","$0.00 ","$190.30 ","$103.33 ","$0.00 ","$39.66 ","$0.00 ","$0.00 ","$33.32 ","$190.30 ","$0.00 ","$95.15 ","$150.72 ","$152.24 ","$0.00 ","$29.78 ","$0.00 ","$30.30 ","$0.00 "
"M001271860","SUP","Custom 27203010","","M001271860  -  SET NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001271870","SUP","Custom 27203010","","M001271870  -  KIT NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK REGULAR","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001271880","SUP","Custom 27203010","","M001271880  -  KIT NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK REGULAR","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001271900","SUP","Custom 27203010","","M001271900  -  KIT NEPHROSTOMY J PIGTAIL CURVE 18FR 21GA 25CM DUROMETER","BOTH IP/OP","$344.00 ","$254.56 ","$0.00 ","$344.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$344.00 ","$0.00 ","$172.00 ","$272.45 ","$275.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001272600","SUP","HCPCS C1729","","M001272600  -  CATH DRAIN 8FR 35CM LCK PGTL REG DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272610","SUP","HCPCS C1729","","M001272610  -  CATH DRAIN 10FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272620","SUP","HCPCS C1729","","M001272620  -  CATH DRAIN 12FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272630","SUP","HCPCS C1729","","M001272630  -  CATH DRAIN 14FR 35CM LCK PGTL REG DRMTR RADIOPQ BIL PU FLXM","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272640","SUP","HCPCS C1729","","M001272640  -  CATH DRAIN 8FR 35CM LCK FIRM DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272650","SUP","HCPCS C1729","","M001272650  -  CATH DRAIN 10FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272660","SUP","HCPCS C1729","","M001272660  -  CATH DRAIN 10FR 35CM LCK SFT DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001272670","SUP","HCPCS C1729","","M001272670  -  CATH DRAIN 12FR 35CM LCK SFT DRMTR RADIOPQ BIL PU HYDPHI","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001273130","SUP","HCPCS C1729","","M001273130  -  CATHETER DRAIN 30CM 2 LUMEN REGULAR DUROMETER VANSONNENBERG","BOTH IP/OP","$364.25 ","$269.55 ","$0.00 ","$364.25 ","$197.79 ","$0.00 ","$75.92 ","$0.00 ","$0.00 ","$63.78 ","$364.25 ","$0.00 ","$182.13 ","$288.49 ","$291.40 ","$0.00 ","$57.01 ","$0.00 ","$57.99 ","$0.00 "
"M001274000","SUP","HCPCS C2617","","M001274000  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 20CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274010","SUP","HCPCS C2617","","M001274010  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 22CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274020","SUP","HCPCS C2617","","M001274020  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 24CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274030","SUP","HCPCS C2617","","M001274030  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 26CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274040","SUP","HCPCS C2617","","M001274040  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 28CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274050","SUP","HCPCS C2617","","M001274050  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 20CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274060","SUP","HCPCS C2617","","M001274060  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 22CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274070","SUP","HCPCS C2617","","M001274070  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 24CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274080","SUP","HCPCS C2617","","M001274080  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 26CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274090","SUP","HCPCS C2617","","M001274090  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 28CM","BOTH IP/OP","$266.25 ","$197.03 ","$0.00 ","$266.25 ","$119.81 ","$0.00 ","$55.49 ","$0.00 ","$0.00 ","$46.62 ","$266.25 ","$0.00 ","$133.13 ","$210.87 ","$213.00 ","$0.00 ","$41.67 ","$0.00 ","$42.39 ","$0.00 "
"M001274110","SUP","HCPCS C2617","","M001274110  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 22CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274120","SUP","HCPCS C2617","","M001274120  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 24CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274130","SUP","HCPCS C2617","","M001274130  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 26CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274140","SUP","HCPCS C2617","","M001274140  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 28CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274150","SUP","HCPCS C2617","","M001274150  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 20CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274160","SUP","HCPCS C2617","","M001274160  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 22CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274170","SUP","HCPCS C2617","","M001274170  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 24CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274180","SUP","HCPCS C2617","","M001274180  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 26CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001274190","SUP","HCPCS C2617","","M001274190  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 28CM DRAIN","BOTH IP/OP","$423.75 ","$313.58 ","$0.00 ","$423.75 ","$190.69 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$74.20 ","$423.75 ","$0.00 ","$211.88 ","$335.61 ","$339.00 ","$0.00 ","$66.32 ","$0.00 ","$67.46 ","$0.00 "
"M001281560","SUP","HCPCS C1729","","M001281560  -  CATHETER DRAIN 8FR 35CM 1 LUMEN REGULAR DUROMETER FLEXIBLE","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$107.31 ","$0.00 ","$41.19 ","$0.00 ","$0.00 ","$34.60 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$30.93 ","$0.00 ","$31.46 ","$0.00 "
"M001281570","SUP","HCPCS C1729","","M001281570  -  CATHETER DRAIN 10FR 35CM REGULAR DUROMETER DISSOLVABLE TIP","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$107.31 ","$0.00 ","$41.19 ","$0.00 ","$0.00 ","$34.60 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$30.93 ","$0.00 ","$31.46 ","$0.00 "
"M001281580","SUP","HCPCS C1729","","M001281580  -  CATHETER DRAIN REGULAR 12FR 35CM TEMP TIP FLEXIMA HYDPHI","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$107.31 ","$0.00 ","$41.19 ","$0.00 ","$0.00 ","$34.60 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$30.93 ","$0.00 ","$31.46 ","$0.00 "
"M001281590","SUP","HCPCS C1729","","M001281590  -  CATHETER DRAIN 14FR 35CM REGULAR DUROMETER DISSOLVABLE TIP","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$107.31 ","$0.00 ","$41.19 ","$0.00 ","$0.00 ","$34.60 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$30.93 ","$0.00 ","$31.46 ","$0.00 "
"M001281660","SUP","Custom 27203010","","M001281660  -  KIT NEPHROSTOMY .018IN PIGTAIL CURVE FLOPPY 10FR 21GA 25CM","BOTH IP/OP","$364.13 ","$269.46 ","$0.00 ","$364.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$364.13 ","$0.00 ","$182.06 ","$288.39 ","$291.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001281790","SUP","HCPCS C1726","","M001281790  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$107.31 ","$0.00 ","$41.19 ","$0.00 ","$0.00 ","$34.60 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$30.93 ","$0.00 ","$31.46 ","$0.00 "
"M001281800","SUP","HCPCS C1729","","M001281800  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK SOFT","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$107.31 ","$0.00 ","$41.19 ","$0.00 ","$0.00 ","$34.60 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$30.93 ","$0.00 ","$31.46 ","$0.00 "
"M001281810","SUP","Custom 27203010","","M001281810  -  CATHETER NEPHROSTOMY 12FR 25CM REGULAR DUROMETER DRAIN HOLE","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001281820","SUP","Custom 27203010","","M001281820  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK REGULAR","BOTH IP/OP","$197.63 ","$146.25 ","$0.00 ","$197.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$197.63 ","$0.00 ","$98.81 ","$156.52 ","$158.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001282600","SUP","HCPCS C1729","","M001282600  -  CATH DRAIN 8FR 35CM LCK REG DRMTR TMPTP RADIOPQ BIL PU","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001282610","SUP","HCPCS C1729","","M001282610  -  CATH DRAIN 10FR 35CM LCK TEMP TIP RADIOPQ BIL PU HYDPHI FLXM","BOTH IP/OP","$200.63 ","$148.47 ","$0.00 ","$200.63 ","$108.94 ","$0.00 ","$41.82 ","$0.00 ","$0.00 ","$35.13 ","$200.63 ","$0.00 ","$100.31 ","$158.90 ","$160.50 ","$0.00 ","$31.40 ","$0.00 ","$31.94 ","$0.00 "
"M001291650","SUP","HCPCS C1729","","M001291650  -  KIT DRAIN 35CM 8FR PU HYDPHI FLXM BIL REG DRMTR STRL DISP","BOTH IP/OP","$402.85 ","$298.11 ","$0.00 ","$402.85 ","$218.75 ","$0.00 ","$83.96 ","$0.00 ","$0.00 ","$70.54 ","$402.85 ","$0.00 ","$201.43 ","$319.06 ","$322.28 ","$0.00 ","$63.05 ","$0.00 ","$64.13 ","$0.00 "
"M0013120021","SUP","Custom 27803010","","M0013120021  -  COIL EMBOLIZATION .018IN HELIX STR 2MM PLATINUM FIBER","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120051","SUP","Custom 27803010","","M0013120051  -  COIL EMBOLIZATION STR 2MM 50MM 5MM 18 COIL PLATINUM FIBER","BOTH IP/OP","$136.50 ","$101.01 ","$0.00 ","$136.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$136.50 ","$0.00 ","$68.25 ","$108.11 ","$109.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120211","SUP","Custom 27803010","","M0013120211  -  COIL EMBOLIZATION 2MM 5MM 10MM 8-18 COIL FIBERED PLATINUM","BOTH IP/OP","$198.83 ","$147.13 ","$0.00 ","$198.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.83 ","$0.00 ","$99.42 ","$157.47 ","$159.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120221","SUP","Custom 27803010","","M0013120221  -  COIL EMBOLIZATION .018IN HELIX 4MM 4MM COMPLEX PLATINUM","BOTH IP/OP","$994.15 ","$735.67 ","$0.00 ","$994.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$994.15 ","$0.00 ","$497.08 ","$787.37 ","$795.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120331","SUP","Custom 27803010","","M0013120331  -  COIL EMBOLIZATION .018IN HELIX 6MM 6MM COMPLEX PLATINUM","BOTH IP/OP","$198.83 ","$147.13 ","$0.00 ","$198.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.83 ","$0.00 ","$99.42 ","$157.47 ","$159.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120431","SUP","Custom 27803010","","M0013120431  -  COIL EMBOLIZATION .018IN HELIX 4MM 30MM COMPLEX PLATINUM","BOTH IP/OP","$1,025.05 ","$758.54 ","$0.00 ","$1,025.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.05 ","$0.00 ","$512.53 ","$811.84 ","$820.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120441","SUP","Custom 27803010","","M0013120441  -  COIL EMBOLIZATION .018IN HELIX 7MM 10MM COMPLEX PLATINUM","BOTH IP/OP","$205.01 ","$151.71 ","$0.00 ","$205.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.01 ","$0.00 ","$102.51 ","$162.37 ","$164.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120551","SUP","Custom 27803010","","M0013120551  -  COIL EMBOLIZATION .018IN HELICAL 8MM 12MM FIBERED COMPLEX","BOTH IP/OP","$1,025.05 ","$758.54 ","$0.00 ","$1,025.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,025.05 ","$0.00 ","$512.53 ","$811.84 ","$820.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120661","SUP","Custom 27803010","","M0013120661  -  COIL EMBOLIZATION .018IN HELICAL COMPLEX 10MM 14MM 60MM","BOTH IP/OP","$205.01 ","$151.71 ","$0.00 ","$205.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.01 ","$0.00 ","$102.51 ","$162.37 ","$164.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0013120771","SUP","Custom 27803010","","M0013120771  -  COIL EMBOLIZATION .018IN HELIX 11MM 17MM COMPLEX PLATINUM","BOTH IP/OP","$205.01 ","$151.71 ","$0.00 ","$205.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.01 ","$0.00 ","$102.51 ","$162.37 ","$164.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001314001","SUP","HCPCS C1725","","M001314001  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314011","SUP","HCPCS C1725","","M001314011  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 100CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314021","SUP","HCPCS C1725","","M001314021  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314031","SUP","HCPCS C1725","","M001314031  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314041","SUP","HCPCS C1725","","M001314041  -  CATHETER ANGIOGRAPHIC BERN CURVE FLUTE TAPER 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314051","SUP","HCPCS C1725","","M001314051  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314061","SUP","HCPCS C1725","","M001314061  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314071","SUP","HCPCS C1725","","M001314071  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314081","SUP","HCPCS C1887","","M001314081  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE","BOTH IP/OP","$127.40 ","$94.28 ","$0.00 ","$127.40 ","$69.18 ","$0.00 ","$26.55 ","$0.00 ","$0.00 ","$22.31 ","$127.40 ","$0.00 ","$63.70 ","$100.90 ","$101.92 ","$0.00 ","$19.94 ","$0.00 ","$20.28 ","$0.00 "
"M001314101","SUP","HCPCS C1725","","M001314101  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314111","SUP","HCPCS C1725","","M001314111  -  CATHETER ANGIOGRAPHIC WEIN CURVE FLUTE TAPER 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314121","SUP","HCPCS C1725","","M001314121  -  CATHETER ANGIOGRAPHIC WEIN CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314131","SUP","HCPCS C1725","","M001314131  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314141","SUP","HCPCS C1725","","M001314141  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314151","SUP","HCPCS C1725","","M001314151  -  CATHETER ANGIO HDHNTR 1 CRV 5FR 100CM IMGR2 BRD TRQ SLCT","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314161","SUP","HCPCS C1725","","M001314161  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM TAPER TIP","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314171","SUP","HCPCS C1725","","M001314171  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314181","SUP","HCPCS C1725","","M001314181  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314191","SUP","HCPCS C1725","","M001314191  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314201","SUP","HCPCS C1725","","M001314201  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 5FR 100","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314211","SUP","HCPCS C1725","","M001314211  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314221","SUP","HCPCS C1725","","M001314221  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314231","SUP","HCPCS C1725","","M001314231  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314241","SUP","HCPCS C1725","","M001314241  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314251","SUP","HCPCS C1725","","M001314251  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314261","SUP","HCPCS C1725","","M001314261  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314271","SUP","HCPCS C1725","","M001314271  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314281","SUP","HCPCS C1725","","M001314281  -  CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314291","SUP","HCPCS C1725","","M001314291  -  CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314301","SUP","HCPCS C1725","","M001314301  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314311","SUP","HCPCS C1725","","M001314311  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314321","SUP","HCPCS C1725","","M001314321  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314331","SUP","HCPCS C1725","","M001314331  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314341","SUP","HCPCS C1725","","M001314341  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314351","SUP","HCPCS C1725","","M001314351  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314361","SUP","HCPCS C1725","","M001314361  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314371","SUP","HCPCS C1725","","M001314371  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314381","SUP","HCPCS C1725","","M001314381  -  CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314391","SUP","HCPCS C1725","","M001314391  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314401","SUP","HCPCS C1725","","M001314401  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314411","SUP","HCPCS C1725","","M001314411  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314421","SUP","HCPCS C1725","","M001314421  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314431","SUP","HCPCS C1725","","M001314431  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314441","SUP","HCPCS C1725","","M001314441  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM TAPER TIP","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314451","SUP","HCPCS C1725","","M001314451  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314461","SUP","HCPCS C1725","","M001314461  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM TAPER TIP","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314471","SUP","HCPCS C1725","","M001314471  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314481","SUP","HCPCS C1725","","M001314481  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314491","SUP","HCPCS C1725","","M001314491  -  CATHETER ANGIOGRAPHIC CK CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314501","SUP","HCPCS C1725","","M001314501  -  CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314511","SUP","HCPCS C1725","","M001314511  -  CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314521","SUP","HCPCS C1725","","M001314521  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314531","SUP","HCPCS C1725","","M001314531  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314541","SUP","HCPCS C1725","","M001314541  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314551","SUP","HCPCS C1725","","M001314551  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM TAPER TIP","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314561","SUP","HCPCS C1725","","M001314561  -  CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314571","SUP","HCPCS C1725","","M001314571  -  CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314581","SUP","HCPCS C1725","","M001314581  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314591","SUP","HCPCS C1726","","M001314591  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314601","SUP","HCPCS C1725","","M001314601  -  CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314611","SUP","HCPCS C1725","","M001314611  -  CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314621","SUP","HCPCS C1725","","M001314621  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314631","SUP","HCPCS C1725","","M001314631  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314641","SUP","HCPCS C1725","","M001314641  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314651","SUP","HCPCS C1725","","M001314651  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314661","SUP","HCPCS C1725","","M001314661  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314671","SUP","HCPCS C1725","","M001314671  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314681","SUP","HCPCS C1725","","M001314681  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314691","SUP","HCPCS C1725","","M001314691  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314701","SUP","HCPCS C1725","","M001314701  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314711","SUP","HCPCS C1725","","M001314711  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314721","SUP","HCPCS C1725","","M001314721  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314731","SUP","HCPCS C1725","","M001314731  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314741","SUP","HCPCS C1725","","M001314741  -  CATHETER ANGIOGRAPHIC VAN ANDEL 2 CURVE 5FR 65CM BRAID","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314751","SUP","HCPCS C1725","","M001314751  -  CATHETER ANGIOGRAPHIC TRAIN CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314761","SUP","HCPCS C1725","","M001314761  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314771","SUP","HCPCS C1725","","M001314771  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314781","SUP","HCPCS C1725","","M001314781  -  CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314791","SUP","HCPCS C1725","","M001314791  -  CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314801","SUP","HCPCS C1725","","M001314801  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314811","SUP","HCPCS C1725","","M001314811  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314821","SUP","HCPCS C1725","","M001314821  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314831","SUP","HCPCS C1725","","M001314831  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314841","SUP","HCPCS C1725","","M001314841  -  CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314851","SUP","HCPCS C1725","","M001314851  -  CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314861","SUP","HCPCS C1725","","M001314861  -  CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314871","SUP","HCPCS C1725","","M001314871  -  CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314881","SUP","HCPCS C1725","","M001314881  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314891","SUP","HCPCS C1725","","M001314891  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001314901","SUP","HCPCS C1725","","M001314901  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001314911","SUP","HCPCS C1725","","M001314911  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001315001","SUP","HCPCS C1725","","M001315001  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315011","SUP","HCPCS C1725","","M001315011  -  CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 4FR 90CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315021","SUP","HCPCS C1725","","M001315021  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315031","SUP","HCPCS C1725","","M001315031  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315041","SUP","HCPCS C1725","","M001315041  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 90CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315051","SUP","HCPCS C1725","","M001315051  -  CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 5FR 100CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315061","SUP","HCPCS C1725","","M001315061  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315071","SUP","HCPCS C1725","","M001315071  -  CATHETER ANGIOGRAPHIC .038IN TENNIS RACQUET CURVE 5FR 90CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315081","SUP","HCPCS C1725","","M001315081  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315091","SUP","HCPCS C1725","","M001315091  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315101","SUP","HCPCS C1725","","M001315101  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 4FR 65CM HIGH FLOW","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315111","SUP","HCPCS C1725","","M001315111  -  CATHETER ANGIOGRAPHIC .035IN 4FR 90CM PIGTAIL IMAGER II","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315121","SUP","HCPCS C1725","","M001315121  -  CATHETER ANGIOGRAPHIC STR 4FR 90CM BRAID TORQUE SELECTIVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315131","SUP","HCPCS C1726","","M001315131  -  CATHETER ANGIOGRAPHIC PIGTAIL FLUSH CURVE 5FR 65CM HIGH FLOW","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315141","SUP","HCPCS C1725","","M001315141  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM TAPER TIP FLUTE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315151","SUP","HCPCS C1725","","M001315151  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM TAPER TIP","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315161","SUP","HCPCS C1725","","M001315161  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 65CM HIGH FLOW","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315171","SUP","HCPCS C1725","","M001315171  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 90CM HIGH FLOW","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315181","SUP","HCPCS C1725","","M001315181  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315191","SUP","HCPCS C1725","","M001315191  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M00131520","SUP","HCPCS C1725","","M00131520  -  CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315201","SUP","HCPCS C1725","","M001315201  -  CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315211","SUP","HCPCS C1725","","M001315211  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315221","SUP","HCPCS C1725","","M001315221  -  CATHETER ANGIOGRAPHIC STR 5FR 90CM TAPER TIP FLUTE HUB BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315231","SUP","HCPCS C1725","","M001315231  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315241","SUP","HCPCS C1725","","M001315241  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315251","SUP","HCPCS C1725","","M001315251  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315261","SUP","HCPCS C1725","","M001315261  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 90CM IMAGER II","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315271","SUP","HCPCS C1725","","M001315271  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315281","SUP","HCPCS C1726","","M001315281  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315291","SUP","HCPCS C1725","","M001315291  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315301","SUP","HCPCS C1725","","M001315301  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315311","SUP","HCPCS C1725","","M001315311  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM TAPER TIP","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315321","SUP","HCPCS C1725","","M001315321  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001315331","SUP","HCPCS C1725","","M001315331  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316021","SUP","HCPCS C1725","","M001316021  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316031","SUP","HCPCS C1725","","M001316031  -  CATHETER ANGIOGRAPHIC SHORT TIP CURVE 4FR 100CM TAPER TIP","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316041","SUP","HCPCS C1725","","M001316041  -  CATHETER ANGIOGRAPHIC BARNH CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316061","SUP","HCPCS C1725","","M001316061  -  CATHETER ANGIOGRAPHIC .035IN BERN CURVE 4FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316071","SUP","HCPCS C1725","","M001316071  -  CATHETER ANGIOGRAPHIC BERNSTEIN CURVE 4FR 40CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316091","SUP","HCPCS C1725","","M001316091  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316121","SUP","HCPCS C1725","","M001316121  -  CATHETER ANGIOGRAPHIC WEINBERG CEREBRAL CURVE 4FR 100CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316131","SUP","HCPCS C1725","","M001316131  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316151","SUP","HCPCS C1725","","M001316151  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 100CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316171","SUP","HCPCS C1725","","M001316171  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 4FR 100CM BRAID","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316191","SUP","HCPCS C1725","","M001316191  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 4FR 100","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316201","SUP","HCPCS C1725","","M001316201  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 4FR 100","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316211","SUP","HCPCS C1725","","M001316211  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316231","SUP","HCPCS C1725","","M001316231  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316251","SUP","HCPCS C1725","","M001316251  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 4FR 100CM TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316271","SUP","HCPCS C1725","","M001316271  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316291","SUP","HCPCS C1725","","M001316291  -  CATHETER ANGIOGRAPHIC MANI CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316311","SUP","HCPCS C1725","","M001316311  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316331","SUP","HCPCS C1725","","M001316331  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316351","SUP","HCPCS C1725","","M001316351  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 4FR 100CM TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316371","SUP","HCPCS C1725","","M001316371  -  CATHETER ANGIOGRAPHIC SIM3 CURVE 4FR 100CM BRAID IMAGER II","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316381","SUP","HCPCS C1725","","M001316381  -  CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316401","SUP","HCPCS C1725","","M001316401  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 4FR 100CM TORQUE SELECT","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316421","SUP","HCPCS C1725","","M001316421  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316441","SUP","HCPCS C1725","","M001316441  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316461","SUP","HCPCS C1725","","M001316461  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316481","SUP","HCPCS C1725","","M001316481  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 4FR 100CM BRAID IMAGER","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316491","SUP","HCPCS C1725","","M001316491  -  CATHETER ANGIOGRAPHIC CK CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316511","SUP","HCPCS C1725","","M001316511  -  CATHETER ANGIOGRAPHIC GEN CURVE 4FR 100CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316531","SUP","HCPCS C1725","","M001316531  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 4FR 65CM TORQUE SELECT","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316551","SUP","HCPCS C1725","","M001316551  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316571","SUP","HCPCS C1725","","M001316571  -  CATHETER ANGIOGRAPHIC CHUANG 2 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316581","SUP","HCPCS C1725","","M001316581  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316611","SUP","HCPCS C1725","","M001316611  -  CATHETER ANGIOGRAPHIC DUCK CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316631","SUP","HCPCS C1725","","M001316631  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316651","SUP","HCPCS C1725","","M001316651  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316671","SUP","HCPCS C1725","","M001316671  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316691","SUP","HCPCS C1725","","M001316691  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM TAPER TIP FLUTE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316711","SUP","HCPCS C1725","","M001316711  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316731","SUP","HCPCS C1725","","M001316731  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316741","SUP","HCPCS C1725","","M001316741  -  CATHETER ANGIOGRAPHIC VAN CURVE 4FR 65CM BRAID TORQUE","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001316751","SUP","HCPCS C1725","","M001316751  -  CATHETER ANGIOGRAPHIC TRAIN CURVE FLUTE TAPER 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316771","SUP","HCPCS C1725","","M001316771  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE FLUTE TAPER 4FR 65CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316791","SUP","HCPCS C1725","","M001316791  -  CATHETER ANGIOGRAPHIC HK 1 CURVE FLUTE TAPER 4FR 65CM BRAID","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316811","SUP","HCPCS C1725","","M001316811  -  CATHETER ANGIOGRAPHIC SHK .8 CURVE FLUTE TAPER 4FR 65CM","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316831","SUP","HCPCS C1725","","M001316831  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 4FR 65CM TAPER","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316851","SUP","HCPCS C1725","","M001316851  -  CATHETER ANGIOGRAPHIC RIGHT CORON 1 CURVE 4FR 65CM TAPER TIP","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316871","SUP","HCPCS C1725","","M001316871  -  CATHETER ANGIOGRAPHIC RIGHT CORON SHEPHERDS CROOK 2 CURVE","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316891","SUP","HCPCS C1725","","M001316891  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65","BOTH IP/OP","$25.48 ","$18.86 ","$0.00 ","$25.48 ","$13.84 ","$0.00 ","$5.31 ","$0.00 ","$0.00 ","$4.46 ","$25.48 ","$0.00 ","$12.74 ","$20.18 ","$20.38 ","$0.00 ","$3.99 ","$0.00 ","$4.06 ","$0.00 "
"M001316911","SUP","HCPCS C1725","","M001316911  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65","BOTH IP/OP","$30.00 ","$22.20 ","$0.00 ","$30.00 ","$16.29 ","$0.00 ","$6.25 ","$0.00 ","$0.00 ","$5.25 ","$30.00 ","$0.00 ","$15.00 ","$23.76 ","$24.00 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M001321751","SUP","HCPCS C1887","","M001321751  -  CATHETER ANGIO .038IN C2 4FR 65CM GLDCATH TIP HDRPH","BOTH IP/OP","$139.50 ","$103.23 ","$0.00 ","$139.50 ","$75.75 ","$0.00 ","$29.08 ","$0.00 ","$0.00 ","$24.43 ","$139.50 ","$0.00 ","$69.75 ","$110.48 ","$111.60 ","$0.00 ","$21.83 ","$0.00 ","$22.21 ","$0.00 "
"M001361480","SUP","HCPCS C1895","","M001361480  -  COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 4CM","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001361490","SUP","HCPCS C1895","","M001361490  -  COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 6CM","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001361500","SUP","Custom 27803010","","M001361500  -  COIL EMBOLIZATION 2D HELIX 3MM 6CM 18 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361510","SUP","Custom 27803010","","M001361510  -  COIL EMBOLIZATION 2D HELIX 3MM 12CM 18 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361520","SUP","Custom 27803010","","M001361520  -  COIL EMBOLIZATION 2D HELIX 4MM 8CM 18 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361530","SUP","Custom 27803010","","M001361530  -  COIL EMBOLIZATION 2D HELIX 4MM 15CM 8 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361540","SUP","Custom 27203010","","M001361540  -  COIL EMBL 8CM 5MM INTLK 2D HLCL FBR OCL DTCH","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$942.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$942.88 ","$0.00 ","$471.44 ","$746.76 ","$754.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361550","SUP","Custom 27803010","","M001361550  -  COIL EMBOLIZATION 2D HELIX 5MM 15CM 8 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361560","SUP","Custom 27803010","","M001361560  -  COIL EMBOLIZATION 2D HELIX 6MM 10CM 18 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361570","SUP","Custom 27803010","","M001361570  -  COIL EMBOLIZATION 2D HELIX 6MM 20CM 18 COIL OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361580","SUP","Custom 27803010","","M001361580  -  COIL EMBOLIZATION 2D HELIX 8MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361590","SUP","Custom 27803010","","M001361590  -  COIL EMBOLIZATION 2D HELIX 10MM 20CM DETACHABLE OCCLUSION","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361600","SUP","Custom 27803010","","M001361600  -  COIL EMBOLIZATION .018IN 2D HELIX BUCK 10MM 30CM OCCLUSION","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361610","SUP","Custom 27803010","","M001361610  -  COIL EMBOLIZATION 2D HELIX 12MM 20CM OCCLUSION INTERLOCK","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361620","SUP","Custom 27803010","","M001361620  -  COIL EMBOLIZATION .018IN 2D HELIX TAPER 12MM 30CM 18 COIL","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361630","SUP","Custom 27803010","","M001361630  -  COIL EMBOLIZATION .018IN 2D HELIX TAPER 14MM 20CM 18 COIL","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361640","SUP","Custom 27803010","","M001361640  -  COIL EMBOLIZATION .018IN 2D HELIX 14MM 30CM INTERLOCK IDC","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361740","SUP","Custom 27803010","","M001361740  -  COIL EMBOLIZATION DIAMOND 2/3MM 2.3CM 18 COIL RETRACTABLE","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361750","SUP","Custom 27803010","","M001361750  -  COIL EMBOLIZATION DIAMOND 2/4MM 4.1CM 18 COIL RETRACTABLE","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361760","SUP","Custom 27803010","","M001361760  -  COIL EMBOLIZATION DIAMOND 2/5MM 5.8CM 18 COIL RETRACTABLE","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361770","SUP","Custom 27803010","","M001361770  -  COIL EMBOLIZATION DIAMOND 2/6MM 8CM OCCLUSION SYSTEM","BOTH IP/OP","$1,022.48 ","$756.64 ","$0.00 ","$1,022.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,022.48 ","$0.00 ","$511.24 ","$809.80 ","$817.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001361920","SUP","HCPCS C1895","","M001361920  -  COIL EMBOLIZATION 2D LONG LENGTH 10MM 50CM 18 COIL","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001361930","SUP","HCPCS C1895","","M001361930  -  COIL EMBOLIZATION .018IN 2D LONG 14CM 50CM 18 COIL","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001361940","SUP","HCPCS C1895","","M001361940  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 18CM 50CM","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001361950","SUP","HCPCS C1895","","M001361950  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001361960","SUP","HCPCS C1895","","M001361960  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"M001363500","SUP","Custom 27803010","","M001363500  -  COIL EMBOLIZATION .035IN 2D 3MM 4CM OCCLUSION INTERLOCK IDC","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363520","SUP","Custom 27803010","","M001363520  -  COIL EMBOLIZATION .035IN 2D HELICAL 4MM 10CM 35 COIL","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363530","SUP","Custom 27803010","","M001363530  -  COIL EMBL 20CM 4MM INTLK .035IN","BOTH IP/OP","$1,755.00 ","$1,298.70 ","$0.00 ","$1,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,755.00 ","$0.00 ","$877.50 ","$1,389.96 ","$1,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363540","SUP","Custom 27803010","","M001363540  -  COIL EMBOLIZATION .035IN 2D 6MM 10CM OCCLUSION DETACHABLE","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363550","SUP","Custom 27803010","","M001363550  -  COIL EMBOLIZATION .035IN 2D 6MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363560","SUP","Custom 27803010","","M001363560  -  COIL EMBL 40CM 6MM INTLK .035IN","BOTH IP/OP","$2,340.00 ","$1,731.60 ","$0.00 ","$2,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,340.00 ","$0.00 ","$1,170.00 ","$1,853.28 ","$1,872.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363570","SUP","HCPCS C1895","","M001363570  -  COIL EMBOLIZATION .018IN 2D HELIX 8MM 10CM OCCLUSION SYSTEM","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$529.71 ","$0.00 ","$245.34 ","$0.00 ","$0.00 ","$206.11 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$184.22 ","$0.00 ","$187.40 ","$0.00 "
"M001363580","SUP","Custom 27803010","","M001363580  -  COIL EMBOLIZATION .035IN 2D 8MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363590","SUP","Custom 27803010","","M001363590  -  COIL EMBOLIZATION .035IN 2D 8MM 40CM OCCLUSION SYSTEM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363600","SUP","Custom 27803010","","M001363600  -  COIL EMBOLIZATION .035IN 2D 10MM 20CM OCCLUSION INTERLOCK","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363610","SUP","Custom 27803010","","M001363610  -  COIL EMBOLIZATION .035IN 2D 10MM 40CM OCCLUSION SYSTEM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363620","SUP","Custom 27803010","","M001363620  -  COIL EMBOLIZATION .035IN 2D 12MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363630","SUP","Custom 27803010","","M001363630  -  COIL EMBOLIZATION .035IN 2D 12MM 40CM FIBER OCCLUSION SYSTEM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363640","SUP","Custom 27803010","","M001363640  -  COIL EMBOLIZATION .035IN 2D 15MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363650","SUP","Custom 27803010","","M001363650  -  COIL EMBOLIZATION .035IN 2D 15MM 40CM OCCLUSION SYSTEM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363660","SUP","HCPCS C1895","","M001363660  -  COIL EMBOLIZATION .018IN 2D 18MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$792.63 ","$0.00 ","$367.12 ","$0.00 ","$0.00 ","$308.41 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$275.66 ","$0.00 ","$280.41 ","$0.00 "
"M001363670","SUP","Custom 27803010","","M001363670  -  COIL EMBOLIZATION .035IN 2D 18MM 40CM OCCLUSION SYSTEM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363700","SUP","Custom 27803010","","M001363700  -  COIL EMBOLIZATION .035IN CUBE 4MM 6CM OCCLUSION SYSTEM","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363710","SUP","Custom 27803010","","M001363710  -  COIL EMBL 17CM 4MM INTLK 360D","BOTH IP/OP","$1,755.00 ","$1,298.70 ","$0.00 ","$1,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,755.00 ","$0.00 ","$877.50 ","$1,389.96 ","$1,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363720","SUP","Custom 27803010","","M001363720  -  COIL EMBOLIZATION .035IN CUBE 6MM 10CM OCCLUSION SYSTEM","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363730","SUP","Custom 27803010","","M001363730  -  COIL EMBOLIZATION .035IN CUBE 6MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363760","SUP","Custom 27803010","","M001363760  -  COIL EMBOLIZATION .035IN CUBE 8MM 20CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363770","SUP","Custom 27803010","","M001363770  -  COIL EMBL 40CM 8MM INTLK 360D","BOTH IP/OP","$2,340.00 ","$1,731.60 ","$0.00 ","$2,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,340.00 ","$0.00 ","$1,170.00 ","$1,853.28 ","$1,872.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363790","SUP","Custom 27803010","","M001363790  -  COIL EMBOLIZATION .035IN CUBE 10MM 25CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363800","SUP","Custom 27803010","","M001363800  -  COIL EMBOLIZATION .035IN CUBE 10MM 40CM OCCLUSION SYSTEM","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363810","SUP","Custom 27803010","","M001363810  -  COIL EMBOLIZATION .035IN CUBE 15MM 25CM OCCLUSION SYSTEM","BOTH IP/OP","$1,761.40 ","$1,303.44 ","$0.00 ","$1,761.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,761.40 ","$0.00 ","$880.70 ","$1,395.03 ","$1,409.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363820","SUP","Custom 27803010","","M001363820  -  COIL EMBOLIZATION .035IN CUBE 15MM 40CM FIBER OCCLUSION","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363830","SUP","Custom 27803010","","M001363830  -  COIL EMBOLIZATION .035IN CUBE 20MM 40CM FIBER OCCLUSION","BOTH IP/OP","$2,250.00 ","$1,665.00 ","$0.00 ","$2,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,250.00 ","$0.00 ","$1,125.00 ","$1,782.00 ","$1,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363910","SUP","Custom 27803010","","M001363910  -  COIL EMBOLIZATION .035IN DIAMOND 4MM 4.5CM OCCLUSION SYSTEM","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363920","SUP","Custom 27803010","","M001363920  -  COIL EMBOLIZATION .035IN DIAMOND 6MM 9CM OCCLUSION INTERLOCK","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363930","SUP","Custom 27803010","","M001363930  -  COIL EMBOLIZATION .035IN DIAMOND 8MM 14CM OCCLUSION","BOTH IP/OP","$1,177.13 ","$871.08 ","$0.00 ","$1,177.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,177.13 ","$0.00 ","$588.56 ","$932.29 ","$941.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363940","SUP","Custom 27803010","","M001363940  -  COIL EMBL 10MM INTLK .035IN","BOTH IP/OP","$1,755.00 ","$1,298.70 ","$0.00 ","$1,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,755.00 ","$0.00 ","$877.50 ","$1,389.96 ","$1,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001363950","SUP","Custom 27803010","","M001363950  -  COIL EMBL 12MM INTLK .035IN","BOTH IP/OP","$1,755.00 ","$1,298.70 ","$0.00 ","$1,755.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,755.00 ","$0.00 ","$877.50 ","$1,389.96 ","$1,404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001391260","SUP","HCPCS C1769","","M001391260  -  GUIDEWIRE VASCULAR STR .014IN 185CM JOURNEY NITINOL HYDPHI","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"M001391270","SUP","HCPCS C1769","","M001391270  -  GUIDEWIRE VASCULAR .014IN 185CM 7CM NAVIGATE RADIOPQ ANGLE","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"M001391280","SUP","HCPCS C1769","","M001391280  -  GUIDEWIRE VASCULAR .014IN 300CM 2CM FLEXIBLE CONVENTION STR","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"M001391290","SUP","HCPCS C1769","","M001391290  -  GUIDEWIRE VASCULAR .014IN 300CM 7CM NAVIGATE RADIOPQ ANGLE","BOTH IP/OP","$318.50 ","$235.69 ","$0.00 ","$318.50 ","$172.95 ","$0.00 ","$66.38 ","$0.00 ","$0.00 ","$55.77 ","$318.50 ","$0.00 ","$159.25 ","$252.25 ","$254.80 ","$0.00 ","$49.85 ","$0.00 ","$50.71 ","$0.00 "
"M0014012160","SUP","Custom 27803010","","M0014012160  -  PUSHER SURG .016FR .018IN 177CM EMBOLIZATION COIL","BOTH IP/OP","$419.80 ","$310.65 ","$0.00 ","$419.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$419.80 ","$0.00 ","$209.90 ","$332.48 ","$335.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001442001","SUP","Custom 27203010","","M001442001  -  DEVICE FLOW CONTROL 1050 PSI 1 WAY HIGH PRESSURE FLOSWITCH","BOTH IP/OP","$11.43 ","$8.46 ","$0.00 ","$11.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.43 ","$0.00 ","$5.71 ","$9.05 ","$9.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001461541","SUP","HCPCS C1769","","M001461541  -  GUIDEWIRE VASC .035IN 260CM 3CM GLDWR ANG TIP FLXB COR STD","BOTH IP/OP","$712.50 ","$527.25 ","$0.00 ","$712.50 ","$386.89 ","$0.00 ","$148.50 ","$0.00 ","$0.00 ","$124.75 ","$712.50 ","$0.00 ","$356.25 ","$564.30 ","$570.00 ","$0.00 ","$111.51 ","$0.00 ","$113.43 ","$0.00 "
"M001461940","SUP","HCPCS C1769","","M001461940  -  GWIRE VASC .035IN 145CM 9CM INFUS KTZN PERI","BOTH IP/OP","$473.28 ","$350.23 ","$0.00 ","$473.28 ","$256.99 ","$0.00 ","$98.64 ","$0.00 ","$0.00 ","$82.87 ","$473.28 ","$0.00 ","$236.64 ","$374.84 ","$378.62 ","$0.00 ","$74.07 ","$0.00 ","$75.35 ","$0.00 "
"M001461960","SUP","HCPCS C1769","","M001461960  -  GWIRE VASC .035IN 145CM 12CM INFUS KTZN","BOTH IP/OP","$473.28 ","$350.23 ","$0.00 ","$473.28 ","$256.99 ","$0.00 ","$98.64 ","$0.00 ","$0.00 ","$82.87 ","$473.28 ","$0.00 ","$236.64 ","$374.84 ","$378.62 ","$0.00 ","$74.07 ","$0.00 ","$75.35 ","$0.00 "
"M001465001","SUP","HCPCS C1769","","M001465001  -  GUIDEWIRE VASCULAR 6CM J .035IN 145CM 3MM FLEXIBLE TIP","BOTH IP/OP","$75.95 ","$56.20 ","$0.00 ","$75.95 ","$41.24 ","$0.00 ","$15.83 ","$0.00 ","$0.00 ","$13.30 ","$75.95 ","$0.00 ","$37.98 ","$60.15 ","$60.76 ","$0.00 ","$11.89 ","$0.00 ","$12.09 ","$0.00 "
"M001465011","SUP","HCPCS C1769","","M001465011  -  GUIDEWIRE VASCULAR SHORT LARGE J FLAT SPRING COIL .035IN 180","BOTH IP/OP","$103.81 ","$76.82 ","$0.00 ","$103.81 ","$56.37 ","$0.00 ","$21.64 ","$0.00 ","$0.00 ","$18.18 ","$103.81 ","$0.00 ","$51.90 ","$82.22 ","$83.04 ","$0.00 ","$16.25 ","$0.00 ","$16.53 ","$0.00 "
"M001465021","SUP","HCPCS C1769","","M001465021  -  GUIDEWIRE VASCULAR J .035IN 260CM 3MM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$108.46 ","$80.26 ","$0.00 ","$108.46 ","$58.89 ","$0.00 ","$22.61 ","$0.00 ","$0.00 ","$18.99 ","$108.46 ","$0.00 ","$54.23 ","$85.90 ","$86.77 ","$0.00 ","$16.97 ","$0.00 ","$17.27 ","$0.00 "
"M001465031","SUP","HCPCS C1769","","M001465031  -  GUIDEWIRE VASCULAR J .035IN 145CM 3MM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$75.95 ","$56.20 ","$0.00 ","$75.95 ","$41.24 ","$0.00 ","$15.83 ","$0.00 ","$0.00 ","$13.30 ","$75.95 ","$0.00 ","$37.98 ","$60.15 ","$60.76 ","$0.00 ","$11.89 ","$0.00 ","$12.09 ","$0.00 "
"M001465041","SUP","HCPCS C1769","","M001465041  -  GUIDEWIRE VASCULAR 6CM LARGE J .035IN 180CM 3MM FLEXIBLE TIP","BOTH IP/OP","$103.81 ","$76.82 ","$0.00 ","$103.81 ","$56.37 ","$0.00 ","$21.64 ","$0.00 ","$0.00 ","$18.18 ","$103.81 ","$0.00 ","$51.90 ","$82.22 ","$83.04 ","$0.00 ","$16.25 ","$0.00 ","$16.53 ","$0.00 "
"M001465091","SUP","HCPCS C1769","","M001465091  -  GUIDEWIRE VASCULAR SHORT STR .035IN 260CM FLEXIBLE TIP","BOTH IP/OP","$110.79 ","$81.98 ","$0.00 ","$110.79 ","$60.16 ","$0.00 ","$23.09 ","$0.00 ","$0.00 ","$19.40 ","$110.79 ","$0.00 ","$55.40 ","$87.75 ","$88.63 ","$0.00 ","$17.34 ","$0.00 ","$17.64 ","$0.00 "
"M001465101","SUP","HCPCS C1769","","M001465101  -  GUIDEWIRE VASCULAR .038IN 260CM 1CM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$110.79 ","$81.98 ","$0.00 ","$110.79 ","$60.16 ","$0.00 ","$23.09 ","$0.00 ","$0.00 ","$19.40 ","$110.79 ","$0.00 ","$55.40 ","$87.75 ","$88.63 ","$0.00 ","$17.34 ","$0.00 ","$17.64 ","$0.00 "
"M001465171","SUP","HCPCS C1769","","M001465171  -  GUIDEWIRE VASCULAR TAPER .038IN 145CM 6CM STR TIP AMPLATZ","BOTH IP/OP","$66.57 ","$49.26 ","$0.00 ","$66.57 ","$36.14 ","$0.00 ","$13.87 ","$0.00 ","$0.00 ","$11.65 ","$66.57 ","$0.00 ","$33.28 ","$52.72 ","$53.25 ","$0.00 ","$10.42 ","$0.00 ","$10.60 ","$0.00 "
"M001465181","SUP","HCPCS C1769","","M001465181  -  GUIDEWIRE VASCULAR SHORT J .038IN 145CM 4CM FLEXIBLE TIP","BOTH IP/OP","$69.58 ","$51.49 ","$0.00 ","$69.58 ","$37.78 ","$0.00 ","$14.50 ","$0.00 ","$0.00 ","$12.18 ","$69.58 ","$0.00 ","$34.79 ","$55.11 ","$55.66 ","$0.00 ","$10.89 ","$0.00 ","$11.08 ","$0.00 "
"M001465191","SUP","HCPCS C1769","","M001465191  -  GUIDEWIRE VASCULAR STR .038IN 180CM 6CM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$101.48 ","$75.10 ","$0.00 ","$101.48 ","$55.10 ","$0.00 ","$21.15 ","$0.00 ","$0.00 ","$17.77 ","$101.48 ","$0.00 ","$50.74 ","$80.37 ","$81.18 ","$0.00 ","$15.88 ","$0.00 ","$16.16 ","$0.00 "
"M001465201","SUP","HCPCS C1769","","M001465201  -  GUIDEWIRE VASCULAR STR .038IN 260CM 6CM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$106.14 ","$78.54 ","$0.00 ","$106.14 ","$57.63 ","$0.00 ","$22.12 ","$0.00 ","$0.00 ","$18.58 ","$106.14 ","$0.00 ","$53.07 ","$84.06 ","$84.91 ","$0.00 ","$16.61 ","$0.00 ","$16.90 ","$0.00 "
"M001465231","SUP","HCPCS C1769","","M001465231  -  GUIDEWIRE VASCULAR STR .035IN 145CM 7CM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$66.15 ","$48.95 ","$0.00 ","$66.15 ","$35.92 ","$0.00 ","$13.79 ","$0.00 ","$0.00 ","$11.58 ","$66.15 ","$0.00 ","$33.08 ","$52.39 ","$52.92 ","$0.00 ","$10.35 ","$0.00 ","$10.53 ","$0.00 "
"M001465241","SUP","HCPCS C1769","","M001465241  -  GUIDEWIRE VASCULAR STR .035IN 145CM 3.5CM SUPER STIFF SHAFT","BOTH IP/OP","$66.15 ","$48.95 ","$0.00 ","$66.15 ","$35.92 ","$0.00 ","$13.79 ","$0.00 ","$0.00 ","$11.58 ","$66.15 ","$0.00 ","$33.08 ","$52.39 ","$52.92 ","$0.00 ","$10.35 ","$0.00 ","$10.53 ","$0.00 "
"M001465251","SUP","HCPCS C1769","","M001465251  -  GUIDEWIRE VASCULAR TAPER .035IN 180CM 7CM STR TIP AMPLATZ","BOTH IP/OP","$101.48 ","$75.10 ","$0.00 ","$101.48 ","$55.10 ","$0.00 ","$21.15 ","$0.00 ","$0.00 ","$17.77 ","$101.48 ","$0.00 ","$50.74 ","$80.37 ","$81.18 ","$0.00 ","$15.88 ","$0.00 ","$16.16 ","$0.00 "
"M001465261","SUP","HCPCS C1769","","M001465261  -  GUIDEWIRE VASCULAR STR .035IN 260CM 7CM FLEXIBLE TIP AMPLATZ","BOTH IP/OP","$106.14 ","$78.54 ","$0.00 ","$106.14 ","$57.63 ","$0.00 ","$22.12 ","$0.00 ","$0.00 ","$18.58 ","$106.14 ","$0.00 ","$53.07 ","$84.06 ","$84.91 ","$0.00 ","$16.61 ","$0.00 ","$16.90 ","$0.00 "
"M001465501","SUP","Custom 27203010","","M001465501  -  VISE TORQUE ACCEPTS .025-.038 IN GWIRE","BOTH IP/OP","$155.95 ","$115.40 ","$0.00 ","$155.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$155.95 ","$0.00 ","$77.98 ","$123.51 ","$124.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001465631","SUP","HCPCS C1769","","M001465631  -  GUIDEWIRE VASCULAR .035IN 75CM 7CM DISTAL STR TIP ATRAUMATIC","BOTH IP/OP","$66.15 ","$48.95 ","$0.00 ","$66.15 ","$35.92 ","$0.00 ","$13.79 ","$0.00 ","$0.00 ","$11.58 ","$66.15 ","$0.00 ","$33.08 ","$52.39 ","$52.92 ","$0.00 ","$10.35 ","$0.00 ","$10.53 ","$0.00 "
"M001465641","SUP","HCPCS C1769","","M001465641  -  GUIDEWIRE VASCULAR STR .038IN 75CM 6CM FLOPPY TIP AMPLATZ","BOTH IP/OP","$66.15 ","$48.95 ","$0.00 ","$66.15 ","$35.92 ","$0.00 ","$13.79 ","$0.00 ","$0.00 ","$11.58 ","$66.15 ","$0.00 ","$33.08 ","$52.39 ","$52.92 ","$0.00 ","$10.35 ","$0.00 ","$10.53 ","$0.00 "
"M001465911","SUP","HCPCS C1769","","M001465911  -  GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 180CM 5CM STR TIP","BOTH IP/OP","$126.58 ","$93.67 ","$0.00 ","$126.58 ","$68.73 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$22.16 ","$126.58 ","$0.00 ","$63.29 ","$100.25 ","$101.27 ","$0.00 ","$19.81 ","$0.00 ","$20.15 ","$0.00 "
"M001465921","SUP","HCPCS C1769","","M001465921  -  GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 260CM 5CM STR TIP","BOTH IP/OP","$126.58 ","$93.67 ","$0.00 ","$126.58 ","$68.73 ","$0.00 ","$26.38 ","$0.00 ","$0.00 ","$22.16 ","$126.58 ","$0.00 ","$63.29 ","$100.25 ","$101.27 ","$0.00 ","$19.81 ","$0.00 ","$20.15 ","$0.00 "
"M001466000","SUP","HCPCS C1769","","M001466000  -  GUIDEWIRE VASCULAR LONG .018IN 145CM 10CM RADIOPQ PLATINUM","BOTH IP/OP","$194.35 ","$143.82 ","$0.00 ","$194.35 ","$105.53 ","$0.00 ","$40.51 ","$0.00 ","$0.00 ","$34.03 ","$194.35 ","$0.00 ","$97.18 ","$153.93 ","$155.48 ","$0.00 ","$30.42 ","$0.00 ","$30.94 ","$0.00 "
"M001466010","SUP","HCPCS C1769","","M001466010  -  GUIDEWIRE VASCULAR LONG .018IN 180CM 10CM RADIOPQ PLATINUM","BOTH IP/OP","$194.35 ","$143.82 ","$0.00 ","$194.35 ","$105.53 ","$0.00 ","$40.51 ","$0.00 ","$0.00 ","$34.03 ","$194.35 ","$0.00 ","$97.18 ","$153.93 ","$155.48 ","$0.00 ","$30.42 ","$0.00 ","$30.94 ","$0.00 "
"M001466020","SUP","HCPCS C1769","","M001466020  -  GUIDEWIRE VASCULAR LONG .018IN 260CM 8CM RADIOPQ PLATINUM","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001466040","SUP","HCPCS C1769","","M001466040  -  GUIDEWIRE VASCULAR SHORT .018IN 180CM 3CM RADIOPQ PLATINUM","BOTH IP/OP","$194.35 ","$143.82 ","$0.00 ","$194.35 ","$105.53 ","$0.00 ","$40.51 ","$0.00 ","$0.00 ","$34.03 ","$194.35 ","$0.00 ","$97.18 ","$153.93 ","$155.48 ","$0.00 ","$30.42 ","$0.00 ","$30.94 ","$0.00 "
"M001466050","SUP","HCPCS C1769","","M001466050  -  GUIDEWIRE VASC .018IN 260CM 3CM PLTN + SHRT TPR TIP RADOPQ","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001466100","SUP","HCPCS C1769","","M001466100  -  GUIDEWIRE VASCULAR SHORT .025IN 180CM 3CM RADIOPQ PLATINUM","BOTH IP/OP","$194.35 ","$143.82 ","$0.00 ","$194.35 ","$105.53 ","$0.00 ","$40.51 ","$0.00 ","$0.00 ","$34.03 ","$194.35 ","$0.00 ","$97.18 ","$153.93 ","$155.48 ","$0.00 ","$30.42 ","$0.00 ","$30.94 ","$0.00 "
"M001466110","SUP","HCPCS C1769","","M001466110  -  GUIDEWIRE VASCULAR SHORT .025IN 260CM 3CM RADIOPQ PLATINUM","BOTH IP/OP","$202.33 ","$149.72 ","$0.00 ","$202.33 ","$109.86 ","$0.00 ","$42.17 ","$0.00 ","$0.00 ","$35.43 ","$202.33 ","$0.00 ","$101.16 ","$160.25 ","$161.86 ","$0.00 ","$31.66 ","$0.00 ","$32.21 ","$0.00 "
"M001467120","SUP","HCPCS C1769","","M001467120  -  GUIDEWIRE VASCULAR .014IN 300CM 7CM SHORT TAPER STR TIP","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001467300","SUP","HCPCS C1769","","M001467300  -  GUIDEWIRE VASCULAR STR .018IN 60CM 3CM RADIOPQ PLATINUM PLUS","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001467310","SUP","HCPCS C1769","","M001467310  -  GUIDEWIRE VASCULAR STR .018IN 180CM 3CM RADIOPQ PLATINUM","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001467320","SUP","HCPCS C1769","","M001467320  -  GUIDEWIRE VASCULAR STR .018IN 260CM 3CM RADIOPQ PLATINUM","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001467400","SUP","HCPCS C1769","","M001467400  -  GUIDEWIRE VASCULAR .014IN 180CM 3CM RADIOPQ PLATINUM PLUS","BOTH IP/OP","$203.35 ","$150.48 ","$0.00 ","$203.35 ","$110.42 ","$0.00 ","$42.38 ","$0.00 ","$0.00 ","$35.60 ","$203.35 ","$0.00 ","$101.68 ","$161.05 ","$162.68 ","$0.00 ","$31.82 ","$0.00 ","$32.37 ","$0.00 "
"M001468010","SUP","HCPCS C1769","","M001468010  -  GUIDEWIRE VASCULAR STR .014IN 190CM 2CM STEERABLE TRANSEND","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$296.48 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"M001468050","SUP","HCPCS C1769","","M001468050  -  GUIDEWIRE VASC .014IN 182CM 2CM TRNSD EX RADOPQ HDRPH PLTN","BOTH IP/OP","$1,116.25 ","$826.03 ","$0.00 ","$1,116.25 ","$606.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$195.45 ","$1,116.25 ","$0.00 ","$558.13 ","$884.07 ","$893.00 ","$0.00 ","$174.69 ","$0.00 ","$177.71 ","$0.00 "
"M001468070","SUP","HCPCS C1769","","M001468070  -  GUIDEWIRE VASC .014IN 205CM 2CM TRNSD EX SHP FLPY","BOTH IP/OP","$1,116.25 ","$826.03 ","$0.00 ","$1,116.25 ","$606.12 ","$0.00 ","$232.65 ","$0.00 ","$0.00 ","$195.45 ","$1,116.25 ","$0.00 ","$558.13 ","$884.07 ","$893.00 ","$0.00 ","$174.69 ","$0.00 ","$177.71 ","$0.00 "
"M001468100","SUP","HCPCS C1769","","M001468100  -  GUIDEWIRE VASCULAR STR .014IN 135CM 2CM STEERABLE TRANSEND","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$296.48 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"M001468110","SUP","HCPCS C1769","","M001468110  -  GUIDEWIRE VASCULAR STR .014IN 165CM 2CM STEERABLE TRANSEND","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$296.48 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"M001468120","SUP","HCPCS C1769","","M001468120  -  GUIDEWIRE VASCULAR STR .018IN 135CM 2CM STEERABLE TRANSEND","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$296.48 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"M001468130","SUP","HCPCS C1769","","M001468130  -  GUIDEWIRE VASCULAR STR .018IN 165CM 2CM STEERABLE TRANSEND","BOTH IP/OP","$546.00 ","$404.04 ","$0.00 ","$546.00 ","$296.48 ","$0.00 ","$113.80 ","$0.00 ","$0.00 ","$95.60 ","$546.00 ","$0.00 ","$273.00 ","$432.43 ","$436.80 ","$0.00 ","$85.45 ","$0.00 ","$86.92 ","$0.00 "
"M001468480","SUP","HCPCS C1769","","M001468480  -  GUIDEWIRE VASCULAR STR .018IN 110CM 8CM RADIOPQ V-18","BOTH IP/OP","$211.00 ","$156.14 ","$0.00 ","$211.00 ","$114.57 ","$0.00 ","$43.98 ","$0.00 ","$0.00 ","$36.94 ","$211.00 ","$0.00 ","$105.50 ","$167.11 ","$168.80 ","$0.00 ","$33.02 ","$0.00 ","$33.59 ","$0.00 "
"M001468500","SUP","HCPCS C1769","","M001468500  -  GUIDEWIRE VASCULAR STR .018IN 150CM 8CM RADIOPQ V-18","BOTH IP/OP","$178.95 ","$132.42 ","$0.00 ","$178.95 ","$97.17 ","$0.00 ","$37.30 ","$0.00 ","$0.00 ","$31.33 ","$178.95 ","$0.00 ","$89.48 ","$141.73 ","$143.16 ","$0.00 ","$28.01 ","$0.00 ","$28.49 ","$0.00 "
"M001468520","SUP","HCPCS C1769","","M001468520  -  GUIDEWIRE VASCULAR TAPER .018IN 200CM 8CM RADIOPQ STR TIP","BOTH IP/OP","$188.53 ","$139.51 ","$0.00 ","$188.53 ","$102.37 ","$0.00 ","$39.29 ","$0.00 ","$0.00 ","$33.01 ","$188.53 ","$0.00 ","$94.26 ","$149.32 ","$150.82 ","$0.00 ","$29.50 ","$0.00 ","$30.01 ","$0.00 "
"M001468540","SUP","HCPCS C1769","","M001468540  -  GUIDEWIRE VASCULAR TAPER .018IN 300CM 8CM RADIOPQ STR TIP","BOTH IP/OP","$197.25 ","$145.97 ","$0.00 ","$197.25 ","$107.11 ","$0.00 ","$41.11 ","$0.00 ","$0.00 ","$34.54 ","$197.25 ","$0.00 ","$98.63 ","$156.22 ","$157.80 ","$0.00 ","$30.87 ","$0.00 ","$31.40 ","$0.00 "
"M001468560","SUP","HCPCS C1769","","M001468560  -  GUIDEWIRE VASCULAR STR .018IN 150CM 12CM RADIOPQ V-18","BOTH IP/OP","$213.15 ","$157.73 ","$0.00 ","$213.15 ","$115.74 ","$0.00 ","$44.43 ","$0.00 ","$0.00 ","$37.32 ","$213.15 ","$0.00 ","$106.58 ","$168.81 ","$170.52 ","$0.00 ","$33.36 ","$0.00 ","$33.93 ","$0.00 "
"M001468580","SUP","HCPCS C1769","","M001468580  -  GUIDEWIRE VASCULAR STR .018IN 200CM 12CM RADIOPQ V-18","BOTH IP/OP","$213.15 ","$157.73 ","$0.00 ","$213.15 ","$115.74 ","$0.00 ","$44.43 ","$0.00 ","$0.00 ","$37.32 ","$213.15 ","$0.00 ","$106.58 ","$168.81 ","$170.52 ","$0.00 ","$33.36 ","$0.00 ","$33.93 ","$0.00 "
"M001468600","SUP","HCPCS C1769","","M001468600  -  GUIDEWIRE VASCULAR STR .018IN 300CM 12CM RADIOPQ V-18","BOTH IP/OP","$213.15 ","$157.73 ","$0.00 ","$213.15 ","$115.74 ","$0.00 ","$44.43 ","$0.00 ","$0.00 ","$37.32 ","$213.15 ","$0.00 ","$106.58 ","$168.81 ","$170.52 ","$0.00 ","$33.36 ","$0.00 ","$33.93 ","$0.00 "
"M001491001","SUP","HCPCS C1769","","M001491001  -  GUIDEWIRE VASCULAR STANDARD TAPER .025IN 150CM 3CM FIX CORE","BOTH IP/OP","$15.28 ","$11.31 ","$0.00 ","$15.28 ","$8.29 ","$0.00 ","$3.18 ","$0.00 ","$0.00 ","$2.67 ","$15.28 ","$0.00 ","$7.64 ","$12.10 ","$12.22 ","$0.00 ","$2.39 ","$0.00 ","$2.43 ","$0.00 "
"M001491011","SUP","HCPCS C1769","","M001491011  -  GUIDEWIRE STAR SFC .035 150CM PTFE","BOTH IP/OP","$15.28 ","$11.31 ","$0.00 ","$19.50 ","$10.59 ","$0.00 ","$3.18 ","$0.00 ","$0.00 ","$3.41 ","$19.50 ","$0.00 ","$9.75 ","$15.44 ","$15.60 ","$0.00 ","$3.05 ","$0.00 ","$3.10 ","$0.00 "
"M001491021","SUP","HCPCS C1769","","M001491021  -  GUIDEWIRE VASCULAR STANDARD STR SPRING COIL .038IN 150CM 3CM","BOTH IP/OP","$15.28 ","$11.31 ","$0.00 ","$15.28 ","$8.29 ","$0.00 ","$3.18 ","$0.00 ","$0.00 ","$2.67 ","$15.28 ","$0.00 ","$7.64 ","$12.10 ","$12.22 ","$0.00 ","$2.39 ","$0.00 ","$2.43 ","$0.00 "
"M001491031","SUP","HCPCS C1769","","M001491031  -  GUIDEWIRE VASCULAR STR .035IN 260CM 3CM FIX CORE FLEXIBLE","BOTH IP/OP","$34.94 ","$25.86 ","$0.00 ","$34.94 ","$18.97 ","$0.00 ","$7.28 ","$0.00 ","$0.00 ","$6.12 ","$34.94 ","$0.00 ","$17.47 ","$27.67 ","$27.95 ","$0.00 ","$5.47 ","$0.00 ","$5.56 ","$0.00 "
"M001491451","SUP","HCPCS C1769","","M001491451  -  GUIDEWIRE VASCULAR STR SPRING COIL .035IN 150CM 15CM STARTER","BOTH IP/OP","$24.71 ","$18.29 ","$0.00 ","$24.71 ","$13.41 ","$0.00 ","$5.15 ","$0.00 ","$0.00 ","$4.33 ","$24.71 ","$0.00 ","$12.35 ","$19.57 ","$19.76 ","$0.00 ","$3.87 ","$0.00 ","$3.93 ","$0.00 "
"M001491471","SUP","HCPCS C1769","","M001491471  -  GUIDEWIRE VASCULAR STANDARD TAPER .035IN 180CM 15CM STR TIP","BOTH IP/OP","$195.50 ","$144.67 ","$0.00 ","$195.50 ","$106.16 ","$0.00 ","$40.75 ","$0.00 ","$0.00 ","$34.23 ","$195.50 ","$0.00 ","$97.75 ","$154.84 ","$156.40 ","$0.00 ","$30.60 ","$0.00 ","$31.12 ","$0.00 "
"M001491481","SUP","HCPCS C1769","","M001491481  -  GUIDEWIRE VASCULAR STANDARD TAPER .035IN 260CM 15CM STR TIP","BOTH IP/OP","$251.38 ","$186.02 ","$0.00 ","$251.38 ","$136.50 ","$0.00 ","$52.39 ","$0.00 ","$0.00 ","$44.01 ","$251.38 ","$0.00 ","$125.69 ","$199.09 ","$201.10 ","$0.00 ","$39.34 ","$0.00 ","$40.02 ","$0.00 "
"M001491561","SUP","HCPCS C1769","","M001491561  -  GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN","BOTH IP/OP","$129.88 ","$96.11 ","$0.00 ","$129.88 ","$70.52 ","$0.00 ","$27.07 ","$0.00 ","$0.00 ","$22.74 ","$129.88 ","$0.00 ","$64.94 ","$102.86 ","$103.90 ","$0.00 ","$20.33 ","$0.00 ","$20.68 ","$0.00 "
"M001491571","SUP","HCPCS C1769","","M001491571  -  GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN","BOTH IP/OP","$208.95 ","$154.62 ","$0.00 ","$208.95 ","$113.46 ","$0.00 ","$43.55 ","$0.00 ","$0.00 ","$36.59 ","$208.95 ","$0.00 ","$104.48 ","$165.49 ","$167.16 ","$0.00 ","$32.70 ","$0.00 ","$33.26 ","$0.00 "
"M001491601","SUP","HCPCS C1769","","M001491601  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 150CM 3CM FIX CORE","BOTH IP/OP","$18.62 ","$13.78 ","$0.00 ","$18.62 ","$10.11 ","$0.00 ","$3.88 ","$0.00 ","$0.00 ","$3.26 ","$18.62 ","$0.00 ","$9.31 ","$14.75 ","$14.90 ","$0.00 ","$2.91 ","$0.00 ","$2.96 ","$0.00 "
"M001491611","SUP","HCPCS C1769","","M001491611  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM FIX CORE","BOTH IP/OP","$37.24 ","$27.56 ","$0.00 ","$37.24 ","$20.22 ","$0.00 ","$7.76 ","$0.00 ","$0.00 ","$6.52 ","$37.24 ","$0.00 ","$18.62 ","$29.49 ","$29.79 ","$0.00 ","$5.83 ","$0.00 ","$5.93 ","$0.00 "
"M001491771","SUP","HCPCS C1769","","M001491771  -  GUIDEWIRE VASCULAR BENTSON STANDARD .035IN 180CM 15CM SPRING","BOTH IP/OP","$216.00 ","$159.84 ","$0.00 ","$216.00 ","$117.29 ","$0.00 ","$45.02 ","$0.00 ","$0.00 ","$37.82 ","$216.00 ","$0.00 ","$108.00 ","$171.07 ","$172.80 ","$0.00 ","$33.80 ","$0.00 ","$34.39 ","$0.00 "
"M001491851","SUP","HCPCS C1769","","M001491851  -  GUIDEWIRE VASCULAR J ROSEN CURVE SPRING COIL .035IN 180CM","BOTH IP/OP","$180.63 ","$133.67 ","$0.00 ","$180.63 ","$98.08 ","$0.00 ","$37.65 ","$0.00 ","$0.00 ","$31.63 ","$180.63 ","$0.00 ","$90.31 ","$143.06 ","$144.50 ","$0.00 ","$28.27 ","$0.00 ","$28.76 ","$0.00 "
"M001492031","SUP","HCPCS C1769","","M001492031  -  GWIRE VASC 125CM .025IN STR FIX CORE 3CM TIP 10MM STRT PTFE","BOTH IP/OP","$19.50 ","$14.43 ","$0.00 ","$19.50 ","$10.59 ","$0.00 ","$4.06 ","$0.00 ","$0.00 ","$3.41 ","$19.50 ","$0.00 ","$9.75 ","$15.44 ","$15.60 ","$0.00 ","$3.05 ","$0.00 ","$3.10 ","$0.00 "
"M001492061","SUP","HCPCS C1769","","M001492061  -  GWIRE VASC 150CM .028IN STR FIX CORE 3CM TIP 10MM STRT PTFE","BOTH IP/OP","$19.50 ","$14.43 ","$0.00 ","$19.50 ","$10.59 ","$0.00 ","$4.06 ","$0.00 ","$0.00 ","$3.41 ","$19.50 ","$0.00 ","$9.75 ","$15.44 ","$15.60 ","$0.00 ","$3.05 ","$0.00 ","$3.10 ","$0.00 "
"M001492081","SUP","HCPCS C1769","","M001492081  -  GWIRE VASC 150CM .032IN STR FIX CORE 3CM TIP 10MM STRT PTFE","BOTH IP/OP","$28.75 ","$21.28 ","$0.00 ","$28.75 ","$15.61 ","$0.00 ","$5.99 ","$0.00 ","$0.00 ","$5.03 ","$28.75 ","$0.00 ","$14.38 ","$22.77 ","$23.00 ","$0.00 ","$4.50 ","$0.00 ","$4.58 ","$0.00 "
"M001492111","SUP","HCPCS C1769","","M001492111  -  GWIRE VASC 125CM .035IN STR FIX CORE 3CM TIP 10MM STRT PTFE","BOTH IP/OP","$19.50 ","$14.43 ","$0.00 ","$19.50 ","$10.59 ","$0.00 ","$4.06 ","$0.00 ","$0.00 ","$3.41 ","$19.50 ","$0.00 ","$9.75 ","$15.44 ","$15.60 ","$0.00 ","$3.05 ","$0.00 ","$3.10 ","$0.00 "
"M001492121","SUP","HCPCS C1769","","M001492121  -  GUIDEWIRE VASCULAR STR .035IN 180CM 3CM FIX CORE STARTER","BOTH IP/OP","$38.45 ","$28.45 ","$0.00 ","$38.45 ","$20.88 ","$0.00 ","$8.01 ","$0.00 ","$0.00 ","$6.73 ","$38.45 ","$0.00 ","$19.23 ","$30.45 ","$30.76 ","$0.00 ","$6.02 ","$0.00 ","$6.12 ","$0.00 "
"M001492311","SUP","HCPCS C1769","","M001492311  -  GUIDEWIRE VASCULAR STR .035IN 80CM 3MM FIX CORE STARTER PTFE","BOTH IP/OP","$15.28 ","$11.31 ","$0.00 ","$15.28 ","$8.29 ","$0.00 ","$3.18 ","$0.00 ","$0.00 ","$2.67 ","$15.28 ","$0.00 ","$7.64 ","$12.10 ","$12.22 ","$0.00 ","$2.39 ","$0.00 ","$2.43 ","$0.00 "
"M001492751","SUP","HCPCS C1769","","M001492751  -  GUIDEWIRE VASCULAR .018IN 130CM 3CM SHORT TAPER STR TIP","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492761","SUP","HCPCS C1769","","M001492761  -  GUIDEWIRE VASCULAR J SHORT TAPER .018IN 130CM 3CM THRUWAY","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492771","SUP","HCPCS C1769","","M001492771  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 130CM 3CM SHAPEABLE","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492781","SUP","HCPCS C1769","","M001492781  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 130CM 3CM THRUWAY","BOTH IP/OP","$210.10 ","$155.47 ","$0.00 ","$210.10 ","$114.08 ","$0.00 ","$43.79 ","$0.00 ","$0.00 ","$36.79 ","$210.10 ","$0.00 ","$105.05 ","$166.40 ","$168.08 ","$0.00 ","$32.88 ","$0.00 ","$33.45 ","$0.00 "
"M001492791","SUP","HCPCS C1769","","M001492791  -  GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 190CM 3CM","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492801","SUP","HCPCS C1769","","M001492801  -  GUIDEWIRE VASCULAR .018IN 190CM 3CM SHORT TAPER J TIP DISTAL","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492811","SUP","HCPCS C1769","","M001492811  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 190CM 3CM SHAPEABLE","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492821","SUP","HCPCS C1769","","M001492821  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 190CM 3CM THRUWAY","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492831","SUP","HCPCS C1769","","M001492831  -  GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 300CM 3CM","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492841","SUP","HCPCS C1769","","M001492841  -  GUIDEWIRE VASCULAR J SHORT TAPER .018IN 300CM 3CM THRUWAY","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492851","SUP","HCPCS C1769","","M001492851  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 300CM 3CM SHAPEABLE","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001492861","SUP","HCPCS C1769","","M001492861  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 300CM 3CM THRUWAY","BOTH IP/OP","$196.00 ","$145.04 ","$0.00 ","$196.00 ","$106.43 ","$0.00 ","$40.85 ","$0.00 ","$0.00 ","$34.32 ","$196.00 ","$0.00 ","$98.00 ","$155.23 ","$156.80 ","$0.00 ","$30.67 ","$0.00 ","$31.20 ","$0.00 "
"M001503000","SUP","HCPCS C1884","","M001503000  -  SYSTEM EMBL PRTC 47MM VC JUG INTROD 12FR TI 38MM GRNFLD","BOTH IP/OP","$2,497.25 ","$1,847.97 ","$0.00 ","$2,497.25 ","$1,123.76 ","$0.00 ","$520.49 ","$0.00 ","$0.00 ","$437.25 ","$2,497.25 ","$0.00 ","$1,248.63 ","$1,977.82 ","$1,997.80 ","$0.00 ","$390.82 ","$0.00 ","$397.56 ","$0.00 "
"M001503010","SUP","HCPCS C1884","","M001503010  -  SYSTEM EMBL PRTC 47MM VC FEM INTROD 15FR TI 38MM GRNFLD","BOTH IP/OP","$2,497.25 ","$1,847.97 ","$0.00 ","$2,497.25 ","$1,123.76 ","$0.00 ","$520.49 ","$0.00 ","$0.00 ","$437.25 ","$2,497.25 ","$0.00 ","$1,248.63 ","$1,977.82 ","$1,997.80 ","$0.00 ","$390.82 ","$0.00 ","$397.56 ","$0.00 "
"M001503350","SUP","Custom 27803010","","M001503350  -  DILATOR VASC 12FR INTRO 6-14FR GRNFLD RADOPQ TI VC","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001503500","SUP","HCPCS C1884","","M001503500  -  SYSTEM EMBL PRTC 47MM VC NDL SYR ACC INTROD 12FR TI 38MM","BOTH IP/OP","$332.50 ","$246.05 ","$0.00 ","$332.50 ","$149.63 ","$0.00 ","$69.30 ","$0.00 ","$0.00 ","$58.22 ","$332.50 ","$0.00 ","$166.25 ","$263.34 ","$266.00 ","$0.00 ","$52.04 ","$0.00 ","$52.93 ","$0.00 "
"M001504000","SUP","Custom 27803010","","M001504000  -  FILTER VASCULAR .035IN 12FR 46MM 32MM OTW REINFORCE SHEATH","BOTH IP/OP","$2,363.53 ","$1,749.01 ","$0.00 ","$2,363.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,363.53 ","$0.00 ","$1,181.76 ","$1,871.92 ","$1,890.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001505010","SUP","Custom 27803010","","M001505010  -  FILTER VASCULAR 12FR OTW CAPSULE GREENFIELD FEMORAL SYSTEM","BOTH IP/OP","$2,363.53 ","$1,749.01 ","$0.00 ","$2,363.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,363.53 ","$0.00 ","$1,181.76 ","$1,871.92 ","$1,890.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001509000","SUP","HCPCS C1769","","M001509000  -  GUIDEWIRE VASCULAR STR .016IN 140CM 25CM STEERABLE FATHOM","BOTH IP/OP","$744.33 ","$550.80 ","$0.00 ","$744.33 ","$404.17 ","$0.00 ","$155.14 ","$0.00 ","$0.00 ","$130.33 ","$744.33 ","$0.00 ","$372.16 ","$589.51 ","$595.46 ","$0.00 ","$116.49 ","$0.00 ","$118.50 ","$0.00 "
"M001509010","SUP","HCPCS C1769","","M001509010  -  GUIDEWIRE VASCULAR STR .016IN 140CM 35CM STEERABLE FATHOM","BOTH IP/OP","$744.33 ","$550.80 ","$0.00 ","$744.33 ","$404.17 ","$0.00 ","$155.14 ","$0.00 ","$0.00 ","$130.33 ","$744.33 ","$0.00 ","$372.16 ","$589.51 ","$595.46 ","$0.00 ","$116.49 ","$0.00 ","$118.50 ","$0.00 "
"M001509100","SUP","HCPCS C1769","","M001509100  -  GUIDEWIRE VASCULAR .016IN 180CM 25CM STEERABLE STR TIP","BOTH IP/OP","$744.33 ","$550.80 ","$0.00 ","$744.33 ","$404.17 ","$0.00 ","$155.14 ","$0.00 ","$0.00 ","$130.33 ","$744.33 ","$0.00 ","$372.16 ","$589.51 ","$595.46 ","$0.00 ","$116.49 ","$0.00 ","$118.50 ","$0.00 "
"M001509110","SUP","HCPCS C1769","","M001509110  -  GUIDEWIRE VASCULAR .016IN 180CM 35CM STEERABLE STR TIP","BOTH IP/OP","$744.33 ","$550.80 ","$0.00 ","$744.33 ","$404.17 ","$0.00 ","$155.14 ","$0.00 ","$0.00 ","$130.33 ","$744.33 ","$0.00 ","$372.16 ","$589.51 ","$595.46 ","$0.00 ","$116.49 ","$0.00 ","$118.50 ","$0.00 "
"M0015501010","SUP","HCPCS C1887","","M0015501010  -  CATHETER INFUS .014IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 105","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M0015501030","SUP","HCPCS C1887","","M0015501030  -  CATHETER INFUS .038IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 125","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M0015501040","SUP","HCPCS C1887","","M0015501040  -  CATHETER INFUS .014IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 135","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M0015502030","SUP","HCPCS C1887","","M0015502030  -  CATHETER INFUS .016IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 125","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M0015502040","SUP","HCPCS C1887","","M0015502040  -  CATHETER INFUS .038IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 135","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M001705020","SUP","HCPCS C1874","","M001705020  -  STENT ENDOPRSTH 116CM 10MM 10FR 20MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705030","SUP","HCPCS C2628","","M001705030  -  STENT ENDOPRSTH 116CM 10MM 10FR 30MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001705050","SUP","HCPCS C1874","","M001705050  -  STENT ENDOPRSTH 116CM 10MM 10FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705070","SUP","HCPCS C1874","","M001705070  -  STENT ENDOPRSTH 116CM 10MM 10FR 70MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705230","SUP","HCPCS C2628","","M001705230  -  STENT ENDOPRSTH 116CM 12MM 11FR 30MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001705250","SUP","HCPCS C2628","","M001705250  -  STENT ENDOPRSTH 116CM 12MM 11FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$0.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$0.00 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001705270","SUP","HCPCS C1874","","M001705270  -  STENT ENDOPRSTH 116CM 12MM 11FR 70MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705450","SUP","HCPCS C1874","","M001705450  -  STENT ENDOPRSTH 116CM 14MM 12FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705470","SUP","HCPCS C1874","","M001705470  -  STENT ENDOPRSTH 116CM 14MM 12FR 70MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705620","SUP","HCPCS C1874","","M001705620  -  STENT ENDOPRSTH 116CM 6MM 20MM 90CM DELIVERY SYSTEM","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705630","SUP","HCPCS C1874","","M001705630  -  STENT ENDOPRSTH 116CM 6MM 9FR 30MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705650","SUP","HCPCS C2617","","M001705650  -  STENT ENDOPRSTH 116CM 6MM 9FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705670","SUP","HCPCS C1874","","M001705670  -  STENT ENDOPRSTH 116CM 6MM 9FR 70MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705720","SUP","HCPCS C1874","","M001705720  -  STENT ENDOPRSTH 116CM 7MM 9FR 20MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705730","SUP","HCPCS C1874","","M001705730  -  STENT ENDOPRSTH 116CM 7MM 9FR 30MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705750","SUP","HCPCS C1874","","M001705750  -  STENT ENDOPRSTH 116CM 7MM 9FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705770","SUP","HCPCS C1874","","M001705770  -  STENT ENDOPRSTH 116CM 7MM 9FR 90MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705820","SUP","HCPCS C1874","","M001705820  -  STENT ENDOPRSTH 116CM 8MM 9FR 20MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705830","SUP","HCPCS C1874","","M001705830  -  STENT ENDOPRSTH 116CM 8MM 9FR 30MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705850","SUP","HCPCS C1874","","M001705850  -  STENT ENDOPRSTH 116CM 8MM 9FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705870","SUP","HCPCS C1874","","M001705870  -  STENT ENDOPRSTH 116CM 8MM 9FR 70MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705920","SUP","HCPCS C1874","","M001705920  -  STENT ENDOPRSTH 116CM 9MM 10FR 20MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705930","SUP","HCPCS C1874","","M001705930  -  STENT ENDOPRSTH 116CM 9MM 10FR 30MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705950","SUP","HCPCS C1874","","M001705950  -  STENT ENDOPRSTH 116CM 9MM 10FR 50MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001705970","SUP","HCPCS C1874","","M001705970  -  STENT ENDOPRSTH 116CM 9MM 10FR 70MM 90CM COVER COATED","BOTH IP/OP","$3,920.00 ","$2,900.80 ","$0.00 ","$3,920.00 ","$1,764.00 ","$0.00 ","$817.03 ","$0.00 ","$0.00 ","$686.36 ","$3,920.00 ","$0.00 ","$1,960.00 ","$3,104.64 ","$3,136.00 ","$0.00 ","$613.48 ","$0.00 ","$624.06 ","$0.00 "
"M001711000","SUP","HCPCS C1877","","M001711000  -  STENT ENDOPRSTH 100CM 5MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711010","SUP","HCPCS C1877","","M001711010  -  STENT ENDOPRSTH 5MM 6FR 20MM 135CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711020","SUP","HCPCS C1877","","M001711020  -  STENT ENDOPRSTH 100CM 5MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711030","SUP","HCPCS C1877","","M001711030  -  STENT ENDOPRSTH 160CM 5MM 40MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711040","SUP","HCPCS C1877","","M001711040  -  STENT ENDOPRSTH 100CM 5MM 55MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711050","SUP","HCPCS C1877","","M001711050  -  STENT ENDOPRSTH 160CM 5MM 55MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711060","SUP","HCPCS C1877","","M001711060  -  STENT ENDOPRSTH 100CM 5MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711070","SUP","HCPCS C1877","","M001711070  -  STENT ENDOPRSTH 160CM 5MM 80MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711080","SUP","HCPCS C1877","","M001711080  -  STENT ENDOPRSTH 100CM 6MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711090","SUP","HCPCS C1877","","M001711090  -  STENT ENDOPRSTH 5MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711100","SUP","HCPCS C1877","","M001711100  -  STENT ENDOPRSTH 100CM 6MM 45MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711110","SUP","HCPCS C1877","","M001711110  -  STENT ENDOPRSTH 160CM 6MM 45MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711120","SUP","HCPCS C1877","","M001711120  -  STENT ENDOPRSTH 100CM 6MM 60MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711130","SUP","HCPCS C1877","","M001711130  -  STENT ENDOPRSTH 160CM 6MM 60MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711140","SUP","HCPCS C1877","","M001711140  -  STENT ENDOPRSTH 100CM 6MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711150","SUP","HCPCS C1877","","M001711150  -  STENT ENDOPRSTH 160CM 6MM 90MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711160","SUP","HCPCS C1877","","M001711160  -  STENT ENDOPRSTH 100CM 7MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711170","SUP","HCPCS C1877","","M001711170  -  STENT ENDOPRSTH 7MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711180","SUP","HCPCS C1877","","M001711180  -  STENT ENDOPRSTH 100CM 7MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711190","SUP","HCPCS C1877","","M001711190  -  STENT ENDOPRSTH 160CM 7MM 40MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711200","SUP","HCPCS C1877","","M001711200  -  STENT ENDOPRSTH STENT 100CM 7MM 6FR 60MM 75CM SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711210","SUP","HCPCS C1877","","M001711210  -  STENT ENDOPRSTH 160CM 7MM 60MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711220","SUP","HCPCS C1877","","M001711220  -  STENT ENDOPRSTH 100CM 7MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711230","SUP","HCPCS C1877","","M001711230  -  STENT ENDOPRSTH 160CM 7MM 90MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711240","SUP","HCPCS C1877","","M001711240  -  STENT ENDOPRSTH 8MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711250","SUP","HCPCS C1877","","M001711250  -  STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711260","SUP","HCPCS C2617","","M001711260  -  STENT ENDOPRSTH 8MM 6FR 40MM 100CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711270","SUP","HCPCS C1877","","M001711270  -  STENT TRACHEOBRONCHIAL 8MM 6FR 40MM 135CM ENDOPRSTH UNISTEP","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711280","SUP","HCPCS C2617","","M001711280  -  STENT ENDOPRSTH 8MM 6FR 60MM 100CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711290","SUP","HCPCS C2617","","M001711290  -  STENT ENDOPRSTH 160CM 8MM 60MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711300","SUP","HCPCS C2617","","M001711300  -  STENT ENDOPRSTH 100CM 8MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711310","SUP","HCPCS C2617","","M001711310  -  STENT ENDOPRSTH 160CM 8MM 80MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711320","SUP","HCPCS C1877","","M001711320  -  STENT ENDOPRSTH 10MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711330","SUP","HCPCS C1877","","M001711330  -  STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711340","SUP","HCPCS C1877","","M001711340  -  STENT ENDOPRSTH 10MM 7FR 42MM 75CM ENDOPRSTH UNCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711350","SUP","HCPCS C1877","","M001711350  -  STENT ENDOPRSTH 160CM 10MM 42MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711360","SUP","HCPCS C1877","","M001711360  -  STENT ENDOPRSTH 10MM 68MM 100CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711370","SUP","HCPCS C1877","","M001711370  -  STENT ENDOPRSTH 160CM 10MM 68MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711380","SUP","HCPCS C2617","","M001711380  -  STENT ENDOPRSTH 100CM 10MM 94MM 75CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001711390","SUP","HCPCS C1877","","M001711390  -  STENT ENDOPRSTH 160CM 10MM 94MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712000","SUP","HCPCS C1877","","M001712000  -  STENT ENDOPRSTH 100CM 6MM 24MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712010","SUP","HCPCS C1877","","M001712010  -  STENT ENDOPRSTH 160CM 6MM 24MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712020","SUP","HCPCS C1877","","M001712020  -  STENT ENDOPRSTH 100CM 6MM 6FR 36MM 75CM SYSTEM NONCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712030","SUP","HCPCS C1877","","M001712030  -  STENT ENDOPRSTH 160CM 6MM 36MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712040","SUP","HCPCS C1877","","M001712040  -  STENT ENDOPRSTH 100CM 6MM 46MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712050","SUP","HCPCS C1877","","M001712050  -  STENT ENDOPRSTH 160CM 6MM 46MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712060","SUP","HCPCS C1877","","M001712060  -  STENT ENDOPRSTH 100CM 6MM 59MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712070","SUP","HCPCS C1877","","M001712070  -  STENT ENDOPRSTH 160CM 6MM 59MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712080","SUP","HCPCS C1877","","M001712080  -  STENT ENDOPRSTH 100CM 7MM 23MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712090","SUP","HCPCS C1877","","M001712090  -  STENT ENDOPRSTH 160CM 7MM 6FR 23MM 135CM SYSTEM NONCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712100","SUP","HCPCS C1877","","M001712100  -  STENT ENDOPRSTH 100CM 7MM 34MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712110","SUP","HCPCS C1877","","M001712110  -  STENT ENDOPRSTH 160CM 7MM 34MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712120","SUP","HCPCS C1877","","M001712120  -  STENT ENDOPRSTH 100CM 7MM 6FR 55MM 75CM SYSTEM NONCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712130","SUP","HCPCS C1877","","M001712130  -  STENT ENDOPRSTH 160CM 7MM 55MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712140","SUP","HCPCS C1877","","M001712140  -  STENT ENDOPRSTH 100CM 7MM 67MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712150","SUP","HCPCS C1877","","M001712150  -  STENT ENDOPRSTH 160CM 7MM 67MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712160","SUP","HCPCS C1877","","M001712160  -  STENT ENDOPRSTH 100CM 8MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712170","SUP","HCPCS C1877","","M001712170  -  STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712180","SUP","HCPCS C1877","","M001712180  -  STENT ENDOPRSTH 100CM 8MM 38MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712190","SUP","HCPCS C1877","","M001712190  -  STENT ENDOPRSTH 160CM 8MM 38MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712200","SUP","HCPCS C1877","","M001712200  -  STENT ENDOPRSTH 100CM 8MM 47MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712210","SUP","HCPCS C1877","","M001712210  -  STENT ENDOPRSTH 160CM 8MM 47MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712220","SUP","HCPCS C1877","","M001712220  -  STENT ENDOPRSTH 100CM 8MM 6FR 66MM 75CM SYSTEM NONCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712230","SUP","HCPCS C1877","","M001712230  -  STENT ENDOPRSTH 160CM 8MM 66MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712240","SUP","HCPCS C1877","","M001712240  -  STENT ENDOPRSTH 100CM 9MM 6FR 18MM 75CM SYSTEM NONCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712250","SUP","HCPCS C1877","","M001712250  -  STENT ENDOPRSTH 160CM 9MM 6FR 18MM 135CM SYSTEM NONCOVERED","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712260","SUP","HCPCS C1877","","M001712260  -  STENT ENDOPRSTH 100CM 9MM 35MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712270","SUP","HCPCS C1877","","M001712270  -  STENT ENDOPRSTH 9MM 35MM 160CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712280","SUP","HCPCS C1877","","M001712280  -  STENT ENDOPRSTH 100CM 9MM 52MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712290","SUP","HCPCS C1877","","M001712290  -  STENT ENDOPRSTH 9MM 52MM 160CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712300","SUP","HCPCS C1877","","M001712300  -  STENT ENDOPRSTH 100CM 9MM 61MM 75CM DELIVERY SYSTEM FLEXIBLE","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712310","SUP","HCPCS C1877","","M001712310  -  STENT ENDOPRSTH 160CM 9MM 61MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712320","SUP","HCPCS C1877","","M001712320  -  STENT ENDOPRSTH 100CM 10MM 20MM 75CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712330","SUP","HCPCS C1877","","M001712330  -  STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712340","SUP","HCPCS C1877","","M001712340  -  STENT ENDOPRSTH 100CM 10MM 39MM 75CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712350","SUP","HCPCS C1877","","M001712350  -  STENT ENDOPRSTH 160CM 10MM 39MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712360","SUP","HCPCS C2617","","M001712360  -  STENT ENDOPRSTH 10MM 6FR 49MM 75CM UNCOVERED UNISTEP PLUS","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712370","SUP","HCPCS C1877","","M001712370  -  STENT ENDOPRSTH 160CM 10MM 49MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712380","SUP","HCPCS C2617","","M001712380  -  STENT ENDOPRSTH 100CM 10MM 69MM 75CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001712390","SUP","HCPCS C1877","","M001712390  -  STENT ENDOPRSTH 160CM 10MM 69MM 135CM DELIVERY SYSTEM","BOTH IP/OP","$2,200.00 ","$1,628.00 ","$0.00 ","$2,200.00 ","$990.00 ","$0.00 ","$458.54 ","$0.00 ","$0.00 ","$385.20 ","$2,200.00 ","$0.00 ","$1,100.00 ","$1,742.40 ","$1,760.00 ","$0.00 ","$344.30 ","$0.00 ","$350.24 ","$0.00 "
"M001719000","SUP","HCPCS C1876","","M001719000  -  STENT ENDOPRSTH 6MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M001719010","SUP","HCPCS C1876","","M001719010  -  STENT ENDOPRSTH 8MM 21MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M001719020","SUP","HCPCS C1876","","M001719020  -  STENT ENDOPRSTH 8MM 29MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M001719030","SUP","HCPCS C1876","","M001719030  -  STENT ENDOPRSTH 8MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M001719040","SUP","HCPCS C1876","","M001719040  -  STENT ENDOPRSTH 10MM 24MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M001719050","SUP","HCPCS C1876","","M001719050  -  STENT ENDOPRSTH 10MM 31MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M001719060","SUP","HCPCS C1876","","M001719060  -  STENT ENDOPRSTH 10MM 37MM CLOSE CELL DESIGN HIGH DELIVERABLE","BOTH IP/OP","$4,500.00 ","$3,330.00 ","$0.00 ","$4,500.00 ","$2,025.00 ","$0.00 ","$937.91 ","$0.00 ","$0.00 ","$787.91 ","$4,500.00 ","$0.00 ","$2,250.00 ","$3,564.00 ","$3,600.00 ","$0.00 ","$704.25 ","$0.00 ","$716.40 ","$0.00 "
"M0017600121","SUP","HCPCS C1884","","M0017600121  -  PARTICLES EMBOLIZATION 45-150UM 2 VIAL CNTOUR-PVA PVA","BOTH IP/OP","$367.01 ","$271.59 ","$0.00 ","$367.01 ","$165.16 ","$0.00 ","$76.49 ","$0.00 ","$0.00 ","$64.26 ","$367.01 ","$0.00 ","$183.51 ","$290.67 ","$293.61 ","$0.00 ","$57.44 ","$0.00 ","$58.43 ","$0.00 "
"M0017600151","SUP","HCPCS C1884","","M0017600151  -  PARTICLES EMBOLIZATION 45-150UM 5 VIAL CNTOUR PVA","BOTH IP/OP","$358.51 ","$265.30 ","$0.00 ","$358.51 ","$161.33 ","$0.00 ","$74.72 ","$0.00 ","$0.00 ","$62.77 ","$358.51 ","$0.00 ","$179.26 ","$283.94 ","$286.81 ","$0.00 ","$56.11 ","$0.00 ","$57.07 ","$0.00 "
"M0017600221","SUP","HCPCS C1884","","M0017600221  -  PARTICLES EMBOLIZATION 150-250UM 2 VIAL CNTOUR PVA","BOTH IP/OP","$367.01 ","$271.59 ","$0.00 ","$367.01 ","$165.16 ","$0.00 ","$76.49 ","$0.00 ","$0.00 ","$64.26 ","$367.01 ","$0.00 ","$183.51 ","$290.67 ","$293.61 ","$0.00 ","$57.44 ","$0.00 ","$58.43 ","$0.00 "
"M0017600251","SUP","HCPCS C1884","","M0017600251  -  PARTICLES EMBOLIZATION 150-250UM 5 VIAL CNTOUR PVA","BOTH IP/OP","$358.51 ","$265.30 ","$0.00 ","$358.51 ","$161.33 ","$0.00 ","$74.72 ","$0.00 ","$0.00 ","$62.77 ","$358.51 ","$0.00 ","$179.26 ","$283.94 ","$286.81 ","$0.00 ","$56.11 ","$0.00 ","$57.07 ","$0.00 "
"M0017600321","SUP","HCPCS C1884","","M0017600321  -  PARTICLES EMBOLIZATION 250-355UM 2 VIAL CNTOUR PVA","BOTH IP/OP","$367.01 ","$271.59 ","$0.00 ","$367.01 ","$165.16 ","$0.00 ","$76.49 ","$0.00 ","$0.00 ","$64.26 ","$367.01 ","$0.00 ","$183.51 ","$290.67 ","$293.61 ","$0.00 ","$57.44 ","$0.00 ","$58.43 ","$0.00 "
"M0017600351","SUP","HCPCS C1884","","M0017600351  -  PARTICLES EMBOLIZATION 250-355UM 5 VIAL CNTOUR PVA","BOTH IP/OP","$358.51 ","$265.30 ","$0.00 ","$358.51 ","$161.33 ","$0.00 ","$74.72 ","$0.00 ","$0.00 ","$62.77 ","$358.51 ","$0.00 ","$179.26 ","$283.94 ","$286.81 ","$0.00 ","$56.11 ","$0.00 ","$57.07 ","$0.00 "
"M0017600421","SUP","HCPCS C1884","","M0017600421  -  PARTICLES EMBOLIZATION 355-500UM 2 VIAL CNTOUR PVA","BOTH IP/OP","$367.01 ","$271.59 ","$0.00 ","$367.01 ","$165.16 ","$0.00 ","$76.49 ","$0.00 ","$0.00 ","$64.26 ","$367.01 ","$0.00 ","$183.51 ","$290.67 ","$293.61 ","$0.00 ","$57.44 ","$0.00 ","$58.43 ","$0.00 "
"M0017600451","SUP","Custom 27203010","","M0017600451  -  PARTICLES EMBL 355-500UM 5 VL CNTOUR PVA","BOTH IP/OP","$348.00 ","$257.52 ","$0.00 ","$348.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.00 ","$0.00 ","$174.00 ","$275.62 ","$278.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0017600621","SUP","Custom 27203010","","PARTICLES EMBL 500-710UM 2 VL CNTOUR-PVA","BOTH IP/OP","$356.25 ","$263.63 ","$0.00 ","$356.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$356.25 ","$0.00 ","$178.13 ","$282.15 ","$285.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0017600651","SUP","HCPCS C1884","","M0017600651  -  PARTICLES EMBOLIZATION 500-710UM 5 VIAL CNTOUR PVA","BOTH IP/OP","$358.51 ","$265.30 ","$0.00 ","$358.51 ","$161.33 ","$0.00 ","$74.72 ","$0.00 ","$0.00 ","$62.77 ","$358.51 ","$0.00 ","$179.26 ","$283.94 ","$286.81 ","$0.00 ","$56.11 ","$0.00 ","$57.07 ","$0.00 "
"M0017600821","SUP","Custom 27203010","","PARTICLES EMBL 710-1000UM 2 VL CNTOUR-PVA","BOTH IP/OP","$367.01 ","$271.59 ","$0.00 ","$498.75 ","$0.00 ","$0.00 ","$76.49 ","$0.00 ","$0.00 ","$0.00 ","$498.75 ","$0.00 ","$249.38 ","$395.01 ","$399.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0017600851","SUP","HCPCS C1884","","M0017600851  -  PARTICLES EMBOLIZATION 710-1000UM 5 VIAL CNTOUR PVA","BOTH IP/OP","$358.51 ","$265.30 ","$0.00 ","$358.51 ","$161.33 ","$0.00 ","$74.72 ","$0.00 ","$0.00 ","$62.77 ","$358.51 ","$0.00 ","$179.26 ","$283.94 ","$286.81 ","$0.00 ","$56.11 ","$0.00 ","$57.07 ","$0.00 "
"M0017601151","SUP","HCPCS C1884","","M0017601151  -  PARTICLES EMBOLIZATION 1000-1180UM 5 VIAL CNTOUR PVA","BOTH IP/OP","$358.51 ","$265.30 ","$0.00 ","$358.51 ","$161.33 ","$0.00 ","$74.72 ","$0.00 ","$0.00 ","$62.77 ","$358.51 ","$0.00 ","$179.26 ","$283.94 ","$286.81 ","$0.00 ","$56.11 ","$0.00 ","$57.07 ","$0.00 "
"M001BATR111000","SUP","HCPCS C1753","","M001BATR111000  -  MODULE CATH POLARCATH PWR SYS PERI CRYOPLASTY","BOTH IP/OP","$1,415.95 ","$1,047.80 ","$0.00 ","$1,415.95 ","$768.86 ","$0.00 ","$295.12 ","$0.00 ","$0.00 ","$247.92 ","$1,415.95 ","$0.00 ","$707.98 ","$1,121.43 ","$1,132.76 ","$0.00 ","$221.60 ","$0.00 ","$225.42 ","$0.00 "
"M001NC20000001","SUP","Custom 27203010","","M001NC20000001  -  CARTRIDGE CATH POLARCATH N2O PERI","BOTH IP/OP","$1,354.38 ","$1,002.24 ","$0.00 ","$1,354.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,354.38 ","$0.00 ","$677.19 ","$1,072.67 ","$1,083.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001P4100080010","SUP","HCPCS C1753","","M001P4100080010  -  CATHETER BLNDIL 4MM 80CM 100MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P4100120010","SUP","HCPCS C1753","","M001P4100120010  -  CATHETER BLNDIL 4MM 120CM 100MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P420080010","SUP","HCPCS C1753","","M001P420080010  -  CATHETER BLNDIL 4MM 80CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P420120010","SUP","HCPCS C1753","","M001P420120010  -  CATHETER BLNDIL 4MM 120CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P440080010","SUP","HCPCS C1753","","M001P440080010  -  CATHETER BLNDIL 4MM 80CM 40MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P440120010","SUP","HCPCS C1753","","M001P440120010  -  CATHETER BLNDIL 4MM 120CM 40MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P460080010","SUP","HCPCS C1753","","M001P460080010  -  CATHETER BLNDIL 4MM 80CM 60MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P460120010","SUP","HCPCS C1726","","M001P460120010  -  CATHETER BLNDIL 4MM 120CM 60MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P480080010","SUP","HCPCS C1753","","M001P480080010  -  CATHETER BLNDIL 4MM 80CM 80MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P480120010","SUP","HCPCS C1726","","M001P480120010  -  CATHETER BLNDIL 4MM 120CM 80MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P5100080010","SUP","HCPCS C1753","","M001P5100080010  -  CATHETER BLNDIL 5MM 80CM 100MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P5100120010","SUP","HCPCS C1753","","M001P5100120010  -  CATHETER BLNDIL 5MM 120CM 100MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P5120120010","SUP","HCPCS C1725","","M001P5120120010  -  CATHETER BLNDIL 5MM 120CM 120MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$2,228.58 ","$1,649.15 ","$0.00 ","$2,228.58 ","$1,210.12 ","$0.00 ","$464.49 ","$0.00 ","$0.00 ","$390.21 ","$2,228.58 ","$0.00 ","$1,114.29 ","$1,765.04 ","$1,782.86 ","$0.00 ","$348.77 ","$0.00 ","$354.79 ","$0.00 "
"M001P5150120010","SUP","HCPCS C1725","","M001P5150120010  -  CATHETER BLNDIL 5MM 150CM 120MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$2,487.13 ","$1,840.48 ","$0.00 ","$2,487.13 ","$1,350.51 ","$0.00 ","$518.38 ","$0.00 ","$0.00 ","$435.48 ","$2,487.13 ","$0.00 ","$1,243.56 ","$1,969.81 ","$1,989.70 ","$0.00 ","$389.24 ","$0.00 ","$395.95 ","$0.00 "
"M001P520080010","SUP","HCPCS C1753","","M001P520080010  -  CATHETER BLNDIL 5MM 80CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P520120010","SUP","HCPCS C1753","","M001P520120010  -  CATHETER BLNDIL 5MM 120CM 20MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P540080010","SUP","HCPCS C1753","","M001P540080010  -  CATHETER BLNDIL 5MM 80CM 40MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P540120010","SUP","HCPCS C1726","","M001P540120010  -  CATHETER BLNDIL 5MM 120CM 40MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P560080010","SUP","HCPCS C1753","","M001P560080010  -  CATHETER BLNDIL 5MM 80CM 60MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P560120010","SUP","HCPCS C1726","","M001P560120010  -  CATHETER BLNDIL 5MM 120CM 60MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P580080010","SUP","HCPCS C1753","","M001P580080010  -  CATHETER BLNDIL 5MM 80CM 80MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P580120010","SUP","HCPCS C1726","","M001P580120010  -  CATHETER BLNDIL 5MM 120CM 80MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P6100080010","SUP","HCPCS C1753","","M001P6100080010  -  CATHETER BLNDIL 6MM 80CM 100MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P6100120010","SUP","HCPCS C1753","","M001P6100120010  -  CATHETER BLNDIL 6MM 120CM 100MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P6120120010","SUP","HCPCS C1725","","M001P6120120010  -  CATHETER BLNDIL 6MM 120CM 120MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$2,228.58 ","$1,649.15 ","$0.00 ","$2,228.58 ","$1,210.12 ","$0.00 ","$464.49 ","$0.00 ","$0.00 ","$390.21 ","$2,228.58 ","$0.00 ","$1,114.29 ","$1,765.04 ","$1,782.86 ","$0.00 ","$348.77 ","$0.00 ","$354.79 ","$0.00 "
"M001P6150120010","SUP","HCPCS C1725","","M001P6150120010  -  CATHETER BLNDIL 6MM 120CM 150MM POLARCATH PERI ACPT .035IN","BOTH IP/OP","$2,487.13 ","$1,840.48 ","$0.00 ","$2,487.13 ","$1,350.51 ","$0.00 ","$518.38 ","$0.00 ","$0.00 ","$435.48 ","$2,487.13 ","$0.00 ","$1,243.56 ","$1,969.81 ","$1,989.70 ","$0.00 ","$389.24 ","$0.00 ","$395.95 ","$0.00 "
"M001P620080010","SUP","HCPCS C1753","","M001P620080010  -  CATHETER BLNDIL 6MM 80CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P620120010","SUP","HCPCS C1753","","M001P620120010  -  CATHETER BLNDIL 6MM 120CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P640080010","SUP","HCPCS C1726","","M001P640080010  -  CATHETER BLNDIL 6MM 80CM 40MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P640120010","SUP","HCPCS C1726","","M001P640120010  -  CATHETER BLNDIL 6MM 120CM 40MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P660080010","SUP","HCPCS C1753","","M001P660080010  -  CATHETER BLNDIL 6MM 80CM 60MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P660120010","SUP","HCPCS C1726","","M001P660120010  -  CATHETER BLNDIL 6MM 120CM 60MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P680080010","SUP","HCPCS C1753","","M001P680080010  -  CATHETER BLNDIL 6MM 80CM 80MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P680120010","SUP","HCPCS C1753","","M001P680120010  -  CATHETER BLNDIL 6MM 120CM 80MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P720080010","SUP","HCPCS C1753","","M001P720080010  -  CATHETER BLNDIL 7MM 80CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P720120010","SUP","HCPCS C1726","","M001P720120010  -  CATHETER BLNDIL 7MM 120CM 20MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P740080010","SUP","HCPCS C1753","","M001P740080010  -  CATHETER BLNDIL 7MM 80CM 40MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P740120010","SUP","HCPCS C1726","","M001P740120010  -  CATHETER BLNDIL 7MM 120CM 40MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P760080010","SUP","HCPCS C2618","","M001P760080010  -  CATHETER BLNDIL 7MM 80CM 60MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001P760120010","SUP","HCPCS C1753","","M001P760120010  -  CATHETER BLNDIL 7MM 120CM 60MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P780080010","SUP","HCPCS C1753","","M001P780080010  -  CATHETER BLNDIL 7MM 80CM 80MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P780120010","SUP","HCPCS C1726","","M001P780120010  -  CATHETER BLNDIL 7MM 120CM 80MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,982.33 ","$1,466.92 ","$0.00 ","$1,982.33 ","$1,076.40 ","$0.00 ","$413.17 ","$0.00 ","$0.00 ","$347.09 ","$1,982.33 ","$0.00 ","$991.16 ","$1,570.01 ","$1,585.86 ","$0.00 ","$310.23 ","$0.00 ","$315.59 ","$0.00 "
"M001P820080010","SUP","HCPCS C1725","","M001P820080010  -  CATHETER BLNDIL 8MM 80CM 20MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P840080010","SUP","HCPCS C1725","","M001P840080010  -  CATHETER BLNDIL 8MM 80CM 40MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001P840120010","SUP","HCPCS C1726","","M001P840120010  -  CATHETER BLNDIL 8MM 120CM 40MM POLARCATH PERI ACPT .035IN GW","BOTH IP/OP","$1,699.13 ","$1,257.36 ","$0.00 ","$1,699.13 ","$922.62 ","$0.00 ","$354.14 ","$0.00 ","$0.00 ","$297.50 ","$1,699.13 ","$0.00 ","$849.56 ","$1,345.71 ","$1,359.30 ","$0.00 ","$265.91 ","$0.00 ","$270.50 ","$0.00 "
"M001PCB50201350","SUP","HCPCS C1726","","M001PCB50201350  -  CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB5020500","SUP","HCPCS C1753","","M001PCB5020500  -  CATHETER BALDILAT 5MM 50CM 2CM OTW PERIPHERAL CUTTING","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB5020900","SUP","HCPCS C1726","","M001PCB5020900  -  CATHETER BALDILAT 5MM 90CM 20MM OTW PLAQUE MODIFICATION","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB60201350","SUP","HCPCS C1726","","M001PCB60201350  -  CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB6020500","SUP","HCPCS C1753","","M001PCB6020500  -  CATHETER BLNDIL 6MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB6020900","SUP","HCPCS C1726","","M001PCB6020900  -  CATHETER BLNDIL 6MM 90CM 20MM PR CTBLN OTW INFL PORT TPR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB70201350","SUP","HCPCS C1753","","M001PCB70201350  -  CATHETER BLNDIL 7MM 135CM 20MM PR CTBLN OTW TPR TIP INFL","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB7020500","SUP","HCPCS C1753","","M001PCB7020500  -  CATHETER BLNDIL 7MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB7020900","SUP","HCPCS C1753","","M001PCB7020900  -  CATHETER BLNDIL 7MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB80201350","SUP","HCPCS C1753","","M001PCB80201350  -  CATHETER BALDILAT 8MM 135CM 2CM OTW PLAQUE MODIFICATION","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB8020500","SUP","HCPCS C1753","","M001PCB8020500  -  CATHETER BLNDIL 8MM 50CM 20MM PR CTBLN OTW INFL PORT TPR TIP","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCB8020900","SUP","HCPCS C1753","","M001PCB8020900  -  CATHETER BLNDIL 8MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT","BOTH IP/OP","$1,750.00 ","$1,295.00 ","$0.00 ","$1,750.00 ","$950.25 ","$0.00 ","$364.74 ","$0.00 ","$0.00 ","$306.41 ","$1,750.00 ","$0.00 ","$875.00 ","$1,386.00 ","$1,400.00 ","$0.00 ","$273.88 ","$0.00 ","$278.60 ","$0.00 "
"M001PCIU400000","SUP","HCPCS C2618","","M001PCIU400000  -  UNIT CATH POLARCATH PERI CRYOPLASTY","BOTH IP/OP","$2,561.00 ","$1,895.14 ","$0.00 ","$2,561.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,561.00 ","$0.00 ","$1,280.50 ","$2,028.31 ","$2,048.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M001T20100135010","SUP","HCPCS C1725","","M001T20100135010  -  CATHETER BLNDIL 2MM 135CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T20100150010","SUP","HCPCS C1725","","M001T20100150010  -  CATHETER BLNDIL 2MM 150CM 100MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T20120150010","SUP","HCPCS C1725","","M001T20120150010  -  CATHETER BLNDIL 2MM 150CM 120MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T20150150010","SUP","HCPCS C1725","","M001T20150150010  -  CATHETER BLNDIL 2MM 150CM 150MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T2020135010","SUP","HCPCS C1725","","M001T2020135010  -  CATHETER BLNDIL 2MM 135CM 20MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2020150010","SUP","HCPCS C1725","","M001T2020150010  -  CATHETER BLNDIL 2MM 150CM 20MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2040135010","SUP","HCPCS C1725","","M001T2040135010  -  CATHETER BLNDIL 2MM 135CM 40MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2040150010","SUP","HCPCS C1725","","M001T2040150010  -  CATHETER BLNDIL 2MM 150CM 40MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2060135010","SUP","HCPCS C1725","","M001T2060135010  -  CATHETER BLNDIL 2MM 135CM 60MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2060150010","SUP","HCPCS C1725","","M001T2060150010  -  CATHETER BLNDIL 2MM 150CM 60MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T25100135010","SUP","HCPCS C1725","","M001T25100135010  -  CATHETER BLNDIL 2.5MM 135CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T25100150010","SUP","HCPCS C1725","","M001T25100150010  -  CATHETER BLNDIL 2.5MM 150CM 100MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T25120150010","SUP","HCPCS C1725","","M001T25120150010  -  CATHETER BLNDIL 2.5MM 150CM 120MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T25150150010","SUP","HCPCS C1725","","M001T25150150010  -  CATHETER BLNDIL 2.5MM 150CM 150MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T2520135010","SUP","HCPCS C1725","","M001T2520135010  -  CATHETER BLNDIL 2.5MM 135CM 20MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2520150010","SUP","HCPCS C1725","","M001T2520150010  -  CATHETER BLNDIL 2.5MM 150CM 20MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2540135010","SUP","HCPCS C1725","","M001T2540135010  -  CATHETER BLNDIL 2.5MM 135CM 40MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2540150010","SUP","HCPCS C1725","","M001T2540150010  -  CATHETER BLNDIL 2.5MM 150CM 40MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2560135010","SUP","HCPCS C1725","","M001T2560135010  -  CATHETER BLNDIL 2.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T2560150010","SUP","HCPCS C1725","","M001T2560150010  -  CATHETER BLNDIL 2.5MM 150CM 60MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T30100135010","SUP","HCPCS C1725","","M001T30100135010  -  CATHETER BLNDIL 3MM 135CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T30100150010","SUP","HCPCS C1725","","M001T30100150010  -  CATHETER BLNDIL 3MM 150CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T30120150010","SUP","HCPCS C1725","","M001T30120150010  -  CATHETER BLNDIL 3MM 150CM 120MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T30150150010","SUP","HCPCS C1725","","M001T30150150010  -  CATHETER BLNDIL 3MM 150CM 150MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T3020135010","SUP","HCPCS C1725","","M001T3020135010  -  CATHETER BLNDIL 3MM 135CM 20MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3020150010","SUP","HCPCS C1725","","M001T3020150010  -  CATHETER BLNDIL 3MM 150CM 20MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3040135010","SUP","HCPCS C1725","","M001T3040135010  -  CATHETER BLNDIL 3MM 135CM 40MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3040150010","SUP","HCPCS C1725","","M001T3040150010  -  CATHETER BLNDIL 3MM 150CM 40MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3060135010","SUP","HCPCS C1725","","M001T3060135010  -  CATHETER BLNDIL 3MM 135CM 60MM POLARCATH COAX RADOPQ MRKNG","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3060150010","SUP","HCPCS C1725","","M001T3060150010  -  CATHETER BLNDIL 3MM 150CM 60MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T35100135010","SUP","HCPCS C1725","","M001T35100135010  -  CATHETER BLNDIL 3.5MM 135CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T35100150010","SUP","HCPCS C1725","","M001T35100150010  -  CATHETER BLNDIL 3.5MM 150CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T35120150010","SUP","HCPCS C1725","","M001T35120150010  -  CATHETER BLNDIL 3.5MM 150CM 120MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T35150150010","SUP","HCPCS C1725","","M001T35150150010  -  CATHETER BLNDIL 3.5MM 150CM 150MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T3520135010","SUP","HCPCS C1725","","M001T3520135010  -  CATHETER BLNDIL 3.5MM 135CM 20MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3520150010","SUP","HCPCS C1725","","M001T3520150010  -  CATHETER BLNDIL 3.5MM 150CM 20MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3540135010","SUP","HCPCS C1725","","M001T3540135010  -  CATHETER BLNDIL 3.5MM 135CM 40MM POLARCATH COAX RADOPQ MRKNG","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3540150010","SUP","HCPCS C1725","","M001T3540150010  -  CATHETER BLNDIL 3.5MM 150CM 40MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3560135010","SUP","HCPCS C1725","","M001T3560135010  -  CATHETER BLNDIL 3.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T3560150010","SUP","HCPCS C1725","","M001T3560150010  -  CATHETER BLNDIL 3.5MM 150CM 60MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T40100135010","SUP","HCPCS C1725","","M001T40100135010  -  CATHETER BLNDIL 4MM 135CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T40100150010","SUP","HCPCS C1725","","M001T40100150010  -  CATHETER BLNDIL 4MM 150CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T40120150010","SUP","HCPCS C1725","","M001T40120150010  -  CATHETER BLNDIL 4MM 150CM 120MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T40150150010","SUP","HCPCS C1725","","M001T40150150010  -  CATHETER BLNDIL 4MM 150CM 150MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T4020135010","SUP","HCPCS C1725","","M001T4020135010  -  CATHETER BLNDIL 5FR 4MM 135CM 20MM POLARCATH SHTH PERI ACPT","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T4020150010","SUP","HCPCS C1725","","M001T4020150010  -  CATHETER BLNDIL 4MM 150CM 20MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T4040135010","SUP","HCPCS C1725","","M001T4040135010  -  CATHETER BLNDIL 4MM 135CM 40MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T4040150010","SUP","HCPCS C1725","","M001T4040150010  -  CATHETER BLNDIL 4MM 150CM 40MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T4060135010","SUP","HCPCS C1725","","M001T4060135010  -  CATHETER BLNDIL 4MM 135CM 60MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T4060150010","SUP","HCPCS C1725","","M001T4060150010  -  CATHETER BLNDIL 4MM 150CM 60MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T50100135010","SUP","HCPCS C1725","","M001T50100135010  -  CATHETER BLNDIL 5MM 135CM 100MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T50120135010","SUP","HCPCS C1725","","M001T50120135010  -  CATHETER BLNDIL 5MM 135CM 120MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T50150135010","SUP","HCPCS C1725","","M001T50150135010  -  CATHETER BLNDIL 5MM 135CM 150MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T5020135010","SUP","HCPCS C1725","","M001T5020135010  -  CATHETER BLNDIL 5MM 135CM 20MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T5040135010","SUP","HCPCS C1725","","M001T5040135010  -  CATHETER BLNDIL 5MM 135CM 40MM POLARCATH COAX RADOPQ PERI","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T5060135010","SUP","HCPCS C1725","","M001T5060135010  -  CATHETER BLNDIL 5MM 135CM 60MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T60100135010","SUP","HCPCS C1725","","M001T60100135010  -  CATHETER BLNDIL 6MM 135CM 100MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,536.38 ","$1,876.92 ","$0.00 ","$2,536.38 ","$1,377.25 ","$0.00 ","$528.64 ","$0.00 ","$0.00 ","$444.10 ","$2,536.38 ","$0.00 ","$1,268.19 ","$2,008.81 ","$2,029.10 ","$0.00 ","$396.94 ","$0.00 ","$403.79 ","$0.00 "
"M001T60120135010","SUP","HCPCS C1725","","M001T60120135010  -  CATHETER BLNDIL 6MM 135CM 120MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$2,794.95 ","$2,068.26 ","$0.00 ","$2,794.95 ","$1,517.66 ","$0.00 ","$582.54 ","$0.00 ","$0.00 ","$489.37 ","$2,794.95 ","$0.00 ","$1,397.48 ","$2,213.60 ","$2,235.96 ","$0.00 ","$437.41 ","$0.00 ","$444.96 ","$0.00 "
"M001T60150135010","SUP","HCPCS C1725","","M001T60150135010  -  CATHETER BLNDIL 6MM 135CM 150MM POLARCATH PERI ACPT .014IN","BOTH IP/OP","$3,041.20 ","$2,250.49 ","$0.00 ","$3,041.20 ","$1,651.37 ","$0.00 ","$633.86 ","$0.00 ","$0.00 ","$532.49 ","$3,041.20 ","$0.00 ","$1,520.60 ","$2,408.63 ","$2,432.96 ","$0.00 ","$475.95 ","$0.00 ","$484.16 ","$0.00 "
"M001T6020135010","SUP","HCPCS C1725","","M001T6020135010  -  CATHETER BLNDIL 6MM 135CM 20MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T6040135010","SUP","HCPCS C1725","","M001T6040135010  -  CATHETER BLNDIL 6MM 135CM 40MM POLARCATH RADOPQ PERI ACPT","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M001T6060135010","SUP","HCPCS C1725","","M001T6060135010  -  CATHETER BLNDIL 6MM 135CM 60MM POLARCATH PERI ACPT .014IN GW","BOTH IP/OP","$2,265.50 ","$1,676.47 ","$0.00 ","$2,265.50 ","$1,230.17 ","$0.00 ","$472.19 ","$0.00 ","$0.00 ","$396.67 ","$2,265.50 ","$0.00 ","$1,132.75 ","$1,794.28 ","$1,812.40 ","$0.00 ","$354.55 ","$0.00 ","$360.67 ","$0.00 "
"M002002231680","SUP","HCPCS C1768","","M002002231680  -  GRAFT CARDIO 40CM 16X8MM WVN BFUR NONSEALED CLY VRSFT EPTFE","BOTH IP/OP","$1,337.50 ","$989.75 ","$0.00 ","$1,337.50 ","$601.88 ","$0.00 ","$278.77 ","$0.00 ","$0.00 ","$234.19 ","$1,337.50 ","$0.00 ","$668.75 ","$1,059.30 ","$1,070.00 ","$0.00 ","$209.32 ","$0.00 ","$212.93 ","$0.00 "
"M002020195300","SUP","HCPCS C1768","","M002020195300  -  PATCH CARDIO THK.36MM 3X1IN KNTD ULTHN HMSH FNS","BOTH IP/OP","$278.93 ","$206.41 ","$0.00 ","$278.93 ","$125.52 ","$0.00 ","$58.13 ","$0.00 ","$0.00 ","$48.84 ","$278.93 ","$0.00 ","$139.46 ","$220.91 ","$223.14 ","$0.00 ","$43.65 ","$0.00 ","$44.40 ","$0.00 "
"M00202019530P0","SUP","HCPCS C1768","","M00202019530P0  -  PATCH CV THK.36MM ULTHN TPR 3X1IN HMSH PL FNS KNIT PRETRIM","BOTH IP/OP","$321.70 ","$238.06 ","$0.00 ","$310.35 ","$139.66 ","$0.00 ","$67.05 ","$0.00 ","$0.00 ","$54.34 ","$310.35 ","$0.00 ","$155.18 ","$245.80 ","$248.28 ","$0.00 ","$48.57 ","$0.00 ","$49.41 ","$0.00 "
"M002020851470","SUP","HCPCS C1768","","M002020851470  -  GRAFT CV 2 BRCH THN 14MM 7MM 40CM STRL HMSH G2 VLR MCVL SFT","BOTH IP/OP","$1,772.45 ","$1,311.61 ","$0.00 ","$1,834.55 ","$825.55 ","$0.00 ","$369.42 ","$0.00 ","$0.00 ","$321.22 ","$1,834.55 ","$0.00 ","$917.28 ","$1,452.96 ","$1,467.64 ","$0.00 ","$287.11 ","$0.00 ","$292.06 ","$0.00 "
"M002020851680","SUP","HCPCS C1768","","M002020851680  -  GRAFT VASC 2 BRCH 16MM 8MM 40CM STRL HMSH GMCVL 2 VLR CLGN","BOTH IP/OP","$1,834.55 ","$1,357.57 ","$0.00 ","$1,834.55 ","$825.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$321.22 ","$1,834.55 ","$0.00 ","$917.28 ","$1,452.96 ","$1,467.64 ","$0.00 ","$287.11 ","$0.00 ","$292.06 ","$0.00 "
"M002020952080","SUP","HCPCS C1768","","M002020952080  -  GRAFT CV 8MM 60CM STRL HMSH GMCVL 2 VLR STRG TUBE KNIT SFT","BOTH IP/OP","$1,308.00 ","$967.92 ","$0.00 ","$1,245.73 ","$560.58 ","$0.00 ","$272.62 ","$0.00 ","$0.00 ","$218.12 ","$1,245.73 ","$0.00 ","$622.86 ","$986.62 ","$996.58 ","$0.00 ","$194.96 ","$0.00 ","$198.32 ","$0.00 "
"M002020952160","SUP","HCPCS C1768","","M002020952160  -  GRAFT VASC 16MM 30CM STRL HMSH GMCVL PLSTR 2 VLR STRG TUBE","BOTH IP/OP","$1,239.88 ","$917.51 ","$0.00 ","$1,283.30 ","$577.49 ","$0.00 ","$258.42 ","$0.00 ","$0.00 ","$224.70 ","$1,283.30 ","$0.00 ","$641.65 ","$1,016.37 ","$1,026.64 ","$0.00 ","$200.84 ","$0.00 ","$204.30 ","$0.00 "
"M00202175416P0","SUP","HCPCS C1768","","M00202175416P0  -  GRAFT CARDIO 30CM 16MM 2 VLR WVN STR TUBE HMSH PL PLSTR STRL","BOTH IP/OP","$1,384.73 ","$1,024.70 ","$0.00 ","$1,303.78 ","$586.70 ","$0.00 ","$288.61 ","$0.00 ","$0.00 ","$228.28 ","$1,303.78 ","$0.00 ","$651.89 ","$1,032.59 ","$1,043.02 ","$0.00 ","$204.04 ","$0.00 ","$207.56 ","$0.00 "
"M002021754180","SUP","HCPCS C1768","","M002021754180  -  GRAFT VASC 30CM 18MM HMSHLD MCVL WVN STR","BOTH IP/OP","$1,235.50 ","$914.27 ","$0.00 ","$1,235.50 ","$555.98 ","$0.00 ","$257.51 ","$0.00 ","$0.00 ","$216.33 ","$1,235.50 ","$0.00 ","$617.75 ","$978.52 ","$988.40 ","$0.00 ","$193.36 ","$0.00 ","$196.69 ","$0.00 "
"M00202175420P0","SUP","HCPCS C1768","","M00202175420P0  -  GRAFT VASC 30CM 20MM HMSH PL EPTFE 2 VLR WVN STR TUBE SFT","BOTH IP/OP","$1,384.73 ","$1,024.70 ","$0.00 ","$1,318.78 ","$593.45 ","$0.00 ","$288.61 ","$0.00 ","$0.00 ","$230.91 ","$1,318.78 ","$0.00 ","$659.39 ","$1,044.47 ","$1,055.02 ","$0.00 ","$206.39 ","$0.00 ","$209.95 ","$0.00 "
"M00202175426P0","SUP","HCPCS C1768","","M00202175426P0  -  GRAFT CARDIO 30CM 36MM 2 VLR SL TXTL STR TUBE WVN HMSH PL","BOTH IP/OP","$1,371.55 ","$1,014.95 ","$0.00 ","$1,371.55 ","$617.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$240.15 ","$1,371.55 ","$0.00 ","$685.78 ","$1,086.27 ","$1,097.24 ","$0.00 ","$214.65 ","$0.00 ","$218.35 ","$0.00 "
"M00202175428P0","SUP","HCPCS C1768","","M00202175428P0  -  GRAFT CV STRG TUBE 28MM 30CM HMSH PL WVN SMTH NDL PSG SUT","BOTH IP/OP","$1,440.13 ","$1,065.70 ","$0.00 ","$1,955.63 ","$880.03 ","$0.00 ","$300.16 ","$0.00 ","$0.00 ","$342.41 ","$1,955.63 ","$0.00 ","$977.81 ","$1,548.86 ","$1,564.50 ","$0.00 ","$306.06 ","$0.00 ","$311.34 ","$0.00 "
"M00202175430P0","SUP","HCPCS C1768","","M00202175430P0  -  GRAFT CARDIO 30CM 30MM 2 VLR WVN STR TUBE HMSH PL PLSTR STRL","BOTH IP/OP","$1,440.13 ","$1,065.70 ","$0.00 ","$1,371.55 ","$617.20 ","$0.00 ","$300.16 ","$0.00 ","$0.00 ","$240.15 ","$1,371.55 ","$0.00 ","$685.78 ","$1,086.27 ","$1,097.24 ","$0.00 ","$214.65 ","$0.00 ","$218.35 ","$0.00 "
"M00202175434P0","SUP","HCPCS C1768","","M00202175434P0  -  GRAFT VASC 30CM 34MM HMSH PL WVN STR","BOTH IP/OP","$1,440.13 ","$1,065.70 ","$0.00 ","$1,371.55 ","$617.20 ","$0.00 ","$300.16 ","$0.00 ","$0.00 ","$240.15 ","$1,371.55 ","$0.00 ","$685.78 ","$1,086.27 ","$1,097.24 ","$0.00 ","$214.65 ","$0.00 ","$218.35 ","$0.00 "
"M002363200201","SUP","HCPCS C1768","","M002363200201  -  GRAFT SIZER 5-24MM","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$24.83 ","$11.17 ","$0.00 ","$5.42 ","$0.00 ","$0.00 ","$4.35 ","$24.83 ","$0.00 ","$12.41 ","$19.67 ","$19.86 ","$0.00 ","$3.89 ","$0.00 ","$3.95 ","$0.00 "
"M002363200211","SUP","HCPCS C1768","","M002363200211  -  TMPLT SZ 24-38MM VASC GFT","BOTH IP/OP","$26.00 ","$19.24 ","$0.00 ","$24.83 ","$11.17 ","$0.00 ","$5.42 ","$0.00 ","$0.00 ","$4.35 ","$24.83 ","$0.00 ","$12.41 ","$19.67 ","$19.86 ","$0.00 ","$3.89 ","$0.00 ","$3.95 ","$0.00 "
"M0031351020","SUP","HCPCS C1757","","M0031351020  -  CATHETER INFS MIC 155CM 15CM FRCKR10","BOTH IP/OP","$2,303.00 ","$1,704.22 ","$0.00 ","$2,303.00 ","$0.00 ","$0.00 ","$480.00 ","$0.00 ","$0.00 ","$0.00 ","$2,303.00 ","$0.00 ","$1,151.50 ","$1,823.98 ","$1,842.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0031441890","SUP","HCPCS C1751","","M0031441890  -  MICROCATHETER CRBRVASC .014-.016IN STRG 2.6-2FR .019IN 150CM","BOTH IP/OP","$2,138.50 ","$1,582.49 ","$0.00 ","$2,138.50 ","$1,161.21 ","$0.00 ","$445.72 ","$0.00 ","$0.00 ","$374.43 ","$2,138.50 ","$0.00 ","$1,069.25 ","$1,693.69 ","$1,710.80 ","$0.00 ","$334.68 ","$0.00 ","$340.45 ","$0.00 "
"M0031681890","SUP","HCPCS C1751","","M0031681890  -  CATHETER INFS .038IN 2.4-1.7FR .014IN 150CM 6CM EXCLS SL-10","BOTH IP/OP","$2,162.00 ","$1,599.88 ","$0.00 ","$2,162.00 ","$1,173.97 ","$0.00 ","$450.61 ","$0.00 ","$0.00 ","$378.55 ","$2,162.00 ","$0.00 ","$1,081.00 ","$1,712.30 ","$1,729.60 ","$0.00 ","$338.35 ","$0.00 ","$344.19 ","$0.00 "
"M0031681900","SUP","HCPCS C1751","","M0031681900  -  MICROCATHETER CRBRVASC 45D .014IN PSHP 2.4-1.7FR .0165IN 150","BOTH IP/OP","$2,326.50 ","$1,721.61 ","$0.00 ","$2,326.50 ","$1,263.29 ","$0.00 ","$484.90 ","$0.00 ","$0.00 ","$407.35 ","$2,326.50 ","$0.00 ","$1,163.25 ","$1,842.59 ","$1,861.20 ","$0.00 ","$364.10 ","$0.00 ","$370.38 ","$0.00 "
"M003182880US0","SUP","HCPCS C1887","","M003182880US0  -  MICROCATHETER INFS 135CM RNGD HFL RADOPQ DIST TIP VORTEC +","BOTH IP/OP","$1,774.25 ","$1,312.95 ","$0.00 ","$1,774.25 ","$963.42 ","$0.00 ","$369.80 ","$0.00 ","$0.00 ","$310.66 ","$1,774.25 ","$0.00 ","$887.13 ","$1,405.21 ","$1,419.40 ","$0.00 ","$277.67 ","$0.00 ","$282.46 ","$0.00 "
"M003182900US0","SUP","HCPCS C1751","","M003182900US0  -  CATHETER INFS 150CM 10CM RNGD HF KT MCTH RADOPQ BRAID HDRPH","BOTH IP/OP","$1,774.25 ","$1,312.95 ","$0.00 ","$1,774.25 ","$963.42 ","$0.00 ","$369.80 ","$0.00 ","$0.00 ","$310.66 ","$1,774.25 ","$0.00 ","$887.13 ","$1,405.21 ","$1,419.40 ","$0.00 ","$277.67 ","$0.00 ","$282.46 ","$0.00 "
"M0032072209150","SUP","HCPCS C1726","","M0032072209150  -  CATHETER BLNDIL 1.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072209200","SUP","HCPCS C1726","","M0032072209200  -  CATHETER BLNDIL 2MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072209250","SUP","HCPCS C1726","","M0032072209250  -  CATHETER BLNDIL 2.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072209300","SUP","HCPCS C1726","","M0032072209300  -  CATHETER BLNDIL 3MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072209350","SUP","HCPCS C1726","","M0032072209350  -  CATHETER BLNDIL 3.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072215250","SUP","HCPCS C1726","","M0032072215250  -  CATHETER BLNDIL 2.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072215300","SUP","HCPCS C1726","","M0032072215300  -  CATHETER BLNDIL 3MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH ACPT","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M0032072215350","SUP","HCPCS C1726","","M0032072215350  -  CATHETER BLNDIL 3.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH","BOTH IP/OP","$2,643.75 ","$1,956.38 ","$0.00 ","$2,643.75 ","$1,435.56 ","$0.00 ","$551.02 ","$0.00 ","$0.00 ","$462.90 ","$2,643.75 ","$0.00 ","$1,321.88 ","$2,093.85 ","$2,115.00 ","$0.00 ","$413.75 ","$0.00 ","$420.89 ","$0.00 "
"M00326110","SUP","HCPCS C1769","","M00326110  -  GUIDEWIRE VASCULAR .014IN 200CM 35CM SOFT TIP ATRAUMATIC","BOTH IP/OP","$1,386.50 ","$1,026.01 ","$0.00 ","$1,386.50 ","$752.87 ","$0.00 ","$288.98 ","$0.00 ","$0.00 ","$242.77 ","$1,386.50 ","$0.00 ","$693.25 ","$1,098.11 ","$1,109.20 ","$0.00 ","$216.99 ","$0.00 ","$220.73 ","$0.00 "
"M00326410","SUP","HCPCS C1769","","M00326410  -  GUIDEWIRE VASC .014IN 200CM 35CM SYNCHRO2 STD ATRM RBN TIP","BOTH IP/OP","$1,316.00 ","$973.84 ","$0.00 ","$1,316.00 ","$714.59 ","$0.00 ","$274.29 ","$0.00 ","$0.00 ","$230.42 ","$1,316.00 ","$0.00 ","$658.00 ","$1,042.27 ","$1,052.80 ","$0.00 ","$205.95 ","$0.00 ","$209.51 ","$0.00 "
"M00326420","SUP","HCPCS C1769","","M00326420  -  GUIDEWIRE VASCULAR STANDARD .014IN 200CM 35CM PRESHAPED","BOTH IP/OP","$1,386.50 ","$1,026.01 ","$0.00 ","$1,386.50 ","$752.87 ","$0.00 ","$288.98 ","$0.00 ","$0.00 ","$242.77 ","$1,386.50 ","$0.00 ","$693.25 ","$1,098.11 ","$1,109.20 ","$0.00 ","$216.99 ","$0.00 ","$220.73 ","$0.00 "
"M00326520","SUP","HCPCS C1769","","M00326520  -  GUIDEWIRE VASC .014IN 300CM 35CM SYNCHRO2 STD ATRM RBN TIP","BOTH IP/OP","$1,715.50 ","$1,269.47 ","$0.00 ","$1,715.50 ","$931.52 ","$0.00 ","$357.55 ","$0.00 ","$0.00 ","$300.37 ","$1,715.50 ","$0.00 ","$857.75 ","$1,358.68 ","$1,372.40 ","$0.00 ","$268.48 ","$0.00 ","$273.11 ","$0.00 "
"M003468140","SUP","HCPCS C1769","","M003468140  -  GUIDEWIRE VASC .014IN 300CM STRL LF 2CM TRNSD X SPRT ICE","BOTH IP/OP","$1,351.25 ","$999.93 ","$0.00 ","$1,351.25 ","$733.73 ","$0.00 ","$281.63 ","$0.00 ","$0.00 ","$236.59 ","$1,351.25 ","$0.00 ","$675.63 ","$1,070.19 ","$1,081.00 ","$0.00 ","$211.47 ","$0.00 ","$215.12 ","$0.00 "
"M0035503010","SUP","HCPCS C1887","","M0035503010  -  CATHETER INFUS .038IN MICRO 3FR .024IN 105CM 12CM KIT GWIRE","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M0035503040","SUP","HCPCS C1887","","M0035503040  -  CATHETER INFUS .018IN MICRO 3-2.8FR .024-.018IN 135CM 12CM","BOTH IP/OP","$1,157.13 ","$856.28 ","$0.00 ","$1,157.13 ","$628.32 ","$0.00 ","$241.17 ","$0.00 ","$0.00 ","$202.60 ","$1,157.13 ","$0.00 ","$578.56 ","$916.45 ","$925.70 ","$0.00 ","$181.09 ","$0.00 ","$184.21 ","$0.00 "
"M003N3EZ25200","SUP","HCPCS C2617","","M003N3EZ25200  -  STENT INTRCRAN 2.5MM 20MM NRFRM EZ 3","BOTH IP/OP","$15,745.00 ","$11,651.30 ","$0.00 ","$15,745.00 ","$7,085.25 ","$0.00 ","$3,281.65 ","$0.00 ","$0.00 ","$2,756.82 ","$15,745.00 ","$0.00 ","$7,872.50 ","$12,470.04 ","$12,596.00 ","$0.00 ","$2,464.09 ","$0.00 ","$2,506.60 ","$0.00 "
"M003N3EZ30200","SUP","HCPCS C2617","","M003N3EZ30200  -  STENT INTRCRAN 3MM 20MM NRFRM EZ NRFRM3","BOTH IP/OP","$15,745.00 ","$11,651.30 ","$0.00 ","$15,745.00 ","$7,085.25 ","$0.00 ","$3,281.65 ","$0.00 ","$0.00 ","$2,756.82 ","$15,745.00 ","$0.00 ","$7,872.50 ","$12,470.04 ","$12,596.00 ","$0.00 ","$2,464.09 ","$0.00 ","$2,506.60 ","$0.00 "
"M003N3EZ35200","SUP","HCPCS C2617","","M003N3EZ35200  -  STENT INTRCRAN 3.5MM 20MM NRFRM EZ NRFRM3","BOTH IP/OP","$15,745.00 ","$11,651.30 ","$0.00 ","$15,745.00 ","$7,085.25 ","$0.00 ","$3,281.65 ","$0.00 ","$0.00 ","$2,756.82 ","$15,745.00 ","$0.00 ","$7,872.50 ","$12,470.04 ","$12,596.00 ","$0.00 ","$2,464.09 ","$0.00 ","$2,506.60 ","$0.00 "
"M003N3EZ40200","SUP","HCPCS C2617","","M003N3EZ40200  -  STENT INTRCRAN 4MM 20MM NRFRM EZ 3","BOTH IP/OP","$15,745.00 ","$11,651.30 ","$0.00 ","$15,745.00 ","$7,085.25 ","$0.00 ","$3,281.65 ","$0.00 ","$0.00 ","$2,756.82 ","$15,745.00 ","$0.00 ","$7,872.50 ","$12,470.04 ","$12,596.00 ","$0.00 ","$2,464.09 ","$0.00 ","$2,506.60 ","$0.00 "
"M003N3EZ45200","SUP","HCPCS C2617","","M003N3EZ45200  -  STENT INTRCRAN 4.5MM 20MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL","BOTH IP/OP","$15,745.00 ","$11,651.30 ","$0.00 ","$15,745.00 ","$7,085.25 ","$0.00 ","$3,281.65 ","$0.00 ","$0.00 ","$2,756.82 ","$15,745.00 ","$0.00 ","$7,872.50 ","$12,470.04 ","$12,596.00 ","$0.00 ","$2,464.09 ","$0.00 ","$2,506.60 ","$0.00 "
"M003N3EZ45300","SUP","Custom 27803010","","M003N3EZ45300  -  STENT INTRCRAN 4.5MM 30MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL","BOTH IP/OP","$15,745.00 ","$11,651.30 ","$0.00 ","$15,745.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,745.00 ","$0.00 ","$7,872.50 ","$12,470.04 ","$12,596.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003SNF3STA0","SUP","Custom 27203010","","M003SNF3STA0  -  STENT INTRCRAN 2FR NRFRM3 STAB CATH","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS30150","SUP","Custom 27803010","","M003UZAS30150  -  STENT 3.0MM 15MM 3.5MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS30210","SUP","Custom 27803010","","M003UZAS30210  -  STENT 3.0MM 21MM 3.5MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS30240","SUP","Custom 27803010","","M003UZAS30240  -  STENT 3.0MM 24MM 3.5MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS40210","SUP","Custom 27803010","","M003UZAS40210  -  STENT 4.0MM 21MM 4.5MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS40240","SUP","Custom 27803010","","M003UZAS40240  -  STENT 4.0MM 24MM 4.5MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS45210","SUP","Custom 27803010","","M003UZAS45210  -  STENT 4.5MM 21MM 5.0MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003UZAS45300","SUP","Custom 27803010","","M003UZAS45300  -  STENT 4.5MM 30MM 5.0MM NEUROFORM ATLAS","BOTH IP/OP","$18,125.00 ","$13,412.50 ","$0.00 ","$18,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18,125.00 ","$0.00 ","$9,062.50 ","$14,355.00 ","$14,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003WS0250090","SUP","HCPCS C2617","","M003WS0250090  -  STENT INTRCRAN 2.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$7,191.00 ","$0.00 ","$3,330.63 ","$0.00 ","$0.00 ","$2,797.97 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$2,500.87 ","$0.00 ","$2,544.02 ","$0.00 "
"M003WS0250150","SUP","HCPCS C2617","","M003WS0250150  -  STENT INTRACRANIAL .014IN 2.5MM 15MM OTW FLEXIBLE TRACKABLE","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$7,191.00 ","$0.00 ","$3,330.63 ","$0.00 ","$0.00 ","$2,797.97 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$2,500.87 ","$0.00 ","$2,544.02 ","$0.00 "
"M003WS0300090","SUP","HCPCS C2617","","M003WS0300090  -  STENT INTRCRAN 3MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$7,191.00 ","$0.00 ","$3,330.63 ","$0.00 ","$0.00 ","$2,797.97 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$2,500.87 ","$0.00 ","$2,544.02 ","$0.00 "
"M003WS0300150","SUP","Custom 27803010","","M003WS0300150  -  STENT INTRCRAN 3MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003WS0350090","SUP","HCPCS C2617","","M003WS0350090  -  STENT INTRCRAN 3.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$7,191.00 ","$0.00 ","$3,330.63 ","$0.00 ","$0.00 ","$2,797.97 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$2,500.87 ","$0.00 ","$2,544.02 ","$0.00 "
"M003WS0350150","SUP","Custom 27803010","","M003WS0350150  -  STENT INTRCRAN 3.5MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M003WS0400090","SUP","HCPCS C2617","","M003WS0400090  -  STENT INTRCRAN 4MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$7,191.00 ","$0.00 ","$3,330.63 ","$0.00 ","$0.00 ","$2,797.97 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$2,500.87 ","$0.00 ","$2,544.02 ","$0.00 "
"M003WS0400150","SUP","Custom 27803010","","M003WS0400150  -  STENT INTRCRAN 4MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510860","SUP","Custom 27203010","","M00510860  -  BASKET SPEC RTRVL 1.5CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$529.02 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510860","SUP","Custom 27203592","","RX LITHOTRIPTER COMPATABLE BASKET 3","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510870","SUP","Custom 27203010","","M00510870  -  BASKET SPEC RTRVL 2MM 3.2MM STRL 4CM TRPZD RX LTHTRP DIST","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$529.02 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510870","SUP","Custom 27203593","","RX LITHOTRIPTER COMPATABLE BASKET 4","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510880","SUP","Custom 27203010","","M00510880  -  BASKET SPEC RTRVL 2.5CM 3.2MM STRL 5CM TRPZD RX LTHTRP DIST","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$529.02 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510880","SUP","Custom 27203594","","RX LITHOTRIPTER COMPATABLE BASKET 5","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510890","SUP","Custom 27203010","","M00510890  -  BASKET SPEC RTRVL 3CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$529.02 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00510890","SUP","Custom 27203595","","RX LITHOTRIPTER COMPATABLE BASKET 6","BOTH IP/OP","$645.18 ","$477.43 ","$0.00 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$710.00 ","$0.00 ","$355.00 ","$562.32 ","$568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00513210","SUP","Custom 27203010","","M00513210  -  BASKET SPECIMEN RETRIEVAL 16MM 1MM 120CM AIRWAY ZERO TIP","BOTH IP/OP","$622.40 ","$460.58 ","$0.00 ","$626.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$626.53 ","$0.00 ","$313.26 ","$496.21 ","$501.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00513740","SUP","HCPCS C1874","","M00513740  -  STENT ESOPHAGEAL 18-23MM 12CM 9CM COVER DISTAL RELEASE NEXT","BOTH IP/OP","$4,137.50 ","$3,061.75 ","$0.00 ","$4,142.68 ","$1,864.20 ","$0.00 ","$862.36 ","$0.00 ","$0.00 ","$725.35 ","$4,142.68 ","$0.00 ","$2,071.34 ","$3,281.00 ","$3,314.14 ","$0.00 ","$648.33 ","$0.00 ","$659.51 ","$0.00 "
"M00516720","SUP","HCPCS C1874","","M00516720  -  STENT ESOPHAGEAL FLARE LP 18MM 18.5FR 15CM 120CM SELF EXPAND","BOTH IP/OP","$5,892.90 ","$4,360.75 ","$0.00 ","$5,973.03 ","$2,687.86 ","$0.00 ","$1,228.23 ","$0.00 ","$0.00 ","$1,045.83 ","$5,973.03 ","$0.00 ","$2,986.51 ","$4,730.64 ","$4,778.42 ","$0.00 ","$934.78 ","$0.00 ","$950.91 ","$0.00 "
"M00516900","SUP","HCPCS C1874","","M00516900  -  STENT ESOPHAGEAL LP 18MM 18.5FR 10CM 7CM PRTL COVER COAXIAL","BOTH IP/OP","$5,772.58 ","$4,271.71 ","$0.00 ","$5,912.23 ","$2,660.50 ","$0.00 ","$1,203.15 ","$0.00 ","$0.00 ","$1,035.18 ","$5,912.23 ","$0.00 ","$2,956.11 ","$4,682.49 ","$4,729.78 ","$0.00 ","$925.26 ","$0.00 ","$941.23 ","$0.00 "
"M00516910","SUP","HCPCS C1874","","M00516910  -  STENT ESOPHAGEAL LP 18MM 18.5FR 12CM 9CM PRTL COVER COAXIAL","BOTH IP/OP","$5,772.58 ","$4,271.71 ","$0.00 ","$5,912.23 ","$2,660.50 ","$0.00 ","$1,203.15 ","$0.00 ","$0.00 ","$1,035.18 ","$5,912.23 ","$0.00 ","$2,956.11 ","$4,682.49 ","$4,729.78 ","$0.00 ","$925.26 ","$0.00 ","$941.23 ","$0.00 "
"M00516920","SUP","HCPCS C1874","","M00516920  -  STENT ESOPHAGEAL LP 23MM 18MM 153MM 12CM PRTL COVER COAXIAL","BOTH IP/OP","$5,772.58 ","$4,271.71 ","$0.00 ","$5,912.23 ","$2,660.50 ","$0.00 ","$1,203.15 ","$0.00 ","$0.00 ","$1,035.18 ","$5,912.23 ","$0.00 ","$2,956.11 ","$4,682.49 ","$4,729.78 ","$0.00 ","$925.26 ","$0.00 ","$941.23 ","$0.00 "
"M00516930","SUP","HCPCS C1874","","M00516930  -  STENT ESOPHAGEAL LP 23MM 18.5MM 10CM 7CM BRAID DELIVERY","BOTH IP/OP","$5,772.58 ","$4,271.71 ","$0.00 ","$5,912.23 ","$2,660.50 ","$0.00 ","$1,203.15 ","$0.00 ","$0.00 ","$1,035.18 ","$5,912.23 ","$0.00 ","$2,956.11 ","$4,682.49 ","$4,729.78 ","$0.00 ","$925.26 ","$0.00 ","$941.23 ","$0.00 "
"M00516950","SUP","HCPCS C1874","","M00516950  -  STENT ESOPHAGEAL LP 23MM 18.5FR 15CM 12CM BRAID DELIVERY","BOTH IP/OP","$5,772.58 ","$4,271.71 ","$0.00 ","$5,912.23 ","$2,660.50 ","$0.00 ","$1,203.15 ","$0.00 ","$0.00 ","$1,035.18 ","$5,912.23 ","$0.00 ","$2,956.11 ","$4,682.49 ","$4,729.78 ","$0.00 ","$925.26 ","$0.00 ","$941.23 ","$0.00 "
"M00522611","SUP","Custom 27803010","","M00522611  -  CLIP INTERNAL 11MM 235CM 2.8MM SECURE LOCK RADIOPQ USER","BOTH IP/OP","$392.29 ","$290.29 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$314.53 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00522611","SUP","Custom 27203591","","RESOLUTION 235CM","BOTH IP/OP","$392.29 ","$290.29 ","$0.00 ","$425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00522612","SUP","Custom 27803010","","M00522612  -  CLIP INTERNAL 11MM OPEN 235CM 2.8MM HEMOSTASIS RESOLUTION","BOTH IP/OP","$380.74 ","$281.75 ","$0.00 ","$384.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$384.76 ","$0.00 ","$192.38 ","$304.73 ","$307.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00530850","SUP","HCPCS C1769","","M00530850  -  CANNULA ERCP STANDARD 5FR 210CM GWIRE CNTOUR BILIARY STERILE","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$114.38 ","$62.11 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$20.03 ","$114.38 ","$0.00 ","$57.19 ","$90.59 ","$91.50 ","$0.00 ","$17.90 ","$0.00 ","$18.21 ","$0.00 "
"M00530860","SUP","HCPCS C1769","","M00530860  -  CANNULA ERCP TAPER 5FR 210CM CNTOUR BILIARY DISPOSABLE","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$114.38 ","$62.11 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$20.03 ","$114.38 ","$0.00 ","$57.19 ","$90.59 ","$91.50 ","$0.00 ","$17.90 ","$0.00 ","$18.21 ","$0.00 "
"M00530960","SUP","HCPCS C1769","","M00530960  -  CANNU ERCP .025IN STD TIP GWIRE FLRTP 210CM 5FR BIL STRL","BOTH IP/OP","$81.93 ","$60.63 ","$0.00 ","$81.93 ","$44.49 ","$0.00 ","$17.08 ","$0.00 ","$0.00 ","$14.35 ","$81.93 ","$0.00 ","$40.96 ","$64.89 ","$65.54 ","$0.00 ","$12.82 ","$0.00 ","$13.04 ","$0.00 "
"M00530970","SUP","HCPCS C1769","","M00530970  -  CANNU ERCP .035IN TPR TIP GWIRE FLRTP 210CM 5FR BIL STRL","BOTH IP/OP","$81.93 ","$60.63 ","$0.00 ","$81.93 ","$44.49 ","$0.00 ","$17.08 ","$0.00 ","$0.00 ","$14.35 ","$81.93 ","$0.00 ","$40.96 ","$64.89 ","$65.54 ","$0.00 ","$12.82 ","$0.00 ","$13.04 ","$0.00 "
"M00530980","SUP","HCPCS C1769","","M00530980  -  CANNU ERCP .025IN TPR TIP FLRTP 210CM 5FR BIL STRL DISP","BOTH IP/OP","$81.93 ","$60.63 ","$0.00 ","$81.93 ","$44.49 ","$0.00 ","$17.08 ","$0.00 ","$0.00 ","$14.35 ","$81.93 ","$0.00 ","$40.96 ","$64.89 ","$65.54 ","$0.00 ","$12.82 ","$0.00 ","$13.04 ","$0.00 "
"M00532240","SUP","HCPCS C2617","","M00532240  -  STENT BILIARY 2 PIGTAIL CURVE 10FR 3CM RAPEX TEMPORARY","BOTH IP/OP","$133.55 ","$98.83 ","$0.00 ","$135.88 ","$61.14 ","$0.00 ","$27.84 ","$0.00 ","$0.00 ","$23.79 ","$135.88 ","$0.00 ","$67.94 ","$107.62 ","$108.70 ","$0.00 ","$21.26 ","$0.00 ","$21.63 ","$0.00 "
"M00532260","SUP","HCPCS C2617","","M00532260  -  STENT BILIARY 2 PIGTAIL CURVE 3.3MM 5CM TEMPORARY RAPEX","BOTH IP/OP","$133.55 ","$98.83 ","$0.00 ","$135.88 ","$61.14 ","$0.00 ","$27.84 ","$0.00 ","$0.00 ","$23.79 ","$135.88 ","$0.00 ","$67.94 ","$107.62 ","$108.70 ","$0.00 ","$21.26 ","$0.00 ","$21.63 ","$0.00 "
"M00532270","SUP","HCPCS C2617","","M00532270  -  STENT BILIARY 2 PIGTAIL CURVE 10FR 7CM RAPEX TEMPORARY","BOTH IP/OP","$133.55 ","$98.83 ","$0.00 ","$135.88 ","$61.14 ","$0.00 ","$27.84 ","$0.00 ","$0.00 ","$23.79 ","$135.88 ","$0.00 ","$67.94 ","$107.62 ","$108.70 ","$0.00 ","$21.26 ","$0.00 ","$21.63 ","$0.00 "
"M00533580","SUP","HCPCS C2617","","M00533580  -  STENT BILIARY 10FR 202.5CM DELIVERY SYSTEM RAPEX ADVANIX","BOTH IP/OP","$198.93 ","$147.21 ","$0.00 ","$201.45 ","$90.65 ","$0.00 ","$41.46 ","$0.00 ","$0.00 ","$35.27 ","$201.45 ","$0.00 ","$100.73 ","$159.55 ","$161.16 ","$0.00 ","$31.53 ","$0.00 ","$32.07 ","$0.00 "
"M00534200","SUP","HCPCS C2617","","M00534200  -  STENT BILIARY DUODENAL BEND 7FR 5CM RAPEX PRELOAD DELIVERY","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534210","SUP","HCPCS C2617","","M00534210  -  STENT BILIARY DUODENAL BEND 7FR 7CM PRELOAD TEMPORARY RAPEX","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534220","SUP","HCPCS C2617","","M00534220  -  STENT BILIARY DUODENAL BEND 7FR 9CM RAPEX PRELOAD ADVANIX","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534230","SUP","HCPCS C2617","","M00534230  -  STENT BILIARY DUODENAL BEND 7FR 12CM RAPEX PRELOAD ADVANIX","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534260","SUP","HCPCS C2617","","M00534260  -  STENT BILIARY DUODENAL BEND 2.83MM 5CM PRELOAD RAPEX","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534270","SUP","HCPCS C2617","","M00534270  -  STENT BILIARY DUODENAL BEND 2.83MM 7CM PRELOAD RAPEX","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534320","SUP","HCPCS C2617","","M00534320  -  STENT BILIARY DUODENAL BEND 10FR 5CM PRELOAD RAPEX DELIVERY","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534330","SUP","HCPCS C2617","","M00534330  -  STENT BILIARY DUODENAL BEND 10FR 7CM PRELOAD RADIOPQ MARKER","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534340","SUP","HCPCS C2617","","M00534340  -  STENT BILIARY DUODENAL BEND 10FR 9CM PRELOAD RADIOPQ MARKER","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534350","SUP","HCPCS C2617","","M00534350  -  STENT BILIARY DUODENAL BEND 10FR 12CM PRELOAD TEMPORARY","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$148.83 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00534360","SUP","HCPCS C1726","","M00534360  -  STENT BILIARY DUODENAL BEND 10FR 15CM PRELOAD TEMPORARY","BOTH IP/OP","$324.83 ","$240.37 ","$0.00 ","$330.73 ","$179.58 ","$0.00 ","$67.70 ","$0.00 ","$0.00 ","$57.91 ","$330.73 ","$0.00 ","$165.36 ","$261.94 ","$264.58 ","$0.00 ","$51.76 ","$0.00 ","$52.65 ","$0.00 "
"M00545170","SUP","HCPCS C1769","","M00545170  -  SPHINCTEROTOME ESCP 4.4FR 20MM STRL 5MM ATME RX CANNULATE","BOTH IP/OP","$518.20 ","$383.47 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$108.01 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$555.00 ","$418.60 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545170","SUP","Custom 27203596","","AUTOTOME RX 44-20MM","BOTH IP/OP","$518.20 ","$383.47 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$108.01 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$555.00 ","$879.12 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545190","SUP","HCPCS C1769","","M00545190  -  SPHINCTEROTOME ESCP 3.9FR 20MM STRL 5MM ATME RX CANNULATE","BOTH IP/OP","$518.20 ","$383.47 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$108.01 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$555.00 ","$418.60 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545190","SUP","Custom 27203597","","AUTOTOME RX 39-20MM","BOTH IP/OP","$518.20 ","$383.47 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$108.01 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$555.00 ","$879.12 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545261","SUP","Custom 27203010","","M00545261  -  SYSTEM CHLGM RX LCK DEV BX CAP DISP OLMPS FUJIFILM G5 SER","BOTH IP/OP","$22.58 ","$16.71 ","$0.00 ","$23.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.06 ","$0.00 ","$11.53 ","$18.26 ","$18.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545550","SUP","Custom 27803070","","RX STENT / 7 X 5CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545550","SUP","HCPCS C2617","","M00545550  -  STENT BIL DDNL BND 7FR 5CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545560","SUP","HCPCS C2617","","M00545560  -  STENT BIL DDNL BND 7FR 7CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$256.53 ","$115.44 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$44.92 ","$256.53 ","$0.00 ","$128.26 ","$203.17 ","$205.22 ","$0.00 ","$40.15 ","$0.00 ","$40.84 ","$0.00 "
"M00545570","SUP","Custom 27803081","","RX STENT / 7 X 10CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545570","SUP","HCPCS C2617","","M00545570  -  STENT BIL DDNL BND 7FR 10CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545580","SUP","Custom 27803072","","RX STENT / 7 X 12CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545580","SUP","HCPCS C2617","","M00545580  -  STENT BIL DDNL BND 7FR 12CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$247.50 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$247.50 ","$0.00 ","$123.75 ","$203.17 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545610","SUP","Custom 27803074","","RX STENT / 10 X 7CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545610","SUP","HCPCS C2617","","M00545610  -  STENT BIL DDNL BND 10FR 7CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545620","SUP","Custom 27803075","","RX STENT / 10 X 10CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545620","SUP","HCPCS C2617","","M00545620  -  STENT BIL DDNL BND 10FR 10CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545630","SUP","Custom 27803076","","RX STENT / 10 X 12CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545630","SUP","HCPCS C2617","","M00545630  -  STENT BIL DDNL BND 10FR 12CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545650","SUP","Custom 27803077","","RX STENT / 8.5 X 5CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545650","SUP","HCPCS C2617","","M00545650  -  STENT BIL DDNL BND 8.5FR 5CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545660","SUP","Custom 27803078","","RX STENT / 8.5 X 7CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545660","SUP","HCPCS C2617","","M00545660  -  STENT BIL DDNL BND 8.5FR 7CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545670","SUP","Custom 27803079","","RX STENT / 8.5 X 10CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545670","SUP","HCPCS C2617","","M00545670  -  STENT BIL DDNL BND 8.5FR 10CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545680","SUP","Custom 27803080","","RX STENT / 8.5 X 12CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545680","SUP","HCPCS C2617","","M00545680  -  STENT BIL DDNL BND 8.5FR 12CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$0.00 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$0.00 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545700","SUP","HCPCS C2625","","RX STENT / 11.5 X 5","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545700","SUP","HCPCS C2617","","M00545700  -  STENT BIL DDNL BND 11.5FR 5CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545710","SUP","HCPCS C2625","","RX STENT / 11.5 X 7CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545710","SUP","HCPCS C2617","","M00545710  -  STENT BIL DDNL BND 11.5FR 7CM RX DLV SYS DISP ACPT .035IN GW","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545720","SUP","HCPCS C2625","","RX STENT / 11.5 X 10CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545720","SUP","HCPCS C2617","","M00545720  -  STENT BIL DDNL BND 11.5FR 10CM RX DLV SYS DISP ACPT .035IN","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545730","SUP","HCPCS C2625","","RX STENT / 11.5 X 12CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545730","SUP","HCPCS C2617","","M00545730  -  STENT BIL DDNL BND 11.5FR 12CM RX DLV SYS DISP ACPT .035IN","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545740","SUP","HCPCS C2625","","RX STENT / 11.5 X 15CM","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$121.00 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$95.83 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545740","SUP","HCPCS C1876","","M00545740  -  STENT BIL DDNL BND 11.5FR 15CM RX DLV SYS DISP ACPT .035IN","BOTH IP/OP","$254.25 ","$188.15 ","$0.00 ","$203.17 ","$54.45 ","$0.00 ","$52.99 ","$0.00 ","$0.00 ","$21.19 ","$121.00 ","$0.00 ","$60.50 ","$203.17 ","$96.80 ","$0.00 ","$18.94 ","$0.00 ","$19.26 ","$0.00 "
"M00545840","SUP","Custom 27203599","","NEEDLEKNIFE RX","BOTH IP/OP","$487.50 ","$360.75 ","$0.00 ","$487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$487.50 ","$0.00 ","$243.75 ","$386.10 ","$390.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545900","SUP","HCPCS C1726","","M00545900  -  CATHETER BLNDIL 12 ATM 4MM 180CM 4CM HRCN RX LOPRFL RADOPQ","BOTH IP/OP","$595.55 ","$440.71 ","$0.00 ","$722.50 ","$0.00 ","$0.00 ","$124.13 ","$0.00 ","$0.00 ","$0.00 ","$722.50 ","$0.00 ","$361.25 ","$477.62 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545900","SUP","Custom 27203112","","RX DILATATION BLN 4-4/5.8/180","BOTH IP/OP","$595.55 ","$440.71 ","$0.00 ","$722.50 ","$0.00 ","$0.00 ","$124.13 ","$0.00 ","$0.00 ","$0.00 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545920","SUP","HCPCS C1726","","M00545920  -  CATHETER BLNDIL 11 ATM 6MM 180CM 4CM HRCN RX LOPRFL RADOPQ","BOTH IP/OP","$595.55 ","$440.71 ","$0.00 ","$722.50 ","$0.00 ","$0.00 ","$124.13 ","$0.00 ","$0.00 ","$0.00 ","$722.50 ","$0.00 ","$361.25 ","$477.62 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545920","SUP","Custom 27203113","","RX DILATATION BLN 6-4/5.8/180","BOTH IP/OP","$595.55 ","$440.71 ","$0.00 ","$722.50 ","$0.00 ","$0.00 ","$124.13 ","$0.00 ","$0.00 ","$0.00 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545960","SUP","HCPCS C1726","","M00545960  -  CATHETER BLNDIL 8 ATM 10MM 180CM 4CM HRCN RX LOPRFL RADOPQ","BOTH IP/OP","$595.55 ","$440.71 ","$0.00 ","$722.50 ","$0.00 ","$0.00 ","$124.13 ","$0.00 ","$0.00 ","$0.00 ","$722.50 ","$0.00 ","$361.25 ","$477.62 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00545960","SUP","Custom 27203115","","RX DILATATION BALLOON 10-5.8/180","BOTH IP/OP","$595.55 ","$440.71 ","$0.00 ","$722.50 ","$0.00 ","$0.00 ","$124.13 ","$0.00 ","$0.00 ","$0.00 ","$722.50 ","$0.00 ","$361.25 ","$572.22 ","$578.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00546900","SUP","HCPCS C1726","","M00546900  -  CATHETER SPEC RTRVL .035IN 6-7FR 9-12MM 200CM STRL LTX XTRT","BOTH IP/OP","$395.06 ","$292.34 ","$0.00 ","$395.06 ","$214.52 ","$0.00 ","$82.34 ","$0.00 ","$0.00 ","$69.17 ","$395.06 ","$0.00 ","$197.53 ","$312.89 ","$316.05 ","$0.00 ","$61.83 ","$0.00 ","$62.89 ","$0.00 "
"M00546910","SUP","HCPCS C1726","","M00546910  -  CATHETER SPEC RTRVL .035IN 7-6FR 12-15MM 200CM STRL LTX XTRT","BOTH IP/OP","$395.06 ","$292.34 ","$0.00 ","$395.06 ","$214.52 ","$0.00 ","$82.34 ","$0.00 ","$0.00 ","$69.17 ","$395.06 ","$0.00 ","$197.53 ","$312.89 ","$316.05 ","$0.00 ","$61.83 ","$0.00 ","$62.89 ","$0.00 "
"M00546920","SUP","HCPCS C1769","","M00546920  -  CATHETER SPEC RTRVL .035IN 7-6FR 15-18MM 200CM STRL LTX XTRT","BOTH IP/OP","$395.06 ","$292.34 ","$0.00 ","$397.50 ","$0.00 ","$0.00 ","$82.34 ","$0.00 ","$0.00 ","$0.00 ","$397.50 ","$0.00 ","$198.75 ","$312.89 ","$318.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00546920","SUP","Custom 27203101","","EXTRACTOR RX 15-18MM ABOVE","BOTH IP/OP","$395.06 ","$292.34 ","$0.00 ","$397.50 ","$0.00 ","$0.00 ","$82.34 ","$0.00 ","$0.00 ","$0.00 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00547000","SUP","Custom 27203010","","M00547000  -  CATHETER BALDILAT 7-6FR 9-12MM 200CM 3 LUMEN SPECIMEN","BOTH IP/OP","$356.55 ","$263.85 ","$0.00 ","$366.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.25 ","$0.00 ","$183.13 ","$290.07 ","$293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00547010","SUP","Custom 27203010","","M00547010  -  CATHETER BALDILAT 7-6FR 12-15MM 200CM 3 LUMEN SPECIMEN","BOTH IP/OP","$356.55 ","$263.85 ","$0.00 ","$366.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.25 ","$0.00 ","$183.13 ","$290.07 ","$293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00547020","SUP","Custom 27203010","","M00547020  -  CATHETER BALDILAT 7-6FR 15-18MM 200CM 3 LUMEN SPECIMEN","BOTH IP/OP","$356.55 ","$263.85 ","$0.00 ","$366.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$366.25 ","$0.00 ","$183.13 ","$290.07 ","$293.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00551591","SUP","HCPCS C1769","","M00551591  -  GWIRE ENDSCP .018IN 450CM EXCH SHP PTHFND BIL STRL DISP","BOTH IP/OP","$317.83 ","$235.19 ","$0.00 ","$317.83 ","$172.58 ","$0.00 ","$66.24 ","$0.00 ","$0.00 ","$55.65 ","$317.83 ","$0.00 ","$158.92 ","$251.72 ","$254.26 ","$0.00 ","$49.74 ","$0.00 ","$50.60 ","$0.00 "
"M00553650","SUP","HCPCS C1874","","M00553650  -  STENT PNCR 15MM 24MM 10MM 146MM 138MM 10.8FR CAUT","BOTH IP/OP","$11,000.00 ","$8,140.00 ","$0.00 ","$11,187.50 ","$5,034.38 ","$0.00 ","$2,292.68 ","$0.00 ","$0.00 ","$1,958.84 ","$11,187.50 ","$0.00 ","$5,593.75 ","$8,860.50 ","$8,950.00 ","$0.00 ","$1,750.84 ","$0.00 ","$1,781.05 ","$0.00 "
"M00553750","SUP","HCPCS C1874","","M00553750  -  STENT BIL 10MM 10.8FR 146CM 10MM 21MM LUM SDL AXS","BOTH IP/OP","$9,500.00 ","$7,030.00 ","$0.00 ","$9,687.50 ","$4,359.38 ","$0.00 ","$1,980.04 ","$0.00 ","$0.00 ","$1,696.20 ","$9,687.50 ","$0.00 ","$4,843.75 ","$7,672.50 ","$7,750.00 ","$0.00 ","$1,516.09 ","$0.00 ","$1,542.25 ","$0.00 "
"M00556021","SUP","HCPCS C1769","","M00556021  -  GUIDEWIRE ENDSCP STR .035IN 260CM HIGH PERFORMANCE RAPEX","BOTH IP/OP","$423.74 ","$313.57 ","$0.00 ","$428.74 ","$232.80 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$75.07 ","$428.74 ","$0.00 ","$214.37 ","$339.56 ","$342.99 ","$0.00 ","$67.10 ","$0.00 ","$68.26 ","$0.00 "
"M00556041","SUP","HCPCS C1769","","M00556041  -  GUIDEWIRE ENDSCP STR .035IN 450CM HIGH PERFORMANCE RAPEX","BOTH IP/OP","$423.74 ","$313.57 ","$0.00 ","$428.74 ","$232.80 ","$0.00 ","$88.32 ","$0.00 ","$0.00 ","$75.07 ","$428.74 ","$0.00 ","$214.37 ","$339.56 ","$342.99 ","$0.00 ","$67.10 ","$0.00 ","$68.26 ","$0.00 "
"M00556621","SUP","HCPCS C1769","","M00556621  -  GUIDEWIRE ENDSCP STANDARD STR TRIM .038IN 260CM HIGH","BOTH IP/OP","$240.35 ","$177.86 ","$0.00 ","$244.64 ","$132.84 ","$0.00 ","$50.09 ","$0.00 ","$0.00 ","$42.83 ","$244.64 ","$0.00 ","$122.32 ","$193.75 ","$195.71 ","$0.00 ","$38.29 ","$0.00 ","$38.95 ","$0.00 "
"M00558330","SUP","Custom 27203090","","CRE DILATION BALLOON CRE 6-8MM 8CM F/G","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00558340","SUP","Custom 27203091","","CRE DILATION BALLOON 8-10MM 8CM F/G","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00558350","SUP","Custom 27203092","","CRE DILATION BALLOON 10-12MM 8CM F/G","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00558360","SUP","Custom 27203094","","CRE DILATION BALLOON 15-18MM 8CM F/G","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00558370","SUP","HCPCS C1726","","M00558370  -  CATHETER BALDILAT 6FR 15-18MM 180CM 8CM FIX WIRE HIGH","BOTH IP/OP","$460.05 ","$340.44 ","$0.00 ","$468.95 ","$254.64 ","$0.00 ","$95.89 ","$0.00 ","$0.00 ","$82.11 ","$468.95 ","$0.00 ","$234.48 ","$371.41 ","$375.16 ","$0.00 ","$73.39 ","$0.00 ","$74.66 ","$0.00 "
"M00558380","SUP","HCPCS C1726","","M00558380  -  CATHETER BALDILAT 6FR 18-20MM 180CM 8CM FIX WIRE HIGH","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$371.41 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00558380","SUP","Custom 27203095","","CRE DILATION BALLOON 18-20MM 8CM F/G","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00558410","SUP","HCPCS C1726","","M00558410  -  DILATOR ENDSCP 7.5FR 10-12MM 180CM 5.5CM CRE PEBAX ESOPHAGUS","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558420","SUP","HCPCS C1726","","M00558420  -  DILATOR ENDSCP 7.5FR 12-15MM 180CM 5.5CM CRE PEBAX ESOPHAGUS","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558450","SUP","HCPCS C1769","","M00558450  -  DILATOR ENDSCP 7.5FR 6-8MM 240CM 5.5CM INFLATE CRE PEBAX","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558480","SUP","HCPCS C1769","","M00558480  -  DILATOR ENDSCP 7.5FR 12-15MM 240CM 5.5CM INFLATE CRE PEBAX","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558500","SUP","HCPCS C1726","","M00558500  -  CATHETER BALDILAT 7.5FR 18-20MM 240CM 5.5CM WIRE GUIDE CRE","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558660","SUP","HCPCS C1726","","M00558660  -  DILATOR ESCP 7.5FR 6-8MM 240CM STRL LF 5.5CM CRE INFL BLN","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558670","SUP","HCPCS C1726","","M00558670  -  DILATOR ESCP 7.5FR 8-10MM 240CM STRL LF 5.5CM CRE INFL BLN","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558680","SUP","HCPCS C1726","","M00558680  -  DILATOR ESCP 7.5FR 10-12MM 240CM STRL LF 5.5CM CRE INFL BLN","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558690","SUP","HCPCS C1726","","M00558690  -  DILATOR ESCP 7.5FR 12-13.5-15MM 240CM STRL LF 5.5CM CRE INFL","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558700","SUP","HCPCS C1726","","M00558700  -  DILATOR ESCP 7.5FR 15-16.5-18MM 240CM STRL LF 5.5CM CRE INFL","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00558710","SUP","HCPCS C1726","","M00558710  -  DILATOR ESCP 7.5FR 18-20MM 240CM STRL LF 5.5CM CRE INFL","BOTH IP/OP","$530.33 ","$392.44 ","$0.00 ","$534.35 ","$290.15 ","$0.00 ","$110.53 ","$0.00 ","$0.00 ","$93.56 ","$534.35 ","$0.00 ","$267.18 ","$423.21 ","$427.48 ","$0.00 ","$83.63 ","$0.00 ","$85.07 ","$0.00 "
"M00560071","SUP","HCPCS C1726","","M00560071  -  CATHETER ELHMST 7FR 300CM STRL GLDPRB BP RND DIST TIP FIRM","BOTH IP/OP","$303.35 ","$224.48 ","$0.00 ","$307.83 ","$167.15 ","$0.00 ","$63.23 ","$0.00 ","$0.00 ","$53.90 ","$307.83 ","$0.00 ","$153.91 ","$243.80 ","$246.26 ","$0.00 ","$48.17 ","$0.00 ","$49.01 ","$0.00 "
"M00560150","SUP","Custom 27203010","","M00560150  -  CATHETER ELHMST 7FR 25GA .24MM 210CM INJ GLDPRB BP RND DIST","BOTH IP/OP","$557.75 ","$412.74 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$420.81 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00560150","SUP","Custom 27203118","","INJECTION GOLD PROBE 7FR","BOTH IP/OP","$557.75 ","$412.74 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00560160","SUP","HCPCS C1726","","M00560160  -  CATHETER ELECTROHEMOSTASIS 10FR 210CM BIPOL STANDARD PLUG","BOTH IP/OP","$557.75 ","$412.74 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$116.25 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$420.81 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00560160","SUP","Custom 27203117","","INJECTION GOLD PROBE 10FR","BOTH IP/OP","$557.75 ","$412.74 ","$0.00 ","$750.00 ","$0.00 ","$0.00 ","$116.25 ","$0.00 ","$0.00 ","$0.00 ","$750.00 ","$0.00 ","$375.00 ","$594.00 ","$600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00561831","SUP","Custom 27203010","","M00561831  -  SNARE ENDSCP MINI STANDARD OVAL 2.4MM 195CMX20MM POLYPECTOMY","BOTH IP/OP","$46.48 ","$34.40 ","$0.00 ","$47.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.00 ","$0.00 ","$23.50 ","$37.22 ","$37.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00562321","SUP","Custom 27203010","","M00562321  -  SNARE ESCP MED OVL 2.4MM 240CM 27MM CPTVTR STF DISP PLYP","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$34.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.05 ","$0.00 ","$17.03 ","$26.97 ","$27.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00562391","SUP","Custom 27203010","","M00562391  -  SNARE ENDSCP THIN JUMBO OVAL 2.4MM 240CM 30MM FLEXIBLE WIRE","BOTH IP/OP","$33.68 ","$24.92 ","$0.00 ","$34.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.05 ","$0.00 ","$17.03 ","$26.97 ","$27.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00562401","SUP","Custom 27203010","","M00562401  -  SNARE ENDSCP MEDIUM OVAL 2.4MM 240CM 27MM LOOP FLEXIBLE","BOTH IP/OP","$32.88 ","$24.33 ","$0.00 ","$32.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.92 ","$0.00 ","$16.46 ","$26.07 ","$26.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00562402","SUP","Custom 27203010","","M00562402  -  SNARE ENDSCP STANDARD OVAL 2.4MM 240CMX27MM FLEXIBLE","BOTH IP/OP","$21.19 ","$15.68 ","$0.00 ","$21.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.63 ","$0.00 ","$10.82 ","$17.13 ","$17.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00562671","SUP","Custom 27203010","","M00562671  -  INTRODUCER SHTH 9.5FR HMSTS VLV SDPRT","BOTH IP/OP","$61.41 ","$45.44 ","$0.00 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.00 ","$0.00 ","$22.50 ","$35.64 ","$36.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00565020","SUP","HCPCS C1876","","M00565020  -  STENT DUODENAL 22-27MM 10FR 9CM 230CM DELIVERY SYSTEM","BOTH IP/OP","$6,159.53 ","$4,558.05 ","$0.00 ","$6,258.18 ","$2,816.18 ","$0.00 ","$1,283.80 ","$0.00 ","$0.00 ","$1,095.76 ","$6,258.18 ","$0.00 ","$3,129.09 ","$4,956.48 ","$5,006.54 ","$0.00 ","$979.40 ","$0.00 ","$996.30 ","$0.00 "
"M00565040","SUP","HCPCS C1874","","M00565040  -  STENT COLONIC 25-30MM 10FR 60CM 230CM DELIVERY SYSTEM","BOTH IP/OP","$6,159.53 ","$4,558.05 ","$0.00 ","$6,258.18 ","$2,816.18 ","$0.00 ","$1,283.80 ","$0.00 ","$0.00 ","$1,095.76 ","$6,258.18 ","$0.00 ","$3,129.09 ","$4,956.48 ","$5,006.54 ","$0.00 ","$979.40 ","$0.00 ","$996.30 ","$0.00 "
"M00565050","SUP","HCPCS C1874","","M00565050  -  STENT COLONIC 25-30MM 10FR 90CM 230CM DELIVERY SYSTEM","BOTH IP/OP","$6,159.53 ","$4,558.05 ","$0.00 ","$6,258.18 ","$2,816.18 ","$0.00 ","$1,283.80 ","$0.00 ","$0.00 ","$1,095.76 ","$6,258.18 ","$0.00 ","$3,129.09 ","$4,956.48 ","$5,006.54 ","$0.00 ","$979.40 ","$0.00 ","$996.30 ","$0.00 "
"M00565060","SUP","HCPCS C1874","","M00565060  -  STENT COLONIC 25-30MM 10FR 120CM 230CM DELIVERY SYSTEM","BOTH IP/OP","$6,159.53 ","$4,558.05 ","$0.00 ","$6,258.18 ","$2,816.18 ","$0.00 ","$1,283.80 ","$0.00 ","$0.00 ","$1,095.76 ","$6,258.18 ","$0.00 ","$3,129.09 ","$4,956.48 ","$5,006.54 ","$0.00 ","$979.40 ","$0.00 ","$996.30 ","$0.00 "
"M00566461","SUP","Custom 27203010","","M00566461  -  KIT PG 20FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN","BOTH IP/OP","$219.16 ","$162.18 ","$0.00 ","$242.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.87 ","$0.00 ","$121.43 ","$192.35 ","$194.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00566471","SUP","HCPCS C1769","","M00566471  -  KIT PG 11 20FR 22GA 1.5IN STRL LF EVV SFGLD CHLRPRP PUSH","BOTH IP/OP","$219.16 ","$162.18 ","$0.00 ","$242.87 ","$131.88 ","$0.00 ","$45.68 ","$0.00 ","$0.00 ","$42.52 ","$242.87 ","$0.00 ","$121.43 ","$192.35 ","$194.29 ","$0.00 ","$38.01 ","$0.00 ","$38.66 ","$0.00 "
"M00566481","SUP","Custom 27203010","","M00566481  -  KIT PG 24FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN","BOTH IP/OP","$219.16 ","$162.18 ","$0.00 ","$242.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.86 ","$0.00 ","$121.43 ","$192.35 ","$194.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00566670","SUP","Custom 27203116","","ENCORE 26 SINGLE","BOTH IP/OP","$182.50 ","$135.05 ","$0.00 ","$182.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$182.50 ","$0.00 ","$91.25 ","$144.54 ","$146.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0056820","SUP","Custom 27203010","","M0056820  -  KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00568201","SUP","Custom 27203010","","M00568201  -  KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML","BOTH IP/OP","$147.75 ","$109.34 ","$0.00 ","$202.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.00 ","$0.00 ","$101.00 ","$159.98 ","$161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0056824","SUP","Custom 27203010","","KIT PG 24FR PUL METH STD EVV","BOTH IP/OP","$137.50 ","$101.75 ","$0.00 ","$137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.50 ","$0.00 ","$68.75 ","$108.90 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00568241","SUP","Custom 27203010","","M00568241  -  KIT PG 24FR 6824","BOTH IP/OP","$147.75 ","$109.34 ","$0.00 ","$202.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$202.00 ","$0.00 ","$101.00 ","$159.98 ","$161.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00570360","SUP","HCPCS C1874","","M00570360  -  STENT BIL .035IN 10MM 8.5FR 40MM 194CM WALLFLEX RMLM FLLY","BOTH IP/OP","$6,198.75 ","$4,587.08 ","$0.00 ","$6,297.90 ","$2,834.06 ","$0.00 ","$1,291.97 ","$0.00 ","$0.00 ","$1,102.71 ","$6,297.90 ","$0.00 ","$3,148.95 ","$4,987.94 ","$5,038.32 ","$0.00 ","$985.62 ","$0.00 ","$1,002.63 ","$0.00 "
"M00570370","SUP","HCPCS C1874","","M00570370  -  STENT BIL .035IN 10MM 8.5FR 60MM 194CM WALLFLEX RMLM FLLY","BOTH IP/OP","$6,198.75 ","$4,587.08 ","$0.00 ","$6,297.90 ","$2,834.06 ","$0.00 ","$1,291.97 ","$0.00 ","$0.00 ","$1,102.71 ","$6,297.90 ","$0.00 ","$3,148.95 ","$4,987.94 ","$5,038.32 ","$0.00 ","$985.62 ","$0.00 ","$1,002.63 ","$0.00 "
"M00570380","SUP","HCPCS C1874","","M00570380  -  STENT BIL .035IN 10MM 8.5FR 80MM 194CM WALLFLEX RMLM FLLY","BOTH IP/OP","$6,198.75 ","$4,587.08 ","$0.00 ","$6,297.90 ","$2,834.06 ","$0.00 ","$1,291.97 ","$0.00 ","$0.00 ","$1,102.71 ","$6,297.90 ","$0.00 ","$3,148.95 ","$4,987.94 ","$5,038.32 ","$0.00 ","$985.62 ","$0.00 ","$1,002.63 ","$0.00 "
"M00570520","SUP","HCPCS C1874","","M00570520  -  STENT BILIARY 10MM 8.5FR 40MM RAPEX WALLFLEX PERMALUME","BOTH IP/OP","$6,297.90 ","$4,660.45 ","$0.00 ","$6,297.90 ","$2,834.06 ","$0.00 ","$1,312.64 ","$0.00 ","$0.00 ","$1,102.71 ","$6,297.90 ","$0.00 ","$3,148.95 ","$4,987.94 ","$5,038.32 ","$0.00 ","$985.62 ","$0.00 ","$1,002.63 ","$0.00 "
"M00570530","SUP","HCPCS C1769","","M00570530  -  STENT BILIARY 10MM 8.5FR 60MM RAPEX SELF EXPAND WALLFLEX","BOTH IP/OP","$6,297.90 ","$4,660.45 ","$0.00 ","$6,297.90 ","$3,419.76 ","$0.00 ","$1,312.64 ","$0.00 ","$0.00 ","$1,102.71 ","$6,297.90 ","$0.00 ","$3,148.95 ","$4,987.94 ","$5,038.32 ","$0.00 ","$985.62 ","$0.00 ","$1,002.63 ","$0.00 "
"M00570540","SUP","HCPCS C1874","","M00570540  -  STENT BILIARY 10MM 8.5FR 80MM RAPEX SELF EXPAND WALLFLEX","BOTH IP/OP","$6,297.90 ","$4,660.45 ","$0.00 ","$6,297.90 ","$2,834.06 ","$0.00 ","$1,312.64 ","$0.00 ","$0.00 ","$1,102.71 ","$6,297.90 ","$0.00 ","$3,148.95 ","$4,987.94 ","$5,038.32 ","$0.00 ","$985.62 ","$0.00 ","$1,002.63 ","$0.00 "
"M00570640","SUP","HCPCS C1769","","M00570640  -  STENT BIL 10MM 8FR 60MM 194CM WLSTNT UNCOVER INTGR RTRVL","BOTH IP/OP","$4,133.58 ","$3,058.85 ","$0.00 ","$4,215.63 ","$2,289.08 ","$0.00 ","$861.54 ","$0.00 ","$0.00 ","$738.12 ","$4,215.63 ","$0.00 ","$2,107.81 ","$3,338.78 ","$3,372.50 ","$0.00 ","$659.75 ","$0.00 ","$671.13 ","$0.00 "
"M00570650","SUP","HCPCS C1769","","M00570650  -  STENT BILIARY 10MM 8FR 80MM RAPEX DELIVERY SYSTEM WALLFLEX","BOTH IP/OP","$4,133.58 ","$3,058.85 ","$0.00 ","$4,215.63 ","$2,289.08 ","$0.00 ","$861.54 ","$0.00 ","$0.00 ","$738.12 ","$4,215.63 ","$0.00 ","$2,107.81 ","$3,338.78 ","$3,372.50 ","$0.00 ","$659.75 ","$0.00 ","$671.13 ","$0.00 "
"M00570660","SUP","HCPCS C1769","","M00570660  -  STENT BILIARY .035IN 10MM 8.5FR 100MM UNCOVERED RAPEX GWIRE","BOTH IP/OP","$4,133.58 ","$3,058.85 ","$0.00 ","$4,215.63 ","$2,289.08 ","$0.00 ","$861.54 ","$0.00 ","$0.00 ","$738.12 ","$4,215.63 ","$0.00 ","$2,107.81 ","$3,338.78 ","$3,372.50 ","$0.00 ","$659.75 ","$0.00 ","$671.13 ","$0.00 "
"M00570720","SUP","HCPCS C1874","","M00570720  -  STENT BILIARY .035IN 10MM 8.5FR 40MM 3.2MM RAPEX PARTIALLY","BOTH IP/OP","$6,123.15 ","$4,531.13 ","$0.00 ","$6,263.53 ","$2,818.59 ","$0.00 ","$1,276.22 ","$0.00 ","$0.00 ","$1,096.69 ","$6,263.53 ","$0.00 ","$3,131.76 ","$4,960.72 ","$5,010.82 ","$0.00 ","$980.24 ","$0.00 ","$997.15 ","$0.00 "
"M00570730","SUP","HCPCS C1874","","M00570730  -  STENT BIL .035IN 10MM 8.5FR 60MM 3.2MM WALLFLEX FLRSCP MRKR","BOTH IP/OP","$6,123.15 ","$4,531.13 ","$0.00 ","$6,263.53 ","$2,818.59 ","$0.00 ","$1,276.22 ","$0.00 ","$0.00 ","$1,096.69 ","$6,263.53 ","$0.00 ","$3,131.76 ","$4,960.72 ","$5,010.82 ","$0.00 ","$980.24 ","$0.00 ","$997.15 ","$0.00 "
"M00573080","SUP","HCPCS C1769","","M00573080  -  SPHINCTEROTOME ENDSCP .035IN 3.9FR 20MM 260CM CHOLANGIOGRAM","BOTH IP/OP","$750.00 ","$555.00 ","$0.00 ","$757.08 ","$411.09 ","$0.00 ","$156.32 ","$0.00 ","$0.00 ","$132.56 ","$757.08 ","$0.00 ","$378.54 ","$599.61 ","$605.66 ","$0.00 ","$118.48 ","$0.00 ","$120.53 ","$0.00 "
"M00582120","SUP","Custom 27203010","","M00582120  -  TUBE GSTRM STD RT ANG 14FR EVV BLN REPL BLSTR","BOTH IP/OP","$77.78 ","$57.56 ","$0.00 ","$87.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.58 ","$0.00 ","$43.79 ","$69.36 ","$70.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00582130","SUP","Custom 27203010","","M00582130  -  TUBE GSTRM STD RT ANG 16FR EVV BLN REPL BLSTR","BOTH IP/OP","$77.78 ","$57.56 ","$0.00 ","$87.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.58 ","$0.00 ","$43.79 ","$69.36 ","$70.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00582160","SUP","Custom 27203010","","M00582160  -  TUBE GSTRM STD RT ANG 24FR EVV BLN REPL BLSTR","BOTH IP/OP","$77.78 ","$57.56 ","$0.00 ","$87.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.58 ","$0.00 ","$43.79 ","$69.36 ","$70.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00583040","SUP","HCPCS C1769","","M00583040  -  SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 260CM CANN PRELOAD","BOTH IP/OP","$1,002.23 ","$741.65 ","$0.00 ","$1,011.08 ","$549.01 ","$0.00 ","$208.89 ","$0.00 ","$0.00 ","$177.03 ","$1,011.08 ","$0.00 ","$505.54 ","$800.78 ","$808.86 ","$0.00 ","$158.23 ","$0.00 ","$160.96 ","$0.00 "
"M00583060","SUP","HCPCS C1769","","M00583060  -  SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 450CM CANN PRELOAD","BOTH IP/OP","$1,002.23 ","$741.65 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$208.89 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$555.00 ","$800.78 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00583060","SUP","Custom 27203598","","HYDRATOME RX 44-20MM / 450CM","BOTH IP/OP","$1,002.23 ","$741.65 ","$0.00 ","$1,110.00 ","$0.00 ","$0.00 ","$208.89 ","$0.00 ","$0.00 ","$0.00 ","$1,110.00 ","$0.00 ","$555.00 ","$879.12 ","$888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M00584040","SUP","HCPCS C1769","","M00584040  -  SPHINCTEROTOME ENDSCP .035IN STR 4.4FR 260CM 20MM CANN","BOTH IP/OP","$1,002.23 ","$741.65 ","$0.00 ","$1,011.08 ","$549.01 ","$0.00 ","$208.89 ","$0.00 ","$0.00 ","$177.03 ","$1,011.08 ","$0.00 ","$505.54 ","$800.78 ","$808.86 ","$0.00 ","$158.23 ","$0.00 ","$160.96 ","$0.00 "
"M0061453500","SUP","HCPCS C2617","","M0061453500  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 22CM ATTACH","BOTH IP/OP","$524.30 ","$387.98 ","$0.00 ","$524.30 ","$235.94 ","$0.00 ","$109.28 ","$0.00 ","$0.00 ","$91.80 ","$524.30 ","$0.00 ","$262.15 ","$415.25 ","$419.44 ","$0.00 ","$82.05 ","$0.00 ","$83.47 ","$0.00 "
"M0061453510","SUP","HCPCS C2617","","M0061453510  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 24CM ATTACH","BOTH IP/OP","$524.30 ","$387.98 ","$0.00 ","$524.30 ","$235.94 ","$0.00 ","$109.28 ","$0.00 ","$0.00 ","$91.80 ","$524.30 ","$0.00 ","$262.15 ","$415.25 ","$419.44 ","$0.00 ","$82.05 ","$0.00 ","$83.47 ","$0.00 "
"M0061453520","SUP","HCPCS C2617","","M0061453520  -  STENT URETERAL PIGTAIL CURVE LP 4.8FR 26CM TAPER TIP BLADDER","BOTH IP/OP","$524.30 ","$387.98 ","$0.00 ","$524.30 ","$235.94 ","$0.00 ","$109.28 ","$0.00 ","$0.00 ","$91.80 ","$524.30 ","$0.00 ","$262.15 ","$415.25 ","$419.44 ","$0.00 ","$82.05 ","$0.00 ","$83.47 ","$0.00 "
"M0061453530","SUP","HCPCS C2617","","M0061453530  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 28CM ATTACH","BOTH IP/OP","$524.30 ","$387.98 ","$0.00 ","$524.30 ","$235.94 ","$0.00 ","$109.28 ","$0.00 ","$0.00 ","$91.80 ","$524.30 ","$0.00 ","$262.15 ","$415.25 ","$419.44 ","$0.00 ","$82.05 ","$0.00 ","$83.47 ","$0.00 "
"M0061453610","SUP","HCPCS C2617","","M0061453610  -  STENT URETERAL PIGTAIL CURVE LP TAPER 6FR 24CM ATTACH SUTURE","BOTH IP/OP","$524.30 ","$387.98 ","$0.00 ","$524.30 ","$235.94 ","$0.00 ","$109.28 ","$0.00 ","$0.00 ","$91.80 ","$524.30 ","$0.00 ","$262.15 ","$415.25 ","$419.44 ","$0.00 ","$82.05 ","$0.00 ","$83.47 ","$0.00 "
"M0061752500","SUP","HCPCS C2617","","M0061752500  -  STENT URETERAL TAPER 4.8FR 20CM BLADDER MARK HIGH COIL","BOTH IP/OP","$581.43 ","$430.26 ","$0.00 ","$581.43 ","$261.64 ","$0.00 ","$121.18 ","$0.00 ","$0.00 ","$101.80 ","$581.43 ","$0.00 ","$290.71 ","$460.49 ","$465.14 ","$0.00 ","$90.99 ","$0.00 ","$92.56 ","$0.00 "
"M0061901340","SUP","HCPCS C2617","","M0061901340  -  STENT URET 6FR 28CM W/O GWIRE DUAL DRMTR PLRS HDR+","BOTH IP/OP","$356.40 ","$263.74 ","$0.00 ","$356.40 ","$160.38 ","$0.00 ","$74.28 ","$0.00 ","$0.00 ","$62.40 ","$356.40 ","$0.00 ","$178.20 ","$282.27 ","$285.12 ","$0.00 ","$55.78 ","$0.00 ","$56.74 ","$0.00 "
"M0061901440","SUP","HCPCS C2617","","M0061901440  -  STENT URET 7FR 28CM W/O GWIRE DUAL DRMTR PLRS HDR+","BOTH IP/OP","$306.25 ","$226.63 ","$0.00 ","$306.25 ","$137.81 ","$0.00 ","$63.83 ","$0.00 ","$0.00 ","$53.62 ","$306.25 ","$0.00 ","$153.13 ","$242.55 ","$245.00 ","$0.00 ","$47.93 ","$0.00 ","$48.76 ","$0.00 "
"M0061901520","SUP","HCPCS C2617","","M0061901520  -  STENT URET 8FR 24CM W/O GWIRE PLRS HDR+","BOTH IP/OP","$306.25 ","$226.63 ","$0.00 ","$306.25 ","$137.81 ","$0.00 ","$63.83 ","$0.00 ","$0.00 ","$53.62 ","$306.25 ","$0.00 ","$153.13 ","$242.55 ","$245.00 ","$0.00 ","$47.93 ","$0.00 ","$48.76 ","$0.00 "
"M0061901530","SUP","HCPCS C2617","","M0061901530  -  STENT URET 8FR 26CM W/O GWIRE PLRS HDR+","BOTH IP/OP","$356.40 ","$263.74 ","$0.00 ","$356.40 ","$160.38 ","$0.00 ","$74.28 ","$0.00 ","$0.00 ","$62.40 ","$356.40 ","$0.00 ","$178.20 ","$282.27 ","$285.12 ","$0.00 ","$55.78 ","$0.00 ","$56.74 ","$0.00 "
"M0061901540","SUP","HCPCS C2617","","M0061901540  -  STENT URET 8FR 28CM W/O GWIRE PLRS HDR+","BOTH IP/OP","$359.98 ","$266.39 ","$0.00 ","$359.98 ","$161.99 ","$0.00 ","$75.03 ","$0.00 ","$0.00 ","$63.03 ","$359.98 ","$0.00 ","$179.99 ","$285.10 ","$287.98 ","$0.00 ","$56.34 ","$0.00 ","$57.31 ","$0.00 "
"M0061921300","SUP","HCPCS C2617","","M0061921300  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 20CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921310","SUP","HCPCS C1768","","M0061921310  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 22CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921320","SUP","HCPCS C1768","","M0061921320  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 24CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921330","SUP","HCPCS C1768","","M0061921330  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 26CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921340","SUP","HCPCS C2617","","M0061921340  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 28CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921410","SUP","HCPCS C2617","","M0061921410  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 22CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921420","SUP","HCPCS C2617","","M0061921420  -  STENT URETERAL 2 PIGTAIL CURVE TAPER 7FR 2.1FR 24CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921430","SUP","HCPCS C2617","","M0061921430  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 26CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921440","SUP","HCPCS C2617","","M0061921440  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 28CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921510","SUP","HCPCS C2617","","M0061921510  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 22CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921520","SUP","HCPCS C2617","","M0061921520  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 24CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0061921530","SUP","HCPCS C2617","","M0061921530  -  STENT URETERAL 2 PIGTAIL CURVE TAPER 8FR 2.1FR 26CM 2","BOTH IP/OP","$658.50 ","$487.29 ","$0.00 ","$658.50 ","$296.33 ","$0.00 ","$137.25 ","$0.00 ","$0.00 ","$115.30 ","$658.50 ","$0.00 ","$329.25 ","$521.53 ","$526.80 ","$0.00 ","$103.06 ","$0.00 ","$104.83 ","$0.00 "
"M0062101170","SUP","HCPCS C1726","","M0062101170  -  CATHETER BLNDIL 17CM 30FR 55CM LF 12CM NPHRMX AMPTZ LOPRFL","BOTH IP/OP","$1,077.18 ","$797.11 ","$0.00 ","$1,077.18 ","$584.91 ","$0.00 ","$224.51 ","$0.00 ","$0.00 ","$188.60 ","$1,077.18 ","$0.00 ","$538.59 ","$853.13 ","$861.74 ","$0.00 ","$168.58 ","$0.00 ","$171.49 ","$0.00 "
"M0062251020","SUP","HCPCS C1758","","M0062251020  -  CATHETER BLNDIL 6MM 75CM LF 4CM URMT U QD-FOLD HI-PRS KINK","BOTH IP/OP","$1,131.68 ","$837.44 ","$0.00 ","$1,131.68 ","$614.50 ","$0.00 ","$235.87 ","$0.00 ","$0.00 ","$198.15 ","$1,131.68 ","$0.00 ","$565.84 ","$896.29 ","$905.34 ","$0.00 ","$177.11 ","$0.00 ","$180.16 ","$0.00 "
"M0062251170","SUP","HCPCS C1758","","M0062251170  -  CATHETER BALDILAT SHORT TAPER 5.8FR 18FR 75CM 10CM KINK","BOTH IP/OP","$1,131.68 ","$837.44 ","$0.00 ","$1,131.68 ","$614.50 ","$0.00 ","$235.87 ","$0.00 ","$0.00 ","$198.15 ","$1,131.68 ","$0.00 ","$565.84 ","$896.29 ","$905.34 ","$0.00 ","$177.11 ","$0.00 ","$180.16 ","$0.00 "
"M0062502091","SUP","HCPCS C1894","","M0062502091  -  SHEATH ACCES 2 TAPER 15FR 13FR 36CM KINK RESISTANT RADIOPQ","BOTH IP/OP","$94.17 ","$69.69 ","$0.00 ","$94.17 ","$51.13 ","$0.00 ","$19.63 ","$0.00 ","$0.00 ","$16.49 ","$94.17 ","$0.00 ","$47.08 ","$74.58 ","$75.33 ","$0.00 ","$14.74 ","$0.00 ","$14.99 ","$0.00 "
"M0062601200","SUP","HCPCS C1769","","M0062601200  -  DILATOR SURG 8-10FR 70CM 30CM KINK RESISTANT STYLET SHEATH","BOTH IP/OP","$236.20 ","$174.79 ","$0.00 ","$236.20 ","$128.26 ","$0.00 ","$49.23 ","$0.00 ","$0.00 ","$41.36 ","$236.20 ","$0.00 ","$118.10 ","$187.07 ","$188.96 ","$0.00 ","$36.97 ","$0.00 ","$37.60 ","$0.00 "
"M0062602500","SUP","Custom 27203010","","M0062602500  -  DILATOR SURG SHEATH SET AMPLATZ RENAL STERILE","BOTH IP/OP","$1,131.68 ","$837.44 ","$0.00 ","$1,131.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,131.68 ","$0.00 ","$565.84 ","$896.29 ","$905.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063201020","SUP","Custom 27203010","","M0063201020  -  BASKET SPEC RTRVL 20MM 7FR 70CM SGR 4WR 0 TIP OVR GW","BOTH IP/OP","$528.75 ","$391.28 ","$0.00 ","$528.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$528.75 ","$0.00 ","$264.38 ","$418.77 ","$423.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063201040","SUP","Custom 27203010","","M0063201040  -  BASKET SPEC RTRVL 3FR 16MM 90CM S-D 4WR STON LSR","BOTH IP/OP","$649.00 ","$480.26 ","$0.00 ","$649.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$649.00 ","$0.00 ","$324.50 ","$514.01 ","$519.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063301060","SUP","Custom 27203010","","M0063301060  -  BASKET STON RTRVL HLCL 11MM 3FR 120CM STRL GMN 3 PR WRE SCR","BOTH IP/OP","$853.95 ","$631.92 ","$0.00 ","$853.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.95 ","$0.00 ","$426.98 ","$676.33 ","$683.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063311060","SUP","Custom 27203010","","M0063311060  -  BASKET SPEC RTRVL 120CM 3FR 11MM STON 3WR HLCL 0 TIP PR GMN","BOTH IP/OP","$473.00 ","$350.02 ","$0.00 ","$473.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$473.00 ","$0.00 ","$236.50 ","$374.62 ","$378.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063401220","SUP","Custom 27203010","","M0063401220  -  BASKET STON RTRVL HLCL 10MM 1.9FR 120CM STRL BGLY 3WR DISP","BOTH IP/OP","$853.95 ","$631.92 ","$0.00 ","$853.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.95 ","$0.00 ","$426.98 ","$676.33 ","$683.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063601000","SUP","HCPCS C1726","","M0063601000  -  CATHETER SPEC RTRVL 3FR 120CM 60CM OVL LOOP","BOTH IP/OP","$455.50 ","$337.07 ","$0.00 ","$455.50 ","$247.34 ","$0.00 ","$94.94 ","$0.00 ","$0.00 ","$79.75 ","$455.50 ","$0.00 ","$227.75 ","$360.76 ","$364.40 ","$0.00 ","$71.29 ","$0.00 ","$72.52 ","$0.00 "
"M0063801100","SUP","Custom 27203010","","M0063801100  -  BASKET STON RTRVL 20MM 3FR 120CM STRL LF SGR HEMI PERMAFORM","BOTH IP/OP","$853.95 ","$631.92 ","$0.00 ","$853.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$853.95 ","$0.00 ","$426.98 ","$676.33 ","$683.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063901010","SUP","Custom 27203010","","M0063901010  -  BASKET STON RTRVL 12MM 2.4FR 120CM STRL LF 0TP 4WR FLT DIST","BOTH IP/OP","$921.93 ","$682.23 ","$0.00 ","$921.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$921.93 ","$0.00 ","$460.96 ","$730.17 ","$737.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063901020","SUP","Custom 27203010","","M0063901020  -  BASKET STON RTRVL 16MM 3FR 90CM STRL LF 0TP 4WR FLT DIST","BOTH IP/OP","$921.93 ","$682.23 ","$0.00 ","$921.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$921.93 ","$0.00 ","$460.96 ","$730.17 ","$737.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063901050","SUP","Custom 27203010","","M0063901050  -  BASKET STON RTRVL 12MM 1.9FR 120CM STRL LF 0TP 4WR FLT DIST","BOTH IP/OP","$939.48 ","$695.22 ","$0.00 ","$939.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$939.48 ","$0.00 ","$469.74 ","$744.07 ","$751.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063902000","SUP","Custom 27203010","","M0063902000  -  BASKET STON RTRVL 1.9FR 90CM STRL LF ESCAPE SGR STD 4WR NTNL","BOTH IP/OP","$1,158.53 ","$857.31 ","$0.00 ","$1,158.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,158.53 ","$0.00 ","$579.26 ","$917.56 ","$926.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063902010","SUP","Custom 27203010","","M0063902010  -  BASKET STON RTRVL 1.9FR 120CM STRL LF ESCAPE SGR STD 4WR","BOTH IP/OP","$1,158.53 ","$857.31 ","$0.00 ","$1,158.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,158.53 ","$0.00 ","$579.26 ","$917.56 ","$926.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063903100","SUP","Custom 27203010","","M0063903100  -  COIL SPECIMEN RETRIEVAL 7MM 3FR 115CM LATEX FREE STONE CONE","BOTH IP/OP","$1,112.15 ","$822.99 ","$0.00 ","$1,112.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,112.15 ","$0.00 ","$556.08 ","$880.82 ","$889.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0063903200","SUP","Custom 27803010","","M0063903200  -  COIL SPECIMEN RETRIEVAL 3FR 10MM 115CM SHEAQTH QUICK RELEASE","BOTH IP/OP","$1,112.15 ","$822.99 ","$0.00 ","$1,112.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,112.15 ","$0.00 ","$556.08 ","$880.82 ","$889.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0064002011","SUP","HCPCS C1758","","M0064002011  -  CATHETER URETERAL 5FR 70CM 1 LUMEN OPEN END INJEC HUB LATEX","BOTH IP/OP","$921.45 ","$681.87 ","$0.00 ","$921.45 ","$500.35 ","$0.00 ","$192.05 ","$0.00 ","$0.00 ","$161.34 ","$921.45 ","$0.00 ","$460.73 ","$729.79 ","$737.16 ","$0.00 ","$144.21 ","$0.00 ","$146.69 ","$0.00 "
"M0064201000","SUP","Custom 27203010","","M0064201000  -  CATH SPBC FDRTP 14FR 15CM KIT BLN PNCT 5ML","BOTH IP/OP","$198.00 ","$146.52 ","$0.00 ","$198.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.00 ","$0.00 ","$99.00 ","$156.82 ","$158.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M006580211","SUP","Custom 27203010","","M006580211  -  UNIT ELECTROSURGICAL PROCEDURE SET GENESYS HTA","BOTH IP/OP","$4,209.12 ","$3,114.75 ","$0.00 ","$4,209.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,209.12 ","$0.00 ","$2,104.56 ","$3,333.62 ","$3,367.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0066301001","SUP","HCPCS C1769","","M0066301001  -  GWIRE ENDSCP .035IN 150CM STR FLX TP STF SHFT GLDWR HYDPHI 3","BOTH IP/OP","$137.89 ","$102.04 ","$0.00 ","$137.89 ","$74.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.14 ","$137.89 ","$0.00 ","$68.95 ","$109.21 ","$110.31 ","$0.00 ","$21.58 ","$0.00 ","$21.95 ","$0.00 "
"M0066301011","SUP","HCPCS C1769","","M0066301011  -  GUIDEWIRE URO STD .038IN 150CM STRL 3CM GLDWR SFT FLXB STRG","BOTH IP/OP","$137.89 ","$102.04 ","$0.00 ","$137.89 ","$74.87 ","$0.00 ","$28.74 ","$0.00 ","$0.00 ","$24.14 ","$137.89 ","$0.00 ","$68.95 ","$109.21 ","$110.31 ","$0.00 ","$21.58 ","$0.00 ","$21.95 ","$0.00 "
"M0066301101","SUP","HCPCS C1769","","M0066301101  -  GWIRE ENDSCP .035IN 150CM ANG TIP FLX TP STF SHFT GLDWR PU 3","BOTH IP/OP","$201.16 ","$148.86 ","$0.00 ","$201.16 ","$109.23 ","$0.00 ","$41.93 ","$0.00 ","$0.00 ","$35.22 ","$201.16 ","$0.00 ","$100.58 ","$159.32 ","$160.93 ","$0.00 ","$31.48 ","$0.00 ","$32.02 ","$0.00 "
"M0066301121","SUP","HCPCS C1769","","M0066301121  -  GWIRE ENDSCP .038IN 150CM ANG TIP FLX TP STF SHFT GLDWR PU 3","BOTH IP/OP","$201.16 ","$148.86 ","$0.00 ","$201.16 ","$109.23 ","$0.00 ","$41.93 ","$0.00 ","$0.00 ","$35.22 ","$201.16 ","$0.00 ","$100.58 ","$159.32 ","$160.93 ","$0.00 ","$31.48 ","$0.00 ","$32.02 ","$0.00 "
"M0066401041","SUP","HCPCS C1769","","M0066401041  -  GUIDEWIRE URO STRG .035IN 145CM LF 7CM AMP SPST BNTSN FLX TP","BOTH IP/OP","$120.44 ","$89.13 ","$0.00 ","$120.44 ","$65.40 ","$0.00 ","$25.10 ","$0.00 ","$0.00 ","$21.09 ","$120.44 ","$0.00 ","$60.22 ","$95.39 ","$96.35 ","$0.00 ","$18.85 ","$0.00 ","$19.17 ","$0.00 "
"M0066703051","SUP","HCPCS C1769","","M0066703051  -  GUIDEWIRE ENDSCP STR FLOPPY .035IN 150CM 3CM HIGH","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$526.03 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"M0066703061","SUP","HCPCS C1769","","M0066703061  -  GUIDEWIRE ENDSCP ANGLE FLOPPY .035IN 150CM 3CM HIGH","BOTH IP/OP","$193.75 ","$143.38 ","$0.00 ","$193.75 ","$105.21 ","$0.00 ","$40.38 ","$0.00 ","$0.00 ","$33.92 ","$193.75 ","$0.00 ","$96.88 ","$153.45 ","$155.00 ","$0.00 ","$30.32 ","$0.00 ","$30.85 ","$0.00 "
"M0066703091","SUP","HCPCS C1769","","M0066703091  -  GUIDEWIRE ENDSCP STR .038IN 150CM 3CM RADIOPQ FLEXIBLE TIP","BOTH IP/OP","$193.75 ","$143.38 ","$0.00 ","$193.75 ","$105.21 ","$0.00 ","$40.38 ","$0.00 ","$0.00 ","$33.92 ","$193.75 ","$0.00 ","$96.88 ","$153.45 ","$155.00 ","$0.00 ","$30.32 ","$0.00 ","$30.85 ","$0.00 "
"M0066703101","SUP","HCPCS C1769","","M0066703101  -  GUIDEWIRE ENDSCP ANGLE .038IN 150CM 3CM 2 FLEXIBLE TIP","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$526.03 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"M0067201001","SUP","Custom 27203010","","M0067201001  -  SYSTEM PUMP IRRIGATION 1 HAND ACTION 1 WAY VALVE VACUUM","BOTH IP/OP","$212.74 ","$157.43 ","$0.00 ","$212.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.74 ","$0.00 ","$106.37 ","$168.49 ","$170.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0067301251","SUP","Custom 27203010","","M0067301251  -  EVACUATOR UROLOGY UROVAC BLADDER","BOTH IP/OP","$107.98 ","$79.91 ","$0.00 ","$107.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.98 ","$0.00 ","$53.99 ","$85.52 ","$86.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0068318170","SUP","HCPCS C1781","","M0068318170  -  MESH TRANSVAGINAL UPHOLD CAPIO","BOTH IP/OP","$7,046.25 ","$5,214.23 ","$0.00 ","$7,046.25 ","$3,170.81 ","$0.00 ","$1,468.61 ","$0.00 ","$0.00 ","$1,233.74 ","$7,046.25 ","$0.00 ","$3,523.13 ","$5,580.63 ","$5,637.00 ","$0.00 ","$1,102.74 ","$0.00 ","$1,121.76 ","$0.00 "
"M0068502110","SUP","HCPCS C1771","","M0068502110  -  SLING TRANSVAGINAL 2.7MM CURVE SYSTEM DELIVERY DEVICE MESH","BOTH IP/OP","$3,940.00 ","$2,915.60 ","$0.00 ","$3,940.00 ","$1,773.00 ","$0.00 ","$821.19 ","$0.00 ","$0.00 ","$689.86 ","$3,940.00 ","$0.00 ","$1,970.00 ","$3,120.48 ","$3,152.00 ","$0.00 ","$616.61 ","$0.00 ","$627.25 ","$0.00 "
"M0068503000","SUP","HCPCS C1771","","M0068503000  -  SLING PUBOVAGINAL SLING SYSTEM LYNX FMALE SUPRAPUBIC","BOTH IP/OP","$3,753.08 ","$2,777.28 ","$0.00 ","$3,753.08 ","$1,688.88 ","$0.00 ","$782.23 ","$0.00 ","$0.00 ","$657.13 ","$3,753.08 ","$0.00 ","$1,876.54 ","$2,972.44 ","$3,002.46 ","$0.00 ","$587.36 ","$0.00 ","$597.49 ","$0.00 "
"M0068505000","SUP","HCPCS C1771","","M0068505000  -  SLING PUBOVAGINAL SLING SYSTEM NEEDLE OBTRYX HALO FMALE","BOTH IP/OP","$3,187.50 ","$2,358.75 ","$0.00 ","$3,187.50 ","$1,434.38 ","$0.00 ","$664.35 ","$0.00 ","$0.00 ","$558.11 ","$3,187.50 ","$0.00 ","$1,593.75 ","$2,524.50 ","$2,550.00 ","$0.00 ","$498.84 ","$0.00 ","$507.45 ","$0.00 "
"M0068505110","SUP","HCPCS C1771","","M0068505110  -  SLING PUBOVAGINAL NEEDLE OBTRYX II HALO MIDURETHRAL","BOTH IP/OP","$3,500.00 ","$2,590.00 ","$0.00 ","$3,500.00 ","$1,575.00 ","$0.00 ","$729.49 ","$0.00 ","$0.00 ","$612.82 ","$3,500.00 ","$0.00 ","$1,750.00 ","$2,772.00 ","$2,800.00 ","$0.00 ","$547.75 ","$0.00 ","$557.20 ","$0.00 "
"M0613","SUP","Custom 25003010","","ANTIBODY EMA CLONE E29 MS ANHMN .2ML LAB","BOTH IP/OP","$569.13 ","$421.16 ","$0.00 ","$569.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$569.13 ","$0.00 ","$284.56 ","$450.75 ","$455.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0630","SUP","Custom 25003010","","ANTIBODY CYKRTN CLONE 34BETAE12 MS IGG1 KAPPA MNCLN ANHMN .2","BOTH IP/OP","$1,016.33 ","$752.08 ","$0.00 ","$1,016.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,016.33 ","$0.00 ","$508.16 ","$804.93 ","$813.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0634","SUP","Custom 25003010","","ANTIBODY MLNSM CLONE HMB45 MS ANHMN .2ML LAB","BOTH IP/OP","$1,900.00 ","$1,406.00 ","$0.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,900.00 ","$0.00 ","$950.00 ","$1,504.80 ","$1,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0701","SUP","Custom 25003010","","ANTIBODY CD45 LCA CLONE 2B11 PD7/26 MS IGG1 KAPPA ANHMN 1ML","BOTH IP/OP","$817.85 ","$605.21 ","$0.00 ","$817.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$817.85 ","$0.00 ","$408.93 ","$647.74 ","$654.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0725","SUP","Custom 25003010","","ANTIBODY VM CLONE V9 MS ANHMN 1ML LAB","BOTH IP/OP","$1,187.50 ","$878.75 ","$0.00 ","$1,187.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,187.50 ","$0.00 ","$593.75 ","$940.50 ","$950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0733","SUP","Custom 25003010","","ANTIBODY CD15 CLONE C3D-1 MS IGM KAPPA ANHMN 1ML LAB","BOTH IP/OP","$861.60 ","$637.58 ","$0.00 ","$861.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$861.60 ","$0.00 ","$430.80 ","$682.39 ","$689.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0750","SUP","Custom 25003010","","ANTIBODY PSA CLONE ER-PR8 MS ANHMN 1ML LAB","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0751","SUP","Custom 25003010","","ANTIBODY CD30 CLONE BER H2 MS IGG1 KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,101.68 ","$815.24 ","$0.00 ","$1,101.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,101.68 ","$0.00 ","$550.84 ","$872.53 ","$881.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0755","SUP","Custom 25003010","","ANTIBODY CD20CY CLONE L26 MS IGG2A KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,213.70 ","$898.14 ","$0.00 ","$1,213.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,213.70 ","$0.00 ","$606.85 ","$961.25 ","$970.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0776","SUP","Custom 25003010","","ANTIBODY SNPTSN CLONE SY38 MS IGG1 KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,252.00 ","$926.48 ","$0.00 ","$1,252.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,252.00 ","$0.00 ","$626.00 ","$991.58 ","$1,001.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0781","SUP","Custom 25003010","","ANTIBODY IGG1 KAPPA DAK-TG6 CLONE MS ANHMN MNCLN CULT SPRNT","BOTH IP/OP","$877.60 ","$649.42 ","$0.00 ","$877.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$877.60 ","$0.00 ","$438.80 ","$695.06 ","$702.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0823","SUP","Custom 25003010","","ANTIBODY CD31 CLONE JC/70A MS IGG1 .2ML 1ML LAB","BOTH IP/OP","$1,072.33 ","$793.52 ","$0.00 ","$1,072.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,072.33 ","$0.00 ","$536.16 ","$849.29 ","$857.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M085401","SUP","Custom 25003010","","ANTIBODY CMV CLONE CCH2 DDG9 MS ANHMN 1ML LAB","BOTH IP/OP","$1,091.25 ","$807.53 ","$0.00 ","$1,091.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,091.25 ","$0.00 ","$545.63 ","$864.27 ","$873.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M0873","SUP","Custom 25003010","","ANTIBODY NSE CLONE BBS/NC/6-H14 MS ANHMN .2ML LAB","BOTH IP/OP","$1,556.85 ","$1,152.07 ","$0.00 ","$1,556.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,556.85 ","$0.00 ","$778.43 ","$1,233.03 ","$1,245.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M1599B","SUP","Custom 27203010","","CABLE NIBP  INTERCONNECT 3.0M","BOTH IP/OP","$115.50 ","$85.47 ","$0.00 ","$115.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$115.50 ","$0.00 ","$57.75 ","$91.48 ","$92.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M1900B","SUP","Custom 27203010","","CABLE OXM 3MR 12TO 9 PIN D-SUB INPT CONNCTR SPO2 ADPR LF","BOTH IP/OP","$339.60 ","$251.30 ","$0.00 ","$339.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$339.60 ","$0.00 ","$169.80 ","$268.96 ","$271.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M3526A","SUP","Custom 27203010","","WIRE 3 LEAD SET SNAP","BOTH IP/OP","$340.00 ","$251.60 ","$0.00 ","$340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$340.00 ","$0.00 ","$170.00 ","$269.28 ","$272.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M3556","SUP","Custom 25003010","","ANTIBODY CALPONIN CLONE CALP MS IGG1 KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,900.00 ","$1,406.00 ","$0.00 ","$1,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,900.00 ","$0.00 ","$950.00 ","$1,504.80 ","$1,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M3569","SUP","Custom 25003010","","ANTIBODY PR CLONE PGR 636 MS IGG1 KAPPA MNCLN ANHMN .2ML 1ML","BOTH IP/OP","$3,115.03 ","$2,305.12 ","$0.00 ","$3,115.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,115.03 ","$0.00 ","$1,557.51 ","$2,467.10 ","$2,492.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M3609","SUP","Custom 25003010","","ANTIBODY INHIBIN ALPHA CLONE R1 MS ANHMN 1ML LAB","BOTH IP/OP","$1,193.10 ","$882.89 ","$0.00 ","$1,193.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,193.10 ","$0.00 ","$596.55 ","$944.94 ","$954.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M365SC550040","SUP","HCPCS C1787","","M365SC550040  -  KIT STIMULATOR PRECISION SPECTRA SPINE CORD CASE REMOTE CONT","BOTH IP/OP","$2,000.00 ","$1,480.00 ","$0.00 ","$2,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,000.00 ","$0.00 ","$1,000.00 ","$1,584.00 ","$1,600.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M3717A","SUP","Custom 27203010","","M3717A  -  PAD DFBR HRTSTRT MLFNC XTRN PLUG CONCTR PED LATEX FREE DISP","BOTH IP/OP","$60.16 ","$44.52 ","$0.00 ","$60.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$60.16 ","$0.00 ","$30.08 ","$47.65 ","$48.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M6275033/10.S","SUP","HCPCS A6209","","M6275033/10.S  -  DRSG THK1CM LG 15X10CM NADH CMFT VRSTL PVA VAC WHITEFOAM","BOTH IP/OP","$23.48 ","$17.38 ","$0.00 ","$23.48 ","$12.75 ","$0.00 ","$4.89 ","$0.00 ","$0.00 ","$4.11 ","$23.48 ","$0.00 ","$11.74 ","$18.60 ","$18.78 ","$0.00 ","$3.67 ","$0.00 ","$3.74 ","$0.00 "
"M6275034/10.S","SUP","HCPCS A6209","","M6275034/10.S  -  DRSG THK1CM LG 15X10CM NADH CMFT VRSTL PVA VAC WHITEFOAM","BOTH IP/OP","$30.02 ","$22.21 ","$0.00 ","$30.02 ","$16.30 ","$0.00 ","$6.26 ","$0.00 ","$0.00 ","$5.26 ","$30.02 ","$0.00 ","$15.01 ","$23.78 ","$24.01 ","$0.00 ","$4.70 ","$0.00 ","$4.78 ","$0.00 "
"M6275053/10.S","SUP","HCPCS A6209","","M6275053/10.S  -  DRSG THK3.3CM MED 18X12.5CM NADH CMFT VRSTL PU VAC GFM FOAM","BOTH IP/OP","$135.29 ","$100.11 ","$0.00 ","$135.29 ","$73.46 ","$0.00 ","$28.20 ","$0.00 ","$0.00 ","$23.69 ","$135.29 ","$0.00 ","$67.64 ","$107.15 ","$108.23 ","$0.00 ","$21.17 ","$0.00 ","$21.54 ","$0.00 "
"M6275096/10","SUP","Custom 27203010","","DRESSING THK3.3CM MED 18X12.5CM 2 ADH DRP KT PU VAC GFM SLVR","BOTH IP/OP","$148.16 ","$109.64 ","$0.00 ","$148.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.16 ","$0.00 ","$74.08 ","$117.34 ","$118.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M6275096/10.S","SUP","HCPCS A6209","","M6275096/10.S  -  DRSG MED 18X12.5CM OPN PORE HDRPHB NEG PRSS KIT PU VAC GFM","BOTH IP/OP","$155.06 ","$114.74 ","$0.00 ","$155.06 ","$84.19 ","$0.00 ","$32.32 ","$0.00 ","$0.00 ","$27.15 ","$155.06 ","$0.00 ","$77.53 ","$122.81 ","$124.04 ","$0.00 ","$24.27 ","$0.00 ","$24.68 ","$0.00 "
"M6275098/10","SUP","Custom 27203010","","DRESSING THK3.3CM SM VAC GFM SLVR BLK 10X7.5CM M6275098/10","BOTH IP/OP","$1,180.45 ","$873.53 ","$0.00 ","$1,180.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,180.45 ","$0.00 ","$590.23 ","$934.92 ","$944.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M6275098/10.S","SUP","HCPCS A6209","","M6275098/10.S  -  DRSG SM 10X7.5CM 1 DRP PAD CONCTR PU VAC GFM SLVR FOAM BLK","BOTH IP/OP","$123.77 ","$91.59 ","$0.00 ","$123.77 ","$67.20 ","$0.00 ","$25.80 ","$0.00 ","$0.00 ","$21.67 ","$123.77 ","$0.00 ","$61.88 ","$98.03 ","$99.01 ","$0.00 ","$19.37 ","$0.00 ","$19.70 ","$0.00 "
"M6275099/10","SUP","Custom 27203010","","DRESSING THK3.3CM LG VAC GFM SLVR BLK 26X15CM M6275099/10","BOTH IP/OP","$179.29 ","$132.67 ","$0.00 ","$179.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$179.29 ","$0.00 ","$89.65 ","$142.00 ","$143.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M6275099/10.S","SUP","HCPCS A6209","","M6275099/10.S  -  DRSG LG 26X15CM 2 DRP SENSATRAC PAD CONCTR PU VAC GFM SLVR","BOTH IP/OP","$17.36 ","$12.85 ","$0.00 ","$17.36 ","$9.43 ","$0.00 ","$3.62 ","$0.00 ","$0.00 ","$3.04 ","$17.36 ","$0.00 ","$8.68 ","$13.75 ","$13.89 ","$0.00 ","$2.72 ","$0.00 ","$2.76 ","$0.00 "
"M653G","SUP","Custom 27203010","","M653G  -  SUTURE SS 5 CCS 18IN MFL NABSB","BOTH IP/OP","$133.64 ","$98.89 ","$0.00 ","$39.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.71 ","$0.00 ","$19.85 ","$31.45 ","$31.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7001","SUP","Custom 27803010","","M7001  -  CATHETER DRN SYS ASPT PLR","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7019","SUP","Custom 25003010","","ANTIBODY CYKRTN 20 CLONE KS20.8 MS IGG2A KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,013.43 ","$749.94 ","$0.00 ","$1,013.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,013.43 ","$0.00 ","$506.71 ","$802.64 ","$810.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7047","SUP","Custom 25003010","","ANTIBODY ER CLONE 1D5 MS IGG1 KAPPA MNCLN ANHMN .2ML 1ML LAB","BOTH IP/OP","$2,638.43 ","$1,952.44 ","$0.00 ","$2,638.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,638.43 ","$0.00 ","$1,319.21 ","$2,089.64 ","$2,110.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7165","SUP","Custom 25003010","","ANTIBODY CD34 CLONE QBEND MS IGG1 KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,173.58 ","$868.45 ","$0.00 ","$1,173.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,173.58 ","$0.00 ","$586.79 ","$929.48 ","$938.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7191","SUP","Custom 25003010","","ANTIBODY PLAP CLONE 8A9 MS ANHMN .2ML LAB","BOTH IP/OP","$1,018.50 ","$753.69 ","$0.00 ","$1,018.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,018.50 ","$0.00 ","$509.25 ","$806.65 ","$814.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7240","SUP","Custom 25003010","","ANTIBODY KI-67 CLONE MIB-1 MS IGG1 KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,193.03 ","$882.84 ","$0.00 ","$1,193.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,193.03 ","$0.00 ","$596.51 ","$944.88 ","$954.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M7630-1A","SUP","Custom 27203010","","MEDIA CYSL 60 LVISC CLR MOUNT","BOTH IP/OP","$319.08 ","$236.12 ","$0.00 ","$319.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$319.08 ","$0.00 ","$159.54 ","$252.71 ","$255.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275040/10.S","SUP","Custom 27203010","","DRESSING MED SPIRAL FOAM V.A.C. SIMPLACE","BOTH IP/OP","$129.88 ","$96.11 ","$0.00 ","$129.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$129.88 ","$0.00 ","$64.94 ","$102.86 ","$103.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275041/5.S","SUP","HCPCS A6209","","M8275041/5.S  -  KIT DRESSING THK1.75CM MEDIUM 7.5X11.5CM DRAPE PAD CONCTR","BOTH IP/OP","$93.58 ","$69.25 ","$0.00 ","$93.58 ","$50.81 ","$0.00 ","$19.50 ","$0.00 ","$0.00 ","$16.39 ","$93.58 ","$0.00 ","$46.79 ","$74.12 ","$74.86 ","$0.00 ","$14.65 ","$0.00 ","$14.90 ","$0.00 "
"M8275051/10","SUP","HCPCS A6209","","M8275051/10  -  DRSG THK3.3CM SM 10X7.5CM SENSATRAC PAD DRP HDRPHB FLXB OPN","BOTH IP/OP","$80.69 ","$59.71 ","$0.00 ","$80.69 ","$43.81 ","$0.00 ","$16.82 ","$0.00 ","$0.00 ","$14.13 ","$80.69 ","$0.00 ","$40.34 ","$63.91 ","$64.55 ","$0.00 ","$12.63 ","$0.00 ","$12.85 ","$0.00 "
"M8275052/10","SUP","Custom 27203010","","DRESSING THK3.3CM LG 18X12.5CM OPN PORE HDRPHB NEG PRSS KT","BOTH IP/OP","$109.07 ","$80.71 ","$0.00 ","$109.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.07 ","$0.00 ","$54.54 ","$86.38 ","$87.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275052/10.S","SUP","HCPCS A6209","","M8275052/10.S  -  KIT DRESSING THK3.3CM MEDIUM STANDARD 18X12.5CM 2 ADHESIVE","BOTH IP/OP","$99.71 ","$73.79 ","$0.00 ","$99.71 ","$54.14 ","$0.00 ","$20.78 ","$0.00 ","$0.00 ","$17.46 ","$99.71 ","$0.00 ","$49.85 ","$78.97 ","$79.76 ","$0.00 ","$15.60 ","$0.00 ","$15.87 ","$0.00 "
"M8275053/10","SUP","Custom 27203010","","DRESSING THK3.3CM LG VAC GFM WHT 26X15CM HDRPHB KT PU STRL","BOTH IP/OP","$135.28 ","$100.11 ","$0.00 ","$135.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.28 ","$0.00 ","$67.64 ","$107.14 ","$108.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275053/10.S","SUP","HCPCS A6209","","M8275053/10.S  -  KIT VAC GFM DRSG SENSATRAC PAD DRP HDRPHB FLXB OPN PORE PU","BOTH IP/OP","$122.79 ","$90.86 ","$0.00 ","$122.79 ","$66.67 ","$0.00 ","$25.59 ","$0.00 ","$0.00 ","$21.50 ","$122.79 ","$0.00 ","$61.39 ","$97.25 ","$98.23 ","$0.00 ","$19.22 ","$0.00 ","$19.55 ","$0.00 "
"M8275057","SUP","Custom 27203010","","CANISTER WND DRAIN PAD TBG CLMP CONNCTR SENSATRAC STRL LF","BOTH IP/OP","$48.03 ","$35.54 ","$0.00 ","$48.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48.03 ","$0.00 ","$24.01 ","$38.04 ","$38.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275057/10.S","SUP","Custom 27203010","","M8275057/10.S  -  PAD WOUND DRAIN TUBE CLMP CONCTR SENSATRAC VAC STERILE","BOTH IP/OP","$42.59 ","$31.52 ","$0.00 ","$42.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.59 ","$0.00 ","$21.29 ","$33.73 ","$34.07 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275063/10.S","SUP","Custom 27203010","","M8275063/10.S  -  CANISTER WOUND DRAIN C500ML GEL TUBE CLMP CONCTR CHARCOAL","BOTH IP/OP","$82.68 ","$61.18 ","$0.00 ","$82.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$82.68 ","$0.00 ","$41.34 ","$65.48 ","$66.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275065/5","SUP","HCPCS A6209","","M8275065/5  -  DRSG THK1.5CM XL 60X30CM OPN PORE HDRPHB NEG PRSS KIT PU VAC","BOTH IP/OP","$253.80 ","$187.81 ","$0.00 ","$253.80 ","$137.81 ","$0.00 ","$52.90 ","$0.00 ","$0.00 ","$44.44 ","$253.80 ","$0.00 ","$126.90 ","$201.01 ","$203.04 ","$0.00 ","$39.72 ","$0.00 ","$40.40 ","$0.00 "
"M8275080/5","SUP","Custom 27203010","","KCI V.A.C. GRANU FOAM DRESSING ABDOMINAL","BOTH IP/OP","$801.14 ","$592.84 ","$0.00 ","$801.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$801.14 ","$0.00 ","$400.57 ","$634.50 ","$640.91 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275080/5.S","SUP","Custom 27203010","","M8275080/5.S  -  DRSG NADH LYR SENSATRAC PAD TBG PU VAC GFM FOAM ABD","BOTH IP/OP","$793.52 ","$587.20 ","$0.00 ","$793.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$793.52 ","$0.00 ","$396.76 ","$628.47 ","$634.81 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275096/10","SUP","HCPCS A6209","","M8275096/10  -  KIT DRESSING THK3.2CM MEDIUM 18X12.5CM 2 ADHESIVE DRAPE 1","BOTH IP/OP","$140.73 ","$104.14 ","$0.00 ","$140.73 ","$76.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$24.64 ","$140.73 ","$0.00 ","$70.36 ","$111.46 ","$112.58 ","$0.00 ","$22.02 ","$0.00 ","$22.40 ","$0.00 "
"M8275096/10.S","SUP","HCPCS A6209","","M8275096/10.S  -  DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR","BOTH IP/OP","$140.73 ","$104.14 ","$0.00 ","$140.73 ","$76.42 ","$0.00 ","$29.33 ","$0.00 ","$0.00 ","$24.64 ","$140.73 ","$0.00 ","$70.36 ","$111.46 ","$112.58 ","$0.00 ","$22.02 ","$0.00 ","$22.40 ","$0.00 "
"M8275096/5.S","SUP","Custom 27203010","","M8275096/5.S  -  DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR","BOTH IP/OP","$172.74 ","$127.83 ","$0.00 ","$172.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.74 ","$0.00 ","$86.37 ","$136.81 ","$138.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275098/10","SUP","HCPCS A6209","","M8275098/10  -  DRESSING FOAM THK3.3CM SMALL 10X7.5CM SENSATRAC PAD DRAPE","BOTH IP/OP","$112.33 ","$83.12 ","$0.00 ","$112.33 ","$60.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.67 ","$112.33 ","$0.00 ","$56.16 ","$88.97 ","$89.86 ","$0.00 ","$17.58 ","$0.00 ","$17.88 ","$0.00 "
"M8275098/10.S","SUP","HCPCS A6209","","M8275098/10.S  -  DRSG THK3.3CM SM 10X7.5CM SENSATRAC PAD DRP FLXB CNTOUR","BOTH IP/OP","$112.33 ","$83.12 ","$0.00 ","$112.33 ","$60.99 ","$0.00 ","$23.41 ","$0.00 ","$0.00 ","$19.67 ","$112.33 ","$0.00 ","$56.16 ","$88.97 ","$89.86 ","$0.00 ","$17.58 ","$0.00 ","$17.88 ","$0.00 "
"M8275099/10","SUP","HCPCS A6209","","M8275099/10  -  DRESSING FOAM THK3.3CM LARGE 26X15CM ADHESIVE DRAPE","BOTH IP/OP","$170.41 ","$126.10 ","$0.00 ","$170.41 ","$92.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.84 ","$170.41 ","$0.00 ","$85.20 ","$134.96 ","$136.33 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"M8275099/10.S","SUP","HCPCS A6209","","M8275099/10.S  -  DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR","BOTH IP/OP","$170.41 ","$126.10 ","$0.00 ","$170.41 ","$92.53 ","$0.00 ","$35.52 ","$0.00 ","$0.00 ","$29.84 ","$170.41 ","$0.00 ","$85.20 ","$134.96 ","$136.33 ","$0.00 ","$26.67 ","$0.00 ","$27.13 ","$0.00 "
"M8275099/5","SUP","Custom 27203010","","DRESSING THK3.3CM LG VAC GFM SLVR BLK 26X15CM M8275099/5","BOTH IP/OP","$199.48 ","$147.62 ","$0.00 ","$199.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$199.48 ","$0.00 ","$99.74 ","$157.99 ","$159.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8275099/5.S","SUP","Custom 27203010","","M8275099/5.S  -  DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR","BOTH IP/OP","$206.04 ","$152.47 ","$0.00 ","$206.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$206.04 ","$0.00 ","$103.02 ","$163.18 ","$164.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8730","SUP","Custom 27203010","","M8730  -  SUTURE NONABSORBABLE 8-0 BV130-5 18IN 2 ARM MONOFILAMENT","BOTH IP/OP","$202.54 ","$149.88 ","$0.00 ","$205.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.58 ","$0.00 ","$102.79 ","$162.82 ","$164.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8747","SUP","Custom 27203010","","M8747  -  SUTURE PRLN 7-0 BV175-8 24IN MFL DBL ARM BLUE NABSB ETM8747","BOTH IP/OP","$137.60 ","$101.82 ","$0.00 ","$137.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$137.60 ","$0.00 ","$68.80 ","$108.98 ","$110.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"M8805","SUP","Custom 27203010","","SUTURE PRLN 6-0 BV-1 24IN MFL DBL ARM BLUE NABSB ET8805H","BOTH IP/OP","$1,166.83 ","$863.45 ","$0.00 ","$1,166.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,166.83 ","$0.00 ","$583.41 ","$924.13 ","$933.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MA30AC","SUP","HCPCS V2632","","MA30AC  -  LENS IOL 5 D +1 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.100","SUP","HCPCS V2632","","MA30AC.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.105","SUP","HCPCS V2632","","MA30AC.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.110","SUP","HCPCS V2632","","MA30AC.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.115","SUP","HCPCS V2632","","MA30AC.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.120","SUP","HCPCS V2632","","MA30AC.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.125","SUP","HCPCS V2632","","MA30AC.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.130","SUP","HCPCS V2632","","MA30AC.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.135","SUP","HCPCS V2632","","MA30AC.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.140","SUP","HCPCS V2632","","MA30AC.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.145","SUP","HCPCS V2632","","MA30AC.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.150","SUP","HCPCS V2632","","MA30AC.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.155","SUP","HCPCS V2632","","MA30AC.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.160","SUP","HCPCS V2632","","MA30AC.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.165","SUP","HCPCS V2632","","MA30AC.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.170","SUP","HCPCS V2632","","MA30AC.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.175","SUP","HCPCS V2632","","MA30AC.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.180","SUP","HCPCS V2632","","MA30AC.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.185","SUP","HCPCS V2632","","MA30AC.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.190","SUP","HCPCS V2632","","MA30AC.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.195","SUP","HCPCS V2632","","MA30AC.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.200","SUP","HCPCS V2632","","MA30AC.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.205","SUP","HCPCS V2632","","MA30AC.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.210","SUP","HCPCS V2632","","MA30AC.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.215","SUP","HCPCS V2632","","MA30AC.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.220","SUP","HCPCS V2632","","MA30AC.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.225","SUP","HCPCS V2632","","MA30AC.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.230","SUP","HCPCS V2632","","MA30AC.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.235","SUP","HCPCS V2632","","MA30AC.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.240","SUP","HCPCS V2632","","MA30AC.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.245","SUP","HCPCS V2632","","MA30AC.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.250","SUP","HCPCS V2632","","MA30AC.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.255","SUP","HCPCS V2632","","MA30AC.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.260","SUP","HCPCS V2632","","MA30AC.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.265","SUP","HCPCS V2632","","MA30AC.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.270","SUP","HCPCS V2632","","MA30AC.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.275","SUP","HCPCS V2632","","MA30AC.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.280","SUP","HCPCS V2632","","MA30AC.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.285","SUP","HCPCS V2632","","MA30AC.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.290","SUP","HCPCS V2632","","MA30AC.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.295","SUP","HCPCS V2632","","MA30AC.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA30AC.300","SUP","HCPCS V2632","","MA30AC.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM","SUP","HCPCS V2632","","MA50BM  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.060","SUP","HCPCS V2632","","MA50BM.060  -  LENS IOL 10 D +6 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.065","SUP","HCPCS V2632","","MA50BM.065  -  LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.070","SUP","HCPCS V2632","","MA50BM.070  -  LENS IOL 10 D +7 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.075","SUP","HCPCS V2632","","MA50BM.075  -  LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.080","SUP","HCPCS V2632","","MA50BM.080  -  LENS IOL 10 D +8 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.085","SUP","HCPCS V2632","","MA50BM.085  -  LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.090","SUP","HCPCS V2632","","MA50BM.090  -  LENS IOL 10 D +9 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.095","SUP","HCPCS V2632","","MA50BM.095  -  LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.100","SUP","HCPCS V2632","","MA50BM.100  -  LENS IOL 10 D +10 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.105","SUP","HCPCS V2632","","MA50BM.105  -  LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.110","SUP","HCPCS V2632","","MA50BM.110  -  LENS IOL 10 D +11 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.115","SUP","HCPCS V2632","","MA50BM.115  -  LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.120","SUP","HCPCS V2632","","MA50BM.120  -  LENS IOL 10 D +12 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.125","SUP","HCPCS V2632","","MA50BM.125  -  LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.130","SUP","HCPCS V2632","","MA50BM.130  -  LENS IOL 10 D +13 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.135","SUP","HCPCS V2632","","MA50BM.135  -  LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.140","SUP","HCPCS V2632","","MA50BM.140  -  LENS IOL 10 D +14 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.145","SUP","HCPCS V2632","","MA50BM.145  -  LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.150","SUP","HCPCS V2632","","MA50BM.150  -  LENS IOL 10 D +15 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.155","SUP","HCPCS V2632","","MA50BM.155  -  LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.160","SUP","HCPCS V2632","","MA50BM.160  -  LENS IOL 10 D +16 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.165","SUP","HCPCS V2632","","MA50BM.165  -  LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.170","SUP","HCPCS V2632","","MA50BM.170  -  LENS IOL 10 D +17 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.175","SUP","HCPCS V2632","","MA50BM.175  -  LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.180","SUP","HCPCS V2632","","MA50BM.180  -  LENS IOL 10 D +18 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.185","SUP","HCPCS V2632","","MA50BM.185  -  LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.190","SUP","HCPCS V2632","","MA50BM.190  -  LENS IOL 10 D +19 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.195","SUP","HCPCS V2632","","MA50BM.195  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.200","SUP","HCPCS V2632","","MA50BM.200  -  LENS IOL 10 D +20 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.205","SUP","HCPCS V2632","","MA50BM.205  -  LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.210","SUP","HCPCS V2632","","MA50BM.210  -  LENS IOL 10 D +21 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.215","SUP","HCPCS V2632","","MA50BM.215  -  LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.220","SUP","HCPCS V2632","","MA50BM.220  -  LENS IOL 10 D +22 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.225","SUP","HCPCS V2632","","MA50BM.225  -  LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.230","SUP","HCPCS V2632","","MA50BM.230  -  LENS IOL 10 D +23 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.235","SUP","HCPCS V2632","","MA50BM.235  -  LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.240","SUP","HCPCS V2632","","MA50BM.240  -  LENS IOL 10 D +24 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.245","SUP","HCPCS V2632","","MA50BM.245  -  LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.250","SUP","HCPCS V2632","","MA50BM.250  -  LENS IOL 10 D +25 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.255","SUP","HCPCS V2632","","MA50BM.255  -  LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.260","SUP","HCPCS V2632","","MA50BM.260  -  LENS IOL 10 D +26 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.265","SUP","HCPCS V2632","","MA50BM.265  -  LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.270","SUP","HCPCS V2632","","MA50BM.270  -  LENS IOL 10 D +27 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.275","SUP","HCPCS V2632","","MA50BM.275  -  LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.280","SUP","HCPCS V2632","","MA50BM.280  -  LENS IOL 10 D +28 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.285","SUP","HCPCS V2632","","MA50BM.285  -  LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.290","SUP","HCPCS V2632","","MA50BM.290  -  LENS IOL 10 D +29 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.295","SUP","HCPCS V2632","","MA50BM.295  -  LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA50BM.300","SUP","HCPCS V2632","","MA50BM.300  -  LENS IOL 10 D +30 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.060","SUP","HCPCS V2630","","MA60AC.060  -  LENS IOL 10 D +6 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.065","SUP","HCPCS V2632","","MA60AC.065  -  LENS IOL +6.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.070","SUP","HCPCS V2632","","MA60AC.070  -  LENS IOL 10 D +7 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.075","SUP","HCPCS V2632","","MA60AC.075  -  LENS IOL +7.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.080","SUP","HCPCS V2632","","MA60AC.080  -  LENS IOL +8 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.085","SUP","HCPCS V2632","","MA60AC.085  -  LENS IOL 10 D +8.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.090","SUP","HCPCS V2632","","MA60AC.090  -  LENS IOL 10 D +9 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.095","SUP","HCPCS V2632","","MA60AC.095  -  LENS IOL 10 D +9.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.100","SUP","HCPCS V2632","","MA60AC.100  -  LENS IOL +10 DIOP 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.105","SUP","HCPCS V2632","","MA60AC.105  -  LENS IOL +10.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.110","SUP","HCPCS V2632","","MA60AC.110  -  LENS IOL 10 D +11 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.115","SUP","HCPCS V2632","","MA60AC.115  -  LENS IOL +11.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.120","SUP","HCPCS V2632","","MA60AC.120  -  LENS IOL +12 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.125","SUP","HCPCS V2632","","MA60AC.125  -  LENS IOL +12.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.130","SUP","HCPCS V2632","","MA60AC.130  -  LENS IOL 10 D +13 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.135","SUP","HCPCS V2632","","MA60AC.135  -  LENS IOL +13.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.140","SUP","HCPCS V2630","","MA60AC.140  -  LENS IOL 10 D +14 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.145","SUP","HCPCS V2632","","MA60AC.145  -  LENS IOL +14.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.150","SUP","HCPCS V2630","","MA60AC.150  -  LENS IOL 10 D +15 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.155","SUP","HCPCS V2630","","MA60AC.155  -  LENS IOL +15.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.160","SUP","HCPCS V2632","","MA60AC.160  -  LENS IOL 10 D +16 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.165","SUP","HCPCS V2632","","MA60AC.165  -  LENS IOL +16.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.170","SUP","HCPCS V2632","","MA60AC.170  -  LENS IOL 10 D +17 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.175","SUP","HCPCS V2632","","MA60AC.175  -  LENS IOL +17.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.180","SUP","HCPCS V2630","","MA60AC.180  -  LENS IOL 10 D +18 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.185","SUP","HCPCS V2630","","MA60AC.185  -  LENS IOL +18.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.190","SUP","HCPCS V2630","","MA60AC.190  -  LENS IOL 10 D +19 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.195","SUP","HCPCS V2630","","MA60AC.195  -  LENS IOL +19.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.200","SUP","HCPCS V2630","","MA60AC.200  -  LENS IOL 10 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.205","SUP","HCPCS V2630","","MA60AC.205  -  LENS IOL +20.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.210","SUP","HCPCS V2630","","MA60AC.210  -  LENS IOL 10 D +21 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.215","SUP","HCPCS V2630","","MA60AC.215  -  LENS IOL +21.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.220","SUP","HCPCS V2630","","MA60AC.220  -  LENS IOL 10 D +22 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.225","SUP","HCPCS V2630","","MA60AC.225  -  LENS IOL +22.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.230","SUP","HCPCS V2632","","MA60AC.230  -  LENS IOL 10 D +23 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.235","SUP","HCPCS V2632","","MA60AC.235  -  LENS IOL +23.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.240","SUP","HCPCS V2630","","MA60AC.240  -  LENS IOL 10 D +24 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.245","SUP","HCPCS V2632","","MA60AC.245  -  LENS IOL 10 D +24.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.250","SUP","HCPCS V2632","","MA60AC.250  -  LENS IOL 10 D +25 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.255","SUP","HCPCS V2632","","MA60AC.255  -  LENS IOL +25.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.260","SUP","HCPCS V2632","","MA60AC.260  -  LENS IOL +26 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.265","SUP","HCPCS V2632","","MA60AC.265  -  LENS IOL 10 D +26.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.270","SUP","HCPCS V2632","","MA60AC.270  -  LENS IOL +27 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.275","SUP","HCPCS V2632","","MA60AC.275  -  LENS IOL +27.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.280","SUP","HCPCS V2632","","MA60AC.280  -  LENS IOL +28 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.285","SUP","HCPCS V2632","","MA60AC.285  -  LENS IOL +28.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60AC.290","SUP","HCPCS V2632","","MA60AC.290  -  LENS IOL 10 D +29 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.295","SUP","HCPCS V2632","","MA60AC.295  -  LENS IOL 10 D +29.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60AC.300","SUP","HCPCS V2632","","MA60AC.300  -  LENS IOL 10 D +30 DIOPTER BICNVX 6MM 13MM MULTIPIECE","BOTH IP/OP","$372.50 ","$275.65 ","$0.00 ","$372.50 ","$167.63 ","$0.00 ","$77.64 ","$0.00 ","$0.00 ","$65.22 ","$372.50 ","$0.00 ","$186.25 ","$295.02 ","$298.00 ","$0.00 ","$58.30 ","$0.00 ","$59.30 ","$0.00 "
"MA60MA.000","SUP","HCPCS V2632","","MA60MA.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MA.010","SUP","HCPCS V2632","","MA60MA.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MA.030","SUP","HCPCS V2632","","MA60MA.030  -  INTRAOUCLAR LENS MA60MA  3.0D","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MAN010","SUP","HCPCS V2632","","MA60MAN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MAN020","SUP","HCPCS V2632","","MA60MAN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MAN030","SUP","HCPCS V2632","","MA60MAN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MAN040","SUP","HCPCS V2632","","MA60MAN040  -  LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MA60MAN050","SUP","HCPCS V2632","","MA60MAN050  -  LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"MAJ-210","SUP","Custom 27203010","","VALVE BIOP BSCP NOMENCLATURE DISP","BOTH IP/OP","$166.85 ","$123.47 ","$0.00 ","$166.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$166.85 ","$0.00 ","$83.43 ","$132.15 ","$133.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MAL-0002","SUP","Custom 27803010","","MAL-0002  -  EXPANDER OPHTHALMIC 7MM SAVES CONSIDERABLE TIME DISPOSABLE","BOTH IP/OP","$1,937.50 ","$1,433.75 ","$0.00 ","$1,937.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,937.50 ","$0.00 ","$968.75 ","$1,534.50 ","$1,550.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MAP111","SUP","HCPCS C1725","","MAP111  -  VALVE HEMOSTASIS 9FR MAP INSERTION TOOL ACCES-9 METAL","BOTH IP/OP","$33.25 ","$24.61 ","$0.00 ","$33.25 ","$18.05 ","$0.00 ","$6.93 ","$0.00 ","$0.00 ","$5.82 ","$33.25 ","$0.00 ","$16.63 ","$26.33 ","$26.60 ","$0.00 ","$5.20 ","$0.00 ","$5.29 ","$0.00 "
"MAP500","SUP","HCPCS C1769","","MAP500  -  DEVICE TORQUE LATEX FREE PIN VISE SALMON PTFE HYDPHI ACCEPTS","BOTH IP/OP","$0.44 ","$0.33 ","$0.00 ","$0.44 ","$0.24 ","$0.00 ","$0.09 ","$0.00 ","$0.00 ","$0.08 ","$0.44 ","$0.00 ","$0.22 ","$0.35 ","$0.36 ","$0.00 ","$0.07 ","$0.00 ","$0.07 ","$0.00 "
"MAXA","SUP","Custom 27203010","","SENSOR ADLT OXMX OXM ADH STRAP CBL LF DISP 18IN","BOTH IP/OP","$34.93 ","$25.85 ","$0.00 ","$34.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.93 ","$0.00 ","$17.46 ","$27.66 ","$27.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MAXIICRTDMMAM","SUP","HCPCS C1882","","MAXIICRTDMMAM  -  MAXIMO II CRT-D ADVANCED SYSTEM","BOTH IP/OP","$60,500.00 ","$44,770.00 ","$0.00 ","$60,500.00 ","$27,225.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$60,500.00 ","$0.00 ","$30,250.00 ","$47,916.00 ","$48,400.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"MAXIIDRMMEM","SUP","HCPCS C1882","","MAXIIDRMMEM  -  MAXIMO II DR SYSTEM","BOTH IP/OP","$49,812.50 ","$36,861.25 ","$0.00 ","$49,812.50 ","$22,415.63 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$49,812.50 ","$0.00 ","$24,906.25 ","$39,451.50 ","$39,850.00 ","$0.00 ","$7,751.33 ","$0.00 ","$7,930.15 ","$0.00 "
"MAXIIVREMEM","SUP","HCPCS C1882","","MAXIIVREMEM  -  MAXIMO II VR SYSTEM","BOTH IP/OP","$43,750.00 ","$32,375.00 ","$0.00 ","$43,750.00 ","$19,687.50 ","$0.00 ","$9,118.59 ","$0.00 ","$0.00 ","$7,660.28 ","$43,750.00 ","$0.00 ","$21,875.00 ","$34,650.00 ","$35,000.00 ","$0.00 ","$6,846.88 ","$0.00 ","$6,965.00 ","$0.00 "
"MAX-N","SUP","Custom 27203010","","SENSOR NEO 18IN OXM ADH SPO2","BOTH IP/OP","$30.80 ","$22.79 ","$0.00 ","$30.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.80 ","$0.00 ","$15.40 ","$24.39 ","$24.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MAX-P","SUP","Custom 27203010","","SENSOR PED OXMX OXM ADH STRAP CBL LF DISP 18IN","BOTH IP/OP","$34.93 ","$25.85 ","$0.00 ","$34.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$34.93 ","$0.00 ","$17.46 ","$27.66 ","$27.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MAXR","SUP","Custom 27203010","","CABLE SENSOR PULSE OXIMETRY DISPOSABLE ADULT NASAL 18IN  F/O","BOTH IP/OP","$30.80 ","$22.79 ","$0.00 ","$30.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.80 ","$0.00 ","$15.40 ","$24.39 ","$24.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MAXX-1915","SUP","HCPCS C1874","","MAXX-1915  -  STENT ESPH 19MM 24FR 150MM 90CM ENDOMAXX OTW FLLY COVERED","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,458.98 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"MAXX-197","SUP","HCPCS C1874","","MAXX-197  -  STENT ESPH 19MM 24MM 70MM ENDOMAXX FLLY COVERED","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,458.98 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"MAXX-2310","SUP","HCPCS C1874","","MAXX-2310  -  STENT ESOPHAGEAL 23MM 24FR 90CM 100CM FULLY COVERED OTW LP","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,458.98 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"MAXX-237","SUP","HCPCS C1874","","MAXX-237  -  STENT ESPH 28MM 23MM 24FR 70MM 90CM ENDOMAXX OTW FLLY CVR","BOTH IP/OP","$7,000.00 ","$5,180.00 ","$0.00 ","$5,750.00 ","$2,587.50 ","$0.00 ","$1,458.98 ","$0.00 ","$0.00 ","$1,006.78 ","$5,750.00 ","$0.00 ","$2,875.00 ","$4,554.00 ","$4,600.00 ","$0.00 ","$899.88 ","$0.00 ","$915.40 ","$0.00 "
"MB3555","SUP","HCPCS C1713","","MB3555  -  DISC INTVRTB 15MM 15X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"MB3556","SUP","HCPCS C1713","","MB3556  -  DISC INTVRTB 15MM 15X6MM STRL MOBI-C FLT SPHRCL PLT MBL INS","BOTH IP/OP","$13,750.00 ","$10,175.00 ","$0.00 ","$13,750.00 ","$6,187.50 ","$0.00 ","$2,865.84 ","$0.00 ","$0.00 ","$2,407.52 ","$13,750.00 ","$0.00 ","$6,875.00 ","$10,890.00 ","$11,000.00 ","$0.00 ","$2,151.88 ","$0.00 ","$2,189.00 ","$0.00 "
"MB3575","SUP","HCPCS C1713","","MB3575  -  DISC INTVRTB 15MM 17X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"MB3595","SUP","HCPCS C1713","","MB3595  -  DISC INTVRTB 15MM 19X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS","BOTH IP/OP","$11,250.00 ","$8,325.00 ","$0.00 ","$11,250.00 ","$5,062.50 ","$0.00 ","$2,344.78 ","$0.00 ","$0.00 ","$1,969.79 ","$11,250.00 ","$0.00 ","$5,625.00 ","$8,910.00 ","$9,000.00 ","$0.00 ","$1,760.63 ","$0.00 ","$1,791.00 ","$0.00 "
"MB46G","SUP","Custom 27203010","","MB46G  -  SUTURE NONABSORBABLE 5 V-40 30IN 4 STRAND BRAID ETHIBOND","BOTH IP/OP","$45.35 ","$33.56 ","$0.00 ","$46.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46.03 ","$0.00 ","$23.02 ","$36.46 ","$36.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MC*PE28131YB","SUP","HCPCS C1725","","MC*PE28131YB  -  CATH INTVN .021IN 2.8FR .027IN 130CM MCTH HYDPHI PROGREAT","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,350.00 ","$705.90 ","$0.00 ","$291.80 ","$0.00 ","$0.00 ","$236.37 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$211.28 ","$0.00 ","$214.92 ","$0.00 "
"MC011502","SUP","HCPCS C1751","","MC011502  -  CATHETER TRIPLE LUMEN  SIZE 20","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"MC011503","SUP","HCPCS C1751","","MC011503  -  CATHETER CV 24CM 3 LUM","BOTH IP/OP","$287.50 ","$212.75 ","$0.00 ","$287.50 ","$129.38 ","$0.00 ","$59.92 ","$0.00 ","$0.00 ","$50.34 ","$287.50 ","$0.00 ","$143.75 ","$227.70 ","$230.00 ","$0.00 ","$44.99 ","$0.00 ","$45.77 ","$0.00 "
"MC011505","SUP","HCPCS C1750","","MC011505  -  SET CATH 15.5FR 32CM 3 LUM BSC GW DIL SCPL HMDIAL","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"MC061402","SUP","HCPCS C1752","","MC061402  -  SET CATH 14FR 15CM SLX 2 LUM BSC INTRO NDL GW DIL","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MC061404","SUP","HCPCS C1752","","MC061404  -  SET CATH 14FR 24CM SLX 2 LUM BSC INTRO NDL GW DIL","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MC061405","SUP","HCPCS C1751","","MC061405  -  SET CATH 14FR 30CM SLX 2 LUM BSC STY INTRO NDL DIL","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"MC-125","SUP","Custom 27203010","","FILTER BCTR/VIR DISP","BOTH IP/OP","$6.20 ","$4.59 ","$0.00 ","$6.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.20 ","$0.00 ","$3.10 ","$4.91 ","$4.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MC172150SX","SUP","HCPCS C1725","","MC172150SX  -  CATHETER BLNOCC MIC STRG 2.4-1.7FR .017IN 150CM HEADWAY SMTH","BOTH IP/OP","$1,911.55 ","$1,414.55 ","$0.00 ","$1,911.55 ","$1,037.97 ","$0.00 ","$398.41 ","$0.00 ","$0.00 ","$334.70 ","$1,911.55 ","$0.00 ","$955.78 ","$1,513.95 ","$1,529.24 ","$0.00 ","$299.16 ","$0.00 ","$304.32 ","$0.00 "
"MC40BD.100","SUP","HCPCS V2632","","MC40BD.100  -  LENS IOL 5 D +10 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.105","SUP","HCPCS V2632","","MC40BD.105  -  LENS IOL 5 D +10.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.110","SUP","HCPCS V2632","","MC40BD.110  -  LENS IOL 5 D +11 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.115","SUP","HCPCS V2632","","MC40BD.115  -  LENS IOL 5 D +11.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.120","SUP","HCPCS V2632","","MC40BD.120  -  LENS IOL 5 D +12 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.125","SUP","HCPCS V2632","","MC40BD.125  -  LENS IOL 5 D +12.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.130","SUP","HCPCS V2632","","MC40BD.130  -  LENS IOL 5 D +13 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.135","SUP","HCPCS V2632","","MC40BD.135  -  LENS IOL 5 D +13.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.140","SUP","HCPCS V2632","","MC40BD.140  -  LENS IOL 5 D +14 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.145","SUP","HCPCS V2632","","MC40BD.145  -  LENS IOL 5 D +14.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.150","SUP","HCPCS V2632","","MC40BD.150  -  LENS IOL 5 D +15 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.155","SUP","HCPCS V2632","","MC40BD.155  -  LENS IOL 5 D +15.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.160","SUP","HCPCS V2632","","MC40BD.160  -  LENS IOL 5 D +16 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.165","SUP","HCPCS V2632","","MC40BD.165  -  LENS IOL 5 D +16.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.170","SUP","HCPCS V2632","","MC40BD.170  -  LENS IOL 5 D +17 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.175","SUP","HCPCS V2632","","MC40BD.175  -  LENS IOL 5 D +17.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.180","SUP","HCPCS V2632","","MC40BD.180  -  LENS IOL 5 D +18 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.185","SUP","HCPCS V2632","","MC40BD.185  -  LENS IOL 5 D +18.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.190","SUP","HCPCS V2632","","MC40BD.190  -  LENS IOL 5 D +19 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.195","SUP","HCPCS V2632","","MC40BD.195  -  LENS IOL 5 D +19.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.200","SUP","HCPCS V2632","","MC40BD.200  -  LENS IOL 5 D +20 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.205","SUP","HCPCS V2632","","MC40BD.205  -  LENS IOL 5 D +20.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.210","SUP","HCPCS V2632","","MC40BD.210  -  LENS IOL 5 D +21 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.215","SUP","HCPCS V2632","","MC40BD.215  -  LENS IOL 5 D +21.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.220","SUP","HCPCS V2632","","MC40BD.220  -  LENS IOL 5 D +22 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.225","SUP","HCPCS V2632","","MC40BD.225  -  LENS IOL 5 D +22.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.230","SUP","HCPCS V2632","","MC40BD.230  -  LENS IOL 5 D +23 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.235","SUP","HCPCS V2632","","MC40BD.235  -  LENS IOL 5 D +23.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.240","SUP","HCPCS V2632","","MC40BD.240  -  LENS IOL 5 D +24 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.245","SUP","HCPCS V2632","","MC40BD.245  -  LENS IOL 5 D +24.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.250","SUP","HCPCS V2632","","MC40BD.250  -  LENS IOL 5 D +25 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.255","SUP","HCPCS V2632","","MC40BD.255  -  LENS IOL 5 D +25.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.260","SUP","HCPCS V2632","","MC40BD.260  -  LENS IOL 5 D +26 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.265","SUP","HCPCS V2632","","MC40BD.265  -  LENS IOL 5 D +26.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.270","SUP","HCPCS V2632","","MC40BD.270  -  LENS IOL 5 D +27 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.275","SUP","HCPCS V2632","","MC40BD.275  -  LENS IOL 5 D +27.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.280","SUP","HCPCS V2632","","MC40BD.280  -  LENS IOL 5 D +28 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.285","SUP","HCPCS V2632","","MC40BD.285  -  LENS IOL 5 D +28.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.290","SUP","HCPCS V2632","","MC40BD.290  -  LENS IOL 5 D +29 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.295","SUP","HCPCS V2632","","MC40BD.295  -  LENS IOL 5 D +29.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC40BD.300","SUP","HCPCS V2632","","MC40BD.300  -  LENS IOL 5 D +30 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD","SUP","HCPCS V2632","","MC50BD  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.100","SUP","HCPCS V2632","","MC50BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.110","SUP","HCPCS V2632","","MC50BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.120","SUP","HCPCS V2632","","MC50BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.130","SUP","HCPCS V2632","","MC50BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.140","SUP","HCPCS V2632","","MC50BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.150","SUP","HCPCS V2632","","MC50BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.160","SUP","HCPCS V2632","","MC50BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.170","SUP","HCPCS V2632","","MC50BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.180","SUP","HCPCS V2632","","MC50BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.190","SUP","HCPCS V2632","","MC50BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.200","SUP","HCPCS V2632","","MC50BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.210","SUP","HCPCS V2632","","MC50BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.220","SUP","HCPCS V2632","","MC50BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.230","SUP","HCPCS V2632","","MC50BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.240","SUP","HCPCS V2632","","MC50BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.250","SUP","HCPCS V2632","","MC50BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.260","SUP","HCPCS V2632","","MC50BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.270","SUP","HCPCS V2632","","MC50BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.280","SUP","HCPCS V2632","","MC50BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.285","SUP","HCPCS V2632","","MC50BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.290","SUP","HCPCS V2632","","MC50BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC50BD.295","SUP","HCPCS V2632","","MC50BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD","SUP","HCPCS V2632","","MC60BD  -  LENS IOL 5D BCNVX 6MM 13.5MM STRL SLANT 1 PC UV ABS PMMA PC","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.100","SUP","HCPCS V2632","","MC60BD.100  -  LENS IOL 5 D +10 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.105","SUP","HCPCS V2632","","MC60BD.105  -  LENS IOL 5 D +10.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.110","SUP","HCPCS V2632","","MC60BD.110  -  LENS IOL 5 D +11 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.115","SUP","HCPCS V2632","","MC60BD.115  -  LENS IOL 5 D +11.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.120","SUP","HCPCS V2632","","MC60BD.120  -  LENS IOL 5 D +12 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.125","SUP","HCPCS V2632","","MC60BD.125  -  LENS IOL 5 D +12.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.130","SUP","HCPCS V2632","","MC60BD.130  -  LENS IOL 5 D +13 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.135","SUP","HCPCS V2632","","MC60BD.135  -  LENS IOL 5 D +13.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.140","SUP","HCPCS V2632","","MC60BD.140  -  LENS IOL 5 D +14 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.145","SUP","HCPCS V2632","","MC60BD.145  -  LENS IOL 5 D +14.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.150","SUP","HCPCS V2632","","MC60BD.150  -  LENS IOL 5 D +15 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.155","SUP","HCPCS V2632","","MC60BD.155  -  LENS IOL 5 D +15.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.160","SUP","HCPCS V2632","","MC60BD.160  -  LENS IOL 5 D +16 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.165","SUP","HCPCS V2632","","MC60BD.165  -  LENS IOL 5 D +16.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.170","SUP","HCPCS V2632","","MC60BD.170  -  LENS IOL 5 D +17 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.175","SUP","HCPCS V2632","","MC60BD.175  -  LENS IOL 5 D +17.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.180","SUP","HCPCS V2632","","MC60BD.180  -  LENS IOL 5 D +18 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.185","SUP","HCPCS V2632","","MC60BD.185  -  LENS IOL 5 D +18.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.190","SUP","HCPCS V2632","","MC60BD.190  -  LENS IOL 5 D +19 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.195","SUP","HCPCS V2632","","MC60BD.195  -  LENS IOL 5 D +19.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.200","SUP","HCPCS V2632","","MC60BD.200  -  LENS IOL 5 D +20 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.205","SUP","HCPCS V2632","","MC60BD.205  -  LENS IOL 5 D +20.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.210","SUP","HCPCS V2632","","MC60BD.210  -  LENS IOL 5 D +21 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.215","SUP","HCPCS V2632","","MC60BD.215  -  LENS IOL 5 D +21.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.220","SUP","HCPCS V2632","","MC60BD.220  -  LENS IOL 5 D +22 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.225","SUP","HCPCS V2632","","MC60BD.225  -  LENS IOL 5 D +22.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.230","SUP","HCPCS V2632","","MC60BD.230  -  LENS IOL 5 D +23 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.235","SUP","HCPCS V2632","","MC60BD.235  -  LENS IOL 5 D +23.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.240","SUP","HCPCS V2632","","MC60BD.240  -  LENS IOL 5 D +24 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.245","SUP","HCPCS V2632","","MC60BD.245  -  LENS IOL 5 D +24.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.250","SUP","HCPCS V2632","","MC60BD.250  -  LENS IOL 5 D +25 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.255","SUP","HCPCS V2632","","MC60BD.255  -  LENS IOL 5 D +25.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.260","SUP","HCPCS V2632","","MC60BD.260  -  LENS IOL 5 D +26 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.265","SUP","HCPCS V2632","","MC60BD.265  -  LENS IOL 5 D +26.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.270","SUP","HCPCS V2632","","MC60BD.270  -  LENS IOL 5 D +27 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.275","SUP","HCPCS V2632","","MC60BD.275  -  LENS IOL 5 D +27.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.280","SUP","HCPCS V2632","","MC60BD.280  -  LENS IOL 5 D +28 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.285","SUP","HCPCS V2632","","MC60BD.285  -  LENS IOL 5 D +28.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.290","SUP","HCPCS V2632","","MC60BD.290  -  LENS IOL 5 D +29 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.295","SUP","HCPCS V2632","","MC60BD.295  -  LENS IOL 5 D +29.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MC60BD.300","SUP","HCPCS V2632","","MC60BD.300  -  LENS IOL 5 D +30 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MCEN133","SUP","Custom 27203010","","ELEVATOR SURG 11CM 2MM 2.5MM WORMALD BLNT SCT MLBL FRNTL SIN","BOTH IP/OP","$1,332.50 ","$986.05 ","$0.00 ","$1,332.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,332.50 ","$0.00 ","$666.25 ","$1,055.34 ","$1,066.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MCPE28131YB","SUP","HCPCS C1725","","MCPE28131YB  -  CATHETER INTERVENTIONAL MICRO 2.8FR .027IN 130CM MARKER BAND","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,300.00 ","$705.90 ","$0.00 ","$291.80 ","$0.00 ","$0.00 ","$227.62 ","$1,300.00 ","$0.00 ","$650.00 ","$1,029.60 ","$1,040.00 ","$0.00 ","$203.45 ","$0.00 ","$206.96 ","$0.00 "
"MCR-0007","SUP","Custom 27203010","","MCR-0007  -  RETRACTOR SRG STRL MST CPSL RTRCTR","BOTH IP/OP","$283.33 ","$209.66 ","$0.00 ","$283.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$283.33 ","$0.00 ","$141.67 ","$224.40 ","$226.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MCSK3","SUP","Custom 27203010","","HOOK 152MM RTRCT VRT MLBL KNDY","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MCSK5","SUP","Custom 27203010","","TIP SCT MCFR KN 6FR MLBL","BOTH IP/OP","$380.00 ","$281.20 ","$0.00 ","$380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$380.00 ","$0.00 ","$190.00 ","$300.96 ","$304.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MD800F","SUP","HCPCS C1880","","MD800F  -  FILTER CARDIO MRDN VC FEM DLV KIT","BOTH IP/OP","$4,151.00 ","$3,071.74 ","$0.00 ","$4,151.00 ","$1,867.95 ","$0.00 ","$865.17 ","$0.00 ","$0.00 ","$726.81 ","$4,151.00 ","$0.00 ","$2,075.50 ","$3,287.59 ","$3,320.80 ","$0.00 ","$649.63 ","$0.00 ","$660.84 ","$0.00 "
"MD800J","SUP","HCPCS C1880","","MD800J  -  FILTER CARDIO MRDN VC JUG DLV KIT","BOTH IP/OP","$4,151.00 ","$3,071.74 ","$0.00 ","$4,151.00 ","$1,867.95 ","$0.00 ","$865.17 ","$0.00 ","$0.00 ","$726.81 ","$4,151.00 ","$0.00 ","$2,075.50 ","$3,287.59 ","$3,320.80 ","$0.00 ","$649.63 ","$0.00 ","$660.84 ","$0.00 "
"MDRT4101","SUP","HCPCS Q4105","","MDRT4101  -  GRAFT SKIN 10X4IN MESHED DERMAL REGENERATION TEMPLATE BOVINE","BOTH IP/OP","$17,768.95 ","$13,149.02 ","$0.00 ","$20,192.00 ","$9,086.40 ","$0.00 ","$3,703.49 ","$0.00 ","$0.00 ","$25.37 ","$20,192.00 ","$0.00 ","$10,096.00 ","$15,992.06 ","$16,153.60 ","$0.00 ","$24.15 ","$0.00 ","$3,214.57 ","$0.00 "
"MDRT8101","SUP","HCPCS Q4105","","MDRT8101  -  GRAFT SKIN 25X20CM MESH DERMAL REGENERATION TEMPLATE","BOTH IP/OP","$28,137.80 ","$20,821.97 ","$0.00 ","$31,974.78 ","$14,388.65 ","$0.00 ","$5,864.62 ","$0.00 ","$0.00 ","$25.37 ","$31,974.78 ","$0.00 ","$15,987.39 ","$25,324.03 ","$25,579.82 ","$0.00 ","$24.15 ","$0.00 ","$5,090.38 ","$0.00 "
"MH443","SUP","Custom 27011340","","MH443  -  VALVE SCT RED BTN EVIS 140 VID IMG SYS STRL DISP","BOTH IP/OP","$183.78 ","$136.00 ","$0.00 ","$183.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$183.78 ","$0.00 ","$91.89 ","$145.55 ","$147.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MHC1434","SUP","Custom 27203010","","RETAINER TBGRP E 10MR NTR DRSG","BOTH IP/OP","$93.33 ","$69.06 ","$0.00 ","$93.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.33 ","$0.00 ","$46.66 ","$73.92 ","$74.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MHC1439","SUP","Custom 27203010","","RETAINER TBGRP G 10MR NTR DRSG STRL","BOTH IP/OP","$117.60 ","$87.02 ","$0.00 ","$117.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.60 ","$0.00 ","$58.80 ","$93.14 ","$94.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MIS-7F11","SUP","HCPCS C1894","","MIS-7F11  -  SET INTROD .018IN MICRO STR 7FR 21GA 11CM 2.75IN 1 END GWIRE","BOTH IP/OP","$152.50 ","$112.85 ","$0.00 ","$152.50 ","$82.81 ","$0.00 ","$31.78 ","$0.00 ","$0.00 ","$26.70 ","$152.50 ","$0.00 ","$76.25 ","$120.78 ","$122.00 ","$0.00 ","$23.87 ","$0.00 ","$24.28 ","$0.00 "
"MMSLED-42","SUP","HCPCS C1713","","MMSLED-42  -  WIRE FIX 42MM SLED MEDIAL MALLEOLAR","BOTH IP/OP","$1,887.50 ","$1,396.75 ","$0.00 ","$1,887.50 ","$849.38 ","$0.00 ","$393.40 ","$0.00 ","$0.00 ","$330.49 ","$1,887.50 ","$0.00 ","$943.75 ","$1,494.90 ","$1,510.00 ","$0.00 ","$295.39 ","$0.00 ","$300.49 ","$0.00 "
"MMSLEDW","SUP","HCPCS C1713","","MMSLEDW  -  WASHER ORTHOPEDIC SLED MEDIAL MALLEOLAR","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$185.63 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"MN60AC.060","SUP","HCPCS V2632","","MN60AC.060  -  LENS IOL 10 D +6 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.065","SUP","HCPCS V2632","","MN60AC.065  -  LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.075","SUP","HCPCS V2632","","MN60AC.075  -  LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.085","SUP","HCPCS V2632","","MN60AC.085  -  LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.095","SUP","HCPCS V2632","","MN60AC.095  -  LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.100","SUP","HCPCS V2632","","MN60AC.100  -  LENS IOL 10 D +10 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.105","SUP","HCPCS V2632","","MN60AC.105  -  LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.110","SUP","HCPCS V2632","","MN60AC.110  -  LENS IOL 10 D +11 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.115","SUP","HCPCS V2632","","MN60AC.115  -  LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.120","SUP","HCPCS V2632","","MN60AC.120  -  LENS IOL 10 D +12 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.125","SUP","HCPCS V2632","","MN60AC.125  -  LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.130","SUP","HCPCS V2632","","MN60AC.130  -  LENS IOL 10 D +13 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.135","SUP","HCPCS V2632","","MN60AC.135  -  LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.140","SUP","HCPCS V2632","","MN60AC.140  -  LENS IOL 10 D +14 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.145","SUP","HCPCS V2632","","MN60AC.145  -  LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.150","SUP","HCPCS V2632","","MN60AC.150  -  LENS IOL 10 D +15 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.155","SUP","HCPCS V2632","","MN60AC.155  -  LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.160","SUP","HCPCS V2632","","MN60AC.160  -  LENS IOL 10 D +16 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.165","SUP","HCPCS V2632","","MN60AC.165  -  LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.170","SUP","HCPCS V2632","","MN60AC.170  -  LENS IOL 10 D +17 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.175","SUP","HCPCS V2632","","MN60AC.175  -  LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.180","SUP","HCPCS V2632","","MN60AC.180  -  LENS IOL 10 D +18 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.185","SUP","HCPCS V2632","","MN60AC.185  -  LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.190","SUP","HCPCS V2632","","MN60AC.190  -  LENS IOL 10 D +19 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.195","SUP","HCPCS V2632","","MN60AC.195  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.200","SUP","HCPCS V2632","","MN60AC.200  -  LENS IOL 10 D +20 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.205","SUP","HCPCS V2632","","MN60AC.205  -  LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.210","SUP","HCPCS V2632","","MN60AC.210  -  LENS IOL 10 D +21 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.215","SUP","HCPCS V2632","","MN60AC.215  -  LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.220","SUP","HCPCS V2632","","MN60AC.220  -  LENS IOL 10 D +22 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.225","SUP","HCPCS V2632","","MN60AC.225  -  LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.230","SUP","HCPCS V2632","","MN60AC.230  -  LENS IOL 10 D +23 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.235","SUP","HCPCS V2632","","MN60AC.235  -  LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.240","SUP","HCPCS V2632","","MN60AC.240  -  LENS IOL 10 D +24 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.245","SUP","HCPCS V2632","","MN60AC.245  -  LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.250","SUP","HCPCS V2632","","MN60AC.250  -  LENS IOL 10 D +25 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.255","SUP","HCPCS V2632","","MN60AC.255  -  LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.260","SUP","HCPCS V2632","","MN60AC.260  -  LENS IOL 10 D +26 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.265","SUP","HCPCS V2632","","MN60AC.265  -  LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.270","SUP","HCPCS V2632","","MN60AC.270  -  LENS IOL 10 D +27 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.275","SUP","HCPCS V2632","","MN60AC.275  -  LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.280","SUP","HCPCS V2632","","MN60AC.280  -  LENS IOL 10 D +28 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.285","SUP","HCPCS V2632","","MN60AC.285  -  LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.290","SUP","HCPCS V2632","","MN60AC.290  -  LENS IOL 10 D +29 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.295","SUP","HCPCS V2632","","MN60AC.295  -  LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60AC.300","SUP","HCPCS V2632","","MN60AC.300  -  LENS IOL 10 D +30 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MA.000","SUP","HCPCS V2632","","MN60MA.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MA.010","SUP","HCPCS V2632","","MN60MA.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MA.030","SUP","HCPCS V2632","","MN60MA.030  -  LENS IOL 5 D +30 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MA.040","SUP","HCPCS V2632","","MN60MA.040  -  LENS IOL 5 D +4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MA.050","SUP","HCPCS V2632","","MN60MA.050  -  LENS IOL 5 D +5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MAN010","SUP","HCPCS V2632","","MN60MAN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MAN020","SUP","HCPCS V2632","","MN60MAN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MAN030","SUP","HCPCS V2632","","MN60MAN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MAN040","SUP","HCPCS V2632","","MN60MAN040  -  LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MN60MAN050","SUP","HCPCS V2632","","MN60MAN050  -  LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"MPIS-501-NT-SST","SUP","HCPCS C1894","","MPIS-501-NT-SST  -  SET INTROD 40CM 5FR MPNCH .018IN NTNL GWIRE 10CM VLNK STRL","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$47.50 ","$25.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.32 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$7.43 ","$0.00 ","$7.56 ","$0.00 "
"MPQ-2.5","SUP","HCPCS L8603","","MPQ-2.5  -  AGENT BULKING MACROPLASTIQUE SILICONE ELASTOMER 2.5 ML","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MR17035101","SUP","HCPCS C1751","","MR17035101  -  SET CATHETER 5FR 60CM 1 LUMEN PICC BASIC GWIRE INTROD NEEDLE","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"MR17035201","SUP","HCPCS C1751","","MR17035201  -  SET CATHETER 5FR 55CM PICC 2 LUMEN BASIC GWIRE INTROD NEEDLE","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"MRCT15004M","SUP","HCPCS C1750","","MRCT15004M  -  5F MINI ATTACHABLE CATHETER","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"MRDP50ASN","SUP","HCPCS C1750","","MRDP50ASN  -  5F MINI ATTACHABLE CATHETER","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"MRDP66AMN","SUP","HCPCS C1788","","MRDP66AMN  -  6.6F DIGNITY PORT","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"MRN-420","SUP","HCPCS L8606","","MRN-420  -  NEEDLE ESCP 3.8FR MACROPLASTIQUE URTH","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$0.00 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$0.00 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MRPP80AFS","SUP","HCPCS C1751","","MRPP80AFS  -  CATHETER CENTRAL VENOUS PRO-FUSE TRINIFLEX OD8 FR ATTACHABLE","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$225.00 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"MS DC5020","SUP","Custom 27203010","","MS DC5020  -  BIT DRILL 5IN 2MM QRLSE STRL","BOTH IP/OP","$66.30 ","$49.06 ","$0.00 ","$66.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.30 ","$0.00 ","$33.15 ","$52.51 ","$53.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS03","SUP","Custom 27203010","","MS03  -  STOCKINETTE CAST 25YDX3IN WATER REPELLENT 3M SYNTH","BOTH IP/OP","$24.00 ","$17.76 ","$0.00 ","$42.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27.36 ","$0.00 ","$13.68 ","$42.49 ","$21.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-1106ST","SUP","HCPCS C1769","","MS-1106ST  -  WIRE FIX .045IN KWIRE","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$3.65 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"MS-2213","SUP","Custom 27203010","","MS-2213  -  TIP SCRDRVR CRCIFRM","BOTH IP/OP","$470.00 ","$347.80 ","$0.00 ","$470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$470.00 ","$0.00 ","$235.00 ","$372.24 ","$376.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MSC9023Z","SUP","HCPCS A6196","","MSC9023Z  -  DRESSING GRMCDL 3.125X2.375IN LF ARGLS ANMC FLM TRNS IONIC","BOTH IP/OP","$26.69 ","$19.75 ","$0.00 ","$26.69 ","$14.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.67 ","$26.69 ","$0.00 ","$13.35 ","$21.14 ","$21.35 ","$0.00 ","$4.18 ","$0.00 ","$4.25 ","$0.00 "
"MSC97310","SUP","Custom 27203010","","MSC97310  -  DRESSING FOAM 10X3.5IN GENTLE POSTOPERATIVE STRIP","BOTH IP/OP","$58.60 ","$43.36 ","$0.00 ","$58.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.60 ","$0.00 ","$29.30 ","$46.41 ","$46.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MSC9736","SUP","Custom 27203010","","MSC9736  -  DRESSING FOAM 6X3.5IN 7 DAY ADHESIVE ANTIMICROBIAL FLEXIBLE","BOTH IP/OP","$45.48 ","$33.66 ","$0.00 ","$50.59 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.48 ","$0.00 ","$22.74 ","$50.59 ","$36.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-CT21","SUP","Custom 27203010","","MS-CT21  -  TAP 2.1MM SURG","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-CT27","SUP","Custom 27203010","","MS-CT27  -  TAP 2.7MM SURG","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-CTL21","SUP","Custom 27100030","","MS-CTL21  -  TAP 2.7MM LNG BONE TIP SURG ELB ACUMED","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-CTL27","SUP","Custom 27100030","","MS-CTL27  -  TAP 2.7MM LNG BONE TIP SURG ELB ACUMED","BOTH IP/OP","$277.50 ","$205.35 ","$0.00 ","$277.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$277.50 ","$0.00 ","$138.75 ","$219.78 ","$222.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-D761","SUP","Custom 27203010","","MS-D761  -  BIT DRL 6.1MM","BOTH IP/OP","$215.00 ","$159.10 ","$0.00 ","$215.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$215.00 ","$0.00 ","$107.50 ","$170.28 ","$172.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-DC15","SUP","Custom 27203010","","MS-DC15  -  BIT DRL 1.5MM","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MSDC-20","SUP","Custom 27203010","","MSDC-20  -  BIT DRILL 5IN 2MM LNG QRLSE STRL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MS-DC28","SUP","Custom 27203010","","MS-DC28  -  DRILL SRG 2.8MM 5IN QRLSE","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MSDC-35","SUP","Custom 27203010","","MSDC-35  -  BIT DRILL 5IN 3.5MM ACTRK2 ORTH QRLSE STRL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"MTA3U0.185","SUP","HCPCS V2630","","MTA3U0.185  -  LENS IOL +18.5 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.190","SUP","HCPCS V2632","","MTA3U0.190  -  INTRAOCULAR LENS  MTA3U0   19.0D","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.200","SUP","HCPCS V2632","","MTA3U0.200  -  INTRAOUCLAR LENS  MTA3U0  20.0D","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.205","SUP","HCPCS V2630","","MTA3U0.205  -  LENS IOL +20.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.210","SUP","HCPCS V2630","","MTA3U0.210  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.215","SUP","HCPCS V2630","","MTA3U0.215  -  LENS IOL +21.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.220","SUP","HCPCS V2630","","MTA3U0.220  -  LENS IOL +22 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.230","SUP","HCPCS V2630","","MTA3U0.230  -  LENS IOL +23 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.235","SUP","HCPCS V2630","","MTA3U0.235  -  LENS IOL +23.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.240","SUP","HCPCS V2630","","MTA3U0.240  -  LENS IOL +24 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.245","SUP","HCPCS V2630","","MTA3U0.245  -  LENS IOL +24.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.250","SUP","HCPCS V2630","","MTA3U0.250  -  LENS IOL +25 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.255","SUP","HCPCS V2630","","MTA3U0.255  -  LENS IOL +25.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.260","SUP","HCPCS V2630","","MTA3U0.260  -  LENS IOL +26 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.265","SUP","HCPCS V2630","","MTA3U0.265  -  LENS IOL +26.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.270","SUP","HCPCS V2630","","MTA3U0.270  -  LENS IOL +27 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.275","SUP","HCPCS V2630","","MTA3U0.275  -  LENS IOL +27.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.280","SUP","HCPCS V2630","","MTA3U0.280  -  LENS IOL +28 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.285","SUP","HCPCS V2630","","MTA3U0.285  -  LENS IOL +28.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.290","SUP","HCPCS V2630","","MTA3U0.290  -  LENS IOL +29 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.295","SUP","HCPCS V2630","","MTA3U0.295  -  LENS IOL +29.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA3U0.300","SUP","HCPCS V2630","","MTA3U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0","SUP","HCPCS V2630","","MTA4U0  -  LENS IOL +6.5 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.015","SUP","HCPCS V2630","","MTA4U0.015  -  LENS IOL +15 DIOP 13MM 5.5MM ANTER CHAM CNVXPLN 1 PC PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.050","SUP","HCPCS V2630","","MTA4U0.050  -  LENS IOL +5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.055","SUP","HCPCS V2630","","MTA4U0.055  -  LENS IOL +5.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.060","SUP","HCPCS V2630","","MTA4U0.060  -  LENS IOL +6 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.065","SUP","HCPCS V2630","","MTA4U0.065  -  LENS IOL +6.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.070","SUP","HCPCS V2630","","MTA4U0.070  -  LENS IOL +7 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.075","SUP","HCPCS V2630","","MTA4U0.075  -  LENS IOL +7.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.080","SUP","HCPCS V2630","","MTA4U0.080  -  LENS IOL +8 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.085","SUP","HCPCS V2630","","MTA4U0.085  -  LENS IOL +8.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.090","SUP","HCPCS V2630","","MTA4U0.090  -  LENS IOL +9 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.095","SUP","HCPCS V2630","","MTA4U0.095  -  LENS IOL +9.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.100","SUP","HCPCS V2630","","MTA4U0.100  -  LENS IOL +10 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.105","SUP","HCPCS V2630","","MTA4U0.105  -  LENS IOL +10.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.110","SUP","HCPCS V2630","","MTA4U0.110  -  LENS IOL +11 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.115","SUP","HCPCS V2630","","MTA4U0.115  -  LENS IOL +11.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.120","SUP","HCPCS V2630","","MTA4U0.120  -  LENS IOL +12 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.125","SUP","HCPCS V2630","","MTA4U0.125  -  LENS IOL +12.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.130","SUP","HCPCS V2630","","MTA4U0.130  -  LENS IOL +13 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.135","SUP","HCPCS V2630","","MTA4U0.135  -  LENS IOL +13.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.140","SUP","HCPCS V2630","","MTA4U0.140  -  LENS IOL +14 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.145","SUP","HCPCS V2630","","MTA4U0.145  -  LENS IOL +14.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.155","SUP","HCPCS V2630","","MTA4U0.155  -  LENS IOL +15.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.160","SUP","HCPCS V2630","","MTA4U0.160  -  LENS IOL +16 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.165","SUP","HCPCS V2632","","MTA4U0.165  -  INTRAOCULAR LENS  MTA4U0  16.5 D","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.170","SUP","HCPCS V2632","","MTA4U0.170  -  INTRAOCULAR LENS  MTA4UO  17.0D","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.175","SUP","HCPCS V2630","","MTA4U0.175  -  LENS IOL +17.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.180","SUP","HCPCS V2630","","MTA4U0.180  -  LENS IOL +18 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.185","SUP","HCPCS V2630","","MTA4U0.185  -  LENS IOL +18.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.190","SUP","HCPCS V2630","","MTA4U0.190  -  LENS IOL +19 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.195","SUP","HCPCS V2632","","MTA4U0.195  -  INTRAOCULAR LENS  MTA4U0  19.5D","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.200","SUP","HCPCS V2630","","MTA4U0.200  -  LENS IOL +20 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.205","SUP","HCPCS V2632","","MTA4U0.205  -  INTRAOCULAR LENS MTA4U0  20.5D","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.210","SUP","HCPCS V2630","","MTA4U0.210  -  LENS IOL +21 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.215","SUP","HCPCS V2630","","MTA4U0.215  -  LENS IOL +21.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.220","SUP","HCPCS V2630","","MTA4U0.220  -  LENS IOL +22.0 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.225","SUP","HCPCS V2630","","MTA4U0.225  -  LENS IOL +22.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.230","SUP","HCPCS V2630","","MTA4U0.230  -  LENS IOL +23 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.235","SUP","HCPCS V2630","","MTA4U0.235  -  LENS IOL +23.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.240","SUP","HCPCS V2630","","MTA4U0.240  -  LENS IOL +24 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.245","SUP","HCPCS V2630","","MTA4U0.245  -  LENS IOL +24.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.250","SUP","HCPCS V2630","","MTA4U0.250  -  LENS IOL +25 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.255","SUP","HCPCS V2630","","MTA4U0.255  -  LENS IOL +25.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.260","SUP","HCPCS V2630","","MTA4U0.260  -  LENS IOL +26 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.265","SUP","HCPCS V2630","","MTA4U0.265  -  LENS IOL +26.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.270","SUP","HCPCS V2630","","MTA4U0.270  -  LENS IOL +27 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.275","SUP","HCPCS V2630","","MTA4U0.275  -  LENS IOL +27.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.280","SUP","HCPCS V2630","","MTA4U0.280  -  LENS IOL +28 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.285","SUP","HCPCS V2630","","MTA4U0.285  -  LENS IOL +28.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.290","SUP","HCPCS V2630","","MTA4U0.290  -  LENS IOL +29 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA4U0.300","SUP","HCPCS V2630","","MTA4U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN MULTIFLEX","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0","SUP","HCPCS V2630","","MTA5U0  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.050","SUP","HCPCS V2630","","MTA5U0.050  -  LENS IOL +5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.060","SUP","HCPCS V2630","","MTA5U0.060  -  LENS IOL +6 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.070","SUP","HCPCS V2630","","MTA5U0.070  -  LENS IOL +7 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.080","SUP","HCPCS V2630","","MTA5U0.080  -  LENS IOL +8 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.085","SUP","HCPCS V2630","","MTA5U0.085  -  LENS IOL +8.5 DIOP CNVXPLN 13.5MM 5.5MM ANTER CHAM","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.095","SUP","HCPCS V2630","","MTA5U0.095  -  LENS IOL +9.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.100","SUP","HCPCS V2630","","MTA5U0.100  -  LENS IOL +10 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.105","SUP","HCPCS V2630","","MTA5U0.105  -  LENS IOL +10.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.115","SUP","HCPCS V2630","","MTA5U0.115  -  LENS IOL +11.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.125","SUP","HCPCS V2630","","MTA5U0.125  -  LENS IOL +12.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.135","SUP","HCPCS V2630","","MTA5U0.135  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.140","SUP","HCPCS V2630","","MTA5U0.140  -  LENS IOL +14 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.145","SUP","HCPCS V2630","","MTA5U0.145  -  LENS IOL +14.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.150","SUP","HCPCS V2630","","MTA5U0.150  -  LENS IOL +15 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.155","SUP","HCPCS V2630","","MTA5U0.155  -  LENS IOL +15.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.160","SUP","HCPCS V2630","","MTA5U0.160  -  LENS IOL +16 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.165","SUP","HCPCS V2632","","MTA5U0.165  -  LENS IOL +16.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.170","SUP","HCPCS V2630","","MTA5U0.170  -  LENS IOL +17 DIOP 13.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.175","SUP","HCPCS V2630","","MTA5U0.175  -  LENS IOL +17.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.180","SUP","HCPCS V2630","","MTA5U0.180  -  LENS IOL +18 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.185","SUP","HCPCS V2630","","MTA5U0.185  -  LENS IOL +18.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.190","SUP","HCPCS V2630","","MTA5U0.190  -  LENS IOL +19 DIOP 13.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.195","SUP","HCPCS V2630","","MTA5U0.195  -  LENS IOL +19.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.200","SUP","HCPCS V2630","","MTA5U0.200  -  LENS IOL +20 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.210","SUP","HCPCS V2630","","MTA5U0.210  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.215","SUP","HCPCS V2630","","MTA5U0.215  -  LENS IOL +21.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.220","SUP","HCPCS V2630","","MTA5U0.220  -  LENS IOL +22 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.225","SUP","HCPCS V2630","","MTA5U0.225  -  LENS IOL +22.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.230","SUP","HCPCS V2630","","MTA5U0.230  -  LENS IOL +23 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.235","SUP","HCPCS V2630","","MTA5U0.235  -  LENS IOL +23.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.240","SUP","HCPCS V2630","","MTA5U0.240  -  LENS IOL +24 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.250","SUP","HCPCS V2630","","MTA5U0.250  -  LENS IOL +25 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.260","SUP","HCPCS V2630","","MTA5U0.260  -  LENS IOL +26 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.270","SUP","HCPCS V2630","","MTA5U0.270  -  LENS IOL +27 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.280","SUP","HCPCS V2630","","MTA5U0.280  -  LENS IOL +28 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.285","SUP","HCPCS V2630","","MTA5U0.285  -  LENS IOL +28.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.290","SUP","HCPCS V2630","","MTA5U0.290  -  LENS IOL +29 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.295","SUP","HCPCS V2630","","MTA5U0.295  -  LENS IOL +29.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTA5U0.300","SUP","HCPCS V2630","","MTA5U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN","BOTH IP/OP","$212.50 ","$157.25 ","$0.00 ","$212.50 ","$95.63 ","$0.00 ","$44.29 ","$0.00 ","$0.00 ","$37.21 ","$212.50 ","$0.00 ","$106.25 ","$168.30 ","$170.00 ","$0.00 ","$33.26 ","$0.00 ","$33.83 ","$0.00 "
"MTLS-30060-TS","SUP","HCPCS C1713","","MTLS-30060-TS  -  SCREW BN 3MM 6MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTLS-30080-TS","SUP","HCPCS C1713","","MTLS-30080-TS  -  SCREW BN 3MM 8MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTLS-30100-TS","SUP","HCPCS C1713","","MTLS-30100-TS  -  SCREW BN 3MM 10MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTLS-30120-TS","SUP","HCPCS C1713","","MTLS-30120-TS  -  SCREW BN 3MM 12MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTLS-30140-TS","SUP","HCPCS C1713","","MTLS-30140-TS  -  SCREW BN 3MM 14MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTLS-30160-TS","SUP","HCPCS C1713","","MTLS-30160-TS  -  SCREW BN 3MM 16MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTLS-30180-TS","SUP","HCPCS C1713","","MTLS-30180-TS  -  SCREW BN 3MM 18MM NS MULTITHREAD LCK TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30060-TS","SUP","HCPCS C1713","","MTNL-30060-TS  -  SCREW BN 3MM 6MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30080-TS","SUP","HCPCS C1713","","MTNL-30080-TS  -  SCREW BN 3MM 8MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30100-TS","SUP","HCPCS C1713","","MTNL-30100-TS  -  SCREW BN 3MM 10MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30120-TS","SUP","HCPCS C1713","","MTNL-30120-TS  -  SCREW BN 3MM 12MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30140-TS","SUP","HCPCS C1713","","MTNL-30140-TS  -  SCREW BN 3MM 14MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30160-TS","SUP","HCPCS C1713","","MTNL-30160-TS  -  SCREW BN 3MM 16MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTNL-30180-TS","SUP","HCPCS C1713","","MTNL-30180-TS  -  SCREW BN 3MM 18MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"MTP-F010","SUP","Custom 27203010","","MTP-F010  -  REAMER SURG CNCV JNT","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-F012","SUP","Custom 27203010","","MTP-F012  -  REAMER SURG 12MM CNCV MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-F014","SUP","Custom 27203010","","MTP-F014  -  REAMER SRG 14MM CNCV","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-F016","SUP","Custom 27203010","","MTP-F016  -  REAMER SURG 16MM CNCV MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-F020","SUP","Custom 27203010","","MTP-F020  -  REAMER SRG 20MM CNCV","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-F024","SUP","Custom 27203010","","MTP-F024  -  REAMER SURG 24MM CNCV MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-M010","SUP","Custom 27203010","","MTP-M010  -  REAMER SURG 10MM CNVX MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-M012","SUP","Custom 27203010","","MTP-M012  -  REAMER SURG 12MM CNVX MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-M014","SUP","Custom 27203010","","MTP-M014  -  REAMER SURG 14MM CNVX MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-M016","SUP","Custom 27203010","","MTP-M016  -  REAMER SURG 16MM CNVX MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-M020","SUP","Custom 27203010","","MTP-M020  -  REAMER SURG 20MM CNVX MTP FRFT MIDFT LG","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MTP-M024","SUP","Custom 27203010","","MTP-M024  -  REAMER SURG 24MM CNVX MTP","BOTH IP/OP","$1,120.00 ","$828.80 ","$0.00 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.00 ","$0.00 ","$560.00 ","$887.04 ","$896.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MWCE-35-5/3-TORNADO","SUP","Custom 27803010","","MWCE-35-5/3-TORNADO  -  COIL EMBOLIZATION TORNADO .035IN PLATINUM 5-3MM","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MWM4051","SUP","HCPCS C9363","","MWM4051  -  DRESSING BIOLOGICAL 5X4IN MESHED ADHERENT BILAYER MATRIX","BOTH IP/OP","$11,030.65 ","$8,162.68 ","$0.00 ","$12,534.83 ","$5,640.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,194.75 ","$12,534.83 ","$0.00 ","$6,267.41 ","$9,927.59 ","$10,027.86 ","$0.00 ","$1,961.70 ","$0.00 ","$1,995.54 ","$0.00 "
"MX0100","SUP","HCPCS C1782","","MX0100  -  TISSUE MORCELLATOR","BOTH IP/OP","$3,567.27 ","$2,639.78 ","$0.00 ","$3,567.27 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,567.27 ","$0.00 ","$1,783.64 ","$2,825.28 ","$2,853.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MX563","SUP","Custom 27203010","","MX563  -  SUTURE NONABSORBABLE 2-0 SH 30IN 2 ARM 4 STRAND BRAID","BOTH IP/OP","$124.00 ","$91.76 ","$0.00 ","$42.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42.80 ","$0.00 ","$21.40 ","$33.90 ","$34.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"MX6740","SUP","HCPCS C1760","","MX6740  -  DEVICE CLSR BLK GRN 6-7FR MYNX ACE .035IN VASC LCK SYR","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"MZ30BD","SUP","HCPCS V2632","","MZ30BD  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.100","SUP","HCPCS V2632","","MZ30BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.110","SUP","HCPCS V2632","","MZ30BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.120","SUP","HCPCS V2632","","MZ30BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.130","SUP","HCPCS V2632","","MZ30BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.140","SUP","HCPCS V2632","","MZ30BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.150","SUP","HCPCS V2632","","MZ30BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.160","SUP","HCPCS V2632","","MZ30BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.170","SUP","HCPCS V2632","","MZ30BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.180","SUP","HCPCS V2632","","MZ30BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.190","SUP","HCPCS V2632","","MZ30BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.200","SUP","HCPCS V2632","","MZ30BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.210","SUP","HCPCS V2632","","MZ30BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.220","SUP","HCPCS V2632","","MZ30BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.225","SUP","HCPCS V2632","","MZ30BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.235","SUP","HCPCS V2632","","MZ30BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.245","SUP","HCPCS V2632","","MZ30BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.255","SUP","HCPCS V2632","","MZ30BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.265","SUP","HCPCS V2632","","MZ30BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.275","SUP","HCPCS V2632","","MZ30BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.285","SUP","HCPCS V2632","","MZ30BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ30BD.295","SUP","HCPCS V2632","","MZ30BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.100","SUP","HCPCS V2632","","MZ40BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.105","SUP","HCPCS V2632","","MZ40BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.110","SUP","HCPCS V2632","","MZ40BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.115","SUP","HCPCS V2632","","MZ40BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.120","SUP","HCPCS V2632","","MZ40BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.125","SUP","HCPCS V2632","","MZ40BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.130","SUP","HCPCS V2632","","MZ40BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.135","SUP","HCPCS V2632","","MZ40BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.140","SUP","HCPCS V2632","","MZ40BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.145","SUP","HCPCS V2632","","MZ40BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.150","SUP","HCPCS V2632","","MZ40BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.155","SUP","HCPCS V2632","","MZ40BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.160","SUP","HCPCS V2632","","MZ40BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.165","SUP","HCPCS V2632","","MZ40BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.170","SUP","HCPCS V2632","","MZ40BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.175","SUP","HCPCS V2632","","MZ40BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.180","SUP","HCPCS V2632","","MZ40BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.185","SUP","HCPCS V2632","","MZ40BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.190","SUP","HCPCS V2632","","MZ40BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.195","SUP","HCPCS V2632","","MZ40BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.200","SUP","HCPCS V2632","","MZ40BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.205","SUP","HCPCS V2632","","MZ40BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.210","SUP","HCPCS V2632","","MZ40BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.215","SUP","HCPCS V2632","","MZ40BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.220","SUP","HCPCS V2632","","MZ40BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.225","SUP","HCPCS V2632","","MZ40BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.230","SUP","HCPCS V2632","","MZ40BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.235","SUP","HCPCS V2632","","MZ40BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.240","SUP","HCPCS V2632","","MZ40BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.245","SUP","HCPCS V2632","","MZ40BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.250","SUP","HCPCS V2632","","MZ40BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.255","SUP","HCPCS V2632","","MZ40BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.260","SUP","HCPCS V2632","","MZ40BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.265","SUP","HCPCS V2632","","MZ40BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.270","SUP","HCPCS V2632","","MZ40BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.275","SUP","HCPCS V2632","","MZ40BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.280","SUP","HCPCS V2632","","MZ40BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.285","SUP","HCPCS V2632","","MZ40BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.290","SUP","HCPCS V2632","","MZ40BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.295","SUP","HCPCS V2632","","MZ40BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ40BD.300","SUP","HCPCS V2632","","MZ40BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD","SUP","HCPCS V2632","","MZ60BD  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.040","SUP","HCPCS V2632","","MZ60BD.040  -  LENS IOL 5 D +4 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.050","SUP","HCPCS V2632","","MZ60BD.050  -  LENS IOL 5 D +5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.060","SUP","HCPCS V2632","","MZ60BD.060  -  LENS IOL 5 D +6 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.070","SUP","HCPCS V2632","","MZ60BD.070  -  LENS IOL 5 D +7 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.080","SUP","HCPCS V2632","","MZ60BD.080  -  LENS IOL 5 D +8 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.090","SUP","HCPCS V2632","","MZ60BD.090  -  LENS IOL 5 D +9 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.100","SUP","HCPCS V2632","","MZ60BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.110","SUP","HCPCS V2632","","MZ60BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.120","SUP","HCPCS V2632","","MZ60BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.130","SUP","HCPCS V2632","","MZ60BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.140","SUP","HCPCS V2632","","MZ60BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.150","SUP","HCPCS V2632","","MZ60BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.160","SUP","HCPCS V2632","","MZ60BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.170","SUP","HCPCS V2632","","MZ60BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.180","SUP","HCPCS V2632","","MZ60BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.190","SUP","HCPCS V2632","","MZ60BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.200","SUP","HCPCS V2632","","MZ60BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.210","SUP","HCPCS V2632","","MZ60BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.220","SUP","HCPCS V2632","","MZ60BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.230","SUP","HCPCS V2632","","MZ60BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.240","SUP","HCPCS V2632","","MZ60BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.245","SUP","HCPCS V2632","","MZ60BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.250","SUP","HCPCS V2632","","MZ60BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.260","SUP","HCPCS V2632","","MZ60BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.270","SUP","HCPCS V2632","","MZ60BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.280","SUP","HCPCS V2632","","MZ60BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.290","SUP","HCPCS V2632","","MZ60BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.300","SUP","HCPCS V2632","","MZ60BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.320","SUP","HCPCS V2632","","MZ60BD.320  -  LENS IOL 5 D +32 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60BD.340","SUP","HCPCS V2632","","MZ60BD.340  -  LENS IOL 5 D +34 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MD","SUP","HCPCS V2632","","MZ60MD  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MD.000","SUP","HCPCS V2632","","MZ60MD.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MD.010","SUP","HCPCS V2632","","MZ60MD.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MD.020","SUP","HCPCS V2632","","MZ60MD.020  -  LENS IOL 5 D +2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MD.030","SUP","HCPCS V2632","","MZ60MD.030  -  LENS IOL 5 D +3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MDN010","SUP","HCPCS V2632","","MZ60MDN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MDN020","SUP","HCPCS V2632","","MZ60MDN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60MDN030","SUP","HCPCS V2632","","MZ60MDN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN040","SUP","HCPCS V2632","","MZ60PDN040  -  LENS IOL 5 D -4 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN050","SUP","HCPCS V2632","","MZ60PDN050  -  LENS IOL 5 D -5 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN060","SUP","HCPCS V2632","","MZ60PDN060  -  LENS IOL 5 D -6 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN070","SUP","HCPCS V2632","","MZ60PDN070  -  LENS IOL 5 D -7 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN080","SUP","HCPCS V2632","","MZ60PDN080  -  LENS IOL 5 D -8 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN090","SUP","HCPCS V2632","","MZ60PDN090  -  LENS IOL 5 D -9 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"MZ60PDN100","SUP","HCPCS V2632","","MZ60PDN100  -  LENS IOL 5 D -10 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$73.13 ","$0.00 ","$33.87 ","$0.00 ","$0.00 ","$28.45 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$25.43 ","$0.00 ","$25.87 ","$0.00 "
"N103A","SUP","Custom 27203010","","N103A  -  NEEDLE DSCT MIC STRG 3CM LF CO HEAT RST TIP UL SHRP TUNG","BOTH IP/OP","$90.13 ","$66.70 ","$0.00 ","$245.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$245.00 ","$0.00 ","$122.50 ","$194.04 ","$196.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N143001","SUP","HCPCS C1769","","N143001  -  GWIRE VASC 15D .014IN 300CM 5CM INT STY A SHP TIP NTRX NTNL","BOTH IP/OP","$281.67 ","$208.44 ","$0.00 ","$281.67 ","$152.94 ","$0.00 ","$58.71 ","$0.00 ","$0.00 ","$49.32 ","$281.67 ","$0.00 ","$140.83 ","$223.08 ","$225.33 ","$0.00 ","$44.08 ","$0.00 ","$44.84 ","$0.00 "
"N1526","SUP","Custom 25003010","","ANTIBODY DESMIN CLONE D33 MS ANHMN 11ML LAB","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N1580","SUP","Custom 25003010","","ANTIBODY CD3 RBT PLYCLN ANHMN 7ML LAB","BOTH IP/OP","$1,320.00 ","$976.80 ","$0.00 ","$1,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,320.00 ","$0.00 ","$660.00 ","$1,045.44 ","$1,056.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N181805","SUP","HCPCS C1769","","N181805  -  GWIRE ENDSCP .018IN 180CM HPRFR STF ANG TIP FLXB EXC TRQ","BOTH IP/OP","$216.67 ","$160.34 ","$0.00 ","$216.67 ","$117.65 ","$0.00 ","$45.16 ","$0.00 ","$0.00 ","$37.94 ","$216.67 ","$0.00 ","$108.33 ","$171.60 ","$173.33 ","$0.00 ","$33.91 ","$0.00 ","$34.49 ","$0.00 "
"N2031-3","SUP","Custom 27203010","","HOLDER LOOP BRSS INSL HNDL 8IN","BOTH IP/OP","$56.90 ","$42.11 ","$0.00 ","$56.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.90 ","$0.00 ","$28.45 ","$45.06 ","$45.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N7695","SUP","HCPCS A7520","","N7695  -  TUBE ET SYR CK","BOTH IP/OP","$11.13 ","$8.24 ","$0.00 ","$11.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$11.13 ","$0.00 ","$5.56 ","$8.81 ","$8.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N8254","SUP","Custom 27203010","","CANNULA CPAP NEO BN ARWY RDC IRRIT SIL LF DISP 4CM 2.5MM","BOTH IP/OP","$28.25 ","$20.91 ","$0.00 ","$28.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.25 ","$0.00 ","$14.13 ","$22.37 ","$22.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N8304","SUP","Custom 27203010","","CANNULA CPAP NEO BN ARWY RDC IRRIT SIL LF DISP 4CM 3MM","BOTH IP/OP","$28.25 ","$20.91 ","$0.00 ","$28.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.25 ","$0.00 ","$14.13 ","$22.37 ","$22.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NAV2076","SUP","Custom 27203010","","NAV2076  -  BIT DRL 2.9MM STRL VRTX DISP","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$0.00 ","$1,950.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,950.00 ","$0.00 ","$975.00 ","$1,544.40 ","$1,560.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NB5STFLP","SUP","Custom 27203010","","NB5STFLP  -  TROCAR LAPSCOP STANDARD LP 5MM FIX SMOOTH ENTRY DIRECTIONAL","BOTH IP/OP","$50.75 ","$37.56 ","$0.00 ","$50.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$50.75 ","$0.00 ","$25.38 ","$40.19 ","$40.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NC9822012","SUP","Custom 27203010","","KIT FTL CELL STN BLOOD BANK 300 TST","BOTH IP/OP","$505.00 ","$373.70 ","$0.00 ","$505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$505.00 ","$0.00 ","$252.50 ","$399.96 ","$404.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NCSP2009X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP2012X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP2015X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP2021X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP22506X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.25MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP22512X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.25MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP22521X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.25MM 21MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP2506X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.5MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP2509X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.5MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP2512X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.5MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP2515X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP2521X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP2527X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP27506X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.7MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP27509X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.75MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP27512X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.75MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP27515X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.75MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP27521X","SUP","HCPCS C1725","","CATHETER BALDILAT 2.75MM 21MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3006X","SUP","HCPCS C1725","","CATHETER BALDILAT 3MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3009X","SUP","HCPCS C1725","","CATHETER BALDILAT 3MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3012X","SUP","HCPCS C1725","","CATHETER BALDILAT 3MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3015X","SUP","HCPCS C1725","","CATHETER BALDILAT 3MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3021X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP3027X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP32506X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.25MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP32509X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.25MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP32512X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.25MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP32515X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.25MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP32521X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.25MM 21MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3506X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.5MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3509X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.5MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3512X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.5MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3515X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP3521X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP3527X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP37506X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.75MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP37509X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.75MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP37512X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.75MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP37515X","SUP","HCPCS C1725","","CATHETER BALDILAT 3.75MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP37521X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP4006X","SUP","HCPCS C1725","","CATHETER BALDILAT 4MM 6MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP4009X","SUP","HCPCS C1725","","CATHETER BALDILAT 4MM 9MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP4012X","SUP","HCPCS C1725","","CATHETER BALDILAT 4MM 12MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP4015X","SUP","HCPCS C1725","","CATHETER BALDILAT 4MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP4021X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP4027X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP4515X","SUP","HCPCS C1725","","CATHETER BALDILAT 4.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NCSP4521X","SUP","HCPCS C1725","","BALLON SPRINTER NC  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"NCSP5015X","SUP","HCPCS C1725","","CATHETER BALDILAT 5MM 15MM RAPEX NC NC SPNTR ANGIOPLST","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"NL8505061","SUP","Custom 27203010","","NL8505061  -  SHUNT CARDIO 5MM 3.5MM SUNDT CRTD INTNL LOOP CONICAL SPRG","BOTH IP/OP","$1,035.00 ","$765.90 ","$0.00 ","$1,035.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,035.00 ","$0.00 ","$517.50 ","$819.72 ","$828.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL850-5063","SUP","Custom 27803010","","NL850-5063  -  SHUNT CARDIO 10CM 3.5-4MM SUNDT CRTD XTRN NREIN SEG SIL STRL","BOTH IP/OP","$1,120.13 ","$828.90 ","$0.00 ","$1,120.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.13 ","$0.00 ","$560.06 ","$887.14 ","$896.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL8505065","SUP","Custom 27803010","","NL8505065  -  SHUNT CARDIO 10CM 3X4MM SUNDT CRTD INTNL LOOP SFT CONICAL","BOTH IP/OP","$867.78 ","$642.16 ","$0.00 ","$867.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$867.78 ","$0.00 ","$433.89 ","$687.28 ","$694.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL850-5067","SUP","Custom 27803010","","NL850-5067  -  SHUNT CARDIO 10CM 4X5MM SUNDT CRTD INTNL LOOP SFT CONICAL","BOTH IP/OP","$867.78 ","$642.16 ","$0.00 ","$867.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$867.78 ","$0.00 ","$433.89 ","$687.28 ","$694.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL8505070","SUP","Custom 27803010","","NL8505070  -  SHUNT CARDIO 30CM 4X3MM SUNDT CRTD XTRN LOOP SFT CONICAL","BOTH IP/OP","$965.63 ","$714.57 ","$0.00 ","$965.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$965.63 ","$0.00 ","$482.81 ","$764.78 ","$772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL8505071","SUP","Custom 27803010","","NL8505071  -  SHUNT CARDIO 30CM 3X5MM SUNDT CRTD XTRN LOOP SFT CONICAL","BOTH IP/OP","$1,221.03 ","$903.56 ","$0.00 ","$965.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$965.63 ","$0.00 ","$482.81 ","$764.78 ","$772.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL850-5072","SUP","Custom 27803010","","NL850-5072  -  SHUNT CARDIO 30CM 5X4MM SUNDT CRTD XTRN LOOP SFT CONICAL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL850-5076","SUP","Custom 27803010","","NL850-5076  -  SHUNT NS SUNDT CRTD 30CM NREIN XTRN LOOP SIL 4MM 3MM STRL","BOTH IP/OP","$1.00 ","$0.74 ","$0.00 ","$1.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.00 ","$0.00 ","$0.50 ","$0.79 ","$0.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL8505078","SUP","Custom 27803010","","NL8505078  -  SHUNT CARDIO 30CM 4MM 5MM SUNDT CRTD XTRN LOOP NREIN CNTR","BOTH IP/OP","$1,507.68 ","$1,115.68 ","$0.00 ","$1,189.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,189.65 ","$0.00 ","$594.83 ","$942.20 ","$951.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NL865","SUP","Custom 27203010","","NL865  -  BLADE WIRE SAW 12IN ROUND SPIRAL LOOPED END LATEX FREE GIGLI","BOTH IP/OP","$121.50 ","$89.91 ","$0.00 ","$121.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$121.50 ","$0.00 ","$60.75 ","$96.23 ","$97.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NN-8004","SUP","Custom 27011340","","NN-8004  -  HANDPIECE ELECTROSURGICAL 13GA 13CM MYRIAD","BOTH IP/OP","$8,235.00 ","$6,093.90 ","$0.00 ","$7,402.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,402.50 ","$0.00 ","$3,701.25 ","$5,862.78 ","$5,922.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NN-8011","SUP","HCPCS C1894","","NN-8011  -  SHEATH ENDSCP 13.5MM 50MM GROUNDBREAK ACCES TECHNOLOGY","BOTH IP/OP","$5,535.00 ","$4,095.90 ","$0.00 ","$4,975.00 ","$2,701.43 ","$0.00 ","$1,153.63 ","$0.00 ","$0.00 ","$871.08 ","$4,975.00 ","$0.00 ","$2,487.50 ","$3,940.20 ","$3,980.00 ","$0.00 ","$778.59 ","$0.00 ","$792.02 ","$0.00 "
"NN-8012","SUP","HCPCS C1894","","NN-8012  -  SHEATH ENDSCP 13.5MM 60MM GROUNDBREAK ACCES TECHNOLOGY","BOTH IP/OP","$2,767.50 ","$2,047.95 ","$0.00 ","$2,487.50 ","$1,350.71 ","$0.00 ","$576.82 ","$0.00 ","$0.00 ","$435.54 ","$2,487.50 ","$0.00 ","$1,243.75 ","$1,970.10 ","$1,990.00 ","$0.00 ","$389.29 ","$0.00 ","$396.01 ","$0.00 "
"NN-8013","SUP","HCPCS C1894","","NN-8013  -  SHEATH ENDSCP 13.5MM 75MM GROUNDBREAK ACCES TECHNOLOGY","BOTH IP/OP","$5,125.00 ","$3,792.50 ","$0.00 ","$4,975.00 ","$2,701.43 ","$0.00 ","$1,153.63 ","$0.00 ","$0.00 ","$871.08 ","$4,975.00 ","$0.00 ","$2,487.50 ","$3,940.20 ","$3,980.00 ","$0.00 ","$778.59 ","$0.00 ","$792.02 ","$0.00 "
"NN-8016","SUP","Custom 27203010","","NN-8016  -  VALVE MRCLTR .5MM STRL LF NICO MYRIAD INFS MTR LN DISP","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NN-8030","SUP","Custom 27203010","","NN-8030  -  SHEATH ESCP 13.5MM 95MM STRL BRAINPATH ATRM TIP LCK FRST","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$1,243.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,243.75 ","$0.00 ","$621.88 ","$985.05 ","$995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NON28226","SUP","HCPCS C1713","","NON28226  -  CAP BOUF REG LG 24IN FLG LF PR MULTIPLY ELC CLSR LTWT LINT","BOTH IP/OP","$0.22 ","$0.16 ","$0.00 ","$0.22 ","$0.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.04 ","$0.22 ","$0.00 ","$0.11 ","$0.17 ","$0.17 ","$0.00 ","$0.03 ","$0.00 ","$0.03 ","$0.00 "
"NON28234P","SUP","HCPCS C1713","","NON28234P  -  CAP BOUF REG LG 24IN LF PR MULTIPLY ELC CLSR LTWT LINT FR PP","BOTH IP/OP","$150.88 ","$111.65 ","$0.00 ","$434.85 ","$195.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.14 ","$434.85 ","$0.00 ","$217.43 ","$119.50 ","$347.88 ","$0.00 ","$23.61 ","$0.00 ","$69.23 ","$0.00 "
"NONB12STF","SUP","Custom 27203010","","NONB12STF  -  TROCAR LAPSCP STD 12MM STRL VPRT+ FX CNN BLDLS INS TIP TISS","BOTH IP/OP","$68.08 ","$50.38 ","$0.00 ","$68.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$68.08 ","$0.00 ","$34.04 ","$53.92 ","$54.46 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NPAS-100","SUP","HCPCS C1894","","NPAS-100  -  GWIRE VASC .018IN 7FR 22GA 20CM 15CM INTROD NDL NEFF SS PERC","BOTH IP/OP","$170.84 ","$126.42 ","$0.00 ","$170.84 ","$92.76 ","$0.00 ","$35.61 ","$0.00 ","$0.00 ","$29.91 ","$170.84 ","$0.00 ","$85.42 ","$135.31 ","$136.67 ","$0.00 ","$26.74 ","$0.00 ","$27.20 ","$0.00 "
"NR-09903-S","SUP","HCPCS C1894","","INTRODUCER SHTH 9FR 10CM INTGR HMSTS VLV SDPRT TISS DILAT","BOTH IP/OP","$75.38 ","$55.78 ","$0.00 ","$75.38 ","$40.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13.20 ","$75.38 ","$0.00 ","$37.69 ","$59.70 ","$60.30 ","$0.00 ","$11.80 ","$0.00 ","$12.00 ","$0.00 "
"NSLX120L","SUP","Custom 27203010","","NSLX120L  -  SEALER BP 13MM 20CM ENSEAL X1 CRV LG JAW","BOTH IP/OP","$2,180.86 ","$1,613.84 ","$0.00 ","$2,180.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,180.86 ","$0.00 ","$1,090.43 ","$1,727.24 ","$1,744.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NTSE-030115-UDH-MB","SUP","Custom 27203010","","NTSE-030115-UDH-MB  -  XTRT STON 115CM 3FR 1.8CM TPLS MOD BSKT NCRCL NTNL","BOTH IP/OP","$458.25 ","$339.11 ","$0.00 ","$458.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$458.25 ","$0.00 ","$229.13 ","$362.93 ","$366.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"N-VVDC-01-ABRM","SUP","Custom 27803010","","N-VVDC-01-ABRM  -  CATHETER XTRN DRN 3MM 33CM EVM VNTRC","BOTH IP/OP","$144.00 ","$106.56 ","$0.00 ","$144.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$144.00 ","$0.00 ","$72.00 ","$114.05 ","$115.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"NWL214066H","SUP","HCPCS C1785","","NWL214066H  -  PACEMAKER SENSIA DR CARD SEDR01 NWL214066H","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$3,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,488.28 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$1,353.20 ","$0.00 "
"OHOOKR-8","SUP","HCPCS C1713","","OHOOKR-8  -  PLATE BN RT OFST OLCRN HK PLT CORT","BOTH IP/OP","$2,212.50 ","$1,637.25 ","$0.00 ","$2,212.50 ","$995.63 ","$0.00 ","$461.14 ","$0.00 ","$0.00 ","$387.39 ","$2,212.50 ","$0.00 ","$1,106.25 ","$1,752.30 ","$1,770.00 ","$0.00 ","$346.26 ","$0.00 ","$352.23 ","$0.00 "
"OM-10000","SUP","Custom 27203010","","OM-10000  -  STABILIZER SURGICAL ACROBAT I SUCTION POD MALLEABLE FOOT","BOTH IP/OP","$4,092.50 ","$3,028.45 ","$0.00 ","$4,092.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,092.50 ","$0.00 ","$2,046.25 ","$3,241.26 ","$3,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"OMST12BT","SUP","Custom 27203010","","OMST12BT  -  TROCAR LAPSCOP 5-10MM 12MM BLUNT TIP BUILT IN CONVERTER","BOTH IP/OP","$1,089.22 ","$806.02 ","$0.00 ","$1,089.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,089.22 ","$0.00 ","$544.61 ","$862.66 ","$871.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"OMS-T12BT","SUP","Custom 27203010","","OMS-T12BT  -  TROCAR LAPSCOP 12MM SPCMKR BLNT TIP BLN STRL DISP PRPERITN","BOTH IP/OP","$318.05 ","$235.36 ","$0.00 ","$318.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$318.05 ","$0.00 ","$159.03 ","$251.90 ","$254.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"OMST12T","SUP","Custom 27203010","","OMST12T  -  BALLON TIP TROCAR","BOTH IP/OP","$1,645.90 ","$1,217.97 ","$0.00 ","$1,645.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,645.90 ","$0.00 ","$822.95 ","$1,303.55 ","$1,316.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONB12LGF","SUP","Custom 27203010","","ONB12LGF  -  TROCAR LAPSCP LNG 12MM 150MM STRL LF VRSPRT V2 FX CNN BLDLS","BOTH IP/OP","$450.75 ","$333.56 ","$0.00 ","$450.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$450.75 ","$0.00 ","$225.38 ","$356.99 ","$360.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONXACE-19","SUP","Custom 27803010","","ONXACE-19  -  VALVE AOR 19MM ONX","BOTH IP/OP","$14,875.00 ","$11,007.50 ","$0.00 ","$14,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,875.00 ","$0.00 ","$7,437.50 ","$11,781.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONXACE-21","SUP","Custom 27803010","","ONXACE-21  -  VALVE AOR 21MM ONX","BOTH IP/OP","$14,875.00 ","$11,007.50 ","$0.00 ","$14,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,875.00 ","$0.00 ","$7,437.50 ","$11,781.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONXACE-23","SUP","Custom 27803010","","ONXACE-23  -  VALVE AOR 23MM ONX","BOTH IP/OP","$14,875.00 ","$11,007.50 ","$0.00 ","$14,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,875.00 ","$0.00 ","$7,437.50 ","$11,781.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONXACE-25","SUP","Custom 27803010","","ONXACE-25  -  VALVE AOR 23.4MM 25MM 17.4MM ONX CNFRM-X SW RING PROS","BOTH IP/OP","$14,875.00 ","$11,007.50 ","$0.00 ","$14,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,875.00 ","$0.00 ","$7,437.50 ","$11,781.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONXACE-25/33","SUP","Custom 27803010","","ONXACE-25/33  -  ON-X AORTIC VALVE SIZE 25/33","BOTH IP/OP","$14,875.00 ","$11,007.50 ","$0.00 ","$14,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,875.00 ","$0.00 ","$7,437.50 ","$11,781.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ONXACE-27/29","SUP","Custom 27803010","","ONXACE-27/29  -  VALVE AOR 23.4MM 27/29MM 17.4MM ONX CNFRM-X SW RING PROS","BOTH IP/OP","$14,875.00 ","$11,007.50 ","$0.00 ","$14,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,875.00 ","$0.00 ","$7,437.50 ","$11,781.00 ","$11,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"OS-401","SUP","Custom 27804086","","OS-401  -  FILLER BN VOID 4CC","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"OSN-50","SUP","HCPCS C1713","","OSN-50  -  WIRE FX 50MM SLED NTRL OLCRN","BOTH IP/OP","$2,150.00 ","$1,591.00 ","$0.00 ","$2,150.00 ","$967.50 ","$0.00 ","$448.11 ","$0.00 ","$0.00 ","$376.45 ","$2,150.00 ","$0.00 ","$1,075.00 ","$1,702.80 ","$1,720.00 ","$0.00 ","$336.48 ","$0.00 ","$342.28 ","$0.00 "
"OSN-70","SUP","HCPCS C1713","","OSN-70  -  WIRE FIX 70MM SLED NEUTRAL OLECRANON","BOTH IP/OP","$2,412.50 ","$1,785.25 ","$0.00 ","$2,412.50 ","$1,085.63 ","$0.00 ","$502.83 ","$0.00 ","$0.00 ","$422.41 ","$2,412.50 ","$0.00 ","$1,206.25 ","$1,910.70 ","$1,930.00 ","$0.00 ","$377.56 ","$0.00 ","$384.07 ","$0.00 "
"OSW","SUP","HCPCS C1713","","OSW  -  WASHER ORTHOPEDIC LP FIX OLECRANON STERILE","BOTH IP/OP","$687.50 ","$508.75 ","$0.00 ","$687.50 ","$309.38 ","$0.00 ","$143.29 ","$0.00 ","$0.00 ","$120.38 ","$687.50 ","$0.00 ","$343.75 ","$544.50 ","$550.00 ","$0.00 ","$107.59 ","$0.00 ","$109.45 ","$0.00 "
"P100510","SUP","HCPCS C1781","","P100510  -  GRAFT SFT TIS THK1MM 10X5CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$22.05 ","$0.00 ","$10.21 ","$0.00 ","$0.00 ","$8.58 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$7.67 ","$0.00 ","$7.80 ","$0.00 "
"P101010","SUP","HCPCS C9364","","P101010  -  GRAFT SFT TIS THK1MM 10X10CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P101015","SUP","HCPCS C9364","","P101015  -  GRAFT SFT TIS THK1MM 15X10CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$7,500.00 ","$5,550.00 ","$0.00 ","$7,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,500.00 ","$0.00 ","$3,750.00 ","$5,940.00 ","$6,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P101828","SUP","HCPCS C9364","","P101828  -  GRAFT SFT TIS THK1MM 28X18CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$27,720.00 ","$20,512.80 ","$0.00 ","$27,720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$27,720.00 ","$0.00 ","$13,860.00 ","$21,954.24 ","$22,176.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P151015","SUP","HCPCS C9364","","P151015  -  GRAFT SFT TIS THK1.5MM 15X10CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P151020","SUP","HCPCS C9364","","P151020  -  GRAFT SFT TIS THK1.5MM 10X20CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$73.50 ","$54.39 ","$0.00 ","$73.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$73.50 ","$0.00 ","$36.75 ","$58.21 ","$58.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P151520","SUP","HCPCS C9364","","P151520  -  GRAFT SFT TIS THK1.5MM 20X15CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$49.00 ","$36.26 ","$0.00 ","$49.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$49.00 ","$0.00 ","$24.50 ","$38.81 ","$39.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P152030","SUP","HCPCS C9364","","P152030  -  GRAFT SFT TIS THK1.5MM 30X20CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$53.90 ","$39.89 ","$0.00 ","$53.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$53.90 ","$0.00 ","$26.95 ","$42.69 ","$43.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P152040","SUP","HCPCS C9364","","P152040  -  GRAFT SFT TIS THK1.5MM 40X20CM STRL PERMACOL PRCN DRML CLGN","BOTH IP/OP","$43,120.00 ","$31,908.80 ","$0.00 ","$43,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$43,120.00 ","$0.00 ","$21,560.00 ","$34,151.04 ","$34,496.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P224PC8T","SUP","HCPCS C1725","","P224PC8T  -  CATHETER  CENTRAL VENOUS","BOTH IP/OP","$124.88 ","$92.41 ","$0.00 ","$124.88 ","$67.81 ","$0.00 ","$26.03 ","$0.00 ","$0.00 ","$21.86 ","$124.88 ","$0.00 ","$62.44 ","$98.90 ","$99.90 ","$0.00 ","$19.54 ","$0.00 ","$19.88 ","$0.00 "
"P350","SUP","Custom 27203010","","P350  -  PUNCH SURG 3MM SS DRML BIOP RZR SHRP RB HNDL ACPNCH STRL","BOTH IP/OP","$7.56 ","$5.59 ","$0.00 ","$7.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.56 ","$0.00 ","$3.78 ","$5.99 ","$6.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P4676-110","SUP","Custom 27203010","","PIPETTE SERO PLST 10ML GRAD PLG MOLD TIP STRL DISP .1ML","BOTH IP/OP","$33.00 ","$24.42 ","$0.00 ","$33.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$33.00 ","$0.00 ","$16.50 ","$26.14 ","$26.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"P82012001","SUP","HCPCS C1725","","CATHETER  POLAR DILATOR BALLOON 8X20X120","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$814.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"PALS-25100-CC","SUP","HCPCS C1713","","PALS-25100-CC  -  SCREW BN 2.5MM 10MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25120-CC","SUP","HCPCS C1713","","PALS-25120-CC  -  SCREW BN 2.5MM 12MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25140-CC","SUP","HCPCS C1713","","PALS-25140-CC  -  SCREW BN 2.5MM 14MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25160-CC","SUP","HCPCS C1713","","PALS-25160-CC  -  SCREW BN 2.5MM 16MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25180-CC","SUP","HCPCS C1713","","PALS-25180-CC  -  SCREW BN 2.5MM 18MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25200-CC","SUP","HCPCS C1713","","PALS-25200-CC  -  SCREW BN 2.5MM 20MM GEMINUS CNN LCK PA COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25220-CC","SUP","HCPCS C1713","","PALS-25220-CC  -  SCREW BN 2.5MM 22MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25240-CC","SUP","HCPCS C1713","","PALS-25240-CC  -  SCREW BN 2.5MM 24MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25260-CC","SUP","HCPCS C1713","","PALS-25260-CC  -  SCREW BN 2.5MM 26MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25280-CC","SUP","HCPCS C1713","","PALS-25280-CC  -  SCREW BN 2.5MM 28MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PALS-25300-CC","SUP","HCPCS C1713","","PALS-25300-CC  -  SCREW BN 2.5MM 30MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$157.50 ","$0.00 ","$72.95 ","$0.00 ","$0.00 ","$61.28 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$54.78 ","$0.00 ","$55.72 ","$0.00 "
"PANL-35080-TS","SUP","HCPCS C1713","","PANL-35080-TS  -  SCREW BN 3.5MM 8MM NLCKG TI CORT","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35090-TS","SUP","HCPCS C1713","","PANL-35090-TS  -  SCREW BN 3.5MM 9MM NLCKG TI CORT","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35100-TS","SUP","HCPCS C1713","","PANL-35100-TS  -  SCREW BN 3.5MM 10MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"PANL-35110-TS","SUP","HCPCS C1713","","PANL-35110-TS  -  SCREW BN 3.5MM 11MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"PANL-35120-TS","SUP","HCPCS C1713","","PANL-35120-TS  -  SCREW BN 3.5MM 12MM NS GEMINUS PA NLCKG TI CORT DIST VOLR","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35130-TS","SUP","HCPCS C1713","","PANL-35130-TS  -  SCREW BN 3.5MM 13MM NS GEMINUS PA NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35140-TS","SUP","HCPCS C1713","","PANL-35140-TS  -  SCREW BN 3.5MM 14MM NS GEMINUS PA NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35150-TS","SUP","HCPCS C1713","","PANL-35150-TS  -  SCREW BN 3.5MM 15MM NS GEMINUS PA NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35160-TS","SUP","HCPCS C1713","","PANL-35160-TS  -  SCREW BN 3.5MM 16MM NS GEMINUS PA NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35170-TS","SUP","HCPCS C1713","","PANL-35170-TS  -  SCREW BN 3.5MM 17MM NS GEMINUS PA NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PANL-35180-TS","SUP","HCPCS C1713","","PANL-35180-TS  -  SCREW BN 3.5MM 18MM NS GEMINUS PA NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"PAPS1","SUP","Custom 27203010","","PUMP SCT PK","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PC02520OS","SUP","HCPCS C1781","","PC02520OS  -  MESH SURG PARIETEX 10X8IN VNTRL HERN OPN SKRT RECT PLSTR","BOTH IP/OP","$3,925.00 ","$2,904.50 ","$0.00 ","$3,925.00 ","$1,766.25 ","$0.00 ","$818.07 ","$0.00 ","$0.00 ","$687.24 ","$3,925.00 ","$0.00 ","$1,962.50 ","$3,108.60 ","$3,140.00 ","$0.00 ","$614.26 ","$0.00 ","$624.86 ","$0.00 "
"PC1016SN","SUP","HCPCS C1768","","PC1016SN  -  PATCH CARDIO 16X10CM APEX PROCESSING SUPPLE PERI-GUARD","BOTH IP/OP","$1,767.10 ","$1,307.65 ","$0.00 ","$1,767.10 ","$795.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$309.40 ","$1,767.10 ","$0.00 ","$883.55 ","$1,399.54 ","$1,413.68 ","$0.00 ","$276.55 ","$0.00 ","$281.32 ","$0.00 "
"PC-1016SN","SUP","HCPCS C1768","","PC-1016SN  -  PATCH CV 16X10CM SP PRGRD APX PRC BVN PRICRD","BOTH IP/OP","$2,027.50 ","$1,500.35 ","$0.00 ","$1,767.10 ","$795.19 ","$0.00 ","$422.58 ","$0.00 ","$0.00 ","$309.40 ","$1,767.10 ","$0.00 ","$883.55 ","$1,399.54 ","$1,413.68 ","$0.00 ","$276.55 ","$0.00 ","$281.32 ","$0.00 "
"PC111","SUP","Custom 27803010","","PC111  -  LEGEND FN2-DISS TO M-SCHR(UK)","BOTH IP/OP","$405.90 ","$300.37 ","$0.00 ","$405.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$405.90 ","$0.00 ","$202.95 ","$321.47 ","$324.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PCA-15","SUP","HCPCS C1713","","PCA-15  -  LOCKING PLATE, CURVED A, 15-HOLE","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"PCB10","SUP","HCPCS C1713","","PCB10  -  PLATE BN CRV B NS 10 HL LCK","BOTH IP/OP","$2,587.50 ","$1,914.75 ","$0.00 ","$2,587.50 ","$1,164.38 ","$0.00 ","$539.30 ","$0.00 ","$0.00 ","$453.05 ","$2,587.50 ","$0.00 ","$1,293.75 ","$2,049.30 ","$2,070.00 ","$0.00 ","$404.94 ","$0.00 ","$411.93 ","$0.00 "
"PCB15","SUP","HCPCS C1713","","PCB15  -  PLATE BN CRV B NS 15 HL LCK","BOTH IP/OP","$3,375.00 ","$2,497.50 ","$0.00 ","$3,375.00 ","$1,518.75 ","$0.00 ","$703.43 ","$0.00 ","$0.00 ","$590.94 ","$3,375.00 ","$0.00 ","$1,687.50 ","$2,673.00 ","$2,700.00 ","$0.00 ","$528.19 ","$0.00 ","$537.30 ","$0.00 "
"PCDT1","SUP","HCPCS C1781","","PCDT1  -  MESH SRG OVL 13X10IN STRL PRC FLXB TISS SEP LTWT MFL PRLN","BOTH IP/OP","$6,122.25 ","$4,530.47 ","$0.00 ","$6,122.25 ","$2,755.01 ","$0.00 ","$1,276.03 ","$0.00 ","$0.00 ","$1,071.96 ","$6,122.25 ","$0.00 ","$3,061.13 ","$4,848.82 ","$4,897.80 ","$0.00 ","$958.13 ","$0.00 ","$974.66 ","$0.00 "
"PCO12","SUP","HCPCS C1781","","PCO12  -  MESH SRG RND 4.8IN PARIETEX COMP 3D WV RND PLSTR VNTRL HRN","BOTH IP/OP","$1,322.03 ","$978.30 ","$0.00 ","$1,322.03 ","$594.91 ","$0.00 ","$275.54 ","$0.00 ","$0.00 ","$231.48 ","$1,322.03 ","$0.00 ","$661.01 ","$1,047.05 ","$1,057.62 ","$0.00 ","$206.90 ","$0.00 ","$210.47 ","$0.00 "
"PCO12X","SUP","HCPCS C1781","","PCO12X  -  MESH SURG ROUND 12CM 2X4.8IN 2 SIDE OPTIMIZE COMPOSITE LARGE","BOTH IP/OP","$951.10 ","$703.81 ","$0.00 ","$1,207.75 ","$543.49 ","$0.00 ","$198.23 ","$0.00 ","$0.00 ","$211.47 ","$1,207.75 ","$0.00 ","$603.88 ","$956.54 ","$966.20 ","$0.00 ","$189.01 ","$0.00 ","$192.27 ","$0.00 "
"PCO1510OS","SUP","HCPCS C1781","","PCO1510OS  -  MESH SRG RECT 6X4IN PARIETEX RSRB COMP PLSTR VNTRL HRN","BOTH IP/OP","$1,704.65 ","$1,261.44 ","$0.00 ","$1,704.65 ","$767.09 ","$0.00 ","$355.29 ","$0.00 ","$0.00 ","$298.47 ","$1,704.65 ","$0.00 ","$852.33 ","$1,350.08 ","$1,363.72 ","$0.00 ","$266.78 ","$0.00 ","$271.38 ","$0.00 "
"PCO15X","SUP","HCPCS C1781","","PCO15X  -  MESH SURG ROUND 15CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE","BOTH IP/OP","$1,244.88 ","$921.21 ","$0.00 ","$1,580.50 ","$711.23 ","$0.00 ","$259.46 ","$0.00 ","$0.00 ","$276.73 ","$1,580.50 ","$0.00 ","$790.25 ","$1,251.76 ","$1,264.40 ","$0.00 ","$247.35 ","$0.00 ","$251.62 ","$0.00 "
"PCO2015X","SUP","HCPCS C1781","","PCO2015X  -  MESH SURG RECTANGLE OVAL 20X15CM OPTIMIZE COMPOSITE 2 SIDE","BOTH IP/OP","$1,525.73 ","$1,129.04 ","$0.00 ","$1,937.43 ","$871.84 ","$0.00 ","$318.00 ","$0.00 ","$0.00 ","$339.23 ","$1,937.43 ","$0.00 ","$968.71 ","$1,534.44 ","$1,549.94 ","$0.00 ","$303.21 ","$0.00 ","$308.44 ","$0.00 "
"PCO20X","SUP","HCPCS C1781","","PCO20X  -  MESH SURG ROUND 20CM 8IN COMPOSITE OPTIMIZE PROPRIETARY","BOTH IP/OP","$1,830.70 ","$1,354.72 ","$0.00 ","$3,206.15 ","$1,442.77 ","$0.00 ","$381.56 ","$0.00 ","$0.00 ","$561.37 ","$3,206.15 ","$0.00 ","$1,603.08 ","$2,539.27 ","$2,564.92 ","$0.00 ","$501.76 ","$0.00 ","$510.42 ","$0.00 "
"PCO2520OS","SUP","HCPCS C1781","","PCO2520OS  -  MESH SRG RECT RND 10X8IN STRL LF PARIETEX OPN SKRT OPTIMIZE","BOTH IP/OP","$4,387.38 ","$3,246.66 ","$0.00 ","$4,387.38 ","$1,974.32 ","$0.00 ","$914.44 ","$0.00 ","$0.00 ","$768.19 ","$4,387.38 ","$0.00 ","$2,193.69 ","$3,474.80 ","$3,509.90 ","$0.00 ","$686.62 ","$0.00 ","$698.47 ","$0.00 "
"PCO2520X","SUP","HCPCS C1781","","PCO2520X  -  MESH SURG RECTANGLE OVAL 25X20CM 2 SIDE OPTIMIZE COMPOSITE","BOTH IP/OP","$2,318.93 ","$1,716.01 ","$0.00 ","$2,944.65 ","$1,325.09 ","$0.00 ","$483.32 ","$0.00 ","$0.00 ","$515.58 ","$2,944.65 ","$0.00 ","$1,472.33 ","$2,332.16 ","$2,355.72 ","$0.00 ","$460.84 ","$0.00 ","$468.79 ","$0.00 "
"PCO3020","SUP","HCPCS C1781","","PCO3020  -  MESH SRG RECT 12X8IN PARIETEX RSRB COMP SKRT RECT PLSTR","BOTH IP/OP","$4,471.20 ","$3,308.69 ","$0.00 ","$4,471.20 ","$2,012.04 ","$0.00 ","$931.91 ","$0.00 ","$0.00 ","$782.87 ","$4,471.20 ","$0.00 ","$2,235.60 ","$3,541.19 ","$3,576.96 ","$0.00 ","$699.74 ","$0.00 ","$711.82 ","$0.00 "
"PCO3020X","SUP","HCPCS C1781","","PCO3020X  -  MESH SURG RECTANGLE OVAL 30X20CM OPTIMIZE COMPOSITE TEXTILE","BOTH IP/OP","$3,170.33 ","$2,346.04 ","$0.00 ","$4,025.80 ","$1,811.61 ","$0.00 ","$660.77 ","$0.00 ","$0.00 ","$704.89 ","$4,025.80 ","$0.00 ","$2,012.90 ","$3,188.43 ","$3,220.64 ","$0.00 ","$630.04 ","$0.00 ","$640.91 ","$0.00 "
"PCO3728","SUP","HCPCS C1781","","PCO3728  -  MESH SRG RECT 14.5X11IN LF PARIETEX 3D WV RSRB COMP PLSTR","BOTH IP/OP","$5,309.55 ","$3,929.07 ","$0.00 ","$5,309.55 ","$2,389.30 ","$0.00 ","$1,106.64 ","$0.00 ","$0.00 ","$929.66 ","$5,309.55 ","$0.00 ","$2,654.78 ","$4,205.16 ","$4,247.64 ","$0.00 ","$830.94 ","$0.00 ","$845.28 ","$0.00 "
"PCO8OSX","SUP","HCPCS C1781","","PCO8OSX  -  PARIETEX DUAL MESH POLYESTER SKIRTED 8 CM ROUND","BOTH IP/OP","$1,147.35 ","$849.04 ","$0.00 ","$1,147.35 ","$516.31 ","$0.00 ","$239.14 ","$0.00 ","$0.00 ","$200.89 ","$1,147.35 ","$0.00 ","$573.68 ","$908.70 ","$917.88 ","$0.00 ","$179.56 ","$0.00 ","$182.66 ","$0.00 "
"PCO9","SUP","HCPCS C1781","","PCO9  -  MESH SRG RND 3.6IN STRL PARIETEX RND RSRB 3D WV PLSTR VNTRL","BOTH IP/OP","$958.53 ","$709.31 ","$0.00 ","$958.53 ","$431.34 ","$0.00 ","$199.78 ","$0.00 ","$0.00 ","$167.83 ","$958.53 ","$0.00 ","$479.26 ","$759.16 ","$766.82 ","$0.00 ","$150.01 ","$0.00 ","$152.60 ","$0.00 "
"PCO9X","SUP","HCPCS C1781","","PCO9X  -  MESH SURG ROUND 9CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE","BOTH IP/OP","$231.17 ","$171.07 ","$0.00 ","$293.55 ","$132.10 ","$0.00 ","$48.18 ","$0.00 ","$0.00 ","$51.40 ","$293.55 ","$0.00 ","$146.78 ","$232.49 ","$234.84 ","$0.00 ","$45.94 ","$0.00 ","$46.73 ","$0.00 "
"PCP 050 120 130","SUP","HCPCS C1725","","PCP 050 120 130  -  CATHETER BLNDIL 5MM 130CM 120MM PCFC + OTW LOPRFL COAX","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$305.44 ","$0.00 ","$117.24 ","$0.00 ","$0.00 ","$98.49 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$88.03 ","$0.00 ","$89.55 ","$0.00 "
"PD0606","SUP","Custom 27803010","","PD0606  -  PATCH BIOLOGICAL L6 CM X W6 CM W PORCINE DERMIS SOFT TISSUE","BOTH IP/OP","$1,566.00 ","$1,158.84 ","$0.00 ","$1,566.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,566.00 ","$0.00 ","$783.00 ","$1,240.27 ","$1,252.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD0808","SUP","Custom 27803010","","PD0808  -  PATCH BIOLOGICAL L8 CM X W8 CM W PORCINE DERMIS SOFT TISSUE","BOTH IP/OP","$2,784.00 ","$2,060.16 ","$0.00 ","$2,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,784.00 ","$0.00 ","$1,392.00 ","$2,204.93 ","$2,227.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD0822","SUP","Custom 27803010","","PD0822  -  PATCH BIOLOGICAL L22 CM X W8 CM W PORCINE DERMIS SOFT TISSUE","BOTH IP/OP","$7,656.00 ","$5,665.44 ","$0.00 ","$7,656.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,656.00 ","$0.00 ","$3,828.00 ","$6,063.55 ","$6,124.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD1010","SUP","Custom 27803010","","PD1010  -  PATCH BIOLOGICAL L10 CM X W10 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$4,350.00 ","$3,219.00 ","$0.00 ","$4,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,350.00 ","$0.00 ","$2,175.00 ","$3,445.20 ","$3,480.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD1016","SUP","Custom 27803010","","PD1016  -  PATCH BIOLOGICAL L10 CM X W16 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$6,960.00 ","$5,150.40 ","$0.00 ","$6,960.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,960.00 ","$0.00 ","$3,480.00 ","$5,512.32 ","$5,568.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD1025","SUP","Custom 27803010","","PD1025  -  PATCH BIOLOGICAL L10 CM X W25 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$10,875.00 ","$8,047.50 ","$0.00 ","$10,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10,875.00 ","$0.00 ","$5,437.50 ","$8,613.00 ","$8,700.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD1620","SUP","Custom 27803010","","PD1620  -  PATCH BIOLOGICAL L16 CM X W20 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$13,920.00 ","$10,300.80 ","$0.00 ","$13,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$13,920.00 ","$0.00 ","$6,960.00 ","$11,024.64 ","$11,136.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD2020","SUP","Custom 27803010","","PD2020  -  PATCH BIOLOGICAL L20 CM X W20 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$17,400.00 ","$12,876.00 ","$0.00 ","$17,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$17,400.00 ","$0.00 ","$8,700.00 ","$13,780.80 ","$13,920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD2025","SUP","Custom 27803010","","PD2025  -  PATCH BIOLOGICAL L25 CM X W20 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$21,750.00 ","$16,095.00 ","$0.00 ","$21,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21,750.00 ","$0.00 ","$10,875.00 ","$17,226.00 ","$17,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD2035","SUP","Custom 27803010","","PD2035  -  PATCH BIOLOGICAL L35 CM X W20 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$30,450.00 ","$22,533.00 ","$0.00 ","$30,450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30,450.00 ","$0.00 ","$15,225.00 ","$24,116.40 ","$24,360.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD3030","SUP","Custom 27803010","","PD3030  -  PATCH BIOLOGICAL L30 CM X W30 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$39,150.00 ","$28,971.00 ","$0.00 ","$39,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,150.00 ","$0.00 ","$19,575.00 ","$31,006.80 ","$31,320.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PD-31-200","SUP","HCPCS C1713","","PD-31-200  -  CAGE SPNL B STRL DTRAX TI CRV","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"PD-31-201","SUP","HCPCS C1713","","PD-31-201  -  CAVUX CERVICAL CAGE B 5MM","BOTH IP/OP","$4,375.00 ","$3,237.50 ","$0.00 ","$4,375.00 ","$1,968.75 ","$0.00 ","$911.86 ","$0.00 ","$0.00 ","$766.03 ","$4,375.00 ","$0.00 ","$2,187.50 ","$3,465.00 ","$3,500.00 ","$0.00 ","$684.69 ","$0.00 ","$696.50 ","$0.00 "
"PD-32-301","SUP","HCPCS C1713","","PD-32-301  -  DTRAX BONE SCREW","BOTH IP/OP","$1,000.00 ","$740.00 ","$0.00 ","$1,000.00 ","$450.00 ","$0.00 ","$208.43 ","$0.00 ","$0.00 ","$175.09 ","$1,000.00 ","$0.00 ","$500.00 ","$792.00 ","$800.00 ","$0.00 ","$156.50 ","$0.00 ","$159.20 ","$0.00 "
"PD3535","SUP","Custom 27803010","","PD3535  -  PATCH BIOLOGICAL L35 CM X W35 CM W PORCINE DERMIS SOFT TISSU","BOTH IP/OP","$52,925.00 ","$39,164.50 ","$0.00 ","$52,925.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$52,925.00 ","$0.00 ","$26,462.50 ","$41,916.60 ","$42,340.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PDG-AIM-015","SUP","HCPCS C1713","","PDG-AIM-015  -  GUIDE SURG 1.5MM AIMING GEMINUS VOLAR DISTAL RAD","BOTH IP/OP","$75.00 ","$55.50 ","$0.00 ","$75.00 ","$33.75 ","$0.00 ","$15.63 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"PF-20","SUP","HCPCS C1729","","PF-20  -  CATHETER DRN 20FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE","BOTH IP/OP","$968.75 ","$716.88 ","$0.00 ","$968.75 ","$526.03 ","$0.00 ","$201.91 ","$0.00 ","$0.00 ","$169.62 ","$968.75 ","$0.00 ","$484.38 ","$767.25 ","$775.00 ","$0.00 ","$151.61 ","$0.00 ","$154.23 ","$0.00 "
"PF-24","SUP","HCPCS C1729","","PF-24  -  CATHETER DRN 24FR STRL PLEURAFLOW ACT CLRNC TCH CHST TUBE","BOTH IP/OP","$912.50 ","$675.25 ","$0.00 ","$912.50 ","$495.49 ","$0.00 ","$190.19 ","$0.00 ","$0.00 ","$159.77 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$142.81 ","$0.00 ","$145.27 ","$0.00 "
"PF-28","SUP","HCPCS C1729","","PF-28  -  CATHETER DRN 28FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE","BOTH IP/OP","$912.50 ","$675.25 ","$0.00 ","$912.50 ","$495.49 ","$0.00 ","$190.19 ","$0.00 ","$0.00 ","$159.77 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$142.81 ","$0.00 ","$145.27 ","$0.00 "
"PF-32","SUP","HCPCS C1729","","PF-32  -  CATHETER DRN 32FR PLEURAFLOW ACT CLRNC TCH","BOTH IP/OP","$912.50 ","$675.25 ","$0.00 ","$912.50 ","$495.49 ","$0.00 ","$190.19 ","$0.00 ","$0.00 ","$159.77 ","$912.50 ","$0.00 ","$456.25 ","$722.70 ","$730.00 ","$0.00 ","$142.81 ","$0.00 ","$145.27 ","$0.00 "
"PFF0025","SUP","HCPCS C1713","","PFF0025  -  SCREW PFF0025 25MM FACET FIXATION ANCHOR","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$5,940.00 ","$2,673.00 ","$0.00 ","$1,238.04 ","$0.00 ","$0.00 ","$1,040.05 ","$5,940.00 ","$0.00 ","$2,970.00 ","$4,704.48 ","$4,752.00 ","$0.00 ","$929.61 ","$0.00 ","$945.65 ","$0.00 "
"PFF0030","SUP","HCPCS C1713","","PFF0030  -  SCREW PFF0030 30MM FACET FIXATION ANCHOR","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$5,940.00 ","$2,673.00 ","$0.00 ","$1,238.04 ","$0.00 ","$0.00 ","$1,040.05 ","$5,940.00 ","$0.00 ","$2,970.00 ","$4,704.48 ","$4,752.00 ","$0.00 ","$929.61 ","$0.00 ","$945.65 ","$0.00 "
"PFF0035","SUP","HCPCS C1713","","PFF0035  -  SCREW PFF0035 35MM FACET FIXATION ANCHOR","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$5,940.00 ","$2,673.00 ","$0.00 ","$1,238.04 ","$0.00 ","$0.00 ","$1,040.05 ","$5,940.00 ","$0.00 ","$2,970.00 ","$4,704.48 ","$4,752.00 ","$0.00 ","$929.61 ","$0.00 ","$945.65 ","$0.00 "
"PFF0040","SUP","HCPCS C1713","","PFF0040  -  SCREW PFF0040 40MM FACET FIXATION ANCHOR","BOTH IP/OP","$5,940.00 ","$4,395.60 ","$0.00 ","$5,940.00 ","$2,673.00 ","$0.00 ","$1,238.04 ","$0.00 ","$0.00 ","$1,040.05 ","$5,940.00 ","$0.00 ","$2,970.00 ","$4,704.48 ","$4,752.00 ","$0.00 ","$929.61 ","$0.00 ","$945.65 ","$0.00 "
"PGEN00506","SUP","Custom 27203010","","PGEN00506  -  TIP APPLICATOR 6IN SPRAY EXTENDED ERGONOMIC APPLICATOR","BOTH IP/OP","$1,390.00 ","$1,028.60 ","$0.00 ","$850.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$850.00 ","$0.00 ","$425.00 ","$673.20 ","$680.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PGPS002","SUP","Custom 27203010","","PGPS002  -  SEALANT PROGEL PLEURAL AIR LEAK","BOTH IP/OP","$2,453.75 ","$1,815.78 ","$0.00 ","$2,075.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,075.00 ","$0.00 ","$1,037.50 ","$1,643.40 ","$1,660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PHSE6","SUP","HCPCS C1781","","PHSE6  -  MESH HERN POLYPRO 4 15/16INX2 5/32INX.5IN NABSB SFT KNTD","BOTH IP/OP","$1,704.02 ","$1,260.97 ","$0.00 ","$1,704.02 ","$766.81 ","$0.00 ","$355.16 ","$0.00 ","$0.00 ","$298.36 ","$1,704.02 ","$0.00 ","$852.01 ","$1,349.58 ","$1,363.22 ","$0.00 ","$266.68 ","$0.00 ","$271.28 ","$0.00 "
"PHSM","SUP","HCPCS C1781","","PHSM  -  MESH SURG 3IN 3D MEDIUM 2 15/16IN .75IN 3 15/16INX1.75INX.5","BOTH IP/OP","$882.48 ","$653.04 ","$0.00 ","$882.48 ","$397.12 ","$0.00 ","$183.93 ","$0.00 ","$0.00 ","$154.52 ","$882.48 ","$0.00 ","$441.24 ","$698.92 ","$705.99 ","$0.00 ","$138.11 ","$0.00 ","$140.49 ","$0.00 "
"PHSM6","SUP","HCPCS C1781","","PHSM6  -  MESH HERN POLYPRO 3 15/16INX1.75INX.5IN NABSB SFT KNTD PRLN","BOTH IP/OP","$1,704.02 ","$1,260.97 ","$0.00 ","$1,704.02 ","$766.81 ","$0.00 ","$355.16 ","$0.00 ","$0.00 ","$298.36 ","$1,704.02 ","$0.00 ","$852.01 ","$1,349.58 ","$1,363.22 ","$0.00 ","$266.68 ","$0.00 ","$271.28 ","$0.00 "
"PHY1015V","SUP","HCPCS C1781","","PHY1015V  -  MESH SURG 15X10CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP","BOTH IP/OP","$1,856.93 ","$1,374.13 ","$0.00 ","$1,856.93 ","$835.62 ","$0.00 ","$387.03 ","$0.00 ","$0.00 ","$325.13 ","$1,856.93 ","$0.00 ","$928.46 ","$1,470.69 ","$1,485.54 ","$0.00 ","$290.61 ","$0.00 ","$295.62 ","$0.00 "
"PHY1520V","SUP","HCPCS C1781","","PHY1520V  -  MESH SURG 20X15CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP OVAL","BOTH IP/OP","$3,372.53 ","$2,495.67 ","$0.00 ","$3,372.53 ","$1,517.64 ","$0.00 ","$702.92 ","$0.00 ","$0.00 ","$590.50 ","$3,372.53 ","$0.00 ","$1,686.26 ","$2,671.04 ","$2,698.02 ","$0.00 ","$527.80 ","$0.00 ","$536.91 ","$0.00 "
"PHY2025V","SUP","HCPCS C1781","","PHY2025V  -  MESH SURG 25X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP","BOTH IP/OP","$5,461.58 ","$4,041.57 ","$0.00 ","$5,461.58 ","$2,457.71 ","$0.00 ","$1,138.33 ","$0.00 ","$0.00 ","$956.28 ","$5,461.58 ","$0.00 ","$2,730.79 ","$4,325.57 ","$4,369.26 ","$0.00 ","$854.74 ","$0.00 ","$869.48 ","$0.00 "
"PHY2030R","SUP","HCPCS C1781","","PHY2030R  -  MESH SURG 30X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE","BOTH IP/OP","$5,891.08 ","$4,359.40 ","$0.00 ","$5,891.08 ","$2,650.98 ","$0.00 ","$1,227.85 ","$0.00 ","$0.00 ","$1,031.48 ","$5,891.08 ","$0.00 ","$2,945.54 ","$4,665.74 ","$4,712.86 ","$0.00 ","$921.95 ","$0.00 ","$937.86 ","$0.00 "
"PIC-301-IK","SUP","HCPCS C1729","","PIC LINE 3FR","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"PIKA","SUP","Custom 27203010","","PIKA  -  PERCUTANEOUS INSERTION KIT ARTERIAL","BOTH IP/OP","$157.63 ","$116.65 ","$0.00 ","$157.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$157.63 ","$0.00 ","$78.81 ","$124.84 ","$126.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PIKV","SUP","Custom 27203010","","PIKV  -  KIT CATH INS .038IN 18GA 11 SCPL INS NDL SYR GW DIL VN PERC","BOTH IP/OP","$159.99 ","$118.39 ","$0.00 ","$159.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$159.99 ","$0.00 ","$79.99 ","$126.71 ","$127.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PJN1976284","SUP","HCPCS C1898","","PJN1976284  -  LEAD PCMKR 58CM CP NV AV STRD-ELUT SIL BIPOL ACT PJN1976284","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$675.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$262.64 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$234.75 ","$0.00 ","$238.80 ","$0.00 "
"PK-16","SUP","HCPCS V2790","","PK-16  -  GRAFT SFT TIS THK50-100UM 16MM AMNIOGRAFT PROKERA AMNIO","BOTH IP/OP","$2,372.50 ","$1,755.65 ","$0.00 ","$2,237.50 ","$1,006.88 ","$0.00 ","$494.49 ","$0.00 ","$0.00 ","$391.77 ","$2,237.50 ","$0.00 ","$1,118.75 ","$1,772.10 ","$1,790.00 ","$0.00 ","$350.17 ","$0.00 ","$356.21 ","$0.00 "
"PL-2080","SUP","HCPCS C1713","","PL-2080  -  SCREW BN CNTRSNK CO CA","BOTH IP/OP","$352.50 ","$260.85 ","$0.00 ","$352.50 ","$158.63 ","$0.00 ","$73.47 ","$0.00 ","$0.00 ","$61.72 ","$352.50 ","$0.00 ","$176.25 ","$279.18 ","$282.00 ","$0.00 ","$55.17 ","$0.00 ","$56.12 ","$0.00 "
"PLA230300","SUP","Custom 27806190","","PLA230300  -  GRAFT EVAS 23MM 19-21MM 3.3CM AORTA","BOTH IP/OP","$8,932.50 ","$6,610.05 ","$0.00 ","$7,937.50 ","$0.00 ","$0.00 ","$1,861.76 ","$0.00 ","$0.00 ","$0.00 ","$7,937.50 ","$0.00 ","$3,968.75 ","$6,286.50 ","$6,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PLA320400","SUP","HCPCS C1874","","PLA320400  -  GRAFT EVAS 32MM 27-29MM 4.5CM XCLDR STNT XTD ABRSN RST","BOTH IP/OP","$8,932.50 ","$6,610.05 ","$0.00 ","$8,135.00 ","$3,660.75 ","$0.00 ","$1,861.76 ","$0.00 ","$0.00 ","$1,424.37 ","$8,135.00 ","$0.00 ","$4,067.50 ","$6,442.92 ","$6,508.00 ","$0.00 ","$1,273.13 ","$0.00 ","$1,295.09 ","$0.00 "
"PL-BG07","SUP","Custom 27203010","","PL-BG07  -  BIT DRILL 7MM BNGFT HRVT","BOTH IP/OP","$852.50 ","$630.85 ","$0.00 ","$852.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$852.50 ","$0.00 ","$426.25 ","$675.18 ","$682.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-BSWDL","SUP","HCPCS C1713","","PL-BSWDL  -  PLATE BN NS WDG LT 1ST MTP","BOTH IP/OP","$1,592.50 ","$1,178.45 ","$0.00 ","$1,592.50 ","$716.63 ","$0.00 ","$331.92 ","$0.00 ","$0.00 ","$278.83 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$249.23 ","$0.00 ","$253.53 ","$0.00 "
"PL-BSWDR","SUP","HCPCS C1713","","PL-BSWDR  -  PLATE BN NS WDG TI RT MTRSL OSTM","BOTH IP/OP","$1,592.50 ","$1,178.45 ","$0.00 ","$1,592.50 ","$716.63 ","$0.00 ","$331.92 ","$0.00 ","$0.00 ","$278.83 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$249.23 ","$0.00 ","$253.53 ","$0.00 "
"PLC141400","SUP","HCPCS C1874","","PLC141400  -  GRAFT EVAS 14.5MM 12-13.5MM 14CM GORE XCLDR CNTRLT LG AAA","BOTH IP/OP","$12,695.00 ","$9,394.30 ","$0.00 ","$11,557.50 ","$5,200.88 ","$0.00 ","$2,645.96 ","$0.00 ","$0.00 ","$2,023.63 ","$11,557.50 ","$0.00 ","$5,778.75 ","$9,153.54 ","$9,246.00 ","$0.00 ","$1,808.75 ","$0.00 ","$1,839.95 ","$0.00 "
"PLC161000","SUP","HCPCS C1876","","PLC161000  -  GRAFT EVAS 16MM 13.5-14.5MM 9.5CM XCLDR STNT ABRSN RST","BOTH IP/OP","$12,695.00 ","$9,394.30 ","$0.00 ","$11,275.00 ","$5,073.75 ","$0.00 ","$2,645.96 ","$0.00 ","$0.00 ","$1,974.16 ","$11,275.00 ","$0.00 ","$5,637.50 ","$8,929.80 ","$9,020.00 ","$0.00 ","$1,764.54 ","$0.00 ","$1,794.98 ","$0.00 "
"PL-CL6SL","SUP","HCPCS C1713","","PL-CL6SL  -  PLATE SM TI 6 HOLE LCK BONE LEFT CLVCL NONSTRL","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"PL-CL6SR","SUP","HCPCS C1713","","PL-CL6SR  -  PLATE SM 5MM TI 6 HOLE LCK ACUMED BONE RIGHT CLVCL NONSTRL","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"PL-CL8JR","SUP","HCPCS C1713","","PL-CL8JR  -  PLATE TI 8 HOLE J LCK SYS BONE RIGHT CLVCL SHLDR STRL","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"PL-CL8LL","SUP","HCPCS C1713","","PL-CL8LL  -  PLATE LG TI 8 HOLE LCK BONE CLVCL STRL","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"PL-CL8LR","SUP","HCPCS C1713","","PL-CL8LR  -  PLATE LG TI 8 HOLE LCK ACUMED BONE RIGHT CLVCL SHLDR STRL","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"PL-DL26","SUP","HCPCS C1713","","PL-DL26  -  PLATE BN 26MM LT DRSL RADL","BOTH IP/OP","$1,115.00 ","$825.10 ","$0.00 ","$1,115.00 ","$501.75 ","$0.00 ","$232.39 ","$0.00 ","$0.00 ","$195.23 ","$1,115.00 ","$0.00 ","$557.50 ","$883.08 ","$892.00 ","$0.00 ","$174.50 ","$0.00 ","$177.51 ","$0.00 "
"PL-DMTPL","SUP","HCPCS C1713","","PL-DMTPL  -  PLATE TI FSN BONE LEFT DORSAL MTP NONSTRL","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-DMTPR","SUP","HCPCS C1713","","PL-DMTPR  -  PLATE TI BONE RIGHT DORSAL 1ST MTP NONSTRL","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-DR26","SUP","HCPCS C1713","","PL-DR26  -  PLATE BN 26MM NS TI RT DIST DRSL RADL","BOTH IP/OP","$1,115.00 ","$825.10 ","$0.00 ","$1,115.00 ","$501.75 ","$0.00 ","$232.39 ","$0.00 ","$0.00 ","$195.23 ","$1,115.00 ","$0.00 ","$557.50 ","$883.08 ","$892.00 ","$0.00 ","$174.50 ","$0.00 ","$177.51 ","$0.00 "
"PL-DR30L","SUP","HCPCS C1713","","PL-DR30L  -  PLATE BN NAR ACLC RDS LT DIST VOLR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR30R","SUP","HCPCS C1713","","PL-DR30R  -  PLATE BN NAR ACLC RDS RT DIST VOLR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR50L","SUP","HCPCS C1713","","PL-DR50L  -  PLATE BN STD ACLC RDS LT DIST VOLR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR50R","SUP","HCPCS C1713","","PL-DR50R  -  PLATE BN STD ACLC RDS RT DIST VOLR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PLDR60L","SUP","HCPCS C1713","","PLDR60L  -  PLATE LNG STD BONE LEFT DISTAL RADL","BOTH IP/OP","$1,737.50 ","$1,285.75 ","$0.00 ","$1,737.50 ","$781.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$304.22 ","$1,737.50 ","$0.00 ","$868.75 ","$1,376.10 ","$1,390.00 ","$0.00 ","$271.92 ","$0.00 ","$276.61 ","$0.00 "
"PL-DR60L","SUP","HCPCS C1713","","PL-DR60L  -  PLATE LNG 60MM TI 6 HOLE ACLC BONE LEFT DISTAL VOLR RADL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR60R","SUP","HCPCS C1713","","PL-DR60R  -  PLATE BN LNG ACLC RDS RT DIST VOLR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR65L","SUP","HCPCS C1713","","PL-DR65L  -  PLATE XL ACLC BONE LEFT RADL DISTAL WR HND NONSTRL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR65R","SUP","HCPCS C1713","","PL-DR65R  -  PLATE XLNG TI ACLC BONE RIGHT DISTAL RADL WR HND STRL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR70L","SUP","HCPCS C1713","","PL-DR70L  -  PLATE W ACLC BONE LEFT DISTAL RADL WR HND STRL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-DR70R","SUP","HCPCS C1713","","PL-DR70R  -  PLATE BN W ACLC RDS RT DIST VOLR","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PLDS15","SUP","Custom 27203010","","PLDS15  -  STAPLER INTNL ANG RT 15MM STRL LF LDS LNR CUT LKOUT PRELD TI","BOTH IP/OP","$1,015.55 ","$751.51 ","$0.00 ","$1,015.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,015.55 ","$0.00 ","$507.78 ","$804.32 ","$812.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-ELCLL","SUP","HCPCS C1713","","PL-ELCLL  -  PLATE TI XTD BONE LEFT CORONOID NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-ELCLR","SUP","HCPCS C1713","","PL-ELCLR  -  PLATE BN NS XTD LCK TI ELB RT CORONOID","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-ELCOL","SUP","HCPCS C1713","","PL-ELCOL  -  PLATE BN SM NS TI ELB LT CORONOID","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-ELCOR","SUP","HCPCS C1713","","PL-ELCOR  -  PLATE BN NS TI ELB RT CORONOID","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-ELLXL","SUP","HCPCS C1713","","PL-ELLXL  -  PLATE XLNG TI BONE L/L EPCND ELB","BOTH IP/OP","$1,847.35 ","$1,367.04 ","$0.00 ","$1,847.35 ","$831.31 ","$0.00 ","$385.03 ","$0.00 ","$0.00 ","$323.46 ","$1,847.35 ","$0.00 ","$923.68 ","$1,463.10 ","$1,477.88 ","$0.00 ","$289.11 ","$0.00 ","$294.10 ","$0.00 "
"PL-ELPO","SUP","HCPCS C1713","","PL-ELPO  -  PLATE BN POST ELB","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-ELRD","SUP","HCPCS C1713","","PL-ELRD  -  PLATE TI 7 HOLE BONE RADL HEAD NONSTRL","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"PL-ELT1027","SUP","Custom 27100030","","PL-ELT1027  -  TAP 2.7MM 2.7MM QRLSE SURG ELB ACUMED 2MM SCR","BOTH IP/OP","$565.00 ","$418.10 ","$0.00 ","$565.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$565.00 ","$0.00 ","$282.50 ","$447.48 ","$452.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-ELT1035","SUP","HCPCS C1713","","PL-ELT1035  -  PLATE TI 3.5MM SCR TAP BONE 3.5MM ELB NONSTRL DISP","BOTH IP/OP","$565.00 ","$418.10 ","$0.00 ","$565.00 ","$254.25 ","$0.00 ","$117.76 ","$0.00 ","$0.00 ","$98.93 ","$565.00 ","$0.00 ","$282.50 ","$447.48 ","$452.00 ","$0.00 ","$88.42 ","$0.00 ","$89.95 ","$0.00 "
"PL-FIB11","SUP","HCPCS C1713","","PL-FIB11  -  PLATE TI 11 HOLE BONE LAT MLR FIB NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-FIB5","SUP","HCPCS C1713","","PL-FIB5  -  PLATE TI 5 HOLE BONE FIB NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-FIB7","SUP","HCPCS C1713","","PL-FIB7  -  PLATE TI 7 HOLE BONE FIB NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-FIB9","SUP","HCPCS C1713","","PL-FIB9  -  PLATE TI 9 HOLE BONE LAT MLR FIB NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-GLD3","SUP","HCPCS C1713","","PL-GLD3  -  PLATE TI 3 HOLE GLD BONE MLR NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-GLD5","SUP","HCPCS C1713","","PL-GLD5  -  PLATE 5 HOLE GLD BONE","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-GLD7","SUP","HCPCS C1713","","PL-GLD7  -  PLATE TI 7 HOLE GLD BONE MLR NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-LE011","SUP","HCPCS C1713","","PL-LE011  -  PLATE 11 HOLE LCK BONE OLCRN ELB","BOTH IP/OP","$2,125.00 ","$1,572.50 ","$0.00 ","$2,125.00 ","$956.25 ","$0.00 ","$442.90 ","$0.00 ","$0.00 ","$372.07 ","$2,125.00 ","$0.00 ","$1,062.50 ","$1,683.00 ","$1,700.00 ","$0.00 ","$332.56 ","$0.00 ","$338.30 ","$0.00 "
"PL-LE013","SUP","HCPCS C1713","","PL-LE013  -  PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"PL-LE09","SUP","HCPCS C1713","","PL-LE09  -  PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"PL-LEL10L","SUP","HCPCS C1713","","PL-LEL10L  -  PLATE BN 100MM NS 10 HL LCK TI ELB L/L","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL10R","SUP","HCPCS C1713","","PL-LEL10R  -  PLATE BN 100MM NS 10 HL LCK TI ELB RL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL14","SUP","HCPCS C1713","","PL-LEL14  -  PLATE 14 HOLE SYS BONE RL ELB STRL","BOTH IP/OP","$1,875.00 ","$1,387.50 ","$0.00 ","$1,875.00 ","$843.75 ","$0.00 ","$390.80 ","$0.00 ","$0.00 ","$328.30 ","$1,875.00 ","$0.00 ","$937.50 ","$1,485.00 ","$1,500.00 ","$0.00 ","$293.44 ","$0.00 ","$298.50 ","$0.00 "
"PL-LEL14L","SUP","HCPCS C1713","","PL-LEL14L  -  PLATE TI 14 HOLE LCK BONE L/L ELB STRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL14R","SUP","HCPCS C1713","","PL-LEL14R  -  PLATE XLNG TI 14 HOLE BONE RL EPCND NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL20L","SUP","HCPCS C1713","","PL-LEL20L  -  PLATE TI 20 HOLE LCK BONE L/L EPCND NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL20R","SUP","HCPCS C1713","","PL-LEL20R  -  PLATE TI 20 HOLE LCK BONE RL ELB NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL6L","SUP","HCPCS C1713","","PL-LEL6L  -  PLATE TI 6 HOLE LCK BONE L/L ELB NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEL6R","SUP","HCPCS C1713","","PL-LEL6R  -  PLATE TI 6 HOLE LCK BONE RL ELB NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEM12","SUP","HCPCS C1713","","PL-LEM12  -  PLATE TI 12 HOLE LCK ACUMED BONE MDL ELB NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEM16","SUP","HCPCS C1713","","PL-LEM16  -  PLATE BN 16 HL LCK","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEM7","SUP","HCPCS C1713","","PL-LEM7  -  PLATE 84MM TI 7 HOLE LCK ACUMED BONE MDL ELB NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEM8","SUP","HCPCS C1713","","PL-LEM8  -  PLATE 88MM TITANIUIM 8 HOLE LCK BONE MDL ELB NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEM9L","SUP","HCPCS C1713","","PL-LEM9L  -  PLATE LNG TITANIUIM 9 HOLE LCK SYS BONE MDL ELB STRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEM9S","SUP","HCPCS C1713","","PL-LEM9S  -  PLATE SHRT TI 9 HOLE LCK BONE MDL ELB STRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEO11","SUP","HCPCS C1713","","PL-LEO11  -  PLATE BN NS 11 HL LCK PRECONTOUR TI ELB OLCRN","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEO13","SUP","HCPCS C1713","","PL-LEO13  -  PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEO13E","SUP","HCPCS C1713","","PL-LEO13E  -  PLATE BN 13 HL XTD ELB","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LEO17L","SUP","HCPCS C1713","","PL-LEO17L  -  PLATE BN NS 17 HL LCK PRECONTOUR TI ELB LT OLCRN","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$1,153.13 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$448.67 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$401.03 ","$0.00 ","$407.95 ","$0.00 "
"PL-LEO17R","SUP","HCPCS C1713","","PL-LEO17R  -  PLATE BN NS 17 HL LCK PRECONTOUR TI OLCRN RT","BOTH IP/OP","$2,562.50 ","$1,896.25 ","$0.00 ","$2,562.50 ","$1,153.13 ","$0.00 ","$534.09 ","$0.00 ","$0.00 ","$448.67 ","$2,562.50 ","$0.00 ","$1,281.25 ","$2,029.50 ","$2,050.00 ","$0.00 ","$401.03 ","$0.00 ","$407.95 ","$0.00 "
"PL-LEO9","SUP","HCPCS C1713","","PL-LEO9  -  PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL","BOTH IP/OP","$2,252.50 ","$1,666.85 ","$0.00 ","$2,252.50 ","$1,013.63 ","$0.00 ","$469.48 ","$0.00 ","$0.00 ","$394.39 ","$2,252.50 ","$0.00 ","$1,126.25 ","$1,783.98 ","$1,802.00 ","$0.00 ","$352.52 ","$0.00 ","$358.60 ","$0.00 "
"PL-LL8LR","SUP","HCPCS C1713","","PL-LL8LR  -  PLATE LNG 8 HOLE BONE RIGHT CLVCL","BOTH IP/OP","$1,862.50 ","$1,378.25 ","$0.00 ","$1,862.50 ","$838.13 ","$0.00 ","$388.19 ","$0.00 ","$0.00 ","$326.11 ","$1,862.50 ","$0.00 ","$931.25 ","$1,475.10 ","$1,490.00 ","$0.00 ","$291.48 ","$0.00 ","$296.51 ","$0.00 "
"PL-MCPL","SUP","HCPCS C1713","","PL-MCPL  -  PLATE BN RND NS FSN TI 1ST MCP LT","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-MCPR","SUP","HCPCS C1713","","PL-MCPR  -  PLATE TI BONE RIGHT MCP","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-MPJL","SUP","HCPCS C1713","","PL-MPJL  -  PLATE BN NS 4 HL FSN TI 1ST MTP LT","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-MPJR","SUP","HCPCS C1713","","PL-MPJR  -  PLATE SHRT BONE RIGHT MTP","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-MTPL","SUP","HCPCS C1713","","PL-MTPL  -  PLATE TI FSN BONE LEFT 1ST MTP NONSTRL","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-MTPLR","SUP","HCPCS C1713","","PL-MTPLR  -  PLATE BN NS 6 HL REV FSN TI 1ST MTP LT","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-MTPR","SUP","HCPCS C1713","","PL-MTPR  -  PLATE BN NS 4 HL FSN TI 1ST MTP RT","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PL-MTPRR","SUP","HCPCS C1713","","PL-MTPRR  -  PLATE TI FSN BONE RIGHT GRT TOE","BOTH IP/OP","$1,275.00 ","$943.50 ","$0.00 ","$1,275.00 ","$573.75 ","$0.00 ","$265.74 ","$0.00 ","$0.00 ","$223.24 ","$1,275.00 ","$0.00 ","$637.50 ","$1,009.80 ","$1,020.00 ","$0.00 ","$199.54 ","$0.00 ","$202.98 ","$0.00 "
"PLP10342","SUP","HCPCS C1713","","PLP10342  -  PLATE BN 1.3MM NS ANCHORAGE 6 HL LOPRFL PIN FX HL VRSN V1 TI","BOTH IP/OP","$2,760.75 ","$2,042.96 ","$0.00 ","$3,675.75 ","$1,654.09 ","$0.00 ","$575.41 ","$0.00 ","$0.00 ","$643.59 ","$3,675.75 ","$0.00 ","$1,837.88 ","$2,911.19 ","$2,940.60 ","$0.00 ","$575.25 ","$0.00 ","$585.18 ","$0.00 "
"PLP10462","SUP","HCPCS C1713","","PLP10462  -  PLATE BN LNG 1.3MM NS ANCHORAGE 8 HL LOPRFL PIN FX HL VRSN V","BOTH IP/OP","$2,760.75 ","$2,042.96 ","$0.00 ","$3,675.75 ","$1,654.09 ","$0.00 ","$575.41 ","$0.00 ","$0.00 ","$643.59 ","$3,675.75 ","$0.00 ","$1,837.88 ","$2,911.19 ","$2,940.60 ","$0.00 ","$575.25 ","$0.00 ","$585.18 ","$0.00 "
"PLP20342","SUP","HCPCS C1713","","PLP20342  -  PLATE BN 0MM STP 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI","BOTH IP/OP","$2,760.75 ","$2,042.96 ","$0.00 ","$3,675.75 ","$1,654.09 ","$0.00 ","$575.41 ","$0.00 ","$0.00 ","$643.59 ","$3,675.75 ","$0.00 ","$1,837.88 ","$2,911.19 ","$2,940.60 ","$0.00 ","$575.25 ","$0.00 ","$585.18 ","$0.00 "
"PLP30201","SUP","HCPCS C1713","","PLP30201  -  PLATE BN LG 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI LT 3","BOTH IP/OP","$2,760.75 ","$2,042.96 ","$0.00 ","$3,675.75 ","$1,654.09 ","$0.00 ","$575.41 ","$0.00 ","$0.00 ","$643.59 ","$3,675.75 ","$0.00 ","$1,837.88 ","$2,911.19 ","$2,940.60 ","$0.00 ","$575.25 ","$0.00 ","$585.18 ","$0.00 "
"PLP40160","SUP","HCPCS C1713","","PLP40160  -  PLATE BN STRG 16MMX1.5MM NS ANCHORAGE 2 HL LOPRFL UTL SMTR","BOTH IP/OP","$2,300.63 ","$1,702.47 ","$0.00 ","$3,061.50 ","$1,377.68 ","$0.00 ","$479.51 ","$0.00 ","$0.00 ","$536.04 ","$3,061.50 ","$0.00 ","$1,530.75 ","$2,424.71 ","$2,449.20 ","$0.00 ","$479.12 ","$0.00 ","$487.39 ","$0.00 "
"PLP40220","SUP","HCPCS C1713","","PLP40220  -  PLATE BN STRG 22MMX1.5MM NS ANCHORAGE 3 HL LOPRFL UTL SMTR","BOTH IP/OP","$2,300.63 ","$1,702.47 ","$0.00 ","$3,061.50 ","$1,377.68 ","$0.00 ","$479.51 ","$0.00 ","$0.00 ","$536.04 ","$3,061.50 ","$0.00 ","$1,530.75 ","$2,424.71 ","$2,449.20 ","$0.00 ","$479.12 ","$0.00 ","$487.39 ","$0.00 "
"PL-PHGL","SUP","HCPCS C1713","","PL-PHGL  -  PLATE LG TI PLRS BONE LEFT PROX HUM NONSTRL","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"PL-PHGR","SUP","HCPCS C1713","","PL-PHGR  -  PLATE BN LG HUM RT","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"PL-PHSL","SUP","HCPCS C1713","","PL-PHSL  -  PLATE BN SM HUM LT PROX","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"PL-PHSR","SUP","HCPCS C1713","","PL-PHSR  -  PLATE SM TI PLRS BONE RIGHT PROX HUM NONSTRL","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"PL-PHXGL","SUP","HCPCS C1713","","PL-PHXGL  -  PLATE XLNG TI PLRS BONE LEFT PROX HUM NONSTRL","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"PL-PHXGR","SUP","HCPCS C1713","","PL-PHXGR  -  PLATE XLNG TI PLRS BONE RIGHT PROX HUM","BOTH IP/OP","$3,747.50 ","$2,773.15 ","$0.00 ","$3,747.50 ","$1,686.38 ","$0.00 ","$781.07 ","$0.00 ","$0.00 ","$656.16 ","$3,747.50 ","$0.00 ","$1,873.75 ","$2,968.02 ","$2,998.00 ","$0.00 ","$586.48 ","$0.00 ","$596.60 ","$0.00 "
"PL-PTACK","SUP","Custom 27803010","","PL-PTACK  -  HOLDER IMPL FRFT MIDFT TEMP FIX TACK PLT","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-SA06L","SUP","HCPCS C1713","","PL-SA06L  -  PLATE BN NS 6 HL TI SCAPULAR LT ACROMION","BOTH IP/OP","$3,592.50 ","$2,658.45 ","$0.00 ","$3,592.50 ","$1,616.63 ","$0.00 ","$748.77 ","$0.00 ","$0.00 ","$629.02 ","$3,592.50 ","$0.00 ","$1,796.25 ","$2,845.26 ","$2,874.00 ","$0.00 ","$562.23 ","$0.00 ","$571.93 ","$0.00 "
"PL-SA06R","SUP","HCPCS C1713","","PL-SA06R  -  PLATE BONE RIGHT ACROMION","BOTH IP/OP","$3,592.50 ","$2,658.45 ","$0.00 ","$3,592.50 ","$1,616.63 ","$0.00 ","$748.77 ","$0.00 ","$0.00 ","$629.02 ","$3,592.50 ","$0.00 ","$1,796.25 ","$2,845.26 ","$2,874.00 ","$0.00 ","$562.23 ","$0.00 ","$571.93 ","$0.00 "
"PLS-AIM-0910","SUP","Custom 27203010","","PLS-AIM-0910  -  GUIDE PLS AIMING, .9MM X 10?","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-SG04L","SUP","HCPCS C1713","","PL-SG04L  -  PLATE 4 HOLE BONE LEFT GLND SCAPULA STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"PL-SG04R","SUP","HCPCS C1713","","PL-SG04R  -  PLATE 4 HOLE BONE RIGHT GLND SCAPULA NONSTRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"PLSL3012","SUP","HCPCS C1713","","PLSL3012  -  SCREW BN T8 3MM 12MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL","BOTH IP/OP","$392.63 ","$290.55 ","$0.00 ","$522.60 ","$235.17 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$91.50 ","$522.60 ","$0.00 ","$261.30 ","$413.90 ","$418.08 ","$0.00 ","$81.79 ","$0.00 ","$83.20 ","$0.00 "
"PLSL3016","SUP","HCPCS C1713","","PLSL3016  -  SCREW BN T8 3MM 16MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL","BOTH IP/OP","$392.63 ","$290.55 ","$0.00 ","$522.60 ","$235.17 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$91.50 ","$522.60 ","$0.00 ","$261.30 ","$413.90 ","$418.08 ","$0.00 ","$81.79 ","$0.00 ","$83.20 ","$0.00 "
"PLSL3516","SUP","HCPCS C1713","","PLSL3516  -  SCREW BN T8 3.5MM 16MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL","BOTH IP/OP","$392.63 ","$290.55 ","$0.00 ","$522.60 ","$235.17 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$91.50 ","$522.60 ","$0.00 ","$261.30 ","$413.90 ","$418.08 ","$0.00 ","$81.79 ","$0.00 ","$83.20 ","$0.00 "
"PLSL3518","SUP","HCPCS C1713","","PLSL3518  -  SCREW BN T8 3.5MM 18MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL","BOTH IP/OP","$392.63 ","$290.55 ","$0.00 ","$522.60 ","$235.17 ","$0.00 ","$81.83 ","$0.00 ","$0.00 ","$91.50 ","$522.60 ","$0.00 ","$261.30 ","$413.90 ","$418.08 ","$0.00 ","$81.79 ","$0.00 ","$83.20 ","$0.00 "
"PLSL3530","SUP","HCPCS C1713","","PLSL3530  -  SCREW BN T8 3.5MM 30MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL","BOTH IP/OP","$384.75 ","$284.72 ","$0.00 ","$522.60 ","$235.17 ","$0.00 ","$80.19 ","$0.00 ","$0.00 ","$91.50 ","$522.60 ","$0.00 ","$261.30 ","$413.90 ","$418.08 ","$0.00 ","$81.79 ","$0.00 ","$83.20 ","$0.00 "
"PL-SLB10L","SUP","HCPCS C1713","","PL-SLB10L  -  PLATE BN 10 HL LT SCAPULA LAT","BOTH IP/OP","$4,570.00 ","$3,381.80 ","$0.00 ","$4,570.00 ","$2,056.50 ","$0.00 ","$952.50 ","$0.00 ","$0.00 ","$800.17 ","$4,570.00 ","$0.00 ","$2,285.00 ","$3,619.44 ","$3,656.00 ","$0.00 ","$715.21 ","$0.00 ","$727.54 ","$0.00 "
"PL-SLB10R","SUP","HCPCS C1713","","PL-SLB10R  -  PLATE 10 HOLE BONE SCAPULAR","BOTH IP/OP","$4,570.00 ","$3,381.80 ","$0.00 ","$4,570.00 ","$2,056.50 ","$0.00 ","$952.50 ","$0.00 ","$0.00 ","$800.17 ","$4,570.00 ","$0.00 ","$2,285.00 ","$3,619.44 ","$3,656.00 ","$0.00 ","$715.21 ","$0.00 ","$727.54 ","$0.00 "
"PL-SMB09L","SUP","HCPCS C1713","","PL-SMB09L  -  PLATE BN 9 HL MED LT SCAPULA","BOTH IP/OP","$4,235.00 ","$3,133.90 ","$0.00 ","$4,235.00 ","$1,905.75 ","$0.00 ","$882.68 ","$0.00 ","$0.00 ","$741.51 ","$4,235.00 ","$0.00 ","$2,117.50 ","$3,354.12 ","$3,388.00 ","$0.00 ","$662.78 ","$0.00 ","$674.21 ","$0.00 "
"PL-SMB09R","SUP","HCPCS C1713","","PL-SMB09R  -  PLATE 9 HOLE BRDR BONE RIGHT MDL SCAPULA NONSTRL","BOTH IP/OP","$4,235.00 ","$3,133.90 ","$0.00 ","$4,235.00 ","$1,905.75 ","$0.00 ","$882.68 ","$0.00 ","$0.00 ","$741.51 ","$4,235.00 ","$0.00 ","$2,117.50 ","$3,354.12 ","$3,388.00 ","$0.00 ","$662.78 ","$0.00 ","$674.21 ","$0.00 "
"PL-SMB13L","SUP","HCPCS C1713","","PL-SMB13L  -  PLATE 13 HOLE BRDR BONE LEFT MDL SCAPULA","BOTH IP/OP","$4,570.00 ","$3,381.80 ","$0.00 ","$4,570.00 ","$2,056.50 ","$0.00 ","$952.50 ","$0.00 ","$0.00 ","$800.17 ","$4,570.00 ","$0.00 ","$2,285.00 ","$3,619.44 ","$3,656.00 ","$0.00 ","$715.21 ","$0.00 ","$727.54 ","$0.00 "
"PL-SMB13R","SUP","HCPCS C1713","","PL-SMB13R  -  PLATE 13 HOLE BRDR LCK BONE RIGHT MDL SCAPULAR NONSTRL","BOTH IP/OP","$4,570.00 ","$3,381.80 ","$0.00 ","$4,570.00 ","$2,056.50 ","$0.00 ","$952.50 ","$0.00 ","$0.00 ","$800.17 ","$4,570.00 ","$0.00 ","$2,285.00 ","$3,619.44 ","$3,656.00 ","$0.00 ","$715.21 ","$0.00 ","$727.54 ","$0.00 "
"PL-SR27","SUP","Custom 27203010","","PL-SR27  -  REAMER SRG MN FSN PLT SLV WRST","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-SR29","SUP","HCPCS C1776","","PL-SR29  -  HEAD RMR MN WRST FSN PLT","BOTH IP/OP","$552.50 ","$408.85 ","$0.00 ","$552.50 ","$248.63 ","$0.00 ","$115.15 ","$0.00 ","$0.00 ","$96.74 ","$552.50 ","$0.00 ","$276.25 ","$437.58 ","$442.00 ","$0.00 ","$86.47 ","$0.00 ","$87.96 ","$0.00 "
"PL-SR30","SUP","Custom 27203010","","PL-SR30  -  REAMER SRG MN ASMB","BOTH IP/OP","$1,690.00 ","$1,250.60 ","$0.00 ","$1,690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,690.00 ","$0.00 ","$845.00 ","$1,338.48 ","$1,352.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PL-SR38","SUP","HCPCS C1776","","PL-SR38  -  HEAD RMR NS HBCP SHFT HND WRST","BOTH IP/OP","$587.50 ","$434.75 ","$0.00 ","$587.50 ","$264.38 ","$0.00 ","$122.45 ","$0.00 ","$0.00 ","$102.87 ","$587.50 ","$0.00 ","$293.75 ","$465.30 ","$470.00 ","$0.00 ","$91.94 ","$0.00 ","$93.53 ","$0.00 "
"PL-SR39","SUP","HCPCS C1776","","PL-SR39  -  HEAD RMR HBCP WRST FSN PLT","BOTH IP/OP","$630.00 ","$466.20 ","$0.00 ","$630.00 ","$283.50 ","$0.00 ","$131.31 ","$0.00 ","$0.00 ","$110.31 ","$630.00 ","$0.00 ","$315.00 ","$498.96 ","$504.00 ","$0.00 ","$98.60 ","$0.00 ","$100.30 ","$0.00 "
"PL-SR41","SUP","Custom 27203010","","PL-SR41  -  WRENCH SRG RMR HD HUB CAP","BOTH IP/OP","$270.00 ","$199.80 ","$0.00 ","$270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$270.00 ","$0.00 ","$135.00 ","$213.84 ","$216.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PLSS3016","SUP","HCPCS C1713","","PLSS3016  -  SCREW BN STD T8 3MM 16MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$271.13 ","$200.64 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$56.51 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3018","SUP","HCPCS C1713","","PLSS3018  -  SCREW BN STD T8 3MM 18MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$271.13 ","$200.64 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$56.51 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3020","SUP","HCPCS C1713","","PLSS3020  -  SCREW BN STD T8 3MM 20MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$525.00 ","$236.25 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$91.92 ","$525.00 ","$0.00 ","$262.50 ","$415.80 ","$420.00 ","$0.00 ","$82.16 ","$0.00 ","$83.58 ","$0.00 "
"PLSS3022","SUP","HCPCS C1713","","PLSS3022  -  SCREW BN STD T8 3MM 22MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3024","SUP","HCPCS C1713","","PLSS3024  -  SCREW BN STD T8 3MM 24MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3026","SUP","HCPCS C1713","","PLSS3026  -  SCREW BN STD T8 3MM 26MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3028","SUP","HCPCS C1713","","PLSS3028  -  SCREW BN STD T8 3MM 28MM BLU NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3514","SUP","HCPCS C1713","","PLSS3514  -  SCREW BN STD T8 3.5MM 14MM YLW NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3516","SUP","HCPCS C1713","","PLSS3516  -  SCREW BN STD T8 3.5MM 16MM YLW NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3520","SUP","HCPCS C1713","","PLSS3520  -  SCREW BN STD T8 3.5MM 20MM YLW NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3522","SUP","HCPCS C1713","","PLSS3522  -  SCREW BN STD T8 3.5MM 22MM YLW NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3526","SUP","HCPCS C1713","","PLSS3526  -  SCREW BN STD T8 3.5MM 26MM YLW NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLSS3532","SUP","HCPCS C1713","","PLSS3532  -  SCREW BN STD T8 3.5MM 32MM YLW NS ANCHORAGE TX HD TI FT/ANKL","BOTH IP/OP","$265.50 ","$196.47 ","$0.00 ","$358.80 ","$161.46 ","$0.00 ","$55.34 ","$0.00 ","$0.00 ","$62.82 ","$358.80 ","$0.00 ","$179.40 ","$284.17 ","$287.04 ","$0.00 ","$56.15 ","$0.00 ","$57.12 ","$0.00 "
"PLT-1030","SUP","HCPCS C1713","","PLT-1030  -  PLATE MAXFACL 7X7 HOLE MESH BIODEG 1.5 MM SCR BONE CPS TI","BOTH IP/OP","$2,833.13 ","$2,096.52 ","$0.00 ","$2,833.13 ","$1,274.91 ","$0.00 ","$590.49 ","$0.00 ","$0.00 ","$496.06 ","$2,833.13 ","$0.00 ","$1,416.56 ","$2,243.84 ","$2,266.50 ","$0.00 ","$443.38 ","$0.00 ","$451.03 ","$0.00 "
"PL-TACK2","SUP","HCPCS C1713","","PL-TACK2  -  PLATE BN 3.75IN TEMP","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$40.50 ","$0.00 ","$18.76 ","$0.00 ","$0.00 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$14.09 ","$0.00 ","$14.33 ","$0.00 "
"PL-TIBAM","SUP","HCPCS C1713","","PL-TIBAM  -  PLATE TI BONE ANT MLR NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-TIBMM","SUP","HCPCS C1713","","PL-TIBMM  -  PLATE TI BONE MDL MLR NONSTRL","BOTH IP/OP","$1,017.50 ","$752.95 ","$0.00 ","$1,017.50 ","$457.88 ","$0.00 ","$212.07 ","$0.00 ","$0.00 ","$178.16 ","$1,017.50 ","$0.00 ","$508.75 ","$805.86 ","$814.00 ","$0.00 ","$159.24 ","$0.00 ","$161.99 ","$0.00 "
"PL-TMT14","SUP","HCPCS C1713","","PL-TMT14  -  PLATE TI 4 HOLE CNGR BONE MIDFT NONSTRL","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"PL-TMT24","SUP","HCPCS C1713","","PL-TMT24  -  PLATE CNGR BONE MIDFT NONSTRL","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"PL-TMT5","SUP","HCPCS C1713","","PL-TMT5  -  PLATE TI 5 HOLE BONE TARSOMETATARSAL NONSTRL","BOTH IP/OP","$1,222.50 ","$904.65 ","$0.00 ","$1,222.50 ","$550.13 ","$0.00 ","$254.80 ","$0.00 ","$0.00 ","$214.05 ","$1,222.50 ","$0.00 ","$611.25 ","$968.22 ","$978.00 ","$0.00 ","$191.32 ","$0.00 ","$194.62 ","$0.00 "
"PL-UL06","SUP","HCPCS C1713","","PL-UL06  -  PLATE BN SHRT STRL 6 HL TI ULNA OSTM","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"PL-UL06-S","SUP","HCPCS C1713","","PL-UL06-S  -  PLATE TI 6 HOLE SHTNG ACUMED BONE WRST ULN HAND STRL","BOTH IP/OP","$1,790.00 ","$1,324.60 ","$0.00 ","$1,790.00 ","$805.50 ","$0.00 ","$373.08 ","$0.00 ","$0.00 ","$313.41 ","$1,790.00 ","$0.00 ","$895.00 ","$1,417.68 ","$1,432.00 ","$0.00 ","$280.14 ","$0.00 ","$284.97 ","$0.00 "
"PL-VO47","SUP","HCPCS C1713","","PL-VO47  -  PLATE 47MM TI BONE VOLR RADL NONSTRL","BOTH IP/OP","$1,020.00 ","$754.80 ","$0.00 ","$1,020.00 ","$459.00 ","$0.00 ","$212.59 ","$0.00 ","$0.00 ","$178.59 ","$1,020.00 ","$0.00 ","$510.00 ","$807.84 ","$816.00 ","$0.00 ","$159.63 ","$0.00 ","$162.38 ","$0.00 "
"PL-VO60","SUP","HCPCS C1713","","PL-VO60  -  PLATE 60MM TI BONE VOLR RADL NONSTRL","BOTH IP/OP","$1,020.00 ","$754.80 ","$0.00 ","$1,020.00 ","$459.00 ","$0.00 ","$212.59 ","$0.00 ","$0.00 ","$178.59 ","$1,020.00 ","$0.00 ","$510.00 ","$807.84 ","$816.00 ","$0.00 ","$159.63 ","$0.00 ","$162.38 ","$0.00 "
"PLVW-14.0-38","SUP","HCPCS C1892","","PLVW-14.0-38  -  SET INTROD 15.5CM 14FR PLWY PERC STRL DISP","BOTH IP/OP","$104.40 ","$77.26 ","$0.00 ","$104.40 ","$56.69 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$18.28 ","$104.40 ","$0.00 ","$52.20 ","$82.68 ","$83.52 ","$0.00 ","$16.34 ","$0.00 ","$16.62 ","$0.00 "
"PL-WF33","SUP","HCPCS C1713","","PL-WF33  -  PLATE BN MN NS HBCP 3 CRNR FSN TI WRST","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-WF40","SUP","HCPCS C1713","","PL-WF40  -  PLATE BN NS HBCP TI WRST","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-WF44","SUP","HCPCS C1713","","PL-WF44  -  PLATE MINI TI 4 CRNR FSN HBCP BONE WRST NONSTRL","BOTH IP/OP","$2,047.50 ","$1,515.15 ","$0.00 ","$2,047.50 ","$921.38 ","$0.00 ","$426.75 ","$0.00 ","$0.00 ","$358.50 ","$2,047.50 ","$0.00 ","$1,023.75 ","$1,621.62 ","$1,638.00 ","$0.00 ","$320.43 ","$0.00 ","$325.96 ","$0.00 "
"PL-WF50","SUP","HCPCS C1713","","PL-WF50  -  PLATE TI FSN POST HBCP BONE WRST","BOTH IP/OP","$82.50 ","$61.05 ","$0.00 ","$82.50 ","$37.13 ","$0.00 ","$17.20 ","$0.00 ","$0.00 ","$14.45 ","$82.50 ","$0.00 ","$41.25 ","$65.34 ","$66.00 ","$0.00 ","$12.91 ","$0.00 ","$13.13 ","$0.00 "
"PL-WF60","SUP","HCPCS C1713","","PL-WF60  -  PLATE TI SCR HBCP BONE WRST NONSTRL","BOTH IP/OP","$237.50 ","$175.75 ","$0.00 ","$237.50 ","$106.88 ","$0.00 ","$49.50 ","$0.00 ","$0.00 ","$41.58 ","$237.50 ","$0.00 ","$118.75 ","$188.10 ","$190.00 ","$0.00 ","$37.17 ","$0.00 ","$37.81 ","$0.00 "
"PM010-A","SUP","Custom 27200555","","PM010-A  -  KIT DRUG DELIVERY 3.5IN 2.5IN CATHETER ANTIMICROBIAL NEEDLE","BOTH IP/OP","$89.00 ","$65.86 ","$0.00 ","$23.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.00 ","$0.00 ","$11.50 ","$18.22 ","$18.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PM020","SUP","Custom 27200555","","PM020  -  SYSTEM DRG DLV ONQ PNBSTR SKR XPD KIT CATH TPL NDL 5IN 6IN","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$154.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$154.50 ","$0.00 ","$77.25 ","$122.36 ","$123.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PM020-A","SUP","Custom 27200555","","PM020-A  -  SYSTEM DRG DLV T 5IN 6IN ONQ PNBSTR SLSKR TPL XPD CATH NDL","BOTH IP/OP","$116.00 ","$85.84 ","$0.00 ","$29.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$29.50 ","$0.00 ","$14.75 ","$23.36 ","$23.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PM040-A","SUP","Custom 27200555","","PM040-A  -  SYSTEM DRG DLV ONQ SLSKR CATH XPD KIT TPL NDL 10IN 8IN","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PM1110","SUP","HCPCS C1786","","PM1110  -  PACEMAKER CRD THK6MM 52X42MM 9.5ML ACT 1 CHMBR IS-1 CNCT PLS","BOTH IP/OP","$7,425.00 ","$5,494.50 ","$0.00 ","$7,425.00 ","$0.00 ","$0.00 ","$1,547.56 ","$0.00 ","$0.00 ","$0.00 ","$7,425.00 ","$0.00 ","$3,712.50 ","$5,880.60 ","$5,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PM1210","SUP","HCPCS C1785","","PM1210  -  PACEMAKER CRD THK6MM 52X52MM 12.8ML ACT 1 CHMBR IS-1 CNCT RF","BOTH IP/OP","$8,775.00 ","$6,493.50 ","$0.00 ","$8,775.00 ","$3,948.75 ","$0.00 ","$1,828.93 ","$0.00 ","$0.00 ","$1,536.43 ","$8,775.00 ","$0.00 ","$4,387.50 ","$6,949.80 ","$7,020.00 ","$0.00 ","$1,373.29 ","$0.00 ","$1,396.98 ","$0.00 "
"PM2110","SUP","HCPCS C1785","","PM2110  -  PACEMAKER CRD THK6MM 52X46MM 10.5CC ACT 2 CHMBR IS-1 CNCT","BOTH IP/OP","$8,550.00 ","$6,327.00 ","$0.00 ","$8,550.00 ","$3,847.50 ","$0.00 ","$1,782.03 ","$0.00 ","$0.00 ","$1,497.04 ","$8,550.00 ","$0.00 ","$4,275.00 ","$6,771.60 ","$6,840.00 ","$0.00 ","$1,338.08 ","$0.00 ","$1,361.16 ","$0.00 "
"PM2210","SUP","HCPCS C1785","","PM2210  -  PACEMAKER CARDIAC THK6MM 52X52MM 2 CHAMBER INDUCTIVE","BOTH IP/OP","$10,575.00 ","$7,825.50 ","$0.00 ","$10,575.00 ","$4,758.75 ","$0.00 ","$2,204.09 ","$0.00 ","$0.00 ","$1,851.60 ","$10,575.00 ","$0.00 ","$5,287.50 ","$8,375.40 ","$8,460.00 ","$0.00 ","$1,654.99 ","$0.00 ","$1,683.54 ","$0.00 "
"PM3210","SUP","HCPCS C2621","","PM3210  -  PACEMAKER CRD THK6MM 58X52MM 13.7ML ANTHEM RF 2 CHMBR IS-1","BOTH IP/OP","$14,750.00 ","$10,915.00 ","$0.00 ","$14,750.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14,750.00 ","$0.00 ","$7,375.00 ","$11,682.00 ","$11,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PMG-18SP-60-COPE","SUP","HCPCS C1769","","PMG-18SP-60-COPE  -  GWIRE VASC .018IN 60CM 7CM ANG SFT CP MDRL SS STRL DISP","BOTH IP/OP","$82.39 ","$60.97 ","$0.00 ","$82.39 ","$44.74 ","$0.00 ","$17.17 ","$0.00 ","$0.00 ","$14.43 ","$82.39 ","$0.00 ","$41.19 ","$65.25 ","$65.91 ","$0.00 ","$12.89 ","$0.00 ","$13.12 ","$0.00 "
"PMH","SUP","HCPCS C1781","","PMH  -  MESH SURG FLAT 6X6IN KNIT NONABSORBABLE NONREACTIVE PROLENE","BOTH IP/OP","$164.86 ","$122.00 ","$0.00 ","$167.34 ","$75.30 ","$0.00 ","$34.36 ","$0.00 ","$0.00 ","$29.30 ","$167.34 ","$0.00 ","$83.67 ","$132.53 ","$133.87 ","$0.00 ","$26.19 ","$0.00 ","$26.64 ","$0.00 "
"PMII","SUP","HCPCS C1781","","PMII  -  MESH SURG FLAT 6X3IN KNIT NONABSORBABLE NONREACTIVE LATEX","BOTH IP/OP","$149.00 ","$110.26 ","$0.00 ","$151.22 ","$68.05 ","$0.00 ","$31.06 ","$0.00 ","$0.00 ","$26.48 ","$151.22 ","$0.00 ","$75.61 ","$119.77 ","$120.98 ","$0.00 ","$23.67 ","$0.00 ","$24.07 ","$0.00 "
"PML","SUP","HCPCS C1781","","PML  -  MESH SURG FLAT 12X12IN KNIT MONOFILAMENT SOFT PROLENE","BOTH IP/OP","$374.24 ","$276.94 ","$0.00 ","$379.86 ","$170.93 ","$0.00 ","$78.00 ","$0.00 ","$0.00 ","$66.51 ","$379.86 ","$0.00 ","$189.93 ","$300.85 ","$303.88 ","$0.00 ","$59.45 ","$0.00 ","$60.47 ","$0.00 "
"PMXS","SUP","HCPCS C1781","","PMXS  -  MESH SURG FLAT 4X1IN KNIT NONABSORBABLE NONREACTIVE PROLENE","BOTH IP/OP","$117.33 ","$86.82 ","$0.00 ","$117.33 ","$52.80 ","$0.00 ","$24.45 ","$0.00 ","$0.00 ","$20.54 ","$117.33 ","$0.00 ","$58.66 ","$92.93 ","$93.86 ","$0.00 ","$18.36 ","$0.00 ","$18.68 ","$0.00 "
"PN-152836002","SUP","Custom 27203010","","PN-152836002  -  CONCTR EKG ATR VNTRC ASMBLY","BOTH IP/OP","$45.05 ","$33.34 ","$0.00 ","$45.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$45.05 ","$0.00 ","$22.53 ","$35.68 ","$36.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PND6F070956","SUP","HCPCS C1757","","PND6F070956  -  CATHETER DELIVERY SYSTEM STR 6FR .07IN 95CM 6CM LUMEN","BOTH IP/OP","$1,587.50 ","$1,174.75 ","$0.00 ","$1,587.50 ","$0.00 ","$0.00 ","$330.87 ","$0.00 ","$0.00 ","$0.00 ","$1,587.50 ","$0.00 ","$793.75 ","$1,257.30 ","$1,270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PND6F1056","SUP","HCPCS C1757","","PND6F1056  -  CATHETER DELIVERY SYSTEM .035IN .038IN 6FR .053IN 105CM 6CM","BOTH IP/OP","$1,587.50 ","$1,174.75 ","$0.00 ","$1,587.50 ","$0.00 ","$0.00 ","$330.87 ","$0.00 ","$0.00 ","$0.00 ","$1,587.50 ","$0.00 ","$793.75 ","$1,257.30 ","$1,270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PND6F1156","SUP","HCPCS C1757","","PND6F1156  -  CATHETER DELIVERY SYSTEM .035IN .038IN STR 6FR .053IN 115CM","BOTH IP/OP","$1,587.50 ","$1,174.75 ","$0.00 ","$1,587.50 ","$0.00 ","$0.00 ","$330.87 ","$0.00 ","$0.00 ","$0.00 ","$1,587.50 ","$0.00 ","$793.75 ","$1,257.30 ","$1,270.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG220","SUP","HCPCS C9352","","PNG220  -  GUIDE NERVE 2MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$651.47 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG230","SUP","HCPCS C9352","","PNG230  -  GUIDE NERVE 2MM 3CM SEMIPERMEABLE NEURAGEN COLLAGEN MATRIX","BOTH IP/OP","$4,202.28 ","$3,109.69 ","$0.00 ","$4,202.28 ","$0.00 ","$0.00 ","$875.86 ","$0.00 ","$0.00 ","$0.00 ","$4,202.28 ","$0.00 ","$2,101.14 ","$3,328.21 ","$3,361.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG320","SUP","HCPCS C9352","","PNG320  -  GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG-320","SUP","HCPCS C9352","","PNG-320  -  GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$651.47 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG330","SUP","HCPCS C9352","","PNG330  -  GUIDE NERVE 3MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE","BOTH IP/OP","$4,202.28 ","$3,109.69 ","$0.00 ","$4,202.28 ","$0.00 ","$0.00 ","$875.86 ","$0.00 ","$0.00 ","$0.00 ","$4,202.28 ","$0.00 ","$2,101.14 ","$3,328.21 ","$3,361.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG420","SUP","HCPCS C9352","","PNG420  -  GUIDE NERVE 4MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$651.47 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG430","SUP","HCPCS C9352","","PNG430  -  GUIDE NERVE 4MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE","BOTH IP/OP","$4,202.28 ","$3,109.69 ","$0.00 ","$4,202.28 ","$0.00 ","$0.00 ","$875.86 ","$0.00 ","$0.00 ","$0.00 ","$4,202.28 ","$0.00 ","$2,101.14 ","$3,328.21 ","$3,361.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG520","SUP","HCPCS C9352","","PNG520  -  GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG-520","SUP","HCPCS C9352","","PNG-520  -  GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$651.47 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG530","SUP","HCPCS C9352","","PNG530  -  GUIDE NERVE 5MM 3CM FLEXIBLE ABSORBABLE TUBE NEURAGEN","BOTH IP/OP","$4,202.28 ","$3,109.69 ","$0.00 ","$4,202.28 ","$0.00 ","$0.00 ","$875.86 ","$0.00 ","$0.00 ","$0.00 ","$4,202.28 ","$0.00 ","$2,101.14 ","$3,328.21 ","$3,361.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG620","SUP","HCPCS C9352","","PNG620  -  GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG-620","SUP","HCPCS C9352","","PNG-620  -  GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$651.47 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG630","SUP","HCPCS C9352","","PNG630  -  GUIDE NERVE 6MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE","BOTH IP/OP","$4,202.28 ","$3,109.69 ","$0.00 ","$4,202.28 ","$0.00 ","$0.00 ","$875.86 ","$0.00 ","$0.00 ","$0.00 ","$4,202.28 ","$0.00 ","$2,101.14 ","$3,328.21 ","$3,361.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG720","SUP","HCPCS C9352","","PNG720  -  GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG-720","SUP","HCPCS C9352","","PNG-720  -  GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE","BOTH IP/OP","$3,125.68 ","$2,313.00 ","$0.00 ","$3,125.68 ","$0.00 ","$0.00 ","$651.47 ","$0.00 ","$0.00 ","$0.00 ","$3,125.68 ","$0.00 ","$1,562.84 ","$2,475.54 ","$2,500.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNG730","SUP","HCPCS C9352","","PNG730  -  GUIDE NERVE 7MM 3CM EXCELLENT HANDLING SEMIPERMEABLE SIMPLE","BOTH IP/OP","$4,202.28 ","$3,109.69 ","$0.00 ","$4,202.28 ","$0.00 ","$0.00 ","$875.86 ","$0.00 ","$0.00 ","$0.00 ","$4,202.28 ","$0.00 ","$2,101.14 ","$3,328.21 ","$3,361.82 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PNML6F088904M","SUP","HCPCS C1892","","PNML6F088904M  -  SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM 4CM NEURON MXSS","BOTH IP/OP","$1,137.50 ","$841.75 ","$0.00 ","$1,137.50 ","$617.66 ","$0.00 ","$237.08 ","$0.00 ","$0.00 ","$199.17 ","$1,137.50 ","$0.00 ","$568.75 ","$900.90 ","$910.00 ","$0.00 ","$178.02 ","$0.00 ","$181.09 ","$0.00 "
"PNS5F120BER","SUP","HCPCS C1757","","PNS5F120BER  -  CATH THRMB 120CM 5FR .4IN NEURON SLCT .035IN .038IN BER","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PP17/10","SUP","HCPCS C1894","","DEVICE 17GA 10CM ECHTP COAX THNWL PP INTROD BIOP","BOTH IP/OP","$33.88 ","$25.07 ","$0.00 ","$33.88 ","$18.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.93 ","$33.88 ","$0.00 ","$16.94 ","$26.83 ","$27.10 ","$0.00 ","$5.30 ","$0.00 ","$5.39 ","$0.00 "
"PP1715","SUP","HCPCS C1894","","DEVICE 17GA 15CM ECHTP COAX THNWL PP INTROD BIOP","BOTH IP/OP","$40.50 ","$29.97 ","$0.00 ","$40.50 ","$21.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.09 ","$40.50 ","$0.00 ","$20.25 ","$32.08 ","$32.40 ","$0.00 ","$6.34 ","$0.00 ","$6.45 ","$0.00 "
"PP19/10","SUP","HCPCS C1894","","DEVICE 19GA 10CM ECHTP COAX THNWL PP INTROD BIOP","BOTH IP/OP","$33.75 ","$24.98 ","$0.00 ","$33.75 ","$18.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.91 ","$33.75 ","$0.00 ","$16.88 ","$26.73 ","$27.00 ","$0.00 ","$5.28 ","$0.00 ","$5.37 ","$0.00 "
"PP1915","SUP","HCPCS C1894","","DEVICE 19GA 15CM ECHTP COAX THNWL PP INTROD BIOP","BOTH IP/OP","$33.75 ","$24.98 ","$0.00 ","$33.75 ","$18.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5.91 ","$33.75 ","$0.00 ","$16.88 ","$26.73 ","$27.00 ","$0.00 ","$5.28 ","$0.00 ","$5.37 ","$0.00 "
"PP196","SUP","Custom 27203010","","NEEDLE BIOP 19GA 6CM ECHTP COAX THNWL PP INTROD","BOTH IP/OP","$32.38 ","$23.96 ","$0.00 ","$37.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.43 ","$0.00 ","$18.71 ","$29.64 ","$29.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PP9031","SUP","Custom 27203010","","PP9031  -  KIT ESCP STRL LF PNPT PAQ DISP","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PRE1001US.S","SUP","HCPCS A6212","","PRE1001US.S  -  UNIT THERAPEUTIC INCISION MANAGEMENT SYSTEM PEEL PLACE KIT","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$671.96 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"PRE1101US","SUP","Custom 27011340","","PRE1101US  -  SYSTEM NEG PRSS 13CM PREVENA PEEL AND PLC PTCH","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PRE2001US","SUP","Custom 27203010","","PRE2001US  -  KIT DRESSING 125 THERAPY UNIT CARRYING CASE CANISTER","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PRE4001US","SUP","HCPCS C1713","","PRE4001US  -  SYSTEM NEG PRSS -125 MMHG 150ML PREVENA + VIS ADBL ALRM REPL","BOTH IP/OP","$1,625.00 ","$1,202.50 ","$0.00 ","$1,625.00 ","$731.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$284.52 ","$1,625.00 ","$0.00 ","$812.50 ","$1,287.00 ","$1,300.00 ","$0.00 ","$254.31 ","$0.00 ","$258.70 ","$0.00 "
"PROTECTACRTDMMAM","SUP","HCPCS C1721","","PROTECTACRTDMMAM  -  PROTECTA CRT-D ADVANCED SYSTEM","BOTH IP/OP","$60,500.00 ","$44,770.00 ","$0.00 ","$60,500.00 ","$27,225.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$60,500.00 ","$0.00 ","$30,250.00 ","$47,916.00 ","$48,400.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"PROTECTADRMMEM","SUP","HCPCS C1721","","PROTECTADRMMEM  -  PROTECTA DR SYSTEM (INCLUDING DF4 HEADER)","BOTH IP/OP","$49,812.50 ","$36,861.25 ","$0.00 ","$49,812.50 ","$22,415.63 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$49,812.50 ","$0.00 ","$24,906.25 ","$39,451.50 ","$39,850.00 ","$0.00 ","$7,751.33 ","$0.00 ","$7,930.15 ","$0.00 "
"PROTECTAVREMEM","SUP","HCPCS C1721","","PROTECTAVREMEM  -  PROTECTA VR SYSTEM (INCLUDING DF4 HEADER)","BOTH IP/OP","$43,750.00 ","$32,375.00 ","$0.00 ","$43,750.00 ","$19,687.50 ","$0.00 ","$9,118.59 ","$0.00 ","$0.00 ","$7,660.28 ","$43,750.00 ","$0.00 ","$21,875.00 ","$34,650.00 ","$35,000.00 ","$0.00 ","$6,846.88 ","$0.00 ","$6,965.00 ","$0.00 "
"PRT-FSP-DU","SUP","HCPCS C1713","","PRT-FSP-DU  -  PLATE BN PRTN FRAG ULNA DISTAL","BOTH IP/OP","$2,190.00 ","$1,620.60 ","$0.00 ","$2,190.00 ","$985.50 ","$0.00 ","$456.45 ","$0.00 ","$0.00 ","$383.45 ","$2,190.00 ","$0.00 ","$1,095.00 ","$1,734.48 ","$1,752.00 ","$0.00 ","$342.74 ","$0.00 ","$348.65 ","$0.00 "
"PRT-FSP-LR","SUP","HCPCS C1713","","PRT-FSP-LR  -  PLATE BN PRTN FRAG ULNA DIST DOUBLE HOCKEY STICK","BOTH IP/OP","$1,970.00 ","$1,457.80 ","$0.00 ","$1,970.00 ","$886.50 ","$0.00 ","$410.60 ","$0.00 ","$0.00 ","$344.93 ","$1,970.00 ","$0.00 ","$985.00 ","$1,560.24 ","$1,576.00 ","$0.00 ","$308.31 ","$0.00 ","$313.62 ","$0.00 "
"PRT-FSP-YS","SUP","HCPCS C1713","","PRT-FSP-YS  -  PLATE BN PRTN FRAG ULNA DIST Y","BOTH IP/OP","$1,970.00 ","$1,457.80 ","$0.00 ","$1,970.00 ","$886.50 ","$0.00 ","$410.60 ","$0.00 ","$0.00 ","$344.93 ","$1,970.00 ","$0.00 ","$985.00 ","$1,560.24 ","$1,576.00 ","$0.00 ","$308.31 ","$0.00 ","$313.62 ","$0.00 "
"PS11055","SUP","Custom 27803010","","PS11055  -  GRAFT SFT TIS 5X5CM GRFX PRM ALGRF PLCNT MEMBR","BOTH IP/OP","$6,875.00 ","$5,087.50 ","$0.00 ","$6,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,875.00 ","$0.00 ","$3,437.50 ","$5,445.00 ","$5,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PS12055","SUP","Custom 27803010","","PS12055  -  GRAFT SFT TIS 5X5CM GRFX COR PLCNT MEMBR ALGRF","BOTH IP/OP","$6,900.00 ","$5,106.00 ","$0.00 ","$6,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,900.00 ","$0.00 ","$3,450.00 ","$5,464.80 ","$5,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PS60005","SUP","Custom 27803010","","PS60005  -  GRAFT SFT TIS 4X2CM STRAVIX ALGRF PLCNT TISS","BOTH IP/OP","$4,512.50 ","$3,339.25 ","$0.00 ","$4,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,512.50 ","$0.00 ","$2,256.25 ","$3,573.90 ","$3,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PS60008","SUP","Custom 27803010","","PS60008  -  GRAFT SFT TIS 6X3CM STRAVIX ALGRF PLCNT TISS","BOTH IP/OP","$7,956.25 ","$5,887.63 ","$0.00 ","$7,956.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7,956.25 ","$0.00 ","$3,978.13 ","$6,301.35 ","$6,365.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSC026","SUP","HCPCS C1757","","PSC026  -  CATHETER THROMBECTOMY 3.9-2.8FR .026IN 154CM 150CM","BOTH IP/OP","$3,725.00 ","$2,756.50 ","$0.00 ","$3,725.00 ","$0.00 ","$0.00 ","$776.38 ","$0.00 ","$0.00 ","$0.00 ","$3,725.00 ","$0.00 ","$1,862.50 ","$2,950.20 ","$2,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSC041","SUP","HCPCS C1757","","PSC041  -  CATHETER THROMBECTOMY 4.1FR .041IN 141CM REPERFUSION","BOTH IP/OP","$3,725.00 ","$2,756.50 ","$0.00 ","$3,725.00 ","$0.00 ","$0.00 ","$776.38 ","$0.00 ","$0.00 ","$0.00 ","$3,725.00 ","$0.00 ","$1,862.50 ","$2,950.20 ","$2,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSC054","SUP","HCPCS C1757","","PSC054  -  CATHETER THROMBECTOMY 6-5FR .054IN 132CM 136CM REPERFUSION","BOTH IP/OP","$3,725.00 ","$2,756.50 ","$0.00 ","$3,725.00 ","$0.00 ","$0.00 ","$776.38 ","$0.00 ","$0.00 ","$0.00 ","$3,725.00 ","$0.00 ","$1,862.50 ","$2,950.20 ","$2,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSD 6002-UN","SUP","Custom 27203010","","PSD 6002-UN  -  STAPLER INTNL 60MM UNV 2 FRNG 1 GEL TUBE STRL LF DISP PRSTRP","BOTH IP/OP","$368.75 ","$272.88 ","$0.00 ","$122.92 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$122.92 ","$0.00 ","$61.46 ","$97.35 ","$98.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSD 6006-UV","SUP","Custom 27203010","","PSD 6006-UV  -  STAPLER INTNL STRL LF PRSTRP DR 6 FRNG GEL TUBE LNR VRTS","BOTH IP/OP","$67.99 ","$50.31 ","$0.00 ","$67.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.99 ","$0.00 ","$33.99 ","$53.85 ","$54.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSD 8006-UN","SUP","Custom 27203010","","PSD 8006-UN  -  STAPLER INTNL ENDSCP LNR CTR 6 FRNG PRSTRP DR","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSE45A","SUP","Custom 27203010","","PSE45A  -  STAPLER INTERNAL 45MM 340MM LINEAR CUTTER ARTICULATION","BOTH IP/OP","$8,484.68 ","$6,278.66 ","$0.00 ","$8,484.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8,484.68 ","$0.00 ","$4,242.34 ","$6,719.87 ","$6,787.74 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSEE45A","SUP","Custom 27203010","","PSEE45A  -  STAPLER INTNL STD 340MM 45MM ECHLN FLX PWR + LNR CTR ESCP","BOTH IP/OP","$1,661.12 ","$1,229.23 ","$0.00 ","$1,661.12 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,661.12 ","$0.00 ","$830.56 ","$1,315.61 ","$1,328.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSEE60A","SUP","Custom 27203010","","PSEE60A  -  STAPLER INTERNAL BENT 60MM 440MM RIDGE ASYMMETRICAL LEG LINE","BOTH IP/OP","$1,993.34 ","$1,475.07 ","$0.00 ","$3,375.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,375.63 ","$0.00 ","$1,687.81 ","$2,673.50 ","$2,700.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PSS-6F-4MT","SUP","HCPCS C1894","","PSS-6F-4MT  -  INTRODUCER SHEATH SHORT 6FR 4CM NO WIRE PRELUDE GREEN","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$42.50 ","$23.08 ","$0.00 ","$9.90 ","$0.00 ","$0.00 ","$7.44 ","$42.50 ","$0.00 ","$21.25 ","$33.66 ","$34.00 ","$0.00 ","$6.65 ","$0.00 ","$6.77 ","$0.00 "
"PSS-7F-4MT","SUP","HCPCS C1894","","PSS-7F-4MT  -  INTRODUCER SHEATH SHORT 7FR 21GA 4CM ORANGE HUB TUBING","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$9.90 ","$4.62 ","$0.00 ","$9.90 ","$0.00 ","$0.00 ","$1.49 ","$8.50 ","$0.00 ","$4.25 ","$6.73 ","$6.80 ","$0.00 ","$1.33 ","$0.00 ","$1.35 ","$0.00 "
"PTA5-35-135-7-14.0","SUP","HCPCS C1725","","PTA5-35-135-7-14.0  -  CATH BALDILAT .035IN 5FR 7MM 135CM 14CM 2 LUM PTA LP GWIRE","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$278.29 ","$0.00 ","$106.82 ","$0.00 ","$0.00 ","$89.73 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$80.21 ","$0.00 ","$81.59 ","$0.00 "
"PTB124275","SUP","HCPCS C1874","","PTB124275  -  GORE VIATORR TIPS ENDOPROSTHESIS","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"PTB126275","SUP","HCPCS C1874","","PTB126275  -  GORE VIATORR TIPS ENDOPROSTHESIS","BOTH IP/OP","$10,500.00 ","$7,770.00 ","$0.00 ","$10,500.00 ","$4,725.00 ","$0.00 ","$2,188.46 ","$0.00 ","$0.00 ","$1,838.47 ","$10,500.00 ","$0.00 ","$5,250.00 ","$8,316.00 ","$8,400.00 ","$0.00 ","$1,643.25 ","$0.00 ","$1,671.60 ","$0.00 "
"PTB128275","SUP","HCPCS C1874","","PTB128275  -  GORE VIATORR TIPS ENDOPROSTHESIS","BOTH IP/OP","$9,750.00 ","$7,215.00 ","$0.00 ","$9,750.00 ","$4,387.50 ","$0.00 ","$2,032.14 ","$0.00 ","$0.00 ","$1,707.15 ","$9,750.00 ","$0.00 ","$4,875.00 ","$7,722.00 ","$7,800.00 ","$0.00 ","$1,525.88 ","$0.00 ","$1,552.20 ","$0.00 "
"PTB8106275","SUP","HCPCS C1874","","PTB8106275  -  STENT EPRSTH 10MM 6CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM","BOTH IP/OP","$12,855.00 ","$9,512.70 ","$0.00 ","$12,360.00 ","$5,562.00 ","$0.00 ","$2,679.30 ","$0.00 ","$0.00 ","$2,164.14 ","$12,360.00 ","$0.00 ","$6,180.00 ","$9,789.12 ","$9,888.00 ","$0.00 ","$1,934.34 ","$0.00 ","$1,967.71 ","$0.00 "
"PTB8108275","SUP","HCPCS C1874","","PTB8108275  -  STENT EPRSTH 10MM 8CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM","BOTH IP/OP","$12,855.00 ","$9,512.70 ","$0.00 ","$12,360.00 ","$5,562.00 ","$0.00 ","$2,679.30 ","$0.00 ","$0.00 ","$2,164.14 ","$12,360.00 ","$0.00 ","$6,180.00 ","$9,789.12 ","$9,888.00 ","$0.00 ","$1,934.34 ","$0.00 ","$1,967.71 ","$0.00 "
"PTH-MP","SUP","Custom 27203010","","MAS PTH TRI-LEVEL CONTROL 6X3ML","BOTH IP/OP","$275.00 ","$203.50 ","$0.00 ","$275.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$275.00 ","$0.00 ","$137.50 ","$217.80 ","$220.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PV014300","SUP","HCPCS C1769","","PV014300  -  JETWIRE JETSTREAM","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,696.88 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"PV2014L016N","SUP","HCPCS C1751","","PV2014L016N  -  CATHETER ART LN 4FR 16CM PICCO GW NTNL","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"PV2014L022N","SUP","HCPCS C1751","","PV2014L022N  -  CATHETER ART LN 4FR 22CM PICCO GW ADLT FEM ART BRACHIA","BOTH IP/OP","$62.50 ","$46.25 ","$0.00 ","$62.50 ","$28.13 ","$0.00 ","$13.03 ","$0.00 ","$0.00 ","$10.94 ","$62.50 ","$0.00 ","$31.25 ","$49.50 ","$50.00 ","$0.00 ","$9.78 ","$0.00 ","$9.95 ","$0.00 "
"PV2015L20N","SUP","HCPCS C1751","","PV2015L20N  -  CATH ART 5FR .028IN 7.78IN FEM PICCO ADLT STD","BOTH IP/OP","$3,125.00 ","$2,312.50 ","$0.00 ","$3,125.00 ","$1,406.25 ","$0.00 ","$651.33 ","$0.00 ","$0.00 ","$547.16 ","$3,125.00 ","$0.00 ","$1,562.50 ","$2,475.00 ","$2,500.00 ","$0.00 ","$489.06 ","$0.00 ","$497.50 ","$0.00 "
"PV3116F","SUP","HCPCS C1714","","PV3116F  -  CATHETER ATHRCM JETSTREAM NAVITUS ROT","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,488.28 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$1,353.20 ","$0.00 "
"PV3118F","SUP","HCPCS C1714","","PV3118F  -  CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM JETSTREAM NAVITUS","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,488.28 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$1,353.20 ","$0.00 "
"PV31300","SUP","HCPCS C1714","","PV31300  -  CATHETER ATHRCM JETSTREAM NAVITUS ROT","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,488.28 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$1,353.20 ","$0.00 "
"PV4046","SUP","HCPCS C1751","","PV4046  -  KIT ART LN INJECTATE TEMP SNSR HSNG PICCO","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$371.25 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"PV41340","SUP","HCPCS C1714","","PV41340  -  CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM LF JETSTREAM","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$4,615.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,488.28 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$1,330.25 ","$0.00 ","$1,353.20 ","$0.00 "
"PVE35A","SUP","Custom 27203010","","PVE35A  -  STAPLER INTERNAL 320MM 35MM POWER ADVANCE PLACEMENT TIP","BOTH IP/OP","$990.33 ","$732.84 ","$0.00 ","$990.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$990.33 ","$0.00 ","$495.16 ","$784.34 ","$792.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PVPS","SUP","HCPCS C1781","","PVPS  -  MESH SURG 4.3X4.3CM SELF EXPAND PRTL ABSORBABLE FLEXIBLE","BOTH IP/OP","$1,462.90 ","$1,082.55 ","$0.00 ","$1,462.90 ","$658.31 ","$0.00 ","$304.90 ","$0.00 ","$0.00 ","$256.14 ","$1,462.90 ","$0.00 ","$731.45 ","$1,158.62 ","$1,170.32 ","$0.00 ","$228.94 ","$0.00 ","$232.89 ","$0.00 "
"PWL229997H","SUP","HCPCS C1785","","PWL229997H  -  PACEMAKER SENSIA DR CARD SEDR01 PWL229997H","BOTH IP/OP","$22,500.00 ","$16,650.00 ","$0.00 ","$22,500.00 ","$10,125.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,939.57 ","$22,500.00 ","$0.00 ","$11,250.00 ","$17,820.00 ","$18,000.00 ","$0.00 ","$3,521.25 ","$0.00 ","$3,582.00 ","$0.00 "
"PWL242945H","SUP","HCPCS C1785","","PWL242945H  -  PACEMAKER SENSIA 2CH CARD PWL242945H","BOTH IP/OP","$19,655.00 ","$14,544.70 ","$0.00 ","$19,655.00 ","$8,844.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,441.43 ","$19,655.00 ","$0.00 ","$9,827.50 ","$15,566.76 ","$15,724.00 ","$0.00 ","$3,076.01 ","$0.00 ","$3,129.08 ","$0.00 "
"PWL243503H","SUP","HCPCS C1785","","PWL243503H  -  PACEMAKER SENSIA 2CH CARD PWL243503H","BOTH IP/OP","$19,207.50 ","$14,213.55 ","$0.00 ","$19,207.50 ","$8,643.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,363.08 ","$19,207.50 ","$0.00 ","$9,603.75 ","$15,212.34 ","$15,366.00 ","$0.00 ","$3,005.97 ","$0.00 ","$3,057.83 ","$0.00 "
"PWR224751H","SUP","HCPCS C1785","","PWR224751H  -  PACEMAKER SENSIA 2CH CARD PWR224751H","BOTH IP/OP","$18,900.00 ","$13,986.00 ","$0.00 ","$18,900.00 ","$8,505.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,309.24 ","$18,900.00 ","$0.00 ","$9,450.00 ","$14,968.80 ","$15,120.00 ","$0.00 ","$2,957.85 ","$0.00 ","$3,008.88 ","$0.00 "
"PWR230180H","SUP","HCPCS C1785","","PWR230180H  -  PACEMAKER SENSIA DR CARD SEDR01 PWR230180H","BOTH IP/OP","$7,237.50 ","$5,355.75 ","$0.00 ","$7,237.50 ","$3,256.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,267.23 ","$7,237.50 ","$0.00 ","$3,618.75 ","$5,732.10 ","$5,790.00 ","$0.00 ","$1,132.67 ","$0.00 ","$1,152.21 ","$0.00 "
"PXC121000","SUP","Custom 27806189","","PXC121000  -  GRAFT EVAS LOPRFL 12MM 10CM XCLDR STNT XTD DLV SYS SL CUF","BOTH IP/OP","$11,275.00 ","$8,343.50 ","$0.00 ","$11,275.00 ","$0.00 ","$0.00 ","$2,349.99 ","$0.00 ","$0.00 ","$0.00 ","$11,275.00 ","$0.00 ","$5,637.50 ","$8,929.80 ","$9,020.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PXSLIM045","SUP","HCPCS C1757","","PXSLIM045  -  CATHETER DELIVERY SYSTEM 45D MICRO 2.95FR .025IN 150CM 2 TIP","BOTH IP/OP","$2,210.00 ","$1,635.40 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$460.62 ","$0.00 ","$0.00 ","$0.00 ","$2,210.00 ","$0.00 ","$1,105.00 ","$1,750.32 ","$1,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PXSLIM090","SUP","HCPCS C1757","","PXSLIM090  -  CATHETER DLV SYS 90D 0-.025IN MIC 2.6-2.95FR 150CM PX SLIM 2","BOTH IP/OP","$2,210.00 ","$1,635.40 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$460.62 ","$0.00 ","$0.00 ","$0.00 ","$2,210.00 ","$0.00 ","$1,105.00 ","$1,750.32 ","$1,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PXSLIM130","SUP","HCPCS C1757","","PXSLIM130  -  CATHETER DELIVERY SYSTEM 130D 0-.025IN MICRO 2.6-2.95FR 150","BOTH IP/OP","$2,210.00 ","$1,635.40 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$460.62 ","$0.00 ","$0.00 ","$0.00 ","$2,210.00 ","$0.00 ","$1,105.00 ","$1,750.32 ","$1,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PXSLIMSTR","SUP","HCPCS C1757","","PXSLIMSTR  -  CATHETER DLV SYS 0-.02IN MIC STRG 2.6-2.95FR .025IN 150CM PX","BOTH IP/OP","$2,210.00 ","$1,635.40 ","$0.00 ","$2,210.00 ","$0.00 ","$0.00 ","$460.62 ","$0.00 ","$0.00 ","$0.00 ","$2,210.00 ","$0.00 ","$1,105.00 ","$1,750.32 ","$1,768.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PXX52","SUP","Custom 27203010","","PXX52  -  SUTURE NONABSORBABLE THK1/16IN 2-0 V-5 30IN .25X1/8IN 2 ARM","BOTH IP/OP","$195.26 ","$144.49 ","$0.00 ","$198.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$198.19 ","$0.00 ","$99.10 ","$156.97 ","$158.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"PXX77","SUP","Custom 27203010","","PXX77  -  SUTURE NONABSORBABLE THK1/16IN 2-0 V-7 30IN .25X1/8IN 2 ARM","BOTH IP/OP","$211.39 ","$156.43 ","$0.00 ","$211.39 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$211.39 ","$0.00 ","$105.70 ","$167.42 ","$169.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Q50-65P","SUP","Custom 27204833","","Q50-65P  -  CATHETER OCL 10-50MM 65CM Q50 + BLN STNT GFT DLV FLX TP","BOTH IP/OP","$1,212.50 ","$897.25 ","$0.00 ","$1,212.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,212.50 ","$0.00 ","$606.25 ","$960.30 ","$970.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"QC-12-30-HELIX","SUP","HCPCS C2628","","QC-12-30-HELIX  -  COIL EMBL .3683MM HLX 12MM .0145IN 30CM AXIUM DTCH PLTN","BOTH IP/OP","$1,802.50 ","$1,333.85 ","$0.00 ","$1,802.50 ","$0.00 ","$0.00 ","$375.69 ","$0.00 ","$0.00 ","$0.00 ","$1,802.50 ","$0.00 ","$901.25 ","$1,427.58 ","$1,442.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"QC-12-40-3D","SUP","Custom 27803010","","QC-12-40-3D  -  COIL EMBL .3683MM 3D 12MM .0145IN 40CM AXIUM DTCH PLTN","BOTH IP/OP","$2,432.50 ","$1,800.05 ","$0.00 ","$2,432.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,432.50 ","$0.00 ","$1,216.25 ","$1,926.54 ","$1,946.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"QS70406","SUP","Custom 27203010","","QS70406  -  ADHESIVE SKIN DERMA FLEX QS","BOTH IP/OP","$40.63 ","$30.07 ","$0.00 ","$40.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.63 ","$0.00 ","$20.31 ","$32.18 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"QTX321256","SUP","Custom 27203010","","QTX321256  -  ROPE TRC 10FT STRL LF","BOTH IP/OP","$203.10 ","$150.29 ","$0.00 ","$195.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$195.78 ","$0.00 ","$97.89 ","$155.06 ","$156.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R020","SUP","HCPCS C1768","","R020  -  GRAFT SFT TIS CRYOARTERY FEM POPLT ART","BOTH IP/OP","$16,250.00 ","$12,025.00 ","$0.00 ","$16,250.00 ","$7,312.50 ","$0.00 ","$3,386.91 ","$0.00 ","$0.00 ","$2,845.25 ","$16,250.00 ","$0.00 ","$8,125.00 ","$12,870.00 ","$13,000.00 ","$0.00 ","$2,543.13 ","$0.00 ","$2,587.00 ","$0.00 "
"R0450","SUP","Custom 27203010","","CURETTE 4MM ADSP DRML LOOP TIP SURG SS STRL DISP","BOTH IP/OP","$3.75 ","$2.78 ","$0.00 ","$3.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.75 ","$0.00 ","$1.88 ","$2.97 ","$3.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R1212","SUP","Custom 27203010","","DRESSING WOUND PROCELLERA ANTIMICROBIAL 12X12","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R21121","SUP","Custom 27203010","","DISK BTYRT ESTRS M CATRRHL ID","BOTH IP/OP","$148.80 ","$110.11 ","$0.00 ","$148.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$148.80 ","$0.00 ","$74.40 ","$117.85 ","$119.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R30859602","SUP","Custom 27203010","","KIT WLCGN BCTR AG RPD LTX AGGL MCBLTST 30 TST","BOTH IP/OP","$59.03 ","$43.68 ","$0.00 ","$59.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$59.03 ","$0.00 ","$29.51 ","$46.75 ","$47.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R30950801","SUP","Custom 27203010","","REAGENT MCBL STRP GRP C LTX AGGL STREPTEX 50 TST","BOTH IP/OP","$4.05 ","$3.00 ","$0.00 ","$4.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.05 ","$0.00 ","$2.03 ","$3.21 ","$3.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R30951001","SUP","Custom 27203010","","REAGENT MCBL XTRT ENZM SPL VL STREPTEX 25 TST","BOTH IP/OP","$3.85 ","$2.85 ","$0.00 ","$3.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.85 ","$0.00 ","$1.93 ","$3.05 ","$3.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R30951201","SUP","Custom 27203010","","REAGENT MCBL STRP GRP G LTX AGGL STREPTEX 50 TST","BOTH IP/OP","$3.98 ","$2.95 ","$0.00 ","$3.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.98 ","$0.00 ","$1.99 ","$3.15 ","$3.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R314II","SUP","Custom 27203010","","CABLE EKG 3 LEAD SHLD CONNCTR .059IN","BOTH IP/OP","$172.08 ","$127.34 ","$0.00 ","$172.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$172.08 ","$0.00 ","$86.04 ","$136.29 ","$137.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R324II","SUP","Custom 27203010","","CABLE EKG 3 LEAD CONNCTR 3 SHLD .059IN","BOTH IP/OP","$186.63 ","$138.11 ","$0.00 ","$186.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$186.63 ","$0.00 ","$93.31 ","$147.81 ","$149.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R32611","SUP","Custom 27203010","","CABLE  ECG/PATIENT LIFEPACK .059IN 3 LEAD CONFIGURATION 3B C","BOTH IP/OP","$164.63 ","$121.83 ","$0.00 ","$164.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$164.63 ","$0.00 ","$82.31 ","$130.39 ","$131.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.003","SUP","Custom 27203010","","R390.003  -  DEVICE EXFIX ROD ATTCH LG EXFIX 4-6 MM SCHNZ SCR NONSTRL","BOTH IP/OP","$632.50 ","$468.05 ","$0.00 ","$632.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$632.50 ","$0.00 ","$316.25 ","$500.94 ","$506.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.005","SUP","HCPCS C1713","","CLAMP COMBO MR CONDITIONAL CNTRL EXFIXA LG NSTRL","BOTH IP/OP","$0.03 ","$0.02 ","$0.00 ","$0.03 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.03 ","$0.00 ","$0.01 ","$0.02 ","$0.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.008","SUP","HCPCS C1713","","CLAMP OPN ADJ MR CONDITIONAL CNTRL EXFIXA LG NSTRL","BOTH IP/OP","$0.03 ","$0.02 ","$0.00 ","$0.03 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.03 ","$0.00 ","$0.01 ","$0.02 ","$0.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.009","SUP","HCPCS C1713","","PIN CLMP ROD 4 PSTN ADJ CNTRL EXFIXA LG NSTRL","BOTH IP/OP","$0.03 ","$0.02 ","$0.00 ","$0.03 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.03 ","$0.00 ","$0.01 ","$0.02 ","$0.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.010","SUP","Custom 27203010","","R390.010  -  CLAMP EXFIX LG 6 PSTN PIN NONSTRL","BOTH IP/OP","$705.00 ","$521.70 ","$0.00 ","$705.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$705.00 ","$0.00 ","$352.50 ","$558.36 ","$564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.012","SUP","HCPCS C1713","","PIN 11MM ADJ CNTRL ROD POST OTRGR EXFIXA 30D NSTRL","BOTH IP/OP","$0.03 ","$0.02 ","$0.00 ","$0.03 ","$0.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.03 ","$0.00 ","$0.01 ","$0.02 ","$0.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R390.051","SUP","Custom 27203010","","R390.051  -  CLAMP EXFIX 4MM DISTAL RADL ADJ NONSTRL","BOTH IP/OP","$1,127.50 ","$834.35 ","$0.00 ","$1,127.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,127.50 ","$0.00 ","$563.75 ","$892.98 ","$902.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R394.85","SUP","Custom 27203010","","R394.85  -  ROD EXFIX 300MM 11MM CARFBR SLFDRILL MR CONDITIONAL SET","BOTH IP/OP","$355.00 ","$262.70 ","$0.00 ","$355.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$355.00 ","$0.00 ","$177.50 ","$281.16 ","$284.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R395.786","SUP","Custom 27203010","","R395.786  -  ROD EXFIX 240MM 8MM DISTAL RADL CARFBR NONSTRL","BOTH IP/OP","$232.50 ","$172.05 ","$0.00 ","$232.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$232.50 ","$0.00 ","$116.25 ","$184.14 ","$186.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"R6515-01","SUP","Custom 25803010","","R6515-01  -  SOLUTION IRR 2L LTX PHYSIOLYTE PIC 5% MNTL","BOTH IP/OP","$30.61 ","$22.65 ","$0.00 ","$30.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.61 ","$0.00 ","$15.31 ","$24.24 ","$24.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RA-04020","SUP","HCPCS C1729","","RA-04020  -  KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ","BOTH IP/OP","$39.45 ","$29.19 ","$0.00 ","$28.80 ","$15.64 ","$0.00 ","$8.22 ","$0.00 ","$0.00 ","$5.04 ","$28.80 ","$0.00 ","$14.40 ","$22.81 ","$23.04 ","$0.00 ","$4.51 ","$0.00 ","$4.58 ","$0.00 "
"RAN-811-OT","SUP","Custom 27203010","","RAN-811-OT  -  NEEDLE IO 8GA 11CM DLV OPN TIP","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RBY2C0725","SUP","Custom 27803010","","RBY2C0725  -  COIL EMBL STD .02IN 7MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG","BOTH IP/OP","$2,475.00 ","$1,831.50 ","$0.00 ","$2,475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,475.00 ","$0.00 ","$1,237.50 ","$1,960.20 ","$1,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RBY2C0825","SUP","Custom 27803010","","RBY2C0825  -  COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG","BOTH IP/OP","$2,475.00 ","$1,831.50 ","$0.00 ","$2,475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,475.00 ","$0.00 ","$1,237.50 ","$1,960.20 ","$1,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RBY2C0840","SUP","Custom 27803010","","RBY2C0840  -  COIL EMBL STD .02IN 8MM 40CM PENUMBRA COIL 400 RUBY CMPLX LG","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RBYPOD8","SUP","Custom 27803010","","RBYPOD8  -  COIL EMBL 8MM 60CM RUBY POD CMPLX OCCULUSION DEV","BOTH IP/OP","$4,475.00 ","$3,311.50 ","$0.00 ","$4,475.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,475.00 ","$0.00 ","$2,237.50 ","$3,544.20 ","$3,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RBYPODJ60","SUP","Custom 27803010","","RBYPODJ60  -  COIL EMBL J-SFT 60CM STRL LF POD PK","BOTH IP/OP","$3,225.00 ","$2,386.50 ","$0.00 ","$3,225.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,225.00 ","$0.00 ","$1,612.50 ","$2,554.20 ","$2,580.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RC-15","SUP","HCPCS C1760","","SYSTEM EMBL PRTC VC FLTR 2LVL REM 12FR RCVR CN","BOTH IP/OP","$1,312.50 ","$971.25 ","$0.00 ","$1,312.50 ","$590.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$229.81 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$205.41 ","$0.00 ","$208.95 ","$0.00 "
"RC41-12027","SUP","Custom 27203010","","RC41-12027  -  CIRCUIT BRTHG ANES HEAT WIRE 40IN NEO INF","BOTH IP/OP","$66.67 ","$49.34 ","$0.00 ","$66.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$66.67 ","$0.00 ","$33.33 ","$52.80 ","$53.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RCFW-5.0-35","SUP","HCPCS C1894","","RCFW-5.0-35  -  SET INTROD 13CM 5FR CHK-FLO PRFRMR SDARM FIT SIDE CONNECT LN","BOTH IP/OP","$47.15 ","$34.89 ","$0.00 ","$47.15 ","$25.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$8.26 ","$47.15 ","$0.00 ","$23.58 ","$37.34 ","$37.72 ","$0.00 ","$7.38 ","$0.00 ","$7.51 ","$0.00 "
"RCP3","SUP","HCPCS C1713","","RCP3  -  PLATE BN NS RADL CLMN PIN PLT 3 HL PIN CLMN RADL","BOTH IP/OP","$1,550.00 ","$1,147.00 ","$0.00 ","$1,550.00 ","$697.50 ","$0.00 ","$323.06 ","$0.00 ","$0.00 ","$271.39 ","$1,550.00 ","$0.00 ","$775.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$242.58 ","$0.00 ","$246.76 ","$0.00 "
"RCP5","SUP","HCPCS C1713","","RCP5  -  PLATE BN NS RADL CLMN PIN PLT 5 HL PIN CLMN RADL","BOTH IP/OP","$1,550.00 ","$1,147.00 ","$0.00 ","$1,550.00 ","$697.50 ","$0.00 ","$323.06 ","$0.00 ","$0.00 ","$271.39 ","$1,550.00 ","$0.00 ","$775.00 ","$1,227.60 ","$1,240.00 ","$0.00 ","$242.58 ","$0.00 ","$246.76 ","$0.00 "
"RF-310F","SUP","HCPCS C1760","","SYSTEM EMBL PRTC 48CM VC FLTR FEM DLV KT 7FR G2","BOTH IP/OP","$2,750.00 ","$2,035.00 ","$0.00 ","$2,750.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$481.50 ","$2,750.00 ","$0.00 ","$1,375.00 ","$2,178.00 ","$2,200.00 ","$0.00 ","$430.38 ","$0.00 ","$437.80 ","$0.00 "
"RFP-400","SUP","Custom 25003010","","SOLUTION DLYST 140 MEQ NA 2 MEQ K 3 MEQ CALCIUM 1 MEQ MG 111","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RFP-401","SUP","Custom 25003010","","SOLUTION DLYST 140 MEQ NA 4 MEQ K 3 MEQ CALCIUM 1 MEQ MG 113","BOTH IP/OP","$118.75 ","$87.88 ","$0.00 ","$118.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$118.75 ","$0.00 ","$59.38 ","$94.05 ","$95.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RG*ES1818SP","SUP","HCPCS C1769","","RG*ES1818SP  -  GUIDEWIRE VASCULAR STR .018IN 180CM 25CM SHAPEABLE SHAFT","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$215.84 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"RG*GA1818SP","SUP","HCPCS C1769","","RG*GA1818SP  -  GUIDEWIRE VASCULAR 45D .018IN 180CM 25CM GLIDEWIRE GT HYDPHI","BOTH IP/OP","$46.50 ","$34.41 ","$0.00 ","$43.00 ","$23.35 ","$0.00 ","$9.69 ","$0.00 ","$0.00 ","$7.53 ","$43.00 ","$0.00 ","$21.50 ","$34.06 ","$34.40 ","$0.00 ","$6.73 ","$0.00 ","$6.85 ","$0.00 "
"RH1","SUP","Custom 27203010","","RH1  -  HANDLE INST RUBY DTCH COIL","BOTH IP/OP","$595.00 ","$440.30 ","$0.00 ","$595.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$595.00 ","$0.00 ","$297.50 ","$471.24 ","$476.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RL-3019-S","SUP","HCPCS C1713","","RL-3019-S  -  ROD ORTH 190MM 3MM LEFT RADL WR HND RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RL-3021-S","SUP","HCPCS C1713","","RL-3021-S  -  ROD ORTH 210MM 3MM LEFT RADL WR HND RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RL-3023-S","SUP","HCPCS C1713","","RL-3023-S  -  ROD ORTH 230MM 3MM LEFT RADL WR HND TI RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RL-3619-S","SUP","HCPCS C1713","","RL-3619-S  -  ROD ORTH 190MM 3.6MM LEFT RADL FRARM RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RL-3621-S","SUP","HCPCS C1713","","RL-3621-S  -  ROD ORTH 210MM 3.6MM LEFT DISTAL RADL FRARM RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RL-3623-S","SUP","HCPCS C1713","","RL-3623-S  -  ROD ORTH 230MM 3.6MM LEFT RADL FRARM RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RMT3130","SUP","Custom 27203010","","RMT3130  -  REAMER SURG 3.1MM THDL ROD SYS WR HND 300MM STRL","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RMT-3130","SUP","Custom 27203010","","RMT-3130  -  REAMER SURG 3.1MM THDL ROD SYS WR HND 300MM STRL","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RMT-3137","SUP","Custom 27203010","","RMT-3137  -  REAMER SRG 3.7MM THDL DISP FRARM ROD SYS","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RMT3730","SUP","Custom 27203010","","RMT3730  -  REAMER SURG 3.7MM THDL WR HND DISP","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RMT7340","SUP","Custom 27203010","","RMT7340  -  REAMER SURG 7.3MM THDL 400MM","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RMT8340","SUP","Custom 27203010","","RMT8340  -  REAMER SURG 8.3MM THDL 400MM","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RPC-35-260","SUP","HCPCS C1769","","RPC-35-260  -  GWIRE VASC .035IN 260CM ANG STD TPR STF SHFT EXCH RDRR PC","BOTH IP/OP","$81.40 ","$60.24 ","$0.00 ","$81.40 ","$44.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$14.25 ","$81.40 ","$0.00 ","$40.70 ","$64.47 ","$65.12 ","$0.00 ","$12.74 ","$0.00 ","$12.96 ","$0.00 "
"RR-3019-S","SUP","HCPCS C1713","","RR-3019-S  -  ROD ORTH 190MM 3MM RIGHT RADL WR HND RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RR-3021-S","SUP","HCPCS C1713","","RR-3021-S  -  ROD ORTH 210MM 3MM RIGHT RADL WR HND RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RR-3023-S","SUP","HCPCS C1713","","RR-3023-S  -  ROD ORTH 230MM 3MM RIGHT RADL FRARM RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RR-3619-S","SUP","HCPCS C1713","","RR-3619-S  -  ROD RADIUS 3.6MM 90MM RIGHT","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RR-3621-S","SUP","HCPCS C1713","","RR-3621-S  -  ROD RADIUS 3.6MM 210MM RIGHT","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RR-3623-S","SUP","HCPCS C1713","","RR-3623-S  -  ROD ORTH 230MM 3.6MM RIGHT RADL WR HND RAD IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"RRT08030040L","SUP","HCPCS C1768","","RRT08030040L  -  GRAFT VASCULAR THIN WALL RING STANDARD 8MM 40CM 30CM","BOTH IP/OP","$1,830.00 ","$1,354.20 ","$0.00 ","$1,830.00 ","$823.50 ","$0.00 ","$381.42 ","$0.00 ","$0.00 ","$320.42 ","$1,830.00 ","$0.00 ","$915.00 ","$1,449.36 ","$1,464.00 ","$0.00 ","$286.40 ","$0.00 ","$291.34 ","$0.00 "
"RRT08070070L","SUP","HCPCS C1768","","RRT08070070L  -  GRAFT VASCULAR THIN WALL RING 8MM 70CM 70CM GORE-TEX","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"RRT10030030L","SUP","HCPCS C1768","","RRT10030030L  -  GRAFT VASCULAR THIN WALL 10MM 30CM 30CM REMOVABLE RING LINE","BOTH IP/OP","$2,302.50 ","$1,703.85 ","$0.00 ","$2,302.50 ","$1,036.13 ","$0.00 ","$479.90 ","$0.00 ","$0.00 ","$403.15 ","$2,302.50 ","$0.00 ","$1,151.25 ","$1,823.58 ","$1,842.00 ","$0.00 ","$360.34 ","$0.00 ","$366.56 ","$0.00 "
"RRT10070070L","SUP","HCPCS C1768","","RRT10070070L  -  GRAFT VASCULAR THIN WALL 10MM 70CM 70CM REMOVABLE RING LINE","BOTH IP/OP","$3,002.50 ","$2,221.85 ","$0.00 ","$3,002.50 ","$1,351.13 ","$0.00 ","$625.80 ","$0.00 ","$0.00 ","$525.71 ","$3,002.50 ","$0.00 ","$1,501.25 ","$2,377.98 ","$2,402.00 ","$0.00 ","$469.89 ","$0.00 ","$478.00 ","$0.00 "
"RS22","SUP","Custom 27203010","","RS22  -  SUTURE NONABSORBABLE 5MM CTX 12IN 2 ARM MERSILENE WHITE","BOTH IP/OP","$80.02 ","$59.21 ","$0.00 ","$81.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$81.22 ","$0.00 ","$40.61 ","$64.33 ","$64.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RS317","SUP","Custom 27203010","","CABLE  ECG/PATIENT 3 LEAD FOR SRS SERIES HP 345P","BOTH IP/OP","$93.75 ","$69.38 ","$0.00 ","$93.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$93.75 ","$0.00 ","$46.88 ","$74.25 ","$75.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RSB501","SUP","HCPCS C1894","","RSB501  -  INTRODUCER SHTH 5FR 6CM 2.5CM PNCL RADOPQ DIL NO MN GW","BOTH IP/OP","$62.88 ","$46.53 ","$0.00 ","$46.88 ","$25.45 ","$0.00 ","$13.10 ","$0.00 ","$0.00 ","$8.21 ","$46.88 ","$0.00 ","$23.44 ","$37.13 ","$37.50 ","$0.00 ","$7.34 ","$0.00 ","$7.46 ","$0.00 "
"RSB502","SUP","HCPCS C1894","","RSB502  -  INTRODUCER SHTH 5FR 10CM 2.5CM PNCL RADOPQ DIL NO MN GW","BOTH IP/OP","$68.50 ","$50.69 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$14.28 ","$0.00 ","$0.00 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"RSB503","SUP","HCPCS C1894","","RSB503  -  INTRODUCER SHTH 5FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"RSB602","SUP","HCPCS C1894","","RSB602  -  INTRODUCER SHTH 6FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST","BOTH IP/OP","$68.50 ","$50.69 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$14.28 ","$0.00 ","$0.00 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"RSB603","SUP","HCPCS C1894","","RSB603  -  INTRODUCER SHTH 6FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"RSB702","SUP","HCPCS C1894","","RSB702  -  INTRODUCER SHTH 7FR 2.5CM 10CM DILAT RADIOPQ MRKR","BOTH IP/OP","$68.50 ","$50.69 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$14.28 ","$0.00 ","$0.00 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"RSB703","SUP","HCPCS C1894","","RSB703  -  INTRODUCER SHTH 7FR 2.5CM 25CM DILAT RADIOPQ MRKR","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"RSB802","SUP","HCPCS C1894","","RSB802  -  INTRODUCER SHTH 8FR 2.5CM 10CM GWIRE DILAT RADIOPQ","BOTH IP/OP","$68.50 ","$50.69 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$14.28 ","$0.00 ","$0.00 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"RSB803","SUP","HCPCS C1894","","RSB803  -  INTRODUCER SHTH 8FR 2.5CM 25CM DILAT RADIOPQ MRKR","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"RSB902","SUP","HCPCS C1894","","RSB902  -  INTRODUCER SHTH 9FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST","BOTH IP/OP","$68.50 ","$50.69 ","$0.00 ","$53.50 ","$29.05 ","$0.00 ","$14.28 ","$0.00 ","$0.00 ","$9.37 ","$53.50 ","$0.00 ","$26.75 ","$42.37 ","$42.80 ","$0.00 ","$8.37 ","$0.00 ","$8.52 ","$0.00 "
"RSB903","SUP","HCPCS C1894","","RSB903  -  INTRODUCER SHTH 9FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST","BOTH IP/OP","$87.15 ","$64.49 ","$0.00 ","$65.00 ","$35.30 ","$0.00 ","$18.16 ","$0.00 ","$0.00 ","$11.38 ","$65.00 ","$0.00 ","$32.50 ","$51.48 ","$52.00 ","$0.00 ","$10.17 ","$0.00 ","$10.35 ","$0.00 "
"RSR01","SUP","HCPCS C1887","","RSR01  -  INTROD SHTH 6FR 45CM GUID STR XCUT VLV PN DSTN HYDPHI PTFE","BOTH IP/OP","$261.25 ","$193.33 ","$0.00 ","$206.70 ","$112.24 ","$0.00 ","$54.45 ","$0.00 ","$0.00 ","$36.19 ","$206.70 ","$0.00 ","$103.35 ","$163.71 ","$165.36 ","$0.00 ","$32.35 ","$0.00 ","$32.91 ","$0.00 "
"RSR02","SUP","HCPCS C1887","","RSR02  -  SHEATH GD HS CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS NYL","BOTH IP/OP","$261.25 ","$193.33 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$54.45 ","$0.00 ","$0.00 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"RSR14","SUP","HCPCS C1894","","RSR14  -  SHEATH GD LIMA CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS","BOTH IP/OP","$261.25 ","$193.33 ","$0.00 ","$205.00 ","$111.32 ","$0.00 ","$54.45 ","$0.00 ","$0.00 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"RSS001","SUP","HCPCS C1894","","RSS001  -  INTRODUCER SHEATH .035IN 10FR 10CM 2.5CM GWIRE DILAT KINK","BOTH IP/OP","$27.18 ","$20.11 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$5.66 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"RSS005","SUP","HCPCS C1894","","RSS005  -  INTRODUCER SHEATH 10FR 25CM 2.5CM DILAT KINK RESISTANT","BOTH IP/OP","$59.38 ","$43.94 ","$0.00 ","$49.88 ","$27.08 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$8.73 ","$49.88 ","$0.00 ","$24.94 ","$39.50 ","$39.90 ","$0.00 ","$7.81 ","$0.00 ","$7.94 ","$0.00 "
"RSS503","SUP","HCPCS C1894","","RSS503  -  SHEATH INTRO 5FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038","BOTH IP/OP","$27.18 ","$20.11 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$5.66 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"RSS505","SUP","HCPCS C1894","","RSS505  -  SHEATH INTRO 5FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE","BOTH IP/OP","$59.38 ","$43.94 ","$0.00 ","$49.88 ","$27.08 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$8.73 ","$49.88 ","$0.00 ","$24.94 ","$39.50 ","$39.90 ","$0.00 ","$7.81 ","$0.00 ","$7.94 ","$0.00 "
"RSS601","SUP","HCPCS C1894","","RSS601  -  INTRODUCER SHEATH .035IN 6FR 10CM 2.5CM MINI GWIRE DILAT","BOTH IP/OP","$27.18 ","$20.11 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$5.66 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"RSS603","SUP","HCPCS C1894","","RSS603  -  SHEATH INTRO 6FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038","BOTH IP/OP","$271.75 ","$201.10 ","$0.00 ","$218.75 ","$118.78 ","$0.00 ","$56.64 ","$0.00 ","$0.00 ","$38.30 ","$218.75 ","$0.00 ","$109.38 ","$173.25 ","$175.00 ","$0.00 ","$34.23 ","$0.00 ","$34.83 ","$0.00 "
"RSS605","SUP","HCPCS C1894","","RSS605  -  INTRODUCER SHEATH .035IN 6FR 25CM 2.5CM GWIRE DILAT KINK","BOTH IP/OP","$59.38 ","$43.94 ","$0.00 ","$49.88 ","$27.08 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$8.73 ","$49.88 ","$0.00 ","$24.94 ","$39.50 ","$39.90 ","$0.00 ","$7.81 ","$0.00 ","$7.94 ","$0.00 "
"RSS606","SUP","HCPCS C1894","","RSS606  -  INTRODUCER SHEATH 6FR 25CM 2.5CM DILAT KINK RESISTANT","BOTH IP/OP","$42.88 ","$31.73 ","$0.00 ","$42.88 ","$23.28 ","$0.00 ","$8.94 ","$0.00 ","$0.00 ","$7.51 ","$42.88 ","$0.00 ","$21.44 ","$33.96 ","$34.30 ","$0.00 ","$6.71 ","$0.00 ","$6.83 ","$0.00 "
"RSS705","SUP","HCPCS C1894","","RSS705  -  SHEATH INTRO 7FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE","BOTH IP/OP","$593.75 ","$439.38 ","$0.00 ","$498.75 ","$270.82 ","$0.00 ","$123.75 ","$0.00 ","$0.00 ","$87.33 ","$498.75 ","$0.00 ","$249.38 ","$395.01 ","$399.00 ","$0.00 ","$78.05 ","$0.00 ","$79.40 ","$0.00 "
"RSS706","SUP","HCPCS C1894","","RSS706  -  INTRODUCER SHEATH 7FR 25CM 2.5CM DILAT KINK RESISTANT SMOOTH","BOTH IP/OP","$42.88 ","$31.73 ","$0.00 ","$42.88 ","$23.28 ","$0.00 ","$8.94 ","$0.00 ","$0.00 ","$7.51 ","$42.88 ","$0.00 ","$21.44 ","$33.96 ","$34.30 ","$0.00 ","$6.71 ","$0.00 ","$6.83 ","$0.00 "
"RSS803","SUP","HCPCS C1894","","RSS803  -  INTRODUCER SHEATH .035IN 8FR 10CM 2.5CM DILAT KINK RESISTANT","BOTH IP/OP","$27.18 ","$20.11 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$5.66 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"RSS805","SUP","HCPCS C1894","","RSS805  -  INTRODUCER SHTH 8FR 25CM 2.5CM PNCL DIL MN GW KINK RST PERI","BOTH IP/OP","$59.38 ","$43.94 ","$0.00 ","$49.88 ","$27.08 ","$0.00 ","$12.38 ","$0.00 ","$0.00 ","$8.73 ","$49.88 ","$0.00 ","$24.94 ","$39.50 ","$39.90 ","$0.00 ","$7.81 ","$0.00 ","$7.94 ","$0.00 "
"RSS903","SUP","HCPCS C1894","","RSS903  -  SHEATH INTROD .038IN 9FR 10CM 2.5CM GWIRE DILAT KINK","BOTH IP/OP","$27.18 ","$20.11 ","$0.00 ","$21.88 ","$11.88 ","$0.00 ","$5.66 ","$0.00 ","$0.00 ","$3.83 ","$21.88 ","$0.00 ","$10.94 ","$17.33 ","$17.50 ","$0.00 ","$3.42 ","$0.00 ","$3.48 ","$0.00 "
"RSZ-3004","SUP","Custom 27203010","","RSZ-3004  -  SIZER IMPL P4.5CM HI PRFL RND 11.1CM 300ML STRL MEMORYGEL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RSZ-3504","SUP","Custom 27203010","","RSZ-3504  -  SIZER IMPL P4.8CM HI PRFL RND 11.7CM 350ML STRL MEMORYGEL","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RSZ-8004","SUP","Custom 27803010","","RSZ-8004  -  SIZER IMPL P6CM HI PRFL RND 15.5CM 800ML STRL MEMORYGEL GEL","BOTH IP/OP","$2,325.00 ","$1,720.50 ","$0.00 ","$2,325.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,325.00 ","$0.00 ","$1,162.50 ","$1,841.40 ","$1,860.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RT500-853","SUP","Custom 27203010","","CIRCUIT BRTHG HEAT RESP PORTLESS WYE PRLL WIRE CSTM 5FT ADLT","BOTH IP/OP","$31.25 ","$23.13 ","$0.00 ","$31.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$31.25 ","$0.00 ","$15.63 ","$24.75 ","$25.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"RU510418","SUP","HCPCS C1758","","RU510418  -  CATHETER URETHERAL SZ 18","BOTH IP/OP","$7.51 ","$5.56 ","$0.00 ","$7.51 ","$4.08 ","$0.00 ","$1.57 ","$0.00 ","$0.00 ","$1.31 ","$7.51 ","$0.00 ","$3.76 ","$5.95 ","$6.01 ","$0.00 ","$1.18 ","$0.00 ","$1.20 ","$0.00 "
"RU510420","SUP","HCPCS C1729","","RU510420  -  CATHETER ROBINSON URETHERAL SZ 20","BOTH IP/OP","$7.81 ","$5.78 ","$0.00 ","$7.81 ","$4.24 ","$0.00 ","$1.63 ","$0.00 ","$0.00 ","$1.37 ","$7.81 ","$0.00 ","$3.90 ","$6.19 ","$6.25 ","$0.00 ","$1.22 ","$0.00 ","$1.24 ","$0.00 "
"RV80510","SUP","HCPCS C1725","","RV80510  -  CATHETER BLNDIL 5MM 80CM 10CM RIVAL CK 2 LUM TPR TIP LOPRFL","BOTH IP/OP","$575.00 ","$425.50 ","$0.00 ","$575.00 ","$312.23 ","$0.00 ","$119.84 ","$0.00 ","$0.00 ","$100.68 ","$575.00 ","$0.00 ","$287.50 ","$455.40 ","$460.00 ","$0.00 ","$89.99 ","$0.00 ","$91.54 ","$0.00 "
"S0412-00","SUP","Custom 27203010","","KIT FTL MTRN BLOOD HMTLTST 950ML 300 TST","BOTH IP/OP","$625.25 ","$462.69 ","$0.00 ","$625.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$625.25 ","$0.00 ","$312.63 ","$495.20 ","$500.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-0793-HA42","SUP","Custom 27803010","","S-0793-HA42  -  CUP ACETAB 42MM 22MM CEMENTED ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-0793-HA46","SUP","Custom 27803010","","S-0793-HA46  -  CUP ACETAB 46MM 22MM CEMENTED ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-0793-HA50","SUP","Custom 27803010","","S-0793-HA50  -  CUP ACETAB 50MM 22MM CEMENTED ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-0793-HA54","SUP","Custom 27803010","","S-0793-HA54  -  CUP ACETAB 54MM 22MM CEMENTED ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-0793-HA58","SUP","Custom 27803010","","S-0793-HA58  -  CUP ACETAB 58MM 22MM CEMENTED ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S0809","SUP","Custom 27203010","","REAGENT AB DILU DAKO 125ML INVIT DX IMMUN","BOTH IP/OP","$162.20 ","$120.03 ","$0.00 ","$162.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.20 ","$0.00 ","$81.10 ","$128.46 ","$129.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S100000","SUP","Custom 27203010","","S100000  -  NEEDLE INSFL 14GA 100MM STP TROC BLDLS RADL EXPANDABLE SLV","BOTH IP/OP","$111.14 ","$82.24 ","$0.00 ","$40.37 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.37 ","$0.00 ","$20.19 ","$31.97 ","$32.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-101","SUP","HCPCS C1763","","S-101  -  GRAFT SFT TIS 3X3IN MEDISKIN PIG DRML CLGN MTRX SHT","BOTH IP/OP","$321.00 ","$237.54 ","$0.00 ","$321.00 ","$144.45 ","$0.00 ","$66.90 ","$0.00 ","$0.00 ","$56.20 ","$321.00 ","$0.00 ","$160.50 ","$254.23 ","$256.80 ","$0.00 ","$50.24 ","$0.00 ","$51.10 ","$0.00 "
"S1020GH","SUP","HCPCS C1884","","S1020GH  -  PARTICLES EMBL 900-1200UM MCSPH 1ML PUR EMBSPH PREFL SYR","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"S-104","SUP","HCPCS C1763","","S-104  -  DRESSING WND .25SQ FT PRCN","BOTH IP/OP","$175.78 ","$130.08 ","$0.00 ","$175.78 ","$79.10 ","$0.00 ","$36.64 ","$0.00 ","$0.00 ","$30.78 ","$175.78 ","$0.00 ","$87.89 ","$139.22 ","$140.62 ","$0.00 ","$27.51 ","$0.00 ","$27.98 ","$0.00 "
"S1-1500U","SUP","Custom 27803010","","S1-1500U  -  STENT LCRML DCT .64MM 40MM STRL MN MNK DIL PLG INSRTR SIL","BOTH IP/OP","$145.83 ","$107.91 ","$0.00 ","$145.83 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$145.83 ","$0.00 ","$72.92 ","$115.50 ","$116.67 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH22","SUP","Custom 27803010","","S-1399-HH22  -  HEAD FEM HIP MRS TPR INTLK ION","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH31","SUP","Custom 27803010","","S-1399-HH31  -  HEAD FEM HIP MRS TPR INTLK ION","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH32","SUP","Custom 27803010","","S-1399-HH32  -  HEAD FEM HIP MRS TPR INTLK ION","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH34","SUP","Custom 27803010","","S-1399-HH34  -  HEAD FEM 34MM HIP MRS TPR INTLK","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH62","SUP","Custom 27803010","","S-1399-HH62  -  HEAD FEM 62MM HIP MRS TPR INTLK","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH64","SUP","Custom 27803010","","S-1399-HH64  -  HEAD FEM 64MM HIP MRS TPR INTLK","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH82","SUP","Custom 27803010","","S-1399-HH82  -  HEAD FEM 82MM HIP MRS TPR INTLK","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH83","SUP","Custom 27803010","","S-1399-HH83  -  HEAD FEM 83MM HIP MRS TPR INTLK ION","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1399-HH84","SUP","Custom 27803010","","S-1399-HH84  -  HEAD FEM 84MM HIP MRS TPR INTLK","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH22","SUP","Custom 27803010","","S-1400-HH22  -  HEAD FEMORAL +2.5MM C TAPER 22MM LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH31","SUP","Custom 27803010","","S-1400-HH31  -  HEAD FEM -2.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH32","SUP","Custom 27803010","","S-1400-HH32  -  HEAD FEMORAL +2.5MM 32MM C TAPER NECK PRIM LFIT TRIDENT COCR","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH34","SUP","Custom 27803010","","S-1400-HH34  -  HEAD FEM +7.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH62","SUP","Custom 27803010","","S-1400-HH62  -  HEAD FEMORAL +2.5MM 26MM C TAPER INTERLOK LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH64","SUP","Custom 27803010","","S-1400-HH64  -  HEAD FEMORAL +7.5MM 26MM C TAPER INTERLOK LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH82","SUP","Custom 27803010","","S-1400-HH82  -  HEAD FEMORAL +2.5MM OFFST C TAPER 28MM LFIT TRIDENT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1400-HH84","SUP","Custom 27803010","","S-1400-HH84  -  HEAD FEMORAL C TAPER INTERLOCK LFIT COCR HIP","BOTH IP/OP","$862.50 ","$638.25 ","$0.00 ","$862.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$862.50 ","$0.00 ","$431.25 ","$683.10 ","$690.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1539-HA46","SUP","Custom 27803010","","S-1539-HA46  -  CUP ACETAB 26MM ODC ALPLY","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1539-HA50","SUP","Custom 27803010","","S-1539-HA50  -  CUP ACETAB 50MM 26MM ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1539-HA54","SUP","Custom 27803010","","S-1539-HA54  -  CUP ACETAB 54MM 26MM ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1539-HA58","SUP","Custom 27803010","","S-1539-HA58  -  CUP ACETAB 58MM 26MM ODC ALL POLY HIP","BOTH IP/OP","$822.00 ","$608.28 ","$0.00 ","$822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$822.00 ","$0.00 ","$411.00 ","$651.02 ","$657.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-1645-HF01","SUP","HCPCS C1776","","S-1645-HF01  -  STEM FEM MOD HYDRXAPT 1 HIP","BOTH IP/OP","$5,300.00 ","$3,922.00 ","$0.00 ","$5,300.00 ","$2,385.00 ","$0.00 ","$1,104.65 ","$0.00 ","$0.00 ","$927.99 ","$5,300.00 ","$0.00 ","$2,650.00 ","$4,197.60 ","$4,240.00 ","$0.00 ","$829.45 ","$0.00 ","$843.76 ","$0.00 "
"S1699","SUP","Custom 27203010","","REAGENT TRGT RTRVL SOL 500ML CONCEN IMMUN","BOTH IP/OP","$773.05 ","$572.06 ","$0.00 ","$773.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$773.05 ","$0.00 ","$386.53 ","$612.26 ","$618.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S17-45","SUP","Custom 27803010","","S17-45  -  GRAFT ENDOVASCULAR SHEATH ABDOMINAL AORTIC ANEURYSM","BOTH IP/OP","$1,247.50 ","$923.15 ","$0.00 ","$1,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,247.50 ","$0.00 ","$623.75 ","$988.02 ","$998.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S195","SUP","Custom 27203010","","STAIN GMS 8OZ STK SOL HMTL","BOTH IP/OP","$246.25 ","$182.23 ","$0.00 ","$246.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$246.25 ","$0.00 ","$123.13 ","$195.03 ","$197.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S1967","SUP","Custom 27203010","","REAGENT CLEAN SOL DAB-AWAY 1.25L HMTL","BOTH IP/OP","$347.30 ","$257.00 ","$0.00 ","$347.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$347.30 ","$0.00 ","$173.65 ","$275.06 ","$277.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S20SFRN8","SUP","Custom 27803010","","S20SFRN8  -  CLIP SHRT INTNL UCLP FLXB REG NDL","BOTH IP/OP","$6,210.00 ","$4,595.40 ","$0.00 ","$6,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,210.00 ","$0.00 ","$3,105.00 ","$4,918.32 ","$4,968.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2646","SUP","Custom 27803010","","S-2301-2646  -  INSERT ACETAB 46-48MM 26MM 10D KNEE ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2648","SUP","Custom 27803010","","S-2301-2648  -  INSERT ACETAB 48MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2650","SUP","Custom 27803010","","S-2301-2650  -  INSERT ACETAB 50-52MM 26MM 10D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2652","SUP","Custom 27803010","","S-2301-2652  -  INSERT ACETAB 52MM 26MM 10D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2654","SUP","Custom 27803010","","S-2301-2654  -  INSERT ACETAB 54-56MM 26MM 10D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2656","SUP","Custom 27803010","","S-2301-2656  -  INSERT ACETAB 56MM 26MM 10D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2658","SUP","Custom 27803010","","S-2301-2658  -  INSERT ACETAB 58-60MM 26MM 10D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2662","SUP","Custom 27803010","","S-2301-2662  -  INSERT ACETAB 61-72MM 26MM 10D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2846","SUP","Custom 27803010","","S-2301-2846  -  INSERT ACETAB 46-48MM 28MM 10D ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2848","SUP","Custom 27803010","","S-2301-2848  -  INSERT ACETAB 48MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2850","SUP","Custom 27803010","","S-2301-2850  -  INSERT ACETAB 50MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2852","SUP","Custom 27803010","","S-2301-2852  -  INSERT ACETAB 52MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2854","SUP","Custom 27803010","","S-2301-2854  -  INSERT ACETAB 54MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2856","SUP","Custom 27803010","","S-2301-2856  -  INSERT ACETAB 56MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2858","SUP","Custom 27803010","","S-2301-2858  -  INSERT ACETAB 58-60MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2862","SUP","Custom 27803010","","S-2301-2862  -  INSERT ACETAB 61-72MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2866","SUP","Custom 27803010","","S-2301-2866  -  INSERT ACETAB 66-68MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2870","SUP","Custom 27803010","","S-2301-2870  -  INSERT ACETAB 70-72MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-2874","SUP","Custom 27803010","","S-2301-2874  -  INSERT ACETAB 74MM 28MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3250","SUP","Custom 27803010","","S-2301-3250  -  INSERT ACETAB 50-52MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3252","SUP","Custom 27803010","","S-2301-3252  -  INSERT ACETAB 52MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3254","SUP","Custom 27803010","","S-2301-3254  -  INSERT ACETAB 54-56MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3256","SUP","Custom 27803010","","S-2301-3256  -  INSERT ACETAB 56MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3258","SUP","Custom 27803010","","S-2301-3258  -  INSERT ACETAB 58-60MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3262","SUP","Custom 27803010","","S-2301-3262  -  INSERT ACETAB 61-72MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3266","SUP","Custom 27803010","","S-2301-3266  -  INSERT ACETAB 66-68MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3270","SUP","Custom 27803010","","S-2301-3270  -  INSERT ACETAB 70-72MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301-3274","SUP","Custom 27803010","","S-2301-3274  -  INSERT ACETAB 74MM 32MM 10D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2846","SUP","Custom 27803010","","S-2301C-2846  -  INSERT ACETAB 10D 46MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2848","SUP","Custom 27803010","","S-2301C-2848  -  INSERT ACETAB 10D 48MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2850","SUP","Custom 27803010","","S-2301C-2850  -  INSERT ACETAB 10D 50MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2852","SUP","Custom 27803010","","S-2301C-2852  -  INSERT ACETAB 10D 52MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2854","SUP","Custom 27803010","","S-2301C-2854  -  INSERT ACETAB 10D 54MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2856","SUP","Custom 27803010","","S-2301C-2856  -  INSERT ACETAB 10D 56MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2858","SUP","Custom 27803010","","S-2301C-2858  -  INSERT ACETAB 10D 58-60MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2862","SUP","Custom 27803010","","S-2301C-2862  -  INSERT ACETAB 10D 62MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2866","SUP","Custom 27803010","","S-2301C-2866  -  INSERT ACETAB 10D 66MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2870","SUP","Custom 27803010","","S-2301C-2870  -  INSERT ACETAB 10D 70MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-2874","SUP","Custom 27803010","","S-2301C-2874  -  INSERT ACETAB 10D 74MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3250","SUP","Custom 27803010","","S-2301C-3250  -  INSERT ACETAB 10D 50MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3252","SUP","Custom 27803010","","S-2301C-3252  -  INSERT ACETAB 10D 52MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3254","SUP","Custom 27803010","","S-2301C-3254  -  INSERT ACETAB 10D 54MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3256","SUP","Custom 27803010","","S-2301C-3256  -  INSERT ACETAB 10D 56MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3258","SUP","Custom 27803010","","S-2301C-3258  -  INSERT ACETAB 10D 58-60MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3262","SUP","Custom 27803010","","S-2301C-3262  -  INSERT ACETAB 10D 62MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3266","SUP","Custom 27803010","","S-2301C-3266  -  INSERT ACETAB 10D 66MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3270","SUP","Custom 27803010","","S-2301C-3270  -  INSERT ACETAB 10D 70MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2301C-3274","SUP","Custom 27803010","","S-2301C-3274  -  INSERT ACETAB 74MM 32MM 10D HIP ECNTRC OMFT","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2646","SUP","Custom 27803010","","S-2302-2646  -  INSERT ACETAB 46-48MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2648","SUP","Custom 27803010","","S-2302-2648  -  INSERT ACETAB 48MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2650","SUP","Custom 27803010","","S-2302-2650  -  INSERT ACETAB 50-52MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2652","SUP","Custom 27803010","","S-2302-2652  -  INSERT ACETAB 52MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2654","SUP","Custom 27803010","","S-2302-2654  -  INSERT ACETAB 54-56MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2656","SUP","Custom 27803010","","S-2302-2656  -  INSERT ACETAB 56MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2658","SUP","Custom 27803010","","S-2302-2658  -  INSERT ACETAB 58-60MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2662","SUP","Custom 27803010","","S-2302-2662  -  INSERT ACETAB 61-72MM 26MM 20D HIP ECNTRC","BOTH IP/OP","$2,299.38 ","$1,701.54 ","$0.00 ","$2,299.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,299.38 ","$0.00 ","$1,149.69 ","$1,821.11 ","$1,839.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2846","SUP","Custom 27803010","","S-2302-2846  -  INSERT ACETAB 46-48MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2848","SUP","Custom 27803010","","S-2302-2848  -  INSERT ACETAB 48MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2850","SUP","Custom 27803010","","S-2302-2850  -  INSERT ACETAB 50-52MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2852","SUP","Custom 27803010","","S-2302-2852  -  INSERT ACETAB 52MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2854","SUP","Custom 27803010","","S-2302-2854  -  INSERT ACETAB 54-56MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2856","SUP","Custom 27803010","","S-2302-2856  -  INSERT ACETAB 56MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2858","SUP","Custom 27803010","","S-2302-2858  -  INSERT ACETAB 58-60MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2862","SUP","Custom 27803010","","S-2302-2862  -  INSERT ACETAB 61-72MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2866","SUP","Custom 27803010","","S-2302-2866  -  INSERT ACETAB 66-68MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2870","SUP","Custom 27803010","","S-2302-2870  -  INSERT ACETAB 70-72MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-2874","SUP","Custom 27803010","","S-2302-2874  -  INSERT ACETAB 74MM 28MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3250","SUP","Custom 27803010","","S-2302-3250  -  INSERT ACETAB 50-52MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3252","SUP","Custom 27803010","","S-2302-3252  -  INSERT ACETAB 52MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3254","SUP","Custom 27803010","","S-2302-3254  -  INSERT ACETAB 54-56MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3256","SUP","Custom 27803010","","S-2302-3256  -  INSERT ACETAB 56MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3258","SUP","Custom 27803010","","S-2302-3258  -  INSERT ACETAB 58-60MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3262","SUP","Custom 27803010","","S-2302-3262  -  INSERT ACETAB 61-72MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3266","SUP","Custom 27803010","","S-2302-3266  -  INSERT ACETAB 66-68MM 32MM 20D HIP ECNTRC","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3270","SUP","Custom 27803010","","S-2302-3270  -  INSERT ACETAB 70-72MM 32MM 20D ECNTRC 8MM","BOTH IP/OP","$2,125.50 ","$1,572.87 ","$0.00 ","$2,125.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,125.50 ","$0.00 ","$1,062.75 ","$1,683.40 ","$1,700.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302-3274","SUP","Custom 27803010","","S-2302-3274  -  INSERT ACETAB 74MM 32MM HIP ECNTRC","BOTH IP/OP","$1,421.88 ","$1,052.19 ","$0.00 ","$1,421.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,421.88 ","$0.00 ","$710.94 ","$1,126.13 ","$1,137.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2846","SUP","Custom 27803010","","S-2302C-2846  -  INSERT ACETAB 20D 46MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2848","SUP","Custom 27803010","","S-2302C-2848  -  INSERT ACETAB 20D 48MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2850","SUP","Custom 27803010","","S-2302C-2850  -  INSERT ACETAB 20D 50MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2852","SUP","Custom 27803010","","S-2302C-2852  -  INSERT ACETAB 20D 52MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2854","SUP","Custom 27803010","","S-2302C-2854  -  INSERT ACETAB 20D 54MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2856","SUP","Custom 27803010","","S-2302C-2856  -  INSERT ACETAB 20D 56MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2858","SUP","Custom 27803010","","S-2302C-2858  -  INSERT ACETAB 20D 58MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2862","SUP","Custom 27803010","","S-2302C-2862  -  INSERT ACETAB 20D 62MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2866","SUP","Custom 27803010","","S-2302C-2866  -  INSERT ACETAB 20D 66MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2870","SUP","Custom 27803010","","S-2302C-2870  -  INSERT ACETAB 20D 70MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-2874","SUP","Custom 27803010","","S-2302C-2874  -  INSERT ACETAB 20D 74MM 28MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3250","SUP","Custom 27803010","","S-2302C-3250  -  INSERT ACETAB 20D 50MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3252","SUP","Custom 27803010","","S-2302C-3252  -  INSERT ACETAB 20D 52MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3254","SUP","Custom 27803010","","S-2302C-3254  -  INSERT ACETAB 20D 54MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3256","SUP","Custom 27803010","","S-2302C-3256  -  INSERT ACETAB 20D 56MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3258","SUP","Custom 27803010","","S-2302C-3258  -  INSERT ACETAB 20D 58MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3262","SUP","Custom 27803010","","S-2302C-3262  -  INSERT ACETAB 20D 62MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3266","SUP","Custom 27803010","","S-2302C-3266  -  INSERT ACETAB 20D 66MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3270","SUP","Custom 27803010","","S-2302C-3270  -  INSERT ACETAB 20D 70MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2302C-3274","SUP","Custom 27803010","","S-2302C-3274  -  INSERT ACETAB 20D 74MM 32MM ECCENTRIC XFIRE HIP","BOTH IP/OP","$3,105.00 ","$2,297.70 ","$0.00 ","$3,105.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,105.00 ","$0.00 ","$1,552.50 ","$2,459.16 ","$2,484.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2337-HF04","SUP","HCPCS C1776","","S-2337-HF04  -  STEM FEMORAL 4 100MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF05","SUP","HCPCS C1776","","S-2337-HF05  -  STEM FEMORAL 5 110MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF06","SUP","HCPCS C1776","","S-2337-HF06  -  STEM FEMORAL 6 COLLARED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF07","SUP","HCPCS C1776","","S-2337-HF07  -  STEM FEMORAL 7 COLLARED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF08","SUP","HCPCS C1776","","S-2337-HF08  -  STEM FEMORAL 8 COLLARED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF09","SUP","HCPCS C1776","","S-2337-HF09  -  STEM FEMORAL COLLARED ARC DEPOSITED SECFIT HYDRXAPT","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF10","SUP","HCPCS C1776","","S-2337-HF10  -  STEM FEMORAL 10 COLLARED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF11","SUP","HCPCS C1776","","S-2337-HF11  -  STEM FEMORAL 11 COLLARED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF12","SUP","HCPCS C1776","","S-2337-HF12  -  STEM FEMORAL 12 COLLAR ARC DEPOSITED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF13","SUP","HCPCS C1776","","S-2337-HF13  -  STEM FEMORAL 13 COLLARED ARC DEPOSITED SECFIT HYDRXAPT HIP","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S-2337-HF14","SUP","HCPCS C1776","","S-2337-HF14  -  STEM FEMORAL 14 180MM COLLAR ARC PRESS FIT SECFIT HA","BOTH IP/OP","$5,180.00 ","$3,833.20 ","$0.00 ","$5,180.00 ","$2,331.00 ","$0.00 ","$1,079.64 ","$0.00 ","$0.00 ","$906.98 ","$5,180.00 ","$0.00 ","$2,590.00 ","$4,102.56 ","$4,144.00 ","$0.00 ","$810.67 ","$0.00 ","$824.66 ","$0.00 "
"S2368","SUP","Custom 27203010","","REAGENT TRIS EDTA BUFF 500ML PH 9 TRGT RTRVL SOL HISTOLGY","BOTH IP/OP","$243.68 ","$180.32 ","$0.00 ","$243.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$243.68 ","$0.00 ","$121.84 ","$192.99 ","$194.94 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S2369","SUP","Custom 27203010","","REAGENT TRGT RTRVL SOL CITR 500ML PH 6 CONCEN HISTOLGY","BOTH IP/OP","$1,109.15 ","$820.77 ","$0.00 ","$1,109.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,109.15 ","$0.00 ","$554.58 ","$878.45 ","$887.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-2651-0711","SUP","HCPCS C1776","","S-2651-0711  -  NECK FEMORAL 7 -5MM STR 11MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-0713","SUP","HCPCS C1776","","S-2651-0713  -  NECK FEMORAL 7 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-0812","SUP","HCPCS C1776","","S-2651-0812  -  NECK FEMORAL 8 -5MM STR 12MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-0814","SUP","HCPCS C1776","","S-2651-0814  -  NECK FEMORAL 8 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-0913","SUP","HCPCS C1776","","S-2651-0913  -  NECK FEMORAL 9 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-0915","SUP","HCPCS C1776","","S-2651-0915  -  STEM FEMORAL 9 -5MM STR 15MM 155MM REDUCE NECK RSTOR HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-1014","SUP","HCPCS C1776","","S-2651-1014  -  NECK FEMORAL 10 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-1016","SUP","HCPCS C1776","","S-2651-1016  -  NECK FEMORAL 10 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-1115","SUP","HCPCS C1776","","S-2651-1115  -  NECK FEMORAL 11 -5MM STR 15MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-1117","SUP","HCPCS C1776","","S-2651-1117  -  NECK FEMORAL 11 -5MM STR 17MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-1216","SUP","HCPCS C1776","","S-2651-1216  -  NECK FEMORAL 12 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2651-1218","SUP","HCPCS C1776","","S-2651-1218  -  NECK FEMORAL 12 -5MM STR 18MM 155MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$11,937.50 ","$8,833.75 ","$0.00 ","$11,937.50 ","$5,371.88 ","$0.00 ","$2,488.07 ","$0.00 ","$0.00 ","$2,090.16 ","$11,937.50 ","$0.00 ","$5,968.75 ","$9,454.50 ","$9,550.00 ","$0.00 ","$1,868.22 ","$0.00 ","$1,900.45 ","$0.00 "
"S-2652-0812","SUP","HCPCS C1776","","S-2652-0812  -  NECK FEMORAL 8 -5MM STR 12MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-0814","SUP","HCPCS C1776","","S-2652-0814  -  NECK FEMORAL 8 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-0913","SUP","HCPCS C1776","","S-2652-0913  -  NECK FEMORAL 9 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-0915","SUP","HCPCS C1776","","S-2652-0915  -  NECK FEMORAL 9 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1014","SUP","HCPCS C1776","","S-2652-1014  -  NECK FEMORAL 10 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1016","SUP","HCPCS C1776","","S-2652-1016  -  NECK FEMORAL 10 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1115","SUP","HCPCS C1776","","S-2652-1115  -  NECK FEMORAL 11 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1117","SUP","HCPCS C1776","","S-2652-1117  -  STEM FEMORAL 11 -5MM STR 17MM 205MM REDUCE NECK RSTOR HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1216","SUP","HCPCS C1776","","S-2652-1216  -  NECK FEMORAL 12 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1218","SUP","HCPCS C1776","","S-2652-1218  -  STEM FEMORAL 12 -5MM STR 18MM 205MM REDUCE NECK RSTOR HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1317","SUP","HCPCS C1776","","S-2652-1317  -  NECK FEMORAL 17 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1319","SUP","HCPCS C1776","","S-2652-1319  -  NECK FEMORAL 13 -5MM STR 19MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1418","SUP","HCPCS C1776","","S-2652-1418  -  NECK FEMORAL 14 -5MM STR 18MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1420","SUP","HCPCS C1776","","S-2652-1420  -  NECK FEMORAL 14 -5MM STR 20MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2652-1422","SUP","HCPCS C1776","","S-2652-1422  -  NECK FEMORAL 14 -5MM STR 22MM 205MM REDUCE RSTOR TITANIUM HA","BOTH IP/OP","$12,645.00 ","$9,357.30 ","$0.00 ","$12,645.00 ","$5,690.25 ","$0.00 ","$2,635.53 ","$0.00 ","$0.00 ","$2,214.04 ","$12,645.00 ","$0.00 ","$6,322.50 ","$10,014.84 ","$10,116.00 ","$0.00 ","$1,978.94 ","$0.00 ","$2,013.08 ","$0.00 "
"S-2653-0812-L","SUP","HCPCS C1776","","S-2653-0812-L  -  STEM FEM LEFT HIP 255MM 12-8MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-0812-R","SUP","HCPCS C1776","","S-2653-0812-R  -  STEM FEM RIGHT HIP 255MM 12-8MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-0913-L","SUP","HCPCS C1776","","S-2653-0913-L  -  STEM FEM LEFT HIP 255MM 13-9MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-0913-R","SUP","HCPCS C1776","","S-2653-0913-R  -  STEM FEM RIGHT HIP 255MM 13-9MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1014-L","SUP","HCPCS C1776","","S-2653-1014-L  -  STEM FEM LEFT HIP 255MM 14-10MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1014-R","SUP","HCPCS C1776","","S-2653-1014-R  -  STEM FEM RIGHT HIP 255MM 14-10MM STR DISTAL SLOT RED NECK","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1115-L","SUP","HCPCS C1776","","S-2653-1115-L  -  STEM FEM LEFT HIP 255MM 15-11MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1115-R","SUP","HCPCS C1776","","S-2653-1115-R  -  STEM FEM RIGHT HIP 255MM 15-11MM STR DISTAL SLOT RED NECK","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1216-L","SUP","HCPCS C1776","","S-2653-1216-L  -  STEM FEM LEFT HIP 255MM 16-12MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1216-R","SUP","HCPCS C1776","","S-2653-1216-R  -  STEM FEM RIGHT HIP 255MM 16-12MM STR DISTAL SLOT RED NECK","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1317-L","SUP","HCPCS C1776","","S-2653-1317-L  -  STEM FEM LEFT HIP 255MM 17-13MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1317-R","SUP","HCPCS C1776","","S-2653-1317-R  -  STEM FEM RIGHT HIP 255MM 17-13MM STR DISTAL SLOT RED NECK","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1418-L","SUP","HCPCS C1776","","S-2653-1418-L  -  STEM FEM LEFT HIP 255MM 18-14MM STR DISTAL SLOT RED NECK REV","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2653-1418-R","SUP","HCPCS C1776","","S-2653-1418-R  -  STEM FEM RIGHT HIP 255MM 18-14MM STR DISTAL SLOT RED NECK","BOTH IP/OP","$13,222.63 ","$9,784.75 ","$0.00 ","$13,222.63 ","$5,950.18 ","$0.00 ","$2,755.93 ","$0.00 ","$0.00 ","$2,315.18 ","$13,222.63 ","$0.00 ","$6,611.31 ","$10,472.32 ","$10,578.10 ","$0.00 ","$2,069.34 ","$0.00 ","$2,105.04 ","$0.00 "
"S-2722-2210","SUP","Custom 27803010","","S-2722-2210  -  HEAD FEM HIP MRS TPR COCR LFIT","BOTH IP/OP","$1,147.00 ","$848.78 ","$0.00 ","$1,147.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,147.00 ","$0.00 ","$573.50 ","$908.42 ","$917.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S2801","SUP","Custom 27203010","","CONTROL PASCAL QUAL STRP HISTOLGY","BOTH IP/OP","$302.50 ","$223.85 ","$0.00 ","$302.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$302.50 ","$0.00 ","$151.25 ","$239.58 ","$242.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S3006","SUP","Custom 27203010","","REAGENT WSH BUFF DUOCISH 1L IMMUN 10X","BOTH IP/OP","$192.45 ","$142.41 ","$0.00 ","$192.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$192.45 ","$0.00 ","$96.23 ","$152.42 ","$153.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S302030-2","SUP","Custom 27203010","","ENZYME LAB PRTNS K PREDIL 110ML","BOTH IP/OP","$890.68 ","$659.10 ","$0.00 ","$890.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$890.68 ","$0.00 ","$445.34 ","$705.42 ","$712.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S3417","SUP","Custom 27203010","","LABEL SLD RL RBN CLEAN PEN KT SEYMOUR","BOTH IP/OP","$1,058.50 ","$783.29 ","$0.00 ","$1,058.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,058.50 ","$0.00 ","$529.25 ","$838.33 ","$846.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S3425","SUP","Custom 27203010","","VIAL STN REAGENT","BOTH IP/OP","$156.73 ","$115.98 ","$0.00 ","$156.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$156.73 ","$0.00 ","$78.36 ","$124.13 ","$125.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S420GH","SUP","HCPCS C1884","","S420GH  -  PARTICLES EMBOLIZATION 300-500UM MICROSPHERE .038IN PREFILL","BOTH IP/OP","$607.50 ","$449.55 ","$0.00 ","$607.50 ","$273.38 ","$0.00 ","$126.62 ","$0.00 ","$0.00 ","$106.37 ","$607.50 ","$0.00 ","$303.75 ","$481.14 ","$486.00 ","$0.00 ","$95.07 ","$0.00 ","$96.71 ","$0.00 "
"S-55-150-120-P6","SUP","HCPCS C1876","","S-55-150-120-P6  -  STENT VASCULAR 5.5MM 6FR 150MM 120CM OTW SELF EXPANDABLE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"S620GH/C","SUP","HCPCS C1884","","S620GH/C  -  PARTICLES EMBL 500-700UM RND 2ML 20ML RD STRL EMBSPH SAL SYR","BOTH IP/OP","$515.00 ","$381.10 ","$0.00 ","$515.00 ","$231.75 ","$0.00 ","$107.34 ","$0.00 ","$0.00 ","$90.17 ","$515.00 ","$0.00 ","$257.50 ","$407.88 ","$412.00 ","$0.00 ","$80.60 ","$0.00 ","$81.99 ","$0.00 "
"S-65-080-120-P6","SUP","HCPCS C1876","","S-65-080-120-P6  -  STENT VASCULAR 6.5MM 6FR 80MM 120CM OTW SELF EXPANDABLE","BOTH IP/OP","$2,062.50 ","$1,526.25 ","$0.00 ","$2,062.50 ","$928.13 ","$0.00 ","$429.88 ","$0.00 ","$0.00 ","$361.13 ","$2,062.50 ","$0.00 ","$1,031.25 ","$1,633.50 ","$1,650.00 ","$0.00 ","$322.78 ","$0.00 ","$328.35 ","$0.00 "
"S7150","SUP","Custom 27203010","","REAGENT TSTK XP FRML 3 SET HISTOLGY","BOTH IP/OP","$660.00 ","$488.40 ","$0.00 ","$660.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$660.00 ","$0.00 ","$330.00 ","$522.72 ","$528.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S7439-12","SUP","Custom 27203010","","STAIN CLRFR 2 4GL HPRFR WKG SOL RA HEMATOX CYTO","BOTH IP/OP","$58.28 ","$43.13 ","$0.00 ","$58.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$58.28 ","$0.00 ","$29.14 ","$46.16 ","$46.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S7439-3","SUP","Custom 27203010","","STAIN HMTX 2 4PT HPRFR HISTOLGY","BOTH IP/OP","$67.03 ","$49.60 ","$0.00 ","$67.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$67.03 ","$0.00 ","$33.51 ","$53.09 ","$53.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S7439-33","SUP","Custom 27203010","","STAIN MOD HRS HMTX 1GL HG FR WKG SOL HISTOLGY","BOTH IP/OP","$209.35 ","$154.92 ","$0.00 ","$209.35 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$209.35 ","$0.00 ","$104.68 ","$165.81 ","$167.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S7439-39","SUP","Custom 27203010","","STAIN MOD PAP OG-6 1GL CYTO","BOTH IP/OP","$187.10 ","$138.45 ","$0.00 ","$187.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$187.10 ","$0.00 ","$93.55 ","$148.18 ","$149.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S7439-4","SUP","Custom 27203010","","STAIN EOSIN Y 4PT HPRFR WKG SOL HISTOLGY","BOTH IP/OP","$242.15 ","$179.19 ","$0.00 ","$242.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$242.15 ","$0.00 ","$121.08 ","$191.78 ","$193.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S7439-7A","SUP","Custom 27203010","","STAIN BLUING SGNTR 1GL WKG SOL REAGENT HMTL","BOTH IP/OP","$99.58 ","$73.69 ","$0.00 ","$99.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$99.58 ","$0.00 ","$49.79 ","$78.87 ","$79.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S820GH","SUP","HCPCS C1884","","S820GH  -  PARTICLES EMBL 700-900UM MCSPH 2ML GRN EMBSPH PREFL SYR","BOTH IP/OP","$607.50 ","$449.55 ","$0.00 ","$515.00 ","$231.75 ","$0.00 ","$126.62 ","$0.00 ","$0.00 ","$90.17 ","$515.00 ","$0.00 ","$257.50 ","$407.88 ","$412.00 ","$0.00 ","$80.60 ","$0.00 ","$81.99 ","$0.00 "
"SA30AT.100","SUP","HCPCS V2632","","SA30AT.100  -  LENS IOL 0 D +10 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.105","SUP","HCPCS V2632","","SA30AT.105  -  LENS IOL 0 D +10.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.110","SUP","HCPCS V2632","","SA30AT.110  -  LENS IOL 0 D +11 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.115","SUP","HCPCS V2632","","SA30AT.115  -  LENS IOL 0 D +11.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.120","SUP","HCPCS V2632","","SA30AT.120  -  LENS IOL 0 D +12 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.125","SUP","HCPCS V2632","","SA30AT.125  -  LENS IOL 0 D +12.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.130","SUP","HCPCS V2632","","SA30AT.130  -  LENS IOL 0 D +13 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.135","SUP","HCPCS V2632","","SA30AT.135  -  LENS IOL 0 D +13.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.140","SUP","HCPCS V2632","","SA30AT.140  -  LENS IOL 0 D +14 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.145","SUP","HCPCS V2632","","SA30AT.145  -  LENS IOL 0 D +14.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.150","SUP","HCPCS V2632","","SA30AT.150  -  LENS IOL 0 D +15 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.155","SUP","HCPCS V2632","","SA30AT.155  -  LENS IOL 0 D +15.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.160","SUP","HCPCS V2632","","SA30AT.160  -  LENS IOL 0 D +16 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.165","SUP","HCPCS V2632","","SA30AT.165  -  LENS IOL 0 D +16.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.170","SUP","HCPCS V2632","","SA30AT.170  -  LENS IOL 0 D +17 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.175","SUP","HCPCS V2632","","SA30AT.175  -  LENS IOL 0 D +17.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.180","SUP","HCPCS V2632","","SA30AT.180  -  LENS IOL 0 D +18 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.185","SUP","HCPCS V2632","","SA30AT.185  -  LENS IOL 0 D +18.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.190","SUP","HCPCS V2632","","SA30AT.190  -  LENS IOL 0 D +19 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.195","SUP","HCPCS V2632","","SA30AT.195  -  LENS IOL 0 D +19.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.200","SUP","HCPCS V2632","","SA30AT.200  -  LENS IOL 0 D +20 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.205","SUP","HCPCS V2632","","SA30AT.205  -  LENS IOL 0 D +20.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.210","SUP","HCPCS V2632","","SA30AT.210  -  LENS IOL 0 D +21 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.215","SUP","HCPCS V2632","","SA30AT.215  -  LENS IOL 0 D +21.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.220","SUP","HCPCS V2632","","SA30AT.220  -  LENS IOL 0 D +22 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.225","SUP","HCPCS V2632","","SA30AT.225  -  LENS IOL 0 D +22.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.230","SUP","HCPCS V2632","","SA30AT.230  -  LENS IOL 0 D +23 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.235","SUP","HCPCS V2632","","SA30AT.235  -  LENS IOL 0 D +23.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.240","SUP","HCPCS V2632","","SA30AT.240  -  LENS IOL 0 D +24 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.245","SUP","HCPCS V2632","","SA30AT.245  -  LENS IOL 0 D +24.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.250","SUP","HCPCS V2632","","SA30AT.250  -  LENS IOL 0 D +25 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.255","SUP","HCPCS V2632","","SA30AT.255  -  LENS IOL 0 D +25.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.260","SUP","HCPCS V2632","","SA30AT.260  -  LENS IOL 0 D +26 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.265","SUP","HCPCS V2632","","SA30AT.265  -  LENS IOL 0 D +26.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.270","SUP","HCPCS V2632","","SA30AT.270  -  LENS IOL 0 D +27 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.275","SUP","HCPCS V2632","","SA30AT.275  -  LENS IOL 0 D +27.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.280","SUP","HCPCS V2632","","SA30AT.280  -  LENS IOL 0 D +28 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.285","SUP","HCPCS V2632","","SA30AT.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.290","SUP","HCPCS V2632","","SA30AT.290  -  LENS IOL 0 D +29 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.295","SUP","HCPCS V2632","","SA30AT.295  -  LENS IOL 0 D +29.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA30AT.300","SUP","HCPCS V2632","","SA30AT.300  -  LENS IOL 0 D +30 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA4644","SUP","Custom 27203010","","BLADDER TOP CCB SA4694","BOTH IP/OP","$716.08 ","$529.90 ","$0.00 ","$716.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$716.08 ","$0.00 ","$358.04 ","$567.14 ","$572.86 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SA4645","SUP","Custom 27203010","","BLADDER BOTTOM CCB SA4645","BOTH IP/OP","$733.23 ","$542.59 ","$0.00 ","$733.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$733.23 ","$0.00 ","$366.61 ","$580.72 ","$586.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SA4901","SUP","Custom 27203010","","FOAM CCB #SA4901","BOTH IP/OP","$171.38 ","$126.82 ","$0.00 ","$171.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$171.38 ","$0.00 ","$85.69 ","$135.73 ","$137.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SA60AT.290","SUP","HCPCS V2632","","SA60AT.290  -  LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60AT.310","SUP","HCPCS V2632","","SA60AT.310  -  LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60AT.350","SUP","HCPCS V2632","","SA60AT.350  -  LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60AT.360","SUP","HCPCS V2632","","SA60AT.360  -  LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60AT.370","SUP","HCPCS V2632","","SA60AT.370  -  LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60AT.380","SUP","HCPCS V2632","","SA60AT.380  -  LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60AT.390","SUP","HCPCS V2632","","SA60AT.390  -  LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60AT.400","SUP","HCPCS V2632","","SA60AT.400  -  LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$375.00 ","$277.50 ","$0.00 ","$375.00 ","$168.75 ","$0.00 ","$78.16 ","$0.00 ","$0.00 ","$65.66 ","$375.00 ","$0.00 ","$187.50 ","$297.00 ","$300.00 ","$0.00 ","$58.69 ","$0.00 ","$59.70 ","$0.00 "
"SA60WF","SUP","HCPCS V2632","","SA60WF  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SA60WF.060","SUP","HCPCS V2632","","SA60WF.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.065","SUP","HCPCS V2632","","SA60WF.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.070","SUP","HCPCS V2632","","SA60WF.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.075","SUP","HCPCS V2632","","SA60WF.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.080","SUP","HCPCS V2632","","SA60WF.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.085","SUP","HCPCS V2632","","SA60WF.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.090","SUP","HCPCS V2632","","SA60WF.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.095","SUP","HCPCS V2632","","SA60WF.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.100","SUP","HCPCS V2632","","SA60WF.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.105","SUP","HCPCS V2632","","SA60WF.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.110","SUP","HCPCS V2632","","SA60WF.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.115","SUP","HCPCS V2632","","SA60WF.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.120","SUP","HCPCS V2632","","SA60WF.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.125","SUP","HCPCS V2632","","SA60WF.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.130","SUP","HCPCS V2632","","SA60WF.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.135","SUP","HCPCS V2632","","SA60WF.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.140","SUP","HCPCS V2632","","SA60WF.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.145","SUP","HCPCS V2632","","SA60WF.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.150","SUP","HCPCS V2632","","SA60WF.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.155","SUP","HCPCS V2632","","SA60WF.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.160","SUP","HCPCS V2632","","SA60WF.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.165","SUP","HCPCS V2632","","SA60WF.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.170","SUP","HCPCS V2632","","SA60WF.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM CLR STRL LF ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.175","SUP","HCPCS V2632","","SA60WF.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.180","SUP","HCPCS V2632","","SA60WF.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.185","SUP","HCPCS V2632","","SA60WF.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.190","SUP","HCPCS V2632","","SA60WF.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.195","SUP","HCPCS V2632","","SA60WF.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.200","SUP","HCPCS V2632","","SA60WF.200  -  LENS IOL 0 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM 1","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.205","SUP","HCPCS V2632","","SA60WF.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.210","SUP","HCPCS V2632","","SA60WF.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.215","SUP","HCPCS V2632","","SA60WF.215  -  LENS IOL 0 D +21.5 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.220","SUP","HCPCS V2632","","SA60WF.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.225","SUP","HCPCS V2632","","SA60WF.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.230","SUP","HCPCS V2632","","SA60WF.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.235","SUP","HCPCS V2632","","SA60WF.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.240","SUP","HCPCS V2632","","SA60WF.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.245","SUP","HCPCS V2632","","SA60WF.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.250","SUP","HCPCS V2632","","SA60WF.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.255","SUP","HCPCS V2632","","SA60WF.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.260","SUP","HCPCS V2632","","SA60WF.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.265","SUP","HCPCS V2632","","SA60WF.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.270","SUP","HCPCS V2632","","SA60WF.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.275","SUP","HCPCS V2632","","SA60WF.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.280","SUP","HCPCS V2632","","SA60WF.280  -  LENS IOL 0 D +28 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.285","SUP","HCPCS V2632","","SA60WF.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.290","SUP","HCPCS V2632","","SA60WF.290  -  LENS IOL 0 D +29 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.295","SUP","HCPCS V2632","","SA60WF.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA60WF.300","SUP","HCPCS V2632","","SA60WF.300  -  LENS IOL 0 D +30 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF","BOTH IP/OP","$335.00 ","$247.90 ","$0.00 ","$335.00 ","$150.75 ","$0.00 ","$69.82 ","$0.00 ","$0.00 ","$58.66 ","$335.00 ","$0.00 ","$167.50 ","$265.32 ","$268.00 ","$0.00 ","$52.43 ","$0.00 ","$53.33 ","$0.00 "
"SA8630","SUP","Custom 27203010","","COVER MATTRESS /5J:4K","BOTH IP/OP","$919.10 ","$680.13 ","$0.00 ","$919.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$919.10 ","$0.00 ","$459.55 ","$727.93 ","$735.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SAK 4689","SUP","Custom 27203010","","BLADE MCTM ACED LOW PROFILE","BOTH IP/OP","$580.05 ","$429.24 ","$0.00 ","$580.05 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$580.05 ","$0.00 ","$290.03 ","$459.40 ","$464.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SAX02D","SUP","HCPCS C1768","","SAX02D  -  GRAFT VASC 90CM 8MM GRTX AXLBFM STRCH REM RING THNWL INTGR","BOTH IP/OP","$6,235.00 ","$4,613.90 ","$0.00 ","$6,235.00 ","$2,805.75 ","$0.00 ","$1,299.53 ","$0.00 ","$0.00 ","$1,091.70 ","$6,235.00 ","$0.00 ","$3,117.50 ","$4,938.12 ","$4,988.00 ","$0.00 ","$975.78 ","$0.00 ","$992.61 ","$0.00 "
"SB6AL10","SUP","HCPCS C1887","","CATHETER GUID AL1 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6AL10SH","SUP","HCPCS C1887","","CATHETER GUID AL1 CURVE 6FR SH SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6AL20","SUP","HCPCS C1887","","CATHETER GUID AL2 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6AL20SH","SUP","HCPCS C1887","","CATHETER GUID AL2 CURVE 6FR SH SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6AL75","SUP","HCPCS C1887","","CATHETER GUID AL7.5 CURVE 6FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6AR10","SUP","HCPCS C1887","","CATHETER GUID AR1 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6EBU35","SUP","HCPCS C1887","","CATHETER GUID XB3.5 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6HS1","SUP","HCPCS C1887","","CATHETER GUID HS1 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6HS1SH","SUP","HCPCS C1887","","SA6MP1  -  CATHETER GUIDING SHERPA NX, 6FRX 100CM MP1","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$23.45 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6JL35","SUP","HCPCS C1887","","CATHETER GUID JL3.5 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6JL40","SUP","HCPCS C1887","","CATHETER GUID JL4 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6JL40SH","SUP","HCPCS C1887","","CATHETER GUID JL4 CURVE 6FR 100CM SH SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6JR35","SUP","HCPCS C1887","","CATHETER GUID JR3.5 CURVE 6FR SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB6JR40","SUP","HCPCS C1887","","CATHETER GUID JR4 CURVE 6FR SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB6JR40SH","SUP","HCPCS C1887","","CATHETER GUID JR4 CURVE 6FR SH SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7AL10","SUP","HCPCS C1887","","CATHETER GUID AL1 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7AL20","SUP","HCPCS C1887","","CATHETER GUID AL2 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7AL75","SUP","HCPCS C1887","","CATHETER GUID AL.75 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7AR10","SUP","HCPCS C1887","","CATHETER GUID AR1 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7AR10SH","SUP","HCPCS C1887","","CATHETER GUID AR1 CURVE 7FR 100CM SH SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7EBU30","SUP","HCPCS C1887","","CATHETER GUID XB3 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7EBU35","SUP","HCPCS C1887","","CATHETER GUID XB3.5 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7EBU40","SUP","HCPCS C1887","","CATHETER GUID XB4 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7HS1","SUP","HCPCS C1887","","CATHETER GUIDING VISTA BRITE TIP 7FR X .078IN HS","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7HS1SH","SUP","HCPCS C1887","","CATHETER GUID HS1 CURVE 7FR SH SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7IMA","SUP","HCPCS C1887","","CATHETER GUID IM CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7IMASH","SUP","HCPCS C1887","","CATHETER GUID IM CURVE 7FR 100CM SH SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7JL35","SUP","HCPCS C1887","","CATHETER GUID JL3.5 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7JL40","SUP","HCPCS C1887","","CATHETER GUID JL4 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7JL40SH","SUP","HCPCS C1887","","CATHETER GUID JL4 CURVE 7FR 100CM SH SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7JL50","SUP","HCPCS C1887","","CATHETER GUID JL5 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7JR35","SUP","HCPCS C1887","","CATHETER GUID JR3.5 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB7JR40","SUP","HCPCS C1887","","CATHETER GUID JR4 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7JR4SH","SUP","HCPCS C1887","","CATHETER GUIDING VISTA BRITE TIP 7FR X 100CM JR4 SH","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7JR50","SUP","HCPCS C1887","","CATHETER GUID JR5 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7LCB","SUP","HCPCS C1887","","CATHETER GUID LCB CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB7MP1","SUP","HCPCS C1887","","CATHETER GUID MP1 CURVE 7FR 100CM SHR NX BAL","BOTH IP/OP","$112.50 ","$83.25 ","$0.00 ","$112.50 ","$61.09 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$19.70 ","$112.50 ","$0.00 ","$56.25 ","$89.10 ","$90.00 ","$0.00 ","$17.61 ","$0.00 ","$17.91 ","$0.00 "
"SB8AL20","SUP","HCPCS C1887","","CATHETER GUID AL2 CURVE 8FR 100CM CORON SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SB8EBU40","SUP","HCPCS C1887","","CATHETER GUID XB4 CURVE 8FR 100CM CORON SHR NX BAL","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SBFS045","SUP","Custom 27203010","","SBFS045  -  KIT TRMA FX 1.1MM .045IN SBFS","BOTH IP/OP","$1,015.00 ","$751.10 ","$0.00 ","$1,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,015.00 ","$0.00 ","$507.50 ","$803.88 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SBFS062","SUP","Custom 27203010","","SBFS062  -  KIT IM NL .062IN SLT AWL LK DV BNDRG TL CAP SM BN FX SYS","BOTH IP/OP","$1,015.00 ","$751.10 ","$0.00 ","$1,015.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,015.00 ","$0.00 ","$507.50 ","$803.88 ","$812.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SBM-4963","SUP","HCPCS C1765","","SBM-4963  -  BLANKET SECTION MED (MUST ORDER MIN 4 BX, MED OR SM)","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$0.00 ","$0.00 "
"SBRAR20","SUP","HCPCS C1887","","CATHETER GUIDING VISTA BRITE TIP 7FR X 100CM AR2","BOTH IP/OP","$125.00 ","$92.50 ","$0.00 ","$125.00 ","$67.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$21.89 ","$125.00 ","$0.00 ","$62.50 ","$99.00 ","$100.00 ","$0.00 ","$19.56 ","$0.00 ","$19.90 ","$0.00 "
"SBT1602D","SUP","HCPCS C1768","","SBT1602D  -  GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 16MM 8MM 50","BOTH IP/OP","$2,852.50 ","$2,110.85 ","$0.00 ","$2,852.50 ","$1,283.63 ","$0.00 ","$594.53 ","$0.00 ","$0.00 ","$499.45 ","$2,852.50 ","$0.00 ","$1,426.25 ","$2,259.18 ","$2,282.00 ","$0.00 ","$446.42 ","$0.00 ","$454.12 ","$0.00 "
"SBT1802D","SUP","HCPCS C1768","","SBT1802D  -  GRAFT VASC STD WL THNWL 2 BRCH 18MM 9MM 50CM STRL STRCH GRTX","BOTH IP/OP","$2,852.50 ","$2,110.85 ","$0.00 ","$2,852.50 ","$1,283.63 ","$0.00 ","$594.53 ","$0.00 ","$0.00 ","$499.45 ","$2,852.50 ","$0.00 ","$1,426.25 ","$2,259.18 ","$2,282.00 ","$0.00 ","$446.42 ","$0.00 ","$454.12 ","$0.00 "
"SBT2002D","SUP","HCPCS C1768","","SBT2002D  -  GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 20MM 10MM 50","BOTH IP/OP","$2,852.50 ","$2,110.85 ","$0.00 ","$2,852.50 ","$1,283.63 ","$0.00 ","$594.53 ","$0.00 ","$0.00 ","$499.45 ","$2,852.50 ","$0.00 ","$1,426.25 ","$2,259.18 ","$2,282.00 ","$0.00 ","$446.42 ","$0.00 ","$454.12 ","$0.00 "
"SC-1110-02","SUP","HCPCS L8688","","SC-1110-02  -  NEUROSTIMULATOR IMPLTABLE PRCS PLS GNTR SC-1110","BOTH IP/OP","$36,900.00 ","$27,306.00 ","$0.00 ","$36,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$36,900.00 ","$0.00 ","$18,450.00 ","$29,224.80 ","$29,520.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SC-2218-50","SUP","Custom 27203010","","KIT STM 50CM LINEAR 8 CNTCT LEAD","BOTH IP/OP","$4,780.00 ","$3,537.20 ","$0.00 ","$4,780.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,780.00 ","$0.00 ","$2,390.00 ","$3,785.76 ","$3,824.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SC-4385-50","SUP","Custom 27203010","","SC-4385-50  -  KIT STM 50CM STY CAP","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SC-4400","SUP","HCPCS L8688","","SC-4400  -  NEUROSTIMULATOR IMPLTABLE PLS GNTR PLG PORT","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SC-5500-2","SUP","Custom 27203010","","KIT STM PRCS LINEAR PT PRGMR NEUROMASCULAR","BOTH IP/OP","$2,380.00 ","$1,761.20 ","$0.00 ","$2,380.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,380.00 ","$0.00 ","$1,190.00 ","$1,884.96 ","$1,904.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SC-6412","SUP","Custom 27203010","","KIT STM SPNL CORD CHRGR ONLY","BOTH IP/OP","$5,980.00 ","$4,425.20 ","$0.00 ","$5,980.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$5,980.00 ","$0.00 ","$2,990.00 ","$4,736.16 ","$4,784.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SCD13","SUP","Custom 27011340","","SCD13  -  DISSECTOR LAPSCOP US HNDPC 13CM SONICISION DISP","BOTH IP/OP","$4,777.50 ","$3,535.35 ","$0.00 ","$4,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,777.50 ","$0.00 ","$2,388.75 ","$3,783.78 ","$3,822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SCD26","SUP","Custom 27011340","","SCD26  -  DISSECTOR ENDSCP STR JAW HND SWCH CRDLS US 26CM 5","BOTH IP/OP","$4,777.50 ","$3,535.35 ","$0.00 ","$4,777.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,777.50 ","$0.00 ","$2,388.75 ","$3,783.78 ","$3,822.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SCREWTEST","SUP","HCPCS C1713","","SCREWTEST  -  SCREW SUPPLY TEST NEW ITEM","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$0.00 ","$0.00 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"SD242.003","SUP","HCPCS C1713","","SD242.003  -  PLATE BN STRG 170MM NS LCP SS WRST 2.4MM SCR","BOTH IP/OP","$7,192.50 ","$5,322.45 ","$0.00 ","$7,192.50 ","$3,236.63 ","$0.00 ","$1,499.10 ","$0.00 ","$0.00 ","$1,259.35 ","$7,192.50 ","$0.00 ","$3,596.25 ","$5,696.46 ","$5,754.00 ","$0.00 ","$1,125.63 ","$0.00 ","$1,145.05 ","$0.00 "
"SE5423WV","SUP","Custom 27203010","","SE5423WV  -  PACK 23 GA POSTERIOR WIDE-FIELD ELITE","BOTH IP/OP","$887.50 ","$656.75 ","$0.00 ","$887.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$887.50 ","$0.00 ","$443.75 ","$702.90 ","$710.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SE5425WVB","SUP","Custom 27203010","","SE5425WVB  -  PACK VITRTM 25GA STRL LF STELLARIS ELT 2 BLDE CTR W FLD POST","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SE5427MVB","SUP","Custom 27203010","","SE5427MVB  -  PACK 27 GA. BI-BLADE VITREOUS CUTTER POSTERIOR MID-FIELD STE","BOTH IP/OP","$987.50 ","$730.75 ","$0.00 ","$987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$987.50 ","$0.00 ","$493.75 ","$782.10 ","$790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SECOC 28/28","SUP","Custom 27803010","","SECOC 28/28  -  OUTER SMALL FRAGMENT CLAMP","BOTH IP/OP","$537.50 ","$397.75 ","$0.00 ","$537.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.50 ","$0.00 ","$268.75 ","$425.70 ","$430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SECURADRMMEM","SUP","HCPCS C1721","","SECURADRMMEM  -  SECURA DR SYSTEM (INCLUDING DF4 HEADER)","BOTH IP/OP","$49,812.50 ","$36,861.25 ","$0.00 ","$49,812.50 ","$22,415.63 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$49,812.50 ","$0.00 ","$24,906.25 ","$39,451.50 ","$39,850.00 ","$0.00 ","$7,751.33 ","$0.00 ","$7,930.15 ","$0.00 "
"SECURAVREMEM","SUP","HCPCS C1721","","SECURAVREMEM  -  SECURA VR SYSTEM (INCLUDING DF4 HEADER)","BOTH IP/OP","$43,750.00 ","$32,375.00 ","$0.00 ","$43,750.00 ","$19,687.50 ","$0.00 ","$9,118.59 ","$0.00 ","$0.00 ","$7,660.28 ","$43,750.00 ","$0.00 ","$21,875.00 ","$34,650.00 ","$35,000.00 ","$0.00 ","$6,846.88 ","$0.00 ","$6,965.00 ","$0.00 "
"SECX-10-7-30-135","SUP","HCPCS C1876","","SECX-10-7-30-135  -  STENT VASC 30MM 10/7MM 6FR PRTG .014IN 8.5-9.5MM PERI CRTD","BOTH IP/OP","$5,127.50 ","$3,794.35 ","$0.00 ","$5,127.50 ","$2,307.38 ","$0.00 ","$1,068.70 ","$0.00 ","$0.00 ","$897.78 ","$5,127.50 ","$0.00 ","$2,563.75 ","$4,060.98 ","$4,102.00 ","$0.00 ","$802.45 ","$0.00 ","$816.30 ","$0.00 "
"SECX-10-7-40-135","SUP","HCPCS C1876","","SECX-10-7-40-135  -  STENT VASC 40MM 10/7MM 6FR PRTG .014IN 8.5-9.5MM PERI CRTD","BOTH IP/OP","$5,127.50 ","$3,794.35 ","$0.00 ","$5,127.50 ","$2,307.38 ","$0.00 ","$1,068.70 ","$0.00 ","$0.00 ","$897.78 ","$5,127.50 ","$0.00 ","$2,563.75 ","$4,060.98 ","$4,102.00 ","$0.00 ","$802.45 ","$0.00 ","$816.30 ","$0.00 "
"SECX-8-6-30-135","SUP","HCPCS C1876","","SECX-8-6-30-135  -  STENT VASC 8/6MM 6/8FR 30MM 135CM .014IN RAPEX TPR EXPRT","BOTH IP/OP","$5,127.50 ","$3,794.35 ","$0.00 ","$5,127.50 ","$2,307.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$897.78 ","$5,127.50 ","$0.00 ","$2,563.75 ","$4,060.98 ","$4,102.00 ","$0.00 ","$802.45 ","$0.00 ","$816.30 ","$0.00 "
"SECX-8-6-40-135","SUP","HCPCS C1876","","SECX-8-6-40-135  -  STENT VASC 40MM 8/6MM 6FR PRTG .014IN 6.5-7.5MM PERI CRTD","BOTH IP/OP","$5,127.50 ","$3,794.35 ","$0.00 ","$5,127.50 ","$2,307.38 ","$0.00 ","$1,068.70 ","$0.00 ","$0.00 ","$897.78 ","$5,127.50 ","$0.00 ","$2,563.75 ","$4,060.98 ","$4,102.00 ","$0.00 ","$802.45 ","$0.00 ","$816.30 ","$0.00 "
"SEDR01","SUP","HCPCS C1786","","SEDR01  -  PACEMAKER CARDIAC 2.8V 1.2AH 7.5MM 47.9X44.7MM IMPLTABLE 2","BOTH IP/OP","$8,500.00 ","$6,290.00 ","$0.00 ","$8,500.00 ","$0.00 ","$0.00 ","$1,771.61 ","$0.00 ","$0.00 ","$0.00 ","$8,500.00 ","$0.00 ","$4,250.00 ","$6,732.00 ","$6,800.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SEG1411","SUP","HCPCS C1769","","SEG1411  -  GWIRE VASC .014IN 190CM 8CM ANG SEGWAY HYDPHI","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$169.69 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"SEG1412","SUP","HCPCS C1769","","SEG1412  -  STR GUIDEWIRE .014X180 SEGWAY GT","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$169.69 ","$0.00 ","$65.13 ","$0.00 ","$0.00 ","$54.72 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$48.91 ","$0.00 ","$49.75 ","$0.00 "
"SENSH1428W","SUP","HCPCS C1894","","SENSH1428W  -  SHEATH INTROD 28CM GWIRE FLEXIBILITY REINFORCED COIL RADIOPQ","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"SENSH1628W","SUP","HCPCS C1894","","SENSH1628W  -  SHEATH INTRO .035IN 16FR 28CM SENTRANT RADOPQ REINF COIL DIL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"SENSH1828W","SUP","HCPCS C1894","","SENSH1828W  -  SHEATH INTRO .035IN 18FR 28CM SENTRANT RADOPQ REINF COIL DIL","BOTH IP/OP","$500.00 ","$370.00 ","$0.00 ","$500.00 ","$271.50 ","$0.00 ","$104.21 ","$0.00 ","$0.00 ","$87.55 ","$500.00 ","$0.00 ","$250.00 ","$396.00 ","$400.00 ","$0.00 ","$78.25 ","$0.00 ","$79.60 ","$0.00 "
"SENSH2028W","SUP","HCPCS C1894","","SENSH2028W  -  SHEATH INTROD 28CM RADIOPQ MARKER BAND REINFORCED COIL DILAT","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"SENSH2228W","SUP","HCPCS C1894","","SENSH2228W  -  SHEATH INTRO 22FR 28CM SENTRANT HDRPH AAA","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$339.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"SENSIADRK2","SUP","HCPCS C2619","","SENSIADRK2  -  SENSIA DR SYSTEM","BOTH IP/OP","$12,500.00 ","$9,250.00 ","$0.00 ","$12,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12,500.00 ","$0.00 ","$6,250.00 ","$9,900.00 ","$10,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SENSIASRK2","SUP","HCPCS C2620","","SENSIASRK2  -  PACEMAKER CARDIAC THK7.5MM 42.9X40.2MM IMPLTABLE 1 CHAMBER","BOTH IP/OP","$5,992.50 ","$4,434.45 ","$0.00 ","$6,012.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6,012.50 ","$0.00 ","$3,006.25 ","$4,761.90 ","$4,810.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SESR01","SUP","HCPCS C1786","","SESR01  -  PACEMAKER CARDIAC 2.8V .97AH 7.5MM 42.9MMX40.2MM 1 CHAMBER","BOTH IP/OP","$5,000.00 ","$3,700.00 ","$0.00 ","$5,000.00 ","$0.00 ","$0.00 ","$1,042.13 ","$0.00 ","$0.00 ","$0.00 ","$5,000.00 ","$0.00 ","$2,500.00 ","$3,960.00 ","$4,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SF-2500-6101","SUP","HCPCS C1713","","SF-2500-6101  -  PIN HALF 500MM NONSTRL DISPOSABLE","BOTH IP/OP","$5,250.00 ","$3,885.00 ","$0.00 ","$5,250.00 ","$2,362.50 ","$0.00 ","$1,094.23 ","$0.00 ","$0.00 ","$919.23 ","$5,250.00 ","$0.00 ","$2,625.00 ","$4,158.00 ","$4,200.00 ","$0.00 ","$821.63 ","$0.00 ","$835.80 ","$0.00 "
"SFR-4-15","SUP","Custom 27203010","","SFR-4-15  -  DEVICE THROMBECTOMY SOLITARE FR 4X15","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SFR-4-20","SUP","Custom 27203010","","SFR-4-20  -  DEVICE THRMB 31MM 4MM SOLITAIRE FR REVSC","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SFR-6-20","SUP","Custom 27203010","","SFR-6-20  -  DEVICE THRMB 31MM 6MM SOLITAIRE FR REVSC","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SFR-6-30","SUP","Custom 27203010","","SFR-6-30  -  DEVICE THRMB 42MM 6MM SOLITAIRE FR REVSC","BOTH IP/OP","$15,250.00 ","$11,285.00 ","$0.00 ","$15,250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,250.00 ","$0.00 ","$7,625.00 ","$12,078.00 ","$12,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SGL-1","SUP","Custom 27203010","","SGL-1  -  SUTURE CR SURGITIE 0 21IN LGT LOOP DLV SYS ABS","BOTH IP/OP","$607.98 ","$449.91 ","$0.00 ","$607.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$607.98 ","$0.00 ","$303.99 ","$481.52 ","$486.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"S-H00703","SUP","HCPCS C1776","","S-H00703  -  STEM FEM HDNK OMFT LNG HIP","BOTH IP/OP","$3,866.00 ","$2,860.84 ","$0.00 ","$3,866.00 ","$1,739.70 ","$0.00 ","$805.77 ","$0.00 ","$0.00 ","$676.91 ","$3,866.00 ","$0.00 ","$1,933.00 ","$3,061.87 ","$3,092.80 ","$0.00 ","$605.03 ","$0.00 ","$615.47 ","$0.00 "
"SH-0713-S","SUP","HCPCS C1776","","SH-0713-S  -  STEM HUM 130MM 7MM MDLR SHRT SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0813-S","SUP","HCPCS C1776","","SH-0813-S  -  STEM HUM 130MM 8MM MDLR SHRT SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0818-S","SUP","HCPCS C1776","","SH-0818-S  -  STEM HUM 180MM 8MM LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0820","SUP","HCPCS C1776","","SH-0820  -  STEM HUM 200MM 8MM PLRS LNG SHLDR STRL","BOTH IP/OP","$4,987.50 ","$3,690.75 ","$0.00 ","$4,987.50 ","$2,244.38 ","$0.00 ","$1,039.52 ","$0.00 ","$0.00 ","$873.27 ","$4,987.50 ","$0.00 ","$2,493.75 ","$3,950.10 ","$3,990.00 ","$0.00 ","$780.54 ","$0.00 ","$794.01 ","$0.00 "
"SH-0820-S","SUP","HCPCS C1776","","SH-0820-S  -  STEM HUM 200MM 8MM PLRS LNG SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0822-S","SUP","HCPCS C1776","","SH-0822-S  -  STEM HUM 220MM 8MM MDLR LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0824-S","SUP","HCPCS C1776","","SH-0824-S  -  STEM HUM 240MM 8MM MDLR PLRS LNG SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0826-S","SUP","HCPCS C1776","","SH-0826-S  -  STEM HUM 8MM 260MM STRL MDLR SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0828-S","SUP","HCPCS C1776","","SH-0828-S  -  STEM HUM 280MM 8MM MDLR LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-0913-S","SUP","HCPCS C1776","","SH-0913-S  -  STEM HUM 130MM 9MM TI SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1013-S","SUP","HCPCS C1776","","SH-1013-S  -  STEM HUM 130MM 10MM PLRS TI SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1018-S","SUP","HCPCS C1776","","SH-1018-S  -  STEM HUM 180MM 10MM MDLR LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1020-S","SUP","HCPCS C1776","","SH-1020-S  -  STEM HUM 200MM 10MM MDLR LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1022-S","SUP","HCPCS C1776","","SH-1022-S  -  STEM HUM 220MM 10MM MDLR LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1024-S","SUP","HCPCS C1776","","SH-1024-S  -  STEM HUM 240MM 10MM MDLR LNG SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1026-S","SUP","HCPCS C1776","","SH-1026-S  -  STEM HUM 260MM 10MM MDLR SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1028-S","SUP","HCPCS C1776","","SH-1028-S  -  STEM HUM 280MM 10MM MDLR LNG SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1213-S","SUP","HCPCS C1776","","SH-1213-S  -  STEM HUM 130MM 12MM MDLR SHRT SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1313-S","SUP","HCPCS C1776","","SH-1313-S  -  STEM HUM 130MM 13MM MDLR SHRT SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1340L-S","SUP","HCPCS C1776","","SH-1340L-S  -  HEAD HUM 13MM LEFT SHLDR BODY ASMBLY MDLR PLRS STRL","BOTH IP/OP","$5,910.00 ","$4,373.40 ","$0.00 ","$5,910.00 ","$2,659.50 ","$0.00 ","$1,231.79 ","$0.00 ","$0.00 ","$1,034.79 ","$5,910.00 ","$0.00 ","$2,955.00 ","$4,680.72 ","$4,728.00 ","$0.00 ","$924.92 ","$0.00 ","$940.87 ","$0.00 "
"SH-1340R-S","SUP","HCPCS C1776","","SH-1340R-S  -  STEM HUM 13MM ASMBLY TI RIGHT SHLDR","BOTH IP/OP","$5,910.00 ","$4,373.40 ","$0.00 ","$5,910.00 ","$2,659.50 ","$0.00 ","$1,231.79 ","$0.00 ","$0.00 ","$1,034.79 ","$5,910.00 ","$0.00 ","$2,955.00 ","$4,680.72 ","$4,728.00 ","$0.00 ","$924.92 ","$0.00 ","$940.87 ","$0.00 "
"SH-1413-S","SUP","HCPCS C1776","","SH-1413-S  -  STEM HUM 130MM 14MM MDLR SHRT SHLDR","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1513-S","SUP","HCPCS C1776","","SH-1513-S  -  STEM HUM 130MM 15MM MDLR SHRT SHLDR STRL","BOTH IP/OP","$4,055.00 ","$3,000.70 ","$0.00 ","$4,055.00 ","$1,824.75 ","$0.00 ","$845.16 ","$0.00 ","$0.00 ","$710.00 ","$4,055.00 ","$0.00 ","$2,027.50 ","$3,211.56 ","$3,244.00 ","$0.00 ","$634.61 ","$0.00 ","$645.56 ","$0.00 "
"SH-1540L-S","SUP","HCPCS C1776","","SH-1540L-S  -  STEM HUM 15MM MDLR BODY ASMBLY LEFT SHLDR STRL","BOTH IP/OP","$5,910.00 ","$4,373.40 ","$0.00 ","$5,910.00 ","$2,659.50 ","$0.00 ","$1,231.79 ","$0.00 ","$0.00 ","$1,034.79 ","$5,910.00 ","$0.00 ","$2,955.00 ","$4,680.72 ","$4,728.00 ","$0.00 ","$924.92 ","$0.00 ","$940.87 ","$0.00 "
"SH-1540R-S","SUP","HCPCS C1776","","SH-1540R-S  -  STEM HUM 15MM MDLR BODY ASMBLY RIGHT SHLDR","BOTH IP/OP","$5,910.00 ","$4,373.40 ","$0.00 ","$5,910.00 ","$2,659.50 ","$0.00 ","$1,231.79 ","$0.00 ","$0.00 ","$1,034.79 ","$5,910.00 ","$0.00 ","$2,955.00 ","$4,680.72 ","$4,728.00 ","$0.00 ","$924.92 ","$0.00 ","$940.87 ","$0.00 "
"SH-3916-S","SUP","HCPCS C1776","","SH-3916-S  -  HEAD HUM 39MM 16MM SHLDR MDLR PLRS STRL","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-3920-S","SUP","HCPCS C1776","","SH-3920-S  -  HEAD HUM 39MM 20MM SHLDR MDLR STRL","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-4317-S","SUP","HCPCS C1776","","SH-4317-S  -  HEAD HUM 43MM 17MM SHLDR TI","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-4321-S","SUP","HCPCS C1776","","SH-4321-S  -  HEAD HUM 21MM 43MM SHLDR","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-4718-S","SUP","HCPCS C1776","","SH-4718-S  -  HEAD HUM 47MM 18MM SHLDR PLRS TI","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-4722-S","SUP","HCPCS C1776","","SH-4722-S  -  HEAD HUM 47MM 22MM STRL MDLR SHLDR","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-5119-S","SUP","HCPCS C1776","","SH-5119-S  -  HEAD HUM 19MM 51MM SHLDR MDLR STRL","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-5123-S","SUP","HCPCS C1776","","SH-5123-S  -  HEAD HUM 51MM 23MM SHLDR MDLR PLRS","BOTH IP/OP","$3,462.50 ","$2,562.25 ","$0.00 ","$3,462.50 ","$1,558.13 ","$0.00 ","$721.67 ","$0.00 ","$0.00 ","$606.26 ","$3,462.50 ","$0.00 ","$1,731.25 ","$2,742.30 ","$2,770.00 ","$0.00 ","$541.88 ","$0.00 ","$551.23 ","$0.00 "
"SH-R1307","SUP","Custom 27203010","","SH-R1307  -  REAMER SURG 13MM 7MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1308","SUP","Custom 27203010","","SH-R1308  -  REAMER SURG 13MM 8MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1309","SUP","Custom 27203010","","SH-R1309  -  REAMER SURG 13MM 9MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1310","SUP","Custom 27203010","","SH-R1310  -  REAMER SURG 13MM 10MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1311","SUP","Custom 27203010","","SH-R1311  -  REAMER SURG 13MM 11MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1312","SUP","Custom 27203010","","SH-R1312  -  REAMER SURG 13MM 12MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1313","SUP","Custom 27203010","","SH-R1313  -  REAMER SURG 13MM 13MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1514","SUP","Custom 27203010","","SH-R1514  -  REAMER SURG 15MM 14MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1515","SUP","Custom 27203010","","SH-R1515  -  REAMER SURG 15MM 15MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1716","SUP","Custom 27203010","","SH-R1716  -  REAMER SURG 17MM 16MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SH-R1717","SUP","Custom 27203010","","SH-R1717  -  REAMER SURG 17MM 17MM SHLDR","BOTH IP/OP","$735.00 ","$543.90 ","$0.00 ","$735.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$735.00 ","$0.00 ","$367.50 ","$582.12 ","$588.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SIG-3616","SUP","Custom 25003010","","ANTIBODY CA 19-9 PRF MNCLN LAB","BOTH IP/OP","$1,827.50 ","$1,352.35 ","$0.00 ","$1,827.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,827.50 ","$0.00 ","$913.75 ","$1,447.38 ","$1,462.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SIG45CTAVM","SUP","Custom 27203010","","SIG45CTAVM  -  RELOAD STPLR 2MM 2.5MM 3MM 45MM TN STRL LF EGIA ARTC KNF","BOTH IP/OP","$3,073.20 ","$2,274.17 ","$0.00 ","$3,073.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,073.20 ","$0.00 ","$1,536.60 ","$2,433.97 ","$2,458.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SILSPT12","SUP","Custom 27203010","","SILSPT12  -  PORT ENDSCP 5MM 12MM FLEXIBLE CANNU OBTURATOR LATEX FREE","BOTH IP/OP","$1,205.31 ","$891.93 ","$0.00 ","$1,205.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,205.31 ","$0.00 ","$602.66 ","$954.61 ","$964.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SK-0480-C","SUP","Custom 27203010","","STAIN KT COMBO 480 TST HISTOLGY","BOTH IP/OP","$106.25 ","$78.63 ","$0.00 ","$106.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.25 ","$0.00 ","$53.13 ","$84.15 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SK200","SUP","Custom 27203010","","SK200  -  KIT VASC 175CM 2MM 2.3-3FR AGN MIC NTNL INTROD TRQ DEV CATH","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SK400","SUP","Custom 27203010","","SK400  -  SNARE VASC 175CM 4MM 2.3-3FR AGN MIC NTNL MCTH KIT 150CM","BOTH IP/OP","$1,400.00 ","$1,036.00 ","$0.00 ","$1,400.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,400.00 ","$0.00 ","$700.00 ","$1,108.80 ","$1,120.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SMC-5060","SUP","Custom 27203010","","SMC-5060  -  SHAFT SM 60MM FXTR BONE","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SMC-5090","SUP","HCPCS C1713","","SMC-5090  -  SCREW BONE 90MM SM SHFT FXTR","BOTH IP/OP","$205.00 ","$151.70 ","$0.00 ","$205.00 ","$92.25 ","$0.00 ","$42.73 ","$0.00 ","$0.00 ","$35.89 ","$205.00 ","$0.00 ","$102.50 ","$162.36 ","$164.00 ","$0.00 ","$32.08 ","$0.00 ","$32.64 ","$0.00 "
"SMT-5060","SUP","Custom 27203010","","SMT-5060  -  ROD EXFIX STABLELOC RADL SS SM BONE FIX SYS STRL","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SMT-5090","SUP","Custom 27203010","","SMT-5090  -  ROD EXFIX 90MM STABLELOC SS SM BONE FIX SYS STRL","BOTH IP/OP","$387.50 ","$286.75 ","$0.00 ","$387.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$387.50 ","$0.00 ","$193.75 ","$306.90 ","$310.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN 7016X","SUP","Custom 27203010","","SN 7016X  -  DEVICE BIOP 10CM 14GA MNPTY 22MM INSTR AUTO STRL DISP","BOTH IP/OP","$85.00 ","$62.90 ","$0.00 ","$85.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$85.00 ","$0.00 ","$42.50 ","$67.32 ","$68.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN60AT","SUP","HCPCS V2632","","SN60AT  -  LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF N STABLEFORCE 1","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.060","SUP","HCPCS V2632","","SN60AT.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.070","SUP","HCPCS V2632","","SN60AT.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.075","SUP","HCPCS V2632","","SN60AT.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.080","SUP","HCPCS V2632","","SN60AT.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.085","SUP","HCPCS V2632","","SN60AT.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.090","SUP","HCPCS V2632","","SN60AT.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.095","SUP","HCPCS V2632","","SN60AT.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.100","SUP","HCPCS V2632","","SN60AT.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.105","SUP","HCPCS V2632","","SN60AT.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.110","SUP","HCPCS V2632","","SN60AT.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.115","SUP","HCPCS V2632","","SN60AT.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.120","SUP","HCPCS V2632","","SN60AT.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.125","SUP","HCPCS V2632","","SN60AT.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.130","SUP","HCPCS V2632","","SN60AT.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.135","SUP","HCPCS V2632","","SN60AT.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.140","SUP","HCPCS V2632","","SN60AT.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.145","SUP","HCPCS V2632","","SN60AT.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.150","SUP","HCPCS V2632","","SN60AT.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.155","SUP","HCPCS V2632","","SN60AT.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.160","SUP","HCPCS V2632","","SN60AT.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.165","SUP","HCPCS V2632","","SN60AT.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.170","SUP","HCPCS V2632","","SN60AT.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.175","SUP","HCPCS V2632","","SN60AT.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.180","SUP","HCPCS V2632","","SN60AT.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.185","SUP","HCPCS V2632","","SN60AT.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.190","SUP","HCPCS V2632","","SN60AT.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.195","SUP","HCPCS V2632","","SN60AT.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.200","SUP","HCPCS V2632","","SN60AT.200  -  LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.205","SUP","HCPCS V2632","","SN60AT.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.210","SUP","HCPCS V2632","","SN60AT.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.215","SUP","HCPCS V2632","","SN60AT.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.220","SUP","HCPCS V2632","","SN60AT.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.225","SUP","HCPCS V2632","","SN60AT.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.230","SUP","HCPCS V2632","","SN60AT.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.235","SUP","HCPCS V2632","","SN60AT.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.240","SUP","HCPCS V2632","","SN60AT.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.245","SUP","HCPCS V2632","","SN60AT.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.250","SUP","HCPCS V2632","","SN60AT.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.255","SUP","HCPCS V2632","","SN60AT.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.260","SUP","HCPCS V2632","","SN60AT.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.265","SUP","HCPCS V2632","","SN60AT.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.270","SUP","HCPCS V2632","","SN60AT.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.275","SUP","HCPCS V2632","","SN60AT.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.280","SUP","HCPCS V2632","","SN60AT.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.285","SUP","HCPCS V2632","","SN60AT.285  -  LENS IOL 0 D +28.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.295","SUP","HCPCS V2632","","SN60AT.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.300","SUP","HCPCS V2632","","SN60AT.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.310","SUP","HCPCS V2632","","SN60AT.310  -  LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.320","SUP","HCPCS V2632","","SN60AT.320  -  LENS IOL 0 D +32 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.330","SUP","HCPCS V2632","","SN60AT.330  -  LENS IOL 0 D +33 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.340","SUP","HCPCS V2632","","SN60AT.340  -  LENS IOL 0 D +34 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.350","SUP","HCPCS V2632","","SN60AT.350  -  LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.360","SUP","HCPCS V2632","","SN60AT.360  -  LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.370","SUP","HCPCS V2632","","SN60AT.370  -  LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.380","SUP","HCPCS V2632","","SN60AT.380  -  LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.390","SUP","HCPCS V2632","","SN60AT.390  -  LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60AT.400","SUP","HCPCS V2632","","SN60AT.400  -  LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N","BOTH IP/OP","$472.50 ","$349.65 ","$0.00 ","$472.50 ","$212.63 ","$0.00 ","$98.48 ","$0.00 ","$0.00 ","$82.73 ","$472.50 ","$0.00 ","$236.25 ","$374.22 ","$378.00 ","$0.00 ","$73.95 ","$0.00 ","$75.22 ","$0.00 "
"SN60WF","SUP","HCPCS V2632","","SN60WF  -  LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF IQ 1 PC FLD ANT","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.065","SUP","HCPCS V2632","","SN60WF.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.075","SUP","HCPCS V2632","","SN60WF.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.085","SUP","HCPCS V2632","","SN60WF.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.090","SUP","HCPCS V2632","","SN60WF.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.095","SUP","HCPCS V2632","","SN60WF.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.100","SUP","HCPCS V2632","","SN60WF.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.105","SUP","HCPCS V2632","","SN60WF.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.110","SUP","HCPCS V2632","","SN60WF.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.115","SUP","HCPCS V2632","","SN60WF.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.120","SUP","HCPCS V2632","","SN60WF.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.125","SUP","HCPCS V2632","","SN60WF.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.135","SUP","HCPCS V2632","","SN60WF.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.145","SUP","HCPCS V2632","","SN60WF.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.155","SUP","HCPCS V2632","","SN60WF.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.160","SUP","HCPCS V2632","","SN60WF.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.165","SUP","HCPCS V2632","","SN60WF.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.170","SUP","HCPCS V2632","","SN60WF.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.185","SUP","HCPCS V2632","","SN60WF.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.215","SUP","HCPCS V2632","","SN60WF.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.220","SUP","HCPCS V2632","","SN60WF.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.225","SUP","HCPCS V2632","","SN60WF.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.230","SUP","HCPCS V2632","","SN60WF.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.240","SUP","HCPCS V2632","","SN60WF.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.245","SUP","HCPCS V2632","","SN60WF.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.250","SUP","HCPCS V2632","","SN60WF.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.260","SUP","HCPCS V2632","","SN60WF.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.270","SUP","HCPCS V2632","","SN60WF.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.275","SUP","HCPCS V2632","","SN60WF.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.280","SUP","HCPCS V2632","","SN60WF.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.290","SUP","HCPCS V2632","","SN60WF.290  -  LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.295","SUP","HCPCS V2632","","SN60WF.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WF.300","SUP","HCPCS V2632","","SN60WF.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"SN60WS","SUP","HCPCS V2632","","SN60WS  -  LENS IOL 0D BCNVX 6MM 13MM STRL ACRSF IQ NTR STABLEFORCE","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.060","SUP","HCPCS V2632","","SN60WS.060  -  LENS IOL 0 D +6 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.065","SUP","HCPCS V2632","","SN60WS.065  -  LENS IOL 0 D +6.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.070","SUP","HCPCS V2632","","SN60WS.070  -  LENS IOL 0 D +7 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.075","SUP","HCPCS V2632","","SN60WS.075  -  LENS IOL 0 D +7.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.080","SUP","HCPCS V2632","","SN60WS.080  -  LENS IOL 0 D +8 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.085","SUP","HCPCS V2632","","SN60WS.085  -  LENS IOL 0 D +8.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.090","SUP","HCPCS V2632","","SN60WS.090  -  LENS IOL 0 D +9 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.095","SUP","HCPCS V2632","","SN60WS.095  -  LENS IOL 0 D +9.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.100","SUP","HCPCS V2632","","SN60WS.100  -  LENS IOL 0 D +10 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.105","SUP","HCPCS V2632","","SN60WS.105  -  LENS IOL 0 D +10.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.110","SUP","HCPCS V2632","","SN60WS.110  -  LENS IOL 0 D +11 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.115","SUP","HCPCS V2632","","SN60WS.115  -  LENS IOL 0 D +11.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.120","SUP","HCPCS V2632","","SN60WS.120  -  LENS IOL 0 D +12 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.125","SUP","HCPCS V2632","","SN60WS.125  -  LENS IOL 0 D +12.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.130","SUP","HCPCS V2632","","SN60WS.130  -  LENS IOL 0 D +13 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.135","SUP","HCPCS V2632","","SN60WS.135  -  LENS IOL 0 D +13.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.140","SUP","HCPCS V2632","","SN60WS.140  -  LENS IOL 0 D +14 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.145","SUP","HCPCS V2632","","SN60WS.145  -  LENS IOL 0 D +14.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.150","SUP","HCPCS V2632","","SN60WS.150  -  LENS IOL 0 D +15 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.155","SUP","HCPCS V2632","","SN60WS.155  -  LENS IOL 0 D +15.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.160","SUP","HCPCS V2632","","SN60WS.160  -  LENS IOL 0 D +16 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.165","SUP","HCPCS V2632","","SN60WS.165  -  LENS IOL 0 D +16.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.170","SUP","HCPCS V2632","","SN60WS.170  -  LENS IOL 0 D +17 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.175","SUP","HCPCS V2632","","SN60WS.175  -  LENS IOL 0 D +17.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.180","SUP","HCPCS V2632","","SN60WS.180  -  LENS IOL 0 D +18 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.185","SUP","HCPCS V2632","","SN60WS.185  -  LENS IOL 0 D +18.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.190","SUP","HCPCS V2632","","SN60WS.190  -  LENS IOL 0 D +19 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.195","SUP","HCPCS V2632","","SN60WS.195  -  LENS IOL 0 D +19.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.200","SUP","HCPCS V2632","","SN60WS.200  -  LENS IOL 0 D +20 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.205","SUP","HCPCS V2632","","SN60WS.205  -  LENS IOL 0 D +20.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.210","SUP","HCPCS V2632","","SN60WS.210  -  LENS IOL 0 D +21 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.215","SUP","HCPCS V2632","","SN60WS.215  -  LENS IOL 0 D +21.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.220","SUP","HCPCS V2632","","SN60WS.220  -  LENS IOL 0 D +22 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.225","SUP","HCPCS V2632","","SN60WS.225  -  LENS IOL 0 D +22.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.230","SUP","HCPCS V2632","","SN60WS.230  -  LENS IOL 0 D +23 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.235","SUP","HCPCS V2632","","SN60WS.235  -  LENS IOL 0 D +23.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.240","SUP","HCPCS V2632","","SN60WS.240  -  LENS IOL 0 D +24 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.245","SUP","HCPCS V2632","","SN60WS.245  -  LENS IOL 0 D +24.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.250","SUP","HCPCS V2632","","SN60WS.250  -  LENS IOL 0 D +25 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.255","SUP","HCPCS V2632","","SN60WS.255  -  LENS IOL 0 D +25.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.260","SUP","HCPCS V2632","","SN60WS.260  -  LENS IOL 0 D +26 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.265","SUP","HCPCS V2632","","SN60WS.265  -  LENS IOL 0 D +26.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.270","SUP","HCPCS V2632","","SN60WS.270  -  LENS IOL 0 D +27 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.275","SUP","HCPCS V2632","","SN60WS.275  -  LENS IOL 0 D +27.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.280","SUP","HCPCS V2632","","SN60WS.280  -  LENS IOL 0 D +28 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.285","SUP","HCPCS V2632","","SN60WS.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.290","SUP","HCPCS V2632","","SN60WS.290  -  LENS IOL 0 D +29 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.295","SUP","HCPCS V2632","","SN60WS.295  -  LENS IOL 0 D +29.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN60WS.300","SUP","HCPCS V2632","","SN60WS.300  -  LENS IOL 0 D +30 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR","BOTH IP/OP","$1,202.50 ","$889.85 ","$0.00 ","$1,202.50 ","$541.13 ","$0.00 ","$250.63 ","$0.00 ","$0.00 ","$210.55 ","$1,202.50 ","$0.00 ","$601.25 ","$952.38 ","$962.00 ","$0.00 ","$188.19 ","$0.00 ","$191.44 ","$0.00 "
"SN6AT3.150","SUP","HCPCS V2787","","SN6AT3.150  -  DRILL SRG 2.1MM 110MM CNN TI","BOTH IP/OP","$995.00 ","$736.30 ","$0.00 ","$995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$995.00 ","$0.00 ","$497.50 ","$788.04 ","$796.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT3.210","SUP","HCPCS V2787","","SN6AT3.210  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT3.215","SUP","HCPCS V2787","","SN6AT3.215  -  LENS IOL 0 D +21.5 DIOP +1.5 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$995.00 ","$736.30 ","$0.00 ","$995.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$995.00 ","$0.00 ","$497.50 ","$788.04 ","$796.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT5.145","SUP","HCPCS V2632","","SN6AT5.145  -  LENS IOL 0 D +14.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$310.03 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"SN6AT5.150","SUP","HCPCS V2632","","SN6AT5.150  -  LENS IOL 0 D +15 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$1,487.50 ","$1,100.75 ","$0.00 ","$1,487.50 ","$669.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$260.45 ","$1,487.50 ","$0.00 ","$743.75 ","$1,178.10 ","$1,190.00 ","$0.00 ","$232.79 ","$0.00 ","$236.81 ","$0.00 "
"SN6AT5.165","SUP","HCPCS V2787","","SN6AT5.165  -  LENS IOL 0 D +16.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT5.185","SUP","HCPCS V2787","","SN6AT5.185  -  LENS IOL 0 D +18.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT5.220","SUP","HCPCS V2787","","SN6AT5.220  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT5.225","SUP","HCPCS V2787","","SN6AT5.225  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT6.175","SUP","HCPCS V2787","","SN6AT6.175  -  LENS IOL 0 D +17.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT6.195","SUP","HCPCS V2632","","SN6AT6.195  -  LENS IOL 0 D +19.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"SN6AT6.205","SUP","HCPCS V2632","","SN6AT6.205  -  LENS IOL 0 D +20.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"SN6AT6.215","SUP","HCPCS V2787","","SN6AT6.215  -  LENS IOL 0 D +21.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT6.245","SUP","HCPCS V2632","","SN6AT6.245  -  LENS IOL 0 D +24.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"SN6AT6.250","SUP","HCPCS V2632","","SN6AT6.250  -  LENS IOL +25 DIOPTER +3.75 CYLINDER 0 D BICNVX 6MM 13MM 1","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$257.93 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"SN6AT7.115","SUP","HCPCS V2632","","SN6AT7.115  -  LENS IOL 0 D +11.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"SN6AT7.205","SUP","HCPCS V2632","","SN6AT7.205  -  LENS IOL 0 D +20.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$556.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.68 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$193.67 ","$0.00 ","$197.01 ","$0.00 "
"SN6AT7U230","SUP","HCPCS V2787","","SN6AT7U230  -  LENS IOL 0 D +23 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT8.160","SUP","HCPCS V2787","","SN6AT8.160  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT8U150","SUP","HCPCS V2787","","SN6AT8U150  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +1","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT9.165","SUP","HCPCS V2787","","SN6AT9.165  -  LENS IOL 0 D +16.5 DIOP +6 CYL BICNVX 13MM 6MM","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT9.170","SUP","HCPCS V2787","","SN6AT9.170  -  LENS IOL 0 D +17 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$1,237.50 ","$915.75 ","$0.00 ","$1,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,237.50 ","$0.00 ","$618.75 ","$980.10 ","$990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SN6AT9U210","SUP","HCPCS V2632","","SN6AT9U210  -  LENS IOL 0 D +21 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$995.00 ","$736.30 ","$0.00 ","$995.00 ","$447.75 ","$0.00 ","$207.38 ","$0.00 ","$0.00 ","$174.22 ","$995.00 ","$0.00 ","$497.50 ","$788.04 ","$796.00 ","$0.00 ","$155.72 ","$0.00 ","$158.40 ","$0.00 "
"SN6CWS","SUP","HCPCS V2632","","SN6CWS  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.060","SUP","HCPCS V2632","","SN6CWS.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.065","SUP","HCPCS V2632","","SN6CWS.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.070","SUP","HCPCS V2632","","SN6CWS.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.075","SUP","HCPCS V2632","","SN6CWS.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.080","SUP","HCPCS V2632","","SN6CWS.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.085","SUP","HCPCS V2632","","SN6CWS.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.090","SUP","HCPCS V2632","","SN6CWS.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.095","SUP","HCPCS V2632","","SN6CWS.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.100","SUP","HCPCS V2632","","SN6CWS.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.105","SUP","HCPCS V2632","","SN6CWS.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.110","SUP","HCPCS V2632","","SN6CWS.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.115","SUP","HCPCS V2632","","SN6CWS.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.120","SUP","HCPCS V2632","","SN6CWS.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.125","SUP","HCPCS V2632","","SN6CWS.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.130","SUP","HCPCS V2632","","SN6CWS.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.135","SUP","HCPCS V2632","","SN6CWS.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.140","SUP","HCPCS V2632","","SN6CWS.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.145","SUP","HCPCS V2632","","SN6CWS.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.150","SUP","HCPCS V2632","","SN6CWS.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.155","SUP","HCPCS V2632","","SN6CWS.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.160","SUP","HCPCS V2632","","SN6CWS.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.165","SUP","HCPCS V2632","","SN6CWS.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.170","SUP","HCPCS V2632","","SN6CWS.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.175","SUP","HCPCS V2632","","SN6CWS.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.180","SUP","HCPCS V2632","","SN6CWS.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.185","SUP","HCPCS V2632","","SN6CWS.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.190","SUP","HCPCS V2632","","SN6CWS.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.195","SUP","HCPCS V2632","","SN6CWS.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.200","SUP","HCPCS V2632","","SN6CWS.200  -  LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.205","SUP","HCPCS V2632","","SN6CWS.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.210","SUP","HCPCS V2632","","SN6CWS.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.215","SUP","HCPCS V2632","","SN6CWS.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.220","SUP","HCPCS V2632","","SN6CWS.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.225","SUP","HCPCS V2632","","SN6CWS.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.230","SUP","HCPCS V2632","","SN6CWS.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.235","SUP","HCPCS V2632","","SN6CWS.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.240","SUP","HCPCS V2632","","SN6CWS.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.245","SUP","HCPCS V2632","","SN6CWS.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.250","SUP","HCPCS V2632","","SN6CWS.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.255","SUP","HCPCS V2632","","SN6CWS.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.260","SUP","HCPCS V2632","","SN6CWS.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.265","SUP","HCPCS V2632","","SN6CWS.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.270","SUP","HCPCS V2632","","SN6CWS.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.275","SUP","HCPCS V2632","","SN6CWS.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.280","SUP","HCPCS V2632","","SN6CWS.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.295","SUP","HCPCS V2632","","SN6CWS.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SN6CWS.300","SUP","HCPCS V2632","","SN6CWS.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ","BOTH IP/OP","$397.50 ","$294.15 ","$0.00 ","$397.50 ","$178.88 ","$0.00 ","$82.85 ","$0.00 ","$0.00 ","$69.60 ","$397.50 ","$0.00 ","$198.75 ","$314.82 ","$318.00 ","$0.00 ","$62.21 ","$0.00 ","$63.28 ","$0.00 "
"SOFT33","SUP","Custom 27203010","","SOFT33  -  INSERT CLMP 33MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW","BOTH IP/OP","$32.50 ","$24.05 ","$0.00 ","$32.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.50 ","$0.00 ","$16.25 ","$25.74 ","$26.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SOFT61","SUP","Custom 27203010","","SOFT61  -  INSERT CLMP 61MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SOFT86","SUP","Custom 27203010","","SOFT86  -  INSERT CLMP FGRTY SFJW 86MM ATRM OCL HFLO RBR STRL LATEX","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$32.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.75 ","$0.00 ","$16.38 ","$25.94 ","$26.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SP-1863","SUP","HCPCS C1713","","SP-1863  -  COVER BURR HOLE 18.5MM SLOT TEFLON PI","BOTH IP/OP","$835.00 ","$617.90 ","$0.00 ","$835.00 ","$375.75 ","$0.00 ","$174.03 ","$0.00 ","$0.00 ","$146.20 ","$835.00 ","$0.00 ","$417.50 ","$661.32 ","$668.00 ","$0.00 ","$130.68 ","$0.00 ","$132.93 ","$0.00 "
"SP-1864","SUP","HCPCS C1713","","SP-1864  -  PLATE BONE 26MM 2X4 HOLE MATRIX ORAL CRANIOMAXILLOFACIAL","BOTH IP/OP","$870.00 ","$643.80 ","$0.00 ","$870.00 ","$391.50 ","$0.00 ","$181.33 ","$0.00 ","$0.00 ","$152.33 ","$870.00 ","$0.00 ","$435.00 ","$689.04 ","$696.00 ","$0.00 ","$136.16 ","$0.00 ","$138.50 ","$0.00 "
"SP-1865","SUP","HCPCS C1713","","SP-1865  -  MESH CRNL .2MM NS LORENZ TRAUMAONE MDFC ORBT FLR 1.5MM SCR","BOTH IP/OP","$3,670.00 ","$2,715.80 ","$0.00 ","$3,670.00 ","$1,651.50 ","$0.00 ","$764.92 ","$0.00 ","$0.00 ","$642.59 ","$3,670.00 ","$0.00 ","$1,835.00 ","$2,906.64 ","$2,936.00 ","$0.00 ","$574.36 ","$0.00 ","$584.26 ","$0.00 "
"SP-1889","SUP","Custom 27203010","","SP-1889  -  BLADE SURG 7X2MM REDX","BOTH IP/OP","$757.50 ","$560.55 ","$0.00 ","$757.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$757.50 ","$0.00 ","$378.75 ","$599.94 ","$606.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SP-1942","SUP","HCPCS C1713","","SP-1942  -  PLATE SHUNT MEDIUM 18.5MM SPECIALTY X-DRIVE THINFLAP","BOTH IP/OP","$847.50 ","$627.15 ","$0.00 ","$847.50 ","$381.38 ","$0.00 ","$176.64 ","$0.00 ","$0.00 ","$148.39 ","$847.50 ","$0.00 ","$423.75 ","$671.22 ","$678.00 ","$0.00 ","$132.63 ","$0.00 ","$134.92 ","$0.00 "
"SP-2032","SUP","HCPCS C1713","","SP-2032  -  SCREW BONE 2.5MM 6MM SLFDRILL REDX BLADE BYRD LORENZ","BOTH IP/OP","$1,032.50 ","$764.05 ","$0.00 ","$1,032.50 ","$464.63 ","$0.00 ","$215.20 ","$0.00 ","$0.00 ","$180.78 ","$1,032.50 ","$0.00 ","$516.25 ","$817.74 ","$826.00 ","$0.00 ","$161.59 ","$0.00 ","$164.37 ","$0.00 "
"SP-2256","SUP","HCPCS C1713","","SP-2256  -  PLATE BONE 1MM SPECIALTY TRAUMAONE MANDIB","BOTH IP/OP","$1,847.50 ","$1,367.15 ","$0.00 ","$1,847.50 ","$831.38 ","$0.00 ","$385.07 ","$0.00 ","$0.00 ","$323.48 ","$1,847.50 ","$0.00 ","$923.75 ","$1,463.22 ","$1,478.00 ","$0.00 ","$289.13 ","$0.00 ","$294.12 ","$0.00 "
"SP-2258","SUP","Custom 27203010","","SP-2258  -  TAP SURG 2.3MM","BOTH IP/OP","$1,592.50 ","$1,178.45 ","$0.00 ","$1,592.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,592.50 ","$0.00 ","$796.25 ","$1,261.26 ","$1,274.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SP-2276","SUP","HCPCS C1713","","SP-2276  -  PLATE BONE THK2.6MM SMALL SPECIALTY SYSTEM LORENZ","BOTH IP/OP","$9,147.50 ","$6,769.15 ","$0.00 ","$9,147.50 ","$4,116.38 ","$0.00 ","$1,906.57 ","$0.00 ","$0.00 ","$1,601.65 ","$9,147.50 ","$0.00 ","$4,573.75 ","$7,244.82 ","$7,318.00 ","$0.00 ","$1,431.58 ","$0.00 ","$1,456.28 ","$0.00 "
"SP-2277","SUP","HCPCS C1713","","SP-2277  -  PLATE BONE THK2.6MM MEDIUM SPECIALTY SYSTEM LORENZ","BOTH IP/OP","$9,945.00 ","$7,359.30 ","$0.00 ","$9,945.00 ","$4,475.25 ","$0.00 ","$2,072.79 ","$0.00 ","$0.00 ","$1,741.29 ","$9,945.00 ","$0.00 ","$4,972.50 ","$7,876.44 ","$7,956.00 ","$0.00 ","$1,556.39 ","$0.00 ","$1,583.24 ","$0.00 "
"SP-2284","SUP","HCPCS C1713","","SP-2284  -  PLATE BONE 1MM 4 HOLE STR LORENZ TRAUMAONE TITANIUM MANDIB","BOTH IP/OP","$1,582.50 ","$1,171.05 ","$0.00 ","$1,582.50 ","$712.13 ","$0.00 ","$329.83 ","$0.00 ","$0.00 ","$277.08 ","$1,582.50 ","$0.00 ","$791.25 ","$1,253.34 ","$1,266.00 ","$0.00 ","$247.66 ","$0.00 ","$251.93 ","$0.00 "
"SP-2292","SUP","HCPCS C1713","","SP-2292  -  PLATE BONE 2MM SPECIALTY TRAUMAONE MANDIB","BOTH IP/OP","$2,492.50 ","$1,844.45 ","$0.00 ","$2,492.50 ","$1,121.63 ","$0.00 ","$519.50 ","$0.00 ","$0.00 ","$436.42 ","$2,492.50 ","$0.00 ","$1,246.25 ","$1,974.06 ","$1,994.00 ","$0.00 ","$390.08 ","$0.00 ","$396.81 ","$0.00 "
"SP-2371","SUP","HCPCS C1713","","SP-2371  -  PLATE BONE SPECIALTY LORENZ MIDFAC","BOTH IP/OP","$910.00 ","$673.40 ","$0.00 ","$910.00 ","$409.50 ","$0.00 ","$189.67 ","$0.00 ","$0.00 ","$159.33 ","$910.00 ","$0.00 ","$455.00 ","$720.72 ","$728.00 ","$0.00 ","$142.42 ","$0.00 ","$144.87 ","$0.00 "
"SP-2375","SUP","HCPCS C1713","","SP-2375  -  PLATE BONE 1MM LORENZ MANDIB","BOTH IP/OP","$1,677.50 ","$1,241.35 ","$0.00 ","$1,677.50 ","$754.88 ","$0.00 ","$349.63 ","$0.00 ","$0.00 ","$293.72 ","$1,677.50 ","$0.00 ","$838.75 ","$1,328.58 ","$1,342.00 ","$0.00 ","$262.53 ","$0.00 ","$267.06 ","$0.00 "
"SP-2376","SUP","HCPCS C1713","","SP-2376  -  PLATE BONE 1MM LORENZ MANDIB","BOTH IP/OP","$1,677.50 ","$1,241.35 ","$0.00 ","$1,677.50 ","$754.88 ","$0.00 ","$349.63 ","$0.00 ","$0.00 ","$293.72 ","$1,677.50 ","$0.00 ","$838.75 ","$1,328.58 ","$1,342.00 ","$0.00 ","$262.53 ","$0.00 ","$267.06 ","$0.00 "
"SP-2377","SUP","HCPCS C1713","","SP-2377  -  PLATE BONE 2MM LORENZ TRAUMAONE MIDFAC","BOTH IP/OP","$2,450.00 ","$1,813.00 ","$0.00 ","$2,450.00 ","$1,102.50 ","$0.00 ","$510.64 ","$0.00 ","$0.00 ","$428.98 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$390.04 ","$0.00 "
"SP-2465","SUP","HCPCS C1713","","SP-2465  -  PLATE BONE THK1.6MM LONG Y GRADE II TRAUMAONE LORENZ GOLD","BOTH IP/OP","$2,017.50 ","$1,492.95 ","$0.00 ","$2,017.50 ","$907.88 ","$0.00 ","$420.50 ","$0.00 ","$0.00 ","$353.25 ","$2,017.50 ","$0.00 ","$1,008.75 ","$1,597.86 ","$1,614.00 ","$0.00 ","$315.74 ","$0.00 ","$321.19 ","$0.00 "
"SP-2467","SUP","HCPCS C1713","","SP-2467  -  PLATE BONE THK2.6MM SMALL STR ANGLED LORENZ MAGENTA MANDIB","BOTH IP/OP","$4,520.00 ","$3,344.80 ","$0.00 ","$4,520.00 ","$2,034.00 ","$0.00 ","$942.08 ","$0.00 ","$0.00 ","$791.42 ","$4,520.00 ","$0.00 ","$2,260.00 ","$3,579.84 ","$3,616.00 ","$0.00 ","$707.38 ","$0.00 ","$719.58 ","$0.00 "
"SP-2468","SUP","HCPCS C1713","","SP-2468  -  PLATE BONE THK2.6MM 7 HOLE TRAUMAONE LORENZ MAGENTA MANDIB","BOTH IP/OP","$4,075.00 ","$3,015.50 ","$0.00 ","$4,075.00 ","$1,833.75 ","$0.00 ","$849.33 ","$0.00 ","$0.00 ","$713.50 ","$4,075.00 ","$0.00 ","$2,037.50 ","$3,227.40 ","$3,260.00 ","$0.00 ","$637.74 ","$0.00 ","$648.74 ","$0.00 "
"SP-2469","SUP","HCPCS C1713","","SP-2469  -  PLATE BONE THK2.6MM 16 HOLE STR TRAUMAONE LORENZ MAGENTA","BOTH IP/OP","$6,870.00 ","$5,083.80 ","$0.00 ","$6,870.00 ","$3,091.50 ","$0.00 ","$1,431.88 ","$0.00 ","$0.00 ","$1,202.88 ","$6,870.00 ","$0.00 ","$3,435.00 ","$5,441.04 ","$5,496.00 ","$0.00 ","$1,075.16 ","$0.00 ","$1,093.70 ","$0.00 "
"SP-2470","SUP","HCPCS C1713","","SP-2470  -  PLATE BONE THK2.6MM SMALL 7 HOLE CVD LORENZ MAGENTA MANDIB","BOTH IP/OP","$4,075.00 ","$3,015.50 ","$0.00 ","$4,075.00 ","$1,833.75 ","$0.00 ","$849.33 ","$0.00 ","$0.00 ","$713.50 ","$4,075.00 ","$0.00 ","$2,037.50 ","$3,227.40 ","$3,260.00 ","$0.00 ","$637.74 ","$0.00 ","$648.74 ","$0.00 "
"SP-2472","SUP","HCPCS C1713","","SP-2472  -  PLATE BONE L CRNMXF LEFT 8X10 HOLE XRIGID 1.5/1MM","BOTH IP/OP","$737.50 ","$545.75 ","$0.00 ","$737.50 ","$331.88 ","$0.00 ","$153.71 ","$0.00 ","$0.00 ","$129.13 ","$737.50 ","$0.00 ","$368.75 ","$584.10 ","$590.00 ","$0.00 ","$115.42 ","$0.00 ","$117.41 ","$0.00 "
"SP-2473","SUP","HCPCS C1713","","SP-2473  -  PLATE BN L 8X10 HL XRIGID CRNMXF RT 1.5/1MM SCR","BOTH IP/OP","$1,242.50 ","$919.45 ","$0.00 ","$1,242.50 ","$559.13 ","$0.00 ","$258.97 ","$0.00 ","$0.00 ","$217.55 ","$1,242.50 ","$0.00 ","$621.25 ","$984.06 ","$994.00 ","$0.00 ","$194.45 ","$0.00 ","$197.81 ","$0.00 "
"SP-2526","SUP","HCPCS C1713","","SP-2526  -  PLATE BONE CURVE CRNMXF 5 HOLE 1MM SCR","BOTH IP/OP","$2,892.50 ","$2,140.45 ","$0.00 ","$2,892.50 ","$1,301.63 ","$0.00 ","$602.87 ","$0.00 ","$0.00 ","$506.45 ","$2,892.50 ","$0.00 ","$1,446.25 ","$2,290.86 ","$2,314.00 ","$0.00 ","$452.68 ","$0.00 ","$460.49 ","$0.00 "
"SP-2566","SUP","HCPCS C1713","","SP-2566  -  PLATE BONE STR 2MM 6 HOLE TRAUMAONE BLUE TITANIUM MANDIB","BOTH IP/OP","$2,290.00 ","$1,694.60 ","$0.00 ","$2,290.00 ","$1,030.50 ","$0.00 ","$477.29 ","$0.00 ","$0.00 ","$400.96 ","$2,290.00 ","$0.00 ","$1,145.00 ","$1,813.68 ","$1,832.00 ","$0.00 ","$358.39 ","$0.00 ","$364.57 ","$0.00 "
"SP-2575","SUP","HCPCS C1713","","SP-2575  -  PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ","BOTH IP/OP","$877.50 ","$649.35 ","$0.00 ","$877.50 ","$394.88 ","$0.00 ","$182.89 ","$0.00 ","$0.00 ","$153.64 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$137.33 ","$0.00 ","$139.70 ","$0.00 "
"SP-2576","SUP","HCPCS C1713","","SP-2576  -  PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ","BOTH IP/OP","$877.50 ","$649.35 ","$0.00 ","$877.50 ","$394.88 ","$0.00 ","$182.89 ","$0.00 ","$0.00 ","$153.64 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$137.33 ","$0.00 ","$139.70 ","$0.00 "
"SP-2585","SUP","HCPCS C1713","","SP-2585  -  PLATE .6MM MANDIB 4 HOLE STR 2/2.3MM SCR BONE","BOTH IP/OP","$1,817.50 ","$1,344.95 ","$0.00 ","$1,817.50 ","$817.88 ","$0.00 ","$378.81 ","$0.00 ","$0.00 ","$318.23 ","$1,817.50 ","$0.00 ","$908.75 ","$1,439.46 ","$1,454.00 ","$0.00 ","$284.44 ","$0.00 ","$289.35 ","$0.00 "
"SP-2630","SUP","HCPCS C1713","","SP-2630  -  PLATE BONE THK1.6MM STR 2X7 HOLE MATRIX GRADE II TRAUMAONE","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"SP-2631","SUP","HCPCS C1713","","SP-2631  -  PLATE BONE THK1.6MM 7X2MM CVD MATRIX GOLD MANDIB 2/2.3MM","BOTH IP/OP","$2,625.00 ","$1,942.50 ","$0.00 ","$2,625.00 ","$1,181.25 ","$0.00 ","$547.12 ","$0.00 ","$0.00 ","$459.62 ","$2,625.00 ","$0.00 ","$1,312.50 ","$2,079.00 ","$2,100.00 ","$0.00 ","$410.81 ","$0.00 ","$417.90 ","$0.00 "
"SP-2665","SUP","HCPCS C1713","","SP-2665  -  PLATE BONE THK1.6MM 7 HOLE 2Y GRADE II TRAUMAONE LORENZ","BOTH IP/OP","$1,515.00 ","$1,121.10 ","$0.00 ","$1,515.00 ","$681.75 ","$0.00 ","$315.76 ","$0.00 ","$0.00 ","$265.26 ","$1,515.00 ","$0.00 ","$757.50 ","$1,199.88 ","$1,212.00 ","$0.00 ","$237.10 ","$0.00 ","$241.19 ","$0.00 "
"SP-2703","SUP","HCPCS C1713","","SP-2703  -  PLATE STR 1.6MM 6 HOLE GAP BONE","BOTH IP/OP","$2,450.00 ","$1,813.00 ","$0.00 ","$2,450.00 ","$1,102.50 ","$0.00 ","$510.64 ","$0.00 ","$0.00 ","$428.98 ","$2,450.00 ","$0.00 ","$1,225.00 ","$1,940.40 ","$1,960.00 ","$0.00 ","$383.43 ","$0.00 ","$390.04 ","$0.00 "
"SP-2834","SUP","HCPCS C1713","","SP-2834  -  SCREW BONE L8 MM OD2.4 MM RIB SELF DRILL LOCK","BOTH IP/OP","$625.00 ","$462.50 ","$0.00 ","$625.00 ","$281.25 ","$0.00 ","$130.27 ","$0.00 ","$0.00 ","$109.43 ","$625.00 ","$0.00 ","$312.50 ","$495.00 ","$500.00 ","$0.00 ","$97.81 ","$0.00 ","$99.50 ","$0.00 "
"SP-2889","SUP","HCPCS C1713","","SP-2889  -  PLATE BN STRG STERNALOCK BLU 24 HL STRNM PRM CLSR SYS","BOTH IP/OP","$3,760.00 ","$2,782.40 ","$0.00 ","$3,760.00 ","$1,692.00 ","$0.00 ","$783.68 ","$0.00 ","$0.00 ","$658.35 ","$3,760.00 ","$0.00 ","$1,880.00 ","$2,977.92 ","$3,008.00 ","$0.00 ","$588.44 ","$0.00 ","$598.59 ","$0.00 "
"SP-2890","SUP","HCPCS C1713","","SP-2890  -  PLATE BN HEX STERNALOCK BLU 6 HL STRNM PRM CLSR SYS","BOTH IP/OP","$2,210.00 ","$1,635.40 ","$0.00 ","$2,210.00 ","$994.50 ","$0.00 ","$460.62 ","$0.00 ","$0.00 ","$386.95 ","$2,210.00 ","$0.00 ","$1,105.00 ","$1,750.32 ","$1,768.00 ","$0.00 ","$345.87 ","$0.00 ","$351.83 ","$0.00 "
"SP-2891","SUP","HCPCS C1713","","SP-2891  -  PLATE BN JL STRG STERNALOCK BLU 8 HL STRNM PRM CLSR SYS","BOTH IP/OP","$1,945.00 ","$1,439.30 ","$0.00 ","$1,945.00 ","$875.25 ","$0.00 ","$405.39 ","$0.00 ","$0.00 ","$340.55 ","$1,945.00 ","$0.00 ","$972.50 ","$1,540.44 ","$1,556.00 ","$0.00 ","$304.39 ","$0.00 ","$309.64 ","$0.00 "
"SP-2899","SUP","HCPCS C1713","","SP-2899  -  PLATE BN STRG STERNALOCK BLU 6 HL STRNM PRM CLSR SYS","BOTH IP/OP","$1,962.50 ","$1,452.25 ","$0.00 ","$1,962.50 ","$883.13 ","$0.00 ","$409.03 ","$0.00 ","$0.00 ","$343.62 ","$1,962.50 ","$0.00 ","$981.25 ","$1,554.30 ","$1,570.00 ","$0.00 ","$307.13 ","$0.00 ","$312.43 ","$0.00 "
"SP-2913","SUP","HCPCS C1713","","SP-2913  -  PLATE BN 70D L STERNALOCK BLU 8 HL STRNM PRM CLSR SYS","BOTH IP/OP","$1,692.50 ","$1,252.45 ","$0.00 ","$1,692.50 ","$761.63 ","$0.00 ","$352.76 ","$0.00 ","$0.00 ","$296.34 ","$1,692.50 ","$0.00 ","$846.25 ","$1,340.46 ","$1,354.00 ","$0.00 ","$264.88 ","$0.00 ","$269.45 ","$0.00 "
"SP-2914","SUP","HCPCS C1713","","SP-2914  -  PLATE BN Y STERNALOCK BLU 12 HL STRNM PRM CLSR SYS","BOTH IP/OP","$3,332.50 ","$2,466.05 ","$0.00 ","$3,332.50 ","$1,499.63 ","$0.00 ","$694.58 ","$0.00 ","$0.00 ","$583.49 ","$3,332.50 ","$0.00 ","$1,666.25 ","$2,639.34 ","$2,666.00 ","$0.00 ","$521.54 ","$0.00 ","$530.53 ","$0.00 "
"SP-2927","SUP","HCPCS C1713","","SP-2927  -  PLATE BN STRG 1.6MM STERNALOCK BLU 16 HL STRNM PRM CLSR SYS","BOTH IP/OP","$2,870.00 ","$2,123.80 ","$0.00 ","$2,870.00 ","$1,291.50 ","$0.00 ","$598.18 ","$0.00 ","$0.00 ","$502.51 ","$2,870.00 ","$0.00 ","$1,435.00 ","$2,273.04 ","$2,296.00 ","$0.00 ","$449.16 ","$0.00 ","$456.90 ","$0.00 "
"SP-2984","SUP","HCPCS C1713","","SP-2984  -  PLATE BN 100D X STERNALOCK BLU 8 HL STRNM","BOTH IP/OP","$2,445.00 ","$1,809.30 ","$0.00 ","$2,445.00 ","$1,100.25 ","$0.00 ","$509.60 ","$0.00 ","$0.00 ","$428.10 ","$2,445.00 ","$0.00 ","$1,222.50 ","$1,936.44 ","$1,956.00 ","$0.00 ","$382.64 ","$0.00 ","$389.24 ","$0.00 "
"SP-2985","SUP","HCPCS C1713","","SP-2985  -  PLATE BN 100D Y STERNALOCK BLU 6 HL STRNM","BOTH IP/OP","$2,445.00 ","$1,809.30 ","$0.00 ","$2,445.00 ","$1,100.25 ","$0.00 ","$509.60 ","$0.00 ","$0.00 ","$428.10 ","$2,445.00 ","$0.00 ","$1,222.50 ","$1,936.44 ","$1,956.00 ","$0.00 ","$382.64 ","$0.00 ","$389.24 ","$0.00 "
"SP-3001","SUP","HCPCS C1713","","SP-3001  -  PLATE BN 13MM STERNALOCK BLU STRNM JL G","BOTH IP/OP","$2,070.00 ","$1,531.80 ","$0.00 ","$2,070.00 ","$931.50 ","$0.00 ","$431.44 ","$0.00 ","$0.00 ","$362.44 ","$2,070.00 ","$0.00 ","$1,035.00 ","$1,639.44 ","$1,656.00 ","$0.00 ","$323.96 ","$0.00 ","$329.54 ","$0.00 "
"SP-3022","SUP","HCPCS C1713","","SP-3022  -  PLATE BN LG .6MM 4 HL CNTR MESH STRNL 1.5MM SCR EZ","BOTH IP/OP","$1,677.50 ","$1,241.35 ","$0.00 ","$1,677.50 ","$754.88 ","$0.00 ","$349.63 ","$0.00 ","$0.00 ","$293.72 ","$1,677.50 ","$0.00 ","$838.75 ","$1,328.58 ","$1,342.00 ","$0.00 ","$262.53 ","$0.00 ","$267.06 ","$0.00 "
"SP-3060","SUP","HCPCS C1713","","SP-3060  -  SCREW BN 2MM 9MM OMNIMAX MXLMNDB SD XD","BOTH IP/OP","$2,172.50 ","$1,607.65 ","$0.00 ","$2,172.50 ","$977.63 ","$0.00 ","$452.80 ","$0.00 ","$0.00 ","$380.39 ","$2,172.50 ","$0.00 ","$1,086.25 ","$1,720.62 ","$1,738.00 ","$0.00 ","$340.00 ","$0.00 ","$345.86 ","$0.00 "
"SP-3142","SUP","HCPCS C1713","","SP-3142  -  PLATE BN 60D JL STERNALOCK BLU STRNM","BOTH IP/OP","$2,977.50 ","$2,203.35 ","$0.00 ","$2,977.50 ","$1,339.88 ","$0.00 ","$620.59 ","$0.00 ","$0.00 ","$521.34 ","$2,977.50 ","$0.00 ","$1,488.75 ","$2,358.18 ","$2,382.00 ","$0.00 ","$465.98 ","$0.00 ","$474.02 ","$0.00 "
"SP-3192","SUP","HCPCS C1713","","SP-3192  -  PLATE BN W STERNALOCK BLU 8 HL STRNL","BOTH IP/OP","$3,537.50 ","$2,617.75 ","$0.00 ","$3,537.50 ","$1,591.88 ","$0.00 ","$737.30 ","$0.00 ","$0.00 ","$619.39 ","$3,537.50 ","$0.00 ","$1,768.75 ","$2,801.70 ","$2,830.00 ","$0.00 ","$553.62 ","$0.00 ","$563.17 ","$0.00 "
"SP-3215","SUP","HCPCS C1713","","SP-3215  -  PLATE BN XW 80MM MESH CRNM CHIARI","BOTH IP/OP","$2,977.50 ","$2,203.35 ","$0.00 ","$2,977.50 ","$1,339.88 ","$0.00 ","$620.59 ","$0.00 ","$0.00 ","$521.34 ","$2,977.50 ","$0.00 ","$1,488.75 ","$2,358.18 ","$2,382.00 ","$0.00 ","$465.98 ","$0.00 ","$474.02 ","$0.00 "
"SP719521","SUP","Custom 27203010","","REAGENT .8% RBC RSLV 3ML PNL B BLOOD BANK","BOTH IP/OP","$391.75 ","$289.90 ","$0.00 ","$391.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.75 ","$0.00 ","$195.88 ","$310.27 ","$313.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SP721380","SUP","Custom 27203010","","REAGENT ANTI-JK LTTL A BCLN 3ML MNCLN RARE GRP BLOOD BANK","BOTH IP/OP","$47.50 ","$35.15 ","$0.00 ","$47.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.50 ","$0.00 ","$23.75 ","$37.62 ","$38.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPD2-US-040-320","SUP","HCPCS C1884","","SPD2-US-040-320  -  SYSTEM EMBL PRTC 320CM .014IN FLTR CPTR WIRE GUID CATH 4MM","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"SPD2-US-050-320","SUP","HCPCS C1884","","SPD2-US-050-320  -  SYSTEM EMBL PRTC 320CM .014IN FLTR CPTR WIRE GUID CATH 5MM","BOTH IP/OP","$2,875.00 ","$2,127.50 ","$0.00 ","$2,875.00 ","$1,293.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$503.39 ","$2,875.00 ","$0.00 ","$1,437.50 ","$2,277.00 ","$2,300.00 ","$0.00 ","$449.94 ","$0.00 ","$457.70 ","$0.00 "
"SPD2-US-060-320","SUP","HCPCS C1773","","SPD2-US-060-320  -  SYSTEM EMBL PRTC 3.2-4.2FR 6MM 320CM 190CM SPIDERFX CPTR WRE","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$1,893.71 ","$0.00 ","$726.88 ","$0.00 ","$0.00 ","$610.63 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$545.79 ","$0.00 ","$555.21 ","$0.00 "
"SPH100200-20","SUP","Custom 27803010","","SPH100200-20  -  COIL EMBL 2MM 2.5CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,497.15 ","$1,847.89 ","$0.00 ","$2,497.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,497.15 ","$0.00 ","$1,248.58 ","$1,977.74 ","$1,997.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100250-20","SUP","Custom 27803010","","SPH100250-20  -  COIL EMBL 2.5MM 3.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,530.45 ","$1,872.53 ","$0.00 ","$2,530.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.45 ","$0.00 ","$1,265.23 ","$2,004.12 ","$2,024.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100300-20","SUP","Custom 27803010","","SPH100300-20  -  COIL EMBL 3MM 5.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,530.45 ","$1,872.53 ","$0.00 ","$2,530.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.45 ","$0.00 ","$1,265.23 ","$2,004.12 ","$2,024.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100350-20","SUP","Custom 27803010","","SPH100350-20  -  COIL EMBL 3.5MM 6.6CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,530.45 ","$1,872.53 ","$0.00 ","$2,530.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,530.45 ","$0.00 ","$1,265.23 ","$2,004.12 ","$2,024.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100500-20","SUP","Custom 27803010","","SPH100500-20  -  COIL EMBL 5MM 9.7CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,563.73 ","$1,897.16 ","$0.00 ","$2,563.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,563.73 ","$0.00 ","$1,281.86 ","$2,030.47 ","$2,050.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100600-20","SUP","Custom 27803010","","SPH100600-20  -  COIL EMBL 6MM 11.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,597.03 ","$1,921.80 ","$0.00 ","$2,597.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,597.03 ","$0.00 ","$1,298.51 ","$2,056.85 ","$2,077.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100620-20","SUP","Custom 27803010","","SPH100620-20  -  COIL EMBL 6MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT","BOTH IP/OP","$2,730.20 ","$2,020.35 ","$0.00 ","$2,730.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,730.20 ","$0.00 ","$1,365.10 ","$2,162.32 ","$2,184.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100700-20","SUP","Custom 27803010","","SPH100700-20  -  COIL EMBL 7MM 13.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,630.33 ","$1,946.44 ","$0.00 ","$2,630.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,630.33 ","$0.00 ","$1,315.16 ","$2,083.22 ","$2,104.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100720-20","SUP","Custom 27803010","","SPH100720-20  -  COIL EMBL 7MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT","BOTH IP/OP","$2,730.20 ","$2,020.35 ","$0.00 ","$2,730.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,730.20 ","$0.00 ","$1,365.10 ","$2,162.32 ","$2,184.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100800-20","SUP","Custom 27803010","","SPH100800-20  -  COIL EMBL 8MM 16.1CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,663.63 ","$1,971.09 ","$0.00 ","$2,663.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,663.63 ","$0.00 ","$1,331.81 ","$2,109.59 ","$2,130.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100825-20","SUP","Custom 27803010","","SPH100825-20  -  COIL EMBL 8MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT","BOTH IP/OP","$2,796.80 ","$2,069.63 ","$0.00 ","$2,796.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,796.80 ","$0.00 ","$1,398.40 ","$2,215.07 ","$2,237.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100900-20","SUP","Custom 27803010","","SPH100900-20  -  COIL EMBL 9MM 18.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,696.93 ","$1,995.73 ","$0.00 ","$2,696.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,696.93 ","$0.00 ","$1,348.46 ","$2,135.97 ","$2,157.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH100925-20","SUP","Custom 27803010","","SPH100925-20  -  COIL EMBL 9MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT","BOTH IP/OP","$2,796.80 ","$2,069.63 ","$0.00 ","$2,796.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,796.80 ","$0.00 ","$1,398.40 ","$2,215.07 ","$2,237.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH101000-20","SUP","Custom 27803010","","SPH101000-20  -  COIL EMBL SPHR 10MM 20.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP","BOTH IP/OP","$2,730.20 ","$2,020.35 ","$0.00 ","$2,730.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,730.20 ","$0.00 ","$1,365.10 ","$2,162.32 ","$2,184.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH10103020","SUP","Custom 27803010","","SPH10103020  -  COIL EMBL SPHR 10MM 30CM MICRUSPHERE 10 MCIOL SPHRCL LOOP","BOTH IP/OP","$2,830.10 ","$2,094.27 ","$0.00 ","$2,830.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,830.10 ","$0.00 ","$1,415.05 ","$2,241.44 ","$2,264.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH101030-20","SUP","Custom 27803010","","SPH101030-20  -  COIL EMBL 30CM 10MM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,830.10 ","$2,094.27 ","$0.00 ","$2,830.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,830.10 ","$0.00 ","$1,415.05 ","$2,241.44 ","$2,264.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181100-20","SUP","Custom 27803010","","SPH181100-20  -  COIL EMBL 11MM 18.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,725.80 ","$2,017.09 ","$0.00 ","$2,725.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,725.80 ","$0.00 ","$1,362.90 ","$2,158.83 ","$2,180.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181200-20","SUP","Custom 27803010","","SPH181200-20  -  COIL EMBL 12MM 20.7CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,725.80 ","$2,017.09 ","$0.00 ","$2,725.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,725.80 ","$0.00 ","$1,362.90 ","$2,158.83 ","$2,180.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181300-20","SUP","Custom 27803010","","SPH181300-20  -  COIL EMBL 13MM 22.6CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,725.80 ","$2,017.09 ","$0.00 ","$2,725.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,725.80 ","$0.00 ","$1,362.90 ","$2,158.83 ","$2,180.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181400-20","SUP","Custom 27803010","","SPH181400-20  -  COIL EMBL 14MM 24.3CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,761.68 ","$2,043.64 ","$0.00 ","$2,761.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,761.68 ","$0.00 ","$1,380.84 ","$2,187.25 ","$2,209.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181500-20","SUP","Custom 27803010","","SPH181500-20  -  COIL EMBL 15MM 26CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,797.53 ","$2,070.17 ","$0.00 ","$2,797.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,797.53 ","$0.00 ","$1,398.76 ","$2,215.64 ","$2,238.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181600-20","SUP","Custom 27803010","","SPH181600-20  -  COIL EMBL 16MM 27.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,797.53 ","$2,070.17 ","$0.00 ","$2,797.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,797.53 ","$0.00 ","$1,398.76 ","$2,215.64 ","$2,238.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181700-20","SUP","Custom 27803010","","SPH181700-20  -  COIL EMBL 17MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,833.40 ","$2,096.72 ","$0.00 ","$2,833.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,833.40 ","$0.00 ","$1,416.70 ","$2,244.05 ","$2,266.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPH181800-20","SUP","Custom 27803010","","SPH181800-20  -  COIL EMBL 18MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH","BOTH IP/OP","$2,833.40 ","$2,096.72 ","$0.00 ","$2,833.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,833.40 ","$0.00 ","$1,416.70 ","$2,244.05 ","$2,266.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPL15006X","SUP","HCPCS C1725","","SPL15006X  -  CATH BALDILAT 1.5MM 6MM RAPEX SMCPNT SPNTR LGND","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL15010X","SUP","HCPCS C1726","","SPL15010X  -  CATHETER BLNDIL 21CM .02IN 1.5MM 142CM LF 10MM SPNTR LGND","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"SPL15012X","SUP","HCPCS C1725","","CATHETER BLN 1.5MM 12MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL15015X","SUP","HCPCS C1725","","CATHETER BLN 1.5MM 15MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL15020X","SUP","HCPCS C1725","","CATHETER BLN 1.5MM 20MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL20006X","SUP","HCPCS C1726","","SPL20006X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 6MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL20010X","SUP","HCPCS C1726","","SPL20010X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 10MM SPNTR LGND","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"SPL20012X","SUP","HCPCS C1725","","CATHETER BLN 2MM 12MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL20015X","SUP","HCPCS C1725","","CATHETER BLN 2MM 15MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL20020X","SUP","HCPCS C1725","","CATHETER BLN 2MM 20MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL20025X","SUP","HCPCS C1726","","SPL20025X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 25MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL20030X","SUP","HCPCS C1726","","SPL20030X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 30MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL22506X","SUP","HCPCS C1726","","SPL22506X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 6MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL22510X","SUP","HCPCS C1726","","SPL22510X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 10MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL22512X","SUP","HCPCS C1726","","SPL22512X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 12MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL22515X","SUP","HCPCS C1726","","SPL22515X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 15MM SPNTR LGND","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"SPL22520X","SUP","HCPCS C1726","","SPL22520X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 20MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL22525X","SUP","HCPCS C1726","","SPL22525X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 25MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL250010X","SUP","HCPCS C1726","","SPL250010X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 10MM SPNTR LGND","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"SPL25006X","SUP","HCPCS C1726","","SPL25006X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 6MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL25012X","SUP","HCPCS C1725","","CATHETER BLN 2.5MM 12MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL25015X","SUP","HCPCS C1725","","CATHETER BLN 2.5MM 15MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL25020X","SUP","HCPCS C1725","","CATHETER BLN 2.5MM 20MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL25025X","SUP","HCPCS C1726","","SPL25025X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 25MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL25030X","SUP","HCPCS C1726","","SPL25030X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 30MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL27506X","SUP","HCPCS C1726","","SPL27506X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 6MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL27512X","SUP","HCPCS C1726","","SPL27512X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 12MM SPNTR LGND","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"SPL27515X","SUP","HCPCS C1726","","SPL27515X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 15MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL27520X","SUP","HCPCS C1726","","SPL27520X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 20MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL27525X","SUP","HCPCS C1726","","SPL27525X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 25MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL30006X","SUP","HCPCS C1726","","SPL30006X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 6MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL30010X","SUP","HCPCS C1726","","SPL30010X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 10MM SPNTR LGND","BOTH IP/OP","$412.50 ","$305.25 ","$0.00 ","$412.50 ","$223.99 ","$0.00 ","$85.98 ","$0.00 ","$0.00 ","$72.23 ","$412.50 ","$0.00 ","$206.25 ","$326.70 ","$330.00 ","$0.00 ","$64.56 ","$0.00 ","$65.67 ","$0.00 "
"SPL30012X","SUP","HCPCS C1725","","CATHETER BLN 3MM 12MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL30015X","SUP","HCPCS C1725","","CATHETER BLN 3MM 15MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL30020X","SUP","HCPCS C1725","","CATHETER BLN 3MM 20MM RAPEX LGND SPNTR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$237.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"SPL30025X","SUP","HCPCS C1726","","SPL30025X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 25MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL30030X","SUP","HCPCS C1726","","SPL30030X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 30MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL32512X","SUP","HCPCS C1726","","SPL32512X  -  CATHETER BLNDIL 21CM .023IN 3.25MM 142CM LF 12MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL32515X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL32520X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35006X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35010X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35012X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35015X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35020X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35025X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL35030X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL37512X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL37515X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL37520X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL40006X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL40010X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL40012X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL40015X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL40020X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPL40025X","SUP","HCPCS C1726","","SPL40025X  -  CATHETER BLNDIL 21CM .024IN 4MM 142CM LF 25MM SPNTR LGND","BOTH IP/OP","$425.00 ","$314.50 ","$0.00 ","$425.00 ","$230.78 ","$0.00 ","$88.58 ","$0.00 ","$0.00 ","$74.41 ","$425.00 ","$0.00 ","$212.50 ","$336.60 ","$340.00 ","$0.00 ","$66.51 ","$0.00 ","$67.66 ","$0.00 "
"SPL40030X","SUP","HCPCS C1725","","BALLON SPRINTER LEGEND  RX","BOTH IP/OP","$12.50 ","$9.25 ","$0.00 ","$12.50 ","$6.79 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.19 ","$12.50 ","$0.00 ","$6.25 ","$9.90 ","$10.00 ","$0.00 ","$1.96 ","$0.00 ","$1.99 ","$0.00 "
"SPLS-20100-TS","SUP","HCPCS C1713","","SPLS-20100-TS  -  PEG FX 2MM 10MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20120-TS","SUP","HCPCS C1713","","SPLS-20120-TS  -  PEG FX 2MM 12MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20140-TS","SUP","HCPCS C1713","","SPLS-20140-TS  -  PEG FX 2MM 14MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20160-TS","SUP","HCPCS C1713","","SPLS-20160-TS  -  PEG FX 2MM 16MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20170-TS","SUP","HCPCS C1713","","SPLS-20170-TS  -  PEG FX 2MM 17MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20180-TS","SUP","HCPCS C1713","","SPLS-20180-TS  -  PEG FX 2MM 18MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20190-TS","SUP","HCPCS C1713","","SPLS-20190-TS  -  PEG FX 2MM 19MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20200-TS","SUP","HCPCS C1713","","SPLS-20200-TS  -  PEG FX 2MM 20MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20210-TS","SUP","HCPCS C1713","","SPLS-20210-TS  -  PEG FX 2MM 21MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20220-TS","SUP","HCPCS C1713","","SPLS-20220-TS  -  PEG FX 2MM 22MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20230-TS","SUP","HCPCS C1713","","SPLS-20230-TS  -  PEG FX 2MM 23MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20240-TS","SUP","HCPCS C1713","","SPLS-20240-TS  -  PEG FX 2MM 24MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20260-TS","SUP","HCPCS C1713","","SPLS-20260-TS  -  PEG FX 2MM 26MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20280-TS","SUP","HCPCS C1713","","SPLS-20280-TS  -  PEG FX 2MM 28MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20300-TS","SUP","HCPCS C1713","","SPLS-20300-TS  -  PEG FX 2MM 30MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPLS-20320-TS","SUP","HCPCS C1713","","SPLS-20320-TS  -  PEG FX 2MM 32MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"SPMTS4014","SUP","Custom 27203010","","REAGENT ANTI-IGG C3D ID MTS GEL CRD 6 TST ANALY","BOTH IP/OP","$160.70 ","$118.92 ","$0.00 ","$160.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$160.70 ","$0.00 ","$80.35 ","$127.27 ","$128.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPMTS4024","SUP","Custom 27203010","","REAGENT ANTI-IGG ID MTS GEL CRD PLYCLN 6 TST ANALY","BOTH IP/OP","$494.85 ","$366.19 ","$0.00 ","$494.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$494.85 ","$0.00 ","$247.43 ","$391.92 ","$395.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SPS0121K","SUP","HCPCS C1713","","SPS0121K  -  SPACER HUM 99MMX16MM 41MM 7MM INTSPC SM SHLDR PMMA","BOTH IP/OP","$9,975.00 ","$7,381.50 ","$0.00 ","$9,975.00 ","$4,488.75 ","$0.00 ","$2,079.04 ","$0.00 ","$0.00 ","$1,746.54 ","$9,975.00 ","$0.00 ","$4,987.50 ","$7,900.20 ","$7,980.00 ","$0.00 ","$1,561.09 ","$0.00 ","$1,588.02 ","$0.00 "
"SR-0620-CS","SUP","HCPCS C1876","","SR-0620-CS  -  STENT VASC STRG 6MM 20MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0630-CS","SUP","HCPCS C1876","","SR-0630-CS  -  STENT VASC 6MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0640-CS","SUP","HCPCS C1876","","SR-0640-CS  -  STENT VASC 6MM 40MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0730-CS","SUP","HCPCS C1876","","SR-0730-CS  -  STENT VASC 7MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0740-CS","SUP","HCPCS C1876","","SR-0740-CS  -  STENT VASC 7MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0830-CS","SUP","HCPCS C1876","","SR-0830-CS  -  STENT VASC 8MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0840-CS","SUP","HCPCS C1876","","SR-0840-CS  -  STENT VASC 8MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0930-CS","SUP","HCPCS C1876","","SR-0930-CS  -  STENT VASC 9MM 30MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-0940-CS","SUP","HCPCS C1876","","SR-0940-CS  -  STENT VASC 9MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-1030-CS","SUP","HCPCS C1876","","SR-1030-CS  -  STENT VASC SHRT STRG 10MM 6FR 30MM 57CM ENROUTE UBER FLX","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SR-1040-CS","SUP","HCPCS C1876","","SR-1040-CS  -  STENT VASC 10MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS","BOTH IP/OP","$6,750.00 ","$4,995.00 ","$0.00 ","$6,750.00 ","$3,037.50 ","$0.00 ","$1,406.87 ","$0.00 ","$0.00 ","$1,181.87 ","$6,750.00 ","$0.00 ","$3,375.00 ","$5,346.00 ","$5,400.00 ","$0.00 ","$1,056.38 ","$0.00 ","$1,074.60 ","$0.00 "
"SRC140306-20","SUP","Custom 27803010","","SRC140306-20  -  COIL EMBL 3MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,785.85 ","$2,061.53 ","$0.00 ","$2,785.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,785.85 ","$0.00 ","$1,392.93 ","$2,206.39 ","$2,228.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140406-20","SUP","Custom 27803010","","SRC140406-20  -  COIL EMBL 4MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,785.85 ","$2,061.53 ","$0.00 ","$2,785.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,785.85 ","$0.00 ","$1,392.93 ","$2,206.39 ","$2,228.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140408-20","SUP","Custom 27803010","","SRC140408-20  -  COIL EMBL 4MM 8CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,829.38 ","$2,093.74 ","$0.00 ","$2,829.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,829.38 ","$0.00 ","$1,414.69 ","$2,240.87 ","$2,263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140445-20","SUP","Custom 27803010","","SRC140445-20  -  COIL EMBL 4MM 4.5CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,785.85 ","$2,061.53 ","$0.00 ","$2,785.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,785.85 ","$0.00 ","$1,392.93 ","$2,206.39 ","$2,228.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140507-20","SUP","Custom 27803010","","SRC140507-20  -  COIL EMBL 5MM 7CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,829.38 ","$2,093.74 ","$0.00 ","$2,829.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,829.38 ","$0.00 ","$1,414.69 ","$2,240.87 ","$2,263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140512-20","SUP","Custom 27803010","","SRC140512-20  -  COIL EMBL 5MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,829.38 ","$2,093.74 ","$0.00 ","$2,829.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,829.38 ","$0.00 ","$1,414.69 ","$2,240.87 ","$2,263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140609-20","SUP","Custom 27803010","","SRC140609-20  -  COIL EMBL 6MM 9CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,829.38 ","$2,093.74 ","$0.00 ","$2,829.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,829.38 ","$0.00 ","$1,414.69 ","$2,240.87 ","$2,263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140615-20","SUP","Custom 27803010","","SRC140615-20  -  COIL EMBL 6MM 15CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,872.90 ","$2,125.95 ","$0.00 ","$2,872.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,872.90 ","$0.00 ","$1,436.45 ","$2,275.34 ","$2,298.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140711-20","SUP","Custom 27803010","","SRC140711-20  -  COIL EMBL 7MM 11CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,829.38 ","$2,093.74 ","$0.00 ","$2,829.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,829.38 ","$0.00 ","$1,414.69 ","$2,240.87 ","$2,263.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140717-20","SUP","Custom 27803010","","SRC140717-20  -  COIL EMBL 7MM 17CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,959.95 ","$2,190.36 ","$0.00 ","$2,959.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,959.95 ","$0.00 ","$1,479.98 ","$2,344.28 ","$2,367.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140812-20","SUP","Custom 27803010","","SRC140812-20  -  COIL EMBL 8MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,872.90 ","$2,125.95 ","$0.00 ","$2,872.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,872.90 ","$0.00 ","$1,436.45 ","$2,275.34 ","$2,298.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140820-20","SUP","Custom 27803010","","SRC140820-20  -  COIL EMBL 8MM 20CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,003.48 ","$2,222.58 ","$0.00 ","$3,003.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,003.48 ","$0.00 ","$1,501.74 ","$2,378.76 ","$2,402.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140914-20","SUP","Custom 27803010","","SRC140914-20  -  COIL EMBL 9MM 14CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,959.95 ","$2,190.36 ","$0.00 ","$2,959.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,959.95 ","$0.00 ","$1,479.98 ","$2,344.28 ","$2,367.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC140922-20","SUP","Custom 27803010","","SRC140922-20  -  COIL EMBL 9MM 22CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,003.48 ","$2,222.58 ","$0.00 ","$3,003.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,003.48 ","$0.00 ","$1,501.74 ","$2,378.76 ","$2,402.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC141016-20","SUP","Custom 27803010","","SRC141016-20  -  COIL EMBL 10MM 16CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$2,959.95 ","$2,190.36 ","$0.00 ","$2,959.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,959.95 ","$0.00 ","$1,479.98 ","$2,344.28 ","$2,367.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC141025-20","SUP","Custom 27803010","","SRC141025-20  -  COIL EMBL 10MM 25CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,047.03 ","$2,254.80 ","$0.00 ","$3,047.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,047.03 ","$0.00 ","$1,523.51 ","$2,413.25 ","$2,437.62 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC141118-20","SUP","Custom 27803010","","SRC141118-20  -  COIL EMBL 11MM 18CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,003.48 ","$2,222.58 ","$0.00 ","$3,003.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,003.48 ","$0.00 ","$1,501.74 ","$2,378.76 ","$2,402.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC141127-20","SUP","Custom 27803010","","SRC141127-20  -  COIL EMBL 11MM 27CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,090.55 ","$2,287.01 ","$0.00 ","$3,090.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,090.55 ","$0.00 ","$1,545.28 ","$2,447.72 ","$2,472.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC141219-20","SUP","Custom 27803010","","SRC141219-20  -  COIL EMBL 12MM 19CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,003.48 ","$2,222.58 ","$0.00 ","$3,003.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,003.48 ","$0.00 ","$1,501.74 ","$2,378.76 ","$2,402.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRC141230-20","SUP","Custom 27803010","","SRC141230-20  -  COIL EMBL 12MM 30CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH","BOTH IP/OP","$3,134.08 ","$2,319.22 ","$0.00 ","$3,134.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,134.08 ","$0.00 ","$1,567.04 ","$2,482.19 ","$2,507.26 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRE-CV-320S","SUP","Custom 27803010","","SRE-CV-320S  -  EXPANDER TISSUE WALL CHART CURVILINEAR EXTREMITY SOFTSPAN","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRE-CV-720S","SUP","Custom 27803010","","SRE-CV-720S  -  EXPANDER TISSUE CURVILINEAR 26.2X9CM WALL CHART EXTREMITY","BOTH IP/OP","$1,825.00 ","$1,350.50 ","$0.00 ","$1,825.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,825.00 ","$0.00 ","$912.50 ","$1,445.40 ","$1,460.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SRS-003-FSP","SUP","HCPCS C1713","","SRS-003-FSP  -  CEMENT BONE NRN SRS FST ST 3ML PTTY STRL","BOTH IP/OP","$2,018.60 ","$1,493.76 ","$0.00 ","$2,018.60 ","$908.37 ","$0.00 ","$420.73 ","$0.00 ","$0.00 ","$353.44 ","$2,018.60 ","$0.00 ","$1,009.30 ","$1,598.73 ","$1,614.88 ","$0.00 ","$315.91 ","$0.00 ","$321.36 ","$0.00 "
"SRS-005-FSP","SUP","HCPCS C1713","","SRS-005-FSP  -  CEMENT BONE NRN SRS FST ST 5ML PTTY STRL","BOTH IP/OP","$3,315.05 ","$2,453.14 ","$0.00 ","$3,315.05 ","$1,491.77 ","$0.00 ","$690.94 ","$0.00 ","$0.00 ","$580.44 ","$3,315.05 ","$0.00 ","$1,657.53 ","$2,625.52 ","$2,652.04 ","$0.00 ","$518.81 ","$0.00 ","$527.76 ","$0.00 "
"SRS-010-FSP","SUP","HCPCS C1713","","SRS-010-FSP  -  CEMENT BONE NRN SRS FST ST 10ML PTTY STRL","BOTH IP/OP","$6,518.20 ","$4,823.47 ","$0.00 ","$6,518.20 ","$2,933.19 ","$0.00 ","$1,358.56 ","$0.00 ","$0.00 ","$1,141.28 ","$6,518.20 ","$0.00 ","$3,259.10 ","$5,162.41 ","$5,214.56 ","$0.00 ","$1,020.10 ","$0.00 ","$1,037.70 ","$0.00 "
"SRS-015-FSP","SUP","HCPCS C1713","","SRS-015-FSP  -  CEMENT BONE NRN SRS FST ST 15ML PTTY STRL","BOTH IP/OP","$9,567.20 ","$7,079.73 ","$0.00 ","$9,567.20 ","$4,305.24 ","$0.00 ","$1,994.04 ","$0.00 ","$0.00 ","$1,675.14 ","$9,567.20 ","$0.00 ","$4,783.60 ","$7,577.22 ","$7,653.76 ","$0.00 ","$1,497.27 ","$0.00 ","$1,523.10 ","$0.00 "
"SSSA-EW-09","SUP","Custom 27203010","","SSSA-EW-09  -  ADAPTER INTRO LNG 9FR SFSHTH SL XTD WNG VASC ATN","BOTH IP/OP","$110.00 ","$81.40 ","$0.00 ","$110.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$110.00 ","$0.00 ","$55.00 ","$87.12 ","$88.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ST-030","SUP","Custom 27203010","","BLANKET 30X24IN MED WT PED THRMPLST HPR/HPO H2O CIRC LMNT","BOTH IP/OP","$107.00 ","$79.18 ","$0.00 ","$107.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$107.00 ","$0.00 ","$53.50 ","$84.74 ","$85.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ST09875","SUP","HCPCS C1729","","CATHETER TWIST LOCK CATH-GUARD  CONTAMINATION SHIELD","BOTH IP/OP","$38.93 ","$28.81 ","$0.00 ","$38.93 ","$21.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$6.82 ","$38.93 ","$0.00 ","$19.46 ","$30.83 ","$31.14 ","$0.00 ","$6.09 ","$0.00 ","$6.20 ","$0.00 "
"ST5678","SUP","HCPCS C1713","","ST5678  -  SET SCREW","BOTH IP/OP","$250.00 ","$185.00 ","$0.00 ","$250.00 ","$112.50 ","$0.00 ","$52.11 ","$0.00 ","$0.00 ","$43.77 ","$250.00 ","$0.00 ","$125.00 ","$198.00 ","$200.00 ","$0.00 ","$39.13 ","$0.00 ","$39.80 ","$0.00 "
"STRAP25","SUP","HCPCS C1781","","STRAP25  -  DEVICE FX 5MM SECURESTRAP 25 ABS STRAP MESH DISP HRN REPR","BOTH IP/OP","$1,527.95 ","$1,130.68 ","$0.00 ","$1,527.95 ","$687.58 ","$0.00 ","$318.46 ","$0.00 ","$0.00 ","$267.53 ","$1,527.95 ","$0.00 ","$763.98 ","$1,210.14 ","$1,222.36 ","$0.00 ","$239.12 ","$0.00 ","$243.25 ","$0.00 "
"SU16030","SUP","Custom 27203010","","HOLDER 8IN HGR NDL NAR","BOTH IP/OP","$84.63 ","$62.63 ","$0.00 ","$84.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$84.63 ","$0.00 ","$42.31 ","$67.03 ","$67.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SW46","SUP","Custom 27203010","","SOCK ABS 46X3IN SPC UNV APL","BOTH IP/OP","$200.60 ","$148.44 ","$0.00 ","$200.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.60 ","$0.00 ","$100.30 ","$158.88 ","$160.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SXP77","SUP","Custom 27203010","","SXP77  -  SUTURE NONABSORBABLE THK1.5MM 2-0 V-7 30IN 7X3MM 2 ARM BRAID","BOTH IP/OP","$197.33 ","$146.02 ","$0.00 ","$200.29 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$200.29 ","$0.00 ","$100.15 ","$158.63 ","$160.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"SYNCRACRTPMEAM","SUP","HCPCS C2621","","SYNCRACRTPMEAM  -  SYNCRA CRT-P ADVANCED SYSTEM","BOTH IP/OP","$20,177.50 ","$14,931.35 ","$0.00 ","$20,587.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$20,587.50 ","$0.00 ","$10,293.75 ","$16,305.30 ","$16,470.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T1002","SUP","Custom 27203010","","T1002  -  RETRACTOR SRG 10IN 30MM POST GLND NK TTH SHLDR OSTM","BOTH IP/OP","$653.13 ","$483.32 ","$0.00 ","$653.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$653.13 ","$0.00 ","$326.56 ","$517.28 ","$522.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12BA20D","SUP","Custom 27203010","","T12BA20D  -  TOOL LGD T12CM 2MM BALL DIAM","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12BA30D","SUP","Custom 27203010","","T12BA30D  -  TOOL LGD T12CM 3MM BALL DIAM","BOTH IP/OP","$412.25 ","$305.07 ","$0.00 ","$412.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$412.25 ","$0.00 ","$206.13 ","$326.50 ","$329.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH15","SUP","Custom 27203010","","T12MH15  -  TOOL LEGEND 12CM 1.5MM MH","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH20","SUP","Custom 27203010","","T12MH20  -  TOOL LEGEND 12CM 2MM MH","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH20D","SUP","Custom 27203010","","T12MH20D  -  TOOL LEGEND 12CM 2MM DIAM","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH25","SUP","Custom 27203010","","T12MH25  -  TOOL LEGEND 12CM 2.5MM MH","BOTH IP/OP","$320.88 ","$237.45 ","$0.00 ","$320.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$320.88 ","$0.00 ","$160.44 ","$254.14 ","$256.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH25D","SUP","Custom 27203010","","T12MH25D  -  TOOL LEGEND 12CM 2.5MM DIAM","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH30D","SUP","Custom 27203010","","T12MH30D  -  TOOL LEGEND 12CM 3MM DIAM","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH35D","SUP","Custom 27203010","","T12MH35D  -  TOOL LEGEND 12CM 3.5MM DIAM","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T12MH45D","SUP","Custom 27203010","","T12MH45D  -  TOOL LEGEND 12CM 4.5MM DIAM","BOTH IP/OP","$348.50 ","$257.89 ","$0.00 ","$348.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$348.50 ","$0.00 ","$174.25 ","$276.01 ","$278.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T1415A","SUP","Custom 27203010","","T1415A  -  NEEDLE BIOP STANDARD 14GA 15CM COAXIAL HANDLE TEMNO","BOTH IP/OP","$227.32 ","$168.22 ","$0.00 ","$162.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.30 ","$0.00 ","$81.15 ","$128.54 ","$129.84 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T14BA20","SUP","Custom 27203010","","T14BA20  -  TOOL LEGD 14CM TELESC 2MM BALL","BOTH IP/OP","$331.50 ","$245.31 ","$0.00 ","$331.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$331.50 ","$0.00 ","$165.75 ","$262.55 ","$265.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"T14MH30D","SUP","Custom 27203010","","T14MH30D  -  TOOL LEGEND 14CM 3MM MH DIAM","BOTH IP/OP","$391.00 ","$289.34 ","$0.00 ","$391.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$391.00 ","$0.00 ","$195.50 ","$309.67 ","$312.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
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"T16X12","SUP","HCPCS C1894","","T16X12  -  SHEATH DLV ONQ TNL SYS 12IN 16GA DISP","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$175.00 ","$95.03 ","$0.00 ","$14.38 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"T17MH30D","SUP","Custom 27203010","","T17MH30D  -  TOOL LEGEND 17CM 3MM DIAM","BOTH IP/OP","$365.50 ","$270.47 ","$0.00 ","$365.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$365.50 ","$0.00 ","$182.75 ","$289.48 ","$292.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T17X8","SUP","HCPCS C1894","","T17X8  -  TUNNELER SRG 17GA 8IN STRL LF ONQ SHTH DISP","BOTH IP/OP","$69.00 ","$51.06 ","$0.00 ","$75.00 ","$40.73 ","$0.00 ","$14.38 ","$0.00 ","$0.00 ","$13.13 ","$75.00 ","$0.00 ","$37.50 ","$59.40 ","$60.00 ","$0.00 ","$11.74 ","$0.00 ","$11.94 ","$0.00 "
"T18MH25","SUP","Custom 27203010","","T18MH25  -  TOOL MATCH HEAD 2.5 MM 18 CM","BOTH IP/OP","$333.63 ","$246.89 ","$0.00 ","$333.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$333.63 ","$0.00 ","$166.81 ","$264.23 ","$266.90 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T18MH30D","SUP","Custom 27203010","","T18MH30D  -  TOOL MATCH HEAD 3.0 MM DIAMOND","BOTH IP/OP","$367.63 ","$272.05 ","$0.00 ","$367.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$367.63 ","$0.00 ","$183.81 ","$291.16 ","$294.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T4031","SUP","Custom 27203010","","GRINDER TISS LG 50ML CNTRF TUBE PCTV SLV PEEL PCH STRL DISP","BOTH IP/OP","$28.70 ","$21.24 ","$0.00 ","$28.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$28.70 ","$0.00 ","$14.35 ","$22.73 ","$22.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T43101","SUP","Custom 27804086","","T43101  -  GRAFT BN .5ML GRFTN PTTY JR DBM","BOTH IP/OP","$312.50 ","$231.25 ","$0.00 ","$312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$312.50 ","$0.00 ","$156.25 ","$247.50 ","$250.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T43102","SUP","Custom 27804086","","T43102  -  GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 1ML","BOTH IP/OP","$350.00 ","$259.00 ","$0.00 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$350.00 ","$0.00 ","$175.00 ","$277.20 ","$280.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T43103","SUP","Custom 27804086","","T43103  -  GRAFT BN 2.5ML GRFTN PTTY JR DBM","BOTH IP/OP","$1,190.00 ","$880.60 ","$0.00 ","$1,190.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,190.00 ","$0.00 ","$595.00 ","$942.48 ","$952.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T43105","SUP","Custom 27804086","","T43105  -  GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 5ML","BOTH IP/OP","$2,162.50 ","$1,600.25 ","$0.00 ","$2,162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,162.50 ","$0.00 ","$1,081.25 ","$1,712.70 ","$1,730.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH15","SUP","Custom 27203010","","T9MH15  -  TOOL LEGEND 9CM 1.5MM MH","BOTH IP/OP","$318.75 ","$235.88 ","$0.00 ","$318.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$318.75 ","$0.00 ","$159.38 ","$252.45 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH20","SUP","Custom 27203010","","T9MH20  -  TOOL LEGEND 9CM 2MM MH","BOTH IP/OP","$318.75 ","$235.88 ","$0.00 ","$318.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$318.75 ","$0.00 ","$159.38 ","$252.45 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH25","SUP","Custom 27203010","","T9MH25  -  TOOL LEGEND 9CM 2.5MM MH","BOTH IP/OP","$318.75 ","$235.88 ","$0.00 ","$318.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$318.75 ","$0.00 ","$159.38 ","$252.45 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH25D","SUP","Custom 27203010","","T9MH25D  -  TOOL LEGEND 9CM 2.5MM DIAM","BOTH IP/OP","$361.25 ","$267.33 ","$0.00 ","$361.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.25 ","$0.00 ","$180.63 ","$286.11 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH30D","SUP","Custom 27203010","","T9MH30D  -  TOOL LEGEND 9CM 3MM MH DIAM","BOTH IP/OP","$361.25 ","$267.33 ","$0.00 ","$361.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.25 ","$0.00 ","$180.63 ","$286.11 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH35D","SUP","Custom 27203010","","T9MH35D  -  TOOL LEGEND 9CM 3.5MM DIAM","BOTH IP/OP","$361.25 ","$267.33 ","$0.00 ","$361.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.25 ","$0.00 ","$180.63 ","$286.11 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"T9MH45D","SUP","Custom 27203010","","T9MH45D  -  TOOL LEGEND 9CM 4.5MM DIAM","BOTH IP/OP","$361.25 ","$267.33 ","$0.00 ","$361.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$361.25 ","$0.00 ","$180.63 ","$286.11 ","$289.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA3035L","SUP","Custom 27203010","","TA3035L  -  RELOAD STPLR 30MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR","BOTH IP/OP","$89.75 ","$66.42 ","$0.00 ","$91.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$91.10 ","$0.00 ","$45.55 ","$72.15 ","$72.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA3035S","SUP","Custom 27203010","","TA3035S  -  STAPLER INTERNAL 30MMX3.5MM 1.5MM 2 ROW 2 ACTION HANDLE","BOTH IP/OP","$204.93 ","$151.65 ","$0.00 ","$208.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$208.00 ","$0.00 ","$104.00 ","$164.74 ","$166.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA3048S","SUP","Custom 27203010","","TA3048S  -  STAPLER INTERNAL 30MMX4.8MM 2MM 2 ROW 2 ACTION HANDLE LINEAR","BOTH IP/OP","$216.93 ","$160.53 ","$0.00 ","$216.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$216.93 ","$0.00 ","$108.47 ","$171.81 ","$173.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA30V3L","SUP","Custom 27203010","","TA30V3L  -  RELOAD STPLR 30MMX2.5MM WHT STRL LF 1MM DST TA 3 ROW LNR CTR","BOTH IP/OP","$102.77 ","$76.05 ","$0.00 ","$102.77 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$102.77 ","$0.00 ","$51.38 ","$81.39 ","$82.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA30V3S","SUP","Custom 27203010","","TA30V3S  -  STAPLER INTERNAL 30MM 3 ROW 2 ACTION HANDLE LINEAR CUTTER","BOTH IP/OP","$249.36 ","$184.53 ","$0.00 ","$249.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$249.36 ","$0.00 ","$124.68 ","$197.49 ","$199.49 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA6035L","SUP","Custom 27203010","","TA6035L  -  RELOAD STPLR 60MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR","BOTH IP/OP","$100.93 ","$74.69 ","$0.00 ","$102.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$102.44 ","$0.00 ","$51.22 ","$81.13 ","$81.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA6035S","SUP","Custom 27203010","","TA6035S  -  STAPLER INTERNAL 60X3.5MM STAPLE 2 ACTION HANDLE LINEAR","BOTH IP/OP","$211.95 ","$156.84 ","$0.00 ","$215.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$215.13 ","$0.00 ","$107.56 ","$170.38 ","$172.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA6048S","SUP","Custom 27203010","","TA6048S  -  STAPLER INTERNAL 60X4.8MM STAPLE 2 ACTION HANDLE LINEAR","BOTH IP/OP","$217.44 ","$160.91 ","$0.00 ","$217.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$217.44 ","$0.00 ","$108.72 ","$172.21 ","$173.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA9035L","SUP","Custom 27203010","","TA9035L  -  RELOAD STPLR 90MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR","BOTH IP/OP","$106.55 ","$78.85 ","$0.00 ","$108.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$108.15 ","$0.00 ","$54.07 ","$85.65 ","$86.52 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA9035S","SUP","Custom 27203010","","TA9035S  -  STAPLER INTERNAL 90X3.5MM STAPLE 2 ACTION HANDLE LINEAR","BOTH IP/OP","$223.78 ","$165.60 ","$0.00 ","$227.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$227.13 ","$0.00 ","$113.57 ","$179.89 ","$181.71 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA9048L","SUP","Custom 27203010","","TA9048L  -  RELOAD STPLR 90MMX4.8MM GRN STRL LF 2MM DST TA 2 ROW LNR CTR","BOTH IP/OP","$109.32 ","$80.90 ","$0.00 ","$109.32 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$109.32 ","$0.00 ","$54.66 ","$86.58 ","$87.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TA9048S","SUP","Custom 27203010","","TA9048S  -  STAPLER INTERNAL 90X4.8MM STAPLE 2 ACTION HANDLE LINEAR","BOTH IP/OP","$263.98 ","$195.35 ","$0.00 ","$263.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$263.98 ","$0.00 ","$131.99 ","$209.07 ","$211.18 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TB-1550K-S","SUP","HCPCS C1713","","TB-1550K-S  -  PIN TNSNBND SYS 50MM ORTH SS STRL","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"TB-1570K-S","SUP","HCPCS C1713","","TB-1570K-S  -  PIN TNSNBND KIT 70MM ORTH SS STRL","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"TB-1590K-S","SUP","HCPCS C1713","","TB-1590K-S  -  PIN TNSNBND SYS 90MM ORTH SS STRL","BOTH IP/OP","$510.00 ","$377.40 ","$0.00 ","$510.00 ","$229.50 ","$0.00 ","$106.30 ","$0.00 ","$0.00 ","$89.30 ","$510.00 ","$0.00 ","$255.00 ","$403.92 ","$408.00 ","$0.00 ","$79.82 ","$0.00 ","$81.19 ","$0.00 "
"TC003","SUP","HCPCS C1729","","TC003  -  CATH IU THRMCH BLN ABLT EXCESSIVE MENSTRUAL BLD","BOTH IP/OP","$2,472.50 ","$1,829.65 ","$0.00 ","$2,472.50 ","$1,342.57 ","$0.00 ","$515.33 ","$0.00 ","$0.00 ","$432.91 ","$2,472.50 ","$0.00 ","$1,236.25 ","$1,958.22 ","$1,978.00 ","$0.00 ","$386.95 ","$0.00 ","$393.62 ","$0.00 "
"TC7465","SUP","Custom 27203010","","TRACHEOSTOMY TRAY","BOTH IP/OP","$255.98 ","$189.43 ","$0.00 ","$255.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.98 ","$0.00 ","$127.99 ","$202.74 ","$204.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TDF010U","SUP","HCPCS C1721","","TDF010U  -  PARADYM 9550 RF DR","BOTH IP/OP","$38,750.00 ","$28,675.00 ","$0.00 ","$38,750.00 ","$17,437.50 ","$0.00 ","$8,076.47 ","$0.00 ","$0.00 ","$6,784.82 ","$38,750.00 ","$0.00 ","$19,375.00 ","$30,690.00 ","$31,000.00 ","$0.00 ","$6,064.38 ","$0.00 ","$6,169.00 ","$0.00 "
"TDF011U","SUP","HCPCS C1722","","TDF011U  -  PARADYM 9250 RF VR","BOTH IP/OP","$33,750.00 ","$24,975.00 ","$0.00 ","$33,750.00 ","$15,187.50 ","$0.00 ","$7,034.34 ","$0.00 ","$0.00 ","$5,909.36 ","$33,750.00 ","$0.00 ","$16,875.00 ","$26,730.00 ","$27,000.00 ","$0.00 ","$5,281.88 ","$0.00 ","$5,373.00 ","$0.00 "
"TDF012U","SUP","HCPCS C1882","","TDF012U  -  PARADYM RF CRT 9750","BOTH IP/OP","$45,500.00 ","$33,670.00 ","$0.00 ","$45,500.00 ","$20,475.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$7,966.69 ","$45,500.00 ","$0.00 ","$22,750.00 ","$36,036.00 ","$36,400.00 ","$0.00 ","$7,120.75 ","$0.00 ","$7,243.60 ","$0.00 "
"TDF012U SYSTEM","SUP","HCPCS C1882","","TDF012U SYSTEM  -  PARADYM RF CRT 9750 SYSTEM","BOTH IP/OP","$60,500.00 ","$44,770.00 ","$0.00 ","$60,500.00 ","$27,225.00 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$60,500.00 ","$0.00 ","$30,250.00 ","$47,916.00 ","$48,400.00 ","$0.00 ","$7,751.33 ","$0.00 ","$8,138.89 ","$0.00 "
"TE-1000","SUP","Custom 27203010","","TE-1000  -  TOOL INSERTION EMBEDDING CURVED PLASTIC HANDLE TITANIUM TIP","BOTH IP/OP","$332.50 ","$246.05 ","$0.00 ","$332.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$332.50 ","$0.00 ","$166.25 ","$263.34 ","$266.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TECR1510","SUP","HCPCS C1781","","TECR1510  -  MESH SRG RECT 6X4IN PARIETEX 2D FLT SHT RGD PLSTR HRN","BOTH IP/OP","$179.68 ","$132.96 ","$0.00 ","$179.68 ","$80.85 ","$0.00 ","$37.45 ","$0.00 ","$0.00 ","$31.46 ","$179.68 ","$0.00 ","$89.84 ","$142.31 ","$143.74 ","$0.00 ","$28.12 ","$0.00 ","$28.60 ","$0.00 "
"TECT1510AL","SUP","HCPCS C1781","","TECT1510AL  -  MESH SRG 6X4IN PARIETEX FLXB ANTM PLSTR LT HRN","BOTH IP/OP","$294.83 ","$218.17 ","$0.00 ","$393.10 ","$176.90 ","$0.00 ","$61.45 ","$0.00 ","$0.00 ","$68.83 ","$393.10 ","$0.00 ","$196.55 ","$311.34 ","$314.48 ","$0.00 ","$61.52 ","$0.00 ","$62.58 ","$0.00 "
"TECT1510AR","SUP","HCPCS C1781","","TECT1510AR  -  MESH SURG PARIETEX 6X4IN RIGHT HERN 3D FLXB LTWT ANTM","BOTH IP/OP","$294.83 ","$218.17 ","$0.00 ","$425.13 ","$191.31 ","$0.00 ","$61.45 ","$0.00 ","$0.00 ","$74.44 ","$425.13 ","$0.00 ","$212.56 ","$336.70 ","$340.10 ","$0.00 ","$66.53 ","$0.00 ","$67.68 ","$0.00 "
"TEM1208GL","SUP","HCPCS C1781","","TEM1208GL  -  MESH SURG 4.7X3IN LEFT FLAP SELF FIXATING ANATOMIC","BOTH IP/OP","$613.08 ","$453.68 ","$0.00 ","$739.40 ","$332.73 ","$0.00 ","$127.78 ","$0.00 ","$0.00 ","$129.46 ","$739.40 ","$0.00 ","$369.70 ","$585.60 ","$591.52 ","$0.00 ","$115.72 ","$0.00 ","$117.71 ","$0.00 "
"TEM1208GR","SUP","HCPCS C1781","","TEM1208GR  -  MESH SURG 4.7X3IN RIGHT FLAP SELF FIXATING ANATOMIC","BOTH IP/OP","$613.08 ","$453.68 ","$0.00 ","$739.40 ","$332.73 ","$0.00 ","$127.78 ","$0.00 ","$0.00 ","$129.46 ","$739.40 ","$0.00 ","$369.70 ","$585.60 ","$591.52 ","$0.00 ","$115.72 ","$0.00 ","$117.71 ","$0.00 "
"TEST","SUP","Custom 27203010","","STENT URETERAL RESONANCE METALLIC 6.0 X 26CM","BOTH IP/OP","$2,425.00 ","$1,794.50 ","$0.00 ","$2,425.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,425.00 ","$0.00 ","$1,212.50 ","$1,920.60 ","$1,940.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TET1309","SUP","HCPCS C1781","","TET1309  -  MESH SRG RECT 5.2X3.6IN LF PARIETEX 3D HCMB WV KNIT FLT SHT","BOTH IP/OP","$206.50 ","$152.81 ","$0.00 ","$275.33 ","$123.90 ","$0.00 ","$43.04 ","$0.00 ","$0.00 ","$48.21 ","$275.33 ","$0.00 ","$137.66 ","$218.06 ","$220.26 ","$0.00 ","$43.09 ","$0.00 ","$43.83 ","$0.00 "
"TF-19A","SUP","Custom 27803010","","TF-19A  -  VALVE AORTIC 15MM 24MM 19MM TRIFECTA 12MM TISS ANNULUS LTRM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TF-21A","SUP","Custom 27803010","","TF-21A  -  VALVE AORTIC 16MM 21MM 26MM TRIFECTA 13MM TISS ANNULUS LTRM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TF-23A","SUP","Custom 27803010","","TF-23A  -  VALVE AOR 13MM 23MM 38IN 17MM TRIFECTA LINX AC BPRTH STNT","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TF-25A","SUP","Custom 27803010","","TF-25A  -  VALVE AORTIC 18MM 25MM 31MM TRIFECTA 14MM TISS ANNULUS LTRM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TF-27A","SUP","Custom 27803010","","TF-27A  -  VALVE AOR 27MM 27MM 33MM 19MM TRIFECTA LINX FTG RST STNT","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TF-29A","SUP","Custom 27803010","","TF-29A  -  VALVE AORTIC 20MM 29MM 35MM TRIFECTA 16MM TISS ANNULUS LTRM","BOTH IP/OP","$15,000.00 ","$11,100.00 ","$0.00 ","$15,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$15,000.00 ","$0.00 ","$7,500.00 ","$11,880.00 ","$12,000.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TH90G01","SUP","HCPCS C1787","","TH90G01  -  KIT STM NS LF PRX HNDST GU REUSE","BOTH IP/OP","$4,875.00 ","$3,607.50 ","$0.00 ","$4,875.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4,875.00 ","$0.00 ","$2,437.50 ","$3,861.00 ","$3,900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"THD155024/2","SUP","HCPCS C1751","","THD155024/2  -  CATHETER CV STD 14.5FR 19CM HMGLD PRMCTH STAR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"THD155028/3","SUP","HCPCS C1751","","THD155028/3  -  CATHETER CV STD 14.5FR 23CM HMGLD PRMCTH STAR","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$196.88 ","$0.00 ","$91.19 ","$0.00 ","$0.00 ","$76.60 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$68.47 ","$0.00 ","$69.65 ","$0.00 "
"THD155032","SUP","HCPCS C1750","","THD155032  -  SET CATH 32CM 15.5FR TTN HD 2 LUM HMDIAL","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"THD155036","SUP","HCPCS C1750","","THD155036  -  SET CATH 90D STRG 15.5FR 36CM TTN HD INTRO NDL GW DIL SCPL","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"THD155040","SUP","HCPCS C1750","","THD155040  -  SET CATH 90D STRG 15.5FR 40CM TTN HD INTRO NDL GW DIL SCPL","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"THD155055","SUP","HCPCS C1750","","THD155055  -  SET CATH 55CM 15.5FR TTN HD 2 LUM LTRM HMDIAL","BOTH IP/OP","$475.00 ","$351.50 ","$0.00 ","$475.00 ","$213.75 ","$0.00 ","$99.00 ","$0.00 ","$0.00 ","$83.17 ","$475.00 ","$0.00 ","$237.50 ","$376.20 ","$380.00 ","$0.00 ","$74.34 ","$0.00 ","$75.62 ","$0.00 "
"THSF-35-145-AUS","SUP","HCPCS C1769","","THSF-35-145-AUS  -  GWIRE VASC .035IN 145CM 8CM STR FLX TP AMPTZ ULT STF SS PTFE","BOTH IP/OP","$59.45 ","$43.99 ","$0.00 ","$59.45 ","$32.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$10.41 ","$59.45 ","$0.00 ","$29.73 ","$47.08 ","$47.56 ","$0.00 ","$9.30 ","$0.00 ","$9.46 ","$0.00 "
"TKFV-2","SUP","Custom 27203010","","TKFV-2  -  CLAMP SURG MIC 2 DISP 15GM GRN .2-1MM VN","BOTH IP/OP","$178.75 ","$132.28 ","$0.00 ","$1,787.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,787.50 ","$0.00 ","$893.75 ","$1,415.70 ","$1,430.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TKMV-1","SUP","Custom 27203010","","TKMV-1  -  CLAMP SURG 30GM/SQ MM MEDIUM HEMISPHERE BIOVER POLYCARBONATE","BOTH IP/OP","$87.50 ","$64.75 ","$0.00 ","$87.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$87.50 ","$0.00 ","$43.75 ","$69.30 ","$70.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TKMV-2","SUP","Custom 27203010","","TKMV-2  -  CLAMP SRG 30GM/SQ MM MED HMSPHR BIOVER 2 PLYCRB VN","BOTH IP/OP","$162.50 ","$120.25 ","$0.00 ","$162.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$162.50 ","$0.00 ","$81.25 ","$128.70 ","$130.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TKS100","SUP","Custom 27203010","","TKS100  -  TUBING SCT STRL NEURO","BOTH IP/OP","$23.76 ","$17.58 ","$0.00 ","$23.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$23.76 ","$0.00 ","$11.88 ","$18.00 ","$19.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TN30MCD","SUP","Custom 27203010","","TN30MCD  -  BURR SURG 3MM MATCH FLUTED DIAMOND COARSE TRANSNASAL STERILE","BOTH IP/OP","$904.50 ","$669.33 ","$0.00 ","$904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$904.50 ","$0.00 ","$452.25 ","$716.36 ","$723.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TN30MFL","SUP","Custom 27203010","","TN30MFL  -  BURR SURG 3MM MATCH FLUTED TRANSNASAL STERILE","BOTH IP/OP","$904.50 ","$669.33 ","$0.00 ","$904.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$904.50 ","$0.00 ","$452.25 ","$716.36 ","$723.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TN7115","SUP","Custom 27203010","","PROCESSOR TISS PREPRC SOL TSTK XP","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TN7120","SUP","Custom 27203010","","FIXATIVE TSTK XP 3.8L MOL HISTOLGY","BOTH IP/OP","$111.25 ","$82.33 ","$0.00 ","$111.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$111.25 ","$0.00 ","$55.63 ","$88.11 ","$89.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TO-FTRT","SUP","Custom 27203010","","TO-FTRT  -  RTRCTR TOBY 2.5MM 4MM SM LG FNL SHOHN TNDN SHTH SURG","BOTH IP/OP","$908.38 ","$672.20 ","$0.00 ","$908.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$908.38 ","$0.00 ","$454.19 ","$719.44 ","$726.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP-14","SUP","HCPCS C1713","","TP-14  -  PEG FIX 2.5MM 14MM PTHRD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"TP-16","SUP","HCPCS C1713","","TP-16  -  PEG 2.5MM 16MM LNG THRD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$36.47 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"TP20","SUP","HCPCS C1713","","TP20  -  PEG FIXAT 2.5MM 20MM ORTH THRD","BOTH IP/OP","$175.00 ","$129.50 ","$0.00 ","$175.00 ","$78.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$30.64 ","$175.00 ","$0.00 ","$87.50 ","$138.60 ","$140.00 ","$0.00 ","$27.39 ","$0.00 ","$27.86 ","$0.00 "
"TP341-M01","SUP","Custom 27203010","","TP341-M01  -  2.0-2.5MM BROKEN SCREW HEAD","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP342-M01","SUP","Custom 27203010","","TP342-M01  -  TIP XTRT 2.5-4 MM BRKN SCR","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP343-M01","SUP","Custom 27203010","","TP343-M01  -  3.5-5.0MM BROKEN SCREW HEAD","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP344-M01","SUP","Custom 27203010","","TP344-M01  -  4.5-6.0MM BROKEN SCREW HEAD","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP345-M01","SUP","Custom 27203010","","TP345-M01  -  5.5-7.0MM BROKEN SCREW HEAD","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP346-M01","SUP","Custom 27203010","","TP346-M01  -  7.0-8.0MM BROKEN SCREW HEAD","BOTH IP/OP","$562.50 ","$416.25 ","$0.00 ","$562.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$562.50 ","$0.00 ","$281.25 ","$445.50 ","$450.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP347-M01","SUP","Custom 27203010","","TP347-M01  -  2.0-2.5MM STRIPPED SCREW HEAD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP348-M01","SUP","Custom 27203010","","TP348-M01  -  2.5-3.5MM STRIPPED SCREW HEAD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP349-M01","SUP","Custom 27203010","","TP349-M01  -  3.5-4.5MM STRIPPED SCREW HEAD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP350-M01","SUP","Custom 27203010","","TP350-M01  -  4.5-5.5MM STRIPPED SCREW HEAD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP351-M01","SUP","Custom 27203010","","TP351-M01  -  5.0-6.5MM STRIPPED SCREW HEAD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TP352-M01","SUP","Custom 27203010","","TP352-M01  -  6.0-7.0MM STRIPPED SCREW HEAD","BOTH IP/OP","$512.50 ","$379.25 ","$0.00 ","$512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$512.50 ","$0.00 ","$256.25 ","$405.90 ","$410.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TPEG-14","SUP","HCPCS C1713","","TPEG-14  -  PEG FIX 14MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPEG-16","SUP","HCPCS C1713","","TPEG-16  -  PEG FIX 16MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPEG-18","SUP","HCPCS C1713","","TPEG-18  -  PEG FIX 18MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPEG-20","SUP","HCPCS C1713","","TPEG-20  -  PEG FIX 20MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPEG-22","SUP","HCPCS C1713","","TPEG-22  -  PEG FIX 22MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPEG-24","SUP","HCPCS C1713","","TPEG-24  -  PEG FIX 24MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPEG-28","SUP","HCPCS C1713","","TPEG-28  -  PEG FIX 28MM THREAD LOCK TORX WRIST VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"TPLS-23100-TS","SUP","HCPCS C1713","","TPLS-23100-TS  -  PEG FX 2.3MM 10MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23120-TS","SUP","HCPCS C1713","","TPLS-23120-TS  -  PEG FX 2.3MM 12MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23140-TS","SUP","HCPCS C1713","","TPLS-23140-TS  -  PEG FX 2.3MM 14MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23160-TS","SUP","HCPCS C1713","","TPLS-23160-TS  -  PEG FX 2.3MM 16MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23170-TS","SUP","HCPCS C1713","","TPLS-23170-TS  -  PEG FX 2.3MM 17MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23180-TS","SUP","HCPCS C1713","","TPLS-23180-TS  -  PEG FIX 2.3MM 18MM THREADED LOCKING GEMINUS TITANIUM DISTAL","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"TPLS-23190-TS","SUP","HCPCS C1713","","TPLS-23190-TS  -  PEG FX 2.3MM 19MM NS THRDLK TI GEMINUS VOLR PLT SYS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23200-TS","SUP","HCPCS C1713","","TPLS-23200-TS  -  PEG FX 2.3MM 20MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23210-TS","SUP","HCPCS C1713","","TPLS-23210-TS  -  PEG FX 2.3MM 21MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23220-TS","SUP","HCPCS C1713","","TPLS-23220-TS  -  PEG FX 2.3MM 22MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23230-TS","SUP","HCPCS C1713","","TPLS-23230-TS  -  PEG FX 2.3MM 23MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23240-TS","SUP","HCPCS C1713","","TPLS-23240-TS  -  PEG FX 2.3MM 24MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23260-TS","SUP","HCPCS C1713","","TPLS-23260-TS  -  PEG FX 2.3MM 26MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23280-TS","SUP","HCPCS C1713","","TPLS-23280-TS  -  PEG FX 2.3MM 28MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23300-TS","SUP","HCPCS C1713","","TPLS-23300-TS  -  PEG FX 2.3MM 30MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPLS-23320-TS","SUP","HCPCS C1713","","TPLS-23320-TS  -  PEG FX 2.3MM 32MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPM002U","SUP","HCPCS C1786","","TPM002U  -  REPLY SR","BOTH IP/OP","$6,962.50 ","$5,152.25 ","$0.00 ","$6,962.50 ","$0.00 ","$0.00 ","$1,451.16 ","$0.00 ","$0.00 ","$0.00 ","$6,962.50 ","$0.00 ","$3,481.25 ","$5,514.30 ","$5,570.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TPM002U SYSTEM","SUP","HCPCS C1786","","TPM002U SYSTEM  -  REPLY SR SYSTEM","BOTH IP/OP","$8,205.00 ","$6,071.70 ","$0.00 ","$8,205.00 ","$0.00 ","$0.00 ","$1,710.13 ","$0.00 ","$0.00 ","$0.00 ","$8,205.00 ","$0.00 ","$4,102.50 ","$6,498.36 ","$6,564.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TPNL-27100-TS","SUP","HCPCS C1713","","TPNL-27100-TS  -  PEG FX 2.7MM 10MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27120-TS","SUP","HCPCS C1713","","TPNL-27120-TS  -  PEG FX 2.7MM 12MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27140-TS","SUP","HCPCS C1713","","TPNL-27140-TS  -  PEG FX 2.7MM 14MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27160-TS","SUP","HCPCS C1713","","TPNL-27160-TS  -  PEG FX 2.7MM 16MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27180-TS","SUP","HCPCS C1713","","TPNL-27180-TS  -  PEG FX 2.7MM 18MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27200-TS","SUP","HCPCS C1713","","TPNL-27200-TS  -  PEG FIX 2.7MM 20MM THREADED NONLOCKING GEMINUS TITANIUM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"TPNL-27220-TS","SUP","HCPCS C1713","","TPNL-27220-TS  -  PEG FIX 2.7MM 22MM THREADED NONLOCKING GEMINUS TITANIUM","BOTH IP/OP","$247.50 ","$183.15 ","$0.00 ","$247.50 ","$111.38 ","$0.00 ","$51.59 ","$0.00 ","$0.00 ","$43.34 ","$247.50 ","$0.00 ","$123.75 ","$196.02 ","$198.00 ","$0.00 ","$38.73 ","$0.00 ","$39.40 ","$0.00 "
"TPNL-27240-TS","SUP","HCPCS C1713","","TPNL-27240-TS  -  PEG FX 2.7MM 24MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27260-TS","SUP","HCPCS C1713","","TPNL-27260-TS  -  PEG FX 2.7MM 26MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27280-TS","SUP","HCPCS C1713","","TPNL-27280-TS  -  PEG FX 2.7MM 28MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27300-TS","SUP","HCPCS C1713","","TPNL-27300-TS  -  PEG FX 2.7MM 30MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPNL-27320-TS","SUP","HCPCS C1713","","TPNL-27320-TS  -  PEG FX 2.7MM 32MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS","BOTH IP/OP","$217.50 ","$160.95 ","$0.00 ","$217.50 ","$97.88 ","$0.00 ","$45.33 ","$0.00 ","$0.00 ","$38.08 ","$217.50 ","$0.00 ","$108.75 ","$172.26 ","$174.00 ","$0.00 ","$34.04 ","$0.00 ","$34.63 ","$0.00 "
"TPT1000","SUP","Custom 27203010","","TRAY DRAIN 4.75IN 8FR 15GA PU NDL THOR PARA 1.5IN STRL LTX","BOTH IP/OP","$75.25 ","$55.69 ","$0.00 ","$75.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$75.25 ","$0.00 ","$37.63 ","$59.60 ","$60.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TR-H200L-S","SUP","HCPCS C1776","","TR-H200L-S  -  HEAD RADL 20MM LEFT ELB","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H200R-S","SUP","HCPCS C1776","","TR-H200R-S  -  HEAD RADL 4D 20MM RT ELB","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H220L-S","SUP","HCPCS C1776","","TR-H220L-S  -  HEAD RADL ANG 22MM STRL ACUMED ARH ANTM ELB LT","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H220R-S","SUP","HCPCS C1776","","TR-H220R-S  -  HEAD RADL 22MM RT","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H240R-S","SUP","HCPCS C1776","","TR-H240R-S  -  HEAD RADL ANG 24MM STRL ACUMED ARH ANTM ELB RT","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H260L-S","SUP","HCPCS C1776","","TR-H260L-S  -  HEAD RADL ANG 26MM STRL ACUMED ARH ANTM ELB LT","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H260R-S","SUP","HCPCS C1776","","TR-H260R-S  -  HEAD RADL 26MM 4D RIGHT ANTM STRL","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H280L-S","SUP","HCPCS C1776","","TR-H280L-S  -  HEAD RADL 28MM ACUMED LEFT ELB TOT STRL","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-H280R-S","SUP","HCPCS C1776","","TR-H280R-S  -  HEAD RADL 28MM STRL RT","BOTH IP/OP","$6,015.00 ","$4,451.10 ","$0.00 ","$6,015.00 ","$2,706.75 ","$0.00 ","$1,253.68 ","$0.00 ","$0.00 ","$1,053.18 ","$6,015.00 ","$0.00 ","$3,007.50 ","$4,763.88 ","$4,812.00 ","$0.00 ","$941.35 ","$0.00 ","$957.59 ","$0.00 "
"TR-S0600-S","SUP","HCPCS C1776","","TR-S0600-S  -  STEM RADL 0MM 6MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0602-S","SUP","HCPCS C1776","","TR-S0602-S  -  STEM RADL 2MM 6MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0604-S","SUP","HCPCS C1776","","TR-S0604-S  -  STEM RADL 4MM 6MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0606-S","SUP","Custom 27203010","","TR-S0606-S  -  BNDG NUSTIMWRAP 36X2.5IN CMPR","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TR-S0608-S","SUP","HCPCS C1776","","TR-S0608-S  -  STEM RADL 6MM 8MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0700-S","SUP","HCPCS C1776","","TR-S0700-S  -  STEM RADL 0MM 7MM ELB","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0702-S","SUP","HCPCS C1776","","TR-S0702-S  -  STEM RADL 2MM 7MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0704-S","SUP","HCPCS C1776","","TR-S0704-S  -  STEM RADL 7MM 4MM ELB TOT STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0706-S","SUP","HCPCS C1776","","TR-S0706-S  -  STEM RADL 7MM 6MM","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0708-S","SUP","HCPCS C1776","","TR-S0708-S  -  STEM RADL 8MM 7MM ELB TOT STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0800-S","SUP","HCPCS C1776","","TR-S0800-S  -  STEM RADL 8MM 4MM ELB TI HEAD TOT STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0802-S","SUP","HCPCS C1776","","TR-S0802-S  -  STEM RADL 8MM 2MM ELB HEAD STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0804-S","SUP","HCPCS C1776","","TR-S0804-S  -  STEM RADL 4MM 8MM ELB TI HEAD STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0806-S","SUP","HCPCS C1776","","TR-S0806-S  -  STEM RADL 6MM 8MM HEAD","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0808-S","SUP","HCPCS C1776","","TR-S0808-S  -  STEM RADL 8MM 8MM ELB TOT STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0900-S","SUP","HCPCS C1776","","TR-S0900-S  -  STEM RADL 0MM 9MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0902-S","SUP","HCPCS C1776","","TR-S0902-S  -  STEM RADL 9MM 2MM ELB SYS STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0904-S","SUP","HCPCS C1776","","TR-S0904-S  -  STEM RADL 9MM 4MM ELB TOT STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0906-S","SUP","HCPCS C1776","","TR-S0906-S  -  STEM RADL 9MM 6MM TI STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S0908-S","SUP","HCPCS C1776","","TR-S0908-S  -  STEM RADL 9MM 8MM ELB STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S1000-S","SUP","HCPCS C1776","","TR-S1000-S  -  STEM RADL 0MM 10MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S1002-S","SUP","HCPCS C1776","","TR-S1002-S  -  STEM RADL 2MM 10MM STRL ELB","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S1004-S","SUP","HCPCS C1776","","TR-S1004-S  -  STEM RADL 4MM 10MM STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TR-S1006-S","SUP","Custom 27203010","","TR-S1006-S  -  BNDG NUSTIMWRAP 36X6IN CMPR","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TR-S1008-S","SUP","HCPCS C1776","","TR-S1008-S  -  STEM RADL 10MM 8MM 8MM TR ELB TI STRL","BOTH IP/OP","$3,610.00 ","$2,671.40 ","$0.00 ","$3,610.00 ","$1,624.50 ","$0.00 ","$752.41 ","$0.00 ","$0.00 ","$632.08 ","$3,610.00 ","$0.00 ","$1,805.00 ","$2,859.12 ","$2,888.00 ","$0.00 ","$564.97 ","$0.00 ","$574.71 ","$0.00 "
"TRX2.3-10","SUP","HCPCS C1713","","TRX2.3-10  -  SCREW BONE 2.3MM 10MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-12","SUP","HCPCS C1713","","TRX2.3-12  -  SCREW BONE 2.3MM 12MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-14","SUP","HCPCS C1713","","TRX2.3-14  -  SCREW BONE 2.3MM 14MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-16","SUP","HCPCS C1713","","TRX2.3-16  -  SCREW BONE 2.3MM 16MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-18","SUP","HCPCS C1713","","TRX2.3-18  -  SCREW BONE 2.3MM 18MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-20","SUP","HCPCS C1713","","TRX2.3-20  -  SCREW BONE 2.3MM 20MM CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-22","SUP","HCPCS C1713","","TRX2.3-22  -  SCREW BONE 2.3MM 22MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-24","SUP","HCPCS C1713","","TRX2.3-24  -  SCREW BONE 2.3MM 24MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-26","SUP","HCPCS C1713","","TRX2.3-26  -  SCREW BONE 2.3MM 26MM ANKLE CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-28","SUP","HCPCS C1713","","TRX2.3-28  -  SCREW BONE 2.3MM 28MM CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TRX2.3-30","SUP","HCPCS C1713","","TRX2.3-30  -  SCREW BONE 2.3MM 30MM CORTICAL","BOTH IP/OP","$225.00 ","$166.50 ","$0.00 ","$225.00 ","$101.25 ","$0.00 ","$46.90 ","$0.00 ","$0.00 ","$39.40 ","$225.00 ","$0.00 ","$112.50 ","$178.20 ","$180.00 ","$0.00 ","$35.21 ","$0.00 ","$35.82 ","$0.00 "
"TS101DC","SUP","Custom 27203010","","TS101DC  -  SET TBG DIEGO ELT DECLOG","BOTH IP/OP","$117.64 ","$87.05 ","$0.00 ","$117.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$117.64 ","$0.00 ","$58.82 ","$93.17 ","$94.11 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT12","SUP","Custom 27203010","","TT12  -  TUBE LEGEND 12CM T12 TELE STRAIGHT","BOTH IP/OP","$1,486.25 ","$1,099.83 ","$0.00 ","$1,486.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,486.25 ","$0.00 ","$743.13 ","$1,177.11 ","$1,189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT12A","SUP","Custom 27203010","","TT12A  -  TUBE LEGEND 12CM T12 TELE ANGLED","BOTH IP/OP","$1,486.25 ","$1,099.83 ","$0.00 ","$1,486.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,486.25 ","$0.00 ","$743.13 ","$1,177.11 ","$1,189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT12C","SUP","Custom 27203010","","TT12C  -  TUBE LEGEND 12CM T12 TELE CURVED","BOTH IP/OP","$1,486.25 ","$1,099.83 ","$0.00 ","$1,486.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,486.25 ","$0.00 ","$743.13 ","$1,177.11 ","$1,189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT12F","SUP","Custom 27203010","","TT12F  -  TUBE LEGEND 12CM T12 TELE CURVED","BOTH IP/OP","$1,486.25 ","$1,099.83 ","$0.00 ","$1,486.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,486.25 ","$0.00 ","$743.13 ","$1,177.11 ","$1,189.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT14A","SUP","Custom 27203010","","TT14A  -  TUBE LEGEND 14CM T14 TELE ANGLED","BOTH IP/OP","$1,590.80 ","$1,177.19 ","$0.00 ","$1,590.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,590.80 ","$0.00 ","$795.40 ","$1,259.91 ","$1,272.64 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT15","SUP","Custom 27203010","","TT15  -  TUBE LEGEND 15CM T15 TELE STRAIGHT","BOTH IP/OP","$1,521.10 ","$1,125.61 ","$0.00 ","$1,521.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,521.10 ","$0.00 ","$760.55 ","$1,204.71 ","$1,216.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT15H","SUP","Custom 27203010","","TT15H  -  TUBE LEGEND 15CM T15 TELE HOODED","BOTH IP/OP","$2,144.30 ","$1,586.78 ","$0.00 ","$2,144.30 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,144.30 ","$0.00 ","$1,072.15 ","$1,698.29 ","$1,715.44 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT17","SUP","Custom 27203010","","TT17  -  TUBE LEGEND 17CM T17 TELE STRAIGHT","BOTH IP/OP","$1,596.95 ","$1,181.74 ","$0.00 ","$1,596.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,596.95 ","$0.00 ","$798.48 ","$1,264.78 ","$1,277.56 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT18H","SUP","Custom 27203010","","TT18H  -  TUBE LEGEND 18CM T18 TELE HOODED","BOTH IP/OP","$2,207.85 ","$1,633.81 ","$0.00 ","$2,207.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,207.85 ","$0.00 ","$1,103.93 ","$1,748.62 ","$1,766.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT9","SUP","Custom 27203010","","TT9  -  TUBE LEGEND 9CM T9 TELE STRAIGHT","BOTH IP/OP","$1,250.50 ","$925.37 ","$0.00 ","$1,250.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,250.50 ","$0.00 ","$625.25 ","$990.40 ","$1,000.40 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TT9C","SUP","Custom 27203010","","TT9C  -  TUBE LEGEND 9CM T9 TELE CURVED","BOTH IP/OP","$1,330.45 ","$984.53 ","$0.00 ","$1,330.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,330.45 ","$0.00 ","$665.23 ","$1,053.72 ","$1,064.36 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TU1101","SUP","Custom 27203010","","CONTROL MLANLT TMKR LVL 1 ASY 3ML IMMUN","BOTH IP/OP","$83.33 ","$61.66 ","$0.00 ","$83.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.33 ","$0.00 ","$41.66 ","$66.00 ","$66.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TU2202","SUP","Custom 27203010","","CONTROL MLANLT TMKR LVL 2 ASY 3ML IMMUN","BOTH IP/OP","$83.33 ","$61.66 ","$0.00 ","$83.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.33 ","$0.00 ","$41.66 ","$66.00 ","$66.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TU3303","SUP","Custom 27203010","","CONTROL MLANLT TMKR LVL 3 ASY 3ML IMMUN","BOTH IP/OP","$83.33 ","$61.66 ","$0.00 ","$83.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$83.33 ","$0.00 ","$41.66 ","$66.00 ","$66.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TVI07","SUP","HCPCS C1894","","TVI07  -  TOOL INSERTION 7FR TRANSVALVULAR","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$4.89 ","$0.00 ","$1.88 ","$0.00 ","$0.00 ","$1.58 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$1.41 ","$0.00 ","$1.43 ","$0.00 "
"TVI-07","SUP","HCPCS C1894","","TVI-07  -  TOOL INSERTION 7FR TRANSVALVULAR","BOTH IP/OP","$9.00 ","$6.66 ","$0.00 ","$9.00 ","$4.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1.58 ","$9.00 ","$0.00 ","$4.50 ","$7.13 ","$7.20 ","$0.00 ","$1.41 ","$0.00 ","$1.43 ","$0.00 "
"TVTRL","SUP","HCPCS C1771","","TVTRL  -  SLING GYNECOLOGICAL GYNECARE TVT SECUR STRESS URINARY","BOTH IP/OP","$2,262.00 ","$1,673.88 ","$0.00 ","$2,262.00 ","$1,017.90 ","$0.00 ","$471.46 ","$0.00 ","$0.00 ","$396.06 ","$2,262.00 ","$0.00 ","$1,131.00 ","$1,791.50 ","$1,809.60 ","$0.00 ","$354.00 ","$0.00 ","$360.11 ","$0.00 "
"TW173016","SUP","Custom 27203010","","TW173016  -  ENDO STITCH 10 MM SUTURING DEVICE","BOTH IP/OP","$836.10 ","$618.71 ","$0.00 ","$836.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$836.10 ","$0.00 ","$418.05 ","$662.19 ","$668.88 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"TYPE 14C","SUP","HCPCS L8610","","RING FIXAT 24-28MM MORCHER 11-13MM CPSLR TNSN EXPANDABLE","BOTH IP/OP","$447.50 ","$331.15 ","$0.00 ","$447.50 ","$201.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$78.35 ","$447.50 ","$0.00 ","$223.75 ","$354.42 ","$358.00 ","$0.00 ","$70.03 ","$0.00 ","$71.24 ","$0.00 "
"U202H","SUP","Custom 27203010","","U202H  -  SUTURE ABSORBABLE 5-0 RB-1 27IN MONOFILAMENT CHROMIC","BOTH IP/OP","$294.60 ","$218.00 ","$0.00 ","$299.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$299.02 ","$0.00 ","$149.51 ","$236.82 ","$239.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"U2295-40","SUP","Custom 27203010","","STAIN TCHRM BLUE PRPK 500ML BHOSPHATE BUFF PRSTLGY","BOTH IP/OP","$537.15 ","$397.49 ","$0.00 ","$537.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$537.15 ","$0.00 ","$268.58 ","$425.42 ","$429.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"U2295-5","SUP","Custom 27203010","","STAIN TCHRM PRPK WHEATLEY 500ML PRSTLGY","BOTH IP/OP","$369.73 ","$273.60 ","$0.00 ","$369.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$369.73 ","$0.00 ","$184.86 ","$292.83 ","$295.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"U2316-2","SUP","Custom 27203010","","SLIDE GSTCLT GCB HMTLTST","BOTH IP/OP","$332.45 ","$246.01 ","$0.00 ","$332.45 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$332.45 ","$0.00 ","$166.23 ","$263.30 ","$265.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UA1329-S","SUP","Custom 27203010","","UA1329-S  -  GUIDE NEEDLE DUAL READY TO USE INDIVIDUALLY STERILE","BOTH IP/OP","$900.00 ","$666.00 ","$0.00 ","$900.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$900.00 ","$0.00 ","$450.00 ","$712.80 ","$720.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UAB-260","SUP","Custom 27203010","","CONTROL MAS LVL 2 ABN 60ML UA","BOTH IP/OP","$56.25 ","$41.63 ","$0.00 ","$56.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$56.25 ","$0.00 ","$28.13 ","$44.55 ","$45.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UFH-624-R","SUP","HCPCS C2617","","UFH-624-R  -  STENT URET 6FR 24CM W/O GWIRE SET TETH STRAIGHTENER RADIOPQ","BOTH IP/OP","$281.25 ","$208.13 ","$0.00 ","$281.25 ","$152.72 ","$0.00 ","$58.62 ","$0.00 ","$0.00 ","$49.24 ","$281.25 ","$0.00 ","$140.63 ","$222.75 ","$225.00 ","$0.00 ","$44.02 ","$0.00 ","$44.78 ","$0.00 "
"UH1-36-22","SUP","Custom 27803010","","UH1-36-22  -  HEAD BIPOL 36MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-38-22","SUP","Custom 27803010","","UH1-38-22  -  HEAD BIPOL 38MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-40-22","SUP","Custom 27803010","","UH1-40-22  -  HEAD BIPOL UNIVERSAL 40MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-41-22","SUP","Custom 27803010","","UH1-41-22  -  HEAD BIPOL UNIVERSAL 41MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-41-26","SUP","Custom 27803010","","UH1-41-26  -  HEAD BIPOL UNIVERSAL 41MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-42-22","SUP","Custom 27803010","","UH1-42-22  -  HEAD BP UNV 42MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-42-26","SUP","Custom 27803010","","UH1-42-26  -  HEAD BIPOL UNIVERSAL 42MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-42-28","SUP","Custom 27803010","","UH1-42-28  -  HEAD BIPOL UNIVERSAL 42MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-43-22","SUP","Custom 27803010","","UH1-43-22  -  HEAD BIPOL UNIVERSAL 43MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-43-26","SUP","Custom 27803010","","UH1-43-26  -  HEAD BIPOL UNIVERSAL 43MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-44-22","SUP","Custom 27803010","","UH1-44-22  -  HEAD BIPOL UNIVERSAL 44MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-44-26","SUP","Custom 27803010","","UH1-44-26  -  HEAD BIPOL UNIVERSAL 44MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-44-28","SUP","Custom 27803010","","UH1-44-28  -  HEAD BIPOL UNIVERSAL 44MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-45-22","SUP","Custom 27803010","","UH1-45-22  -  HEAD BIPOL UNIVERSAL 45MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-45-26","SUP","Custom 27803010","","UH1-45-26  -  HEAD BIPOL UNIVERSAL 45MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-45-28","SUP","Custom 27803010","","UH1-45-28  -  HEAD BP 45MM 28MM UHR HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-46-22","SUP","Custom 27803010","","UH1-46-22  -  HEAD BIPOL UNIVERSAL 46MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-46-26","SUP","Custom 27803010","","UH1-46-26  -  HEAD BIPOL UNIVERSAL 46MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-46-28","SUP","Custom 27803010","","UH1-46-28  -  HEAD BIPOL UNIVERSAL 46MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-47-22","SUP","Custom 27803010","","UH1-47-22  -  HEAD BIPOL UNIVERSAL 47MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-47-26","SUP","Custom 27803010","","UH1-47-26  -  HEAD BIPOL UNIVERSAL 47MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-47-28","SUP","Custom 27803010","","UH1-47-28  -  HEAD BP UNV 47MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-48-22","SUP","Custom 27803010","","UH1-48-22  -  HEAD BIPOL UNIVERSAL 48MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-48-26","SUP","Custom 27803010","","UH1-48-26  -  HEAD BIPOL UNIVERSAL 48MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-48-28","SUP","Custom 27803010","","UH1-48-28  -  HEAD BP 48MM 28MM UHR HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-48-32","SUP","Custom 27803010","","UH1-48-32  -  HEAD BIPOL UNIVERSAL 48MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-49-22","SUP","Custom 27803010","","UH1-49-22  -  HEAD BIPOL UNIVERSAL 49MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-49-26","SUP","Custom 27803010","","UH1-49-26  -  HEAD BIPOL UNIVERSAL 49MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-49-28","SUP","Custom 27803010","","UH1-49-28  -  HEAD BIPOL UNIVERSAL 49MM 28MM UHR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-49-32","SUP","Custom 27803010","","UH1-49-32  -  HEAD BIPOL UNIVERSAL 49MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-50-22","SUP","Custom 27803010","","UH1-50-22  -  HEAD BIPOL UNIVERSAL 50MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-50-26","SUP","Custom 27803010","","UH1-50-26  -  HEAD BIPOL UNIVERSAL 50MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-50-28","SUP","Custom 27803010","","UH1-50-28  -  HEAD BIPOL UNIVERSAL 50MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-50-32","SUP","Custom 27803010","","UH1-50-32  -  HEAD BIPOL UNIVERSAL 50MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-51-22","SUP","Custom 27803010","","UH1-51-22  -  HEAD BIPOL UNIVERSAL 51MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-51-26","SUP","Custom 27803010","","UH1-51-26  -  HEAD BIPOL UNIVERSAL 51MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-51-28","SUP","Custom 27803010","","UH1-51-28  -  HEAD BIPOL UNIVERSAL 51MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-51-32","SUP","Custom 27803010","","UH1-51-32  -  HEAD BIPOL UNIVERSAL 51MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-52-22","SUP","Custom 27803010","","UH1-52-22  -  HEAD BIPOL UNIVERSAL 52MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-52-26","SUP","Custom 27803010","","UH1-52-26  -  HEAD BIPOL UNIVERSAL 52MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-52-28","SUP","Custom 27803010","","UH1-52-28  -  HEAD BP 52MM 28MM UHR HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-52-32","SUP","Custom 27803010","","UH1-52-32  -  HEAD BIPOL UNIVERSAL 52MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-53-22","SUP","Custom 27803010","","UH1-53-22  -  HEAD BIPOL UNIVERSAL 53MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-53-26","SUP","Custom 27803010","","UH1-53-26  -  HEAD BIPOL UNIVERSAL 53MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-53-28","SUP","Custom 27803010","","UH1-53-28  -  HEAD BP 53MM 28MM UHR HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-53-32","SUP","Custom 27803010","","UH1-53-32  -  HEAD BIPOL UNIVERSAL 53MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-54-22","SUP","Custom 27803010","","UH1-54-22  -  HEAD BIPOL UNIVERSAL 54MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-54-26","SUP","Custom 27803010","","UH1-54-26  -  HEAD BIPOL UNIVERSAL 54MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-54-28","SUP","Custom 27803010","","UH1-54-28  -  HEAD BIPOL UNIVERSAL 54MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-54-32","SUP","Custom 27803010","","UH1-54-32  -  HEAD BIPOL UNIVERSAL 54MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-55-22","SUP","Custom 27803010","","UH1-55-22  -  HEAD BIPOL UNIVERSAL 55MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-55-26","SUP","Custom 27803010","","UH1-55-26  -  HEAD BIPOL UNIVERSAL 55MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-55-28","SUP","Custom 27803010","","UH1-55-28  -  HEAD BP 55MM 28MM UHR HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-55-32","SUP","Custom 27803010","","UH1-55-32  -  HEAD BIPOL UNIVERSAL 55MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-56-22","SUP","Custom 27803010","","UH1-56-22  -  HEAD BIPOL UNIVERSAL 56MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-56-26","SUP","Custom 27803010","","UH1-56-26  -  HEAD BIPOL UNIVERSAL 56MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-56-28","SUP","Custom 27803010","","UH1-56-28  -  HEAD BIPOL UNIVERSAL 56MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-56-32","SUP","Custom 27803010","","UH1-56-32  -  HEAD BIPOL UNIVERSAL 56MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-58-22","SUP","Custom 27803010","","UH1-58-22  -  HEAD BIPOL UNIVERSAL 58MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-58-26","SUP","Custom 27803010","","UH1-58-26  -  HEAD BIPOL UNIVERSAL 58MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-58-28","SUP","Custom 27803010","","UH1-58-28  -  HEAD BIPOL UNIVERSAL 58MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-58-32","SUP","Custom 27803010","","UH1-58-32  -  HEAD BIPOL UNIVERSAL 58MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-61-22","SUP","Custom 27803010","","UH1-61-22  -  HEAD BIPOL UNIVERSAL 61MM 22MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-61-26","SUP","Custom 27803010","","UH1-61-26  -  HEAD BIPOL UNIVERSAL 61MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-61-28","SUP","Custom 27803010","","UH1-61-28  -  HEAD BIPOL UNIVERSAL 61MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-61-32","SUP","Custom 27803010","","UH1-61-32  -  HEAD BIPOL UNIVERSAL 61MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-64-26","SUP","Custom 27803010","","UH1-64-26  -  HEAD BIPOL UNIVERSAL 64MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-64-28","SUP","Custom 27803010","","UH1-64-28  -  HEAD BIPOL UNIVERSAL 64MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-64-32","SUP","Custom 27803010","","UH1-64-32  -  HEAD BIPOL UNIVERSAL 64MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-68-26","SUP","Custom 27803010","","UH1-68-26  -  HEAD BIPOL UNIVERSAL 68MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-68-28","SUP","Custom 27803010","","UH1-68-28  -  HEAD BIPOL UNIVERSAL 68MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-68-32","SUP","Custom 27803010","","UH1-68-32  -  HEAD BIPOL UNIVERSAL 68MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-72-26","SUP","Custom 27803010","","UH1-72-26  -  HEAD BIPOL UNIVERSAL 72MM 26MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-72-28","SUP","Custom 27803010","","UH1-72-28  -  HEAD BIPOL UNIVERSAL 72MM 28MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UH1-72-32","SUP","Custom 27803010","","UH1-72-32  -  HEAD BIPOL UNIVERSAL 72MM 32MM UHR COCR UHMWPE HIP","BOTH IP/OP","$1,150.00 ","$851.00 ","$0.00 ","$1,150.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,150.00 ","$0.00 ","$575.00 ","$910.80 ","$920.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UL-3021-S","SUP","HCPCS C1713","","UL-3021-S  -  ROD ORTH 210MM 3MM ULN WR HND ULNA IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3023-S","SUP","HCPCS C1713","","UL-3023-S  -  ROD ORTH 230MM 3MM ULN ULNA IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3025-S","SUP","HCPCS C1713","","UL-3025-S  -  ROD OTHOPEDIC 250MM 3MM ULN WR HND ULNA IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3027-S","SUP","HCPCS C1713","","UL-3027-S  -  NAIL 3MM 27CM ULN IM TI NONSTRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3621-S","SUP","HCPCS C1713","","UL-3621-S  -  NAIL 3.6MM 21CM ULN IM STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3623-S","SUP","HCPCS C1713","","UL-3623-S  -  ROD ORTH 230MM ULN ULNA IM IMPL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3625-S","SUP","HCPCS C1713","","UL-3625-S  -  ROD ORTH 250MM 3.6MM ULN WR HND ULNA IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"UL-3627-S","SUP","HCPCS C1713","","UL-3627-S  -  ROD OTHOPEDIC 270MM 3.6MM ULN WR HND ULNA IM IMPL STRL","BOTH IP/OP","$2,690.00 ","$1,990.60 ","$0.00 ","$2,690.00 ","$1,210.50 ","$0.00 ","$560.66 ","$0.00 ","$0.00 ","$471.00 ","$2,690.00 ","$0.00 ","$1,345.00 ","$2,130.48 ","$2,152.00 ","$0.00 ","$420.99 ","$0.00 ","$428.25 ","$0.00 "
"ULTRA O-RNG RPL","SUP","Custom 27803010","","ULTRA O-RNG RPL  -  O RING OPTH BLK ULFL REPL SIL","BOTH IP/OP","$135.00 ","$99.90 ","$0.00 ","$135.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$135.00 ","$0.00 ","$67.50 ","$106.92 ","$108.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UM-04018","SUP","Custom 27203010","","UM-04018  -  KIT ARTERIAL LINE 18GA 20GA 16CM 1.5IN INDWELL CATHETER","BOTH IP/OP","$75.50 ","$55.87 ","$0.00 ","$131.23 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$131.23 ","$0.00 ","$65.61 ","$103.93 ","$104.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UOCP","SUP","HCPCS C1713","","UOCP  -  PLATE BN SHTNG ULNA","BOTH IP/OP","$2,150.00 ","$1,591.00 ","$0.00 ","$2,150.00 ","$967.50 ","$0.00 ","$448.11 ","$0.00 ","$0.00 ","$376.45 ","$2,150.00 ","$0.00 ","$1,075.00 ","$1,702.80 ","$1,720.00 ","$0.00 ","$336.48 ","$0.00 ","$342.28 ","$0.00 "
"UPA3030","SUP","HCPCS C1781","","UPA3030  -  MESH SURG ULTRAPRO ADV 30X30CM PRTL ABS LTWT","BOTH IP/OP","$619.33 ","$458.30 ","$0.00 ","$619.33 ","$278.70 ","$0.00 ","$129.08 ","$0.00 ","$0.00 ","$108.44 ","$619.33 ","$0.00 ","$309.66 ","$490.51 ","$495.46 ","$0.00 ","$96.92 ","$0.00 ","$98.60 ","$0.00 "
"UPA31015","SUP","HCPCS C1781","","UPA31015  -  MESH SRG RECT 15X10CM BLU STRP ULTRAPRO ADV PRT ABS LTWT HI","BOTH IP/OP","$310.66 ","$229.89 ","$0.00 ","$310.66 ","$139.80 ","$0.00 ","$64.75 ","$0.00 ","$0.00 ","$54.39 ","$310.66 ","$0.00 ","$155.33 ","$246.04 ","$248.53 ","$0.00 ","$48.62 ","$0.00 ","$49.46 ","$0.00 "
"UPC510","SUP","Custom 27203010","","PACK PRNTR 5 7/8INX8 3/8IN SNY COLOR INK RBN UP-50 UP-50","BOTH IP/OP","$2.25 ","$1.67 ","$0.00 ","$2.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2.25 ","$0.00 ","$1.13 ","$1.78 ","$1.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"UPEG-14","SUP","HCPCS C1713","","UPEG-14  -  PEG FIX 14MM UNTHREADED VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"UPEG-16","SUP","HCPCS C1713","","UPEG-16  -  PEG FIX 14MM UNTHREADED VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"UPEG-18","SUP","HCPCS C1713","","UPEG-18  -  PEG FIX 18MM UNTHREADED VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"UPEG-20","SUP","HCPCS C1713","","UPEG-20  -  SCREW BONE 20MM PEG UNTHREADED TRX","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"UPEG-22","SUP","HCPCS C1713","","UPEG-22  -  PEG FIX 22MM UNTHREADED VOLAR","BOTH IP/OP","$262.50 ","$194.25 ","$0.00 ","$262.50 ","$118.13 ","$0.00 ","$54.71 ","$0.00 ","$0.00 ","$45.96 ","$262.50 ","$0.00 ","$131.25 ","$207.90 ","$210.00 ","$0.00 ","$41.08 ","$0.00 ","$41.79 ","$0.00 "
"UPLUG403","SUP","HCPCS C1781","","UPLUG403  -  MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 40MM","BOTH IP/OP","$674.33 ","$499.00 ","$0.00 ","$674.33 ","$303.45 ","$0.00 ","$140.55 ","$0.00 ","$0.00 ","$118.07 ","$674.33 ","$0.00 ","$337.16 ","$534.07 ","$539.46 ","$0.00 ","$105.53 ","$0.00 ","$107.35 ","$0.00 "
"UPLUG553","SUP","HCPCS C1781","","UPLUG553  -  MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 55MM","BOTH IP/OP","$674.33 ","$499.00 ","$0.00 ","$674.33 ","$303.45 ","$0.00 ","$140.55 ","$0.00 ","$0.00 ","$118.07 ","$674.33 ","$0.00 ","$337.16 ","$534.07 ","$539.46 ","$0.00 ","$105.53 ","$0.00 ","$107.35 ","$0.00 "
"USA-FDX","SUP","Custom 27203010","","USA-FDX  -  ASPIRATOR SCT 72IN LF FLD DMD TUBE DISP","BOTH IP/OP","$1,350.00 ","$999.00 ","$0.00 ","$1,350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,350.00 ","$0.00 ","$675.00 ","$1,069.20 ","$1,080.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"V1205","SUP","Custom 27203010","","REAGENT .45% NA CHLOR BTL 1L ANALY","BOTH IP/OP","$12.08 ","$8.94 ","$0.00 ","$12.08 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$12.08 ","$0.00 ","$6.04 ","$9.57 ","$9.66 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"V402G","SUP","Custom 27203010","","V402G  -  SUTURE ABS 9-0 BV100-3 5IN VIOL VCL MFL COAT","BOTH IP/OP","$46.45 ","$34.37 ","$0.00 ","$47.15 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.15 ","$0.00 ","$23.57 ","$37.34 ","$37.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"V4900","SUP","HCPCS C1729","","CATHETER DLYS PRTNL TROCATH ADLT","BOTH IP/OP","$125.75 ","$93.06 ","$0.00 ","$125.75 ","$68.28 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$22.02 ","$125.75 ","$0.00 ","$62.88 ","$99.59 ","$100.60 ","$0.00 ","$19.68 ","$0.00 ","$20.02 ","$0.00 "
"V4908(SUB)","SUP","Custom 27203010","","V4908(SUB)  -  SET PERITONEAL DIALYSIS","BOTH IP/OP","$201.93 ","$149.43 ","$0.00 ","$201.93 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$201.93 ","$0.00 ","$100.96 ","$159.93 ","$161.54 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAC6000M","SUP","Custom 27203010","","VAC6000M  -  VACUUM EXTRACTION 6MM CUP MUSHROOM TRACTION FORCE INDICATOR","BOTH IP/OP","$139.98 ","$103.59 ","$0.00 ","$139.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$139.98 ","$0.00 ","$69.99 ","$110.86 ","$111.99 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAC-6000M","SUP","Custom 27203010","","VAC-6000M  -  VACUUM EXTRACTION 6MM CUP MUSHROOM TRACTION FORCE INDICATOR","BOTH IP/OP","$61.48 ","$45.50 ","$0.00 ","$61.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$61.48 ","$0.00 ","$30.74 ","$48.69 ","$49.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF2626C100TU","SUP","Custom 27803010","","VAMF2626C100TU  -  GRAFT STNT 26MM 100MM VALIANT PROX MAIN SECT FREEFLO CLS WEB","BOTH IP/OP","$42,487.50 ","$31,440.75 ","$0.00 ","$42,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$42,487.50 ","$0.00 ","$21,243.75 ","$33,650.10 ","$33,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF2824C150TU","SUP","Custom 27803010","","VAMF2824C150TU  -  GRAFT STNT STRG TPR SINUSOIDAL 25FR 24MM 112MM 100MM VALIANT","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3026C150TU","SUP","Custom 27803010","","VAMF3026C150TU  -  GRAFT STNT TPR 30MM 26MM 150MM VALIANT CAPTIVIA THRX","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3228C150TU","SUP","Custom 27803010","","VAMF3228C150TU  -  GRAFT STNT TPR 28MM 150MM VALIANT CAPTIVIA DLV SYS","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3430C150TU","SUP","Custom 27803010","","VAMF3430C150TU  -  GRAFT STNT TPR 34MM 30MM 150MM VALIANT CAPTIVIA EVAS","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3434C150TU","SUP","Custom 27803010","","VAMF3434C150TU  -  GRAFT STNT STRG 34MM 150MM VALIANT PROX MAIN SECT CLS WEB","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3434C200TU","SUP","Custom 27803010","","VAMF3434C200TU  -  GRAFT STNT STRG SINUSOIDAL 34MM 24FR 200MM 212MM VALIANT SYS","BOTH IP/OP","$48,737.50 ","$36,065.75 ","$0.00 ","$48,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48,737.50 ","$0.00 ","$24,368.75 ","$38,600.10 ","$38,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3632C150TU","SUP","Custom 27803010","","VAMF3632C150TU  -  GRAFT STNT STRG TPR 32MM 36MM 150MM STRL LF VALIANT CAPTIVIA","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3636C150TU","SUP","Custom 27803010","","VAMF3636C150TU  -  GRAFT STNT SINUSOIDAL STRG 36MM 24FR 167MM 150MM VALIANT","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3636C200TU","SUP","Custom 27803010","","VAMF3636C200TU  -  GRAFT STNT STRG 36MM 200MM 207MM VALIANT PROX FREEFLO EVAS","BOTH IP/OP","$48,737.50 ","$36,065.75 ","$0.00 ","$48,737.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$48,737.50 ","$0.00 ","$24,368.75 ","$38,600.10 ","$38,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF3838C200TU","SUP","HCPCS C2625","","VAMF3838C200TU  -  GRAFT STNT SINUSOIDAL STRG 38MM 24FR 207MM 200MM VALIANT","BOTH IP/OP","$48,737.50 ","$36,065.75 ","$0.00 ","$48,737.50 ","$21,931.88 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$48,737.50 ","$0.00 ","$24,368.75 ","$38,600.10 ","$38,990.00 ","$0.00 ","$7,627.42 ","$0.00 ","$7,759.01 ","$0.00 "
"VAMF4242C150TU","SUP","Custom 27803010","","VAMF4242C150TU  -  GRAFT STNT SINUSOIDAL STRG 42MM 25FR 157MM 150MM VALIANT","BOTH IP/OP","$46,237.50 ","$34,215.75 ","$0.00 ","$46,237.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$46,237.50 ","$0.00 ","$23,118.75 ","$36,620.10 ","$36,990.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VAMF4242C200TU","SUP","HCPCS C1768","","VAMF4242C200TU  -  GRAFT STNT SINUSOIDAL STRG 42MM 25FR 207MM 200MM VALIANT","BOTH IP/OP","$48,737.50 ","$36,065.75 ","$0.00 ","$48,737.50 ","$21,931.88 ","$0.00 ","$9,417.94 ","$0.00 ","$0.00 ","$8,138.89 ","$48,737.50 ","$0.00 ","$24,368.75 ","$38,600.10 ","$38,990.00 ","$0.00 ","$7,627.42 ","$0.00 ","$7,759.01 ","$0.00 "
"VBH060502","SUP","HCPCS C1874","","VBH060502  -  STENT ENDOPRSTH 6MM 7FR 5CM 120CM .035IN HEP BIOACTIVE SRFC","BOTH IP/OP","$7,097.50 ","$5,252.15 ","$0.00 ","$7,097.50 ","$3,193.88 ","$0.00 ","$1,479.30 ","$0.00 ","$0.00 ","$1,242.72 ","$7,097.50 ","$0.00 ","$3,548.75 ","$5,621.22 ","$5,678.00 ","$0.00 ","$1,110.76 ","$0.00 ","$1,129.92 ","$0.00 "
"VBH061002","SUP","HCPCS C1874","","VBH061002  -  STENT ENDOPRSTH 6MM 10CM 120CM .035IN DLV SYS TIP TO HUB DPL","BOTH IP/OP","$8,122.50 ","$6,010.65 ","$0.00 ","$8,122.50 ","$3,655.13 ","$0.00 ","$1,692.93 ","$0.00 ","$0.00 ","$1,422.18 ","$8,122.50 ","$0.00 ","$4,061.25 ","$6,433.02 ","$6,498.00 ","$0.00 ","$1,271.17 ","$0.00 ","$1,293.10 ","$0.00 "
"VBH080502","SUP","HCPCS C1874","","VBH080502  -  STENT ENDOPRSTH 8MM 5CM 120CM .035IN DLV SYS TIP TO HUB DPL","BOTH IP/OP","$6,737.50 ","$4,985.75 ","$0.00 ","$6,737.50 ","$3,031.88 ","$0.00 ","$1,404.26 ","$0.00 ","$0.00 ","$1,179.68 ","$6,737.50 ","$0.00 ","$3,368.75 ","$5,336.10 ","$5,390.00 ","$0.00 ","$1,054.42 ","$0.00 ","$1,072.61 ","$0.00 "
"VBH081002","SUP","HCPCS C1874","","VBH081002  -  STENT ENDOPRSTH 8MM 10CM 120CM .035IN DLV SYS TIP TO HUB DPL","BOTH IP/OP","$7,737.50 ","$5,725.75 ","$0.00 ","$7,737.50 ","$3,481.88 ","$0.00 ","$1,612.69 ","$0.00 ","$0.00 ","$1,354.77 ","$7,737.50 ","$0.00 ","$3,868.75 ","$6,128.10 ","$6,190.00 ","$0.00 ","$1,210.92 ","$0.00 ","$1,231.81 ","$0.00 "
"VBH081502","SUP","HCPCS C1874","","VBH081502  -  STENT ENDOPRSTH 8MM 15CM 120CM .035IN DLV SYS TIP TO HUB DPL","BOTH IP/OP","$8,900.00 ","$6,586.00 ","$0.00 ","$8,900.00 ","$4,005.00 ","$0.00 ","$1,854.98 ","$0.00 ","$0.00 ","$1,558.32 ","$8,900.00 ","$0.00 ","$4,450.00 ","$7,048.80 ","$7,120.00 ","$0.00 ","$1,392.85 ","$0.00 ","$1,416.88 ","$0.00 "
"VBH090502","SUP","HCPCS C1874","","VBH090502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM TIP TO HUB DEPLOYMENT","BOTH IP/OP","$7,487.50 ","$5,540.75 ","$0.00 ","$7,487.50 ","$3,369.38 ","$0.00 ","$1,560.58 ","$0.00 ","$0.00 ","$1,311.00 ","$7,487.50 ","$0.00 ","$3,743.75 ","$5,930.10 ","$5,990.00 ","$0.00 ","$1,171.79 ","$0.00 ","$1,192.01 ","$0.00 "
"VBH091002","SUP","HCPCS C1874","","VBH091002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM TIP TO HUB DEPLOYMENT","BOTH IP/OP","$8,237.50 ","$6,095.75 ","$0.00 ","$8,237.50 ","$3,706.88 ","$0.00 ","$1,716.90 ","$0.00 ","$0.00 ","$1,442.32 ","$8,237.50 ","$0.00 ","$4,118.75 ","$6,524.10 ","$6,590.00 ","$0.00 ","$1,289.17 ","$0.00 ","$1,311.41 ","$0.00 "
"VBH100502","SUP","HCPCS C1874","","VBH100502  -  STENT EPRSTH 10MM 11FR 5CM 120CM VBHN DLV SYS TIP TO HUB DPL","BOTH IP/OP","$6,737.50 ","$4,985.75 ","$0.00 ","$6,737.50 ","$3,031.88 ","$0.00 ","$1,404.26 ","$0.00 ","$0.00 ","$1,179.68 ","$6,737.50 ","$0.00 ","$3,368.75 ","$5,336.10 ","$5,390.00 ","$0.00 ","$1,054.42 ","$0.00 ","$1,072.61 ","$0.00 "
"VBH101002","SUP","HCPCS C1874","","VBH101002  -  STENT ENDOPRSTH 10MM 10CM 120CM .035IN DLV SYS TIP TO HUB","BOTH IP/OP","$7,737.50 ","$5,725.75 ","$0.00 ","$7,737.50 ","$3,481.88 ","$0.00 ","$1,612.69 ","$0.00 ","$0.00 ","$1,354.77 ","$7,737.50 ","$0.00 ","$3,868.75 ","$6,128.10 ","$6,190.00 ","$0.00 ","$1,210.92 ","$0.00 ","$1,231.81 ","$0.00 "
"VBH101002A","SUP","HCPCS C1874","","VBH101002A  -  STENT EPRSTH 10MM 11FR 10CM 120CM VBHN DLV SYS TIP TO HUB","BOTH IP/OP","$9,807.50 ","$7,257.55 ","$0.00 ","$9,615.00 ","$4,326.75 ","$0.00 ","$2,044.13 ","$0.00 ","$0.00 ","$1,683.51 ","$9,615.00 ","$0.00 ","$4,807.50 ","$7,615.08 ","$7,692.00 ","$0.00 ","$1,504.75 ","$0.00 ","$1,530.71 ","$0.00 "
"VBHR080502A","SUP","HCPCS C1874","","VBHR080502A  -  VIABAHN ENDOPROSTHESIS , 8X5","BOTH IP/OP","$8,940.00 ","$6,615.60 ","$0.00 ","$8,765.00 ","$3,944.25 ","$0.00 ","$1,863.32 ","$0.00 ","$0.00 ","$1,534.68 ","$8,765.00 ","$0.00 ","$4,382.50 ","$6,941.88 ","$7,012.00 ","$0.00 ","$1,371.72 ","$0.00 ","$1,395.39 ","$0.00 "
"VBJ050502","SUP","HCPCS C1874","","VBJ050502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5","BOTH IP/OP","$7,737.50 ","$5,725.75 ","$0.00 ","$7,737.50 ","$3,481.88 ","$0.00 ","$1,612.69 ","$0.00 ","$0.00 ","$1,354.77 ","$7,737.50 ","$0.00 ","$3,868.75 ","$6,128.10 ","$6,190.00 ","$0.00 ","$1,210.92 ","$0.00 ","$1,231.81 ","$0.00 "
"VBJ051002","SUP","HCPCS C1874","","VBJ051002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5","BOTH IP/OP","$8,487.50 ","$6,280.75 ","$0.00 ","$8,487.50 ","$3,819.38 ","$0.00 ","$1,769.01 ","$0.00 ","$0.00 ","$1,486.09 ","$8,487.50 ","$0.00 ","$4,243.75 ","$6,722.10 ","$6,790.00 ","$0.00 ","$1,328.29 ","$0.00 ","$1,351.21 ","$0.00 "
"VBJ051502","SUP","HCPCS C1874","","VBJ051502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5","BOTH IP/OP","$9,737.50 ","$7,205.75 ","$0.00 ","$9,737.50 ","$4,381.88 ","$0.00 ","$2,029.54 ","$0.00 ","$0.00 ","$1,704.96 ","$9,737.50 ","$0.00 ","$4,868.75 ","$7,712.10 ","$7,790.00 ","$0.00 ","$1,523.92 ","$0.00 ","$1,550.21 ","$0.00 "
"VBJ052502","SUP","HCPCS C1874","","VBJ052502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER LOWER","BOTH IP/OP","$15,987.50 ","$11,830.75 ","$0.00 ","$15,987.50 ","$7,194.38 ","$0.00 ","$3,332.19 ","$0.00 ","$0.00 ","$2,799.28 ","$15,987.50 ","$0.00 ","$7,993.75 ","$12,662.10 ","$12,790.00 ","$0.00 ","$2,502.04 ","$0.00 ","$2,545.21 ","$0.00 "
"VBJ060502","SUP","HCPCS C1874","","VBJ060502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 6","BOTH IP/OP","$7,737.50 ","$5,725.75 ","$0.00 ","$7,737.50 ","$3,481.88 ","$0.00 ","$1,612.69 ","$0.00 ","$0.00 ","$1,354.77 ","$7,737.50 ","$0.00 ","$3,868.75 ","$6,128.10 ","$6,190.00 ","$0.00 ","$1,210.92 ","$0.00 ","$1,231.81 ","$0.00 "
"VBJ061002","SUP","HCPCS C1874","","VBJ061002  -  STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM","BOTH IP/OP","$8,487.50 ","$6,280.75 ","$0.00 ","$8,487.50 ","$3,819.38 ","$0.00 ","$1,769.01 ","$0.00 ","$0.00 ","$1,486.09 ","$8,487.50 ","$0.00 ","$4,243.75 ","$6,722.10 ","$6,790.00 ","$0.00 ","$1,328.29 ","$0.00 ","$1,351.21 ","$0.00 "
"VBJ061502","SUP","HCPCS C1874","","VBJ061502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 6","BOTH IP/OP","$9,737.50 ","$7,205.75 ","$0.00 ","$9,737.50 ","$4,381.88 ","$0.00 ","$2,029.54 ","$0.00 ","$0.00 ","$1,704.96 ","$9,737.50 ","$0.00 ","$4,868.75 ","$7,712.10 ","$7,790.00 ","$0.00 ","$1,523.92 ","$0.00 ","$1,550.21 ","$0.00 "
"VBJ062502","SUP","HCPCS C1874","","VBJ062502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER LOWER","BOTH IP/OP","$15,987.50 ","$11,830.75 ","$0.00 ","$15,987.50 ","$7,194.38 ","$0.00 ","$3,332.19 ","$0.00 ","$0.00 ","$2,799.28 ","$15,987.50 ","$0.00 ","$7,993.75 ","$12,662.10 ","$12,790.00 ","$0.00 ","$2,502.04 ","$0.00 ","$2,545.21 ","$0.00 "
"VBJ070502","SUP","HCPCS C1874","","VBJ070502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7","BOTH IP/OP","$7,737.50 ","$5,725.75 ","$0.00 ","$7,737.50 ","$3,481.88 ","$0.00 ","$1,612.69 ","$0.00 ","$0.00 ","$1,354.77 ","$7,737.50 ","$0.00 ","$3,868.75 ","$6,128.10 ","$6,190.00 ","$0.00 ","$1,210.92 ","$0.00 ","$1,231.81 ","$0.00 "
"VBJ071002","SUP","HCPCS C1874","","VBJ071002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7","BOTH IP/OP","$8,487.50 ","$6,280.75 ","$0.00 ","$8,487.50 ","$3,819.38 ","$0.00 ","$1,769.01 ","$0.00 ","$0.00 ","$1,486.09 ","$8,487.50 ","$0.00 ","$4,243.75 ","$6,722.10 ","$6,790.00 ","$0.00 ","$1,328.29 ","$0.00 ","$1,351.21 ","$0.00 "
"VBJ071502","SUP","HCPCS C1874","","VBJ071502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7","BOTH IP/OP","$9,737.50 ","$7,205.75 ","$0.00 ","$9,737.50 ","$4,381.88 ","$0.00 ","$2,029.54 ","$0.00 ","$0.00 ","$1,704.96 ","$9,737.50 ","$0.00 ","$4,868.75 ","$7,712.10 ","$7,790.00 ","$0.00 ","$1,523.92 ","$0.00 ","$1,550.21 ","$0.00 "
"VBJ072502","SUP","HCPCS C1874","","VBJ072502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER DELIVERY","BOTH IP/OP","$15,987.50 ","$11,830.75 ","$0.00 ","$15,987.50 ","$7,194.38 ","$0.00 ","$3,332.19 ","$0.00 ","$0.00 ","$2,799.28 ","$15,987.50 ","$0.00 ","$7,993.75 ","$12,662.10 ","$12,790.00 ","$0.00 ","$2,502.04 ","$0.00 ","$2,545.21 ","$0.00 "
"VBJ080202","SUP","HCPCS C1874","","VBJ080202  -  STENT ENDOPRSTH 2.5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM","BOTH IP/OP","$7,355.00 ","$5,442.70 ","$0.00 ","$7,355.00 ","$3,309.75 ","$0.00 ","$1,532.97 ","$0.00 ","$0.00 ","$1,287.80 ","$7,355.00 ","$0.00 ","$3,677.50 ","$5,825.16 ","$5,884.00 ","$0.00 ","$1,151.06 ","$0.00 ","$1,170.92 ","$0.00 "
"VBJ080502","SUP","HCPCS C1874","","VBJ080502  -  STENT ENDOPRSTH 8MM 7FR 5CM 120CM DELIVERY SYSTEM VIABAHN","BOTH IP/OP","$7,737.50 ","$5,725.75 ","$0.00 ","$7,737.50 ","$3,481.88 ","$0.00 ","$1,612.69 ","$0.00 ","$0.00 ","$1,354.77 ","$7,737.50 ","$0.00 ","$3,868.75 ","$6,128.10 ","$6,190.00 ","$0.00 ","$1,210.92 ","$0.00 ","$1,231.81 ","$0.00 "
"VBJ081002","SUP","HCPCS C1874","","VBJ081002  -  STENT ENDOPRSTH 8MM 7FR 10CM 120CM DELIVERY SYSTEM VIABAHN","BOTH IP/OP","$8,950.00 ","$6,623.00 ","$0.00 ","$8,950.00 ","$4,027.50 ","$0.00 ","$1,865.40 ","$0.00 ","$0.00 ","$1,567.07 ","$8,950.00 ","$0.00 ","$4,475.00 ","$7,088.40 ","$7,160.00 ","$0.00 ","$1,400.68 ","$0.00 ","$1,424.84 ","$0.00 "
"VBJ081502","SUP","HCPCS C1874","","VBJ081502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 8","BOTH IP/OP","$9,660.00 ","$7,148.40 ","$0.00 ","$9,660.00 ","$4,347.00 ","$0.00 ","$2,013.39 ","$0.00 ","$0.00 ","$1,691.39 ","$9,660.00 ","$0.00 ","$4,830.00 ","$7,650.72 ","$7,728.00 ","$0.00 ","$1,511.79 ","$0.00 ","$1,537.87 ","$0.00 "
"VBJR050502A","SUP","HCPCS C1874","","VBJR050502A  -  STENT EPRSTH 5MM 5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ HEP","BOTH IP/OP","$9,207.50 ","$6,813.55 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,919.07 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"VBJR051002A","SUP","HCPCS C1874","","VBJR051002A  -  STENT ENDOPRSTH 5MM 10CM 120CM FLEXIBLE SELF EXPAND RADIOPQ","BOTH IP/OP","$10,072.50 ","$7,453.65 ","$0.00 ","$9,875.00 ","$4,443.75 ","$0.00 ","$2,099.36 ","$0.00 ","$0.00 ","$1,729.03 ","$9,875.00 ","$0.00 ","$4,937.50 ","$7,821.00 ","$7,900.00 ","$0.00 ","$1,545.44 ","$0.00 ","$1,572.10 ","$0.00 "
"VBJR060502A","SUP","HCPCS C1874","","VBJR060502A  -  STENT EPRSTH 6MM 6FR 5CM 120CM VBHN DLV SYS HEP SPRFC FEM","BOTH IP/OP","$9,207.50 ","$6,813.55 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,919.07 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"VBJR061002A","SUP","HCPCS C1874","","VBJR061002A  -  STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC","BOTH IP/OP","$10,072.50 ","$7,453.65 ","$0.00 ","$9,875.00 ","$4,443.75 ","$0.00 ","$2,099.36 ","$0.00 ","$0.00 ","$1,729.03 ","$9,875.00 ","$0.00 ","$4,937.50 ","$7,821.00 ","$7,900.00 ","$0.00 ","$1,545.44 ","$0.00 ","$1,572.10 ","$0.00 "
"VBJR061502A","SUP","HCPCS C1874","","VBJR061502A  -  VIABAHN ENDOPROSTHESIS, 6MMX 15CM","BOTH IP/OP","$11,225.00 ","$8,306.50 ","$0.00 ","$11,005.00 ","$4,952.25 ","$0.00 ","$2,339.57 ","$0.00 ","$0.00 ","$1,926.89 ","$11,005.00 ","$0.00 ","$5,502.50 ","$8,715.96 ","$8,804.00 ","$0.00 ","$1,722.28 ","$0.00 ","$1,752.00 ","$0.00 "
"VBJR062502A","SUP","HCPCS C1874","","VBJR062502A  -  STENT ENDOPRSTH 6MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ","BOTH IP/OP","$18,450.00 ","$13,653.00 ","$0.00 ","$18,087.50 ","$8,139.38 ","$0.00 ","$3,845.44 ","$0.00 ","$0.00 ","$3,166.98 ","$18,087.50 ","$0.00 ","$9,043.75 ","$14,325.30 ","$14,470.00 ","$0.00 ","$2,830.69 ","$0.00 ","$2,879.53 ","$0.00 "
"VBJR070202A","SUP","HCPCS C1874","","VBJR070202A  -  STENT EPRSTH 7MM 2.5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ","BOTH IP/OP","$9,207.50 ","$6,813.55 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,919.07 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"VBJR070502A","SUP","HCPCS C1874","","VBJR070502A  -  LOW-PROFILE, VIABAHN 7MMX 5CM","BOTH IP/OP","$9,207.50 ","$6,813.55 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,919.07 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"VBJR071002A","SUP","HCPCS C1874","","VBJR071002A  -  STENT ENDOPRSTH SPRFC FEM ART ILIUM 10CM 7MM 7FR","BOTH IP/OP","$10,072.50 ","$7,453.65 ","$0.00 ","$9,875.00 ","$4,443.75 ","$0.00 ","$2,099.36 ","$0.00 ","$0.00 ","$1,729.03 ","$9,875.00 ","$0.00 ","$4,937.50 ","$7,821.00 ","$7,900.00 ","$0.00 ","$1,545.44 ","$0.00 ","$1,572.10 ","$0.00 "
"VBJR071502A","SUP","HCPCS C1874","","VBJR071502A  -  STENT ENDOPRSTH 7MM 7FR 15CM 120CM DELIVERY SYSTEM VIABAHN","BOTH IP/OP","$11,225.00 ","$8,306.50 ","$0.00 ","$11,005.00 ","$4,952.25 ","$0.00 ","$2,339.57 ","$0.00 ","$0.00 ","$1,926.89 ","$11,005.00 ","$0.00 ","$5,502.50 ","$8,715.96 ","$8,804.00 ","$0.00 ","$1,722.28 ","$0.00 ","$1,752.00 ","$0.00 "
"VBJR072502A","SUP","HCPCS C1874","","VBJR072502A  -  STENT ENDOPRSTH 7MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ","BOTH IP/OP","$18,450.00 ","$13,653.00 ","$0.00 ","$18,087.50 ","$8,139.38 ","$0.00 ","$3,845.44 ","$0.00 ","$0.00 ","$3,166.98 ","$18,087.50 ","$0.00 ","$9,043.75 ","$14,325.30 ","$14,470.00 ","$0.00 ","$2,830.69 ","$0.00 ","$2,879.53 ","$0.00 "
"VBJR080502A","SUP","HCPCS C1874","","VBJR080502A  -  VIABAHN ENDOPROSTHESIS, 8MMX 5CM","BOTH IP/OP","$9,207.50 ","$6,813.55 ","$0.00 ","$9,027.50 ","$4,062.38 ","$0.00 ","$1,919.07 ","$0.00 ","$0.00 ","$1,580.64 ","$9,027.50 ","$0.00 ","$4,513.75 ","$7,149.78 ","$7,222.00 ","$0.00 ","$1,412.80 ","$0.00 ","$1,437.18 ","$0.00 "
"VBP32","SUP","HCPCS C1713","","VBP32  -  PIN FIX 32MM BUTTRESS TITANIUM VOLAR","BOTH IP/OP","$937.50 ","$693.75 ","$0.00 ","$937.50 ","$421.88 ","$0.00 ","$195.40 ","$0.00 ","$0.00 ","$164.15 ","$937.50 ","$0.00 ","$468.75 ","$742.50 ","$750.00 ","$0.00 ","$146.72 ","$0.00 ","$149.25 ","$0.00 "
"VCP740D","SUP","Custom 27203010","","VCP740D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND","BOTH IP/OP","$32.80 ","$24.27 ","$0.00 ","$32.80 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$32.80 ","$0.00 ","$16.40 ","$25.98 ","$26.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VE220GS","SUP","HCPCS C1884","","VE220GS  -  PARTICLES EMBL 100-300UM 2ML YLW LC BEAD VL","BOTH IP/OP","$4,237.50 ","$3,135.75 ","$0.00 ","$4,237.50 ","$1,906.88 ","$0.00 ","$883.20 ","$0.00 ","$0.00 ","$741.95 ","$4,237.50 ","$0.00 ","$2,118.75 ","$3,356.10 ","$3,390.00 ","$0.00 ","$663.17 ","$0.00 ","$674.61 ","$0.00 "
"VE420GS","SUP","HCPCS C1884","","VE420GS  -  PARTICLES EMBL 300-500UM 2ML BLU LC BEAD LBL","BOTH IP/OP","$4,037.50 ","$2,987.75 ","$0.00 ","$4,037.50 ","$1,816.88 ","$0.00 ","$841.52 ","$0.00 ","$0.00 ","$706.93 ","$4,037.50 ","$0.00 ","$2,018.75 ","$3,197.70 ","$3,230.00 ","$0.00 ","$631.87 ","$0.00 ","$642.77 ","$0.00 "
"VE620GS","SUP","Custom 27203010","","PARTICLES EMBL 500-700UM 2ML LBL LC BEAD RD","BOTH IP/OP","$3,487.50 ","$2,580.75 ","$0.00 ","$3,487.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,487.50 ","$0.00 ","$1,743.75 ","$2,762.10 ","$2,790.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VEDR01","SUP","HCPCS C1785","","VEDR01  -  PACEMAKER CARDIAC 2.8V 1.3AH 7.5MM 47.9X7.5X44.7MM IMPLTABLE","BOTH IP/OP","$6,002.50 ","$4,441.85 ","$0.00 ","$6,125.00 ","$2,756.25 ","$0.00 ","$1,251.07 ","$0.00 ","$0.00 ","$1,072.44 ","$6,125.00 ","$0.00 ","$3,062.50 ","$4,851.00 ","$4,900.00 ","$0.00 ","$958.56 ","$0.00 ","$975.10 ","$0.00 "
"VERSADRK2","SUP","HCPCS C1785","","VERSADRK2  -  PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER","BOTH IP/OP","$7,987.50 ","$5,910.75 ","$0.00 ","$8,150.00 ","$3,667.50 ","$0.00 ","$1,664.79 ","$0.00 ","$0.00 ","$1,427.00 ","$8,150.00 ","$0.00 ","$4,075.00 ","$6,454.80 ","$6,520.00 ","$0.00 ","$1,275.48 ","$0.00 ","$1,297.48 ","$0.00 "
"VG-0108N","SUP","HCPCS C1768","","VG-0108N  -  PATCH CARDIO TAPER 8X.8CM APEX PROCESS VASCU-GUARD BOVINE","BOTH IP/OP","$525.28 ","$388.71 ","$0.00 ","$495.10 ","$222.80 ","$0.00 ","$109.48 ","$0.00 ","$0.00 ","$86.69 ","$495.10 ","$0.00 ","$247.55 ","$392.12 ","$396.08 ","$0.00 ","$77.48 ","$0.00 ","$78.82 ","$0.00 "
"VG-0209N","SUP","HCPCS C1768","","VG-0209N  -  PATCH CARDIO 9X2CM TPR VSGRD BVN PRICRD PERI","BOTH IP/OP","$532.50 ","$394.05 ","$0.00 ","$532.50 ","$239.63 ","$0.00 ","$110.99 ","$0.00 ","$0.00 ","$93.24 ","$532.50 ","$0.00 ","$266.25 ","$421.74 ","$426.00 ","$0.00 ","$83.34 ","$0.00 ","$84.77 ","$0.00 "
"VG1CPAR10P","SUP","HCPCS C1762","","VG1CPAR10P  -  GRAFT BONE 12X14.5X10MM ANTERIOR CERV FUSION PARALLEL SOLID","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1CPAR5P","SUP","HCPCS C1762","","VG1CPAR5P  -  GRAFT BONE VG1 CERV","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1CPAR6P","SUP","HCPCS C1762","","VG1CPAR6P  -  GRAFT BONE 12X14.5X6MM ANTERIOR CERV FUSION PARALLEL SOLID","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1CPAR7P","SUP","HCPCS C1762","","VG1CPAR7P  -  GRAFT BONE 12X14.5X7MM ANTERIOR CERV FUSION PARALLEL SOLID","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1CPAR8P","SUP","HCPCS C1762","","VG1CPAR8P  -  GRAFT BONE 12X14.5X8MM ANTERIOR CERV FUSION PARALLEL","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1CPAR9P","SUP","HCPCS C1762","","VG1CPAR9P  -  GRAFT BONE 12X14.5X9MM ANTERIOR CERV FUSION PARALLEL SOLID","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1C-T46P","SUP","HCPCS C1762","","VG1C-T46P  -  GRAFT BONE 7D 6MM 4MM 1 PIECE LORDOSIS SOLID CENTRL VOID","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$3,327.50 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$3,327.50 ","$0.00 ","$1,663.75 ","$2,635.38 ","$2,662.00 ","$0.00 ","$520.75 ","$0.00 ","$0.00 ","$0.00 "
"VG1C-T57P","SUP","HCPCS C1762","","VG1C-T57P  -  GRAFT BONE 7D 7MM 5MM 1 PIECE LORDOSIS SOLID CENTRL VOID","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG1C-T68P","SUP","HCPCS C1762","","VG1C-T68P  -  GRAFT BONE 7D 12X14.5X8MM 6MM ANTERIOR CERV FUSION PRESERVON","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$3,327.50 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$3,327.50 ","$0.00 ","$1,663.75 ","$2,635.38 ","$2,662.00 ","$0.00 ","$520.75 ","$0.00 ","$0.00 ","$0.00 "
"VG1C-T79P","SUP","HCPCS C1762","","VG1C-T79P  -  GRAFT BONE 7D 12X14.5X9MM 7MM ANTERIOR CERV FUSION PRESERVON","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$3,247.50 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$3,247.50 ","$0.00 ","$1,623.75 ","$2,572.02 ","$2,598.00 ","$0.00 ","$508.23 ","$0.00 ","$0.00 ","$0.00 "
"VG1C-T810P","SUP","HCPCS C1762","","VG1C-T810P  -  GRAFT BONE 7D 12X14.5X10MM 8MM ANTERIOR CERV FUSION","BOTH IP/OP","$2,495.63 ","$1,846.77 ","$0.00 ","$2,995.00 ","$0.00 ","$0.00 ","$520.15 ","$0.00 ","$0.00 ","$0.00 ","$2,995.00 ","$0.00 ","$1,497.50 ","$2,372.04 ","$2,396.00 ","$0.00 ","$468.72 ","$0.00 ","$0.00 ","$0.00 "
"VG2C-T57P","SUP","Custom 27803010","","VG2C-T57P  -  LIFENET HEALTH 5.75 X 7.22MM CERVICAL LORDOTIC","BOTH IP/OP","$2,630.63 ","$1,946.67 ","$0.00 ","$3,247.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3,247.50 ","$0.00 ","$1,623.75 ","$2,572.02 ","$2,598.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VG501","SUP","Custom 27203010","","CONTROLLER, V-GRIP DETACHMENT","BOTH IP/OP","$437.50 ","$323.75 ","$0.00 ","$437.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$437.50 ","$0.00 ","$218.75 ","$346.50 ","$350.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VH - 2004","SUP","Custom 27203010","","VH - 2004  -  SYSTEM VSL HRVT SHRT BLNT CONE 30ML VSVW TROC ESCP CNN SL","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,312.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,312.50 ","$0.00 ","$656.25 ","$1,039.50 ","$1,050.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VKML","SUP","HCPCS C1781","","VKML  -  MESH SURG FLAT 12X12IN KNIT VICRYL POLYGLACTIN 910 WOVEN","BOTH IP/OP","$1,899.22 ","$1,405.42 ","$0.00 ","$1,927.71 ","$867.47 ","$0.00 ","$395.84 ","$0.00 ","$0.00 ","$337.53 ","$1,927.71 ","$0.00 ","$963.85 ","$1,526.75 ","$1,542.16 ","$0.00 ","$301.69 ","$0.00 ","$306.89 ","$0.00 "
"VL1060031","SUP","Custom 27203010","","KIT OC VAP GRD PKG","BOTH IP/OP","$3.03 ","$2.24 ","$0.00 ","$3.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$3.03 ","$0.00 ","$1.51 ","$2.40 ","$2.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLBPL-11-7","SUP","HCPCS C1713","","VLBPL-11-7  -  PLATE BONE 11 HOLE 7 PEG LOCKING VOLAR BEARING PLATE","BOTH IP/OP","$5,187.50 ","$3,838.75 ","$0.00 ","$5,187.50 ","$2,334.38 ","$0.00 ","$1,081.20 ","$0.00 ","$0.00 ","$908.29 ","$5,187.50 ","$0.00 ","$2,593.75 ","$4,108.50 ","$4,150.00 ","$0.00 ","$811.84 ","$0.00 ","$825.85 ","$0.00 "
"VLBPL-3-7","SUP","HCPCS C1713","","VLBPL-3-7  -  PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$1,215.00 ","$0.00 ","$562.75 ","$0.00 ","$0.00 ","$472.75 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$422.55 ","$0.00 ","$429.84 ","$0.00 "
"VLBPL-5-5","SUP","HCPCS C1713","","VLBPL-5-5  -  PLATE BONE 5 HOLE 5 PEG LOCKING VOLAR BEARING PLATE TITANIUM","BOTH IP/OP","$2,962.50 ","$2,192.25 ","$0.00 ","$2,962.50 ","$1,333.13 ","$0.00 ","$617.46 ","$0.00 ","$0.00 ","$518.71 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$463.63 ","$0.00 ","$471.63 ","$0.00 "
"VLBPL-5-7","SUP","HCPCS C1713","","VLBPL-5-7  -  PLATE BONE 5 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT","BOTH IP/OP","$2,962.50 ","$2,192.25 ","$0.00 ","$2,962.50 ","$1,333.13 ","$0.00 ","$617.46 ","$0.00 ","$0.00 ","$518.71 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$463.63 ","$0.00 ","$471.63 ","$0.00 "
"VLBPL-7-7","SUP","HCPCS C1713","","VLBPL-7-7  -  PLATE BONE 7 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"VLBPL-9-7","SUP","HCPCS C1713","","VLBPL-9-7  -  PLATE BN VOLR BRNG PLT 9 HL 7 PG LCK TI LT WRST","BOTH IP/OP","$4,225.00 ","$3,126.50 ","$0.00 ","$4,225.00 ","$1,901.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$739.76 ","$4,225.00 ","$0.00 ","$2,112.50 ","$3,346.20 ","$3,380.00 ","$0.00 ","$661.21 ","$0.00 ","$672.62 ","$0.00 "
"VLBPR-11-7","SUP","HCPCS C1713","","VLBPR-11-7  -  PLATE BONE VOLAR BEARING PLATE TITANIUM RIGHT WRIST 11 HOLE","BOTH IP/OP","$5,187.50 ","$3,838.75 ","$0.00 ","$5,187.50 ","$2,334.38 ","$0.00 ","$1,081.20 ","$0.00 ","$0.00 ","$908.29 ","$5,187.50 ","$0.00 ","$2,593.75 ","$4,108.50 ","$4,150.00 ","$0.00 ","$811.84 ","$0.00 ","$825.85 ","$0.00 "
"VLBPR-3-7","SUP","HCPCS C1713","","VLBPR-3-7  -  PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM","BOTH IP/OP","$2,700.00 ","$1,998.00 ","$0.00 ","$2,700.00 ","$1,215.00 ","$0.00 ","$562.75 ","$0.00 ","$0.00 ","$472.75 ","$2,700.00 ","$0.00 ","$1,350.00 ","$2,138.40 ","$2,160.00 ","$0.00 ","$422.55 ","$0.00 ","$429.84 ","$0.00 "
"VLBPR-5-5","SUP","HCPCS C1713","","VLBPR-5-5  -  PLATE TI 5 HOLE 5 PG LCK VOLR BRNG PLT BONE RIGHT","BOTH IP/OP","$2,962.50 ","$2,192.25 ","$0.00 ","$2,962.50 ","$1,333.13 ","$0.00 ","$617.46 ","$0.00 ","$0.00 ","$518.71 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$463.63 ","$0.00 ","$471.63 ","$0.00 "
"VLBPR-5-7","SUP","HCPCS C1713","","VLBPR-5-7  -  PLATE BONE STANDARD 5 HOLE PEG VOLAR BEARING PLATE RIGHT","BOTH IP/OP","$2,962.50 ","$2,192.25 ","$0.00 ","$2,962.50 ","$1,333.13 ","$0.00 ","$617.46 ","$0.00 ","$0.00 ","$518.71 ","$2,962.50 ","$0.00 ","$1,481.25 ","$2,346.30 ","$2,370.00 ","$0.00 ","$463.63 ","$0.00 ","$471.63 ","$0.00 "
"VLBPR-7-7","SUP","HCPCS C1713","","VLBPR-7-7  -  PLATE BONE STANDARD 7 HOLE PEG VOLAR BEARING PLATE RIGHT","BOTH IP/OP","$3,237.50 ","$2,395.75 ","$0.00 ","$3,237.50 ","$1,456.88 ","$0.00 ","$674.78 ","$0.00 ","$0.00 ","$566.86 ","$3,237.50 ","$0.00 ","$1,618.75 ","$2,564.10 ","$2,590.00 ","$0.00 ","$506.67 ","$0.00 ","$515.41 ","$0.00 "
"VLBPR-9-7","SUP","HCPCS C1713","","VLBPR-9-7  -  PLATE BONE 9 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM","BOTH IP/OP","$4,225.00 ","$3,126.50 ","$0.00 ","$4,225.00 ","$1,901.25 ","$0.00 ","$880.60 ","$0.00 ","$0.00 ","$739.76 ","$4,225.00 ","$0.00 ","$2,112.50 ","$3,346.20 ","$3,380.00 ","$0.00 ","$661.21 ","$0.00 ","$672.62 ","$0.00 "
"VLOCL0315","SUP","Custom 27203010","","VLOCL0315  -  DEVICE CLSR 2-0 GS-21 .5 CRC 12IN GRN 37MM V-LOC 180 TPR PNT","BOTH IP/OP","$65.75 ","$48.66 ","$0.00 ","$65.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.75 ","$0.00 ","$32.88 ","$52.07 ","$52.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCL0316","SUP","Custom 27203010","","VLOCL0316  -  DEVICE CLOSURE 0 GS-21 .5 CIR 12IN 37MM TAPER POINT","BOTH IP/OP","$7.89 ","$5.84 ","$0.00 ","$7.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.89 ","$0.00 ","$3.95 ","$6.25 ","$6.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCL0325","SUP","Custom 27203010","","VLOCL0325  -  DEVICE CLOSURE 2-0 GS-21 .5 CIR 18IN 37MM TAPER POINT","BOTH IP/OP","$72.53 ","$53.67 ","$0.00 ","$72.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$72.53 ","$0.00 ","$36.26 ","$57.44 ","$58.02 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCL0346","SUP","Custom 27203010","","VLOCL0346  -  DEVICE CLSR 0 GS-21 9IN GRN V-LOC 180 ABS TPR PNT","BOTH IP/OP","$75.89 ","$56.16 ","$0.00 ","$910.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$910.63 ","$0.00 ","$455.31 ","$721.22 ","$728.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCL0604","SUP","Custom 27203010","","VLOCL0604  -  DEVICE CLSR 3-0 V-20 6IN GRN V-LOC 180 SURGALLOY ABS TPR PNT","BOTH IP/OP","$62.63 ","$46.35 ","$0.00 ","$62.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.63 ","$0.00 ","$31.31 ","$49.60 ","$50.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCL0614","SUP","Custom 27203010","","VLOCL0614  -  DEVICE CLOSURE 3-0 V-20 .5 CIR 12IN 26MM TAPER POINT","BOTH IP/OP","$789.00 ","$583.86 ","$0.00 ","$789.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$789.00 ","$0.00 ","$394.50 ","$624.89 ","$631.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCL0615","SUP","Custom 27203010","","VLOCL0615  -  DEVICE CLSR 2-0 V-20 12IN GRN V-LOC 180 TPR PNT ABS 2 ANG","BOTH IP/OP","$65.75 ","$48.66 ","$0.00 ","$65.75 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.75 ","$0.00 ","$32.88 ","$52.07 ","$52.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCM0315","SUP","Custom 27203010","","VLOCM0315  -  DEVICE CLOSURE 2-0 GS-21 .5 CIR 12IN 37MM TAPER POINT","BOTH IP/OP","$7.89 ","$5.84 ","$0.00 ","$7.89 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$7.89 ","$0.00 ","$3.95 ","$6.25 ","$6.31 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCM0345","SUP","HCPCS C1760","","VLOCM0345  -  WOUND CLOSURE DEVICE ABSORB V LOC 90 2-0 GS-21","BOTH IP/OP","$73.68 ","$54.52 ","$0.00 ","$73.68 ","$33.15 ","$0.00 ","$15.36 ","$0.00 ","$0.00 ","$12.90 ","$73.68 ","$0.00 ","$36.84 ","$58.35 ","$58.94 ","$0.00 ","$11.53 ","$0.00 ","$11.73 ","$0.00 "
"VLOCM0604","SUP","Custom 27203010","","VLOCM0604  -  DEVICE CLSR 3-0 V-20 6IN VIOL V-LOC 90 SURGALLOY ABS TPR PNT","BOTH IP/OP","$62.63 ","$46.35 ","$0.00 ","$62.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.63 ","$0.00 ","$31.31 ","$49.60 ","$50.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCM0804","SUP","Custom 27203010","","VLOCM0804  -  DEVICE CLSR 3-0 CV-23 6IN VIOL V-LOC 90 ABS","BOTH IP/OP","$753.48 ","$557.58 ","$0.00 ","$753.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$753.48 ","$0.00 ","$376.74 ","$596.76 ","$602.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCM1904","SUP","Custom 27203010","","VLOCM1904  -  DEVICE CLSR 3-0 CV-23 6IN UD 17MM V-LOC 90 SURGALLOY ABS","BOTH IP/OP","$62.63 ","$46.35 ","$0.00 ","$62.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.63 ","$0.00 ","$31.31 ","$49.60 ","$50.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLOCM1944","SUP","Custom 27203010","","VLOCM1944  -  DEVICE CLSR 3-0 CV-23 .5 CRC 9IN UD 17MM V-LOC 90 SURGALLOY","BOTH IP/OP","$62.63 ","$46.35 ","$0.00 ","$62.63 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$62.63 ","$0.00 ","$31.31 ","$49.60 ","$50.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLS03AF","SUP","Custom 27011340","","VLS03AF  -  LINER TRC AIRFLO SHRT HEAD SYNTH","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VLS05AF","SUP","Custom 27011340","","VLS05AF  -  HALTER TRC BREMER AIRFLO TALL CERV LINR LTWT VAC FRM","BOTH IP/OP","$255.00 ","$188.70 ","$0.00 ","$255.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$255.00 ","$0.00 ","$127.50 ","$201.96 ","$204.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VN1004040","SUP","HCPCS C1874","","VN1004040  -  STENT ENDOPRSTH 10MM 4CM 40CM EXPANDABLE PULL LINE SOLID","BOTH IP/OP","$7,695.00 ","$5,694.30 ","$0.00 ","$7,695.00 ","$3,462.75 ","$0.00 ","$1,603.83 ","$0.00 ","$0.00 ","$1,347.33 ","$7,695.00 ","$0.00 ","$3,847.50 ","$6,094.44 ","$6,156.00 ","$0.00 ","$1,204.27 ","$0.00 ","$1,225.04 ","$0.00 "
"VN1006040","SUP","HCPCS C1874","","VN1006040  -  STENT ENDOPRSTH 10MM 6CM 40CM EXPANDABLE PULL LINE SOLID","BOTH IP/OP","$7,695.00 ","$5,694.30 ","$0.00 ","$7,695.00 ","$3,462.75 ","$0.00 ","$1,603.83 ","$0.00 ","$0.00 ","$1,347.33 ","$7,695.00 ","$0.00 ","$3,847.50 ","$6,094.44 ","$6,156.00 ","$0.00 ","$1,204.27 ","$0.00 ","$1,225.04 ","$0.00 "
"VN1008040","SUP","HCPCS C1874","","VN1008040  -  STENT ENDOPRSTH 10MM 8CM 40CM EXPANDABLE PULL LINE HOLE","BOTH IP/OP","$7,695.00 ","$5,694.30 ","$0.00 ","$7,695.00 ","$3,462.75 ","$0.00 ","$1,603.83 ","$0.00 ","$0.00 ","$1,347.33 ","$7,695.00 ","$0.00 ","$3,847.50 ","$6,094.44 ","$6,156.00 ","$0.00 ","$1,204.27 ","$0.00 ","$1,225.04 ","$0.00 "
"VN1010040","SUP","HCPCS C1874","","VN1010040  -  STENT ENDOPRSTH 10MM 10CM 40CM EXPANDABLE PULL LINE HOLE","BOTH IP/OP","$7,695.00 ","$5,694.30 ","$0.00 ","$7,695.00 ","$3,462.75 ","$0.00 ","$1,603.83 ","$0.00 ","$0.00 ","$1,347.33 ","$7,695.00 ","$0.00 ","$3,847.50 ","$6,094.44 ","$6,156.00 ","$0.00 ","$1,204.27 ","$0.00 ","$1,225.04 ","$0.00 "
"VP40101-070","SUP","Custom 27011340","","VP40101-070  -  IMMOBILIZER ORTH UNV 24IN QCK WRP REINF POST STAY ELC HKLP","BOTH IP/OP","$37.45 ","$27.71 ","$0.00 ","$39.70 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.70 ","$0.00 ","$19.85 ","$31.44 ","$31.76 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VP-C328","SUP","Custom 25003010","","ANTIBODY CD10 CLONE 56C6 MS IGG1 KAPPA ANHMN 1ML LAB","BOTH IP/OP","$1,512.50 ","$1,119.25 ","$0.00 ","$1,512.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,512.50 ","$0.00 ","$756.25 ","$1,197.90 ","$1,210.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VPPL-5-7","SUP","HCPCS C1713","","VPPL-5-7  -  PLATE BN NS VOLR FA PLT 5 HL 7 PG WRST LT VOLR","BOTH IP/OP","$1,950.00 ","$1,443.00 ","$0.00 ","$1,950.00 ","$877.50 ","$0.00 ","$406.43 ","$0.00 ","$0.00 ","$341.43 ","$1,950.00 ","$0.00 ","$975.00 ","$1,544.40 ","$1,560.00 ","$0.00 ","$305.18 ","$0.00 ","$310.44 ","$0.00 "
"VR702","SUP","Custom 27203010","","VR702  -  REG PRFSN PMP KIT EXTN","BOTH IP/OP","$1,500.00 ","$1,110.00 ","$0.00 ","$1,500.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,500.00 ","$0.00 ","$750.00 ","$1,188.00 ","$1,200.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VS0602","SUP","Custom 27203010","","VIVASPIN 6 @ 10,000 MWCO","BOTH IP/OP","$877.50 ","$649.35 ","$0.00 ","$877.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$877.50 ","$0.00 ","$438.75 ","$694.98 ","$702.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VS101000","SUP","Custom 27203010","","VS101000  -  SLEEVE LAPSCOP 12MM 100MM RADIAL EXPAND BLADELESS TROCAR","BOTH IP/OP","$112.30 ","$83.10 ","$0.00 ","$113.98 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$113.98 ","$0.00 ","$56.99 ","$90.27 ","$91.19 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VS101005","SUP","Custom 27203010","","VS101005  -  CANNULA ESCP 5MM BLU STRL LF VRSTP BLDLS TROC DIL RADL XPD","BOTH IP/OP","$106.55 ","$78.85 ","$0.00 ","$106.55 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$106.55 ","$0.00 ","$53.28 ","$84.39 ","$85.24 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VS150000","SUP","Custom 27203010","","VS150000  -  NEEDLE INSFL LNG 14GA 150MM VRSTP BLDLS TROC EXPANDABLE SLV","BOTH IP/OP","$39.95 ","$29.56 ","$0.00 ","$39.95 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.95 ","$0.00 ","$19.98 ","$31.64 ","$31.96 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VTP2201","SUP","HCPCS C9356","","VTP2201  -  PROTECTOR TENDON VERAWRAP HYALURONIC ACID ALGINATE 2X2 TENDO","BOTH IP/OP","$4,900.00 ","$3,626.00 ","$0.00 ","$4,900.00 ","$2,205.00 ","$0.00 ","$1,021.28 ","$0.00 ","$0.00 ","$857.95 ","$4,900.00 ","$0.00 ","$2,450.00 ","$3,880.80 ","$3,920.00 ","$0.00 ","$766.85 ","$0.00 ","$780.08 ","$0.00 "
"VU-CTE-520","SUP","HCPCS C1789","","VU-CTE-520  -  XPD TISS 520-780ML TXTR CNTER PRFL DERMASPAN P4.5-7CM","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$894.38 ","$0.00 ","$414.24 ","$0.00 ","$0.00 ","$348.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$311.04 ","$0.00 ","$316.41 ","$0.00 "
"VU-CTE-720","SUP","Custom 27803010","","VU-CTE-720  -  EXPANDER TISS P4.7-7.5CM CURVILINEAR 26.2X9CM 720-1080CC","BOTH IP/OP","$1,987.50 ","$1,470.75 ","$0.00 ","$1,987.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,987.50 ","$0.00 ","$993.75 ","$1,574.10 ","$1,590.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"VXH13300","SUP","HCPCS C1874","","VXH13300  -  STENT CORON 3MM 13MM 137CM .014IN RAPEX RPTRL DLV SYS BX VLC","BOTH IP/OP","$2.50 ","$1.85 ","$0.00 ","$2.50 ","$1.13 ","$0.00 ","$0.52 ","$0.00 ","$0.00 ","$0.44 ","$2.50 ","$0.00 ","$1.25 ","$1.98 ","$2.00 ","$0.00 ","$0.39 ","$0.00 ","$0.40 ","$0.00 "
"W0400D","SUP","Custom 27203010","","BRACE WLK S/MED LOW PROFILE ANKL LEG HTOP RCKR SOLE HK/LOP","BOTH IP/OP","$163.13 ","$120.72 ","$0.00 ","$163.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$163.13 ","$0.00 ","$81.56 ","$129.20 ","$130.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"W4200","SUP","HCPCS C1760","","W4200  -  CLIP LG INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE ORNG","BOTH IP/OP","$15.59 ","$11.54 ","$0.00 ","$15.59 ","$7.02 ","$0.00 ","$3.25 ","$0.00 ","$0.00 ","$2.73 ","$15.59 ","$0.00 ","$7.80 ","$12.35 ","$12.47 ","$0.00 ","$2.44 ","$0.00 ","$2.48 ","$0.00 "
"WA22706S","SUP","Custom 27203010","","WA22706S  -  ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA LOOP 30 D MEDIUM DI","BOTH IP/OP","$1,157.59 ","$856.62 ","$0.00 ","$1,071.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,071.85 ","$0.00 ","$535.92 ","$848.91 ","$857.48 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"WA22760S","SUP","Custom 27203010","","WA22760S  -  ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA BUTTON MEDIUM DISPO","BOTH IP/OP","$1,209.74 ","$895.21 ","$0.00 ","$1,120.13 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,120.13 ","$0.00 ","$560.06 ","$887.14 ","$896.10 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"WA425600","SUP","Custom 27203010","","KIT IMMUN TST CNTRL CLBRT ELISA VZV IGG 2 96 TST","BOTH IP/OP","$779.73 ","$577.00 ","$0.00 ","$779.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$779.73 ","$0.00 ","$389.86 ","$617.55 ","$623.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"WBTN-2750-T","SUP","HCPCS C1713","","WBTN-2750-T  -  WASHER ORTH 5MM 27MM NS GEMINUS TI DIST VOLR RDS FOSSA","BOTH IP/OP","$100.00 ","$74.00 ","$0.00 ","$100.00 ","$45.00 ","$0.00 ","$20.84 ","$0.00 ","$0.00 ","$17.51 ","$100.00 ","$0.00 ","$50.00 ","$79.20 ","$80.00 ","$0.00 ","$15.65 ","$0.00 ","$15.92 ","$0.00 "
"WHV-4","SUP","HCPCS C1713","","WHV-4  -  VOLAR HOOK PLATE","BOTH IP/OP","$1,812.50 ","$1,341.25 ","$0.00 ","$1,812.50 ","$815.63 ","$0.00 ","$377.77 ","$0.00 ","$0.00 ","$317.35 ","$1,812.50 ","$0.00 ","$906.25 ","$1,435.50 ","$1,450.00 ","$0.00 ","$283.66 ","$0.00 ","$288.55 ","$0.00 "
"WHV-6","SUP","HCPCS C1713","","WHV-6  -  VOLAR HOOK PLATE","BOTH IP/OP","$2,075.00 ","$1,535.50 ","$0.00 ","$2,075.00 ","$933.75 ","$0.00 ","$432.48 ","$0.00 ","$0.00 ","$363.32 ","$2,075.00 ","$0.00 ","$1,037.50 ","$1,643.40 ","$1,660.00 ","$0.00 ","$324.74 ","$0.00 ","$330.34 ","$0.00 "
"WIRE-0.7/080","SUP","HCPCS C1713","","WIRE-0.7/080  -  WIRE FX .7MM 80MM KRSH SS","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$0.00 ","$0.00 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"WIRE-0.8/120","SUP","HCPCS C1713","","WIRE-0.8/120  -  WIRE FX .8MM 120MM KRSH SS","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$0.00 ","$0.00 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"WIRE-0.9","SUP","HCPCS C1713","","WIRE-0.9  -  WIRE FIX .9MM KWIRE STAINLESS STEEL","BOTH IP/OP","$37.50 ","$27.75 ","$0.00 ","$37.50 ","$16.88 ","$0.00 ","$7.82 ","$0.00 ","$0.00 ","$6.57 ","$37.50 ","$0.00 ","$18.75 ","$29.70 ","$30.00 ","$0.00 ","$5.87 ","$0.00 ","$5.97 ","$0.00 "
"WIRE-0.9/100","SUP","HCPCS C1713","","WIRE-0.9/100  -  WIRE FX .9MM 100MM NS KRSH","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$0.00 ","$0.00 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"WIRE-1.1","SUP","HCPCS C1713","","WIRE-1.1  -  WIRE FX 1.1MM NS KRSH","BOTH IP/OP","$40.00 ","$29.60 ","$0.00 ","$40.00 ","$18.00 ","$0.00 ","$8.34 ","$0.00 ","$0.00 ","$7.00 ","$40.00 ","$0.00 ","$20.00 ","$31.68 ","$32.00 ","$0.00 ","$6.26 ","$0.00 ","$6.37 ","$0.00 "
"WIRE-1.6/100","SUP","HCPCS C1713","","WIRE-1.6/100  -  WIRE FX 1.6MM 100MM NS KRSH","BOTH IP/OP","$50.00 ","$37.00 ","$0.00 ","$50.00 ","$22.50 ","$0.00 ","$10.42 ","$0.00 ","$0.00 ","$8.75 ","$50.00 ","$0.00 ","$25.00 ","$39.60 ","$40.00 ","$0.00 ","$7.83 ","$0.00 ","$7.96 ","$0.00 "
"WN-1104ST","SUP","HCPCS C1769","","WN-1104ST  -  GUIDEWIRE ORTH .045IN 4IN SS","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$48.87 ","$0.00 ","$18.76 ","$0.00 ","$0.00 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$14.09 ","$0.00 ","$14.33 ","$0.00 "
"WN-2020","SUP","HCPCS C1769","","WN-2020  -  GWIRE ORTH 20IN 2MM SGL TROCAR TIP","BOTH IP/OP","$187.50 ","$138.75 ","$0.00 ","$187.50 ","$101.81 ","$0.00 ","$39.08 ","$0.00 ","$0.00 ","$32.83 ","$187.50 ","$0.00 ","$93.75 ","$148.50 ","$150.00 ","$0.00 ","$29.34 ","$0.00 ","$29.85 ","$0.00 "
"WN-2020ST","SUP","HCPCS C1769","","WN-2020ST  -  GUIDEWIRE ORTH 2MM 20IN TROC TIP NTNL","BOTH IP/OP","$230.00 ","$170.20 ","$0.00 ","$230.00 ","$124.89 ","$0.00 ","$47.94 ","$0.00 ","$0.00 ","$40.27 ","$230.00 ","$0.00 ","$115.00 ","$182.16 ","$184.00 ","$0.00 ","$36.00 ","$0.00 ","$36.62 ","$0.00 "
"WS0450090","SUP","HCPCS C1876","","WS0450090  -  STENT INTRCRAN 4.5MM 9MM WINGSPAN","BOTH IP/OP","$15,980.00 ","$11,825.20 ","$0.00 ","$15,980.00 ","$7,191.00 ","$0.00 ","$3,330.63 ","$0.00 ","$0.00 ","$2,797.97 ","$15,980.00 ","$0.00 ","$7,990.00 ","$12,656.16 ","$12,784.00 ","$0.00 ","$2,500.87 ","$0.00 ","$2,544.02 ","$0.00 "
"WS1406ST","SUP","HCPCS C1769","","WS1406ST  -  GUIDEWIRE ORTH 6IN .054IN ACTRK SS 1 TROC TIP","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$13.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.38 ","$25.00 ","$0.00 ","$12.50 ","$19.80 ","$20.00 ","$0.00 ","$3.91 ","$0.00 ","$3.98 ","$0.00 "
"WS-1504STT","SUP","HCPCS C1769","","WS-1504STT  -  GWIRE ORTH 4IN .054IN SS THRD","BOTH IP/OP","$122.50 ","$90.65 ","$0.00 ","$122.50 ","$66.52 ","$0.00 ","$25.53 ","$0.00 ","$0.00 ","$21.45 ","$122.50 ","$0.00 ","$61.25 ","$97.02 ","$98.00 ","$0.00 ","$19.17 ","$0.00 ","$19.50 ","$0.00 "
"WS1505-DT","SUP","HCPCS C1769","","WS1505-DT  -  WIRE FIX .062IN KWIRE FSN","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$9.50 ","$0.00 ","$3.65 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"WS-1606","SUP","HCPCS C1771","","WS-1606  -  GWIRE ORTH 6IN .062IN SS","BOTH IP/OP","$17.50 ","$12.95 ","$0.00 ","$17.50 ","$7.88 ","$0.00 ","$3.65 ","$0.00 ","$0.00 ","$3.06 ","$17.50 ","$0.00 ","$8.75 ","$13.86 ","$14.00 ","$0.00 ","$2.74 ","$0.00 ","$2.79 ","$0.00 "
"WS2009ST","SUP","HCPCS C1769","","WS2009ST  -  GUIDEWIRE ORTH 9IN 2IN SHLDR ELB SS","BOTH IP/OP","$25.00 ","$18.50 ","$0.00 ","$25.00 ","$13.58 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$4.38 ","$25.00 ","$0.00 ","$12.50 ","$19.80 ","$20.00 ","$0.00 ","$3.91 ","$0.00 ","$3.98 ","$0.00 "
"WS-2020","SUP","HCPCS C1769","","WS-2020  -  GWIRE ORTH 20IN .078IN PLRS HUM SHLDR SS","BOTH IP/OP","$147.50 ","$109.15 ","$0.00 ","$147.50 ","$80.09 ","$0.00 ","$30.74 ","$0.00 ","$0.00 ","$25.83 ","$147.50 ","$0.00 ","$73.75 ","$116.82 ","$118.00 ","$0.00 ","$23.08 ","$0.00 ","$23.48 ","$0.00 "
"WS-2409STT","SUP","HCPCS C1769","","WS-2409STT  -  GWIRE ORTH 9IN .094IN 1 TROCAR THRD","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$48.87 ","$0.00 ","$18.76 ","$0.00 ","$0.00 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$14.09 ","$0.00 ","$14.33 ","$0.00 "
"WT-0906STT","SUP","HCPCS C1769","","WT-0906STT  -  GWIRE ORTH 6IN .035IN TI THRD","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$48.87 ","$0.00 ","$18.76 ","$0.00 ","$0.00 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$14.09 ","$0.00 ","$14.33 ","$0.00 "
"WT-1606STT","SUP","HCPCS C1769","","WT-1606STT  -  GWIRE ORTH 5.75IN .062IN ACTRK TI 1 TROCAR TIP THRD","BOTH IP/OP","$90.00 ","$66.60 ","$0.00 ","$90.00 ","$48.87 ","$0.00 ","$18.76 ","$0.00 ","$0.00 ","$15.76 ","$90.00 ","$0.00 ","$45.00 ","$71.28 ","$72.00 ","$0.00 ","$14.09 ","$0.00 ","$14.33 ","$0.00 "
"X0411407","SUP","HCPCS C1713","","X0411407  -  CONNECTOR ROD 10MM CD HORIZON CROSSLINK GDLH LIBERTY SEXTANT","BOTH IP/OP","$4,822.50 ","$3,568.65 ","$0.00 ","$4,822.50 ","$2,170.13 ","$0.00 ","$1,005.13 ","$0.00 ","$0.00 ","$844.38 ","$4,822.50 ","$0.00 ","$2,411.25 ","$3,819.42 ","$3,858.00 ","$0.00 ","$754.72 ","$0.00 ","$767.74 ","$0.00 "
"X0590","SUP","Custom 27203010","","BLOTTER EPHRS BIOTN 15ML","BOTH IP/OP","$386.53 ","$286.03 ","$0.00 ","$386.53 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$386.53 ","$0.00 ","$193.26 ","$306.13 ","$309.22 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"X42200","SUP","HCPCS C1713","","X42200  -  SUB BNGFT 10X2.5CM GRFTN DBM PLIF","BOTH IP/OP","$4,926.25 ","$3,645.43 ","$0.00 ","$4,926.25 ","$2,216.81 ","$0.00 ","$1,026.75 ","$0.00 ","$0.00 ","$862.55 ","$4,926.25 ","$0.00 ","$2,463.13 ","$3,901.59 ","$3,941.00 ","$0.00 ","$770.96 ","$0.00 ","$784.26 ","$0.00 "
"X42210","SUP","HCPCS C1713","","X42210  -  SUB BNGFT 5X2.5CM GRFTN DBM PLIF","BOTH IP/OP","$3,053.75 ","$2,259.78 ","$0.00 ","$1,701.38 ","$765.62 ","$0.00 ","$636.48 ","$0.00 ","$0.00 ","$297.90 ","$1,701.38 ","$0.00 ","$850.69 ","$1,347.49 ","$1,361.10 ","$0.00 ","$266.27 ","$0.00 ","$270.86 ","$0.00 "
"X44135","SUP","HCPCS C1713","","X44135  -  SUB BNGFT GRFTN LG DFCT DBM OTHBLND JAR 15ML","BOTH IP/OP","$3,080.00 ","$2,279.20 ","$0.00 ","$3,432.00 ","$1,544.40 ","$0.00 ","$641.95 ","$0.00 ","$0.00 ","$600.92 ","$3,432.00 ","$0.00 ","$1,716.00 ","$2,718.14 ","$2,745.60 ","$0.00 ","$537.11 ","$0.00 ","$546.37 ","$0.00 "
"X44145","SUP","HCPCS C1713","","X44145  -  SUB BNGFT GRFTN SM DFCT DBM OTHBLND JAR 5ML","BOTH IP/OP","$2,340.00 ","$1,731.60 ","$0.00 ","$2,340.00 ","$1,053.00 ","$0.00 ","$487.71 ","$0.00 ","$0.00 ","$409.72 ","$2,340.00 ","$0.00 ","$1,170.00 ","$1,853.28 ","$1,872.00 ","$0.00 ","$366.21 ","$0.00 ","$372.53 ","$0.00 "
"X523H","SUP","Custom 27203010","","X523H  -  SUTURE NABSB 2-0 SH 36IN GRN EBND 2 ARM BRD","BOTH IP/OP","$387.23 ","$286.55 ","$0.00 ","$393.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$393.03 ","$0.00 ","$196.52 ","$311.28 ","$314.43 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"X559H","SUP","Custom 27203010","","X559H  -  SUTURE NONABSORBABLE 2-0 SH-2 36IN 2 ARM BRAID ETHIBOND","BOTH IP/OP","$416.10 ","$307.91 ","$0.00 ","$422.34 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$422.34 ","$0.00 ","$211.17 ","$334.49 ","$337.87 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"X833H","SUP","Custom 27203010","","X833H  -  SUTURE NABSB 2-0 SH 30IN GRN EBND BRD","BOTH IP/OP","$5.31 ","$3.93 ","$0.00 ","$191.33 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$191.33 ","$0.00 ","$95.66 ","$151.53 ","$153.06 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XA3816KT","SUP","HCPCS C1751","","XA3816KT  -  KIT CATHETER 8.5FR 16CM 3 LUMEN EXPAND CHLORAPREP SAFETY","BOTH IP/OP","$825.00 ","$610.50 ","$0.00 ","$825.00 ","$371.25 ","$0.00 ","$171.95 ","$0.00 ","$0.00 ","$144.45 ","$825.00 ","$0.00 ","$412.50 ","$653.40 ","$660.00 ","$0.00 ","$129.11 ","$0.00 ","$131.34 ","$0.00 "
"XA3820KT","SUP","HCPCS C1751","","XA3820KT  -  CATHETER CV 20CM PEDIASAT 3 LUM OXM CNT SCVO2 MNTR PED","BOTH IP/OP","$1,125.00 ","$832.50 ","$0.00 ","$1,125.00 ","$506.25 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$196.98 ","$1,125.00 ","$0.00 ","$562.50 ","$891.00 ","$900.00 ","$0.00 ","$176.06 ","$0.00 ","$179.10 ","$0.00 "
"XBR001002","SUP","HCPCS C1713","","XBR001002  -  WIRE FX OLV 1.2MM 65MM KRSH SMTH TROC TIP","BOTH IP/OP","$209.95 ","$155.36 ","$0.00 ","$350.05 ","$157.52 ","$0.00 ","$43.76 ","$0.00 ","$0.00 ","$61.29 ","$350.05 ","$0.00 ","$175.03 ","$277.24 ","$280.04 ","$0.00 ","$54.78 ","$0.00 ","$55.73 ","$0.00 "
"XC200","SUP","Custom 27803010","","XC200  -  CLIP SUT STRL LF LPR TY VCL 1 PC ABS POLY","BOTH IP/OP","$352.00 ","$260.48 ","$0.00 ","$489.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$352.00 ","$0.00 ","$176.00 ","$489.50 ","$281.60 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XF0012002","SUP","Custom 27203010","","XF0012002  -  BIT DRL 2MM AO","BOTH IP/OP","$490.85 ","$363.23 ","$0.00 ","$490.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.85 ","$0.00 ","$245.43 ","$388.75 ","$392.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XFO082001","SUP","Custom 27203010","","XFO082001  -  BIT DRL 2MM 3MM SCR","BOTH IP/OP","$287.30 ","$212.60 ","$0.00 ","$490.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.85 ","$0.00 ","$245.43 ","$388.75 ","$392.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XFO082501","SUP","Custom 27203010","","XFO082501  -  BIT DRL 2.5MM 3.5MM SCR","BOTH IP/OP","$287.30 ","$212.60 ","$0.00 ","$490.85 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$490.85 ","$0.00 ","$245.43 ","$388.75 ","$392.68 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XHAT45","SUP","Custom 27203010","","KIT IMMUN TST ELISA ANTI-PF4 45 TST","BOTH IP/OP","$1,181.73 ","$874.48 ","$0.00 ","$1,181.73 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$1,181.73 ","$0.00 ","$590.86 ","$935.93 ","$945.38 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XL-105914","SUP","HCPCS C1776","","XL-105914  -  LINER ACETAB 24 36MM HIGH WALL RINGLOC ARCOMXL HIP","BOTH IP/OP","$6,575.00 ","$4,865.50 ","$0.00 ","$6,575.00 ","$2,958.75 ","$0.00 ","$1,370.39 ","$0.00 ","$0.00 ","$1,151.23 ","$6,575.00 ","$0.00 ","$3,287.50 ","$5,207.40 ","$5,260.00 ","$0.00 ","$1,028.99 ","$0.00 ","$1,046.74 ","$0.00 "
"XM106.0204S","SUP","HCPCS C1763","","XM106.0204S  -  GRAFT SFT TIS 4X2CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$485.00 ","$358.90 ","$0.00 ","$485.00 ","$218.25 ","$0.00 ","$101.09 ","$0.00 ","$0.00 ","$84.92 ","$485.00 ","$0.00 ","$242.50 ","$384.12 ","$388.00 ","$0.00 ","$75.90 ","$0.00 ","$77.21 ","$0.00 "
"XM106.0407S","SUP","HCPCS C1763","","XM106.0407S  -  GRAFT SFT TIS 7X4CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$1,732.50 ","$1,282.05 ","$0.00 ","$1,732.50 ","$779.63 ","$0.00 ","$361.10 ","$0.00 ","$0.00 ","$303.35 ","$1,732.50 ","$0.00 ","$866.25 ","$1,372.14 ","$1,386.00 ","$0.00 ","$271.14 ","$0.00 ","$275.81 ","$0.00 "
"XM106.0416S","SUP","HCPCS C1763","","XM106.0416S  -  GRAFT SFT TIS 16X4CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$4,790.00 ","$3,544.60 ","$0.00 ","$4,790.00 ","$2,155.50 ","$0.00 ","$998.36 ","$0.00 ","$0.00 ","$838.69 ","$4,790.00 ","$0.00 ","$2,395.00 ","$3,793.68 ","$3,832.00 ","$0.00 ","$749.64 ","$0.00 ","$762.57 ","$0.00 "
"XM106.0516S","SUP","HCPCS C1763","","XM106.0516S  -  GRAFT SFT TIS 16X5CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$5,985.00 ","$4,428.90 ","$0.00 ","$5,985.00 ","$2,693.25 ","$0.00 ","$1,247.42 ","$0.00 ","$0.00 ","$1,047.93 ","$5,985.00 ","$0.00 ","$2,992.50 ","$4,740.12 ","$4,788.00 ","$0.00 ","$936.65 ","$0.00 ","$952.81 ","$0.00 "
"XM106.0612S","SUP","HCPCS C1763","","XM106.0612S  -  GRAFT SFT TIS 12X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$4,455.30 ","$3,296.92 ","$0.00 ","$4,455.30 ","$2,004.89 ","$0.00 ","$928.60 ","$0.00 ","$0.00 ","$780.09 ","$4,455.30 ","$0.00 ","$2,227.65 ","$3,528.60 ","$3,564.24 ","$0.00 ","$697.25 ","$0.00 ","$709.28 ","$0.00 "
"XM106.0616S","SUP","HCPCS C1763","","XM106.0616S  -  GRAFT SFT TIS 16X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$5,939.73 ","$4,395.40 ","$0.00 ","$5,939.73 ","$2,672.88 ","$0.00 ","$1,237.99 ","$0.00 ","$0.00 ","$1,040.00 ","$5,939.73 ","$0.00 ","$2,969.86 ","$4,704.27 ","$4,751.78 ","$0.00 ","$929.57 ","$0.00 ","$945.60 ","$0.00 "
"XM106.0620S","SUP","HCPCS C1763","","XM106.0620S  -  GRAFT SFT TIS 20X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$8,977.50 ","$6,643.35 ","$0.00 ","$8,977.50 ","$4,039.88 ","$0.00 ","$1,871.14 ","$0.00 ","$0.00 ","$1,571.89 ","$8,977.50 ","$0.00 ","$4,488.75 ","$7,110.18 ","$7,182.00 ","$0.00 ","$1,404.98 ","$0.00 ","$1,429.22 ","$0.00 "
"XM106.0812S","SUP","HCPCS C1763","","XM106.0812S  -  GRAFT SFT TIS 12X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$5,939.73 ","$4,395.40 ","$0.00 ","$5,939.73 ","$2,672.88 ","$0.00 ","$1,237.99 ","$0.00 ","$0.00 ","$1,040.00 ","$5,939.73 ","$0.00 ","$2,969.86 ","$4,704.27 ","$4,751.78 ","$0.00 ","$929.57 ","$0.00 ","$945.60 ","$0.00 "
"XM106.0816S","SUP","HCPCS C1763","","XM106.0816S  -  GRAFT SFT TIS 16X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$7,920.30 ","$5,861.02 ","$0.00 ","$7,920.30 ","$3,564.14 ","$0.00 ","$1,650.79 ","$0.00 ","$0.00 ","$1,386.78 ","$7,920.30 ","$0.00 ","$3,960.15 ","$6,272.88 ","$6,336.24 ","$0.00 ","$1,239.53 ","$0.00 ","$1,260.91 ","$0.00 "
"XM106.0820S","SUP","HCPCS C1763","","XM106.0820S  -  GRAFT SFT TIS 20X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$9,898.88 ","$7,325.17 ","$0.00 ","$9,898.88 ","$4,454.49 ","$0.00 ","$2,063.17 ","$0.00 ","$0.00 ","$1,733.21 ","$9,898.88 ","$0.00 ","$4,949.44 ","$7,839.91 ","$7,919.10 ","$0.00 ","$1,549.17 ","$0.00 ","$1,575.90 ","$0.00 "
"XM106.1016S","SUP","HCPCS C1763","","XM106.1016S  -  GRAFT SFT TIS 16X10CM XCM BIOLOGIC THK PIG DERM XCLR MTRX","BOTH IP/OP","$9,898.88 ","$7,325.17 ","$0.00 ","$9,898.88 ","$4,454.49 ","$0.00 ","$2,063.17 ","$0.00 ","$0.00 ","$1,733.21 ","$9,898.88 ","$0.00 ","$4,949.44 ","$7,839.91 ","$7,919.10 ","$0.00 ","$1,549.17 ","$0.00 ","$1,575.90 ","$0.00 "
"XM106.1020S","SUP","HCPCS C1762","","XM106.1020S  -  DD-XCM BIOLOGIC TISSUE MATRIX 10CM X 20CM/THICK-STERILE","BOTH IP/OP","$12,373.60 ","$9,156.46 ","$0.00 ","$12,373.60 ","$0.00 ","$0.00 ","$2,578.97 ","$0.00 ","$0.00 ","$0.00 ","$12,373.60 ","$0.00 ","$6,186.80 ","$9,799.89 ","$9,898.88 ","$0.00 ","$1,936.47 ","$0.00 ","$0.00 ","$0.00 "
"XM106.1220S","SUP","HCPCS C1763","","XM106.1220S  -  GRAFT SFT TIS 20X12CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK","BOTH IP/OP","$14,848.33 ","$10,987.76 ","$0.00 ","$14,848.33 ","$6,681.75 ","$0.00 ","$3,094.76 ","$0.00 ","$0.00 ","$2,599.82 ","$14,848.33 ","$0.00 ","$7,424.16 ","$11,759.88 ","$11,878.66 ","$0.00 ","$2,323.76 ","$0.00 ","$2,363.85 ","$0.00 "
"XM106.1620S","SUP","HCPCS C1762","","XM106.1620S  -  DD-XCM BIOLOGIC TISSUE MATRIX 16CM X 20CM/THICK-STERILE","BOTH IP/OP","$19,795.80 ","$14,648.89 ","$0.00 ","$19,795.80 ","$0.00 ","$0.00 ","$4,125.94 ","$0.00 ","$0.00 ","$0.00 ","$19,795.80 ","$0.00 ","$9,897.90 ","$15,678.27 ","$15,836.64 ","$0.00 ","$3,098.04 ","$0.00 ","$0.00 ","$0.00 "
"XM106.1625S","SUP","HCPCS C1763","","XM106.1625S  -  GRAFT SFT TIS 25X16CM XCM BIOLOGIC THK PIG DERM HDRT XCLR","BOTH IP/OP","$23,201.73 ","$17,169.28 ","$0.00 ","$23,201.73 ","$10,440.78 ","$0.00 ","$4,835.82 ","$0.00 ","$0.00 ","$4,062.44 ","$23,201.73 ","$0.00 ","$11,600.86 ","$18,375.77 ","$18,561.38 ","$0.00 ","$3,631.07 ","$0.00 ","$3,693.71 ","$0.00 "
"XM106.2020S","SUP","HCPCS C1763","","XM106.2020S  -  GRAFT SFT TIS 20X20CM XCM BIOLOGIC THK PIG DERM XCLR MTRX","BOTH IP/OP","$24,745.23 ","$18,311.47 ","$0.00 ","$24,745.23 ","$11,135.35 ","$0.00 ","$5,157.52 ","$0.00 ","$0.00 ","$4,332.69 ","$24,745.23 ","$0.00 ","$12,372.61 ","$19,598.22 ","$19,796.18 ","$0.00 ","$3,872.63 ","$0.00 ","$3,939.44 ","$0.00 "
"XM106.2025S","SUP","HCPCS C1763","","XM106.2025S  -  GRAFT SFT TIS 25X20CM XCM BIOLOGIC THK PIG DERM MTRX STRL","BOTH IP/OP","$30,933.00 ","$22,890.42 ","$0.00 ","$30,933.00 ","$13,919.85 ","$0.00 ","$6,447.21 ","$0.00 ","$0.00 ","$5,416.12 ","$30,933.00 ","$0.00 ","$15,466.50 ","$24,498.94 ","$24,746.40 ","$0.00 ","$4,841.01 ","$0.00 ","$4,924.53 ","$0.00 "
"XM106.2030S","SUP","HCPCS C1763","","XM106.2030S  -  GRAFT SFT TIS 30X20CM XCM BIOLOGIC THK PIG DERM HDRT XCLR","BOTH IP/OP","$37,116.85 ","$27,466.47 ","$0.00 ","$37,116.85 ","$16,702.58 ","$0.00 ","$7,736.08 ","$0.00 ","$0.00 ","$6,498.86 ","$37,116.85 ","$0.00 ","$18,558.43 ","$29,396.55 ","$29,693.48 ","$0.00 ","$5,808.79 ","$0.00 ","$5,909.00 ","$0.00 "
"XP-5000","SUP","Custom 27203010","","XP-5000  -  STABILIZER SRG YLW ACRB-I VAC PSTNR","BOTH IP/OP","$2,467.50 ","$1,825.95 ","$0.00 ","$2,467.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$2,467.50 ","$0.00 ","$1,233.75 ","$1,954.26 ","$1,974.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"XT-7542","SUP","HCPCS C1725","","XT-7542  -  CATHETER BLNDIL .035IN 5FR 4MM 75CM 2CM OPTPLST XT 2 LUM","BOTH IP/OP","$497.50 ","$368.15 ","$0.00 ","$497.50 ","$270.14 ","$0.00 ","$103.69 ","$0.00 ","$0.00 ","$87.11 ","$497.50 ","$0.00 ","$248.75 ","$394.02 ","$398.00 ","$0.00 ","$77.86 ","$0.00 ","$79.20 ","$0.00 "
"Y3462","SUP","Custom 27203010","","MEDIA CULT YST BROTH SENSITITRE","BOTH IP/OP","$65.20 ","$48.25 ","$0.00 ","$65.20 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$65.20 ","$0.00 ","$32.60 ","$51.64 ","$52.16 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"YO-9","SUP","Custom 27203010","","KIT MYCTST YEASTONE ANIDULAFUNGIN MICAFUNGIN PLT","BOTH IP/OP","$791.78 ","$585.92 ","$0.00 ","$791.78 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$791.78 ","$0.00 ","$395.89 ","$627.09 ","$633.42 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Z117H","SUP","Custom 27203010","","Z117H  -  SUTURE ABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II","BOTH IP/OP","$39.65 ","$29.34 ","$0.00 ","$39.65 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39.65 ","$0.00 ","$19.83 ","$31.40 ","$31.72 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Z126H","SUP","Custom 27203010","","Z126H  -  SUTURE ABSORBABLE 5-0 C-1 30IN 2 ARM MONOFILAMENT PDS II","BOTH IP/OP","$46.32 ","$34.28 ","$0.00 ","$47.01 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$47.01 ","$0.00 ","$23.51 ","$37.23 ","$37.61 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Z135H","SUP","Custom 27203010","","Z135H  -  SUTURE ABSORBABLE 7-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II","BOTH IP/OP","$40.04 ","$29.63 ","$0.00 ","$40.04 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$40.04 ","$0.00 ","$20.02 ","$31.71 ","$32.03 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Z137H","SUP","Custom 27203010","","Z137H  -  SUTURE ABSORBABLE 4-0 V-5 36IN 2 ARM MONOFILAMENT PDS II","BOTH IP/OP","$25.17 ","$18.63 ","$0.00 ","$25.17 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$25.17 ","$0.00 ","$12.58 ","$19.93 ","$20.14 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"Z60353","SUP","HCPCS L8614","","Z60353  -  IMPLANT COCHLEAR FREEDOM CNTOUR ADVANCE NUCLEUS CI24RE","BOTH IP/OP","$39,847.50 ","$29,487.15 ","$0.00 ","$39,847.50 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$39,847.50 ","$0.00 ","$19,923.75 ","$31,559.22 ","$31,878.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 ","$0.00 "
"ZBM12060","SUP","HCPCS C2625","","ZBM12060  -  STENT BIL 12MM 6FR 60MM 80CM .035IN SLF XPD DLV SYS LMNX","BOTH IP/OP","$3,883.20 ","$2,873.57 ","$0.00 ","$3,883.20 ","$1,747.44 ","$0.00 ","$809.36 ","$0.00 ","$0.00 ","$679.92 ","$3,883.20 ","$0.00 ","$1,941.60 ","$3,075.49 ","$3,106.56 ","$0.00 ","$607.72 ","$0.00 ","$618.21 ","$0.00 "
"ZTEG-2P-28-120-PF-US","SUP","HCPCS C1874","","ZTEG-2P-28-120-PF-US  -  GRAFT EVAS 120MM 28MM 22FR ZNTH TX2 THOR AORTIC ANRSM PROX","BOTH IP/OP","$30,235.00 ","$22,373.90 ","$0.00 ","$30,235.00 ","$13,605.75 ","$0.00 ","$6,301.73 ","$0.00 ","$0.00 ","$5,293.91 ","$30,235.00 ","$0.00 ","$15,117.50 ","$23,946.12 ","$24,188.00 ","$0.00 ","$4,731.78 ","$0.00 ","$4,813.41 ","$0.00 "
"Grady Health System","","","","","","","","","","","","","","","","","","","","","","","","",""
"Updated April 2022","","","","","","","","","","","","","","","","","","","","","","","","",""